Ventricular edema of the brain in newborns
Increased cerebral ventricles in newborns
Before answering the question of why the ventricles of the brain are dilated in a child, one should have an idea of what these ventricles are.
Brain ventricles are a whole system that communicates between the cavities in the brain, necessary for the deposition of cerebrospinal fluid (CSF).
Lateral ventricles. Are all the same capacity in the headbrain, intended for the deposition of cerebrospinal fluid. By their size, the lateral ventricles outweigh all the others. The ventricle located on the left side is designated as the first, and the one on the right is the second. Both lateral ventricles communicate with the third ventricle with the help of special (monrope) openings. The location of these ventricles is the lateral sides, slightly below the corpus callosum. The lateral ventricles contain anterior, posterior, lower horns and body.
The fourth ventricle. It is a very important education of the headbrain, and is located in the gap between the medulla oblongata and the cerebellum. In its structure, the fourth ventricle looks like a rhombus, but many associate its shape with the shape of the tent, which has a roof and a bottom. The very bottom of the fourth ventricle has a rhomboid shape, which is why it is called a diamond-shaped fossa. In this anatomical formation there is a spinal canal, as well as a channel communicating the fourth ventricle with a water pipe.
In addition to the cumulative function, cerebral ventriclesstill perform a generating function, namely the formation of cerebrospinal fluid. Normally, the synthesized cerebrospinal fluid must enter the subarachnoid space, but there are situations when this process fails. If the body breaks the normal outflow of cerebrospinal fluid from the ventricles, this condition is called hydrocephalus.
What is the expansion of the ventricles in the child?
Do not always panic if there is athis state. Increasing the size of the brain's ventricles in the child does not always signal a pathological process. This process can be physiologically conditioned, and he says only that the child just has a large head size. The increase in the ventricles of the brain is not uncommon in children before the first year of life. In this case, it is necessary to establish the dimensions of not only all ventricles, but also other liquor systems.
Excess accumulation of CSF is the basiswhy the ventricles of the brain can be enlarged in a baby or a child of an early age. Violation of the outflow of cerebrospinal fluid can be caused by a certain obstacle in the way of its exit.
Such a condition as an increase in the ventriclesof the brain in a child, most often observed in children born before the term. This is due to the fact that in such children the size of the lateral ventricles is relatively larger than that of children born according to the term. If there is a suspicion of an increase or asymmetry of the lateral ventricles, it is necessary to measure them and determine the qualitative characteristics. Let us consider in more detail the conditions under which an increase in the size of the ventricles of the brain in children is possible.
Under this pathology is meant an increasecavities of the cerebral ventricles, as a result of which a number of disorders are developing from the functions of the CNS. Most often this pathology affects the lateral ventricles of the brain.
By severity, this disease can be divided into heavy, medium and light forms. Depending on the localization of the pathological process, ventriculomegaly is divided into the following types:
- Lateral shape. With this form, the lateral and posterior ventricles are enlarged.
- Type No. 4. Affects the area of the cerebellum and medulla oblongata.
- Type No. 3. The pathological process is localized in the area between the visual crescents and the frontal part.
The main cause of the development of this process are chromosome abnormalities in the body of a pregnant woman. To secondary causes of the development of the disease include all kinds of infections.
Such a complex pathology can cause the child to develop Turner and Down syndrome. Moreover, ventriculomegaly affects the structure of the brain and heart.
A pathological increase in the ventricles of the brain is determined using ultrasound diagnosis of the brain.
The key moment in the treatment of this pathologyis the maximum prevention of possible complications on the part of organs and systems. First of all, drug therapy is provided, which includes the intake of diuretics, vitamin preparations and antihypoxic drugs. Additional methods include massage and special therapeutic gymnastics. To prevent the development of serious neurological complications, the reception of drugs detaining potassium ions in the child's body is shown.
It is also impossible to exclude another possible variant of the pathology, in which the ventricles of the brain in the infants will be dilated, viz. hypertensive-hydrocephalic syndrome (HGS) .
Under this syndrome is meant a state,characterized by excessive production of cerebrospinal fluid, which has the property of accumulating under the envelopes of the brain and in its ventricles. From the point of view of frequency of occurrence, the hypertensive-hydrocephalic syndrome is a rather rare pathology, and it requires a serious justification.
Classify this pathology according to the age of children, and allocate GGS for newborns, and children, older.
All the reasons for the appearance of HGS can be conditionally divided into congenital and acquired. To innate reasons can be attributed:
- Complicated during the period of pregnancy with subsequent complicated birth.
- Damage to the brain of the child due to intrauterine oxygen starvation, malformations and birth trauma.
- Childbirth before the due date.
