Ventriculomegaly in the fetus, treatment during pregnancy

Ventriculomegaly is a pathological change in the formation of the brain in a child in the womb. The disease is characterized by changes in the size of the cerebral ventricles, which subsequently leads to various abnormalities, as the central nervous system, spinal cord and brain are affected. The process may also involve peripheral nerves, the autonomic system, and muscles.

Abnormal fetal development is determined during routine studies, and the degree of deviation is established. All deviations, except severe ones, are amenable to therapeutic measures. If a pathology is identified that is incompatible with the life of the child, then the pregnancy is terminated in the early stages.

The disease is very serious, can have serious consequences, and if the pathology is severe, the pregnancy is terminated. The moderately expressed form is characterized by a relatively favorable prognosis.

Etiology

The brain contains four ventricles, the main function of which is to produce cerebrospinal fluid (CSF). When disruption and stagnation of fluid occurs, ventriculomegaly develops.

A pathology is considered to be a process when the ventricles enlarge from 15 to 20 millimeters (the norm is no more than 15 millimeters). This condition may be isolated or may be accompanied by other developmental defects.

The main cause of the disease is gene and chromosomal mutations in women with pathological abnormalities during childbearing.

The causes of ventriculomegaly in the fetus are as follows:

• woman’s age – after 35 years the risk increases several times;
• intrauterine infections;
• physical damage;
• oxygen starvation;
• hemorrhage or hemorrhage;
• destructive brain damage;
• hereditary predisposition.

Ventriculomegaly in the fetus can have consequences in the form of the following diseases:

• Bonnevie-Ulrich syndrome;

The pathological size of the ventricles negatively affects the heart, the musculoskeletal system, and the structural elements of the pituitary gland are disrupted.

Causes of ventriculomegaly

Ventriculomegaly corresponds to an increase in the cerebral ventricles from 12 to 20 mm. In this case, the condition can be observed both in isolation and against the background of other developmental defects. It should be noted that dilatation of the ventricles of the brain, which is an independent disorder, is quite often not accompanied by chromosomal abnormalities in the child.

The main cause of ventriculomegaly in the fetus is genetic diseases and chromosomal abnormalities in women whose pregnancy is complicated by various pathologies. In addition, there is a certain relationship between the enlargement of the ventricles in the fetus and the age of the expectant mother: for example, in women over 35 years of age, the risk of giving birth to a child with ventriculomegaly is three times higher than the same outcome in younger mothers.

Other causes of ventriculomegaly include:

• Intrauterine infections;
• Physical injuries;
• Obstructive dropsy of the brain (obstructive hydrocephalus), developing against the background of obstruction (blockade) of the outflow tract of cerebrospinal fluid at the level of the cerebral ventricular system;
• Hemorrhage (bleeding);
• Fetal hypoxia;
• Lissencephaly;
• Destructive brain damage (for example, due to perivericular leukomalacia);
• Hereditary predisposition.

Ventriculomegaly is a prerequisite for the development in a child of diseases such as Down syndrome, gonadal dysgenesis (Bonnevie-Ulrich syndrome), trisomy 18 (Edwards syndrome). In addition, the pathology affects the function of the heart, causes disorders of the musculoskeletal system and all structures of the brain.

Ventriculomegaly is usually detected in the fetus during an ultrasound examination between 17 and 34 weeks of intrauterine development. However, the data obtained from ultrasound are not enough to make a final accurate diagnosis. Therefore, to begin with, a recommendation is given to undergo a repeat examination, which will allow us to evaluate the development of the fetus over time (as a rule, it is carried out 2-3 weeks after the first ultrasound). Based on its results, the pregnant woman is additionally sent for a consultation with a geneticist and to undergo a fetal karyotyping procedure, thanks to which it is possible to identify possible deviations in the structure and quantitative composition of chromosomes.

Classification

Ventriculomegaly of the lateral ventricles is classified by type, cause, course and location.

Due to the occurrence:

• idiopathic, when the cause of the pathological process has not been identified and all indicators in the pregnant woman are normal;
• symptomatic - a woman suffered from an infectious disease during pregnancy, abused alcoholic beverages, or suffered a severe illness.

• right-sided;
• isolated – has a favorable prognosis, recovery occurs in 80% of cases;
• asymmetric – with a severe course, the prognosis for recovery is low.

According to the severity of ventriculomegaly in newborns and preschool children, it is:

• mild degree, when the ventricles are small in size - up to 12 millimeters, the child becomes irritable and easily excited;
• moderate degree, when the ventricles increase to 15 millimeters - an asymmetric anomaly and a change in blood flow in the area of ​​​​the disturbance are observed;
• severe - the ventricles increase to 20 millimeters, which leads to irreversible consequences in the structure of the brain;

According to the location of ventriculomegaly, it can be:

• with lateral dilatation of the ventricles (left and posterior);
• pathological changes affect the third ventricle (in the front, on the forehead);
• changes in the fourth ventricle (in the occipital part, in the cerebellum and medulla oblongata).

Moderate ventriculomegaly is a borderline condition when the size of the ventricles is 10–15 millimeters, which is a high risk, since there is a high probability of developing a pathological process. Such cases are monitored and constantly checked to eliminate the risk of further growth.

Symptoms

Ventriculomegaly in a child is accompanied by symptoms, depending on the degree of the pathological process.

Mild disease is accompanied by:

• increased excitability;
• severe irritability.

