How does hydrocephalus develop? Hydrocephalus of the brain: causes and treatment
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Hydrocephalus of the brain
The name of this disease comes from two Greek words, namely hyd?r and kephal? – water and head, respectively. Given this fact, most neurologists prefer to call the disease hydrocephalus, omitting the specification of its localization. Ordinary people, as a rule, call the disease dropsy of the brain.Within the brain (in particular, its ventricles) a person constantly circulates cerebrospinal fluid or cerebrospinal fluid. This natural moisture can be absorbed and renewed as needed and depending on the processes occurring in the organ. In cases where there is a disruption in the functioning of departments or the course of certain processes, cerebrospinal fluid can begin to accumulate, filling the ventricles or subarachnoid space. As a result, additional pressure is created on the organ itself and the cranium that stores it.
Hydrocephalus of the brain can arise and progress both in an adult (acquired origin) and in a new person. born child(congenital disease). There are also 4 stages of the disease - acute, chronic, compensated and decompensated.
Liquor
Liquor(cerebrospinal fluid) plays vital role in the metabolic processes of the brain and spinal cord, also providing humoral direct and feedback between their various distributions, and in case of injury also plays a purely mechanical inertial-stabilizing role during kinetic displacements of the brain. The body constantly renews and circulates cerebrospinal fluid. Detailed study of cerebrospinal fluid (CSF) has been possible since Quincke performed a lumbar puncture in 1891. The total amount of cerebrospinal fluid in an adult reaches 150 ml, of which one half is almost equally distributed between the ventricles and the subarachnoid space of the brain, and the other is located in the subarachnoid space of the spinal cord. Every day, the choroid plexus of the ventricles produces 500-800 ml of cerebrospinal fluid from the blood. Mainly cerebrospinal fluid is produced in the lateral ventricles, from where through the interventricular foramina (f. Monroi) cerebrospinal fluid enters the third ventricle, from there through the cerebral aqueduct to the fourth ventricle. Next, the cerebrospinal fluid flows out through the lateral paired openings of the fourth ventricle (f. Magendie) and the middle odd opening (f. Luschka). arachnoid membrane to the surface of the brain and spinal cord, where it is absorbed into the blood. During the day, the cerebrospinal fluid is renewed 4-5 times. Under normal circumstances, there is a clear balance between the production and absorption of cerebrospinal fluid, which ensures its constant volume and, accordingly, pressure. However, when this state of equilibrium is disturbed, or there are obstacles to the normal movement of cerebrospinal fluid in the cerebrospinal fluid tract, excessive accumulation of cerebrospinal fluid in the cranial cavity occurs, an increase in intracranial cerebrospinal fluid pressure and a pathological condition called hydrocephalus.Types of hydrocephalus
Depending on the mechanism, disturbance of liquor formation or circulation The following types of hydrocephalus are distinguished:- open (combined)
- closed (occlusal, not combined)
Based on the location of fluid accumulation, hydrocephalus is divided into external And internal. With external hydrocephalus, excess fluid accumulates mainly in the subarachnoid spaces, and with internal hydrocephalus, it occurs in the ventricles of the brain.
From a practical point of view, it is extremely important to distinguish between hydrocephalus progressive(increasing) and stabilized. Progressive hydrocephalus predominantly occurs with an increase in cerebrospinal fluid pressure, accompanied by compression and atrophy of brain tissue, and dilation of the ventricles. However, expansion of the ventricles and subarachnoid spaces of the brain can also occur due to atrophy of brain tissue after severe traumatic brain injury, ischemic stroke or brain hypoxia. This type of hydrocephalus is called compensatory, stabilized, or normotensive (with an increase in the volume of the ventricles and other cavities of the brain and, accordingly, an increase in the volume of cerebrospinal fluid, its pressure remains within normal limits and subsequent brain atrophy is not observed).
According to the time of occurrence of hydrocephalus, they are distinguished congenital(which develops before birth or from the moment of birth) and acquired. Congenital hydrocephalus occurs due to abnormal development of the brain with narrowing or blocking of the cerebrospinal fluid ducts, infection suffered during pregnancy (sore throat, influenza, toxoplasmosis, pneumonia, etc.), intoxication, injury or physical overload. Congenital also includes hydrocephalus resulting from birth trauma with intracranial hemorrhage or fetal asphyxia. Acquired hydrocephalus develops as a result of brain injury, brain tumors, or previous inflammatory processes of the meninges (meningitis, arachnoiditis).
Internal hydrocephalus
Depending on the location of fluid accumulation in dropsy, internal and external forms of the disease are distinguished. In the case where there is internal hydrocephalus, free cerebrospinal fluid tends to the ventricular system, namely the lateral ventricles of the brain, and accumulates directly in them, creating increased pressure here and affecting nearby parts of the organ.There are no specific manifestations of this form of hydrocephalus - the symptoms remain within the general complex. The external manifestations of the disease (manifested in most cases in children), as well as the range of sensations characteristic of the disease, have no pronounced differences. But each form of the disease affects treatment methods in its own way, since one of the main goals of the doctor is to remove the maximum amount of fluid from the patient’s skull (medically or through surgery) to ensure a reduction in intracranial pressure to optimal level.
External hydrocephalus
Unlike the internal form, external hydrocephalus characterized by the accumulation of fluid in the subarachnoid and subdural spaces, and not in the lateral ventricles of the brain. In this form, the disease has general symptoms, and the localization of free cerebrospinal fluid can be diagnosed solely by conducting a full examination.The external form is noticeably less common. One of the varieties of external dropsy is external replacement hydrocephalus, which occurs most often in people suffering from cardiac pathology. vascular system(in particular, arterial hypertension), osteochondrosis in the cervical spine, or a previously experienced head injury.
Like the internal form of the disease, external hydrocephalus may not manifest itself for a long time, causing only minimal discomfort. This fact leads to a delay in the start of treatment and reduces the patient’s chances of a full recovery. That’s why the disease is often called “insidious.”
