Mild hydrocephalic syndrome in children. Hydrocephalic syndrome: causes of development, symptoms, diagnosis, treatment, prognosis. What is it - hypertension syndrome in children

Hydrocephalic syndrome in infants is a disease in which there is an increase in the ventricles of the brain and a large amount of cerebrospinal fluid accumulates. Among the obvious signs stands out the enlarged head of the child. With hydrocephalic syndrome, the baby may develop brain atrophy. High intracranial pressure leads to swelling of the fontanel and frequent anxiety of the baby. The diagnosis of the disease is based on the results of the examination, ultrasound, CT and MRI. We will tell you more about what it is and how to treat it.

Symptoms of hydrocephalic syndrome

Hydrocephalus can appear in children and adults of any age. In most cases, hydrocephalic syndrome occurs in children. When the liquor (cerebrospinal fluid) began to collect before the fusion of the bones of the skull, the child's head increases significantly in size, the skull begins to deform, which is visually very noticeable.

Along with this, there is atrophy or a stop in the development of tissues of the cerebral hemisphere. In this regard, the intracranial pressure in the child does not rise very high. With a prolonged course of the disease, normotensive hydrocephalus is formed, in which the ventricles are large and dilated, brain atrophy is more pronounced.

External hydrocephalus with a gradual development in a child is characterized by atrophy that progresses. Due to a conduction disorder, the baby develops movement disorders.

Also typical symptoms are visual impairment, and sometimes endocrine disorders. Increased intracranial pressure leads to cerebral ischemia. The baby has disorders at the level of intelligence and psyche. The skin on the head becomes thinner, the bones of the skull become thinner with an increase in the gaps between them. The fontanelles of such a child are constantly tense and are in an expanded state, the pulsation is completely absent. With gentle tapping of the baby's head, you can hear the sound of an empty vessel.

With this disease, there is a violation of the motor function of the eyeball. In such a child, the gaze is directed downward, strabismus develops, which can ultimately lead to complete loss of vision.
Over time, newborns with hydrocephalic syndrome manifest:

• violation of statics and coordination of movements;
• inability to sit, stand and hold the head.

Further, the baby experiences a strong decrease in intelligence, behavioral symptoms change, irritability, excitability, and an indifferent attitude towards others appear. Of the neurological symptoms observed:

• headache;
• drowsiness;
• decreased vision;
• piercing cry.

Swelling of the optic nerve occurs gradually after intracranial pressure begins to rise. It also affects the appearance of the following symptoms:

• slow information processing;
• premature puberty;
• problems with concentration and memory.

The consequences of hypertensive-hydrocephalic syndrome in a child can be expressed as:

• weakness in arms and legs;
• complete loss of vision and hearing;
• disturbed metabolism;
• non-standard temperatures.

There is also a risk of death. But in the case when the operation is performed on time, the patient is on the mend, therefore, there is a chance for recovery. After shunting, the disease ceases to cause concern. If symptoms of hydrocephalic syndrome do not appear within 3 months, the shunt is completely removed.

Diagnostics

If there is a suspicion of hydrocephalic syndrome, first of all, the circumference of the head is measured in the child. Other body parameters are also measured and compared with the indicator of a healthy child. One study is not considered reliable for establishing a diagnosis, because an increase in head volume may be a consequence of rickets or some individual structure of the baby. Measurements must be taken multiple times. If the volume of the head grows, then there is a possibility of hydrocephalic syndrome.

When examining a sick child, methods such as echoencephalography and neurosonography are used. As an indicator of the norm, a slightly increased or slowed down speed of the cerebrospinal fluid (cerebrospinal fluid) is considered. A slight change in the parameters of the ventricle of the brain. All signs of the disease should be examined several times. Also, when diagnosing, a lumbar puncture is performed to measure fluid pressure in the spinal cord.

Treatment of hydrocephalic syndrome in a child

The method of treatment will completely depend on the causes of the onset of the disease and the intensity of the development of the hydrocephalic syndrome. If necessary, pathogenic or symptomatic therapy is practiced, the main goal of which is the elimination of intracranial pressure. Conservative treatment for this disease is ineffective, but it can be applied at the initial stage or as dehydration therapy.

The basis of all effective methods is surgical intervention. It is used in the absence of inflammation of the meninges or in the case of progression of the syndrome. The operation consists of forming a path through which CSF is able to be removed to one of the parts of the body, where it can be utilized.

In the case of an open hydrocephalic syndrome, it is necessary to constantly remove excess cerebrospinal fluid from the cranial cavity. Bypass can be applied to connect the lumbar cistern and the abdominal cavity.

To date, shunting of the cavity of the lateral ventricle with utilization of the cerebrospinal fluid into the cavity of the right atrium is considered the most acceptable. For a long distance, the shunt is carried out under the skin. Shunting is done for children with progressive hydrocephalic syndrome. With any type of shunting, there is a possibility of an infectious complication, therefore, examinations are periodically carried out using ultrasound and computed tomography.

Complications in the treatment of hydrocephalic syndrome

After shunting, some complications may appear in the form of:

• hyperdrainage state;
• shunt occlusion at different levels;
• seizures of epilepsy;
• shunt infection with further development of certain diseases, etc.

To date, with occlusive hydrocephalus, endoscopic surgery is used to restore the patency of the cerebrospinal fluid. Shunt removal is very rare.

Preventive measures for hydrocephalic syndrome
If a child has infections such as syphilis, meningitis, encephalitis, after treatment, preventive measures should be directed to them. It is also desirable to exclude stress and overwork from the child's life. In case of suspicious behavior of a child, seek advice from a pediatrician, neurologist, surgeon, neonatologist.

