Signs of external and internal hydrocephalus. Hydrocephalus (dropsy of the brain) - what it is, causes, signs and symptoms of hydrocephalus in adults and children, diagnosis and treatment

Hydrocephalus of the brain can act as an independent disease, or as a complication after strokes, tumors, cerebral hemorrhages, traumatic brain injuries, and infectious processes in the brain.

Hydrocephalus of the brain can acquire a nosological form, which is characterized by rapid accumulation cerebrospinal fluid in the liquor spaces. Hydrocephalus of the brain in adults manifests itself differently depending on the forms and causes of the disease:

• Impaired production of cerebrospinal fluid (CSF) causes a hypersecretory form of the disease, in which the ventricles of the brain enlarge;
• Improper CSF circulation causes distal, proxinal and occlusive hydrocephalus;
• Impaired absorption of CSF provokes the aresorptive and dysresorptive forms of the disease.

IN recent years hydrocephalus in adults began to appear much more often, although in the past it was generally believed that this was exclusively childhood disease. The percentage of newborn children with this disease has also increased significantly: now for every thousand children there are from one to ten children with hydrocele.

Neurologists and neurosurgeons are involved in diagnosis and treatment, but since the development of the disease in adults has not yet been fully studied, there are no clear diagnostic criteria doesn't exist yet.

The name "dropsy of the brain" (another name, official name- hydrocephalus) speaks for itself: it is characterized by the appearance of excessive amounts of “water”, or cerebrospinal fluid, in one or more ventricles of the human brain.

Normally, the human brain has a small amount of this fluid inside, but dropsy begins when there is a drainage problem, or blockage. This disease is dangerous because excess fluid accumulates between the brain and the walls of the skull, putting pressure on the soft tissue of the brain, which leads to its damage and severe cases may result in death.

Brain fluid, its functions and localization

To understand what hydrocephalus is, you will need a brief excursion into the structure of the brain.

Cerebrospinal fluid, also called cerebrospinal fluid, healthy person washes away the gray and white matter head and spinal cord. Its functions are to protect and nourish brain tissue. From the outer part of the brain surface, cerebrospinal fluid moves between choroid And soft tissues, in a special space called subarachnoid, along the surface (cloak) of the cerebral cortex.

At the bottom of the skull, under bottom brain, there are special cavities - tanks where liquor accumulates. They are connected to each other and to the subarachnoid space of the spinal cord. The main part of the cerebrospinal fluid is contained in the cerebral ventricles, located in cerebral hemispheres, and in the middle, along midline brain Through a narrow canal in the medulla oblongata there is communication with the fourth ventricle.

Dropsy of the brain can be congenital or developed throughout life. The prognosis depends on how quickly and accurately the diagnosis is made and treatment is started. The condition may be aggravated concomitant diseases(for example, mental disorders).

Hydrocephalus of the brainrefers to a dangerous disease of a neurological nature, the causes of which lie in excessive fluid content in various partsbrain. This disease is often also calleddropsy, which occurs due to the accumulation of cerebrospinal fluid in different partsbrainperson. This disease, regardless of the causes that caused it, requires mandatorytreatmentwith the involvement of highly qualified specialists.

Hydrocephalusobserved even in children. This is the field of study of neurosurgeons and neurologists.

Hydrocephalus brain: reasons, treatment

Before considering the forms of this insidious disease Let us dwell in more detail on the reasons that caused it. This disease can be caused by: infections associated with : meningitis, encephalitis, etc.; neoplasms and pathologies; encelopathy; traumatic injuries heads; congenital anomalies in the central nervous system.

CSF or cerospinal fluid is responsible for supplying the brain nutrients and removal of various toxins. In order for the brain to function properly, it is necessary to remove fluid from the ventricular space in a timely manner. In case of developmenthydrocephalusthis outflow slows down, and the formation of cerebrospinal fluid occurs in the same volume. As a result, the ventricles become overfilled with cerebrospinal fluid and subsequently expand. The consequences of such processes can be disastrous, including hemorrhage. In order to avoid this condition, you need to know the main signs of the disease.

