The brain and spinal cord are constantly washed by a fluid called cerebrospinal fluid.
Thanks to cerebrospinal fluid, the brain is protected from all kinds of damage:
- the liquid creates a kind of “airbag”
- shock absorbing strokes.
This is not the only function of cerebrospinal fluid:
- it also delivers nutrients to the tissues,
- supports microenvironment,
- contributing to the normal functioning of the thinking organ, etc.
- Liquor is produced from the blood.
Normally, cerebrospinal fluid is in a state of constant circulation: cerebrospinal fluid is produced and absorbed in such a way that its total volume remains unchanged.
In some cases, fluid stagnates, accumulating in the ventricles of the brain or under its shells. It is a violation of circulation that becomes the cause of the development of hydrocephalus.
In this case, an increase in the volume of produced cerebrospinal fluid and a violation of the process of its absorption can cause pathology.
Hydrocephalus (dropsy of the brain) (from the group “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 communicating with each other, filled with cerebrospinal fluid (cerebrospinal fluid). These cavities are called ventricles.
The ventricular system consists of two lateral ventricles, which connect to the slit-like third ventricle (III ventricle), which, in turn, connects to the fourth ventricle (IV ventricle) through the thin canal (Silvia water supply). Liquor is produced in the vascular plexuses of the ventricles and moves freely from the lateral to the IV ventricle, and from it into 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.
In the same place, it is re-absorbed into the bloodstream. Liquor is a clear, colorless liquid that looks very similar to water and contains a small amount of cells, protein and salts. In a baby, the amount of cerebrospinal fluid is about 50 ml, in a teenager and 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 violation in the system of cerebrospinal fluid production, cerebrospinal fluid 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.
- Hydrocephalus in children up to a year: signs, causes and treatment
- Varieties of hydrocephalus
- Symptoms and signs
- A bit of anatomy and physiology
- Hydrocephalus in newborns – diagnosis, treatment, precautions
- Therefore, it is important to monitor the condition of the baby in the dynamics.
- How is hydrocephalus formed?
Hydrocephalus in children up to a year: signs, causes and treatment
The causes of hydrocephalus are very diverse and largely depend on the age of the child.
- Hydrocephalus in the fetus. Modern types of prenatal diagnosis (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 undergo research for these infections, which often proceed secretly, and treat them. This will avoid many health problems of the baby. In rare cases, hydrocephalus is caused by genetic disorders.
- 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. In approximately 20%, hydrocephalus is a consequence of birth trauma, especially in premature babies, which is accompanied by intracerebral or intraventricular hemorrhage and associated meningitis (inflammation of the meninges), which leads to impaired cerebrospinal fluid absorption. It is extremely rare at this age to detect tumors and vascular malformations of the brain, which can also cause the development of dropsy.
- Hydrocephalus in babies and older children (1-2 years old and older). The reasons for the development of hydrocephalus in such children are many. These include tumors of the brain and spinal cord; the effects of meningitis, encephalitis (inflammation of the substance of the brain), various infectious diseases (e.g. tuberculosis); malformations of the brain and cerebral vessels; consequences of hemorrhage; consequences of traumatic brain injury; genetic disorders. Sometimes the cause of hydrocephalus cannot be determined.
Endoscopic ventriculostomy avoids the implantation of a foreign body.
In the event of a diagnosis of hydrocephalus (for any reason), 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 neurologist or pediatrician without the involvement of a neurosurgeon is a mistake and sometimes leads to an unreasonable delay in surgical intervention.
Parents have a hard time deciding whether to perform an operation. However, a prolonged increase in intracranial pressure causes a delay in psychomotor development, which is not always possible to compensate for 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 – you can only stop its further growth.
The purpose of the operation is that the cerebrospinal fluid is removed from the ventricles of the brain to other cavities of the body. The most common operation is ventriculo-peritoneal shunting (VPS). According to the system of silicone catheters, cerebrospinal fluid from the lateral ventricle of the brain flows into the abdominal cavity, where it is absorbed between the loops of the intestine.
Less often, the cerebrospinal fluid is diverted to the right atrium (ventriculo-atrial bypass), to the large occipital cistern (Torkildsen surgery) or the spinal canal at the lumbar level is connected by a catheter to the abdominal cavity (lumbar-peritoneal bypass).
With the development of modern endoscopic technology (an endoscope is inserted into the cavity of the human body through small incisions, allows you to examine them, perform manipulations), it became possible to treat patients without installing a shunt system. With the help of an endoscope deep in the brain, a workaround is created for the outflow of cerebrospinal fluid.
This is a very effective operation (it is called endoscopic ventriculostomy), which avoids the implantation of a foreign body, which is a 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 occlusal hydrocephalus can help this operation. In other cases, it is necessary to install a shunt 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 attends kindergarten, school.
