Echo signs of expansion of external cerebrospinal fluid spaces. Ultrasound examination of the brain of newborns (normal anatomy) Pathologies detected using neurosonography

The owners of the patent RU 2424004:

The invention relates to medicine, namely to pediatric neurology and physiotherapy, and can be used in the treatment of perinatal brain damage of hypoxic-ischemic origin in children of the first year of life. A course of exposure to galvanic current is carried out, while the bifurcated anode is placed on the eye sockets, the cathode is placed on the projection of the sixth-seventh cervical vertebrae and a current of 0.15-0.25 mA is applied. The method contributes to the normalization of the state of liquor-containing spaces, has no contraindications and complications. 6 tab.

Physiotherapeutic methods are the most promising in the treatment of children in the first year of life, since with the correct individual prescription they do not lead to the development of complications, are highly effective and allow you to reduce the amount of drugs or completely abandon drug therapy.

A known method for the treatment of perinatal brain damage of hypoxic-ischemic genesis in children of the first year of life, including conducting drug electrophoresis according to the method of A.Yu. Ratner (Ratner A.Yu. Neurology of newborns. - Publishing house of Kazan University, 1995. - 368 p.). Electrophoresis is most often carried out with aminophylline on the cervical spine transversely. The anode is placed at the level of the second-seventh cervical vertebrae, the cathode - at the level of the upper edge of the sternum. Electrophoresis is carried out at low current - up to 0.5 mA. The duration of exposure, depending on age, is 8-10 minutes. The course of treatment is 8-10 procedures performed daily.

However, the method has virtually no effect on the severity of CSF disorders according to neurosonographic studies. The use of eufillin in children with hypertensive-hydrocephalic syndrome, which occurs in 30-70% of children with perinatal brain damage, is not indicated due to the fact that eufillin is a non-selective vasodilator, reduces peripheral resistance and adversely changes the state of cerebral hemodynamics and liquorodynamics. In addition, eufillin belongs to antiplatelet agents, and in children with perinatal brain damage, platelet pathology and a tendency to increased bleeding are often detected. Thus, the use of aminophylline can provoke hemorrhages.

The technical result achieved by the invention is to eliminate liquorodynamic disorders, as well as to reduce contraindications and complications.

The essence of the invention lies in the achievement of the claimed technical result in a method for the treatment of perinatal brain damage of hypoxic-ischemic genesis in children of the first year of life, including a course of exposure to low-strength galvanic current, according to which a bifurcated anode is placed on the eye sockets, the cathode is placed on the projection of the sixth-seventh cervical vertebrae and act with a current of 0.15-0.25 mA.

The clinical studies conducted by the authors showed that the use of a galvanic current of 0.15-0.25 mA according to the orbital-occipital technique in children of the first year of life with perinatal brain damage of hypoxic-ischemic genesis leads to the normalization of the state of the CSF-containing spaces, which was confirmed by neurosonographic data. research, reducing the severity and frequency of complaints and clinical manifestations of this pathology. The galvanization procedure is well tolerated by children, has no side effects and contraindications.

The method is carried out, for example, as follows.

The galvanization procedure is carried out from the apparatus "Elfor-prof" (firm Nevoton, St. Petersburg). The bifurcated anode is placed on the eye sockets, the cathode - on the projection of the sixth-seventh cervical vertebrae. The current strength is 0.15-0.25 mA. The duration of exposure, depending on age, is 8-10 minutes. The course of treatment consists of eight to ten procedures performed daily.

The method is illustrated by the following clinical examples.

1. Girl D.T. entered the department of physiotherapy at the age of 4 months 20 days with a diagnosis of perinatal brain damage of hypoxic-ischemic origin, moderate form, hypertension-hydrocephalic syndrome, psychomotor retardation, vegetative-visceral syndrome, syndrome of motor disorders. Concomitant disease: intestinal dysbiosis with overgrowth of Staphylococcus aureus.

Anamnesis: she was born from the second pregnancy (the first one ended with a medical abortion for a period of 7 weeks without complications). Pregnancy proceeded against the background of late mild toxicosis. Childbirth at 36 weeks. Childbirth is fast. The first period of labor is 3 hours, the second period of labor is 45 minutes. Body weight at birth 2490 g, height 49 cm, head circumference 32 cm Apgar score - 7/8 points. The period of adaptation without features. Neurological symptoms began to appear from 1 month of age. There were complaints about poor night and daytime sleep, frequent regurgitation, meteorological dependence, and a tendency to constipation. Examination revealed increased pyramidal muscle tone, hyperreflexia with expansion of reflexogenic zones, marbling of the skin.

