Hydrocephalus: causes, symptoms, diagnosis and treatment. Internal hydrocephalus of the brain: how to live with the problem Death from hydrocephalus of the brain

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Hydrocephalus of the brain

Name of this disease was formed thanks to two Greek words, namely hyd?r and kephal? – water and head, respectively. Given this fact, most neurologists prefer to call the disease hydrocephalus, omitting the specification of its localization. Ordinary people, as a rule, call the disease dropsy of the brain.

Within the brain (in particular, its ventricles) a person constantly circulates cerebrospinal fluid or cerebrospinal fluid. This natural moisture can be absorbed and renewed as needed and depending on the processes occurring in the organ. In cases where there is a disruption in the functioning of departments or the course of certain processes, cerebrospinal fluid can begin to accumulate, filling the ventricles or subarachnoid space. As a result, additional pressure is created on the organ itself and the cranium that stores it.

Hydrocephalus of the brain can occur and progress both in an adult (acquired origin) and in a newborn child (congenital disease). There are also 4 stages of the disease - acute, chronic, compensated and decompensated.

Liquor

Liquor(cerebrospinal fluid) plays a critical role in the metabolic processes of the brain and spinal cord, also providing humoral direct and feedback between their various distributions, and in case of injury also plays a purely mechanical inertial-stabilizing role during kinetic displacements of the brain. The body constantly renews and circulates cerebrospinal fluid. Detailed study of cerebrospinal fluid (CSF) has been possible since Quincke performed a lumbar puncture in 1891. The total amount of cerebrospinal fluid in an adult reaches 150 ml, of which one half is almost equally distributed between the ventricles and the subarachnoid space of the brain, and the other is located in the subarachnoid space of the spinal cord. Every day, the choroid plexus of the ventricles produces 500-800 ml of cerebrospinal fluid from the blood. Mainly cerebrospinal fluid is produced in the lateral ventricles, from where through the interventricular foramina (f. Monroi) cerebrospinal fluid enters the third ventricle, from there through the cerebral aqueduct to the fourth ventricle. Next, the cerebrospinal fluid through the lateral paired openings of the IV ventricle (f. Magendie) and the middle odd opening (f. Luschka) flows under the arachnoid membrane to the surface of the brain and spinal cord, where it is absorbed into the blood. During the day, the cerebrospinal fluid is renewed 4-5 times. Under normal circumstances, there is a clear balance between the production and absorption of cerebrospinal fluid, which ensures its constant volume and, accordingly, pressure. However, when this state of equilibrium is disturbed, or there are obstacles to the normal movement of cerebrospinal fluid in the cerebrospinal fluid tract, excessive accumulation of cerebrospinal fluid in the cranial cavity occurs, an increase in intracranial cerebrospinal fluid pressure and a pathological condition called hydrocephalus.

Types of hydrocephalus

Depending on the mechanism, disturbance of liquor formation or circulation The following types of hydrocephalus are distinguished:

• open (combined)
• closed (occlusal, not combined)

In turn, open hydrocephalus, in which the circulation of cerebrospinal fluid in the ventricular system occurs normally, can be aresorptive (due to decreased absorption of cerebrospinal fluid) and hypersecretory (due to increased production of cerebrospinal fluid by the choroid plexuses of the ventricles of the brain). The latter occurs quite rarely, mainly with tumors of the choroid plexus, hypervitaminosis A. Occlusive hydrocephalus occurs when outflow is impaired at the level of the interventricular foramen, third ventricle, cerebral aqueduct, median and lateral foramina of the fourth ventricle, and pontocerebellar cistern.

Based on the location of fluid accumulation, hydrocephalus is divided into external And internal. With external hydrocephalus, excess fluid accumulates mainly in the subarachnoid spaces, and with internal hydrocephalus, it occurs in the ventricles of the brain.

From a practical point of view, it is extremely important to distinguish between hydrocephalus progressive(increasing) and stabilized. Progressive hydrocephalus predominantly occurs with an increase in cerebrospinal fluid pressure, accompanied by compression and atrophy of brain tissue, and dilation of the ventricles. However, expansion of the ventricles and subarachnoid spaces of the brain can also occur due to atrophy of brain tissue after severe traumatic brain injury, ischemic stroke or brain hypoxia. This type of hydrocephalus is called compensatory, stabilized, or normotensive (with an increase in the volume of the ventricles and other cavities of the brain and, accordingly, an increase in the volume of cerebrospinal fluid, its pressure remains within normal limits and subsequent brain atrophy is not observed).

According to the time of occurrence of hydrocephalus, they are distinguished congenital(which develops before birth or from the moment of birth) and acquired. Congenital hydrocephalus occurs due to abnormal development of the brain with narrowing or blocking of the cerebrospinal fluid ducts, infection suffered during pregnancy (sore throat, influenza, toxoplasmosis, pneumonia, etc.), intoxication, injury or physical overload. Congenital hydrocephalus also includes hydrocephalus resulting from a birth injury with intracranial hemorrhage or fetal asphyxia. Acquired hydrocephalus develops as a result of brain injury, brain tumors, or previous inflammatory processes of the meninges (meningitis, arachnoiditis).

Internal hydrocephalus

Depending on the location of fluid accumulation in dropsy, internal and external forms of the disease are distinguished. In the case where there is internal hydrocephalus, free cerebrospinal fluid tends to the ventricular system, namely the lateral ventricles of the brain, and accumulates directly in them, creating increased pressure here and affecting nearby parts of the organ.

There are no specific manifestations of this form of hydrocephalus - the symptoms remain within the general complex. The external manifestations of the disease (manifested in most cases in children), as well as the range of sensations characteristic of the disease, have no pronounced differences. But each form of the disease affects treatment methods in its own way, since one of the main goals of the doctor is to remove the maximum amount of fluid from the patient’s skull (medically or through surgery) to ensure a reduction in intracranial pressure to an optimal level.

External hydrocephalus

Unlike the internal form, external hydrocephalus characterized by the accumulation of fluid in the subarachnoid and subdural spaces, and not in the lateral ventricles of the brain. In this form the disease has general symptoms, and the location of free cerebrospinal fluid can only be diagnosed by performing a complete examination.

The external form is noticeably less common. One of the types of external dropsy is external replacement hydrocephalus, which occurs most often in people suffering from pathology of cardio-vascular system(in particular, arterial hypertension), osteochondrosis in the cervical spine, or a previously experienced head injury.

Like the internal form of the disease, external hydrocephalus may not manifest itself for a long time, causing only minimal discomfort. This fact leads to a delay in the start of treatment and reduces the patient’s chances of a full recovery. That’s why the disease is often called “insidious.”

Hydrocephalus Clinic

Clinical signs hydrocephalus varies significantly in children infancy, kids and adults. Progressive hydrocephalus in infants is manifested by changes in the size and shape of the head. The increase in size occurs predominantly in the sagittal direction, as a result of which the frontal bone protrudes above the relatively small facial skeleton. The bones of the skull are thinned, the edges of the bones diverge with the formation of significant gaps, especially along the lines of the coronal and sagittal sutures. The anterior and posterior fontanels are tense. Since the facial skeleton is significantly retarded in growth, the face takes on a triangular shape and, compared with the large spherical head, appears small, senile-looking, pale and wrinkled. The skin on the head is thin and atrophic, there is a compensatory expansion of the cutaneous veins of the head and an increase in their number.

