Replacement hydrocephalus of the brain in adults. What is external replacement hydrocephalus of the brain? Moderately severe replacement hydrocephalus

Replacement dropsy is a pathology of the brain in which it partially atrophies and dries out, and the vacated space is occupied by excess fluid - cerebrospinal fluid. This can be caused by circulatory disorders, helminthic infestation, and trauma during childbirth. Older people often suffer from the disease when the cerebral cortex decreases.

Classification of replacement hydrocephalus

There is both congenital and acquired dropsy. Replacement hydrocephalus is classified into several forms:

1. External - cerebrospinal fluid accumulates in the subarachnoid space.
2. Internal replacement hydrocephalus is hydrocephalus of the four ventricles.
3. Mixed - accumulation of excess cerebrospinal fluid both in the ventricles and in the subarachnoid space.
4. Non-occlusive hydrocephalus or open external replacement hydrocephalus without disruption of the outflow of cerebrospinal fluid.
5. Occlusive or closed with impaired outflow due to blockage of the cerebrospinal fluid passages by a tumor, abscess or cyst. This form is always internal.

Symptoms of pathology

Signs:

1. Headache accompanied by nausea, vomiting that does not bring relief, and in children - regurgitation.
2. Changes in blood pressure.
3. Convulsive syndrome, muscle weakness or spastic paralysis, chorea, athetosis.
4. , shuffling gait.
5. Rapid mood swings, outbursts of anger, depression.
6. Auditory and visual hallucinations.
7. Mental disorders, delusional disorders.
8. Decreased mental abilities.
9. Large head with pronounced veins.
10. Visual impairment: diplopia (double vision), increased sensitivity to light (photophobia).
11. Motor hyperactivity and attention deficit syndrome.

Dropsy can be accompanied by either increased intracranial pressure, normal pressure, or even decreased pressure.

Mild to moderate external or internal mixed replacement hydrocephalus in adults is manifested by weakness, nausea, headache, and confusion. Severe forms, usually congenital, affect the structure of the skull bones. At the same time, the head is disproportionately large.

The initial manifestations of external replacement hydrocephalus in adults include the following symptoms: memory impairment, mental disorders. As the disease progresses without treatment, disability may be required. The person becomes unable to work.

In the internal form, the subcortical centers (hypothalamus, basal ganglia) are affected, extrapyramidal disorders (, athetosis), impaired swallowing, speech, and decreased strength of the muscles of the limbs predominate. With external dropsy, the cortex is affected.

Causes of liquorodynamic disorders

The causes of the development of liquorodynamic disorders and dropsy may be:

If you have symptoms such as nausea, vomiting, headaches, you should contact a neurologist. The study includes:

Treatment of replacement hydrocephalus

The following drugs are used to treat internal, external and mixed replacement hydrocephalus:

1. Diuretics: Furosemide, including osmotic (Mannitol).
2. Anticonvulsants: Phenobarbital.
3. Painkillers: Ketorolac, Analgin.
4. Nonsteroidal anti-inflammatory drugs: Diclofenac, Indomethacin, Ibuprofen.
5. Glucocorticoid hormones: Prednisolone, Metypred, Dexamethasone to reduce edema syndrome.
6. Nootropic drugs to improve cognitive functions: Piracetam, Encephabol, Glycine.
7. Angioprotectors (Actovegin).
8. Antihypoxants: Mexidol, Reamberin.
9. Vitamins: B1, riboflavin, nicotinic, folic acid, pyridoxine.
10. Vasodilators: Cavinton, Cinnarizine to improve cerebral circulation.
11. Antihypertensive drugs for hypertensive encephalopathy - calcium channel and beta-adrenergic receptor blockers, ACE inhibitors.
12. Tranquilizers (Phenazepam, Gidazepam) to reduce anxiety, irritability and other mental symptoms.

Removing edema with diuretics, corticosteroids, non-steroidal anti-inflammatory drugs leads to a weakening or cessation of convulsions, nausea, vomiting, and increased photosensitivity. The liquor stops putting pressure on nerve cells and vomiting receptors.

After a stroke, antihypoxic, metabolic agents and vitamins are used: Cytoflavin, Cerebrolysin, Mexidol, Mildronate. If the cause is ischemia due to blockage by a thrombus, then direct anticoagulants and fibrinolytics are used for hemorrhage.

If drug treatment is ineffective, surgical intervention is resorted to: bypass surgery into the abdominal cavity, aqueductoplasty (for occlusive form), septostomy.

Rehabilitation and prognosis

For children with congenital defects, classes are held in a special group. After a stroke, it is necessary to restore speech, practical skills, and physical activity with the help of physical therapy.

The prognosis for external, internal or mixed replacement hydrocephalus of the brain depends on the severity of the disease. Treatment with diuretics stops the progression of the disease in children with congenital defects or in adults with hypertensive encephalopathy. In cases where Alzheimer's disease has already developed, cognitive impairment is irreversible.

Currently, the number of people suffering from diseases of the nervous system is increasing. Provoking factors include stress, emotional overload, unfavorable environmental conditions and lifestyle. This group of diseases also includes external replacement hydrocephalus.

Key Aspects

In some cases of inflammatory diseases of the central nervous system, injuries and developmental disorders, pathological processes involving blood vessels are accompanied by the formation of external replacement hydrocephalus of the brain.

The essence of this syndrome, as well as open hydrocephalus, lies in the fact that there is a disruption in the processes of production and absorption of cerebrospinal fluid. This leads to an increase in its quantity and accumulation in the cranial cavity.

