home Audience 3 Hydrocephalus intrauterine causes. By time of occurrence. Causes of dropsy in children

Hydrocephalus intrauterine causes. By time of occurrence. Causes of dropsy in children

The disease known as cerebral hydrocephalus in children is one of the most dangerous and rapidly progressing, so knowledge about it can save the life of a child.

The name of the disease includes two words: “hydro” (water) and “cephalon” (head), and is often colloquially referred to as “dropsy of the brain.”

It is known that in the brain of Homosapiens there are several so-called ventricles, connected in series and filled with cerebrospinal fluid.

Liquor is a specific cerebrospinal fluid that has a significant visual resemblance to water (which is reflected in the colloquial name of the disease).

This fluid is continuously produced in the lateral ventricles (I and II) and flows along the route “I and II ventricles - III ventricle of the brain - IV ventricle of the brain - subarachnoid space (otherwise - subarachnoid space, located between the hard membranes of the brain and the brain itself) and further - washes the brain itself, specifically - outer surface, then absorbed into the blood.

It is disturbances in the flow, production or absorption of cerebrospinal fluid that provoke its accumulation in any part of the brain diagnosed by doctors.

Many classifications of hydrocephalus have been developed, of which the most commonly used are the following:

depending on the pathways of cerebrospinal fluid circulation- occlusive (otherwise - non-communicating, closed) hydrocephalus, characterized by the fact that the cerebrospinal fluid does not enter the subarachnoid space due to any obstacles along the way (without outflow), and communicating (otherwise - open) hydrocephalus, characterized by the fact that there are problems with there is no outflow of cerebrospinal fluid;
depending on genesis- primary hydrocephalus, which is the main disease of the child, and secondary, accompanying another disease (complication, for example, with brain tumors, with lesions of the central nervous system, other ailments);
depending on the degree of occurrence- congenital (due to abnormalities during intrauterine development), as well as acquired hydrocephalus (developed in initially healthy babies);
depending on the location of the cerebrospinal fluid accumulation- external (CSF accumulates around the skull, this is visualized as a large head), internal (CSF accumulates inside the ventricles, is not visually noticeable) and mixed hydrocephalus.

Hydrocephalus of the brain in children: symptoms

Among the main symptoms of hydrocephalus there are those that are noticeable only to a specialist.

And there are symptoms that parents themselves can track by regularly examining their baby:

an excessive increase in the circumference of an infant’s head is the main symptom for children under two years of age; this symptom is also visible to parents, who can themselves (as well as a pediatrician at a monthly examination) measure the circumference of the baby’s head and compare it with the norm;
the presence of a venous network on the baby’s face;
a bulging, and at the same time enlarged, large fontanel - normally it closes by about one year, and with hydrocephalus it is open up to two and sometimes three years;
disproportionate enlargement of the skull in the forehead area, as if protruding forward and upward;
frequent vomiting and headache;
irritability of the child, sometimes - unmotivated tearfulness and apathy;
frequent muscle hypertonicity and trembling of the baby’s hands and feet;
“dropping” of the eyeball, when a white membrane appears between the pupil and both eyelids;
a lag in psychophysiological development, increasingly noticeable over time.

Advice to parents: if you notice at least one or two of the symptoms described above, contact a specialist (neurologist or neurosurgeon), even if your pediatrician does not give such recommendations. Perhaps, while constantly being with your child, you noticed something that the doctor might have missed at the appointment.

Causes of occurrence in children

Often a child is diagnosed with increased ICP (), and such a diagnosis also implies the appearance of hydrocephalus in the baby, because increased ICP precisely caused by difficulties with the outflow of cerebrospinal fluid.

If we talk about the reasons for the appearance and development of such disorders, then hydrocephalus of the brain in children under one year old will differ from the course of the disease in older children.

most often occurs due to the following reasons:

malformations of intrauterine development of the fetal brain;
consequences of infections suffered in the womb, such as cytomegaly, toxoplasmosis, etc.;
fetal prematurity;
(very rarely);
birth trauma with intracerebral hemorrhage, and sometimes with meningitis.

For children aged 1 - 2 years and older:

suffered by a child (inflammation of the membranes of the brain) and / or encephalitis (inflammation of the brain substance itself);
suffered severe infectious diseases (for example, tuberculosis);
brain tumors (not only the brain, but also the spinal cord);
malformations of the child’s central nervous system or the entire vascular system brain;
consequences of any head injuries suffered by the child;
occurred cerebral hemorrhages.

Of course, individually, these reasons do not yet guarantee the appearance of hydrocephalus, but these are reasons to monitor the baby even more carefully to exclude it.

Open and outdoor shapes

Depending on the shape of the accumulating flow cerebrospinal fluid highlight:

open outer shape illnesses, characterized by impaired absorption of cerebrospinal fluid, but with the remaining free communication of the ventricles producing this fluid;
closed external form of the disease, characterized by the fact that there is no free communication between the liquor-bearing cavities;
external, characterized by an ongoing decrease in volume gray matter brain by replacing it with excess cerebrospinal fluid, and that is why this form is the most dangerous, because it can be almost asymptomatic for quite a long time.

Do not neglect examinations by a doctor (at first - every month, then less often), as well as checking the child with special diagnostic equipment, if necessary.

Consequences

In case of late diagnosis of the problem, untimely provision (or even failure to provide at all) of medical care to a child with hydrocephalus, the onset of any complications is inevitable.

Advanced hydrocephalus of the brain in children, the most common consequences are as follows::

various speech disorders;
persistent severe headaches caused by further increases (permanent) intracranial pressure The child has;
development of visual impairment, up to the onset of blindness;
a significant lag behind peers in physical and mental development;
the appearance of epileptic seizures in a child.

In case of setting such terrible diagnosis You shouldn’t give up, because timely medical assistance can, if not completely cure the baby, then certainly stop the development of the disease.

Treatment

The primary diagnosis of hydrocephalus can be made by a pediatrician, neonatologist, or neurologist (neurologist).

However, such a diagnosis must be confirmed by a neurosurgeon after conducting a set of studies, including laboratory tests:

If the above methods, in particular CT and - especially - MRI, confirm the diagnosis of “hydrocephalus of the brain in children”, treatment should begin immediately.

MRI of a child's brain

The most commonly used type of treatment is surgical: the child undergoes surgery to install a system of silicone catheters, through which excess cerebrospinal fluid is drained from the sites of production (that is, from the lateral ventricles) into the peritoneum for absorption between the intestinal loops.

The volume of discharged liquid is regulated by built-in special valves. This operation is called “ventriculo-peritoneal shunt”. It is also important to know that these catheters are placed subcutaneously and are therefore not visible to anyone.

Sometimes a ventriculo-atrial shunt operation is performed (the principle is the same, but the cerebrospinal fluid is diverted not into the peritoneum, but into the region of the right atrium, less often - the Thorkildsen operation, which involves the diversion of cerebrospinal fluid into the occipital cistern, as well as the lumbo-peritoneal shunt operation, its principle is in the drainage of cerebrospinal fluid through the connection, a catheter of the spinal canal and peritoneum.

