Hydrocephalus, also known as “water on the brain”, is a condition that occurs when there is an excess of cerebrospinal fluid (CSF). This fluid surrounds the brain and spinal cord in the human body and when in excess, it can cause spaces in between the brain, called ventricles, to enlarge.
This can cause undue and dangerous pressure on brain tissues, and may even result in destroying them completely. Excessive pressure on the brain tissues must be taken very seriously because it can lead to multiple health problems and if left, unattended, may even cause death.
Hydrocephalus can be acquired (from a disease or head injury after birth) or be congenital (present at birth). Congenital hydrocephalus can be caused by a number of events that affect fetal development. It may also be the result of a genetic defect. Failure to diagnose this condition by Bronx, New York physicians may clearly be a case of medical negligence.
Who can Develop Hydrocephalus?
A wide range of people are affected by hydrocephalus, including older adults, middle aged adults, young children, older children, and infants.
Here are some facts about hydrocephalus:
- There are over 1,000,000 people in the US that are currently living with hydrocephalus.
- For every 1,000 babies that are born in the country, one or two will develop hydrocephalus.
- Hydrocephalus is one of the most common reason for brain surgery in children.
- It is estimated that more than 700,000 people in the US have Normal Pressure Hydrocephalus (NPH) and less than 20% of them ever receive an appropriate diagnosis.
What Mistakes are Commonly Made while Diagnosing or Treating Hydrocephalus in Bronx, NY and what are the Consequences?
It may be a case of medical negligence or malpractice when a health care professional, such as a physician, who is involved in treating a patient with hydrocephalus, fails to make a proper evaluation of the warning signs and symptoms of the problem.
Some of the more common mistakes made while diagnosing or treating hydrocephalus include:
- Prenatal failure to identify signs of hydrocephalus and to diagnose the condition
- Failure to identify and fix malfunctioning shunts
- Failure to identify and treat infected shunts properly
Few consequences of mistakes made in Bronx hospitals include:
- Brain damage
- Nerve damage
- Loss of physical and mental abilities
- Problems with vision
Signs of Hydrocephalus in an Infant
Babies with hydrocephalus may not show obviously outward signs. However, many would have an increasing head circumference as a result of excess fluid. Infant’s skull has the ability to expand in order to accommodate fluid build-up since their sutures have not fused together fully.
Other signs of hydrocephalus in infants include:
- Eyes fixed downward, also called “sun-setting”
- Bulging fontanel
- Low muscle tone (hypotonia)
- Feeding problems
It is important to understand that adults and older children who have hydrocephalus exhibit different symptoms.
How Is Hydrocephalus Diagnosed By Bronx, NY Doctors?
Hydrocephalus should always be the first suspicion in babies with larger than normal head circumferences at birth or whose head measurements indicate excessive growth after birth. Babies born of traumatic delivery or who are pre-term must have frequent head measurements. On top of this, babies with increased intracranial pressure must always be suspected of developing hydrocephalus.
Head imaging helps in diagnosing and confirming the presence of hydrocephalus. However, in some cases, the diagnostic tools may also include, MRI, ultrasounds, and CT scans.
Brain imaging can help distinguish between communicating hydrocephalus and obstructive hydrocephalus. The ventricles tend to stay open in communicating hydrocephalus, allowing CSF to continue flowing between them. However, in obstructive hydrocephalus, the flow of CSF is blocked. Identifying this distinction is important since that shall influence the course of treatment.
Types of Hydrocephalus
It is important to understand that hydrocephalus is not a disease, but a condition, which can develop for a variety of reasons, and can also be part of some other condition.
Congenital hydrocephalus is caused by a complex interaction of environmental and genetic factors during fetal development. This condition is present at birth and is often diagnosed before labor through routine ultrasound.
Compensated hydrocephalus is a type of hydrocephalus that could have been present at birth, and maybe even treated during early childhood, but has remained asymptomatic and largely compensated for many years.
Acquired hydrocephalus tends to develop after birth because of neurological conditions such as brain tumor, head trauma, cyst, intra-ventricular hemorrhaging, or some central nervous system infection.
Normal pressure hydrocephalus is known to occur in older adults when the brain ventricles become enlarged, but results in little to no increase in pressure within the ventricles. In some instances, the cause of NPH may be known. However, more often the condition is idiopathic, which means that the cause is unknown.
“Communicating” and “non-communicating” are two common set of terms used by doctors to describe hydrocephalus. When the cerebrospinal fluid (CSF) can flow freely through the brain’s subarachnoid space and ventricular system, it is known as communicating hydrocephalus.
However, when there is some physical blockage that doesn’t allow free-flow, it is known as non-communicating hydrocephalus. This blockage could be in the form of a tumor.
Causes of Hydrocephalus in Infants
Hydrocephalus in newborns can be acquired or congenital. Acquired hydrocephalus is the result of some issue during the birthing process or after. Congenital hydrocephalus is caused by genetic complications or abnormalities during fetal development.
Examples of acquired hydrocephalus include birth trauma. Excessive mechanical force during delivery and labor can harm a baby through a traumatic birth injury or birth trauma. Birth trauma can often result in brain bleeds or intracranial hemorrhages, especially if the baby is born prematurely. Intracranial hemorrhages often lead to hydrocephalus.
Since Intracranial hemorrhages are often the underlying cause of acquired hydrocephalus cases, it is important to understand the various causes and risk factors associated with it. These include:
- Prematurity: Premature babies tend to have underdeveloped blood vessels and low birth weight. These can easily rupture because of an injury. Hence, preemies are thought to be at an increased risk of intracranial hemorrhages. Indeed, prematurity is known to be a major risk factor for most birth injury types. This makes it crucial for medical professionals to do everything in their power to prevent preterm births.
