Повышенное внутричерепное pressure: симптомы,treatment, complications

Update: December 2018 Many of us don’t care
symptoms, like minor headaches, light dizziness,
blurred vision … But these manifestations of increased
внутричерепного pressure (сокращенно — ATЧД) могут свидетельствовать
about severe structural damage to the substance of brain tissue,
mainly in children (tumor, hemorrhage, hematoma,
hydrocephalus). ATот почему такое огромное внимание уделяется
neurologists problems with intracranial hypertension, or increased
ATЧД.

Что такое внутричерепное pressure?

ATнутричерепное pressure представляет собой количественный
indicator reflecting the effect of cerebrospinal fluid on
brain tissue. Нормальное значение ATЧД находится в диапазоне от
100 to 151 mm.vod.st., which corresponds to 10 – 17 mm.rt.st.

Методы определения внутричерепного pressure

Оценка уровня внутричерепного pressure может быть произведена
перечисленными ниже  способами:

  • insertion of a catheter into the lumen of the spinal canal or
    ventricles of the brain, followed by the addition of a manometer,
    working by analogy with a mercury thermometer;
  • the use of methods both computer and
    magnetic resonance imaging;
  • brain ultrasound (synonym:
    neurosonography) in children under 1 year of age;
  • echoencephaloscopy;
  • examination of the fundus picture with the definition of a typical clinic –
    swelling of the optic nerve head, blurred contours, pallor.

Перед тем, как измерить внутричерепное pressure, важно
determine the method of research. In infants
preference is given to neurosonography and echoencephaloscopy.
Patients with acute cerebrovascular accident,
appointed tomographic study, assessment of the eye
by the ophthalmologist.

Причины, ведущие к повышению внутричерепного pressure

To conditions in which high intracranial arises
pressure, относятся:ATнутричерепное pressure: симптомы, лечение

  • increase in brain volume due to edema,
    inflammations;
  • the formation of a large amount of cerebrospinal fluid with
    hydrocephalus;
  • the presence of a mass (tumor, hematoma, foreign
    body) in the cranial cavity;
  • increase in blood content in dilated vessels of the head
    brain poisoning and intoxication.

Основные заболевания, сопровождающиеся нарастанием ATЧД:

  • disorders of cerebral circulation of various origin
    (ischemic and hemorrhagic strokes);
  • traumatic injury of brain tissue (concussion and contusion
    brain);
  • inflammatory changes in the membranes of meningitis, encephalitis and
    ventriculitis;
  • intoxication with heavy metal salts, methanol or ethyl
    alcohol, fumes of poisonous gases;
  • tumors of not only substances, but also the membranes of the brain, sub-
    and epidural hematomas;
  • developmental anomalies (Arnold-Chiari, Dandy-Walker);
  • benign intracranial hypertension;
  • hydrocephalus.

It should be noted that the symptoms of increased intracranial
pressure у грудничков в 90 % случаев обусловлены родовой
trauma.

Common symptoms characteristic of intracranial hypertension

AT случае повышенного внутричерепного pressure симптомы
characterized by diversity and polymorphism. Clinical picture
diseases in children and adults is different. ATедущими признаками,
которыми сопровождается повышение ATЧД, are:

  • headache occurring predominantly in the morning during
    of awakening, localized in the frontal, temporal, and
    occipital region, having a pressing or arching character;
  • nausea and vomiting;
  • drowsiness;
  • impaired memory, attention and thinking;
  • dizziness;
  • подъем или падение артериального pressure;
  • bradycardia – a rare pulse;
  • sweating;
  • visual impairment due to edema of the optic papilla
    down to blindness.

Симптомы внутричерепного pressure у детей

Повышенное внутричерепное pressure у детей, симптомы которого
may occur in the first minutes and hours after birth, often
leads to the development of serious complications. Knowing the key features
diseases, it is possible to establish the correct diagnosis in the early stages and
give the child the correct treatment (see increased intracranial
pressure у грудничка). Symptoms indicating high
ATЧД у детей, относятся:

  • bulging large and small fontanels, as well as their
    pulsation;
  • divergence of the bones of the skull with an increase in the size of the seams;
  • change in child behavior: drowsiness, lethargy or
    on the contrary, irritability, tearfulness;
  • chin tremor;
  • repeated vomiting (“fountain”), not bringing relief;
  • visual impairment;
  • eye movement disorders in the form of strabismus, restrictions
    range of motion of the eyeballs;
  • violation of the level of consciousness, in severe cases may develop
    coma;
  • convulsive syndrome;
  • increased head circumference;
  • limb strength down to full
    immobility;
  • regurgitation when eating.

