The clinical picture of treatment and prognosis for benign idiopathic intracranial

The brain is located in the bone structure, inside which the organ is placed in a liquid medium that performs an additional protective function. In the skull are also localized fluid media – ventricles. A cerebrospinal fluid acts as a protective fluid (exudate, cerebrospinal fluid). It is cerebrospinal fluid that creates intracranial pressure.

Interesting! Intracranial hypertension syndrome was first characterized by the concept proposed by Monroe-Kelly.

The ventricles and fluid locations are interconnected by ducts through which exudate circulates. Spinal fluid is updated up to 7 times a day. In violation of excretion, absorption or permeability of exudate, ICH develops.

The human brain is structurally divided into substance, blood, exudate and interstitial fluid. The components have a specific volume and are separated from each other by an encephalopathic barrier. In a healthy person, all elements are balanced among themselves. In violation of the volumes of one component, intracranial pressure rises in the entire brain cavity.

Symptoms of ICH include a number of signs, the degree of manifestation of which depends on the level of increase in values ​​in the cranial structure. The most common symptom of the disease is severe headache, growing at night. This is due to the fact that when the victim is lying, enhanced synthesis of exudate begins along with a slowdown in the absorption of cerebrospinal fluid.

With a maximum increase in values, a person becomes irritable, aggressive, quickly tired. Vomiting does not bring relief. Excessive sweating, jumps in blood pressure, increased heart rate are recorded. The patient may lose consciousness. Convulsive seizures intensify, visual disturbances are manifested.

Some painful manifestations indicate impaired functioning of the nervous system. Similar symptoms relate to indirect signs of intracranial hypertension:

  • trouble falling asleep;
  • decreased attention and intellectual abilities;
  • tremor of hands, chin;
  • excessive sweating;
  • increased heart rate;
  • the presence of bruises under the eyes, an increase in the capillaries of the fundus;
  • blurred consciousness;
  • lack of sexual desire;
  • high weather sensitivity.

A single manifestation of any symptom does not indicate pathology. ICH can be suspected with a complex severity of symptoms.

Intracranial hypertension (ICH) is a dangerous disease that occurs due to increased pressure. A similar condition is diagnosed against the background of injuries, stroke, infectious lesions and the development of the tumor process.

Medicine is able to cope with many problems with timely treatment of the patient for help. To assess the nature of pathological changes, an MRI, x-ray, and laboratory tests are performed.

Treatment of intracranial hypertension involves both conservative therapy using traditional and folk remedies, and surgical techniques.

The change in pressure is the result of various adverse effects. Violation of the outflow of cerebrospinal fluid provoke the following etiological factors:

  1. The formation of a tumor in the cranial cavity. Neoplasms are able to compress both the brain itself and the vessels and lymphatic pathways that feed it. Such changes disrupt the process of fluid outflow, which leads to the occurrence of intracranial hypertension syndrome.
  2. A common cause of pressure changes is damage to arteries and veins. A stroke is a dangerous condition accompanied by the development of ischemic processes in the tissues of the brain. Intracranial hypertension may result from a hemorrhagic type of disease.
  3. The formation of hematomas as a result of injuries. In case of damage to large vessels or bones, compression of structures located in the cranial cavity is recorded. In addition, as a result of traffic accidents, accidents or injuries sustained in the army during the hostilities, disturbances in the work of other organs are often noted, which only aggravates the manifestations of the lesion and increases bleeding.
  4. Inflammatory diseases of the brain and its membranes are encephalitis and meningitis. Viral and bacterial agents provoke inflammation of the cerebral structures, which leads to an increase in their volume. Such changes disrupt the normal flow of fluid through the vessels in the cranial cavity, which leads to increased intracranial pressure.
  5. Heart failure, as well as terminal stages of damage to kidney function. These structures control the overall level of pressure throughout the body. If their work is disturbed, patients often suffer from hypertension, including the brain. Common consequences of such chronic problems are cerebral edema and intracranial hypertension.
  6. Obstructive pulmonary disease provokes hemodynamic changes in the pulmonary circulation. This leads to a gradual increase in hypertension, which affects not only the respiratory system, but also the function of all other organs. The brain also suffers. The situation is aggravated by an increase in hypoxia due to a decrease in the ability of the lungs to enrich blood with oxygen.

In rare cases, intracranial hypertension can also form in the absence of damaging factors. A similar phenomenon occurs in children and adults, cases have been recorded in pregnant women.

The condition is characterized by a relatively mild course and passes on its own when the exposure to negative factors ceases.

The separation of pathology into types is used to select the tactics for treating an ailment. At the same time, several characteristics of the disease are used to differentiate. The main are two classifications of intracranial hypertension:

  1. With the course, acute and chronic forms of the problem are distinguished. The first occurs due to a sharp disruption of the cerebrospinal fluid or blood flow in the cranial cavity. Similar changes form on the background of injuries, can also be a consequence of hemorrhagic stroke. The chronic form of the disease is diagnosed when taking certain drugs, for example, with prolonged use of hormonal drugs. The terminal stages of heart and kidney failure, pulmonary emphysema also lead to problems.
  2. By the nature of pathogenesis, four types of disease are differentiated. The first form is venous, resulting from a violation of the function of the corresponding vessels. A similar condition is observed with thrombosis, compression of the circulatory network by tumor masses, and is also formed in severe respiratory diseases. Liquor hypertension is noted in violation of the outflow of fluid, as well as with an increase in its formation. The cause of these problems are most often oncological processes. This type is common in children with congenital defects in the structure of the skull and brain. In a separate diagnosis, benign or idiopathic hypertension is made. This condition is associated with the most favorable prognosis. It occurs when various factors act, for example, during malnutrition or hormonal disruptions, and when the cause is eliminated, it passes on its own and does not require treatment.

The main symptoms of intracranial hypertension include:

  1. Dizziness and pain in the temple and neck, which can also give off to the neck and eyes. Unpleasant sensations arise due to compression of the nerve structures, can form suddenly and have a long-lasting character.
  2. Patients complain of aggravation of general health. Patients become irritable, quickly get tired, it is difficult for them to concentrate. Often diagnosed with sleep disorders, which only exacerbate the situation.
  3. A characteristic sign of intracranial hypertension is nausea and vomiting, which are not accompanied by an improvement in a person’s condition.
  4. Common manifestations of an increase in intracranial pressure are also considered to be violations of the analyzers, that is, a decrease in visual acuity, the occurrence of tinnitus.

Confirmation of a problem begins with a medical history. The doctor examines the patient, finds out about the disturbing symptoms. To identify indirect signs of intracranial hypertension, an ophthalmologist will be required.

The doctor examines the fundus, during which often there is swelling of the optic disc. Magnetic resonance imaging is used to diagnose hypertension in the cranial cavity.

It allows not only to confirm the presence of a problem, but also to identify its cause, for example, a hematoma with a stroke or a tumor lesion.