In some cases, patients with hydrocephalus are not operated on, but are monitored 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.
The causes of hydrocephalus in children are divided into two types: congenital and acquired. Congenital pathology appears under the influence of several factors.
- Malformations of the central nervous system (central nervous system).
- Intrauterine infections, such as toxoplasmosis, herpes, or cytomegaly.
- Birth injuries.
- Inflammatory diseases of the brain.
- Hemorrhages in the brain. Read about cerebral hemorrhage of the 3rd degree in premature infants.
- Congenital brain tumors (this pathology is extremely rare).
It is impossible to completely protect your newborn baby from the development of hydrocephalus, but every expectant mother, during pregnancy planning, must undergo a thorough medical examination to identify all diseases and their treatment.
- Head injuries from a stroke.
- Infectious diseases.
- Formations in the spinal cord and brain.
- Meningitis, encephalitis (inflammatory processes in the brain).
- Violation of the development of blood vessels in the brain or the organ itself is not sufficiently developed.
- Genetic disorders.
There are cases when the true cause of hydrocephalus cannot be established. All the causes of dropsy of the brain cannot be listed. Usually the disease appears through the fault of the above factors, but in fact there are a great many reasons, about 180.
Two decades ago, most children with hydrocephalus died. Today, this disease is treated quite successfully, and in most cases, the kids recover fully or partially.
The first and most striking sign is the large size of the head of a sick child. This is due to the high pressure inside the skull. The diameter of the head of such a patient can be very large.
- Anxiety and nervousness, or vice versa, constant drowsiness.
- The baby’s scalp becomes thin and shiny in appearance, veins are clearly visible.
- Poor appetite or its complete absence.
- The tone of the limbs is increased.
- Backwardness of the baby in psychomotor development. He sits, stands and crawls later than he should be.
- The changed type of eyes, the pupil rolls to the bottom.
- Spitting up and vomiting, bothering the baby constantly and often.
- Serious visual impairment.
- Low physical activity of the baby.
- Fontanelle swelling.
Symptoms may be persistent or paroxysmal. An open form of the disease predisposes to the gradual development of symptoms. Closed manifests itself in the form of seizures.
- Headaches of high intensity.
- Lack of appetite.
- Lethargy, the child wants to sleep all the time.
- Irritability and nervousness.
- Nausea and vomiting.
- Urinary incontinence.
- Visual impairment, double vision.
- Malfunctioning and cramping.
If life-threatening attacks of the disease occur, immediate medical attention is required, otherwise the child may suffocate and die.
Basically, treatment of dropsy of the brain is possible with the help of surgical intervention, this is the preferred method of therapy. The neurosurgeon will eliminate the causes of obstruction of the cerebrospinal fluid paths or the causes of dropsy, such as tumors or adhesions.
In addition to such treatment, quite often doctors recommend brain bypass surgery, which gives a positive effect in 85% of cases of hydrocephalus. However, there are complications of shunt operations.
- Blockage of shunt system components.
- Inadequate or too intense drainage.
- Pseudocysts of cerebrospinal flu >
Hydrocephalus cannot be treated with drugs. Auxiliary drugs are diuretics – furosemide and acetazolamide, which reduce the formation of cerebral fluid.
Surely everyone is interested in why we need cerebrospinal fluid in our heads. Why so conceived? It turns out that mother – nature is very smart, because cerebrospinal fluid performs important functions.
Three functions of the cerebrospinal fluid, which are known to scientists:
- Protection of nerve cells from irritants and mechanical influences from the outside.
- Removal of metabolic products and substances harmful to the brain, supplying it with nutrients.
- Stabilization and maintenance of normal intracranial pressure.
Most often, hydrocephalus is detected up to three months of age, in boys it develops more often.
Neurosurgeons as a whole have more than 180 causes that can cause the development of hydrocephalus.
1) In more than half of cases, an increase in the ventricles of the brain in the fetus occurs due to excess cerebrospinal fluid. This occurs in conjunction with malformations of the central nervous system (CNS). For example, with anomalies of Dandy Walker or Chiari.
- About 20% of children are born with hydrocephalus, which developed under the influence of intrauterine infection. The most common among them is cytomegalovirus, followed by herpes, toxoplasmosis, syphilis and other infections. Pregnant children’s infection is also dangerous – rubella, which causes multiple defects in the development of the fetus. Also, the cause of the development of hydrocephalus can be an injury received during childbirth. Approximately 2% of cases of congenital hydrocephalus occur in the genetic mutation of the 11th gene. This mutation is more common in boys.
- Hydrocephalus in children under two years of age in 80% of cases is a consequence of congenital malformations of the central nervous system. It is characterized by a progressive course.
