What is Hydrocephalus?

Hydrocephalus is not a single disease. Hydrocephalus is more common after various traumatic brain injuries or intracranial masses, which cause cerebrospinal fluid absorption disorders, blocked circulation, or excessive secretion, leading to progressive expansion of the ventricular system or ( And) The subarachnoid space is dilated. According to the pressure, it can be divided into high intracranial pressure hydrocephalus and normal intracranial pressure hydrocephalus. According to cerebrospinal fluid dynamics, it can be divided into traffic and obstructive. Early CT manifestations were progressive expansion of the ventricular system or (and) subarachnoid space expansion ^[1] . Its typical symptoms are headache, weakness in the lower limbs, instability in starting or gait standing, urinary incontinence, ataxia, slow response, and decreased progressive autonomic language physical activity. The diagnosis can be confirmed after lumbar puncture observation. Moderate and severe hydrocephalus is generally enlarged through a CT scan of the ventricles, accompanied by urinary incontinence, progressive dementia, bedridden ^[2] , constipation, blurred vision, optic nerve papillary edema, occasional diplopia, dizziness, and epilepsy Onset, the diagnosis can be confirmed. Untreated hydrocephalus can also cause atrophy of the brain tissue due to the progressive expansion of the ventricular system. Although 20% can stop development, about half of the children die within a year and a half. The degree of neurological dysfunction in patients with hydrocephalus is positively related to the severity of cerebral atrophy caused by hydrocephalus, and measures should be actively taken for diagnosis and treatment.

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Cerebral spinal fluid (CSF) is a colorless transparent fluid that fills the ventricular system, the central canal of the spinal cord, and the subarachnoid space. It is a non-functional extracellular fluid containing inorganic ions, glucose, and a small amount of protein. Mononuclear cells and lymphocytes, which function as lymph in peripheral tissues, buffer, protect, nutrition, transport metabolites, and maintain normal intracranial pressure in the central nervous system. The total amount of cerebrospinal fluid in adults is about 150ml, the rate of production is 0.3ml / min, and the daily secretion volume is 400 ~ 500ml. It is in a state of equilibrium in which it is constantly produced, recursive, and recirculated.

Cerebrospinal fluid circulation pathway obstruction and malabsorption are usually common, while those with excessive secretion are rare. In the broad sense, hydrocephalus should also include subarachnoid fluid and subdural fluid.

Obstructive hydrocephalus: Obstructive hydrocephalus is also called non-traffic hydrocephalus or intraventricular obstructive hydrocephalus, which refers to the formation of lesions in or near the ventricular system, which block the cerebrospinal fluid circulation of the ventricular system. That is, hydrocephalus caused by obstruction above the fourth ventricle outlet is the most common type of hydrocephalus. Common in arachnoid cysts, blocked or narrow aqueducts, and hypoplasia of the mesial or interventricular foramen. Chiari deformity, craniopharyngioma, etc.

Traffic hydrocephalus: Traffic hydrocephalus is caused by hydrocephalus due to obstruction of the cerebrospinal fluid circulation pathway outside the brain, or hydrocephalus (papilloma) caused by excessive production of cerebrospinal fluid.

Etiological classification

(2) traumatic hydrocephalus; (3) ear-derived hydrocephalus; (3) infectious hydrocephalus; (2) occupying hydrocephalus; (2) hemorrhagic hydrocephalus. Onset rate

acute hydrocephalus; chronic hydrocephalus; normal intracranial pressure hydrocephalus; static hydrocephalus.

Age classification

Hydrocephalus in infants: Infant cerebrospinal fluid circulation is blocked. Absorption or excessive secretion causes the cerebrospinal fluid to accumulate in the ventricular system and the subarachnoid space, causing the ventricle or subarachnoid space to enlarge. Enlarged skull, increased intracranial pressure, and brain dysfunction. Its incidence is 3 to 5 . Hydrocephalus in children and adults.

