Neuropathological Changes in Hydrocephalus—A Comprehensive Review

Abstract

Hydrocephalus is a heterogeneous, neurological condition characterized by altered flow of cerebrospinal fluid (CSF) that can occur at any age. Neuropathological changes associated with hydrocephalus are dependent on the age of onset, rate of ventricular enlargement, and the etiology. Hydrocephalic brain damage is also influenced by contributions from both mechanical forces and metabolic changes, which increases the heterogeneity of the condition. However, as ventriculomegaly progresses, the surrounding brain tissue is compressed within the cranial vault, elevating intracranial pressure and eventually leading to severe brain damage. From this perspective, it makes sense that periventricular brain regions are the initial sites of damage as ventricular dilatation occurs. The following review of neuropathological changes in hydrocephalus will first discuss cellular and region specific damage from the ventricles and outward towards the cortex and brainstem. This will be followed by vascular and hypoxic changes associated with the condition. Both types of brain impairments are dependent on the severity of the condition, and they will be described accordingly.