If the fluid is localized in spaces outside the brain structures, the prognosis will be more favorable compared to a pathological process that extends to the cerebral ventricles. If detected and treated in a timely manner, the disease poses no threat to human life.

The cause of formation may also be inflammatory processes. The peculiarity of their course lies in the fact that the volume of cerebrospinal fluid production does not increase, but stagnation of the cerebrospinal fluid occurs.

But an important point that needs to be paid attention to is that in any case, an increase in the amount of cerebrospinal fluid in the cranial cavity leads to external compression (that is, compression) of the brain. There is a progressive decrease in the number of nerve cells. And this, in turn, leads to the formation of pathological symptoms, the appearance of which forces a person to go to a medical institution.

Classification

The presented pathological condition is distributed depending on:

1. Origin. It can be either hereditary or acquired.
2. Features of the course. There are acute, chronic and subacute hydrocephalus.

The peculiarity of acute is that from the moment the first pathological symptoms appear, it usually takes three days for brain dysfunction to occur.

As for subacute, its duration is about a month.

Chronic disease develops from six months or longer. There is a latent form, which is considered more dangerous than the progressive form, since it does not manifest itself in any way.

The disease is detected already in an advanced form. It is characterized by a constant course, in which there is no decrease in brain volume and no increase in cerebrospinal fluid.

There is also a progressive form, in which there is a rapid increase in symptoms. Her treatment must be radical, since otherwise severe pain in the head, urinary incontinence, dementia and even impaired motor function will appear. If left untreated, the patient may die.

Causes

The main provoking factor in the formation of external replacement hydrocephalus is considered to be an imbalance between the formation of cerebrospinal fluid (its amount can increase as a result of the presence of vascular and metabolic diseases of the brain) and absorption (this process can be disrupted due to the presence of inflammatory processes that spread to the membranes of the brain and its substance) .

The list of reasons that most often provoke the occurrence of the disease includes:

• hypoxia fetus;
• defeat nervous system of a child of an infectious nature that occurred in utero or immediately after birth;
• nervous system damage infectious character in an adult;
• intoxication exogenous or endogenous origin;
• state changes vessels, that occur with age;
• traumatic brain damage;
• shake brain and alcohol dependence in history.

Treatment of this pathological condition will be effective and efficient only if the provoking factor is correctly identified and measures are taken to eliminate it.

Clinical picture

The most common clinical manifestations of the disease include:

• feeling pain in the head (a feature of this symptom is that it bothers patients mainly in the morning);
• alternating rises and falls of arterial blood pressure pressure;
• violation heart rhythm;
• tachycardia;
• increase in the amount released sweat;
• nausea;
• vomit;
• disorders sleep, which manifest themselves as difficulty falling asleep and drowsiness during the day;
• increased level nervousness;
• emotional incontinence and irritability;
• violation vision;
• in some cases change walking.

It is not uncommon for the disease to lead to memory loss, absent-mindedness and the inability to carry out even the simplest mental calculations.

As a result, the formation of dementia or other mental disorders may occur. The listed pathological conditions, in turn, can cause epileptic seizures and even coma.

Diagnostic measures

The following methods are used to diagnose hydrocephalus:

1. Magnetic resonance tomography This study helps to obtain an MRI picture, the analysis of which will provide information about the stage of the disease, the volume of fluid and its location.
2. Computer tomography
3. Ophthalmoscopy. Using this type of study, an examination of the fundus of the eye is performed.
4. Analysis spinal fluid obtained as a result of puncture.
5. Analyzes blood, which allow us to detect the presence of pathogenic microorganisms in the body.
6. Ultrasound(ultrasound examination) of the vessels of the head and neck.
7. Angiography(i.e. examination of the condition of blood vessels). The study is carried out by introducing a contrast agent into the lumen of the vessel.

The listed studies make it possible to identify the disease, find out at what stage of development it is, and also select the optimal treatment option.

Methods of treating the disease

The choice of treatment method will depend on how severe the disease is. Since one of the main symptoms of the disease is intracranial hypertension, treatment should be aimed primarily at its elimination.

For this purpose, drugs are prescribed that are endowed with the ability to influence the production of cerebrospinal fluid in a certain way:

• Diacarb;
• vascular medications;
• trophic preparations.

If it is not possible to eliminate the pathological symptoms conservatively, then the symptoms of the disease are eliminated surgically by performing:

• spinal punctures;
• bypass surgery meningeal spaces of the brain using endoscopic or traditional neurosurgical operations.

In most cases, shunting is preferred. This surgical intervention allows you to create a bypass route for the fluid. For this purpose, flexible tubes are inserted into the intracranial space and taken out into the internal environments of the body.

A significant number of neurosurgeons practice endoscopic operations, during which holes are created through which excess cerebrospinal fluid flows into the cisterns of the brain. The process itself is monitored on the monitor; this is possible due to the fact that the endoscope is equipped with a microscopic camera.

This intervention has certain advantages:

1. Minimal risk of occurrence complications.
2. The best quality life of the patient after surgery, since there is no need to regularly check the condition of the shunts and clogged tubes.

Please note that replacement external dropsy is considered a disease, the risk of the formation of which accompanies a person throughout all years of his life. Therefore, even after successful treatment, the patient should undergo regular examination by his attending physician.

Forecast

If external replacement hydrocephalus is promptly identified and treated at the initial stage, the prognosis is considered positive, and the patient has a much better chance of returning to his normal routine. However, there are cases when the disease leads to impaired speech function.

If medical care and treatment were not carried out in a timely manner, then the sick person will lose not only his ability to work and his social status, but also his personality.

