What Is It?
Hydrocephalus, also known as "water on the brain," is a condition in which there is extra cerebrospinal fluid around the brain and spinal cord. Cerebrospinal fluid acts as a cushion for the brain and spinal cord, supplies nutrients, and takes away waste products.
Hydrocephalus can be present at birth (congenital) or can develop later (acquired).
Hydrocephalus can be classified according to its cause:
Another type of hydrocephalus, called normal pressure hydrocephalus is an acquired type of communicating hydrocephalus in which the ventricles are enlarged but not under high pressure. Normal pressure hydrocephalus is seen in older adults. It may be the result of injury or illness, but in the majority of cases the cause is unknown.
Premature infants born before 34 weeks or weighing less than 4 pounds have a higher risk of blood vessels bleeding in the brain. Severe bleeding can lead to acquired hydrocephalus, communicating or non-communicating, depending on the site and extent of the bleeding.
The most common symptoms of hydrocephalus vary depending on the age of onset.
In infants, symptoms include:
In older children and adults, symptoms include:
At any age, symptoms include:
Congenital hydrocephalus may be diagnosed during a routine prenatal ultrasound, but often is discovered during infancy or early childhood. A doctor may suspect hydrocephalus before other symptoms appear if an infant has a head that seems to be getting larger too rapidly or is larger than would be expected given the baby's current weight or length. If the soft spot (anterior fontanelle) is still open, an ultrasound of the head can determine if the head is getting larger due to hydrocephalus. If the results of that ultrasound are abnormal, more evaluation is necessary.
The doctor will ask questions about the person's medical history, and he or she will do a physical and neurological examination. Detailed pictures of the brain may be obtained with computed tomography (CT) or magnetic resonance imaging (MRI). If these pictures reveal hydrocephalus or other problems, the child or adult usually is referred to a neurosurgeon for further evaluation and treatment.
Although the symptoms may subside with treatment, the duration varies according to the type and cause of the hydrocephalus.
A few of the causes of hydrocephalus can be prevented:
Treatment of hydrocephalus depends on its cause. Occasionally, medications are used to slow the rate of cerebrospinal fluid production temporarily. However, this has not been successful for long-term treatment. Most cases require drainage of the excess fluid. A tube called a shunt is inserted into one of the cavities in the brain through a hole in the skull. The shunt is tunneled under the skin and carries the cerebrospinal fluid into another area of the body, such as the abdomen, where it can be absorbed. The shunt may need to be replaced periodically as a child grows or if an infection of it develops, or the shunt becomes blocked.
Some people with obstructive hydrocephalus can be treated with a technique called ventriculostomy in which a neurosurgeon makes an incision at the site of the blockage to allow cerebrospinal fluid to drain. Surgeons also are experimenting with surgical repair of congenital hydrocephalus while the fetus is still inside the mother's womb (uterus).
When To Call a Professional
Call your doctor if you or your child develops symptoms of hydrocephalus or has a severe head injury. Also call your doctor if you become pregnant.
The outlook depends on the cause of hydrocephalus and usually is better if the problem is diagnosed and treated early. If hydrocephalus gets worse rapidly or lasts a long time, it can cause brain damage and death.
Children with hydrocephalus are more likely to have various developmental disabilities. Even after treatment, most children with hydrocephalus have lower intelligence, memory problems and visual problems, including strabismus (abnormally aligned eyes). Children with hydrocephalus also may enter puberty earlier than normal.
With appropriate treatment, most infants with hydrocephalus survive and approximately half have normal intelligence.
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824