Hydrocephalus Symptoms: Early Signs, Causes & Diagnosis

Quick Glance: Common Hydrocephalus Symptoms

Listed below are some of the common signs and symptoms of hydrocephalus:

Persistent or worsening headache
Nausea or repeated vomiting
Blurred or double vision
Difficulty walking or maintaining balance
Unusual sleepiness or reduced alertness
Changes in memory, concentration or behaviour
Urinary urgency or loss of bladder control
Rapid head growth or a bulging fontanelle in infants

The symptom pattern of hydrocephalus varies considerably by age. While infants often show changes in head size and feeding, older adults with normal pressure hydrocephalus commonly develop walking, thinking and bladder-control problems.

Hydrocephalus Symptoms That Should Not Be Ignored

Persistent or worsening symptoms of hydrocephalus may indicate increasing pressure inside the brain and require prompt medical evaluation. Some hydrocephalus symptoms and what they may indicate are given in the table below:

Symptom	What It May Indicate
A persistent or progressively worsening headache	Increasing pressure or another neurological problem requiring assessment
Repeated vomiting without an obvious digestive cause	Possible raised pressure within the skull
Blurred or double vision	Pressure affecting visual pathways or eye movements
New difficulty walking or repeated falls	Impaired balance, coordination or movement control
Increasing drowsiness or reduced responsiveness	Worsening brain dysfunction or rising intracranial pressure
New confusion, memory loss or behavioural change	Cognitive effects of hydrocephalus or another neurological condition
Urinary urgency or incontinence with walking difficulty	Possible normal pressure hydrocephalus, particularly in an older adult
Rapidly increasing head circumference in an infant	Progressive ventricular enlargement
A bulging or tense fontanelle	Increased pressure in an infant’s skull
Loss of previously acquired developmental skills	Worsening neurological function in a child

Why Do Hydrocephalus Symptoms Occur?

Hydrocephalus develops when cerebrospinal fluid, or CSF, builds up within the brain’s ventricles because its flow is blocked, it is not absorbed properly or, rarely, too much is produced. The excess fluid enlarges the ventricles and may stretch or place pressure on nearby brain tissue.

This can affect areas involved in movement, balance, memory, behaviour, bladder control and vision, causing symptoms such as headache, vomiting, walking difficulty, confusion or blurred vision. In infants, the skull bones have not fully fused, so increased fluid may cause rapid head growth and a bulging fontanelle instead of a typical severe headache.

Hydrocephalus Symptoms That Require Immediate Medical Attention

Seek medical attention if you notice the following symptoms of hydrocephalus:

A severe or rapidly worsening headache
Repeated vomiting
Rapidly worsening vision
New walking difficulty or repeated falls
Increasing drowsiness or unusual behaviour
A rapidly growing head or bulging fontanelle in an infant
Poor feeding, repeated vomiting or a high-pitched cry in an infant
Headache, vomiting or recurrent symptoms in a person with a shunt

Emergency medical care is recommended if you see or experience the symptoms mentioned below:

A seizure
Loss of consciousness
Severe confusion or inability to respond
Difficulty breathing
Sudden weakness or inability to walk
Extreme drowsiness progressing towards unconsciousness
Fever with neck stiffness, worsening neurological symptoms or redness along a shunt
Sudden severe headache with repeated vomiting

These signs may indicate rapidly increasing intracranial pressure, acute obstruction, shunt failure, shunt infection or another neurological emergency.

Symptoms of Hydrocephalus Based on Type

Hydrocephalus can be classified according to when it develops, how CSF flow is affected and the age-related pattern of symptoms. Since these categories overlap, imaging is required to identify the underlying type.

Symptoms of hydrocephalus, based on its type, are summarised in the table below:

Hydrocephalus Type or Presentation	Common Symptoms and Signs
Congenital Hydrocephalus	An unusually large or rapidly growing head, a bulging or tense fontanelle, visible scalp veins, poor feeding, vomiting, irritability, sleepiness, seizures, abnormal muscle tone and downward-looking or “sunsetting” eyes
Acquired Hydrocephalus	Headache, nausea, vomiting, blurred or double vision, drowsiness, confusion, balance problems, difficulty walking, poor coordination and loss of bladder control
Normal Pressure Hydrocephalus	Progressive walking difficulty, shuffling steps or feet that seem stuck to the floor, slowed thinking, memory problems, urinary urgency and urinary incontinence
Obstructive or Communicating Hydrocephalus	Symptoms overlap and may include headache, vomiting, vision changes, drowsiness, balance problems or cognitive changes; sudden obstruction may cause rapid and severe deterioration

Symptoms of Hydrocephalus-Related Presentations and Shunt Complications

People who have a CSF shunt require assessment if hydrocephalus symptoms return or new signs of infection develop. Shunt malfunction and infection are complications of treatment rather than separate forms of hydrocephalus.

