Cerebral hydrocephalus symptoms. Symptoms and treatment of hydrocephalus in adults. External or open hydrocephalus

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

The disease differs significantly from the manifestations of the disease in the adult population due to the fact that the brain is still being formed in the child's body. In this article, we will look at the causes, symptoms and treatment of cerebral hydrocephalus in adults.

Causes

Each person has special spaces in the brain that contain a special fluid - cerebrospinal fluid. Inside the brain itself is a system of cerebral ventricles communicating with each other, outside the brain is a subarachnoid space with brain cisterns. CSF performs very important functions: it protects the brain from shocks, shocks and infectious agents (the latter thanks to the antibodies contained in it), nourishes the brain, participates in the regulation of blood circulation in the confined space of the brain and skull, provides homeostasis due to optimal intracranial pressure.

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

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

Thus, the cerebrospinal fluid produced in the vascular plexus inside the brain washes it from all sides and then is absorbed into the venous system, this process is continuous. This is the normal circulation, the amount of liquid produced per day is equal to the absorbed. If at any stage there are "problems" - either with products or with absorption, then hydrocephalus occurs.

Hydrocephalus can be caused by:

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

Types of hydrocephalus

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

Depending on the development mechanism, there are:

closed (occlusive, non-communicating) hydrocephalus - when the cause is a violation of the cerebrospinal fluid flow due to the overlap (block) of the cerebrospinal fluid pathways. More often, a blood clot (due to intraventricular hemorrhage), part of a tumor, or adhesion interferes with the normal flow of cerebrospinal fluid;
open (communicating, disresorptive) hydrocephalus - the basis is a violation of absorption into the venous system of the brain at the level of arachnoid villi, cells, pachyon granulations, venous sinuses;
hypersecretory hydrocephalus - with excessive production of cerebrospinal fluid by the choroid plexuses of the ventricles;
external (mixed, ex vacuo) hydrocephalus - when the content of cerebrospinal fluid is increased both in the ventricles of the brain and in the subarachnoid space. V last years this form was no longer attributed to hydrocephalus, since the reason for the increase in cerebrospinal fluid content is atrophy of the brain tissue and a decrease in the brain itself, and not in a violation of the circulation of cerebrospinal fluid.

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

hypertensive - with an increase in cerebrospinal fluid pressure;
normotensive - at normal pressure;
hypotensive - with reduced cerebrospinal fluid pressure.

By the time of occurrence, there are:

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

Symptoms

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

In acute and subacute occlusive hydrocephalus, a person complains of a headache, more pronounced in the morning (especially after sleep), accompanied by nausea and sometimes vomiting, bringing relief. There is a feeling of pressure on the eyeballs from the inside, there is a burning sensation, "sand" in the eyes, the pain is bursting. Possible injection of vessels of the sclera.

As the pressure of the cerebrospinal fluid increases, drowsiness joins, which serves as a poor prognostic sign, since it indicates an increase in symptoms and threatens with loss of consciousness.
Possible deterioration of vision, a feeling of "fog" before the eyes. In the fundus, stagnant discs of the optic nerves are detected.
If the patient does not seek medical help in time, then the continuing increase in the content of cerebrospinal fluid and intracranial pressure will lead to the development of dislocation syndrome - a life-threatening condition. It manifests itself as a rapid depression of consciousness up to coma, paresis of the gaze upward, diverging strabismus, inhibition of reflexes. These symptoms are characteristic of the compression of the midbrain. When there is a compression of the medulla oblongata, symptoms of swallowing disorders appear, the voice changes (until loss of consciousness), and then cardiac activity and respiration are inhibited, which leads to the death of the patient.

Chronic hydrocephalus is more often associated with normal or slightly increased intracranial pressure. It develops gradually, months after the causative factor. At first, the cyclicity of sleep is disrupted, either insomnia or drowsiness appears. Memory worsens, lethargy and fatigue appear. General asthenization is characteristic. As the disease progresses, mnestic (cognitive) impairments worsen up to dementia in advanced cases. Patients cannot serve themselves independently and behave inadequately.

The second common symptom of chronic hydrocephalus is walking disorder. At first, the gait changes - it becomes slower, unstable. Then comes uncertainty when standing, difficulty in starting movement. In a lying or sitting position, the patient can imitate walking, cycling, but in an upright position this ability is instantly lost. The gait becomes "magnetic" - the patient seems to be glued to the floor, and, having moved from the spot, makes small shuffling steps on widely spaced legs, treading water. These changes are called "gait apraxia". Muscle tone increases, in advanced cases, muscle strength decreases, and paresis in the legs appears. Balance disorders also tend to progress to the inability to stand or sit on their own.

Patients with chronic hydrocephalus often complain of frequent urination, especially at night. Gradually, the imperative urge to urinate, requiring immediate emptying, and then urinary incontinence altogether join.

Diagnostics

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

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

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

Treatment

The initial stages of hydrocephalus can be treated with medication. For this, the following drugs are used:

to reduce intracranial pressure and remove excess fluid (provided that the outflow of cerebrospinal fluid is preserved) - diacarb (acetazolamide), mannitol and mannitol in combination with furosemide or lasix. Correction of the level of potassium in the body is mandatory with such treatment; for this, asparkam (Panangin) is used;
to improve the nutrition of the brain tissue, Cavinton (Vinpocetine), Actovegin (Solcoseryl), Gliatilin, Choline, Cortexin, Cerebrolysin, Semax, Memoplant, etc. are shown.

