Enlargement of the lateral ventricles of the brain in a child. How does ventricular dilatation manifest? Diseases that cause dilatation, other causes

Ventricles of the brain

The ventricles of the brain are a system of anastomizing cavities that communicate with the subarachnoid space and the spinal cord canal. They contain cerebrospinal fluid. Inner surface The walls of the ventricles are covered by ependyma.

Types of cerebral ventricles

1. The lateral ventricles are cavities in the brain that contain cerebrospinal fluid. These ventricles are the largest in the ventricular system. The left ventricle is called the first, and the right - the second. It is worth noting that lateral ventricles through the interventricular or Monroe foramina they communicate with the third ventricle. Their location is below the corpus callosum, on both sides of the midline, symmetrically. Each lateral ventricle has an anterior horn, a posterior horn, a body, and an inferior horn.
2. The third ventricle is located between the visual tuberosities. It has a ring-shaped form because the intermediate visual tuberosities grow into it. The walls of the ventricle are filled with central gray medulla. It contains subcortical autonomic centers. The third ventricle communicates with the midbrain aqueduct. Posterior to the nasal commissure, it communicates through the interventricular foramen with the lateral ventricles of the brain.
3. The fourth ventricle is located between the medulla oblongata and the cerebellum. The vault of this ventricle is the cerebral velum and the worm, and the bottom is the pons and medulla oblongata.

This disease is manifested by certain symptoms - signs of deterioration in health, which should definitely be paid attention to. They directly depend on age group, which the patient belongs to, as well as the degree of progression of the disease. For example, hydrocephalus of the brain in newborns is accompanied by a number of features. First of all, those children who have been diagnosed with this disease have an excessively large head circumference, which continues to increase in the future. At the same time, a convex fontanel is noticeable on the parietal part of the child’s head. Other manifestations of this disease in young children include vomiting, bad dream, irritability, eye rolling and convulsions. Most often, the development of such children is delayed, complicated by poor perception of information, slow thinking, learning difficulties, etc.

Hydrocephalus of the brain in children can appear during the mother’s pregnancy. This type of this disease is called congenital. Its occurrence is caused by intrauterine infections, fetal malformations, hemorrhages in the ventricles of the brain in not yet born child. Another type of this disease is acquired hydrocephalus. It develops after the baby is born. Its causes may be traumatic brain injuries received during childbirth, as well as various infectious diseases.

All of the above types of hydrocephalus are in an active progressive form, in which the intracranial pressure, brain tissue atrophies and the ventricles of the brain expand. But the expansion of the ventricles of the brain can be passive, this form is called moderate external hydrocephalus. Doctors believe that moderate external hydrocephalus is a rather dangerous disease, since in most cases there are no symptoms characteristic of hydrocephalus. It is worth noting that moderate external hydrocephalus leads to impaired blood circulation in the brain and the patient begins to suffer from disorders nervous system, lethargy, migraine.

Symptoms of brain hydrocephalus

The most basic signs of hydrocephalus are advanced head growth and a greatly enlarged skull.

Symptoms of hydrocephalus in newborns

• frequent tilting of the head;
• tense fontanel;
• eyeballs shifted to the bottom;
• strabismus;
• pulsating round protrusions in places where the bones of the skull have not fused normally.

Closed and open hydrocephalus

The immediate cause of excessive fluid accumulation will always be some kind of disruption in its production and circulation. Sometimes there is a violation of fluid circulation, caused, for example, by a tumor. This is occlusive hydrocephalus; when it is treated, circulation is restored by removing the obstruction. Closed, or occlusive, hydrocephalus is divided into:

1. monoventicular - in this case, communication with one of the ventricles of the brain is disrupted,
2. Biventicular hydrocephalus occurs if both interventricular foramina of the anterior and middle sections of the 3rd ventricle are blocked. The lateral ventricles are always enlarged.
3. triventicular hydrocephalus is accompanied by a blockade of the cerebral aqueduct or the 4th ventricle, while all ventricles, aqueduct and interventricular foramina are dilated,
4. tetraventicular hydrocephalus is also manifested by dilation of all components of the ventricular system; it is characterized by blockage of the median and lateral aperture of the 4th ventricle.

Gomel (

Please tell me, in our NSG conclusion it is written: microcalcifications in both caudothalamic sulci; single microcalcifications in both thalami. Signs of external hydrocephalus. Boundary dimensions of the anterior horns, lateral ventricles and 3rd ventricle.” What does it mean? Is it dangerous? Is this treatable? Thank you.

Dear Elena, microcalcifications in the basal ganglia may be a sign of Farah disease or, more likely, the child does not have any calcifications. Sometimes doctors perceive hyperechoic formations of an ischemic nature in this area and misinterpret. Calcifications are confirmed by performing a CT scan of the brain. The remaining changes in the NSG correspond to fetal hypoxia. Perform NSG from another doctor or carry out NSG control after 3 months.

Kaliningrad region, Ozersk (

Dear Oleg Igorevich! My son is 4 years 11 months old. The boy has had recurrent neuropathy since he was 3.5 years old. facial nerve on right. On May 16, 2011, an MRI with a resolution of 1.0 Tesla was performed. The results are:

On a series of MR tomograms, weighted by T1 and T2 in three projections, sub- and supratentorial structures are visualized. An arachnoid cyst is visualized transparent partition dimensions 4.8×1.3×2.3 cm. The lateral ventricles of the brain are not expanded, III and U-l ventricles not changed, the basal cisterns are not expanded. The chiasmal area is without features; the pituitary tissue has a normal signal. The subarachnoid convexital spaces and grooves are locally expanded, mainly in the area of ​​the frontal and parietal lobes. The midline structures are not displaced. The cerebellar tonsils are located normally. No focal or diffuse changes were detected in the brain substance. On a series of MR angiograms performed in the TOP mode, the internal carotid, main, and intracranial segments are visualized in the axial projection vertebral arteries and their ramifications. The circle of Willis is closed. A narrowing of the lumen and a decrease in blood flow in the intracranial section of the right VA is determined (hypoplasia?). The lumens of the remaining vessels are uniform, the blood flow is symmetrical, and no areas with pathological blood flow were identified.

