Increased intracranial pressure and hydrocephalus

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Cerebrospinal fluid (CSF)

Cerebrospinal fluid (CSF) – a fluid biological environment of the body, circulating in the ventricles of the brain, the subarachnoid space of the brain and spinal cord.

In a healthy person during the day continuously at a rate of 0.2-0.8 ml/min. formed from 350 to 1150 ml. of cerebrospinal fluid, which depends on intracranial pressure: the lower the pressure, the faster the formation of cerebrospinal fluid.

Choroid plexus in ventricles produce cerebrospinal fluid (CSF, liquor). Volume of CSF in cerebral ventricles – 25 ml, volume of CSF in cerebral cisterns – 120 ml and volume of CSF in spinal subarachnoid space – 40-70 ml.

Functions of the cerebrospinal fluid (CSF) in the central nervous system are as follows:

  • It protects the brain and spinal cord from mechanical influences
  • It maintains a constant intracranial pressure and fluid and electrolyte balance in cells of the brain and its membranes
  • remove products of metabolism of the nerve cells, transports nutrients and biologically active substances
  • carries out respiratory function
  • It performs the function of specific immunobiological protective barrier CNS

Main volume of cerebrospinal fluid (CSF) is formed by active secretion by glandular cells of the vascular plexus of the ventricles of the brain and the blood through dialysis walls of blood vessels in the brain ventricles ependymomas.

Cerebrospinal fluid system is divided into inner and outer liquor spaces interconnected:

  1. Domestic liquor spaces (ventricular system) – presented the ventricles of the brain. Two are located in the lateral ventricle of the left and right hemispheres of the brain, each containing 10-15 ml of CSF. In the III and IV ventricles contained 3-5 ml of CSF. All the ventricles have a vascular plexus formed folds of the pia mater, and played a leading role in the formation of liquor.
  2. External liquor spaces – presented the subarachnoid space of the brain and spinal cord. Brain and spinal cord is covered by three membranes – dural, pial and arachnoid. Between the inner plate of the dura mater and the outer plate of the arachnoid is the subdural space. Between the two plates arachnoid produced subarachnoid (subarachnoid) space is divided into a large number of cells and the intersection of trabeculae. The subarachnoid space of the brain and cisterns contains 120 ml of CSF, and the subarachnoid space of the spinal cord, which is a continuation of the external cerebrospinal fluid spaces of the brain – 40-70 ml of CSF.
Lumbar puncture (LP) is used for measurement of the cerebrospinal fluid (CSF) pressure and analysis.

Cerebrospinal fluid from the lateral ventricles of the brain (where it is formed by the choroid plexus) flows into the third ventricle, and then through Silvio electricity into the fourth ventricle, in the tank of a base of the brain and the subarachnoid space of the brain. A smaller part of the cerebrospinal fluid in the subarachnoid space down the spinal cord.

The movement of the cerebrospinal fluid due to its continuous formation and resorption. The reason for the movement of cerebrospinal fluid are the heart beat, respiration, body position and movement, the movement of ciliated epithelium choroid plexus.

Liquor flowing from the subarachnoid space into the subdural and then absorbed by small veins of the dura mater.

The ventricular venous anatomy is illustrated with the veins especially associated with operative procedures marked.

The blood-brain barrier (BBB) is associated with a surface that separates the brain from the blood and cerebrospinal fluid, and provides bi-directional selective exchange of molecules between different blood, cerebrospinal fluid and brain. Sealed contacts the endothelium of brain capillaries, choroid plexus epithelial cells of the arachnoid membrane and the base are morphological barrier.

The term "barrier" refers to the condition of impermeability to certain critical molecular size. Low molecular weight components of plasma, such as glucose, urea and creatinine, flows freely from the plasma into the cerebrospinal fluid. While proteins are passive diffusion through the wall of the choroid plexus, and between plasma and CSF has a significant gradient, depending on the molecular weight of the protein. The limited permeability of the BBB and choroid plexus support normal homeostasis and composition of cerebrospinal fluid.

Brain magnetic resonance imaging (MRI) indicated in headaches attributed to increased intracranial pressure or hydrocephalus.

Increased intracranial pressure causes, hydrocephalus types

Increased intracranial pressure (intracranial hypertension), as well as certain types of hydrocephalus - is one of the common signs of some brain diseases. That is, it is not an independent disease, as is often mistakenly believed, but is only one symptom of a disease such as pain or fever, etc.

