Severe external hydrocephalus of the brain. Compensated and decompensated form. How is external cerebral hydrocephalus diagnosed?

External hydrocephalus brain is neurological disease, the development of which occurs in and in the space under meninges. It is the result of an excessive accumulation of cerebrospinal fluid. This pathology associated with higher education cerebrospinal fluid or disruption of its outflow.

There is congenital or acquired hydrocephalus. In addition, open, closed hydrocephalus and the ex vacuo form are distinguished.

The open form of the disease develops as a result of a violation of the production and absorption of cerebrospinal fluid. And in this case liquor-bearing spaces freely communicate.

The closed form of hydrocephalus involves the separation of liquor-bearing spaces into different levels.

The ex vacuo form is a consequence of the reduction of the brain parenchyma, which occurs as a result of atrophy during different pathologies nervous system or because of aging. In addition, depending on clinical manifestations there is a progressive, stabilizing and regressing form of the disease.

Causes of development of external hydrocephalus

There are a number of reasons why hydrocephalus develops:

  • Diseases associated with inflammation of the brain or its membranes.
  • Violations of the cervical vertebrae.
  • Pathological changes in the work of cerebral vessels.
  • Traumatic brain injury.
  • Pathologies in the development of the central nervous system.

Symptoms of hydrocephalus in adults

For this disease characterized by symptoms such as:

Often, the symptoms of this disease in adults may not appear, and therefore an increase blood pressure and headaches are not observed for long period time.

Moderate external hydrocephalus is considered a very insidious form of this disease. It is characterized by the absence of any symptoms for several years. However, then there comes a moment when a person's condition deteriorates sharply - this is due to a violation of cerebral circulation. In most cases, this diagnosis is made by chance during an examination of the fundus.

Symptoms of hydrocephalus in children

In the case of the congenital form of this disease, an increase in the volume of the head by fifty percent, a divergence of the bone sutures, swelling of the skin veins, and fontanelles can be observed. In addition, the disease is accompanied by capriciousness, which is associated with increased intracranial pressure, poor appetite, lethargy, marbling skin. One of the characteristic signs is too much opening of the eyes and the direction of the look down.

In adolescents and older children external hydrocephalus of the brain has the same symptoms as in adults. It should be noted that this disease in most cases is observed in premature babies.

Diagnostics

Today one of the most informative methods research for staging correct diagnosis is . In addition, methods such as angiography, x-ray examination. Also apply laboratory research in order to determine the presence of herpes, rubella, toxoplasmosis, syphilis viruses.

Treatment

Treatment tactics are determined based on the type of disease and the age of the patient. A person is prescribed diuretics and vasodilators, which normalize the work of the central nervous system, and also control the outflow of cerebrospinal fluid. At the same time, carbonic anhydrase inhibitors are used - these agents reduce the production of cerebrospinal fluid, and saluretics, which improve venous outflow. It is very important to understand that drug therapy can only slow down the course of the disease and alleviate the patient's condition - it rarely leads to a complete recovery.

If within two or three months conservative treatment does not give the desired results, and the process cannot be stabilized, they resort to surgical intervention. One of the most common methods is bypass surgery - in its course, excess cerebrospinal fluid is removed. It must be taken into account that similar interference may have some complications, these include:

Today it is considered very effective endoscopic surgery. With its help, it is possible to create pathways for the outflow of cerebrospinal fluid from the ventricles into the cisterns of the brain, through which its absorption is carried out.

The benefits of this type of intervention include:

  • Low trauma.
  • Absence foreign body in the body.
  • Restoration of the correct liquor flow.
  • Significant improvement in patient quality of life.

Forecast

Of course, it is quite difficult for doctors to make any predictions, because each case is individual. However, it should be borne in mind that external hydrocephalus in adulthood can cause serious physiological and mental disorders. If the disease is left untreated, it can be fatal. In practice, after surgery, many patients manage to fully recover and return to normal life.

