• brain encephalopathy

  Due to some circumstances and difficult childbirth, from the moment the baby was born, I worry about not overlooking some deviations in him. I know that, for example, brain encephalopathy is very difficult to diagnose in babies. Mine is almost 5 months now. Sometimes I notice that the child does not fall asleep well and is naughty for a long time before going to bed. and sometimes for a long time he cannot focus on any subject. What examination would you recommend to undergo to rule out encephalopathy, thank you!

• hyperactive child

  What to do with a hyperactive child? Doctor, please advise what to do, I no longer have the strength to deal with a third child. The birth was difficult, almost immediately after the second pregnancy. The third child was born prematurely, but now he has more or less gained weight. And now he is almost a year old, not a minute of literally rest. He crawls, howls, if I don’t look at him or don’t work with him, he starts screaming, crying, banging his head on the floor ((They did soothing baths, massage, everything helps for a while. Such hyperactivity - is there a reason to prescribe special treatment? And you can can home methods do? thank you very much

Neurosonography (NSG) is a term applied to the study of the brain of a young child: a newborn and an infant until the fontanel is closed by ultrasound.

Neurosonography, or ultrasound of the child's brain, can be prescribed by the pediatrician of the maternity hospital, the neurologist of the children's clinic in the 1st month of life as part of the screening. In the future, according to indications, it is carried out on the 3rd month, on the 6th month and until the fontanel closes.

As a procedure, neurosonography (ultrasound) is one of the safest research methods, but it should be carried out strictly according to the doctor's prescription, because. ultrasonic waves can thermal effect on body tissue.

On the this moment no negative consequences in children from the procedure of neurosonography have been identified. The examination itself does not take much time and lasts up to 10 minutes, while it is completely painless. Timely neurosonography can save the health, and sometimes the very life of the child.

Indications for neurosonography

The reasons for requiring an ultrasound scan in the maternity hospital are varied. The main ones are:

• fetal hypoxia;
• asphyxia of newborns;
• difficult childbirth (accelerated / prolonged, with the use of obstetric aids);
• intrauterine infection of the fetus;
• birth trauma of newborns;
• infectious diseases of the mother during the gestation period;
• Rhesus conflict;
• C-section;
• examination of premature newborns;
• ultrasound detection of fetal pathology during pregnancy;
• less than 7 points on the Apgar scale in the delivery room;
• retraction / protrusion of the fontanel in newborns;
• suspected chromosomal pathology (according to a screening study during pregnancy).

Childbirth by method caesarean section, despite its prevalence, is quite traumatic for the baby. Therefore, babies with such a history are required to undergo NSG for early diagnosis. possible pathology

Indications for ultrasound examination within a month:

• suspected ICP;
• congenital Apert syndrome;
• with epileptiform activity (NSG is an additional method for diagnosing the head);
• signs of strabismus and the diagnosis of cerebral palsy;
• the girth of the head does not correspond to the norm (symptoms of hydrocephalus / dropsy of the brain);
• hyperactivity syndrome;
• injuries in the head of the child;
• lag in the development of the infant's psychomotor;
• sepsis;
• cerebral ischemia;
• infectious diseases (meningitis, encephalitis, etc.);
• rickety shape of the body and head;
• CNS disorders due to a viral infection;
• suspicion of neoplasms (cyst, tumor);
• genetic anomalies of development;
• monitoring the condition of premature babies, etc.

In addition to the main causes, which are serious pathological conditions, NSG is prescribed when the child has a fever for more than a month and has no obvious causes.

Preparation and method of conducting the study

Neurosonography does not require any preliminary preparation. The baby should not be hungry, thirsty. If the baby fell asleep, it is not necessary to wake him up, this is even welcome: it is easier to ensure the immobility of the head. The results of neurosonography are issued 1-2 minutes after the completion of the ultrasound.

You can take milk for the baby, a diaper with you to put the newborn baby on the couch. Before the NSG procedure, it is not necessary to apply creams or ointments to the fontanel area, even if there are indications for this. This worsens the contact of the sensor with the skin, and also negatively affects the visualization of the organ under study.

The procedure is no different from any ultrasound. The newborn or infant is placed on the couch, the place of skin contact with the sensor is lubricated with a special gel substance, after which the doctor performs neurosonorography.

Access to the structures of the brain during ultrasound is possible through the large fontanelle, the thin bone of the temple, the anterior and posterolateral fontanelles, as well as the large occipital foramen. In a child born at term, small lateral fontanelles are closed, but the bone is thin and permeable to ultrasound. The interpretation of neurosonography data is carried out by a qualified doctor.

Normal NSG results and interpretation

Deciphering the diagnostic results consists in describing certain structures, their symmetry and tissue echogenicity. Normally, in a child of any age, the structures of the brain should be symmetrical, homogeneous, corresponding to echogenicity. In deciphering neurosonography, the doctor describes:

• symmetry of brain structures - symmetrical / asymmetric;
• visualization of furrows and convolutions (should be clearly visualized);
• condition, shape and location of the cerebellar structures (natata);
• state of the cerebral crescent (thin hyperechoic strip);
• the presence / absence of fluid in the interhemispheric fissure (there should be no fluid);
• homogeneity/heterogeneity and symmetry/asymmetry of the ventricles;
• the state of the cerebellar plaque (tent);
• absence / presence of formations (cyst, tumor, developmental anomaly, change in the structure of the medulla, hematoma, fluid, etc.);
• the state of the vascular bundles (normally they are hyperechoic).

Table with standards for neurosonography indicators from 0 to 3 months:

Parameters	Norms for newborns	Norms at 3 months
Lateral ventricles of the brain	Anterior horns - 2-4 mm. Occipital horns - 10-15 mm. Body - up to 4 mm.	Anterior horns - up to 4 mm. Occipital horns - up to 15 mm. Body - 2-4 mm.
III ventricle	3-5 mm.	Up to 5 mm.
IV ventricle	Up to 4 mm.	Up to 4 mm.
Interhemispheric fissure	3-4 mm.	3-4 mm.
big cistern	Up to 10 mm.	Up to 6 mm.
subarachnoid space	Up to 3 mm.	Up to 3 mm.

Structures should not contain inclusions (cyst, tumor, fluid), ischemic foci, hematomas, developmental anomalies, etc. The decoding also contains the dimensions of the described brain structures. At the age of 3 months, the doctor pays more attention to the description of those indicators that should normally change.

Pathologies detected by neurosonography

According to the results of neurosonography, a specialist can identify possible developmental disorders of the baby, as well as pathological processes: neoplasms, hematomas, cysts:

1. Choroid plexus cyst (do not require intervention, asymptomatic), usually there are several. These are small bubble formations in which there is a liquid - cerebrospinal fluid. Self-absorbing.
2. Subependymal cysts. Formations containing liquid. Occur due to hemorrhage, can be pre- and postpartum. Such cysts require observation and possibly treatment, as they may increase in size (due to the failure to eliminate the causes that caused them, which may be hemorrhage or ischemia).
3. Arachnoid cyst (arachnoid membrane). They require treatment, observation by a neurologist and control. They can be located anywhere in the arachnoid membrane, they can grow, they are cavities containing liquid. Self-absorption does not occur.
4. Hydrocephalus / dropsy of the brain - a lesion, as a result of which there is an expansion of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, observation, control of NSG over the course of the disease.
5. Ischemic lesions also require mandatory therapy and control studies in dynamics with the help of NSG.
6. Hematomas of brain tissue, hemorrhages in the space of the ventricles. Diagnosed in premature babies. In term infants, this alarm symptom, require mandatory treatment, control and observation.
7. Hypertension syndrome is, in fact, an increase in intracranial pressure. It is a very alarming sign of a significant shift in the position of any hemisphere, both in premature and in term babies. This occurs under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome is associated with an excess amount of accumulated fluid (liquor) in the space of the brain.

If any pathology is detected during ultrasound, it is worth contacting special centers. This will help to get qualified advice, make a correct diagnosis and prescribe the correct treatment regimen for the child.

Shunt techniques have long lost their relevance due to frequent complications - infections and others. Sometimes operations are performed, after which excess fluid constantly drains into the abdominal cavity and area. In some cases, they resort to puncture - a puncture to remove excess cerebrospinal fluid.

As already mentioned, a common cause of the disease is concussion and trauma. Therefore, the best option for preventing moderate external hydrocephalus is to protect yourself from injury.

For pregnant women, it is important to follow the doctor's instructions and undergo all the necessary examinations. This will help to identify pathology in the child early and be ready for timely treatment.

Moderate external hydrocephalus is usually asymptomatic until discovered. serious violations in organism. Therefore, it is so important to be regularly examined by narrow specialists (or at least by a therapist).

Increased intracranial pressure is a diagnosis that almost all young parents know, since it is widely exhibited in our country, and often unreasonably, without conducting the necessary research. In fact, this pathology is based on severe diseases, one of which is hydrocephalus.

Some anatomy and physiology

Hydrocephalus (dropsy of the brain) (from the Greek "hydro" - water, "cephalon" - head) is a condition accompanied by an increase in the volume of the ventricles of the brain. In the human brain there are several cavities that communicate with each other and are filled with CSF (cerebrospinal fluid). These cavities are called ventricles. The ventricular system consists of two lateral ventricles that connect to a slit-like third ventricle (III ventricle), which, in turn, through a thin canal (Sylvius aqueduct) connects to the fourth ventricle (IV ventricle). CSF is produced in the choroid plexuses of the ventricles and moves freely from the lateral to the IV ventricle, and from it to the subarachnoid space of the brain and spinal cord (the subarachnoid (subarachnoid) space is the space between the brain and the dura mater), where it washes the outer surface of the brain. There it is reabsorbed into the bloodstream. Liquor is a clear, colorless liquid, very similar in appearance to water, contains a small amount of cells, protein and salts. In an infant, the amount of cerebrospinal fluid is about 50 ml, in a teenager and an adult - up to 120-150 ml. Liquor is constantly produced and absorbed, up to 500 ml of cerebrospinal fluid is produced per day by the vascular plexuses of the brain.

Any disturbance in the system of liquor production, liquor circulation and absorption of cerebrospinal fluid leads to its excessive accumulation in the cavities of the brain, which is called hydrocephalus, or dropsy of the brain.

Types of hydrocephalus

In cases where there is an obstacle on the way of the cerebrospinal fluid from the lateral ventricles to the exit from the IV ventricle and the cerebrospinal fluid cannot freely enter the subarachnoid space, hydrocephalus is called non-communicating(closed, occlusive). In other cases, hydrocephalus is called communicating(open). Hydrocephalus happens primary(as the underlying disease) and secondary, i.e., a complication of other diseases (tumors, malformations of the central nervous system (CNS) and cerebral vessels, etc.). There are many classifications of hydrocephalus, but these are the main ones and are used most often.

