Indirect signs of intracranial hypertension

Increased intracranial pressure( ICP), or intracranial hypertension - often meeting the clinical situation. It is believed that it is diagnosed mainly in children of early and preschool age. In fact, this problem has enough high relevance for adults, because they have a syndrome of intracranial hypertension may appear again for many diseases. And in the vast majority of cases, the diagnosis of elevated ICP is based on a set of indirect symptoms.

Contents of

1 When talking about elevated ICP
2 Symptoms of increased ICP: direct and indirect
3 Indirect signs of elevated ICP
4 Symptoms of increased ICP in children
5 Do these symptoms always indicate an elevated ICP?

When talking about increased ICP

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The pressure of cerebrospinal fluid contained in the cranial cavity is not a constant. His physiological fluctuations in an adult man are normally within the range of 3-15 mm Hg. Art. In children it is slightly lower, and the permissible values depend on age. For example, for newborns, liquor pressure of 1.5-6 mm Hg is normal.st, and for a child of preschool and primary school age - already 3-7 mm Hg. Art.

The physiological and transient moderate increase in cerebrospinal fluid pressure occurs regularly:

when crying;
for coughing and sneezing;
during straining during defecation and during labor;
against the background of deliberate retention of breathing( in untrained people);
with orgasm;
when lifting weights and in other everyday situations.

These transient episodes do not lead to brain damage, although they can pose a certain danger to people with arterial hypertension and vascular pathology. Reduction of such liquor pressure occurs quickly enough due to the compensatory activation of natural liquorodynamic mechanisms.

If the level of ICP alone is not corrected and remains permanently elevated, the syndrome of intracranial hypertension( increased intracranial pressure) is diagnosed. This requires mandatory detection of the causative factor, which will allow the doctor to make the most effective treatment regimen and to evaluate the prognosis.

Symptoms of increased ICP: direct and indirect

The only direct and unambiguous sign of intracranial hypertension is the instrumentally confirmed increase in cerebrospinal fluid pressure. The most reliable methods of diagnosis are invasive methods, with measurement of the level of pressure in the ventricles of the brain, subdural or epidural spaces of the skull. But they are used quite rarely, which is associated with their traumatism and the risk of infection of the meninges and nervous tissue.

In addition, invasive diagnosis is performed only to unambiguously confirm intracranial hypertension and to accurately determine the level of ICP increase. And in everyday clinical practice, the most important are the indirect signs of this syndrome, many of which underlie the emergence of a set of specific complaints. This is why a thoughtful analysis of the patient's deviations, coupled with the data of some studies, allows the competent doctor to correctly diagnose. At the same time, it is possible and overdiagnosis, because similar symptoms can appear and at a normal level of intracranial pressure.

Indirect signs of increased ICP

In adults and older children, the indirect clinical signs of increased intracranial pressure include:

Headaches of an exaggerating-pressing character. They are usually accompanied by a sensation of pressure in the nose region or from the inside to the eyeballs, often amplified in the early morning hours in a prone position. This is the most frequent and characteristic sign of increased intracranial pressure. Simple analgesics and NSAIDs are ineffective, and the decrease in the total( systemic) level of arterial pressure does not help either.
The increased meteosensitivity with deterioration of state of health at change of atmospheric pressure.
Functional disorders: mood instability with increased irritability, often with a tendency to tearfulness, increased fatigue, not always sufficient concentration of attention, sleep disturbances.
Vegetative disorders: increased sweating, strengthened vascular pattern with periodic appearance of marbling of the skin and acrocyanosis.
Recurrent nasal bleeding, spontaneous and often difficult to stop. Their appearance is associated with the inclusion of an emergency compensatory mechanism for the regulation of intracranial and arterial pressure. But they are not noted in all cases, they are predisposed to them by people with extensive and closely located venous plexuses in the walls of the nasal cavity.
Dizziness. It is unstable, non-systemic, usually worried when weather conditions change, neuro-emotional stress, increased blood pressure.
Vomiting that does not have a unique connection with food intake and is not explained by any intoxication or pathology of the gastrointestinal tract. And it is not always accompanied by clearly delineated nausea, does not lead to its relaxation and does not facilitate the condition.
Doubling in the eyes, blurred vision. Such violations are not mandatory and transitory, they arise in the acute decompensation of intracranial hypertension.
Epileptiform seizures( convulsive and non-convulsive), and abortive forms are possible. They are infrequent and usually do not go into epileptic status.
Transient mental disorders. They appear only in a small number of people with intracranial hypertension and are usually associated with decompensation of liquorodynamic disorders. It can be a perception disorder( from illusory disturbances to a true hallucinosis), impaired consciousness( confusion, stunnedness), asthenodepressive syndrome, dysphoria.

