Intracranial Hypertension Syndrome – Indirect Signs, Symptoms and Treatment

Contents

The study of brain hypertension using computed tomography

Intracranial hypertension (VCG) means an increase in intracranial pressure inside the skull. This leads to compression of the brain, which is expressed in intense, long-lasting headaches. A painful condition is diagnosed in both adults and . Increased pressure is a secondary disease that occurs after a head injury or due to pathologies in the bone structure of the skull.

General description of the disease

The brain is located in the bone structure, inside of which the organ is placed in a liquid medium that performs an additional protective function. In the skull also localized fluid medium – the ventricles. The liquor (exudate, cerebrospinal fluid) acts as a protective fluid. It is the cerebrospinal fluid that creates intracranial pressure.

Interesting! Intracranial hypertension syndrome was first characterized by the concept proposed by Monroe-Kelly.

The ventricles and fluid locations are interconnected by channels through which exudate circulates. Spinal fluid is updated up to 7 times per day.. In case of violation of excretion, absorbability or patency of exudate, VCG develops.

The human brain is structurally divided into substance, blood, exudate and interstitial fluid. Components have a specific volume and are separated from each other by an encephalopathic barrier. In a healthy person, all elements are balanced among themselves. In case of violation of the volume of one component, intracranial pressure increases in the entire brain cavity.

Reasons for high values

At disturbance of blood circulation supply of an arterial blood is slowed down, it stagnates in a venous site. This increases blood volume, which squeezes brain structures. The causes that influence the development of brain hypertension are divided into benign and malignant. The latter are irreversible and require surgery: tumor formation, cranial injuries, strokes. Benign intracranial hypertension is represented by treatable disorders: obesity, electrolyte imbalance, impaired menstruation cycle.

The causes of cerebral hypertension include:

  • traumatic brain injury – bruise, concussion;
  • failures in the cerebral circulation – thrombosis, stroke;
  • tumors in the cranial cavity;
  • inflammation of the brain structures – abscess, encephalitis, meningitis;
  • congenital malformations in the structure of the brain;
  • intoxication with ethanol, gas, lead;
  • metabolic disorders in hyponatremia, cirrhosis;
  • diseases of the organs, leading to a slow outflow of venous blood, are cardiac, pulmonary pathologies.

VCG in children develops due to congenital anomalies, prolonged oxygen deficiency, prematurity, unhealthy pregnancy or childbirth.

Note! Normal VCG values ​​are 1.5–6 mm Hg for infants, 3–7 mm for adolescents.

In infants, the disease is often formed due to intrauterine infections.

Manifestations of hypertension in children

If babies have an increase in head parameters, anxiety, systematic regurgitation, sleep problems, this may indicate intracranial hypertension. With intracranial form, the monthly increase in head circumference will be more than 1 cm. The pathological symptom is usually accompanied by a divergence of the sutures of the skull, swelling of the fontan, and increased excitability.

If one-year-old kids often hold their heads, this may indicate intense pain, which can increase with movement, sneezing, cough reflex. A characteristic symptom of the disease is vomiting, not due to overeating. The clinical picture is complemented by visual disorders, reduced intelligence.

Symptoms of the disease in adults

Symptoms of VCG include a number of signs, the degree of manifestation of which depends on the level of increase in values ​​in the cranial structure. The most common symptom of the disease is severe pain in the head, increasing at night. This results from the fact that when the victim lies, the strengthened synthesis of exudate begins, along with slowing down of the absorption of cerebrospinal fluid.

With the maximum increase in values, the person becomes irritable, aggressive, quickly tired. Vomiting brings relief. Fixed excessive sweating, jumps, increased heart rate. The patient may lose consciousness. Convulsive seizures increase, visual disturbances appear.

Some painful manifestations indicate impaired functioning of the . Similar symptoms are indirect signs of intracranial hypertension:

  • trouble falling asleep;
  • decrease in concentration of attention and intellectual opportunities;
  • tremor of hands, chin;
  • excessive sweating;
  • increased heart rate;
  • the presence of bruises under the , an increase in the capillaries of the fundus;
  • blurred consciousness; 
  • lack of sexual attraction;
  • high meteosensitivity. 

A single manifestation of any trait does not indicate pathology. VCG may be suspected if symptoms are complex.

Read also … What causes swelling of the brain?

Classification

Brain hypertension occurs in acute or chronic form. The acute form is expressed in sudden drops in intracranial pressure, which can be fatal. In this case, an emergency surgical intervention is required – craniotomy. During the operation, the surgeon removes the affected areas, pressing on the substance of the brain.

Chronic pathology is accompanied by neurological disorders. Usually, this form occurs as a result of taking medications, prolonged illness, or after injury.

Intracranial hypertension can be cerebrospinal fluid, venous, benign.

Liquor

It develops as a result of the production of a large volume of spinal fluid, which leads to an increase in pressure. Liquor hypertension is accompanied by swelling of the optic nerves, in which the congestive disc swells. Reduced visual acuity. Neurological disorders are absent.

Venous

Appears as a result of slowing the outflow of venous blood from the brain. Venous hypertension is diagnosed with thrombosis, tumor neoplasms, emphysema.

Benign

Another name for the form is idiopathic. This type is not a disease, but refers to temporary violations. Formed as a result of negative factors: hypovitaminosis, obesity, menstrual cycle failure, pregnancy, an excess of vitamin A, cessation of medication.

A special feature of the idiopathic form is the reversibility of symptoms, an easy course. Initially, the disease is expressed in the development of moderate pain in the head, which is eliminated by taking an analgesic agent. Treatment of hypertensive patients with a benign form is the adjustment of lifestyle and diet.

