Liquorodynamic disorders of the brain: signs, treatment. Expansion of external cerebrospinal fluid spaces in adults. What does the diagnosis of "moderate hydrocephalus of the brain" mean? Dilatation of internal cerebrospinal fluid spaces

No one will argue with the fact that it is quite complicated. He is entrusted with many tasks that he must consistently perform throughout his life. In order for the brain to function properly, it must be provided with adequate nutrition through proper blood supply.

Pathologies associated with the functioning of the brain are always serious. One of the common problems is the expansion of the subarachnoid space. According to the ICD (International Classification of Diseases), the expansion of the subarachnoid space in adults is rare, more often this pathology is found in newborns. We will talk about its causes, diagnosis, treatment and methods of prevention.

Structural features of the brain

To understand the essence of this pathology, it is important to know which membranes cover the brain. There are three of them:

cobweb;
hard;
soft.

The subarachnoid space is located between the arachnoid and pia mater. The first covers the entire surface of the brain, which in turn envelops the endometrium. For communication with other tissues, plexuses under the arachnoid membrane are used - membranes. The subarachnoid vascular plexus consists of the ventricular system of the spinal cord and brain. It consists of 4 reservoirs in which cerebrospinal fluid constantly circulates.

Subarachnoid spaces are small cavities in the brain filled with a special fluid (cerebrospinal fluid). Their job is to nourish and protect the brain. Nutrients are concentrated in the cerebrospinal fluid, which are used to maintain the vital activity of nerve cells and ventricles of the brain. The waste products of tissues are also removed through the cerebrospinal fluid. If the subarachnoid space is expanded, it begins to compress adjacent tissues and vessels. Brain cells that do not receive proper nutrition suffer.

Liquor continuously circulate in the cavities of the brain. This is provided by heart contractions, breathing, body position. Normally, the volume of fluid filling the CSF spaces should not exceed 140 ml.

What does this diagnosis mean?

Most often, the diagnosis "Expansion of the subarachnoid space" is made to infants. Birth trauma, a deviation in the development of the brain, can lead to such a pathology. If an enlarged subarachnoid convexital space is suspected, an ultrasound of the brain is performed. This is the main diagnostic method.

If there has been an expansion of the cerebrospinal fluid spaces of the brain, the cerebrospinal fluid is unevenly distributed and spills out of the subarachnoid space. The result is hydrocephalus (dropsy), increased intracranial pressure, expansion of the ventricles of the brain. At the same time, the cerebrospinal fluid system does not work properly, which causes brain tissue and internal organs to suffer.

The expansion of the external cerebrospinal fluid spaces leads to various pathologies (asymmetry of the skull, impaired vision, speech, coordination, some functions of the brain, mental development, etc.). The degree of development of such pathologies directly depends on how much the subarachnoid space is expanded. Weak and moderate expansion of the external cerebrospinal fluid spaces is amenable to complex treatment if it is started in a timely manner. If the ventricles are not dilated, then there are chances that by the age of two, the state of the baby's brain will normalize, hydrocephalus will go away.

It is important that parents do not wait for everything to go away by itself. You can waste precious time. The bones of the skull will be strengthened, and dropsy may remain. It is imperative to conduct a full diagnosis and, if necessary, undergo a course of treatment.

Sometimes the expansion of the subarachnoid spaces can be observed with a tumor, cystic formation, or an inflammatory process. This is extremely dangerous, as it often leads to death. If medical care is provided on time, the prognosis is quite favorable.

In an inflammatory process, for example, meningitis, more CSF is produced than necessary. A large amount of fluid leads to expansion of the space (dilation). If it is a tumor, then it interferes with the proper circulation of fluids inside the brain, creating a physical barrier to it. Other causes may be an abscess, a hematoma, due to which cerebral edema has begun.

Diagnostics

Now, brain pathologies are fairly easy to diagnose. For this, hardware methods are used (ultrasound, MRI), and, if necessary, lumbar puncture. The latter allows not only to detect the tumor, but also to examine all its layers and structure. This method allows you to choose the most accurate treatment regimen for other formations.

Main diagnostic methods:

Neurosonography. The duration of the procedure is ~ 15 minutes. It is carried out when it comes to a newborn, and consists in the fact that a special ultrasonic sensor is attached to the patient's head. Through an open fontanel, it allows you to collect information about the state of the brain. The advantage of this method is that it can be carried out frequently, without any consequences for the baby. Now neurosonography is done in the maternity hospital to rule out pathologies of brain development. The result is deciphered by a pediatrician or neurologist.
CT, . These methods, although effective, are expensive. They are mainly used to diagnose children older than 3 years and adults. Now considered the most accurate. To diagnose infants, using CT or MRI is very problematic, since the patient must lie absolutely still during the procedure. If such a diagnosis is indicated for a small patient, it is performed under general anesthesia.
Cisternography. The purpose of the procedure is to determine how correctly the flow of cerebrospinal fluid is directed. It allows you to accurately determine the type of hydrocephalus in a particular patient.
Angiography. With this diagnostic method, a special contrast is introduced into the artery. The goal is to identify deviations in vascular patency.
Neuropsychological examination. The patient is examined, and the doctor conducts a survey. Such a survey is carried out in children older than 3 years and adults. The doctor collects together the data of all tests and the results of a visual examination. The goal is to identify disorders in the functioning of the brain.

The results of an ultrasound scan or MRI should only be interpreted by an experienced doctor. Self-diagnosis here is unacceptable and extremely dangerous. It is very important to accurately determine the cause of the pathology and immediately begin to eliminate it. This directly affects the course of recovery and further functional capabilities of the brain.

A blood test is also performed, the patient's behavior, the presence of symptoms, and its severity are assessed.

anxiety symptoms

With the expansion of convexital spaces, the following symptoms are observed:

(she appears immediately after waking up);
nausea;
vomit;
dizziness;
memory impairment (in adults);
irritability;
drowsiness;
fatigue;
in babies, the size of the skull increases;
high sensitivity to light, sound.

At first, the disease proceeds without visible symptoms. Then they make themselves felt, but the intensity can be different. It depends on the degree of brain damage and the amount of CSF secreted. If the lesion is local, insignificant, the symptoms may be minimal. This condition responds well to treatment, but it is important to start it at the first sign of pathology, until irreversible structural changes have occurred. The greater the accumulation of fluid, the more significant these changes. Over time, there may be an increase in cavities. In infants, external changes may occur - the cranium increases (especially its frontal or posterior hemisphere), the basal functions of the brain suffer.

The causes of the appearance of pathology at different ages are different. In infants, this is most often birth trauma, meningitis, arachnoiditis, or developmental pathologies (the genetic code is broken). In adults - mechanical trauma, pseudocyst or tumor.

There are different degrees of uniform expansion of the subarachnoid space:

lung (1-2 mm);
medium (3-4 mm);
heavy (4 mm and more).

Localization is also different (interhemispheric, posterior, anterior, etc.). A different amount of liquid can accumulate, and manifestations outside will be different. Sometimes the skull increases, its pronounced asymmetry is observed.

Treatment

In order for the treatment of the enlarged arachnoid or subarachnoid space to be as effective as possible, and tissue damage to be minimal, you should seek the help of a neurologist as soon as possible. His consultation is obligatory if an injury has occurred, including a birth injury, an inflammatory process is suspected, or the listed symptoms are disturbing.

Please note that for a long time such a pathology can be asymptomatic.

For successful treatment, it is important to establish the exact cause and eliminate it. Liquorodynamics must be taken into account. It can express the degree of expansion, show how much the surrounding tissues, blood vessels, and nerves suffer. Often, sinusitis, intracranial pressure, otitis media, and infectious diseases can provoke an expansion in a child. With this development, antibacterial drugs, vitamins of group B are prescribed. Treatment can be quite long. It is prescribed purely individually, the nature of the pathology, the age of the patient must be taken into account. The patient must be constantly under the supervision of doctors, at the first stages of treatment he can be placed in the neurology department.

It is important to limit the spread of cerebrospinal fluid, protect the hemispheres and sulci of the brain from being squeezed, and clear the path for fluid to drain. To do this, it is important to determine exactly which area is affected, which part of the brain suffers from compression. It can be the hypothalamus, the cerebellum, several departments at once, etc.