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

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

Chronic hydrocephalus requires CSF shunting operations. This type of surgical treatment is the withdrawal of excess cerebrospinal fluid into the natural cavities of the human body using a complex system of catheters and valves (abdominal cavity, pelvic cavity, atria, etc.): ventriculoperitoneal, ventriculoatrial, cystoperitoneal shunting. In the cavities of the body, there is an unhindered absorption of excess cerebrospinal fluid. These operations are quite traumatic, however, if performed correctly, they can achieve the recovery of patients, their labor and social rehabilitation.

To date, the less traumatic neuroendoscopic technique has come out on top among invasive methods of treatment. So far, it is more often performed abroad due to the high cost of the operation itself. This method is called as follows: endoscopic ventriculocisternostomy of the bottom of the third ventricle. The operation takes only 20 minutes. With this method of treatment, a surgical instrument with a neuroendoscope (camera) at the end is inserted into the ventricles of the brain. The camera allows you to demonstrate the image using a projector and precisely control all manipulations. An additional opening is created at the bottom of the third ventricle, which connects to the cisterns of the base of the brain, which eliminates the cause of hydrocephalus. Thus, the physiological cerebrospinal fluid between the ventricles and cisterns is restored.

Effects

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

Untimely treatment can turn into a tragedy for a person: disability and social significance. Mental impairments, problems with movement, urination disorders, decreased vision, hearing, epileptic seizures, - this is the list of possible consequences of hydrocephalus, if its treatment is not started in a timely manner. Therefore, at the slightest suspicion of hydrocephalus, it is necessary to seek qualified medical help.

TVC, program "Doctors" on the topic "Hydrocephalus"

Ivan Drozdov 02.10.2017

Hydrocephalus (dropsy of the brain) is a disease in which a large amount of cerebrospinal fluid accumulates in the parts of the brain. The cause of this condition is dysfunction of the production or outflow of cerebrospinal fluid from the structures of the brain. The disease affects children and adults. Hydrocephalus of the brain in an adult is more difficult than in a child, since the bones of the skull that have grown together in the fontanel area do not move apart and the fluid begins to press on the nearby brain tissue. Hydrocephalus quite often occurs as a complication of other pathologies affecting the nervous and vascular systems, brain structures. According to ICD 10 of hydrocephalus, in the section "Other disorders of the nervous system", a separate code G91 is highlighted, in which the types of the disease are described in paragraphs 0-9.

Hydrocephalus symptoms

Headache

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

Headache - radiating to the area of the eye sockets, disturb mainly in the morning immediately after waking up. After a short period of wakefulness, their intensity decreases.
Nausea - appears along with head pains mainly in the morning hours.
Vomiting is not associated with food, after its attack, the patient becomes easier.
Visual disturbances - a burning sensation in the eyes, the appearance of a foggy veil.
Drowsiness is a sign of a large accumulation of fluid, the rapid development of intracranial hypertension and the likelihood of a sharp appearance of a number of neurological symptoms.
Signs of displacement of brain structures relative to the axis of the brainstem are impaired oculomotor functions, unnatural head position, impaired breathing, depression of consciousness up to the development of coma.
Epileptic seizures.

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

Signs of dementia - confusion, sleep disturbance, decreased memory and thought processes, decreased ability to self-service in everyday life.
Apraxia of gait - violation of gait when walking (unsteadiness, uncertainty, unnaturally large steps), while in the supine position, the patient confidently demonstrates motor functions imitating cycling or walking.
Violation of urination and defecation - manifests itself in advanced cases in the form of urinary and fecal incontinence.
Constant muscle weakness, lethargy.
Imbalance - at a later stage, it manifests itself in the inability of the patient to move or sit on his own.

It is important to timely distinguish cerebral hydrocephalus in an adult according to the described symptoms from other pathologies and consult a doctor.

The cerebrospinal fluid produced by the vascular plexuses of the brain washes its structures and is absorbed into the venous tissues. Normally, this process occurs continuously and the amount of produced and absorbed liquid is equal. If one of the described functions is impaired, there is an excessive accumulation of cerebrospinal fluid in the brain structures, which is the main reason the occurrence of hydrocephalus.

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

Acute disturbances in the blood supply to the brain caused by thrombosis, hemorrhagic or ischemic strokes, rupture, subarachnoid or intraventricular bleeding.
Development of infections and inflammatory processes that affect the central nervous system, structures and membranes of the brain - ventriculitis, encephalitis, tuberculosis.
-, alcoholic and its other types, causing chronic hypoxia of the brain and its subsequent atrophy.
growing in the cells of the ventricles, brainstem and parastem tissues.
Intracranial injuries causing edema of brain structures and rupture of blood vessels, as well as post-traumatic complications.
Complications after surgical operations in the form of cerebral edema and compression of the cerebrospinal fluid and blood supply channels.
Rare genetic abnormalities and defects of the central nervous system are Bickers-Adams, Dandy-Walker syndromes.

In the presence of at least one of the described diseases, the patient should take into account the risk of developing hydrocephalus as a complication and, if characteristic symptoms appear, immediately report them to the treating doctor.

Varieties of hydrocephalus

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

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By the nature of origin:

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

According to indicators of intracranial pressure:

Hypotensive - the pressure of the cerebrospinal fluid is reduced.
Hypertensive - CSF pressure indicators are increased.
Normotensive - intracranial pressure is normal.