Hydrocephalus Clinic
Clinical signs of hydrocephalus vary significantly in children infancy, kids and adults. Progressive hydrocephalus in infants is manifested by changes in the size and shape of the head. The increase in size occurs predominantly in the sagittal direction, as a result of which the frontal bone protrudes above the relatively small facial skeleton. The bones of the skull are thinned, the edges of the bones diverge with the formation of significant gaps, especially along the lines of the coronal and sagittal sutures. The anterior and posterior fontanels are tense. Since the facial skeleton is significantly retarded in growth, the face becomes triangular shape and in comparison with the large spherical head it seems small, senile-looking, pale and wrinkled. The skin on the head is thin and atrophic, there is a compensatory expansion of the cutaneous veins of the head and an increase in their number.When does hydrocephalus develop? in children older than one year, then this is manifested by a progressive expansion of the cranial sutures; upon percussion of the skull, a characteristic sound of a “pot that has cracked” appears.
Multifaceted neurological symptoms in hydrocephalus are a consequence of increased intracranial pressure, with the development of atrophic and degenerative processes in the brain and cranial nerves, and in occlusive hydrocephalus it is often supplemented by focal symptoms of the underlying disease.
U newborns and infants age, there is a fixed downward displacement of the eyeballs (a symptom of the setting sun), a decrease in acuity and a narrowing of the visual fields may develop until blindness occurs. The function of the abducens nerve is often impaired, which leads to convergent strabismus, and movement disorders- in the form of paresis, sometimes combined with hyperkinesis. Cerebellar disorders cause disturbances in statics and coordination of movements. There may be a significant lag in intellectual and physical development; increased excitability, irritability or lethargy, adynamia, and apathy are often manifested.
Emergence hydrocephalus in older age groups, as a rule, is a consequence of severe organic lesions nervous system and manifests itself as a syndrome of increasing intracranial hypertension. Appears headache, which worries mainly in the morning, nausea, vomiting at the peak of the headache, depression of the function of the cerebral cortex (memory disorders, disrupted thinking, impaired consciousness varying degrees), swelling of the optic discs with a tendency to rapid progression of secondary atrophy of these nerves with a decrease in acuity and narrowing of visual fields, corresponding changes in the bones of the cranial vault and sella turcica.
Symptoms of an occlusive attack are associated primarily with a delay in the outflow of cerebrospinal fluid from the ventricular system, and progresses rapidly. This leads to an increase in intraventricular pressure and compression of the brain stem. The clinical picture of an occlusive attack is especially striking when there are disturbances in the cerebrospinal fluid circulation in the lower parts of the fourth ventricle, when, due to the increasing volume of cerebrospinal fluid, the bottom of the rhomboid fossa and the midbrain experience the greatest pressure. In this case, there is a sharp headache, nausea, vomiting, forced position of the head, motor activity, combined with general lethargy, impaired consciousness, an increase in oculomotor disorders, increased nystagmus, autonomic disorders in the form of profuse sweating, facial hyperemia or severe pallor, bradycardia, arrhythmia, increased pyramidal disorders, sometimes tonic convulsions, increased respiratory rate with disruption of its rhythm until it stops. The presence of stem symptoms is one of the most important signs of an occlusive attack.
Focal neurological symptoms depend on the nature and location of the main pathological process and level of occlusion. Two syndromes are most commonly observed:
- with occlusion at the level of the Sylvian aqueduct - midbrain lesion syndrome (impaired vision along the vertical axis, disorders pupillary reflex, ptosis, spontaneous convergent nystagmus, hearing impairment).
- With occlusion at the level of the IV ventricle, there are symptoms of damage to the cerebellum and brain stem.
Diagnosis of hydrocephalus
The diagnosis of hydrocephalus is made on the basis of characteristic clinical manifestations and data from additional examination methods. It is important to determine the nature of hydrocephalus(progressive or stabilized) - dynamic monitoring of the child is carried out. The level of occlusion is determined using pneumoencephalography, ventriculography (in modern conditions used quite rarely), computed tomography (CT) or magnetic resonance imaging (MRI).The simplest, non-invasive, highly informative method for diagnosing hydrocephalus is ultrasonography brain (ultrasound) - neurosonography. The method allows you to diagnose hydrocephalus already in the seventh month of pregnancy. Neurosonography is widely used to examine young children, when the bone sutures of the skull and fontanelles have not yet grown.
As a result of the examination, the size of the ventricles of the brain is established, the level and causes of occlusion are clarified. The examination is convenient for dynamic monitoring of the patient, since it is harmless to the body.
Age-related features of hydrocephalus
Most often, this disease occurs in newborns, but even adults can experience symptoms of this serious illness. As a rule, this condition is acquired and is a consequence of past illnesses or existing pathologies. In particular, changes that occur in the body under the influence of persistently increased pressure in the network of arteries, as well as during the atherosclerotic process, can lead to dropsy. The normal flow of cerebrospinal fluid can also be disrupted due to the formation and growth of various types of tumors that put pressure on various parts of the brain. Injuries and neuroinfections accompanied by an inflammatory process and disturbances of normal blood circulation are also dangerous from the point of view of the possibility of hydrocephalus.Medical scientists have proven that any type of impact on the brain is potentially dangerous, as a result of which its integrity and functionality may be impaired. This also applies to internal processes leading to damage to organ tissue.
Hydrocephalus of the brain in adults is treated exclusively under the close supervision of a medical specialist. Immediately after a thorough diagnosis, medications are started to reduce the pressure in the patient’s skull. In critical cases, the fluid is removed by surgery. The main goal of the medical staff is to ensure normal fluid flow, that is, to eliminate the cause of its disruption.
Needless to say, early diagnosis allows doctors to minimize possible harmful effects on the organ and the body as a whole, increasing the patient’s chances of staying alive and maintaining health.
Hydrocephalus in adults
Manifests hydrocephalus in adults in the form of a set of symptoms characteristic of increased intracranial pressure, which appears due to the accumulation of cerebrospinal fluid. As applied to adults, as well as older children, the extensive list of symptoms includes severe headache that does not subside under the influence of various analgesics, a feeling of pressure in the eyeballs, nausea and vomiting. As the disease progresses, the symptoms may expand; at first, the listed signs may appear periodically and increase gradually.Often, dropsy manifests itself in neurological symptoms, which is explained by compression of the brain structure when the cerebrospinal fluid space expands, as well as the impact of the underlying disease that led to hydrocephalus. As a rule, we are talking about disturbances in the functioning of the vestibular apparatus, as well as in the perception of visual signals, up to nerve atrophy.
