What is external cerebral hydrocephalus? Moderate external hydrocephalus: symptoms, causes, treatment

Dropsy of the brain is the accumulation of fluid in the ventricles of the brain. Excess CSF puts pressure on the ventricles, increasing its volume and the size of the skull. As a result, the shape of the head changes. Increased CSF pressure can damage the brain tissue and cause a variety of violations of its functions and a delay in the development of the child.

Hydrocephalus of the brain can develop in people of any age, but it is most common in infants and the elderly. An operation that restores and maintains a normal amount of cerebrospinal fluid can help the patient. Physiotherapy methods, medicines, physiotherapy exercises and other methods of restoring impaired brain functions are used. Severe pathology in a newborn child requires urgent surgical intervention.

The disease in newborns occurs in 1 case per 500 births. It is difficult to estimate its prevalence among adults; such records are not kept. However, many patients with elevated intracranial pressure may have this condition.

The causes of the disease are completely unknown. Main risk factors:

hereditary genetic anomaly, leading to a narrowing of the outflow of cerebrospinal fluid;
neural tube malformations, such as spina bifida or anencephaly;
intrauterine infections (herpes, toxoplasmosis, cytomegaly);
premature birth, complicated by intraventricular hemorrhage in the fetus;
diseases of the nervous system: meningitis, brain tumors, trauma, hemorrhage in the subarachnoid space in hemorrhagic stroke.

All these conditions disrupt the free circulation of cerebrospinal fluid around the brain or its absorption into the venous bed.

Signs of pathology

Symptoms of the disease depend on the age of the patient, the severity of the pathology, as well as individual differences. For example, a child's ability to compensate for ventricular expansion differs from that of an adult. The skull of an infant expands under the influence of increased intracranial pressure, since its sutures are not yet closed.

Signs of hydrocephalus in the congenital form of the disease:

a rapid increase in the head or its size is too large;
vomit;
drowsiness, lethargy;
restlessness, prolonged crying;
rolling eyes down;
convulsions.

The appearance of the child acquires characteristic features: the bones of the skull become thinner, the seams are expanded, the forehead is disproportionately large, the eyebrows hang over the eyes. The fontanel bulges, the veins on the scalp are clearly visible. There may be divergent strabismus, increased muscle tone.

In adults, the space inside the skull cannot increase. Their pathology is accompanied by such manifestations:

headache;
vomiting, nausea;
clouding or double vision, blurred vision (this condition develops due to swelling of the optic nerve);
rolling eyes down;
imbalance, gait;
urinary incontinence;
retardation of development;
lethargy, drowsiness, irritability;
personality changes, including memory loss.

Signs of the external form of the disease:

gait disturbance;
increased urination or urinary incontinence;
progressive dementia or mental disorders;
slow movements, weakness in the legs.

Often these symptoms appear due to the expansion of the cavities of the ventricles during atrophy of the brain substance caused by a stroke, tumor, trauma in adults. Differential diagnosis with Parkinson's disease, Alzheimer's disease and Creutzfeldt-Jakob disease is required.

Hydrocephalus in children

Hydrocephalus of the brain in a newborn develops with improper development of the nervous system due to genetic abnormalities, intrauterine infections, and complications during childbirth. The cavities of the brain expand under the action of CSF pressure, the size of the head increases, its shape changes. Neurological disorders occur, but convulsions and disruption of the heart appear even earlier.

Hydrocephalus in a child is often accompanied by endocrine diseases:

growth retardation;
underdevelopment of the genital organs;
diabetes insipidus;
obesity;
hypothyroidism.

There are cases of hyperkinesis (tics, involuntary movements), lower paraparesis (weakness and lack of movement in the legs), impaired coordination of movements. If the operation is not performed on time, these disorders will steadily progress. When treatment is started in a timely manner, the disease does not threaten the life of the child.

Hydrocephalus in adults

Dropsy of the brain, or hydrocephalus in adults, leads to mental disorders, changes in gait, loss of control over urination and other pathological conditions.

There are several forms of the disease. External pathology in an adult is characterized by a retention of cerebrospinal fluid in the space under the membranes of the brain and compression of its tissues from the outside. If fluid accumulates in the cavities of the ventricles, it causes them to stretch. There is also a mixed form of pathology.

This chronic process is accompanied by an increase in intracranial pressure. The first sign of the disease is a change in gait. It can occur acutely, against the background of normal health. Other symptoms develop after a few months.

The patient hardly takes the first step when walking, in the future he can simply stagnate. Hand movements are also difficult. In the future, balance is disturbed, muscle tremors occur, sometimes the patient falls. In severe cases, he cannot sit, walk, or even get out of bed.

