<p>Hydrocephalus is a frequently encountered neurological disorder of cerebrospinal fluid (CSF) physiology or dynamics, resulting in the abnormal enlargement of CSF spaces and often presenting with signs and symptoms of raised intracranial pressure. The etiology of hydrocephalus is numerous, regardless of the model used to understand its pathophysiology. Differentiating ventricular enlargement due to hydrocephalus or parenchymal atrophy can be difficult in pediatric patients, but certain imaging signs could help differentiate the two entities. The management of hydrocephalus aims to restore normal CSF dynamics, alleviate symptoms, and prevent long-term neurological complications with the help of ventricular drains and shunts. In this review, we will cover the updated pathophysiology, key etiologies, characteristic imaging findings of acute hydrocephalus and its complications, thus providing practical guidance for pediatric radiology fellows and radiologists in emergency settings.</p> Graphical Abstract <p></p>