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Raised intracranial pressure in a neonate presenting as stridor

Neonatal stridor is an important sign of upper airway obstruction. This is most commonly secondary to laryngeal pathology and investigated by otolaryngologists. However neurological causes of stridor, secondary to vocal cord paralysis also occur for a variety of reasons ( 1 ). In cases of meningomyelocele up to 20% of infants may develop stridor ( 2 ). Respiratory distress may be severe and require prompt surgical and medical intervention. We describe a neonate born with a meningomyelocele, who developed stridor secondary to evolving hydrocephalus after surgical repair of the meningomyelocele. This was treated acutely by direct tapping of cerebrospinal fluid from the right coronal horn via the coronal suture with immediate symptomatic improvement prior to a definitive shunt procedure.