Symptoms and treatment of hydrocephalus of the brain (dropsy) in adults. Internal hydrocephalus of the brain: how to live with the problem

Hydrocephalus, or in other words, dropsy of the brain, which is formed as a result of excessive accumulation of cerebrospinal fluid in the cavities of the brain, the movement of which from the cavities (ventricles) of the brain to the cardiovascular system of the body was disrupted by certain factors.

The outcome of this disease is dangerous, because if you are late in starting therapy, then the consequences may be irreparable.

Stable pressure, as a rule, causes disruption of the brain and deformation of the skull. Dementia is often a result of this disease.

Death is also not uncommon, which is why it poses a great danger to human health.

As already mentioned, hydrocephalus of the brain in an adult this is a dangerous disease, which can affect basic brain functions and cause death.

Therefore, a timely, correct doctor’s opinion and the start of therapy can contribute to a speedy recovery and return to your normal life. But it is worth remembering that taking medications is ineffective, so you should not refuse operations if it is really necessary.

Types of hydrocephalus

Depending on the mechanism of onset of the disease, three types of hydrocephalus are determined in adults:

Closed (not communicating). This form of the disease is related to the disorganization of the process of outflow of cerebrospinal fluid due to the blockage of the drainage pathways. The cause of such a violation, as a rule, is a neoplasm or a blood clot that remains after the inflammatory process.
Communicating or open form. In this case, the root cause is considered to be malfunctions in the processes of cerebrospinal fluid absorption in the venous system, since certain structures are damaged.
Hypersecretory form. This is a form of the disease that results in the production of more cerebrospinal fluid than needed, i.e. its excess.

Classification of the disease

Depending on the underlying causes that caused hydrocephalus, distinguish:

congenital;
acquired hydrocephalus.

Congenital is a consequence of intrauterine dysfunction of the central nervous system or developmental defects. Acquired, as a rule, occurs after a World Cup injury, inflammation, the appearance of neoplasms, etc.

Birth defects that contribute to development hydrocephalus:

Hereditary defects caused by genetics:

genes that are associated with chromosome x are responsible for the development of hydrocephalus;
Dandy-Walker congenital disorder of the circulatory system.

Acquired defects that contribute to the development hydrocephalus:

Caused by infection. Very often diagnosed in the case of communicating hydrocephalus.
Damage that appears as a consequence of subarachnoid hemorrhage.
Posthemorrhagic. It is the second most common underlying cause of communicating hydrocephalus.
Damage that appears after hemorrhage inside the cavities of the brain. According to statistics, 25-48% of patients develop developing hydrocephalus. Without the formation of neoplasms. Tumors, arteriovenous malformations.
Secondary. With extensive processes inside the skull.
Accompanied by the formation of neoplasms. The disease is formed as a result of the presence of obstacles in the cerebrospinal fluid flow directions, which causes neoplasms in the cerebellum of the lateral cavity of the brain.
After the operation the following is typical. Approximately 20 percent of children who have had tumors removed from the posterior cranial fossa feel the need for surgical intervention by implanting shunts.

Hydrocephalus is recognized morphologically, depending on its location in relation to the brain tissue of the enlarged spinal cavities. Note:

intracavitary;
subarachnoid;
external hydrocephalus in adults.

Depending on the degree of pressure exerted by the cerebrospinal fluid, normo- and hypertensive hydrocephalus are distinguished.

From a clinical and functional point of view distinguish:

stabilized hydrocephalus;
progressive;
regressing.

From a clinical point of view, the second type of disease is subcompensated or decompensated (this is precisely the goal of surgical intervention).

Regressive and stabilized deviations are usually compensated, so surgical intervention is not an urgent need.

Causes of the disease

You can highlight a list of ailments that contribute to the development of this disease in adults. Here are the main causes of hydrocephalus in adults:

Neoplasms in GM. Neoplasms located in the stem part of the brain and in the cavities of the brain have a strong influence on the movement of matter.
Inflammatory processes and damage to the body by diseases such as meningitis, encephalitis, tuberculosis, etc.
Bleeding of blood vessels inside the skull. An important point is subarachnoid and intracavitary bleeding, which is most closely associated with hydrocephalus.
Disorders of the circulatory process in the brain, for the most part, are of an acute nature: hemorrhagic and ischemic strokes.
Encephalopathies that have different sources of occurrence: alcoholic, as a result of prolonged oxygen starvation, etc.

Symptoms of the disease

Signs and symptoms of hydrocephalus in adults depend on the form of the disease.

Acute hydrocephalus

In acute hydrocephalus, symptoms are the result of increased pressure inside skulls:

Emerging pain in the head - the patient experiences especially severe pain when waking up in the morning. This can be explained by the fact that blood pressure increases during sleep.
Nausea and vomiting - the manifestation of these symptoms is also typical in the morning hours. After cleansing the stomach, the pain in the head sometimes subsides.
Lethargy is one of the most dangerous symptoms indicating increased pressure inside the skull. When it occurs, most likely, a rapid, sharp progression of neurological symptoms is approaching.
Symptoms of displacement of brain tissue relative to hard formations of the brain are rapid suppression of the patient’s consciousness until the development of coma, then the patient takes a forced position of the head, and oculomotor disturbances occur.

Chronic hydrocephalus

Signs of hydrocephalus in adults in this case:

Cognitive disorder - in most cases, symptoms in adults appear 15-20 days after an injury, bleeding of blood vessels in the brain, meningitis, or others.
The patient is confused about the time of day, that is, he experiences lethargy during the daytime and cannot sleep at night. The patient becomes passive, indifferent to what is happening.
Memory impairment - first of all, the ability to remember numbers deteriorates. In this case, the patient pronounces months and numbers incorrectly and forgets how old he is.
At advanced stages of the disease, intellectual abilities may be impaired, as a result of which the patient cannot take care of himself, and he may not answer the questions asked at all or answer, spending a lot of time, taking breaks between words.
Walking disorder is a syndrome in which the patient, in a supine position, easily demonstrates how to move or ride a bicycle, but when he gets up, he is not able to move normally, that is, he moves with his legs wide apart, rolling from one foot to the other.
Involuntary loss of urine does not necessarily occur and is a late symptom of the disease. Fundus deviations are usually absent.

Diagnostic techniques

To make a correct diagnosis, you need to do a whole complex procedures:

Computed tomography is a fairly accurate diagnosis of the contours of the brain, its cavities and the skull. It is carried out to establish the shape and size of cavities, determine deviations - various neoplasms.
Magnetic resonance makes it possible to determine the severity and type of disease. These studies are necessary to accurately establish the causes of dropsy.
X-ray of the cisterns of the base of the skull is used to establish the type of disease and determine the path of loss of cerebrospinal fluid.
Internal examination of blood vessels - after the contrast substance enters the arteries, abnormalities in the vessels are detected.

MRI for hydrocephalus in adults photo

Healing procedures

Treatment of hydrocephalus in adults depends on the form of the disease.

Acute form

Treatment of acute hydrocephalus in adults:

in case of acute illness, medications are usually prescribed that reduce the pressure inside the skull;
a procedure for extracting a small amount of cerebrospinal fluid by inserting a needle into the area of the fontanelles, with the goal of reducing pressure.

