Why brain hydrocephalus occurs: early diagnosis, treatment and prognosis
- 1 Hydrocephalus
- 2 Causes and mechanism of development
- 3 Kinds
- 4 Symptoms
- 5 Diagnostics
- 6 Treatment
- 7 Effects
- 8 Conclusion
Under normal conditions, the function of the cerebrospinal fluid (CSF) is to protect the brain from strokes, infections, its nutrition and blood supply. However, in hydrocephalus (dropsy), an excess of this fluid occurs, leading to brain damage and death.
The disease occurs both in the prenatal period and after birth in a person of any age. The beginning of its development depends only on the time of action of pathogenic factors.
Causes and mechanism of development
Inside the skull is the brain, blood and cerebrospinal fluid. In normal condition, the balance between these three components is maintained. Any violation of it leads to the development of complex pathologies. Thus, an increase in the volume of cerebrospinal fluid squeezes blood vessels and the brain, leads to disruption of blood supply, tissue death, increased blood pressure. Hemorrhage in turn leads to disruption of the outflow of liquor, its accumulation.
The basis of the development of hydrocephalus is just the excess of cerebrospinal fluid. It is formed in the four cerebral ventricles, while up to 70% is produced in the glands, the remainder is sweating of the liquid component of the blood through the walls of blood vessels. The cerebrospinal fluid moves from the ventricles to the subarachnoid cavity, which expands and forms brain tanks.
From these cavities it gets to the outer surface of the brain, and later absorbed through the villi located in the area of the venous sinuses. Normally, the amount of liquor produced (on average in an adult is 150 ml) corresponds to the intake.
However, in any of these areas there may be obstructions or disturbances leading to an excessive content of cerebrospinal fluid – hydrocephalus.
The disease is caused by the following reasons:
- Inflammation of the brain and its membranes. This group may include meningitis, encephalitis, tuberculosis.
- Blood supply failure. Hydrocephalus develops as a result of hemorrhage in the brain, the appearance of a blood clot, rupture of the protrusion of the vessel (aneurysm).
- Neoplasm. Regardless of their nature – benign or malignant, they lead to blocking the circulation of liquor.
- Intoxication. The action of alcohol, drugs, heavy metal salts.
- Injuries. This group includes not only craniocerebral injuries that led to swelling of the brain, destruction of blood vessels, but also the consequences after operations.
- Diseases of the central nervous system.
- Infectious diseases. This is rubella, syphilis.
- Age changes. Substitution hydrocephalus is associated precisely with how the body and its tissues change with age.
Analysis of the disease allows to identify the main factors that characterize its course and form: the period of occurrence, the speed and mechanism of development, the level of intracranial pressure, location, the severity of symptoms.
Period of occurrence
The appearance of signs of dropsy in prenatal development or within three months in a newborn suggests a congenital disease.
Acquired disease occurs due to the action of pathogenic factors that appeared after birth. It can be parasites, neoplasms, cysts, hemorrhages, inflammatory processes.
The appearance of signs of hydrocephalus, their development within 3 days indicates an acute form. During this period, the first manifestations of the disease lead to a profound brain damage.
If their occurrence stretches to 3-4 weeks, they say about the subacute progressive form. The slow increase of symptoms for six months or more, their weakness indicates a chronic form.
Depending on the cause leading to the appearance of dropsy, there are several types of this disease. With a closed (not communicating) current of the cerebrospinal fluid is disturbed due to the occurrence of an obstacle in its path. This may be a blood clot, spike, neoplasm, narrowing of the aqueduct. Liquor accumulates in this place and leads to an increase in intracranial pressure and an increase in ventricular size. Another name for this form is occlusive.
Open (disresponsive) hydrocephalus appears due to impaired absorption processes, while the process of production of CSF is preserved. Elimination of imbalance occurs due to an increase in ICP. It occurs mainly due to hemorrhage, inflammation or the appearance of metastasis.
When hypersecretory cerebrospinal fluid is produced too much, there is a surplus.
According to the latest data, the replacement external form is not brain hydrocephalus. The content of cerebrospinal fluid increases in the subarachnoid cavity and ventricles, as in dropsy. Pathology arises as a secondary, compensating phenomenon caused by processes associated with the brain: its atrophy and size reduction. Liquor as it replaces the gray matter. This allows us to conclude that the mixed form is not dropsy.
The data obtained as a result of the measurement indicate normal, reduced and increased intracranial pressure. In the first case, we are talking about normotensive hydrocephalus, in the second – about hypotensive, in the third – about hypertensive.
The place of accumulation of cerebrospinal fluid allows us to talk about external, internal and mixed dropsy.
In the first variant, the cerebrospinal fluid accumulates in the subarachnoid space. The main cause is the death of the nervous tissue. Internal occurs when there is excess fluid in the cerebral cisterns and ventricles. With mixed hydrocephalus, an increased volume of liquor accumulates at all points.
Depending on the location, the diagnosis is determined, for example, “external hydrocephalus of the subarachnoid space”.
The severity of symptoms
Obvious, bright manifestations indicate severe hydrocephalus. Mild, sometimes disappearing symptoms speak of moderate external hydrocephalus.
The main signs of hydrocephalus are pain in the head, visual impairment, nausea, often accompanied by vomiting, emotional, cognitive, motor impairment.
