Sometimes in children and adults are detected above the normpressure inside the skull. The reasons for this symptom can be many, and one of the most dangerous is hydrocephalus of the brain. Pathology is more characteristic of small children, although there are certain risks in adulthood. It is reasonable to imagine in general what hydrocephalus is, how it manifests itself, what dangers are involved. This will allow you to turn to the doctor with the primary dubious manifestations in the child or yourself.
Anatomy and health
Hydrocephalus of the brain - pathology, withwhich the brain ventricles become larger volume. In cerebral cavities there should be a cerebrospinal fluid - a liquid of the spinal cord. If the reservoirs with CSF increase, the surrounding tissues are squeezed. The system containing the cerebrospinal fluid is formed by two ventricles, a channel between them (the third ventricle), the Sylvian aqueduct and the last, fourth ventricle. Forms the cerebrospinal fluid in the ventricular weave, normally moves from the lateral elements through the channels to the fourth ventricle, from where it gets access to the subarachnoid space that separates the brain tissue from the shell of this organ. One of the tasks of cerebrospinal fluid is the washing of the brain tissues that form the surface of the organ. With the liquid, irreplaceable components are supplied here. The used cerebrospinal fluid is gradually absorbed into the circulatory system from the subarachnoid cavity.
With hydrocephalus of the brain are violatedprocesses of absorption or production of cerebrospinal fluid (individually or both). In itself, the cerebrospinal fluid is a transparent fluid substance without color, which visually is similar to water. It is formed by cells, salts, protein structures. At an infant age, the body at an average of 50 ml of cerebrospinal fluid at once, in an adult these volumes are almost three times larger. In a healthy person, absorption and generation of cerebrospinal fluid are counterbalancing processes, so that the total volume is constantly maintained stable. In just one day, the brain plexuses produce about half a liter of fluid.
Vodian can be provoked by the processes associated with cerebrospinal fluid:
- excessive production;
- too slow absorption;
- incorrect circulation.
Disease: Forms and Classification
Hydrocephalus of the brain can be closed.This form is diagnosed if it is possible to detect an obstacle in the path of the CSF current. Due to such a barrier, the substance does not enter the subarachnoid space.
All other cases are an open form of the disease.
Hydrocephalus happens:
- primary;
- secondary (appears against the background of other diseases).
The cause of hydrocephalus may be defects in the formation of the central nervous system, neoplasms, diseases that have affected the cerebral vascular system.
At present, several systems of classification of cases of hydrocephalus are common.
Symptomatology
Symptoms of hydrocephalus of the brain are explainedthe main feature of the disease - the accumulation of cerebrospinal fluid, which increases the pressure inside the skull. Features of external manifestations depend on the course of the disease, its severity, the age of the patient.
Up to two years of suspicion of the child's illness can befor too fast a head size increase. At a tender age the cranial sutures have not yet acquired firmness, so the growth of the brain, caused by the increase in the ventricles in which the cerebrospinal fluid accumulates, leads to the fact that the bones seem to "inflate". Since hydrocephalus of the brain in newborns and small children is a rather urgent problem, there are special tables on which determine how much the growth of the head corresponds to the norm. If the indicators exceed the established standard, the child is referred for special examinations.
Pediatrician every month (sometimes twice as often) measuresdiameter of the head of the observed baby. This procedure is an obligatory part of preventive examinations to which any parents should bring newly born babies. From the statistics it is known that the rate of growth of the head in a circle above the norm in most cases indicates exactly hydrocephalus.
What else?
In addition to this manifestation, moderate hydrocephalus of the brain (as well as other forms of this disease) can manifest itself:
- bulging fontanel;
- unclosed at the time of the fontanel;
- thin cranial bones;
- disproportionality of the skull;
- protruding separate parts of the skull;
- venous net on the face, forehead;
- omission of the eyes;
- increased muscle tone of the lower limbs;
- convulsivity.
The sick child develops more slowlypeers, which is especially noticeable in the progress of motor skills, the psyche. In due time the kid can not keep the head, sit, play. Usually such children are apathetic, whiny women without an obvious reason, sometimes they grab the head. If this happens, it indicates severe pain.
Attention to all details
Note the mixed hydrocephalus of the brain,internal, external (in short, any form) can the doctor. Most of the symptoms are quite nonspecific, so parents are difficult to identify the disease, but you can check the size of the child's head at home. If the circle grows beyond measure, you can pay attention to the doctor. In combination with the development gap, there is every reason to suspect hydrocephalus and send the child to a full examination. Doctors will be engaged in the following specializations:
- neurosurgeon;
- neurologist.
If the diagnosis is not confirmed, the doctors will take measures to detect the causes of abnormalities.
The child is growing, manifestations are changing
All known types of hydrocephalusthe brain (replacement, external, internal - any case, regardless of the reference to any class) can develop in the child not only in infancy, but also older than two years of age. A less common disease is diagnosed in adults. The features of hydrocephalus in children over two years of age are explained by the neplastichnosti skull - to this age, all the seams harden. Violation of the balance of development and absorption of cerebrospinal fluid causes a rise in pressure in the skull, which soon leads to a specific symptomatology:
- headache;
- sick, tears;
- the disk of the nerve responsible for vision is swelling.
