A 4-month-old infant is suspected of developing hydrocephalus. Which of the following is considered an early clinical sign?

Correct option is B

The setting-sun sign (downward deviation of eyes with scleral show above iris) is one of the earliest clinical indicators of raised ICP in infants with hydrocephalus.
Explanation of options: (a) ✘ Bulging fontanelle occurs but usually later with sustained raised ICP. (b) ✔ Correct; “sunset eye” is a classic early marker of hydrocephalus. (c) ✘ Dilated scalp veins develop in more advanced stages. (d) ✘ Macrocephaly is a later finding as head circumference increases.