In children, this disease has a fairly good prognosis. On condition timely treatment and full rehabilitation, there are quite a few chances to return to normal life.

External hydrocephalus of the brain- it's pretty dangerous disease, which may have serious consequences for human health. Timely appeal to the doctor and competent therapy will avoid many problems. In some cases, conservative treatment is ineffective - in such situations, it is impossible to do without surgical intervention. If there are such indications, in no case should they be neglected - a timely operation will allow a person to live a normal, full life.

Hydrocephalus is a disease in which excess cerebral fluid (CSF) accumulates in the brain cavity. Most often, hydrocephalus or dropsy of the brain occurs in newborns and infants first three months of life. In more rare cases pathology develops in adults. The frequency of the disease is quite rare and is diagnosed in one in 3000-4000 people, mostly male infants. Dropsy is a life-threatening pathology and causes many neurological disorders.

External and internal hydrocephalus

AT normal condition amount of liquor in infancy should be about 50 ml., in an adult 120-150 ml. With hydrocephalus, this amount can increase many times over, as a result, excess cerebral fluid accumulates and compresses the brain structures, thereby disrupting the functioning of the brain.

Normally, the cerebrospinal fluid protects the brain from impacts, acting as a shock absorber in case of head blows, and the liquid also prevents the skull from moving and maintains the correct flora. If the outflow is disturbed or more cerebrospinal fluid is synthesized than necessary, in such cases dropsy develops.

Depending on the location of the fluid accumulation, the pathology is divided into two types:

  • external hydrocephalus of the brain;
  • mixed dropsy of the brain.

In the case of internal dropsy, the fluid is localized in the cisterns or ventricles of the brain. It is diagnosed much more often than other types, it is more typical for newborns.

External is extremely rare, characterized by localization excess fluid in the subarachnoid space, while the amount of cerebrospinal fluid in the ventricles and cisterns of the brain is normal. As a rule, external hydrocephalus is formed with atrophy of the brain.

The mixed form implies the accumulation of cerebral fluid, both in the external part of the brain (in the subarachnoid space) and internal (in the ventricles and cisterns).

Moderate and severe type of hydrocephalus

In some cases, patients hear diagnoses such as moderate or severe hydrocephalus. Basically, such conclusions can be heard from the results of MRI, which showed a slight increase in the ventricles or subarachnoid space. Minor external hydrocephalus may also be diagnosed with similar MRI results.

But these diagnoses do not always correspond to reality and do not indicate the clinical manifestations of hydrocephalus, but only temporary changes in the size of the brain. They can suddenly appear and disappear without a trace during life, repeatedly.

Therefore, based on the results of only one MRI performed once, it is not correct to make a diagnosis of moderate or severe hydrocephalus. Dropsy of the brain is a progressive pathology, so the MRI procedure should be performed several times with an interval of 2-3 weeks. If there is progress and an increase in the amount of CSF, then it is advisable to carry out additional research and talk about hydrocephalus. In all other cases, such conclusions are conjectural.

Compensated and decompensated form

Hydrocephalus has quite a few various classifications. So, depending on the severity of the pathology and how it affects the structure of the brain, hydrocephalus is divided into:

  • compensated form. In this case, there is a certain excess of cerebrospinal fluid, but it does not affect the functioning of the brain, without squeezing it. Therefore, the patient does not experience unpleasant clinical manifestations and long time may not seek help.
  • decompensated form. In this case, the situation is the opposite. Cerebral fluid compresses the structure of the brain and thereby disrupts its work, causing a number of neurological and mental changes.

Open and closed mold

Depending on the nature causative factor and the mechanism of development of the disease, distinguish:

  • open and closed form of hydrocephalus.

Only internal hydrocephalus can be a closed form. Its essence lies in the fact that the fluid accumulates in the right or left ventricle of the brain and does not have an outflow into the cisterns or subarachnoid space, from where the CSF must be absorbed into the bloodstream. Similar situation may occur due to the formation of an obstruction to the outflow, for example, cysts or tumors.