Consequences and complications

The consequences of external replacement hydrocephalus can be different. A person can not only become disabled, but also to die, since pathological processes occurring in the brain during this pathological condition may be irreversible.

It must be remembered that the development of external replacement hydrocephalus can also be prevented. To do this, you just need to be attentive to your health and treat viral and infectious diseases (and more) as early as possible.

The condition of the cardiovascular system also requires special attention. A significant role in this issue belongs to proper nutrition. It is necessary to lead a healthy lifestyle, engage in moderate physical activity and give up all bad habits.

Surgeries are mainly performed to eliminate excess amounts of cerebrospinal fluid, for example, cerebrospinal fluid shunting. In most cases, it is extremely effective and the results of therapy are visible almost immediately. A surgical intervention is performed using a set of tubes and valves to drain the cerebrospinal fluid into the body cavity, where it will not cause harm and will be disposed of. After the operation, the patient expects a long recovery period (at least 7 months). If the system is damaged, repeated surgery will have to be performed. This procedure is required mainly to replace the shunt or adjust the design.

Basically, doctors recommend endoscopic operations, since there is no need to install a complex structure and the outflow of cerebrospinal fluid occurs faster. This type of surgery involves creating a small hole in the ventricular space to drain cerebrospinal fluid. This procedure is suitable mainly for closed type hydrocephalus. After it, the patient usually recovers completely and does not feel much discomfort. However, it is prescribed only in 10% of cases, and in all other situations it is necessary to use liquor shunting.

Moderate external hydrocephalus usually does not manifest itself and often becomes chronic, which is characterized by the development of dementia. To prevent this, it is necessary to be promptly examined and undergo a course of treatment aimed at eliminating the cause of the disease.

It was classified exclusively as an infant disease.

Over time, doctors were forced to admit that no age group is immune from such a diagnosis.

When external hydrocephalus of the brain is diagnosed in adults, treatment is prescribed according to one of the clinical programs.

External hydrocephalus is a neurological disease with dangerous complications. Normally, intracerebral fluid (CSF) continuously circulates, providing nutrition to soft tissues and protecting them from damage.

Neoplasms, adhesions and any other obstacles pose a threat of outflow disruption. An excess of accumulated fluid creates pressure, leading to a decrease in brain volume or rupture of the ventricles.

Drug treatment is considered not the most effective, but at the same time, the most gentle method. Conservative treatment is prescribed based on the general condition, age and nature of hydrocephalus.

The emphasis is on vasodilators, diuretics and potent saluretics that increase the outflow of cerebrospinal fluid. At the same time, pharmacological agents are prescribed to slow down its production.

Concomitant medications are also prescribed to alleviate the patient’s condition; here are the medications included in a standard prescription:

1. acetazolamide- a means of lowering intraocular pressure;
2. beckons, diacarb, glimarite- diuretics;
3. painkillers and barbiturates;
4. furosemide and ethacrynic acid- preparations that remove salts and excess water;
5. 20% albumin solution to correct the composition of blood and plasma;
6. 25% solution of magnesium sulfate, glivenol, troxevasin- drugs that improve blood circulation;
7. betamethasone, dexamethasone, methylprednisolone, prednisolone- hormonal steroids that have anti-inflammatory effects.

Conservative therapy leads to complete recovery only in some cases; its primary task is to slow down the development of external hydrocephalus and alleviate the patient’s condition.

If a stable condition cannot be achieved within 2-3 months, surgical intervention is required. Drug treatment is unacceptable in acute clinical forms of the disease.

Brain shunt

Brain shunting is one of the effective methods for treating external hydrocephalus in adults; 85% of the operations performed give a satisfactory result. Using a system of tubes and valves, excess cerebrospinal fluid is removed by natural and forced means into the body cavities, where fluid accumulation is not so critical.

Brain shunt for hydrocephalus

Complete recovery is the main advantage of the technique, at the same time, there is a possibility of complications and inconveniences for the patient, the most common of which are:

• periodic need for partial or complete replacement of the shunt;
• dependence on system performance;
• risk of hematoma formation due to intense outflow;
• outflow too slow;
• the likelihood of inflammation, bedsores, .

There are a number of contraindications for bypass surgery:

1. chronic form of hydrocephalus;
2. neurological diseases;
3. mental disorders;
4. epilepsy;
5. blindness.

Endoscopy

In most cases, the indication for endoscopy in adults is the presence of a tumor or formation of traumatic origin. Thanks to this technology, it is possible to remove an obstacle that impedes the circulation of cerebrospinal fluid without trephination or opening the skull.

Using an endoscope, neurosurgical instruments are inserted into the areas of cerebrospinal fluid accumulation to ensure that excess fluid is sucked out to normal limits.

If we compare shunting and endoscopy, the advantages of the endoscopic method are obvious:

1. the initial goal of endoscopy is to normalize natural liquor flow;
2. minimal trauma during surgery;
3. absence of a foreign body in the body;
4. high probability of full recovery.

With the help of an endoscope, it is possible to completely remove tumors that have caused a blockage in the circulation of cerebrospinal fluid, as a result, the patient’s condition improves almost immediately after completion of the operation.

Folk remedies

Folk methods of helping someone suffering from dropsy have been known since ancient times and continue to be used today. Experts say that none of them guarantees a complete cure, however, they note their beneficial effects.

Decoctions and tinctures of medicinal plants improve blood circulation, accelerate metabolism in soft tissues, and are recognized as effective diuretics and salt-removing agents; some of them are listed below.

