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Mild external replacement hydrocephalus. Let's find out what external replacement hydrocephalus of the brain is

Most often the disease is diagnosed in infants, the pathology rarely affects the older generation. Unknown to many reliable information about how dangerous replacement external hydrocephalus of the brain is, what it is, whether it can cause hallucinations or cause a person’s death.

External replacement hydrocephalus (ERHH) is popularly called “dropsy,” because in the presence of pathology in a person, the normal movement of fluid is disrupted. The disease appears as a result of an imbalance between the production and absorption of fluid produced by the spinal cord (also called cerebrospinal fluid) by various segments of the ventricles and subarachnoid space. As a result, the brain decreases in size and cerebrospinal fluid appears in its place.

FGM can develop as an independent pathology or become a consequence of other brain diseases.

With the external type, cerebrospinal fluid accumulates in the subarachnoid and subdural segment. The first area is between the arachnoid and pia mater of the brain and spinal cord. The second is a narrow cavity between the dura mater and the arachnoid membrane. With this type of hydrocephalus, the patient does not have cysts or tumors, but despite this fact, the fluid does not circulate in the same way as in a healthy state.

Varieties

FGM can be congenital, acquired, or atrophic. The first type is detected at an early age, most often in infants. Acquired appears as a result of bruises and other injuries, some pathologies of an infectious nature. The atrophic form affects older people as a consequence of the death of brain cells.

The picture of external replacement hydrocephalus observed in younger age, differs from the disease diagnosed in older people. The reason for this phenomenon is that the brain in babies is just developing.

Doctors distinguish between types of pathology depending on their course:

  • Closed (occlusive, non-communicating) – develops due to the blockage of the CSF pathways. This provokes a disruption of the normal flow of fluid. Most often the paths are blocked blood clot(the cause of which may be hemorrhages). Factors in the development of this type of pathology can be tumors or adhesions.
  • The open (communicating, disresorbtin) form is detected against the background of malabsorption venous system brain
  • The development of hypersecretory hydrocephalus most often results from increased production cerebrospinal fluid.
  • External replacement hydrocephalus of the brain appears if the cerebrospinal fluid volume exceeds the norm and it begins to accumulate in the subarachnoid space, and the tissues of the parenchyma (brain substance) change shape.

According to condition intracranial pressure classified:

  • hypertensive form (increased levels);
  • hypotensive (low blood pressure);
  • normotensive (at normal blood pressure).

According to time indicators, the process is divided as:

  • acute form - the period when the first symptoms of the disease appeared and decompensation occurred for 3 days;
  • subacute external hydrocephalus – the described process takes 1 month;
  • chronic form - the pathology drags on for 6 months or more.

Based on its effect on brain functioning, hydrocephalus in older patients is defined as compensated and decompensated. Compensated pathology does not affect the state of health. With the decompensated type, work activity decreases nervous system, the brain loses its functionality. This type of disease is not affected by the amount of cerebrospinal fluid.

Reasons for appearance

The appearance of UFGM in some situations is caused by:

  • cerebral vascular diseases (atherosclerosis, hematoma);
  • traumatic brain injuries and various spinal injuries;
  • alcoholism;
  • diseases of the cervical vertebrae;
  • diseases of the blood system;
  • age-related changes(in adults);
  • congenital abnormalities in the central nervous system;
  • inflammation of brain tissue caused by neuroinfection;
  • helminths located in the brain;
  • arterial hypertension.

There are also unexplored reasons that trigger the development of the disease.

Symptoms

The disease has symptoms inherent in disorders of the central nervous system. The main sign of pathology is increased intracranial pressure. Light form The disease can go unnoticed, since a person has enough body resources to independently restore the circulation of spinal fluid.

With this form, the patient feels slight discomfort; with sudden movements, circles appear before the eyes. The patient's intracranial pressure changes slightly in one direction or another.

Moderate external replacement hydrocephalus causes the patient:

  • Severe pain in the head in the morning after waking up. This is due to prolonged stay in a horizontal position.
  • Nausea and vomiting.
  • Pressure changes.
  • Sleep disorders - insomnia at night and drowsiness during the day.
  • Tachycardia.
  • Fatigue, lethargy.
  • Deterioration of vision.
  • Impaired coordination in the limbs.

The middle stage of the disease is treated with medications and light exercise.

With the development of replacement hydrocephalus, the patient experiences memory loss, absent-mindedness, and it becomes difficult to perform basic operations with numbers and think logically. In an adult, motor skills are impaired and spontaneous emission of feces and urine occurs.

