Hydrocephalus in Infants

A relatively common condition that can affect infants, hydrocephalus must be promptly treated to prevent permanent brain damage. This condition occurs when the infant suffers an excess buildup of cerebrospinal fluid in the brain. The buildup of fluid can place pressure on the brain tissues, which can result in brain damage. If your baby has suffered hydrocephalus that resulted in complications, it’s important for you to understand the causes and whether your baby’s condition resulted from medical malpractice. Here is some information about this condition and its potential causes from the Philadelphia birth injury lawyers at Raynes & Lawn.

What Is Hydrocephalus?

Hydrocephalus is a medical condition that results from the buildup of excessive amounts of cerebrospinal fluid (CSF) inside the brain ventricles or cavities. While people might refer to hydrocephalus as water on the brain, CSF is actually a clear liquid that surrounds the spinal cord and brain and cushions them. Cerebrospinal fluid constantly circulates inside the brain ventricles and the spinal cord and provides several important functions. It cushions the brain and spinal cord and absorbs shocks. It is also used as a medium for the delivery of nutrients and the removal of waste from the brain. Finally, the flow of the CSF between the spine and the cranium helps to regulate pressure changes.

While CSF is beneficial, it can cause excessive pressure on the brain tissues because of the confines of the skull when it builds up. Cerebrospinal fluid can happen because of an increase in its production or a decrease in its absorption rate. It can also happen when an infant suffers a condition that blocks the normal flow of the CSF through the ventricles.

While people of any age can develop hydrocephalus, it most commonly occurs in infants and older adults who are at least 60. According to UCLA Health, hydrocephalus occurs in approximately two out of every 1,000 live births in the U.S. It can also be acquired after birth because of infections or other issues.

Types of Hydrocephalus

The causes of hydrocephalus are not well understood. Some children will have hydrocephalus at birth. Others will acquire the condition during childhood or as adults. Hydrocephalus can be inherited as a genetic condition, be associated with certain developmental disorders, including spina bifida and encephalocele, or can result because of head injuries, tumors, brain hemorrhage, or infections like meningitis. Hydrocephalus is categorized based on whether any structural defects are present, the age of onset, and whether the pressure of the CSF is high or normal. The various categories of hydrocephalus include the following:

• Congenital hydrocephalus – This type of hydrocephalus is present when the child is born and is present in the fetus. It might be caused because of problems during fetal development or because of genetic defects.
• Acquired hydrocephalus – This form of hydrocephalus can develop at birth or later in childhood or adulthood and be caused by injuries or infections. For example, infants who develop meningitis might subsequently develop hydrocephalus as a complication.
• Communicating hydrocephalus – This type of hydrocephalus occurs when there is an insufficient rate of absorption of CSF or when there is too much production of CSF. Communicating hydrocephalus does not occur because of an obstruction to the flow of CSF.
• Obstructive hydrocephalus – This form of hydrocephalus happens when there is a blockage or obstruction along one or more of the ventricular passages. The obstruction then causes the pathways upstream of the blockage to enlarge and increased pressure within the skull.
• Normal pressure hydrocephalus – This type of hydrocephalus happens when the ventricles are dilated, allowing excess CSF to build up. The pressure within the spinal column is normal with this form of the condition. While it can occur at any age, normal pressure hydrocephalus most commonly occurs in elderly adults.
• Hydrocephalus ex-vacuo – This form of hydrocephalus primarily occurs in association with degenerative brain disease or as a complication of trauma or stroke and is most common in adults. This type of hydrocephalus can cause the brain tissues to shrink because of damage.

Causes and Risk Factors of Hydrocephalus

In most cases, infants with hydrocephalus will have congenital forms of the condition, meaning they are born with it. However, babies and children can also acquire hydrocephalus following birth.

While there isn’t a specific cause of this condition, the following factors can result in its development:

• Birth injuries
• Brain hemorrhaging
• Brain lesions or tumors
• Maternal or fetal infections during pregnancy
• Meningitis following birth
• Preterm birth
• Traumatic brain injuries (TBIs)
• Spinal cord injuries (SCIs)
• Spina bifida

Hydrocephalus can sometimes occur during labor and delivery when the infant suffers head trauma. For example, if a doctor improperly uses birth assistive devices such as vacuum extractors or forceps, the baby can suffer head injuries that lead to hydrocephalus. In these and other similar situations, hydrocephalus might be the result of medical negligence and form the basis of a malpractice lawsuit.

