Hydrocephalus in children: symptoms and treatment

Hydrocephalus in children is a brain disease that develops as a result of excessive accumulation of cerebrospinal fluid (cerebrospinal fluid) in the brain ventricles and / or subarachnoid space. Since the child's brain continues its formation after birth, the development of hydrocephalus can stop this process, leading to severe consequences in the form of a backlog in physical and neuropsychic development. Sometimes the consequences of the transferred hydrocephalus in childhood accompany a person all his life, interfering with a full-fledged existence. Careful observation of the child by a pediatrician and related specialists (in particular a neurologist) allows to detect the initial manifestations of hydrocephalus in children in time and to eliminate it.

In order to start treatment on time and minimize complications and unpleasant consequences, it is important for parents to know the causes of this ailment.

Functions of the cerebrospinal fluid

Liquor - this is a special fluid that is washing the brain from all sides. Inside the brain it is contained in the ventricles - cavities inside the brain tissue, outside - between the soft and arachnoid shells. In children, the amount of CSF varies from 40 ml to 100-150 ml, depending on the age. During the day spinal fluid is updated several times. This is due to the continuous production of cerebrospinal fluid by the plexus of the ventricles of the brain and simultaneous absorption of it into the venous and the lymphatic system through outgrowths in the membranes of the brain (arachnoid villi, pachian granulation) and perineural spaces.

Normally, the ventricles of the brain communicate with each other (Monroe's hole, the brain drain) and with the subarachnoid space (the holes of Magendie and Lushka). The continuous process of liquorodynamics provides the brain with nutrients, forms its defense (antibodies, neutrophils), protects against injuries.

If, for some reason, the exchange and the current of the cerebrospinal fluid are disturbed, hydrocephalus develops.

Causes of hydrocephalus in children

Development of hydrocephalus is facilitated by infectious diseases during pregnancy.

The syndrome of hydrocephalus in children has a fundamental division into congenital and acquired. Among the factors contributing to the onset of congenital hydrocephalus, there are:

• anomalies and malformations of the nervous system (Dandy Walker cider, Arnold-Chiari anomaly, stenosis or atresia of the Sylvian aqueduct, hypoplasia of the subarachnoid space, underdevelopment or aneurysm of a large vein of the brain, etc.): they are formed during pregnancy in utero under the influence of various teratogenic effects. These can be infections that the mother suffered during the laying of the brain in the first trimester of pregnancy (especially dangerous rubella, toxoplasmosis, herpes, cytomegalovirus infection); bad habits - smoking, alcoholism, drug use;
• intracranial birth trauma, are subarachnoid and intraventricular hemorrhages, asphyxia in childbirth. The risk of developing hydrocephalus increases in preterm infants with a low birth weight.

Acquired hydrocephalus can develop when:

• inflammatory diseases of the brain and its membranes (meningitis, encephalitis);
• brain tumors and skull bones;
• brain traumas obtained after birth;
• rupture of arteriovenous malformations of the brain.

Classification

Depending on where the excess of cerebrospinal fluid predominates, the outer (in the subarachnoid space), the inner (in the ventricles of the brain) and the mixed (general) hydrocephalus are isolated.
On the mechanism of development:

• open (communicating) - if the communication between the ventricles of the brain and the subarachnoid space is maintained;
• closed (non-communicating, occlusive) - when the circulation of cerebrospinal fluid between the ventricles of the brain and the subarachnoid space is impossible due to occlusion or atresia of the holes of Magendie and Lushka. This is the most dangerous and prognostically unfavorable form of hydrocephalus, requiring immediate neurosurgical intervention;
• hypersecretory (hyperproductive) - with the suspended secretion of cerebrospinal fluid plexus.

By the level of intracranial pressure:

• hypertensive - in high blood pressure. The most common form in children;
• Normotensive - with normal pressure. Usually observed in the very first stages, then replaced by hypertension;
• hypotensive - with reduced pressure. It is very rare.

Symptoms

Clinical manifestations in children of the first years of life before the closure of cranial sutures and overgrowing of the fontanel differ from all other age groups.

With an increase in the amount of CSF and an increase in intracranial pressure in children of the first two years of life, there is an increase in the size of the head due to the fact that the cranial bones are loosely fused together. The head looks disproportionately large compared to the trunk. Pediatrics clearly defined the norms of head circumference growth for a month in the first months and years of life. The measurement of this indicator monthly allows us to judge the possible onset of hydrocephalus development. In addition, with increasing intracranial pressure, attention is drawn to the bulging and pulsation of the large fontanel.

