Symptoms and treatment of dropsy of the brain
Dropsy of the brain, or hydrocephalus, is a consequence of excess cerebrospinal fluid in the ventricles of the brain and the spaces between the meninges. Pathology can develop after injuries and some diseases. The brain cavities expand, putting pressure on the surrounding tissues, causing neurological disruptions.
With hydrocephalus, the balance between the formation of cerebrospinal fluid and its reabsorption into the bloodstream is disturbed. As a result, the volume of cerebrospinal fluid significantly exceeds the reserve capacity of the brain cavities (cisterns, ventricles, subarachnoid fissures). Normally, the constant renewal of cerebrospinal fluid allows you to get rid of toxic metabolic products.
CSF is responsible for the amortization of the brain during blows to the head and sudden movements, its circulation provides the cells of the cerebral cortex with nutrition. In case of imbalance between the incoming and absorbed cerebral fluid, it presses on the walls of the internal cavities of the brain, in some cases causing irreversible damage.
All kinds of damage to the brain and meninges can become the cause of hydrocephalus. In most cases, it occurs as a complication of infectious diseases (meningitis, meningoencephalitis) or previous traumatic brain injury. Dropsy can be associated with a difficulty in the return flow of blood from the cranial cavities, a similar violation is usually caused by the pathology of the venous vessels, the formation of blood clots in the sinuses, cicatricial and adhesions in the cavity of the discharge veins. Tumors, high blood pressure, kidney disease, and brain parasites can also cause dropsy in the brain. In some cases, hydrocephalus is associated with underdevelopment of the brain, overgrowth of a cerebral or spinal hernia.
- Classification of hydrocephalus
- Causes of the appearance of dropsy of the brain
- Symptoms of dropsy of the brain
- Diagnostics of the hydrocephalus
- Treatment of dropsy of the brain
Classification of hydrocephalus
The division of dropsy of the brain into categories is carried out on several grounds.
Depending on the etiology of the disease:
Closed, or non - communicating - the outflow of cerebrospinal fluid is disrupted due to the fact that the pathways of its transportation into the bloodstream are blocked due to the formation of a tumor, cyst, clogging of the holes of Magendie and Luschka, narrowing of the aqueduct of the brain or the occurrence of a blood clot. An increase in cranial pressure leads to infringement and compression of the brain structures.
Open, or communicating - the physiology of the absorption of cerebral fluid into the systemic circulation is disturbed, this process occurs very slowly due to inflammation of the meninges, cysticercosis, sarcoidosis, cerebral hemorrhage, metastases. Stable high cranial pressure gradually destroys the medulla.
Hypersecretory form - an excess of cerebrospinal fluid is produced.
Classification of dropsy of the brain by etiology:
Congenital hydrocephalus - is formed during intrauterine development due to infection of the fetus, genetic diseases, birth trauma, hemorrhage in the fetal brain. This type of pathology is not compensated for in all patients in childhood and sometimes passes into an adult state.
Acquired hydrocephalus - occurs against the background of craniocerebral infections, brain trauma, cysts and tumors.
Replacement hydrocephalus - occurs against the background of cerebral atrophy due to age-related changes, encephalopathy.
Types of dropsy, depending on the nature of the course of the disease:
- Acute form - develops within a few days, the patient's condition quickly becomes extremely difficult;
- Chronic form - develops over several months or six months with a gradual increase in intracranial pressure and worsening of symptoms.
Classification of the disease depending on the location of excess cerebrospinal fluid:
- External form - cerebral fluid accumulates in the subarachnoid space under the meninges without expansion of the ventricles, occurs with brain atrophy;
- Internal form - cerebrospinal fluid accumulates in the cisterns and ventricles of the brain;
- Mixed form - cerebral fluid accumulates in all cavities of the brain.
