Hydrocephalus in children: symptoms and treatment. Moderate hydrocephalus in children Stages of hydrocephalus in children

Hydrocephalus (syn. dropsy) of the brain in children is a disease characterized by the fact that an excessive amount of cerebrospinal fluid, also called cerebrospinal fluid, collects in its internal cavities and under the meninges. There are many reasons for the formation of the disease, and they may differ depending on the age at which the pathology formed. The most common provoking factors are infectious and oncological processes, congenital malformations and birth injuries.

The disease has pronounced symptoms that cannot be ignored. For example, an increase in head circumference, swelling of the fontanelles and saphenous veins on the head, as well as retardation in physical development.

The diagnosis can be confirmed using a wide range of instrumental examinations that are completely safe for the baby. A thorough physical examination is also important diagnostic criteria.

Methods for treating such a pathology are divided into conservative ones, in particular, medicinal and surgical.

The International Classification of Diseases allocates a separate meaning for hydrocephalus of the brain in children. Thus, the ICD-10 code will be G 91.

Etiology

Hydrocele of the brain in a child belongs to the category of the most common developmental anomalies - it is diagnosed in approximately one child per 500-1000 children.

Currently, quite a few provoking factors are known that influence the formation of such a disease - it is noteworthy that they can be both general and individual for a certain age category.

Reasons why the disease appears during intrauterine development:

• CNS defects;
• the pathological influence of infectious diseases that the expectant mother suffers from during pregnancy;
• genetic pathologies.

In newborns, the disease can develop against the background of:

• previous intrauterine infections;
• abnormalities in the structure of the brain or spinal cord;
• injuries received during childbirth and leading to the formation of meningitis and intracranial hemorrhage;
• tumors of blood vessels responsible for feeding the brain.

Factors influencing the appearance of hydrocele in children over 1 year of age are presented:

• malignant or benign formations in the brain or spinal cord;
• intracranial hemorrhages;
• consequences of a previous cerebral hemorrhage or traumatic brain injury. In such situations they talk about normal pressure hydrocephalus;
• congenital anomalies of the development of this organ or the vessels that feed it;
• genetic diseases.

• infection;
• pathological influence, and microorganisms belonging to the herpetic group.

Defects and anomalies that can lead to hydrocephalus:

• occlusion of the canal connecting the ventricles of the brain;
• primary arachnoid cysts;
• underdevelopment of the openings involved in the outflow of cerebrospinal fluid;
• Dandy-Walker syndrome;
• abnormal structure of veins in the brain.

Often, oncological formations act as a trigger, including:

• with localization in the choroid plexus;
• tumors in the bones of the skull or cerebral ventricles;
• spinal cord neoplasms that limit the absorption or circulation of cerebrospinal fluid.

In addition, the following can lead to dropsy:

• cancer metastasis to this area;
• vascular malformation.

It is also worth highlighting risk factors that significantly increase the risk of developing such a disease:

• premature birth of a baby - before 35 weeks of pregnancy;
• narrow pelvis of the expectant mother;
• baby's weight is 1.5 kilograms or less;
• presence during labor or fetal asphyxia;
• congenital intrauterine diseases affecting internal organs;
• suffered by a woman during the period of bearing a baby or, or;
• inadequate management of pregnancy, namely the mother’s addiction to bad habits.

All of the above factors lead to disruption of the development and maturation of the nervous system of children.

Classification

Division of the disease by time of formation:

• congenital hydrocephalus– is such if it develops before the birth of a child;
• acquired dropsy– diagnosed some time after the birth of the baby.

The secondary variant of the occurrence of pathology has its own classification and is divided into:

• closed or occlusive hydrocephalus– in such situations, there is a violation of the outflow of cerebrospinal fluid due to the closure of the holes in the brain through which it passes;
• open or communicating hydrocephalus– in this case, a violation of the absorption of cerebrospinal fluid occurs against the background of damage to the structures taking part in this process;
• hypersecretory hydrocephalus– characterized by increased production of cerebrospinal fluid.

Depending on the location of the focus of excessive cerebrospinal fluid content in the structures of the skull, the disease exists in the following types:

• external hydrocephalus– accumulation of fluid occurs around the outer surface of the brain, but under its membranes;
• internal hydrocephalus– cerebrospinal fluid accumulates in the ventricles and cisterns of the brain;
• mixed hydrocephalus in children– this type of disease is characterized by the accumulation of cerebrospinal fluid in areas such as the ventricles, cisterns and subarachnoid space.

According to the course of the disease, there are:

• acute– from the time of the first clinical signs to the appearance of deep decompensation, no more than 3 days pass;
• subacute– develops within a month from the moment the pathology begins to progress;
• chronic– characterized by slow development, which lasts from 3 weeks to six months or more.

Based on the severity of the disturbance in the structure of the affected organ, hydrocephalus is divided into:

• compensated– excess cerebrospinal fluid does not lead to compression of the brain, which is why the disease proceeds completely without expressing any signs, the state of health is normal, and physical development is not impaired;
• decompensated– excessive accumulation of cerebrospinal fluid compresses the brain, causing multiple pathologies of the central nervous system to form.

Based on deviations in MRI results, it is customary to distinguish:

• moderate hydrocephalus– in this case, minor changes in the volume of brain structures are observed;
• severe hydrocephalus.

The latest classification of hydrocephalus in children is based on the stability of symptoms:

• progressive;
• stabilized;
• regressing.

Symptoms

Clinical signs of this syndrome can appear from the first days of a baby’s life and develop at any age. The intensity of symptoms is dictated by the form and rate of progression of the disease, as well as the severity of the underlying illness.

