Hello dear guests and readers of my blog. Today's topic will be liquor And liquorrhea, let's analyze together what it is, why we need liquor and what is the risk of its loss for us or an overabundance.

CSF circulation in the central nervous system.

Liquor is the cerebrospinal fluid (CSF) that circulates in the anatomical spaces of the spinal cord and brain. The term “spinal” contains the answer to the question of its location, but not everything is so simple - the liquor is located not only in the spinal cord, but also in the brain.

CSF is normally a colorless, clear liquid that fills and circulates in these spaces in the spinal cord and brain, performing a number of important functions. The spaces in which cerebrospinal fluid circulates are called subarachnoid and subdural. This fluid is synthesized in the internal cavities of the brain, called the ventricles, a special membrane lining these cavities - the ependyma (vascular membrane).

Based on the anatomical location of the CSF pathways, cerebrospinal fluid is taken for laboratory analysis. The procedure by which CSF is taken is called a lumbar puncture.

Norm in laboratory studies


CSF analysis standards.

The cerebrospinal fluid has relatively constant properties that can change with diseases of the central nervous system. The relative density of the cerebrospinal fluid is 1.005-1.008, and its change indicates a pathological process.

The pH of the cerebrospinal fluid is normally 7.35-7.8, its shift to the “sour” side (decreased pH) occurs with infectious and toxic diseases (for example, meningitis, encephalitis, syphilis, etc.).

Color has a special diagnostic value. Liquor is normally completely transparent. Doctors who deal with CSF in clinical practice say that “cerebrospinal fluid must be as clean as a tear”. That is, normally it should not have any impurities. A change in its color also indicates a disease of the brain or spinal cord.

The color of the cerebrospinal fluid darkens with jaundice and melanoma. A yellowish tint indicates an increase in protein content, and is also a sign of the presence of blood cells - which should not be. Erythrocytes in a small amount give a yellowish tint, this occurs with subarachnoid hemorrhage, when blood enters the cerebrospinal fluid pathways as a result of a rupture of a blood vessel. Read more about subarachnoid hemorrhage.

The level of glucose and chlorides: a decrease in the level of glucose in the cerebrospinal fluid is one of the signs of meningitis, and an increase is a possible stroke. A decrease in chlorides also occurs in meningitis, and an increase in neoplasms of the brain and spinal cord.

The main norms are reflected in the table above, taking into account age-related changes.

Diseases in which the study of cerebrospinal fluid is crucial in diagnosis and treatment:

  • with breakthrough bleeding into the cerebrospinal fluid
  • infectious and inflammatory diseases of the brain and spinal cord, as well as its membranes
  • tumor diseases of the central nervous system
  • demyelinating diseases of the nervous system (, encephalomyelitis, etc.)
  • toxic lesions of the brain and spinal cord

Liquorrhea: what is it and why is it dangerous

Liquorrhea is the outflow of cerebrospinal fluid out of the CSF system. Very dangerous condition! There must be mechanical damage to damage the sheaths of the CSF pathways. These injuries are the result of craniocerebral and spinal cord injuries.

In addition to being a metabolic mediator, cerebrospinal fluid also acts as a hydraulic cushion that protects the brain and spinal cord from shocks, especially the brain. Too rapid outflow of cerebrospinal fluid during CSF can cause rapid death or a sharp deterioration in the patient's condition.

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Quite often, babies have enlarged ventricles of the brain after birth. Such a condition does not always mean the presence of a disease in which treatment is certainly required.

Ventricular system of the brain

The ventricles of the brain are several interconnected collectors in which the formation and distribution of cerebrospinal fluid occurs. Liquor is washed by the brain and spinal cord. Normally, when a certain amount of cerebrospinal fluid is always in the ventricles.

Two large collectors of cerebrospinal fluid are located on both sides of the corpus callosum. Both ventricles are interconnected. On the left side is the first ventricle, and on the right - the second. They consist of horns and a body. The lateral ventricles are connected through a system of small holes with the 3rd ventricle.

The fourth ventricle is located in the distal region of the brain between the cerebellum and the medulla oblongata. It is quite large in size. The fourth ventricle is diamond-shaped. At the very bottom there is a hole called the rhomboid fossa.

Proper functioning of the ventricles ensures the penetration of cerebrospinal fluid into the subarachnoid space when necessary. This zone is located between the hard and arachnoid membranes of the brain. This ability allows you to save the required volume of cerebrospinal fluid in various pathological conditions.

In newborn babies, dilatation of the lateral ventricles is often observed. In this condition, the horns of the ventricles are dilated, and there may also be an increased accumulation of fluid in the area of ​​\u200b\u200btheir bodies. This condition often causes both left and right ventricular enlargement. In differential diagnosis, asymmetry is excluded in the region of the main brain collectors.

The size of the ventricles is normal

In infants, the ventricles are often dilated. This condition does not mean that the child is seriously ill. The dimensions of each of the ventricles have specific values. These indicators are shown in the table.

To assess normal indicators, the definition of all structural elements of the lateral ventricles is also used. The lateral cisterns should be less than 4 mm deep, the anterior horns 2 to 4 mm, and the occipital horns 10 to 15 mm.

Causes of ventricular enlargement

Premature babies may have dilated ventricles immediately after birth. They are arranged symmetrically. Symptoms of intracranial hypertension in a child with this condition usually do not occur. If only one of the horns increases slightly, then this may be evidence of the presence of pathology.

The following reasons lead to the development of ventricular enlargement:

    Fetal hypoxia, anatomical defects in the structure of the placenta, the development of placental insufficiency. Such conditions lead to disruption of the blood supply to the brain of the unborn child, which can cause him to expand the intracranial collectors.

