Newborn's cerebral cortex: symptoms, treatment

An increased level of cerebrospinal fluid in the meninges is a dropsy. Consider the features of this pathology in children, the causes, symptoms, treatment.

Hydrocephalus in newborns is a disease that most often develops in utero. An excessive amount of CSF fills the spaces between the cerebral membranes and penetrates the ventricles of the brain. The disease is associated with the mother's illnesses during pregnancy. Another reason is birth trauma, stroke, tumor formation.

Neurological disease is distinguished by the nature of its localization:

• External - cerebrospinal fluid accumulates around the brain at the base of the skull. It is accompanied by the expansion of bones.
• Internal - fluid accumulates in the ventricles of the brain. Does not cause changes in the size of the baby's head.
• Mixed - the accumulation of cerebrospinal fluid is observed both around the brain and inside its ventricles.

Normally cerebrospinal fluid constantly flushes the brain. This substance is constantly circulating. It delivers nutrients to the tissues from the blood vessels and protects them from damage. It affects the processes of respiration and circulation, preserves the normal environment around the brain. If the cerebrospinal fluid stagnates, accumulates under the cerebral membranes or in its ventricles, it leads to hydrocephalus.

[1], [2], [3]

Epidemiology

Medical statistics indicate that every 500th newborn patient suffers from a dropsy of the brain.

• The development of the disease in the fetus in 80% is due to intrauterine infections, in 20% it is the developmental disorders of the nervous system or genetic disorders.
• In newborns, hydrocephalus is most often associated with developmental defects of the brain or spinal cord, in 20% with birth traumas and, most rarely, with tumor neoplasms or malformations of the vessels feeding the brain.
• VGM in children older than 1 year often develops due to tumor processes, hemorrhages, as a result of inflammatory lesions of the brain or its membranes, after injuries and less often because of hereditary problems.

Statistical data greatly facilitates the process of diagnosing the disease and allows the implementation of preventive measures to prevent it.

[4], [5], [6], [7], [8]

Causes of the hydrops of the brain in newborns

Hydrocephalus is a frequently diagnosed pathology in children. The causes of dropsy of the brain in newborns can be associated with congenital, that is, intrauterine and acquired factors.

Of the infectious causes of VMG are the following:

• Herpes virus 1 or 2 types.
• Toxoplasmosis.
• Cytomegalovirus.
• Neurosyphilis.
• Rubella.
• Parotitis.
• Viruses and bacteria that cause meningitis and meningoencephalitis.

Congenital malformations that cause disease:

• Arachnoid cysts.
• Anomalies of the veins of the brain.
• The narrowing of the channel connecting the ventricles of the brain.
• Congenital underdevelopment of the holes, through which the outflow of liquor from the canal to the subarachnoid space occurs.
• Arnold-Chiari Syndrome is a disorder in which the volume of the posterior fossa of the skull does not correspond to the structures that are inside it. This leads to the fact that they descend into the occipital orifice, in which the brain passes into the dorsal and oblong. Such displacement is dangerously infringement of brain structures. This can lead to violations of the vasomotor and respiratory center, and even to death.
• Dandy Walker syndrome is an abnormal development of cerebrospinal fluid and cerebellum.

Causes of cancer:

• Brain cancer
• Tumor lesions of the cerebral ventricles.
• Papillomas.
• Tumors of the spinal cord that limit the process of circulation or absorption of the cerebrospinal fluid.
• Tumors of the skull bones.
• Meningiomas of vascular plexuses.

The disease can occur because of the craniocerebral injuries received during the birth process. When the cause of the violation is identified, the nature of its course and localization are taken into account.

[9], [10]

Risk factors

The increased content of cerebrospinal fluid in the spaces between the cerebral membranes, or in the ventricles of the brain itself, arises for a variety of reasons.

Highlights the main risk factors for the birth of a child with dropsy:

• Infectious diseases, borne by a woman during pregnancy.
• Diseases of the mother's nervous system that are transmitted to the fetus.
• Drugs and alcohol use, smoking.
• Genetic disorders of both parents.
• The child was born before 35 weeks of gestation.
• The weight of the baby is less than 1500 g.
• A parturient mother has a narrow pelvis that hampers delivery.
• During the birth process, vacuum, forceps, or manual techniques were used to help the newborn.
• During labor was fetal asphyxia or hypoxia.
• The baby was born with intrauterine pathologies of internal organs.

The risk of hydrocephalus in the prenatal period is associated with such factors:

• Rhesus-conflict between mother and fetus (immune dropsy).
• Pregnancy against a background of severe forms of diabetes mellitus, anemia or gestosis.
• Pathology of the cardiovascular system or blood disease in the fetus.
• Disorders of metabolic processes in the fetus.
• Malformations of the placenta and umbilical cord lesions.

