Hydrocephalus in Maltese Dogs: Symptoms and Treatments

Hydrocephalus Maltese

Hydrocephalus is a neurological condition that affects Maltese dogs and other small dog breeds where there is an excessive buildup of cerebrospinal fluid on the brain. It is also commonly known as water on the brain. Although this can happen to any dog breed it is more likely to occur in toy breeds such as the Maltese. It also more likely to be found in Maltese puppies less than 4 months old and Maltese Breeders are more likely to see it then a buyer of a Maltese puppy.

What is Water on the Brain or Hydrocephalus in the Maltese breed ?

Hydrocephalus occurs because of a build up of cerebrospinal fluid inside the dogs skull. This fluid is normal and is usually found surrounding the brain and the spinal cord, but when a leak occurs the fluid can build up in the Maltese puppy’s skull. Hydrocephalus occurs due to two specific reasons:

  • Genetic/Congenital: It can be a genetic condition that is present at birth where the Maltese puppy is born with an obstruction in the mesencephalic (also known as the middle brain). Even if this is the case a very young Maltese puppy may not show any of the symptoms to indicate anything is wrong. Usually puppies who are born with a very round head shape and have short muzzles are more susceptible to showing the condition.
  • Acquired: An injury to the head or neck, an abnormal growth such as a tumor, or serious infections such as parvo or other brain diseases can bring on this condition. A low level of Vitamin A is known as one of the possible causes of acquired Hydrocephalus. Other reasons may be a hemorrhage in the brain or a severe trauma to the skull. For instance a dog which has been in car accident may have this condition present itself in the weeks after the accident. Acquired Hydrocephalus is much more rare than congenital (Genetic) hydrocephalus.

Is Hydrocephalus serious and fatal?

In some serious cases Hydrocephalus can be fatal or cause serious trauma to your Maltese’s brain. But if you catch it early by identifying the symptoms then you will be able to treat the condition with your Veterinarian’s assistance. It will depend on the severity and they type of Hydrocephalus present (Acquired vs Congenital). Keep in mind this is a very serious disease in Maltese Puppies.

What are the Symptoms of Water on the Brain or Hydrocephalus in Maltese Dogs?

The symptoms are numerous and if you believe that any of these are present in your Maltese puppy then you should seek a veterinarian’s advice. Early symptoms include:

  • The head has a an abnormal bulge or shape. This symptom is more likely in the young Maltese puppies while they are still growing and the fluid affects the skull.
  • Eyes are cross-eyed or not quite right: The brain tends to adjust the eyes to compensate for any trauma and this can result in the eyes being adjusted. It will be easily noticeable if your Maltese puppy has cross eyes.
  • Abnormal Gait: The Maltese moves in a very smooth flowing gait as if they are floating on air. If the gait looks too small, elongated or the puppy is struggling to walk as per normal it should be noted and assessed by the vet. Get a video of it as the Maltese puppy will not always do what you want in the veterinarian office.
  • Arching of back and legs: Maltese dogs will not arch their back and legs very often unless it is for a stretch. If you notice they are doing it more often then normal this could be to relieve any pressure they are feeling from the fluid buildup.
  • Abnormal breathing: Any breathing issues should be investigated by your vet. Maltese are known for breathing issues such as reverse sneezing so this symptom can indicate a range of possible issues and would need to be present with other symptoms to indicate Hydrocephalus.
  • Vision trouble or blindness: If you Maltese puppy starts to bump into things because they have issues with their vision then get them to the vet as soon as possible. Vision issues are usually a sign of a neurological condition.
  • Toilet accidents in the house: If your Maltese starts to have toilet accidents when they have previously been house trained
  • this can be a symptom. A house trained Maltese will rarely start to have accidents without a physical or neurological condition.
  • Excessive sleeping: A lethargic Maltese puppy or even adult Maltese dog is a sign that something is wrong. Dogs will usually rest and sleep if they feel unwell and it can be a sign of something more serious as dogs will rarely want to show they are affected by sickness as it is seen as a weakness.
  • Hyper-excitability: While some Maltese sleep a lot when affected by Hydrocephalus, some Maltese are affected the opposite way and become hyper active. If this is unusual for your Maltese then you should explain this to your veterinarian.
  • Walking in circles or pacing: Neurological diseases often result in the Maltese dog pacing or walking around in circles as they are uncomfortable. If you notice that your Maltese has started to do this more frequently then get the vet to check them out for any brain issues such as Hydrocephalus (Water on the brain).
  • Head tilting: Maltese will tilt their heads for a variety or reasons such as ear infections, but it is also commonly a symptom of Hydrocephalus. Other reasons will be ruled out by your vet first but when this is combined with other symptoms your vet will want to do some tests for Hydrocephalus.
  • Head pressing: The pressure from the fluid can cause the Maltese puppy to seek relief by pressing their head against an object such as a wall, door or lounge. It is very uncommon to see Maltese dogs doing this behavior so be sure to treat this as a good reason to go get your Maltese puppy checked out by your vet.
  • Restlessness: This is a very generic symptom that can be present as the Maltese puppy can not get comfortable in any position. They will get up and down and move around to try and find a more comfortable position to relieve any pressure they are feeling in their skull.
  • Depression: If you Maltese looks upset and depressed this can be a general symptom which is present with Hydrocephalus. This symptom when combined with other symptoms can help identify the need for further testing.
  • Slower growth: Due to the condition putting pressure on the brain it can result in a slower growth rate for the Maltese puppy.
  • Slower to Learn: The Maltese puppy may have a much harder time learning simple commands as they are unable to focus on what needs to be done.
  • Seizures: Seizures will develop as the pressure continues to build up. The brain will not be able to cope with the pressure from the fluid and your dog will have a seizure. Obviously if your dog has a seizure this can be a very scary situation and you should take your Maltese puppy to the vet immediately.
  • Coma: In extreme cases your Maltese puppy can fall into a coma. This is a serious situation where the brain has decided to shut down to protect itself. Your vet will run extensive testing to find the cause of the issue but this usually only happens when the situation has been building up over a length of time and the other symptoms have not been addressed.
Maltese Dog looking cute

