Open mixed hydrocephalus in adults. Hydrocephalus

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Hydrocephalus of the brain

Within the brain (in particular, its ventricles) of a person, the circulation of cerebrospinal fluid or cerebrospinal fluid constantly occurs. This natural moisture can be absorbed and renewed as needed and depending on the processes taking place in the body. In the case when there is a violation of the work of departments or the course of certain processes, the cerebrospinal fluid may begin to accumulate, filling the ventricles or the subarachnoid space. As a result, additional pressure is created on the organ itself and the skull that stores it.

Hydrocephalus of the brain can occur and progress both in an adult (acquired origin) and in a newborn child (congenital disease). There are also 4 stages of the disease - acute, chronic, compensated and decompensated.

Liquor

Types of hydrocephalus

• open (combined)
• closed (occlusive, incompatible)

According to the place of accumulation of fluid, hydrocephalus is divided into external and internal. With external hydrocephalus, excess accumulation of fluid occurs mainly in the subarachnoid spaces, and with internal hydrocephalus, in the ventricles of the brain.

From a practical point of view, it is extremely important to distinguish between hydrocephalus progressive(increasing) and stabilized. Progressive hydrocephalus predominantly occurs with an increase in CSF pressure, accompanied by compression and atrophy of the brain tissue, and expansion of the ventricles. However, the expansion of the ventricles and subarachnoid spaces of the brain can also occur due to atrophy of the brain tissue after a severe traumatic brain injury, ischemic stroke, or brain hypoxia. This hydrocephalus is called compensatory, stabilized, or normotensive (with an increase in the volume of the ventricles and other cavities of the brain and, accordingly, an increase in the volume of cerebrospinal fluid, its pressure remains within the normal range and subsequent brain atrophy is not observed).

According to the time of occurrence of hydrocephalus, they distinguish congenital(which develops before birth or from birth) and acquired. Congenital hydrocephalus occurs as a result of abnormal development of the brain with narrowing or blocking of the CSF pathways, infection during pregnancy (tonsillitis, influenza, toxoplasmosis, pneumonia, etc.), intoxication, trauma or physical overload. Congenital also includes hydrocephalus resulting from a birth injury with intracranial hemorrhage or asphyxia of the fetus. Acquired hydrocephalus develops as a result of brain injury, with brain tumors, and inflammatory processes of the meninges (meningitis, arachnoiditis).

Internal hydrocephalus

There are no features of the manifestation of this form of hydrocephalus - the symptoms persist within the general complex. The external manifestations of the disease (manifested in most cases in children), as well as the spectrum of sensations characteristic of the disease, do not have pronounced differences. But each form of the disease affects the methods of treatment in its own way, since one of the main goals of the doctor is to remove the maximum amount of fluid from the patient's skull (medication or surgery) to ensure that intracranial pressure is reduced to an optimal level.

External hydrocephalus

The external form is much less common. One of the varieties of external dropsy is external replacement hydrocephalus, which occurs most often in people suffering from pathologies of the cardiovascular system (in particular, arterial hypertension), osteochondrosis in the cervical spine, or once experienced TBI.

Like the internal form of the disease, external hydrocephalus may not manifest itself for a long time, delivering only minimal discomfort. This fact leads to a delay in the start of treatment and reduces the patient's chances of a full recovery. Because the disease is often called "insidious".

Hydrocephalus Clinic

When does hydrocephalus develop? in children older than one year, then this is manifested by a progressive expansion of the cranial sutures, with percussion of the skull, a characteristic sound of a "pot that cracked" occurs.

Multifaceted neurological symptoms in hydrocephalus are a consequence of increased intracranial pressure, with the development of atrophic and degenerative processes in the brain and cranial nerves, and in occlusive hydrocephalus it is often supplemented by focal symptoms of the underlying disease.

At newborns and infants age, there is a fixed downward displacement of the eyeballs (a symptom of the setting sun), a decrease in acuity and narrowing of the visual fields may develop before the onset of blindness. The function of the abducens nerve is often disturbed, which leads to convergent strabismus, and movement disorders in the form of paresis, sometimes combined with hyperkinesis. Cerebellar disorders cause a violation of statics and coordination of movements. There may be a significant lag in intellectual and physical development, often manifested by increased excitability, irritability or lethargy, weakness, apathy.

emergence hydrocephalus in older age groups, as a rule, is a consequence of severe organic lesions of the nervous system and is manifested by a syndrome of increasing intracranial hypertension. There is a headache that worries mainly in the morning, nausea, vomiting at the peak of headache, depression of the function of the cerebral cortex (memory disorders, broken thinking, impairment of consciousness of varying degrees), swelling of the optic discs with a tendency to rapidly progressing secondary atrophy of these nerves with a decrease sharpness and narrowing of the visual fields, corresponding changes in the bones of the cranial vault and the Turkish saddle.

Symptoms of an occlusive seizure associated mainly with a delay in the outflow of cerebrospinal fluid from the ventricular system, rapidly progressing. This leads to an increase in intraventricular pressure and compression of the brainstem. A particularly striking clinic of an occlusive attack occurs with disorders of the cerebrospinal fluid circulation in the lower parts of the fourth ventricle, when, due to the increasing volume of cerebrospinal fluid, the bottom of the rhomboid fossa and the midbrain experience the greatest pressure. In this case, there is a sharp headache, nausea, vomiting, forced position of the head, motor activity, combined with general lethargy, impaired consciousness, an increase in oculomotor disorders, increased nystagmus, autonomic disorders in the form of profuse sweating, flushing of the face or severe pallor, bradycardia, arrhythmia, intensification of pyramidal disorders, sometimes tonic convulsions, an increase in the frequency of breathing with a violation of its rhythm up to a stop. The presence of stem symptoms is one of the most important signs of an occlusive attack.

Focal neurological symptoms depend on the nature and localization of the underlying pathological process and the level of occlusion. The two most common syndromes are:

1. with occlusion at the level of the Sylvian aqueduct - a syndrome of damage to the midbrain (violation of gaze along the vertical axis, pupillary reflex disorders, ptosis, spontaneous convergent nystagmus, hearing disorders).
2. With occlusion at the level of the IV ventricle - symptoms of damage to the cerebellum and brain stem.

Diagnosis of hydrocephalus

The simplest, non-invasive, highly informative method for diagnosing hydrocephalus is an ultrasound examination of the brain (ultrasound) - neurosonography. The method allows diagnosing hydrocephalus as early as the seventh month of pregnancy. Neurosonography is widely used to examine young children, when the bone sutures of the skull and fontanelles have not yet been overgrown.
As a result of the examination, the dimensions of the ventricles of the brain are established, the level and causes of occlusion are specified. The examination is convenient for dynamic monitoring of the patient, since it is harmless to the body.