Manifestations of hydrocephalus

Violation of the circulation and absorption of cerebrospinal fluid leads to its excessive accumulation and increased intracranial pressure. This manifests itself in different ways in babies under 2 years old and in older children.

The main symptom of the development of dropsy of the brain in children under 2 years of age is an accelerated growth in head circumference. The sutures of the skull in babies have not yet been overgrown, and the size of the head increases because the bones of the skull are pushed apart from the inside by the growing brain. In the same way, the balloon increases in volumewhen we inflate it. There is a graph of head circumference growth. It is necessary to measure it every one to two months, this is done by the local pediatrician during preventive examinations. If the baby's head grows faster than normal, then this is an alarming symptom; it most often indicates the development of hydrocephalus, when the accelerated growth of the head occurs due to an excess of cerebrospinal fluid in the ventricles of the brain. This is often the first symptom of the disease. In addition to the accelerated growth of the head in children, an enlarged and bulging large fontanel can be detected, which should close by about 1 year, but with hydrocephalus it can be open up to 2 and even up to 3 years. The bones of the skull become thinner, the forehead becomes disproportionately enlarged and protruding. A venous network appears on the forehead and face. In more advanced cases, the eyes may go down (Grefe's symptom). The tone of the muscles of the legs increases. Seizures may occur.

The child begins to lag behind in the pace of psychomotor development. He does not keep his head on time, does not sit, does not get up, does not play. A sick child is lethargic, apathetic, sometimes unmotivated whining. Maybe the baby is experiencing headache: He can grab his head.

Most of the symptoms of increased intracranial pressure can only be recognized by an experienced pediatrician, neuropathologist or neurosurgeon, but parents can measure the growth rate of the head themselves and check it according to special charts. In any case, the accelerated growth of the circumference of the child's head, as well as the incomprehensible lag in the pace of its development, should serve as a reason for a serious examination of the baby by a neuropathologist or neurosurgeon to rule out hydrocephalus.

In children older than 2 years, the sutures of the skull overgrow, and the increase in intracranial pressure manifests itself in a different way. The classic picture is headaches with nausea and vomiting (more often at night or in the morning), changes in the fundus (the so-called papilledema, which can be detected by an ophthalmologist). Headaches, especially with nausea and vomiting, are symptoms that require examination by a neurologist or neurosurgeon. They can be caused by hydrocephalus, a brain tumor, malformations of the brain. Pediatricians often forget about this, and children are treated aimlessly for a long time for gastritis, pancreatitis, dyskinesia biliary tract, poisoning and gastrointestinal infections, etc., and they get to a neurologist and a neurosurgeon late in a serious condition. It is necessary to insist on a consultation with a neurologist and examination in case of incomprehensible headaches, regular episodes of nausea and vomiting, decreased vision, and in some cases this will make it possible to make a correct diagnosis in the early stages and save the child's life.

Other symptoms of hydrocephalus are varied and depend on the cause that caused it. These can be epileptic convulsions, blurred vision, increased tone in the legs, pelvic disorders (incontinence or urinary retention), endocrine disorders (growth retardation or gigantism, premature sexual development, hypothyroidism - decreased production of thyroid hormones, obesity), decreased academic performance. school, etc.

Causes of hydrocephalus in children

The causes of hydrocephalus are very diverse and largely depend on the age of the child.

1. hydrocephalus in the fetus. Modern types of prenatal diagnostics (for example, ultrasound - ultrasound) can detect hydrocephalus in an unborn baby. In most cases, it is caused by various malformations of the central nervous system (CNS). In 20%, dropsy is associated with intrauterine infections (cytomegaly, herpes, toxoplasmosis). When planning a pregnancy, parents should be tested for these often occult infections and treated. This will avoid many health problems for the baby. V rare cases hydrocephalus is caused by genetic disorders.
2. Hydrocephalus of the newborn. Most often (up to 80%), dropsy in newborns is caused by malformations of the brain and spinal cord and the consequences of intrauterine infections. Approximately 20% of hydrocephalus is a consequence of birth trauma, especially in premature infants, which is accompanied by intracerebral or intraventricular hemorrhage and associated meningitis (inflammation of the meninges), which leads to impaired CSF absorption. It is extremely rare at this age that tumors and vascular malformations of the brain are detected, which can also cause the development of dropsy.
3. Hydrocephalus in toddlers and older children (from 1-2 years and older). There are many reasons for the development of hydrocephalus in such children. These include tumors of the brain and spinal cord; consequences of meningitis, encephalitis (inflammation of the substance of the brain), various infectious diseases (for example, tuberculosis); malformations of the brain and cerebral vessels; consequences of hemorrhages; consequences of traumatic brain injury; genetic disorders. Sometimes the cause of hydrocephalus cannot be determined.

How is the diagnosis made?

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

The most common operation is the ventriculo-peritoneal shunt (VPSH).

If a diagnosis of hydrocephalus (any cause) is made, the child should be examined by a neurosurgeon. Most often, children with hydrocephalus are treated surgically, and the neurosurgeon determines the indications and contraindications for surgery. Observation of children with hydrocephalus only by a neuropathologist or pediatrician without the participation of a neurosurgeon is a mistake and sometimes leads to an unreasonable delay in surgical intervention.

It is not easy for parents to decide on the need to perform the operation. However, a prolonged increase in intracranial pressure causes a delay in psychomotor development, which is not always possible to compensate after an unreasonably delayed surgical intervention. It should also be noted that the excessively large head of a child suffering from dropsy, even after the operation, will no longer be the same size - it will only be possible to stop its further growth. In the literal sense of the word, it will be difficult for a child to carry it on his shoulders, in addition, in the future it will cause many cosmetic problems. Parents of children with hydrocephalus should be aware that even if a neurologist does not refer them to a neurosurgeon, they must take the initiative and organize this consultation themselves.

The purpose of the operation is that the cerebrospinal fluid is diverted from the ventricles of the brain to other cavities of the body. The most common operation is the ventriculo-peritoneal shunt (VPSH). Through a system of silicone catheters, cerebrospinal fluid from the lateral ventricle of the brain flows into the abdominal cavity, where it is absorbed between intestinal loops. The amount of liquor flowing out is regulated by a special valve. The catheters are placed under the skin and are not visible from the outside. More than 200 thousand such operations are performed annually in the world. Shunt systems have saved millions of children's lives.

Less commonly, cerebrospinal fluid is drained into the right atrium (ventriculo-atrial shunt), into a large occipital cistern (Thorkildsen operation), or the spinal canal at the lumbar level is connected by a catheter to the abdominal cavity (lumbo-peritoneal shunt).

With the development of modern endoscopic technology (an endoscope is inserted into the human body cavities through small incisions, allowing them to be examined and manipulated), it became possible to treat patients without installing a bypass system. With the help of an endoscope in the depths of the brain, a bypass is created for the outflow of cerebrospinal fluid. This very effective operation (called endoscopic ventriculostomy) avoids implantation foreign body what is the shunt system, and thereby prevent many complications. Unfortunately, only a limited number of patients (about 10% of the total number of patients) with some forms of occlusive hydrocephalus can be helped by this operation. In other cases, it is necessary to install a bypass system, since there will be no improvement from endoscopic surgery.

A successful operation stops the progression of the disease. Most of the children have the opportunity to return to normal life, along with healthy peers attend kindergarten, school.

In some cases, patients with hydrocephalus are not operated on, but are under observation and take Diacarb (a drug that reduces the production of cerebrospinal fluid) for a more or less long period of time. This is done in cases where there are no obvious signs of disease progression and increased intracranial pressure. Observation is carried out under the strict supervision of a neuropathologist or neurosurgeon with frequent examinations, measurements of the circumference of the child's head, repeated NSG or CT studies.

Myths about increased intracranial pressure

The diagnosis of "increased intracranial pressure", "intracranial hypertension (ICH)" or "hypertensive-hydrocephalic syndrome", as already mentioned, is often made and in some cases unreasonably. How is increased intracranial pressure (ICP) manifested? As already noted, in children under 2 years of age, such manifestations are, first of all, an accelerated growth in head circumference, a bulging and enlarged large fontanel, possible eye movement disorders, and psychomotor retardation. Most often, all these disorders are manifested in a complex. In children older than 2 years, these are headaches with nausea and vomiting, more often in the morning, changes in the fundus (detected during examination by an ophthalmologist). Of course, the clinical picture may be different, but without the above symptoms, the diagnosis of "increased intracranial pressure" is doubtful.

Symptoms such as sleep and behavioral disorders, hyperactivity, attention deficit, bad habits, poor academic performance, hypertonicity in the legs, "marble" skin pattern, including on the head, nosebleeds, chin trembling, tiptoe walking, by themselves are not indicate increased intracranial pressure. And yet, some neurologists diagnose ICH precisely on the basis of these complaints. Neurosonography, having become a huge boon for pediatrics and neurology, has made its significant contribution to the excessive and false diagnosis of "hypertensive-hydrocephalic syndrome". NSG makes it possible to quickly obtain an image of the substance of the brain, to measure the size of the ventricles. However, to clarify the diagnosis, as we have already said, CT and MRI are mandatory.

What is tomography?

Computed tomography (CT) is an x-ray research method that allows you to obtain images of the internal organs and bones of a person in the form of transverse sections. In a CT scan, an x-ray tube rotates around the patient's body, taking many pictures, and then the computer summarizes the data and builds the finished image. Magnetic Resonance Imaging (MRI) also provides slices internal organs man, but due to a different physical principle. The patient is placed in a tube with a strong magnetic field, a special electromagnetic signal is applied, and then a computer builds an image based on the reflected signals. With MRI, you can image in all three planes (transverse, longitudinal and straight). X-ray irradiation is not used, so MRI can be performed on pregnant women. MRI is the "gold standard" in the diagnosis of hydrocephalus, it allows you to assess the size of the ventricular system, the structure of the substance of the brain, detect tumors and malformations of the brain and spinal cord, and in some cases even see and describe the circulation of CSF. CT is a simpler and faster, but less sensitive method of examination. It can be recommended for primary diagnosis and follow-up.

Parents often ask what methods can measure intracranial pressure. Direct measurement of intracranial pressure is possible by installing a special sensor in the cranial cavity. This is done in large clinics for special indications (for example, with severe traumatic brain injury). Relatively objectively, one can judge intracranial pressure during lumbar puncture - the introduction of a needle into the cavity of the spinal canal at the lumbar level. All other research methods provide only indirect information and are valuable only when they are comprehensively assessed.