As a result of the disease, mental disorders occur. Emotional reactions are dulled, apathy, loss of a sense of time occurs. There are seizures and even hallucinations.

Moderate pathology of the brain in an adult is accompanied by frequent urge to urinate, which is gradually replaced by urinary incontinence.

The listed 3 signs are the main symptoms of pathology in adults. Vomiting is not typical for them. The presence of this triad should alert the doctor. The patient is referred for a brain tomography.

Neurosurgery is performed to relieve symptoms and slow the progression of the disease. During it, the surgeon installs a shunt in the desired area of the brain, through which excess liquor is removed from the ventricles and spaces under the membranes.

Some patients are prescribed drugs that stop the excess production of cerebrospinal fluid.

moderate hydrocephalus

This condition usually occurs as a complication of strokes, trauma, meningitis, or brain tumors. A moderate form of the disease is most often recognized after an additional examination of the patient. The course of the disease is not accompanied by severe symptoms.

Moderate external hydrocephalus is accompanied by an increase in pressure in the cranial cavity and compression of its tissues. Cerebral manifestations are possible - headache, nausea and vomiting. With a stable or regressing form of pathology, drug treatment is prescribed. If the severity increases, surgery is indicated.

Replacement hydrocephalus

With a decrease in brain volume, a substitution form of the disease develops as a secondary condition. It can occur in children, but is more common in adults. In children, the causes of the accumulation of cerebrospinal fluid in the dilated ventricles may be congenital anomalies in the development of the brain. In older people, atrophy of the brain tissue occurs due to infections, poor nutrition, and circulatory disorders. Pathology can occur with normal or increased intracranial pressure.

Diagnosis of pathology is based on data on the past brain disease, neurological examination and tomography indicators. Since the symptoms of the disease are secondary, surgery is usually not required, medications are prescribed. The operation is performed only with a significant violation of the outflow of cerebrospinal fluid.

Mixed hydrocephalus

With the accumulation of cerebrospinal fluid both in the ventricles of the brain and in the subarachnoid space, mixed hydrocephalus occurs. It develops in people of any age and is manifested by a combination of signs of external and internal forms of pathology.

In children, abuse is accompanied by an increase in head size and neurological disorders. In adults, it can appear acutely, for example, after an injury. Surgical treatment.

Internal hydrocephalus

With the accumulation of excess CSF in the cavities of the ventricles of the brain, internal hydrocephalus develops. It occurs when malabsorption of cerebrospinal fluid or as a result of deterioration of ventricular shunting.

The internal form of the disease is often accompanied by increased intracranial pressure, headache, nausea, and neurological disorders. It can be congenital and acquired (after injuries, infectious diseases). Treatment of pathology is surgical.

Non-occlusive hydrocephalus

Communicating, or non-occlusive hydrocephalus, is caused by impaired absorption of CSF by the villi of the arachnoid membrane of the brain. It is usually a complication of meningitis. It also happens with excessive formation of cerebrospinal fluid due to a tumor of the choroid plexus. Examination reveals enlarged subarachnoid spaces.

The course of the disease is more favorable, since the normal flow of cerebrospinal fluid between the ventricles is maintained. However, with a long process in the body, changes occur that are characteristic of a severe form of the disease - neurological symptoms, visual impairment, gait, headache. With this form of the disease, surgical intervention is necessary.

Occlusive hydrocephalus

The condition in which the circulation of cerebrospinal fluid from the ventricles under the membranes of the brain stops is occlusive hydrocephalus. Cerebrospinal fluid is not absorbed, the development of dropsy of the brain. Pathology is caused by a congenital anomaly in the structure of the brain. In adults, it can be caused by a tumor, trauma to the skull, or another neurological disease. Treatment of pathology is only surgical.

Diagnosis of the disease

With symptoms of pathology, you need to contact a neurologist. Diagnosis of hydrocephalus begins with determining the age of the patient, his complaints, assessing the circumference and shape of the head. A neurological examination is carried out, including the diagnosis of intracranial hypertension syndrome. The doctor finds out whether the pathology has an acute or chronic course, whether it was preceded by an infection (meningitis) or an injury. A spinal puncture and CSF analysis are prescribed, an increase in intracranial pressure is recognized. An ophthalmologist is consulted.

Additional diagnostic methods to clarify the form of dropsy of the brain and the state of its tissues:

tomography (computer or magnetic resonance);
monitoring of intracranial pressure.

