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Myths about Hydranencephaly
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Dear Doctor Letter
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Hydrocephalus
One of the first difficulties that you may
face is a recommendation that your child have a shunt placed. As children with
Hydranencephaly are born with an accumulation of fluid in their skulls there is
sometimes trouble with the drainage of the fluid. This problem is called
Hydrocephalus. Some children with Hydra...are found to need a shunt almost
immediately whereas others may never need one. The Dr will recommend a shunt if
it is found that your baby's head is growing too rapidly or there are
indications of increased intracranial pressure.
My child does not have a shunt,
does he/she still have Hydranencephaly?
Over the years,
several people have asked if their child never needs a shunt, do they still have
Hydranencephaly. The following are answers to those questions by Dr. Bjorn
Merker, Neuroscientist:
I am no expert on the ventricular system, and know almost nothing about how it
is affected specifically in hydranencephaly, but there is one general principle
which makes the hydranencephaly situation rather easy to understand. The
principle is that cerebrospinal fluid, the fluid that bathes the brain, is
produced in the ventricles by a flimsy tissue called choroid plexus, and that
all the fluid that is produced has to drain "downwards" to get to the fourth
ventricle, and from there out into the outer fluid-filled space surrounding the
brain. So any obstruction at any place along this successive drainage path will
cause pressure to build up ABOVE that place. There are the lateral ventricles
(inside the hemispheres, one in each), the third ventricle (inside the
tweenbrain), and the fourth ventricle (in the hindbrain), and there are narrow
passages between each of these, which can be obstructed. The lateral ventricles
produce more CSF than the others, and so a slow flow from them downwards along
the chain is taking place all the time. Applying this to hydranencephaly, the
choroid plexus continues to produce fluid after the hemispheres are resorbed in
hydranencephaly, and if the passage to the third ventricle (tweenbrain) and
fourth ventricle (hindbrain) is open, there is no problem. That child will not
need a shunt. But you can imagine that it easily happens, during the massive
damage to the hemispheres in hydranencephaly, that the passage to, say, the
third ventricle, or between the third and the fourth, gets blocked, and so
pressure will build up, and sooner or later such a child will need a shunt.
For your reference please
see the various brain diagrams created by Bjorn
Brain in
Hydranencephaly
Comparison between intact brain and
Hydranencephaly brain
Hydrocephalus vs. Hydranencephaly
Another common
discussion among families of children with Hydranencephaly is the difference
between Hydrocephalus and Hydranencephaly. Following is an explanation of this
from Dr. Bjorn Merker.

What may help you
understand the difference between hydrocephalus and hydranencephaly-which is a
big difference-is to imagine that in those first MRIs you saw, just inside the
light-colored thin round "rim" that marks the skull bone, might have been a thin
coating of brain tissue, so thin that it simply made the skull bone look a bit
thicker. Now such a thin coating can actually be the whole thickness of the
hemispheres pressed back against the skull (that is, all around the entire
inside of the skull in a continuous balloon-like millimeter-thin continuous
coating,-see enclosed figure) by expanding ventricles. Looking at such a picture
the radiologist may think that the thin coating is not even there, and IF SO-if
not there-that would mean the whole hemispheres are missing, and so it is a
radical case of hydranencephaly. But if that millimeter-thin coating is there,
the whole hemispheres are still there, just unbelievably compressed and
distorted, and then it is hydrocephalus.
Now it may sound hard to believe that these big lumps of hemisphere can actually
be compressed to that extent (so I quickly made a drawing to help your
imagination), but it just happens to be a fact that they can, and I hope the
drawing helps to understand how.
Other pages in this
section:
Hydrocephalus Links
Hydrocephalus Experiences
Hydrocephalus Glossary
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