Hydrocephalus

Hydrocephalus is a build up of fluid inside the skull, leading to brain swelling. Hydrocephalus means
"water on the brain."

Causes
Hydrocephalus is due to a problem with the flow of cerebrospinal fluid (CSF), the liquid that surrounds
the brain and spinal cord. The fluid brings nutrients to the brain, takes away waste from the brain, and
acts as a cushion.
CSF normally moves through areas of the brain called ventricles, then around the outside of the brain
and the spinal cord. It is then reabsorbed into the bloodstream.. Build up of CSF can occur in the brain
if it's flow or absorption is blocked, or if too much CSF is produced.
This build up of fluid puts pressure on the brain, pushing the brain up against the skull and damaging or
destroying brain tissues.
Hydrocephalus may start while the baby is growing in the womb. It is commonly present with
myelomeningocele , a birth defect involving incomplete closure of the spinal column. Genetic defects
and certain infections that occur during pregnancy may also cause hydrocephalus.
In young children, hydrocephalus may also be associated with the following conditions:
• 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, but may also occur in adults and the elderly. See: Normal
pressure hydrocephalus

Symptoms
The symptoms depend on the cause of the blockage, the person's age, and how much brain tissue has
been damaged by the swelling.
In infants with hydrocephalus, CSF fluid builds up in the central nervous system, causing 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 0-5 years)
• Slow or restricted movement
• Vomiting

Exams and Tests

When a health care provider taps fingertips on the skull, there may be abnormal sounds that indicated
thinning and separation of skull bones. Scalp veins may appear stretched or enlarged.
Part or the entire head may be larger than normal. Enlargement is most commonly seen in the front part
of the head. Head circumference measurements, repeated over time, may show that the head is getting
bigger.
The eyes may look "sunken in." The white part of the eye may appear above the colored part of the eye,
given the eyes a "setting-sun" appearance. Reflexes may be abnormal.
A head CT scan is one of the best tests for identifying hydrocephalus. Other tests that may be done
include:
• Arteriography
• Brain scan using radioisotopes
• Cranial ultrasound (an ultrasound of the brain)
• Lumbar puncture and examination of the cerebrospinal fluid (rarely done)
• Skull x-rays

Treatment
The goal of treatment is to reduce or prevent brain damage by improving the flow of CSF.
The blockage may be surgically removed, if possible. If the blockage cannot be removed, a shunt
(flexible tube) may be placed within the brain to allow CSF to flow around the blocked area. The shunt
tubing travels to another part of the body, such as the abdomen, where the extra CSF can be absorbed.
Antibiotics are given if there are signs of infection. Severe infections may require the shunt to be
removed.
Another option is endoscopic third ventriculostomy (ETV), which relieves pressure without replacing
the shunt.
Removing or burning away (cauterizing) the parts of the brain that produce CSF may reduce CSF
production.
Follow-up examinations generally continue throughout the child's life. These are done to check the
child's developmental level and to treat any intellectual, neurological, or physical problems.
Visiting nurses, social services, support groups, and local agencies can provide emotional support and
assist with the care of a child with hydrocephalus who has significant brain damage.

Outlook (Prognosis)
Untreated hydrocephalus has a 50-60% death rate, with the survivors having varying degrees of
intellectual, physical, and neurological disabilities.
The outlook for treated hydrocephalus depends on the cause. Hydrocephalus that is caused by disorders
not associated with infection has the best outlook. Persons with hydrocephalus caused by tumors
usually do very poorly.
Most children with hydrocephalus that survive for 1 year will have a fairly normal life span.
Approximately a third will have normal intellectual function, but neurological difficulties may persist.

Possible Complications
Shunt placement may lead to blockage. 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 to Contact a Medical Professional

Seek immediate medical care if your child has any symptoms of this disorder. Go to the emergency
room or call 911 if emergency symptoms occur, which include:
• Breathing problems
• Extreme drowsiness or sleepiness
• Feeding difficulties
• Fever
• High-pitched cry
• No pulse (heart beat)
• Seizures
• Severe headache
• Stiff neck
• Vomiting
You should also call your health care provider if the child has been diagnosed with hydrocephalus and
the condition gets worse and you are unable to care for him or her at home.
Prevention
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.

Alternative Names
Water on the brain