Congenital expansion of the subarachnoid space of the large occipital cistern. When is subarachnoid space enlargement diagnosed?

The cavity between the membranes of the spinal cord - soft and arachnoid - filled with cerebrospinal fluid, is called the subarachnoid space. Ligaments pass through this space, fixing the position of the spinal cord.

CSF pathways consist of the subarachnoid spaces of the spinal cord and brain and the ventricular system. The ventricles of the brain, whose function is the production of cerebrospinal fluid, are lined with epithelium of a different nature - cubic and cylindrical. In the normal state, they contain less CSF than the subarachnoid spaces. The walls of the ventricles are quite strong and unyielding, and the subarachnoid spaces change their volume under the influence of various factors.

Liquor plays the role of a shock absorber - it protects the brain from traumatic effects, performs a transport role and immunological functions.

The subarachnoid space of the brain and spinal cord communicate directly with the ventricles of the brain, forming a series of communicating vessels. The outer part of the arachnoid spaces is divided by membranes. Such a structure forms separate chambers and tanks.

Liquor pressure briefly increases with changes in functional states - hard physical work, stress, even with emotional disorders. With injuries, inflammatory processes of the central nervous system and oncological diseases, its increase increases, which leads to the expansion of the subarachnoid space.

Expansion of the subarachnoid space in infants

Subarachnoid convexital spaces expand in infants with the growth of the head - its increase in circumference. Parents can notice the pathological process of protrusion of the fontanelles - the places of the skull where the bones of the skull converged, so that the child could freely pass through the birth canal.

Also, in infants, the expansion of the interhemispheric fissure and subarachnoid space is accompanied by a rapid increase in the skull, which leads to the fact that the child cannot raise his head. In this case, the diagnosis is perinatal encephalopathy. In addition to a general disturbance of the state, a decrease in reflex function, children become capricious, refuse to eat, lag behind their peers physiologically, and lose weight.

There is another very revealing symptom - "moon gaze". The eyelids of sick babies are constantly lowered down and part of the protein is visible from under the skin - the pupil and iris roll under the eyelids. With minor brain damage, such a look appears periodically, with severe ones, the iris can be seen for a short time.

In children, brain atrophy can also occur, in which there is an expansion of the convexital subarachnoid spaces. Furrows increase in the frontal, parietal, temporal and occipital regions.

The ventricular system is also pathologically deformed due to expansion. In this case, serious examinations are carried out only in the second year of life - earlier diagnostic measures are considered dangerous for the life of the baby.

It may be necessary not only to compute and tomographic studies, but also to extract cerebrospinal fluid by puncture.

At an early age, neurosonography is performed for children - the state of the cranial cavity can be examined in this way only until the fusion of the fontanelles.

If a significant area has been damaged or leukomalacia is diagnosed - this term is called softening of the brain, a state when functional abilities are impaired, impulse signals are not sent or received in the required volume - in the future the child will lag behind in development.

But you shouldn't panic. The child's body has a great chance of recovery, with timely and adequate treatment - when the first symptoms appear - the chances of recovery increase.

What does a moderate expansion of the subarachnoid space in adults indicate?

Unreasonably, the expansion of subarachnoid convexital spaces - uneven or uniform - cannot occur. Violation of the circulation of cerebrospinal fluid is always caused by pathological processes of an inflammatory or traumatic nature, which negatively affect the general condition, cause the ventricles of the brain to spasm, and lead to an expansion of the interhemispheric gap.

Factors causing a similar change:

congenital pathologies of the cerebrospinal fluid system;
craniocerebral injuries of varying severity;
infectious diseases - encephalitis and meningitis of various etiologies;
oncological processes of the brain - arachnoendotheliomas, meningiomas and the like.

In these diseases, the volume of the brain increases due to edema, but the functional cells of the gray and white medulla atrophy due to increased intracranial pressure.

The amount of cerebrospinal fluid increases, the pattern of the convolutions of the cerebral cortex is smoothed out, the subarachnoid space first expands slightly, and then pathological changes increase.

If you neglect the treatment - leave the victim in a helpless state - then the physiological vital activity will not recover on its own, a fatal outcome is possible. But even with adequate treatment, some brain functions will be lost to a significant extent.

The expansion of convexital spaces is progressing.

There are 3 degrees of severity of such changes:

light, insignificant - up to 2 mm;
medium - from 2 to 4 mm;
heavy - more than 4 mm.

Symptoms of intracranial disorders: changes in mental activity, sensory and motor disorders, pseudobulbar syndrome.

Pseudobulbar syndrome is a condition during which speech is simultaneously disturbed - the functions of reproducing sounds are lost, words can only be pronounced in a whisper, swallowing is difficult. This is due to the fact that an uneven change in the position of the hemispheres and their compression leads to a disruption in the activity of the cortical centers that innervate the muscles of the pharynx and larynx, which leads to paralysis or paresis of the muscles of the larynx.

Surgical treatment does not always help the victims - it is almost impossible to achieve complete work and life adaptation. However, with timely treatment, it turns out that with timely treatment, a person can return the ability in daily affairs - when caring for oneself - to do without outside help. In some cases, mental abilities and intellectual qualities are preserved.

CSF pressure increases with any expansion of the subarachnoid space.

The diagnosis is easy to make on the basis of characteristic symptoms and the results of an instrumental examination.

In children, the state of the brain is assessed immediately after birth, adults after an injury or illness are examined if they notice threatening symptoms or uncharacteristic actions.

In most cases, close relatives have to seek medical help - the patient himself, with a significant increase in intracranial pressure, loses the ability to adequately perceive his own condition.

The subarachnoid space is a cavity between the arachnoid and pia maters, 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.

