Background: Hydrocephalus remains a significant neurosurgical problem in the pediatric age group with varied etiologies and clinical presentations. This study analyzes the demographic distribution, etiological classification, and clinical manifestations of pediatric hydrocephalus.(1,2,5,6). In this observation retrospective study, 132 patients diagnosed as hydrocephalus by neuroimaging (i.e.USG, MRI) admitted and treated over a span of one year at pediatric department of tertiary care center in Gujrat were included and evaluated for demographic profile and etiology, classification(communicating vs. non-communicating) (congenital vs. acquired) and clinical manifestations. Results: out of 132 patients, 65(49.2%) were males and 67(50.8%) females. The majority (55 i.e. 41.6% cases) were under 1 year of age. Congenital hydrocephalus was present in 56(42.4%) cases, while 76(57.6%) were acquired. Communicating hydrocephalus was more common (74i.e. 56.1% cases) compared to non-communicating (58 i.e. 43.9% cases). Among congenital hydrocephalus, Arnold–Chiari malformation (16 i.e. 28.6%cases) and Dandy–Walker malformation (20 i.e.35.7%cases) were the leading causes. Acquired hydrocephalus was most commonly due to tuberculous meningitis (58 i.e.76.3% cases). Clinical manifestations included convulsions (121 i.e. 91.6%), abnormal head shape (102 i.e. 77.3%), bulging fontanelle (77 i.e. 58.3%), and fever (90 i.e. 68.2%). Common signs like rigidity, bradycardia & sunset sign were noted in respectivelyin 51, 49 and 40 patients.Out of total 56 patients of congenital hydrocephalus43 patients required surgical procedure however out of total 76 patients of acquired hydrocephalus, 54 patients required surgical procedures while others were managed medically. Total 116 patients were discharged;8 patients took discharged against medical advice due to poor prognosis and 8 patients succumbed during course of treatment. Conclusion: Hydrocephalus in children shows diverse etiologies, with infectious causes dominating acquired cases and malformations contributing to congenital cases. Early recognition of clinical manifestations is crucial for timely intervention.
Hydrocephalus is a common neurosurgical condition in the pediatric population, characterized by abnormal accumulation of cerebrospinal fluid (CSF) within the ventricular system. It results from an imbalance between CSF production and absorption or obstruction of CSF pathways.
The condition is associated with significant morbidity if not diagnosed and managed early. Understanding the etiological spectrum and clinical presentation of hydrocephalus in children is essential for planning effective treatment strategies. This study aims to analyze the demographic profile, etiology, and clinical spectrum of pediatric hydrocephalus in a tertiary care setting.
This cross-sectional study was being done retrogradely on pediatric patients diagnosed as hydrocephalus by neuroimaging (i.e. USG, MRI) admitted and treated over a span of one year at pediatric department of tertiary care center in Gujarat. 132 Patients were evaluated for demographic profile (age, sex), etiology (congenital vs. acquired), classification (communicating vs. non-communicating) and clinical manifestations. Their treatment mode and outcome noted in form of discharge/DAMA/EXIRED
|
Variables |
No of patients(n=132) |
percentage |
|
Sex distribution Male Female |
65 67 |
49.2% 50.8% |
|
Age distribution < 1 year 1–3 years 3–5 years > 5 years |
55 47 21 19 |
41.7% 35.6% 15.9% 14.4% |
|
Classification Communicating hydrocephalus Non Communicating hydrocephalus |
74 58 |
56.1% 43.9% |
|
Etiological classification 1. Congenital hydrocephalus: a. Non-communicating (n=36) i. Arnold–Chiari malformation
ii. Dandy–Walker malformation iii. Aqueductal stenosis iv. Porencephaly b. Communicating (n=20): i. Dandy–Walker malformation: ii. Lissencephaly: iii. Congenital CMV infection: |
56
16 (Type I: 4, Type II: 12) 7 5
12 5 3 |
42.4% |
|