- The remaining 20% of cases occur in perinatal injuries (received from the 28th week of pregnancy and up to 7 days after birth) and endured in the first 28 days of life, meningoencephalitis (inflammation of the brain and its membranes).
- In children over two years of age, the main cause of development are tumors that impede the flow of cerebrospinal fluid. Then, according to the frequency of occurrence, there are the same reasons as in newborns.
- Hydrocephalus can develop as a result of a pronounced displacement of the brain structures by volumetric processes inside the skull. These can be large hematomas, injuries and tumors.
- Hydrocephalus in newborns is common enough, a similar brain pathology is diagnosed, according to neonatal statistics, in 1 case out of 4 thousand infants.
- Dropsy leads to severe destructive and functional disorders, but is successfully cured by timely surgical intervention.
- Shunting technique gives the child a chance for normal physiological and mental development, allowing him to lead a full life in the future.
Varieties of hydrocephalus
There are several classification of hydrocephalus.
The first is based on the location of the accumulated liquid:
- internal. Fluid accumulates mainly in the cerebral ventricles;
- external, or external. Liquor accumulates in the subarachnoid space, that is, between the brain and the walls of the skull;
- general, otherwise called mixed form. With this form of pathology, cerebrospinal fluid is distributed throughout the organ of thought, that is, it accumulates in the ventricles and in the subarachnoid space. With a mixed form, the tissues of the organ of thought are gradually replaced by cerebrospinal fluid, which is fraught with the development of serious mental and physical deviations.
According to the mechanism of development of pathology, there are:
- an open, or communicating form in which a message is maintained between the subarachnoid space and the ventricles of the brain;
- closed form. With this type of hydrocephalus, the normal communication between the ventricles and the subarachnoid space is impaired. This form of pathology is considered the most dangerous: without immediate surgical intervention, the baby may die;
- hypersecretory form. In this case, the pathology develops due to the excess volume of the produced cerebrospinal fluid.
By the level of intracranial pressure are distinguished:
- hypertensive form, accompanied by an increase in intracranial pressure;
- normotensive, flowing without an increase in intracranial pressure. Usually, the absence of an increase in intracranial pressure is observed in the early stages of the development of the disease;
- antihypertensive form in which the intracranial pressure in the baby decreases. This form of dropsy is extremely rare.
- Intrauterine. It is diagnosed in the early stages of pregnancy (usually at 16-18 weeks of gestation).
- Congenital. Congenital hydrocephalus occurs as a result of genetic defects in the fetus (violation of the laying and differentiation of organs), as well as due to birth injuries.
- Acquired. It occurs in children older than one year as a result of past viral infections, due to the presence of brain tumors, traumatic brain injuries with hemorrhages.
According to morphological characteristics, hydrocephalus is:
- Communicating – it is a violation of the ratio of CSF production to its reabsorption by tissues.
- Occlusal – is a difficulty in the outflow of cerebrospinal fluid along the cerebrospinal fluid paths due to some pathological conditions.
By localization of the cerebrospinal fluid accumulation:
- Internal – cerebrospinal fluid is concentrated in the ventricles of the brain.
- External – the fluid in the child’s head is concentrated between the meninges (soft and arachnoid).
- Mixed – the fluid in the head of a newborn is concentrated in the ventricles of the brain and subshell spaces.
In terms of stability, hydrocephalus can be:
- Progressive – with a rapid increase in clinical symptoms and, as a result, a deterioration in the general condition of the patient.
- Regressive – with a decrease in the severity of clinical symptoms with a marked improvement in the patient’s condition.
- Stable – the clinical symptoms are permanent.
One should not think that the dropsy of the brain in babies is always “visible to the naked eye”: its symptoms are characteristic of many pathologies, and the baby still cannot tell about his feelings. Therefore, the first manifestations are far from always recognized.
Most often, the following methods are used to diagnose hydrocephalus:
- neurosonography. This examination in infants is carried out through the fontanel. In modern hospitals, neurosonography is a mandatory study that is carried out in the second month of a baby’s life;
- MRI and CT. Thanks to these modern methods, you can get a fairly complete picture of the development and structure of the main organ of the central nervous system of the baby. Unlike neurosonography, MRI and CT in infants should be performed under general anesthesia: otherwise, the immobility of the baby cannot be ensured;
- craniography, that is, an examination of the size of the baby’s head;
- lumbar puncture, which makes it possible to evaluate intracranial pressure;
- EEG (electroencephalography), which allows to obtain additional data on the state of the baby.
It is important to remember that the sooner treatment of hydrocephalus is started, the lesser the consequences for the pathology in the future. The prognosis depends not only on the nature of the course, but also on the neglect of the disease!