Such a deviation in children is treated with the help of a complex of drugs:

means for removing excess liquor (Asparkam, Veroshpiron, Diakarb);
funds that improve brain trophism (Pantogam, Cavinton).

For the treatment of children older than 3 years and adults, a slightly different tactic is chosen. They are shown:

barbiturates;
diuretics;
saluretics;
glucocorticosteroids;
plasma substitutes (solutions);
painkillers;
vasoactive agents.

Not all of the listed drugs are included in the treatment regimen. Their selection directly depends on the established reason. If the case is in hydrocephalus, diuretics are prescribed, when the cause is an infection - antibiotics.

It is advisable to supplement the treatment with medicines with physioneurological procedures. They reduce symptoms, restore the metabolism of cells and brain tissues. The main task of treatment is to restore the blood supply to the brain and the normal discharge of cerebrospinal fluid. This will stabilize intracranial pressure, restore the metabolism of cells and tissues.

The prognosis for the outcome of treatment, despite the complexity of therapy, is quite favorable. The main thing is to start it in a timely manner and continue until the state of the brain returns to normal.

Sometimes it happens that drug therapy does not bring the desired effect. In such cases, the intervention of a surgeon may be required.

Please note that in a neglected state, such a pathology leads to dementia, impaired coordination, speech defects, mental retardation, urinary incontinence and a number of other undesirable manifestations.

One of the most dangerous complications is hydrocephalus. It can cause a number of irreversible vicarious changes, such as blindness, speech disorders. It can also cause the child to lag behind in development.

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

Hydrocephalus can be an independent nosological unit, or it can be the result of various brain diseases. It requires mandatory qualified treatment, since the prolonged existence of the disease can lead to disability and even death.

The disease in children is significantly different from the manifestations of the disease in the adult population due to the fact that in the child's body the brain is still being formed. In this article, we will look at the causes, symptoms and treatment of cerebral hydrocephalus in adults.

The reasons

Each person in the brain has special spaces containing a special fluid - liquor. Inside the brain itself, this is a system of ventricles of the brain that communicate with each other; outside the brain, this is the subarachnoid space with brain cisterns. Liquor performs very important functions: it protects the brain from shocks, shocks and infectious agents (the latter thanks to the antibodies it contains), nourishes the brain, participates in the regulation of blood circulation in the closed space of the brain and skull, and provides homeostasis due to optimal intracranial pressure.

The volume of cerebrospinal fluid in an adult is ml, it is updated several times a day. The production of cerebrospinal fluid occurs in the choroid plexuses of the ventricles of the brain. From the lateral ventricles of the brain (containing approximately 25 ml), the CSF enters through the foramen of Monro into the third ventricle, the volume of which is 5 ml. From the third ventricle, the cerebrospinal fluid moves to the fourth (also contains 5 ml) along the Sylvius aqueduct (brain aqueduct). At the bottom of the fourth ventricle there are openings: a median unpaired Magendie and two lateral Luschkas. Through these openings, cerebrospinal fluid enters the subarachnoid space of the brain (located between the pia and arachnoid membranes of the brain). On the basal surface of the brain, the subarachnoid space expands, forming several cisterns: cavities filled with CSF. From the tanks, the cerebrospinal fluid enters the outer (convexital) surface of the brain, as if “washing” it from all sides.

Absorption (resorption) of CSF occurs in the venous system of the brain through arachnoid cells and villi. The accumulation of villi around the venous sinuses is called pachyonic granulation. Part of the CSF is absorbed into the lymphatic system at the level of the nerve sheaths.

Thus, the liquor produced in the vascular plexuses inside the brain washes it from all sides and is then absorbed into the venous system, this process is continuous. This is how normal circulation occurs, the amount of fluid produced per day is equal to that absorbed. If at any stage there are "problems" - either with production or with absorption, then hydrocephalus occurs.

Causes of hydrocephalus can be:

infectious diseases of the brain and its membranes - meningitis, encephalitis, ventriculitis;
brain tumors of stem or near-stem localization, as well as brain ventricles);
vascular pathology of the brain, including subarachnoid and intraventricular hemorrhages as a result of aneurysm rupture, arteriovenous malformations;
encephalopathy (alcoholic, toxic, etc.);
brain injury and post-traumatic conditions;
malformations of the nervous system (for example, Dandy-Walker syndrome, stenosis of the Sylvian aqueduct).

Types of hydrocephalus

Hydrocephalus can be congenital or acquired. Congenital, as a rule, manifests itself in childhood.

Depending on the mechanism of development, there are:

closed (occlusive, non-communicating) hydrocephalus - when the cause is a violation of the CSF flow due to the overlap (block) of the CSF pathways. More often, a blood clot (due to intraventricular hemorrhage), part of a tumor, or adhesion interferes with the normal flow of cerebrospinal fluid;
open (communicating, dysresorbtive) hydrocephalus - based on a violation of absorption into the venous system of the brain at the level of arachnoid villi, cells, pachyon granulations, venous sinuses;
hypersecretory hydrocephalus - with excessive production of cerebrospinal fluid by the vascular plexuses of the ventricles;
external (mixed, ex vacuo) hydrocephalus - when the content of cerebrospinal fluid is increased both in the ventricles of the brain and in the subarachnoid space. In recent years, this form has ceased to be attributed to hydrocephalus, since the reason for the increase in the content of cerebrospinal fluid is the atrophy of the brain tissue and the reduction of the brain itself, and not the violation of the circulation of cerebrospinal fluid.

Depending on the level of intracranial pressure, hydrocephalus can be:

hypertensive - with an increase in the pressure of the cerebrospinal fluid;
normotensive - at normal pressure;
hypotensive - with reduced pressure of the cerebrospinal fluid.

According to the time of occurrence, they are distinguished:

acute hydrocephalus - the period of development of the process is up to 3 days;
subacute progredient - develops within a month (some authors consider the period to be 21 days);
chronic - from 3 weeks to 6 months and above.

Symptoms

The clinical picture depends on the period of formation of hydrocephalus and the level of pressure of the cerebrospinal fluid, the mechanism of development.

In acute and subacute occlusive hydrocephalus, a person complains of a headache that is more pronounced in the morning (especially after sleep), accompanied by nausea and sometimes vomiting, which brings relief. There is a feeling of pressure on the eyeballs from the inside, there is a burning sensation, "sand" in the eyes, the pain is bursting. It is possible to inject vessels of the sclera.

As the CSF pressure increases, drowsiness joins, which serves as a poor prognostic sign, as it indicates an increase in symptoms and threatens with loss of consciousness.

Perhaps blurred vision, a feeling of "fog" before the eyes. Congestive discs of the optic nerves are revealed in the fundus.

If the patient does not seek medical help in time, then the continued increase in the content of cerebrospinal fluid and intracranial pressure will lead to the development of dislocation syndrome, a life-threatening condition. It manifests itself as a rapid depression of consciousness up to coma, paresis of upward gaze, divergent strabismus, and inhibition of reflexes. These symptoms are characteristic of compression of the midbrain. When compression of the medulla oblongata occurs, symptoms of swallowing disorders appear, the voice changes (up to loss of consciousness), and then cardiac activity and respiration are inhibited, which leads to the death of the patient.

Chronic hydrocephalus is more often communicating and with normal or slightly increased intracranial pressure. It develops gradually, months after the causative factor. Initially, the sleep cycle is disturbed, either insomnia or drowsiness appears. Memory deteriorates, lethargy, fatigue appear. Characterized by general asthenia. As the disease progresses, mnestic (cognitive) impairments worsen up to dementia in advanced cases. Patients cannot take care of themselves and behave inappropriately.

The second typical symptom of chronic hydrocephalus is impaired walking. Initially, the gait changes - it becomes slow, unstable. Then uncertainty joins when standing, difficulty in starting to move. In the supine or sitting position, the patient can imitate walking, cycling, but in an upright position this ability is instantly lost. The gait becomes "magnetic" - the patient seems to be glued to the floor, and, having moved from his place, he takes small shuffling steps on widely spaced legs, marking time. These changes are called "apraxia of walking". Muscle tone increases, in advanced cases, muscle strength decreases, and paresis in the legs appears. Balance disorders also tend to progress to the point of being unable to stand or sit on their own.

