pediatric external hydrocephalus
Introduction
Introduction to external hydrocephalus in children External hydrocephalus (EH) is a benign, self-healing disease that occurs in infancy. With the development of neuroimaging, some infants with larger heads were found in the clinic. Head CT and MRI showed a subarachnoid widening on both frontal or frontal foreheads, with no or only mild ventricular enlargement. After the age of 3 years, the enlarged subarachnoid space slowly disappears. This phenomenon is called EH, also known as benign subarachnoid enlargement, benign subdural effusion in infants, cerebral obstructive hydrocephalus, Water outside the brain, etc., belongs to pseudo hydrocephalus. basic knowledge The proportion of sickness: 0.01% Susceptible people: children Mode of infection: non-infectious Complications: facial muscle twitching
Cause
Causes of external hydrocephalus in children
(1) Causes of the disease
Can be divided into primary and secondary two, primary EH refers to the EH can not find a clear cause, secondary EH refers to EH caused by certain pathological factors, can be seen in premature birth, lack of oxygen Bloody encephalopathy, intracranial hemorrhage, hyperbilirubinemia, purulent meningitis, vitamin A deficiency, etc.
(two) pathogenesis
The pathogenesis of EH is still unclear. Most scholars believe that the increase of intracranial venous pressure caused by extracranial venous obstruction, especially the increase of superior sagittal sinus pressure, is related to the absorption of cerebrospinal fluid in the arachnoid granule level. Recently, some studies have suggested that EH may be It is caused by the delayed development of arachnoid function. Some scholars believe that EH may be caused by uneven development of brain and skull. Some scholars have suggested that the CT or MRI of primary EH may be the development of some normal infants. The special pathological significance, CT showed that the ventricle was not enlarged, but the basal pool, lateral fissure, longitudinal fissure pool and cerebral hemisphere sulcus widened.
The subarachnoid space has been enlarged. Some people think that it may be an early manifestation of traffic hydrocephalus. Some people think that this manifestation is benign. The self-limited subarachnoid space is enlarged and is not a traffic hydrocephalus because in 2 Infants and young children, the growth rate of the skull is faster than that of the brain, the gap between the brain and the skull is increased, and the sulcus, fissure, and pool are relatively wide on CT. Under normal circumstances, the subarachnoid surface of the brain The cavity can be as wide as 4mm, the longitudinal fissure pool is 6mm, and the lateral fissure pool is 10mm. All of them are in the normal range. After 18 months to 2 years old, the brain development is accelerated, the gap between the brain parenchyma and the skull is gradually reduced, and the subarachnoid space is widened. The situation is no longer obvious.
Prevention
Pediatric external hydrocephalus prevention
1. Promote eugenic knowledge and reduce parity.
2. Promote the right age to give birth.
3. Strengthen eugenics education and improve the cultural quality of the population to enhance the people's ability to accept eugenics education and self-care awareness.
4. Safe production, beware of suffocation, birth injury, pregnant women must be produced in a hospital with better environmental conditions, do not delay the production process in the production process, beware of perinatal suffocation, lack of oxygen, prevent birth injury.
5. Other prevention of various infectious diseases, prevention of vitamin A deficiency and hyperbilirubinemia.
Complication
Pediatric external hydrocephalus complications Complications facial muscle twitching
Some children have seizures and the anterior tendon tension is increased.
Symptom
Symptoms of external hydrocephalus in children Common symptoms Hydrocephalus twitching sputum closed late head increased before sputum tension increased
The age of onset of the disease is between 1 and 1.5 years old. Before the closure of the anterior iliac crest, the infants occurred in about 6 months. The foreign investigation found that more than 80% of the cases had a large family history, often with a head circumference increase. Some children have The seizure occurred, the tension of the anterior iliac crest was increased and the bulge was delayed, and the sacral closure was delayed. Although the head was large, there was no hydrocephalus, and there was no sign of the eye. The development and intelligence of the child were mostly normal.
Examine
Examination of external hydrocephalus in children
Generally, there is no abnormality in primary EH laboratory examination. Secondary EH may have different laboratory findings, such as vitamin A deficiency and anemia.
CT showed that the ventricle enlargement was not obvious, while the basal pool, lateral fissure, longitudinal fissure pool and cerebral hemisphere sulcus widened, and the subarachnoid space was enlarged. Under normal conditions of infants under 2 years old, the subarachnoid space on the brain surface could be wide. Up to 4mm, 6mm longitudinal slitting pool and 10mm lateral fissure pool are all in the normal range. After 18 months to 2 years old, brain development is accelerated, the gap between brain parenchyma and skull is gradually reduced, and the subarachnoid space is no longer widened. obvious.
The performance of a head CT or MRI scan is symmetrical, showing:
1. The subarachnoid space in the frontal and frontal areas is widened by >5 mm (normal <2.3 mm), and the subarachnoid space in other areas is not widened or slightly wider.
2. The longitudinal fissure pool and lateral fissure pool in the front of the brain are widened.
3. The basement pool is mainly enlarged by the upper saddle pool.
4. The ridge of the forehead area is deepened and widened.
5. The ventricles are not large or slightly enlarged.
Diagnosis
Diagnostic identification of external hydrocephalus in children
EH is mainly diagnosed based on short-term head circumference increase and unique CT or MRI findings. The reference standard is:
1. Abnormal increase in head circumference: In the short-term (1 to 3 months), the head circumference of the child is abnormally increased, and some convulsions or anterior hernia are present.
2. Development and intelligence are normal.
3. Auxiliary examination: Skull CT or MRI scan showed a localized widening of the symmetry of the subarachnoid space in the bilateral frontal and frontal areas, with or without mild enlargement of the ventricle.
4. Expanded subarachnoid space self-recovery: Follow-up observation of the enlarged subarachnoid space can slowly return to normal.
Need to identify with brain atrophy, hydrocephalus and subdural accumulation.
1. Brain atrophy: The head circumference of the child is not large or smaller. On the CT or MRI of the head, the whole brain sulcus is generally deepened and widened, sometimes the cerebral sulcus is deepened, the ventricle is enlarged, and most cases have no anterior ventricle. The split pool is widened. When the brain longitudinal split pool is widened, the entire longitudinal split pool is wide and not limited to the front.
2. Subdural effusion: mostly due to meningitis and trauma, head CT or MRI scan showed that subdural effusion was not accompanied by basal pool enlargement and anterior longitudinal fissure widening, often accompanied by ventricular compression, its enlarged lumen The inner edge is smoother and the left and right sides are more asymmetrical.
3. Hydrocephalus: Increased intracranial pressure, there are signs of diurnal, eye performance and cranial nerve damage, etc., auxiliary examination such as gas cerebral angiography can help identify.
