Hydrocephalus means an excess build-up of cerebrospinal fluid within the cavities of the brain, which places pressure on brain tissue. It occurs in both children and adults, its causes and symptoms differ with age, and treatment is usually surgical.
What is cerebrospinal fluid, and what does it do?
The brain and spinal cord are surrounded by a clear fluid called cerebrospinal fluid (CSF). The body produces it continuously inside cavities in the brain known as the ventricles; the fluid circulates around them and is then absorbed, in a balanced cycle.
Hydrocephalus occurs when that balance is disturbed — either an obstruction in the fluid's pathway, a problem with absorption, or, rarely, excess production. Fluid accumulates, the ventricles enlarge, and pressure inside the skull rises.
Symptoms in newborns and infants
The skull bones of a young baby have not yet fused, so pressure shows itself as a change in head size:
- An abnormal increase in head circumference, or unusually rapid head growth.
- Bulging or tension of the fontanelle (the soft area on top of the head).
- Repeated vomiting and poor feeding.
- Excessive sleepiness or lethargy, or unusual irritability and persistent crying.
- A noticeable downward turning of the eyes.
- Delay in the motor skills expected for the baby's age.
Tracking head circumference is a routine part of a child's growth monitoring with the paediatrician — and any concern about the rate of growth warrants assessment.
Symptoms in older children and adults
- Headache, often worse in the morning or when lying down.
- Vomiting, particularly alongside headache.
- Changes in vision: blurring or double vision.
- Loss of balance, or a change in the way of walking.
- Changes in concentration or memory, or declining school performance in children.
- Drowsiness or a change in level of consciousness — a symptom that needs urgent assessment.
A particular form: normal pressure hydrocephalus in older adults
There is a presentation seen in older adults whose symptoms develop gradually and include a change in walking, decline in memory and concentration, and problems with bladder control. What matters about this form is that its symptoms can resemble other conditions common in later life, and so are sometimes put down to ageing.
Distinguishing it requires medical assessment and brain imaging, and early diagnosis matters because some cases respond to treatment. If someone in your family shows these changes, it deserves specialist assessment rather than dismissal.
Causes
- Congenital — present before birth, sometimes alongside other conditions affecting the formation of the nervous system.
- Following infection — such as meningitis, which can affect fluid absorption.
- Following bleeding — particularly bleeding inside the brain, and notably in premature babies.
- Tumours — where they cause pressure on, or obstruction of, the fluid pathway.
- After head injury or certain brain operations.
Diagnosis
Diagnosis rests on clinical examination together with imaging:
- CT or MRI to assess ventricle size and locate any obstruction.
- In children, plotting head circumference measurements on a growth chart.
- Head ultrasound in newborns, in some cases.
- An eye examination to assess the effect of pressure on the optic nerve.
- In older adults, the doctor may request additional assessments to judge how likely the case is to respond to treatment.
Imaging, laboratory and radiology services are available inside Town Hospital 24 hours a day, which shortens the time to diagnosis.
Treatment
Hydrocephalus usually requires surgical intervention, because the aim is to drain the excess fluid and relieve pressure. The main options are:
- A shunt: the most common approach — a fine tube with a valve that drains fluid from the brain to another part of the body where it can be absorbed. It requires long-term follow-up.
- Endoscopic surgery: in selected cases, an internal opening is created to let fluid pass without needing a shunt. Suitability depends on the cause of the obstruction.
- Treating the cause: where a tumour or infection is responsible, treating it forms part of the plan.
The choice between these is made by a neurosurgeon after full assessment, with the benefits and risks explained to the patient or family beforehand. No single approach suits every case.
After a shunt — signs you should know
A shunt is a device that needs monitoring, and it can become blocked or infected. Go to the emergency department immediately if there is:
- Severe headache or repeated vomiting that has returned after improving.
- Fever, or redness and swelling along the line of the shunt.
- Unusual drowsiness or a change in level of consciousness.
- A change in vision, or seizures.
- In infants: the fontanelle bulging again, or refusal to feed.
Town Hospital's emergency department is open 24 hours.
Frequently Asked Questions
Can hydrocephalus be treated?
Most cases are managed surgically to relieve the pressure, and outcomes vary with the cause, the age of the patient and how early the diagnosis is made. The aim is to control pressure and prevent complications; your doctor can explain what is realistic in your case.
Does a shunt stay in for life?
In many cases yes, with regular follow-up. In some cases it may need adjustment or replacement. The team explains the follow-up plan appropriate to the individual.
Does it affect intelligence or learning in children?
That depends on the cause, how early it was diagnosed, and the degree of pressure before treatment. Regular follow-up with a specialist team, and educational support where needed, play an important part — individual assessment is what matters.
Does a large head size mean my child has hydrocephalus?
Not necessarily — some children naturally have a larger-than-average head circumference, often running in the family. What matters is the rate of growth plotted on the growth chart alongside any other symptoms, and that is what the paediatrician assesses.
Can it be prevented?
Not every case can be prevented, particularly congenital ones. But antenatal care, vaccinations that reduce the risk of meningitis, careful care of premature babies, and preventing head injuries all reduce some of the causes.
Surgical consultation
If you need a surgical opinion on your own or your child's case, you can book with Dr Ahmed El Ghannam, Neurosurgery Consultant at Town Hospital — Fifth Settlement, New Cairo. To book or ask a question: WhatsApp or call 15276.