Hydrocephalus

The neurologists and neurosurgeons at Torrance Memorial Medical Center offer expert care for hydrocephalus and its complications. Our affiliation with the neurology team at Cedars-Sinai — which is ranked among the best hospitals in the nation for neurology care by U.S. News & World Report — means that our patients have access to the most advanced treatment options.

What is Hydrocephalus?

Hydrocephalus, also known as “water on the brain,” is a condition in which cerebrospinal fluid (CSF) builds up in the cavities (ventricles) within your brain. Your brain needs some CSF to function normally, but when too much CSF accumulates in your brain, it can cause increased pressure and may damage brain tissue and disrupt brain function.

Hydrocephalus is most commonly associated with infants and young children, but can occur in people of all ages.

Types of Hydrocephalus

Hydrocephalus can be congenital, meaning you are born with it, or it can develop after birth.

In older adults, strokes or degenerative brain diseases can cause a type of hydrocephalus known as hydrocephalus ex-vacuo, in which your brain may actually shrink. Older adults are also more likely to have normal pressure hydrocephalus (NPH), which can occur from head trauma, surgery, a tumor, or unknown causes.

Symptoms

The symptoms of hydrocephalus change depending on your age when you develop hydrocephalus.

Infants may experience symptoms that include:

Overly large head or quickly growing head
A swollen or sensitive spot on the top of the head
Easily visible veins on the scalp
Bones of the skull feel separated
Sleepiness or irritability
Vomiting
Poor feeding habits
Seizures
Sunset eyes (pupils low in the eye, looking downward)
Weakness
Decreased responses to touch
Delayed development or growth

Toddlers and older children may experience symptoms including:

Headache
Sunset eyes (pupils low in the eye, looking downward)
Overly large head
Blurred or double vision
Poor balance
Sleepiness
Nausea, vomiting, or poor appetite
Seizures
Urinary incontinence (loss of bladder control)
Irritability or change in personality
Poor academic performance
Delayed or reversed development (struggling to walk or talk again)

Young or middle-aged adults may experience symptoms including:

Headache
Problems with vision
Lethargy or excess tiredness
Urinary incontinence (loss of bladder control)
Poor coordination or balance
Decline in memory, concentration, or other skills
Change in gait (pattern of walking) or difficulty walking

Adults 60 years of age or older may experience symptoms including:

Headache
Urinary incontinence (loss of bladder control)
Poor coordination or balance
Decline in memory, concentration, or other skills
Change in gait (pattern of walking) or difficulty walking

Hydrocephalus can lead to complications, including problems with physical, developmental, or mental functioning. The severity of the complication depends on the age at onset, how long the condition lasted, the severity of the symptoms, and other medical conditions.

Causes and Risk Factors

The root cause of hydrocephalus is an imbalance in the rate at which your body can produce and absorb cerebrospinal fluid (CSF). This imbalance can be created in a number of ways, including:

Blockages. Blockages are the most common cause of hydrocephalus. When the flow of CSF in or around your brain is blocked, it can cause excess CSF to build up within your brain.

Decreased absorption of CSF. When your blood vessels are no longer able to absorb enough CSF to match the rate at which your body produces it, excess CSF can begin to build up within your brain. Poor absorption of CSF is often associated with inflammation from disease or injury.

Overproduction of CSF. Overproduction of CSF is the rarest cause of hydrocephalus. When your body makes CSF more quickly than it can absorb it, excess CSF can begin to build up within your brain.

Known factors that increase your risk of developing hydrocephalus after birth include:

Brain or spinal cord injuries or tumors
Infections of the central nervous system
Head injury or stroke that causes bleeding in the brain
General trauma to the brain

For newborns, the risk factors for congenital hydrocephalus include:

Fetal brain inflammation as a result of an infection inside the uterus during pregnancy
Development of the central nervous system in a way that blocks the flow of CSF
Premature birth and bleeding within the ventricles

Diagnosis

Diagnosis usually includes both a neurological exam and imaging tests.

Neurological exams. Neurological exams will differ based on your age, but older children and adults will be asked to answer questions and complete simple tasks to test movement, muscle condition, the function of each of the senses, and general neurological well-being.
Brain imaging tests.
- Ultrasound imaging. This test uses high-frequency sound waves to create an image of your brain and is often used to detect hydrocephalus in infants or a fetus before birth.
- Magnetic resonance imaging (MRI). MRI uses radio waves and magnetic fields to create detailed images of your brain and may be used for adults or children. Because you have to be very still for an MRI, some children may be put in a very fast MRI machine or be given a mild sedative to help them stay still.
- Computed tomography (CT) scans. CT scans use x-rays to create images of your brain. Because you have to be very still for a CT scan, some children may be given a mild sedative to help them stay still. Because CT scans are not as accurate as MRI exams and expose you to a small amount of radiation, they are usually used only in emergencies to diagnose hydrocephalus.

Treatment

Treatment for hydrocephalus usually requires surgery. Types of surgery include:

Shunt surgery. Shunt surgery, which helps to drain CSF at the proper rate and relieve pressure on your brain, is the most common treatment for hydrocephalus. A shunt is a long, flexible, hollow tube that connects at one end to your brain’s ventricles and is threaded underneath your skin to another part of your body, such as your abdomen, where CSF can be more easily absorbed. People who have shunt surgery for hydrocephalus generally need to have a shunt for the rest of their lives and will need to have their shunt monitored regularly.
Endoscopic third ventriculostomy. During this procedure, your surgeon will make a hole in the bottom of one of your ventricles or between ventricles to allow CSF to drain from your brain. Endoscopic third ventriculostomy may not be suitable for some people.

Additional treatment may be required for some people with hydrocephalus, especially for children or adults with long-term untreated or severe hydrocephalus that causes complications. Hydrocephalus treatment may also include additional services — such as occupational or speech therapy, visits with a psychiatrist, appointments with a social worker, or assistance from a special education teacher — to treat physical, mental, or developmental complications.