The average course of the disease is accompanied by the following symptoms:

• seizures;
• the head increases in size;
• veins are clearly visible in the frontal part of the head;
• the child is lagging behind in physical development;

During this period of development, the disease can be combined with other abnormalities, such as ventricular asymmetry and agenesis of the corpus callosum.

In severe cases, in addition to severe dilatation of the ventricles, the following is observed:

• strong, which occurs due to the asymmetry and large size of the ventricles, which compress the surrounding tissues;
• frequent headaches;
• speech disorders.

When the pathological process becomes irreversible, diseases of the musculoskeletal system, Down syndrome and hydrocephalus are added to the existing symptoms.

Diagnostics

Ventriculomegaly is detected during a routine ultrasound examination between 17 and 30 weeks. To make an accurate diagnosis, it is necessary to observe the process over time, and for this, repeated diagnostics are prescribed. After a few weeks, if the suspicions are confirmed, the patient is referred to a geneticist for consultation.

Additional genetic studies are carried out, karyotyping is prescribed, which will help to clarify the structure of the anomaly and the composition of the chromosomes.

Additionally, the patient undergoes a blood test to determine the presence or absence of an infection that could affect the deviation of intrauterine development.

The fetus or newborn is checked for congenital abnormalities.

A magnetic resonance thermogram of the child is performed, and if a mild or moderate degree is detected, then neurosonography is performed to track the process over time.

If no abnormalities are detected, therapy is prescribed in the form of potassium tablets, which will replenish the cells with the missing oxygen.

If a severe pathology is detected, the pregnancy is terminated, and in the case of a mild to moderate degree, therapeutic measures are used.

Treatment

Ventriculomegaly in infants, if the disease is mild, cannot be treated. If the ventricles are slightly enlarged, it is necessary to monitor the child, and if there is the slightest deviation, contact a neurologist.

In case of moderate severity, medications are prescribed that will speed up processes in the pituitary gland, remove excess fluid, and are also prescribed to improve blood circulation.

When a severe degree of illness is detected in a child, an operation is performed, since therapeutic measures will not bring any effect. During surgery, ventriculoperitoneal shunting is performed, which corrects ventricular asymmetry.

If the child is still in the womb, then for mild to moderate pathology, drug treatment is prescribed with potassium, vitamins and drugs to improve blood circulation. When the cause of the disease is related to infection, antibacterial therapy is prescribed. If a severe degree is diagnosed, the pregnancy is terminated only if the timing allows this to be done without harm to the mother’s health.

Possible complications

Ventriculomegaly is a severe pathological process that leads to irreversible consequences, causing severe complications:

• Down syndrome - will be acquired due to defects in the structure of the brain;
• Edwards syndrome - mutational changes in chromosomes are observed, which leads to a whole group of pathological abnormalities in development;
• Turner syndrome - physical abnormalities occur in development;
• problems with the musculoskeletal system;
• hydrocephalus, when cerebrospinal fluid accumulates in the head.

Moreover, if the child is in the womb, such disorders can contribute to the baby's freezing or miscarriage, and pathological processes can cause premature birth.

Complications of the disease

Complications of ventriculomegaly include the likelihood of serious diseases of the nervous system. Such diseases include:

• Down syndrome;
• Edwards syndrome. This is a chromosomal pathology in which there are many malformations of the child;
• Turner syndrome. This syndrome is characterized by serious physical developmental abnormalities and sexual infantilism.
• Severe fetal hydrocephalus. A serious condition in which large amounts of cerebrospinal fluid accumulate in the ventricles of the brain.

Prevention

The best prevention of ventriculomegaly is to maintain a healthy lifestyle, avoiding stress and infectious diseases during pregnancy. It is also necessary to eliminate alcohol and nicotine, spend more time in the fresh air, see a doctor and undergo all routine tests.

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Diseases with similar symptoms:

Cerebral ischemia is a disease that is a progressive disruption of the blood supply to brain tissue, which leads to oxygen starvation of this organ. The main risk group is newborn babies. This condition often develops during intrauterine development of the fetus or directly during labor. As for adults, their illness develops against the background of other diseases and an irrational lifestyle.

The health of the future baby is established during the gestation process in the mother’s womb. Even the slightest deviation associated with intrauterine development of the fetus can negatively affect the further development and health of the newborn. Uterine ventriculomegaly poses a particular danger to the unborn child.

Hydrocephalus, ventriculomegaly, increased intracranial pressure

When we are 3 months old. a neurologist at the clinic diagnosed ventriculomegaly and was about to urgently admit her to the hospital, and then we waited 2 weeks for an appointment with a good specialist in neuralgia for children under one year old to check the diagnosis - I thought I was going crazy, I read so much on the Internet, the milk of course was almost gone, I I hardly ate, “ventricuolmegaly, ventriculomegaly” was constantly spinning in my head…. terrible, as I remember.

We are now almost 9 months old. a couple of months ago, all diagnoses were finally removed from us; we didn’t take a single pill, because... We did not have any ventriculomegaly.

Remembering how I myself was looking for similar cases, while I’m sick and my grandmother is sitting with Vanka, I decided to describe our story in detail, with ultrasound data, maybe it will help someone.

To begin with, I want to share a link to Komarovsky’s video about ICP, everything is explained very well

https://video.komarovskiy.net/vnutricherepnoe-davlenie-10-04-011.html

All the diseases listed in the topic are very rare, although neurologists are very fond of diagnosing them, for example, if a child’s head circumference does not fit into certain norms.

We were born with standard weight 3400, height 51 cm, apgar 8/9, normal birth, 5 days earlier than expected, lasted 8 hours, although in the exchange they still wrote intrauterine hypoxia, unfortunately, I didn’t ask the birth center why.