Age features of hydrocephalus

Scientists in the field of medicine have proven that any kind of impact on the brain, as a result of which its integrity and functionality may be impaired, is a potential danger. This also applies to internal processes leading to damage to the tissues of the organ.

Hydrocephalus of the brain in adults is treated exclusively under the vigilant supervision of a specialist in the field of medicine. Immediately after a thorough diagnosis, medications are started to reduce pressure in the patient's cranium. In critical cases, the fluid is removed by surgery. The main goal of the medical staff is to ensure the normal flow of fluid, that is, to eliminate the cause of its violation.

Needless to say, early diagnosis allows doctors to minimize the possible harmful effects on the organ and the body as a whole, increasing the patient's chances of staying alive and maintaining health.

Hydrocephalus in adults

Often, dropsy manifests itself in neurological symptoms, which is explained by compression of the brain structure during the expansion of the cerebrospinal fluid space, as well as the impact of the underlying disease that led to hydrocephalus. As a rule, we are talking about violations of the vestibular apparatus, as well as the perception of visual signals, up to nerve atrophy.

Less common in medical practice are cases characterized by disturbances in motor and sensory functions. These can be paralysis and paresis, changes in the area of ​​tendon reflexes, partial or even complete loss of one or all types of sensitivity, etc.

In addition, this disease may also be accompanied by manifestations in the field of mental health of the patient. As a rule, violations are noted in the sphere of emotions and manifestations of will. The patient shows emotional instability, sometimes neurasthenia, demonstrates abrupt and most often causeless transitions from euphoria to apathy or vice versa. In the case when the pressure in the cranium increases rapidly, aggression may occur.

All these symptoms, described by the patient or his inner circle, allow the neurologist to assume the presence of the disease already at the first examination, before the tests.

Hydrocephalus in children

The skull begins to grow under the pressure of the cerebrospinal fluid and due to the body's desire to reduce intracranial pressure. Growth can be indicated both on both sides of the skull, and on one of them. As the disease progresses and the skull grows, head movements and subsequently movement in general become more difficult. Quite often, this symptom is accompanied by a complex of others - protrusion of the veins, swelling of the optic discs, tension in the region of the large fontanel. Even in the early stages, a doctor may suspect hydrocephalus based on the "setting sun" syndrome that manifests itself in children.

Symptoms of dropsy of the brain in children partially repeat the set of symptoms in an adult. In particular, there may be a change in muscle tone, partial or complete loss of vision and sensation, neurological disorders and psychological disorders. Unlike adults, children rarely show disorders of the emotional-volitional sphere - in this case, retardation in intellectual and physical development is manifested. Due to low mobility, sick children quickly gain weight and become obese. The psychological picture shows apathy, lack of initiative and strong attachment to relatives and relatives.

The causes of the disease, as a rule, are congenital pathology at an early age or an infection during adolescence. Diagnosis and treatment are similar to those applicable to adult patients and are individualized.

Hydrocephalus in newborns

The cause of this pathology in a child may be a defect in the vascular system, various malformations in the development and formation of the central nervous system (hernia, aneurysm or cyst in the skull), breakdowns or aberrations in the set of chromosomes. Less often, such consequences occur as a result of the formation of formations in the brain of an unborn child. Dangerous for the fetus there may be infections ever transferred or still not eliminated from the mother's body. Even a completely harmless infection like SARS can critically increase the likelihood of developing hydrocephalus. It is extremely rare that there are cases in which the disease was provoked by trauma to the fetus.

In the first year of a baby's life, dropsy can provoke not only external manifestations (a disproportionate and excessive increase in the volume of the skull, scalp tension, etc.), but also disturbances in the development of the body. Due to the growth of the skull, the child is limited in movement, which leads to impaired muscle formation and deformities. In addition, squeezing parts of the brain leads to mental, emotional and often psychological retardation. As the disease progresses, strabismus appears, and the “setting sun” syndrome can manifest itself even in the first days of life.

At this age, the damage caused to the body by the disease is maximum, therefore it is extremely important to identify its onset and progress as early as possible and seek qualified medical care until the consequences are irreversible. Fortunately, due to the compliance of the maturing organism, it is possible to diagnose disorders almost immediately after birth.

Hydrocephalus Treatments

Mostly hydrocephalus is treated surgically. Regardless of the pathogenetic features of hydrocephalus, the main goal of surgical interventions is to create conditions that ensure the removal of excess cerebrospinal fluid from the CSF spaces of the brain and maintain CSF pressure at a normal level. To ensure this goal are carried out:

1. Operations aimed at diverting cerebrospinal fluid by creating detours (various types of cerebrospinal fluid shunting operations).
2. Actions aimed at eliminating occlusion of the CSF pathways (removal of tumors, crushing or blocking various parts of the CSF pathways, dissection of the cerebellar vermis with occlusion at the level of the foramen of Magendie, as well as perforation of the end plate and puncture of the corpus callosum).

• Ventriculoperitoneal shunting
• Ventriculocardial shunting
• Lumboperitoneostomy
• Ventriculocisternostomy

Results of hydrocephalus treatment

Sometimes inflammatory complications can be eliminated by anti-inflammatory therapy. If treatment is not effective, the shunt system must be removed.

Another complication when using liquor shunting systems is their clogging. The latter can occur at any level. The central catheter can be clogged with protein, which is in the cerebrospinal fluid, brain tissue or choroid plexus. The distal catheter located in the abdominal cavity can be clogged with peritoneum, intestines, fibrin deposits.

With ventriculoperitoneal shunting in young children, 2-4 years after the operation, due to the growth of the child, the abdominal end of the catheter comes out of the abdominal cavity, which leads to the cessation of drainage and rapid deterioration of the patient's condition.

The long-term consequences of surgical treatment of hydrocephalus of various origins with the use of liquor shunting systems depend, first of all, on the degree of their severity, i.e., the degree of impairment of the structure and function of various parts of the brain. With a relative preservation of the cerebral mantle (cerebral tissue) of more than 2-3 cm, it is possible to predict the normal physical and mental development of the child (Yu. A. Orlov, 1996). Even keeping this size to 1 cm often makes it possible to compensate for the corresponding deficiency in more than 70% of patients (given that in most people no more than 12-15% of the cerebral cortex functions).

Only in cases of significant atrophy of the brain structures can surgical intervention be unpromising.

Hydrocephalus, or in other words, dropsy of the brain, which is formed as a result of excessive accumulation of cerebrospinal fluid in the cavities of the GM, the movement of which from the cavities (ventricles) of the GM into the cardiovascular system of the body was disturbed by certain factors.

The outcome of this disease is dangerous, because if you are late with the start of therapy, then consequences can be irreparable.

Stable pressure, as a rule, causes disruption of the GM and deformation of the skull. Often, dementia is the result of this disease.

