Hydrocephalus In Infants – Causes, Symptoms & Treatment

Hydrocephalus In Infants

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As parents, we want our child to be born perfect. Many of us get our wish, but some may have to contend with problems, which are both stressful and devastating. Hydrocephalus in infants is one such condition that can leave parents devastated. If your doctor tells you that your infant has hydrocephalus, it is time to take the bull by the horns. Estimates show that hydrocephalus occurs in one in every 500 to 1,000 kids. This condition can cause a range of medical issues.

You may have many questions related to your infant’s hydrocephalus and how it will affect your child and you. That is why MomJunction has assimilated some critical information about the condition and how it can affect children. Read on to learn more.

What Is Hydrocephalus In Infants:

The term hydrocephalus originates from two Greek words – hydro (water) and cephalus (head). As the name suggests, it is a condition where excessive fluid accumulates in the brain [1]. Hydrocephalus, also known as water on the brain, is not the accumulation of water. Rather, it is the buildup of cerebrospinal fluid. When this fluid accumulates in the brain, it causes an abnormal widening of the ventricles, the spaces in the brain. This widening exerts harmful pressure on the brain tissue.

The brain has four ventricles, connected via narrow passages. Under normal circumstances, the cerebrospinal fluid flows through the ventricles and enters the cisterns, or fluid reservoirs. After the cerebrospinal fluid lubricates and bathes the brain and spinal cord, it is reabsorbed by the blood.

You may wonder why the cerebrospinal fluid or CSF is so important for the brain. Well, here’s why:

  • The fluid protects the brain by functioning as a shock absorber
  • It transports vital nutrients to the brain and removes cellular waste
  • It makes up for the changes of blood within the brain

CSF is an essential fluid for the brain. The absorption and production of the fluid are a continuous process. So any condition that obstructs the normal flow and absorption of cerebrospinal fluid results in the fluid building up in the cranium, exerting unwarranted pressure on the delicate brain tissue. This build up of CSF and subsequent pressure is called hydrocephalus.

[ Read: Hemorrhagic Disease Of The Newborn ]

Types Of Hydrocephalus In Infants:

Your infant can be born with hydrocephalus or acquire it after birth. Congenital hydrocephalus is present when your baby is born, and may occur due to problems in fetal develop or genetic abnormalities. On the other hand, your baby can develop acquired hydrocephalus at birth or later on. Usually, acquired hydrocephalus occurs due to some injury or disease.

Your child also can develop communicable or non-communicable hydrocephalus. In the former, the CSF flows normally through the ventricles but gets blocked after exiting the ventricles. In non-communicating hydrocephalus, the CSF is unable to flow between the ventricles because there may be one or more obstruction in the passages connecting the ventricles.

Causes Of Hydrocephalus In Infants:

In a majority of infants, hydrocephalus is present at birth. You shouldn’t blame yourself or feel responsible for this condition. In most congenital cases, hydrocephalus develops due to the complex interaction between certain environmental factors and genetics. The circumstances leading to your little one developing hydrocephalus are beyond your control, and there is nothing you could have done to prevent your child from getting it.

Some of the most common causes of hydrocephalus in newborn babies include:

1. Aqueductal Obstruction:

Also known as stenosis, aqueductal obstruction is one of the most common causes of hydrocephalus in infants. If the aqueduct between the third and fourth ventricles gets blocked, is narrow, or your child develops an infection, tumor or hemorrhage, it could present free flow of the CSF, resulting in hydrocephalus.

2. Neural Tube Defects:

If your child is born with a neural tube defect, such as spina bifida or myelomeningocele, he will suffer from abnormalities of the central nervous system. In nearly 90 percent of kids born with neural tube defects, hydrocephalus is a problem.

3. Intraventricular Hemorrhage:

This problem occurs primarily in premature infants. It occurs due to rupture of the tiny blood vessels present alongside the lining of the ventricles. Blood or scar tissue may block the ventricles or arachnoid villi, which are responsible for absorbing cerebrospinal fluid. In rare instances, malformation of the blood vessels due to injury to the head or tumor close to the ventricles can also lead to intraventricular hemorrhage and subsequently hydrocephalus.

