Infant Hydrocephalus

What is infant hydrocephalus?

Hydrocephalus is a buildup of cerebrospinal fluid inside the cavities (ventricles) of the brain, where the pressure of the excess fluid can enlarge the head and injure brain tissue. Cerebrospinal fluid normally flows through and around the brain and is reabsorbed in a steady balance; hydrocephalus develops when that flow is blocked, or when the fluid is produced faster than it can be reabsorbed. In infants, whose skull bones have not yet fused, the head can enlarge in response (a visible warning sign), but the rising pressure still threatens the developing brain. The word means “water on the brain,” though the fluid is cerebrospinal fluid, not water.

Hydrocephalus is not always a birth injury; many cases are congenital or follow illness. But when it results from a preventable event, such as an untreated brain bleed, or when the warning signs are missed, the delay in treatment can cause harm that timely care would have avoided. That is the distinction this page draws.

Types of hydrocephalus

• Obstructive (non-communicating): the flow of cerebrospinal fluid is blocked within the ventricular system, for example by a narrowing (aqueductal stenosis) or a bleed.
• Communicating: the fluid flows out of the ventricles but is not properly reabsorbed, often after bleeding or infection.
• Post-hemorrhagic: hydrocephalus that develops after a brain bleed, a leading cause in premature infants.
• Congenital: present at birth from a developmental cause (such as spina bifida or aqueductal stenosis).

Causes, including brain bleeds (IVH)

A central cause in newborns (and one with clear negligence potential when mismanaged) is bleeding inside the brain:

• Intraventricular hemorrhage (IVH): bleeding into the ventricles, most common in premature babies. Blood can block the reabsorption of cerebrospinal fluid and lead to post-hemorrhagic hydrocephalus. See our guide to infant brain bleeds.
• Other birth-related brain bleeds: subdural or subarachnoid hemorrhage, sometimes linked to traumatic or instrument-assisted delivery.
• Congenital malformations: aqueductal stenosis, spina bifida, and related conditions.
• Infection: meningitis, before or after birth, can scar the fluid pathways.
• Hypoxic or ischemic injury: severe oxygen deprivation, which can also coexist with HIE.

Signs and symptoms

• A head that grows abnormally fast, crossing percentile lines on the growth chart, the most important early sign in infants
• A full, bulging, or tense soft spot (fontanelle)
• Prominent scalp veins and a “setting-sun” downward gaze of the eyes
• Irritability, poor feeding, vomiting, and excessive sleepiness
• Seizures in some cases

Serial head-circumference measurement is deliberately simple, cheap, and routine precisely because it catches hydrocephalus early, which is why a rapidly enlarging head that goes unremarked is a recognized failure point.

Diagnosis and monitoring

In infants, cranial ultrasound through the open soft spot is the first-line imaging test and is used to screen premature babies at risk of IVH; CT or MRI gives more detail. Diagnosis and monitoring rest on measuring and plotting head circumference over time and imaging when growth accelerates. Premature infants with known IVH require close surveillance for developing hydrocephalus, because it can evolve over days to weeks after the bleed.

Treatment: shunts and ETV

Hydrocephalus is treated by diverting or restoring the flow of cerebrospinal fluid; medication is not a cure. The main options are:

• Ventriculoperitoneal (VP) shunt: a thin tube surgically placed to drain excess fluid from the ventricle to the abdomen, where it is absorbed. The most common treatment, it is lifelong and can require revision if it blocks or becomes infected.
• Endoscopic third ventriculostomy (ETV): a surgical opening created to let fluid bypass a blockage, avoiding a shunt in selected patients.
• Temporary measures: in premature infants with post-hemorrhagic hydrocephalus, reservoirs or taps may be used to relieve pressure until definitive surgery.

With timely treatment, many children do well; the harm comes from pressure that is allowed to persist. A blocked or infected shunt is itself an emergency, and failure to recognize shunt malfunction is a recognized source of avoidable injury.

Was it preventable? Monitoring failures

Not every case of infant hydrocephalus is malpractice. Many are congenital or follow illnesses that no one could prevent. The negligence question turns on recognition and response: was a premature infant at risk of IVH monitored with the recommended cranial ultrasounds; was a rapidly enlarging head circumference noticed and acted upon; was imaging ordered when the signs appeared; was rising pressure treated before it injured the brain; and was a shunt malfunction recognized promptly? When timely monitoring and treatment would have prevented the pressure-related injury, and they did not happen, the harm may have been preventable.

Legal options for families

A hydrocephalus claim generally focuses not on the underlying condition but on whether it was recognized and treated in time. These cases examine the head-circumference records, the imaging that was or was not ordered, the monitoring of at-risk premature infants, and the response to signs of rising pressure or shunt failure. Because untreated hydrocephalus can cause lasting brain injury, the lifetime costs (therapy, repeated surgeries, and developmental support) can be substantial, and are quantified in a life-care plan. Where hydrocephalus accompanies other injuries, our guides to HIE and brain bleeds may also be relevant. Filing deadlines vary by state; see our statute of limitations guide.

Where your case is handled depends on where the birth occurred: Banville Law attorneys are licensed in New York and Washington, D.C.; The Weitz Firm attorneys are licensed in Pennsylvania and New Jersey; elsewhere, the alliance connects families with its vetted network of local birth injury attorneys.

Frequently asked questions

Can hydrocephalus be cured?

There is no cure that restores normal fluid dynamics, but it is highly treatable. A shunt or an endoscopic third ventriculostomy manages the fluid buildup, and with timely treatment many children develop well. Treatment is typically lifelong and may require revisions.

What is the most important early sign in a baby?

An abnormally fast-growing head that crosses percentile lines on the growth chart, often with a full or bulging soft spot. This is why routine head-circumference measurement matters: it is the simplest way to catch hydrocephalus early.

How is hydrocephalus connected to a brain bleed?

Bleeding into the brain’s ventricles (intraventricular hemorrhage), common in premature infants, can block the reabsorption of cerebrospinal fluid and cause post-hemorrhagic hydrocephalus. At-risk babies are supposed to be monitored with cranial ultrasound for exactly this reason.

Is a shunt malfunction an emergency?

Yes. A blocked or infected shunt can cause pressure to rise quickly and is a medical emergency. Failure to recognize and treat shunt malfunction promptly is a recognized cause of avoidable harm, and warning signs should be evaluated urgently.

Sources

This page is for general education and is not medical advice. Medical facts above are drawn from the cited primary sources; legal statements reflect the reviewing attorneys’ professional experience. Always consult your child’s physician about medical concerns.