Not so rare is a fatal outcome, which is why it poses a great danger to human health.

As already mentioned, hydrocephalus of the brain in an adult it's a dangerous disease, which can affect basic brain functions and cause death.

Therefore, the timely correct conclusion of the doctor and the start of therapy can serve as a speedy recovery and return to your normal life. But it is worth remembering that taking medications is ineffective, so you should not refuse operations if it is really necessary.

Types of hydrocephalus

Depending on the mechanism of the onset of the disease, three types of hydrocephalus are determined in adults:

1. Closed (not communicating). This form of the disease is related to the disorganization of the process of outflow of cerebrospinal fluid due to the overlap of the descending pathways. The cause of such a violation, as a rule, becomes a neoplasm or thrombus that remains after the inflammatory process.
2. Communicating or open type form. In this case, the root cause is considered to be a malfunction in the absorption of cerebrospinal fluid in the venous system, since certain structures are violated.
3. hypersecretory form. This is a form of the disease, as a result of which more cerebrospinal fluid is produced than necessary, i.e. its excess.

Disease classification

Depending on the underlying causes that caused hydrocephalus, distinguish:

• congenital;
• acquired hydrocephalus.

Congenital is a consequence of intrauterine disruption of the central nervous system or developmental defects. Acquired occurs, as a rule, after FM injury, inflammation, the appearance of neoplasms, etc.

Birth defects that contribute to development hydrocephalus:

hereditary defects due to genetics:

• genes that are associated with the x chromosome are responsible for the development of hydrocephalus;
• congenital disorder of the development of the Dandy-Walker circulatory system.

Acquired defects that contribute to the development hydrocephalus:

1. caused by infection. It is often diagnosed in cases of communicating hydrocephalus.
2. Damage that appears as a result of subarachnoid hemorrhage.
3. Posthemorrhagic. It is the second most common underlying cause of communicating hydrocephalus.
4. Damage that appears after hemorrhage inside the GM cavities. If you believe the statistics, then 25-48% of patients develop developing hydrocephalus. No neoplasm formation. Tumors, arteriovenous malformations.
5. Secondary. With extensive processes inside the skull.
6. Accompanied by the formation of neoplasms. The disease is formed as a result of the presence of obstacles in the liquor-bearing directions, which causes neoplasms in the cerebellum of the lateral cavity of the brain.
7. After the operation, the following is typical. Approximately 20 percent of children who have undergone removal of posterior fossa tumors feel the need for surgical intervention, by implanting shunts.

Morphologically, hydrocephalus is recognized, depending on its location in relation to the brain tissue of the dilated spinal cavities. Note:

• intracavitary;
• subarachnoid;
• external hydrocephalus in adults.

Depending on the degree of pressure exerted by the cerebrospinal fluid, normo- and hypertensive hydrocephalus are distinguished.

From a clinical and functional point of view distinguish:

• stabilized hydrocephalus;
• progressive;
• regressive.

From a clinical point of view, the second type of disease is subcompensated or decompensated (it is precisely this that is the goal of surgical intervention).

Regressive and stabilized deviations are usually compensated, so surgery is not an urgent need.

Reasons for the development of the disease

You can select a list of ailments that contribute to the development of this disease in adults. Here are the main causes of hydrocephalus in adults:

• Innovations in GM. A strong influence on the movement of matter is exerted by neoplasms located in the stem part of the GM and in the cavities of the GM.
• Inflammatory processes and lesions of the body with such diseases as: meningitis, encephalitis, tuberculosis, etc.
• Bleeding of blood vessels inside the skull. Important points are subarachnoid and intracavitary bleeding, which are most closely associated with hydrocephalus.
• Disorders of the circulatory process in the GM, for the most part, of an acute nature: hemorrhagic and ischemic strokes.
• Encephalopathies that have different sources of occurrence: alcohol, as a result of prolonged oxygen starvation, etc.

Symptoms of the disease

Signs and symptoms of hydrocephalus in adults depend on the form of the disease.

Acute hydrocephalus

In acute hydrocephalus, the symptoms are the result of increased pressure inside skulls:

1. Arising pains in the head - the patient experiences especially severe pain when waking up in the morning. This can be explained by the fact that the pressure increases during sleep.
2. Nausea and vomiting - the manifestation of these symptoms is also characteristic of the morning hours. After cleansing the stomach, the pain in the head sometimes subsides.
3. Lethargy is one of the most dangerous symptoms, indicating an increase in pressure inside the skull. When it occurs, most likely, a rapid, sharp progress in neurological symptoms is approaching.
4. Symptoms of displacement of the brain tissue relative to solid formations of the brain - a quick suppression of the patient's consciousness up to the development of a coma, then the patient takes a forced position of the head, oculomotor disorders occur.

Chronic hydrocephalus

Signs of hydrocephalus in adults in this case:

1. Cognitive impairment - in most cases, symptoms in adults appear 15-20 days after an injury, bleeding of blood vessels in the brain, meningitis, etc.
2. The patient is confused in the time of day, that is, in the daytime he experiences lethargy, and at night he cannot sleep. The patient becomes passive, indifferent to what is happening.
3. Memory impairment - first of all, the ability to remember numbers is deteriorating. In this case, the patient incorrectly voices months, numbers and forgets how old he is.
4. In the advanced stages of the disease, intellectual impairments may occur, as a result of which the patient cannot take care of himself, and the questions posed may not be answered at all or answered, while spending a lot of time, taking breaks between words.
5. Walking disorder is a syndrome in which the patient in the supine position easily demonstrates how to move or ride a bicycle, but when he rises, he is not able to move normally, that is, he moves, spreading his legs wide, rolling from foot to foot.
6. Involuntary excretion of urine is not necessarily manifested, and is a late symptom of the disease. Fundus deviations are usually absent.

Diagnostic methods

To make a correct diagnosis, you need to do a whole complex procedures:

1. Computed tomography is a fairly accurate diagnosis of the contours of the GM, its cavities and the skull. It is carried out to establish the shape and size of the cavities, to determine deviations - various neoplasms.
2. Magnetic resonance - makes it possible to establish the severity and type of the disease. These studies are necessary to accurately establish the causes of dropsy.
3. X-ray of the cisterns of the base of the skull - used to determine the type of disease and determine the path of decreasing CSF.
4. Internal examination of blood vessels - after the process of entering the arteries of a contrast substance, deviations in the vessels are detected.

MRI for hydrocephalus in adults photo

Healing procedures

Treatment of hydrocephalus in adults depends on the form of the disease.

acute form

Treatment of acute hydrocephalus in adults:

• in the acute form of the disease, as a rule, drugs are prescribed that reduce the pressure inside the skull;
• the procedure for extracting a small amount of cerebrospinal fluid by inserting a needle into the area of ​​\u200b\u200bthe fontanels, aims to reduce pressure.