Less common in medical practice are cases characterized by disturbances in motor and sensory functions. These may be paralysis and paresis, changes in the area of tendon reflexes, partial or even total loss one or all types of sensitivity, etc.
In addition, this disease may also be accompanied by manifestations in the area mental health patient. As a rule, violations are noted in the sphere of emotions and manifestations of will. The patient exhibits emotional instability, sometimes neurasthenia, and demonstrates abrupt and most often causeless transitions from euphoria to apathy or vice versa. When pressure in the skull increases rapidly, aggression can occur.
All these symptoms, described by the patient or his immediate environment, allow the neurologist to assume the presence of the disease already at the first examination, before conducting tests.
Hydrocephalus in children
Hydrocephalus in children- a more common occurrence than a similar disease in adults. Since the child’s body has not yet completed the process of its full formation, it largely “succumbs” to the disease, as a result of which, along with other symptoms, an increase in the size of the skull may also appear.The skull begins to grow under the pressure of the cerebrospinal fluid and due to the body’s desire to reduce intracranial pressure. Growth can appear on both sides of the skull, or on one of them. As the disease progresses and the skull grows, head movements and subsequently movement in general become more difficult. Often this symptom accompanied by a complex of others - bulging veins, disc swelling optic nerve, tension in the area of the large fontanel. Even on early stages The doctor may suspect hydrocephalus based on the “setting sun” syndrome that occurs in children.
The symptoms of hydrocele in children partially repeat the complex of symptoms in adults. In particular, changes in muscle tone, partial or complete loss of vision and sensation, neurological disorders and psychological disorders may be present. Unlike adults, children extremely rarely demonstrate disorders of the emotional-volitional sphere - in this case, retardation in intellectual and physical development. Due to low mobility, sick children quickly gain weight and become obese. The psychological picture shows apathy, lack of initiative and strong attachment to loved ones and relatives.
The causes of the disease, as a rule, are congenital pathologies at an early age or infection during adolescence. Diagnosis and treatment are similar to those for adult patients and are individualized.
Hydrocephalus in newborns
Most often, the development of the disease is determined in a person during his maturation in the womb. In this case, the manifestation of the first symptoms is not long in coming, and medicine is faced with such a phenomenon as hydrocephalus in newborns.The cause of this pathology in a child may be a defect in the vascular system, various types of defects in the development and formation of the central nervous system (hernia, aneurysm or cyst in the skull), breakage or aberration in the set of chromosomes. Most rarely, such consequences occur as a result of the formation of formations in the brain of an unborn child. Dangerous for the fetus There may be infections that have ever been suffered or that have not yet been eliminated from the mother’s body. Even a completely harmless infection like ARVI can critically increase the likelihood of developing hydrocephalus. It is extremely rare to encounter cases in which the disease was triggered by fetal trauma.
In the first year of a baby’s life, dropsy can provoke not only external manifestations (disproportionate and excessive increase in the volume of the skull, tension of the scalp, etc.), but also disturbances in the development of the body. Due to the growth of the skull, the child is limited in movement, which leads to impaired muscle formation and deformities. In addition, compression of parts of the brain leads to mental, emotional and often psychological retardation. As the disease progresses, strabismus appears, and the “setting sun” syndrome can manifest itself even in the first days of life.
At this age, the damage caused to the body by the disease is maximum, therefore it is extremely important to identify its onset and progress as early as possible and contact a qualified specialist. medical care until the consequences were irreversible. Fortunately, due to the pliability of the maturing organism, disorders can be diagnosed almost immediately after birth.
Treatment of hydrocephalus
To date, there is no conservative drug treatment that would be effective for progressive hydrocephalus. Existing facilities How plant origin(juniper fruits, bear ears, dill seeds), and stronger pharmacological drugs (diacarb, furosemide, lasix, novorit, urix, hypothiazide), provide only a temporary decrease in the amount of circulating cerebrospinal fluid and a decrease in intracranial pressure. They are used on initial stages hydrocephalus or to improve the patient’s condition in preparation for surgical treatment, i.e. is largely a palliative or purely symptomatic measure. In order to improve the patient's condition, especially in cases of a sharp increase in intracranial pressure, which can be complicated by an occlusive attack, ventricular puncture with the removal of cerebrospinal fluid is also indicated. In cases of the development of hydrocephalus during infectious diseases in the acute and subacute stages, it is used antibacterial treatment(sulfonamides, antibiotics, symptomatic treatment). After CSF shunt operations in cases of compensated hydrocephalus, drug treatment is used to improve metabolic processes brain (nootropil, actovegin, vitamin E, etc.), improving blood circulation.Hydrocephalus is mainly treated with surgical methods. Regardless of the pathogenetic features of hydrocephalus, the main goal of surgical interventions is to create conditions that ensure the removal of excess cerebrospinal fluid from the cerebrospinal fluid spaces of the brain and maintain cerebrospinal fluid pressure at a normal level. To achieve this goal, the following is carried out:
- Operations aimed at draining cerebrospinal fluid by creating bypass routes (various types of cerebrospinal fluid shunting operations).
- Actions aimed at eliminating occlusion of the cerebrospinal fluid ducts (removal of tumors that compress or block various parts of the cerebrospinal fluid ducts, dissection of the cerebellar vermis with occlusion at the level of the foramen of Magendie, as well as perforation of the lamina terminalis and puncture of the corpus callosum).
Often with CSF shunt operations they use:
- Ventriculoperitoneal shunt
- Ventriculocardial shunting
- Lumboperitoneostomy
- Ventriculocisternostomy
Treatment results for hydrocephalus
The introduction of valve drainage systems into practice allowed reduce mortality due to hydrocephalus from 23% to 1%. Infectious complications are among the most frequent and dangerous in any surgical intervention, but their percentage increases when it is necessary to implement foreign objects, performing operations on newborns and infants in severe general condition and exhaustion of the patient.Sometimes inflammatory complications can be eliminated with anti-inflammatory therapy. If treatment is not effective, the shunt system must be removed.
