Brain hydrocephalus develops in children up to a year, it happens at an older age. Less commonly, dropsy is diagnosed in adult patients. Any of the options is life-threatening and requires the provision of adequate medical care as quickly as possible. If the doctor helps the child by quickly and accurately diagnosing, choosing the appropriate therapeutic measures, the consequences will be minimal, the person will live a long life. But if the disease can not be detected really quickly, the results can be the most deplorable - even fatal. However, statistics show that mortality is estimated at five percent, which means that the danger is not as great as it was, for example, several decades ago, when half of all patients died of dropsy.
general information
To understand what are the causes of hydrocephalus in children, the consequences of this disease, you first need to delve into the very essence of the disease. The name came to us from a foreign language and is translated quite simply - "water in the head." This term well describes the condition of the patient - a specific substance, a fluid circulating through the spinal cord, is accumulating in the brain tissue. This secretion is produced in excessive volume, is not absorbed by cells, therefore, it accumulates in those channels through which the substance must move, ensuring the efficiency of brain cells. Channels are both inside the skull and at the exit from this part of the body.
Hydrocephalus in children is a disease in which the size of the skull gradually increases under the influence of a negative factor. This is because the fluid cannot be compressed. When it accumulates, it presses on the surrounding tissues, bursts them. This process is especially pronounced if dropsy begins in a newborn, children in the first years of life, while the cranial bones have not yet formed completely, have plasticity, softness, suppleness. If the disease begins when the connections of the skull become tight, there is no fontanel, then pressure leads to leaching of the cells by the fluid. The skull box no longer has pliable areas, so no head enlargement is observed.
Attention to all factors
To minimize the effects of hydrocephalus in a child, at the first suspicion of an illness, the baby should be shown to a qualified doctor for an accurate diagnosis. The choice of the correct therapeutic approach is possible only if it is possible to establish the cause that provoked impaired circulation of the cerebrospinal fluid. The doctor evaluates the pressure, determines in which places the substance accumulates. It must be remembered that in some cases the onset of the disease is latent. In order to notice the wrong thing in time, it is necessary from the very birth of the baby to regularly undergo regular medical examinations with him. If dropsy is detected in the primary stages, the disease can be successfully cured completely. Sometimes specific medicines are enough. In more advanced cases, the only option is an emergency operation. Choose what to do in a particular case, based on the survey. The decision is made by a consultation of doctors with the participation of a neurosurgeon, a neurologist. If a compensatory state is established, the slightest delay with surgery may already be fatal. Adequacy, timeliness of medical care - these are the main points to save a life and restore health to a baby.
Unfortunately, it is not always possible to notice the first signs of hydrocephalus in children on time, since the disease can initially proceed hiddenly. This is due to its features. Hydrocephalus is caused by a violation of the balance of production, absorption of cerebrospinal fluid by the cells of the body. The human brain is a complex structured object that is supplied with nutrients through the blood vessels. Brain tissues are elastic, dense, but cavities are provided in the organ - cerebral ventricles. The inner surface of these elements is covered with a vascular network that forms the cerebrospinal fluid. The substance washes the spinal cord, penetrates between the meninges, where it is absorbed in the subarachnoid space. Also, vessels capable of absorbing fluid are in the spinal column. Liquor flows through the intended cranial venous sinuses. The liquid is absorbed here only with the right pressure indicators, when there is a difference in this indicator in different tissues. If intracranial pressure is higher than sinus pressure, cerebrospinal fluid enters here. When the balance of absorption and fluid production is disturbed, dropsy develops.
Anatomical features
Hydrocephalus in children is associated with irregular dynamics of cerebrospinal fluid. Normally, this fluid is intended to protect brain tissue from injury and damage. This is achieved by her inability to contract. At the same time, the substance washes tissues, ridding them of metabolites, removing some other compounds. Due to the cerebrospinal fluid, which is present all the time in one volume, stable pressure is maintained inside the skull. The circulatory system receives certain advantages at its expense - the water-electrolyte composition is stabilized. Vegetative NS is normalized due to oscillatory movements of the liquid. So that there are no malfunctions, in the human body liquor is produced continuously, and in the same way it is constantly absorbed. Per day, tissues produce 40-150 ml, specific parameters depend on the age of the child. In adults, this figure sometimes reaches one and a half liters in 24 hours. Liquor is rich in lymphocytes, protein structures, electrolytes. Saturation with sugars and gases depends on blood counts. Studies have shown that there are half as much sugar in the cerebrospinal fluid as in the main body fluid.
