The lateral ventricles of the child’s brain are dilated. Physiological role and most common diseases of the third ventricle of the brain

The newborn's brain is not yet fully adapted to life outside the mother's body.

There are often situations when the ventricles of the brain enlarge in an infant. This can happen by various reasons.

The brain is the most complex organ in all animals. In addition to the bark, it contains internal education, for example, the ventricles. There are 4 of them in total, two paired and two unpaired. They are designed to collect and store cerebrospinal fluid, or cerebrospinal fluid. The ventricles end in cisterns, which are a reservoir for cerebrospinal fluid.

The largest ventricle, the fourth, collects all the fluid, so it is the one that dilates most often. The ventricles communicate through the foramina of Monroy, which is necessary to reduce the pressure in one of them. Fluid collects in the brain space and leaks from the surrounding veins. The higher the pressure in them, the more liquid will accumulate.

If too much brain fluid collects, dilatation of the ventricles of the brain occurs. Most often, one unpaired one is enlarged. Dilatation of the lateral ventricles, left or right, is less common.

Why does fluid accumulate?

Liquor can accumulate and cause dilatation of the ventricles of the brain for various reasons:

• the size of the ventricles and cisterns is too small compared to the large volume of cerebrospinal fluid. Their greatest length is 4 cm and width is 2 cm. With improper distribution, dilatation of the ventricles occurs in newborns. This process is not a pathology, but it needs to be controlled;
• Ventriculomegaly is an increase in the size of the ventricles as a result of a birth defect. If everyone is evenly enlarged, then this is normal. This condition is not a pathology and will not affect the child’s condition. You should be wary if one ventricle is enlarged, especially if it is severe. In this case, hydrocephalus develops. It is caused by enlargement of the ventricles of the brain in newborns. More often, pathology affects the occipital horns as the weakest;
• pressure on the channels from the outside as a result of birth trauma, hematoma, brain tumor. The liquid cannot flow out completely, since the lumen of the tank is narrowed. Its walls expand, and the ventricle enlarges. The most common type is dilatation of the lateral ventricles. Only a neurosurgeon can cope with this condition, and urgently.

The causes of the pathology can be:

• complicated pregnancy or childbirth;
• acute intrauterine fetal hypoxia;
• developmental defects;
• premature birth;
• birth injury.

A competent obstetrician will promptly notice a condition in which the ventricles of the brain are enlarged.

In this case, urgent treatment is needed.

Manifestations of the disease

The expansion of the ventricles of the brain in a child is accompanied by an increase in intracranial pressure. In newborns, it is difficult to notice alarming symptoms in time:

• decreased appetite;
• decline muscle tone;
• trembling of limbs;
• enlarged veins on the forehead, temples and back of the head, as the outflow of blood in them is impaired;
• slow reaction of the child. He has difficulty moving and grasping;
• eyes can look in different directions;
• the protrusions of the skull and other irregularities of the head are visible;
• The baby spits up frequently.

An older baby may complain of weakness, nausea, dizziness and pallor.

Diagnosis of the disease

You should not hope that the dilated ventricles of the brain in a newborn will decrease on their own. A neurosurgeon or neurologist should prescribe treatment.

In order to choose the right therapy, you need to make an accurate diagnosis. Best methods Radiation studies are recognized as diagnostics.

1. MRI (magnetic resonance therapy). Excellent display of soft tissues. But it has contraindications, especially for children. It is almost impossible to properly assess a restless child. The procedure requires remaining still for 20 minutes. If a child is awake and moving during an MRI, there is a chance of getting a false result. The problem can be solved with the help of anesthesia, but it will have a bad effect on health.
2. CT scan. The most preferred research method if there are dilated ventricles of the brain in an infant. It is carried out much faster and does not require anesthesia. The dimensions of the lateral and posterior ventricles can be determined. The disadvantage compared to MRI is lower quality. CT scan does not allow images to be taken high resolution, especially on small objects. Tomography best shows hemorrhages in the interthecal spaces. This allows you to quickly diagnose the disease and begin treatment.
3. Additionally, the condition of the fundus is assessed. It clearly shows dilated vessels, which are an indicator of increased intracranial pressure.
4. Neurosonography. Determines the size of the lateral ventricles, but does not visualize them. Sizes up to 3-4 mm are considered normal. The device does not show less than 1 mm.
5. The composition of the cerebrospinal fluid can tell about changes in the body. To do this, a puncture of the lumbar spine is performed.

Treatment

Dilatation of the lateral ventricles is treated with medication. If the child is under 2 years old, treatment should take place in a hospital. Older children are treated on an outpatient basis.

The neurologist prescribes:

• diuretics. They increase urine excretion by the kidneys. At the same time, the volume of blood in the vessels and intercellular fluid decreases. From them liquor is formed. If there is less blood, it will not increase intracranial pressure. Therefore, fluid will not leak into the ventricles and cause their dilatation.
• nootropic drugs. Brain fluid is formed for different reasons, but it affects surrounding tissue in the same way. Their swelling and compression occurs. The blood vessels of the brain are compressed. This leads to hypoxia and death. Nootropic drugs improve cerebral circulation, help eliminate hypoxia in the nervous system and reduce the amount of cerebrospinal fluid. Their use in combination with diuretics helps ensure that fluid from the ventricles returns to the blood and is excreted by the kidneys. The child’s condition improves;
• sedatives. Despite the weakness, the child is worried. Any little thing can trigger stress. When stressed, adrenaline is released, which constricts blood vessels and increases blood pressure. The outflow from the brain further decreases, and hydrocephalus progresses. Sedatives remove this effect. They should be used only as prescribed by a doctor and should not exceed the prescribed dose. Overdose may have life-threatening consequences;
• drugs that improve muscle tone. As a rule, it is reduced at high blood pressure. The muscles do not regulate the stretching of the veins, and they swell. To normalize tone, medications or massage and gymnastics are used. With physical activity, tone increases. A trained person's blood pressure decreases. All treatment methods can be used only with the permission of a doctor and gradually. No harsh effects should be allowed.

For some, hydrocephalic syndrome occurs as a complication of a bacterial infection. First of all, it is necessary to cure it, getting rid of the cause of dilatation of the lateral ventricles.

If the condition is physiological and the child’s life is not in danger, for example, when the baby is large, then there is no need to treat. As a preventative measure, massage and physical therapy are recommended.

Modern medicine does not recognize the effectiveness of acupuncture, homeopathy and similar things. If used incorrectly, they can harm the child.

Taking vitamins has restorative effect, but he does not fight the cause of the disease.

Consequences of the disease

Most often, the disease itself is not fatal. It can lead to other complications that will be much more severe. The most severe consequence is rupture of the wall of the veins or ventricles. It is an irreversible condition that causes instant death or coma.

In some cases, visual and auditory nerve, irreversible deafness develops. If the nerve is simply compressed by fluid, then the blindness is temporary. Vision will return when the swelling subsides.

Epilepsy attacks. They occur when the brain is damaged. Their cause and mechanism of development are not exactly clear, but prolonged dilatation of the lateral ventricles can provoke an attack.

Unpleasant but less dangerous complications:

• developmental delays;
• urination and defecation disorders;
• periodic blindness and deafness.

How younger child with hydrocephalus, the greater his chances of a favorable outcome. Over time, the condition may return to normal.

Conclusion

A mild disease may not be treated, but no one guarantees the absence of complications. Hydrocephalus in infants is common, so a lot of experience has been accumulated in its treatment. A favorable outcome depends on prevention and care, which parents should take care of.

However, certain deviations from the norm can cause the development of neurological pathologies. One such condition is asymmetry of the lateral ventricles of the brain. This disease may not cause clinical symptoms, but in some cases it indicates the presence of a number of diseases.

What are the ventricles of the brain, their role

The ventricles of the brain are strips of tissue necessary for the deposition of cerebrospinal fluid. External and internal factors may lead to their increase in volume. The lateral ventricles are the largest. These formations are involved in the formation of cerebrospinal fluid.

Asymmetry is a condition in which one or both cavities are enlarged varying degrees.

1. Lateral. The ventricles are the most voluminous, and they contain cerebrospinal fluid. They connect to the third ventricle via the interventricular foramina.
2. Third. Located between the visual tuberosities. Its walls are filled with gray matter.
3. Fourth. Located between the cerebellum and medulla oblongata.

Causes of dilatation

Enlargement or dilatation of the lateral ventricles of the brain occurs due to increased production of cerebrospinal fluid. This leads to the fact that it cannot be excreted normally.

This, in turn, leads to disruption of the flow of cerebrospinal fluid. This disease most often occurs in premature babies, but is observed in people of any age.

What causes the disorder in newborns?

This is how dilatation of the lateral ventricles looks schematically

Dilatation of the lateral ventricles of the brain in infants is often a sign of hydrocephalus, and can also be caused by a number of other reasons.

In newborns, asymmetry is caused by trauma or space-occupying lesions in the brain. Regardless of the possible cause, urgent consultation with a neurosurgeon is required.

Mild asymmetry may be a congenital disorder that does not cause symptoms. In this case, only constant monitoring is required so that the difference between the ventricles does not change.

The main causes of dilatation include:

• viral and other diseases of a woman during pregnancy;
• oxygen starvation of the fetus;
• premature birth;
• birth injuries;
• malformations of the central nervous system.

Ventricular asymmetry can also result from hemorrhage. This pathology occurs due to compression of one of the ventricles by an additional volume of blood. Due to hemorrhage, the ventricles of the brain in an infant may be enlarged for the following reasons:

• various maternal diseases, for example, type I diabetes or heart defects;
• intrauterine infections;
• a long time between the water breaking and the baby being born.

The most common cause of dilatation is hypoxia. Other causes account for less than 1% of cases. It is hypoxia that leads to the accumulation of cerebrospinal fluid, which, in turn, increases intracranial pressure. This leads to expansion of the cavity of the lateral ventricles.

Risk zone for adult patients

A change in the size of the lateral ventricles leads to disruption of the circulation of cerebrospinal fluid. Asymmetry of the lateral ventricles of the brain in adults occurs for the following reasons:

Provoking diseases

The main disease causing this pathology is hydrocephalus. It can interfere with the absorption of cerebrospinal fluid. This leads to its accumulation in the lateral ventricles.

Excessive formation of cerebrospinal fluid is also observed with serious lesions of the central nervous system. Poor circulation is also associated with the formation of cysts, tumors and other neoplasms.

A common cause of hydrocephalus is a defect of the Sylvian aqueduct. If this defect was discovered during the prenatal period, termination of pregnancy is recommended. At the birth of a child, complex systematic treatment will be required.

Another cause is aneurysm of the vein of Galev and Arnold-Chiari syndrome. However, in children, the disease can be caused by rickets or due to the specific structure of the skull, so observation by a specialist is important if there is a predisposition to the disease.

Symptoms and diagnosis of the disorder

In adults, ventricular asymmetry rarely causes symptoms. However, in some cases, this anomaly can cause the following symptoms:

In addition to these symptoms, the picture of the disease can be supplemented by symptoms of diseases that caused ventricular asymmetry.

Such symptoms include cerebellar disorders, paresis, cognitive impairment or sensory disorders.

In infants, symptoms depend on the severity of the pathology. In addition to general discomfort, symptoms such as throwing back the head, regurgitation, increased head size and others may occur.

Symptoms of the pathology also include strabismus, refusal to breastfeed, frequent crying, anxiety, tremors, and decreased muscle tone.

However, quite often the pathology does not cause characteristic symptoms and can only be detected after an ultrasound scan.

Health care

Dilatation of the lateral ventricles of the brain itself does not require treatment. It is prescribed only in the presence of symptoms characteristic of the pathology. Treatment is aimed at eliminating the disease that is causing the dilatation.

