Hydrocephalus

Symptoms

The symptoms of hydrocephalus can vary by age.

Infants

Common symptoms of hydrocephalus in infants include:

Changes in the head

• A head that is larger than usual.
• A rapid increase in the size of an infant's head.
• A bulge or tense soft spot on the top of the head.

Physical symptoms

• Nausea and vomiting.
• Sleepiness or sluggishness, known as lethargy.
• Irritability.
• Poor eating.
• Seizures.
• Eyes fixed downward, known as sunsetting of the eyes.
• Issues with muscle tone and strength.

Toddlers and older children

Among toddlers and older children, hydrocephalus symptoms might include:

Physical symptoms

• Headache.
• Blurred or double vision.
• Unusual eye movements.
• Enlargement of a toddler's head.
• Sleepiness or sluggishness.
• Nausea or vomiting.
• Trouble with balance.
• Poor coordination.
• Poor appetite.
• Loss of bladder control or urinating often.

Behavioral and cognitive changes

• Irritability.
• Change in personality.
• Decline in school performance.
• Delays or difficulty with earlier gained skills, such as walking or talking.

Young and middle-aged adults

Common hydrocephalus symptoms in young and middle-aged adults include:

• Headache.
• Sluggishness.
• Loss of coordination or balance.
• Loss of bladder control or needing to urinate often.
• Vision problems.
• Decline in memory, concentration and other thinking skills that may affect job performance.

Older adults

Among adults 60 and older, the more common symptoms of hydrocephalus are:

• Loss of bladder control or needing to urinate often.
• Memory loss.
• Progressive loss of other thinking or reasoning skills.
• Trouble walking, often described as shuffling or the feeling of the feet being stuck.
• Poor coordination or balance.

When to see a doctor

Seek emergency medical care for infants and toddlers with these symptoms:

• A high-pitched cry.
• Difficulty with sucking or feeding.
• Vomiting that happens again and again with no clear cause.
• Seizures.

Seek prompt medical attention for other hydrocephalus symptoms in any age group.

More than one condition can cause the symptoms associated with hydrocephalus. It's important to get a timely diagnosis and appropriate care.

Risk factors

In many cases, the cause of hydrocephalus isn't clear. But it can result from medical conditions or from issues that affect brain development before birth.

Newborns

Hydrocephalus that begins before or shortly after birth is called congenital hydrocephalus. In newborns, it may be caused by:

• Development of the central nervous system in a way that blocks the flow of cerebrospinal fluid.
• Bleeding inside the brain. This is a possible complication of premature birth.
• An infection in the uterus during pregnancy, such as rubella or syphilis. An infection can cause swelling in the brain tissues of an unborn baby.

Other causes at any age

Hydrocephalus also can develop later in life due to health issues or injuries. These may include:

• Brain or spinal cord tumors.
• Infections in the brain or spinal cord, such as meningitis or mumps.
• Bleeding in the brain caused by a stroke or head injury.
• Other types of brain injury that affect how CSF flows or is absorbed.

Prevention

Hydrocephalus can't always be prevented. In many cases, the cause is unknown or happens before birth. But certain steps may lower the risk, especially for conditions that lead to hydrocephalus later in life.

During pregnancy

• Get regular prenatal care. Routine checkups help catch infections and other issues that may affect brain development. Prenatal care also can help lower the risk of preterm birth, which is linked to bleeding in the brain and a higher chance of hydrocephalus.
• Avoid infections. Rubella, syphilis and other infections during pregnancy can increase hydrocephalus risk. Vaccination and good hygiene can help prevent them.

At any age

• Protect against infections. Vaccines for illnesses such as meningitis can reduce the risk of brain infections.
• Prevent head injuries. Use car seats, helmets and seat belts to protect the brain from trauma.
• Treat brain infections early. Quick treatment for infections such as meningitis or encephalitis can help prevent complications.
• Manage health conditions. Strokes, tumors and certain injuries can lead to hydrocephalus. Taking care of overall health, such as managing blood pressure, may help reduce risk.

Should you be vaccinated against meningitis?

Ask your healthcare professional if you or your child should receive a vaccine against meningitis, once a common cause of hydrocephalus. The Centers for Disease Control and Prevention recommends meningitis vaccination for preteen children and boosters for teenagers.

