Encephalocele and Medical Negligence in Chicago
Encephalocele is a rare birth defect involving an opening in the skull through which a sac containing membranes, fluid, brain tissue, or a combination of these structures extends outside the skull. It is classified as a neural tube defect because it begins during the earliest stages of fetal development.
The condition varies substantially from one child to another. A small encephalocele may contain primarily membranes and fluid, while a larger one may involve significant brain tissue. Its medical effects depend on its location, size, contents, associated brain abnormalities, and whether other congenital conditions are present.
Most cases of encephalocele are not caused by medical malpractice. Researchers do not know the precise cause in many pregnancies. Genetic changes, maternal health factors, folate levels, certain medication exposures, and other developmental influences may affect risk, but the diagnosis alone does not demonstrate that a doctor, hospital, or another provider acted negligently.
A legal issue may exist in limited circumstances involving a specific prenatal imaging error, failure to communicate an abnormal finding, negligent medication management, inappropriate delivery planning, delayed treatment, or a preventable injury during surgery or follow-up care.
Free legal evaluation: If your concern involves a particular medical error rather than the encephalocele itself, contact Sexner Injury Lawyers LLC or call (312) 243-9922.
How Encephalocele Develops
During approximately the third and fourth weeks of pregnancy, a narrow structure called the neural tube folds and closes. Its upper portion contributes to the formation of the brain and skull, while the lower portion develops into the spinal cord and surrounding bones.
An encephalocele can occur when this early developmental process is incomplete and an opening remains in the skull. Tissue then extends through that opening and forms an external sac or protrusion.
The opening can occur at different places along the center of the skull. Common locations include:
- The back of the head
- The upper portion of the skull
- The area between the forehead and nose
- Less commonly, another area near the skull base or face
Encephaloceles at the back of the skull are often associated with a greater risk of neurological problems, although no location alone determines a child’s outcome.
General medical information is available from the Centers for Disease Control and Prevention.
Risk Factors and Possible Causes
In many cases, no single cause can be identified. Encephalocele may involve a combination of genetic and developmental influences rather than one preventable event.
Factors associated with a higher risk of neural tube defects include:
- Low folate levels during the earliest part of pregnancy
- Diabetes that existed before pregnancy and was not well controlled
- Use of certain antiseizure medications
- High fever or significant overheating during early pregnancy
- Particular genetic conditions or changes
- A combination of inherited and environmental factors
A risk factor does not prove why an individual child developed encephalocele. It also does not establish that the condition could have been prevented or that a healthcare provider failed to meet the standard of care.
Folic Acid and Neural Tube Development
Adequate folic acid before conception and during the earliest weeks of pregnancy can reduce the overall likelihood of neural tube defects. The timing is important because development of the neural tube begins before many people know that they are pregnant.
Following folic-acid recommendations cannot prevent every neural tube defect. A diagnosis of encephalocele should not be used to blame a mother for her diet, vitamin use, health condition, or another aspect of the pregnancy.
Additional information is available through the CDC’s neural tube defect resource.
Possible Medical Effects
The medical consequences depend on the location and size of the opening, the amount and function of the involved brain tissue, and other conditions affecting the child.
Possible findings or complications can include:
- Hydrocephalus, or excessive fluid within the brain
- Seizures
- Muscle weakness or paralysis
- Problems with balance or coordination
- Developmental delay
- Intellectual disability
- Vision problems
- Feeding or swallowing difficulty
- An unusually small head size
- Other abnormalities involving the brain, face, skull, or spine
Not every child will experience all of these problems. Some children have relatively limited neurological impairment, while others require extensive medical, surgical, developmental, and supportive care.
Prenatal and Postnatal Diagnosis
Some encephaloceles can be identified or suspected during prenatal ultrasound. Detailed ultrasound or fetal MRI may be used to evaluate the opening, the tissue within the sac, the surrounding brain, and other possible abnormalities.
Other encephaloceles are recognized immediately after delivery. A small opening near the nose or forehead may be less obvious and can sometimes be identified later.
After birth, diagnostic evaluation may include:
- A physical and neurological examination
- MRI to evaluate the brain and soft tissues
- CT imaging to examine the skull opening and bony anatomy
- Testing for hydrocephalus or other brain abnormalities
- Genetic evaluation when a syndrome or inherited condition is suspected
- Vision, hearing, feeding, and developmental assessments
Surgical Treatment and Long-Term Care
Surgery is generally used to close the opening in the skull and place tissue that can safely be preserved within the skull. The surgeon may also remove tissue that cannot be preserved, reconstruct affected bone or facial structures, and protect the brain from injury or infection.