Sometimes during therapy it is also necessary surgical intervention— extracting the root cause of the violation of the decrease in cerebrospinal fluid or determining other ways of removing cerebrospinal fluid, for example, removing a substance into the abdominal cavity.

Chronic form

Treatment is surgical implantation of a shunt. The shunt diverts excess cerebrospinal fluid from the brain to another part of the body, where the substance is absorbed.

Such operations are at least 85% effective.

The principle of surgical intervention is as follows - excess cerebrospinal fluid is evacuated to other parts of the human body (to the abdominal cavity, to the right atrium, etc.) using systems of tubes, valves and catheters.

The decision on how to treat hydrocephalus in adults should be made exclusively by the attending physician.

Complications of the disease

Patients, provided they are diagnosed in a timely manner and undergo therapy, may well live the rest of their lives without significant complications.

In some cases there is a speech disorder. There may be problems with the shunt malfunctioning or infection during its installation, which requires its reinstallation. In particularly complex and advanced cases of hydrocephalus in adults, disability is possible.

Forecast

The prognosis for this disease depends on the underlying cause and the time spent on diagnosis and appropriate therapy. Some restrictions on future life activities are possible. In some cases, dysfunction of the speech apparatus may occur.

Preventive measures

First of all, to prevent hydrocephalus of the brain in adults, you need to avoid diseases such as meningitis, polio, encephalitis, as well as traumatic brain injury.

Avoidance of infectious diseases in a pregnant woman, extreme caution when taking medications during pregnancy.

Video: About the causes and treatment of hydrocephalus of the brain

A neurosurgeon of the highest qualification category talks about the causes of the disease and methods of treating hydrocephalus.

The human brain is a system that requires fluid circulation and performs many functions. This fluid is called cerebrospinal fluid, it is produced by special choroid plexuses of the lateral ventricles.

In total, a person has no more than 150–160 ml of this fluid in the central nervous system, which is incomparably less than the volume of circulating blood.

However, during the day, about 0.5 - 0.6 liters of cerebrospinal fluid are produced, which must be absorbed near the venous sinuses of the dura mater of the brain in the pachyonic granulations. If there is an imbalance between the production of cerebrospinal fluid and its absorption, hydrocephalus develops (see photo).

Hydrocephalus of the brain, what is it?

What it is? - Modern medicine defines hydrocephalus as an independent disease, or a complication, in which the accumulation of cerebrospinal fluid in the brain progresses, as a result of which its movement along the cerebrospinal fluid pathways of the brain and spinal cord is disrupted.

Despite the relative simplicity of its formal definition, hydrocephalus can develop in many different ways. Therefore, neurosurgeons distinguish the following types of this pathology:

Occlusive hydrocephalus. An obstacle arises in the path of the cerebrospinal fluid flow - occlusion. It could be a commissure or, for example, a tumor. In this case, the rate of production and absorption of cerebrospinal fluid may be normal;
Aresorptive and dysresorptive forms. In this case, the absorption of cerebrospinal fluid (resorption) is impaired, as a result of which it accumulates;
Hypersecretory form. With this type, an excess of cerebrospinal fluid production occurs, and absorption “lags behind” in volume. As a result, cerebrospinal fluid accumulates.

Convenient classification for doctors according to the duration of the disease:

acute hydrocephalus. The entire process from the first symptoms to severe cerebral disorders lasts no more than 3 days;
subacute form – lasting up to 30 days;
chronic - lasting from 3 weeks to 6 months or more.

In addition, hydrocephalus is classified according to the level of cerebrospinal fluid pressure. The process can be either normotensive or hypotensive.

Occlusive forms of acute hydrocephalus are often hypertensive, that is, they occur with a sharp increase in cerebrospinal fluid pressure.

It should be noted that all speculation about “increased intracranial pressure” is meaningless if there are no clear signs of this process.

The only direct way to measure this pressure was and remains the placement of a pressure gauge in the ventricles of the brain. Of course, this requires drilling into the skull bones.

This method is used during surgical interventions and bypass operations, which will be discussed below, and in outpatient practice they use indirect signs.

Causes of hydrocephalus

There are many reasons for the occurrence of hydrocephalus, but the main factors leading to this diagnosis are either compression by any space-occupying formation, edema, or an inflammatory and adhesive process. The following diseases and conditions most often lead to hydrocephalus, both in adults and children:

Strokes. Compression of the cerebrospinal fluid pathways can be caused by both blood volume (intracerebral hematoma) and edema due to an ischemic focus;
malignant and benign brain tumors. Most often they are located inside the ventricles, near the brain stem, or inside the brainstem;
Infections of the central nervous system. Most often these are purulent or other infections. As a rule, serous meningitis causes hypertensive hydrocephalus, which responds well to treatment;
Injuries of the central nervous system: brain contusions, diffuse axonal damage, ruptured aneurysms, subarachnoid and subdural hemorrhages;
Also, the causes of the development of chronic hydrocephalus include various metabolic and toxic encephalopathies (hypertensive, alcoholic).

Internal and external hydrocephalus of the brain

This formulation can be heard or read in interpretations of MRI findings. Internal hydrocephalus is determined by enlargement of the ventricles and median unpaired cerebrospinal fluid tracts, external hydrocephalus refers to the “circumference” and peripheral space.

Mixed hydrocephalus of the brain often develops. It is important that these forms are open, in which all liquor paths are passable and the fluid flow is not disturbed.

If there is an obstacle, as with occlusion, then a closed form of the disease develops.

There is also replacement hydrocephalus of the brain in adults, in which the gray matter of the brain (that is, the cortex) is replaced with cerebrospinal fluid, which circulates in the subarachnoid space of the convexital surface of the cerebral hemispheres.

This occurs as a result of cortical atrophy, and not due to hydrocephalus, that is, atrophy is the primary process. Therefore, this term is gradually falling out of use.

Symptoms and signs of hydrocephalus in adults

In neurology, in addition to focal symptoms, in which the function of any part of the nervous system is affected, there are also general cerebral symptoms, which are present in hydrocephalus.

For example, in acute form rapidly developing occlusive hydrocephalus (for example, when a tumor dislocates, or when adhesions occur during purulent meningitis), the following symptoms will be expressed:

Intolerable, “bursting” headache, from all sides, without clear localization. The patient feels as if his head is being “pumped with a pump.” This is characterized by increased headaches in the morning and relief in the evening or in the afternoon.
The appearance of nausea and vomiting; in more severe cases, with the development of hypertensive forms, there may be “cerebral vomiting” - vomiting “fountain” without any previous nausea, which comes as a complete surprise to the patient. This occurs due to irritation of the receptors of the bottom of the 4th ventricle, or the “diamond-shaped fossa”. This vomiting does not bring relief;
When examining the fundus, congestive optic discs are noted;
If the condition worsens, drowsiness, stupor and coma occur, which can result in dislocation and swelling of the brain substance. This process is dangerous due to various variants of herniation of the vital ancient centers of the brain, which are localized in the trunk and medulla oblongata and are responsible for breathing and blood circulation. A classic example is the herniation of the cerebellar tonsils into the foramen magnum. This leads to death.

For chronic hydrocephalus, which lasts for many months against the background of organic damage to the central nervous system, there will be completely different symptoms:

Manifestation of progressive dementia;
Gait instability, or leg paresis (so-called peripheral lower paraparesis);
Urinary disorders.