An operation has also been invented that makes it possible to do without installation into the body. foreign bodies(catheters) - endoscopic ventriculostomy. During this operation, a bypass path for the outflow of excess fluid is created deep in the child’s brain using an endoscope.

However, unfortunately, this type of surgical care is effective only in cases of illness in children, some variants of closed hydrocephalus (and this is no more than ten percent of the total number of patients with such a diagnosis), in all other cases its effectiveness is insignificant, which means that implantation of a shunt is necessary. systems.

Tablets "Diacarb"

There are also variants of the disease in question in which surgical treatment is not required. This often happens if there are no signs of progression of the disease and with normal intracranial pressure.

In this case, drug treatment is used: patients are prescribed the drug "Diacarb", which is the only active drug, which reduces the volume of cerebrospinal fluid production. In addition, the patient is under constant supervision of a neurosurgeon/neurologist who carefully monitors all changes in the patient’s condition.

Remember that regardless of your fear of surgery, when performing surgical intervention you can save the child! Yes, your baby will have several catheters implanted, but he will live!

Video on the topic

Tips for parents with hydrocephalic syndrome in children:

What is dropsy? Dropsy or occlusive hydrocephalus – congenital pathology, which occurs in the cavities of the brain due to the accumulation of large volumes cerebrospinal fluid. Liquor gradually accumulates in the cavities and ventricles of the organ. The disease manifests itself externally as an increase in the volume of the head in the brain area. In young children, the bones of the skull are mobile, and the sutures have not yet healed, so the pressure of the cerebrospinal fluid displaces the bones cranium. A change in the size of the skull occurs in a child under 2 years of age and can manifest itself in varying degrees. If the symptoms of hydrocephalus are severe, surgery is necessary.

Inside the brain there is cerebrospinal fluid (CSF), a special fluid that protects it from damage due to injuries and concussions. It circulates around the conduction system and throughout the brain. The outflow of fluid from the cavities occurs through special channels. Liquor is produced constantly, but the body maintains its amount at the same level. The volume of inflow always corresponds to the outflow.

Dropsy occurs when the outflow is disrupted or its production increases. Excess cerebrospinal fluid collects in the cavities, swelling the skull.

Causes of the disease:

Defects of brain structures;
Brain defects, the presence of neoplasms, cysts, hemorrhages;
Head injuries;
Infectious diseases of the mother during pregnancy;
Anomalies of the central nervous system, genetic damage.

Symptoms

Moderate dropsy does not cause obvious deformities. External hydrocephalus manifested by an increase in the volume of the cranium with divergence of the cranial sutures. The size of a newborn's head grows rapidly, increasing to 60 cm. A clear venous network appears on the skin. The fontanelles swell, including the lateral ones. Due to cranial deformation disorders, the position of the eyes changes.

“Sunset syndrome” is a typical eye condition in a child with hydrocephalus.

When symptoms appear in the prenatal period, due to the abnormal size, head shapes are impossible natural childbirth. Large amounts of fluid contribute to increased intracranial pressure. A child of 4–5 months of age develops chin and hands, and has convulsions. The disease is accompanied by nausea and vomiting. Pale skin, blurred vision, problems with heart function and eye movement are prerequisites for the disease.

Occlusive hydrocephalus is manifested by a lag in the psychomotor development of the child: the baby is inactive, his movements are difficult.

In an older child, the head size does not increase, but there is a sharp increase in cerebrospinal fluid pressure. This condition is accompanied by severe headaches, impaired memory, psyche, and intellect. The baby screams often. Moderate hydrocephalus is asymptomatic; the baby’s condition depends on the cause.

Types and stages

Depending on the location of fluid accumulation, external and internal hydrocephalus differ. External flow occurs when cerebrospinal fluid accumulates in the subarachnoid space, internal flow occurs when it accumulates in the ventricles of the brain. Internal flow mainly proceeds as compensated dropsy. There are mixed symptoms of the disease.

According to the mechanism of action, the disease is distinguished:

Open form, in which the exchange between the ventricles and the subarachnoid cavity is preserved;
Closed, in which the movement of cerebrospinal fluid between the ventricles and cavities is impossible due to atresia or blockage of the passages of Luschka and Magendie, in this situation shunting is performed;
Hypersecretory, in which the secretion of fluid by the choroid plexus increases.

Internal dropsy of the brain can occur acutely, when from the beginning to serious condition no more than 4 days pass. The subacute form involves the gradual development of the disease over 30 days. The chronic form lasts from 14 days to 6 months. The closed form of the disease is the most dangerous; it requires immediate surgical intervention. Hydrocephalus may manifest with increased, decreased or normal pressure. Normotensive disease occurs on initial stage, and the hypotensive variety is rare.

There are the following stages of the disease:

Decompensated (progressive) – manifests itself clearly severe symptoms and the presence of cerebrospinal fluid hypertension;
Compensated degree - the ventricles are dilated, but the pressure is not increased;
Subcompensated - the pressure is normal, but the likelihood of relapse is quite high;
Atrophic degree - the ventricles and cavities are significantly expanded, and atrophic processes occur in the tissues.

Diagnostics

Diagnosis is made based on external manifestations When the symptoms are clearly expressed, the causes are also determined. The dynamics of head growth is monitored for up to a year. Indirect signs The diseases are manifested by a monthly increase in head circumference over 3 cm, the appearance of disproportions, the presence of swelling of the fontanelles and suture dehiscence.

Sometimes the size of the head is increased due to heredity, but this is not a congenital anomaly, therefore, if dropsy is suspected, the following is additionally carried out:

Examination of the fundus by an ophthalmologist;
Two-plane radiography of the skull;
Ultrasound of the head (neurosonography) through the fontanelle with measurements of all parameters - performed on a baby up to one year old in cases where it is not overgrown; at an older age, the procedure is technically impossible;
Carrying out CT and MRI of the head - to identify structural anomalies, the degree of deformation and view the quality of brain structures;

The compensated degree does not appear externally. Additionally, blood tests are required to detect infections, and a puncture of the cerebrospinal fluid is taken to determine its composition. If seizures are present, an EEG is performed.

Treatment

Conservative treatment is possible only for non-progressive open hydrocephalus. To reduce the amount of fluid, “Furosemide”, “Mannitol” are prescribed. Incorrectly prescribed medication can worsen the child's condition. If the drugs do not have the desired effect, the disease continues to progress, surgical treatment is prescribed.

The operation is also indicated in a closed form.

If the symptoms of the disease gradually increase and become a threat to the child’s life, ventricular drainage is performed.