The following drugs are used to treat ventricular asymmetry:

• diuretics;
• nootropic substances;
• anti-inflammatory drugs;
• vasoactive drugs;
• neuroprotectors
• sedatives;
• if the disease is caused by infections, antibacterial agents are prescribed.

If the pathology is caused by a cyst or tumor, their removal is required. If the patient's condition quickly deteriorates, an operation is performed to form a new connection of the ventricular system, which will bypass the anomaly.

Most often, ventricular dilatation occurs in infants. In the absence of timely and competent therapy, dilatation may persist and even worsen. With mild dilatation and the absence of obvious symptoms, the condition does not require special treatment. All that is needed is constant monitoring of the size of the asymmetry, as well as the general condition of the child.

If the disease is caused by injury, intrauterine development disorder, infection or tumor, constant monitoring of the patient, treatment of symptoms, and, if possible, elimination of the causes of the pathology are required.

The child is treated by a neurologist together with a neurosurgeon. To minimize the risk of complications, a child with this diagnosis should be constantly monitored by doctors. Most often, diuretics are prescribed for treatment, which promote the production of cerebrospinal fluid, which puts pressure on the lateral ventricles.

Additionally, it requires taking medications to improve blood supply to the brain, and sedatives are prescribed.

Massage, therapeutic exercises and other methods of physiotherapy are required. Infants with this diagnosis are observed on an outpatient basis. Treatment of the pathology may take several months.

Older children are treated depending on the cause of the pathology. Antimicrobial drugs are prescribed if the cause of the asymmetry is a brain infection. In case of tumors, cysts and other formations, surgery is prescribed.

Mild pathology most often does not cause any symptoms. IN in rare cases there may be a slight delay motor sphere, however, it also goes away completely over time. A severe form of the pathology can lead to cerebral palsy as a result of high intracranial pressure.

Asymmetry of the lateral ventricles of the brain is not the most dangerous, but it requires attention pathology that occurs in people of any age.

If this problem is detected, you should visit an experienced specialist who will prescribe the appropriate tests to confirm the diagnosis. Treatment consists of eliminating the cause of dilatation, as well as reducing intracranial pressure.

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

Hydrocephalus of the brain in adults: causes, symptoms, treatment

Hydrocephalus in adults (“dropsy of the brain”) is a pathological condition characterized by excessive accumulation of cerebrospinal fluid (CSF) in the cerebrospinal fluid spaces of the brain. Hydrocephalus can be an independent nosological entity, or it can be a consequence of various brain diseases. It requires mandatory qualified treatment, since the long-term existence of the disease can lead to disability and even death.

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

Causes

Each person in the brain has special spaces containing a special liquid - cerebrospinal fluid. Inside the brain itself there is a system of brain ventricles communicating with each other, outside the brain there is a subarachnoid space with brain cisterns. Liquor performs very important functions: it protects the brain from blows, jolts 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 ensures homeostasis due to optimal intracranial pressure.

The volume of cerebrospinal fluid in an adult is ml, and it is renewed 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), cerebrospinal fluid flows through the foramen of Monro into the third ventricle, whose volume is 5 ml. From the third ventricle, the cerebrospinal fluid moves to the fourth (also contains 5 ml) along the aqueduct of Sylvius (aqueduct of the brain). At the bottom of the fourth ventricle there are openings: the median unpaired Magendie and two lateral Luschka. Through these openings, cerebrospinal fluid enters the subarachnoid space of the brain (located between the pia mater and the arachnoid membrane of the brain). On the basal surface of the brain, the subarachnoid space expands, forming several cisterns: cavities filled with cerebrospinal fluid. From the tanks, cerebrospinal fluid flows to the outer (convexital) surface of the brain, as if “washing” it from all sides.

Absorption (resorption) of cerebrospinal fluid occurs in venous system brain through arachnoid cells and villi. lint accumulation around venous sinuses called pachyon granulations. Part of the cerebrospinal fluid is absorbed into lymphatic system at the level of the nerve sheaths.

Thus, the cerebrospinal fluid produced in the choroid plexuses inside the brain washes it from all sides and is then absorbed into the venous system, this process is continuous. This is how circulation occurs normally, the amount of fluid produced per day is equal to that absorbed. If “problems” arise at any stage, either with production or with absorption, then hydrocephalus occurs.

The causes of hydrocephalus can be:

• infectious diseases of the brain and its membranes - meningitis, encephalitis, ventriculitis;
• brain tumors of stem or peri-stem localization, as well as brain ventricles);
• vascular pathology of the brain, including subarachnoid and intraventricular hemorrhages as a result of rupture of aneurysms, arteriovenous malformations;
• encephalopathies (alcoholic, toxic, etc.);
• brain injuries 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 development mechanism, there are:

• closed (occlusive, non-communicating) hydrocephalus - when the cause is a violation of the flow of cerebrospinal fluid due to an overlap (block) of the cerebrospinal fluid pathways. More often, the normal flow of cerebrospinal fluid is interfered with by a blood clot (due to intraventricular hemorrhage), part of a tumor or adhesion;
• open (communicating, disresorptive) hydrocephalus - based on impaired absorption into the venous system of the brain at the level of arachnoid villi, cells, pachyonic granulations, venous sinuses;
• hypersecretory hydrocephalus - with excessive production of cerebrospinal fluid by the choroid 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 last years this form is no longer classified as hydrocephalus, since the reason for the increase in cerebrospinal fluid content is atrophy of brain tissue and a decrease in the brain itself, and not in disruption of the circulation of cerebrospinal fluid.

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

• hypertensive – with increased cerebrospinal fluid pressure;
• normotensive - with normal blood pressure;
• hypotensive – with low cerebrospinal fluid pressure.

Based on the time of occurrence, they are distinguished:

• acute hydrocephalus – the development period of the process is up to 3 days;
• subacute progressive – 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 cerebrospinal fluid pressure, the mechanism of development.

In acute and subacute occlusive hydrocephalus, a person complains of headache, more pronounced in the morning (especially after sleep), accompanied by nausea and sometimes vomiting, which brings relief. There is a feeling of pressure on the eyeballs from the inside, a burning sensation, “sand” in the eyes, and the pain is bursting in nature. Injection of scleral vessels is possible.

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

Possible deterioration of vision, a feeling of “fog” before the eyes. The fundus reveals stagnant discs optic nerves.

If the patient does not seek medical help in time, then a 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 by rapid depression of consciousness up to coma, paresis of upward gaze, divergent strabismus, and suppression 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 (to the point of loss of consciousness), and then cardiac activity and breathing are depressed, which leads to the death of the patient.

Chronic hydrocephalus is often communicating and with normal or slightly increased intracranial pressure. Develops gradually, months after causative factor. Initially, the sleep cycle is disrupted, and either insomnia or drowsiness appears. Memory deteriorates, lethargy appears, fast fatiguability. General asthenia is characteristic. As the disease progresses, mnestic (cognitive) impairments worsen, leading to dementia in advanced cases. Patients cannot care for themselves and behave inappropriately.

The second typical symptom of chronic hydrocephalus is difficulty walking. At first, the gait changes – it becomes slow and unstable. Then comes uncertainty when standing and difficulty starting to move. In a lying or sitting position, the patient can imitate walking or riding a bicycle, 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 “gait apraxia.” Muscle tone increases, in advanced cases muscle strength decreases, and paresis appears in the legs. Balance disorders also tend to progress to the point of being unable to stand or sit independently.

Often patients with chronic hydrocephalus complain of frequent urination, especially at night. Gradually, an imperative urge to urinate begins, requiring immediate emptying, and then urinary incontinence.

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.

X-ray of the cisterns at the base of the brain allows one to assess the direction of the cerebrospinal fluid flow and clarify the type of hydrocephalus.

It is possible to conduct a trial diagnostic lumbar puncture with the removal of ml 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 tissue against the background of a decrease in intracranial pressure. This serves as a favorable prognostic sign when predicting surgical treatment of hydrocephalus. You should know that when acute hydrocephalus lumbar puncture is contraindicated due to high risk herniation of the brain stem and the development of dislocation syndrome.

Treatment

The initial stages of hydrocephalus can be treated with medication. The following medications are used for this:

• to reduce intracranial pressure and remove excess fluid (provided that the outflow of cerebrospinal fluid is preserved) - diacarb (acetazolamide), mannitol and mannitol in combination with furosemide or lasix. Mandatory for this treatment is the correction of potassium levels in the body, for this they use asparkam (panangin);
• To improve the nutrition of brain tissue, Cavinton (vinpocetine), Actovegin (solcoseryl), gliatilin, choline, cortexin, Cerebrolysin, Semax, Memoplant, etc. are indicated.

Clinically advanced hydrocephalus is subject to surgical treatment; medication methods improve the condition for a short time.

Acute hydrocephalus, as a life-threatening condition, requires immediate neurosurgical treatment. It consists of craniotomy and the application of external drainages to ensure the outflow of excess fluid. This is called external ventricular drainage. In addition, through the drainage system it is possible to administer drugs that dilute blood clots (since intraventricular hemorrhage is one of the most common causes of acute hydrocephalus).

Chronic hydrocephalus requires cerebrospinal fluid shunting operations. This type of surgical treatment involves removing excess cerebrospinal fluid into the natural cavities of the human body using complex system catheters and valves (abdominal cavity, pelvic cavity, atria, etc.): ventriculoperitoneal, ventriculoatrial, cystoperitoneal shunting. Unimpeded absorption of excess cerebrospinal fluid occurs in the body cavities. These operations are quite traumatic, but when performed correctly, they allow patients to recover and achieve their labor and social rehabilitation.

Today, the less traumatic neuroendoscopic technique has taken first place among invasive treatment methods. It is still more often performed abroad due to the high cost of the operation itself. This method is called: endoscopic ventriculocisternostomy of the bottom of the third ventricle. The operation lasts 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 display an image using a projector and accurately control all manipulations. An additional hole is created at the bottom of the third ventricle, connecting to the cisterns of the base of the brain, which eliminates the cause of hydrocephalus. Thus, the physiological fluid flow between the ventricles and cisterns is restored.

Consequences

Hydrocephalus is a dangerous disease, ignoring the symptoms of which can lead to 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 result in a tragedy for a person: loss of ability to work and social significance. Mental impairment, mobility problems, urination problems, decreased vision, hearing, epileptic seizures, - here is the list possible consequences hydrocephalus, if treatment is not started in a timely manner. Therefore, at the slightest suspicion of hydrocephalus, it is necessary to seek qualified medical help.

TVC, program “Doctors” on the topic “Hydrocephalus”

What should you do if the doctor reports on an ultrasound that your child has enlarged ventricles of the brain? If the baby feels normal and there are no abnormalities in neuropsychic development, the specialist may suggest simply regularly visiting a neurologist to monitor the little patient’s condition. With a pronounced clinical picture of brain damage, pronounced neurological symptoms and a significant deviation in the size of the ventricles from the norm, treatment is necessary, which is prescribed by a neurologist.

Normal cerebral ventricles in a newborn

Normally, a person has four ventricles in the head: two lateral, they are located symmetrically, the third and fourth, located in the middle. The third is conventionally anterior, the fourth is posterior. The fourth ventricle passes through the cisterna magna, connecting to the central canal (spinal cord).

Why are doctors concerned about enlarged ventricles of the brain? The main function of the lateral structures is the production of cerebrospinal fluid and regulation of the volume of cerebrospinal fluid. A large release of fluid and a violation of its excretion provokes disruption of brain function.

The depth of the third ventricle should normally not exceed 5 mm, the fourth ventricle – 4 mm. If the lateral ventricles of the brain are considered, the norm for a newborn is calculated as follows:

• Anterior horns – from 2 mm to 4 mm.
• Occipital horns – from 10 mm to 15 mm.
• Lateral bodies - no deeper than 4 mm.

The standard depth for a large tank is 3-6 mm. All brain structures should grow gradually, the size of the ventricles should be linearly consistent with the size of the skull.

