10 Key Hydrocephalus Symptoms You Should Never Ignore

Hydrocephalus, commonly known as “water on the brain,” is a serious medical condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF) within the brain’s ventricles. This buildup creates pressure on brain tissue, which can lead to a variety of neurological symptoms ranging from mild to severe. Understanding the symptoms of hydrocephalus is crucial for early detection and timely medical intervention, as delayed treatment can result in permanent brain damage or life-threatening complications.

The symptoms of hydrocephalus can vary significantly depending on the patient’s age, the rate of CSF accumulation, and whether the condition is congenital or acquired. In infants, the signs may differ from those in children, adults, or elderly individuals. This comprehensive guide will help you recognize the key warning signs of hydrocephalus across different age groups, enabling you to seek appropriate medical care when necessary.

1. Persistent and Severe Headaches

Headaches are one of the most common and noticeable symptoms of hydrocephalus, particularly in older children and adults. These headaches are caused by increased intracranial pressure resulting from excess cerebrospinal fluid accumulation. Unlike typical tension headaches, hydrocephalus-related headaches tend to be more severe and persistent.

The headaches associated with hydrocephalus often exhibit specific characteristics:

• They are typically worse in the morning upon waking, as lying flat allows more fluid to accumulate
• They may be accompanied by nausea and vomiting
• They often worsen with activities that increase intracranial pressure, such as coughing, sneezing, or straining
• They may temporarily improve when sitting or standing upright
• They progressively worsen over time without treatment

If you experience persistent headaches with these characteristics, especially when combined with other neurological symptoms, it’s essential to consult a healthcare provider immediately for proper evaluation.

2. Enlarged Head in Infants

In infants and young children whose skull bones have not yet fused, an abnormally large or rapidly growing head circumference is often the most visible sign of hydrocephalus. This occurs because the excess cerebrospinal fluid causes the ventricles to expand, which in turn pushes outward on the flexible skull bones.

Healthcare providers monitor head circumference carefully during routine pediatric checkups, comparing measurements to standard growth charts. Warning signs include:

• Head circumference that exceeds the 95th percentile for age
• Rapid increase in head size over a short period
• A bulging or tense soft spot (fontanelle) on top of the head
• Prominent scalp veins due to increased blood flow
• Disproportionately large forehead
• Downward deviation of the eyes (known as “sunsetting”)

Parents should never ignore unusual head growth patterns in their infants, as early detection and treatment of hydrocephalus can prevent serious complications and improve long-term outcomes.

3. Vision Problems and Eye Movement Abnormalities

Visual disturbances are common symptoms of hydrocephalus because increased intracranial pressure can affect the optic nerves and the parts of the brain responsible for vision and eye movement control. These vision-related symptoms can range from subtle changes to significant impairment.

Common vision problems associated with hydrocephalus include:

• Blurred or double vision: Caused by pressure on the optic nerves or eye movement control centers
• Papilledema: Swelling of the optic disc that can be detected during an eye examination
• Difficulty focusing: Problems maintaining clear vision at different distances
• Downward gaze deviation: Eyes appearing to look downward constantly (sunsetting sign)
• Nystagmus: Involuntary, rapid eye movements
• Loss of peripheral vision: Reduced ability to see objects to the sides
• Light sensitivity: Increased discomfort in bright environments

If left untreated, vision problems caused by hydrocephalus can become permanent, making prompt medical evaluation essential when these symptoms appear.

4. Nausea and Vomiting

Nausea and vomiting are frequent symptoms of hydrocephalus, particularly when the condition develops or worsens rapidly. These symptoms result from increased intracranial pressure affecting the brain’s vomiting center and are often most severe in the morning hours.

Characteristics of hydrocephalus-related nausea and vomiting include:

• Vomiting that occurs without prior nausea (projectile vomiting)
• Symptoms that are worse upon waking and may improve as the day progresses
• Vomiting not related to food intake or gastrointestinal illness
• Nausea that accompanies headaches
• Persistent symptoms that don’t respond to typical anti-nausea remedies

When nausea and vomiting occur alongside other neurological symptoms such as headaches, vision changes, or balance problems, they should be evaluated by a medical professional to rule out hydrocephalus or other serious conditions.

5. Balance and Coordination Difficulties

Problems with balance, coordination, and walking are hallmark symptoms of hydrocephalus, especially in adults and elderly patients. These symptoms occur because excess cerebrospinal fluid puts pressure on brain regions responsible for motor control and coordination, particularly the cerebellum and motor cortex.

Balance and coordination issues in hydrocephalus may manifest as:

• Gait disturbances: Difficulty walking, often described as a shuffling, magnetic, or wide-based gait
• Frequent falls: Increased risk of falling or loss of balance
• Poor coordination: Difficulty performing tasks requiring fine motor skills
• Clumsiness: Dropping objects or bumping into things more frequently
• Difficulty turning: Problems changing direction while walking
• Slow movements: Reduced speed of physical activities

In normal pressure hydrocephalus, a condition affecting primarily older adults, gait disturbance is often one of the earliest and most prominent symptoms, sometimes preceding other signs by months or years.