Sometimes during therapy it is also required surgical intervention- extraction of the root cause of the violation of the decrease in CSF or the determination of other ways to remove CSF, for example, the removal of a substance into the abdominal cavity.

Chronic form

The treatment is surgical implantation of a shunt. The shunt diverts excess CSF from the GM to another part of the body where the substance is absorbed.

Such operations are at least 85% effective.

The principle of surgical intervention is as follows - excess CSF is evacuated with the help of tube systems, valves and catheters to other parts of the human body (into the abdominal cavity, into the right atrium, etc.).

The decision on how to treat hydrocephalus in adults should solely be the attending physician.

Complications of the disease

Patients, subject to a timely diagnosis, who undergo therapy, may well live the rest of their lives without significant complications.

In some cases there is a speech disorder. There may be problems with the malfunction of the shunt or infection during its installation, which suggests its reinstallation. In especially complex and advanced cases with hydrocephalus in adults, disability is possible.

Forecast

The prognosis for this disease depends on the underlying cause and the time spent diagnosing and prescribing appropriate therapy. There may be some restrictions on further life. In some cases, a violation of the functions of the speech apparatus is possible.

Preventive measures

The first step to prevent cerebral hydrocephalus in adults is to avoid diseases such as meningitis, polio, encephalitis, and FM trauma.

Avoidance of infectious diseases of a pregnant woman, extreme caution when taking medications during pregnancy.

Video: About the causes and treatment of cerebral hydrocephalus

A neurosurgeon of the highest qualification category talks about the causes of the disease and methods of treating hydrocephalus.

Hydrocephalus of the brain is a neurological disease caused by the presence of excess fluid in the subarachnoid regions, the ventricular system of the brain. Another name for this disease is dropsy of the brain. Its development occurs due to excessive production or insufficient outflow of cerebrospinal fluid - CSF. Hydrocephalus can occur both after infectious diseases and after receiving craniocerebral injuries.

This disease is manifested by certain symptoms - signs of deterioration in well-being, which should definitely be paid attention to. They directly depend on the age group to which the patient belongs, as well as on the degree of progression of the disease. For example, cerebral hydrocephalus in newborns is accompanied by a number of features. First of all, those children who have been diagnosed with this disease have an overly large head circumference, which continues to increase in the future. At the same time, a convex fontanel is noticeable on the parietal part of the child's head. Other manifestations of this disease in young children include vomiting, poor sleep, irritability, eye rolling, and convulsions. Most often, the development of such children occurs with a delay, complicated by poor perception of information, a slow thinking process, learning difficulties, etc.

Hydrocephalus of the brain in children can appear even during the mother's pregnancy. This kind of this disease is called congenital. Intrauterine infections, fetal malformations, hemorrhages in the ventricles of the brain in an unborn child lead to its occurrence. Another type of this disease is acquired hydrocephalus. It develops after the baby is born. Its causes can be traumatic brain injuries received during childbirth, as well as various infectious diseases.

Hydrocephalus of the brain in adults and older children also has its own characteristics. In most cases, adults with hydrocephalus report the following symptoms:

• migraine-like pain in the head, accompanied by nausea;
• increase in intracranial pressure;
• causeless vomiting;
• deterioration in the sensitivity of the ears;
• visual impairment: inability to focus vision, double vision attacks, and eye rolling;
• difficulty in moving due to poor balance, fatigue, inability to coordinate and control their movements;
• sudden mood changes, irritability;
• temporary memory loss.

Symptoms of this disease also depend on the stage at which it is located. There are two stages of hydrocephalus: acute and chronic. At the first, acute stage of the course of this disease, one can notice signs of the pathology that caused hydrocephalus. In the second, chronic stage, the patient already experiences other symptoms that are characteristic of the provoked disease.

Causes and varieties

Currently, there are three main forms of this disease:

1. Internal hydrocephalus of the brain. It is characterized by the presence of an excess amount of CSF directly inside the ventricles. As a rule, this happens due to a disturbed process of absorption of excess fluid in the cavities of the brain. The main causes that provoke the appearance of this type of hydrocephalus are:
   • malformations of the central nervous system;
   • various neoplasms located in the brain and increasing in size;
   • inflammatory processes occurring in the brain;
   • serious injuries, bruises of the head.
2. External hydrocephalus of the brain. This type of disease is characterized by an excess of cerebrospinal fluid in the subarachnoid space. Unlike its previous form, the content of cerebrospinal fluid in the ventricles in this type of disease remains within the normal range. According to statistics, this form of this disease is much less common than all the others, since it indicates brain atrophy.

   This type of disease also includes external replacement hydrocephalus of the brain, in which, for some reason, the volume of the brain decreases, and the vacated space is filled with cerebrospinal fluid. The causes of this form of hydrocephalus are diseases such as atherosclerosis and hypertension, as well as trauma to the brain or cervical vertebrae. It may not manifest itself as headaches or high blood pressure for a long period of time. This is due to the fact that the missing volume of the brain is compensated by cerebrospinal fluid.

3. Mixed hydrocephalus of the brain. With this form of this disease, the localization of cerebrospinal fluid is observed in all parts of the brain. It also includes mixed replacement hydrocephalus of the brain. It occurs against the background of mixed hydrocephalus and is characterized by a decrease in brain volume, as well as filling the vacated space with cerebrospinal fluid. According to statistics, this form of hydrocephalus most often occurs in older people. It appears against the background of instability of the cervical vertebrae, hypertension, atherosclerosis, as well as against the background of excessive consumption of alcoholic beverages and.

It is interesting! One of the most insidious forms of this disease is moderate hydrocephalus of the brain, as it is characterized by the complete absence of any signs for many years. Therefore, in this situation, a person himself may not guess what kind of dangerous disease he is susceptible to. But, sooner or later, there comes a moment when the disease manifests itself, and the patient's condition worsens significantly due to impaired blood circulation in the brain.

Hydrocephalus of the brain - what threatens?

The severity of hydrocephalus depends on the age at which the disease begins to develop. For example, if this disease was detected in a newborn child, then, most likely, his brain will be seriously damaged. And, as a result of these unfavorable processes, in the future he will face complete or partial physical incapacity. In such a situation, one must hope for the effectiveness of prompt and modern treatment, because only with proper medical treatment the patient will be able to live an almost normal, full life in the future with minimal health consequences.

Treatment

To combat hydrocephalus at a mild stage, drug treatment is used, which includes taking medications that reduce intracranial pressure. They can significantly slow down the progression of this disease, because in this case the human body can still independently restore fluid circulation.

