Intracranial hypertension - Causes, Symptoms, Diagnosis and Treatment

Intracranial hypertension - Increased intracranial pressure syndrome. It may be idiopathic or occur with various brain lesions. The clinical picture consists of a headache with pressure on the eyes, nausea and vomiting, and sometimes - transient vision disorders; in severe cases, there is disturbance of consciousness. Diagnosis is exposed to the light of clinical data, results of Echo EG, tomography, analysis of CSF, intraventricular monitoring of intracranial pressure, cerebral vascular Doppler ultrasound. Treatment includes diuretics, etiotropic and symptomatic therapy. According to the testimony of a brain operation.

  • The causes and pathogenesis
  • intracranial hypertension.
  • symptoms of intracranial hypertension.
  • Diagnosis of intracranial hypertension
  • Treatment of intracranial hypertension
  • Intracranial hypertension - treatment

  • Intracranial hypertension


    Neurology. We are talking about increased intracranial (intracranial) pressure. Since the level of the latter directly affects the pressure in the liquor system, intracranial hypertension is also known as liquor-hypertensive syndrome or hypertension liquor. In most cases, intracranial hypertension is secondary and develops due to head trauma or various pathological processes inside the skull.

    Widespread and primary, idiopathic intracranial hypertension, classified according to ICD-10 as benign. It is a diagnosis of exclusion, ie. E. Set only once not been confirmed all other causes of increasing intracranial pressure. Furthermore, acute and chronic isolated intracranial hypertension. The first is usually accompanied by head injuries and infectious processes, the second - vascular disorders, slow-growing intracerebral tumors, brain cysts. Chronic intracranial hypertension often acts EARN A PERMANENT result of acute intracranial processes (trauma, infection, stroke, toxic encephalopathy), as well as brain surgery.

    Metastatic brain tumors, cysts, hematoma, brain aneurysm, brain abscess). The second - a diffuse cerebral edema, or local character that develops against the backdrop of encephalitis, brain injury, hypoxia, hepatic encephalopathy, ischemic stroke, toxic lesions. The swelling is not actually brain tissue and cerebral membranes with meningitis and arachnoiditis also leads to hypertension liquor.

    The next group - it causes vascular nature, causes an increase in blood circulation in the brain. The excess amount of blood inside the skull may be associated with an increase in its inflow (during hyperthermia, hypercapnia) or obstruction of its outflow from the cranial cavity (with vascular encephalopathy with impaired venous drainage). The fourth group of reasons constitute liquorodynamic disorders, which in turn are caused by the increase likvoroproduktsii, violation of liquor circulation or decreasing absorption of cerebrospinal fluid (CSF). In such cases, we are talking about hydrocephalus - excess fluid in the cranium.

    Causes of benign intracranial hypertension are not clear. More often it occurs in women and in many cases linked to weight gain. In this regard, there is an assumption of a significant role in its formation endocrine adjustment body. Experience has shown that the development of idiopathic intracranial hypertension may cause an excessive intake of vitamin A in the body, intake of certain pharmaceutical products, the abolition of corticosteroids after long periods of use.

    Since the cranial cavity is a limited space, any increase in the size of the structures are in it entails the rise of intracranial pressure. The result is expressed in varying degrees of compression of the brain, leading to changes in its dismetabolic neurons. A significant increase in dangerous shift of cerebral structures (dislocation syndrome) intracranial pressure with herniation of the cerebellar tonsils into the foramen magnum. This results in compression of the brain stem, which entails a disorder of vital functions, as in the trunk of localized respiratory and cardiovascular nerve centers.

    Children etiofaktorami intracranial hypertension may act abnormalities of brain development (microcephaly, congenital hydrocephalus, cerebral arteriovenous malformation), intracranial birth trauma suffered by intrauterine infection, fetal hypoxia, asphyxia newborn. In early childhood skull bones softer and the joints between them are flexible and malleable. Such features contribute to significant compensation intracranial hypertension, which ensures its long sometimes subclinical.

    coma. Chronic intracranial hypertension usually leads to a deterioration in the general condition of the patient - irritability, sleep disturbances, mental and physical fatigue, increased meteosensitivity. It may occur with liquor-hypertensive crises - sharp rise in intracranial pressure, clinically severe headache, nausea and vomiting, and sometimes - a short-term loss of consciousness.