6. Cognitive Impairment and Memory Problems

Hydrocephalus can significantly impact cognitive function, affecting memory, concentration, thinking speed, and overall mental performance. These cognitive symptoms result from pressure on brain tissue and disruption of normal neural pathways, and they can range from subtle changes to severe dementia-like symptoms.

Cognitive symptoms associated with hydrocephalus include:

• Short-term memory loss: Difficulty remembering recent events or conversations
• Reduced attention span: Problems concentrating or maintaining focus
• Slowed thinking: Taking longer to process information or respond to questions
• Executive dysfunction: Difficulty with planning, organizing, and problem-solving
• Confusion or disorientation: Uncertainty about time, place, or situation
• Difficulty learning new information: Reduced ability to acquire new skills or knowledge
• Mental fog: A general sense of unclear thinking

In elderly patients with normal pressure hydrocephalus, cognitive decline may be mistaken for Alzheimer’s disease or other forms of dementia, making proper diagnosis crucial. Unlike most forms of dementia, cognitive symptoms from hydrocephalus may improve with appropriate treatment.

7. Sleepiness and Lethargy

Excessive sleepiness, fatigue, and lethargy are common but often overlooked symptoms of hydrocephalus. The accumulation of cerebrospinal fluid affects brain function broadly, leading to reduced alertness and energy levels. These symptoms can significantly impact daily functioning and quality of life.

Sleep and energy-related symptoms include:

• Increased need for sleep or frequent napping
• Difficulty waking up in the morning
• Persistent tiredness despite adequate rest
• Reduced motivation and initiative (apathy)
• Difficulty staying awake during normal activities
• General lack of energy throughout the day

In infants with hydrocephalus, lethargy may present as excessive sleepiness, poor feeding, lack of interest in surroundings, or decreased responsiveness to stimulation. Parents should be alert to significant changes in their child’s energy levels and sleep patterns.

8. Irritability and Personality Changes

Changes in mood, behavior, and personality are significant symptoms of hydrocephalus, particularly affecting the emotional regulation centers of the brain. These changes can be subtle initially but may become more pronounced as the condition progresses.

Behavioral and personality symptoms may include:

• Increased irritability: Becoming easily frustrated or angry
• Mood swings: Rapid or unpredictable emotional changes
• Social withdrawal: Losing interest in social activities or interactions
• Apathy: Lack of interest or emotional response to previously enjoyable activities
• Aggression: Uncharacteristic hostile or combative behavior
• Depression or anxiety: Persistent sadness or excessive worry
• Reduced emotional expression: Flat affect or diminished emotional responses

In children, these changes might manifest as fussiness, excessive crying, poor feeding, or developmental regression. In adults, family members often notice that their loved one “isn’t acting like themselves,” which can be an important early warning sign.

9. Seizures

Seizures can occur in some individuals with hydrocephalus, though they are less common than other symptoms. Seizures result from abnormal electrical activity in the brain, which can be triggered by the pressure effects and structural changes caused by excess cerebrospinal fluid.

Seizure activity in hydrocephalus may present as:

• Convulsions or uncontrolled shaking movements
• Loss of consciousness or awareness
• Staring spells or brief periods of unresponsiveness
• Muscle stiffness or rhythmic jerking
• Temporary confusion following the episode
• Various types of seizures, from focal to generalized

Any seizure activity, especially when accompanied by other symptoms of hydrocephalus, requires immediate medical evaluation. Seizures can be particularly dangerous in infants and young children and should never be ignored.

10. Urinary Incontinence

Urinary incontinence, or loss of bladder control, is a significant symptom particularly associated with normal pressure hydrocephalus in adults and elderly patients. This symptom results from the pressure effects on brain regions that control bladder function.

Bladder control problems in hydrocephalus typically include:

• Urge incontinence: Sudden, intense need to urinate with inability to reach the bathroom in time
• Frequency: Needing to urinate more often than normal
• Nocturia: Waking multiple times during the night to urinate
• Complete loss of control: Involuntary urination without awareness or warning
• Urgency without incontinence: Strong urges to urinate even with an empty bladder

In the classic triad of normal pressure hydrocephalus, urinary incontinence typically appears after gait disturbance and cognitive decline have already developed. However, the timing and severity of symptoms can vary among individuals. Bladder control problems can significantly impact quality of life and should be discussed with healthcare providers, especially when occurring with other neurological symptoms.

