home Folk remedies Mild hydrocephalus of the brain in a child. Causes of internal hydrocephalus. By time of occurrence

Mild hydrocephalus of the brain in a child. Causes of internal hydrocephalus. By time of occurrence

Hydrocephalus or hypertensive-hydrocephalic syndrome is a condition that includes two main symptoms: an increase in intracranial pressure and an increase in the content of cerebrospinal fluid in the ventricular system of the brain. Some people mistakenly believe that in addition to these signs, another main one is an increase in head size. This judgment is partly valid, since it will be typical for children under 2 years of age. At an older age, when the bones of the skull are already tightly fused, an increase in the size of the head is not observed.

Liquor is clear liquid, produced by special cells located in the ventricles of the brain. This fluid contains a small number of cells (neutrophils, white blood cells), sugar, proteins and electrolytes. Produced in the ventricles of the brain, cerebrospinal fluid flows through special ducts from the cavities of the brain, washing the brain and spinal cord from the outside. Occurs in the ventricles of the brain reverse suction cerebrospinal fluid into the blood. The volume of cerebrospinal fluid varies depending on age, ranging from 40 ml in newborns to 150-200 ml in adults.

The ventricular system of the brain consists of 4 ventricles interconnected and communicating with the space around the brain. Ventricles are cavities in the brain that contain special cells that produce and absorb cerebrospinal fluid.

Causes of hydrocephalus

Reasons causing increased intracranial pressure:

1. Prematurity. Very often, premature babies experience increased intracranial pressure. This is due to the fact that children have not fully completed their development, which is necessary for life in the external environment. The child’s body is subject to a strong impact, and all systems and organs try to throw all their strength into helping the child adapt to the impact environment. But the body’s reactions are not yet perfect, so so-called perverted reactions very often occur, one of which is increased production of cerebrospinal fluid.

2. Transferred infections mother during pregnancy. Some infections, especially viral ones, contribute to developmental disorders nervous system, in particular the brain. Depending on what stage of pregnancy the infection occurred, various abnormalities in brain development may be observed, including its complete absence. Such infections may include rubella, toxoplasmosis, herpetic infection, cytomegalovirus infection. If the infection occurred on early stages pregnancy, this leads to the development of defects that are incompatible with the life of the fetus, and because of this, termination of pregnancy occurs. If the infection occurred more than later, then this leads to the development of minor brain lesions, one of which is hypertensive-hydrocephalic syndrome.

3. Bad habits mother. Smoking, alcohol abuse, and drug use by the mother of the child before and during pregnancy lead to impaired brain development.

4. Injuries. A baby can suffer head injuries during birth or throughout life. Concussions very often lead to an increase in the production of cerebrospinal fluid.

5. Brain tumors. Space-occupying lesions in the brain lead to increased intracranial pressure. Special place occupy tumors that prevent the outflow of cerebrospinal fluid from the ventricular system of the brain, since in this case the development of hypertensive-hydrocephalic syndrome occurs quite quickly.

Symptoms of hydrocephalus in children

Clinical manifestations of hypertensive-hydrocephalic syndrome vary slightly up to 2 years of age and in older children.

In children under 2 years of age, the first signs of the development of hypertensive-hydrocephalic syndrome, which the child’s parents and doctors begin to pay attention to, are an increase in the size of the head. The head size is measured by a pediatrician at a clinic appointment once every 3 months. In this case, the doctor evaluates the rate of increase in head circumference and the ratio of this value according to chest circumference. Normally, a child is born with a head 1-2 cm larger than the chest circumference. The growth rate of chest circumference is slightly higher than the growth rate of head volume, so by 6 one month old head circumference is smaller than chest circumference. If the head circumference remains larger than the chest circumference, you need to be wary of the child developing hydrocephalus.

