This is an increase in the volume of cerebrospinal fluid (CSF) within the ventricular system and may be communicating or non-communicating.
- There is a uniform enlargement of the head before birth causing obstructed labour or developing insidiously after birth.
- There are prominent dilated scalp veins, and wide, bulging, and tense fontanelles.
- Brow overhangs the roof of orbit
- There is a
cracked-potsound when the head is percussed (McEwen’s sign)
- A clear margin of sclera beneath the upper lid (setting sun sign), and wide sutures.
- Nystagmus is common and transillumination is positive later.
- In isolated hydrocephalus there is usually no neurological deficit. But if there was intrauterine infection then it may be accompanied by other defects.
Note: Some of these features develop over a period depending on the rate of increase in the head size.
- Skull x-ray is useful
- Cranial ultrasound
- CT scan where possible
- Screen for congenital infections if necessary
In order to prevent brain damage, early evaluation and diagnosis is essential. The baby therefore needs to be referred as soon as possible to a specialized unit.
Management – Operative (Specialized Neurosurgical)
- A shunt from the ventricle to the peritoneal cavity is inserted in a specialized centre.
- Contraindications for referral (Surgery)
- Multiple congenital abnormalities.