Hydrocephalus brain : symptoms

The manifestations of this disease depend on the age of the patient, as well as the speed of development of the disease. In newly born childrenhydrocephalusmanifests itself in such noticeable external manifestations How:

Such manifestations should alert parents. Often these manifestations are accompanied by strabismus, gag reflexes, as well as anxiety during sleep and even some disruption of the functioning of auditory and visual receptors.

In children, the disease manifests itself in the difficulty of the child’s learning, as well as in the disruption of his mental activity. In most cases in infantsdropsy – congenital disease, which occurs as a result of infections suffered by the mother during pregnancy. Although it happens thathydrocephalusis acquired in nature (for example, when a child has suffered meningitis or injuries to the skull).

Hydrocephalus brain atadult : symptoms

U adultsIn people, the disease manifests itself as follows:

• migraines with the onset of nausea with a significant increase in blood pressure;
• impaired coordination of movements;
• double vision;
• frequent mood swings with constant feeling feeling of anxiety;
• predominance of depression;
• the occurrence of hallucinations, disturbances of consciousness, and other nervous disorders;
• partial memory loss.

Signs will differ depending on the stage of development of the disease, the level of fluid pressure in the spinal canal, and the mechanism of development. Uadultspeople are distinguished into two stages: acute and chronic. When the second stage occurs, the disease progresses sharply.

In the acute course of the disease, most complaints are associated with stronghead onespain mostly in the morning. The patient feels “heaviness” in the eyes, the appearance of “sand”. As the course progresses, the patient develops a feeling constant drowsiness, visual impairment as a consequence of increased accumulation of cerebrospinal fluid. If in this case you do not apply for qualified assistance, then such a condition can lead to dislocation syndrome with impaired consciousness, strabismus and possibly even a coma.

Chronic hydrocephalusmostly develops gradually. Firstsymptom, which is typical for early stage This disease is a violation of a person’s functional activity and the occurrence of insomnia. Next is a violation of movement coordination. Gait whenhydrocephalusbecomes shaky and movement is often difficult. The progression of the disease can lead, even in particularly severe cases, to the fact thatadultperson is violated motor activity up to the impossibility of walking.

In most patients with chronichydrocephalus arise symptomsassociated with disruption of the urinary system ( frequent urination not only at night, but also during the day, as well as urinary incontinence).

Diagnosticshydrocephalus

To diagnose this disease, methods are mainly used such as computed tomography, MRI, cystenography of the cisterns of the base of the human skull, radiography of blood vessels by introducing a special substance into the arteries, as well as neuropsychological examinations related to the collection of tests, identificationsymptoms etc.

Hydrocephalus brain : varieties and symptoms

The causes of this disease directly depend on the form of this disease. There are: internal, external and mixeddropsy. Internal hydrocephaluscaused by accumulation in the ventriclesbraincerebrospinal fluid in significant quantities. This form of the disease occurs due to disruption of the central nervous system. nervous system, the occurrence of strokes, enphelopathies of various natures, traumatic lesionsbrain etc.

Outdoor hydrocephalusdevelops due to an excess of cerebrospinal fluid in the subarachnoid space. This formhydrocephalusis a consequence of the rapid progression of atherosclerosis, as well as increased intracranial pressure, injuries suffered not only of the skull, but also cervical regions spine.

Mixed hydrocephalusmost often occurs in old people. The reasons lie in high blood pressure, the development of atherosclerotic manifestations, excessive alcohol consumption, etc. This typehydrocephalusin young children it manifests itself as sleep disturbances, unnatural turns of the head, convulsions, constant crying, poor appetite. Externallyhydrocephalusin infants it manifests itself in large sizes skullsTreatment mixed hydrocephalus of the brain at adultsshould be based on the results of tomographic and clinical trials.

Depending on the time of occurrence and characteristics of the course, they are distinguished: acute (the disease progresses over several days); subacute (progression and development occurs within 3 weeks - a month);moderate, when the disease can develop up to six months or more.

The last type is the most difficult to determine.hydrocephalus of the brain, which does not manifest itself for a long time. A person lives with this disease for a single year and does not suspect the presence of such a disease, and then there is a sudden deterioration in health due to circulatory problemsbrain.

Treatment hydrocephalus of the brain at adultsis assigned based on the stage at which it is detected. On initial stage emergence of weaksymptoms hydrocephalus of the brain For treatmentmedications that normalize blood pressure, diuretics and antibiotics are used. In especially severe cases with the risk of this type of transitionhydrocephalusV acute form the doctor may prescribe surgery.