Rheoencephalography (REG) and echo-encephalography (Echo-EG or Echo-ES) are useless for diagnosing intracranial hypertension: they do not provide objective information, and their use is a sham.

Only on the basis of a careful comparison of clinical data with the results of additional studies (examination of the fundus by an ophthalmologist, NSG data together with CT or MRI images) can one speak of an increase in intracranial pressure and find its cause. The diagnosis of ICH requires urgent and most often neurosurgical treatment, as it threatens the health and life of the patient. Watching a child with intracranial hypertension without showing it to a neurosurgeon is like suspecting appendicitis or acute myocardial infarction and suggesting to come back in a week.

Overdiagnosis of increased intracranial pressure leads to stress for parents and to the unreasonable prescription of a large number of drugs to the child. The only drug that can reduce intracranial pressure on an outpatient basis is Diacarb. It is given very widely. Drugs such as Cavinton, Cinnarizine, Sermion, nicotinic acid, Nootropil, Piracetam, Pantogam, Encephabol, Picamilon, herbs, vitamins, homeopathic remedies are very popular, but do not affect intracranial pressure in any way. In any case, there is not a single study that would objectively confirm their effectiveness in ICH. Medications prescribed without indications cannot bring any benefit, but they have side effects. In addition, this is a significant burden on the pocket of parents.

03/27/2017 02:50:38 PM, Sharifa

My sister's child was diagnosed with "Hydrocephalus", but only in question (and a bunch of others are also in question). All the symptoms of this disease described in the article are on the face. Pregnancy was normal, ultrasound is also all right. But for some reason, on the very first day after birth, the child was already with a collar. The doctors explained that it happens, just a minor injury during childbirth, nothing to worry about. But the child moved his head a little, as it should be. At discharge, they said that it was possible to remove the collar, another doctor advised to wear it for at least another month, but they listened and removed it ... They underwent an examination, everything is in doubt, but the child has pronounced symptoms. Doctors at first undertook to help (where she gave birth, the perinatal center), and then they simply said that they could not do anything. and the mother was told in the eyes that the child was not a tenant. Now they are waiting for a call to Moscow for examination, only when it is unknown. Time is running out. The child is already nine months old, he is suffering. They are looking for masseurs themselves, they have undergone some kind of treatment (the head has stopped growing, but it is very heavy). tell me how to be, where to go? The child is suffering. they live in Khabarovsk.

26.11.2016 02:45:21, EVGENIA

Can't take time

10/16/2016 16:18:23, Daraev Akhmetzhan

If the diagnosis is hydrocephalus, then only shunting will help, a good neurosurgeon is needed

10/16/2016 16:17:46, Daraev Akhmetzhan

Hello! NSG at 1 month: interhemispheric fissure expanded 3.2mm; convexital cerebrospinal fluid space expanded 3.3 mm. The lateral ventricles are symmetrical and dilated. Front horns: 5.3 and 5.3mm. Body: 4.8 and 4.8mm. Occipital horns 10 and 10 mm. Third ventricle 2.9 mm. The fourth ventricle is triangular in the sagittal plane. Vascular plexuses: smooth contours, homogeneous structures. Everything else is unchanged, homogeneous, symmetrical. Conclusion: expansion of the interhemispheric fissure and convexital cerebrospinal fluid space. Ventriculomegaly.
NSG at 4 months: the interhemispheric fissure in the anterior sections was expanded to 4.3-6.5 mm. Subarachnoid convexital space up to 2.7-4.3 mm. The lateral ventricles are symmetrical: PRBZH: pr. 7.3 mm, lev. 6.8 mm. Body BJ: pr.6mm, lev.4.8mm. ZRBZH: pr.9mm, lev.8mm. Third ventricle 4 mm. The fourth is not expanded, the basal cisterns are not expanded. The vascular plexuses are symmetrical, the pulsation of the intracranial vessels is preserved. Conclusion: a picture of unexpressed mixed hydrocephalus.
The neurologist prescribed: general massage, hypothiazide, asparkam, pantogam and cerebrolysin injections.
The child became excitable, sleeps restlessly at night, screams in his sleep, during the day he sleeps 2 times for 40 minutes maximum. He is naughty, constantly on his hands, but not on his back, screaming on his back. No developmental delay was noticed, he rolls over on his stomach quickly from 3 months, tries to crawl, lying on his hands, pulls his shoulders to his knees and tries to take a more sitting position. Gulit, smiles, follows objects. How big are the deviations from the norm, what is the risk? Is the treatment appropriate? To whom else to turn, maybe some more examinations to pass?

Conclusion: a consequence of perinatal hypoxia in the form of small areas of periventicular leukomalacia of the frontal and parietal lobes. External hydrocephalus in the projection of the frontal temporal lobes and cerebellum. Hypoplasia of the lower parts of the cerebellar vermis. 8 month old baby please help! And how is it treated please tell me!

02/07/2016 08:31:56, Zhanna

Hello, please tell me, the child is 5.5 months old and we had a diagnosis at 3 months of hydrocephalus, the doctor attributed to us asparks and diacarb, we drank them for almost 3 months and went as the doctor said for improvement, then they stopped giving and fell ill with ARVI, and now the indications of hydrocephalus have increased by 1 ,5 times and it is not clear why the temperature jumps to 38

Hello! Please tell me, our baby is now 8 months old. diagnosed with the consequences of perinatal lesions of the central nervous system in the form of mixed hydrocephalus. Neurosonography showed that the interhemispheric fissure is 13.3 mm, the antral-occipital regions of the side. Left 6.2 mm, width 3.5 mm, length up to 16 mm. Right 5.1 mm, width. 3.5 mm, length up to 15 mm. 3 ventricle width 5.2 mm. Vascular plexus without pathology., Transparent septum 4.0 mm Subcortical ganglia without pathology, Caudotamic region. changed: on the left ring-shaped. anechoic structure 5 mm by 8 mm, on the right 9 mm by 6.6 mm. The cerebellum is without pathology. Conclusion: There is a moderate expansion of the interhemispheric fissure and convexitalg subarachnoid space, slight dilatation of the lateral and third ventricles. Subependymal pseudocysts in the caudothalamic corners of the side. The blood flow is not broken. Now the volume of the head is 48 cm. The child is normal in development. Please tell me, DO WE HAVE A CHANCE TO RECOVERY???? We drink Diakarb, asparkam, tanakan, magne B6 for a week, we do electrophoresis on the cervical-collar zone. .A week later we go to the Neurosurgeon.

Discussion

Author, go to "other children". there everyone will tell and tell.
I have a son with shunted hydrocephalus, but that's another story.
Based on my experience of lying down with shunted children, I can say that people from different regions came to the RCCH for the bypass surgery. And the kids were mentally normal. And the heads are also normal, except that the forehead is a bit high.
The only thing that is the same for everyone is meteopathic, you can’t engage in certain sports that are associated with jumping and shaking the body, you can’t relax in hot countries and overheat in the sun.

Hey-Bo, ask those who live with these children.

Definitely, go to double-check the diagnosis! Hydrocephalus, hydrocephalus syndrome are very often put on the bulldozer, how many have already encountered this ... Look, repeat the NSG, evaluate the overall development. Good luck!!!

07/08/2007 10:59:38 AM, Utah zebra

Hydrocephalus: do not miss the time! Some anatomy and physiology. Hydrocephalus (dropsy of the brain) (from the Greek "hydro" It is necessary to insist on a consultation with a neurologist and examination in case ...

Discussion

Dont be upset. This disease is very often cured by medication. In my experience, I can say that surgery is not always the best treatment. My son has congenital occlusive hydrocephalus. He is already 1 year 4 months old, he has been to many doctors .. And what I noticed is that in all paid clinics they insist on surgery, while doctors in the state. hospitals do not see the need for surgery. While not operated, we are observed by a neurologist. His physical and psychomotor development is normal...

Discussion

We are now 1.5 months old and there is a question about a trip from Moscow to Krasnodar, there is an apartment there and a wife with a mother-in-law in order to take the child to an ecologically clean place. Although we did not find normal doctors there. (Pregnancy and a false diagnosis - "agenesis of the corpus callosum" was given to us there) The question arises - in our case, how will the child endure the trip? By plane it is impossible, because. 1) pressure 2) contact with people (and he has not been vaccinated, because doctors forbade vaccinations). The train does not fit for the same reason - contact with people and so on. infections. It remains only a car, but to go there 1400 km! Drove for 1 day for 15 hours, but it's non-stop. Otherwise, you will have to travel with a child for two days with a stop at a hotel, say, in Voronezh. How will our son handle the trip in such a situation? I will take him only fastened (cradle from the stroller - lying or baby car seat - half-sitting). How will he cope with acclimatization? Although it’s not summer now and it’s not hot there, shouldn’t there be problems with this? Has anyone traveled this far with kids? What can be recommendations in this case?

2. carry out treatment. Discussion

Hello dear! I have a 6 year old son. Hydrocephalus compensated. Operated at 1 month. He lags behind in development, movement coordination is slightly impaired, partial atrophy of the optic nerve, etc. in general, but it's all nothing nonsense, if not for epilepsy since the spring of last year. All titanic efforts come to naught. All over again. The degradation is terrible, AEP pills give such a reaction to the brain, in general, we can only dream of peace. We were operated on at 9. Speransky at Zinenko Dmitry Yurievich. He created his own charitable organization for children suffering from hydrocephalus.

We are shunted too. Shunted early at 1.5 months.
Now 2.4. We are physically lagging behind, but this is rather a consequence of deep prematurity and hemorrhage. But on the other hand, we speak, we repeat everything, we build sentences from 2-3 words, we try to recite poems.

Adhesion of the lungs (disease of hyaline membranes, respiratory distress of newborns) - very often in premature babies, has no relation to mental abilities (if Alinin's diagnosis sounded almost like the name of a monastic order - Hydrocephalus of the Brain.

Discussion

Honestly, there are no words. This is not a man. What does it mean to give a baby home. Maybe just invite this man to visit some kind of baby house? Then maybe he'll understand what's going on. Maybe the baby does not have hydrocephalus at all, but a hypertensive hydrocephalic syndrome. And that's not it at all. And the fact that a premature and small child was born would have been nothing but bones and meat would grow. And why necessarily stupid. All the moms who write here do NOT have stupid kids. And everyone has problems. But they solve them. And they are successful.

Thanks everyone. I'll print it out tomorrow morning and let Lena read it. I hope that everything will be alright. Thanks again.

