Localizing features are to be found in squints, inequality of pupils, retraction of the head and neck, dyspnœa, and dysphagia, whilst compression of the cortical motor centres is evidenced by twitchings, convulsions, and spasticity of the limbs. General convulsions are by no means uncommon. Remissions and intermissions of both local and general symptoms are frequently observed, paralyses, for example, fluctuating in depth and character.
B. The bones comprising the vault of the skull become greatly thinned and widely separated from one another, the fontanelles enlarged, and the sutures unduly prominent. The head becomes enlarged in all directions, and its increased weight renders the child incapable of retaining postural control, the head being top-heavy and falling about in all directions.
The bones of the base share in the deformity. The pressure exerted on the orbital plates of the frontal bone force the globe in the downward direction in such a manner that the infra-corneal sclerotic is obscured by the lower lid, whilst the supra-corneal portion is unduly prominent. The bony eminences in the region of the sella turcica are diminished in size, the middle fossa of the skull flattened from side to side, and the posterior fossa from before backwards. In such cases the skull assumes an almost dolicocephalic appearance. In any case, the disproportion between the enlarged skull and diminutive face is a marked feature.[14]
The scalp becomes stretched, hairs are sparse and brittle, and the veins dilated.
Treatment.
Indications for operation.
The results obtained by operation for internal hydrocephalus are not sufficiently encouraging to enable the surgeon to urge immediate operative treatment.[15] Still, it is perfectly clear that he cannot possibly carry out surgical treatment with benefit to the patient if the ventricular distension is allowed to progress to such a degree that marked cortical flattening and degeneration occurs. No fixed probationary period can be laid down as a guide, each case must be judged on its own merits. Special attention should be paid, however, to the disks and lower extremities. Any suggestion of optic neuritis or spasticity should be regarded as urgently demanding operative interference.
Lumbar puncture
cannot be expected to confer other than temporary benefit even under the most favourable circumstances, whilst, in the event of interference in the normal communication between the ventricular and cerebro-spinal spaces, no relief can be anticipated. Connal recommends that lumbar puncture should be carried out daily, or twice daily, over extended periods of time. This operation, however, is by no means devoid of danger, and the results obtained by such treatment are not at all satisfactory.