Hydrocephalus

Diagnosis

A diagnosis of hydrocephalus is based on a combination of symptoms, physical examinations, and brain imaging tests. The process helps determine the cause and extent of fluid buildup in the brain.

The evaluation typically includes:

• A review of symptoms and medical history

• A general physical examination

• A neurological exam

• Brain imaging tests

Neurological exam

The type of neurological exam depends on the person’s age. A healthcare professional may ask questions and perform simple tests to assess:

• Muscle strength and coordination

• Reflexes and balance

• Sensory functions

• Mental and emotional well-being

Brain imaging

Imaging tests are key in diagnosing hydrocephalus and identifying the underlying cause of symptoms.

Common imaging tests include:

• Ultrasound: Often the first test for infants. The device is placed over the soft spot on the baby’s head and can also detect hydrocephalus during prenatal exams.

• MRI: Uses radio waves and magnetic fields to produce detailed brain images. It shows enlarged ventricles and helps find causes of hydrocephalus. Some hospitals use faster MRI methods that reduce or eliminate the need for sedation in children.

• CT scan: Provides cross-sectional brain images quickly, often used in emergencies. However, it exposes the patient to a small amount of radiation and offers less detail compared to MRI scans.

Treatment

Treatment for hydrocephalus typically involves surgery to restore the normal flow of cerebrospinal fluid in the brain. Two main surgical procedures are used.

Shunt system

The most common treatment is the surgical placement of a shunt system. The shunt consists of a flexible tube with a valve that helps regulate fluid flow.

• One end of the tube is placed inside a brain ventricle.

• The other end is tunneled under the skin to another area, such as the abdomen or heart, where the fluid can be absorbed.

People with hydrocephalus often need a shunt for life and require regular monitoring to ensure proper function.

Endoscopic third ventriculostomy

In some cases, a surgeon performs an endoscopic third ventriculostomy. Using a small camera, the surgeon creates a tiny opening in the bottom of a brain ventricle to allow cerebrospinal fluid to drain more effectively.

Complications of surgery

Both procedures can have complications, such as:

• Shunt malfunction or blockage

• Infection

• Poor fluid drainage regulation

• Bleeding after surgery

If these complications occur, immediate medical attention and sometimes another surgery are needed.

Other treatments

Some people, especially children, may require supportive therapies depending on the long-term effects of hydrocephalus.

The care team may include:

• Pediatrician or physiatrist to oversee medical care

• Pediatric neurologist for neurological management

• Occupational or developmental therapist to aid daily functioning and growth

• Psychologist or psychiatrist for emotional and behavioral support

• Social worker to help with services and care coordination

Children in school may benefit from special education services to address learning challenges and provide tailored educational support.

Adults may need rehabilitation, occupational therapy, or dementia care depending on their condition’s severity.