Hydrocephalus
A disorder involving accumulation of cerebrospinal fluid within the brain’s ventricles.
General educational information is not a diagnosis or treatment recommendation for an individual.
Overview
Cerebrospinal fluid, or CSF, normally circulates through spaces in and around the brain and spinal cord. Hydrocephalus develops when this circulation or absorption is disturbed, often enlarging the brain’s fluid spaces, called ventricles. Enlarged ventricles alone do not prove hydrocephalus: loss of brain tissue can also make them appear larger and requires a different interpretation.
Common Symptoms
Symptoms vary with the cause and how quickly the condition develops. Headache, nausea, vomiting, vision changes, difficulty walking, or drowsiness can occur. Normal-pressure hydrocephalus, usually evaluated in older adults, can involve gait difficulty, cognitive changes, and urinary symptoms. This combination has other possible causes and is not diagnostic on its own.
Causes and Different Forms
Obstructive hydrocephalus involves a blockage along a CSF pathway. Communicating hydrocephalus involves disturbed circulation or absorption without the same internal obstruction pattern. Hydrocephalus may be associated with developmental conditions, bleeding, infection, or a mass. Normal-pressure hydrocephalus is a distinct clinical assessment; the name does not mean that all aspects of fluid pressure are normal.
Evaluation and Diagnosis
A neurological assessment and CT or MRI help evaluate ventricular size, possible obstruction, and other explanations for symptoms. Previous imaging can show change over time. Selected patients may undergo additional CSF or physiological testing. Testing is tailored to the suspected type; a lumbar puncture is not a routine requirement for every patient with ventricular enlargement.
Observation and Nonsurgical Assessment
When the cause of ventricular enlargement is uncertain, further evaluation or monitoring may be appropriate. Rehabilitation and management of other conditions may address some functional difficulties but do not substitute for treating clinically important CSF obstruction. There is no single nonsurgical plan that fits all forms of hydrocephalus.
When Surgery May Be Considered
A shunt uses tubing and a valve to divert CSF to another body space for absorption. Endoscopic third ventriculostomy creates an alternative fluid pathway and is suitable only for selected patients. Choice depends on the underlying mechanism and individual circumstances. Shunts and endoscopic procedures can fail or have complications, so continued follow-up is important.
When to Seek Neurosurgical Evaluation
Assessment is appropriate when symptoms and imaging suggest a CSF circulation disorder or when a previously treated patient develops concerning changes. Bring earlier scans, records of CSF testing, and any shunt device information. For suspected normal-pressure hydrocephalus, discuss how gait, cognition, and bladder function will be assessed and how competing diagnoses will be considered.
Important Warning Signs
Rapidly worsening headache, repeated vomiting, increasing drowsiness, new vision changes, or neurological decline requires urgent assessment. In someone with a shunt, fever or redness along the device with illness may indicate infection. Possible shunt malfunction or recurrent hydrocephalus should not wait for a routine follow-up visit.
Questions to Ask Your Neurosurgical Clinician
Is this hydrocephalus or ventricular enlargement from another cause? What mechanism is suspected? Would further testing change the decision? Why might a shunt or an endoscopic procedure be suitable, and what follow-up and warning signs would apply afterward?
References and Further Reading
These professional-society patient-education resources informed this draft. They are not formal clinical practice guidelines and do not endorse this website.
Preparing for Your Consultation
Bring your imaging, reports, medication list, and relevant treatment history. Describe symptoms and the activities that matter most to you. Clinical assessment combines examination and imaging with individualized discussion of options.
Medical Information Disclaimer
This article is an editorial draft requiring physician review. It provides general education, not individualized medical advice or a guarantee of treatment results. Seek qualified medical assessment for your own circumstances and emergency care for urgent symptoms. This independently maintained physician-information website is not an official website of CU Medicine, the University of Colorado, or UCHealth. References do not imply society or institutional endorsement.