Hydrocephalus: symptoms, causes and treatments

Understand hydrocephalus (cerebrospinal fluid buildup) causes, symptoms, diagnosis and advanced treatments like ETV for improved outcomes. 

By Adesh Tandon, MD, Neurosurgery, Nuvance Health, now part of Northwell Health 

Learning you or a loved one may have hydrocephalus can be very concerning. This condition, caused by excess cerebrospinal fluid (CSF) in the brain, can lead to headaches, balance issues, memory changes and other neurological symptoms. Recognizing the signs and knowing when to seek care can help you get treatment as soon as possible: Early intervention is key to improving symptoms and having a positive long-term outcome.  

This guide will help you understand hydrocephalus causes, symptoms, diagnosis and treatments, including advanced surgical options. 

Learn more about neurosurgery at the Nuvance Health Neuroscience Institute, now part of Northwell Health. 

What is hydrocephalus? 

Hydrocephalus happens when cerebrospinal fluid (CSF) builds up within the brain’s ventricles (fluid-filled cavities). CSF cushions the brain and spinal cord, removes waste and provides essential nutrients. When this fluid doesn’t drain properly or is produced in excess, it can increase pressure on the brain, leading to neurological symptoms. 

Hydrocephalus symptoms vary by age and severity but may include: 

• Headaches and pressure in the skull that usually are worse in the morning after lying down while sleeping or with positional changes. 

• Nausea or vomiting from increased pressure in the skull (intracranial pressure). 

• Balance problems and difficulty walking, especially in adults with normal pressure hydrocephalus (NPH). 

• Cognitive changes, including memory problems, confusion or slowed thinking. 

• Vision changes, like blurred or double vision, from pressure on optic nerves. 

• In infants, hydrocephalus may cause rapid head growth, bulging fontanelle (soft spot on the head), irritability and poor feeding. 

If left untreated, hydrocephalus can lead to permanent brain damage or life-threatening complications. Keep reading to learn about the treatments that can help to avoid these complications. 

Related content: Should you go to the emergency department for a headache or migraine? 

What are types of hydrocephalus? 

Hydrocephalus is categorized based on how CSF circulation is disrupted. Understanding the type of hydrocephalus is critical to finding the right treatment. Here are the types and subtypes of hydrocephalus. 

• Communicating hydrocephalus: In this type of hydrocephalus, CSF can flow between the ventricles in the brain, but it isn’t reabsorbed efficiently into the bloodstream. Infections, like meningitis, or bleeding in the brain can cause communicating hydrocephalus. 

• Normal pressure hydrocephalus (NPH): This type of communicating hydrocephalus typically affects older adults and can cause three hallmark symptoms: gait disturbances, including problems with balance and walking; cognitive changes, including decline in remembering and thinking skills; and urinary incontinence. 

• Hydrocephalus ex vacuo: This type of hydrocephalus occurs when brain tissue shrinks due to aging, injury or neurodegenerative disease, like Alzheimer's disease or Parkinson’s disease, and ventricles enlarge to fill the space. 

• Non-communicating hydrocephalus: This is also called obstructive hydrocephalus and happens when CSF flow is blocked by a tumor, cyst or congenital narrowing of passages that connect ventricles in the brain. 

• Acquired hydrocephalus can happen when:  A brain tumor blocks CSF flow; A head injury damages brain tissue and blood vessels and affects CSF flow; Meningitis causes inflammation and scarring of the brain and spinal cord membranes and blocks CSF flow; or, Bleeding in the brain ventricles (intraventricular hemorrhage), which happens most commonly in premature babies. 

• Congenital hydrocephalus occurs at birth because of developmental problems with the brain or spinal cord. 

   

 What are the causes of hydrocephalus? 

Hydrocephalus can happen for many different reasons. Some causes of hydrocephalus include: 

• Congenital causes: Present at birth due to conditions like spina bifida or aqueductal stenosis. Aqueductal stenosis is a narrowing of the channel connecting the third and fourth ventricles in the brain. 

• Traumatic brain injury: Bleeding or swelling can block the flow of CSF in the brain. 

• Brain tumors or cysts can obstruct CSF fluid circulation. 

• Infections: Meningitis or encephalitis (inflammation of the brain) can inflame CSF pathways or cause scarring that blocks drainage. 

• Hemorrhage: Subarachnoid bleeding (on the surface of the brain) or intraventricular bleeding can lead to hydrocephalus. 

• Aging and degenerative conditions: Brain atrophy in Alzheimer’s disease or other dementias can contribute to hydrocephalus ex vacuo or NPH. 

How is hydrocephalus diagnosed? 

Neurologists or neurosurgeons typically diagnose hydrocephalus. Primary care physicians or pediatricians may also be involved in the diagnosis from initial symptom evaluation or in pediatric cases. 

Your doctor will take your medical history, perform a neurological exam and review imaging tests like CT and MRI scans. 

What are treatments for hydrocephalus? 

Treatments depend on the underlying cause of hydrocephalus and your age and overall health. Treatments aim to restore proper CSF flow and reduce pressure on the brain. Early intervention is important to reduce the risk of long-term or permanent damage to the brain. 

Here are possible treatments your doctor will discuss with you: 

Endoscopic third ventriculostomy (ETV) is a minimally invasive procedure where a neurosurgeon creates a small opening in the floor of the third ventricle to allow CSF to flow freely. The neurosurgeon will make a small incision and use a video camera to see inside the brain. ETV is an advanced option offered at Nuvance Health for certain patients and can eliminate the need for a permanent shunt.  

Ventriculoperitoneal (VP) shunt is the most common treatment for hydrocephalus. A neurosurgeon places a thin tube at one of the brain’s ventricles to drain CSF fluid to the abdominal cavity, where it can be absorbed. Shunts are usually permanent and require monitoring for infection or malfunction. 

Find a neurosurgeon near me. 

Supportive and rehabilitative treatments: Depending on the extent of symptoms and how much function is regained, some people may benefit from physical therapy, occupational therapy, mental health and social worker support.  

Can you recover fully from hydrocephalus? 

Recovery depends on the type, cause and severity of hydrocephalus, as well as how quickly treatment is initiated: 

• Children: Early treatment often allows for normal development, though some may experience learning delays or motor challenges. 

• Adults with NPH: Many see significant improvements in walking and memory after shunt placement or ETV, especially if diagnosed early. 

• Severe or long-standing cases: Some symptoms may persist, but rehabilitation and ongoing care can improve quality of life. 

Comprehensive recovery from hydrocephalus often includes: 

• Physical therapy can help improve gait, balance and coordination. 

• Occupational therapy can help you regain daily function and independence. 

• Cognitive therapy and mental health support can help address memory and emotional changes. 

Learn about specialized therapies at Nuvance Health. 

The bottom line: Hydrocephalus is a serious but treatable condition. Recognizing hydrocephalus symptoms, understanding the underlying cause and seeking prompt evaluation are essential for the best outcomes. Modern treatments like endoscopic third ventriculostomy and shunt placement allow many people to regain independence and maintain a good quality of life.