Adult Hydrocephalus

What is adult hydrocephalus?

Hydrocephalus is a complex neurological condition that affects approximately 1 million Americans, according to the Hydrocephalus Association. It is a condition in which cerebrospinal fluid (CSF) (a colorless, clear liquid that surrounds the brain and spinal cord) accumulates in the brain’s ventricles (four areas of brain). It is most often caused by an obstruction that disrupts the flow of CSF due to a failure of the body to reabsorb the CSF. If it is not present at birth or in childhood, hydrocephalus can develop in adults.

Among adults, a frequently diagnosed form is normal pressure hydrocephalus (NPH). While some types of hydrocephalus involve significantly elevated fluid pressure within the skull, NPH occurs when CSF accumulates in the ventricles while brain pressure remains normal or only slightly elevated. Despite this lack of high pressure, NPH can still cause distinct and impactful symptoms, such as balance issues, cognitive changes, and bladder control problems.

The experts at the AHN Hydrocephalus Center understand this condition and the challenges it can present to their adult patients. We are here to listen, assist, and find tailored treatment options that offer significant relief. Hydrocephalous can present challenges that extend beyond physical and medical needs, and our compassionate health care providers are here to support you in your emotional and mental well-being as well. 

AHN Adult Hydrocephalus Center

An adult hydrocephalus diagnosis can bring about complex emotions and concerns. The AHN Adult Hydrocephalus Center is focused on providing state-of-the-art care for our patients in the evaluation, diagnosis, and medical and surgical treatment of hydrocephalus. This advanced approach is important given the common symptoms associated with adult onset hydrocephalus, such as difficulty walking or memory trouble. These symptoms can be caused by a variety of other medical conditions, not specifically hydrocephalus. By a thorough medical and physical examination, other causes of these symptoms may be identified and treated, thus protecting patients from unnecessary invasive tests or unindicated surgical treatment. Our multidisciplinary approach, where multiple medical specialties are working together, ensures patients who have hydrocephalus are afforded the best chance of reducing their symptoms and improving their quality of life. Learn more about the AHN Adult Hydrocephalus Center.

Why choose AHN for your adult hydrocephalus treatment

From your first visit through diagnosis, treatment, and follow-up care, AHN is here to help you and your family feel informed and supported. The AHN Adult Hydrocephalus Center is dedicated to providing each of our patients with a personalized treatment plan designed to effectively manage and improve hydrocephalus symptoms. Our team is committed to delivering:

• Thorough diagnosis: Our specialists use advanced diagnostic evaluations to accurately identify hydrocephalus and determine the precise, personalized path forward for your care.
• Advanced surgical options: Our expert neurosurgeons are leaders in performing specialized, intricate procedures — such as advanced shunt placements and endoscopic techniques — tailored to your unique anatomical needs.
• Coordinated care: Your treatment is managed by a multidisciplinary team including neurosurgeons, neurologists, advanced practice providers, and therapists who work seamlessly together to execute your specific care plan.
• Nurse Navigator support: Your dedicated Nurse Navigator guides you and your family through every step of the journey, helping to coordinate appointments, answer questions, and provide consistent support.
• Commitment to improving quality of life: Our goal is to provide effective treatments that preserve neurological function, prevent future complications, and help you return to the activities you enjoy.

Find us

AHN Adult Hydrocephalus Center
Allegheny General Hospital
320 East North Avenue
Hemlock Building, 2nd Floor
Pittsburgh, PA 15212
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Quick guide to adult hydrocephalus

Adult hydrocephalus symptoms and signs

Adult hydrocephalus screening and diagnosis

Types and stages of adult hydrocephalus

Adult hydrocephalus treatment

Adult hydrocephalus FAQs

Contact us

Adult hydrocephalus symptoms and signs

Hydrocephalus symptoms in adults can have many causes including tumors, bacterial infections such as meningitis, hemorrhaging or bleeding within the brain, and traumatic injury. At times, no definitive cause can be identified. There are many types of hydrocephalus that can affect adults and all can present with different types of symptoms, including:

• Headache
• Memory problems, particularly short-term memory
• Seizures
• Inability to perform simple tasks
• Confusion
• Imbalance
• Frequent falls
• Shuffling gait
• Urinary incontinence (loss of bladder control)
• Sleepiness
• Visual disturbances

Causes and risk factors

Identifying the underlying cause is an essential step in managing adult hydrocephalus. AHN specializes in working with each patient to determine the potential risk factors and causes of developing adult hydrocephalus. The condition can stem from a variety of origins, and understanding these factors helps our expert team tailor your care plan.