By the rate of development:

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

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

Diagnostics

It is impossible to diagnose cerebral hydrocephalus in an adult solely by visual signs or symptoms, since the disease does not manifest itself outwardly, but feeling unwell can be caused by other pathologies.

Before diagnosing hydrocephalus, the doctor prescribes a set of studies, consisting of the following techniques:

Examination by specialists - includes the collection of information about the symptoms and diseases that provoke the appearance of dropsy of the brain; conducting tests to assess the degree of damage to the structures of the brain and a decrease in its functionality.
Computed tomography - to study the size and shape of the ventricles, parts of the brain, subarachnoid space and bones of the skull, to determine their size and shape, the presence of tumors.
Magnetic resonance imaging - to identify fluid in the brain structures, to determine the shape and severity of hydrocephalus, which will make it possible to make a preliminary conclusion about the cause of the development of pathology.
X-ray or angiography using a contrast agent - to determine the state of the vessels, the degree of thinning of their walls.
Cisternography - performed to identify the form of hydrocephalus and clarify the direction of movement of the cerebrospinal fluid.
Echoencephalography - ultrasound procedure structures of the brain for the presence of pathological changes occurring in them.
Lumbar puncture - the sampling of cerebrospinal fluid is performed to determine intracranial pressure, to study its composition according to the degree of thickening and for the presence of inflammatory processes.
Ophthalmoscopy - performed as a concomitant study to identify visual disturbances and the reasons that caused them.

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

Hydrocephalus treatment

With a small and moderate accumulation of fluid in the parts of the brain, the patient is recommended drug treatment.

If the cerebrospinal fluid creates too high pressure and the patient's life is in danger, then he needs to urgently perform a surgical operation.

In hydrocephalus, it is important to reduce the pressure of the cerebrospinal fluid on the brain. To do this, in the course of treatment, the doctor prescribes the following drugs:

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

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

Bypass surgery- drainage of cerebrospinal fluid with a special tool from the structures of the brain in the body cavity, which naturally absorb fluid without hindrance. There are types of shunting:

ventriculo-peritoneal - drainage of fluid into abdominal cavity;
ventriculo-atrial - in the section of the right atrium;
ventriculo-cisternomy - in occipital part, large tank department.

Endoscopy- the liquid is removed to the outside through a special catheter inserted into the hole made in the skull.
Ventricular drainage- open operation involving the installation of an external drainage system. This type of intervention is indicated in cases where other types of operations cannot be performed. When it is performed, there is a high percentage of the risk of developing complications later.

The consequences of hydrocephalus

The prognosis of doctors when diagnosing cerebral hydrocephalus in an adult depends on the form and neglect of the disease. Identification of pathology on initial stage increases the likelihood of maintaining efficiency, as well as self-orientation of the patient in everyday life and society. To do this, at the first symptoms of the disease, you need to see a doctor, be regularly examined, and also undergo the recommended courses of treatment and rehabilitation.

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

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

In the presence of the described complications and their strong severity, the patient is assigned a disability, the group of which depends on how much he can independently navigate in society and everyday life.

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

The content of the article

Cerebral hydrocephalus

The name of this disease is derived from two Greek words, hyd? R and kephal? - water and head, respectively. Given this fact, most neurologists prefer to call the disease hydrocephalus, omitting the specification of its localization. Ordinary people, as a rule, call the disease dropsy of the brain.

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

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

Liquor

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

Types of hydrocephalus

Depending on the mechanism, violation of cerebrospinal fluid formation or cerebrospinal fluid circulation the following types of hydrocephalus are distinguished:

open (matching)
closed (occlusal, not matching)

In turn, open hydrocephalus, in which the circulation of cerebrospinal fluid to the ventricular system occurs normally, can be resorptive (due to a decrease in the absorption of cerebrospinal fluid) and hypersecretory (due to increased production of cerebrospinal fluid by the vascular plexuses of the ventricles of the brain). The latter is quite rare, mainly with tumors of the choroid plexus, hypervitaminosis A. Occlusive hydrocephalus occurs when outflow disorders at the level of the interventricular opening, third ventricle, cerebral aqueduct, median and lateral openings of the fourth ventricle, cerebellar cisterna.

At the place of accumulation of fluid, hydrocephalus is divided into external and internal... With external hydrocephalus, excessive accumulation of fluid occurs mainly in the subarachnoid spaces, and with internal hydrocephalus, in the ventricles of the brain.

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

By the time of occurrence, hydrocephalus is distinguished congenital(which develops even before birth or from the moment of birth) and acquired... Congenital hydrocephalus occurs due to abnormal development of the brain with narrowing or overlapping of cerebrospinal fluid, infection during pregnancy (tonsillitis, flu, toxoplasmosis, pneumonia, etc.), intoxication, trauma or physical overload. Congenital also includes hydrocephalus resulting from birth injury with intracranial hemorrhage or fetal asphyxia. Acquired hydrocephalus develops as a result of brain injury, with brain tumors, inflammatory processes of the meninges (meningitis, arachnoiditis).

Internal hydrocephalus

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

There are no features of the manifestation of this form of hydrocephalus - the symptoms persist within the general complex. The external manifestations of the disease (manifested in most cases in children), as well as the spectrum of sensations characteristic of the disease, do not have pronounced differences. But on the methods of treatment, each form of the disease affects in its own way, since one of the main goals of the doctor is to remove the maximum amount of fluid from the patient's skull (medication or with the help of surgery) to ensure that intracranial pressure is reduced to an optimal level.