This operation is performed extremely rarely, only in cases where it is impossible to save the child’s life by other methods. It always causes many complications. An increase in the amount of cerebrospinal fluid is caused by neoplasms in the brain. Their removal helps to naturally reduce fluid volume. Previously, bypass surgery was used to relieve symptoms. This operation was often accompanied by a large number of complications. The child’s quality of life depended on the condition of the shunt; it had to be changed periodically. Latest achievements

in medicine, bypass surgery was replaced by the endoscopic method of surgery.

The advantages of endoscopy treatment include:
Low trauma;
Reduced risk of complications;
No need to embed foreign bodies;

Effective reduction in the amount of cerebrospinal fluid. Replacement hydrocephalus requires constant monitoring. Moderate compensated degree does not require surgical treatment . The child is being monitored at the dispensary. The key to successful rehabilitation and reducing the risk of relapse is a systematic examination and constant monitoring of the amount of fluid in the cavities of the brain and ventricle. Treatment is necessary even if available mild degree increasing its volume, while internal dropsy

Consequences

may be asymptomatic. The prognosis of hydrocele depends on associated factors and the severity of the disease. Unreasonable delay in surgical treatment leads to severe complications , as well as to. fatal outcome Congenital hydrocephalus leads to irreversible delays. mental development timely treatment children up to one year old.

Consequences of the disease:

and speech disorders;
Visual impairment leading to complete loss;
Constant headaches due to surges in intracranial pressure;
Mental retardation of varying degrees;
Epilepsy attacks.

The consequences of the disease depend on the cause and timely seeking help. Required here dispensary observation neurologist and neurosurgeon. Congenital hydrocephalus is not completely curable, but turns into a replacement form, in which systematic treatment is necessary, even if signs do not appear. The frequency of the procedure is determined by the doctor based on the patient’s condition. Shunting has unpredictable consequences.

If there is a significant increase in head circumference after surgery, its shape will remain the same.

The later the treatment is carried out, the more noticeable the curvature of the skull is. Minor defects in the head may smooth out a little as the child grows, but it will still remain enlarged. It is impossible to influence the defect during surgical treatment of hydrocephalus.

Hydrocephalus is serious disease, affecting the tissues surrounding the brain. It is most often observed in young children, but adults are also not immune from this disease. The disease can progress over time and cause severe complications and death.

Description of the disease

The word "hydrocephalus" is formed from two Greek words meaning "water" and "head". In other words, the disease consists of excess water in the head. Hence its second name – dropsy of the brain. However, strictly speaking, the name is not entirely correct. The fact is that with hydrocephalus, there is an excess not of water in the head, but of cerebrospinal fluid, or cerebrospinal fluid.

Liquor is a liquid that is vital for the functioning of nervous tissue. It can be found in both the spinal cord and the brain. In the brain, cerebrospinal fluid is concentrated in four ventricles located in the center of the skull. The two upper ventricles are located in both hemispheres, and the two lower ones are located along the central axis of the brain. The ventricles communicate with each other through a system of pipes called the cerebral aqueduct. In addition, cerebrospinal fluid can enter the subarachnoid space, which separates the meninges, and special brain cisterns located at the base of the skull.

The functions of cerebrospinal fluid are varied:

protection of nerve tissue from external mechanical influences
output from the brain harmful substances and delivery of nutrients
maintaining a stable value of intracranial pressure.

The volume of cerebrospinal fluid is relatively small, in infants it is 50 ml, in adults – 120-150 ml.

Liquor, like blood, circulates inside the cranial cavity. At the same time, its composition is constantly updated. In adults, on average, this happens 3 times a day, in infants more often – up to 8 times a day. Every minute an adult produces 0.35 ml of cerebrospinal fluid, and per day - approximately 500 ml. CSF pressure in an adult can vary widely - from 70 to 180 mm Hg. Art.

CSF is mainly formed in the ventricles of the brain. Two-thirds of the fluid is generated by the choroid plexuses of the ventricles, and the rest by the ventricular membrane and meninges. In special veins located inside the skull, in its occipital-parietal part - the venous sinuses, it is absorbed.

Consequently, if for some reason the circulation of cerebrospinal fluid is disrupted and more of it is formed than necessary, or it is not absorbed quickly enough, then there is an excess of fluid in the cranial cavity. This syndrome is called hydrocephalus.

Excess cerebrospinal fluid manifests itself differently in children and adults. Adults have hard skull bones, so excess cerebrospinal fluid typically leads to increased intracranial pressure. It’s a completely different matter for small children under the age of 2-3 years. They have rather soft skull bones, and therefore hydrocephalus often manifests itself in the form of an abnormal expansion of the head circumference.

Types of disease

There are three main forms of hydrocephalus: open, closed (occlusive) and hypersecretory. Closed type The disease occurs if there is a physical obstruction to the outflow of cerebrospinal fluid from the skull containers intended for it into the systemic bloodstream. This type can be caused by cysts, tumors or hemorrhages. The open type of hydrocephalus is observed when the mechanism of absorption of cerebrospinal fluid into the systemic circulation is disrupted. In this type, the cause of the disease is most often previous infections, for example, meningitis or the presence of blood in the subarachnoid space. Hypersecretory hydrocephalus is a relatively rare type of disease, observed in approximately 5% of cases. It occurs as a result of excessive production of cerebrospinal fluid. This situation can happen, for example, due to pathology of the choroid plexus.

There are also types of hydrocephalus such as congenital, acquired and replacement. The congenital type of the disease is said to occur when hydrocephalus is present in a person from the moment of birth. Acquired hydrocephalus is a consequence past diseases. The replacement type of the disease occurs when brain tissue degrades and is replaced by an increased volume of cerebrospinal fluid.

According to the intensity of the flow pathological processes the disease can be divided into acute and chronic types. The acute type develops over several days, usually in a closed form, and requires immediate surgical treatment. The chronic form develops over several months. It is often combined with the open type of the disease.

Based on the location of the increased volume of cerebrospinal fluid, the disease is divided into external, internal and mixed varieties. With the external type, excess fluid accumulates mainly in the space between the meninges. At internal disease affects the ventricles of the brain. This type of disease is most often combined with a congenital closed form. Besides, internal hydrocephalus can be divided into symmetrical and unilateral. A unilateral type of hydrocephalus is diagnosed if an increase in the volume of cerebrospinal fluid affects only one of the two symmetrically located ventricles. At mixed type There is an increase in fluid volume both in the ventricles and in the space between the meninges.

The disease can also have compensated and decompensated forms. In the compensated form, despite an increase in the amount of fluid, no compression is observed nerve structures brain and, accordingly, negative neurological symptoms. However, if left untreated, the disease can progress to a decompensated stage.

According to the dynamics of development, hydrocephalus is divided into progressive, stabilized and regressive. According to the degree of cerebrospinal fluid pressure, the disease can be divided into hypertensive (with high blood pressure), normotensive (with normal blood pressure) and hypotensive (with low blood pressure) types.

Causes of hydrocele in children

Although the disease is more common in children than in adults, its prevalence is much lower than is generally believed. Statistics say that one case of hydrocephalus occurs in several thousand newborns (from 1000 to 3000 according to different sources). However, hydrocele is one of the most common developmental disorders in children. Boys get sick somewhat more often than girls. Most often the disease is detected in the first three months of life.

