Hydrocephalus

What is hydrocephalus?

Hydrocephalus is a condition caused by too much cerebrospinal fluid (CSF) inside your brain. CSF is fluid made by your body that surrounds your brain and spinal cord. CSF is constantly being made and absorbed by your body. It moves through spaces inside your brain called ventricles before draining out and being absorbed into your bloodstream. When CSF cannot drain properly, the fluid pressure may cause the ventricles to swell. The excess fluid presses against your brain and often creates problems with thinking, vision, and movement.

What are the most common types of hydrocephalus in adults?

Hydrocephalus can be congenital (born with) or acquired (occurs later in life). Ask your caregiver for more information about these and other types of hydrocephalus:

• Communicating: This occurs when CSF drainage is blocked after it exits the ventricles.
  
  
• Non-communicating: This is when CSF is blocked from leaving the ventricles. Non-communicating hydrocephalus is also called obstructive hydrocephalus.
  
  
• Idiopathic normal pressure hydrocephalus: This type of hydrocephalus occurs when the ventricles swell for no known reason. This is more common in people aged 60 and older.
  
  
• Ex-vacuo: This type of hydrocephalus can occur after an injury to the brain, such as a stroke or trauma. The injury may cause the brain tissue to shrink.

What increases my risk of hydrocephalus?

Ask your caregiver for more information about the following risk factors for hydrocephalus:

• Brain injuries. Your risk for hydrocephalus increases if you hemorrhage (bleed) inside your skull.
  
  
• Infection. Infections are caused by germs called bacteria. Infections that can lead to hydrocephalus include meningitis (infected covering of the brain or spinal cord) or ventriculitis (infected ventricles).
  
  
• Brain tumors or cysts. Tumors or cysts are abnormal lumps of tissue that can block the flow of CSF.
  
  
• Aqueductal stenosis. This is a narrowed passage between two of your brain ventricles. You may be born with this condition and get hydrocephalus as an adult.
  
  
• Medical conditions. Your risk may increase if you have hypertension (high blood pressure), heart disease, or diabetes (high blood sugar).

What are the signs and symptoms of hydrocephalus?

Signs and symptoms of hydrocephalus may be mild at first and get worse over time. Signs and symptoms may include the following:

• Headache or dizziness.
  
  
• Nausea (upset stomach) or vomiting (throwing up).
  
  
• Double vision.
  
  
• Urinary problems, such as needing to urinate often, urgently, or leaking urine.
  
  
• Sleepiness or tiredness.
  
  
• Seizures (convulsions) or loss of consciousness (you look like you are sleeping, but cannot be woken up).
  
  
• Problems walking.
  
  
• Thinking or memory problems.

How is hydrocephalus diagnosed?

Hydrocephalus can look like many other medical problems, so tests are needed to confirm a diagnosis. Ask your caregiver about these or any other tests you may need:

• Blood tests. You may need blood taken to check for infections. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. You may need to have blood drawn more than once.
  
  
• Neuropsychological tests. Caregivers test your memory and thinking skills.
  
  
• Magnetic resonance imaging. This is also called an MRI. This test takes pictures of parts of your brain to help find aqueductal stenosis, tumors, or cysts. You will need to lie still during an MRI. Never enter the MRI room with any metal objects. This can cause serious injury.
  
  
• Computerized tomography. This is also called a CT scan. This x-ray uses computers to take pictures of your brain ventricles and to check for bleeding or excess fluid. You may be given dye before the pictures are taken. The dye is usually given in your IV. The dye may help your caregiver see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell the caregiver if you are allergic to shellfish, or have other allergies or medical conditions.
  
  
• Lumbar puncture. This may also be called a spinal tap. Caregivers put a needle into your back to collect CSF from the spinal space (the area around your spine). The CSF may be tested for infection. Caregivers also may check the CSF pressure.
  
  
• Lumbar drainage. Caregivers use a needle to insert a catheter (tube) into the spinal space for this test. The catheter drains CSF for up to 5 days. This test is done to see if surgery to drain CSF fluid would resolve your signs and symptoms. You must stay in the hospital during this test.
  
