intracranial hypertension - a pathological changes in the brain caused by an increase in the pressure gradient, which moves CSF of pathways.Intracranial hypertension is prevalent and negatively affects all brain structures.Typically, this pathology is secondary syndrome, occurring against the background of the impact of any factor, such traumatic nature.According to world statistics neurological abnormalities, intracranial hypertension suffer more men, although in childhood, this pathology occurs with equal frequency among both sexes.
Note that the pathologic substrate of intracranial hypertension can act not only intracerebral fluid and blood, tissue fluid, and even tumor substrate.
Causes of intracranial hypertension
Before we understand the causes of increased intracranial pressure, should be considered the normal physiology of cerebrospinal fluid movement.Under normal conditions, the whole brain tissue surrounded by liquor, which is located in an enclosed
In a situation when there is an excessive accumulation of cerebrospinal fluid, which may be due to a violation of his absorption or against an increase in the activity of its products, there is increasing pressure gradient that liquor has on the structure of the brain.In addition, there is another pathogenic mechanism of intracranial hypertension, is in violation of patency of intracranial fluid circulation paths, which is extremely rare.
Unfortunately, not all situations, even severe intracranial hypertension has an obvious provocative etiological factor, and the physician has to more carefully verify the cause of the increased intracranial pressure.When the harmful effects of a provoking factor, mechanisms of development of intracranial hypertension can be very different.Thus, when a bulk formation in the brain, which can serve as an example of a hematoma or hemorrhagic tumor conglomerate developed compression effect on the structure of the brain.As a compensatory mechanism in this situation, there is a moderate or severe intracranial hypertension, characterized by a progressive course.
intracranial hypertension in infants often develops as a result of hydrocephalus, occurs for various reasons (prolonged intrauterine fetal hypoxia, intrauterine infection of the fetus neyrogruppy infectious agents).To a large extent this pathology affects newborn babies born earlier than you expect.
The adult category of patients intracranial hypertension develops in virtually all pathological conditions which are accompanied by the development of even minimal edema of the brain tissue, such as post-traumatic exposure, infection of the meninges, etc.
There are a range of chronic diseases, which can serve as a backdrop for the development of signs of intracranial hypertension, notably the congestive heart failure and the presence of effusion in the pericardium.In a situation where the increase in intracranial fluid pressure gradient is prolonged and pronounced, there is a compensatory expansion of the fluid cavities of the brain, which is called 'hydrocephalus'.Of course, this condition allows for some time to eliminate the manifestation of intracranial hypertension, but it should be borne in mind that the dilatation of the cavities of the brain atrophy occurs simultaneously with the bulk of the brain that negatively affects its function.
Symptoms and signs of intracranial hypertension
The symptom of intracranial hypertension include a fairly broad spectrum of clinical manifestations, so each patient, this pathology can occur in very different ways.Also of great importance in regard to the development of clinical symptoms is the amount of increase of the pressure gradient in the skull.The most common symptom of intracranial hypertension is a pain in the head region of varying degrees of intensity.Pathognomonic symptom is the appearance and severity of pain expressed widespread nature in the head during the night the day that has a pathogenetic explanation (in the supine position in humans there has been increasing production of liquor at the same time slowing down the process of absorption of cerebrospinal fluid).
At the peak of increased intracranial pressure of the patient concerned about severe nausea and retching, and these pathological conditions have nothing to do with eating the day before.Even after the vomiting, patients' condition does not change for the better, which is also a pathognomonic sign of intracranial hypertension.
Easy intracranial hypertension, provided that it is a long course, violates the psycho-emotional balance of the person, which is manifested in increased excitability, irritability flashes and fatigue, even without the presence of heavy physical exertion.
Specialists in neurology noted that for patients with intracranial hypertension tend to complain characteristic of vegetative-vascular dystonia, manifested in the form of a sharp change in blood pressure, excessive sweating, heart palpitations and feeling short-term loss of consciousness.
notable objective clinical criteria of intracranial hypertension is the appearance of "bruises" in the projection of the periorbital area, which are not eliminated cosmetics.Since the skin in the area of Ages is very thin, through it appears expanded venous network, which is a cosmetic defect, and brings discomfort female.
the period of acute intracranial hypertension have a clear correlation dependence on weather changes the environment in which the person suffering from this disorder.Due to this fact, intracranial hypertension can be classified meteosensitive pathology.
In some situations with chronic intracranial hypertension in patients has been a sharp decrease in sexual attraction to the opposite sex, which can also be regarded as a clinical marker of the disease, allowing the right to verify the diagnosis.
features of the course of intracranial hypertension in infants is a long latency period, during which the parents did not notice the presence of any symptoms suggestive of the presence of this disease in children.This feature is due to imperfections in the bone of the skull of the child (cleft joints and springs).However, when expressed increasing intracranial pressure gradient, a child marked the emergence of a range of specific clinical symptoms in the form of high-pitched crying, sharp protrusions on the location of the skin with a characteristic pulsation fontanelle, increased seizure, vomiting and various degrees of impaired consciousness.Attentive parents during the period of increased intracranial pressure noted behavioral changes in a child that is manifested in rapid succession expressed concern at the lethargy and inactivity.
