Ventriculomegaly of the lateral ventricles in a child, treatment. Special children are happy children! Causes and symptoms of ventriculomegaly

Having first heard the diagnosis of ventriculomegaly of the lateral ventricles in a child, the mother’s natural desire is to figure out what it is. this pathology, what consequences can it lead to? Let's try to find out when ventriculomegaly is dangerous?

Moderate fetal ventricular ventriculomegaly - what is it?

Ventriculomegaly is the expansion of the lateral ventricles of the brain. Already at the 17th week of gestation, pathology can be detected using ultrasound. The resulting images clearly show an increase in the sinuses. The expansion considered pathological is more than 10 mm.

In this case we are talking about moderate stage extensions. If the ventricles are enlarged by 10-15 mm, they speak of a borderline condition. When the fetal ventricles are dilated by more than 15 mm, there is a pathology of brain development.

Unlike hydrocephalus, this pathology during pregnancy is most often characterized by the expansion of organs without a lack of growth of the head. In this case, a pairwise expansion is not necessary. The defect may affect only one of the ventricles.

A person has 2 lateral ventricles, from which the cerebrospinal fluid produced is discharged into the third and then into the fourth, connected to the spinal cord canal. When it is difficult to remove cerebrospinal fluid, the sinuses expand, causing growth intracranial pressure and compression of surrounding tissues.

What is the danger of having ventriculomegaly in a fetus?

The consequences are truly serious. With ventriculomegaly, the outflow of cerebrospinal fluid containing the lateral ventricles into the spinal cord is disrupted. As a result, abnormal development occurs nervous system fetus Subsequently, the child may develop developmental anomalies such as cerebral palsy and hydrocephalus. However, such anomalies are observed only in the case of a rapid process. Often a fetus with a pathology is found to be non-viable.

It is worth considering that ventriculomegaly in the fetus progresses if appropriate measures are not taken in a timely manner. Therefore, it is so important not to skip an ultrasound and strictly adhere to all medical recommendations.

Ventriculomegaly of the fetal ventricles: causes

Unfortunately, the reason causing this anomaly has not yet been clarified.

However, there are a number of provocateurs that can lead to violations:

• difficulty in the outflow of cerebrospinal fluid from the lateral ventricles caused by excessive secretion of this fluid;
• physical brain injury;
• heredity;
• infectious diseases of the mother affecting the fetus;
• insufficient volume of brain tissue;
• vascular diseases of the brain.

The frequency of pathology does not exceed 0.6%. But it has been noted that in women over 35 years of age, the fetus is 3 times more likely to be at risk of anomaly.

In addition to the hereditary factor, toxoplasmosis and cytomegalovirus infection. However, it is worth remembering that any infection during pregnancy can cause disturbances in the development of the child, especially if self-treatment with the use of drugs prohibited in this provision.

Fetal ventricular ventriculomegaly: symptoms

If during pregnancy ventriculomegaly of the lateral ventricles was not detected in the child and the disturbances were moderate, the consequences are expressed in the overly excited state of the newborn and excessive tearfulness.

At times, a child, on the contrary, may be too calm.

Moderate ventriculomegaly in a newborn child does not lead to serious developmental abnormalities if it does not progress and is not accompanied by complications from the nervous system.

Otherwise, symptoms corresponding to chromosomal pathologies such as Edwards, Down or Patau syndrome are observed. Symptoms of a complicated course of the disease: protruding veins, increased head size, convulsive movements.

Therefore, ultrasound should not be neglected during pregnancy. If the fetus has been exposed to infections or hypoxia leading to moderate expansion ventricles, only 82% of children do not experience any dysfunction of the central nervous system after birth. In approximately 10% of children with a complicated course of the defect, severe disturbances in the functioning of the central nervous system are observed, leading to disability.

Treatment of ventriculomegaly in infants

Treatment of pathology is based on diagnosis. It is worth considering that correction of the defect in the fetus is almost impossible. In case of moderate pathology, the doctor may recommend measures to reduce the risk of progression of the defect.

If the fetus is characterized high degree pathologies, doctors suggest terminating the pregnancy, since in the overwhelming majority of births will lead to the birth of a non-viable child or one doomed to disability.

Treatment for mild fetuses depends largely on the cause. For example, termination of pregnancy for a moderate but progressive anomaly is recommended if chromosomal abnormalities have previously been identified in relatives of the mother or father.