Open hydrocephalus is characterized by problems with fluid absorption, despite the fact that the ways for this are not blocked by a tumor and other formations. The reason for the development open form dropsy most often become infectious processes in the lining of the brain, such as meningitis or encephalitis.

Other types of classification

Depending on when exactly the pathology arose, hydrocephalus is distinguished:

  • congenital;
  • acquired;
  • atrophic.

Regarding the congenital form, its development begins in the womb, and its first manifestations are diagnosed in the first three months of a baby's life. Main reasons congenital pathology- this is an anomaly of development and malformations of the brain in the fetus during pregnancy, as well as in case of trauma at the time of childbirth. In most cases, congenital dropsy of the brain is closed.

The acquired form develops as a result of one of the pathological processes that affected the structure of the brain. It can be:

  • neuroinfections, for example, meningitis, encephalitis;
  • consequences of traumatic brain injury;
  • effects ;
  • the development of tumors or cysts that compress the structure of the brain or block the outflow pathways for the cerebrospinal fluid.

Substitutive or atrophic hydrocephalus occurs on the background of brain atrophy. At the time of atrophy, free cavities appear in the structure of the brain, which are filled with fluid. The atrophic form is not hydrocephalus in pure form, its predecessors are:

  • age-related changes, such as senile dementia;
  • multiple sclerosis;
  • and etc.

According to the nature of the course of the pathology, there are: chronic and acute hydrocephalus.

Acute hydrocephalus develops at lightning speed, the patient's condition worsens literally within a few days. In this case, it is necessary urgent hospitalization and surgical intervention.

Chronic hydrocephalus develops much more slowly. Symptoms may develop over six months or more. Gradually arise neurological disorders and increased intracranial pressure. chronic course more characteristic of the open form of hydrocephalus.

Characteristic symptoms

Clinical picture hydrocephalus is quite extensive and can be divided into two groups: symptoms caused by high ICP and signs of a neurological nature.

To the symptoms elevated ICP include:

  • abnormal increase in head size;
  • clearly visible venous mesh under the scalp;
  • headaches and dizziness;
  • nausea and vomiting, more often occurs after waking up, not associated with food intake;
  • heaviness in the head;
  • eye pressure, pain eyeballs Oh;
  • increased drowsiness and fatigue;
  • nervousness;
  • jumps in blood pressure;
  • depressive states, etc.

Neurological symptoms resulting from CSF compression brain structures, resulting in:

  • loss of visual acuity;
  • double vision;
  • atrophy optic nerve;
  • development of strabismus;
  • paralysis or paresis of the limbs;
  • increased muscle tone;
  • lack of coordination;
  • reduced sensitivity, etc.

For children under one year old, in addition to the described symptoms, characteristic features diseases are:

  • protrusion of the fontanel, its pulsation due to increased intracranial pressure;
  • increase in head circumference by more than 1.5 cm per month;
  • exotropia;
  • deterioration of hearing and vision;
  • loss of already formed skills, etc.

Diagnosis and treatment

Diagnostic methods depend on the age of the patient. Small children of the first year of life are prescribed:

  • , through a fontanel that has not yet protracted;
  • examination by an ophthalmologist, fundus;
  • measurement of head circumference and anamnesis of complaints that have arisen.

As a rule, these data are sufficient to identify pathology in baby. If there is no fontanel in the skull, then instead of ultrasound, an MRI of the brain is prescribed, this method is informative and can definitely help in establishing the diagnosis.

In rare cases, like helper methods can be assigned: EEG and REG, but these studies are uninformative.

As a rule, the treatment of hydrocephalus is surgical intervention. In most cases, drug therapy is ineffective. In rare cases, conservative treatment is advisable, as a rule, this applies to acquired hydrocephalus as a result of traumatic brain injury. Also, drug therapy can be prescribed as preparatory stage to surgery if it is not possible to carry it out urgently.