The external form of the disease is characterized by an expansion of the intrathecal spaces, the internal form by an increase in the ventricles. The external replacement form of the disease is accompanied not only by an increase in the size of the ventricles, but also by atrophy of the nervous tissue. Depending on the data obtained, the tactics of helping the patient is determined - medical or surgical.

Symptoms of the disease

Signs of pathology depend on the age of the patient.

Symptoms of the disease in infants:

big head;
rapid growth of the skull;
tense fontanel;
feeding difficulties;
vomit;
lethargy.

Symptoms of hydrocephalus in children:

headache;
blurred vision;
violation of balance and coordination;
nausea, vomiting, drowsiness, behavioral disturbances, convulsions;
learning difficulties.

Symptoms of pathology in adults:

headache in the morning;
loss of balance;
frequent urination;
impaired vision, memory, attention, decreased performance.

Symptoms of cerebral hydrocephalus in the elderly:

urinary incontinence;
disorders of memory and thinking;
shuffling gait;
slow movements, poor coordination.

These signs are caused by a violation of the absorption of cerebrospinal fluid under the membranes of the brain or an obstacle to its normal outflow. The patient needs a neurological examination. Medical care consists in prescribing drugs or surgical intervention (bypassing the outflow of CSF).

Treatment of the disease

Violation of the circulation of cerebrospinal fluid in the cavities of the brain and spaces under its membranes leads to neurological syndromes, vascular disorders. Pressure on the nerve tissue of the child causes a delay in its development. This condition is accompanied by vomiting, headache, muscle dysfunction. The problem can be congenital or acquired, due to a tumor or an infectious process. But in any case, the treatment of hydrocephalus of the brain is carried out surgically.

Treatment of the disease includes 2 surgical methods: shunting and ventriculostomy.

One of the indications for shunting is open hydrocephalus, but the operation is also used for other forms of pathology. A shunt is a long, flexible tube with a valve that directs CSF from the brain into the abdomen or heart chamber. The shunt is placed under the skin and can be replaced if necessary.

Treatment of the disease in adults and children with impaired outflow from the ventricles is endoscopic ventriculostomy. The surgeon, under video control, using endoscopic instruments, expands the hole in the 3rd ventricle, restoring the normal circulation of CSF.

Additionally, patients need the help of a physiotherapist, social worker, psychologist, teacher (for children with developmental delays).

Treatment of external hydrocephalus of the brain in an adult with its mild degree and the absence of progression can be carried out with the help of drugs, for example, diuretics. Neurotropic medications are prescribed to improve brain metabolism. In severe cases, the help of a social worker, vocational training specialist, psychiatrist is needed.

Treatment of the external form of the disease, as well as the internal one, should begin as early as possible. A timely operation will enable the child to develop normally, and the adult to avoid neurological and mental disorders.

Disease prevention

It is impossible to prevent the appearance of dropsy of the brain. However, the prevention of hydrocephalus helps to reduce the risk of pathology.

The disease in children under one year old is prevented with regular prenatal examination and prevention of preterm birth.

Vaccination against infectious diseases is required. It will protect the body from meningitis, tuberculosis and other dangerous conditions that can cause a violation of the outflow of cerebrospinal fluid.

To avoid head injuries leading to an occlusive or open form of the disease, it is necessary to observe safety measures: transport children in car seats, use non-traumatic devices for care, feeding, and so on. Children and adults must wear a helmet when riding a bicycle, scooter, skateboard, etc.

At the first symptoms of the disease, a neurological diagnosis is necessary. A study of cerebral fluid, ultrasound, tomography is prescribed. The consequences of hydrocephalus are dangerous, so it is necessary to carry out surgical intervention (bypass surgery or endoscopic surgery) in time and take prescribed medications.

Video about hydrocephalus

Increased accumulation of cerebrospinal fluid in the cerebrospinal fluid system of the brain. Hydrocephalus accompanies many congenital and acquired neurological diseases. Clinically, it manifests itself with signs of increased intracranial pressure (headache, nausea, pressure on the eyes), symptoms of compression of brain structures (vestibular ataxia, visual impairment, mental disorders, epileptic seizures) and symptoms characteristic of the disease that caused it. Diagnosis of hydrocephalus includes x-ray of the skull, ophthalmologic examinations, Echo-EG (in infants - neurosonography), MRI or CT of the brain. Surgical treatment of hydrocephalus makes it possible to correct congenital anomalies of the CSF system, to remove intracranial formations that violate CSF circulation, and to establish an outflow of CSF from the cranial cavity.