It should be borne in mind that the real type of hydrocephalus has nothing in common with the much more common diagnosis of “hypertensive-hydrocephalic syndrome” in infants. This condition is characterized by slightly increased values of intracranial pressure, but in most cases it goes away on its own and does not require serious treatment, unlike true hydrocephalus.

The disease in children can be congenital or acquired. Various factors can lead to congenital hydrocephalus:

birth injuries,
fetal hypoxia,
genetic abnormalities
infection of the child's body in the womb with infectious diseases.

To the number infectious diseases that can cause dropsy of the brain include:

Congenital genetic abnormalities leading to the development of hydrocephalus:

Chiari syndrome is a disease in which the volume of the brain is less than the volume of the skull;
Congenital narrowing of the cerebral aqueduct;
Underdevelopment of openings for the outflow of cerebrospinal fluid;
Other chromosomal disorders.

The acquired type of disease can be a complication of acute infectious diseases, such as meningitis, otitis or encephalitis, appear after poisoning with toxic substances, as a result of hemorrhages and tumors, etc. In total, experts believe there are more than 180 causes of hydrocephalus.

Symptoms of the disease in children

In infants and younger age As a rule, the symptoms are pronounced. First of all, attention is drawn to the large size of the skull. It should be taken into account that the head of infants grows quite quickly - approximately 1.5 cm in circumference per month. However, if the rate of head enlargement exceeds this value, then this is a cause for concern.

In newborns, the skull consists of individual bones that are separated from each other. With age, bones should grow together. An increase in brain fluid interferes with this process and pushes the bones apart, making the baby's head disproportionately large.

But a large head size is not the only sign of hydrocephalus; moreover, in some cases this symptom may be absent. It is also necessary to pay attention to the scalp. Usually with hydrocephalus it is thin and shiny, a network is noticeable on it blood vessels. Although children have malleable skull bones, nevertheless, in some cases, an increase in the amount of fluid in the cranial cavity leads to compression of various parts of the brain.

Also, symptoms of the disease in infant are a swollen fontanel, protrusions of the skin in the areas where the bones of the skull meet. When you tap on the bones of the skull, you hear the characteristic sound of a “cracked pot.”

A child with hydrocephalus may suffer from various neurological disorders:

paresis of certain parts of the body,
changes in muscle tone,
muscle weakness,
convulsions,
bad dream,
poor appetite,
tremor of hands and chin,
difficulty holding the head, standing and sitting,
speech and developmental delays.

It is also worth paying attention to the appearance eyeballs and the nature of their movements. The list of ophthalmological symptoms characteristic of the disease includes:

involuntary movements of the eyeballs,
rolling eyes,
strabismus,
Graeff syndrome or the “setting sun” symptom (a white stripe between the eyelid and the pupil that appears when the eyes move).

In most cases, infants are characterized by the normotensive type of hydrocephalus. For children over 2 years of age, symptoms may include signs of increased intracranial pressure:

vomit;
headache;
impaired coordination of movements;
irritability;
drowsiness;
double vision and other visual impairments, up to complete blindness.

In children of senior preschool and school age There may be problems with memory, academic performance, social adaptation, neuroses, and headaches.

Causes of the disease in adults

In most cases, the disease in adults and children over 12 years of age is secondary. This means that the cause of the disease is some other disease.

The list of diseases that can cause hydrocephalus in adults is quite long:

The disease can also be caused by atrophy of brain tissue. This variant of the disease is called replacement hydrocephalus.

Symptoms of hydrocephalus in adults

In adults, with an increase in the amount of fluid circulating in the cranial cavity, there is no increase in the bones of the skull. Therefore, in most cases, hydrocele of the brain is accompanied by an increase in intracranial pressure (ICP). This syndrome can be identified by characteristic symptoms. Main symptom increased ICP– constant headaches that cannot be relieved with analgesics. Headache most often worsens in the morning, which is associated with an increase in ICP at night. In the acute form of hydrocephalus, the following may be observed:

blurred vision;
vomiting and nausea;
drowsiness;
vestibular symptoms - dizziness, gait disturbances;
paresis;
changes in muscle tone;
oculomotor disorders.

IN severe cases Patients may experience speech and behavior disorders, increased aggressiveness, or, conversely, apathy.

For chronic form Hydrocephalus is characterized by the following disorders:

Diagnosis of the disease

There are several ways to determine the disease. The disease is often easier to detect in children than in adults. But in adult patients, recognizing the disease is sometimes difficult. Previously, many adult patients suffering from hydrocephalus were diagnosed with various mental and neurological disorders. However, naturally, their treatment was not very effective. Only after the advent of modern diagnostic methods did the situation change for the better.

In children, the disease is most often detected by a pediatrician during regular examination of the child. The doctor may pay attention to such obvious signs hydrocephalus, such as enlargement of the head, bulging fontanel, divergence of the sutures of the skull, changes in the appearance of the skin, characteristic neurological symptoms. To facilitate diagnosis, parents are advised to record the baby's head circumference at certain intervals. If a disease is suspected, the pediatrician can give a referral to a neurologist, neurosurgeon or pediatric surgeon.

However, many of the above symptoms can also be observed in other pathologies - intracranial hematomas, cysts and tumors, some congenital diseases, for example, Canavan disease. Therefore, a preliminary diagnosis can be confirmed or refuted only with the help of instrumental studies– MRI (the most informative method), computed tomography, radiography. In young children, ultrasound (so-called neurosonography) can be used, which uses individual areas baby's heads accessible to the passage of ultrasonic waves. Ultrasound also makes it possible to diagnose hydrocephalus in a child while still in the womb. Similar diagnostics very important, since an enlarged fetal head can significantly complicate childbirth.

When diagnosing the causes of closed hydrocephalus, endoscopic techniques can be used. The essence of this method is the introduction of a special device into the cavity of the ventricles - an endoscope, with the help of which the image can be transmitted to the doctor’s monitor.

For diagnosis, fundus examination can also be used to help identify increased ICP. However, this method cannot be called important, since the disease is not always accompanied by an increase in ICP.

Electroencephalography for hydrocephalus in most cases is also uninformative and can only be used as a aid diagnostics However, EEG may be used in the treatment of hydrocephalus-related neurological disorders, for example, convulsive syndrome.

When diagnosing the disease, the dynamics of the occurring pathological changes should be taken into account. That is, for example, a single increase in the size of the ventricles recorded on MRI is not yet a sign indicating hydrocephalus. In many cases, this symptom may go away on its own. It’s another matter if studies conducted at intervals of several months show a deterioration in the condition. Only in this case can the diagnosis be confirmed. If observations show that the volume of the ventricles is increased, but it remains stable, then, as a rule, treatment in such a situation is not required.

