Miscellaneous

Intracranial Hypertension: Symptoms, Treatment.

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Intracranial hypertension - is increased pressure in the skull. Intracranial pressure (ICP) - a force with which the intracerebral fluid pressure on the brain.

His improvement is usually caused by the increase in the cranial cavity contents (blood, cerebrospinal fluid, tissue fluid, extraneous tissue). ICP may periodically increase or decrease due to changes in environmental conditions and the need to adapt the body to them. If its high values ​​are stored for a long time, the syndrome is diagnosed intracranial hypertension.

The causes of the syndrome are different, most often congenital and acquired diseases. Intracranial hypertension in children and adults developed hypertension, edema of the brain, tumors, traumatic brain trauma, encephalitis, meningitis, hydrocephalus, hemorrhagic stroke, heart failure, hematomas, abscesses.

What it is?

Intracranial hypertension - a pathological condition in which the pressure rises inside the skull. That is, in fact it is nothing like increased intracranial pressure.

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basic concepts

Intracranial pressure is the pressure difference in the cranial cavity and atmospheric pressure. Normally, this indicator in adults ranges from 5 to 15 mm Hg. The pathophysiology of intracranial pressure is subject to the doctrine of Monroe-Kelly.

The basis of this concept is based on a dynamic balance of three components:

  1. brain;
  2. Cerebrospinal fluid;
  3. Blood.

Changing the pressure level of one of the components should lead to compensatory transformation others. This is mainly due to the properties of the blood and cerebrospinal fluid to maintain the constancy of the acid-base balance, that is, to act as a buffer systems. Besides brain tissue and blood vessels possess sufficient elasticity, which is an additional one for the conservation of this balance. Due to such protective mechanisms and normal pressure is performed to maintain inside the cranium.

If any reason causing breakdown of the regulation (the so-called conflict pressures), there intracranial hypertension (ICH).

In the absence of focal causes syndrome (e.g., at a moderate hyperproduction CSF with little or venous distsirkulyatsii) formed benign intracranial hypertension. Once this diagnosis is present in the International Classification of Diseases ICD-10 (G93.2 code). There is a slightly different concept - "idiopathic intracranial hypertension." At this state, the etiology of the syndrome set and can not be.

Causes of

In most cases, increased intracranial pressure occurs because of a violation of the circulation of cerebrospinal fluid (CSF). This is possible by increasing its production, infringement of its outflow, the deterioration of its absorption. Circulatory disorders are the cause of poor inflow of arterial blood and venous stasis in her department, which increases the total blood volume in the cranial cavity, and also leads to increased intracranial pressure.

In general, the most common causes of intracranial hypertension may be:

  • tumors of the skull cavity, including metastasized tumors at other sites;
  • inflammation (encephalitis, meningitis, abscess);
  • congenital malformations of the brain structures, vessels of the skull (imperforate outflow tract cerebrospinal fluid, Arnold-Chiari anomaly and so on);
  • traumatic brain injury (concussions, contusions, intracranial hematoma, birth injuries, etc.);
  • acute and chronic cerebral circulatory disorders (stroke, thrombosis dural sinuses);
  • diseases of other organs, which lead to difficulty venous outflow of blood from the cranial cavity (heart disease, obstructive pulmonary disease, neoplasm neck and mediastinum, etc.);
  • poisoning and metabolic disorders (alcohol poisoning, lead, carbon monoxide own metabolites such as liver cirrhosis, hyponatremia, and so on).

This, of course, not all possible situations that lead to the development of intracranial hypertension. We would like to say about the existence of the so-called benign intracranial hypertension, increased intracranial pressure when there is, as it were gratuitously.

symptoms

Formation of clinical hypertension syndrome, the nature of its manifestations depend on the localization of the pathological process, its prevalence and speed of development.

Intracranial hypertension syndrome manifested by symptoms in adults:

  1. Head of increased frequency or severity of pain (increasing headache) sometimes awakening from sleep, often forced position of the head, nausea, recurrent vomiting. It can be complicated by a cough, micturition and defecation, similar to the Valsalva maneuver actions. Possible disturbance of consciousness, seizures. With long-term existence join visual impairment.
  2. The history can include trauma, ischemia, meningitis, cerebrospinal fluid shunt, lead intoxication or metabolic disorders (Reye syndrome, diabetic ketoacidosis). Neonates with hemorrhage into brain ventricles, meningomyelocele or have a predisposition to intracranial hydrocephalus. Children with a blue heart disease are predisposed to abscesses in children with sickle cell disease can be detected by a stroke, leading to intracranial hypertension.

Objective evidence of intracranial hypertension are papilledema, increased pressure cerebrospinal fluid, increasing the osmotic pressure of the limbs, typical radiographic changes skull bones. It will be appreciated that these features do not appear immediately, and after a long time (except elevation of cerebrospinal fluid pressure).

Also produce symptoms such as:

  • loss of appetite, nausea, vomiting, headache, drowsiness;
  • inattention, decreased ability to wake up;
  • papilledema, paresis lookup;
  • increased tone, a positive Babinski;

With a significant increase in intracranial pressure may be disturbance of consciousness, seizures, visceral-autonomic changes. When dislocation and impaction stem brain structures arise bradycardia, respiratory failure, decreases or disappears pupil reaction to light, increases systemic blood pressure.

Intracranial hypertension in children

The children are two types of pathology:

  1. Syndrome increases slowly in the first months of life, when fontanels not closed.
  2. The disease develops rapidly in children after a year, when sutures and fontanelles closed.

In children up to a year because of open cranial sutures and fontanelles symptoms usually unexpressed. Compensation is due to the opening of joints and springs and increased head.