Vaccination also is recommended for younger children and adults who might be at increased risk of meningitis for any of the following reasons:

• Traveling to countries where meningitis is common.
• Having an immune system disease called terminal complement pathway deficiency.
• Having a damaged spleen or having had the spleen removed.
• Living in a college dormitory.
• Joining the military.

Treatment

There are two main surgical treatments for hydrocephalus.

Shunt for hydrocephalus

The most common hydrocephalus treatment is a shunt — a flexible tube with a one-way valve. The valve helps drain extra fluid from the brain at the right speed and in the right direction.

One end of the tube is placed in a ventricle inside the brain. The rest of the tubing is threaded under the skin, usually down to the belly or sometimes to the chest. This allows the fluid to drain and be absorbed by the body.

Most people with hydrocephalus need their shunt for life. Regular checkups are important to make sure it's working well.

Endoscopic third ventriculostomy

Some people may have a surgery called endoscopic third ventriculostomy (EVT) for hydrocephalus. In this procedure, a surgeon uses a small camera to look inside the brain and makes a tiny hole at the bottom of one of the ventricles. This opening lets the extra fluid flow out of the brain, helping to relieve pressure.

Complications of surgery

Both shunting and ETV surgical procedures for hydrocephalus can result in complications. Shunt systems can stop draining cerebrospinal fluid. Or shunt systems may poorly regulate drainage because of mechanical problems, a blockage or infections. Complications of EVT surgery include bleeding and infections.

Problems after surgery need quick medical care. Sometimes another surgery or other treatment may be needed. Call your healthcare professional right away if you have a fever or any symptoms of hydrocephalus.

Other treatments

Some people with hydrocephalus, particularly children, might need supportive therapies. The need for these therapies depends on the long-term complications of hydrocephalus.

Children's care teams might include:

• Pediatrician or physiatrist, who oversees the treatment plan and medical care.
• Pediatric neurologist, who specializes in diagnosing and treating neurological conditions in children.
• Occupational therapist, who specializes in therapy to develop everyday skills.
• Developmental therapist, who specializes in therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills.
• Mental health professional, such as a psychologist or psychiatrist.
• Social worker, who helps the family get needed services and plan for transitions in care.

Children who are in school may need special education. Special education teachers address learning disabilities, determine educational needs and help find needed resources.

Adults with more serious complications might need the services of occupational therapists or social workers. Or they may need to see specialists in dementia care or other medical specialists.

In adults with normal-pressure hydrocephalus that doesn't cause symptoms, treatment may not be needed. Only monitoring may be needed in these instances, as it may take many years to develop any symptoms.

Preparing for an appointment

The timing of diagnosing a child with hydrocephalus can depend on the symptoms are and when they appeared. It also may depend on whether there were risk factors for hydrocephalus during pregnancy or delivery. Sometimes hydrocephalus can be diagnosed at birth or before birth.

Well-baby visits

It's important to take your child to all regularly scheduled well-baby visits. Healthcare professionals monitor your child's development in key areas, including:

• Head size, rate of head growth and overall body growth.
• Muscle strength and tone.
• Coordination.
• Posture.
• Age-appropriate motor skills.
• Sensory abilities such as vision, hearing and touch.

Questions you should be prepared to answer during regular checkups might include:

• What concerns do you have about your child's growth or development?
• How well does your child eat?
• How does your child respond to touch?
• Is your child reaching certain milestones in development, such as rolling over, pushing up, sitting up, crawling, walking or speaking?

Preparing for other healthcare visits

You'll likely start by seeing your child's healthcare professional or your healthcare professional. You may then be referred to a doctor who specializes in brain and nervous system conditions, known as a neurologist.

Be prepared to answer the following questions about your symptoms or your child's symptoms:

• What symptoms have you noticed? When did they begin?
• Have these symptoms changed over time?
• Do these symptoms include nausea or vomiting?
• Have you or your child had any vision issues?
• Have you or your child had a headache or fever?
• Have you noticed personality changes, including increased irritability?
• Has your child's school performance changed?
• Have you noticed new issues with movement or coordination?
• Is your child having trouble sleeping or lacking in energy?
• Has your infant had seizures?
• Has your infant had difficulty with eating or breathing?
• In older children and adults, have symptoms included loss of bladder control and urinating often?
• Have you or your child had a recent head injury?
• Have you or your child recently begun a new medicine?