The above factors represent a high risk of the baby's death in the womb. That's why the pregnant woman should be under careful medical supervision.

Risk factors for dropsy in the postnatal period:

• Birth trauma and premature birth.
• Chromosomal abnormalities.
• Tumors of the spinal cord, brain.
• Meningitis, encephalitis.

Knowing the main risk factors for the disease, pregnant women and doctors should do everything to prevent its development. But in some cases, to establish the true cause of the disease and the factors that led to its development is impossible.

[11], [12], [13], [14], [15], [16]

Pathogenesis

A complex neurological disease in which the balance between absorption and production of cerebrospinal fluid disturbs has a certain mechanism of origin. Pathogenesis is associated with the features of the brain and the functions of the cerebrospinal fluid.

So, the brain is a blood supply structure from several cavities, that is, ventricles. The ventricles are lined with vessels that are responsible for the formation of the cerebrospinal fluid. All the cavities communicate with each other, and the liquid circulates between them. Likvor washes the spinal cord. Then it enters the venous sinuses in the cranial cavity. The absorption of cerebrospinal fluid depends on the difference in pressure. In sinuses, the pressure should be lower than the intracranial pressure.

Liqvor is formed constantly. In newborns, it is synthesized in a volume of 40 to 150 ml per day. The liquid consists of leukocytes, lymphocytes, protein, electrolytes and other substances.

Cerebrospinal fluid performs such functions:

• Protects the brain from injury, since it is an incompressible fluid.
• Maintains equilibrium with the water-electrolyte composition of the circulatory system.
• Due to oscillatory movements affects the autonomic nervous system.
• Displays certain substances from parts of the central nervous system.
• Supports intracranial pressure at a constant level.

Violation of these functions leads to a disorder in the formation and absorption of the CSF. It is possible to change the current of the liquid along uncontained paths. This leads to the development of hydrocephalus. Depending on the degree of severity of the disorder and pressure in the cranial cavity, there may be a different severity of the course of the VGM and the corresponding symptomatology.

[17]

Symptoms of the hydrops of the brain in newborns

The increased content of cerebrospinal fluid between the cerebral membranes, or in the ventricles of the brain itself, has a different symptomatology. Signs of the violation completely depend on the nature of its flow:

1. Acute - rapidly increases intracranial pressure, sharply worsens the condition (less than 3 days).
2. Subacute - the pathological process develops within 3-6 months, and leads to severe damage to brain structures.
3. Chronic - the neurological problem develops extremely slowly and has an increasing symptomatology. This form is most often found with open hydrocephalus.

Symptoms of dropsy of the brain in newborns also depend on its cause. Most often hydrocephalus is diagnosed by such signs:

• Reduced muscle tone.
• Frequent cramps and muscle tension.
• Accelerated growth and enlargement of the skull.
• The dimensions of the baby's head do not correspond to the proportions of the trunk and deviate from normal indices.
• Frequent head tilt.
• The rodnichok is enlarged in size, and the frontal part is strongly pushed forward.
• Syndrome of "setting sun" (eyeballs are displaced downwards), strabismus.
• Spontaneous movement of the eyes.
• Tremor of limbs and chin.
• A small set of weight and a delay in psychomotor development.
• Frequent regurgitation.
• Anxiety, bad sleep, frequent crying.
• Lack of reaction to what is happening around.

Increased intracranial pressure in a baby causes severe headaches. At such times a child can put the handles to his head. Such signs can not be ignored. To detect the disease before the baby is born, scheduled ultrasound is performed, it is also possible to take blood from the umbilical cord or amniocentesis.

The clinic of hydrocephalus in children after the year is supplemented with such pathological symptoms:

• Attacks of nausea and vomiting in the morning and in the evening.
• Epileptic seizures with loss of consciousness.
• Muscular hypertonia.
• The face and forehead are covered with a venous net.
• Urinary incontinence.
• Violation of coordination of movements.
• Spring does not overgrow, increases in size and swells.
• Visual acuity deteriorates, which can lead to blindness.
• Propensity to obesity.

As the disease progresses, mental and physical impairments become more noticeable. All of the above symptoms can occur not only with VGM, but also with other pathologies. A similar symptom complex is observed with malformations of the brain, various neoplasms. It is very important to identify the disorder in its early stages and start treatment as soon as possible.

