Intra cranial hypertensia
Intra cranial hypertensia — a syndrome of the increased intrakranialny pressure. Can be idiopathic or develop at various damages of a brain. The clinical picture consists of a headache with pressure upon eyes, nausea and vomiting, sometimes — tranzitorny disorders of sight; in hard cases consciousness violation is noted. The diagnosis is exposed taking into account clinical yielded, results of Ekho-EG, tomographic researches, the analysis of a likvor, intra ventricular monitoring of VChD, UZDG of cerebral vessels. Treatment includes diuretic medicines, etiotropny and symptomatic therapy. According to indications neurosurgical operations are performed.
Intra cranial hypertensia
Intra cranial hypertensia — the sindromologichesky diagnosis which is often found both in adult and in children's neurology. It is about increase in intra cranial (intrakranialny) pressure. As the level of the last directly affects pressure in likvorny system, intra cranial hypertensia also carries the name a likvorno-gipertenzionny syndrome or a syndrome of likvorny hypertensia. In most cases intra cranial hypertensia is secondary and develops owing to injuries of the head or various pathological processes in a skull.
Also primary, idiopathic, intra cranial hypertensia classified by MKB-10 as good-quality is widespread. It is the diagnosis of an exception, i.e. is established only after all other reasons of increase in intrakranialny pressure did not find confirmation. Besides, allocate sharp and chronic intra cranial hypertensia. The first, as a rule accompanies craniocereberal injuries and infectious processes, the second — vascular disorders, slowly growing intracerebral tumors, brain cysts. Chronic intra cranial hypertensia often acts as a residual consequence of sharp intrakranialny processes (injuries, infections, strokes, toxic encephalopathies), and also brain operations.
Reasons and pathogenesis of intra cranial hypertensia
Increase in intrakranialny pressure is caused by a number of the reasons which can be divided into 4 main groups. The first — existence in a cavity of a skull of volume education (primary or metastatic tumor of a brain, a cyst, a hematoma, aneurism of vessels of a brain, brain abscess). The second — hypostasis of a brain of diffusion or local character which develops against the background of encephalitis, a bruise of a brain, a hypoxia, hepatic encephalopathy, an ischemic stroke, toxic defeats. Swelled not actually brain tissues, and cerebral covers at meningitis and an arakhnoidita also leads to likvorny hypertensia.
The following group is the reasons of vascular character causing the raised brain krovenapolneniye. The excess volume of blood in a skull can be connected with increase in its inflow (at a hyperthermia, a giperkapniya) or difficulty of its outflow from a skull cavity (at distsirkulyatorny encephalopathy with violation of venous outflow). The fourth group of the reasons is made by liquorodynamic frustration which are in turn caused by increase in a likvoroproduktion, violation of a likvorotsirkulyation or decrease in absorption of a likvor (tserebrospinalny liquid). In such cases it is about hydrocephaly — an excess congestion of liquid in a cranium.
The reasons of benign intrakranialny hypertensia are not absolutely clear. More often it develops at women and in many cases is connected with a set of body weight. In this regard there is an assumption of an essential role in its formation of endocrine reorganization of an organism. Experience showed what to development of idiopathic intra cranial hypertensia can bring excess intake of vitamin A into an organism, reception of separate pharmaceuticals, cancellation of corticosteroids after the long period of their application.
As the cavity of a skull represents limited space, any increase in the sizes of the structures which are in it involves rise in intrakranialny pressure. The brain sdavleniye expressed in various degree leading to dismetabolichesky changes in its neurons is result. Considerable increase of intra cranial pressure is dangerous by the shift of cerebral structures (a dislocation syndrome) with a vklineniye of almonds of a cerebellum in a big occipital opening. At the same time there is a compression of a brain trunk involving disorder of vital functions as in a trunk the respiratory and cardiovascular nervous centers are localized.
At children as etiofaktor of intra cranial hypertensia anomalies of development of a brain (a mikrotsefaliya, congenital hydrocephaly, arteriovenozny malformation of a brain), an intra cranial patrimonial trauma, the postponed pre-natal infection, a fruit hypoxia, asphyxia of the newborn can act. At younger children's age of a bone of a skull softer, and seams between them are elastic and pliable. Such features promote considerable compensation of intrakranialny hypertensia that provides with its time a long subclinical current.
Symptoms of intra cranial hypertensia
The headache acts as the main clinical substratum of a likvorno-gipertenzionny syndrome. Sharp intra cranial hypertensia is followed by the accruing intensive headache, chronic — periodically amplifying or a constant. Localization of pain in frontal and parietal areas, its symmetry and the accompanying feeling of pressure upon eyeballs is characteristic. In some cases patients describe the headache as which is "holding apart", "pressing on eyes from within". Often along with a headache there is a feeling of a podtashnivaniye, morbidity at the movements by eyes. At substantial increase of intra cranial pressure nausea with vomiting is possible.
Quickly accruing sharp intra cranial hypertensia, as a rule, leads to heavy disorders of consciousness up to a coma. Chronic intra cranial hypertensia usually leads to deterioration in the general condition of the patient — irritability, sleep disorders, mental and physical fatigue, the increased meteosensitivity. Can proceed with likvorno-gipertenzionny crises — sharp rises in intrakranialny pressure, clinically shown severe headache, nausea and vomiting, sometimes — short-term loss of consciousness.