ATозможно два варианта развития клинической картины
intracranial hypertension:

  • внезапное возникновение  симптомов заболевания с
    impaired consciousness to a level deep coma; probability
    death rate is 92%;
  • gradual onset of symptoms.

What is hydrocephalus?

Hydrocephalus is an excess accumulation
cerebrospinal fluid in the cranial cavity and is accompanied
increased intracranial pressure. To the occurrence of hydrocephalus
result in the following states:

  • increased formation of liquor (fluid that surrounds
    brain) for tumors of the choroid plexus;
  • obstruction of spinal drainage
    liquids;
  • inflammatory process in the brain tissue.

Symptoms of hydrocephalus in children

The leading symptom characteristic of hydrocephalus in a child
is a progressive increase in head size at the age of
two years. To the main symptoms of hydrocephalus in newborns,
due to increased intracranial pressure, include:

  • intensive head growth by the end of the first month;
  • sparse hair coat;
  • disproportionate large forehead;
  • exophthalmos – protrusion of the eyeballs;
  • progressive reduction in visual acuity due to
    developing optic atrophy;

Hydrocephalus in children of other age periods is accompanied by
neuroendocrine disorders, psychomotor retardation,
jerking of the head with a frequency of 2-4 times in one second.

Symptoms of increased intracranial pressure in adults

Symptoms in adults with increased intracranial pressure
develop in most cases gradually. To the fore
there is a headache having the following parameters:

  • character – pressing, bursting, compressing, occasionally –
    throbbing;
  • time of occurrence – in the morning after waking up, which
    associated with an increase in ICP;
  • provoking factors – the horizontal position of the body,
    coughing, sneezing, straining, over-bending of the head;
  • associated symptoms – nausea and vomiting, noise in the head;
  • not removed by the use of analgesics.

In second place in frequency with an increase in intracranial
pressure is vegetative dysfunction syndrome, which
accompanied by:

  • fluctuations in blood pressure and pulse during
    days;
  • violation of intestinal motility with the development of constipation or
    on the contrary, diarrhea;
  • hypersalivation – increased salivation;
  • moisture of the skin, especially in the region of the palmar and
    plantar surfaces;
  • asthma attacks;
  • dizziness;
  • feeling of fear, anxiety, irritability, apathy,
    sleepiness;
  • pains in the heart, abdomen.

Much less likely increased intracranial pressure may
accompanied by the development of stroke-like conditions that
threaten the patient’s life. In such cases, the following are observed
symptoms:

  • нарушение сознания вплоть до coma;
  • severe dizziness and instability when walking;
  • reduced strength in the limbs;
  • speech function disorder;
  • indomitable vomiting;
  • dysfunction of the pelvic organs in the form of incontinence
    or retention of urine and feces;
  • dysfunction of the cardiovascular and respiratory systems.

What is benign intracranial hypertension?

Benign (idiopathic) intracranial hypertension
refers to one of the most neglected pathological conditions
in modern neurology and neurosurgery. The disease
typical for overweight women and children. AT
numerous studies have failed to establish the cause.

In benign intracranial hypertension,
same symptoms that are characteristic of increased intracranial
pressure. It should be noted that with this disease
spontaneous recovery occurs in a few months
после первых проявлений.

Complications that may result in increased intracranial
pressure

A life threatening condition is a sudden increase.
intracranial pressure leading to lethal (fatal)
outcome with no appropriate treatment. To others
осложнениям, характерным для высокого ATЧД, относятся:

  • pinching the cerebellum in the large occipital foramen that
    accompanied by respiratory failure, decreased strength in the limbs,
    a disorder of consciousness;
  • epileptic syndrome;
  • decreased vision, including blindness;
  • violation of mental functions;
  • ischemic or hemorrhagic strokes.

Modern methods of treatment of increased intracranial
pressure

Treatment begins after establishing the cause that led to 
development of the disease.

Stage первый – Устранение причины
diseases.

