Ultrasonic Diagnosis of Non-communicating Hydrocephalus in a 7-month old Baby (A case report)

Abstract

Hydrocephalus is the accumulation of excess quantity of cerebrospinal fluid causing cerebroventricular enlargement and increased intra-cranial pressure. It is a devastating condition affecting the newborn. Symptoms include bulging fontanelles, neonate irritability, nausea, convulsions and lethargic demeanor. We present the case of a seven-month-old baby referred to Kampala International University Teaching Hospital from a private clinic. There was no history of patient prenatal ultrasound. The baby was scanned through the anterior fontanelle in coronal and sagittal planes with obtuse angulations to accurately measure the ventricles; making the midline falx as a reference point. The mean diameter of the anterior horn of the left and right ventricles in the baby were 17.3 mm and 14.6 mm respectively at the level of the Foramen of Monro, there was no statistically significant difference (p>0.05) between LT and RT hemispheres. High-resolution real-time sonograms obtained revealed bilaterally dilated ventricles with a median of 15.1 mm (> 90^th percentile; for normal baseline of 2.5 mm & 2.4 mm /and above yardstick of 10.0 mm ventriculomegaly definition). There is partial blockage or complete obstruction of the inferior Foramen of Magendie. Development in sonography and Magnetic Resonance Imaging combined with relevant lab tests has greatly streamlined diagnosis. Treatment ranges from observation to surgery depending on stages and severity of symptoms. Hopefully, the information in this case report will be utilized as a formal diagnostic template to exclude hemorrhagic hydrocephalus or ventriculomegaly and other diverse etiology of the congenital disease.