Hydrocephalus: Types, Causes, Symptoms & Treatment Options

Hydrocephalus might sound like a complicated medical term, but at its core, it refers to a condition where there is too much fluid inside the brain. While a small amount of this fluid is normal and essential, excess fluid can increase pressure in the brain and lead to serious problems.

In this article, we’ll break down hydrocephalus in plain language. You’ll learn what it is, why it happens, the symptoms to watch for, how doctors diagnose it, the treatments available, and what life looks like after treatment. Whether you’re a patient, caregiver, or simply curious, this guide will give you a clear, easy-to-understand overview.

What Is Hydrocephalus?

The human brain is cushioned and nourished by a clear liquid called cerebrospinal fluid (CSF). This fluid flows in and around the brain and spinal cord. It serves several important roles:

• Protects the brain from injury by acting as a shock absorber.

• Carries nutrients to the brain and removes waste products.

• Maintains proper pressure inside the skull.

In hydrocephalus, the normal flow or absorption of CSF is disrupted. The fluid builds up, leading to increased pressure inside the skull.

Hydrocephalus is sometimes called “water on the brain”, although it’s not water—it’s cerebrospinal fluid (CSF.)

Types of Hydrocephalus

Doctors classify hydrocephalus based on the cause and how the CSF builds up:

1. Communicating Hydrocephalus

The CSF can still flow between the brain’s ventricles (fluid-filled spaces inside the brain that are normally also there), but it can’t be absorbed properly into the bloodstream.

2. Non-communicating (Obstructive) Hydrocephalus

Here, the CSF flow is blocked somewhere in the brain’s ventricles or pathways, leading to fluid buildup behind the blockage.

3. Normal Pressure Hydrocephalus (NPH)

This type often affects older adults. Even though CSF pressure may appear normal on tests, it still causes problems such as walking difficulties, memory issues, and loss of bladder control.

4. Congenital Hydrocephalus

Present at birth, usually due to abnormal brain development, genetic conditions, or infections and other complications during pregnancy.

5. Acquired Hydrocephalus

Develops later in life due to infections (like meningitis), bleeding, head injury, brain tumors, or stroke.

Causes of Hydrocephalus

Several issues can interfere with CSF circulation:

• Blockages: Tumors, cysts, or structural problems can physically block the flow.

• Bleeding in the brain: Often from head injury, premature birth, or stroke.

• Infections: Meningitis or encephalitis can scar brain tissues and block absorption.

• Developmental problems: Birth defects like spina bifida may contribute.

• Aging-related changes: In older adults, the brain’s absorption system may simply become less efficient.

Who Is at Risk?

Hydrocephalus can occur at any age, but the risk is higher in:

• Newborns and infants with brain development problems or complications during pregnancy.

• Premature babies who are prone to brain bleeding.

• Adults over 60 with conditions like Normal Pressure Hydrocephalus.

• People with brain injuries, infections, or tumors.

Symptoms of Hydrocephalus

The symptoms of hydrocephalus can look very different depending on a person’s age and how severe the condition is. Here’s a closer look:

In Infants

• Rapid increase in head size (large head). The baby’s head may grow faster than expected, which is often one of the first visible signs.

• Bulging soft spot (fontanel) on the skull. The soft spot on top of the baby’s head may feel tight or look swollen.

• Irritability, poor feeding, vomiting. Babies may cry more than usual, refuse to feed, or spit up often.

• Sleepiness or seizures. A very tired baby who is hard to wake, or one who has seizures, may be showing signs of pressure in the brain.

In Older Children

• Headache (often worse in the morning). Morning headaches can happen because fluid builds up overnight when lying flat.

• Nausea, vomiting. These often come along with the headaches and may improve temporarily after vomiting.

• Vision problems (blurred or double vision). Kids may complain of trouble seeing the board in class or needing to squint.

• Trouble with balance or walking. They may seem clumsy, fall more often, or have difficulty keeping up with friends.

• Learning or memory difficulties. School performance can drop because the brain isn’t working as efficiently under pressure.

In Adults

• Headaches. Persistent or severe headaches may signal fluid pressure in the brain.

• Poor coordination, difficulty walking. Adults might notice unsteadiness, tripping, or difficulty with simple tasks like climbing stairs.

• Urinary incontinence (loss of bladder control). Sudden leaks or accidents can be a warning sign, especially when paired with walking problems.

• Memory problems or confusion. Forgetfulness, difficulty concentrating, or getting lost easily may appear.

• Vision changes. Blurry or double vision can occur as pressure affects the optic nerves.

In Older Adults with Normal Pressure Hydrocephalus (NPH)

This group often shows a classic triad of symptoms:

1. Trouble walking (shuffling or unsteady steps). Movements may resemble Parkinson’s disease, with short, hesitant steps.

2. Memory and thinking problems (sometimes mistaken for dementia). Loved ones may notice increasing forgetfulness or slowed thinking.

3. Loss of bladder control. Frequent or urgent bathroom trips, or sudden accidents, are common.

How Hydrocephalus Is Diagnosed

If a doctor suspects hydrocephalus, several tests can help confirm the diagnosis:

• Physical exam: Checking head size in infants, neurological signs in adults.