Key words: perinatal encephalopathy (PEP) or perinatal lesions of the central nervous system (CNS PP), hypertensive-hydrocephalic syndrome (HHS); expansion of the ventricles of the brain, interhemispheric fissure and subarachnoid spaces, pseudocysts on neurosonography (NSG), muscular dystonia syndrome (MDS), hyperexcitability syndrome, perinatal convulsions.
It turns out ... more than 70-80%! children of the first year of life come for a consultation to neurological centers about a non-existent diagnosis - perinatal encephalopathy (PEP):

Pediatric neurology was born relatively recently, but is already going through difficult times. At the moment, many doctors practicing in the field of infant neurology, as well as parents of infants with any changes in the nervous system and mental sphere, are "between two fires". On the one hand, the school of "Soviet child neurology" - excessive diagnosis and incorrect assessment of the functional and physiological changes in the nervous system of a child in the first year of life, combined with long-outdated recommendations for intensive treatment with a variety of medications. On the other hand, there is often an obvious underestimation of the existing psychoneurological symptoms, ignorance of general pediatrics and the basics of medical psychology, some therapeutic nihilism and fear of using the potential of modern drug therapy; and as a result - wasted time and missed opportunities. At the same time, unfortunately, a certain (and sometimes significant) "formality" and "automaticity" of modern medical technologies lead, at least, to the development of psychological problems in a child and his family members. The concept of "norm" in neurology at the end of the 20th century was sharply narrowed, now it is intensively and not always justifiably expanding. The truth is probably somewhere in the middle...

According to the clinic of perinatal neurology of the medical center "NEVRO-MED" and other leading medical centers in Moscow (and probably in other places), so far, more than 80%!!! children of the first year of life come in the direction of a pediatrician or neuropathologist from the district clinic for a consultation about a non-existent diagnosis - perinatal encephalopathy (PEP):
The diagnosis of "perinatal encephalopathy" (PEP) in Soviet pediatric neurology characterized very vaguely almost any dysfunction (and even structure) of the brain in the perinatal period of a child's life (from about 7 months of intrauterine development of a child to 1 month of life after childbirth), arising from pathology of cerebral blood flow and oxygen deficiency.

Such a diagnosis was usually based on one or more sets of any signs (syndromes) of a probable disorder of the nervous system, for example, hypertensive-hydrocephalic syndrome (HHS), muscular dystonia syndrome (MDS), hyperexcitability syndrome.
After an appropriate comprehensive examination: a clinical examination in combination with an analysis of data from additional research methods (ultrasound of the brain - neurosonography) and cerebral circulation (dopplerography of cerebral vessels), fundus examination and other methods, the percentage of reliable diagnoses of perinatal brain damage (hypoxic, traumatic, toxic-metabolic, infectious) is reduced to 3-4% - this is more than 20 times!

The most bleak thing in these figures is not only a certain unwillingness of individual doctors to use the knowledge of modern neurology and conscientious delusion, but also a clearly visible, psychological (and not only) comfort in striving for such “overdiagnosis”.
Hypertensive-hydrocephalic syndrome (HHS): increased intracranial pressure (ICP) and hydrocephalus
Until now, the diagnosis of "intracranial hypertension" (increased intracranial pressure (ICP)), one of the most common and "favorite" medical terms among pediatric neurologists and pediatricians, which can explain almost everything! and at any age complaints of parents.
For example, a child often cries and shudders, sleeps poorly, spit up a lot, eats poorly and gains little weight, goggles his eyes, walks on his toes, his hands and chin tremble, there are convulsions and there is a lag in psychoverbal and motor development: “only it is to blame - increased intracranial pressure. Is it a convenient diagnosis?

Quite often, at the same time, “heavy artillery” is used as the main argument for parents - data from instrumental diagnostic methods with mysterious scientific graphs and numbers. The methods can be used either completely outdated and uninformative / echoencephalography (ECHO-EG) and rheoencephalography (REG) /, or examinations of the “wrong opera” (EEG), or incorrect, in isolation from clinical manifestations, subjective interpretation of the normal variants in neurosonodopplerography or tomography.

Unhappy mothers of such children involuntarily, at the suggestion of doctors (or voluntarily, feeding on their own anxiety and fears), pick up the flag of "intracranial hypertension" and for a long time fall into the system of observation and treatment of perinatal encephalopathy.
In fact, intracranial hypertension is a very serious and rather rare neurological and neurosurgical pathology. It accompanies severe neuroinfections and brain injuries, hydrocephalus, cerebrovascular accident, brain tumors, etc.
Hospitalization is mandatory and urgent!!!

Intracranial hypertension (if it really exists) is not difficult to notice for attentive parents: it is characterized by persistent or paroxysmal headaches (more often in the morning), nausea and vomiting not associated with food. The child is often lethargic and sad, constantly naughty, refuses to eat, he always wants to lie down, cuddle up to his mother.
A very serious symptom can be strabismus or pupillary difference, and, of course, impaired consciousness. In infants, the bulging and tension of the fontanel, the divergence of the sutures between the bones of the skull, as well as the excessive growth of the head circumference are very suspicious.
Without a doubt, in such cases, the child must be shown to specialists as soon as possible. Quite often, one clinical examination is enough to exclude or pre-diagnose this pathology. Sometimes it requires additional research methods (fundus, neurosonodopplerography, computed or magnetic resonance imaging of the brain)
Of course, expansion of the interhemispheric fissure, cerebral ventricles, subarachnoid and other spaces of the cerebrospinal fluid system on neurosonography images (NSG) or brain tomograms (CT or MRI) cannot serve as proof of intracranial hypertension. The same applies to isolated from the clinic, disorders of cerebral blood flow, detected by Doppler ultrasound of the vessels, and "finger impressions" on the X-ray of the skull.