Neurological status

Complaints: restless daytime and nighttime sleep (he falls asleep for a long time, wakes up to 6-10 times a night). The severity of this complaint (3 points). Expressed tremor of the arms and chin with anxiety (2 points). Parents also complain of rare but profuse regurgitation (2 points). Parents note a clear connection between sleep disturbance and behavior when weather conditions change (3 points), anxiety during the day almost daily (2 points). The girl suffers from constipation.

Objective examination: head circumference 43 cm (+11 cm in 4 months 20 days). Large fontanel 2.0/2.0 cm, dense edges. Divergence of the sagittal suture. The head is hydrocephalic in shape: frontal tubercles are pronounced, the back of the head hangs down. Expanded venous network on the scalp. Severe marbling of the skin, distal hyperhidrosis. Graefe's symptom is constantly at rest. Neurological examination revealed a moderate increase in pyramidal muscle tone and hyperreflexia with expansion of reflexogenic zones. Delay in the formation of motor skills (does not roll over, uncertainly holds the head in a vertical position).

Thus, based on the examination data, the following syndromes of perinatal brain damage of hypoxic-ischemic genesis were established: hypertensive-hydrocephalic syndrome (3 points), delayed psychomotor development (2 points), vegetative-visceral syndrome (3 points), motor motor syndrome violations (2 points).

A neurosonographic study was performed, which was assessed according to the following parameters: the size of the lateral ventricles of the brain on the right and left - Vls=14 mm, Vld=15 mm, the size of the third ventricle of the brain - Vt=3 mm, the indices of the bodies of the lateral ventricles on the right and left - ITBZhl=0 .25, ITBZHp=0.27, the size of the interhemispheric fissure - MPSch=5/14 mm, bone-marrow diastasis=5.5 mm. Minor changes in the architectonics of the brain of posthypoxic genesis. Dilatation of the left ventricle, moderate expansion of the subarachnoid space. Violation of liquorodynamics by hyporesorptive type.

Physiotherapy treatment: Girl D.T. received 10 sessions of galvanization by the orbital-occipital technique. Current strength 0.15 mA, procedure time 8 minutes. Tolerability of procedures is satisfactory. From drug therapy, the girl received pantogam for 1 month at the age dosage.

The results of the examination at the age of the child 6 months 3 days

Complaints: improvement of night sleep (wakes up 1-2 times a night). Daytime sleep normalized. Complaint about sleep disturbance - 1 point. There are no complaints about tremor and regurgitation. Parents noted that the girl's sleep and behavior were much less likely to be disturbed when weather conditions changed, so the complaint about weather sensitivity was 1 point. Parents noted that their daughter had stopped constipation after the end of physiotherapy.

On neurological examination: head circumference 45 cm (+2 cm in 2 months), large fontanel 1.5/1.5 cm, no divergence of the skull sutures. Graefe's symptom (-). Mild marbling of the skin remains. There is no distal hyperhidrosis. Muscle tone is satisfactory. Tendon reflexes are normal. Psychomotor development by age.

Neurosonography: Vls=13 mm, Vld=13 mm, Vt=3 mm, ITBZhl=0.23, ITBZhn=0.23, MPS can be traced at a small distance, bone-marrow diastasis=3 mm. Echoarchitectonics of the brain is not disturbed. There are no violations of liquorodynamics.

Diagnosis: perinatal brain damage of hypoxic-ischemic origin: vegetative-visceral syndrome (1 point).

Examined at 1 year old. There are no complaints.

Neurological examination: Satisfactory condition. Physiological muscle tone. Tendon reflexes are normal. Psychomotor development by age.

Neurosonography: Vls=14 mm, Vld=14 mm, Vt=3 mm, ITBZhl=0.24, ITBZhn=0.24, MPS can be traced at a small distance, bone-marrow diastasis=3 mm. Echoarchitectonics of the brain is not disturbed. There are no violations of liquorodynamics.

Healthy. No further treatment is needed.

