Picture of local expansion of subarachnoid convexital spaces. Expansion of the subarachnoid space on MRI

The subarachnoid space is a cavity between the arachnoid and pia mater, where cerebrospinal fluid circulates in an amount of 130 ml. There are tanks here - places of a small expansion of the arachnoid and soft shells. It contains the largest amount of cerebrospinal fluid.

What does it mean

The expansion of the subarachnoid spaces is a pathological condition that has formed as a result of exposure to the brain of harmful factors, for example, traumatic brain injury, or a defect in fetal maturation.

The expansion of the subarachnoid spaces of the brain in adults does not apply to independent diseases. This pathological condition displays painful processes in the cranium.

The reasons

Causes can be congenital or acquired. Congenital causes of expansion of subarachnoid spaces:

Fetal injury during maternal pregnancy.
Congenital defects in the development of the nervous system.
Chromosomal abnormalities.

Acquired Causes:

Trauma of the skull and brain.
Neuroinfections: meningitis, encephalitis, inflammation of the arachnoid membrane.
brain tumors.
Hemorrhagic stroke and small hemorrhages.
Cerebral edema.
Acute intoxication with heavy metals.
Chronic heart, kidney and liver failure.

Inflammation of the meninges leads to the formation of adhesions. This impedes the circulation of cerebrospinal fluid, which leads to increased intracranial pressure and childhood hydrocephalus. Most often it appears after inflammation of meningococcal, tuberculous and syphilitic nature.

In the period of manifestation of inflammation, the hemodynamics of blood and brain vessels changes: the permeability of arteries and veins increases, and the plasma enters the intercellular space. This causes swelling, which further increases intracranial pressure.

Tumors, being a voluminous process, compress the structures of the brain and tissues, squeezing the lymphatic and blood vessels. This makes it difficult for the outflow of cerebrospinal fluid and blood, the brain becomes full-blooded, pressure rises in it and diffuse hydrocephalus occurs.

Expand subarachnoid spaces and chronic diseases of the heart and kidneys. Due to the disruption of these organs, the outflow of blood from the brain worsens, which leads to a deterioration in the outflow of cerebrospinal fluid and intracranial hypertension. Less commonly, pathology is caused by poisoning with heavy metals: lead, bromine or mercury.

In newborns, the expansion of spaces is mainly due to congenital malformations of the formation of the central nervous system and the heart.

People with enlarged subarachnoid spaces may experience disorders in the circulation of cerebrospinal cerebrospinal fluid: excessive production of fluid and impaired utilization of it. These pathologies are considered as individual characteristics of a person.

Symptoms

Uneven expansion of the subarachnoid spaces of the brain in children is observed by the following symptoms:

Irritation to bright light, loud sound and pronounced odors.
Sleep disturbance.
Vomiting immediately after eating.
Crying for no reason.
Damage to the oculomotor nerve, which is manifested by strabismus.
Pulsation and bulging of the fontanel, incomplete closure of the sutures.
Trembling in limbs and chin.
Changes in behavior and reactions when the weather changes.

In adults, the symptoms are:

Liquorodynamic headache. It is characterized by bursting and aching pains in the head. The symptom is accompanied by dizziness, nausea and often vomiting, which brings temporary relief to the patient.
Mental disorders: emotional lability, irritability, tearfulness, apathy, agitation. Decreased concentration, memory impairment and slowing down the pace of thinking. Intolerance to bright lights, loud music and strong smells. Sleep is usually superficial, intermittent, with difficulty falling asleep.
Autonomic disorders: dizziness, loss of appetite, alternating constipation and diarrhea, excessive sweating, heart pain.

Over time, prolonged expansion of the subarachnoid spaces can lead to hypertensive encephalopathy. This condition is caused by a violation of cerebral circulation and liquor circulation, which causes diffuse or focal lesions of the cerebral cortex. The disease is accompanied by severe headaches, restlessness and anxiety, impaired consciousness in the form of syncope or somnolence.