X-rays are used in the event of a person receiving injuries, as it allows to visualize bone structures and exclude the presence of damage in the spine. If an infectious lesion that causes an increase in intracranial pressure is suspected, a lumbar puncture is performed. It allows you to get a sample of cerebrospinal fluid, which is subsequently investigated in the laboratory. During the analysis, it is possible to identify the pathogen, as well as determine its sensitivity to antibacterial agents.

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Therapies

The doctor chooses the tactics of combating the disease on the basis of the diagnosis. In an acute problem, the patient may need emergency care, that is, hospitalization in intensive care.

For chronic problems, treatment of intracranial hypertension is performed on an outpatient basis. Both medications and surgical techniques are used.

With the permission of the doctor, folk remedies made at home are also used.

Traditional

When the patient is in a stable condition, they resort to conservative methods of treatment. If a person enters a medical facility with an injury or stroke, more drastic measures may be required. Two traditional methods of combating pathology are common:

  1. Therapy of intracranial hypertension is based on the use of medicines of various groups. Diuretics are prescribed, for example, Mannit, Diakarb and Furosemide, which help to remove excess fluid from the body. Nonsteroidal anti-inflammatory drugs are widely used in many diseases, as they have an analgesic effect. Means such as Diclofenac and Ketonal are also used to reduce the severity of swelling of cerebral structures. If the patient is diagnosed with a hematoma due to rupture of large vessels, hemostatic agents are prescribed, for example, Ethamsylate. In the period of recovery after a disease, nootropic medicines are widely used, a popular representative of which is Piracetam. When an infection is detected, antibacterial drugs are prescribed. Vasodilators, such as Magnesium Sulfate, are used with caution.
  2. Surgical techniques are used in the absence of the proper effect of conservative therapy. The operation is performed to eliminate the effects of injuries, lowering the hematoma and suturing damaged vessels. When a large amount of fluid accumulates in the cavity of the ventricles of the brain, shunting is performed. This technique allows you to create a drainage system that will facilitate the outflow of cerebrospinal fluid, which greatly improves the patient’s condition.

Causes of intracranial hypertension

Causes of cerebral hypertension include:

  • head injuries – bruise, concussion;
  • failures in the cerebral circulation – thrombosis, stroke;
  • neoplasms in the cranial cavity;
  • inflammation of the brain structures – abscess, encephalitis, meningitis;
  • congenital malformations in the structure of the brain;
  • intoxication with ethanol, gas, lead;
  • metabolic disorders with hyponatremia, cirrhosis;
  • organ diseases leading to a delayed outflow of venous blood – cardiac, pulmonary pathologies.

ICH in children develops due to congenital anomalies, prolonged oxygen deficiency, prematurity, unhealthy pregnancy or childbirth.

Note! Normal values ​​of ICH are 1,5-6 mmHg for infants, 3-7 mm for adolescents.

In infants, the disease is often formed due to intrauterine infections.

Although the causes of idiopathic hypertension are not currently known, there are suggestions. Pathology develops without any external causes, but can occur due to a number of risk factors:

  • Overweight.
  • Chronic stress.
  • Violation of blood clotting.
  • The stress of the physical plane, which lasted a long time.
  • Taking vasoconstrictor drugs and hormones.
  • Diseases of the endocrine system.
  • Transfer of asphyxia at birth.

Common intracranial hypertension occurs due to

or the presence of diseases of the nervous system (developmental abnormalities,

Before understanding the causes of increased intracranial pressure, the normal physiology of cerebrospinal fluid movement should be considered. Under normal conditions, the entire brain tissue is surrounded by cerebrospinal fluid, which is located in a confined space (cranium) under a certain pressure. Intracerebral fluid or cerebrospinal fluid is constantly in a moving state, and its movement occurs at a certain speed.

In a situation when there is an excessive accumulation of cerebrospinal fluid, which may be due to a violation of its absorption or, on the contrary, an increase in the activity of its production, an increase in the pressure gradient is observed, which the cerebrospinal fluid exerts on the structure of the brain. In addition, there is another pathogenetic mechanism for the development of intracranial hypertension, which is a violation of the patency of the circulation paths of intracerebral fluid, which is extremely rare.

Unfortunately, not in all situations even pronounced intracranial hypertension has an obvious provoking etiological factor, and the attending physician has to more carefully verify the cause of the increased intracranial pressure. With the harmful effects of one or another provoking factor, the mechanisms of development of intracranial hypertension can vary greatly.

So, with the existing volumetric formation in the brain, an example of which can be a posthemorrhagic hematoma or tumor conglomerate, a compression effect on the structure of the brain develops. As a compensatory mechanism in this situation, severe or moderate intracranial hypertension occurs, characterized by a progressive course.

Intracranial hypertension in infants most often develops as a result of hydrocephalus, which occurs for various reasons (prolonged intrauterine hypoxia of the fetus, intrauterine infection of the fetus with infectious agents of the neurogroup). To a greater extent, this pathology affects newborn babies born earlier than expected.

In the adult category of patients, intracranial hypertension develops in almost any pathological conditions that are accompanied by the development of even minimal swelling of the brain tissue, for example, post-traumatic effects, infectious lesions of the meninges, etc.

There is a whole range of chronic diseases that can serve as a background for the development of signs of intracranial hypertension, among which should be noted congestive heart failure and the presence of effusion in the pericardial sac. In a situation when the increase in the pressure gradient of the intracerebral fluid is continuous and pronounced, there is a compensatory expansion of the fluid cavities of the brain, which is called “hydrocephalus”.

Intracranial hypertension accompanies many neurological diseases of childhood. Her symptoms can be almost imperceptible, and can significantly affect the physical, motor and neuropsychic development of the baby, his condition and even threaten life.

Diseases that are accompanied by intracranial hypertension can occur in a child of any age. It is important for fathers and mothers to pay attention to alarming symptoms and consult a specialist in order to avoid irreparable consequences.

Do not confuse the concepts of intracranial pressure and intracranial hypertension. Intracranial pressure, as well as arterial pressure, is a physiological concept. Intracranial hypertension is caused by an increase in intracranial pressure and is a symptom of the disease.

Cerebrospinal fluid, or cerebrospinal fluid, is formed in the cranial cavity from the blood by filtering it in the vascular plexuses of the third and fourth ventricles. Then, through special openings, it enters the tanks located at the base of the brain. Further, the cerebrospinal fluid circulates along its surface, filling all the free spaces.

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The absorption of cerebrospinal fluid occurs due to special cells of the arachnoid membrane of the brain. So its surplus is liquidated.

In its composition, cerebrospinal fluid contains hormones, vitamins, organic and inorganic compounds (proteins, salts, glucose), and cellular elements. Due to a certain ratio of all components, the required viscosity is maintained.

The composition and quantity of cerebrospinal fluid is maintained by the body at the same level. Any changes are an indicator of pathology.

Liquor performs a cushioning function. The brain and spinal cord seem to “hang” in a confined space and do not touch the bones of the skull and vertebrae.

During movement and strokes, soft tissues are susceptible to shock, and cerebrospinal fluid softens them. He is also involved in metabolism.

