Which early signs are associated with hydrocephalus in infants?

Choice A rationale

Stridor is a high-pitched, inspiratory sound resulting from turbulent airflow through a partially obstructed upper airway, specifically the larynx or trachea. In viral croup (laryngotracheobronchitis), inflammation and edema of the subglottic region cause this characteristic narrowing, making stridor a key expected clinical manifestation, especially when the child is agitated or crying.

Choice B rationale

The barking or "seal-like" cough is the hallmark symptom of viral croup, primarily caused by the inflammation and edema localized to the larynx and vocal cords. The narrowed, swollen subglottic area below the vocal cords creates the distinctive resonant sound as air rushes past the restricted space during exhalation, often worsening at night.

Choice C rationale

Hoarseness is a direct result of the inflammatory process affecting the vocal cords within the larynx. The edema and irritation cause the vocal cords to vibrate abnormally, altering the voice's pitch and quality, leading to the rough or husky sound that is commonly observed in children with viral croup.

Choice D rationale

Tripod positioning (sitting upright, leaning forward, with the neck extended) is a compensatory posture typically associated with severe respiratory distress from epiglottitis or a foreign body, indicating imminent airway collapse, but is generally not an expected early finding in the milder upper airway obstruction of viral croup.

Choice E rationale

Drooling results from the inability to swallow secretions due to severe pain and swelling of the epiglottis, making it a cardinal sign of epiglottitis, a bacterial infection. In contrast, viral croup typically involves inflammation lower down in the subglottic area, so drooling is not an expected clinical feature.

Choice A rationale

A mild headache is a very common and expected symptom following a concussion, resulting from the temporary biomechanical injury to brain tissue or surrounding structures. This symptom alone typically does not indicate an immediate neurological deterioration or an expanding intracranial lesion, provided it doesn't rapidly worsen in severity or become refractory to simple analgesics. Management generally involves rest and observation.

Choice B rationale

Vomiting, especially if persistent or projectile, suggests a significant increase in intracranial pressure (ICP) due to brain swelling or an intracranial hemorrhage. This pressure irritates the vomiting center in the medulla, a critical area of the brainstem. Given that normal ICP is 5-15 mmHg in adults and slightly lower in children, new or worsening emesis warrants prompt clinical and possibly neuroimaging reevaluation.

Choice C rationale

Alertness indicates an intact reticular activating system (RAS), which is crucial for consciousness. Maintaining an alert mental status is a positive sign that suggests the primary brain centers are functioning adequately and the ICP is not critically elevated. A decreased level of consciousness would be a much more concerning indicator of neurological decline.

Choice D rationale

A normal gait reflects proper coordination of motor, sensory, and cerebellar functions. Gross neurological integrity suggests that the cerebral and cerebellar pathways, which govern balance and movement, are not significantly compromised. An abnormal gait, like ataxia, would be a sign of focal neurological deficit or severe intracranial pressure.