Diagnosis

A diagnosis of hydrocephalus is usually based on:

  • Your answers to the doctor's questions about signs and symptoms
  • A general physical
  • A neurological exam
  • Brain imaging tests

Neurological exam

The type of neurological exam will depend on a person's age. The neurologist may ask questions and conduct relatively simple tests in the office to judge:

Muscle condition

  • Reflexes
  • Muscle strength
  • Muscle tone

Sensory status

  • Sense of touch
  • Vision and eye movement
  • Hearing

Movement status

  • Coordination
  • Balance

Psychiatric condition

  • Mental status
  • Mood

Brain imaging

Brain imaging tests can show enlargement of the ventricles caused by excess cerebrospinal fluid. They may also be used to identify underlying causes of hydrocephalus or other conditions contributing to the symptoms. Imaging tests may include:

  • Ultrasound. Ultrasound imaging, which uses high-frequency sound waves to produce images, is often used for an initial assessment for infants because it's a relatively simple, low-risk procedure. The ultrasound device is placed over the soft spot (fontanel) on the top of a baby's head. Ultrasound may also detect hydrocephalus prior to birth when the procedure is used during routine prenatal examinations.
  • Magnetic resonance imaging (MRI) uses radio waves and a magnetic field to produce detailed 3-D or cross-sectional images of the brain. This test is painless, but it is noisy and requires lying still. Some MRI scans can take up to an hour and require mild sedation for children. However, some hospitals may use a quick version of MRI that takes about five minutes and doesn't require sedation.
  • Computerized tomography (CT) scan is a specialized X-ray technology that can produce cross-sectional views of the brain. Scanning is painless and takes about 20 minutes. This test also requires lying still, so a child usually receives a mild sedative. CT scans for hydrocephalus are usually used only for emergency exams.

Treatment

One of two surgical treatments may be used to treat hydrocephalus.

Shunt

The most common treatment for hydrocephalus is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate. One end of the tubing is usually placed in one of the brain's ventricles. The tubing is then tunneled under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed — such as the abdomen or a chamber in the heart.

People who have hydrocephalus usually need a shunt system for the rest of their lives, and regular monitoring is required.

Endoscopic third ventriculostomy

Endoscopic third ventriculostomy is a surgical procedure that can be used for some people. In the procedure, your surgeon uses a small video camera to have direct vision inside the brain and makes a hole in the bottom of one of the ventricles or between the ventricles to enable cerebrospinal fluid to flow out of the brain.

Complications of surgery

Both surgical procedures can result in complications. Shunt systems can stop draining cerebrospinal fluid or poorly regulate drainage because of mechanical malfunctions, blockage or infections. Complications of ventriculostomy include bleeding and infections.

Any failure requires prompt attention, surgical revisions or other interventions. Signs and symptoms of problems may include:

  • Fever
  • Irritability
  • Drowsiness
  • Nausea or vomiting
  • Headache
  • Vision problems
  • Redness, pain or tenderness of the skin along the path of the shunt tube
  • Abdominal pain when the shunt valve is in the abdomen
  • Recurrence of any of the initial hydrocephalus symptoms

Other treatments

Some people with hydrocephalus, particularly children, may need additional treatment, depending on the severity of long-term complications of hydrocephalus.

A care team for children may include a:

  • Pediatrician or physiatrist, who oversees the treatment plan and medical care
  • Pediatric neurologist, who specializes in the diagnosis and treatment of neurological disorders in children
  • Occupational therapist, who specializes in therapy to develop everyday skills
  • Developmental therapist, who specializes in therapy to help your child develop age-appropriate behaviors, social skills and interpersonal skills
  • Mental health provider, such as a psychologist or psychiatrist
  • Social worker, who assists the family with accessing services and planning for transitions in care
  • Special education teacher, who addresses learning disabilities, determines educational needs and identifies appropriate educational resources

Adults with more severe complications also may require the services of occupational therapists, social workers, specialists in dementia care or other medical specialists.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Coping and support

With the help of rehabilitative therapies and educational interventions, many people with hydrocephalus live with few limitations.

There are many resources available to provide emotional and medical support as you parent a child with hydrocephalus. Children with developmental problems due to hydrocephalus may be eligible for government-sponsored health care and other support services. Check with your state or county social services agency.

Hospitals and voluntary organizations serving people with disabilities are good resources for emotional and practical support, as are doctors and nurses. Ask these resources to help you connect with other families who are coping with hydrocephalus.

Adults living with hydrocephalus may find valuable information and support from organizations dedicated to hydrocephalus education and support, such as the Hydrocephalus Association.

Preparing for your appointment

How you learn about your child's condition — if your child has hydrocephalus — may depend on how severe the symptoms are, when problems first appear, and whether there were any significant risk factors during the pregnancy or delivery. In some cases, hydrocephalus may be diagnosed at birth or prior to birth.

Well-baby visits

It's important to take your child to all regularly scheduled well-baby visits. These visits are an opportunity for your child's doctor to monitor your child's development in key areas, including:

  • Head size, rate of head growth and overall body growth
  • Muscle strength and tone
  • Coordination
  • Posture
  • Age-appropriate motor skills
  • Sensory abilities — vision, hearing and touch

Questions you should be prepared to answer during regular checkups might include the following:

  • What concerns do you have about your child's growth or development?
  • How well does he or she eat?
  • How does your child respond to touch?
  • Is your child reaching certain milestones in development, such as rolling over, pushing up, sitting up, crawling, walking or speaking?

Preparing for other doctor visits

If you're seeing your doctor because of the recent onset of symptoms, you'll likely start by seeing your general practitioner or your child's pediatrician. After an initial evaluation, your doctor may refer you to a doctor who specializes in the diagnosis and treatment of conditions that affect the brain and nervous system (neurologist).

Be prepared to answer the following questions about your symptoms or on your child's behalf:

  • What signs or symptoms have you noticed? When did they begin?
  • Have these signs or symptoms changed over time?
  • Do these signs or symptoms include nausea or vomiting?
  • Have you or your child had any vision problems?
  • Have you or your child had a headache or fever?
  • Have you noticed any personality changes, including increased irritability?
  • Has your child experienced any changes in school performance?
  • Have you noticed any new problems with movement or coordination?
  • Have signs or symptoms included abnormal sleepiness or lack of energy?
  • In infants: Have signs and symptoms included seizures?
  • In infants: Have signs and symptoms included problems with eating or breathing?
  • In older children and adults: Have signs and symptoms included headache?
  • In older children and adults: Have signs and symptoms included urinary incontinence?
  • Have you or your child had a recent head injury?
  • Are you or is your child being treated for any other medical conditions?
  • Have you or your child recently begun a new medication?

Hydrocephalus care at Mayo Clinic

Aug. 02, 2014
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