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
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, movement, well-being and how well the senses are functioning.
Imaging tests can help diagnose hydrocephalus and identify underlying causes of the symptoms. These 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 3D or cross-sectional images of the brain. This test is painless, but it is noisy and requires lying still.
MRI scans can show enlarged ventricles caused by excess cerebrospinal fluid. They may also be used to identify underlying causes of hydrocephalus or other conditions contributing to the symptoms.
Children may need mild sedation for some MRI scans. However, some hospitals use a very fast version of MRI that generally 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 quick. But this test also requires lying still, so a child usually receives a mild sedative.
Drawbacks to CT scanning include less detailed images than an MRI, and exposure to a small amount of radiation. CT scans for hydrocephalus are usually used only for emergency exams.
One of two surgical treatments may be used to treat hydrocephalus.
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. Your surgeon 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:
- Nausea or vomiting
- 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
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.
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.
Should you be vaccinated against meningitis?
Ask your doctor if you or your child should receive a vaccine against meningitis, once a common cause of hydrocephalus. The Centers for Disease Control and Prevention recommends meningitis vaccination for preteen children and boosters for teenagers. It's also recommended for younger children and adults who may be at increased risk of meningitis for any of the following reasons:
- Traveling to countries where meningitis is common
- Having an immune system disorder called terminal complement deficiency
- Having a damaged spleen or having had the spleen removed
- Living in a college dormitory
- Joining the military
Preparing for your appointment
The timing of diagnosing a child with 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.
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
- 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 a doctor because of the recent onset of symptoms, you'll likely start by seeing your primary care doctor 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 urinary incontinence?
- Have you or your child had a recent head injury?
- Have you or your child recently begun a new medication?