Hydrocephalus is a fairly common disease that affects both adults and children, regardless of gender. But why does the disease develop and what is its occurrence associated with? Who is hydrocephalus and what features of the appearance of a newborn baby should you pay attention to? What diagnosis is needed if you suspect a similar pathology? What is the treatment of cerebral hydrocephalus in adults and children? What are the prognoses for patients?
Hydrocephalus: ICD-10, a general description of the disease
The word “hydrocephalus” itself is formed by the merger of two Greek words meaning “water” and “head”. By the way, that is why the disease is often called dropsy of the brain.
Before figuring out what hydrocephalus is, it is worth considering some anatomical and physiological features of the structure of the human body. A cerebrospinal fluid constantly circulates between the brain and spinal cord - cerebrospinal fluid in the brain is concentrated mainly in the ventricles (there are four in total), and also enters the subarachnoid space that separates the meninges.
Liquor performs a number of important functions. It is with this fluid that many nutrients enter the nerve tissues, while toxins and metabolic products, on the contrary, are removed from the brain. Cerebrospinal fluid also protects nerve structures from being squeezed, clumped, and mechanically affected.
Normally, the volume of cerebrospinal fluid in infants is about 50 ml, and in an adult - not more than 150 ml. If for one reason or another, cerebrospinal fluid is formed much more than necessary or if its circulation is impaired, then hydrocephalus develops.
ICD-10 assigned pathology code G91. Against the background of the disease, cerebrospinal fluid accumulates in the ventricles of the brain, which leads to a sharp increase in intracranial pressure. Since the cranium in an adult consists of hard bones, an abundance of fluid presses directly on the nerve structures.
Causes of Congenital Hydrocephalus
Who is hydrocephalus? This is a person suffering from dropsy. It should be understood that the disease can develop at any age. But as statistics show, very often hydrocephalus is congenital. So what is the reason for the appearance of dropsy of the brain in a child? The reasons may be as follows:
- congenital malformations of the system responsible for the synthesis and circulation of cerebrospinal fluid (stenosis of the sylvian aqueduct, irregular structure of the subarachnoid space);
- craniovertebral anomalies;
- infections transmitted during fetal development (for example, rubella, toxoplasmosis, cytomegaly, syphilis);
- head injuries during the birth process.
Acquired forms of dropsy: causes and risk factors
The disease can develop after the birth of a child or already in adolescence, adulthood, old age. The causes of brain hydrocephalus can be different.
- The accumulation of fluid is most often associated with inflammation of certain sections of the central nervous system. Dropsy is often complicated by encephalitis, meningitis, arachnoiditis.
- The list of causes includes vascular disorders, including the formation of intracerebral hematomas, ventricular hemorrhage, and stroke.
- Hydrocephalus can be the result of severe traumatic brain injury.
- Cysts and intracerebral tumors often grow in the cerebral ventricles, thereby blocking the circulation of cerebrospinal fluid.
Features of replacement hydrocephalus
Replacement (atrophic) dropsy, as a rule, develops in old age. It is allocated in a separate group, since the development of the disease is associated with age-related atrophy of nerve tissues. The brain is reduced, and the cerebrospinal fluid, in fact, just fills the free volume of the skull.
In elderly patients, atrophic hydrocephalus can be associated with severe forms of hypertension, arteriosclerosis of blood vessels that carry blood to the brain and vice versa, macroangiopathy with diabetes mellitus.
Disease classification
There are many types of hydrocephalus. For example, depending on the development mechanism, there are:
- open form (there is either a hypersynthesis of cerebrospinal fluid, or a violation of its absorption);
- closed (develops against the background of impaired cerebrospinal fluid outflow).
The location of the cerebrospinal fluid cluster is also of importance. Stand out:
- internal dropsy (cerebrospinal fluid accumulates in the ventricles);
- external (cerebrospinal fluid is concentrated in the subdural and subarachnoid spaces).
Depending on the course, hydrocephalus can be:
- acute (development is very fast; from the beginning of the accumulation of cerebrospinal fluid to the appearance of the first symptoms of decompensation takes no more than 3 days);
- subacute (progresses within a month);
- chronic (the disease develops slowly, the symptoms are invisible at first, as their intensity increases gradually; the disease develops for 6 months or longer).
