Hydrocephalus of the brain: signs, diagnosis, treatment, surgery, prices

External hydrocephalus of the brain is considered a disease of newborns, but the disease also occurs in adult patients. The development of hydrocephalus is caused by impaired absorption or outflow of cerebrospinal fluid. At the Yusupov Hospital, neurologists use modern diagnostic methods that make it possible to establish the causes, form of the disease and severity.

For mild hydrocephalus, conservative therapy is carried out aimed at reducing intracranial pressure and improving the function of nerve cells in the brain. Neurosurgeons at partner clinics perform surgical interventions that eliminate the cause of the disease. After surgery, patients’ quality of life improves and impaired nerve functions are restored.

Causes of hydrocephalus

With this disease, the balance between the formation, circulation and absorption of cerebrospinal fluid is disrupted. The causes of hydrocephalus have not been fully elucidated.

Hydrocephalus in a child is usually the result of inherited genetic abnormalities and congenital disorders of the brain and spinal cord. It can also occur after premature birth, during which hemorrhage occurred in the ventricles of the newborn’s brain.

Hydrocephalus of the brain in an adult can have the following causes:

• meningitis;
• brain tumors;
• traumatic brain injury;
• subarachnoid hemorrhage;
• other conditions that impede the release of cerebrospinal fluid from the ventricles into the cisterns of the brain.

How is the procedure performed?

MRI of the brain is performed with or without contrast enhancement. In the first case, the patient is injected intravenously with special drugs that create a clear image of the affected areas and improve the quality of visualization. For example, with this approach, not only the tumor itself is clearly visible, but also its exact boundaries.

No special preparation is required for the procedure, but before it begins, you will have to remove all metal jewelry. The tomography machine itself looks like a large cylinder, inside of which there is a movable platform. The patient is placed on it lying on his back. To protect against the noise produced by the device, earplugs are used.

The table slides inside the tomograph, and the doctor performs the procedure from an adjacent office, controlling the device using a computer. Throughout the examination, voice communication with the doctor is maintained, so the patient can report unpleasant or uncomfortable sensations at any time.

The tomograph sequentially takes a series of images, which ultimately form the finished image. In order for the images to be of high quality, the patient must remain completely still. On average, the procedure takes about 30-45 minutes.

Classification of the disease

There are three main forms of pathology:

• occlusive hydrocephalus, or internal, is a condition in which fluid does not flow from the ventricles, while the space around the brain is compressed;
• non-occlusive hydrocephalus, or external, - fluid can enter from the ventricles into the space between the brain and its membranes, while they expand and compress the nervous tissue from the outside;
• mixed hydrocephalus is a combination of several blocks of cerebrospinal fluid outflow pathways.

External replacement hydrocephalus is a severe form in which the substance of the cerebral cortex atrophies, and excess fluid takes its place. A synonym for this condition is atrophic hydrocephalus.

The disease is also divided depending on its causes into post-traumatic, post-infectious and post-hemorrhagic forms. Hydrocephalus can be progressive (active) or chronic (compensated). It is accompanied by an increase in intracranial pressure.

Features of drug therapy

Treatment and diagnosis of hydrocephalus is the responsibility of a neurosurgeon. Drugs are used in therapy exclusively at an early stage of the disease or as an adjunct to surgery. Their purpose serves two purposes: removing excess fluid from the body and improving blood supply and nutrition of brain structures.

If necessary, the doctor prescribes sedatives to eliminate the patient’s psycho-emotional stress. Additionally, it is recommended to take vitamin complexes. Specific medications, their dosage and duration of use are determined by the attending physician.

Use of diuretics

The main drugs used for hydrocephalus are diuretics. They promote the removal of urine from the body and reduce the amount of fluid in internal organs and tissues. As a result, intracranial pressure decreases - one of the signs of the disease. In the case of cerebral hydrops, diuretics of three subgroups are used: loop, osmotic and carbonhydrase inhibitors.

Diuretics are prescribed not as the main medicine, but as a symptomatic remedy.

This means that they cannot eliminate the cause of the disease; they can only temporarily alleviate the patient’s condition. For hydrocephalus, long-term use of diuretics is prohibited. This is due to the fact that useful substances and microelements leave the body along with the fluid. Subsequently, the deficit of the latter is quite difficult to restore. In addition, when using potent medications, severe dehydration occurs, and excess cerebrospinal fluid does not always drain away as quickly.

Review of effective diuretics

Loop diuretics are considered the most fast-acting and effective. Their action is based on slowing the reabsorption of sodium ions and inhibiting chlorides. Most often, patients are prescribed Furosemide in tablets, injections for intramuscular or intravenous administration. The dosage is selected individually.

