Dropsy of the brain
The content of the article:
- Causes
- Forms
- Symptoms
- Features of the course of dropsy of the brain in infants
- Diagnostics
- Treatment
- Prevention
- Consequences and complications
Dropsy of the brain is a progressive pathological condition characterized by the accumulation of large volumes of cerebrospinal fluid (cerebrospinal fluid) in the ventricles, cisterns and subarachnoid space. Decompensated dropsy of the brain, accompanied by compression of the brain structures and a persistent increase in intracranial pressure, can lead to severe neurological deficit and severe disability of the patient.
An external sign of dropsy of the brain in a newborn
Causes
Normally, cerebrospinal fluid is produced in the choroid plexuses of the ventricles, gradually moving into the subarachnoid space of the brain and spinal cord. Subsequently, part of the cerebrospinal fluid enters the spinal canal, part is absorbed into the bloodstream, and the residual amount returns to the ventricular system. Dropsy of the brain is a consequence of a malfunction of one or more elements of the cerebrospinal fluid-producing system:
- excessive secretion of cerebrospinal fluid;
- violation of the cerebrospinal fluid flow inside the ventricular system;
- violation of the absorption of cerebrospinal fluid.
According to statistics, dropsy of the brain is most often diagnosed in newborns and infants in the first three months of life. The spread of pathology is 1: 500. Congenital hydrocephalus occurs for various reasons:
- infectious diseases transferred by the mother during pregnancy: toxoplasmosis, cytomegalovirus infection, syphilis, mumps, rubella, primary herpesvirus infection;
- malformations and anomalies of the central nervous system and cerebral vessels;
- birth trauma, accompanied by hemorrhages in the ventricular system or subarachnoid space and post-traumatic meningitis;
- congenital tumors and cysts of the brain.
Infectious diseases transferred by a woman during pregnancy can cause dropsy of the brain in a newborn
Under certain circumstances, dropsy of the brain can develop in older children and in adult patients. The provoking factors include:
- inflammatory processes in the brain and its membranes;
- chronic infectious diseases;
- damage to the brain substance by parasites;
- severe intoxication;
- neoplasms and metastases in the brain;
- traumatic brain injury;
- neurosarcoidosis;
- cerebral vascular malformations;
- hemorrhages in the ventricular system and subarachnoid space.
Statistical studies reveal a direct relationship between dropsy of the brain in adults and hypertension, degenerative-dystrophic pathologies of the cervical spine, alcohol abuse, smoking and sclerotic changes in the cerebral arteries.
With atrophy of the nervous tissue, replacement hydrocephalus often develops - filling the free space inside the skull with liquor.
Forms
A branched multi-stage classification of forms of organic brain damage in hydrocephalus is guided by a number of parameters, including the specificity of pathogenesis, the location of CSF accumulation, the severity of the course and the rate of progression.
Based on the nature of violations of the circulation of cerebrospinal fluid, there are three categories of dropsy of the brain:
- open, or communicating - characterized by difficult absorption of the cerebrospinal fluid into the bloodstream in the absence of obstacles to the cerebrospinal fluid and a persistent compensatory increase in intracranial pressure, which leads to an expansion of the cerebrospinal fluid spaces and a gradual thinning of the nervous tissue;
- hypersecretory - occurs against the background of excess production of cerebrospinal fluid;
- closed, obstructive or occlusive - due to a violation of the circulation of the intraventricular system due to obstacles that limit the movement of cerebrospinal fluid from the ventricles into the cisterns and subarachnoid spaces.
Occlusive hydrocephalus on x-ray
Depending on the localization of the obstacle to the outflow of cerebrospinal fluid, closed dropsy of the brain manifests itself in different ways. So, when one of Monroe's holes becomes infected, dropsy of one ventricle develops; overlapping of both openings leads to the development of hydrocephalus of both lateral ventricles. With a narrowing of the aqueduct of the brain, dropsy of the third ventricle joins the lesion of the lateral ventricles. In the case of blockage of the holes of Magendie and Lyushka, cerebrospinal fluid accumulates in all cerebrospinal fluid structures.