Children note:

  • swelling of the fontanelles;
  • poor appetite;
  • divergence of seams between parts of the skull;
  • enlargement of the frontal region;
  • significant enlargement of the head;
  • appearance venous network under thin skin heads.

If a complex type of disease is detected, the patient may be recommended surgical intervention to eliminate the causes that caused the development of hydrocephalus. Specific symptoms diseases are explained by a decrease in brain density, as it is saturated with fluid.

Diagnostics

The disease is difficult to diagnose correctly. It is not easy for experienced physicians to make a diagnosis based solely on patient interviews and visual examination. A detailed picture of a person’s condition is obtained using MRI. Magnetic resonance imaging allows you to see the ventricles of the brain even with moderate external replacement hydrocephalus. It detects changes in tissue volume.

Additionally, to establish an accurate diagnosis, the patient is prescribed:

  • angiography - x-ray blood vessels brain;
  • fundus ophthalmoscopy;
  • computed tomography;
  • X-ray of the head;
  • blood test for antibodies to pathogens of infectious diseases (the test is necessary if a person is suspected of being infected).

Based on the stage of development of the disease and its form, therapy is determined.

Treatment methods

Most often, patients are prescribed conservative therapy for external replacement hydrocephalus of the brain. The choice of drugs and treatment methods is made by the doctor after studying test data and the person’s health. Treatment is carried out with the aim of: relieving intracranial pressure, normalizing cerebral circulation, strengthening the body.

Medication and therapeutic methods

To treat the pathology, the patient is prescribed:

  • taking nootropic drugs;
  • diuretic medications, they remove excess liquid from the body;
  • massage;
  • various types of baths;
  • physical activity;
  • special diet.

Surgical

Surgical treatment of replacement hydrocephalus is rarely carried out - in extreme cases. There are 2 types of operations performed for dropsy: endoscopic surgery.

Surgeons perform bypass surgery. It allows you to remove excess liquid. Various tubes and valves are inserted into the patient, through which cerebrospinal fluid flows into the peritoneum. Endoscopic surgery is performed to provide additional pathways for the drainage of cerebrospinal fluid into the cisterns of the brain, in which it is absorbed naturally. Blood clots are removed from a person and veins are treated.

Second type surgical intervention used more often because it is less traumatic for the patient. At mild form disease, surgery can completely restore the patient’s health. In advanced situations – to alleviate the patient’s condition.

Prevention of hydrocephalus of the brain

To avoid illness you should:

  • control intracranial pressure and prevent its increase;
  • do not abuse alcohol;
  • avoid infections that can lead to brain complications;
  • treat arterial hypertension.

The diagnosis of replacement hydrocephalus is not a death sentence. On early stage The body itself successfully copes with excess cerebrospinal fluid. The person feels slightly dizzy, which goes away over time. Treatment of the disease in the middle stage is carried out successfully medicines. Pathology in complex cases is eliminated by surgical methods and complex therapy.

Increased congestion cerebrospinal fluid in the cerebrospinal fluid system. Hydrocephalus accompanies many congenital and acquired neurological diseases. Clinically, it manifests itself as signs of increased intracranial pressure ( headache, nausea, pressure on the eyes), symptoms of compression of brain structures ( vestibular ataxia, visual impairment, mental disorders, epileptic seizures) and symptoms characteristic of the disease that caused it. Diagnosis of hydrocephalus includes radiography of the skull, ophthalmological examinations, Echo-EG (in infants - neurosonography), MRI or CT scan of the brain. Surgical treatment hydrocephalus allows you to correct congenital anomalies of the cerebrospinal fluid system, remove intracranial formations that disrupt the cerebrospinal fluid circulation, and establish the outflow of cerebrospinal fluid from the cranial cavity.

General information

Hydrocephalus literally means “dropsy of the head.” In modern neurology, this is a common clinical syndrome that can be observed in many diseases, congenital anomalies or post-traumatic conditions of the brain. The occurrence of hydrocephalus is associated with certain disorders in the cerebrospinal fluid system of the brain. People of any age are susceptible to hydrocephalus. Hydrocephalus can occur in newborns, be congenital, develop in children and adults, and accompany atrophic processes occurring in the brain in the elderly. However, it is most often encountered in pediatric practice.

