Hydrocephalus - dropsy of the brain in children

Hydrocephalus of the brain (dropsy) in children is a serious pathology, but this diagnosis cannot be considered a sentence. With the right approach and timely treatment, a child can lead a completely normal life - with minor restrictions, or even without them at all. You will learn about what a disease is and how parents should act by reading this article.

What it is?

The disease is also called dropsy of the brain, and this definition very accurately reflects what happens in the body in reality. Excess cerebrospinal fluid accumulates inside the skull, under the membranes of the brain, in its ventricles. In a healthy baby, this substance should flow to the spinal canal through the tubules (ventricles) and circulate freely.

The difficulty of this movement with a large amount of fluid leads to increased pressure, to partial or rather significant washing out of the structures of the nervous system under pressure. The consequences of such an impact can be very diverse, they depend on the degree of damage and specific areas of the brain.

Liquor (this liquid) performs many useful and essential functions for life. It protects the main human organ (brain), washes it, leukocytes in the fluid provide the necessary immune task. Cerebral fluid is produced continuously. In case of impaired circulation, stagnation appears, dropsy begins to develop.

If an ailment is detected at the initial stage, the child is quickly and competently provided with medical assistance, the consequences may be minimal or completely absent. In advanced and difficult cases, the child may have problems with speech, development, psyche, neurological diagnoses, impaired vision, hearing, vestibular and motor apparatus. In the absence of help, the child dies.

This pathology is not so common, but not as rare as we would like. Statistics from the World Health Organization (WHO) show that hydrocephalus of varying degrees and varieties is found in one out of 4000 newborn babies.

In theory, hydrocephalus may well develop in an adult, but more often it is children who suffer from it.

Types and reasons

Dropsy of the brain can be either congenital or acquired.

In the first case, the development of the disease is influenced by unfavorable intrauterine factors: an acute infectious disease in the mother during pregnancy (most often this is how cytomegalovirus infection affects the child), developmental defects that have arisen due to genetic "errors".

Acquired hydrocephalus most often affects children under one year old who were born much earlier than the due date, as well as babies who received a brain injury during childbirth.

The cause of the pathology can also be a traumatic brain injury or a previous infectious disease, brain tumors. The most dangerous combination of risk factors is if, for example, a premature baby develops meningitis, encephalitis, or meningoencephalitis. The disease can develop after surgical procedures.

Dropsy is divided into several types. – depending on where exactly the cerebral fluid accumulates:

outdoor;
internal;
mixed (combined).

With external dropsy, the accumulation of cerebrospinal fluid is concentrated only under the membranes of the brain, it does not affect the deep areas. This condition usually occurs in newborns and children with birth trauma.

Internal hydrocephalus - this is a situation in which cerebral substance accumulates in the cerebral ventricles, through which it cannot flow normally. Such a lesion can be a congenital pathology, as well as acquired - in toddlers older than a year.

The mixed variety of dropsy combines the signs of the first and second types, while the cerebrospinal fluid accumulates both inside and outside the brain.

According to the assessment of the true obstacles that interfere with the full circulation of fluid, dropsy is divided into:

open (communicating);
closed (occlusal).

With the communicating form of the disease, there are no objective obstacles, the ventricles are sufficiently dilated, there are no mechanical obstacles to the flow of cerebrospinal fluid. Occlusive hydrocephalus occurs as a result of improper development of the cerebrospinal fluid themselves, pathologies in the structure of the ventricles, tubules, tumors in this system, neoplasms, adhesions. This form of the disease is almost never external; it is characterized by the accumulation of fluid inside the brain.

By the time of development of pathology, there are three types of hydrocephalus:

sharp;
subacute;
chronic.

Acute develops rapidly, the pressure inside the cranium increases in literally 2-3 days. Subacute pathology can develop up to six months, gradually, almost imperceptibly for parents. Its consequences can be more devastating. In chronic dropsy, the cerebrospinal fluid accumulates very slowly, for more than six months, which at first does not affect the well-being of the baby in any way, because the pressure also grows at a very slow pace. And only then, when it reaches a critical level, the diagnosis becomes obvious.

The child's body has very high compensatory abilities. If something is wrong somewhere, the body tries in every possible way to compensate for this at the expense of other resources. Therefore, it happens that with the established diagnosis of dropsy of the brain, the child does not show any deterioration in well-being or change in behavior. In this case, they speak of compensated hydrocephalus.

