Hydrocephalus in Infants: MRI Insights and Growth Monitoring

Hydrocephalus and Magnetic Resonance Imaging (MRI)

Dear Dr.
Hsiao,
My younger brother is seven months and thirteen days old.
Today, we went for a follow-up ultrasound of his brain because he was previously diagnosed with hydrocephalus.
The first ultrasound showed a hydrocephalus measurement of 0.7 cm, the second was 0.5 cm, and today it was down to 0.3 cm.
The doctor said the condition is looking good, but his head circumference continues to grow (on August 27, when he was six months old and received the pneumococcal and five-in-one vaccines, his head circumference was 47 cm; on September 11, after the third dose of the hepatitis B vaccine, it was 47.8 cm; and today it measured 48.2 cm).
The doctor mentioned that 0.3 cm of fluid should not affect head circumference size and advised me to observe him for two months.
After two months, we should return for a check-up to see if there is any further increase in head circumference.
If there is, an MRI will be needed to check for abnormalities.
I would like to ask Dr.
Hsiao:
1.
For a six-month-old child, how many centimeters of head circumference growth per month is considered normal?
2.
Should a child like my brother stop increasing head circumference, or is a decrease necessary to be considered normal?
3.
If there is a brain tumor, can it be visually detected, or can it be observed through his motor skills?
4.
Currently, my brother's development seems a bit slow; at seven months, the doctor said his motor skills are at the level of a six-month-old.
Does this qualify as developmental delay?

Zhuang Tai Tai, 20~29 year old female. Ask Date: 2012/10/09

Dr. Xiao Kaiwen reply Pediatrics

1.
After birth, an infant's head circumference typically increases by an average of 8 to 10 centimeters in the first six months, and by about 2 to 4 centimeters in the second six months.
You can estimate this growth or use the growth charts in the child's health booklet to compare long-term head circumference for any abnormalities.
2.
A larger head circumference may be due to normal genetic factors (for example, if the parents have larger heads, the child may also have a larger head) or rapid growth and development in the infant, resulting in a relatively larger head.
However, it could also indicate pathological conditions such as hydrocephalus or megalencephaly.
Since the cause for your child's condition is still unknown, it is not necessarily definitive to say that a cessation or reduction in head circumference is normal.
A cranial ultrasound is convenient but less detailed, while magnetic resonance imaging (MRI) is more precise.
3.
If there is a brain tumor causing increased intracranial pressure, the infant may exhibit signs such as an enlarged head circumference, seizures, bulging fontanelle, and "sunsetting" eyes (where the eyeballs are positioned below the horizontal line).
4.
A developmental delay of only one month does not qualify as a significant delay and should be monitored over time.

Reply Date: 2012/10/09

More Info

Understanding hydrocephalus in infants is a critical aspect of pediatric neurology, particularly when it comes to monitoring growth and development through imaging studies like MRI. Hydrocephalus, characterized by an accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, can lead to increased intracranial pressure and potentially impact neurological function and development.
In your case, your seven-month-old brother has shown a decrease in the amount of hydrocephalus from 0.7 cm to 0.3 cm, which is a positive sign. However, the continuous increase in head circumference raises valid concerns that warrant careful monitoring.
1. Normal Growth of Head Circumference: For infants, the growth of head circumference can vary significantly. Typically, during the first six months, the average head circumference increases by about 1.5 cm per month. After six months, this rate may slow down to approximately 0.5 cm per month. Therefore, a head circumference increase of about 1 cm over a month in a six-month-old is generally considered within normal limits. However, each child is unique, and growth patterns should be assessed in the context of overall development and health.

2. Head Circumference Concerns: In your brother's case, the continuous increase in head circumference, despite the reduction in hydrocephalus, suggests that it is essential to monitor this closely. A head circumference that continues to grow significantly may indicate that the underlying issue has not resolved or that there are other factors at play. Ideally, head circumference should stabilize or even decrease if the hydrocephalus is resolving. If the head circumference continues to increase, further evaluation with MRI may be warranted to rule out any other abnormalities, such as a brain tumor or other structural issues.

3. Signs of Brain Tumors: While some brain tumors may present with visible signs, such as an abnormal head shape or increased head circumference, many do not show outward symptoms until they have progressed significantly. Symptoms can include developmental delays, changes in behavior, seizures, or neurological deficits. Regular monitoring and imaging studies are crucial for early detection, especially in the context of existing hydrocephalus.

4. Developmental Delays: Your observation regarding your brother's developmental milestones is also significant. If he is exhibiting motor skills that are more aligned with a six-month-old rather than a seven-month-old, this could indicate a developmental delay. Developmental delays can be multifactorial, including neurological issues, environmental factors, or genetic predispositions. It is essential to work closely with pediatric specialists, including neurologists and developmental pediatricians, to assess his growth and development comprehensively. Early intervention services may also be beneficial to support his development.

In conclusion, while the decrease in hydrocephalus is encouraging, the continuous increase in head circumference and the noted developmental delays necessitate ongoing observation and potential further investigation. Regular follow-ups with your healthcare provider, including possible MRI assessments, will be crucial in ensuring that any underlying issues are addressed promptly. It is essential to maintain open communication with your healthcare team and advocate for your brother's health and developmental needs.

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