Hydrocephalus

Living with hydrocephalus can cause many changes. Although treatment can’t fix every symptom, proper care can make a real difference.

At Banner Health, we want to help you or someone you love live as well and comfortably as possible. We use advanced imaging and have expert neurologists and neurosurgeons. Our caring team works with you to make a care plan that fits your needs and goals. 

What is hydrocephalus?

Hydrocephalus might sound scary but it’s easier to understand if you look at the words. “Hydro” means water, and “cephalus” means brain. That’s why some people call it “water on the brain” but this nickname isn’t quite accurate. 

The “water” is really cerebrospinal fluid (CSF), a clear liquid that moves around your brain and spinal cord. CSF has several important jobs. It:

• Cushions your brain, acting as a shock absorber
• Removes metabolic waste   
• Helps control pressure inside your skull

Your body normally makes and removes cerebrospinal fluid (CSF) at a steady rate. CSF is produced and fills fluid spaces within the brain called ventricles. It later leaves the brain and surrounds the brain and the spine. If something blocks the flow or stops it from being absorbed, fluid can start to build up in the ventricles, which may cause these fluid spaces to become enlarged. This buildup of fluid may increase pressure in your brain, which can lead to the brain not functioning properly and causing harm to the brain tissue over time. 

Hydrocephalus is a condition that can affect people of all ages, from infants and children to adults and older people. In the United States, more than one million people have this condition. 

What causes hydrocephalus?

Hydrocephalus is a condition that can happen for different reasons. Some people are born with it and others get it later in life. 

Common causes of hydrocephalus include:

• Congenital issues (present at birth): Problems with brain development before birth, such as spina bifida or aqueductal stenosis (a blockage in the brain’s fluid pathways).
• Genetic conditions: Inherited genetic conditions may increase your risk of impaired flow of CSF within the brain.
• Infections during pregnancy: Conditions like rubella or syphilis can increase the chance of hydrocephalus in newborns.
• Bleeding in the brain: A stroke or head injury can block the flow of cerebrospinal fluid.
• Brain infections: Illnesses like meningitis or encephalitis can cause swelling and block fluid drainage of cerebrospinal fluid.
• Tumors or cysts: Growths near the ventricles can block the flow of fluid.

Sometimes, older adults develop a condition called normal pressure hydrocephalus (NPH) without an apparent cause. It is linked to changes in how the brain drains fluid.

Types of hydrocephalus

Hydrocephalus is described in different ways depending on the cause and how it affects the flow of fluid in the brain. 

Hydrocephalus can be:

• Congenital hydrocephalus: Present at birth, often caused by brain development problems or genetic factors.
• Acquired hydrocephalus: Develops later in life from an injury, infection, tumor or bleeding in the brain.

Within these categories, there are several types of hydrocephalus. Every kind of hydrocephalus has its own symptoms and treatment needs:

• Communicating hydrocephalus: This happens when CSF can still flow between the brain's ventricles but isn’t absorbed properly into the bloodstream.
• Non-communicating (obstructive) hydrocephalus: This occurs when a blockage inside the brain’s ventricles keeps CSF from flowing normally.
• Normal pressure hydrocephalus (NPH): This is a type of communicating hydrocephalus that mostly affects older adults. Fluid slowly builds up, so the pressure may seem normal even though symptoms like walking problems, memory loss and bladder issues develop.

Sometimes, you might hear the term 'hydrocephalus ex vacuo.' This isn’t a true type of hydrocephalus. It happens when the brain tissue shrinks or is lost, making the ventricles look enlarged. In this case, the extra space is caused by brain changes, not fluid buildup. Hydrocephalus ex vacuo often happens after a stroke, injury or because of diseases like Alzheimer’s or other dementias.

Learn more about the different types of hydrocephalus. 

Symptoms of hydrocephalus

Hydrocephalus signs can look different depending on your age and what caused it. Since it affects pressure in the brain, symptoms often include changes in movement, balance, vision, mood or thinking. 

