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- Hydrocephalus — accumulation of cerebrospinal fluid in the cavities of the brain, which causes intracranial pressure to rise.
- Causes: congenital anomalies, haemorrhage, brain infections, tumours and cysts, head injury, age-related changes.
- Symptoms: morning headache, nausea and vomiting, double vision, unsteady gait, drowsiness.
- In infants a warning sign is rapid growth of head circumference and bulging of the fontanelle.
- The condition is managed by a neurosurgeon together with a neurologist: examination, tomography, and surgery if indicated.
What is hydrocephalus
Hydrocephalus is a condition in which cerebrospinal fluid accumulates in the cavities of the brain. Let us look at how this works, why it occurs and who is affected more often.
What happens in the body
Cerebrospinal fluid is constantly produced in the cavities of the brain and bathes its surface. Normally it passes freely along narrow pathways and is absorbed into the blood through special channels. When the outflow is disrupted or too much fluid is produced, it is retained and presses on the walls of the cavities. Because of this, the cavities dilate, and intracranial pressure gradually rises. This pressure affects the functioning of the brain and can cause headaches, nausea and changes in vision. In infants the skull is still pliable, so the head may increase in size. Adults should remember: persistent headaches and worsening vision are a reason to undergo examination by a doctor.
What causes it to develop
- Congenital anomalies: disruption of the formation of the nervous system and the fluid outflow pathways in a child before birth, which manifests from the first months of life.
- Intracranial haemorrhage: blood in the cavities of the brain clots and blocks the outflow pathways, which happens especially often in premature infants.
- Infections of the brain and its membranes: inflammation leaves adhesions and scars that prevent the fluid from passing freely along the channels.
- Tumours and cysts: a space-occupying formation compresses the outflow pathways from the outside, causing fluid to be retained in the cavities.
- Traumatic brain injury: a contusion or haemorrhage disrupts the normal movement of fluid and its absorption.
- Age-related changes: after a stroke, fluid absorption worsens, so its accumulation becomes more noticeable in the elderly.
Who is affected more often
Hydrocephalus occurs at any age, but the causes and frequency differ noticeably. In newborns it is more often associated with congenital anomalies of the nervous system development. Premature infants are at high risk because of intracranial haemorrhages, which occur in the first days of life. In older children and adults the condition often develops after brain infections, injuries or with tumours. In the elderly, fluid accumulation is more often associated with a previous stroke and age-related changes in absorption. Heredity and the course of pregnancy also influence the likelihood of congenital forms. If a close relative has had this condition, this should be reported to the doctor during a routine examination.
What symptoms can there be?
The manifestations of hydrocephalus depend on the person's age and on how quickly the pressure rises. Therefore, in adults and in young children the signs are noticed differently, and some of them are easily put down to ordinary fatigue.
How it is noticed at the very beginning
Headache in hydrocephalus most often worsens in the morning after sleep or when the head is bent down. It is often accompanied by nausea and vomiting, which occur unrelated to food intake. A person may notice that their vision has become worse or that double vision of objects appears before their eyes. The gait becomes unsteady and unstable, as if one is slightly pulled to the side when walking. Drowsiness appears, and thinking becomes slowed, usual work becomes harder. In a young child, parents may notice rapid growth of the head circumference and bulging of the fontanelle. Such changes are easily mistaken for overfatigue, lack of sleep or an ordinary cold, so they are often not linked to pressure inside the head.
Signs that occur most often
- Headache: worsens in the morning or when bending down, so it is easily confused with ordinary overfatigue.
- Nausea and vomiting: occur unrelated to food intake and do not bring relief after eating.
- Deterioration of vision: double vision and blurring appear, and this is noticeable when reading or looking into the distance.
- Unsteady gait: the person is unstable, is pulled to the side, especially noticeable when walking quickly.
- Drowsiness and slowed thinking: it is harder to concentrate, usual tasks take more time.
- In children, head growth: the circumference increases quickly, the fontanelle bulges, which parents notice.
When to seek help urgently
Examinations and tests
Examination for hydrocephalus begins with a conversation and a physical examination, and imaging methods confirm the picture. Below is a breakdown of what exactly is done at the appointment and which investigations help to see the state of the brain's ventricles.
How the examination begins
The first step is a neurological examination, during which the doctor collects complaints and the medical history. They check reflexes and coordination, assess muscle tone and gait, and compare the sides of the body with each other. In infants, the size of the head and the condition of the fontanelle are additionally examined, because their skull bones are still pliable. Such a conversation and examination give direction to further investigation and help to distinguish hydrocephalus from other conditions with similar signs. If the complaints indicate raised intracranial pressure, the doctor moves on to instrumental methods. To confirm the diagnosis, brain imaging is prescribed, which shows the size and shape of the ventricles. Write down in advance when the first changes appeared and how they changed over time, so that the doctor can more accurately assess the dynamics.
What is prescribed and what it shows
What is worth preparing for the appointment
- Discharge summaries: take all previous doctors' reports and investigation results so that the specialist sees the full picture and does not prescribe again what has already been done.
- Images and descriptions: bring the discs or films of the tomography together with the written reports, since from the images the doctor assesses the size of the ventricles over time.
- Records of observations: note when changes in behaviour, gait or head size appeared, because the timing helps to understand the speed of the process.
- List of questions: formulate in advance what you want to clarify with the doctor, so as not to forget anything important in a short conversation at the appointment.