According to the pressure level they distinguishhydrocephalus:

• hypertensive;
• normotensive;
• hypotensive.

Hydrocephalus of the brain : treatment insidious disease

Getting rid of hydrocephalus brain at adult, like any disease, it is necessary to begin with a thorough examination of the patient under the strict supervision of doctors of this profile. To begin with, any personadultor child, the cause that triggered the development of hydrocephalus is establishedbrain. If the disease is found in its initial stage, then treatment may be limited to taking medications. The main thing is a decrease in intracranial pressure, which has gone beyond the norm due to the accumulation of cerebrospinal fluid
sti in cavities .

Often the following are used as non-operative remedies at this stage:

• soothing baths with vegetable oils and salts;
• conducting physical therapy;
• diet with exclusion of liquid intake;
• taking medications that inhibit rapid developmenthydrocephalus.

Medicines that are used to get rid ofhydrocephalusat the initial stage: diuretics, plasma expanders, vasoactive agents, glucocorticosteroids, painkillers, barbiturates.

If the patient who applies has clinical manifestations disease, then this method of treatment will have no effect. In case of development of a severe formhydrocephalus of the brainimmediate intervention by neurosurgeons is necessary. During operations, drainages are used with the administration of medications, which not only help to significantly reduce blood pressure, but also dilute blood clots. In any case, the purposetreatment mixed hydrocephalus of the brainmust be taken by a medical specialist.

Treatment chronic hydrocephalusis also surgical intervention, which promotes the outflow of excessively formed cerebrospinal fluid into those areasbrain, where the absorption process is not impaired. In this case, various shunt devices are used. Despite the effectiveness of bypass surgerybrainthis method has a number of disadvantages associated with a short period of operation, as well as the inability to use shunts with a large diameter.

Shunting happens various types: ventriculo-atrial (connection of the ventricles with the right atrium), ventriculo-peritoneal (cerebrospinal fluid is redirected to abdominal cavity), ventriculocisternostomy and atypical shunting. Such operations take several hours, and the patient then remains in the hospital for no more than three days. To make shunts, a substance based on silicone is used. It is absolutely harmless to the human body.

Treatment dropsy brain at adultsin progressive countries it is carried out using neuroendoscopy. This method is as follows: the endoscope is inserted into the channelsbrain, then using a catheter, a hole is drilled in the ventricle to allow cerebrospinal fluid to flow out. This method is effective and does not require constant interventions; the operation itself is performed within 30 minutes, but it is expensive, so not every patient can do it.

All of the above features and symptoms relate totreatment hydrocephalus of the brain at elderlypeople. Produced diagnostic examinations, the stage of development of the disease is determined, and medications are prescribed or a decision is made on surgical intervention forhydrocephalus of the brain. Symptomsand the results of clinical trials will be the main factor in making a decision, as inadults, and in children.

Hydrocephalus of the brainrefers to the insidious and dangerous disease, therefore, in case of the slightest suspicion and the occurrence of the abovesymptoms at adultsand children should immediately seek help from doctors. Delaying the process of going to the clinic and ignoring itsymptomscan lead to disastrous consequences.

Hydrocephalus or hydrocephalus is a disease that affects not only young children, but also adults. It is very dangerous and can lead to extreme serious consequences. It will be useful for you to know what specific symptoms does hydrocephalus have and what are the methods of treating the disease.

What is hydrocele in adults?

Hydrocephalus is a disease in which cerebrospinal fluid accumulates in the head. Doesn't mean ordinary water, and cerebrospinal fluid. If in children dropsy, as a rule, is congenital, in which the head is enlarged in size, as can be seen in the photo, then in adults it appears as a result past diseases. The disease is very difficult to detect and some even die from it. The effectiveness of treatment for hydrocephalus of the brain in an adult depends entirely on the degree to which it was detected. Each type of dropsy has its own characteristic manifestations.