Depending on the nature of development, two more types are distinguished:
- compensated (stabilized) hydrocephalus is spoken of if intracranial pressure does not reach critical limits, cerebrospinal fluid flow is gradually restored, the disease does not develop;
- increasing (progressing) dropsy of the brain is distinguished by a sharp increase in pressure inside the skull, is accompanied by atrophy of nerve tissues and is very difficult to conservative therapy (sometimes taking medications does not give any result at all).
Dropsy in adults: features of the clinical picture
The cranium space is limited. That is why the accumulation of cerebrospinal fluid leads to an increase in intracranial pressure - this is how very characteristic symptoms of brain hydrocephalus appear. Patients (adolescents and adults) complain of severe headache that cannot be stopped with the help of analgesics. In addition, severe nausea is observed, leading to vomiting. Patients note a feeling of pressure on the eyeballs.
The only exception is atrophic dropsy - there are no signs of increased pressure inside the skull with this form of the disease.
As cerebrospinal fluid begins to squeeze brain structures, neurological symptoms also appear. Many patients suffer from vestibular ataxia, which is accompanied by the appearance of tinnitus and dizziness. The gait of a person becomes unstable.
If the optic nerves are damaged / compressed against the background of the disease, then a decrease in visual acuity is observed. In some patients, the field of view is significantly narrowed. If we are talking about chronic hydrocephalus, then there is a chance of developing atrophy of the optic nerves and complete loss of vision.
Dropsy can lead to violations of tendon reflexes, muscle hypertonicity, paralysis and paresis. Some patients complain of a complete loss of skin sensitivity - they cease to feel pain, pressure, temperature, touch.
Sometimes accumulation of cerebrospinal fluid causes mental disorders. The disease, as a rule, affects the emotional sphere: a person often changes his mood, he loses emotional stability. Sometimes causeless euphoria appears, which, however, quickly turns into deep apathy and a state of complete indifference. A sharp increase in cerebrospinal fluid level can lead to aggressive behavior.
Symptoms of the disease in children
In newborns, the disease proceeds differently. The fact is that the child’s skull bones are more flexible, supple, and fontanelles have not yet had time to overgrow. That is why intracranial pressure does not increase, but the shape of the child’s head changes. The fontanel swells, and sometimes its pulsation can be seen with the naked eye. The scalp veins swell strongly, and the movements of the eyeballs are disturbed, which is associated with swelling and compression of the optic nerves. The kid is a little behind in development - later begins to hold his head, sit, crawl, roll over.
If treatment was not started on time, then the child’s head takes on a very characteristic shape. The skull of a hydrocephalus is spherical, too large. The patient’s eyes are deep-set, his ears are bulging, and his skin is thinning.
Who is hydrocephalus and how does dropsy affect the well-being of the child? Unlike adult patients, children rarely suffer from emotional and mental disorders - most often there is a delay in intellectual development. A small patient with such a diagnosis is usually apathetic, inactive, often suffers from obesity.
Dropsy of the brain in a child is very rarely accompanied by psychotic seizures, epileptic seizures and hallucinations, but this possibility should not be ruled out.
Diagnostic Features
You already know who hydrocephalus is, what symptoms accompany the disease, and what you need to pay attention to. If you have any suspicions, it is best to consult a doctor right away.
When it comes to dropsy of the brain in a child, the external signs, as a rule, are so characteristic that a specialist can make a diagnosis on the basis of only a general examination. But even in such cases, additional examinations are necessary, because it is important to determine the causes of development and the form of hydrocephalus.
First of all, an ultrasound scan is performed - echoencephalography. This quick and painless procedure allows you to evaluate the degree of pressure increase inside the skull. Children of the first year of life, as a rule, are sent for ultrasonography - an ultrasound scan is carried out through the fontanel.
X-ray of the skull is informative - in the pictures the doctor can see the discrepancy of the sutures between the bones of the skull, as well as the thinning of the bone tissue itself. On the inner surface of the bones you can see a kind of “indentation”. In addition, computed and magnetic resonance imaging of the brain is performed - such procedures can not only confirm the presence of hydrocephalus, but also determine the nature and causes of the disease, detect cysts, tumors, and anatomical features.
The patient is also sent to an ophthalmologist so that specialists evaluate the condition of the optic nerve discs, assess the acuity and field of view, as well as some other characteristics.
