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Hydrocephalus

What is hydrocephalus?

Hydrocephalus is a condition caused by too much cerebrospinal fluid (CSF) inside the ventricles of your brain. Ventricles are spaces inside the brain where cerebrospinal fluid (CSF) is produced. CSF surrounds your brain and spinal cord. CSF is constantly being made and absorbed by your body. It moves through ventricles before it drains out and gets absorbed into your bloodstream. When CSF cannot drain properly, the fluid pressure may cause the ventricles to swell.

What are the most common types of hydrocephalus in adults?

  • Communicating hydrocephalus: This occurs when CSF leaves the ventricles but cannot drain and be absorbed by the bloodstream.

  • Noncommunicating hydrocephalus: This is also called obstructive hydrocephalus. It occurs when the flow of CSF between the ventricles is blocked.

  • Idiopathic normal pressure hydrocephalus: This occurs when the ventricles swell for no known reason. It is more common in people aged 60 or older.

  • Ex-vacuo hydrocephalus: This 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?

You may have been born with hydrocephalus. The following can also increase your risk:

  • A brain injury or bleeding inside your skull

  • Infections, such as meningitis (infected covering of the brain or spinal cord) or ventriculitis (infected ventricles)

  • Tumors or cysts that block the flow of CSF

  • Aqueductal stenosis (narrowed passage between 2 ventricles), a condition you are born with that increases your risk as an adult

What are the signs and symptoms of hydrocephalus?

Signs and symptoms may be mild at first and get worse over time:

  • Headache or dizziness

  • Nausea or vomiting

  • Double vision

  • Urinary problems, such as needing to urinate often or urgently, or leaking urine

  • Sleepiness or fatigue

  • Seizures or loss of consciousness

  • 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:

  • Blood tests: You may need blood taken to check for infections. You may need to have blood drawn more than once.

  • MRI: This scan uses powerful magnets and a computer to take pictures of your brain. An MRI may show aqueductal stenosis, tumors, or cysts. You may be given dye to help the pictures show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the caregiver if you have any metal in or on your body.

  • CT scan: This test is also called a CAT scan. An x-ray machine uses a computer to take pictures of your brain ventricles and to check for bleeding or excess fluid. You may be given a dye before the pictures are taken to help caregivers see the pictures better. Tell the caregiver if you have ever had an allergic reaction to contrast dye.

  • Lumbar puncture: This may also be called a spinal tap. Caregivers put a needle into your back to collect CSF from 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) to drain CSF from around your spine for up to 5 days. This test is done to see if surgery to drain CSF fluid would relieve your signs and symptoms. You must stay in the hospital during this test.

  • Intracranial pressure monitoring: This is also called ICP monitoring. A small tube is put through your skull. The other end is connected to a monitor. Caregivers use ICP monitoring to keep an ongoing measurement of the pressure inside your skull.

  • Cisternography: Caregivers inject a tracer (radioactive substance) around your spine to watch how CSF moves through your brain and spinal canal for 1 to 3 days.

How is hydrocephalus treated?

You may need long-term treatment to keep your symptoms from coming back.

  • Surgery:

    • Shunt placement: A catheter (shunt) is placed inside a brain ventricle or around your spine to drain CSF. A plastic tube is attached to the catheter. The tube drains into your chest or abdomen, 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: This is also called endoscopic third ventriculostomy, or ETV. Your caregiver uses a tool called an endoscope to look into the brain and ventricles. An endoscope is a thin, flexible tube with a camera at the end. Caregivers make a small hole in a ventricle to allow the CSF to drain and be absorbed by the body.

    • Tumor or cyst removal: Your caregiver may remove a cyst or tumor from your brain to relieve a blockage.

  • Medicines: You may need antibiotics to treat an infection. Steroids or other medicines can help lower the amount of CSF your body makes.

What are the risks of hydrocephalus?

  • After a shunt placement, the shunt valve may need adjustments if there are any problems. 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, which can be life-threatening.

  • Without treatment, symptoms such as headaches, vision problems, or seizures may become worse. You may develop incontinence (leaking urine). Your ability to think clearly may get worse. Over time, the pressure on your brain caused by hydrocephalus may be life-threatening.

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 your questions so you remember to ask them during 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 severe. 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: Tell your caregivers if you gain or lose weight. Your shunt valve may need adjustment.

Where can I find more information?

  • 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 contact my caregiver?

Contact your caregiver if:

  • You have a fever.

  • Your neck and shoulders feel sore.

  • The skin around your shunt looks red and feels tender.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • You feel sleepy, or have problems waking.

  • You have nausea or are vomiting, even after treatment.

  • You feel dizzy or your vision changes.

  • You had a seizure or lost consciousness.

  • You have a fever and a stiff neck, or you feel confused.

  • You have headaches do not get better, even after you take medicine.

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. 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.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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