Reasons

3 lead to the accumulation of excess amounts of cerebrospinal fluid in the cerebrospinal fluid system of the brain pathological mechanism: production of excess cerebrospinal fluid, impaired absorption or disorder of liquor circulation. Hydrocephalus may be based on one of these mechanisms or a combination of them. Reasons causing disturbances in the functioning of the liquor system, can act during the period intrauterine development and cause congenital hydrocephalus or affect the brain after birth and cause the appearance of so-called acquired hydrocephalus. Causes of hydrocephalus include:

1. Congenital hydrocephalus:

  • malformations of the cerebrospinal fluid system (atresia of the foramina of Magendie and Luschka
  • defects in the structure of the subarachnoid space
  • stenosis of the Sylvian aqueduct, Dandy-Walker syndrome, etc.)
  • craniovertebral anomalies (Chiari malformation, congenital basilar impression)
  • intrauterine infections (toxoplasmosis, congenital syphilis, cytomegaly, rubella), birth trauma.

2. Acquired hydrocephalus:

  • inflammatory processes in the brain and its membranes (encephalitis, arachnoiditis, meningitis)
  • vascular disorders (bleeds into the ventricles, hemorrhagic stroke or intracerebral hematomas with bleeding into the ventricles).
  • sprouting of the ventricles and compression of the cerebrospinal fluid ducts against the background of a colloid cyst of the third ventricle and intracerebral tumors(astrocytomas, germinomas, ganglioneuromas, etc.). This disrupts the normal circulation of cerebrospinal fluid and its outflow from the cranial cavity.

Separately, there is an atrophic (replacement) form of hydrocephalus, which occurs as a result of post-traumatic death or age-related atrophy of brain tissue. In this case, cerebrospinal fluid fills the space that is formed inside the skull as a result of a decrease in the volume of the brain. Atrophic hydrocephalus in old age can develop against the background of impaired blood supply to the brain due to atherosclerosis cerebral vessels, hypertension, diabetic macroangiopathy.

Pathogenesis

Normally, cerebrospinal fluid (CSF) is produced choroid plexuses interconnected ventricles of the brain. The largest amount of it is formed in the lateral ventricles, from where the cerebrospinal fluid enters the third ventricle, and from it through the Sylvian aqueduct into the fourth ventricle. Then the cerebrospinal fluid enters the subarachnoid (subarachnoid) space, which extends over the entire surface of the brain, and in the caudal direction passes the region of the craniovertebral junction and further surrounds spinal cord along its entire length. The cerebrospinal fluid located in the subarachnoid space is constantly absorbed by the arachnoid (arachnoid) membrane of the spinal cord and brain and enters the blood. The above etiological factors, disrupting the production, movement and absorption of cerebrospinal fluid, lead to its excessive accumulation and the occurrence of hydrocephalus.

Classification

According to the etiological principle, congenital and acquired hydrocephalus are distinguished. According to the mechanism of occurrence, hydrocephalus is classified into open and closed forms.

  • Open hydrocephalus associated with overproduction of cerebrospinal fluid or a violation of its absorption during normal cerebrospinal fluid circulation.
  • Closed hydrocephalus caused by a violation of the outflow of cerebrospinal fluid due to compression, partial or complete obstruction of any part of the cerebrospinal fluid system of the brain.

Depending on where the excess accumulation of cerebrospinal fluid occurs, internal and external hydrocephalus are distinguished. Internal hydrocephalus is accompanied by the accumulation of cerebrospinal fluid in the ventricles of the brain. External hydrocephalus is characterized by excess cerebrospinal fluid in the subarachnoid and subdural space.

According to the characteristics of its course, hydrocephalus is classified as acute, subacute and chronic. Acute hydrocephalus is characterized by rapid development, in which decompensation occurs a few days after the onset of the first signs of the disease. Subacute hydrocephalus develops within a month, and chronic hydrocephalus develops over six months.

Big clinical significance hydrocephalus is divided into stabilized (compensated) and progressive (increasing).

  • Stabilized hydrocephalus does not increase and usually proceeds with normal pressure cerebrospinal fluid.
  • Progressive hydrocephalus characterized by aggravation of symptoms, is accompanied by an increase in cerebrospinal fluid pressure, does not respond well to conservative therapy and leads to atrophy of brain tissue.

Symptoms of hydrocephalus

Hydrocephalus in adults

The accumulation of an excess amount of cerebrospinal fluid in a limited space of the cranium leads to an increase in intracranial pressure, which causes the most typical symptoms hydrocephalus. In adults and older children, these include: intense headache that cannot be relieved by analgesics, nausea, vomiting, and a feeling of pressure on the eyeballs. Symptoms mentioned may occur acutely or increase gradually, having a transient nature at the onset of the disease. Atrophic hydrocephalus often occurs without signs of increased intracranial pressure and is detected only with additional examination of the patient.

