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Communicating hydrocephalus is a type of hydrocephalus in which cerebrospinal fluid (CSF) can still flow between the ventricles, but its absorption into the bloodstream is impaired. This leads to CSF buildup and increased intracranial pressure.

What “communicating” means
The ventricular system is open and connected, so CSF moves freely within it.
The problem occurs after the CSF leaves the ventricles, usually at the arachnoid villi/granulations.
No physical blockage inside the ventricles (unlike non-communicating/obstructive hydrocephalus).
🧠 Causes
Common causes include:
Subarachnoid hemorrhage (most common)
Meningitis or other infections
Inflammation of meninges
Post-surgical or post-traumatic scarring
Normal pressure hydrocephalus (NPH) is technically a communicating type
🧾 Pathophysiology
CSF is produced normally.
It circulates through ventricles and into the subarachnoid space.
Absorption at arachnoid granulations is impaired → CSF pressure builds up.
Ventricles enlarge → symptoms.
🩺 Symptoms
Depends on age and pressure level.
Infants
Rapid head enlargement/head circumference increase
Bulging fontanelle
Irritability, vomiting
Sunsetting eyes
Adults
Headache (worse in morning)
Nausea/vomiting
Papilledema
Gait disturbances
Cognitive slowing
Normal Pressure Hydrocephalus (elderly)
The classic triad:
Gait disturbance (magnetic gait)
Urinary incontinence
Cognitive impairment
🔎 Diagnosis
MRI or CT → enlarged ventricles without an obstructing lesion
Lumbar puncture may help in NPH (high-volume tap test)
CSF opening pressure may be high (except in NPH)
🧑‍⚕️ Treatment
Ventriculoperitoneal (VP) shunt — most common
Endoscopic third ventriculostomy (ETV) — less effective for communicating types
Treat the cause (e.g., infection, bleeding)