    Traumatic brain injury or falls. In this case, the outflow of cerebrospinal fluid is disturbed. This condition leads to stagnation of water in the ventricles, which can lead to symptoms of increased intracranial pressure.

    pathological childbirth. Traumatic injuries, as well as unforeseen circumstances during childbirth, can lead to disruption of the blood supply to the brain. These emergency conditions often contribute to the development of ventricular dilatation.

    Infection with bacterial infections during pregnancy. Pathogenic microorganisms easily cross the placenta and can cause various complications in the child.

    Prolonged childbirth. Too long a time between the discharge of amniotic fluid and the expulsion of the baby can lead to the development of intrapartum hypoxia, which causes a violation of the outflow of cerebrospinal fluid from the dilated ventricles.

    Oncological formations and cysts that are in the brain. The growth of tumors puts excessive pressure on intracerebral structures. This leads to the development of pathological expansion of the ventricles.

    Foreign bodies and elements that are in the brain.

    Infectious diseases. Many bacteria and viruses easily cross the blood-brain barrier. This contributes to the development of numerous pathological formations in the brain.

Fetal hypoxia

Traumatic brain injury or falls

Pathological childbirth

Infection with bacterial infections during pregnancy

Oncological formations and cysts that are in the brain

infectious diseases

How is it manifested?

The expansion of the ventricles does not always lead to adverse symptoms. In most cases, the child does not experience any discomfort that would indicate the presence of a pathological process.

Only with severe violations begin to appear the first adverse manifestations of the disease. These include:

    Gait disturbance. Toddlers begin to walk on tiptoe or step heavily on their heels.

    The appearance of visual disturbances. They often manifest themselves in babies in the form of strabismus or insufficiently good focus on various objects. In some cases, the child may develop double vision, which increases when looking at small objects.

    Trembling of hands and feet.

    Behavioral disorders. Babies become more lethargic, drowsy. In some cases, even apathetic. It is very difficult to captivate a child with some games or recreational activities.

    Headache. Manifested with an increase in intracranial pressure. At the height of the pain, vomiting may occur.

    Dizziness.

    Decreased appetite. Babies in the first months of life refuse breastfeeding, eat poorly. In some cases, the child spit up more.

    Sleep disturbance. Babies may have difficulty falling asleep. Some kids sleepwalk.

The disease can be of varying severity. With minimal symptoms, they talk about a mild course. With the appearance of headache, dizziness, and other symptoms indicating high intracranial hypertension, the disease becomes moderately severe. If the general condition of the child is severely disturbed and treatment is required in a hospital, then the disease becomes already severe.

Consequences

Untimely diagnosis of pathological conditions that led to the appearance of dilations in the region of the ventricles of the brain may affect the further development of the child. The first persistent symptoms of ventricular dilatation are observed in babies at 6 months.

Violation of the outflow of cerebrospinal fluid can lead to a persistent increase in intracranial pressure. In severe cases of the disease, this contributes to the development of impaired consciousness. Disorders of vision and hearing lead to the development of hearing loss in the child and weakening of vision. Some babies have epileptic seizures and seizures.

Diagnostics

In order to determine the exact dimensions of the ventricles, as well as to find out their depth, doctors prescribe several examination methods.

The most informative and reliable are:

    Ultrasound procedure . Allows you to accurately describe the quantitative indicators of the ventricles, as well as calculate the ventricular index. With the help of ultrasound, it is possible to estimate the volume of cerebrospinal fluid that is present in the brain collectors during the study.

    CT scan. With high accuracy allows you to describe the structure and size of all the ventricles of the brain. The procedure is safe and does not cause pain in the baby.

    Magnetic resonance imaging. It is used in complex diagnostic cases, when establishing a diagnosis is difficult. Suitable for older children who are able to remain still for the duration of the study. In small children, MRI is performed under general anesthesia.

    Fundus examination.

    Neurosonography.

Ultrasound procedure

CT scan

Magnetic resonance imaging

Fundus examination

Neurosonography

Treatment

Therapy of pathological conditions that led to dilatation and asymmetry of the ventricles of the brain is usually carried out by a neurologist. In some cases, when volumetric formations or the consequences of craniocerebral injuries become the cause of the disease, a neurosurgeon joins.

To eliminate pathological symptoms, the following methods of treatment are used:

    Prescribing diuretics. Diuretics help reduce the manifestations of intracranial hypertension and improve the well-being of the baby. They also contribute to the normalization of the formation of liquor.

    Nootropics. They improve the functioning of the brain, and also contribute to good blood filling of blood vessels.

    Medications with a sedative effect. They are used to eliminate increased anxiety and agitation.

    Potassium preparations. Positively affect the excretion of urine. This helps to reduce the increased amount of cerebrospinal fluid in the body.

    Multivitamin complexes. They are used to compensate for all the necessary trace elements involved in vital processes. They also help to strengthen the body and contribute to a better resistance to disease.

    Soothing and relaxing massage. Allows you to reduce muscle tone, and also helps to relax the nervous system.

    Physiotherapy. Helps to normalize the outflow of cerebrospinal fluid and prevents its stagnation in the cerebral ventricles.

    Appointment of antibacterial or antiviral drugs according to indications. They are used only in cases where viruses or bacteria have become the cause of the disease. Appointed for coursework.

    Surgery. It is used in the case of the presence of various volumetric formations or to remove fragments of bone tissue as a result of a skull fracture due to craniocerebral trauma.

Forecast

If the condition develops in infancy and early infancy, then the course of the disease is usually favorable. With appropriate treatment, all uncomfortable symptoms quickly pass and do not bother the baby. High intracranial pressure normalizes.

In older children, the prognosis is somewhat different. Adverse symptoms are much more difficult to treat. The long course of the disease can lead to persistent visual and hearing impairments. If the treatment was started out of time, then in most cases the child has persistent disorders that negatively affect his mental and mental development.

