Hydrocephalus is a neurological condition that occurs when too much cerebrospinal fluid (CSF) collects inside the brain. This buildup can enlarge the brain’s fluid-filled spaces, called ventricles, and sometimes increase pressure on surrounding brain tissue.

Although hydrocephalus is commonly associated with babies and young children, adults can also develop this condition. Some people experience it because of a brain injury, infection, tumour or bleeding. Others develop symptoms gradually as they grow older.

Early diagnosis is important because untreated hydrocephalus can affect walking, memory, vision, coordination and everyday activities. Fortunately, appropriate treatment, including surgery in selected patients, can help manage the condition and improve quality of life.

In this guide, we explain the causes, types, warning signs, diagnostic tests, treatment options and recovery process for adult hydrocephalus.

Key Takeaways

• Hydrocephalus develops when cerebrospinal fluid builds up inside the brain’s ventricles.
• Adults can develop hydrocephalus because of infections, brain injuries, tumours or bleeding.
• Normal pressure hydrocephalus (NPH) mainly affects older adults and can cause walking difficulties, memory problems and bladder control issues.
• Common symptoms include headaches, nausea, vision changes, poor balance, confusion and difficulty walking.
• Doctors use neurological examinations, MRI scans, CT scans and selected CSF tests to diagnose the condition.
• Treatment may involve a shunt or endoscopic third ventriculostomy (ETV).
• Regular medical follow-up is important because complications can develop even after successful treatment.

What Is Hydrocephalus?

Hydrocephalus is a neurological disorder in which cerebrospinal fluid accumulates abnormally inside the brain’s ventricles.

Cerebrospinal fluid is a clear liquid that surrounds the brain and spinal cord. It provides protection, helps maintain a stable environment for brain cells and removes certain waste products.

Under normal conditions, the body continuously produces and absorbs CSF. The fluid moves through interconnected spaces in the brain before entering the surrounding areas and eventually returning to the bloodstream.

An adult typically produces approximately 500 mL of CSF every day. At any given time, around 150 mL is present within the brain and spinal cord.

Hydrocephalus develops when this normal process becomes disrupted. This may happen because:

• A blockage prevents CSF from flowing normally.
• The body cannot absorb CSF effectively.
• Rarely, an underlying condition causes excessive CSF production.

As fluid accumulates, the brain’s ventricles may become enlarged. Because the adult skull cannot expand significantly, this can increase pressure inside the head and damage surrounding brain tissue.

However, not every person with enlarged ventricles has active or progressive hydrocephalus. Doctors must consider symptoms, imaging results and other clinical findings before recommending treatment.

Types of Hydrocephalus in Adults

Hydrocephalus can develop for different reasons. Understanding its type helps doctors determine the most appropriate treatment.

1. Congenital Hydrocephalus Diagnosed in Adulthood

Congenital hydrocephalus begins before birth, although some individuals may not receive a diagnosis until adolescence or adulthood.

In certain cases, the brain gradually adapts to changes in CSF circulation. Symptoms may remain unnoticed until the condition progresses or the brain can no longer compensate.

Possible causes include:

• Aqueductal stenosis, which narrows a passage through which CSF normally flows.
• Spina bifida and associated neurological abnormalities.
• Congenital brain development abnormalities.
• Genetic conditions affecting normal brain development.

Some adults discover enlarged ventricles during brain imaging performed for an unrelated medical problem.

An imaging finding alone does not always mean that treatment is necessary. A specialist must determine whether the condition is causing symptoms or progressing.

2. Acquired Hydrocephalus

Acquired hydrocephalus develops after birth and may occur at any age.

Several medical conditions can interfere with the normal movement or absorption of cerebrospinal fluid.

Common causes include:

Brain tumours: A tumour may block the pathways through which CSF travels, causing fluid to accumulate.

Head injuries: Serious trauma can damage brain structures or interfere with normal CSF circulation.

Brain infections: Conditions such as meningitis can cause inflammation and scarring that affect fluid absorption.

Brain haemorrhage: Bleeding inside or around the brain can obstruct CSF pathways or interfere with absorption.

The treatment depends on the underlying cause, the location of the blockage and the severity of symptoms.

3. Hydrocephalus Treated During Childhood

Some adults have lived with hydrocephalus since childhood and received treatment when they were younger.

