Symptoms and signs of progressive hydrocephalus. Arch Dis Child

SUMMARY The clinical features of 107 cases of children with hydrocephalus and measured raised intraventricular pressure were analysed retrospectively. Fifty one children had recently been diagnosed as having hydrocephalus, and the remainder had had shunts injected to direct the cerebrospinal fluid. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins. Half the infantile cases of hydrocephalus were without symptoms, and a quarter of the cases with cerebrospinal fluid shunts and measured raised intraventricular pressure were without signs. There were no fewer than 33 different clinical signs including several unusual ones, such as macular rash and sweating. We believe that the presentation of hydrocephalus with raised intraventricular pressure is sufficiently variable, unusual, or even absent to justify the direct measurement of intracranial pressure. The classical adult presentation of raised intracra-nial pressure (headache, vomiting, and papil-loedemal) is rare in children with progressive hydrocephalus. There are few studies of the clinical presentation of hydrocephalus with raised intracra-nial pressure either before or after an operation to divert the cerebrospinal fluid. There are certainly no studies in which raised intracranial pressure has been confirmed by direct measurement, and such reports that do exist in children frequently include those with causes of raised intracranial pressure other than hydrocepha-lus alone. The aim of this study therefore was to document the symptoms and signs of 107 cases of progressive hydrocephalus (that is, hydrocephalus with raised intracranial pressure) in which the clinical features were documented and raised ven-tricular pressure had been confirmed on direct measurement. Patients and methods All the patients were admitted to the neurology uni