This picture can be observed in various senile disorders due to chronic intoxication, for example, in experienced alcoholics.

At the same time, the development of the chronic form does not manifest itself acutely, but develops gradually, often the first symptoms appear a month after the illness, for example, a stroke.

In patients, wakefulness and sleep patterns are distorted, initiative and activity decrease, they become lethargic and indifferent, memory and attention begin to deteriorate, then gait disturbances appear, and in the end, urinary incontinence occurs, and in severe cases, fecal incontinence.

Diagnosis of hydrocephalus

Currently, making a diagnosis does not present any particular difficulties. Imaging techniques (CT, MRI) allow us to draw conclusions based on indirect signs. Thus, hydrocephalus can be caused by dilated lateral ventricles.

However, each of these methods has its own “advantages”: computed x-ray tomography reveals the exact contours and boundaries of the cerebrospinal fluid pathways and allows you to accurately calculate the size of the ventricles. Magnetic resonance imaging based on the reaction of brain tissue allows us to clarify the severity of the process.

Of course, fundus examination, echoencephalography and direct measurement of cerebrospinal fluid pressure, which is carried out during neurosurgical operations, remain important.

As in many other cases, there are conservative and surgical treatment. External hydrocephalus of the brain in adults, which is treated in the same way as for internal hydrocephalus, involves the following therapeutic tactics:

Use of osmotically active diuretics (urea, mannitol in infusions);
Diacarb is a diuretic drug that inhibits carbonic anhydrase and is used specifically for increased intracranial pressure in outpatient practice;
In case of an inflammatory reaction (for example, with meningitis), infusions of glucocorticosteroids, for example, dexamethasone, are helpful.
Analgesics are administered symptomatically, as well as barbiturates, which protect brain tissue from hypoxia, reducing its need for oxygen.

If conservative treatment of cerebral hydrocephalus is unsuccessful, surgical intervention may be required.

Thus, in case of acute hydrocephalus, it is necessary to “establish outflow”, which will relieve the ventricular system and reduce pressure. For this purpose, external ventricular drainage is installed.

Bypass surgery brain for hydrocephalus - a method of treating chronic hydrocephalus, in which excess cerebrospinal fluid is “dumped” to a place where it does not interfere and is quietly absorbed. To do this, a catheter is installed in the ventricles of the brain, which is connected to a valve that allows you to “bleed off” excess cerebrospinal fluid when certain pressure values are reached.

Prognosis and complications

Before performing bypass surgery, it is necessary to check whether the reduction in the volume of cerebrospinal fluid causes improvement in the patient. To do this, a lumbar puncture is performed and about 40 ml of cerebrospinal fluid is taken. If the patient’s health improves, it makes sense to undergo bypass surgery. If there is no effect, then you should look for other ways of treatment.

The most dangerous complication of hydrocephalus, mentioned above, is the development of edema - swelling of the brain and dislocation of the median structures.

Signs that indicate the onset of this formidable complication are a gradual loss of consciousness, starting with drowsiness, as well as dilation of the pupil on one side after a short-term constriction, convulsions, increased temperature (hyperthermia), and pyramidal insufficiency.
Therefore, such patients should be urgently hospitalized in the neurosurgery department.

With chronic hydrocephalus, the prognosis for life is favorable with appropriate timely treatment.

Hydrocephalus is one of those terms whose meaning is clear to a layman. Any educated person will immediately say that this is a condition in which the brain is “saturated with water.” People usually call this phenomenon “dropsy of the brain.” Many people have seen terrible pictures on the Internet in which babies have incredibly swollen heads covered with a network of veins. But few people know that the pliable and soft bones of a child’s skull move apart under the influence of increased pressure and thereby prevent it from rising to catastrophic levels. Thus, in children, hydrocephalus becomes sluggish and perennial.

What about adults? No matter how hard you try, the skull has already ossified, the fontanelles have hardened, and the bones are very tightly fused to each other. How does increased intracranial pressure manifest? Why does it occur, what mechanisms make it possible to compensate for it in the absence of the ability to enlarge the skull? Is it possible to cure dropsy of the brain in adults? You will find answers to these and many other questions. But you need to start by defining the problem.

Definition

This phenomenon is understood as excessive accumulation of cerebrospinal fluid in the cavities of the central nervous system, which are intended for its circulation. These are slits, spaces, ventricles and cisterns. It would be a big mistake to assume that in this case the brain matter is saturated with cerebrospinal fluid and can be “squeezed into a bucket.” The brain, unlike other organs, is a very dense structure. And if during pulmonary edema it is filled with fluid, then with hydrocephalus we are not talking about “wateriness of the brain”, but about the accumulation of this fluid in various spaces that are not occupied by dense tissue and communicate with each other.

A little about the normal anatomy and physiology of liquor circulation in the central nervous system

The volume of the cranium, or cranial cavity, is constant in an adult. Normally it is distributed like this:

brain tissue – 80%;
cerebrospinal fluid – 10%;
venous and arterial blood located in the cranial cavity – 10%.

In absolute figures, the volume of cerebrospinal fluid in the cranial cavity occupies about 150 ml, and a little more is accounted for by the structures of the spinal cord and the terminal cistern. Normal cerebrospinal fluid pressure (when measured while lying down during a lumbar puncture) is about 150–180 mm, but not the mercury column, but the water column. And given that mercury is 13.6 times heavier than water, we can assume that intracranial pressure is approximately 13 times lower than arterial pressure.

In the cranial cavity there is not a single ventricle, aqueduct or tank that does not communicate with the other cavities containing cerebrospinal fluid. Constant circulation of cerebrospinal fluid is one of the necessary conditions for normal brain function. Therefore, the following structures in which it circulates communicate with each other:

unpaired (axial) ventricles of the brain (third, fourth);

lateral ventricles;

brain cisterns at its base;

a narrow slit of the subarachnoid space on the surface of the convex, or cerebral hemispheres.

Of course, cerebrospinal fluid can easily “flow” into the subarachnoid space of the spinal cord, right up to the terminal cistern at the level of 3–4 lumbar vertebrae.

The production of cerebrospinal fluid occurs in the vascular, or choroidal, plexuses in the lateral ventricles, and absorption occurs in special formations (pachyonic granulations) near the sagittal (sagittal) sinus.

The daily production of cerebrospinal fluid in adults is about 600 ml, and the same amount is absorbed. Judge for yourself how finely balanced this mechanism is. But in some cases it is disrupted, which leads to either excess production (hyperproductive form), or insufficient absorption of cerebrospinal fluid (aresorptive, which occurs in 80% of all cases), or a combination of both. What reasons lead to increased intracranial pressure (ICP) and why does hydrocephalus of the brain develop in adults?

About the reasons

In addition, in some pathological processes the volume of the brain substance itself may increase due to its swelling. This is an emergency situation that requires early diagnosis and urgent care. Prevention of this condition is a very important stage, and it is the duty of the attending physician to anticipate cerebral edema.

Quite often, increased intracranial pressure occurs due to meningitis and ruptured aneurysms. The consequences of purulent meningitis and encephalitis can be pronounced adhesive processes on the pachyonic granulations, which makes absorption very difficult. Adhesive arachnoiditis also leads to this.

