Ten years ago, working on a night shift as a resident in a Madison emergency room, Josh Medow found himself treating a child with hydrocephalus, a disease in which fluid accumulates in the brain. The child had a headache and the anxious parents feared the worst — that a shunt designed to drain the fluid had failed and potentially lethal pressure was building up in the boy's brain.
Medow realized there was no way to check whether pressure was indeed increasing, short of intrusive and painful procedures. The child ended up in the operating room.
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Today, Medow, 38, and an attending neurosurgeon at UW Hospital, is on the verge of patenting a device he invented that allows doctors and even parents to easily keep track of cranial pressure in a child with hydrocephalus.
About 700,000 people have hydrocephalus, a disease in which the body is missing the ability to re-absorb the cerebral spinal fluid that bathes the brain. That fluid is normally made and drained three times a day, Medow said.
But in those with the disease, it builds up and creates dangerous pressure that can lead to brain damage, stroke and blindness. Normally, a shunt keeps the fluid drained, but studies show half of all shunts fail within two years. Sometimes, for example, they get clogged; fluid builds up and pressure increases.
Medow couldn't stop thinking about the problem. There had to be a better way, he thought, to know whether a shunt has failed than doing surgery on the shunt itself, an operation that can cost as much as $15,000 and cause considerable pain.
That night, when he got home, he made the initial drawings for a device that could eventually be made small enough to be implanted to monitor pressure and allow parents and doctors to know whether a shunt had failed without doing invasive surgery.
Medow realized there was no way to check whether pressure was indeed increasing, short of intrusive and painful procedures. The child ended up in the operating room
The long journey from that night in the emergency room to the invention of the tiny silicon implant that now sits on his desk is partly a tale of how medical devices come to be. But it is also a story of invention, full of twists and turns, moments of insight (that light bulb going on over the head), night-long sessions in Medow's basement where he initially cobbled together a prototype, and a trip or two to Radio Shack.
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http://www.hydroassoc.org/ha-updates/university-of-wisconsin-doctor-creates-pressure-monitor/
Life-Threatening Complications of Hydrocephalus
Hydrocephalus is almost always treated successfully with surgical placement of a shunt or an ETV; but rarely does either treatment last a lifetime without complications. A critical aspect of managing hydrocephalus is being well informed and staying vigilant about potential life-threatening complications. Most problems associated with shunting or ETV occur weeks or even years after the surgery. When things are going well, it is easy to forget about hydrocephalus and having a shunt or an ETV. We encourage you to stay alert and informed. Feel free to call or email the Hydrocephalus Association for more information about any of the complications listed here.Knowing what symptoms to watch for will help you become more at ease. Although the early symptoms of shunt malfunction or infection in children—fever, vomiting and irritability—are similar to many childhood illnesses, you will learn to determine the symptoms associated with shunt failure in a particular individual. Adults tend to exhibit the symptoms they experienced before treatment when there is a problem. If you have any doubt about symptoms, don’t hesitate to contact a doctor. If you suspect there is a problem with the shunt, you are wise to have it checked by the neurosurgeon rather than ignore it. It is better to have a false alarm checked than to leave it unattended. Remember, although shunt complications can be very serious and become life threatening, they can almost always be treated successfully when they are discovered early.
An estimated 50% of shunts fail within two years and 20-50% of ETVs close up within five years. Either treatment can fail at any time. Infections are less common, but still not infrequent. Be informed and vigilant. Be prepared to act quickly. Mere hours can mean the difference between a resolvable complication and brain damage or even death, especially in children.
Shunt infection usually is caused by a person’s own bacterial organisms; it is not acquired from exposure to other children or adults who are ill. The most common organism to produce infection is Staphylococcus Epidermidis, which is normally found on the surface of the person’s skin and in the sweat glands and hair follicles deep within the skin. Infections of this type are most likely to occur one to three months after surgery but may occur up to six months after the placement of a shunt. People with ventriculo-peritoneal (VP) shunts are at risk of developing a shunt infection secondary to abdominal infection, whereas people with ventriculo-atrial (VA) shunts may develop generalized infection, which can quickly become serious. In either case, the shunt infection must be treated immediately to avoid life-threatening illness or possible brain damage.
Other Shunt Complications may include the shunt system draining fluid at the wrong rate. Overdrainage of the ventricles can cause the ventricle to decrease in size to the point where the brain and its meninges pull away from the skull or the ventricles become like slits. If blood from broken vessels in the meninges becomes trapped between the brain and skull, resulting in a subdural hematoma, further surgery is required. This is most common in older adults with normal pressure hydrocephalus (NPH). Slit-like ventricles, sometimes called slit-ventricle syndrome (SVS), are most commonly a problem in young adults who have been shunted since childhood. Underdrainage of the ventricles can fail to relieve the symptoms of hydrocephalus. To restore a balanced flow of CSF it may be necessary to place a new shunt containing a more appropriate pressure valve. For those who have externally adjustable or programmable valves, the balance of flow can often be restored by re-setting the opening pressure.




Jenny Kleeman and Suemay Oram travel to Uganda to investigate hydrocephalus: a preventable yet misunderstood condition that affects a quarter of a million babies a year in Sub-Saharan Africa. 


