Intracranial hypertension in children and adults - causes and symptoms, diagnosis, therapies and prevention

What is intracranial hypertension

The syndrome of intracranial hypertension is an increased intracranial pressure( intracranial pressure - in the subarachnoid, epidural spaces, cerebral ventricles, venous sinuses of the brain) .This condition is also called a cerebro-hypertensive syndrome or a syndrome of cerebrospinal hypertension, due to the fact that this pathology affects the overall pressure in the cerebrospinal fluid system. It occurs, as a rule, against the background of a head injury or due to the development of complications of severe systemic disease.

Intracranial pressure is divided into primary( idiopathic, benign intracranial hypertension), diagnosed after exclusion of other forms of the disease, and secondary. An acute condition occurs against the background of an infectious process or a craniocerebral trauma, the chronic develops due to vascular disorders, the appearance or growth of a neoplasm, as a complication after a surgical operation on the brain.

Causes of

The intracranial pressure rises as a result of an increase in the volume of any structure located in the cranial cavity. The result is compression of the brain, fraught with dismetabolic changes in neurons, the displacement of cerebral structures, the disruption of vital functions due to compression of the brain stem, because it contains the respiratory and cardiovascular centers. All factors that cause acute or chronic cerebrospinal hypertension can be conditionally divided into the following large groups:

1. Vascular pathologies that cause excessive blood supply to the brain. Increased intracranial pressure occurs with an increase in blood flow( against hyperthermia, hypercapnia) or worsening of its outflow( for example, with discirculatory encephalopathy).
2. Cerebral edema or cerebral membranes, diffuse or local in nature( with brain contusions, ischemic stroke, encephalitis and hepatic encephalopathy, hypoxia, meningitis or arachnoiditis).
3. Growth of neoplasm in the cranial cavity( hematoma, cyst, vascular aneurysm, abscess, metastatic tumor, etc.).
4. Liquorodynamic disorders associated with excessive secretion of cerebrospinal fluid( cerebrospinal fluid), impaired absorption or circulation( hydrocephalus).

The nature of benign, primary hypertension is not exactly defined. According to statistics, this pathology is more often recorded in women in connection with a set of body weight. Therefore, the provoking factor is considered to be changes in connection with the restructuring of the endocrine system. Other possible reasons for doctors are the excess of group A vitamins, the intake of certain medications and the abolition of corticosteroids after prolonged therapy.

Intracranial hypertension in children immediately after birth develops as a result of brain development abnormalities( congenital hydrocephalus or microcephaly, arteriovenous malformations), or because of the following factors:

• adverse course of pregnancy or childbirth;
• intrauterine infection;
• fetal hypoxia;
• is a generic intracranial injury;
• asphyxia of the newborn.

Symptoms of intracranial hypertension

The main symptom of intracranial hypertension is a bursting, increasing, pressing headache, localized mainly in the frontal parietal area. Due to the fact that during the night in the horizontal position of the body the outflow of fluid from the cranial cavity worsens, the pain syndrome is more intense in the mornings and after three o'clock in the morning. Dull pain intensifies with physical exertion, sneezing and coughing, can be accompanied by dizziness, a feeling of pressure on the eyeballs from the inside, a feeling of heaviness and noise in the head.

In adults

The main symptom( headache) is associated with a number of concomitant nonspecific clinical signs. P Excessive intracranial pressure may be accompanied by the following phenomena and conditions:

• Nausea or vomiting, not related to food intake, occurring suddenly, at the peak of a headache or immediately after awakening. After vomiting, the pain is weakened and the patient feels relieved.
• High fatigue with mental or physical exertion .In a number of cases it is accompanied by the symptoms of neurasthenia - emotional instability, nervousness, tearfulness and irritability, sleep disturbances.
• Failures in the work of the autonomic nervous system, expressed by changes in blood pressure, intense heartbeat, increased sweating.
• Meteosensitivity, worsening of well-being and increased symptomatology with changes in atmospheric pressure.
• Visual impairment( blurred vision, double vision, soreness in the movement of the eyeballs).
• Seizures, depression, coma( in severe severe condition).

Idiopathic hypertension rarely causes vomiting, a headache with this type of increased intracranial pressure is accompanied by transient impairment of vision, pain behind the eyes, diplopia, synchronous pulse with tinnitus. Oppression of mental functions( inhibition, short-term loss of consciousness, etc.) with idiopathic hypertension does not occur.

In children

Elevated intracranial pressure in a child diagnosed at the age of up to one year is in most cases a consequence of birth trauma or developmental disorders during the prenatal period of life. Characteristic signs of intracranial pressure disorders in children in the first year of life are:

• . Fusion of the fontanel, its pulsation.
• Behavioral disorders - the child confuses the time of day, becomes sluggish or overly overexcited.
• Convulsive syndrome.
• Anxiety, capriciousness.
• Loss of appetite.
• Drowsiness.
• Decreased muscle tone.
• Vomiting, frequent regurgitation.

With the growth of the baby, in the absence of adequate timely therapy, the head volume increases to indicators that exceed the norm, against the backdrop of developing hydrocephalus. The child suffers from a severe headache, signs of neurasthenia, blood pressure jumps, symptoms of permanent loss of consciousness can begin to appear.