Of course, in some cases, hydrocephalus is a consequence of increased production of cerebrospinal fluid, for example, with a tumor of the choroidal plexus. Sometimes increased ICP syndrome is a consequence of severe traumatic brain injury.

Pathogenesis, or the mechanism of development

Despite the obvious “iron” argument that the adult skull “has nowhere to expand,” hydrocephalus does not occur immediately. Even in a closed volume of the skull, a person has powerful compensation mechanisms that keep intracranial pressure at a normal level. And only when they fail, mild and then progressive intracranial hypertension occurs. The mechanism of the struggle for normal pressure is that venous blood is displaced from the sinuses (collectors).

Venous pressure drops, followed by a decrease in the pressure in the cerebrospinal fluid, which is forced out of the ventricles and from the subarachnoid space. As a result, the ventricles become empty, and the volume of the brain itself decreases.

This mechanism may even lead to brain atrophy, but not hydrocephalus. This compensation works well for slow-growing tumors that are benign. But malignant and rapidly growing formations cause pronounced symptoms even when they reach small sizes.

After the compensatory possibilities have been exhausted, the pressure in the ventricles begins to increase, then the venous pressure, the outflow becomes difficult, the blood remains in the veins and sinuses of the brain, and this leads to the emergence of a vicious circle.

Next, ischemia of the brain tissue occurs. After all, the degree of perfusion (blood flow in the brain, or perfusion pressure) is more effective, the greater the difference between the pressure in the arteries and veins. And as venous pressure increases, this gradient decreases. If it falls below 50 mmHg. Art., then there is a high risk of cerebral edema and its various complications in the form of herniation of the brain matter, which leads to death. And if the pressure in the veins is equal to the arterial pressure, then the blood flow in the brain will completely stop.

Classification

Typically, the abundance of terms that describe hydrocephalus confuses the patient, especially in old age. Quite often this diagnosis is “mentioned” on MRI reports, and it suddenly becomes a subject of concern for the patient. So, we distinguish between external and internal form.

External, or external, hydrocephalus is an accumulation of cerebrospinal fluid on the “cap” of the hemispheres, or in their subarachnoid spaces. It is most often visible by the flattening of the gyri and grooves of the cortex. At the same time, the amount of cerebrospinal fluid in the ventricles of the brain is, as a rule, normal, and atrophic processes in the cortex often correspond to old age. For example, the diagnosis of “external replacement hydrocephalus” speaks of a process in which there are no signs of increased ICP in the ventricles of the brain, but there are signs outside the brain.

The internal form is a condition in which the ventricles are distended, and in the subarachnoid spaces the amount of cerebrospinal fluid is within acceptable limits. As noted above, normally all cavities communicate with each other. And usually, if there are changes in the convex, then they are also present in the ventricles. Then they talk about a mixed form.

For example, mixed replacement hydrocephalus is a condition in which cerebrospinal fluid “replaces” the place where the cerebral cortex used to be. At the same time, hypotrophic processes are visible in the cortex (flattening of the grooves and convolutions), and the fact that the cerebrospinal fluid slightly “overstretches” the ventricles indicates a mixed form.

Caution: occlusion!

The mechanism of development of increased ICP is especially important for neurosurgeons. There is a concept of occlusion, or obstruction to the flow of cerebrospinal fluid. If you dammed a stream, you caused its occlusion. The occlusive form of hydrocephalus is a closed path for the outflow of cerebrospinal fluid. It can appear anywhere, but its occurrence is especially dangerous in narrow central conductors - for example, in the area of the Sylvian aqueduct or near the foramina of Luschka and Magendie. It is here that you can reliably “block” the entire flow of cerebrospinal fluid.

Sometimes the cause is cysts, in children - stenosis of the aqueduct, in adults - the consequences of purulent meningoencephalitis or a malignant tumor. At the same time, there is no time for a long-term compensated course. There is a pronounced increase in cerebrospinal fluid pressure with compression of spaces on the surface and base of the brain. Rapid atrophy of brain tissue appears, and focal symptoms occur. But the most dangerous thing is the rapid dislocation, or displacement, of brain structures, which leads to cerebral edema and death if no measures are taken. Death occurs due to infringement of the brain substance in the tentorial or foramen magnum. Therefore, a non-occlusive process, in which there is no sudden obstruction to the flow of cerebrospinal fluid, is always more favorable in terms of prognosis and possible results.

Hydrocephalus without hypertension

Can hydrocele of the brain exist without an increase in cerebrospinal fluid pressure? It seems impossible. After all, if there is more cerebrospinal fluid than necessary, then the brain substance “gives” its place to it. And this can only be done by yielding to the pressure of the liquid. But it turns out that there is hydrocephalus, which is not accompanied by an increase in ICP. It is called “normotensive” and has a special name - Hakim-Adams syndrome. Its symptoms are so different from usual that this type of hydrocephalus is dedicated.

Clinical manifestations and symptoms

Let us recall that we are talking about the syndrome of increased ICP in adults, which underlies any hydrocephalus, except for its normotensive variety. The main signs and symptoms of increased intracranial pressure are quite characteristic and can be identified even after competent questioning of the patient, even before the examination. The main complaints are:

Periodic headache, which is of an increasing nature, intensifies with prolonged horizontal position (for example, in the early morning hours).

The headache is spread throughout the entire cranial vault, and patients often say that “the head is about to burst,” “it is being pumped up.” These figurative comparisons already contain an indication of an increase in pressure.

As the intensity of the headache increases, attacks of vomiting occur, which often begins without previous nausea, completely suddenly. It is called “cerebral”, it is associated with irritation of the vomiting centers at the bottom of the brain ventricle, it is abundant, comes out in a “fountain” and is associated with headache.

Characteristic is a decrease in migraine after a long stay in an upright position and an improvement in well-being in the evening. If you sleep on a high pillow, your headache in the morning will be less than if you sleep on a flat one.

Vision decline progresses, lethargy develops (especially with severe headaches), and higher cortical functions also suffer, since prolonged exposure to high pressure disrupts the trophism of the nervous tissue. As a result, atrophy of the cortex begins.

Deterioration of vision (spots, spots, blurred vision), headaches intensify when working in an incline, with abdominal tension - these situations provoke difficulty in venous outflow.

With the rapid development of hydrocephalus, complete blindness may occur (with atrophy of the optic nerves).

All these negative symptoms of impaired cerebrospinal fluid outflow indicate a general increase in intracranial pressure, which is more or less long-term, chronic. If the patient experiences occlusive hydrocephalus, then the “block” of cerebrospinal fluid flow causes an extremely rapid increase in pressure. Cortical atrophy and dysfunction do not have time to develop. Dislocation and infringement of brain structures occurs, as the brain simply moves out of place. Most often it is wedged into the foramen magnum or tentorial foramen.

Attention! The development of drowsiness and lethargy against the background of previous severe complaints may indicate the onset of cerebral edema, which requires urgent hospitalization in a neurosurgical hospital.

Diagnostics

In addition to the typical complaints described above, evidence and objective data are needed. Therefore, a neurologist, in order to make the correct diagnosis:

Examines the condition of the fundus (presence of congestion). It is known that the veins through which blood flows from the optic nerves have a connection with the cavernous sinus. Therefore, congestion and swelling of the optic nerve head is an early symptom of the development of hydrocephalus and increased ICP.