Acquired hydrocephalus can occur as a result of inflammatory processes in the brain and its membranes (encephalitis, arachnoiditis, meningitis), traumatic brain injury, vascular disorders (ventricular hemorrhage, hemorrhagic stroke or intracerebral hematoma with a breakthrough of blood into the ventricles). Hydrocephalus often develops against the background of a colloid cyst of the third ventricle and intracerebral tumors (astrocytomas, germinomas, ganglioneuromas, etc.), which grow into the ventricles of the brain or compress the CSF pathways, thereby disrupting the normal circulation of CSF and its outflow from the cranial cavity.

Separately, an atrophic (replacement) form of hydrocephalus is distinguished, which occurs as a result of post-traumatic death or age-related atrophy of brain tissues. In this case, cerebrospinal fluid fills the space that is formed inside the cranium as a result of a decrease in the volume of the brain. Atrophic hydrocephalus in old age can develop against the background of a violation of the blood supply to the brain with atherosclerosis of the cerebral vessels, hypertension, diabetic macroangiopathy.

Pathogenesis

Normally, CSF (cerebrospinal fluid) is produced by the choroid plexuses of the interconnected ventricles of the brain. Its largest amount is formed in the lateral ventricles, from where the cerebrospinal fluid enters the third ventricle, and from it through the sylvian water supply to the fourth ventricle. Then the cerebrospinal fluid enters the subarachnoid (subarachnoid) space, which extends over the entire surface of the brain, and in the caudal direction passes the region of the craniovertebral junction and further surrounds the spinal cord throughout its entire length. The cerebrospinal fluid located in the subarachnoid space is constantly absorbed by the arachnoid (arachnoid) membrane of the spinal cord and brain and enters the bloodstream. The above etiological factors that disrupt the production, movement and absorption of CSF lead to its excessive accumulation and the occurrence of hydrocephalus.

Classification

According to the etiological principle, congenital and acquired hydrocephalus are distinguished.

According to the mechanism of occurrence, hydrocephalus is classified into open and closed forms. Open hydrocephalus is associated with hyperproduction of CSF or impaired absorption during normal CSF circulation. Closed hydrocephalus is caused by a violation of the outflow of cerebrospinal fluid due to compression, partial or complete obstruction of any part of the CSF system of the brain.

Depending on where the excess accumulation of CSF occurs, internal and external hydrocephalus are distinguished. Internal hydrocephalus is accompanied by the accumulation of cerebrospinal fluid in the ventricles of the brain. External hydrocephalus is characterized by an excess of CSF in the subarachnoid and subdural space.

According to the features of the course, hydrocephalus is classified as acute, subacute and chronic. Acute hydrocephalus is characterized by rapid development, in which a few days after the onset of the first signs of the disease, decompensation occurs. Subacute hydrocephalus develops within a month, and chronic - more than six months.

Of great clinical importance is the division of hydrocephalus into stabilized (compensated) and progressive (increasing). Stabilized hydrocephalus does not grow and usually proceeds with normal CSF pressure. Progressive hydrocephalus is characterized by aggravation of symptoms, accompanied by an increase in cerebrospinal fluid pressure, poorly amenable to conservative therapy and leads to atrophy of brain tissue.

Symptoms of hydrocephalus

In adults

The accumulation of excess amounts of cerebrospinal fluid in a limited space of the cranium leads to an increase in intracranial pressure, which causes the most typical symptoms of hydrocephalus. In adults and older children, these include: intense headache not relieved by analgesics, nausea, vomiting, a feeling of pressure on the eyeballs. These symptoms may occur acutely or increase gradually, having a transient character at the beginning of the disease. Atrophic hydrocephalus often occurs without signs of increased intracranial pressure and is detected only with an additional examination of the patient.

In most cases, hydrocephalus is accompanied by neurological symptoms, which are caused both by compression of the brain structures by enlarged cerebrospinal fluid spaces, and by the underlying disease that causes the development of hydrocephalus. Most often with hydrocephalus, vestibular and visual disturbances are noted. The first includes vestibular ataxia, manifested by dizziness, gait instability, tinnitus and head noise, nystagmus. On the part of vision, there may be a significant decrease in visual acuity, loss of certain parts of the visual fields, congestive optic discs; with a long course of hydrocephalus, atrophy of the optic nerves may develop.

Hydrocephalus can occur with disorders of the motor and sensory spheres: paresis and paralysis, increased tendon reflexes and muscle tone, a decrease or complete loss of all types of sensitivity, and the formation of spastic contractures of the limbs. Occlusive hydrocephalus, caused by a violation of the CSF circulation in the region of the posterior cranial fossa, is characterized by symptoms of cerebellar ataxia: impaired coordination and gait, large-scale disproportionate movements, changes in handwriting, etc.

