Hydrocephalus: symptoms. Brain hydrocephalus: causes, diagnosis and treatment
High intracranial pressure is a diagnosis with which many people are familiar. It is quite common. In this case, it is often put without foundation, without conducting appropriate research. But the pathology is based on serious diseases. One of them is hydrocephalus. Symptoms of the disease are sufficiently recognizable and can result in serious consequences.
A bit of anatomy
During normal human activity, the brain is constantly washed with a clear liquid. She nourishes and protects him. The fluid circulates in the space between the soft and vascular membranes of the hemispheres and the cerebellum. In the body there are special places - cisterns, in which it accumulates. They are located at the base of the skull. These tanks are connected with each other and the spinal cord. In gray matter, the liquid is placed in four ventricles. This is the norm.
Cerebrospinal fluid is produced from the blood. The norm of the total volume is 150 ml. The process of producing liquid and suction is in equilibrium. The disharmony of this balance has serious consequences. The liquid begins to accumulate in the brain. This leads to either a decrease in absorption, or an increase in production.
If the outflow of fluid is disturbed, the patient develops hydrocephalus. Symptoms can be observed in newborns and adults. The source of the problem is the narrowing of the channel between the ventricles or the violation of absorption of the liquid by the body. To understand the pathology, you should consider what the brain looks like( the photo is in the article).Often an unpleasant illness is diagnosed in newborns. According to statistics, every 500th child is born on light, having the above-mentioned serious problem.
Sometimes an ailment is not a congenital disease. Medicine knows cases when signs of hydrocephalus were acquired in the course of life. As a rule, the reasons for its occurrence lie in the transferred diseases. Often it is cerebrovascular disease of the brain that provokes the development of a terrible pathology.
Types of the disease
Hydrocephalus is quite diverse in its forms and causes. To date, in medicine, there are several classifications of the disease.
In the place of accumulation of fluid, the disease is divided into species:
- Internal hydrocephalus. The liquid( cerebrospinal fluid) accumulates in excess in the ventricles.
- External hydrocephalus of the brain. It is also called external. With this kind of ailment, the accumulation of cerebrospinal fluid is observed in the subarachnoid space. In other words, the liquid is localized near the skull.
- General hydrocephalus. With this form, the cerebrospinal fluid is kept throughout the brain. It is found both in the ventricles and in the subarachnoid space. This form has another name - hydrocephalus mixed.
Causes of the disease in children
The main factor that provokes the disease in newborns is heavy childbirth. As a rule, we are talking about a long anhydrous period of the fetus or the child's birth trauma.
Sometimes there is a buildup of fluid in the brain of a child still in the womb. This pathology is associated with the infection of pregnant women and viral diseases. Especially dangerous are herpes, toxoplasmosis, cytomegalia.
The most common is congenital cerebral hydrocephalus. Her symptoms begin to appear already in the first months of the child's life. However, in older children, there may be a malaise. There are many sources provoking a serious illness. Among them are:
- brain tumors( both head and spinal);
- infectious diseases( tuberculosis);
- brain and vascular defects;
- craniocerebral trauma;
- genetic disorders.
Sometimes the source of the terrible disease can not even be established.
Causes of the disease in adults
Not only in infants is a terrible diagnosis. He can be delivered at any age. There is a hydrocephalus, or, as it is called in the people, a dropsy of the brain, in adults due to the transferred ailments:
- hemorrhage in the brain;
- operation on the brain;
- oncological diseases of the brain;
- traumatic brain injury;
- brain atrophy.
In most cases, cerebrovascular disease of the brain( atherosclerosis, stroke, arterial hypertension) becomes a real hotbed of hydrocele.
Clinical signs of a disease in children
Cerebrospinal fluid( cerebrospinal fluid) performs an important function in the body. It feeds the brain with all useful substances and removes slag from it. A timely outflow of fluid causes the normal operation of the main organ. Any violation of the withdrawal of cerebrospinal fluid is fraught with consequences. After all, the production of fluid does not change. As a result, the ventricles overflow. As a consequence, their expansion is observed.
The most common symptoms in the diagnosis of "hydrocephalus" are the symptoms:
- a rapid increase in the head( acquires the shape of a ball);
- the child is very whiny and irritable;
- baby is plentiful and often belch;
- fontanel rises above the surface of the skull, there is no ripple;
- the eyes of the newborn are shifted downward, vision deteriorates, sometimes strabismus arises;
- may experience seizures;
- lag in physical and mental development;
- frequent tilting of the head;
- pallor of the skin;
- jitter of the chin and limbs.