Dr. Komarovsky will tell about the expansion of the ventricles of the brain in infants and its consequences.


This article will be relevant for parents whose children have been diagnosed with ventricular enlargement

The ventricles are a system of anastomizing cavities that communicate with the canal of the spinal cord.

The human brain contains structures that contain cerebrospinal fluid (CSF). These structures are the largest in the ventricular system.

They can be divided into the following types:

  • Side;
  • The third;
  • Fourth.

The lateral ventricles are designed to store cerebrospinal fluid. Compared to the third and fourth, are the largest among them. On the left side is the ventricle, which can be called the first, on the right side - the second. Both ventricles work with the third ventricle.

The ventricle, which is called the fourth, is one of the most important formations. The spinal canal is located in the fourth ventricle. It looks like a diamond shape.

  • Reduced appetite of the child, it often happens that the child refuses to breastfeed.
  • Muscle tone is reduced.
  • There is a tremor of the upper and lower extremities.
  • A distinct manifestation of the veins on the forehead, the cause is from the cranial cavity.
  • Swallowing and grasping abilities of the child are reduced.
  • High chance of developing strabismus.
  • Head disproportion.
  • Frequent regurgitation due to increased CSF pressure.


A characteristic sign of ventricular expansion and the development of hypertensive-hydrocephalic syndrome (HHS) is manifested in a headache that begins in the morning on the left or right. Often the baby is sick and vomits.

The child often complains of the inability to raise his eyes and lower his head, dizziness and weakness appear, the skin begins to turn pale.

Diagnostic methods

It is very difficult to determine whether the baby's ventricle is enlarged. Diagnostics does not give a 100% guarantee that the diagnosis can be determined, even with the help of the latest methods.

The closure of the fontanelles occurs in, after, the change in the size of the cerebrospinal fluid is monitored.

The following types of diagnostics include the following activities:

  1. Magnetic resonance imaging. Quite well reveals problems in the soft tissue structures of the child's brain.
  2. The condition of the fundus is assessed for the presence of edema or hemorrhage.
  3. Neurosonography. It is carried out to determine the size of the ventricles (both left and right).
  4. Lumbar puncture.
  5. CT scan.

The problem of diagnosing a newborn with the help of MRI is that the baby needs to lie quietly for about 20-25 minutes. Since this task is almost impossible for a baby, doctors have to put the child into artificial sleep. At the same time, this procedure is


Therefore, most often, computed tomography is used to diagnose the size of the ventricles of the brain. At the same time, the quality of diagnostics is slightly lower than with the help of MRI.

It is considered a violation if the ventricles of the brain have a norm different from 1 to 4 mm.

Treatment

Not always an increase in the ventricles is a reason to sound the alarm. When the ventricles of the brain are enlarged, this may be a case of individual and physiological development of the baby's brain system. For example, for large babies, this is the norm.

Also, in the treatment of this disease will be ineffective: acupuncture, herbal treatment, homeopathy, therapy with vitamins.

First of all, in the treatment of dilatation of the lateral ventricles in a child, it is to prevent the development of possible complications in the child.


Possible consequences of HGS

The state of hypertensive-hydrocephalic often causes a number of serious complications, these include:

  • falling into a coma;
  • Development of complete or partial blindness;
  • Deafness;
  • Death.

Ventricular enlargement in newborns, as a diagnosis, has a higher chance of a favorable outcome than in older children, due to an increase in arterial and intracranial pressure, which returns to normal as they grow older.

The expansion of the lateral ventricles of the brain have adverse consequences and primarily depend on the cause of the development of HGS.

Video

Conclusion

Expansion in newborns should not be considered an anomaly in the development of the baby. Rarely, when serious medical assistance is required. A complete and final diagnosis, which will be established by a qualified specialist - a neurologist, will reflect the complete picture of the disease.

Therefore, supervision and consultations of a specialist are necessary so that your child does not receive any complications.

Why do an ultrasound of the brain of the baby?

The discovery of the ability of ultrasound to reflect differently from structures of different density was made 200 years ago, but in pediatrics this diagnostic method has become in demand since the middle of the 20th century.

Receive ultrasonic waves using piezoelectric crystals. Sound vibrations with a frequency of 0.5 - 15 MHz tend to penetrate through soft tissue, meeting structures with different acoustic characteristics.

Sometimes the sound is reflected as an echo, hence the other name of the procedure - echography. Yielding to cutting-edge techniques, ultrasound has its advantages:

  • Does not harm tissues, fetus, chromosomes, has no contraindications and side effects;
  • It does not need special preparation, the introduction of anesthesia for examination;
  • Available at a very early age;
  • Doesn't take much time;
  • A simple procedure can be repeated more than once;
  • It is easily tolerated by children.

Why do an ultrasound of the brain in infants. Studies using the properties of sound vibrations are one of the most informative ways to study the structure of the infant's brain, on which both the effectiveness and timing of treatment completely depend.

Neurosonography

A study of the brain that allows you to identify the limits of the midbrain structures, displacements, additional brain cavities, expansion of the ventricles, blood flow velocity and changes in the vessels that feed the brain, using ultrasound, is called neurosonography (NSG).

The method helps to diagnose a tumor, brain abscess, intracranial hemorrhage, underdevelopment, dropsy and swelling of the brain, complications from intrauterine infections.

By examining the vessels and blood flow velocity on ultrasound, it is possible to identify a zone of ischemia (lack of blood circulation), infarction (cell damage due to poor blood flow).

For infants, ultrasound plays a special role, since fontanelles - areas free of skull bones - remain on the baby's head up to 1-1.5 years.

Without a craniotomy at this age, one can easily penetrate through these “windows”, examining information about the work of the brain.

The size of the fontanel also determines the possibility of studying brain regions.