External hydrocephalus

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

The external form is much less common. One of the varieties of external dropsy is external replacement hydrocephalus, which occurs most often in people suffering from cardiovascular pathology. vascular system(in particular, arterial hypertension), osteochondrosis in the cervical spine, or once experienced TBI.

Like the internal form of the disease, external hydrocephalus may not manifest itself for a long time, delivering only minimal discomfort. This fact leads to a delay in the initiation of treatment and reduces the patient's chances of a full recovery. Therefore, the disease is often called "insidious".

Hydrocephalus clinic

The clinical signs of hydrocephalus differ significantly in infants, toddlers, and adults. Progressive hydrocephalus in infants is manifested by a change in the size and shape of the head. The increase in size occurs mainly in the sagittal direction, as a result of which the frontal bone protrudes above the relatively small facial skeleton. The bones of the skull are refined, the edges of the bones diverge with the formation of significant gaps, especially along the lines of the coronal and sagittal sutures. The anterior and posterior fontanelles are tense. Since the facial skeleton is significantly behind in growth, the face acquires a triangular shape and, in comparison with a large spherical head, seems small, senile, pale and wrinkled. The skin on the head is thin and atrophic, there is a compensatory expansion of the cutaneous veins of the head, an increase in their number.

When hydrocephalus develops in children over a year old, then this is manifested by the progressive expansion of the cranial sutures, with percussion of the skull, a characteristic sound of "a pot that cracked" appears.

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

Have newborns and babies of age, there is a fixed displacement of the eyeballs downward (a symptom of the setting sun), a decrease in acuity and narrowing of the visual fields may develop before the onset of blindness. Often the function of the abducens nerve is impaired, which leads to converging strabismus, and movement disorders in the form of paresis, sometimes combined with hyperkinesis. Cerebellar disorders cause impairment of statics and coordination of movements. There can be a significant lag in intellectual and physical development, often there is increased excitability, irritability or lethargy, weakness, apathy.

Emergence hydrocephalus in older age groups, as a rule, is a consequence of severe organic lesions of the nervous system and is manifested by a syndrome of increasing intracranial hypertension. Appears headache, which bothers mainly in the morning, nausea, vomiting at the peak of headache, suppression of the function of the cerebral cortex (memory disorders, torn thinking, impaired consciousness of varying degrees), edema of the optic nerve discs with a tendency to rapid progression of secondary atrophy of these nerves with a decrease in acuity and narrowing visual fields, corresponding changes in the bones of the cranial vault and sella turcica.

Symptoms of an occlusive attack associated mainly with a delay in the outflow of cerebrospinal fluid from the ventricular system, rapidly progressing. This leads to an increase in intraventricular pressure and compression of the brainstem. The clinic of an occlusive attack is especially striking when there are violations of the cerebrospinal fluid in the lower parts of the IV ventricle, when, due to the increasing volume of the cerebrospinal fluid, the bottom of the rhomboid fossa experiences the greatest pressure and midbrain... At the same time, there is a sharp headache, nausea, vomiting, forced position of the head, motor activity combined with general lethargy, impaired consciousness, an increase in oculomotor disorders, increased nystagmus, autonomic disorders in the form of profuse sweating, facial hyperemia or severe pallor, bradycardia, arrhythmia, increased pyramidal disorders, sometimes tonic convulsions, an increase in the frequency of breathing with a violation of its rhythm up to a stop. The presence of stem symptoms is one of the most important signs occlusive attack.

Focal neurological symptoms depend on the nature and location of the main pathological process and the level of occlusion. Two syndromes are more often observed:

with occlusion at the level of the sylvian aqueduct - a syndrome of damage to the midbrain (violation of the gaze along the vertical axis, disorders pupillary reflex, ptosis, spontaneous converging nystagmus, hearing disorders).
With occlusion at the level of the IV ventricle - symptoms of damage to the cerebellum and brain stem.

Diagnostics of the hydrocephalus

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

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

Age features of hydrocephalus

Most often, this disease occurs in newborn children, however, quite adults can find symptoms of this serious disease in themselves. As a rule, this condition is acquired in nature and is a consequence of past illnesses or pathologies present. In particular, changes occurring in the body under the influence of sustained high blood pressure in the network of arteries, as well as during the atherosclerotic process. The normal flow of the cerebrospinal fluid can also be disrupted due to the formation and growth of various kinds of tumors, which exert pressure on various parts of the brain. Dangerous from the point of view of the possibility of the occurrence of hydrocephalus are also injuries and neuroinfections, accompanied by an inflammatory process, disorders of normal blood circulation.

Scientists in the field of medicine have proven that any type of effect on the brain is potentially dangerous, as a result of which its integrity and functionality can be violated. This also applies to internal processes leading to damage to the tissues of the organ.

Hydrocephalus of the brain in adults is treated exclusively under the vigilant supervision of a specialist in the field of medicine. Immediately after a thorough diagnosis, medications are taken to reduce the pressure in the patient's cranium. In critical cases, the fluid is removed by surgery. The main goal of the medical staff is to ensure the normal flow of fluid, that is, to eliminate the cause of its violation.

Needless to say that early diagnosis allows doctors to minimize possible harmful effects on the organ and the body as a whole, increasing the patient's chances of staying alive and maintaining health.