2. Boy D.K. entered the department of physiotherapy at the age of 10 months 11 days with a diagnosis of perinatal brain damage of hypoxic-ischemic origin, moderate form, hypertension-hydrocephalic syndrome, vegetative-visceral syndrome, movement disorders syndrome. Concomitant disease: right-sided installation torticollis, JVP, hepatomegaly.

Anamnesis: was born from the first pregnancy. Pregnancy proceeded against the background of early mild toxicosis, acute respiratory viral infections for a period of 24 weeks. Delivery at 40 weeks. Emergency caesarean section due to breech presentation. Birth weight 3400 g, height 51 cm, head circumference 34 cm Apgar score - 8/9 points. The period of adaptation without features. Neurological symptoms began to manifest themselves from the age of 6 months, when the parents first noted a pronounced emotional lability in the child, superficial night sleep. The child received drug therapy (Cavinton) for 1 month. After a month of therapy, the complaints are the same.

Neurological status

Complaints: restless night sleep (he falls asleep for a long time, wakes up up to 8 times a night). The severity of this complaint is 3 points. Anxiety during the day daily (3 points).

Objective examination: head circumference 46 cm (+12 cm in 10 months 11 days, +3 cm in 2 months). The big spring is closed. The head is hydrocephalic in shape: frontal tubercles are pronounced. Expanded venous network on the scalp. Moderately pronounced marbling of the skin, distal hyperhidrosis. Neurological examination revealed a moderate increase in pyramidal muscle tone and hyperreflexia with expansion of reflexogenic zones. Head tilt to the right.

Thus, based on the examination data, the following syndromes of perinatal brain damage of hypoxic-ischemic genesis were established: hypertensive-hydrocephalic syndrome (2 points), vegetative-visceral syndrome (1 point), movement disorders syndrome (2 points). Concomitant diseases: Right-sided mounting torticollis, hepatomegaly.

Neurosonography: Vls=13.3 mm, Vld=14.4 mm, Vt=2 mm, ITBVl=0.21, ITBZhn=0.23, MPV=4.7/15 mm, bone-marrow diastasis=2 mm. Slight residual changes in the architectonics of the brain of posthypoxic origin. Moderate expansion of the subarachnoid space. Slight violation of liquorodynamics by hyporesorptive type.

Physical Therapy: Boy D.K. received 10 sessions of galvanization by the orbital-occipital technique. Current strength 0.25 mA, procedure time 10 minutes. Tolerability of procedures is satisfactory. He did not receive medical therapy.

The results of the examination of a child at the age of 1 year.

Complaints: normalization of night sleep. There are no complaints about anxiety during the day.

On neurological examination: head circumference 47 cm (+1 cm in 2 months), large fontanel closed. Graefe's symptom (-). Muscle tone is diffusely reduced. Plano-valgus deformity of the feet. Torticollis is not noted. Tendon reflexes are normal. Psychomotor development by age.

Neurosonography: Vls=14.2 mm, Vld=14.6 mm, Vt=1.8 mm, ITBZhl=0.22, ITBZhn=0.22, MPS can be traced at a small distance, bone-marrow diastasis=2 mm . Normalization of liquorodynamic processes.

Perinatal brain damage of hypoxic-ischemic origin, syndrome of movement disorders (muscle hypotension) - 1 point.

In the future, orthopedic observation is required for diffuse muscle hypotension.

To confirm the effectiveness of the claimed method, 35 children with perinatal brain damage aged from 1 to 11 months were under observation.

All children underwent a full range of clinical examination, analysis of anamnesis data, as well as an examination by a neuropathologist, pediatrician, orthopedist, ophthalmologist. Assessment of the severity of complaints and the clinical condition of children was carried out according to the point system (Zhitomirskaya M.L. Features of the diagnosis and course of intranatal intraventricular hemorrhages in children of the first year of life with hereditary hemostasiopathies. - St. Petersburg, 2001). The state of the brain structures was examined by ultrasonography (standard technique and transcranial ultrasonography). Researches were carried out on devices ACUSON - 128 (USA); TOSHIBA 140 (Japan) complete with sector sensors (3.5 MHz, 5 MHz and 7.5 MHz) and linear sensor (5 and 7 MHz). For a dynamic assessment of the size of the cerebral ventricles and the state of liquorodynamics, neurosonographic indicators were used: ventricular index, the size of the lateral ventricles, the third ventricle of the brain, and bone-marrow diastasis, the size of the interhemispheric fissure.