In some cases, hydrocephalus is accompanied by mental disorders, which in adults are more often manifested by violations of the emotional-volitional sphere: emotional instability, neurasthenia, causeless euphoria with a rapid transition to a state of indifference and apathy. With a sharp increase in intracranial pressure, aggressive behavior is possible.

Symptoms of hydrocephalus in children

In children, due to the great compliance of the skull bones, there is no increase in intracranial pressure; hydrocephalus in them is accompanied by an increase in the size of the skull. In newborns and young children, hydrocephalus is characterized by too large a head, swelling of the scalp veins, tension and lack of pulsation of the large fontanel, and swelling of the optic discs. Often there is a symptom of the "setting sun" - restriction of upward movement of the eyeballs. There may be a divergence of the sutures of the skull. Tapping on the skull is accompanied by a characteristic sound ("cracked pot" symptom). In children of the first year of life, hydrocephalus leads to developmental delays. They later begin to hold their heads, roll over, sit and walk.

Children who have severe hydrocephalus are distinguished by a spherical head shape, its too large size, deep-set eyes, protruding ears, and thinning of the scalp. There may be a decrease in vision, increased muscle tone in the lower extremities, disorders of the cranial nerves. Unlike adults, in childhood, hydrocephalus is more often accompanied not by emotional and volitional disorders, but by intellectual insufficiency. Children with hydrocephalus are usually inactive and obese. They are apathetic, lack of initiative, do not have attachment to relatives characteristic of their peers. Reducing the degree of hydrocephalus often leads to an increase in the intellectual abilities and activity of the child.

In adolescence, hydrocephalus often occurs acutely against the background of an infectious disease, mental or physical trauma. At the same time, it is accompanied by intense headache, repeated vomiting, bradycardia. There may be bouts of loss of consciousness, sometimes convulsive seizures. In some cases, there are episodic psychoses with hallucinatory or delusional syndrome.

Diagnostics

The clinical symptoms of hydrocephalus are usually so characteristic that they allow the neurologist to suspect its presence at the first examination of the patient. To determine the degree and form of hydrocephalus, as well as to identify the underlying disease, additional examinations are carried out: X-ray, ultrasound, computed or magnetic resonance imaging.

An ophthalmologist evaluates visual disturbances and the condition of the optic discs. As a rule, the list of ophthalmological examinations for hydrocephalus includes ophthalmoscopy, determination of visual acuity and perimetry.

Tomographic diagnostic methods make it possible to determine the nature of hydrocephalus, to identify the site of occlusion of the CSF tract or an existing congenital anomaly, to diagnose the causative disease (tumor, cyst, hematoma, etc.). With hydrocephalus, the use of MRI of the brain is most informative.

In the absence of contraindications, a lumbar puncture may be performed to identify the causative disease, followed by examination of the cerebrospinal fluid. If vascular disorders are suspected, MRA of cerebral vessels is indicated. Congenital hydrocephalus of infectious etiology requires PCR diagnostics to determine the type of infection that caused it.

Treatment of hydrocephalus

The choice of treatment for hydrocephalus depends on its etiology. Conservative therapy is often carried out with acquired hydrocephalus due to inflammatory diseases, traumatic brain injury, hemorrhage into the ventricles. The underlying disease is treated, and diuretics (acetazolamide, furosemide) are prescribed to reduce the degree of hydrocephalus and increased intracranial pressure.

Ventriculoperitoneal shunting, lumboperitoneal shunting, external ventricular drainage. They are aimed at creating additional pathways for the outflow of cerebrospinal fluid from the cranial cavity. Bypass surgery can be performed as an addition to the surgical treatment of the underlying disease, if during the operation it is not possible to restore the normal circulation of the CSF.

External hydrocephalus is also called "dropsy". This pathology has several forms at once. The main characteristic of the disease can be considered an excessive accumulation of cerebrospinal fluid in the spaces of the brain, and in some cases also a violation of its production and outflow.

External hydrocephalus: what is it?

This pathology is classified as a serious disease of the neurological sphere. It occurs in the ventricular system and the subarachnoid space of the brain. The peculiarity of the pathology is manifested in the accumulation of excess cerebrospinal fluid in these areas and the violation of its outflow. At the same time, the amount of cerebrospinal fluid in the brain significantly exceeds the norm. Doctors distinguish congenital (obtained as a result of pathologies of intrauterine development) and acquired forms of the disease.

