Hydrocephalus of the brain in an adult
This neurological pathology is based on an excessive accumulation of cerebrospinal fluid (CSF) in various parts of the brain. Hydrocephalus in adults is often diagnosed as a complication of traumatic brain injury, a consequence of a brain tumor, stroke, neuroinfection, meningitis. In addition, hydrocephalus can be congenital or develop as a result of age-related changes.
The clinical picture of the disease depends on the causes of its occurrence and the form that the pathology takes:
- Hypersecretory hydrocephalus - the pathology is based on a violation of the production of cerebrospinal fluid, leading to the expansion of the ventricles;
- Dysresorptive and non-resorptive hydrocephalus - the cause is a violation of the absorption of cerebrospinal fluid;
- Proximal and distal forms of occlusive hydrocephalus - the cause of the development of the disease is a violation of the circulation of cerebrospinal fluid.
The treatment of hydrocephalus of the brain of an adult is carried out by specialists practicing in such fields of medicine as neurology and neurosurgery. More recently, it was traditionally believed that hydrocephalus is a pediatric problem, because it is most often diagnosed as a congenital pathology. According to medical statistics, there are from one to ten newborns with a similar diagnosis per thousand infants at the age of 1 month.
Until now, very little attention has been paid to the diagnosis and treatment of the pathology of the same name in adults, if we do not take into account the activities of specialized clinics and hospitals. That is why, to this day, there are no definite standards for diagnosing hydrocephalus in adults, although in most cases the results of echoencephalography and rheoencephalography would be sufficient for the diagnosis.
The consequence of incorrect diagnosis is the treatment of hydrocephalus after injuries and strokes, as diseases and conditions with similar symptoms:
- Psychoorganic symptom;
- Dementia of mixed origin;
- Consequences of a stroke, brain injury;
- Post-traumatic and discirculatory encephalopathy.
Patients with hydrocephalus are treated for a long time in psychiatric clinics and neurological hospitals with a negative result and minimal dynamics, although a correctly conducted examination in a specialized department reveals hydrocephalic syndrome in 25% of adult patients.
These people can be helped to return to work, to avoid disability, to be able to serve themselves without assistance. Almost 100% of adult patients suffering from hydrocephalus are able to achieve recovery after surgical treatment.
Modern methods of emergency surgical care, carried out in the first two days, will help to avoid a negative outcome of the disease as a result of an acute form of hydrocephalus, which arose due to subarachnoid hemorrhage. Bypass surgery and the introduction of thrombolytics into the structures of the brain stabilizes the patient's condition and will give a chance for a full recovery.
- Hydrocephalus causes
- Classification of hydrocephalus in adults
- Symptoms of cerebral hydrocephalus
- Diagnostics of the hydrocephalus
- Hydrocephalus treatment
Hydrocephalus can result from many neurological pathologies, disorders of the central nervous system.
Common causes of the onset of the disease:
- Acute disorders of cerebral circulation, as a result of hemorrhagic or ischemic stroke;
- Encephalopathy resulting from trauma, alcoholism, hypoxia, toxic damage;
- Malignant tumors localized inside the ventricles, in the brain stem;
- Neuroinfection, inflammatory diseases of the central nervous system (tuberculosis, encephalitis, meningitis, ventriculitis);
- Rupture of an aneurysm or arteriovenous vessels of the brain;
- Traumatic lesion causing intraventricular and subarachnoid bleeding.
Classification of hydrocephalus in adults
Type of hydrocephalus
By the level of cerebrospinal fluid pressure
By the rate of flow
Adult hydrocephalus is an acquired form of the disease. On the basis of pathogenesis, it is divided into 3 types. Several years ago, the classification list included mixed external hydrocephalus, which occurs with progressive brain atrophy due to ventricular hypertrophy.
At the moment, this item has been removed from the classification, since its cause is not a violation of the circulation of cerebrospinal fluid, but a decrease in the mass of brain tissues, their atrophy.
Symptoms of cerebral hydrocephalus
There are acute and chronic forms of the disease.
Symptoms of the acute form of occlusive hydrocephalus manifest themselves as signs of increased intracranial pressure:
Headache - most acutely manifested in the first half of the day, since intracranial pressure often rises during a night's sleep;
Nausea and vomiting - most often observed in the morning, often after vomiting, the patient feels a decrease in the intensity of the pain syndrome;
Drowsiness is a negative symptom of intracranial pressure, indicating the approach of deterioration.