In most cases, hydrocephalus is accompanied by neurological symptoms, which are caused both by compression of brain structures by expanded cerebrospinal fluid spaces and by the underlying disease that causes the development of hydrocephalus. The most common signs of hydrocephalus are vestibular and visual disturbances. The first includes vestibular ataxia, manifested by dizziness, unsteady gait, noise in the ears and head, and nystagmus. On the visual side, there may be a significant decrease in visual acuity, loss of certain areas of the visual fields, congestive optic discs; with prolonged hydrocephalus, optic nerve atrophy may develop.

Hydrocephalus can occur with disturbances in the motor and sensory sphere: paresis and paralysis, increased tendon reflexes and muscle tone, decreased or complete loss of all types of sensitivity, and the formation of spastic contractures of the limbs. Occlusive hydrocephalus, caused by impaired circulation of cerebrospinal fluid in the posterior region cranial fossa, is characterized by symptoms of cerebellar ataxia: impaired coordination and gait, large-scale disproportionate movements, changes in handwriting, etc.

In some cases, hydrocephalus is accompanied mental disorders, which in adults are more often manifested by disorders of the emotional-volitional sphere: emotional instability, neurasthenia, causeless euphoria with a rapid transition to a state of indifference and apathy. With a sharp increase in intracranial pressure, it is possible aggressive behavior.

Hydrocephalus in children

In children, due to the great flexibility of the skull bones, there is no increase in intracranial pressure; hydrocephalus in them is accompanied by an increase in the size of the skull. In newborns and children early age hydrocephalus is characterized by too large size head, bulging veins of the scalp, tension and lack of pulsation of the large fontanel, swelling of the optic discs.

Often there is a symptom of “setting sun” - limitation of movements eyeballs up. There may be dehiscence of the sutures of the skull. Tapping on the skull is accompanied by a characteristic sound (the “cracked pot” symptom). In children in the first year of life, hydrocephalus leads to developmental delays. They later begin to hold their head up, roll over, sit up and walk.

Children who have severe hydrocephalus are distinguished by a spherical shape of the head, its too large size, deep-set eyes, protruding ears, and thinning of the scalp. There may be decreased vision, increased muscle tone in lower limbs, violations by cranial nerves. Unlike adults, in childhood hydrocephalus is often accompanied not by emotional-volitional disorders, but by intellectual deficiency.

Children with hydrocephalus are usually sedentary and obese. They are apathetic, lack initiative, and do not have the attachment to relatives characteristic of their peers. A decrease in the degree of hydrocephalus often leads to an increase intellectual abilities and child activity.

IN adolescence hydrocephalus often occurs acutely against the background of an infectious disease, mental or physical trauma. At the same time, it is accompanied by intense headache, repeated vomiting, and bradycardia. There may be attacks of loss of consciousness, sometimes convulsive seizures. IN in some cases episodic psychoses with hallucinatory or delusional syndrome.

Diagnostics

The clinical symptoms of hydrocephalus are usually so characteristic that they allow the neurologist to suspect its presence during the first examination of the patient. To determine the degree and form of hydrocephalus, as well as to identify the underlying disease, additional examinations are carried out:

  • X-ray. X-rays of the skull reveal thinning of the skull bones and divergence of the sutures between them; on inner surface of the cranial vault, a symptom of “finger impressions” is observed. Hydrocephalus, caused by stenosis of the cerebral aqueduct, is accompanied by a decrease in the volume of the posterior cranial fossa on radiographs of the skull. Hydrocephalus with Dandy-Walker syndrome, on the contrary, is characterized by an increase in the volume of the posterior cranial fossa on craniograms. Hydrocephalus when one of the interventricular communications is closed is manifested by the asymmetry of the skull visible on the craniogram.
  • Computed tomography or MRI. Tomographic diagnostic methods make it possible to determine the nature of hydrocephalus, identify the location of cerebrospinal fluid tract occlusion or existing congenital anomaly, diagnose the causative disease (tumor, cyst, hematoma, etc.). For hydrocephalus, the most informative use is

Diseases of the central nervous system in modern society become a real problem for patients suffering from these diseases and for doctors who have to prescribe treatment. Very often inflammatory diseases The central nervous system, its injuries and developmental defects, pathological changes, affecting the vessels of the arterial and venous beds, are accompanied by the occurrence of external replacement hydrocephalus of the brain.

The essence of this syndrome is that that in the central structures of the nervous system the delicate balance between the production of cerebrospinal fluid and its reabsorption is disturbed. The volume of cerebrospinal fluid is constantly increasing, which leads to the fact that it accumulates in the cranial cavity - in the spaces located between the membranes of the brain and its substance.

Excess fluid forms in spaces that are located outside the structures included in the brain - which is why this condition occurs best forecast than pathological processes affecting the ventricles of the brain. This pathology almost never poses a visible threat to the patient’s life and, if detected in a timely manner, is more easily amenable to drug correction.