When does hydrocephalus develop? in children older than one year, then this is manifested by a progressive expansion of the cranial sutures; upon percussion of the skull, a characteristic sound of a “pot that has cracked” appears.

Multifaceted neurological symptoms in hydrocephalus are a consequence of increased intracranial pressure, with the development of atrophic and degenerative processes in the brain and cranial nerves, and in occlusive hydrocephalus it is often supplemented focal symptoms underlying disease.

U newborns and infants age, there is a fixed downward displacement of the eyeballs (a symptom of the setting sun), a decrease in acuity and a narrowing of the visual fields may develop until blindness occurs. The function of the abducens nerve is often impaired, which leads to convergent strabismus, and movement disorders- in the form of paresis, sometimes combined with hyperkinesis. Cerebellar disorders cause disturbances in statics and coordination of movements. There may be a significant lag in intellectual and physical development; increased excitability, irritability or lethargy, adynamia, and apathy are often manifested.

Emergence hydrocephalus in older age groups, as a rule, is a consequence of severe organic lesions nervous systems s and manifests itself as a syndrome of increasing intracranial hypertension. A headache appears, which occurs mainly in the morning, nausea, vomiting at the peak of the headache, depression of the function of the cerebral cortex (memory disorders, confused thinking, impaired consciousness varying degrees), swelling of the optic discs with a tendency to rapid progression of secondary atrophy of these nerves with a decrease in acuity and narrowing of visual fields, corresponding changes in the bones of the cranial vault and sella turcica.

Symptoms of an occlusive attack are associated primarily with a delay in the outflow of cerebrospinal fluid from the ventricular system, and progresses rapidly. This leads to an increase in intraventricular pressure and compression of the brain stem. The clinical picture of an occlusive attack is especially striking when there are disturbances in the cerebrospinal fluid circulation in the lower parts of the fourth ventricle, when, due to the increasing volume of cerebrospinal fluid, the bottom of the rhomboid fossa and the midbrain experience the greatest pressure. In this case, there is a sharp headache, nausea, vomiting, forced position of the head, motor activity, combined with general lethargy, impaired consciousness, an increase in oculomotor disorders, increased nystagmus, autonomic disorders in the form profuse sweating, facial hyperemia or severe pallor, bradycardia, arrhythmia, increased pyramidal disorders, sometimes tonic convulsions, increased respiratory rate with disruption of its rhythm until it stops. The presence of stem symptoms is one of the most important signs occlusive attack.

Focal neurological symptoms depend on the nature and localization of the main pathological process and the level of occlusion. Two syndromes are most commonly observed:

1. with occlusion at the level of the Sylvian aqueduct - midbrain lesion syndrome (impaired vision along the vertical axis, disorders of the pupillary reflex, ptosis, spontaneous convergent nystagmus, hearing impairment).
2. With occlusion at the level of the IV ventricle, there are symptoms of damage to the cerebellum and brain stem.

Diagnosis of hydrocephalus

The diagnosis of hydrocephalus is made based on the characteristic clinical manifestations and data from additional examination methods. It is important to determine the nature of hydrocephalus(progressive or stabilized) - dynamic monitoring of the child is carried out. The level of occlusion is determined using pneumoencephalography, ventriculography (in modern conditions it is used quite rarely), computed tomography (CT) or magnetic resonance imaging (MRI).

The simplest, non-invasive, highly informative method for diagnosing hydrocephalus is ultrasonography brain (ultrasound) - neurosonography. The method allows you to diagnose hydrocephalus already in the seventh month of pregnancy. Neurosonography is widely used to examine young children, when the bone sutures of the skull and fontanelles have not yet grown.
As a result of the examination, the size of the ventricles of the brain is established, the level and causes of occlusion are clarified. The examination is convenient for dynamic monitoring of the patient, since it is harmless to the body.

Age-related features of hydrocephalus

Most often, this disease occurs in newborns, but even adults can experience symptoms of this serious illness. As a rule, this condition is acquired and is a consequence of past illnesses or existing pathologies. In particular, dropsy can be caused by changes that occur in the body under the influence of persistent high blood pressure in the network of arteries, as well as during the atherosclerotic process. The normal flow of cerebrospinal fluid can also be disrupted due to the formation and growth of various types of tumors that put pressure on various parts of the brain. Injuries and neuroinfections accompanied by inflammatory process, disturbances of normal blood circulation.

Medical scientists have proven that any type of impact on the brain is potentially dangerous, as a result of which its integrity and functionality may be impaired. This also applies internal processes leading to damage to organ tissue.

Hydrocephalus of the brain in adults is treated exclusively with vigilant control specialist in the field of medicine. Immediately after a thorough diagnosis, medications are started to reduce the pressure in the patient’s skull. In critical cases, the fluid is removed surgical intervention. The main goal of the medical staff is to ensure normal fluid flow, that is, to eliminate the cause of its disruption.

Should it be said that early diagnosis allows doctors to minimize possible bad influence on the organ and the body as a whole, increasing the patient’s chances of staying alive and maintaining health.

Hydrocephalus in adults

Manifests hydrocephalus in adults in the form of a set of symptoms characteristic of increased intracranial pressure, which appears due to the accumulation of cerebrospinal fluid. In relation to adults, as well as older children, in extensive list symptoms include a severe headache that does not subside under the influence of various analgesics, a feeling of pressure in the eyeballs, nausea and vomiting. As the disease progresses, symptoms may expand, but initially listed signs may appear periodically and increase gradually.

Often, dropsy manifests itself in neurological symptoms, which is explained by compression of the brain structure when the cerebrospinal fluid space expands, as well as the impact of the underlying disease that led to hydrocephalus. As a rule, we are talking about disturbances in the functioning of the vestibular apparatus, as well as in the perception of visual signals, up to nerve atrophy.

Less common in medical practice cases characterized by disturbances in motor and sensory functions. These may be paralysis and paresis, changes in the area of ​​tendon reflexes, partial or even complete loss of one or all types of sensitivity, etc.

In addition, this disease may also be accompanied by manifestations in the area mental health patient. As a rule, violations are noted in the sphere of emotions and manifestations of will. The patient exhibits emotional instability, sometimes neurasthenia, and demonstrates abrupt and most often causeless transitions from euphoria to apathy or vice versa. When pressure in the skull increases rapidly, aggression can occur.

All these symptoms, described by the patient or his immediate environment, allow the neurologist to assume the presence of the disease already at the first examination, before conducting tests.

Hydrocephalus in children

Hydrocephalus in children- a more common occurrence than a similar disease in adults. Since the child’s body has not yet completed the process of its full formation, it largely “succumbs” to the disease, as a result of which, along with other symptoms, an increase in the size of the skull may also appear.

The skull begins to grow under the pressure of the cerebrospinal fluid and due to the body’s desire to reduce intracranial pressure. Growth can appear on both sides of the skull, or on one of them. As the disease progresses and the skull grows, head movements and subsequently movement in general become more difficult. Often this symptom accompanied by a complex of others - bulging veins, disc swelling optic nerve, tension in the area of ​​the large fontanel. Even on early stages The doctor may suspect hydrocephalus based on the “setting sun” syndrome that occurs in children.

