Internal hydrocephalus (or dropsy) of the brain (HMG) is a pathology that is characterized by the fact that there is an excess of cerebrospinal fluid (also called cerebrospinal fluid), which is not excreted anywhere and causes an increase in intracranial pressure (ICP), thinning of the walls of the cerebral ventricles and their gap. The disease is very dangerous, accompanied by neurological disorders and serious complications.
This ailment can occur as a result of neoplasms, injuries or other pathologies, or it can also be an independent disease. Diagnose internal hydrocephalus of the brain in adults less often than in children, especially in the first months of their life.
On a note! In boys, this serious ailment is observed more often than in girls.
A little about liquor and its functionality
In the human skull are soft tissues, which are nothing but his brain. A fluid (cerebrospinal fluid) circulates between the bone and the meninges, which fills not only the internal ventricles, but also all existing indentations (grooves) on the surface of the central nervous system organ.
How is cerebrospinal fluid formed? This happens as a result of a process such as filtering the plasma (that is, the liquid part of the blood) through the walls of the capillaries with the subsequent release of organic and inorganic substances into it. The composition of the cerebrospinal fluid circulating in the subarachnoid space and the ventricles of the brain includes minerals, proteins, and a very small number of cells such as lymphocytes and white blood cells. That is, in terms of chemical composition, cerebrospinal fluid is very similar to the composition of blood.
What is the main function of cerebrospinal fluid? First of all, it is to protect the brain and blood vessels located on its base from all kinds of mechanical influences (for example, concussions or tremors). Also, cerebrospinal fluid contributes to the creation of a beneficial environment, which is so necessary for the normal functioning of the human central nervous system; supports ICP at a certain level; participates in metabolic processes and nutrition of brain cells; and also serves as a protective barrier against bacteria, that is, it helps to increase immunity.
How is the outflow of cerebrospinal fluid
In an adult individual, the amount of cerebrospinal fluid, which is a crystal-clear substance, varies between 140-270 ml. Its updating during the day occurs 4 times. This process largely depends on such factors as water balance, nutrition and physical loads that a person experiences.
The space in which cerebrospinal fluid circulates is closed. The outflow of fluid occurs by filtering not only through the arachnoid membrane into the venous system, but also through the vagina of the nerves into the lymph. In a normal state, the volume of outflow corresponds to the amount of inflow, that is, a balance is maintained. In the case of a neoplasm in the brain area, hemorrhage, spinal cord or skull injury, the outflow process is disrupted, resulting in an increase in cerebrospinal fluid volume (i.e., internal hydrocephalus), an increase in intracranial pressure, impaired functioning of the central nervous system and, as a result, the emergence of various pathologies.
Classification of dropsy
Patients may experience:
- External GGM, which is characterized by the fact that there is no absorption of cerebrospinal fluid into the bloodstream. And that is the big problem.
- Internal GMF. It differs in that there is an accumulation of a certain amount of cerebrospinal fluid in the subarachnoid space and the ventricles of the brain.
On a note! External and internal hydrocephalus of the brain can be either congenital (that is, arise even at the stage of fetal development), or acquired (that is, appear in the process of human life).
- Mixed GMM. It is characterized by the fact that cerebrospinal fluid accumulates not only in the tanks and ventricles of the brain (that is, inside), but also under its shells (that is, outside).
- Internal replacement hydrocephalus of the brain, as a result of which there is an atrophy of brain tissues and their replacement with cerebrospinal fluid. This is very serious. Most often, such “metamorphoses” occur due to age-related factors. But the internal replacement hydrocephalus of the brain in an adult can be caused by other reasons (for example, alcoholism or infections).
Depending on the reasons for the impossibility of cerebrospinal fluid outflow, the following forms of the disease are distinguished:
- Closed (or occlusal) hydrocephalus. The ailment arises due to the fact that the outflow of cerebrospinal fluid is impossible due to the presence of neoplasm, with the growth of which the situation only worsens. Very severe form.
- Internal open hydrocephalus of the brain (or communicating GBM). Hypersecretion of cerebrospinal fluid occurs and failure occurs during its absorption.
The form of development of the disease can be:
- Sharp. The disease progresses rapidly, the symptoms expand.
- Subacute. Symptoms increase gradually (within 1-1.5 months).
- Chronic The development of clearly noticeable manifestations of the disease is observed no earlier than 6-12 months after the onset of pathology.
On a note! Moderately expressed internal hydrocephalus of the brain is very poorly recognized, and diagnosed altogether completely randomly. Pronounced symptoms are observed when significant structural brain disorders occur, as well as a malfunction in the blood circulation of the main organ of the central nervous system. Do not forget about it. And more often contact a medical institution in order to prevent serious pathologies and their treatment. Remember: the development of moderate internal hydrocephalus of the brain in adults threatens with serious complications.
Depending on changes in the size of the ventricles, the disease is divided into:
- Vicarine hydrocephalus. With this disease, an increase in ventricles occurs. Moreover, no changes in the structure of the organ in terms of anatomy are observed.
