Internal Hydrocephalus - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Internal hydrocephalus

Hydrocephalus, or dropsy of the brain, is a pathology of the central nervous system, provoked by a violation of the formation, circulation and absorption of cerebrospinal fluid. Another name for the pathology, dropsy of the brain, is not entirely accurate, since the cerebrospinal fluid, or cerebrospinal fluid, is not water, but the production of the choroid plexus of the ventricles. It washes the brain and spinal cord, filling not only the ventricles, but also the subarachnoid and subdural spaces.

Cerebrospinal fluid transports hormones, biologically active and nutrients, protects the brain from possible physical influences, and removes metabolic waste. In addition, the cerebrospinal fluid stabilizes intracranial pressure, provides nutrition to the brain and its homeostasis, and protection against pathogenic microorganisms. Therefore, any pathological changes in the cerebrospinal fluid negatively affect the functioning of the central nervous system.

Content:

• Classification
• Internal hydrocephalus causes
• Symptoms of internal hydrocephalus
• Diagnosis
• Internal hydrocephalus treatment methods

Classification

Internal hydrocephalus is an accumulation of cerebrospinal fluid in the ventricles of the brain, excluding the subarachnoid space. Almost 90% of patients with a similar diagnosis are children born with this pathology, who received it during intrauterine development. In adults, internal hydrocephalus occurs several times less frequently.

Forms of internal hydrocephalus, depending on the cause of its appearance:

• Communicating or open - develops as a result of impaired absorption of cerebrospinal fluid or its hypersecretion;
• Occlusive, or closed - develops if the pathways of circulation of the cerebrospinal fluid are blocked by adhesions, a tumor, changes that have occurred as a result of the inflammatory process.

The prognosis of the course of the closed form is often unfavorable, it depends on how operable such changes are.

Forms of the disease, depending on the time of its course and the severity of symptoms:

• Acute - fixed in the first few days of the course of hydrocephalus, rapidly progressing;
• Subacute - severe symptoms are diagnosed during the first month of the disease;
• Chronic - the disease enters this phase for 6-10 months or more.

The moderate form of the disease practically does not manifest itself with significant symptoms, and is accidentally detected during examination of brain structures for other reasons. Sometimes it is found when cerebrovascular accidents and functional changes in the brain parenchyma are already irreversible.

Types of the disease depending on the dynamics of its development:

• Progressive hydrocephalus - symptoms are actively increasing, the volume of cerebrospinal fluid is rapidly increasing;
• Stabilizing, or passive hydrocephalus - disease progression does not occur;
• Regressive hydrocephalus - spontaneous healing occurs.

When diagnosed, internal hydrocephalus is defined in one of three stages:

• Compensated stage - no treatment is prescribed, recovery occurs spontaneously.
• Subcompensated stage - some of the symptoms do not disappear without drug treatment.
• Decompensated stage - the negative impact of pathology on the functioning of the brain is so significant that surgical treatment is required.

Depending on the severity of intracranial pressure, there are:

• Hypertensive form - with increased ICP;
• Normotensive form - the level of pressure is normal;
• The hypotensive form - with reduced ICP.

Internal hydrocephalus causes

It is necessary to distinguish between congenital and acquired factors that contribute to the development of the disease in newborns, in older children, and in adults.

Causes of the congenital form of the disease:

• Infections transferred by a pregnant woman in the early stages of fetal development (rubella, mumps, herpes, cytomegalovirus, syphilis, influenza, respiratory infection);
• Genetically determined pathologies;
• Disorders of the fetal brain anatomy due to intoxication (smoking a pregnant woman, drinking alcohol);
• Metabolic disorders due to hepatic or renal failure of the fetus;
• Oxygen starvation of the fetus, pathology of its circulatory system;
• Fetal brain injury.

Causes of the disease that arose in early childhood:

• Birth injury;
• Hypoxia during labor;
• Neuroinfection (meningitis, encephalitis);
• Hemorrhage in the ventricles of the brain;
• Vascular disorders;
• Brain tumors of any etiology;
• Genetic diseases, one of the symptoms of which is external hydrocephalus.

