In the article, we will consider what is mixed replacement hydrocephalus of the brain in adults and children.
This is a pathology in which there is an accumulation of cerebrospinal fluid in the cerebrospinal fluid. The problem can occur as an independent disease, as well as be the result of neoplasms, injuries, infectious brain lesions and other causes. Another name for hydrocephalus is dropsy of the brain.
Classification
Hydrocephalus is both acquired and congenital. The latter begins to manifest in infancy, while the acquired form is characteristic of adults and even elderly patients. Depending on the prerequisites for the appearance of hydrocephalus, the following types are distinguished:
- Closed, occlusal hydrocephalus occurs due to disruption of cerebrospinal fluid flow due to blockage of fluid paths. Most often, clogging occurs due to a tumor, the presence of a blood clot, or adhesions.
- Open, or disresorptive, hydrocephalus. It develops against the background of disturbance of structures that are involved in the process of cerebrospinal fluid absorption into the cerebral vein system (arachnoid villi, venous sinuses, cells and pachyon granulation).
- Hypersecretory hydrocephalus. The production of large quantities of cerebrospinal fluid in the plexus of the ventricular vessels.
- Substitutional mixed hydrocephalus of the brain. It develops as a result of an increase in the number of cerebrospinal fluid both in the subarachnoid space and in the cerebral ventricles. In this case, atrophy of the brain tissue occurs.
The latter option is considered the most dangerous for the life and health of the patient.
Depending on the level of intracranial pressure
In addition, several more types of pathology are distinguished depending on the level of intracranial pressure:
- Hypertensive hydrocephalus - fluid pressure in the spinal cord is increased.
- Normotensive hydrocephalus - pressure at a normal level.
- Antihypertensive hydrocephalus - cerebrospinal fluid pressure is reduced
From the speed of development
Depending on the amount of time over which a replacement mixed hydrocephalus of the brain develops, the following types are distinguished:
- Acute hydrocephalus - the period of development of the pathological process is less than three days.
- Subacute progressive hydrocephalus - development occurs up to three weeks.
- Chronic hydrocephalus progresses from three weeks to six months.
Causes
Severe replacement mixed hydrocephalus is most typical of newborn babies. In adults, this pathology is less common, but also occurs. Studies in the field of medicine have shown that any disturbances in the functioning of the human nervous system can provoke the development of hydrocephalus. Acquired causes of hydrocephalus can be:
Ruptures of hematomas or hemorrhages in the brain.
Severe head injuries.
Birth injury.
Severe cerebrovascular accident.
Previously infectious and inflammatory diseases, including encephalitis, meningitis, arachnoiditis, etc.
Infection of brain structures with various parasites.
Germins, astrocytomas, tumors in blood vessels and other neoplasms.
Metastasis of tumors of other organs in the brain.
The formation of cetacean cavities in the third ventricle.
The occurrence of vascular malformations.
Atrophy of brain tissue as a result of organ damage by encephalopathy.
Dropsy of the brain can have a negative effect on all organ systems. Therefore, to eliminate hydrocephalus, it is necessary to accurately determine the cause of the pathology.
What are the signs of mixed replacement hydrocephalus?
Symptoms
The first symptoms of the pathological process make themselves felt when there is an increase in pressure inside the skull and compression of brain structures.
The main signs of mixed replacement hydrocephalus of the brain in adults is intracranial hypertension. In the future, various disorders of the neurological type begin to appear, pressure on the tissues increases and the symptoms become more pronounced.
Clinical picture
The characteristic clinical picture of mixed replacement hydrocephalus are the following symptoms:
- Constant pain in the head and a feeling of heaviness, worse during sleep and immediately after waking up. Inability to determine the focus of pain. When a person is in a prone position, the symptom becomes more pronounced, as the pressure of the cerebrospinal fluid increases.
- Nausea and vomiting in the morning, regardless of the meal and the time it was taken.
- Pressure on eyes.
- Persistent hiccups.
- Constant weakness, increased fatigue, drowsiness.
- Difficulties with concentration and attentiveness, it is difficult for a person to perform elementary actions.
- Apathy, nervousness, decreased intellectual abilities.
- A sharp drop in blood pressure, slowing or increasing heart rate.
- Permanent dark circles under the eyes. When stretching the skin of the lower eyelids, blood-filled capillaries are clearly visible.
- A significant increase in sweat, a tendency to fainting.
The listed symptoms indicate intracranial hypertension.
The manifestation of neurological disorders
Neurological disorders in mixed replacement hydrocephalus of the brain in adults will manifest as follows:
- Reducing the quality of vision - bifurcation and difficulty focusing your eyes on one subject.
- The loss of visual fields.
- Against the background of constant compression, atrophy of the optic nerve occurs, which in the future can cause complete loss of vision.
- Strabismus.
- Lack of pupil response to bright light.
- Disruption of the vestibular system. Dizziness, shakiness in gait, tinnitus, involuntary fluctuations of eyeballs appear.