Hydrocephalus in children is observed when the balance between the production and absorption of cerebrospinal fluid is lost, there are problems in passing through the vessels intended for this. The level of violation, the pressure indicators inherent in the patient’s condition, determine what happens in the cranial cavity. Certain parameters allow doctors to talk about a case belonging to one of the key forms. The correct definition of a patient in a specific group is the key to a well-chosen treatment program.
What will the doctor say?
With hydrocephalus in children, an imbalance of processes affecting the cerebrospinal fluid is observed, circulation is affected. To improve the situation, fluid should be forced through the vessels responsible for its disposal. To do this, you have to increase the pressure inside the skull. Without adequate therapeutic assistance, natural processes lead to the expansion of the spaces occupied in the skull by cerebrospinal fluid. In infants, the skull is still plastic in the first few months after birth, so its volumes change quite easily under the influence of harmful factors, because the seams and fontanel have not yet grown together. If at the same time the cerebrospinal fluid circulates incorrectly, the spaces allotted for it pathologically increase, respectively, the size of the brain tissue decreases. At first, the process is not so dangerous, because the tissues are elastic, so there is a slight compression. But a gradual increase in the volume of cerebrospinal fluid leads to atrophic processes. It is atrophy that leads to the externally visible symptoms of the disease.
The article provides photos of hydrocephalus in children. Most often, the disease develops during the pregnancy of matter, that is, it is a congenital disorder. This is explained by infection of the maternal organism during the period of gestation of the embryo. In some cases, the cause is inflammatory processes that affect the central nervous system, injuries received at the time of birth or soon after. Up to three quarters of all cases are triggered by tumor processes in the brain.
Age and disease
Hydrocephalus of the brain in a child can occur in different ways, a lot depends on the age of the patient. This also applies to the reasons. Some provoke dropsy in young children, while others are dangerous for older people. At the stage of intrauterine development, quite often the disease is caused by malformations of the NS. Every fifth case is caused by infection. A considerable risk is associated with genetic disorders. But in a newborn, the disease in 80% of cases is due to infection transferred during being in the mother's body. One in five faces hydrocephalus due to injuries sustained at birth and shortly after. Malformations of the brain (brain, spinal cord), inflammatory processes, meningitis, hemorrhage in the tissue inside the skull, tumors that affect the vessels through which blood is delivered to the brain - all these causes can cause dropsy in an infant.
At the age of a year and older, such causes of brain hydrocephalus in a child are often found: hemorrhages, neoplasms in the brain, spinal cord. The disease can occur with inflammatory processes in the brain, membranes of the organ. Dropsy is observed against the background of injuries, malformations of blood vessels, and the brain. The cause may be heredity, genetic disorders.
Reasons: diseases provoking diseases
Cytomegalovirus, rubella can initiate hydrocephalus of the brain in children. Sometimes the disease develops against the background of infection with the first, second type of herpes. Dangerous toxoplasmosis, neurosyphilis. Dropsy of the brain can develop against a background of mumps, a viral, bacterial lesion that has caused meningitis, meningoencephalitis. Infection with meningo-, pneumococci, hemophilic bacillus is dangerous. Various viruses from the herpetic family can provoke hydrocephalus.
Sometimes hydrocephalus of the brain in children develops against a background of defects, specific conditions. The danger is associated with Arnold-Chiari syndrome. These are such developmental features when the cranial occipital fossae do not correspond to the brain structures located in these zones. This leads to the lowering of the nape of the neck, where the spinal, medulla oblongata intersect. The disease can cause infringement of nerve fibers and other structures in the bone ring, and this provokes malfunction, stopping the activity of centers responsible for the movement of blood vessels, respiration. Such a syndrome can cause death. An equally dangerous condition is a narrowing of the channel responsible for the communication of the cerebral ventricles. Some babies from birth have underdeveloped holes designed for fluid outflow into the subarachnoid region.
Dangers lurk at every turn
Cysts that develop in the subarachnoid space can cause hydrocephalus in children under one year old. Ill-formed cerebral veins can provoke the disease. Well-known medicine and a kind of Dandy-Walker syndrome. This term refers to a condition in which spaces for cerebrospinal fluid, cerebellum develop incorrectly, which leads to deformation of the fourth ventricle. Due to this change, a cyst of the fossa of the skull appears behind, and the cerebellar worm does not receive enough resources for full development.
It is known that hydrocephalus in children under one year of age is possible against the background of the oncological process in the children's body. Papilloma virus infection, brain cancer or tumors that affect the cerebral ventricles can provoke the disease. Extremely dangerous meningioma, localized in the vascular plexus. Tumors of the cranial bones, oncology, which affected the spinal cord, can provoke dropsy. With these pathologies, the current, the absorption of cerebrospinal fluid are difficult or impossible, which leads to hydrocephalus.
Risks When is the danger higher?