Open hydrocephalus, in turn, is divided into internal and external. With internal dropsy of the brain, excess cerebrospinal fluid is retained in the ventricular system, and with external dropsy, in the subarachnoid spaces. Open external dropsy, as a rule, is of a substitutional nature.
The hypersecretory form is characterized by the simultaneous accumulation of cerebrospinal fluid in all CSF structures.
Depending on the time of manifestation, a distinction is made between primary (congenital) and secondary (acquired) hydrocephalus. Congenital usually appears in the first three months of life; acquired - in children over two years of age and adults. In the course of monitoring the dynamics of the pathological process, compensated, subcompensated and decompensated hydrocephalus are distinguished. A vivid clinical picture of hypertensive-hydrocephalic syndrome is observed only in the case of decompensated course.
Acquired hydrocephalus takes three forms:
- acute - 2-3 days pass from the first signs to the stage of decompensation;
- subacute - clinical manifestations are recorded throughout the month;
- chronic - lasts from 3-4 weeks to six months or more.
According to the observations of neurologists, closed dropsy of the brain usually proceeds acutely, while chronic and subacute course is inherent in open varieties of this pathology.
Symptoms
Compensated hydrocephalus is asymptomatic and does not bother the patient. Decompensated dropsy of the brain in adults and older children is characterized by severe neurological symptoms caused by compression of the brain and a persistent increase in intracranial pressure.
Typical manifestations of intracranial hypertension include:
- headaches without clear localization and a feeling of heaviness in the head, aggravated in the morning and in the supine position;
- pressing pain in the eyes;
- nausea and vomiting in the morning;
- attacks of hiccups;
- dark circles under the eyes caused by capillary dilation;
- constant sleepiness and persistent yawning;
- impairment of memory and coordination of attention;
- fatigue and apathy;
- decreased intellectual productivity;
- autonomic disorders: drops in blood pressure, sweating, tachycardia or bradycardia, light-headedness.
One of the symptoms of dropsy of the brain is headaches without a clear localization
A characteristic sign of infringement of the brain structures is vestibular ataxia - a combination of dizziness, unsteadiness of gait, tinnitus and nystagmus. With closed dropsy with impaired outflow of cerebrospinal fluid in the posterior fossa, cerebellar ataxia is observed - a complex violation of gait, coordination of movements and fine motor skills. Open hydrocephalus can be accompanied by seizures and respiratory failure. Other neurological symptoms are present at the same time:
- increased muscle tone and spastic contractures of the limbs;
- paralysis, paresis and paraparesis;
- hyperkinesis and tics;
- apraxia of walking;
- weakening of all types of sensitivity and an increase in the pain threshold;
- decreased visual acuity and hearing;
- exotropia;
- defocused gaze;
- a symptom of the setting sun - the eyes are constantly lowered down, and a wide area of the sclera is visible from above;
- oculomotor disorders, in particular the Greve symptom - when the eyeballs move to the side and down, a strip is visible between the pupil and the eyelid;
- drooping of the eyelids;
- blurry vision, double vision;
- narrowing of the field of view;
- dilated pupils with loss of reaction to light;
- urinary incontinence;
- emotional instability;
- sharp mood swings ranging from euphoria to depression and aggression.
Sometimes the companions of hydrocephalus are metabolic disorders - obesity, hypothyroidism and diabetes insipidus.
Features of the course of dropsy of the brain in infants
In children under two years of age, closed forms of hydrocephalus prevail, due to congenital defects of the central nervous system and blood vessels of the brain. The most common pathologies are:
- Dandy-Walker syndrome - clogging of the holes of Magendie and Lyushka, through which cerebrospinal fluid flows from the ventricles into the cisterns and subarachnoid spaces;
- Chiari Syndrome - excess volume of the brain that exceeds the capacity of the cranium;
- congenital basilar compression;
- Adams syndrome - narrowing of the aqueduct of the brain;
- aneurysm of the great vein of the brain.
Dropsy of the brain in children can be recognized by the characteristic shape of the skull.
