You may have seen scary pictures of a baby with a swollen head. Hydrocephalus is a condition where there is excessive accumulation of cerebrospinal fluid (CSF) in the brain. This is due to an imbalance in the production, drainage and absorption of CSF in the brain for various reasons.
It’s a rare condition in Singapore, occurring in some two out of 1,000 live births here. When the fluid accumulates and puts extra pressure on the brain, the baby’s skull compensates by increasing in size.
Advanced hydrocephalus can cause serious problems with physical and cognitive development, and it can be life-threatening when the pressure in the brain gets too high. However, with timely treatment, those who had hydrocephalus as babies can actually go on to lead relatively normal lives!
Dr Phuah Huan Kee, a paediatrician at Mount Elizabeth Medical Centre, and Dr Furene Wang, an associate consultant under the division of paediatric neurology at the National University Hospital, answers our burning questions on hydrocephalus.
What causes hydrocephalus?
Dr Phuah: Hydrocephalus can be caused by:
- developmental brain anomalies;
- a complication as a result of intra-uterine infections or acquired meningo-encephalitis (both the brain and membranes surrounding the brain and spinal cord are infected or inflamed); or
- brain tumours, which cause CSF drainage to be obstructed.
When is hydrocephalus detected?
Dr Wang: Hydrocephalus can be detected during the prenatal ultrasound, which is performed between the 15th and 35th weeks of gestation. The doctor will determine if the ventricles, which are spaces containing cerebrospinal fluid in the brain, are enlarged, and if there is any evidence of increased pressure.
With timely treatment, those who had hydrocephalus as babies can actually go on to lead relatively normal lives!
Can children get it?
Dr Wang Children get hydrocephalus, too. However, it is usually acquired, rather than congenital (born with it).
Hydrocephalus in babies can cause a rapid increase in head circumference, bulging at the soft spots on the skull, gaps between skull bones, sun-setting eyes (downward gaze of both eyes), and swollen scalp veins.
Older kids will have different symptoms as the skull bones have already fused. They might experience severe headaches in the morning or after waking up, nausea and vomiting, excessive sleepiness, double vision or problems with balance and motor skills.
Is this a serious condition?
Dr Phuah If not treated, progressive hydrocephalus may cause a rapidly enlarging head in young infants, severe neurodevelopmental delay with spasticity of limbs, visual impairment (optic atrophy/compression of occipital lobes) and possible cognitive delay. In older children, progressive hydrocephalus may lead to raised intracranial pressure with headaches, vomiting, and accompanying gait difficulties.
How is hydrocephalus treated?
Dr Wang Surgery is required for hydrocephalus if the symptoms become more severe over time. This includes a shunt placement or endoscopic third ventriculostomy (ETV). The paediatric hospitals in Singapore have neurosurgeons who are experienced in these surgical procedures.
The surgical techniques have an excellent success rate in allowing proper drainage of the accumulation of cerebrospinal fluid. These will help to prevent further damage on the brain. However, the shunt can get blocked or infected over time and may need to be replaced.
What is the mortality rate of hydrocephalus in babies or children?
Dr Wang The overall mortality rate of hydrocephalus in studies done over the world ranges from zero to three per cent, depending on the duration of the follow-up.
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Dr Furene Wang is an associate consultant at the Division of Paediatric Neurology, National University Hospital.
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