Hydrocephalus – Diagnosis and Treatment
Diagnosis
Checking the Nervous System
A health specialist uses a variety of checks to assess how the brain and nerves are working. The approach varies by age.
For infants and young children, a doctor observes movement, checks for irritability, measures muscle tone, and monitors developmental milestones.
Older children and adults may answer questions to check memory, balance, strength, senses, and overall mental sharpness. Patterns of symptoms such as vomiting, headaches, sleepiness, or seizures can also give important clues.
Common signs found during these checks include trouble walking, loss of bladder control, or changes in alertness, which especially occur in normal pressure hydrocephalus.
A neurological check is especially important after brain injury, stroke, or if someone shows signs of brain dysfunction. Detecting neurological changes early can help prevent lasting brain damage from hydrocephalus.
Scanning the Brain
Brain imaging studies confirm hydrocephalus by creating detailed pictures to show if the fluid-filled ventricles are larger than usual due to cerebrospinal fluid.
Imaging shows the type of hydrocephalus—such as communicating or non-communicating—and can reveal the underlying cause, like a tumor, cysts, aqueductal stenosis, or neural tube defects like spina bifida.
| Test Type | Use | Pros | Cons |
|---|---|---|---|
| Ultrasound | Infants/Prenatal | Safe, quick | Limited to those with soft skull spots |
| MRI | Detailed imaging | No radiation, high detail | Noisy, may require sedation |
| CT Scan | Emergencies | Fast, easy | Radiation, less detail |
Ultrasound is often the first test for babies because it is safe and simple. By placing a probe over the soft spot in the baby’s head, doctors see the ventricles and fluid flow. Ultrasound sometimes detects hydrocephalus before birth during prenatal scans.
MRI uses magnets and radio waves to make detailed images of brain tissue and fluid. It reveals enlarged ventricles, blockages, or damage caused by excess CSF. For children, a quick MRI may be used to avoid sedation.
CT scan takes a series of X-rays to produce cross-sectional images. While it is fast and helpful in emergencies, doctors usually use it less often due to radiation exposure and less detail compared to MRI. CT still shows signs such as enlarged ventricles and is useful for rapid diagnosis, especially after a head injury or stroke.
Other tests, such as lumbar puncture or cisternography, help in complex cases. These imaging methods help healthcare professionals confirm hydrocephalus, find causes, and plan treatment like ventriculostomy, if needed.
Treatment
Drainage Tubes and Valves
Doctors often treat hydrocephalus by placing a flexible tube system, known as a shunt. This setup includes a tube and a small valve that keeps the flow of cerebrospinal fluid steady and in the correct direction.
The upper end of this tube goes into one of the brain’s ventricles, while the other end is threaded beneath the skin to a spot such as the abdomen or sometimes a heart chamber.
The most typical example is a ventriculoperitoneal (VP) shunt.
Most patients need shunt placement for life. Regular health checkups monitor the system’s function and catch any issues early. Types of shunt systems can be compared in the table below:
| Type of Shunt | Where Fluid Drains | Commonly Used For |
|---|---|---|
| VP (Ventriculoperitoneal) | Abdomen | Most patients |
| VA (Ventriculoatrial) | Heart chamber | Select adult patients |
| LP (Lumboperitoneal) | Abdomen | Some types of hydrocephalus |
Creating a New Drainage Path
Surgeons can also perform endoscopic third ventriculostomy (ETV). In this procedure, the surgeon uses a tiny camera to look inside the brain. With precise tools, the surgeon makes a small opening at the base of a ventricle.
This new pathway lets fluid flow out of the brain, helping to reduce pressure. ETV is best for certain patients and may not be suitable for everyone. When successful, it can work without leaving a shunt inside the body.
Possible Surgical Risks
Operations for hydrocephalus, whether shunt surgery or ETV, can come with risks. The shunt may become blocked or fail to drain fluid at the right rate.
Infections can also occur in the shunt or the area around it, and sometimes the body’s immune system reacts to the hardware.
For ETV, problems like infection or bleeding inside the brain are possible, but not common. Any fever or signs of shunt blockage, such as headaches or vomiting, are important warning signs.
A healthcare provider should check these right away. Some people will need more surgeries to fix a problem or replace a shunt.
Supportive Care and Other Medical Help
After surgery, patients may still need additional treatment. Doctors may prescribe medicines such as acetazolamide in some cases, but these rarely replace surgery.
Many patients, especially children, benefit from a team of specialists. These specialists may include pediatricians, neurologists, occupational therapists, and social workers.
Extra support can include help with schoolwork, behavioral therapy, and resources for special education. Adults with more serious effects may need continuing care from mental health professionals or dementia specialists.
Ways to Manage and Find Support
Living with hydrocephalus can be challenging, but many ways exist to make things easier. Connecting with groups like the Hydrocephalus Association and talking to hospital social workers helps families find needed resources.
These supports range from emotional counseling to special educational services. Many children may also qualify for government programs that offer extra healthcare or learning help.
Adults can join organizations for hydrocephalus awareness, which provide useful tips and connect people who share similar experiences.
People can benefit from joining support groups, either in person or online. Sharing stories and advice with others in similar situations can make a real difference.
Hospitals and agencies that serve people with disabilities often know about these groups and can help you get started. It helps to keep a list of trusted contacts, such as doctors, counselors, and patient advocates.
Should You Consider Getting a Meningitis Vaccine?
Meningitis can cause hydrocephalus. The Centers for Disease Control and Prevention (CDC) recommend that certain groups get vaccinated against meningitis. Here is a quick look at who should think about it:
| Group | Recommended? |
|---|---|
| Preteens and teens | Yes, with booster shots |
| Children or adults with weakened immune systems | Yes |
| Those with spleen issues (damaged/removed spleen) | Yes |
| People living in college dorms or joining the military | Yes |
| Travelers to high-risk countries | Yes |
Ask your health care provider if you or your child are in one of these groups. Vaccination helps reduce the chance of meningitis, which protects your health in the long run.
Getting Ready for Your Child’s Medical Visit
Scheduled Baby Checkups
Regular checkups for your baby are important for watching their growth and development. At these visits, health care providers keep track of things such as:
- Changes in head size
- Growth of the body
- How strong the muscles are
- Posture and body coordination
- When skills like sitting, crawling, or walking begin
They may also test how well your baby sees, hears, and feels touch. Caregivers can write down notes about their child’s milestones and any changes they see at home. Below is a helpful table of what to observe:
| Area | Questions to Consider |
|---|---|
| Eating | Does your child eat well? |
| Response to Touch | How does your child react when touched? |
| Developmental Milestones | Are major motor skills developing on time? |
| Sensory Response | Are there changes in hearing or vision? |
Caregivers should bring a list of any specific worries or questions to the visit. They should also keep a record of when key milestones—such as rolling over or speaking—are reached.
Getting Ready for Other Appointments
If symptoms come up, you may need to see a specialist, like a neurologist. Caregivers and patients should be ready to talk about:
- Types of symptoms noticed and when they started
- Any changes in the symptoms
- Issues such as nausea, headaches, vision changes, or fever
- Changes in attitude or mood, such as new irritability
- Problems with movement, bladder control, or sleep
- For infants: issues with eating, breathing, or any seizures
Tracking these details in a notebook lets you share them during the appointment. You should also note any recent injuries or new medicines.
Bringing all this information helps the health care team better understand what is happening with the child.