Complications of hydrocephalus

If left untreated, the disease will progress in most cases. This may lead to negative consequences, including those that threaten the patient with death.

The main complications of hydrocephalus:

For hydrocephalus in children infancy there is a slowdown or stop in the formation of new brain tissue. And this leads to a lag in the mental, mental and emotional development of the child.

Treatment

Recently, medicine has made great progress in the treatment of hydrocephalus. If a quarter of a century ago more than half of the sick died, now the mortality rate is no more than 5%.

The choice of treatment methods for hydrocephalus depends on the etiology of the disease, its form and degree of development. In some cases, etiotropic treatment is possible. However, in most cases, therapy is aimed at removing fluid from the cranial cavity. Treatment of progressive hydrocephalus in adults and children can only be carried out surgical methods, conservative treatment however, it is ineffective.

The operations performed for closed and open hydrocephalus are somewhat different. Previously, open dropsy of the brain was considered practically incurable disease. However, in the middle of the 20th century. New technologies have emerged that can save the majority of patients.

In order to remove excess fluid from the cranial cavity, shunting is usually used. It consists of laying a pipeline through which liquor would be pumped to other body cavities. For most of their length, such tubes are located under the surface of the skin. The peritoneal area (95% of cases), atria, and chest area can be used as places where fluid collects. In some cases, fluid may be drained not from the brain, but from the spinal cord and also directed into the abdominal cavity.

If the operation is performed on a child, then as the child matures and grows, the catheters will require lengthening or replacement. Modern catheters are equipped with special valves that allow you to regulate the fluid pressure in the brain vessels.

In the absence of an immediate threat to life, bypass surgery is carried out as planned. As a temporary measure to reduce cerebrospinal fluid pressure, punctures in the spine are used.

Closed hydrocephalus often requires rapid surgical intervention, since with this form of the disease compression of the respiratory center can occur. Therefore, in such a case, a temporary operation can be performed with the installation of a special container for the outflow of cerebrospinal fluid.

With closed hydrocephalus, the surgeon's main efforts should be aimed at eliminating the obstacle that interferes with the normal circulation of the cerebrospinal fluid. In some cases, such an obstacle (vascular aneurysm, cyst, hematoma, tumor) can be eliminated. Most often, endoscopic systems inserted into the ventricular cavity are used for this purpose. The operation is performed using surgical instruments, an electrode or a laser, and allows you to restore the function of the brain pipelines.

However, in some cases, for example, with tumors, both benign and malignant, such operations are not possible. In this case, the surgeon can lay a pipeline from the container in which the cerebrospinal fluid accumulates to another container where it can be absorbed into the blood.

In all cases, the purpose of the operation is to restore the balance of generation and output of cerebrospinal fluid that has been disturbed for some reason. Of course, if the disease is secondary, then the main efforts should be directed to treating the underlying disease that caused the excess cerebrospinal fluid.

Drug therapy

Drug treatment in most cases is auxiliary, not primary. As a rule, diuretics and agents that increase the excretion of calcium from the body, such as Diacarb, Mannitol, Furosemide, are used.

In the case of mild hydrocephalus, therapy is possible only with diuretics. However, with a progressive form of the disease, drugs are used only during preparation for surgery, or in recovery period after operation.

Diet

Diet for hydrocephalus is also auxiliary and helps to curb the rapid progression of the disease. First of all, you should exclude from your diet foods that contribute to the accumulation of fluid in the body. In particular, the following products are strictly contraindicated:

Forecast

The prognosis for hydrocephalus depends on how quickly and promptly the diagnosis is made and treatment is started. Children with hydrocephalus can live a normal life, although they may face some problems related to the maintenance of shunts. If treatment of the disease in an infant is not started in a timely manner, then its development threatens the child with developmental delays, speech impairment, as well as irreversible changes in the brain leading to disability.

Hydrocephalus, or dropsy of the brain is a disease in which excessive amounts of cerebrospinal fluid accumulate in the ventricles (internal cavities) of the brain and under the meninges.

Some facts about hydrocephalus:

According to statistics, this disease occurs in 1 out of 500-1000 newborns.
Hydrocephalus is the most common developmental disorder in children, which is more common than Down syndrome and congenital deafness.
There are only about 700,000 children and adults living in the United States today with hydrocephalus.
In Western countries, hydrocephalus is the most common cause brain surgery in children.
There are more than 180 various reasons of this disease. The most common is perinatal damage (shortly before, during or immediately after childbirth).
25 years ago, more than half of patients with hydrocephalus died. Today the mortality rate has dropped to 5%.

Features of the anatomy of the central nervous system. What is cerebrospinal fluid? How is it formed and removed?

Normally, the brain is surrounded by cerebrospinal fluid. It fills its internal cavities, the cerebral ventricles, as well as the space around it.

Functions of cerebrospinal fluid:

Acts as a shock absorber and protects the brain from damage during impacts.
Removes waste, metabolic products that are formed in the brain.
Delivers some essential substances to the brain.

The amount of cerebrospinal fluid is always constant. For an adult - approximately 150 milliliters. For a child – less, depending on age.

The formation of cerebrospinal fluid occurs mainly due to many small vessels located in the walls of the cerebral ventricles. Every minute an adult produces approximately 0.35 ml of cerebrospinal fluid, and about 500 ml per day. The same amount should be absorbed into the veins of the brain. This is how it is constantly updated.

Normally, cerebrospinal fluid pressure fluctuates within certain limits. For an adult, this interval is 70-180 mm. rt. Art., for children the numbers are lower, according to age.

Hydrocephalus develops when there is a discrepancy between the amount of cerebrospinal fluid produced and absorbed. This can happen for various reasons.

What types of hydrocephalus are there?

Depending on the causes, there are two types of hydrocephalus in children:

Closed (syn.: non-communicating, occlusive). A blockade occurs, as a result of which the outflow of cerebrospinal fluid to the place where it is absorbed is disrupted. This condition can be compared to a pinched garden hose. Above the block, the pressure of the cerebrospinal fluid increases.

Open (communicating). In this form of hydrocephalus, cerebrospinal fluid circulates freely, but it is not absorbed or is absorbed less intensely than it should.

More common in children closed form hydrocephalus. Usually it is more severe than open and is accompanied by a stronger increase in intracranial pressure.

Types of hydrocephalus, depending on the time of occurrence:

congenital
acquired

Types of hydrocephalus depending on the course:

Acute. Dropsy of the brain and elevation increase very quickly. This is more typical for closed hydrocephalus. The child’s condition is deteriorating sharply and urgent care is required. health care.
Chronic. The increase in intracranial pressure increases gradually. This is more common with communicating hydrocephalus.

Types of hydrocephalus depending on the location of the dropsy:

Types of hydrocephalus depending on the severity of the disorders to which it leads:

Compensated– there is hydrocephalus, but it does not manifest itself with practically any symptoms, the child’s condition is practically not disturbed, he develops normally.
Decompensated– dropsy of the brain leads to pronounced disorders.