If the pathology is caused by an infection in a pregnant woman, treat the cause, prescribe diuretics that remove excess fluid from the body, and compensate for the lack of potassium. It is often recommended to take antihypoxants that saturate the tissues with oxygen. Physical procedures include exercises that help strengthen the muscle tissue of the pelvic area, massage.

Any treatment is carried out under the supervision of a doctor monitoring the course of pregnancy. If an anomaly is detected in a newborn, treatment is also based on symptoms and diagnosis. Often, in addition to ultrasound, the child may be prescribed an MRI of the brain, which allows a detailed study of the defect.

For a newborn baby, an ultrasound of the brain is performed in the first 1.5-2 months of life. It is during this examination that special attention is paid to the structure of the organ, identifying the slightest deviations in its development.

When is a newborn diagnosed mild degree dilation of the lateral ventricles without progression, no treatment required. The prescription of drugs that remove fluid and replace potassium loss is rather of a preventive nature.

However, if there is a tendency to progress or if the degree is severe, the help of a neurosurgeon is often necessary.

In this case, we are talking about surgical treatment. The essence of the operation is to install a special shunt, which facilitates the task of removing excess fluid from the lateral ventricles, thereby reducing intracranial pressure and eliminating the risk of complications.

Ventriculomegaly is a disease that occurs in the fetus and is associated with enlargement of the ventricles of the brain. The lateral ventricles of the brain are most often affected.

The ventricles of the brain are cavities in the brain that are filled with cerebrospinal fluid. It is their increase that is greater than the established ones normal sizes and leads to the development of ventriculomegaly.

Depending on the causes of development, ventriculomegaly is divided into 2 main groups:

1. Symptomatic ventriculomegaly;
2. Idiopathic ventriculomegaly

Idiopathic ventriculomegaly

This is a type of ventriculomegaly where the cause is unknown and the pregnancy proceeds normally without complications. At the same time, there are no hereditary prerequisites for the occurrence of the disease in the fetus.

Types of Ventriculomegaly Disease

There are three main types of ventriculomegaly disease:

• easy;
• average;
• heavy.

At mild type no ventriculomegaly major changes does not occur and this type of disease does not require special therapy.

The average type of disease is accompanied by a moderate increase in the size of the ventricles (they reach 15-17 mm in size) and a slight disturbance of the outflow cerebrospinal fluid.

At severe course The disease causes a strong increase in the size of the ventricles of the brain and a violation of the outflow of cerebrospinal fluid from them. Additional abnormalities and pathologies of the brain and nervous system also appear.

In addition, the following types of ventriculomegaly are distinguished:

• isolated (when only the lateral ventricles are affected);
• extensive (covers various groups ventricles of the brain);
• heredity.

Causes of the disease

The causes of symptomatic ventriculomegaly are the following:

1. chromosomal changes in fetal development;
2. fetal hypoxia;
3. infectious diseases during pregnancy;
4. Hemorrhage (bleeding);
5. Physical injuries.

Symptoms of ventriculomegaly

Symptoms of the disease usually begin to be detected by ultrasound examination at 22-25 weeks of pregnancy.

It is important to know! With a rapid increase in the size of the ventricles of the fetal brain, there is a high risk of developing fetal hydrocephalus.

Main symptoms and manifestations of this disease are enlarged ventricles of the fetal brain. It is at 22-25 weeks of pregnancy that signs of ventriculomegaly are clearly visible during ultrasound examination.

The diagnosis of ventriculomegaly is made when the ventricles reach a width of more than 10 millimeters!

In addition to an increase in the size of the ventricles in the fetus, symptoms of the disease may include the following:

• changes in the structure of the heart;
• disturbances in the structure bone apparatus;
• changes in brain structure;
• hydrocephalus (cerebrospinal fluid retention) in the fetal brain.

Depending on the degree of increase in the size of the ventricles of the brain and the presence of additional pathologies, the geneticist diagnoses the risk of developing dangerous diseases nervous system. If the fetus has only ventriculomegaly against the background of a slight increase in the ventricles of the brain, then the outcome of the disease is favorable in most cases.