With advanced encephalopathy, memory is reduced, attention is scattered and intelligence is reduced. Also, with the growth of the disease, asthenic syndrome is formed: patients become irritable, weak, exhausted. They increase anxiety and a tendency to depression.

Diagnosis and treatment

Instrumental methods help to diagnose the expansion of spaces:

. A method accessible to all, including children and pregnant women.
Computer and.
Cisternography. A contrast agent is injected into the cisterns of the brain, after which an x-ray is taken.

The goal of treatment is to stop intracranial hypertension, relieve symptoms and improve the patient's standard of living.

After clarifying the etiology of the expansion, the underlying disease is treated. For example, in case of a tumor, an operation is prescribed to remove the neoplasm, in case of infections, antibacterial or antiviral agents are prescribed. After the elimination of the underlying disease, symptomatic therapy is started.

Full treatment includes the following appointments:

Diuretics to relieve cerebral edema and reduce intracranial pressure.
B vitamins to restore the nutrition of the nervous tissue.
Antibiotics and antivirals for the treatment of infectious diseases.
Nootropic agents for the restoration of cognitive functions.
Analgesics for headaches.

The subarachnoid space is a cavity between the arachnoid and pia mater of the brain and spinal cord. This space is filled with CSF or cerebrospinal fluid. The fluid is involved in protecting and nourishing the brain.

What is the subarachnoid space? The subarachnoid space contains up to one hundred and forty milliliters of cerebrospinal fluid, which flows from the brain through openings in the fourth ventricle.
Its maximum is contained in the tanks of space, which are located above the large cracks and furrows of the brain.

The subarachnoid space is divided by the dentate ligaments and the cervical septum, which are fixed.

Video: Subarachnoid hemorrhage

The reason for the expansion of the subarachnoid space

Local expansions of the subarachnoid space are a signal of disturbances in the normal circulation of CSF. This may be due to trauma, tumors, or infectious diseases of the central nervous system. Undoubtedly, such a condition requires direct consultation with a neurologist or neurosurgeon and appropriate examinations.

The fact is that very often the expansion of the subarachnoid space is a symptom of hydrocephalus or increased intracranial pressure.

The set of signs of external benign hydrocephalus in children of the first year of life is an increase in subarachnoid spaces, which is most noticeable in the zone of the poles of the frontal lobes, while the ventricles of the brain can only be slightly dilated or have normal sizes. At the same time, the contents of these spaces have dense cerebrospinal fluid, which is observed on MRI, CT, and neurosonography. If this is benign hydrocephalus, then in most cases it resolves by two years of age.

Expansion of the subarachnoid space

The expansion of the subarachnoid spaces occurs in conjunction with an increase in head circumference and protrusion of the fontanelles, and a delay in the timing of their closure.

Video: Structure and functions of the brain

A noticeable expansion of the subarachnoid space may also indicate arachnoiditis or leptomeningitis, in which the soft and arachnoid membranes of the brain become inflamed. This can be the result of trauma, infection, and a number of other influences. This pathology is detected by ultrasound.

The cause of arachnoiditis can also be chronic intoxications, for example, lead, alcohol, arsenic, reactive inflammation in slowly developing tumors and encephalitis.

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Common symptoms of arachnoiditis:

headache that is worse in the early morning, sometimes accompanied by nausea and vomiting,
dizziness,
general fatigue,
irritability,
sleep disturbance.

In treatment, the main thing is to eliminate the source of infection, for example, sinusitis or otitis media. For this, antibiotics are prescribed in therapeutic doses.

With regard to the life of the patient, the prognosis is usually favorable, only arachnoiditis of the posterior cranial fossa with occlusive hydrocephalus is dangerous.

It is a rather complex structure. He, like the human heart, is constantly working. To function properly, this complex system must have a good supply of blood and nutrients. Such a “nutritive” role for the brain is played by its membranes, which not only maintain homeostasis, but also protect against injuries, various bacteria and viruses. There are three shells of the brain - hard, arachnoid and soft.

Subarachnoid space and its meaning

The space between the arachnoid (arachnoid) and pia maters is called subarachnoid.