Unlike the previous situation, with a severe form of hydrocephalus, surgical intervention is mandatory. At the moment, surgical treatment of hydrocephalus is carried out using a system of shunts - special equipment consisting of valves and thin silicone catheter tubes. Through these tubes, fluid is removed from the brain and sent to the abdominal cavity. With the help of this device, optimal intracranial pressure is maintained in the head, preventing the cerebrospinal fluid from flowing in the opposite direction. But, despite the fact that brain bypass for hydrocephalus is an effective method of treating this disease, its use also has disadvantages: the small diameter of the cord, its short service life, etc.

Another new way to treat this disease is endoscopic surgery. It allows the most safe for a person to carry out the outflow of cerebrospinal fluid, as a rule, through the bottom of the third ventricle into the extracerebral cisterns. One endoscopic operation will be enough for a person to be saved forever.

Hydrocephalus is a dangerous disease that occurs when there is an excessive accumulation of cerebrospinal fluid in the brain. The consequences of this disease can be brain dysfunction, difficulty in thinking and perceiving information, so it is very important to prevent its occurrence by all means. Take care of yourself and be healthy!

Increased intracranial pressure is a diagnosis that almost all young parents know, since it is widely diagnosed in our country, and often unreasonably, without the necessary research. In fact, this pathology is based on serious diseases, one of which is hydrocephalus.

Some anatomy and physiology

Hydrocephalus (dropsy of the brain) (from the Greek "hydro" - water, "cephalon" - head) is a condition accompanied by an increase in the volume of the ventricles of the brain. In the human brain there are several cavities that communicate with each other and are filled with CSF (cerebrospinal fluid). These cavities are called ventricles. The ventricular system consists of two lateral ventricles that connect to a slit-like third ventricle (III ventricle), which, in turn, through a thin canal (Sylvius aqueduct) connects to the fourth ventricle (IV ventricle). CSF is produced in the choroid plexuses of the ventricles and moves freely from the lateral to the IV ventricle, and from it to the subarachnoid space of the brain and spinal cord (the subarachnoid (subarachnoid) space is the space between the brain and the dura mater), where it washes the outer surface of the brain. There it is reabsorbed into the bloodstream. Liquor is a clear, colorless liquid, very similar in appearance to water, contains a small amount of cells, protein and salts. In an infant, the amount of cerebrospinal fluid is about 50 ml, in a teenager and an adult - up to 120-150 ml. Liquor is constantly produced and absorbed, up to 500 ml of cerebrospinal fluid is produced per day by the vascular plexuses of the brain.

Any disturbance in the system of liquor production, liquor circulation and absorption of cerebrospinal fluid leads to its excessive accumulation in the cavities of the brain, which is called hydrocephalus, or dropsy of the brain.

Types of hydrocephalus

In cases where there is an obstacle on the way of the cerebrospinal fluid from the lateral ventricles to the exit from the IV ventricle and the cerebrospinal fluid cannot freely enter the subarachnoid space, hydrocephalus is called non-communicating(closed, occlusive). In other cases, hydrocephalus is called communicating(open). Hydrocephalus happens primary(as the underlying disease) and secondary, i.e., a complication of other diseases (tumors, malformations of the central nervous system (CNS) and cerebral vessels, etc.). There are many classifications of hydrocephalus, but these are the main ones and are used most often.

Manifestations of hydrocephalus

Violation of the circulation and absorption of cerebrospinal fluid leads to its excessive accumulation and increased intracranial pressure. This manifests itself in different ways in babies under 2 years old and in older children.

The main symptom of the development of dropsy of the brain in children under 2 years of age is an accelerated growth in head circumference. The sutures of the skull in babies have not yet been overgrown, and the size of the head increases because the bones of the skull are pushed apart from the inside by the growing brain. In the same way, a balloon increases in volume when we inflate it. There is a graph of head circumference growth. It is necessary to measure it every one to two months, this is done by the local pediatrician during preventive examinations. If the baby's head grows faster than normal, then this is an alarming symptom; it most often indicates the development of hydrocephalus, when the accelerated growth of the head occurs due to an excess of cerebrospinal fluid in the ventricles of the brain. This is often the first symptom of the disease. In addition to the accelerated growth of the head in children, an enlarged and bulging large fontanel can be detected, which should close by about 1 year, but with hydrocephalus it can be open up to 2 and even up to 3 years. The bones of the skull become thinner, the forehead becomes disproportionately enlarged and protruding. A venous network appears on the forehead and face. In more advanced cases, the eyes may go down (Grefe's symptom). The tone of the muscles of the legs increases. Seizures may occur.

The child begins to lag behind in the pace of psychomotor development. He does not keep his head on time, does not sit, does not get up, does not play. A sick child is lethargic, apathetic, sometimes unmotivated whining. Perhaps the baby is experiencing a headache: he can grab his head.

Most of the symptoms of increased intracranial pressure can only be recognized by an experienced pediatrician, neuropathologist or neurosurgeon, but parents can measure the growth rate of the head themselves and check it according to special charts. In any case, the accelerated growth of the circumference of the child's head, as well as the incomprehensible lag in the pace of its development, should serve as a reason for a serious examination of the baby by a neuropathologist or neurosurgeon to rule out hydrocephalus.

In children older than 2 years, the sutures of the skull overgrow, and the increase in intracranial pressure manifests itself in a different way. The classic picture is headaches with nausea and vomiting (more often at night or in the morning), changes in the fundus (the so-called papilledema, which can be detected by an ophthalmologist). Headaches, especially with nausea and vomiting, are symptoms that require examination by a neurologist or neurosurgeon. They can be caused by hydrocephalus, a brain tumor, malformations of the brain. Pediatricians often forget about this, and children are treated for a long time and aimlessly for gastritis, pancreatitis, biliary dyskinesia, poisoning and gastrointestinal infections, etc., and they get to a neurologist and neurosurgeon late in a serious condition. It is necessary to insist on a consultation with a neurologist and examination in case of incomprehensible headaches, regular episodes of nausea and vomiting, decreased vision, and in some cases this will make it possible to make a correct diagnosis in the early stages and save the child's life.

Other symptoms of hydrocephalus are varied and depend on the cause that caused it. These can be epileptic convulsions, blurred vision, increased tone in the legs, pelvic disorders (incontinence or urinary retention), endocrine disorders (stunting or gigantism, premature sexual development, hypothyroidism - decreased production of thyroid hormones, obesity), reduced academic performance. school, etc.

Causes of hydrocephalus in children

The causes of hydrocephalus are very diverse and largely depend on the age of the child.