A common treatment is the placement of a shunt, which helps drain excess cerebrospinal fluid away from the brain.

Although many individuals live independently after treatment, shunt-related complications can occur years later.

Possible long-term problems include:

• Shunt blockage or malfunction.
• Infection involving the shunt system.
• Seizures.
• Difficulties with memory and concentration.
• Learning or coordination challenges.
• Changes in everyday functioning.

Adults who received treatment during childhood should continue neurological follow-up, particularly if they develop new or returning symptoms.

4. Normal Pressure Hydrocephalus (NPH)

Normal pressure hydrocephalus is a condition that mainly affects older adults, particularly people over 60.

In NPH, the brain’s ventricles become enlarged, but measurements of CSF pressure may be within the normal range when taken at certain times.

The condition can gradually affect movement, thinking and bladder control.

There are two main forms:

Idiopathic NPH: The exact cause is unknown.

Secondary NPH: It develops following an identifiable condition, such as a brain injury, haemorrhage, infection or other neurological problem.

One important feature of NPH is that its symptoms can resemble those of dementia or Parkinson’s disease. However, some symptoms may improve with appropriate treatment.

Symptoms of Hydrocephalus in Adults

Hydrocephalus symptoms vary according to the patient’s age, the speed of fluid accumulation and the type of condition.

Some people experience sudden and severe symptoms, while others develop gradual changes over several months or years.

Common Symptoms of Adult Hydrocephalus

Watch for the following warning signs:

• Persistent or worsening headaches.
• Nausea and vomiting.
• Blurred or double vision.
• Difficulty maintaining balance.
• Unsteady walking.
• Muscle weakness.
• Poor coordination.
• Memory difficulties.
• Problems concentrating.
• Personality or behavioural changes.
• Unusual sleepiness.
• Seizures.

In some adults, these symptoms may initially appear mild. However, progressive changes should never be ignored.

Symptoms of Normal Pressure Hydrocephalus

Normal pressure hydrocephalus is commonly associated with three major symptoms, known as the NPH triad.

These include walking difficulties, cognitive changes and urinary problems.

Not every patient develops all three symptoms, and their severity can differ.

1. Walking and Balance Problems

Walking difficulties are often the earliest and most noticeable symptom of NPH.

A person may experience:

• Difficulty starting to walk: Taking the first step may become unusually difficult.
• Short, shuffling steps: The feet may move in small steps rather than normal walking movements.
• Magnetic gait: The feet may seem stuck to the floor when attempting to walk.
• Poor balance: Maintaining stability while standing or moving may become difficult.
• Difficulty turning: Changing direction may require several small steps.
• Frequent falls: Reduced coordination can increase the risk of falling.

These changes can make everyday activities, such as walking outdoors, climbing stairs or getting out of a chair, more challenging.

2. Cognitive and Memory Changes

Hydrocephalus can affect the brain areas responsible for thinking, planning and memory.

Common cognitive changes include:

Slower thinking: The person may take longer to understand information or respond to questions.

Poor concentration: Maintaining attention during conversations or daily activities may become difficult.

Memory problems: Individuals may forget recent conversations, appointments or everyday tasks.

Difficulty planning: Organising activities, making decisions and solving problems may become challenging.

Emotional changes: Some people may become less interested in activities, appear withdrawn or experience changes in their behaviour.

These symptoms can resemble other neurological conditions. A proper medical assessment is necessary to identify the underlying cause.

3. Urinary Problems

Changes in bladder control are another important feature of normal pressure hydrocephalus.

Symptoms may include:

• Frequent urination.
• Sudden and urgent need to urinate.
• Difficulty reaching the bathroom in time.
• Accidental urine leakage.
• Urinary incontinence in more advanced cases.

Some individuals may initially experience urgency without actual urine leakage.

Because urinary problems can have several causes, doctors evaluate them alongside walking and cognitive symptoms.

What Causes Hydrocephalus in Adults?

The underlying cause determines how hydrocephalus develops and which treatment may be appropriate.

The most common contributing conditions include:

Brain Bleeding

Bleeding inside the brain or into the ventricles can interfere with normal CSF circulation. Blood products may block fluid pathways or affect absorption.

Meningitis

Meningitis causes inflammation of the protective membranes surrounding the brain and spinal cord.