The precise operation depends on:
- The location and size of the encephalocele
- Whether the sac contains functioning brain tissue
- The condition of the surrounding skin and skull
- The child’s neurological and overall medical condition
- Whether the face, eyes, nose, airway, or other structures are involved
- The presence of hydrocephalus or another associated abnormality
Some children require more than one operation. A shunt may be necessary when hydrocephalus causes excessive fluid and pressure within the brain.
Surgical closure can protect exposed tissue and repair the skull, but it may not reverse neurological injury or developmental differences that already exist. Long-term care may include neurology, neurosurgery, rehabilitation, physical and occupational therapy, seizure management, vision care, educational services, and developmental support.
Most Encephalocele Cases Do Not Involve Malpractice
The presence of encephalocele does not show that a healthcare provider caused it. A possible claim generally requires evidence of a separate and identifiable medical error that caused legally recognized harm.
When Could Medical Negligence Be Relevant?
Prenatal Imaging and Communication Errors
A legal review may be appropriate when there is evidence that:
- A significant abnormality visible on prenatal imaging was overlooked
- An ultrasound or MRI was interpreted incorrectly
- A provider failed to order medically indicated follow-up imaging
- An abnormal finding was not communicated to the patient or another provider
- A referral to maternal-fetal medicine, pediatric neurosurgery, genetics, or another specialist was unreasonably delayed
- The patient was given inaccurate information about the findings or limitations of prenatal testing
A missed prenatal diagnosis does not automatically constitute negligence. The evaluation must consider what could reasonably have been seen at that stage of pregnancy, the quality of the images, fetal position, the provider’s responsibilities, and whether acting earlier would have changed the family’s medical care or available decisions.
A potential wrongful birth claim may focus on whether negligent testing, interpretation, counseling, or communication deprived the parents of important prenatal information. Such a claim does not necessarily allege that the provider caused the encephalocele.
Medication Management During Pregnancy
The prior version of this page identified SSRIs, contraceptives, anti-nausea drugs, acne medications, antimetabolites, and other broad medication categories as causes of encephalocele. Those assertions have been removed because they overstated the available medical evidence.
Certain antiseizure medications are recognized as factors that may increase the risk of neural tube defects. Prescribing one is not automatically negligent. Untreated seizures, bipolar disorder, and other maternal conditions may also create serious risks.
A medication-related evaluation may consider:
- The particular medication and dose
- The medical condition being treated
- When the medication was taken
- The risks of changing or stopping treatment
- Reasonably available alternatives
- The scientific information available at that time
- The counseling, coordination, and monitoring provided
A pregnant patient should not discontinue a prescribed medication without first discussing the risks and alternatives with an appropriate healthcare provider. Learn more about preventable medication mistakes on our medication and prescription error page.
Delivery Planning
An encephalocele diagnosis may require coordination among obstetricians, maternal-fetal medicine specialists, neonatologists, anesthesiologists, and pediatric surgical specialists. The safest timing, location, and method of delivery depend on the size and position of the sac, the risk of rupture or trauma, the baby’s condition, and other obstetric factors.
A cesarean delivery is not automatically required in every case. A potential concern would be whether the medical team developed and followed a reasonable individualized plan based on the information available.
Negligent Treatment or Surgery
Recognized complications can occur even when treatment is appropriate. A possible malpractice issue may arise, however, when preventable additional harm results from:
- Unreasonable delay in obtaining neurosurgical evaluation
- Failure to protect exposed tissue before surgery
- Inadequate preoperative planning
- A preventable surgical error
- An anesthesia, medication, or monitoring error
- Failure to recognize infection, bleeding, fluid leakage, hydrocephalus, seizures, or neurological deterioration
- Inadequate postoperative or developmental follow-up
Records Used to Evaluate a Potential Case
A medical and legal review may require:
- Prenatal and obstetric records
- Ultrasound reports and original images
- Fetal MRI studies
- Maternal-fetal medicine and genetic counseling records
- Medication and pharmacy records
- Delivery-planning records
- Hospital and newborn records
- Postnatal MRI and CT studies
- Neurosurgical, anesthesia, and operative records
- Neurology, developmental, therapy, and follow-up records
Qualified medical experts may need to distinguish the effects of the congenital condition from any additional injury allegedly caused by delayed diagnosis, negligent planning, or improper treatment.
Contact Sexner Injury Lawyers LLC
Most children diagnosed with encephalocele do not have a medical malpractice claim. A legal review may be appropriate when there is a specific concern involving prenatal imaging, communication of findings, medication management, delivery planning, delayed treatment, or preventable injury during surgery or follow-up care.
Contact Sexner Injury Lawyers LLC or call (312) 243-9922 for a free and confidential evaluation. We will explain honestly whether the circumstances appear to justify further investigation.