Refers for a regular radiograph of the skull - craniogram. If the disease is long-term and chronic, then changes in bone tissue occur - osteoporosis and deformation of the sella turcica, and the anterior edge of the foramen magnum becomes thinner. The phenomenon of “finger impressions” is observed - the bones of the cranial vault are thinned, and from the inside the fingertips appear to be imprinted on them in the form of depressions, the channels in the diploe - the spongy substance of the skull bones - are expanded.

Recommends CT angiography to show late filling of the venous system, sinuses, and slowing of cerebral blood flow in the post-capillary phase. Normally, the contrast from the veins disappears 6 hours after administration, and with an increase in ICP this time is extended by 1.5–2 times.

MRI both with and without contrast. Shows the type and nature of hydrocephalus and very often allows you to find the cause (adhesions, space-occupying formations).

In some cases, lumbar puncture. Currently, the indications for it in ICP are extremely limited, since with a sharp decrease in pressure caused by a decrease in its volume, compensatory cerebral edema occurs, and such manipulation can end in failure.

A little about the actual numbers

It is important for all patients to know that if they have not undergone the above studies and are not bothered by the above complaints, then a diagnosis of hydrocephalus (except for Hakim-Adams syndrome) is unlikely. The level of intracranial pressure can be directly determined only by “screwing” a pressure gauge into the skull and bringing its sensor into the ventricular cavity or subarachnoid space.

This is what is done in neurosurgical intensive care units. The level can be indirectly determined using lumbar puncture data. Therefore, if a doctor says that “you have intracranial”, then it doesn’t hurt to ask him what criteria he was guided by in the absence of complaints, data from instrumental research methods and direct measurements?

Currently, there is a very intensive search abroad for non-invasive methods of measuring ICP (using computer online analysis of pressure in the eyeball adjusted for ICP and scleral curvature), but so far the error remains high, and such methods have not found widespread use in clinical and outpatient settings. practice.

Treatment

Of course, in the case when a space-occupying formation is found and there are indications for surgery, the treatment of hydrocephalus is surgical. If there is no such finding, but there is, for example, adhesive and adhesive arachnoiditis after purulent meningitis, but there are no indications for dissection of adhesions, then the treatment will be conservative. Of course, preparation for surgery begins with traditional treatment (ICP correction). What medications are indicated and how do neurologists treat the disease?

Conservative treatment

Based on the physical principles of the occurrence of hydrocephalus, it is clear that the possibilities of drug therapy are limited. At best, they achieve a reduction in liquor production and a reduction in complaints. Therefore, conservative treatment is, as a rule, the first stage of dynamic observation. If it progresses, surgery is required.

Important! In cases of advanced clinical hydrocephalus with a pronounced increase in ICP, a consultation with a neurosurgeon is required!

The basic principles of treating high ICP are:

A diet with restriction not only of liquid, but also of salt.

It is known that excess salt “pulls” water with it according to the laws of osmosis. Therefore, eating herring in the evening and drinking water at night can lead to persistent headaches. Strong tea, coffee and especially alcohol are not recommended. Beer is strictly prohibited, since it is primarily a liquid load.

Purpose of "Diacarb". This drug inhibits the enzyme carbonic anhydrase and can reduce the production of cerebrospinal fluid. “Diacarb” is prescribed by neurologists and therapists for a course of a month.

Taking diuretics with mandatory potassium correction. Dehydration therapy is indicated to relieve signs of hydrocephalus at the beginning of treatment.

If symptoms progress, surgery is necessary.

Surgical treatment

The results of surgical methods are incomparably higher than taking pills. In occlusive forms of hydrocephalus (for example, with ventricular tamponade due to blood clots), only urgent surgery can save the patient’s life. This is external drainage of the ventricles, in which the cerebrospinal fluid is diverted outside into a special container.

A number of surgical interventions have also been developed in which bypass routes for the circulation of cerebrospinal fluid are created (for example, the formation of artificial holes in brain structures). These are Stuckey's operation or ventriculocisternostomy, in which communication is established between the occipital cistern and the lateral ventricles.

About bypass surgery

Shunting is a series of surgical interventions, the purpose of which is to divert cerebrospinal fluid from the cranial cavity and “dump” excess volume into other structures where it is absorbed. In some cases, this operation alleviates the patient’s condition, for example, with inoperable brain tumors that have caused occlusion. And sometimes (in the treatment of chronic hydrocephalus) these shunts last a lifetime.

Each system consists of a catheter, which is installed in the lateral ventricle to collect cerebrospinal fluid, and a valve, which releases this fluid into the system when a certain pressure is raised. It ends with a long peripheral catheter, through which the cerebrospinal fluid is discharged.

Currently, the design of the shunt system is complex. The most expensive part is the valve, which must be anti-siphon, that is, not allow the cerebrospinal fluid to return to the ventricle. Modern valves are programmable and are able to maintain a given pressure level within the desired range. After all, an incorrectly selected valve can lead to rupture and thrombosis of the veins, and the occurrence of hematomas.

You need to dump it to a place where the liquor is well absorbed. That's why shunting happens:

ventriculoperitoneal (discharge into the abdominal cavity);
into the pleural cavity;
into the gallbladder;
into the ureter;
into the lymphatic system;
into the vascular bed - into the atrium;
into the pelvic cavity.

The most commonly used is ventriculoperitoneal shunting. In the absence of occlusion and in the open form of hydrocephalus, the shortest path to the abdominal cavity is, naturally, not from the lateral ventricle of the brain, but from the spinal subarachnoid space, for example, the terminal cistern, which is located in the lumbar region. The main thing is that the spinal spaces and the spaces of the brain communicate.

In addition to the valve, such a shunt system may also have a hand pump. When squeezing a special cavity under the skin, you can “manually” pump the drainage system yourself.

There are also contraindications to the installation of long-term shunts. This, for example, is active inflammation or a high level of protein in the cerebrospinal fluid, which will lead to rapid thrombosis of the shunt. First, it is necessary to stop the inflammation.

In conclusion, it must be said that with timely detected hydrocephalus, with its correctly diagnosed form and selected treatment method, the positive prognosis is almost 100%.

Of course, here we are talking about a benign process, the correct indications and timely installation of the shunt, careful monitoring of its operation (to avoid excessive drainage and adhesion of the ventricles), valve programming, changing the shunt system if necessary, and careful prevention of thrombosis and infection.

Increased accumulation of cerebrospinal fluid in the cerebrospinal fluid system of the brain. Hydrocephalus accompanies many congenital and acquired neurological diseases. Clinically, it is manifested by signs of increased intracranial pressure (headache, nausea, pressure on the eyes), symptoms of compression of brain structures (vestibular ataxia, visual impairment, mental disorders, epileptic seizures) and symptoms characteristic of the disease that caused it. Diagnosis of hydrocephalus includes radiography of the skull, ophthalmological studies, echo-EG (in infants - neurosonography), MRI or CT scan of the brain. Surgical treatment of hydrocephalus allows you to correct congenital anomalies of the cerebrospinal fluid system, remove intracranial formations that disrupt the circulation of the cerebrospinal fluid, and establish the outflow of cerebrospinal fluid from the cranial cavity.

