Dawaa Reference

chronic

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.

1

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

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.

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.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.