Hydrocephalus - Symptoms of hydrocephalus

Hydrocephalus (fluid on the brain) causes slightly different symptoms depending on the type of hydrocephalus and the age of the person affected.

Congenital hydrocephalus

Babies born with hydrocephalus (congenital hydrocephalus) often have distinctive physical characteristics. Physical signs include:

• your baby’s head may appear unusually large
• your baby’s scalp may be thin and shiny with easily visible veins
• your baby may have a bulging or tense fontanelle (the soft spot on the top of their head) 
• the baby's eyes appear to be looking down; this is known as the ‘setting-sun sign’ because the eyes resemble the sun setting below the horizon
• the muscles in your baby’s lower limbs may appear stiff and be prone to muscle spasms (contractions)

As well as these physical signs, congenital hydrocephalus can also cause symptoms such as:

• poor feeding
• irritability
• being sick
• drowsiness

Acquired hydrocephalus

Hydrocephalus that develops in adults or children (acquired hydrocephalus) can cause headaches. The headache may be worse in the morning after waking up, as the fluid in your brain doesn't drain so well while you're lying down and may have built up overnight. Sitting up for a while may improve your headache. However, as the condition progresses, the headaches may become continuous. If hydrocephalus is not treated, it can be life-threatening. 

Other symptoms of acquired hydrocephalus include:

• neck pain
• feeling sick
• being sick – which may be worse in the morning
• drowsiness, which can progress to a coma
• changes in your mental state, such as confusion
• blurred vision or double vision 
• difficulty walking
• not being able to control your bladder (urinary incontinence) and, in some cases, your bowel (bowel incontinence)

Normal pressure hydrocephalus

Unlike the other two types of hydrocephalus, the symptoms of hydrocephalus that develop in older people (normal pressure hydrocephalus or NPH) usually develop slowly, over the course of many months or years.

There are three sets of distinctive symptoms. They affect:

• how you walk
• your urinary system
• your mental abilities

These are discussed below.

How you walk 

Usually, the first noticeable symptom of normal pressure hydrocephalus (NPH) is a change in how you walk (your gait). You may find it increasingly difficult to take the first step when you want to start walking. Some people have described it as feeling as though they're frozen to the spot. You may also shuffle rather than take proper steps.

As the condition progresses, you may become increasingly unsteady on your feet. You may be more likely to fall, particularly when turning.

Urinary symptoms

The change in the way that you walk is often followed by bouts of urinary incontinence, which may include symptoms such as:

• a frequent need to urinate
• an urgent need to urinate
• loss of bladder control

Mental abilities

The normal thinking process also starts to slow down. This can take the form of:

• being slow to respond to questions
• reacting slowly to situations
• being slow to process information

These may be confused with the symptoms of dementia. You may actually have mild dementia, which will improve when the normal pressure hydrocephalus (NPH) is treated.