ACUTE OBSTRUCTIVE HYDROCEPHALUS AND SUDDEN-DEATH IN CHILDREN

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.