Another complication when using cerebrospinal fluid shunt systems, they become clogged. The latter can occur at any level. Central catheter may become clogged with protein found in the cerebrospinal fluid, brain tissue, or choroid plexus. The distal catheter located in the abdominal cavity can become clogged with peritoneum, intestines, and fibrin deposits.
During ventriculoperitoneal shunting in young children, 2-4 years after surgery due to the child’s growth, the abdominal end of the catheter leaves the abdominal cavity, which leads to the cessation of drainage and rapid deterioration of the patient's condition.
Long-term consequences of surgical treatment of hydrocephalus of various origins with the use of liquor shunt systems depend, first of all, on the degree of their severity, i.e., the degree of disruption of the structure and function of various parts of the brain. With relative preservation of the brain mantle (tissue cerebral hemispheres) more than 2-3 cm can predict normal physical and mental development child (Yu. A. Orlov, 1996). Even maintaining this size to 1 cm often makes it possible to compensate for the corresponding deficiency in more than 70% of patients (considering that in most people no more than 12-15% of the cerebral cortex functions).
Only in cases of significant atrophy brain structures surgical intervention may be futile.
Hydrocephalus of the brain is popularly called dropsy - it is a neurological disease caused by excess cerebrospinal fluid in the ventricular system of the brain. As a rule, hydrocephalus of the brain is considered a disease of childhood, since it affects 1-10 newborns out of a thousand. But this disease can also be detected in patients over 18 years of age.
Hydrocephalus in adults is complicated by the fact that, due to the lack of competent and clear diagnosis, most patients are given incorrect diagnoses, for example, “post-traumatic encephalopathy” or “psycho-organic syndrome” and given incorrect treatment.
The causes of hydrocephalus can be different. Hydrocephalus in newborns most often occurs as a result of maternal illness during pregnancy. In addition, hydrocephalus of the brain in children can develop in the first months of life as a result of meningitis, intoxication, head trauma, and so on. This disease can lead to the death of the child or the development of neurological disorders, including decreased intellectual abilities.
Hydrocephalus in adults most often occurs due to brain tumors, infectious processes and injuries. So, the causes of hydrocephalus:
- Infectious and inflammatory diseases, for example, ventriculitis, meningitis, tuberculosis, encephalitis;
- Brain tumors of intraventricular, parastem or stem localization;
- Violations cerebral circulation;
- Non-traumatic and traumatic and intraventricular hemorrhages;
- Encephalopathies of various origins, for example, alcoholism.
Classification of the disease
- By origin, hydrocephalus of the brain can be hereditary or acquired. The causes of hereditary hydrocephalus, as mentioned above, are a variety of intrauterine infections. Acquired hydrocele of the brain is classified depending on etiological factors;
- Internal and external hydrocephalus are classified according to the location of fluid accumulation. Internal hydrocephalus occurs due to the accumulation of cerebrospinal fluid in the ventricular system, mainly in the lateral ventricles. Internal hydrocephalus may be accompanied by the development of Dandy-Walker defect. External hydrocephalus develops as a result of the accumulation of cerebrospinal fluid in the subdural and subarachnoid spaces;
- According to pathogenesis, they distinguish between open hydrocephalus, which is not characterized by impaired circulation of cerebrospinal fluid, and closed hydrocephalus, in which there is a violation of the outflow of fluid;
- According to the rate of progression of the disease, the following types of hydrocephalus are distinguished: acute, subacute and chronic. In acute hydrocephalus, less than 3 days pass from the first symptoms to decompensation. With subacute hydrocephalus, the development of the disease occurs within about a month. Chronic hydrocephalus of the brain develops over 6 or more months;
- Replacement hydrocephalus occurs mainly in older people. As a result of this form of the disease, the volume of the brain decreases, and the vacant space is filled with cerebrospinal fluid. Replacement hydrocephalus can develop against the background of atherosclerosis, hypertension, alcohol abuse, instability of the cervical vertebrae;
All of the above types of hydrocephalus are in an active progressive form, in which intracranial pressure increases, brain tissue atrophies and the ventricles of the brain expand. But the expansion of the ventricles of the brain can be passive, this form is called moderate external hydrocephalus. Doctors believe that moderate external hydrocephalus is quite dangerous disease, since in most cases there are no symptoms characteristic of hydrocephalus. It is worth noting that moderate external hydrocephalus leads to impaired blood circulation in the brain and the patient begins to suffer from nervous system disorders, lethargy, and migraines.
Symptoms of brain hydrocephalus
The most basic signs of hydrocephalus are advanced head growth and a greatly enlarged skull.
Symptoms of hydrocephalus in newborns
- frequent tilting of the head;
- tense fontanel;
- eyeballs shifted to the bottom;
- strabismus;
- pulsating round protrusions in places where the bones of the skull have not fused normally.
Characteristic symptoms of hydrocephalus in adults:
- Feelings of heaviness in the head and headaches, worsening in the morning;
- Increase and decrease in blood pressure, heart rate, sweating;
- Vomiting and nausea in the morning;
- Increased fatigue and tiredness;
- Nervousness;
- Urinary incontinence;
- Impotence, decreased libido;
- Gait disturbances;
- Deterioration of the condition with changes in atmospheric pressure.
If you discover signs of hydrocephalus, you should immediately contact a specialist.
Diagnosis of the disease
Moderate, internal, external, replacement hydrocephalus and other forms of the disease are diagnosed using the following studies:
- Magnetic resonance imaging;
- CT scan;
- Fundus examination;
- Lumbar puncture, which diagnoses normal pressure in the cerebrospinal fluid (cerebrospinal fluid).
Treatment of hydrocephalus of the brain
For treatment, it is necessary to find out the causes of hydrocephalus, the form, nature and degree of the disease. Treatment of hydrocephalus conservative methods is ineffective, it is carried out only in the early stages of the disease. Today it is widespread surgical methods treatment of hydrocephalus. It is worth noting that surgical intervention is the main method of combating such a complex disease as hydrocephalus. Drug treatment in most cases can only slow down the development of the disease, but not eliminate it. If the operation is successful, it is possible to completely cure hydrocephalus and return to a normal lifestyle.
