What kind of diagnosis are the consequences of sec. Hemorrhage in a newborn

A subependymal cyst is a structural change in the medulla in the area of the walls of the lateral ventricles, which has the form of a hollow formation with liquid contents. Such cysts can be combined with, give severe neurological symptoms or be asymptomatic.

Typically, cystic changes in the brain are congenital in nature, formed during intrauterine development or during childbirth, so they are found in the practice of neonatologists and pediatricians. Representing a benign formation, they are nevertheless capable of significantly influencing the psychomotor development of the baby, therefore, they require timely diagnosis and dynamic monitoring.

Parents faced with the problem of a subependymal cyst often do not know how to behave with their child and what to do, and pediatric neurologists are in no hurry to reassure, especially in the case of severe hypoxic changes or intrauterine infection. This is due, first of all, to the variability of the course of the pathology, when it is impossible to predict anything in advance.

However, even if the doctor does not provide comprehensive information, and the baby is discharged from the maternity hospital home under the supervision of a local pediatrician and neurologist, there is no need to panic. In some cases, a subependymal cyst resolves on its own during the first year of life or remains forever without having a significant impact on the child’s development.

Why do subependymal cysts appear?

The occurrence of a subependial cyst of the brain is usually associated with factors such as:

Infection with herpes, cytomegaly, rubella, etc. viruses during intrauterine development;
Birth injuries with hemorrhage or necrosis of the subependymal germinal matrix;
Severe during pregnancy or childbirth with severe circulatory disorders in the brain, mainly around the lateral ventricles.

One of the important circumstances contributing to the appearance of a subependymal cyst of the brain is infection with herpes and cytomegaly. Every tenth baby who is exposed to the virus in utero or at the time of birth has certain manifestations of the nervous system. Generalized infection is accompanied by high mortality, reaching 90%, and at least half of surviving infants have profound psychoneurological problems.

The appearance of subependymal cavities during a viral infection is associated with the direct damaging effect of the “aggressor” on the so-called germinal matrix - the nervous tissue around the lateral ventricles. The virus provokes neuronal necrosis, which resolves over the next month with the formation of cavities. The resorption of necrotic masses occurs the slower, the larger the source of damage, and in severe cases it can take several months.

The detection of formed cysts in newborn babies indicates episodes of ischemia and necrosis from the action of the virus during embryonic development, usually at the end of the second and beginning of the third trimester of gestation.

Another possible cause of the appearance of a subependymal cyst is considered with, that is, softening and necrosis, the outcome of which will be the appearance of a cavity. Premature babies and those born with very low weight (one and a half to two kilograms) are especially susceptible to this pathology.

Lack of oxygen during the intrauterine formation of the brain or during childbirth has a very detrimental effect on nerve cells, especially in the tissue surrounding the lateral ventricles due to insufficient blood supply to this area due to the small development of collaterals. Free radical processes, the release of large amounts of acidic metabolic products, and local thrombus formation lead to necrotization and cyst formation around the ventricles.

Subependymal cysts formed after leukomalacia are often multiple, 2-3 mm in diameter, surrounded by denser nervous tissue due to the proliferation of microglia. As they subside during the first months of life, irreversible atrophic changes and the formation of neuroglial nodules occur in the baby’s brain.

Birth injuries and cerebral hemorrhages against the background of hemodynamic and coagulation disorders can also lead to cyst formation. Hematomas can form in any part of the brain, including under the ependyma of the ventricles and in the ventricles themselves. Resorption of the spilled blood ends with the appearance of a cavity, which, if appropriately localized, will be called a subependymal cyst.

Manifestations of subependymal cysts

Subependymal cystic cavities, detected by ultrasound, have clear contours, spherical or slit-like shape, their sizes range from a few millimeters to a centimeter or more. Sometimes cystic transformation resembles a honeycomb due to the multiplicity of lesions. Experts associate the different structures of cysts with their detection at different stages of pathological development, when some of the cavities are relatively fresh, while others are already undergoing the process of resorption and “healing.”

subependymal cyst on ultrasound

Subependymal cysts can be located symmetrically, only on the right or left, in the area of the middle sections or horns of the lateral ventricles. The stronger the hypoxia experienced, the greater the volume of brain tissue that will be damaged. If the baby has a hemorrhage, then a single cavity filled with clear cerebrospinal fluid may subsequently be detected.

