小動物疾病系統

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水腦
作者
謝明瑞;賴政宏;鄭豐邦
中文病名 水腦
英文病名 Hydrocephalus
疾病描述

一、疾病概述

水腦即顱腔內的腦脊髓液增加,造成顱內壓增加而使大腦受到壓迫。依腦脊髓液的堆積位置可分類為堆積於腦室內的內水腦症 (internal hydrocephalus)及堆積在蜘蛛膜下腔的外水腦症 (external hydrocephalus);依照水腦的形成原因可進一步分類為交通性水腦 (communicating hydrocephalus)和阻塞性水腦 (obstructive hydrocephalus),可能為先天性也可能為後天性,先天性較為常見。
交通性水腦在腦室內沒有任何阻塞情況發生,但所有的腦室均擴張,這可能是因為腦脊髓液吸收不良或生產過多所致。而阻塞性水腦則是腦室內因腫瘤、出血或炎症反應而阻塞腦室內的腦脊髓液通路所致,腦室擴張的情況端看受阻的路徑而定,可能為雙側性也可能為單側性。
先天性水腦好發於玩賞犬和短吻犬,被報告過的犬種包括瑪爾濟斯、約克夏、英國鬥牛犬、吉娃娃、博美犬、玩具貴賓、波士頓梗犬、巴哥犬以及北京犬等,因中腦導水管的先天性狹窄或發育不良所致,因骨骼尚未發育完全,會導致顱蓋增大以及頭蓋骨無法癒合,而囟門也常因此有一個小開口。但在許多玩賞犬種中,囟門的開口並不等於水腦的發生。

二、臨床症狀
水腦的臨床症狀包括行為改變、共濟失調以及癲癇發作。先天性水腦常見腹外側的斜視。單側性的病變會造成如迴旋等單側性症狀。急性阻塞性水腦較容易導致顱內壓增加而造成天幕脫疝 (tentorial herniation)。先天性水腦的小狗或小貓其發育會比同窩的同伴遲緩,學習能力也較差。
 

診斷方法

一、腦電波儀
可見到同步的高電位活性 (high-voltage synchronous activity),但仍需以影像學方式做最終診斷。
二、超音波
若囟門很大,可從此區域以超音波進行檢查。優點在於動物不須鎮靜或全身麻醉,可在很年幼的動物進行。
三、電腦斷層掃描 (CT)或磁振造影 (MRI)
磁振造影效果較佳,除能辨識腦室及蜘蛛膜下腔擴張的情況,也能提供是否有潛在病因 (如腫瘤使腦脊髓液回流受阻)或是否同時存在其他疾病 (如腦膜腦炎)。電腦斷層掃描雖對軟組織的敏感度較低,但仍可用來診斷水腦症。

治療方法

成年動物的後天性水腦症必須治療導致水腦的病因。內科療法則以對症療法為主,可給予抗痙攣藥物控制癲癇發作、給予利尿劑嘗試降低顱內壓,症狀可能會有所改善,但疾病仍會繼續進展。
最有效的治療方式為以外科方式置入引流管,將擴張腦室內的腦脊髓液引流至腹腔。

 

預防控制方法

無特殊預防方法。

相關圖片 <p><span style="color: rgb(93, 92, 92); font-family: &quot;新細明體&quot;,&quot;serif&quot;; font-size: 11pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">罹患水腦症的巴哥犬,可見頭頂呈圓形以及兩眼出現腹外側斜視</span><span lang="EN-US" style="color: rgb(93, 92, 92); font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: 新細明體; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">(</span><span style="color: rgb(93, 92, 92); font-family: &quot;新細明體&quot;,&quot;serif&quot;; font-size: 11pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">引自</span><span lang="EN-US" style="color: rgb(93, 92, 92); font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: 新細明體; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;"><a href="http://www.pethydro.org">http://www.pethydro.org</a>)</span></p>
Close<p><span style="color: rgb(93, 92, 92); font-family: &quot;新細明體&quot;,&quot;serif&quot;; font-size: 11pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">罹患水腦症的巴哥犬,可見頭頂呈圓形以及兩眼出現腹外側斜視</span><span lang="EN-US" style="color: rgb(93, 92, 92); font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: 新細明體; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">(</span><span style="color: rgb(93, 92, 92); font-family: &quot;新細明體&quot;,&quot;serif&quot;; font-size: 11pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">引自</span><span lang="EN-US" style="color: rgb(93, 92, 92); font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: 新細明體; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;"><a href="http://www.pethydro.org">http://www.pethydro.org</a>)</span></p>

<p><span style="color: rgb(93, 92, 92); font-family: &quot;新細明體&quot;,&quot;serif&quot;; font-size: 11pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">罹患水腦症的巴哥犬,可見頭頂呈圓形以及兩眼出現腹外側斜視</span><span lang="EN-US" style="color: rgb(93, 92, 92); font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: 新細明體; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">(</span><span style="color: rgb(93, 92, 92); font-family: &quot;新細明體&quot;,&quot;serif&quot;; font-size: 11pt; mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;">引自</span><span lang="EN-US" style="color: rgb(93, 92, 92); font-family: &quot;Calibri&quot;,&quot;sans-serif&quot;; font-size: 11pt; mso-ascii-theme-font: minor-latin; mso-fareast-theme-font: minor-fareast; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: 新細明體; mso-ansi-language: EN-US; mso-fareast-language: ZH-TW; mso-bidi-language: AR-SA;"><a href="http://www.pethydro.org">http://www.pethydro.org</a>)</span></p>


<p>此為MRI影像,圖中顱腔邊緣的白色條狀為腦組織,其餘灰色部分為充滿腦脊髓液的腦腔。(引自<a href="http://www.pethydro.org">http://www.pethydro.org</a>)</p>
Close<p>此為MRI影像,圖中顱腔邊緣的白色條狀為腦組織,其餘灰色部分為充滿腦脊髓液的腦腔。(引自<a href="http://www.pethydro.org">http://www.pethydro.org</a>)</p>

<p>此為MRI影像,圖中顱腔邊緣的白色條狀為腦組織,其餘灰色部分為充滿腦脊髓液的腦腔。(引自<a href="http://www.pethydro.org">http://www.pethydro.org</a>)</p>


參考文獻

1. Johnson KA. Skeletal diseases. In: Ettinger SJ. Textbook of veterinary internal medicine. 7th ed. Saunders Elsevier, St. Louis, 819-845, 2010.
2. Lorenz MD, Coates JR, Kent M. In: Handbook of veterinary neurology. 5th ed. Saunders Elsevier, St. Louis, 368-372, 2011.
3. Selby LA, Hayes HM, Becker SV. Epizootiologic features of canine hydrocephalus. Am J Vet Res 40:411-414, 1979.

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