External hydrocephalus

External substitution hydrocephalus (also known as compensatory hydrocephalus) is a condition in which the volume of fluid inside the cranial cavity (cerebral ventricle) increases, but unlike typical hydrocephalus, this occurs as a compensatory mechanism to address other problems or circumstances affecting the brain.

Substitute hydrocephalus can occur, for example, when there is excessive loss of brain tissue due to trauma, tumor, infection, or other factors. The increased volume of fluid inside the cranial cavity helps maintain pressure inside the skull and prevents the brain from collapsing. It is a kind of compensatory mechanism that can help maintain normal brain function in conditions where brain tissue is reduced.

Treatment for replacement hydrocephalus is usually aimed at treating the underlying condition or cause that led to the condition. Sometimes, surgery may be needed to stabilize the pressure inside the skull or remove the source of the problem. Treatment depends on the patient’s individual circumstances and symptoms and may require consultation with a neurosurgeon or other specialists.

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Causes external hydrocephalus

Causes of external substitution hydrocephalus may include:

1. Trauma: Traumatic injury to the brain or spinal cord can lead to external substitution hydrocephalus, as it can damage blood vessels or tissues, which can lead to disruption of the cerebrospinal fluid flow dynamics.
2. Infections: Infections such as meningitis or inflammation of the brain and spinal cord can cause external substitution hydrocephalus.
3. Tumors: Some tumors can block the normal flow of brain fluid or cause excess fluid, which can lead to increased fluid volume outside the cranial cavity.
4. Inflammation or bleeding: Inflammation or bleeding in the brain can cause external substitution hydrocephalus.

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Pathogenesis

External hydrocephalus in adults is the result of deterioration of cerebrospinal fluid resorption, which results in stretching of the cerebral ventricles. This pathology can be the result of a concussion, brain surgery, stroke, tumors or infectious pathologies. This form of the disease in most cases affects elderly people, requires observation and control of a doctor and mandatory treatment.

This disease is characterized by an active process of excessive accumulation of cerebrospinal fluid in the cerebrospinal fluid spaces, which is caused by a disruption in its circulation, absorption or production. The main manifestations of the disease are an enlargement of the cerebral ventricles, a decrease in the density of the brain matter as a result of it being saturated with cerebrospinal fluid, and a narrowing of the subarachnoid spaces.

External hydrocephalus of the brain has the following symptoms: nausea and vomiting, the patient constantly wants to sleep, painful migraine attacks appear, signs of brain dislocation.

External substitution hydrocephalus occurs as a result of a malfunction of the central nervous system, which occurs due to improper resorption of the cerebrospinal fluid located in the intracranial cavity. External substitution hydrocephalus can develop in both small children and elderly people.

The main characteristic of this pathology is a decrease in the volume of the brain and filling the remaining space with cerebrospinal fluid, which causes an increase in blood pressure and headaches. Such a disease as external substitution hydrocephalus of the brain differs from other forms in that it may not manifest itself for a long time. In elderly people, such a disease can occur against the background of high blood pressure or atherosclerosis, as well as concussion and alcohol abuse.

Symptoms external hydrocephalus

Symptoms of external substitution hydrocephalus may vary depending on its cause and the degree of disruption to the circulation of cerebral fluid. Common symptoms that may be seen with this condition may include:

1. Headache: This is one of the most common symptoms. Headaches can be moderate or severe and may be accompanied by a throbbing sensation.
2. Nausea and vomiting: Excess brain fluid and increased pressure inside the skull can cause nausea and vomiting.
3. Difficulty with coordination and balance: Due to increased pressure on brain structures, patients may experience difficulty with coordination and balance.
4. Decreased vision: Increased pressure inside the skull can put pressure on the optic nerves, which can lead to changes in vision, including double vision, blurring, and decreased vision.
5. Seizures: Some patients may experience seizures.
6. Changes in mental status: Changes in mental status such as irritability, depression, drowsiness or insomnia may occur.
7. Increased head size (in children): In children, external substitution hydrocephalus can cause an increase in head size (hydrocephalus) because their cranial bones have not yet closed and the brain can push the skull outward.

