What is normal pressure hydrocephalus?

It's a form of hydrocephalus that mainly affects adults over 60, causing unsteady walking, memory problems and bladder urgency. It's often mistaken for dementia, yet it can improve with a shunt.

What's the difference between hydrocephalus in adults vs children?

A baby's skull can still expand, so the head grows unusually fast. An adult's skull can't, so the pressure causes headaches, walking problems or memory changes instead.

What causes hydrocephalus?

Common causes are bleeding in the brain, a fluid channel that's narrow from birth, tumours or cysts, and scarring after meningitis or head injury. Sometimes no clear cause is found.

How is hydrocephalus diagnosed?

A CT or MRI scan confirms it by showing enlarged ventricles, and young babies can often be checked with an ultrasound. Adults with suspected NPH may also have a tap test.

What is a shunt, and can it stop working?

A shunt is a thin tube with a valve that drains extra brain fluid, usually into the abdomen. Shunts can block or get infected, so knowing the warning signs really matters.

What's the difference between a standard and a programmable shunt valve?

A standard valve has a fixed drainage setting. A programmable valve lets Dr. Sunkara adjust that setting from outside the body, without needing another operation.

Can hydrocephalus be treated without surgery?

Mild, stable cases may only need regular scans and monitoring. Once hydrocephalus causes symptoms, a shunt or ETV is the standard treatment, since medicine alone can't drain the fluid long term.

Can hydrocephalus be fatal?

Untreated hydrocephalus that keeps worsening can be life-threatening as pressure on the brain builds. With timely treatment and regular follow-up, many people go on to live a normal lifespan.

What Is Hydrocephalus? Types & Causes

Q: What is hydrocephalus?

Hydrocephalus is a buildup of cerebrospinal fluid in the brain's ventricles that raises pressure on brain tissue. It affects babies, children and adults, and is usually treated with a shunt or ETV.

Overview

Hydrocephalus in Adults vs Children

Quick Answer

Hydrocephalus is a buildup of cerebrospinal fluid inside the brain's ventricles, the fluid-filled spaces deep in the brain. The extra fluid widens the ventricles and presses on the brain tissue around them. It can affect babies, children and adults, and in most cases it's treatable with a shunt or an endoscopic procedure.

Hydrocephalus diagram showing enlarged fluid-filled ventricles pressing on the surrounding brain — Hydrocephalus: fluid builds up in the brain's ventricles, which swell and press outward on the brain tissue around them.

Here's what surprises most families: your brain makes about half a litre of cerebrospinal fluid every day. Normally it flows through the ventricles, cushions the brain and spinal cord, then gets absorbed into the bloodstream. Hydrocephalus starts when that cycle breaks. The fluid gets blocked, isn't absorbed properly or, rarely, is overproduced. With nowhere to go, it builds up and raises pressure. And where exactly the flow breaks down decides which treatment works best.

Hydrocephalus is most common in babies and adults over 60. A baby's skull can still stretch, so the head grows unusually fast. Pediatric Neurosurgery → An adult's skull can't, so pressure shows up as headaches, vision disturbances, unsteady walking or memory changes. Not every problem needs a surgery, either; some enlarged ventricles only need watching.

Types

Types of Hydrocephalus

Your scan report will usually name one of these. The label matters because it tells Dr. Sunkara where the fluid is getting stuck, and that shapes which treatment is most likely to work.

Communicating

Fluid moves freely between the ventricles but isn't absorbed properly afterwards, often after bleeding, meningitis or a head injury scars the absorption sites.

Obstructive

Also called non-communicating. Something physically blocks the fluid's pathway, most often a narrowed channel, a tumour or a cyst, so fluid backs up behind it.

Normal Pressure

A form of communicating hydrocephalus in older adults. Pressure readings look normal, yet walking, memory and bladder control slowly worsen, and often improve with treatment.

Congenital

Present at birth, from how the brain developed in the womb or alongside conditions like spina bifida. It can be communicating or obstructive in type.