Brain cells receive through the cerebrospinal fluid the nutrition necessary for their vital functions, and remove unnecessary metabolic products.

So, the cerebrospinal fluid is in a closed cavity in motion, constantly forming and absorbed. During its circulation along the cerebrospinal fluid paths, it creates a certain pressure on the bone tissue and the brain, which is called intracranial. And it is maintained at a strictly defined level.

Intracranial hypertension accompanies a number of diseases:

  • intrauterine infections;
  • hypoxic lesions of the central nervous system;
  • traumatic lesions of the central nervous system;
  • abnormalities in the development of the brain and bones of the skull, for example, craniostenosis;
  • hydrocephalus;
  • inflammatory diseases of the brain (neuroinfection);
  • brain tumors;
  • anomalies in the structure of blood vessels;
  • cerebral hemorrhages;
  • various severe metabolic diseases (severe diabetes mellitus, mucopolysacchar >

With the above diseases, a pathology of the cerebrospinal fluid can occur (narrowing of the sylvian water supply, its bifurcation and branching). In premature infants, as well as in children who have undergone meningitis, hemorrhage, and intrauterine viral infections, the glial lining of the aqueduct grows and it becomes completely obstructed.

As a result of congenital malformations of the cerebral vessels (malformations), their abnormal growth in the form of glomeruli occurs. These glomeruli grow in size and can interfere with the flow of cerebrospinal fluid.

Various hemorrhages impede the flow of cerebrospinal fluid. In meningitis, pathogens secrete a thick and viscous exudate, also causing obstruction of the cerebrospinal fluid. Due to intrauterine infections, they can be destroyed.

There is the concept of benign intracranial hypertension. This is a group of conditions with an increase in intracranial pressure without signs of cerebrospinal fluid obstruction and neuroinfection.

  • Benign intracranial hypertension is a diagnosis of exclusion unless other serious causes of increased intracranial pressure are found.
  • The clinical manifestations of intracranial hypertension are diverse and depend on its cause.
  • There are several common symptoms.
  1. In infants, the size of the head is growing rapidly. You can notice the features of its shape: a wide overhanging forehead, the predominance of the cerebral region of the skull over the facial.
  2. Wide open fontanelles, their protrusion and pulsation, as well as large differences in cranial sutures. In infants with intracranial hypertension, dilated saphenous veins in the head area are noteworthy.
  3. There is a symptom of Gref, or a symptom of the setting sun: the child has a white strip of sclera between the upper eyelid and the iris. The baby’s eyes are wide open, and the look looks surprised. Also, the child can throw his head back while sleeping.
  4. Characterized by constant piercing monotonous crying for no apparent reason, the so-called brain crying.
  5. In children with intracranial hypertension, persistent spitting up with a fountain appears.
  6. In severe cases, the baby lags behind in development: it begins to hold its head, sit, crawl, speak later than its healthy peers.
  7. Terrible signs are the appearance of convulsions, trembling, and vomiting.
  8. Irritability, lethargy, poor appetite, vomiting, superficial fast sleep are characteristic symptoms of intracranial hypertension in children both younger and older. Headaches appear during sleep and in the morning, during the day they are less pronounced.
  9. Gradual personality changes, a decrease in school performance, dizziness, changes in visual acuity, double vision in older children make it possible to suspect an increase in intracranial pressure.
  10. With intracranial hypertension, which appeared sharply after an injury to the brain and skull, loss of consciousness and coma are possible.

Benign ICH Syndrome

Intracranial hypertension is a fairly common diagnosis, which is established in patients of various age categories, including in childhood.

It is a manifestation of one or another neurological pathology and is not considered as an independent disease.

However, the forms of the syndrome of increasing intracranial pressure can be extremely polar – from severe cases ending in fatal outcomes, to an almost asymptomatic course of pathology.

Development mechanism

Intracranial pressure is calculated as the difference in pressure in the cranial cavity and atmospheric. Normal values ​​range from 1,5 to 6 mmHg. Art. for newborns and from 3 to 7 mm RT. Art. for children over 12 months old. The threshold values ​​for intracranial pressure are:

  • 14,7 mmHg Art. (for infants and children under 6 years old);
  • 15 mmHg Art. (from 7 to 10 years);
  • 15,6 mmHg Art. (for a child from 11 years old and adolescents).

With an increase in these indicators, intracranial hypertension (ICH) can be diagnosed.

The theory of the appearance of ICH obeys the Monroe-Kelly doctrine. According to her, the cranial cavity is a closed cavity. Its filling is represented by 85% brain substance, 10% cerebrospinal fluid and 5% blood.

The constancy of intracranial pressure is ensured by the dynamic balance between the volume of cerebrospinal fluid and blood. With an increase in one of the components and the exhaustion of the compensatory capabilities of the brain, an intracranial hypertension syndrome is formed.

On the other hand, increased intracranial pressure shifts the cerebral structures along the pressure gradient and is capable of provoking organic disorders, including wedging.

Causes

The reason for the development of intracranial hypertension in children can be hidden both in the pathology of the brain and in non-cerebral processes.

The main etiological factors for the development of the syndrome include:

  • Perinatal pathology of the nervous system;
  • Neuroinfection;
  • Cerebral neoplasms;
  • Cerebrovascular disease;
  • Head injuries
  • Endocrine and metabolic disorders;
  • Blood diseases
  • Collagenoses;
  • Taking certain medications
  • Heavy metal poisoning.

In some cases, the etiological factor in the development of intracranial hypertension, especially in newborns, cannot be established. Then we are talking about idiopathic intracranial hypertension.

Perinatal pathology is the most common cause of intracranial hypertension in infants and newborns.

Depending on the level of increase in intracranial pressure, intracranial hypertension syndrome is divided into the following degrees:

Severe and severe ICH, as a rule, are the result of gross decompensated neurological pathology (for example, with a brain tumor or hemorrhage).

In children, benign intracranial hypertension syndrome is often encountered, in which there are no signs of volumetric formation of the brain or symptoms of hydrocephalus.

This is mainly manifested by a mild to moderate increase in intracranial pressure.

Intracranial hypertension, based on extracerebral processes, is often accompanied by symptoms of increased pressure of another location (for example, arterial, pulmonary or portal hypertension).

The presence of intracranial hypertension in infants, including newborns, can be suspected with an increase in head size, motor anxiety, frequent spitting up, not associated with eating, difficulty falling asleep or, conversely, drowsiness.

The increase in head circumference for a month with intracranial hypertension in the first half of the year exceeds 1 cm in a full-term newborn, and 2 cm in a premature baby.

Such symptoms can be supplemented by a divergence of cranial sutures, tension or bulging of a large fontanel, Gref’s reaction when changing the position of the body, hyperreflexia with expansion of reflexogenic zones, an increased level of general excitability is characteristic.

Children older than a year in the presence of intracranial hypertension complain of frequent headaches spreading throughout the head, of varying intensity, occurring mainly in the morning. They can be aggravated by coughing, sneezing, straining and changing body position.