The symptoms of hydrocele in children partially repeat the complex of symptoms in adults. In particular, there may be a change muscle tone, partial or complete loss of vision and sensitivity, neurological disorders and psychological disorders. Unlike adults, children extremely rarely demonstrate disorders of the emotional-volitional sphere - in in this case retardation in intellectual and physical development is manifested. Due to low mobility, sick children quickly gain weight and become obese. The psychological picture shows apathy, lack of initiative and strong attachment to loved ones and relatives.

The cause of the disease is usually congenital pathology V early age or an infection in teenage years. Diagnosis and treatment are similar to those for adult patients and are individualized.

Hydrocephalus in newborns

Most often, the development of the disease is determined in a person during his maturation in the womb. In this case, the manifestation of the first symptoms is not long in coming, and medicine is faced with such a phenomenon as hydrocephalus in newborns.

The cause of this pathology in a child may be a defect in the vascular system, various types of defects in the development and formation of the central nervous system (hernia, aneurysm or cyst in the skull), breakage or aberration in the set of chromosomes. Most rarely, such consequences occur as a result of the formation of formations in the brain of an unborn child. Dangerous for the fetus There may be infections that have ever been suffered or that have not yet been eliminated from the mother’s body. Even a completely harmless infection like ARVI can critically increase the likelihood of developing hydrocephalus. It is extremely rare to encounter cases in which the disease was triggered by fetal trauma.

In the first year of a baby’s life, dropsy can provoke not only external manifestations(disproportionate and excessive increase in the volume of the skull, tension of the scalp, etc.), but also disturbances in the development of the body. Due to the growth of the skull, the child is limited in movement, which leads to impaired muscle formation and deformities. In addition, compression of parts of the brain leads to mental, emotional and often psychological retardation. As the disease progresses, strabismus appears, and the “setting sun” syndrome can manifest itself even in the first days of life.

At this age, the damage caused to the body by the disease is maximum, therefore it is extremely important to identify its onset and progress as early as possible and seek qualified medical care before the consequences are irreversible. Fortunately, due to the pliability of the maturing organism, disorders can be diagnosed almost immediately after birth.

Treatment of hydrocephalus

To date, there is no conservative drug treatment that would be effective for progressive hydrocephalus. Existing remedies of both herbal origin (juniper fruits, bear ears, dill seeds) and stronger pharmacological preparations (diacarb, furosemide, Lasix, Novurit, Urix, hypothiazide) provide only a temporary decrease in the amount of circulating cerebrospinal fluid and a decrease in intracranial pressure. They are used in the initial stages of hydrocephalus or to improve the patient’s condition in preparation for surgical treatment, i.e. is largely a palliative or purely symptomatic measure. In order to improve the patient's condition, especially in cases of a sharp increase in intracranial pressure, which can be complicated by an occlusive attack, ventricular puncture with the removal of cerebrospinal fluid is also indicated. In cases of hydrocephalus development with infectious diseases used in acute and subacute stages antibacterial treatment(sulfonamides, antibiotics, symptomatic treatment). After cerebrospinal fluid shunt operations in cases of compensated hydrocephalus, drug treatment is used to improve metabolic processes in the brain (nootropil, actovegin, vitamin E, etc.) and improve blood circulation.

Hydrocephalus is mainly treated with surgical methods. Regardless of the pathogenetic features of hydrocephalus, the main goal of surgical interventions is to create conditions that ensure the removal of excess cerebrospinal fluid from the cerebrospinal fluid spaces of the brain, and to maintain cerebrospinal fluid pressure on the brain. normal level. To achieve this goal, the following is carried out:

1. Operations aimed at draining cerebrospinal fluid by creating bypasses ( different kinds liquor shunt operations).
2. Actions aimed at eliminating occlusion of the cerebrospinal fluid ducts (removal of tumors that compress or block various parts of the cerebrospinal fluid ducts, dissection of the cerebellar vermis with occlusion at the level of the foramen of Magendie, as well as perforation of the lamina terminalis and puncture of the corpus callosum).

The effectiveness of hydrocephalus treatment qualitatively improved with the introduction of valve drainage systems into practice various designs, are implanted into the body (Denver, Pudensa, Holtara, Jaquidoa, etc.). The schematic diagram of the systems produced ensures the flow of fluid in only one direction and is turned on when spinal pressure levels exceed a predetermined one. The system consists of a central catheter through which cerebrospinal fluid flows from the ventricle of the brain, a unidirectional valve device with a pump, and peripheral catheter to drain liquid. Valve devices are available in various modifications for three modes: low cerebrospinal fluid pressure (15-49 mm water column), average(50-99 mm water column) and high(100-150 mm water column) pressure. The device allows fluid to pass through the valve when the pressure in the central catheter begins to exceed the prescribed value. When the pressure decreases, the valve “closes”. The choice of pressure mode is selected depending on the patient’s age, type of hydrocephalus and characteristics clinical course. The pump is designed for artificial rapid fluid discharge and for monitoring the patency of the CSF shunt system itself. The pump works by pressing it through the skin. CSF shunt systems are made from inert materials, mainly silicone or silastic, which do not cause allergenicity or rejection by the body, provide long-term drainage of cerebrospinal fluid, are elastic, durable and do not change their properties for a long time.
Often with CSF shunt operations they use:

• Ventriculoperitoneal shunt
• Ventriculocardial shunting
• Lumboperitoneostomy
• Ventriculocisternostomy

In case of occlusion at the level of the interventricular foramen or III ventricle perform bilateral bypass surgery, since the lateral ventricles may be disconnected.

Treatment results for hydrocephalus

The introduction of valve drainage systems into practice allowed reduce mortality due to hydrocephalus from 23% to 1%. Infectious complications are among the most common and dangerous in any surgical intervention, but their percentage increases when it is necessary to introduce foreign objects, or when operations are performed on newborns and infants with severe general condition and exhaustion of the patient.

Sometimes inflammatory complications can be eliminated with anti-inflammatory therapy. If treatment is not effective, the shunt system must be removed.

Another complication when using cerebrospinal fluid shunt systems, they become clogged. The latter can occur at any level. Central catheter may become clogged with protein found in the cerebrospinal fluid, brain tissue, or choroid plexus. The distal catheter located in the abdominal cavity can become clogged with peritoneum, intestines, and fibrin deposits.

During ventriculoperitoneal shunting in young children, 2-4 years after surgery due to the child’s growth, the abdominal end of the catheter leaves the abdominal cavity, which leads to the cessation of drainage and rapid deterioration of the patient's condition.

The long-term consequences of surgical treatment of hydrocephalus of various origins using cerebrospinal fluid shunt systems depend, first of all, on the degree of their severity, i.e., the degree of disruption of structure and function various departments brain With relative preservation of the cerebral mantle (tissue of the cerebral hemispheres) of more than 2-3 cm, normal physical and mental development of the child can be predicted (Yu. A. Orlov, 1996). Even maintaining this size to 1 cm often makes it possible to compensate for the corresponding deficiency in more than 70% of patients (considering that in most people no more than 12-15% of the cerebral cortex functions).

Only in cases of significant atrophy of brain structures surgical intervention may be futile.

Hydrocephalus in adults (“dropsy of the brain”) is a pathological condition characterized by excessive accumulation of cerebrospinal fluid (CSF) in the cerebrospinal fluid spaces of the brain. Hydrocephalus can be an independent nosological entity, or it can be a consequence of various brain diseases. It requires mandatory qualified treatment, since the long-term existence of the disease can lead to disability and even death.