The disease in children under 2 years of age has its own characteristics - it is severe, leads to rapid deterioration of the condition and irreversible brain damage. Symptoms of this variant of the disease are presented:

• an increase in head circumference - an increase of more than 1.5 centimeters per month;
• thinning of the bones of the skull and skin on the head;
• excessively large forehead;
• swelling fontanel;
• frequent regurgitation;
• divergent;
• decreased hearing and vision;
• increased irritability and anxiety;
• drowsiness and decreased activity;
• decreased appetite;
• loss of previously existing skills;
• cramps and muscle hypertonicity.

In a child over 2 years old, hydrocephalus of the brain is often characterized by slow progression and a gradual increase in the severity of the clinical picture, while the signs of hydrocephalus in children will be as follows:

• lethargy and inactivity;
• drowsiness and apathy;
• slowly developing loss of hearing and vision;
• double images before the eyes and squint;
• headaches and vomiting - such symptoms are most often observed in the morning;
• retardation in physical and mental development;
• gaining excess body weight;
• appearance and ;
• sudden and uncontrollable twitching of the limbs and face;
• impaired coordination of gait and movements;
• the appearance of blue circles under the eyes;
• breathing problems;
• urinary incontinence;
• cramps and paraparesis of the legs;
• attacks of loss of consciousness.

In cases where parents ignore the above symptoms, there is a high probability of developing serious and irreparable complications.

Diagnostics

Given that the pathology has pronounced and specific symptoms, there are often no difficulties in establishing the correct diagnosis. In newborns and older children, the diagnosis will be complex. First of all, the pediatrician needs to:

• study your medical history - this is necessary to look for congenital or genetic abnormalities that can lead to dropsy;
• collect and analyze a life history - this includes information regarding the course of pregnancy and labor;
• examine the patient, which includes measuring head circumference, assessing the child’s gait and skills;
• interview parents in detail to find out the severity of symptoms, which will make it possible to determine the nature of the course of such a disease.

Instrumental diagnostic measures for hydrocephalus include:

• neurosonography or ultrasound of the skull;
• CT and MRI of the brain;
• X-ray of the skull;
• echoencephalography;
• ophthalmoscopy;
• EEG and MR angiography.

Laboratory studies are limited to the study of cerebrospinal fluid, which is obtained through a procedure such as a ventricular puncture or lumbar puncture.

It is worth noting that it is possible to identify pathology even at the stage of intrauterine development of the fetus, starting from the first trimester - in this case, diagnosis is carried out by a neonatologist using ultrasound. In such situations, artificial termination of pregnancy is recommended.

Treatment

Despite the fact that therapy for the disease can be conservative or surgical, in the vast majority of cases it is complex.

Treatment of hydrocephalus in children with medications is based on taking medications that are aimed at reducing the production of cerebrospinal fluid. These include:

• diuretics;
• saluretics;
• carbonic anhydrase inhibitors.

If their use is ineffective for 3 months, surgical intervention is indicated. The operation can be aimed at:

After surgical therapy, children are advised to undergo a course of exercise therapy to restore motor function.

There are no other ways to get rid of the disease, including folk remedies.

Possible complications

The most common consequences of hydrocephalus in children are:

• chronic;
• speech disorder;
• significant retardation in mental or physical development;
• seizures;
• complete loss of hearing and vision;
• preservation of increased head volumes for life;
• weakness of arms and legs;
• urinary incontinence or fecal retention;
• pathologies of the respiratory and cardiovascular systems.

Prevention and prognosis

To avoid the formation of hydrocephalus of the brain in children, you need to adhere to these rules.

Hydrocele in newborns is a frequently diagnosed pathology. Its occurrence is provoked by an imbalance between the production and absorption of cerebrospinal fluid. The baby’s health depends on the stage of detection and timely treatment.

Hydrocephalus: what is the pathology?

Hydrocephalus, or hydrocephalus (literally translated as “water on the brain”), is a neurological disease manifested by excessive formation of cerebrospinal fluid (CSF) in the cranial cavity. The pathology develops during the period of intrauterine maturation of the fetus or after the birth of the child.

Cerebrospinal fluid (CSF) is the substance that contains the brain and spinal cord. During normal development, it moves freely, washing and nourishing the brain, pulsating in the same rhythm as the heartbeat. It is the cerebrospinal fluid that helps protect the brain from injury, maintains normal intracranial pressure, and preserves the functionality of the human autonomic system.

This process in infants in the first months of life provokes an increase in the size of the skull, since it is not yet formed. If cerebrospinal fluid is formed in patients at an older age, the shape of the skull does not undergo any changes. However, in this case, an increase in the volume of cerebrospinal fluid has a negative effect, washing out individual structures of the nervous system.

Sign of hydrocephalus

Hydrocephalus in an infant can be determined by the non-standard shape of the skull (normal indicators of a child’s head vary between 33-37 cm) and impaired reflex function. According to WHO standards, in the first six months of a baby’s life, the diameter of the baby’s head should grow by no more than 9 cm, and in subsequent months - by 4 cm. If the volume of the head exceeds the norm, this may indicate the presence of cerebral hydrocele. However, in this case, hereditary factors should also be taken into account: a child with a head size exceeding the norm can be absolutely healthy if all members of the family have a heroic build or a large head.

To determine the subsequent therapeutic method, it is important to determine not only the cause of the formation of the pathology, but also the location and nature of the pressure created.

Hydrocephalus of the brain in newborns is eliminated at the initial stage of development through the use of medications; in more severe cases, medical specialists prescribe surgical intervention.

Classification of disease and varieties

By origin, hydrocele in a newborn can be congenital or acquired. The first type is detected in patients in the first month of life. Diagnose:

1. acute form - duration does not exceed 3 days;
2. subacute – the development period ranges from 3 months to six months;
3. chronic - the length varies from 6 months to one year.