[18], [19], [20]

First signs

Complex neurological disease has characteristic for him the first signs. The dyspnoea of the brain in newborns can be recognized by such symptoms:

• Accelerated growth of the head circumference, which does not correspond to normal indices. This is due to the growth of the brain, which pushes from inside the bones and seams of the skull, which have not yet overgrown.
• Increase in size and strong fontanel tension. Normally, the fontanelle disappears by the first year of the child's life, but in the event of a breakdown, it can be swept up to 2-3 years.
• Stump and disproportionate forehead enlargement.
• Involuntary vibrational movements of the eyes, strabismus, nystagmus.
• Venous setochka on the face.
• Convulsions, increased muscle tone of the extremities.

In addition, the newborn has a delayed psychomotor development. He often tilts his head, can not hold it, sit, get up. The kid often cries and fusses for no apparent reason. Periodic touches to the head indicate severe headaches.

[21], [22], [23], [24], [25]

External edema of the brain in newborns

A pathology of a neurological nature, in which certain disorders occur in the ventricular system and in the space under the cerebral membrane - it is the external dropsy of the brain. In newborns and older children, this disease is associated with increased cerebrospinal fluid formation or a violation of its outflow.

External hydrocephalus is extremely rare. It is characterized by the localization of excess cerebrospinal fluid in the subarachnoid space. In this case, the cerebrospinal fluid in the ventricles and brain spaces is normal. In most cases, external edema is formed when the brain is atrophied.

Outer hydrocele can be congenital and acquired, and also secrete an open, closed and ex vacuo form.

• Open form - develops due to impaired production and absorption of cerebrospinal fluid. Likvoronosnye spaces normally communicate with each other.
• Closed - characterized by the separation of liquor-bearing spaces at different levels.
• Ex vacuo - a consequence of a decrease in the parenchyma of the brain due to its atrophy or various pathologies of the nervous system. It can have a progressive, stabilizing and regressing course.

The external form of hydrocephalus can be caused by such causes: craniocerebral trauma, pathology in the development of the central nervous system, disorders of the cervical vertebrae, diseases of the brain or its membranes, changes in the functioning of the brain vessels.

Symptoms of the disease are manifested by a sharp increase in the volume of the head by 50%. Against this background, there is a divergence of bone seams, a swelling of the fontanel and skin veins. The most dangerous is the mild course of the disorder. This is due to the lack of obvious symptoms for several years. But then comes the moment when the baby's condition deteriorates sharply because of a cerebral circulation disorder.

To diagnose the disease using MRI, CT, ultrasound, X-ray studies, various tests. Treatment can be both medicated, that is, conservative, and surgical.

[26], [27], [28], [29]

Complications and consequences

The cerebral cortex in newborns is a serious disease that requires compulsory treatment. The consequences and complications of pathology are manifested by various symptoms and depend on the age of the patient:

• Newborns - increased excitability, sleep disorders, developmental lag, deviations in the psyche.
• Preschool age - problems with speech, hearing and vision impairment, aggression, attacks of hysteria, delayed psychomotor development, strabismus, stammering.
• School age - different degrees of debility, personality disorders, poor memory, neuropathic disorders, frequent headaches, epileptic seizures, psychoemotional disorders.

Hydrocephalus can lead to disability. Delay in motor development, cerebral palsy and convulsions indicate physical disability.

The consequences and complications of VGM depend on the methods of treatment. After surgical intervention, hematomas, pseudocysts, epileptic seizures of varying severity, shunt dysfunction can form. Also, a lethal outcome is possible if the disorder accepts a malignant course or has been diagnosed too late.

[30]

Diagnostics of the hydrops of the brain in newborns

Modern diagnostics of the dropsy of the brain in newborns is of paramount importance for the treatment and further recovery of the baby. The medicine has developed many methods that are effective in detecting dropsy. Consider the main ones:

• Neurosonography - ultrasound examination of the brain through the fontanel. The procedure is absolutely painless and safe. It is part of the complex of compulsory neonatal studies in the first months of life. Identifies various pathologies at the earliest stages.
• MRI, CT and electroencephalography give more detailed information about the state of brain structures. Both methods are performed under general anesthesia.
• Ophthalmoscopy - examination of the fundus of the baby. If the optic nerve discs have swelling, this indicates an increased intracranial pressure, which may be a symptom of dropsy.
• Lumbar puncture - is performed to identify infections and assess the strength of cerebrospinal fluid pressure on the brain.
• Craniography - determines the size of the head of the newborn and reveals the divergence of the sutures. If the head increases by more than 1.5 cm per month, then this indicates hydrocephalus.

For the final diagnosis to be made, not only the results of the diagnosis carried out, but also the presence of symptoms of the disease. Based on the findings, the doctor makes a treatment plan. The sooner therapy is started, the better the prognosis for recovery.