Then rapid growth began, Vanka grew 5 cm per month, and his head and chest grew in proportion to his body.

As a result, a visit to a neurologist at 3 months and 16 days ended with us being sent for an ultrasound, because... our head and chest were 42, 5 and 42 cm. respectively, this is more than the norm for our age, these are the sizes for a 5.5 month old child. His head grew by 4 cm in 1.5 months. To my remark, it’s okay that he grew quickly at all, and his height is also 5.5. a month-old baby, the neurologist told me that she was only interested in the head. She prescribed us to drink glycine, it seems to be beneficial. We didn’t drink, my husband found information that it somehow had a bad effect on the absorption of iron (I can’t vouch for the correctness of this statement), but our hemoglobin was not high anyway, and in general I’m not a supporter of unnecessary medications, especially at that age.

Then I thought, okay, let’s do an ultrasound, everything is fine with us, we sleep well, we are developed for our age, we have no complaints about the child. Although it was necessary even then to run away from this doctor.

I already knew a little about these diseases and understood that they do not appear out of nowhere. My nephew, when he was still in my sister’s tummy, was diagnosed with hydrocephalus and insisted on an abortion, but she did well, didn’t believe the diagnosis and had the ultrasound done, it turned out that everything was fine. Now my nephew is already 6 months old. - a completely healthy child, but if she had believed the diagnosis, he would not have existed. By the way, he was diagnosed with hydrocephalus even after birth, but then it was just that everyone, as they say, “let it fall on deaf ears.”

So we went for an ultrasound, the result is detailed at the end of the text, the ultrasound specialist’s diagnosis was ventriculomegaly (he refused to explain anything). But I understand that the ultrasound specialist does not make definitive diagnoses and I calmly go to the neurologist again. Yes, and we also visited an ophthalmologist, a good, familiar doctor, she said that we had slight deviations, but for our age this is normal.

4 Months, second visit to the neurologist.

I don’t even want to remember. How can such doctors be allowed to see children? In general, according to her diagnosis, everything is bad with us, we need to go straight from the office to the hospital (I said that we won’t go anywhere), she registered us, prescribed so many things. Unfortunately, I won’t write the entire list of appointments now (because I can’t make out anything on the map). She did not answer my questions (I asked why she made the diagnosis only by ultrasound, because nothing worries us and the development is good, and in general where this disease came from, there were no prerequisites), and in the end she asked us to leave the office altogether.

Of course, we didn’t drink anything, we made an appointment at Neuromed with Zaitsev (a neurologist) and for an ultrasound at the Center for Reproduction and Family Planning (on Sevastopol Avenue).

How I survived these 2 weeks before the appointment was a nightmare. Then I even went to the manager and complained, but they politely sent me there. Now I have already made inquiries about this unfortunate doctor, and found out that she has been famous for a long time, that she has never had a single healthy child, she is rude to everyone and in general it is better not to go to her.

The sun shone again after the ultrasound in the center of the rep. and plan. families. The ultrasound specialist there was very nice and explained everything to us. That we don’t have any ventriculomegaly, that such results could be due to our skull shape, we have a flattened back of the head (it grows ragged due to rapid growth and early teeth), which the neurologist didn’t even notice. It is easy to make a mistake that all these standards are very conditional, and in general we are talking about millimeters. She said that we need to find a good neurologist and just observe. I won’t rewrite the results of this ultrasound; they are almost no different from the first one.

Neurologist Zaitsev also said that everything is fine with us, that the one who prescribed us this treatment needs to be treated, including me for my nerves. He said that we need to be observed, we need more massage than everyone else, again due to the rapid growth of the muscles, they are rather weak.

Because At that time, summer had come and we left Moscow for the region, and we found an excellent neurologist here. We still see her to this day. At first she diagnosed us with compensated hydrocephalic syndrome, and now she has diagnosed us as completely healthy. The first neurologist who noticed rickets in us and began treatment for it. In general, we found our doctor. She explained to us that a large head can be hereditary and, first of all, we need to look at relatives, including grandparents. She generally paid little attention to the ultrasound, mostly tapped her head and said that she didn’t feel any excess fluid there, just brains.

We also redid the ultrasound at 6 months, the results, again, are not much different from the first (some things increased, some decreased) and this is all normal.

Dear mothers, what I want to say in the end. Don't be afraid of the ultrasound results and double check the diagnosis. Don’t rush to stuff your kids with pills, because it’s not at all useful. Especially if you had a normal birth, there were no infections during pregnancy, the child sleeps normally (by normally I mean does not wake up every 30 minutes crying), is developed according to age, precisely according to age, and not like others, when they start early sit, walk, etc.

Good luck to everyone and good health.

Ultrasound 3 months 3 weeks.

The echogenicity of the parenchyma is average

The pattern of convolutions and furrows is formed correctly and clearly, with normal echogenicity. In the convexital space the amount of fluid is slightly increased (4 mm).

The midline structures are not displaced.

The interhemispheric fissure in cross-section through the bodies of the lateral ventricles is 6 mm (normal is 4 mm). In cross-section through the frontal lobes 9 mm (normal 4 mm). The lateral ventricles are symmetrical and not dilated. The width of the frontal horns on the right is 8 mm, on the left 8 mm (norm 4). The depth of the anterior horns on the right is 9 mm, on the left 9 mm (norm 5). Antrum 10 mm on both sides.

The width of the third ventricle is 5 mm (normal 4). The IV ventricle is triangular in shape and not deformed. The water supply has not been extended. The liquor is anechoic.

