Gipertenzivny cerebral crisis
Gipertenzivny cerebral crisis — the sudden increase in arterial pressure to critical figures leading to violation of brain blood circulation. Depending on a type of gipertenzivny cerebral crisis the headache and other symptoms of increase in intra cranial pressure, a mentality deviation accompanied by focal symptomatology or a combination of the specified symptoms can be its clinical manifestations. Gipertenzivny cerebral crisis by complex application of antigipertenzivny and sedative therapy (standard for knocking over of hypertensive crisis), the vazoaktivny medicines which are picked up according to a type of crisis (spazmolitik or venotonik) and symptomatic means is treated.
Gipertenzivny cerebral crisis
Gipertenzivny cerebral crisis is one of types of hypertensive crisis. Most often it develops against the background of a hypertension as its current is followed by the raised load of the device which is responsible for regulation of a tone of brain vessels. Gipertenzivny cerebral crisis can arise also at other diseases leading to substantial increase of figures of arterial pressure (atherosclerosis, pyelonephritis, a glomerulonefrita, a feokhromotsitoma, a diabetic nephropathy, primary giperaldosteronizm, etc.). It is noted that in half of cases gipertenzivny cerebral crisis arises after stressful situations. Act as the additional factors leading to violation of regulation of a tone of vessels of a brain: sharp weather changing, overcooling, overeating, physical overwork, etc.
Classification of gipertenzivny cerebral crisis
On the mechanism of development of the pathological changes arising at arterial hypertension in brain vessels allocate: angiogipotonichesky, ischemic and difficult gipertenzivny cerebral crisis. Angiogipotonichesky gipertenzivny cerebral crisis arises at decrease in a tone of vessels of a brain and deposition of blood in venous system that is followed by increase in intra cranial pressure. Ischemic gipertenzivny cerebral crisis is caused by the oxygen starvation of tissues of brain resulting from a sharp reflex spasm of brain arteries in response to increase in arterial pressure. Difficult gipertenzivny cerebral crisis represents a combination of both specified mechanisms.
Depending on existence/lack of complications the clinical neurology classifies gipertenzivny cerebral crisis as complicated or uncomplicated. Treat complications of gipertenzivny cerebral crisis: the tranzitorny ischemic attack, an ischemic stroke, a rupture of aneurism of vessels of a brain, pregnant women have an eklampsiya.
Pathogenesis of gipertenzivny cerebral crisis
Normal the system of regulation of brain blood circulation works in such a way that at increase system HELL occurs the increase in a tone of cerebral arteries allowing to avoid receipt in brain vessels of excess amount of blood. Failure of this compensatory mechanism can be shown by insufficient or excess tonic reaction of brain arteries.
In case at increase HELL tonic reaction of cerebral vessels is insufficient, there is a break of excess amount of blood in blood vessels of a brain. At the same time the second compensatory mechanism consisting in increase in a tone of venous vessels has to work. It provides acceleration of outflow of excess blood from a skull cavity. If sufficient increase in a tone of venous system does not happen, then angiogipotonichesky gipertenzivny cerebral crisis develops. The developments of stagnation arising in venous system of a brain which are followed by accumulation of excess amount of liquid in limited space of a cranium (hydrocephaly) that leads to increase in intra cranial pressure are its cornerstone.
Excess increase in a tone of arteries of a brain in response to races leads HELL to violation of blood supply of tissues of brain with development of a hypoxia in them (oxygen starvation) and emergence of ischemic option of gipertenzivny cerebral crisis. At the same time first of all the brain structures (cerebral cortex), most sensitive to a hypoxia, suffer. Unevenness of very tectonics of brain vessels, and also possible accession of a local angiospazm lead to emergence of the centers with more expressed ischemia with which observed clinically focal symptomatology is connected.
The pathogenesis of difficult gipertenzivny cerebral crisis includes hypotonia of brain vessels with deposition of blood in venous system and ischemia of certain sites of a brain because of deterioration in a capillary blood-groove because of shuntovy dumping of blood from arteries in veins, passing capillary network.
Symptoms of gipertenzivny cerebral crisis
Angiogipotonichesky gipertenzivny cerebral crisis usually develops against the background of a headache, typical and habitual for hypertensive persons, which is localized in occipital area or arises in the form of heavy feeling in the head. A characteristic symptom of such headache is its strengthening at position of a body which complicates venous outflow from a skull cavity (a natuzhivaniye, inclinations, lying, cough). The headache of similar character in itself is already a sign of an angiodistoniya of cerebral vessels, however it often passes in vertical position of a body and at reception of kofeinsoderzhashchy drinks.
Tells spread of a headache to retroorbital area about the beginning of gipertenzivny cerebral crisis. At the same time patients complain of emergence of pressure upon eyes and behind eyeballs. Distinctive feature of angiogipotonichesky gipertenzivny cerebral crisis is its emergence at moderate rise HELL (170/100 mm of mercury.). Further occur prompt (within an hour) strengthening of a headache and its diffusion distribution on all head. There is nausea, the repeated vomiting giving some temporary relief. Angiogipotonichesky gipertenzivny cerebral crisis, as a rule, is followed by vegetative reactions: the increased perspiration, tachycardia, wavy breath, sometimes cyanosis of the person. The late phase of crisis is characterized by the increasing block, nistagmy, dissociation of tendinous reflexes. During this period HELL can be at the level of 220/120 mm of mercury. and more, but in certain cases it does not rise higher than 200/100 mm of mercury.
