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What is Aqueductal Stenosis?

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  • Written By: Mary McMahon
  • Edited By: Kristen Osborne
  • Last Modified Date: 22 August 2016
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Aqueductal stenosis is a narrowing of one of the channels in the brain that acts as a conduit for cerebrospinal fluid, the fluid that bathes the brain and provides protectant properties. In a person with aqueductal stenosis, the free flow of the fluid is restricted and the patient can develop hydrocephalus, a buildup of cerebrospinal fluid that leads to neurological complications over time. One of the most common causes of congenital hydrocephalus, where someone is born with fluid on the brain, is aqueductal stenosis.

This condition involves the cerebral aqueduct, also known as the aqueductal of Sylvius. This particular channel for cerebrospinal fluid runs between the third and fourth ventricles. When the aqueduct narrows, it limits the flow of cerebrospinal fluid, and the fluid can begin to back up and accumulate. Over time, this can cause swelling that will lead to brain damage by putting pressure on brain cells. In infants, it may cause distortions in skull shape because the developing skull expands to accommodate the excess fluid.

In congenital aqueductal stenosis, something goes wrong during the development of the brain and this channel is narrow or not fully formed, impairing the circulation of cerebrospinal fluid in the fetus. In acquired cases, someone develops a condition such as an infection, inflammation, or neurological disease that damages the aqueduct and causes it to narrow. This leads to obstructive hydrocephalus, where cerebrospinal fluid builds up because it has nowhere to go.

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People with aqueductal stenosis usually experience headaches that may worsen over time and do not resolve with rest or medications. Nausea and vomiting can also develop as a result of the pressure on the brain. Altered level of consciousness is another symptom that tends to occur as the hydrocephalus persists untreated. Generally, any time people experience a combination of headaches, mood changes, and nausea, it can be a warning sign that there is a neurological problem.

Medical imaging studies of the brain will be used to determine what is going on inside and to determine how much damage has occurred, if any. The recommended treatment is usually installation of a shunt to allow the excess cerebrospinal fluid to safely drain. If a tumor is involved, surgery to remove the tumor is recommended and the removal of the growth should resolve the hydrocephalus. Other treatment options can include radiation treatment of tumors that are not considered operable. These treatments are performed by a neurosurgeon, a physician who specializes in performing surgery on the brain.

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pleonasm
Post 3

Even adults can develop hydrocephalus, and unfortunately, many of the symptoms are things that could also be considered symptoms of old age, so even if you think someone is just getting older, you should maybe get them a full examination if they get some of the symptoms. The classic ones are apparently continence, clumsiness, and dementia. Often people get headaches and have problems with their vision as well.

I can easily see someone dismissing these complaints as simply part of getting older, when they actually have an origin in cerebral aqueductal stenosis.

indigomoth
Post 2

@umbra21 - Unfortunately, even though shunting can be effective for people with aqueductal stenosis of all kinds, it has a high failure rate, simply because of its nature. You can't easily stick something into the brain and hope for the best while it drains out fluid.

Many people who have a shunt end up having to have more surgery in order to readjust it, or end up with infections which can be potentially very dangerous considering where they are located.

Fortunately, the technology is always improving. Unfortunately, we still have to wait until it does and there are people who need the treatment now.

umbra21
Post 1

I remember seeing a picture of a baby born with fluid on the brain when I was in high school. It was back lit so that the child's head seemed huge and you could see the arteries through its skull.

I don't know about that particular baby, but I remember looking at that picture and thinking that hydrocephalus was a terrible thing that no one could possibly survive.

Of course, they can shunt the fluid out now, and often children born with this condition suffer from few side effects (although others can end up with brain damage).

Even more interesting, I think they can detect this in the womb. The earlier they fix it, the better the outcome, no doubt.

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