Ependymoma (ependymatitis; synonymous with apandemic) - inflammation of ependyma brain ventricles. Ependymoma usually occurs as a complication of purulent or meningitis late and insufficient intensity of their treatment. Symptoms of ependymoma always significantly worsens the prognosis of the underlying disease.
Pathological anatomy. The inflammatory process there are two main forms: acute and chronic ependymoma.
In acute ependymoma observed exudative inflammation ependyma (serous, purulent or fibrinous).
In chronic ependymoma inflammation is productive (specific or non-specific).
Macroscopically in exudative form of acute or chronic ependymoma regardless of age the brain is increased in size, convolutions flat, smooth grooves, the ventricles, especially the side, stretched and filled with serous and purulent or fibrinous exudate. Ependyma dull, under ependymal visible damaged vessels and focal hemorrhages.
Serous ependymoma macroscopically difficult to distinguish it from beginning hydrocephalus.
In introducing the fibrinous ependymoma ependyma dim, covered with greenish viscous fluid or grayish-yellow solid films, which are identified necrosis ependyma and hemorrhage; it is often a process extends to the choroid plexus.
Microscopically in acute cases of ependymoma noted desquamation ependymomas epithelium often in the form of layers and clusters of cells. In subependymal matter of the brain is swelling, a plethora of vessels, small extravasate, reasonable proliferation of astroglia.
In introducing the form of ependymoma pronounced leukocytic infiltration of ependyma, blood vessels and subependymal matter of the brain with the development of small lesions melting. Around vessels - proliferation elements glia in the form of clutches and accumulation of neutrophils.
If exudative form of ependymoma have a chronic course (2-3 months), in children of early age (up to 1 year) can be observed deformation of the skull, the divergence of the sagittal and lateral seams. The ventricles are expanding, brain atrophy, gyrus and furrow smoothed. In ventricular cavities to accumulate large amount of thick fluid.
Histological examination ependymomas epithelium flattened sharply, mostly dies, sometimes proliferate, forming small growths.
In subependymal layer of the brain - diffuse the proliferation of mesenchymal cells and glia cells with the formation of nodules, wibehouse in the lumen of the ventricles, sclerosis of vessels to the full obliteration. Developing productive ependymoma nonspecific nature of the so - called ependymatitis granulans. Macroscopically it differs little from the specific.
In specific productive ependimoma, mostly tubercular etiology, macroscopically ependyma sharply thickened, grayish-yellow, coarsely grained with the centers caseous necrosis.
Histological pattern of TB ependymoma is the sum of the changes of superficial and deep character.
When superficial lesions ependyma epithelium places clusen, sometimes there is a proliferation of it with several layers of cells ependyma each other and the formation of a small protuberances well macroscopically visible. Often appear true TB tubercles. Many granulomas in the centre undergo necrosis. Specific bumps in places on the surface of ependyma form a continuous, unbroken chain. In the lumen of the ventricles appear "flocculate", which consists of gross protein mass, cells sladenkogo ependymomas epithelium and macrophages, which settle in the places damaged ependyma.
In subependymal layer of the brain, along with swelling, perivascular lymphoid infiltration expressed rapid proliferation of glia and education of TB bumps.
TB bumps on the surface of ependyma have a mushroom shape, loosely built, often have communication with perivascular infiltrates. Subependymal granuloma more compact.
In the treatment of tuberculous ependymoma antibiotics A. P. Awzen, I.e., Ivanovo noted a marked predominance of productive reaction to Paradise can lead to fusion and education gross adhesions in the cavities of the ventricles.
Heavy changes ependyma, vascular plexuses, education rough adhesions and binding until the complete obliteration of the channels of the brain leads to violation of allocation and absorption of CSF, which is the primary cause of the hydrocephalus.
Clinical manifestations of ependymoma consist of cerebral and local symptoms determined by the level of destruction. Cerebral symptoms when ependymoma depend on substantial violations of proper circulation of cerebrospinal fluid and due to growing hydrocephalus. In patients notes growing headaches, dizziness, weakness, drowsiness. Later joined by repeated vomiting, aetiology, congestive changes in the fundus. The increase in the intensity meningeal symptoms in this period of the disease caused severe intracranial hypertension due ependymoma. Sometimes hypertensive symptoms occur pristupoobrazna and can be combined with clonic or clintonesque convulsions and focal neurological symptoms associated with damage to the ventricles, which indicates a hydrocephalic-occlusive kind of crises. Nature focal symptoms and seizures determined by the level of emerging occlusion. Adhesions when ependymoma is not only a cause of occlusive crises, but may lead to the formation of piacevoli. In these cases, if the puncture ventricle get purulent exudate, while the cerebrospinal fluid obtained by lumbar puncture, not changed. Inflammatory changes when ependymoma in subependymal region also lead to the development of focal neurological symptoms respective ventricle (the so-called ventricular). The stability of this specific symptoms of ventriculitis, and its appearance in the period of Priluka - occlusive crises.
Especially frequent dependibility most of the defeat of III and IV of the cerebral ventricles and selview water.
Defeat the field of III ventricle is fairly constant in tuberculous meningitis. In patients experiencing various symptoms of hypothalamic diseases - violations of different types of metabolism, bulimia, disorders of thermoregulation, early puberty, menstrual irregularities, etc.
When violations of the middle of the brain (cerebral aqueduct) is significant muscle rigidity with sgibateli-leading the arms and razgibatelnyh-leading installing the feet, the muscles of the back - the so-called decerebration rigidity, always greatly disturbing prognosis.
Severe symptoms occur when ependymoma IV cerebral ventricle. Patients appear dizziness, nystagmus, coordination disorder, persistent hiccups, vomiting. Respiratory arrhythmia, blood pressure fluctuations and instability heart rate, pointing to the defeat of the respiratory and vasomotor centers, always dangerous to life. When ependymoma region IV heart can be also defeats located in this area nuclei VI - XII of the cranial nerves. Pathology in region IV heart is always accompanied by a particularly severe hypertensive syndrome and clear stiff neck.
Started in the early periods of intensive treatment of meningitis (see) is the main condition for prevention of ependymoma. When symptoms of ependymoma it is necessary to strengthen anti-inflammatory treatment with antibiotics in combination with dehydration and stimulants.