Infants

• Unusually large head size
• A rapidly increasing head size
• A bulging soft spot (fontanelle)
• Vomiting 
• Irritability
• Seizures
• Trouble feeding
• Sleepiness or poor responsiveness
• Problems with eye movement 
• Vision loss 
• Not meeting developmental milestones

Children

• Headaches
• Nausea and vomiting
• Sleepiness or trouble staying awake
• Irritability
• Coordination and balance problems
• Delayed learning
• Poor sensory motor skills
• Double or blurry vision
• Vision loss
• Personality changes

Adolescents and adults, symptoms can include:

• Headaches, especially in the morning
• Nausea and vomiting
• Vision problems
• Loss of balance and coordination
• Slowed thinking or problems with attention and concentration
• Difficulty walking
• Personality or mood changes
• Loss of urinary control
• Hearing a heartbeat sound in your ears

In older adults with NPH, the most common symptoms are:

• Difficulty walking (often described as shuffling, imbalance or a feeling of feet glued to the floor)
• Cognitive changes including problems with planning and decision-making, reduced motivation and slowness in thought process
• Loss of bladder control without other cause

If you see these changes in yourself or someone you care about, see a health care specialist. Hydrocephalus can get worse if not treated, but many people get better or learn to cope with it if they get help quickly. 

How hydrocephalus is diagnosed

Because hydrocephalus has similar signs and symptoms to other brain conditions, accurate diagnosis is important. Your healthcare provider will first look at your medical history and ask about your symptoms. Then, they will do physical and neurological exams to check your health. 

To confirm a diagnosis, your provider might order the following tests:

• Ultrasound may be used in infants and pregnant women to identify hydrocephalus
• Magnetic resonance imaging (MRI) scans provide detailed images of the brain and ventricles
• Computed tomography (CT) scans spot enlarged ventricles or blockages
• Lumbar punctures (spinal taps) measure pressure and analyze CSF

These tests help determine the type of hydrocephalus you have and guide your treatment plan.

Learn more about diagnosing hydrocephalus.

Treatment for hydrocephalus

Treatment focuses on relieving pressure in the brain and restoring normal CSF flow. The most common treatment is surgery, often combined with ongoing monitoring and therapy. 

Surgical options include:

• Shunt placement: A thin, flexible tube (called a shunt) is placed in the brain to drain extra fluid to another part of the body, such as the abdomen. The shunt has a valve to control fluid flow.
• Endoscopic third ventriculostomy (ETV): Sometimes, surgeons make a small opening in the floor of the third ventricle. This helps fluid flow normally around the blockage without the need for a shunt.

Your surgeon will recommend the best approach based on your age, the type of hydrocephalus you have and your overall health. After treatment, regular check-ups help watch for changes in fluid pressure and make sure the shunt or ETV is working well.

Learn more about hydrocephalus treatment. 

Living with hydrocephalus

Living with hydrocephalus can bring daily challenges and you may feel overwhelmed. But with proper care, many people live full, active lives. Treatment can help reduce symptoms, protect your brain function and improve quality of life. 

You might need to change your schedule and have regular checkups to watch your condition. Children may need physical, occupational and speech therapy as they get older. Adults and seniors often see neurologists and rehab specialists to help with balance, memory and movement problems. 

If you or someone you care about has a shunt, watch for symptoms of shunt failure. Signs of shunt failure can vary depending on the type of hydrocephalus, but can include decreased level of alertness, confusion, headaches, nausea, double vision, vision loss, hearing your heartbeat in your ears, imbalance and urinary incontinence. These signs can mean the shunt isn’t working right and needs to be checked by a doctor quickly.

Contact Banner Health

If you have hydrocephalus or show symptoms of it, Banner Health’s neurology and neurosurgery experts are here to help. Our neuroscience team provides advanced diagnostic tools, innovative surgical options and caring support focused on your long-term health.

Find a Banner Health specialist near you.