In some cases, this inflammation leads to scarring that interferes with CSF movement or absorption.

Brain Tumours

Certain brain tumours can block the narrow passages through which cerebrospinal fluid travels.

The resulting obstruction may cause fluid to collect inside the ventricles.

Traumatic Brain Injury

A serious head injury may damage brain structures and affect the circulation of CSF.

Hydrocephalus can develop following certain traumatic injuries, sometimes after a delay.

Congenital Abnormalities

Some people have structural differences in the brain that interfere with normal fluid circulation from birth.

These abnormalities may remain undetected until adulthood.

How Is Hydrocephalus Diagnosed?

Diagnosing hydrocephalus requires a combination of medical history, neurological examination and appropriate investigations.

Doctors also need to determine whether enlarged ventricles are causing symptoms or are simply an incidental imaging finding.

1. Neurological Examination

The doctor evaluates the patient’s neurological health by checking:

• Muscle strength.
• Reflexes.
• Coordination.
• Walking pattern.
• Balance.
• Vision.
• Mental alertness.
• Memory and concentration.

The doctor may also ask when symptoms began and whether they have become worse over time.

2. CT Scan

A computed tomography (CT) scan uses X-rays to create detailed images of the brain.

It can help doctors identify:

• Enlarged brain ventricles.
• Brain haemorrhage.
• Certain brain tumours.
• Structural abnormalities.
• Other possible causes of neurological symptoms.

CT scans are particularly useful when doctors need to assess a patient quickly.

3. MRI Scan

Magnetic resonance imaging (MRI) uses strong magnetic fields and radio waves to produce detailed brain images.

MRI can help identify:

• Enlarged ventricles.
• Blockages in CSF pathways.
• Structural abnormalities.
• Certain brain tumours.
• Changes associated with normal pressure hydrocephalus.

Doctors may use different MRI techniques depending on the suspected cause.

An MRI can also help distinguish hydrocephalus from other conditions that cause similar symptoms.

4. Lumbar Puncture (Spinal Tap)

A lumbar puncture involves inserting a thin needle into the lower back to collect or measure cerebrospinal fluid.

In selected patients with suspected normal pressure hydrocephalus, doctors may remove a controlled amount of CSF to determine whether symptoms improve.

This is sometimes called a CSF tap test.

Doctors may assess changes in walking, balance and cognitive performance before and after the procedure.

Improvement after CSF removal may indicate that the patient could benefit from shunt surgery.

However, a negative tap test does not completely rule out the possibility of improvement after treatment.

5. External Lumbar Drainage

External lumbar drainage involves placing a small catheter into the lower spinal fluid space.

The catheter allows CSF to drain gradually over a period of time, usually while the patient remains in hospital.

Doctors monitor changes in symptoms, particularly walking ability and cognitive function.

This test may be recommended when additional information is needed to assess whether shunt surgery is likely to help.

6. Intracranial Pressure Monitoring

Intracranial pressure (ICP) monitoring measures pressure inside the skull.

In selected cases, a neurosurgeon inserts a small pressure-sensitive device through a carefully created opening in the skull.

The measurements help doctors investigate abnormal pressure patterns.

This is an invasive procedure and is not required for every patient with hydrocephalus.

7. Neuropsychological Assessment

Neuropsychological testing examines how changes in brain function affect thinking and behaviour.

It may evaluate:

• Short-term and long-term memory.
• Attention and concentration.
• Language abilities.
• Problem-solving skills.
• Decision-making.
• Planning and organisation.
• Emotional functioning.

The results help healthcare professionals understand the patient’s cognitive difficulties and distinguish hydrocephalus from other neurological conditions.

8. Isotope Cisternography

Isotope cisternography is a specialised investigation in which a small amount of radioactive tracer is introduced into the CSF through a lumbar puncture.

Doctors then use imaging to observe how the fluid moves and is absorbed.

This test has limited use in modern clinical practice because MRI and other diagnostic methods provide useful information without requiring the same procedure.

Not all patients need every diagnostic test. The neurologist or neurosurgeon selects investigations according to the patient’s symptoms and medical history.

Treatment of Hydrocephalus in Adults

Treatment aims to improve cerebrospinal fluid circulation, reduce harmful pressure when present and prevent further neurological damage.

