Одним из проявлений патологии brain может стать
hydrocephalus (brain edema). This condition is accompanied by
excessive accumulation of cerebrospinal fluid in special spaces of the brain. In children
and adults, the course of this disease is significantly different. but
in all cases, qualified medical assistance is required.
The progression of this disease can lead to disability.
Causes of development
In the human brain there are free spaces,
which are filled with liquor (special liquid). Outside the brain is
subarachnoid space, and inside – the ventricular system,
cisterns and plumbing of the brain.
The body of an adult contains from 120 to 150 ml
liquor. The fluid is updated every few hours.
ATыработка ее происходит в сосудистых сплетениях brain, а
absorption – in the veins through special villi and arachnoid
Acting in the cavity, the CSF washes the surface of the brain from all
sides, and then absorbed into the venous system. Healthy
the amount of produced fluid is equal to
sucked If at any of the stages of this physiological
process fails, hydrocephalus may develop.
The following can cause hydrocephalus
- Infectious and inflammatory diseases of the central nervous system
– encephalitis, meningitis, ventriculitis.
- Опухоли brain.
- Acute vascular diseases of the brain – aneurysm ruptures,
arteriovenous malformations, subarachnoid hemorrhages,
- Head injuries and their consequences.
- Encephalopathy of various origins.
- Congenital malformations of the nervous system – fusion
Luska or Magendie’s holes, stenosis of the brain’s water supply system, stenosis
venous system of the brain.
- Complications after surgery – swelling and compression
liquor canals and blood vessels.
Classification of hydrocephalus
In clinical practice, there are several classifications.
pathology. They are based on various criteria. AT
depending on the causes, mechanism of development and duration of flow
The following varieties are distinguished:
- Closed hydrocephalus (occlusive, obstructive) –
develops in cases where there is an obstacle to exit
or outflow of fluid. The barrier may be located in different
openings (interventricular, Lushki, Mazhandi). AT итоге ликвор не
enters the subarachnoid space and cisterns of the brain. AT
hydrocephalus may develop depending on the location of the obstruction
one or both lateral ventricles. When clogging holes Lushki
or majandi fluid accumulates in all brain structures.
- Open (communicating) –
develops in cases where liquor is not absorbed into the systemic
blood flow, while the obstacles to the movement of fluid is not detected.
The accumulation of fluid leads to an increase in intracranial pressure,
dilatation of the ventricles and subarachnoid spaces, atrophy
brain matter. Usually such a picture develops with inflammation.
meninges or hemorrhages.
- ATрожденная гидроцефалия формируется при внутриутробном
development. Symptoms manifest in the first months after birth.
The most common causes of congenital hydrocephalus are
malformations and anomalies of development, hemorrhages in the ventricles of the brain,
intrauterine infection, birth trauma. Usually congenital
forms of the disease are closed.
- Acquired hydrocephalus develops in children after birth
or in adults as a result of infectious and
inflammatory diseases, hemorrhages, traumatic brain injuries,
tumors, strokes, parasitic diseases.
- Substitution hydrocephalus – a condition that accompanies
primary atrophy of the cortex and subcortical structures. Since the volume
the medulla decreases, its place gradually begins
to be filled with liquor. AT этом случае баланса выработки и всасывания
fluid does not occur, additional treatment such a form is not
requires An exception is the normotensive variety.
hydrocephalus, in which the pressure of the CSF remains normal, but
the walls of the ventricles are over-stretched. A similar picture may
develop in people of old and old age, with different
- AT зависимости от
the duration and nature of the flow distinguish acute and chronic
forms of the disease. Sharp variety starts very fast
the patient’s condition may deteriorate dramatically over several
days. Такое течение присуще закрытой форме pathology. Acute form
requires immediate neurosurgical treatment. For development
chronic forms require a period of six months or more. Boost
pressure and expansion of structures occurs gradually and slowly.
Neurological symptoms also increases gradually.
Chronic course is more common with open forms.
- Based on the localization of the pathological process, there are
external and internal form of the disease. When the outer form of the liquor
accumulates in spaces located outside of the brain
fabrics but inside the meninges (subarachnoid
space). ATнутри желудочков гидродинамические показатели не
are changing. The external form usually accompanies cortical atrophy.
substances. In the internal form, fluid accumulates in the ventricles and
- According to the severity of the condition, hydrocephalus is divided into compensated
and decompensated forms. With a compensated variety
an excess of CSF does not squeeze brain tissue and does not cause a characteristic
symptomatology. When decompensated form accumulated liquid
squeezes brain structures, eventually developing characteristic
- Another severity classification divides hydrocephalus into
moderate and pronounced. Such characteristics of the pathological
The process is based on MRI results. but следует
take into account that the picture on an MRI may change repeatedly during
short period. To make a diagnosis of moderate or severe
hydrocephalus was the most reliable, you need to hold
examination several times with a break in 2−3 weeks.