Often patients with chronic hydrocephalus complain of frequent urination, especially at night. Gradually, imperative urges to urinate are added, requiring immediate emptying, and then urinary incontinence at all.

Diagnostics

The main role in establishing the diagnosis belongs to computed tomography (CT) and magnetic resonance imaging (MRI). These methods make it possible to determine the shape and size of the ventricles, subarachnoid space, and brain cisterns.

Radiography of the cisterns of the base of the brain makes it possible to assess the direction of the CSF flow and clarify the type of hydrocephalus.

It is possible to conduct a trial diagnostic lumbar puncture with the removal of cerebrospinal fluid, which is accompanied by a temporary improvement in the condition. This is due to the restoration of blood supply to ischemic brain tissues against the background of a decrease in intracranial pressure. This serves as a favorable prognostic sign in predicting the surgical treatment of hydrocephalus. You should know that in acute hydrocephalus, lumbar puncture is contraindicated due to the high risk of hernia of the brain stem and the development of dislocation syndrome.

Treatment

The initial stages of hydrocephalus can be treated with medication. For this, the following drugs are used:

to reduce intracranial pressure and remove excess fluid (provided that the outflow of CSF is preserved) - diacarb (acetazolamide), mannitol and mannitol in combination with furosemide or lasix. Mandatory in this treatment is the correction of the level of potassium in the body, for this they use asparkam (panangin);
to improve the nutrition of the brain tissue, cavinton (vinpocetine), actovegin (solcoseryl), gliatilin, choline, cortexin, cerebrolysin, semax, memoplant, etc. are indicated.

Clinically developed hydrocephalus is subject to surgical treatment, drug methods improve the condition for a short time.

Acute hydrocephalus, as a life-threatening condition, requires urgent neurosurgical treatment. It consists in trepanation of the skull and the imposition of external drainage, providing an outflow of excess fluid. This is called external ventricular drainage. In addition, through the drainage system, it is possible to administer drugs that thin blood clots (since intraventricular hemorrhage is one of the most common causes of acute hydrocephalus).

Chronic hydrocephalus requires CSF shunting operations. This type of surgical treatment is the removal of excess cerebrospinal fluid into the natural cavities of the human body using a complex system of catheters and valves (abdominal cavity, pelvic cavity, atria, etc.): ventriculoperitoneal, ventriculoatrial, cystoperitoneal shunting. In the cavities of the body, unhindered absorption of excess cerebrospinal fluid occurs. These operations are quite traumatic, but if performed correctly, they can achieve recovery of patients, their labor and social rehabilitation.

To date, the less traumatic neuroendoscopic technique has taken the first place among invasive methods of treatment. It is still more often performed abroad due to the high cost of the operation itself. This method is called as follows: endoscopic ventriculocisternostomy of the bottom of the third ventricle. The operation takes only 20 minutes. With this method of treatment, a surgical instrument with a neuroendoscope (camera) at the end is inserted into the ventricles of the brain. The camera allows you to demonstrate an image using a projector and accurately control all manipulations. At the bottom of the third ventricle, an additional hole is created that connects to the cisterns of the base of the brain, which eliminates the cause of hydrocephalus. Thus, the physiological liquor flow between the ventricles and cisterns is restored, as it were.

Effects

Hydrocephalus is a dangerous disease, ignoring the symptoms of which is fraught with disability or even a threat to life. The fact is that the changes that occur in the brain as a result of the long-term existence of hydrocephalus are irreversible.

Untimely treatment can turn into a tragedy for a person: loss of ability to work and social significance. Mental disorders, movement problems, urination disorders, decreased vision, hearing, epileptic seizures - this is the list of possible consequences of hydrocephalus if its treatment is not started in a timely manner. Therefore, at the slightest suspicion of hydrocephalus, it is necessary to seek qualified medical help.

TVC, program "Doctors" on the topic "Hydrocephalus"

MODERATE EXPANSION OF EXTERNAL CSF SPACES

I have already asked questions earlier that it’s hard for me to walk and sit starts to press in my head, if I don’t lie down, then the pulse increases to 182 and the pressure rises to 150/120, while the condition becomes pre-fainting, very bad.

1. What is it?

2. Could this be the cause of pressing pains in the head?

3. Is the moderate expansion of the external liquor spaces an independent disease or a consequence of something, for example, a high pulse or pressure?

4. How to deal with it?

On MRI images, there is a zone of CSF density (signal intensity) associated with the ventricle and (or) subarachnoid space. Their choroid plexuses are just the main source of production of cerebrospinal fluid (CSF) into the subarachnoid space. The mechanism for the development of such changes is quite simple: the inflammatory process (often arachnoiditis) enhances the production of cerebrospinal fluid, which gradually stretches the subarachnoid space (liquor space.

It does not require any treatment, since this is a variant of the structure and development. For clarity, I am attaching a picture below:

Now for the description. MRI. Almost EVERYTHING in the description is in proportion to the norm and variants of the norm. THIS space is NOT expanded. A grimace of overdiagnosis, such a habit of SEEING this NORMAL space expanded.

General analysis of blood and urine.

Blood lipid spectrum (total cholesterol, LDL, HDL, triglycerides).

Creatinine (creatinine clearance or glomerular filtration rate), potassium, serum uric acid.

God bless you never have a reason to go to the doctor! And if you have to, then do not delay.

If you have symptoms, you need to see a neurologist and a cardiologist.

I still don’t understand my expansion of cerebrospinal fluid spaces can be the cause of pressing pains in my head?

or MRI did not establish the reason why I have pressure in my head?

today after mri

and still presses, yes, with an increase in pressure, it presses me, but even without it, too

and I have pressure in my head and the inadequacy of the pulse,

Or will it still show?

Unfortunately, no angiography images are visible. In general - by age - are you 43? Question about lifestyle and weight: how much do you weigh? bad habits? How much do you move per day and how much do you sleep? Is there a family - a wife and children.

Rather, your headaches are related to vascular dystonia or migraines on a hormonal background.

This is from vasoconstriction during a shift in body position. Better check your spine - for osteochondrosis of the cervical and other parts, and remember - when was the last time you ran. was there shortness of breath. If yes - the cardiologist will be not superfluous. It can be valves and weakness of cardiac blood flow.

Try to analyze everything and I wish you to be a healthy strong man!

Best wishes. All diseases begin in our head - that is, from the nerves. Psychology help!

Please tell me, since my pulse behaves inappropriately, increasing strongly with minor loads for a long time without decreasing, can this be a sign of autonomic neuropathy?

If autonomic neuropathy is suspected, what tests should be done? maybe some vitamins?

ENMG can show something, or is it only on peripheral nerves? or if the vegetative ones are affected, then the peripheral ones will also be affected?

On a series of brain MRI scans performed in T1, T2, FLAIR modes in axial, sagittal and coronary projections before and after contrast enhancement, images of sub- and supratentorial structures were obtained

In the frontal, temporal, occipital and parietal lobes of both hemispheres of the brain, periventricular and subcortical, in the subcortical regions on both sides, there are multiple hyperintense foci on T2-WI and FLAIR-IP, sized 11.0x7.0 mm and less, with a tendency to confluence, no evidence of contrast agent accumulation and perifocal edema. There is marked periventricular gliosis.

The median structures of the brain are not displaced. The basal cisterns are differentiated and distinct. The ventricular system is not expanded. The lateral ventricles are symmetrical, the contours are clear, even. The third ventricle is up to 4.1 mm wide. The fourth ventricle is 12.5 mm wide. The corpus callosum, subcortical nuclei are usually formed. Subarachnoid convexital spaces are moderately dilated. The perivascular spaces of Virchow-Robin are expanded on both sides in the projection of the basal ganglia, in the white matter of the brain of the cerebral hemispheres. The pituitary gland with smooth contours, homogeneous structure, normal size. The funnel of the pituitary gland is located centrally. Chiasma is structural. The cerebellum, stem structures and substance of the spinal cord up to the level of the C3 vertebra were without pathological changes. Cerebellar tonsils at the level of the foramen magnum. Cranio-vertebral transition without features. Moderately pronounced thickening of the mucous membranes of the maxillary sinuses, cells of the ethmoid bone. On the lower wall of the right maxillary sinus, a cyst with dimensions of 19.5x14.0 mm is determined. The nasal septum is smoothly curved to the right. The frontal sinuses are aplastic.

b Conclusion: MR signs of vascular encephalopathy. Moderately pronounced expansion of the external cerebrospinal fluid spaces of a substitutive nature. MRI signs of bilateral maxillary sinusitis, ethmoiditis. Cyst in the right maxillary sinus.