2. Acquired hydrocephalus: a. Communicating (n=54): i. tuberculous meningoencephalitis(TBME) ii. Pyogenic meningitis: iii. Preterm: iv. Birth asphyxia: v. Hemorrhagic disease of newborn (HDN): b. Non-communicating (n=22): i. TBME: ii. Pyogenic meningitis: iii. Glioma:
|
76
39
8 3 3 1
19 2 1 |
(57.6%) |
|
Signs&Symptoms: a. Fever: 90 b. Vomiting: 60 c. Convulsions: 121 d. Bulging fontanelle: 77 e. Abnormal head shape: 102 f. Headache: 9 g. Decreased vision: 2 h. Behavioral changes: 4 i. Rigidity: 51 j. MacEwan sign: 28 k. Bradycardia: 49 l. Hypertension: 3 m. Irregular respiration: 7 n. Tachycardia: 12 o. Papilledema: 8 p. Sunset sign: 40 q. Macewen sign: 10 r. Cranial nerve palsy: 5 |
90 60 121 77 102 9 2 4 51 28 49 3 7 12 8 40 10 5 |
68.2% 45.5% 91.7% 58.3% 77.3% 6.8% 1.5% 3.0% 38.6% 21.2% 37.1% 2.3% 5.3% 9.1% 6.1% 30.3% 7.6% 3.8% |
|
Management a. Medical managed b. Surgically managed |
35 97 |
26.5% 73.5% |
|
Outcome a. Discharged b. Discharged against medical advice c. Expired |
116 8 8 |
87.8% 6.1% 6.1% |
Sex ratio in patients of hydrocephalusshows almost equal distribution. (Males 65, Females 67). Maximum patients were under age of one year (41.7%). Communicating hydrocephalus was more common as compared to non-communicating type of hydrocephalus. Congenital hydrocephalus was diagnosed in total 56 patients out of which 36 patients had non communicating type of hydrocephalus which includes 16 patients of Arnold chiari mal formation. Rest patients were diagnosed dandy walker (8), aquedactalstenosis (7) and porencephaly (5). While communicating congenital hydrocephalus patients were 20, 12 patients had dandy walker malformation and rest 5 and 3 patients were diagnosed as lissencephaly and congenital CMV infection respectively. Total 76 patients were diagnosed as communicating acquired hydrocephalus out of which 39 patients had tuberculous meningoencephalitisand 8 had meningitis. Out of 22 patients of non-communicating acquired hydrocephalus, 19 patients had tuberculous meningoencephalitis.
Convulsion was most common presenting complaint (121) followed by fever and vomiting. 2 patients were presented with complaint of decreased vision while 4 patients had been presented with behavioral changes as noted by parents. Mc ewan sign was positive in 28 patients while cushing s triad, was positive in 3 patients suggestive of raised intra cranial pressure. 8 patients had papilledema when examined for fundus while 40 patients had sunset sign. Bulging fontanelle was also found in 77 patients. Out of 132 patients, 35 were managed with medical management only while 97 required surgicalmanagementdespite adequate measures. 116 patients were discharged while 8 took DAMA for poor prognosis while 8 patients were expired in the course of treatment.This study highlights the diverse etiological and clinical spectrum of hydrocephalus in children. The nearly equal male-to-female ratio suggests no significant gender predisposition. The highest incidence in children under one year emphasizes the congenital nature of many cases.
Among congenital causes, Arnold–Chiari malformation and Dandy–Walker malformation were predominant. This finding is consistent with literature that identifies posterior fossa malformations as key contributors to pediatric hydrocephalus.Acquired hydrocephalus was more common, with TB meningitis being the leading cause, reflecting the high prevalence of CNS infections in developing regions. Clinical manifestations were dominated by convulsions, abnormal head shape, and bulging fontanelle, underlining the importance of early recognition of these features.Signs of raised intracranial pressure, such as rigidity, bradycardia, and sunset sign, were common, and should prompt early neuroimaging and intervention.
Hydrocephalus in children demonstrates a wide range of etiologies, with congenital malformations dominating the congenital group and infections (especially TB meningitis) being the most common acquired cause. Clinical manifestations, particularly convulsions and abnormal head enlargement, remain crucial for early suspicion. Timely recognition and management are essential to reduce morbidity and mortality.
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