Which finding would suggest hydrocephalus in a neonate?

• A. Closed fontanel and high-pitched cry
• B. Constant low-pitched cry and restlessness
• C. Depressed fontanel and decreased blood pressure
• D. Bulging fontanel and dilated scalp veins

Answer: (D)

In a neonate, signs of hydrocephalus come from increased intracranial pressure. The most telling clue is a fontanelle that bulges under pressure, along with visible dilation of scalp veins as venous pressure rises and outflow is impeded. This combination—bulging fontanelle plus dilated scalp veins—directly reflects raised intracranial pressure affecting the skull where sutures are still open.

Other findings described are less specific. A closed fontanelle isn’t consistent with neonatal hydrocephalus, since the fontanelle is still open in this age. A high-pitched or a constant low-pitched cry can occur with distress but isn’t as diagnostic for hydrocephalus, and a depressed fontanelle with low blood pressure points more toward dehydration or shock rather than elevated intracranial pressure.