If all the body's forces are not enough to compensate, the child's well-being worsens, there are pronounced disorders in his development, then they speak of decompensated dropsy.

A slight compensated failure in the circulation of the cerebrospinal fluid sometimes does not even need serious medical support, which cannot be said about decompensated disorders.

According to the degree of damage, doctors also divide the disease into stages. There are two of them:

moderate;
pronounced.

According to the dynamics of manifestations, hydrocephalus can be:

progressive (with a noticeable deterioration in the condition);
stable (when new symptoms do not appear, but there is no improvement);
regressing (with a gradual decrease in symptoms).

Risk factors

The likelihood of developing dropsy of the brain in utero is influenced by a lot, but first of all - the unfavorable conditions for the development of the fetus. These factors include Rh-conflict between mother and fetus.

In fairness, it should be noted that not every Rh-conflict pregnancy ends in the birth of a child with congenital hydrocephalus. However, if the mother has a negative Rh factor, and the baby is positive, and the antibody titer in the woman's blood is high, then doctors will definitely consider this probability.

Risk factors include infectious diseases that a woman can contract during pregnancy.

The first trimester is especially dangerous in this respect. Such diseases include herpes sore throat, chickenpox, Coxsackie virus, sometimes problems arise due to infection with Toxoplasma, rubella or measles viruses. It is these ailments that can cause a violation in the formation of parts of the baby's brain, and then the development of occlusive cerebral dropsy is possible.

Often, hydrocephalic changes are closely associated with a concomitant diagnosis of genetic disorders in the fetus. Often, children with Down syndrome, Turner, Edwards appear with severe congenital hydrocephalus.

A certain danger is also posed by gestosis during the period of bearing crumbs; diabetes mellitus, as well as severe anemia in the expectant mother, can play a role. When pregnant with twins, revealing gross malformations of the heart, circulatory system, and kidneys in a child, the risk of hydrocephalus birth increases.

For boys and girls, in the perspective of hydrocephalus, the postnatal period is also important. Premature birth, a long waterless period, rapid labor, in which the baby may have cerebral hemorrhages, are dangerous. Some birth trauma, infection in an early newborn age with meningitis and encephalitis can also cause hydrocephalus.

Symptoms

It is not always possible to determine the excessive accumulation of cerebrospinal fluid in the head immediately after the birth of the baby, sometimes the symptoms manifest themselves much later. The main visual symptom is an enlarged head. Normally, a newborn's head circumference is 1-2 centimeters larger than the chest circumference. These proportions should be diametrically changed by 6 months. If this does not happen, the head continues to remain larger than the breast and grows ahead of age norms, this is the reason for the appointment of a survey.

The characteristic hydrocephalic skull with protruding frontal lobes, an irregularly enlarged shape, appears when the imbalance of body proportions reaches a maximum.

Each pediatrician has a table on the table or in the office, with the help of which doctors compare the age norms for head circumference. In a newborn, these values are usually in the range of 34-35 centimeters, and in a child of 3 months, 40-41 centimeters. Do not panic if the baby has a volume of 40 centimeters not at 3 months, but per month. All children are different in height, and the size of the head is larger for some and smaller for others. Being ahead of the age norm in itself cannot speak of pathology.

The important thing is how fast the baby's head grows. Normally, it increases by one centimeter per month. A symptom can be considered alarming if the head has grown not by 1, but by 3-4 centimeters in a month.

Remaining symptoms should be assessed if growth rates are abnormal.

A sick child usually:

On the forehead, temples and the back of the head veins are clearly visible.
The child does not hold his head well (the symptom matters only if the baby is already more than 3 months old).
The kid doesn't smile, even if he is already 3-4 months old.
The skin above the fontanelle protrudes above the surface, pulsates noticeably.
The baby is constantly crying eats poorly, sleeps restlessly, slowly gains weight (an ambiguous symptom, which in itself cannot speak of anything).
The frontal lobes are very largespeakers.
Pupils are not fixed on the subject, all the time finely "tremble" from side to side or from top to bottom (the symptom should be assessed only after 2 months of independent life of the child).
The location of the eyes seems deep due to overhanging massive brow ridges.
There are signs of strabismus on a divergent type.
Loss of acquired skills (the baby ceases to fix his gaze on the object, he cannot keep his head in an upright position, even if he did it before, he stops walking and sitting).
Convulsions, vomiting, and incessant monotonous crying (These signs usually accompany emergencies in cerebral dropsy).

