Saturday, April 30, 2011

Signs and Symptoms of Hydrocephalus

The signs and symptoms of hydrocephalus in infants and children vary depending on their age, the degree of hydrocephalus at presentation, the primary etiology, and the time over which the hydrocephalus develops. Because of the plasticity of the infant brain and the ability of the cranium to expand, ventriculomegaly can progress without obvious signs of increased intracranial pressure. In premature infants, in which hydrocephalus is caused predominately by an IVH, there is a general correlation between the severity of hemorrhage and the degree of hydrocephalus. Infants with PHH may have minimal symptoms, or may exhibit increasing spells of apnea and bradycardia. They may also have hypotonia, sunsetting eyes, ophthalmoplegia and seizures. As the ventriculomegaly progresses, the fontanel will bulge, become tense and nonpulsatile, and the cranial sutures become splayed. In a healthy premature infant, the head circumference generally increases about 1 cm a week. In premature infants with progressive ventriculomegaly, the head circumference may increase more rapidly than normal (when charted on the head growth chart), but may not accurately reflect the rate of increase in ventricular size.

Table : Signs and symptoms of hydrocephalus in children
Premature infantsFull-term infantsToddlers and older
ApneaMacrocephaly Headache
BradycardiaRapid head growth Nausea
HypotoniaDecreased feeding Vomiting
AcidosisIncreased drowsiness Irritability
SeizuresTense fontanel Lethargy
Rapid head growthVomiting Delayed development
Tense fontanelDistended scalp veins Decreased school performance
Splayed cranial suturesSplayed cranial sutures Behavioral disturbance
VomitingPoor head control Papilledema
Sunsetting eyesParinaud’s sign Parinaud’s sign
Sunsetting eyes Sunsetting eyes
Frontal bossing Bradycardia
Hypertension
Irregular breathing patterns

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