hypertensive hydrocephalus
Introduction
Introduction to high intracranial hydrocephalus High intracranial pressure hydrocephalus is essentially due to occlusion of the ventricular system and subarachnoid space in the cerebrospinal fluid circulation pathway, causing an increase in the average intraventricular pressure or pulsating pressure to produce a ventricular enlargement, so that it cannot be compensated, and corresponding clinical symptoms appear. Most of the high intracranial pressure hydrocephalus is secondary, and there may be a clear cause such as subarachnoid hemorrhage or meningitis. It often occurs 2 to 3 weeks after the onset of the disease. After the original condition improves, symptoms such as headache and vomiting appear, or the symptoms are further aggravated. Most patients have unexplained or secondary diseases such as intracranial tumors. basic knowledge The proportion of illness: the incidence rate of hypertension patients is about 0.05% - 0.08% Susceptible people: no specific population Mode of infection: non-infectious Complications: precocious puberty
Cause
Cause of high intracranial hydrocephalus
(1) Causes of the disease
The most common cause is cerebrospinal fluid occlusion in various parts of the circulation pathway, and excessive production of cerebrospinal fluid or malabsorption is rare.
(two) pathogenesis
1. Developmental abnormalities of the cerebrospinal fluid circulation pathway are congenital stenosis of the midbrain aqueduct, occlusion, bifurcation and glial cell proliferation around the aqueduct are common. Patients with aortic stenosis often have a diencephalic brain due to proximal hydrocephalus Pressing down forces the aqueduct to bend, which increases the degree of stenosis and obstruction. In addition, patients with Dandy-Walker syndrome and Arnold-Chiari malformation can have cerebrospinal fluid circulation obstruction, cerebrospinal fluid circulation pathway obstruction is mostly incomplete, completely Sexual obstruction is difficult to survive.
2. Inflammatory adhesion The inflammatory adhesion of the cerebrospinal fluid circulation pathway is one of the common causes of hydrocephalus. The site is more common in the aqueduct, the occipital pool, the bottom of the brain and the ring pool. It can also occur in the cerebral hemisphere convex surface. Some patients may accompany There are local cysts, causing the corresponding symptoms of compression. Adhesion may be caused by intracerebral hemorrhage, inflammation and trauma. Intracranial hemorrhage may cause inflammatory reaction in the brain, and blood mechanization forms adhesions or blood absorption blocks the arachnoid granules, thus affecting the clearing of cerebrospinal fluid. Circulation and absorption, intracranial inflammation caused by various reasons, especially meningitis such as purulent meningitis or tuberculous meningitis can also cause intracranial adhesions or block arachnoid granules and cause hydrocephalus. Patients with craniocerebral surgery also It can cause hydrocephalus due to postoperative intracranial hemorrhage and inflammatory reaction. Some intracranial tumors such as craniopharyngioma and cholesteatoma contents may cause changes in hydrocephalus after the spillover.
3. Intracranial space-occupying lesions All tumors located in the cerebrospinal fluid circulation pathway and its adjacent sites can cause hydrocephalus. For example, tumors in the lateral ventricle and parasitic cysts can cause one or both sides. Ventricular enlargement; tumors in the third ventricle or tumors in the anterior and posterior ventricles such as pineal tumors, craniopharyngioma, etc. can compress the third ventricle to cause enlargement of the ventricular system above the third ventricle; tumors in the fourth ventricle and its surrounding areas such as four Ventricular tumors, cerebellar vermis and hemisphere tumors, brainstem tumors, and cerebellopontine angle tumors can be compressed to block the expansion of the fourth ventricle or the outlet of the fourth ventricle. Other sites such as hemisphere glioma and arachnoid cyst can also be oppressed. Blocking the cerebrospinal fluid circulation pathway causes hydrocephalus.
4. Cerebrospinal fluid produces excessive choroid plexus papilloma or hyperplasia in the ventricle, which can secrete excessive cerebrospinal fluid and its absorption function does not increase and traffic hydrocephalus occurs. In addition, vitamin A deficiency can also cause secretion of cerebrospinal fluid. Loss of balance with absorption and cause hydrocephalus.
