Hydrocephalus: A treatable condition when caught early
Hydrocephalus: A treatable condition when caught early
Maria Endah Hulupi, The Jakarta Post, Jakarta
Twenty-year-old Sariti, a single mother from a small village in
Lombok, West Nusa Tenggara, first sensed something was wrong with
her son Sarobi when he was two months old.
His head seemed larger than it should be, but she carried on
with her life, leaving her small home to work in the paddy fields
early in the morning after putting Sarobi down to sleep. She
returned late in the afternoon, bringing home a little of the
discarded paddy as her wage.
She fed Sarobi plain rice with a little salt twice a day, and
brokenheartedly watched as the baby grew weaker and his head grew
larger.
Sarobi, now 15 months old and diagnosed with hydrocephalus,
was recently flown along with his mother to Jakarta, in the care
of Yayasan Sayap Ibu. He is being prepared for surgery at Cipto
Mangunkusumo General Hospital in Central Jakarta.
Webster's Medical Desk Dictionary defines hydrocephalus as an
abnormal increase in the amount of cerebrospinal fluid within the
cranial cavity. It is accompanied by an expansion of the cerebral
ventricles, an enlargement of the skull, especially the forehead,
and atrophying of the brain.
The condition, according to a neurosurgeon at Mitra Keluarga
Kelapa Gading, Dr. Jimmy Sugiarto, can affect fetuses, babies and
adults.
Hydrocephalus, he said, is most often the result of the
impaired resorption of the cerebrospinal fluid, causing the fluid
to pool in the brain's ventricles. In very rare cases, however,
the disease is caused by overproduction of the fluid.
In adults, the ventricles expand and compress the brain
against the skull bones, increasing intracranial pressure. When
left untreated it can lead to brain atrophy and death.
Symptoms include increased intra-cranial pressure, headaches,
nausea, double vision, apathy, incontinence, concentration
problems and coma.
"The symptoms are often mistaken for other diseases and
instead of undergoing surgery to release the brain from the
damaging pressure, patients get treatment for some other disease.
The delay further exposes patients to increased pressure and
greater brain damage, and brain cells simply don't regenerate,"
Jimmy said.
In fetuses and babies below the age of four, when the skull
bones have not yet sutured, hydrocephalus causes the brain's
ventricles to enlarge, making the skull expand as well. At this
age, the disease is commonly characterized by a distended vein of
the scalp, the "sunset phenomena" (where the eyes tend to be
directed downward) and a bulging fontanel.
Jimmy said hydrocephalus could be caused by factors like a
tumor, infections (such as tuberculosis, toxoplasma or
meningitis), congenital malformations and bleeding, and
conditions that disturb the circulation of cerebrospinal fluid.
Detection is effectively done by means of a ultrasonography
(USG) for pregnant women and a CT scan. Once detected and the
underlying cause found, patients should be operated on as soon as
possible to drain away the fluid and relieve the pressure on the
brain.
"It's a small operation but it can save lives and prevent
further impairment of the person's condition," Jimmy said, adding
that surgery would not help those patients with extreme cases.
Immediate surgery is especially important for babies under
five months old because this is a period of rapid brain growth.
Failure to treat the disease could affect the baby's intelligence
in later life.
Cerebrospinal fluid, Jimmy said, can be drained off through
external or internal surgery. External surgery is performed by
inserting a ventricle drain to drain away the fluid in a closed
steril container and reduce intracranial pressure. The drain can
be left in position after surgery for several days.
Internal surgery is performed by implanting a shunt (a long
tube) under the skin to drain away the fluid. The shunt can be
implanted either in the abdomen (ventriculo peritoneal shunt) or
in an atrium of the heart (ventriculo atrial shunt).
Because the surgery is usually effective, people seldom
require a second surgery. However, further surgery is required to
adjust the length of the shunt after a child patient has grown
up, or to replace a shunt when a blockage occurs.
"Recovery depends on the patient's condition and the
underlying cause (of the hydrocephalus)," Jimmy said.
After surgery, an enlarged baby's head will gradually reduce
in size. Overlapping skull bones may occur afterward, but this
can be corrected through cosmetic surgery.
Babies with hydrocephalus, Jimmy explained, can physically
grow normally, but their intelligence may depend on how much
damage the disease has caused.
Another neurosurgeon at the hospital, Bambang Setiawan, said
doctors needed to talk to the parents and other family members of
young hydrocephalus patients to help trace potential causes for
the disease, such as the possibility that a toxoplasmosis
infection occurred during pregnancy.
He also stressed the importance of a healthy diet and
lifestyle to prevent the disease.