In children over one year old, the signs of hydrocephalus are usually somewhat different:

spontaneous convulsions with loss of consciousness;
frequent headaches (usually they get worse in the morning and almost disappear in the evening);
frequent nosebleeds against a background of headache, vomiting;
frequent episodes of nightly panic screaming and crying - for no apparent reason;
urinary incontinence;
visual impairment.

It should be noted that most of the symptoms that can accompany dropsy of the brain in a child after a year are, in fact, everything that a neurologist usually notes. This is a trembling chin, and distracted attention, and hyperactivity, and irritability, and even walking on tiptoes. The main thing here is not to evaluate each such symptom separately, you should not immediately "write" the baby into the ranks of hydrocephalus.

Usually, one by one, these signs, even neurological disorders, can only be considered with great stretch. For this reason, it is important to evaluate a combination of factors, signs and rely not on the fact that the baby pees and screams at night, but on the results of medical examinations.

By the way, it makes no sense to measure a child's head after a year. Even with severe hydrocephalus, it does not change in size, since the bones of the skull, when the fontanelle closes, cease to be mobile, but the intracranial pressure in such children is significantly higher.

Diagnostics

Very often, the diagnosis of the state of the brain is redundant. This means that mothers and fathers are told the names of diseases that babies do not have. Quite often (about 3-4 crumbs out of a dozen), when undergoing magnetic resonance imaging or computed tomography (and even on a conventional ultrasound of the head), they put hypertensive-hydrocephalic syndrome. Some neuropathologists even manage to make such a diagnosis without additional examinations.

The reality is that this syndrome does not happen very often, and not in 30-40% of children. The dilated ventricles of the brain are sometimes only an individual feature of the structure of the brain in a given toddler, therefore it is important not to rush to treat the child, but choose observation tactics, monitor the change in the size of the questionable brain structures during the growth of the baby. To do this, the head circumference is regularly measured and from time to time a special study is carried out - neurosonography.

Hypertensive-hydrocephalic syndrome is always associated with increased pressure inside the skull, which is due to the accumulation of cerebrospinal fluid. Most parents have absolutely nothing to worry about.

However, the danger cannot be underestimated either. You should definitely see a doctor if your child has several of the symptoms from the above lists. And that doctor should be a pediatrician. The doctor assesses the baby's general well-being, "takes measurements" from the head, sets the chest circumference, correlates all this with the alarming signs described by the parents and gives a referral to a neurologist.

It should be noted that pediatric neurologists are very fond of finding what is not, and treating what they have found. Therefore, parents should clearly understand when a neurologist can assume a disease, on the basis of what research he confirms or refutes such a serious diagnosis.

The neurologist first evaluates the child's reflexes. If he doesn't like something, he sends the little patient to the ophthalmologist's office, who assesses the condition of the fundus using special devices. If a stagnant disc, strabismus, or dilated pupils are found in the absence of a reaction to light, the eye doctor again sends the child to a neurologist, who at this stage may suggest the presence of hydrocephalus. But only to assume, and nothing more.

An ultrasound of the brain, which is recommended by a neurologist, is also not a basis for a diagnosis. The likelihood of overdiagnosis is too high. Although the brain structure can be viewed through the fontanelle, it is impossible to assess their size and correlate them with any norms, observation is needed in dynamics.

If the child's condition inspires concern, and the neurologist considers it inappropriate to wait, he will send the baby to an MRI. Magnetic resonance imaging allows you to obtain more detailed and reliable information about the state of each area and each layer of the brain.Using such a picture, a doctor will be able to determine with great accuracy not only the presence of the disease, but also its degree, the location of dropsy, the degree of damage to neighboring structures, the volume of fluid in the ventricles of the brain and other important nuances.

This method, excellent in all respects, is not very convenient for infants, because during the study for a long time the child will have to lie motionless - in a special chamber with a huge magnet. Therefore, for young children, medical anesthesia is necessary to conduct research and obtain reliable results.

The computed tomography method is also suitable for diagnosing dropsy of the brain. Only MRI and CT are able to answer the main question - is everything okay with the baby. An important nuance: for the diagnosis to be reliable, it is advisable to carry out an MRI scan 2-3 times - with intervals of 2-3 weeks between examinations.

Practice shows that doctors often prescribe other studies (echoencephalography, electroencephalography). However, according to the existing diagnostic standards, these methods are not reliable in cases with hydrocephalus; parents may well refuse them.