Causes of enlarged ventricles of the brain

It is believed that changes in ventricular structures in infants are genetically determined. Pathological changes in the brain develop due to chromosomal abnormalities that occur in pregnant women. There are other factors that provoke asymmetry of the ventricles and excessive enlargement of parts of the brain:

• Diseases infectious etiology, which a woman suffered from during pregnancy.
• Sepsis, intrauterine infections.
• Hit foreign body into brain structures.
• Pathological course of pregnancy caused by chronic diseases of the mother.
• Premature birth.
• Intrauterine fetal hypoxia: insufficient blood supply to the placenta, increased placental blood flow, umbilical cord varicose veins.
• Long waterless period.
• Rapid birth.
• Birth trauma: strangulation by the umbilical cord, deformation of the skull bones.

Experts also note that the ventricles of the brain in newborns may increase due to the occurrence of hydrocephalus. unknown etiology. Congenital causes that provoke expansion of the ventricles of the head include the growth of neoplasms: cysts, benign and malignant tumors, hematomas.

A traumatic brain injury received by a child during childbirth, cerebral hemorrhage, ischemic or hemorrhagic stroke can also cause enlargement of the ventricles of the baby’s brain.

Clinical manifestations of ventricular dilatation

The ventricles not only store cerebrospinal fluid, they also secrete cerebrospinal fluid into the subarachnoid space. An increase in fluid secretion and a deterioration in its outflow leads to the fact that the ventricles stretch and enlarge.

An increase in the ventricular structures of the brain (dilatation, ventriculomegaly) may be a normal variant if a symmetrical expansion of the lateral ventricles is detected. If there is asymmetry of the lateral structures, the horns of only one of the ventricles are enlarged, this is a sign of development pathological process A.

Not only the lateral ventricles of the brain can become pathologically enlarged; the normal production and excretion of cerebrospinal fluid may be disrupted in the third or fourth. There are three types of ventriculomegaly:

• Lateral: enlargement of the left or right part of the ventricular structures, expansion of the posterior ventricle.
• Cerebellar: the medulla oblongata and cerebellar region are affected.
• When pathological release of cerebrospinal fluid occurs between the visual tuberosities, in the frontal part of the head.

The disease can occur in mild, moderate, severe form. In this case, not only an expansion of the cavities of the ventricles of the brain is noted, but also a disruption in the functioning of the child’s central nervous system.

There is normal symmetrical oversizing of the lateral ventricular structures when the child is large, has a large head or an unusual skull shape.

Symptoms of the disease in an infant

Since the outflow of cerebrospinal fluid is impaired, it remains in large quantities in the head, while the intracranial pressure in the newborn increases, and swelling of the tissues, gray matter, and cerebral cortex increases. Due to pressure on the brain, blood supply is disrupted and the functioning of the nervous system deteriorates.

If the growth of the horns of the ventricles of the brain is accompanied by hydrocephalus, the child’s skull bones move apart, the fontanel bulges and tenses, the frontal part of the head can significantly exceed the facial part in size, and a network of veins protrudes on the forehead.

When the ventricle of the brain is enlarged in a newborn or pathological asymmetry of the lateral ventricles is noted, the child experiences the following neurological symptoms:

• Impaired tendon reflex, increased muscle tone.
• Visual impairment: inability to focus, squint, constantly downturned pupils.
• Trembling of limbs.
• Walking on tiptoe.
• Low manifestation of basic reflexes: swallowing, sucking, grasping.
• Apathy, lethargy, drowsiness.
• Irritability, loudness, capriciousness.
• Poor sleep, jumping up in sleep.
• Poor appetite.

One of the most striking symptoms is frequent regurgitation, sometimes vomiting. Normally, a child should burp only after feeding - no more than two tablespoons at a time. Due to the fact that when intracranial pressure increases (it is provoked by excessive accumulation of cerebrospinal fluid in the cavity of the cranium), the vomiting center in the fourth ventricle at the bottom of the rhomboid fossa is irritated, the frequency of regurgitation in a newborn increases significantly (more than twice after feeding and later).

The acute, rapid development of the disease provokes severe headaches, which is why the child constantly screams loudly and monotonously (brain scream).

Diagnostic methods

For the first time, a doctor can pay attention to deviations in the size of brain structures from the norm during an intrauterine ultrasound examination of the fetus. If the head size does not return to normal, a repeat ultrasound is performed after the baby is born.

Enlargement of the ventricles of the brain in newborns is diagnosed after neurosonography - ultrasound performed through the skin of an undeveloped fontanel. This study can be carried out until the child’s skull bones have completely fused.

If the disease develops chronically, the doctor may pay attention to the fact that the ventricles of the brain are larger than normal when examining the child with an ultrasound scan at three months of age. To clarify the diagnosis, it is recommended to undergo additional examination:

• Ophthalmological examination - helps to identify swelling of the eye discs, indicating increased intracranial pressure, hydrocephalus.
• Magnetic resonance imaging can be used to monitor the growth of the cerebral ventricles after the bones of the child’s skull have fused. MRI is a long procedure, the time spent under the machine is 20-40 minutes. In order for the child to lie motionless for such a long time, he is immersed in medicated sleep.
• When undergoing a CT scan, you do not need to remain motionless for a long time. Therefore, this type of study is suitable for children for whom anesthesia is contraindicated. Using CT and MRI, you can obtain accurate images of the brain, determine how much the size of the ventricular system deviates from the norm, and whether there are neoplasms or hemorrhages in the medulla.

It is recommended to undergo an ultrasound of the brain for children in the first month of life if pregnancy or childbirth was accompanied by complications. If the ventricles are enlarged but there are no neurological symptoms, it is recommended to be re-examined after three months.

When a child has enlarged ventricles of the brain, only a neurologist or neurosurgeon can prescribe the necessary treatment.

Drug therapy

Enlargement or asymmetry of ventricular structures does not always require treatment. If the child develops correctly, eats and sleeps well, it is considered that enlargement of the ventricular horns is an acceptable deviation from the norm.

When pronounced neurological symptoms The baby is prescribed special medications:

• Diuretics (Diacarb, Furosemide) - to reduce cerebral edema, speed up urination, and normalize fluid excretion from the body.
• Potassium preparations (Panangin, Asparkam) - to replenish potassium deficiency, which occurs during accelerated work of the urinary tract.
• Vitamins (Multitabs, B6, D3, Magne B6) - to prevent rickets and accelerate regeneration processes in the body of a newborn.
• Nootropic drugs (Cavinton, Vinpocetine, Noofen, Ecephabol, Cerebrolysin) - for normalization cerebral circulation, strengthening blood vessels, improving microcirculation in brain tissue.
• Sedative medications (Glycine) – help reduce nervous symptoms: tearfulness, moodiness, irritability; stabilize the process of falling asleep, normalize sleep.

If the provoking factors that caused the pathological growth of the ventricles of the brain are identified, they are also eliminated: viral and infectious diseases are treated. If the cause of the pathology is brain damage or tumor growth, surgical intervention is performed: the cyst is excised, cancer tumor is deleted.

When enlarged ventricles of the brain are diagnosed in a child, treatment takes a long period of time. Newborns need to undergo massage courses and constantly perform physical therapy exercises to restore muscle tone and prevent atrophy.

Possible consequences and complications

Probably due to the wide availability of information and the opportunity to consult with other parents, Lately there is an unhealthy trend. Parents refuse to treat their children for hydrocephalus; they attribute constant crying to capriciousness and stubbornness, and lethargy to character traits. People are frightened by serious medications and contraindications, and they decide that the disease will go away on its own.

But asymmetry of the ventricles of the brain, their significant increase can lead to serious consequences:

• Delayed mental, physical, mental development.
• Loss of vision: complete or partial.
• Hearing loss.
• Paralysis of limbs, complete immobilization.
• Pathological head growth.
• Inability to regulate bowel movements and urination.
• Epileptic seizures.
• Frequent loss of consciousness.
• Comatose state.
• Lethal outcome.

It’s good if the doctor notes a slight deviation from the norm during the ultrasound and suggests only observing the patient. This is possible if there are no symptoms of the disease: the child is calm, eats well, sleeps, and develops normally.

A diagnosis of “Dilation of the lateral ventricles of the brain in a child” has been made, but you doubt the professionalism of the doctor, and do not want to give your newborn medications in vain? Contact several independent specialists, get data full examination. Do not refuse treatment, since the actions of the parents determine how fulfilling the child’s life will be.

In the first hours after birth, the child is under the supervision of neonatologists who monitor his physiological state and do the necessary examinations of the body. In this case, health assessment is carried out in stages, starting from the first minute of life, and ends before discharge.

The most thorough examination is carried out on the first day and consists of a standard procedure for monitoring activity and appearance newborn If the doctor suspects congenital malformations, then it is possible to use an ultrasound examination, which makes it possible to identify deviations in the formation of not only internal organs, but also the brain. In this case, the sizes of the ventricles are especially carefully measured, which normally should not exceed a certain value.

At this stage, the neonatologist can diagnose dilation of the ventricles of the brain in newborns. Based on the degree of pathology and the impact on the child’s life, the question will be raised about further solving this problem: for example, in case of minor deviations from the norm, observation by a neurologist and monitoring of the condition are prescribed. If the violations are serious and the symptoms are pronounced, then the child needs special treatment and observation in a hospital setting.

Ventricular system of the brain

The ventricular system consists of 4 cavities located in parts of the brain. Their main purpose is the synthesis of cerebrospinal fluid or cerebrospinal fluid, which performs a large number of tasks, but its main function is to cushion the brain matter from external influences, control intracranial pressure and stabilize metabolic processes between the blood and the brain.

The movement of cerebrospinal fluid occurs through channels connecting the common 4th ventricle and the subarachnoid space formed by the membranes of the spinal cord and brain. Moreover, its main volume is located above significant fissures and convolutions of the cortex.

The largest lateral ventricles are located equidistant from the midline below the corpus callosum. The first ventricle is considered to be the cavity located on the left side, and the second - on the right. They are C-shaped and wrap around the dorsal parts of the basal ganglia. They produce cerebrospinal fluid, which enters the third ventricle through the intergastric openings. Structurally, segments I and II of the ventricular system include the anterior (frontal) horns, body and inferior (temporal) horns.

The third ventricle is located between the visual tuberosities and has the shape of a ring. At the same time, in its walls there is Gray matter, which is responsible for the regulation of the autonomic system. This section is connected with the midbrain aqueduct, and through the interventricular foramen, located behind the nasal commissure, with the I and II ventricles.

The most important IV ventricle is located between the cerebellum and the medulla oblongata, with the vermis and medullary velum located above it, and the medulla oblongata and pons below it. This cavity was formed from the remains of the posterior brain bladder and is common to the rhomboid region. At its bottom lie the nuclei of the V-XII cranial nerves. In this case, the posterior lower corner communicates with the spinal cord through the central canal, and through the upper anterior part with the aqueduct.

Sometimes, when examining a newborn, the fifth ventricle is detected, which is a feature of the structure of the brain. It is located in the anterior midline, below the corpus callosum. Usually its closure occurs by 6 months of age, but if the gap is more than 10 mm, then we are talking about a pathology of the liquorodynamic system.

If an ultrasound revealed asymmetry of the lateral ventricles in a child, the prognosis depends on the degree of pathology and the depth of damage to brain tissue, as well as the reasons that provoked the development of the disease. Thus, a significant increase interferes with normal circulation and production of cerebrospinal fluid, which entails neurological problems. But congenital asymmetry, not aggravated by outflow disorders, in most cases does not require treatment. However, such a child needs observation in order to prevent relapse of the disease and possible consequences.