In addition, signs of decreased memory and attention, general distraction and excessive motor activity may appear.

Objectively, patients can find scotomas, hemianopsia, oculomotor nerve insufficiency, general hyperesthesia, increased tendon reflexes with expansion of their zones, staggering in the Romberg position and symptoms of autonomic dysfunction – bradycardia, central hyperthermia, increased salivation, and lability of blood pressure.

Diagnostics

Diagnosis of intracranial hypertension in childhood has a number of difficulties, especially in newborn children who are not able to express subjective feelings.

In addition, conducting diagnostic measures in children that require a static position (for example, neuroimaging) is also accompanied by a number of inconveniences.

When conducting neuroimaging in young children, premedication (drug sedation) is required beforehand.

Benign intracranial hypertension in children suggests the absence of focal neurological symptoms (an exception may be only paresis of the external rectus muscle innervated by the abducent nerve). In this case, there may be indirect signs of an increase in intracranial pressure according to the conclusion of neuroimaging.

Treatment

Most often, intracranial hypertension is a consequence of one or another pathological process in the brain.

The exception is idiopathic benign intracranial hypertension, in which it is not possible to establish the cause of the syndrome.

Therefore, the main treatment of patients with manifestations of increased intracranial pressure is directed to the elimination of the etiological factor. In parallel, measures are being taken to stabilize the general condition of the patient and prevent complications.

The main methods of combating intracranial hypertension syndrome can be distinguished into:

  • non-drug effects (compliance with the regime of work and rest, diet correction, physiotherapeutic treatment, massage, physiotherapy, neuropsychological counseling);
  • drug treatment (dehydration, sedation, metabolic, neuroprotective and nootropic therapy, symptomatic treatment).
  • surgical intervention in severe forms of ICH, not amenable to conservative therapy, and the presence of an organic lesion requiring neurosurgical surgery.

Intracranial hypertension in childhood is a multifactorial symptom complex that can have completely different clinical manifestations and outcomes.

Timely detection of pathology, diagnosis of the causes of its development and adequate therapeutic measures can significantly improve the prognosis of the condition.

This is also facilitated by preventive measures aimed at preventing the impact of adverse factors on the child, conducting timely dispensary monitoring and providing quality medical care to children at risk.

In ICD 10, benign intracranial hypertension is separately identified. This type of hypertension is caused by increased cerebrospinal fluid pressure, which is accompanied by the absence of changes in the cerebrospinal fluid (cerebral fluid) and the absence of volumetric formations in the cranial cavity.

The patient has swelling of the optic nerve, as well as swelling of the stagnant disc. Quite often, the functions of vision are disturbed.

This syndrome, as a rule, is not accompanied by severe neurological disorders.

Idiopathic hypertension is a condition with increased cerebrospinal fluid pressure around the brain. The syndrome is also known as a pseudotumor of the brain, resulting from the appearance of symptoms suggesting the presence of a brain tumor, although this is not present.

From an anatomical point of view, cerebrospinal fluid is located in the cerebrospinal space. With an increase in its number, pressure increases around the brain, provided that absorption and outflow decrease.

In their practice, not only neuropathologists, but also specialists of other profiles often encounter cases of benign intracranial hypertension, which is regarded not as a disease, but as a compensatory mechanism observed in various physiological conditions. In some neurological manuals, this variant of intracranial hypertension is interpreted as a “false brain tumor”. At risk for benign intracranial hypertension are young women who are overweight.

A feature of this pathogenetic form of intracranial hypertension is the reversibility of its manifestations, as well as a latent favorable course. As a rule, the establishment of a benign or idiopathic form of intracranial hypertension occurs when neither the specialists nor the patient are able to recognize the etiological factor that provoked its development.

The debut of benign intracranial hypertension consists in the periodic appearance of a mild pain syndrome in the head, which quickly stops taking any analgesic drug or even disappears on its own. At this stage, patients almost never seek medical help.

Manifestations of hypertension in children

Intracranial hypertension (ICH) is a fairly common pathology that occurs in children. It is well studied, there is a lot of talk about it, the famous pediatrician Komarovsky also mentions it.

This disease, resulting from a violation of the outflow of cerebrospinal fluid against venous stagnation and damage to the cardiovascular system. An increase in intracranial pressure (ICP) is accompanied by characteristic symptoms: pain, nausea, fatigue. The disease is diagnosed in children of various ages.

Treatment involves the use of medications, the use of alternative recipes, as well as surgical intervention.

Causes

If in infants there is an increase in the parameters of the head, anxiety, systematic regurgitation, sleep problems, this may indicate intracranial hypertension. With an intracranial form, a monthly increase in head circumference will be more than 1 cm. A pathological symptom is usually accompanied by a divergence of the sutures of the skull, swelling of the fontanel, and increased irritability.

If one-year-old babies often hold their heads, this may indicate intense pain that can intensify with movement, sneezing, and a cough reflex. A characteristic sign of the disease is vomiting, not caused by overeating. The clinical picture is supplemented by visual disturbances, decreased intelligence.

Diagnosis of the disease

If pressure determination inside the skull is required, then it becomes necessary to introduce a special needle equipped with a pressure gauge into its fluid cavities.

This procedure is quite complicated and unsafe, it is performed exclusively in adults. Other methods are used to establish the diagnosis:

  • Ultrasound examination of blood vessels to establish violations of the blood outflow from the skull.
  • Magnetic resonance imaging (MRI) or X-ray computed tomography (CT) of the brain. An indirect MR or CT sign will be the presence of an accumulation of cerebrospinal fluid in the form of a butterfly inside the brain and a wide white border outside, the expansion of fluid cavities.
  • Echoencephalography.

Diagnosis of the disease in infants occurs in other ways, which include:

  • A neurologist examines the condition of the fontanel in a newborn, during which there is also an assessment of the size of the head and muscle tone.
  • Neurosonography (ultrasound of the brain).
  • Ophthalmologist examination of the fundus of the baby.
  • Computed tomography and magnetic resonance imaging.

Pathogenesis

The human brain is located inside the cranium – this is an enclosed space with rigid walls, in which approximately 80% of the volume is occupied by the brain substance itself, about 15% is cerebrospinal fluid, and the remaining 5% is allocated to blood. Cerebrospinal fluid (cerebrospinal fluid) is produced in special vascular plexuses, it constantly circulates between the ventricles of the brain and the subarachnoid space, where it is absorbed into the venous sinuses. Liquor performs a protective and nutritional function, and also creates a certain pressure on the walls of the skull and brain structure.

Normally, ICP (intracranial pressure) is not felt by a person, its value is from 3 to 15 mm RT. Art. When coughing, straining, lifting weights or screaming, a short-term increase in ICP may occur, which occurs after the person returns to his original state.

A persistent and long-term increase in ICP leads to the exhaustion of the compensatory capabilities of the body, chronic intracranial hypertension develops.

This happens when the normal ratios of all components of the cranial box are violated (for example, due to an increase in the amount of cerebrospinal fluid, impaired venous outflow, the appearance of edema or pathological volumes in the brain substance, etc.).

