Conflict of interest

hydrocephaly affects developmental processes of cell genesis and myelination [68]. Potential early therapeutics are antioxidative, anti-inflammatory, antiapoptotic, and anti-excitotoxic drugs that can be used in neonatal hypoxic-ischemic brain injury. Memantine, a noncompetitive NMDA receptor antagonist, protects neurons and axons [72]. The neuronal cytoskeleton has been shown to play an important role in the maintenance of cytoplasmic morphology and axonal transport [15]. The functional effects of early shunt placement have been reported to prevent

Bifemelane is a monoamine oxidase inhibitor used as an antidepressant and cerebral metabolic activator to normalize norepinephrine in the striatum and cerebral cortex [74]. Methylphenidate acts by blocking the dopamine and norepinephrine transporters and was administered to NPH patient at the dose of 20 mg after shunting improved cognitive performance and reduced apathy [75]. In another case reports, patients with hydrocephaly and akinetic mutism responded well to bromocriptine and ephedrine [76, 77]. An unshunted severe hydrocephaly

Hydrocephaly can be defined briefly as the excess formation of cerebrospinal fluid (CSF) leading to an increase in the fluid volume of ventricles and subarachnoid spaces of the brain [1, 2]. Water is distributed in four compartments within the brain: (i) the intracellular space, (ii) the interstitial space, (iii) the cerebral ventricles and subarachnoid spaces, and (iv) the cerebral blood vessels. CSF flow obstruction in hydrocephaly leads to transependymal flow of water and electrolytes from the enlarged ventricles into the interstitial space of the brain adjacent to the ventricular wall which is called hydrocephalic edema [79]. The osmotic agents in these patients increase serum osmolality by drawing fluid from the interstitial space into the capillaries and then out of the cranium to the general circulation. Currently used osmotic diuretics for the treatment of hydrocephaly include isosorbide and mannitol. Fibrin can also deposit in arachnoid villi that can block its openings which is resulted in reduced CSF absorption. This can be ameliorated by the administration of fibrinolytic agents injected directly into the CSF or ventricular system. Hydrocephaly secondary to an IVH has been managed with intraventricular fibrinolytic therapy, alone or in combination with carbonic anhydrase inhibitors. Another situation is the reduction of CSF absorption that can be present in the acute period after subarachnoid hemorrhage and bacterial or carcinomatous meningitis. Steroids can regulate the inflammatory response after inflammation, but fibroblast growth or collagen synthesis

Hydrocephaly treatment can be classified as nonsurgical and surgical, which in turn can be divided into nonshunting and shunting procedures. Nonsurgical treatment includes reducing CSF formation, and the most common drugs used for this purpose are acetazolamide and furosemide. Hydrocephaly secondary to intraventricular hemorrhage (IVH) has been treated

patient with self-injurious behavior responded well to trazodone (200 mg/day) [78].

impairment of synaptogenesis and learning disability [73].

3.8. Cerebral stimulants

84 Hydrocephalus: Water on the Brain

4. Conclusions

cannot be inhibited by steroids [2].

No conflict of interest was declared by the authors. The authors declared that this study had received no financial support.
