hydrocephalus
Introduction
Introduction Hydrocephalus refers to an increase in the volume of intracranial cerebrospinal fluid. In addition to neurological signs, there is often mental decline or dementia. Hydrocephalus is a chronic disease of cerebrospinal fluid caused by excessive secretion of cerebrospinal fluid caused by intracranial diseases or (and) circulation and absorption disorders, and a chronic disease of ventricle enlargement, which belongs to the category of "solving the skull" of traditional Chinese medicine. Clinical children often see enlarged head, enlarged sputum, fullness of tension, cranial suture, dysfunction, falling eyes, vomiting, convulsions, language and movement disorders, mental retardation; adult more intermittent headache, head swelling, head sinking, dizziness , tinnitus ear plugs, decreased vision, weakness of limbs, etc.
Cause
Cause
There are many causes of hydrocephalus, and there are several common reasons:
1) Congenital malformations such as midbrain aqueduct stenosis, decidual formation or atresia, interventricular pore atresia (fourth ventricle median or lateral occlusion), cerebral vascular malformation, spina bifida, cerebellar tonsil sac.
2) infection of intrauterine infections such as various viruses, protozoa and treponema pallidum meningitis failed to control early, hyperplastic fibrous tissue obstructs the circulation of cerebrospinal fluid, or fetal intracranial inflammation can also make the brain pool, subarachnoid Cavity and arachnoid adhesions are occluded.
3) Bleeding Fibroplasia caused by intracranial hemorrhage, malabsorption of intracranial hemorrhage due to birth injury.
4) Tumors can block any part of the cerebrospinal fluid circulation, more common in the vicinity of the fourth ventricle, or choroid plexus papilloma.
5) Others Some hereditary metabolic diseases, perinatal and neonatal asphyxia, severe vitamin A deficiency.
Examine
an examination
1. Head line adjustment or CT examination: the cranial cavity is enlarged, the skull is thinned, the cranial suture is separated and the anterior ankle is enlarged.
2. Lumbar puncture: the side cavity was injected with neutral phenol red 1m1, lumbar puncture was performed within 2 to 12 minutes, and phenol red was found in CSF, suggesting that non-obstructive hydrocephalus was water. If phenol red does not appear in the CSF for 20 minutes, it is suggestive of obstructive hydrocephalus.
3. Ventricular angiography: Slowly injecting filtered oxygen into the ventricles, and then performing X-ray examination, the ventricular enlargement and thinning of the cerebral cortex can be observed. If the thickness of the cerebral cortex is more than 2 cm, and the hydrocephalus can be relieved, the patient's intelligence is expected to recover. At the same time, ventriculography can also help identify obstructed areas or find intracranial tumors. Ventricular gas or water-soluble iodine imaging can show the shape and size of the ventricular system and the thickness of the cerebral cortex.
4. Two-dimensional ultrasound examination of the skull: It can be seen that there is no displacement of the midline wave and the ventricular system is enlarged.
5. CT or MRI scan: see the ventricular system is significantly enlarged, and sometimes can detect the cause of hydrocephalus.
Diagnosis
Differential diagnosis
In babies, care should be taken to identify the following:
1. Immature children: The head enlarges faster, some resembles hydrocephalus, but the ventricles are not large.
2. Rickets: The skull is mostly square and has other symptoms of rickets.
3. Malformed head: The head is large, the growth is fast, there is obvious mental deficiency, no eyeball drooping phenomenon, ventriculography is normal.
4. Chronic subdural hematoma, the head enlargement is slower, more red or yellow liquid can be seen under the dura mater, and there is bleeding in the fundus. CT can confirm the diagnosis.
5. Intracranial space-occupying lesions such as tumors, abscesses, etc.
In the elderly, hydrocephalus also needs to be differentiated from the expansion of the relative ventricular system caused by brain atrophy. Both can be identified from symptoms, imaging studies and other aspects. Simple brain atrophy, no typical symptoms of hydrocephalus, such as dementia, urinary incontinence and gait instability. On CT and MRI, the ventricular system of brain atrophy is enlarged, and the sulcus is widened. The key is that there is no edema around the ventricle.
Clinical symptoms are not consistent, and are related to the age of pathological changes, the severity of pathology, and the length of the disease. Fetal congenital hydrocephalus is more than stillbirth. After birth, hydrocephalus may appear at any age, most of which occurs 6 months after birth. In younger patients, the cranial suture is not joined, and the skull is easily enlarged, so the symptoms of increased intracranial pressure are less. Hydrocephalus is mainly manifested by a rapid and progressive increase in the skull several weeks or months after birth. Normal infants increase 1.2-1.3cm per month in the first six months of the head, and 2-3 times in this case. The skull is round, the frontal forehead, the head and ankle are abnormally enlarged, and the anterior ankle is enlarged and raised. Separation of the seams, thinning of the skull, and even transparency, the appearance of "broken pot sound" (Maceen) sign. The forehead is presented with a swelled vein, the eyeball is under the spine, and the upper sclera is often exposed (sunset sign). The sick infant is apathetic, the head can not be lifted, and severe cases may be associated with brain dysfunction, manifested as epilepsy, vision and olfactory disturbance, nystagmus, strabismus, limb paralysis and intelligent disorders. As the baby's head is compensatory, headache, vomiting and optic nerve head edema are not obvious.