Under normal conditions, it is impossible to measure the rate of intracranial (intracranial) pressure, unlike blood pressure, this can only be done during a neurosurgical operation or during a spinal puncture.

A marked increase in pressure in the confined space of the skull causes the development of a condition such as intracranial hypertension syndrome.

This pathology is dangerous because, as a result of compression of the brain substance, metabolic processes in neurons are disturbed, dislocation (displacement) of individual brain structures can occur, up to the wedge of the cerebellum and medulla oblongata in the occipital foramen, followed by a violation of vital functions.

Causes

What can increase intracranial pressure? In adults and children there are some differences in the etiology of the problem. Common is the severity of the pathology. There are 2 groups of causes of intracranial hypertension.

  1. the presence of an additional formation that increases the volume of the brain (the growth of a tumor, cyst, the formation of a hematoma, cerebral aneurysm, the development of an abscess);
  2. edema of the substance of the brain that arose against the background of encephalitis, traumatic brain injury, hypoxia, with ischemic strokes, poisoning, with encephalopathy of hepatic etiology;
  3. edema of the cerebral membranes – pachymeningitis, arachnoiditis;
  4. disorders of cerebrospinal fluid dynamics (hydrocephalus) – arising from an increase in production, impaired absorption of cerebrospinal fluid or the presence of an obstacle to its outflow.
  1. increased blood flow to the brain with hyperthermia, hypercapnia (carbon dioxide poisoning), hypertension;
  2. difficulty in venous outflow from the cranial cavity (for example, discirculatory encephalopathy in elderly patients);
  3. a constant increase in intrathoracic or intra-abdominal pressure.

In adult patients, cerebral hypertension is most common against the background of acquired encephalopathy of post-traumatic, vascular, toxic, and discirculatory genesis. In childhood, among the causes, innate factors prevail:

  • various anomalies in the development of the central nervous system – microcephaly, congenital form of hydrocephalus;
  • birth injuries of the brain and their consequences – residual or residual encephalopathy with intracranial hypertension (manifests itself some time after an injury and brain hypoxia during childbirth);
  • intrauterine neuroinfection (meningitis, arachnoiditis, encephalitis);
  • congenital tumor formations of the brain (craniopharyngioma).

With the course, acute and chronic forms of ICH are distinguished. The first is usually the result of damage to the brain as a result of traumatic brain injuries, strokes or infections, the second develops gradually against the background of slowly growing tumors, cystic formations or as vascular disorders increase. This includes residual encephalopathy in children and adults.

A pathology such as idiopathic or benign intracranial hypertension is distinguished, the etiology of which is considered to be unknown. Most often, it develops in women with overweight.

The role of endocrine disorders, chronic kidney diseases, poisoning, treatment with corticosteroid drugs and antibiotics is being studied.

With this form of hypertension, volumetric formations are not detected, there is no thrombosis of venous sinuses and signs of infectious brain damage.

symptomatology

In young children, intracranial hypertension can remain compensated for a rather long time due to the softness of the bones and the presence of elastic sutures between them, this explains the long subclinical course of the disease. Signs of pathology in infants can be restless behavior, screaming, refusal to eat, vomiting “fountain”, bulging fontanel and divergence of stitches. In chronic hypertension, children lag behind in neuropsychic development.

In aged patients, the clinical picture is typical, its severity depends on the form of the disease. In the acute course of intracranial hypertension, the symptoms in adults will be vivid:

  • a severe headache of a bursting nature throughout the skull, especially in the symmetrical frontal and parietal areas, often bothers in the morning after getting up from the bed, increases with tilting the head and coughing;
  • feeling of pressure on the eyes;
  • nausea, sometimes sudden vomiting without preliminary nausea, especially in the morning;
  • transient visual disturbances in the form of fog or “flies” in front of the eyes, double vision, loss of visual fields;
  • noise in the head, dizziness;
  • neurological picture – the appearance of focal symptoms from different pairs of cranial nerves.

With a sharp increase in ICP, for example, in acute craniocerebral hypertension, there are often disorders of consciousness up to the confluence of a coma.

The chronic form of ICH usually proceeds calmer. Headache can be of constant, moderate intensity with periods of aggravation.

Deterioration of the general condition of the patient occurs gradually: insomnia, irritability, meteosensitivity, chronic fatigue.

Sometimes crises may occur with increased blood pressure, headache, vomiting, respiratory distress, and short-term impaired consciousness.

Benign intracranial hypertension in most cases is manifested by transient visual impairment, which often precede the appearance of a headache of varying intensity, bilateral symptoms of bilateral symptoms of the abducent pair of cranial nerves that innervate the eye muscles and are responsible for turning the eye outward.

How to diagnose

If you suspect an ICH, first of all, an anamnesis is collected, a patient is examined, and the clinical manifestations of the disease are evaluated. The examination plan is determined in accordance with the identified symptoms of ICH.

It is possible to accurately determine the increase in intracranial pressure only with the introduction of the pressure gauge needle into the cerebrospinal fluid during lumbar puncture or in the cavity of the ventricles of the brain during neurosurgical interventions. This is a very complex and dangerous procedure, which is carried out according to special indications in adults.

For example, spinal puncture is a mandatory procedure for suspected subarachnoid hemorrhage or meningitis.

Invasive intracranial pressure measurement using special sensors located in the cranial cavity is most often used for cerebral edema caused by severe traumatic brain injury.

Other methods allow only indirect signs of intracranial hypertension to be determined. What it is:

  1. Puffiness of the optic nerves, expansion and tortuosity of the venous plexuses – this conclusion can be made by an ophthalmologist when examining the fundus.
  2. “Finger impressions” on the X-ray of the skull, destruction of the back of the Turkish saddle – indirectly indicate the continued existence of ICH, in addition, tumors are usually visible on the X-ray film.
  3. A significant decrease in normal venous blood flow is seen on an ultrasound scan with dopplerography of the vessels of the head, in combination with echo-encephalography, you can see dilated ventricles, displacement of brain structures, and the presence of a tumor. Ultrasound data of the brain are not always reliable, therefore, in the presence of doubtful results, a CT scan of the brain is performed to clarify the diagnosis.
  4. The rarefaction and thinning of the brain substance along the edges of the ventricles, the expansion of flu >

All data obtained during the examination are compared with the patient’s existing complaints and clinical signs, only on the basis of the totality of all the results, a diagnosis is made and intracranial hypertension is treated.

Classification

Cerebral hypertension occurs in acute or chronic form. The acute form is expressed in sharp changes in intracranial pressure, which can lead to death. In this case, emergency surgery is required – craniotomy. During the operation, the surgeon removes the affected areas, pressing on the substance of the brain.

The chronic course of pathology is accompanied by neurological disorders. Usually this form occurs due to the use of drugs, a prolonged illness, or after an injury.

Intracranial hypertension can be cerebrospinal, venous, benign.

