Symptoms and Diagnosis

Symptoms of Hydrocephalus

The symptoms of untreated hydrocephalus vary. During pregnancy, routine ultrasound can detect enlarged ventricles or spaces within a baby’s brain. In an infant, the most obvious sign of hydrocephalus is an abnormal enlargement of the baby’s head. In children symptoms tend to be related to high pressure and may include nausea, vomiting, headache and vision problems.

In young and middle aged adults symptoms most often include dizziness and vision problems. In older adults with normal pressure hydrocephalus (NPH) the symptoms are more likely to be loss of function in three main areas: walking, thinking and bladder control.

Infants and Children

  • Abnormal head enlargement
  • Tense, bulging fontanel
  • Prominent scalp veins
  • Skull bones may feel separated
  • Vomiting, sleepiness, irritability
  • Headache, nausea, vomiting, vision
  • Downward deviation of eyes

Young and Middle Aged Adults

  • Chronic headaches
  • Difficulty walking/gait disturbances
  • Cognitive challenges or complaints
  • Urinary urgency or incontinence

Older Adults (NPH)

  • Difficulty walking/gait disturbances
  • Cognitive challenges/mild dementia
  • Urinary urgency or incontinence

Diagnosing Hydrocephalus

The most common initial diagnostic test to determine hydrocephalus at any age is an image of the brain using CT or MRI to identify if the ventricles or spaces within the brain are enlarged. More tests are often performed in adults in order to diagnosis the condition. The decision to order a particular test may depend on the specific clinical situation, as well as the preference and experience of the medical team. Not all of the tests described here are required in order to make a diagnosis.

  • Clinical exams to evaluate symptoms consist of an interview and/or physical neurological examination.
  • Brain images to detect enlarged ventricles commonly include magnetic resonance imaging (MRI) and computerized tomography (CT).
  • CSF tests to predict shunt responsiveness and/or determine shunt pressure include lumbar puncture, external lumbar drainage, measurement of CSF outflow resistance, intracranial pressure (ICP) monitoring and isotopic cisternography.

The following links provide information about the signs, symptoms and diagnostic tests for hydrocephalus in various age groups.

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