Study objective: Sudden death from obstructive hydrocephalus related t
o intracranial neoplasms has rarely been reported in the pediatric lit
erature. We sought to review the presenting signs and symptoms of acut
e hydrocephalus resulting from intracranial mass lesions to guide clin
icians in the early identification of these potentially reversible les
ions. Methods: All cases of sudden unexpected death attributable to ob
structive hydrocephalus that occurred from 1990 through 1994 at the Ho
spital for Sick Children, Toronto, were retrospectively reviewed. Resu
lts: During the study period, seven children, ages 10 months to 15 yea
rs, died unexpectedly with acute obstructive hydrocephalus. Six childr
en were apparently normal, and none had any known neurologic disease.
All patients had a previously undiagnosed intracranial tumor located a
t a critical site for CSF flow: colloid cyst (n=2), astrocytoma (n=2),
ependymoma (n=2), suspected lymphoma (n=1). Presenting features inclu
ded vomiting in all cases, vomiting for longer than 2 weeks in three,
headache in four, and lethargy in three. Five patients were misdiagnos
ed with viral illnesses, including three with presumed gastroenteritis
who received intravenous rehydration therapy. Focal gastrointestinal
signs were absent. Conclusion: This case series highlights a life-thre
atening but misleading presentation of intracranial tumors. The diagno
sis of gastroenteritis should be made cautiously when headache and vom
iting occur in the absence of focal intestinal complaints. A history o
f vomiting exceeding a few days' duration warrants further investigati
on. Persistent lethargy should be considered a neurologic rather than
a nonspecific clinical sign. Heightened awareness of this neurosurgica
l emergency may lead to swift intervention and potential reversibility
with diversion of CSF.