The true cause of dropsy (whether it is an infection or a birth injury) in infants often remains a mystery to both doctors and parents. More or less accurately, it is possible to determine only the traumatic causes if a traumatic brain injury was received.

The last diagnostic "touch" - determination of the level of cranial pressure... There are no devices that can do this, and therefore invasive procedures are used to clarify this factor. Most often, a puncture of the cerebrospinal fluid is done - in the intervertebral space, in the lumbar region.

Further decisions will be made together by two specialists - a neurologist and a neurosurgeon.

Treatment

Treatment (regardless of the cause that caused the cerebral dropsy) is always carried out according to certain schemes and principles. The main method is surgical treatment, but sometimes neurosurgeons allow the use of drug therapy - if they believe that there is no danger to the child, and the outflow of cerebrospinal fluid can be established without surgery.

Conservative treatment

For conservative treatment, diuretic drugs are usually used, which can reduce the production of cerebrospinal fluid and increase its circulation. In most cases, with open hydrocephalus, which is not complicated by severe symptoms, this is quite enough.

The drug "Diakarb" is prescribed to children most often. It slows down the production of cerebral fluid and encourages more active urination. The medicine has a big minus - it rapidly removes potassium, which is so necessary for growth and development, from the child's body. Therefore, it is taken together with preparations containing this substance - "Panangin" or "Asparkam".

If the child has a sufficiently high level of intracranial pressure, but neurosurgeons consider it advisable to wait with the operation or see an opportunity to cope with hydrocephalus without a scalpel, the baby is prescribed diuretics "Mannitol" or "Furosemide". Moreover, in the second case, it is also necessary to take potassium preparations.

Additionally, the doctor may prescribe drugs that stimulate the work of neurons... To relieve minor symptoms of dropsy of the brain (delayed speech development, distracted attention), the general tonic and adaptogenic drug "Kogitum" is often prescribed. It is intended for children from 7 years old.

To increase the effectiveness of medications, the child is recommended additional treatment, which includes massage, exercise therapy, microcurrent reflexology. The main thing is not to go to extremes and not start looking for osteopaths who promise to put all the bones of the skull in place for a "moderate" reward.

Such procedures can be extremely dangerous for the life of a child, and therefore it is not worth visiting osteopaths without the recommendation of a neurosurgeon. The benefits of their massage in medicine have not been documented, in contrast to the sad consequences of unsuccessful manipulations.

Usually, no more than 3-5 months are given for conservative treatment. If the child's condition has not improved, and intermediate studies using MRI and CT have shown deterioration and ineffectiveness of drug therapy, a decision is made to perform an operation.

Operative treatment

The most common surgical technique for removing excess cerebrospinal fluid in a child's head is bypass surgery. After craniotomy, the child is injected into the cerebral ventricle, expanded from the fluid, special silicone tubes - shunts, through which excess fluid is drained into the abdominal cavity. One end of the shunt is permanently in the brain, and the other is brought out into the abdominal cavity. The middle of the tube passes subcutaneously.

The risk of complications during bypass surgery (despite the high qualifications of the surgical team and the excellent quality of the bypass) is quite high. It accounts for about half of all cases.

In 40-60% of cases, complications develop within six months or a year, which require another surgical intervention associated with the replacement of the shunt or a certain part of it.

It should be understood that as they grow older, the child will need several more such operations. Shunts need to be replaced, because nothing is eternal. They can clog, bend, fray. As planned, they are changed due to age-related changes in the child's body.

The rest of the life of "shunted" children is no different from the life of their peers - unless, of course, hydrocephalus caused other disorders of the nervous system in the period preceding the operation. There is one more factor that cannot be ignored - this is shunt dependence. While the child is small, his parents will worry about this, then he himself will understand that his life directly depends on the state of the silicone tubes inside his head.

In search of an alternative, medicine also considered drainage operations, when CSF was removed after trepanation and catheter insertion. Firstly, this did not eliminate the true cause of the disease, especially with malformations of the brain structures, and the fluid began to accumulate again. Secondly, the danger of brain infection during drainage increases tenfold. Therefore, this method takes place, but it is used extremely rarely - as a "gesture of despair", when only urgent drainage can save the baby's life at this stage.

Endoscopic operations have also been practiced in medicine for the last 40 years. They are considered a priority way to combat hydrocephalus. With the help of an endoscope, neurosurgeons can not only install a shunt, if necessary, but also "fix" some defects that led to closed deep hydrocephalus.

