Intracranial hypertension: symptoms and treatment

Intracranial hypertension is a pathological condition in which pressure builds up inside the skull. That is, in fact, it is nothing more than increased intracranial pressure. There are a great number of reasons for this condition( starting from the immediate diseases and brain injuries and ending with metabolic and poisoning disorders).Regardless of the cause, intracranial hypertension manifests itself with the same symptoms: a bursting headache, often combined with nausea and vomiting, visual impairment, inhibition, slowed-down mental processes. This is not all signs of a possible syndrome of intracranial hypertension. Their spectrum depends on the cause, duration of the pathological process. Diagnosis of intracranial hypertension usually requires the use of additional methods of examination. Treatment can be both conservative and operative. In this article we will try to understand what kind of state it is, how it manifests itself and how to fight it.

Causes of formation of intracranial hypertension

The human brain is placed in the cranial cavity, that is, the bone box, the dimensions of which do not change in an adult. Inside the skull is not only the brain tissue, but also cerebrospinal fluid and blood. Together, all these structures occupy an appropriate volume. Cerebrospinal fluid forms in the cavities of the ventricles of the brain, flows through the cerebral flow to other parts of the brain, is partially absorbed into the bloodstream, partially flows into the subarachnoid space of the spinal cord. The volume of blood includes the arterial and venous channel. With an increase in the volume of one of the components of the cranial cavity, intracranial pressure also increases.

Most often, an increase in intracranial pressure occurs due to impaired circulation of cerebrospinal fluid( CSF).This is possible with an increase in its production, a violation of its outflow, a deterioration in its absorption. Circulatory disorders cause poor arterial flow and stagnation in the venous area, which increases the total volume of blood in the cranial cavity and also leads to increased intracranial pressure. Sometimes the amount of brain tissue in the cranial cavity may increase due to the edema of the nerve cells themselves and the intercellular space or the growth of the tumor( tumor).As we see, the appearance of intracranial hypertension can be caused by a variety of causes. In general, the most common causes of intracranial hypertension can be:

• craniocerebral trauma( concussions, bruises, intracranial hematomas, birth injuries, and so on);
• acute and chronic disorders of cerebral circulation( strokes, thrombosis of the sinuses of the dura mater);
• tumors of the cranial cavity, including metastases of tumors of other localization;
• inflammatory processes( encephalitis, meningitis, abscess);
• congenital anomalies in the structure of the brain, blood vessels, the skull itself( infection of the outflow of cerebrospinal fluid, Arnold-Chiari anomaly, and so on);
• poisoning and metabolic disorders( alcohol, lead, carbon monoxide poisoning, proprietary metabolites, eg, liver cirrhosis, hyponatremia, and so on);
• diseases of other organs that lead to difficulty in the outflow of venous blood from the cranial cavity( heart defects, obstructive pulmonary diseases, neoplasms of the neck and mediastinum, and others).

This, of course, is far from all possible situations leading to the development of intracranial hypertension. Separately, I would like to say about the existence of the so-called benign intracranial hypertension, when the increase in intracranial pressure appears as if for no reason. In most cases, benign intracranial hypertension has a favorable prognosis.

Symptoms of

Increased intracranial pressure leads to compression of nerve cells, which affects their work. Regardless of the cause, the syndrome of intracranial hypertension manifests itself:

• with a diffusive diffuse headache. Headache is more pronounced in the second half of the night and in the mornings( as the outflow of fluid from the cranial cavity deteriorates at night), is blunt in nature, accompanied by a feeling of pressure on the eyes from the inside. The pain increases with coughing, sneezing, straining, physical exertion, can be accompanied by noise in the head and dizziness. With a slight increase in intracranial pressure, one can feel just a heaviness in the head;
• with sudden nausea and vomiting."Sudden" means that neither nausea nor vomiting is provoked by any factors from outside. Most often, vomiting occurs at the height of the headache, during the period of its peak. Of course, such nausea and vomiting are not at all connected with eating. Sometimes vomiting occurs on an empty stomach immediately after awakening. In some cases, vomiting is very strong, fountain-like. After vomiting, a person may experience relief, and the intensity of the headache decreases;
• increased fatigue, rapid exhaustion, both with mental and physical exertion. All this can be accompanied by unmotivated nervousness, emotional instability, irritability and crying;
• meteosensitivity. Patients with intracranial hypertension do not tolerate changes in atmospheric pressure( especially its decrease, which happens before rainy weather).Most of the symptoms of intracranial hypertension are amplified at these times;
• disorders in the autonomic nervous system. This is manifested by increased sweating, changes in blood pressure, palpitation;
• vision impairment. Changes develop gradually, initially being transitory. Patients mark the appearance of periodic fuzziness, as if the blurred vision, sometimes the image of objects is doubled. The movements of the eyeballs are often painful in all directions.

The duration of the symptoms described above, their variability, the tendency to decrease or increase is largely determined by the underlying cause of intracranial hypertension. The increase in the phenomena of intracranial hypertension is accompanied by the intensification of all signs. In particular, it can be manifested:

• by persistent daily morning vomiting on the background of severe headache for whole days( and not only at night and in the morning hours).Vomiting can be accompanied by persistent hiccups, which is a very unfavorable symptom( may indicate the presence of a tumor in the posterior cranial fossa and signal the need for immediate medical attention);
• increased oppression of mental functions( the appearance of inhibition, up to the violation of consciousness by the type of stunning, sopor and even coma);
• by increasing blood pressure along with respiratory depression( slowing) and slowing the heart rate to less than 60 beats per minute;
• appearance of generalized seizures.

