This is a case involving a baby born at term without any apparent complications. The patient underwent an uneventful newborn hospital stay of two days and his initial head circumference was measured to be thirty-six centimeters. At approximately one month of life, the child suffered a fall and blow to the head, for which he received a CT scan that was read to be normal. At about four months of age, the child was seen by his pediatrician who noted a rapid increase in head circumference to forty-five centimeters. Two months after this visit, the circumference increased again by four centimeters to forty-nine centimeters. Unrelated to issues with the head, the child was brought to the ER by his father for an upper respiratory infection, at which time he was described by physicians to have some developmental delay that included trouble sitting up. During the visit, the head circumference was noticed by the ER physician and a head CT was performed that revealed hydrocephalus. The child was scheduled for neurosurgery within forty-eight hours and had a ventriculostomy with shunt placement for obstructive hydrocephalus, dilated ventricles, and aqueductal stenosis. Postoperatively, the child suffered multiple strokes that left him significantly impaired.
Question(s) For Expert Witness
1. Could this complication have been avoided if the patient was managed with medical therapy alone?
Expert Witness Response E-006004
Shunts eventually are performed in most patients. Only about 25% of patients with hydrocephalus are treated successfully without shunt placement. The principle of shunting is to establish a communication between the CSF (ventricular or lumbar) and a drainage cavity (peritoneum, right atrium, pleura). It is important to remember that shunts are not perfect and that all alternatives to shunting should be considered.
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