The arachnoid membrane surrounds the brain and is covered by endothelium. It is connected to the hard and soft shells of the supra- and subarachnoid connective tissue membranes. Its outer surface is not fused with the hard shell, however, in some places, the so-called granulations depart from it, which penetrate deep into the latter and, together with it, onto the inner surface of the cranial bones or into the sinuses, which ensures the resorption of fluid into the venous system. The inner surface of the arachnoid membrane is connected to soft thin membranes. In places where such adhesions are absent, extensions are formed - the so-called tanks.

The environment where CSF circulates consists of the ventricular system and the subarachnoid space of the brain and spinal cord. The ventricular system is formed from 4 reservoirs - two lateral, third and fourth.

Their choroid plexuses are the main source of production of cerebrospinal fluid into the subarachnoid space. The norm for children averages 80-120 ml, and for adults - from 120 to 160 ml per day, and it is completely updated 3-5 times.

Circulation liquor

The circulation of cerebrospinal fluid is a rather complex process.

It constantly flows from the lateral ventricles through the interventricular foramen to
third, and then - to the IV ventricle. From the latter, through the median and lateral openings, the cerebrospinal fluid enters a large tank. Then it goes to the basal and washes the subarachnoid convexital spaces of both hemispheres, after which it goes to the spinal cord. The fluid eventually returns to the brain, where it is absorbed by the venous system of the dura mater. In general, the functions of the cerebrospinal fluid are very important. The cerebrospinal fluid performs the function of protecting the brain from injuries and the regulator of internal pressure, performs an excretory, immunological and transport role.

Expansion of the subarachnoid space and its causes

A change in size and pressure in the subarachnoid space is often a sign of an inflammatory process or tumor.

The mechanism for the development of such changes is quite simple. The inflammatory process (often arachnoiditis or meningitis) enhances the production of cerebrospinal fluid, which gradually stretches the subarachnoid space. During the tumor process, a mechanical barrier is created for the outflow of cerebrospinal fluid, which is a consequence of a local increase in pressure and the formation of extensions in a certain area of the ventricular system of the brain. However, there are other options that can lead to the expansion of the subarachnoid space. In particular, a temporary change in the size of the CSF circulating system is possible with reactive cerebral edema and a decrease in intracranial space due to a hematoma or abscess.

Symptoms of expansion of the subarachnoid space

The expansion of the subarachnoid space leads to an increase in CSF pressure, which has relatively characteristic symptoms.

Patients note a stubborn, persistent headache with symptoms of nausea and fountain-like vomiting, increased sensitivity to visual and auditory stimuli, and dizziness. The degree of manifestation of symptoms depends on the severity of development and on how expanded the subarachnoid space. In children, the expansion of the subarachnoid space is most often observed with hydrocephalus and arachnoiditis. Much less often, birth trauma or malformations of the nervous system become the causes of this complication.

In adults, tumors and inflammatory processes of the subarachnoid space are more common. Hydrocephalus is extremely rare and develops most often after a brain injury.

Diagnostics

Expansion of the subarachnoid space is easily determined using
instrumental examinations, the sequence of which is determined by the underlying disease. Echoencephalography is performed more often in children and makes it possible to see the displacement of the brain relative to the bones of the skull under the pressure of the cerebrospinal fluid. CT and magnetic resonance imaging are used in most cases for adults. The latest methods make it possible to establish the layered structure of the brain and the nature of tumor growth, and, in combination with the results of a lumbar puncture, determine the tactics of treating inflammatory diseases.

Subarachnoid space (SAP) exists in all people. It is located between the soft and arachnoid (arachnoid) membranes of the brain. Its purpose is the circulation of liquor, that is, cerebrospinal fluid.

SAP extension occurs when there is a lot of cerebrospinal fluid, or its outflow is difficult. Since the brain is placed in a limited cavity of the cranium, with an increase in the volume of fluid, its structures are compressed. There is a general (uniform) expansion and local.

subarachnoid fissure- sheets of the membranes of the brain diverge above the recess of the gyrus and connect above its surface, these spaces are called slits. SAP extension concept- this is only a conclusion obtained during x-ray, ultrasound or tomographic diagnostics. Additional testing is needed to determine.