Liquor system of the brain

One of the causes of headaches and other brain disorders lies in the violation of the circulation of the cerebrospinal fluid. CSF is cerebrospinal fluid (CSF) or cerebrospinal fluid (CSF), which is a constant internal environment of the ventricles of the brain, the pathways along which the CSF passes and the subarachnoid space of the brain.

Liquor, which is often an inconspicuous part of the human body, performs a number of important functions:

Maintaining the constancy of the internal environment of the body
Control over the metabolic processes of the central nervous system (CNS) and brain tissues
Mechanical support for the brain
Regulation of the activity of the arteriovenous network by stabilizing intracranial pressure and blood supply to the brain
Normalization of the level of osmotic and oncotic pressure
Bactericidal action against foreign agents, through the content in its composition of T- and B-lymphocytes, immunoglobulins responsible for immunity

The choroid plexus, located in the cerebral ventricles, is the starting point for the production of CSF. Cerebrospinal fluid passes from the lateral ventricles of the brain through the foramen of Monro to the third ventricle.

The aqueduct of Sylvius serves as a bridge for the passage of cerebrospinal fluid into the fourth ventricle of the brain. After passing a few more anatomical formations, such as the foramen of Magendie and Luschka, the cerebellar-cerebral cistern, the Sylvian sulcus, enters the subarachnoid or subarachnoid space. This gap is located between the arachnoid and pia mater of the brain.

CSF production corresponds to a rate of approximately 0.37 ml / min or 20 ml / h, regardless of the intracranial pressure. The general figures for the volume of cerebrospinal fluid in the cavitary system of the skull and spine in a newborn child are ml, a child aged one year has 35 ml, and an adult is about ml.

Within 24 hours, the cerebrospinal fluid is completely renewed from 4 to 6 times, in connection with which its production during the day averages approx.

The high rate of CSF formation corresponds to the high rate of its absorption by the brain. The absorption of CSF occurs with the help of pachyon granulations - the villi of the arachnoid membrane of the brain. The pressure inside the skull determines the fate of the cerebrospinal fluid - with a decrease, its absorption stops, and with an increase, on the contrary, it increases.

In addition to pressure, the absorption of CSF also depends on the state of the arachnoid villi themselves. Their compression, blockage of the ducts due to infectious processes, leads to a cessation of the flow of cerebrospinal fluid, disrupting its circulation and causing pathological conditions in the brain.

Liquor spaces of the brain

The first information about the liquor system is associated with the name of Galen. The great Roman physician was the first to describe the membranes and ventricles of the brain, as well as the cerebrospinal fluid itself, which he mistook for a certain animal spirit. The CSF system of the brain aroused interest again only many centuries later.

The scientists Monroe and Magendie own the descriptions of the openings describing the course of the CSF, which received their name. Domestic scientists also had a hand in the contribution of knowledge to the concept of the CSF system - Nagel, Pashkevich, Arendt. In science, the concept of cerebrospinal fluid spaces appeared - cavities filled with cerebrospinal fluid. These spaces include:

Subarachnoid - a slit-like cavity between the membranes of the brain - arachnoid and soft. Allocate cranial and spinal spaces. Depending on the attachment of a part of the arachnoid to the brain or spinal cord. The head cranial space contains about 30 ml of CSF, and the spinal space contains about 30 ml of CSF.
Virchow-Robin spaces or perivascular spaces - the perivascular region of the brain and spinal cord, which incorporates part of the arachnoid
The ventricular spaces are represented by the cavity of the ventricles. Disturbances in liquorodynamics associated with ventricular spaces are characterized by the concept of monoventricular, biventricular, triventricular
tetraventricular, depending on the number of damaged ventricles;
Cisterns of the brain - spaces in the form of extensions of the subarachnoid and pia mater

CSF spaces, CSF pathways, as well as CSF-producing cells are united by the concept of the CSF system. Violation of any of its links can cause disorders of liquorodynamics or liquorocirculation.

CSF disorders and their causes

The emerging liquorodynamic disturbances in the brain are referred to such conditions in the body in which the formation, circulation and utilization of CSF is disturbed. Disorders can occur in the form of hypertensive and hypotensive disorders, with characteristic intense headaches. The causative factors of liquorodynamic disorders include congenital and acquired.

Among congenital disorders, the main ones are:

Arnold-Chiari malformation, which is accompanied by a violation of the outflow of cerebrospinal fluid
Dandy-Walker malformation, the cause of which is an imbalance in the production of cerebrospinal fluid between the lateral and third and fourth cerebral ventricles
Stenosis of the cerebral aqueduct of primary or secondary origin, which leads to its narrowing, resulting in an obstacle to the passage of CSF;
Agenesis of the corpus callosum
Genetic disorders of the X chromosome
Encephalocele - a craniocerebral hernia that leads to compression of brain structures and disrupts the movement of cerebrospinal fluid
Porencephalic cysts that lead to hydrocephalus - hydrocele of the brain, impeding the flow of CSF fluid

Among the acquired causes, there are:

Already in the period of a week of pregnancy, one can judge the state of the baby's cerebrospinal fluid system. Ultrasound at this time allows you to determine the presence or absence of pathology of the fetal brain. Liquorodynamic disorders are divided into several types depending on:

The course of the disease in the acute and chronic phase
The stages of the course of the disease are a progressive form that combines the rapid development of abnormalities and an increase in intracranial pressure. Compensated form with stable intracranial pressure, but an expanded cerebral ventricular system. And subcompensated, which is characterized by an unstable state, leading, with minor provocations, to liquorodynamic crises
CSF locations in the brain cavity are intraventricular, caused by stagnation of CSF inside the ventricles of the brain, subarachnoid, encountering difficulty in CSF flow in the arachnoid of the brain, and mixed, combining several different points of impaired CSF flow
The level of CSF pressure on - hypertensive type associated with high intracranial pressure, normotensive - with optimal intracranial pressure, but there are causative factors for violations of liquor dynamics and hypotensive type, accompanied by reduced pressure inside the skull

Symptoms and diagnosis of liquorodynamic disorders

Depending on the age of the patient with impaired liquorodynamics, the symptomatic picture will be different. Newborn babies under the age of one year suffer from:

Frequent and profuse regurgitation
Sluggish overgrowth of fontanelles. Increased intracranial pressure leads, instead of overgrowth, to swelling and intense pulsation of large and small fontanels
The rapid growth of the head, the acquisition of an unnatural elongated shape;
Spontaneous crying for no apparent reason, which leads to lethargy and weakness of the child, his drowsiness
Twitching of the limbs, tremor of the chin, involuntary shuddering
A pronounced vascular network in the nose of the child, on the temporal region, his neck and at the top of the chest, which manifests itself in the tension of the baby when crying, trying to raise his head or sit down
Motor disorders in the form of spastic paralysis and paresis, more often lower paraplegia and less often hemiplegia with increased muscle tone and tendon reflexes
Late onset of functioning of head holding capacity, sitting and walking
Converging or divergent strabismus due to oculomotor nerve block

Children over the age of one year begin to experience symptoms such as:

Increased intracranial pressure leading to bouts of severe headache, more often in the morning, accompanied by nausea or vomiting that does not relieve
Rapidly changing apathy and restlessness
Coordination imbalance in movements, gait and speech in the form of its absence or difficulty in pronunciation
Decreased visual function with horizontal nystagmus, as a result of which children cannot look up
"Bobbling Doll Head"
Intellectual developmental disorders, which may have minimal or global severity. Children may not understand the meaning of the words they say. With a high level of intelligence, children are talkative, prone to superficial humor, inappropriate use of loud phrases, due to difficulty in understanding the meaning of words and mechanical repetition of easily remembered. Such children have increased suggestibility, lack initiative, are unstable in mood, often in a state of euphoria, which can easily be replaced by anger or aggression.
Endocrine disorders with obesity, delayed puberty
Convulsive syndrome, which becomes more pronounced over the years

Adults more often suffer liquorodynamic disorders in the hypertensive form, which manifests itself in the form of:

High pressure figures
severe headaches
Periodic dizziness
Nausea and vomiting that accompany the headache and do not bring relief to the patient
Cardiac imbalance

Among the diagnostic studies for violations in liquorodynamics, there are such as:

Examination of the fundus by an ophthalmologist
MRI (magnetic resonance imaging) and CT (computed tomography) - methods that allow you to get an accurate and clear image of any structure
Radionuclide cisternography based on the study of brain cisterns filled with cerebrospinal fluid by means of labeled particles that can be traced
Neurosonography (NSG) is a safe, painless, not time-consuming study that gives an idea of the picture of the brain ventricles and CSF spaces.