Liquor

It develops as a result of the production of a large volume of spinal fluid, which leads to an increase in pressure. Liquor hypertension is accompanied by swelling of the optic nerves, in which the stagnant disc swells. Visual acuity decreases. Neurological disorders are absent.

Venous

Appears due to a slowdown in the outflow of venous blood from the brain. Venous hypertension is diagnosed with thrombosis, tumor neoplasms, emphysema.

Benign

Another name for the form is idiopathic. This species is not a disease, but refers to temporary disorders. It is formed as a result of exposure to negative factors: hypovitaminosis, obesity, menstrual irregularities, pregnancy, an excess of vitamin A, and cessation of medication.

A feature of the idiopathic form is the reversibility of symptoms, a mild course. Initially, the disease is expressed in the development of moderate headache, which is eliminated by taking an analgesic. The treatment of hypertensive patients with a benign form consists in adjusting the lifestyle and diet.

Methods of treating intracranial hypertension

The choice in favor of a particular treatment regimen depends primarily on the underlying disease that caused the development of cranial hypertension.

Intensive care is indicated with an increase in intracranial pressure above 20 mm Hg. Art., before surgery to facilitate access, in the event of dislocation syndromes, with cerebral edema (according to computed tomography or the presence of indirect signs), with a rapid increase in neurological symptoms.

Drug therapy consists in the use of diuretic (diuretic) drugs that can quickly reduce cranial pressure by removing fluid from the body. Substances of this group include furosemide, glycerol, mannitol, etc.

In order to support the functioning of nerve cells in cranial hypertension, neurometabolic drugs are prescribed. In some cases, corticosteroids, vasoconstrictors (vasoconstrictors) are indicated.

Therapy may include mechanical ventilation, the use of sedatives, normalization of the electrolyte composition of the blood, and other measures, depending on the symptoms.

The main treatment can be supplemented by physiotherapy, folk remedies (in this capacity, decoctions and infusions of medicinal herbs with diuretic and restorative effects are usually used).

Surgical treatment can be urgent and planned.

In some cases, shunting is performed – implantation of a special tube to create an artificial outflow of excess cerebrospinal fluid. Such types of bypass operations are performed: ventriculoatrial, ventriculoperitoneal and lumboperitoneal bypass.

If there are abnormalities on the part of the visual analyzer, surgical fenestration of the optic sheath may be necessary. During this operation, an opening is made of the membrane that surrounds the optic nerve, in order to reduce pressure on the nerve and remove a certain amount of fluid.

Let’s figure out how to treat intracranial hypertension.

Treatment of pathology should be aimed at eliminating the factor that led to increased pressure in the brain. During treatment, doctors use methods that contribute to the normalization of body weight.

The treatment of hypertension can be performed using drugs, using the surgical method, and also treatment without drugs and treatment with folk remedies can be performed.

During this treatment, the patient is prescribed medications. Patients suffering from intracranial hypertension are prescribed diuretic drugs (diuretics).

For a long time, Acetazolamide (Diacarb) provides excellent indicators for this purpose. In some cases, dexamethasone and methylprednisolone are added to diuretics.

Breasts are prescribed massage, nootropic and only in some cases diuretics. Sometimes in children, the cure comes on its own.

To prevent relapse, patients should limit themselves in the use of water and salt. Must monitor body weight. Stop smoking and alcohol. Exercising will help improve blood circulation. As a medical prophylactic, the doctor may prescribe Mexidol.

Surgical treatment of pathology is carried out in the case when taking medications did not give the expected effect. To lower the pressure of the cerebrospinal fluid, repeated lumbar punctures are performed.

Neurosurgeons use a sufficient number of bypass surgery techniques to normalize intracranial pressure.

An increase in intracranial pressure provokes not only the development of vivid clinical symptoms, which extremely negatively affect the patient’s well-being, but can also provoke the development of severe complications up to death. In this regard, the use of medical and non-therapeutic measures is the main task for intracranial hypertension.

It is permissible to use non-drug methods of therapy even at the stage of incomplete verification of the diagnosis, and they consist in normalizing the drinking regimen, performing special exercises of physiotherapy exercises and using physiotherapeutic techniques.

The basis of the pathogenetic orientation of intracranial hypertension therapy is drugs whose action is aimed at simultaneously reducing cerebrospinal fluid production and enhancing the process of cerebrospinal fluid absorption. The gold standard in this role is the diuretic regimen used. The drug of choice in eliminating the signs of intracranial hypertension at the stage of development of hydrocephalus is Diakarb in an effective therapeutic dose of 250 mg, the pharmacological effect of which is aimed at reducing the production of cerebrospinal fluid.

In a situation where even prolonged use of drugs of a diuretic pharmacological series does not have the desired effect in the form of stopping clinical manifestations and normalizing indicators of instrumental examination methods, it is advisable to prescribe glucocorticosteroid drugs (Dexamethasone in an initial daily dose of 12 mg).

In severe cases of intracranial hypertension, neuropathologists use pulse therapy, which consists in the parenteral administration of Methylprednisolone at 1000 mg per day for five days and the subsequent transition to taking the drug in oral form. This scheme, as a rule, is supplemented by the appointment of Diakarb in the usual therapeutic dose.

In order to correct venous intracranial hypertension, drugs are used that improve the outflow of venous blood from the brain, which includes Troxevasin in an average daily dose of 600 mg. As a symptomatic treatment of severe pain in the head, it is allowed to use drugs of the group of non-steroidal anti-inflammatory drugs (Nimid in the permissible maximum dosage of 400 mg), as well as anti-migraines (Antimigren in a daily dose of not more than 200 mg).

With a marked increase in intracranial pressure, parenteral administration of hypertonic solutions (400 ml of a 20% Mannitol solution) is permissible, the dehydrating effect of which is realized by the method of dehydration of the brain substance, which limits their use.

In acute intracranial hypertension, the occurrence of which has a clear connection with neurosurgical surgery, the use of barbiturate drugs is indicated (a single intravenous administration of thiopental sodium at a dose of 350 mg).

If intracranial hypertension is characterized by a progressive malignant course and is not stopped by any medications, the patient should use surgical correction of this pathological condition. The most common palliative method of surgical treatment for intracranial hypertension of any etiology is lumbar puncture, with the help of which mechanical removal of a small amount of cerebrospinal fluid occurs (no more than 30 ml per one manipulation).

The operational benefit “lumbar-peritoneal shunting” has a longer and more pronounced positive effect in relation to leveling not only manifestations, but also the pathogenetic mechanisms of development of intracranial hypertension. As an surgical treatment for visual disturbances that develop at a late stage of intracranial hypertension, decompression of the optic sheaths is used.

Intracranial hypertension – which doctor will help? If there is or is suspected of developing intracranial hypertension, you should immediately consult a doctor such as a neurologist and therapist.

How and how to treat

Treatment of intracranial hypertension is carried out by conservative and surgical methods. Drug therapy is recommended for a chronic form of pathology without pronounced progression or for slow dynamics of symptoms of acute form of ICH, if there are no signs of impaired consciousness and dislocation of brain structures.