Most often, external, internal or mixed hydrocephalus is detected in children born prematurely, up to the 35th week of gestation. The risk group includes babies with insufficient weight (less than one and a half kilograms), as well as with too narrow a mother's pelvis. The probability of dropsy is higher if the delivery was carried out using auxiliary instruments - vacuum devices, forceps. Asphyxia, oxygen deficiency, breathing problems at the time of birth are another factor that suggests a high risk of hydrocephalus. At risk are babies who, at birth, already had infected internal organs, as well as those born to mothers who, during pregnancy, have had any kind of infectious, viral disease. The list of such pathologies is quite wide, from flu and colds to mononucleosis, toxoplasmosis.
Often diagnosed with internal, external hydrocephalus in children whose mothers were addicted to bad habits, if they were not eliminated for the period of bearing the child. With any of these factors, it is important to constantly monitor the condition of the baby, and at the first suspicion of pathological processes, you should consult a qualified doctor to monitor your health. Timely detection of pathological processes allows you to provide adequate assistance, while doing this with "little blood."
Disease. What types are there?
In order for the treatment of cerebral hydrocephalus in children to give a quick and maximum result, it is important to make an accurate diagnosis, correctly determine the reason for the development of the disorder, and what method of eliminating it is optimal for a particular case. To identify belonging to a particular class, a number of criteria will have to be analyzed, including the causes of the disease, indicators of pressure inside the skull, and the quality of the pathways for cerebrospinal fluid. The doctor evaluates at what point the disease appeared, and on the basis of this, an acquired pathology or congenital is revealed. Depending on the course, acute and chronic forms are distinguished. At the first, there is a sharp deterioration in the patient's condition, as the pressure rises rapidly. The patient becomes ill in just a few days. In chronicles, pressure indicators increase gradually, imperceptibly, the duration of the disease - up to six months. More often, such a course is characteristic of open dropsy. In addition, there is a subacute form, when the condition becomes gradually worse, the development of processes takes from a quarter of a year to six months. The consequences of the subacute form are very severe, brain structures suffer greatly if adequate assistance is not provided on time.
It is possible to suspect, on the basis of certain symptoms, hydrocephalus in a child, developing in an open type. This disease is called communicating. Liquor is produced and absorbed with different activity, which leads to an imbalance. There is a communication system between the ventricles, the cerebrospinal fluid enters the space between the meninges, where absorption must occur. The imbalance is provoked by meningitis, metastases, can occur against the background of local hemorrhage in the brain tissue, sarcoidosis. There are cases when the open form was detected as a disease that accompanies tumor processes in the vascular plexuses. Closed dropsy is explained by a block of pathways for the withdrawal of cerebrospinal fluid, which leads to the expansion of the ducts. This form is more often found open, and its course is more severe. Stenosis, obstruction of holes, hemorrhages, cystic formations can provoke the disease.
What else happens?
Doctors know what treatment for hydrocephalus in children should be if the disease develops in a hyperproduction scenario. This pathology is due to excess generation of cerebrospinal fluid. Another type of disease is areresorbent, in which the liquid is formed in adequate volumes, but for various reasons it is not absorbed. There is also a mixed type in which cerebrospinal fluid forms and is absorbed, but the first process proceeds more actively than the second, which leads to an imbalance.
The external form of the disease is diagnosed if fluid accumulates between the meninges, but the internal hydrocephalus in children is detected if the accumulation processes occur in the ventricles, which gradually overflow. There is a mixed type of disease when there is no one place to localize the accumulation of cerebrospinal fluid.
Pressure and degree of pathology
The choice of treatment for hydrocephalus in children is based on various characteristics of the disease, including indicators of pressure inside the cranium. It is customary to talk about a disease that occurs with normal, high and low blood pressure. The indicators are maintained normal, often at the very beginning of the disease, after which the pressure gradually rises. Hypotension with dropsy is extremely rare. In some cases, hydrocephalus is observed compensated. , , . – , . .
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What to count on?
The consequences of brain hydrocephalus in children can be different, it all depends on the form of the disease and how quickly and correctly its treatment began. The most favorable forecasts relate to the communicating form. Congenital forms are sometimes easier to tolerate than acquired. If the doctor timely took measures to save a life, the child lives a long life, develops normally, although a decrease in the quality of everyday life is possible. Against the background of the disease, the functions of hearing, vision, and speech may be impaired. Sometimes there are difficulties in coordinating movements.
In order not to encounter the effects of brain hydrocephalus in children, preventive measures should be taken to prevent the development of the disease. The first and most important rule is to protect the baby’s head from a variety of herbs, using helmets, car seats. Avoid locations where the risk of injury is higher. During pregnancy, you need to completely abandon bad habits, undergo examination for possible infectious infections. If you have had a disease, even a simple acute respiratory viral infection, you should come for an appointment to check the condition of the fetus, and also consult with an infectious disease specialist, a geneticist. A pregnant woman should attend a consultation with a neurologist, undergo an MRI scan, an ultrasound. This is especially true if the baby is born prematurely.