Hydrocephalus is a disease characterized by excessive accumulation of cerebrospinal fluid (CSF). Its balanced circulation is very important for normal brain activity.
Typically, such a pathology is associated with high intracranial pressure (ICP), when cerebrospinal fluid is intensively produced, but is poorly absorbed, provoking the development of foci of the disease.
Causes of the anomaly
The causes of the pathology are caused by changes related to the production and movement of cerebrospinal fluid. The diagnosis of encephalia in newborns is associated with infections that the pregnant woman had.
For example, its cytomegalovirus variety contributes to the defective functioning of the ventricles of the fetal brain. Depending on the location of the pathology, doctors distinguish between internal, external and mixed types of the disease.
In addition to the congenital form, infants can also develop acquired hydrocephalus as a complication after meningitis, intoxication, or head injuries. Most types of this disease are a consequence of obstructed outflow of cerebrospinal fluid that accumulates in the ventricles of the brain.
Forms of the disease
Depending on the location there are:
- Internal (ventricular) dropsy - cerebrospinal fluid collects directly in the ventricles, stretching the brain.
- External form - excess cerebrospinal fluid is concentrated under the meninges and compresses it from the outside. At the same time, inside, in the ventricles, its content remains normal. This is a fairly rare type of dropsy that occurs against the background of brain atrophy.
- Mixed hydrocephalus is the accumulation of cerebrospinal fluid inside, in the ventricles, and outside, in the subarachnoid space.
The choice of treatment methods - both conservative and surgical - will depend on the type of this serious disease.
Features of hydrocephalus
The characteristics of the disease, due to the interaction of certain mechanisms, cause other types of cerebral hydrocele.
Mixed replacement hydrocephalus is usually observed in elderly patients with signs of decreased brain volume. Its distinctive feature is the replacement of the vacated space with liquor. The background for the formation of such pathology is often concussions, hypertension, atherosclerosis, weakness of the cervical vertebrae, and alcohol dependence.
A moderate form helps reduce blood flow. This may be the result of inhibition of many brain functions. If replacement hydrocephalus is accompanied by an increase in the volume of the cerebral ventricles, then a decrease in ICP is detected in patients; alternatively, it will be increased.
If there are no complaints, moderate mixed hydrocephalus does not require treatment. The patient's condition can be monitored using additional examinations. An MRI will show the dynamics of the disease. If the cavity with cerebrospinal fluid increases, the neurologist will recommend diuretics and vasodilators.
As the disease progresses, brain cells die. The patient may be offered surgical treatment. In the past, bypass surgery was always performed, modern technologies supplemented the arsenal of methods with neuroendoscopic surgery.
Surgical treatment of such a pathology as moderate mixed hydrocephalus of the brain is carried out only after agreement with the attending physician. If the patient does not receive adequate therapy, he will subsequently be forced into a wheelchair.
Symptoms of the disease
Symptoms of the disease indicate increased ICP:
- attacks of nausea;
- drowsiness;
- constant headaches;
- optic nerve congestion;
- displacement along the head axis.
Signs of hydrocephalus mixed type characterized by headaches with maximum intensity in the morning, immediately after waking up. This is explained by an increase in ICP during sleep.
Important symptom- a state of drowsiness, which plays the role of a harbinger of more dangerous neurological disorders.
When a diagnosis of mixed hydrocephalus is made in adults, sharp pains that tear through the skull are noted around the head. In the morning, the malaise is accompanied by nausea.
In addition to headaches with the mixed form atrophic hydrocephalus Speech disorder, weakness in the legs, epilepsy, memory impairment, especially memorization of numerical information are observed. With any form of dropsy, patients are passive and uninitiative.
As the disease progresses, further mental disorder occurs, eliminating the possibility of self-care. The patient responds inadequately to simple questions.
In the later stages of the disease, urinary incontinence is possible. After a comprehensive examination with the correct diagnosis, the doctor develops a personal treatment regimen for the patient.
Hydrocephalus in children
Hydrocele in children is not such a rare disease: one baby in 4000 newborns. But there are also comforting statistics: congenital cancer is successfully treated with shunting, and children with a tube in their head can live full life with adequate loads.
A serious illness with unpredictable consequences can be caused by:
- Congenital causes - impaired brain development of the fetus, infections suffered by the pregnant woman, disruption of normal circulation of cerebrospinal fluid.
- The acquired form occurs in premature infants, as well as with birth injuries. It can develop after neurosurgery, bleeding, concussion, tumor, infection of the meninges.
The external type of pathology is considered congenital. Treated with medications. If the result is unsatisfactory, surgery is performed.
Internal dropsy can be acquired or congenital. Treatment methods are similar.
Mixed hydrocephalus in children is characterized by the accumulation of cerebrospinal fluid under the meninges and in the ventricles. The principle of treatment is therapy that improves cerebral blood flow and reduces ICP; diuretics are also used.
Herbal medicine and massage are used as additional methods. Effective and manual therapy. The result is monitored monthly by ultrasound.
Signs of the disease can be detected with problems with breastfeeding, difficulty turning the head, and frequent restless crying.
Other signs include:
- increased ICP;
- protruding open fontanel;
- omission eyeball;
- astigmatism and eye twitching;
- throwing back the head;
- seizures;
- slow development;
- lack of coordination;
- loss of vision and hearing.
But the most obvious symptom is the intensive growth of the skull, regardless of the baby’s constitution. An experienced doctor determines the hydrocephalic shape of the skull visually. But the last word belongs to the neurosurgeon, who clarifies the need and urgency of the operation, and the chances of curing the child without it.
During surgical treatment, shunts are inserted: they drain excess fluid into the abdominal cavity. The valve regulates the level of cerebrospinal fluid. As children get older, they need corrective surgery.