The disease differs significantly from the manifestations of the disease in adults due to the fact that in a child’s body the brain is still developing. In this article we will look at the causes, symptoms and treatment of hydrocephalus of the brain in adults.

Causes

Each person in the brain has special spaces containing a special liquid - cerebrospinal fluid. Inside the brain itself there is a system of brain ventricles communicating with each other, outside the brain there is a subarachnoid space with brain cisterns. Liquor performs very important functions: it protects the brain from blows, jolts and infectious agents (the latter thanks to the antibodies it contains), nourishes the brain, participates in the regulation of blood circulation in the closed space of the brain and skull, and ensures homeostasis due to optimal intracranial pressure.

The volume of cerebrospinal fluid in an adult is 120-150 ml, and it is renewed several times a day. The production of cerebrospinal fluid occurs in the choroid plexuses of the ventricles of the brain. From the lateral ventricles of the brain (containing approximately 25 ml), cerebrospinal fluid flows through the foramen of Monro into the third ventricle, whose volume is 5 ml. From the third ventricle, the cerebrospinal fluid moves to the fourth (also contains 5 ml) along the aqueduct of Sylvius (aqueduct of the brain). At the bottom of the fourth ventricle there are openings: the median unpaired Magendie and two lateral Luschka. Through these openings, cerebrospinal fluid enters the subarachnoid space of the brain (located between the soft and arachnoid membranes brain). On the basal surface of the brain, the subarachnoid space expands, forming several cisterns: cavities filled with cerebrospinal fluid. From the tanks, cerebrospinal fluid flows to the outer (convexital) surface of the brain, as if “washing” it from all sides.

Absorption (resorption) of cerebrospinal fluid occurs in venous system brain through arachnoid cells and villi. The accumulation of villi around the venous sinuses is called pachion granulations. Part of the cerebrospinal fluid is absorbed into the lymphatic system at the level of the nerve sheaths.

Thus, the cerebrospinal fluid produced in the choroid plexuses inside the brain washes it from all sides and is then absorbed into the venous system, this process is continuous. This is how circulation occurs normally, the amount of fluid produced per day is equal to that absorbed. If “problems” arise at any stage, either with production or with absorption, then hydrocephalus occurs.

The causes of hydrocephalus can be:

• infectious diseases of the brain and its membranes - encephalitis, ventriculitis;
• brain tumors of stem or peri-stem localization, as well as brain ventricles);
• vascular pathology of the brain, including as a result of rupture of aneurysms, arteriovenous malformations;
• encephalopathies (alcoholic, toxic, etc.);
• brain injuries and post-traumatic conditions;
• malformations of the nervous system (for example, Dandy-Walker syndrome, stenosis of the Sylvian aqueduct).

Types of hydrocephalus

Hydrocephalus can be congenital or acquired. Congenital, as a rule, manifests itself in childhood.

Depending on the development mechanism, there are:

• closed (occlusive, non-communicating) hydrocephalus - when the cause is a violation of the flow of cerebrospinal fluid due to an overlap (block) of the cerebrospinal fluid pathways. More often, the normal flow of cerebrospinal fluid is interfered with by a blood clot (due to intraventricular hemorrhage), part of a tumor or adhesion;
• open (communicating, disresorptive) hydrocephalus - based on impaired absorption into the venous system of the brain at the level of arachnoid villi, cells, pachyonic granulations, venous sinuses;
• hypersecretory hydrocephalus - with excessive production of cerebrospinal fluid by the choroid plexuses of the ventricles;
• external (mixed, ex vacuo) hydrocephalus - when the content of cerebrospinal fluid is increased both in the ventricles of the brain and in the subarachnoid space. In recent years, this form has ceased to be classified as hydrocephalus, since the reason for the increase in cerebrospinal fluid content is atrophy of brain tissue and a decrease in the brain itself, and not in disruption of the circulation of cerebrospinal fluid.

Depending on the level of intracranial pressure, hydrocephalus can be:

• hypertensive – with increased cerebrospinal fluid pressure;
• normotensive - with normal blood pressure;
• hypotensive – with low cerebrospinal fluid pressure.

Based on the time of occurrence, they are distinguished:

• acute hydrocephalus – the development period of the process is up to 3 days;
• subacute progressive – develops within a month (some authors consider the period to be 21 days);
• chronic - from 3 weeks to 6 months and above.

Symptoms

The clinical picture depends on the period of formation of hydrocephalus and the level of cerebrospinal fluid pressure, the mechanism of development.

In acute and subacute occlusive hydrocephalus, a person complains of a headache, more pronounced in the morning (especially after sleep), accompanied by nausea and sometimes vomiting, which brings relief. There is a feeling of pressure on the eyeballs from the inside, a burning sensation, “sand” in the eyes, and the pain is bursting in nature. Injection of scleral vessels is possible.

As the cerebrospinal fluid pressure increases, drowsiness occurs, which serves as a poor prognostic sign, as it indicates an increase in symptoms and threatens loss of consciousness.
Possible deterioration of vision, a feeling of “fog” before the eyes. Congestive optic discs are detected in the fundus.
If the patient does not apply for medical care, then a continued increase in the content of cerebrospinal fluid and intracranial pressure will lead to the development of dislocation syndrome - a life-threatening condition. It manifests itself by rapid depression of consciousness up to coma, paresis of upward gaze, divergent strabismus, and suppression of reflexes. These symptoms are characteristic of compression of the midbrain. When compression of the medulla oblongata occurs, symptoms of swallowing disorders appear, the voice changes (to the point of loss of consciousness), and then cardiac activity and breathing are depressed, which leads to the death of the patient.

Chronic hydrocephalus is often communicating and with normal or slightly increased intracranial pressure. It develops gradually, months after the causative factor. Initially, the sleep cycle is disrupted, and either insomnia or drowsiness appears. Memory deteriorates, lethargy and fatigue appear. General asthenia is characteristic. As the disease progresses, mnestic (cognitive) impairments worsen, leading to dementia in advanced cases. Patients cannot care for themselves and behave inappropriately.

Second typical symptom Chronic hydrocephalus is a walking disorder. At first, the gait changes – it becomes slow and unstable. Then comes uncertainty when standing and difficulty starting to move. In a lying or sitting position, the patient can imitate walking or riding a bicycle, but in vertical position this ability is instantly lost. The gait becomes “magnetic” - the patient seems to be glued to the floor, and, having moved from his place, he takes small shuffling steps on widely spaced legs, marking time. These changes are called “gait apraxia.” Muscle tone increases, in advanced cases muscle strength decreases, and paresis appears in the legs. Balance disorders also tend to progress to the point of being unable to stand or sit independently.

Often patients with chronic hydrocephalus complain of frequent urination, especially at night. Gradually, an imperative urge to urinate begins, requiring immediate emptying, and then urinary incontinence.

Diagnostics

The main role in establishing the diagnosis belongs to computed tomography (CT) and magnetic resonance imaging (MRI). These methods make it possible to determine the shape and size of the ventricles, subarachnoid space, and brain cisterns.

X-ray of the cisterns at the base of the brain allows one to assess the direction of the cerebrospinal fluid flow and clarify the type of hydrocephalus.

