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Symptoms and signs of progressive hydrocephalus
M Kirkpatrick1, H Engleman, R A Minns
1Department of Neurology, Royal Hospital for Sick Children, Edinburgh.
Insights
Clinical signs of hydrocephalus in children can be highly variable or absent, even with raised intracranial pressure. This variability underscores the need for direct intracranial pressure measurement in diagnosis.
Area of Science:
- Pediatric Neurology
- Neurosurgery
Background:
- Hydrocephalus is a condition characterized by increased cerebrospinal fluid (CSF) accumulation.
- Elevated intraventricular pressure (IVP) is a key complication of hydrocephalus.
Purpose of the Study:
- To analyze the clinical features of pediatric hydrocephalus with measured raised IVP.
- To determine the variability and presence of clinical signs and symptoms.
Main Methods:
- Retrospective analysis of 107 pediatric cases with hydrocephalus and measured raised IVP.
- Review of clinical features, including symptoms and signs.
Main Results:
- Common symptoms included vomiting, behavioral changes, drowsiness, and headaches.
- Frequent clinical signs were increased head circumference, tense fontanelles, splayed sutures, and scalp vein distension.
- Notably, 50% of infantile cases and 25% of shunted cases were asymptomatic or lacked observable signs.
Conclusions:
- The clinical presentation of hydrocephalus with raised IVP is highly variable, with some cases showing unusual or absent signs.
- Direct measurement of intracranial pressure is recommended due to the unpredictable clinical manifestations.
Abstract:
The clinical features of 107 cases of children with hydrocephalus and measured raised intraventricular pressure were analysed retrospectively. Fifty one children had recently been diagnosed as having hydrocephalus, and the remainder had had shunts injected to direct the cerebrospinal fluid. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins. Half the infantile cases of hydrocephalus were without symptoms, and a quarter of the cases with cerebrospinal fluid shunts and measured raised intraventricular pressure were without signs. There were no fewer than 33 different clinical signs including several unusual ones, such as macular rash and sweating. We believe that the presentation of hydrocephalus with raised intraventricular pressure is sufficiently variable, unusual, or even absent to justify the direct measurement of intracranial pressure.