This happens because the child’s head bones are not yet tightly fused and can shift relative to each other, creating additional volume. Increased intracranial pressure puts pressure on the bones, causing them to move apart. Also, increased intracranial pressure causes bulging of the large fontanel and its pulsation. Children with hypertensive-hydrocephalic syndrome are very often capricious, whiny, sleep poorly, wake up very often, and do not gain weight well. The lag of such children in psycho-motor development is noteworthy: children hold their heads poorly, do not smile, begin to sit up late, crawl, walk, and do not talk. All children with such symptoms should be consulted by a neurologist to rule out hydrocephalus.

In children over 2 years of age, the skull bones are already fused together, so they cannot diverge, creating additional volume. Therefore, the main symptom of increased intracranial pressure in such children will be headaches, blurred vision, convulsions, and loss of consciousness. Children begin to sleep poorly and often wake up in the middle of the night, sometimes screaming. Children may experience nausea and vomiting, especially if the headache gets worse.

Noted increased fatigue, especially in the afternoon, children fall behind in their studies and their performance decreases. Increased headaches can be triggered by physical and mental stress, psycho-emotional shock and stress. In some cases there may be nose bleed at the peak of a headache. Since intracranial pressure increases, this affects the nearby nervous system, in particular the organ of vision. The nerve endings of the eye enter the brain through special openings in the skull. These holes are not isolated from the brain, so all changes in the brain are reflected before our eyes. Due to increased pressure in the cranium, disc swelling occurs optic nerve on the fundus. This affects vision and can lead to complete loss.

Examination for suspected hydrocephalus

If a child develops any neurological symptoms, you must definitely contact your pediatrician. The doctor will examine the child, evaluate his physical, neuropsychic development and give recommendations. If the child really has some kind of disorder, the pediatrician will always recommend that you consult a neurologist to clarify the diagnosis.

To make a diagnosis of hypertensive-hydrocephalic syndrome, the child needs to undergo a brain examination. In children whose fontanelle is not yet closed, neurosonography can be performed - ultrasonography brain. This study can be carried out in such children, since there are no bones in the fontanel area that prevent ultrasound. This study very informative and completely harmless.

In children whose fontanelle is already closed, the brain is examined using magnetic resonance imaging (MRI).

In addition, a lumbar puncture can be performed to exclude the diagnosis of meningitis. With meningitis, there is also an increase in the production of cerebrospinal fluid, but with hydrocephalus this is a long process, and the composition of the cerebrospinal fluid does not change. With meningitis, the process develops acutely (quickly), and changes occur cellular composition, content of electrolytes, sugar, protein in the liquor.

Treatment of hydrocephalus in children

The method of treatment for hypertensive-hydrocephalic syndrome depends on the severity of the disease and the causes that cause it.

With the development of hydrocephalus in premature newborn Dynamic observation is necessary, since this condition has a so-called transient nature. The child continues its development outside the mother’s womb, so after some time the child’s organs and systems mature and the increased production of cerebrospinal fluid stops. To help a child cope with increased intracranial pressure, taking medications that reduce the production of cerebrospinal fluid helps. Such a drug is diacarb. Prescribing this drug is possible only after examination by a neurologist.

In severe cases of hypertensive-hydrocephalic syndrome, with advanced cases, a consultation with a neurosurgeon is necessary to decide on bypass surgery. During this operation, the ventricular cavities communicate with the abdominal cavity using special tubes. Excess cerebrospinal fluid through these tubes will flow into the abdominal cavity and get sucked in there. The operation is quite complicated, but has a good therapeutic effect.

A special place will be occupied by hypertensive-hydrocephalic syndrome associated with a brain tumor. All brain tumors are initially considered malignant. This is due to the fact that the volume cranium The unit is quite constant, so any growth within this volume leads to compression of the brain. If a brain tumor is detected, an urgent consultation with a neurosurgeon is necessary and a decision on the issue of surgical treatment is necessary.

After treatment of hydrocephalus, children are observed by a neurologist for two years. This is necessary to prevent recurrence of the disease. After surgical treatment, children are observed by a neurosurgeon.

Prognosis for hydrocephalus

The prognosis of the disease is favorable. Children develop well and catch up with their peers in neuropsychic and physical development. However, if you contact a doctor late in children with an open large fontanelle, it is possible to develop cosmetic defect in the form of an enlarged head and a change in the shape of the head.