Symptoms of Hydrocephalus

Hydrocephalus symptoms can vary broadly and across different ages. Young children and infants are more likely to show symptoms caused by increased pressure on the brain, including vomiting. Adults might lose functions, including the ability to walk or think.

Symptoms in Infants

The signs that an infant might have hydrocephalus include the following:

• Overly large head
• Rapidly increasing circumference of the head
• Tense, bulging soft spot or fontanelle
• Prominent, visible veins on the scalp
• Eyes that deviate downward
• Excessive sleepiness
• Vomiting
• Seizures
• Irritability

Symptoms in Children and Adolescents

Some of the symptoms of hydrocephalus in older children and adolescents include the following:

• Vomiting and nausea
• Double vision
• Blurred vision
• Optic disc swelling
• Abnormal gait
• Balance problems
• Slowed developmental progress
• Loss of developmental progress
• Personality changes
• Trouble concentrating
• Loss of appetite
• Urinary incontinence
• Seizures

The symptoms of hydrocephalus frequently overlap with symptoms of other types of disorders. This makes it very important to speak with your child’s doctor immediately if you notice any of the possible symptoms of this condition in your child.

How Is Hydrocephalus in Infants Diagnosed?

Congenital hydrocephalus typically starts to develop during the third trimester of pregnancy. During pregnancy, doctors can diagnose congenital hydrocephalus by using a fetal ultrasound.

Following birth, hydrocephalus can be diagnosed through a neurological examination and with brain imaging techniques based on the child’s age, suspected or known spinal cord or brain abnormalities, and symptoms.

Neurological Examination

During the neurological examination, the doctor will perform tests to assess the child’s muscular strength, reflexes, coordination, balance, hearing, eye movement, vision, mood, and mental functioning. Doctors typically diagnose hydrocephalus in infants and children by using brain imaging studies, including ultrasounds, computerized tomography (CT) scans, and magnetic resonance imaging (MRI) studies.

Ultrasounds

An ultrasound creates images of the brain by using sound waves. During a mother’s pregnancy, a fetal ultrasound can reveal the fetal brain’s ventricle sizes. An ultrasound might also be performed following a baby’s birth.

CT Scans

A CT scan can be used to create detailed images of the baby’s body by using a series of x-rays. This can allow the doctor to get a picture of the baby’s brain and other tissues, including bones, organs, muscles, and fat. A CT scan can allow doctors to see whether there is an enlargement of the ventricles and if there is an obstruction in the ventricular passages.

MRIs

An MRI uses radio waves and large magnets to provide detailed images of a baby’s organs. An MRI can help doctors to determine whether the ventricles are enlarged and evaluate the flow of the CSF. It can also provide the doctor with information about the condition of the brain tissue around the brain ventricles. MRIs are typically the first test doctors use to diagnose hydrocephalus in adults.

Treatment of Hydrocephalus

Hydrocephalus can’t be treated during pregnancy. Instead, doctors will carefully monitor the motor and fetus for signs of distress. If the fetus shows signs of fetal distress, an emergency c-section might be performed.

Following birth, hydrocephalus is typically treated with one of the following surgical interventions:

• Surgical insertion of a shunt
• Endoscopic third ventriculostomy (ETV)
• Choroid plexus cauterization

A shunt might be inserted to drain excess CSF into the baby’s abdomen or chest cavity so the body can absorb it. In this surgery, a shunt is inserted into the baby’s brain and connected to a tube that is placed under the baby’s skin to drain the excess fluid buildup.

A doctor might recommend ETV to improve the flow of cerebrospinal fluid out of the baby’s brain. In this procedure, a small hole is made at the lower edge of the third ventricle. The CSF will then be diverted to the hole to relieve pressure on the brain. This is sometimes performed together with cauterization of the choroid plexus to decrease the baby’s overproduction of cerebrospinal fluid.

In choroid plexus cauterization, the doctor burns the tissues that produce CSF with an electric current in the brain’s lateral ventricles so that they will produce less cerebrospinal fluid.