[31], [32], [33], [34], [35], [36]

Analyzes

Laboratory diagnosis of increased accumulation of cerebrospinal fluid in the cerebrospinal fluid system is necessary both for diagnosis and for monitoring the effectiveness of treatment. Analyzes in case of suspected dropsy in newborns consist of:

• General and biochemical analysis of blood.
• General urine analysis.
• Alanine aminotransferase.
• The analysis of a feces on a dysbacteriosis and the latent blood.
• Analysis for intrauterine infections.
• Liquorodynamic tests.

Morphological symptoms of the disease completely depend on the cause, which it provoked and the duration of increased intracranial pressure. The results of laboratory diagnostics are taken into account when designing the treatment regimen.

[37], [38], [39], [40], [41]

Instrumental diagnostics

The difficulty of determining dropsy in newborns is that children do not yet have the opportunity to talk about pain and other features of the disease.

In newborns, diagnostics are carried out with the help of such instrumental methods:

• Ultrasound is the study of the state of the brain through the fontanel.
• Lumbar puncture.
• Magnetic resonance and computed tomography.
• Neurosonography.
• Radiography.
• Ophthalmoscopy.

Instrumental diagnostics makes it possible to reveal signs of a disorder even during intrauterine development of the fetus. To do this, the amniotic fluid and the umbilical cord of the fetus are analyzed.

Differential diagnosis

As a rule, the diagnosis of hydrocephalus does not cause difficulties. Water drops are differentiated with diseases that are similar in symptomatology, but are not associated with abnormal absorption of cerebrospinal fluid:

• Atrophy (hydrocephalus ex vacuo) - with this pathology there are no disturbances of the lympho-dynamics, and there is no loss of brain substance.
• Pathologies of development, in which the ventricles are enlarged - agenesis of corpus callosum and septo-optic dysplasia.

Differential diagnosis is carried out with family cases of megalocephaly and big-headedness. In addition to standard studies, special attention is paid to radiography and diaphanoscopy (reveals an increase in the luminescence zone).

Treatment of the hydrops of the brain in newborns

To eliminate the intracranial pathology associated with abnormal development of cerebrospinal fluid, there are several methods. Treatment of dropsy in the newborn can be both conservative and operative. To ensure a good prognosis, the neuropathologist in a team with a neurosurgeon deals with the development of a treatment regimen.

1. Medicamental treatment of hydrocephalus

To normalize intracranial pressure, it is necessary to reduce the production of CSF or to speed up the process of its elimination. To do this, use drugs that block enzymes responsible for the secretion of cerebrospinal fluid and increase the volume of urination. Such drugs are taken simultaneously with potassium preparations, since this substance is washed out of the body.

Particular attention is paid to diuretics, which also contribute to the removal of excess fluid. In addition, medications are used that improve the work of neurons with increased intracranial pressure. If within 2-3 months after the onset of conservative therapy there is no improvement in the patient's condition, then they resort to surgery.

2. Surgical treatment of dropsy

In most cases, surgery is the only way to stop the progression of pathology, normalize intracranial pressure and save the brain. The mode of operation depends on the form and stage of hydrocephalus.

If the pathology has a closed form, then this indicates an obstruction (tumor, cyst, aneurysm of the vessel, hematoma), which prevents the cerebrospinal fluid from circulating normally. The operation is aimed at its elimination. If tumor neoplasms sprouted into the brain or they do not have clear boundaries, then surgical treatment is aimed at creating a pathway for the withdrawal of cerebrospinal fluid. To do this, perform shunting.

With the open form of hydrocephalus, that is, when the fluid is not absorbed where it is needed, a bypass is performed: ventriculo-peritoneal, ventriculo-atrial, lumbo-peritoneal. Interventions aimed at normalizing the absorption of cerebrospinal fluid, for example, dissection of arachnoid adhesions, may also be performed. With an increase in the synthesis of cerebrospinal fluid, operations that stop this process are performed. It can be the installation of clamps on the vascular plexus of the ventricles or the coagulation of these structures.

The method of treatment is determined by the doctor, individually for each patient. For this purpose, a complex of various diagnostic measures is carried out, which establish the type and severity of the disease.

Medications

Conservative treatment of dropsy of the brain in a newborn is performed to alleviate painful symptoms and prevent complications of the pathological condition. Medications are also prescribed to eliminate the consequences of the disease, for example, epilepsy or oligophrenia. Before the appointment of any medicine, the doctor conducts a thorough diagnosis of the condition of the baby.

For the treatment of a newborn, the following drugs can be used:

1. Veroshpiron - an antagonist of the hormone produced by the cortical layer of the adrenal glands. Has a pronounced diuretic effect. Does not affect the renal circulation and the function of the renal tubules. Does not cause acid-base balance disturbances. Has a tablet form of release.

