Hydrocephalus physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor-In-Chief: Cafer Zorkun M.D., PhD.Kalsang Dolma, M.B.B.S.[2]
Overview
Physical examination shows progressive enlargement of head in infants. Depending upon the rate of development duration of hydrocephalus, signs of increased intracranial pressure may be seen.
Appearance of the Patient
Physical Examination
Vital Signs Note: Vital signs traditionally include the temperature, blood pressure, heart rate, respiratory rate. The vital signs may also include oxygen saturation (at room air) and blood glycemia.
High-grade / low-grade fever Hypothermia / hyperthermia may be present Tachycardia with regular pulse or (ir)regularly irregular pulse Bradycardia with regular pulse or (ir)regularly irregular pulse Tachypnea / bradypnea Kussmal respirations may be present in _____ (advanced disease state) Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure Skin Cyanosis Jaundice Pallor Bruises
Physical Examination
Appearance of the Patient
The patient may appear anxious The patient is often sitting upright and has difficulty breathing The patient is often confused Obesity may be present. The patient may complain of pain and may be in distress
- Vitals
Pulse
- The rate and rhythm is given below:
- Rate
- Bradycardia may be present.
- Rhythm
- The pulse is regular.
- Blood Pressure:
- Hypertension may be present.
- Respiratory Rate===
- Increase in respiratory rate
- Apnea may be present in infants.
Head
Infants
- Large head: Head circumference is measured and recorded.
- Anterior fontanel is wide and bulging
- Scalp veins are visible and prominent
Older children
- Cranial bruit may be audible in cases of arteriovenous malformation
- Macewen's sign: Tapping (percussion) the skull near the junction of the frontal, temporal and parietal bones will produce a stronger resonant sound when either hydrocephalus or a brain abscess are present.
Eyes
- Papilledema
- Sunsetting sign which is inferior ocular deviation due to hydrocephalic pressure on the mesencephalic tegmentum and paralysis of upward gaze.
- Features of chorioretinitis may be present in cases of TORCH infection
Neurologic
- Abducens nerve palsy and
- Vertical gaze palsy
- Parinaud syndrome due to compression of the quadrigeminal plate, where the neural centers coordinating the conjugated vertical eye movement are located
- Pyramidal tract signs are seen in most cases