AT результате скопления жидкости повышается внутричерепное
pressure. Клинически это проявляется в виде следующих
symptoms of hydrocephalus:
- Feeling of heaviness in
head and pressure on the eyeballs. Patients usually complain
discomfort at night or morning. After the patient
wakes up and gets out of bed, weight and pain pass quickly
on their own.
- Headache that occurs at night or early in the morning.
It has no specific localization and, as it were, is spread throughout
head. The severity and pain in the head is pressing or arching.
nature and may increase in the prone position.
- Attacks of nausea or vomiting in the morning or at night. Symptom
in no way associated with eating or drinking liquid, but often
accompanies a headache. After vomiting is over,
the patient feels relieved.
- Long and frequent bouts of hiccups.
- ATыраженная слабость и быстро нарастающая утомляемость,
- Constant sleepiness with a yawn.
- Distracted attention, the patient cannot even concentrate on
the most simple and familiar actions, complains of “dullness”.
- Mental impairment – apathy or increased
- Frequent changes in blood pressure and heart rate
- The characteristic external sign is dark circles under
eyes. If you slightly delay the skin of the lower eyelid, it becomes good
visible extended capillary network.
With the accumulation of a significant amount of liquor can develop
local symptoms of compression or impairment of brain structures. They
напрямую зависят от того, на каком уровне произошло сpressure.
- Visual impairment – double vision, inability
focus view, reduced visual acuity, disc swelling
optic nerve atrophy of optic nerve fibers with prolapse
parts of the visual field or its complete loss, squint, absence
reaction of pupils to light stimuli. ATозможно появление
туманной пелены перед eyes.
- Clinical signs вестибулярной атаксии — неустойчивость
gait, dizziness, noise in the head and ears, nystagmus.
- The patient’s head assumes an unnatural position.
- Boost тонуса скелетной мускулатуры и сухожильных
- Paralysis or paresis of skeletal muscles, most often
affected limbs from one or both sides.
- Impaired sensitivity – possible loss of tactile,
temperature and other species while increasing the threshold
- The formation of spastic contractures – muscle tone
limbs significantly increased, resulting in arms or legs
frozen in a bent position and can not be straightened.
- Signs of cerebellar ataxia – impaired gait and coordination
movements, change of handwriting. ATсе движения становятся размашистыми.
This phenomenon is observed only in closed form with localization.
process in the cerebellum (in the posterior cranial fossa).
- Emotional disturbances – lability, causeless euphoria
may dramatically change the state of apathy. ATозможна неврастения. With
sudden increase in intracranial pressure may flash
- Seizures of epilepsy develop.
- AT тяжелых случаях нарушается дыхание, развивается угнетение
consciousness up to coma.
- With хронической форме гидроцефалии у взрослых клиника нарастает
more slowly. Developing confusion, dementia.
The patient loses the ability to self
- AT запущенных случаях возможно недержание мочи и кала.
Diagnosis of hydrocephalus syndrome is based on
examination of the patient, clinical data and results
laboratory and instrumental studies. Recognize pathology from
a child is a little easier even by external signs –
an increase in the volume of the head, the characteristic position of the eyeballs and
etc. In an adult, only intracranial hypertension is detected.
external signs do not work. With осмотре никаких внешних
changes will not be detected, and cerebral and focal
symptoms can be caused and other neurological
Для постановки точного диагноза необходимо провести
The following set of activities:
- Questioning and inspection
patient – the doctor clarifies the nature and severity of subjective
complaints, the time of their occurrence, the presence of associated pathologies,
information about past infections, injuries, operative
interventions, strokes, etc.
- The next step is to examine the patient with special procedures.
neurological tests to assess the coordination of movements,
muscle tone, function of the eye muscles, etc. The most simple
performed by paltsenosovaya sample, the assessment of stability in
Romberg position, detection of nystagmus. Severity is also evaluated
- In children диагностическое значение имеет измерение окружности
heads. If this indicator increases by more than 1.5 cm
месяц, высока вероятность развития hydrocephalus. In adult
hydrocephalus may be any increase in volume
- Spinal puncture – invasive treatment-diagnostic
method. Liquor sampling is performed to determine
intracranial pressure, the presence of inflammatory processes.
- Examination of the fundus reveals swelling of the optic disc
nerve, pathological changes of the retina, inherent
After a thorough examination, the specialist may prescribe to the patient.
a set of instrumental examinations to establish
accurate diagnosis and cause of it.
- CT scan
allows you to explore the state of different parts of the brain, ventricles and
subarachnoid spaces. In addition, the condition is assessed.
bones of the skull, possible pathologies are identified – tumors, cysts,
vascular aneurysm, foci of hemorrhage. Diagnostic
as a criterion for hydrocephalopathy serve as the expansion of the cavities of the ventricles and
subarachnoid spaces, reducing brain structures in
- Magnetic resonance imaging is a method that allows
determine the amount of fluid in the cranial cavity, the shape and degree
тяжести hydrocephalus. In addition, based on the data
a preliminary conclusion can be made about the possible causes
- Roentgenography of the skull reveals characteristic changes in
children – changing the shape of the skull, the appearance of the characteristic “finger
Impressions “on the bone tissue. In adults, this method may be less
сосудов brain проводится с введением специального
рентгеноконтрастного substances. Using this method you can evaluate
the state of the vessels, the degree of expansion and thinning of their walls,
obstruction of blood flow, etc.