Features of the course of ventriculomegaly in pregnant women after 35 years

Most often, this pathology occurs in pregnant women after 35 years of age. To the occurrence of ventriculomegaly with more late pregnancy have the following factors:

• increased risk of genetic disorders;
• there is a high probability of so-called “chromosomal breakage”. This factor increases the risk of chromosomal abnormalities in the fetus, which lead to the occurrence of ventriculomegaly;
• a high probability of developing fetal hypoxia (scientists have established more frequent cases of fetal hypoxia during pregnancy after 33-35 years);
• infectious complications during pregnancy. How younger woman, the less likely it is to develop serious complications and infectious diseases.

Thus, in pregnant women under 33-35 years of age, the risk of developing fetal ventriculomegaly is minimal.

Complications of the disease

Complications of ventriculomegaly include the likelihood of serious illnesses nervous system. Such diseases include:

• Down syndrome;
• Edwards syndrome. This is a chromosomal pathology in which there are many malformations of the child;
• Turner syndrome. This syndrome is characterized by severe physical abnormalities development and sexual infantilism.
• Severe fetal hydrocephalus. A serious condition in which large amounts of cerebrospinal fluid accumulate in the ventricles of the brain.

Diagnosis of the disease

Methods for diagnosing fetal ventriculomegaly include the following:

• ultrasonography fetus The most early dates, at which it is possible to determine signs of ventriculomegaly - 17 weeks. The most informative ultrasound examination is at the 25th week of pregnancy. With this diagnostic method, an increase in the size of the ventricles of the brain is determined in the fetus. If the width of the ventricle is more than 10 millimeters, a diagnosis of ventriculomegaly becomes possible. In addition, ultrasound examination detects disturbances in the structure of the heart, bone apparatus, and nervous system. Frequency this study- once every 3-4 weeks (depending on the complexity of the disease and the severity of symptoms).
• Fetal MRI. Subject to availability severe symptoms ventriculomegaly.
• Neurosonography. Used this method in a newborn immediately after birth and at the age of 1 month. Based on the dynamics of the process, they conclude that it is necessary to carry out further research and treatment of the disease. This method is very informative and provides detailed information about the course and dynamics of the disease.

Neurosonography (NSG) is an ultrasound examination of the brain.

Treatment of ventriculomegaly

Treatment of this disease is conservative. Treatment methods are used that are aimed at preventing the development of serious illnesses nervous system. For this purpose, the following treatment methods are used:

• prescription of antihypoxic drugs. They prevent and prevent the occurrence and progression of cerebral hypoxia. Among such drugs, piracetam, Actovegin, Olifen, Riboxin and others are widely used.
• prescription of diuretics. Used to remove excess fluid and reduce intracranial pressure (furosemide, diacarb).
• vitamins. B vitamins are prescribed, which help restore the child’s nervous system.
• massage and physical therapy. The massage used in children with ventriculomegaly is relaxing and strengthening (alternating stress and relaxation). Courses of 10 sessions every 2 months are recommended (depending on the age of the child. The older, the shorter the interval between courses). Physiotherapy is aimed at strengthening the child’s muscular system and maintaining the body in good shape. Special attention for this pathology, it is recommended to focus on the muscles of the pelvis and collar area of ​​the head (in order to normalize blood circulation in this section).

Ventriculomegaly in the fetus is pathological condition, in which the ventricles of the brain expand due to the accumulation of cerebrospinal fluid in them. In this case, the ventricles can increase up to 20 mm, with a corresponding norm of 1-4 mm.

What is ventriculomegaly

First, you need to understand two related concepts and decide what hydrocephalus is and what ventriculomegaly is, and what is the fundamental difference between them. So, hydrocephalus is the expansion of the ventricles, as a result of excessive accumulation of cerebrospinal fluid and disruption of its circulation in the subarachnoid space.

Hydrocephalus is accompanied by certain symptoms (see). Unlike hydrocephalus, ventriculomegaly in a child is only an increase in the size of the ventricles by more than 10 mm, without accompanying symptoms. That is, hydrocephalus is a consequence of ventriculomegaly, but enlargement of the ventricles of the brain does not always cause neurological symptoms.

Causes of the disease

The causes of ventriculomegaly in newborns are divided into 2 classes:

1. Idiopathic - the cause remains unknown, and the disease develops in completely healthy parents, against the background of a good pregnancy.
2. Symptomatic – previous infectious diseases during pregnancy, congenital pathology brain structures, genetic or chromosomal diseases.

