Hydrocephalus In Children

What is hydrocephalus?

Hydrocephalus (HEYE-droh-SEF-ah-lus) is a condition when too much fluid collects in the ventricles of the brain. Ventricles are spaces inside the brain where cerebrospinal fluid, or CSF, is produced. CSF is a clear fluid that is around the brain and in the spinal cord. CSF normally flows from the ventricles into the lower part of the brain and up and down the spinal cord. CSF is then absorbed by blood vessels, called veins, into the blood system. CSF acts as a cushion protecting the brain from injury and also delivers nutrients to the brain and removes wastes.

Normally, there is a constant balance of CSF production and absorption. This balance helps control the pressure within the brain. When this balance is disturbed, such as in increased production or decreased absorption of CSF, hydrocephalus may occur. Problems in the flow of CSF, such as a block or clog, may also result in hydrocephalus. These may all lead to an abnormal build up of CSF in the brain. This, in turn, increases pressure on the brain that may damage brain cells. Treatment must begin as soon as possible to prevent further injury to the brain.

What causes hydrocephalus?

Hydrocephalus may be caused by anything that could lead to too much fluid collecting in the brain. It may be congenital (happened before birth) or it may occur anytime during your child's life. Any of the following conditions may result in hydrocephalus:

• Congenital:
  
  
  • Infections in the mother during pregnancy caused by germs, such as bacteria or a virus.
    
    
  • Problems during the growth of the fetus. This may cause defects in body parts, particularly in the brain and spinal cord.
  
  
• Acquired:
  
  
  • Head injuries or trauma.
    
    
  • Infections in the brain and its coverings.
    
    
  • Prematurity (being born too early). This may put your baby at a high risk for bleeding in the brain.
    
    
  • Tumors in the brain or spinal cord that may decrease or block the flow of CSF.

What are the signs and symptoms of hydrocephalus?

The signs and symptoms of hydrocephalus may vary depending on the age of your child.

• Infants and young children: The most common sign is a fast increasing head size. The head size increases because the bones of a baby's skull have not yet fused together. The skin over the scalp appears shiny and thin with blood vessels easily seen under it. Other signs and symptoms may include:
  
  
  • Eyes that are turned downward.
    
    
  • Bulging fontanelles (soft spots of the head).
    
    
  • Fussiness, restlessness, or crying more than normal.
    
    
  • Problems with holding the head up or frequent bobbing of the head.
    
    
  • Seizures (convulsions).
    
    
  • Sleepiness.
    
    
  • Vomiting (throwing up).
  
  
• Older children: The bones of the skull in older children may have fused, which may cause different symptoms than those seen in infants. These may include:
  
  
  • Blurring of vision or double vision.
    
    
  • Drowsiness.
    
    
  • Headaches that have occurred over a long period of time.
    
    
  • Nausea or feeling sick to the stomach.
    
    
  • Mood changes, learning problems, and memory loss.
    
    
  • Problems in controlling urination.
    
    
  • Problems with balance and walking

How is hydrocephalus diagnosed?

• CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your child's body. Your child may be given dye, also called contrast, before the test. Tell the caregiver if your child is allergic to dye, iodine, or seafood.
  
  
• Lumbar puncture: This procedure may also be called a spinal tap. A small needle is placed into your child's lower back. Fluid will be removed from around your child's spinal cord and sent to the lab for tests. The test is done to check for bleeding around your child's brain and spinal cord, and for infection. This procedure may also be done to take pressure off your child's brain and spinal cord, or to give medicine. Your child may need to be held in place so that he does not move during the procedure.
  
  
• MRI: An MRI uses a powerful magnet and radio waves to take pictures of the inside of your child's body. Caregivers may use the MRI to look at your child's brain, muscles, joints, bones, or blood vessels. Your child will need to lie still during his test. Never enter the MRI room with any metal objects. This can cause serious injury.
  
  
• Ultrasound: This is a test using sound waves to look at your child's brain. Pictures of your child's brain and ventricles show up on a TV-like screen. This may show changes in his brain or ventricles that may indicate hydrocephalus.

How is hydrocephalus treated?

Your child may have any of the following:

• Lumbar puncture: This procedure may also be called a spinal tap. A small needle is placed into your child's lower back. Fluid will be removed from around your child's spinal cord and sent to the lab for tests. The test is done to check for bleeding around your child's brain and spinal cord, and for infection. This procedure may also be done to take pressure off your child's brain and spinal cord, or to give medicine. Your child may need to be held in place so that he does not move during the procedure.
  
  
• Medicines: Your child may be given diuretics (water pills) to help decrease the swelling in his brain.
  
  
• Surgery: Surgery is often needed to treat your child's hydrocephalus. The following are the different procedures for hydrocephalus:
  
  
  • Shunt: This is a procedure where caregivers put a flexible tube into your child's ventricle. The tube helps drain CSF out of the brain and into the abdomen (belly) or chest. Ask your caregiver for more information about the use of shunts in hydrocephalus.
    
    
  • Ventriculostomy: This is also called endoscopic third ventriculostomy or ETV. ETV is surgery using an endoscope to make a hole through the third ventricle. This helps restore the flow of CSF. An endoscope is a thin, flexible tube with a camera to help caregivers look into your child's brain and ventricles. Ask your caregiver for more information about ETV.

Treatment should begin as soon as possible to prevent brain injury. With treatment, such as a shunt and medicine, your child's quality of life may be improved.

Where can I find support and more information?

Hydrocephalus may be a life-changing disease for you, your child, and your family. Accepting that your child has hydrocephalus may be hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. You may also want to join a support group of families who have children with hydrocephalus. Contact any of the following for more information:

• Hydrocephalus Association
  870 Market Street, Suite 955
  San Francisco , CA 94102
  Phone: 1- 415 - 732-7040
  Phone: 1- 888 - 598-3789
  Web Address: http://www.hydroassoc.org
  

• The Hydrocephalus Foundation, Inc.
  910 Rear Broadway
  Saugus , MS 01906
  Phone: 1- 781 - 942-1161
  Web Address: http://www.hydrocephalus.org
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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