Cerebral hydrocephalus is a disease in which an excessive amount of cerebrospinal fluid is produced in the brain. Moderate hydrocephalus of the brain is one of the varieties of this pathology.

In a healthy state, fluid (liquor) bathes the brain and helps protect it from concussions, and also performs nutritional functions. In case of violation of the outflow of cerebrospinal fluid, as well as with its excessive formation, hydrocephalus occurs (it is also dropsy).

Classification

Moderate hydrocephalus is of several types:

• moderate - a disease in which a violation of the circulation of fluid leads to its accumulation mainly in the subarachnoid space;
• moderate - a type of pathology in which cerebrospinal fluid accumulates in the ventricles of the brain;
• moderate mixed hydrocephalus of the brain - cerebrospinal fluid accumulates both in the ventricles and in the space under the meninges.

Moderate replacement hydrocephalus of the brain is also diagnosed: in this case, the medulla gradually decreases in volume, and cerebrospinal fluid takes its place. Replacement dropsy usually develops in older people.

Sometimes replacement hydrocephalus can accompany Alzheimer's disease or other degenerative diseases of the central nervous system.

The disease can be acquired or congenital.

In the first case, internal pathology can be the result of external influences - injuries, as well as systemic diseases.

In the second, it can be caused by difficult births or infectious diseases obtained during fetal development.

Causes

The immediate cause of the disease is a violation of the outflow of cerebrospinal fluid from the ventricles of the brain through the proper channels into the tanks and further into the spinal canal, where fluid is absorbed into the circulatory system.

But the factors that can lead to this situation may be different.

Moderate hydrocephalus is usually the result of other diseases:

• atherosclerosis;
• brain tumors and cysts that compress the ventricles or obstruct the outflow of fluid;
• infectious diseases (both current and transferred in the past - it can be meningitis, encephalitis);
• osteochondrosis and hernia of the spine in the cervical region.

In addition, moderate internal dropsy of the brain can be caused by concussion, falls and bruises of the head, injuries received in car accidents.

Internal, external and mixed varieties of dropsy of the brain can also be caused by alcoholism.

signs

Moderate hydrocephalus of the brain can develop asymptomatically for a long time.

For several years, the only sign of the disease may be recurrent headaches, which often occur in.

The disease can be detected with diagnostic examination brain completely by accident.

Sometimes there are no headaches, while intracranial pressure remains normal.

However, in a certain period, the consequences of an excessive accumulation of cerebrospinal fluid still manifest themselves - for example, in the form of a violation of the blood supply to the brain and its hypoxia (oxygen deficiency).

This condition can lead to any consequences, up to a stroke and dementia.

Significant symptoms that occur with the developed form of the disease include:

• vision and hearing problems;
• decrease in intellectual abilities and partial loss of memory;
• loss of attention and ability to concentrate;
• loss of spatial orientation (patients can go for a walk and get lost);
• impaired coordination of movements (in patients, gait may change);
• chronic fatigue;
• sleep disorders;
• irritability.

In the acute stage, external, internal and mixed forms of hydrocephalus give manifestations such as vomiting, urinary incontinence, loss of consciousness, cerebral edema.

This phenomenon is called an occlusive crisis and requires immediate hospitalization: the cause of the crisis is a complete blockage of the outflow of CSF.

Diagnostics

Like all other types of hydrocephalus, a moderate form of the disease is detected using x-ray of the skull in two projections and magnetic resonance imaging.

The second method in modern medicine preferred as it gives more accurate images of the internal cranial cavities.

Sometimes additional procedures may be prescribed:

• - a method of research using a contrast agentintroduced into circulatory system: allows you to see violations in the vessels, to identify aneurysms or stenosis (narrowing) of the vascular walls;
• lumbar puncture - sampling of cerebrospinal fluid for the purpose of its further study in the laboratory (allows you to identify the presence of pathogenic microorganisms in the cerebrospinal fluid).

In addition, examinations by an endocrinologist, psychoneurologist, ophthalmologist can be prescribed.

Treatment

Medical

Moderate hydrocephalus before the onset of severe symptoms is treated with conservative methods - medicines, manual therapy, physiotherapy.

Medicines are prescribed in three varieties - regulating the blood circulation of the brain, antibiotics (in case of infectious causes of the disease) and diuretics (diuretics that stimulate the circulation of fluids in the body).

Operational

Since moderate (internal and external) hydrocephalus can turn into an acute form at any time, doctors, based on diagnostic data, may prescribe surgery.

The most modern look radical treatment, prescribed for hydrocephalus, is an endoscopic operation.

With the help of an endoscope, instruments are inserted into the cranial cavity, with which a hole is made in the central (third) ventricle of the brain. This creates an additional path for the outflow of fluid directly into the brain tanks.

There are also treatments such as external drainage and.

The first method is resorted to in emergency situations, when it is urgent to reduce the pressure of the fluid inside the brain - for example, if the channel for the outflow of cerebrospinal fluid is tightly blocked by the tumor, the second method is used less and less due to its inconvenience and the risk of complications.

Shunts constantly require revision and replacement, and there is a constant risk of infection.

In general, the prognosis for moderate hydrocephalus with well-conducted treatment and timely detection of problems with cerebral fluid is favorable.

The exception is cases when patients do not go to the hospital and the disease leads to irreversible changes in the brain and higher nervous activity.

In contact with

2017-02-06 site

Moderate external hydrocephalus of the brain

They call a disease that is characterized by an excessive accumulation of spinal life in the human brain. In another way, the disease is called dropsy. What is moderate external hydrocephalus of the brain? This is one of the most common brain pathologies that can develop in both newborns and adults.

What characterizes the disease

The function of nourishing the brain and protecting it from concussions is performed by the fluid washing it - cerebrospinal fluid. Its excessive accumulation or violation of the outflow causes the development of moderate external hydrocephalus.

Some neurologists say that this disease can only appear in children and is a congenital pathology. Of course, there are a lot of newborn babies who suffer from dropsy. But it is not necessary to unequivocally attribute hydrocephalus only to congenital pathology.

In adults, the disease is difficult to diagnose. The patient may be treated for an entirely different mental or neurological illness without suspecting hydrocephalus. Dropsy is a dangerous disease that can provoke various neurological disorders.

Moderate hydrocephalus often has two stages of development. The acute stage is characterized by the appearance of signs of the disease that caused hydrocephalus. During the chronic stage, symptoms appear that indicate the pathology of the brain itself.

Classification of moderate hydrocephalus

This state can take one of the following forms:

• External hydrocephalus of the brain. If the result of a violation of the outflow of fluid is its accumulation in the subarachnoid space.
• Internal hydrocephalus of the brain. With the localization of fluid in the ventricles of the brain develops.
• Mixed hydrocephalus. It appears if the accumulation of liquor occurs both in the space under the membranes of the brain and in the ventricles.

Also, the disease can be:

• Congenital. Such a pathology is often the result of a difficult birth or intrauterine infection of the fetus.
• Acquired. Acquired hydrocephalus usually develops on the background of traumatic brain injuries or as a result of a systemic disease.

In older people, mild external replacement hydrocephalus may develop. It is characterized by a decrease in the volume of the medulla, followed by its replacement with CSF. Sometimes the background for the development of moderate becomes atherosclerosis, Alzheimer's disease, hypertension, frequent drinking, neurological pathologies.

This form of hydrocephalus is singled out, as it is very difficult to diagnose due to the absence of symptoms of the disease. Replacement hydrocephalus can manifest itself already with the development of cerebral hypoxia, when normal blood flow is disturbed. The disease is characterized by the accumulation of fluid volume not only inside the brain, but also outside.

Causes

Hydrocephalus in any form can develop as an "independent" pathology (primary) or as a consequence (secondary) of certain diseases. In both cases, the main cause of dropsy is a violation of the outflow of fluid and its accumulation in the ventricles of the brain.

Experts name a number of conditions under which the development of moderate external hydrocephalus is possible:

• Postponed stroke.
• Atherosclerosis.
• The presence of malignant or benign formations that interfere with the normal outflow of fluid.
• Increased blood pressure.
• Current or past infectious diseases (encephalitis or meningitis).
• Hernia in the cervical spine or osteochondrosis.

A disease such as minor external hydrocephalus can also appear as a consequence of head injury, alcohol poisoning, and alcoholism.

In children, the onset of the disease is facilitated by factors such as:

• The birth of a baby ahead of time.
• intrauterine infection.
• Influence of adverse external conditions on the development of the fetus in the perinatal period.

Symptoms

For a long time, the disease may not manifest itself. The patient may only be disturbed by morning headaches. But at a certain point, the pathology will still make itself felt, since the excessive accumulation of cerebrospinal fluid disrupts the blood supply to the brain. Such processes lead to oxygen starvation (hypoxia) of the brain, which is fraught with very serious consequences, for example, the patient may develop dementia or have a stroke.

Symptoms of the disease in an adult

The acute form of moderate external hydrocephalus is characterized by high intracranial pressure, which provokes severe headaches in the morning. They may subside throughout the day. The patient may suffer from an upset digestive system, nausea and vomiting appear. If after vomiting the head hurts less, then the person has obvious problems with the brain.

The most dangerous symptom of the disease is drowsiness. It indicates the presence of high intracranial pressure, which will subsequently cause a sharp deterioration in the patient's condition. Also, moderate external hydrocephalus is often accompanied by the following symptoms:

• Vertigo.
• Hearing or visual impairment.
• Partial loss of memory.
• Decreased intelligence.
• Loss of orientation in space.
• Irritability.
• Violation of coordination of movement.
• Deterioration of well-being when changing weather phenomena.

With an exacerbation of any form of moderate hydrocephalus, a person may experience urinary incontinence, fainting, and cerebral edema. This indicates the development of an occlusive crisis. In this case, the patient should be urgently hospitalized, as complete leakage of cerebrospinal fluid may occur.

Symptoms in children

The most obvious signs of the disease in children are an enlarged skull and head growth ahead of age.

Symptoms of the disease in newborns:

• Constant tilting of the head back.
• Too tense fontanel.
• The eyeballs may move downward.
• Sometimes there is strabismus.
• Pulsating protrusions can be observed between the unfused bones of the skull.

Moderate external hydrocephalus has a negative impact on the formation of the child's nervous system. It provokes the development of defects that affect the properties and dynamics of the CSF.

Diagnostics

All forms of hydrocephalus are diagnosed using x-rays of the skull and. Tomography is performed to check the contours of the brain, ventricles, and also scan the skull with its help. X-ray helps to determine the direction of the cerebrospinal fluid.

With the help of MRI, specialists detect the presence (absence) of tumors and various neoplasms. This method of studying the disease allows you to make an accurate diagnosis, as well as determine the form in which the disease occurs.