Types of ventriculomegaly:

• lateral type – enlargement of the left and posterior ventricle;
• enlargement of the third ventricle - fluid accumulates between the visual tuberosities and the anterior frontal part;
• enlargement of the fourth ventricle - cerebrospinal fluid accumulates in the area of ​​the cerebellum and medulla oblongata.

The symptom complex may vary depending on the severity. This occurs in newborns increased excitability, tearfulness, anxiety, or vice versa, lack of interest. If ventriculomegaly is severe, it manifests itself in an increase in the volume of the head, protrusion of the veins on the head.

What is moderate ventriculomegaly?

This is an increase in the ventricular cavity from 12 to 15 mm. Moderate ventriculomegaly in infants requires regular examination by a doctor and appropriate examination. If neurological symptoms are absent or not pronounced, then no therapeutic approach is required.

Ventriculomegaly in adults may be incidentally detected by planned implementation. Incidentally detected mild or moderate enlargement of the ventricular cavities does not require further examination or treatment. Since this is considered as a variant of the norm or anatomical feature. If the enlargement of cavities in the brain is a consequence of a traumatic brain injury or brain infection, then treatment should begin immediately.

Diagnostics

Enlargement of the ventricles of the brain can be assumed using ultrasound diagnostics(ultrasound) while still in utero. The study is carried out from the 17th week of pregnancy, although the greatest effectiveness is after the 25th week. After birth, an ultrasound of the newborn's head is performed. In adults, an MRI is performed.

How is the treatment carried out?

Treatment of fetal vertriculomegaly is prescribed in no more than 20% of cases. The remaining children are under observation. If pathological changes do not progress, then further treatment not required. Drug therapy is prescribed only to compensate for neurological symptoms.

Drugs used for treatment:

1. - a group of drugs that enhance cerebral circulation and improves metabolism in brain tissue. At long-term use drugs, improve cognitive (cognitive) brain functions, and increase concentration.
2. Antihypoxants – increase the resistance of brain tissue to ischemia (lack of oxygen). The group of antihypoxic agents improves oxygen metabolism, and thereby increases the endurance of brain tissue in conditions of its deficiency. Antioxidants can also be included in this group.
3. Diuretics - reduce the amount of intracranial fluid by increasing diuresis and reducing the volume of circulating blood.
4. Metabolic drugs and vitamins - help restore neural connections and improve metabolic processes in brain tissue.
5. Massage and therapeutic exercises.

Note! The group of drugs, dosage, and duration of treatment are prescribed only by the doctor, taking into account individual characteristics body, and the severity of the disease.

Consequences and complications of the disease

The consequences of ventriculomegaly in the fetus can have different outcomes. From favorable to disturbances in the functioning of the central nervous system (CNS) and the development of cerebral palsy.

Ventriculomegaly of the lateral ventricles in a child is called isolated ventriculomegaly and is considered the most favorable prognosis. This type of disease does not affect the structure of the brain and, as a rule, does not require treatment.

If a violation of the outflow of intracranial fluid occurs against the background genetic diseases, then this may have an unfavorable prognosis, since, the main genetic disease causes disruption of viability.

If the cause of enlargement of the ventricular cavities was an intrauterine infection, which long time caused hypoxia of the brain, this eventually leads to psychoneurological disorders varying degrees severity or up to cerebral palsy. This form is difficult to treat.

In conclusion, it is worth noting that any change in the size of the ventricles of the brain requires additional examination to prevent complications. Treatment tactics are selected taking into account the individual characteristics of the disease, and can range from simply monitoring the child to prescribing medications.

Ventriculomegaly in an infant: what is this diagnosis and what treatment should the child receive?

Ventriculomegaly is a congenital (rather rarely acquired) pathology of the brain caused by its incorrect intrauterine development. The disease is characterized by an increase (dilation) of the lateral ventricles in size, which leads to the formation of various neurological disorders in the newborn.

Normal size lateral ventricle should not exceed 1...4 millimeters. Ventriculomegaly is confirmed if these indicators increase to 12...20 millimeters.

The causes of this pathology are not known to doctors. But according to statistics in children, born of women after 35 years, this deviation is diagnosed much more often than in babies born to younger mothers.