A simple and accessible method makes it possible to use neurosonography in mass screening examinations of infants for the early detection of pathologies in the brain. In some maternity hospitals, the procedure is performed for all newborns, but this method has not yet become mandatory.

Premature babies, as well as those born in difficult conditions, are sent for ultrasound by neurologists. Why babies do an ultrasound of the brain, you can learn from Dr. Komarovsky.

Preparation for the NSG

Access for examination of the baby's head is possible only through the fontanel - a membrane between the bones of the cranium, with the help of which the fetus, moving along the birth canal, adapts to the anatomical features of the mother's body. With an increase in intracranial pressure, excessive volume is discharged through the fontanelles.

In a full-term baby, by the time of birth, most fontanelles are overgrown with hard tissues, only the largest can be determined by touch - normally soft, pulsating, located at the level of the skull bones, sometimes also small.

In the first three months, while fontanelles are available, an NSG is performed. The decoding of the results is not affected by the state of the child: he is sleeping or awake, crying or calm.

There is one limitation for dopplerography, which examines the vessels of the brain: the procedure is carried out 1.5 hours after eating. In other cases, special preparation is not needed. Where to do an ultrasound of the brain in a baby ?

You can check the address with your pediatrician, call or use the form of an electronic round-the-clock appointment with a doctor on the website of the medical institution.

Read here. How do convulsions occur in infants?

Indications for NSG

  • The birth of a baby before the 36th week of pregnancy;
  • Birth weight - up to 2kg 800g;
  • The degree of complexity of childbirth ─ 7/7 points or less on the Apgar scale ─ (possible damage to the central nervous system with malformations: the shape of the ears, the number of fingers);
  • Hernia (protruding part of the brain with a membrane);
  • Absence of a cry at the birth of a baby;
  • Transfer due to birth trauma to intensive care;
  • Protracted or rapid childbirth;
  • Intrauterine infection;
  • The absence of labor activity after the departure of the waters with a conflicting Rh factor;
  • When examining a pregnant woman on ultrasound, a pathology of the brain in the fetus was visible;
  • 1 month after caesarean section;
  • Use of auxiliary instruments during childbirth (forceps, vacuum extractor, etc.);
  • Non-standard head shape;
  • Birth injury;
  • With strabismus, convulsions, torticollis, paresis, paralysis.

With capricious behavior of the baby, constant regurgitation, tearfulness, if no pathology is found in other organs, an ultrasound of the head is prescribed. The effectiveness of the treatment of meningitis, encephalitis, genetic disorders, head trauma is monitored by ultrasound.

Hemorrhage, cysts, ischemia, hydrocephalus, intracerebral abscess are also diagnosed by ultrasound.

How is the procedure

Ultrasound is carried out through the fontanelles, if it is necessary to study the structure of the posterior cranial cavity, then through the back of the head. When laying the baby on the couch, on the temples (if there are still springs) and in the area of ​​​​a large spring, a sensor lubricated with a conductor gel is installed.

Sometimes the neck area is also examined.

By adjusting the position of the sensor, the doctor examines the structures of the brain.

Children do not feel pain, the study lasts no more than 10 minutes.

An echographic image is projected on the display screen. Dense fabrics are highlighted in light colors, loose fabrics in darker colors.

Usually carried out sonometry 12 indicators of the brain. The measurements are compared with the standards, and the specialist gives a conclusion on the compliance of the ultrasound of the brain in the baby with the norm.

This is not a diagnosis yet, just a diagnostic tool for a neurologist. In case of serious deviations, clarifying studies (MRI, CT) are carried out.

Deciphering the results of the NSG

The norms for ultrasound of the baby are determined by the timing of his birth. But there are also mandatory criteria for deciphering an ultrasound of the brain in an infant:

  • Symmetrical arrangement of all brain structures;
  • All convolutions are clearly visible;
  • The cerebral ventricles and cisterns are homogeneous in structure;
  • The thalamus and subcortical nuclei are moderately echogenic;
  • Anterior horn of the lateral ventricle ─ 1-2 mm in length;
  • The body of the lateral ventricle is 4 mm in depth;
  • The interhemispheric fissure (in width ─ up to 2 mm) does not contain liquid;
  • The vascular plexuses are hyperechoic;
  • 3rd ventricle ─ 2-4mm;
  • Large tank ─ 3-6mm;
  • Without displacement of stem structures.

After the study, the doctor deciphers and describes the results. For this, he has 12 normative criteria.

He evaluates the size and contours of the ventricles (this helps to diagnose rickets, hydrocephalus, and other pathologies). Then a study of the state of large vessels is carried out (this helps to identify cysts, hemorrhages).

Dimensions and contours of the cerebral ventricles

Normally, the appearance of the ventricles is a cavity filled with cerebrospinal fluid. An enlarged ventricle can mean hydrocephalus, a buildup of cerebrospinal fluid in the skull.

The disease is congenital and acquired. The cause of development may be intrauterine infection, malformations in the development of the fetus, hemorrhage.

Children with this diagnosis are distinguished by an increased head size, large fontanelles and a convex forehead.

Enlargement of the subarachnoid space

This zone, filled with cerebrospinal fluid, is located between the pia mater and the arachnoid. Normally, the width should be several millimeters. With an increase in this area, one can think of inflammation of the membranes after an injury or infection.

Cysts in the vascular plexus

These neoplasms are visible on ultrasound during pregnancy. They can develop in infants and in children of the second year of life. Cysts also occur in adults.

  • Subependymal cysts are located near the wall of the ventricle and develop after hypoxia and minor hemorrhage. They do not affect brain activity and do not require treatment.
  • Arachnoid cysts are located in the arachnoid membrane. Critical sizes ─ from 3 cm. They already put pressure on the brain, causing epilepsy. Such a cyst does not dissolve on its own.