Among the medicines, diuretics are prescribed, for example:

  • Furosemide;
  • Lasix;
  • Diacarb;
  • Phonurite;
  • Mannitol.

Note! Diuretic drugs cannot cure true hydrocephalus, therefore their use is possible only as directed by a doctor, but at the same time, the operation cannot be postponed for a long time. Since the faster the operation is performed, the more likely it is to prevent neurological complications.

Surgery is carried out in several ways. Operation with drainage outside the CNS. In this case, a shunt is installed in different variations. The shunt can be placed between the brain and:

  • peritoneum;
  • heart;
  • lungs;
  • veins.

Internal shunting can also be performed, its purpose is to create a channel for the removal of cerebrospinal fluid. This can be done by plastic aqueduct of the brain, the installation of internal stents or fenestration. interventricular septum.
Even an operation does not guarantee a 100% recovery, therefore, patients who have undergone hydrocephalus should be systematically observed by a neurosurgeon and a neuropathologist, especially for young patients. Also noted big risk infection of the installed shunt, in which case it is necessary antibiotic therapy and may need reoperation shunt replacement.

Hydrocephalus - serious pathology, which is predominantly formed in infants, the cause of its development is an anomaly in the development of the brain while still in the womb or birth injury. But cases of occurrence of the disease in adulthood are not excluded. Surgical intervention is the justified method of treatment, conservative therapy considered ineffective in hydrocephalus. Remember, the sooner the operation is carried out, the more likely good prognosis.

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Hydrocephalus, which is also commonly defined as dropsy of the brain, is a disease in which there is an increase in the volume of the ventricles in the brain, often to a very impressive size. Hydrocephalus, the symptoms of which are manifested due to excessive production of cerebrospinal fluid (cerebrospinal fluid between the communicating ventricles of the brain) and its accumulation in the area of ​​\u200b\u200bthe brain cavities, mainly occurs in newborns, but this disease has a place in the incidence of other age categories.

general description

In the normal state, the substance of the spinal cord and brain is constantly washed with cerebrospinal fluid (cerebrospinal fluid). Liquor is colorless, has transparent view and performs several functions at the same time, the main of which include protecting the brain and ensuring its additional food. FROM outer side CSF circulation occurs between choroid and a soft sheath along the cerebellum and the surface of the cerebral hemispheres. This space is defined as subarachnoid.

The base of the skull under the brain has additional places where fluid accumulates, they are defined as "cistern". These tanks, when connected in different directions to each other, make the transition to the CSF subarachnoid space of the brain, in addition to this, they also connect to the spinal subarachnoid space, in which the cerebrospinal fluid from cervical up to the lumbar region, the spinal cord is washed.

The location of the cerebrospinal fluid in the brain is concentrated in its ventricles, of which there are several - in the cerebral hemispheres there are two lateral ventricles, along the midline - the third. Somewhat lower, through a thin channel located in the brain stem, fluid passes to the fourth ventricle, which is already located between the cerebellum and the brain stem. This ventricle, through two lateral openings, is connected to the cisterns at the base of the brain and passes below to the central canal belonging to spinal cord, after which it propagates to lumbar way down.

In total, the volume of cerebrospinal fluid in a person is about 150 ml, and during the day it occurs three times comprehensive update. As for the factors of formation and absorption of this fluid that are of interest to us, which are directly related to hydrocephalus, it can be noted here that in the normal state, the indicators of these processes correspond to the level of dynamic equilibrium. Accordingly, at any point in time, an almost constant volume of cerebrospinal fluid and the pressure exerted by it are maintained.

The excess accumulation of cerebrospinal fluid is ensured by meeting two main conditions - a violation in the circulation of the liquid and an imbalance in the formation-absorbability, in which, against the background of a standardly produced liquid, its absorption is much less. Thus, both of these mechanisms act as the leading factors in the occurrence of hydrocephalus and its development.

