Monday, February 27, 2012

Dandy-Walker Syndrome

Dandy-Walker Syndrome is a congenital brain malformation involving the cerebellum (an area at the back of the brain that controls movement) and the fluid-filled spaces around it. The key features of this syndrome are an enlargement of the fourth ventricle (a small channel that allows fluid to flow freely between the upper and lower areas of the brain and spinal cord), a partial or complete absence of the area of the brain between the two cerebellar hemispheres (cerebellar vermis), and cyst formation near the lowest part of the skull. An increase in the size of the fluid spaces surrounding the brain as well as an increase in pressure may also be present.

The syndrome can appear dramatically or develop unnoticed. Symptoms, which often occur in early infancy, include slow motor development and progressive enlargement of the skull. In older children, symptoms of increased intracranial pressure such as irritability and vomiting, and signs of cerebellar dysfunction such as unsteadiness, lack of muscle coordination, or jerky movements of the eyes may occur. Other symptoms include increased head circumference, bulging at the back of the skull, problems with the nerves that control the eyes, face and neck, and abnormal breathing patterns.

Dandy-Walker Syndrome is frequently associated with disorders of other areas of the central nervous system, including absence of the area made up of nerve fibers connecting the two cerebral hemispheres (corpus callosum) and malformations of the heart, face, limbs, fingers and toes.

Dandy-Walker malformation is best diagnosed with the help of ultrasonography (US) and magnetic resonance imaging (MRI). US may be the initial examination performed because it can be done portably and without sedation, as well as allowing multiplanar imaging.[19, 20] US, however, is limited because it is heavily operator-dependent. Abnormalities such as the gyral, dural, tentorial, and skull anomalies that accompany Dandy-Walker malformations are not clearly depicted by US.
Treatments: Treatment for individuals with Dandy-Walker Syndrome generally consists of treating the associated problems, if needed. A surgical procedure called a shunt may be required to drain off excess fluid within the brain. This will reduce intracranial pressure and help control swelling. Parents of children with Dandy-Walker Syndrome may benefit from genetic counseling if they intend to have more children.


Will's Story: 
In May of 2011 we were blessed with a healthy baby boy. It wasn’t until he was 4 weeks old that we started having concerns about William’s health. He wasn’t eating enough to gain weight, he was extremely pale, and his eyes were sunk back into his head. It was then that he was diagnosed with failure to thrive and hospitalized.  While in the hospital they performed many tests in an attempt to discover why Will was not growing.   The tests revealed nothing more than a healthy baby boy.  While in the hospital they developed a special high calorie formula to try to get him to gain weight.   After a week his weight was gaining slightly and we were sent home with the high calorie formula and no answer on what was causing the failure to thrive.   A month later he was hospitalized again for not gaining weight.   More tests were run with no answers and we were sent back home again with a high calorie formula and more questions, but no answers.   A month later we back on the same course and back in the hospital.  After another week they could not find anything wrong and sent us back home.

At this point we have been in the hospital three times with no answers.  So at this point we took our Doctors advice and fired them.  Next we found a new pediatrician.   The new doctor was the same as the others because she too did not know what was wrong with Will.   The difference was this doctor took an aggressive approach to my child and began setting up appointments with a series of specialists.   The semi breakthrough took place after the appointment with neurology.   An MRI was run.   The results showed a malformation in the cerebellum know as Dandy-Walker syndrome.   In other words his brain did not develop normally which causes delay in development of motor skills.   It was only a semi breakthrough because the doctor firmly believes that the Dandy-Walker is not the only cause but instead is a symptom of a greater problem.

In September Will had surgery to put in a feeding tube and a Nissan.   Both procedures were a success.  The Nissan has helped with Will’s acid reflux.  And the feeding tube allows us to feed Will small amounts over a large time span.   This has allowed Will to gain weight and continue gaining weight.

The new diagnosis is leaning towards disease of the cilia.   Ciliopathy is a genetic disease in which the cilia of the body do not work correctly.   Unfortunately there is no cure for cilia related diseases.  Only treatment is of the symptoms that appear.

Through Will’s journey I have learned to never give up and always fight for your little miracle.

Contributed by MOM Admin Natalie Albers

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