Hydrocephalus

Hydrocephalus is a build-up of cerebrospinal fluid in the chambers (ventricles) of the brain, because the fluid is blocked or not reabsorbed properly. The enlarged ventricles press on surrounding brain tissue.

It occurs in babies, in children and adults after bleeding, infection or tumours, and in older people as normal pressure hydrocephalus. It is treatable, but treatment, usually a shunt, is a lifelong commitment that needs a neurosurgical service within reach.

Symptoms

• Babies: rapidly increasing head size, bulging soft spot, downward-looking eyes, vomiting, poor feeding
• Children and adults: headache worse in the morning, nausea and vomiting, blurred or double vision, drowsiness
• Normal pressure hydrocephalus: a shuffling, broad-based walk as if the feet are stuck to the floor
• Urinary urgency or incontinence
• Slowed thinking and forgetfulness
• Balance problems and falls

Causes and risk factors

In infants the usual causes are bleeding into the ventricles after premature birth, spina bifida, narrowing of the channel between the third and fourth ventricles (aqueductal stenosis) and infection. Later in life it follows meningitis, subarachnoid haemorrhage, head injury or a tumour or cyst blocking fluid flow. Normal pressure hydrocephalus typically appears after 60, mostly without a known cause, and is easily mistaken for Parkinson's disease or dementia.

How it is diagnosed

• Ultrasound through the fontanelle: A quick, radiation-free test for babies.
• MRI or CT of the brain: Shows ventricle size, the site of any blockage and the underlying cause.
• Eye examination: Swollen optic discs indicate raised pressure.
• Large-volume lumbar puncture or lumbar drain trial: For suspected normal pressure hydrocephalus: walking is timed before and after fluid removal to predict whether a shunt will help.
• Neuropsychological testing: Documents thinking speed and memory before treatment.

Treatment options

• Ventriculoperitoneal shunt: A thin tube with a valve carries fluid from the ventricle to the abdomen under the skin. Programmable valves can be adjusted from outside with a magnet.
• Endoscopic third ventriculostomy: A small opening made inside the brain bypasses a blockage, avoiding implanted hardware. It suits obstructive hydrocephalus, sometimes combined with choroid plexus cauterisation in infants.
• Treating the cause: Removing a tumour or cyst may resolve the problem.
• Temporary external drain: Used in emergencies and after bleeding or infection.
• Shunt revision: Blockage, infection or over-drainage mean many shunts need revision at some point, particularly in children.

When it is urgent

In anyone with a shunt, headache, vomiting, unusual sleepiness, visual change or seizures may mean shunt failure and need emergency neurosurgical assessment the same day. Fever with redness along the shunt track suggests infection. In babies, a tense fontanelle or downward-fixed eyes is an emergency. These situations must be handled locally.

Travelling to Türkiye for treatment

Acute hydrocephalus is never a reason to travel. A planned trip may be sensible for an older adult needing a structured normal pressure hydrocephalus work-up with a drain trial and, if positive, shunt surgery in the same visit of roughly two weeks. It may also suit endoscopic treatment where that expertise is lacking at home. Before any shunt is placed abroad, identify the neurosurgical unit at home that will handle adjustments and emergencies, and carry the valve model and setting in writing. For children, local long-term care is the priority.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions