Sometimes in children and adults the pressure inside the skull is revealed above normal. There can be many reasons for this symptom, and one of the most dangerous is hydrocephalus of the brain. Pathology is more characteristic of young children, although there are certain risks in adulthood. It is reasonable in general to imagine what hydrocephalus is, how it manifests itself, with what dangers it is associated. This will allow you to consult a doctor with primary doubtful manifestations in a child or yourself.
Anatomy and Health
Brain hydrocephalus is a pathology in which the cerebral ventricles become larger. In the brain cavities there must be cerebrospinal fluid - the fluid of the spinal cord. If reservoirs with cerebrospinal fluid increase, compression of the surrounding tissue occurs. A system containing cerebrospinal fluid is formed by two ventricles, a channel between them (the third ventricle), Sylvia water supply and the last, fourth ventricle. The cerebrospinal fluid is formed in the ventricular weaving, normally moves from the lateral elements through the channels to the fourth ventricle, from where it gets access to the subarachnoid space that separates the brain tissue from the shell of this organ. One of the tasks of cerebrospinal fluid is the washing of brain tissue that forms the surface of the organ. Essential components for life are supplied with liquid. Used cerebrospinal fluid is gradually absorbed into the circulatory system from the subarachnoid cavity.
With hydrocephalus of the brain, the processes of absorption or production of cerebrospinal fluid (individually or both) are disrupted. The cerebrospinal fluid itself is such a transparent fluid substance without color, which is visually similar to water. It is formed by cells, salts, protein structures. In infancy, an average of 50 ml of cerebrospinal fluid is simultaneously present in the body at one time; in an adult, these volumes are almost three times more. In a healthy person, the absorption and generation of cerebrospinal fluid are balancing processes, due to which the total volume is constantly maintained stable. In just one day, the plexuses produce about half a liter of fluid.
Dropsy can trigger processes related to cerebrospinal fluid:
- overproduction;
- too slow absorption;
- improper circulation.
Disease: Forms and Classification
Brain hydrocephalus may be closed. This form is diagnosed if it is possible to detect an obstruction in the flow of cerebrospinal fluid. Due to such a barrier, the substance does not enter the subarachnoid space.
All other cases are an open form of the disease.
Hydrocephalus happens:
- primary;
- secondary (appears against a background of other diseases).
The cause of hydrocephalus can be malformations of the central nervous system, neoplasms, diseases that affect the vascular brain system.
Currently, there are several classification systems for cases of hydrocephalus.
Symptomatology
Symptoms of cerebral hydrocephalus are explained by the main feature of the disease - the accumulation of cerebrospinal fluid, which increases the pressure inside the skull. Features of external manifestations depend on the course of the disease, its severity, age of the patient.
Up to two years, a child can be suspected of having a disease by enlarging his head too quickly. At a tender age, the cranial sutures have not yet acquired hardness, so the growth of the brain, due to the increase in the ventricles in which the cerebrospinal fluid accumulates, leads to the fact that the bones seem to be "inflated." Since hydrocephalus of the brain in newborns and young children is a rather urgent problem, there are special tables that determine how much head growth corresponds to the norm. If the indicators exceed the established standard, the child is sent for special examinations.
A pediatrician every month (sometimes half as often) measures the diameter of the head of the observed baby. This procedure is a mandatory part of preventive examinations, to which any parents should bring recently born babies. From statistics it is known that the head growth rate in a circle in excess of the norm in most cases indicates precisely hydrocephalus.
What else?
In addition to this manifestation, moderate hydrocephalus of the brain (like other forms of this disease) can manifest itself:
- bulging fontanel;
- unclosed fontanel on time;
- thin cranial bones;
- disproportionality of the skull;
- protruding parts of the skull;
- venous mesh on the face, forehead;
- drooping eyes;
- increased muscle tone of the lower extremities;
- convulsiveness.
A sick child develops more slowly than peers, which is especially noticeable in the progress of motor skills and psyche. In due time, the baby still can not hold his head, sit, play. Usually such children are lethargic, tearful for no apparent reason, sometimes clutching their heads. If this happens, it indicates severe pain.
Attention to all the details
A doctor can notice mixed hydrocephalus of the brain, internal, external (in a word, any form). Most of the symptoms are rather nonspecific, so it is difficult for parents to identify the disease, but you can check the size of the child’s head at home. If the circle grows beyond measure, you can pay attention to the doctor. In combination with a developmental delay, there is every reason to suspect hydrocephalus and send the child to a full examination. Doing it will be doctors of the following specializations:
- neurosurgeon;
- neuropathologist.
If the diagnosis is not confirmed, doctors will take measures to detect the causes of deviations.
The child grows, manifestations change
All types of cerebral hydrocephalus known to modern science (replacement, external, internal — any case, regardless of class) can develop in a child not only in infancy, but also over two years of age. More rarely, the disease is detected in adults. Features of hydrocephalus in children older than two years are explained by the ductility of the skull - by this age, all sutures harden. Imbalance in the production and absorption of cerebrospinal fluid becomes the cause of an increase in pressure in the skull, which soon leads to specific symptoms:
- headache;
- vomiting, vomiting;
- swollen disc of the nerve responsible for vision.
Vomiting, often sick at night or in the early morning. Changing the elements of the visual system can only be seen by an ophthalmologist in a specialized study. If the parents notice that the child complains of a headache, this condition is accompanied by nausea, the urge to vomit, you must immediately show the child to the doctor. Diagnosis, diagnosis, treatment - in the area of responsibility of the neurosurgeon, neurologist. However, the described symptoms are not always explained by hydrocephalus of the brain (external replacement, internal of any type). Possible reasons:
- tumor processes;
- malformations of the brain.
The sooner it is possible to make the correct diagnosis and choose a successful treatment strategy, the higher the chance of minimizing the negative consequences.
Additional symptoms
Hydrocephalus of the brain (internal, external, of all subtypes) in some cases may occur:
- seizures similar to epilepsy;
- enuresis;
- Anuria
- gigantism;
- growth lag;
- visual impairment;
- hypothyroidism;
- untimely development of the reproductive system;
- overweight;
- low academic performance.
Where did the trouble come from?
Before figuring out how to treat hydrocephalus of the brain, you should understand the causes that provoked the disease. Doctors know a fairly extensive list of problems that can lead to such a pathology.
Congenital malformations of the central nervous system can contribute to the formation of hydrocephalus during the period in the mother's body. Modern methods of research of the fetus allow already during pregnancy to identify this health problem. About one in five cases is attributable to infectious diseases. Virus infection is associated with particular danger:
- herpetic;
- cytomegalovirus;
- toxoplasma.
When planning a baby’s birth, you should be screened for infection - often the infection is hidden, does not manifest itself with symptoms. First you have to eliminate the pathological agent, only after that you can think about conception.
There are cases when the hydrocephalus in the fetus was explained by genetics.
Children and causes of ill health
Up to 80% of all cases of hydrocephalus in children under two years of age are caused by malformations of the brain (spinal cord, brain) and infections transferred during fetal development. Other cases are due to birth injuries. Premature babies are more susceptible to them. Injury at birth is often complicated by hemorrhage in any part of the brain, meningitis. All these processes inhibit the ability of tissues to absorb cerebrospinal fluid.
In a small percentage of cases in newborns, hydrocephalus is due to neoplasms, vascular malformations.
In older children, hydrocephalus is possible due to:
- tumor processes;
- meningitis;
- encephalitis;
- infection;
- malformations of blood vessels and brain tissue;
- hemorrhage;
- injuries
- genetic failures.
In a certain percentage of cases, it is not possible to identify why the violation developed.
Diagnostics
They establish that treatment of hydrocephalus of the brain is necessary, based on the results of research and the collection of clinical features. Doctors examine the fundus. The patient is sent to:
- ultrasound;
- tomography;
- neurosonography.
What to do?
In most cases, treatment of cerebral hydrocephalus involves surgery. The classic approach is VPSh, shunting performed using special high-precision technology. In recent years, a method using an endoscope has spread. It is called ventriculostomy. The main advantage is that there is no need to install a foreign body in the brain.
The choice of treatment remains with the neurosurgeon. The doctor formulates contraindications, indications for the event. If surgical intervention is recommended, do not pull: the child’s condition will only worsen over time, and the increase in pressure will cause a significant slowdown in development. In this case, the effects of brain hydrocephalus may be irreversible.
It is worth noting that even the operation will not allow to return the healthy normal dimensions of the head - the skull will remain more than normal for life. The problem is not only cosmetic: increased sizes and weight cause significant pressure on the cervical vertebrae.
During the operation, the cerebrospinal fluid is removed from the brain to other parts of the body. The most common approach is EPS, when silicone catheters are inserted into the body, through which cerebrospinal fluid moves into the abdominal cavity. Responsibility for the absorption of the substance is transferred to the intestinal loops. The system is equipped with a valve to adjust the amount of liquor flowing through such a system. It is impossible to visually notice catheters, everything is hidden under the skin. According to statistics, up to 200,000 operations using the VPSh technology are performed annually in the world.
New technologies
The latest methods of operations allow you to inflict minimal injury to healthy patient tissue. Using an endoscope inserted into the patient’s cavity through small incisions, the doctor gets the opportunity to see the internal structures and manipulate the device with high accuracy. Endoscope surgery is a good alternative to the shunt system. The doctor forms a path for bypass cerebrospinal fluid current. The operation is effective, safe, does not require the installation of implants, is associated with a minimum of complications.
The only weakness of using an endoscope is the limited cases in which this method is indicated. On average, only one out of a dozen patients can undergo minimally invasive surgery; the predominant percentage needs a shunt system.
If the operation was successful, the progress of the disease stops. Almost all children can again live normally, play, study on an equal basis with everyone.
A special case
Occasionally, hydrocephalus surgery is not indicated. If the disease does not progress, the patient is monitored, the drug "Diacarb" is prescribed, the active components of which allow you to control the process of producing cerebrospinal fluid. Periodically check the pressure inside the skull. The patient’s condition is monitored by a neurosurgeon, a neuropathologist. A patient with hydrocephalus should regularly visit the clinic for a full examination and measurement of the size of the head, taking data by instrumental methods of research.
Not only children get sick!
In adults, hydrocephalus of the brain develops less frequently than in childhood, but there are still risks. Usually the pathological condition is secondary, develops against the background of the tumor process, stroke or trauma, meningitis.
It is possible to notice hydrocephalus of the brain in adults by the following manifestations:
- severe pain in the head;
- nausea and vomiting;
- vision problems, inability to focus on the subject;
- displacement of the eyeballs;
- disruption of the vestibular apparatus;
- memory impairment;
- enuresis.
Reasons and nuances
In adults, hydrocephalus of the brain most often appears after a stroke, since this condition leads to impaired blood flow in the brain tissues. The various etiologies of neoplasms, encephalitis, tuberculosis can provoke a complication in the form of dropsy. In some cases, the cause of the disease is addiction to alcohol. Hemorrhages in the cerebral ventricles, subarachnoid space can play a role.
In adulthood, you can encounter one of the types of hydrocephalus: congenital or acquired. He is probably aware of the first person from an early age, he may take Diacarb to monitor his condition. Acquired disease is the result of trauma, inflammation, infection, and other negative effects on brain tissue.
Doctors know many types of brain hydrocephalus developing in adults: replacement, atrophic, open, closed. Each of the cases has its own peculiarities, a unique development mechanism, which means approaches to treatment.
Quite often reveal a closed form. The cerebrospinal fluid is disturbed due to obstacles - for example, a tumor. An open option is a violation of the integrity of the brain areas, a failure of the absorption mechanisms, due to which the cerebrospinal fluid does not enter the circulatory system, but instead accumulates in the cavities.
With increased activity of the cells responsible for the production of cerebrospinal fluid, a hypersecretory form is diagnosed. Atrophic is observed if the brain tissue becomes thinner, and cerebrospinal fluid takes their place.
In the absence of acute symptoms, for a long time they speak of moderate hydrocephalus of the brain. In adults, this form of the disease, as can be seen from statistics, is relatively common. A distinctive feature is a sharp deterioration in the patient's condition. The reasons are often incomprehensible, since there was not even a suspicion of a latent course of hydrocephalus. This significantly complicates the correct and timely provision of adequate assistance.
Is treatment necessary?
Adult brain hydrocephalus can cause irreversible serious consequences. Without adequate assistance, the functioning of the brain is impaired, blood pressure rises, and a fatal outcome is possible. In a rather large percentage of cases, patients are given the status of persons with disabilities. In the absence of proper treatment, a person loses his ability to work, memory and intellectual abilities deteriorate, the ability to become aware of oneself is lost.
If it was possible to notice hydrocephalus, when the disease was just beginning to develop, drug therapy is practiced. In the acute form, an urgent operation is required - this condition is dangerous to the patient's life. As in the case of dropsy, it is necessary to open the cranium to install a fluid drainage system.
In chronic form, a shunt system for the removal of cerebrospinal fluid is established. The external form can sometimes be treated with conservative methods, including gymnastic practices and drug therapy - take funds to expand the blood vessels. If external hydrocephalus has transferred to a substitution form, surgery is indicated. With a mixed form of the disease, the only option is surgery.
Bypass surgery: complications
Statistical studies show that IPS provokes complications with a probability of 40-60%. From time to time, replacement of system elements is necessary. Most often, complications that force an additional operation occur 6-12 months after the event. In some cases, it is necessary to change only some elements, sometimes the whole system.If hydrocephalus is detected, surgery is indicated, one should immediately prepare mentally: most likely, two or more interventions will have to be postponed. In the future, the life of the patient depends on the reliability of the installed system.
Possible complications:
- blockage in the abdominal cavity, cerebral ventricles;
- infection
- mechanical damage to the system;
- too active discharge of cerebrospinal fluid;
- too slow fluid outflow;
- epileptic syndrome;
- internal pressure sores.
Alternative approaches
The most rarely used hydrocephalus treatment is ventricular puncture. They resort to it only if all other recreational activities are impossible. The patient has an external system for the outflow of cerebrospinal fluid. This procedure is fraught with numerous complications, the risk of infection is extremely high.
At present, operations with an endoscope can be safely called the priority vector for improving medical procedures. Possible ventriculocysternostomy of the bottom, aqueductoplasty, septostomy, removal of the tumor and the installation of a shunt with an endoscope.
Most often, ventriculocysternostomy of the ventricular fundus is done. In some modern clinics, up to 80% of all brain operations using an endoscope for dropsy account for precisely this technology. The doctor forms a way for the cerebrospinal fluid to move into the brain tanks so that when the fluid passes through the tissues, it is absorbed. It is possible to turn to the method for occlusal hydrocephalus, when replacing the shunt due to complications, the need for revision, as well as dropsy after injury, with a mixed form of the disease. Compared to the classical bypass system, an endoscope can restore the physiological flow of cerebrospinal fluid, and the quality of life of the patient after the rehabilitation period will be higher.