To enhance the therapeutic effect, loop diuretics must be combined with Diacarb. It is a carbonhydrase inhibitor. The regimen for taking it is also determined individually, taking into account the clinical picture, but the daily dosage cannot exceed 750 mg. Duration of use is 5 days. If this period is exceeded, the likelihood of metabolic acidosis increases.

The group of osmotic diuretics is represented by Mannitol and Triampur Compositum. The latter is a combination drug that includes a diuretic and antihypertensive component. Take it orally after meals with a sufficient amount of liquid. The maximum daily dosage is 4 tablets.

Medicines for correcting potassium levels

Treatment of hydrocephalus is impossible to imagine without the use of diuretics. However, such drugs remove from the body not only excess cerebrospinal fluid, but also many useful substances and microelements. To compensate for the deficiency of the latter, the course of treatment for hydrocephalus is always supplemented with Asparkam.

This drug is used to correct potassium and magnesium levels. It is also able to regulate metabolic processes. The drug is available in the form of tablets and solution for injection. The doctor selects its dosage individually. The course of treatment is usually at least a month. If necessary, they are repeated after a short break of 2-3 weeks.

Asparkam should be taken with caution. This drug is not recommended for patients with a history of impaired renal function, a high likelihood of edema, or metabolic acidosis of the blood. In addition, it should be taken strictly according to the regimen prescribed by the doctor to avoid overdose. It manifests itself as bradycardia, decreased blood pressure, and respiratory paralysis.

Nootropics

Nootropics are neurometabolic stimulants. They have a beneficial effect on higher mental functions. However, it is necessary to carefully select the dosage.

One of the representatives of this group is the drug Cortexin. It has a pronounced neuroprotective, antioxidant and nootropic effect. The medication helps to normalize the ratio of amino acids that perform mediator functions of inhibitory and excitatory types of action. Reduces the level of convulsive brain activity. The duration of treatment is no more than 10 days.

Quite often doctors prescribe Mexidol. This is a powerful antioxidant and nootropic agent. It helps increase the body's resistance to aggressive factors and pathological conditions caused by oxygen deficiency. The drug should not be used in patients with liver/renal impairment. It is usually prescribed intravenously for 10-14 days, and then intramuscularly.

Correctors of cerebral circulation

One of the stages of drug treatment for hydrocephalus is the use of drugs to improve the nutrition of brain tissue. These are Cavinton and Actovegin. They have a dilating effect on blood vessels, increasing blood circulation and improving the supply of oxygen to tissues.

Cavinton is taken in long courses. Immediately after taking it, a moderate decrease in blood pressure may occur. It has a relaxing effect on smooth muscles, which leads to vasodilation. Cavinton also enhances the exchange of norepinephrine and serotonin in brain tissue. It is prescribed with caution due to the large number of side effects. Among them, it is necessary to highlight tachycardia, changes in ECG indicators and extrasystole.

Actovegin increases glucose consumption in cells and improves the process of oxygen utilization. This helps to activate energy processes in brain structures, affecting their functional metabolism. Treatment of hydrocephalus begins with the use of high doses of the drug, gradually reducing them.

Vasoactive drugs

Vasoactive medications are used when it is necessary to simultaneously improve blood supply to the brain, dilate blood vessels and lower intracranial pressure. They quickly relieve unpleasant symptoms such as headaches, problems with coordination of movements, etc. Magnesium sulfate is most often used in neurology. The drug acts as an antispasmodic, dilates blood vessels and has a diuretic effect. In addition, it normalizes heart rhythm.

Among other medications in this group, Nicergoline, Sermion, and Glivenol are characterized by a positive therapeutic effect. As a result of their intake, there is an improvement in blood circulation in the brain, intracranial pressure quickly normalizes, and painful symptoms are relieved. However, the use of vasoactive drugs is strictly controlled by doctors. Their use is strictly contraindicated in cases of low blood pressure, bradycardia and depressed breathing.

Medicines for headaches

Headache is a common accompaniment of hydrocephalus. It significantly worsens the quality of life of patients. For pain relief, neurologists suggest using the following drugs:

1. Analgin
   . This is an inexpensive and universal drug. Its active substances block pain impulses in the central nervous system. Tablets are usually taken 2-3 times a day.

2. Aspirin
   . The medication has a pronounced analgesic effect. In addition, it acts as an antipyretic and relieves inflammation.

3. Paracetamol
   . The drug belongs to the first group of drugs of choice for severe pain syndrome. It is also effective in case of high temperature.

4. Ibuprofen
   . This is a non-steroidal anti-inflammatory drug. Has a high toxicological threshold. It belongs to the first group of drugs of choice for various pains and inflammations.

