Hydrocephalus physical examination

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, headache, fever, nausea, vomiting

• The physical examination of hydrocephalus is given below:^[1][2][3]

• 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

• 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 is given below:
  • Increase in respiratory rate.
  • Apnea may be present in infants.

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.

• Papilledema

• Abducens nerve palsy.
• Vertical gaze palsy.
• Parinaud syndrome due to compression of the quadrigeminal plate, where the neural centers coordinating the conjugated vertical eye movement are intact.
• Pyramidal tract signs are seen in most cases.

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