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Brain hydrocephalus in adults, types and methods of treatment

The human brain is a system that needs to circulate fluid, which performs many functions. This fluid is called cerebrospinal cerebrospinal fluid; it is produced by the special vascular plexuses of the lateral ventricles.

Just a person in the central nervous system is no more than 150 - 160 ml of this fluid, which is incomparably smaller than the volume of circulating blood.

However, during the day about 0.5 - 0.6 liters of cerebrospinal fluid is produced, which should be absorbed near the venous sinuses of the dura mater of the brain in pachyon granulations. In the event that an imbalance occurs between the production of liquor and its absorption, hydrocephalus develops (see photo).

Content

Brain hydrocephalus, what is it?

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

Brain hydrocephalus

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

  1. Occlusive hydrocephalus. There is an obstacle in the path of the liquor current - an occlusion. This may be a spike or, for example, a tumor. At the same time, the rate of production and absorption of liquor may be normal;
  2. Arezorptive and disresponsive forms. In this case, the absorption of cerebrospinal fluid (resorption) is disturbed, as a result of which it accumulates;
  3. Hypersecretory form. In this form, there is an excess production of liquor, and absorption "lags behind" in volume. As a result, cerebrospinal fluid accumulates.

Convenient classification for doctors on the duration of the disease:

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

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

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

It should be noted that all the speculations about "increasing intracranial pressure" are meaningless if there are no clear signs of this process.

The only direct way to measure this pressure was and remains staging a pressure gauge in the ventricles of the brain. Of course, for this you need to drill the bones of the skull.

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

Causes of hydrocephalus

The reasons for the occurrence of hydrocephalus, there are many, but the main factors leading to this diagnosis - or compression of any bulk education, edema, or inflammatory and adhesive process. The most common diseases and conditions of hydrocephalus in both adults and children are the following:

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

Internal and external hydrocephalus of the brain

Internal Hydrocephalus Brain

This formulation can be heard or read in interpretations of MRI - conclusions. Internal hydrocephalus is determined by the increase in ventricles and median unpaired cerebrospinal fluid routes, external hydrocephalus refers to the "circumference" and peripheral space.

Often develops mixed brain hydrocephalus. It is important that these forms belong to the open, while all the cerebrospinal fluid paths are passable, and the fluid flow is not disturbed.

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

There is also the replacement hydrocephalus of the brain in adults, in which the gray matter of the brain (that is, the cortex) is replaced by liquor that circulates in the subarachnoid space of the convexital surface of the big hemispheres.

This occurs as a result of atrophy of the cortex, and not due to hydrocephalus, that is, atrophy is the primary process. Therefore, this term is gradually becoming obsolete.

Symptoms and signs of hydrocephalus in adults

Symptoms of hydrocephalus in adults

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

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

  • Intolerable, "bursting" headache, from all sides, without clear localization. The patient has a feeling that he is “pumped in his head”. It is characterized by increased headaches in the morning and relief of well-being in the evening or in the afternoon.
  • The appearance of nausea and vomiting, in more severe cases with the development of hypertensive forms, there may be “brain vomiting” - vomiting “fountain” without any previous nausea, which becomes a complete surprise for the patient. This is due to irritation of the receptors of the bottom of the 4th ventricle, or the “rhomboid fossa”. This vomiting does not bring relief;
  • At research of an eyeground stagnant disks of optic nerves are noted;
  • In case of deterioration, drowsiness, stupor and coma occur, which can result in dislocation and swelling of the brain substance. This process is dangerous by different variants of penetration of the vital ancient centers of the brain, which are localized in the trunk and the medulla oblongata, and are responsible for respiration and blood circulation. A classic example is the insertion of the cerebellar tonsils into the large foramen. This is fatal.

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

  • Manifestation of progressive dementia;
  • Instability of gait, or paresis of the legs (the so-called peripheral lower paraparesis);
  • Urinary Disorders.

This picture can be observed in various senile disorders on the basis of chronic intoxication, for example, in deeply experienced alcoholics.

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

Patients distort wakefulness and sleep regimes, initiative and activity decrease, they become lethargic and indifferent, memory and attention begin to deteriorate, then gait disturbances appear, and in the final urinary incontinence joins, and in severe cases feces.

Diagnosis of hydrocephalus

Currently, the diagnosis is not particularly difficult. Visualization techniques (CT, MRI) allow to draw conclusions on indirect evidence. So, by MRI of the brain, hydrocephalus can be exhibited along the dilated lateral ventricles.

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

Of course, the fundus examination, echoencephalography and direct measurement of the CSF pressure, which is performed during neurosurgical operations, remain important.

Treatment of brain hydrocephalus

Treatment of brain hydrocephalus

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

  1. The use of osmotically active diuretic drugs (urea, mannitol in infusions);
  2. Diacarb is a diuretic drug that inhibits carbonic anhydrase and is used specifically with increased intracranial pressure in outpatient practice;
  3. In an inflammatory reaction (for example, in meningitis), glucocorticosteroid infusions, such as dexamethasone, help well.
  4. Symptomatically, analgesics are administered as well as barbiturates, which protect the brain tissue from hypoxia, reducing its need for oxygen.

If conservative treatment of brain hydrocephalus was unsuccessful, surgery may be required.

So, in case of acute hydrocephalus, it is required to “adjust the outflow”, which will relieve the ventricular system and reduce the pressure. To do this, carry out the installation of external ventricular drains.

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

After its decrease the valve closes. Next, a long catheter is attached, allowing the fluid to be diverted, for example, into the abdominal cavity, where it is absorbed. This type of shunting is called ventriculoperitoneal.

Prognosis and complications

Before carrying out a shunting operation, it is necessary to check whether the patient has an improvement in reducing the volume of cerebrospinal fluid. To do this, perform a lumbar puncture and take about 40 ml of cerebrospinal fluid. In the event that the patient is feeling better, it makes sense to do a bypass operation. If there is no effect, then other ways of treatment should be sought.

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

The signs that speak of the onset of this formidable complication are a gradual loss of consciousness, starting with drowsiness, as well as pupil dilation on the one hand after short-term narrowing, convulsions, fever (hyperthermia), and pyramidal insufficiency.
Therefore, such patients should be urgently hospitalized in the neurosurgery department.

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

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