Failure To Diagnose Hydrocephalus

Hydrocephalus is a condition where there is an overabundance of cerebrospinal fluid in the head, commonly known as “water on the brain.”  It is a condition that is usually thought to occur in newborns but it is not uncommon for the condition to develop in adults.

Hydrocephalus can be caused in many different ways such as:

• Congenital abnormalities including Arnold-Chiari malformation, Dandy-Walker Syndrom, and aqueduct stenosis are known precipitators of this condition and may not manifest until adulthood.
• Intraventricular hematomas
• Tumors
• Abscesses
• Trauma
• Arachnoid cysts

Cerebralspinal fluid is produced in the ventricles of the brain, which are cavities or chambers within the brain.  Each ventricle has walls which contain a structure called the choroid plexus, the producer of CSF.  CSF travels from the ventricles throughout the brain and spinal cord.  It is eventually absorbed through the arachnoid granulations into the venous blood of the brain.  When a condition such as the ones listed above causes a blockage in the flow of CSF, the result is hydrocephalus.  Intracranial pressure and the expansion of the ventricles is a result of the buildup of CSF.  If CSF is not drained it can result in white matter damage, grey matter damage, gliotic scarring, and even death.  Brain herniation may also result due to the increase in intracranial pressure.

A shunt is used to drain CSF in a patient, whether adult or child.  The shunt system consists of silastic tubing, catheters, a reservoir, and a pressure activated valve.  A hole is burred in the skull and two catheters are inserted.  The pressure activated valve and reservoir are spliced under the scalp, allowing aspiration of CSF for analysis.  Once intracranial pressure has reached a certain level, the valve is activated and it drains the fluid, preventing dilation of the ventricles and preventing a lethal increase in intracranial pressure.

As with all devices, failure is a possibility.  Therefore, a physician must be vigilant to ensure that failures are recognized and fixed.  A catheter may be clogged by debris, infection, catheter migration, and movement.  Signs of malfunctioning shunts include severe headaches, nausea, vomiting, impaired balance, lethargy, and papilloedema.

If a shunted patient begins to display these symptoms it is mandatory that a CT Scan of the brain be ordered and compared to a prior baseline scan and/or records of such scan, if available.  If the scan shows an interval increase in the size of the ventricles, this conclusive proof of a shunt failure and that surgery is necessary to revise the shunt.  However, there may not be a prior scan with which to compare.  In this case, an increase in the size of the ventricles should be viewed with suspicion but is not conclusive proof of a shunt failure.

If you or a loved one has been injured as a result of shunt failure contact an experienced Kingston, New York medical malpractice attorney as soon as possible to evaluate your case.

But what do you think?  I would love to hear from you!  Leave a comment or I also welcome your phone call on my toll-free cell at 1-866-889-6882 or you can drop me an e-mail at jfisher@fishermalpracticelaw.com.  You are always welcome to request my FREE book, The Seven Deadly Mistakes of Malpractice Victims, at the home page of my website at www.protectingpatientrights.com.