For the first type of pathology is characterized by the following features:

  • vomiting occurs several times a day;
  • the baby does not sleep;
  • diverge cranial sutures;
  • the child often and long crying for no reason;
  • fontanels swell, throbbing in them will not be heard;
  • under the skin veins clearly visible;
  • children lag behind in development and later begin to hold the head and sit;
  • Skull not great age;
  • the bones of the skull are formed disproportionately forehead unnatural acts;
  • when a child looks down between the iris and the upper eyelid visible white stripe eyeball protein.

Each of these features alone does not indicate an increased pressure within the skull, but the presence of at least two of them - is an occasion to examine the child.

When overgrown with fontanelles and cranial sutures, the manifestations of intracranial hypertension are pronounced. At this time the child has the following symptoms:

  • persistent vomiting;
  • anxiety;
  • convulsions;
  • loss of consciousness.

In this case, it is necessary to call an ambulance.

The syndrome may develop at a later age. In children two years of the disease manifests itself as follows:

  • violated function of the sense organs due to accumulation of CSF;
  • vomiting occurs;
  • in the morning on waking appear arching headaches that put pressure on the eyes;
  • when lifting the pain diminishes or retreats due to outflow of CSF;
  • child lags behind in growth, is overweight.

Increased intracranial pressure in children leads to disturbances in brain development, so it is important to detect abnormalities as early as possible.

Benign intracranial hypertension (DBH)

This is one of the varieties of ICP, which can be attributed to a temporary phenomenon, which is caused by a number of adverse factors. Status of benign intracranial hypertension is reversible and does not pose a serious danger, as in this case, the brain squeezing is not due to the influence of any foreign body.

DBH can cause the following factors:

  1. hyperparathyroidism;
  2. Failures in the menstrual cycle;
  3. Cancellation of some drugs;
  4. vitamin deficiencies;
  5. Obesity;
  6. Pregnancy;
  7. An overdose of vitamin A and others.

Benign intracranial hypertension is associated with impaired absorption or outflow of cerebrospinal fluid. Patients complain of headaches, aggravated by movement, and sometimes even when you sneeze or cough. The main difference from the classic disease of brain hypertension is that the patient does not there is no sign of oppression of consciousness, and the state itself does not have any effect and does not require special treatment.

complications

Brain - vulnerable organ. Prolonged compression leads to atrophy of the nerve tissue, and, therefore, suffer mental development, the ability to move, there are vegetative disorders.

If time does not see a specialist, there will be a squeeze. The brain can be displaced in the foramen magnum or cutting tentorium cerebelli. Thus compressed the medulla oblongata, where the centers of respiration and circulation. This will lead to loss of life. Etched in the clipping constant gallop accompanied by sleepiness, yawning, breathing becomes deep and speeded up, the pupils markedly narrowed. Found wedging hook hippocampus, which is a symptom of mydriasis or absence of light on the reaction side of the injury. The pressure increase will lead to expansion of the second pupil failure rate of respiration and coma.

High intracranial pressure is always accompanied by a loss of vision due to compression of the optic nerve.

Diagnostics

For the diagnosis of the measurement is the pressure inside the skull using a needle insertion manometer attached to the spinal canal or into fluid cranial cavity.

For statement is taken into account a number of features:

  1. Set of poor outflow of venous blood from the skull area.
  2. According to an MRI (magnetic resonance imaging) and CT (Computed Tomography).
  3. Judged by the degree of dilution of the brain ventricles and the edges of the expansion of the fluid cavities.
  4. According to the degree of expansion and venous blood supply to the eyeball.
  5. According to US cerebral vessels.
  6. According to the EEG results.
  7. If the ophthalmic vein well reviewed and highly filled with blood (red eye), it is possible to indirectly assert the increasing pressure inside the skull.

In practice, in most cases, for a more accurate diagnosis of the disease and the degree of use Differentiation of symptoms of clinical manifestations of hypertension, combined with the results of the study of the head hardware brain.

Treatment of intracranial hypertension

What is the treatment of increased intracranial pressure in adults? If it is benign hypertension, neurologist appoints diuretics. As a rule, one that is sufficient to facilitate the patient's condition. However, this traditional treatment is not always acceptable to the patient and they can not always be performed. not "sit" on diuretics during working hours. Therefore, you can do special exercises to reduce intracranial pressure.

It is also very good at helping with intracranial hypertension special drinking regime, sparing diet, chiropractic, physiotherapy and acupuncture. In some cases, the patient manages, even without medical treatment. Symptoms of the disease can pass during the first week of starting treatment.

Several other treatment is applied at a craniocerebral hypertension arising on the basis of some other diseases. But before you treat the effects of these diseases, it is required to eliminate the cause. For example, if a person has developed a tumor, which creates pressure in the skull, you must first save the patient from this tumor, and then deal with the consequences of its development. If it's meningitis, there is no reason to treat diuretic without simultaneous control of the inflammatory process.

In very severe cases (e.g., block liquor after neurosurgical operations or congenital liquor unit) surgical treatment. For example, a technology developed implantation tubes (shunts) for discharging the excess cerebrospinal fluid.

PS: To decrease the intracranial pressure (hypotension), cause dehydration (vomiting, diarrhea, high blood loss), chronic stress, vegetative-vascular dystonia, depression, neurosis, diseases accompanied by blood circulation in the vessels of the brain (e.g. ischemia, encephalopathy, cervical osteochondrosis).

Total

Thus, intracranial hypertension - is a pathological condition that can occur when a wide variety of diseases of the brain and not only. It requires mandatory treatment. Otherwise, a wide variety of possible outcomes (including blindness and even death).

What would previously diagnosed with this pathology, the best results can be achieved with less effort. So do not delay the visit to the doctor if there is suspicion of increased intracranial pressure.

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