- Internal – cerebrospinal fluid centers in the ventricles. It is congenital and acquired. Drug therapy is prescribed, and if it is ineffective, surgery is indicated.
- External – cerebrospinal fluid accumulates under the lining of the brain. It is a congenital form, rarely acts as a consequence of birth injury. Drug therapy has been shown to help stabilize fluid outflow and reduce its production. The operation is prescribed if the conservative treatment is ineffective and the patient worsens.
- Mixed – is rare, cerebrospinal fluid accumulates in the ventricular cavities and under the membranes. The principle of treatment is determined based on the severity of the condition of the child.
Parents should show the child to a pediatrician, neurologist and neurosurgeon. Only a consilium can decide on the need for surgery and the choice of conservative treatments.
The obvious progress of the disease does not leave time to observe in dynamics, the chances of recovery are reduced, therefore, there is only one method of eliminating the problem – bypass surgery.
The timeliness of the decision in this case is very important, each day of delay can lead to irreversible consequences.
- It moves every second both inside the ventricles and along the spinal canal, washing the brain and spinal cord.
- Intensity, absorbability, direction of flow and the amount of cerebrospinal fluid are important criteria, deviations in their values affect the functioning of the brain, changing the parameters of intracranial pressure.
- With a cerebrospinal fluid surplus and poor absorption, the fluid circulation process is disrupted, which leads to hydrocephalus.
- Predisposing factors also depend on the type of pathology:
- Congenital dropsy of the brain develops against the background of severe infectious diseases suffered by a pregnant woman. Serious intrauterine abnormalities in the development of the fetal brain are diagnosed. Indicative signs: changes in the circulation of cerebrospinal fluid and its excess. True dropsy is the most severe form of hydrocephalus in newborns.
- The acquired form of hydrocephalus is characteristic of children of the first year of life, manifests itself in prematurity or is a consequence of injuries received during childbirth. Less commonly, neurosurgery, intracranial hemorrhage, and closed cranial trauma lead to the development of dropsy.
- One of the causes of hydrocephalus in infancy is brain tumors and infections that provoke an inflammatory process in the membranes of the brain, for example, meningoencephalitis.
Much depends on the forms of hydrocephalus, children who have a history of this disease have been registered in the dispensary for a long time. But with mild forms, proper treatment and extinction, the symptoms of the child are removed from the register.
Bypass surgery involves constant medical supervision until the end of life.
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Symptoms and signs
Signs of hydrocephalus lie in the behavior of the child: he is crying, restless, unable to take a chest, neck muscles are atonic, there are no head movements.
Violations are also visible at the physiological level: in an adequately developing baby, the head circumference increases by 1 cm per month.
At the pediatric scheduled examination, such anthropometric measurements are made each time. With hydrocephalus, the head increases disproportionately, while the circumference is not important, but the rate of its increase.
If the growth is 3cm or more, then they talk about unnatural growth. This is called a “hydrocephalic skull” and is a typical sign of dropsy.
Secondary signs of dropsy of the brain:
- uncharacteristic increase in intracranial pressure;
- protruding fontanel, without signs of intergrowth;
- the site of fusion of the edges of the fontanel is tuberous, with palpation there is soreness;
- strabismus, nystagmus, displacement of the eyeball down;
- involuntary tipping of the head, convulsive syndrome of unknown origin;
- frequent spitting up, vomiting;
- insomnia, restlessness;
- the absence or gradual attenuation of reactions to sound and visual stimuli.
Additional symptoms, manifested in children older than 12 months with acquired hydrocephalus:
- chronic nausea
- headaches that provoke overexcitation, irritability and aggressiveness;
- increased muscle tone of limbs;
- violation of coordination in space;
- urinary incontinence;
- delayed psychomotor development, poor memory.
Symptoms of dropsy largely depend on age, the rate of development of the disease and individual tolerance to conditions caused by hydrocephalus.
In this case, tolerance refers to the ability to endure.
For example, the body of a newborn is able to compensate for the excess of cerebrospinal fluid by increasing pressure and expanding the intracerebral ventricles, and the body of an adult is not capable of this.
- That is, increased ICP is provoked by the accumulation of cerebrospinal fluid in the cavity of the ventricles.
- You can clarify the diagnosis using CT, neurosonography and MRI.
- A condition with increased intracranial pressure is characteristic of 1 out of 10 infants in the first week of life.
There is also a “reverse side of the coin”, an increase in intracranial pressure may not be a pathology, but an individual norm, for example, provided that the structure of the brain of this particular baby is distinguished by large ventricles. The dynamics of their growth is observed for several months, and in some cases for years, the sizes shown by the results of a single examination do not represent diagnostic value.