The most appropriate treatment depends on the type of hydrocephalus, its underlying cause and the patient’s general health.

Surgery is a common treatment for symptomatic hydrocephalus.

1. Shunt Surgery

A shunt is a medical device designed to move excess cerebrospinal fluid away from the brain.

It consists of a thin tube, a valve and a drainage catheter.

The most common type is the ventriculoperitoneal (VP) shunt.

During surgery, a neurosurgeon places one end of the tube inside a brain ventricle. The other end passes beneath the skin and usually reaches the abdominal cavity, where excess fluid can be absorbed.

The valve helps regulate the amount of fluid that drains.

Shunt surgery can reduce fluid accumulation and improve symptoms in suitable patients.

However, shunts require ongoing monitoring because they can become blocked, infected or malfunction over time.

2. Endoscopic Third Ventriculostomy (ETV)

Endoscopic third ventriculostomy is another surgical option for selected patients.

During this procedure, the neurosurgeon uses a thin instrument called an endoscope to access the brain’s ventricular system.

A small opening is created in the floor of the third ventricle. This provides an alternative route for CSF to flow around certain obstructions.

Unlike shunt surgery, ETV does not require a permanent drainage tube.

However, it is not suitable for every type of hydrocephalus. Its success depends on the location and nature of the CSF blockage.

3. Treatment of the Underlying Cause

Sometimes, treating the condition responsible for hydrocephalus is also necessary.

Examples include:

• Treating a brain infection.
• Managing inflammation.
• Removing or treating a brain tumour.
• Addressing complications following a brain haemorrhage.
• Managing problems related to a previous shunt.

Some patients require more than one treatment approach.

Recovery After Hydrocephalus Surgery

Recovery depends on the patient’s age, overall health, severity of symptoms and the extent of neurological damage before treatment.

Some patients notice improvements relatively quickly, while others need several weeks or months to recover.

Following surgery, healthcare professionals monitor:

• Neurological function.
• Walking and balance.
• Headaches and nausea.
• Cognitive performance.
• Signs of infection.
• Shunt function, if applicable.

Rehabilitation and Physical Therapy

Rehabilitation can play an important role in recovery, particularly when hydrocephalus has affected movement or everyday functioning.

Depending on individual needs, rehabilitation may include:

Physical therapy: Helps improve muscle strength, balance, walking and coordination.

Occupational therapy: Supports independence in everyday activities such as dressing, bathing and preparing meals.

Cognitive rehabilitation: Helps individuals work on memory, attention, planning and problem-solving.

Speech and language therapy: May help patients who experience communication or swallowing difficulties.

Not every patient requires all these therapies.

Warning Signs After Surgery

Patients and caregivers should contact the treating medical team immediately if they notice:

• Increasing or severe headaches.
• Repeated nausea or vomiting.
• Fever.
• Redness, swelling or tenderness around the surgical incision or shunt pathway.
• Unusual sleepiness.
• Confusion or changes in behaviour.
• Double vision or other new vision problems.
• Returning walking difficulties.
• Abdominal pain or tenderness.

These symptoms may indicate infection, shunt malfunction or another complication.

Sudden severe symptoms, reduced consciousness or serious neurological changes require emergency medical assessment.

What Is the Long-Term Outlook for Adults With Hydrocephalus?

The long-term outlook varies from one person to another.

Some adults experience significant improvement after treatment and regain many of their previous abilities. Others may continue to experience memory difficulties, movement problems or other neurological symptoms.

Several factors influence recovery:

• The underlying cause of hydrocephalus.
• How early the condition is diagnosed.
• The duration of symptoms before treatment.
• The amount of existing brain damage.
• The patient’s response to surgery.
• Other medical or neurological conditions.

Can Hydrocephalus Be Reversed?

Some symptoms, particularly those associated with normal pressure hydrocephalus, may improve following appropriate treatment.

Walking difficulties often respond well in suitable NPH patients, although memory and bladder symptoms may improve to different degrees.

However, treatment cannot always reverse permanent brain damage.

Early diagnosis and timely medical care may improve the chances of a better outcome.

Can Hydrocephalus Become Life-Threatening?

Yes. Untreated progressive hydrocephalus can cause serious neurological damage.

In some cases, rapidly increasing pressure inside the skull can become a medical emergency.