Dilation of the lateral ventricles is perceived by many pediatricians not as an independent disease, but as a pathological condition caused by intrauterine developmental defects. Ventriculomegaly can form in response to the prematurity of the child, as well as in children whose mothers suffered a severe infectious disease during pregnancy and suffered an abdominal injury, accompanied by uterine bleeding.

Very often, dilatation of the lateral ventricles of the brain is diagnosed in conjunction with chromosomal abnormalities, for example, Down syndrome. Non-hereditary developmental defects are no exception.

In healthy infants, pathology can develop as a complication of rickets. In older children, dilation of the ventricular cavities may accompany mental illness such as schizophrenia and bipolar disorder.

What are the types of ventricular dilatation?

To assess the development of the fetal brain, a woman undergoes an ultrasound procedure. This is the only reliable method for diagnosing pathology.

There are two types of ventriculomegaly - right-sided and asymmetric.

The next gradation is based on the type of severity of the current.

1. Easy pathology format. The expansion of the ventricles does not exceed 12 millimeters.
2. Moderate severity. Dilatation reaches 15 millimeters and is accompanied by suffocation of the outflow of cerebrospinal fluid (brain fluid). The child is diagnosed with neurological disorders.
3. Severe form. The volume of the cerebral ventricle is increased to 20 millimeters (sometimes more). In this case, severe pathologies of brain development are recorded, in particular, hydrocephalus can be confirmed.

According to location they are distinguished:

• lateral dilatation of the ventricles (left + posterior);
• pathology of the third ventricle (in the area of ​​the visual tuberosities in the front of the forehead);
• fourth ventricle (in the occipital part - in the medulla oblongata and cerebellum).

Symptoms of pathology

The disease can special problems diagnosed during an intrauterine ultrasound procedure. But a specialist can miss the pathology if the deviation is small ( light form ventriculomegaly, not combined with any other diseases).

If a child is born with this deviation, then it is necessary to carefully monitor the progress of its development. The baby requires specialist advice in the following cases:

• he later sat down and walked (in comparison with his peers);
• the child is silent at a time when it is time to babble and try to pronounce sounds;
• experiences headaches and seizures;
• with a large head size (the difference between the volume of the skull and the baby’s chest exceeds 3 centimeters).

Sometimes the diagnosis is made in children with existing motor and motor delays. speech development. But as such, ventriculomegaly is absent. Subsequently, such children easily catch up with their peers in development and, of course, we are not talking about any neurological type deviations.

Treatment of ventriculomegaly

After determining the degree of dilatation of the ventricles, the child can be prescribed either treatment or simply observation. In approximately 80% of all diagnosed cases of mild and medium degree children develop without any deviations. The remaining 20% ​​accounts for the formation of various neurology.

Scheme drug treatment compiled by a doctor in individually. Here the severity of the pathology and the characteristics of the course of the disease are taken into account. You need to understand that medications cannot return the ventricle to the “correct” size, but they normalize the processes occurring with “errors.”

The most common appointments are:

• Nootropic drugs that improve blood supply to brain cells.
• Antihypoxants. The drugs increase the body's resistance to hypoxia.
• Diuretics. Medicines help remove excess fluid.
• Potassium-sparing drugs. Drugs slow down the removal of potassium from child's body, which prevents the formation of neurological disorders.
• Vitamin complexes.

Classes give good results therapeutic exercises and massage sessions.

In case of severe pathology, the child may be prescribed surgery. A drainage tube is installed in the baby's skull to drain excess fluid.

In both hemispheres of the brain, diencephalon and between the cerebellum and the medulla oblongata there are four special cavities - the cerebral ventricles (ventriculi cerebri), which produce cerebrospinal fluid (cerebrospinal or cerebrospinal fluid). Their pathological expansion or enlargement and is defined as ventriculomegaly.

ICD-10 code

Q00-Q07 Congenital anomalies [malformations] of the nervous system

Epidemiology

Given in various sources the statistics are:

• the prevalence of ventriculomegaly, according to The Fetal Medicine Foundation, is one case per 100 fetuses at 22 weeks of pregnancy and one case per thousand infants born;
• in more than 94% of cases, ventriculomegaly of the largest lateral ventricles (ventriculi laterales) is observed;
• cranial anomalies are observed in 15-65% of cases of ventriculomegaly, and chromosome defects - on average in 14.7%;
• the frequency of neurodestruction associated with this pathology in infancy is approximately 12% (according to other sources, almost 60%).