In addition, there is no connection between intracranial hypertension and translucent blood vessels on the face and scalp, tiptoeing, shaking hands and chin, hyperexcitability, developmental disorders, poor academic performance, nosebleeds, tics, stuttering, bad behavior, etc. and etc.

That's why, if your baby was diagnosed with "PEP, intracranial hypertension", based on the "goggle" of the eye (Gref's symptom, "setting sun") and tiptoe walking, then you should not go crazy in advance. In fact, these reactions may be characteristic of excitable young children. They react very emotionally to everything that surrounds them and what happens. Attentive parents will easily notice these relationships.

Thus, when making a diagnosis of PEP and an increase in intracranial pressure, it is naturally best to contact a specialized neurological clinic. This is the only way to be sure of the correct diagnosis and treatment.
It is absolutely unreasonable to start treatment of this serious pathology according to the recommendations of one doctor on the basis of the above “arguments”, moreover, such unreasonable treatment is not at all safe.
What are only diuretic drugs that are prescribed to children for a long time, which has an extremely adverse effect on a growing organism, causing metabolic disorders.

There is another, no less important aspect of the problem that must be taken into account in this situation. Sometimes medicines are necessary and the unlawful refusal of them, based only on the mother's (and more often the father's!) own conviction of drug hazard, can lead to serious trouble. In addition, if there really is a serious progressive increase in intracranial pressure and the development of hydrocephalus, then often the wrong drug therapy for intracranial hypertension leads to the loss of a favorable moment for surgical intervention (bypass surgery) and the development of severe irreversible consequences for the child: hydrocephalus, developmental disorders, blindness , deafness, etc.

Now a few words about the no less "adored" hydrocephalus and hydrocephalic syndrome. In fact, we are talking about a progressive increase in intracranial and intracerebral spaces filled with cerebrospinal fluid (CSF) due to the existing one! at the time of intracranial hypertension. At the same time, neurosonograms (NSG) or tomograms reveal the expansion of the ventricles of the brain, the interhemispheric fissure, and other parts of the cerebrospinal fluid system that change over time. It all depends on the severity and dynamics of symptoms, and most importantly, on the correct assessment of the relationship between an increase in intracerebral spaces and other nervous changes. This can be easily determined by a qualified neurologist. True hydrocephalus, which does require treatment, as well as intracranial hypertension, is relatively rare. Such children must be observed by neurologists and neurosurgeons of specialized medical centers.
Unfortunately, in ordinary life, such an erroneous “diagnosis” occurs in almost every fourth or fifth baby. It turns out that often hydrocephalus (hydrocephalic syndrome), some doctors incorrectly call a stable (usually slight) increase in the ventricles and other cerebrospinal fluid spaces of the brain. It does not manifest itself in any way by external signs and complaints, it does not require treatment. Moreover, if hydrocephalus is suspected in a child based on a “large” head, translucent blood vessels on the face and scalp, etc. - this should not cause panic among parents. The large size of the head in this case plays almost no role. However, the dynamics of head circumference growth is very important. In addition, you need to know that among modern children, the so-called "tadpoles" are not uncommon, in which the head is relatively large for their age (macrocephaly). In most of these cases, babies with a large head show signs of rickets, less often - macrocephaly, due to the family constitution. For example, dad or mom, or maybe grandfather has a big head, in a word, it is a family matter, it does not require treatment.

Sometimes, during neurosonography, an ultrasound doctor finds pseudocysts in the brain - but this is not at all a reason to panic! Pseudocysts are called single rounded tiny formations (cavities) containing cerebrospinal fluid and located in typical areas of the brain. The reasons for their appearance, as a rule, are not known for certain; they usually disappear by 8-12 months. life. It is important to know that the existence of such cysts in most children is not a risk factor for further neuropsychic development and does not require treatment. However, although quite rare, pseudocysts form at the site of subependymal hemorrhages, or are associated with previous perinatal cerebral ischemia or intrauterine infection. The number, size, structure and location of cysts provide specialists with very important information, taking into account which, based on a clinical examination, final conclusions are formed.
Description of NSG is not a diagnosis! and not necessarily a reason for treatment.

Most often, NSG data give indirect and uncertain results, and are taken into account only in conjunction with the results of a clinical examination.
Once again, I remind you of the other extreme: in complex cases, sometimes there is a clear underestimation on the part of parents (less often, doctors) of the problems the child has, which leads to a complete rejection of the necessary dynamic monitoring and examination, as a result of which the correct diagnosis is made late, and treatment does not lead to the desired result.
Undoubtedly, therefore, if elevated intracranial pressure and hydrocephalus are suspected, diagnostics should be carried out at the highest professional level.

What is muscle tone and why is it so “loved”?
Look at your child's medical record: is there no such diagnosis as "muscular dystonia", "hypertension" and "hypotension"? - probably, you just didn’t go with your baby to a neurologist for up to a year. This is, of course, a joke. However, the diagnosis of "muscular dystonia" is no less common (and maybe more often) than hydrocephalic syndrome and increased intracranial pressure.
Changes in muscle tone can be, depending on the severity, either a normal variant (most often) or a serious neurological problem (much less often).

Briefly about the external signs of changes in muscle tone.
Muscular hypotension is characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity may be limited, muscle palpation is somewhat reminiscent of "jelly or very soft dough." Pronounced muscle hypotension can significantly affect the pace of motor development (for more details, see the chapter on motor disorders in children of the first year of life).

