Spontaneous Resolution of Fetal Hydrocephalus | Spontaneous Remission Database

Abstract

Hydrocephalus, when diagnosed prenatally, is usually progressive and frequently associated with other anomalies. Few of the survivors have had a normal development. We are reporting a case in which hydrocephalus was identified in the second trimester, progressed for a short period and then resolved before birth, with a subsequent normal outcome.

Case Details

Personal Characteristics

A 25-year-old woman, was referred by her obstetrician because of a previous child with multiple malformations that included a congenital heart defect, dysmorphic facies including frontal bossing, hypertelorism, flat nasal bridge, highly arched palate, bifid uvula, ear abnormalities, cryptochidism, intestinal malrotation, and mild mental retardation. The family history was negative except for a male first cousin (through the maternal grandmothers sister) WHO was mildly retarded and had a speech problem.

Clinical Characteristics

Hydrocephalus was identified in the second trimester, progressed for a short period and then resolved before birth, with a subsequent normal outcome. The third and fourth ventricles were normal in size. No associated anomalies were detected, except for a tiny choroid plexus cyst first seen at 32 weeks. Hydrocephalus started to diminish at 21 weeks and the ventricles were normal in size at 36 weeks. An apparently normal female infant weighing 2,955 grams with apgars of 8 and 9 was delivered by cesarean section at 39 weeks. Pediatric and neurologic examinations were normal. Cranial ultrasound studies at 2 1/2 months were entirely normal except for the small choroid plexus cyst. At 15 months, her development has been entirely normal and the head circumference has remained at the fiftieth percentile.

Remission Characteristics

Hydrocephalus started to diminish at 21 weeks and the ventricles were normal in size at 36 weeks.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

The patient requested amniocentesis and this was completed without incident; the result was a 46, xx, apparently normal chromosome pattern. One hundred cells were examined for a fragile x, but this was negative. Alphafetoprotein (AFP) was 1.21 mg% (normal) and acetylcholinesterase negative. She was referred for follow-up ultrasound studies because early hydrocephalus was noted.