During the first year of life, the subependymal cyst shows a tendency to decrease in size and even completely disappear, while it is possible to both maintain the normal size of the sections of the lateral ventricles and increase the volume of their bodies or anterior horns. In rare cases, it is possible to observe the growth of a cystic formation, which can provoke compression of surrounding tissues and disruption of liquor dynamics.

The symptoms of a subependymal cyst on the left or right are variable, they can be either absent or quite severe, which is determined by the size, number and location of the cavities, as well as their combination with other lesions of the brain tissue. Small cysts or a single small cavity may not manifest themselves in any way, not change the baby’s development and not cause any concern. In most cases this is what happens.

Concerned parents can read a variety of information, usually from Internet resources, in which the symptoms will include both visual and motor disturbances, however, the small cavities located under the ependyma (lining) of the ventricles are unlikely to somehow affect the corresponding brain structures, therefore, such judgments should be treated critically, without panicking and trusting only the opinion of a pediatric neurologist.

With large, multiple or growing subependymal cysts that appear against the background of large ones, it is possible to disrupt the function of the corresponding parts of the nervous tissue with neurological symptoms, however, such events develop extremely rarely and are usually based on a combined lesion of the central nervous system. Possible signs of trouble are:

Sleep disorders, causeless crying, anxiety;
Anxiety, hyperexcitability of the baby or, conversely, lethargy and lethargy;
Tendency to muscle hypertonicity, in severe cases - hypotension and hyporeflexia;
Poor weight gain, weak sucking reflex;
Visual and hearing impairments;
Tremor of arms, legs, chin;
Severe and frequent regurgitation;
Pulsation and bulging of the fontanelle due to intracranial hypertension;
Convulsive syndrome.

These symptoms can be expressed to varying degrees. As cysts are reabsorbed, they often weaken and even disappear by the end of the first year of life, but in severe cases, delays in mental and motor development, stunted growth of the child, and problems with speech and learning become noticeable.

A subependymal cyst, which appears against the background of leukomalacia of the periventricular nervous tissue, can have cerebral palsy, convulsive syndrome, and mental retardation as the most severe consequences.

Problems with child development are most often recorded with brain damage combined with other signs of a generalized infection. In these cases, malformations of other organs, viral pneumonia and even sepsis are often diagnosed after childbirth.

The prognosis when subependymal cysts are detected is often uncertain, which is why doctors do not rush to premature conclusions. Both normal brain development and serious neurological deficits with combined pathology are possible. Children often exhibit polymorphic symptoms - from severe depression of the central nervous system to hyperexcitability.

In some cases, normally developing infants exhibit some signs of immaturity of the nervous system in the form of transient and short-term tremor of the chin or limbs, restlessness, and regurgitation. It is difficult to associate these symptoms with small subependymal cysts, but children are under the close attention of specialists.

Diagnostics

Diagnosis of a subependymal cyst in a newborn baby is made using ultrasound in the first days after birth. An open large fontanelle allows you to clearly visualize structural changes without harming the baby. After the fontanel is closed, an MRI is prescribed. Examinations are carried out regularly throughout the first year of life to monitor the dynamics of cysts.

Ultrasound of the brain

If a herpetic or cytomegalovirus infection is present or suspected, additional tests are performed to verify the diagnosis and decide on further treatment tactics - immunological diagnostics.

The complexity and high cost of immunological research do not allow them to be carried out even in large cities, and in small towns they are completely unavailable. In addition, an immunologically confirmed diagnosis of a viral infection does not provide information about the nature of brain damage, so it is most rational to perform echoencephalography, which shows the degree and nature of brain damage, but at the same time is safe for newborns.

Treatment

Treatment tactics for subependymal cysts depend on the severity of the pathology. These may be resuscitation measures in case of dysfunction of vital organs in the early postpartum period. Newborns born in conditions of deep hypoxia may require artificial ventilation, correction of biological blood constants through infusion therapy, and detoxification measures carried out in pediatric intensive care.

In cases where there is no threat to life, but there are signs of brain damage, drug therapy is prescribed:

and drugs that improve metabolism in nervous tissue - piracetam, pantogam, nicergoline;
Vitamins and minerals - B vitamins, ;
at risk of cerebral edema or the development of intracranial hypertension (diakarb);
Anticonvulsants for seizures (carbamazepine, depakine).

