Moderate hydrocephalus in adults on MRI. What is hydrocephalus of the brain, what is the danger of the diagnosis

The so-called accumulation of excess fluid in the head. Its excess contributes to an increase in pressure on the brain tissue, while pressing them to the skull. Hydrocephalus in adults (or dropsy in the common people) can lead to lethal outcome with advanced disease. It can be congenital or acquired. The degree of cure depends on how much the brain is affected, as well as what the symptoms of abnormalities are.

Hydrocephalus in adults: symptoms

Most often, this disease is manifested by nausea, vomiting, headache, blurred vision (a person cannot focus his eyes, there is a split). It is also possible to have impaired coordination, memory loss, urinary incontinence (sensitivity disappears). Eyeballs seem to change their position (rolling eye effect), worsens nervous state and sometimes drowsiness is present. However, the main sign by which it can be determined that this is hydrocephalus in an adult is various psychical deviations(epileptic seizures, hallucinations, all kinds of mania and the most common - emotional stupor).

Classification

The most common form is occlusive hydrocephalus in adults (closed). It develops in violation of the outflow of cerebrospinal fluid. The congestion is most often caused by blockage due to the development of a tumor, which can appear after an inflammatory process or with various congenital malformations.

Dizrezorbtivnaya, or open hydrocephalus. In this case, the disease manifests itself in the fact that the processes of absorption of cerebrospinal fluid are disturbed.

hypersecretory form. The disease occurs when overproduction cerebrospinal fluid. Often this is caused by the presence of papilloma of the choroid plexus.

Mixed hydrocephalus in adults is the most dangerous form diseases. With it, the brain decreases in volume, and cerebrospinal fluid begins to take its place.

Hydrocephalus in adults: causes

The congenital form of hydrocephalus is diagnosed in childhood. In adults, this disease is mostly acquired. It can be caused by various head injuries, previous diseases(meningoencephalitis, meningitis), intoxication, hemorrhage or tumor. In general, hydrocephalus in adults is not very common.

To find the right treatment, you need to determine the cause of the disease. For this, all analyzes and data on the human condition are collected. First of all, you need to undergo a neuropathological examination. There should also be tomography results. After all, only in the picture you can see what state the brain is in, whether any pathologies can be present there. On initial stage treatment doctors assist the patient strictly by medication, prescribing drugs such as Asparkam, Cavinton, Gliatilin, Cerebrocurin. All of these drugs promote the outflow and inflow of cerebrospinal fluid. As the disease progresses, surgery is necessary. With the new technique, the neurosurgeon makes a small incision at the bottom of the third ventricle, which connects to the external cistern and allows the cerebrospinal fluid to circulate freely. After the operation, there is a complete recovery.

In adults, also called “dropsy of the brain” in the common people, is a clinical syndrome, the main manifestation of which is an excessive volume of cerebrospinal fluid that has accumulated in the cavities of the skull.

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

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

Also, cerebral hydrocephalus in adults is divided into three forms in accordance with the patient's typical level of pressure inside the cranium: hypertensive type, normotensive type, hypotensive variant.

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

Memory problems, deterioration mental capacity, the appearance of depressive and manic states, decreased or loss of vision, inability to orientate in space, uncontrolled urge to urinate - only a small fraction of the symptoms that occur with hydrocephalus of the brain in adults. Due to the existence of a real threat to human life, it is necessary when the slightest sign diseases in urgent order apply to neurological clinic, undergo a large-scale examination and comply with all medical prescriptions of a doctor.

Hydrocephalus in adults: causes

To date, the causes of the development of cerebral hydrocephalus in adults have been well studied and described, but the question of the true mechanism for the development of the normotensive form of the disease remains unclear. Let us describe the main factors provoking the onset of the disease in adults.

Hydrocephalus in adults: symptoms

The clinical symptoms of pathology depend on the factors that gave rise to the disease, the duration of the disease and the level intracranial pressure. In hydrocephalus following a traumatic brain injury or subarachnoid hemorrhage, symptoms may occur during the first week of illness. At chronic course hydrocephalus, they appear and are aggravated gradually.

Almost always, the earliest and most prevalent symptom of hydrocephalus is the subject's trouble walking. On initial segment ailment, a person’s gait becomes uncertain. An excessively slow pace of movement is noticeable. Spontaneous falls during movement are possible.

