Intracranial pressure. Symptoms in adults how to identify and remove the causes and treatment

Symptoms of intracranial pressure gives a lot of concern at any age. In adults, this condition of the body can lead to permanent disability and violation of chronic pathologies.

The concept of intracranial pressure and performance standards

The term "intracranial pressure" to denote the pressure on the formation of intracranial CSF - cerebrospinal fluid circulating in the cerebral ventricles, central spinal canal between the meninges and also in the space between the hemispheres of the brain and the cranial vault.

For a normal human adult is considered an indicator of intracranial pressure, it is in the range of from 2 to 12 mm Hg at a measurement condition in the supine position. This corresponds to about 100-200 mm water column.

Why is increased or decreased intracranial pressure

Intracranial pressure (symptoms in adults occur in the cases listed below) is characterized by the following features:

• the presence of obstacles to the outflow of the cerebrospinal fluid from the cranial cavity;
• craniocerebral trauma of varying severity;
• intoxication;
• cerebrovascular accident (stroke, transient ischemic attack, hypertensive crisis, hemorrhage due to rupture of the aneurysm);
• osteochondrosis of the cervical spine;
• presence volume processes in the cranial cavity (cyst, hematoma, tumors of different nature);
• the presence of inflammatory diseases of the cranial cavity (meningitis, encephalitis, abscess);
• excess vitamin in the body;
• swelling of the brain;
• internal diseases (hepatic encephalopathy);
• increase the amount of liquor;
• overheating of the body;
• excess concentration of carbon dioxide in blood;
• disturbance of venous outflow from the skull, for example by reducing the venous vascular tone wall;
• dysmetabolic processes (obesity);
• the presence of congenital malformations.

Separately emit so-called benign - idiopathic intracranial hypertension.

Among the risk factors for this condition are the following reasons:

endocrine diseases	pregnancy; use of oral contraceptives; adrenal insufficiency; hypo- or hyperthyroidism; hyperaldosteronism; irregular menstrual cycle.
Pathology of the blood system	anemia; hypercoagulation.
Admission drugs	tetracycline; nitrofurans; sulfamethoxazole; penicillin; glucocorticosteroids, including their harsh cancellation; amiodarone; cyclosporine; vitamin A.

Decreased intracranial pressure and symptoms in adults occur in the following cases:

1. Hypotension, which arose as a result of medical procedures such as lumbar puncture.
2. By lowering the intracranial pressure also results in surgery of the head or spines in the event that a result of operation violated the integrity of the meninges.
3. Injuries that result in rupture of the dura mater. They also include all the situations when damage results in even the most insignificant at first glance, the impact (coughing, sneezing, vigorous sports training).
4. Pathological conditions of a systemic nature, such as uremia, dysmetabolic coma, dehydration.

Separately allocated a spontaneous (or idiopathic) intracranial hypotension - a situation where localization of leakage of cerebrospinal fluid and cause the intracranial pressure drop is not set succeed.

Symptomatology high and low intracranial pressure

Intracranial pressure (in adults the symptoms are nonspecific and may be mistaken for an ordinary sickness) is shown by the following features:

1. Headaches having blunt bursting nature and localized predominantly in the frontal and occipital areas or diffuse. Unlike pain during migraine attack, the feeling is not concentrated on one of the parties and shows the dependence of the time of day - is most active at night and in the morning clock. Characterized by a weak efficacy or complete absence of the effect of analgesics.
2. Violation of visual perception (double vision before my eyes, blurred vision of objects, disorder or complete disappearance of peripheral vision). In some cases, there are bouts of blindness or a subjective sensation of mist before his eyes. Objectively, wherein the reduction in activity recorded pupillary response to light.
3. When expressed in increased intracranial pressure possible deformation eyeballs even impossible completely closed eyelids.
4. Dizziness, unsteadiness when walking.
5. Confusion, memory impairment, decreased ability to concentrate.
6. Increased sleepiness.
7. Instability blood pressure - fluctuations in its upward, so hypotension.
8. Nausea, vomiting.
9. Lethargy, fatigue, asthenia.
10. Chills.
11. Mood disorders: depressive episodes, sudden changes in emotional state.
12. Increased sensitivity of the skin.
13. Pain in the neck and spine.
14. Disorder breathing rate, shortness of breath.
15. Muscle paresis.