In addition, experts classify several types of dropsy of the brain.

Communicating dropsy

The process is characterized by excessive formation of fluid, while it is not able to be absorbed in optimal quantities. The circulation of cerebrospinal fluid is not disrupted. The process is associated with diagnosing metastases of cancer in a patient, identifying sarcoidosis, detecting meningitis or various types of hemorrhages.

Closed hydrocephalus

It occurs due to blockage through cystic formations, scars, and as a result of hemorrhages.

Depending on the location of the pathological focus, the disease can be external or internal. The first type is characterized by the accumulation of fluid in special expansions at the base of the brain, and the second - directly in the ventricles. In case of timely treatment of dropsy, the chance of minor damage to vital processes increases significantly. This gives a good prognosis for subsequent recovery.

The classification of pathology is also carried out on the basis of the manifestation of certain disturbances of processes in the brain:

1. compensated - the disease is detected without accompanying symptomatic signs and manifestations, while the child’s development occurs without any deviations;
2. decompensated – clearly expressed violations of the patient’s general health are detected.

Based on the severity of the identified deviations, hydrocephalus is distinguished between moderate (minor deviations from normal values) and severe (significant increase in the cerebrospinal fluid tract and brain substance).

Disease factors in children

So why are newly born babies diagnosed with hydrocele? This question worries all parents without exception who are faced with a similar problem. Experts believe that the reasons influencing the occurrence and subsequent development of pathology largely depend on the age characteristics of the patient. The factors of excessive accumulation of cerebrospinal fluid include the following:

1. violation of the chromosomal level;
2. Rh conflict in the child and mother, as a result of which immune dropsy begins to develop;
3. the influence of infections, as well as the possible transmission of diseases from the mother in the initial stages of pregnancy;
4. disruption of fetal metabolic processes;
5. diagnosing a severe form of anemia and gestosis in a pregnant woman during pregnancy;
6. elevated blood sugar levels;
7. pathological processes of congenital etymology diagnosed in a child (heart and vascular diseases, thrombophlebitis, leukemia);
8. mixing of blood when carrying twins;
9. identification of brain tumors of various etiologies;
10. fetal injury.

Pathology of the cerebrospinal fluid may be caused by other disorders. The most common among them is Arnold Kizri syndrome. It is characterized by the accumulation of large amounts of fluid in the back of the skull, which can gradually descend into the foramen magnum.

In some cases, the causes of the disease include intrauterine infection.

The appearance of cerebral hydrocele in newborns is often influenced by premature birth or low birth weight of the child. No less dangerous is the narrow pelvis of the expectant mother, as well as fetal hypoxia.

The disease diagnosed in patients older than one year deserves special attention. The causes may be tumors in the brain/spinal cord, hemorrhage, previous inflammation of the meninges, and traumatic brain injuries.

Symptomatic manifestations

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Signs of pathological changes can be detected during the prenatal period. The main symptom is a significant increase in head size. If intrauterine hydrocephalus is diagnosed, a woman can give birth exclusively by cesarean section. This will avoid compression of the skull, and, therefore, prevent the development of other pathologies of the central nervous system, which are subsequently almost impossible to eliminate.

The main symptomatic manifestations also include:

• prolonged closure of the “fontanel”;
• bulge/disproportionate increase in the forehead area;
• bulging and increasing size of the fontanel;
• uncontrolled eye movement (nystagmus), divergent strabismus;
• overhanging brow ridges;
• disturbance of visual activity;
• change in the appearance of the skin, mainly its pallor;
• increased heart rate;
• chin trembling;
• involuntary twitching of limbs;
• transillumination of the venous network on the forehead, temples, and back of the head;
• frequent regurgitation;
• excessive tearfulness, capriciousness;
• general restless state of the child, sleep disorder and subsequent developmental delay.

In older children, a venous network appears in the facial area, an increase in the size of the fontanel, which prevents the possibility of its overgrowing, an increase in muscle tone in the limbs, and insufficient mental and physical development of the baby.

As for patients older than 2 years, the disease, as a rule, is severe. The general condition often worsens due to damage to the structural elements of the brain. Symptoms that appear during this period: a significant increase in head size, morning headaches, nosebleeds, attacks of nausea, vomiting, poor coordination of movements, enuresis.

Diagnostic measures

Intrauterine hydrocephalus is diagnosed during a routine ultrasound examination of pregnant women. If cerebral hydrocele is detected, the frequency of procedures may be increased. Additionally, intrauterine fluid/blood may be collected from the umbilical cord for laboratory testing.

The disease in young children is detected as a result of medical patronage. To confirm the diagnosis, neurosonography is prescribed - an ultrasound of the brain performed through the fontanel. This procedure is now mandatory for every child who has reached the age of one month.

However, based on the results of an ultrasound examination, it is not always possible to accurately determine the causes of the disease, which is extremely important for prescribing subsequent treatment.

In such cases, a magnetic resonance or computed tomography procedure will help to study the causes in more detail and establish the type of hydrocephalus. To undergo it, the small patient is put into a state of medicated sleep. Layer-by-layer study helps to identify even minor deviations and changes in the structure of the brain.

Additional measures include consultation with a neurologist and ophthalmologist with mandatory fundus examination.

Often, specialists resort to electroencephalography, which records the electrical activity of the brain. If necessary, intracranial pressure can be measured.

Features of therapy

The method of therapeutic measures largely depends on what stage the disease is at, as well as the main factor that triggered the development. Dropsy is treated in different ways

Conservative method

It is considered effective only in the initial stages of the disease, when there are no aggravating factors. Medical specialists prescribe special medications (hormonal group). Some products help remove sodium from the body, which makes it possible to get rid of excess fluid. There are no drugs to treat the disease; their action is aimed at preventing further development of the disease.