As the disease progresses, gait disturbances become aggravated. It is very difficult for a person to move from a place: it looks as if his legs are "magnetized" to the floor. The patient moves with small steps. His legs are usually wide apart. His shuffling gait is striking. It freezes in place when turning. Sometimes, when moving, a hydrocephalus patient stops and freezes in place, because he is not able to perform the next step.

Moreover, if the patient is in a sitting or lying position, he easily imitates a normal walking step, cycling. He, while lying or sitting, is able to “draw” intricate symbols in the air with his feet. Sometimes there are signs of a violation of control over movements in the upper limbs.

At neurological examination The patient may exhibit the following symptoms:

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

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

Many adults with hydrocephalus complain of severe headache. It usually occurs after waking up in the morning. Other signs join the headache - discomfort and discomfort in the epigastrium. Vomiting is possible, after which the patient with hydrocephalus experiences relief.
A common symptom of hydrocephalus in adults is a feeling of pressure coming from within on the eyes. A person may feel a burning sensation in the eyes or feel as if fine grains of sand have been poured into them. Visually visible dilated vessels eyeballs. Many adults have a decrease in visual acuity. A person describes the appearance of a veil and "fog" before the eyes. likely to develop atrophy optic nerves.
As hydrocephalus aggravates, mental signs appear that differ in their brightness. In adults, there is a lack of motivation for mental, speech, motor activity. There is a state of complete indifference, indifference to ongoing phenomena. The patient may be disoriented in time and not understand where he is. There is a dulling of the emotional perception of reality. Common anomalies are productive symptoms, including visual and verbal hallucinations. May develop manic syndrome, which are characterized by a triad of features: elevated mood, acceleration of thinking and speech, motor excitation. In other adults, symptoms of depression predominate: low mood, inhibition of intellectual activity, and motor retardation.
Excessive sleepiness is a poor prognostic sign. daytime, failure in sleep-wake mode, persistent insomnia. A separate group of patients develop epileptic seizures. The progression of hydrocephalus leads to a significant deterioration in human cognitive functions. Some patients lose the ability to care for themselves on their own.
Often patients are already early stages hydrocephalus indicate an increase in their urination. Most adults excrete most of the daily amount of urine at night. In the future, patients have an imperative urge to perform an act of urination. Later, people suffering from hydrocephalus cease to be aware of the urge to urinate. At the same time, they have a complete indifference to the involuntary urination that occurs in them.

Hydrocephalus: treatment

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

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

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

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

In the chronic course of hydrocephalus, a variety of shunt operations are performed. This type of surgical treatment is aimed at ensuring the outflow of excess CSF into the natural cavities of the body by placing a variety of shunts. Such surgical treatment- complex and traumatic manipulations, however, with their correct and competent performance, recovery is observed in more than 60% of patients with hydrocephalus. At the same time, over 20% of patients who underwent bypass surgery note significant improvement states. Mortality in this type of surgical treatment ranges from 6%.

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

The daily life of a person is so diverse and filled with many events that contributes to overwork, lack of sleep, stressful experiences or high blood pressure. Often this causes headaches. Such phenomena are not uncommon and pass quickly, unless it is, of course, hydrocephalus.

The human brain is a system. Constantly in need of circulating fluid (liquor), necessary to perform many important functions. The central nervous system contains about 160 milliliters of this fluid, which is much less than the volume of blood.

During the day, liquor is produced within 0.6 milliliters. In this case, it should be absorbed about venous sinuses hard shell of the brain. If the balance is disturbed, one can observe the development of hydrocephalus, or dropsy in another way.

IN modern medicine this pathology represents independent disease, as a result of which the accumulated cerebrospinal fluid begins to progress. As a result, there is a violation of its movement along the liquor pathways.

The most common and main causes that provoke hydrocephalus include the following diseases:

Classification and characteristic symptoms

Depending on the time of occurrence, hydrocephalus is divided into:

congenital - diagnosis is possible even in the period of intrauterine development;
acquired - occurs as a result of traumatic brain injuries or inflammatory processes that directly affect the brain.

According to the features of development, pathology has the following types:

Depending on the location of the cerebrospinal fluid, dropsy of the brain is divided into:

moderate internal - the formation of fluid occurs in the ventricular space;
moderately expressed - can proceed as an independent disease or act as a symptom of some other pathology;
moderate external - localization of excess liquor falls on the subarachnoid space;
mixed replacement - the formation of cerebrospinal fluid is observed not only in the space of the ventricle, but also in the area under the membranes of the brain;
replacement external - occurs in newborns, the localization site falls on the frontal lobe;
external expressed - one of the types of dropsy of the external form.