Having one of these symptoms is still no evidence of intracranial syndrome hypertension, but the combination of several characteristics of the patients is the reason for a more detailed survey. Reduction of intracranial pressure in adults most often manifests itself a headache.

It can have both local and diffuse in nature and depends on the patient's body position. In the sitting position and standing it is enhanced and significantly weaken or even disappear in the supine position. Headache, and prone enhanced by rapid movement of the head and walking.

Pain syndrome has a high intensity and may be accompanied by the following symptoms:

• nausea;
• vomiting;
• dizziness, feeling of instability;
• visual disturbances (diplopia, blurred vision or partial loss of peripheral regions of the field of vision, photophobia, oculomotor disorders as nystagmus);
• facial paralysis;
• the sensitivity of the violation;
• seizures;
• stiffness in the neck muscles and neck;
• noise, ringing in the ears;
• the depressed state of mind;
• tendency to palpitations - up to 100 beats per minute;
• pale skin;
• respiratory failure rate (with marked reduction - less than 80 ml of water column).

Methods of diagnosing intracranial pressure

The leading method for diagnosing intracranial pressure variations today is magnetic resonance imaging. Visualizing the state of intracranial structures, this method facilitates and differential diagnosis of conditions that have similar symptoms. Signs of intracranial hypotension with MRI is a diffuse thickening of the meninges.

When imaging using contrast agents they accumulate in hard and soft meninges. Furthermore, the low intracranial pressure will indicate the offset structures below the level of the cerebellum foramen, as well as other signs of brain displacement relative to its normal position.

In addition, the following methods are used:

1. X-ray of the skull bones. In the case of long-term increased intracranial pressure existing on the inner surface of the cranial bones visible thinning characteristic changes resembling digital impressions.
2. Lumbar puncture. When performing this manipulation for expiration liquor speed can assume the character of changes liquor pressure. Moreover, this manipulation is very informative for the differential diagnosis of conditions leading to increased intracranial pressure: Appearance and cellular composition of cerebrospinal fluid indicate disease such as meningitis, meningoencephalitis, acute cerebrovascular circulation.
3. Fundus examination. During ophthalmoscopy expert to draw conclusions about the value of intracranial pressure as retinal vessels. About intracranial hypertension will indicate swelling of the optic nerve tortuosity and extension of the retinal veins, visible in the fundus.
4. Rheoencephalography. The weakening of the pulse wave detected in the course of the study, will point to the increased intracranial pressure.
5. Electroencephalography. This technique reveals violation bioelectric activity of various parts of the central nervous system that are typical of intracranial hypertension. In addition, this kind of study allows you to identify the early stages of one of the complications - convulsive readiness.
6. Direct measurement of the intracranial pressure It requires high professional skill, sterile conditions and the availability of appropriate medical equipment. The measurement is performed by puncture of the brain ventricles, followed by introduction catheters.

Prevention of abnormalities of intracranial pressure

In order to prevent the rise in intracranial pressure must be careful to avoid factors causing this condition:

• possible to protect yourself from stressful situations;
• adhere to the optimal regime and diet;
• regular physical exercise in the open air activity.

An effective way to prevent intracranial hypertension is to maintain optimal airway patency.

People who have a tendency to increased intracranial pressure or intracranial hypertension episodes in history, necessary to comply with complex precautions:

• reception limit or fully abandon the use of vasodilating agents;
• set the optimum drinking mode, reducing the amount of fluid intake to 1.5 liters per day.

An additional precaution would sleep on a bed with slightly raised head end.

Methods of treating increased intracranial pressure and reduced

Intracranial hypotension in some cases tend to regress on their own. Therefore, the strategy of conducting such patients is characterized by conservatism. Treatment of intracranial hypotension is reduced in most cases to the massive hydration of the patient and the reception of caffeine on background of bed rest and limit any stress.

However, under stable to conservative treatment of spontaneous intracranial hypotension resort to such manipulation of both the hard plastic meninges or introduction into the epidural space of a small quantity of the patient's own blood (so-called blood patch). These medical procedures are designed to eliminate the defect of the dura mater, which is the source of the expiration of the cerebrospinal fluid.