Evans index 0.34 (normal 0.27 - 0.30)

The cavity of the transparent septum is not determined.

The choroid plexuses are not dilated, with clear contours, and a homogeneous structure.

The subcortical ganglia and visual thalamus are of normal structure and echogenicity. No changes were detected in the caudothalamic areas. The structure and echogenicity of the periventricular zones is not impaired. The structure of the brain stem is of normal echogenicity. The tentorium of the cerebellum is symmetrical on both sides, with normal echo density. The resistance index of the anterior cerebral artery is 0.71 (normal).

What is ventriculomegaly in the fetus?

Such a pathological abnormality in the fetus as ventriculomegaly is a disease for which a characteristic feature is a significant increase in the size of the ventricles located in the brain

. In most cases, the pathology affects the lateral ventricles, which are special cavities located in the brain and filled with cerebrospinal fluid. The process of their increase and disruption of the outflow of cerebrospinal fluid provokes the development of a disease such as ventriculomegaly.

In normal ventricular conditions

, their depth ranges from 1 to 4 mm. In case of pathology development, their size can increase to 20 mm. And if the disease is not treated in time, the fetus may be born with obvious mental and neurological abnormalities. Well, in the most difficult cases, ventriculomegaly can lead to impaired fetal viability.

Since the disease progresses extremely quickly, if the mother does not take action in time, she may give birth to a sick child, and in the worst case, lose him.

This is quite a serious illness.

, which, depending on the complexity of the pathological process, has three main forms.

Any person has only four ventricles, which are located directly in the brain. Moreover, their sizes can vary significantly from person to person.

and be asymmetrical, which is quite normal. However, when identifying pathology, doctors are always guided by established standards, the limits of which cannot be exceeded.

The greater the depth of each ventricle in an unborn fetus, the greater the likelihood of developing serious abnormalities in the functioning of the central nervous system.

Pediatric neurosurgeon

Unknown29 March 2020, 15:51

Hello! Please tell me!!!! Our daughter is now 9 months old, head circumference 43.5 cm, height 68 cm, weight 8200 kg (at birth 55 cm, birth weight 4020 kg, head circumference 36.5 cm). We hold our heads, walk, laugh, eat with appetite, no problems, roll over only from stomach to back, does not crawl, sits with support (cannot sit on her own), reacts to sounds, fixes gaze, smoothly follows objects, holds a toy, grabs, pulls in the mouth, but not for long (her hands are very weak, or she doesn’t know how to control them), we do massage and exercise therapy. The pregnancy was difficult: I was sick, there was a threat of miscarriage, and before that there were 2 undeveloped pregnancies. The first birth was at 41 weeks and 2 days, green water and after approximately 2-3 hours of caesarean, there was fetal hypoxia and congenital pneumonia. She was under the supervision of doctors. Ultrasound of the brain 2 days later the child was diagnosed with Dandy-Walker syndrome, venticulohemaly, and cerebellar dysplasia (no ultrasound data was provided). The first ultrasound at home was done at 3 months: choroid plexus - cyst on the left in diameter. approx. 3 mm, the pattern of grooves and convolutions is clear, the width of the bladder is 4-3 mm, the depth of the anterior horn of the lateral ventricle is 4 mm on the left, 3 mm on the right; depth of the body of the lateral ventricle on the left is 7 mm, on the right is 4 mm, the width of the occipital horn on the left is 22 mm, on the right is 20 mm, the width of the 3rd ventricle is 4 mm, the 4th ventricle is not expanded, the visual tuberosities are dia. 26 mm, BCM 4 mm, cerebellum to the side. pr-tion 26x20 mm, frontal 23x30 mm, vascular pulsation is not increased, free fluid is within normal limits. Conclusion: left-sided ventriculomegolia, against the background of form. pseudocysts, moderate cerebellar hypoplasia. Next ultrasound after 2 months: - at 5 months: the depth of the body of the lateral ventricle on the left has changed - 8 mm, the width of the occipital horn on the left is 24 mm, on the right - 18 mm, the width of the 3rd ventricle is 4.2 mm, the choroid plexus - a cyst on the left in diameter. approx. 1.8 mm, visual cusps dia. 26.6 mm, BCM 4.5 mm, cerebellum to the side. dimensions 30x21 mm, frontal 24x27 mm, MPB width 4.4-3.5 mm. - at 7 months: the depth of the anterior horn of the lateral ventricle on the left changed 7 mm on the right 5 mm, the width of the occipital horn on the left 26 mm, the width of the 3rd ventricle 4 mm, the width of the 4th ventricle 10 mm, visual tuberosities dia. on the left 32 mm on the right 33 mm, the cerebellum 30x30 mm (t), the width of the bladder is closed. - at 9 months (done by another specialist): the depth of the anterior horn of the lateral ventricle on the right has changed - 4 mm, the width of the occipital horn on the right is 20 mm, the width of the 4th ventricle is 5.8 mm, the visual tuberosities are dia. 27.5 mm, BCM 5 mm, cerebellum to the side. dimensions 37x22 mm, frontal 32x32 mm, MPB width 4.5-3.7 mm. Conclusion: left-sided ventriculomegolia, cerebellar hypoplasia, dilatation of the 4th ventricle.

The neurologist prescribed: encephabol, glycine, orotate, vit. e, neuromedin, elcar. We also have a delay in motor development (against the background of congenital malformation of the brain), but it is impossible to say that the child is not developing at all, but somehow, very slowly, we are developmentally, as doctors say, at 5-6 months.