The listed drugs can be replaced with analogues (Nurofen, Citramon, Pentalgin). With hydrocephalus, headaches are usually regular, so patients try to relieve them in various ways. When using analgesic medications, it is important to avoid overdose.

Glucocorticoids and barbiturates

Glucocorticosteroid drugs remove toxins from the body. In addition, for hydrocephalus they are indicated to relieve swelling of the brain. Effectively reduce the formation of cerebrospinal fluid due to its effect on the choroid plexus.

Typically, glucocorticoids are prescribed to critically ill patients as immunosuppressants.

Depending on the situation, the doctor’s choice may fall on Dexamethasone or Prednisolone. The minimum dosage per day of the latter is 20-30 mg. For long-term or palliative therapy, it is selected at the rate of 1-2 mg of the drug per kg of patient weight. Long-term use of glucocorticoids can provoke iatrogenic hypercortisolism.

Barbiturates are characterized by a sedative effect. They successfully eliminate the negative influence of external factors on the central nervous system. Phenobarbital is most often used in the treatment of hydrocephalus. Take it 30-50 mg three times a day. Phenobarbital is used as a sleeping pill and a sedative. The circulation of this drug is currently limited; it is prohibited for import into some countries (USA, UAE, Lithuania).

Symptoms and signs of hydrocephalus

External hydrocephalus is accompanied by the following symptoms:

• a disproportionately large skull in a child, divergence of sutures, enlargement of the fontanel;
• nausea and vomiting;
• intense headache;
• decreased intelligence, memory, hearing, vision;
• drowsiness;
• speech disorders.

Moderate external hydrocephalus appears gradually, and its symptoms are often mild. Only as the disease progresses does replacement hydrocephalus occur with severe consequences:

• mental disorders;
• violation of motor functions, balance;
• disturbance of mental activity.

Hydrocephalus in adults is accompanied by the following symptoms:

• intense, untreatable headache;
• vestibular disorders;
• loss of visual fields;
• paralysis of limbs;
• lack of skin sensitivity.

Internal hydrocephalus mainly affects the structures of the cerebellum: gait is disrupted, coordination of movements is lost, handwriting becomes uneven and large.

Symptoms of hydrocephalus require urgent medical attention, as this disease can cause irreversible consequences.

How to treat dropsy?

This brain pathology is practically incurable. Existing medications are designed only to slow down the process.

The most effective treatment method today is surgical, when the patient undergoes bypass surgery or endoscopic surgery.

Massage plays an important role in the treatment of hydrocephalus. Dropsy helps to increase muscle tone, and stroking and rubbing movements have a relaxing effect, helping to restore motor functions.

Another type of treatment, manual therapy, is used as an addition to the use of medications. Manual influence is aimed at activating the human body’s own reserves. The use of manual therapy for secondary dropsy is especially effective.

Recommendations for the use of treatment methods are given by a neurologist or neurosurgeon.

Treatment of hydrocephalus

For this disease, medications are ineffective. Hydrocephalus is treated surgically. During the operation, the doctor installs a shunt system that allows cerebrospinal fluid to flow normally from the cavities of the brain into the abdominal cavity, and less often into the heart chamber or pleural cavity. The shunt system is equipped with a valve that prevents liquid backflow.

In some patients, ventriculostomy may be used. This is an endoscopic operation during which the surgeon makes a small hole in the wall of the 3rd ventricle of the brain. The normal outflow of cerebrospinal fluid then occurs through it.

Folk remedies for hydrocephalus have limited use. You can use tinctures of mint, lemon balm, cornflower, astragalus, calamus, and buckthorn berries.

Diagnostics

When a patient enters the neurology clinic, the doctor conducts an examination, checks motor reflexes, muscle and joint reactions. To clarify the diagnosis, additional examinations are carried out:

• Ultrasound examination of the head and neck for a preliminary assessment of the condition of the vascular bed;
• Computed tomography, which helps to establish the degree of damage to brain tissue, assess the degree of expansion of the subarachnoid fissures, determine the presence of neoplasms in the skull that impede the outflow of cerebrospinal fluid;
• Magnetic resonance imaging, which allows you to see changes in brain tissue with maximum accuracy;
• X-ray of the skull to determine changes characteristic of liquor hypertension and space-occupying formations;
• An ophthalmological examination to determine the presence of congestion, swelling of the optic nerve, and atrophy of eye tissue.

Patients undergo a lumbar puncture, which is used to determine the level of cerebrospinal fluid pressure. Improvement in the condition of a patient with hydrocephalus after removal of 40 ml of cerebrospinal fluid indicates a good prognosis after surgery.

Make an appointment

Prevention and consequences of hydrocephalus

The prognosis for this disease is difficult to determine. It largely depends on how early treatment is started and the extent of irreversible brain damage.

