Congenital hydrocephalus

lPatient 3 years girl,

lBorn of non consanginoous marriage, 1st by birth order

lComplaints

l        Large growing head since birth

l        Headache

l        Unable to sit crawl stand  hold neck

lDevelopmental history

l      Marked gross motor delay.

l      Developmental index<15%(5/36x100)>

l      Fine motor,language,social developmental history normal. 

Clinical findings

lLarge head with head circumference of 77cms.

lLateral rectus palsy in left eye.

lDownward gaze.

Anterior fontanelle not closed and pulsatile.

Pressure sores over the posterior aspect of scalp. 

l

l

Hemangioma

Patient has presented with reddish swelling in left cheek since childhood which is gradually in increasing in size.there is history of raise in temperature at the site. 

EXAMINATION

Inspection:- greyishbrown pappule is present over left cheek in front of tragus extending to angle of mandible.Edges are not clearly made out.No punctum.

Palpation:-size:-21/2x2 inches

 extent:- from lateral canthus of eye to angle of mandible and from tragus to nasolabial fold. 

soft in consistency. 

Investigation:-On doppler ultrasound examination swelling is found to be have increased blood flow.