Diagnosis of Hydrocephalus in Maltese:

To determine if a Maltese puppy has Hydrocephalus may just require that the vet do a checkup and see the clear swelling on the skull. Most vets will want to run a number of tests to clearly prove that the diagnosis is right, especially in older Maltese dogs. These tests can include a combination of the following:

  • Neurological Evaluations
  • MRI
  • X-Rays of the skull
  • Blood analysis
  • ECG
  • Spinal Tap
  • Ultrasound

The tools that your vet uses to determine the diagnosis will depend on what they have access to at their facility as well as which will give a solid indication of the problem. Sometimes certain vets also have a preference for one method of diagnosis over another based on experience.

The tests will let the vet diagnosis if the Maltese puppy has Hydrocephalus. Once a positive diagnosis is made the veterinarian will determine the best treatments.

Treatment of Hydrocephalus in Maltese:

Treatment of Hydrocephalus will depend a lot on the likely cause of the fluid build up and also on the severity of the Maltese puppy’s condition. Treatment aims to minimize the chance of any brain damage occurring to the Maltese by improving the flow of the fluid and reducing any pressure build up it can be causing in the Maltese dogs skull. The list of treatments include:

  • Behavior adjustments: The first and least invasive treatment is to ensure that the Maltese is not jumping up and down. The main places that Maltese puppies are jumping up and down are any stairs and up onto furniture. A good solution for this is to install small steps for the Maltese to easily traverse the larger steps or to get onto the furniture. An alternative to small steps is to use a ramp that the dog can walk up and down. Any sudden jumps by your Maltese puppy can transfer the fluid in the dogs skull rapidly which will apply pressure to new areas and can result in further injuries and complications.
  • Medication: Your vet will likely prescribe medication to help relieve the pressure and to help reabsorb the fluid into the body quicker. This may include medications such as anti-inflammatory medication such as cortisone or predisone, diuretic medication such as forosemide or acetazolamide to help with the fluid absorption and anti-seizure medications.
  • Followup Checkups: Your vet will need to monitor the situation to ensure that no permanent damage has occurred and that the medication is doing what it is suppose to and relieve the fluid and pressure from the poor Maltese puppy’s skull.
  • Surgery: There are some options for surgery to relieve the pressure. This is usually a much more costly exercise but it does have a much higher chance of success then the medication by itself. It should be kept in mind that the risk associated with this type of surgery are also very high.
Beautiful Maltese Puppy

Prognosis and Outcome with Treatment for a Maltese Puppy with Hydrocephalus

If no treatment is given then the condition is almost always fatal as the symptoms progress.

With treatment the outlook for the puppy will depend a lot on how early it was diagnosed and how much damage could have been done already. If the medications work successfully and reduce the pressure before any damage is done then the Maltese can live for a very long time and may live out its life expectancy. If damage has already been done by the water on the brain condition then the Maltese may need additional care to help it throughout its life.

In all cases it is best to look on the positive side that treatment will help will Maltese and if successful will greatly improve and extend what the Maltese puppy’s life would have been had no treatment been given.

Breeding Maltese and Hydrocephalus

As far as breeding if a Maltese puppy is diagnosed with Congenital (Genetic) hydrocephalus then they should not be bred. While it is not proven that it will be passed on from parent to child it is advisable to not continue the breeding line of any dogs associated with hydrocephalus.

Did we Answer all your Questions on Hydrocephalus in Maltese Puppies?

Hopefully this article has done a good job of answering all of your questions on the very scary and debilitating disease known as water on the brain or hydrocephalus in Maltese dogs. Have you had a dog with hydrocephalus and what was the prognosis? Let us know in the comments so that others can hear about your story.


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