In his writings, Avicenna insists on the use of spices: cinnamon, fennel, suneli hops, ginger and parsley.

According to him, these plants not only improve the taste of the patient’s very limited menu, but also help eliminate any blockages in the body.

There is an opinion that due to age or prolonged inactivity, the volume of the brain decreases and the empty space is filled with fluid.

However, this is a reversible process: intellectual activity helps restore the brain to its previous dimensions and displace excess moisture.

There is no official confirmation or refutation of this theory in medicine, however, in any case, reading, mastering new material, solving crosswords and solving problems will not cause harm.

Diet

The diet includes foods that do not contain salts and sugar:

• steamed lean meat;
• boiled eggs or steamed omelet;
• vegetables and herbs;
• stale bread;
• porridge.

Dishes that promote fluid accumulation should be excluded from the patient’s menu:

• confectionery and freshly baked flour products;
• fried, smoked, fatty meat, sausages;
• mushroom and fish soups;
• carbonated drinks;
• onion, garlic, radish.

When cerebrospinal fluid fills the subarachnoid space and ventricles of the brain. A variety of reasons can lead to this disease - from congenital disorders to inflammatory processes.

Moderate hydrocephalus in adults is characterized by striking and particularly severe symptoms. How this brain disease is treated is described in detail.

Video on the topic

About the causes and treatment of hydrocephalus (dropsy) of the brain:

The prognosis of external hydrocephalus of the brain in adults is not always predictable. This is a fairly serious disease, the advanced form of which can be fatal. Even a successful and timely operation does not guarantee the absence of complications and some limitations in the future.

Experts note not only physiological, but also psychoneurological disorders. Moderate physical activity and regular walks will help the patient relieve stress. Practice shows that in most cases, complete recovery after surgical treatment and a return to a full life are possible.

Treatment of external hydrocephalus of the brain in adults is prescribed exclusively by a qualified specialist, based on the results of the examination.

Any head injury, infection, or tumor can cause replacement hydrocephalus. This disease is considered difficult to tolerate, especially in childhood. Dropsy is due to the fact that too much cerebrospinal fluid is synthesized. In general, this liquid has many useful functions, but its volume should be within normal limits.

If its quantity begins to increase, it accumulates in the cavities of the skull. And this provokes serious disorders in the functioning of the brain.

Causes and symptoms

External hydrocephalus in adults can be caused by various reasons. Usually these are disorders that affect certain areas of the nervous system. However, a clear diagnosis has not yet been developed. There are cases when doctors send their patients to a psychiatric ward and try to treat, but this is the wrong therapy.

The main causes are traumatic brain injuries. The disease can cause a stroke. Moreover, this applies to both ischemic and hemorrhagic forms. The cause may be a psychoorganic syndrome. In addition, some hemorrhages are also a problem. Inflammatory processes in the central nervous system increase the risk of developing dropsy, especially if they are caused by infections (encephalitis, ventriculitis, tuberculosis, meningitis, etc.).

Dropsy can be provoked not only by encephalitis caused by infection, but also by post-traumatic encephalitis. The risk of developing hydrocephalus increases in people who suffer from cancer. Moreover, this also applies to the intraventricular, trunk and para-stem location.

Hydrocealia can be acute or chronic. In both cases, the symptoms will be slightly different. If the disease develops in a child who is no more than 2 years old, then his head circumference will begin to increase sharply.

This happens because the fluid creates pressure, and the sutures of the skull have not yet strengthened, so they begin to separate. As a result, the child’s head becomes disproportionate, the forehead begins to protrude greatly, and the veins on the head are visible. The child becomes very lethargic and finds it difficult to keep his head straight.

In adults, symptoms will be slightly different. The patient complains of constant nausea. Vomiting attacks appear. Most often, this symptom torments a person in the morning. It is constantly felt, especially when a person wakes up. The first sign that indicates that a person's condition is worsening is drowsiness.

Consciousness may be depressed, which will develop into a coma. Stagnant processes sometimes affect the optic nerves, so a person’s vision and perception deteriorate.

Sometimes hydrocephalus of the brain in adults and children develops into a chronic form. In this case, all violations will be systemic, and some of them will be impossible to correct. Typically, the disease manifests itself approximately a couple of weeks after a cerebral hemorrhage, meningitis, or injury.

In the chronic form, the patient may notice an unusual condition. His memory begins to deteriorate sharply. This is especially true for numbers over a short period of time - age, date, etc. The patient begins to confuse day and night. If you ask a patient questions, he thinks for a long time before answering, but produces monosyllabic sentences and speaks slowly. Sometimes speech becomes completely inadequate.

In addition, he has urinary incontinence, but in the later stages. Another characteristic symptom is gait apraxia. If you ask a patient in a supine position to show how to walk or ride a bicycle, he will easily show it. But in a standing position in the later stages, he will no longer be able to do this.

Diagnostics

Treatment should begin only after the diagnosis has been accurately confirmed. The main place in diagnosis is given to magnetic resonance and computed tomography. Doctors must evaluate the size, position and condition of the ventricles, the space in the skull and the degree of deformity. Only after this does treatment begin.

Magnetic resonance allows you to determine the severity of the disease and its shape. In addition, thanks to this diagnostic method, it is possible to identify the main causes that triggered the onset of the disease. Computed tomography helps to examine the contours of the brain, the space in it, and so on. Thanks to this technique, you can accurately determine the shape and size of the ventricles, as well as find cysts, tumors and other neoplasms.

Angiography involves the injection of a contrast agent through an artery, after which an X-ray of the circulatory system can be taken. Any, even the smallest, violations will be identified.