Idiopathic likvorny hypertensia in most cases is followed by passing disorders of sight in the form of a zatumanivaniye, deterioration in sharpness of the image, doubling. Decrease in visual acuity is observed approximately at 30% of patients. Secondary intrakranialny hypertensia is accompanied by symptoms of the main disease (all-infectious, intoksikatsionny, all-brain, focal).
Likvorny hypertensia at children about one year demonstrates change of behavior (concern, tearfulness, a capriciousness, refusal of a breast), frequent vomiting by "fountain", glazodvigatelny frustration, a fontanel vybukhaniye. Chronic intrakranialny hypertensia at children can become the reason of a delay of mental development with formation mental retardation.
Diagnosis of intra cranial hypertensia
Installation of the fact of increase in intrakranialny pressure and assessment of its degree is a difficult task for the neurologist. The matter is that the intra cranial pressure (VChD) significantly fluctuates, and clinical physicians still have no consensus to its norm. It is considered that normal VChD of the adult is in horizontal position ranging from 70 to 220 mm w.g. Besides, there is no still easy and available way of exact measurement of VChD. The echo encephalography allows to obtain only indicative data which correct interpretation is possible only by comparison to a clinical picture. The hypostasis of optic nerves revealed by the ophthalmologist at an oftalmoskopiya can demonstrate increase in VChD. At long existence of a likvorno-gipertenzionny syndrome on a X-ray analysis of a skull so-called "manual vdavleniye" are found; at children change of a form and thinning of cranial bones can be noted.
It is reliable only direct introduction of a needle to likvorny space by means of a lyumbalny puncture or a puncture of ventricles of a brain allows to determine intra cranial pressure. Now electronic sensors are developed, but their intra ventricular introduction still is rather invasive procedure and demands creation of a trepanatsionny opening in a skull. Therefore the similar equipment is used only by neurosurgical offices. In hard cases of intra cranial hypertensia and during neurosurgical interventions it allows to carry out monitoring of VChD. For the purpose of diagnosis of causal pathology apply brain KT, MCKT and MPT, a neyrosonografiya through a fontanel, UZDG of vessels of the head, a research of tserebrospinalny liquid, a stereotaksichesky biopsy of intracerebral tumors.
Treatment of intra cranial hypertensia
Conservative therapy of likvorny hypertensia is performed at its residual or chronic character without the expressed progressing, in sharp cases — at slow increase of VChD, lack of data for a dislocation syndrome and serious disorders of consciousness. The basis of treatment is made by diuretic pharmaceuticals. The choice of medicine is dictated by the VChD level. In sharp and hard cases it is applied and other osmodiuretik, in other situations act as medicines of the choice furosemide, , acetazoleamide, a hydrochlorothiazide. The majority of diuretics should be applied against the background of introduction of medicines of potassium (potassium of asparaginate, potassium chloride).
Treatment of causal pathology is in parallel carried out. At infectious and inflammatory damages of a brain etiotropny therapy (antiviral medicines, antibiotics) is appointed, at toxic — desintoxication, at vascular — vazoaktivny therapy (, , nifedipine), at venous stagnation — venotonik (, horse-chestnut extract, + ), etc. For maintenance of functioning of nervous cages in the conditions of intra cranial hypertensia in complex therapy use neurometabolic means (gamma aminooleic acid, piracetam, glycine, a hydrolyzate of a brain of a pig, etc.). For the purpose of improvement of venous outflow kranialny manual therapy can be applied. In the sharp period the patient has to avoid emotional overloads, exclude work at the computer and listening of audio recordings in earphones, to sharply limit viewing of movies and reading books, and also other kinds of activity with load of sight.
Surgical treatment of intra cranial hypertensia is applied urgentno and according to plan. In the first case the purpose is urgent decrease in VChD in order to avoid development of a dislocation syndrome. In such situations neurosurgeons often carry out decompressive cranial trepanation, according to indications — external ventrikulyarny drainage. Planned intervention aims at elimination of the reason of increase in VChD. It can consist intrakranialny volume formation, correction of congenital anomaly, elimination of hydrocephaly by means of cerebral shunting at a distance (kistoperitonealny, ventrikuloperitonealny).
Forecast and prevention of intra cranial hypertensia
The outcome of a likvorno-gipertenzionny syndrome depends on the main pathology, speed of increase of VChD, timeliness of therapy, compensatory abilities of a brain. At development of a dislocation syndrome the lethal outcome is possible. Idiopathic intra cranial hypertensia has a good-quality current and will usually well respond to treatment. Long likvorny hypertensia at children can lead to a delay of psychological development with formation of moronity or a deficiency of intellect.
Prevention of intrakranialny pathology, timely treatment of neuroinfections, distsirkulyatorny and liquorodynamic frustration allows to prevent development of intrakranialny hypertensia. It is possible to refer observance of a normal day regimen, work rationing to preventive measures; avoiding of mental overloads; adequate conducting pregnancy and childbirth.