Conclusion: MR picture of arachnoid changes of a liquorocystic nature. The circle of Willis is closed. Decreased blood flow in the intracranial segment of the right VA (hypoplasia?).

Dear doctor, tell me why the situation is dangerous, is it necessary? surgery? What treatment methods are there? Best regards, Yulia.

Dear Yulia, recurrent neuropathy of the facial nerve is not associated with those small changes on the MRI. You need to be observed by a pediatric neurologist and initiate therapy in a timely manner. Perhaps the child has a hereditary nature of this pathology.

Vladivostok (

Oleg Igorevich! We are very lucky to have such a wonderful specialist like you in our city! Thank you for your advice and even moral support. But please allow me to address you once again with my meticulous questions! I just can’t calm down about the future health of my child. I have already written to you that the size of the cistern magna of the fetal brain at 31 weeks was 9 mm. You said that there is still some increase. I scoured the entire Internet for standard values, but I couldn’t find anything. I'm still worried about how this might affect the psychological and physiological health baby after birth. I asked at the ultrasound - they said that the cerebellar vermis was normal, the lateral ventricles were also normal, and the cerebellum was also normal. BUT they didn’t say anything about the fact that the dimensions of the large tank are slightly larger than the norm (according to you). And is it normal that in almost 2 months the dimensions of this tank have not changed at all? Is all this pathology or normal? Of course, I understand that a more accurate answer and result can only be obtained after the birth of the child. But still, presumably, what should we hope for? Maybe you need to undergo an ultrasound again?

I'm especially interested in what normal values at this time? Of course, you need to hope for the best. But I think that you need to be prepared for anything. What can happen to a child with this size? Thank you very much for your understanding!

Dear Ekaterina, do not panic and forget about these changes. Normal sizes- This is an approximate calculation that most people have. But everything is in human body individually, and perhaps this is also the norm for your child. I repeat once again, at such sizes, there may not be any neurological symptoms.

Velsk (

Hello, Oleg Igorevich! The child is 2 months old. After birth, she was diagnosed with a cyst: on the right - 82 * 59 mm, and now: on the right, subependymal cysts up to 5 mm, in the parenchyma in the parietotemporal region there is a cyst: 75 * 56 * 84 mm of a homogeneous internal structure. Frontal horn 3.8 mm; body 9.5 mm, occipital horn 12 mm, (left lateral ventricle), and right lateral ventricle: frontal horn 3.7 mm, body 9.3 mm, third ventricle 7 mm. The echogenicity on the left is heterogeneous, the choroid plexus on the right is not clearly visible. The interhemispheric fissure is widened in the frontal regions to 5.5 mm. There is a displacement of the middle structures. The cerebral peduncles are of regular shape. This is serious? Should I be worried? We are very excited!! Thank you in advance!!

Dear Lisa, you need to perform an MRI to clarify the cyst. You can then send MRI images to me by email. We will discuss further tactics in more detail.

Hello, dear Oleg Igorevich! Please consult us! The child is 2 months old. NSG results (at 1.5 months): the brain was examined in standard sections. Lateral. In p/sag. square right: 2–2-12 mm, left: 3–2-9 mm. Oblique section of the anterior horns: right 2 mm, left: 3 mm. Choroid plexus: heterogeneous right - anechoic formation 4.3 mm closer to the body. 3rd ventricle - 3.6 mm. Monroe d=s=2 mm. Interhemispheric fissure - 3 mm. Posterior cranial fossa: bzc - 6.3 mm. Additionally: the thalamocaudal notch is clearly visualized; with CLC, the blood flow is not depleted. Conclusion: moderate dilatation of the interhemispheric fissure and BZZ, cyst of the right choroid plexus, asymmetry of the lateral ventricles without dilatation. Now we drink Asparkam, Cavinton, Diacarb. Tell me please, what is this? What are the risks and consequences? How to treat?

Dear Irina, I see no reason to take Diacarb and Asparkam. As for Cavinton, it is probably necessary if there are neurological symptoms. See a neurologist. Monitoring of blood glucose levels is indicated after 2–3 months.

Vladivostok (

Dear Oleg Igorevich. At 23–24 weeks, a second ultrasound revealed cysts of the posterior cranial fossa and dilation of the cistern magna up to 11 mm. But at the subsequent ultrasound at 25 weeks they didn’t tell me anything about cysts and the size of the large cistern was 9 mm. The results of cordocentesis are normal: 46 chromosomes. I was with you for a consultation. You said that you need to look at the dynamics. Now I am 31 weeks pregnant - I underwent the 3rd planned ultrasound - the results say that there are no deviations, but the size of the cistern magna, 9 mm, remains the same, the cerebellum is normal. Please tell me, is everything okay with the fetus’s brain at the moment and is it possible to definitely exclude a disease such as Dandy Walker? Do the dimensions (9 mm) of the cisterna magna correspond to the given stage of pregnancy? Can cysts of the posterior cranial fossa resolve on their own? Thanks in advance for your answer!!!

Dear Ekaterina, go into labor calmly. After birth, it will be necessary to perform an NSG and appear. I think there is nothing wrong with your child, since some enlargement of the cistern magna of the brain can go away without neurological symptoms.

Zaporozhye (

Good afternoon, Oleg Igorevich! I am now 24 weeks pregnant, and an ultrasound revealed a “Blake’s pouch” cyst, 14x12 mm. The doctor says there is nothing wrong. And I want to know what this threatens our baby with and what needs to be done in this situation. Thank you.

Dear Svetlana, according to ultrasound data it is very difficult to determine the type of cyst: Blake, Dandy-Walker, retrocerebellar cyst, enlarged cisterna magna, etc. Such sizes are not dangerous for neurological deficit. However, for a more detailed examination, you can perform an MRI of the fetus and place all the points.

Velsk (

Good evening, Oleg Igorevich! We are 2 months old. We have a diagnosis: posthemorrhagic cyst of the right parietotemporal region. Is this dangerous, will it go away over time, can it be treated without surgery, and is it possible to refuse an MRI of the brain? Thanks in advance!!!