According to the degree of development of the disease, it is classified into such forms as:

It should be noted that the development of hydrocephalus can be acute and chronic. This determines the main symptomatology of the pathology.

Dropsy of an acute form has everything standard features that accompanies high intracranial pressure:

severe headaches in the morning;
stagnation of the optic discs, which is associated with impaired current in the nerves, provoking high blood pressure leading to visual impairment;
axial dislocation of the brain - is expressed by loss of consciousness, the head acquires a forced position, oculomotor disorders occur; cases of oppressed work of the heart and organs are not excluded respiratory system, which leads to death;
attacks of nausea and vomiting in the morning, after which his headaches subside;
drowsiness is one of the dangerous signs, indicating possible development more serious neurological disorder.

At chronic form hydrocephalus symptoms are significantly different from acute and are expressed in the following manifestations:

Apraxia of walking. This syndrome is characterized by such a condition when the patient in the supine position easily shows how to walk or ride a bicycle correctly, but when he tries to walk, he cannot do it normally. When moving, the legs are widely spaced, swaying and shuffling occurs;
Dementia. In most cases, the first signs of the presence of the disease begin to appear 15-20 days after the injury, the formation of meningitis or some other disease: the patient has confusion between day and night; activity decreases; there is indifference, lack of initiative to everything that happens; memory worsens, primarily numerical, when the patient cannot even name his age; more late stage has the likelihood of developing mnestic-intellectual disorders;
Urinary incontinence. This symptom may not appear in all cases.

Changes in the fundus is not observed.

Diagnostic methods

Among the most effective studies in the diagnosis of dropsy of the brain, there are computed tomography(CT) and magnetic resonance imaging (MRI). These methods contribute to the determination of the shapes and sizes of the ventricles, cisterns of the brain and subarachnoid space.

To determine the direction of the flow of CSF and clarify the type of disease, radiography of the cisterns of the base of the brain is used.

In some cases, a trial lumbar puncture may be prescribed, as a result of which about 50 milliliters of fluid is excreted, which helps to temporarily improve the condition. This is due to the fact that there is a restoration of blood supply to ischemic tissues against the background of reduced pressure. This is a fairly favorable prognosis for surgical treatment.

It is important, however, to remember that a contraindication to lumbar puncture is an acute form of hydrocephalus, as this can cause the development of a dislocation syndrome.

Treatment of cerebral hydrocephalus in adults

First of all, before defining therapeutic measures it is necessary to identify the root cause of the development of hydrocephalus of the brain. In the pathology of a tumor character, first of all, the tumor formation itself is eliminated. Choosing the type of treatment, the specialist should be based on indications such as:

stage of development of the disease;
pathogenesis;
age category of the patient;
CSF pressure level and many others.

If the disease is in initial stage formation, it is possible to use medications. However, it must be remembered that drugs may not eliminate the pathological process, but only slow down its development.

the only effective method counts surgical intervention. A hastily performed operation and related favorable factors can lead to complete recovery and habitual way life.

Among additional methods therapies include:

physiotherapy;
massage;
microcurrent reflexology;
drug treatment.

The main task of the neurosurgical operation is to create artificial way, contributing to the removal of excess fluid in those areas where its free absorption will occur.

For these purposes, a shunting method is used, which includes three components:

venticular crater - its installation is carried out in the region of the lateral ventricles of the brain;
valve - regulates the outflow of fluid;
peripheral catheter - is installed in the area whose task is to absorb the outflow.

In modern medicine, there is also such a method as endoscopy. Its main goal is to create pathways for the outflow of cerebrospinal fluid from the ventricles to the cisterns of the brain, where fluid will be absorbed. This method, compared with shunting, has some advantages, since it eliminates the presence of foreign bodies in the body, contributes to less injury and reduces the risk of adverse effects.

For more information on how an endoscopy operation is performed for this disease, a neurosurgeon tells, watch the video:

Complications of the disease

Hydrocephalus is enough dangerous disease not to take into account the symptoms of its manifestation. Ignoring the treatment of pathology, you can provoke disability or even a threat to life.

