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 infants	Full-term infants	Toddlers and older
Apnea	Macrocephaly	Headache
Bradycardia	Rapid head growth	Nausea
Hypotonia	Decreased feeding	Vomiting
Acidosis	Increased drowsiness	Irritability
Seizures	Tense fontanel	Lethargy
Rapid head growth	Vomiting	Delayed development
Tense fontanel	Distended scalp veins	Decreased school performance
Splayed cranial sutures	Splayed cranial sutures	Behavioral disturbance
Vomiting	Poor head control	Papilledema
Sunsetting eyes	Parinaud’s sign	Parinaud’s sign
	Sunsetting eyes	Sunsetting eyes
	Frontal bossing	Bradycardia
		Hypertension
		Irregular breathing patterns