Axial dislocation of the brain is another manifestation of hydrocephalus. As a result, the dislocation of the brain tissue is displaced in relation to its solid substances. In this case, the space inside the cranium is divided and limited. In this state, the brain is displaced along an axis passing through a large opening in the occiput and through the opening of the tentorium of the cerebellum.
- Decreased vision (may be persistent or transient), oculomotor disorders are diagnosed;
- Severe headaches;
- Nausea and repeated vomiting;
- Rapid depression of consciousness, leading to a coma;
- The patient's desire to take a forced position.
With compression of the medulla oblongata, the patient suffers from depression of respiratory and cardiovascular activity, leading to death. Stagnation of the optic discs leads to visual impairment due to increased intracranial pressure.
The symptoms of this form of the disease are different from the picture of the acute form of acquired hydrocephalus.
Dementia - occurs 2-3 weeks after neuroinfection or injury, manifested by the following symptoms:
- During the day, the patient mainly sleeps, at night he experiences insomnia;
- Short-term memory is impaired, especially for numbers - the patient forgets his age, month, day of the week, ordinary numbers;
- In the later stages of the disease, the patient is not able to answer questions, or his answers are monosyllabic, he selects words for a long time, that is, there are pronounced mnestic-intellectual disorders;
- The patient is unable to perform the simplest self-care actions.
Apraxia of walking - theoretically, the patient knows how to walk, ride a bicycle, and in a prone position easily shows these movements, but in practice he cannot walk, shuffles his legs, sways when walking, spreads his legs wide when trying to continue walking.
Urinary incontinence - a symptom manifests itself in some patients in the later stages of the process.
The fundus of the eye in this disease remains unchanged.
Diagnostics of the hydrocephalus
- Angiography, or X-ray of blood vessels - changes in the blood vessels of the brain are detected after examination against the background of the introduction of a contrast agent into the bloodstream.
- CT, or computed tomography - determines the contours of the cranium, ventricles of the brain, the shape and size of its structures, the presence or absence of cysts and tumors.
MRI, or magnetic resonance imaging - helps to determine the type and shape of dropsy in the brain, the cause.
- X-ray of the cisterns of the base of the skull, or cisternography - helps to determine the direction of movement of the cerebrospinal fluid, to clarify the form of hydrocephalus.
- EEC, or echoencephalography.
- Neuropsychological examination is effective for collecting anamnesis, identifying complaints and symptoms of brain pathology.
- Retiki - Glimarite, urea, Manit;
- Loop diuretics - Furosemide, ethacrynic acid;
- Saluretics - Diacarb, Acetazolamide;
- Plasma substitutes - albumin solution 20%;
- Venotonics - Glivenol, Troxevasin;
- Vasoactive agents - solution of magnesium sulfate 25%;
- Glucocorticosteroids - Prednisolone, Betamethasone, Dexamethasone, Methylprednisolone;
- Barbiturates - Amital, Phenobarbital, Nembutal.
With a pronounced clinical picture of hydrocephalus in adults, drug treatment is ineffective. If the disease has arisen as a result of intraventricular hemorrhage, in order to avoid death, an immediate neurosurgical operation is required.
The modern level of neuroendoscopic surgery in countries with a high level of development of medicine makes it possible to treat hydrocephalus in the shortest possible time using low-traumatic methods. In Russia, such a level is still achievable only in the central regions, where specialized clinics have high-tech equipment and doctors of appropriate qualifications work.
The surgical treatment of hydrocephalus in adults is based on the introduction into the cerebral canal of a special instrument with a miniature camera at the end. Thanks to the neuroendoscope, the surgeon can monitor the progress of the operation on a large screen. At the bottom of the third ventricle, using a catheter, an artificial canal is created between this cavity and the extracerebral cisterns. An excessive amount of cerebrospinal fluid flows into the hole, increasing intracranial pressure, and the risk of death is reduced to almost zero.
- Ventriculoperitoneal - excess cerebrospinal fluid is excreted into the abdominal cavity;
- Ventriculo-arterial - the ventricles of the brain are connected to the right atrium and to the superior vena cava;
- Ventriculo-cisternostomy - cerebrospinal fluid is excreted into the occipital cistern;
- Atypical shunting - CSF is directed to other body cavities.
The duration of such an operation is 1.5-2 hours, the period of rehabilitation within the walls of the hospital lasts 2-3 days. A shunt made of inert and safe silicone is installed in the brain. With the formation of an excessive amount of cerebrospinal fluid and an increase in intracranial pressure, the shunt helps to remove fluid in the patient's body cavity.
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".