Hydrocephalus present from birth but diagnosed later

Some individuals are born with congenital conditions that cause fluid buildup, but the condition may remain mild and undiagnosed until later in life. The primary risk factor is advancing age, which reduces the brains ability to handle the long-standing fluid imbalance. As a form of hydrocephalus in adults, symptoms can eventually be triggered by age-related changes or minor physiological stressors. The causes often stem from:

• Congenital aqueductal stenosis: A narrowing of the cerebral aqueduct—the narrow passageway connecting the brain's ventricles—that is present from birth. This narrowing blocks the normal flow of cerebrospinal fluid, causing fluid to accumulate.
• Neural tube defects: Congenital conditions where the brain, spine, or spinal cord does not form properly during early embryonic development (such as spina bifida). These defects frequently disrupt normal cerebrospinal fluid pathways and are closely linked to hydrocephalus.
• Genetic factors: Inherited traits, gene mutations, or chromosomal variations passed down from parents that can increase an individual's susceptibility to structural brain differences or conditions associated with fluid buildup.

Hydrocephalus caused by illness or injury

Sometimes, hydrocephalus can be caused by illness or injury. This often happens when a medical event or trauma disrupts the normal flow, circulation, or absorption of cerebrospinal fluid in the brain. Some main illness or injuries that cause hydrocephalus include:

• Infections (such as meningitis): Severe infections can cause inflammation and scarring in the brain's delicate pathways or in the arachnoid villi, which are responsible for absorbing CSF back into the bloodstream. This blockage leads to a fluid buildup.
• Bleeding (hemorrhage): Conditions like a subarachnoid hemorrhage introduce blood into the cerebrospinal fluid pathways or absorption sites, physically clogging the system and preventing proper drainage.
• Traumatic brain injury: Physical trauma to the head can cause internal bleeding, swelling, or structural damage that obstructs the normal movement of CSF. Learn more about traumatic brain injury.
• Tumors: Growths can physically block the ventricles, preventing fluid from flowing freely through the brain's pathways.

Normal pressure hydrocephalus in older adults

Normal pressure hydrocephalus (NPH) is primarily diagnosed in older adults, most commonly in individuals aged 60 and older. It can be classified into two main categories based on what triggers the fluid buildup: idiopathic NPH, where the underlying cause is unknown, and secondary NPH, which develops as a result of a distinct medical event. Idiopathic NPH is the most common and, in the majority of cases, no specific trigger can be identified. This form typically develops gradually as part of the normal aging process, though it is considered a distinct medical condition rather than a normal part of aging. Secondary NPH occurs when a prior event or medical condition disrupts the normal circulation or absorption of cerebrospinal fluid (CSF). Common causes include:

• Subarachnoid hemorrhage or other forms of bleeding within the brain.
• Traumatic brain injury or severe head trauma.
• Central nervous system infections, such as meningitis.
• Previous brain surgeries or radiation treatments.

Adult hydrocephalus screening and diagnosis

At the AHN Adult Hydrocephalus Center, patients receive comprehensive medical care from our multidisciplinary team who specialize in the diagnosis and management of this condition. Because hydrocephalus symptoms in adults can sometimes overlap with other age-related or neurological issues, a careful and accurate hydrocephalus diagnosis is essential. Furthermore, for individuals experiencing specific cognitive and mobility changes, securing an accurate normal pressure hydrocephalus (NPH) diagnosis involves specialized clinical assessments to pinpoint the exact cause of your symptoms.