1. hydrocephalus in the fetus. Modern types of prenatal diagnostics (for example, ultrasound - ultrasound) can detect hydrocephalus in an unborn baby. In most cases, it is caused by various malformations of the central nervous system (CNS). In 20%, dropsy is associated with intrauterine infections (cytomegaly, herpes, toxoplasmosis). When planning a pregnancy, parents should be tested for these often occult infections and treated. This will avoid many health problems for the baby. Rarely, hydrocephalus is caused by a genetic disorder.
2. Hydrocephalus of the newborn. Most often (up to 80%), dropsy in newborns is caused by malformations of the brain and spinal cord and the consequences of intrauterine infections. Approximately 20% of hydrocephalus is a consequence of birth trauma, especially in premature infants, which is accompanied by intracerebral or intraventricular hemorrhage and associated meningitis (inflammation of the meninges), which leads to impaired CSF absorption. It is extremely rare at this age that tumors and vascular malformations of the brain are detected, which can also cause the development of dropsy.
3. Hydrocephalus in toddlers and older children (from 1-2 years and older). There are many reasons for the development of hydrocephalus in such children. These include tumors of the brain and spinal cord; consequences of meningitis, encephalitis (inflammation of the substance of the brain), various infectious diseases (for example, tuberculosis); malformations of the brain and cerebral vessels; consequences of hemorrhages; consequences of traumatic brain injury; genetic disorders. Sometimes the cause of hydrocephalus cannot be determined.

How is the diagnosis made?

Diagnosis of hydrocephalus is based on the clinical picture, examination of the fundus, as well as additional research methods, such as neurosonography (NSG), ultrasound of the brain (in infants up to 2 years), computed tomography (CT) or magnetic resonance imaging (MRI) of the head brain. The primary diagnosis can be made by a neonatologist, pediatrician, neuropathologist or neurosurgeon.

The most common operation is the ventriculo-peritoneal shunt (VPSH).

Neurosonography is an effective method for diagnosing the state of the substance of the brain and ventricular system in children up to 1.5-2 years old, until the large fontanel and other “ultrasonic windows” have closed - areas of the skull where the bones are very thin (for example, the temporal bone) and pass ultrasound. It allows you to detect the expansion of the ventricular system, intracranial volumetric formations (tumors, hematomas, cysts), some malformations of the brain. However, it should be remembered that the NSG method is not entirely accurate. The image of the brain is obtained with a much lower resolution (less clear) than with CT and MRI.

If any pathology of the brain is detected, CT or MRI is necessary. Without them, it is impossible to make an accurate diagnosis, identify the cause of hydrocephalus, and even more so carry out treatment. This equipment is expensive and is still not installed in all hospitals. In this case, parents should insist on CT or MRI at other centers or perform them themselves on a commercial basis. It should be borne in mind that a clinic that undertakes the treatment of children with hydrocephalus must have this equipment. Otherwise, parents can be advised to choose another, more equipped hospital, even in another city.

Treatment of hydrocephalus

Endoscopic ventriculostomy avoids foreign body implantation.

If a diagnosis of hydrocephalus (any cause) is made, the child should be examined by a neurosurgeon. Most often, children with hydrocephalus are treated surgically, and the neurosurgeon determines the indications and contraindications for surgery. Observation of children with hydrocephalus only by a neuropathologist or pediatrician without the participation of a neurosurgeon is a mistake and sometimes leads to an unreasonable delay in surgical intervention.

It is not easy for parents to decide on the need to perform the operation. However, a prolonged increase in intracranial pressure causes a delay in psychomotor development, which is not always possible to compensate after an unreasonably delayed surgical intervention. It should also be noted that the excessively large head of a child suffering from dropsy, even after the operation, will no longer be the same size - it will only be possible to stop its further growth. In the literal sense of the word, it will be difficult for a child to carry it on his shoulders, in addition, in the future it will cause many cosmetic problems. Parents of children with hydrocephalus should be aware that even if a neurologist does not refer them to a neurosurgeon, they must take the initiative and organize this consultation themselves.

The purpose of the operation is that the cerebrospinal fluid is diverted from the ventricles of the brain to other cavities of the body. The most common operation is the ventriculo-peritoneal shunt (VPSH). Through a system of silicone catheters, cerebrospinal fluid from the lateral ventricle of the brain flows into the abdominal cavity, where it is absorbed between intestinal loops. The amount of liquor flowing out is regulated by a special valve. The catheters are placed under the skin and are not visible from the outside. More than 200 thousand such operations are performed annually in the world. Shunt systems have saved millions of children's lives.

Less commonly, cerebrospinal fluid is drained into the right atrium (ventriculo-atrial shunt), into a large occipital cistern (Thorkildsen operation), or the spinal canal at the lumbar level is connected by a catheter to the abdominal cavity (lumbo-peritoneal shunt).

With the development of modern endoscopic technology (an endoscope is inserted into the human body cavities through small incisions, allowing them to be examined and manipulated), it became possible to treat patients without installing a bypass system. With the help of an endoscope in the depths of the brain, a bypass is created for the outflow of cerebrospinal fluid. This is a very effective operation (it is called endoscopic ventriculostomy), which allows you to avoid the implantation of a foreign body, which is a bypass system, and thereby prevent many complications. Unfortunately, only a limited number of patients (about 10% of the total number of patients) with some forms of occlusive hydrocephalus can be helped by this operation. In other cases, it is necessary to install a bypass system, since there will be no improvement from endoscopic surgery.

A successful operation stops the progression of the disease. Most of the children have the opportunity to return to normal life, along with healthy peers attend kindergarten, school.

In some cases, patients with hydrocephalus are not operated on, but are under observation and take Diacarb (a drug that reduces the production of cerebrospinal fluid) for a more or less long period of time. This is done in cases where there are no obvious signs of disease progression and increased intracranial pressure. Observation is carried out under the strict supervision of a neuropathologist or neurosurgeon with frequent examinations, measurements of the child's head circumference, repeated NSG or CT studies.

Myths about increased intracranial pressure

The diagnosis of "increased intracranial pressure", "intracranial hypertension (ICH)" or "hypertensive-hydrocephalic syndrome", as already mentioned, is often made and in some cases unreasonably. How is increased intracranial pressure (ICP) manifested? As already noted, in children under 2 years of age, such manifestations are, first of all, an accelerated growth in head circumference, a bulging and enlarged large fontanel, possible eye movement disorders, and psychomotor retardation. Most often, all these disorders are manifested in a complex. In children older than 2 years, these are headaches with nausea and vomiting, more often in the morning, changes in the fundus (detected during examination by an ophthalmologist). Of course, the clinical picture may be different, but without the above symptoms, the diagnosis of "increased intracranial pressure" is doubtful.

Symptoms such as sleep and behavioral disorders, hyperactivity, attention deficit, bad habits, poor academic performance, hypertonicity in the legs, "marble" skin pattern, including on the head, nosebleeds, chin trembling, tiptoe walking, are not in themselves indicate increased intracranial pressure. And yet, some neurologists diagnose ICH precisely on the basis of these complaints. Neurosonography, having become a huge boon for pediatrics and neurology, has made its significant contribution to the excessive and false diagnosis of "hypertensive-hydrocephalic syndrome". NSG makes it possible to quickly obtain an image of the substance of the brain, to measure the size of the ventricles. However, to clarify the diagnosis, as we have already said, CT and MRI are mandatory.

