Hydrocephalus is a condition that occurs when fluid builds up in the skull and causes the brain to swell. The name means “water on the brain.”
Brain damage can occur as a result of the fluid buildup. This can lead to developmental, physical, and intellectual impairments. It requires treatment to prevent serious complications.
Hydrocephalus is a build-up of fluid on the brain. The excess fluid puts pressure on the brain, which can damage it.
The damage to the brain can cause a wide range of symptoms, including:
- being sick
- blurred vision
- difficulty walking
Babies born with hydrocephalus (congenital) often have distinctive physical characteristics. Physical signs in a baby include:
- an unusually large head
- their scalp may be thin and shiny with easily visible veins
- a bulging or tense fontanelle (the soft spot on the top of their head)
- their eyes may appear to be looking down; this is known as the ‘setting-sun sign’ because the eyes resemble the sun setting below the horizon
- the muscles in your baby’s lower limbs may appear stiff and be prone to muscle spasms
- poor feeding
- being sick
Hydrocephalus that develops in adults or children (acquired) can cause headaches. The headache may be worse in the morning after waking up because the fluid in your brain doesn't drain so well while you're lying down and may have built up overnight.
Other symptoms of acquired hydrocephalus include:
- neck pain
- feeling sick
- being sick (which may be worse in the morning)
- drowsiness, which can progress to a coma
- changes in your mental state, such as confusion
- blurred vision or double vision
- difficulty walking
- not being able to control your bladder (urinary incontinence) and, in some cases, your bowel
The change in the way that you walk is often followed by bouts of urinary incontinence, which may include symptoms such as:
- a frequent need to urinate
- an urgent need to urinate
- loss of bladder control
In some cases, hydrocephalus starts before a baby is born. This can result from:
- a birth defect in which the spinal column doesn’t close
- a genetic abnormality
- certain infections that occur during pregnancy, such as rubella
This condition can also occur in infants, toddlers, and older children due to:
- central nervous system infections such as meningitis, especially in babies
- bleeding in the brain during or shortly after delivery, especially in babies born prematurely
- injuries that occur before, during, or after delivery
- head trauma
- central nervous system tumors
If you suspect that you or your child has hydrocephalus, your doctor will perform a physical exam to look for signs and symptoms. In children, doctors check for eyes that are sunken in, slow reflexes, a bulging fontanel, and a head circumference that is larger than normal for their age.
Your doctor may also use an ultrasound to get a closer look at the brain. These tests use high-frequency sound waves to create images of the brain.
- Magnetic resonance imaging (MRI) scans can be used to look for signs of excess CSF. MRIs use a magnetic field and radio waves to make a cross-sectional image of the brain.
- Computerized tomography (CT) scans can also help diagnose hydrocephalus in children and adults. CT scans use several different X-rays to form a cross-sectional image of the brain. These scans can show enlarged brain ventricles that result from too much CSF.
Hydrocephalus can be fatal if it’s left untreated. Treatment may not reverse brain damage that’s already occurred. The goal is to prevent further brain damage.
This involves restoring the normal flow of CSF. Your doctor may explore either of the following surgical options:
- In most cases, a shunt is surgically inserted. The shunt is a drainage system made of a long tube with a valve. The valve helps CSF flow at a normal rate and in the right direction. Your doctor inserts one end of the tube in your brain and the other end into your chest or abdominal cavity. Excess fluid then drains from the brain and out the other end of the tube, where it can be more easily absorbed. A shunt implant is typically permanent and has to be monitored regularly.
- A procedure called a ventriculostomy can be performed as an alternative to having a shunt inserted. This involves making a hole at the bottom of a ventricle or in between ventricles. This allows CSF to leave the brain.
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