Vomiting, toshnits more often at night or early morning.Changes in the elements of the visual system can only be seen by an ophthalmologist on a specialized study. If parents notice that the child complains of a headache, this condition is accompanied by nausea, urge to vomit, you should immediately show the child to the doctor. Diagnosis, diagnosis, treatment - in the area of responsibility of a neurosurgeon, neuropathologist. However, the described symptoms are not always explained by cerebral hydrocephalus (external replacement, internal any type). Possible reasons:
- tumor processes;
- malformations of the formation of the brain.
The sooner it is possible to put the right diagnosis and choose a successful treatment strategy, the higher the chance of minimizing the negative consequences.
Additional symptoms
Hydrocephalus of the brain (internal, external, all subtypes) in some cases can manifest itself:
- seizures similar to epilepsy;
- enuresis;
- anuria;
- gigantism;
- growth retardation;
- visual impairment;
- hypothyroidism;
- untimely development of the reproductive system;
- overweight;
- low academic performance.
Where did trouble come from?
Before you figure out how to treat hydrocephalusbrain, should understand the causes that provoked the disease. Doctors know a rather extensive list of problems that can lead to such a pathology.
Способствовать формированию гидроцефалии в период occurrence in the maternal organism can malformations of the central nervous system. Modern methods of research of the fetus allow already during pregnancy to identify this health problem. Approximately every fifth case is attributed to postponed infectious diseases. Virus infection is particularly dangerous:
- herpes;
- cytomegalovirus;
- toxoplasma.
Planning the birth of a child should goscreening for the presence of infection - often a latent infection, with no symptoms. First you have to eliminate the pathological agent, only after that you can think about conception.
There are cases when the fetal hydrocephalus is explained by genetics.
Children and the causes of ill health
Up to 80% of all cases of hydrocephalus in children youngertwo years of age due to malformations of the brain (spinal, brain) and infections, transferred to the period of prenatal development. Other cases are the results of birth injuries. Most premature babies are affected. Trauma at birth is often complicated by hemorrhage in any part of the brain, meningitis. All these processes inhibit the ability of tissues to absorb liquor.
In a small percentage of cases in newborns, hydrocephalus is explained by neoplasms, vascular malformations.
Older children have hydrocephalus possible due to:
- tumor processes;
- meningitis;
- encephalitis;
- infection;
- malformations of blood vessels and brain tissue;
- hemorrhage;
- injuries;
- genetic failures.
In a certain percentage of cases, it is not possible to identify the reason for the violation.
Diagnostics
Establish that you need treatment of brain hydrocephalus, according to the results of research and collection of features of the clinical picture. Doctors study the fundus of the eye. The patient is directed to:
- ultrasound;
- tomography;
- neurosonography.
What to do?
In most cases, the treatment of hydrocephalusbrain involves surgery. The classic approach is HPS, shunting performed using a special high-precision technology. In recent years, the spread of the method using the endoscope. It is called ventriculostomy. The main advantage is that there is no need to install a foreign body in the brain.
Выбор лечения остается за нейрохирургом.The doctor formulates contraindications, indications for the event. If a surgical intervention is recommended, do not pull it: the child’s condition will only worsen over time, and the pressure increase will cause a significant slowdown in development. In this case, the effects of brain hydrocephalus may be irreversible.
It is worth noting that even the operation will not allowreturn healthy normal dimensions of the head - the skull will remain above the norm for a lifetime. The problem is not only cosmetic: the increased size and weight cause significant pressure on the cervical vertebrae.
During the operation, discharge of liquor frombrain in other parts of the body. The most common approach is HPS, when silicone catheters are inserted into the body, along which liquor moves into the abdominal cavity. Responsibility for the absorption of a substance is shifted to intestinal loops. The system is equipped with a valve to adjust the amount of liquor flowing through such a system. Visually, it is impossible to notice the catheters, everything is hidden under the skin. According to statistics, annually in the world they carry out up to 200,000 operations using the technology of HPS.
New technologies
The newest methods of operations allowcause minimal injury to healthy patient tissues. Using an endoscope inserted into the patient's cavity through small incisions, the doctor is able to see the internal structures and manipulate the device with high accuracy. An endoscope operation is a good alternative to a shunt system. The doctor forms the path for bypass liquor flow. The operation is effective, safe, does not require the installation of implants, is associated with a minimum of complications.
The only weakness of the endoscope islimitations of the cases in which this method is shown. On average, only one out of ten patients can undergo minimally invasive surgery, the predominant percentage needs a shunt system.
If the operation was successful, the progress of the disease stops. Almost all children again can live normally, play, learn along with everyone.
A special case
Occasionally, hydrocephalus surgery is not indicated.If the disease does not progress, the patient is monitored, the drug "Diacarb" is prescribed, the active components of which allow you to keep under control the process of production of CSF. Periodically check the pressure inside the skull. The patient’s condition is monitored by a neurosurgeon, a neuropathologist. A patient with hydrocephalus should regularly visit the clinic for a full examination and measurement of head size, removal of data using instrumental methods of investigation.