Common Causes of Hydrocephalus

Understanding what causes hydrocephalus can help with recognition and early detection. The condition develops when there is an imbalance between cerebrospinal fluid production and absorption. Several factors can lead to this imbalance:

• Congenital defects: Birth defects affecting brain development, such as spina bifida or aqueductal stenosis, can cause hydrocephalus present at birth
• Intraventricular hemorrhage: Bleeding within the brain’s ventricles, particularly common in premature infants, can obstruct CSF flow
• Infections: Meningitis, encephalitis, or other brain infections can cause inflammation that blocks CSF pathways
• Brain tumors: Growths in or near the ventricles can obstruct cerebrospinal fluid circulation
• Traumatic brain injury: Head injuries can damage tissues involved in CSF production or absorption
• Subarachnoid hemorrhage: Bleeding on the brain’s surface can interfere with CSF absorption
• Cysts or lesions: Abnormal fluid-filled sacs can block CSF pathways
• Age-related changes: In normal pressure hydrocephalus, the exact cause is often unknown but may relate to aging processes
• Complications of prematurity: Premature babies face higher risk due to underdeveloped brain structures

In many cases, especially with normal pressure hydrocephalus in older adults, the exact cause cannot be identified. Regardless of the underlying cause, recognizing symptoms early is essential for preventing complications.

Prevention Strategies

While not all cases of hydrocephalus can be prevented, certain measures may reduce the risk or help with early detection:

• Prenatal care: Regular prenatal checkups and ultrasounds can detect some forms of congenital hydrocephalus before birth, allowing for planning and early intervention
• Vaccination: Keeping up-to-date with vaccinations, particularly those preventing meningitis and other infections, can reduce infection-related hydrocephalus risk
• Head injury prevention: Using appropriate safety equipment (helmets, seatbelts), childproofing homes, and preventing falls can reduce traumatic brain injury risk
• Prompt treatment of infections: Seeking immediate medical care for suspected brain or spinal cord infections can prevent complications
• Regular pediatric checkups: Monitoring infant head circumference growth patterns enables early detection of developing hydrocephalus
• Pregnancy health: Maintaining good health during pregnancy, including adequate folic acid intake, may reduce risk of neural tube defects associated with hydrocephalus
• Awareness of symptoms: Being familiar with hydrocephalus warning signs allows for earlier medical consultation and diagnosis

For individuals who have conditions that increase hydrocephalus risk (such as brain tumors, previous brain infections, or premature birth), regular monitoring by healthcare providers is important for early detection should the condition develop.

Frequently Asked Questions

What is the main difference between hydrocephalus in babies and adults?

In babies, hydrocephalus typically causes visible head enlargement because their skull bones haven’t fused yet. Adults have rigid skulls, so their symptoms focus more on headaches, cognitive problems, balance difficulties, and urinary incontinence. The underlying condition is the same—excess cerebrospinal fluid—but the manifestations differ based on skull flexibility.

Can hydrocephalus symptoms appear suddenly or do they develop gradually?

Both patterns can occur. Acute hydrocephalus develops rapidly, often over hours or days, with sudden severe symptoms requiring emergency care. Chronic hydrocephalus develops gradually over weeks, months, or years with slowly progressive symptoms. Normal pressure hydrocephalus in elderly patients typically has a very gradual onset.

Is hydrocephalus the same as water on the brain?

Yes, “water on the brain” is a common term for hydrocephalus. However, the fluid isn’t actually water—it’s cerebrospinal fluid (CSF), a clear liquid that normally cushions and protects the brain and spinal cord. In hydrocephalus, this fluid accumulates excessively in the brain’s ventricles.

Can hydrocephalus go away on its own?

Hydrocephalus rarely resolves without treatment. Most cases require medical intervention to drain excess cerebrospinal fluid and relieve pressure on the brain. Without treatment, hydrocephalus typically worsens over time and can cause permanent brain damage or be life-threatening.

What age group is most commonly affected by hydrocephalus?

Hydrocephalus can occur at any age, but it’s most common in two groups: infants (congenital or acquired in early life) and adults over 60 (particularly normal pressure hydrocephalus). However, anyone can develop hydrocephalus following brain injury, infection, tumor, or other causative events.

How quickly should I seek medical attention if I suspect hydrocephalus?

If you or someone you know experiences symptoms suggesting hydrocephalus—especially severe headaches, vision changes, altered consciousness, seizures, or rapid head growth in an infant—seek immediate medical evaluation. Early diagnosis and treatment are critical for preventing permanent brain damage and improving outcomes.

Can symptoms of hydrocephalus be mistaken for other conditions?

Yes, hydrocephalus symptoms can mimic other conditions. In elderly patients, normal pressure hydrocephalus is often mistaken for Alzheimer’s disease, Parkinson’s disease, or simply normal aging. In children, symptoms might be attributed to developmental delays or behavioral problems. Accurate diagnosis requires medical imaging and professional evaluation.

Are there different types of hydrocephalus with different symptoms?

Yes, the main types include communicating hydrocephalus (where CSF flow is blocked after leaving the ventricles), non-communicating or obstructive hydrocephalus (where flow is blocked within the ventricle system), and normal pressure hydrocephalus (with characteristic triad of gait disturbance, dementia, and urinary incontinence). While core symptoms overlap, each type may have distinctive features.

References:

• Mayo Clinic – Hydrocephalus
• National Institute of Neurological Disorders and Stroke – Hydrocephalus
• Johns Hopkins Medicine – Hydrocephalus
• NHS – Hydrocephalus
• Hydrocephalus Association