The size of the ventricles is normal

A healthy newborn normally has 4 ventricles: two lateral, the third is conventionally anterior, and the fourth ventricular component, which is considered posterior. An enlargement of the lateral ventricles entails the production of a large amount of cerebrospinal fluid, which will not be able to circulate normally between the membranes of the brain and, accordingly, perform its functions of regulating metabolic processes. Therefore, when assessing the size of the ventricles of newborns, the following standards are used:

• the lateral anterior horns should fall within the range of 2-4 mm;
• lateral occipital horns - 10-15 mm;
• body of the lateral ventricles - no deeper than 4 mm;
• III ventricle - no more than 5 mm;
• IV - up to 4 mm.

When examining the brain of infants up to a year and older, the use of these standards will be incorrect, since the brain matter and ventricles will grow, so the assessment is carried out using other indicators and corresponding tables.

Causes of enlarged ventricles

If the initial examination revealed that the ventricles of the brain in a newborn are slightly enlarged, then do not despair, since in most cases this condition requires only observation during the first years of life, and the prognosis is favorable.

Initially, a small discrepancy between indicators and norms may be genetically determined and be a feature of the brain structure, while pathological changes occur due to a chromosomal malfunction during fetal formation.

There are a number of factors that provoke asymmetry and dilatation (enlargement) of the ventricular cavity:

• infectious diseases during pregnancy (in particular, infection of the fetus with cytomelalovirus);
• blood poisoning, sepsis;
• complications caused by chronic maternal diseases;
• premature birth;
• acute hypoxia during fetal development caused by insufficient blood supply to the placenta;
• varicose veins feeding the fetus;
• long anhydrous period and prolonged labor;
• rapid birth;
• birth injuries, hypoxia caused by umbilical cord entanglement;
• deformation of the cranial bones;
• entry of foreign objects into the brain structures;
• cysts, neoplasms of various nature;
• hemorrhages;
• ischemic and hemorrhagic stroke.

Also, dilation of the ventricles can be caused by cerebral hydrocele of unknown etiology and other congenital diseases.

This is what Evgeniy Komarovsky, a well-known pediatrician in the post-Soviet space and a doctor of the highest category, says about the expansion of the ventricles.

How it manifests itself

The main function of the ventricles is to secrete cerebrospinal fluid, as well as ensure its normal circulation in the subarachnoid space. If the balance of exchange and production of cerebrospinal fluid is disturbed, then stagnation is formed and, as a result, the walls of the cavities are stretched. The same slight expansion of the lateral segments may be a variant of the norm, but their asymmetry and increase individual parts(for example, only the horn) will be a sign of the development of pathology.

Enlarged ventricles of the brain in an infant can be diagnosed with a congenital disease such as ventriculomegaly. It varies in severity:

1. Slight expansion of the ventricles of the brain up to 11-12 mm, with no significant symptoms. It manifests itself in the child’s behavior: he becomes more excitable and irritable.
2. Increasing the depth of the ventricles up to 15 mm. Most often, the pathology is accompanied by asymmetry and impaired blood supply to the affected area, which entails the appearance of seizures, an increase in head size and a lag in mental and physical development.
3. Ventricular dilatation up to 20 mm, characterized by irreversible changes brain structures, in infants is often accompanied by Down syndrome and cerebral palsy.

In adulthood, an increase in ventricular volume is manifested by the following symptoms:

• Gait disturbance, with the child walking “on tiptoes” or vice versa, focusing only on the heels.
• The appearance of visual disorders, such as squint, insufficient focus of the gaze, as well as double images when trying to see small details.
• Tremor of arms and legs.
• Behavioral disorders that manifest themselves in excessive lethargy and drowsiness, while it is difficult to captivate the child with any activity.
• The appearance of headaches due to increased intracranial pressure, sometimes nausea and even vomiting can occur.
• Dizziness.
• Frequent regurgitation, loss of appetite. Some newborns are able to refuse breastfeeding.

Consequences

Late detection of the pathology that resulted in the expansion of the ventricle of the brain in a newborn can lead to a stop in development and deterioration in physical condition.

The main symptoms of the disease most often appear in the first 6 months after birth and are expressed in persistent increased intracranial pressure. Impaired consciousness, vision, hearing loss, epileptic seizures and fits, and disorders of the peripheral nervous system may also be observed.

Lack of proper attention to the child and failure to comply with specialists’ prescriptions can provoke the transition of the disease from more light form to severe, treatment of which is carried out only in a hospital setting and, if necessary, with the use of surgical interventions.

Diagnosis and treatment

During pregnancy, dilation of the ventricles of the fetal brain is most often detected during a routine ultrasound examination. Subsequent examinations are carried out to monitor the clinical picture of the disease, but the final diagnosis can be made only after the birth of the child and neurosonography - ultrasound of the brain through a large fontanelle that has not yet become overgrown. In this case, the pathology can develop at any age, but most often occurs in infancy.

To make a more accurate diagnosis, the baby may need a consultation and examination with an ophthalmologist, who will assess the condition of the fundus vessels, swelling of the eye discs and other manifestations of increased intracranial pressure.

After the fusion of the cranial bones, it is possible to use MRI of the brain: it will allow tracking the dilatation of the walls of the ventricles in dynamics. However, when using this method, the child will have to remain motionless for a long time, so before the procedure he is put into medicated sleep. If anesthesia is contraindicated, the examination is performed using computed tomography.

A consultation with a neurologist is also required, who will help identify developmental problems even at an early age. initial stage. Depending on the degree of pathology further treatment can be surgical or conservative with medication.

If there is a significant deviation from the norm in the size of the ventricles, only surgery, accordingly, the child should also be examined by a neurosurgeon. In this case, during the operation, foci of neoplasms or fragments of skull bones that appear as a result of traumatic brain injuries can be removed. To reduce intracranial pressure, normalize blood circulation and metabolic processes, brain shunting is used.

Conservative therapy is prescribed for slight enlargement of the ventricles and includes the use of diuretics, nootropics, sedatives and vitamin complexes. If the disorders are caused by infections, then antibiotics are prescribed. The use of therapeutic exercises will also help improve the outflow of cerebrospinal fluid and reduce its stagnation.

Forecast

If pathology in the development of the ventricles was identified in the first days after birth, then the prognosis in most cases is favorable and depends on adequate treatment and the severity of the abnormalities.

Detection of the disease and therapy in older age can be complicated due to the formation of a large number of anomalies that arise as a result of the development of pathology, its causes and influence on other body systems.

Video: Increased intracranial pressure in a child

Quite often, after birth, babies have enlarged ventricles of the brain. This condition does not always mean the presence of a disease that necessarily requires treatment.

Ventricular system of the brain

The ventricles of the brain are several interconnected collectors in which the formation and distribution of liquor fluid occurs. Liquor washes the brain and spinal cord. Normally, there is always a certain amount of cerebrospinal fluid in the ventricles.

Two large collectors of cerebrospinal fluid are located on either side of the corpus callosum. Both ventricles are connected to each other. On the left side is the first ventricle, and on the right is the second. They consist of horns and a body. The lateral ventricles are connected through a system of small holes to the 3rd ventricle.

In the distal part of the brain, between the cerebellum and the medulla oblongata, there is the 4th ventricle. It is quite large in size. The fourth ventricle is diamond-shaped. At the very bottom there is a hole called the diamond-shaped fossa.

Proper functioning of the ventricles allows cerebrospinal fluid to enter the subarachnoid space when necessary. This zone is located between the dura mater and the arachnoid membrane of the brain. This ability allows you to maintain the required volume of cerebrospinal fluid in various pathological conditions.

In newborn babies, dilatation of the lateral ventricles is often observed. In this condition, the horns of the ventricles are enlarged, and increased accumulation of fluid in the area of ​​their bodies may also be observed. This condition often causes both left and right ventricle enlargement. At differential diagnosis asymmetry in the area of ​​the main brain collectors is excluded.

The size of the ventricles is normal

In infants, the ventricles are often dilated. This condition does not at all mean that the child is seriously ill. The dimensions of each ventricle have specific values. These indicators are shown in the table.

For rate normal indicators The definition of all structural elements of the lateral ventricles is also used. The lateral cisterns should be less than 4 mm deep, the anterior horns between 2 and 4 mm, and the occipital horns between 10 and 15 mm.

Causes of enlarged ventricles

Premature babies may have dilated ventricles immediately after birth. They are located symmetrically. Symptoms intracranial hypertension in a child with this state usually does not occur. If only one of the horns increases slightly, then this may be evidence of the presence of pathology.

The following reasons lead to the development of ventricular enlargement:

Fetal hypoxia, anatomical defects in the structure of the placenta, development of placental insufficiency. Such conditions lead to disruption of the blood supply to the brain of the unborn child, which can cause expansion of the intracranial collectors.

Traumatic brain injuries or falls. In this case, the outflow of cerebrospinal fluid is disrupted. This condition causes water to stagnate in the ventricles, which can lead to symptoms of increased intracranial pressure.

Pathological birth. Traumatic injuries, as well as unforeseen circumstances during childbirth, can lead to disruption of the blood supply to the brain. These emergency conditions often contribute to the development of ventricular dilatation.

Infection with bacterial infections during pregnancy. Pathogenic microorganisms easily penetrate the placenta and can cause various complications in the child.

Prolonged labor. Too long a time between the rupture of amniotic fluid and the expulsion of the baby can lead to the development of intrapartum hypoxia, which causes a disruption in the outflow of cerebrospinal fluid from the dilated ventricles.

Oncological formations and cysts that are located in the brain. The growth of tumors puts excess pressure on intracerebral structures. This leads to the development of pathological expansion of the ventricles.

Foreign bodies and elements which are located in the brain.

Infectious diseases. Many bacteria and viruses easily penetrate the blood-brain barrier. This contributes to the development of numerous pathological formations in the brain.

How does it manifest?

Ventricular dilatation does not always lead to adverse symptoms. In most cases, the child does not experience any discomfort that would indicate the presence of a pathological process.

Only when pronounced violations The first adverse manifestations of the disease begin to appear. These include:

Gait disturbance. Babies begin to walk on tiptoes or step on their heels.

The appearance of visual disturbances. They often manifest themselves in children in the form of squint or insufficient focusing on various objects. In some cases, a child may experience double vision, which worsens when looking at small objects.

Trembling of hands and feet.

Behavioral disorders. Babies become more lethargic and drowsy. In some cases, even apathetic. It is very difficult to captivate a child with any games or recreational activities.

Headache. It appears when intracranial pressure increases. At the height of pain, vomiting may occur.

Dizziness.

Decreased appetite. Babies in the first months of life refuse to breastfeed and eat poorly. In some cases, the baby spits up more.

Sleep disturbance. Babies may have difficulty falling asleep. Some children walk in their sleep.

The disease can vary in severity. With minimal symptoms, they speak of a mild course. When headache, dizziness, and other symptoms indicating high intracranial hypertension appear, the disease becomes moderately severe. If the child’s general condition is severely disturbed and treatment in a hospital setting is required, then the disease becomes more severe.

Consequences

Late diagnosis pathological conditions, leading to the appearance of expansions in the area of ​​the ventricles of the brain, can affect the further development of the child. The first persistent symptoms of ventricular dilatation are observed in babies at 6 months.

Impaired outflow of liquor fluid can lead to a persistent increase in intracranial pressure. At severe course diseases – this contributes to the development of consciousness disorders. Visual and hearing disorders lead to the development of hearing loss and weakened vision in the child. Some children experience epileptic seizures and seizures.

Diagnostics

In order to determine the exact size of the ventricles, as well as find out their depth, doctors prescribe several examination methods.

The most informative and reliable are:

Ultrasonography. Allows you to accurately describe the quantitative indicators of the ventricles, as well as calculate the ventricular index. Using ultrasound, you can estimate the volume of liquor fluid that is present in the brain collectors during the study.

CT scan. With high accuracy it allows you to describe the structure and size of all ventricles of the brain. The procedure is safe and does not cause pain in the baby.