What is tomography?

Parents often ask what methods can measure intracranial pressure. Direct measurement of intracranial pressure is possible by installing a special sensor in the cranial cavity. This is done in large clinics for special indications (for example, with severe traumatic brain injury). Relatively objectively, one can judge intracranial pressure during lumbar puncture - the introduction of a needle into the cavity of the spinal canal at the lumbar level. All other research methods provide only indirect information and are valuable only when they are comprehensively assessed.

Rheoencephalography (REG) and echo-encephalography (Echo-EG or Echo-ES) are useless for diagnosing intracranial hypertension: they do not provide objective information, and their use is a sham.

Only on the basis of a careful comparison of clinical data with the results of additional studies (examination of the fundus by an ophthalmologist, NSG data together with CT or MRI images) can one speak of an increase in intracranial pressure and find its cause. The diagnosis of ICH requires urgent and most often neurosurgical treatment, as it threatens the health and life of the patient. Watching a child with intracranial hypertension without showing it to a neurosurgeon is like suspecting appendicitis or acute myocardial infarction and suggesting to come back in a week.

Overdiagnosis of increased intracranial pressure leads to stress for parents and to the unreasonable prescription of a large number of drugs to the child. The only drug that can reduce intracranial pressure on an outpatient basis is Diacarb. It is given very widely. Drugs such as Cavinton, Cinnarizine, Sermion, nicotinic acid, Nootropil, Piracetam, Pantogam, Encephabol, Picamilon, herbs, vitamins, homeopathic remedies are very popular, but do not affect intracranial pressure in any way. In any case, there is not a single study that would objectively confirm their effectiveness in ICH. Medications prescribed without indications cannot bring any benefit, but they have side effects. In addition, this is a significant burden on the pocket of parents.

Only the doctor who saw the patient has the right to make a diagnosis and prescribe treatment. However, the problem of overdiagnosis of increased intracranial pressure syndrome exists and requires attention and vigilance on the part of parents.

Sergey Ozerov, neurosurgeon,
cand. honey. Sciences, Research Institute of Neurosurgery. N.N. Burdenko, Moscow

Discussion

Hello, a 4-month-old child was diagnosed with intraventricular hydrocephalus. What should I do? Where to apply? They said everything was bad.

Hello. My child had a bypass when she was 7 months old. Now she is 2 years and 10 months old. Until that time, everything is fine. Ana lives like a normal child. Walking, talking and everything is fine. As parents, we live in fear all the time. What will happen to her tomorrow?

My sister's child was diagnosed with "Hydrocephalus", but only in question (and a bunch of others are also in question). All the symptoms of this disease described in the article are on the face. Pregnancy was normal, ultrasound is also all right. But for some reason, on the very first day after birth, the child was already with a collar. The doctors explained that it happens, just a minor injury during childbirth, nothing to worry about. But the child moved his head a little, as it should be. At discharge, they said that it was possible to remove the collar, another doctor advised to wear it for at least another month, but they listened and removed it ... They underwent an examination, everything is in doubt, but the child has pronounced symptoms. Doctors at first undertook to help (where she gave birth, the perinatal center), and then they simply said that they could not do anything. and the mother was told in the eyes that the child was not a tenant. Now they are waiting for a call to Moscow for examination, only when it is unknown. Time is running out. The child is already nine months old, he is suffering. They are looking for masseurs themselves, they have undergone some kind of treatment (the head has stopped growing, but it is very heavy). tell me how to be, where to go? The child is suffering. they live in Khabarovsk.

Can't take time

If the diagnosis is hydrocephalus, then only shunting will help, a good neurosurgeon is needed

Hello! NSG at 1 month: interhemispheric fissure expanded 3.2mm; convexital cerebrospinal fluid space expanded 3.3 mm. The lateral ventricles are symmetrical and dilated. Front horns: 5.3 and 5.3mm. Body: 4.8 and 4.8mm. Occipital horns 10 and 10 mm. Third ventricle 2.9 mm. The fourth ventricle is triangular in the sagittal plane. Vascular plexuses: smooth contours, homogeneous structures. Everything else is unchanged, homogeneous, symmetrical. Conclusion: expansion of the interhemispheric fissure and convexital cerebrospinal fluid space. Ventriculomegaly.
NSG at 4 months: the interhemispheric fissure in the anterior sections was expanded to 4.3-6.5 mm. Subarachnoid convexital space up to 2.7-4.3 mm. The lateral ventricles are symmetrical: PRBZH: pr. 7.3 mm, lev. 6.8 mm. Body BJ: pr.6mm, lev.4.8mm. ZRBZH: pr.9mm, lev.8mm. Third ventricle 4 mm. The fourth is not expanded, the basal cisterns are not expanded. The vascular plexuses are symmetrical, the pulsation of the intracranial vessels is preserved. Conclusion: a picture of unexpressed mixed hydrocephalus.
The neurologist prescribed: general massage, hypothiazide, asparkam, pantogam and injections of cerebrolysin.
The child became excitable, sleeps restlessly at night, screams in his sleep, during the day he sleeps 2 times for 40 minutes maximum. He is naughty, constantly on his hands, but not on his back, screaming on his back. No developmental delay was noticed, he rolls over on his stomach quickly from 3 months, tries to crawl, lying on his hands, pulls his shoulders to his knees and tries to take a more sitting position. Gulit, smiles, follows objects. How big are the deviations from the norm, what is the risk? Is the treatment appropriate? To whom else to turn, maybe some more examinations to pass?

Conclusion: a consequence of perinatal hypoxia in the form of small areas of periventicular leukomalacia of the frontal and parietal lobes. External hydrocephalus in the projection of the frontal temporal lobes and cerebellum. Hypoplasia of the lower parts of the cerebellar vermis. 8 month old baby please help! And how is it treated please tell me!

Hello, please tell me, the child is 5.5 months old and we had a diagnosis at 3 months of hydrocephalus, the doctor attributed to us asparks and diacarb, we drank them for almost 3 months and went as the doctor said for improvement, then they stopped giving and fell ill with ARVI, and now the indications of hydrocephalus have increased by 1 ,5 times and it is not clear why the temperature jumps to 38

Hello! Please tell me, our baby is now 8 months old. diagnosed with the consequences of perinatal lesions of the central nervous system in the form of mixed hydrocephalus. Neurosonography showed that the interhemispheric fissure is 13.3 mm, the antral-occipital regions of the side. Left 6.2 mm, width 3.5 mm, length up to 16 mm. Right 5.1 mm, width. 3.5 mm, length up to 15 mm. 3 ventricle width 5.2 mm. Vascular plexus without pathology., Transparent septum 4.0 mm Subcortical ganglia without pathology, Caudotamic region. changed: on the left ring-shaped. anechoic structure 5 mm by 8 mm, on the right 9 mm by 6.6 mm. The cerebellum is without pathology. Conclusion: There is a moderate expansion of the interhemispheric fissure and convexitalg subarachnoid space, slight dilatation of the lateral and third ventricles. Subependymal pseudocysts in the caudothalamic corners of the side. The blood flow is not broken. Now the volume of the head is 48 cm. The child is normal in development. Please tell me, DO WE HAVE A CHANCE TO RECOVERY???? We drink Diakarb, asparkam, tanakan, magne B6 for a week, we do electrophoresis on the cervical-collar zone. .A week later we go to the Neurosurgeon.