Ischemic gipertenzivny cerebral crisis is observed much less often than angiogipotonichesky and is characteristic generally of the hypertensive persons who do not have headaches and well transferring increase HELL. Often ischemic gipertenzivny cerebral crisis develops against the background of very high figures HELL which sometimes are going beyond a tonometer scale. Clinical displays of such crisis in an initial stage can remain unnoticed. They concern mainly frustration of the mental sphere in the form of the increased vigor, excess emotionality or external efficiency. Then there is an irritability which is replaced by depression and tearfulness, perhaps aggressive behavior. At the same time due to the lack of criticism patients cannot adequately estimate the condition.
Further development of ischemic gipertenzivny cerebral crisis is followed by emergence of focal symptomatology: sight violations (flashing of "front sights" in eyes, a diplopiya), disorders of sensitivity (a sleep, a pricking, etc.), a dizartriya (violation of the speech), shaky gait, a vestibular ataxy, asymmetry of tendinous reflexes.
Difficult gipertenzivny cerebral crisis begins with the clinical manifestations characteristic of angiogipotonichesky option of cerebral crisis, but at the same time often arises against the background of much raised HELL. In process of development of crisis, during the expressed clinical manifestations, the focal symptomatology typical for ischemic option of cerebral crisis is shown. At the same time character of the arising focal symptoms depends on the place of localization of ischemic sites of brain fabric.
Diagnosis of gipertenzivny cerebral crisis
Gipertenzivny cerebral crisis is diagnosed by the therapist, the neurologist or the cardiologist on the basis of a typical clinical picture, data on development of the available symptomatology and measurement HELL. Additional tool researches are usually conducted after rendering emergency aid to the patient and are directed to profound diagnostics of a condition of brain blood circulation and cardiovascular system. They can include the ECG, daily monitoring HELL, a rheoencephalography, Ekho-EG, EEG, UZDG of vessels of the head, consultation of the ophthalmologist, an oftalmoskopiya, perimetry, brain MRT.
It is necessary to differentiate gipertenzivny cerebral crisis from a hemorrhagic stroke, TIA, an ischemic stroke, sharply developing hydrocephaly at tumors of a brain and liquorodynamic violations of other etiology.
Treatment of gipertenzivny cerebral crisis
The ischemic and mixed gipertenzivny cerebral crisis are the indication to hospitalization of the patient. Need of hospitalization at uncomplicated angiogipotonichesky option of crisis depends on its weight. Anyway gipertenzivny cerebral crisis demands the complex treatment including the general for all types of hypertensive crisis antigipertenzivny and trankvilizruyushchy therapy, purpose of vazoaktivny medicines which choice depends on type of cerebral crisis, and symptomatic treatment. The patient needs to observe a bed rest until stabilization HELL and regress of the arisen neurologic symptomatology.
Hypotensive therapy of cerebral crisis is carried out according to the general principles of emergency aid at hypertensive crisis. Application of vazodilatator, blockers of calcic channels, ß-adrenoblokatorov, APF inhibitors, etc. is possible. Need of purpose of tranquilizers (diazepam, chlordiazepoxide, a fenazepam and so forth) is connected with the fact that in half of cases crisis develops against the background of emotional pressure and often is followed by concern and fear.
Introduction of vazoaktivny medicines is carried out in mainly intravenous drop or jet way. Ischemic gipertenzivny cerebral crisis is most effectively stopped by introduction of a vinkamin. Application of a papaverine, drotaverin, eufillin is possible. Treatment of angiogipotonichesky gipertenzivny cerebral crisis is performed by venotonik. The good effect gives caffeine introduction, however it is contraindicated at IBS, ventricular premature ventricular contraction, the increased individual sensitivity. In therapy of difficult gipertenzivny cerebral crisis caffeine is applied along with vinkaminy or drotaveriny.
Prevention of gipertenzivny cerebral crisis
The main way to prevent gipertenzivny cerebral crisis consists in adequate hypotensive therapy of patients with arterial hypertension. With the preventive purpose even at moderately increased figures HELL it is necessary to exclude the work demanding heavy lifting, the inclined pose or the fixed position of a body. It is necessary to avoid overcooling of the head, an emotional overstrain, at locks to keep to a diet and to accept laxatives. At regular developing of a morning headache, it is better for patient to sleep on a high pillow and to arrange before going to bed foot walks.
Strengthening of a headache can be a harbinger of the beginning cerebral crisis. To avoid development of crisis in a similar situation, it is necessary to make massage cervical areas, to warm the head a warm shower or the hair dryer, to drink strong tea; at an intensive headache to accept caffeine in tablets or . If at the hypertensive person increase of a headache is observed, then the two-week course of a bellaspon (belloid) or a vinkapan (vinkaton) is recommended to it.