Muscular dystonia is characterized by a condition where muscle hypotonia alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in individual muscle groups (for example, more in the arms than in the legs, more on the right than on the left, etc.)
At rest, these children may experience some muscular hypotonia with passive movements. When you try to actively perform any movement, with emotional reactions, with a change in the body in space, muscle tone increases sharply, pathological tonic reflexes become pronounced. Often, such disorders further lead to improper formation of motor skills and orthopedic problems (for example, torticollis, scoliosis).

Muscular hypertension is characterized by increased resistance to passive movements and limitation of spontaneous and voluntary motor activity. Severe muscle hypertension can also significantly affect the rate of motor development.
Violation of muscle tone (muscle tension at rest) can be limited to one limb or one muscle group (obstetric paresis of the arm, traumatic paresis of the leg) - and this is the most noticeable and very alarming sign that makes parents immediately contact a neurologist.

It is sometimes quite difficult even for a competent doctor to notice the difference between physiological changes and pathological symptoms in one consultation. The fact is that a change in muscle tone is not only associated with neurological disorders, but also strongly depends on the specific age period and other features of the child's condition (excited, crying, hungry, drowsy, cold, etc.). Thus, the presence of individual deviations in the characteristics of muscle tone does not always cause concern and requires any treatment.
But even if functional disorders of muscle tone are confirmed, there is nothing to worry about. A good neurologist will most likely prescribe massage and physiotherapy exercises (exercises on large balls are very effective). Medicines are prescribed extremely rarely.

Syndrome of hyperexcitability
(syndrome of increased neuro-reflex excitability)
Frequent cries and whims with or without reason, emotional instability and hypersensitivity to external stimuli, sleep and appetite disorders, profuse frequent regurgitation, restlessness and shuddering, trembling of the chin and arms (etc.), often in combination with a poor increase weight and impaired stool - do you recognize such a child?

All motor, sensory and emotional reactions to external stimuli in a hyperexcitable child arise intensely and abruptly, and can fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for some objects and capture them. Usually children show a keen interest in the environment, but increased emotional lability often makes it difficult for them to contact others. They are very impressionable, emotional and vulnerable! They fall asleep extremely badly, only with their mother, they constantly wake up, cry in their sleep. Many of them have a long-term fear reaction to communication with unfamiliar adults with active protest reactions. Usually hyperexcitability syndrome is combined with increased mental exhaustion.
The presence of such manifestations in a child is just a reason to contact a neurologist, but in no case is it a reason for parental panic, and even more so, drug treatment.

Constant hyperexcitability is causally a little specific and can most often be observed in children with temperamental characteristics (for example, the so-called choleric type of response).

Much less often, hyperexcitability can be associated and explained by perinatal pathology of the central nervous system. In addition, if the child’s behavior suddenly and unexpectedly and for a long time was disturbed for almost no apparent reason, he developed hyperexcitability, it is impossible to exclude the possibility of developing a reaction of impaired adaptation (adaptation to external environmental conditions) due to stress. And the sooner the child is seen by specialists, the easier and faster it is possible to cope with the problem.
And, finally, most often, transient hyperexcitability is associated with pediatric problems (rickets, digestive disorders and intestinal colic, hernia, teething, etc.).

There are two extremes in the tactics of monitoring such children. Or an “explanation” of hyperexcitability with the help of “intracranial hypertension” and intense drug treatment, often using drugs with serious side effects (diacarb, phenobarbital, etc.). Or complete neglect of the problem, which can later lead to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disturbances) in the child and his family members, and will require long-term psychological correction.
Of course, it is logical to assume that an adequate approach lies somewhere in between...

Separately, I would like to draw the attention of parents to convulsions - one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures are not common in infancy, but are sometimes severe, insidious and disguised, and immediate medical therapy is almost always necessary.
Such seizures can be hidden behind any stereotypical and repetitive episodes in the child's behavior. Incomprehensible shudders, head nods, involuntary eye movements, “fading”, “squeezing”, “softening”, especially with a stop of the gaze and lack of response to external stimuli, should alert parents and force them to turn to specialists. Otherwise, a late diagnosis and untimely prescribed drug therapy significantly reduce the chances of successful treatment.
All the circumstances of the episode of convulsions must be accurately and completely remembered and, if possible, recorded on video, for a further detailed story at the consultation. If the convulsions last for a long time or recur - call "03" and urgently consult a doctor.

At an early age, the child's condition is extremely changeable, so developmental deviations and other disorders of the nervous system can sometimes be detected only in the process of long-term dynamic monitoring of the baby, with repeated consultations. For this purpose, specific dates for planned consultations by a pediatric neurologist in the first year of life have been determined: usually at 1, 3, 6 and 12 months. It is during these periods that most of the serious diseases of the nervous system of children of the first year of life (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.) can be detected. Thus, the identification of a specific neurological pathology in the early stages of development allows you to start complex therapy on time and achieve the maximum possible result.

And in conclusion, I would like to remind parents: be sensitive and attentive to your kids! First of all, it is your meaningful participation in the lives of children that is the basis for their further well-being. Do not treat them for "supposed illnesses", but if something worries and worries you, find an opportunity to get independent advice from a qualified specialist.

It often happens that in the first years of life, active development is accompanied by a huge number of challenges for his body. This leads to the fact that the baby has a risk of defects or serious ones. One of these is hypertensive-hydrocephalic syndrome(GGS). Despite the effectiveness of modern diagnostic and therapeutic methods, this diagnosis brings parents real excitement, since the disease is quite complex, and complications threaten to disrupt brain activity. Therefore, today we decided to reassure all worried parents and find out what HHS syndrome really is, why it is dangerous to health, and what is needed to successfully combat this disease.