Surgical method

Surgery is the most effective way to combat dropsy. It is carried out by shunting. Among the varieties of this procedure are:

1. venticuloperitoneal shunting - insertion of silicone catheters through which fluid is mixed from the head region to the abdominal region;
2. lumboperitoneal shunting – connection of the abdominal cavity with the spinal canal;
3. ventriculoarthrial shunting – transportation of a substance to the right atrium;
4. Torkildsen operation - extraction of fluid into the so-called occipital cistern;
5. endoscopic ventriculostomy - the technique does not involve the use of a shunt system; the procedure involves the creation of small incisions using an endoscope.

After surgery, the development of the pathological process stops, which allows the child to actively develop in the future. However, the procedure is prohibited for patients with a chronic form of the disease, as well as when other inflammatory processes, neurological disorders or mental disorders are detected.

Dropsy can be treated using traditional medicine methods. Among the most effective herbal remedies, the best proven ones are freshly squeezed juices of black radish, onions, and pumpkin, which are recommended to be drunk on an empty stomach. Decoctions of parsley, clover, birch leaves, adonis, and lemon balm help well with hydrocephalus.

Before using the above herbal remedies, you must consult a doctor!

Possible consequences and prevention

Late diagnosis and lack of treatment for hydrocephalus can lead to serious complications of the disease. The consequences of cerebral hydrocele include not only a delay in the general development of the child, but also impaired speech activity, deterioration of vision (its complete disappearance is not excluded), the development of epilepsy and cerebral palsy. A fatal outcome cannot be ruled out.

Regardless of the severity of the symptomatic signs that appear, the child should be seen immediately by a medical professional. It is important to remember that the situation may worsen due to the influence of concomitant diseases. The duration of a child's subsequent life depends on all of the above factors. As a rule, after surgical treatment the further prognosis is favorable.

An important role is given to preventive measures. They include limiting the child from head injuries, regular consultations with specialists during the process of bearing a child, including an infectious disease specialist (if necessary, if the expectant mother suffered from certain diseases during pregnancy: ARVI, rubella).

Remember that it is easier to prevent any disease than to get rid of it later. Monitor the health and development of your baby, and if you detect the slightest pathological symptoms, contact qualified specialists.

Among pathologies in newborns, hydrocephalus makes up a considerable percentage. There are many varieties of this disease, but the essence remains the same. It consists of increased production and subsequent accumulation of cerebrospinal fluid, i.e., cerebrospinal fluid in the child’s head. The causes and symptoms of this disease are described in detail below.

What is hydrocephalus of the brain

Hydrocephalus is also called dropsy, because the term itself is translated as “water in the brain.” This disease characterizes a condition in the body when special cavities called ventricles fill with excessive amounts of cerebrospinal fluid. It also penetrates under the membranes of the brain. This increases intracranial pressure. The consequence is compression of the brain and poor blood supply. Because of these processes, the baby cannot develop normally, and his nervous system matures more slowly.

Hydrocephalus of the brain in children has several classifications:

1. External or internal. In the first case, the cerebrospinal fluid accumulates under the meninges, and in the second case, inside the ventricles of the brain.
2. Closed or open. The first is also called occlusive or non-communicating. It is characterized by a blockage of the outflow of brain fluid to the site of absorption. The second is communicating. With it there is no blockage of cerebrospinal fluid, but there are disturbances in its absorption.
3. Normotensive, hypotensive and hypertensive. The classification is based on the degree of intracranial pressure.
4. Congenital or acquired. More often, the development of hydrocephalus of the brain in children is noted in the womb, so the baby is born with the pathology.
5. Acute or chronic. This classification depends on how cerebral hydrocele develops: quickly or gradually.
6. Substitute (compensated) or uncompensated. The first practically does not manifest itself with any symptoms, while the second is accompanied by severe disturbances.

Outdoor

Another name for this disease is hydrocephalic syndrome. The external or external type of the disease is characterized by the accumulation of cerebrospinal fluid under the meninges. This type of disease is congenital, as it is a consequence of birth injuries. Treatment is carried out with the help of medications aimed at reducing the outflow of fluid and stabilizing it. In the absence of positive dynamics, surgical intervention is prescribed.

Internal

There is internal dropsy of the brain in children. This type is characterized by the accumulation of cerebrospinal fluid in the ventricles of the brain. Internal hydrocephalus may appear during the subsequent development of the baby, but it can also be congenital. The treatment is practically the same as for the external type of dropsy. First, medications are used, and if there is no good result, surgery is performed.

Mixed

Based on the name, it is clear that with this type of hydrocephalus, fluid in the child’s head accumulates both in the ventricles of the brain and under its membrane. This form of dropsy, along with the moderate type, which may not manifest itself for a long time, is the most dangerous of all. The prognosis of the disease is often unfavorable, because the disorders are intense. Convulsions, epileptic seizures and paralysis of the limbs appear.

Why does dropsy of the brain occur in children?

In general, the reasons why hydrocephalus of the brain develops in children are classified as congenital or acquired. The first include:

• impaired fetal brain development;
• infections suffered during pregnancy;
• failure of cerebrospinal fluid circulation;
• abuse of cigarettes, drugs or alcohol during pregnancy.

The severity of the disease depends on the time when the infection occurred. In the short term, this leads to termination of pregnancy, and in the later stages, it leads to disruption of the formation of blood vessels and tissues, which is why hydrocephalus develops. Risk factors for developing the acquired form of the disease include:

1. Premature baby. When intrauterine development has not yet ended, and the baby has already been born, the production of cerebrospinal fluid begins to increase.
2. Injuries during childbirth or subsequently. The resulting concussion also often causes increased production of cerebrospinal fluid.
3. Brain tumors. They put pressure on surrounding tissues, reducing the ducts, which disrupts the flow of cerebrospinal fluid and causes it to accumulate.

