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April 24, 2003
Water on the brain
Q: Shortly after our baby was born, the paediatrician said its head was larger than normal. He ordered a brain scan, and it turns out he was right. The baby had hydrocephalus. A plastic tube was inserted to drain the fluid. No one gives us an idea of what we can expect about our baby’s development. Can you?
A: “Hydrocephalus” is a word borrowed from the Greek. It means “water-in-the-head” or “water-on-the-brain.” The water is cerebrospinal fluid.
The brain and spinal cord have their own fluid system-cerebrospinal fluid. It drains through the caverns within the brain and in the space surrounding the brain and spinal cord. It provides nourishment for the brain and cord and acts as a shock absorber for them.
When the normal flow of cerebrospinal fluid is obstructed, fluid pressure builds up. The brain enlarges. Since a baby’s skull bones are not fused, as they are later in life, the head also enlarges. If cerebrospinal fluid is not drained, the head can grow to gigantic proportions - something that is seldom seen in these days, thanks to neurosurgeons.
Putting a drainage tube into one of the brain’s caverns lowers fluid pressure and stops head enlargement and possible brain damage. Often the choice for fluid drainage is into the abdominal cavity. The tube is inched there under the skin. No one can see it.
The prognosis for a baby who has hydrocephalus cannot be determined immediately. Sometimes abnormalities in brain anatomy that lead to fluid obstruction can create learning disabilities and vision difficulties. The prompt attention your baby received favors a good outcome.
Q: I have a rare skin disease. It’s pemphigus. It causes my skin to blister, and I even get blisters in my mouth. I take prednisone for control, and it works well. I am as frightened of prednisone as I am of pemphigus. Isn’t there any other medicine I can take?
A: Build a shrine for prednisone, a cortisone drug. In the days before its discovery, pemphigus was often a fatal disease. Thanks to prednisone, pemphigus is now a controllable disease. As you say, with pemphigus the skin and mouth break out in blisters that can become quite painful. The immune system has backfired. Instead of protecting the body, it turns on the body, the result being skin, oral and sometimes genital blisters.
All cortisone drugs, when taken in high doses for prolonged periods, create many serious side effects. They can make the skin thin and fragile. They can weaken bones. They can upset blood sugar control. The list is long, but there are ways of dealing with most side effects.
As soon as pemphigus comes under control, the doctor lowers the dose of prednisone and keeps doing so until the drug can be given on alternate days. That keeps side effects to a minimum. When pemphigus becomes inactive, the prednisone can be stopped. It is restarted if blisters recur.
Azathioprine or cyclophosphamide, two drugs that bring the immune system back to normal function, can be given with prednisone so a lower prednisone dose can be given. If your current dose of prednisone is not generating intolerable side effects, stick with it. If its side effects are intolerable, then inquire about using azathioprine or cyclophosphamide so the prednisone dose can be reduced.
Q: I have two teenage sons who are good kids. However, they have the habit of cracking their knuckles-all the time. If one is not doing it, the other is. I tell them that they are going to end up with arthritis. They laugh at me. If you tell them to stop, they won’t laugh at you.
A: I would love to come to your aid and warn your boys that knuckle-cracking leads to arthritis. In honesty, I cannot. It doesn’t. The popping noise comes from the formation of a bubble in the joint fluid and its subsequent bursting. The joint gyrations of knuckle cracking create the bubble and also burst it. The sound drives me up the wall. —2003 North America Syndicate Inc.
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