Hydrocephalus occurs when cerebrospinal fluid builds up within the brain, causing enlargement of the fluid-filled spaces and sometimes increased pressure. It may be present at birth or develop following infection, bleeding, injury or a brain tumour. Treatment depends on the cause and may include observation, shunt surgery or an endoscopic procedure in selected cases.

Possible symptoms may include:

• Rapid increase in head size in infants

• A tense or bulging soft spot

• Irritability, unusual sleepiness or recurrent vomiting

• Persistent or morning headaches in older children

• Blurred or double vision

• Difficulty with balance or walking

• Decline in school performance or development

Tumours may develop within the brain, spinal cord or surrounding tissues. Symptoms vary according to the tumour’s location, size and effect on nearby neurological structures. Evaluation usually involves imaging, and treatment may include surgery, biopsy, chemotherapy or radiotherapy as part of multidisciplinary care.

Possible symptoms may include:

• Persistent or progressively worsening headaches

• Recurrent vomiting, particularly in the morning

• New seizures

• Weakness or altered sensation in an arm or leg

• Difficulty with balance or coordination

• Changes in vision, speech, behaviour or school performance

• Persistent back pain

• Changes in bladder or bowel function

Head injuries may affect the scalp, skull, brain or tissues surrounding the brain. Many minor injuries recover without surgery, but urgent assessment is important when symptoms suggest bleeding, swelling, a skull fracture or injury to the brain.

Warning signs may include:

• Loss of consciousness

• Repeated vomiting

• Increasing sleepiness or difficulty waking the child

• Seizures

• Severe or worsening headache

• Weakness, imbalance or difficulty walking

• Confusion or unusual behaviour

• Bleeding or clear fluid from the nose or ears

• Unequal pupils or visual changes

Spinal dysraphism describes a group of congenital conditions in which the spine, spinal cord or surrounding tissues do not develop normally. These include myelomeningocele, meningocele, spinal lipoma, dermal sinus and other forms of occult spinal dysraphism. Management depends on the type of abnormality and its effect on neurological function.

Possible signs and symptoms may include:

• A swelling, dimple, birthmark or hairy patch over the lower back

• Weakness or reduced movement in the legs

• Abnormalities of the feet or legs

• Difficulty walking

• Reduced sensation

• Scoliosis or other spinal deformity

• Bladder or bowel difficulties

• Recurrent infections associated with a dermal sinus

A tethered spinal cord occurs when the spinal cord is abnormally attached to tissues within the spinal canal. As a child grows, this attachment may stretch the spinal cord and affect nerve function. Surgery may be considered when there is clinical or neurological deterioration.

Possible symptoms may include:

• Back or leg pain

• Progressive weakness or numbness in the legs

• Changes in walking pattern

• Foot deformity or scoliosis

• Loss of previously acquired motor abilities

• New or worsening bladder or bowel problems

• A dimple, fatty swelling, birthmark or hairy patch over the lower back

Chiari malformation occurs when part of the lower brain extends towards or into the spinal canal. Some children have no symptoms and require only observation, while others may develop symptoms due to pressure on nearby structures or changes in cerebrospinal fluid circulation.

Possible symptoms may include:

• Headache at the back of the head

• Headache aggravated by coughing, sneezing or straining

• Neck pain

• Dizziness or balance difficulties

• Weakness or numbness in the arms or legs

• Difficulty swallowing or choking episodes

• Sleep-related breathing problems

• Delayed motor development in younger children

Arachnoid cysts are fluid-filled sacs that develop between the brain or spinal cord and their surrounding membranes. Many are discovered incidentally and do not require treatment. Surgery may be considered if a cyst causes pressure, blocks cerebrospinal fluid circulation or is associated with progressive symptoms.

Possible symptoms may include:

• Headaches

• Nausea or vomiting

• Seizures

• Weakness or altered sensation

• Balance or coordination difficulties

• Developmental concerns

• Increasing head size in infants

Some children are born with structural abnormalities involving the skull, brain, spine or spinal cord. These conditions vary widely and may require observation, surgery or coordinated assessment by several specialists.

These conditions may include:

• Craniosynostosis

• Encephalocele

• Dermal sinus tracts

• Spinal lipomas

• Split cord malformations

• Congenital cysts

• Other developmental abnormalities of the brain or spine