脑积水
脑积水是脑脊液在脑室内过度积聚，可升高颅内压并压迫脑组织。
最后更新: 2026-06-06
Definition
Hydrocephalus is fluid accumulation and ventricular enlargement resulting from an imbalance in CSF production, circulation or absorption. Obstruction of CSF flow produces obstructive (non-communicating) hydrocephalus, whereas impaired absorption causes communicating hydrocephalus. Normal pressure hydrocephalus is a distinct subtype in adults.
Causes and Risk Factors
Congenital causes include aqueductal stenosis and neural tube defects. Acquired causes include brain hemorrhage (especially subarachnoid hemorrhage), infections such as meningitis, brain tumors and head trauma. Normal pressure hydrocephalus is most often seen in older adults.
Symptoms
In infants, rapid head growth, a tense fontanelle and irritability are seen. In children and adults, headache, nausea and vomiting, visual disturbance, balance problems and altered consciousness may occur. The classic triad of normal pressure hydrocephalus is gait disturbance, urinary incontinence and cognitive decline.
Diagnosis
Diagnosis relies on imaging; computed tomography (CT) and magnetic resonance imaging (MRI) show ventricular enlargement and the likely cause. Cranial ultrasound through the fontanelle can be used in infants. In normal pressure hydrocephalus, a CSF tap test (high-volume lumbar puncture) may help predict response to treatment.
Treatment
Treatment aims to reduce CSF accumulation. The most common method is a ventriculoperitoneal (VP) shunt, which diverts excess fluid to another cavity (usually the abdomen). In selected obstructive cases, endoscopic third ventriculostomy (ETV) can be an alternative to shunting. The choice depends on the type and cause of hydrocephalus.
Prognosis
With early diagnosis and appropriate treatment, symptoms can be controlled in many patients; however, complications such as shunt malfunction and infection require follow-up. Prognosis depends on the underlying cause, the patient's age and response to treatment; outcomes vary individually.
参考文献
- Rekate HL. A consensus on the classification of hydrocephalus. Childs Nerv Syst. 2011.
- Williams MA, Malm J. Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus. Continuum. 2016.
- StatPearls — Hydrocephalus. NCBI Bookshelf.
本文仅供一般参考，不能替代医疗检查。诊断与治疗决策因人而异。