How to notice a problem?
Symptoms of hydrocephalus in a child under two years of age differ from the manifestations observed in older children. The first option is more often - a congenital form, which is difficult to tolerate, accompanied by a sharp deterioration in the condition, damage to brain structures. It is known that such dropsy formed after meningitis, encephalitis, and developed according to the chronic scenario. The cranial bones in young children have not yet grown together, displacements are possible, therefore, a key symptom of hydrocephalus is an abnormal increase in head volume. If the measurements show a monthly increase of one and a half centimeters or more in the first quarter of a year of life, you can already suspect the disease. A problem can be assumed if subsequently the increase reaches 9 millimeters. Typically, the circumference of the baby’s head is only a couple of centimeters larger than the circumference of the chest, by six months the indicators become the same, but with dropsy the head remains larger than the body.
The very first consequences of cerebral hydrocephalus in children, already observed during the course of the disease, are sleep disturbances, weight failure, and slow development. A sick child learns to keep his head at the age of three months, sometimes later. At the same time, many are tearful, capricious, the skin on the head is thin, wreaths shine through it, over time, the integuments begin to shine. A sick baby later learns to sit, move, and healthy, and on top of his head a supple, pulsating spot remains. The baby's forehead is larger in size than the norm, the child often throws back his head, eats seldom and a little, eyelids are lowered. If the disease develops rapidly, urgent hospitalization is needed. This can be noted by the convulsive state, crying, craving for sleep, vomiting, loss of previously acquired skills.
What to do?
There are two treatment options - surgical treatment (often shunted hydrocephalus in children), medication. Conservative methods are possible if it was possible to identify a pathology at the very beginning. For the best prognosis, a neurosurgeon and a neuropathologist in a team should work with the patient. To reduce the pressure inside the skull, measures are taken to reduce the production of cerebrospinal fluid or enhance its absorption. Efficacy shows the tool "Diacarb". The dosage should be chosen by the doctor, evaluating the age, general condition of the patient. The active compounds of the drug stop the activity of enzymes responsible for the production of cerebrospinal fluid, activate urination, and help get rid of excess potassium in the tissues. To strengthen the therapeutic approach, the child is prescribed Asparkam and Panangin preparations. They are used simultaneously with "Diacarb" in the morning, on an empty stomach.
In some cases, funds that help get rid of excess moisture in the body come to the benefit. These are some diuretics that affect plasma, stimulate the transfer of water from the brain to the vascular system, followed by its excretion by the kidneys. Glycerin for oral administration and Mannitol, Furosemide have proven themselves well. These names show great efficiency in combination with Panangin, Asparkam. To improve the prognosis, the patient may be prescribed “Calcium hopantenate” and “Encephabol”, which positively affect the brain at a neural level.
Need an operation!
If medical methods do not show sufficient effectiveness with a course duration of two to three months, it is necessary to resort to a surgical method. It is also indispensable if the disease develops in a closed form. Quite often, a bypass method is used for hydrocephalus in children. There are many cases when it was precisely the operation that was the only way to stop the progress of the disease and prevent the damage to the brain structures. Choose a specific method of operation, focusing on age, general condition of the patient, stage of the disease.
With a closed form, you can remove objects that cause liquor to circulate incorrectly. This helps if the cause of the disease is in tumor processes, hematomas, cysts, aneurysms. The cerebrospinal fluid current returns to normal, the fluid flows to the points where it is absorbed. A situation is possible when the neoplasms sprouted into the brain tissue or do not have clearly defined boundaries. Then the doctors intervene to form an alternative pathway for the passage of cerebrospinal fluid. To do this, bypass surgery. A common practice - the drainage of fluid through silicone catheters into the abdominal cavity to the films lining the organ from the inside - they are characterized by increased suction capacity. As can be seen from medical statistics, such an operation is performed annually at least 200,000 times in different countries of the world. The invention of this method saved a huge number of lives.
Alternatives
Another method of shunting involves the diversion of cerebrospinal fluid into the atrium on the right. At the same time, doctors direct artificial vessels so that the liquid enters the tank intended for it in the neck. Another way is to connect the peritoneum and the canal for the spinal cord. In some cases, it is possible to avoid the use of silicone tubes, if it is possible to use an endoscope to create outflow paths. By this term it is customary to designate a fiber optic tube, with the help of which minimally invasive operations become possible, which are much more easily tolerated by patients than traditional methods of surgical intervention.