The main causes of hydrocele in children:

Cause	Description
Fetal infections Congenital malformations of the brain
Chiari syndrome (Arnold-Chiari syndrome, Arnold-Chiari malformation)	A condition in which the brain is larger than the space inside the skull. Due to this, the cerebellum shifts downward, compressing lower sections brain, the outflow of cerebrospinal fluid is disrupted. Previously it was thought that this congenital disease. Now scientists are inclined to believe that violations occur as a result rapid growth brain.
Congenital narrowing of the cerebral aqueduct	Waterhole The cerebral duct is a channel that connects the cerebral ventricles. It normally carries out the outflow of cerebrospinal fluid. Narrowing of the cerebral aqueduct is a congenital disorder, but it usually begins to manifest itself with age.
Underdevelopment of the openings that are necessary for the normal outflow of cerebrospinal fluid	These disorders also lead to the development of closed hydrocephalus.
Rare malformations associated with chromosomal abnormalities
Other causes of hydrocephalus in children
Intracranial tumor	A tumor of sufficiently large size compresses the brain, leading to displacement of brain structures. Closed hydrocephalus develops.
Hemorrhage	Depending on its location and size, an intracranial hematoma (a collection of blood) can also compress brain structures and impair the outflow of cerebrospinal fluid.
Infections	Meningitis and meningoencephalitis are inflammation of the brain and meninges, - lead to impaired absorption of cerebrospinal fluid. Developing open hydrocephalus.

What happens with hydrocephalus?

Due to the fact that with dropsy of the brain, fluid accumulates in the cranial cavity. a large number of fluid, intracranial pressure increases. There is compression of the brain, disruption of blood circulation in it. As a result, the development and maturation of the child’s nervous system is disrupted.

After birth, the skull consists of several individual bones - they continue to grow. At a certain age, they must grow together and bone sutures are formed. In children with hydrocephalus, these processes are disrupted. Their skull bones diverge to the sides, grow together more slowly, and become thinner.

Signs of hydrocele in a child

Signs of congenital hydrocephalus:

At open form In hydrocephalus, these symptoms increase gradually. Closed often manifests itself in the form of attacks. During one of them, breathing problems may develop - dangerous condition requiring immediate assistance.

Signs of hydrocephalus in older children (mostly all of them are associated with increased intracranial pressure):

headache;
lethargy, drowsiness;
increased irritability;
poor appetite;
nausea, vomiting;
visual impairment, double vision;
convulsions and breathing problems (usually during an attack with open hydrocephalus).

What could be the consequences of hydrocephalus for a child in the future?

With the development of dropsy of the brain in early age, untimely treatment, with age in The child may develop the following problems:

decreased attention;
difficulties with learning at school, the child does not learn new information well;
movement coordination disorders;
memory problems;
speech defects;
visual impairment, up to complete blindness.

Diagnosis of hydrocephalus

Diagnosis of hydrocele in the fetus before birth

Most often, hydrocephalus is detected in a child while he is still in the womb, during a routine ultrasound. The screen of the device shows the dilated ventricles of the brain and the accumulation of fluid in them. Sometimes the size of the head begins to increase even before birth. This makes childbirth difficult.

Diagnosis of hydrocele of the brain after the birth of a child

Every child is examined periodically by a pediatrician from birth. Most often, it is this doctor who first identifies signs of hydrocephalus and prescribes further examination.

Diagnosis of hydrocephalus:

Treatment of hydrocephalus in children

The main method of treating hydrocephalus in children is surgical. Exist medications, which help reduce edema of the brain, reduce intracranial pressure, improve the patient’s condition, but they act temporarily.

Conservative therapy is used for compensated forms of the disease, when a small excess amount of fluid accumulates in the cranial cavity, intracranial pressure is slightly increased, and there are no or mild symptoms. Such children are under the supervision of a neurologist.

Which doctor treats hydrocephalus?

For the first time, signs of dropsy of the brain are identified, as a rule, by a pediatrician. He refers the child for consultation, examination and treatment to other specialists:

neurosurgeon;
pediatric surgeon;
neurologist;
ophthalmologist: with hydrocephalus, compression and dysfunction of the optic nerve often occurs, decreased vision, even complete blindness.

Drug treatment of hydrocephalus

A drug	Description	Application*
Diakarb	Diuretic drug. Removes fluid from the body, thereby reducing intracranial pressure. Along with liquid diacarb removes potassium from the body, so it is often prescribed along with asparkam.	Prescribed to children from 4 months at a dosage of 50 mg per day - divided into 2 doses.
Furosemide	A powerful diuretic. Removes fluid from the body, thereby helping to reduce intracranial pressure.	Use in children: in tablets: 1-3 mg of the drug per kilogram of body weight per day; in injections: 1-1.5 mg per kilogram of body weight per day.
Mannitol	A diuretic whose action is due to an increase in osmotic pressure in renal tubules.	The drug is a powder that is dissolved in sterile water and administered intravenously. It is also available from pharmacies in the form of a ready-made solution.

Emergency surgical care for closed hydrocephalus

With closed hydrocephalus, a life-threatening condition may arise when, due to large cluster cerebrospinal fluid and a significant increase in intracranial pressure, the brain is displaced, it goes down, wedges into the hole connecting the skull with the spine.

In this case, compression of the nerve center responsible for regulating breathing often occurs. This threatens respiratory arrest and death.

In such cases, it is necessary to quickly remove excess cerebrospinal fluid and reduce intracranial pressure.

Carrying out emergency surgery:

The child is given anesthesia.
A hole is made in the skull. If the seams and fontanelles are not yet overgrown, then a puncture can be made. For older children, cutters are used.
A silicone catheter is inserted into the brain ventricle and immersed to the required depth. With some malformations, it is necessary to drill two holes and install two catheters in both ventricles - the right and left.
The other end of the catheter is connected to a special container.

This measure is temporary. When caring for a child who has undergone surgery, it is necessary to strictly follow the rules of asepsis to avoid infection. The container into which the cerebrospinal fluid flows is periodically changed.

Surgical treatment of open and closed hydrocephalus in children

If attacks of acute increase in intracranial pressure do not occur, then the operation is performed as planned. The doctor examines the child and sets a date for surgery.

Before surgery, cerebrospinal fluid pressure can be reduced using a spinal tap: the doctor places the child on his side, inserts a needle between the lumbar vertebrae, and removes some cerebrospinal fluid.

Diseases for which it is indicated spinal taps before surgery:

meningitis and meningoencephalitis;
intracranial hemorrhages.