The average head circumference, depending on the age of the child

Perhaps the divergence of the cranial sutures, the increase in the pattern and the overflow of the blood of the extracranial veins, which is evident when viewed with the naked eye. The cerebral part of the skull predominates over the facial. Characteristic eye manifestations: divergent strabismus, a symptom of "setting sun" or Gref (with involuntary movement of the eyes downwards between the edge of the eyelid and the iris there is a white band of sclera, eyes seem to roll up), exophthalmos (bulging eyeballs).

Suffer the behavior of children: they are whiny, characterized by a monotonous crying "on one note", restless, sleep badly. When feeding such children, profuse regurgitation is possible.

With hydrocephalus, children lag behind in motor development: they later start to hold their heads, turn over, sit. With severe hydrocephalus, the formation of these skills does not occur at all, paresis and paralysis develop (muscle strength in limbs) with an increase in muscle tone. There may be a convulsive syndrome. There is a lag in mental and neurodevelopment: a late smile, a lack of a revitalization complex in the first months, a child does not follow the toy, no walking is formed, and later speech. Intellectual development suffers.

Children who have already undergone fusion of fontanelles and cranial sutures are closely fused, have a slightly different symptomatology. The shape of the head is normal, the proportions between the brain and facial skeleton are preserved. These children complain of intense headaches, more in the morning, frequent nausea and vomiting that occur in the absence of errors in nutrition. Spontaneous nasal bleeding is possible.

Vision is impaired: acuity decreases, double vision appears, and on the fundus there are signs of congestive optic discs. There is a convulsive syndrome with loss of consciousness, unsteadiness in walking and coordination disorders. Such children also lag behind in physical and mental development from their peers. With prolonged existence of hydrocephalus, a decrease in muscle strength, a disorder of urinary function in the form of urinary incontinence develop.

Diagnostics

Modern and sufficiently informative methods for detecting hydrocephalus in children is ultrasound. Ultrasound is performed in the women's consultation to clarify the development of the brain in the fetus. Until the fontanelle is closed, you can determine the presence of hydrocephalus with the help of neurosonography - ultrasound through the fontanel.

The dynamics of head growth in cm in the first year of life, despite its simplicity, has not lost its diagnostic significance for today.

A non-invasive method for diagnosing hydrocephalus in children is transillumination of the skull: examination of the head using a tube with a lamp. By the degree and size of the luminescence, the presence or absence of hydrocephalus is judged.

CT and MRI are used to diagnose hydrocephalus after the ultrasound of the brain.
Additional methods to confirm the diagnosis include examination of the fundus, EEG in the presence of convulsive syndrome.

Treatment

Treatment of hydrocephalus in children can be conservative and operative. Conservative treatment is effective in cases with an open, non-progressive hydrocephalus.

In order to reduce the production of CSF and improve the flow of liquor dynamics in children, it is allowed to use diacarb (acetazolamide), furosemide (lasix), mannitol, glycerol (convenient because it is taken orally).
If there is no effect from taking medicines, and also in cases when the disease progresses, in the presence of closed hydrocephalus, surgical treatment is indicated.

External ventricular drainage is performed in urgent cases, when the growing symptoms of increased intracranial pressure threaten the child's life.

If the cause of disturbance of the CSF current was a tumor or hematoma, then its removal is shown, which in itself allows to restore normal liquor dynamics.

In a planned manner, liquor-shunting operations are performed (ventriculoperitoneal, ventriculoatrium, lumboritoneal bypass). With the help of tube and valve systems, it is possible to remove excess cerebrospinal fluid from the brain in the body cavity (abdominal, pelvis, atrial). Of course, these are very traumatic operations, but if they are successfully carried out, the child gets the opportunity to live a full life, does not suffer from physical and intellectual development.

Effects

The prognosis of hydrocephalus in children depends on many factors. Both the cause, the mechanism of development, the level of intracranial pressure, the age of development and the duration of existence play a role.

With the communicating forms of hydrocephalus, the prognosis is more favorable than with occlusive ones.

In general, with early diagnosis and successful treatment, it is possible to recover without lagging behind in the physical and mental development of most children.

Video on the topic "Hydrocephalic syndrome"