What is it - hypertension syndrome in children

HGS is a dangerous disease, which leads to increased pressure inside the baby's skull. develops due to the accumulation of excess fluid in the brain, which begins to put pressure on its tissues. There are several reasons for fluid accumulation. This can occur as a result of violations of its natural outflow, with excessive production by the body and when the processes of its reabsorption are disturbed.

Did you know?Such a term as hypertensive-hydrocephalic syndrome is known only to the countries of the former USSR. In international medicine, this pathology refers to the course of any brain disease.

The disease is one of the most common diagnoses that occur in pediatric neurology. And this problem is especially acute for the parents of a newborn child who suffers from perinatal encephalopathy, since it is the best springboard for the development of hypertension syndrome. The disease has two forms of flow: congenital and acquired. Most often, a pathology of a congenital nature is diagnosed, but the syndrome is not uncommon in older children. In this case, it is a side effect after suffering head injuries or diseases affecting the functioning of higher nervous activity (HNA).

Reasons for development

The common causes of this syndrome include: difficult and caused by various factors, brain damage, blood effusions into the intracranial box, intrauterine infections, etc. In addition, the causes of the disease are also distinguished with respect to the form of the course. Next, consider them in more detail.

So, the reasons for the development of congenital hypertension syndrome in children are:

• pathologies caused by unfavorable pregnancy;
• disruption of the brain during unforeseen injuries;
• bradycardia, intrauterine hypoxia or developmental delay;
• brain damage caused by defects in the vascular system;
• hemorrhage in the brain area;
• unplanned childbirth during the term up to 36 weeks;
• viral infections that are transmitted from mother to fetus;
• abnormal development of GNI;
• excess of the total terms of pregnancy (delivery after 42 weeks);
• chronic illness of the mother;
• lack of access of the baby's body to water for more than 12 hours.

Did you know?Volumecerebrospinal fluid is a constant value. In an average person, its amount is within 150 ml, in children it is much lower and depends on age.

Acquired HHS develops in the case of:

• purulent inflammation of tissues, hematomas, tumors, brain cysts;
• the appearance of foreign formations in the brain;
• with fractures of the skull with crushing of the bone, as a result of which small fragments damage the brain;
• spontaneous intracranial hypertension caused by unexplained circumstances;
• brain diseases of an infectious nature;
• disturbances in the work of the VND caused by strokes or metabolic pathologies.

Symptoms

It is not so easy to identify the first symptoms of the development of a progressive hydrocephalic syndrome in children, it is especially difficult to diagnose in infants. However, this medical event is still possible, the main thing that parents should remember is the need for constant attention to the child. You must respond as quickly as possible to uncharacteristic behavior and anxiety for him. Only in this case will it be possible to avoid the height of this syndrome and the development of severe and dangerous consequences for GNI.

The first symptoms of a change in pressure in the intracranial box are rather lubricated and varied. However, all parents whose children were diagnosed with this disease during infancy, note the following signs:

• constant crying, occasionally groans;
• poor appetite and frequent fountain-like regurgitation;
• blunting of congenital reflexes of swallowing and grasping;
• initial stages of strabismus;
• when examining the eyes, a peculiar white strip is observed between the upper eyelid and the pupils, the iris is hidden behind the lower eyelid;
• during the examination of the fundus, you can see a pronounced swelling of the visual discs;
• on the head, one can notice the opening of the cranial sutures and the modification of the fontanelles;
• the shape of the head changes, and its size increases markedly relative to the body (the average growth is about 1 cm per month).

Did you know?The cerebrospinal fluid plays a critical role in maintaining the integrity of the brain during a head injury. This is because when it collides with an object, it acts as a kind of shock absorber, which dampens the force of a direct blow to the head area.

Signs of hydrocephalic syndrome in older children are much easier to identify. First of all, the child begins to be disturbed by frequent headaches, especially in the morning, followed by severe nausea and. At the same time, the pains are characterized by localization in the temporal region, in the area of ​​the forehead and superciliary arches and have a dull, aching and bursting nature of palpability. The child may constantly or periodically complain that it is difficult for him to lower his head and raise his eyes, he is tormented by dizziness of a swinging nature. He begins to think slowly, it becomes difficult for him to understand and remember the features of what is happening, and he also begins to inattentively react to various kinds of actions.

During the next attack of headache, take a look at the color of the baby's skin, if there is a characteristic blanching of their color (especially the face), which is accompanied by general lethargy, weakness of the body, irritability to bright light sources and excessive noise - this is another sign of increasing fluid pressure on brain. In addition, with hypertensive-hydrocephalic syndrome, one can observe characteristic tiptoe walking, which is the result of increased muscle tone of the lower extremities.

Important!If your child has at least some of the symptoms listed above, in no case should you hesitate. It is urgent to seek help from doctors, this will help save the baby from dangerous brain damage.

Which doctor should be consulted

The main specialist who deals with problems related to the functioning of the brain and its support systems is a neurologist. It is this specialist who is able to make an accurate diagnosis, prescribe effective treatment and help parents cope with the problem that has arisen without side effects. However, before going to a neurologist, we advise you to visit your attending pediatrician. Hypertension-hydrocephalic syndrome- a rather rare disease, the symptoms of which in 97% of cases are the development of a completely different disease. The initial visit to the pediatrician will help to correctly expose the suspicions about the existing ailment and direct them exclusively in the right direction.