In neuroendoscopic surgery, an endoscope with a tiny camera marks the insertion site for a catheter to drain cerebrospinal fluid. This creates a backup channel for excess fluid. Repeated operations to replace the tubes are not needed - they are not there. The innovative method is not as universal as bypass surgery.
Patients diagnosed with hydrocephalus are observed by a neurologist with mandatory periodic diagnostics. In mild forms, patients may be removed from the register; shunt-dependent patients remain under observation for life.
It is important to remember that hydrocephalus is not a death sentence.. If you find an experienced doctor, undergo a full examination, clarify the type of disease, and collect all possible information about it, then with timely and competent treatment you can count on a favorable prognosis.
High intracranial pressure is a diagnosis with which many people are familiar. It's quite common. At the same time, it is often placed without reason, without conducting appropriate research. But the basis of pathology is serious illnesses. One of them is hydrocephalus. The symptoms of the disease are quite recognizable and can lead to serious consequences.
A little anatomy
During normal human activity, the brain is constantly bathed in clear fluid. She nourishes him and protects him. The liquid circulates in the space between the soft and choroid hemispheres and cerebellum. There are special places in the body - tanks in which it accumulates. They are located at the base of the skull. These tanks are interconnected and spinal cord. In the gray matter, fluid is located in the four ventricles. This is the norm.
Cerebrospinal fluid is produced from the blood. The total volume norm is 150 ml. The process of fluid production and absorption are in balance. The disharmony of this balance entails serious consequences. Fluid begins to accumulate in the brain. This results in either a decrease in absorption or an increase in production.
If the outflow of fluid is disrupted, the patient experiences hydrocephalus. Symptoms can be observed in both newborns and adults. The source of the problem is a narrowing of the channel between the ventricles or a violation of the absorption of fluid by the body. To understand the pathology, you should consider what the brain looks like (there is a photo in the article). Often unpleasant illness diagnosed specifically in newborns. According to statistics, every 500th child is born with the above-mentioned serious problem.
Sometimes the disease is not a congenital disease. Medicine knows of cases where the signs of hydrocephalus were acquired during life. As a rule, the causes of its occurrence lie in past diseases. Often it is the brain that provokes the development of a terrible pathology.
Types of illness
Hydrocephalus is quite diverse in its forms and causes. Today in medicine there are several classifications of the disease.
Based on the location of fluid accumulation, the disease is divided into types:
- Internal hydrocephalus. Fluid (cerebrospinal fluid) accumulates in excess in the ventricles.
- External hydrocephalus of the brain. It is also called external. With this type of disease, accumulation of cerebrospinal fluid is observed in the subarachnoid space. In other words, the fluid is localized near the skull.
- General hydrocephalus. With this form, cerebrospinal fluid is contained throughout the brain. It is found both in the ventricles and in the subarachnoid space. This form has another name - mixed hydrocephalus.
Causes of the disease in children
The main factor provoking the disease in newborns is difficult birth. As a rule, we are talking about a long anhydrous period of the fetus or birth injuries received by the child.
Sometimes there is an accumulation of fluid in the brain of a child who is still in the womb. This pathology is associated with infections and viral diseases suffered by a pregnant woman. Herpes, toxoplasmosis, and cytomegaly are especially dangerous.
The most common is the brain. Its signs begin to appear in the first months of a child’s life. However, older children can also develop the disease. Sources provoking serious illness, a bunch of. Among them are:
- brain tumors (both brain and spinal);
- meningitis;
- encephalitis;
- infectious diseases (tuberculosis);
- brain and vascular defects;
- hemorrhages;
- traumatic brain injuries;
- genetic disorders.
Sometimes the source of a terrible disease cannot even be determined.
Causes of illness in adults
It’s not just children who face this terrible diagnosis. It can be placed at any age. Hydrocephalus occurs, or, as it is popularly called, dropsy of the brain, in adults due to illnesses suffered:
- cerebral hemorrhage;
- stroke;
- brain surgery;
- meningitis;
- brain cancer;
- traumatic brain injury;
- brain atrophy.
In most cases, it is cerebrovascular disease, stroke, arterial hypertension) becomes a real focus for the development of dropsy.
Clinical signs of the disease in children
Cerebrospinal fluid (CSF) performs in the body the most important function. It nourishes the brain with all useful substances and removes toxins from it. Timely outflow of fluid determines the normal functioning of the main organ. Any violation of the discharge of cerebrospinal fluid is fraught with consequences. After all, fluid production does not change. As a result, the ventricles become full. As a result, their expansion is observed.
The most common symptoms for a diagnosis of hydrocephalus are:
- rapid enlargement of the head (takes on the shape of a ball);
- the child is very whiny and irritable;
- the baby burps profusely and frequently;
- the fontanel rises above the surface of the skull, there is no pulsation;
- the newborn’s eyes shift downward, vision deteriorates, and sometimes strabismus occurs;
- convulsions may occur;
- retardation in physical and mental development;
- frequent tilting of the head;
- pallor skin;
- trembling of the chin and limbs.
In older children, the head does not grow larger, because the bones of the skull are already fused together. However, liquid still accumulates. This manifestation The doctor will see it when he examines the brain on the image. The photo will be very different from the images that come with healthy people. As a rule, children suffer from severe headaches, vomiting, and a feeling of nausea. Decreased hearing and vision may occur. The child becomes weak.
Symptoms of the disease in adults
The following signs of hydrocephalus are distinguished:
- dizziness, pain;
- nausea, vomiting;
- noises in the head;
- epileptic seizures;
- disorders of motor and neurological functions;
- decreased performance, the occurrence of apathy, depression;
- blurred vision.
A feature of the disease in older people is a normal or slight increase in intracranial pressure. A small deviation from the norm characterizes normotensive hydrocephalus. Compression of gray matter due to fluid leads to brain destruction.
If mixed replacement hydrocephalus is diagnosed, then internal pressure does not increase at all, since most often the cause of the disease lies in brain atrophy. Thus, the liquid simply fills the empty space. This space arises as a result of atrophy.
Features of external hydrocephalus
As noted above, this disease characterized by the accumulation of fluid near the skull. Liquor can freely communicate between places of its localization. This kind of brain is called open. The closed form implies complete separation of all spaces from the liquid.