The basis of therapy are diuretics, the choice of which depends on the severity of the disease. An acute course requires the use of osmotic diuretics (Mannitol, Mannitol), in other situations, Furosemide (Lasix), Veroshpiron, Aldactone, Hypothiazide are used. In benign ICH, the drug of choice is Diacarb.

At the same time, the causes of hypertension are being treated: antibiotics are prescribed for infectious and inflammatory lesions of the brain, venotonics for venous congestion, detoxification for poisoning, etc. Women with a benign form of ICH require endocrinologist consultation and weight loss.

According to indications, metabolite drugs (Glycine, Piracetam and others) are used, although their effectiveness is controversial. In addition, the conservative therapy complex includes medical and protective measures with a limited load on the eyesight.

In the case of ineffective drug therapy or with the rapid progression of pathology, surgical methods of treatment are used. Operations are carried out in two modes:

  1. Emergency interventions – removing excess fluid by puncture of the ventricles of the brain and the installation of a catheter. In extreme cases, decompression trepanation of the skull is performed (a defect is artificially created in the bones on one side of the skull to reduce brain compression).
  2. Scheduled operations – laying an artificial path for the outflow of cerebrospinal fluid (bypass), while the excess fluid is sent from the skull to the abdominal cavity.

It is possible to treat ICH with folk remedies only after examination and the establishment of the cause of the pathology.

Medical events

Initially, it is necessary to examine the patient, to study the condition of the eyeballs and blood vessels. With pronounced red eyes with enlarged capillaries, intracranial hypertension can be suspected. A person is sent for an ultrasound scan of the brain vessels. The study establishes the presence of violations in the outflow of blood.

It is possible to accurately detect the presence of the disease by measuring the pressure of the cerebral fluid cavities. For this, invasive manipulation is performed. The doctor inserts a special needle into the ventricles or other structures of the brain. Then the specialist attaches a pressure gauge to the needle. To measure pressure, special sensors are also used, which are implanted in the skull box. A similar procedure is carried out under the control of magnetic resonance imaging.

Magnetic resonance imaging and computed tomography assess the state of the cerebral ventricles, fluid cavities. As a concomitant diagnostic method, an encephalogram is performed.

It is much more difficult to detect the disease in children, especially in infants who are not able to maintain a static position and express their feelings. The standard procedures that detect a pathological condition in a child include the collection of necessary blood tests, puncture, examining the spinal fluid, neurosonography in newborns. Consultation of a psychologist, neurologist, cardiologist, endocrinologist is also required.

In order to prevent the development of hypertension syndrome, it is necessary to consume more than a liter of water per day. Also, diuretics and glucocorticoids should not be taken uncontrollably.

The prognosis of the disease depends on the cause of the ICH, the correctness and timeliness of therapy, and brain compensatory abilities. If the syndrome has a malignant etiology, then a fatal outcome is possible. The benign course of hypertension is easily amenable to therapy.

First of all, the treatment of intracranial hypertension should be aimed at the main causes that led to the formation of the syndrome.

A direct decrease in intracranial pressure is based on four basic principles:

  • Monroe-Kelly Doctrine (required to bring to balance the amount of intracranial volumes);
  • Escalation of therapy (a gradual transition from the started treatment to a more complex and aggressive correction);
  • Normalization of the vascular link (vasodilation and vasoconstriction processes);
  • Impact on factors of secondary damage to the brain (ischemia, hypoxia, decreased perfusion).

Before treating a patient, it is necessary to classify the level of increase in intracranial pressure.

Benign and idiopathic intracranial hypertension, as a rule, respond well to treatment. Such conditions are corrected by the use of antioxidants, vitamin and mineral complexes, therapeutic exercises, normalization of the regime of work and rest, and optimization of the diet. In addition, light diuretic drugs (mainly diuretic herbs) can be used. Such conditions can be treated on an outpatient basis.

Severe cerebral hypertension requires hospitalization in a specialized hospital. Decreased intracranial pressure is phased. In this case, treatment is divided into prophylactic and emergency.

The first includes therapy aimed at eliminating factors that can aggravate and / or accelerate the development of intracranial hypertension. To this end, the doctor corrects:

  • Violations of the venous outflow;
  • Respiratory distress;
  • Hyperthermia;
  • Systemic hemodynamics.

In the absence of a result from preventive therapy, they resort to emergency measures. For this, a stepwise algorithm for reducing intracranial pressure is used:

  • CT is performed to eliminate the need for surgical correction of the condition. In some cases, it is required to do an MR diagnosis, which better visualizes volumetric formations. If there is evidence, they put systems of controlled discharge of cerebrospinal fluid;
  • Perform hyperventilation;
  • Hyperosmolar solutions are introduced (preparations “Mannitol” and “HyperHAES”);
  • If the previous measures are ineffective, the patient is injected into the drug barbiturate coma;
  • Apply artificial hypothermia. Lowering the temperature of the brain reduces the processes of metabolism of the nervous tissue, and, accordingly, cerebral blood flow.
  • If necessary, resort to decompressive trepanation of the skull to increase intracranial volume.

The use of hyperosmolar solutions, especially constant, can be accompanied by a change in the decrease in intracranial pressure with its subsequent jump due to the accumulation of drugs in the substance of the brain.

The presence of intracranial hypertension is a serious complication of brain diseases. Its severity determines the clinical manifestations of the syndrome, the amount of treatment required and the prognosis. Timely seeking medical help can significantly reduce the risks of developing secondary effects of intracranial hypertension and achieve the necessary results of therapy.

The prognosis depends on the rate of increase in pressure inside the skull (rapidly progressive hypertension has a worse prognosis), the course of the underlying disease, as well as the timeliness of diagnosis and the adequacy of treatment.

With uncomplicated cranial hypertension, the prognosis is generally favorable. Lifestyle correction and supportive therapy help keep intracranial pressure under control and avoid complications.

Often patients ask a question whether they will take into the army a person with such a disease. The answer to it depends on the cause of the increase in intracranial pressure and the severity of the patient’s condition.

The consequences of ICH

The brain loses functionality when it is in an unhealthy strangled state. This leads to atrophy of brain cells, which affects a decrease in intelligence and a violation of regulatory processes. In the absence of treatment, compression of the brain provokes the displacement or wedging of parts into the base of the skull. Such a condition leads to death.

When squeezing, the brain can shift to the occipital or cerebellar part, the process is accompanied by squeezing the stem sections. In this situation, the patient dies from respiratory arrest. When wedging in the temporal lobe, the pupil expands, breathing is difficult, a person falls into a coma.

If wedging occurs in the area of ​​the designation, then the patient stalls, becomes drowsy, inhibited. Slows breathing. An increase in intracranial pressure provokes a rapid decrease in vision, since pathology leads to atrophy of the optic nerves.

If the necessary treatment is not provided for intracranial hypertension, the disease can lead to more serious consequences.

Such may be cerebral ischemia, displacement of its structures, compression of the brain, in extreme cases – a fatal outcome. Also, untreated pathology can lead to mental disorders, paralysis, mental retardation and blindness.