Causes of the disease in adults:

• Traumatic brain injury, complicated by cerebral hemorrhage;
• Consequence of stroke, aortic aneurysm;
• Malignant brain tumor;
• Complications of neuroinfections;
• Diabetes;
• Alcoholism;
• Addiction;
• Violation of cerebral circulation as a result of a stroke.

Symptoms of internal hydrocephalus

The manifestations of the disease in children under one year old are due to the fact that the bones of the skull are still mobile, and the seams between them are not completely ossified, the fontanelles are not tightened.

Symptoms of internal hydrocephalus in infants:

• Pronounced venous network under the thin skin of the skull;
• Refusal to suck, due to painful sensations due to sucking movements and subsequent increase in intracranial pressure;
• Vomiting;
• Lag in weight gain;
• Excessive increase in head circumference;
• Moodiness, restless behavior;
• Gref's syndrome, or “setting sun” syndrome, when the sclera of the eye is visible above its iris;
• Delay in psychomotor development (the ability to crawl, sit, walk);
• Drowsiness;
• Convulsions.

Symptoms of internal hydrocephalus in preschool and primary school children:

• Irritability;
• Sleep and appetite disorders;
• Impaired cognitive functions (intelligence, memory, attention);
• Headaches, often occurring in the morning;
• Disorders of gross and fine motor skills;
• Visual impairment;
• Problems in school.

Children suffering from internal hydrocephalus do not always have pathologies of intellectual activity. They can have excellent musical skills, counting, good mechanical memory.

Symptoms of the disease in adults:

• Impaired memory, intelligence, thinking;
• Unsteadiness of gait, incorrect movements due to dysfunction of the vestibular apparatus;
• Headache that is not relieved by pain medication;
• Deterioration of vision, pressure on the eye sockets from the inside;
• Mental disorders (aggression, emotional instability, apathy, neurasthenia);
• Decreased muscle tone, the development of contractures in the joints).

Some of the symptoms are manifested in elderly patients, and they are mistaken for symptoms of aging, but not disease.

Diagnosis

An experienced pediatric neuropathologist can easily determine the disease in a child by visual signs - the appearance of the pupils, an enlarged skull.

Methods for diagnosing the disease in adults:

• Magnetic resonance imaging is an informative study that allows you to accurately determine the form and features of the pathology;
• Angiography - X-ray of blood vessels using a contrast agent, which allows you to assess violations of the circulatory system of the brain;
• A study of the cerebrospinal fluid, taken as a result of a puncture.

The data obtained from the study underpins the treatment strategy prescribed by the doctor.

Internal hydrocephalus treatment methods

Disease therapy in most cases is carried out in combination, depending on the stage of the disease. At the onset of the disease, medications are prescribed to reduce intracranial pressure and reduce the volume of cerebrospinal fluid in the ventricles of the brain. Most often these are diuretics, vasodilators, vitamin complexes. For the treatment of children, play therapy, physiotherapy exercises, music are used.

If drug therapy does not reduce the intensity of symptoms of internal hydrocephalus, surgical treatment is used. The main method to alleviate the patient's condition is bypass surgery - the installation of a shunt connecting the cavity of the ventricles with the body cavity, into which the cerebrospinal fluid can be withdrawn.

Ways of excretion of cerebrospinal fluid:

• Into the abdominal cavity;
• Into the atrium;
• Into the ureter;
• In a container located outside the patient's body.

There is a more modern, sparing method of treatment - ventriculoperitoneal neuroendoscopic shunting. With the help of miniature surgical instruments and an endoscope camera, a gentle operation is performed to create artificial pathways for the removal of cerebrospinal fluid from the ventricles. Most often, the cerebrospinal fluid is excreted into the occipital cistern of the brain.

To prevent the disease, it is necessary to timely identify pathologies of fetal development, to avoid infections. Small children should be protected from traumatic brain injury and neuroinfection. The same precautions should be taken by adults.

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".