Hydrocephalus: the main forms of the disease

In the practice of the course of the disease, the following forms are distinguished:

  • General hydrocephalus. It is characterized by an increase in the content of cerebrospinal fluid in the subarachnoid space and ventricles of the brain.
  • Internal (ventricular). It is characterized by excessive content of cerebrospinal fluid in the ventricles.
  • external hydrocephalus, the symptoms of which are infrequent, characterized by the presence of an excessive content of cerebrospinal fluid in the subarachnoid space, while normal its content in the stomach. Development occurs ex vacuo as a result of brain atrophy.

Internal hydrocephalus: symptoms

This type of hydrocephalus, resulting from excessive accumulation of CSF in the cerebral ventricles, can manifest itself in congenital or acquired form. The development of this type of hydrocephalus begins as a result of a malformation of the central nervous system, serious injury, inflammatory processes or the growth of neoplasms, concentrated in the area of ​​​​the meninges of the brain. The current course of the disease implies a sharp dilatation in the system of cerebral ventricles, as well as thinning of the medulla.

Development internal hydrocephalus also possible in a situation in which the brain, due to atrophy or during prenatal development began to occupy cranium smaller volume. This, in turn, leads to the filling of the empty space with CSF.

Focusing directly on the symptoms, first of all, one can note an increase intracranial pressure, which is accompanied by severe headaches, as well as nausea and vomiting, visual and hearing impairments. In this form, young children experience disorders in the form of bulging and tension of the fontanel with constant tilting of the head to the back and displacement of the eyeballs downwards.

Based on the specific cause that contributes to the appearance of internal hydrocephalus, a change in symptoms is possible. The disease may be chronic or acute stage. For acute, the symptoms of the underlying disease are characteristic, against which hydrocephalus arose. The chronic stage is characterized by manifestations of hydrocephalus directly, the course of which is complicated in the absence of necessary treatment.

External replacement hydrocephalus: symptoms

Hydrocephalus itself is a disease that occurs due to disturbances in the functioning of the central nervous system, but if it is defined more precisely, it is due to an incorrect absorption process of the cerebrospinal fluid filling the intracranial box. Both infants and older people are equally susceptible to the disease, despite the difference in causes. It should be noted that hydrocephalus is an extremely dangerous and complex disease, which, accordingly, excludes the possibility of negligent treatment of it.

The course of hydrocephalus can occur in the open or in closed form, which determines the difference in symptoms. One of the forms of the disease is external hydrocephalus of the brain, the symptoms of which, in particular, manifest themselves in the form of a decrease in the volume of the brain and in the filling of the space previously filled with brain cells with cerebrospinal fluid. It is noteworthy that given form different from other types of the disease. So, replacement hydrocephalus, the symptoms of which may not appear for many years, due to the filling of the empty space with liquid, proceeds, respectively, without the characteristic headaches and increased blood pressure.

Older people are faced with hydrocephalus mainly against the background of their existing or. In addition, the diagnosis of the disease is possible as a result of processes caused or excessive alcohol abuse. Hydrocephalus in general can be relevant in the constancy of its own course or in the progression of the course.

Hydrocephalus in adults: symptoms

Pathogenesis (features of the course and development of the disease due to the action of specific mechanisms) determines hydrocephalus in its following varieties:

  • Hydrocephalus occlusive (non-communicating, closed). In this case, the outflow of cerebrospinal fluid is disturbed due to the closure of the pathways for this. As the reasons for closure, a thrombus, a tumor, or adhesive process, which arose against the background of inflammation. When blockage occurs within the cerebral ventricles, a secretion is produced proximal form, in case of blockage within the basal cisterns - distal form.
  • Hydrocephalus communicating (dysresorbative, open). The reason for the appearance is based on violations in the processes of absorption in venous system cerebrospinal fluid, which occurs as a result of violations of the work of specific structures.
  • Hydrocephalus hypersecretory. It is formed due to excessive production of cerebrospinal fluid, for example, as a result of papilloma formed in the choroid plexus.