In people with enlarged subarachnoid spaces, there may be disorders with 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 impaired cerebral circulation and cerebrospinal fluid 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 the distance between the soft and arachnoid membranes of the head and. The second seems to “close” its surface. From above, it is protected by an additional layer of the endometrium, through which it communicates with other tissues using the subarachnoid membranes. They are shaped like vessels and consist of several reservoirs where cerebrospinal fluid circulates.

In the subarachnoid space, the fluid is called cerebrospinal fluid, it is responsible for the following functions:

Nutrition and brain protection.
A medium for the exchange of useful substances that come from the blood and must enter the body.
The connection channel between nutrients and nerve cells.
Promotes the contractile activity of the heart, the functioning of the respiratory system, etc. Allows the human body to maintain the selected position.

Norm and extension

What is the expansion of subarachnoid convexital spaces? This means that the norm is determined only when the amount of liquid is about 140 ml. If there is an expansion of the interhemispheric fissure, a pathological condition occurs. The disease does not manifest itself in adults, it is inherent in newly born children and older babies.

The expansion of the subarachnoid space in infants can be diagnosed due to injury during childbirth or the formation of abnormalities associated with the development of the brain. this factor in the development of pathology is quite common.

In order to understand what character such an increase has - moderate or significant, babies are prescribed an ultrasound examination. This helps to find abnormalities and determine the state of the subarachnoid convexital spaces.

The expansion comes in several degrees of severity:

light;
average;
heavy.

At the first degree, the expansion is small: a maximum of 1-2 mm (the norm is 0). With an average, the gap can reach 4 mm, and with a heavy one, it can go beyond this mark.

If an enlarged subarachnoid space is suspected in an infant, it is necessary to consult a neurosurgeon and a neuropathologist. Usually, hydrocephalus is diagnosed in babies under one year old. In this case, there is an increase in the interhemispheric fissure, which can be seen in the frontal lobes.

The ventricles of the brain at the same time have a moderate or slight character of expansion. Quite often they are fully consistent with the established norm. The cerebrospinal fluid inside the space is solid, which is evident from the results obtained with the help of diagnostic measures.

Hydrocephalus can be benign or malignant. In the first case, it passes by the second year of a child's life. The uneven expansion of the space indicates that the cerebrospinal fluid was not distributed correctly in the cavities. Therefore, there is an increase in the gap between the ventricles, the pressure inside the skull increases.

If the subarachnoid space is expanded unevenly due to inflammation or tumors, then the cause of the disease is determined more quickly. They provoke pathological processes or infections, which are accompanied by inflammation and increased fluid production inside the cavity.

Reasons for expansion

The detection of this pathology is focused on establishing the causes that cause deviations from the norm in the amount of fluid. The main ones include:

The presence of infectious diseases affecting the central nervous system.
The formation of a small tumor in the cerebrospinal fluid or in the cavity.
Getting injured. or hematomas.
Inflammation of the sinuses.
The manifestation of intoxication, which are chronic. Such substances that can cause such poisoning include: arsenic, alcohol, lead, derivatives of reactive inflammation accompanying.

The disease is characterized by signs or development of hydrocephalus. Sometimes pathologies such as subarachnoid arachnoiditis, leptomeningitis are diagnosed, in which the soft and arachnoid membranes of the brain become inflamed, the cavities are unevenly expanded.

Signs and diagnosis of pathology

If the baby has signs of the disease, then self-medication is not worth it. Symptoms for each child have an individual character, but only a specialist is able to draw up a general picture of the development of space expansion.

It was found that the most common manifestations of the disease are such signs as:

development of irritability to light and auditory factors;
persistent headache;
dizziness, nausea and vomiting;
memory impairment (in adults);
increased drowsiness and fatigue;
large skull (in babies).

At the beginning of development, the disease may not manifest itself at all, therefore it is usually found already in the second or later stages. Symptoms occur in direct proportion to the type and type of skull deformation.

You can determine the severity of the pathology using traditional methods of examining the skull:

magnetic resonance imaging;
computed tomography;
neurosonography;
to exclude the formation of tumors;
ultrasound examination of the brain.

The results show what a tumor can be in space, make it possible to see the layers of the brain structure, to trace the growth dynamics of formations. Based on this, a decision is made regarding the use of a particular therapeutic technique.

The treatment is carried out by a neurologist, who may invite a neurosurgeon or other brain specialist for consultation. Therapy is aimed at, first of all, removing the cause of inflammation. As a result, the subarachnoid space should return to the parameters that the norm provides.

First, the doctor prescribes medications that should fight infectious pathologies (sinusitis, otitis media, etc.) that can lead to infection of the cavity in the brain. If there is increased pressure inside the skull, then special medicines are prescribed to reduce it and normalize the condition.

The therapy is complex, it includes useful substances (vitamin B occupies the main place) and various antibacterial drugs. All drugs are selected based on the individual characteristics of the patient.

Babies under 3 years old are usually prescribed the following drugs:

Asparkam or Diarcarb to remove excess fluid in the skull;
Pantogam or its analogues to improve the trophism of the brain and cerebrospinal fluid.

For older children or adults, many more medications are included in the treatment. These can be drugs that can relieve pain or spasms, as well as various types of barbiturates, saluretics, glucocorticosteroids, vasoactive substances and solutions containing plasma substitutes.

Drug treatment is carried out simultaneously with a visit to the physiotherapy room. A set of special exercises is aimed at relieving symptoms, ensuring active metabolism in the body, and normalizing the nutrition of brain tissues. Usually, such methods - medicines plus physiotherapy exercises - are enough to successfully fight the disease and make positive predictions. In some cases, when medications are ineffective, surgery may be performed.

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 be only 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.

Video: Space 1 Season 9 episode

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.

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