Available via license: CC BY 4.0
Content may be subject to copyright.
HYDROCEPHALUS
PROGRESSIVE
HYDROCEPHALUS:
SYMPTOMS
AND
SIGNS
The
etiologies
and
clinical
features
of
progressive
hydrocephalus
in
107
children,
56
with
and
51
without
shunts,
were
analyzed
retrospectively
at
the
Department
of
Neurology,
Poyal
Hospital
for
Sick
Children,
Edinburgh,
Scotland.
Patients
with
arrested
hydrocephalus,
or
with
ventriculomegaly
resulting
from
atrophic
or
ischemic
brain
damage
or
tumor
were
excluded.
Intracranial
pressure
was
measured
percutaneously
or
through
ventriculostomy
reservoirs,
using
a
Gaeltec
miniature
strain
gauge
transducer.
Etiologies
included
spina
bifida
(54%),
idiopathic
(15%),
hemorrhage
(13%),
and
meningitis
(10%).
In
those
with malfunctioning
shunts,
symptoms
were
vomiting,
drowsiness,
headache,
behavioral
change,
and
anorexia;
and
signs
were
absent
in
25%
and
included
decreased
level
of
consciousness
in
18%,
acute
strabismus
(18%),
neck
retraction
(11%),
and
distended
retinal
veins
(11%).
Patients
without
shunts
were
asymptomatic
in
49%;
headache
occurred
in
33%,
and
vomiting
in
16%.
Signs
in
the
nonshunted
group
included
abnormal
head
growth
in
76%,
tense
fontanelle
(65%),
scalp
vein
distention
(33%),
setting
sun
sign
or
absent
upward
gaze
(22%),
and
neck
rigidity
(14%).
Unusual
clinical
features
included
neurogenic
pulmonary
edema,
profuse
sweating,
macular
rash,
ptosis,
autonomic
dysfunction,
and
neurogenic
stridor.
Papilledema
occurred
in
only
eight
cases
(8%).
The
authors
emphasize
the
variability,
unreliability,
unusual
nature,
and
even
absence
of
clinical
symptoms
and
signs
of
hydrocephalus
with
raised
intracranial
pressure.
CT
or
MR
I
may
not
be
diagnostic,
and
direct
measurement
of
intracranial
pressure
is
essential
in
patients
with
unexplained
clinical
features.
(Kirkpatrick
M,
Engleman
H,
Minns
RA.
Symptoms
and
signs
of
progressive
hydrocephalus.
Arch
Pis
Child
Jan
1989;
64:124-128).
COMMENT.
The
infant
referred
because
of
a
large
head
is
a
fairly
common
problem
in
pediatric
neurology
practice.
This
instructive
article
points out
that
we
may
be
relying
too
frequently
on
our
colleagues
in
neuroradiology
for
diagnostic
help
and
neglecting
the
much
simpler
and
more
economical
method
of
direct
measurement
of intracranial
pressure.
The
finding
that
one-half
the
infantile
cases of
hydrocephalus
were
without
symptoms
is
disturbing.
MANAGEMENT
OF
HYDROCEPHALUS
WITH
IC
PRESSURE
MONITOR
Thirteen
premature
infants
with
posthemorrhagic
hydrocephalus
were
treated
by
repeated
aspiration
of
cerebrospinal
fluid
using
a
subcutaneous
ventricular
catheter
reservoir
at
the
Departments
of
Paediatrics
and
Neurosurgery,
University
of
Heidelberg,
Federal
Republic
of
Germany.
Criteria
for
the
insertion
of
the
catheter
and
reservoir
were
as
follows:
1)
Increase
in
head
circumference
of
more
than
1
cm/week;
2)
Progressive
ventricular
dilatation
on
ultrasound
scan;
3)
Failure
of
lumbar
puncture
route
of
fluid
removal;
or
4)
Bradyardia
or
apneic
complications
of
lumbar
puncture.
Hydrocephalus
was
controlled
by
aspiration
of
fluid
(median
6ml)
one
to
four
times
a
day
for
an
average
of
40
days.
Clinical
signs
(tense
fontanelle
and
increasing
head
size)
and
ultrasound
were
unreliable
indicators
of
the
amount
and frequency
of
fluid
removal.
Direct
intracranial
pressure
measurements
made
through
the
reservoir
increased
the
efficacy
and
-15-