At untimely treatment the ability to work and the significance of a person are lost. Mental disorders, problems with movement and urination, blurred vision, epileptic seizures - all this possible complications, which leads to untimely appeal for medical help.

Perhaps the greatest danger is the development of cerebral edema, characterized by a gradual loss of consciousness, which is accompanied by drowsiness, unilateral pupil dilation, fever and pyramidal insufficiency.

Chronic hydrocephalus in an adult has a more favorable prognosis with appropriate and timely treatment.

Preventive measures for pathology

Prevention to prevent the formation of dropsy of the brain includes the following recommendations:

prevent infection during pregnancy;
timely treat viral diseases that can be complicated by neuroinfections;
undergo an ultrasound screening study to detect hydrocephalus;
during childbearing, use only those drugs that are not capable of negatively affecting the fetus.

It should be remembered that a disease such as hydrocephalus of the brain is quite dangerous, capable of causing irreversible changes in the brain or even leading to death.

Only timely diagnosis of the disease and properly selected therapy can return the patient to the usual, normal way life.

In contact with

Increased accumulation of cerebrospinal fluid in the cerebrospinal fluid system of the brain. Hydrocephalus accompanies many congenital and acquired neurological diseases. Clinically, it manifests itself with 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 x-ray of the skull, ophthalmic research, Echo-EG (at infants- neurosonography), MRI or CT of the brain. Surgical treatment of hydrocephalus makes it possible to correct congenital anomalies of the CSF system, to remove intracranial formations that violate CSF circulation, and to establish an outflow of CSF from the cranial cavity.

Acquired hydrocephalus may result from inflammatory processes in the brain and its membranes (encephalitis, arachnoiditis, meningitis), traumatic brain injury, vascular disorders (ventricular hemorrhage, hemorrhagic stroke or intracerebral hematoma with a breakthrough of blood 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 the cerebrospinal fluid and its outflow from the cranial cavity.

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

Pathogenesis

Normally, CSF (cerebrospinal fluid) is produced by the choroid plexuses of the interconnected ventricles of the brain. Its largest amount is formed in the lateral ventricles, from where the cerebrospinal fluid enters the third ventricle, and from it through the sylvian water supply to 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 further surrounds the spinal cord throughout 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 bloodstream. Above etiological factors that disrupt the production, movement and absorption of CSF, 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 form. Open hydrocephalus is associated with hyperproduction of CSF or impaired absorption during normal CSF 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 CSF system of the brain.

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

According to the features of the course, hydrocephalus is classified as acute, subacute and chronic. Acute hydrocephalus is different rapid development, in which a few days after the onset of the first signs of the disease, decompensation occurs. Subacute hydrocephalus develops within a month, and chronic - more than six months.

big clinical significance has a division of hydrocephalus into stabilized (compensated) and progressive (increasing). Stabilized hydrocephalus does not build up and usually proceeds with normal pressure liquor. Progressive hydrocephalus is characterized by aggravation of symptoms, accompanied by an increase in cerebrospinal fluid pressure, poorly amenable to conservative therapy and leads to atrophy of brain tissue.

Symptoms of hydrocephalus

In adults

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

In most cases, hydrocephalus is accompanied by neurological symptoms, which are caused both by compression of the brain structures by enlarged cerebrospinal fluid spaces, and by the underlying disease that causes the development of hydrocephalus. Most often with hydrocephalus, vestibular and visual disturbances are noted. The first includes vestibular ataxia, manifested by dizziness, gait instability, tinnitus and head noise, nystagmus. On the part of vision, there may be a significant decrease in visual acuity, loss of certain parts of the visual fields, congestive optic discs; with a long course of hydrocephalus, atrophy of the optic nerves may develop.

Hydrocephalus can occur with disorders of the motor and sensory spheres: paresis and paralysis, increased tendon reflexes and muscle tone, decrease or complete loss of all types of sensitivity, the formation of spastic contractures of the limbs. Occlusive hydrocephalus, caused by a violation of the circulation of the 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 mental disorders which in adults are more often manifested by disorders of 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 compliance 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 children early age hydrocephalus is characterized by big size head, swelling of the veins of the scalp, tension and lack of pulsation of the large fontanel, swelling of the optic discs. Often there is a symptom of the "setting sun" - restriction of upward movement of the eyeballs. There may be a divergence of the sutures of the skull. Tapping on the skull is accompanied by a characteristic sound ("cracked pot" symptom). In children of the first year of life, hydrocephalus leads to developmental delays. They later begin to hold their heads, roll over, sit and walk.

