Which sign is most associated with obstructive hydrocephalus due to aqueductal stenosis?

• A. Rash
• B. Cough
• C. Hearing loss
• D. Headache and nausea

Answer: (D)

The sign reflects raised intracranial pressure from obstructive (non-communicating) hydrocephalus caused by aqueductal stenosis. When CSF cannot pass through the cerebral aqueduct, it dials up pressure in the brain, leading to symptoms of increased ICP. Headache and nausea are classic, direct manifestations of this pressure rise, often worse in the morning and sometimes accompanied by vomiting, papilledema, and other ICP-related findings. The other options don’t fit this pattern: a rash points to dermatologic or infectious processes, coughing is nonspecific and not a hallmark of ICP elevation, and hearing loss is not a typical primary sign of obstructive hydrocephalus.