Previously, hydrocephalus was considered exclusively a childhood disease, since it was almost always congenital and was recorded in approximately 2-10 babies per 1000 newborns. Later, the disease began to be detected in adults. In this case, the disease is formed as a complication after other pathologies of the brain, such as stroke, traumatic brain injury, certain neoplasms, infections, or meningitis. Sometimes the disease is also “independent”, that is, it is formed solely as a result of an improper outflow of cerebrospinal fluid and its accumulation in the spaces of the brain.

Forms of the disease

Depending on the pathogenesis, doctors distinguish several forms of the disease:

open (non-occlusive);
closed;
hydrocephalus ex vacuo.

In the first case, the disease is formed as a result of a violation of the production and absorption of cerebrospinal fluid, and free communication of spaces carrying cerebrospinal fluid is assumed. With a closed form, these spaces are separated at different levels. Hydrocephalus ex vacuo is characterized by the consequence of atrophy (wasting) in the case of certain CNS pathologies (eg Alzheimer's disease) or the normal aging process.

There are other options. Vicarious hydrocephalus is accompanied by an increase in the size of the ventricles, but the normal anatomy of the brain is not affected. The internal form differs significantly from the external one. In the second case (with an open external form), the space under the membranes of the brain expands, the "dropsy" overflows, as a result of which thinning of the medulla may occur in the future. This is not the case with internal hydrocephalus.

Signs of external hydrocephalus

Symptoms of this disease can be different, to a greater extent they depend on the form of the disease and the characteristics of its course. Possible signs of external hydrocephalus include:

A mild or mild stage of the disease may not be accompanied by changes in well-being at all. In this case, the patient writes off fatigue, weakness and a slight headache to adverse weather conditions, stress or workload at home or at home. The clinical picture is unexpressed, the patient has only weak manifestations of the initial signs.

In the absence of the necessary treatment, the patient develops replacement hydrocephalus. It is accompanied by significant changes in the body and can lead to such unpleasant symptoms as impaired memory and thinking, as well as dementia. Separately, it is necessary to highlight the signs of hydrocephalus in infants. Usually in babies, the disease is pronounced and is accompanied by symptoms such as swelling of the veins and fontanelles, excessive head volume, discrepancies in the areas of connection and fusion of the bones of the skull, loss of appetite, inhibited reaction, and others.

Diagnostics

The most effective method for examining patients with this pathology is MRI (magnetic resonance therapy). It allows you to assess the severity of the disease and its form. However, in some cases, other diagnostic methods may be recommended, for example, computed tomography, angiography (contrast x-ray examination of blood vessels), ultrasound examination of the brain, and some laboratory tests. CT is necessary to diagnose the contours of the anatomical structures of the brain, to identify other anomalies, such as neoplasms.

Treatment

The tactics of therapy primarily depend on the form of hydrocephalus and the age category of the patient. In most cases, conservative therapy is prescribed first. The patient is recommended diuretics and vasodilators. They normalize the functioning of the central nervous system and control the outflow of cerebrospinal fluid. At the same time, special drugs are prescribed to reduce the production of cerebrospinal fluid and improve venous outflow. Most often, conservative treatment can only slow down the development of the disease and alleviate the patient's condition, only occasionally does it help to achieve a complete recovery.

If therapy with drugs for several months did not help stabilize the process, and the accumulation of cerebrospinal fluid progresses, the patient is recommended surgical intervention. Most often this is a bypass or endoscopic surgery. Both methods have their advantages and disadvantages, as well as indications and contraindications, so only a qualified neurosurgeon can decide on the type of intervention. Remember that conservative treatment and therapy with folk or traditional methods are ineffective for external hydrocephalus. Do not self-medicate, it is not only useless, but can be dangerous to your health!

Hydroencephalopathy of the brain is also known as dropsy. Any head injuries, infections, strokes (), tumors, etc. can provoke replacement hydrocephalus. This disease is considered very difficult to tolerate in adults, and even more so in childhood.

Risk factors for the formation of hydrocephalus are associated with the fact that too much CSF is synthesized. In general, this fluid has many useful functions, but its volume should be within the normal range. If its quantity begins to increase, then it accumulates in the cavities of the skull. And this provokes serious disturbances in the work of the brain.

External hydrocephalus can be triggered by various reasons. Usually these are disorders that affect certain areas of the nervous system.

However, a clear diagnosis has not yet been developed. There are times when doctors send their patients to a psychiatric ward and try to treat, but this is the wrong therapy.

The main causes of hydrocephalus in adults are head injuries. The disease can cause a stroke. And this applies to both ischemic and hemorrhagic forms. The cause may be a psychoorganic syndrome.

Increase the risk of developing external dropsy of the brain inflammatory processes in the central nervous system, especially if they are caused by infections (, ventriculitis, tuberculosis, meningitis, etc.).