Moderate external hydrocephalus has symptoms such as rolling of the eyes, urinary incontinence, migraine attacks, nausea, vomiting, double vision, the patient feels constant fatigue, a tendency to sleep, there is also a disturbance of gait and coordination of movements. Such a diagnosis can only be made by a specialist based on the results of magnetic resonance imaging (carried out no more than once every six months). If such a pathology is detected, the patient needs treatment, which is prescribed by a neurosurgeon.

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Stages

The stages of this form of hydrocephalus can be as follows:

1. Initial stage: At this stage, the patient may not experience obvious symptoms, or the symptoms may be mild and short-lived. Typically, there are no significant changes in the brain structure yet.
2. Progressive stage: Over time, hydrocephalus may progress and symptoms may become more severe. In this stage, the brain ventricles may enlarge and put pressure on surrounding tissue.
3. Decompensated stage: At this stage, the symptoms become very severe and life-threatening. The pressure on the brain increases, which can cause seizures, loss of consciousness, and other dangerous conditions.

There are several degrees of severity of replacement hydrocephalus:

1. Severe: Characterized by significant accumulation of fluid within the skull, which can lead to serious symptoms and complications.
2. Moderate: In this case, the fluid accumulation is less severe, but may still cause various symptoms and require medical intervention.

Forms

External hydrocephalus and its types:

• congenital - this form occurs as a result of intrauterine lesions or the development of defects;
• acquired - is a consequence of traumatic brain injury, as well as inflammatory processes.

1. Internal replacement hydrocephalus: This is a type where excess fluid accumulates inside the ventricles of the brain.
2. Mixed substitution hydrocephalus: in this case, different aspects of substitution hydrocephalus are combined, for example, both internal and external signs of fluid accumulation inside the skull may be present.

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Complications and consequences

Complications of external substitution hydrocephalus can be serious and include the following:

1. Worsening symptoms: External replacement hydrocephalus may progress over time, leading to worsening symptoms. This may include headaches, nausea, vomiting, increased head size, and other neurological symptoms.
2. Brain Damage: With prolonged external replacement of hydrocephalus, the pressure exerted by the fluid on the brain can cause damage to brain tissue, which can lead to cognitive impairment, paralysis, and other neurological deficits.
3. Dangerous conditions: In case of decompensated external substitution hydrocephalus, dangerous conditions such as seizures, loss of consciousness and even death may occur.
4. Infections: Introduction of infection into a drainage system (eg, ventriculoperitoneal shunt) can be a serious complication requiring urgent medical attention and antibiotic treatment.
5. Shunt Problems: If a patient has a shunt installed to drain cerebral spinal fluid, there may be complications associated with the device. This may include shunt blockage, ruptures, infections, and other problems that may require surgery.

Diagnostics external hydrocephalus

The diagnostics of external substitution hydrocephalus is based on similar principles to the diagnostics of ordinary hydrocephalus. Here are the main diagnostic methods:

1. Clinical examination: The doctor performs a physical examination of the patient, assessing symptoms such as enlarged head, headaches, nausea, vomiting, and other neurological signs.
2. Ultrasound (ultrasound of the brain): This method is often used to diagnose hydrocephalus in newborns and infants. It allows us to evaluate the size of the brain ventricles and the amount of fluid accumulated.
3. Computed tomography (CT) or magnetic resonance imaging (MRI): These scans provide more detailed images of the brain and its structures. They can help determine the cause of hydrocephalus and assess its severity.
4. Cerebrospinal fluid (CSF) tap: This procedure can be used to analyze cerebrospinal fluid (CSF) for infections or other abnormalities.
5. Neurosurgical consultation: If hydrocephalus is confirmed, neurosurgical consultation may be required to assess the need for surgical intervention.