There are several stages in the development of the disease, each of which has its own symptoms, and the previously discovered ones acquire new features:
- The first stage. The main symptom is weak, not constant pain in the head, weakness, malaise, dizziness. Perhaps the appearance of darkening, mist in the eyes. A person feels weak, tired. This stage is characterized by moderate hydrocephalus.
- Second stage Pain in the head increases, it becomes especially noticeable after a night’s rest, physical activity, coughing, sneezing. A bursting skull feeling appears. In the eyes may appear spots of color, flash. There is a feeling that something is pressing on them from the inside, a squint appears. Swollen face. Often there is nausea, accompanied by vomiting, and their appearance is not associated with food. A slight tendency to fatigue in the first stage is replaced by a constant feeling of fatigue and weakness. A person becomes dissatisfied, nervous, irritable, aggressive. Violated gait, coordination. A feeling of numbness in the arms and legs appears, and this sensation is gradually replaced by the inability to move them – paralysis develops. The patient loses the ability to express his thoughts and perceive what was said in his address. Signs of dementia appear.
- The third stage. At this stage, epileptic seizures appear, often loss of consciousness, involuntary urination and defecation. There is a complete loss of intelligence, memory, self-care skills. The patient loses the ability to walk, perhaps the appearance of chaotic movements, complete or partial paralysis. Swallowing is impaired. Inhibits the work of the heart and respiratory system.
Dropsy of the brain, especially in the first stage, is diagnosed only after all the necessary research has been done. Before prescribing them, the doctor collects data on the history of the disease, possible provoking factors, conducts tests of reflexes, tests. All this allows you to specify the degree of brain damage.
If an increased intracranial pressure is suspected, lumbar puncture is made. This operation allows you to measure pressure, take a sample of cerebrospinal fluid, analyze its composition, color, and identify the cause of the disease.
For instrumental examination prescribed computed tomography with the introduction of a contrast agent. During its implementation, the device makes a series of images that help determine the organic lesions of various parts of the brain, the presence of hematomas, tumors, signs of vascular pathologies. Separately, a CT cisternography can be performed. During this study, a contrast agent is injected into the cerebrospinal fluid, which allows you to see its movement in all areas.
Using magnetic resonance imaging determine the stage of hydrocephalus, its cause, shape.
To clarify the changes in various parts of the brain, echoencephalography is performed, which allows you to obtain information about the third ventricle, the displacement of the trunk, the content of the cerebrospinal fluid.
If necessary, carried out angiography – the study of cerebral vessels.
An important method for determining the disease is an ophthalmologic examination. It helps to check the end of the optic nerve, pulsation in the vessels of the eye, hemorrhage, and other signs of intracranial pressure.
In the initial stages, hydrocephalus can be treated with drugs, in case of acute or advanced form, surgical treatment is indicated. Folk remedies relieve symptoms only.
Drug treatment is aimed at reducing the pressure of the cerebrospinal fluid, restoration of blood supply and nutrition of the brain. It includes:
- Diuretic drugs. These medicines reduce the level of fluid in the body. Use Diacarb, Furosemide.
- Preparations containing potassium. They are prescribed to replenish the potassium content in the body. In particular, use Asparkam.
- Painkillers Aimed at reducing the intensity of pain in the head. This may be Nurofen, Ketorolak.
- Nootropic Drugs of this class help restore blood supply. Appointed Pantogam, Noofen.
- Hormonal. Prednisolone, Dexamethasone relieve swelling and inflammation.
If necessary, take urgent measures, the ineffectiveness of conservative therapy operations.
Shunting involves the installation of a special catheter with a valve and tubes. With an increase in intracranial pressure, the opening valve promotes the output of cerebrospinal fluid into the abdominal cavity. In children due to the constant growth of the operation is carried out repeatedly.
Endoscopic surgery is performed if shunting has resulted in complications or after injuries. In the bottom of the ventricle make a hole and connect it with the tank. This allows you to restore the outflow of cerebrospinal fluid.
As a means of improving the removal of fluids from the body, use cranberry or cranberry juice. To prepare them, take 2 tablespoons of berries and 30 grams of sugar for a glass of water. The mixture is boiled, cooled and drunk.
The broth from the hips can be prepared from 100 g of the fruits of this plant and a liter of water. Take 100 g three times a day.
Dill decoction will help not only to get rid of excess fluid, but also reduce blood pressure. In half a liter of water boil a teaspoon of seeds and the same amount of greens. Seeds can be taken dry in half a spoonful.
In a water bath, a decoction of nettle leaves is prepared. To do this, take 1 liter of water and 4 tablespoons of the plant.
The prognosis regarding how much people live with dropsy depends on its shape, transience and the timeliness of the start of treatment. In time, the detected external hydrocephalus of the brain, to a slight degree, makes it possible to preserve a person’s ability to work, intellect.
Launched stage, improper treatment, rapid development leads to irreversible organic changes. They, in turn, lead to the development of epilepsy, dementia, disruption of the heart, paralysis, and in some cases coma and death.
Hydrocephalus occurs due to excess production of cerebrospinal fluid, the occurrence of obstacles in its path and violation of suction. Develops in acute and chronic form. Used for the treatment of drugs, surgery. With timely initiated therapy, the prognosis is favorable.