In older children, the head does not increase, because the bones of the skull are already intertwined. In this case, the liquid still accumulates. The doctor will see this manifestation when he considers the brain in the picture. The photo will be very different from those images that are in healthy people. As a rule, children suffer from severe headaches, vomiting, a feeling of nausea. There may be a decrease in hearing, sight. The child has a weakness.
Symptomatic disease in adults
The following signs of hydrocephalus distinguish:
- dizziness, pain;
- nausea, vomiting;
- noises in the head;
- epileptic seizures;
- disorders of motor and neurological functions;
- reduced efficiency, the emergence of apathy, depression;
- vision impairment.
The peculiarity of the ailment of the elderly is a normal or insignificant increase in intracranial pressure. A small deviation from the norm characterizes normotensive hydrocephalus. The squeezing of a gray matter at the expense of a liquid leads to the destruction of the brain.
If mixed substitution hydrocephalus is diagnosed, the internal pressure does not increase at all, since most often the cause of the ailment lies in brain atrophy. Thus, the liquid simply fills the free space. This space arises as a result of atrophy.
Features of external hydrocephalus
As noted above, this ailment is characterized by the accumulation of fluid near the skull. Liquor can freely communicate between places of its localization. This external hydrocephalus of the brain is called open. The closed form assumes a complete separation of all spaces with a liquid.
The main symptoms of the disease are increased fatigue, weakness, drowsiness. There can be a double vision in the eyes, a headache. In some cases - nausea, vomiting. Accompany the ailment of coordination of movement, change in gait. Sometimes urine incontinence is added to such symptoms.
There are cases in which there is an inconspicuous development of hydrocephalus. Symptoms are completely absent for a long time. The patient does not experience any increase in pressure. Headache does not arise.
A very insidious form is considered moderate hydrocephalus. It characterizes the absence of symptoms for several years. At one point, the patient's condition deteriorates sharply. The source of the problem is the violation of cerebral circulation. As a rule, the diagnosis of "moderate cerebral hydrocephalus" in most cases is random. The doctor notices the pathology during the examination of the fundus.
Nuances of internal hydrocephalus
This type of ailment characterizes the accumulation of fluid in the ventricles. Internal hydrocephalus can develop as a result of poor absorption of the CSF in the tissue. The causes of this phenomenon can be in the transferred infections, strokes in the subarachnoid region, blockage of veins by thrombi.
A strong manifestation of the disease is a severe headache. It often involves nausea, a violation of visual and auditory functions. However, as with the above described form of the disease, moderately expressed hydrocephalus may not manifest at all by any symptom.
General form of the disease
The development of such hydrocephalus is associated with the accumulation of fluid in both the ventricles and in areas near the cranium. It is believed that the progression of cerebral atrophy provoked exactly hydrocephalus mixed. Extension of the ventricles and subarachnoid space leads to this form of disease. However, their increase provokes a decrease in brain tissue in the process of atrophy.
Mixed hydrocephalus substitution is a serious ailment in which the space of the brain replaces the cerebrospinal fluid. The risk group for this form of the disease includes people of age who are diagnosed with hypertension, atherosclerosis. Replenish this category of patients with instability of the vertebrae of the neck, who suffered a concussion. They are at risk of getting a terrible diagnosis and people who are addicted to alcohol.
With this form, the symptomatology may be completely absent. Or it can be manifested by frequent dizziness, constant drowsiness, nausea, vomiting.
Diagnosis of the disease
The diagnosis is possible only after a complete examination of the patient. Initially, carefully examined the fundus. Further, the patient is recommended to undergo additional studies, such as neurosonography, MRI, CT.To suspect a terrible illness on the characteristic symptomatology and put the primary diagnosis can the therapist( pediatrician), neonatologist, neurosurgeon or neurologist.
For children under 2 years old, an effective method is often used - neurosonography. This procedure is possible until the fontanel of the newborn has not been closed. In infants, there are other areas of the skull, characterized by a very thin bone. These places are also excellent "ultrasonic windows".For example, the temporal bone is well suited for this study. This method allows to determine the expansion of the ventricles, to reveal the presence of voluminous formations( cysts, hematomas, tumors), to diagnose some brain defects. However, the above method is not accurate enough. Therefore, it is better for babies to make an MRI.
A distinctive feature of diagnosing adults is the ability to listen to the patient's complaints. It is the careful data collection and neurological examination that suggest the development of this pathology. However, such an inspection is not enough to finally determine the diagnosis. Therefore, the adult doctor recommends the doctor make an MRI.It is this study that allows us to identify any pathology of the brain.