Dear Nadezhda, at 2 months you can do without an MRI by performing an NSG. If it is definitely posthemorrhagic, then it does not require surgical treatment, and its regression depends on the size of the lesion. There is a risk of developing cerebral palsy, in the form of a hemiparetic form.

Saint Petersburg (

We are 9 months old. The head is larger than the chest. Head 46 cm, chest 44 cm. Sent for ultrasound of the brain: V3–3 mm, MS - 52 mm, MD - 52 mm, VLD - 16.5 mm, VLS - 15.2 mm, temporal horns of the lateral ventricles: s - 26/2 mm, D - 26/2 mm, interhemispheric fissure - 1 mm, subrachnoid spaces - 1.5/1.5 mm. A diagnosis was made: dilatation of the right lateral ventricle. Isn't this dangerous? So what should we do? Thank you.

Dear Natalya, judging by the description, your child has dilatation of both ventricles. Whether it is related to hydrocephalus or not (that is, whether there are signs of increased intracranial pressure) can be determined by a neurologist or neurosurgeon.

Arkhangelsk (

Good afternoon CIS results:

• echogenicity of the brain parenchyma: slightly increased in the parieto-occipital region;
• left lateral ventricle: frontal horn - 5.5 mm, body - 5.5 mm, occipital horn - 13.3 mm;
• right lateral ventricle: frontal horn - 5.0 mm, body - 4.6 mm, occipital horn - 12.6 mm;
• third ventricle: 3.5 mm;
• Ventricular ependyma: not thickened;
• choroid plexuses of the ventricles: smooth contours, homogeneous echogenicity, cysts are not detected;
• interhemispheric fissure: not widened;
• the cavity of the transparent septum is not expanded;
• displacement of the median structures - no;
• the cerebral peduncles are regular in shape and symmetrical;

A diagnosis was made: increased echogenicity in the air defense, ventriculomegaly, left ventricular vein. My son is now 2 months old, born at 36 weeks, the umbilical cord was entangled and he was without water for 6 hours. Please decipher the diagnosis. THANK YOU IN ADVANCE!

Dear Anna, this is not a diagnosis, but simply a conclusion from the NSG. Your diagnosis will be made by a neurologist after an objective examination, taking into account this conclusion and medical history. It is likely that your child has perinatal lesion CNS of hypoxic origin. Syndromic details will be clarified after examination.

Abovyan (

Dear Oleg Igorevich, I am 25 and I have a pineal cyst. On a series of MRI scans of the brain in three projections, the interhemispheric fissure runs along the midline. The membranes of the brain are not thickened. Ventricles - the shape, size and location of the lateral ventricles are normal, the cavity of the fourth ventricle is free, the Sylvian aqueduct is passable. The furrows of both hemispheres are not changed, the architectonics are not disturbed. The subarachnoid spaces of the convexital surfaces of the brain are not expanded. An enlarged gland is visualized, with dimensions:

• on sagittal sections up to 14 mm
• on coronal up to 12 mm
• on axial up to 14 mm

The parenchyma of the gland is represented by a cystic-transformed structure, the contents of which in all scanning modes have an MR signal intensity corresponding to a dense liquid. When examined in DWI, there were no signs of diffusion impairment. In a series of post-contrast MR tomograms, accumulation of contrast along the contour of this structure is observed. The anterior contour of the structure is intimately adjacent to the posterior surface of the posterior commissure (commisura posterior), upper contour reaches the splenium of the corpus callosum.

There were no signs of liquorodynamic disturbances at the time of the study. The corpus callosum, basal ganglia, thalamus optic, stem structures of the brain and cerebellum are usually formed. The pituitary gland is located in the center of the sella turcica, without structural changes. The differentiation into adeno and neurohypophysis is not changed. The funnel is located centrally and is not thickened. The structures of the cerebellopontine angles are unchanged. Cranio - vertebral junction without visible pathology.

Conclusion: The MR picture of the main changes in the brain leaves the impression of a pineal cyst, without signs of impaired cerebrospinal fluid dynamics. Recommended dynamic observation depending on the size of the cyst.

This MRI was done on 02/07/2011. I have two questions:

1. Will this cyst be able to resolve with medications or other means? Please tell me if you know any remedy...
2. Can massages help resolve a cyst?

Thanks for your reply.

Good afternoon, it is enough to monitor this cyst over time. There is no need to “dissolve” it, especially since this cannot be done with any medications or massage. You are advised to be monitored by an endocrinologist and MRI - once a year.

Karaganda (

Oleg Igorevich, please tell me how terrible our diagnosis is and whether bypass surgery is necessary. At 7.5 months, an ultrasound scan was performed: parenchyma of medium echogenicity, interhemispheric fissure is not deformed, widened to 5.0 mm, lateral ventricles are symmetrical, anterior horns D=S - 9.7 mm, bodies D=S-12 mm, occipital horns D =S - 16 mm, choroid plexus contours are clear, even, D=S - 11 mm, 3rd ventricle 7.1 mm, 4th ventricle 4.9 mm, subarachnoid space D=S - 4.7 mm. Conclusion: moderate ventriculomegaly, moderate expansion of the interhemispheric fissure and subarachnoid space in the frontal region. Hypoxic-ischemic damage to the central nervous system (hydrocephalic syndrome). We took Diacarb and Asparkam for 1 month. They did an ultrasound at 8.5 months - enlargement of the ventricles, anterior horns D=S - 10 mm, bodies D=S - 13 mm, occipital horns D=S - 17.3 mm and blood flow through the vein of Galen 17 cmsec. The diagnosis is the same, it is recommended: in drug treatment We don’t need it, a dehydration course at the end of May, diacarb and asparkam for 2 weeks. Before that, we saw another doctor for 4 months and also took a diuretic. The child develops according to age. The fontanel is 6.0 by 6.0 cm, the head at 7.5 months was 47 cm, at 8.5 months - 48 cm. We have no more complaints, the child is like a child. The doctor says that if it weren’t for the ultrasound results, he would never have thought that the child had hydrocephalus. Oleg Igorevich, thank you in advance.

Dear Irina, your child does not have hydrocephalus. These changes in the NSG are caused by perinatal brain hypoxia. Diacarb with asparkam are not shown. See a neurologist and get a massage.

