Cerebrospinal fluid normally circulates sequentially through the four ventricles of the brain and then passes into the large veins on top of the brain where it is reabsorbed. Hydrocephalus occurs when there is too much cerebrospinal fluid (CSF) within the ventricles, resulting in excess pressure in the brain. A child can be born with hydrocephalus (congenital) or develop the condition during or after birth (acquired).

The brain constantly makes cerebrospinal fluid. CSF is normally absorbed into the blood and carried out of the brain as new CSF is made. In hydrocephalus, the CSF continues to build up in the brain and can cause brain injury.

Signs & Symptoms

Signs and symptoms of hydrocephalus vary depending on a patient’s age and other underlying conditions.

  • Rapid increase of head circumference
  • Bulging of soft spot on a baby’s head (fontanelle)
  • Sleepiness
  • Irritability
  • Vomiting
  • Downward-gazing eyes
  • Seizures
  • Headache
  • Nausea and vomiting
  • Clumsiness
  • Downward-gazing eyes
  • Sleepiness and irritability
  • Blurred or double vision
  • Incontinence
  • Personality changes
  • Balance changes

Causes & Risks

The most common cause of congenital hydrocephalus is a blockage between two ventricles that prevents CSF from moving through the brain.

Many other types of brain development problems can cause hydrocephalus such as:

  • Spinal cord abnormalities
  • Brain cysts
  • Infections during pregnancy
  • Genetic disorders
  • Bleeding in the brain
  • Head injury
  • Brain tumors
  • Brain infections (meningitis)
  • Family history of congenital hydrocephalus
  • Poor prenatal care during pregnancy
  • Diabetes present during pregnancy

Diagnosis & Treatment

Hydrocephalus is diagnosed with a physical exam, medical history and brain imaging tests including an MRI or CT scan. Congenital hydrocephalus can be diagnosed before birth using a fetal ultrasound during pregnancy.

Surgery is the only treatment for hydrocephalus. The most common type of surgery is the placement of a flexible tube (shunt) in the brain or spinal cord to drain the fluid into another part of the body. The shunt may need to be adjusted or replaced over time as your child grows.

Normal Pressure Hydrocephalus (NPH) in Adults

Late onset hydrocephalus in adults or normal pressure hydrocephalus (NPH) occurs when patients cannot tolerate brain pressures considered “normal” as they age. NPH is associated with aging or certain medical conditions.

NPH may be caused by anything that blocks the flow of CSF such as:

  • Head injury
  • Infections
  • Brain surgery
  • Bleeding from a blood vessel in the brain
  • Tumors or cancer
  • Difficulty walking
    • Shuffling feet when walking
    • Unsteadiness
    • Feet feeling as though they are stuck to the floor
  • Problems with bowel or bladder control
  • Memory problems
    • Forgetfulness
    • Lack of concentration
    • Mood problem
    • Confusion

Diagnosis is based on the following:

  • Medical history
  • Physical exam
  • Diagnostic testing

NPH may be treated with surgery to place a narrow tube (ventriculoperitoneal shunt or VP shunt) in the brain to drain excess CSF. After the placement of the shunt you will be monitored to ensure CSF is draining properly.

Advanced Expertise

At UChicago Medicine, our dedicated neurosurgeons are here to help. For more information about hydrocephalus and the resources we have available, please call the Margaret Hackett Family Program (MHFP) at 773-795-0622, or email us at mhfcp@bsd.uchicago.edu.

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