Symptoms

Signs of Hydrocephalus To Recognise

MORNING HEADACHE
A headache that's often worst on waking, sometimes with nausea or vomiting, because fluid pressure tends to build while you lie flat overnight.
VISION DISTURBANCES
Blurred or double vision, and sometimes brief flickering or dimming of sight, as rising fluid pressure presses on the nerves and pathways behind the eyes.
UNSTEADY WALKING
A slow, shuffling, wide-based walk where the feet seem stuck to the floor. It's the most typical early sign of normal pressure hydrocephalus.
MEMORY CHANGES
Forgetfulness, slower thinking and trouble concentrating that creep in over months, and are easily put down to ageing or early dementia.
BLADDER URGENCY
A sudden, frequent need to pass urine, or leaks before reaching the toilet, especially when walking and memory are changing at the same time.
FAST HEAD GROWTH
In babies, a head that grows faster than expected, a tense or bulging soft spot, poor feeding, irritability, or eyes that seem fixed downward.

When To Worry

Most Hydrocephalus Develops Slowly

Hydrocephalus usually builds over weeks or months, which leaves time for a planned visit and proper scans. What matters more than any single symptom is a sudden change, especially if you already have a shunt, since a blockage can raise pressure within hours.

Seek Immediate Care If You Also Have:

Sudden severe headache with repeated vomiting
Unusual drowsiness or trouble staying awake
A seizure, especially a first one
Sudden double vision or blurred eyesight
A baby's soft spot tense and bulging
Headache, fever or vomiting with a shunt

Causes

Common Hydrocephalus Causes

01
Bleeding in the Brain
Blood from a brain haemorrhage, including bleeding in premature babies, can clog the tiny absorption sites, so fluid keeps being made but can't drain away.
02
Narrowed Fluid Channel
The narrow channel linking two of the brain's ventricles, called the aqueduct, can be too tight from birth or narrow later, backing fluid up behind it.
03
Tumours and Cysts
A tumour or cyst near the ventricles can press on the fluid pathway. Removing or shrinking it sometimes clears the hydrocephalus without any further surgery.
04
Infection or Head Injury
Meningitis or a serious head injury can leave scarring on the brain's lining, which slows how fluid is absorbed, sometimes weeks after the original illness.
05
Normal Pressure Hydrocephalus (NPH)
Normal pressure hydrocephalus mostly affects older adults, often with no clear trigger, and typically brings difficulty walking, memory or thinking changes, and bladder control problems.

Who's More Likely To Develop Hydrocephalus

PREMATURE BIRTH
Babies born very early are more prone to bleeding inside the ventricles, one of the leading triggers in newborns.
SPINA BIFIDA
Most babies born with myelomeningocele, the severe form of spina bifida, also develop hydrocephalus and need close monitoring from birth.
AGE OVER 60
Normal pressure hydrocephalus mostly affects people in their sixties and older, when its signs are easily mistaken for ordinary ageing.
PAST BRAIN EVENTS
A previous brain bleed, meningitis, brain surgery or serious head injury raises the chance of fluid building up later.

Diagnosis

How Hydrocephalus Is Diagnosed

01
History & Exam
Dr. Sunkara asks how symptoms began and how quickly they've changed, then checks walking, balance, memory and eye movements. In babies, head size is measured against expected growth charts.
02
CT or MRI Scan
Brain imaging is the test that confirms it, showing enlarged ventricles and often the point where flow is blocked. In young babies, an ultrasound through the soft spot works without radiation.
03
Tap Test & Plan
For suspected normal pressure hydrocephalus, draining a little spinal fluid shows whether walking improves, a strong hint a shunt will help. Your results then point to monitoring, a shunt or ETV.

Treatment

How Hydrocephalus Is Treated

Worried that treatment means major brain surgery? Both standard procedures work through small openings, and the aim is simple: give the trapped fluid a new way to drain.

MILD, STABLE CASES
may only need regular scans and check-ups when the ventricles aren't growing and there are no symptoms.
MOST SYMPTOMATIC CASES
are treated with a shunt or ETV, both of which give the trapped fluid a reliable new route out.
SOME CASES
also need the underlying cause treated, such as a tumour or cyst that's blocking the fluid's normal path.

