What is hydrocephalus?
Hydrocephalus is a condition in which there is a build-up of fluid called cerebrospinal fluid (CSF) within the brain. This can increase pressure and cause damage to the brain. It needs medical assessment and treatment as in some cases, depending on the type of hydrocephalus, it can be life-threatening.
Hydrocephalus can be congenital, acquired, normal pressure or idiopathic.
Congenital hydrocephalus – hydrocephalus that is present at birth. Symptoms may be present at birth but usually appear in childhood. In some cases, they may not appear until adulthood.
Acquired hydrocephalus - hydrocephalus can be acquired at any stage of life due to head injuries, strokes, brain tumours, meningitis, brain haemorrhages and other forms of ABI.
Normal pressure hydrocephalus – hydrocephalus that usually develops in older people, with the cause often unknown.
Idiopathic hydrocephalus – hydrocephalus with no known cause.
What causes hydrocephalus?
Hydrocephalus is caused by complications with the brain’s cerebrospinal fluid (CSF). This is a fluid naturally found in the brain, responsible for protecting the central nervous system, removing waste, cushioning the brain and spinal cord, and providing important nutrients for the brain. CSF is continuously produced, circulated around the brain and spinal cord, and then reabsorbed by the body.
Hydrocephalus can develop when the flow of CSF is blocked or when the body cannot reabsorb it normally. More rarely, too much CSF may be produced.
These issues can cause the ventricles of the brain (fluid filled cavities) to enlarge as the fluid pressure increases.
What happens in hydrocephalus?
Acquired and idiopathic forms of hydrocephalus can occur at any time in life and typical symptoms include:
Headaches;
Neck pain;
Nausea;
Vomiting;
Drowsiness;
Confusion;
Poor co-ordination;
Blurred or double vision;
Difficulty walking;
Bladder and/or bowel incontinence.
The symptoms of normal pressure hydrocephalus may appear slowly over months or years. These include:
A change in gait (the way someone walks), such as stumbling or shuffling;
Urinary symptoms, including a frequent and urgent need to urinate, and loss of bladder control;
Changes in thinking skills, such as slower reactions, difficulty processing information or memory problems.
Symptoms of congenital hydrocephalus tend to appear early in childhood and include an unusually large head, muscle spasms, poor feeding, irritability and drowsiness.
Call 999 or go to A&E if symptoms develop suddenly or rapidly. Contact a GP if you think you or your child may have symptoms of hydrocephalus.
Shana's story
42-year-old Shana Lewis, from London, had been running her own cake business and enjoying life as a loving mother and family woman when she was diagnosed with hydrocephalus.
Having battled to overcome communication problems and relearned how to read and write following her brain injury, Shana writing her story is possibly one of her greatest achievements yet.
Read more about Shana’s experience of living with hydrocephalus and her story writing achievements.
How is hydrocephalus treated?
Brain scans such as computerised tomography (CT) or magnetic resonance imaging (MRI) can show signs of CSF build-up, such as enlarged ventricles. Brain scans can also help doctors determine the cause of hydrocephalus and rule out other possible reasons for the symptoms.
Other tests may include an eye examination to check vision and look for signs of increased pressure such as swelling behind the eyes. In some cases, a lumbar puncture may be used to assess CSF pressure or help investigate normal pressure hydrocephalus. This involves taking a sample of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) from the lower back and testing it for signs that can help identify the cause of hydrocephalus.
Initial treatment for hydrocephalus focuses on reducing pressure on the brain and restoring the normal flow of CSF.
A shunt is usually used to drain excess CSF from the brain. A shunt is a small tube that is placed into one of the fluid-filled spaces in the brain and runs to another part of the body, usually the abdomen, where the CSF can be absorbed into the bloodstream.
In some cases, a procedure called endoscopic third ventriculostomy is used in which a small opening is made in the floor of a ventricle, allowing CSF to bypass a blockage and flow to an area where it can be absorbed.
Both of these procedures are done under general anaesthetic.
What happens after hydrocephalus is treated?
Following treatment for hydrocephalus, a person will usually need to stay in hospital. They will continue to be monitored by the medical team. Further treatment may be needed if a person has had a shunt installed and this becomes infected or blocked. The length of the hospital stay will depend on the severity of the illness, the treatment needed and the person’s individual circumstances.
The person may have rehabilitation to help manage the physical, cognitive or emotional impact of hydrocephalus. Rehabilitation may take place in hospital, at a specialist rehabilitation unit or through community-based services.
The person may be able to return directly home from hospital, but they will need to continue resting. The time needed to recover and return to usual activities varies from person to person.
Keith's story
53-year-old Keith, from London, was just six weeks old when he was diagnosed with hydrocephalus and was fitted with a venticuloperitoneal (VP) shunt.
Sadly, due to complications, Keith’s shunt has had to be replaced four times during the course of his life.
Hydrocephalus has led to various hospital admissions and surgeries but Keith remains ever-positive, attributing his light-hearted mood to his love of writing.
Find out more about Keith’s experience of hydrocephalus and how he copes.