It is possible to conduct a trial diagnostic lumbar puncture with the removal of 30-50 ml of cerebrospinal fluid, which is accompanied by a temporary improvement in the condition. This is due to the restoration of blood supply to ischemic brain tissue against the background of a decrease in intracranial pressure. This serves as a favorable prognostic sign when predicting surgical treatment of hydrocephalus. You should know that in acute hydrocephalus, lumbar puncture is contraindicated due to the high risk of brainstem herniation and the development of dislocation syndrome.

Treatment

The initial stages of hydrocephalus can be treated with medication. The following medications are used for this:

• to reduce intracranial pressure and remove excess fluid (provided that the outflow of cerebrospinal fluid is preserved) - diacarb (acetazolamide), mannitol and mannitol in combination with furosemide or lasix. Mandatory for this treatment is the correction of potassium levels in the body, for this they use asparkam (panangin);
• To improve the nutrition of brain tissue, Cavinton (vinpocetine), Actovegin (solcoseryl), gliatilin, choline, cortexin, Cerebrolysin, Semax, Memoplant, etc. are indicated.

Clinically advanced hydrocephalus is subject to surgical treatment; medication methods improve the condition for a short time.

Acute hydrocephalus, as a life-threatening condition, requires immediate neurosurgical treatment. It consists of craniotomy and the application of external drainages to ensure the outflow of excess fluid. This is called external ventricular drainage. In addition, through the drainage system it is possible to administer drugs that dilute blood clots (since intraventricular hemorrhage is one of the most common causes of acute hydrocephalus).

Chronic hydrocephalus requires cerebrospinal fluid shunting operations. This type of surgical treatment involves removing excess cerebrospinal fluid into the natural cavities of the human body using complex system catheters and valves ( abdomen, pelvic cavity, atrium, etc.): ventriculoperitoneal, ventriculoatrial, cystoperitoneal shunting. Unimpeded absorption of excess cerebrospinal fluid occurs in the body cavities. These operations are quite traumatic, but when performed correctly, they allow patients to recover and achieve their labor and social rehabilitation.

Today, the less traumatic neuroendoscopic technique has taken first place among invasive treatment methods. It is still more often performed abroad due to the high cost of the operation itself. This method is called: endoscopic ventriculocisternostomy of the bottom of the third ventricle. The operation lasts only 20 minutes. With this method of treatment, a surgical instrument with a neuroendoscope (camera) at the end is inserted into the ventricles of the brain. The camera allows you to display an image using a projector and accurately control all manipulations. An additional hole is created at the bottom of the third ventricle, connecting to the cisterns of the base of the brain, which eliminates the cause of hydrocephalus. Thus, the physiological fluid flow between the ventricles and cisterns is restored.

Consequences

Hydrocephalus is dangerous disease, ignoring the symptoms of which is fraught with disability or even a threat to life. The fact is that the changes that occur in the brain as a result of the long-term existence of hydrocephalus are irreversible.

Untimely treatment can result in a tragedy for a person: loss of ability to work and social significance. Mental impairment, mobility problems, urination problems, decreased vision, hearing, epileptic seizures, - here is the list of possible consequences of hydrocephalus if its treatment is not started in a timely manner. Therefore, at the slightest suspicion of hydrocephalus, it is necessary to seek qualified medical help.

TVC, program “Doctors” on the topic “Hydrocephalus”

Ivan Drozdov 02.10.2017

Hydrocephalus (dropsy of the brain) is a disease in which a large amount of cerebrospinal fluid accumulates in parts of the brain. The cause of this condition is dysfunction of the production or outflow of cerebrospinal fluid from brain structures. Children and adults are susceptible to the disease. Hydrocephalus of the brain in an adult is more complicated than in a child, since the skull bones fused in the area of ​​the fontanelle do not move apart and the fluid begins to put pressure on nearby brain tissue. Hydrocephalus quite often occurs as a complication of other pathologies affecting the nervous and vascular systems, and brain structures. According to ICD 10, hydrocephalus in the section “Other disorders of the nervous system” has a separate code G91, in which the types of disease are described in points 0-9.

Symptoms of hydrocephalus

Headache

Signs of cerebral hydrocele differ significantly depending on the form in which the disease develops. For acute form The pathology is characterized by a rapid increase in ICP and the appearance of the following symptoms:

• Headache – radiating to the area of ​​the eye sockets, occurs mainly in the morning immediately after waking up. After a short period of wakefulness, their intensity decreases.
• Nausea - appears along with headaches, mainly in the morning.
• Vomiting is not associated with food; after an attack, the patient feels better.
• Visual disturbances – a burning sensation in the eyes, the appearance of a foggy veil.
• Drowsiness is a sign of a large accumulation of fluid, the rapid development of intracranial hypertension and the likelihood of a sudden onset of a number of neurological symptoms.
• Signs of displacement of brain structures relative to the axis of the brain stem are disturbances in oculomotor functions, unnatural position of the head, respiratory failure, depression of consciousness up to the development of coma.
• Epilepsy attacks.

With the chronic development of hydrocephalus in an adult, symptoms appear gradually and in a less pronounced form. Most often the patient experiences:

1. Signs of dementia include confusion, sleep disturbances, memory loss and thought processes, decreased ability to independently care for oneself in everyday life.
2. Apraxia of walking is a gait disorder when walking (unsteadiness, uncertainty, unnaturally large steps), while in a supine position the patient confidently demonstrates motor functions, imitating cycling or walking.
3. Violation of urination and defecation - manifests itself in advanced cases in the form of urinary and fecal incontinence.
4. Constant muscle weakness, lethargy.
5. Balance imbalance - on late stage manifests itself in the patient’s inability to move or sit independently.

It is important to promptly distinguish hydrocephalus of the brain in an adult from other pathologies based on the described symptoms and consult a doctor.

Liqueur fluid produced by the choroid plexuses of the brain washes its structures and is absorbed into the venous tissues. Normally, this process occurs continuously and the amount of fluid produced and absorbed is equal. When one of the described functions is disrupted, excessive accumulation of cerebrospinal fluid occurs in the brain structures, which is the main cause of hydrocephalus.

Hydrocephalus of the brain in an adult can occur against the background of the following pathological conditions:

• Acute disturbances in the cerebral blood supply system caused by thrombosis, hemorrhagic or ischemic strokes, rupture, subarachnoid or intraventricular bleeding.
• The development of infections and inflammatory processes affecting the central nervous system, structures and membranes of the brain - ventriculitis, encephalitis, tuberculosis.
• – , alcohol and other types of it that cause chronic hypoxia brain and its subsequent atrophy.
• , growing in the cells of the ventricles, brain stem and peri-stem tissues.
• Intracranial injuries causing swelling brain structures and vascular rupture, as well as post-traumatic complications.
• Complications after surgical operations in the form of cerebral edema and compression of the cerebrospinal fluid and blood supply channels.
• Rare genetic anomalies and defects of the central nervous system - Bickers-Adams, Dandy-Walker syndromes.

If at least one of the described diseases is present, the patient should take into account the risk of developing hydrocephalus as a complication and in the event of characteristic symptoms Immediately report them to your doctor.