Cisternography allows you to determine how the cerebrospinal fluid circulates. In addition, a neuropsychological examination is carried out. An anamnesis is being collected. It is also necessary to conduct a survey of the patient. This way you can identify primary disorders in the functioning of the brain.

Drug treatment

Treatment of hydrocephalus must begin with the use of drug therapy.

If you make a diagnosis at an early stage of the disease and start therapy on time, complications will not arise. A set of measures has been developed that allows you to restore the balance of fluid in the human body, so that this will completely eliminate dropsy. However, these measures do not always help, so sometimes people are treated not only with medications.

It is imperative to maintain the correct mode of activity and rest. In addition, you need to monitor your own nutrition, and this applies not only to your diet, but also to your regimen. It is imperative to perform a set of therapeutic exercises. They improve blood circulation and metabolism.

As for medications, the doctor prescribes medications that have a diuretic effect. Anti-inflammatory drugs are mandatory. Vasodilator medications will also be required.

These remedies help at an early stage of the development of the disease. Usually the doctor prescribes Panangin or Asparkam. These are drugs that include magnesium and potassium.

Choline Alfoscerate-Cerepro or Gliatilin are prescribed. Mannitol or Mannitol is used. Sometimes Actovegin or Solcoseryl are used. A separate group consists of Telektol, Vinpocetine or Korsavin. Acetazolamil is also prescribed. For severe pain, you can use painkillers. For example, non-steroidal anti-inflammatory drugs will be used - Nimesulide, Ketoprofen, Ketonal, Nimesil, etc. Treximed helps with migraines. Sometimes barbiturates are used - amytal, nembutal or phenobarbital.

Surgery

If drug treatment does not help, then surgery will be required. In addition, if the acute form of the disease is caused by hemorrhage inside the ventricle, then such a severe complication can only be eliminated with a neurosurgical operation.

First, a liquor bypass can be performed. The desired effect is achieved in 90% of all operations. This will help eliminate accumulated fluid and pump it into natural areas of the body. A system of valves and tubes is used. However, it must be remembered that unpleasant complications are also possible, and in 50% of all operations.

For example, a patient may become infected with a shunt, which means that microorganisms will spread to the membranes of the brain. There is a risk of blockage in the ventricles. Sometimes the shunt leads to mechanical damage. There are other side effects. In addition, the outflow of fluid is very slow.

Secondly, endoscopic therapy can be performed. This option is considered more successful, so it is used much more often than liquor bypass. Therapy assumes that the outflow of fluid will take place artificially.

The advantage of the operation is that the level of trauma during the operation is very low. After surgery, the patient's quality of life begins to improve. There will be no foreign bodies in the body. The fluid drainage will gradually be restored, so that the patient recovers.

This condition of hydrocephalus is very complex and severe. Adults and children find it difficult to tolerate this disease. Determine hydrocephalus of the brain by symptoms. It is also necessary to carry out complex diagnostic procedures. Most often, this disease appears in newborns.

Video Hydrocephalus brain operation:

In this case, proper treatment will help fix everything. However, drug therapy does not always help, so surgery is required. To avoid causing dropsy, you need to avoid head injuries, eat right, and undergo a full examination in the hospital at least once a year. These rules will help prevent the occurrence of the disease.

External hydrocephalus of the brain in an adult

External hydrocephalus of the brain is consistently considered a “childhood” pathology, since it is almost always a congenital disease. If we talk about the course of the disease in adults, there are still no clear criteria by which hydrocephalus is identified and treated. Despite this, every fourth neurosurgery patient over 18 years of age suffers from dropsy.

Most often, external hydrocephalus occurs as a result of certain neurological pathologies (for example, stroke, neoplasms, meningitis, etc.). Because of this, in the patient’s extract the disease is characterized as a consequence of these primary diseases, which is not entirely correct.

Causes

Most often, hydrocephalus occurs as a complication of certain brain pathologies, and almost any disorder of the central nervous system can be the root cause. Most often, the disease occurs after a stroke, brain cancer, encephalopathy, infectious or inflammatory lesions and head injuries.

Along with this, external hydrocephalus can be an independent pathology. This is accompanied by the accumulation of cerebrospinal fluid (CSF) in certain cerebrospinal fluid spaces of the brain. Depending on the causes, there are several main subtypes of external hydrocephalus:

• The replacement type is characterized by its occurrence due to problems with the functioning of the central nervous system, most often after cerebral hemorrhages, Alzheimer's disease or trauma.
• Moderate hydrocephalus can occur as a result of a group of factors: atherosclerosis, hypertension, old age, concussion, alcoholism and past inflammatory diseases.
• Moderately severe hydrocephalus does not manifest itself in any way until the brain begins to suffer from a lack of oxygen (hypoxia). This can occur due to atherosclerosis, intoxication, trauma, chronic pathologies or senile changes. A form of hydrocephalus is characterized by the accumulation of cerebrospinal fluid both outside and inside the brain.
• The unexpressed form is one of the most dangerous, as it practically does not manifest itself.

Classification

Based on the course of pathological processes, external hydrocephalus of the brain is divided into three main types:

• Open - this type involves the processes of resorption of cerebrospinal fluid in pathologies of the venous sinuses and arachnoid membrane of the brain, which accompanies the entry of cerebrospinal fluid into the venous bed.
• Closed - accompanied by a change in the flow of cerebrospinal fluid due to improper closure of the cerebrospinal fluid pathways (usually a consequence of inflammation, neoplasm or thrombosis).
• Hypersecretory - occurs due to increased secretion of cerebrospinal fluid.