Suspected intracranial hypertension is possible and according to some studies. For example, in favor of this pathology is evidence of enlarged and full-blooded veins on the fundus, especially in combination with a picture of the edema of the optic nerve.

And on EEG with increased intracranial pressure, diffuse changes are often detected with signs of increased convulsive readiness of the cerebral cortex without specific focal epileptic activity. And such deviations are possible even in the absence of any attacks in the history.

Symptoms of increased ICP in children

The main indirect symptoms of intracranial hypertension in children of early life:

Increased excitability, tremor of the chin, tearfulness, superficial sleep with frequent awakenings and flinches, meteosensitivity. As the child grows, parents often start complaining about his restlessness, distractions and behavioral disorders, headaches appear when weather changes and overwork.
Frequent and profuse regurgitation in infants, which in some cases can be considered equivalent to vomiting.
Gradual change in the proportions and increase in the volume of the cerebral part of the skull, with the formation of the hydrocephalic shape of the head. In this case, the extension and later ossification of the sutures and fontanelles, thinning of the bones( up to the parchment density) is noted. And with a pronounced uncompensated increase in intracranial pressure, there may even appear bulging and pulsation of fontanelles, and sometimes ballotation of bones.
Diffuse and small-focal neurologic symptoms, which is a consequence of the reaction of brain tissue to excessive CSF pressure. Most often in infants, there is a change in the muscle tone, an excessively long preservation of the reflexes characteristic of the period of newborn. In older children, there may be violations of psycho-speech development, dystonia.
Reinforced venous pattern in the temporomandibular regions, pastosity and blueness of the infraorbital region.

Sometimes signs of intracranial hypertension are already observed in a newborn child, in this case it is a question of expressed congenital forms of hydrocephalus due to intrauterine infections or developmental anomalies. But most often the symptoms are manifested in the first half of life or during the first 2-3 years, becoming a reason for resorting to a pediatric neurologist or even a psychiatrist.

Do these symptoms always indicate elevated ICP?

It is important to understand that indirect clinical signs of elevated ICP appear only when internal compensatory mechanisms fail, and many patients with this pathology do not make certain complaints for a long time. And there is no single-valued relationship between the level of CSF pressure and the time of appearance of obvious clinical signs.

Some people experience discomfort with a slight excess of thresholds, others feel relatively healthy and with a slow increase in hypertension to 50-60 mm Hg. Art. Therefore, the doctor is guided not only by the complaints, but also on the deviations detected during examination and the picture of the fundus.

Do not forget, some signs( hydrocephalic shape of the head, a number of psychoneurological symptoms, autonomic dysfunction) persist after normalization of intracranial pressure. This is due to the irreversibility of the evolving changes. Therefore, the detection of such abnormalities requires careful clinical analysis to avoid overdiagnosis of the syndrome of intracranial hypertension.

The presence of 1-3 indirect signs of elevated ICP is not enough to diagnose and prescribe therapy. Self-medication is inadmissible. It is necessary to consult a doctor who will conduct a comprehensive assessment of the overall clinical picture, prescribe an examination to determine the etiology and determine the optimal therapeutic tactics.

Children's neurologist A. Ilyashenko talks about symptoms of intracranial hypertension in children:

Symptoms of intracranial hypertension - children's neurologist Alla Ilyashenko. Healthy interest. Issue 117