Much less often, the cause of the development of external replacement hydrocephalus is inflammatory processes, which result in disruption of the normal circulation of cerebrospinal fluid in the spaces located around the brain - its production does not increase, but local stagnation is formed (most often due to previous serous or purulent meningitis)

It is important to understand that the space enclosed in the cranial cavity has a finite volume - an increase in the amount of cerebrospinal fluid inevitably leads to external compression of the brain. As a result, the number of cells of the nervous tissue (various structures of the central nervous system) progressively decreases, which becomes the cause of the appearance characteristic symptoms this condition, which force the patient to seek qualified medical care.

Often occurs with mental disorders.

Causes of external hydrocephalus

Experts believe that the main mechanism explaining the development of external replacement hydrocephalus is an imbalance between the formation of cerebrospinal fluid (its production can increase against the background of vascular and metabolic diseases of the brain and their complications) and absorption, which is disrupted as a result of inflammatory processes affecting the substance of the brain and its shells.

The most common causes of external replacement hydrocephalus in patients of different ages become:

  • in children in the neonatal period and early age - intrauterine hypoxia and infection of the nervous system suffered before birth or in the first months of life;
  • in preschool and school age, adolescents and adults – infections of the nervous system, exogenous and endogenous intoxications, violations metabolic processes in the body, brain injuries (including long-term ones);
  • in elderly patients - age-related changes in blood vessels and diffuse metabolic disorders in the body (common forms of atherosclerosis).

It must be remembered that effective treatment of this condition, necessary to restore normal well-being, is possible only after establishing the real reason diseases and purposes etiotropic treatment(therapy that affects the cause). Otherwise the assignment symptomatic treatment will improve the patient's condition only for a very short period of time, and the symptoms of external replacement hydrocephalus will appear again and again.

Despite the fact that the course of this form of hydrocephalus is benign and the clear clinical picture of the disease develops late stages, the prognosis remains unfavorable - the volume of cerebrospinal fluid inside the cranial cavity cannot exceed a certain limit value, upon reaching which compression of the brain itself begins. However, with this variant of the disease there is never a significant increase blood pressure(if there are no concomitant pathologies that may be complicated by hypertension).

Diagnosis of replacement intracranial external hypertension

The examination program for a patient with this disease must include:

  • magnetic resonance imaging;
  • computed tomography;
  • angiography of cerebral vessels, vertebral and carotid arteries;
  • radiography of the skull in two projections;
  • neurosonography of the brain - this research method can be used in children until the fontanelles of the skull close);
  • serological blood tests to identify the true cause of the disease (causative agent of infection that can affect the brain) - toxoplasmosis, herpes virus, and cytomegalovirus.

The examination must be repeated once every 6 months, even if the patient’s condition remains stable and he does not make any complaints - if symptoms of hydrocephalus progression appear, an extraordinary examination is necessary.

Treatment of replacement intracranial external hypertension

The treatment program for this condition should focus on:

  • eliminating the cause of the disease (if possible)
  • relief of hypertension symptoms conservative methods– diuretics are prescribed that can affect the production of cerebrospinal fluid (diacarb), vascular and trophic drugs;
  • relief of hypertension symptoms operational methods– performing a spinal puncture, shunting the meningeal spaces of the brain using traditional and endoscopic neurosurgical interventions.

The appearance of the first signs of deterioration (headache, sleep disturbances, behavioral changes) should alert the patient and force him to seek medical help - it must be remembered that brain neurons are very sensitive to external influences and have very little ability to recover.

Hydrocephalus of the brain is a serious disease of the nervous system that leads to neurological defects and can be life-threatening for the patient. This condition can be congenital or develops in adulthood. Surgery is considered the most effective treatment.

There are several types of dropsy of the brain, each of which has its own causes, characteristics of manifestation and degree of risk to the patient’s life. General mechanism the development of pathology is associated with a violation of the outflow of cerebrospinal fluid from the ventricles of the brain. In children this forms a characteristic appearance, in adults leads to increased intracranial pressure (ICP).

Causes of congenital hydrocephalus:

  • pathologies of head development;
  • trauma during childbirth;
  • hereditary diseases;
  • intrauterine infection;
  • side effects of medications the mother took;
  • unhealthy lifestyle of parents (alcohol, smoking, drugs).

Congenital dropsy has a more pronounced effect on the development of the nervous system and is almost always accompanied by atrophic processes in the brain. Causes of acquired hydrocephalus:

  • previous meningitis, encephalitis;
  • consequences of strokes;
  • brain tumors;
  • head injuries;
  • complications of chronic diseases ( diabetes mellitus, tuberculosis, vascular pathologies).