If there is reason to believe that the ailment is caused by an infection, then the patient can be sent for lumbar puncture. This procedure is unpleasant, but allows you to get samples of cerebrospinal fluid and check it for the presence of certain pathogens, markers. With congenital dropsy, doctors recommend PCR diagnostics. Brain vascular MRI is performed if serious vascular disorders are suspected.
Possible complications
You already know what hydrocephalus is and what symptoms the disease accompanies. This is a serious pathology, because any effect on the brain is fraught with complications. If we are talking about congenital forms of the disease, then the accumulation of cerebrospinal fluid leads to compression of the nerve tissue - the baby’s brain cannot develop normally.
In addition, rapidly progressing hydrocephalus can lead to consequences such as:
- cerebral edema;
- epileptic seizures;
- cerebral hemorrhage (stroke);
- displacement and compression of certain parts of the brain;
- coma;
- respiratory failure.
Sometimes the accumulation of fluid in the skull can result in the death of the patient, so in no case should you delay the start of therapy.
Acquired cerebral hydrocephalus in an adult: drug treatment
Modern medicine offers patients a lot of opportunities for therapy. If a couple of dozen years ago, more than half of the patients died, today the mortality rate is about 5%.
Therapy in this case directly depends on the causes of the onset of the disease, the stage and reasons for its development. If hydrocephalus is the result of an inflammatory or infectious disease, then the patient is first prescribed a course of antibiotics or antiviral agents. Sometimes the amount of cerebrospinal fluid in the brain is not too large - in such a situation, excess diuretics are eliminated with the help of diuretics (Furosemide, Acetazolamide).
But, according to statistics, surgery for hydrocephalus is necessary in most cases.
Diet features
Brain hydrocephalus is a disease that is accompanied by an accumulation of cerebrospinal fluid. That is why patients with such a diagnosis are recommended to adhere to a special diet. First of all, they need to completely exclude products from the diet that retain fluid in the body. Potentially dangerous are salty foods and dishes, sausages, smoked meats, fatty poultry and meat, sweets and other confectionery, white bread, spicy spices. Before buying this or that product, be sure to study its composition - it should not contain sodium gluconate.
You can include foods with mild diuretics in your diet (for example, lemon, oatmeal, cranberry juice, ginger, celery, eggplant, watermelon, parsley). Diet is not a way to get rid of dropsy - it is only auxiliary in nature.
Some folk healers recommend taking alcohol tincture of black elderberry root, as well as a powder made from bark or buckthorn berries. But, again, such alternative medicines can only be used as adjuvant therapy, and they can be taken only with the permission of the attending physician.
Surgical intervention
The nature of the surgery depends on what caused the accumulation of cerebrospinal fluid in the brain. Perhaps, during the operation, the neurosurgeon will remove the tumor, cyst, intracranial hematoma, hide and clean the abscess, disconnect the adhesions that have arisen between the walls of the channels for cerebrospinal fluid flow.
In the event that it is impossible to eliminate the cause of the dropsy of the brain, shunting is performed. With hydrocephalus, this procedure helps to reduce intracranial pressure, creating additional pathways for the outflow of cerebrospinal fluid.
Predictions for Patients
How dangerous can hydrocephalus be? The prognosis directly depends on how quickly the disease was diagnosed and how appropriate the choice of therapy was. Very often, dropsy can, if not completely cured, then at least take control of the further progression of the disease.
How many live with hydrocephalus and how does the disease affect a person's condition? If we are talking about timely detected dropsy of the brain in a newborn, it is highly likely that the baby will develop at the usual pace and live a completely normal life. Yes, problems related to the maintenance of shunts installed in the brain may occur, but they can also be solved.
If the disease was diagnosed at a later stage, then complications are possible. The brain of the child will not be able to develop normally, which is fraught with speech impairment and a lag in intellectual growth in the future. Sometimes damage to the central nervous system is so serious that it leads to disability.
Preventive actions
If we are talking about congenital forms of the disease, then it is almost impossible to predict the likelihood of their development. Nevertheless, expectant mothers are advised to take vitamins, eat right, and avoid communicating with potential carriers of infectious diseases (rubella is especially dangerous in this case).
As for acquired hydrocephalus, here too doctors recommend avoiding the risk of catching one or another infection (syphilis). Remember that when the first symptoms of increased intracranial pressure, meningitis, encephalitis appear, you should consult a doctor as soon as possible. Any disease is much easier to treat in the early stages of development. Do not forget to undergo a scheduled medical examination once a year and take tests (even if there are no problems with well-being).