Kazakhstan, Pavlodar (

Dear Oleg Igorevich! Daughters 2 and 10 underwent another examination - a computer EEG. Conclusion: against the background of moderately pronounced general cerebral changes in brain activity, signs of irritation of mesodiencephalic structures are recorded. Please decipher the diagnosis. Should we worry? Is treatment necessary? My daughter has been diagnosed with hydrocephalus since she was one year old. mild degree compensated form." Is the diagnosis correct? Thank you.

Dear Yulia, the EEG conclusion is not a diagnosis, and it does not indicate anything specific. Perform an MRI of the brain to confirm or confirm the diagnosis of Hydrocephalus. In my opinion, there is nothing to worry about.

Odintsovo (

Hello, Oleg Igorevich! My daughter is 7 months old. 2 months ago, a lump grew on my head from the suture between the frontal and temporal bones. On ultrasound: expanded connective tissue suture, no additional vessels. Doctors don’t know what it is, I’m a paramedic myself. Perhaps this manifestation of rickets is atypical? I hope you can help us decide on further tactics.

Dear Elena, a dermoid cyst is usually localized in this place. You can operate on it after a year or earlier if it increases quickly.

Diagnosis of hydrocephalus is based on the clinical picture, examination of the fundus, as well as additional research methods, such as neurosonography (NSG), ultrasound examination of the brain (in infants under 2 years), computed tomography (CT) or magnetic resonance imaging (MRI) of the brain brain The primary diagnosis can be made by a neonatologist, pediatrician, neurologist or neurosurgeon.

The most common operation is ventriculoperitoneal shunt (VPS).

Neurosonography is effective method diagnosing the state of the brain and ventricular system in children under 1.5-2 years of age, until the large fontanel and other “ultrasound windows” - areas of the skull where the bones are very thin (for example, the temporal bone) and allow ultrasound to pass through - have not closed. It allows you to detect expansion of the ventricular system, intracranial volumetric formations(tumors, hematomas, cysts), some malformations of the brain. However, it should be remembered that NSG is not an entirely accurate method. The image of the brain is obtained with significantly lower resolution (less clear) than with CT and MRI.

If any brain pathology is detected, a CT or MRI is necessary. Without them, it is impossible to make an accurate diagnosis, identify the cause of hydrocephalus, and even more so carry out treatment. This equipment is expensive and is still not installed in all hospitals. In this case, parents should insist on having a CT or MRI scan performed at other centers or perform them themselves on a commercial basis. It should be borne in mind that a clinic that undertakes the treatment of children with hydrocephalus is required to have this equipment. Otherwise, we can recommend that parents choose another, more equipped hospital, at least in another city.

At 1.5 months, development corresponds to age. We did an ultrasound (it would be better if I didn’t do it, this nightmare began again) and received the following conclusion:

“lateral ventricles are dilated, asymmetrical edges are rounded

On the left, the anterior horn is 15.2 mm, the body is 5.3 mm (Ventriculomegaly on the left)

Right anterior horn 11 mm body 3.6 mm

The echogenicity of the brain parenchyma is moderately increased

no displacement of the middle structures was detected

periventricular area of ​​increased echogenicity

No focal changes

The choroid plexuses are homogeneous

Width of 3rd ventricle 2.6 mm

The interhemispheric fissure is up to 3.2 mm wide in the frontal and parietal parts

The subarachnoid space along the contour of the frontal and parietal lobes is slightly expanded to 2.3 mm.”

I'm in a panic and don't understand anything. We were prescribed to drink encephobol, but we couldn’t really drink it, the child won’t take the bottle, and we choke on the spoon.

Other questions from the “ENT” section: cryodestruction of tonsils

The most common disease of the cerebral ventricles is hydrocephalus. It is a disease in which the volume of the cerebral ventricles increases, sometimes to impressive sizes. Symptoms of this disease appear due to excess production of cerebrospinal fluid and accumulation of this substance in the area of ​​the brain cavities. Most often, this disease is diagnosed in newborns, but sometimes it occurs in people of other age categories.

For diagnostics various pathologies work of the ventricles of the brain using magnetic resonance or computed tomography. Using these research methods, it is possible to detect the disease in a timely manner and prescribe adequate therapy.

Ventricles of the brain have a complex structure, in their work they are associated with various organs and systems. It is worth noting that their expansion may indicate developing hydrocephalus - in this case, consultation with a competent specialist is required.

Ultrasound examination allows you to study the work and structure internal organs. By reflecting the waves, the finished data is sent to the monitor. Ultrasound of the brain in an infant is mandatory procedure preventive examination. Thanks to the data obtained, it is possible to judge the structure of the brain and the functioning of the vascular system. The examination is carried out quickly and painlessly and does not pose any danger to the child..

NSG (neurosonography) allows you to determine disturbances in the functioning and structure of all brain structures, as well as evaluate the functioning of the central nervous system.

NSG is carried out through the fontanel, which is located between the unfused bones of the skull. Thanks to this, the result will be accurate and correct. The fontanel is soft to the touch, pulsation is palpable. Normally it should be at the level of the surface of the head. Swelling indicates health problems.

The NSG procedure does not require additional preparation - it is enough to free the child’s head from the cap. The result is not affected in any way by the child’s condition, even if he cries, is capricious, or calmly examines the situation. The procedure is also carried out when the child is sleeping.

What is the reason for this study?

Ultrasound is a mandatory scheduled procedure every month. In other cases, indications for performing NSG before the first month of life are the following cases:

In one month mandatory NSG is performed in the following cases:

• children who were born by caesarean section;
• irregular head shape;
• conduct research to monitor the condition;
• with developmental disorders such as torticollis, strabismus, paralysis;

For children older than one month, NSG is performed for the following indications:

• evaluate the effectiveness of treatment for injuries or neurological diseases brain;
• after infectious diseases (encephalitis, meningitis);
• genetic and gene disorders;
• head injury.

In some cases, an MRI of the brain is indicated, which is performed under anesthesia.

Interpretation of the results obtained during the survey

The results will depend on many factors - due date, birth weight. Normal for all children different months life consists of the following parameters.