  
• Intracranial pressure monitoring. This is also called ICP monitoring. An ICP monitor is a small tube that is put through the skull and into the head. The tubing is connected to a TV-type screen. Caregivers use the ICP monitor to keep an ongoing measurement of the pressure inside your skull (the bones of your head).
  
  
• Cisternography. Caregivers inject a tracer (radioactive substance) into your spinal space to watch how CSF moves through your brain and spinal canal for 1 to 3 days.

How is hydrocephalus treated?

Hydrocephalus can become chronic, meaning that you will need long-term treatment to keep your symptoms from coming back. You may need any of the following:

• Observation. If you do not have symptoms, caregivers may monitor your hydrocephalus at first. You may need an MRI each year. If you start to have symptoms, caregivers will work with you to plan your treatment.
  
  
• Medicines. Steroids or other medicines can help lower the amount of CSF your body makes. You may also need antibiotics to treat an infection.
  
  
• Surgery. Your caregivers will work with you to choose a surgery that helps drain the excess CSF. Common surgery options include:
  
  
  • Tumor or cyst removal. Your caregiver may remove a cyst or tumor from your brain to relieve a blockage.
    
    
  • Shunt placement. This surgery places a catheter (shunt) inside a brain ventricle or the spinal space to drain CSF. A plastic tube is attached to the catheter. The tube drains into your chest or abdomen (belly), where your body absorbs the excess CSF. A valve on the tube helps slow down or speed up the CSF drainage. The shunt valve may need to be adjusted to maintain the proper amount of CSF drainage.
    
    
  • Ventriculostomy. Your caregiver uses a tool called an endoscope to make a small hole in a brain ventricle. CSF drains through the hole to be absorbed by the body.

What are the risks of hydrocephalus and its treatment?

• The symptoms you have from excess CSF will not get better without medical treatment. Any headaches, vision problems, or seizures may become worse, and happen more often. An urgent need to urinate can progress to incontinence (leaking urine). Your ability to think clearly may get worse. You can die from hydrocephalus when there is too much pressure on the brain for too long. With treatment, most of these symptoms can improve.
  
  
• After a shunt placement, the shunt valve will need adjustments at first. Headaches and other hydrocephalus symptoms may return. You may feel sleepy or confused. You may not be able to move one side of your body. Tell your caregivers about any of these symptoms right away so they can adjust your shunt valve and check for other problems. Your shunt can also become blocked or stop working. You will need another surgery to fix a blocked shunt. You may also be at risk for an infection after surgery. An infection can be life-threatening. Talk with your caregiver about any questions or concerns you have about hydrocephalus and its treatment.

How do I manage hydrocephalus?

• Keep your follow-up visits. Ask your caregiver when to return for follow-up visits. You may need CT scans before shunt adjustments every 2 to 3 weeks at first. Write down any questions you have. This way you will remember to ask them at your visits.
  
  
• Keep a headache diary. If your headaches get worse during treatment, your caregivers may suggest you keep a headache diary. Rate your headache, such as from mild to very bad. Write down what you were doing when the headache started. Also note when you have been sitting or standing for a long time. Caregivers may use the headache diary to change your treatment if needed.
  
  
• Report weight changes. If you gain or lose weight, tell your caregivers. Your shunt valve may need adjustment.
  
  
• Stay upright. Sit up often, even if you have to stay in bed. This will help your shunt drain CSF better.

Where can I find more information?

Contact the following:

• National Institute of Neurological Disorders and Stroke
  P.O. Box 5801
  Bethesda , MD 20824
  Phone: 1- 301 - 496-5751
  Phone: 1- 800 - 352-9424
  Web Address: http://www.ninds.nih.gov
  

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• Your neck and shoulders feel sore.
  
  
• The skin around your shunt looks red and feels tender (sore to the touch).

When should I seek immediate help?

Seek care immediately or call 911 if:

• You feel sleepy, or have problems waking.
  
  
• You have nausea or vomiting even after treatment.
  
  
• You feel dizzy or your vision changes.
  
  
• You have had a seizure or have lost consciousness.
  
  
• You have a fever and a stiff neck. You may also feel confused.
  
  
• Your headaches are not getting better, even after you take medicine.
  
  
• You are having headaches after hydrocephalus surgery.

Care Agreement

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

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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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