How does hydrocephalus manifest in newborns?

Symptoms of dropsy depend on the age of the patient. For adults they are one, and for children they are different. It is also important that hydrocephalic syndrome in a child under one or two years of age manifests itself differently than in children older than this age. In an infant, signs of dropsy are:

• the size of the head increases very quickly;
• the forehead becomes thin;
• the fontanel tenses, swells and protrudes;
• the baby often throws his head back;
• strabismus;
• no attempts to crawl, sit, stand, talk;
• cephalic incontinence;
• convulsions;
• crying for no reason and moodiness.

How does hydrocephalus manifest in a child after two years of age?

In older children, hydrocephalus manifests itself differently. If the child is over 2 years old, then the increase in head volume is practically not observed. Schoolchildren do not have this sign at all. Instead, the disease manifests itself with other symptoms:

• severe headaches, especially at night or in the morning;
• nausea and vomiting;
• vision problems;
• convulsions;
• sleep disorders;
• nosebleeds;
• decreased intellectual abilities;
• severe fatigue;
• drowsiness;
• memory impairment;
• premature puberty;
• growth retardation or advance;
• obesity;
• lack of interest in outdoor games;
• loss of coordination;
• urinary incontinence.

How is hydrocephalus diagnosed and treated in children?

Newborns whose skull bones have not yet fused completely are sent for an ultrasound of the brain. For older children, magnetic resonance imaging or computed tomography is prescribed. If hydrocephalus is acquired, then a cerebrospinal fluid analysis is performed using puncture. Treatment of dropsy is divided into medicinal and surgical. Surgery is more effective. It is carried out using 2 methods:

1. Liquor shunting. Excess cerebrospinal fluid is removed into the natural environment of the body using a shunt located in the brain. In adults, this method allows you to completely cure the disease, but for children, this important detail is changed over time, because their heads are constantly enlarging due to natural growth.
2. Endoscopic surgery. Considered less dangerous. It represents the restoration of normal liquor flow without the introduction of foreign bodies. For this reason, the risk of complications is also reduced. The peculiarity is that only external dropsy can be treated in this way, because with internal dropsy there is no endoscope access to the desired brain area.

Video: childhood hydrocephalus of the brain

Hydrocephalus is a pathology in which cerebrospinal fluid accumulates in the channels through which it should flow. The channels running inside the cranium collect a large volume of fluid, and it, in turn, puts pressure on the soft bones of the skull of a newborn child, increasing its volume. At an older age, when the bones are stronger and the fontanelle is overgrown, the skull will not increase in size. But instead, under pressure, the nervous tissue of the brain is injured.

To treat hydrocephalus, it is necessary to know the cause of the development of the pathology, its location and the increasing pressure. If detected in time, the disease can be cured before skull defects form. On the contrary, a delay in providing assistance results in death for the child.

Formation of hydrocephalus

Hydrocephalus develops under the influence of excess amounts cerebrospinal fluid. This occurs when the rate of fluid formation exceeds its absorption. The brain is a complex structure containing a number of cavities. These cavities are called ventricles. The ventricles are covered with a network of vessels that are responsible for the formation of cerebrospinal fluid. To remove cerebrospinal fluid, the ventricles form a communication system with each other. Liquor exits through this system, washes the spinal cord and enters the cavity between the membranes. This place is also called the subarchnoid space, which is also located in the cavity of the cranium.

The liquid is then absorbed into the veins that are located in the skull for this process. They are called venous sinuses, and are attached to the bones of the skull. Suction occurs due to the difference in pressure. Intracranial pressure must be greater than the pressure inside the venous sinuses.

Intracranial fluid performs functions:

Children produce from 40 to 150 ml of cerebrospinal fluid per day. When disturbances occur, the generation of cerebrospinal fluid increases, and its absorption decreases, the flow of fluid through the channels designated for this stops and develops hydrocephalus. Under the influence of pressure, not only does the volume of the skull expand, but also brain atrophy and reduction occur. At first, the brain shrinks under the influence of fluid due to its tissue elasticity, then it atrophies. The size of the skull can only be changed in children under one month of age.

Reasons for the formation of hydrocephalus

Hydrocele of the brain in newborns occurs in 3-4 children out of 10 due to the development of diseases of the central nervous system. In 1-4 out of 10 children it develops due to infectious diseases. The largest number of cases of hydrocephalus development occurs in tumor diseases, 9 out of 10 cases.

Infections, contributing to the development of hydrocephalus:

Various kinds vices:

• Arnold-Chiarri syndrome has a great influence on the formation of cerebral hydrocele in newborns.
• Congenital narrow channels for cerebrospinal fluid.
• Development of a brain cyst.
• Abnormal cerebral veins.
• Hydrocephalus in newborns develops under the influence of Dandy-Walker syndrome.

Reasons related to oncology:

• Brain cancer.
• Tumors inside the skull.
• Spinal cord oncology.

Factors, affecting the development of hydrocele of the brain:

Symptoms of the disease in children under 2 years of age

Hydrocephalus in newborns is very severe. The child’s well-being rapidly deteriorates, and brain structures are damaged. The peculiarities of the course are that the bone structure of the skull, at this age, is quite soft and susceptible to change. Based on this, the main symptom of the disease will be an enlargement of the skull. The progression of the increase in head volume is more than 1.5 centimeters per month. Within a month head increases by 9 mm.

Normally, the baby's head circumference after birth is 1-2 centimeters larger than the chest circumference. But by 6 months, this ratio changes.

Table of age of normal head circumference in centimeters.

