Clinical features of adult hydrocephalus

The presentation of hydrocephalus in adults is variable and dependent on the type and the underlying aetiology.

Features of an acute onset include:

• features of raised intracranial pressure - headache, vomiting, papilloedema and impaired conscious level
• impaired upward gaze (1)

Features of a gradual onset are similar to those seen in normal pressure hydrocephalus. These develop progressively and include:

• mental impairment
• gait apraxia; plantar reflexes often extensor; tendon jerks exaggerated or diminished
• urinary incontinence due to sphincter dysfunction
• hypopituitarism due to enlargement of the third ventricle into the posterior fossa (2)

Reference:

• (1) Kandasamy J, Jenkinson MD, Mallucci CL. Contemporary management and recent advances in paediatric hydrocephalus. BMJ. 2011;343:d4191
• (2) Shprecher D1, Schwalb J, Kurlan R.Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurol Neurosci Rep. 2008(5):371-6.