If necessary, the doctor may prescribe the following diagnostic procedures:

• Angiography. This method is based on the introduction of a contrast agent into the circulatory system, which allows you to notice the pathology of the vessels.
• General blood analysis.
• Lumbar puncture. To identify pathogenic organisms in the cerebrospinal fluid, cerebrospinal fluid is taken.

In addition to the above methods for diagnosing moderate hydrocephalus, the patient can be sent for examination to narrow specialists: an ophthalmologist, an endocrinologist, a neuropsychiatrist. For children, the diagnosis "Moderate" is made on the basis of the existing symptoms, measurements taken from the circumference of the head, tomography, ultrasound, MRI.

Conducting a complete examination helps the doctor accurately diagnose the disease itself and the form in which it occurs. Accurate diagnosis makes it possible to start timely treatment, which will be prescribed taking into account the patient's age, intracranial pressure, and the state of brain structures.

Treatment

Moderate external hydrocephalus can be treated conservatively or with surgery. The postoperative period is necessarily accompanied by physiotherapy and the appointment of drugs.

conservative methods

Minor external hydrocephalus at the initial stage is usually treated with conservative methods. These include:

• Complexes of exercises of therapeutic gymnastics (the program is developed by a doctor).
• Significant reduction in daily fluid intake.
• Taking oil baths with pine needles oil.
• Taking certain medications.
• Compliance with a special diet.

To remove excess fluid from the body, the patient usually takes potassium preparations and Diacarb. If the cause of the pathology was an infectious disease, then a course of antibiotics is prescribed. Mandatory is the therapy with medicines that help regulate the blood circulation of the brain.

These methods are carried out in order to reduce intracranial pressure and restore the normal functioning of the brain. But they are often useless in the fight against this disease. Then they resort to surgical treatment of the disease.

Surgical treatments

Today, the technique of surgical intervention in the fight against moderate hydrocephalus is the main one. It is aimed at preventing the acute form of the development of the disease. If the operation is successful, then the patient can permanently get rid of such a disease as moderate external hydrocephalus.

Now for operating more use a modern method - endoscopy. An important positive point here is the creation of all conditions for the outflow of cerebrospinal fluid to occur through natural openings (without the use of foreign objects). This method of conducting the operation helps to avoid the development of autoimmune reactions in the patient.

Other methods of surgical intervention for moderate external hydrocephalus include drainage and shunting. The first method is used only in emergency situations that require an immediate reduction in brain fluid pressure. The second method (bypass) causes a large number of postoperative complications, so now it is rarely used. Shunts need to be replaced periodically, which puts the patient at risk of infection.

Prevention

In order to avoid the appearance of such a dangerous disease as moderate external and in adults, it is necessary to observe elementary preventive measures:

• It is important for pregnant women to monitor their health throughout the entire period of pregnancy. It is not necessary to allow the development of infectious diseases, seek medical help in time, undergo all scheduled examinations in a timely manner, and avoid injury. Early detection of pathology in the fetus will help to conduct timely treatment of the newborn.
• Since concussion is the most common cause of moderate cerebral hydrocephalus in adults, head injury should be avoided in the first place.
• You should lead a correct lifestyle, do not abuse alcohol, control blood pressure.
• It is necessary to treat infectious diseases in time, periodically undergo an examination with a doctor.

When the first symptoms of the disease appear, you should immediately seek medical attention. medical care.

The patient must remember, if he is diagnosed with moderate external hydrocephalus, that this is such a dangerous disease, which, if not contacted by a doctor in time, can lead to serious complications. Therefore, it is recommended that every person be examined at least once a year by a therapist or a narrow specialist.

Video

Rating: 5 - 68 votes

Officially, according to medical terminology, hydrocephalus of the brain is a pathology associated with an increase in the volume of the ventricles due to excessive outflow of cerebrospinal fluid, which is the basis of cerebrospinal fluid and is used to facilitate the nutrition of all parts of the central nervous system. Sometimes the disease is also called dropsy, since the very liquor that fills the cavity of the ventricles is absolutely transparent, odorless and, in all physiological respects, is similar to ordinary water. But in fact, it contains a whole range of nutrients and minerals that are used for the work of certain parts of the brain.

But what causes cerebral hydrocephalus? There are several reasons for this, and they cover many combined pathologies, ranging from excessive production of cerebrospinal fluid to obstruction of the excretory channels. And this may be a consequence of both the physical pathology of the brain, and the action of certain bacteria. Until now, doctors cannot describe all the reasons why cerebral hydrocephalus occurs in an adult. Literally every year, several new culprits of the disease are discovered.

2 Fluid accumulation

So, the cerebrospinal fluid, as we have already found out, is the cerebrospinal fluid, which is washed by the subarachnoid cavity. There are also cells that absorb it, deliver it to the ventricles, and then bring it back. As a rule, in a normal state, when there are no pathologies in the brain, about 150 ml of such a liquid is constantly in it. Liquor flows through the brain 3 times within 24 hours. In newborns - significantly more. But if there are any inflammatory processes at the base of the skull, which leads to swelling of the tissues, then the output of the cerebrospinal fluid is disturbed. Accordingly, it accumulates in the ventricles, and those, in turn, sharply increase in size. And so on until the channels are revealed (at least partially). In this state, the volume of the cavity increases up to 1 liter, which affects a sharp increase. In such cases, hydrocephalus of the brain without surgical treatment leads to irreparable pathologies that can end and lethal outcome for the patient.

3 Disease classification

According to the pathogenesis, the following types of dropsy are distinguished:

• occlusal;
• communicating;
• hypersecretory.

Previously, such a concept as external hydrocephalus (mixed type) was still used in medicine, but now it is referred to as brain pathologies that lead to complex atrophy of tissues with a decrease in their volume. That is, this disease is treated in other ways, and the consequences of it can be radically different. And moderate mixed hydrocephalus is quite rare in adults, but is diagnosed in almost every baby after birth. It does not pose a danger to him and passes by itself as the natural volume of the brain increases.

In terms of the rate of flow, dropsy differs in acute and chronic. There is also such a thing as subacute hydrocephalus, which is a combination of acute and chronic. It is considered the most dangerous, but is quite rare.

Even hydrocephalus of the brain is conditionally divided by the pressure of the cerebrospinal fluid, however, for each person, the critical parameter is individual. That is, the description of this symptom is just a note for the doctor.

4 Symptoms of internal hydrocephalus

What are the symptoms of internal hydrocephalus? The basis is a sharp increase in intracranial pressure, which affects the size of the skull. More precisely, only the layer visually increases, but it looks like a mutation of the bones. In newborns, everything is somewhat different - the size of the open area of ​​\u200b\u200bthe crown increases, since their skull is not completely fused during this period (this is a physiological feature that simplifies the birth of a baby).

How does the patient feel at this moment? It is accompanied by a constant headache, a feeling of nausea, violations of the main receptor functions (hearing, vision, smell, chewing reflex). Over time, the symptoms become more pronounced, as the pressure on the tissues only increases, and they themselves atrophy. All this slowly flows into the chronic stagewhen the disease causes irreparable harm to human health. In many cases, hydrocephalus of the brain ends with the death of the patient. A person is simply paralyzed, although he continues to breathe, sweat, and digest food. In rare cases, more often in children, internal hydrocephalus recedes on its own. In this case, doctors talk about the so-called temporary pathology, which is the result of mechanical damage to the head (concussion, hematomas).

6 Other pathological manifestations

With an increase in the volume of the ventricles, doctors can diagnose the disease based on the following signs:

• gait disturbance;
• constant drowsiness (considered the most dangerous symptom, as it indicates the patient's risk of falling into a coma);
• dementia;
• urinary incontinence (sphincter dysfunction, even without visible problems in the urinary system);
• inhibition of reactions;
• pupils can move asymmetrically (the patient does not even know about it);
• lower paraparesis;
• asymmetrical smile (a certain part of the lips does not move).

Just keep in mind that the causes of all these symptoms are mixed, that is, they can indicate the presence of other diseases of the neural system. If hydrocephalus is suspected directly, the doctor will definitely prescribe an MRI, after the results of which treatment is prescribed.

7 Discirculatory course of the disease

It is in adults that dyscirculatory hydrocephalus also occurs, which differs from the rest not in problems with the outflow of cerebrospinal fluid, but in the fact that its natural circulation is disturbed. Because of this, the period that is necessary for the withdrawal of cerebrospinal fluid increases. Accordingly, the brain increases dramatically in volume (sometimes up to 50%), putting pressure not only on soft tissues, but also on the cranium itself. All this also leads to a partial impairment of auditory and visual functions, headaches, lack of coordination in space. Often, dyscirculatory hydrocephalus also causes dysfunction of some groups of the pelvic organs (including the reproductive group).

Conventionally, dyscirculatory hydrocephalus is divided into three categories. Already from the second patient receives a disability, as he partially or completely loses his working capacity. Over time, degeneration of the vascular channels develops, so surgical intervention is indispensable.

8 Curative actions

In the early stages, the treatment of hydrocephalus is medical. Those drugs are used that are able to quickly and also accelerate the outflow of cerebrospinal fluid. Sometimes hormonal components are prescribed, with the help of which the secretion of cerebrospinal fluid is regulated.

In more severe situations, surgery and bypass surgery are performed. That is, a valve and a special bundle of silicone tubes are mounted in the skull, through which the CSF is transported back to the abdominal cavity, and from there to the spinal cord. However, such a procedure is quite dangerous, as there is a risk of physical damage to some parts of the brain.

The most modern option for eliminating hydrocephalus is endoscopic surgery.

At the same time, the outflow of cerebrospinal fluid is regulated directly from the ventricles, and not from the cavity around the brain. Thanks to this procedure, the patient will be permanently freed from hydrocephalus and will be able to continue his life.

If the cause of the disease lies in an infectious lesion of the neural system, then after stabilization of the pressure inside the cranium, the main problem is eliminated, which led to the accumulation of cerebrospinal fluid. As a rule, the patient takes antibiotics and immunocorrectors for a certain time. All this happens necessarily under the constant supervision of a doctor, since shunting of the skull can provoke internal hemorrhage.

The human brain is one of the most complex and little-studied organs, which is constantly forced to work. For its normal functioning, it needs proper nutrition and blood supply.

The human brain consists of three membranes: soft, hard and arachnoid. The subarachnoid space is the space between the pia mater and the arachnoid. The arachnoid membrane envelops the brain; it communicates with other tissues by the subarachnoid junction.

They form ventricular system spinal cord and brain, consisting of four tanks in which fluid circulates.