Hydrocephalus in adults

It appears hydrocephalus in adults in the form of a complex of symptoms characteristic of increased intracranial pressure, which appears due to the accumulation of cerebrospinal fluid. With regard to adults, as well as older children, the extensive list of symptoms includes a severe headache that does not subside under the influence of various analgesics, a feeling of pressure in eyeballs, nausea and vomiting. As the disease progresses, the symptoms may expand, but at first the listed symptoms may appear periodically, increase gradually.

Often, dropsy manifests itself in symptoms of a neurological nature, which is explained by the compression of the brain structure with the expansion of the cerebrospinal fluid, as well as the effect of the underlying disease that led to hydrocephalus. As a rule, we are talking about violations of the vestibular apparatus, as well as the perception of visual signals up to nerve atrophy.

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

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

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

Hydrocephalus in children

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

The skull begins to grow under the pressure of the cerebrospinal fluid and as a result of the body's desire to reduce intracranial pressure. Growth can appear both on both sides of the cranium, and on one of them. As the disease progresses and the skull grows, head movement becomes more difficult and subsequently movement in general. Often this symptom accompanied by a complex of others - protrusion of veins, edema of the optic nerve discs, tension in the region of the large fontanelle. Even on early stages the doctor may suggest hydrocephalus based on the setting sun syndrome in children.

The symptomatology of dropsy of the brain in children partially repeats the complex of symptoms in an adult. In particular, changes in muscle tone, partial or complete loss of vision and sensitivity, neurological disorders and psychological disorders may be present. Unlike adults, children very rarely demonstrate disorders of the emotional-volitional sphere - in this case, backwardness in intellectual and physical development is manifested. Due to low mobility, sick children quickly gain weight and become obese. The psychological picture shows apathy, lack of initiative and strong attachment to loved ones and relatives.

The causes of the disease, as a rule, are congenital pathology at an early age or infection during adolescence. Diagnosis and treatment are similar to those for adult patients and are individualized.

Hydrocephalus in newborns

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

The cause of this pathology in a child may be a defect in the vascular system, various defects in the development and formation of the central nervous system (hernia, aneurysm or cyst in the skull region), breakage or aberration in the set of chromosomes. Less often, such consequences occur as a result of the formation of formations in the brain of an unborn child. Harmful to the fetus there may be infections that have ever been transferred or have not yet been eliminated from the mother's body. Even a completely harmless infection like ARVI can critically increase the likelihood of developing hydrocephalus. It is extremely rare that there are cases in which the disease was provoked by a fetal injury.

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

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

Hydrocephalus treatment

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

Mostly hydrocephalus is treated with surgery. Regardless of the pathogenetic features of hydrocephalus, the main goal of surgical interventions is to create conditions that ensure the drainage of excess cerebrospinal fluid from the cerebrospinal fluid spaces and maintain the cerebrospinal fluid pressure at a normal level. To ensure this goal, the following are carried out:

Operations aimed at draining cerebrospinal fluid by creating detours ( different kinds liquor shunting operations).
Actions aimed at eliminating the occlusion of the cerebrospinal fluid (removal of tumors, squeezing, or blocking various parts of the cerebrospinal fluid, dissection of the cerebellar worm with occlusion at the level of the Magendie opening, as well as perforation of the final plate and puncture of the corpus callosum).

The effectiveness of hydrocephalus treatment It has improved qualitatively with the introduction of various valve drainage systems into practice, they are implanted into the body (Denver, Poodens, Holtara, Hakidoa, etc.) ... The system consists of a central catheter through which cerebral fluid flows from the cerebral ventricle, a unidirectional valve device with a pump, and a peripheral drainage catheter. The valve assemblies are available in various modifications for three modes: low cerebrospinal fluid pressure (15-49 mm water column), middle(50-99 mm water column) and high(100-150 mm of water column) pressure. The device allows fluid to pass through the valve when the pressure in the central catheter exceeds a specified value. When the pressure drops, the valve "closes". The choice of the pressure mode is selected depending on the patient's age, type of hydrocephalus and characteristics clinical course... The pump is designed for artificial rapid discharge of fluid and to control the permeability of the liquid shunting system itself. The pump works by pressing it through the skin. Liquor shunt systems are made from inert materials, mainly from silicone or silastic, which do not cause allergization, rejection by the body, provide long-term drainage of the cerebrospinal fluid, are elastic, durable and do not change their properties for a long time.
Often, with liquor shunting operations, they use:

Ventriculoperitoneal shunting
Ventriculocardiac bypass
Lumboperitoneostomy
Ventriculocisternostomy

In case of occlusion at the level of the interventricular foramen or the third ventricle, bilateral bypass is performed, since lateral ventricles may be disunited.

Hydrocephalus treatment results

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

Sometimes inflammatory complications can be eliminated with anti-inflammatory therapy. In the absence of effective treatment, the shunt system must be removed.

Another complication when using liquor shunt systems is their clogging. The latter can arise at any level. The central catheter can be blocked by proteins in the cerebrospinal fluid, brain tissue or choroid plexus. The distal catheter in the abdominal cavity can become clogged by the peritoneum, intestines, and fibrin deposits.

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

Long-term consequences of surgical treatment of hydrocephalus of various origins with the use of cerebrospinal fluid shunting systems depend, first of all, on the degree of their severity, i.e., the degree of disturbance in the structure and function of various parts of the brain. With the relative intactness of the cerebral mantle (tissue large hemispheres) more than 2-3 cm, you can predict the normal physical and mental development of the child (Yu. A. Orlov, 1996). Even maintaining this size to 1 cm often makes it possible to compensate for the corresponding deficiency in more than 70% of patients (considering that in most people no more than 12-15% of the cerebral cortex is functioning).

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

Hydrocephalus of the brain in adults is a disease that can occur as a complication of various diseases of the brain, such as stroke, traumatic brain injury, tumor, hemorrhage, infectious process, meningitis.

And also as an independent nosological form in which there is active process accumulation of cerebrospinal fluid in the cerebrospinal fluid spaces. Clinical symptoms and the manifestations of the disease depend on the causes and forms of hydrocephalus in adults:

CSF circulation disorders - occlusive hydrocephalus, proximal and distal forms
disorders of its absorption - disresorptive and nonresorptive forms
violations of its production - a hypersecretory form in which the ventricles of the brain increase

Today, hydrocephalus in adults does not have clear diagnostic boundaries.

That is why today there are no clear criteria for the diagnosis of hydrocephalus in adults in non-specialized clinics and hospitals (although it is enough to do Rheoencephalography and echo-encephalography). And often patients after injuries and strokes under the guise of other diseases are unsuccessfully treated in psychiatric hospitals, neurological hospitals, polyclinics and are discharged from ordinary hospitals with a diagnosis of:

consequences of stroke
psychoorganic syndrome
consequences of traumatic brain injury
dementia of mixed genesis

However, with a specialized examination of patients in neurosurgical hospitals, in the population over 18 years of age, hydrocephalic syndrome is found in 25% of adult patients. But timely, competent, adequate diagnosis of hydrocephalus in adults with correct surgical treatment allows almost 100% of cases to achieve recovery of patients, to help them in social rehabilitation. After operations performed by highly qualified specialists, most patients can return to their previous work, some with incomplete work adaptation after surgical operations can do without outside help, returning to a fulfilling life.

Especially relevant modern methods external drainage and the introduction of thrombolytics into the ventricles of the brain, which can reduce deaths in acute forms hydrocephalus arising from non-traumatic subarachnoid hemorrhages. Since a person, at the onset of such a disease, dies within 2 days, and the provision of emergency surgical care saves his life and stabilizes the patient's condition for a long time.

The reasons for its occurrence

To date, it has been established that almost any disorders, pathology of the central nervous system can contribute to such a complication as hydrocephalus. The most common, main diseases in which hydrocephalus can form:

Ischemic or hemorrhagic stroke - acute disorders cerebral circulation.
Oncological diseases - brain tumors, more often intraventricular, stem, parastem localization.
Encephalopathy of various origins - post-traumatic, chronic hypoxic conditions, alcoholism.
Infectious, inflammatory diseases CNS - tuberculosis, meningitis, encephalitis, ventriculitis.
Traumatic or non-traumatic intraventricular, subarachnoid hemorrhages arising from rupture.

Internal and external hydrocephalus in adults

There are many different classifications hydrocephalus, the main of which is congenital or acquired hydrocephalus. Hydrocephalus of the brain in adults is an acquired type of hydrocephalus, which in turn is subdivided into 3 types by pathogenesis. Previously, there was also a fourth form, mixed, external hydrocephalus, which is manifested by an increase in the subarachnoid space and ventricles of the brain with progressive brain atrophy.

However, now such a process is not considered hydrocephalus, but is referred to as brain atrophy, since with external hydrocephalus in adults, the expansion of the subarachnoid space and an increase in the ventricles of the brain are not caused by excessive accumulation of CSF, impaired circulation, processes of its production, resorption, but is a consequence of atrophy of the brain tissue, a decrease in its mass. Classification of hydrocephalus in adults:

By pathogenesis	Open - communicating, disresorptive hydrocephalus. In this case, the processes of resorption of cerebrospinal fluid are disrupted due to damage to the venous sinuses, cells, arachnoid villi, pachyon granulations, while the absorption of CSF into the venous bed is impaired. Closed - occlusive, non-communicating hydrocephalus, in this case, a change in CSF flow occurs due to the closure of the CSF pathways after an inflammatory adhesion process, due to a tumor or blood clots. Hypersecretory hydrocephalus, it appears due to excess production of cerebrospinal fluid.
By the level of cerebrospinal fluid pressure	Hypotensive Hypertensive Normotensive
By the rate of flow	Chronic hydrocephalus, the duration of which is from 21 days to six months or more. Subacute progressive hydrocephalus, which lasts for a month. Acute hydrocephalus, in which the time from the onset of the first signs and symptoms of hydrocephalus in an adult to the onset of gross decompensation is no more than 3 days.

Symptoms, signs of hydrocephalus

Acute hydrocephalus

With acutely developing occlusive hydrocephalus in adults, the symptoms are due to signs of increased intracranial pressure:

Headache - especially pronounced in the morning upon awakening, which is explained by an additional increase in intracranial pressure during sleep.

Nausea and vomiting - also observed in the morning hours, after vomiting, headache relief sometimes occurs.

Drowsiness is one of the most dangerous signs of increased intracranial pressure, if drowsiness occurs, then a rapid, rather sharp deterioration of neurological symptoms is approaching.

Symptoms of axial dislocation of the brain- rapid depression of the patient's consciousness up to deep coma, while the patient takes a forced position of the head, oculomotor disorders appear. If compression of the medulla oblongata occurs, then signs of hydrocephalus are manifested by inhibition of cardiovascular activity and respiration, which can be fatal.

Stagnation of the optic nerve discs- violation of axoplasmic current in optic nerve and an increase in pressure in the subarachnoid space around him, leads to.

Chronic hydrocephalus

If chronic hydrocephalus develops, then the symptoms clinical picture significantly different from acute hydrocephalus in adults:

Dementia - most often the first symptoms, signs of cerebral hydrocephalus in adults occur 15-20 days after injury, hemorrhage, meningitis or other disease:

A person confuses day with night, that is, during the day he experiences drowsiness, and insomnia at night.
Decrease in the general activity of the patient, he becomes inert, indifferent, indifferent, lack of initiative.
Memory is impaired - first of all, this is a decrease in short-term numerical memory, while a person incorrectly names the month, date, forgets his age.
In the late advanced stages of the disease, gross mnestic-intellectual disorders may develop, when a person is not able to serve himself, he may not answer or answer in monosyllables, inadequate, think for a long time, pause between words to the questions that are asked to him.

Apraxia of walking is a syndrome when a person in a prone position can easily show how to walk or ride a bicycle, and when he gets up, he cannot walk normally, walks with his legs apart, sways, shuffles.

Urinary incontinence may not always be present and is a late and intermittent sign of hydrocephalus in adults.

Fundus changes are usually absent.

Types of diagnostic studies of the brain in adults

Computed tomography is a fairly accurate diagnosis of the contours of the brain, ventricles, skull and subarachnoid space., Is performed to determine the shape and size of the ventricles, to determine anomalies - cysts, tumors.
Magnetic resonance - according to MRI data, you can determine the severity and form of hydrocephalus. These studies are indispensable for clarifying the causes of dropsy.
Cisternography or radiography of the cisternae of the base of the skull - it is used to clarify the type of hydrocephalus and determine the direction of the cerebrospinal fluid.
X-ray blood vessels or angiography - after the introduction of a contrast agent into the arteries, abnormalities at the level of blood vessels are detected.
Neuropsychological examination - taking the patient's anamnesis, interviewing the patient, which reveals the presence of disorders, abnormalities in the functioning of the brain.
Echoencephalography.

Treatment of acute and chronic hydrocephalus

Diuretics are osmotic (urea and lures, glimarite). Saluretics - diacarb, acetazolamide (Carbonic anhydrase inhibitors), ethacrynic acid, furosemide (Loop diuretics)
Plasma substitute solutions (20% albumin solution).
Vasoactive drugs - magnesium sulfate (25% solution), venotonics (troxevasin, glivenol).
Glucocorticosteroids (dexamethasone, prednisolone, methylprednisolone, betamethasone).
Painkillers - NSAIDs (nimesil, nimesulide, ketonal, ketoprofen), anti-migraine (treximed).
Barbiturates (phenobarbital, nembutal, amytal).

If the patient has Clinical signs diseases, non-surgical, conservative treatment of cerebral hydrocephalus in adults is ineffective. For the treatment of acute hydrocephalus, which occurs most often with intraventricular hemorrhage, this is a formidable complication that requires urgent neurosurgical intervention.

Surgery

Today, medical technologies in the field of treatment of neurological diseases in developed countries make it possible to use low-traumatic and quickly performed operations by the method of neuroendoscopic surgery. In Russia, this method has not yet found widespread use (in regions remote from Moscow and St. Petersburg) due to the lack of qualified specialists and very expensive equipment. In Western countries, these operations are widespread.

The essence of the method is that a special instrument with a neuroendoscope (camera) at the end is inserted into the cerebral canals. Therefore, doctors can watch the entire operation on a large screen. At the bottom of the 3rd ventricle, a hole is made with a special catheter (into which the cerebrospinal fluid flows), which connects to the extracerebral cisterns. By creating such a hole, the threat to the patient's life disappears. Neurosurgeons perform different types of bypass surgery:

ventriculo-atrial shunting - with the right atrium, as well as with the superior vena cava, the ventricles of the brain are connected;
ventriculo-peritoneal shunting - the cerebrospinal fluid is sent to the abdominal cavity;
ventriculo-cisternostomy - into the greater occipital cistern;
atypical shunting operations - to other cavities.

Such operations last 1-2 hours, the patient spends 2-3 days in the hospital. For the production of such liquor shunting systems, silicone is used - an inert material that is safe for the body. With an increase in intracranial pressure above normal, these systems remove cerebrospinal fluid into the cavity (abdominal cavity or into the occipital cistern, etc.).

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

The outcome of this disease is dangerous, because if you are late with the start of therapy, then the consequences can be irreparable.

Stable pressure, as a rule, becomes the cause of malfunction of the GM and deformation of the skull. Dementia is often the result of this disease.

Death is not so rare, which is why it poses a great danger to human health.

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

Therefore, the timely correct conclusion of the doctor and the beginning of therapy can serve as a speedy recovery and return to one's own ordinary life... But it is worth remembering that taking medications is ineffective, so you should not refuse operations if it is really necessary.

Types of hydrocephalus

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

Closed (not communicating). This form of the disease is related to the disorganization of the process of outflow of cerebrospinal fluid due to the overlap of the descending pathways. The cause of such a violation, as a rule, becomes a neoplasm or a thrombus that remained after the inflammatory process.
Communicating or open form. In this case, it is customary to consider the malfunctioning of the processes of absorption of cerebrospinal fluid in the venous system as the root cause, since certain structures are disturbed.
Hypersecretory form. This is a form of the disease, as a result of which more cerebrospinal fluid is produced than necessary, i.e. its excess.

Classification of the disease

Depending on the underlying causes of hydrocephalus, distinguish between:

congenital;
acquired hydrocephalus.

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

Birth defects that promote development hydrocephalus:

Hereditary defects due to genetics:

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

Acquired defects that promote development hydrocephalus:

Caused by infection. It is very often diagnosed in the case of communicating hydrocephalus.
Damage that appears as a result of subarachnoid hemorrhage.
Posthemorrhagic. It is the second most common underlying cause of communicating hydrocephalus.
Damage that manifests itself after hemorrhage inside the cavities of the GM. If you believe the statistics, then in 25-48% of patients developing hydrocephalus develops. Without the formation of neoplasms. Tumors, arteriovenous malformations.
Secondary. With extensive processes inside the skull.
It is accompanied by the formation of neoplasms. The disease is formed as a result of the presence of obstacles to liquor-bearing directions, which causes neoplasms in the cerebellum of the lateral cavity of the GM.
After the operation, the following is typical. Approximately 20 percent of children who have undergone extraction of tumors in the posterior part of the cranial fossa feel the need for surgery by implanting shunts.

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

intracavitary;
subarachnoid;
external hydrocephalus in adults.

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

From a clinical and functional point of view distinguish between:

stabilized hydrocephalus;
progressive;
regressive.

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

Regressive and stabilized deviations, as a rule, are compensated, therefore, surgical intervention is not an urgent need.

The reasons for the development of the disease

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

Neoplasms in the GM. Neoplasms located in the stem part of the GM and in the cavities of the GM exert a strong influence on the movement of the substance.
Inflammatory processes and damage to the body with diseases such as meningitis, encephalitis, tuberculosis, etc.
Bleeding of the vessels inside the skull. Subarachnoid and intracavitary bleeding, which are most closely associated with hydrocephalus, are important points.
Disturbances of the circulatory process in the GM are, for the most part, of an acute nature: hemorrhagic and ischemic strokes.
Encephalopathy with different sources of occurrence: alcoholic, as a result of prolonged oxygen starvation, etc.

Symptoms of the disease

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

Acute hydrocephalus

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

The emerging pains in the head - especially severe pains, the patient experiences waking up in the morning. This can be explained by the fact that pressure increases during sleep.
Nausea and vomiting - the manifestation of these symptoms is also characteristic of the morning hours. After cleansing the stomach, the pain in the head sometimes subsides.
Lethargy is one of the the most dangerous symptoms, indicating an increase in pressure inside the skull. When it occurs, most likely, a rapid, sharp progress of neurological symptoms is approaching.
Symptoms of displacement of the brain tissue relative to solid formations of the brain are the rapid suppression of the patient's consciousness up to the development of a coma, then the patient takes a forced position of the head, oculomotor disorders occur.

Chronic hydrocephalus

Signs of hydrocephalus in adults in this case:

Cognitive disorder - in most cases, symptoms in adults appear after 15-20 days after injury, bleeding of blood vessels in the GM, meningitis, or others.
The patient is confused about the time of day, that is, during the daytime he feels lethargic, and at night he cannot sleep. The patient becomes passive, indifferent to what is happening.
Memory impairment - first of all, the ability to memorize numbers deteriorates. In this case, the patient incorrectly announces the months, numbers and forgets how old he is.
In the advanced stages of the disease, intellectual disabilities may appear, as a result of which the patient cannot take care of himself, and may not answer at all or answer the questions posed, spending a lot of time, taking breaks between words.
A disorder of the walking process is a syndrome in which the patient, in a supine position, easily demonstrates how to move or ride a bicycle, but when he rises, he is not able to move normally, that is, he moves, spreading his legs wide, rolling from foot to foot.
Involuntary discharge of urine is optional and is late symptom diseases. Fundus deviations are usually absent.

Diagnostic techniques

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

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

MRI for hydrocephalus in adults photo

Healing procedures

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

Acute form

Treatment of acute hydrocephalus in adults:

in acute illness, medications are usually prescribed to lower the pressure inside the skull;
the procedure for extracting a small amount of cerebrospinal fluid by inserting a needle into the fontanel area, aims to reduce the pressure.

Sometimes during therapy it is also required surgical intervention- extraction of the root cause of the violation of the decrease in the cerebrospinal fluid or determination of other ways of excretion of the cerebrospinal fluid, for example, the removal of the substance into the abdominal cavity.

Chronic form

The treatment is surgical implantation of a shunt. The shunt removes excess cerebrospinal fluid from the GM to another part of the body, where the substance is absorbed.

Such operations are at least 85% effective.

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

The decision on how to treat hydrocephalus in adults is up to the attending physician.

Complications of the disease

Patients, subject to a timely diagnosis and undergoing therapy, may well live the rest of their lives without significant complications.

In some cases speech impairment is observed... There may be problems with the malfunction of the shunt or infection during its installation, which implies its reinstallation. In especially difficult and advanced cases with hydrocephalus in adults, disability is possible.

Forecast

The prognosis for a given disease depends on the underlying cause and the time spent on diagnosis and appropriate therapy. Some restrictions on further life are possible. V individual cases possible manifestation of a violation of the functions of the speech apparatus.

Preventive measures

The first step in preventing cerebral hydrocephalus in adults is to avoid diseases such as meningitis, polio, encephalitis, and FM trauma.

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

Video: On the causes and treatment of cerebral hydrocephalus

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