Overview of Hydrocephalus
Hypercranial pressure hydrocephalus is caused by obstruction of the ventricular system and subarachnoid space on the cerebrospinal fluid circulation pathway, resulting in an increase in mean or pulsatile intraventricular pressure producing ventricular enlargement to the point of not being able to compensate for it, and the corresponding clinical symptoms.
Etiology
The most common cause is obstruction of the cerebrospinal fluid at various points in its circulatory pathway, whereas excessive production or impaired absorption of cerebrospinal fluid is rare.
Symptoms
Most cases of high cranial pressure hydrocephalus are secondary and may have a definite etiology, such as subarachnoid hemorrhage or meningitis. It often occurs 2 to 3 weeks after the onset of the disease, and symptoms such as headache and vomiting appear after the original condition has improved, or the symptoms are further aggravated, and the cause is unknown or secondary to intracranial tumors and other diseases in most patients.
The clinical manifestations of high cranial pressure hydrocephalus include headache, vomiting as the main clinical symptoms, and ataxia. In severe cases, the patient may have blurred vision and diplopia. The headache and vomiting symptoms of patients are mostly specific, and the headache is most common in the bilateral temporal side. When the patient is in the prone position, the cerebrospinal fluid reflux is reduced, so the headache worsens after the patient is in the prone position or in the morning, and the headache can be relieved when the patient adopts the prone position. With the progression of the disease, the headache can be persistent severe pain. When accompanied by subcerebellar tonsillar hernia, the headache may involve the cervico-occipital region, and there may even be forced head position. Vomiting is a common symptom of high cranial pressure hydrocephalus except for headache, which is often accompanied by severe headache regardless of the position of the head, and the headache symptoms can be relieved after vomiting.
Visual impairment is common in patients with hydrocephalus, mostly in the middle and late stages of disease development, due to fundus edema, which may manifest as blurred vision, diplopia, and loss of vision in the late stage. Diplopia is primarily due to increased intracranial pressure, which paralyzes the longest-traveling spreading nerve in the skull. Patients may have ataxia, with trunk ataxia being the most common, characterized by unsteady standing, wide foot spacing, large stride length, and rarely cerebellar ataxia. Patients with advanced hydrocephalus may have memory loss, especially near memory loss, mental retardation, and poor calculation ability.
Examination
The pressure of cerebrospinal fluid examination may be elevated, and the biochemical indexes are generally normal. However, if the intracranial pressure is too high, lumbar puncture may induce cerebral herniation, which needs attention.CT or MRI can determine the enlargement of cerebral ventricles and the degree of cortical atrophy, and sometimes it can understand the cause of hydrocephalus at the same time. In addition, CT or MRI can also understand whether the hydrocephalus is acute hydrocephalus or chronic hydrocephalus, which can provide the basis for the application of clinical management measures. In the diagnosis of hydrocephalus, attention should be paid to differentiate it from the enlarged ventricles caused by cerebral atrophy, in which the enlarged ventricles can clearly show the lateral fissure or the sulcus, and there can even be obvious enlargement of the sulcus and the fissure. In addition, the diagnosis of hydrocephalus should clarify whether it is obstructive hydrocephalus or traffic hydrocephalus as far as possible.
Diagnosis
With the wide application of CT and MRI, it is no longer difficult to diagnose hydrocephalus. The key lies in the fact that patients with symptoms such as headache, vomiting, etc., should pay enough attention to them and undergo CT or MRI examination in time for early diagnosis.
Treatment of hydrocephalus
1. Surgical treatment
For acute high pressure hydrocephalus, surgery should be the main treatment. Surgical methods can be based on the following three aspects: (1) surgery for the cause of the disease, such as removal of intracranial tumors causing hydrocephalus; (2) surgery to reduce the production of cerebrospinal fluid, such as choroid plexus resection, etc. has been used sparingly; (3) cerebrospinal fluid drainage or shunt, is the main treatment method for hydrocephalus.
2. Drug treatment
In addition to surgical treatment, drug therapy can also be applied. The main use of dehydrating agents such as mannitol, diuretics such as hydrochlorothiazide (dihydrochlorothiazide) to increase the discharge of water or acetazolamide to inhibit the secretion of cerebrospinal fluid, but the drug therapy should not be applied for a long time.
3. Treatment of complications
For cranial hypertension hydrocephalus caused by sharp vision loss or loss of emergency treatment, cerebrospinal fluid shunt, no shunt conditions, should be performed in the intensive care unit in the ward ventricular puncture, continuous external drainage in the hydrocephalus patient’s condition permits the choice of ventriculoperitoneal shunt or excision of intracranial primary lesions to lift the hydrocephalus. With the development of neuroimaging and advances in microsurgical techniques, resection of the primary lesion to relieve obstructive hydrocephalus is an important treatment option.