Severe dropsy of the brain in newborns is recognized by the characteristic shape of the skull with a disproportionately large forehead and overhanging brow ridges. A rapid increase in head circumference - by 1.5 cm or more in 30 days for 2-3 months in a row, bulging fontanelles, thinning of the cranial bones and scalp, expansion of visible cerebral veins and pulsating protrusions in the open sutures of the skull should also alert parents. With a prolonged course, decompensated dropsy of the brain in a child under two years old is accompanied by symptoms of infringement of the brain and a persistent increase in intracranial pressure:
- delayed psychomotor development or loss of previously acquired skills;
- downward shift of one or both eyes;
- frequent throwing back of the head;
- muscle hypertonia;
- poor appetite;
- frequent vomiting and regurgitation;
- paresis of the abducens nerves;
- Difficulty straightening the legs;
- convulsions, tremors and hyperkinesis;
- weakness and apathy;
- neurasthenic disorders: lethargy, abnormal lethargy, drowsiness or anxiety, constant crying and increased excitability.
Diagnostics
The identification of characteristic signs during the examination by a neuropathologist gives reason to suspect hydrocephalus. To refine the diagnosis, it is required to consult an ophthalmologist and examine the fundus to detect edema of the optic nerve discs, as well as an MRI of the brain. The main criteria for MRI diagnostics of hydrocephalus are:
- an increase in the volume of cerebrospinal fluid at a rate of 120 to 150 ml for an adult;
- ventricular index from 0.5 and higher;
- periventricular edema.
With a long course of dropsy of the brain, serious damage to the brain structures is found - increased digital indentations and destruction of the sella turcica.
According to the indications, angiography of the cerebral arteries is performed.
Angiography of the cerebral arteries can be done to diagnose dropsy in the brain.
When screening children under one year old, neurosonography is widely practiced - ultrasound of the skull through an open fontanelle. Identification of abnormalities is the basis for referring the child to an MRI.
In order to exclude overdiagnosis of hydrocephalus in adults and older children, dynamic observation of the patient and MRI control for 6–12 months is of decisive importance, and in children under one year old - periodic measurements of the head circumference and control neurosonography every 4–6 weeks. If a progressive increase in CSF structures is not observed, the diagnosis is not confirmed.
Treatment
In the absence of clinical manifestations, hydrocephalus does not require treatment. When signs of neurological deficit appear, surgical intervention is indicated. Endoscopic techniques are the gold standard in neurosurgery. In favor of neuroendoscopic operations, there is a minimal risk of complications, a short recovery period, a relatively low cost and the absence of the need for revision in the treatment of children.
The most commonly used method is endoscopic ventriculocisternotomy of the fundus of the third ventricle, which restores natural cerebrospinal fluid from the ventricular system to cisterns and subarachnoid spaces. It is also possible to perform endoscopic septostomy, aqueductoplasty and removal of neoplasms from the ventricular system. If a shunt was previously installed in the child, ventriculocisternotomy will help eliminate postoperative complications and achieve shunt independence.
The gold standard for surgical treatment of dropsy of the brain is the method of endoscopic ventriculocisternotomy of the fundus of the third ventricle
Drug treatment is ineffective. Taking nootropics and stimulants of cerebral circulation, at best, slows down the progression of hydrocephalus. To reduce intracranial pressure, diuretics may be prescribed before surgery.
Prevention
Prevention of dropsy of the brain should begin at the planning stage of pregnancy. A woman is recommended to be tested for latent infections and, if necessary, undergo a course of treatment. During gestation, it is necessary to avoid infectious diseases and not take strong medications without consulting a doctor. Timely scheduled check-ups prevent complications of childbirth and birth trauma in newborns. In order to prevent hydrocephalus in adulthood, one should give up bad habits, lead a healthy lifestyle, and control blood pressure.
Consequences and complications
With timely treatment, dropsy of the brain in a child does not worsen the quality of life. A few consequences of compensated hydrocephalus are minor speech impairments and decreased visual acuity. In chronic decompensated hydrocephalus, the prognosis is less favorable: there is a likelihood of developing dementia, gross ataxic disorders and blindness due to optic nerve atrophy. With the rapid progression of dropsy, the possibility of death is not excluded.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