Acquired hydrocephalus can occur as a result of inflammatory processes in the brain and its membranes (encephalitis, arachnoiditis, meningitis), traumatic brain injury, vascular disorders (bleeding into the ventricles, hemorrhagic stroke or intracerebral hematoma with blood breaking into the ventricles). Hydrocephalus often develops against the background of a colloid cyst of the third ventricle and intracerebral tumors (astrocytomas, germinomas, ganglioneuromas, etc.), which grow into the ventricles of the brain or compress the cerebrospinal fluid pathways, thereby disrupting the normal circulation of cerebrospinal fluid and its outflow from the cranial cavity.

Separately, there is an atrophic (replacement) form of hydrocephalus, which occurs as a result of post-traumatic death or age-related atrophy of brain tissue. In this case, cerebrospinal fluid fills the space that is formed inside the skull as a result of a decrease in the volume of the brain. Atrophic hydrocephalus in old age can develop against the background of impaired blood supply to the brain due to atherosclerosis of cerebral vessels, hypertension, diabetic macroangiopathy.

Pathogenesis

Normally, cerebrospinal fluid (CSF) is produced by the choroid plexus of interconnected ventricles of the brain. The largest amount of it is formed in the lateral ventricles, from where the cerebrospinal fluid enters the third ventricle, and from it through the Sylvian aqueduct into the fourth ventricle. Then the cerebrospinal fluid enters the subarachnoid (subarachnoid) space, which extends over the entire surface of the brain, and in the caudal direction passes the region of the craniovertebral junction and then surrounds the spinal cord along its entire length. The cerebrospinal fluid located in the subarachnoid space is constantly absorbed by the arachnoid (arachnoid) membrane of the spinal cord and brain and enters the blood. The above etiological factors that disrupt the production, movement and absorption of cerebrospinal fluid lead to its excessive accumulation and the occurrence of hydrocephalus.

Classification

According to the etiological principle, congenital and acquired hydrocephalus are distinguished.

According to the mechanism of occurrence, hydrocephalus is classified into open and closed forms. Open hydrocephalus is associated with overproduction of cerebrospinal fluid or impaired absorption during normal cerebrospinal fluid circulation. Closed hydrocephalus is caused by a violation of the outflow of cerebrospinal fluid due to compression, partial or complete obstruction of any part of the cerebrospinal fluid system of the brain.

Depending on where the excess accumulation of cerebrospinal fluid occurs, internal and external hydrocephalus are distinguished. Internal hydrocephalus is accompanied by the accumulation of cerebrospinal fluid in the ventricles of the brain. External hydrocephalus is characterized by excess cerebrospinal fluid in the subarachnoid and subdural space.

According to the characteristics of its course, hydrocephalus is classified as acute, subacute and chronic. Acute hydrocephalus is characterized by rapid development, in which decompensation occurs a few days after the onset of the first signs of the disease. Subacute hydrocephalus develops within a month, and chronic hydrocephalus develops over six months.

Of great clinical importance is the division of hydrocephalus into stabilized (compensated) and progressive (increasing). Stabilized hydrocephalus does not grow and usually occurs with normal cerebrospinal fluid pressure. Progressive hydrocephalus is characterized by worsening symptoms, is accompanied by an increase in cerebrospinal fluid pressure, does not respond well to conservative therapy and leads to atrophy of brain tissue.

Symptoms of hydrocephalus

In adults

The accumulation of excess cerebrospinal fluid in a limited space of the cranium leads to increased intracranial pressure, which causes the most typical symptoms of hydrocephalus. In adults and older children, these include: intense headache that cannot be relieved by analgesics, nausea, vomiting, and a feeling of pressure on the eyeballs. These symptoms may occur acutely or increase gradually, being transient at the onset of the disease. Atrophic hydrocephalus often occurs without signs of increased intracranial pressure and is detected only with additional examination of the patient.

In most cases, hydrocephalus is accompanied by neurological symptoms, which are caused both by compression of brain structures by expanded cerebrospinal fluid spaces and by the underlying disease that causes the development of hydrocephalus. The most common symptoms of hydrocephalus are vestibular and visual disturbances. The first includes vestibular ataxia, manifested by dizziness, unsteady gait, noise in the ears and head, and nystagmus. On the visual side, there may be a significant decrease in visual acuity, loss of certain areas of the visual fields, congestive optic discs; with prolonged hydrocephalus, optic nerve atrophy may develop.

Hydrocephalus can occur with disturbances in the motor and sensory sphere: paresis and paralysis, increased tendon reflexes and muscle tone, decreased or complete loss of all types of sensitivity, and the formation of spastic contractures of the limbs. Occlusive hydrocephalus, caused by impaired circulation of cerebrospinal fluid in the posterior cranial fossa, is characterized by symptoms of cerebellar ataxia: impaired coordination and gait, large-scale disproportionate movements, changes in handwriting, etc.

In some cases, hydrocephalus is accompanied by mental disorders, which in adults are more often manifested by disturbances in the emotional-volitional sphere: emotional instability, neurasthenia, causeless euphoria with a rapid transition to a state of indifference and apathy. With a sharp increase in intracranial pressure, aggressive behavior is possible.

Symptoms of hydrocephalus in children

In children, due to the great flexibility of the skull bones, there is no increase in intracranial pressure; hydrocephalus in them is accompanied by an increase in the size of the skull. In newborns and young children, hydrocephalus is characterized by an overly large head size, bulging scalp veins, tension and lack of pulsation of the large fontanel, and swelling of the optic discs. The symptom of “setting sun” is often noted - restriction of upward movements of the eyeballs. There may be dehiscence of the sutures of the skull. Tapping on the skull is accompanied by a characteristic sound (the “cracked pot” symptom). In children in the first year of life, hydrocephalus leads to developmental delays. They later begin to hold their head up, roll over, sit up and walk.

Children who have severe hydrocephalus are distinguished by a spherical shape of the head, its too large size, deep-set eyes, protruding ears, and thinning of the scalp. There may be decreased vision, increased muscle tone in the lower extremities, and disorders of the cranial nerves. Unlike adults, in childhood hydrocephalus is often accompanied not by emotional-volitional disorders, but by intellectual deficiency. Children with hydrocephalus are usually sedentary and obese. They are apathetic, lack initiative, and do not have the attachment to relatives characteristic of their peers. A decrease in the degree of hydrocephalus often leads to an increase in the child’s intellectual abilities and activity.

In adolescence, hydrocephalus often occurs acutely against the background of an infectious disease, mental or physical trauma. At the same time, it is accompanied by intense headache, repeated vomiting, and bradycardia. There may be attacks of loss of consciousness, sometimes convulsive seizures. In some cases, episodic psychoses with hallucinatory or delusional syndrome are observed.

Diagnostics

The clinical symptoms of hydrocephalus are usually so characteristic that they allow the neurologist to suspect its presence during the first examination of the patient. To determine the degree and form of hydrocephalus, as well as to identify the underlying disease, additional examinations are performed: radiography, ultrasound, computed tomography or magnetic resonance imaging.

An ophthalmologist assesses visual disturbances and the condition of the optic discs. As a rule, the list of ophthalmological examinations for hydrocephalus includes ophthalmoscopy, determination of visual acuity and perimetry.

Tomographic diagnostic methods make it possible to determine the nature of hydrocephalus, identify the location of cerebrospinal fluid tract occlusion or an existing congenital anomaly, and diagnose the causative disease (tumor, cyst, hematoma, etc.). For hydrocephalus, the most informative use is brain MRI.