Shunts typically perform well, but they sometimes do not drain the excess CSF properly because of infections or mechanical failure. If this occurs, the CSF can again start building up in the brain and cause the recurrence of symptoms. To reduce the excessive CSF, the shunt system will need to be replaced.

Shunts must be checked regularly during medical appointments and require ongoing monitoring. Several surgeries might be necessary to repair or replace shunts during the person’s life. If your child develops symptoms that indicate their shunt is not properly working, you should see a doctor immediately.

Some of the signs that a shunt system is malfunctioning include the following:

• Light sensitivity
• Headache
• Double vision
• Nausea
• Vomiting
• Seizures
• Muscular soreness in the shoulders or neck
• Tenderness and redness along the shunt’s tract
• Fever
• Exhaustion
• Excessive sleepiness
• Recurrence of the symptoms of hydrocephalus

In addition to surgery, many children who suffer from hydrocephalus also benefit from educational intervention and therapy. Your child might have an interdisciplinary team of professionals, including doctors, neurologists, rehabilitation therapists, and educational experts to facilitate your child’s development and ability to function.

Some of the types of therapy and intervention your child might receive include the following:

• Developmental and occupational therapy to help your child develop prosocial behaviors and learn to function independently
• Special education teachers to help your child address learning disabilities
• Social workers and/or mental health therapists to help your family find services and receive emotional support

Follow-Up Care

Following your child’s surgery, their neurological functioning will be evaluated. If the neurologist identifies persistent neurological problems, your child might need to undergo rehabilitation. Your child’s recovery might be limited by the extent of the brain damage caused by hydrocephalus and the ability of their brain to heal.

Hydrocephalus is a chronic condition, so long-term care will be necessary. Your child might undergo follow-up tests to help to determine whether their shunt system is functioning properly. Contact your child’s doctor immediately if you notice any of the signs the shunt system is not working properly.

Prognosis

Your child’s prognosis will depend on the cause of their hydrocephalus, the extent of the damage and symptoms, and how quickly your child was diagnosed and treated. Some children dramatically improve following treatment, but others do not. Symptoms that are related to high pressure might be relieved almost immediately following the placement of a shunt.

The faster that hydrocephalus is diagnosed, the better your child’s chances for improvements will be. If your child’s symptoms were present for a long time before being diagnosed and treated, your child’s outcome might be less successful.

Your child’s shunt might fail or malfunction at some point. The shunt’s valve might become clogged, or the pressure inside of your child’s shunt might not meet their needs. Either issue can require your child to undergo another surgery. If your child suffers an infection, your child might require antibiotics and the temporary removal of their shunt until their infection resolves.

Complications in Infants

Hydrocephalus in infants is associated with several other conditions, but the complications that can arise are difficult to predict. Since hydrocephalus causes brain damage, children with this condition might suffer from multiple conditions, including epilepsy, vision problems, learning disabilities, coordination problems, vision problems, and short-term memory loss. Some children with hydrocephalus also have early-onset puberty. In addition, some children develop surgical complications and complications from shunts, including the following:

• Infections
• Bleeding
• Insufficient or excessive drainage

In children with mild hydrocephalus who underwent successful treatment, they might experience normal development.

Hydrocephalus and Medical Malpractice

In some cases, hydrocephalus is caused by birth injuries resulting from medical negligence. If a doctor’s medical errors caused your child’s hydrocephalus and resulting complications, you might have grounds to file a medical malpractice lawsuit.

To prove medical malpractice, you will need to retain a medical expert who can give an expert opinion about the expected standard of care and how your doctor’s treatment fell below it and caused your child’s injuries and harm. Pennsylvania requires plaintiffs in medical malpractice cases to first have their cases evaluated by medical experts before they can file claims.

The attorneys at Raynes & Lawn work closely with medical experts to evaluate potential claims. These types of cases are complex and require substantial medical documentation and investigation. However, if the care provided by your child’s doctor amounted to medical malpractice, you might be able to recover compensation to pay for all of your child’s treatment and the losses your family has suffered as a result.

To learn more about your potential case, contact the medical malpractice attorneys in Philadelphia at Raynes & Lawn for a free consultation at 1-800-535-1797.

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