Provoke hydrocephalus can not only encephalitis caused by infection, but also post-traumatic. The risk of its development increases in people who suffer from cancer. And this also applies to the intraventricular, stem and parastem location.

Hydrocephalus of the brain can be acute and chronic. In both cases, the symptoms will be slightly different. If the disease develops in a child who is not more than 2 years old, then his head circumference will begin to increase sharply.

This is due to the fact that the fluid creates pressure, and the sutures of the skull have not yet strengthened, so they begin to diverge. As a result, the child's head becomes disproportionate, the forehead begins to protrude strongly, the veins on the head are visible. The child becomes very lethargic, it is difficult for him to keep his head straight.

Symptoms

In adults, the symptoms of hydrocephalus will be slightly different. The person complains about constant nausea. There are vomiting episodes. Most often, this symptom torments a person in the morning. There is constant pain in the head, especially after sleep.

The first sign of hydrocephalus, which indicates that the condition is getting worse, is drowsiness. Consciousness can be oppressed, which will develop into a coma. Congestive processes sometimes affect the optic nerves and in a sick person getting worse vision.

Sometimes hydrocephalus in adults develops into a chronic form. In this case, all violations will be systemic, and some of them cannot be corrected. Usually, the disease manifests itself about a couple of weeks after a stroke, meningitis, or injury.

In the chronic form, a person's memory begins to deteriorate dramatically. This is especially true for short-term numbers - age, date, etc. The patient begins to confuse day and night.

If you ask the victim questions, then he thinks for a long time and gives monosyllabic answers, speaks slowly. Sometimes speech becomes completely inadequate.

Diagnostics

The main place in the diagnosis of cerebral hydrocephalus is given to magnetic resonance imaging (MRI) and computed tomography. Physicians should evaluate the size, position and condition of the ventricles, the space in the skull, and the degree of deformity. Only then does the treatment begin.

Computed tomography helps to examine the contours of the brain, the space in it, and so on. Thanks to this technique, you can accurately determine the shape and size of the ventricles, as well as find cysts, tumors and other neoplasms.

Angiography involves the introduction of a contrast agent through an artery, after which an x-ray of the circulatory system can be taken. Any, even the smallest, violations will be identified.

Cisternography allows you to determine how the cerebrospinal fluid circulates. A neuropsychological examination is also carried out. An anamnesis is collected and the patient is interviewed. So you can identify primary disorders in the brain.

Medical treatment

Treatment of hydrocephalus should be started only after the diagnosis has been accurately confirmed. Treatment is carried out with the use of drug therapy.

The applied therapy for hydrocephalus in adults is determined exclusively by a qualified specialist, based on the results of the examination.

If you diagnose at an early stage and start therapy on time, then complications will not arise. A set of measures has been developed that allows you to restore the balance of fluid in the human body, so that this will to some extent eliminate hydrocephalus.

However, these measures do not always help, so treatment is carried out not only with medicines. Be sure to follow the correct mode of activity and rest. In addition, you need to monitor your own nutrition, and this applies not only to the diet, but also to the regimen. Be sure to perform a set of therapeutic exercises. They improve blood circulation and metabolism.

As for medications in the treatment of external hydrocephalus, your doctor will prescribe drugs that have a diuretic effect. Anti-inflammatory drugs are essential. You will also need vasodilators.

These funds help at an early stage in the development of hydroencephalopathy. Usually Panangin or Asparkam is prescribed by a doctor. These are drugs that include magnesium and potassium.

Choline Alfoscerate-cerepro or Gliatilin is prescribed. Mannitol or Mannitol is used. Sometimes Actovegin or Solcoseryl is used.

A separate group consists of:

Telektol;
Vinpocetine or Korsavin;
Acetazolamil;

For severe pain, you can use painkillers. For example, non-steroidal anti-inflammatory drugs - Nimesulide, Ketoprofen, Ketonal, Nimesil and others will go.

Treximed helps with migraine. Barbiturates such as Amital, Nembutal, or Phenobarbital are sometimes used.

Surgical intervention

If medical treatment of hydrocephalus does not help, then surgery will be required. If the acute form of the disease is caused by a hemorrhage inside the ventricle, then such a severe complication can be eliminated only with a neurosurgical operation.

First, a CSF shunt can be performed. The desired effect is achieved in 90% of all operations. This will help eliminate the accumulated fluid and pump it into the natural areas of the body for it. A system of valves and tubes is used.

However, it must be remembered that unpleasant complications of the operation are also possible, and in 50% of all cases. For example, a patient may become infected with a shunt, which means that microorganisms will also pass to the membranes of the brain. There is a risk of blockage in the ventricles. Sometimes the shunt leads to mechanical damage. There are other side effects as well. In addition, the outflow of liquid is very slow.