Types of surgical interventions for hydrocephalus:

Indications	Type of operation
Closed hydrocephalus	Removing an obstruction that is blocking the flow of cerebrospinal fluid: tumor; hematoma; cyst; vascular aneurysm. After the obstruction is removed, the cerebrospinal fluid begins to flow freely to the place where it should be absorbed.
Closed hydrocephalus, in which the obstruction cannot be removed	For example, some tumors grow into the brain, do not have a clear border, and they can be removed without damaging healthy tissue. nerve tissue, does not work. In such cases, the surgeon creates a workaround - he makes an artificial hole through which the cerebrospinal fluid begins to flow. Sometimes a catheter is installed - a tube that drains cerebrospinal fluid, bypassing the site of narrowing. Previously, patients endured such operations very difficult. But today new endoscopic techniques have appeared.
Open hydrocephalus	With open hydrocele of the brain, cerebrospinal fluid is not absorbed where it should normally occur. The surgeon’s task is to take it to another place, to a place where it can be absorbed. Previously, this was impossible to do - open hydrocephalus was considered a serious incurable disease. But in the middle of the last century, special silicone catheters appeared. Thanks to them, surgeons today successfully cope with the disease. Types of operations, depending on the location of the cerebrospinal fluid drainage: How the operation is performed? The child is given anesthesia. The surgeon makes two incisions: one on the head and one on the abdomen. One end of the catheter is immersed in the abdominal cavity. A tunnel is made under the skin up to the head, through which a catheter is passed. The second end of the catheter is immersed in the cerebral ventricle. Check the patency of the catheter. All wounds are sutured. As the child grows, the catheter must be replaced with a longer one. Modern catheters are equipped with special valves. They help regulate the level of cerebrospinal fluid pressure and prevent it from rising and falling excessively. The type of valve is selected by the attending physician. Possible complications after catheter installation: Impaired patency. Causes: incorrect installation (kinks, punctures); blockage by adhesions inside the skull, tumor cells, inflammatory cells, hematoma; blockage by adhesions inside the abdominal cavity. Infection. Causes: violation of the rules of asepsis and antisepsis during surgery; any inflammatory processes: infection can enter the catheter site through the bloodstream. Sharp fluctuations intracranial pressure. It may be excessively increased or decreased. It is difficult to select a catheter that would provide optimal performance the first time. In these conditions, the catheter must be replaced.

Modern techniques allow you to successfully combat open and closed hydrocephalus in children. With timely treatment, a sick child has every chance of becoming a normal, full-fledged member of society.

Prevention of hydrocephalus

In order to identify hydrocephalus in a child in advance and take the necessary measures, all pregnant women must undergo an ultrasound scan on time.

Infectious diseases that can cause hydrocephalus in the fetus are detected during a blood test of a pregnant woman for TORCH infections: toxoplasmosis, rubella, herpes, cytomegalovirus infection. This test must be prescribed at the antenatal clinic during pregnancy.

Doctors should pay special attention to children who have risk factors for hydrocephalus:

prematurity;
various pathologies during pregnancy in the mother, in particular infections;
malformations of the nervous system: spina bifida, cerebral hernia, etc. (hydrocephalus can develop much later, after the child has been operated on for the defect and has had time to grow up);
brain tumors and spinal cord;
previous meningitis, meningoencephalitis, infections of the nervous system;
intracranial hemorrhages;
suffered head injuries.

These children should be examined and observed by a specialist.

Hydrocephalus often develops after traumatic brain injury, so an important preventative measure is to protect children from injury:

use of child seats in cars;
walks – on specially equipped, safe playgrounds;
protection of a small child in the house: you need to purchase special covers for all sharp corners, remove all heavy, unstable objects;
When riding a bicycle, skateboard, roller skates, etc., the child must wear a helmet and other protective equipment.

Hydrocephalus is a pathological condition resulting from an imbalance between the production and absorption of cerebrospinal fluid (CSF) that washes the brain. Excessive fluid accumulated as a result of this begins to put pressure on brain structures and nerve endings, thereby causing disorders brain activity.

Hydrocephalus is most often diagnosed in children. Its danger lies in the pressure of the cerebrospinal fluid on the brain tissue and, as a result, the natural functioning of brain activity is disrupted. According to ICD 10, depending on the type of pathology of childhood hydrocephalus, the following codes are assigned:

Q03 – congenital hydrocephalus;
P91 – hydrocephalus acquired in infants (disorders of the cerebral status of newborns);
1 – congenital hydrocephalus caused by toxoplasmosis.

Symptoms of hydrocephalus

In children under 2 years of age and older, hydrocephalus manifests itself in different ways. In infants, hydrocele of the brain is almost always congenital; the complex course of the pathology negatively affects the fragile central nervous system and brain structures, thereby significantly worsening the baby’s health.

At the age of up to 1 year, the bones of the skull in the area of the fontanel have not yet fused and have the property of moving apart with an increase in the volume of fluid in the structures of the brain.

From the 1st to the 2nd year of life, in the area of an already overgrown fontanel, the bones are still elastic, so they can also shift slightly.

The main symptoms of developing hydrocephalus from birth to 2 years in children are:
disproportionately large head size, enlarged forehead; Availability venous network
visible through the skin on the temples, back of the head and frontal part of the head;
visual disturbances in the form of divergent strabismus, the appearance of a white stripe of the sclera when blinking, drooping eyelids;
weak weight gain;
delayed development - the child later begins to hold his head up, sit, crawl, walk;
protrusion of the fontanel above the level of the skull bones and its intense pulsation;
frequent and profuse regurgitation; reluctance to breastfeed or complete failure
from her;
unnatural tilting of the head;
the baby's tearfulness, which seems unreasonable at first glance, restless sleep;

the knees are in a bent position, it is difficult to straighten them.

If hydrocephalus of the brain progresses rapidly, then the child exhibits the following symptoms of acute brain failure:
convulsions;
vomit;
drowsiness;
incessant monotonous crying;
disturbance of consciousness;
loss of previously acquired skills;

limitation or loss of reflexes responsible for movement. When acute symptoms

hydrocephalus, the child should be immediately hospitalized for resuscitation.

After 2 years of life, the symptoms of hydrocephalus of the brain in children begin to manifest themselves differently, since the bones of the skull have already fused and lost their elasticity.

Is something bothering you? Illness or life situation?

Signs of excessive accumulation of cerebrospinal fluid in brain tissue are:
headaches, which the child complains of most often in the morning;
nosebleeds that appear directly during a painful attack;
pressure on the eye sockets;
nausea, less often vomiting;
decreased vision, double vision;
muscle spasms in the limbs, trembling of the chin;
restless sleep in the form of frequent waking up at night and crying;
blueness under the eyes;
mood swings - bursts of irritability, tearfulness, capriciousness and, conversely, apathy and despondency;
hyperactivity and attention deficit syndromes;
violation urinary function in the form of urinary incontinence and increased excretion;
obesity;
epileptic seizures.

Identification of the described symptoms of hydrocephalus of the brain in children early stage, undergoing diagnosis and treatment will increase the chances of recovery and further fulfilling life.

Causes of hydrocephalus

The development of childhood hydrocephalus is facilitated by many pathologies and unfavorable factors. Each age has its own causes of this pathology.