However, skull enlargement is not the only symptom; there are many others. symptoms, will indicate the presence of increasing dropsy of the brain.

After identifying symptoms of the disease, you should immediately consult a doctor. During the rapid progression of the development of hydrocele, symptoms appear in the form of constant convulsions, vomiting, and drooling, and the child loses the ability to move and move his limbs. In this situation, urgent hospitalization is necessary.

Symptoms of the disease in children over 2 years of age

The head bones of a child over two years old are hard enough to increase the volume of the skull. Therefore the symptoms will differ.

Establishing diagnosis

• For diagnosis, an examination by a neurologist is necessary. He measures the circumference of the head, chest, checks muscle tone, and the child's reflexes.
• An optometrist should check the optic nerve.
• Ultrasound of the fontanel. It is performed on children up to a month of age, while the fontanel is still open.
• MRI diagnostics will provide a complete picture of the state of the brain. But to carry it out, you need to be completely motionless. For this reason, children under 5 years of age are given anesthesia.

Most effective method diagnostics is MRI, which allows you to look at changes in the brain, determine the stage of the disease and the extent of damage. A less effective diagnostic technique is computed tomography. However, this method can detect the presence of tumors in the brain, as well as confirm Arnold-Chiarri and Dandy-Walker symptoms.

To confirm hydrocephalus, doctors prescribe measurement of intracranial pressure. This is done using a puncture between the lumbar vertebrae.

Treatment method

Treatment There are two types of hydrocephalus:

1. Medication.
2. Surgical.

During drug treatment, measures are taken to reduce intracranial pressure. In this case, it is necessary to reduce the production of cerebrospinal fluid and speed up the process of its absorption and excretion. For this purpose, the drug Diacarb is prescribed. It inhibits the production of spinal fluid and reduces its volume. The process of urination increases due to a decrease in the amount of potassium in the body.

Appointed diuretics drugs such as Mannitol, Lasix, Furosemide. Along with these drugs, a medicine is also prescribed that improves brain function under high pressure conditions. If the situation does not improve within 2-3 months with drug treatment, surgical intervention is used.

Surgical intervention

Carrying out surgery is a chance to save a child's life. Its implementation will depend on the shape of the flow.

During closed forms of hydrocephalus, the operation occurs in 2 situations:

1. When it is possible to remove an obstacle that interferes with the flow of cerebrospinal fluid. Removal of a tumor, cyst, removal of an aneurysm.
2. When it is possible to create alternative pathways for the flow of cerebrospinal fluid.

Most often, cerebrospinal fluid is drained by placing catheters into the abdominal cavity, where the tube enters between the sheets of peritoneum, which has an excellent ability to absorb liquids. More fluid may be drained into the atrium. This technique is called ventricular shunting.

During a critically rapid increase intracranial pressure, shunting is a very dangerous operation. Therefore, the catheter is installed in the ventricle of the brain and brought out into a vessel, the size of which should be no less than the size of the child’s head.

Prevention of disease development

To reduce the chances of a child developing hydrocele, parents need to follow certain rules prevention. The mother of the child must give up bad habits, such as carrying a raft for a while. During pregnancy, a woman must be examined for infectious diseases. If a case of red ear disease occurs, it is advisable to undergo an ultrasound to examine the fetus.

When the baby is born, care should be taken to ensure that it does not suffer any brain injuries. Children should undergo all routine examinations by doctors; in case of serious injuries, it is advisable to undergo an examination.

Hydrocephalus cerebri or hydrocephalus is a neurological disease caused by the accumulation of fluid in the ventricular system and subarachnoid regions of the brain. Hydrocephalus of the brain develops due to excess production or poor drainage of cerebrospinal fluid (CSF).

The brain and spinal cord are constantly bathed in a fluid called cerebrospinal fluid. Thanks to cerebrospinal fluid, the brain is protected from all kinds of damage:

• the liquid creates a kind of “airbag”,
• shock absorbing.

This is not the only function of cerebrospinal fluid:

• it also delivers nutrients to tissues,
• supports the microenvironment,
• promoting the normal functioning of the thinking organ, etc.
• CSF is produced from the blood.

In a healthy adult, the volume of cerebrospinal fluid is about 150 ml, in a newborn - 50 ml.

Normally, cerebrospinal fluid is in a state of constant circulation: cerebrospinal fluid is produced and absorbed in such a way that its total volume remains unchanged. In some cases, the fluid stagnates, accumulating in the ventricles of the brain or under its membranes. It is the disruption of circulation that causes the development of hydrocephalus. In this case, both an increase in the volume of produced cerebrospinal fluid and a disruption in the process of its absorption can cause pathology.

Classification

Infantile hydrocele of the brain is classified according to many characteristics.

So, according to the time of formation of hydrocephalus of the brain in children, it happens:

• Intrauterine– diagnosed during pregnancy, mainly at 16-20 weeks. The disease can develop in the fetus after a pregnant woman has suffered infections or viruses, against the background of a genetic predisposition, as well as the expectant mother’s abuse of such addictions as alcohol and drugs.
• Congenital– occurs due to congenital abnormalities of the brain or central nervous system, premature birth, as well as during difficult labor and resulting intracranial injuries.
• Acquired– develops in children aged 1 year and older under the influence of certain factors: past infectious diseases affecting brain tissue; pathologies of the vascular system; intracranial tumors and injuries.

According to morphological characteristics, hydrocephalus is divided into:

• communicating (open) – occurs due to an imbalance in the production and absorption of cerebrospinal fluid;
• occlusive (closed) - appears due to blockage of the liquor-conducting pathways caused by a pathological process.

In turn, the described types of hydrocephalus are divided into the following subtypes:

• internal - cerebrospinal fluid accumulates in the ventricles and overwhelms them;
• external (external) - fluid fills the subarachnoid space, accumulating between the membranes of the brain;
• mixed - does not have a clear localization of fluid accumulation, which can fill the ventricles and subarachnoid space at the same time.

