Mixed Hydrocephalus - Causes, Symptoms And Treatment

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

Mixed hydrocephalus

Hydrocephalus is a neurological pathology characterized by the production of excessive amounts of cerebrospinal fluid. This circumstance leads to an increase in cranial pressure and other negative symptoms. Hydrocephalus can be congenital or acquired and is classified for various reasons. Mixed hydrocephalus is one of the rare, but very dangerous types of dropsy of the brain

Content:

• The clinical picture of mixed hydrocephalus
• The causes of mixed hydrocephalus
• Symptoms of mixed hydrocephalus
• How is mixed hydrocephalus diagnosed?
• Treatment of mixed hydrocephalus

The clinical picture of mixed hydrocephalus

The brain is protected from external influences by several membranes. The cavity between them is called the subarachnoid space. Inside the brain there are peculiar cavities - the ventricles in which the cerebrospinal fluid circulates. With the concentration of cerebrospinal fluid in the ventricles, the disease is referred to as the internal form of hydrocephalus; with the accumulation of cerebrospinal fluid in the subarachnoid cavity, external hydrocephalus is diagnosed.

If the cerebrospinal fluid overflows both cavities, the diagnosis is “mixed hydrocephalus”. At the same time, the destruction of brain tissue is observed, the place of which is taken by the cerebrospinal fluid. Its excess compresses the structures of the brain, which is manifested by intellectual impairment, decreased memory capacity, pain syndrome. Most often, such complications appear in old age due to brain atrophy.

Mixed atrophy may appear against the background of alcoholism, the consequences of traumatic brain injury, severe atherosclerosis. In severe cases, during the development of the disease, the patient falls into a coma, he may be fatal, or there may be prerequisites for disability. Lack of muscle control leads to involuntary urination and defecation. The patient loses the ability to self-care, cannot do without outside help.

The causes of mixed hydrocephalus

Hydrocephalus a few years ago was considered a pathology inherent in childhood. Until now, the lion's share of diagnosed cases of mixed hydrocephalus occur in the first half of a child's life, or during the period of intrauterine development.

Causes of the mixed form of hydrocephalus in children:

• Birth injury;
• Pathology of intrauterine development;
• Infection of the fetus, diseases suffered by a pregnant woman;
• Intoxication of the fetus during pregnancy;
• Genetically determined fetal pathologies.

Causes of mixed hydrocephalus in adults:

• Spinal and traumatic brain injuries;
• Consequences of meningitis and neuroinfections;
• Intoxication with alcohol, narcotic drugs;
• Fragility of the cervical spine in old age;
• Arterial hypertension;
• Atherosclerosis.

Mixed hydrocephalus in childhood significantly inhibits the intellectual and mental development of the child. In adults, this disease may not appear in the early stages, but over several years or months, it significantly impairs quality of life.

Symptoms of mixed hydrocephalus

The main symptomatology is given by increased intracranial pressure and such neurological symptoms as impaired memory, speech, emotional reactions to the surrounding reality.

Symptoms in adults:

• Nausea and vomiting in the morning;
• Passivity, loss of interest in the environment;
• Intense headaches;
• Dislocation of the brain, or its displacement along the main axis;
• Drowsiness, as a harbinger of deterioration;
• Visual impairment.

With the development of mixed hydrocephalus, epileptic seizures can begin, the ability to remember and manipulate numbers is lost. The answers to the simplest questions are difficult for the patient, he does not adequately respond to an appeal to him.

Symptoms in children:

• Bulging fontanelle;
• Astigmatism;
• Crying attacks with throwing back the head;
• Seizures;
• Ptosis of the eyeball (Grefe symptom);
• Frequent restless crying;
• Refusal to eat;
• Decreased hearing and visual acuity;
• Impaired coordination of movements.

The most noticeable visual symptom is an enlargement of the skull, especially noticeable in the frontal part. A slight increase in the frontal lobes can be recorded even in an adult. Mixed hydrocephalus, even in its mildest form, requires immediate medical attention. If you do not provide the necessary help in a timely manner, problems with low intelligence, the child's inability to lead independent life support are inevitable.

How is mixed hydrocephalus diagnosed?

The clinical picture of hydrocephalus usually so clearly indicates its presence that in most cases the doctor has no doubts about the diagnosis already at the initial examination. To clarify the type of hydrocephalus and the stage of its development, additional studies are being carried out.

There are "three whales", or three main signs, on the basis of which a diagnosis of "mixed hydrocephalus" is made:

• Symptoms;
• MRI data;
• Analysis of the condition of the fundus.

If they all confirm the alleged diagnosis, it is made without a doubt. If there are doubts for at least one reason, or the firm answer is "no", most likely, instead of hydrocephalus, the patient suffers from pathology with similar symptoms.

Diagnostics of the hydrocephalus:

• X-ray of the skull - a discrepancy between the sutures of the skull, thinning of its bones, on the inner surface of the cranial vault, a symptom of "digital depressions", an asymmetry of the skull are revealed;
• Echoencelography, or ultrasound scan of the brain, determines the degree of intracranial pressure;
• Ultrasonography - scanning the brain in infants through an open fontanelle;
• Ophthalmoscopy, perimetry, determination of visual acuity - the ophthalmologist determines the degree of visual impairment, the state of the optic nerve discs;
• MRI of the brain - determines the type of hydrocephalus, the cause of the development of pathology (cyst, tumor), congenital anomaly;
• Lumbar puncture with examination of cerebrospinal fluid - helps to identify the causes of the disease.

If mixed hydrocephalus is caused by an infection, PCR diagnostics is recommended to clarify the type of infectious factor.

Treatment of mixed hydrocephalus

The main method of treatment for this complex disease is surgery.

Conservative therapy, although it is used to reduce the volume of CSF production, is used only in special cases:

• Mitigation of neurological symptoms in preparation for surgery;
• Treatment of acquired mixed hydrocephalus of mild degree, resulting from hemorrhage in the ventricles, traumatic brain injury or alcoholization of the patient.

Most often, diuretics are used, which reduce the amount of fluid in the body and the volume of cerebrospinal fluid in the ventricles and subarachnoid space.

Groups of drugs for the treatment of mixed hydrocephalus:

• Diuretics - Lasix, Mannitol, Diacarb;
• Nootropics and means for improving cerebral circulation - Cerebrolysin, Cavinton, Phenotropil, Glycine;
• Preparations that replenish potassium and magnesium, actively excreted along with diuretics - Panangin, Asparkam;
• Analgesics;
• Sedatives;
• Venotonics;
• Fortifying drugs.

In difficult cases, an operation is performed to install a shunt between the subarachnoid cavity, the ventricles of the brain and other cavities of the patient's body to reduce intracranial pressure.

External shunt routes - where the shunt is removed from the brain:

• In the peritoneum;
• In heart;
• Into the lungs;
• Into a vein;
• Into the urethra.

Internal shunting techniques:

• Creation of a message between the ventricle of the brain and the occipital cistern (Thorkildsen's operation);
• Creation of a message between the ventricle of the brain and the cisterna between the cisternae in the area of the gray tubercle;
• Implantation of stents that expand the pathways of CSF circulation;
• Expansion of the lumen of the aqueduct of the brain;
• Creation of an opening between the ventricles for the circulation of cerebrospinal fluid.

The introduction of a shunt into the brain requires regular monitoring of the patient by a neurosurgeon, neurologist. If a shunt is placed in a child, as the head grows, reoperation is required to replace it with a larger shunt. When an artificially created canal is infected, courses of antibiotic therapy are prescribed.

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".