Causes of pathology with uniform and local: increased production of cerebrospinal fluid; malabsorption with inflammation, swelling; outflow obstruction - tumor, cyst, hemorrhage. May occur during fetal development. The baby in this case is born with hydrocephalus (dropsy of the brain). Factors provocateurs: malformations; anomalies in the structure of the skull, its connection with the spine; trauma during childbirth; maternal infectious diseases.

A special form of the disease is atrophy(reduced volume) of the brain and the filling of the formed spaces with fluid. It is typical for elderly patients against the background of atherosclerosis, malignant course of hypertension, complications of diabetes.

Clinical signs:

In adults: headache that does not work with painkillers; nausea, vomiting; feeling of pressure on the eyes. Signs appear suddenly or gradually increase, perhaps periodic subsidence and exacerbation. In brain atrophy, enlargement of the SAP is an incidental finding during examination. Complications with delayed treatment: unsteadiness when walking; dizziness; instability when changing position; difficulty in coordinating movements; sensation of tinnitus, visual disturbances, up to blindness; partial immobility or paralysis; muscle spasms; loss of consciousness, convulsions; mood swings, aggression, psychosis.
For breasts: swollen veins on the surface of thin skin; spherical head; a large fontanel is tense, motionless (no pulsation); divergence of seams; when tapped, a sound appears, as when hitting a cracked pot; upward gaze is limited, in the fundus there is swelling of the disks of the optic nerves. Effects: lag in psychomotor development; late acquisition of skills; increased muscle tone of the legs; low physical activity, obesity; mental disorders - apathy, no attachment to parents, reduced intelligence.

Examinations for lesions of the frontal and parietal lobes: visual examination, radiography, ultrasound, MRI, oculist consultation, puncture, PCR study.

Treatment of expansion of the subarachnoid space. Drug therapy is indicated for meningitis, encephalitis, trauma, stroke. The complex includes diuretics (Lasix, Diakarb). Indications for surgery: anomalies in the development of the skull and SAP; benign and malignant neoplasms; intracerebral hemorrhage; brain abscess; adhesive process in arachnoiditis. If it is impossible to carry out a radical elimination of the cause of hydrocephalus, then additional outflow tracts from the cranial cavity are created by shunting.

Read more in our article about the expansion of the subarachnoid space, its signs, treatment.

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Explanation of terms: subarachnoid space, convexital and cerebrospinal fluid, gaps

The subarachnoid space (SAS) exists in all people. It is located between the soft and arachnoid (arachnoid) membranes of the brain. Its purpose is the circulation of liquor, that is, cerebrospinal fluid. Therefore, it is also called the liquor space. Liquor and membranes protect the brain from traumatic injuries, deliver the necessary microelements and biologically active substances, and remove products of tissue metabolism.

The expansion of the SAP occurs when there is a lot of cerebrospinal fluid or its outflow is difficult. Since the brain is placed in a limited cavity of the cranium, with an increase in the volume of fluid, its structures are compressed. Depending on the types of the disease, there is a general (uniform) expansion and local. In turn, the latter can cover the frontal, parietal lobes, convexital surfaces (as all the convex parts of the cerebral hemispheres are called).

When describing a tomogram, there is such a thing as a subarachnoid fissure. The leaves of the membranes of the brain diverge above the deepening of the gyrus and connect above its surface. These spaces are called slots. When expanding, a sufficiently large amount of liquid accumulates in them.

It should be noted that the concept of SAP expansion is only a conclusion obtained during X-ray, ultrasound or tomographic diagnostics. To determine its cause, a study of symptoms, a history of complaints, a neurological examination is carried out.

Causes of pathology with uniform and local

In order for the SAP to expand, an excess amount of cerebrospinal fluid is needed. This happens for one of the following reasons or a combination of them:

increased education (uniform expansion);
malabsorption with inflammation, swelling (there are usually local and uneven changes);
outflow obstructions - tumor, cyst, hemorrhage (both local and general disorders occur depending on the level of blockage of liquor circulation);

These pathological mechanisms can occur even during fetal development. The baby in this case is born with hydrocephalus (dropsy of the brain).