A neuropathologist, a neonatologist, a pediatrician and a neurosurgeon can make a primary suggestion of dropsy. After the diagnosis is confirmed / refuted using various anthropometric, instrumental and hardware examinations:
- collecting a history of the pregnant woman, clarifying the picture of the course of pregnancy;
- fundus examination;
- Ultrasound of the brain, dopplerography;
- CT, MRI.
MRI of the brain – hydrocephalus
Far from every city hospital can clarify the diagnosis, a specialist-sonologist is needed to deal with the problems of newborn development. Centers providing such services are usually taken to treat the child.
The choice of treatment for hydrocephalus in newborns depends on the condition of the child, the form of pathology and its severity:
- The conservative drug method is effective only with a mild degree of hydrocephalus. Drugs are prescribed comprehensively by a neurologist and neurosurgeon. The baby is placed on the dispensary register, involving regular hardware and anthropometric examinations. Treatment consists in normalizing blood circulation in the vessels of the brain, lowering ICP and eliminating edema by taking diuretics.
- Surgery with intraventricular bypass surgery is considered the most effective in the treatment of true hydrocephalus. The shunt looks like a silicone tube, allowing excess cerebrospinal fluid to be discharged into the peritoneal cavity. Outflow volume is regulated using a special pre-installed valve. This normalizes the ICP and prevents the reverse reflux of cerebrospinal fluid. The disadvantage of this method is the need for multiple operations as the child grows up, since the shunts clog, wear out, bend. Age-related changes in the children’s body are also prerequisites for a new operation.
- Neuroendoscopic surgery is innovative and very expensive. The process of eliminating puffiness itself lasts no more than 20 minutes, the catheter is inserted optionally precisely thanks to the use of a mini-camera. Excess fluid is removed from the ventricles or enlarged areas of the lining of the brain. Repeated interventions are not required, since the shunt is not installed. A significant drawback is that not all types and forms of dropsy can be cured in this way.
The child can die, death is rare and is a consequence of the late detection of pathology, rapid progress and lack of treatment (improper treatment).
In order to prevent the development of dropsy, pregnant women are prescribed folic acid preparations in the early stages, which prevents neural tube defects. Natural folic acid can be obtained from spinach, sprouted wheat, oranges, avocados, cornmeal.
Pregnancy should take place under the supervision of a physician; during childbirth, the main thing is to avoid transmission of infection, birth injuries, and intracranial bleeding.
- Preterm birth can also cause dropsy.
- Antenatal care includes immediate treatment for all infections found in the mother. The baby must be protected from head injuries.
- After shunting, the patient’s physical and emotional stress should be limited, with particular attention to his psychomotor and mental development.
- Hydrocephalus of the brain in newborns is a difficult diagnosis, therefore it is so important to consult a specialist, undergo examinations, establish the causes and begin treatment. The prognosis in most cases is favorable, but provided that the disease was detected in a timely manner and the treatment was appropriate for the situation.
- analysis of the clinical picture (i.e., symptoms);
- fundus examination;
- Ultrasound of the brain;
- CT scan;
- Magnetic resonance imaging.
- Neurologist examination. which determines the head and chest circumference in dynamics, muscle tone, special reflexes of infants and those that are caused by tendons.
- Inspection by an oculist of the fundus. on which, with hydrocephalus, a congestive optic disc is detected.
- Neurosonography or “Ultrasound through the fontanel.” This is a screening method performed in children in the first months of life while a large fontanel is open. It allows you to examine the structure of the brain, measure the ventricles. But the diagnosis is made only on the basis of the following method.
- Magnetic resonance imaging. This is a technique for obtaining a layered image of each part of the brain using a special large magnet. It requires a stationary stay in the device, therefore, in children the first 5-6 years of life is carried out after medical sedation (anesthesia).
- Computed tomography is the study of the structure of the brain and its structures using x-ray radiation. This is a less informative method than the previous one.
A bit of anatomy and physiology
In our brain there are cavities interconnected. They are called ventricles. They produce cerebrospinal fluid resembling water. Circulating through the ventricles, fluid (cerebrospinal fluid) enters the subarachnoid space (between the dura mater and the brain). There, the brain surface is washed, after which it is absorbed into the blood.
But if, for some reason, malfunctions occur in the synthesis of cerebrospinal fluid or in its absorption, the fluid accumulates in the cavities of the brain, and the condition is called hydrocephalus. Treatment in such cases is required. It’s just impossible to leave the disease.
This is how the brain looks like in an illness
There are many classifications of the disease. It is important to know that hydrocephalus happens:
- closed (occlusal) – when the cerebrospinal fluid cannot freely penetrate into the subarachnoid space, for example, due to a blood clot or tumor;
- open when the cause of hypertensive cerebrospinal fluid syndrome lies in the violation of specific structures.