As a result of neurological examination, the following syndromes of perinatal brain damage were revealed: movement disorder syndrome (SDR), vegetative-visceral syndrome (VVS), psychomotor developmental delay syndrome (MPMR), hypertensive-hydrocephalic syndrome (HHS).

The children were divided into two groups. The first (main) group (20 children) received treatment according to the claimed method against the background of drug therapy. The second (control) group (15 children) received eufillin electrophoresis on the cervical spine transversely according to the Ratner method against the background of drug therapy. Drug therapy included vasoactive drugs (mainly cavinton), drugs containing hydrolysates of amino acids, neuropeptides that improve the functional state of neurons (actovegin, cortexin), GABAergic drugs (piracetam, pantogam, phenibut), diuretics (diacarb, diuretic herbs) , amino acids (glycine), vitamins of group B (vitamin B1, B6, complex drug "Neuromultivit").

The effectiveness of treatment in the groups was assessed by comparing the dynamics of complaints, the severity of neurological syndromes, general condition, neurosonographic parameters before and after treatment. An examination after the fifth procedure was carried out to identify possible side effects of the treatment, and the individual tolerance of the factor was assessed. To assess the dynamics of the child's condition during treatment, a second examination by a neuropathologist and pediatrician, neurosonographic study was carried out a month after the end of treatment. The effectiveness of the treatment was assessed by the dynamics of complaints, neurological syndromes (in points), neurosonographic parameters before and after the course of treatment.

The data obtained as a result of the study were processed using the methods of mathematical statistics: the method of paired comparisons, methods of decision theory (Belkin A.R., Levin M.Sh. Decision making: combinatorial models of information approximation. M., Nauka, 1990 , - 160 pp. David G. The method of paired comparisons - M., Statistics, 1978), which allows to form integral (total) estimates for a set of indicators.

All children of the main group tolerated the galvanization procedure satisfactorily, no side effects were noted. In this group of children, according to parents, a positive trend in changes in complaints was noted: 50% of children had normalized night sleep, every third child stopped spitting up; 22.22% of children after treatment did not respond to changes in weather conditions, in 25% of children the tremor of the chin and limbs disappeared.

An integral assessment of the dynamics of complaints in the main group is presented in Table 1.

From the data in Table 1, it follows that the inclusion of galvanization according to the orbito-occipital technique in the complex of therapeutic measures helps to reduce the severity and frequency of all major complaints.

In the control group of children, the positive dynamics is not so pronounced: normalization of sleep was noted only in 20% of children; only 13.33% of children stopped spitting up. In one child, after the first procedure, the parents noted a reaction to the treatment in the form of increased anxiety and an increase in the frequency of regurgitation. Tremor of the limbs and chin stopped in 2 children. Complaints about meteosensitivity were not observed only in one child.

An integral assessment of the dynamics of complaints in the control group is presented in Table 2.

According to integral assessments (Table 2), in the control group there is a tendency to reduce the severity and frequency of complaints of developmental delay and anxiety under the influence of electrophoresis on the cervical spine according to the Ratner method.

In the main group, after treatment according to the claimed method, 72.22% of children improved muscle tone, motor activity, unconditioned and tendon reflexes. Manifestations of autonomic dysfunction syndrome decreased in 53.33% of children. Clinical manifestations of HHS decreased in 33.33% of children.

An integral assessment of the dynamics of neurological syndromes in children of the main group is presented in Table 3.

From the data of table 3 it follows that the claimed method of treatment significantly reduces the severity and frequency of all major neurological syndromes. The best results were achieved in the treatment of SDR and VVS.

The use of eufillin electrophoresis on the cervical spine made it possible to reduce the incidence of SDR in 26.67% of children. A decrease in the frequency and severity of VVS was noted in 33.33% of children. In the control group, only 20% of children showed stabilization of the head size and a decrease in the severity of other clinical manifestations of HHS.

An integral assessment of the dynamics of neurological syndromes in children in the control group is presented in Table 4.

From the data in Table 4 it follows that electrophoresis according to the Ratner method had practically no effect on the severity and frequency of neurological syndromes (p=0.05). There is a slight trend towards a decrease in the severity and frequency of clinical manifestations of HHS and MRT.

The dynamics of neurosonographic parameters in children of the main group is presented in Table 5.