- Companionship: take a close person who will help you remember what was said and will support you if the conversation turns out to be difficult.
Which doctor should I see?
In hydrocephalus, care is provided by a neurosurgeon together with a neurologist, and understanding their roles helps you choose whom to see. Below — who manages the condition, what treatment consists of, and what depends on the regularity of follow-up.
Which specialist manages this condition
The neurosurgeon is the main specialist who determines the approach in hydrocephalus, while the neurologist provides follow-up and selects supportive care. If there is no specialised neurosurgeon nearby, start with a neurologist: they will assess the condition and refer you further along the right pathway. The approach is chosen jointly, because with a minor disorder, observation and medication support may be sufficient. With a pronounced impairment of fluid outflow, surgery is discussed, which restores the pathway for cerebrospinal fluid. The neurologist monitors the condition over time and records changes noticeable on examination and in how the person feels. The neurosurgeon assesses whether surgery is needed and which method of restoring outflow is suitable in a particular case. If the neurologist sees signs of worsening disorders, they refer to a neurosurgeon without a long wait.
What treatment consists of
- Follow-up with a neurologist: regular monitoring of the condition allows changes to be noticed in time and further management approach to be adjusted.
- Selection of therapy: the doctor selects support that reduces fluid production and assesses how the person responds to it.
- Surgery when indicated: with a pronounced impairment of outflow, a shunt is placed or a bypass pathway for fluid is created.
- Rehabilitation: sessions with a speech therapist and psychologist help with developmental delay, and they are added as needed.
- Joint decisions: the neurosurgeon and neurologist agree between themselves on the scope of care, so that follow-up and treatment do not diverge.
What depends on the patient themselves
The regularity of follow-up is the part of the result that rests on the person themselves and their loved ones, and not only on the doctors. If visits to the neurologist take place at the appointed rhythm, changes in the condition are noticed earlier and the approach can be discussed before the situation becomes more complicated. Missed examinations lead to worsening disorders being detected later, when care requires more effort. Notes on how the person felt between appointments help the doctor assess the dynamics more accurately and not rely only on memory. After surgery, it is important to attend follow-up examinations, even if the person feels better and has no complaints. Sessions with a speech therapist and psychologist give more when they are not interrupted and recommendations are followed at home. If loved ones notice new changes, it is worth telling the doctor about them without waiting for the scheduled visit.
What helps prevent an exacerbation?
There is no specific prevention of hydrocephalus, but some risks can be reduced. Below is what depends on the person themselves and why regular monitoring is important.
What is changed in habits
Vaccination against infections that affect the brain reduces the risk of conditions that can lead to hydrocephalus. Vaccinations are given according to the schedule, and in cases of bites, injuries and contact with sick people the timing is clarified with a doctor. Timely treatment of head injuries is important because even a mild blow sometimes has delayed consequences. If after a fall a headache, nausea or drowsiness appears, a visit to the doctor should not be postponed. Blood pressure control helps prevent a stroke, and a stroke is sometimes a cause of secondary hydrocephalus. Monitoring of pregnancy and the child's development allows deviations to be noticed at an early stage. Giving up bad habits and reasonable physical activity support the general condition. Discuss with your doctor which measures are suitable for you — there is no universal set.
What should be kept under control
- Vaccination: vaccinations against infections that affect the brain are given according to the schedule, and the timing is clarified with a doctor.
- Head injuries: any fall or blow requires examination, even if at first it seems that everything is fine.
- Blood pressure: it is measured regularly, because a persistent increase raises the risk of stroke.
- Pregnancy: monitoring by a specialist helps to notice deviations in the development of the foetus in time.
- Child's development: it is important for parents to monitor the growth of the head, the skills and the behaviour of the baby.
- Self-monitoring: write down changes in how you feel, so that at the appointment you can accurately describe to the doctor what appeared and when.
How often to see a doctor
A regular examination by a doctor is needed even when you feel well and nothing is troubling you. Hydrocephalus can develop gradually, and the first changes are sometimes noticeable only to a specialist during examination and measurements. The doctor assesses the head circumference in a child, the gait, vision and memory in an adult, comparing the indicators with previous visits. If a person has had a head injury, an infection or a stroke, monitoring becomes especially important. If new complaints appear — headache, nausea, deterioration of vision or attention — the visit is not postponed until the scheduled date. The frequency of examinations is determined by the doctor taking into account the condition, age and past illnesses. Keep records of how you feel and take them to the appointment: this helps to notice the dynamics earlier.
What is worth remembering
Hydrocephalus is a condition in which cerebrospinal fluid accumulates in the cavities of the brain and intracranial pressure rises. The discussion of it should end with what is truly important to keep in mind.
Key takeaways
Hydrocephalus does not always manifest clearly and sometimes develops gradually, so changes in how you feel are easily put down to fatigue or age. Recurring signs help to notice it: worsening headache, nausea in the mornings, deteriorating vision, unsteadiness when walking, slowed thinking. In young children, a warning signal is too rapid growth of the head circumference. Hydrocephalus can be congenital or acquired, and the causes of these forms differ. It is not worth postponing a visit to the doctor: the sooner the cause is understood, the clearer the next steps. Self-diagnosis is a poor helper here, because similar complaints occur in many conditions. It is worth relying on an examination by a specialist and the tests they prescribe, rather than on random advice. With already known hydrocephalus, it is important not to miss scheduled check-ups, even when you feel well.
