Hydrocephalus: A treatable condition when caught early<\/p>\n
Maria Endah Hulupi, The Jakarta Post, Jakarta<\/p>\n
Twenty-year-old Sariti, a single mother from a small village in
\nLombok, West Nusa Tenggara, first sensed something was wrong with
\nher son Sarobi when he was two months old.<\/p>\n
His head seemed larger than it should be, but she carried on
\nwith her life, leaving her small home to work in the paddy fields
\nearly in the morning after putting Sarobi down to sleep. She
\nreturned late in the afternoon, bringing home a little of the
\ndiscarded paddy as her wage.<\/p>\n
She fed Sarobi plain rice with a little salt twice a day, and
\nbrokenheartedly watched as the baby grew weaker and his head grew
\nlarger.<\/p>\n
Sarobi, now 15 months old and diagnosed with hydrocephalus,
\nwas recently flown along with his mother to Jakarta, in the care
\nof Yayasan Sayap Ibu. He is being prepared for surgery at Cipto
\nMangunkusumo General Hospital in Central Jakarta.<\/p>\n
Webster's Medical Desk Dictionary defines hydrocephalus as an
\nabnormal increase in the amount of cerebrospinal fluid within the
\ncranial cavity. It is accompanied by an expansion of the cerebral
\nventricles, an enlargement of the skull, especially the forehead,
\nand atrophying of the brain.<\/p>\n
The condition, according to a neurosurgeon at Mitra Keluarga
\nKelapa Gading, Dr. Jimmy Sugiarto, can affect fetuses, babies and
\nadults.<\/p>\n
Hydrocephalus, he said, is most often the result of the
\nimpaired resorption of the cerebrospinal fluid, causing the fluid
\nto pool in the brain's ventricles. In very rare cases, however,
\nthe disease is caused by overproduction of the fluid.<\/p>\n
In adults, the ventricles expand and compress the brain
\nagainst the skull bones, increasing intracranial pressure. When
\nleft untreated it can lead to brain atrophy and death.<\/p>\n
Symptoms include increased intra-cranial pressure, headaches,
\nnausea, double vision, apathy, incontinence, concentration
\nproblems and coma.<\/p>\n
\"The symptoms are often mistaken for other diseases and
\ninstead of undergoing surgery to release the brain from the
\ndamaging pressure, patients get treatment for some other disease.
\nThe delay further exposes patients to increased pressure and
\ngreater brain damage, and brain cells simply don't regenerate,\"
\nJimmy said.<\/p>\n
In fetuses and babies below the age of four, when the skull
\nbones have not yet sutured, hydrocephalus causes the brain's
\nventricles to enlarge, making the skull expand as well. At this
\nage, the disease is commonly characterized by a distended vein of
\nthe scalp, the \"sunset phenomena\" (where the eyes tend to be
\ndirected downward) and a bulging fontanel.<\/p>\n
Jimmy said hydrocephalus could be caused by factors like a
\ntumor, infections (such as tuberculosis, toxoplasma or
\nmeningitis), congenital malformations and bleeding, and
\nconditions that disturb the circulation of cerebrospinal fluid.<\/p>\n
Detection is effectively done by means of a ultrasonography
\n(USG) for pregnant women and a CT scan. Once detected and the
\nunderlying cause found, patients should be operated on as soon as
\npossible to drain away the fluid and relieve the pressure on the
\nbrain.<\/p>\n
\"It's a small operation but it can save lives and prevent
\nfurther impairment of the person's condition,\" Jimmy said, adding
\nthat surgery would not help those patients with extreme cases.<\/p>\n
Immediate surgery is especially important for babies under
\nfive months old because this is a period of rapid brain growth.
\nFailure to treat the disease could affect the baby's intelligence
\nin later life.<\/p>\n
Cerebrospinal fluid, Jimmy said, can be drained off through
\nexternal or internal surgery. External surgery is performed by
\ninserting a ventricle drain to drain away the fluid in a closed
\nsteril container and reduce intracranial pressure. The drain can
\nbe left in position after surgery for several days.<\/p>\n
Internal surgery is performed by implanting a shunt (a long
\ntube) under the skin to drain away the fluid. The shunt can be
\nimplanted either in the abdomen (ventriculo peritoneal shunt) or
\nin an atrium of the heart (ventriculo atrial shunt).<\/p>\n
Because the surgery is usually effective, people seldom
\nrequire a second surgery. However, further surgery is required to
\nadjust the length of the shunt after a child patient has grown
\nup, or to replace a shunt when a blockage occurs.<\/p>\n
\"Recovery depends on the patient's condition and the
\nunderlying cause (of the hydrocephalus),\" Jimmy said.<\/p>\n
After surgery, an enlarged baby's head will gradually reduce
\nin size. Overlapping skull bones may occur afterward, but this
\ncan be corrected through cosmetic surgery.<\/p>\n
Babies with hydrocephalus, Jimmy explained, can physically
\ngrow normally, but their intelligence may depend on how much
\ndamage the disease has caused.<\/p>\n
Another neurosurgeon at the hospital, Bambang Setiawan, said
\ndoctors needed to talk to the parents and other family members of
\nyoung hydrocephalus patients to help trace potential causes for
\nthe disease, such as the possibility that a toxoplasmosis
\ninfection occurred during pregnancy.<\/p>\n
He also stressed the importance of a healthy diet and
\nlifestyle to prevent the disease.<\/p>",
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