Signs

External hydrocephalus can occur in acute, subacute or chronic forms. The general symptoms depend on this. What is acute and subacute hydrocephalus? The acute variety is characterized by rapid development of symptoms (up to three days); for the subacute variety, the period increases to a month. The main manifestations in this case will be headaches, nausea, sometimes accompanied by vomiting, blurred vision and drowsiness. The first two symptoms usually bother patients in the morning, after waking up. This is due to changes in intracranial pressure during sleep. Drowsiness is a warning sign. Typically, increased fatigue begins to bother patients only when serious neurological changes begin.

With the development of the chronic form, completely different manifestations are observed. The first “alarm bells” appear 2–3 weeks after the development of the root cause of the disease (for example, injury or stroke). The chronic form is more characterized by mental changes. The patient begins to “confuse” day with night, preferring to sleep during the daytime and be active at night. This is accompanied by symptoms of depression: inertia, indifference to the outside world, indifference, etc. There are problems with memory, mainly with remembering numbers or figures (forgetting one’s own age, date of birth, etc.). With a long course of the disease, the patient ceases to be able to care for himself, he has serious problems with mental activity. A late symptom may be urinary incontinence.

Diagnosis and treatment

Using computed tomography, you can determine the contours of brain structures (for example, its membranes or ventricles) and identify neoplasms. A more detailed method is MR. The picture of external replacement hydrocephalus, its severity and form, causes - all this helps to understand this diagnostic method.

X-ray examination methods are used if necessary to determine the type of pathology, as well as the direction of movement of the cerebrospinal fluid. If the disease has already developed sufficiently and it has reached the point of psychoneurological changes, then consultation with an appropriate specialist is mandatory. A neuropsychiatrist identifies the severity of problems with memory, thinking, etc. The need for conservative or surgical treatment is determined by the doctor. Diuretics, plasma expanders, drugs to improve smooth muscle tone, glucocorticosteroids, analgesics, etc. are prescribed.

In recent years, pathologies associated with the central nervous system have become the most common diseases. It is also worth considering the fact that these abnormalities are getting younger and therefore are increasingly being diagnosed in patients at quite young and middle ages.

Many pathologies, developmental defects, diseases of the central system are accompanied by external replacement hydrocephalus of the brain.

This syndrome is characterized violation balance between the production of cerebral fluid and its absorption. This diagnosis can be treated, but it is advisable that it be timely, as complications may arise. Engage in independent treatment and diagnosis in such a situation Not recommended.

External replacement hydrocephalus of the brain: definition

External replacement hydrocephalus of the brain (popular name “dropsy”)– a common pathology that leads to disruption of the central nervous system. As a result, the patient experiences absorption of cerebral fluid into this organ.

Also, this pathology can provoke decrease the size of the brain, and the space that has become free and is filled with this fluid. Replacement hydrocephalus can develop almost asymptomatic over a long period of time.

If the disease progresses, the symptoms become more pronounced and intensified:

• The patient may have problems with memory, thinking, logic, and becomes inattentive.
• Such changes can provoke dementia and other psychological disorders.
• Often, patients with cerebral hydrocele experience complications in the form of epileptic seizures and coma.

Treatment

Treatment of this brain pathology can be carried out using various methods - conservative or surgical. Therapy will depend on the results of the examination.

For the process to have a positive result, it is necessary to achieve the following goals:

1. Elimination of the provoking cause.
2. Elimination of unpleasant symptoms. Conservative treatment is prescribed - taking medications, agents that have a positive effect on the production of cerebral fluid.

The positive result of treatment is a reduction in swelling and stabilization of the pressure inside the skull. As for eliminating symptoms, it can also be done surgically. Outpatient treatment is comprehensive, but only if the disease does not progress. The patient may be prescribed diuretics for long-term use.

Surgical methods of treatment

Surgical treatment is prescribed only if progression brain pathologies. Shunting is recognized as an effective operation, which helps restore normal fluid circulation. It is also worth considering the fact that such surgical intervention can also provoke complications.

A more modern method of surgical intervention is considered endoscopic treatment.

Has a lot of positive aspects:

1. No shunt is used.
2. Low chance of complications.
3. Restores the circulation of cerebral fluid.
4. Minor surgery.
5. The body recovers quickly and easily.
6. Acceptable cost of the operation.

It must be remembered that conservative treatment only helps suspend development of the disease, but will not get rid of it.

Disease Prevention

If the disease is diagnosed in a timely manner and treated, most complications can be avoided.

1. Timely treatment of infections and inflammatory processes.
2. Refusal to drink alcoholic beverages.
3. Prevention of atherosclerosis and hypertension.
4. Correct lifestyle, active lifestyle.
5. Proper and balanced nutrition.
6. Careful and regular assessment after a brain injury.
7. Visit a specialist at the first manifestations of the disease.

If the patient is examined in a timely manner and hydrocephalus is detected at the initial stage, then Great chance recovery.

External replacement hydrocephalus is a common brain pathology that can cause irreversible consequences. Treatable, surgical intervention is required to obtain a positive result. It has certain symptoms, but only at the middle and late stages of development.

Hydrocephalus of the brain is a serious disease of the nervous system that leads to neurological defects and can be life-threatening for the patient. This condition can be congenital or develops in adulthood. Surgery is considered the most effective treatment.

There are several types of dropsy of the brain, each of which has its own causes, characteristics of manifestation and degree of risk to the patient’s life. The general mechanism for the development of pathology is associated with a violation of the outflow of cerebrospinal fluid from the ventricles of the brain. In children, this forms a characteristic appearance; in adults, it leads to increased intracranial pressure (ICP).