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Causes of ventriculomegaly

Listing possible reasons expansion of the cerebral ventricles, it should be noted that pathological dilatation of the ventricular (ventricular) system of the brain - due to excess volume of cerebrospinal fluid (CSF) in the ventricles and subarachnoid spaces and disturbances in its circulation - is called hydrocephalus, often associated with increased intracranial pressure.

Since it is impossible to measure intracranial pressure during intrauterine development (prenatally), the terms hydrocephalus and ventriculomegaly in the fetus are used interchangeably. Although hydrocephalus should be called an enlargement of the fetal ventricles to more than 15 mm.

Experts see the main causes of ventriculomegaly in brain dysgenesis, excessive amounts of CSF in the ventricular system of the brain, and chromosome defects.

Antenatal ventriculomegaly, that is, ventriculomegaly in the fetus can be the result of a defect in the neural tube of the embryo, as well as primary congenital anomalies brain: agenesis of the corpus callosum; subependymal heterotopia; colloid or arachnoid cyst of the brain; Arnold-Chiari malformation type 2, leading to Arnold-Chiari syndrome ; Cystic dilatation of the fourth ventricle – Dandy-Walker syndrome and etc.

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Pathogenesis

The pathogenesis of overproduction of CSF by the ventricles of the fetal brain may be due to:

• infections (bacterial, fungal, herpes meningitis);
• tumors (platelet glioma, endodermal sinus tumor, common oligodendroglial tumor);
• hypertrophy, hyperplasia or tumor of the choroid plexus of the ventricles of the brain.

There is an association of pathological dilatation of the cerebral ventricles with trisomy of the 13th, 18th and 21st chromosomes - with Patau, Edwards and Down syndromes, respectively.

Ventriculomegaly in a newborn baby can be caused by:

• birth trauma with a sharp increase in venous pressure in the dural sinuses or in the internal jugular veins;
• narrowing of the intraventricular (Monroy) foramina connecting the third ventricle with the lateral ones;
• congenital stenosis of Sylvius water supply - canal between the third ventricle of the brain (ventriculus tertius) and the fourth (ventriculus quartus).

In addition, rapidly or gradually developing ventriculomegaly in a child is possible with:

• traumatic brain injuries (especially with hemorrhage);
• brain damage pork tapeworm – neurocysticercosis;
• meningioma, diffuse glial tumors or teratoma brain;
• choroid papilloma (with damage to the lateral ventricles of the brain).

Ventriculomegaly in adults

Secondary ventriculomegaly in adults is possible due to head trauma, inflammation of the meninges, cerebral neoplastic formations, Sylvian stenosis water supply, intracranial aneurysm, chronic subdural hematomas, as well as intraventricular or general cerebral hemorrhage, including hemorrhagic strokes.

In addition, as Canadian researchers have established, the development of ventriculomegaly, the pathogenesis of which is caused by impaired absorption of CSF or leakage of cerebrospinal fluid into the subdural space, occurs more often in older people than in young people.

Symptoms of ventriculomegaly

The first signs of the presence of this pathology in the fetus are the large size of the ventricles of the brain, reaching 12-20 mm. The optimal period for its detection is 24-25 weeks of gestation.

Symptoms of ventriculomegaly in newborns include lethargy, inactive sucking and difficulty swallowing; the child often spits up and cries; sleep intervals are short; on the head and facial part of the skull through the skin often appear blood vessels; there is protrusion of the fontanel, periodic trembling lower jaw and convulsive movements of the limbs. Until the sutures of the skull have fused, there is a rapid increase in its circumference (macrocephaly).

Children of the first two to three years have headaches; pain intensifies with tension and sudden movements, jumping, bending. Nausea and vomiting occur spontaneously. In the presence of chromosomal syndromes, symptoms acquire characteristics characteristic of them.

Ventriculomegaly in adults can manifest as headaches, nausea, vomiting, increased intracranial pressure, and blurred vision. The latter is caused by swelling of the optic disc - papillodema, which is early stages may be asymptomatic or give headache. Over time, this swelling can lead to the appearance of a blind spot, blurred vision, and periodic limitation of the field of vision. As a result, it is possible total loss vision.

If the third ventricle located in the diencephalon increases, then due to pressure on the subcortical autonomic centers in the gray medulla of its walls there may be gait disturbances, paresthesia, urinary incontinence, and deterioration of cognitive functions.