Treatment Options Dr. Sunkara Offers

01
Monitoring
NON-SURGICAL
Mildly enlarged ventricles without symptoms, or hydrocephalus that has stopped progressing, may only need regular scans and check-ups over time.
02
Shunt Surgery
SURGICAL
A thin tube drains extra fluid from the brain to the abdomen, where it's absorbed naturally. A valve, fixed or programmable, controls the flow, and the shunt stays in long term.
03
Endoscopic Third Ventriculostomy
SURGICAL
A tiny camera passes through a small opening to create a new drainage path inside the brain, with no implant left behind. It suits many obstructive cases.
04
Treating the Cause
SURGICAL
When a tumour or cyst is blocking the fluid pathway, removing it can restore normal flow, sometimes without a shunt being needed afterwards.
See Brain Tumor Surgery →

Outlook

Is Hydrocephalus Curable?

Usually it's managed rather than cured, and managed well. Many patients arrive expecting the worst, then find that once the fluid drains properly, headaches ease and walking steadies. Many children with treated hydrocephalus grow up to study, work and live full lives, with regular check-ups along the way.

OVER 80% OF NPH CASES
may go unrecognised or untreated, because the signs get put down to ageing, so a scan is worth asking for.
WALKING OFTEN IMPROVES FIRST
after a shunt for normal pressure hydrocephalus, while memory and bladder changes respond more slowly, which is why earlier treatment tends to help more.
IF IGNORED
rising fluid pressure can permanently damage brain tissue and eyesight, and in babies it can hold back development, so waiting rarely pays off.

Living With It

Living Well With a Shunt

Most of daily life carries on as normal. A few habits keep treatment working well.

Dr. Raveesh Sunkara at his consultation desk, talking a patient through their condition

KNOW YOUR VALVE
If your shunt has a programmable valve, ask whether MRI scans or strong magnets can reset it, and keep your valve card with you.
LEARN THE WARNING SIGNS
Headache, vomiting, drowsiness or the return of old symptoms can mean a blocked shunt, so get checked the same day.
KEEP YOUR FOLLOW-UPS
Regular reviews and scans catch slow changes early, even when you feel well, and keep small problems from turning into urgent ones.
STAY ACTIVE
Most people with a shunt walk, swim, study and work normally. Check with your surgeon before contact sports or very heavy exertion.

Before Your Appointment

Questions To Ask Your Doctor

01
Which type of hydrocephalus does my scan show, and what's causing it?
02
Is a shunt or ETV the better option in my case?
03
Could my walking or memory problems be normal pressure hydrocephalus?
04
Which symptoms should send me straight to the emergency department?
05
How often will I need follow-up scans after treatment?

Told You Need A Shunt Or ETV?

A second opinion reviews your scans and options, so you can go ahead with surgery feeling sure it's the right step.

Get Second OpinionCase Review

TESTIMONIALS

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Review summary

Her father had a grade 4 brain haemorrhage. Dr. Sunkara explained how critical it was, took every necessary step including a shunt, then guided his rehab.

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Brain haemorrhage

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Review summary

Her relative was admitted with a severe brain injury. Close monitoring and timely surgery led to a remarkable recovery, and he now leads a normal life.

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Severe brain injury

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Their parent was treated in an emergency and recovered after successful brain surgery. Dr. Sunkara even visited during rehab to check on progress.

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Emergency brain surgery

What Is Hydrocephalus?

Hydrocephalus in Adults vs Children

Types of Hydrocephalus

Communicating

Obstructive

Normal Pressure

Congenital

Signs of Hydrocephalus To Recognise

Most Hydrocephalus Develops Slowly

Common Hydrocephalus Causes

Bleeding in the Brain

Narrowed Fluid Channel

Tumours and Cysts

Infection or Head Injury

Normal Pressure Hydrocephalus (NPH)

Who's More Likely To Develop Hydrocephalus

How Hydrocephalus Is Diagnosed

History & Exam

CT or MRI Scan

Tap Test & Plan

How Hydrocephalus Is Treated

Treatment Options Dr. Sunkara Offers

Monitoring

Shunt Surgery

Endoscopic Third Ventriculostomy

Treating the Cause

Is Hydrocephalus Curable?

Living Well With a Shunt

Questions To Ask Your Doctor

Told You Need A Shunt Or ETV?

Trusted By Families Across India And Abroad.

Your Hydrocephalus Questions, Answered

Has Your Scan Report Mentioned Enlarged Ventricles?