The place where cerebrospinal fluid is produced is the lateral ventricles. In addition to the lateral ventricles, there are the third ventricle and the fourth ventricle.
The ventricular system can be called a "pool" containing cerebrospinal fluid, which flows from the lateral ventricles to the third ventricle and then to the fourth ventricle.
How is cerebrospinal fluid recycled? It is recycled through the arachnoid granulations and into the venous system.
The above cycle sounds like a very closed environment.
That's right. The blood-brain barrier that we often hear about actually includes three barriers: blood-brain barrier, blood-cerebrospinal fluid barrier, and cerebrospinal fluid-brain barrier. This shows how closed the cerebrospinal fluid environment is.
The specific deconstruction of how "closure" and "barrier" come about is more complicated. There are cytological interpretations and mechanical and physical interpretations.
Let's talk about this patient, hydrocephalus. Hydrocephalus means that there is "water" in the brain, and there is too much cerebrospinal fluid. The excess cerebrospinal fluid indicates that the "water" may be over-secreted, or there may be problems with the recycling mechanism, or there may be obstructions in the circulation path. The "water" body cannot circulate smoothly, and naturally the "pool" containing the cerebrospinal fluid is expanded.
Clinically, CT shows dilation of the ventricular system and/or subarachnoid space, which compresses normal brain tissue and is often accompanied by brain atrophy. What are the symptoms of brain atrophy? We just talked about the symptoms of cerebellar atrophy, which is only more serious than cerebellar atrophy.
Typical symptoms: Adult patients suffer from headache, nausea, vomiting, abnormal mental state, drowsiness, mania, ataxia, incontinence, etc.
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Given that we have talked a lot about cerebrospinal fluid above, we know that if hydrocephalus is caused by other diseases, such as a tumor, it may be solved with a surgical knife.
Unfortunately, the most common hydrocephalus patients in clinical practice do not necessarily have a clear and visible cause. If it involves a more complicated secretion problem, it is naturally better to use internal medicine to solve it than surgery.
Surgery cannot cure the root cause and there is a fear that the disease will recur frequently, so why let the patient undergo the surgery in vain?
If surgical intervention is necessary, it is necessary to make sure that the cause of the disease can be resolved surgically.
For example, ventriculostomy under ventriculoscopy is aimed at the obstruction of cerebrospinal fluid circulation in the path from the third ventricle to the fourth ventricle through the cerebral aqueduct. A hole is directly made in the third ventricle to guide the cerebrospinal fluid to the prepontine cistern.
If the cause of the disease cannot be identified or cannot be solved by surgical means, the surgeon still has conservative treatment options, the most common of which is cerebrospinal fluid shunt.
Time was tight, so a group of neurosurgeons entered the ward first to conduct rounds.
Doctor Jin waited outside and waited until they checked their own ward before going in to see them.
Starting from the last bed, we found the patient in bed 23, a friend of Dr. Jin, who was a woman in her 30s or 40s. The initial diagnosis was that it might be hydrocephalus caused by some kind of infection, because no other cause could be found for the time being. However, after it was later discovered that she had a cerebral arteriovenous malformation, it was unclear which came first.
The patient's current condition is quite serious and he has become drowsy.
A group of fellow students came.
During the ward rounds, Huang Zhilei asked his junior colleagues to perform neurosurgery examinations on the patients, treating it as an on-site exam.
According to what Pan and several other students thought, for patients with hydrocephalus, just looking at the patient's head does not tell what the condition of the hydrocephalus is like.
If you want to thoroughly check for ataxia, the patient is drowsy and cannot cooperate with the doctor when you want him to open his eyes and answer questions.
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