The main symptoms of the disease are increased fatigue, weakness, and drowsiness. Double vision and headache may occur. In some cases - nausea, vomiting. The disease is accompanied by changes in gait. Sometimes urinary incontinence is added to these symptoms.
There are cases in which hydrocephalus develops unnoticed. Symptoms are completely absent for a long time. The patient does not experience any increase in blood pressure. No headache occurs.
Moderate hydrocephalus is considered a very insidious form. It is characterized by the absence of symptoms for several years. At one point, the patient's condition deteriorates sharply. The source of the problem is a violation of cerebral circulation. As a rule, the diagnosis of “moderate hydrocephalus of the brain” is made accidentally in most cases. The doctor notices the pathology during an examination of the fundus.
Nuances of internal hydrocephalus
This type of disease is characterized by the accumulation of fluid in the ventricles. Internal hydrocephalus can develop as a result of poor absorption of cerebrospinal fluid into the tissue. The reasons for this phenomenon may be past infections, strokes in the subarachnoid region, or blockage of veins by blood clots.
A characteristic manifestation of the disease is a severe headache. It is often associated with nausea, visual impairment and auditory functions. However, as with the type of illness described above, moderately severe hydrocephalus may not be manifested by any symptoms at all.
General form of the disease
The development of such hydrocephalus is associated with the accumulation of fluid both in the ventricles and in areas near the skull. It is believed that the progression is caused by mixed hydrocephalus. This form of the disease is caused by expansion of the ventricles and subarachnoid space. However, their increase provokes a decrease in brain tissue in the process of atrophy.
Mixed replacement hydrocephalus is a serious illness in which the brain space is replaced by cerebrospinal fluid. The risk group for this form of the disease includes older people who are diagnosed with hypertension and atherosclerosis. This category is expanded to include patients with instability of the neck vertebrae who have suffered a concussion. People who are addicted to alcohol are also at risk of receiving a terrible diagnosis.
With this form, symptoms may be completely absent. Or it may manifest itself as frequent dizziness, nausea, and vomiting.
Diagnosis of the disease
A diagnosis can only be made after a complete examination of the patient. Initially, the fundus of the eye is carefully examined. Next, the patient is advised to undergo additional research, such as neurosonography, MRI, CT. A general practitioner (pediatrician), neonatologist, neurosurgeon or neurologist can suspect a terrible disease based on its characteristic symptoms and make a primary diagnosis.
For children under 2 years old, an effective method is often used - neurosonography. This procedure is possible as long as the newborn’s fontanelle has not closed. In infants, there are other areas of the skull characterized by very thin bone. These places are also excellent “ultrasonic windows”. For example, the temporal bone is well suited for this study. This method allows you to determine the expansion of the ventricles, identify the presence volumetric formations(cysts, hematomas, tumors), diagnose some brain defects. However, the above method is not accurate enough. Therefore, it is better for children to have an MRI.
A distinctive feature of diagnosing adults is the opportunity to listen to the patient’s complaints. It is the careful collection of data and neurological examination that suggests the development of this pathology. However, such an examination is not enough to finally determine the diagnosis. Therefore, the doctor recommends that adult patients undergo an MRI. It is this study that allows us to identify any pathology of the brain.
For adults, angiography and skull radiography can be used instead of tomography. If the occurrence of the disease is associated with a viral infection, a laboratory test for DNA or antibodies of the pathogen is prescribed. differentiated from brain tumors. In children - with complications of rickets.
Drug treatment
With slow progression of the disease, conservative therapy can be selected. In adults, this treatment method determines open form illness. It should be understood that the choice of method of combating the disease is determined solely by the doctor.
As a rule, hydrocephalus of the brain requires the following conservative treatment:
- Reducing high levels of intracranial pressure. For such purposes, the doctor prescribes Diacarb and Furosemide. These medications are taken over a long period of time. Often we are talking about several months.
- Reducing the amount of fluid. The most optimal medications are Glycerin and Mannitol.
- Strengthening blood vessels with complete preservation of electrolyte balance. For achievement this effect potassium supplements are used.
- Decreased cerebrospinal fluid production. An excellent remedy is Acetazolamide.
- Therapeutic puncture. This procedure is only suitable for infants. This is a method of removing excess fluid from the brain through an open fontanel.
- General strengthening therapy. Patients are usually prescribed pine and salt baths. A special course of vitamins is selected. Complements this therapy
- Treatment of ailments that provoke the development of hydrocephalus. The relevance of this therapy is due to the acquired form of the disease.
If the above treatment is ineffective, doctors recommend surgery. This procedure allows patients to achieve recovery, in some cases even complete healing. And sometimes the operation is aimed at saving the patient’s life.
Surgery. Contraindications
Unfortunately, effective medicinal methods combating the disease at any stage has not yet been developed. The above treatment is used for mild forms of the disease. As a rule, such methods perfectly reduce intracranial pressure and protect the patient from complications. Doctors strictly monitor the dynamics of hydrocephalus.
If there are prerequisites for surgical intervention, some contraindications should be taken into account. None of the following operations can be performed if the patient has:
- ongoing inflammation in the lining of the brain;
- irreversible processes (blindness, deafness, epilepsy, mental disorders).
Bypass surgery
If the brain does not restore the mechanism for removing fluid, the doctor prescribes surgery. In such cases, only surgery can help. In the recent past, hydrocephalus was quite effectively eradicated by a single method - shunting.
The goal of this intervention is to restore the flow of cerebrospinal fluid from the brain. For this purpose, a shunt is installed. The ventricular catheter is placed in the lateral ventricles. A special valve regulates the outflow of liquid. Peripheral catheter is introduced into the area of the atria or into the abdominal cavity. This helps optimize the absorption of cerebrospinal fluid. In some cases, after excision of one kidney, fluid is discharged into the ureter.
This operation has a number of possible complications and disadvantages. Among them are the following:
- shunt infection;
- mechanical damage to the implemented system;
- violation of the functionality of the shunt;
- slow outflow of cerebrospinal fluid.
Under these circumstances, there is a need for repeated surgery.