The consequences of hydrocephalus include delayed physical and mental development. However, with the right rehabilitation program, many children with this diagnosis can lead normal lives with minor limitations.

With a progressive form of pathology, the prognosis is unfavorable.

On the other hand, even bypass surgery is not always accompanied by complete recovery. The factors on which this depends have not been fully established.

Therefore, disease prevention is important:

• if necessary, genetic counseling for expectant mothers;
• protection against infectious diseases during pregnancy;
• prevention of traumatic brain and birth injuries;
• vaccination against pneumococcus, which protects against meningitis;
• timely diagnosis and treatment of diseases causing hydrocephalus in adults.

What is the danger of the disease?

The consequences of dropsy largely depend on the age at which the disorders occurred and the development of complications:

• Infants experience high excitability, sleep disturbances, and increased muscle tone. The most severe manifestation is developmental delay and mental deviations.
• Preschoolers show aggression, stutter, develop strabismus, and experience developmental delays.
• School-age children experience memory loss and headaches. The learning process is difficult.
• In adults, epilepsy, increased excitability, and hallucinations appear.

The danger of the disease in adulthood is the development of mental disorders, motor functions and motor skills. If urgent measures are not taken, the patient becomes disabled.

Why should you contact the Mama Papa Ya clinic?

The network of family clinics “Mama Papa Ya” has a wide network of branches in Moscow and other cities and offers medical services]at affordable prices[/anchor]:

• consultation with a pediatrician to identify symptoms of pathology in the child;
• consultation with a neurologist and ophthalmologist;
• observation and rehabilitation after surgical treatment of hydrocephalus;
• accurate instrumental diagnosis of the state of the brain;
• the possibility of treating both children and adults in one clinic.

If you suspect such a pathology, we invite you to sign up for a consultation at the nearest branch by phone or on our website.

Reviews

Good clinic, good doctor!
Raisa Vasilievna can clearly and clearly explain what the problem is. If something is wrong, she speaks about everything directly, not in a veiled way, as other doctors sometimes do. I don’t regret that I ended up with her. Anna

I would like to express my gratitude to the staff of the clinic: Mom, Dad, and me. The clinic has a very friendly atmosphere, a very friendly and cheerful team and highly qualified specialists. Thank you very much! I wish your clinic prosperity.

Anonymous user

Today I had a mole removed on my face from dermatologist I.A. Kodareva. The doctor is very neat! Correct! Thanks a lot! Administrator Yulia Borshchevskaya is friendly and accurately fulfills her duties.

Belova E.M.

Today I was treated at the clinic, I was satisfied with the staff, as well as the gynecologist. Everyone treats patients with respect and attention. Many thanks to them and continued prosperity.

Anonymous user

The Mama Papa Ya clinic in Lyubertsy is very good. The team is friendly and responsive. I recommend this clinic to all my friends. Thanks to all doctors and administrators. I wish the clinic prosperity and many adequate clients.

Iratyev V.V.

We visited the “Mama Papa Ya” Clinic with our child. A consultation with a pediatric cardiologist was needed. I liked the clinic. Good service, doctors. There was no queue, everything was the same price.

Evgeniya

I liked the first visit. They examined me carefully, prescribed additional examinations, and gave me good recommendations. I will continue treatment further; I liked the conditions at the clinic.

Christina

The doctor carefully examined my husband, prescribed an ECG and made a preliminary diagnosis. She gave recommendations on our situation and ordered additional examination. No comments so far. Financial agreements have been met.

Marina Petrovna

I really liked the clinic. Helpful staff. I had an appointment with gynecologist E.A. Mikhailova. I was satisfied, there are more such doctors. Thank you!!!

Olga

How is replacement hydrocephalus diagnosed?

Even an experienced doctor finds it difficult to make an accurate diagnosis of this disease based on the patient’s complaints and visual signs.

For a complete examination, the following methods are used:

• Magnetic resonance therapy (MRI) is the most informative study, allowing one to see the enlarged cavities of the ventricles of the brain, atrophic changes in its tissues, and an increased volume of cerebrospinal fluid;
• Angiography – X-ray examination of cerebral vessels;
• Ultrasound of the brain;
• X-ray of the skull;
• Fundus ophthalmoscopy;
• Carrying out a PCR reaction to determine in the blood antibodies to pathogens of herpes, toxoplasmosis, rubella, syphilis if an infectious cause of the disease is suspected.

If replacement hydrocephalus occurs in a moderate form with minimal symptoms, you need to undergo examination every 6 months to timely detect the negative dynamics of the disease. If symptoms of increased intracranial pressure are severe, treatment should be started immediately.