Fat Molecule May Cause ‘Water on the Brain’

Jennifer Couzin-Frankel

Many babies born prematurely suffer from bleeding in their still-developing brains. Even when the bleeding stops, another life-threatening condition can strike: hydrocephalus, which occurs when fluid produced to keep the brain healthy builds up because it can’t properly drain. For decades, doctors have known that the bleeding and hydrocephalus, also called "water on the brain," were linked, but they weren’t sure why. A new study suggests the answer lies in a lipid that’s common in blood but that can also profoundly disrupt brain structure and function when it’s present in large quantities.

Hydrocephalus strikes about one in 1500 babies, and treatment is imperfect. Doctors usually implant a shunt to drain cerebrospinal fluid out of the brain and into the spinal cord. Shunts fail over time, however, and follow-up surgeries are sometimes needed. The condition itself can also cause lifelong neurological problems. The roots of hydrocephalus remain murky, but for those linked to brain bleeds, the hypothesis was that blood clots—necessary to stop the bleeding—blocked the razor-thin pathways through which cerebrospinal fluid must travel to exit the brain. "We assumed for 100 years that it was just a mechanical block," says James McAllister II, a neuroembryologist at the University of Utah School of Medicine in Salt Lake City, who wasn’t involved in the recent work. "Everybody thought that you dammed up the narrow channels."

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Fluid filled. Compared with a healthy human fetus (left), a fetus with hydrocephalus cannot drain the fluid it needs to from its brain.

Credit: J. P. McAllister, Science Translational Medicine

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