Pediatrician Litashov M.V.

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
removal of harmful substances from the brain 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 - 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 bones skull, so excess cerebrospinal fluid usually 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. The closed type of the disease occurs if there is a physical obstacle to the outflow of cerebrospinal fluid from the designated containers of the skull 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 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 open type diseases.

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 congenital closed form. In addition, 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. With the mixed type, an increase in fluid volume is observed 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 pressure) and hypotensive (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 several increased values 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 young children, as a rule, symptoms are pronounced. First of all, attracts attention big size skulls 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 various departments 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 can 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 of the 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, 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. The main symptom of increased ICP is constant headaches that cannot be relieved with analgesics. Headache most often increases in the morning, which is associated with an increase in ICP at night. At acute form hydrocephalus can 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 identify 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 the situation has changed for the better.

In children, the disease is most often diagnosed by a pediatrician when regular inspection child. The doctor may pay attention to such obvious signs hydrocephalus, such as enlargement of the head, bulging fontanelle, dehiscence of the sutures of the skull, changes appearance 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. Such a diagnosis is 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 to introduce 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.

Fundus examination can also be used for diagnosis, helping to 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 can be used in the treatment of neurological disorders associated with hydrocephalus, such as seizures.

When diagnosing a disease, one should take into account the dynamics of what is happening pathological changes. 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.

If there is no 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 may 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.

In case of closed hydrocephalus, the main efforts of the surgeon should be aimed at eliminating the obstacle that interferes with normal circulation 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 carried out using surgical instruments, electrode or laser, and allows you to restore the functions 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 mild case forms of hydrocephalus can only be treated 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 with the maintenance of their 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 is pathological condition, resulting from an imbalance between the production and absorption of cerebrospinal fluid (CSF) that washes the brain. The excess fluid that accumulates as a result begins to put pressure on the brain structures and nerve endings, thereby causing disturbances 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 of 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 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;
transferred inflammatory processes affecting the tissues and membranes of the brain (encephalitis);
consequences of intracranial injuries received, including during labor;
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 the expectant mother’s abuse of such addictions as alcohol and 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 identified type of hydrocephalus in a baby allows you to select necessary treatment and thereby prevent the development of complications and serious consequences in 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:

Inspection 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 collected between the vertebrae lumbar region(in the first case) or through a hole 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 hydrocephalus light form:

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 with rapid progression of hydrocephalus in a child, doctors resort to surgical treatment. The most effective types interventions with minimal risk development of complications are:

Ventriculoperitoneal shunt- excretion from the ventricles excess liquid 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 undergoes 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.

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, which 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 (cerebrospinal fluid accumulates around the skull, this is visualized as big head), internal (the accumulation of cerebrospinal fluid occurs 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;
"lowering" 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 increased ICP(), and such a diagnosis also implies the appearance of hydrocephalus in the baby, because the increase in ICP is 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 of the 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 form of flow of the accumulating cerebrospinal fluid, the following are distinguished:

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 a decrease in the volume of gray matter in the 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 it at all) medical care for 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;
constant severe headaches caused by a further increase (permanent) intracranial pressure in the child;
development of visual impairment, up to the onset of blindness;
a significant lag behind peers in physical and mental development;
appearance epileptic seizures at the baby's.

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 liquid discharged 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 Torkildsen 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 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 that reduces the volume of cerebrospinal fluid production. In addition, the patient is under constant supervision of a specialist neurosurgeon/neurologist, who carefully monitors all changes in the patient’s condition.

Remember that regardless of your fear of surgery, you can save your child during surgery! Yes, your baby will have several catheters implanted, but he will live!

Video on the topic

Tips for parents with hydrocephalic syndrome in children:

“Dropsy” or hydrocephalus in the fetus during pregnancy occurs due to concentration or obstructed outflow large quantity cerebrospinal fluid in the brain. The cerebrospinal fluid does not find a way out and puts pressure on the brain. As a result, the baby's head enlarges and development, both mental and physical, is disrupted.