Hydrocephalus

The factors of such a pathology are:

malformations (blockage of outflow holes, narrowing of the sylvian water supply system, defect in the structure of the SAP);
anomalies in the structure of the skull, its connection with the spine;
trauma during childbirth;
infectious diseases of the mother - syphilitic, toxoplasmic, cytomegalovirus, rubella.

Older children and adults suffer from hydrocephalus for the following reasons:

inflammation of the brain tissue (encephalitis) or membranes (meningitis, arachnoiditis);
skull trauma, concussion;
hemorrhage - ventricular, intracerebral with the transition to the ventricles;
cyst or brain tumor.

A brain tumor is one of the causes of hydrocephalus and expansion of the subarachnoid space

A special form of the disease is atrophy (reduced volume) of the brain and filling of the formed spaces with fluid. Such changes are typical for elderly patients against the background of complications of diabetes with widespread damage to the arteries (macroangiopathy).

Clinical signs

Manifestations of FAP expansion differ in adulthood and in infants.

In adults

A large amount of fluid in the space limited by the bones causes an increase in CSF pressure. The symptoms of this pathology consist of such violations:

on which painkillers do not work;
nausea, vomiting;
feeling of pressure on the eyes.

These signs appear suddenly or gradually intensify, perhaps periodic subsidence and exacerbation. With cerebral atrophy, the pressure inside the skull may not increase, so the detection of FAP expansion is an accidental finding during instrumental examination.

If hydrocephalus is not recognized in time and treatment is not started, then complications arise from compression and progression of the underlying disease.

These include:

unsteadiness when walking;
dizziness;
instability when changing position;
difficulty in coordinating movements;
sensation of ringing in the ears.

Visual disturbances are manifested by a decrease in sharpness, loss of fields, congestive changes in the fundus. Prolonged hydrocephalus leads to blindness due to atrophy of the optic nerves.

The neurological consequences of the expansion of the subarachnoid space include:

decreased motor function of the limbs - paresis (partial immobility) and paralysis;
increased tendon reflexes and muscle tone;
muscle spasm, which leads to contractures (limitation of mobility) of the limbs;
in severe forms - loss of consciousness, convulsions.

MRI for hydrocephalus

Additional Methods

Patients are shown a consultation with an oculist to determine visual acuity, fields and the condition of the fundus. In case of difficulties in diagnosis and the absence of signs of displacement of the brain, a puncture is prescribed. It can slightly alleviate the condition of patients, and the study of cerebrospinal fluid helps in diagnosing inflammation, hemorrhage. With a congenital infection, a PCR study is performed to determine the pathogen.

Treatment of expansion of the subarachnoid space

Drug therapy is indicated for meningitis, encephalitis, trauma,. The complex includes diuretics (Lasix, Diakarb).

Indications for surgery include:

anomalies in the development of the skull and SAP;
benign and malignant neoplasms;
intracerebral hemorrhage;
brain abscess;
adhesive process in arachnoiditis.

If it is impossible to radically eliminate the cause of hydrocephalus, then create additional outflow tracts from the cranial cavity a. Such operations are called bypass operations, they can also end with surgical treatment when a cyst or tumor is removed, if the circulation of cerebrospinal fluid is not restored at the main stage.

Expansion of the subarachnoid space occurs in congenital and acquired hydrocephalus. Its causes are excessive formation of cerebrospinal fluid and / or a violation of its outflow. In adults, it manifests itself as a severe headache and psycho-emotional disorders, while in infants the head increases, physical and intellectual development slows down. To search for the causes, instrumental diagnostics are carried out. Treatment is conservative and operative.

Expansion of the subarachnoid space: the essence of the diagnosis, development, manifestations, how to treat, prognosis

The expansion of the subarachnoid space is often recorded according to the results of ultrasound of the brain of babies or MRI in adults. This change may be subtle or very noticeable, as in the case of hydrocephalus. In all cases, such a phenomenon requires consultation with a neurologist, finding out the causes and resolving the issue of treatment tactics.

