Hydrocephalus physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Ahsan Hussain, M.D.[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, headache, fever, nausea, vomiting
Physical Examination
Appearance of the Patient
- The patient may appear anxious.
- The patient is often sitting upright and has difficulty breathing.
- The patient may complain of pain and may be in distress
Vital Signs
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 is given below:
- 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
Neurologic
- 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.
References
- ↑ Binder DK, Lyon R, Manley GT (April 2004). "Transcranial motor evoked potential recording in a case of Kernohan's notch syndrome: case report". Neurosurgery. 54 (4): 999–1002, discussion 1002–3. PMID 15046669.
- ↑ Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ (August 2002). "Management of severe head injury: institutional variations in care and effect on outcome". Crit. Care Med. 30 (8): 1870–6. PMID 12163808.
- ↑ Mauritz W, Steltzer H, Bauer P, Dolanski-Aghamanoukjan L, Metnitz P (July 2008). "Monitoring of intracranial pressure in patients with severe traumatic brain injury: an Austrian prospective multicenter study". Intensive Care Med. 34 (7): 1208–15. doi:10.1007/s00134-008-1079-7. PMID 18365169.