The subarachnoid space is filled with cerebrospinal fluid, or cerebrospinal fluid, which is responsible for nourishing and protecting the brain. A favorable environment is created for the interchange of useful substances between the blood and the human brain, the movement of nutrients to the nerve endings and ventricles.

In the cerebrospinal fluid are ejected and excreted final products tissue metabolism. It constantly circulates in the brain cavity.

Up to 140 million CSF cells must be present in the subarachnoid space, which flows out of the brain through an opening in the fourth ventricle. Its maximum volume is contained in the cisterns of space located above the large crevices and furrows of the brain.

Why is the subarachnoid space enlarged

Malfunctions in the circulation of cerebrospinal fluid cause chronic diseases, or birth trauma. This leads to a decrease in the amount of gray and white matter in the brain, and as a result, the subarachnoid space expands.

An enlarged subarachnoid space indicates a malfunction in the circulation of the cerebrospinal fluid, its excessive production and entry into the brain cavity occurs, that is, development or dropsy occurs and, as a result, it is noted.

Increased intracranial pressure and hydrocephalus are two interrelated diagnoses that are diagnosed in almost every newborn.

If there is a benign local expansion of the subarachnoid spaces, the ventricles are slightly dilated or are within the normal range, then the violation resolves on its own in one or two years and does not harm the health of the baby.

But you can’t just hope for a favorable outcome of the disease, you need to contact a neurologist who will prescribe the necessary treatment.

The expansion of the subarachnoid spaces of the brain in adults can cause the following reasons:

• or ;
• (meningitis, tuberculosis, encephalitis);

These factors contribute to the start of the process, the amount of white and gray matter decreases, contributing to the expansion of the subarachnoid space.

Degrees of expansion

Expansion of the subarachnoid space is of three degrees:

• moderate— increase from 1 to 2 mm;
• average— magnification from 3 to 4 mm;
• heavy from 4 mm.

The expansion of the cerebrospinal fluid spaces occurs in proportion to the growth of the head of the newborn and the swelling of the fontanel.

The course and outcome of the disease depends on timely seeking medical help and initiation of treatment. If the treatment is chosen correctly, then the change in the ventricles remains almost within the normal range.

Features of the clinical picture

The following symptoms will help to suspect abnormalities in the functioning of the brain and the expansion of the subarachnoid space in a newborn baby:

• irritability to moderate or low sounds, noises;
• increased sensitivity to light;
• profuse regurgitation;
• disturbed sleep;
• pupils of different sizes or strabismus;
• an increase in the size of the head;
• anxiety about changing weather;
• the fontanel slowly overgrows and its swelling is present;
• trembling of limbs and chin.

The fact that the subarachnoid spaces are expanded in an adult is characterized by the following symptoms:

The presence of at least one of the symptoms in a child or an adult is a reason to urgently contact a neurologist.

Methods and goals of diagnosis

It is possible to diagnose the disease only after a comprehensive examination and laboratory research. After receiving the results or, the results of blood biochemistry, the cerebral hemispheres, assessing the symptoms and behavior of the patient, the neuropathologist will establish the final diagnosis, the degree of the disease and prescribe medication.

Basic diagnostic methods:

Health care

Treatment of the enlarged subarachnoid space is aimed at eliminating the causes and factors that provoked the disease. The main therapy includes vitamins, especially groups B and D and intake antibacterial drugs in the presence of an infection.

Treatment is long and is prescribed for each patient individually.

The main drugs include:

If the disease progresses rapidly and the subarachnoid cavity enlarges, then the main therapy will be to find the cause of the causing disorder, if it is hydrocephalus, diuretics are used, and antibacterial drugs are used to treat infections.

Hydrocephalus as a common complication

At severe course diseases, when medications and physical procedures did not bring the desired result, surgical treatment is indicated.

An extremely dangerous disease that can cause blindness or decreased vision, impaired speech and lag in child development.

The principles and methods of treatment of the disease are carried out for a long time and are selected individually for each patient. Treatment will depend on the nature, severity and complications. The main task is to restore normal circulation and outflow of CSF from the supracerebral region, which will lead to the normalization of intracranial pressure, which will make it possible to improve and restore the metabolism of cells and tissues of the nervous system.

Physioneuropological procedures are also prescribed in the complex, which reduce the symptoms of the disease and speed up the healing process.

Why is it dangerous?

Launched expansion of subarachnoid convexital spaces and its untimely treatment in infants can lead to more serious complications:

• manifestation of chronic diseases;
• delayed psycho-emotional and physical development of the baby.

Timely diagnosis and treatment will reduce the risk or eliminate the complications of the disease, contribute to the favorable course and outcome of the disease, so that it will not affect the functioning, vital activity and physical development of the child and, as a rule, disappears by the age of two.

Preventive measures

Prevention should be done by a woman (future parents) even before conception. Before conception, conduct a complete examination of the body to identify chronic and infectious diseases, if any, to treat them, during pregnancy, follow the recommendations of the doctor, protect yourself from and behave correctly during childbirth.

After the birth of the baby, monitor his behavior to prevent injury.

Expansion of the subarachnoid space in adults is diagnosed very rarely, but in order to prevent its occurrence, it is necessary to avoid and monitor your health.

Hydrocephalus can be an independent nosological unit, or it can be the result of various brain diseases. It requires mandatory qualified treatment, since the prolonged existence of the disease can lead to disability and even death.

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

Causes

Each person in the brain has special spaces containing a special fluid - liquor. Inside the brain itself, this is a system of ventricles of the brain that communicate with each other; outside the brain, this is the subarachnoid space with brain cisterns. Liquor performs very important functions: it protects the brain from shocks, shocks and infectious agents (the latter thanks to the antibodies it contains), nourishes the brain, participates in the regulation of blood circulation in the closed space of the brain and skull, and provides homeostasis due to optimal intracranial pressure.

The volume of cerebrospinal fluid in an adult is ml, it is updated 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 (containing approximately 25 ml), the CSF enters through the foramen of Monro 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 Sylvius aqueduct (brain aqueduct). At the bottom of the fourth ventricle there are openings: a median unpaired Magendie and two lateral Luschkas. Through these openings, cerebrospinal fluid enters the subarachnoid space of the brain (located between the pia and arachnoid membranes of the brain). On the basal surface of the brain, the subarachnoid space expands, forming several cisterns: cavities filled with CSF. From the tanks, the cerebrospinal fluid enters the outer (convexital) surface of the brain, as if “washing” it from all sides.

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

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

Causes of hydrocephalus can be:

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

Types of hydrocephalus

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

Depending on the mechanism of development, there are:

• closed (occlusive, non-communicating) hydrocephalus - when the cause is a violation of the CSF flow due to the overlap (block) of the CSF 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, dysresorbtive) hydrocephalus - based on 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 vascular 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. In recent years, this form has ceased to be attributed to hydrocephalus, since the reason for the increase in the content of cerebrospinal fluid is the atrophy of the brain tissue and the reduction of the brain itself, and not the violation of the circulation of cerebrospinal fluid.

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

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

According to the time of occurrence, they are distinguished:

• acute hydrocephalus - the period of 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 above.

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 that is more pronounced in the morning (especially after sleep), accompanied by nausea and sometimes vomiting, which brings relief. There is a feeling of pressure on eyeballs from the inside, there is a burning sensation, "sand" in the eyes, the pain is bursting. It is possible to inject vessels of the sclera.

As the CSF pressure increases, drowsiness joins, which serves as a poor prognostic sign, as it indicates an increase in symptoms and threatens with loss of consciousness.

Perhaps blurred vision, a feeling of "fog" before the eyes. Congestive discs of the optic nerves are revealed in the fundus.

If the patient does not seek medical help in time, then the continued 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 upward gaze, divergent strabismus, and inhibition of reflexes. These symptoms are characteristic of compression of the midbrain. When compression of the medulla oblongata occurs, symptoms of swallowing disorders appear, the voice changes (up to loss of consciousness), and then cardiac activity and respiration are inhibited, which leads to the death of the patient.

Chronic hydrocephalus is more often communicating and with normal or slightly increased intracranial pressure. It develops gradually, months after the causative factor. Initially, the sleep cycle is disturbed, either insomnia or drowsiness appears. Memory deteriorates, lethargy, fatigue appear. Characterized by general asthenia. As the disease progresses, mnestic (cognitive) impairments worsen up to dementia in advanced cases. Patients cannot take care of themselves and behave inappropriately.

The second typical symptom of chronic hydrocephalus is impaired walking. Initially, the gait changes - it becomes slow, unstable. Then uncertainty joins when standing, difficulty in starting to move. In the supine 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 his place, he takes small shuffling steps on widely spaced legs, marking time. These changes are called "apraxia of walking". Muscle tone increases, in advanced cases it decreases muscle strength, and paresis appears in the legs. Balance disorders also tend to progress to the point of being unable to stand or sit on their own.

Often patients with chronic hydrocephalus complain of frequent urination, especially at night. Gradually, imperative urges to urinate are added, requiring immediate emptying, and then urinary incontinence at all.

Diagnostics

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

Radiography of the cisterns of the base of the brain makes it possible to assess the direction of the CSF flow and clarify the type of hydrocephalus.

It is possible to conduct a trial diagnostic lumbar puncture with the removal of cerebrospinal fluid, which is accompanied by a temporary improvement in the condition. This is due to the restoration of blood supply to 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 know that in acute hydrocephalus, lumbar puncture is contraindicated due to the high risk of hernia 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 CSF is preserved) - diacarb (acetazolamide), mannitol and mannitol in combination with furosemide or lasix. Mandatory in this treatment is the correction of the level of potassium in the body, for this they use asparkam (panangin);
• to improve the nutrition of the brain tissue, cavinton (vinpocetine), actovegin (solcoseryl), gliatilin, choline, cortexin, cerebrolysin, semax, memoplant, etc. are indicated.

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

Acute hydrocephalus, as a life-threatening condition, requires urgent neurosurgical treatment. It consists in trepanation of the skull and the imposition of external drainage, providing an 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 common causes of acute hydrocephalus).

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

To date, the first place among invasive methods treatment came out less traumatic neuroendoscopic technique. It is still 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 an image using a projector and accurately control all manipulations. At the bottom of the third ventricle, an additional hole is created that connects to the cisterns of the base of the brain, which eliminates the cause of hydrocephalus. Thus, the physiological liquor flow between the ventricles and cisterns is restored, as it were.

Consequences

Hydrocephalus is a 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 long-term existence of hydrocephalus are irreversible.