Symptoms and signs of hydrocephalus

There are external, internal and mixed type dropsy. Moreover, the latter is considered the most dangerous. Mixed hydrocephalus involves a reduction in the brain, in which the accumulation of liquid is coming both in the ventricular and subarachnoid spaces. If it is moderate, then the patient has practically no complaints and can live with it for a very long time. In more serious cases, the manifestations of hydroencephalopathy in adults are as follows:

1. Headache. It hardly goes away, but in the morning it is stronger than in other periods.
2. Nausea. Like headache, it is especially acute in the morning.
3. Drowsiness. This symptom signals that hydrocephalus is accompanied by other neurological disorders.
4. Speech disorders, memory problems.

Outdoor

This is non-occlusal replacement hydrocephalus. The subarachnoid space is expanded, and fluid accumulates in it. An adult with this disease will experience the following symptoms:

• constant feeling fatigue;
• nausea, vomiting;
• minor visual impairment;
• sweating;
• double vision;
• changes in sexual behavior;
• walking disorders.

Internal

If an adult has triventricular occlusive hydrocephalus, in which cerebrospinal fluid fills the spaces of the ventricles, he may suffer from:

• increased intracranial pressure;
• nausea, vomiting;
• severe headaches;
• problems with vision and hearing.

Causes of hydrocephalus in adults

A huge number of factors can provoke dropsy of the brain. The disease occurs due to:

• suffered a stroke;
• infectious diseases of the brain and membranes (meningitis, encephalitis, ventriculitis, tuberculosis);
• tumors;
• vascular pathologies, including aneurysm ruptures;
• head injuries and post-traumatic conditions (normotensive hydrocephalus);
• neurodevelopmental disorders;
• disturbances in the production, circulation, and absorption of cerebrospinal fluid;
• low brain matter density.

Treatment

Hydrocephalus of the brain in an adult is diagnosed using the following methods:

1. MRI. It helps not only to verify the correctness of the diagnosis, but also to determine its causes.
2. Computed tomography.
3. Cisternography. Diagnostics is used to determine the type of hydrocephalus.
4. Neuropsychological examination.
5. X-ray with contrast agent.

If, as a result of one or more of these studies, the prognosis is confirmed, the following treatment methods are used:

1. Drug therapy. The option is suitable if hydrocephalus is moderate. An adult patient is prescribed medications that reduce intracranial pressure(Lasix, Mannitol), diuretics. During therapy, light therapeutic massage. All this will help stabilize the adult patient’s condition, but not cure him, but achieve a subcompensated stage.
2. Brain shunt. It is not used for chronic hydroencephaly, inflammation, or vision problems, but is effective for asymmetrical forms. An adult patient is given a drainage through which excess cerebrospinal fluid goes to other spaces of the body. In the vast majority of cases, the operation gives positive result. After some time, the adult fully returns to his ordinary life. Periodically, secondary shunt installation is necessary.
3. Endoscopy. Effective for mixed, replacement, symmetric hydrocephalus. Endoscopic surgery is performed using micro-instruments. With their help, fluid and the cause that disrupts its circulation, for example, a tumor, are removed.
4. Folk remedies. They are effective solely to suppress the symptoms that manifest hydrocephalic syndrome. It is recommended to use diuretics herbal infusions(oregano, bearberry, parsley), juniper berries, alcohol solution calamus root
5. Diet. In the case of hydrocephalus of the brain in an adult, it is necessary to follow nutritional rules aimed at improving metabolism water-salt balance. You need to categorically avoid foods that cause fluid to accumulate in the body. This fresh bread, fatty meat and poultry, smoked meats, sausages, sweets. You need to eat more instead fresh vegetables and fruits, porridge. Dishes are best cooked steamed.

Consequences of the disease

The disease can be cured with timely detection and selection the right way therapy. However, in an adult this does not always happen so quickly. If hydrocephalus is not treated, the condition will worsen and the symptoms will progress. As a result, an adult faces complete dementia. In particularly severe cases, hydrocephalus leads to fatal outcome.

Video about hydrocephalus

This disease occurs due to excessive accumulation of cerebrospinal fluid (CSF) in the brain. IN healthy body this fluid is formed in the ventricular part of the brain, after which it enters the spinal canal and is absorbed into the blood. When hydrocephalus occurs, no transport or absorption occurs and fluid remains where it should not be present in such quantities.

Dropsy of the brain - description of the disease

Hydrocephalus occurs mainly in children, but can also affect adults. The accumulation of fluid in this disease leads to the pressing of brain tissue against the skull, which contributes to the disorder normal operation brain

If timely treatment is not started, the disease can lead to irreversible consequences in the brain tissue and cause death.