In addition, hydrocephalus of the brain, the symptoms of which appear in adults, is also divided into sharp shape- the interval between the moment of development of the disease and the occurrence of phenomena characteristic of decompensation is no more than 3 days. For the subacute form, this interval is defined as a month, for the acute form, respectively, more than a month.

As for the symptoms, there are manifestations indicating an increase in intracranial pressure: headaches, nausea / vomiting, stagnation in the optic nerve head (vision is suppressed), displacement along the axis of the brain, drowsiness. Upon awakening, the headache is most severe, which is associated with an increase in intracranial pressure during sleep. Nausea/vomiting is most pronounced in morning time, in some cases, their completion leads to a decrease in headache. by the most dangerous symptom is drowsiness, acting as a harbinger of the occurrence of neurological disorders of a serious scale.

The specified symptomatology is characteristic to a greater extent for the acute form. In relation to chronic, a slightly different picture of manifestations can be noted. In particular, this includes changes in sleep patterns (drowsiness during the day, disturbed night sleep), which subsequently manifests itself in the general constant fatigue. Passivity of patients, their lack of initiative is noted. short term memory subject to violations, especially with regard to numerical information.

Then there are intellectual disabilities gross specificity, which may even exclude the possibility of self-care of patients, inadequacy in the answers to questions. There is also apraxia of walking, in which lying position the patient can simulate cycling or walking, and in vertical position movement data is drastically disrupted. Among the non-permanent and late symptoms also excrete urinary incontinence.

Hydrocephalus in newborns: symptoms

In this case, the disease manifests itself similar to the previous variants of the specificity of occurrence. The only thing is that newborns have 15-20 ml of cerebrospinal fluid, by the age of 12 months its volume is about 35 ml. Hydrocephalus as a whole is accompanied by an increase in the volume of cerebrospinal fluid up to 1.5 liters. It is noteworthy that its formation in children is more intense than in adults - renewal can reach 8 times / day.

Hydrocephalus in children, the symptoms of which are manifested under the influence of a number of causes, with intrauterine formation diseases and completely excludes the possibility of their reliable determination. Due to this disease, a characteristic deformity of the skull occurs, there is a significant predominance of brain department above the facial section. At the same time, the forehead protrudes strongly, and venous superficial vessels are determined on the temples. Toddlers experience a strong expansion of the fontanelles, which are closed due to this very late. Among other things, the symptom of the so-called "setting sun" is relevant, accompanied by a shift of the eyes upward, where they hide under the eyebrows.

The beginning of head growth occurs at the stage of intrauterine development, in connection with which childbirth is subsequently difficult. Also, there are symptoms in the form of manifestations from the nervous system: trembling of the hands and chin, as well as other parts of the body, disturbance in the movements of the eyeballs, convulsions. Often associated with symptoms of nervous vegetative system(blanching of the skin, arrhythmias, etc.), symptoms of increased intracranial pressure (headache, nausea / vomiting, drowsiness). The progression of hydrocephalus is characterized by retardation in the development of children, poor retention of the head and passivity. The asymptomatic course of the disease is also possible, which leads only to its accidental detection.

Diagnosis of hydrocephalus

In diagnosing the disease, the leading role is played by computer or magnetic resonance imaging. Through these studies, an assessment is made of the state of the cerebral ventricles, as well as the subarachnoid spaces, their size, degree of deformation, location, etc. It is only when conducting these studies by highlighting hydrocephalus and its features that it is possible to determine adequate therapy.

Treatment of hydrocephalus

When diagnosing a disease at an early stage, it is determined possible effectiveness drug therapy. Meanwhile, if hydrocephalus continues to progress rapidly, urgent surgical intervention. Previously, shunting was the only common method in it, but this required, due to the imperfection of the shunts, their systematic replacement.

An endoscopic third ventriculostomy (ETV) is also applicable, in which an opening is made in the cerebral ventricle, through which the cerebrospinal fluid subsequently drains. With a congenital form of hydrocephalus, this method is applicable in case of unsuccessful shunting or infection in its process. Now this method is not as effective as other methods. possible options, appoint it to children from 6 months.