Despite all the diversity and pathognomonic clinical manifestations of intracranial hypertension, reliably establish the correct diagnosis neurologists manage only after the application of instrumental methods of research of the patient.Currently, most reliable and at the same time safe for the patient's life studies to establish the diagnosis even at early stages of development of intracranial hypertension is magnetic resonance imaging.However, there are a variety of minimally invasive techniques, which can be recognized surrogate intracranial hypertension, which should also include examination of the fundus, the ultrasonic Doppler blood vessels of the brain and echoencephalography.
clinical criteria of intracranial hypertension in the fundus examination is to detect abnormal expansion and severe tortuosity of the veins.In magnetic resonance imaging of a patient with intracranial hypertension in virtually 100% of observed expansion fluid cavities of the brain with simultaneous thinning or primary vacuum medulla.Intracranial venous hypertension is well diagnosed by Doppler blood vessels of the brain in which there is a significant reduction in venous blood flow.
benign intracranial hypertension
in their practice, not only neurologists, and specialists of other profiles are often confronted with cases of benign intracranial hypertension, which is regarded not as an illness but as a compensatory mechanism, observed in different physiological states.Some neurological benefits the option of intracranial hypertension is treated as a "false brain tumor".Risk of benign intracranial hypertension are women of young age, are overweight.
feature of this pathogenic form of intracranial hypertension is reversibility of its manifestations, as well as latent favorable course.As a rule, the establishment of benign or idiopathic intracranial hypertension occurs when no specialists or to the patient fails to recognize the causative factor that provoked its development.In the children's age group benign intracranial hypertension often develops after drug withdrawal glucocorticosteroid incorrect number, and as a side effect of prolonged use of antimicrobials tetracycline group.
debut benign intracranial hypertension is the periodic appearance of moderate pain in my head, which quickly stopped by taking any analgesic drug or at all held their own.At this stage, patients almost never seek medical help.
Over time, the clinical manifestations in the form of pain in the head become more aggressive and attacks of such pain are increasingly becoming the cause of long-term human health disorders.Character headache benign intracranial hypertension patients embodiment is described as a diffuse "bursting" in the head with a maximum concentration in the periorbital and frontal areas.A characteristic feature of the pain is to strengthen its intensity by tilting the head and cough movements of the diaphragm.With a sharp change in body position in space, patients often report dizziness, nausea and even vomiting.
fundamental element in the development of the program management and treatment of patients with benign intracranial hypertension is a form of modification of its lifestyle, which consists in the development of individual diet reduces the weight.Medicines diuretic number used only in case of pronounced increase in intracranial pressure, and the drug of choice in this situation is Diakarb a single dose of 250 mg orally.
Treatment of intracranial hypertension
increased intracranial pressure provokes not only the development of a bright clinical symptoms that negatively affect the well-being of the patient, but also can be an agent provocateur of serious complications, including death.In this regard, the use of medication and therapeutic activities is a major concern in intracranial hypertension.Consequences of intracranial hypertension, provided the total absence of remedial measures, may be the most severe in the form of lower intellectual-mental capabilities, disorders of the nervous regulation of the internal organs, hormonal imbalance.
, drug therapies used even admissible at the stage of the incomplete verification of the diagnosis, and they are in the normalization of drinking regime, performing specific exercises of physiotherapy and the use of physiotherapy techniques.
pathogenetic basis of targeted therapy of intracranial hypertension make preparations, the effect of which is directed to the simultaneous decrease in the production of cerebrospinal fluid, and strengthening the process of absorption of CSF.The gold standard in this role acts applied scheme diuretic therapy.The drug of choice in removing the signs of intracranial hypertension at the stage of development of hydrocephalus is Diakarb in the effective therapeutic dose of 250 mg, the pharmacological effect of which is aimed at reducing the production of liquor.
In a situation where even the prolonged use of diuretic drugs pharmacological series does not have the desired effect as the relief of clinical manifestations and normalization of instrumental methods of examination, it is advisable to appoint a glucocorticosteroid drugs (dexamethasone in the initial daily dose of 12 mg).In severe intracranial hypertension neurologists used pulse therapy, which consists in parenteral administration Methylprednisolone 1000 mg per day for five days, and the subsequent transition to the drug in oral form.This circuit usually complement purpose Diamox in usual therapeutic doses.
To correct venous intracranial hypertension used drugs that enhance the outflow of venous blood from the brain, which include Troxevasin in the average daily dose of 600 mg.As expressed symptomatic therapy of pain in the head is allowed to use preparations of non-steroidal anti-inflammatory drugs (Nimid a permissible maximum 400 mg) and protivomigrenoznyh means (Antimigren a daily dose not exceeding 200 mg).
In marked increase in intracranial pressure is acceptable parenteral administration of hypertonic solutions (400 ml mannitol solution 20%), dehydrating effect of which is realized by the dehydration of the brain substance, which limits their application.
In acute intracranial hypertension, the occurrence of which has a clear connection with the performance of neurosurgical operation shows the use of drugs the group of barbiturates (single intravenous injection of sodium thiopental in a dose of 350 mg).
if intracranial hypertension is characterized by progressive malignant course and is not stopped by any medication therapy, the patient should apply the surgical correction of the pathological condition.The most common method of palliative surgical treatment of intracranial hypertension of any etiology is a lumbar puncture, with the help of which the mechanical removal of a small amount of cerebrospinal fluid (not more than 30 ml per manipulation).In some situations, a lumbar puncture has a pronounced positive effect after the first of its application, but most often occurs in remission after only a few manipulations are carried out with a multiplicity of one every two days.
longer and more pronounced positive effect in relation to leveling not only displays, but the pathogenetic mechanisms of development of intracranial hypertension has an operational manual "lyumbo-peritoneal shunt."