Inspection and diagnostics

Diagnosis of hypertension in children is no less difficult than the identification of the first symptoms. This is because modern methods and equipment cannot give a 100% correct answer about the presence of this pathology in a baby. This issue is especially acute for the parents of a newborn, since the baby is not able to independently explain what worries him. In this case, preventive measurements of the volume of the head in dynamics are suitable.

If the baby’s head increases by an average of 1 cm or more every month, there is a reason to urgently contact the clinic. Often, when pregnancy was hampered by any factor, for preventive purposes, children are prescribed an assessment of the fundus for the presence of vasospasms and hemorrhages, which also clearly indicate an increase in intracranial pressure.

After the first symptoms of HHS have been identified, a neurologist will prescribe a series of diagnostic studies, against the general background of which we can talk about the presence of any ailment. For these purposes, use:

• ultrasound diagnostics of brain structures, in particular pathology of the size of its ventricles;
• study of the state of the brain, thanks to the apparatus of nuclear magnetic resonance and computed tomography;
• taking samples of cerebrospinal fluid in the lumbar region to determine its total pressure.

Did you know?Humanity owes such a diagnostic procedure as computed tomography (CT) to Godfrey Housefield and his colleague Allan Cormac. It was these scientists who in 1972 offered the world medicine CT as a new diagnostic method, for which they were awarded the Nobel Prize.

Methods and treatment regimen

Depending on the age of the baby, there are two forms of treatment for the pathological condition of intracranial pressure in a child. This issue is often dealt with by several specialists representing neurology, neurosurgery and ophthalmology.

newborns

If this syndrome is detected in children under 6 months, urgent outpatient treatment is indicated. It is a rather lengthy process, which can take more than one month. In general therapeutic practice for the treatment of such patients use the following activities:

• the use of medical diuretics. Diakarb is best suited for these purposes, which helps to reduce the production of cerebrospinal fluid by the body and remove excess moisture from organs and systems;
• taking drugs of nootropic action (Actovegin, Asparkam, Piracetam), which help to improve the blood supply to the brain;
• the use of sedative drugs on the body (Diazepam, Tezam);
• massage procedures.

older children

Treatment of older children from this disease is one of the most difficult processes in pediatrics. First of all, this is due to the fact that hypertensive-hydrocephalic syndrome in most cases is the result of a more complex disease or pathology. Therefore, the elimination of increased pressure in the brain area is carried out in parallel with the treatment of the underlying disease. In this case, therapy is individual in nature, which seriously complicates the effectiveness of treatment. Often, such children are prescribed surgical methods of treatment (bypass surgery), since therapeutic methods remain powerless (especially in cases of tumors or traumatic brain injuries).

Important!In addition to the basic methods of treatment, a small patient must undergo physiotherapy and corrective measures, which are especially necessary in case of violations of general development.

Possible Complications

Identified hydrocephalic syndrome in a child under one year old or at a later age, with untimely and poor-quality treatment, threatens the body with severe consequences. In most cases, they affect the functioning of the brain and related systems. First of all it is:

• complete or partial loss of functioning of vision;
• hearing loss;
• difficulty holding urine or feces;
• violation of the processes of excretion of feces from the body;
• the appearance of epilepsy or epileptic seizures;
• delay in the overall development of the child;
• fontanel deformation.

However, if the disease is severe, then in addition to the above complications, the child's body may face more dangerous consequences:

• partial or complete paralysis;
• lumpy states;
• fatal outcome.

Prevention

Despite the complexity of the disease, preventive measures to prevent hypertension-hydrocephalic syndrome are quite simple. In order to prevent a congenital type of pathology, expectant mother needs:

• take a responsible approach to the course of pregnancy;
• timely take preventive measures to prevent neuroinfectious diseases;
• avoid stress and overly emotional situations;
• do not overwork the body;
• treat with all severity the confectionary diseases during pregnancy;
• observe the correct and do away with bad habits and alcohol consumption.

• premature;
• whose mothers suffered from infectious diseases during pregnancy;
• newborns with malformations of the brain and spinal cord;
• children who have had meningoencephalitis and other serious infections of the nervous system.

The disease often develops as a result of injuries and severe blows to the head, which is why one of the main precautions for acquired hypertension-hydrocephalic syndrome is to ensure decent safety for babies. This is, first of all:

• the use of child seats when transporting children in a car;
• daily walks exclusively in safe park areas and playgrounds;
• use of special protective equipment for children who roller-skate, skateboard, bicycle, etc.

Important!Self-treatment with folk methods for this ailment is contraindicated, otherwise the child may expect brain damage and other related problems with the activity of the GNI.

Hypertensive-hydrocephalic syndrome is a rather dangerous disease of the brain, which sometimes not every family can cope with. Despite the fact that the incidence of this pathology is quite low, the mortality of children from this disease has remained at a high level for many years. Therefore, in order for your child to remain completely safe, you must carefully monitor his health and follow all existing preventive measures.

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Hydrocephalic syndrome (HS) is a pathological condition caused by hypersecretion, malabsorption and discirculation of CSF fluid. As a result of such changes, cerebrospinal fluid accumulates in the ventricles of the brain and between its membranes. This leads to an increase in pressure in the venous sinuses, epidural and subarachnoid spaces. The distended ventricles of the brain become inflamed and the circumference of the head increases. More often this condition develops in infants, less often in adolescents and adults.