So, intrauterine hydrocephalus may result from:

malformations of the central nervous system;
genetic abnormalities;
infections transmitted from the expectant mother to the fetus.

Congenital hydrocephalus most often appears for the following reasons:

consequences of infections transmitted in the womb - within 80% of cases;
consequences of birth injuries – within 20% of cases;
defects of the vascular system, intracranial tumors - very rarely.

Acquired hydrocephalus brain in children, typical in most cases for children over 1 year of age, appears as a result of:

tumors growing in the tissues of the spinal cord or brain;
suffered inflammatory processes affecting the tissues and membranes of the brain (encephalitis);
consequences of intracranial injuries received, including during labor activity;
the presence of genetic pathologies;
development of pathologies of the brain and vascular system;
hemorrhages.

Among the infections that provoke the appearance of hydrocephalus as a complication, the following are distinguished:

toxoplasmosis;
rubella;
meningococci, pneumococci;
herpes viruses;
epidermal parotitis.

The most common types of tumors that contribute to the appearance of childhood hydrocephalus are:

cranial tumors;
formations in the ventricles of the brain;
affecting the choroid plexuses;
brain cancer;
tumors localized in the cerebrospinal canals and blocking the production or absorption of cerebrospinal fluid.

Infantile hydrocele of the brain is classified according to many characteristics.

So, according to the time of formation of hydrocephalus of the brain in children, it happens:

Intrauterine– diagnosed during pregnancy, mainly at 16-20 weeks. The disease can develop in the fetus after a pregnant woman has suffered infections or viruses, against the background of a genetic predisposition, as well as abuse by the expectant mother of such bad habits like alcohol, drugs.
Congenital– occurs due to congenital abnormalities of the brain or central nervous system, premature birth, as well as during difficult labor and resulting intracranial injuries.
Acquired– develops in children aged 1 year and older under the influence of certain factors: past infectious diseases affecting brain tissue; pathologies of the vascular system; intracranial tumors and injuries.

According to morphological characteristics, hydrocephalus is divided into:

communicating (open) – occurs due to an imbalance in the production and absorption of cerebrospinal fluid;
occlusive (closed) - appears due to blockage of the liquor-conducting pathways caused by a pathological process.

In turn, the described types of hydrocephalus are divided into the following subtypes:

internal - cerebrospinal fluid accumulates in the ventricles and overwhelms them;
external (external) - fluid fills the subarachnoid space, accumulating between the membranes of the brain;
mixed - does not have a clear localization of fluid accumulation, which can fill the ventricles and subarachnoid space at the same time.

According to the criterion of stability of manifestations, the following types of hydrocephalus of the brain in children are distinguished:

progressive – with increasing symptoms and rapid deterioration of well-being;
regressing - a decrease in the intensity of symptoms followed by its disappearance;
stabilized - the symptoms are stable, while the state of health does not change, either for the better or for the worse.

Hydrocephalus is also divided into two types depending on the stage of the disorder:

compensated - despite the diagnosed hydrocele of the brain, there are no signs characteristic of this pathology, while the child develops normally and feels well;
decompensated – accompanied by severe symptoms and a significant deterioration in well-being.

Timely identification of the type of hydrocephalus in a baby allows you to select the necessary treatment and thereby prevent the development of complications and serious consequences in the future.

Diagnostics

To detect hydrocephalus of the brain in children, the first brain examination is carried out on the fetus in the womb of the expectant mother. During pregnancy, a woman undergoes an ultrasound, during which the doctor determines the size of the head and its compliance with standards. Abnormally rapid intrauterine growth of the fetal head indicates abnormal development of the nervous system and accumulation of fluid in the brain structures.

After the birth of a baby, if there are symptoms characteristic of hydrocephalus, he is prescribed the following methods and types of studies:

An examination by a pediatric neurologist involves taking measurements of chest and head circumference, checking for the presence of infant reflexes, and analyzing muscle tone.
Examination by an ophthalmologist - the fundus of the eye is examined, namely, the presence stagnant disk in the area of the optic nerve.
Neurosonography is an ultrasound screening method that is performed in infancy until the large fontanel overgrows. The technique allows you to examine the structures of the brain and determine the size of the ventricles, but a final diagnosis is not made based on its results.
Computed tomography - involves analyzing the structure of brain structures, identifying intracranial tumors and other pathologies that contribute to the formation of cerebral hydrocele.
MRI - allows you to study the structures of the brain layer by layer and determine the type of hydrocephalus if it is present.
An examination by an infectious disease specialist is necessary to determine the type of virus or infection in cases where they caused the development of hydrocephalus.
Lumbar or ventricular puncture - cerebrospinal fluid is taken between the lumbar vertebrae (in the first case) or through an opening in the skull (in the second case) to determine the level.

Such types of studies as echoencephalography, electroencephalography and rheoencephalography are ineffective in diagnosing hydrocephalus of the brain in children, so they are not prescribed to children if this pathology is suspected.

In newborns and older children, hydrocephalus must be treated, as this disease does not go away on its own and can begin to progress. To do this, depending on the type of disease and the degree of its development pediatrician may prescribe medication or surgery.

Medications are prescribed for compensated and external mild hydrocephalus forms:

diuretics– to remove accumulated fluid through the kidney system;
nootropics– to nourish the brain and improve its activity.

Nomenclature and active substance medications are determined exclusively by the attending physician, taking into account the age of the baby, general state and the risk of side effects.

IN advanced cases or if hydrocephalus progresses rapidly in a child, doctors resort to surgical treatment. The most effective types interventions with minimal risk development of complications are:

Ventriculoperitoneal shunt– removal of excess fluid from the ventricles into the abdominal cavity using special catheters.
Endoscopic ventriculostomy– insertion of an endoscope into the cavity of the subarachnoid space through small incisions in the skin to drain accumulated cerebrospinal fluid. This type of surgical intervention is most indicated for newborns and infants up to one year of age, as it minimizes the risks of postoperative complications and consequences.

After treatment, the baby should be under regular medical supervision.

With the right treatment method, the child has every chance of making a full recovery and developing on par with his peers.

Consequences of hydrocephalus

Doctors' prognosis for a diagnosis of cerebral hydrocephalus in children depends on many criteria - the cause and type of pathology, the degree of its neglect. The most favorable prognosis is made with a communicating (open) form. Due to the nature of its course, congenital hydrocephalus is tolerated more easily by children compared to acquired hydrocephalus.

In cases where cerebral hydrocele is diagnosed in time and the child receives adequate treatment, he has every chance of recovery, as well as full mental and physical development. If you neglect treatment and do not follow doctors’ recommendations, as your baby grows older, he or she may experience the following consequences:

developmental delay, both physical and mental;
decreased vision, up to complete blindness;
regular attacks of cephalalgia caused by;
speech disorder;
epileptic seizures;
mental disorders.

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When the cerebrospinal fluid tract is completely blocked and there is excessive accumulation of fluid in the brain structures, there is a risk fatal outcome, if the child is not provided with prompt medical care.