Not only children get sick!
In adults, brain hydrocephalusdevelops more rarely than in childhood, but the risks are still there. Usually, the pathological condition is secondary, it develops on the background of a tumor process, stroke or trauma, meningitis.
Observe the hydrocephalus of the brain in adults by the following manifestations:
- severe pain in the head;
- nausea and vomiting;
- vision problems, inability to focus on the object;
- displacement of the eyeballs;
- violation of the vestibular apparatus;
- memory impairment;
- enuresis.
Causes and nuances
У взрослых гидроцефалия головного мозга чаще only appears after a stroke, since this condition leads to disruption of blood flow in the brain tissues. Different etiology of neoplasm, encephalitis, tuberculosis can provoke a complication in the form of dropsy. In some cases, the cause of the disease - addiction to alcohol. Hemorrhages in the cerebral ventricles, subarachnoid space can play a role.
Во взрослом возрасте можно столкнуться с одним из types of hydrocephalus: congenital or acquired. About the first person, probably aware from an early age, perhaps taking "Diakarb" to monitor the condition. Acquired disease is the result of injuries, inflammations, infections and other negative effects on brain tissue.
Doctors know many types of developingadult brain hydrocephalus: replacement, atrophic, open, closed. Each case has its own characteristics, a unique mechanism of development, and therefore, approaches to treatment.
Quite often reveal a closed form.The liquor current is disrupted due to obstacles - for example, a tumor. An open variant is a violation of the integrity of the brain areas, a failure of the suction mechanisms, because of which the CSF does not enter the bloodstream, instead accumulating in the cavities.
With increased activity of cells responsible for the production of CSF, a hypersecretory form is diagnosed. Atrophic is observed if the brain tissues become thinner, and their place is taken by the cerebrospinal fluid.
In the absence of acute symptomsFor a long time they speak of moderate hydrocephalus of the brain. In adults, this form of the disease, as can be seen from statistics, is relatively common. A distinctive feature is a sharp deterioration in the patient's condition. The reasons are often incomprehensible, since with latent flow to hydrocephalus there was not even suspicion. This greatly complicates the proper and timely provision of adequate assistance.
Do I need treatment?
Гидроцефалия головного мозга у взрослого может cause irreversible severe consequences. Without adequate assistance, the functioning of the brain is disturbed, the pressure rises, and death is possible. In a fairly large percentage of cases, patients are assigned the status of disabled. In the absence of proper treatment, a person loses working capacity, memory and intellectual abilities deteriorate, the ability to realize oneself is lost.
If managed to notice hydrocephalus when the diseaseonly started to develop, practice drug therapy. In acute form, an urgent operation is required - this condition is dangerous for the patient's life. As in the case of children's edema, it is necessary to open the skull to install a drainage system.
In chronic form, establish a shuntcerebrospinal fluid drainage system. The external form can sometimes be treated by conservative methods, including gymnastic practices and drug therapy - they take the means to expand the blood vessels. If the external hydrocephalus has passed into the substitution form, an operation is indicated. In the mixed form of the disease, the only option is surgery.
Shunting: complications
Statistical studies show that HPSprovokes complications with a probability of 40-60%. From time to time, replacement of system components is necessary. Most often, complications that force an additional operation occur 6-12 months after the event. In some cases, only a few elements need to be changed, sometimes the system completely. If hydrocephalus is detected, an operation is indicated, you should immediately prepare yourself mentally: you will most likely have to undergo two or more interventions. In the future, the patient's life depends on the reliability of the installed system.
Possible complications:
- obstruction in the abdominal cavity, cerebral ventricles;
- infection;
- mechanical damage to the system;
- too active liquor discharge;
- fluid flow too slow;
- epileptic syndrome;
- internal bedsores
Alternative approaches
The most rarely used treatment methodhydrocephalus - ventricular puncture. It is resorted to only when all other recreational activities are impossible. The patient is set to an external system for the outflow of liquor. This procedure is associated with numerous complications, the risk of infection is extremely high.
The priority vector of improvement of medicalmanipulations now it is possible to call operations with the endoscope safely. Ventriculocystomy of the bottom, aqueductoplasty, septostomy, removal of the tumor and the installation of a shunt with an endoscope are possible.
Чаще всего делают вентрикулоцистерностомию ventricular bottom. In some modern clinics, up to 80% of all operations on the brain using an endoscope with dropsy fall on this technology. The doctor forms a pathway to move the cerebrospinal fluid into the brain tanks so that when the fluid passes through the tissue, it is absorbed. It is possible to refer to the method for occlusive hydrocephalus, when replacing a shunt due to complications, the need for revision, as well as dropsy after injury, with a mixed form of the disease. In comparison with the classical shunting system, the physiological CSF current can be restored with the help of an endoscope, and the patient’s quality of life after the rehabilitation period will be higher.