Magnetic resonance imaging. It is used in complex diagnostic cases when establishing a diagnosis is difficult. Suitable for older children who are able to remain still throughout the examination. In young children, MRI is performed under general anesthesia.

Fundus examination.

Neurosonography.

Treatment of pathological conditions that lead to dilatation and asymmetry of the ventricles of the brain is usually carried out by a neurologist. In some cases, when the cause of the disease is space-occupying formations or the consequences of traumatic brain injuries, a neurosurgeon is involved.

To eliminate pathological symptoms, the following treatment methods are used:

Prescribing diuretics. Diuretics help reduce the manifestations of intracranial hypertension and improve the baby’s well-being. They also help normalize the formation of cerebrospinal fluid.

Nootropics. They improve brain function and also promote good blood supply to blood vessels.

Medicines with a sedative effect. Used to eliminate increased anxiety and agitation.

Potassium preparations. Positively affects urine excretion. This helps reduce the increased amount of cerebrospinal fluid in the body.

Multivitamin complexes. They are used to compensate for all the necessary microelements involved in vital processes. They also help strengthen the body and promote better resistance to disease.

Soothing and relaxing massage. Allows you to reduce muscle tone and also helps to relax the nervous system.

Physiotherapy. Helps normalize the outflow of liquor fluid and prevents its stagnation in the cerebral ventricles.

Prescribing antibacterial or antiviral drugs according to indications. They are used only in cases where the cause of the disease is viruses or bacteria. Appointed for a course appointment.

Surgery. Used in cases of various volumetric formations or to remove fragments bone tissue as a result of a skull fracture due to traumatic brain injury.

Forecast

If the condition develops in infancy and early infancy, the course of the disease is usually favorable. With appropriate treatment, all discomfort symptoms quickly disappear and do not bother the baby. High intracranial pressure is normalized.

In older children, the prognosis of the disease is somewhat different. Adverse symptoms are much more difficult to treat. A long course of the disease can lead to permanent visual and hearing impairment. If treatment was not started in a timely manner, then in most cases the child experiences persistent disorders that negatively affect his mental and mental development.

Dr. Komarovsky will talk about the expansion of the ventricles of the brain in infants and its consequences.

Immediately after birth, the baby begins an active hospital life: he is given vaccinations and undergoes many tests that allow him to assess the health of the newborn. Among them mandatory procedure– Ultrasound of the brain, it is important to check it for the absence of pathologies, and also to assess how developed it is, because the whole future life of the baby depends on this.

Ultrasound examination of the brain in an infant

Anatomy of the ventricular system of the brain

The structure of the human brain is heterogeneous; it consists of several parts, each of which is responsible for a specific vital function. Anyone healthy person the brain consists of four ventricles, which are interconnected by vessels, canals, openings and valves.

The brain consists of the lateral ventricles, the third and fourth. The side ones also have their own numbers: the left one is designated by the first number, and the right one by the second. 3 and 4 have a different name - front and rear, respectively. The lateral ventricles have horns - anterior and posterior, and a body of the ventricles. Cerebrospinal fluid (CSF) constantly circulates around all ventricles.

A change in the size of one or all ventricles entails a deterioration in the circulation of cerebrospinal fluid. This can have serious consequences: it leads to an increase in the volume of fluid in the spinal cord and a deterioration in the functioning of the body. Asymmetrical ventricles are not normal occurrence in babies and children under one year old.

Standard size chart

The sizes of all parts of the brain have standards for each age. Deviation from the average values ​​is not always a pathology, however, doctors still take into account the normal values ​​and, if values ​​exceeding the standards are detected, they prescribe a number of additional examinations.

The norms for the size of parts of the brain in newborns and infants are presented in the table.

Why do the ventricles of a child’s brain enlarge?

The lateral ventricles may increase in size due to impaired circulation of cerebrospinal fluid. The reasons may be:

• difficulty in cerebrospinal fluid drainage;
• impaired adsorption of cerebrospinal fluid;
• overproduction (excess formation) of cerebrospinal fluid.

In addition, dilatation (enlargement) of the lateral ventricles can lead to their asymmetry. This is a condition in which parts of the brain are unequally enlarged in size. More often, an increase in the width of the lateral ventricles occurs due to:

• infections;
• head injuries;
• tumors;
• hydrocephalus;
• hematomas;
• thrombosis

Hydrocephalus

The ventricles may be asymmetrical due to hemorrhage. The pathology occurs due to compression of one of the ventricles by additional blood flow. In newborns, the condition can be triggered by prolonged stay in the womb after a puncture or rupture of the bladder and development of asphyxia.

Symptoms of pathology

Asymmetry of the ventricles of the brain is accompanied by an increase in intracranial pressure, and therefore causes many various symptoms. In this regard, diagnosis can be difficult, and it is difficult to associate them with any disease. In newborns, deviations from the norm are expressed in the following manifestations:

• lack of appetite;
• lethargy of the limbs;
• tremor;
• swollen veins on the forehead, temples and back of the head due to obstruction of blood outflow;
• absence of age-appropriate reactions: decreased grasping and motor reflexes;
• the pupils of the eyes are directed in different directions;
• irregularities of the skull;
• frequent belching and nausea not associated with food intake.

A child with this diagnosis refuses to breastfeed and often spits up. Diagnostic methods

Expansion of the cerebrospinal fluid spaces of the brain in children is one of those pathologies that cannot be left to chance. To prescribe competent treatment, you must first make a diagnosis. Modern medicine knows several methods for diagnosing the condition of the brain. Radiation diagnostics is considered the most informative, but it is suitable for children after the fontanelles have become overgrown with bone tissue (more details in the article: when and how do the fontanelles overgrow in children?). Other methods include:

1. MRI – magnetic resonance imaging. It allows you to get full picture condition of soft tissues, including the brain, but has many contraindications. For young children it is prescribed only in extreme cases, since for a reliable result it is necessary for the patient to lie still for at least 20 minutes, which infants cannot do. There is a way out - this general anesthesia, but it negatively affects the baby’s health.
2. An alternative to MRI is diagnosis using a computed tomography scanner - CT. It is carried out much faster and does not require anesthesia, therefore it is the most preferable way to diagnose the condition of the brain in an infant. It has a significant drawback compared to MRI - lower quality of images, especially when it comes to small shooting areas. CT scans best show hemorrhage in the interthecal spaces, so a diagnosis can be made quickly and treatment can be prescribed.
3. NSG, or neurosonography. The procedure allows you to estimate only the size of the ventricles, but does not provide a visual picture. The device is capable of capturing organ sizes from 1 mm, no less.
4. An additional diagnostic method is to assess the condition of the fundus. During the process, dilated vessels can be seen, which will indicate that the patient has increased intracranial pressure.
5. Cerebrospinal fluid puncture, which is performed in lumbar region spine. By analyzing the taken material, the state of the cerebrospinal fluid is assessed.

MRI of the brain allows you to correctly assess the severity of the pathology Treatment methods

Mild enlargement of the lateral ventricles is treated with medications. More serious cases, as well as if the patient is under 2 years of age, must be treated in a hospital. Older children are referred for outpatient treatment. The neurologist prescribes:

1. Diuretics that enhance kidney function and help eliminate excess fluid. This reduces the volume of blood in the vessels and the amount of intercellular fluid. Accordingly, cerebrospinal fluid will be produced in smaller quantities and will cease to put pressure on the ventricles, causing them to enlarge.
2. Nootropic agents for stimulating cerebral circulation. They are prescribed to prevent fluid from compressing the blood vessels of the brain, which can lead to death. These drugs, in combination with diuretics, help cope with hypoxia and remove excess fluid from the ventricles into the blood, and then out through the kidneys, this helps alleviate the condition of children.
3. Sedatives. The child may become anxious and stressed, resulting in the production of adrenaline, which increases blood pressure and constricts blood vessels. As a result, hydrocephalus progresses. Sedatives are used only as prescribed by a doctor with strict adherence to dosage.
4. Drugs to improve muscle tone. Due to increased intracranial pressure, it is reduced, and since the muscles cannot control the stretching of the veins, the latter swell. In addition to medications, massage is used for this purpose, therapeutic exercises. You can start doing exercises with your baby to reduce blood pressure under the supervision of a doctor; sudden movements should not be allowed.

If the cause of dilatation or asymmetry of the 3rd and 4th ventricles is an infection caused by bacteria or viruses, such as meningitis, hydrocephalus syndrome may become one of the complications. In this case, you first need to treat the underlying cause of the enlarged ventricles.

Sometimes the deviation in the size of the liquor spaces from the norm is physiological, for example, when the newborn is large. This condition does not require specific treatment; it may only require a course of massage and special physical therapy.

Official medicine does not recognize the treatment of ventricular dilatation using acupuncture, taking homeopathic remedies and other methods of non-traditional intervention. People who engage in such practices, instead of the expected healing, can cause irreparable harm to the child. Taking vitamins is also ineffective, but they can be prescribed as a concomitant tonic in parallel with the main course of treatment.

Complications and consequences for the child

Although dilatation of the ventricles of the brain is not fatal dangerous disease, it can lead to various complications. The most dangerous condition is a rupture of the wall of a vein or ventricle. This pathology leads to immediate death or coma.

Enlargement of the ventricles of the brain can have serious consequences, so a child with this diagnosis should be observed for a long time in a medical facility

An enlarged ventricle can compress the optic or auditory nerve, leading to partial or complete blindness or deafness. If the compression is due to accumulated fluid, the condition will be reversible and vision or hearing will return when the excess fluid leaves the area.

A state of prolonged ventricular dilatation can lead to an attack of epilepsy. The mechanism of seizures is currently not fully understood, but it is known that they appear in various brain lesions.

The younger the child who is diagnosed with dilatation, the greater the chance of a full recovery. Less dangerous, but still unpleasant complications relate:

• delayed speech development, mental and mental development;
• urinary and fecal incontinence;
• blindness and deafness occurring in episodes.

In such cases, immediate treatment is necessary. Up to a year possible full recovery the functioning of the ventricular system and the baby’s recovery.

What it is

To store and collect cerebrospinal fluid, the human brain has 2 paired and 2 unpaired ventricles. Each of them contains a reservoir for cerebrospinal fluid. Features of each element of the ventricular system:

The first (left) ventricle and the second (right) ventricle. They consist of three pairs of horns and a body, connected to each other. Dilatation of the lateral ventricles is often diagnosed in newborns. Liquid accumulates in the horns or body of the cerebrospinal fluid collectors.

The third ventricle is connected to the paired ones and is located between their anterior and lower horns.

The fourth ventricle (diamond-shaped fossa) collects all the fluid from the three previous elements. From it, the fluid is distributed along the spinal or central canal.

The growth of the ventricles occurs gradually, consistent with the linear dimensions of the skull. However, in the presence of provoking factors, dilatation of the third or fourth collector for cerebrospinal fluid occurs. Sometimes an ultrasound examination of the expectant mother may indicate the presence of the 5th ventricle. This is the norm.

Ventricular system

The ventricular system is designed to store and secrete cerebrospinal fluid. At proper operation In the tanks of its collectors, cerebrospinal fluid collects from the surrounding veins. From there, the cerebrospinal fluid is distributed into the subarachnoid space.

An enlargement of one of the ventricles in an infant is not always pathological. Minor deviations in their size are due to the baby’s large head at birth. There is an expansion of the elements of the ventricular system to one year old. When a pathology is detected, it is recommended to measure the entire liquor apparatus.

Disruption of the outflow from the ventricles of the brain occurs due to the appearance of an obstruction to the excretion of cerebrospiral fluid. With prolonged accumulation of fluid, an enlarged head and a hydrocephalic condition of the infant are observed. Which leads to disruption of brain function. These disorders occur with pathological or premature birth, head trauma of the newborn.