Classification of dropsy of the brain, depending on the severity of violations of its structures:
- Compensated - an excess of cerebrospinal fluid does not squeeze the brain structures, there are no pronounced symptoms, the patient's state of health is normal;
- Decompensated - due to compression of brain tissue, a variety of neurological symptoms, disorders of the central nervous system are diagnosed.
Causes of the appearance of dropsy of the brain
If we exclude the congenital form of hydrocephalus of an adult, which appeared in him in early childhood due to intrauterine infection, birth trauma or congenital pathologies, the following reasons for the development of dropsy can be distinguished:
- Hemorrhage due to rupture of an aortic aneurysm, breakthrough of a hematoma under the meninges or into the ventricles;
- Traumatic brain injury;
- Inflammation of the brain structures due to complications of neuroinfections and systemic pathologies (meningitis, neurosyphilis, sarcoidosis, encephalitis);
- Helminthiasis (cysticercosis, echinococcosis);
- Benign and malignant brain tumors;
- Brain metastases;
- Ventricular cysts;
- Vascular encephalopathy as a consequence of diabetes, atherosclerosis, hypertension;
- Toxic encephalopathy resulting from poisoning with substances toxic to the central nervous system.
Symptoms of dropsy of the brain
Symptoms of an acute form of hydrocephalus:
- Severe headaches without a specific localization, most pronounced in the morning;
- Nausea and vomiting, most felt in the morning;
- Persistent hiccups;
- Weakness, constant fatigue;
- Tachycardia (over 120 beats per minute) or bradycardia (less often 50 beats per minute);
- Lethargy, indicating an increase in cranial pressure;
- Confused consciousness;
- Violation of oculomotor movements, maintaining a forced head posture.
Symptoms of the chronic form of dropsy of the brain:
- Lethargy, passivity, indifference to what is happening;
- Impaired cognitive functions, memory, ability to count;
- Disruptions in sleep and rest mode;
- Depression of speech function and intellectual abilities;
- Violation of the walking process, when the patient in the prone position imitates the movements of the legs when walking, but in the standing position is not capable of coordinated movements;
- Restlessness, nervousness, inability to concentrate;
- Excessive sweating;
- Involuntary urination - appears in the later stages of the development of the disease.
When the brain is compressed, such visual impairments appear as double vision, loss of visual fields, dilation of the pupil with no response to light, atrophy of the optic nerve up to blindness, decreased visual acuity, strabismus.
Children who suffer from congenital hydrocephalus or become ill in early childhood are lagging behind in development and are inactive. They have a violation of the basic metabolic processes: water, carbohydrate and fat. Changes in fat metabolism can cause general obesity. Against the background of the disease, exhaustion can also occur, a characteristic shape of the head can form: it increases in size and becomes like a ball, the forehead is large and overhanging, the orbits of the eyes are deeply set, the eyes are half-closed.
The skin on the patient's head is thinned, with a translucent network of venous vessels. The fontanelles increase in size during the disease, bulge out and tense, the bones become thinner, the sutures connecting the bones of the skull may diverge. The disease is accompanied by neurological symptoms - these are paralysis, paresis of individual limbs, weakening of reflexes and muscle tone, there may be impaired coordination of movements, statics, and a change in gait. Among the symptoms of dropsy of the brain, there is also a decrease in visual acuity, in some cases, complete blindness can be observed.
Cerebral edema is often manifested by mental disorders, which can be conditionally divided into states associated with intellectual disability and personality disorders. Intellectual disability can manifest itself in the form of a reversible mild form of mental retardation, or it can be aggravated by oligophrenia, which is characterized by varying degrees of mental retardation. In most cases, euphoria prevails, which is quickly replaced by apathy. Among the clinical manifestations, symptoms characteristic of high intracranial pressure are noted: headache, vomiting, attacks of nausea.
In addition to collecting anamnesis, when making a diagnosis, additional examination methods are used to establish the form, stage, etiology and severity of the symptoms of the disease. For these purposes, oscillography, echoencephalography, ventriculography, angiography are used.