- Asymmetric internal hydrocephalus of the brain. In this case, an increase in one ventricle, as well as all of them, can be observed.
Hydrocephalus may be:
- Hypertensive. In this case, there is a significant increase in intracranial pressure.
- Normotensive. The size of the ventricles varies, but the pressure does not differ from the norm.
Important! Regardless of what type of dropsy is diagnosed, remember: this is a very dangerous disease of a neurological nature, which requires observation by a specialist and, in case of worsening condition, immediate surgical intervention.
Stages of the development of the disease
There are three stages of the development of the disease:
- Compensated. This form of the disease does not require any treatment. No change in intelligence is observed. The patient is only observed by a specialist who fixes the dynamics of the development of the disease.
- Subcompensated. Almost compensated, but with some troubling symptoms.
- Decompensated. At this stage, it is unlikely to manage without operational measures.
What is the danger of hydrocephalus for adult patients
Internal hydrocephalus of the brain in adults can be expressed in the development of:
- Manifestations of an epileptic nature.
- Strokes that may result from an increase in cerebrospinal fluid.
- Injuries resulting from a violation of the motor function of a person.
- Hyperactivity.
- Psycho-emotional disorders.
- Hallucinations.
- Deviations in the behavior of a mental nature.
- Sometimes, partial or complete paralysis of the limbs.
- Motor impairment.
Important! If the treatment of the disease is not started in a timely manner, then disability may occur.
The danger of hydrocephalus for children
The development of internal hydrocephalus of the brain in children largely depends on the age of the baby. What the disease can lead to:
- In infants, as a result of the disease, sometimes, there is a delay in mental and physical development, as well as some mental abnormalities.
- Preschool children can differ in strabismus, stuttering, some aggressiveness and delays in psycho-emotional development.
- As a rule, schoolchildren are “poorly given” to study due to memory problems, frequent headaches and neuropathic disorders. It is difficult for them to complete even the simplest school tasks.
That is, the effect on the mental development of the consequences of such a pathology as internal brain hydrocephalus in children is obvious: it is difficult for them to concentrate and adapt normally in society.
On a note! Statistics say that 30% of children who have had an illness have a dysfunction in speech; and 20% of patients are very difficult to express such positive emotions as happiness and joy.
But do not despair. Remember: if the operative measures are taken on time, then you can avoid the lag in the mental development of your child. And one more thing: most of the children suffering from hydrocephalus of the brain, grow up quite happy and friendly people who communicate with others with great pleasure.
Causes of the disease in adult patients
Internal brain hydrocephalus in adults can occur due to the following reasons:
- Stroke. As a result, the blood circulation of the brain is disturbed.
- Pathologies of an infectious and viral nature.
- Injuries to the skull and brain itself, resulting in hemorrhage.
- Hypoxia, i.e. oxygen starvation.
- Neoplasms of a benign or malignant nature.
- Alcoholism.
- Circulatory disorders of the brain.
- Infectious diseases, which are characterized by the fact that the pathogen is localized directly in the central nervous system and affects any part of it (for example, meningitis or encephalitis).
- Hemorrhages as a result of damage to the vessels of the brain of a pathological nature.
- Addiction.
- Diabetes mellitus, which results in a malfunction in the process of formation of cerebrospinal fluid.
Causes of hydrocephalus in children
Hydrocephalus in children can be congenital or acquired. The first form is quite common. Its development occurs during the period of the fetus inside the womb and may be due to the following reasons:
- Diseases of an infectious nature that the expectant mother fell ill during the period of bearing the baby (for example, toxoplasmosis, rubella, mumps, syphilis or herpes). As a result, the viruses were transmitted to the fetus from the mother.
- The use of drugs or "strong" drinks.
- Smoking.
- Intracranial injuries received by the child during the complex birth.
- Anomalies of fetal development.
- Renal or hepatic insufficiency in the fetus, which could occur as a result of exposure to the mother's body of chemical substances.
- Genetics, that is, a predisposition to pathology.
The second form may develop as a result of:
- cerebral hemorrhages;
- traumatic brain injuries;
- neoplasms in the tissues of the brain, that is, oncology;
- development of vascular malformations;
- various inflammatory processes occurring in the cerebral cortex.
Symptoms of the disease in adults
What symptoms may indicate the presence of internal brain hydrocephalus in adults:
- Pretty high intracranial pressure.
- Nausea (especially in the morning), sometimes turning into vomiting. And this happens regardless of whether you ate or not.
- The presence of a headache (migraine), which cannot be eliminated with the help of pain medication.
Important! The feeling of heaviness and headache are intensified during a person’s sleep and in the morning (immediately after waking up). Moreover, in a horizontal position, the symptom only intensifies.
- Deviations of a mental nature.
- Sensation of constant drowsiness and weakness.
- Internal open hydrocephalus of the brain in adults can be expressed in the presence of cerebellar ataxia, which manifests itself in the fact that a person has an uncoordinated movement, as well as an uncertain and shaky gait.
- Visual impairment. Moreover, the patient feels some pressure on the eyes.