Damage to the skull is especially dangerous because its consequences may not raise doubts for a long time either among the victim or his relatives. After a blow or fall, it may take a long time before a person notices that it becomes difficult for him to concentrate and that his head hurts too often.

Depending on the causes, symptoms, and severity of the condition, there are several classifications of the disease. By origin, congenital and acquired hydrocephalus are distinguished. According to the characteristics of its course, it happens:

  • closed(occlusive) – there is an obstacle to the exit of cerebrospinal fluid;
  • open(non-occlusive) – normal communication between the ventricles of the brain and the bloodstream;
  • hypersecretory– occurs due to excess production of cerebrospinal fluid.

It is also common to divide hydrocephalus into internal (fluid accumulates in the ventricles) and external (in the subarachnoid space). By clinical signs Acute (up to 3 days), subacute (up to a month) and chronic (more than 30 days) forms can be distinguished. According to the dynamics of pathology development:

  • progressive- most dangerous look, characterized by a gradual increase in symptoms;
  • regressive – light type, recovery is possible;
  • stable– no significant changes in condition occur.

If the ventricles are affected, then a monoventricular form is isolated, when only one of them is involved in the pathological process. More rare variants of the course are biventricular and triventricular dropsy. In this case, several ventricles are affected, and the outflow of fluid from them is impossible. Such pathologies are more severe and dangerous, and are less treatable.

Symptoms of the disease

The clinic can be roughly divided into deterioration general condition, cerebral symptoms and focal phenomena. In any case, the main damaging factors– this is an accumulation of fluid and an increase in intracranial pressure, hypotrophic and atrophic changes in the adjacent nervous tissue.

Deterioration of the general condition is a rather uncharacteristic and unexpressed symptomatology, which does not allow making an unambiguous diagnosis. It is manifested by moderate headaches, nausea, and, less commonly, discomfort in the eyes, which is paroxysmal in nature. These signs are most pronounced with internal hydrocephalus, and with external hydrocephalus they are insignificant.

General cerebral symptoms are associated with malnutrition of the brain; in the initial stages they are accompanied by common features, are not of great value for diagnosis. Such manifestations include convulsive syndrome, photophobia, tinnitus, memory, attention, and motor coordination disorders.

Of higher value for diagnosis are focal phenomena that are associated with the expansion of the cerebral ventricles. They quite accurately indicate the affected area. Most often they manifest themselves in the form of impaired sensitivity of the limbs, paralysis, partial seizures(when one area is affected, for example, an arm or leg), can be either asymmetrical or symmetrical.

In children of the first year of life, hydrocephalic syndrome is formed - an increase in the volume of the head, a lag in physical and intellectual development, up to severe mental retardation. At mild degree the disease, partial restoration of functions is possible, and with timely surgical intervention, hydrocephalus becomes curable. If the genesis of the disease is caused intrauterine causes, the death of a small hydrocephalus is possible during childbirth or during the first year of life.

Characteristic signs of pathology in children are disproportionate big head, retraction of the eyeballs. The fontanel does not pulsate and protrudes above the surface of the skull (hernia of the fontanel). The baby constantly cries or, on the contrary, is lethargic and does not show emotions.

It is worth mentioning separately about one more form of the disease – vicarious. Another name for it is replacement. It develops mainly in older people. The essence of the disease is that the primary processes are atrophic processes in the nervous tissue, which increases the volume of the formation in which the cerebrospinal fluid collects. ICP does not increase, so this type of disease is called normotensive. It is practically incurable in itself, since it is a consequence, not a cause.

Diagnostics

The presence of hydrocephalus in adults is determined by a neurologist or neurosurgeon, in children - pediatric neurologist, and when obvious signs changes in the shape of the skull - pediatrician. The doctor begins the diagnosis with an examination, which reveals certain disorders, pathologies of perception (vision, hearing), swelling of the veins on the head, and in young children - an increase in the size of the skull, sunken eyeballs. If acquired hydrocephalus is suspected in adults, medical history becomes important: injuries, inflammatory diseases, etc.

But the first place in diagnosing dropsy belongs to instrumental methods. The most informative is MSCT (multispiral computed tomography). It allows you to see dilated ventricles or subarachnoid cisterns, as well as tumors, if they are the cause of the disease. The same method allows you to distinguish between closed and open form pathology.

Echoencephalography (ultrasound of the brain) clarifies the condition of blood vessels, possible risk complications on their part. The method is very important if the doctor assumes that the cause of dropsy is a hemorrhagic stroke. In newborns, a similar examination is used - ultrasonography, which can detect hydrocephalus caused by genetic reasons or trauma during childbirth.