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

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

Diagnostics

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

An ophthalmologist evaluates visual disturbances and the condition of the optic discs. Typically, the list ophthalmic examinations hydrocephalus includes ophthalmoscopy, determination of visual acuity and perimetry.

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

In the absence of contraindications, a lumbar puncture may be performed to identify the causative disease, followed by examination of the cerebrospinal fluid. If you suspect vascular disorders MRA of cerebral vessels is shown. congenital hydrocephalus 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 performed for acquired hydrocephalus due to inflammatory diseases, transferred TBI, hemorrhage in the ventricles. The underlying disease is treated, and diuretics (acetazolamide, furosemide) are prescribed to reduce the degree of hydrocephalus and increased intracranial pressure.

Ventriculoperitoneal shunting, lumboperitoneal shunting, external ventricular drainage. They are aimed at creating additional pathways for the outflow of cerebrospinal fluid from the cranial cavity. Bypass surgery may be performed as an adjunct to surgical treatment the underlying disease, if during the operation it is not possible to restore the normal circulation of the cerebrospinal fluid.

Hydrocephalus of the brain is a serious pathology characterized by the accumulation of cerebrospinal fluid in the head. Most often it develops in young children, but adults are no exception. Their dropsy is considered acquired, and any external signs of it are not visible.

If the disease is not detected in time, the person may even die. The effectiveness of hydrocephalus therapy depends on when it was detected. Fluid accumulates in the subarachnoid compartments, as well as the ventricular system.

General description of pathology

The human brain has a complex structure. It consists of a large number of departments, which are protected by arachnoid, hard and soft shells. The space located between the first and last shell is called "subarachnoid". These tissues are interconnected by membranes that create the ventricular system. It consists of reservoirs connected by holes and channels. It is in them that the circulation of liquor occurs. Liquor flows through the ventricles, and then goes into the cisterns, located at the base of the brain. Next, the liquid washes the surface tissues, and then absorbed into the blood.

The ventricular system of the brain and the scheme of movement of the cerebrospinal fluid in it

The cerebrospinal fluid performs several important functions:

It is a kind of shock absorber for the tissues of the brain and spinal cord, protecting them from accidental damage.
Delivers nutrients to the brain, and then removes waste from it.
Regulates the amount of blood inside the skull.

Hydrocephalus of the brain is characterized by the fact that excessive cerebrospinal fluid presses on the brain, causing disorders of its functionality. This fluid surrounds the brain and spinal cord.

Varieties of the disease

Classification of hydrocephalus is very important for prescribing proper treatment. Vodyanka is of the following types:

Internal. It is characterized by the fact that CSF accumulates directly in the ventricles. The reason for this pathological condition is a violation of the process of absorption of excess amounts of cerebrospinal fluid. Moreover, its outflow is disturbed by a thrombus or tumor that blocked the path.
External dropsy. In this case, excess fluid accumulates in the subarachnoid space, as it is not absorbed into the circulatory system. At the same time, there are no disturbances in the ventricles of the brain. This form of hydrocephalus is extremely rare. If such a diagnosis is made, this indicates atrophy of the most important organ in the human body. A very severe type of external dropsy of the brain is considered replacement hydrocephalus in adults. It is characterized by the fact that the volume of the brain decreases, and free place filled with liquor.

Mixed hydrocephalus. Here, fluid accumulates in all parts of the brain. Most often, this form of the disease develops in adults who have reached old age. mixed type is heavy enough for a person.
Moderate type of dropsy of the brain. It is characterized by the fact that any symptoms and signs may be absent for years. However, at one fine moment, the disease manifests itself very sharply and the patient's condition is rapidly deteriorating.

In addition, dropsy can be classified by origin:

Congenital. Such dropsy develops from birth and is provoked by a hereditary predisposition to impaired functioning of the brain. main reason the appearance of pathology is a malformation.
Acquired. It is more typical for adults and develops due to traumatic injury brain, as well as infectious disease. Treatment of such a pathology is faster.

And hydrocephalus can be acute, subacute or chronic.

