17334 Hydrocephalus

Overview

Hydrocephalus is a condition where too much fluid builds up in the cavities inside the brain, called ventricles. This extra fluid puts pressure on the brain and can cause damage if not treated. The word comes from Greek: 'hydro' means water and 'cephalus' means head. The fluid is called cerebrospinal fluid (CSF), which normally cushions the brain and spinal cord.

Hydrocephalus is not extremely common, but it affects thousands of infants, children, and adults every year. It is one of the most common conditions treated by pediatric brain surgeons, but it also occurs in adults and older people.

Hydrocephalus can affect anyone. It may be present at birth (congenital), or it can develop later in life due to injury, infection, bleeding in the brain, or other causes. It can affect babies, children, adults, and older adults. A type called 'normal pressure hydrocephalus' mainly affects older adults over 60.

Symptoms

Common symptoms

• Headache
• Nausea or vomiting
• Blurred or double vision
• Problems with balance or walking
• Difficulty concentrating or memory problems
• Sleepiness or low energy
• Changes in mood or behavior

Symptoms in children

• In babies, a rapidly growing head size or an unusually large head
• A bulging or tense soft spot on top of the head (fontanel)
• Unusual irritability or excessive crying
• Poor feeding or vomiting
• Eyes that look downward (often called 'sunset eyes')
• Seizures
• Developmental delays (like slow to reach milestones)

Symptoms in older adults

• Trouble walking or shuffling feet
• Poor balance, sometimes leading to falls
• Memory loss or confusion that comes and goes
• Slow thinking or difficulty making decisions
• Urinary urgency or loss of bladder control
• Changes in personality, such as losing interest in activities

Causes

Main causes

• The body makes too much cerebrospinal fluid (rare)
• A blockage that stops cerebrospinal fluid from flowing normally
• The brain cannot reabsorb cerebrospinal fluid back into the bloodstream
• Bleeding in the brain, often from a head injury or stroke
• Infections of the brain or spinal cord, such as meningitis
• A brain tumor or cyst pressing on the fluid pathways
• Being born with conditions like spina bifida or aqueductal stenosis

Risk factors

• Premature birth or low birth weight
• Infections during pregnancy (like some viral infections that affect the brain)
• A family history of certain brain or spinal cord conditions
• Traumatic brain injury
• Bleeding inside the brain, such as from an aneurysm
• Brain tumors or other growths in the brain
• Spinal cord conditions, like spina bifida

When to see a doctor

See a doctor urgently if:

• If you or your child have any of the 'call emergency' or 'urgent' symptoms listed above, seek medical care right away.
• A rapid increase in head size in a baby should be checked that day.
• A severe headache that comes on suddenly or is unlike your usual headaches needs urgent medical attention.
• If you have a head injury and then develop confusion, vomiting, or sleepiness, see a doctor or go to an emergency department immediately.

Book a routine appointment if:

• If you notice a gradual change in walking, memory, or bladder control, especially if you are over 60, talk to your doctor about it.
• If your child is missing developmental milestones or you are concerned about their head growth, make an appointment.
• If you have had an infection like meningitis and feel that your recovery is not going well, follow up with your doctor.

Diagnosis

To diagnose hydrocephalus, a doctor will ask about symptoms, do a physical exam, and check your neurological function (like reflexes, balance, eye movements, and memory). In babies, the doctor will measure the head circumference and check the soft spot. If hydrocephalus is suspected, the doctor will order imaging tests of the brain.

Tests that may be done

• Head ultrasound — used mainly in babies, using sound waves to create pictures of the brain
• CT scan (computed tomography) — a special X-ray that shows the brain and fluid spaces
• MRI scan (magnetic resonance imaging) — a detailed scan that gives clearer images of the brain and fluid pathways
• In some cases, a lumbar puncture (spinal tap) to check fluid pressure and look for infection

What to expect at your appointment

If a doctor suspects hydrocephalus, they may refer you to a neurologist or a neurosurgeon. These specialists will review the scans and discuss treatment options. Diagnosis often happens quickly, especially in an emergency setting. It is normal to feel anxious, but the medical team will explain every step. The main goal is to relieve pressure on the brain as safely as possible.

Treatment

Hydrocephalus is not usually cured with medicine. The main treatment is a procedure to drain the extra fluid and relieve pressure on the brain. Treatment depends on the cause, the person's age, and how severe the pressure is. There are two common surgical approaches: placing a shunt system, or performing an endoscopic third ventriculostomy (ETV). Your healthcare team will explain which option is best.