What is the subarachnoid space and why does it expand

The human brain is one of the most complex and little-studied organs, which is forced to constantly work. For its normal functioning, it needs proper nutrition and blood supply.

The human brain consists of three membranes: soft, hard and arachnoid. The subarachnoid space is the space between the pia mater and the arachnoid. The arachnoid membrane envelops the brain; it communicates with other tissues by the subarachnoid junction.

They form the ventricular system of the spinal cord and brain, consisting of four tanks in which fluid circulates.

The subarachnoid space is filled with cerebrospinal fluid, or cerebrospinal fluid, which is responsible for nourishing and protecting the brain. A favorable environment is created for the interchange of useful substances between the blood and the human brain, the movement of nutrients to the nerve endings and ventricles.

The end products of tissue metabolism are thrown into the cerebrospinal fluid and excreted. It constantly circulates in the brain cavity.

Up to 140 million CSF cells must be present in the subarachnoid space, which flows out of the brain through an opening in the fourth ventricle. Its maximum volume is contained in the cisterns of space located above the large crevices and furrows of the brain.

Anatomical reference - membranes and spaces of the brain:

Why is the subarachnoid space enlarged

Failures in the circulation of CSF cause infectious diseases of the central nervous system, chronic diseases, meningitis, encephalitis, tumors or birth trauma. This leads to a decrease in the amount of gray and white matter in the brain, and as a result, the subarachnoid space expands.

An enlarged subarachnoid space indicates a malfunction in the circulation of cerebrospinal fluid, its excessive production and entry into the brain cavities occurs, that is, hydrocephalus or dropsy develops and, as a result, increased intracranial pressure is noted.

If there is a benign local expansion of the subarachnoid spaces, the ventricles are slightly dilated or are within the normal range, then the violation resolves on its own in one or two years and does not harm the health of the baby.

But you can’t just hope for a favorable outcome of the disease, you need to contact a neurologist who will prescribe the necessary treatment.

The expansion of the subarachnoid spaces of the brain in adults can cause the following reasons:

These factors contribute to the start of the process of atrophy, the amount of white and gray matter decreases, contributing to the expansion of the subarachnoid space.

Degrees of expansion

Expansion of the subarachnoid space is of three degrees:

The expansion of the cerebrospinal fluid spaces occurs in proportion to the growth of the head of the newborn and the swelling of the fontanel.

The course and outcome of the disease depends on timely seeking medical help and initiation of treatment. If the treatment is chosen correctly, then the change in the ventricles remains almost within the normal range.

Features of the clinical picture

The following symptoms will help to suspect abnormalities in the functioning of the brain and the expansion of the subarachnoid space in a newborn baby:

irritability to moderate or low sounds, noises;
increased sensitivity to light;
profuse regurgitation;
disturbed sleep;
pupils of different sizes or strabismus;
an increase in the size of the head;
anxiety about changing weather;
the fontanel slowly overgrows and its swelling is present;
trembling of limbs and chin.

The fact that the subarachnoid spaces are expanded in an adult is characterized by the following symptoms:

headache after waking up in the morning;
nausea and vomiting, as a result of a severe headache that disappears after vomiting;
dizziness;
drowsiness, a dangerous symptom of intracranial pressure, reporting the progression of the disease;
visual impairment;
dementia, observed after receiving a head injury, sleep is disturbed, a person confuses day with night, memory lapses occur;
apraxia of walking, the patient in the supine position shows how to walk, but when getting up he sways, shuffles, walks with his legs wide apart.

Methods and goals of diagnosis

It is possible to diagnose the disease only after a comprehensive examination and laboratory tests. After receiving the results of magnetic resonance or computed tomography, the results of blood biochemistry, ultrasound examination of the cerebral hemispheres, assessment of the symptoms and behavior of the patient, the neuropathologist will establish the final diagnosis, the degree of the disease and prescribe medication.

Basic diagnostic methods:

Neurosonography. It lasts no more than fifteen minutes, is carried out using an ultrasonic sensor through an open fontanelle on the head of a newborn. The study can be carried out quite often, without negative consequences for the child. As a rule, neurosonography is done for all newborns in the maternity hospital to detect pathologies in the development of the brain at the initial stage. The neuropathologist or pediatrician deciphers the examination data. Only by comparing the symptoms and examination data, the doctor can make a diagnosis.
Computed and magnetic resonance imaging are very expensive research methods and are carried out when serious abnormalities are detected. As a rule, for newborns, it is enough to conduct neurosonography through the fontanel, but adults already need more serious diagnostic methods. Today, these are the most reliable and accurate methods for studying the human body. MRI allows you to see a layered image of the desired part of the brain. Examination of infants is very problematic, since it requires complete fixation and the adoption of a stationary state, which is very problematic for young children. If the baby needs this type of examination, it is carried out under anesthesia.
Cisternography is used to determine the direction of the cerebrospinal fluid and clarify the type of hydrocephalus.
Angiography is a method of examination when contrast is injected into an artery and deviations in the patency of blood vessels are detected.
Neuropsychological examination - examination and questioning of the patient, collection of all analyzes and studies together, to identify violations in the functioning and functioning of the brain.

Health care

Treatment of the enlarged subarachnoid space is aimed at eliminating the causes and factors that provoked the disease. Basic therapy includes vitamins, especially B and D groups, and antibiotics if infection is present.

Treatment is long and is prescribed for each patient individually.

The main drugs include:

diuretics, to remove excess fluid from the body (Veroshpiron, Diakarb);
potassium-containing preparations (Asparkam);
means for improving brain trophism (Pantogam, Cavinton);
vitamins of groups B and D;
painkillers after injury and with tumors (for example, Ketonal, Nimesil, Ketoprofen, Nimesulide);
barbiturates (Nembutal, Phenobarbital, Amital);
saluretics (Acetazolamide, Furosemide, Ethacrynic acid);
glucocorticosteroid drugs (Prednisalone, Dexamethasone, Betamethasone).

If the disease progresses rapidly and the subarachnoid cavity enlarges, then the main therapy will be to find the cause of the causing disorder, if it is hydrocephalus, diuretics are used, and antibacterial drugs are used to treat infections.

Hydrocephalus as a common complication

In severe cases of the disease, when medications and physical procedures did not bring the desired result, surgical treatment is indicated.

Hydrocephalus is an extremely dangerous disease that can cause blindness or decreased vision, impaired speech, and lag in the development of the child.

The principles and methods of treatment of the disease are carried out for a long time and are selected individually for each patient. Treatment will depend on the nature, severity and complications. The main task is to restore normal circulation and outflow of CSF from the supracerebral region, which will lead to the normalization of intracranial pressure, which will make it possible to improve and restore the metabolism of cells and tissues of the nervous system.

Physioneuropological procedures are also prescribed in the complex, which reduce the symptoms of the disease and speed up the healing process.

Why is it dangerous?

Launched expansion of subarachnoid convexital spaces and its untimely treatment in infants can lead to more serious complications:

Timely diagnosis and treatment will reduce the risk or eliminate complications of the disease, contribute to a favorable course and outcome of the disease, so that it will not affect the functioning, vital activity and physical development of the child and, as a rule, disappears by the age of two.

Preventive measures

Prevention should be done by a woman (future parents) even before conception. Before conception, conduct a complete examination of the body to identify chronic and infectious diseases, if any, treat them, follow the doctor's recommendations during pregnancy, protect yourself from stress and behave correctly during childbirth.

After the birth of the baby, monitor his behavior to prevent injury.

The expansion of the subarachnoid space in adults is diagnosed very rarely, but in order to prevent its occurrence, it is necessary to avoid traumatic brain injuries and monitor your health.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

The subarachnoid space of the brain and spinal cord communicate directly with the ventricles of the brain, forming a series of communicating vessels.