Indicators of normal sizes

The sizes of the ventricles are determined by ultrasound examination of the infant's brain. At the slightest deviation, there is a risk of cerebrospinal fluid stagnation.

Normal indicators of the elements of the ventricular system in newborns:

• Lateral (first and second): 4 mm. Features of paired elements: front horns - up to 4 mm, rear horns up to 15 mm, lateral bodies 4 mm each.
• Third: 5 mm.
• Normal fourth ventricle measurements range from 3 to 6 mm.

Brain structures in healthy children should grow symmetrically and gradually. Indicators are calculated depending on the linear dimensions of the skull. If one of the ventricles is larger than normal, it is necessary to examine the entire liquor apparatus and make sure of the asymmetry of paired or pathological enlargement of unpaired elements.

When fluid is retained in the ventricles of the brain, their volume increases and intracranial pressure increases. With hydrecephalic-hypertensive syndrome, disruption and atrophy of the hemispheres occurs.

The causes of the pathology are as follows:

Congenital hydrocephalus: fetal hypoxia, pathological birth, birth of a child before 35 weeks, maternal infection or virus during pregnancy, genetic pathologies brain development.

Acquired hydrocephalus: infection, neoplasms in the ventricles, head trauma, disruption of the integrity of the bones of the skull and brain.

A newborn with this syndrome is characterized by tearfulness, impaired motor skills and a lag in physical and psycho-emotional development. There is a gradual or sudden enlargement of the head, the bones of the skull diverge, and the fontanel protrudes.

It is also necessary to pay attention to a baby who has strabismus, who often spits up, is capricious in the morning, and reacts negatively to bright light and loud sounds.

If dilatation of the left ventricle is diagnosed in newborns up to six months, hospital treatment is possible. The child is prescribed sedatives, diuretics and nootropic drugs. Massage is required and gymnastic exercises.

Enlarged and dilated ventricles affect the functioning of the central nervous system. If the changes evenly affected every element of the liquor structure, this is the norm. There are types and degrees of severity of the ventriculomegalic condition.

According to localization they distinguish following types pathologies:

Enlargement of the rear or side (left, right) element.

Enlargement affecting the visual thalamus and frontal region of the brain.

Enlargement of the fourth ventricle, which affects the cerebellum and medulla oblongata.

The main causes of this congenital condition are abnormal development of the fetus due to abnormalities in the chromosomal sequence. Other factors are associated with abnormal birth, head trauma, or infections affecting the brain.

After ultrasound diagnostics of the brain in newborns, diuretic, potassium-containing and vitamin supplements are prescribed. medicines. Lack of adequate treatment leads to the development of Down syndrome, Turner syndrome, and Edwards genetic mutation.

The child will not be able to live a full life, since the dilated ventricles will negatively affect the brain and heart.

Causes of dilatation

Dilatation may occur in utero or develop gradually after pathological childbirth or head injuries. Even the smallest changes in the size of liquor structures can lead to serious consequences. Their increase leads to increased intracranial pressure, which provokes hydrocephalus.

The main causes of dilated paired or unpaired ventricles of the brain in infants:

• Pathological pregnancy: lack of oxygen, early placental abruption.
• Early birth long labor, lack of labor activity.
• Head injury during childbirth, due to a fall, blow, accident.
• Benign and malignant tumors in the brain, which prevent the outflow of fluid.
• Cyst formation.
• Foreign bodies entering the brain.
• Past infectious diseases.
• Subdural and subarachoid hemorrhages leading to ventricular asymmetry.

Dilatation in infants leads to diseases of the nervous system and developmental disorders. It is possible to detect pathology in the first days of the child and mother’s stay in the neonatal unit. Therefore, it is possible to prevent the development of serious complications.

Symptoms of enlargement

Manifestations of enlarged ventricles are not noticeable with minor changes. With the gradual accumulation of fluid, disturbances in the functioning of the central nervous system, heart, organs of vision and hearing are observed.

According to availability the following signs Doctors may suspect dilatation in a newborn:

• lack of appetite and frequent regurgitation;
• tremor of the chin, arms and legs;
• epileptic seizures;
• motor impairment;
• retardation in mental and physical development;
• strabismus and other visual impairments;
• pale skin;
• the appearance of enlarged veins on the forehead, temples and head;
• the head enlarges, the bones of the skull diverge.

If ventricular enlargement occurs at an older age, the child may complain of nausea and headache. Coordination problems, hallucinations, and memory loss are also observed. The presence of certain symptoms may depend on the degree of dilation of the cerebral ventricles and the location of the pathology.

Diagnostics

Detection of the disease includes instrumental examinations. Such diagnostic measures make it possible to accurately determine the size and depth of the ventricles and the degree of fluid accumulation in them. If there are external changes in the outline of the skull or when characteristic symptoms The doctor prescribes the following procedures:

Fundus examination to examine the condition of blood vessels and identify visual impairments.

Neurosonography to determine the size of each of the paired ventricles.

Magnetic resonance therapy for older children. Prescribed when it is difficult to diagnose a child’s condition using other methods.

Computed tomography to detect subtle changes in the size of the ventricles.

Ultrasound examination of the child’s brain to identify echo signs of ventricular dilatation. In addition to accurate measurements of cerebrospinal fluid structures, it is possible to determine the volume of accumulated cerebrospinal fluid.

Puncture of cerebrospinal fluid to determine its composition and nature.

Only after an examination can a doctor prescribe adequate treatment. If the changes are minor and symmetrical, constant monitoring of the child’s condition is prescribed. Identified cysts can resolve on their own during the first year of life.

How is an ultrasound performed on infants?

An ultrasound examination is carried out through the child’s non-overgrown fontanel. Therefore, after a year, when the bones of the skull grow together, it is prescribed CT scan or MRI.

The procedure is carried out according to the following algorithm:

1. Treatment of the spring with a special gel that promotes the penetration of ultrasonic rays.
2. Setting up the device based on the age of the child being examined.
3. Brain examination and recording of results.

Based on the presented conclusion, you should not make a diagnosis yourself. After studying the results, examining the child, recording accompanying symptoms disorders of brain development, treatment will be prescribed.

Interpretation of ultrasound results

The results are interpreted by the attending physician; sometimes a consultation with a neurosurgeon is required. If the examination reveals that the baby’s ventricles are dilated, but there are no pathological symptoms, it is necessary to undergo the examination again.

In addition to the size and depth of the elements of the liquor apparatus, which were mentioned above, the following indicators are provided: the interhemispheric fissure should be no more than 3 mm;

subarachnoid space about 3mm.

These measurements indicate the condition of the ventricles and the degree of dilatation. If they are greatly enlarged, there are disturbances in the structures of the brain. The lateral ventricles should not exceed 4 mm, otherwise hydrocephalus is diagnosed.

Treatment of the disease

Dilatation therapy includes medication and physical therapy.

To treat dilation of the lateral and azygos ventricles of the brain in newborns, the following are prescribed: diuretics to reduce the production of cerebrospinal fluid; nootropics to improve blood circulation; Central sedatives nervous system; gymnastics and massage of the child to improve the child’s condition and relieve muscle tone; vitamin complexes to prevent rickets.

If ventricular enlargement is a consequence infectious disease, antibiotics and antiviral drugs are prescribed. In case of violations of the integrity of the skull and brain, surgical treatment is performed.

Consequences and complications

The consequences of an enlarged cerebral ventricle can be different. It all depends on the degree of expansion and localization of the pathology. The main complications that can occur if medical recommendations are not followed:

• loss of vision and hearing;
• impaired coordination, lack of physical and mental activity;
• lagging behind peers;
• paralysis;
• constant growth of the head, deformation of the bones of the skull;
• epileptic seizures and loss of consciousness;
• hallucinations;
• hemorrhagic shock;
• paralysis;
• death.

If an ultrasound reveals a slight enlargement of the ventricles, but the baby is not capricious and develops according to the norm, a repeat examination is scheduled. To avoid the development of possible complications, do not ignore doctor’s orders. Complete all necessary examinations and treat your child.

To understand why the ventricles of the brain are enlarged, you need to know the anatomical side of the problem. The ventricles, located in the brain zone of a small infant, are represented by many cavity formations necessary for the preservation of cerebrospinal fluid.

Ventricles of the brain

The capacitive structure of the brain for liquor storage is the lateral ventricles. In terms of size, they are larger than all the others. The left ventricular formation of the brain is the first, and located on the right edge is the second.

The third ventricular element is closely interconnected with the two located laterally due to the hole located between the column of the fornix and the anterior thalamic ending, connecting the third ventricular element with the lateral ones (interventricular). The corpus callosum has sides, and these cavity formations in the form of ventricles, they are localized on the sides, just below this body. The composition of the lateral ventricles is presented in the form of anterior, posterior, inferior horns, as well as the body.

The fourth ventricular component is very important and is located near the cerebellum and medulla oblongata. It is similar to a rhomboid shape, which is why it is called the rhomboid fossa, in which the canal of the spinal cord is located with the canal where there is communication between the fourth ventricular component and the aqueduct.

It is worth noting that if there is a 5th ventricle located in the brain region during ultrasound diagnostics during pregnancy, then this is the norm.

Together with the accumulation function of the ventricles, the secreting function of spinal cerebrospinal fluid is performed. In a normal state, this fluid drains into the area of ​​the subarachnoid space, but sometimes this process is disrupted; the various ventricles located in the brain region of a helpless infant are dilated. This indicates an impaired outflow of cerebrospinal fluid from the ventricular zone, and a hydrocephalic condition develops.

What does this mean

There is no need to panic if some of the ventricles located in the brain region of a helpless baby are dilated. After all, dilatation of some ventricles located in the brain region is not always pathological. A slight enlargement of any ventricle located in the area of ​​the baby’s brain is due to physiology due to the baby’s large head.

Enlargement of the ventricles of the brain in newborns is not uncommon until one year of age. In this situation, it is necessary to find out not only how dilated some of the ventricles located in the brain zone of a small baby are, but also to measure the entire liquor apparatus.

An excess of cerebrospinal fluid is considered the main root cause of what actually causes this expansion of the ventricles of the brain. The cerebrospinal fluid does not flow due to an obstruction in the place where it leaves, which results in dilatation of the existing ventricular system located in the medullary region.

Expansion of the lateral ventricles of the brain occurs in those babies who were born prematurely. When dilatation of some lateral ventricles located in the area of ​​the brain in newborns, or their asymmetry, is suspected, they need to be measured and a qualitative parameter established. This is what happens when existing lateral ventricles human brain expanded, and what this means is already clear. Conditions when many ventricles are dilated require careful description.

Ventriculomegalic state

With it, the cavity system of the ventricular apparatus is enlarged, which will result in dysfunction of the central nervous system.

Ventriculomegalic types

Depending on the severity, the pathology occurs in mild, moderate and severe; location determines the following types:

• lateral, in which there is a pronounced enlargement of some ventricles in small child, such as rear and side;
• another type, where the pathology is located in the area near the visual thalamus and frontal region;
• V next case the focus affects the cerebellar region with the medulla oblongata of the brain.

What are the causes of the pathology

The main root cause of possible pathology in newborns is considered to be a chromosomal abnormality in pregnant women. Other circumstances that determine why certain ventricles of the brain zone in a small child are enlarged include infectious diseases, physical trauma, hydrocephalic obstruction, hemorrhagic manifestations, and complicated heredity.

Symptoms of the disease

Dilated certain ventricles of the brain in a small child are the root cause of the Down, Turner, and Edwards syndrome conditions. In addition, enlarged certain ventricles of the brain area in a small infant affect cardiac activity, brain structures and the musculoskeletal system.

Diagnostic measures

This condition in children is diagnosed using ultrasound examination heads.