Self-care at home

• Follow your healthcare team's instructions exactly, especially after surgery.
• Watch for signs of shunt problems, such as fever, headache, vomiting, irritability, or a return of old symptoms.
• Keep a diary of symptoms to share with your doctor — this can help spot changes early.
• Protect your head from injury by wearing a seatbelt and using a helmet when cycling or doing contact sports.
• Get enough rest and avoid straining activities if your doctor advises it.

Medical treatments

Medication is not a primary cure for hydrocephalus. In some very specific situations, a doctor may temporarily prescribe a medicine called acetazolamide (which reduces fluid production), but this is not standard for most patients and is not a long-term solution. Never take such medication unless a specialist prescribes it. Pain relief for headaches may be suggested, but the underlying pressure needs to be treated. Always talk to your healthcare provider before taking any medicine.

When is surgery considered?

Surgery is the standard treatment for hydrocephalus. The most common procedure is to insert a shunt — a thin tube that moves excess fluid from the brain to another part of the body (like the abdomen) where it can be absorbed. Another option, called endoscopic third ventriculostomy (ETV), creates a small hole in the floor of one ventricle to let fluid flow out naturally. A neurosurgeon will decide which approach is best based on the cause and your age. After surgery, you will need regular follow-up visits, as shunts can sometimes block or become infected.

Living with this condition

Living with hydrocephalus often means managing a chronic condition with regular check-ups. Many people with hydrocephalus lead normal, independent lives. For children, early support and school accommodations can help with learning. For adults and older people, daily routines may need small adjustments, such as memory aids, physical therapy, or a walking aid for balance. The key is to notice changes early and stay in touch with your healthcare team.

Lifestyle tips

• Keep a routine to help memory — use calendars, alarms, and notes if needed.
• Stay active, but avoid high-impact sports or activities with a risk of head injury unless your doctor says it's safe.
• Avoid heavy lifting or straining if you have a shunt, as it may affect pressure.
• Get good sleep — tiredness can make symptoms worse.
• Stay socially connected and talk to friends, family, or a support group.
• Wear a medical alert bracelet if you have a shunt, so emergency staff know about it.

Diet and exercise

Eating a balanced diet and staying physically active are good for overall brain health. There is no special 'hydrocephalus diet', but healthy foods rich in fruits, vegetables, whole grains, and lean proteins support well-being. Exercise like walking, swimming, or gentle yoga can improve circulation and mood — always check with your doctor first. If you have balance problems, ask about safe exercises or physical therapy. Stay well hydrated, but some people with shunts may need to follow fluid advice from their doctor.

Mental health and emotional wellbeing

Living with a brain condition can be stressful. You may feel anxious, depressed, or frustrated — especially after diagnosis or surgery. It is completely normal to have these feelings. Talk to your healthcare provider about mental health support. Counselling, cognitive behavioral therapy, or support groups can be very helpful. Remember: your emotional health is just as important as your physical health. If you ever have thoughts of self-harm, please reach out for help immediately.

Prevention

Many cases of hydrocephalus cannot be prevented because they are caused by genetics, birth defects, or unknown factors. However, some causes can be reduced: treating head injuries seriously, managing infections like meningitis quickly, and protecting your head from trauma can lower the risk of acquired hydrocephalus. Good prenatal care and vaccinating your children can prevent some infections that might lead to hydrocephalus.

Vaccines

Vaccines can prevent some infections that can cause hydrocephalus, such as meningitis. Following the recommended vaccination schedule for children and adults is an important way to protect against certain brain infections. Ask your doctor or local health service about vaccinations you or your child might need.

Screening programmes

There is no routine screening for hydrocephalus in healthy people. However, during pregnancy, routine ultrasound scans may sometimes show changes in the baby's brain that suggest hydrocephalus. After birth, babies' head size is measured at check-ups, and doctors monitor for early signs. People with conditions that raise their risk, like spina bifida, are closely monitored.

Complications

If left untreated

• Permanent brain damage
• Intellectual disability or learning problems
• Vision problems, including blindness
• Muscle weakness, stiffness, or coordination problems
• Problems with walking and balance
• Loss of bladder control
• Cognitive decline and memory loss
• In severe cases, death — especially if pressure rises rapidly

Long-term outlook

With early diagnosis and proper treatment, the outlook for hydrocephalus is often good. Many children grow up to lead healthy, independent lives. Adults and older people can also improve with surgery, especially when treatment happens early. Some people may have long-term challenges, but with ongoing medical care, therapy, and support, most can manage their condition well. Having hydrocephalus can feel overwhelming, but modern treatments have transformed the future for people with this condition, and there is hope.

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