Hemorrhages in brain centers

Pathology occurs due to intrauterine infection, with conflicting blood rhesus, oxygen deficiency. birth trauma, bleeding disorders. It occurs more often in premature babies.

Such hemorrhages are of four degrees of complexity. With such a diagnosis, observation by a neurologist is mandatory, since the consequences of self-treatment are very dangerous.

Ischemia

Oxygen deficiency during ischemia can lead to damage to nerve cells. Occurs after premature birth, when the lungs are not sufficiently developed by the time the baby is born.

Damage to nerve cells is accompanied by a softening of the brain, which provokes disturbances in the development of the baby.

Meningitis

When the brain is infected, thickening and inflammation of its membranes occur. The disease requires immediate treatment.

Tumors

Volumetric neoplasms in the cranium are rare, the more important it is to be under the constant supervision of a neurologist.

With a significant number of “finds”, it is worth consulting with a doctor about prescribing vitamin D to the baby, which contributes to the rapid overgrowth of fontanelles. With increased intracranial pressure, this is not useful.

Consultations in such cases also require the terms or complete refusal of vaccinations. With closed springs, transcranial ultrasound is performed, which is less informative than NSG.

MRI can give a clearer picture of the disease, but mandatory general anesthesia for the baby is not always justified. The price of an ultrasound of the brain in a baby can be in the range of 1300 - 3800 rubles. The cost depends on the region where the examination is carried out: for Moscow it is 1600 rubles. and above, ultrasound of the brain in infants in St. Petersburg - from 1000 rubles.

Conclusion

At the thematic forums, parents are satisfied with the conditions of the examination. Only the conclusions of sonologists scare them.

But timely diagnosis significantly increases the chances of recovery, because the brain of an infant in the first year of life is immature, and the body's capabilities at this age are great.

Parents need to study the list of indications in order to understand that inexplicable crying, whims, shivering, convulsions are harmless “little things” that indicate a pathology that is difficult to detect with age and no less difficult to treat.

More information

Examination of the brain of a newborn is a mandatory procedure that allows you to identify various pathologies of the nervous system in the first days of life. However, it should be remembered that an increase in the size of the lateral ventricles of the brain does not always indicate serious neurological disorders.

The human central nervous system is very complex. Its most important centers are the brain and spinal cord. Any pathology and deviations from the norm can cause the development of a number of neurological disorders, therefore, examination of the brain and spinal cord in newborns must be done in the first days of life.

Ultrasound of the brain is mandatory in the following cases:

  • complicated childbirth;
  • birth injury;
  • fetal hypoxia;
  • prematurity;
  • maternal infections.

Also, a brain examination in newborns is indicated in case of a low Apgar score (less than 7 points) and with changes in the fontanel.

If there are indications for an ultrasound of the brain, it is carried out immediately after the birth of the baby, a re-examination is indicated upon reaching the age of one month.

There is a table describing the norms of the brain for newborns. So, if during the primary ultrasound there is a discrepancy between the norm of the ventricles of the brain in children - the norm in the table is presented for different ages - additional examinations are carried out.

Dimensions of the lateral ventricles

If an ultrasound scan showed enlarged lateral ventricles in a child under one year old, this is not necessarily a pathology. In many children, their normal size may be slightly larger than normal, especially if the child has a large skull.


It is important to control the development of the brain in a child. The examination must be repeated regularly. If there is a tendency to further increase in the size of the ventricles, only then can we talk about pathology.

These organs perform the function of an intermediate "storage" of cerebrospinal fluid. With a significant increase in their size in a child, the outflow of cerebrospinal fluid is disturbed, intracranial pressure increases and there is a risk of developing hydrocephalus.

What does the expansion mean?

Ultrasound of the brain is necessarily assigned to children born. An increase and asymmetry of the lateral ventricles may indicate the presence of the following pathologies in a child:

  • hydrocephalus;
  • traumatic brain injury;
  • cyst;
  • developmental pathology of the CNS.

With an increase in a premature baby, expectant tactics are chosen. The examination should be carried out regularly to determine the trend in the size of the ventricles and the state of the brain.

In most cases, deviation from the norm does not mean pathology. In premature infants, enlargement and asymmetry of the ventricles are associated with features of brain development. This problem goes away on its own without treatment, when the child begins to catch up with peers in weight.

It is not uncommon for premature babies to be born with a cyst of the septum pellucidum. Such a cyst is a small neoplasm of the correct form, filled with fluid. The cyst compresses neighboring tissues and blood vessels, which can cause a violation of the metabolic processes of the brain.

As a rule, in 90% of cases, the cyst resolves on its own without treatment and does not cause any neurological disorders in the child.

Treatment is necessary if the cyst is not diagnosed from birth, but obtained as a result of an illness or injury. In such cases, its size increases rapidly and provokes the accumulation of cerebrospinal fluid, which can be fraught with the development of a number of disorders.

How and when is the diagnosis carried out?

Regular ultrasound examination of the brain is prescribed in the first month of the baby's life, in the presence of alarming symptoms, for example, mild reflexes or causeless anxiety of the child.

In the presence of pathology, examination in children under one year old is repeated every three months.

Deviation from the norm at this age does not always require treatment. Expectant tactics and regular examinations are needed to determine the dynamics of changes in the state of brain tissues. Often, enlarged ventricles are temporary and bounce back quickly without any treatment.


In complicated childbirth, ultrasound is performed in the first hours of life. In all other cases, a neurologist may refer you for examination if the child has the following symptoms:

  • too big head;
  • weakening of reflexes;
  • anxiety;
  • fontanel injury;
  • strabismus;
  • elevated body temperature.

Also, the diagnosis of the state of the brain is carried out with suspicions of cerebral palsy, rickets and a number of other congenital disorders.

