Fluid on the brain, or hydrocephalus, develops when fluid builds up inside the brain's ventricles. As it gathers, the fluid presses on brain tissue and can cause lasting damage.

Left untreated, that pressure can cause brain damage or even death, according to the National Institute of Neurological Disorders and Stroke (NINDS). The case below shows how quickly warning signs can be missed.

Two Pathways Toward Emergency

There are two routes toward crisis.

One pathway involves a faster pressure build-up. Hydrocephalus is most common in infants and adults aged 60 and older, according to NINDS.

Risk factors include brain or spinal tumours, infections, and bleeding from injury or stroke. In babies, hydrocephalus can be congenital or can appear after birth.

Inherited genetic abnormalities, developmental disorders and premature birth complications are among the possible causes. Infections such as rubella during pregnancy are also a risk.

A slower pathway is normal-pressure hydrocephalus, or NPH, which is common in older adults. NINDS says it develops gradually and can be hard to diagnose.

Even so, NPH symptoms can worsen without treatment, carrying serious risks on a longer timeline. Recognising either pathway early matters greatly.

Spotting the Warning Signs

Symptoms vary by age. Older children and adults may suffer headaches, vomiting, vision problems and poor coordination, while older adults can develop memory loss and trouble walking, according to the Mayo Clinic.

Young and middle-aged adults may experience sluggishness, balance problems and bladder symptoms, alongside effects on memory and concentration. Bladder issues can also affect older adults.

In infants and toddlers, emergency care is advised for a high-pitched cry, feeding difficulties, repeated unexplained vomiting or seizures. Prompt attention is advised for other symptoms at any age.

Diagnosis relies on neurological exams and brain imaging. An MRI is usually the first test for children and adults, while a CT scan may be used in emergencies.

A Case That Shows the Stakes

The stakes appear in the case of Oli Coppock, 34, of Warrington, Cheshire. He attended Warrington Hospital's A&E in May 2024 with dizziness, fatigue and vomiting. His case reflects the faster pathway described earlier, where pressure builds quickly.

A CT scan was not ordered, and his symptoms were instead treated as a virus. A week later, a scan at another hospital identified hydrocephalus, and he suffered a respiratory arrest.

An internal investigation found a CT scan should have been performed. It also found earlier surgery would have prevented his respiratory arrest.

Coppock was left with locked-in syndrome and severe disability. He is now non-verbal and communicates using his eyes, showing how untreated hydrocephalus can cause lasting brain damage.

North Cheshire and Mersey NHS Foundation Trust, which runs Warrington Hospital, has accepted liability. It apologised for the care he received and acknowledged the lasting harm caused.

The family's lawyer said delays in admitting liability deprived Coppock of funds for needed therapies. That reflects her account, not an independent finding.

Treatment and a Second Risk Point

Surgery is the standard treatment, according to NINDS. A shunt can drain excess fluid into the chest or abdomen, while endoscopic third ventriculostomy creates an alternate route.

Treatment does not remove the risk permanently. Shunts can stop working or become infected, allowing fluid to build up again.

Immediate medical attention is advised for headache, vomiting, seizures or returning symptoms in anyone with a shunt. This is a second point where hydrocephalus can turn into an emergency.

Recognising both pathways, and acting on symptoms quickly, is what separates a manageable diagnosis from lasting brain damage. Coppock's case shows how much is lost when that window is missed.

Frequently Asked Questions

  • What is hydrocephalus?
    Hydrocephalus is a condition where fluid builds up in the brain's ventricles, causing pressure on brain tissue.
  • What are the symptoms of hydrocephalus?
    Symptoms vary by age but can include headaches, vomiting, vision problems, and coordination issues.
  • How is hydrocephalus treated?
    Treatment typically involves surgery to drain excess fluid, such as shunt placement or endoscopic third ventriculostomy.
  • What are the risks if hydrocephalus is left untreated?
    Untreated hydrocephalus can lead to brain damage or death due to increased pressure on brain tissue.
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