Hydrocephalus is a fairly common disease that affects both adults and children, regardless of gender. But why does the disease develop and what is the reason for its appearance? Who is a hydrocephalus and what features of the appearance of a newborn baby should you pay attention to? What diagnosis is needed if such a pathology is suspected? What is the treatment for cerebral hydrocephalus in adults and children? What are the prognosis for patients?
Hydrocephalus: ICD-10, general description of the disease
The word "hydrocephalus" itself is formed by the fusion of two Greek words meaning "water" and "head". By the way, that is why the disease is often called dropsy of the brain.
Before finding out what hydrocephalus is, it is worth considering some anatomical and physiological features of the structure of the humanbody. CSF constantly circulates between the brain and spinal cord - cerebrospinal fluid in the brain, it is concentrated mainly in the ventricles (there are four in total), and also enters the subarachnoid space that separates the meninges.
Liquor performs a number of important functions. It is with this fluid that many nutrients enter the nervous tissues, and toxins and metabolic products, on the contrary, are removed from the brain. The cerebrospinal fluid also protects the nerve structures from being squeezed, stuck together and mechanically affected.
Normally, the volume of CSF in infants is about 50 ml, and in an adult - no more than 150 ml. If, for one reason or another, the cerebrospinal fluid is formed much more than necessary, or its circulation is disturbed, then hydrocephalus develops.
ICD-10 assigned the pathology code G91. Against the background of the disease, cerebrospinal fluid accumulates in the ventricles of the brain, which leads to a sharp increase in intracranial pressure. Since the skull in an adult consists of hard bones, the abundance of fluid presses directly on the nerve structures.
Causes of congenital hydrocephalus
Who is a hydrocephalus? This is a man suffering from dropsy. It should be understood that the disease can develop at any age. But as statistics show, very often hydrocephalus is congenital. So what is the reason for the appearance of dropsy of the brain in a child? The reasons may be as follows:
- congenital malformations of the system responsible for the synthesis andcirculation of cerebrospinal fluid (stenosis of the Sylvian aqueduct, abnormal structure of the subarachnoid space);
- craniovertebral anomalies;
- infections during fetal development (e.g. rubella, toxoplasmosis, cytomegaly, syphilis);
- head injury during childbirth.
Acquired dropsy: causes and risk factors
The disease can develop after the birth of a child or already in adolescence, adulthood, old age. Causes of cerebral hydrocephalus can be different.
- The accumulation of fluid is most often associated with inflammation of certain parts of the central nervous system. Dropsy is often complicated by encephalitis, meningitis, arachnoiditis.
- The list of causes includes vascular disorders, including the formation of intracerebral hematomas, ventricular hemorrhage, stroke.
- Hydrocephalus can be the result of severe traumatic brain injury.
- Cysts and intracerebral tumors often grow into the cerebral ventricles, thereby blocking the circulation of CSF.
Features of replacement hydrocephalus
Replacement (atrophic) dropsy, as a rule, develops in old age. It is isolated in a separate group, since the development of the disease is associated with age-related atrophy of nerve tissues. The brain shrinks, and the cerebrospinal fluid, in fact, simply fills the free volume of the skull.
In elderly patients, atrophic hydrocephalus may be associated with severe forms of hypertension, atherosclerosis of blood vessels carrying blood to and from the brain, macroangiopathyon the background of diabetes.
Disease classification
There are many types of hydrocephalus. For example, depending on the development mechanism, they distinguish:
- open form (there is either hypersynthesis of cerebrospinal fluid, or a violation of its absorption);
- closed (develops against the background of a violation of the outflow of cerebrospinal fluid).
The location of the CSF accumulation also matters. Stand out:
- internal dropsy (cerebrospinal fluid builds up in the ventricles);
- external (cerebrospinal fluid is concentrated in the subdural and subarachnoid spaces).
Depending on the course of hydrocephalus can be:
- acute (development is very fast; from the beginning of the accumulation of CSF to the appearance of the first symptoms of decompensation, no more than 3 days pass);
- subacute (progresses within a month);
- chronic (the disease develops slowly, the symptoms are not noticeable at first, as their intensity increases gradually; the disease develops over 6 months or longer).