According to the results of neurosonographic studies (table 5), a pronounced positive trend was noted, consisting in the normalization of the size of CSF-containing structures. In the main group of children, the size of the lateral ventricles returned to normal in 35% of children. It was possible to achieve the elimination of hyporesorptive disorders in 25% of children.

27.04.2014, 19:21

Good evening, dear doctors. I am very worried about the situation that has developed at the moment based on the results of the NSG and examination by a neurologist. I read frequently asked questions, similar questions too, but it’s difficult for me, not being a doctor, to figure it out. I beg you, do not leave without attention. The baby was born at the 40th week, 3680 kg, 53 cm. head: 36 cm. The first NSG per month. MD=49mm MS=49mm VLD=12.8mm VLS=13.5mm V3=3.5mm. There is no offset. Bone-marrow diastasis = normal. M / P gap is not expanded. No pathologies were found. Despite this, I had complaints about the child's poor sleep (practically did not sleep until three and a half months, only in the fresh air), the effect of the "setting sun", shuddering, regurgitation. Head circumference per month 37 cm. Massage is prescribed. At three months, on examination by a neurologist okr. head: 43 cm. Hypotonia of the shoulder girdle. I have the same complaints. Appointed lingonberry decoction before vaccination, electrophoresis, glycine. Vaccination was not carried out due to obstructive bronchitis. Then he was examined by a neurologist at the age of 4 months in the hospital: neuro-reflex excitability syndrome. Recommended massage, nervoheel, turnout in two months.
NSG at 7 months: MD=57 mm MS=56 mm VLD=18.3 mm VLS=10.6 mm (18.6?, written very illegibly, the neurologist did not understand later), V3=3.5 mm. Bone-Marrow Diastasis =4. There is no offset. M / P gap: 22x6. Violation of liquorodynamics by the type of hyposorption. I am attaching the result of the examination by a neurologist. Appointed triampur, pantocalcin. Appearance in 1.5 months. Vaccination medicine. The child received only BCG in the maternity hospital. From 30.03 - 7.04 he had chicken pox, earlier obstructive bronchitis, stenosis of the larynx of the 2nd degree. At the moment, from complaints - startling, restless sleep, can wake up four times, sometimes cries in a dream with eyes closed, breastfeeding does not always help. Periodically there are red whites of the eyes. A week ago, he began to frequently "shake" his head from side to side, as if saying "no", involuntarily. Maybe even while feeding. Sometimes vomits. But earlier doctors told me that it was because of overfeeding or because of mobility immediately after eating. Of the "skills" - he rolls over, tries to sit down and crawl, but until he sits himself and crawls only in a plastunsky way, pronounces separate syllables. Active. Smiling, recognizes his. Breastfeeding + complementary foods (vegetables, fruits, cereals). Can you tell me if I should take the prescribed treatment? (For three days we have been drinking Triapur and Pantocalcin). When to repeat NSG? And is it dangerous? And if so, what? Thank you very much![Only registered and activated users can see links] ([Only registered and activated users can see links])

27.04.2014, 19:35

I would also like to add that the weight at the moment is 10 kg, 400 g, height is 69 cm, blood and urine tests are normal. In addition, rickets of the 2nd degree was made from the diagnoses, they took 4 drops of Vigantol for a month, now they switched to two. And the neurologist at the hospital at the age of four months already suspected violations of the liquor metabolism, asked to do stroking movements every day in the direction from the head to the feet, but in the conclusion he did not write anything, because. NSG was not done at that time.

28.04.2014, 12:16

Dear specialists, pediatric neurologists! I re-read the article about ICP and so on. on the forum. It is written that taking diuretic drugs is contraindicated, but what then to do? I didn’t understand, is an increase in the volume of cerebrospinal fluid this is hydrocephalus? How to treat it, if not promptly, as described in the article? Can it go away on its own? I understand that deviations from the norms in one direction or another are allowed, but as far as I can estimate myself, our values differ greatly from the norm. The child does not sleep for a week at night practically + everything that I described above. Although I do not rule out that this may be due to other factors. The norms of the growth of the volume of the head are not opened by the link. The phrase about the hydrocephalic shape of the skull is confusing. Help me, I can't find a place for myself anymore. I think, should I go to another specialist or continue treatment? The doctor who deciphered the NSG said "everything is bad with you." The neurologist just wrote a treatment plan. I would like to know if we are on the right track or do we need to do something fundamentally different or do nothing at all? Thank you very much in advance!