Types of hydrocephalus

Adult hydrocephalus is almost always classified as an acquired disease. Depending on the characteristics, nature of origin and development, it is divided into the following types:

1. By nature of origin:

• Open (external) - due to poor absorption of fluid into the walls venous vessels its excess accumulates in the subarachnoid space, while no disturbances are observed in the ventricles of the brain. This type of dropsy is uncommon; its progression leads to a gradual decrease in brain volume and atrophy of brain tissue.
• Closed (internal) - liquor fluid accumulates in the sections of the ventricles. The reason for this process is a violation of its outflow through the liquor-conducting channels, caused by the inflammatory process, thrombosis, and tumor growth.
• Hypersecretory - occurs when there is excessive production of cerebrospinal fluid.
• Mixed - until recently, this type of hydrocephalus was diagnosed when fluid accumulated simultaneously in the ventricles of the brain and the subarachnoid space. Today, brain atrophy is identified as the root cause of this condition, and fluid accumulation is a consequence, so this type of pathology does not apply to hydrocephalus.

1. According to intracranial pressure indicators:

• Hypotensive – cerebrospinal fluid pressure is reduced.
• Hypertensive – cerebrospinal fluid pressure indicators are increased.
• Normotensive – intracranial pressure is normal.

1. According to the pace of development:

• Acute - the rapid development of pathology, the period from the first symptoms to deep damage to the brain structures is 3-4 days.
• Subacute – the disease develops over 1 month.
• Chronic – poorly characterized severe symptoms, the development period is 6 months or more.

Each form of hydrocephalus manifests itself in the form of certain symptoms, the presence of which helps doctors make the correct diagnosis in the process of additional diagnostics.

Diagnostics

It is impossible to diagnose hydrocephalus of the brain in an adult solely by visual signs or symptoms, since the disease does not manifest itself externally, and poor health can be caused by other pathologies.

Before making a diagnosis of hydrocephalus, the doctor prescribes a set of studies consisting of the following methods:

1. Examination by specialists - includes collecting information about symptoms and diseases that provoke the appearance of cerebral hydrocele; conducting tests to assess the degree of damage to brain structures and a decrease in its functionality.
2. Computed tomography - to study the size and shape of the ventricles, parts of the brain, subarachnoid space and skull bones, determining their sizes and shapes, the presence of tumors.
3. Magnetic resonance imaging - to detect fluid in the brain structures, determine the form and severity of hydrocephalus, which will allow a preliminary conclusion to be made about the cause of the development of the pathology.
4. X-ray or angiography using a contrast agent - to determine the condition of the vessels and the degree of thinning of their walls.
5. Cisternography is performed to identify the form of hydrocephalus and clarify the direction of movement of cerebrospinal fluid.
6. Echoencephalography is an ultrasound examination of brain structures for the presence of pathological changes occurring in them.
7. Lumbar puncture - cerebrospinal fluid is taken to determine intracranial pressure, study its composition according to the degree of thickening and the presence of inflammatory processes.
8. Ophthalmoscopy is carried out as a concomitant study to identify visual disorders and the causes that caused them.

If the results of the examination confirm the presence of fluid in the brain structures, the doctor diagnoses hydrocephalus and prescribes treatment depending on its form.

Treatment of hydrocephalus

For small and moderate accumulation of fluid in parts of the brain, the patient is recommended to undergo drug treatment.

If the cerebrospinal fluid creates too high pressure and the patient’s life is in danger, then he needs urgent surgery.

With hydrocephalus, it is important to reduce the pressure of cerebrospinal fluid on the brain. For this purpose, during the treatment process, the doctor prescribes the following medications:

• Diuretics (Diacarb, Glimarit) - to remove excess fluid from the body.
• Vasoactive drugs (Glivenol, Magnesium Sulfate) - to improve blood circulation and restore vascular tone.
• Painkillers (Ketoprofen, Nimesil), anti-migraine tablets (Sumatriptan, Imigren) - to relieve pain attacks and a number of neurological symptoms.
• Glucocorticosteroids (Prednisolone, Betamethasone) are indicated in severe conditions as an immunosuppressant and a toxin-neutralizing agent.
• Barbiturates (Phenobarbital) – sedatives, which have a depressant effect on the central nervous system.

Drug therapy can reduce the amount of fluid in the brain structures and relieve symptoms, however complete cure with its help it is impossible. In acute and advanced cases, if there is high risk development of coma or death, the patient undergoes neurosurgical intervention. Depending on the indications and condition of the patient with hydrocephalus of the brain in an adult, the following types of operations are performed:

1. Bypass surgery– drainage of cerebrospinal fluid with a special instrument from brain structures into the body cavity, which naturally absorb liquid freely. There are different types of shunting:

• ventriculo-peritoneal – drainage of fluid into the abdominal cavity;
• ventriculoatrial - to the right atrium;
• ventriculocisternomia - in the occipital part, section of the cistern magna.

1. Endoscopy– the fluid is drained out through a special catheter inserted into a hole made in the skull.
2. Ventricular drainage– an open operation involving the installation of an external drainage system. This type of intervention is indicated in cases where other types of operations cannot be performed. When performing it, there is a high risk of developing complications later.

Consequences of hydrocephalus

Doctors’ prognosis when diagnosing hydrocephalus of the brain in an adult depends on the form and severity of the disease. Identification of pathology at the initial stage increases the likelihood of maintaining working capacity, as well as the patient’s independent orientation in everyday life and society. To do this, at the first symptoms of the disease, you need to consult a doctor, undergo regular examinations, and also undergo the courses of treatment and rehabilitation recommended by him.

Hydrocephalus in an advanced stage threatens the patient with serious complications and a disappointing prognosis for doctors. The reason for this is irreversible processes in the brain tissue that occur during prolonged pressure of the cerebrospinal fluid on its structures. The consequences that occur with advanced hydrocephalus include:

• decreased muscle tone of the limbs;
• deterioration of hearing and vision;
• mental disorders, manifested in decreased thinking, memory, and concentration;
• disorders of the respiratory and cardiac systems;
• water-salt imbalance;
• lack of coordination;
• the appearance of epileptic seizures;
• signs of dementia.

If the described complications are present and their severity is severe, the patient is assigned a disability, the group of which depends on how much he can independently navigate society and everyday life.

Is something bothering you? Illness or life situation?

If the disease progresses rapidly or the brain has almost completely lost functionality due to atrophy of its tissues, then there is a high probability of comatose state and death.

In adults, also popularly called “dropsy of the brain” - clinical syndrome, the main manifestation of which is the excessive volume of cerebrospinal fluid accumulated in the cavities of the cranium.

In accordance with the specifics in the mechanism of development of hydrocephalus of the brain in adults, the disease is divided into subtypes:

• occlusive form, which is characterized by disturbances in the flow of cerebrospinal fluid due to blockage of transport routes;
• dysresorptive type, which occurs when there is a failure in the absorption of cerebrospinal fluid;
• hypersecretory type, starting due to excessive secretion of cerebrospinal fluid.

Also, hydrocephalus of the brain in adults is divided into three forms in accordance with the patient’s typical level of pressure inside the skull: hypertensive type, normotensive type, hypotensive type.

Hydrocephalus of the brain is a serious illness, untimely treatment of which can cause disability and premature death. fatal outcome. The pathology causes irreversible changes in the structures of the brain, as a result of which the patient loses his ability to work and becomes incapable of independent self-care.

