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Hydrocephalus in newborns is caused by an imbalance between the production and absorption of cerebrospinal fluid (CSF), leading to accumulation in the brain’s ventricular system. The underlying causes can be grouped into several categories:

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1. Obstructive (Non-communicating) Hydrocephalus
• Aqueductal stenosis (most common congenital cause): Narrowing of the cerebral aqueduct prevents CSF from flowing between the 3rd and 4th ventricles.
• Malformations such as:
• Chiari malformation
• Dandy–Walker malformation
• Intraventricular cysts or tumors blocking CSF pathways.

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2. Communicating Hydrocephalus
• CSF pathways are open, but absorption is impaired.
• Causes:
• Intraventricular hemorrhage (IVH) – common in preterm infants; blood obstructs arachnoid villi.
• Meningitis or infection – inflammation and scarring impair CSF absorption.
• Congenital infections (e.g., toxoplasmosis, CMV, syphilis) damaging ependymal lining or subarachnoid space.

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3. Overproduction of CSF (rare)
• Seen in choroid plexus papillomas, which produce excess CSF.

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4. Associated Genetic and Developmental Disorders
• Neural tube defects (e.g., myelomeningocele with Chiari II malformation).
• X-linked aqueductal stenosis due to L1CAM mutations.

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5. Acquired Causes in the Neonatal Period
• Birth trauma causing hemorrhage.
• Post-hemorrhagic hydrocephalus after premature intraventricular bleeding.
• Secondary to hypoxic-ischemic injury leading to impaired CSF circulation.