The cause of hydrocephalic syndrome in infants is perinatal CNS damage caused by hypoxia, infection, birth trauma. The syndrome has the ICD-10 code G91 and the name "Hydrocephalus". In modern neonatology, it is called CSF-vascular distension syndrome. This is a fairly rare disease, which is diagnosed and treated by pediatric neurologists and pediatricians. Children's appetite worsens, trembling in the upper limbs and convulsions occur, they lag behind their peers in psychophysical and speech development.

Depending on the age of the patients, HS of newborns, HS of children and HS of adults are distinguished. HS occurs predominantly in newborns suffering from perinatal encephalopathy. In the absence of timely treatment, the syndrome progresses and transforms into an organic brain disease - hydrocephalus.

Etiology

All etiopathogenetic factors of HS are divided into two large groups - congenital and acquired.

Congenital causes of hydrocephalic syndrome include:

• perinatal hypoxia,
• Intrauterine intoxication with alcohol or drugs,
• cerebral ischemia,
• Birth head injury
• Hemorrhage into the subarachnoid space
• Intrauterine infection of viral or bacterial etiology,
• congenital toxoplasmosis,
• Congenital malformations of the brain.

Among the acquired causes:

An idiopathic syndrome develops in cases where it is impossible to identify its cause.

There are risk factors that contribute to the development of pathology in newborns:

• toxicosis in a pregnant woman - preeclampsia, eclampsia,
• arterial hypertension in a future mother,
• drinking alcohol during pregnancy
• childbirth up to 36 weeks,
• late birth - after 42 weeks,
• long stay of the fetus in the womb without water,
• multiple pregnancy,
• chronic pathologies of the mother - diabetes mellitus, hypo- or hyperthyroidism, collagenoses,
• mother's age over 40 years,
• hereditary predisposition.

Liquor is actively produced by the choroid plexuses of the ventricles of the brain, ependyma and meninges. Passive production of cerebrospinal fluid is carried out as a result of changes in osmotic pressure and movement of ions outside the vascular bed.

Liquor is absorbed by the cells of the arachnoid, vascular elements of the membranes of the brain and spinal cord, ependyma, parenchyma, connective tissue fibers that run along the cranial and spinal nerves.

Mechanisms that provide liquor flow:

1. hydrostatic pressure drop,
2. secretion of cerebrospinal fluid
3. movement of ependymal villi
4. brain pulsation.

At the heart of the pathogenesis of hydrocephalic syndrome are the processes of obstruction and obstruction of the CSF pathways with impaired CSF reabsorption.

Pathogenetic factors of the syndrome:

• Hyperproduction of cerebrospinal fluid in the brain,
• accumulation of liquor,
• Enlargement of the ventricles of the brain
• Penetration of cerebrospinal fluid into the medulla
• Scar formation in brain tissue.

The amount of cerebrospinal fluid in the skull changes when the balance between its production and absorption is disturbed. The accumulation of CSF in the ventricles of the brain is due to the formation of obstacles in the way of its normal outflow. If left untreated, death is possible.

Symptoms

Clinical signs of hydrocephalic syndrome differ in newborns, older children, and adults. The symptomatology of the disease depends on the individual sensitivity of the body to changes in CSF pressure and the general condition of the patients.

In children

Affected children are born in serious condition and have a low Apgar score. The acute development of the syndrome in infants is manifested by anxiety, crying, vomiting and confusion. A sick child does not take the breast well, screams and moans for no reason. In patients, the volume of the head rapidly increases, the venous vessels on the head expand, the sutures of the skull diverge, the fontanel tenses, muscle tone decreases, congenital reflexes weaken, tremor and convulsions appear, horizontal nystagmus, converging strabismus is observed, regurgitation is possible. The gradual onset is characterized by a delay in the psychophysical development of the child.

Experts note a monthly increase in head circumference by 1-2 cm. The head of newborns acquires a specific shape - with an overhanging nape or large frontal tubercles. Enlargement and deformation of the child's head can be seen with the naked eye. When examining the fundus, swelling of the optic nerve head is detected. The reaction of the eyeballs to the irritant decreases, which sooner or later leads to complete blindness. Through the overstretched scalp, blood vessels are visible. The bones of the deformed skull become thinner. Newborns have discoordination of movements. Sick children cannot sit, crawl and hold their heads up. Their psycho-emotional development is inhibited.

If untreated, the syndrome is complicated by atrophy of the brain tissue. In patients, the functions of the musculoskeletal system are first impaired, and then the visual analyzer and thyroid gland. Gradually, sick children begin to lag behind their peers in development, they develop mental disorders of varying severity.

In adults

In adults, suddenly there is a dull and aching headache in the temples and forehead, tinnitus, paroxysmal dizziness, temporary disorientation in space, vomiting in the morning, cramps of the limbs, gait is disturbed. They sleep restlessly, often shudder in their sleep, are overly excited or lethargic, apathetic. Violations of the emotional-volitional sphere range from emotional instability, neurasthenia, causeless euphoria to complete indifference and apathy. In some cases, there are episodic psychoses with hallucinatory or delusional syndrome. With a sharp increase in intracranial pressure, aggressive behavior is possible. The head becomes large due to chronic hypertension. Full-blooded blood vessels are clearly visible on it - the venous pattern is enhanced.

Perhaps the appearance of pain in the neck, nausea, diplopia, a feeling of pressure on the eyes, blurred vision, loss of visual fields, urinary incontinence. It is difficult for patients to raise their eyes and lower their head. Their skin turns pale, weakness and lethargy, lethargy, absent-mindedness, drowsiness, hypertonicity of the leg muscles, and strabismus occur. The process of thinking slows down, memory and attention are disturbed, there is an inadequate reaction to bright light and loud sound. Perhaps clouding of consciousness up to the development of a coma.

