Hydrocephalus
What is Hydrocephalus?
Overview
Hydrocephalus is a condition of excess fluid on the brain. The brain and spinal cord are normally bathed by cerebrospinal fluid (CSF) which gives the brain buoyancy and acts as a shock-absorber to protect these delicate structures.
CSF is produced in fluid-filled structures called ventricles. The brain has four ventricles: two lateral ventricles connected to the third ventricle via the foramina of Munro. This drains into the fourth ventricle via the cerebral aqueduct (Aqueduct of Sylvius). The fluid then leaves the fourth ventricle, bathes the entire brain and spinal cord and is absorbed back into the blood stream via arachnoid granules along the venous sinuses.
The CSF is produced by the “choroid plexus.” This structure lines all four ventricles and produces enough fluid to cycle through the entire central nervous system at least three times per day.
Unfortunately, there is no off switch to stop this process. Hence, if there is blockage along the drainage pathway or if the fluid cannot be absorbed back into the blood, then the fluid is backed-up into the ventricles, causing enlargement – a.k.a. Hydrocephalus.
Who is Affected?
Hydrocephalus can affect people of all ages, but it is more common in:
- Infants and children, often due to congenital causes or complications of premature birth.
- Adults over age 60, where it is frequently related to normal pressure hydrocephalus (NPH).
- Individuals with brain injury, infection, or tumors that disrupt CSF flow.
Hydrocephalus Symptoms & Causes
Symptoms
Symptoms of hydrocephalus range from:
- Memory difficulties
- Walking difficulties
- Incontinence
- Vision disturbances
- Headaches
- Nausea
- Vomiting
- Seizures
- Altered mental status in more acute cases
Basic brain imaging including CT scan of the head and brain MRI are necessary to make this diagnosis. Though there are some medications that can slow this fluid production, there is no medical way to stop production as of yet.
Causes
There are numerous causes of hydrocephalus that occur in adults. One can be born with an obstruction (aqueductal stenosis) and in utero or developmental events can result in some versions of hydrocephalus. Conversely, one can have a cerebral disease that results in hydrocephalus including meningitis, hemorrhage (brain bleed), traumatic brain injury, brain tumors or CSF spread of cancer cells (leptomeningeal carcinomatosis).
When to See a Doctor
Prompt diagnosis and treatment are critical to prevent long-term complications. Seek immediate medical attention if you or a loved one experiences:
- Sudden severe headache.
- Nausea, vomiting, or vision changes.
- Sudden confusion or changes in consciousness.
- Rapidly worsening balance or walking difficulties.
Hydrocephalus Diagnosis
Hydrocephalus is diagnosed through:
- Imaging: MRI or CT scans to assess ventricular enlargement and rule out masses or obstructions.
- Lumbar puncture: In certain cases, removing CSF may help clarify the diagnosis or guide treatment (especially in suspected NPH).
Hydrocephalus is categorized into three main types:
- Normal Pressure Hydrocephalus (NPH): Occurs mainly in older adults with a triad of symptoms: gait disturbance, cognitive decline, and urinary incontinence. Despite fluid buildup, intracranial pressure remains normal.
- Obstructive Hydrocephalus (Non-communicating): A physical blockage within the ventricular system prevents proper CSF circulation.
- Communicating Hydrocephalus: CSF can flow between ventricles, but absorption into the bloodstream is impaired.
Understanding the cause and type of hydrocephalus is essential for creating the best treatment plan.
NPH is a type of hydrocephalus that occurs mainly in older adults causing dementia-like symptoms, where CSF builds up in the brain’s ventricles, but the pressure inside the brain remains normal, hence the name “normal pressure.”
Symptoms: The classic triad of symptoms includes:
- Gait disturbance: Difficulty walking, often described as shuffling or unsteady.
- Cognitive impairment: Memory loss, confusion, and difficulty in thinking, resembling dementia.
- Urinary incontinence: Loss of bladder control, leading to frequent urination or the inability to hold urine.
Cause: The exact cause is often unclear but may be related to impaired CSF absorption, leading to gradual accumulation without significant pressure elevation.