Consequences of

In intracranial hypertension, the brain is in a compressed state, due to which there is a violation of its functions, failure of the nervous regulation of internal organs, a decrease in intellectual abilities and atrophy of the medulla. Perhaps the development of dislocation syndrome - the displacement of some brain structures relative to others. The following are the likely consequences of these disorders:

• Organic irreversible lesions of the kidneys, heart, fundus and other target organs.
• Movement coordination malfunctions.
• Weakness of arms and legs.
• Severe visual impairment, in severe cases - its loss.
• Deterioration of cognitive functions of the brain.
• Nasal bleeding.
• Disturbances of cerebral circulation( rarely).

Diagnosis

If a patient is suspected of having cerebrospinal fluid hypertension, a number of physical and instrumental examinations are performed. Evaluation of the index of intracranial pressure is a difficult task for a neurologist, because the degree of its fluctuations is significant. A simple and convenient way of measuring the indicator does not exist, approximate data in conjunction with the overall clinical picture can be obtained as a result of echo-encephalography. The level of hypertension can be determined by lumbar puncture( by direct injection of the needle into the cerebrospinal fluid) or by puncture of the ventricles of the brain.

On examination, the patient is diagnosed with edema of the optic disc( with the help of ophthalmoscopy), assesses the condition of the cranial nerve, and the bones of the skull according to the results of radiography. A neurological examination is performed, muscle tone, gait, mental state, activity level and patient's susceptibility are evaluated. Instrumental examination includes:

• CT( computed tomography).Helps to identify hemorrhage, determine the change in ventricular size, the effect of mass.
• Intravenous contrast. It is performed if there is a suspicion of a blood-brain barrier violation in case of infection or inflammation.
• MRI( magnetic resonance imaging) or magnetic resonance angiography. It is done if there is a suspicion of a venous sinus thrombosis.
• CT angiography or intraluminal angiography.
• Neurosonography( for newborns).

Treatment of intracranial pressure

Based on the results of diagnostic activities, adequate treatment of intracranial hypertension in adults is selected, depending on the cause of the pathology and the clinical picture of the disease. The main goal of therapy is to reduce the amount of excess fluid, to remove surplus liquor. The main methods are conservative, physiotherapeutic and surgical treatment. In parallel, they struggle with the original pathology, which causes an increase in intracranial pressure.

Medication therapy

Correction of pathology using medical products is performed in accordance with the symptoms, the causes of intracranial hypertension. The main role in reducing the indices is played by diuretics( in severe cases - Mannitol or other osmodiuretics, in a medium state - Spironolactone, Hydrochlorothiazide, Furosemide, Acetazolamide) .In parallel with diuretics, potassium preparations( asparaginate or potassium chloride) are used to increase their effectiveness. Dosage and treatment scheme is selected individually, by the attending physician.

Depending on the clinical picture of the underlying disease that caused an increase in intracranial pressure, within the framework of etiotropic therapy is prescribed the following drug groups:

• Hormonal steroid preparations.
• Neurometabolic( Piracetam, Porcine Brain Hydrolyzate, Glycine, Gamma-Aminobutyric Acid, etc.) - to maintain the functions of the nervous system.
• Antiviral drugs, antibacterial drugs - in the presence of an infectious or inflammatory process.
• Vasoactive - in vascular disorders( Nifedipine, Aminophylline).
• Venotonics - with expressed venous stasis( Diosmin with Hesperidin, Dihydroergoccristine)

Physiotherapeutic procedures

Physiotherapy with liquor hypertension helps to relieve stagnant phenomena in the movement of lymph and blood, normalize their circulation, increase the rate of metabolic processes. A good therapeutic effect is provided by the observance of a special low-salt diet and drinking regimen. As an auxiliary method for increasing the effectiveness of conservative treatment, the following can be prescribed:

• Medical gymnastics( helps reduce pressure and reduce pain syndrome).
• Massage.
• Acupuncture.
• Physiotherapy, for example, electrophoresis with lidazo d - the process of electric shock with parallel subcutaneous administration of the drug.

Surgery

Moderate intracranial hypertension responds well to conservative therapies. In a number of cases, according to indications( for example, an emergency reduction in intracranial pressure with an increased risk of developing a dislocation syndrome), surgical intervention is required, for example, following operations:

• Decompression trepanation of the skull.
• External vertical drainage.
• Cerebral bypass.

Forecast and Prevention

Prognosis of intracranial hypertensive syndrome depends on the rate of increase in pressure indicators, individual compensatory abilities of the patient's brain, timeliness and correctness of the medical measures taken. A lethal outcome threatens the patient with the development of a dislocation syndrome. In newborns, cerebrospinal fluid hypertension may contribute to developmental delay, the formation of imbecility or debility of .The idiopathic form of the disease is well treatable, in most cases the prognosis is favorable.

The preventive measures of pathology include the timely access to a doctor at the appearance of signs of the disease( in order to avoid severe brain damage and the development of dangerous complications). General rules, according to the recommendations of doctors, are the following methods of prevention:

• rationing of the regime of work and rest;
• healthy day regimen;
• avoidance of mental overload;
• performance of medical prescriptions during pregnancy and childbirth.

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