The need for this kind of prescription arises quite rarely, with severe and combined brain lesions, and then the cause of treatment is, rather, not a subependymal cyst, but more severe disorders. More often, young patients only need physiotherapy, massage, water activities, as well as parental care and warmth.

When children are infected, immunotherapy with immunoglobulin preparations is indicated - Cytotect, pentaglobin, as well as antiviral agents (Virolex), which give a good therapeutic effect in an absolute number of cases.

An asymptomatic subependymal cyst does not require treatment; only dynamic observation is sufficient - periodic examinations by a neurologist, ultrasound control, and after closure of the fontanelle - MRI. In some cases of asymptomatic cysts, doctors still prescribe a variety of drugs such as nootropics and vitamins, although in such cases their use is usually poorly justified.

If parents doubt the need for treatment, looking at a well-growing and apparently healthy baby, then it is better to consult with other specialists, and only after that decide whether or not to follow the prescribed treatment regimen for asymptomatic cysts.

Brain pathologies can occur during the period of intrauterine development of the fetus, which is associated with the lifestyle and habits of the mother, as well as the presence of various chronic diseases, the characteristics of pregnancy, and the penetration of infection into the body. The condition of the newborn is also affected by the phenomenon in which an insufficient amount of oxygen reaches his brain. Brain cysts in newborns are quite common and are a factor influencing the development and condition of the body. These neoplasms are not tumorous in nature and do not pose a direct threat to the child’s life. However, the danger of cysts is that they compress the surrounding healthy brain tissue, which causes mental and physical disorders. In addition, these neoplasms do not show any signs for a long time, and during puberty they begin to actively grow, which leads to a deterioration in health.

Brain cyst occurring in a newborn , called a fluid-filled volumetric structure (spherical cavity), which replaces dead areas of the brain and can be located in any part of this organ. It can be both single and multiple. This pathology is common and is diagnosed in approximately 40% of newborns.

A cavity with fluid located in the brain area can form in the fetus in the womb or after the birth of the child. Sometimes it becomes so small that it does not affect the child’s condition in any way, and the neoplasm itself resolves on its own over time. But, if the cysts are numerous and large in size, children experience delayed psychomotor development, slow growth, poor weight gain, and deterioration in visual function.

Dr. Komarovsky will talk about the causes and treatment of the disease in children:

After childbirth, examination for the presence of a scalp cyst in a newborn is mandatory in the following cases:

If there was a birth injury;
If the mother was infected with a herpes infection during pregnancy;
If the pregnancy proceeded with complications (large fetus size, oligohydramnios).

If the cyst is single and small in size, timely treatment begins to guarantee a favorable outcome. Otherwise, the consequences become irreversible: the child lags behind in physical and then sexual development, suffers from hearing and vision impairment. There is a high risk of disability, and in the most severe cases, death occurs.

Reasons for formation

A brain cyst in a child is formed under the influence of factors such as:

Injuries received during or after childbirth;
Past infectious diseases that affected the central nervous system (encephalitis, meningitis);

Congenital anomalies of the central nervous system;
Insufficient blood supply to the brain, resulting in hypoxia - oxygen deficiency;
The presence of the herpes virus in the body of the mother carrying the fetus.

All of these reasons contribute to the degeneration of brain tissue, its death and the formation of empty space, which is filled with fluid. This is a cyst.

Intensive growth of brain cysts in infants is observed in the case of progression of inflammatory or infectious diseases, as well as with severe head contusions and traumatic brain injuries.

Types of brain cysts in children

Depending on what part of the organ the cyst is localized in a newborn, the following types of this formation are distinguished:

Subependymal cyst. It is also called intracerebral or cerebral. It occurs in children as a consequence of hypoxia and prolonged circulatory disorders in the vessels of the brain. Usually, pathology appears during the period of intrauterine development if the fetus has acute or moderate hypoxia, which develops as a result of infectious diseases, anemia, and Rh conflict. Other reasons for the appearance of a cyst are hemorrhage. Most often, the neoplasm is located in the ventricular and occipital regions, cerebellum, temporal lobe, and pituitary gland. This is the most dangerous type of neoplasm: a cyst of the ventricle of the brain or other internal structures, if left untreated, leads to dysfunction of the central nervous system, disability and even death;

