How does hydrocephalus typically present in infants compared with older children?

• A. Infants show rapidly increasing head circumference and bulging fontanelle; older children have headaches, vomiting, papilledema, and gait changes.
• B. Infants have headaches; older children have macrocephaly.
• C. Infants show hearing loss; older children show seizures.
• D. Infants show gait changes; older children have neck stiffness.

Answer: (A)

Hydrocephalus presents differently by age because the skull is still growing in infants and is rigid in older children. In infancy, open fontanelles and sutures allow the head to expand as CSF accumulates, so the most noticeable sign is a rapidly increasing head circumference with a bulging fontanelle. In older children, the skull is closed, so the increased intracranial pressure cannot enlarge the head; instead, symptoms include headaches, vomiting, papilledema, and gait changes. This pattern matches the described presentation: infants with rapid head growth and a bulging fontanelle, older children with signs of raised intracranial pressure like headaches, vomiting, papilledema, and gait disturbances.