To determine the consequences of the disease, ophthalmoscopy is used (increased ICP can cause glaucoma), lumbar puncture (shows the composition and pressure of the cerebrospinal fluid), determination neurological status the patient and identifying mental disorders, if any.

Differential diagnosis in adults is carried out with other pathologies of the nervous system that cause degenerative processes in the brain - dementia, Alzheimer's disease, tumors that do not interfere with the outflow of cerebrospinal fluid.

Early detection method congenital disorders– intrauterine determination of the size and shape of the transparent septum of the brain. This structure consists of two plates of brain tissue and a small cavity between them. Normally it contains liquor. Thickening and formation of a cyst of the septum pellucidum is a fairly common occurrence that easily resolves after birth. Much more danger sign– partial or complete absence of structure, which leads to significant pathologies of the brain.

Surgical treatment

The operation is the most effective way get rid of dropsy. Several types of intervention are used for treatment:

  • removal of the cause of the disease in a closed form(thrombus, tumor, septum);
  • shunting with communicating(open) or hypersecretory form, if it is impossible to eliminate the cause of the pathology;
  • combined operations for mixed type.

In most cases, the doctor decides to bypass the affected ventricle of the brain. The essence of the operation is that the patient is implanted with a tube (shunt), which drains excess fluid from the source of the disease. The free end of the implant is directed into abdominal cavity, less often - into the atrium. Artificial communication allows you to get rid of unnecessary cerebrospinal fluid and remove it to a place where absorption into the blood is not impaired. The result is the restoration of normal liquor circulation and the cessation of its accumulation in the cranial cavity. If the operation is performed on a child, the shunt is installed “for growth” and is replaced every few years. To prevent reverse flow of liquid due to the pressure difference, it is equipped with a valve, the design of which allows the movement of the cerebrospinal fluid only in the desired direction.

If the disease can be cured, the causative factors are eliminated: blood clots and blood clots, tumors, adhesions. Such operations can prolong the patient's life. If the measures taken are not enough and the fluid continues to accumulate, an additional shunt may be performed.

There are a number of contraindications to the operation:

  • active inflammatory process in nerve tissue– encephalitis, meningitis, ventriculitis;
  • stable or regressing form of dropsy;
  • irreversible consequences of the disease– blindness, neurological disorders, atrophy of the cerebral hemispheres;
  • exhaustion, severe pathologies of the heart, blood vessels, respiratory system.

Widely used to reduce risk endoscopic operations: installation and revision of a shunt, removal of hematomas and small tumors, destruction of adhesions and septa. This is relevant for monoventricular pathology; in more severe cases, techniques with craniotomy are used.

Rehabilitation and drug treatment

Medicines are prescribed for stable or regressing forms of the disease, for contraindications to surgery, or in recovery period after her. The choice of drugs depends on the patient’s condition and the severity of the disease.

To improve the outflow of fluid, Mannitol or Diacarb is used, they remove it into the bloodstream. In addition to medications, diuretics of the thiazide group are taken, for example, Furosemide. It prevents the increase in blood pressure while taking potassium-sparing diuretics.

To improve the nutrition of nervous tissue and its blood supply, Detralex, Glycine and Piracetam are prescribed. Anticonvulsants, anti-inflammatory and sedative medications can be used as symptomatic drugs. On early stages treatment at home is possible, but if the disease progresses, it is necessary to go to the hospital. The doctor will decide whether a course of medications is enough or surgical intervention is necessary.

Rehabilitation measures help the patient live with the consequences of the disease or shunt after surgery. He needs to limit physical activity, follow a diet with strict control liquids and salts. You should also be regularly examined by a neurologist and attend treatment procedures.

Modern medicine does not deny the use of some unconventional methods treatment. The most effective among them is hirudotherapy: leeches reduce blood and intracranial pressure. The use of various herbs to improve well-being is permissible only with the consent of the attending physician. The effectiveness of homeopathy and similar remedies has not been proven in clinical trials.

Complications and prognosis

Why is hydrocephalus dangerous? The prognosis of the disease should be considered separately for children and adults. Congenital forms caused by pathology of intrauterine development are considered the most severe. Most often, young patients are born with irreversible damage to the nervous tissue, which leads to death or severe mental impairment.

Children who were injured during childbirth or in the first year of life have a much better chance of correcting the situation if treatment is started on time. If not, there is a high risk of disability. In the presence of a shunt, the baby develops normally, due to the plasticity of the nervous system, brain functions are quickly restored, but regular examinations and replacement of the implant are required as the child grows.

