Hydrocephalus — Water on the Brain: Causes, Symptoms and Treatment in Children and Adults

Hydrocephalus — literally "water head" — is the abnormal accumulation of cerebrospinal fluid (CSF) within the brain's ventricular system, producing ventricular dilatation and elevated intracranial pressure. CSF is produced by the choroid plexus, circulates through the ventricular system, and is reabsorbed into the bloodstream. When any part of this circulation is blocked, or reabsorption fails, CSF accumulates. Hydrocephalus can occur at any age — from premature infants to the elderly — and the clinical presentation varies dramatically by age and cause.

Types of Hydrocephalus

Obstructive (non-communicating): CSF flow is blocked within the ventricular system — most commonly at the narrow aqueduct of Sylvius (aqueductal stenosis — often congenital) or by tumours, blood clots, or cysts blocking CSF flow. Surgical intervention urgently needed.

Communicating hydrocephalus: CSF can flow freely between ventricles but reabsorption is impaired — typically after meningitis, subarachnoid haemorrhage, or trauma, which scars the arachnoid granulations (reabsorption sites). CSP accumulates progressively.

Normal Pressure Hydrocephalus (NPH): A specific communicating hydrocephalus of the elderly — enlarged ventricles without high CSF pressure. Presents with the classic triad: gait disturbance (wide-based, magnetic gait — "walking as if feet are stuck to the floor"); urinary incontinence; and cognitive decline. This triad in an elderly patient is NPH until proven otherwise. Highly treatable with CSF shunting — the gait improves dramatically within days of shunting.

Warning Signs in Infants

Head circumference growing too fast (crossing percentile lines upward on growth chart); bulging fontanelle; downward gaze deviation ("sunsetting sign"); irritability; vomiting; prominent scalp veins. Early recognition prevents irreversible brain compression damage.

Warning Signs in Older Children and Adults

Headache worse in the morning and on lying down; nausea and vomiting; blurred or double vision; drowsiness; gait problems; cognitive deterioration.

Treatment

Ventriculoperitoneal (VP) shunt: a tube inserted surgically from a ventricle to the peritoneal cavity, draining excess CSF continuously. Highly effective but requires monitoring for shunt malfunction and infection. Endoscopic third ventriculostomy (ETV): a hole is created in the floor of the third ventricle to bypass obstruction — preferred for obstructive hydrocephalus, avoids implanted hardware.

For hydrocephalus evaluation and neurological assessment: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.