- Intra-traumatic injury with subsequent hemorrhage into the subarachnoid space.
- Any intrauterine infection.
- Anomalies of the development of the brain.
- Late childbirth.
- A long period of time between the passage of amniotic fluid and the expulsion of the fetus.
- Some chronic diseases of the mother.
To the acquired reasons of GGS can be attributed:
- Any tumor formation of the brain (cysts, hematomas, abscesses).
- The presence of a foreign body in the brain.
- Fractures of cranial bones with the subsequent introduction of bone particles into the brain.
- Infectious diseases.
- Unidentified cause of GHS.
How does the disease manifest itself?
At the heart of the whole clinical picture of the hypertensive-hydrocephalic syndrome lie the following factors:
- Increased intracranial pressure (hypertension).
- Increase in the number of cerebrospinal fluid in the ventricles (hydrocephalus).
In newborn children, HGS can be suspected for a number of the following symptoms:
- The child refuses breastfeeding, cries and is capricious for no particular reason.
- Reduces the overall muscle tone.
- Quivering (tremor) of the upper lower extremities often develops.
- All congenital reflexes, such as swallowing and grasping, are sharply reduced.
- There is frequent regurgitation.
- Strabismus develops.
- During the medical examination, the child may have a symptom of the rising sun, when the child's iris of the eye is half covered by the lower eyelid.
- There is a discrepancy between the cranial sutures, in particular, the sagittal suture.
- Rodnichki tense and bulging.
- With each month there is a pathological increase in the indices of the head circumference.
- During the examination of the fundus, the edema of the visual discs is clearly visible.
In older children, the manifestation of the symptoms of HGS develops immediately after the transferred infectious process or craniocerebral trauma.
The most characteristic sign of an increaseventricles of the brain in a child and the development of HGS, is the appearance of a headache, which often appears in the morning. Also, constant nausea and vomiting are characteristic. Headache is oppressive or bursting, and localized in the area of the temples or forehead.
Often such children complain about the lack ofthe ability to lift up your eyes and at the same time lower your head down. There are also cases of dizziness. During typical seizures, the child's skin becomes pale, there is a general weakness and unwillingness to do anything. Loud sounds and bright lights, for such children are strong irritants.
Due to the increased tone in the muscles of the lower extremities, such children can walk on their toes, they develop strabismus, there is increased drowsiness and slowing of psychomotor development.
In general, conduct an accurate diagnosishypertensive-hydrocephalic syndrome, and to understand whether the ventricle of the brain is really enlarged in a newborn is quite difficult. Not always, even the latest diagnostic methods allow you to put this diagnosis with an accuracy of 100%. In children in the period of newborns, the main diagnostic criteria are the indices of the head circumference and the control over the reflexes. Other diagnostic measures include:
- Assessment of the state of the vascular network of the fundus for swelling, hemorrhage, or spasm.
- Conducting neurosonography to determine the size of the ventricles of the brain.
- MRI and computed tomography of the brain.
- Lumbar puncture to determine the pressure of the cerebrospinal fluid. This method is the most reliable.
Treatment of this pathology should deal witha neuropathologist together with a neurosurgeon. Children with this syndrome should be under constant medical supervision to avoid possible complications and worsening of the condition. In new-born children up to six months, an increase in the ventricles of the brain and GGS is treated as an outpatient. The main medical measures include:
- Receiving diuretics (diuretics), as well as drugs that reduce the production of cerebrospinal fluid (Diacarb).
- Inclusion in the therapy of nootropic drugs. This group of drugs improves blood flow to the brain.
- Taking sedatives.
- Special gymnastics and massage.
The treatment of infants is long and serious. Sometimes it takes several months.
In older children, treatment of GGSis pathogenetic in nature, and the choice of therapy is conducted according to the cause that caused this syndrome. If the disease occurred after the infection, then therapy necessarily includes the use of antibacterial or antiviral drugs.
If the cause of HGS is a craniocerebral injury or a tumor process, then surgery is not excluded.
Such a condition as hypertensive-hydrocephalic syndrome can cause a number of complications from various organs and systems. Such complications include:
- Delay in psychomotor development.
- Complete or partial blindness.
- Persistent hearing impairment up to deafness.
- Development of coma.
- Full or partial paralysis.
- Abnormal bulging of the fontanel.
- The development of epileptic seizures.
- Incontinence of feces and urine.
- Lethal outcome.
The most favorable forecast is forchildren in the period of infancy. This is associated with a periodic increase in arterial and intracranial pressure, which with age comes back to normal. For older children, the predictions are less favorable, and depend solely on the cause that led to the development of HGS, as well as the approach to treatment.
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