Hydrocephalus: what it is, symptoms, causes and treatment

Hydrocephalus is the accumulation of fluid inside the brain, caused by excessive production of CSF or obstruction of the flow of this fluid, resulting in swelling in the brain and symptoms such as a larger-than-normal head, headache or drowsiness.

Although it is more common in children, due to changes in fetal development during pregnancy, hydrocephalus can also develop in adults as a complication of infections that affect the brain, such as meningitis, or brain tumors, for example.

In most cases, hydrocephalus does not have a definitive cure, however, it can be controlled and treated through different types of surgery, which must be guided by a pediatrician or neurologist and be carried out as quickly as possible, to avoid sequelae, such as delay in physical and mental development.

Hydrocephalus symptoms

The symptoms of hydrocephalus vary according to age, the amount of fluid accumulated and the damage caused to the brain:

Symptoms in babies under 1 year old

The main symptoms of hydrocephalus in children under 1 year of age are:

• Head larger than normal;
• Dilated fontanel and head veins;
• Rapid skull growth;
• Difficulty controlling your head;
• Irritability;
• Eyes that seem to look down;
• Seizures;
• Nausea and vomiting;
• Somnolence.

Additionally, the child may experience stiffness, decreased muscle strength or difficulty breastfeeding.

Symptoms in children over 1 year old

In the case of children over 1 year old, the symptoms may be slightly different, including:

• Headache;
• Difficulty walking;
• Space between the eyes and strabismus;
• Involuntary eye movements;
• Blurred or double vision;
• Loss of movement or lack of motor coordination;
• Irritability or mood changes;
• Slow growth;
• Urinary incontinence;
• Drowsiness or sluggishness;
• Nausea or vomiting;
• Learning, speech and memory problems.

In addition, other symptoms that the child may have are loss of bladder control, frequent urination, as well as difficulty waking up or staying awake.

Symptoms in adults and the elderly

The main symptoms of hydrocephalus in adults or the elderly are:

• Intense headache;
• Difficulty walking;
• Urinary incontinence;
• Loss of coordination and balance.

Furthermore, another symptom that may occur is the progressive loss of memory, thinking or reasoning.

When hydrocephalus occurs in adulthood, there is no increase in the size of the head, because the skull bones are already fully developed. This makes the symptoms more intense and appear more quickly, as the brain ends up being pressed against the skull.

How to confirm the diagnosis

Hydrocephalus can be diagnosed by an obstetrician during the prenatal period by performing an obstetric ultrasound. However, it is more common for the diagnosis to be made by a pediatrician after birth, through assessment of the baby or child’s symptoms and a complete neurological examination.

In addition, the doctor may order imaging tests, such as ultrasound, MRI or CT, to evaluate the brain in detail. These tests can be indicated for both children and adults or elderly people with suspected hydrocephalus.

Possible causes of hydrocephalus

Hydrocephalus occurs when there is a blockage in the passage of CSF, increased production or poor absorption of it by the body, which can happen due to fetal malformations, the presence of tumors, infections or as a result of a stroke, for example.

According to the cause, hydrocephalus can be classified into three main types:

• Fetal or congenital hydrocephalus: occurs in the fetus, due to genetic factors that lead to malformation of the central nervous system, due to drug intake by the pregnant woman or infections during pregnancy, such as toxoplasmosis, syphilis, rubella or cytomegalovirus;
• Infantile hydrocephalus: It is acquired in childhood and can be caused by brain malformations, tumors or cysts that cause obstruction, being called obstructive or non-communicating hydrocephalus. It can also occur due to hemorrhages, bleeding, trauma or infections of the central nervous system, which cause an imbalance between the production of liquor and its absorption, being called communicating hydrocephalus;
• Normal pressure hydrocephalus: It occurs in adults or the elderly, mainly over 65 years of age, due to head trauma, stroke, brain tumors, hemorrhage or as a consequence of degenerative diseases, such as Alzheimer’s. In these cases, there is poor absorption of CSF or excess production.

It is important that the cause of hydrocephalus is identified, as this will enable the pediatrician or neurologist to indicate the most appropriate treatment, in order to eliminate the cause and avoid worsening of symptoms.

How the treatment is carried out

Treatment for hydrocephalus may vary depending on the cause, however the pediatrician or neurologist usually recommends emergency surgery to alleviate symptoms and control the disease.

This surgery can be done in different ways:

• Insertion of a shuntwhich consists of placing a small tube in the brain with a valve that drains the accumulated liquid to another area of ​​the body, such as the abdomen or chest, preventing its accumulation in the brain and facilitating its absorption into the bloodstream;
• Ventriculostomiawhich consists of introducing a thin device, through a hole in the skull, to relieve pressure on the brain and circulate CSF.

The insertion of the shunt It is normally done after the birth of a baby with fetal or congenital hydrocephalus. However, in some cases, the surgery can be performed with the baby still in the mother’s womb, to divert excess CSF into the amniotic fluid, and may be recommended by the doctor from 35 weeks of pregnancy.

After birth, the baby must undergo further surgery to divert the fluid to another area of ​​the body. Although it is not yet possible to prevent hydrocephalus, mothers can avoid it by treating infections as advised by the obstetrician, avoiding the use of drugs and taking folic acid before and during pregnancy. See how to take folic acid during pregnancy.

Furthermore, there are other surgeries that help resolve the cause of the problem and that can be performed to treat hydrocephalus, such as surgery to remove tumors or parts of the brain that are producing too much CSF, for example. Therefore, depending on the cause, the doctor must recommend other appropriate treatments.

Possible complications

Complications of hydrocephalus in babies or children are more common when treatment is not carried out in the early stages of the disease, as this means there is a greater chance of damage to brain tissue. Thus, the child may have problems with their mental or motor development, such as difficulties in learning, reasoning, speaking, memory, walking or controlling the urge to urinate or defecate, for example.

In severe cases, hydrocephalus can cause irreparable brain damage, such as mental retardation or paralysis, or even put the child’s life at risk.

Therefore, it is important to maintain regular follow-up with the doctor, to prevent these complications and treat them as quickly as possible, in order to avoid damage to the brain.

Is hydrocephalus curable?

In most cases, hydrocephalus does not have a definitive cure, however it is possible to alleviate symptoms and prevent complications through treatment indicated by a doctor.

Still, there are some cases in which it is possible to achieve a cure, especially in situations where hydrocephalus is caused by an infection and is still in its early stages. This is because once the infection is treated, the pressure in the brain decreases and the hydrocephalus disappears.