Depending on the nature of development, two more types are distinguished:
- compensated (stabilized) hydrocephalus is said in the event that intracranial pressure does not reach critical limits, the flow of cerebrospinal fluid is gradually restored, the disease does not develop;
- growing (progressive) dropsy of the brain is distinguished by a sharp increase in pressure inside the skull, accompanied by atrophy of nerve tissues and is very difficult toconservative therapy (sometimes taking medication does not give any result at all).
Dropsy in adults: features of the clinical picture
The space of the cranium is limited. That is why the accumulation of cerebrospinal fluid leads to an increase in intracranial pressure - this is how very characteristic symptoms of cerebral hydrocephalus appear. Patients (adolescents and adults) complain of severe headache that cannot be controlled with analgesics. In addition, there is severe nausea, leading to vomiting attacks. Patients note a feeling of pressure on the eyeballs.
The only exception is atrophic dropsy - there are no signs of increased pressure inside the skull with this form of the disease.
Since the CSF begins to compress the structures of the brain, neurological symptoms also appear. Many patients suffer from vestibular ataxia, which is accompanied by tinnitus and dizziness. The person's gait becomes unsteady.
If the optic nerves are damaged/compressed against the background of the disease, then there is a decrease in visual acuity. In some patients, the field of view narrows significantly. If we are talking about chronic hydrocephalus, then there is a possibility of developing atrophy of the optic nerves and complete loss of vision.
Dropsy can lead to impaired tendon reflexes, muscle hypertonicity, paralysis and paresis. Some patients complain of a complete loss of skin sensitivity - they stop feeling pain,pressure, temperature, touch.
Sometimes the accumulation of cerebrospinal fluid causes mental disorders. The disease, as a rule, affects the emotional sphere: a person often changes his mood, he loses emotional stability. Sometimes causeless euphoria appears, which, however, quickly turns into deep apathy and a state of complete indifference. A sharp increase in CSF levels can lead to aggressive behavior.
Symptoms of disease in children
In newborns, the disease proceeds differently. The fact is that in a child, the bones of the skull are more flexible, pliable, and the fontanelles have not yet had time to overgrow. That is why intracranial pressure does not increase, but the shape of the child's head changes. The fontanel swells, and sometimes its pulsation can be seen with the naked eye. The veins of the scalp swell strongly, and the movements of the eyeballs are disturbed, which is associated with swelling and compression of the optic nerves. The kid is a little behind in development - later he starts to hold his head, sit, crawl, roll over.
If the treatment was not started on time, the child's head takes on a very characteristic shape. The skull of a hydrocephalus is spherical, too large. The patient's eyes are deep-set, the ears protrude, and the skin is thinning.
Who is a hydrocephalus and how does dropsy affect a child's well-being? Unlike adult patients, children rarely suffer from emotional and mental disorders - most often there is a delay in intellectual development. A small patient with such a diagnosis,usually lethargic, inactive, often obese.
Edema of the brain in a child is very rarely accompanied by psychotic attacks, epileptic seizures and hallucinations, but such a possibility should not be ruled out.
Diagnostic features
You already know who hydrocephalus is, what symptoms accompany the disease and what you need to pay attention to. If you have any doubts, it is best to see a doctor right away.
When it comes to dropsy of the brain in a child, the external signs are usually so characteristic that a specialist can make a diagnosis based on a general examination alone. But even in such cases, additional examinations are necessary, because it is important to determine the causes of development and the form of hydrocephalus.
First of all, ultrasound is performed - echoencephalography. This quick and painless procedure allows you to assess the degree of pressure increase inside the skull. Children in their first year of life are usually sent for ultrasonography - an ultrasound scan is performed through the fontanel.
The x-ray of the skull is informative - in the pictures the doctor can see the divergence of the sutures between the bones of the skull, as well as the thinning of the bone tissue itself. On the inner surface of the bones, you can see a kind of "indentation". Additionally, computed and magnetic resonance imaging of the brain is carried out - such procedures allow not only to confirm the presence of hydrocephalus, but also to determine the nature and causes of the disease,detect cysts, tumors, anatomical features.
The patient is also sent to an ophthalmologist in order for specialists to assess the condition of the optic discs, assess visual acuity and field of vision, as well as some other characteristics.
If there is reason to believe that the ailment is caused by an infection, then the patient may be referred for a lumbar puncture. This procedure is unpleasant, but it allows you to get samples of cerebrospinal fluid and check it for the presence of certain pathogens, markers. With congenital dropsy, doctors recommend PCR diagnostics. An MRI of the vessels of the brain is performed when serious vascular disorders are suspected.