• Indications for use: puffiness caused by cardiovascular insufficiency, diseases with accumulation of fluid in the abdominal cavity, movement of limbs due to delay in the release of potassium ions by the body.
• The method of administration and dosage are selected by the attending physician, individually for each patient. As a rule, the drug is taken 50 mg 3 times a day.
• Side effects: dizziness, increased drowsiness, hyperkalemia, hyponatremia, skin allergic reactions.
• Contraindications: severe renal failure, hyperkalemia, the first trimester of pregnancy.

2. Mexipur is an antioxidant with a retarding effect on free radical reactions. Has a membrane-protective activity. Reduces the risk of hypoxia and oxidant stress, has nootropic properties. It affects the processes in the cerebral cells, has an anticonvulsant, anxiolytic effect. It is available in the form of tablets and a solution for injection.

• Indications for use depend on the form of release of the medicine. Tablets are prescribed for cognitive disorders, vegetovascular dystonia, alcohol withdrawal, anxiety conditions against a background of neuroses. Injections are indicated for acute disorders of cerebral circulation, neurocirculatory dystonia, cognitive disorders in the background of atherosclerosis, discirculatory encephalopathy, with acute purulent-inflammatory pathologies of the abdominal cavity.
• Usage: tablets are taken orally, single dose is 250-400 mg, maximum daily dose is 800 mg. The course of treatment is determined by the attending physician. The injection solution is used for intramuscular and intravenous administration. The initial dosage is 50-450 mg with a gradual increase to achieve the desired therapeutic effect.
• Side effects: nausea, drowsiness, movement coordination disorders, headaches, allergic reactions, dry mouth, increased anxiety, hypotension, hypertension, emotional reactivity.
• Contraindications: acute violations of the liver, lactation, intolerance of the active ingredients of the drug, pregnancy, severe impairment of the kidneys.
• Overdose causes increased drowsiness, which passes on its own after the medication is stopped.

3. Mannitol is an osmotic diuretic. Reduces intraocular and intracranial pressure, accelerates the process of excretion of water and sodium by the kidneys. Does not affect the level of potassium ions in the blood plasma. Produced in the form of an infusion solution.

• Indications for use: cerebral edema, increased intraocular and / or intracranial pressure, oliguria, accelerated diuresis. The drug is used for complications associated with the introduction of incompatible blood, as well as to prevent kidney ischemia, hemoglobinemia and hemolysis in surgical interventions with extracorporeal circulation.
• Method of use: the agent is used parenterally. The solution is administered by infusion dropwise or slowly. The dosage is calculated at 500-1000 mg / kg body weight of the patient. The duration of therapy depends on the results of treatment in the first days of the drug.
• Side effects: various dyspeptic phenomena, dryness of the oral mucosa, nausea, vomiting, arterial hypotension, tachycardia, electrolyte balance disorders, skin allergic reactions.
• Contraindications: individual hypersensitivity to the components of the drug, severe forms of kidney damage, chronic heart failure, violations of water-electrolyte balance, pregnancy and lactation.
• Overdose develops with the use of high doses of the drug and its too rapid introduction. It is manifested by increased intraocular and intracranial pressure, increased extracellular fluid and disturbances in the water-electrolyte balance.

4. Diacarb - saluretic, causes diuresis by removing certain electrolytes, without interfering with electrolyte balance in the body. Has a tablet form of release.

• Indications for use: a delay in the body of sodium and water. Edema due to circulatory failure, with liver cirrhosis and kidney failure, pulmonary-cardiac syndrome. Puffiness caused by glaucoma, increased intracranial or intraocular pressure, tetany, epilepsy, gout.
• Method of administration: The drug is taken orally 125-250 mg 1-2 times a day for 2 days. The duration of therapy should not exceed 5 days.
• Side effects: drowsiness, fatigue, headaches, disorientation, leukopenia, hemolytic anemia. Overdose manifests itself by the same side reactions. Symptomatic therapy is indicated for their elimination.
• Contraindications: acidosis, adisson disease, hypochloraemia, hypochloruria, hypokalemia, diabetes. It is not used in pregnancy and simultaneously with ammonium chloride, which can cause acidosis.

5. Vazobral is a combined drug. Contains azobral dihydroergocryptine - dihydrated ergot derivative, which blocks alpha1 and alpha2 adrenoreceptors of smooth muscle cells, platelets. Stimulates dopaminergic and serotonergic receptors of the central nervous system. Reduces the adhesion of platelets and erythrocytes. Reduces the permeability of the vasculature, improves blood circulation and metabolism in the brain. Increases the resistance of brain tissue to hypoxia. Produced in the form of a solution and tablets for oral administration.