28.04.2014, 12:25

Write down the increase in head circumference by months (preferably with other parameters (body weight, chest circumference).
I would also like to see NSG scans (ultrasound of the head).

28.04.2014, 13:59

Stanislav Ilnurovich, thank you for responding! From the data I found on the map.
At birth: weight - 3680, height - 53, OG - 36, approx. gr. class - 35.
1 month: weight - 4554, height - 56, OG - 37, approx. gr. class - 36., native. 2.5x2.5
2 months 11 days: weight - 6140, height 60.
3 months: weight - 7100, height - 62, OG - 43, native. 3x3.
4 months 7 days: weight 8300, height - 63, OD - 44.5, approx. gr. class - 50.5.
7.5 months: weight 10400, height 69, OD 45, approx. gr. class 47, native 2x2.
Not everywhere there are parameters for the circumference of the head and chest, because. not every month they were measured in the clinic, but I did not assume that this was important. From 4 to 7 months, a break in measurements, because during this period, bronchitis, chickenpox just fell, they did not go to the clinic, weight gain was already less than kg / month.
Neurosonography at 7.5 months
Neurosonography at 1 month:
[Only registered and activated users can see links] ([Only registered and activated users can see links])

28.04.2014, 15:13

It makes sense to look for a 2nd opinion.
According to the data presented, I consider the prescribed treatment inappropriate.
We observe in dynamics, we discuss.

Ultrasound of the brain
Hello! I did an ultrasound of the brain of a child at 5 months, the 4th ventricle was not expanded, and at 12 months it expanded by 4.5 mm. Please tell me the norm for the size of the expansion of the 4th ventricle at 12 months?
Help me figure out the conclusion of the ultrasound of the brain!
Please help us figure out our problem! Our daughter is 6 months old. At 1 month, an ultrasound of the brain was done, two cysts 3 and 4 mm in size were found on the right and left, respectively. They pierced Cortexin injections, did a massage. There were no complaints about the child. It develops in accordance with age, gains weight well, sleeps calmly, is not particularly capricious. There was a slight tone, but after the massage everything went away. Now he is getting on all fours, trying to crawl, but he is not sitting yet. At 6 months we went for another ultrasound. In conclusion, nothing was written about cysts, but structural changes were written - hyperechoic inclusions along the vascular wall. Note: Periventricularly on the lateral surface in the region of the body of the ventricle, there is an area of significant increased echogenicity with an acoustic shadow 2.5 mm wide, 10 * 3.6 * 6 mm in size. Conclusion: ultrasound signs of focal changes periventricularly on the right (eye area?). We were very frightened by this conclusion, but the neurologist said that outwardly the girl was absolutely healthy and advised us to redo the ultrasound in another place. We will redo the ultrasound, but the unrest still remains, tell me what such a diagnosis means and what should we expect? Many thanks in advance for your reply!
ultrasound of the brain
Hello, we are 2 months old, we did an ultrasound of the brain a month, the result was 1 ultrasound, cerebral ischemia, 2 ultrasounds were done a month, the maturity of the brain structure: mature, right side stomach 4 "7 mm left 4.8 mm, anterior horn index 0.4% third ventricle 3.7mm fourth 3.4mm between the hemispheric fissure 5.6mm, subarachnoid space along the convexital surfaces of the hemispheres 4.0mm echogenicity: average blood flow in cr mc 0.67 venous outflow is not disturbed, conclusion: moderately pronounced postischemic manifestations, dicctation of the cerebrospinal fluid system , the results of 3 ultrasound, at 2 months, 1. The location of the brain structures is correct, 2: the structures of the brain are not mature index of the anterior horns 33MM in r and the large cistern of the brain was not changed 4.0 mm, the hemispheric fissure 4-5 conclusion. Slight signs of immaturity of the brain substance. Moderate expansion of the convexital sections of the subarachnoid space throughout. ,between the hemispheric silk.. slightly third ventricle and left ventricle. Hypoxic manifestations are periventricular 1 degree and predominantly in the beer departments and slightly subependymal. According to hemodynamic parameters, the venous outflow is hampered by psebetarterial pulsation. HF hypertension. Indicators of arterial blood flow were within the normal range. Treatment of tanakam and pantogam, please tell me if the treatment is correct, and how much we seriously thank you

Hydracephalus: external or internal? What is the difference?

