Hydrocephalus

Hydrocephalus is a build-up of excess cerebrospinal fluid within the brain, causing the fluid-filled spaces (ventricles) to enlarge and increasing pressure within the skull. It can occur in infants or, less commonly, develop later in life, and requires prompt treatment to prevent brain damage.

• In infants: an unusually rapidly enlarging head, a tense or bulging soft spot (fontanelle), poor feeding, irritability, and vomiting
• Downward-deviated eyes (a "sunset" appearance) can occur in infants with significant hydrocephalus
• In older children and adults: headache, vomiting, blurred or double vision, difficulty walking, and, in severe cases, confusion or reduced consciousness
• Developmental delay can occur in infants with untreated or long-standing hydrocephalus

• Can result from a blockage in the normal flow of cerebrospinal fluid, from a condition causing excess fluid production, or from reduced fluid absorption.
• In infants, common causes include complications of prematurity (bleeding into the brain), congenital brain abnormalities (sometimes alongside spina bifida), and infections such as meningitis.
• In older children and adults, causes include brain tumours, infections, or bleeding within the brain.

• Suspected clinically based on the characteristic signs, particularly rapidly increasing head size in infants or symptoms of raised pressure within the skull in older individuals.
• Brain imaging (ultrasound in infants with an open fontanelle, or CT/MRI where available) confirms the diagnosis and helps identify the underlying cause and site of any blockage.

Hydrocephalus generally requires surgical treatment to relieve the pressure and drain excess fluid, most commonly by placing a shunt — a thin tube that redirects fluid from the brain to another part of the body where it can be safely absorbed.

In some cases, particularly where a specific blockage is identified, an alternative procedure to create a new pathway for fluid drainage may be used instead of a shunt.

Ongoing follow-up is essential after treatment, as shunts can occasionally become blocked or infected, which requires urgent reassessment and treatment.

Any underlying cause, such as infection, is treated alongside management of the hydrocephalus itself.

With timely treatment, many children with hydrocephalus go on to have good developmental outcomes, though this depends on the underlying cause and any associated brain injury.

• Ensure prompt treatment of infections such as meningitis, which can lead to hydrocephalus if untreated.
• Attend routine infant health checks, which include monitoring of head size and growth.
• Seek prompt medical assessment for a rapidly enlarging head, bulging fontanelle, or persistent vomiting in an infant.
• For anyone with a shunt in place, seek urgent medical attention for headache, vomiting, or reduced consciousness, as these can indicate shunt blockage or infection requiring emergency treatment.