Causes, symptoms and treatment of hydrocephalusbrain

Causes, symptoms and treatment of hydrocephalus brainОдним 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.
the patient.

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
cells

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
states:

  1. Infectious and inflammatory diseases of the central nervous system
    – encephalitis, meningitis, ventriculitis.
  2. Опухоли brain.Опухоли brain.
  3. Acute vascular diseases of the brain – aneurysm ruptures,
    arteriovenous malformations, subarachnoid hemorrhages,
    thrombosis, strokes.
  4. Head injuries and their consequences.
  5. Encephalopathy of various origins.
  6. 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.
  7. 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:

  1. 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.
  2. Classification of hydrocephalusOpen (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.
  3. 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.
  4. 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.
  5. 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
    encephalopathies.
  6. Разновидности гидроцефалииAT 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.
    hydrocephalus.
  7. 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
    brain cisterns.
  8. 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
    neurological signs.
  9. 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.

Clinical signs

AT результате скопления жидкости повышается внутричерепное
pressure. Клинически это проявляется в виде следующих
symptoms of hydrocephalus:

  1. Clinical signs гидроцефалииFeeling 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.
  2. 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.
  3. 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.
  4. Long and frequent bouts of hiccups.
  5. ATыраженная слабость и быстро нарастающая утомляемость,
    pre-unconscious conditions.
  6. Constant sleepiness with a yawn.
  7. Distracted attention, the patient cannot even concentrate on
    the most simple and familiar actions, complains of “dullness”.
  8. Mental impairment – apathy or increased
    irritability.
  9. Frequent changes in blood pressure and heart rate
    rhythm.
  10. Sweating
  11. 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.

Темные круги под eyes.

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.

These include:

  1. 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.
  2. Clinical signs вестибулярной атаксииClinical signs вестибулярной атаксии — неустойчивость
    gait, dizziness, noise in the head and ears, nystagmus.
  3. The patient’s head assumes an unnatural position.
  4. Boost тонуса скелетной мускулатуры и сухожильных
    reflexes.
  5. Paralysis or paresis of skeletal muscles, most often
    affected limbs from one or both sides.
  6. Impaired sensitivity – possible loss of tactile,
    temperature and other species while increasing the threshold
    pain sensitivity.
  7. 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.
  8. 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).
  9. Emotional disturbances – lability, causeless euphoria
    may dramatically change the state of apathy. ATозможна неврастения. With
    sudden increase in intracranial pressure may flash
    aggression.
  10. Seizures of epilepsy develop.
  11. AT тяжелых случаях нарушается дыхание, развивается угнетение
    consciousness up to coma.
  12. With хронической форме гидроцефалии у взрослых клиника нарастает
    more slowly. Developing confusion, dementia.
    The patient loses the ability to self
    service.
  13. AT запущенных случаях возможно недержание мочи и кала.

Diagnostic methods

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
frustrations.

Для постановки точного диагноза необходимо провести
The following set of activities:

  1. Questioning and inspection пациентаQuestioning 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.
  2. 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
    сухожильных reflexes.
  3. 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
    heads.
  4. Spinal puncture – invasive treatment-diagnostic
    method. Liquor sampling is performed to determine
    intracranial pressure, the presence of inflammatory processes.
  5. Examination of the fundus reveals swelling of the optic disc
    nerve, pathological changes of the retina, inherent
    neurological diseases.

Instrumental studies

After a thorough examination, the specialist may prescribe to the patient.
a set of instrumental examinations to establish
accurate diagnosis and cause of it.

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  1. CT scan 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
    volume.
  2. 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
    pathology.
  3. 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
    indicative.
  4. Angiography сосудов brainAngiography
    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.
  5. 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.
  6. 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

Нейросонография — ультразвуковое исследование черепа.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
    movements;
  • atrophic tissue changes;
  • Ухудшение остроты зренияblurred vision and
    hearing
  • decrease in memory and intellectual functions up to total
    dementia;
  • mental disorders, deterioration of concentration
    attention;
  • 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
    self-catering.

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.

Withнципы и способы лечения гидроцефалии

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
    ventriculoperitoneal);
  • implantation of a shunt connecting the brain and the atria;
  • installation of a shunt connecting the cranial box to the pleural
    cavity;
  • implantation of the tube connecting the cranial cavity with the urinary
    a bubble;
  • 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
relate:

  1. Torkildsen operation 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.
  2. 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
    fluid.
  3. Stenting openings Magendie and Lushki – installation of special
    expanding elements (stents).
  4. Plastics plumbing – expansion of its clearance to ensure
    нормального тока liquor.
  5. 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
negative changes.

Drug therapy

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.

Drug therapy гидроцефалии

If the cause of hydrocephalus is inflammatory
process, prescribe antibacterial and anti-inflammatory
drugs.

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.

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