Update: December 2018
Гидроцефалия головного мозга у adults — заболевание, которое
can occur as a complication of various diseases of the head
brain, such as stroke, traumatic brain injury, tumor,
hemorrhage, infectious process, meningitis.
And also as an independent nosological form, in which
there is an active process of accumulation of cerebrospinal fluid in
liquor spaces. Clinical symptoms and manifestations
заболевания зависят от причин и forms гидроцефалии у adults:
- circulatory disorders CSF-occlusive hydrocephalus,
proximal and distal forms
- violation of its absorption – disresponsive and aresorptive
- violations of its products – hypersecretory form, in which
brain ventricles increase
Сегодня гидроцефалия у adults не имеет четких границ
Гидроцефалия головного мозга у adults — заболевание, лечением
whom neuroscientists, neurosurgeons are engaged in. Most people as well
also doctors consider hydrocephalus to be exclusively pediatric
pathology, which in recent years is recorded enough
often in children and is almost always congenital
disease. On 1 тысячу новорожденных малышей приходится 1-10
children with edema of the brain. Read more about treatment.
hydrocephalus in children.
That is why today there are no clear
критерии diagnostics гидроцефалии у adults в неспециализированных
polyclinics and hospitals (although it is enough to make
Rheoencephalography and echo-encephalography). And often patients after
injuries and stroke in the guise of other diseases are unsuccessfully treated in
psychiatric hospitals, neurological hospitals, in
outpatient clinics and discharged from ordinary hospitals with a diagnosis of:
- stroke effects
- psychoorganic syndrome
- effects of traumatic brain injury
- mixed genesis dementia
- dyscirculatory or post-traumatic encephalopathy
However, with specialized examination of patients in
neurosurgical hospitals, the population is over 18 years old
гидроцефальный синдром обнаруживается у 25% adults больных. BUT
after all, timely competent, adequate diagnosis of hydrocephalus in
adults при правильном хирургическом лечении позволяет чуть ли не
in 100% of cases, to achieve recovery of patients, to help them in
social rehabilitation. After operations performed
highly qualified specialists, most patients can
return to previous work, some with part-time work
adaptations after surgery can be done without
help, returning to a full life.
Particularly relevant modern methods of external drainage and
introduction to the ventricles of the brain thrombolytics, which
позволяют снизить летальные исходы при острых
формах гидроцефалии, возникающих при нетравматических
subarachnoid hemorrhage. As a person, at the beginning
this disease dies within 2 days, and rendering
emergency surgical care saves his life for a long time
stabilizes the patient’s condition.
Withчины ее возникновения
On сегодняшний день установлено, что почти любые нарушения,
pathology of the central nervous system may contribute to such
complication like hydrocephalus. Onиболее частые, основные
Diseases in which hydrocephalus can form:
- Ischemic or hemorrhagic stroke – acute disorders
- Oncological diseases – brain tumors, more often
intraventricular, stem, parastyle and localization.
- Encephalopathies of various origins – posttraumatic,
chronic hypoxic conditions, alcoholism.
- Infectious, inflammatory diseases of the central nervous system – tuberculosis,
meningitis, encephalitis, ventriculitis.
- Traumatic or non-traumatic intraventricular,
subarachnoid hemorrhage due to aneurysm rupture
and arteriovenous vessels of the brain.
Внутренняя и наружная гидроцефалия у adults
There are many different classifications of hydrocephalus, the main
of which – congenital hydrocephalus or acquired.
Гидроцефалия головного мозга у adults — это приобретенный вид
hydrocephalus, which in turn is subdivided by pathogenesis
on 3 species. Previously, they also isolated 4 forms, mixed, outer
hydrocephalus, which is manifested by an increase in subarachnoid
spaces and ventricles of the brain with progressive
However, now such a process is not considered hydrocephalus, but referred
к атрофии мозга, поскольку при наружной гидроцефалии у adults,
expansion of the subarachnoid space and enlarged ventricles
the brain is not caused by excessive accumulation of CSF, impaired circulation,
processes of its production, resorption, and is the result of atrophy
brain tissue, reduce its mass. Classification of hydrocephalus
|The level of pressure of the liquor||
|By the rate of flow||
Symptoms, signs of hydrocephalus
With acutely developing occlusive hydrocephalus in adults,
symptoms are due to signs of increased intracranial
Headache – especially pronounced in the morning on waking,
due to the extra boost during sleep
Nausea and vomiting – also observed in the morning, after vomiting
headache is sometimes relieved.
