External Hydrocephalus - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

External hydrocephalus of the brain

With the external form of hydrocephalus, an excessive formation of cerebrospinal fluid occurs, which normally circulates in the structures of the brain and spinal cord and protects it from mechanical damage. In addition, the cerebrospinal fluid supplies the brain with food and removes metabolic products into the blood. As a result of pathological pressure, the brain tissue atrophies, negative symptoms arise, and with complications the risk of coma and death increases.

Content:

• Classification of forms of the disease
• External hydrocephalus symptoms
• Causes of the disease
• Diagnostics of the external hydrocephalus
• Possible treatment options for external hydrocephalus

Classification of forms of the disease

External hydrocephalus is a form of dropsy of the brain, which consists in excessive accumulation of cerebrospinal fluid (CSF) in the subarachnoid and subdural space of the brain. The subarachnoid cavity is located between the soft and arachnoid membranes of the brain and spinal cord. A narrow slit subdural cavity is located between the hard and the arachnoid membrane of the brain. It is permeated with connective tissue fibers.

Types of external hydrocephalus:

• Open form - communication of cerebrospinal fluid circulation pathways is not disturbed, changes affect the mechanism of cerebrospinal fluid absorption;
• Closed form - there is no communication between the spaces in which the cerebrospinal fluid is concentrated and the ways of its circulation;
• Hypersecretory form - the production of cerebrospinal fluid is excessive;
• External substitutional form - the medulla (parenchyma) is transformed, undergoing atrophy, and cerebrospinal fluid takes its place.

Classification of external hydrocephalus by the rate of flow:

• Acute - no more than 3 days pass from the first signs to the initial decompensation;
• Subacute - lasts for a month;
• Chronic - lasts from 3 weeks to six months or more.

According to the level of cerebrospinal fluid pressure, it is divided into hypotensive, hypertensive and normotensive forms. The latent course of the disease, lasting long enough with normal intracranial pressure, is the most dangerous, since the symptoms of pathology can grow suddenly and like an avalanche without any visible prerequisites. Most often, this situation occurs with external replacement hydrocephalus.

Distinguish between congenital and external forms of dropsy of the brain. The congenital form occurs during intrauterine development, acquired hydrocephalus - as a result of injury or inflammation of the brain structures.

External hydrocephalus symptoms

The human body has impressive compensatory abilities. A mild form of external hydrocephalus can pass almost unnoticed for the patient - the circulation of cerebrospinal fluid is restored on its own. The prognosis of such a disease is the most optimistic, and its consequences are minimal.

An increase in intracranial pressure leads to the following symptoms:

• Headache that worsens after a long stay in a horizontal position;
• Nausea and vomiting;
• Drowsiness;
• Visual impairment (double vision);
• Increased fatigue;
• Weakness.

All these manifestations are a consequence of a decrease in the density of cerebral structures due to the fact that they are saturated with cerebrospinal fluid, narrowing of the subarachnoid and subdural spaces, and improper resorption of cerebrospinal fluid. When the cerebral parenchyma is replaced with CSF, the symptoms of the disease are aggravated.

Symptoms of external replacement hydrocephalus:

• Violation of gross and fine motor skills;
• Uncertain wobbly gait;
• Involuntary urination and fecal incontinence;
• Disorders of intellectual activity, memory, attention;
• Signs of dementia.

If external hydrocephalus is diagnosed in an infant, the following symptoms occur:

• Divergence of seams between the bones of the skull;
• Swelling of fontanelles;
• Enlargement of the frontal part of the skull;
• Lack of appetite;
• Swelling of the veins on the skull, clearly visible under the thin, taut skin in the form of a venous mesh;
• Excessive increase in the circumference of the child's head.

Causes of the disease

Any disturbance in the normal functioning of the brain structures can lead to the development of the disease.

External hydrocephalus causes:

• Brain trauma;
• Consequences of injuries and fractures of the spine;
• Tumors of any etiology;
• Stroke, hematoma, cerebral hemorrhage;
• The consequences of inflammatory processes or neuroinfections (meningitis, meningoencephalitis, tuberculosis, herpes, toxoplasmosis);
• Pathology of the cervical vertebrae;
• Diseases of the circulatory system;
• Age-related changes in brain structures;
• Congenital anatomical changes in the central nervous system.

Diagnostics of the external hydrocephalus

The most informative diagnostic method is magnetic resonance imaging, or MRI. A little less information can be obtained from CT, or computed tomography.

What can be seen during an MRI scan:

• Contours of the skull, ventricles, subarachnoid space, brain;
• The presence of abnormalities - cysts, tumors, hematomas, aneurysms;
• The shape and size of the ventricles.

In addition to tomographic diagnostic methods, the following studies are prescribed:

• X-ray of the cisterns of the base of the skull - allows you to clarify the type of hydrocephalus, pkti circulation of cerebrospinal fluid;
• Angiography, or X-ray of blood vessels - diagnoses pathologies of the blood supply to the brain;
• A blood test for the presence of antibodies to possible infectious agents that have influenced the development of the disease.

In addition to prescribing instrumental methods, the doctor conducts a neuropsychological examination, which makes it possible to clarify the symptoms of the disease, the time of their appearance.

Possible treatment options for external hydrocephalus

If the diagnosis of the disease has revealed a moderate degree of external hydrocephalus, the neurologist determines the drug treatment regimen. The goal of therapy is to restore the functioning of the cerebral vessels and the activity of the central nervous system.

The patient takes diuretics (Diacarb) in combination with drugs that compensate for the excessive removal of potassium and magnesium from the body, vitamin complexes, nootropics, vasodilators.

Additional treatments:

• Manual therapy;
• Special diet and diet;
• Salt-pine baths
• Physiotherapy.

If within 2-3 months there is no improvement in indicators, or the patient's condition worsens, surgical treatment is performed.

Surgical methods:

• Bypass surgery to remove excess cerebrospinal fluid
• Endoscopic surgery to create additional pathways for the outflow of cerebrospinal fluid into the cisterns of the brain, designed for the absorption of this fluid in a natural way.

The result of these operations is the restoration of normal circulation of cerebrospinal fluid, an improvement in the patient's quality of life, in some cases - full compensation of the condition.

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".