Diagnosis of external substitution hydrocephalus should be made by experienced physicians and neurosurgeons to determine the appropriate treatment and care plan for the patient.

Differential diagnosis

The differential diagnosis of external substitution hydrocephalus involves identifying and distinguishing this condition from other possible causes of hydrocephalus-like symptoms. Below are some conditions and diseases that may have similar symptoms to external substitution hydrocephalus:

1. Internal hydrocephalus: External substitution hydrocephalus can be similar to internal hydrocephalus, in which fluid builds up inside the ventricles of the brain. Using various imaging techniques such as CT or MRI can help determine the exact location and nature of the hydrocephalus.
2. Meningitis: Meningitis is an inflammation of the membranes covering the brain and spinal cord that can cause symptoms similar to hydrocephalus, such as headaches, nausea, and vomiting. Analysis of cerebrospinal fluid and brain imaging on MRI or CT scans help differentiate meningitis from hydrocephalus.
3. Brain tumors: Brain tumors can cause compression of brain structures and fluid buildup, which can also lead to hydrocephalus-like symptoms. An MRI or CT scan can help detect the presence of tumors and determine their nature.
4. Neurodegenerative diseases: Some neurodegenerative diseases, such as Huntington's disease and amyloidosis, can have similar symptoms to hydrocephalus.
5. Hypertension: High blood pressure within the skull can cause symptoms similar to hydrocephalus. Differential diagnosis includes measuring intracranial pressure.

To accurately diagnose and determine the cause of the patient's symptoms, a complete examination is required, including various medical tests and brain imaging using modern imaging techniques.

Treatment external hydrocephalus

Treatment of external substitution hydrocephalus usually involves surgical methods, as it is a chronic condition associated with the accumulation of cerebral spinal fluid inside the skull. Surgery aims to improve drainage or regulate the circulation of this fluid. Depending on the specific situation and the patient's condition, the following treatment methods may be used:

1. Placement of a shunt: This is the most common treatment. A shunt is a medical device that is inserted into the brain and/or ventricles of the brain and directs excess cerebral spinal fluid to another location in the body, usually the abdomen. This allows the excess fluid to be drained and the pressure inside the skull to be relieved.
2. Endoscopic third ventricular resection: This technique involves using endoscopic techniques to remove a blockage or tumor that may be blocking the normal flow of cerebral spinal fluid within the brain.
3. Endoscopic third ventricular window: This technique creates an artificial opening in the third ventricle of the brain to facilitate drainage of cerebral spinal fluid and improve circulation.
4. Other surgical options: In some cases, other surgical procedures may be required depending on the individual needs of each patient.

Treatment of such a disease as moderate external hydrocephalus is aimed at normalizing intracranial pressure using puncture or medications. Additionally, the attending physician may prescribe a set of special restorative exercises, salt-pine baths, anti-inflammatory drugs, and a decrease in fluid intake.

Of the medications, long-term administration of Diamox in combination with potassium preparations is possible. Manual therapy methods can also be used as part of the complex treatment.

Forecast

The prognosis for external substitution hydrocephalus depends on several factors, including the cause of the hydrocephalus, the extent of brain damage, the patient's age, and the timeliness of seeking medical attention. In general, the prognosis is better if external substitution hydrocephalus is detected and treated early and if the underlying cause can be eliminated. However, in some cases, the condition can progress and cause serious complications.

Potential complications of external replacement hydrocephalus may include worsening neurological symptoms such as loss of consciousness, paralysis, impaired motor function, and problems with cognition and vision.

Children with hydrocephalus (enlarged head size) may experience various developmental delays and disorders if not treated promptly.

Treatment is usually aimed at eliminating the underlying cause of hydrocephalus and relieving symptoms. Surgeries may be needed to remove tumors, correct abnormalities, or restore normal circulation of cerebral fluid. After successful treatment, the prognosis can be good, and patients can recover and lead normal lives. However, it is important to continue medical monitoring and follow doctors' recommendations to prevent relapses and long-term complications.