- Cisternography – X-ray method with
введением контрастного substances. The method is used to clarify
the nature of the movement of the liquor, the form of hydrocephalus and the presence
obstructions in brain structures.
- Echoencephalography – a method of ultrasound diagnosis
allowing to identify the expansion of the cerebral ventricles and cisterns,
the presence of pathological changes in them.
Features of childhood
In children первого года жизни диагностическое значение имеет
neurosonography – ultrasound examination of the skull. AT этом
aged spring is not yet closed, and you can assess the state
central nervous system. In children старше года и взрослых людей
fontanelle usually grows over, bone tissue becomes very dense,
therefore, to use this method is meaningless.
This method gives very rough information and cannot
on its own to serve as a basis for diagnosis. but
changes with neurosonography can be an indication for
computer or magnetic resonance imaging.
ATозможные осложнения и последствия
The prognosis of the disease depends on the severity, form, general
condition of the patient and the presence of concomitant diseases. Withчиной
hazardous to life and health effects of hydrocephalus is
prolonged compression of brain structures by excess fluid. Than
the earlier the disease is detected and treatment is started, the more favorable
forecast. In the early stages, dropsy is considered curable. If not
начать своевременно лечить водянку brain, это
can lead to the development of the following complications:
- decrease in the tone and strength of skeletal muscles, coordination disorders
- atrophic tissue changes;
- blurred vision and
- decrease in memory and intellectual functions up to total
- mental disorders, deterioration of concentration
- violations of respiratory and cardiac activity;
- pathological shift of water-salt balance;
- the occurrence of epileptiform seizures;
- partial or complete loss of performance and skills
AT таких случаях пациент может быть признан инвалидом.
To prevent the development of such complications can only timely
and the right treatment.
Withнципы и способы лечения
The main method of radical treatment of brain hydrocephalus
is surgical. AT процессе операции пациенту
a special shunt is installed, which allows you to divert excess
CSF in the circulatory mainstream. AT результате жидкость свободно уходит
from the cranial cavity. Intracranial pressure normalizes, and
symptoms of the disease disappear.
ATсе операции, направленные на устранение гидроцефалии, можно
conditionally divided into 2 large groups. The first group includes
intervention with the conclusion of the liquor in the bloodstream:
- installing a shunt between the ventricles or cisterns of the brain and
the abdominal cavity (this shunt calls
- implantation of a shunt connecting the brain and the atria;
- installation of a shunt connecting the cranial box to the pleural
- implantation of the tube connecting the cranial cavity with the urinary
- the connection of the circulatory spaces with the venous bed.
ATо вторую группу входят методы так называемого внутреннего
shunting AT этом случае в полости черепа создаются каналы для
free passage of cerebrospinal fluid. To them
- Torkildsen operation
(ventriculocystomy) – between the lateral ventricles and
the occipital tank is fitted with a silicone catheter that
spend on the occipital region under the skin.
- Endoscopic ventriculostomy of the third cerebral ventricle.
With этом типе вмешательства рассекается дно межножковой цистерны в
areas of the gray knoll. AT результате образуется свободный проход для
- Stenting openings Magendie and Lushki – installation of special
expanding elements (stents).
- Plastics plumbing – expansion of its clearance to ensure
нормального тока liquor.
- Fenestration (dissection) of the interventricular septum. AT
the result is a hole through which the cerebrospinal
fluid can circulate freely.
Opinions of experts regarding this method of treatment on
Today is ambiguous. Even if the operation is performed
successfully, it is not a lifetime guarantee of getting rid of
hydrocephalus. In children голова может расти, размеры и пропорции
brain structures may change, which affects the state of the current
liquor. In addition, shunts and catheters may become clogged, in them
infection, etc., to avoid complications,
you need to be constantly monitored and treated by a neurosurgeon,
regularly undergo examination and timely eliminate all
AT некоторых случаях хирургическое лечение возможно заменить
conservative. For this purpose, diuretic drugs are used,
which remove excess fluid from the body, thus reducing
образом внутричерепное pressure. This method is suitable for therapy.
acquired forms of the disease (post-traumatic, developed on
background inflammation or hemorrhage in the cerebral ventricles). Diuretic
drugs can also be used in complex therapy with
preparation for surgery. AT этом случае их применение является
emergency measures to prevent
гибели the patient.
For treatment use drugs Furosemide, Diakarb, Mannitol,
Phonurite. Withменение этих лекарств не устраняет причину заболевания
and is only an auxiliary measure.
If the cause of hydrocephalus is inflammatory
process, prescribe antibacterial and anti-inflammatory
Лечение гидроцефалии brain у взрослого включает в себя
means to improve the trophism of the brain tissue. The patient is assigned
metabolites, nootropics and vascular drugs – Actovegin,
ATинпоцетин, Глатилин, Кортексин, Семакс и пр.