Hydrocephalus

Symptoms:

EARLY SYMPTOMS, IN INFANTS

• enlargement of the head (see increased head circumference)
• bulging fontanelles (soft spots of the head) with or without enlargement of the head size
• sutures - separated

SYMPTOMS OF CONTINUED HYDROCEPHALUS

• irritability, poor temper control
• muscle spasticity (spasm)

LATE SYMPTOMS

• decreased mental function
• delayed development
• decreased movement
• slow or restricted movement
• difficulty feeding
• lethargy, excessive sleepiness
• urinary incontinence (loss of control over bladder)
• brief, shrill, high-pitched cry
• slow growth (child 0-5 years)

IN OLDER INFANTS AND CHILDREN
Symptoms vary depending on the amount of damage caused by pressure in the brain. Symptoms may be similar to symptoms of progression of hydrocephalus in children, or may include the following or other symptoms:

• headache
• vomiting
• vision changes
• crossed eyes
• uncontrolled eye movements
• loss of coordination
• poor gait (walking pattern)
• mental aberrations (such as confusion or psychosis)

Signs and tests:

Tapping with the fingertips (percussion) on the skull may show abnormal sounds associated with thinning and separation of skull bones. Scalp veins may appear dilated. The circumference of the head may be large, or there may be enlargement of only part of the head, most commonly the frontal area. Measurements of the circumference of the head, repeated over time, may show progressive enlargement. The eyes may be depressed, with a "setting-sun" sign where the sclera (white portion of the eye) is visible above the iris (colored portion of the eyes). A neurologic examination may show focal neurologic deficits (localized loss of function), and reflexes may be abnormal for the age of the child.

Tests:

• Transillumination of the head (shining a light against the head) may show abnormal fluid accumulation in various areas of the head.
• A head CT scan indicates if hydrocephalus is present (best test).
• A lumbar puncture (spinal tap) and examination of the CSF may be performed (rarely)
• Skull X-rays show thinning and/or separation of skull bones and enlargement of the skull
• A brain scan using radioisotopes may show abnormalities of the fluid pathway.
• An arteriography of brain blood vessels may show vascular causes of hydrocephalus.
• An echoencephalogram, a form of ultrasound of the brain, may show dilation of the ventricles caused by hydrocephalus or intraventricular bleeding

This disease may also alter the results of a RHISA scan.