  • AT том случае, если к повышению внутричерепного pressure привело
    intracerebral formation – tumor, hematoma, aneurysm, after
    appropriate follow-up perform surgery
    on an emergency basis (removal of a mass formation).
  • AT случае избыточной секреции спинномозговой жидкости при
    hydrocephalus shunt operations are performed to
    is to create an additional outflow path for liquor that
    приводит к снижению внутричерепного pressure.

Stage второй – Медикаментозная коррекция уровня
внутричерепного pressure. The following groups are used for this purpose.
drugs:

  • osmodiuretiki (mannitol, glycerol), whose action is directed
    на уменьшение количества спинномозговой liquids;
  • loopback diuretics (furosemide);
  • hormonal drugs (dexamethasone);
  • diacarb;
  • neuroprotectors (glycine).

Stage третий – Медикаментозные манипуляции.
ATентрикулярная пункция, декомпресионная краниотомия предназначены
to reduce the volume of CSF in the cavity of the skull. Stage
четвертый –
Диетотерапия. Limit the amount
body fluids and salt, which corresponds to diet No.
10, 10a. Stage пятый – Использование методик
manual therapy, hyperbaric oxygenation, controlled
arterial hypotension, hyperventilation.

Extremely rarely during enhanced treatment may occur.
пониженное внутричерепное pressure, симптомами которого
are:

  • drowsiness;
  • weakness;
  • headaches, aggravated by head movements;
  • dizziness;
  • nausea and vomiting.

Лечение повышенного внутричерепного pressure должно носить
complex character.

What if you have symptoms of increased
внутричерепного pressure?

Below is an algorithm of actions, to comply with which
должны  все пациенты с симптомами повышенного ATЧД.

  • Calm down. It must be remembered that at present
    There are many methods to normalize the level
    внутричерепного pressure без угрозы жизни.
  • Seek an appointment with a neurologist, who will appoint
    list of examinations (CT or MRI, ultrasound, radiography, examination
    ophthalmologist).
  • Strictly follow all the recommendations of the doctor (dieting,
    taking medication, if necessary – prompt
    treatment). Failure to comply with appointments may result in death.
    the outcome

5 myths about increased intracranial pressure

  • Миф первый: у пациентов, имеющих повышенное
    ATЧД, с возрастом наблюдается выздоровление, поэтому необходимость в
    no treatment is available.

This is one of the most important misconceptions. Persistent and durable
the effect of cerebrospinal fluid on the substance of the brain
leads to the development of the above complications.

  • Миф второй: внутричерепная гипертензия
    is an incurable disease.

Наличие широкого спектра препаратов,  методик оперативного
treatment refutes this fact. Elimination of the cause
повышение ATЧД, приводит к полному выздоровлению.

  • Миф третий: склонность к возрастанию
    внутричерепного pressure обусловлена генетически и передается по
    inheritance.

AT настоящее время нет ни одного исследования, подтверждающего
наследственную теорию развития diseases.

  • Миф четвертый: дети, страдающие повышенным
    внутричерепным pressureм, являются умственно отсталыми и имеют
    low IQ.

Wrong point of view.

  • Миф пятый: нормализовать уровень ATЧД можно
    only taking medications.

Incorrect fact, as in some cases it may be required
surgical treatment.

Повышенное внутричерепное pressure: факты и цифры

  • ATедущей причиной повышения ATЧД у детей до 1 года является
    hydrocephalus.
  • Idiopathic intracranial hypertension occurs with
    frequency from 1 to 2 cases per 100,000 population.
  • Even 200 years ago, scientists have paid attention to the problem
    повышенного внутричерепного pressure; the question is not fully understood until
    so far, research continues.
  • AT мире существует несколько десятков медицинских ассоциаций,
    dealing with intracranial hypertension.
  • Every tenth child at the reception at the children’s neurologist has
    высокий уровень внутричерепного pressure.
  • The number of people suffering from elevated intracranial
    pressureм, приближается к 100 000 000.
  • According to evidence-based medicine, herbal preparations
    не оказывают никакого влияния на уровень ATЧД, соответственно, не
    can be used for treatment. Similar information is available and
    on homeopathic medicines.
  • Пациенты, которым удалось нормализовать уровень ATЧД, должны с
    once in two years to visit a doctor with a view to
    предупреждения развития рецидива diseases.

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