The cause of disease
There are many reasons. Congenital dysplasia is the main reason, and acquired diseases such as intracranial infection, hemorrhage, intracranial tumor and trauma can also be seen.
According to the nature of cerebrospinal fluid system dysfunction, it can be divided into obstructive (non-communicating) hydrocephalus and non-obstructive (communicating) hydrocephalus. Due to the long-term increase of pressure in the ventricle, the brain tissue is compressed and denatured, which can become extremely thin.
symptom
Congenital hydrocephalus in infants and young children generally begins to expand their heads a few weeks after birth, and it usually takes 3 ~ 5 months to be gradually discovered. Some people have already expanded their heads at birth. Clinically, especially because of the increase of intracranial pressure, the skull gradually increases abnormally, which is out of proportion to the whole body development. The forehead protrudes forward, the orbital apex presses down, the eyes look down, and the eyeballs turn down, which leads to the whitening of the upper sclera, the enlargement of the anterior fontanel, the increase of tension, the enlargement of other fontanels, the separation of skull suture and the expansion of scalp veins. When the infant's suture is not closed and the intracranial pressure is increased, the skull can be compensatory enlarged, so the symptoms of early intracranial pressure increase may not be obvious. However, when hydrocephalus is serious and progresses rapidly, it can also appear, and its symptom is repeated vomiting. Brain degeneration, brain developmental disorder, central paralysis of limbs, especially lower limbs, often lead to intellectual changes and developmental disorders. Compression and atrophy of optic nerve can lead to blindness. Nystagmus and spasms are also common. It is usually complicated by deformities in other parts of the body.
In a few cases, hydrocephalus can stop itself after a certain period of development, the skull will not continue to increase, and the intracranial pressure is not high, which becomes "static hydrocephalus".
cheque
According to the typical clinical symptoms such as head swelling and protrusion, it is generally not difficult to diagnose. During the examination, the skull size of early suspected children was measured regularly, including circumference, anteroposterior diameter and interaural diameter. The head circumference of a normal newborn is 33 ~ 35cm. The posterior fontanel was closed at 6 weeks after birth, and the anterior fontanel was closed in September ~1August. These data can be used as a reference. In order to further clarify the diagnosis and understand the nature and degree of hydrocephalus, the following examinations can be carried out:
(1) X-ray plain film of skull: it can show enlargement of skull, asymmetry of head-face ratio, thinning of skull, separation of cranial suture, delayed closure or obvious enlargement of anterior and posterior fontanels, etc.
(2) CT scan of the head: it can show the nature of the enlarged ventricular system and brain parenchyma, which is helpful to distinguish whether there are diseases such as brain tumors.
(3) There was no midline wave shift and the lateral ventricle or the third ventricle was enlarged by skull ultrasound.
(4) Anterior fontanel puncture: excluding subdural hematoma or hydroma, which often cause skull enlargement. You can also know the thickness of the cerebral cortex and the pressure in the ventricle (50 ~ 60 mm water column for normal infants).
(5) ventriculography: It is of great significance to judge whether there is aqueduct, obstruction of the fourth ventricle, degree of ventricular enlargement and ventricular malformation, to exclude subdural hematoma and effusion, and to distinguish communicating hydrocephalus from non-communicating hydrocephalus.
treat cordially
Divided into non-surgical treatment and surgical treatment.
Generally, mild hydrocephalus should be treated by non-surgery, mainly dehydration therapy (mannitol) and systemic support therapy.
Surgical treatment is suitable for cases with high intraventricular pressure (above 250 mm water column) or failure of non-surgical treatment. Severe hydrocephalus, such as head circumference exceeding 50cm, cerebral cortex atrophy thickness below 65438±0cm, has been complicated with serious dysfunction and deformity, and the surgical effect is not good.
Most surgical methods are cerebrospinal fluid shunt. Postoperative care should be taken to prevent complications, such as thrombus blocking catheter, heart thrombosis, endocarditis, septicemia, etc.