Fayyad Akhmedovich Farhat, a neurosurgeon of the highest qualification category, doctor medical sciences, associate professor of the department operative surgery MGMSU:

Hydrocephalus of the brain: symptoms and signs

So, the presented pathology in adults in a moderate form can be asymptomatic. Signs largely depend on the age of the patient. In more difficult cases dropsy has the following symptoms:

Mixed:

Headache that doesn't go away. In the morning it is marked by greater intensity.
Nausea. It also appears most often in the morning.
Drowsiness. This suggests that hydrocephalus has already affected the brain and caused some neurological signs: impaired memory and speech.

Daytime sleepiness is a very ambiguous symptom, often indicating the presence of many disorders and pathologies. Pay attention to the main reasons

outdoor:

Nausea and vomiting.
A feeling of tiredness that is always present.
Increased sweating.

Excessive sweating is known as hyperhidrosis. It is observed in many people and can lead to disastrous consequences.

Minor vision problems.
Gait disturbance.
Changes in sexual behavior in adults.

Internal:

Strong.
Headache of high intensity.

For more information about the symptoms, see the video:

Vomiting and nausea.
Violation of visual and auditory function.

Dropsy of the brain is also accompanied by such symptoms: inability to control and coordinate movements, temporary loss of memory, increased irritability, sudden mood swings.

Hydrocephalus is also characterized by epileptic seizures, urinary incontinence, too rapid sexual development, inhibition of the function of the production of certain hormones. a serious sign hydrocephalus is confusion, impaired mental function up to the development of dementia. A person's personality can change.

The manifestations of dropsy also depend on the stage of its development. The acute form of the disease is characterized by the fact that its symptoms are similar to those of the pathology that provoked dropsy. Chronic hydrocephalus is characterized by symptoms characteristic of it.

In children, the disease manifests itself in its own way: the baby's skull increases in size, since the fibrous joints that connect the bones of the skull are still soft and not closed. As for adults, the manifestations of hydrocephalus can simultaneously speak of other serious pathologies: Alzheimer's disease, Parkinson's disease.

Dropsy of the brain in adults is often misdiagnosed, so treatment may be ineffective. This is especially true for the moderate form of pathology. It is possible to determine hydrocephalus only with the help of a thorough differential diagnosis.

Why does the disease develop?

Despite the fact that a mixed or moderate type of pathology is diagnosed in an adult, it develops due to the influence of such reasons:

Stroke.
Infectious lesions of the substance and membranes of the brain: encephalitis or meningitis.
Malignant or benign tumors that block the outflow of cerebrospinal fluid.
Head injury.

Problems with the functionality of the nervous system.
Low density of the substance of the brain.
Congenital or acquired developmental anomalies.
The presence of blood clots in the brain.
Rupture of an aneurysm or other vascular pathology.

Subarachnoid hemorrhage. This reason is considered one of the most common. It is more often diagnosed mixed form illness.
Surgical intervention.
Excessive production of cerebrospinal fluid.
Bickers-Adams syndrome.

These reasons are the most common. Naturally, they need to be known in order to be able to correctly diagnose and begin effective treatment.

Features of the diagnosis of pathology

In order to determine the cause of the development of mixed or moderate hydrocephalus, the patient needs to undergo a thorough examination, which involves the following procedures:

External examination of the patient using neurological tests.
CT or MRI. The second procedure is considered safer.
Ultrasound of the brain (three-dimensional).

You can learn more about the procedure for ultrasound of the brain in this video:

Control of intracranial pressure.
Methods of screening monitoring.
Neurosonography.

In addition to these studies, Dopplerography is used to determine the hydrocephalus of the brain - a study of the vessels of the neck and head. Put accurate diagnosis can only be a comprehensive examination using several methods.

Traditional treatment of pathology

Hydrocephalus has its own ICD code: G90. Treatment with medications is used, even if it is congenital, but has a moderate form of development. The patient is prescribed drugs that help lower intracranial pressure: Lasix, as well as diuretics.

Also, the patient may be prescribed drugs to eliminate epileptic convulsions: "Diacarb". In addition, this medicine reduces high intracranial pressure. "Diakarb" has a low cost, but is quite effective. Naturally, the remedy has its own contraindications and causes many side effects. Only a doctor can prescribe "Diakarb".

The drug "Diakarb" is available in Russian pharmacies at a price of 230-270 rubles for 30 tablets

Except medicines, useful massotherapy. These therapies for hydrocephalus will help compensate for damage in an adult, but will not cure the disease completely.