By raising the intracranial pressure and hydrocephalus cause:

By lowering the intracranial pressure lead length of the current illness, dehydration (vomiting, diarrhea, high blood loss), chronic emotional and physical overload (VVD, depression and neurosis), as well as circulatory disorders of the vessels of the brain (ischemia, encephalopathy, osteochondrosis of the cervical spine etc.).

Enlarged cerebral ventricles on brain MRI in hydrocephalus.


Increased intracranial pressure and hydrocephalus diagnosis

Signs of change in intracranial pressure detected by:

Brains computed tomography (CT) shows 3 ventricle colloidal cyst (cause headaches attributed to increased intracranial pressure or hydrocephalus caused by neoplasm).

Papilledema – is a noninflammatory edema caused by increased intracranial pressure. In this case, there are congestion, papilledema, prominentsiya it in the vitreous of wear limits. Retinal vein dilated, tortuous. At an altitude of stagnation of the optic nerve are multi-hemorrhage in the retina.

A – empty sella turcica. Sagittal postcontrast T1-weighted image. The yellow arrowhead illustrates an expanded cerebrospinal fluid (CSF)–filled empty-appearing sella turcica. The white arrowhead illustrates a flattened appearance of the pituitary gland against the floor of the sella turcica.
B – cerebellar tonsillar ectopia. Sagittal postcontrast T1-weighted image. The arrowhead illustrates the low-lying position but normal rounded morphology of the cerebellar tonsils 5 mm below the foramen magnum (white line).
C – enlarged Meckel caves. Coronal T2-weighted image. Arrowheads show abnormally enlarged CSF-filled Meckel caves bilaterally.
D – meningoencephalocele. Coronal T2-weighted image through the right temporal lobe. Yellow arrowheads illustrate margins of defects in the tegmen mastoideum transmitting CSF and a portion of the right inferior temporal lobe (white arrowhead). Fluid within adjacent mastoid air cells indicates an associated CSF leak.
E – posterior scleral flattening and increased optic nerve tortuosity. Oblique sagittal reconstruction of volumetric T2-weighted image in the plane of the optic nerve (ON) illustrates posterior scleral flattening (white arrowhead) and increased vertical tortuosity of the intraorbital ON sheath complex (yellow arrowhead).
F – optic nerve head protrusion and increased perioptic nerve CSF. Axial T2-weighted image illustrates protrusion of the prelaminar optic nerves (yellow arrowheads), indicating severe papilledema and distension of the optic nerve sheaths by CSF (white arrowheads) bilaterally.
G - optic nerve head enhancement. Axial postcontrast T1-weighted image illustrating enhancement of the prelaminar optic nerves bilaterally (arrowheads), indicating optic disc edema.
H - transverse venous sinus stenosis. Cranio-caudal maximum intensity projection of a postcontrast magnetic resonance venogram. Arrowheads illustrate smooth tapered severe stenosis of the distal transverse sinuses bilaterally.


Increased intracranial pressure and hydrocephalus treatment

Treatment of raising or lowering the intracranial pressure with hydrocephalus is symptomatic (receiving diuretic drugs, receiving stimulants, intravenous infusion of fluid, etc.).

But to fully resolve this symptom to be treated directly to disease, which caused it – a concussion, cervical spondylosis, intracranial (subarachnoid) and intracerebral hemorrhage, vertebrobasilar insufficiency (VBI), a brain tumor, etc.

Elevated intracranial pressure (ICP) monitoring during the hydrocephalus treatment.

It should be remembered that the adequate treatment of symptoms increase or decrease the intracranial pressure with hydrocephalus on the background of vertebrobasilar insufficiency (VBI) may be exposed to the cause or causes of dizziness is caused. Osteochondrosis of the cervical spine and vertebral artery atherosclerosis require a systematic approach in the treatment of:

Increased intracranial pressure and hydrocephalus symptoms treatment by physiotherapy.

In obstructive hydrocephalus surgical treatment to address the causes block the normal outflow of cerebrospinal fluid. Causes of normal outflow of CSF are neoplastic processes at arachnoiditis adhesions, cysts, etc.

The essence of the operation is to create a free flow of both natural spaces, and through special cerebrospinal fluid shunt systems installed in the lumen of the ventricles and liquor deducing from them outside.