4. Meningitis:

The brain and spinal cord are covered by protective membranes called meninges. Bacterial or viral infections can inflame these membranes, leading to scar formation. These scars obstruct the CSF pathways, thereby preventing the fluid from flowing through the narrow passages between the ventricles or subarachnoid space.

[ Read: Meningitis In Infants ]

5. Arachnoid Cysts:

In children, arachnoid cysts are congenital. These cysts usually are located in the anterior part of the brain or the third ventricle. Some of the cysts are self-contained, whereas other could be connected to the passageways linking the ventricles or they can be present in the arachnoid space. If these CSF-filled cysts block the free flow of cerebrospinal fluid, it causes hydrocephalus in babies and kids [2].

Even brain tumor, head trauma and a condition called Dandy-Walker Syndrome (enlargement of the fourth ventricle results in complete or particle closure of the inter-ventricle passageways) can cause hydrocephalus in infants.

Signs and Symptoms Of Hydrocephalus In Infants:

You will be able to tell if your infant gets hydrocephalus. The first signs and symptoms of the condition are changes to the head. You will notice the following hydrocephalus symptoms in infants:

  • Disproportionately big head
  • Rapid increase in the head size
  • A bulging, soft spot on the top of your infant’s head

Your infant also will manifest physical symptoms, which include the following:

  • Vomiting
  • Seizures
  • Poor feeding
  • Sleepiness
  • Irritability
  • Sunsetting of the eyes (eyes fixed downward)
  • Lose muscle tone and lack of muscle strength
  • Problems with muscle growth [3]

[ Read: Epilepsy In Babies ]

Diagnosis And Tests For Hydrocephalus In Infants:

Besides a physical evaluation and getting the medical history of your little one, the doctor will also perform some diagnostic tests to confirm your child has hydrocephalus. Of course, the characteristic head enlargement is more than enough to make a diagnosis. However, the doctors will perform tests to find out the reason for CSF obstruction.

Some of the diagnostic tests the doctor will recommend include:

1. Ultrasonography:

This imaging test makes use of high-frequency sound waves to create an outline of the structures inside your little one’s head. Ultrasonography allows doctors to see the ventricles clearly and find the obstruction if any. The waves enter the infant’s head from the fontanel. Don’t worry; this is a painless procedure albeit time-consuming.

2. Computed Tomography:

CT scans or computed tomography is a safe and painless procedure to diagnose and treat hydrocephalus in infants. The technique makes use of X-ray that passes through the cranium and brain tissue to clearly highlight the internal structure of the brain. The doctor can view this image on a monitor to figure out what is obstructing the flow of CSF.

3. Magnetic Resonance Imaging:

Also known as MRI, this imaging technique uses radio signals and a magnet to scan the brain and create images of it. The doctor can view the images on a computer screen or have them printed for more thorough assessment. It is a painless procedure, but will require your infant to stay still during the scanning process. Usually, infants are sedated to reduce movements, as it can result in blurry images. You needn’t worry, as it does not have any harmful side effect.

The doctor may request for a single-shot fast spin echo that assesses the size of the ventricles and takes about three minutes to complete. It does not require sedation. Or, the doctor may ask for a full scan, which takes anywhere from 30 minutes to 60 minutes to complete, and it captures tiny details of the brain.

[ Read: Boils On Babies ]

4. Neurological Examination:

This part of the initial evaluation, and requires a neurologist. The specialist will ask you questions about your infant and conduct simple tests to reach a diagnosis. Here, the doctor checks the muscles for reflex, strength, and tone. He also will check your little one’s eye movement, vision, sense of touch, coordination, hearing and balance.

5. Physical Examination:

As with any other doctor’s visit, a physical examination is part and parcel of diagnosing hydrocephalus in infants. This will allow the physician to check if your infant has some other underlying condition, as well.