Memory problems, deterioration of mental abilities, the appearance of depressive and manic states, decreased or loss of vision, inability to navigate in space, uncontrollable urge to urinate - these are just a few of the symptoms that occur with hydrocephalus of the brain in adults. Due to the existence of a real threat to human life, it is necessary at the slightest sign of disease to urgently go to a neurological clinic, undergo a large-scale examination and follow all medical instructions from the doctor.

Hydrocephalus in adults: causes

Today, the causes of the development of cerebral hydrocephalus in adults have been well studied and described, but the question of the true mechanism of development of the normotensive type of the disease remains unclear. Let us describe the main factors that provoke the onset of the disease in adults.

Hydrocephalus in adults: symptoms

Clinical symptoms of the pathology depend on the factors that gave rise to the disease, the duration of the disease and the level of intracranial pressure. For hydrocephalus that occurs after a traumatic brain injury or subarachnoid hemorrhage, signs may appear during the first week of the disease. In the chronic course of hydrocephalus, they appear and become aggravated gradually.

Almost always, the earliest and most prevalent symptom of hydrocephalus is the subject having problems with walking. At the initial stage of the disease, a person’s gait becomes uncertain. An excessively slow pace of movement is noticeable. Spontaneous falls during movement are possible.

As the disease progresses, walking impairment becomes more severe. It is very difficult for a person to move from his place: it looks as if his legs are “magnetized” to the floor. The patient moves in small steps. His legs are usually wide apart. His shuffling gait is very noticeable. It freezes in place when turning. Sometimes, when moving, a patient with hydrocephalus stops and freezes in place because he is unable to complete the next step.

Moreover, if the patient is in a sitting or lying position, he can easily imitate a normal walking step or movement on a bicycle. While lying down or sitting, he is able to “draw” intricate symbols in the air with his feet. Sometimes there are signs of impaired control over movements in the upper limbs.

A neurological examination of the patient may reveal the following symptoms:

• increased muscle tone of the lower extremities;
• resistance to passive movements of varying degrees;
• involuntary tension in the leg muscles;
• increased segmental reflexes;
• decreased strength in the legs.

Simultaneously with the above symptoms, other signs of hydrocephalus in adults also appear, including imbalance. This anomaly is manifested by a feeling of instability of the torso, which occurs when trying to stand up, take a step, or turn around. Over time, these signs become aggravated: the person loses the ability to stand independently, and in complex forms of hydrocephalus he cannot even sit.

• Many adults with hydrocephalus complain of severe headaches. Typically occurs after waking up in the morning. The headache is accompanied by other symptoms - discomfort and unpleasant sensations in the epigastrium. Vomiting is possible, after which the patient with hydrocephalus experiences relief.
• A common symptom of hydrocephalus in adults is a feeling of pressure coming from inside the eyes. A person may experience a burning sensation in the eyes or feel as if they have been filled with fine grains of sand. Dilated vessels of the eyeballs are visually noticeable. Many adults experience decreased visual acuity. The person describes the appearance of a veil and “fog” before the eyes. The development of optic nerve atrophy is likely.
• As hydrocephalus gets worse, mental signs appear that are distinguished by their brightness. In adults, there is a lack of motivation for mental, speech, and motor activity. A state of complete indifference, indifference to ongoing phenomena arises. The patient may become disoriented in time and not understand where he is. There is a dulling of the emotional perception of reality. Common abnormalities - productive symptoms, including visual and verbal hallucinations. May develop manic syndrome, which are characterized by a triad of symptoms: elevated mood, acceleration of thinking and speech, motor agitation. In other adults, symptoms of depression predominate: low mood, inhibition of intellectual activity, motor retardation.
• Poor prognostic signs include excessive sleepiness during the day, disruption of the sleep-wake pattern, and persistent insomnia. A separate group of patients develop epileptic seizures. The progression of hydrocephalus leads to a significant deterioration in a person’s cognitive functions. Some patients lose the ability to care for themselves independently.
• Often, patients already in the early stages of hydrocephalus indicate increased frequency of urination. Most adults leak most of their daily urine output at night. Subsequently, patients experience an imperative urge to urinate. Later, people suffering from hydrocephalus cease to be aware of the urge to urinate. At the same time, they have complete indifference to the involuntary urination that occurs in them.

Hydrocephalus: treatment

The choice of treatment strategy for hydrocephalus in adults occurs only after an extensive neurological examination and neuroimaging diagnostic methods. The treatment program for the disease is selected depending on the type of hydrocephalus, taking into account its severity and the rate of aggravation of symptoms.

In mild forms it is possible conservative treatment hydrocephalus by prescribing pharmacological agents . As a rule, the patient is prescribed to take the diuretic Diacarb. The action of this medication is aimed at ensuring the removal of excess fluid from the body. Treatment with the diuretic mannit shows a good therapeutic effect. This drug helps reduce intracranial pressure and helps increase the excretion of water by the kidneys. In parallel with these drugs, it is advisable to take the diuretic drug Lasix. To compensate for calcium deficiency associated with taking diuretics, it is recommended to include Panangin in treatment.

The secondary goal of treatment for hydrocephalus in adults is to improve blood supply and nutrition to the brain tissue. For this purpose, drugs of various groups are used. An effective corrector of violations cerebral circulation is Cavinton. To activate cellular metabolism, Actovegin can be added to the treatment program. For quick recovery normal functioning of the central nervous system affected by the negative effects of hydrocephalus, it is advisable to use Cortexinum. Cerebrolysin (Cerebrolysinum) can help improve metabolism in brain tissue.

However, drug treatment in acute and severe conditions with hydrocephalus in adults is inappropriate, since the rapid development of symptoms can lead to irreversible changes in the body and cause premature death of the patient. Therefore, if there is a threat to the patient’s life, immediate surgical treatment is necessary. IN in case of emergency To ensure the outflow of excess cerebrospinal fluid, external ventricular drainage is performed. This technology involves ensuring the drainage of cerebrospinal fluid through the drainage system and intracranial catheter into a sterile container.

In case of chronic hydrocephalus, various shunt operations are performed. This type of surgical treatment is aimed at ensuring the outflow of excess cerebrospinal fluid into the natural cavities of the body by placing a variety of shunts. This surgical treatment– complex and traumatic manipulations, but when performed correctly and competently, recovery is observed in more than 60% of patients with hydrocephalus. Moreover, over 20% of patients who have undergone bypass surgery note a significant improvement in their condition. Mortality with this type of surgical treatment ranges from 6%.

Today, the safest and most atraumatic method of treating hydrocephalus is endoscopic ventriculocisternostomy of the floor of the third ventricle. Ventriculocisternostomy is an operation aimed at artificially creating a line between the basal cisterns of the brain and the ventricle. The use of this method allows you to restore the outflow of cerebrospinal fluid and stimulate the process of its resorption in natural parts. However, today this type of treatment is distinguished by its high cost and is not particularly common in clinics in the Russian Federation.

In medicine, hydrocephalus of the brain is understood as a disease that leads to the accumulation of large volumes of a special fluid (CSF) in the intracranial space. It is common for dropsy to develop among people of different ages, but as a person grows older, it becomes more severe. According to ICD 10, hydrocephalus code is G91.

