In adults symptoms of hydrocephalus include headaches, diplopia, and mental status changes. Clinical signs may include papilledema and impaired upward gaze. Sudden death may occur with severe increases in intracranial pressure. In patients with chronic hydrocephalus (i.e., normal-pressure hydrocephalus among others), symptoms may include gait disturbance, urinary incontinence, and memory loss with or without any other signs or symptoms of elevated intracranial pressure as described previously.

Acute hydrocephalus is best treated with insertion of an intraventricular catheter (IVC). IVCs are placed via burr holes or similar techniques into the ventricular system, usually the lateral ventricles (Fig. 155.1). IVCs can be used to temporarily drain CSF in the hope that
normal CSF circulation is restored (e.g., in the case of intraventricular hemorrhage). The insertion site of IVCs is usually the right frontal or posterior parietal region. The right side is usually chosen, as it is rarely the dominant hemisphere. IVC placement has an overall infection rate of 4% to 10%. The optimal duration of an IVC in order to decrease infection has not been clearly established. However, many practitioners recommend inserting a new IVC by day 5 if there is still a need. The common organisms include coagulase-negative Staphylococcus, methicillin-resistant Staphylococcus, and Gram-negative bacteria such as Escherichia Coli, Klebsiella, and Pseudomonas aeruginosa. If a patient with an IVC becomes febrile and/or septic, CSF sampling should be obtained and appropriate antibiotic coverage should be empirically initiated. Recommended empiric antibiotics include the combination of a third-generation cephalosporin and vancomycin, or meropenem and vancomycin. Sterile technique should be used for CSF sampling and it should be obtained from the sideport of the external tubing system.