If we talk about intracranial hypertension and military service, then the recruiting office assesses the health status of a conscript on the basis of pneumoencephalography or MRI, an ophthalmologist’s opinion and indicators of cerebrospinal fluid pressure.

But if they recognize them fit for military service, then only with restrictions.

When all the recommendations of the doctor are followed and the rules of a healthy lifestyle are observed, benign intracranial hypertension can be completely eliminated.

Increased intracranial pressure is a common diagnosis. It can be established if the patient has a severe neurological disease, as well as in a practically healthy person. The causes of the pathology can be different, its clinical manifestations vary. However, in any case, manifestations of intracranial hypertension can result in undesirable consequences.

Basic Concepts

Intracranial pressure is the difference in pressure in the cranial cavity and atmospheric. Normally, this indicator in adults is from 5 to 15 mmHg. The pathophysiology of intracranial pressure is subject to the Monroe-Kelly doctrine. The basis of this concept is the dynamic balance of three components:

A change in the pressure level of one of the components should lead to a compensatory transformation of the others. This is mainly due to the properties of blood and cerebrospinal fluid to maintain the constancy of acid-base balance, that is, to act as buffer systems. In addition, the brain tissue and blood vessels have sufficient elasticity, which is an additional option to maintain such a balance. Due to such protective mechanisms, the normal pressure inside the cranium is maintained.

If any causes cause a breakdown in regulation (the so-called pressure conflict), intracranial hypertension (ICH) occurs.

In the absence of a focal reason for the development of the syndrome (for example, with moderate overproduction of cerebrospinal fluid or with slight venous discirculation), benign intracranial hypertension is formed. Only this diagnosis is present in the international classification of diseases ICD 10 (code G93.2). There is a slightly different concept – “idiopathic intracranial hypertension.” In this condition, the etiology of the syndrome cannot be established.

Pathophysiology

Currently, it has been reliably established that the level of intracranial pressure above 20 mmHg leads to difficulty in cerebral blood flow and a decrease in brain perfusion. Thus, secondary cerebral ischemia is formed. In addition, the consequences of ICH can also be expressed in the displacement of brain structures along the pressure gradient. Such a circumstance can act as a cause of the development of a dislocation syndrome and a brain wedging into a large occipital foramen.

The main diseases that provoke the development of intracranial hypertension are:

  • Traumatic brain injuries;
  • Hydrocephalus;
  • Cerebrovascular pathology (including venous discirculation);
  • Neuroinfection;
  • Neoplasms of the brain, including benign (for example, cerebrospinal fluid cyst);
  • Status epilepticus;
  • Central autonomic dysfunction.

In addition to brain damage, an increased level of intracranial pressure can also provoke extra-neural causes. They can be systemic endocrine disorders, damage to the immune system, metabolic disorders, generalized infections, severe cardiovascular and pulmonary pathology. Some drugs (such as fluid retention in the body) also contribute to the development of the syndrome.

Persistent ICH with a pressure level above 20 mmHg is extremely dangerous, since it significantly increases the likelihood of a fatal outcome and the development of a vegetative status.

Graduation

The level of intracranial pressure is an individual value. In adults, it can vary, other things being equal, in the range of 5-7 mm Hg. Also, indications will depend on:

  • Human age;
  • Body position;
  • The presence of intracranial pathology.

In adults, the rate of intracranial pressure is twice as high as in children older than a year. A low head position also contributes to an increase in this parameter. However, such a fluctuation is insignificant, more often than not it leads to subjective feelings and is not considered as pathological.

Pathological conditions provoke the development of intracranial hypertension. Its severity determines the clinical manifestations of the syndrome. The higher the gradation of increased intracranial pressure, the more neurological disorders the patient should expect. Intracranial hypertension is divided into the following degrees:

  • Weak (16 – 20 mm Hg);
  • Medium (21 – 30 mm Hg);
  • Pronounced (31 – 40 mm Hg);
  • Extremely pronounced (more than 41 mm Hg).

Intracranial hypertension can be diagnosed both in individuals with severe neurological disorders and in practically healthy people.

Clinic

The clinical picture of the pathological condition will directly depend on the severity of hypertension. If the causes of intracranial hypertension lie in severe cerebral diseases, neurological disorders that are due to the underlying pathology come to the fore. The symptom complex in this case is predetermined by the localization and speed of propagation of the intracranial process.

Benign intracranial hypertension is characterized by the presence of cerebral and disseminated neurological microsymptomatics. An increase in intracranial pressure can be suspected if a person:

  • Frequent headaches;
  • Dizziness;
  • Unmotivated mood swings;
  • Increased drowsiness;
  • Feeling tired and overwhelmed;
  • Nausea and vomiting not associated with food intake;
  • Signs of autonomic dysfunction.

Similar symptoms of intracranial hypertension are nonspecific and can occur in a number of other diseases.

Progressively increasing intracranial hypertension is manifested by depression of consciousness up to a coma and the appearance of focal neurological deficit (paresis, sensory disturbances, cerebellar syndrome, speech disorders). In addition, signs of intracranial hypertension can occur in the form of the so-called Cushing triad:

  • Arterial hypertension;
  • Slow heart rate
  • Breathing problems.

However, with long-running and slowly progressing processes, objective symptoms can be hidden for a long time.

Reliably confirm the diagnosis of “syndrome of intracranial hypertension” is possible only with a combined analysis of clinical and instrumental data.

Diagnostics

An accurate diagnosis of intracranial hypertension is possible only after a direct measurement of the pressure level of the fluid in the brain. For this purpose, an invasive procedure is performed – a special needle with a mandrin is inserted into the cerebral sinuses, ventricles or subarachnoid spaces, after which a pressure gauge is attached.

In cases where such a direct procedure cannot be used or its implementation is inappropriate, rely on indirect signs of increased intracranial pressure. These include:

  • Curvature and dilatation of the fundus veins, optic nerve edema with ophthalmoscopy;
  • Venous discirculation, high pulsation index according to ultrasound dopplerography of the vessels of the head and neck, rheovasography, duplex scanning;
  • Deformation of cerebral cavities, a large volume of the lesion and periventricular rarefaction of brain tissue during neuroimaging (CT and MRI);
  • The displacement of the middle structures according to the results of echoencephaloscopy.

The use of CT and MRI does not allow to reliably judge the presence of intracranial hypertension.

Conclusion

Intracranial hypertension is a dangerous consequence of brain diseases. The degree of manifestation of the pathology is determined by the symptoms, treatment methods and prognosis. With timely medical attention, secondary complications of intracranial hypertension can be avoided.

The following sources were used to prepare the article: Tsarenko S.V. Correction of intracranial hypertension // Research Institute of Emergency Care. N.V. Sklifosovsky. – 2011.

Magzhanov R.V., Davletova A.I., Bakhtiyarova K.Z., Pervushina E.V., Tunik V.F. Benign intracranial hypertension: clinical observations // Annals of Clinical and Experimental Neurology – 2017.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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