Please tell me whether it is worth taking some immediate action, or for now we should take care of the child and monitor it.
Thanks in advance, we will be grateful for your help. ReplyDelete

Reasons for the development of pathology

Despite the fact that the etiology of the disease is not fully understood, the following factors can serve as an impetus for the development of abnormalities in the fetus:

Enlargement of the ventricles of the brain can be detected in the fetus during a routine ultrasound of a pregnant woman, starting at 17 weeks of age. If the disease is neglected, it can lead to the development of such terrible diseases in the born child as Down syndrome, bipolar disorder, schizophrenia and other similar neurological disorders.

The first signs of illness begin to appear in newborn babies in the first weeks of their life. In addition, symptoms largely depend on the stage of ventriculomegaly

.

Ventriculomegaly in a child: treatment of pathology

It is important to note that the choice of treatment for a disease such as ventriculomegaly will largely depend on the stage of the disease and the time of detection of the disease

– in the womb or after birth.

Treatment of a newborn child

You need to understand that such a complex disease as ventriculomegaly in the fetus can cause the development of dangerous neuralgic pathologies

, some of which cannot be cured after the birth of a child.

Ventriculomegaly in the fetus is a pathological change in which an increase in size occurs. This pathology can cause various brain diseases and neurological disorders.

It should be noted that normally each person should have four ventricles of the brain. Two of them are located in the thickness of the white matter, they are called the lateral ventricles of the brain. Each of them has a posterior, anterior and inferior horn.

Using the interventricular foramen, a connection occurs with the third ventricle, which, through the cerebral aqueduct, is connected to the fourth ventricle, located at the bottom of the rhomboid fossa. In turn, the fourth ventricle is connected to the central canal of the spinal cord. This system consists of vessels with cerebrospinal fluid. Normally, the size of the lateral ventricles should be no more than 10 mm at the level of the posterior horn.

The main function of the ventricular system is the production of cerebrospinal fluid, which, in the absence of pathologies, enters the spinal canal. If for some reason its outflow is disrupted, a disease such as ventriculomegaly develops. It is accompanied by expansion of the ventricles of the brain.

This disease can be isolated, but in some cases it is a consequence of a defect associated with other developmental pathologies. It should be noted that ventriculomegaly is characterized by an increase in the ventricles of the fetus in sizes from 12 to 20 millimeters.

The main causes of this disease include chromosomal abnormalities present in women whose pregnancy is accompanied by various kinds of pathologies.

In addition, the causes of ventriculomegaly can be:

• infectious diseases;
• physical injuries;
• obstructive hydrocephalus;
• hemorrhage;
• hereditary predisposition.

This disease in the fetus can cause the appearance of Down, Turner and Edwards syndrome. Ventriculomegaly in the fetus affects changes in the heart, disruption of the musculoskeletal system, and brain structures.

To identify this disease, an ultrasound examination is performed. Signs may appear as early as 20–23 weeks of pregnancy. Sometimes pathology is detected at the beginning of the third trimester.

According to scientists, this disease is most often diagnosed in women who give birth to a child after thirty-five years of age. At a young age, such a diagnosis is not so common. According to statistics, the disease is diagnosed in 0.6% of cases.

What kind of disease is this

A pathological process affecting the fetal brain, in which the ventricles of the brain swell (change their shape), is called ventriculomegaly. Pathology has a negative impact on the developing nervous systems of the body (central and peripheral). As a result of ventriculomegaly, the fetus suffers from:

• spinal cord;
• brain;
• nerve processes and roots;
• autonomic nervous system.

Not only individual organs, but also entire body systems suffer from excess fluid.

The cerebral ventricles communicate with each other through canals. They perform a very important function for the body - they synthesize cerebrospinal fluid (CSF). Normally and in the absence of abnormalities, this fluid flows into a certain space called the subarachnoid space. If an anomaly is present, then the outflow stops, fluid (CSF) accumulates in the ventricles, creating many problems for the baby.

There are three degrees of severity of ventriculomegaly:

• light;
• average;
• heavy.

With a mild degree, the lesions are isolated, quickly respond to treatment and pass without consequences for the baby. Complex drugs are not required, the ventricles quickly return to normal.

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The average degree implies an increase in the ventricles (one or more) up to 15 mm inclusive. This happens because the natural outflow of fluid is disrupted. The functionality of the ventricles is also impaired.

With severe ventriculomegaly, the ventricles are greatly enlarged (up to 21 mm) due to the accumulation of cerebrospinal fluid in them. Serious treatment and monitoring of the condition and intrauterine development of the baby is required.

Causes of ventriculomegaly in the fetus

Ventriculomegaly is a rather dangerous disease that can provoke the death of the fetus in the womb, or manifest itself in the form of anomalies (mental and physical disorders), as a prospect - disability in the future. In order, if possible, to protect the baby from the harmful consequences of ventriculomegaly, it is necessary to select the most effective treatment, identifying the real causes of this pathology. These reasons may be associated with genetic abnormalities of the parents or manifest themselves independently. Ventriculomegaly in the fetus can be caused by the following reasons:

• the age of the pregnant woman is over 35 years;
• abnormal genes and chromosomes in expectant mothers;
• the presence of pathological processes during pregnancy;
• all kinds of infections (including intrauterine ones);
• obstructive fetal hydrocephalus;
• physical injuries;
• oxygen starvation of the fetus;
• strokes;
• periventricular leukomalacia;
• lissencephaly.

