Hydrocephalus (Hydro- water; Cephalus- Brain)

It is excess accumulation of fluid in the water tanks present within the brain which are called as ventricles of the brain. This excess accumulation of fluid most often occurs at the extremes of age but due to different mechanisms and pathology. It can also affect individuals of any age group.


The fluid is called Cerebrospinal fluid (CSF) and is  produced within the ventricles.  It normally flows through the ventricles, and surrounds the brain and spinal cord, allowing them to float. The CSF has a continuous circulation, where it is produced and absorbed within the nervous system.

When the CSF dynamics are altered (obstruction to flow or defect in absorption), the ventricles begin to increase in size, which in turn leads to rise in intracranial pressure (pressure within the skull).


The increase in intracranial pressure causes different symptoms and signs in various age groups as follows-

Unborn babies (fetus) and Infants (upto 12months):

In babies which are yet to be born, large size of head or large ventricles can be detected on antenatal ultrasound scan. In new born babies and upto age of 12 months, the size of head can be large or may rapidly increase in size. Apart from a big head, these babies can also have irritability, dullness, poor sucking reflex, vomiting, excessive crying, delay in developmental milestones and may refuse to feed.

In a child (1-3years):

There is increase in the size of the head above the normal limit for age along with decreased physical activity, irritability, refusal to feed, weak cry and delayed developmental milestones.

**head size does not increase in children older than 5years as the skull bones are formed completely and fused together by this time

Child (5years and above):

In this age group we typically see signs of increased intracranial pressure like headache, vomiting, decrease in vision, irritability, dullness, sleepiness, decrease in school performance, loss of bladder and bowel control.

Now lets look at the causes of hydrocephalus in children:

  1. Bleeding in the ventricle (IVH) during delivery of the baby
  2. Infections during neonatal period
  3. Obstruction to CSF flow in ventricles - can be congenital due to presence of membrane, tumour, ante natal infections.
  4. Tumours, infection, intracranial haemorrhage.

The symptoms of hydrocephalus in adults are:

Headache, vomiting, visual blurring, sudden loss of consciousness, seizures, memory disturbances, slowing of physical activity, change of walking gait to short, hesitant steps, incontinence of urine and bowel.

Causes of hydrocephalus in adults are:

  1. Bleeding in the ventricle (IVH) spontaneous or traumatic
  2. Post Head injury
  3. Tumour, infections.
  4. Absorption defect- mainly in elderly


Investigations needed for diagnosis: MRI Brain, CT Brain

A variety of interventions are often required to manage symptoms or functional impairments resulting from hydrocephalus.

Surgical treatment for hydrocephalus can restore and maintain normal cerebrospinal fluid levels in the brain. This will result in the affected person returning to normal functioning in adults, and aid in normal development in children. The type of procedure done depends on the cause of hydrocephalus.

Surgical Procedures most commonly performed-

  1. Removal of Tumour
  2. Treatment of infections
  3. Endoscopic Third Ventriculostomy (ETV) image below - This procedure is done in cases where there is obstruction to the flow of CSF between lateral and third ventricles.
  4. Placement of CSF diversion shunt (See image below)- In this procedure the excess fluid from the ventricles is usually diverted to the abdominal cavity by placing a shunt tube. 

For any further queries write to us at info@neuralintegrity.com

Some images have been taken from google to help you understand better.

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