• Indications for use: cerebrovascular insufficiency, cerebral circulatory disorders, decreased mental activity, memory impairment, decreased attention, orientation disorders, migraine, cochleovestibular disorders of ischemic origin, retinopathy, Raynaud's disease, chronic venous insufficiency. The drug is not assigned with increased sensitivity to its components.
• Method of application: 1-2 capsules or 2-4 ml 2 times a day. The duration of treatment is determined by the attending physician.
• Side effects: nausea, epigastric pain, skin allergic reactions, arterial hypotension, syncope.

6. Asparks are a source of potassium and magnesium. It is used to restore the electrolyte balance. Regulates metabolic processes, has antiarrhythmic properties. Promotes the penetration of potassium and magnesium into the intracellular space, stimulates the intercellular synthesis of phosphates. It is produced in ampoules with a solution for infusions.

• Indications for use: hypokalemia, hypomagnesemia, chronic circulatory insufficiency, coronary heart disease, cardiac arrhythmias, intolerance or toxic effect of digitalis preparations, ventricular extrasystole, atrial fibrillation paroxysms.

• Method of application: the drug is administered intravenously drip or intravenously struino. Dosage and duration of therapy depend on the severity of the disease state, the patient's age and the doctor's indications.
• Side effects: nausea, vomiting, diarrhea, ulcers of the gastrointestinal tract, flatulence, vein thrombosis, dizziness, increased sweating, paresthesia, bradycardia, skin allergic reactions.
• Overdosing manifests itself in the form of hyperkalemia. To eliminate it, intravenous administration of NaCl solution or 300-500 ml of 5% dextrose solution (with 10-20 units of insulin per 1 liter) is indicated. If necessary, hemodialysis and peritoneal dialysis are possible.
• Contraindications: severe forms of myasthenia gravis, hyperkalemia, renal failure, violation of atrioventricular conduction.

7. Actovegin - activates the cellular metabolism by increasing transport and accumulating glucose and oxygen. Improves blood circulation. It has several forms of release: dragee forte, injection and infusion solution, cream, ointment and eye gel.

• Indications for use: cerebral circulatory insufficiency, ischemic stroke, peripheral circulation disorders, trophic disorders, ulcers and bedsores, burns, prevention and treatment of radiation injuries. The drug is effective for damage to the cornea and sclera. The method of administration and dosage depends on the severity of the course of the disease and on the age of the patient.
• Side effects: skin allergic reactions, excessive sweating, fever, itching and burning in places of application or administration of the drug.
• Contraindications: hypersensitivity to the components of the drug, pregnancy and lactation.

8. Cavinton - expands the vessels of the brain, improves blood flow and supply the brain with oxygen. Reduces platelet aggregation, enhances the metabolism of norepinephrine and serotonin in the brain tissues, reduces the pathologically elevated viscosity of the blood. Produced in the form of 2% solution in ampoules and tablets for oral administration.

• Indications for use: neurological and mental disorders, which are caused by disorders of cerebral circulation, hypertension, vasovegetative symptoms, memory disorders, speech disorders, dizziness. The drug is used in ophthalmic practice and with hearing loss.
• How to use: 1-2 tablets 3 times a day for a long period of time. Improvement is observed after 1-2 weeks of regular use of the drug. Intravenous administration is indicated for neurologic disorders of cerebral circulation. The initial dosage is 10-20 mg. The course of treatment is 1-2 months.
• Side effects: heart palpitations and lowering of blood pressure.
• Contraindications: severe ischemic heart disease, pregnancy, unstable blood pressure and low vascular tone. The drug is not allowed under the skin.

9. Pantogam - nootropic, improves mental activity and memory. It improves the quality of metabolic processes and the body's resistance to hypoxia. Has anticonvulsant effect, improves the condition of patients with cerebral insufficiency, hyperkinetic disorders, neuroleptic syndrome, clonic form of stammering in children. Has a tablet form of release.

• Indications for use: mental failure, oligophrenia, speech delay, epilepsy, polymorphic seizures and epileptic seizures, trigeminal neuralgia. Subcortical hyperkinesis caused by the administration of neuroleptic drugs.
• Dosing: The drug is taken orally 15-30 minutes after eating. The recommended dosage is 500 mg 4-6 times a day, the course of treatment is 2-3 months.
• Side effects are manifested in the form of various allergic reactions. When they occur, the withdrawal of the drug is indicated.

All medicines used to treat hydrocephalus in children should be appointed by the attending physician. During therapy, careful monitoring of the condition of the baby and the progress of treatment are shown.

Vitamins

In combination with drug therapy, as well as before and after surgery, patients are prescribed vitamins, which improve the metabolic process in the brain cells.