The threat can be detected as early as 17 weeks of pregnancy using ultrasound screening. From the 17th to the 34th week, the doctor pays special attention to the development of the brain, as well as the size of its ventricles. Ventriculomegaly is indicated by an increase in one or more ventricles, ranging from 12 mm to 20 mm. If ventriculomegaly is suspected, the doctor recommends undergoing additional tests and repeating the ultrasound after another 2 weeks. It is also mandatory for the expectant mother to visit a geneticist, who will determine whether the pathology is congenital or caused by injury or infection. The karyotyping procedure is also shown for a baby in the womb.

Consequences of ventriculomegaly

Ventriculomegaly in the fetus - the consequences of this disease, which began in the womb, can be very severe, starting with the death of the child in the womb (due to developmental defects), premature birth (accounts for up to 4% of all known cases), severe pathologies and disability .

If a genetic factor plays a role in the appearance of ventriculomegaly, then the following deviations and syndromes are possible:

• Down syndrome;
• hydrocephalus;
• Patau;
• Edwards;
• Turner (with gonadal dysgenesis);
• vascular malformations of the brain;
• mental retardation;
• retardation in physical development.

It has been noted that female infants are more susceptible to anomalies and defects as a result of ventriculomegaly, compared to male infants.

Despite everything, children born with a similar diagnosis have a very good chance of further normal life. So, in 80% of cases out of a hundred, babies outgrow this condition and subsequently develop fully without deviations.

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Among all known cases of ventriculomegaly, 10% of infants are susceptible to serious pathologies. Deviations of moderate severity were noticed in 8% of children born with this diagnosis.

Types of Ventriculomegaly

This pathology has three main types:

1. Light type. It is isolated in nature and does not require any serious treatment.
2. Medium type. It is characterized by enlargement of the ventricles, the size of which can reach 15 mm. This disease is accompanied by certain changes in the outflow of cerebrospinal fluid.
3. Heavy type. This form of the disease is characterized by a significant increase in the fetal cerebral ventricles in combination with other pathological changes in the brain.

Diagnosis and treatment

Only a specialist can tell you what lateroventriculoasymmetry of the brain is. To confirm the diagnosis, magnetic resonance and computed tomography, electroencephalography, and examination of the fundus are performed.

An increase in the size of the ventricles, which is not accompanied by a pathological process, does not require treatment. Suitable therapy can be prescribed if the anomaly is accompanied by a pronounced clinical picture. All treatment in this case will be aimed at normalizing the movement of the cerebrospinal fluid. These goals are achieved with the help of diuretics, nootropic and sedative drugs, anti-inflammatory and antibacterial drugs, and neuroprotectors.

If there are tumors or cysts in the brain, as well as with hydrocephalus, surgery cannot be avoided.

If the patient's condition rapidly deteriorates, endoscopic ventriculostomy is performed. During the procedure, a new ventricular connection is created to bypass the obstruction.

In childhood, such problems arise quite often. But generally they do not need treatment. If the anomaly occurs due to infection, injury or cancer, treatment must be carried out immediately. Otherwise, health and life-threatening disorders develop. Only a qualified specialist should perform therapy.

Diagnosis of the disease

Ventriculomegaly in the fetus is diagnosed during pregnancy - from the seventeenth to the thirty-third week. They do this using . Fetal spectral karyotyping can also be used. It is very important that perinatal examinations include the study of all anatomical structures of the fetus - especially the ventricular system of the brain.

To establish an accurate and reliable diagnosis, it is necessary to conduct a transverse scan of the fetal head. This should include determining the threshold value of the lateral ventricles. Ventriculomegaly in the fetus is diagnosed if the size of the cerebral ventricles exceeds 10 millimeters.

Asymmetry of the ventricles of the brain in adults: causes and treatment

1. Anatomy of the ventricular system of the brain 2. Causes of ventricular dilatation 3. Clinical signs 4. Diagnosis 5. Treatment
There are a number of anatomical features of the brain of each person. Sometimes such specificity is considered physiological; in other situations, deviations from the norm can give rise to manifestations of a pathological process. One such condition is asymmetry of the lateral ventricles of the brain. On the one hand, such cerebral specificity is not considered a separate nosological entity, and its clinical symptoms may be absent. However, often ventricular asymmetry may indicate the presence of a number of diseases.

Asymmetry of the lateral ventricles is a condition in which expansion of the lateral ventricular cavities occurs. However, their sizes do not correspond to each other. Most often, asymmetry is diagnosed in newborns and children in the first year of life, as a manifestation of perinatal pathology of the nervous system. However, cases of increased volume of the lateral ventricles in adults are not uncommon.

Asymmetry of the lateral ventricles is not an independent disease, but serves only as a symptom of a pathological condition.

Treatment methods

Treatment of ventriculomegaly in the fetus should be aimed at eliminating the negative consequences of such a pathology - in particular, severe diseases of the brain, as well as the central nervous system.

If this disease is associated with some kind of infection, then the main treatment should be aimed at eliminating the cause of the pathology. After this, the doctor prescribes a repeat ultrasound examination.

It is worth noting that if the expansion of the ventricles of the brain is isolated and moderate in nature, then special therapy is not required. Such deviations from the norm in no way affect the development of the fetus. The task of specialists in this case is to monitor the condition of the ventricles until birth.

If the disease is accompanied by cerebral hypertension, drug therapy is indicated. In some cases, surgery may even be necessary.

If the width of the ventricles is no more than twelve millimeters, then therapy is carried out by prescribing antihypoxants and static loads on the pelvic muscles. As medications intended to prevent the occurrence of neurological disorders in a child, agents are prescribed to retain potassium in the body.