1. All parts of the brain should be symmetrical in size and homogeneous in composition.
2. The furrows and convolutions have clear contours.
3. There is no fluid in the interhemispheric fissure, and its dimensions do not exceed 3 mm.
4. The choroid plexuses of the ventricles are hyperechoic and homogeneous.
5. The normal size of the lateral ventricles is: anterior horns - up to 4 mm, occipital horns - 15 mm, body - up to 4 mm. The third and fourth ventricle – up to 4 mm.
6. The norm for a large tank is up to 10 mm.
7. There should be no seals, cysts or neoplasms.
8. The membranes of the brain are unchanged.
9. The normal size of the subarachnoid space does not exceed 3 mm. If it is greater, and an increase in temperature and frequent regurgitation are observed, then a disease such as meningitis can be suspected. If there are no accompanying symptoms, all other examinations are normal, perhaps this phenomenon is temporary.

The ventricular cavity should not be enlarged. Their increase indicates diseases such as hydrocephalus and rickets. During hydrocephalus, the child has a large head and swollen fontanel. This violation causes frequent headaches, mental and physical underdevelopment.

The contents of the lateral ventricles (right and left) is cerebrospinal fluid. With the help of special holes they are connected to the third ventricle. There is also a fourth ventricle, which is located between the cerebellum and the medulla oblongata.

In the lateral ventricles, the cerebrospinal fluid joins, after which it moves into the subarachnoid space. If such an outflow is disrupted for some reason, hydrocephalus occurs.

Asymmetry of the lateral ventricles (dilatation) is observed when the amount of fluid increases. The disease can be diagnosed in children who are born ahead of schedule, since their lateral ventricles are larger.

If asymmetry of the lateral ventricles is detected on the NSG, the size is measured and the quantitative and qualitative characteristics are determined.

The main reasons due to which the ventricular cavity expands include hydrocephalus, trauma to the skull and brain, damage to the central nervous system and other malformations of newborns.

A septum pellucida cyst is usually detected at birth. The transparent septum is a thin plate consisting of brain tissue. Between these plates there is a cavity resembling a gap. A septum pellucida cyst is a cavity filled with fluid. The cavity accumulates and begins to compress neighboring tissues and vessels.

A cyst of the septum pellucidum is detected on NSG in almost all premature infants. After some time it may disappear. If a septum pellucida cyst was detected immediately after birth, then in most cases a special drug therapy not prescribed.

If a cyst of the transparent septum occurs due to injury, inflammation or an infectious disease, immediate treatment is required. May occur associated symptoms(head pain, visual and hearing impairment).

During NSG, which is carried out every month after detection of a disorder, the dynamics of the development and growth of the cyst of the transparent septum are determined. Depending on the growth rate and the cause of the cyst, it will depend further treatment. Basically, drugs are prescribed that free up this brain cavity.

If any violations were discovered during the NSG, a decision may be made to medically disqualify all vaccinations. Vaccinations can worsen the condition, so after the examination you should visit a neurologist.

A neurologist interprets and clarifies the diagnosis. Only he can prescribe the correct treatment and observe the development of the disease over time. He will also warn possible complications and will prevent other violations.

The ventricles of the brain are a system of interconnected cavities where cerebrospinal fluid circulates. The ventricles provide:

1. Mechanical protection of the brain, creating a soft “buffer” upon impact.
2. The production of cerebrospinal fluid - a fluid that nourishes brain tissue.
3. Circulation of cerebrospinal fluid. The ventricles ensure the removal of toxic metabolic products from the brain.
4. Filtration of substances entering the cavities of the nervous system.

Dilatation or enlargement of the ventricles of the brain leads to dysfunction, which develops neurological and psychological symptoms.

Dilation develops in two types:

• Increase in the volume of all ventricles.
• An increase in the volume of individual ventricles, which leads to their asymmetry.

Expansion or asymmetry of the cavities leads to changes in intracranial pressure. As it rises, it compresses areas of the brain, forming clinical picture, which is determined primarily by general cerebral symptoms, since the entire ventricular system is affected. A separate brain area is not affected.

Dilatation is not independent disease, but is included in the symptom complex of other, major leading diseases or defects. For example, expansion can be represented as an anatomical change in infectious and inflammatory diseases.

Dilatation is considered a pathology only when it manifests itself: it worsens a person’s quality of life and gives rise to symptoms. When ventricular dilatation occurs latently, asymptomatically, this is considered anatomical feature nervous system.

Dilatation may not manifest itself as a syndrome. The severity of specific symptoms depends on the degree of expansion of the brain cavities.

Expansion of cavities also occurs in newborns. In this case, the pathology is a defect in the intrauterine development of the fetus.

Causes

Dilatation in adults occurs for the following reasons:

1. Inflammatory diseases of the central nervous system: polio, rabies.
2. Congenital features: excess synthesis of cerebrospinal fluid.
3. Insufficient absorption of cerebrospinal fluid in the walls of the ventricles.
4. Mechanical blockage of the spinal cord fluid-conducting tract due to a hernia or tumor.
5. Traumatic brain injury: brain contusion, concussion.
6. Tumors.

Factors that impede the outflow of cerebrospinal fluid:

• cysts, tumors;
• previous intracerebral hemorrhage;
• blood diseases accompanied by excessive clotting;
• vascular pathologies, for example.

Dilatation in a baby can be caused by:

1. Hydrocephalus is a disease that is accompanied by excessive accumulation of cerebrospinal fluid in the ventricles. Acquired hydrocephalus develops in the first month of life against the background of head trauma and intoxication syndromes.
2. Birth traumatic brain injury, if the mother was ill infectious diseases, for example, toxoplasmosis or cytomegalovirus.
3. Oxygen starvation of the fetus. Occurs if the mother smoked, drank or took drugs.
4. Hereditary factor: the peculiarity of the volume of the ventricles arose due to the fact that this was the case in parents and grandparents.
5. Violation of pregnancy terms.
6. Chronic diseases in the mother: diabetes, heart failure, ischemic disease hearts.