If you have these symptoms, you should immediately seek medical help, since they all represent an immediate threat to the life of the patient. They indicate an increase in the phenomena of cerebral edema, in which it may be infringed, which can lead to death.

With prolonged existence of the phenomena of intracranial hypertension, with gradual progression of the process of visual impairment, they become not episodic, but permanent. A great help in the diagnostic plan in such cases is the examination of the ocular fundus by an ophthalmologist. On the ocular day, ophthalmoscopy reveals stagnant discs of the optic nerves( in fact, it is their edema), small hemorrhages in their zone are possible. If the phenomena of intracranial hypertension are quite significant and exist for a long time, gradually stagnant disks of optic nerves are replaced by their secondary atrophy. At the same time, visual acuity is disturbed, and it is impossible to correct it with the help of lenses. Atrophy of the optic nerves can result in complete blindness.

With the prolonged existence of persistent intracranial hypertension, expansion from the inside leads to the formation of even bone changes. The plates of the bones of the skull become thinner, the back of the Turkish saddle collapses. On the inner surface of the bones of the cranial vault, the gyrus of the brain appears to be imprinted( this is usually described as an increase in finger impressions).All these signs are found during the routine radiography of the skull.

Neurological examination in the presence of phenomena of increased intracranial pressure may not reveal any violations at all. Occasionally( and then with prolonged existence of the process), one can find a restriction of eyeballs sidetracking, changes in reflexes, a pathological symptom of Babinsky, a violation of cognitive functions. However, all these changes are nonspecific, that is, they can not testify to the presence of intracranial hypertension.

Diagnosis of

If suspicion of increased intracranial pressure requires a number of additional examinations, in addition to the standard collection of complaints, anamnesis and neurologic examination. First of all, the patient is sent to the oculist who will examine the fundus. Radiography of the bones of the skull is also prescribed. More informative methods of examination are computed tomography and magnetic resonance imaging, since they allow us to consider not only the skeletal structures of the skull, but also the brain tissue itself. They are aimed at finding the immediate cause of increased intracranial pressure.

Previously, for direct measurement of intracranial pressure, a spinal puncture was performed and pressure was measured using a manometer. At present, puncture with the sole purpose of measuring intracranial pressure in the diagnostic plan is considered inadvisable.

Treatment of

Treatment of intracranial hypertension can be carried out only after establishing the immediate cause of the disease. This is due to the fact that some drugs can help the patient for one reason of increased intracranial pressure and may be completely useless for another. And besides, in most cases, intracranial hypertension is just a consequence of another disease.

After an accurate diagnosis, first of all they are engaged in the treatment of the underlying disease. For example, in the presence of a brain tumor or intracranial hematoma resort to surgical treatment. Removal of a tumor or bleeding( with hematoma) usually leads to normalization of intracranial pressure without any accompanying measures. If the cause of increased intracranial pressure is inflammatory disease( encephalitis, meningitis), then the main treatment is massive antibiotic therapy( including the introduction of antibacterial drugs in the subarachnoid space with the extraction of part of the cerebrospinal fluid.) Mechanical extraction of cerebrospinal fluid during puncture allows to reduce intracranial pressure).

Symptomatic drugs that reduce intracranial pressure are diuretics of various chemical groups. With them, treatment is started in cases of benign intracranial hypertension. The most commonly used are Furosemide( Lasix), Diacarb( Acetazolamide).Furosemide is preferable to use a short course( Furosemide is prescribed in addition to potassium preparations), and Diacarb can be prescribed by various schemes that the doctor chooses. Most often Diakarb with benign intracranial hypertension is appointed intermittent courses for 3-4 days, followed by a break of 1-2 days. It not only removes excess fluid from the cranial cavity, but also reduces the production of cerebrospinal fluid, thereby lowering intracranial pressure.

In addition to drug treatment, patients are assigned a special drinking regime( not more than 1.5 liters per day), which allows to reduce the amount of fluid entering the brain. To some extent, help with intracranial hypertension is provided by acupuncture and manual therapy, as well as a set of special exercises( physical therapy).

In some cases it is necessary to resort to surgical methods of treatment. The type and extent of surgical intervention are determined individually. The most frequent routine operation with intracranial hypertension is bypass, that is, the creation of an artificial pathway to the outflow of cerebrospinal fluid. At the same time, with the help of a special tube( shunt), which one end is immersed in the cerebral cortex, and the other end into the heart cavity, the abdominal cavity, an excess amount of cerebrospinal fluid is permanently removed from the cranial cavity, thereby normalizing intracranial pressure.

In cases where intracranial pressure is rapidly increasing, there is a threat to the life of the patient, then resort to urgent measures of care. Intravenous administration of hyperosmolar solutions( Mannit, 7.2% sodium chloride solution, 6% HES), urgent intubation and artificial ventilation in the hyperventilation mode, introduction of the patient into the medicamentous coma( with the help of barbiturates), withdrawal of excess CSF by puncture( ventriculopuncture).If it is possible to install an intraventricular catheter, a controlled discharge of fluid from the cranial cavity is established. The most aggressive measure is decompressive trepanation of the skull, which is used only in extreme cases. The essence of the operation in this case is to create a defect of the skull from one or two sides so that the brain does not "rest" on the bones of the skull.

Thus, intracranial hypertension is a pathological condition that can occur in a variety of brain diseases and not only. It requires compulsory treatment. Otherwise, a variety of outcomes are possible( including complete blindness and even death).The earlier this pathology is diagnosed, the better the results can be achieved with less effort. Therefore, do not delay with a visit to the doctor if there is a suspicion of increased intracranial pressure.

Neurologist MM Shperling talks about intracranial pressure:

The opinion of pediatrician EO Komarovsky on intracranial hypertension in children: