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HYDROCEPHALUS

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HYDROCEPHALIA (syn.: Dropsy of the brain) is characterized by the accumulation of cerebrospinal fluid in the cranial cavity. It occurs due to a violation of its outflow or absorption, less often as a result of increased secretion. As a rule, hydrocephalus is accompanied by expansion of the ventricles of the brain and increased intracranial pressure (ICP). Atrophy (a decrease in the volume of brain tissue) caused by degenerative processes, vascular damage, or brain trauma can also cause ventricular expansion.

There are two main types of hydrocephalus. Obstructive (non-communicating) hydrocephalus occurs as a result of blockade (obstruction) of cerebrospinal fluid outflow pathways at the level of the ventricular system. It can be caused by a tumor or other volumetric process, intraventricular hematoma, brain abscess, ventriculitis or ependymatitis, granulomatous inflammation, arachnoid cyst and other diseases. Communicating (non-obstructive) hydrocephalus develops as a result of malabsorption of cerebrospinal fluid. Communicating hydrocephalus can be a complication of infection (purulent, fungal, tuberculous), subarachnoid hemorrhage, and carcinoma of the meninges.

In young children who have not yet closed cranial sutures, hydrocephalus is accompanied by an increase in the head, divergence of the sutures of the skull, bulging of a large fontanel, increased venous pattern on the scalp, a symptom of the “setting sun” (retraction of the eyelids with limited gaze upward). In acute cases, vomiting develops, depression of consciousness, in chronic cases, a slowdown in mental development is observed. Without appropriate treatment, death can occur, but in many cases, hydrocephalus "stops", and although the ventricles remain dilated, the ICP returns to normal. After stabilization of hydrocephalus, the development of the child resumes, but the mental or physical defect formed by this time may remain irreversible. In older children and adults, the skull has a limited volume, and with acute hydrocephalus signs of intracranial hypertension quickly appear.

Normotensive hydrocephalus is a communicating hydrocephalus that can develop after traumatic brain injury, purulent meningitis, subarachnoid hemorrhage. There are no signs of intracranial hypertension. Clinically, the disease manifests itself in a triad, including walking disorders, dementia, and urination disorders. Violation of walking resembles its changes in Parkinson's disease and cerebellar ataxia: patients cannot move for a long time, walk with small shuffling steps, swaying and legs wide apart, sometimes fall, unable to maintain balance.

Diagnosis. In young children, in order to recognize hydrocephalus, they resort to measurement in the dynamics of the size of the skull, ultrasound, transillumination of the skull. X-ray of the skull allows you to evaluate its size and width of the joints, to identify indirect signs of prolonged intracranial hypertension (osteoporosis, expansion or destruction of the wall of the Turkish saddle).

Treatment. Apply diuretics - acetazolamide (diacarb), furosemide . In acute cases, resort to external drainage of the ventricles, sometimes to repeated lumbar punctures. Tumors or cysts that prevent the outflow of cerebrospinal fluid are removed. In all other cases, shunts are applied (ventriculoperitoneal, less often ventriculoatrial or lumboperitoneal), providing an outflow of cerebrospinal fluid from the ventricles to the abdominal cavity or atrium.