If ventriculomegaly was detected in a newborn, then its consequences are quite difficult to predict. The isolated form of the disease in most cases is not associated with any problems. If the expansion of the ventricles of the brain is accompanied by other chromosomal abnormalities, severe neurological disorders may appear.

Possible disorders and complications

According to research, 11% of children diagnosed with ventricular enlargement suffer from physical and psychological developmental delays. Symptoms may be obvious or subtle.

4% have chromosomal abnormalities. Another 4%, with a combination of fetal development pathology and ventriculomegaly, have a fatal outcome.

If a child is diagnosed with an isolated form of the disease, i.e. no other developmental defects or genetic mutations have been identified, the prognosis will be favorable, provided that treatment is started immediately from the moment the child is born.

Ventriculomegaly requires mandatory treatment and monitoring of the course of the disease over time; if this is not done, the child will develop neurological diseases and other consequences that will significantly affect his health and development.

Consequences of ventriculomegaly in the fetus

Moderate ventriculomegaly with a lateral ventricle size of no more than 15 millimeters, especially with appropriate treatment, is usually not associated with any negative consequences. If the size of the ventricles exceeds 15 millimeters, in addition, an increase in fetal hydrocephalus is observed, then the consequences can be the most severe. They include congenital diseases of the central nervous system, and even fetal death.

It is necessary to understand that the earlier and more rapidly this pathology grows and passes into, the worse the prognosis is. If there are defects in other organs, the risk of having a child with a chromosomal abnormality increases - this could be Edwards, Patau, or Down syndrome.

In addition, it should be noted that the probability of intrauterine fetal death or death during childbirth is approximately 14%. After childbirth, normal development of the child without disruption of the central nervous system is observed in 82% of cases. At the same time, 8% of children experience mild disorders of the nervous system. In 10% of cases of this disease, severe disturbances in the functioning of the nervous system and severe disability of the child are observed.

Ventriculomegaly in the fetus

- This is a rather dangerous pathology that can have serious consequences for the child’s health. Therefore, it is so important to undergo all necessary examinations in a timely manner and monitor your health. In no case should routine ultrasound examinations be neglected during pregnancy. Timely treatment will help prevent or significantly reduce the negative consequences of this pathology.

It should be noted that enlargement of the ventricles of the brain is also diagnosed in many adults. This became obvious after computed tomography was introduced into practice. However, in such situations this is considered a variant of the norm, since ventriculomegaly does not interfere with a normal lifestyle at all.

Ventriculomegaly in the fetus is characterized by dilation of the cerebral ventricles, the cavities of the brain filled with cerebrospinal fluid. The ventricles of the brain have a complex structure and change significantly as the fetus grows. To correctly assess their sizes, special tables have been created, which were the result of special research. With a brain pathology such as ventriculomegaly, the width of the ventricles in the fetus can reach up to fifteen millimeters. The defect can be observed both in isolation and in combination with other developmental defects. If ventriculomegaly is an independent disorder, the newborn may not have chromosomal abnormalities.

How does it manifest?

Pathology is diagnosed when the width of the ventricles exceeds ten millimeters. This condition, of course, can lead to various disorders of the child’s central nervous system. This is the reason for the danger, because the expansion of the brain cavities in itself does not mean anything, but if it rapidly progresses in dynamics, the threat of hydrocephalus will appear.

Ventriculomegaly in the fetus: causes and diagnosis

Most often, the development of pathology is facilitated by intrauterine infections. Therefore, when a problem is detected, a pregnant woman should first be examined for the presence of bacterial and viral infections. In addition, ventriculomegaly can be caused by a chromosomal abnormality or a genetic disease. The causes of the pathology have not been thoroughly studied, only the connection between this disorder and the age of the pregnant woman has been noticed: ventriculomegaly in newborns whose mothers are over 35 years old occurs three times more often than in those whose mothers are younger. Pathology in the fetus can be detected by ultrasound examination performed between the seventeenth and thirty-fourth weeks of gestation. However, ultrasound results are not enough to make a diagnosis; fetal karyotyping will also be required.

Treatment methods

If ventriculomegaly in the fetus is caused by any infection, treatment must be directed specifically at its elimination, after which an ultrasound scan must be repeated. In general, in cases where ventricular dilatation occurs isolated and moderately, therapy is not prescribed, since usually such deviations from the norm do not affect the development of the fetus. Doctors simply monitor the condition of the ventricles until birth. If ventriculomegaly in the fetus is accompanied by cerebral hypertension, drug and sometimes even surgical treatment is required. If the width of the ventricles does not exceed twelve millimeters, therapy can be carried out by taking antihypoxants and performing static loads on the pelvic muscles. If ventriculomegaly is diagnosed in a newborn, its consequences are quite difficult to predict. Isolated pathology in eighty percent of cases does not lead to any problems. But in cases where ventricular enlargement is accompanied by other chromosomal abnormalities, severe neurological disorders may develop.

Ventriculomegaly is a pathological change in the fetus in which there is a slight or significant increase in the size of the ventricles of the brain, which leads to neurological disorders and brain diseases.

Consequences

The prognosis of infants with ventriculomegaly varies significantly and depends on the presence of structural or genetic disorders, infections, and the degree of dilatation of the cerebral ventricles. With mild isolated ventriculomegaly, a favorable outcome can be expected. A meta-analysis in the journal Ultrasonography in Obstetrics and Gynecology showed that the incidence of neurological abnormalities in children with this diagnosis is no more than 8%, which is similar to the average level in the population.