Question:
My son is 1 year 1 month old. Complaints: irritability, attacks of sudden irritability, excessive sweating, restless superficial sleep (sleep better with age), crying when dressing and undressing (now this also happens less often). Up to 8-9 months. frequent regurgitation, divergent strabismus (concomitant) of the right eye (diagnosis from an ophthalmologist), fundus: OU optic disc pale pink, clear boundaries, plethoric veins on the left, narrowed arteries A(B)=1:2.5; on the right, the vessels are not changed A(B)=1:2. At the age of 4.5 months. left-sided torticollis was discovered, it was corrected by massage and a course of MILT (magnetic laser therapy). At 7 months They did an ultrasound of the brain: the right ventricle - anterior horn 2 mm, body 5 mm, occipital horn. 4 mm; left ventricle - anterior horn 2 mm, body 5 mm, occipital horn 8 mm, 3rd ventricle not expanded to 4 mm. In glomusomas, small liquid inclusions up to 5 * 3 mm are visualized, the subarchnoid space is slightly expanded up to 2 - 8 mm. The interhemispheric fissure is slightly expanded to 2-6 mm, the depth is 20 mm in the parietal region. Zach-e: Mild external form of hydrocephalic syndrome. The neuropathologist said that there were no reasons for worries, she recommended only glycine and coniferous baths. At 11 months The child fell and hit his head. A year later, another ultrasound scan was done: the interhemispheric fissure is normal, bone-marrow diastasis in the anterior sections is normal. The anterior horns of the lateral ventricles are 7.5 mm, the occipital horns are 17 mm, the 3rd ventricle is 6 mm, the choroid plexuses of the lateral ventricles are dilated by the solution of the occipital horns, periventricular areas of high echogenicity. Conclusion: Signs of internal hypoxic hydrocephalus. The neurologist prescribed to drink diacarb 5 days every other day and asparkam 10 days, glycine, cynarizine, pantocalcin for 1 month. What kind of hydrocephaly do we have: external or internal? What is the difference? What can this mean for the child in the future? Are we being treated right? Tell me, please, I went around 4 neurologists and everyone says different things.

Answer: When was the last time you went to an ophthalmologist? With an increase in intracranial pressure, usually in the fundus, the changes are bilateral, in your child - on the left, which is combined with left-sided torticollis - if there is a violation of blood circulation in the cervical spine, visual impairment is possible, with eye pathology, the vessels of the fundus also change. Also, venous stasis, impaired blood flow in the cervical spine lead to excessive accumulation of cerebrospinal fluid, and it is the high echogenicity of the periventricular areas - they make up the walls of the lateral ventricles, in which the cerebrospinal fluid is located, confirm this. An increased amount of cerebrospinal fluid in the ventricles of the brain is internal hydrocephalus, with its accumulation in the subshell spaces, on the outer surface of the brain - external. At the moment there are signs of internal hydrocephalus, the external one was compensated over time by therapy. Follow the treatment prescribed by the neurologist. It is necessary to apply for a consultation with an orthopedist, vertebrologist, according to the results, determine the course of massage. It is also possible to conduct ultrasound dopplerography of the vessels of the brain, neck, depending on the age at which this study is carried out in your city.

brain encephalopathy
Due to some circumstances and difficult childbirth, from the moment the baby was born, I worry about not overlooking some deviations in him. I know that, for example, brain encephalopathy is very difficult to diagnose in babies. Mine is almost 5 months now. Sometimes I notice that the child does not fall asleep well and is naughty for a long time before going to bed. and sometimes for a long time he cannot focus on any subject. What examination would you recommend to undergo to rule out encephalopathy, thank you!
hyperactive child
What to do with a hyperactive child? Doctor, please advise what to do, I no longer have the strength to deal with a third child. The birth was difficult, almost immediately after the second pregnancy. The third child was born prematurely, but now he has more or less gained weight. And now he is almost a year old, not a minute of literally rest. He crawls, howls, if I don’t look at him or don’t work with him, he starts screaming, crying, banging his head on the floor ((They did soothing baths, massage, everything helps for a while. Such hyperactivity - is there a reason to prescribe special treatment? And you can can home methods do? thank you very much