Applicable in the treatment of disease innovative methods surgery, for example, neuroendoscopy - an operation using a neuroendoscope equipped with a mini-camera, by obtaining an image from which fluid is drained by doctors.

With any form of hydrocephalus, a visit to a neurologist is necessary.

People who first encountered hydrocephalus (cerebral dropsy) do not know what it is and are afraid of death. However, this disease can be cured if detected in time. It has many types and forms, so it can concern not only kids, but also adults. For this reason, external hydrocephalus is divided into congenital, that is, obtained during childbirth or during fetal development and acquired. The second type concerns adults and occurs due to many causes, such as trauma, dementia (dementia), impaired blood flow, etc.

Hydrocephalus is characterized by disruptions in circulation, which in medicine is called cerebrospinal fluid. Due to its accumulation, the brain cavities, which are the brain stomachs (ventricular space), increase. Gradually soft tissues atrophy, and with moderate external replacement hydrocephalus, the vacated space is filled with cerebrospinal fluid. At the same time, neurological symptoms appear in a person, for example, the fingertips go numb, it darkens in the eyes, coordination of movements is disturbed, etc.

The problem of pathology is a weak outflow of cerebrospinal fluid or its excessive production. You can understand all the features of the pathology, focusing on its forms:

  • Asymmetric dropsy. In this case, a volumetric accumulation of cerebrospinal fluid occurs in one of the ventricles;
  • Double-sided. Fluid overflows all cerebral cavities;
  • Mixed dropsy. This type of disease is considered the most severe, since there is an internal and external increase in cerebrospinal fluid. The prognosis is negative and the patient suffers from paralysis individual groups muscles, epilepsy, seizures, etc.;
  • Atrophic. This form begins to manifest itself due to the injury. It can be external and internal, depending on the nature and severity of the injuries received. On the initial stage the problem does not manifest itself and the formation of cerebrospinal fluid begins in 2-3 weeks. Such a reaction is quite natural, as the body tries to replace the tissues that have been damaged with cerebrospinal fluid. It is necessary to treat atrophic dropsy immediately, since on advanced stages this is difficult to do;
  • Vicarious dropsy. The brain cavities increase, but there are no abnormal changes in the structure of the brain. Symptoms are unexpressed and if the course of therapy is completed in a timely manner, then the prognosis is mostly positive;
  • Hypotrophic. The beginning of the development of this form of pathology is associated with insufficient nutrition of the brain. The manifestations of hypotrophic hydrocephalus are no different from the signs of other varieties of the disease. A person has a headache and the work of the vestibular apparatus is disturbed;
  • Compensatory dropsy. This type of pathology is a residual effect after the treatment. Circulation and CSF production have returned to normal, but the ventricular space is still slightly enlarged;
  • Partial. A kind of disease occurs due to an increase in the synthesis of cerebrospinal fluid. She is characterized by neurological disorders, including seizures of epilepsy;
  • Discirculatory dropsy. You can meet this type of pathology in people with impaired cerebral circulation, and at the same time, atrophy of brain tissue is observed.
  • External hydrocephalus of the brain. In this case, an increase in volume is observed around the brain and in the peripheral space;
  • Internal hydrocephalus of the brain. The form is characterized by an increase in the cerebral ventricles and the median pathways through which the CSF passes;
  • Closed external hydrocephalus (occlusive). It is characterized by a violation of the circulation of the fluid due to a certain obstacle. Usually they are congenital anomaly structures, tumor, hematoma, etc.;
  • Open external (non-occlusive). Excessive synthesis of CSF or its insufficient absorption is characteristic. The circulation is not disturbed;
  • External replacement hydrocephalus of the brain. It is characterized by atrophy of brain tissues, the place of which is occupied by cerebrospinal fluid. Replaced areas of the brain are responsible for important processes in the body, so this process usually does not pass without a trace. This form is divided into several subspecies:
    • Moderate outdoor.