Diagnostic measures

Initially, it is necessary to examine the patient, examine the condition of the eyeballs and blood vessels. With pronounced red eyes with enlarged capillaries, intracranial hypertension can be suspected. A person is sent to the passage of an ultrasound scan of cerebral vessels. The study establishes the presence of irregularities in the outflow of blood.

Accurately detect the presence of the disease can be measured by measuring the pressure of the brain fluid cavities. For this, invasive manipulation is performed. The doctor inserts a special needle into the ventricles or other brain structures. Then the specialist attaches a pressure gauge to the needle. To measure pressure, special sensors are also used that are implanted in the skull. A similar procedure is carried out under the control of magnetic resonance imaging.

Magnetic resonance imaging and computed tomography assess the state of the cerebral ventricles, fluid cavities. An encephalogram is performed as a concomitant diagnostic method.

It is much more difficult to identify the disease in children, especially in infants who are not able to maintain a static position and express their feelings. Standard procedures for detecting a pathological condition in a child include taking the necessary blood tests, puncture, examining spinal fluid, neurosonography in newborns. Consultation with a psychologist, neurologist, cardiologist, endocrinologist is also required.

Therapies

The human brain is not able to function properly with increased pressure. This will lead to atrophic processes, a decrease in intellectual abilities, and impairment of nervous regulation. Therefore, it is necessary to resort to treatment methods that will restore healthy pressure values. 

Treatment of the syndrome includes the use of the following methods:

  • non-drug therapy – lifestyle changes, menu correction, physiotherapy, visiting a neuropsychologist;
  • drug therapy – dehydration, sedation, neuroprotective, metabolic drugs;
  • operative intervention used in severe hypertension of the brain, which is not amenable to drug treatment.

Non-drug therapy can be applied even after recovery. The patient should normalize the diet and drinking regime, perform feasible physical exercises, use physiotherapeutic methods.

The basis of the treatment of VCG is the need to reduce the synthesis of cerebrospinal fluid, along with increasing its absorbability. For this purpose, diuretic drugs are prescribed that reduce the production of exudate (Diacarb). With prolonged use of diuretics and the absence of a therapeutic effect, glucocorticosteroids (Dexamethasone) are prescribed to the patient.

To eliminate the hypertensive syndrome, medication is needed to improve blood flow through the veins (Troxevasin). When the intensity of the painful sensations are applied, a number of anti-inflammatory nonsteroidal groups (Nimid) are used. When VCG, which arose against the background of , antibacterial drugs are administered to the victim..

With a marked increase in VCG, Mannitol, which has a dehydrating activity, is administered intravenously. In case of a pathology that arose against the background of neurosurgical intervention, drugs from a number of barbiturates (Thiopental) are used.

If cerebral hypertension progresses and the painful symptoms are not eliminated by medical means, then the patient is indicated to have surgery. Often resorted to the use of lumbar puncture, through which 30 ml of spinal fluid is removed. In many cases, such manipulation greatly facilitates the patient’s condition. Usually requires multiple procedures.

For leveling of pathological manifestations in severe cases, lumbo-peritoneal shunting is used, which artificially creates conditions for the exudate outflow. To do this, a special tube is introduced into the liquor cavity, the other end of which is placed in the peritoneal region. So excess fluid is evacuated from the brain.

The most aggressive therapeutic method is cranial trepanation, during which doctors deliberately injure the skull so that brain matter does not rest against bone tissue. This therapeutic method is used very rarely.

For the treatment of visual disorders resort to decompression of the myelin sheath of the optic nerve.

Preventive measures and prognosis

To prevent the development of hypertensive syndrome, it is necessary to use more than a liter of water per day. Also, do not take uncontrolled diuretics and glucocorticoids.

The prognosis of the disease depends on the cause of the VCG, the correctness and timeliness of therapy, and brain compensatory abilities. If the syndrome has a malignant etiology, then death is possible. The benign course of hypertension is easily treatable.

Consequences of VCG

The brain loses its functionality, being in an unhealthy squeezed state. This leads to atrophy of brain cells, which affects the decrease in intelligence and impaired regulatory processes. If untreated, squeezing of the brain provokes displacement or penetration of parts into the base of the skull.. This condition leads to death.

When squeezed, the brain can shift to the occipital or cerebellar part, the process is accompanied by squeezing the stem sections. In such a situation, the patient dies from respiratory arrest. When wedging into the temporal lobe, the pupil expands, breathing becomes difficult, the person falls into a coma.

If the wedging occurs in the area of ​​the bastard, then the patient stalls, becomes drowsy, inhibited. Breath is slowed down. An increase in intracranial pressure provokes a rapid decrease in vision, since pathology leads to atrophy of the optic nerves.

Conclusion

Intracranial hypertension is a dangerous consequence of brain diseases. The degree of manifestation of the pathology is determined by the symptoms, treatment methods and prognosis. With timely treatment to the doctor you can avoid the appearance of secondary complications of intracranial hypertension.

The following sources were used to prepare the article:

Tsarenko S.V. Correction of intracranial hypertension // Research Institute of Emergency Care. N.V. Sklifosovsky. – 2011.

Intracranial Hypertension Syndrome - Indirect Signs, Symptoms and Treatment

Magzhanov R.V., Davletova A.I., Bakhtiyarova K.Z., Pervushina E.V., Tunik V.F. Benign intracranial hypertension: clinical observations // Annals of Clinical and Experimental Neurology – 2017.

Parkhomenko EV, Sorokina EA, Nartov SE, Karpov D.Yu., Barinov AN, The problem of diagnosis and treatment of idiopathic intracranial hypertension // Medical alphabet – 2017.

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