Hydrocephalus
Hydrocephalus
Hydrocephalus is a condition where fluid builds up in the brain. This excess fluid affects the brain and how it works.
Common Symptoms
Emergency Warning Signs
Phone 999 or go straight to the emergency department (A&E) if:
- you or your child develops symptoms of hydrocephalus very suddenly or rapidly
Contact your GP if:
- you think you or your child may have symptoms of hydrocephalus
Normal pressure hydrocephalus
Normal pressure hydrocephalus (NPH) usually develops slowly, over many months or years, and is more common in older people.
NPH can affect:
- the way you walk (mobility)
- your urinary system
- your mental abilities
How you walk
If you have NPH, you may find it hard to take that first step when you start walking. Some people describe it as feeling frozen to the spot. NPH can also make you shuffle instead of taking normal steps.
As the condition progresses, you may become increasingly unsteady on your feet and more prone to falls, especially when turning.
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Phone 999 or go straight to the emergency department (A&E) if:
- you or your child develops symptoms of hydrocephalus very suddenly or rapidly
Contact your GP if:
- you think you or your child may have symptoms of hydrocephalus
Normal pressure hydrocephalus
Normal pressure hydrocephalus (NPH) usually develops slowly, over many months or years, and is more common in older people.
NPH can affect:
- the way you walk (mobility)
- your urinary system
- your mental abilities
How you walk
If you have NPH, you may find it hard to take that first step when you start walking. Some people describe it as feeling frozen to the spot. NPH can also make you shuffle instead of taking normal steps.
As the condition progresses, you may become increasingly unsteady on your feet and more prone to falls, especially when turning.
Causes
Hydrocephalus can be congenital, meaning it is present from birth. This is called congenital hydrocephalus, and it may be linked to other health conditions, such as spina bifida.
Hydrocephalus can also happen when the normal pathways for brain fluid become blocked, often due to bleeding in the brain or a tumour. This is called obstructive hydrocephalus.
Sometimes the normal pathways for brain fluid are narrower than they should be. This can lead to triventricular hydrocephalus.
Hydrocephalus can also develop after bleeding or an infection in the brain. The bleeding or infection lowers the brain's ability to absorb brain fluid, and this problem continues even after the bleeding or infection itself has cleared up. This is called aresorbtive hydrocephalus.
Diagnosis
Congenital hydrocephalus is sometimes picked up during a routine pre-natal ultrasound, or during the physical examination given to a newborn baby.
Other types of hydrocephalus are diagnosed using a brain scan, usually a CT scan or an MRI scan.
Treatment
Treating hydrocephalus
Surgery is necessary to treat hydrocephalus. You or your child may be offered temporary or permanent treatments, depending on your circumstances. The medical professionals treating you will fully explain your options.
Temporary treatment
Sometimes a baby with hydrocephalus cannot have permanent treatment. In these circumstances, you’ll be offered a temporary surgical solution.
In some cases, surgeons may insert an access device. This involves inserting a small port under the skin. Brain fluid can then be drained from this device using a needle.
Another option that may be recommended is a subgaleal shunt. This is where surgeons create a pocket under the skin. Brain fluid can then drain into this pocket.
Permanent treatment
Most hydrocephalus cases are treated through surgery to insert a ventriculoperitoneal shunt. This allows fluid to drain from the brain. The fluid normally drains into the abdomen (tummy), but can also drain into the chest cavity or heart.
If you have triventricular hydrocephalus, you may be offered an endoscopic third ventriculostomy. This surgery cuts a small hole in the skull and creates a new pathway for brain fluid to circulate.
The medical professionals looking after you will explain the procedure and answer any questions you may have.
After surgery, you or your child should be able to live a normal life without restrictions. Regular follow up appointments throughout your life are not normally necessary.
Shunt problems
If there are signs of a problem with the shunt a scan can help identify the problem.
Sometimes the shunt might not be in the best position and further surgery might be needed to reposition it. Your surgeon will discuss this with you.
After the shunt has been installed, further treatment for hydrocephalus may be needed if the shunt malfunctions or becomes infected. If this happens shunt repair surgery might be needed.
A shunt blockage can be very serious. It can lead to a build-up of excess fluid in the brain, which can cause brain damage. This will cause the symptoms of hydrocephalus.
Shunt infection can also happen after shunt surgery. Infections are more likely to develop during the first month after surgery.
Phone your surgical team immediately if you or your child shows symptoms of an infection like:
- redness and tenderness along the line of the shunt or the wounds
- a high temperature
- headache
- vomiting
- neck stiffness
- tummy pain caused by the shunt draining into your tummy
- irritability or sleepiness in babies
If there is an infection, the shunt will have to be removed. Antibiotics will then be used to treat the infection. Once the infection is clear a new shunt can be fitted.
As most children have their shunt fitted when they’re so young, they may need further surgeries throughout their life.
There can occasionally be bleeding when a shunt is positioned. This can cause neurological problems. There’s also a small risk of fits after any type of brain surgery.
In younger children, particularly babies, cerebrospinal fluid (CSF) can run alongside the shunt rather than down it. This can cause the fluid to leak through the skin wound. Additional stitches or further surgery will be needed to stop the leak.
Shunt alert cards
Visit Spina Bifida and Hydrocephalus Scotland for information about how to apply for a medical alert card. You carry the card with you if you’ve had a shunt fitted.
Complications
An endoscopic third ventriculostomy (ETV) is a surgery that makes a small opening in the third ventricle, a fluid-filled space inside the brain. This gives the cerebrospinal fluid (CSF) a new path to circulate through.
Possible complications after ETV surgery include:
- the opening can close up again
- your brain may not be able to absorb the CSF that is now draining through it
- infection, though this is less likely than after shunt surgery
- bleeding inside the brain
- neurological damage, such as problems with short term memory, double vision or hormone imbalances
If there is a problem with the opening, it may be possible to repeat the surgery, or a shunt may need to be fitted instead.
Most nerve problems improve over time, but there is a small risk that some may be permanent.
There is also a small risk of epilepsy developing. And there is a very small risk of injury to a blood vessel in the brain, which can be fatal.