Expansion of the subarachnoid space is not an independent disease. It arises in response to traumas suffered in the past, anomalies of embryonic development, is characteristic of infections and tumors of the brain and its membranes. In fact, this is a reflection of many pathological processes inside the skull, so the treatment in each case varies.

The conclusion about the expansion of the subarachnoid space is often faced by parents of newborn babies, who had an ultrasound scan at the maternity hospital and found deviations. As a rule, mothers and fathers do not know how to react, where to run and what to expect from pathology in the future. Answers to their questions should be given by pediatric neurologists, who observe such children especially carefully.

Expansion of the subarachnoid space on an MRI

Symptoms of the enlarged subarachnoid space include a number of neurological manifestations, signs of hydrocephalus, and focal symptoms in tumors are possible. It is impossible to single out the main and strictly characteristic signs, as well as to make a diagnosis according to the clinical picture. Only additional instrumental examinations help shed light on the essence of the pathology.

To better imagine what the subarachnoid space is and how it expands, you need to remember the main features of the structure of the brain and its membranes. So, everyone knows that the central organ of the nervous system is located in the cranium. Many people remember that on the outside it is covered with shells that protect and nourish the nervous tissue.

The outermost is the hard shell of the brain, adjacent to the bones of the skull. It is extremely dense and provides mechanical protection against damage. On the surface of the brain lies a soft shell, rich in blood vessels, and between it and the hard shell - arachnoid (arachnoid), which, due to their close relationship, are often combined into a single whole - leptomeninges.

Under the arachnoid and above the pia mater is the subarachnoid space, in which cerebrospinal fluid circulates. Excess cerebrospinal fluid is absorbed by the arachnoid membrane containing connective tissue cells, fibroblasts, glial elements and forming special trabeculae (outgrowths) that reabsorb excess fluid.

Normally, the relationship between the soft and arachnoid (arachnoid) membranes is quite close, and the cerebrospinal fluid between them contains no more than 140 ml. The fluid circulating in the space between the shells provides cushioning to the brain, as well as nutrition, bringing useful things and taking away metabolic products from the nerve cells.

In pathology, the distance between the shells increases, the fluid becomes larger, and MRI shows an expansion of the corresponding intershell space, moreover, changes can be both local and diffuse.

Reasons for the expansion of the subarachnoid space
Causes expansion of the subarachnoid space can be both congenital factors and acquired negative influences. In the first case, pathology can be detected in infants, in the second, people of all ages suffer, but those born without pathology of the brain and its membranes.
The expansion of the subarachnoid space can lead to:

Inflammatory processes in the brain and its membranes - meningitis, both infectious and non-infectious;

Carried over in the past;

Congenital malformations of the central nervous system;

and membranes, regardless of the degree of malignancy;

under the membranes of the brain;

Edema syndrome.

Inflammatory processes on the part of the membranes and the brain itself cause the formation of adhesions inside the skull, which impede the circulation of the cerebrospinal fluid, resulting in an expansion of not only the ventricular system, but also the subarachnoid space. Spikes are especially pronounced after meningococcal infection, with tuberculosis and syphilitic lesions.

In the acute stage of the inflammatory process, characteristic changes occur inside the skull, consisting in an increase in vascular permeability, the release of the liquid part of the blood and inflammatory cells into the intercellular space, edema, and an increase in CSF production. In this phase of inflammation, the membranes of the brain are full-blooded, thickened, and the subarachnoid space is expanded.

Neoplasms of the brain and membranes, as the volume increases, begin to compress the intershell space, disrupting the flow of cerebrospinal fluid. In this case, both local expansion of the subarachnoid space and diffuse hydrocephalus are possible. Such changes cause not only malignant, but also benign tumors, limited in their growth by the hard bones of the skull.

Moderate diffuse expansion of the subarachnoid spaces is possible with edematous syndrome against the background of pathology of the kidneys, heart and blood vessels, hypoalbuminemia with liver damage, starvation. In more rare cases, it is provoked by lead poisoning, arsenic, chronic alcohol intoxication.