Folk remedies can also be used to combat the disease. In some cases, they help reduce the intensity of symptoms. However, like tablets, folk remedies I can not completely eliminate the pathology.

Dropsy of the brain: surgical treatment

For full recovery adult used operation. There are several types of surgical interventions:

Shunting. This method of operation is used most often. The intervention involves the introduction of special silicone catheters with valves into the cranial cavity. Through these devices, excess fluid is excreted into abdominal cavity. Shunting ensures that optimal intracranial pressure is maintained. You can not perform such an operation in the presence of vision problems, a chronic form of hydrocephalus. Bypass surgery helps an adult to return to a normal life, restore working capacity, and avoid disability. But after such an operation, there may be consequences. The disadvantage of the presented procedure is the small diameter of the shunt. The tube can quickly fail, which requires its replacement. Moreover, the procedure must be carried out immediately. In addition, the tubes may initially be infected, as well as provide too slow or too fast outflow of cerebrospinal fluid. The bypass operation lasts about 1.5 hours under general anesthesia.

Installation of an external drainage system. Hydrocephalus in adults is treated in this way only if it is impossible to get rid of excess CSF in another way. This procedure may cause maximum amount complications, for example: the patient can get a serious infection, which will further aggravate his condition.
Endoscopy. This method of treating cerebral hydrocephalus in an adult is the newest and most effective. However, its cost is quite high, because the procedure requires sophisticated technical equipment and high-class surgeon skills. But this method of treatment is the safest. During the operation, the doctor, using a neuroendoscope equipped with a microscopic video camera, penetrates into the brain canals. The entire course of the procedure is displayed on the screen with high resolution. Further, using a special catheter in right place a hole is made, and the cerebrospinal fluid flows out of the place of accumulation along a previously prepared path. Such a surgical intervention is performed only once. At the same time, it is not necessary to introduce any tubes into the body - that is, the process allows you to achieve permanent effect. However, endoscopy is not always performed.

More about the treatment of the disease surgical methods says the neurosurgeon Alexander Vyacheslavovich Pechiborsch:

Surgical treatment of cerebral hydrocephalus in an adult is preferable, as it allows you to partially or completely get rid of the problem. Naturally, the decision to carry out surgical intervention should be a council of doctors.

Features of nutrition and rehabilitation treatment

The fight against cerebral hydrocephalus in adults requires a review of lifestyle. In order not to aggravate the state of health of the patient, it is necessary to adjust the diet of his diet. The diet provides for an improvement in the exchange of water-salt balance. Therefore, you should stop using fresh bread, fatty meat and fish, smoked products, sausages, sweets - they all contribute to fluid retention in the body.

It's better to prioritize fresh vegetables and fruits, cereals. It's best to give up fried foods. Meals are more useful for steaming. important and drinking regimen. For example, to improve the removal of excess fluid from the body, folk remedies with a diuretic effect are used: decoctions of parsley and oregano.

During the recovery period, it is necessary to protect the patient from possible postoperative infection, head blows, too much activity and other problems.

Disease prognosis

If signs of hydrocephalus are not detected in time, the consequences can be sad. Moreover, disability is not the worst thing that can happen to a patient. So, the consequences of the pathology are as follows:

Risk of improper physical and mental development.
Problems with the work of the nervous system.

Disruption of the nervous system affects the body much more seriously than it seems. To understand the full scale of the problem, just look at what functions lie on the central nervous system

Violation of mental function.
Disability.

These consequences are possible if treatment was not started on time. Timely therapy can significantly improve the quality of life of the patient, restore his working capacity. That is, the prognosis is positive in the case of high-quality work of doctors.

How to prevent disease?

Hydrocephalus in some cases can be fatal, so its treatment is mandatory. However, pathology can be prevented. To do this, you need to follow the following preventive measures:

Even during pregnancy, a woman is obliged to strictly follow all the prescriptions of doctors.
An adult should treat any infectious pathologies capable of provoking the development of hydrocephalus.
It is better to avoid injury to the head, which can also trigger the mechanism for the development of the disease.
It is also important to be careful and Everyday life(avoid falling and hitting). And this rule applies to both children and adults.

We hope that today's article has given you an idea of what hydrocephalus is, how it develops and is treated. This information will help to notice the signs of the disease in time and, having started therapy, to avoid any complications.