Causes of congenital hydrocephalus:

• pathologies of head development;
• trauma during childbirth;
• hereditary diseases;
• intrauterine infection;
• side effects of medications the mother took;
• unhealthy lifestyle of parents (alcohol, smoking, drugs).

Congenital dropsy has a more pronounced effect on the development of the nervous system and is almost always accompanied by atrophic processes in the brain. Causes of acquired hydrocephalus:

• previous meningitis, encephalitis;
• consequences of strokes;
• brain tumors;
• head injuries;
• complications of chronic diseases (diabetes mellitus, tuberculosis, vascular pathologies).

Damage to the skull is especially dangerous because its consequences may not raise doubts for a long time either among the victim or his relatives. After a blow or fall, it may take a long time before a person notices that it becomes difficult for him to concentrate and that his head hurts too often.

Depending on the causes, symptoms, and severity of the condition, there are several classifications of the disease. By origin, congenital and acquired hydrocephalus are distinguished. According to the characteristics of its course, it happens:

• closed(occlusive) – there is an obstacle to the exit of cerebrospinal fluid;
• open(non-occlusive) – normal communication between the ventricles of the brain and the bloodstream;
• hypersecretory– occurs due to excess production of cerebrospinal fluid.

It is also common to divide hydrocephalus into internal (fluid accumulates in the ventricles) and external (in the subarachnoid space). According to clinical signs, acute (up to 3 days), subacute (up to a month) and chronic (more than 30 days) forms can be distinguished. According to the dynamics of pathology development:

• progressive– the most dangerous type, characterized by a gradual increase in symptoms;
• regressive– mild type, recovery is possible;
• stable– no significant changes in condition occur.

If the ventricles are affected, then a monoventricular form is isolated, when only one of them is involved in the pathological process. More rare variants of the course are biventricular and triventricular dropsy. In this case, several ventricles are affected, and the outflow of fluid from them is impossible. Such pathologies are more severe and dangerous, and are less treatable.

Symptoms of the disease

The clinic can be divided into deterioration of general condition, cerebral symptoms and focal phenomena. In any case, the main damaging factors are the accumulation of fluid and increased intracranial pressure, hypotrophic and atrophic changes in the adjacent nervous tissue.

Deterioration of the general condition is a rather uncharacteristic and unexpressed symptomatology, which does not allow making an unambiguous diagnosis. It is manifested by moderate headaches, nausea, and, less commonly, discomfort in the eyes, which is paroxysmal in nature. These signs are most pronounced with internal hydrocephalus, and with external hydrocephalus they are insignificant.

General cerebral symptoms are associated with a malnutrition of the brain; in the initial stages they accompany general symptoms and are not of great value for diagnosis. Such manifestations include convulsive syndrome, photophobia, tinnitus, memory impairment, attention, and coordination of movements.

Of higher value for diagnosis are focal phenomena that are associated with the expansion of the cerebral ventricles. They quite accurately indicate the affected area. Most often they manifest themselves in the form of impaired sensitivity of the limbs, paralysis, partial convulsive seizures (when one area is affected, for example, an arm or leg), and can be both asymmetrical and symmetrical in nature.

In children of the first year of life, hydrocephalic syndrome is formed - an increase in the volume of the head, a lag in physical and intellectual development, up to severe mental retardation. With a mild degree of the disease, partial restoration of functions is possible, and with timely surgical intervention, hydrocephalus becomes curable. If the genesis of the disease is caused by intrauterine causes, the death of a small hydrocephalus is possible during childbirth or during the first year of life.

Characteristic signs of pathology in children are a disproportionately large head and sunken eyeballs. The fontanel does not pulsate and protrudes above the surface of the skull (hernia of the fontanel). The baby constantly cries or, on the contrary, is lethargic and does not show emotions.

It is worth mentioning separately about one more form of the disease – vicarious. Another name for it is replacement. It develops mainly in older people. The essence of the disease is that the primary processes are atrophic processes in the nervous tissue, which increases the volume of the formation in which the cerebrospinal fluid collects. ICP does not increase, so this type of disease is called normotensive. It is practically incurable in itself, since it is a consequence, not a cause.

Diagnostics

The presence of hydrocephalus in adults is determined by a neurologist or neurosurgeon, in children - by a pediatric neurologist, and if there are obvious signs of changes in the shape of the skull - by a pediatrician. The doctor begins the diagnosis with an examination, which reveals certain disorders, pathologies of perception (vision, hearing), swelling of the veins on the head, and in young children - an increase in the size of the skull, sunken eyeballs. If acquired hydrocephalus is suspected in adults, medical history becomes important: injuries, inflammatory diseases, etc.

But the first place in the diagnosis of dropsy belongs to instrumental methods. The most informative is MSCT (multispiral computed tomography). It allows you to see dilated ventricles or subarachnoid cisterns, as well as tumors, if they are the cause of the disease. The same method makes it possible to distinguish between closed and open forms of pathology.

Echoencephalography (ultrasound of the brain) clarifies the condition of the blood vessels and the possible risk of complications on their part. The method is very important if the doctor assumes that the cause of dropsy is a hemorrhagic stroke. In newborns, a similar examination is used - ultrasonography, which can detect hydrocephalus due to genetic causes or trauma during childbirth.

To determine the consequences of the disease, ophthalmoscopy is used (increased ICP can cause glaucoma), lumbar puncture (shows the composition and pressure of the cerebrospinal fluid), determining the neurological status of the patient and identifying mental disorders, if any.