For adults, angiography, radiography of the skull can be used instead of a tomography study. If the occurrence of the disease is associated with a viral infection, a laboratory test for DNA or an antibody of the pathogens is prescribed. In adults, hydrocephalus is differentiated from brain tumors. In children - with complications of rickets.
With a slow progression of the disease, conservative therapy can be chosen. In adults, this method of treatment determines the open form of the disease. It should be understood that the choice of a method of fighting the disease is selected exclusively by the doctor.
As a rule, brain hydrocephalus needs the following conservative treatment:
- Decreased high rates of intracranial pressure. For such purposes, the doctor appoints funds "Diakarb", "Furosemide".These drugs are taken for a long period. Often it is about several months.
- Reduces the amount of liquid. The most optimal drugs are "Glycerin", "Mannitol".
- Strengthening of vessels with complete preservation of electrolyte balance. To achieve this effect, potassium preparations are used.
- Decreased production of cerebrospinal fluid. An excellent tool is "Acetazolamide."
- Therapeutic puncture. This procedure is suitable only for infants. This is a method of removing excess fluid from the brain through an unearthed fontanel.
- General restorative therapy. Patients, as a rule, are assigned coniferous, salt baths. A special course of vitamins is chosen. Supplements this therapy desensitizing drugs.
- Treatment of ailments that provoked the development of hydrocephalus. The urgency of this therapy is due to the acquired form of the disease.
In case of ineffectiveness of the above-described treatment, doctors recommend surgical intervention. 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.
Surgical treatment. Contraindications
Unfortunately, effective medication methods to combat the disease at any stage have 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 the occurrence of complications. Doctors strictly control the course of hydrocephalus.
If there are prerequisites for surgical intervention, some contraindications should be considered. None of the following operations can be performed if the patient has:
- ongoing inflammation in the brain envelope;
- irreversible processes( blindness, deafness, epilepsy, mental abnormalities).
In the event that the brain does not restore the mechanism of fluid withdrawal, the doctor prescribes surgical intervention. In such cases, only surgery can help. Hydrocephalus in the recent past was effectively eradicated by a single method - bypass.
The aim of this intervention is to restore the withdrawal of cerebrospinal fluid from the brain. For this purpose, a shunt is installed. The ventricular catheter is located in the lateral ventricles. A special valve regulates the outflow of liquid. A peripheral catheter is inserted into the atria or into the abdominal cavity. This contributes to the optimization of absorption of cerebrospinal fluid. In some cases, after excision of one kidney, the fluid is removed to the ureter.
This operation has a number of possible complications and shortcomings. Among them are the following:
- shunt infection;
- mechanical damage to the embedded system;
- impaired shunt functionality;
- delayed outflow of liquor.
Under these circumstances, there is a need for repeated surgical intervention.
This method is most common today. Endoscopy involves small incisions. This significantly reduces the risk of any complication. For the patient, the rehabilitation period is reduced. During the operation, the surgeon directs the outflow of fluid to the brain cisterns, which are able to suck up the liquor normally. Thus, the normal circulation of the liquid is restored. A successful operation completely eliminates the need to install a shunt. The patient returns to normal life.
This intervention requires hydrocephalus of the brain, the cause of which lies in various obstacles to the outflow of fluid. As a rule, we are talking about aneurysms, tumors. Depending on the location, they are able to block the liquor-conducting pathways. In such cases, trepanation of the skull is used. As a rule, during the surgical intervention, new ways of outflow of fluid are created.
Consequences of the disease
This disease can lead to encephalomalacia - tissue necrosis. As a result of the violation of the blood supply to areas of the brain, atrophy occurs. These processes are irreversible. Quite often, hydrocephalus can lead to disability. Symptoms have a devastating effect on the body. The patient may lose mental and motor abilities.
A common complication of the disease is a dislocation syndrome. It is characterized by squeezing the brain and the emergence of depressed consciousness, and often coma.
Congenital ailment can stop its development at any age. With a similar outcome, the patient is completely or partially cured. In the case of rapid progression, babies very rarely live to the age of 5-6 years.
The most important rule is full compliance with all the recommendations of a doctor during pregnancy on taking medication. At this stage, you should carefully avoid any infections, especially viral infections. It is recommended to get vaccinated before the pregnancy from those ailments that the future mother did not get sick before. It is necessary to completely eliminate the intake of alcohol and tobacco.
Adult people need to be careful about their health. In time to diagnose ailments, treat them correctly. Especially it concerns diseases of the central nervous system, vessels, heart, spine. Prevent head injury. The best preventive measure from most ailments is an active, healthy lifestyle. Try to strengthen your immunity. Pay attention to the normalization of weight. And no diseases will not be scary to you!