A preliminary diagnosis of “hypertension hydrocephalic syndrome” is made in the maternity hospital by neonatologists. In older children, neuropathologists. Then a diagnostic comprehensive examination is carried out in order to confirm the diagnosis or refute it. In addition to monthly head circumference measurements, the following advanced diagnostic methods are used:
- MRI or CT scan of the brain;
- examination by an oculist of the fundus.
Neurosonography is widely used until the age of 2, while the main fontanel is not yet closed. With its help, the presence of cystic formations, tumors and hematomas is diagnosed.
But a more accurate picture, of course, gives an MRI scan. Although the examination is quite expensive, this modern diagnostic method makes it possible to accurately see the root of the problem, which is fundamentally important for further treatment, in many cases involving surgical intervention.
Hydrocephalus is a very complex disease that is difficult to tolerate by both babies and older children.
Regardless of the severity and development of the disease, it is urgent to see a doctor, as it may require surgical intervention. But in some cases, the need for surgical intervention disappears by itself.
In such cases, the child should be constantly monitored by the attending physician during the entire period prescribed by the doctor. In order for cerebrospinal fluid to be released in smaller quantities, the patient is prescribed the drug Diacarb. The drug is recommended by doctors to the patient only if there is no continuation of the disease.
That is, hydrocephalus should not progress. Neurologist and neurosurgeon should conduct special examinations of the patient’s skull, which consists in taking measurements from the child’s head.
The skull should not increase during treatment with the drug, but if such a threat arises, surgery is needed.
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The operation is performed to divert cerebrospinal fluid from the brain to other parts of the organs.
For example, when cerebrospinal fluid is transferred to the abdominal cavity, where it is absorbed in the intestine.
In other cases, fluid is transferred to the back of the head.
With the development of endoscopy, the need for previous methods has virtually disappeared. The endoscope removes fluid from the brain in such a way that there is no need for foreign bodies introduced into the body. This makes the operation less traumatic.
Although endoscopic methods are suitable for a small number of patients, development is currently underway regarding their improvements.
- the head circumference increases rapidly, since the cranial sutures are in a semi-mobile state, the fluid that increases in volume and the growing brain move apart the bones;
- the fontanel is larger than usual, swells, does not overgrow for a long time, sometimes up to 3 years;
- in the frontal part, as well as on the face, the venous network is clearly visible;
- forehead enlarged, disproportionately large;
- intracranial pressure is increased;
- Gref’s symptom: eyeballs move down;
- strabismus and nystagmus;
- increased tone of the lower extremities;
- the child can handle the head with pens – a symptom of a headache;
- in a later period – lag in psychomotor development: frequent head tilting, apathy, tearfulness; the child does not sit down in due time, does not get up, there is no interest in the game.
Regarding measuring the circumference of the head. the pediatrician carries it out monthly during admission. However, the procedure is quite simple. Parents can measure the circle at home by comparing the numbers with the available graphs of normal indicators.
When in children hydrocephalic syndrome manifests itself after 2 years, the clinical picture looks a little different. There is no increase in head size, but the following symptoms are pronounced:
- frequent headaches along with vomiting and nausea (most pronounced in the morning or at night);
- visual impairment due to edema of the optic disc.
Unfortunately, often a child is taken from one doctor to another, trying to treat dyspeptic symptoms, gastritis, gastrointestinal infections, while forgetting to be examined by a neurologist. But the sooner the disease is detected, the more likely it is to cure the baby. Lost time can cost a living.
The norm is considered to be an increase in head circumference in an infant by 1 cm per month, pathology can be called an increase in its circumference by 3-4 cm or more. The remaining signs of hydrocephalus in newborns can be assessed if the increase in head size is pathological and reaches a maximum.
Dropsy of the brain in children under 1 year of age is characterized by the following clinical symptoms:
- Enlarged head sizes, especially in the frontal region, noticeable bulging fontanelles (pulsation above them during palpation) and divergence of sutures on the skull, deep-seated eyes due to massive brow arches hanging over them.
- The presence of a pronounced venous mesh on the head, translucent on the skin of the forehead and neck.
- Constant tilting of the head, inability to hold it.
- Weak weight gain due to reduced nutrition, restless sleep, frequent regurgitation.
- The presence of visual disturbances.
- Later psychomotor development – the child does not smile, cannot fix his gaze on the subject, begins to crawl late, sit, etc.
- Restless and causeless crying baby.
If hydrocephalus is not diagnosed in time in a newborn or dropsy is progressive, symptoms such as cramps, repeated vomiting, loss of previously acquired motor skills may soon appear.
If at least one of the above signs of acute dropsy of the brain appears, you should immediately hospitalize the child in a specialized hospital to provide qualified medical care.