The accumulation of excess fluid is fraught with increased pressure on the brain tissue, which as a result is pressed against the skull. If the correct diagnosis is not made in time and treatment is not started, a fatal outcome may occur. This disease, as a rule, is congenital, but this does not mean at all that they cannot get sick in adulthood. Hydrocephalus of the brain in adults is treatable, but the effectiveness of this therapy depends on the degree of brain damage, symptoms and comorbidities.

Types of hydrocephalus

According to the place of accumulation of fluid, several types of hydrocephalus are distinguished, among which:

External - in this case, the fluid is concentrated in the subarachnoid space, not far from the cranium;
Ventricular - accumulation of fluid is observed in the ventricles of the brain, deep inside;
General - in this case, the cerebrospinal fluid accumulates in the entire space of the brain.

It is worth noting that if the fluid communicates freely, open hydrocephalus is diagnosed. In the event that the circulation pathways of the cerebrospinal fluid are disturbed, the disease is considered closed.

Causes of hydrocephalus development

Hydrocephalus in adults in most cases develops as a result of infectious diseases, stroke, cerebral hemorrhage, brain tumors. Often this pathology occurs in old age and becomes the cause of the development of premature senile dementia. If the correct diagnosis is made in a timely manner, the consequences can be significantly mitigated.

The immediate causes of hydrocephalus include the following:

violation of fluid circulation;
increased production of liquor;
fluid malabsorption;
narrowing of subarachnoid spaces;
a decrease in the density of the medulla as a result of its impregnation with cerebrospinal fluid.

As a separate species, vacuolar hydrocephalus is isolated - in this situation, the cause of the disease is craniocerebral trauma. As a rule, the body manages to restore normal fluid circulation on its own. In other cases, serious treatment is recommended.

Symptoms of the disease

The most common signs of hydrocephalus include the following:

Headache.
Nausea and vomiting.
Vision problems - double image, inability to focus on some object, fuzzy boundaries.
Changing the position of the eyeballs - in this case, the effect of rolling the eyes occurs.
Disturbances in the work of the vestibular apparatus - they consist in uncertainty, unsteadiness of gait, impaired coordination in space.
Memory loss.
Clumsiness.
Confusion in the mind.
Lack of strength.
Increased nervousness.
Urinary incontinence.
Irritability.

In addition, drowsiness can sometimes be observed. The presence of certain symptoms depends on the cause of the disease. For example, in older people, as a rule, normotensive hydrocephalus is observed, which is caused by age-related changes. This condition is expressed in the occurrence of forgetfulness, impaired coordination of movements, slowness in thought processes, slow reaction to stimuli.

One of the most striking symptoms of hydrocephalus in adults are mental abnormalities. They can be expressed in the form of epileptic seizures, emotional stupor, depression, apathy, mania, delirium, hallucinations.

Diagnostics

In order to make the correct diagnosis, it is necessary to carry out a whole range of measures.

Computed tomography - with its help, you can assess the state of the contours of the brain, skull, ventricles, subarachnoid space. In addition, it allows you to exclude the presence of anomalies - tumors or cysts.
Magnetic resonance imaging - the data of this study allow us to determine the severity and form of hydrocephalus. This procedure makes it possible to establish the cause of the development of the disease.
Radiography of the cisterns of the base of the skull - it is used to clarify the type of hydrocephalus. In addition, using this procedure, it is possible to determine the direction of the cerebrospinal fluid.
Angiography or x-ray of blood vessels - allows you to determine abnormalities at the level of blood vessels.
Neuropsychological examination - involves a survey of the patient. With the help of this study, you can determine the presence of disorders and abnormalities in the brain.

Treatment methods for hydrocephalus

To date, there are no effective drug treatments for this disease. Medicines can only slow down its development. However, in some cases, the CSF circulation can recover on its own - this applies to mild forms of the disease. Drug treatment is prescribed at the first stage - it helps to reduce intracranial pressure and makes it possible to track how the patient's condition is changing.

If necessary, a puncture is performed, with the help of which the fluid is removed from the places of its excessive accumulation. If the brain cannot independently restore the mechanism for removing fluid, an operation is prescribed. This can be endoscopic surgery or traditional bypass surgery. There are a number of options for the withdrawal of fluid - into the right atrium, into the ureter, into the abdominal cavity. In any case, through surgical intervention, a new CSF circulation system is created, the task of which is to replace the inoperative one.

If hydrocephalus in adults is associated with a tumor that interferes with the normal circulation of cerebrospinal fluid, the interference is eliminated, after which the circulation returns to normal. The installation of shunts during surgery is effective in approximately 85% of cases, since during the operation excess fluid is removed from the brain, a shunt is installed through which it will be removed from accumulation sites to areas where fluid is normally absorbed and distributed. After a period of rehabilitation, people can return to normal life: pressure on the brain disappears, and damaged functions are restored. This method of treatment has been used for a long time - since the fifties of the last century.

It should be noted that after such operations, in about % of cases, certain problems may arise after some time. These include:

infection penetration;
mechanical failure of the shunt;
the occurrence of an inflammatory process.

As a result, there is a need to replace the shunt, which involves a new surgical intervention.

Currently, such operations are usually performed endoscopically - in this case, small incisions are made, thereby reducing the risk of complications and reducing the recovery period. Today, endoscopic ventriculocisternostomy of the bottom of the third ventricle is used. During such an operation, the normal cerebrospinal fluid circulation system is restored. The surgeon ensures that fluid enters the cerebral cisterns, where it can be absorbed normally. If the operation is successful, the shunt is not needed and the patient can return to normal life.

Hydrocephalus can pose a fairly serious threat to health and life. It often worsens the quality of human life. This disease causes irreversible changes in the brain. However, with timely diagnosis, you can quickly return to normal life, therefore, under no circumstances should you ignore the symptoms of the disease, especially if you have had any disease that provokes its development.

Consequences of hydrocephalus

The consequences of this disease are dangerous because in case of a delay in the start of treatment, hydrocephalus can have irreversible consequences. Constant pressure causes serious damage to brain function, causes deformation of the skull and, as a result, is life threatening. Often this disease also leads to the premature development of dementia.

Hydrocephalus of the brain in adults is a rather dangerous disease that can lead to irreversible changes in the brain and even death. Only a timely diagnosis and adequate therapy will allow the patient to return to a full life as soon as possible. It must be understood that the drug treatment of this disease is ineffective, and therefore, in no case should one refuse surgical intervention if it is really necessary. With the help of such an operation, you can get rid of hydrocephalus and significantly improve the quality of your life.

Arachnoid cyst of the brain

Retrocerebellar cyst of the brain

fetal ventriculomegaly

My boyfriend had a brain scan and was told that there are signs of hydrocephalus and atrophy of the frontal lobes. There are no symptoms of the disease yet, the doctor said that this could be an erroneous diagnosis, especially since my MCH had an accident recently. He hit his nose on the steering wheel. The headache was not strong. But it was. He went to the hospital only to have his lip sewn up after the accident, but he didn’t find out anything about the concussion. As a child, he hit his head hard, he remembers, it hurt. He was not taken into the army because of some violations. Doesn't say exactly which ones. Apparently, the same head injury. He complains about the memory that he remembers everything badly from childhood. At the age of 18 he suffered paralysis of the left side of his face, was cured by acupuncture. the doctor is mistaken. Help, please, tell me where to go first of all? Do a second tomography, or something else first?

oh, I have a fairy tale in general. in 2005, how it started .. all the symptoms, like a dumb ghost in a dream, went to the walls. I couldn’t get any help, because I couldn’t explain. the real one flooded in. and she lived, she still worked, after all! she was more disgraced. she was shaking all over. and so, until she gave birth. everything was so bad that it couldn’t be described. generally disappeared, only drowsiness)) I forgot how to write and how to read. conditions passed. There is hydrocephalus on MRI. Before, they did some ancient MRI, they treated multiple sclerosis (although they didn’t find it. Only for symptoms. And parkinson))) No questions, I just wanted to speak out.

Hydrocephalus of the brain in an adult

When the cerebrospinal fluid in the cerebrospinal fluid spaces is increased in the brain, we can talk about cerebral hydrocephalus in an adult.

But most often this disease is typical for infants.