Comment on the article "Hydrocephalus: do not miss the time!"

I hope you understand how global the difference is - between dropsy of the brain and dropsy of the testicle? 08/20/2013 11:04:01 am, walked past. Signs of hydrocephalus in newborns, treatment of a child with hydrocephalus. With such a diagnosis, they do not live long, but ...

Discussion

Author, go to "other children". there everyone will tell and tell.
I have a son with shunted hydrocephalus, but that's another story.
Based on my experience of lying down with shunted children, I can say that people from different regions came to the RCCH for the bypass surgery. And the kids were mentally normal. And the heads are also normal, except that the forehead is a bit high.
The only thing that is the same for everyone is meteopathic, you can’t engage in certain sports that are associated with jumping and shaking the body, you can’t relax in hot countries and overheat in the sun.

Hey-Bo, ask those who live with these children.

Definitely, go to double-check the diagnosis! Hydrocephalus, hydrocephalic syndrome are very often put on the bulldozer, how many have already encountered this ... Look, repeat the NSG, evaluate the overall development. Good luck!!!

Shunted hydrocephalus. Medicine/children. Adoption. Discussion of adoption issues, forms of placing children in families, raising foster children, interaction with guardianship, teaching foster parents at school.

Discussion

My girlfriend has a nephew with a shunt to his head... He goes to kindergarten, they live in a regular group in the suburbs, but he and another boy have their own teacher.
Fly on airplanes, etc. it is impossible, i.e. lead the safest possible life. He is still small, but can I find out how many times the shunt has already been changed and how many are planned, if necessary?

My friends, I am from Tajikistan, my son had craniostenosis (hydracephelia) in three months, he had an operation, after that, rehabilitation is underway, now we are 11 months old, my son has seizures, increased hypertonicity, trauma, pressure, and development is lagging behind, he does not crawl, I don’t know what it will be in the future my first child who had this would like to know how they cope with their babies thanks in advance who has a viber please write me my viber: +992927532332 and Facebook Dilya Berdieva

with hydrocephalus in the stage of decompensation, the cerebrospinal fluid (cerebrospinal fluid) begins to compress the brain, with strong compression, the brain stem suffers Hydrocephalus: do not miss the time! Signs of hydrocephalus in newborns, treatment of a child with hydrocephalus.

Discussion

with hydrocephalus in the stage of decompensation, the cerebrospinal fluid (cerebrospinal fluid) begins to compress the brain, with strong compression, the brain stem suffers, where vital functions are located, including breathing, if the situation does not stabilize, this leads to death. time is limited for each individual, for infants who have not overgrown the fontanel, there is more time ... sometimes the situation can stop by itself and hydrocephalus becomes compensated again, but there are very few such cases, most often the only option to save a life is bypass surgery, and the earlier it is done, the more likely it is to save the child without deviations, both physical and mental ... after shunting (installation of a shunt or pump that drains excess cerebrospinal fluid into the stomach cavity), hydrocephalus again becomes compensated .. a lot depends on the type of hydrocephalus and from this the percentage of self-normalization, for example, a cyst, or something similar, when the obstruction of the outflow of cerebrospinal fluid in one place is more likely to self-compensate than with post-traumatic hydrocephalus due to IVH (intraventricular hemorrhage) or with TBI (craniocerebral trauma), when all the hairs sucking the cerebrospinal fluid died, or all thrombosed, although the degree of IVH and TBI is also different ... all of the above is not related to the hydrocephalic syndrome, which can increase or decrease due to conservative drug treatment, so you can live your whole life without shunting

We have hydrocephalus. The child is very heavy. For the last 5 months, he began to whine before going to bed at night. Hydrocephalus. Untreated is fraught with all sorts of problems that can only get out to school - headaches, bad behavior, poor sleep, and so on.

Discussion

my child has a shunt. I myself categorically insisted on a speedy operation. Watching a fontanel bulge, a child go deaf, go blind, become a complete invalid is not for me. We are now three years TTT, while there were no global problems, we go to an ordinary kindergarten

do not waste time, everywhere and everywhere for an urgent consultation (you will immediately understand where your doctor is). If there are indications for shunting, pull it to the last (about 8 years ago, shunts were immediately installed, now the situation has changed - the operation is the last point). After shunting, disability, a lot of consequences, and multiple revisions of the bypass system are possible, and these are all operations ... no matter how there is always anesthesia that kills brain cells, etc.)

Alinin's diagnosis sounded almost like the name of a monastic order - Hydrocephalus of the Brain. With such a diagnosis, they do not live long, but Alina is nothing about it Signs of hydrocephalus in newborns, treatment of a child with hydrocephalus. With such a diagnosis, they do not live long, but ...

In my opinion, you are all right (but, do not lose vigilance). Treated - compensated for 2-3 months, then you will control it, and that's it.
NMR is not a mockery, but a very accurate diagnostic method.
True, I would not go to bed, look for where it is done on an outpatient basis, for money, of course.

I would also do an ultrasound elsewhere before making a decision. Still, in my opinion, this degree of hydrocephalus cannot be asymptomatic.

In the event that too much fluid accumulates in the brain, which prevents its normal functioning, we are talking about hydrocephalus, or, as it is also called, dropsy of the brain. 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.

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

1. Outdoor- in this case, the fluid is concentrated in the subarachnoid space, not far from the cranium;
2. Ventricular- fluid accumulation is observed in, deep inside;
3. 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, cerebral hemorrhages, and 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:

1. Headache.
2. Nausea and vomiting.
3. Vision problems - double image, inability to focus on some object, fuzzy boundaries.
4. Changing the position of the eyeballs - in this case, the effect of rolling the eyes occurs.
5. Disturbances in the work of the vestibular apparatus - they consist in uncertainty, unsteadiness of gait, impaired coordination in space.
6. Memory loss.
7. Clumsiness.
8. Confusion in the mind.
9. Lack of strength.
10. Increased nervousness.
11. Urinary incontinence.
12. 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.

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, which prevents 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 40-60% 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 fundus ventriculocisternostomy 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- This 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.