Diagnosis: Hydrocephalus

 

The ultrasound of Nathan's head revealed that the ventricles inside his brain were enlarged, nearly 10 times their normal size.  

Inside your brain are four ventricles.  They are filled with cerebrospinal fluid (CSF).  The CSF bathes and helps cushion the brain and the spinal cord from the bones that encase them.  It is constantly produced by the body every day

In a normally functioning system, CSF is continuously circulated through the brain, its ventricles, and the spinal cord.  A small quantity is housed in the ventricles. The rest is continuously drained away, primarily into the circulatory system.

 

If someone has a blockage in one of the ventricles, the CSF is unable to drain properly and begins to accumulate in the ventricles.  This condition is known as hydrocephalus.  It is commonly called "Water on the Brain," but that is quite a misnomer as the fluid is not water and the ventricles where the fluid is accumulating are inside the brain, not on it.

As more and more fluid begins to accumulate in the ventricles, they expand, pushing the brain outward, compressing it into the skull.  However, in infants, their heads typically begin to enlarge increasingly as the pressure from the increased fluid causes the individual skull bones--which have yet to fuse--to bulge outward at the juncture points.

Another medical sign of hydrocephalus in infants is a characteristic downward gaze, with whites of the eyes showing above the iris, as if the baby were trying to examine its own lower eyelids.  This condition is referred to as "ocular sunsetting" as the eyes look similar to the sun as it sets into the ocean, and is what Nathan was experiencing. 

To try and get a better picture of the inside of Nathan's head and to see if they could determine the cause of the hydrocephalus, they scheduled him for an MRI.  The MRI didn't really provide a whole lot of new information, except to show that there was a blockage between the third and fourth ventricles.

No one could say how or when the blockage occurred, but they thought that it seemed most likely to have happened following Nathan's bad day in the Cath Lab, which only gave me more cause to understand why I dreaded that procedure so much.

Since the results of Nathan's MRI came back late on a Friday afternoon, the neurosurgeon who had been assigned to Nathan had gone home for the weekend.  So we wouldn't have any additional information or a plan of action until Monday.

But Nathan's primary care doctor in the NICU informed us that there were three likely courses that could take.

1)  Do nothing yet.  Wait and see what happens.

2)  Put in a reservoir to drain off fluid daily.

3)  Put in a shunt to drain the fluid into his abdomen.

The whole of this news was a major blow to us.  We had been so hopeful and optimistic about being home by Christmas. Now those plans were in jeopardy now.  Why did there have to be such a huge setback?  Was Nathan going to be OK?  Were we ever going to get out of here?

It was going to be a long weekend...