Hydrocephalus Lawyers Discuss Neonatal Brain Injury: Hydrocephalus (Fluid in the Brain)
Babies are often admitted to the NICU when they have signs of brain injury. One type of newborn brain injury is called hydrocephalus. Hydrocephalus is significant swelling of the brain’s ventricles caused by bleeding inside the ventricles (intraventricular hemorrhage) or another brain insult. Intraventricular hemorrhage (IVH) or other ventricular problems can cause major disturbances in cerebral spinal fluid (CSF) dynamics. This can cause an excessive amount of CSF to build up in the ventricles and/or in the subarachnoid space, which is a space near the ventricles. This accumulation of CSF and resultant swelling is called hydrocephalus. Hydrocephalus can cause a child to have seizures, cerebral palsy, intellectual disabilities and developmental delays.
In this article, we will discuss the causes, signs and symptoms of hydrocephalus, how the condition is treated, and what the short and long-term outlook may be for a child with hydrocephalus.
What Causes Hydrocephalus? How Does Hydrocephalus Damage a Baby’s Brain?
A lack of oxygen in the baby’s brain (hypoxia) or another type of brain insult can cause an intraventricular hemorrhage or hemorrhages. The hemorrhaging can lead to a disturbance in CSF dynamics, which often causes the ventricles to swell. This ventricular dilation is called hydrocephalus, and it can damage the brain in multiple ways. Hydrocephalus can cause injury to blood vessels in the brain, destruction of the brain’s white matter, and improper development of the cerebral cortex. White matter is important because it helps transmit messages throughout the largest part of the brain. The cerebral cortex is the outer layer of neural tissue, or gray matter. It plays a critical role in thinking, attention, memory, perceptual awareness, language and consciousness. Damage to the white and gray matter can cause the child to have motor problems, such as cerebral palsy, intellectual disabilities and developmental delays. In addition, the child may have seizures as a newborn that can continue throughout her life.
Intraventricular hemorrhages are a common cause of hydrocephalus. Premature babies are more susceptible to IVH because blood vessels and other parts of their brains are fragile.
Conditions that can cause IVH in a term or preterm baby are:
- Hypoxic ischemic encephalopathy (HIE)
- Trauma from prolonged labor
- A traumatic birth caused by a macrosomic (large) baby, cephalopelvic disproportion (CPD – baby is too small for the size of the mother’s pelvis), and use of forceps or vacuum extractors during delivery
- Abnormal changes in blood pressure
- Oxygen deprivation or head trauma caused by the use of Pitocin or Cytotec to facilitate labor
- Abnormal presentation, such as face or breech presentation
Other causes of hydrocephalus include:
- Brain infections, such as meningitis or viral infections
- Intrauterine infections, such as syphilis, cytomegalovirus (CMV), rubella and toxoplasmosis
- Subarachnoid hemorrhage
- Germinal matrix hemorrhage (primarily in premature babies)
What Are the Symptoms of Hydrocephalus?
When birth injuries cause hydrocephalus, fluid build-up may be evident within days. Babies may have puffiness or swelling at the temples, the bridge of the nose, or around the eyes. A very obvious sign of hydrocephalus is an enlarged head. Rapid head growth is a sign of increased intracranial pressure, which is very common in hydrocephalus. This rapid growth occurs in an attempt to decrease pressure in the brain. If left completely untreated, hydrocephalus can cause the brain stem to become so compressed that the baby’s heart or breathing stops. Compression of the cerebellum can cause problems with swallowing, speaking and breathing.
Initial symptoms of hydrocephalus include vomiting, sleepiness, irritability, an inability to look upward and seizures. Diagnosing hydrocephalus early and treating it quickly can help limit long-term problems.
How Is Hydrocephalus Diagnosed?
Hydrocephalus should be suspected in babies who have a head circumference that is larger than normal at birth or whose head measurements after birth indicate excessive head growth. Babies who had a traumatic birth or who were born prematurely should have frequent head measurements. In addition, babies who have an increased intracranial pressure should be suspected of having hydrocephalus.
