1. MACROCEPHALY
ANU PRIYA

2. MACROCEPHALY
Head circumference >2 S.D./>2.5cm above the mean for
the age and sex
Head circumference >97th percentile for the age and sex
Expected HC for a particular child by comparing with
standardized charts

3. Causes
Big skull-chronic anemia,osteogenesis
imperfecta,rickets
Big brain-megalencephaly(tay-sach),cerebral
gigantism
More CSF in ventricles-hydrocephalus
Abnormal accumulation-subdural effusion
Familial-commonest cause

4. HYDROCEPHALUS
(Greek-water in head)
DEFINITION:
Excessive accumulation of CSF in the ventricular system

5. TYPES OF HYDROCEPHALUS
OBSTRUCTIVE OR NON-COMMUNICATING
-at the level of aqueduct 3 mm long & 2 mm wide
NON OBSTRUCTIVE OR COMMUNICATING
-increased production
-decreased absorption

6. CAUSES OF HYDROCEPHALUS
COMMUNICATING HYDROCEPHALUS
Increased Production
• Tumors in choroid plexus
Decreased Absorption
Congenital-TORCH
Acquired-Meningitis,leukemia

7. CAUSES OF HYDROCEPHALUS
• OBSTRUCTIVE HYDROCEPHALUS
Congenital
Aqueductal stenosis
Arnold chiari syndrome
Dandy-walker syndrome
Acquired
Aqueductal gliosis-
meningitis,bleeding,mumps encephalitis
Posterior fossa tumors-medulloblastoma

8. CLINICAL MANIFESTATIONS
SYMPTOMS:
IRRITABILITY
POOR FEED
LETHARGY
VOMITING

9. CLINICAL MANIFESTATIONS
SIGNS:
Before AF closure
-BULGING ANTERIOR FONTANEL,
-INCREASED HEAD CIRC.
-DILATED SCALP VEINS
-SETTING SUN SIGN
-WEAKNESS OF LOWER LIMBS

10. • After AF closure
-Headache,vomiting
-Blurring of vision
-Bradycardia,increased Bp
-6th CN Palsy
-Papilloedema
-Transillumination Test
-Macewen Sign “Cracked Pot”
-Prominent Occiput (Dandy-walker)

11. DIAGNOSIS
History
1.Prematurity
2.Intrauterine infections
3.Intracranial hemorrhage
4.Meningitis
5.Mumps encephalitis

12. On examination
1.Café-au-lait patches
2.Spinal dysmorphism
3.Wide AF,wide sutures,sunset eye sign
4.Lower limb weakness,cranial bruit
5.Chorioretinitis,papilloedema

13. IMAGING STUDIES
PLAIN X-RAY SKULL:
SEPARATION OF SUTURES
EROSION OF POSTERIOR CLINOIDS
INCREASED CONVOLUTIONAL MARKINGS
(SILVER BEATEN APPEAREANCE)
ULTRASOUND
CT SCAN
MRI

14. TREATMENT
SUPPORTIVE:(control of ICP)
a.head elevated to 30o
b.Control of temperature
c.Control of seizures
d.Maintain BP
e.Analgesia and sedation

15. TREATMENT
MEDICAL: (for decreasing the production)
_
MANNITOL/ORAL GLYCEROL
-ACETAZOLAMIDE
-FUROSEMIDE
SURGICAL:(for obstruction and decreased
absorption)
V-P SHUNT PLACEMENT

16. PROGNOSIS
INCREASED RISK FOR DEVELOPMENTAL
DISABILITIES
MEAN IQ IS REDUCED COMPARED TO GENERAL
POPULATION
ABNORMALITIES IN MEMORY
SOME PATIENTS SHOW AGGRESSIVE OR
DELINQUENT BEHAVIOR.

17. PROGNOSIS
VISUAL PROBLEMS:
STRABISMUS
VISUOSPATIAL ABNORMALITIES
DECREASED VISUAL ACUITY
VISUAL FIELD DEFECTS
PATIENTS REQUIRE LONG TERM FOLLOW UP