Treatment And Solutions for Hydrocephalus In Infants:

It is crucial to remember, hydrocephalus can be fatal for your little one if the condition is left untreated. While the treatment cannot reverse any brain damage your infant has sustained, it will prevent your baby from further brain damage.

Hydrocephalus treatment in infants mainly focuses on restoring the normal flow of cerebrospinal fluid. Some of the treatment options include the following:

1. Insertion Of A Shunt:

Usually, a shunt is the most common treatment option that the specialist uses when treating hydrocephalus in infants. It involves surgically placing a long tube with a valve in the cranium, and the other end into the abdominal cavity or chest. The tube removes excess CSF from the brain to the other part of the body where it is resorbed. When it comes to pediatric shunts, doctors prefer putting the other end into the abdominal cavity. In the abdominal cavity, the CSF is absorbed by the intestines so that the fluid becomes part of the bloodstream and the body can utilize the salts and other products the fluid contains.

A shunt is usually a permanent solution and hence, the doctor will monitor the shunt regularly to ensure it is working optimally.

A shunt also is the preferred mode of treatment when there is an obstruction impeding the flow of cerebrospinal fluid, and the doctors are unable to remove the obstruction and enable normal flow of the CSF.

There are different types of shunt systems, right from high-end systems to economy ones. Check with your infant’s neurosurgeon which system he will be using. Make sure the surgeon trained and experienced to insert shunting system for optimal results. At the same time, remember, a shunt system can malfunction or cause an infection. Should this happen, the surgeon would have to replace the system with a new one.

[ Read: Brain Tumors In Babies ]

2. Ventriculostomy:

Sometimes, doctors use a procedure called ventriculostomy to remove excess cerebrospinal fluid from the brain. The surgeon will decide on this procedure if the CSF is not flowing between the ventricles or out of the ventricles the way it should. It involves making a hole between ventricles or at the bottom of the affected ventricle facilitate the flow of cerebrospinal fluid out of the brain.

This procedure is gradually becoming quite popular. However, just like shunts, even a ventriculostomy fail, necessitating another surgery. But the benefit of this treatment is it has lower chances of infection compared to shunt insertion [4]. So ventriculostomy is a preferred alternative to shunting if the doctor thinks the procedure is right for your baby.

Other Treatment Options For Hydrocephalus In Infants:

Your infant may require addition treatment after being diagnosed with hydrocephalus. Depending on the complications hydrocephalus causes, your baby may need the following treatment either right away or as he grows up:

1. Pediatrician:

The specialist will over the see the treatment and care your child receives.

2. Pediatric Neurologist:

If your child has neurological problems due to hydrocephalus, the specialist will diagnose and treat him

3. Occupational Therapist:

Hydrocephalus will result in brain damage. Hence, your child will need to develop his everyday living skills, and an occupational therapist will help in this regard

4. Developmental Therapist:

Your child will need to learn behaviors, social skills and interpersonal skills that are right for his age. A developmental therapist will help your child learn these

5. Special Education Teacher:

Since your child has brain damage due to the buildup of CSF, he will have learning disabilities. A special education teacher will identify these disabilities and your child’s education needs and provide for them.

Risks And Complications Of Hydrocephalus In Infants:

Hydrocephalus in infants can result in long-term complications. Sometimes, complications occur due to the treatment.

Some of the long-term complications that occur due to hydrocephalus in infants include:

  • Learning disabilities
  • Memory problems
  • Impaired speech
  • Problems with organizational skills
  • Squint
  • Visual impairment
  • Short attention span
  • Epilepsy
  • Problems with balance and coordination [5]

Your infant can also develop complications due to the surgical treatment he receives to address hydrocephalus. Some of these complications include:

1. Malfunction Of The Shunt:

Your infant’s shunt can malfunction due to a blockage or infection. Health specialists estimate four of 10 shunts malfunction within the first year of insertion. Sometimes, after the surgery, the doctor may find in a scan the shunt is not placed optimally. This will require a revision surgery to position the shunt correctly.

As your baby grows, the shunt will become small and hence, will need replacement. Since your child will require the shunt throughout his life, he will need a minimum of two replacements. Also, health specialists estimate that by the time a child reaches the age of 10, he may end up with two procedures for shunt-related problems.

