Medicines for Hydrocephalus

What it is

Hydrocephalus is a build-up of cerebrospinal fluid (the clear fluid that surrounds and cushions the brain and spinal cord) within the brain. Normally, this fluid is continually produced, circulates around the brain and spinal cord, and is absorbed, in a balance. In hydrocephalus, this balance is disrupted — usually because the flow or absorption of the fluid is blocked or impaired (or, rarely, too much is produced) — so fluid accumulates in the spaces within the brain (the ventricles), increasing the pressure inside the skull, which can damage the brain if not treated. Hydrocephalus can occur at any age and has several types and causes: it can be present at or from birth (congenital, sometimes associated with other conditions such as spina bifida); it can develop in babies, children, or adults as a result of another problem (acquired) — such as bleeding in or around the brain, infection (like meningitis), a brain tumour, or injury; and there is a particular form in older adults (normal pressure hydrocephalus) with a characteristic set of symptoms. The symptoms depend on the age and cause. In babies, signs can include an unusually large or rapidly growing head, a bulging or tense soft spot, and being irritable, sleepy, or feeding poorly. In older children and adults, symptoms of raised pressure can include headaches (often worse in the morning), feeling or being sick, blurred or double vision, drowsiness, balance and walking problems, and confusion. In normal pressure hydrocephalus in older adults, the typical features are problems with walking, memory and thinking, and bladder control. Hydrocephalus is a serious condition, but it is treatable, and the main treatment is a procedure to drain the excess fluid and relieve the pressure — most commonly by inserting a shunt (a thin tube that drains the fluid from the brain to another part of the body, where it is absorbed), or, in some cases, another procedure to restore the flow of fluid. With treatment, the pressure is relieved and symptoms are often improved or prevented from worsening, though the outlook depends on the cause, the age, and any associated conditions or damage. The key messages are that hydrocephalus is a treatable build-up of fluid and pressure in the brain, that its signs (varying with age) should be assessed, and that treatment (usually a shunt) relieves the pressure.

How it is treated

Hydrocephalus is diagnosed and treated by specialist teams (including neurosurgeons), and the main treatment is to drain the excess fluid and relieve the pressure, most commonly with a shunt. If hydrocephalus is suspected — from the signs described (which vary with age), such as an enlarging head in a baby, symptoms of raised pressure in a child or adult (headaches, vomiting, visual problems, drowsiness), or the walking, memory, and bladder problems of normal pressure hydrocephalus in older adults — assessment is needed, and symptoms of significantly raised pressure (such as severe headache, vomiting, drowsiness, or reduced consciousness) need urgent attention. Diagnosis involves examination and brain scans (such as CT or MRI, which show the fluid build-up), and, in babies, measuring the head size, along with assessing the cause. The main treatment is a procedure to relieve the pressure by draining the excess fluid: most commonly, a shunt is inserted — a thin tube that carries the fluid from the ventricles in the brain to another part of the body (usually the tummy), where it is absorbed, controlling the pressure; alternatively, in suitable cases, an endoscopic procedure (endoscopic third ventriculostomy) may create a new route for the fluid to flow. Treating any underlying cause (such as a tumour or infection) is also part of care. Shunts are effective, but need long-term follow-up, as they can sometimes block or become infected, or need adjusting or revising over time — so people with a shunt (and their families) are advised about the signs of a shunt problem (such as a return of the symptoms of raised pressure), which need prompt assessment. The outlook depends on the type and cause of hydrocephalus, the age, how early it is treated, and any associated conditions or brain damage; with treatment, many people do well, though some have ongoing effects and need support and follow-up. For normal pressure hydrocephalus in older adults, a shunt can improve the symptoms (particularly walking) in suitable cases, so it is worth recognising and assessing. The reassuring message is that hydrocephalus, though serious, is treatable — usually by draining the fluid with a shunt to relieve the pressure — and that recognising the signs (which vary with age) and getting prompt assessment, along with long-term follow-up of any shunt, support the best outcome.