Understanding Hydrocephalus in Children: Symptoms, Causes, and Management

drwagdy
Nov 8, 2024
3 min read

Hydrocephalus, also referred to as “water on the brain,” is a condition characterized by the accumulation of cerebrospinal fluid (CSF) in the fluid-filled spaces of the brain known as ventricles. CSF plays a vital role in cushioning and nourishing the brain and spinal cord; however, an excessive buildup can elevate pressure within the skull, potentially resulting in damage to brain tissue.

In the following sections, we will delve into the causes of hydrocephalus in children, typical symptoms based on age, and the treatments that are available.

Causes of Hydrocephalus in Children

Hydrocephalus can develop for various reasons:

Congenital Causes: Some babies are born with hydrocephalus due to genetic factors or developmental issues like spina bifida, which can obstruct normal CSF flow.
Infections: Conditions like meningitis, which cause inflammation of the brain and spinal cord, can lead to scarring that blocks CSF pathways and leads to hydrocephalus.
Head Injury: Trauma to the head can disrupt the brain's natural drainage of CSF.
Tumors: Brain tumors can press on areas critical to CSF flow, causing hydrocephalus.
Bleeding in the Brain: In premature infants, bleeding in the brain can interfere with CSF flow, leading to hydrocephalus.

Recognizing Symptoms of Hydrocephalus in Children

Symptoms vary depending on age, making it helpful to recognize specific signs in infants versus older children.

Signs in Infants (Under 1 Year)

Rapid Head Growth: If a baby’s head is growing unusually fast, it could signal the development of hydrocephalus. Pediatricians often check head growth at routine visits.
Bulging Soft Spot (Fontanelle): The soft spot on a baby’s head may appear raised and tense.
Sunsetting Eyes: The eyes may appear to look downward, and cannot look up, this is a result of pressure on certain brain areas responsible for gaze.
Irritability and Feeding Challenges: Babies with hydrocephalus may be unusually irritable or have trouble feeding or sleeping.
Deterioration in developmental milestones: Babies developing hydrocephalus may have regression (worsening) in their motor or cognitive milestones.

Symptoms in Older Children

Headaches: Recurring headaches, especially in the morning, this may indicate increased pressure in the brain.
Nausea and Vomiting: Frequent nausea or vomiting, especially on waking, can be a sign of increased pressure in the brain and thus hydrocephalus..
Balance and Coordination Problems: Children might experience difficulty walking or balancing.
School Performance Changes: Hydrocephalus can affect memory and focus, sometimes impacting schoolwork.
Vision Issues: Blurred or double vision can result if pressure affects the centers/nerves responsible for eye movement.

How is Hydrocephalus Diagnosed?

To diagnose hydrocephalus, physicians use clinical examination followed by imaging tests; such as MRI (Magnetic Resonance Imaging), CT scans, or, for infants, cranial ultrasound. These tests help detect fluid buildup and enlarged ventricles.

Treatment Options for Hydrocephalus

Hydrocephalus is often a lifelong condition, treatment should be immediate once diagnosis is confirmed. Hydrocephalus treatment can effectively manage symptoms.

Ventriculoperitoneal (VP) Shunt: A VP shunt involves placing a small tube that drains excess CSF from the brain’s ventricles to another part of the body, usually the abdomen, where it can be reabsorbed. Shunts are equipped with a valve to regulate CSF flow and may require adjustments, repairs, or replacements as the child grows or if they get blocked or infected.
Endoscopic Third Ventriculostomy (ETV): This minimally invasive procedure involves creating a small opening in the floor of one of the brain’s ventricles (third ventricle), allowing CSF to bypass blockages. It’s generally suitable for cases involving specific blockages, rather than issues with CSF absorption.

Living with Hydrocephalus

Children with hydrocephalus can lead active, healthy lives with ongoing monitoring to ensure proper shunt function and symptom management. Parents and caregivers play an essential role in identifying signs of complications, such as shunt malfunctions, which may present as headaches, vomiting, or irritability. Prompt medical attention is crucial if any of these symptoms appear.

With early intervention and continued support, children with hydrocephalus can thrive. For more information, organizations like the Hydrocephalus Association (https://www.hydroassoc.org/) provide resources, support, and community networks for families.