The arachnoid form of pathology is formed in the space of the arachnoid membrane of the brain

. The presence of this neoplasm is usually not expressed in specific symptoms. The cyst occurs between the membranes of the brain, on the surface of the organ (the so-called arachnoid membrane). It is a collection of cerebrospinal fluid. This type occurs infrequently, in only 3% of cases. The cyst quickly increases in size, squeezing surrounding tissues and sections. However, it has a more favorable prognosis than a subependymal cyst, but if left untreated it leads to a child’s retardation in psychomotor development;

Choroid plexus cysts of the brain, also called pseudocysts. Additionally, this neoplasm is referred to as a retrocerebellar cyst. It develops during the period of intrauterine development. Experts believe that such a congenital cyst is a relatively normal phenomenon, since it resolves on its own as the fetus grows.

If the pathology develops without treatment, it is fraught with the following complications:

Impaired functioning of the vestibular apparatus;
Hearing and vision loss;
Mental retardation;
Convulsive syndrome;

Loss of coordination and gait;
Stroke;
Deformation of the skull;
Paralysis and paresis.

Clinical picture

If a cyst localized in the brain area is limited in size and does not increase in size, there are no specific signs of pathology in infants. The only features that parents can note are bulging fontanel and pulsation in it, the baby’s refusal to breastfeed or bottle, frequent and profuse regurgitation, delayed mental and motor development, and lack of response to sounds.

When the fluid cavity grows and puts pressure on surrounding tissues and structures, the clinical picture becomes more pronounced. Typical symptoms of a fluid-filled cavity in the brain include the following:

Visual impairment, which manifests itself in blurred images, double vision and spots before the eyes;
Insufficient physical development;
Delayed sexual development;
Coordination problems;
Convulsions;
Numbness of the upper and lower extremities;

Fainting conditions;
Sleep disturbance;
Strong pulsation in the head area;
Nausea, vomiting;
Partial paralysis of the limbs;
Trembling of limbs.

The intensity and prevalence of certain symptoms depends on which part of the brain the fluid-filled cavity is localized in. For example, the (epiphysis), an organ that is responsible for the production of melanin and serotonin, has pronounced symptoms only if the formation reaches a large size. This type of cyst manifests itself in headache attacks that can last several days, epileptic seizures, visual disturbances, and delirious states.

Large cysts in the cerebellum of the brain provoke seizures, tremors, deterioration in coordination of movements, paralysis and paresis of the upper and lower extremities, and the development of hydrocephalus.

Methods for diagnosing and treating cysts

Brain cysts in newborns do not always require treatment, but in all cases medical supervision is required.

To make a diagnosis and identify the type of neoplasm, the following measures are carried out:

MRI and ultrasound of the brain to determine the location of the cyst and its size;
Laboratory examination of cerebrospinal fluid to identify infection and inflammation;

- the main diagnostic method with which the brain structures of a newborn are examined. Access for research is an open large fontanelle, so this procedure is only relevant for children under 2 years of age in whom this opening has not yet ossified;
Histology is a method by which one can evaluate the nature of a neoplasm and differentiate it from malignant tumors.

Treatment of the pathology depends on how large the size of the cyst is and where it is located. If growth of the tumor is not observed, the patient is prescribed medications that can correct the child’s condition. So, if the cause of the formation of a cavity is a violation of blood circulation in the vessels of the brain, the use of appropriate medications is prescribed. If it is necessary to stop the infectious process, antibacterial agents are prescribed.

In special cases, surgery is required. The conditions for this are:

Hydrocephalus;

Neurosurgeon, MD, tells us more about the pathology. Fayad Akhmedovich Farhad:

Increased intracranial pressure;
A sharp disturbance in movements and coordination;
Cramps.

If there is a cyst in a baby, the following types of operations are performed:

Radical. In this case, craniotomy is performed and the cystic tumor is completely removed. The manipulation is effective, but is characterized by a high degree of trauma;
Endoscopic, the most gentle. During surgery, a puncture is made through which the endoscope is inserted. Next, the contents of the formed cavity are removed;
Cyst shunting. Its contents are drained through a drainage tube. The cyst is not completely removed.