How it manifests itself

Ventriculomegaly is determined by how much intracranial pressure is increased and how the patient’s adaptive mechanisms fight this change. Mild dilatation manifests itself:

• Frequent headache and dizziness. May be worse before bed or upon awakening.
• Nausea.
• Apathy, lethargy.

Severe dilatation manifests itself:

1. Headache and dizziness.
2. Nausea and vomiting.
3. Drowsiness, loss of strength, lack of desire to explore the world around us.
4. Sleep disturbance.
5. Protrusion of a vein on the forehead due to obstructed venous outflow.
6. Changes in muscle tone: tone can weaken or increase.
7. Trembling of hands and feet.
8. Large head, disproportionate to the body.

Ventriculomegaly in a child may manifest itself general symptoms, For example:

• head circumference is growing too quickly;
• the fontanel bulges and pulsates;
• “setting sun” symptom: when the eyelids are raised, the child’s pupils are lowered;
• the head is often thrown back;
• in places of the skull where the bones do not meet at the seams, pulsating round protrusions are observed;
• nystagmus is a synchronous and rhythmic movement of the eyes in one direction (up to 200 movements per minute).

In children, severe expansion of the ventricles of the brain causes hypertensive-hydrocephalic syndrome. The essence of the pathology is a gross increase in intracranial pressure and an increase in the volume of cerebrospinal fluid. Signs of the syndrome:

1. Lack of appetite, apathy, no interest in toys.
2. Decreased muscle tone.
3. Weakness of the basic innate reflexes of swallowing, sucking and grasping.
4. The child spits up like a fountain.
5. Strabismus and nystagmus.
6. The sutures of the skull are not connected; pulsating protrusions protrude between them.
7. Child retardation at psychosomatic age.
8. Reduced intelligence and all mental abilities.

Hypertensive-hydrocephalic syndrome that does not respond to treatment leads to the following consequences:

• paresis or paralysis;
• mental retardation;
• speech disorders;
• deterioration or loss of vision.

Diagnosis and treatment

Dilation can be diagnosed using:

1. (Ultrasound for the brain). Used for adults and children after the first month.
2. . Explores the location and extent of expansion.
3. Ultrasound of the fetus. Allows you to identify pathology at the stage of formation of the child’s body.

The essence of the treatment:

• Treatment of the underlying disease.
• Preventing complications and stabilizing the course of the disease.

Appointed:

1. antihypoxants – drugs that improve oxygen metabolism in the brain;
2. diuretics – for correction water balance and prevention of cerebral edema;
3. nootropics – to improve microcirculation of nervous tissue.
4. B vitamins;
5. Therapeutic exercises, massage and physiotherapeutic procedures.

Neurosonography (NSG) is a term applied to the study of the brain of a young child: a newborn and an infant until the fontanel closes using ultrasound.

Neurosonography, or ultrasound of the child’s brain, can be prescribed by a pediatrician at the maternity hospital or a neurologist at a children’s clinic in the 1st month of life as part of screening. In the future, according to indications, it is carried out on the 3rd month, on the 6th month and until the fontanelle closes.

As a procedure, neurosonography (ultrasound) is one of the most safe methods research, however, it should be carried out strictly as prescribed by the doctor, because Ultrasonic waves can have a thermal effect on body tissue.

At the moment none negative consequences in children, the neurosonography procedure was not detected. The examination itself does not take much time and lasts up to 10 minutes, and it is completely painless. Timely neurosonography can save the health and sometimes even the life of a child.

Indications for neurosonography

Reasons requiring ultrasound scanning in the maternity hospital, varied. The main ones are:

• fetal hypoxia;
• asphyxia of newborns;
• difficult labor (accelerated/prolonged, with the use of obstetric aids);
• intrauterine fetal infection;
• birth injuries of newborns;
• infectious diseases of the mother during pregnancy;
• Rhesus conflict;
• C-section;
• examination of premature newborns;
• detection of fetal pathology on ultrasound during pregnancy;
• less than 7 points on the Apgar scale in the delivery room;
• retraction/protrusion of the fontanelle in newborns;
• suspicion of chromosomal pathologies (according to a screening study during pregnancy).

Indications for ultrasound examination within a month:

• suspicion of ICP;
• congenital Apert syndrome;
• with epileptiform activity (NSH is additional method head diagnostics);
• signs of strabismus and diagnosis of cerebral palsy;
• head circumference is not normal (symptoms of hydrocephalus/dropsy);
• hyperactivity syndrome;
• injuries to the child's head;
• delay in the development of the infant's psychomotor skills;
• sepsis;
• cerebral ischemia;
• infectious diseases (meningitis, encephalitis, etc.);
• rickety shape of the body and head;
• CNS disorders due to a viral infection;
• suspicion of neoplasms (cyst, tumor);
• genetic developmental abnormalities;
• monitoring the condition of premature babies, etc.

Preparation and method of conducting the study

Neurosonography does not require preliminary preparation. The baby should not be hungry or thirsty. If the baby falls asleep, there is no need to wake him up; this is even welcome: it is easier to ensure that the head remains still. The results of neurosonography are issued 1-2 minutes after the completion of the ultrasound.

You can take baby milk and a diaper with you to place your newborn baby on the couch. Before the NSG procedure, there is no need to apply creams or ointments to the fontanel area, even if there are indications for this. This worsens the contact of the sensor with the skin and also negatively affects the visualization of the organ being studied.

The procedure is no different from any ultrasound. A newborn or infant is placed on a couch, the place where the skin comes into contact with the sensor is lubricated with a special gel substance, after which the doctor performs neurosonorgraphy.

Access to brain structures with ultrasound is possible through the large fontanelle, thin temple bone, antero- and posterolateral fontanelles, as well as the foramen magnum. In a child born at term, the small lateral fontanelles are closed, but the bone is thin and permeable to ultrasound. Interpretation of neurosonography data is carried out by a qualified physician.