How is an ultrasound done for babies?

Ultrasound examination methods are the safest and do not adversely affect the body of the newborn.

No special preparatory measures are required for the examination. The child should be full and not feel discomfort. Since newborns spend most of their time sleeping, it is not necessary to wake the baby for examination. Ultrasound does not cause discomfort, so the child will not wake up unless specifically woken up.

The child is placed on a special couch, a small amount of a special gel is applied to the fontanel area, and diagnostics begin. The procedure does not last long and does not bring discomfort.

Deciphering the results

The results of the examination are studied by a neurologist. Do not worry ahead of time if the results obtained show minor deviations from the norm. In addition to the size of the lateral ventricles, an important characteristic is their structure and symmetry. The task of the doctor is to assess not only the size, but also their compliance with the characteristics of the child's body.

Granuloma of the tooth - inflammation of the tissues near the tooth root. Treatment is carried out by a dentist, an additional decoction is used

Granuloma of the tooth - inflammation of the tissues near the tooth root. Treatment is carried out by a dentist, an additional decoction is used

The movement of CSF is due to its continuous formation and resorption. The movement of liquor is carried out in the following direction: from the lateral ventricles, through the interventricular openings to the III ventricle and from it through the cerebral aqueduct to the IV ventricle, and from there through its median and lateral openings to the cerebellar-medulla oblongata cistern. Then the cerebrospinal fluid moves up to the upper lateral surface of the brain and down to the final ventricle and into the spinal cerebrospinal fluid canal. The linear circulation rate of the CSF is about 0.3-0.5 mm/min, and the volumetric rate is between 0.2-0.7 ml/min. The reason for the movement of the cerebrospinal fluid is the contraction of the heart, breathing, position and movement of the body and the movement of the ciliated epithelium of the choroid plexuses.

The cerebrospinal fluid flows from the subarachnoid space into the subdural space, then it is absorbed by the small veins of the dura mater.

Cerebrospinal fluid (CSF) is formed mainly due to ultrafiltration of blood plasma and the secretion of certain components in the vascular plexuses of the brain.

The blood-brain barrier (BBB) ​​is associated with the surface that separates the brain and cerebrospinal fluid from the blood and provides a bidirectional selective exchange of various molecules between the blood, cerebrospinal fluid and the brain. Compacted contacts of the endothelium of the brain capillaries, epithelial cells of the vascular plexuses and arachnoid membranes serve as the morphological base of the barrier.

The term "barrier" indicates a state of impermeability to molecules of a certain critical size. Low molecular weight components of blood plasma, such as glucose, urea and creatinine, freely enter the cerebrospinal fluid from plasma, while proteins pass by passive diffusion through the choroid plexus wall, and there is a significant gradient between plasma and cerebrospinal fluid, depending on the molecular weight of proteins.

The limited permeability of the vascular plexuses and the BBB maintain normal homeostasis and the composition of the CSF.

The physiological significance of liquor:

  • liquor performs the function of mechanical protection of the brain;
  • excretory and so-called Sing-function, i.e., the release of certain metabolites to prevent their accumulation in the brain;
  • liquor serves as a vehicle for various substances, especially biologically active ones, such as hormones, etc.;
  • performs a stabilizing function:
    • maintains an exceptionally stable brain environment, which should be relatively insensitive to rapid changes in blood composition;
    • maintains a certain concentration of cations, anions and pH, which ensures normal excitability of neurons;
  • performs the function of a specific protective immunobiological barrier.

Rules for obtaining and delivering liquor to the laboratory


I.I. Mironova, L.A. Romanova, V.V. Dolgov
Russian Medical Academy of Postgraduate Education

To obtain CSF, a lumbar puncture is most often used, less often a suboccipital puncture. Ventricular cerebrospinal fluid is usually obtained during surgery.

Lumbar puncture is carried out between the III and IV lumbar vertebrae (L 3 -L 4) along the Quincke line (the line connecting the highest parts of the crests of the two iliac bones). The puncture can also be carried out between L 4 -L 5 ; L 5 -S 1 and between L 2 -L 3 .

Suboccipital (cisternal) puncture is carried out between the base of the skull and the 1st cervical vertebra, at the height of the line connecting the mastoid processes.

Ventricular (ventricular) puncture- this is practically a surgical manipulation, performed in cases where other types of puncture are contraindicated or inappropriate. The anterior, posterior, or inferior horn of one of the lateral ventricles of the brain is punctured.

When performing a lumbar puncture, it is necessary to remove the first 3-5 drops of CSF, which allows you to get rid of the admixture of "travel" blood that enters the first portion of the CSF as a result of needle damage to blood vessels located in the epidural space. Then collect 3 servings (in exceptional cases, two) in sterile glass or plastic tubes, close them tightly, indicate on each tube its serial number, first name, patronymic and last name of the patient, puncture time, diagnosis and list of necessary studies. The CSF collected in test tubes is delivered to the clinical diagnostic laboratory immediately.

With the help of a lumbar puncture in an adult, 8-10 ml of cerebrospinal fluid can be obtained without complications, in children, including young children, 5-7 ml, and in infants, 2-3 ml.

Cerebrospinal fluid fills the subarachnoid space, separates the brain from the skull, surrounding the brain with an aqueous environment.

The salt composition of cerebrospinal fluid is similar to that of sea water. Let us note not only the mechanical protective function of the fluid for the brain and the vessels lying on its base, but also its role as a specific internal environment necessary for the normal functioning of the nervous system.

Since its proteins and glucose are a source of energy for the normal functioning of brain cells, and lymphocytes prevent the penetration of infection.

The fluid is formed from the vessels of the choroid plexuses of the ventricles, passing through the blood-brain barrier, and is updated 4-5 times a day. From the lateral ventricles, fluid flows through the interventricular foramen into the third ventricle, then through the cerebral aqueduct into the fourth ventricle (Fig. 1).

