A CASE REPORT OF EXTERNAL HYDROCEPHALUS IN KENYA

Abstract

Introduction: External hydrocephalus, commonly referred to as benign external hydrocephalus is defined as rapidly growing head circumference (occipitofrontal circumference), combined with enlarged subarachnoid spaces on neuroimaging studies. Usually no ventricular enlargement, however moderate enlargement has been reported in some cases. Methodology: We present a case report of a 5 month old black female infant who presented to our emergency department with history of rapidly increasing head circumference. Results: The patient presented with history of rapidly increasing head size, hotness of body, irritability and projectile vomiting. Had visited other institutions and had 2 previous head CT scans and was advised on conservative management (observation and follow up). On examination the infant was sick looking and had a Temperature of 38 degrees Celsius. The GCS was 15, had a macrocephaly of 42 cm with a bulging fontanelle and enlarged scalp veins. The head CT scan showed enlarged subarachnoid space overlying both frontal lobes with normal lateral ventricles. The infant was prepared for Emergency subdural peritoneal shunt. CSF found to be under pressure. Recovery was good with improvement of symptoms. Subsequent follow up in clinic revealed that all symptoms had resolved and both parents were happy with recovery. No case reports have been documented on this subtype of hydrocephalus in Kenya. Currently there is no epidemiological data on extraventricular hydrocephalus in Africa. Conclusion: Currently there are no studies on the outcome of surgical versus conservative management on outcomes and long-term follow up. We hope this will prompt more studies on this subtype and hopefully a management guideline in our setup. We are hopeful that this report will contribute to the apt documentation of this condition.