The symptoms of these hydrocephalus-related presentations are given in the table below in brief:

Presentation or Complication	Common Symptoms and Signs
Shunt Malfunction or Blockage	Headache, nausea, vomiting, double vision, light sensitivity, drowsiness, seizures, balance problems, irritability in children and recurrence of previous hydrocephalus symptoms
Shunt Infection	Fever, redness, tenderness or swelling along the shunt, neck stiffness, headache, vomiting, unusual sleepiness, irritability and worsening neurological symptoms
Stable or Compensated Hydrocephalus	Few or no noticeable symptoms, stable neurological function and no clear progression; headache, cognitive change or walking difficulty may develop if the condition becomes active again

Hydrocephalus Symptoms in Children

Symptoms of hydrocephalus in children can vary according to the child's age. The following table shows the symptoms of hydrocephalus in children:

Age of the Child	Hydrocephalus Symptoms
Infants	Rapid increase in head size Bulging soft spot (fontanelle) Poor feeding Vomiting Excessive sleepiness Irritability Seizures Downward deviation of the eyes ("sunsetting eyes")
Toddlers or Older Children	Persistent headaches Difficulty walking Poor school performance Vision problems Balance difficulties Personality or behavioural changes Delayed development

Parents should seek medical evaluation if a child develops developmental delays, persistent headaches, repeated vomiting or noticeable changes in behaviour or movement.

Can You Have Hydrocephalus Without Symptoms?

Yes, Some people with slowly developing or compensated hydrocephalus may have few noticeable symptoms for some time. Ventricular enlargement may also be discovered incidentally during brain imaging performed for another reason.

However, enlarged ventricles on a scan do not always indicate active hydrocephalus. Doctors interpret imaging alongside walking, cognitive, visual and neurological findings. New headaches, balance problems, behavioural changes or bladder symptoms require reassessment even after a previously stable diagnosis.

When Can Hydrocephalus Symptoms Become Life-Threatening?

Hydrocephalus can become life-threatening when CSF pressure rises rapidly, vital brain structures are compressed or if a shunt becomes blocked or infected. Some of the complications of hydrocephalus and why they are serious are summarised in the table below:

Serious Complication	What Can Happen
Acute Obstructive Hydrocephalus	A sudden blockage causes CSF to accumulate rapidly, leading to severe headache, vomiting, drowsiness and neurological deterioration
Brain Herniation	Extreme pressure shifts and compresses brain tissue, affecting consciousness, breathing and other vital functions
Shunt Blockage or Failure	CSF drainage stops, allowing hydrocephalus symptoms and pressure to return quickly
Shunt Infection	Infection may spread to the CSF and cause meningitis, ventriculitis, sepsis or worsening brain dysfunction
Prolonged or Repeated Seizures	Ongoing seizure activity can impair breathing and cause brain injury
Brainstem Compression	Pressure on the brainstem can affect breathing, heart rate, alertness and protective reflexes

How are Hydrocephalus Symptoms Diagnosed?

Hydrocephalus is diagnosed by a neurologist or neurosurgeon by assessing symptoms, neurological function and brain imaging. The tests used depend on the patient’s age, suspected cause and whether symptoms developed suddenly or gradually. An overview of these tests and their purpose in diagnosing hydrocephalus is given in the table below:

Diagnostic Test or Assessment	Purpose
Medical and Symptom History	Identifies the symptom pattern and possible cause
Physical and Neurological Examination	Assesses the neurological effects and severity
Head Circumference Measurement	Detects abnormal or rapidly increasing head growth
Cranial Ultrasound	Provides an initial, low-risk assessment in babies
MRI of the Brain	Provides detailed imaging and helps identify the cause
CT Scan	Provides rapid imaging, particularly during an emergency
Eye Examination	Looks for the visual effects of raised intracranial pressure
Gait Assessment	Assesses suspected normal pressure hydrocephalus
Cognitive Assessment	Evaluates thinking changes, particularly in NPH
Large-Volume Lumbar Puncture or CSF Drainage Test	May help predict response to shunting in selected patients with suspected NPH
Intracranial-Pressure Monitoring	Used only in selected complex or uncertain cases

FAQs

Q1. What is usually the first symptom of hydrocephalus?

Ans: The initial symptoms of hydrocephalus depend on age. Infants may develop rapid head growth, while older children and adults often experience headaches, vomiting, vision changes or balance problems.
Q2. Can hydrocephalus occur without symptoms?

Ans: Yes, slowly developing or compensated hydrocephalus may cause very few noticeable symptoms and is sometimes discovered during brain imaging performed for another reason.
Q3. When should I consult a doctor for hydrocephalus?

Ans: You should seek medical advice if you have persistent headaches, repeated vomiting, balance or walking difficulties, memory changes, bladder problems or abnormal head growth in an infant.
Q4. What are the symptoms of normal pressure hydrocephalus?

Ans: The main symptoms of normal pressure hydrocephalus (NPH) include progressive difficulty walking, changes in memory or thinking, and urinary urgency or loss of bladder control.
Q5. Can hydrocephalus affect vision?

Ans: Yes, hydrocephalus can cause blurred or double vision, abnormal eye movements and swelling of the optic nerves due to increased pressure inside the skull.
Q6. What are the symptoms of hydrocephalus in babies?

Ans: Common symptoms in babies include rapid head growth, a bulging soft spot (fontanelle), poor feeding, vomiting, excessive sleepiness, irritability and downward-looking eyes.
Q7. What are the signs of a blocked shunt?

Ans: Headache, vomiting, drowsiness, vision changes, seizures, irritability or the return of previous hydrocephalus symptoms may suggest a shunt blockage or malfunction.
Q8. Which hydrocephalus symptoms indicate an emergency?

Ans: Seizures, loss of consciousness, breathing difficulty, severe confusion, rapidly worsening drowsiness or a sudden severe headache with repeated vomiting require immediate emergency medical care.