If appropriate measures are not taken in a timely manner, the formation may burst. This is fraught with the following consequences:

Blood poisoning;
Bleeding inside the skull;
An inflammatory process caused by the entry of purulent contents into the cerebrospinal fluid;
Complete paralysis;
Death.

Brain cysts in a newborn are a common diagnosis. This pathology is quite rarely fatal, but in some cases it can lead to serious developmental disorders and disability. This condition requires constant monitoring by a specialist, and, if necessary, surgical intervention.

Brain cysts in newborns are quite common; many parents may not even know that their child has this disease.

According to statistics, about 40% of children born are born with this disease, but there is no need to panic ahead of time, because many cysts will resolve over time and will not require any special treatment.

The cyst itself is a definite formation that is filled with fluid. It can appear not only after the birth of a child, but even in the womb.

In the latter case, there is no reason to worry, because this kind of formation will disappear on its own over time.

Reasons for education

The reasons for the appearance of a brain cyst in a newborn can be very diverse, now let’s try them figure out:

As mentioned above, a cyst can appear in a child in the womb. This is considered normal, since during some periods of pregnancy these formations can appear and disappear quickly, so you should not worry about this.
A child may also develop a cyst due to infection. This can be observed during a difficult pregnancy or difficult childbirth. Often the appearance of a cyst can be triggered by the presence of the herpes virus in the mother’s body.
Another reason that provokes the appearance of this disease is poor blood supply to the newborn’s brain, which can lead to tissue death and, as a result, to the formation of a cavity filled with fluid.
A cyst can also appear after illnesses, for example, meningitis,.
Also, any injury can cause a brain cyst to appear in a newborn.

Classification by type of cyst in newborns

Classification of a brain cyst is made based on its location or the period of life in which it formed. The main types of brain cysts are: baby:

One of the most severe forms of this disease is subependemic cyst. May appear due to cerebral hemorrhage or due to oxygen deprivation. Often, the cyst can disappear on its own, so it does not require serious treatment in the future. But otherwise, urgent surgery is necessary. Of course, with proper monitoring of the child and implementation of preventive measures, such measures will not be required.
Arachnoid cyst- this is a formation that can be located in the arachnoid membrane of the brain, mainly filled with cerebrospinal fluid. There are two main types of cysts: primary and secondary. Most often, such cysts occur in boys. The cause of the formation may be a previous inflammatory disease, head injury or hemorrhage in the brain. A distinctive feature of this type of cyst is its rapid growth, which can lead to some complications. But with timely treatment, this will not affect the further development of the child.
Retrocerebral cyst– This is one of the most common types of education. Can lead to necrosis of brain cells or complete disruption of its functions. It may appear due to surgery in the skull area, insufficient blood circulation in the brain, injuries or a stroke.

Symptoms and signs

Symptoms of a brain cyst in newborns can be quite varied; this primarily depends on the location of the cyst, so first you should understand the location of this pathology.

If during diagnosis it is found that the cyst is located in the back of the head, then most often the functioning of the optic nerve is disrupted, which leads to such symptoms:

double vision;
a veil before the eyes;
blur;
spots before the eyes.

If it is discovered that the cyst is located in the area of the pituitary gland, then this type of symptoms:

violation of sexual development;
poor coordination;
poor physical development.

But the cyst is also characterized by other symptoms that appear in all cases, This:

Strong headache;
strong pulsation of the head or other parts of the body;
high blood pressure;
loss of consciousness;
hearing disorders;
convulsions;
partial paralysis of the limbs;
nausea;
vomit;
fatigue;
lethargy;
increased drowsiness.

Diagnostic methods

During the period of scientific and technological progress, medicine does not stand still, therefore, even in such a delicate issue as the diagnosis of cysts in newborns, a large number of developments and discoveries have been made that can identify this disease even in the first days of a child’s life.

In children under one year of age, it is quite easy to detect a brain cyst using ultrasound, since this is facilitated not only by the child’s fontanel not being overgrown, but also by the fact that the bones of the skull have not yet become stronger and have not closed.

You can also conduct studies such as and CT. But they are most often used to find out more accurate information about the size and location of a given cyst.

Don't forget about Ultrasound brain of a newborn, if there is a suspicion that a cyst has formed, this examination is primarily prescribed for premature infants or in cases of rather complicated childbirth.