Treatment: The most common treatment is the placement of a shunt to drain excess fluid from the brain to another part of the body.
This type of hydrocephalus occurs when there is a physical blockage in the flow of CSF within the ventricular system, preventing it from circulating properly.
Symptoms: Depending on the location and severity of the blockage, symptoms can include:
- Headaches
- Nausea and vomiting
- Vision problems
- Difficulty with balance and coordination
- Cognitive changes
Cause: The blockage can be caused by congenital malformations, tumors, cysts, or infections.
Treatment: Surgical interventions, such as the removal of the obstruction or the placement of a shunt, are common treatments.
In communicating hydrocephalus, CSF can still flow between the ventricles, but its absorption into the bloodstream is impaired, leading to fluid buildup.
Symptoms: Similar to obstructive hydrocephalus but can vary widely depending on the underlying cause and the age of the patient. Symptoms may include:
- Increased head size in infants
- Headaches
- Nausea and vomiting
- Cognitive difficulties
- Vision problems
Cause: Causes can include infections (like meningitis), hemorrhage, or head trauma, which damage the brain’s ability to absorb CSF.
Treatment: Treatment often involves the surgical placement of a shunt to divert excess fluid or an endoscopic third ventriculostomy (ETV), where a small hole is made in the floor of the third ventricle to allow CSF to bypass the obstruction.
Hydrocephalus Treatment & Outcomes
Treatment Options
The primary treatment for hydrocephalus is surgical diversion of CSF to another part of the body, most commonly via:
- Ventriculoperitoneal (VP) shunt: A small tube drains excess fluid from the brain’s ventricles into the abdomen.
- Endoscopic third ventriculostomy (ETV): A minimally invasive procedure that creates a bypass for CSF flow, often used for obstructive hydrocephalus.
- Combination therapies: In select cases, shunts with programmable valves allow for fine-tuned drainage adjustments.
Medications can temporarily slow CSF production, but there are currently no medical treatments to stop fluid production.
Patient Outcomes
When treated promptly, many patients experience significant improvement in symptoms—especially in walking ability, bladder control, and cognition. Outcomes vary depending on age, underlying cause, and how early treatment begins. Lifelong follow-up is often necessary to monitor shunt function and prevent complications.
Managing Hydrocephalus
Living with hydrocephalus often involves:
Regular Follow-Up Visits
To monitor shunt performance.
Rehabilitation Therapies
For mobility, balance, or cognitive support.
Caregiver Education
To recognize early signs of shunt malfunction or symptom recurrence.
Meet our Expert Specialists & Surgeons
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Our multidisciplinary team at Pacific Neuroscience Institute includes leading neurosurgeons and specialists experienced in diagnosing and treating all types of hydrocephalus using advanced, minimally invasive techniques. We provide personalized, comprehensive care for our patients. From advanced diagnostic evaluations to surgical interventions, our team is dedicated to improving quality of life and supporting patients every step of the way.
Learn More About Hydrocephalus
Prognosis varies depending on the cause and timeliness of treatment. Many patients experience significant symptom improvement after surgery, especially when diagnosed early.
While hydrocephalus typically cannot be “cured,” it can often be effectively managed with surgical treatments like shunts or ETV, allowing patients to lead fulfilling lives.
Yes. With appropriate treatment and ongoing care, many patients maintain independence and enjoy normal activities.
Hydrocephalus can result from congenital malformations, infections, bleeding, trauma, or tumors that block or impair CSF flow or absorption.
There are no specific dietary restrictions for hydrocephalus, but maintaining overall brain health through a balanced diet and proper hydration is beneficial.
With proper treatment and monitoring, many patients live a normal life expectancy.
If untreated, prolonged fluid buildup can cause brain tissue damage. Timely intervention helps prevent or minimize long-term effects.
Hydrocephalus affects the brain, specifically its ventricles and CSF circulation pathways.
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Our expert team specializes in diagnosing and treating hydrocephalus and other CSF conditions. Early diagnosis and treatment can make a significant difference in recovery and quality of life.