- Lack of indicated antenatal steroids: Antenatal steroids can help premature babies mature faster to minimize the risk of intracranial hemorrhage.
- Hypoxic ischemic encephalopathy (HIE): HIE is a form of brain damage which is caused by the lack of oxygenated brain flow to the brain.
- Infections: Meningitis and herpes encephalitis are some typical examples.
- Untreated respiratory distress syndrome (RDS): This neonatal breathing complication is very common in premature babies.
- Delivery involving forceps or vacuum extractors: Use of birthing tools is particularly risky in complicated births, such as the ones involving abnormal fetal presentation, cephalopelvic disproportion (CPD), or macrosomia.
- Pitocin: This is a synthetic version of the oxytocin hormone which is used to induce labor or enhance contractions in some cases. Pitocin, when used incorrectly, increases the risk of intracranial hemorrhage, uterine tachysystole/hyperstimulation, and numerous other complications.
How Does Hydrocephalus Affect Babies in the Long-Term?
The prognosis for babies with hydrocephalus is dependent upon the extent of the condition, promptness of diagnosis, and the causes behind the condition. Some children with the condition can go on to lead healthy and normal lives.
However, in other children, hydrocephalus can result in permanent brain damage. It can also impact both physical and cognitive development when not diagnosed and treated timely. Many children with the condition require rehabilitative therapies, such as occupational and physical therapy, or educational interventions.
Treatment Options in Bronx, NY
Currently, there is no known approach to preventing or curing hydrocephalus. The only treatment available right now requires brain surgery. The future health of many babies is promising if hydrocephalus is detected early and intervened appropriately. Recent advances in technology as well as diagnostic protocols are helping a growing number of people with the condition to lead prosperous and healthy lives.
Hydrocephalus is currently managed by three forms of surgical treatments.
This is the most common treatment for the condition and also the most common surgical procedure performed in the United States by pediatric neurosurgeons. The treatment involves the surgical implantation of a device known as shunt.
A shunt can be best described as a flexible tube that is placed into the brain’s ventricular system to divert the flow of CSF.
Endoscopic Third Ventriculostomy (ETV)
In this procedure a membrane is punctured in the third ventricle to create a pathway for CSF to flow within the brain cavities. This is a reliable alternative to shunting where obstructive hydrocephalus is concerned.
Endoscopic Third Ventriculostomy with Choroid Plexus Cauterization (ETV/CPC)
The third treatment approach involves endoscopic third ventriculostomy with an addition of choroid plexus cauterization in infants. A neurosurgeon shall use a device to cauterize or burn tissue from the choroid plexus, which is a network of vessels in the brain’s ventricles.
Failure to Diagnose Hydrocephalus Led to $4.3 million Settlement in New York
A settlement for $4.3 million was secured just before trial on behalf of a young child because her pediatrician failed to diagnose hydrocephalus. The father of the young girl hired a law firm since the condition went undiagnosed for over five years.
In this case, the girl showed multiple signs of hydrocephalus as young as 9 months when the rest of her body did not grow in accordance with the rapid head growth.
The father’s concerns became more worrisome during the care under her first pediatrician because the child started to show signs of cognitive and physical developmental delays as well, such as delays in speech, gross motor, and fine motor activities. No action was taken by the pediatrician despite these outwardly obvious signs.
The child’s head size measured at greater than 97% by 18 months of age. Also, her head looked misshapen. The pediatrician failed to refer the child for brain or head imaging, or to a neurologist.
When the father lost patience with the lack of concern, he changed doctors so as to gain a second opinion concerning the lack of development in his daughter and the condition with her head.
The next pediatrician erroneously assumed that the girl’s prior pediatrician would have referred her to a neurologist for these conditions and in turn failed to refer the child for any necessary tests or for a neurological consultation to investigate the head shape, size and developmental delays.
It wasn’t until the girl turned five, when her father self-referred her to an endocrinologist because he was greatly concerned about her large head size and small stature. An initial investigation led to a brain MRI test, which identified a large collection of CSF trapped within the child’s brain.
The diagnosis that the child had hydrocephalus was immediately made. The unfortunate condition was so extensive and severe that it resulted in a malformation of the brain, called the Chiari malformation. In this a part of the brain begins growing into the spine.
The five year old underwent immediate surgery in order to relieve the malformation and pressure and to allow her brain to develop and grow as it was supposed to. The child’s malformation automatically resolved once the hydrocephalus condition was treated. She gained strides in her development and quickly made significant improvements with gross motor and fine motor activities.
The medical records were reviewed by experts retained in the fields of Pediatrics and Pediatric Neurology, who opined that both pediatricians of the girl were negligent in their responsibilities and committed medical malpractice by failing to refer the girl to a neurologist or order a brain imaging.
In addition, the experts were of the opinion that the unnecessary prolonged delay owing to the failure resulted in brain damage and developmental delays from the pressure.
The case was then litigated and made ready for trial. However, just before the case could go for trial, we successfully settled it for a sum totaling $4.3 million to compensate the young girl and her father for the sustained injuries.
Choose an Experienced Medical Malpractice Law Firm in Bronx, New York
All birth injury medical malpractice or negligence cases require the attorney to have a high degree of experience and skill to sift through the mountains of data and find the necessary information that would have to be produced in court once the claim is filed.
The skillful birth injury medical malpractice lawyers at Rosenberg, Minc, Falkoff & Wolff in Bronx, New York are experienced enough to build a strong case while recognizing at every step that you and your child are an integral part of the process.
Our lawyers will work with you to create a strategy that can best meet your unique needs. Call us at 212-697-9280 to schedule a free initial case evaluation.