Moderate external replacement hydrocephalus is common. This disease is characterized atrophic changes brain tissues with subsequent filling of the formed spaces with cerebrospinal fluid. It can be cured, but for this you will have to find out the cause of the development of dropsy and undergo a course of therapy.

The reasons

Moderately severe external hydrocephalus develops due to the following reasons:

  • Violations of cerebral circulation;
  • Failures in the nervous system;
  • Psychoorganic syndrome;
  • dementia;
  • Inflammation of the brain tissue;
  • Pathology of the cervical region;
  • head trauma;
  • Incorrect course of therapy after a stroke;
  • encephalopathy.

The acquired form of external hydrocephalus in an adult has the same causes of development as in a baby.

However, in newborns, the disease may be congenital and should be treated as soon as it is discovered. Otherwise, pathology can lead to lethal outcome. This type of hydrocephalus occurs due to damage received during childbirth, a brain anomaly, or fetal hypoxia.

Symptoms

With mildly pronounced external hydrocephalus in adults, the disease does not particularly manifest itself. Of the signs of such a pathology, the most basic can be distinguished:

  • confusion;
  • General fatigue;
  • Vomiting;
  • Insomnia;
  • visual impairment;
  • Headache.

With an external replacement of the congenital type, babies become whiny and irritable. If not treated pathological process, it often leads to disability and death.

Moderate hydrocephalus in adults sometimes turns into chronic stage. The course of the pathology becomes sluggish and the consequences are usually irreversible. It often results in dementia.

After trauma hydrocephalus of the brain in adults develops after about 2-3 weeks. The patient's coordination of movements weakens, and various functional failures develop, for example, urinary incontinence and memory impairment.

Diagnostics

Congenital dropsy of the brain in infants is easy to diagnose by outward signs(enlargement of the head). However, it is not so easy to find out about the presence of a problem in an adult, and for this you will have to use instrumental methods examinations:

  • Tomography (computer and magnetic resonance);
  • radiography;
  • Angiography (examination of blood vessels).

An MRI report can tell about the form of moderate external hydrocephalus of the brain. Having determined the type of disease and severity, the doctor will draw up a treatment regimen.

Medical treatment

Moderate outer shape early stages amenable to drug treatment. Drugs are used to expand blood vessels and remove excess fluid from the body, as well as drugs to normalize the nervous system.

Symptoms and treatment usually go hand in hand, so symptomatic therapy also no less important. It includes medicines for the relief of emerging signs of pathology. However, if after 2 months the symptoms of the disease do not disappear, the doctor will recommend surgery.

Surgery

The main operations are aimed at eliminating excess cerebrospinal fluid, for example, cerebrospinal fluid bypass. In most cases, it is extremely effective and the result of therapy is visible almost immediately. Surgical intervention is carried out using a set of tubes and valves to drain the liquor into the body cavity, where it will not cause harm and will be disposed of. After the operation, the patient expects a long recovery period (at least 7 months). If the system is broken, you will have to perform a second surgical intervention. Such a procedure is required mainly to replace the shunt or adjust the design.

Basically, doctors advise endoscopic operations, since you do not have to install a complex structure and the outflow of cerebrospinal fluid is faster. Such surgery involves the creation of a small hole in the ventricular space for the withdrawal of cerebrospinal fluid. This procedure is suitable mainly for the closed type of hydrocephalus. After it, the patient usually recovers completely and does not feel much discomfort. However, it is prescribed only in 10% of cases, and in all other situations it is necessary to use CSF shunting.

Moderate external hydrocephalus does not particularly manifest itself and often turns into chronic form, which is characterized by the development of dementia. To prevent this, it is necessary to be examined in a timely manner and undergo a course of treatment aimed at eliminating the cause of the disease.

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

External hydrocephalus: what is it?

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

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

Forms of the disease

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

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

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

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

Signs of external hydrocephalus

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

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

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

Diagnostics

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

Treatment

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

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

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