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Condition

Hydrocephalus

Symptoms, Doctors, Treatments, Research & More

Condition 101

What is the definition of Hydrocephalus?

Hydrocephalus is a buildup of fluid inside the skull that leads to brain swelling.

Hydrocephalus means "water on the brain."

What are the alternative names for Hydrocephalus?

Water on the brain

What are the causes for Hydrocephalus?

Hydrocephalus is due to a problem with the flow of the fluid that surrounds the brain. This fluid is called the cerebrospinal fluid, or CSF. The fluid surrounds the brain and spinal cord and helps cushion the brain.

CSF normally moves through the brain and the spinal cord and is soaked into the bloodstream. CSF levels in the brain can rise if:

  • The flow of CSF is blocked.
  • The fluid does not get properly absorbed into the blood.
  • The brain makes too much of the fluid.

Too much CSF puts pressure on the brain. This pushes the brain up against the skull and damages brain tissue.

Hydrocephalus may begin while the baby is growing in the womb. It is common in babies who have a myelomeningocele, a birth defect in which the spinal column does not close properly.

Hydrocephalus may also be due to:

  • Genetic defects
  • Certain infections during pregnancy

In young children, hydrocephalus may be due to:

  • Infections that affect the central nervous system (such as meningitis or encephalitis), especially in infants.
  • Bleeding in the brain during or soon after delivery (especially in premature babies).
  • Injury before, during, or after childbirth, including subarachnoid hemorrhage.
  • Tumors of the central nervous system, including the brain or spinal cord.
  • Injury or trauma.

Hydrocephalus most often occurs in children. Another type, called normal pressure hydrocephalus, may occur in adults and older people.

What are the symptoms for Hydrocephalus?

Symptoms of hydrocephalus depend on:

  • Age
  • Amount of brain damage
  • What is causing the buildup of CSF fluid

In infants, hydrocephalus causes the fontanelle (soft spot) to bulge and the head to be larger than expected. Early symptoms may also include:

  • Eyes that appear to gaze downward
  • Irritability
  • Seizures
  • Separated sutures
  • Sleepiness
  • Vomiting

Symptoms that may occur in older children can include:

  • Brief, shrill, high-pitched cry
  • Changes in personality, memory, or the ability to reason or think
  • Changes in facial appearance and eye spacing
  • Crossed eyes or uncontrolled eye movements
  • Difficulty feeding
  • Excessive sleepiness
  • Headache
  • Irritability, poor temper control
  • Loss of bladder control (urinary incontinence)
  • Loss of coordination and trouble walking
  • Muscle spasticity (spasm)
  • Slow growth (child 0 to 5 years)
  • Slow or restricted movement
  • Vomiting

What are the current treatments for Hydrocephalus?

The goal of treatment is to reduce or prevent brain damage by improving the flow of CSF.

Surgery may be done to remove a blockage, if possible.

If not, a flexible tube called a shunt may be placed in the brain to reroute the flow of CSF. The shunt sends CSF to another part of the body, such as the belly area, where it can be absorbed.

Other treatments may include:

  • Antibiotics if there are signs of infection. Severe infections may require the shunt to be removed.
  • A procedure called endoscopic third ventriculostomy (ETV), which relieves pressure without replacing the shunt.
  • Removing or burning away (cauterizing) the parts of the brain that produce CSF.

The child will need regular check-ups to make sure there are no further problems. Tests will be done regularly to check the child's development, and to look for intellectual, neurological, or physical problems.

Visiting nurses, social services, support groups, and local agencies can provide emotional support and help with the care of a child with hydrocephalus who has serious brain damage.

What is the outlook (prognosis) for Hydrocephalus?

Without treatment, up to 6 in 10 people with hydrocephalus will die. Those who survive will have different amounts of intellectual, physical, and neurological disabilities.

The outlook depends on the cause. Hydrocephalus that is not due to an infection has the best outlook. People with hydrocephalus caused by tumors will often do very poorly.

Most children with hydrocephalus who survive for 1 year will have a fairly normal lifespan.

What are the possible complications for Hydrocephalus?

The shunt may become blocked. Symptoms of such a blockage include headache and vomiting. Surgeons may be able to help the shunt open without having to replace it.

There may be other problems with the shunt, such as kinking, tube separation, or infection in the area of the shunt.

Other complications may include:

  • Complications of surgery
  • Infections such as meningitis or encephalitis
  • Intellectual impairment
  • Nerve damage (decrease in movement, sensation, function)
  • Physical disabilities

When should I contact a medical professional for Hydrocephalus?

Seek medical care right away if your child has any symptoms of this disorder. Go to the emergency room or call 911 if emergency symptoms occur, such as:

  • Breathing problems
  • Extreme drowsiness or sleepiness
  • Feeding difficulties
  • Fever
  • High-pitched cry
  • No pulse (heartbeat)
  • Seizures
  • Severe headache
  • Stiff neck
  • Vomiting

You should also call your provider if:

  • The child has been diagnosed with hydrocephalus, and the condition gets worse.
  • You are unable to care for the child at home.

How do I prevent Hydrocephalus?

Protect the head of an infant or child from injury. Prompt treatment of infections and other disorders associated with hydrocephalus may reduce the risk of developing the disorder.

Skull

REFERENCES

Jamil O, Kestle JRW. Heydocephalus in children: etiology and overall management. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 197.

Kinsman SL, Johnston MV. Congenital anomalies of the central nervous system. In: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 609.

Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 88.

Latest Research

Latest Advance
Study
  • Condition: Human Immunodeficiency Virus-negative Cryptococcal Meningitis
  • Journal: Medicine
  • Treatment Used: Surgery
  • Number of Patients: 42
  • Published —
In this study, researchers evaluated the outcomes of undergoing surgery for the treatment of human immunodeficiency virus-negative cryptococcal meningitis.
Latest Advance
Study
  • Condition: Adult Hydrocephalus
  • Journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
  • Treatment Used: Elective Intracranial Pressure Monitoring
  • Number of Patients: 152
  • Published —
This study investigated the use of elective intracranial pressure monitoring to manage and diagnose patients with adult hydrocephalus.

Clinical Trials

Clinical Trial
Drug
  • Status: Not yet recruiting
  • Study Type: Drug
  • Participants: 100
  • Start Date: January 1, 2021
Improving Outcome in Subarachnoid Hemorrhage wIth Nadroparine
Clinical Trial
Drug
  • Status: Not yet recruiting
  • Study Type: Drug
  • Participants: 120
  • Start Date: December 2020
Deferoxamine In the Treatment of Aneurysmal Subarachnoid Hemorrhage (DISH)