Cure hospital at forefront of hydrocephalus care
Aug 10, 2008
HIS head looked abnormally big. His parents attributed the condition to spells of witch craft. They sought services of several witch doctors but the boy’s condition never changed until he was taken to Cure International Charity Hospital (CCHU) in Mbale. <br>
By Arthur Baguma
HIS head looked abnormally big. His parents attributed the condition to spells of witch craft. They sought services of several witch doctors but the boy’s condition never changed until he was taken to Cure International Charity Hospital (CCHU) in Mbale.
At CCHU, he was diagnoised with hydrocephalus — a swelling of the brain caused by build-up of cerebrospinal fluid. In Uganda, over 3,000 cases of hydrocephalus are recorded annually, according to statistics obtained from CCHU-Uganda.
While most cases are caused by infections stemming from unattended childbirth and unsanitary conditions, people blame it on mysterious curses.
Families are often split when an infant shows signs of the condition, and many mothers are encouraged to abandon or deliberately kill the infants to rid the family of the curse.
Until 2001, many of these cases passed un-attended to until Cure International Charity Hospital in Uganda started Endoscopic Third Ventriculostomy (ETV) surgeries on hydrocephalus patients.
Since beginning the ETV surgeries in 2001, CCHU is now able to serve approximately 700 hydrocephalus patients each year, with nearly half of those receiving the ETV treatment.
A statement from CCHU indicates that 3,000 to 3,500 cases of hydrocephalus are reported in Uganda each year yet there are only three neurosurgeons (outside of CCHU) serving a population of 35 million.
A US neurosurgeon working at CURE Children’s Hospital of Uganda (CCHU) in Mbale, realised that the common treatment of placing shunts in the brain to drain fluid was not practical for the rural, third world environment.
With recent advances in fiber optic and lens technology, Dr. Benjamin Warf, then chief of surgery at CCHU, was able to adapt a surgical technique previously considered impractical for treatment of hydrocephalus.
“The shunt system was always a sort of ‘work around,’ creating a temporary path for the fluid to drain,†said the CURE hospital’s medical director Derek Johnson.
“With a procedure called endoscopic third ventriculostomy (ETV), the source of the blockage within the brain’s ‘drainage system’ – usually scar tissue from a previous infection – is identified and penetrated, restoring normal drainage of the fluid.â€
The ETV procedure is a permanent fix and does not require follow-up visits for the patient.
A charity hospital, CURE does not charge patients who cannot afford to pay, and is dependent upon donations to feed and treat patients, and, therefore, benefits from a more economical treatment option.
Once Dr. Warf had standardised use of ETV to treat hydrocephalus patients at CCHU, CURE International developed a training programme for physicians around the world to benefit from his work.
Through the Programme to Advance the Treatment of Hydrocephalus (PATH), Dr. Warf first trained his replacement at CCHU, Dr. John Mugamba from Uganda.
The two have gone on to train physicians from Nepal, Zambia, Nigeria, Vietnam and Bangladesh. This is multiplying the impact of Dr. Warf’s ETV breakthrough throughout the Third World.
“Typically, medical advances and discoveries are pioneered and perfected in western, developed-world facilities,†Harrison added.
“Now, we have surgeons from all over the world travelling to remote Africa in order to receive neurosurgery training.â€
“It’s very gratifying to know that we have been able to give this gift not only to our patients in Uganda, but to the entire world.â€
Common Causes of Hydrocephalus
Although rare, hydrocephalus can be inherited genetically or may be associated with developmental disorders, including spina bifida (congenital defect of the spine) and encephalocele (hernia of the brain).
Other causes can include bleeding within the brain, brain tumors, head injuries, complications of premature birth such as hemorrhage, or diseases such as meningitis or other infections.
Symptoms
Symptoms of hydrocephalus vary from person to person. The Hydrocephalus Association lists some of the most common symptoms ones
Infants
In infants, abnormal enlargement of the head; soft spot (fontanel) is tense and bulging; scalp can appear thin; bones separated in baby’s head; prominent scalp veins; vomiting; drowsiness; irritability; downward deviation of baby’s eyes; seizures; or poor appetite.
Toddlers
Toddlers and children display abnormal enlargement of baby’s head; headache; nausea; vomiting; fever; blurred or double vision; unstable balance; irritability; sleepiness; delayed progress in walking or talking; poor coordination; change in personality; inability to concentrate; loss of sensory motor functions; seizures; or poor appetite.
Older children may experience difficulty in remaining awake or waking up.
Young adults
In young and middle-aged adults
Headache; difficulty in remaining awake or waking up; loss of coordination or balance; bladder control problems; impaired vision and cognitive skills that may affect job performance and personal skills.
Older adults
Loss of coordination or balance; shuffling gait, memory loss; headache; or bladder control problems are the most common symptoms.
Hydrocephalus is often categorised for age groups as either congenital or normal pressure hydrocephalus. Congenital hydrocephalus refers to conditions that are caused by conditions existing at birth. Primary symptoms include headache, nausea, vomiting and drowsiness.
Normal pressure hydrocephalus (NPH) is the accumulation of cerebrospinal fluid that causes the ventricles in the brain to become enlarged, with little or no increase in pressure.