[ Read: Causes and Symptoms of Birth Defects ]

2. Nerve Problems And Fits:

When the doctor repositions the shunt, it could cause bleeding, which can lead to nerve problems, like weakness on one side of the body. Also, there is a risk your baby may suffer from fits, which is a complication associated with all types of brain surgeries.

In the case of ventriculostomy, nerve problems could lead to double vision, weakness on one side of the body and hormonal imbalances. Usually, nerve-related problems get better, but sometimes the problems can be permanent. Also, if one of the blood vessels in the brain was injured during the surgery, your child will suffer from internal bleeding, which can be fatal.

3. Leaking Of Cerebrospinal Fluid:

This is a common problem in infants, where the cerebrospinal fluid, instead of flowing through the shunt, can flow along the shunt causing it to leak out through the insertion site. This will necessitate giving your infant more sutures to seal up the wound and prevent the fluid from leaking out.

4. Blockage Of The Shunt:

This is a serious complication, as it prevents the free flow of the CSF, leading to brain damage. If you notice your infant’s shunt is not operating properly, take him immediately to the hospital. The blocked shunt will be removed, and a new one will be inserted.

5. Shunt Infection:

This is quite a common complication. Doctors estimate the risk of a shunt infection is about three to 15 percent and is more prevalent during the initial few months of getting the shunt.

Symptoms of an infection include:

  • Redness and soreness along the shunt
  • Your child has a high temperature of about 100.4 deg. Fahrenheit or 38 deg. Celsius
  • He has a headache
  • Has a stiff neck
  • Has pain in the tummy
  • Irritability
  • Drowsiness
  • Appears visually sick and unwell

If your child has shunt infection, the doctor will first treat the infection with antibiotics. However, in some cases, there could be a need to replace the shunt. So be prepared.

6. Complications Due To Ventriculostomy:

As mentioned earlier, ventriculostomy may involve creating a hole in the ventricle or between two ventricles to ensure the free flow of CSF. Some of the complications that can arise due to this surgical procedure include:

  • The hole in the brain may close which may necessitate another surgery to open the hole or place a shunt
  • Your child can get an infection, but the chances of an infection are less likely compared to a shunt
  • Your little one may experience mild bleeding in the brain. Usually, this is no cause for concern, but your doctor needs to take cognizance of it
  • Your infant’s brain may be unable to absorb the CSF flowing through it.

A Note To Parents With An Infant With Hydrocephalus:

You cannot prevent hydrocephalus nor treat this life-threatening condition with home remedies. The good news is medical science has advanced tremendously in the last few years. So this allows early diagnosis and treatment of hydrocephalus. As a result, the prognosis for infants and kids with hydrocephalus is extremely promising.

Thanks to the early detection and subsequent treatment, there are many kids with hydrocephalus who go on to lead a normal life with few limitations. Since there are several programs available to stimulate development and learning, your child will have many wonderful opportunities to reach his full potential.

As a parent, you should realize that your baby is no different from any other child. Hence, don’t let the hydrocephalus prevent you from treating your child differently or not offering your child all the opportunities in life to live a normal and fulfilling life. It is important you educate yourself about your child’s condition. This knowledge will let you care and support your little one with confidence. So if you have doubts or queries, write them down and research on the Internet or speak with your child’s specialist.

If you are worried about the shunt and how you will handle it, you can rest assured knowing this is a durable and sound device. You will be able to handle it without causing any problem or discomfort to your little one. Also, the shunt is resilient to bumps and falls that all children experience during childhood. Your little one, as he grows, will be able to participate in most sports other than contact sports. Don’t stop him. Instead, encourage him to be a normal child, enjoying the pains and pleasures of childhood.

Do you have an infant with hydrocephalus? How did you react when the doctor confirmed the diagnosis? What measures are you taking to ensure your child is leading a normal life? Parents who have just learned about hydrocephalus diagnosis of their babies would feel encouraged reading your comments and opinions. So feel free to comment below.

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