Stages

The degree of enlargement of the cerebral ventricles in the neonatal period - based on the norm of its size up to 10 mm (along the atrium of the posterior or anterior horn of the lateral ventricle) - determines the degree of ventriculomegaly.

Their names are not unified, so expansion of the lateral ventricles (estimated mainly by ventriculi laterales) by 20% - up to 12 mm can be defined as ventriculomegaly of the 1st degree or mild ventriculomegaly.

If the dilation is 20-50% of normal - from 12 to 15 mm, then it is moderate ventriculomegaly, and when the indicator is > 15 mm, ventriculomegaly can be classified as more severe, severe ventriculomegaly, as well as subthreshold or borderline ventriculomegaly.

If the fetal ventricle is enlarged ≥ 20 mm, intraventricular hydrocephalus is diagnosed.

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Forms

Depending on the location they differ:

• ventriculomegaly of the lateral ventricles (ventriculi laterales) or lateral bilateral ventriculomegaly;
• unilateral ventriculomegaly, when only one lateral ventricle is enlarged. There may be ventriculomegaly on the left - left-sided lateral or ventriculomegaly on the right - right-sided lateral.

In cases where the ventricles different sizes(this difference should not exceed 2 mm), asymmetric ventriculomegaly is diagnosed.

If ultrasound does not reveal any brain abnormalities associated with this pathology, this is antenatal isolated ventriculomegaly. Many cases that appear to be isolated dilation of the fetal cerebral ventricles are actually found to have other abnormalities after birth (especially when ventriculomegaly exceeds 15 mm). According to observations, with this variant of pathology there is a 4-fold increase in the risk of an abnormality of the 21st chromosome.

Complications and consequences

Naturally, the question arises: is ventriculomegaly dangerous?

Like all pathologies of the brain, enlargement of its ventricles has serious consequences and complications. This is both macrocephaly and delay general development child, and destructive changes in brain structures: the size of the cortex increases significantly cerebral hemispheres, neuroglia grow in the periventricular and supratentorial areas, and the maturation of the cortical sulcus is delayed.

Sunset syndrome may develop or Graefe syndrome .

Neurological disorders often occur, which negatively affect memory, learning ability, adaptive properties of the psyche and behavior.

According to some data, at the age of two, children with ventriculomegaly have neurological problems in almost 62.5% of cases.

Diagnosis of ventriculomegaly

The only method by which ventriculomegaly is diagnosed is instrumental diagnosis.

Ventriculomegaly is detected in the fetus during maternal pregnancy - during an ultrasound examination after the 22nd week of pregnancy, when the size of the lateral ventricles can be visualized and measured.

Assessment of the fetal head includes determining the shape of the skull and its bilarietal diameter (the size of the head from one temple to the other). Ultrasound imaging allows the medial border of the ventricles to be clearly defined; echo signs of the choroid plexus - an echogenic structure occupying the central part of the lateral ventricle; Cerebrospinal fluid may be visible.

If pathology has been detected, screening for more later(every 4 weeks).

Before the 18th week, and especially in the first trimester, ventriculomegaly is not examined by ultrasound: echo signs of pathology may simply be absent (the accuracy of the readings is less than 47%), since the spaces of the hemispheres are practically completely occupied by the ventriculi laterales.

Differential diagnosis

Clarification of the diagnosis and differential diagnosis require an MRI of the brain. It is given to adults and children younger age. Pregnant women undergo magnetic resonance imaging only in cases where the ventricular system cannot be assessed due to the position of the fetus in the uterus. According to diagnosticians, in half of the cases, MRI can detect additional, sonographically not visualized, abnormalities of the central nervous system.

MRI signs of ventriculomegaly include: dark (low-intensity) signal from the ventricle of the brain (in the coronal plane) in T1 mode and light (increased strength) in images scanned in T2-weighted mode.

Adults can undergo a CT scan or X-ray of the brain with radioisotope contrast - ventriculography.

Hydrocephalus is differentiated from ventriculomegaly based on the parameters of an enlarged cerebral ventricle and intracranial pressure - a spinal puncture is performed.

Among other pathologies, chronic syringomyelia with cavities in the spinal cord and inflammation of the ventriculi cerebri - ventriculitis.