In fact, doctors create drainage pathways for the cerebrospinal fluid. If it is not possible to eliminate the vice, they make these paths "roundabout". During endoscopic surgery, it is possible to remove some of the tumors that interfere with the normal outflow of cerebrospinal fluid, to remove the blockage of the ventricle. Surgical procedures usually last no more than 20-30 minutes.

Most often, endoscopy is prescribed for mixed hydrocephalus, occlusive form, pathology resulting from severe trauma. The operation is less traumatic than bypass surgery, it causes complications much less often, does not worsen the patient's quality of life, because he does not have a foreign object in his body, and there is no dependence on it. Do not think that endoscopy is expensive. With all its advantages, it is also the most cost-effective option for hospitals that does not require cost.

Unfortunately, the method is not effective for every hydrocephalus. If the neurosurgeon does not recommend endoscopy due to the individual characteristics of the child's illness, then only bypass surgery remains.

After the operation, children who have undergone endoscopy are registered with a neurologist. They can be removed from him if their condition has improved, and there are no violations. After bypass surgery, the dispensary registration with a neurologist is lifelong, there is not the slightest opportunity to remove the child from him.

Forecasts

There is no universal prognosis for hydrocephalus in children. Everything is individual, and there are just as many projections as there are patients themselves. The most positive prognosis is given with great caution to children with communicating hydrocephalus. With occlusive dropsy, cure without consequences does not happen so often.

Congenital hydrocephalus, if detected in time, is faster and easier to treat than an acquired disease. Hydrocephalus of the first degree less often leaves irreversible consequences than extensive and severe cerebral dropsy. The prognosis is all the more positive, the earlier the doctors identified the ailment, the sooner medical assistance was provided.

Unfortunately, a large number of children who have undergone severe forms of hydrocephalus still show debility, mental retardation, mental and personality disorders. Among the lesions of the nervous system, infantile cerebral palsy and lack of coordination of movements are leading. Sight and hearing are affected. Postoperative complications - inflammatory processes, infectious and non-infectious brain lesions, epileptic seizures - should not be disregarded.

Children who are treated diligently and consciously by their parents live much longer than refusenik babies with congenital hydrocephalus. Dropsy of the brain is curable. Only the consequences of the disease can be total.

Rehabilitation

Even after successful treatment, the child will need several years to recover.

Do not neglect the opportunity to visit a rehabilitation center with your baby. There are such institutions in every region.

There, speech therapists, neurologists, massage therapists are engaged with the child. Excellent results in treatment and rehabilitation are shown by Chinese clinics, which practice laser therapy sessions. There are also rehabilitation centers in Israel.

In Russia and abroad, there are many sanatoriums that are ready to accept children from 2-3 years old - after undergoing bypass surgery or endoscopic plastic surgery of the ventricles of the brain.

Courses in rehabilitation centers and trips to sanatoriums do not cancel daily intensive classes with such children, because they require much more attention and patience.

The child should eat right, do not allow excess fluid intake, do not eat too much salty, pickled and smoked foods to avoid fluid retention in the body.

Useful Tips

If the child has a confirmed diagnosis of hydrocephalus, there is no need to despair. After all, a baby in this difficult period needs a strong, reasonable and self-possessed mother who will help him overcome the disease. There are many forums on the Internet for parents whose children have successfully recovered from hydrocephalus, and for those who have yet to do so.

You shouldn't look to blame, sometimes this ailment does not depend in any way on the parents and their right or wrong actions.
During pregnancy, be sure to attend antenatal clinic... Many studies and analyzes that are prescribed for expectant mothers will help to know about risk factors in advance.
Before pregnancy, a woman should visit an infectious disease specialist at least onceto find out, by donating blood, what diseases she was sick, and antibodies to what dangerous infections she has in her body.
If during pregnancy (especially in the early stages) a woman gets sick with rubella, measles or other infection, she should definitely agree to additional research on the condition of the fetus, visit genetics in order to make a further (very painful) decision about carrying a child. You need to know about the risks of pathologies, about treatment during gestation.

If the child was born prematurely, you can not miss a single mandatory medical examination and scheduled doctor's visit.
Babies over a year old need to be protected from head injuries. If you bought him a bike, be sure to give him a helmet as well. If the child is being transported by car, then you should definitely use a car seat.
All viral infectious diseases, with which a child becomes infected, cannot be treated on their own - according to grandmother's recipes, viburnum and burdocks. Be sure to consult a doctor, take tests, take medications only as prescribed by a qualified doctor.