With moderate isolated ventriculomegaly, a favorable prognosis, according to various sources, has 75-90% of children. If, after a comprehensive examination, no other pathologies are identified, one can count on the absence of problems in the future, however, such children require periodic monitoring of the state of the central nervous system due to the risk of neurological consequences.

The prognosis for ventriculomegaly combined with other anomalies depends primarily not on the degree of ventricular dilatation, but on the nature and course of the diseases that caused the accumulation of cerebrospinal fluid. The lack of progression and development of the child by age casts doubt on the real risk associated with the characteristics of brain development, since more than 90% of children in this case do not suffer from the consequences of early age pathologies.

The best result (no consequences in 98% of cases) is observed under the following conditions:

• the ventricles are slightly enlarged (up to 15 mm);
• there are no echo signs of other anomalies;
• satisfactory results of genetic testing.

The ventricles of the brain, cavities filled with fluid, are responsible for maintaining intracranial pressure. The amount of this fluid, called cerebrospinal fluid, determines the level of intracranial pressure and blood supply to the brain. A condition in which the ventricles are enlarged and cannot fully perform their function is called ventriculomegaly.

Causes and symptoms of ventriculomegaly

Pathological ventriculomegaly in the fetus can be either isolated or a defect associated with other developmental pathologies. With this disease, the fetus has a large size of the ventricles of the brain, reaching up to 12-20 mm.

In modern medicine, among the main causes of ventriculomegaly are chromosomal abnormalities, which are observed in 17-20% of women with pathologies during pregnancy.

The causes of ventriculomegaly can be obstructive hydrocephalus, physical trauma, infectious diseases, hemorrhage and hereditary factors. The pathology intensifies in the presence of other developmental anomalies.

Ventriculomegaly in the fetus can lead to the development of Down syndrome, Turner syndrome and Edwards syndrome in the child. This disease affects changes in the structures of the brain, heart and musculoskeletal system.

Symptoms of ventriculomegaly can be clearly identified using ultrasound, and their appearance is noticeable at 20-23 weeks of pregnancy. In some cases, pathology is recorded at the beginning of the third trimester of pregnancy; the best period for diagnosing and identifying symptoms of the disease is 25-26 weeks.

If ventriculomegaly is a single pathology in the fetus, then the likelihood of severe chromosome abnormalities is low. The attending physician determines the risk of developing brain diseases in a child in accordance with the increase in the width of the ventricles.

Medical studies have found that the risk of ventriculomegaly is high in pregnant women over the age of 35 (the incidence of the disease is 0.5-0.7%), and in young women giving birth it is significantly reduced.

In pediatrics, there are three main types of ventriculomegaly:

• severe type with the presence of large enlargements of the ventricles of the brain of the fetus or newborn, and also combined with other pathologies of the brain;
• medium type with an increase in the ventricles up to 15 mm and slight changes in the outflow of cerebrospinal fluid;
• mild type, which is isolated in nature and does not require serious treatment.

Features of the course of ventriculomegaly in pregnant women after 35 years

Most often, this pathology occurs in pregnant women after 35 years of age. The following factors contribute to the occurrence of ventriculomegaly during later pregnancy:

• increased risk of genetic disorders;
• high probability of so-called “chromosomal breakage”. This factor increases the risk of chromosomal abnormalities in the fetus, which lead to the occurrence of ventriculomegaly;
• a high probability of developing fetal hypoxia (scientists have established more frequent cases of fetal hypoxia during pregnancy after 33-35 years);
• infectious complications during pregnancy. The younger the woman, the less likely she is to develop serious complications and infectious diseases.

Thus, in pregnant women under 33-35 years of age, the risk of developing fetal ventriculomegaly is minimal.

Diagnosis of the disease

Ventriculomegaly is diagnosed during pregnancy (from 17 to 33 weeks) using ultrasound and spectral karyotyping of the fetus. Perinatal examinations should include studies of all anatomical structures of the fetus, especially the ventricular system of the brain.

To establish an accurate diagnosis, a transverse scan of the fetal head is performed to determine the threshold value of the lateral ventricles of the brain. Ventriculomegaly is defined as ventricle size greater than 10 mm.

Treatment of ventriculomegaly

The main treatment for ventriculomegaly is aimed at preventing the consequences of this pathology, which can be severe diseases of the brain and central nervous system.

A pediatrician and neurologist prescribe antihypoxants, diuretics and vitamins as drug therapy.

To treat ventriculomegaly, massage and physical therapy (static exercises with loads on the pelvic muscles and pelvic floor) are prescribed.

As medications intended to prevent the development of neurological disorders in a child, drugs are prescribed that are aimed at retaining potassium in the body.

Why is ventriculomegaly dangerous?

Ventriculomegaly in a child can lead to the development of serious disorders in the functioning of the central nervous system and brain. In an isolated form, when the deviation is observed on its own, the prognosis is usually favorable.

Ventriculomegaly, the causes of which are genetic disorders, is often combined with abnormalities in mental development. In particularly severe cases, the child may not be viable. It is important not to skip an ultrasound during pregnancy, when it is already possible to detect many developmental disorders, in particular, ventriculomegaly. What is dangerous about this situation is that by starting the process, you can miss precious time.

Ventriculomegaly, caused by prolonged exposure to infection on the fetus, hypoxia during gestation or childbirth can cause consequences from various kinds of psychoneurological disorders to severe forms of cerebral palsy. Such consequences of ventriculomegaly are difficult to treat. It has its effect, but requires a huge amount of time and effort from doctors and parents.