This condition leads to further expansion and death of brain tissue cells, as they are compressed.

Liquid spaces include:

Tanks, especially the largest.
Ventricles of the brain.
Subarachnoid fissures.

When the cerebrospinal fluid in the cerebrospinal fluid spaces is increased in the brain, we can talk about cerebral hydrocephalus in an adult

Hydrocephalus of the brain appears with the development of certain processes, which can be open and closed. Prerequisites for the development of pathology:

Increased production of cerebrospinal fluid.
Liquid is difficult to absorb.
Poor regulation of cerebrospinal fluid.

Hydrocephalus of the brain in adults

In adults, the disease proceeds a little differently than in infancy. Its symptoms are similar to hydrocephalus in older children.

Here are the most common symptoms of this disease in adults:

The pain in the head is like a migraine, while the patient complains of nausea.
High intracranial pressure.
Sometimes vomiting occurs for no reason.
Hearing and ear sensitivity suffer.
The visual function changes - the eyes begin to double, the lack of focus on one object, pupils roll up.
Difficulties appear when moving, a person from fatigue and for other reasons cannot control and coordinate his movements.
The mood often changes, irritability appears.
Temporary memory loss.

Mood changes often occur with hydrocephalus

Hydrocephalus can be different depending on the location of the disease.

Types of dropsy of the brain:

Congenital pathology, develops mainly in newborns.
External hydrocephalus in adults.
Replacement, when the volume of the brain decreases in size for any reason.
Mixed hydrocephalus.
Internal.

Since the disease can develop after a head injury, meningitis, acute poisoning, you should definitely pay attention to the following symptoms, which may indicate hydrocephalus in adults:

When a person begins to confuse day and night, he wants to sleep during the day and stay awake at night.
Lack of activity, apathy, indifference, indifference.
Memory impairment.
A person stops serving himself, makes long pauses when talking, etc.

memory impairment may indicate hydrocephalus in adults

Causes of the disease in adults

Most often in adults, dropsy of the brain occurs suddenly and unexpectedly. At first, signs are generally absent or mildly expressed.

But most often the disease does not appear from scratch. The development of hydrocephalus is possible after a head injury, against the background of existing meningitis, after intoxication of the body, etc.

When the circulation of CSF is disturbed, the pressure in the brain increases over time. This is the main cause of dropsy of the brain - that is, high cranial pressure in certain parts of the brain.

A person's vision is impaired, convulsions occur, pressure on the brain stem occurs, and the above symptoms also occur. At best, the consequences of cerebral hydrocephalus in an adult can be neurological disorders, at worst, death occurs.

Thus, the main causes of the disease, both in adults and in children, are the following:

Infection affecting the nervous system.
The presence of a tumor in the brain.
Chronic insufficiency.

Infection in the nervous system may be the cause of hydrocephalus

Methods of treatment

Unfortunately, external hydrocephalus in adults is currently considered an incurable disease. The only thing that can be done is to stop the development of dropsy a little.

If a person has a disease at an early stage, it is quite possible to completely get rid of the disease, the circulation of cerebrospinal fluid can be restored. Thus, mild hydrocephalus of the brain in adults is treated successfully.

At the initial stages of the disease, the doctor prescribes drugs to reduce cranial pressure.

Since with dropsy of the brain there is an accumulation of fluid in some parts of the brain, a puncture of these areas is often performed in order to pump out excess fluid.

If it is impossible to independently remove excess fluid from the brain, surgical treatment of external hydrocephalus of the brain in an adult is prescribed. This is a traditional bypass or a newer operation using endoscopy.

The fluid is excreted in different parts of the body, it can be the intestines, right atrium or ureter.

At the initial stages of the disease, the doctor prescribes drugs to reduce cranial pressure.

If a malignant tumor is found during the operation, it is also removed.

For the most part, such operations are considered the most effective treatment, as they make it possible to get rid of excess fluid.

Usually, after surgical removal of excess fluid in the brain, a person returns to his previous activities and feels much better, the pressure in the brain disappears, and all symptoms disappear.

Endoscopic operations are performed without any special consequences and complications; small incisions are made in the brain through which the operation is performed.

Consequences of the disease

The consequences of cerebral hydrocephalus in an adult, if left untreated, can be deplorable, even fatal. Due to constant and prolonged cranial pressure, deformity of the cranium develops over time.

With a severe course of the disease, dementia develops over time, therefore, you should regularly see a doctor and, if the disease is detected, begin treatment as early as possible, only then can a successful cure be guaranteed. It should also be remembered that drug therapy does not guarantee getting rid of the disease, only a surgical method can help.

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Hydrocephalus of the brain in adults: causes, symptoms, treatment

Hydrocephalus in adults (“dropsy of the brain”) is a pathological condition characterized by excessive accumulation of cerebrospinal fluid (CSF) in the cerebrospinal fluid spaces of the brain. Hydrocephalus can be an independent nosological unit, or it can be the result of various brain diseases. It requires mandatory qualified treatment, since the prolonged existence of the disease can lead to disability and even death.

The reasons

Absorption (resorption) of CSF occurs in the venous system of the brain through arachnoid cells and villi. The accumulation of villi around the venous sinuses is called pachyonic granulation. Part of the CSF is absorbed into the lymphatic system at the level of the nerve sheaths.

Causes of hydrocephalus can be:

infectious diseases of the brain and its membranes - meningitis, encephalitis, ventriculitis;
brain tumors of stem or near-stem localization, as well as brain ventricles);
vascular pathology of the brain, including subarachnoid and intraventricular hemorrhages as a result of aneurysm rupture, arteriovenous malformations;
encephalopathy (alcoholic, toxic, etc.);
brain injury and post-traumatic conditions;
malformations of the nervous system (for example, Dandy-Walker syndrome, stenosis of the Sylvian aqueduct).

Types of hydrocephalus

Hydrocephalus can be congenital or acquired. Congenital, as a rule, manifests itself in childhood.

Depending on the mechanism of development, there are:

closed (occlusive, non-communicating) hydrocephalus - when the cause is a violation of the CSF flow due to the overlap (block) of the CSF pathways. More often, a blood clot (due to intraventricular hemorrhage), part of a tumor, or adhesion interferes with the normal flow of cerebrospinal fluid;
open (communicating, dysresorbtive) hydrocephalus - based on a violation of absorption into the venous system of the brain at the level of arachnoid villi, cells, pachyon granulations, venous sinuses;
hypersecretory hydrocephalus - with excessive production of cerebrospinal fluid by the vascular plexuses of the ventricles;
external (mixed, ex vacuo) hydrocephalus - when the content of cerebrospinal fluid is increased both in the ventricles of the brain and in the subarachnoid space. In recent years, this form has ceased to be attributed to hydrocephalus, since the reason for the increase in the content of cerebrospinal fluid is the atrophy of the brain tissue and the reduction of the brain itself, and not the violation of the circulation of cerebrospinal fluid.

Depending on the level of intracranial pressure, hydrocephalus can be:

hypertensive - with an increase in the pressure of the cerebrospinal fluid;
normotensive - at normal pressure;
hypotensive - with reduced pressure of the cerebrospinal fluid.

According to the time of occurrence, they are distinguished:

acute hydrocephalus - the period of development of the process is up to 3 days;
subacute progredient - develops within a month (some authors consider the period to be 21 days);
chronic - from 3 weeks to 6 months and above.

Symptoms

The clinical picture depends on the period of formation of hydrocephalus and the level of pressure of the cerebrospinal fluid, the mechanism of development.

As the CSF pressure increases, drowsiness joins, which serves as a poor prognostic sign, as it indicates an increase in symptoms and threatens with loss of consciousness.

Perhaps blurred vision, a feeling of "fog" before the eyes. Congestive discs of the optic nerves are revealed in the fundus.

Chronic hydrocephalus is more often communicating and with normal or slightly increased intracranial pressure. It develops gradually, months after the causative factor. Initially, the sleep cycle is disturbed, either insomnia or drowsiness appears. Memory deteriorates, lethargy, fatigue appear. Characterized by general asthenia. As the disease progresses, mnestic (cognitive) impairments worsen up to dementia in advanced cases. Patients cannot take care of themselves and behave inappropriately.

Diagnostics

Radiography of the cisterns of the base of the brain makes it possible to assess the direction of the CSF flow and clarify the type of hydrocephalus.