The described changes occur more often in adults, while in children, congenital malformations of the brain and trauma during childbirth, leading to impaired circulation of fluid in the skull, hydrocephalus, and expansion of the intershell spaces, come first among the causes.

With severe injuries and defects, an increase in the volume of the lateral ventricles of the brain and atrophic changes in the nervous tissue due to its compression by excess fluid are often observed. With benign hydrocephalus, an increase in the subarachnoid space is possible, mostly in the projection of the frontal lobes, while the ventricles can maintain normal or close to them sizes.

In early childhood, in infants, the expansion of the subarachnoid convexital spaces (from the side of the outer surface of the brain) occurs in parallel with the growth of the diameter of the head, while the bulging of the fontanel can be noticeable with severe hydrocephalus.

Symptoms of expansion of subarachnoid spaces

In children and adults, the pathology manifests itself differently. So, in children of the first year of life, signs such as:

Negative reaction to noise, medium-strength sounds, light;

Frequent regurgitation;

poor sleep, anxiety;

Strabismus, different pupil diameter;

Head growth that does not correspond to age;

Bulging and slowing down of overgrowth of the fontanel;

Meteosensitivity, anxiety when the weather changes;

Startle, tremor of the chin, arms or legs.

As you can see, the symptoms are rather non-specific. They may be more likely to indicate hydrocephalus with intracranial hypertension against the background of expansion of the subarachnoid space. According to these signs, it is impossible to make an accurate diagnosis, but they should be the reason for an immediate visit to a neurologist or pediatrician.

In adults, one of the main symptoms of the expansion of the subarachnoid space is headache, which is quite intense and long. Often, patients complain of severe dizziness and nausea, inability to perform work duties, weakness, restlessness, and anxiety.

Cranialgia is especially pronounced early in the morning, may be accompanied by vomiting, dizziness, hypersensitivity to light, sounds. During the day, patients are often drowsy, at night they cannot sleep, or sleep is restless and intermittent. An increase in headache, its pulsating character, the appearance of vomiting at the height of pain are characteristic symptoms of increasing intracranial pressure.

Diffuse expansion of the subarachnoid space and an increase in the volume of the lateral ventricles will sooner or later cause atrophic and dystrophic changes in the cerebral cortex, which will manifest as symptoms encephalopathy- Decreased memory and attention, impaired vision, intelligence. Vegetative symptoms often join in the form of tachycardia, pressure surges, unmotivated anxiety, and even fainting.

Motor disorders are more typical for the cerebellar localization of the pathology. In this case, among the symptoms, unsteadiness and uncertainty of gait, dizziness, coordination disorders and fine motor skills are possible.

Constant fatigue, repeated bouts of severe headache, inability to get enough sleep disrupt the emotional state of patients who can become irritable, anxious, prone to depression. Secondary changes in the brain disrupt the ability to work and limit active life.

brain compression in subarachnoid hemorrhage

Uneven expansion of the subarachnoid space is possible after trauma, brain surgery, with tumors that locally compress the membranes of the brain and cerebrospinal fluid. In this case, focal neurological symptoms are observed in the form of violations of sensitivity, speech, hearing, etc. A convulsive syndrome or epilepsy indicates a severe course of the pathology.

Depending on the width of the intershell space, light (expansion by 1-2 mm), moderate (up to 4 mm) and severe (over 4 mm) degrees of expansion are distinguished. To a certain extent, such a division is conditional, especially with uneven or local changes in CSF spaces.

The described symptoms usually occur in severe variants of the pathology, severe hydrocephalus and intracranial hypertension. Most often, mild and even moderate degrees of impairment are manifested only by periodic headaches, fatigue, and.

Diagnosis and treatment of expansion of subarachnoid spaces

Diagnostics pathology involves a comprehensive examination, including examination, general clinical blood tests and instrumental methods - ultrasound, computed tomography and MRI, the results of which are compared with the characteristics of the symptoms, after which it will be possible to talk about the nature of the treatment.

