Hydrocephalus

An abnormally large head may be a sign of hydrocephalus.

When pressure in the brain is increased because of hydrocephalus, infants are irritable and listless, have a high-pitched cry, and vomit, and they may have seizures Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often... read more . Also, the soft spots between the skull bones (called the fontanelles) may bulge, causing a soft bump on the head. The eyes may not move together, sometimes making the child look cross-eyed (called strabismus Strabismus Strabismus is an intermittent or constant misalignment of an eye so that its line of vision is not pointed at the same object as the other eye. If untreated, strabismus can cause amblyopia ... read more ).

Older children may have a headache, problems with vision, or both.

If hydrocephalus is not treated, infants do not develop normally. Some children with hydrocephalus, especially those who develop hydrocephalus early in the pregnancy, are intellectually disabled Intellectual Disability Intellectual disability is significantly below average intellectual functioning present from birth or early infancy, causing limitations in the ability to conduct normal activities of daily... read more or have learning disabilities Learning Disorders Learning disorders involve an inability to acquire, retain, or broadly use specific skills or information, resulting from deficiencies in attention, memory, or reasoning and affecting academic... read more , a seizure disorder Seizures in Children Seizures are a periodic disturbance of the brain’s electrical activity, resulting in some degree of temporary brain dysfunction. When older infants or young children have seizures, they often... read more (epilepsy), or, in girls, early puberty Early Puberty Early (precocious) puberty is sexual maturation that begins before the average age. The cause of early puberty is often unknown, but it may be caused by structural abnormalities or tumors in... read more . Some children have vision loss.

Other children develop normal intelligence.

Before birth, hydrocephalus is often detected when routine prenatal ultrasonography Ultrasonography Prenatal diagnostic testing involves testing the fetus before birth (prenatally) to determine whether the fetus has certain abnormalities, including certain hereditary or spontaneous genetic... read more is done.

After birth, doctors suspect the diagnosis in newborns based on symptoms noted during a routine physical examination. Doctors then do ultrasonography Ultrasonography Ultrasonography is a type of medical imaging that uses high-frequency sound (ultrasound) waves to produce images of internal organs and other tissues. During an ultrasound, a device called a... read more of the head to confirm the diagnosis of hydrocephalus.

In older infants and children, doctors do computed tomography Computed Tomography (CT) Computed tomography (CT) is a type of medical imaging that combines a series of x-rays to create cross-sectional, detailed images of internal structures. In computed tomography (CT), which used... read more (CT), magnetic resonance imaging Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (MRI) is a type of medical imaging that uses a strong magnetic field and very high frequency radio waves to produce highly detailed images. During an MRI, a computer... read more (MRI), or ultrasonography of the head to confirm the diagnosis.

Once the diagnosis has been made, all children undergo CT or ultrasonography to monitor the hydrocephalus and determine whether it is worsening.

The goal of treatment is

Treatment of hydrocephalus depends on what is causing the disorder, how severe it is, and whether it is worsening.

If needed, pressure within the brain can often be temporarily reduced by removing spinal fluid with repeated spinal taps Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more (lumbar punctures) until a shunt is placed.

If hydrocephalus is worsening, doctors place a ventricular shunt. The shunt is a plastic tube that creates a permanent alternate drainage path for cerebrospinal fluid. Draining the cerebrospinal fluid decreases the pressure and volume of the fluid inside the brain. Doctors place the shunt in the ventricles in the brain and run it under the skin from the head to another site, usually the abdomen (called a ventriculoperitoneal shunt, or VP shunt). The shunt contains a valve that allows fluid to leave the brain if the pressure becomes too high.

Although a few children can eventually do without the shunt as they get older, shunts are rarely removed because of the risk of bleeding and injury.

In some children, doctors do a ventriculostomy. In this procedure, doctors do not place a shunt and instead create an opening between a ventricle and the subarachnoid space in the brain. This opening allows excess fluid to drain and be absorbed as usual. Sometimes a shunt is still necessary if the ventriculostomy does not cure the hydrocephalus.

After placing a shunt or doing a ventriculostomy, doctors measure head circumference Head Circumference Physical growth refers to an increase in body size (length or height and weight) and in the size of organs. From birth to about age 1 or 2 years, children grow rapidly. After this rapid infant... read more and determine how the child is developing. Imaging tests (such as computed tomography or magnetic resonance imaging) are done periodically.

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