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Chronic H Y Drocephalits

hydrocephalus, congenital, fluid, blood, internal, ventricles and brain

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is a name given to serous effusions into the cavity of the skull, wherever situated. The effusion may be acute or chronic. Acute hydrocephalus is generally the consequence of tubercular inflammation of the meninges of the brain, and the name is practically synonymous with tubercular meningitis—a disease which is discussed in a separate chapter. It is not, however, very uncommon in cases of death from severe and pro tracted convulsions, occurring without discoverable organic lesion of the nervous centres, to find collections of serosity in the cerebral ventricles and at the base of the brain. This effusion is accompanied by turgescence of the veins of the pia mater—it-self probably a consequence of the convul sive seizures—and may be looked upon as a result of the venous conges tion. This may be considered an instance of the non-tubercular form of acute hydrocephalus. Such a case is narrated in the chapter on " Convul sions." Chronic hydrocephalus is called either internal or external, according to the situation of the fluid. In the internal form the fluid is contained in the cerebral ventricles ; in the external variety it collects in the arachnoid cavity. The disease may be congenital, or may be developed at some period after birth. Hence there are two chief divisions of chronic hydro cephalus into the congenital and acquired variety. The congenital form is usually an internal hydrocephalus, for the fluid is for the most part in the ventricles. In the acquired variety it may be either internal or ex ternal, or the fluid may collect in both situations.

Causation.—It is difficult to say what may be the causes of congenital hydrocephalus, although these are probably more than merely temporary agencies ; for a woman who has once given birth to a hydrocephalic infant may do so again in future pregnancies. The tendency appears to be often hereditary, and it has been attributed with a doubtful amount of probability to drunkenness and other constitutional vices on the part of the parents. According to Dr. B. Rennert, of Frankfort, the children of workers in lead who have themselves suffered from chronic lead-poisoning are very apt to develope chronic hydrocephalus. Sometimes it is associate& with

mation of the brain, for if there is congenital atrophy of any part of the organ fluid is thrown out to fill up the resulting space. This has been called "hydrocephalus a vacuo." Rokitansky attributes the large majority of cases of the congenital form of the malady to inflammation of the arach noid lining of the ventricles occurring during foetal life or attacking the infant shortly after birth.

Acquired hydrocephalus usually occurs before the end of the third year. It may be induced by any cause which interferes with the cerebral circulation, such as tumours pressing upon the vend Galeni or straight sinus, and so impeding the escape of blood from the ventricles. Serious pressure upon the veins of the neck by enlarged glands may produce the same result. So also the intracranial effusion may be a part of general .dropsy dependent upon disease of the heart.

Another group of causes are those which modify the quality of the blood. Thus it may occur as a consequence of anaemia, rickets, and other diseases which are accompanied by impoverishment of the blood, and as a sequel of exhausting acute illness. In Bright's disease hydro cephalus may be a part of the general dropsy induced by the state of the kidney. The fluid in acquired hydrocephalus is usually in the ventri cles. In the rare cases where it is found external to the brain it is some times a consequence of meningeal In the chapter on this subject it was stated that an arachnoid clot becomes after a time, if the child survive, converted into a cyst by the adhesion of the edges of the layer of fibrine—left after absorption of the colouring matter of the blood —to the serous membrane. 'This false membrane, according to Legendre, Rilliet, and others, is formed, as above described, directly out of the blood clot. Virchow, on the contrary, is of opinion that it results from an in flammation of the internal surface of the dura matey, and that the exuded lymph arising from this process becomes vascularised and forms a pseudo serous membrane which is the wall of the cyst.

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