In adults, the prognosis depends on the form of the disease. Acute hydrocephalus can go away without consequences if it is treated promptly. The chronic form is amenable to medication or surgical removal, requires long-term rehabilitation. The most difficult thing is with the replacement type, when hydrocephalus is only a consequence of the underlying disease, so it is useless to fight it.

The most dangerous complications of dropsy of the brain:

  • oligophrenia in children;
  • paralysis, paresis of limbs;
  • epileptic seizures;
  • mental disorders;
  • glaucoma and blindness.

The prognosis for work ability depends on the result medical manipulations. At successful treatment it is possible for adult patients to return to labor activity, and children - to study and play. The only limitation is physical activity: Patients should exercise with caution and stop exercising if discomfort occurs.

Untimely or ineffective treatment leads to loss of ability to work. Price rehabilitation activities at the same time quite high, despite benefits provided. In the most severe cases it is possible death. Young men of military age who have a shunt installed are not considered fit for military service.

Conclusion

Dropsy of the brain is a serious disease that requires early surgical intervention. The operation is the most reliable way to recover and avoid complications, medications, and especially folk remedies, can only be used as additional and supportive measures.

The cost of rehabilitation measures, medications and surgery may be high, but it is fully justified, allowing the patient to maintain a quality of life close to the previous one. During measures taken can save his health.

Dropsy can affect both infants and older people.

The main manifestations of dropsy:

  • headaches,
  • convulsions,
  • irritability and nervousness,
  • vomit,
  • paralysis.

In newborns, the main symptom of the disease is rapid growth cranium. But in general, the symptoms of the disease depend on its form and type.

The most common form of dropsy is external replacement hydrocephalus of the brain. IN in this case, for a number of reasons, there is a decrease in the volume of the brain, the place of which is filled with cerebrospinal fluid.

The causes of the disease can be: hypertension, atherosclerosis, concussion, dysfunction of the cervical vertebrae.

The main signs of external replacement hydrocephalus are numbness of various parts of the body (most often the limbs), lack of air, pallor, darkening of the eyes and loss of coordination. But a sick person may not notice its manifestations due to compensation of brain volume with cerebrospinal fluid.

Diagnosis and treatment of replacement hydrocephalus of the brain

External replacement hydrocephalus is diagnosed using the method computed tomography(CT) and magnetic resonance imaging (MRI), as well as taking lumbar puncture and fundus examination. If, as a result of the examination, the patient receives an MRI conclusion showing external replacement hydrocephalus, then he is prescribed treatment. In addition, studies such as ultrasound, radiography, angiography, laboratory diagnostics for the presence of rubella viruses, herpes, syphilis, toxoplasmosis and cytomegalovirus.

External replacement hydrocephalus of the brain can have either a progressive or permanent course. With a constant course, the decrease in brain volume does not progress and, accordingly, there is no increase in the volume of cerebrospinal fluid. And if the patient’s condition is satisfactory, then treatment is usually not prescribed, limited to regular examination and observation by specialists.

The progressive nature of the disease can lead to dementia, gait disturbances, severe headaches, urinary incontinence and even death. Therefore it is required immediate treatment.

A satisfactory result of treatment of replacement hydrocephalus of the brain is a decrease and stabilization of intracranial pressure.

If the nature of the disease is constant, then outpatient treatment. Typically, the complex of prescriptions includes: restorative therapy, salt-pine baths, diuretic, anti-inflammatory and desensitizing therapy.

On long period Diacarb (diuretic) and drugs containing potassium (to maintain electrolyte balance). If the swelling cannot be removed, then a puncture of the cerebrospinal fluid is performed.

With the progressive nature of the course of external replacement hydrocephalus of the brain, surgical methods of treatment are resorted to.

Surgical methods of treatment

The most common method of surgical intervention since the fifties of the twentieth century has been bypass surgery, restoring the circulation of cerebrospinal fluid. This is very effective operation, but has many complications. After surgery, the patient often has to undergo surgical interventions throughout his life due to shunt revision.

Nowadays, the priority method in neurosurgery is endoscopic treatment hydrocephalus. Endoscopy has several advantages over bypass surgery. This:

  • restoration of physiological circulation of cerebrospinal fluid,
  • implantation of a shunt system is not used, which reduces the risk of complications,
  • less surgery and injuries,
  • more economical,
  • V postoperative period The patient's quality of life is better.

    • The surgical method of treating external replacement hydrocephalus is the only method of combating this disease. Drug treatment can only stop the development of the disease.

    With timely treatment of external hydrocephalus of a replacement nature in a young child, in most cases stabilization occurs pathological processes which contributes to it normal development. A timely treatment older children and adults leads to their complete recovery.