Secondly, endoscopic treatment of hydrocephalus can be performed. This option is considered more successful and is used much more often than CSF shunting. Here, the outflow of fluid will take place artificially. The advantage of the operation is that the level of its trauma is very low.

After the operation, the patient's quality of life begins to improve. There will be no foreign bodies in the body. CSF flow will gradually recover, so that the patient recovers.

Hydrocephalus of the brain is a very complex and severe disease. Adults and children are difficult to tolerate this disease. Identify hydrocephalus of the brain by symptoms difficult. It is also necessary to carry out serious diagnostic procedures.

Most often, this disease appears in newborns. In this case, the right treatment will help fix everything. However, drug therapy does not always help, so surgery is required.

In order not to cause the appearance of hydrocephalus, it is required to avoid head injuries, eat right and undergo a complete diagnostic examination at least once a year. These rules will help prevent the appearance of such an unpleasant ailment as dropsy.

Symptoms and treatment of cerebral hydrocephalus in adults updated: February 8, 2017 by: author

With the external form of hydrocephalus, excessive formation of cerebrospinal fluid occurs, which normally circulates in the structures of the brain and spinal cord and protects it from mechanical damage. In addition, cerebrospinal fluid supplies the brain with food and removes metabolic products into the blood. As a result of pathological pressure, brain tissue atrophies, negative symptoms occur, and complications increase the risk of coma and death.

Classification of forms of the disease

External hydrocephalus is a form of dropsy of the brain, which consists in excessive accumulation of cerebrospinal fluid (CSF) in the subarachnoid and subdural space of the brain. The subarachnoid cavity is located between the pia mater and arachnoid membrane of the brain and spinal cord. The narrow slit-like subdural cavity is located between the dura mater and the arachnoid. It is permeated with connective tissue fibers.

Types of external hydrocephalus:

Open form - communication of CSF circulation pathways is not disturbed, changes affect the mechanism of absorption of cerebrospinal fluid;

Closed form - there is no message between the spaces in which the cerebrospinal fluid is concentrated and the ways of its circulation;

Hypersecretory form - the production of cerebrospinal fluid is excessive;

The external replacement form - the medulla (parenchyma) is transformed, undergoing atrophy, and cerebrospinal fluid takes its place.

Classification of external hydrocephalus according to the rate of flow:

Acute - from the first signs to the initial decompensation, no more than 3 days pass;

Subacute - lasts for a month;

Chronic - lasts from 3 weeks to six months or more.

According to the level of pressure of the cerebrospinal fluid, it is divided into hypotensive, hypertensive and normotensive forms. The latent course of the disease, which lasts long enough with normal intracranial pressure, is the most dangerous, since the symptoms of the pathology can increase suddenly and avalanche-like without any visible prerequisites. Most often, this situation occurs with external replacement hydrocephalus.

There are congenital and external forms of dropsy of the brain. The congenital form occurs in the process of intrauterine development, acquired hydrocephalus - as a result of trauma or inflammation of the brain structures.

The human body has impressive compensatory abilities. A mild form of external hydrocephalus can go almost unnoticed for the patient - the circulation of cerebrospinal fluid is restored independently. The prognosis of such a disease is the most optimistic, and its consequences are minimal.

An increase in intracranial pressure leads to the following symptoms:

Drowsiness;

visual disturbances (double vision);

Increased fatigue;

Weakness.

All these manifestations are a consequence of a decrease in the density of brain structures due to the fact that they are saturated with cerebrospinal fluid, narrowing of the subarachnoid and subdural space, and improper resorption of cerebrospinal fluid. With the replacement of the cerebral parenchyma with CSF, the symptoms of the disease are exacerbated.

Symptoms of replacement external hydrocephalus:

Violation of large and small motor skills;

Uncertain unsteady gait;

Involuntary urination and fecal incontinence;

Violations of intellectual activity, memory, attention;

Signs of dementia.

If external hydrocephalus is diagnosed in an infant, the following symptoms occur:

Divergence of sutures between the bones of the skull;

Swelling of fontanelles;

Enlargement of the frontal part of the skull;

Lack of appetite;

Swelling of the veins on the skull, clearly visible under thin, stretched skin in the form of a venous network;

Excessive increase in the circumference of the child's head.

Any disruption in the normal functioning of the brain structures can lead to the development of the disease.

Causes of external hydrocephalus:

brain injury;

Consequences of injuries and fractures of the spine;

Tumors of any etiology;