Differential diagnosis in adults is carried out with other pathologies of the nervous system that cause degenerative processes in the brain - dementia, Alzheimer's disease, tumors that do not interfere with the outflow of cerebrospinal fluid.

An early way to detect congenital disorders is to determine in utero the size and shape of the transparent septum of the brain. This structure consists of two plates of brain tissue and a small cavity between them. Normally it contains liquor. Thickening and formation of a cyst of the septum pellucidum is a fairly common occurrence that easily resolves after birth. A much more dangerous sign is a partial or complete absence of structure, which leads to significant pathologies of the brain.

Surgery

Surgery is the most effective way to get rid of dropsy. Several types of intervention are used for treatment:

• removal of the cause of the disease in a closed form(thrombus, tumor, septum);
• shunting with communicating(open) or hypersecretory form, if it is impossible to eliminate the cause of the pathology;
• combined operations for mixed type.

In most cases, the doctor decides to bypass the affected ventricle of the brain. The essence of the operation is that the patient is implanted with a tube (shunt), which drains excess fluid from the source of the disease. The free end of the implant is directed into the abdominal cavity, less often into the atrium. Artificial communication allows you to get rid of unnecessary cerebrospinal fluid and remove it to a place where absorption into the blood is not impaired. The result is the restoration of normal liquor circulation and the cessation of its accumulation in the cranial cavity. If the operation is performed on a child, the shunt is installed “for growth” and is replaced every few years. To prevent reverse flow of liquid due to the pressure difference, it is equipped with a valve, the design of which allows the movement of the cerebrospinal fluid only in the desired direction.

If the disease can be cured, the causative factors are eliminated: blood clots and blood clots, tumors, adhesions. Such operations can prolong the patient's life. If the measures taken are not enough and the fluid continues to accumulate, an additional shunt may be performed.

There are a number of contraindications to the operation:

• active inflammatory process in nervous tissue– encephalitis, meningitis, ventriculitis;
• stable or regressing form of dropsy;
• irreversible consequences of the disease– blindness, neurological disorders, atrophy of the cerebral hemispheres;
• exhaustion, severe pathologies of the heart, blood vessels, respiratory system.

To reduce the risk, endoscopic operations are widely used: installation and revision of a shunt, removal of hematomas and small tumors, destruction of adhesions and septa. This is relevant for monoventricular pathology; in more severe cases, techniques with craniotomy are used.

Rehabilitation and drug treatment

Medicines are prescribed for stable or regressive forms of the disease, for contraindications to surgery or during the recovery period after it. The choice of drugs depends on the patient’s condition and the severity of the disease.

To improve the outflow of fluid, Mannitol or Diacarb is used, they remove it into the bloodstream. In addition to medications, diuretics of the thiazide group are taken, for example, Furosemide. It prevents the increase in blood pressure while taking potassium-sparing diuretics.

To improve the nutrition of nervous tissue and its blood supply, Detralex, Glycine and Piracetam are prescribed. Anticonvulsants, anti-inflammatory and sedative medications can be used as symptomatic drugs. In the early stages, treatment at home is possible, but if the disease progresses, it is necessary to go to the hospital. The doctor will decide whether a course of medications is enough or surgical intervention is necessary.

Rehabilitation measures help the patient live with the consequences of the disease or shunt after surgery. He needs to limit physical activity and follow a diet with strict control of fluid and salt. You should also be regularly examined by a neurologist and attend treatment procedures.

Modern medicine does not deny the use of some unconventional methods of treatment. The most effective among them is hirudotherapy: leeches reduce blood and intracranial pressure. The use of various herbs to improve well-being is permissible only with the consent of the attending physician. The effectiveness of homeopathy and similar remedies has not been proven in clinical trials.

Complications and prognosis

Why is hydrocephalus dangerous? The prognosis of the disease should be considered separately for children and adults. Congenital forms caused by pathology of intrauterine development are considered the most severe. Most often, young patients are born with irreversible damage to the nervous tissue, which leads to death or severe mental impairment.

Children who were injured during childbirth or in the first year of life have a much better chance of correcting the situation if treatment is started on time. If not, there is a high risk of disability. In the presence of a shunt, the baby develops normally, due to the plasticity of the nervous system, brain functions are quickly restored, but regular examinations and replacement of the implant are required as the child grows.

In adults, the prognosis depends on the form of the disease. Acute hydrocephalus can go away without consequences if it is treated promptly. The chronic form can be treated with medication or surgery and requires long-term rehabilitation. The most difficult thing is with the replacement type, when hydrocephalus is only a consequence of the underlying disease, so it is useless to fight it.

The most dangerous complications of dropsy of the brain:

• oligophrenia in children;
• paralysis, paresis of limbs;
• epileptic seizures;
• mental disorders;
• glaucoma and blindness.

The prognosis for work ability depends on the result of medical procedures. With successful treatment, adult patients can return to work, and children can return to study and play. The only limitation is physical activity: patients should exercise with caution and stop exercising if discomfort occurs.

Untimely or ineffective treatment leads to loss of ability to work. The cost of rehabilitation measures is quite high, despite the benefits provided. In the most severe cases, death is possible. Young men of military age who have a shunt installed are not considered fit for military service.

Conclusion

Dropsy of the brain is a serious disease that requires early surgical intervention. Surgery is the most reliable way to recover and avoid complications; medications, and especially folk remedies, can only be used as additional and supportive measures.

The cost of rehabilitation measures, medications and surgery may be high, but it is fully justified, allowing the patient to maintain a quality of life close to the previous one. Timely measures taken can save his health.