    Idiopathic liquor hypertension in most cases is accompanied by transient disturbances in the form of fogging, deterioration of image sharpness, ghosting. Decrease in visual acuity observed in approximately 30% of patients. Secondary intracranial hypertension is accompanied by symptoms of the underlying disease (obscheinfektsionnye, intoxication, cerebral, focal).

    CSF hypertension in children under one year manifests the change in behavior (restlessness, tearfulness, moodiness, a waiver of the breast), frequent regurgitation "fountain", oculomotor disorders, bulging fontanelle. Chronic intracranial hypertension in children can cause mental retardation with the formation of mental retardation.

    neurologist. The fact that the intracranial pressure (ICP) varies considerably, and clinicians still do not have a consensus of its norm. It is believed that the adult normal ICP in a horizontal position in the range of 70 to 220 mm of water. Art. In addition, there is a simple and affordable way to accurately measure the ICP. Echo-encephalography yields only rough data, the correct interpretation of which is possible only when compared with the clinical picture. On increasing intracranial pressure can indicate swelling of the optic nerve, detectable by an ophthalmologist during ophthalmoscopy. With long-term existence of the liquor-hypertensive syndrome in the X-ray of the skull revealed the so-called "digital impressions"; change shape and thinning of the cranial bones may occur in children.

    Reliably determine the intracranial pressure allows only the direct insertion of a needle into the cerebrospinal fluid space by lumbar puncture or ventricular puncture the brain. Currently developed electronic sensors, intraventricular but still is quite an invasive procedure and requires the creation of burr hole in the skull. Therefore, such equipment is used only neurosurgical department. In severe cases, intracranial hypertension, and in the course of neurosurgery it allows you to monitor ICP. In order to diagnose the cause of the pathology is used CT, spiral CT and MRI of the brain, cranial ultrasonography through the fontanelle, vascular Doppler ultrasound of the head, the study of cerebrospinal fluid, stereotactic biopsy of intracranial tumors.

    disorders of consciousness. The basis of treatment is diuretic pharmaceuticals. The choice of drug is dictated by the level of ICP. In acute and severe cases applied mannitol and other osmodiuretiki, in other situations, the drugs of choice are the furosemide, spironolactone, acetazolamide, hydrochlorothiazide. Most diuretics should be used during administration of drugs potassium (potassium asparaginata, potassium chloride).

    In parallel, we treat causal pathology. When infectious and inflammatory brain lesions assigned causal treatment (antivirals, antibiotics), and toxic - detoxification, vascular - vasoactive therapy (aminophylline, vinpocetine, nifedipine), venous stasis - venotoniki (dihydroergocristine, horse chestnut extract, Diosmin + hesperidin) and m. n. in order to maintain the functioning of nerve cells during intracranial hypertension in a complex therapy using neyrometabolicheskie means (gamma-aminobutyric acid, piracetam, glycine, brain, etc. hydrolyzate pig.). cranial manipulative therapy can be applied in order to improve venous outflow. In the acute phase the patient should avoid emotional overload, work to eliminate the computer and listen to audio with headphones, sharply restrict the viewing of movies and reading books and other activities with the load on the eyes.

    Surgical treatment of intracranial hypertension, and planned emergency basis applies. In the first case, the goal is an urgent reduction of intracranial pressure in order to avoid the development of dislocation syndrome. In such situations, neurosurgeons often performed decompressive craniotomy, according to testimony - an external ventricular drainage. The planned intervention is aimed at addressing the causes of increased intracranial pressure. It may be to remove the intracranial volume of education, correction of congenital anomalies, hydrocephalus liquidation using cerebral artery bypass grafting (kistoperitonealnogo, ventriculoperitoneal).

    Prediction and prevention

    intracranial hypertension.

    Exodus liquor-hypertensive syndrome depends on the underlying pathology, the rate of increase in ICP, the timeliness of treatment, compensatory brain abilities. With the development of dislocation syndrome may be fatal. Idiopathic intracranial hypertension has a benign course and usually respond well to treatment. Long liquor hypertension in children may lead to a delay of mental development with the formation or retardation imbecility.

    Prevent the development of intracranial hypertension allows prevention of intracranial pathology, timely treatment neuroinfections, dyscirculatory and liquorodynamic disorders. Preventive measures include the observance of the normal mode of the day, regulation of labor; Avoidance of mental overload; adequate management of pregnancy and childbirth.