Possible Complications
You already know what hydrocephalus is and what symptoms accompany the disease. This is a serious pathology, because any effect on the brain is fraught with complications. If we are talking about congenital forms of the disease, then the accumulation of cerebrospinal fluid leads to compression of the nerve tissues - the baby's brain cannot develop normally.
In addition, rapidly progressing hydrocephalus can lead to consequences such as:
- cerebral edema;
- epileptic seizures;
- cerebral hemorrhage (stroke);
- displacement and squeezing of certain parts of the brain;
- coma;
- respiratory failure.
Sometimes, the accumulation of fluid in the skull can result in the death of the patient, so in no case should you delay the start of therapy.
Acquired cerebral hydrocephalus inadult: drug treatment
Modern medicine offers patients many options for therapy. If a couple of decades ago, more than half of the patients died, today the mortality rate is about 5%.
Therapy in this case directly depends on the causes of the onset of the disease, the stage and reasons for its development. If hydrocephalus is the result of an inflammatory or infectious disease, then the patient is primarily prescribed a course of antibiotics or antiviral agents. Sometimes the amount of cerebrospinal fluid in the brain is not too large - in such a situation, excess fluid is disposed of with the help of diuretic drugs ("Furosemide", "Acetazolamide").
But, according to statistics, surgery for hydrocephalus is necessary in the vast majority of cases.
Features of the diet
Hydrocephalus of the brain - a disease that is accompanied by the accumulation of cerebrospinal fluid. That is why patients with this diagnosis are advised to follow a special diet. First of all, they need to completely exclude from the diet foods that retain fluid in the body. Potentially dangerous are s alty foods and dishes, sausages, smoked meats, fatty poultry and meat, sweets and other confectionery, white bread, spicy spices. Before buying a product, be sure to study its composition - it should not contain sodium gluconate.
You can include mild diuretic foods in your diet (e.g. lemon, oatmeal, cranberryjuice, ginger, celery, eggplant, watermelon, parsley). Diet is not a way to get rid of dropsy - it is only auxiliary.
Some folk healers recommend taking an alcohol tincture of black elderberry root, as well as a powder made from bark or buckthorn berries. But, again, such folk medicines can only be used as an adjuvant therapy, and they can only be taken with the permission of the attending physician.
Surgery
The nature of the surgical intervention depends on what caused the accumulation of cerebrospinal fluid in the brain. Perhaps, during the operation, the neurosurgeon will remove a tumor, cyst, intracranial hematoma, hide and clean the abscess, separate the adhesions that have arisen between the walls of the channels for the flow of CSF.
In the event that it is impossible to eliminate the cause of dropsy of the brain, shunting is performed. In hydrocephalus, this procedure helps to reduce intracranial pressure by creating additional pathways for the outflow of cerebrospinal fluid.
Prognosis for patients
How dangerous can hydrocephalus be? The prognosis directly depends on how quickly the disease was diagnosed and how appropriate the choice of therapy was. Very often, dropsy can, if not completely cured, then at least take control of the further progression of the disease.
How many people live with hydrocephalus and how does the disease affect a person's condition? If we are talking about a timely detected dropsy of the brain ina newborn, then there is a high probability that the baby will develop at a normal pace and live a completely normal life. Yes, there may be problems associated with the maintenance of shunts installed in the brain, but they can be solved.
If the disease was diagnosed at later stages, then complications are possible. The child's brain will not be able to develop normally, which is fraught with speech disorders and a lag in intellectual growth in the future. Sometimes damage to the central nervous system is so severe that it results in disability.
Prevention measures
If we are talking about congenital forms of the disease, then it is almost impossible to predict the likelihood of their development. Nevertheless, expectant mothers are advised to take vitamins, eat right, avoid contact with potential carriers of infectious diseases (rubella is especially dangerous in this case).
As for acquired hydrocephalus, here, too, doctors recommend avoiding the risk of catching this or that infection (syphilis). Remember that when the first symptoms of increased intracranial pressure, meningitis, encephalitis appear, you need to see a doctor as soon as possible. Any disease is much easier to treat in the early stages of development. Don't forget to have your regular medical check-ups and tests once a year (even if you don't feel well at all).