Consider the main ones:

• Vitamins of group B-B1 improves coordination of movements and reduces the level of fatigue. B2 accelerates mental reactions, relieves headaches and drowsiness. B3 responds to the level of concentration of attention, the speed of recovery of memories. B5 takes part in the transfer of impulses between the nerve cells of the brain. B6 raises the level of intelligence and improves thought processes. B9 fights with increased fatigue, insomnia and apathy. B12 regulates sleep and wakefulness.
• Vitamin C - ascorbic acid has antioxidant properties, protects the body from increased emotional or physical exertion.
• Vitamin D - calciferol advocates the prevention of oncological brain damage. Supports the elasticity of the walls of capillaries and large vessels, prevents oxidative processes.
• Vitamin E - strengthens the walls of the vessels of the brain, prevents their destruction.
• Vitamin R - a bioflavonoid prevents hemorrhages in the brain and fragility of capillaries.

Vitamins are chosen by the doctor, individually for each case of hydrocephalus and each patient individually.

Physiotherapeutic treatment

To additional methods of therapy of dropsy of the brain, includes physiotherapy. Most often, patients are prescribed:

• Microcurrent reflexotherapy.
• Massage.
• Electrophoresis.
• Acupuncture.
• Manual therapy.
• Physiotherapy.

Physiotherapy is carried out at the stage when the main treatment is successfully performed, and it is necessary to restore the body. Physiotherapy procedures are appointed to accelerate the outflow of cerebrospinal fluid and to improve the psychological state and development of patients.

Alternative treatment

A cerebral cortex in newborns is not a new disease. Alternative treatment of this pathology has been used for a long time. For therapy, infusions and medicinal decoctions are most often used. Consider alternative means of dropsy:

• Grapes - it can be eaten as raw, as well as making juice, compotes.
• Broth from elderberry - rhizome and bark of the plant must be poured with boiling water, boil, sue and strain. This drug is effective in the early stages of the disease.
• Juice onions and pumpkins - for therapeutic purposes taken on an empty stomach 1-2 spoons.
• Infusion from the root of parsley.
• Decoction of melissa or leaves of birch, ara of marsh.

Alternative treatment is not an alternative to medicamental or surgical. Before applying this method, it is necessary to consult with the attending physician and evaluate all the risks of such therapy.

[42], [43]

Herbal Treatment

Another option of alternative medicine is the treatment with herbs. When the development / outflow of cerebrospinal fluid is disturbed, the following recipes are recommended:

• Take 20 grams of peppermint and 200 ml of boiling water. Pour the plant and let it brew for 30 minutes. After cooling, strain, and take as tea, but without additives and sweeteners 3 times a day.
• Pour 2 tablespoons of cornflower flowers into 1 liter of boiling water. Once the infusion has cooled, it should be filtered. The drug is taken 50 ml 3 times a day. Infusion cornflower helps to remove excess fluid from the body.
• A tablespoon of astragalus pour a glass of boiling water and let it brew for 3 hours in a dark place. Strain and take 50 ml 2-3 times a day.
• Root the black elderberry fill with alcohol in a proportion of 1:10. The agent should be infused for a week. Take 25 drops 3 times a day.
• Crush the powdered state of the buckthorn berries. Use the powder to make a medicinal drink. The drug is taken up to 3 times a day, but the daily dose should not exceed 5 g of powder.

Before using herbal remedies for the treatment of hydrocephalus, especially in children, you should consult your doctor.

Homeopathy

In some cases, even with the most serious diseases, resort to the use of alternative therapeutic methods. Homeopathy with dropsy of the head in a newborn recommends such drugs:

• Natrum sulphuricum (Aconl, Arn2, Belli, Helll, Hyper2, Nat-sl, Sill) - hydrocephalus caused by trauma.
• Helleborus niger - the disease occurs with severe seizures, there is strabismus or other visual impairment.
• Mercurius - bouts of insomnia, anxiety, inhibition.
• Secale cornutum - a violation of coordination of movements, a sharp loss of body weight.
• Apis - severe headaches, the child often tilts his head, with urination there is little urine.
• Apocynum cannabinum - the seams of the skull and fontanelle are widely open, increased intracranial pressure.
• Sulfur - pupils react poorly to light, painful sensations intensify at night.
• Glonoin - abnormal enlargement of the skull, vomiting of cerebral origin.

All of the above drugs can only be used according to the prescription of a homeopath physician, who will assess all the risks of this therapy for the baby and will select the necessary dosage of medications.

