Hydrocephalus is a condition that is caused by an increase of cerebrospinal fluid (CSF). The center of your brain has cavities, called ventricles that are filled with CSF. The circulating CSF is constantly replenished and absorbed, so that the amount of fluid inside the brain and skull remains basically constant over the course of a lifetime.

With “obstructive hydrocephalus,” the normal flow of cerebrospinal fluid throughout the brain and spinal cord is blocked in some way and backs up behind the obstruction leading to increased pressure. In “communicating hydrocephalus,” there is no obvious obstruction to the flow of CSF, but the reabsorption of CSF back into the bloodstream is impaired.

The Two Types of Hydrocephalus

  • Secondary hydrocephalus – Common causes of secondary hydrocephalus are a brain tumor, hemorrhage, infection or a trauma such as falling down or hitting your head.
  • Idiopathic hydrocephalus – With this type of hydrocephalus, there is no known cause. It typically happens in individuals in their 60s, 70s, and 80s, and symptoms are often very mild or not even detectable.

Individuals with hydrocephalus often have a combination of three symptoms that can help establish the diagnosis:

  • Mental confusion – Mild forgetfulness, short-term memory loss, or loss of interest in normal activities.
  • Gait disturbance – Difficulty in walking can take many forms, including taking small shuffling steps, a tendency to fall, a feeling that your feet are too heavy or difficulty climbing stairs.
  • Urinary incontinence – Impaired bladder control consists of difficulty in holding back urine.

Getting Diagnosed

Hydrocephalus can sometimes be difficult to diagnose since not all of the symptoms may appear at the same time. These symptoms can be similar to those of other disorders, such as Alzheimer’s disease, Parkinson’s disease and osteoarthritis. There is no single test that establishes the diagnosis of hydrocephalus. Our team of specialists at the Normal Pressure Hydrocephalus Center provides thorough neurological evaluations using the latest diagnostic technology to diagnose hydrocephalus, including:

  • Patient history and examination – The basis of establishing the clinical diagnosis.
  • CT scan (Computerized Tomography) of the head – A CT scan is often done as the first test, but may not be needed if an MRI has been obtained. The scan shows enlargement of the ventricles, or cavities, and is helpful in ruling out other specific causes of hydrocephalus.
  • MRI (Magnetic Resonance Imaging) – An MRI is more sensitive to abnormalities of the brain tissue and is a key component of the diagnostic workup.
  • Neuropsychological testing – A thorough neurological evaluation will be done by a trained neuropsychologist and can be helpful in getting a clearer picture of the type and severity of mental impairment. It can also help in following the course of a patient’s disease.
  • Gait testing – This computerized measure helps in quantifying a patient’s gait (walking) impairment and is also helpful in documenting improvement with treatment.
  • Spinal tap or lumbar puncture (LP) – A very fine-gauge needle is placed into the spinal canal, and the pressure of the cerebrospinal fluid is measured. At this time, the CSF is also examined for any other abnormal findings.
  • Lumbar CSF drainage – A catheter is often inserted into the spine in the lower back for continuous drainage of cerebrospinal fluid over a three-day period. This procedure is more sensitive to improvement than a lumbar puncture alone.
  • Intracranial pressure monitoring – This is sometimes used in cases where the diagnosis is unclear and actual monitoring of the pressure inside the head is thought to be necessary.

We work closely with other centers within the Northwell Health Neuroscience Institute, including the Movement Disorders Center and the Chiari Institute, to ensure an accurate diagnosis and the appropriate treatment for the best outcome.

Your Path to Health and Wellness Starts Here

The Normal Pressure Hydrocephalus Center of Northwell Health Neuroscience Institute ensures the best neurological care for yourself and your family, including thorough neurological evaluations, the latest diagnostic technology and the most advanced treatment options.


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