• Ultrasound: Safe for infants since their skull bones haven’t fully fused.

• CT (Computed Tomography) scan: Provides quick images of fluid buildup.

• MRI (Magnetic Resonance Imaging): Offers detailed pictures of the brain and CSF pathways.

• Lumbar puncture (spinal tap): Sometimes used in older adults with NPH to measure pressure or test whether draining fluid improves symptoms.

Treatment Options for Hydrocephalus

The good news is that hydrocephalus is treatable. While it usually requires surgery, most patients can live fulfilling lives with the right care.

1. Shunt System (Most Common Treatment)

A shunt is a small tube that surgeons place in the brain’s ventricles to drain excess CSF. The fluid is redirected to another part of the body (usually the abdomen) where it can be absorbed.

• Advantages: Lifesaving, effective for most patients.

• Challenges: Shunts can sometimes get blocked, infected, or need replacement. Patients require lifelong monitoring.

2. Endoscopic Third Ventriculostomy (ETV)

In this procedure, surgeons create a small opening in the bottom of the third ventricle of the brain. This allows CSF to flow freely, bypassing blockages.

• Often used in: Non-communicating hydrocephalus.

• Advantage: No permanent shunt needed in some cases.

3. Medications (Limited Role)

In some infants, medications that reduce CSF production may be used temporarily, but surgery is usually necessary.

Living with Hydrocephalus

For many patients, life after treatment can be very normal—but it requires attention and follow-up.

In Children

• Developmental support may be needed (physical therapy, speech therapy, special education).

• Regular doctor visits to monitor shunt function.

• Parents should watch for warning signs such as headaches, nausea, irritability, or shunt malfunction.

In Adults

• Returning to work and daily activities is possible after recovery.

• Regular checkups with a neurologist or neurosurgeon are essential.

• Emotional support and counseling can help manage stress or depression.

In Older Adults with NPH

• Many patients see significant improvement in walking and bladder control after surgery.

• Memory improvements vary, but early treatment often leads to better outcomes.

Complications to Watch Out For

Even after treatment, it’s important to recognize red flags:

1. Sudden severe headache. This isn't your average headache; it's a "thunderclap" that comes on fast and feels completely different.

2. Nausea and vomiting. Especially if it's sudden, forceful ("projectile"), and happens along with a severe headache or drowsiness. Don't assume it's just a stomach bug.

3. Changes in vision. Tell your doctor right away if things look blurry, double, or you see unusual spots.

4. Fever (could suggest infection in shunt). Even a low-grade fever can be a big red flag, as it might signal an infection related to the shunt.

5. Seizures. Any new seizure activity is an urgent sign that something needs to be checked.

6. Unusual drowsiness or irritability (in children). If your child is unusually hard to wake up or is excessively fussy and cannot be soothed, don't wait.

If these occur, urgent medical care is needed.

Advances in Hydrocephalus Care

Modern medicine continues to improve outcomes. Some exciting advances include:

• Programmable shunts: Doctors can adjust the drainage level without surgery.

• Robotic-assisted neurosurgery: Improves precision and safety in delicate brain procedures.

• Better imaging: High-resolution MRI helps detect hydrocephalus earlier and guide treatment.

• Genetic research: Identifying mutations that may explain congenital cases and guide future therapies.

Everyday Tips for Patients and Caregivers

• Stay informed: Learn the signs of shunt problems or increased pressure.

• Keep appointments: Regular checkups help catch issues early.

• Support mental health: Counseling and support groups can make a big difference.

• Encourage independence: Many people with hydrocephalus can lead active, productive lives.

Final Thoughts

Hydrocephalus is a serious condition, but with modern treatment options, many patients go on to live healthy, fulfilling lives. Early diagnosis, proper surgical care, and consistent follow-up are key.

If you or a loved one shows signs of hydrocephalus, don’t delay—consult a doctor right away. The sooner it’s diagnosed and treated, the better the outcome.

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Sources:

National Institute of Neurological Disorders and Stroke (NINDS) — Hydrocephalus overview
https://www.ninds.nih.gov/health-information/disorders/hydrocephalus

Mayo Clinic — Hydrocephalus: Symptoms and causes
https://www.mayoclinic.org/diseases-conditions/hydrocephalus/symptoms-causes/syc-20373604

MedlinePlus — Hydrocephalus (Water on the Brain
https://medlineplus.gov/hydrocephalus.html

Cleveland Clinic — Hydrocephalus: What It Is, Causes, Diagnosis & Treatment
https://my.clevelandclinic.org/health/diseases/17334-hydrocephalus

AANS (American Association of Neurological Surgeons) — Hydrocephalus (patient info)
https://www.aans.org/patients/conditions-treatments/hydrocephalus/

Hopkins Medicine — Hydrocephalus: Condition overview
https://www.hopkinsmedicine.org/health/conditions-and-diseases/hydrocephalus

WHO / EMRO — “Hydrocephalus and Its Diagnosis” PDF (review)
https://applications.emro.who.int/imemrf/666/J-Bahria-Univ-Med-Dent-Coll-2020-10-1-72-76-eng.pdf