Diagnosis of hydrocephalus is confirmed by head imaging, usually ultrasonography. However, CT scans and MRIs are more accurate, especially in older babies. Once the anterior fontanelle closes in a baby, an ultrasound cannot be used.
Brain imaging can help distinguish the different types of hydrocephalus, such as obstructive versus communicating hydrocephalus. This is important because it will influence treatment decisions. An MRI provides the best visualization of the pathological processes of the CSF pathway and of CSF flow dynamics.
Sometimes hydrocephalus occurs while the baby is in the womb. This can be detected by intrauterine ultrasonography at or after 24 weeks of gestation. After 32-34 weeks of gestation, the baby’s head size begins to increase as the ventricular dilation increases.
If the cause of the hydrocephalus is birth trauma or birth asphyxia, meaning the insult (often IVH) that caused the hydrocephalus occurred at birth, the hydrocephalus usually begins within one to three weeks after the IVH. Babies at risk of having IVH should have routine (serial) ultrasounds performed by and on day 5 of life since most cases of IVH occur within the first 5 postnatal days. If the baby has symptoms of IVH, confirmation should be made by using head imaging (although treatment of IVH usually should begin prior to confirmation). Once IVH is diagnosed, routine head imaging should continue in order to identify potential hydrocephalus and its progression. And, of course, if the baby has signs or symptoms of hydrocephalus, head imaging must be immediately performed.
Cerebral angiography, CSF analysis, an EEG and an external pressure transducer that measures the baby’s intracranial pressure are all tools that can assist in the diagnosis of hydrocephalus.
How Is Hydrocephalus Treated?
Hydrocephalus is manageable if diagnosed in a timely manner. The most common treatment involves surgical placement of a shunt system. Using tubes, a shunt redirects the flow of fluid from an area of buildup to the abdominal cavity where it can be absorbed as part of the circulatory process. A valve within the shunt system allows physicians to adjust the flow to normalize pressure. Physicians insert a tube long enough to accommodate the child’s growth, thereby potentially eliminating the need for another surgery. Shunts can be placed right after birth if the baby is stable.
Trusted Hydrocephalus Attorneys and Birth Injury Lawyers
If you are seeking the help of a lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children for over 3 decades.
Cerebral palsy lawyer Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Jesse is currently recognized as one of the best medical malpractice lawyers in America by U.S. News and World Report 2014, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as hydrocephalus, cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award winning birth injury lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury firm has numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award winning lawyers are available 24 / 7 to speak with you.
- Haridas A & Tomita T. Hydrocephalus. In: UpToDate. Hoppin AG (Ed), UpToDate, Waltham, MA, 2014.
- Fishman MA. Hydrocephalus. In: Neurological pathophysiology, Eliasson SG, Prensky AL, Hardin WB (Eds), Oxford, New York 1978.
- Carey CM, Tullous MW, Walker ML. Hydrocephalus: Etiology, Pathologic Effects, Diagnosis, and Natural History. In: Pediatric Neurosurgery, 3 ed, Cheek WR (Ed), WB Saunders Company, Philadelphia 1994.
- Yasuda T, Tomita T, McLone DG, Donovan M. Measurement of cerebrospinal fluid output through external ventricular drainage in one hundred infants and children: correlation with cerebrospinal fluid production. Pediatr Neurosurg 2002; 36:22.
- Beni-Adani L, Biani N, Ben-Sirah L, Constantini S. The occurrence of obstructive vs absorptive hydrocephalus in newborns and infants: relevance to treatment choices. Childs Nerv Syst 2006; 22:1543.
- Lindquist B, Carlsson G, Persson EK, Uvebrant P. Learning disabilities in a population-based group of children with hydrocephalus. Acta Paediatr 2005; 94:878.
- Brookshire BL, Fletcher JM, Bohan TP, et al. Verbal and nonverbal skill discrepancies in children with hydrocephalus: a five-year longitudinal follow-up. J Pediatr Psychol 1995; 20:785.
- Adams-Chapman I, Hansen NI, Stoll BJ, et al. Neurodevelopmental outcome of extremely low birth weight infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics 2008; 121:e1167.