According to the criterion of stability of manifestations, the following types of hydrocephalus of the brain in children are distinguished:

• progressive – with increasing symptoms and rapid deterioration of well-being;
• regressing - a decrease in the intensity of symptoms followed by its disappearance;
• stabilized – the symptoms are stable, while the state of health does not change, either for the better or for the worse.

Hydrocephalus is also divided into two types depending on the stage of the disorder:

• compensated - despite the diagnosed hydrocele of the brain, there are no signs characteristic of this pathology, while the child develops normally and feels well;
• decompensated – accompanied by severe symptoms and a significant deterioration in well-being.

Timely identification of the type of hydrocephalus in a baby allows you to select the necessary treatment and thereby prevent the development of complications and serious consequences in the future.

Causes

Hydrocephalus of the brain in children can develop for various reasons. Let us describe the most common conditions that initiate pathology.

The most common cause of hydrocephalus in newborns is obstruction (obstruction) of the aqueduct of Sylvius, the canal connecting the third and fourth ventricles of the brain. Obstruction in this area is often the result of persistent narrowing of the lumen of the canal or gliosis (filling with glial cells) of the brain aqueduct. A common cause of obstruction in this area is the formation of a septum.

Another common cause of hydrocephalus is a developmental anomaly - malformation of the cervicomedullary junction (Arnold-Chiari malformation). This condition is a congenital pathology, characterized by the descent of the cerebellar tonsils into the foramen magnum, which compresses the medulla oblongata.

The cause of hydrocephalus in children is Dandy-Walker syndrome. This anomaly is a severe malformation of the nervous system, in which dilatation of the fourth ventricle occurs with the formation of a cyst and insufficient development of the cerebellar vermis is observed.

The three above reasons account for more than 60% of the factors that provoke hydrocephalus of the brain in children. Other causes that initiate hydrocephalus include the following conditions:

• various infectious diseases of the embryo;
• anoxic brain damage;
• traumatic hemorrhage during the period from the 154th day of intrauterine development to the 7th day inclusive of the life of the newborn;
• meningoencephalitis (inflammation of the membranes and substance of the brain) of a viral or bacterial nature;
• choroidpapilloma is a benign tumor of the fourth ventricle arising from the epithelium of the choroid plexus;
• severe cerebral vascular defect – vein of Galen malformation.

Among the pathological conditions that lead to the development of hydrocephalus in children in the age group from two to ten years, there are:

Signs of hydrocephalus differ between children under 2 years of age and older children.

In children under 2 years of age

At this age, congenital hydrocephalus usually appears. This pathology is severe, the child’s condition quickly deteriorates, and damage to brain structures develops. In some cases, hydrocephalus is a consequence of meningitis or encephalitis, then it has a chronic course.

The peculiarity of the course of the disease in children of this age is due to the fact that the bones of the skull at this age are not yet tightly fused and can move relative to each other, making it possible for additional volume to appear in the skull for an increased amount of fluid. Therefore, the main symptom is an enlargement of the head, which progresses: more than 1.5 cm per month for at least 3 months in a row and more than 9 mm from 3 to 12 months of life.

A child is normally born with a head circumference that is 1-2 cm larger than the chest circumference; by 6 months the ratio should change. If the head remains larger than the chest, it may indicate hydrocephalus.

Other symptoms will be:

• blue-green veins are visible on the frontal, temporal and occipital parts of the head;
• a pliable place at the top of the head - the fontanel - protrudes above the bones of the skull and pulsates;
• forehead increased in size;
• the pupil cannot stay in one place when fixing the gaze - it will make wide or small fluctuations up and down or left and right;
• the brow ridges hang over the facial skull, making the eyes appear deep-set;
• divergent strabismus is noted;
• the child is capricious, whiny, sleeps poorly;
• the baby is not gaining weight well;
• after 3 months he begins to hold his head up;
• does not know how to smile;
• begins to sit up late, crawl, walk;
• the skin on the head becomes thin and shiny;
• frequent regurgitation during feeding;
• throwing back the head;
• it is difficult to straighten your legs, they are bent at the knee joints;
• drooping eyelids;
• when blinking or looking down, a white stripe of sclera appears between the upper eyelid and the upper edge of the iris;
• the child eats little by little, sucks sluggishly, reluctantly.

With rapid progression, which requires immediate hospitalization in a children's multidisciplinary hospital, where there are departments of neurology and neurosurgery, the following signs appear:

• convulsions;
• vomiting;
• crying on one note;
• drowsiness;
• previously acquired skills (sitting, walking, tracking toys) are lost;
• the impossibility (complete or partial) of independent movements in the limbs may develop.

In children over 2 years old

In such children, whose skull bones do not allow for additional head volume, hydrocephalus manifests itself with slightly different symptoms:

• headaches, which are more disturbing in the morning (after a long horizontal position), go away in the evening. Headaches also intensify after daytime sleep, mental or physical activity, stress;
• at the peak of the headache, nosebleeds may develop;
• pain behind the eyes of a pressing nature;
• poor sleep, the child often wakes up in the middle of the night, sometimes screams and cries;
• nausea, vomiting, especially against the background of increased headache;
• visual impairment (decreased visual acuity or double vision) due to the pressure of intracranial fluid on the optic nerves passing through the cranial cavity;
• the child’s academic performance declines;
• lack of coordination;
• decreased muscle strength;
• urinary incontinence;
• hyperactivity;
• attention deficit;
• chin trembling;
• convulsions with loss of consciousness;
• irritability;
• uncontrolled movements in the legs, face or arms;
• obesity;
• walking on tiptoes;
• passing large amounts of urine;
• circles under the eyes are bluish in color, and when the skin is stretched, blood vessels are visible.