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

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

MODERATE EXPANSION OF EXTERNAL CSF SPACES

I have already asked questions earlier that it’s hard for me to walk and sit starts to press in my head, if I don’t lie down, then the pulse increases to 182 and the pressure rises to 150/120, while the condition becomes pre-fainting, very bad.

1. What is it?

2. Could this be the cause of pressing pains in the head?

3. Is the moderate expansion of the external liquor spaces an independent disease or a consequence of something, for example, a high pulse or pressure?

4. How to deal with it?

On MRI images, there is a zone of CSF density (signal intensity) associated with the ventricle and (or) subarachnoid space. Their choroid plexus they are the main source of production of cerebrospinal fluid (CSF) into the subarachnoid space. The mechanism for the development of such changes is quite simple: the inflammatory process (often arachnoiditis) enhances the production of cerebrospinal fluid, which gradually stretches the subarachnoid space (liquor space.

It does not require any treatment, since this is a variant of the structure and development. For clarity, I am attaching a picture below:

Now for the description. MRI. Almost EVERYTHING in the description is in proportion to the norm and variants of the norm. THIS space is NOT expanded. A grimace of overdiagnosis, such a habit of SEEING this NORMAL space expanded.

General analysis of blood and urine.

Blood lipid spectrum (total cholesterol, LDL, HDL, triglycerides).

Creatinine (creatinine clearance or glomerular filtration rate), potassium, serum uric acid.

God bless you never have a reason to go to the doctor! And if you have to, then do not delay.

If you have symptoms, you need to see a neurologist and a cardiologist.

I still don’t understand my expansion of cerebrospinal fluid spaces can be the cause of pressing pains in my head?

or MRI did not establish the reason why I have pressure in my head?

today after mri

and still presses, yes, with an increase in pressure, it presses me, but even without it, too

and I have pressure in my head and the inadequacy of the pulse,

Or will it still show?

Unfortunately, no angiography images are visible. In general - by age - are you 43? Question about lifestyle and weight: how much do you weigh? bad habits? How much do you move per day and how much do you sleep? Is there a family - a wife and children.

Rather, your headaches are related to vascular dystonia or migraines on a hormonal background.

This is from vasoconstriction during a shift in body position. Better check your spine - for osteochondrosis of the cervical and other parts, and remember - when was the last time you ran. was there shortness of breath. If yes - the cardiologist will be not superfluous. It can be valves and weakness of cardiac blood flow.

Try to analyze everything and I wish you to be a healthy strong man!

Best wishes. All diseases begin in our head - that is, from the nerves. Psychology help!

Please tell me, since my pulse behaves inappropriately, increasing strongly with minor loads for a long time without decreasing, can this be a sign of autonomic neuropathy?

If autonomic neuropathy is suspected, what tests should be done? maybe some vitamins?

ENMG can show something, or is it only on peripheral nerves? or if the vegetative ones are affected, then the peripheral ones will also be affected?

On a series of brain MRI scans performed in T1, T2, FLAIR modes in axial, sagittal and coronary projections before and after contrast enhancement, images of sub- and supratentorial structures were obtained

In the frontal, temporal, occipital and parietal lobes of both hemispheres of the brain, periventricular and subcortical, in the subcortical regions on both sides, there are multiple hyperintense foci on T2-WI and FLAIR-IP, sized 11.0x7.0 mm and less, with a tendency to confluence, no evidence of contrast agent accumulation and perifocal edema. There is marked periventricular gliosis.

The median structures of the brain are not displaced. The basal cisterns are differentiated and distinct. The ventricular system is not expanded. The lateral ventricles are symmetrical, the contours are clear, even. The third ventricle is up to 4.1 mm wide. The fourth ventricle is 12.5 mm wide. corpus callosum, subcortical nuclei are usually formed. Subarachnoid convexital spaces are moderately dilated. The perivascular spaces of Virchow-Robin are expanded on both sides in the projection of the basal ganglia, in the white matter of the brain of the cerebral hemispheres. The pituitary gland with smooth contours, homogeneous structure, normal size. The funnel of the pituitary gland is located centrally. Chiasma is structural. The cerebellum, stem structures and substance of the spinal cord up to the level of the C3 vertebra without pathological changes. Cerebellar tonsils at the level of the foramen magnum. Cranio-vertebral transition without features. Moderately pronounced thickening of the mucous membranes of the maxillary sinuses, cells of the ethmoid bone. On the lower wall of the right maxillary sinus, a cyst with dimensions of 19.5x14.0 mm is determined. The nasal septum is smoothly curved to the right. The frontal sinuses are aplastic.

b Conclusion: MR signs of vascular encephalopathy. Moderately pronounced expansion of the external cerebrospinal fluid spaces of a substitutive nature. MRI signs of bilateral maxillary sinusitis, ethmoiditis. Cyst in the right maxillary sinus.

Liquor system of the brain

One of the causes of headaches and other brain disorders, lies in the violation of the circulation of cerebrospinal fluid. CSF is cerebrospinal fluid (CSF) or cerebrospinal fluid (CSF), which is a constant internal environment of the ventricles of the brain, the pathways along which the CSF passes and the subarachnoid space of the brain.

Liquor, often an invisible link human body performs a number of important functions:

• Maintaining Constancy internal environment organism
• Control over the metabolic processes of the central nervous system (CNS) and brain tissues
• Mechanical support for the brain
• Regulation of the activity of the arteriovenous network by stabilizing intracranial pressure and blood supply to the brain
• Normalization of the level of osmotic and oncotic pressure
• Bactericidal action against foreign agents, through the content in its composition of T- and B-lymphocytes, immunoglobulins responsible for immunity

The choroid plexus, located in cerebral ventricles, is the starting point for the production of liquor. Cerebrospinal fluid passes from the lateral ventricles of the brain through the foramen of Monro to the third ventricle.

The aqueduct of Sylvius serves as a bridge for the passage of cerebrospinal fluid into the fourth ventricle of the brain. After passing a few more anatomical formations, such as the foramen of Magendie and Luschka, the cerebellar-cerebral cistern, the Sylvian sulcus, enters the subarachnoid or subarachnoid space. This gap is located between the arachnoid and pia mater of the brain.

CSF production corresponds to a rate of approximately 0.37 ml / min or 20 ml / h, regardless of the intracranial pressure. General figures the volume of cerebrospinal fluid in the cavitary system of the skull and spine in a newborn child is ml, a child aged one year has 35 ml, and an adult is about ml.

Within 24 hours, the cerebrospinal fluid is completely renewed from 4 to 6 times, in connection with which its production during the day averages approx.

The high rate of CSF formation corresponds to the high rate of its absorption by the brain. The absorption of CSF occurs with the help of pachyon granulations - the villi of the arachnoid membrane of the brain. The pressure inside the skull determines the fate of the cerebrospinal fluid - with a decrease, its absorption stops, and with an increase, on the contrary, it increases.

In addition to pressure, the absorption of CSF also depends on the state of the arachnoid villi themselves. Their compression, blockage of the ducts due to infectious processes, leads to a cessation of the flow of cerebrospinal fluid, disrupting its circulation and causing pathological conditions in the brain.

Liquor spaces of the brain

The first information about the liquor system is associated with the name of Galen. The great Roman physician was the first to describe the membranes and ventricles of the brain, as well as the cerebrospinal fluid itself, which he mistook for a certain animal spirit. The CSF system of the brain aroused interest again only many centuries later.

The scientists Monroe and Magendie own the descriptions of the openings describing the course of the CSF, which received their name. Domestic scientists also had a hand in the contribution of knowledge to the concept of the CSF system - Nagel, Pashkevich, Arendt. In science, the concept of cerebrospinal fluid spaces appeared - cavities filled with cerebrospinal fluid. These spaces include:

• Subarachnoid - a slit-like cavity between the membranes of the brain - arachnoid and soft. Allocate cranial and spinal spaces. Depending on the attachment of a part of the arachnoid to the brain or spinal cord. The head cranial space contains about 30 ml of CSF, and the spinal space contains about 30 ml of CSF.
• Virchow-Robin spaces or perivascular spaces - the perivascular region of the brain and spinal cord, which incorporates part of the arachnoid
• The ventricular spaces are represented by the cavity of the ventricles. Disturbances in liquorodynamics associated with ventricular spaces are characterized by the concept of monoventricular, biventricular, triventricular
• tetraventricular, depending on the number of damaged ventricles;
• Cisterns of the brain - spaces in the form of extensions of the subarachnoid and pia mater

CSF spaces, CSF pathways, as well as CSF-producing cells are united by the concept of the CSF system. Violation of any of its links can cause disorders of liquorodynamics or liquorocirculation.

CSF disorders and their causes

The emerging liquorodynamic disturbances in the brain are referred to such conditions in the body in which the formation, circulation and utilization of CSF is disturbed. Disorders can occur in the form of hypertensive and hypotensive disorders, with characteristic intense headaches. The causative factors of liquorodynamic disorders include congenital and acquired.

Among congenital disorders, the main ones are:

• Arnold-Chiari malformation, which is accompanied by a violation of the outflow of cerebrospinal fluid
• Dandy-Walker malformation, the cause of which is an imbalance in the production of cerebrospinal fluid between the lateral and third and fourth cerebral ventricles
• Stenosis of the cerebral aqueduct of primary or secondary origin, which leads to its narrowing, resulting in an obstacle to the passage of CSF;
• Agenesis of the corpus callosum
• Genetic disorders of the X chromosome
• Encephalocele - a craniocerebral hernia that leads to compression of brain structures and disrupts the movement of cerebrospinal fluid
• Porencephalic cysts that lead to hydrocephalus - hydrocele of the brain, impeding the flow of CSF fluid

Among the acquired causes, there are:

Already in the period of a week of pregnancy, one can judge the state of the baby's cerebrospinal fluid system. Ultrasound at this time allows you to determine the presence or absence of pathology of the fetal brain. Liquorodynamic disorders are divided into several types depending on:

• The course of the disease in the acute and chronic phase
• The stages of the course of the disease are a progressive form that combines the rapid development of abnormalities and an increase in intracranial pressure. Compensated form with stable intracranial pressure, but an expanded cerebral ventricular system. And subcompensated, which is characterized by an unstable state, leading, with minor provocations, to liquorodynamic crises
• CSF locations in the brain cavity are intraventricular, caused by stagnation of CSF inside the ventricles of the brain, subarachnoid, encountering difficulty in CSF flow in the arachnoid of the brain, and mixed, combining several different points of impaired CSF flow
• CSF pressure level on - hypertensive type associated with high intracranial pressure, normotensive - with optimal intracranial pressure, but there are causative factors for violations of liquor dynamics and hypotensive type, accompanied by reduced pressure inside the skull

