Hydrocephalic syndrome ( hypertensive-hydrocephalic syndrome or HGS) is a condition characterized by excessive production of cerebrospinal fluid (CSF) that accumulates under the meninges and in the ventricles of the brain.
Hydrocephalic syndrome as a term adopted only in the former USSR and in modern Russia. Western doctors refer to hydrocephalic syndrome to any pathology of the brain.
The syndrome is often put in diagnoses by children’s neurologists, and, as a rule, without a reason. HGS is a rather rare pathology, and in 97% of cases the diagnosis of hydrocephalic syndrome has no right to exist.
Depending on the age of the patient, the following types of hydrocephalic syndrome are distinguished:
- hypertensive-hydrocephalic syndrome in newborns;
- GHS in children;
- GHS in adults.
Congenital causes of hydrocephalic syndrome (HGS in newborns) and acquired are distinguished.
Congenital causes of hydrocephalic syndrome
- during pregnancy and childbirth with complications;
- hypoxic (bradycardia, intrauterine hypoxia and intrauterine growth retardation) and ischemic (trauma during labor) brain damage;
- preterm labor (up to 36-34 weeks);
- head injuries during labor (subarachnoid hemorrhage);
- intrauterine infections ( toxoplasmosis, influenza, cytomegalovirus infection and others);
- congenital malformations of the brain;
- late delivery (42 weeks and later);
- long anhydrous period (more than 12 hours);
- chronic maternal diseases (diabetes and others).
Acquired causes of hydrocephalic syndrome:
- tumors, abscesses, hematomas, parasitic cysts of the brain;
- foreign bodies in the brain;
- fractures of the skull bones with the introduction of fragments in the brain;
- causeless intracranial hypertension;
- infectious diseases ( malaria, tick-borne encephalitis );
- post stroke disorders;
- metabolic disorders.
The hypertensive-hydrocephalic syndrome clinic is explained by two concepts:
- hypertension (increased intracranial pressure)
- hydrocephalus (an increase in the amount of cerebrospinal fluid in the brain).
Signs of Hydrocephalic Syndrome in Newborns
Parents note that the child takes the breast badly, constantly cries for no apparent reason, sometimes groans.
The child is celebrated
- reduced muscle tone (“seal paws” and “heel feet”)
- mild congenital reflexes (swallowing, grabbing)
- tremor (convulsions) and seizures may occur
- regurgitation of the fountain is noted, the squint is observed
- when examined by a doctor, a positive symptom of a grefe is observed (a white line between the pupil and the upper eyelid) and a symptom of the rising sun (the iris is almost half hidden behind the lower eyelid)
- also characterized by the opening of the seams of the skull ( in particular the sagittal) and bulging and tension of the springs
- in dynamics there is an increased increase in head circumference (by 1 cm every month)
- when examining the fundus observed swelling of the optic discs
Clinical manifestations of HHS in children
Symptoms of hypertensive-hydrocephalic syndrome in older children tend to develop after an infection or brain injury.
A characteristic symptom is a headache, often occurring in the morning, nausea and vomiting, following it. The pains are in the nature of dull, aching or arching and localized in the area of the temples, forehead and brows
Children complain that it is difficult for them to raise their eyes and lower their heads. Often there are dizziness (young children define it as “swing on a swing” or “instability of objects”).
During an attack of pain in a patient, paleness of the skin, weakness and lethargy is noted. They are irritated by a bright light, a loud sound.
Also characteristic of walking on tiptoe due to the increased tone of the leg muscles, squint, drowsiness and slow thinking, poor memory and attentiveness.
Hydrocephalic syndrome in adults
HGS in adults develops as a result of head injuries, tumors, neuroinfections, and after a stroke.
Signs of hydrocephalic syndrome are similar to the symptoms of HHS in older children:
- blurred vision (double vision, squint),
- severe headaches
- nausea and vomiting,
- impaired consciousness up to coma and convulsions.
Diagnosis of hydrocephalic syndrome is difficult. Not all instrumental methods help establish the diagnosis in 100% of cases. In infants, regular head circumference measurement and reflex testing are important.
Also in the definition of GHS is used:
- evaluation of the fundus vessels (edema, plethora or vasospasm, hemorrhage);
- neurosonography (ultrasound examination of the anatomical structures of the brain, in particular, the size of the ventricles);
- lumbar puncture of the spinal cord to take the CSF to measure its pressure (the most reliable method);
- computed tomography ( CT ) and nuclear magnetic resonance (NMR).
Neuroscientists and neurosurgeons are involved in the treatment of hydrocephalic syndrome with the involvement of ophthalmologists. Patients with HGS need to be monitored and treated in a specialized neurological center.
Children under 6 months need outpatient treatment.
The main therapeutic measures:
- the appointment of a diuretic drug – diacarb (reduces the production of CSF and removes fluid from the body),
- reception nootropics – improves blood flow in the brain (piracetam, aktovegin, asparkam)
- sedatives are also indicated (diazepam, tazepam )
Treatment of infants is quite long, for several months.
GHS treatment in older children and adults
In adults and older children, therapy depends on the cause of the occurrence of hydrocephalic syndrome.
If it is the result of neuroinfection , then appropriate antiviral or antibacterial therapy is carried out.
In the case of traumatic brain injuries and tumors, surgical intervention is indicated.
Complications of hypertensive-hydrocephalic syndrome are possible at any age:
- mental and physical retardation;
- bulging fontanel;
- incontinence of urine and feces;
The prognosis is most favorable for hydrocephalic syndrome in infants. This is due to the fact that they have a transient increase in blood pressure and cerebrospinal fluid, which stabilizes with age.
In older children and adults, the prognosis is relatively favorable and depends on the cause of the HHS, the timeliness and adequacy of treatment.