Differential Diagnosis for Increased Intracranial Pressure in a 6-month-old Girl with Lumbosacral Myelomeningocele

• Single most likely diagnosis
  • Hydrocephalus: This condition is highly associated with myelomeningocele due to the potential obstruction of cerebrospinal fluid (CSF) pathways, leading to increased intracranial pressure. The bulging fontanelles and rapid increase in head circumference are indicative of hydrocephalus.
• Other Likely diagnoses
  • Chiari II Malformation: Often associated with myelomeningocele, this condition involves the herniation of the cerebellum and brainstem into the spinal canal, which can lead to increased intracranial pressure and is consistent with the clinical presentation.
  • Shunt Malfunction (if a shunt is present): Although not explicitly mentioned, if a ventriculoperitoneal shunt was placed to manage hydrocephalus, malfunction could lead to increased intracranial pressure, presenting with symptoms like bulging fontanelles and increased head circumference.
• Do Not Miss
  • Intracranial Hemorrhage: Although less likely, an intracranial hemorrhage could present with increased intracranial pressure and must be considered due to its potentially catastrophic consequences if missed.
  • Meningitis: An infection like meningitis could cause increased intracranial pressure and has a high morbidity and mortality if not promptly diagnosed and treated.
• Rare diagnoses
  • Vein of Galen Malformation: A rare congenital arteriovenous malformation that could lead to increased intracranial pressure due to high-flow vascular shunting.
  • Brain Tumor: Although rare in infants, a brain tumor could cause increased intracranial pressure by obstructing CSF pathways or directly increasing intracranial volume.