Symptoms and diagnosis of liquorodynamic disorders

Depending on the age of the patient with impaired liquorodynamics, the symptomatic picture will be different. Newborn babies under the age of one year suffer from:

• Frequent and profuse regurgitation
• Sluggish overgrowth of fontanelles. Increased intracranial pressure leads, instead of overgrowth, to swelling and intense pulsation of large and small fontanels
• The rapid growth of the head, the acquisition of an unnatural elongated shape;
• Spontaneous crying for no apparent reason, which leads to lethargy and weakness of the child, his drowsiness
• Twitching of the limbs, tremor of the chin, involuntary shuddering
• A pronounced vascular network in the nose of the child, on the temporal region, his neck and at the top of the chest, which manifests itself in the tension of the baby when crying, trying to raise his head or sit down
• Motor disorders in the form of spastic paralysis and paresis, more often lower paraplegia and less often hemiplegia with increased muscle tone and tendon reflexes
• Late onset of functioning of head holding capacity, sitting and walking
• Converging or divergent strabismus due to oculomotor nerve block

Children aged more than a year begin to experience symptoms such as:

• Increased intracranial pressure leading to bouts of severe headache, more often in the morning, accompanied by nausea or vomiting that does not relieve
• Rapidly changing apathy and restlessness
• Coordination imbalance in movements, gait and speech in the form of its absence or difficulty in pronunciation
• decline visual functions with horizontal nystagmus, as a result of which children cannot look up
• "Bobbling Doll Head"
• Intellectual developmental disorders, which may have minimal or global severity. Children may not understand the meaning of the words they say. With a high level of intelligence, children are talkative, prone to superficial humor, inappropriate use of loud phrases, due to difficulty in understanding the meaning of words and mechanical repetition of easily remembered. Such children have increased suggestibility, lack initiative, are unstable in mood, often in a state of euphoria, which can easily be replaced by anger or aggression.
• Endocrine disorders with obesity, delayed puberty
• Convulsive syndrome, which becomes more pronounced over the years

Adults more often suffer liquorodynamic disorders in the hypertensive form, which manifests itself in the form of:

• High pressure figures
• severe headaches
• Periodic dizziness
• Nausea and vomiting that accompany the headache and do not bring relief to the patient
• Cardiac imbalance

Among the diagnostic studies for violations in liquorodynamics, there are such as:

• Examination of the fundus by an ophthalmologist
• MRI (magnetic resonance imaging) and CT (computed tomography) - methods that allow you to get an accurate and clear image of any structure
• Radionuclide cisternography based on the study of brain cisterns filled with cerebrospinal fluid by means of labeled particles that can be traced
• Neurosonography (NSG) is a safe, painless, not time-consuming study that gives an idea of ​​the picture of the brain ventricles and CSF spaces.

What is the subarachnoid space and why does it expand

The human brain is one of the most complex and little-studied organs, which is forced to constantly work. For its normal functioning, it needs proper nutrition and blood supply.

The human brain consists of three membranes: soft, hard and arachnoid. The subarachnoid space is the space between the pia mater and the arachnoid. The arachnoid membrane envelops the brain; it communicates with other tissues by the subarachnoid junction.

They form the ventricular system of the spinal cord and brain, consisting of four tanks in which fluid circulates.

The subarachnoid space is filled with cerebrospinal fluid, or cerebrospinal fluid, which is responsible for nourishing and protecting the brain. A favorable environment is created for the interchange of useful substances between the blood and the human brain, the movement of nutrients to the nerve endings and ventricles.

The end products of tissue metabolism are thrown into the cerebrospinal fluid and excreted. It constantly circulates in the brain cavity.

Up to 140 million CSF cells must be present in the subarachnoid space, which flows out of the brain through an opening in the fourth ventricle. Its maximum volume is contained in the cisterns of space located above the large crevices and furrows of the brain.

Anatomical reference - membranes and spaces of the brain:

Why is the subarachnoid space enlarged

Failures in the circulation of CSF cause infectious diseases of the central nervous system, chronic diseases, meningitis, encephalitis, tumors or birth trauma. This leads to a decrease in the amount of gray and white matter in the brain, and as a result, the subarachnoid space expands.

An enlarged subarachnoid space indicates a malfunction in the circulation of liquor, its excessive production and entry into the brain cavities occurs, that is, hydrocephalus or dropsy develops and, as a result, increased intracranial pressure is noted.

If there is a benign local expansion of the subarachnoid spaces, the ventricles are slightly dilated or are within the normal range, then the violation resolves on its own in one or two years and does not harm the health of the baby.

But you can’t just hope for a favorable outcome of the disease, you need to contact a neurologist who will prescribe the necessary treatment.

The expansion of the subarachnoid spaces of the brain in adults can cause the following reasons:

These factors contribute to the start of the process of atrophy, the amount of white and gray matter decreases, contributing to the expansion of the subarachnoid space.

Degrees of expansion

Expansion of the subarachnoid space is of three degrees:

The expansion of the cerebrospinal fluid spaces occurs in proportion to the growth of the head of the newborn and the swelling of the fontanel.

The course and outcome of the disease depends on timely seeking medical help and initiation of treatment. If the treatment is chosen correctly, then the change in the ventricles remains almost within the normal range.

Features of the clinical picture

The following symptoms will help to suspect abnormalities in the functioning of the brain and the expansion of the subarachnoid space in a newborn baby:

• irritability to moderate or low sounds, noises;
• increased sensitivity to light;
• profuse regurgitation;
• disturbed sleep;
• pupils of different sizes or strabismus;
• an increase in the size of the head;
• anxiety about changing weather;
• the fontanel slowly overgrows and its swelling is present;
• trembling of limbs and chin.

The fact that the subarachnoid spaces are expanded in an adult is characterized by the following symptoms:

• headache after waking up in the morning;
• nausea and vomiting, as a result of a severe headache that disappears after vomiting;
• dizziness;
• drowsiness, a dangerous symptom of intracranial pressure, reporting the progression of the disease;
• visual impairment;
• dementia, observed after receiving a head injury, sleep is disturbed, a person confuses day with night, memory lapses occur;
• apraxia of walking, the patient in the supine position shows how to walk, but when getting up he sways, shuffles, walks with his legs wide apart.

Methods and goals of diagnosis

It is possible to diagnose the disease only after a comprehensive examination and laboratory tests. After receiving the results of magnetic resonance or computed tomography, the results of blood biochemistry, ultrasound hemispheres of the brain, assessing the symptoms and behavior of the patient, the neuropathologist will establish the final diagnosis, the degree of the disease and prescribe medication.

Basic diagnostic methods:

1. Neurosonography. It lasts no more than fifteen minutes, is carried out using an ultrasonic sensor through an open fontanelle on the head of a newborn. The study can be carried out quite often, without negative consequences for the child. As a rule, neurosonography is done for all newborns in the maternity hospital to detect pathologies in the development of the brain at the initial stage. The neuropathologist or pediatrician deciphers the examination data. Only by comparing the symptoms and examination data, the doctor can make a diagnosis.
2. Computed and magnetic resonance imaging are very expensive research methods and are carried out when serious abnormalities are detected. As a rule, for newborns, it is enough to conduct neurosonography through the fontanel, but adults already need more serious diagnostic methods. Today, these are the most reliable and accurate methods for studying the human body. MRI allows you to see a layered image of the desired part of the brain. Examination of infants is very problematic, since it requires complete fixation and the adoption of a stationary state, which is very problematic for young children. If the baby needs this type of examination, it is carried out under anesthesia.
3. Cisternography is used to determine the direction of the cerebrospinal fluid and clarify the type of hydrocephalus.
4. Angiography is a method of examination when contrast is injected into an artery and deviations in the patency of blood vessels are detected.
5. Neuropsychological examination - examination and questioning of the patient, collection of all analyzes and studies together, to identify violations in the functioning and functioning of the brain.

Health care

Treatment of the enlarged subarachnoid space is aimed at eliminating the causes and factors that provoked the disease. Basic therapy includes vitamins, especially B and D groups, and antibiotics if infection is present.

Treatment is long and is prescribed for each patient individually.

The main drugs include:

• diuretics, to remove excess fluid from the body (Veroshpiron, Diakarb);
• potassium-containing preparations (Asparkam);
• means for improving brain trophism (Pantogam, Cavinton);
• vitamins of groups B and D;
• painkillers after injury and with tumors (for example, Ketonal, Nimesil, Ketoprofen, Nimesulide);
• barbiturates (Nembutal, Phenobarbital, Amital);
• saluretics (Acetazolamide, Furosemide, Ethacrynic acid);
• glucocorticosteroid drugs (Prednisalone, Dexamethasone, Betamethasone).

If the disease progresses rapidly and the subarachnoid cavity enlarges, then the main therapy will be to find the cause of the causing disorder, if it is hydrocephalus, diuretics are used, and antibacterial drugs are used to treat infections.

Hydrocephalus as a common complication

In severe cases of the disease, when medications and physical procedures did not bring the desired result, surgical treatment is indicated.

Hydrocephalus is an extremely dangerous disease that can cause blindness or decreased vision, impaired speech, and lag in the development of the child.

The principles and methods of treatment of the disease are carried out for a long time and are selected individually for each patient. Treatment will depend on the nature, severity and complications. The main task is to restore normal circulation and outflow of CSF from the supracerebral region, which will lead to the normalization of intracranial pressure, which will make it possible to improve and restore the metabolism of cells and tissues of the nervous system.

Physioneuropological procedures are also prescribed in the complex, which reduce the symptoms of the disease and speed up the healing process.

Why is it dangerous?

Launched expansion of subarachnoid convexital spaces and its untimely treatment in infants can lead to more serious complications:

Timely diagnosis and treatment will reduce the risk or eliminate the complications of the disease, contribute to the favorable course and outcome of the disease, so that it will not affect the functioning, vital activity and physical development of the child and, as a rule, disappears by the age of two.

Preventive measures

Prevention should be done by a woman (future parents) even before conception. Before conception, conduct a complete examination of the body to identify chronic and infectious diseases, if any, treat them, follow the doctor's recommendations during pregnancy, protect yourself from stress and behave correctly during childbirth.

After the birth of the baby, monitor his behavior to prevent injury.

The expansion of the subarachnoid space in adults is diagnosed very rarely, but in order to prevent its occurrence, it is necessary to avoid traumatic brain injuries and monitor your health.

This section was created to take care of those who need a qualified specialist, without disturbing the usual rhythm of their own lives.

The subarachnoid space of the brain and spinal cord communicate directly with the ventricles of the brain, forming a series of communicating vessels.