Adult-onset NPH mainly occurs in adults aged 60 and older. Patients with NPH often get misdiagnosed with Alzheimer’s disease or dementia, as some of the symptoms mimic these two conditions.
Source: National Institute of Neurological Disorders and Stroke, US
HIS head looked abnormally big. His parents attributed the condition to spells of witch craft. They sought services of several witch doctors but the boy’s condition never changed until he was taken to Cure International Charity Hospital (CCHU) in Mbale.
At CCHU, he was diagnoised with hydrocephalus — a swelling of the brain caused by build-up of cerebrospinal fluid. In Uganda, over 3,000 cases of hydrocephalus are recorded annually, according to statistics obtained from CCHU-Uganda.
While most cases are caused by infections stemming from unattended childbirth and unsanitary conditions, people blame it on mysterious curses.
Families are often split when an infant shows signs of the condition, and many mothers are encouraged to abandon or deliberately kill the infants to rid the family of the curse.
Until 2001, many of these cases passed un-attended to until Cure International Charity Hospital in Uganda started Endoscopic Third Ventriculostomy (ETV) surgeries on hydrocephalus patients.
Since beginning the ETV surgeries in 2001, CCHU is now able to serve approximately 700 hydrocephalus patients each year, with nearly half of those receiving the ETV treatment.
A statement from CCHU indicates that 3,000 to 3,500 cases of hydrocephalus are reported in Uganda each year yet there are only three neurosurgeons (outside of CCHU) serving a population of 35 million.
A US neurosurgeon working at CURE Children’s Hospital of Uganda (CCHU) in Mbale, realised that the common treatment of placing shunts in the brain to drain fluid was not practical for the rural, third world environment.
With recent advances in fiber optic and lens technology, Dr. Benjamin Warf, then chief of surgery at CCHU, was able to adapt a surgical technique previously considered impractical for treatment of hydrocephalus.
“The shunt system was always a sort of ‘work around,’ creating a temporary path for the fluid to drain,†said the CURE hospital’s medical director Derek Johnson.
“With a procedure called endoscopic third ventriculostomy (ETV), the source of the blockage within the brain’s ‘drainage system’ – usually scar tissue from a previous infection – is identified and penetrated, restoring normal drainage of the fluid.â€
The ETV procedure is a permanent fix and does not require follow-up visits for the patient.
A charity hospital, CURE does not charge patients who cannot afford to pay, and is dependent upon donations to feed and treat patients, and, therefore, benefits from a more economical treatment option.
Once Dr. Warf had standardised use of ETV to treat hydrocephalus patients at CCHU, CURE International developed a training programme for physicians around the world to benefit from his work.
Through the Programme to Advance the Treatment of Hydrocephalus (PATH), Dr. Warf first trained his replacement at CCHU, Dr. John Mugamba from Uganda.
The two have gone on to train physicians from Nepal, Zambia, Nigeria, Vietnam and Bangladesh. This is multiplying the impact of Dr. Warf’s ETV breakthrough throughout the Third World.
“Typically, medical advances and discoveries are pioneered and perfected in western, developed-world facilities,†Harrison added.
“Now, we have surgeons from all over the world travelling to remote Africa in order to receive neurosurgery training.â€
“It’s very gratifying to know that we have been able to give this gift not only to our patients in Uganda, but to the entire world.â€
Common Causes of Hydrocephalus
Although rare, hydrocephalus can be inherited genetically or may be associated with developmental disorders, including spina bifida (congenital defect of the spine) and encephalocele (hernia of the brain).
Other causes can include bleeding within the brain, brain tumors, head injuries, complications of premature birth such as hemorrhage, or diseases such as meningitis or other infections.
Symptoms
Symptoms of hydrocephalus vary from person to person. The Hydrocephalus Association lists some of the most common symptoms ones
Infants
In infants, abnormal enlargement of the head; soft spot (fontanel) is tense and bulging; scalp can appear thin; bones separated in baby’s head; prominent scalp veins; vomiting; drowsiness; irritability; downward deviation of baby’s eyes; seizures; or poor appetite.
Toddlers
Toddlers and children display abnormal enlargement of baby’s head; headache; nausea; vomiting; fever; blurred or double vision; unstable balance; irritability; sleepiness; delayed progress in walking or talking; poor coordination; change in personality; inability to concentrate; loss of sensory motor functions; seizures; or poor appetite.
Older children may experience difficulty in remaining awake or waking up.
Young adults
In young and middle-aged adults
Headache; difficulty in remaining awake or waking up; loss of coordination or balance; bladder control problems; impaired vision and cognitive skills that may affect job performance and personal skills.
Older adults
Loss of coordination or balance; shuffling gait, memory loss; headache; or bladder control problems are the most common symptoms.
Hydrocephalus is often categorised for age groups as either congenital or normal pressure hydrocephalus. Congenital hydrocephalus refers to conditions that are caused by conditions existing at birth. Primary symptoms include headache, nausea, vomiting and drowsiness.
Normal pressure hydrocephalus (NPH) is the accumulation of cerebrospinal fluid that causes the ventricles in the brain to become enlarged, with little or no increase in pressure.
Adult-onset NPH mainly occurs in adults aged 60 and older. Patients with NPH often get misdiagnosed with Alzheimer’s disease or dementia, as some of the symptoms mimic these two conditions.
Source: National Institute of Neurological Disorders and Stroke, US