This is explained by the fact that such children, first of all, need intensive treatment due to the fact that their body is very weak and cannot fight diseases on its own.

Treatment of the disease

If a newborn has been diagnosed with a choroid plexus cyst, then there is no reason to panic, because these formations will disappear over time.

But this doesn't mean you shouldn't do anything. First of all, it is necessary to determine the infection which caused this disease, do not forget to undergo an ultrasound scan every 2 months.

Concerning subependymal cyst, then she also does not need any special treatment. After a certain period of time, this problem will disappear, but do not forget about systematic visits to the doctor and undergoing an MRI a couple of times a year.

The most dangerous is arachnoid cyst, since it develops and progresses very quickly, and also provokes the appearance of various disorders. Unfortunately, these types of cysts will not resolve on their own, so they only need to be treated. There are two ways to get rid of such a formation: conservative or radical treatment.

Conservative treatment includes taking medications, which can eliminate the cyst and relieve the most severe symptoms. These can be antiviral drugs, antibacterial drugs, as well as drugs that improve blood circulation and immune function of the body.

Most often, radical therapy is used, which consists of surgical intervention through craniotomy and endoscopy.

Be careful, video of the operation! Click to open

Parents should remember that treating a cyst in a newborn with folk remedies is strictly prohibited, because this can lead not only to complications, but even to death.

Prognosis and mortality

If this disease was diagnosed on time and the correct treatment was prescribed, then there is no reason to worry.

But in advanced cases or rapid growth of the cyst, there can be quite serious consequences, so in such situations everything depends on the effectiveness of the treatment performed.

If you do not consult a doctor in a timely manner, the following may occur: consequences:

inflammation of the brain;
disruption of the normal functioning of the organs of the motor system;
sudden death.

Prevention

In the initial stages, prevention should be carried out with the expectant mother. That is, take the necessary genetic tests to determine whether there is a possibility of a cyst forming in the child.

Also during pregnancy and during the first months of life various traumatic situations must be avoided, inflammatory diseases, if this happens, you should immediately consult a doctor, and the sooner you do this, the better.

For women, motherhood is the greatest happiness, and it is good when nothing overshadows it. But sometimes it happens that cloudless dreams are clouded by worry and anxiety.

Quite often from the lips of young mothers you can hear the diagnosis: “brain cyst in a newborn.” A scary name, isn't it? Ten years ago, almost no one had heard of this phrase, but now approximately 40% of children are born with a cyst. Let's try to find out what kind of formation this is and how to treat it.

Causes of brain cysts

A cyst is a cavity, a bubble that is filled with fluid. A cyst can appear anywhere in the brain; it occurs in the form of multiple or single formations on one or both sides of the brain.

Choroid plexus cysts sometimes diagnosed during the development of the fetus in the womb. In such cases, there is no need to worry prematurely: just as they appeared, they disappear completely on their own. This phenomenon is considered normal because it appears at a certain stage of pregnancy.

Their formation at a later stage, after the baby is born, is associated with damage to the fetus by infection or a complicated course of pregnancy and childbirth itself. Quite often the cause is the herpes virus.

Subependymal cyst is considered a more serious pathology. Such a cyst in a newborn requires special monitoring of its development. The cause is considered to be insufficient blood circulation in the area of the ventricles of the child’s brain. Tissues die as a result of lack of oxygen, and a cavity may form in their place.

Another pathology associated with the brain, and in particular its arachnoid membrane, is arachnoid cyst, which can have various shapes and sizes and is formed anywhere. What is the reason for its appearance? The exact reason has not yet been established.

In children, a cyst can occur as a result of meningitis or another inflammatory process, trauma or hemorrhage. As a rule, it does not penetrate the ventricles of the brain. It should be taken into account that the cyst is characterized by further development, and over time it acquires large sizes, beginning to compress the nearest areas of the brain.

Diagnosis of the disease

In newborns up to one year old, the cyst is easily diagnosed using ultrasound. This is the most favorable time for this procedure, since the fontanel has not yet completely closed.

Brain cyst in newborns / shutterstock.com

Who is such a diagnosis indicated for?

Neurosonography (ultrasound of the brain) is especially necessary for premature babies. It is advisable to carry it out in a newborn if, for certain reasons, he needs intensive care, or immediately after his birth, doctors were forced to resort to resuscitation measures.