Surgery

In most cases, surgical treatment of edema of the brain is the only way to stop the pathological growth of intracranial pressure and save the brain. The mode of operation depends entirely on the form and stage of the disease. The main task of the operation is the removal of cerebrospinal fluid from the ventricles of the brain to other cavities of the body.

1. Closed hydrocephalus

The type of surgical intervention in this case depends on the cause of the disorder.

• If a failure in the development and withdrawal of cerebrospinal fluid is associated with the presence of a tumor, a cyst or a hematoma, the doctor removes pathological tissue. This normalizes the intake and absorption of cerebrospinal fluid.
• If tumor formations sprouted into the brain, and do not have clear boundaries, then shunting is indicated. During the operation, the doctor creates a path for the movement of the cerebrospinal fluid, which will bypass the congestion.

Most often, the liquor is removed by means of silicone catheters into the abdominal cavity, which has an increased absorption capacity. This type of operation is called ventriculo-peritoneal bypass. Annually it is carried out for more than 200 thousand newborns.

With ventriculo-atrial bypass, the cerebrospinal fluid is diverted to the right atrium. It is also possible to carry out endoscopic ventriculostomy, which is most effective in occlusal forms of dropsy. If the pressure in the skull grows very quickly, and shunting is dangerous, then external ventricular drainage is performed. A catheter is inserted into the ventricle of the brain, through which the liquor is diverted.

2. Open hydrocephalus

If the cerebrospinal fluid is not absorbed where it should, then the following operations are shown:

• Ventriculo-peritoneal bypass.
• Ventriculo-atrial bypass.
• Lumbo-peritoneal shunting.

Surgical interventions are possible that activate suction of the cerebrospinal fluid, for example, dissection of arachnoid adhesions. If there is an increased synthesis of the liquid, the operation is aimed at suppressing the process. To do this, clamps can be placed on the vascular plexuses of the ventricles or cauterized structures that line the ventricular wall.

If the surgical treatment was successful, then the progression of the pathology ceases. The kid returns to normal life, develops on a par with peers. In some cases, the operation with dropsy is not performed. For example, when intracranial pressure does not increase, and there are no clear signs of disease progression. In this case, the child should be observed regularly with a neuropathologist and a neurosurgeon. It is necessary to systematically measure the circumference of the head, carry out neurosonography and CT. It may be prescribed medication with drugs that reduce the production of cerebrospinal fluid.

Prevention

To reduce the risk of a child with hydrocephalus, future parents should carefully approach the stage of pregnancy planning. Prevention begins with a consultation with a geneticist and genetic examinations for both women and men. A future mother should carefully monitor her health, avoid fatigue, stress and trauma. Both before and after conception, one should lead a healthy lifestyle, protect against possible infections.

During pregnancy, it is strictly forbidden to smoke, drink alcohol and drugs. Do not take any medicines without medical permission. If a woman's professional activity is associated with hazardous conditions or toxic substances, she should be suspended for the period of gestation. It is recommended to spend more time outdoors, to keep a balanced diet and to receive more positive emotions.

Regular check-ups and planned diagnostic examinations, a healthy lifestyle and compliance with all medical prescriptions, allow to minimize the risk of a child with VGM.

[44], [45]

Forecast

How and how much the newborn will survive with hydrocephalus, completely depends on the cause of the disease, its shape, stage, severity of the course. The forecast is based on such factors as:

• Presence of concomitant diseases.
• The urgency and effectiveness of the chosen method of treatment.
• The degree of progression of hydrocephalus (late stages are difficult to treat and cause many pathological complications).
• Timeliness of diagnosis of the disease (the time interval from the moment of the onset of the violation to the beginning of treatment).

It is very important in detecting dropsy to begin its immediate treatment. Early stages are better suited for therapy and avoid complications, which can not be said about neglected cases. Many patients, after complete treatment, do not experience difficulties with their health and forget about their diagnosis.

According to medical statistics, more than 90% of newborns with dropsy are successfully recovering from the disease and its consequences. In 10% of cases there is a risk of development of life-threatening conditions:

• Lag in physical and mental development (problems with speech, difficulties in the manifestation of emotions).
• Constant headaches due to increased intracranial pressure.
• Visual impairment and complete blindness.
• Epilepsy, cerebral palsy.
• Increased nervous excitability.
• Expressed sleep disorders.
• Aggression.
• Stuttering.
• Strabismus.
• Hysteria.
• Various neuropathic disorders.

The cerebral cortex of newborns of the communicating form has a more favorable prognosis. Congenital and timely diagnosed disease is much easier than acquired. If the treatment is started on time and correctly formulated, then the life of the baby continues, but there is a risk of deterioration in its quality (speech, sight, hearing, coordination of movements).

[46], [47], [48], [49], [50], [51], [52], [53]