Rice. 1.: 1 - pachion granulations; 2 - lateral ventricle; 3 - cerebral hemisphere; 4 - cerebellum; 5 - fourth ventricle; b - spinal cord; 7 - subarachnoid space; 8 - roots of the spinal nerves; 9 - vascular plexus; 10 - a hint of the cerebellum; 13 - superior sagittal sinus.

Fluid circulation is facilitated by the pulsation of the cerebral arteries. From the fourth ventricle, fluid is directed through the openings of Lushka and Mozhandii (Lushka and Magendii) into the subarachnoid space, washing the spinal cord and brain. Thanks to the movements of the spine, the cerebrospinal fluid flows behind the spinal cord in a downward direction, and through the central canal and in front of the spinal cord - up. From the subarachnoid space, cerebrospinal fluid through pachyonic granulations, granulationes arachnoidales (Pachioni), is filtered into the lumen of the sinuses of the dura mater, into venous blood (Fig. 2).

Rice. 2.: 1 - skin of the scalp; 2 - skull bone; 3 - dura mater; 4 - subdural space; 5 - arachnoid shell; 6 - subarachnoid space; 7 - pia mater; 8 - venous graduate; 9 - superior sagittal sinus; 10 - pachyonic granulations; 11 - cerebral cortex.

cisterns are extensions of the subarachnoid space. There are the following tanks:

  • Cisterna cerebellomedullaris, cisterna magna - posterior cerebellar-cerebral cistern, large cistern;
  • Cisterna cerebellomedullaris lateralis - lateral cerebellar-cerebral cistern;
  • Cisterna fossae lateralis cerebri - cistern of the lateral fossa of the brain;
  • Cisterna chiasmatica - cross tank;
  • Cisterna interpeduncularis - interpeduncular cistern;
  • Cisterna ambiens - covering cistern (at the bottom of the gap between the occipital lobes of the hemispheres and the upper surface of the cerebellum);
  • Cisterna pericallosa - a corpus callosum (along the upper surface and knee of the corpus callosum);
  • Cisterna pontocerebellaris - cerebellopontine cistern;
  • Cisterna laminae terminalis - the cistern of the end plate (from the anterior edge of the decussation, the arachnoid membrane freely spreads to the lower surface of the straight gyrus and to the olfactory bulbs);
  • Cisterna quadrigeminalis (cisterna venae magnae cerebri) - four-hilled cistern (cistern of the great vein of the brain);
  • Cisterna pontis - located according to the main groove of the bridge.

The brain is the most complex organ in the human body, where the ventricles of the brain are considered one of the tools for interconnection with the body.

Their main function is the production and circulation of cerebrospinal fluid, due to which the transport of nutrients, hormones and the removal of metabolic products occur.

Anatomically, the structure of the cavities of the ventricles looks like an expansion of the central canal.

Any ventricle of the brain is a special tank that connects with similar ones, and the final cavity joins the subarachnoid space and the central canal of the spinal cord.

Interacting with each other, they represent the most complex system. These cavities are filled with moving cerebrospinal fluid, which protects the main parts of the nervous system from a variety of mechanical damage, maintaining intracranial pressure at a normal level. In addition, it is a component of the immunobiological protection of the organ.

The inner surfaces of these cavities are lined with ependymal cells. They also cover the spinal canal.

The apical portions of the ependymal surface have cilia that facilitate the movement of cerebrospinal fluid (cerebrospinal fluid, or cerebrospinal fluid). These same cells contribute to the production of myelin, a substance that is the main building material of the electrically insulating sheath that covers the axons of many neurons.

The volume of CSF circulating in the system depends on the shape of the skull and the size of the brain. On average, the amount of fluid produced for an adult can reach 150 ml, and this substance is completely renewed every 6-8 hours.

The amount of liquor produced per day reaches 400-600 ml. With age, the volume of cerebrospinal fluid may increase somewhat: it depends on the amount of fluid absorption, its pressure and the state of the nervous system.

The fluid produced in the first and second ventricles, located in the left and right hemispheres, respectively, gradually moves through the interventricular holes into the third cavity, from which it moves through the openings of the cerebral aqueduct into the fourth.

At the base of the last cistern there is a foramen of Magendie (communicating with the cerebellar-pontine cistern) and paired foramina of Luschka (connecting the terminal cavity with the subarachnoid space of the spinal cord and brain). It turns out that the main organ responsible for the work of the entire central nervous system is completely washed with cerebrospinal fluid.

Once in the subarachnoid space, the cerebrospinal fluid, with the help of specialized structures called arachnoid granulations, is slowly absorbed into the venous blood. A similar mechanism functions as valves that work in one direction: it allows fluid to enter the circulatory system, but does not allow it to get back into the subarachnoid space.

The number of ventricles in humans and their structure

The brain has several communicating cavities connected together. There are four of them, however, very often in medical circles they talk about the fifth ventricle in the brain. This term is used, referring to the cavity of the transparent septum.

However, despite the fact that the cavity is filled with cerebrospinal fluid, it is not connected with other ventricles. Therefore, the only correct answer to the question of how many ventricles are in the brain is: four (two lateral cavities, a third and a fourth).

The first and second ventricles, located to the right and left of the central canal, are symmetrical lateral cavities located in different hemispheres just below the corpus callosum. The volume of any of them is approximately 25 ml, while they are considered the largest.

Each lateral cavity consists of the main body and canals branching off from it - the anterior, inferior and posterior horns. One of these canals connects the lateral cavities with the third ventricle.

The third cavity (from the Latin "ventriculus tertius") is shaped like a ring. It is located on the midline between the surfaces of the thalamus and the hypothalamus, and is connected from below to the fourth ventricle using the Sylvian aqueduct.

