Del Bigio Marc R, Wilson Marla J, Enno Terry
Department of Pathology, University of Manitoba Manitoba Institute for Child Health, Winnipeg, Manitoba, Canada.
Ann Neurol. 2003 Mar;53(3):337-46. doi: 10.1002/ana.10453.
Chronic hydrocephalus that begins in childhood and progresses only very gradually is sometimes called "arrested" hydrocephalus. Data suggest that this state eventually can become symptomatic and may be treatable by shunting. However, the pathological substrate of the disorder is not entirely understood. We studied chronic hydrocephalus in rats, 9 months after induction by kaolin injection into the cisterna magna, and in humans. In both circumstances, destruction of periventricular white matter structures was worst in those with the largest ventricles. Structures damaged include the corpus callosum, corticospinal tract, and fimbria/fornix projections from the hippocampus. Myelin turnover was increased. These changes were associated with deficits of motor and cognitive function. The cerebral cortex was largely spared. There appears to be a threshold of ventricle size beyond which functional changes manifest, but this undoubtedly is modified by factors such as age of onset and rate of enlargement. These data support the need for persistent follow-up of patients with chronic, apparently stable hydrocephalus. A slight increase in size of already enlarged ventricles might cause significant axonal damage.
始于儿童期且进展极为缓慢的慢性脑积水有时被称为“静止性”脑积水。数据表明，这种状态最终可能会出现症状，且或许可通过分流治疗。然而，该病症的病理基础尚未完全明确。我们对大鼠慢性脑积水进行了研究，这些大鼠在经枕大池注射高岭土诱导9个月后出现脑积水，同时也对人类慢性脑积水进行了研究。在这两种情况下，脑室最大的个体脑室周围白质结构破坏最为严重。受损结构包括胼胝体、皮质脊髓束以及海马发出的穹窿/穹窿柱投射。髓鞘更新增加。这些变化与运动和认知功能缺陷相关。大脑皮层在很大程度上未受影响。似乎存在一个脑室大小阈值，超过该阈值便会出现功能改变，但这无疑会受到发病年龄和脑室扩大速度等因素的影响。这些数据支持对慢性、看似稳定的脑积水患者进行持续随访的必要性。已经扩大的脑室出现轻微增大可能会导致显著的轴突损伤。
