Hydrocephalus

Hydrocephalus is a buildup of fluid inside the skull that leads to brain swelling. Hydrocephalus means “water on the brain.

Causes, incidence, and risk factors

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. It 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

It does not get absorbed into the blood properly

Your brain makes too much of it

Too much CSF puts puts pressure on the brain. This pushes the brain up against the skull and damage 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 result from 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.

Signs and tests

The doctor or nurse will examine the baby. This may show:

Stretched or swollen veins on the baby’s scalp

Abnormal sounds when the health care provider taps lightly on the skull, suggesting a problem with the skull bones

All or part of the head may be larger than normal, usually in the front part

Eyes that look “sunken in”

White part of the eye appears over the colored area, making it look like a “setting sun”

Reflexes may be normal

Head circumference measurements, repeated over time, may show that the head is getting bigger.

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)

Skull x-rays

Complications:

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

Symptoms

Symptoms of hydrocephalus depend on:

Age

 Amount of brain damage

What is causing the buildup of CSF fluid

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

Treatment

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 re-route 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 are given 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 are regularly done to check the child’s developmental and for 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.

Calling Your Health Care Provider:

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

 

 

 

 

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