Causes and mechanisms

Hydrocephalus can be caused by a variety of reasons, including common brain trauma, intracranial inflammation, cerebrovascular malformations, various endogenous or exogenous neurotoxins, hypoxia, water and electrolyte disorders, acidosis, liver and kidney failure These can be caused by the accumulation of fluid in the brain through different mechanisms. Cerebrospinal fluid circulation blocked

Congenital malformations: Parents may be exposed to certain chemical radiation-induced genetic mutations during pregnancy, fever during early pregnancy, taking certain drugs, abnormal fetal position, and polyhydramnios. More common deformities include spina bifida and midbrain aqueduct stenosis.

Infection: such as purulent meningitis, tuberculous meningitis, ventriculitis, etc., because the fibrous tissue of the hyperplasia blocks the circulation channels of the cerebrospinal fluid, it is particularly common in the fourth ventricle and the subarachnoid space at the bottom of the brain to cause cerebral effusion. water.

Hemorrhage: Fibrous hyperplasia after intracranial hemorrhage can cause hydrocephalus. Intracranial hemorrhage malabsorption after birth injury is also a common cause of neonatal hydrocephalus, and it is often easy to be ignored. Hydrocephalus due to cerebrospinal fluid absorption disorders caused by subarachnoid hemorrhage after brain trauma.

Tumors: Intracranial tumors can block any part of the cerebrospinal fluid circulation pathway. They are more commonly found near the fourth ventricle. It is rare to encounter tumors in the neonatal period. Glioma, ventricular choroid plexus papilloma, and ependymal tumor, Neuroblastoma. Cerebrospinal fluid secretion

Congenital hydrocephalus has many etiology theories, and the accepted theory is the proliferation of the lateral ventricle choroid plexus and strong secretion, which causes the cerebrospinal fluid secretion of the ventricular choroid plexus to be dysfunctional, and hydrocephalus occurs. Cerebrospinal fluid malabsorption

Such as fetal meningitis caused by cerebrospinal fluid absorption disorders and hydrocephalus.

Typical symptoms are

Hydrocephalus requires early intervention and early treatment to prevent urinary tract infections. Prolonged indwelling of the urinary tract is prohibited. Make sure that the perineum is clean and dry locally, and keep the bed and nursing pads flat and dry. You should always scrub and bathe the perineum. Patients with moderate or severe hydrocephalus should strengthen passive movement of the upper and lower limbs to prevent joint atrophy and muscle atrophy. Every day as much as possible to ensure sitting or turn back and buckle on time to prevent falling pneumonia, daily or every other day, to ensure that the stool is excreted in a timely manner, to ensure adequate intake of water and nutrition, if necessary, nasal feeding. ^[4]

Hydrocephalus preoperative care

Psychological care: Because the patient lacks understanding of the disease and has a fear of surgery, we should take the initiative to talk with the patient to explain the nature and danger of the disease, the necessity of the operation, introduce the patient to the patient, and fill the patient with the doctor. Trust, reduce fears and doubts, and keep your body and mind in optimal condition for surgery.

Observation and nursing after hydrocephalus

(1) Closely observe the changes in consciousness, pupils, vital signs and physical activities, pay attention to observe changes in Bp, P, R and pupils, and record them on a special record sheet.

(2) Note that when T> 38.50C or above, effective cooling measures should be taken to reduce the oxygen consumption and basal metabolism of brain cells. Ice packs, ice pillows, frozen infusions, and ice packs should be placed on both sides of the neck, under the arms and groin. Patients with hypothermia should observe complexion, P, R and sweating signs to prevent excessive collapse.

3. Complication observation

(1) Observe the symptoms of slow and weak P, fast and irregular R, headache, vomiting, increased Bp, and increased intracranial pressure such as dilated pupil on one side.

(2) Observe the surrounding skin. If there is ulcer or leakage of cerebrospinal fluid, report it to the doctor for treatment.

(3) Observe for abdominal pain or abdominal discomfort.