During the hydrocephalic syndrome, two options are possible:

• a favorable outcome of the pathology, which was based only on functional disorders - the complete disappearance of symptoms within a year or their gradual regression,
• an unfavorable outcome is an increase in symptoms and the formation of a picture of an organic brain lesion with the development of hydrocephalus.

Complications of HS in children:

1. epilepsy,
2. general development disorder
3. delay in psychophysical development,
4. loss of hearing and vision
5. coma,
6. paralysis,
7. difficulty in moving
8. urinary and fecal incontinence,
9. brain atrophy,
10. dementia,
11. weakness of the muscles of the arms and legs,
12. thermoregulation disorder,
13. violation of fat and carbohydrate metabolism,
14. fatal outcome.

If treatment is started in a timely manner, severe consequences do not develop, and the prognosis of the syndrome is considered quite favorable. In the absence of medical care, violations occur in all vital systems of the body. The child ceases to see, hear and understand normally. In sick children, hydrocephalus is formed by the year. In the event of an exacerbation of the disease, the risk of death is high.

Powerful compensatory abilities of the body allow achieving stabilization of the process by 2 years. Complete recovery without consequences is observed in 30% of cases.

Diagnostics

To make a correct diagnosis, it is enough for specialists to examine the child and listen to the complaints of the parents. The symptoms of the pathology are so typical that they can not be confirmed by the results of additional methods. Newborn children and infants regularly measure the circumference of the head and check the reflexes. Deviation of anthropometric data from age norms is an important sign of the formation of hydrocephalus.

Specialists examine the brain to determine the degree and form of the disease. For this, the following is carried out:

• radiography,
• electroencephalography,
• echoencephalography,
• rheoencephalography,
• neurosonography,
• tomography,
• dopplerography of cerebral vessels,
• ophthalmoscopy, determination of visual acuity, perimetry,
• PCR diagnostics to determine the type of infection that caused the syndrome.

severe hydrocephalus on MRI

Doctors evaluate the vessels of the fundus for the presence of spasm, plethora, and edema. Lumbar puncture allows you to take CSF, study its cellular composition and measure pressure. In patients with hydrocephalic syndrome, cerebrospinal fluid flows out quickly, it contains erythrocytes and macrophages.

More detailed information can be obtained using nuclear magnetic resonance. This method gives a clear image of the structures of the brain and unmistakably reveals the existing deviations.

Treatment

Treatment of hydrocephalic syndrome is carried out in a neurological hospital by specialists in the field of neurology, neurosurgery, ophthalmology and psychiatry.

Drug therapy consists in the appointment of the following groups of drugs:

1. Diuretics that facilitate the removal of fluid from the body and increase the amount of urine excreted - "Furosemide", "Diakarb", "Veroshpiron";
2. Drugs that improve brain trophism and have metabolic, neuroprotective, antihypoxant and microcirculatory effects - Cortexin, Actovegin, Curantil;
3. Nootropic drugs - neurometabolic stimulants that have a specific effect on the higher mental functions of the brain - "Piracetam", "Phezam", "Vinpocetine";
4. Drugs that dilate blood vessels and improve cerebral circulation - "Cinnarizine", "Drotaverine";
5. Anticoagulants and antiplatelet agents that thin the blood and prevent the formation of blood clots - Ecotrin, Warfarin, Clexane;
6. Venotonics that improve the condition of the vascular wall of capillaries and reduce their permeability - "Detralex", "Phlebodia";
7. Sedative drugs that have an anxiolytic, anticonvulsant, muscle relaxant effect - "Diazepam", "Relanium", "Seduxen";
8. Multivitamin complexes.

This standard treatment regimen is supplemented with other medications depending on the etiology. If the cause of the syndrome is an infectious disease, antibiotics and antiviral drugs are prescribed. If there is a tumor in the brain, they are treated with cytostatics - Methotrexate, Cyclosporine. After the removal of acute phenomena, they resort to non-drug effects: patients are prescribed a course of physiotherapy, including general massage and physiotherapy exercises. These procedures are carried out only by specially trained doctors who have experience working with sick children. Patients are shown speech therapy and remedial classes, the help of a defectologist, a psychologist, a psychotherapist. They are prohibited from exhausting physical activity, watching TV, computer games, loud music.

Spinal puncture has a therapeutic effect in case of acute deterioration of the patient's condition. Surgical treatment is performed to correct congenital anomalies of the CSF system and restore CSF outflow from the cranial cavity. If the cause of the syndrome is a neoplasm, it is removed surgically. Surgery is also indicated for TBI. According to indications, intracranial hematomas are removed, abscesses are opened, adhesions are dissected in arachnoiditis.

If the cause of the syndrome is unknown, shunting and draining operations are performed:

Prevention and prognosis

1. prepare for pregnancy planning,
2. to prevent neuroinfectious diseases,
3. avoid conflicts, stress and psycho-emotional disorders,
4. do not overwork, fully rest,
5. timely treat infectious and inflammatory diseases,
6. to refuse from bad habits,
7. eat properly.

The prognosis of the GS is ambiguous. It depends on the cause of the disease, the timeliness and adequacy of therapy, the age and condition of the patient. Children with the syndrome may have disabilities, but the degree of impairment may remain mild. In infants, the prognosis of the pathology is most favorable, since they have transient increases in blood pressure and cerebrospinal fluid stabilize with age.

Hydrocephalic syndrome is a serious prerequisite for the development of severe consequences in patients. A late-detected ailment without properly prescribed treatment leads to complications and even death.

Video: about hydrocephalic syndrome in children