In a healthy person cranium contains about 150 ml of cerebrospinal fluid. Exceeding this amount indicates pathological disorders in the activity of the body.

Hydrocele of the brain in a child

Medical statistics indicate that about 70% of newborns suffer from hydrocephalus in an obvious or hidden form.

In children under one year old manifestations are:

• crying for no reason;
• sleep disorders;
• frequent regurgitation;
• throwing your head back during sleep;
• increased muscle tone (hands clench into fists, toes stretch forward);
• lack of step reflex;
• delayed motor and mental development;

In preschoolers and schoolchildren dropsy causes:

• hypermobility;
• hysterical reactions;
• stuttering;
• urinary incontinence (enuresis);
• strabismus;
• frequent colds;
• developmental delay (impaired diction, poor vocabulary);
• nosebleeds;
• poor academic performance;
• fatigue;

The main cause of dropsy in newborns is infectious diseases suffered by the mother during pregnancy.

The most obvious symptom of hydrocephalus in children is an increase in the volume of the head and the characteristic shape of the skull with protrusion where the bones have not had time to fuse.

Species

Classification of hydrocephalus according to its origin:

• congenital;
• acquired;

According to pathogenesis, dropsy is divided into three main forms:

• Closed (or occlusal)- in which the outflow of cerebrospinal fluid is disrupted due to the closure of the path by a tumor, blood clot or other pathological formations;
• Open (or communicating)- a form in which the absorption of cerebrospinal fluid into the circulatory system is disrupted;
• Hypersecretory- a form in which the ventricular parts of the brain produce an excess amount of fluid;

Causes of the disease

The direct cause of the disease, as already mentioned, is disturbances in the outflow of fluid or its excessive synthesis in the body. This can occur due to congenital and acquired anomalies.

Hydrocephalus can develop both as a result of maternal infection and due to infections affecting the weak children's body in the first months after the birth of the child.

Dropsy in adults develops due to the presence of tumors and blood clots in the brain; Infectious diseases can also contribute to the occurrence of disturbances in the outflow of cerebrospinal fluid.

Risk factors

Factors influencing the development of hydrocephalus may be:

• prematurity ( birth injuries accompanied by hemorrhages);
• infectious diseases of the uterus during pregnancy (herpes, toxoplasmosis);
• birth defects (malformations of the brain and spinal cord);
• meningitis (the consequences of these diseases can lead to the formation of tumors);
• bleeding in the brain;
• head injuries;

Symptoms

In infants

Hydrocephalus in infants manifests itself in the form of the following symptoms:

• rapid growth in head size with accompanying thinning of the skull bones;
• the appearance of a venous network on the face;
• tense fontanelle (can remain open for up to 2 and 3 years, whereas normally the fontanelle should close for up to a year);
• nausea and vomiting;
• sleep disorders;
• convulsions and seizures;
• throwing back the head;
• eye rolling;
• changes in the fundus, visual impairment;
• delays in physical and mental development(the child cannot hold his head up, sit or stand up, he does not play, is unmotivatedly whiny, lethargic and apathetic, sometimes grabs his head - perhaps experiencing a headache);

In adults

Dropsy in older children and adults has the following symptoms:

• epileptic seizures;
• enuresis (urinary incontinence);
• stunting or gigantism;
• premature sexual development;
• violation hormonal functions (reduced output hormones - for example, the thyroid gland);
• headaches and accompanying vomiting;
• blurred vision, diplopia (double vision), blurred vision;
• loss of coordination of movements, changes in gait;
• weakness and fatigue;
• irritability;
• memory loss;
• impaired thinking, confusion, dementia, personality changes;

In older people, dropsy of the brain may be accompanied by weakened intellectual abilities, a staggering gait and general inhibition of mental processes.

When to see a doctor

Seeing a doctor is necessary if any of the above-described manifestations are present: than earlier illness will be diagnosed, the more successful the therapy will be. This is especially true for infants.

If the child often and without apparent reason cries, has difficulty breastfeeding, does not want to tilt the head or turn, has trouble breathing, and if you experience seizures, changes in the eyes, face or structure of the head, you should seek medical advice and help immediately.

Examination and diagnosis

Primary diagnosis diagnosed by a neonotologist (newborn specialist), pediatrician, surgeon or neurosurgeon. The most accurate diagnosis is achieved with the help of additional studies.

Diagnosis of hydrocephalus is based on observation clinical picture, fundus examination, as well as hardware procedures:

• neurosonography;
• Ultrasound of the brain;
• computed tomography;

This equipment is not available in all hospitals, but if necessary, parents should conduct an examination in private clinic on a commercial basis. Diagnosis in adults is also carried out through examination in a magnetic resonance chamber.

If we're talking about about making a diagnosis of hydrocele of the brain in the fetus, then they resort to three-dimensional ultrasound and Dopplerography. Based on the data obtained, a diagnosis is made or refuted.

In this case, the results of several fetal examinations are considered reliable. different dates pregnancy in order to eliminate the possibility of error as much as possible.

In the photo you can see what hydrocele looks like

Treatment

How to treat dropsy of the brain in this or that case is decided only by the attending physician; there can be no talk of any self-medication. This is very dangerous disease, which, in the case inadequate treatment, can lead to serious consequences.

Medication

At the initial stage of the disease, treatment is carried out with the help of medications, but often this method of therapy turns out to be ineffective and helps only in cases of a very weak, hidden type of cerebral hydrocele.

Surgical

Most commonly used therapeutic methods for hydrocephalus are surgical, as they provide a greater chance of complete recovery.

Bypass surgery

The most common method of surgical intervention for hydrocephalus is ventriculoperitoneal shunting.

To do this, special silicone catheters with valves are inserted into the cranial cavity, through which fluid from the brain is drained into the abdominal cavity. Thus, optimal intracranial fluid pressure is maintained.

The amount of cerebrospinal fluid flowing from the cranial cavity is regulated by special valves.

Such operations are performed in hundreds of thousands per year and save the lives of many newborns.

Complications of bypass surgery

Minus this method is the small diameter of the shunt. The tube easily becomes bent and clogged, and within a few years it fails; in this case, it needs to be replaced. This procedure must be performed immediately, which can be problematic if the patient is far from the clinic.
Other possible complications with bypass:

• shunt infection;
• infection of the ventricles of the brain and meninges;
• overdrainage (too rapid outflow of cerebrospinal fluid);
• hypodrainage (too slow outflow);

External drainage systems

This method removal of fluid from the ventricles of the brain is used in extreme cases when it is impossible to remove cerebrospinal fluid by other means.

This operation is accompanied by the greatest number of complications, of which the most dangerous are associated with a high risk of infection.

Because of this, there may be dangerous inflammations. In this case, the infected drainage is removed urgently.

Endoscopic treatment of hydrocephalus

New modern method Treatment of hydrocephalus - endoscopic ventriculostomy. This operation is more often performed in foreign clinics; in Russia this technique is not widespread due to high cost equipment. The method is safe and reliable.

Doctors penetrate the brain canals using a special device - a neuroendoscope with a mini-video camera, the image from which is transmitted to a computer monitor. From the picture, surgeons see exactly where the intervention needs to be performed in order to create an outflow of cerebrospinal fluid. Then using special catheter a hole is made, and the fluid flows freely from the brain along a bypass route.

This operation is performed only once and does not require further intervention in the brain to replace the tubes. It is very effective and allows you to avoid introduction into the body foreign bodies. However, it is advisable surgery not in all cases of hydrocephalus.

Folk ways

Treatment of hydrocephalus folk ways It is unlikely to be effective and can only bring temporary relief to the patient. There are folk recipes decoctions and infusions that a patient with dropsy should drink.

Plants that are used in these methods are adonis, parsley, bearberry, oregano, and cornflower. It should be remembered that no self-treatment dropsy cannot be performed without the approval of the attending physician.

Rehabilitation treatment

Rehabilitation treatment after surgery is compliance with standard medical instructions. The operated child must be protected from possible infections and head injuries, falls, bruises and excessive physical activity.

Often high blood pressure may be associated with, which due to its characteristics is difficult to diagnose.

Consequences of the disease and prevention

The prognosis for dropsy of the brain directly depends on the timeliness of diagnosis and appropriate treatment.