Normal NSG results and interpretation

Interpretation of diagnostic results consists of describing certain structures, their symmetry and echogenicity of tissues. Normally, in a child of any age, the brain structures should be symmetrical, homogeneous, and have appropriate echogenicity. In the neurosonography transcript, the doctor describes:

• symmetry brain structures– symmetrical/asymmetrical;
• visualization of grooves and convolutions (must be clearly visualized);
• condition, shape and location of the cerebellar structures (tentory);
• condition of the medullary falx (thin hyperechoic stripe);
• presence/absence of fluid in the interhemispheric fissure (fluid should be absent);
• homogeneity/heterogeneity and symmetry/asymmetry of the ventricles;
• condition of the cerebellar tentorium (tent);
• absence/presence of formations (cyst, tumor, developmental anomaly, change in the structure of the brain matter, hematoma, fluid, etc.);
• the state of the vascular bundles (normally they are hyperechoic).

Table with standards for neurosonography indicators from 0 to 3 months:

The structures should not contain inclusions (cyst, tumor, fluid), ischemic foci, hematomas, developmental anomalies, etc. The transcript also contains the dimensions of the described brain structures. At the age of 3 months, the doctor pays more attention to describing those indicators that should normally change.

Pathologies detected using neurosonography

Based on the results of neurosonography, a specialist can identify possible violations baby development, as well as pathological processes: neoplasms, hematomas, cysts:

1. Choroid plexus cyst (does not require intervention, asymptomatic), usually there are several of them. These are small bubble formations, in which there is a liquid - liquor. Self-dissolving.
2. Subependymal cysts. Formations whose contents are liquid. They occur as a result of hemorrhage and can occur pre- and postpartum. Such cysts require observation and, possibly, treatment, since they can increase in size (due to failure to eliminate the causes that caused them, which may be hemorrhage or ischemia).
3. Arachnoid cyst (arachnoid membrane). They require treatment, observation by a neurologist and control. They can be located anywhere in the arachnoid membrane, can grow, and are cavities containing liquid. Self-resorption does not occur.
4. Hydrocephalus/dropsy of the brain is a lesion that results in dilatation of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, observation, and control of the NSG over the course of the disease.
5. Ischemic lesions also require mandatory therapy and control studies over time using NSG.
6. Hematomas of brain tissue, hemorrhages into the ventricular space. Diagnosed in premature babies. In full-term babies this is alarming symptom, require mandatory treatment, control and observation.
7. Hypertension syndrome is, in fact, an increase in intracranial pressure. Is very a worrying sign a significant shift in the position of any hemisphere, both in premature and full-term babies. This occurs under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome associated with an excess amount of accumulated fluid (CSF) in the space of the brain.

If any pathology is detected by ultrasound, you should contact special centers. This will help you get qualified advice, make a correct diagnosis and prescribe the correct treatment regimen for your child.

In the first hours after birth, the child is under the supervision of neonatologists, who monitor his physiological condition and make necessary examinations body. In this case, health assessment is carried out in stages, starting from the first minute of life, and ends before discharge.

The most thorough examination is carried out on the first day and consists of a standard procedure for monitoring activity and appearance newborn If the doctor suspects birth defects development, then it is possible to use ultrasound examination, which allows us to identify deviations in the formation of not only internal organs, but also the brain. In this case, the sizes of the ventricles are especially carefully measured, which normally should not exceed a certain value.

At this stage, the neonatologist can diagnose dilation of the ventricles of the brain in newborns. Based on the degree of pathology and the impact on the child’s life, the question will be raised about further solving this problem: for example, in case of minor deviations from the norm, observation by a neurologist and monitoring of the condition are prescribed. If the violations are serious and the symptoms are pronounced, then the child needs special treatment and observation in a hospital setting.

The ventricular system consists of 4 cavities located in parts of the brain. Their main purpose is the synthesis of cerebrospinal fluid or cerebrospinal fluid, which performs a large number of tasks, but its main function is to absorb brain matter from external influences, intracranial pressure control and stabilization metabolic processes between blood and brain.

The movement of cerebrospinal fluid occurs through channels connecting the common 4th ventricle and the subarachnoid space formed by the membranes of the spinal cord and brain. Moreover, its main volume is located above significant fissures and convolutions of the cortex.

The largest lateral ventricles are located equidistant from the midline below the corpus callosum. The first ventricle is considered to be the cavity located on the left side, and the second - on the right. They have C-shape and go around the dorsal parts of the basal ganglia. They produce cerebrospinal fluid, which enters the third ventricle through the intergastric openings. Structurally, segments I and II of the ventricular system include the anterior (frontal) horns, body and inferior (temporal) horns.

The third ventricle is located between the visual tuberosities and has the shape of a ring. At the same time, gray matter is located in its walls, which is responsible for regulating autonomic system. This section is connected with the midbrain aqueduct, and through the interventricular foramen, located behind the nasal commissure, with the I and II ventricles.

The most important IV ventricle is located between the cerebellum and the medulla oblongata, with the vermis and medullary velum located above it, and the medulla oblongata and pons below it. This cavity was formed from the remains of the posterior medullary vesicle and is common to the rhomboid region. At its bottom lie the nuclei of the V-XII cranial nerves. In this case, the rear lower corner communicates with spinal cord through the central channel, and through the upper front part - with water supply.

Sometimes, when examining a newborn, the fifth ventricle is detected, which is a feature of the structure of the brain. It is located in the anterior midline, below the corpus callosum. Usually its closure occurs by 6 months of age, but if the gap is more than 10 mm, then we are talking about a pathology of the liquorodynamic system.

If an ultrasound revealed asymmetry of the lateral ventricles in a child, the prognosis depends on the degree of pathology and the depth of damage to brain tissue, as well as the reasons that provoked the development of the disease. Thus, a significant increase interferes with normal circulation and production of cerebrospinal fluid, which entails neurological problems. But congenital asymmetry, not aggravated by outflow disorders, in most cases does not require treatment. However, such a child needs observation in order to prevent relapse of the disease and possible consequences.

The size of the ventricles is normal

A healthy newborn normally has 4 ventricles: two lateral, the third is conventionally anterior, and the fourth ventricular component, which is considered posterior. Enlargement of the lateral ventricles entails the production large quantity cerebrospinal fluid, which will not be able to circulate normally between the membranes of the brain and, accordingly, perform its functions of regulating metabolic processes. Therefore, when assessing the size of the ventricles of newborns, the following standards are used:

• the lateral anterior horns should fall within the range of 2-4 mm;
• lateral occipital horns - 10-15 mm;
• body of the lateral ventricles - no deeper than 4 mm;
• III ventricle - no more than 5 mm;
• IV - up to 4 mm.