How is it treated

In a condition where the lateral ventricles of the child’s brain are dilated, the main thing is to prevent complicated conditions in the body. Diuretics, vitamin preparations, and antihypoxants are prescribed. Additional methods Treatments for this condition are massage procedures with special physical therapy. To prevent complicated conditions, potassium-sparing agents are used.

Hydrocephalic-hypertensive syndrome

Another course of the disease cannot be excluded, in which enlarged ventricular medullary components are observed in newborns - hydrocephalic hypertension syndrome.

With it, cerebrospinal fluid is excessively produced, accumulating under meninges and the ventricular system of the brain. This pathology is rare and requires diagnostic confirmation. This syndrome is classified according to the age of the child.

Causes

The root causes are divided into those that existed before birth and those that have already been acquired. Congenital occur due to:

• complicated course of a woman’s condition during which she is pregnant, complicated childbirth;
• intrauterine cerebral hypoxia, trauma during childbirth, developmental anomalies;
• early labor;
• intrapartum trauma with hemorrhage into the subarachnoid space;
• intrauterine infectious pathology;
• brain abnormality;
• prolonged labor;
• a long period between the breaking of amniotic fluid and the expulsion of the fetus;
• maternal chronic pathology.

Acquired root causes include:

• neoplasms of oncological or inflammatory nature;
• foreign body located in the brain;
• condition after a skull fracture with penetration of bone fragments into the brain;
• infectious pathology;
• cause of unknown etiology.

All the root causes of this syndrome lead to the development of dilation of the ventricles of the brain in infants.

Manifestation of pathology

The clinical syndrome manifests itself:

• high intracranial pressure;
• increased volume of fluid in the ventricular system.

The symptoms boil down to:

• baby refuses to feed breast milk, whiny, capricious for no apparent reason;
• he has a decrease in activity in muscle fibers;
• reflexive activity is poorly expressed: poor grasping and swallowing;
• burps frequently;
• there is strabismus;
• upon examination, the iris is half-covered by the lower eyelid;
• the sutures of the skull diverge ─ this also indicates that there is an increase in some of the lateral ventricles of the child’s brain region;
• tension with bulging fontanelles shows that the ventricles of the brain are dilated in the child;
• month after month, the head circumference increases, this is also an important sign that some of the lateral ventricles of the brain are slightly expanded in the infant;
• the fundus shows what visual discs edematous, also an indicator that dilatation of the lateral ventricles located in the brain region of a small baby is occurring.

These manifestations indicate that the ventricular system of an enlarged brain in a small child, or the fifth ventricle of the brain, is enlarged; serious consequences are possible. Older children age category Sometimes they acquire this syndrome immediately after they have had an infectious pathology or damage to the skull and brain.

A characteristic feature of this problem is considered to be morning pain in the area of ​​the head, of a compressive or bursting nature, localized in the temporal and frontal zone, with the manifestation of nausea with vomiting.

The complaint, in which a certain ventricle of a region of the brain in a small child is enlarged, is the inability to raise the eyes upward with the head down. This is often accompanied by a feeling of dizziness. With observed paroxysm skin pale, lethargic, lack of activity. The child is irritated by bright lights and loud sound effects. Based on this, it is already possible to assume that the left ventricle of the child’s brain is enlarged.

Due to high muscle tone in the legs, the child walks on his toes, he has severe squint, he is very sleepy, and his psychomotor development is slow. This is what enlarged ventricles of a diseased brain lead to in a small child of 3 years old.

Diagnostic measures

Highly accurate diagnosis of hydrocephalic syndrome with hypertension, to find out whether the cerebral ventricle is really enlarged in an infant, is not easy. Using the latest diagnostic methods, it is impossible to establish an accurate diagnosis, in which the syndrome leads to the development of a slight dilatation of the ventricular system of a small area of ​​the child’s brain, or the 3rd ventricle located in the area of ​​the brain is expanded, or dilation of the left ventricle located in the area may occur. brain in a child.

The diagnostic parameters of a newborn are the circumference of the head region and the activity of reflexes. Other diagnostics include:

• ophthalmological examination of the fundus;
• neurosonographic examination in order to see how enlarged the ventricle of a certain part of the brain is in a newborn;
• Carrying out a computed tomography examination and MRI will help to accurately determine that this may be a slight dilatation of the lateral ventricles of the brain in a child;
• lumbar puncture study, which determines the degree of pressure of the cerebrospinal fluid. This method is accurate and reliable.

Therapeutic measures

Neurological and neurosurgical specialists are required to treat this disease. Patients are constantly monitored by doctors, otherwise the enlarged ventricles of the child’s brain will bring serious consequences.

Until six months of age, when dilatation of the left lateral ventricle of the brain is observed in newborns, treatment is outpatient. The main treatment is:

• diuretics together with drugs that reduce the reproduction of cerebrospinal fluid;
• nootropic group of drugs that improves cerebral circulation;
• sedatives;
• special gymnastic exercises with massage.

Therapeutic measures for the syndrome, in which an enlargement of the left ventricle of the brain is detected in newborns, are long-term, lasting more than 1 month.

Older children age group They are treated for hydrocephalic syndrome, depending on the pathogenesis, depending on the root cause of the pathology. When the syndrome occurs due to an infectious disease, drugs against bacteria or viruses are prescribed. In case of cranial trauma or oncology, surgical intervention is indicated. If left untreated, the enlarged ventricular system of the brain in newborns will cause serious consequences.

Complicated conditions

The manifestation of hydrocephalic syndrome with hypertension causes complicated conditions in the body, in which the child will have the following consequences:

• psychomotor development of the baby is slow;
• will become completely or partially blind;
• auditory dysfunction, possibly completely deaf;
• may fall into a coma;
• completely or partially paralyzed;
• the fontanel bulges abnormally;
• epileptic seizures are manifested;
• involuntarily urinates, performs an act of defecation;
• may die.

This is what the increased condition of the ventricular elements of the brain in newborns will lead to, what the possible consequences are, if treatment is not performed on time.

In the infancy period, the prognosis is most favorable due to the frequency arterial type pressure and intracranial pressure, which come to normal levels over time the older the baby gets. In the older age category of children, the prognosis is unfavorable, depending on the root cause of this syndrome and the characteristics of treatment.

The information on the site is provided solely for popular informational purposes, does not claim to be reference or medical accuracy, and is not a guide to action. Do not self-medicate. Consult your healthcare provider.

Dilatation of the ventricles of the brain in infants

Quite often, after birth, babies have enlarged ventricles of the brain. This condition does not always mean the presence of a disease that necessarily requires treatment.

Ventricular system of the brain

The ventricles of the brain are several interconnected collectors in which the formation and distribution of liquor fluid occurs. Liquor washes the brain and spinal cord. Normally, there is always a certain amount of cerebrospinal fluid in the ventricles.

Two large collectors of cerebrospinal fluid are located on either side of the corpus callosum. Both ventricles are connected to each other. On the left side is the first ventricle, and on the right is the second. They consist of horns and a body. The lateral ventricles are connected through a system of small holes to the 3rd ventricle.

In the distal part of the brain, between the cerebellum and the medulla oblongata, there is the 4th ventricle. It is quite large in size. The fourth ventricle is diamond-shaped. At the very bottom there is a hole called the diamond-shaped fossa.

Proper functioning of the ventricles allows cerebrospinal fluid to enter the subarachnoid space when necessary. This zone is located between the dura mater and the arachnoid membrane of the brain. This ability allows you to maintain the required volume of cerebrospinal fluid in various pathological conditions.

In newborn babies, dilatation of the lateral ventricles is often observed. In this condition, the horns of the ventricles are enlarged, and increased accumulation of fluid in the area of ​​their bodies may also be observed. This condition often causes both left and right ventricle enlargement. In differential diagnosis, asymmetry in the area of ​​the main brain collectors is excluded.

The size of the ventricles is normal

In infants, the ventricles are often dilated. This condition does not at all mean that the child is seriously ill. The dimensions of each ventricle have specific values. These indicators are shown in the table.

First and second ventricles (lateral)

To assess normal indicators, the determination of all structural elements of the lateral ventricles is also used. The lateral cisterns should be less than 4 mm deep, the anterior horns between 2 and 4 mm, and the occipital horns between 10 and 15 mm.

Causes of enlarged ventricles

Premature babies may have dilated ventricles immediately after birth. They are located symmetrically. Symptoms of intracranial hypertension in a child with this condition usually do not occur. If only one of the horns increases slightly, then this may be evidence of the presence of pathology.

The following reasons lead to the development of ventricular enlargement:

Fetal hypoxia, anatomical defects in the structure of the placenta, development of placental insufficiency. Such conditions lead to disruption of the blood supply to the brain of the unborn child, which can cause expansion of the intracranial collectors.

Traumatic brain injuries or falls. In this case, the outflow of cerebrospinal fluid is disrupted. This condition causes water to stagnate in the ventricles, which can lead to symptoms of increased intracranial pressure.

Pathological birth. Traumatic injuries, as well as unforeseen circumstances during childbirth, can lead to disruption of the blood supply to the brain. These emergency conditions often contribute to the development of ventricular dilatation.

Infection with bacterial infections during pregnancy. Pathogenic microorganisms easily penetrate the placenta and can cause various complications in the child.

Prolonged labor. Too long a time between the rupture of amniotic fluid and the expulsion of the baby can lead to the development of intrapartum hypoxia, which causes a disruption in the outflow of cerebrospinal fluid from the dilated ventricles.

Oncological formations and cysts that are located in the brain. The growth of tumors puts excess pressure on intracerebral structures. This leads to the development of pathological expansion of the ventricles.

Foreign bodies and elements that are located in the brain.

Infectious diseases. Many bacteria and viruses easily penetrate the blood-brain barrier. This contributes to the development of numerous pathological formations in the brain.

How does it manifest?

Ventricular dilatation does not always lead to adverse symptoms. In most cases, the child does not experience any discomfort that would indicate the presence of a pathological process.

Only with pronounced disturbances do the first adverse manifestations of the disease begin to occur. These include:

Gait disturbance. Babies begin to walk on tiptoes or step on their heels.

The appearance of visual disturbances. They often manifest themselves in children in the form of squint or insufficient focusing on various objects. In some cases, a child may experience double vision, which worsens when looking at small objects.

Behavioral disorders. Babies become more lethargic and drowsy. In some cases, even apathetic. It is very difficult to captivate a child with any games or recreational activities.

Headache. It appears when intracranial pressure increases. At the height of pain, vomiting may occur.

Decreased appetite. Babies in the first months of life refuse to breastfeed and eat poorly. In some cases, the baby spits up more.

Sleep disturbance. Babies may have difficulty falling asleep. Some children walk in their sleep.

The disease can vary in severity. With minimal symptoms, they speak of a mild course. When headache, dizziness, and other symptoms indicating high intracranial hypertension appear, the disease becomes moderately severe. If the child’s general condition is severely disturbed and treatment in a hospital setting is required, then the disease becomes more severe.

Consequences

Late diagnosis of pathological conditions that lead to the appearance of enlargements in the area of ​​the ventricles of the brain can affect the further development of the child. The first persistent symptoms of ventricular dilatation are observed in babies at 6 months.

Impaired outflow of liquor fluid can lead to a persistent increase in intracranial pressure. In severe cases of the disease, this contributes to the development of disturbances of consciousness. Visual and hearing disorders lead to the development of hearing loss and weakened vision in the child. Some children experience epileptic seizures and seizures.

Diagnostics

In order to determine the exact size of the ventricles, as well as find out their depth, doctors prescribe several examination methods.

The most informative and reliable are:

Ultrasonography. Allows you to accurately describe the quantitative indicators of the ventricles, as well as calculate the ventricular index. Using ultrasound, you can estimate the volume of liquor fluid that is present in the brain collectors during the study.

CT scan. With high accuracy it allows you to describe the structure and size of all ventricles of the brain. The procedure is safe and does not cause pain in the baby.