If a subependymal cyst has been identified, it will be necessary to carry out an MRI or MRI diagnosis several times a year. Their course is considered favorable, but the consequences can be quite serious if the cystic cavity subsequently enlarges and the fluid pressure in it increases.

In a newborn, a large brain cyst begins to change the position of surrounding tissues and compress them. This manifests itself in the child as convulsive seizures, and they are progressive in nature. Neurological symptoms increase, the general condition worsens. In addition, this process can be aggravated by hemorrhagic stroke.

An arachnoid cyst requires special attention; here it is necessary to take radical measures; it will not disappear on its own. A child with such a defect in brain development should be constantly monitored by a neurologist.

According to indications, he will undergo surgery. One of the available methods for removing brain cysts in newborns will be recommended: microneurosurgery, endoscopic or bypass surgery.

Brain hemorrhage in newborns is a serious pathology that develops as a result of damage to the vessels of the dura mater or rupture of a cerebral vessel. This often happens with birth injuries. According to statistics, intracranial hemorrhage (ICH) occurs in 1 in 1000 cases in full-term infants. However, very premature babies born weighing less than 1.5 kg suffer much more often - hemorrhagic cerebral bleeding occurs in 20-45%.

The consequences of cerebral hemorrhage in newborns are always unfavorable, as they are fraught with complications such as neurological pathologies, hydrocephalus, cerebral palsy, cerebral edema, impaired vision, motor activity, speech apparatus, and even death. It all depends on the degree of hemorrhage, its location, the general condition of the baby and the compensatory abilities of the brain.

Causes

As we have already found out, very premature infants or full-term infants who have a history of intrauterine growth retardation are most at risk of developing pathology.

One of the first reasons can be considered chronic fetal hypoxia at 26-34 weeks of pregnancy. The fact is that during this period the periventricular space is literally penetrated by a large number of vessels, which play an important role at this stage, but over time cease to be functional. If complications arise and there is a lack of oxygen during these weeks, hemorrhages may form, which will worsen during childbirth under the influence of mechanical pressure.

Other causes of cerebral hemorrhage are:

lack of vitamin K and K-dependent factors, other anomalies associated with the coagulation process (blood clotting);
pathologies due to severe hypoxia: acidosis, too strong activation of fat peroxidation, low blood pressure;
intrauterine infections with viruses, mycoplasmas that contribute to the destruction of vascular walls;
chronic maternal diseases (for example, diabetes);
the influence of a woman’s harmful habits (tobacco smoking, alcoholism);
injuries during childbirth due to the narrow birth canal and large fetal head, during rapid labor, caesarean section;
use of obstetric aids (vacuum extraction of the fetus, obstetric forceps).

Types and extent of damage

The brain, like our other organs, has an impressive network of blood and lymphatic vessels, small and large, that deliver oxygen to it and protect the brain center from germs and viruses. The skull is covered on top with a hard shell, called “dura mater” in Latin. If the hemorrhage occurs under this membrane, it is called subdural, if between the membrane and the skull, it is called epidural.

This is followed by the arachnoid (in medicine, arachnoid) and pia mater. Between them there is a subarachnoid space filled with cerebrospinal fluid (CSF). The cavities that are filled with cerebrospinal fluid are called ventricles.

Subarachnoid hemorrhage is said to occur when a vessel ruptures in the space between the arachnoid and soft membrane. If blood fills one or more ventricles, we are talking about intraventricular hemorrhage (hereinafter abbreviated as IVH). Another epithelial layer that protects the brain is called ependyma. Rupture of the vessel in this area leads to subependymal hemorrhage.

The degree of severity is judged depending on which part of the brain or its membrane is damaged and how extensive its damage is:

1st degree of severity - subependymal hemorrhage (hereinafter abbreviated as SEC);
2nd degree - blood partially or completely penetrates the lateral ventricle, but does not change its size;
3rd degree - the ventricle, filling with blood, increases in size;
4th degree - blood fills the ventricles, expanding them, and goes beyond them, entering the substance of the brain in newborns.

According to the ICD-10 classification, hemorrhages are divided as follows:

subependymal;
IVH without penetration into the brain parenchyma (tissue);
IVH with penetration into the brain parenchyma.