To provide a thorough evaluation and help you understand what to expect, our diagnostic process includes:

• A thorough medical history: We review your past health events, prior injuries, or illnesses to uncover potential underlying causes and understand how your symptoms have developed over time.
• Detailed physical and neurological examination: This includes a baseline cognitive evaluation, motor assessment, balance assessment, and a standardized gait assessment to see precisely how the condition is affecting your daily movement and thinking.
• An analytical review of brain imaging: We carefully review your imaging scans (such as MRI or CT) to view the size of the brain's ventricles and fluid pathways, helping us determine if additional testing is warranted to guide your treatment.
• Procedural testing, including a Lumbar Tap Trial (LTT): This temporary procedure safely removes a small amount of spinal fluid to see if your symptoms temporarily improve. This helps our team predict whether a permanent drainage solution, such as a shunt, will be effective for you.
• Laboratory analysis of CSF: We test samples of your cerebrospinal fluid to check for and rule out any inflammatory, infectious, or tumor-related processes.
• Specialized nuclear medicine studies: We use Nuclear Medicine Shunt Studies and Lumbar Cisternograms to evaluate the function of any cerebrospinal fluid devices or ventricular and lumbar shunt systems you may already have in place

Types and stages of adult hydrocephalus

It is important to know that hydrocephalus does not have formal stages. Instead, symptoms can progress over time, especially with normal pressure hydrocephalus. When you receive your results, your AHN care team will explain your diagnosis in clear terms and help you understand what it means for your care and daily life. Some common types and stages can include:

• Communicating hydrocephalus: This occurs when cerebrospinal fluid (CSF) flow is blocked after it exits the ventricles. The fluid can still flow freely between the brain's ventricles, but it is not properly reabsorbed into the bloodstream.
• Normal pressure hydrocephalus (NPH): This is a specific type of communicating hydrocephalus where CSF accumulates in the ventricles, but the pressure within the brain remains normal or only slightly elevated. Symptoms typically develop gradually and can progress over time, most commonly affecting walking, memory, and bladder control.
• Hydrocephalus ex-vacuo: This can occur when damage to the brain—such as from a stroke, traumatic brain injury, or neurodegenerative conditions—causes brain tissue to shrink (atrophy). The ventricles enlarge to fill the extra space, though CSF pressure remains normal.
• Non-communicating hydrocephalus (obstructive hydrocephalus): This happens when the flow of CSF is physically blocked along one of the narrow passages connecting the brain's ventricles, preventing the fluid from circulating correctly.
• Congenital hydrocephalus (diagnosed in adulthood): A condition present from birth (often due to developmental factors) that remains mild or well-compensated during childhood, only to cause noticeable symptoms and be diagnosed later in life.

Adult hydrocephalus treatment

If you are diagnosed with hydrocephalus, treatment options consist of symptom management with medication or surgical procedures to reduce the accumulation of fluid in the brain. AHN delivers custom treatment plans that are built specifically around your diagnosis, symptoms, daily needs, and personal goals for your personal health. At AHN, we see you.

Medical management

There are medications that can help minimize some of the symptoms of hydrocephalus, specifically in terms of memory difficulties and urinary incontinence. These medications will be discussed with you during your initial visit and will continue to be discussed throughout your appointments with your primary care physician and your neurologist. Physicians and staff at the AHN Adult Hydrocephalus Center will work closely with your primary care physician in order to best manage your hydrocephalus.

Surgical treatment

The two types of surgical procedures effective in treating hydrocephalus are cerebrospinal (CSF) shunting and endoscopic third ventriculostomy (ETV).

Endoscopic Third Ventriculostomy (ETV)

This approach is a surgical alternative to the shunt. In an ETV, an endoscope is introduced through a small hole in the skull into the third ventricle of the brain where a perforation is made in a membrane to restore normal flow of CSF. The entire procedure is performed using video guidance, and no device or hardware is implanted in the body. If successful, no revisions or replacements are necessary, and subsequent hospitalizations are markedly reduced. All patients with hydrocephalus in need of surgical treatment should be evaluated to see if they are eligible for an ETV prior to proceeding with shunt placement.

Cerebrospinal fluid shunting

The treatment of hydrocephalus generally focuses on diverting CSF buildup away from the head by way of surgically placed tubes called shunts. Though effective, shunts require open surgery with incisions in both the scalp and abdomen. Patients with shunts should be regularly seen by a neurosurgeon so that they can be monitored to ensure proper shunt function.

Contact us

Call 412-359-6200 for more information about the AHN Adult Hydrocephalus Center.