Hydrocephalus in children: Clinical features and diagnosis
- Abilash Haridas, MD
Abilash Haridas, MD
- Pediatric & Cerebrovascular Neurosurgery, Children’s Hospital of Michigan
- Assistant Professor of Neurosurgery, Wayne State University
- Tadanori Tomita, MD
Tadanori Tomita, MD
- Yeager Professor and Division Head of Pediatric Neurosurgery,
- Director, Falk Brain Tumor Center
- Ann & Robert H. Lurie Children’s Hospital of Chicago;
- Professor and Vice-Chair, Department of Neurosurgery,
- Northwestern University Feinberg School of Medicine
Hydrocephalus is a disorder in which an excessive amount of cerebrospinal fluid (CSF) accumulates within the cerebral ventricles and/or subarachnoid spaces, resulting in ventricular dilation and increased intracranial pressure (ICP) [1,2]. Hydrocephalus can be congenital or acquired; both categories include a diverse group of conditions (table 1).
The clinical features and diagnosis of hydrocephalus in children will be reviewed here. The pathophysiology, etiology, management, and prognosis of hydrocephalus are discussed separately. (See "Hydrocephalus in children: Physiology, pathogenesis, and etiology" and "Hydrocephalus in children: Management and prognosis".)
This topic will focus on the clinical features and diagnosis of obstructive and communicating hydrocephalus in childhood, which are almost always associated with increased ICP. Normal pressure hydrocephalus, a condition seen predominantly in adults in which the cerebral ventricles are pathologically enlarged, but the ICP is not elevated, is discussed separately. (See "Normal pressure hydrocephalus".)
The prevention and initial management of hydrocephalus associated with intraventricular hemorrhage in preterm neonates is also discussed in greater detail separately. (See "Management and complications of intraventricular hemorrhage in the newborn".)
The following terms are used this topic:
- Fishman MA. Hydrocephalus. In: Neurological pathophysiology, Eliasson SG, Prensky AL, Hardin WB (Eds), Oxford, New York 1978.
- Carey CM, Tullous MW, Walker ML. Hydrocephalus: Etiology, Pathologic Effects, Diagnosis, and Natural History. In: Pediatric Neurosurgery, 3 ed, Cheek WR (Ed), WB Saunders Company, Philadelphia 1994.
- Hellbusch LC. Benign extracerebral fluid collections in infancy: clinical presentation and long-term follow-up. J Neurosurg 2007; 107:119.
- Bateman GA, Napier BD. External hydrocephalus in infants: six cases with MR venogram and flow quantification correlation. Childs Nerv Syst 2011; 27:2087.
- Menkes JH, Sarnat HB, Flores-Sarnat L. Malformations of the central nervous system. In: Child Neurology, 7th ed, Menkes JH, Sarnat HB, Maria BL (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.284.
- Kirkpatrick M, Engleman H, Minns RA. Symptoms and signs of progressive hydrocephalus. Arch Dis Child 1989; 64:124.
- Rekate HL. Treatment of Hydrocephalus. In: Pediatric Neurosurgery, 3, Cheek WR (Ed), WB Saunders Company, Philadelphia 1994.
- Alexander E Jr, Davis CH. Macewen's sign--"the cracked pot sound". Surg Neurol 1987; 27:519.
- Löppönen T, Saukkonen AL, Serlo W, et al. Accelerated pubertal development in patients with shunted hydrocephalus. Arch Dis Child 1996; 74:490.
- Cavalheiro S, Moron AF, Almodin CG, et al. Fetal hydrocephalus. Childs Nerv Syst 2011; 27:1575.
- Noorani PA, Bodensteiner JB, Barnes PD. Colpocephaly: frequency and associated findings. J Child Neurol 1988; 3:100.
- Dinçer A, Özek MM. Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst 2011; 27:1543.
- Brunetti MA, Mahesh M, Nabaweesi R, et al. Diagnostic radiation exposure in pediatric trauma patients. J Trauma 2011; 70:E24.
- CLINICAL FEATURES
- Common signs and symptoms
- Clinical suspicion
- Physical examination
- Lumbar puncture
- Measurement of ICP
- Obstructive versus communicating hydrocephalus
- MIMICS OF HYDROCEPHALUS
- Reduced brain volume
- Benign extra-axial fluid of infancy
- Normal pressure hydrocephalus
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS