Diagnosis of Hydrocephalus

Hydrocephalus may be suggested by symptoms; however, imaging studies of the brain are the mainstay of diagnosis. Computed tomography (CT scan) and (MRI scan) typically reveal enlarged ventricles and may indicate a specific cause. Abnormalities such as tumors and hemorrhages can also be detected.

Small abnormalities that may not be detected using CT scan, such as cysts and abscesses, are often seen with MRI. These studies can also help the neurosurgeon differentiate between communicating and noncommunicating hydrocephalus. In cases of suspected normal pressure hydrocephalus, a spinal tap may help determine CSF pressure.

A cisternagram evaluates the dynamics of CSF flow in the brain and spinal cord. In this procedure, a diagnostic dye is injected into the subarachnoid space around the brain. A series of pictures is taken once the dye has circulated through the entire CSF path. Cisternography can reveal CSF concentration, obstruction, leakage, and pressure.

In older people, pressure in the head can cause papilledema, swelling of the optic nerve. Papilledema can often be seen while examining the eyes. Unfortunately, it typically indicates hydrocephalus that is well developed. In rare cases, long standing hydrocephalus causes blindness.

Hydrocephalus treatment usually requires surgery to drain the excess fluid from the brain by diverting it to another place in the body.

Spinal Tap

In patients with normal pressure hydrocephalus, repeated spinal taps are performed to remove excess CSF. If this results in improvement, inserting a permanent shunt may be appropriate.

Hydrocephalus Prognosis

Hydrocephalus is usually a lifelong disorder. Prognosis depends on a number of factors, including the underlying condition that resulted in hydrocephalus, its duration and degree, as well as response to treatment.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 Aug 2001

Last Modified: 22 Sep 2015