1 Development of pathology
Hydro is translated as "water", and cephal - "brain".A literal translation of this disease is a "dropsy of the brain". Hydrocephalus in children is a predominantly congenital disease characterized by the accumulation of cerebrospinal fluid in the brain cavities( ventricles), as well as under the membranes. This pathology is the cause of increased pressure inside the skull and compression of soft tissues.
The disease is found in 2-4 newborns out of 1000. Hydrocephalus often combines with brain tumors, diseases of the central nervous system and craniocerebral trauma. This pathology is diagnosed much more often than Down syndrome and some other congenital diseases. In Western Europe, hydrocephalus is the most common cause of child labor.
Until recently, every second newborn child with this pathology died. To date, the death rate does not exceed 5%.Every person, including newborns, has a constant production of cerebrospinal fluid. It washes the brain and spinal cord. With hydrocephalus, it accumulates in cavities and channels. Gradually, this leads to an increase in the skull and atrophic changes in the tissues, which causes the appearance of mental disorders and neurological symptoms.
2 Types of
Disease in children is congenital and acquired. The latter is divided into post-traumatic, infectious and neoplastic. By the nature of the flow, a sharp, subacute and chronic form of the disease is isolated. Acute hydrocephalus of the brain is characterized by a rapid rate of increase in intracranial pressure and deterioration of the person's well-being. In subacute flow the child's condition worsens gradually within 1-3 months.
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Chronic dropsy of the brain in children is characterized by long development. By the nature of the circulation of the cerebrospinal fluid, an open and closed dropsy is isolated. Open hydrocephalus in a baby is caused by a violation of the absorption of the cerebrospinal fluid. In this spinal fluid flows without any obstructions.
Such a dropsy is otherwise called communicating, since the ventricles of the brain and the spaces between the medullary membranes communicate with each other. When the form of the disease is closed, the outflow of liquor becomes difficult. It is this type of dropsy that is most often detected in young children. The drop is subdivided into the external and internal.
In the first case, the cerebrospinal fluid accumulates under the cerebral membranes, not penetrating into the interior. Internal hydrocele is characterized by congestion of cerebrospinal fluid in the ventricles themselves. The production of cerebrospinal fluid in this pathology can be normal or elevated. Often there is a mixed form of dropsy, when a fluid is formed more than it is absorbed.
3 Basic etiological factors
The true form of dropsy in infants is due to congenital malformations of the brain. The following developmental anomalies are most important:
- Arnold-Chiari malformation;
- primary narrowing of the aqueduct of the brain;
- water atresia;
- Dandy-Walker Syndrome;
- congenital aneurysm.
The most common cause is stenosis of the Sylvian aqueduct.
The accumulation of CSF in a child is possible even during intrauterine development. This is facilitated by the following factors:
- infection of the fetus with various microorganisms;
- thrombophlebitis;
- brain injury.
The most common cause of illness in newborns is infection of the mother during pregnancy.
This can be toxoplasmosis, rubella, cytomegalovirus infection, syphilis, parotitis, herpes of type 1 and type 2.The greatest danger for the child is microorganisms that promote the development of meningitis and encephalitis. A frequent cause of dropsy is an injury during childbirth.
This may be if the baby's head does not match the hole in the pelvic area. Trauma contributes to inflammation of the membranes of the brain and hemorrhage. To rare causes of the development of this pathology include tumors( meningiomas, papillomas, carcinomas, ventricular tumors, cancer).Children may be more than 1 year old from this disease. They develop hydrocephalus due to tumors of the brain and spinal cord, hemorrhage, inflammatory diseases, TBI.
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There are the following risk factors for the development of this pathology in a child:
- contact of a pregnant woman with animals;
- activation of the herpes virus against a background of decreased immunity;
- presence of a narrow pelvis in the mother;
- premature baby;
- early delivery( before 35 weeks of gestation);
- fetal fetal hypoxia;
- presence of pulmonary hypertension in the mother;
- smoking and drinking alcohol during pregnancy.
The risk factor is the infection of a woman before syphilis.
4 Clinical manifestations in infants under 2 years of age
Symptoms of dropsy of the brain in children under 2 years of age and older have their own characteristics. Infants most often develop congenital hydrocephalus. It is characterized by the following features:
- an increase in the circumference and volume of the head;
- bulging of veins in the head region;
- slow increase in weight;
- lag in physical development;
- forehead enlargement;
- violation of fixation of sight;Regurgitation of food during feeding;
- tipping head back;
- ptosis( ovulation of the eyelids);
- poor appetite;
- yield of fontanel;
- strabismus of a divergent type.
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Many children have increased muscle tone of the lower extremities. The legs are bent. The skin in the head region becomes smooth and shiny. This is due to its extension as the volume of the skull increases. Symptoms include sleep disturbance, moody and tearfulness of the child. In severe cases, convulsions and vomiting appear.