The fourth cavity is located a little lower - between the elements of the hindbrain. Its base is called the rhomboid fossa, it is formed by the posterior surface of the medulla oblongata and the pons.

The lateral surfaces of the fourth ventricle limit the upper legs of the cerebellum, and the entrance to the central canal of the spinal cord is located behind. This is the smallest, but very important section of the system.

On the vaults of the last two ventricles there are special vascular formations that produce most of the total volume of cerebrospinal fluid. Similar plexuses are also present on the walls of two symmetrical ventricles.

The ependyma, consisting of ependymal formations, is a thin film that covers the surface of the central duct of the spinal cord and all ventricular cisterns. Almost over the entire area, the ependyma is single-layered. Only in the third, fourth ventricles and the aqueduct of the brain connecting them can it have several layers.

Ependymocytes are oblong cells with a cilia at the free end. By beating these processes, they move the cerebrospinal fluid. It is believed that ependymocytes can independently produce some protein compounds and absorb unnecessary components from the cerebrospinal fluid, which contributes to its purification from the decay products formed during the metabolic process.

Each ventricle of the brain is responsible for the formation of CSF and its accumulation. In addition, each of them is part of the fluid circulation system, which constantly moves along the CSF pathways from the ventricles and enters the subarachnoid space of the brain and spinal cord.

The composition of cerebrospinal fluid is significantly different from any other fluid in the human body. Nevertheless, this does not give grounds to consider it the secret of ependymocytes, since it contains only cellular elements of blood, electrolytes, proteins and water.

The liquor system forms about 70% of the required fluid. The rest penetrates through the walls of the capillary system and the ependyma of the ventricles. The circulation and outflow of cerebrospinal fluid are due to its constant production. Movement itself is passive and occurs due to the pulsation of large cerebral vessels, as well as due to respiratory and muscle movements.

The absorption of cerebrospinal fluid occurs along the perineural sheaths of the nerves, through the ependymal layer and capillaries of the arachnoid and pia mater.

Liquor is a substrate that stabilizes brain tissue and ensures the full activity of neurons by maintaining the optimal concentration of essential substances and acid-base balance.

This substance is necessary for the functioning of the brain systems, since it not only protects them from contact with the skull and accidental impacts, but also delivers the hormones produced to the central nervous system.

Summing up, we formulate the main functions of the ventricles of the human brain:

  • production of cerebrospinal fluid;
  • ensuring the uninterrupted movement of the cerebrospinal fluid.

Diseases of the ventricles

The brain, like all other internal organs of a person, is prone to the appearance of various diseases. Pathological processes affecting the parts of the central nervous system and the ventricles, including, require immediate medical intervention.

In pathological conditions developing in the cavities of the organ, the patient's condition is rapidly deteriorating, since the brain does not receive the required amount of oxygen and nutrients. In most cases, the cause of ventricular diseases is inflammatory processes that have arisen as a result of infections, injuries or neoplasms.

Hydrocephalus

Hydrocephalus is a disease characterized by excessive accumulation of fluid in the ventricular system of the brain. The phenomenon in which there are difficulties in its movement from the place of secretion to the subarachnoid space is called occlusive hydrocephalus.

If the accumulation of fluid occurs due to impaired absorption of CSF into the circulatory system, then such a pathology is called aresorptive hydrocephalus.

Dropsy of the brain can be congenital or acquired. The congenital form of the disease is found, as a rule, in childhood. The causes of the acquired form of hydrocephalus are often infectious processes (for example, meningitis, encephalitis, ventriculitis), neoplasms, vascular pathologies, injuries and malformations.

Dropsy can occur at any age. This condition is dangerous to health and requires immediate treatment.

Hydroencephalopathy

Another of the common pathological conditions, due to which the ventricles in the brain can suffer, is hydroencephalopathy. At the same time, in a pathological state, two diseases are combined at once - hydrocephalus and encephalopathy.

As a result of impaired circulation of cerebrospinal fluid, its volume in the ventricles increases, intracranial pressure rises, because of this, brain function is disrupted. This process is quite serious and without proper control and treatment leads to disability.

With an increase in the right or left ventricles of the brain, a disease called "ventriculomegaly" is diagnosed. It leads to disruption of the central nervous system, neurological abnormalities and can provoke the development of cerebral palsy. Such a pathology is most often detected even during pregnancy for a period of 17 to 33 weeks (the optimal period for detecting pathology is the 24-26th week).

A similar pathology is often found in adults, however, for the formed organism, ventriculomegaly does not pose any danger.

A change in the size of the ventricles can occur under the influence of excessive production of CSF. This pathology never occurs by itself. Most often, the appearance of asymmetry is accompanied by more serious diseases, such as neuroinfection, traumatic brain injury, or a neoplasm in the brain.

Hypotensive syndrome

A rare phenomenon, as a rule, which is a complication after therapeutic or diagnostic manipulations. Most often, it develops after a puncture and leakage of cerebrospinal fluid through the hole from the needle.

Other causes of this pathology can be the formation of cerebrospinal fluid fistulas, a violation of the water-salt balance in the body, and hypotension.

Clinical manifestations of reduced intracranial pressure: the appearance of migraine, apathy, tachycardia, general loss of strength. With a further decrease in the volume of cerebrospinal fluid, pallor of the skin, cyanosis of the nasolabial triangle, and respiratory disorders appear.

Finally

The ventricular system of the brain is complex in its structure. Despite the fact that the ventricles are only small cavities, their importance for the full functioning of the internal organs of a person is invaluable.

The ventricles are the most important brain structures that ensure the normal functioning of the nervous system, without which the vital activity of the body is impossible.

It should be noted that any pathological processes that lead to disruption of the brain structures require immediate treatment.