Medications

Intracranial pressure (symptoms in adults with idiopathic disease regresses form under the action of conservative therapy, which reduces to receiving diuretics) It requires precautionary treatment in which you must take into account the serious impact of drugs on the metabolic processes.

Special precautions are needed in the case of a combination of diuretic therapy with physiotherapy methods, as this combination can increase fluid loss. For effective removal of excess fluid from the body most often recommend taking hydrochlorothiazide or Diakarb.

hydrochlorothiazide	diakarb
Mechanism of action	Blocks the reabsorption of sodium and chloride ions in the proximal renal tubules.	Depresses the activity of the enzyme carbonic anhydrase, which leads to the following effects: increase release of ions of potassium, magnesium and water; reduced secretion of cerebrospinal fluid; anticonvulsant activity.
The application mode	Starting dose ranges from 25 to 100 mg a day every one or every two days. Maintenance - 25-50 mg per day, every day or every other day.	For maximum effect, diuretic reception is performed by one of the following schemes: 1 time in 2 days; 2 consecutive days, followed by 1-day intervals. The daily dose is 250-375 mg.
Side effects	headache; dizziness; Sensitivity disorder; irregular heartbeat; changes in the cellular composition of the blood; reduction of organism resistance to glucose; allergic reactions.	muscle cramps; drowsiness; the sensitivity of the violation; decrease in the number of blood cells; acidification of the internal environment; stone formation in the kidneys (with prolonged use); nausea; allergic reactions.
Contraindications	disruption of normal kidney function; failure potassium and magnesium; age less than 3 years; idiosyncrasy.	acute renal dysfunction; liver failure; diabetes; pregnancy and lactation; idiosyncrasy.

Intracranial pressure (symptoms in adults can disrupt operation) very negative impact on the state of the nervous tissue. To prevent negative effects and eliminate already occurring trophic disorders is recommended to use drugs metabolic action, as well as nootropics.

In order to improve the microcirculation following drugs are used in brain tissue:

• Cavinton (Vinpocetine);
• Trental (pentoxifylline);
• Chimes.

When choosing a drug and treatment regimens need to consider whether or not the patient has contraindications to the use of vasodilator medications, as well as possible side effects.

vinpocetine	pentoxifylline	chimes
Adverse reactions	hypotension; acceleration of the heart rate; appearance of extrasystoles; slowing intraventricular conduction; headache; dizziness; sleep disturbances.	dizziness; disorder of visual perception; headache; subjective feeling of tides; irregular heartbeat; allergic reactions.	redness of the skin; palpitations or heart rate slowing; lowering blood pressure; nausea, dyspepsia syndrome; decrease in blood clotting; dizziness; headache; noise in the head; allergic reactions; a feeling of weakness; pain in joints and muscles.
Contraindications	expressed heart rhythm disturbances; coronary heart disease with severe cases of its course; hemorrhagic stroke acute period; pregnancy; breast-feeding; all cases of individual intolerance or hypersensitivity to the components of the drug.	acute myocardial infarction; heavy bleeding; bleeding in the brain; pregnancy and lactation; age less than 18 years; hypersensitivity to the drug.	acute myocardial ischemia; Atherosclerosis of the arteries; low blood pressure; decompensated heart failure; hypertension, severe; obstruction of the bronchial tree; kidney and liver failure.
The application mode	A single dose of 5-10 mg; the multiplicity of reception 2-3 times a day for 1-2 months.	400 mg 2-3 times a day (depending on the clinical situation) for 1-2 months.	75 mg 2-3 times a day (appointment should be carried out under the control of blood coagulation parameters)

Intracranial pressure (symptoms in adults require differentiation from other diseases) may be a manifestation of other more serious conditions. In this case, the main focus of therapy is etiotropic treatment - a complex of measures aimed at the cause of the pathology.

In case of a bacterial antibiotic process is assigned; in viral lesions - a massive infusion therapy under the control of intracranial and blood pressure. If the cause of the disease is a cerebral circulation - becomes the primary vasoactive therapy - means for the prevention of ischemic lesions of the brain tissue.

In marked edema meninges circuit included in the therapeutic glucocorticosteroid drugs.