In the absence of contraindications, to identify the causative disease, it is possible to perform a lumbar puncture followed by examination of the cerebrospinal fluid. If vascular disorders are suspected, MRA of cerebral vessels is indicated. Congenital hydrocephalus of infectious etiology requires PCR diagnostics to determine the type of infection that caused it.

Treatment of hydrocephalus

The choice of treatment for hydrocephalus depends on its etiology. Conservative therapy is often carried out for acquired hydrocephalus caused by inflammatory diseases, previous TBI, or hemorrhage into the ventricles. The underlying disease is treated, and diuretics (acetazolamide, furosemide) are prescribed to reduce the degree of hydrocephalus and increased intracranial pressure.

Ventriculoperitoneal shunt, lumboperitoneal shunt, external ventricular drainage. They are aimed at creating additional pathways for the outflow of cerebrospinal fluid from the cranial cavity. Shunt operations can be performed as an addition to surgical treatment of the underlying disease if the operation fails to restore normal circulation of the cerebrospinal fluid.

High intracranial pressure is a diagnosis with which many people are familiar. It's quite common. At the same time, it is often placed without reason, without conducting appropriate research. But the pathology is based on serious illnesses. One of them is hydrocephalus. The symptoms of the disease are quite recognizable and can lead to serious consequences.

A little anatomy

During normal human activity, the brain is constantly bathed in clear fluid. She nourishes him and protects him. Fluid circulates in the space between the pia and choroid membranes of the hemispheres and the cerebellum. There are special places in the body - tanks in which it accumulates. They are located at the base of the skull. These tanks are connected to each other and the spinal cord. In the gray matter, fluid is located in the four ventricles. This is the norm.

Cerebrospinal fluid is produced from the blood. The total volume norm is 150 ml. The process of fluid production and absorption are in balance. Disharmony of this balance has serious consequences. Fluid begins to accumulate in the brain. This results in either a decrease in absorption or an increase in production.

If the outflow of fluid is disrupted, the patient experiences hydrocephalus. Symptoms can be observed in both newborns and adults. The source of the problem is a narrowing of the channel between the ventricles or a violation of the absorption of fluid by the body. To understand the pathology, you should consider what the brain looks like (there is a photo in the article). Often, this unpleasant disease is diagnosed in newborns. According to statistics, every 500th child is born with the above-mentioned serious problem.

Sometimes the disease is not a congenital disease. Medicine knows of cases where the signs of hydrocephalus were acquired during life. As a rule, the causes of its occurrence lie in previous diseases. Often it is the brain that provokes the development of a terrible pathology.

Types of illness

Hydrocephalus is quite diverse in its forms and causes. Today in medicine there are several classifications of the disease.

Based on the location of fluid accumulation, the disease is divided into types:

Internal hydrocephalus. Fluid (cerebrospinal fluid) accumulates in excess in the ventricles.
External hydrocephalus of the brain. It is also called external. With this type of disease, accumulation of cerebrospinal fluid is observed in the subarachnoid space. In other words, the fluid is localized near the skull.
General hydrocephalus. With this form, cerebrospinal fluid is contained throughout the brain. It is found both in the ventricles and in the subarachnoid space. This form has another name - mixed hydrocephalus.

Causes of the disease in children

The main factor provoking the disease in newborns is difficult birth. As a rule, we are talking about a long anhydrous period of the fetus or birth injuries received by the child.

Sometimes there is an accumulation of fluid in the brain of a child who is still in the womb. This pathology is associated with infections and viral diseases suffered by a pregnant woman. Herpes, toxoplasmosis, and cytomegaly are especially dangerous.

The most common is the brain. Its signs begin to appear in the first months of a child’s life. However, older children can also develop the disease. There are many sources that provoke serious illness. Among them are:

brain tumors (both brain and spinal);
meningitis;
encephalitis;
infectious diseases (tuberculosis);
brain and vascular defects;
hemorrhages;
traumatic brain injuries;
genetic disorders.

Sometimes the source of a terrible disease cannot even be determined.

Causes of illness in adults

It’s not just children who face this terrible diagnosis. It can be placed at any age. Hydrocephalus occurs, or, as it is popularly called, dropsy of the brain, in adults due to illnesses suffered:

cerebral hemorrhage;
stroke;
brain surgery;
meningitis;
brain cancer;
traumatic brain injury;
brain atrophy.

In most cases, it is cerebrovascular disease (stroke, arterial hypertension) that becomes the real focus of the development of dropsy.

Clinical signs of the disease in children

Cerebrospinal fluid (CSF) performs a vital function in the body. It nourishes the brain with all useful substances and removes toxins from it. Timely outflow of fluid determines the normal functioning of the main organ. Any violation of the discharge of cerebrospinal fluid is fraught with consequences. After all, fluid production does not change. As a result, the ventricles become full. As a result, their expansion is observed.

The most common symptoms for a diagnosis of hydrocephalus are:

rapid enlargement of the head (takes on the shape of a ball);
the child is very whiny and irritable;
the baby burps profusely and frequently;
the fontanel rises above the surface of the skull, there is no pulsation;
the newborn’s eyes shift downward, vision deteriorates, and sometimes strabismus occurs;
convulsions may occur;
retardation in physical and mental development;
frequent tilting of the head;
pale skin;
trembling of the chin and limbs.

In older children, the head does not grow larger, because the bones of the skull are already fused together. However, liquid still accumulates. The doctor will see this manifestation when he examines the brain on the image. The photo will be very different from the images that healthy people have. As a rule, children suffer from severe headaches, vomiting, and a feeling of nausea. Decreased hearing and vision may occur. The child becomes weak.

Symptoms of the disease in adults

The following signs of hydrocephalus are distinguished:

dizziness, pain;
nausea, vomiting;
noises in the head;
epileptic seizures;
disorders of motor and neurological functions;
decreased performance, the occurrence of apathy, depression;
blurred vision.

A feature of the disease in older people is a normal or slight increase in intracranial pressure. A small deviation from the norm characterizes normotensive hydrocephalus. Compression of gray matter due to fluid leads to brain destruction.

If mixed replacement hydrocephalus is diagnosed, then internal pressure does not increase at all, since most often the cause of the disease lies in brain atrophy. Thus, the liquid simply fills the empty space. This space arises as a result of atrophy.

Features of external hydrocephalus

As noted above, this disease is characterized by the accumulation of fluid near the skull. Liquor can freely communicate between places of its localization. This kind of brain is called open. The closed form implies complete separation of all spaces from the liquid.

The main symptoms of the disease are increased fatigue, weakness, and drowsiness. Double vision and headache may occur. In some cases - nausea, vomiting. The disease is accompanied by changes in gait. Sometimes urinary incontinence is added to these symptoms.

There are cases in which hydrocephalus develops unnoticed. Symptoms are completely absent for a long time. The patient does not experience any increase in blood pressure. No headache occurs.

Moderate hydrocephalus is considered a very insidious form. It is characterized by the absence of symptoms for several years. At one point, the patient's condition deteriorates sharply. The source of the problem is a violation of cerebral circulation. As a rule, the diagnosis of “moderate hydrocephalus of the brain” is made accidentally in most cases. The doctor notices the pathology during an examination of the fundus.

