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Hydrocephalus — RACP Paediatrics MCQ

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ModerateNeurologyHydrocephalusRACP Paediatrics

A 6-month-old has rapidly increasing head circumference, bulging fontanelle, sunset sign (downward gaze), and irritability. CT head shows dilated lateral ventricles with periventricular oedema. What is the most likely diagnosis?

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Correct answer: E — Hydrocephalus

Rapidly increasing head circumference with bulging fontanelle, sunset sign (upgaze palsy from pressure on the tectal plate), and dilated ventricles on imaging indicates obstructive hydrocephalus. Causes include aqueductal stenosis, posterior fossa mass, or post-haemorrhagic hydrocephalus. Urgent neurosurgical referral for VP shunt or endoscopic third ventriculostomy (ETV) is required.

Reference: RCH Melbourne – 2023 – Macrocephaly CPG; RACP Paediatric Curriculum – Neurology