5. Cerebrospinal fluid absorption disorders such as venous sinus thrombosis.
6. Other developmental abnormalities such as no cerebral malformation, flat skull base, and achondroplasia can cause hydrocephalus.
Prevention
High intracranial hydrocephalus prevention
Active treatment of primary lesions that cause obstruction helps prevent the formation and development of hydrocephalus. It is very important to maintain a good attitude, to maintain a good mood, to have an optimistic, open-minded spirit, and to be confident in the fight against disease. Don't be afraid, only in this way can you mobilize your subjective initiative and improve your body's immune function.
Complication
High intracranial hydrocephalus complications Complication precocious
High intracranial pressure hydrocephalus can sometimes show symptoms of primary lesions, such as four ventricle cysts or tumors may have forced head or head position changes after symptoms, etc., patients with hydrocephalus caused by pineal tumors may have eyeballs Difficulty in upper vision, dilated pupils or large, may be associated with sexual precocity or sexual development retardation.
Symptom
Symptoms of high intracranial hydrocephalus common symptoms memory disorder nausea and vomiting cerebellar ataxia crying screaming visual impairment double vision ataxia
Most of the high intracranial pressure hydrocephalus is secondary, and there may be a clear cause such as subarachnoid hemorrhage or meningitis. It often occurs 2 to 3 weeks after the onset of the disease, and headaches, vomiting, etc. occur after the original condition improves. Symptoms, or symptoms, are further exacerbated, and most patients are unexplained or secondary to diseases such as intracranial tumors.
The clinical manifestations of high intracranial hydrocephalus include headache and vomiting as the main clinical symptoms. In addition, there may be ataxia. In severe cases, symptoms such as unclear vision and diplopia may occur. The symptoms such as headache and vomiting are mostly specific. Sexuality, headache is most common with the bilateral sacral side. When the patient is in the supine position, the cerebrospinal fluid reflux is reduced. Therefore, the patient has increased headache after lying in the morning position or in the morning, and the headache can be relieved when the patient is in the lying position. Progress, headache can be persistent severe pain, when accompanied by cerebellar tonsil sputum, headache can affect the neck occipital, and even have a forced head position, vomiting is a common symptom of high intracranial hydrocephalus in addition to headache, often With severe headache, it has nothing to do with the position of the head. The symptoms of headache can be relieved after vomiting. Visual impairment is common in patients with hydrocephalus. It occurs mostly in the middle and late stages of the disease development. It can be expressed as visual acuity due to fundus edema. Unclear, double vision, late vision loss, diplopia mainly due to increased intracranial pressure, resulting in the longest intracranial stroke caused by paralysis, patients with ataxia, torso ataxia See performance for standing firm, foot away from the wide, big stride, rarely showed cerebellar ataxia, hydrocephalus terminally ill patients may have memory loss, especially in recent memory loss, mental deterioration, poor computing power.
Examine
Examination of high intracranial hydrocephalus
Cerebrospinal fluid examination pressure can be increased, biochemical indicators are generally normal, but when the intracranial pressure is too high, lumbar puncture may induce cerebral palsy, which needs attention.
CT or MRI can determine the extent of ventricular enlargement and degree and cortical atrophy, and sometimes can also understand the cause of hydrocephalus. In addition, CT or MRI can also understand whether hydrocephalus is acute hydrocephalus or chronic hydrocephalus. The application of treatment measures provides a basis for the diagnosis of hydrocephalus, which should be distinguished from the enlargement of the ventricle caused by brain atrophy. The expansion of the ventricle can obviously show lateral fissures or sulci, and even have sulci and The cerebral fissure is obviously enlarged, and the diagnosis of hydrocephalus should be as clear as possible as obstructive hydrocephalus or traffic hydrocephalus.
Diagnosis
Diagnosis and differentiation of high intracranial pressure hydrocephalus
diagnosis
With the wide application of CT and MRI, the diagnosis of hydrocephalus is not difficult. The key is that patients with symptoms such as headache and vomiting should pay enough attention to timely CT or MRI for early diagnosis.
Differential diagnosis
Low-grade astrocytoma, intraventricular cysts, can be identified by MRI, and also need to be differentiated from localized ventricular enlargement.
