Hydrocephalus

Hydrocephalus happens when cerebrospinal fluid builds up in and around the brain. In adults, one of the most important forms we evaluate is normal pressure hydrocephalus, or NPH, which can affect walking, thinking and bladder control even when fluid pressure appears normal on testing.

Our program is designed around that complexity. Instead of treating hydrocephalus as a single diagnosis, we look at how symptoms developed, how they affect daily function and whether a patient’s pattern truly fits NPH or another neurologic condition.

Many patients come to our program because they have been told their symptoms may be related to aging, memory loss or dementia, but the full picture does not feel complete. NPH is often overlooked because its symptoms overlap with Alzheimer’s disease, dementia and Parkinsonian gait disorders, yet it may respond to treatment when identified correctly.

You may need a hydrocephalus evaluation if you or a loved one has changes such as:

• Difficulty walking, balance problems or a gait that looks slow, shuffling or “stuck” to the floor
• Cognitive changes, including forgetfulness, slowed thinking or reduced attention that seem out of proportion to normal aging
• Urinary urgency, frequency or incontinence that has developed along with walking or memory changes

A program-based evaluation matters because these symptoms should not be reviewed in isolation. Our team looks at them together to determine whether hydrocephalus is a likely cause and whether treatment could improve function.

Diagnosing Hydrocephalus, especially NPH, requires more than a scan. At Baptist Health, the evaluation starts with a detailed health history, neurological exam, mobility testing and imaging review so we can understand how symptoms have changed over time and how strongly they fit the NPH pattern.

When appropriate, we then use a large-volume tap to remove cerebrospinal fluid as part of the diagnostic workup. This helps our team assess whether symptoms may improve when fluid is reduced, which can guide the next step in care.

Our evaluation may include:

• Review of gait, balance and mobility changes, because walking symptoms are often one of the earliest and most responsive signs
• Cognitive and functional assessment, so memory concerns are evaluated in context rather than assumed to be Alzheimer’s disease or another dementia alone
• Imaging and procedural testing, used together to build a more complete picture before recommending surgery

Treatment in our Hydrocephalus program is built around the individual, not just the diagnosis. Some patients need monitoring and follow-up, while others may benefit from surgery designed to divert excess cerebrospinal fluid and reduce pressure on surrounding brain tissue.

For many patients with NPH, shunt surgery is an important part of treatment. Our neurosurgery team performs shunting procedures that place a catheter to continuously drain excess cerebrospinal fluid, and we follow patients closely afterward to watch symptoms, recovery and shunt function.

Program treatments may include:

• Comprehensive NPH evaluation to determine whether symptoms and testing support treatment
• VP shunt placement or shunt surgery for appropriate candidates
• Neurorehabilitation support to help patients regain mobility and confidence after treatment

When hydrocephalus is missed or dismissed, patients may continue to lose mobility, independence and confidence with daily activities. In NPH, delayed diagnosis can be especially frustrating because patients may be treated as though they have irreversible dementia when the actual problem may be more treatable.

There are also risks to any procedure, including shunt surgery, which is why careful screening matters. Our team is deliberate about recommending treatment only after a thorough evaluation, because the goal is not just to place a shunt, but to identify the patients most likely to benefit from it.

Important considerations include:

• Untreated symptoms may lead to falls, loss of independence and worsening daily function
• Misdiagnosis may delay access to a potentially helpful treatment pathway
• Shunts can have complications, so thoughtful patient selection and follow-up are essential

Recovery is not a single event. It is a process that begins before surgery, continues during the hospital stay and extends into follow-up visits where we assess walking, cognition, bladder symptoms and overall function.

Patients who undergo shunt surgery for NPH typically stay in the hospital for 24 to 48 hours, and our team works to get them moving early. From there, we coordinate the next stage of care, which may include neurorehabilitation, symptom tracking and ongoing follow-up to understand how the patient is improving over time.

Our program focuses on recovery in practical terms, including:

• Safer walking and better balance
• Improvement in day-to-day independence
• Clearer follow-up around shunt function, symptoms and next steps