What are physical findings of hydrocephalus in children?

Updated: Jun 04, 2018
  • Author: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Physical findings in children include the following:

  • Papilledema: If the raised ICP is not treated, this can lead to optic atrophy and vision loss. The absence of papilledema does not rule out increased intracranial pressure, since it does not develop acutely.

  • Failure of upward gaze: This is due to pressure on the tectal plate through the suprapineal recess. The limitation of upward gaze is of supranuclear origin. When the pressure is severe, other elements of the dorsal midbrain syndrome (ie, Parinaud syndrome) may be observed, such as light-near dissociation, convergence-retraction nystagmus, and eyelid retraction (Collier sign).

  • Macewen sign: A "cracked pot" sound is noted on percussion of the head.

  • Unsteady gait: This is related to spasticity in the lower extremities.

  • Large head: Sutures are closed, but chronic increased ICP will lead to progressive macrocephaly.

  • Unilateral or bilateral sixth nerve palsy is secondary to increased ICP. Children with ventriculoperitoneal (VP) shunts may be more likely to have congenital esotropia. [11]

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