Grand rounds and Teaching Files - Pediatric Oncall
Congenital Hydrocephalus: Communicating or Obstructive_?

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Clinical Problem:

Jogender Kumar and Amitabh Singh
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

Address for Correspondence: Dr. Jogender Kumar` Senior Resident, Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.160012. Email: jogendrayadv@gmail,com

A two-month-old boy presented with irritability, recurrent episodes of projectile vomiting for 3 days and rapidly increasing head size for 15 days. There was no fever. He was born at term and had a birth weight of 2.69 kg with uneventful perinatal course. Baby was on breast feeds. On examination, anterior fontanelle was tense and bulging and there were widely separated squamoparietal sutures. He had sun setting of the eyes. Lumbar puncture was tried three times by different pediatricians but every time, it was a dry tap. On ventricular tap, 30 ml of cerebrospinal fluid {CSF} was removed following which irritability improved. A bedside cranial ultrasound {Figure 1} showed dilated lateral, third and fourth ventricles suggestive of communicating hydrocephalus. MRI brain {Figure 2} also showed all four ventricles dilated suggestive of communicating hydrocephalus.

Is it is really communicating hydrocephalus_? If yes, then why was the lumbar puncture a dry tap_?

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