- Paralysis of the limbs.
- Increased reflexes and muscle tone.
- Decreased or complete loss of sensitivity.
- Involuntary fixation of arms and legs, when due to increased tone it is impossible to straighten the limbs.
- Symptoms of cerebellar ataxia, accompanied by impaired motor function and widespread handwriting.
- Unstable emotional state, sudden changes in mood.
- With a sharp increase in cerebrospinal fluid pressure, aggression occurs.
The combination of symptoms and diagnostic measures indicated mixed hydrocephalus.
Diagnostics
The diagnosis of mixed replacement hydrocephalus of the brain in adults is confirmed on the basis of a study using both laboratory and instrumental techniques. The latter are in the case of disorders in the brain the most informative. Laboratory tests show the general condition of the patient and how the disease affected his health.
To identify severe and moderate mixed replacement hydrocephalus of the brain, the following studies are prescribed:
- Head circumference measurement with tape. If the child has hydrocephalus in question, then a change in head circumference in the direction of an increase of more than 1.5 cm per month indicates the presence of the disease. In adulthood, any increase in the head is considered pathological, regardless of the period during which it occurred.
- Fundus examination. If edema of the optic nerve disc is detected, we can talk about increased intracranial pressure, which means that hydrocephalus is not excluded.
- Ultrasound examination of the skull, or neurosonography. For adult patients, this study is not prescribed, as it is uninformative. In childhood, ultrasound is performed through the fontanel of the child.
- Magnetic resonance imaging. This is the most accurate technique for detecting hydrocephalus. Tomography not only allows you to confirm the suspicion of a pathology, but also to determine the causes of its development, to assess the damage to the structures of the brain and blood vessels. If the MRI shows the presence of periventricular edema, the diagnosis of hydrocephalus is confirmed.
- CT scan. This is a kind of X-ray, the information content of the method is slightly lower than in the previous version.
- Rheoencephalography and echoencephalography.
- Lumbar puncture. It is a sampling of material for histological examination of the composition and condition of the cerebrospinal fluid.
- Roentgenography. It makes it possible to identify thinning of bone structures.
The main criteria on which the specialist relies in clarifying the diagnosis are the results of the study of the fundus and magnetic resonance imaging. After confirming the diagnosis, treatment of mixed replacement hydrocephalus of the brain is prescribed.
Drug treatment
Mixed hydrocephalus is a dangerous and severe pathology. Treatment of hydrocephalus should include not only a set of measures related to taking drugs, but also surgical intervention. Depending on the identified form of pathology, the selection of a separate therapeutic regimen is required.
Some patients try to use traditional medicine methods, but most experts reject such methods of treating hydrocephalus of any type or allow their use only as an adjuvant.
Preparations
Drug therapy is carried out using the following drugs:
- Diuretics. The diuretic effect of these drugs allows you to stop the production of cerebrospinal fluid. Most often, the choice falls on "Piracetam", "Diacarb" and "Glizerol." All of these drugs are injected. Along with diuretics, vitamin complexes are prescribed to the patient, since diuretics wash away magnesium, potassium and sodium from the body.
- Antibacterial drugs. Assigned to eliminate infectious pathogens.
- Medicines that promote blood circulation in the brain.
- Vitamin and mineral complexes. Most often, vitamins C, B, and E. are prescribed. They can improve the cellular metabolism of the whole organism.
- Enzymes of animal origin. Pyrogenal and lidase help break down and remove excess CSF.
- Glucocorticoids.
If drug therapy of mixed replacement hydrocephalus in adults does not show positive dynamics in the patient's condition, surgical intervention is prescribed.
Surgery
If hydrocephalus proceeds in acute or chronic form, the patient is prescribed an operation. A contraindication for such a treatment of mixed replacement hydrocephalus can be an infectious and inflammatory process that has spread throughout the body. Therefore, first, the infection is eliminated, and then surgery is prescribed.
Surgical treatment involves the formation of pathways for the outflow of cerebrospinal fluid. A similar process is called bypass surgery and requires the prior removal of adhesions and tumors.
Methods
In addition, hydrocephalus is eliminated by the following methods:
- Palliative intervention. It is performed by puncture if hydrocephalus is characterized as open.
- Radical surgery. To eliminate excess fluid, special shunts are installed in the spinal canals. Internal drainage allows liquor to be removed to an adjacent organ or system.
Most often, operations to eliminate hydrocephalus go well and allow you to get rid of the problem. If dropsy was formed due to a tumor in the brain, surgical removal can extend the patient's life by several years.
Complications
However, in some cases, complications may occur after the operation in the form of inflammation, obstruction of the lumen of the tube for drainage, prolapse of the tube from the organ into which the excess cerebrospinal fluid enters, etc. It is important to carefully monitor your condition and if you find symptoms of complications, consult a doctor.
We examined such a pathology as mixed replacement hydrocephalus of the brain.