Hydrocephalus in children older than a year is characterized by the following clinical symptoms:
- Headaches, mainly in the morning;
- Nausea, often vomiting at the peak of pain;
- Feeling of pressure in the orbit;
- Muscular twitches, chin tremors, motor pathologies;
- Dysfunction of the urinary system in the form of episodes of urinary incontinence;
- Frequent changes in mood, tearfulness of the child for no apparent reason;
- Sleep disturbance (in the form of insomnia or lethargy and drowsiness);
- Mnestic disorders (impaired short-term memory);
- Violation of the child’s behavior (interest in active games, communication disappears, general development slows down);
If the child identifies the above symptoms, you should seek medical help with the aim of further examination and qualified treatment.
Hydrocephalus in newborns – diagnosis, treatment, precautions
Brain hydrocephalus in newborns is a disease that no one is safe from.
It is not transmitted by airborne droplets, therefore it is almost impossible to prevent it. Since the disease is often transmitted from mother to child during pregnancy, it is recommended that a pregnant woman constantly undergo ultrasound and just take care of herself while carrying a new life.
Hydrocephalus is a serious illness. Hearing such a baby’s diagnosis for any mother is a major blow. However, do not panic.
Modern medicine has made significant progress towards the effective cure of the disease and is able to cure almost any form of hydrocephalus. The main thing is to take up treatment in time and do not forget to support your baby with love and care.
In order to minimize the chance of developing hydrocephalus, follow these guidelines:
- In every possible way protect the child from head injuries: wear helmets for roller skating / scooter / bicycle, carry him in a car seat, and do not walk in traumatic places.
- During pregnancy, a woman should be examined for a TORCH complex of infections, followed by consultation with an infectious disease specialist.
- If during pregnancy an acute respiratory viral infection, rubella or any other disease has occurred, additionally undergo an ultrasound of the fetus and consult with a medical geneticist and infectious disease specialist regarding the further management of the period of gestation.
- Be sure to undergo scheduled examinations of a neurologist, ultrasound or MRI if the baby was born prematurely.
- The previous rule applies to conditions after suffering meningitis, meningocephalitis, intracranial hemorrhage, head injury. Do not neglect a visit to a doctor.
How not to get the flu. During influenza epidemics, in addition to oxolinic ointment, you can use natural sea buckthorn oil to prevent infection. Before leaving the house, thoroughly grease the nose with sea buckthorn oil. The oil provides protection against the penetration of the virus into the blood and has a moderate antiviral effect.
How often do you take antibiotics?
Today and tomorrow the geomagnetic situation is calm, magnetic storms are not expected.
Also, during the planning period, a woman must undergo an examination for toxoplasmosis, herpes and rubella.
During the bearing of the baby, it is important to abandon bad habits, eat well, regularly attend antenatal clinics and carefully follow all the recommendations of the attending physician.
Of course, these measures will not help to completely insure against the development of hydrocephalus in a baby, but they minimize the risk of pathology.
After the baby is born, special attention is given to children who are at risk:
- born prematurely;
- born to mothers suffering from chronic diseases;
- children with malformations of the nervous system and with birth injuries;
- children who have had meningitis.
Often, dropsy in young children develops as a result of a traumatic brain injury. Therefore, parents should;
- use special child seats;
- walk with your baby in specially equipped safe areas;
- make the house safe for the baby: buy lining for corners, remove heavy objects from the field of reach, etc .;
- during sports, the child must wear head protection such as a helmet.
Problems in violation of the normal development of the organ of thinking in children is a dangerous phenomenon that requires immediate treatment and constant medical supervision. The symptoms of pathology should not be ignored: the sooner therapy is started, the less the thinking organ will be injured by increased cerebrospinal fluid pressure.
Therefore, it is important to monitor the condition of the baby in the dynamics.
Neurosonography alone cannot be the reason for establishing a diagnosis of “dropsy of the brain.” In case of serious visual abnormalities, computed tomography or MRI will be shown. Such methods of diagnosis are carried out in newborns in a state of deep drug sleep (anesthesia).
If the doctor recommends an echoencephalography or electroencephalography, the mother and father of the baby may well refuse with a clear conscience. These methods are not considered informative in the case of hydrocephalus, but continue to be prescribed by old standards.
If the diagnosis is confirmed, any sensible parent raises a completely reasonable question about the forecasts – what will happen to the baby next? No doctor will be able to answer this question, since forecasting with hydrocephalus is considered an ungrateful affair.
- Easy open dropsy usually has no consequences, however, provided that it was discovered on time and properly treated. With closed dropsy of the occlusal type, the consequences for the health and development of the baby are almost inevitable.
- Congenital forms of dropsy are treated faster than acquired. Severe deep forms of the disease often lead to debility, mental disorders, developmental delays. Against the background of severe hydrocephalus, cerebral palsy and epilepsy can develop.