Sleepiness may occur. If before the baby could sit or walk, then such skills can be lost. Severe effects of hydrocephalus include paralysis of the extremities. The main sign of hydrocephalus is an increase in the volume of the head. This is because the bones of newborn babies are supple, and the seams are not completely overgrown.
In the first months the head circumference increases by 1-1.5 cm per month, then the rate increases. In the area of joining the frontal bone with parietal can be found bulging large fontanel. It can be determined by palpation.
In healthy children, the closure of the fontanel occurs at the end of the first year of life. With dropsy this process is broken. With hydrocephalus, the eye symptoms are pronounced( a symptom of the setting sun, the descent of the eyelid, the divergent strabismus).The child's intellect suffers. In severe cases, the development of idiocy is possible.
5 Development of the disease in the elderly
Symptoms of dropsy of the brain in children older than 2 years are somewhat different. This is due to the formation of the skull and the closing of the seams. The bones are already more firmly entwined, which prevents the head from increasing to large sizes. The following signs of hydrocephalus in children and adolescents stand out:
- a pressing headache;
- bleeding;
- pain in the eye area;
- repeated vomiting;
- reduction in heart rate;
- loss of consciousness;
- convulsions;
- nausea;
- sleep disturbance;
- excitability;
- impaired coordination of movements;
- muscle hypotension( decreased strength);
- irritability;
- increase in body weight.
The appearance of these children does not change much. The appearance of circles under the eyes is possible. Violation of the function of the brain is manifested by a decrease in attention, motor impairment, a change in gait. In the area of the skull, optic nerves are located, with their compression possible doubling in the eyes and reduced visual acuity. Often, the function of the pelvic organs is disturbed: there is an increase in diuresis or incontinence.
Signs of hydrocephalus at this age are numerous. The main one is a headache. It has the following features:
- bothers mainly in the morning;
- appears after prolonged lying;
- passes by the evening;
- becomes stronger after sleep during daytime and mental stress.
Children who attend school or kindergarten often lose academic performance. In severe cases, sick children can periodically lose consciousness. Sometimes psychosis develops, which is manifested by delirium and hallucinations. Another formidable sign of dropsy is a convulsive syndrome. During an attack, a breathing disorder is possible. Most often this is observed with the open form of hydrocephalus.
6 Survey plan for
Treatment of hydrocephalus in children begins only after examination. In young children, the diagnosis is straightforward, since the symptoms are quite specific. Diagnostics includes X-rays, echoencephalography, CT or MRI, ophthalmic examination, spinal puncture( if indicated), neurological examination.
The examination begins with examination by a neurologist. The doctor evaluates the proportions of the body and the circumference of the head, reflexes, muscle tone. The size of the head and the increment of the circumference are measured in dynamics. An examination of the organ of vision is required. For this purpose, the examination of the fundus is carried out, visual acuity is assessed, perimetry and ophthalmoscopy are performed.
The diagnosis can be made on the basis of the results of magnetic resonance imaging of the brain. MRI reveals the accumulation of cerebrospinal fluid in the brain cavity, assess the degree of damage and determine the possible cause of this pathology. If there is a suspicion of the infectious nature of the disease, a polymerase chain reaction is carried out.
7 Therapeutic tactics for dropsy
Treatment depends on the type of hydrocephalus and the causes of its occurrence. With open non-progressive, acquired edema, conservative treatment is most often performed. It involves the use of diuretics( Diakarb or Lasix), potassium drugs, neuroprotectors and nootropics( Cerebrolysin, Encephabol).If older children are deficient in attention and memory impairment, then nootropics( Piracetam), as well as funds that improve blood flow( Cavinton) are shown.
They are used after removing fluid from the cranial cavity. In addition, prescribe vitamins. In the absence of the effect of diuretics or in the presence of progressive closed hydrocephalus of the brain, an operation is performed. With closed hydrocephalus it is important to normalize the passability of the cerebrospinal fluid. If there is a tumor, you need to remove it.
Surgical treatment may include the removal of a hematoma or an aneurysm. In severe cases, shunting is performed( superposition of bypass ways for outflow of cerebrospinal fluid).Most often, the removal of fluid is carried out in the abdominal cavity and right atrium. To urgent operations is the external drainage. An emergency operation involves general anesthesia, hole making in the skull, insertion of the catheter, drainage of the fluid.
The main method of surgical treatment of sick children with an open form of dropsy is bypass. The prognosis for communicating hydrocephalus is more favorable. In untimely treatment and in severe cases, dropsy can lead to complications( child's retardation in mental and physical development, speech impairment, hearing loss and vision, motor disorders).
Prevention of dropsy includes protecting children from injury, conducting pregnancy, testing for infection of women during pregnancy, excluding contact with animals when carrying a baby, rejecting the mother from bad habits.