The Government recently started a healthcare programme for pregnant women attending ante-natal clinic to routinely take folate tablets, also known as folic acid. The tablets, which are taken before conception and during the first few weeks of pregnancy, can significantly reduce cases of children born with abnormalities of the spine including hydrocephalus.
Hydrocephalus is a rare condition characterised by excessive accumulation of fluid in the brain.
In infants, the most obvious indication of hydrocephalus is often a rapid increase in head circumference, or an unusually large head size. Dr Edwin Mogere, a neurosurgeon at the Aga Khan University Hospital explains: “Although hydrocephalus is known as ‘water-in-the brain’, the ‘water’ is actually cerebrospinal fluid (CSF), a clear fluid that surrounds the brain and spinal cord. The extra fluid dilates or expands the spaces in the brain called ventricles.”
“There are four ventricles, which are connected by narrow channels. Normally, the fluid flows through the ventricles, which act as storage chambers, bathing the surfaces of the brain and the spinal cord. It is then absorbed into the blood.”
The fluid has three important functions: To act as a cushion, or “shock absorber” to the brain, to deliver nutrients to the brain and take away waste products, and thirdly, to flow between the head and the spine and compensate for changes in intra-cranial blood volume (the amount of blood within the brain).
“The balance between production and absorption of CSF is important. Because CSF is made continuously, medical conditions that block its normal flow, or absorption, will result in its over-accumulation. The resulting pressure of the fluid against brain tissue is what causes hydrocephalus.”
A surgical procedure known as endoscopic third ventriculostomy can be used on some hydrocephalus patients. During the procedure, the surgeon uses a small video camera to see inside the brain and then makes a hole at the bottom of one of the ventricles, or between them to enable cerebrospinal fluid to flow.
The most common treatment for hydrocephalus, however, is the surgical insertion of a drainage system, called a shunt. It consists of a long, flexible tube with a valve that keeps fluid from the brain flowing in the right direction and at the proper rate.
One end of the tubing is usually placed in one of the brain’s ventricles. The tubing is then tunnelled under the skin to another part of the body where the excess cerebrospinal fluid can be more easily absorbed — such as the abdomen, or a chamber in the heart. People who have hydrocephalus usually need a shunt system to drain the fluid for the rest of their lives.
Congenital hydrocephalus is present at birth and may be caused by events, or influences that occur during foetal development, or genetic abnormalities.
Acquired hydrocephalus develops at the time of birth, or at some point afterward. This type of hydrocephalus can affect individuals of all ages and may be caused by injury, or disease.
The causes of hydrocephalus are still not well understood. Other possible causes include complications of premature birth, diseases such as meningitis, tumours, or traumatic head injury which cause scars that block the exit of CSF from the ventricles.
Folate helps. The recommended daily intake of folate for women is 400 micrograms (mcg).
Folate requirements increase substantially in pregnancy, so women should aim to consume at least 600mcg of folate from their daily diet.
If you are planning a pregnancy, or are in the early stages, you should take a daily supplement containing 0.5mg of folic acid. Folate-rich foods include a variety of vegetables (such as asparagus, spinach and broccoli) and fruits (such as oranges, bananas and strawberries) as well as legumes, cereals, nuts and yeast extracts.