Treating and Caring for a Hydrocephalus Pup
Dogs with mild hydro symptoms or when in the earliest stages of the disease may be treated with corticosteroid medicines. Medication helps to reduce the fluid production and inflammation. Additional medication may be prescribed to treat seizures and other symptoms.
In some cases, a doctor may recommend surgery. During surgery the veterinary surgeon places a shunt to drain the excess fluid from the brain into the abdomen. Surgical success rates are high, around 80%, however surgery can be an expensive option, and also highly specialized so it may not be available everywhere. Like with any other surgery there are risks, speak with your vet to see if surgery is the right option for your dog.
A dog wheelchair can be beneficial to help hydrocephalus puppies maintain their balance, walk, and stay upright. A four wheel wheelchair can be used to help prevent them from falling over and maintain a natural stance so they can eat, drink, and get their exercise.
How Veterinarians Diagnose Hydrocephalus in Dogs
A vet may suspect hydrocephalus based on a physical exam alone. The veterinarian will examine the dog’s appearance and interactions with and response to stimuli. A dog with an enlarged dome-like head, open fontanelle (soft spot on the skull), and eyes positioned down and out are often evaluated for hydrocephalus.
X-Ray
The vet may take x-rays to view your dog’s skull, and to determine if there are open plates and other signs suggesting hydrocephalus.
Ultrasound
If your dog has an open fontanelle, the vet may perform an ultrasound to visualize the dilated chambers within the brain.
CT and/or MRI
These imaging tests can provide a definitive diagnosis of hydrocephalus because they provide crucial information about internal brain structure and function that cannot be determined other ways.
In some instances, the vet may also perform electroencephalography (EEG), which detects electrical activity in the dog’s brain and a cerebrospinal fluid analysis, which measures chemicals in the dog’s spinal fluid.
Treatment of hydrocephalus involves addressing the underlying cause. Not all forms of hydrocephalus return to a “normal” state, but the goal is to stop progression of disease. Age, severity, and severity of symptoms all play a role in developing a treatment plan for a dog with hydrocephalus.
Medicine to decrease production of cerebral spinal fluid is often the first treatment option, especially in dogs with mild to moderate disease. The most common medicine used to accomplish this are:
In severe cases or those that don’t respond to medications, the vet may suggest neurosurgery as a treatment option. Surgery typically involves implanting a shunt to remove fluid from the brain and relocating it to another location in the body, usually the abdominal cavity. Surgery has a 50% to 90% success rate in animals with hydrocephalus.
If a dog is having seizures, the vet may administer valium and then prescribe other treatments such as antibiotics, surgery, or steroids, once the dog is stable.
A minimum database to include complete blood count, biochemical analysis, and urinalysis is useful to exclude other underlying systemic diseases that also can mimic signs of hydrocephalus. These diagnostic testing procedures also ensures the animal is healthy for anesthesia. Magnetic resonance imaging (MRI) is the preferred imaging technique for diagnosis of hydrocephalus. MRI provides detailed imaging with respect to obtaining a definitive diagnosis, identifying other congenital abnormalities and determining secondary pathologic effects (e.g., edema, mass effect). If a skull defect is present, an ultrasound can be used to visualize and determine the presence of hydrocephalus.
Onset and rate of progression of clinical signs is variable in dogs and cats with diagnosed congenital hydrocephalus. Clinical signs include behavioral changes, slowness in learning (e.g. housebreaking) loss of coordination, visual deficits and seizures. Physical features may include an enlarged and dome-shaped skull. Presence of a molera (opening in the top of skull) is common in many toy breeds; however, does not necessarily indicate presence of hydrocephalus. Lateral deviation of the eyes is common in congenital hydrocephalus. Even in congenital cases, the disease may follow a waxing and waning course. Sometimes dramatic hydrocephalus may be present but the owners report few clinical signs other than learning deficits.
Hydrocephalus refers to water in the brain or overdistension of the ventricular system from cerebrospinal fluid (CSF) accumulation. Hydrocephalus is broadly defined by pathophysiology as an active distension of the ventricular system of the brain related to inadequate passage of CSF from its point of production within the ventricular system to its point of absorption into the systemic circulation. An animal diagnosed as being hydrocephalic has clinical signs of neurologic dysfunction related to the dilated ventricles. Causes of obstructive hydrocephalus are classified as congenital or acquired. Acquired hydrocephalus usually occurs when a disease process, such as a brain tumor, hemorrhage or inflammation, occludes the flow of CSF. Congenital hydrocephalus is a common distinct entity in some toy and brachycephalic breeds (e.g. Boston terrier, cavalier King Charles spaniel, Chihuahua). A commonly identified cause in predisposed breeds is narrowing or blockage of the CSF flow in the ventricular system. Neonatal infections, such as those with viral causes, can result in stenosis without leaving any indications of the cause once the initial inflammation has resolved. However, the strong breed predilection suggests a hereditary basis in many of these dogs.
The choice of treatment is guided by the patient’s neurologic and physical status and age, and the underlying cause. Medical management of hydrocephalus is largely symptomatic by reducing intracranial pressure and CSF production. Antiepileptic drugs are administered to control seizures. Surgical treatment involves shunting of CSF away from the obstructed regions of the ventricular system and is reserved for animals with worsening of neurologic signs that do not respond or become refractory to medical therapy. Placement of a drainage device (shunt) diverts CSF from the ventricles through a low-pressure valve and reservoir to another site such as the peritoneal space, atrium of the heart or subcutaneous tissue.
Prognosis for severe congenital hydrocephalus is usually guarded as clinical signs are often severe at presentation. Approximately 70 percent of dogs and cats with congenital hydrocephalus and shunt placement will show improvement of clinical signs. However, complications after shunt placement are not uncommon and most likely to develop within the first three months after surgery. Common complications include shunt migration from the skull, mechanical failure, infection and occlusion of the shunt.