Diagnosis of Hydrocephalus
If you think that you or someone you care about may have hydrocephalus, we recommend you learn about the symptoms and diagnostic tests for this condition. We also encourage you to trust your instincts. If you notice changes or have an intuitive feeling that something is not right with the person you are concerned about, act on that feeling and seek medical attention.
Only a medical doctor can make a diagnosis of hydrocephalus. The information here is intended to help you understand and navigate through the process of seeking medical advice. In children, it is often a pediatrician who first suspects hydrocephalus. A pediatric neurosurgeon will typically make the final diagnosis. In adults, hydrocephalus is often diagnosed by a neurologist working with a neurosurgeon.
If you have already received a diagnosis, the information below will help you make sense of theclassifications and causes of hydrocephalus.
Symptoms and Diagnostic Tests
Symptoms of untreated hydrocephalus are variable. During pregnancy, routine ultrasound can detect enlarged ventricles (spaces) within the baby’s brain. In children the symptoms tend to be related to high pressure and may include nausea, vomiting, headache and vision problems. In young and middle aged adults symptoms run the gamut of those seen in children and in older adults and most often include dizziness and vision problems. In older adults with NPH the symptoms are more likely to be loss of function in three main areas: walking, thinking and bladder control.
| Infants and Children | Young & Middle Aged Adults | Older Adults (NPH) |
| Abnormal Head Enlargement | Difficulty Walking | Difficulty Walking |
| Tense, Bulging Fontanel | Cognitive Challenges | Cognitive Challenges |
| Prominent Scalp Veins | Urinary Urgency or Incontinence | Urinary Urgency or Incontinence |
| Skull bones may feel separated | Chronic Headaches | |
| Vomiting, Sleepiness, Irritability | ||
| Headache, Nausea, Vomiting, Vision | ||
| Downward Deviation of Eyes |
The most common initial diagnostic test to determine hydrocephalus at any age is an image of the brain (CT Scan or MRI) to identify the enlarged ventricles (spaces) within the brain that are typical of hydrocephalus. More tests are often performed in adults. The following links take you to detailed information about the signs, symptoms and diagnostic tests for hydrocephalus in various age groups.
Treatment of Hydrocephalus
While there is no known cure, there are two forms of surgical treatment currently used to manage hydrocephalus. In the last 50 years, there have been incremental advancements in the diagnosis and treatment of hydrocephalus, however, long term health outcomes for individuals with hydrocephalus remain unpredictable. Often repeated neurosurgical operations are necessary to treat hydrocephalus. And it is important to recognize when treatment is failing and to stay current with doctors and developments even when things are going well. Learn more about treatment complications and what to be alert for.
Shunt Systems
The most common treatment for hydrocephalus—and the most common procedure performed by pediatric neurosurgeons in the United States—is surgical implantation of a device called a shunt. A flexible tube and valve system, a shunt drains cerebrospinal fluid from the brain to another part of the body.
Shunt Operation Statistics
- About 40,000 shunt-related operations are performed every year in the US for hydrocephalus—that averages out to one every 13 minutes and over 100 every day.
- Shunt operations for hydrocephalus cost over $1 billion a year in the US.
- 50% of shunted individuals require a revising operation within two years.
Endoscopic Third Ventriculostomy (ETV)
A second treatment option is a surgical procedure called endoscopic third ventriculostomy (ETV). An endoscope is used to puncture a membrane in the floor of the third ventricle creating a pathway for CSF flow within the cavities in the brain. ETV is an important alternative to shunting for obstructive hydrocephalus and may be useful in other cases as well.
Unlike many other operations in which the risks are highest during the surgical procedure, most problems associated with shunting occur weeks or even years afterward. Shunt obstruction and malfunction occur in approximately one third of children in the first year after a shunt-related operation and studies have shown that ETVs can close up after time. We cannot overstate the importance of learning the signs and symptoms of treatment failure. Staying in close contact with neurosurgeons if you have a shunt or an ETV is critical.
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