When examining the brain of infants up to a year and older, the use of these standards will be incorrect, since the brain matter and ventricles will grow, so the assessment is carried out using other indicators and corresponding tables.

Causes of enlarged ventricles

If on initial examination It was found that the ventricles of the brain in a newborn are slightly enlarged, then do not despair, since in most cases this condition requires only observation during the first years of life, and the prognosis is favorable.

Initially, a small discrepancy between indicators and norms may be genetically determined and be a feature of the brain structure, while pathological changes occur due to a chromosomal malfunction during fetal formation.

There are a number of factors that provoke asymmetry and dilatation (enlargement) of the ventricular cavity:

• infectious diseases during pregnancy (in particular, infection of the fetus with cytomelalovirus);
• blood poisoning, sepsis;
• complications caused chronic diseases mothers;
• premature birth;
• acute hypoxia during fetal development caused by insufficient blood supply placenta;
• varicose veins feeding the fetus;
• long anhydrous period and prolonged labor;
• rapid birth;
• birth injuries, hypoxia caused by umbilical cord entanglement;
• deformation of the cranial bones;
• entry of foreign objects into the brain structures;
• cysts, neoplasms of various nature;
• hemorrhages;
• ischemic and hemorrhagic stroke.

Also, dilation of the ventricles can be caused by cerebral hydrocele of unknown etiology and other congenital diseases.

This is what a well-known pediatrician and doctor in the post-Soviet space says about ventricular enlargement highest category Evgeny Komarovsky.

How it manifests itself

The main function of the ventricles is to secrete cerebrospinal fluid, as well as ensure its normal circulation in the subarachnoid space. If the balance of exchange and production of cerebrospinal fluid is disturbed, then stagnation is formed and, as a result, the walls of the cavities are stretched. The same slight expansion of the lateral segments may be a normal variant, but their asymmetry and enlargement of individual parts (for example, only the horn) will be a sign of the development of pathology.

Enlarged ventricles of the brain in infants can be diagnosed with this congenital disease, like ventriculomegaly. She be varying degrees severity:

1. Slight expansion of the ventricles of the brain up to 11-12 mm, with no significant symptoms. It manifests itself in the child’s behavior: he becomes more excitable and irritable.
2. Increasing the depth of the ventricles up to 15 mm. Most often, the pathology is accompanied by asymmetry and impaired blood supply to the affected area, which entails the appearance of seizures, an increase in head size and a lag in mental and physical development.
3. Ventricular dilatation up to 20 mm, characterized by irreversible changes brain structures, in infants is often accompanied by Down syndrome and cerebral palsy.

In adulthood, an increase in ventricular volume is manifested by the following symptoms:

• Gait disturbance, with the child walking “on tiptoes” or vice versa, focusing only on the heels.
• The appearance of visual disorders, such as squint, insufficient focus of the gaze, as well as double images when trying to see small details.
• Tremor of arms and legs.
• Behavioral disorders that manifest themselves in excessive lethargy and drowsiness, while it is difficult to captivate the child with any activity.
• The appearance of headaches due to increased intracranial pressure, sometimes nausea and even vomiting may occur.
• Dizziness.
• Frequent regurgitation, loss of appetite. Some newborns are able to refuse breastfeeding.

Consequences

Late detection of the pathology that resulted in the expansion of the ventricle of the brain in a newborn can lead to a stop in development and deterioration in physical condition.

The main symptoms of the disease most often appear in the first 6 months after birth and are expressed in persistent increased intracranial pressure. Impaired consciousness, vision, hearing loss, epileptic seizures and fits, and disorders of the peripheral nervous system may also be observed.

Lack of proper attention to the child and failure to comply with specialists’ prescriptions can provoke the transition of the disease from more light form to severe, treatment of which is carried out only in a hospital setting and, if necessary, with the use of surgical interventions.

Diagnosis and treatment

During pregnancy, dilation of the ventricles of the fetal brain is most often detected during a routine ultrasound examination. Subsequent examinations are carried out to monitor the clinical picture of the disease, but the final diagnosis can be made only after the birth of the child and neurosonography - ultrasound of the brain through a large fontanelle that has not yet become overgrown. In this case, the pathology can develop at any age, but most often occurs in infancy.

To stage more accurate diagnosis the baby may need a consultation and examination with an ophthalmologist, who will assess the condition of the fundus vessels, swelling of the eye discs and other manifestations of increased intracranial pressure.

After the fusion of the cranial bones, it is possible to use MRI of the brain: it will allow tracking the dilatation of the walls of the ventricles in dynamics. However, when using this method, the child will have to long time be motionless, so before the procedure he is immersed in medicated sleep. If anesthesia is contraindicated, the examination is carried out using computed tomography.

A consultation with a neurologist is also required, who will help identify developmental problems even at an early age. initial stage. Depending on the degree of pathology, further treatment can be surgical or conservative medication.

If there is a significant deviation from the norm in the size of the ventricles, only surgery, accordingly, the child should also be examined by a neurosurgeon. In this case, during the operation, foci of neoplasms or fragments of skull bones that appear as a result of traumatic brain injuries can be removed. To reduce intracranial pressure, normalize blood circulation and metabolic processes, brain shunting is used.

Conservative therapy is prescribed for slight enlargement of the ventricles and includes the use of diuretics, nootropics, sedatives and vitamin complexes. If the disorders are caused by infections, then antibiotics are prescribed. The use of therapeutic exercises will also help improve the outflow of cerebrospinal fluid and reduce its stagnation.

Forecast

If pathology in the development of the ventricles was identified in the first days after birth, then the prognosis in most cases is favorable and depends on adequate treatment and severity of deviations.

Detection of the disease and therapy in older age can be complicated due to the formation of a large number of anomalies that arise as a result of the development of pathology, its causes and influence on other body systems.

Video: Increased intracranial pressure in a child