Hydrocephalus is the buildup of cerebrospinal fluid (CSF) inside the brain, caused by excess production, poor drainage, or blocked flow. This condition can lead to symptoms such as abnormal head growth, headache, nausea, and vomiting.
While it is more common in children due to developmental issues during pregnancy, hydrocephalus can also occur in adults as a complication of brain infections, such as meningitis, or brain tumors.
Although hydrocephalus usually has no definitive cure, it can be managed with surgery to prevent further fluid buildup in the brain.
Main symptoms
The symptoms of hydrocephalus vary depending on age and the amount of fluid that accumulates in the brain.
Symptoms in babies under 1 year
The main symptoms of hydrocephalus in babies younger than 1 year are:
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Larger-than-normal head size
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Bulging soft spot or enlarged veins on the head
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Rapid skull growth
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Difficulty moving the head
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Irritability or excessive sleepiness
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Nausea and vomiting
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Developmental delays
In babies under 1 year, hydrocephalus is often first detected by rapid head growth during routine pediatric visits.
Symptoms in children over 1 year
In children older than 1 year, symptoms may include:
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Headache
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Difficulty walking
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Double vision or crossed eyes
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Irritability or sleepiness
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Growth and developmental delays
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Urinary incontinence
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Nausea or vomiting
Other possible signs are frequent urination, loss of bladder control, and difficulty waking up or staying awake.
Symptoms in adults and older adults
The main symptoms of hydrocephalus in adults and older adults are:
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Severe headache
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Nausea and vomiting
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Trouble walking
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Vision changes
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Urinary incontinence
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Irritability or excessive sleepiness
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Memory or reasoning problems
In adults, hydrocephalus tends to cause symptoms more quickly because the skull is fully developed and cannot expand to hold excess CSF.
In cases of normal pressure hydrocephalus, however, symptoms progress more slowly. Early signs often include memory problems, difficulty walking, and urinary incontinence.
How a diagnosis is confirmed
Hydrocephalus is usually diagnosed by a neurologist, or by a pediatric neurologist in babies and children. Diagnosis is based on symptoms and imaging tests, such as MRI or CT scans of the head.
In babies under 1 year, hydrocephalus can also be detected with a cranial ultrasound (transfontanelle ultrasound). In some cases, it may even be identified before birth through prenatal ultrasound.
Possible causes
The main causes of hydrocephalus are:
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Nervous system developmental malformations
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Intraventricular hemorrhage, especially in premature babies
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Hemorrhagic stroke, often due to subarachnoid hemorrhage
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Infections of the central nervous system, such as meningitis
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Brain tumors
Hydrocephalus happens when CSF builds up in the brain because of a blockage in circulation, excessive production, or poor absorption. It is most common in babies, children, and older adults.
Types of hydrocephalus
Hydrocephalus can be classified into several types:
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Communicating hydrocephalus: caused by poor absorption of CSF, often linked to bleeding or inflammation
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Normal pressure hydrocephalus: a type of communicating hydrocephalus, more frequent in older adults, with no exact known cause
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Obstructive hydrocephalus: occurs when there is a blockage in the normal flow of CSF, preventing it from reaching absorption sites in the nervous system
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Congenital hydrocephalus: present from birth, often related to genetic syndromes or nervous system malformations
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Hypersecretory hydrocephalus: caused by an abnormal increase in CSF production
Depending on its cause, hydrocephalus may also be described as primary (no clear cause or linked to developmental issues) or secondary (caused by a specific condition).
Treatment options
Whenever possible, treatment for hydrocephalus should address the underlying cause, under the care of a pediatric neurologist, neurologist, or neurosurgeon. When this is not possible, surgery is typically needed to control CSF buildup.
The main surgical options are:
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Shunt placement: inserting a small tube with a valve into the brain to drain fluid to another part of the body, such as the abdomen or chest, where it can be absorbed into the bloodstream
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Ventriculostomy: creating an opening in the skull and placing a thin device to allow CSF to circulate and relieve pressure in the brain
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External ventricular drainage: an emergency procedure using a temporary device to drain excess CSF from the brain
Hydrocephalus itself cannot be directly prevented, but risks can be reduced through proper prenatal care, avoiding drug use during pregnancy, and taking folic acid before and during pregnancy.
Possible complications
Complications of hydrocephalus in babies and children are more likely if treatment is delayed. These may include problems with mental or motor development, such as learning difficulties, speech or memory problems, walking difficulties, and loss of bladder or bowel control.
In severe cases, hydrocephalus can cause irreversible brain damage, such as intellectual disability or paralysis, and may even be life-threatening.
Regular medical follow-up is essential to detect and treat complications early and to prevent permanent brain damage.
Does hydrocephalus have a cure?
In most cases, hydrocephalus does not have a permanent cure. However, treatment can help relieve symptoms and prevent complications.
In some cases, a cure is possible, especially when hydrocephalus is caused by an infection and diagnosed at an early stage.