What does it mean, expanded perivascular spaces of the brain? The conditions associated with this can be determined in infants by ultrasound of the brain in early childhood or magnetic resonance imaging in adults. The severity of such changes can be different in their intensity.
Such conditions are not an independent disease, they are the consequences of any pathology suffered in the past. This may be trauma, abnormalities in the development of the embryo, brain tumors, an infectious process in the meninges, other conditions. In accordance with this, a different nature of medical correction is used.
The causes of the conditions associated with the expansion of the subarachnoid space
All causes can be both congenital and acquired in nature. In the first embodiment, the pathology concerns infants. As for the second option, people of different age categories are exposed to this. The following situations can lead to such conditions:
- Processes associated with inflammation of the meninges. We are talking about meningitis, meningoencephalitis, arachnoiditis. Moreover, all of them can be caused by both infectious and non-infectious causes.
- Traumatic injury to the skull and brain.
- Malformations of the central nervous system.
- The processes associated with hemorrhage with localization under the meninges.
- Cerebral edema.
Inflammation as the main cause
Inflammation associated with both the membranes and the brain itself leads to the formation of adhesions in the cranial cavity. Naturally, this disrupts the circulation of cerebrospinal fluid, complicates its outflow and leads to the formation of hydrocephalus. This, in turn, determines the expansion of not only the ventricles of the brain, but also the subarachnoid space. This is especially true for the infectious process caused by meningococcus. A similar condition can be observed with tuberculosis, as well as with damage to the brain treponema with syphilis.
When inflammation occurs, all pathomorphological and pathophysiological changes associated with it come to the fore. Significantly increases the permeability of the walls of blood vessels. The liquid part of the blood freely penetrates the space between the cells, which forms edema. In addition, the production of cerebrospinal fluid itself is significantly increased. Pathomorphologically, in this phase, thickening and plethora of the meninges and expansion of the space under the membranes of the brain can be observed.
Tumor effect
If you have to deal with tumors, then with their growth they compress the brain structures and worsen the outflow of cerebrospinal fluid. The expansion may be local or diffuse. Not only a malignant, but also a benign tumor can lead to this condition.
Kidneys as a pathology factor
Pathology of the kidneys can cause a mild edematous syndrome, in which there will be a situation associated with the expansion of spaces under the meninges. Sometimes this may be due to poisoning with salts of heavy metals. The cause may be chronic alcohol intoxication.
Of course, all these conditions are more characteristic of adults. In children, congenital anomalies are the predominant causes. The cause of them may be a birth injury, which disrupts the circulation of fluid in the cranial cavity.
Symptomocomplex of expansion of perivascular spaces
The manifestation of pathology in children is not the same and is determined by the severity of the process. You can suspect the presence of such a condition by the following signs:
- In response to light, medium-intensity noise stimuli, the child responds with an extremely negative reaction.
- In such children, frequent regurgitation is observed.
- The child is too restless, he has a sleep disturbance.
- The pupils of the left and right eyes are different in size, strabismus may occur.
- The dimensions of the head are clearly not age-appropriate.
- The fontanel overgrows very slowly.
- The child often shudders; objectively, tremors of certain parts of the body can be observed.
As you can see, all these symptoms do not have any specificity and it is impossible to establish an exact diagnosis only from them. It is necessary to contact a pediatrician who will refer the child for a consultation with a pediatric neurologist.
As for adults, the dominant symptom will be a headache. It can have varying degrees of intensity. It is different in its duration. Dizziness, nausea, and the inability to fully perform their professional duties in full quality can join. Headache is especially pronounced in the morning. At the peak of pain, the patient feels a pronounced pulsation. Sometimes vomiting occurs. Patients are restless, anxious. With an increase in intracranial pressure, the headache also becomes more intense. Sleep is disturbed. Even if the patient manages to fall asleep, his sleep is intermittent and with clear signs of anxiety. In the afternoon, patients, on the contrary, exhibit pronounced drowsiness.
This state cannot continue indefinitely and there comes a moment when the symptoms characteristic of encephalopathy become distinct. This is due to dystrophic changes in the cerebral cortex. Memory becomes worse, disturbances from the organs of vision are observed, and the level of intelligence decreases. Patients constantly feel pronounced fatigue. An endless recurrence of headache attacks is characteristic.
If the perivascular spaces of the basal nuclei are enlarged, then gait changes can be observed, coordination of movements can be significantly disturbed, fine motor skills are upset. As a result, disability and activity in the lifestyle are disrupted.
Diagnostics
Diagnostic measures include an external examination with a thorough history. Diagnostic assistance is provided by laboratory and instrumental research methods. This includes a general clinical blood test, an ultrasound of the brain, CT or MRI. Neurosonography provides good help in making a diagnosis. The procedure is absolutely painless and accessible even in the hospital. Its availability for children is due to the presence of an open large fontanel. Cisternography is indicative, which involves an X-ray contrast study of the cerebrospinal fluid. Adults usually have a CT scan or an MRI scan.
Treatment
Corrective treatment therapy depends on the cause of this condition. If the culprit is an infection, then a course of antibacterial therapy is prescribed (Sumamed, Zinnat, Flemoxin). In the presence of a tumor, anticancer drugs (Cosmegen, Adriblastin) are administered. Symptomatic treatment is carried out. In the presence of seizures, anticonvulsants are prescribed ("Carbamazepine", "Primidon"). Measures are taken to reduce edema. In the presence of severe pain, analgesics and non-steroidal anti-inflammatory drugs are indicated (Spazmalgon, Pentalgin, Ibufen).
If conservative therapy does not produce results, resort to surgical intervention. Use bypass surgery. According to shunts performed, cerebrospinal fluid is discharged into the chest or abdominal cavity.
It should be said that often in adults, the expansion of the perivascular space can be asymptomatic. In this case, the diagnosis is difficult.