Why does fluid accumulate?
Cerebrospinal fluid is constantly produced in the ventricles of the brain, circulates and is absorbed. Violation at any stage leads to its accumulation.
- Occlusive (closed) form - the outflow path is blocked: congenital narrowing of the cerebral aqueduct, tumor, adhesions after hemorrhage
- Communicating (open) form - absorption is impaired, most often after meningitis or subarachnoid hemorrhage
- Normal pressure hydrocephalus is a special form in the elderly, in which the cerebrospinal fluid pressure remains normal and the ventricles are dilated
- Replacement hydrocephalus - dilation of the ventricles due to brain atrophy; this is not true hydrocephalus and does not require shunting
In children under one year old
While the sutures of the skull are not fused, the head may become enlarged, and this is precisely what becomes the first sign.
- Rapid increase in head circumference with regular measurements
- Bulging, tense fontanel
- Dehiscence of the sutures of the skull, dilated venous network on the head
- Symptom of “setting sun” - the iris is partially hidden by the lower eyelid
- Anxiety, monotonous screaming, vomiting, refusal to eat
- Delayed motor development, head tilting
Normal pressure hydrocephalus in the elderly
This form is important to know because it mimics dementia and Parkinson's disease, but unlike them, it can be treated surgically. The classic triad looks like this:
- Нарушение походки — самый ранний и самый заметный признак: шаги мелкие, шаркающие, ноги «прилипают» к полу, трудно начать движение и развернуться.
- Нарушение мочеиспускания — сначала учащение и императивные позывы, затем недержание.
- Снижение памяти и замедленность мышления.
If an elderly person's gait deteriorates first, and memory worsens later, this is an argument in favor of normal pressure hydrocephalus, rather than Alzheimer's disease, where memory suffers first. Such a patient definitely needs an MRI or CT scan.
Diagnostics
- МРТ или КТ головного мозга — оценка размеров желудочков и поиск причины блока.
- У младенцев — нейросонография через родничок, безопасный и доступный метод.
- Измерение и построение динамики окружности головы у детей.
- Осмотр глазного дна — признаки повышенного внутричерепного давления.
- При нормотензивной гидроцефалии — тест с выведением ликвора: если после пункции походка улучшается, вероятность успеха операции высока.
Treatment
There is no drug treatment for hydrocephalus that eliminates the cause; drugs can only temporarily reduce the production of cerebrospinal fluid. The main method is surgical.
- Ventriculoperitoneal shunting - installation of a system that drains excess fluid from the ventricles into the abdominal cavity
- Endoscopic triventriculostomy - creation of a new outflow tract; preferable for occlusal form
- Removal of tumor or other cause of block, if possible
- For normal pressure hydrocephalus, shunting often significantly improves gait and cognitive function