- Dispersion of attention. It is difficult for a person to perform simple manipulations.
- There is an increase in muscle tone and joint contracture.
- Decreased sensitivity.
- Almost complete loss of control over the urination process.
- Decreased auditory function.
- Sleep disturbance.
- Moderate internal hydrocephalus of the brain in adults, sometimes, causes emotional instability, that is, a sharp change in the mood of a person can be observed, which manifests either aggression and nervousness, or apathy.
- The presence of dark circles under the eyes, indicating the overflow of capillaries with blood.
- Decreased intelligence and mental ability.
- Increased sweating.
- Possible loss of consciousness.
- Memory impairment.
- In some cases, the development of paralysis of the limb.
- Strabismus development.
Important! Very often, patients do not pay attention to all of the above symptoms, taking them for senile manifestations. This is a big mistake, because if the disease is not treated, its consequences can lead to dementia or encephalopathy. Keep this in mind and seek qualified medical assistance in a timely manner.
Symptoms of hydrocephalus in children
In babies, the cranial bones are still not quite strong, and therefore the manifestations of the disease have a more pronounced manifestation than in adults suffering from the same disease. Symptoms of dropsy in newborns are as follows:
- A long, non-overgrowing fontanel that constantly pulsates.
- Abundant regurgitation in the baby after being fed.
- Significant lag in weight gain.
- Increased (compared to normal) head sizes.
- The presence of thin skin on the skull and the veins that stand out beneath it.
- The presence of vomiting.
- Tearfulness.
- Nervousness.
- The baby does not sleep well.
- The presence of some delay in psychomotor development (i.e., crawling, standing and walking).
- Lethargy and drowsiness.
- Cramps.
- Some decrease in visual function.
- Missing gaze and squint.
- Sometimes respiratory failure occurs.
With age, the pathology progresses, and the symptoms only worsen:
- Pain in the head is growing.
- Irritability is accompanied by attacks of aggression.
- Uncontrolled urination is observed.
- Constant weakness and lethargy is noted.
- There are problems with attention and memory.
- There is some violation of coordination of movements.
- Appetite is reduced.
- Vision can be impaired, even blindness.
- There is a lag (compared with peers) in mental and physical development. And as a result, problems at school with learning.
Diagnostic methods
GMF can cause a malfunction in all systems of the human brain. To cope with the disease, it is necessary to determine what was the root cause of the ailment. For this, the neuropathologist, after carefully listening to the patient (that is, having identified a history of the disease) and examining him, performs the following measures:
- Assigns laboratory tests to have an idea of the general condition of the patient.
- Makes head circumference measurement. If the child is at the doctor’s appointment, this measurement is repeated after 60 days. Provided that the head size increased by 1.5 cm, the child is diagnosed with hydrocephalus. If the reception is an adult, then any increase in this parameter is regarded as a sign of dropsy.
Further, the specialist should have data on the HDD. It is possible to determine its level using the following instrumental studies:
- Fundus examination performed by an ophthalmologist. If the study revealed such manifestations of increased intracranial pressure as swelling of the optic disc and expansion of the retinal vessels, then a specialist can talk about the development of hydrocephalus.
- Ultrasonography in babies under the age of 1 year (i.e. an ultrasound of the brain). Why is there such an age limit? The fact is that fontanels have not yet closed in newborns (that is, empty cavities between the bones of the skull) and therefore this study can be carried out: it is at these points that the sensors of the device are applied. In older children, and especially in adults, the skull bones are dense and therefore they do not miss VHF. True, the technique does not allow to obtain absolutely accurate data on ICP, but nevertheless gives indirect confirmation of the presence (or absence) of dropsy.
- Electroencephalography. The method allows you to evaluate the electrical activity of the brain. . , , , .
- ( ). . , , . , , .
Therapy
, :
- If the pathology has a compensated form, then all that is required is only observation by doctors. A specialist can prescribe a course of taking drugs with diuretic properties in order to relieve swelling and remove excess fluid from the body; as well as medicinal drugs to improve cerebral circulation and vitamins to enhance immunity. The children undergo physiotherapeutic and psychotherapeutic procedures using exercise therapy, games and music.
- Treatment in adults of internal hydrocephalus of the brain, which has a normotensive form, begins with the appointment of drugs that lower the ICP and relieve other related manifestations of the disease. Dropsy itself can be removed only by conducting operational measures. In the place of accumulation of cerebrospinal fluid bypass. In this case, a special tube is inserted either into the peritoneum, or into the atrium or ureter, so that a new path of fluid drainage is formed. If the disease is congenital, then this "construction" remains in the body constantly.
- Another method of surgical intervention is trepanation of the skull with subsequent use of external drainage. The method is rather not aesthetic and impractical. But sometimes it is only with the help of it that you can cope with the situation.
- There is a more modern and minimally invasive method for the treatment of dropsy - this is neuroendoscopy. During the operation, the fluid is removed in a manner that minimally damages normally functioning tissues. In this case, the maximum effect on the pathology is observed.