Experts identify the main signs of hydrocephalus, which takes an acute form:

1. Headaches radiating to the area of ​​the eyeballs. In most patients, such sensations are of a pressing, bursting nature, appear in the morning, and gradually weaken in the daytime.
2. An increase in the size of the head, the appearance of a pronounced venous network.
3. Nausea accompanying morning pain syndrome.
4. Vomiting that occurs regardless of the time of eating, after which temporary relief occurs.
5. Visual disturbances, burning sensation in the eyeballs, “fog” before the eyes.
6. Violation of oculomotor and respiratory functions.
7. Depressed consciousness that can result in coma.
8. Drowsiness, epileptic seizures.

A typical symptom is high intracranial pressure, which has a negative effect on the functioning of the brain, causing expansion of its fluid cavities. Newborns with hydrocephalus are characterized by a large forehead that can hang over the eyes, constant tearfulness, strabismus, swelling in the fontanel area, nervous overexcitation, insufficient weight gain.

In case of chronic disease, the symptoms of hydrocephalus are less pronounced and appear gradually. Adult patients are characterized by difficulty falling asleep, confused consciousness, deterioration of memory and thinking. There may be difficulties with self-care in everyday life, loss of balance, gait disturbance, manifested in the form of unsteadiness, uncertain movements, and large steps.

In the absence of adequate therapy, hydrocele of the brain provokes urinary and fecal incontinence in the patient, deterioration or complete absence ability to think, decreased muscle tone, constant lethargy, apathy.

Reasons for the development of pathologists

Dropsy of the brain is often considered as a complication of pathologies of the vascular, nervous systems, and intracranial structures. Common causes of hydrocephalus include:

• infection of the fetus during gestation;
• congenital defects of the central nervous system;
• consequences of injuries, diseases;
• atrophy of gray or white medulla.

While in the womb, the unborn child may suffer from various infections. Babies are susceptible to infection from mothers suffering from rubella, toxoplasmosis, mumps, encephalitis, herpes, syphilis.

Congenital malformations of the central nervous system that cause the formation of hydrocele of the brain are represented by several syndromes:

1. Chiari (types 1 and 2), against which skull has dimensions smaller than the volume of its contents.
2. Adams, which consists in the inability of cerebrospinal fluid to circulate freely, its accumulation in certain areas.
3. Dandy-Walker, associated with the inability of cerebrospinal fluid to enter the cisterns, subarachnoid space, blood flow, causing its accumulation inside the skull.

A factor provoking congenital hydrocephalus is also the development of basilar compression and aneurysm of the great cerebral vein.

Atrophy of the medulla is associated with degenerative processes occurring in the central nervous system. Vascular, toxic encephalopathy, and Creutzfeldt-Jakob disease become the “soil” for their development.

Types of hydrocephalus

Hydrocephalus, which develops in patients of different ages, can be:

• open;
• non-occlusive;
• aresorptive;
• biventricular;
• atrophic.

Open hydrocephalus is caused by slow absorption of cerebral fluid into the blood. The result is unbalanced production and resorption of cerebrospinal fluid, which the body restores due to increased pressure inside the skull.

Non-occlusive hydrocephalus leads to overflow of the cerebral ventricles with cerebrospinal fluid. With this type of pathology, a liquid substance accumulates in the ventricular system, or fills the subdural and subarachnoid space.

Aresorptive hydrocephalus tends to affect adults. With this type, the venous sinuses do not absorb enough cerebrospinal fluid. Biventricular hydrocephalus is caused by the closure of the openings in the 3rd ventricle.

The atrophic form of cerebral hydrocele is caused by a reduction in brain volume. This type of disease is mainly diagnosed in elderly people susceptible to hypertension, diabetic angiopathy, and atherosclerosis.

In addition to the listed forms of the disease, there is a mixed type of hydrocephalus - the accumulation of cerebrospinal fluid in several areas at once.

How is hydrocele diagnosed?

The specialist begins the diagnosis of hydrocephalus with a visual examination of the patient. Pediatricians treat newborn children. Next, the patient is referred to a neurosurgeon, neurologist, or ophthalmologist.

Having determined the presence of pathology, the doctor prescribes an additional examination to clarify its degree and form. To obtain more detailed data, experts resort to the following methods:

• ultrasound examination (ultrasound);
• radiography;
• cisternography;
• magnetic resonance imaging (MRI);
• computed tomography (CT);
• lumbar puncture.

Ultrasound clarifies the degree of intracranial hypertension, which is a typical symptom of hydrocephalus. Radiography determines the condition of blood vessels and their walls. Cisternography serves to clarify the form of the pathology and allows you to find out in which direction the cerebrospinal fluid is moving.

MRI visualizes the fluid present in the brain structures, determines the severity of the disease and its shape. This method allows us to name the probable cause of the formation of dropsy. CT additionally confirms the information obtained during magnetic resonance imaging.

Lumbar puncture involves taking cerebrospinal fluid and subsequently determining intracranial pressure. The procedure allows you to examine the composition of the cerebrospinal fluid and identify the presence of inflammation.

Ophthalmoscopy becomes additional measure, which serves to identify visual impairments and the causes of their development. After the diagnosis of hypertensive-hydrocephalic syndrome is completed, therapy is carried out corresponding to the type of disease.

How is hydrocephalus treated?

Hydrocele of the brain often requires surgical treatment, carried out under general anesthesia. Specialists resort to the following types of surgical intervention:

• palliative;
• radical.

During palliative surgery, a spinal or ventricular puncture is performed. For the treatment of young children, excess fluid is removed through the eye socket. Radical surgical methods include ventriculoperitoneal shunting, Küttner Wenglovsky's operation, and ventriculocisternostomy.

Treatment of cerebral hydrocele using medications brings positive results only in 40-45% of cases; it becomes relevant with small volumes of fluid and moderately high intracranial pressure.

For younger patients, diuretics are prescribed:

1. Furosemide.
2. Mannitol.
3. Diacarb.

For the treatment of hydrocephalus of the brain in adults, magnesium sulfate and Asparkam are used. Antibiotic therapy, taking vitamin and absorbable medications, physiotherapy, and exercise therapy become mandatory.

In most cases surgery allows you to achieve full recovery patient. If the cause of cerebral hydrops is aggressive cancer tumor, a timely operation prolongs the patient’s life for several years.

What complications does dropsy lead to?

Parents whose children are expected to develop pathology need to know why hydrocephalus is dangerous. The consequences of untimely therapy are:

• retardation in terms of mental and physical development;
• inability to concentrate;
• poor memory;
• speech apparatus defects.

In adults, complications take the form of seizures, blindness or deafness, impaired motor coordination, and inability to control urination and bowel movements. There is a high probability of developing irreversible pathological processes in brain tissue.

Hydrocephalus of the brain is one of the most dangerous diseases that can make a person disabled. This is why treatment should begin at initial stage disease and prevent its progression.

Preventive measures

To avoid the manifestation of pathology in the unborn child, pregnant women are recommended:

1. Take folic acid and special vitamin complexes.
2. Treat infectious diseases in a timely manner.
3. To refuse from bad habits.
4. Avoid uncontrolled use of medications.

Detection of signs of the disease in the fetus during a routine ultrasound makes it possible to carry out treatment at the initial stage and prevent its further development.

Dropsy of the brain in adults is prevented by minimizing stress and preventing sexually transmitted diseases. It is important to avoid overwork; if you have a family history of hydrocephalus, you should be regularly examined by a doctor.