This is why severe headaches, repeated vomiting, reduced consciousness and sudden neurological changes should never be ignored.

Hydrocephalus and Other Neurological Conditions

Some symptoms of hydrocephalus overlap with other neurological disorders.

For example, normal pressure hydrocephalus can resemble dementia because both conditions may cause memory and thinking difficulties.

It can also produce walking changes that resemble those seen in Parkinson’s disease.

Other conditions, such as Alzheimer’s disease, stroke and vascular disorders, may coexist with hydrocephalus, particularly in older adults.

A specialist evaluation is important because identifying the correct condition can influence treatment decisions.

When Should You See a Doctor?

Seek medical advice if you or someone in your family experiences:

• Persistent or unexplained headaches.
• New balance or walking difficulties.
• Frequent falls.
• Progressive memory problems.
• Unusual changes in behaviour.
• New bladder control problems.
• Unexplained nausea or vomiting.
• Changes in vision.

Do not assume these symptoms are simply part of ageing.

Seek emergency medical attention if a person develops a sudden severe headache, repeated vomiting, seizures, reduced consciousness or rapidly worsening neurological symptoms.

Frequently Asked Questions About Hydrocephalus

1. Can adults develop hydrocephalus?

Yes. Adults can develop hydrocephalus because of brain injuries, infections, tumours, bleeding or congenital abnormalities. Normal pressure hydrocephalus is another form that mainly affects older adults.

2. What are the first signs of hydrocephalus in adults?

Early symptoms may include headaches, difficulty walking, poor balance, memory changes, nausea and vision problems. In normal pressure hydrocephalus, walking difficulties are often among the earliest noticeable symptoms.

3. Is hydrocephalus a serious condition?

Hydrocephalus can be serious, particularly when fluid accumulation causes increased pressure or progressive neurological damage. However, early diagnosis and appropriate treatment can improve outcomes.

4. Can hydrocephalus cause memory loss?

Yes. Hydrocephalus can affect areas of the brain involved in memory, concentration and decision-making. Some patients experience cognitive improvement after treatment, although recovery varies.

5. Is normal pressure hydrocephalus the same as dementia?

No. Normal pressure hydrocephalus and dementia are different conditions, although their symptoms can overlap. NPH may cause walking difficulties, cognitive changes and urinary problems. Some patients improve after appropriate treatment.

6. Can hydrocephalus be treated without surgery?

Treatment depends on the cause and severity. Some patients with stable or asymptomatic ventricular enlargement may only need monitoring. However, symptomatic hydrocephalus often requires a surgical procedure to improve CSF circulation.

7. What is the difference between a shunt and ETV?

A shunt uses a tube and valve to redirect excess CSF to another part of the body. ETV creates an opening inside the third ventricle to provide an alternative pathway for CSF circulation. The choice depends on the patient’s condition.

8. Can hydrocephalus return after surgery?

Symptoms can return if a shunt becomes blocked, infected or stops functioning properly. ETV can also close over time in some patients. Regular follow-up helps detect complications.

9. How long does recovery from hydrocephalus surgery take?

Recovery varies depending on the patient’s condition and the type of surgery. Some improvements may occur within days or weeks, while other symptoms may take several months to improve.

10. Can someone live a normal life with hydrocephalus?

Many people with appropriately treated hydrocephalus can live active and fulfilling lives. However, some individuals need long-term medical monitoring, rehabilitation or additional treatment.

Final Thoughts

Hydrocephalus in adults is a neurological condition that develops when cerebrospinal fluid builds up abnormally inside the brain. Its symptoms may affect walking, memory, vision, balance and bladder control.

Although the condition can cause serious complications, modern diagnostic techniques and surgical treatments provide effective management options for many patients.

Recognising early warning signs, seeking medical advice and attending regular follow-up appointments are important steps towards protecting neurological health.

If you or a family member experiences unexplained walking difficulties, progressive memory changes or persistent headaches, consult a qualified healthcare professional for proper evaluation.

Medical Disclaimer: This article is intended for educational and informational purposes only. It does not replace professional medical advice, diagnosis or treatment. Always consult a qualified neurologist or neurosurgeon regarding suspected hydrocephalus or any new neurological symptoms. Seek emergency medical attention for severe or sudden neurological symptoms.