Diagnostics of the hydrocephalus
The doctor determines the diagnosis of "hydrocephalus" based on the collected history and the existing clinical picture of pathology.
Instrumental diagnostic methods:
- Magnetic resonance imaging - diagnoses a disease with a high degree of probability, determines its causes, reveals damage to the structure of the brain. The criteria for dropsy are periventricular edema, the value of the interventricular index is more than 0.5.
X-ray of the cisterns of the base of the skull - determines the pathways of resorption of cerebrospinal fluid, helps to establish the form of hydrocephalus.
- Computed tomography - determines the contours of the brain and its cavities, diagnoses neoplasms in the structures of the brain.
- Examination of the fundus - puffiness of the optic discs indicates an increase in cranial pressure.
Treatment of dropsy of the brain
Treatment of dropsy of the brain can be conservative, in some cases - surgical. The goal of therapy is to reduce intracranial pressure (Lasix, Furosemide, Fonurit, Mannit, Diacarb, other diuretics) and stabilize indicators. As part of conservative treatment, restorative procedures are carried out, for example, salt-pine baths, drugs to reduce body temperature and anti-inflammatory drugs are prescribed, dehydration and desensitizing therapy is carried out.
Mental disorders are treated in combination with the above conservative methods. With pronounced affective-volitional disorders and with individual episodes of psychosis, psychotropic drugs are prescribed. If conservative methods of treatment are ineffective, then surgical intervention is indicated.
An operation performed on patients with hydrocephalus caused by trauma or inflammation can help the patient completely get rid of all the symptoms of the disease.
Bypass surgery. Silicone catheters equipped with special valves are inserted into the brain cavity. They contribute to the removal of excess cerebrospinal fluid into the abdominal cavity. Contraindications to bypass surgery are vision pathologies, chronic hydrocephalus.
The operation helps to restore the quality of life, to maintain the cerebrospinal fluid pressure at an optimal level. A complication of shunting can be infection of the tube, the need for its urgent replacement due to loss of properties. Bypass surgery takes 1.5 hours and is performed under general anesthesia.
Types of bypass surgery for the removal of cerebral fluid:
- Ventriculoperitoneal shunt - between the brain and the peritoneum;
- Ventriculoatrial shunt - between the brain and heart;
- Ventriculovenous shunt - between the brain and veins;
- Ventriculopleural shunt - between the brain and lungs;
- Ventriculo-urethral shunt - between the brain and the urethra.
Endoscopy. This method of treating dropsy of the brain requires special equipment in the clinic and a high classification of the neurosurgeon. Endoscopy is a modern and safe way to eliminate excess cerebral fluid by inserting a neuroendoscope into the channels of the brain structures.
Under the control of a miniature video camera, the doctor makes a hole with a special catheter to remove the cerebrospinal fluid along a previously prepared path. The effectiveness of the method allows you to achieve success in just one procedure. Endoscopic intervention is not always possible, it has contraindications.
Patients who have undergone surgery for the treatment of hydrocephalus should be monitored by a surgeon and a neurologist for a long time, timely replace the shunt, and take antibacterial drugs to prevent infection.
It is not easy to predict the development of hydrocephalus. With timely treatment started, there is a chance to avoid disability and intellectual impairment. If the entire complex of therapeutic measures is not carried out in time, the likelihood of symptoms of CNS pathology, psychoemotional and cognitive impairments is high.
The development of dropsy of the brain, especially if the disease is congenital, can stop at any stage, however, complete healing never occurs. The prognosis is favorable only if treatment is started in a timely manner. If it is delayed with therapy, then the accumulation of fluid in the brain will lead to irreversible changes and some brain functions will be impaired. The success of the surgical intervention depends on the time of its implementation, the severity of the disease, as well as on the correct accounting of all indications and contraindications for surgical intervention.
Author of the article: Sokov Andrey Vladimirovich | Neurologist
Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".