Nuances of internal hydrocephalus

This type of disease is characterized by the accumulation of fluid in the ventricles. Internal hydrocephalus can develop as a result of poor absorption of cerebrospinal fluid into the tissue. The reasons for this phenomenon may be past infections, strokes in the subarachnoid region, or blockage of veins by blood clots.

A characteristic manifestation of the disease is a severe headache. It is often accompanied by nausea, impaired visual and auditory functions. However, as with the type of illness described above, moderately severe hydrocephalus may not be manifested by any symptoms at all.

General form of the disease

The development of such hydrocephalus is associated with the accumulation of fluid both in the ventricles and in areas near the skull. It is believed that the progression is caused by mixed hydrocephalus. This form of the disease is caused by expansion of the ventricles and subarachnoid space. However, their increase provokes a decrease in brain tissue in the process of atrophy.

Mixed replacement hydrocephalus is a serious illness in which the brain space is replaced by cerebrospinal fluid. The risk group for this form of the disease includes older people who are diagnosed with hypertension and atherosclerosis. This category is expanded to include patients with instability of the neck vertebrae who have suffered a concussion. People who are addicted to alcohol are also at risk of receiving a terrible diagnosis.

With this form, symptoms may be completely absent. Or it may manifest itself as frequent dizziness, nausea, and vomiting.

Diagnosis of the disease

A diagnosis can only be made after a complete examination of the patient. Initially, the fundus of the eye is carefully examined. Next, the patient is recommended to undergo additional studies, such as neurosonography, MRI, CT. A general practitioner (pediatrician), neonatologist, neurosurgeon or neurologist can suspect a terrible disease based on its characteristic symptoms and make a primary diagnosis.

For children under 2 years old, an effective method is often used - neurosonography. This procedure is possible as long as the newborn’s fontanelle has not closed. In infants, there are other areas of the skull characterized by very thin bone. These places are also excellent “ultrasonic windows”. For example, the temporal bone is well suited for this study. This method allows you to determine the expansion of the ventricles, identify the presence of space-occupying formations (cysts, hematomas, tumors), and diagnose some brain defects. However, the above method is not accurate enough. Therefore, it is better for children to have an MRI.

A distinctive feature of diagnosing adults is the opportunity to listen to the patient’s complaints. It is the careful collection of data and neurological examination that suggests the development of this pathology. However, such an examination is not enough to finally determine the diagnosis. Therefore, the doctor recommends that adult patients undergo an MRI. It is this study that allows us to identify any pathology of the brain.

For adults, angiography and skull radiography can be used instead of tomography. If the occurrence of the disease is associated with a viral infection, a laboratory test for DNA or antibodies of the pathogen is prescribed. differentiated from brain tumors. In children - with complications of rickets.

Drug treatment

With slow progression of the disease, conservative therapy can be selected. In adults, this treatment method is determined by the open form of the disease. It should be understood that the choice of method of combating the disease is determined solely by the doctor.

As a rule, hydrocephalus of the brain requires the following conservative treatment:

Reducing high levels of intracranial pressure. For such purposes, the doctor prescribes Diacarb and Furosemide. These medications are taken over a long period of time. Often we are talking about several months.
Reducing the amount of fluid. The most optimal medications are Glycerin and Mannitol.
Strengthening blood vessels with complete preservation of electrolyte balance. To achieve this effect, potassium preparations are used.
Decreased cerebrospinal fluid production. An excellent remedy is Acetazolamide.
Therapeutic puncture. This procedure is only suitable for infants. This is a method of removing excess fluid from the brain through an open fontanel.
General strengthening therapy. Patients are usually prescribed pine and salt baths. A special course of vitamins is selected. Complements this therapy
Treatment of ailments that provoke the development of hydrocephalus. The relevance of this therapy is due to the acquired form of the disease.

If the above treatment is ineffective, doctors recommend surgery. This procedure allows patients to achieve recovery, in some cases even complete healing. And sometimes the operation is aimed at saving the patient’s life.

Surgery. Contraindications

Unfortunately, effective drug methods to combat the disease at any stage have not yet been developed. The above treatment is used for mild forms of the disease. As a rule, such methods perfectly reduce intracranial pressure and protect the patient from complications. Doctors strictly monitor the dynamics of hydrocephalus.

If there are prerequisites for surgical intervention, some contraindications should be taken into account. None of the following operations can be performed if the patient has:

ongoing inflammation in the lining of the brain;
irreversible processes (blindness, deafness, epilepsy, mental disorders).

Bypass surgery

If the brain does not restore the mechanism for removing fluid, the doctor prescribes surgery. In such cases, only surgery can help. In the recent past, hydrocephalus was quite effectively eradicated by a single method - shunting.

The goal of this intervention is to restore the flow of cerebrospinal fluid from the brain. For this purpose, a shunt is installed. The ventricular catheter is placed in the lateral ventricles. A special valve regulates the outflow of liquid. A peripheral catheter is inserted into the atrium or into the abdominal cavity. This helps optimize the absorption of cerebrospinal fluid. In some cases, after excision of one kidney, fluid is discharged into the ureter.

This operation has a number of possible complications and disadvantages. Among them are the following:

shunt infection;
mechanical damage to the implemented system;
violation of the functionality of the shunt;
slow outflow of cerebrospinal fluid.

Under these circumstances, there is a need for repeated surgery.

Endoscopic surgery

This method is the most common today. Endoscopy involves small incisions. This significantly reduces the risk of any complications. The rehabilitation period for the patient is reduced. During the operation, the surgeon directs the outflow of fluid into the brain cisterns, which are capable of normally absorbing cerebrospinal fluid. Thus, normal fluid circulation is restored. A successful operation completely eliminates the need to install a shunt. The patient returns to normal life.

Craniotomy

This intervention requires hydrocephalus of the brain, the causes of which lie in various obstacles to the outflow of fluid. As a rule, we are talking about aneurysms and tumors. Depending on the location, they can block the liquor-conducting pathways. In such cases, craniotomy is used. As a rule, during surgery, new pathways for the outflow of fluid are created.

Consequences of the disease

This disease can lead to encephalomalacia - tissue necrosis. As a result of impaired blood supply to parts of the brain, atrophy occurs. These processes are irreversible. Quite often, hydrocephalus can lead to disability. The symptoms have a quite destructive effect on the body. The patient may lose mental and motor abilities.

A common complication of the disease is. It is characterized by compression of parts of the brain and the occurrence of depressed consciousness, and often coma.

A congenital disease can stop its development at any age. With such an outcome, the patient is completely or partially cured. In case of rapid progression, children very rarely survive to the age of 5-6 years.

Prevention measures

The most important rule is to fully comply with all doctor’s recommendations for taking medications during pregnancy. At this stage, you should carefully avoid any infections, especially viral ones. Before pregnancy, it is recommended to get vaccinated against diseases that the expectant mother has not previously suffered from. Alcohol and tobacco intake should be completely avoided.

Adults need to be careful about their health. Diagnose illnesses in a timely manner and treat them correctly. This is especially true for diseases of the central nervous system, blood vessels, heart, and spine. Head injury should be prevented. The best preventive measure against most ailments is an active, healthy lifestyle. Try to strengthen your immunity. Pay attention to weight normalization. And no diseases will be scary for you!