Magnetic resonance imaging. It is used in complex diagnostic cases when establishing a diagnosis is difficult. Suitable for older children who are able to remain still throughout the examination. In young children, MRI is performed under general anesthesia.

Fundus examination.

Treatment

Treatment of pathological conditions that lead to dilatation and asymmetry of the ventricles of the brain is usually carried out by a neurologist. In some cases, when the cause of the disease is space-occupying formations or the consequences of traumatic brain injuries, a neurosurgeon is involved.

To eliminate pathological symptoms, the following treatment methods are used:

Prescribing diuretics. Diuretics help reduce the manifestations of intracranial hypertension and improve the baby’s well-being. They also help normalize the formation of cerebrospinal fluid.

Nootropics. They improve brain function and also promote good blood supply to blood vessels.

Medicines with a sedative effect. Used to eliminate increased anxiety and agitation.

Potassium preparations. Positively affects urine excretion. This helps reduce the increased amount of cerebrospinal fluid in the body.

Multivitamin complexes. They are used to compensate for all the necessary microelements involved in vital processes. They also help strengthen the body and promote better resistance to disease.

Soothing and relaxing massage. Allows you to reduce muscle tone and also helps to relax the nervous system.

Physiotherapy. Helps normalize the outflow of liquor fluid and prevents its stagnation in the cerebral ventricles.

Prescribing antibacterial or antiviral drugs according to indications. They are used only in cases where the cause of the disease is viruses or bacteria. Appointed for a course appointment.

Surgery. It is used in the presence of various space-occupying formations or to remove fragments of bone tissue as a result of a skull fracture due to traumatic brain injury.

Forecast

If the condition develops in infancy and early infancy, the course of the disease is usually favorable. With appropriate treatment, all discomfort symptoms quickly disappear and do not bother the baby. High intracranial pressure is normalized.

In older children, the prognosis of the disease is somewhat different. Adverse symptoms are much more difficult to treat. A long course of the disease can lead to permanent visual and hearing impairment. If treatment was not started in a timely manner, then in most cases the child experiences persistent disorders that negatively affect his mental and mental development.

Dr. Komarovsky will talk about the expansion of the ventricles of the brain in infants and its consequences.

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In the first hours after birth, the child is under the supervision of neonatologists, who monitor his physiological condition and perform the necessary examinations of the body. In this case, health assessment is carried out in stages, starting from the first minute of life, and ends before discharge.

The most thorough examination is carried out on the first day and consists of a standard procedure for monitoring the activity and appearance of the newborn. If the doctor suspects congenital malformations, then it is possible to use an ultrasound examination, which can reveal abnormalities in the formation of not only internal organs, but also the brain. In this case, the sizes of the ventricles are especially carefully measured, which normally should not exceed a certain value.

At this stage, the neonatologist can diagnose dilation of the ventricles of the brain in newborns. Based on the degree of pathology and the impact on the child’s life, the question will be raised about further solving this problem: for example, in case of minor deviations from the norm, observation by a neurologist and monitoring of the condition are prescribed. If the violations are serious and the symptoms are pronounced, then the child needs special treatment and observation in a hospital setting.

The ventricular system consists of 4 cavities located in parts of the brain. Their main purpose is the synthesis of cerebrospinal fluid or cerebrospinal fluid, which performs a large number of tasks, but its main function is to cushion the brain matter from external influences, control intracranial pressure and stabilize metabolic processes between the blood and the brain.

The movement of cerebrospinal fluid occurs through channels connecting the common 4th ventricle and the subarachnoid space formed by the membranes of the spinal cord and brain. Moreover, its main volume is located above significant fissures and convolutions of the cortex.

The largest lateral ventricles are located equidistant from the midline below the corpus callosum. The first ventricle is considered to be the cavity located on the left side, and the second - on the right. They are C-shaped and wrap around the dorsal parts of the basal ganglia. They produce cerebrospinal fluid, which enters the third ventricle through the intergastric openings. Structurally, segments I and II of the ventricular system include the anterior (frontal) horns, body and inferior (temporal) horns.

The third ventricle is located between the visual tuberosities and has the shape of a ring. At the same time, gray matter is located in its walls, which is responsible for regulating the autonomic system. This section is connected with the midbrain aqueduct, and through the interventricular foramen, located behind the nasal commissure, with the I and II ventricles.

The most important IV ventricle is located between the cerebellum and the medulla oblongata, with the vermis and medullary velum located above it, and the medulla oblongata and pons below it. This cavity was formed from the remains of the posterior medullary vesicle and is common to the rhomboid region. At its bottom lie the nuclei of the V-XII cranial nerves. In this case, the posterior lower corner communicates with the spinal cord through the central canal, and through the upper anterior part with the aqueduct.

Sometimes, when examining a newborn, the fifth ventricle is detected, which is a feature of the structure of the brain. It is located in the anterior midline, below the corpus callosum. Usually its closure occurs by 6 months of age, but if the gap is more than 10 mm, then we are talking about a pathology of the liquorodynamic system.

If an ultrasound revealed asymmetry of the lateral ventricles in a child, the prognosis depends on the degree of pathology and the depth of damage to brain tissue, as well as the reasons that provoked the development of the disease. Thus, a significant increase interferes with normal circulation and production of cerebrospinal fluid, which entails neurological problems. But congenital asymmetry, not aggravated by outflow disorders, in most cases does not require treatment. However, such a child needs observation in order to prevent relapse of the disease and possible consequences.

The size of the ventricles is normal

A healthy newborn normally has 4 ventricles: two lateral, the third is conventionally anterior, and the fourth ventricular component, which is considered posterior. An enlargement of the lateral ventricles entails the production of a large amount of cerebrospinal fluid, which will not be able to circulate normally between the membranes of the brain and, accordingly, perform its functions of regulating metabolic processes. Therefore, when assessing the size of the ventricles of newborns, the following standards are used:

• the lateral anterior horns should fall within the range of 2-4 mm;
• lateral occipital horns - 10-15 mm;
• body of the lateral ventricles - no deeper than 4 mm;
• III ventricle - no more than 5 mm;
• IV - up to 4 mm.

When examining the brain of infants up to a year and older, the use of these standards will be incorrect, since the brain matter and ventricles will grow, so the assessment is carried out using other indicators and corresponding tables.

Causes of enlarged ventricles

If the initial examination revealed that the ventricles of the brain in a newborn are slightly enlarged, then do not despair, since in most cases this condition requires only observation during the first years of life, and the prognosis is favorable.

Initially, a slight discrepancy between indicators and norms may be genetically determined and be a feature of the structure of the brain, while pathological changes occur due to a chromosomal malfunction during fetal formation.

There are a number of factors that provoke asymmetry and dilatation (enlargement) of the ventricular cavity:

• infectious diseases during pregnancy (in particular, infection of the fetus with cytomelalovirus);
• blood poisoning, sepsis;
• complications caused by chronic maternal diseases;
• premature birth;
• acute hypoxia during fetal development caused by insufficient blood supply to the placenta;
• varicose veins feeding the fetus;
• long anhydrous period and prolonged labor;
• rapid birth;
• birth injuries, hypoxia caused by umbilical cord entanglement;
• deformation of the cranial bones;
• entry of foreign objects into the brain structures;
• cysts, neoplasms of various nature;
• hemorrhages;
• ischemic and hemorrhagic stroke.

Also, dilation of the ventricles can be caused by cerebral hydrocele of unknown etiology and other congenital diseases.

This is what Evgeniy Komarovsky, a well-known pediatrician in the post-Soviet space and a doctor of the highest category, says about the expansion of the ventricles.

How it manifests itself

The main function of the ventricles is to secrete cerebrospinal fluid, as well as ensure its normal circulation in the subarachnoid space. If the balance of exchange and production of cerebrospinal fluid is disturbed, then stagnation is formed and, as a result, the walls of the cavities are stretched. The same slight expansion of the lateral segments may be a normal variant, but their asymmetry and enlargement of individual parts (for example, only the horn) will be a sign of the development of pathology.

Enlarged ventricles of the brain in an infant can be diagnosed with a congenital disease such as ventriculomegaly. It varies in severity:

1. Slight expansion of the ventricles of the brain up to 11-12 mm, with no significant symptoms. It manifests itself in the child’s behavior: he becomes more excitable and irritable.
2. Increasing the depth of the ventricles up to 15 mm. Most often, the pathology is accompanied by asymmetry and impaired blood supply to the affected area, which entails the appearance of seizures, an increase in head size and a lag in mental and physical development.
3. Ventricular dilatation up to 20 mm is characterized by irreversible changes in brain structures and is often accompanied by Down syndrome and cerebral palsy in infants.

In adulthood, an increase in ventricular volume is manifested by the following symptoms:

• Gait disturbance, with the child walking “on tiptoes” or vice versa, focusing only on the heels.
• The appearance of visual disorders, such as squint, insufficient focus of the gaze, as well as double images when trying to see small details.
• Tremor of arms and legs.
• Behavioral disorders that manifest themselves in excessive lethargy and drowsiness, while it is difficult to captivate the child with any activity.
• The appearance of headaches due to increased intracranial pressure, sometimes nausea and even vomiting can occur.
• Dizziness.
• Frequent regurgitation, loss of appetite. Some newborns are able to refuse breastfeeding.

Consequences

Late detection of the pathology that resulted in the expansion of the ventricle of the brain in a newborn can lead to a stop in development and deterioration in physical condition.

The main symptoms of the disease most often appear in the first 6 months after birth and are expressed in persistent increased intracranial pressure. Impaired consciousness, vision, hearing loss, epileptic seizures and fits, and disorders of the peripheral nervous system may also be observed.

Lack of proper attention to the child and failure to follow the instructions of specialists can provoke the transition of the disease from a milder form to a severe one, the treatment of which is carried out only in a hospital setting and, if necessary, with the use of surgical interventions.

Diagnosis and treatment

During pregnancy, dilation of the ventricles of the fetal brain is most often detected during a routine ultrasound examination. Subsequent examinations are carried out to monitor the clinical picture of the disease, but the final diagnosis can be made only after the birth of the child and neurosonography - ultrasound of the brain through a large fontanelle that has not yet become overgrown. In this case, the pathology can develop at any age, but most often occurs in infancy.

To make a more accurate diagnosis, the baby may need a consultation and examination with an ophthalmologist, who will assess the condition of the fundus vessels, swelling of the eye discs and other manifestations of increased intracranial pressure.

After the fusion of the cranial bones, it is possible to use MRI of the brain: it will allow tracking the dilatation of the walls of the ventricles in dynamics. However, when using this method, the child will have to remain motionless for a long time, so before the procedure he is put into medicated sleep. If anesthesia is contraindicated, the examination is performed using computed tomography.

A consultation with a neurologist is also required, who will help identify developmental problems at an early stage. Depending on the degree of pathology, further treatment can be surgical or conservative medication.

If there is a significant deviation from the norm in the size of the ventricles, only surgical treatment is used; accordingly, the child should also be examined by a neurosurgeon. In this case, during the operation, foci of neoplasms or fragments of skull bones that appear as a result of traumatic brain injuries can be removed. To reduce intracranial pressure, normalize blood circulation and metabolic processes, brain shunting is used.

Conservative therapy is prescribed for slight enlargement of the ventricles and includes the use of diuretics, nootropics, sedatives and vitamin complexes. If the disorders are caused by infections, then antibiotics are prescribed. The use of therapeutic exercises will also help improve the outflow of cerebrospinal fluid and reduce its stagnation.

Forecast

If pathology in the development of the ventricles was identified in the first days after birth, then the prognosis in most cases is favorable and depends on adequate treatment and the severity of the abnormalities.

Detection of the disease and therapy in older age can be complicated due to the formation of a large number of anomalies that arise as a result of the development of pathology, its causes and influence on other body systems.

Video: Increased intracranial pressure in a child