- The disease itself in medicine is considered treatable. The consequences may be incurable. If you take care of the child at home and follow the doctor’s recommendations, the forecasts are more positive than the forecasts with the same form and stage, but for the child who was abandoned in the hospital and who ended up in the baby’s house.
Most often, in the treatment regimens there are such drugs as “Diacarb” and “Asparkam”, “Mannitol” and potassium preparations. The baby is recommended gymnastics, massage, sometimes physiotherapy. If positive changes do not occur in 3-4 months, a repeated examination shows the absence of any significant effect, it is recommended to perform an operation.
Most often, shunting is performed. As part of the intervention, craniotomy is performed and the extra cerebrospinal fluid is removed through a silicone shunt inserted into the ventricle of the brain. The second end is removed into the abdominal cavity, laying a tube under the skin of the child.
- Bypass surgery is quite dangerous, complications occur in 50-60% of cases. The shunt has to be changed, the child has to undergo serious surgery again. Alternative drainage operations do not solve the problem, because the liquid after a single pumping can accumulate again and again.
- Endoscopic surgeries are very popular. In modern clinics and medical centers, they try to install the shunt for the baby in this way.
- After the operation, the child is on a follow-up account with a neurologist for life.
- When the diagnosis is proved and justified, it is important for parents to control themselves, says the famous children’s doctor Yevgeny Komarovsky. A reasonable and calm attitude to the prescribed therapy is the key to success.
- In practice, everything may be completely different from what we would like.
Alarmed and desperate parents often begin to look for osteopaths who guarantee that they can straighten the bones of the neck and skull of the baby in place without surgery to normalize the outflow of fluid.
Yevgeny Komarovsky emphasizes that appeals to such specialists can end for the child and his mother with dad rather deplorably. The benefits of osteopaths, according to the doctor, are not officially. Yes, and there is no such specialization of doctors. But there are consequences, and they are very sad.
How is hydrocephalus formed?
Hydrocephalus occurs when the balance between the production of cerebrospinal fluid and its absorption is disturbed. Let us explain what this means.
The brain is a whole, richly circulatory structure of dense elastic properties, in which there are several cavities. They are called the ventricles of the brain. They are lined with a kind of “moss” from the vessels, and it is he (this is called “plexus”) who is responsible for the formation of cerebrospinal fluid (cerebrospinal fluid). The ventricles communicate with each other, and cerebrospinal fluid leaves them from the substance of the brain.
Then he needs to wash the spinal cord, and fall into the gap between the middle and inner membranes, which immediately cover both the spinal cord and the brain. In this gap (it is called the subarachnoid space), which is in the cranial cavity and in the spine, there are vessels that suck up the cerebrospinal fluid, where by that moment the metabolites that have been worked out and released by the brain structures are already contained.
Next, the cerebrospinal fluid should enter the special veins that are in the cranial cavity. They are called venous sinuses and their peculiarity is that they do not fall off, having a special attachment to the cranial bones. The absorption of cerebrospinal fluid into the venous sinuses depends on the difference in pressure: the pressure in the sinuses should be lower than intracranial.
Liquor performs the following functions:
- Being incompressible, protects the brain from injury;
- removes some substances from both parts of the central nervous system;
- maintains constancy of intracranial pressure;
- provides a balance between the water-electrolyte composition of the circulatory system and this fluid;
- oscillatory movements of the cerebrospinal fluid affect the autonomic nervous system.
Cerebrospinal fluid is formed continuously. Depending on the age per day, it is synthesized from 40 to 150 ml (for comparison, in adults – up to 1,5 l / day). This liquid contains a few leukocytes in the form of lymphocytes, a certain amount of protein, electrolytes. The level of gases and sugar correlates with that contained in the blood: for example, the glucose content in the cerebrospinal fluid should be half as much as in the blood.
If a violation occurs:
- formation of cerebrospinal fluid (its excess is synthesized);
- its absorption;
- cerebrospinal fluid flow along the intended paths,
hydrocephalus develops. Depending on the level at which the violation occurs, as well as the pressure that is created in the skull cavity, there is a classification of the disease, which we will consider below. According to her, doctors are guided in the treatment of pathology.
When the equilibrium between the formation and absorption of the cerebrospinal fluid is disturbed, or its circulation suffers, then in order to achieve this absorption in general, the cerebrospinal fluid must be “squeezed” into the vessels utilizing it, that is, to increase intracranial pressure. This leads to the expansion of cerebrospinal fluid spaces. The volume of the skull can only be changed in infants of the first months of life (as long as there are fontanelles and interosseous sutures have not fused), therefore, the expansion of the spaces where cerebrospinal fluid circulates forces the brain to decrease in size.