Causes of hydrocephalus in the fetus during pregnancy

Normally, cerebrospinal fluid is pushed out of the chambers of the brain and moves towards the spine, where it provides protection and nutrition. The cerebrospinal fluid is then absorbed and absorbed by surrounding tissues.

Congenital hydrocephalus in the fetus during pregnancy develops due to cerebrospinal fluid retention. The body is not able to remove the fluid, its stagnation begins and has an adverse effect on the development of the baby.

The reasons that lead to the occurrence of pathology are associated with genetic predisposition. If parents or close relatives have such a disease, the geneticist will draw the attention of doctors to this fact. In order not to miss the disease and to track its development over time, regular ultrasound examinations will be prescribed.

Other causes of the disease include:

infectious diseases (rubella, cytomegalovirus, herpes, toxoplasmosis, syphilis);
pathology of the brain or spinal cord;
developing malignant tumors.

Any birth defects(Chiari syndrome, chromosomal abnormalities, narrowing of the canal) are also provoked by the accumulation of cerebrospinal fluid.

The volume of the baby's brain is often much larger than the skull, pressure is created, fluid stagnates, and the head increases in size.
Therefore, when diagnosing with ultrasound, it is necessary to pay attention to the shape and parameters of the head. Measurements are taken in cross section. In this case, the width of the ventricles should normally be up to 10 mm. A slight excess indicates regular monitoring of the development of pathology.

Symptoms of hydrocephalus in the fetus

The main diagnostic parameter is the baby's large head, with a tendency to further growth, compared with height and weight. The baby's gaze is constantly directed downwards due to his overhanging head. The fontanel on the head hardens ahead of time or becomes more convex. After birth, fetal hydrocephalus becomes more noticeable. The frontal bones are significantly enlarged, the child can hold his head, which means severe headaches.

A woman may feel increased drowsiness, irritability and weakness. High arterial pressure, a persistent feeling of nausea and constant migraines indicate the presence of a pathological process.

Despite the presence of symptoms, it is possible to suspect the disease and make an appropriate diagnosis only after instrumental and laboratory tests.

Possible consequences of hydrocephalus in the fetus

The consequences directly depend on what caused pathological process during the period of intrauterine formation. Enlargement of the chambers up to 15 mm is often treatable during pregnancy. Exceeding this parameter leads to damage to the central nervous system. There is a high risk of having a child with pathologies:

Down syndrome;
"cleft lip";
brain atrophy.

In the womb the baby occupies incorrect position because of the big head. Often labor occurs when the baby is positioned inside the womb, with its legs towards the pharynx, which leads to complications.

At large cluster fluids, doctors often recommend termination of pregnancy, since the likelihood of birth healthy baby very small. Fixed high mortality rate children of the first year of life.

Fetal hydrocephalus during pregnancy - what to do?

Parents of a child often wonder what to do? How to help and cure a baby?

Initially, the diagnosis is made by a pediatrician and neurologist. Afterwards, the baby should be examined by a neurosurgeon for the possibility of surgical action.

The main purpose of surgery is to remove cerebrospinal fluid from the chambers using shunting. During the operation, silicone catheters with special valves are installed for normal outflow into the abdominal cavity. Less commonly, surgeons can drain cerebrospinal fluid into right atrium or into the spinal canal.

On modern stage developments in medicine, operations are performed with minimal intervention in internal organs. Thanks to endoscopic ventriculostomy, shunt implantation can be avoided, but this procedure will only help patients with a certain form of the disease (occlusive).

During intrauterine development, drug therapy is prescribed to drain fluid and improve blood circulation. Also, bypass surgery is possible during pregnancy, through the mother's abdomen. After the baby is born, the shunt is removed and a full diagnosis is carried out.

Hydrocephalus in the fetus in the 3rd trimester, with an unfavorable prognosis from doctors, suggests termination of pregnancy. medical indications. But the decision, in this case, is made only by the parents.