Clinical reference

Congenital Hydrocephalus

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Hydrocephalus - StatPearls (NCBI Bookshelf NBK560875) - https://www.ncbi.nlm.nih.gov/books/NBK560875/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class ND55.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care

Verified against1 document

No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (2)

Infants may show delayed growth and sexual maturation, a high-pitched cry, irritability or drowsiness, vomiting, and seizures [drowsiness · excessive crying · irritability · seizures · vomiting]
Additional features include stiff limbs, reluctance to move the neck, poor feeding, breathing difficulty, and delayed developmental milestones [breathlessness · poor feeding]

Signs — what you find (5)

An abnormally large head is a key sign of the congenital form
A tense, bulging fontanelle with separated skull sutures and thin, shiny scalp with visible veins may be seen [bulging fontanelle]
A cracked-pot sound heard on skull percussion is called the Macewen sign
Downward eye deviation from pressure on the tectal plate produces an impaired upward gaze
Acute hydrocephalus causing brain herniation presents with a dilated, non-reactive pupil on the affected side, autonomic dysfunction, loss of brainstem reflexes, and coma, and needs emergency neurosurgery [coma]

Tests (7)

Genetic testing and counseling may be recommended for the congenital forms
Cranial ultrasound through the open fontanelle can assess the ventricles and track progression in infants
An emergency head CT is the first imaging choice in the acute form to assess ventricle size
Ballooning of the frontal horns and third ventricle on CT is called the Mickey Mouse sign and can indicate obstruction at the aqueduct
MRI is the preferred study since it shows the back of the brain better and can distinguish tumors and degenerative disease
Skull X-ray may show erosion of the sella turcica or a beaten-copper appearance but is rarely needed given better imaging options
CSF analysis can support the diagnosis and rule out an ongoing infection

If not this — what else fits (3)

Idiopathic intracranial hypertension raises pressure without any identifiable structural cause, unlike hydrocephalus
Secondary brain atrophy from autoimmune disease, HIV, or chemotherapy can mimic hydrocephalus on imaging
Other structural mimics include brainstem gliomas, frontal lobe epilepsy or syndromes, intracranial hemorrhage, migraine, CNS lymphoma, pituitary tumors, and subdural hematoma or empyema

SourceStatPearls "Hydrocephalus" - disease-level clinical article

Presentation findings are traced to the source above.

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line

Adult dose and duration

Excess cerebrospinal fluid accumulation from birth causing rapid head enlargement; definitive treatment is neurosurgical shunting, so the GP's role is early recognition through serial head circumference measurement and urgent paediatric neurosurgery referral. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Cautions

No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
RED FLAG - Rapidly increasing head circumference, a bulging or tense fontanelle, or sunsetting eyes, irritability or poor feeding suggesting raised intracranial pressure: refer urgently.

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