Various diagnostic formulations sometimes confuse the correct diagnosis, so when deciding on a treatment regimen, the doctor is guided by the results of an ultrasound, MRI or X-ray examination.

Signs of a brain hemorrhage do not always appear immediately. The pathology may be asymptomatic for the first day

Symptoms

The clinical picture, depending on the location of the vascular damage, will differ slightly, but in general, the characteristic signs of hemorrhage in an infant are identified:

a sharp deterioration in condition, symptoms of hyperexcitability are replaced by signs of depression;
the fontanel swells greatly and is tense;
the strength and nature of the baby’s cry changes;
seizure activity;
peripheral circulatory disorders, rapid heartbeat, frequent regurgitation, weight loss, increased gas formation, shortness of breath, apnea;
anemic syndrome, decreased hemoglobin in the blood;
an increase in ketone bodies and bilirubin in the blood, which poisons the body with toxins;
development of renal and cardiovascular failure;
the addition of a secondary infection, as a result of which the development of sepsis, meningitis, and pneumonia is possible.

Now let us characterize the clinical picture in individual situations:

SEC

One of the most common forms of hemorrhage. SEC does not have any specific symptoms. Its most important manifestation is considered to be repeated attacks of apnea in the first days of a newborn’s life. The diagnosis is made only after neurosonography.

Indirect signs of the disease are expressed in moderate tilting of the head, muscle weakness of the arms of the first or second degree, Graefe's symptom along with increased mobility of the eyeballs and symptoms of mild depression/excitement. As a result of SEC, a cyst often forms.

Intraventricular hemorrhage in newborns

With hemorrhage into the ventricles of the brain of grades 1 and 2, there are no visible symptoms and can pass without the development of neurological pathologies. However, in more severe cases, swelling of the fontanelles, convulsions, and disruptions in breathing and the cardiovascular system are observed. Then lethargy sets in, reflexes and motor activity are inhibited, and the head may increase in size.

All this occurs due to an increase in fluid volume, a sharp increase in intracranial pressure and, as a result, swelling of the brain and compression of the nerve centers responsible for various functions in our body.

If blood ruptures from the lateral ventricles into the brain tissue, the hemorrhage is identified as parenchymal

Epidural and subdural

Simply put, it is a hematoma, a bag of accumulated blood between the skull and the dura mater. In children it develops due to mechanical pressure during childbirth. The symptoms have 2 phases: convulsions and a decrease in all reflexes and organ functions until loss of consciousness, then “clearance” occurs.

With subdural hemorrhage, the picture is almost the same, so differences are made only with the help of diagnostic methods.

Subarachnoid

As in previous cases, the clinical picture is very variable. For the first 2-3 days there may not be any visible disturbances. Then the processes of excitation/depression alternate. Even with the development of seizures in the intervals between them, the child looks completely healthy. The prognosis and need for treatment will again depend on the extent of the lesion.

Diagnosis and treatment

The diagnosis is made based on the results of ultrasound examination through the fontanel and computed tomography, as well as based on blood tests.

Treatment of the acute phase is carried out in special conditions while maintaining the desired temperature and ventilation. Therapy is aimed at reducing intracranial pressure and reducing brain swelling. At the same time, it is necessary to maintain cerebral blood flow.

Using CT, you can see the extent of hemorrhage and its location

If this treatment does not produce results, surgical intervention is indicated: bypass surgery.

Separately, I would like to say about hemorrhage in the adrenal glands in newborns. In severe cases of hypoxia or improper management of labor, adrenal hemorrhages are possible, which, if not treated in time, lead to death. If such a pathology is detected, treatment is aimed at compensating for adrenal hormone deficiency, increasing blood pressure, anti-shock therapy, restoring water and electrolyte balance and fighting infection, if any.

Prevention

It is impossible to calculate everything down to the smallest detail and be safe from all diseases. Therefore, in this situation, prevention comes down to treating your pregnancy responsibly, getting examined by a gynecologist on time and, if necessary, receiving treatment. It is in our power to choose a maternity hospital and a doctor for childbirth whom we trust. But the process of childbirth is sometimes so unpredictable that you don’t know what complications may arise. Therefore, it is also important for parents to remain calm, not to stress themselves out, and after the baby is born, to provide him with proper care.