Drowsiness is one of the most dangerous signs of an increase
intracranial pressure, if drowsiness occurs, it means
nearing rapid, rather sharp deterioration of neurological
Symptoms of axial dislocation of the brain – rapid depression
the patient’s consciousness down to deep coma, while the patient’s
takes the forced position of the head, appear
oculomotor disorders. If compression occurs
medulla oblong, then signs of hydrocephalus manifest
oppression of cardiovascular activity and respiration that may
will be fatal.
Застой дисков зрительных нервов — нарушение
axoplasmic current in the optic nerve and an increase in pressure in
subarachnoid space around it leads to disruption
If chronic hydrocephalus is formed, then the symptoms
clinical picture is significantly different from acute hydrocephalus in
Dementia – most often the first symptoms, signs of hydrocephalus
головного мозга у adults возникают через 15-20 дней после
injury, hemorrhage, meningitis, or other
- A person confuses day with night, that is, he experiences during the day
sleepiness, and sleeplessness at night. Decrease in the general activity of the patient,
he becomes inert, indifferent, indifferent,
- Memory is disturbed – first of all this decrease
short-term numerical memory, a person is wrong
calls the month, the number, forgets his age.
- In the advanced advanced stages of the disease can develop coarse.
mental disorders when a person is not able to
to serve himself, to the questions that are being asked of him, he may not
to answer or respond in monosyllables, inadequately, to think long
pauses between words.
Apraxia walk – such a syndrome when a person is lying down
can easily show how to walk or ride a bike, and
when he gets up, he cannot walk normally, goes wide apart
legs, swinging, shuffling.
Incontinence this symptom may not always be, and is
late and non-persistent sign of hydrocephalus in adults.
Changes in the fundus are usually absent.
Types of diagnostic studies of the brain in adults
- Computed tomography – fairly accurate diagnosis
contours of the brain, ventricles, skull and subarachnoid space.,
produced to determine the shape and size of the ventricles,
determination of anomalies – cysts, tumors.
- Magnetic resonance – MRI can be determined
severity and form of hydrocephalus. These studies are indispensable for
clarify the causes of dropsy.
- Cisternography or radiography of skull base tanks – her
used to clarify the type of hydrocephalus and determine
directions of cerebrospinal fluid.
- Radiography of blood vessels or angiography – after
introduction into the arteries of the contrasting substance;
level of blood vessels.
- Neuropsychological examination – collection of the patient’s history,
a survey of a patient who detects the presence of violations, deviations in
the functioning of the brain.
Treatment of acute and chronic hydrocephalus
- Diuretics – osmotic (urea and lures, glimarite).
Saluretics – diacarb, acetazolamide (carbonic anhydrase inhibitors),
ethacrynic acid, furosemide (loop diuretics)
- Plasma substitutes solutions (20% albumin solution).
- Vasoactive drugs – magnesium sulfate (25% solution),
venotonics (troksevazin, glevenol).
- Glucocorticosteroids (dexamethasone, prednisone,
- Painkillers – NSAIDs (nimesil, nimesulide, ketonal,
ketoprofen), anti-migraine (traximed).
- Barbiturates (phenobarbital, nembutal, amital).
If a patient has clinical signs of the disease,
non-surgical, conservative treatment of brain hydrocephalus
adults ineffective. For the treatment of acute hydrocephalus, which
occurs most often with intraventricular hemorrhage – this
terrible complication that requires urgent neurosurgical
Today medical technologies in the field of therapy
neurological diseases in developed countries allow
use low-impact and quickly performed operations using the method
neuroendoscopic surgery. In Russia, this method is not yet
found widespread use (in remote from Moscow and
St. Petersburg regions) due to lack of qualified
professionals and very expensive equipment. In Western countries, these
operations are widespread.
The essence of the method is that it is introduced into the brain channels
special tool with a neuro-endoscope (camera) at the end.
Therefore, doctors can observe the whole operation on the big screen. On
the bottom of the 3rd ventricle, a special catheter makes a hole (in
which flows down the cerebrospinal fluid), connecting with extracerebral cisterns.
By creating such a hole, the threat to the patient’s life disappears. Neurosurgeons
perform various types of shunting:
- ventriculo-atrial shunting is with the right atrium, and
also with the superior vena cava connect the ventricles of the brain;
- ventriculo-peritoneal shunting – the CSF is sent to
- ventriculocystomy – in a large occipital cistern;
- atypical shunting operations – in other cavities.
Such operations last 1-2 hours, the patient spends in the hospital
2-3 days. For the production of such liquor shunting systems use
Silicone is an inert material that is safe for the body. With
increasing intracranial pressure above normal, these systems deduce
cerebrospinal fluid in the cavity (abdominal cavity or in the occipital
tank and etc.).