Drug therapy is intracranial hypotension reduced to intravenous administration of isotonic sodium chloride solution (1000 to 1500 mL) and subcutaneous administration of a 1% caffeine solution. In some cases, the decision on injection into the subarachnoid space of isotonic sodium chloride solution in an amount of 10-120 ml.

recommended diet

Therapeutic regimens are most effective against a background of optimal drinking regime with intracranial hypertension. Fluid intake for an adult is set to within 1.5 liter per day.

Diagnosed decrease in intracranial pressure require the introduction into the diet of large quantities of liquid - about 3 liters per day. Patients are encouraged to drink plenty of liquids throughout the day.

Physiotherapy

In the treatment of intracranial hypertension can be effective physiotherapy following methods:

• magnetic region on neck area;
• electrophoresis, aid administration of drugs into the body;
• light massage of cervical area and the area of ​​the cervical spine;
• circular shower.

Applies acupuncture method.

Sports and physical exercise

Intracranial pressure is better adjusted using the combined therapy on the background of the wellness regime. In particular, the overall strengthening of the body and increase its resistance to the provoking factors contribute to swimming lessons and, in the absence of contraindications, a simple set of gymnastic exercises.

operative intervention

Surgery of intracranial hypertension is necessary in the case when the increased intracranial pressure a symptom surround process, localizing in the skull:

• tumors of the brain and its meninges;
• when extensive hematoma (e.g., due to rupture of the vascular aneurysm);
• to remove the foreign body.

Idiopathic intracranial hypertension carried shunting or optic nerve decompression shells. Such treatment leads to stabilization of visual function, but has a sufficiently high rate of postoperative complications such as infection and focal brain lesions.

Folk remedies

Funds recommended by folk medicine, applied mainly in idiopathic intracranial hypertension and are complementary.

An example of such means is the following recipe:

1. Mix equal proportions of leaf series and nettle.
2. 3 tablespoons obtained crude drug within 10 minutes in 1 liter of cooking water.
3. The resulting broth to cool.

Taken before a meal 50 ml.

There are indications of efficacy and a simple recipe: 3 tablespoons dried crushed leaf plantain pour boiling water in a volume of 500 ml and infuse for half an hour. A single dose of 50 ml of broth; multiplicity of reception - 3 times a day. You can cook a folk remedy in the form of tinctures.

You will need:

• valerian root;
• motherwort leaves;
• hawthorn;
• green eucalyptus;
• herbs peppermint.

These components must be mixed in equal proportions and full tablespoon of the resulting herbal raw pour vodka or alcohol in a volume of 500 ml. Infuse means should be at room temperature in the dark for 7 days. After this period, take 1 ml 3 times per day. Admission course this tincture is 1 month.

Lemon juice and honey. For the preparation of the national funds will need the juice of 1 lemon, half a cup of water and 2 tablespoons of honey. All components of the mix and drink. The duration of treatment is 20 days.

complications

The symptoms of intracranial hypertension in adults due to lack of timely action progresses, the clinical picture becomes brighter:

• vomiting becomes frequent, leading to dehydration, accompanied by constant hiccup;
• develop disorders of consciousness in the form of stunning, which may progress to coma;
• It appears convulsions - from individual seizures, ending status epilepticus;
• When long-existing intracranial hypertension gradually thinning bones of the cranial vault.
• In the absence of timely treatment or incomplete course of intracranial pressure treatments, progressing, can lead to very serious complications:
• acute ischemic stroke;
• a progressive disorder of the cerebellum functions, expressed in ataxia;
• compression of the structures of the brain stem is fraught with heart rhythm disorders;
• paresis;
• speech disorder;
• mental disorders;
• impairment of consciousness up to a total loss;
• convulsions, epilepsy.

A number of diseases, is a complication of intracranial hypertension in adults can lead to death. There are cases of benign intracranial hypertension. For this variety of diseases characterized by spontaneous regression, without any therapeutic measures.

The most characteristic of this form for the young women of the disease are overweight. The most serious complication of intracranial hypotension are meningitis and meningoencephalitis - inflammatory diseases of the brain and side shells, resulting in penetration of the infection cranial cavity.

This is possible in the presence of dural defect.

The most effective way to combat the symptoms of intracranial pressure in adults is complex treatment regimens that act as the cause of the disease that caused the pathology, and eliminating symptoms disease.

Author: Mayorov Ekaterina

Useful video of elevated or reduced intracranial pressure

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