Experimental and clinical studies on the damage of the brain parenchyma in the disturbance of the cerebrospinal fluid hydrodynamics.

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The influence of the disturbance of cerebrospinal fluid dynamics on the damage of the brain parenchyma and the mechanism of hydrocephalic symptoms were studied on the basis of the clinical findings and the experimental investigations. In experimental studies using hydrocephalic models produced by injection of kaolin into the cisterna magna of rabbits and dogs, content of the free water increased and that of the found water decreased in the periventricular white matter at the acute and subacute stages of hydrocephalus. At these stages content of both free and bound water did not change in the cortical gray matter. The ratio of the free to bound water content recovered near the control values. The energy metabolism was deranged in the periventricular white matter at both acute and subacute stages and recovered near the normal state at the chronic stage. In clinical studies the cerebral blood flow of the supratentorial structures decreased in all stages of hydrocephalus. There was also a disturbance of hemodynamics of the cerebellum as a remote effect. There was a recovery of hemodynamics of the cerebrum as well as the cerebellar structures after cerebrospinal fluid shunting. It is suggested from the result of experimental and clinical studies that increase in free water content in the periventricular white matter may produce disturbance of the cerebral energy metabolism and the cerebro-cerebellar blood flow. As a result of these morphological and functional disturbances the clinical symptoms and signs of hydrocephalus may occur.