Hydrocephalus

Overview

Hydrocephalus is a build-up of fluid inside the skull that can increase pressure on the brain. It is sometimes called 'water on the brain', but the fluid is actually a clear liquid that normally protects and nourishes the brain and spinal cord. When too much of this fluid collects, it can cause symptoms and, if left untreated, brain damage.

Hydrocephalus is not very common, but it is one of the most treatable brain conditions. In the UK, about 1 in 1,000 babies is born with hydrocephalus. A form called normal pressure hydrocephalus (NPH) mainly affects older adults.

Hydrocephalus can affect anyone, but it is most often seen in infants, in people who have had a brain injury, infection, or brain surgery, and in adults over 60 with normal pressure hydrocephalus.

Symptoms

Common symptoms

• Headache
• Nausea and vomiting
• Blurred or double vision
• Balance problems or dizziness
• Drowsiness or difficulty waking up
• Problems with memory or concentration

Symptoms in children

• An unusually large head or a rapid increase in head size
• A bulging soft spot on the top of the head (fontanelle)
• Eyes that appear to look downward (sometimes called 'sunset eyes')
• Irritability or high-pitched crying
• Poor feeding or projectile vomiting
• Seizures (fits)

Symptoms in older adults

• Difficulty walking, often described as feeling like the feet are stuck to the floor
• Memory loss or confusion
• Slowness in thinking and reaction
• Loss of bladder control (urinary incontinence)
• Mood changes, such as low mood or apathy

Causes

Main causes

• Congenital causes: present at birth, often due to a brain malformation (such as aqueductal stenosis or spina bifida)
• Acquired causes: develop after a brain injury, brain tumour, bleeding in the brain, or infection like meningitis
• Normal pressure hydrocephalus (NPH): usually has no clear cause and mainly affects older adults

Risk factors

• Premature birth (before 37 weeks)
• Bleeding in the brain, especially in premature infants
• Infection of the brain or spinal cord (meningitis)
• Head injury
• Brain tumour or brain surgery
• Some genetic conditions (rare)

When to see a doctor

See a doctor urgently if:

• If you or your child has any of the emergency symptoms listed above, call emergency services immediately (999 in the UK).
• If you have a shunt and notice signs of raised pressure—such as a severe headache, vomiting, or increasing drowsiness—seek emergency care right away.

Book a routine appointment if:

• If you have persistent headaches, vision changes, or balance problems, make an appointment with your GP.
• If you are an older adult and have difficulty walking, memory problems, or loss of bladder control, see a doctor for assessment — it could be normal pressure hydrocephalus.

Diagnosis

A doctor assesses your symptoms, medical history, and physical signs, then arranges a brain scan to measure the fluid spaces (ventricles) in the brain.

Tests that may be done

• CT scan (computed tomography) – a quick X-ray-based scan that shows the brain's structure
• MRI scan (magnetic resonance imaging) – provides more detailed pictures of brain tissue and fluid spaces
• Cranial ultrasound – used in babies with an open fontanelle (soft spot) to see the brain

What to expect at your appointment

You may be referred to a neurologist or neurosurgeon. The scans are painless and usually take 15–30 minutes. The doctor may also ask about your ability to think, walk, and control your bladder. If the diagnosis is unclear, a lumbar puncture (spinal tap) may be done to check the fluid pressure in and around the brain.

Treatment

The main treatment for hydrocephalus is surgery to reduce the pressure on the brain. There are two common surgical approaches: a shunt (a thin tube that drains extra fluid to the belly) or an endoscopic third ventriculostomy (a procedure that creates a small alternative drainage path). Medication is not used as a long-term cure, but it may be given temporarily in some cases.

Self-care at home

• Attend all follow-up appointments with your healthcare team
• Learn the signs of shunt failure, such as headache, vomiting, drowsiness, or a change in vision
• Protect your head – wear a helmet when cycling, skiing, or playing contact sports
• Carry a medical ID card or bracelet that says you have hydrocephalus and, if applicable, a shunt

Medical treatments

Surgical treatments such as shunt placement and endoscopic third ventriculostomy are the standard care. In some situations, medicines that reduce the amount of cerebrospinal fluid the brain produces may be used for a short time, but they are not a permanent solution. A neurosurgeon will explain which approach is best for your situation.

When is surgery considered?

Surgery is needed for almost all people with hydrocephalus. The choice of operation depends on your age, the cause of the fluid build-up, and where the blockage is. Your surgical team will explain what the operation involves, the possible risks, and what follow-up care you will need.

Living with this condition

Living with hydrocephalus means staying alert to changes in your body and brain. Most people with treated hydrocephalus study, work, and continue with their families and interests. Regular check-ups help make sure the treatment is working.

Lifestyle tips

• Stay physically active, but follow your doctor's advice about activities that could risk a head injury
• Limit contact sports or anything that might cause a blow to the head
• Keep a written list of your medications, allergies, and any shunt details
• Get enough rest and find healthy ways to manage stress

Diet and exercise

A balanced, healthy diet supports your overall wellbeing. There is no special diet for hydrocephalus, but staying well hydrated is important — aim for 6–8 glasses of fluid a day. Moderate exercise like walking, swimming, or cycling is usually safe, but speak to your doctor if you have balance issues or are newly out of hospital.

Mental health and emotional wellbeing

Living with a long-term condition can feel overwhelming at times. It's normal to feel anxious, frustrated, or low. Talk to your GP about counselling or mental health support. Remember that you are not alone—many people with hydrocephalus live well with the right treatment and support.

Prevention

Hydrocephalus itself cannot always be prevented, because it can result from brain malformations or spontaneous bleeding. However, you can lower your risk of acquired hydrocephalus by protecting your head from injuries and treating infections early.

Vaccines

Vaccinations that prevent meningitis—such as the Hib and pneumococcal vaccines—can reduce the risk of developing hydrocephalus after that infection. In the UK, these vaccines are part of the routine childhood immunisation schedule.

Screening programmes

During pregnancy, some brain abnormalities that might lead to hydrocephalus can be seen on a routine ultrasound scan. Most cases, however, are diagnosed after birth or when symptoms appear.

Complications

If left untreated

• Permanent brain damage, leading to learning difficulties or intellectual disability
• Vision problems, including blindness
• Movement problems, such as difficulty walking and poor coordination
• Urinary incontinence
• In severe cases, coma or death

Long-term outlook

With early diagnosis and treatment, the outlook is often very good. Many people with hydrocephalus live healthy and fulfilling lives. Some may need shunt revisions from time to time, but long-term outcomes continue to improve with modern surgical care.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.