Treatment

The initial stages of hydrocephalus can be treated with medication. For this, the following drugs are used:

to reduce intracranial pressure and remove excess fluid (provided that the outflow of CSF is preserved) - diacarb (acetazolamide), mannitol and mannitol in combination with furosemide or lasix. Mandatory in this treatment is the correction of the level of potassium in the body, for this they use asparkam (panangin);
to improve the nutrition of the brain tissue, cavinton (vinpocetine), actovegin (solcoseryl), gliatilin, choline, cortexin, cerebrolysin, semax, memoplant, etc. are indicated.

Clinically developed hydrocephalus is subject to surgical treatment, drug methods improve the condition for a short time.

Effects

Hydrocephalus is a dangerous disease, ignoring the symptoms of which is fraught with disability or even a threat to life. The fact is that the changes that occur in the brain as a result of the long-term existence of hydrocephalus are irreversible.

TVC, program "Doctors" on the topic "Hydrocephalus"

Liquor system of the brain

Liquor, which is often an inconspicuous part of the human body, performs a number of important functions:

Maintaining the constancy of the internal environment of the body
Control over the metabolic processes of the central nervous system (CNS) and brain tissues
Mechanical support for the brain
Regulation of the activity of the arteriovenous network by stabilizing intracranial pressure and blood supply to the brain
Normalization of the level of osmotic and oncotic pressure
Bactericidal action against foreign agents, through the content in its composition of T- and B-lymphocytes, immunoglobulins responsible for immunity

Within 24 hours, the cerebrospinal fluid is completely renewed from 4 to 6 times, in connection with which its production during the day averages approx.

Liquor spaces of the brain

Subarachnoid - a slit-like cavity between the membranes of the brain - arachnoid and soft. Allocate cranial and spinal spaces. Depending on the attachment of a part of the arachnoid to the brain or spinal cord. The head cranial space contains about 30 ml of CSF, and the spinal space contains about 30 ml of CSF.
Virchow-Robin spaces or perivascular spaces - the perivascular region of the brain and spinal cord, which incorporates part of the arachnoid
The ventricular spaces are represented by the cavity of the ventricles. Disturbances in liquorodynamics associated with ventricular spaces are characterized by the concept of monoventricular, biventricular, triventricular
tetraventricular, depending on the number of damaged ventricles;
Cisterns of the brain - spaces in the form of extensions of the subarachnoid and pia mater

CSF spaces, CSF pathways, as well as CSF-producing cells are united by the concept of the CSF system. Violation of any of its links can cause disorders of liquorodynamics or liquorocirculation.

CSF disorders and their causes

Among congenital disorders, the main ones are:

Arnold-Chiari malformation, which is accompanied by a violation of the outflow of cerebrospinal fluid
Dandy-Walker malformation, the cause of which is an imbalance in the production of cerebrospinal fluid between the lateral and third and fourth cerebral ventricles
Stenosis of the cerebral aqueduct of primary or secondary origin, which leads to its narrowing, resulting in an obstacle to the passage of CSF;
Agenesis of the corpus callosum
Genetic disorders of the X chromosome
Encephalocele - a craniocerebral hernia that leads to compression of brain structures and disrupts the movement of cerebrospinal fluid
Porencephalic cysts that lead to hydrocephalus - hydrocele of the brain, impeding the flow of CSF fluid

Among the acquired causes, there are:

The course of the disease in the acute and chronic phase
The stages of the course of the disease are a progressive form that combines the rapid development of abnormalities and an increase in intracranial pressure. Compensated form with stable intracranial pressure, but an expanded cerebral ventricular system. And subcompensated, which is characterized by an unstable state, leading, with minor provocations, to liquorodynamic crises
CSF locations in the brain cavity are intraventricular, caused by stagnation of CSF inside the ventricles of the brain, subarachnoid, encountering difficulty in CSF flow in the arachnoid of the brain, and mixed, combining several different points of impaired CSF flow
The level of CSF pressure on - hypertensive type associated with high intracranial pressure, normotensive - with optimal intracranial pressure, but there are causative factors for violations of liquor dynamics and hypotensive type, accompanied by reduced pressure inside the skull

Symptoms and diagnosis of liquorodynamic disorders

Depending on the age of the patient with impaired liquorodynamics, the symptomatic picture will be different. Newborn babies under the age of one year suffer from:

Frequent and profuse regurgitation
Sluggish overgrowth of fontanelles. Increased intracranial pressure leads, instead of overgrowth, to swelling and intense pulsation of large and small fontanels
The rapid growth of the head, the acquisition of an unnatural elongated shape;
Spontaneous crying for no apparent reason, which leads to lethargy and weakness of the child, his drowsiness
Twitching of the limbs, tremor of the chin, involuntary shuddering
A pronounced vascular network in the nose of the child, on the temporal region, his neck and at the top of the chest, which manifests itself in the tension of the baby when crying, trying to raise his head or sit down
Motor disorders in the form of spastic paralysis and paresis, more often lower paraplegia and less often hemiplegia with increased muscle tone and tendon reflexes
Late onset of functioning of head holding capacity, sitting and walking
Converging or divergent strabismus due to oculomotor nerve block

Children over the age of one year begin to experience symptoms such as:

Increased intracranial pressure leading to bouts of severe headache, more often in the morning, accompanied by nausea or vomiting that does not relieve
Rapidly changing apathy and restlessness
Coordination imbalance in movements, gait and speech in the form of its absence or difficulty in pronunciation
Decreased visual function with horizontal nystagmus, as a result of which children cannot look up
"Bobbling Doll Head"
Intellectual developmental disorders, which may have minimal or global severity. Children may not understand the meaning of the words they say. With a high level of intelligence, children are talkative, prone to superficial humor, inappropriate use of loud phrases, due to difficulty in understanding the meaning of words and mechanical repetition of easily remembered. Such children have increased suggestibility, lack initiative, are unstable in mood, often in a state of euphoria, which can easily be replaced by anger or aggression.
Endocrine disorders with obesity, delayed puberty
Convulsive syndrome, which becomes more pronounced over the years

Adults more often suffer liquorodynamic disorders in the hypertensive form, which manifests itself in the form of:

High pressure figures
severe headaches
Periodic dizziness
Nausea and vomiting that accompany the headache and do not bring relief to the patient
Cardiac imbalance

Among the diagnostic studies for violations in liquorodynamics, there are such as:

Examination of the fundus by an ophthalmologist
MRI (magnetic resonance imaging) and CT (computed tomography) - methods that allow you to get an accurate and clear image of any structure
Radionuclide cisternography based on the study of brain cisterns filled with cerebrospinal fluid by means of labeled particles that can be traced
Neurosonography (NSG) is a safe, painless, not time-consuming study that gives an idea of the picture of the brain ventricles and CSF spaces.

Good afternoon! My daughter is 3 months old, they did an ultrasound of the brain, the results are as follows: Subarachnoid space according to conv. departments of the hemisphere - 2.4-3.3 mm, interhemispheric sulcus 4.5 mm, large cisterna of the brain 5 mm, width of the 3rd ventricle 2.5 mm, they wrote in the conclusion worry.

Chebunina Olga

Hello Olga. The first thing I can say is that only a pediatric neurologist who ordered an examination and examined the baby can evaluate brain indicators. It is possible to judge the presence or absence of pathology only in the complex. If we evaluate the indicators: normal indicators are: the width of the 3rd ventricle (2-4 mm), a large cistern (3-6 mm), an increase in indicators is noted - the subarachnoid space is expanded - 2.4 -3.3 mm (normally no more than 1, 5-3 mm) and the interhemispheric furrow - normally no more than 2 mm. Dilation is the expansion of the external cerebrospinal fluid spaces.
These are signs of hydrocephalus, which can form as a result of any intrauterine infections and fetal malformations. In this case, an increased amount of cerebrospinal fluid is formed or its slow absorption is noted. But in your case, the indicators are not as elevated, so you need to contact a pediatric neurologist as soon as possible and take all the drugs prescribed by the doctor. In most cases, this condition is corrected by medication and does not affect the physical and mental development of the baby in the future. In the absence of treatment, the expansion of liquor spaces increases, and babies suffer from headaches, weakness, psycho-emotional disorders with head deformity.