Endoscopic surgery
This method is the most common today. Endoscopy involves small incisions. This significantly reduces the risk of any complications. The rehabilitation period for the patient is reduced. During the operation, the surgeon directs the outflow of fluid into the brain cisterns, which are capable of normally absorbing cerebrospinal fluid. Thus, normal fluid circulation is restored. A successful operation completely eliminates the need to install a shunt. The patient returns to normal life.
Craniotomy
This intervention requires hydrocephalus of the brain, the causes of which lie in various obstacles to the outflow of fluid. As a rule, we are talking about aneurysms and tumors. Depending on the location, they can block the liquor-conducting pathways. In such cases, craniotomy is used. As a rule, during surgery, new pathways for the outflow of fluid are created.
Consequences of the disease
This disease can lead to encephalomalacia - tissue necrosis. As a result of impaired blood supply to parts of the brain, atrophy occurs. These processes are irreversible. Quite often, hydrocephalus can lead to disability. The symptoms have a quite destructive effect on the body. The patient may lose mental and motor abilities.
A common complication of the disease is. It is characterized by compression of parts of the brain and the occurrence of depressed consciousness, and often coma.
A congenital disease can stop its development at any age. With such an outcome, the patient is completely or partially cured. In case of rapid progression, children very rarely survive to the age of 5-6 years.
Prevention measures
The most important rule is full compliance with all doctor’s recommendations during pregnancy regarding taking medications. At this stage, you should carefully avoid any infections, especially viral ones. Before pregnancy, it is recommended to get vaccinated against diseases that the expectant mother has not previously suffered from. Alcohol and tobacco intake should be completely avoided.
Adults need to be careful about their health. Diagnose illnesses in a timely manner and treat them correctly. This is especially true for diseases of the central nervous system, blood vessels, heart, and spine. Head injury should be prevented. The best preventive measure against most ailments is an active, healthy lifestyle. Try to strengthen your immunity. Pay attention to weight normalization. And no diseases will be scary for you!
External hydrocephalus of the brain is a neurological disease that develops in and in the space under the meninges. It is the result of excess accumulation of cerebrospinal fluid. This pathology is associated with increased formation of cerebrospinal fluid or impaired outflow.
Congenital or acquired hydrocephalus occurs. In addition, open, closed hydrocephalus and ex vacuo form are distinguished.
The open form of the disease develops due to impaired production and absorption of cerebrospinal fluid. Moreover, in this case, the liquor-bearing spaces communicate freely.
The closed form of hydrocephalus involves separation of the cerebrospinal fluid spaces at different levels.
The ex vacuo form is a consequence of a decrease in brain parenchyma, which occurs as a result of atrophy in various pathologies of the nervous system or due to aging. In addition, depending on the clinical manifestations, there are progressive, stabilizing and regressive forms of the disease.
Reasons for the development of external hydrocephalus
There are a number of reasons why hydrocephalus develops:
- Diseases associated with inflammation of the brain or its membranes.
- Disorders of the cervical vertebrae.
- Pathological changes in the functioning of cerebral vessels.
- Traumatic brain injuries.
- Pathologies in the development of the central nervous system.
Symptoms of hydrocephalus in adults
This disease is characterized by the following symptoms:
Often the symptoms of this disease may not appear in adults, and therefore an increase blood pressure and headaches are not observed for a long period of time.
Moderate external hydrocephalus is considered a very insidious form of this disease. It is characterized by the absence of any symptoms for several years. However, then there comes a time when a person’s condition sharply worsens - this is due to impaired cerebral circulation. In most cases, this diagnosis is made accidentally during fundus examination.
Symptoms of hydrocephalus in children
In the case of the congenital form of this disease, an increase in the volume of the head by fifty percent, divergence of bone sutures, swelling of the skin veins and fontanelles may be observed. In addition, the disease is accompanied by moodiness, which is associated with increased intracranial pressure, poor appetite, lethargy, marbling of the skin. One of characteristic features is too wide an opening of the eyes and a downward gaze.
In teenagers and older children external hydrocephalus of the brain has the same symptoms as in adults. It should be noted that this disease in most cases is observed in premature infants.
Diagnostics
Today one of the most informative methods research to make a correct diagnosis is. In addition, methods such as angiography, X-ray examination. Also applicable laboratory research in order to determine the presence of herpes viruses, rubella, toxoplasmosis, syphilis.
Treatment
Treatment tactics are determined based on the type of disease and the age of the patient. A person is prescribed diuretics and vasodilators that normalize the functioning of the central nervous system and also control the outflow of cerebrospinal fluid. In this case, carbonic anhydrase inhibitors are used - these drugs reduce the production of cerebrospinal fluid, and saluretics, which improve venous outflow. It is very important to understand that drug therapy can only slow down the course of the disease and alleviate the patient’s condition - it extremely rarely leads to complete recovery.
If within two to three months conservative treatment does not provide desired results, and the process cannot be stabilized, they resort to surgical intervention. One of the most common methods is shunt surgery, which removes excess cerebrospinal fluid. It should be borne in mind that such an intervention may have some complications, these include:
Today, endoscopic surgery is considered very effective. With its help, it is possible to create pathways for the outflow of cerebrospinal fluid from the ventricles into the cisterns of the brain, through which its absorption occurs.
The benefits of this type of intervention include:
- Low morbidity.
- Absence foreign body in organism.
- Restoring proper liquor flow.
- Significant improvement in the patient's quality of life.
Forecast
Of course, it is quite difficult for doctors to make any predictions, because each case is individual. However, it must be taken into account that external hydrocephalus in adulthood can cause serious physiological and mental disorders. If this disease is left untreated, it may also death. In practice, after surgery, many patients manage to fully recover and return to normal life.
In children, this disease has a fairly good prognosis. With timely treatment and full rehabilitation, there are many chances to return to normal life.
External hydrocephalus of the brain is a rather dangerous disease that can have serious consequences for human health. Timely consultation with a doctor and competent therapy will help you avoid many problems. In some cases, conservative treatment is ineffective - in such situations it is impossible to do without surgical intervention. If there are such indications, in no case should they be neglected - a timely operation will allow a person to live a normal, full life.