One of the main methods of examination of infants is neurosonography- Ultrasound of the brain. It takes about a quarter of an hour, is painless and harmless, and is widely available both in maternity hospitals and in ordinary clinics. Ultrasound is possible due to the large open fontanel, through which the subarachnoid spaces are well visualized. The result of the study is interpreted by the neurologist or pediatrician who prescribes the treatment.

CT and MRI usually performed on adult patients. These studies are expensive, require fixation of the body in space, which is difficult to achieve in infants, and computed tomography involves X-rays, which are harmful to babies. In addition, in adults, ultrasound will not provide the required amount of information, so it is more expedient for them to prescribe tomography. If there is no other way out, and the baby needs an MRI, then it will be performed under anesthesia.

For hydrocephalus, they can prescribe cisternography- X-ray contrast study of cerebrospinal fluid spaces, and if vascular pathology is suspected - angiography. In addition to the neurologist, the patient can be consulted by a psychotherapist, neurophysiologist and other specialists. General and biochemical blood tests, urinalysis are necessary to exclude the pathology of the internal organs, which could lead to a violation of liquorodynamics.

According to the result of ultrasound or tomography, the attending physician will see the expansion of the interhemispheric fissure and subarachnoid space, and then proceed to treatment. The question of the nature of the therapy of expanded spaces is entirely determined by the root cause of the pathology, because the expansion itself is only one of the signs that cannot be eliminated without treating the underlying disease.

In the absence of symptoms of pathology, the child is monitored with a consultation with a neurologist and neurosonography every 3 months, courses of vitamins, pantogams, and magnesium preparations can be prescribed. Adults with asymptomatic expansion of the subarachnoid space are shown only dynamic observation and annual MRI.

Treatment may include:

The appointment of antibacterial drugs - with an infectious lesion of the brain and its membranes;

The use of vitamins of group B, for young children - D for the prevention and treatment of rickets;

Diuretics;

Vascular and nootropic drugs (pantogam, cavinton, cinnarizine);

anticonvulsant therapy;

Analgesics and anti-inflammatory drugs - nimesulide, ketoprofen, ketonal;

Anticancer drugs.

Treatment is always individual in nature, prescribed for a long time, includes medications, physiotherapy, psychotherapeutic assistance.

Given that the subarachnoid spaces are enlarged in hydrocephalus and intracranial hypertension, it is pathogenetically appropriate to prescribe diuretics - diacarb, mannitol, etc., which help to remove excess fluid and normalize the volume of cerebrospinal fluid in the skull. They can be used in parallel with vitamins, vascular agents and nootropics.

With a severe degree of severity of the pathology, conservative treatment may not bring the expected result, and then specialists are forced to resort to shunt operations, in which excess cerebrospinal fluid is discharged through special catheters into the chest or abdominal cavity. As a rule, shunting is performed for occlusive hydrocephalus with a significant expansion of the cavities of the ventricular system.

In adults, the expansion of the subarachnoid spaces is diagnosed quite rarely, often asymptomatically, and therefore requires only dynamic observation. With symptoms of encephalopathy and vascular disorders, nootropics, vasodilators, and vitamins are indicated.

The prognosis for the expansion of subarachnoid spaces depends on the cause of the pathology and the degree of circulatory disorders. Timely detection and elimination of the disease leads to a cure or a significant improvement in well-being, and normal physical and mental development is restored in babies. Benign hydrocephalus may spontaneously disappear by the age of two.

About questions prevention expansion of the subarachnoid space in babies should be considered by the expectant mother already in the early stages of gestation. Existing infectious processes should be eliminated if possible even before conception, and the entire period of gestation should be regularly visited by a doctor and undergo ultrasound. In childbirth, injuries should be avoided by following the instructions of the staff of the maternity ward.

After childbirth, it is important to carefully monitor the growth and development of the baby, visit a doctor, and if suspicious symptoms appear, do it without delay. Parents usually try to protect their children from stress, trauma and other adverse conditions that can negatively affect the brain. To prevent the expansion of the subarachnoid spaces, adults should avoid trauma to the skull and visit a therapist at least once a year in order to diagnose a pathology that can cause brain disorders.