Diagnostics

Diagnosis of hydrocephalus is based on the clinical picture, examination of the fundus, as well as additional research methods, such as neurosonography (NSG), ultrasound examination of the brain (in infants under 2 years), computed tomography (CT) or magnetic resonance imaging (MRI) of the brain brain The primary diagnosis can be made by a neonatologist, pediatrician, neurologist or neurosurgeon.

Neurosonography is an effective method for diagnosing the state of the brain and ventricular system in children under 1.5-2 years of age, until the large fontanelle and other “ultrasound windows” - areas of the skull where the bones are very thin (for example, the temporal bone) and transmit ultrasound. It allows you to detect expansion of the ventricular system, intracranial space-occupying formations (tumors, hematomas, cysts), and some malformations of the brain. However, it should be remembered that NSG is not an entirely accurate method. The image of the brain is obtained with significantly lower resolution (less clear) than with CT and MRI.

If any brain pathology is detected, a CT or MRI is necessary. Without them, it is impossible to make an accurate diagnosis, identify the cause of hydrocephalus, and even more so carry out treatment. This equipment is expensive and is still not installed in all hospitals. In this case, parents should insist on having a CT or MRI scan performed at other centers or perform them themselves on a commercial basis. It should be borne in mind that a clinic that undertakes the treatment of children with hydrocephalus is required to have this equipment. Otherwise, we can recommend that parents choose another, more equipped hospital, at least in another city.

How to treat hydrocephalus

Treatment (regardless of the cause of cerebral dropsy) is always carried out according to certain schemes and principles. The main method is surgical treatment, but sometimes neurosurgeons allow the use of drug therapy if they believe that there is no danger to the child and the outflow of cerebrospinal fluid can be established without surgery.

Drug treatment

For conservative treatment, diuretics are usually used, which reduce the production of cerebrospinal fluid and increase its circulation. In most cases, with open hydrocephalus, which is not complicated by severe symptoms, this is quite sufficient.

The information is provided for informational purposes only. Treatment should only be prescribed by a doctor. Self-medication is unacceptable, as it can lead to negative consequences.

Operation

In advanced cases or in acute cases, hydrocephalus in newborns requires surgical intervention. Previously, the only radical option was bypass surgery - a long, complex operation. A tube is installed in the brain - a shunt, which ensures the outflow of excess fluid - most often into the stomach or esophagus. Since a foreign body is introduced into the body, there is a high risk of complications and infection. As the child grows, the shunt must be replaced with a longer one. You will have to undergo 2-3 additional operations. No deviations in the development of children were observed after such intervention.

In the 80s of the last century, medicine stepped forward. Neurosurgery has replaced traditional methods. In modern medicine, endoscopic intervention is increasingly used. This operation is performed without installing a foreign body (shunt), it does not last long, is less traumatic, and allows you to restore normal circulation of the cerebrospinal fluid. After endoscopy, there are fewer negative consequences, and the quality of life improves significantly. For patients with dropsy caused by neoplasms, this is the only chance for a full life in the future.

The prognosis for newborns who undergo surgery in the first months of life is optimistic. How long will a baby live after neurosurgery? In the absence of complications - no less than an ordinary healthy child. The rate of growth and development will not differ in any way from the same indicators of peers. With timely diagnosis and treatment, the baby will live a normal life with only minor restrictions. Hydrocephalus syndrome in children is not a death sentence, but a disease that can be treated very successfully.

Consequences of hydrocephalus

An advanced form of hydrocephalus leads to irreversible consequences. Brain tissue is depleted, the nervous system is affected, organs gradually fail - all this leads to the death of the patient. Noticeable external changes in the open form of the pathology are a large head, drooping eyeballs. Due to high intracranial pressure or a growing tumor, vision may deteriorate or hearing may be lost. If the deformation of the skull has already occurred, then it will not be possible to reduce it in the future.

Often the result of hydrocephalus is:

• developmental delay (mental and physical);
• epilepsy attacks;
• deterioration or loss of hearing and vision;
• speech disorders;
• autism;
• chronic migraine;
• nausea and vomiting;
• poor academic performance.

With timely diagnosis and prompt surgical intervention, most of these consequences can be avoided. Modern methods make the life of children diagnosed with hydrocele complete and no different from the lives of other children. Despite the disability group, these children live no worse than healthy ones.

Prevention

In order to identify hydrocephalus in a child in advance and take the necessary measures, all pregnant women must undergo an ultrasound scan on time. Infectious diseases that can cause hydrocephalus in the fetus are detected during a blood test of a pregnant woman for TORCH infections: toxoplasmosis, rubella, herpes, cytomegalovirus infection. This test must be prescribed at the antenatal clinic during pregnancy.

Doctors should pay special attention to children who have risk factors for hydrocephalus:

• prematurity;
• various pathologies during pregnancy in the mother, in particular infections;
• malformations of the nervous system: spina bifida, cerebral hernia, etc. (hydrocephalus can develop much later, after
• the child was operated on for the defect and managed to grow up);
• tumors of the brain and spinal cord;
• previous meningitis, meningoencephalitis, infections of the nervous system;
• intracranial hemorrhages;
• suffered head injuries.

These children should be examined and observed by a specialist.

Hydrocephalus often develops after traumatic brain injury, so an important preventative measure is to protect children from injury:
use of child seats in cars;

• walks – on specially equipped, safe playgrounds;
• protection of a small child in the house: you need to purchase special covers for all sharp corners, remove all heavy, unstable objects;
• When riding a bicycle, skateboard, rollerblades, etc., the child must wear a helmet and other protective equipment.