Intracranial pressure - symptoms and treatment for an increase

Intracranial pressure: what is it and how is it determined

Intracranial pressure (ICP) is a quantitative characteristic showing the strength of the effect of cerebrospinal fluid on brain tissue. Normally, in an adult, its value ranges from 150 to 190 ml of water. Art. (7-16 mm Hg).

Due to the system of complex mechanisms and the interposition of volumetric components (cerebrospinal fluid, blood and tissues), intracranial pressure remains stable.

ICP level depends on:

• the volume of tissues inside the skull;
• tone of arteriolar and venous vascular walls;
• cerebral blood flow velocity;
• production and resorption of cerebrospinal fluid.

ICP is also measured by non-invasive methods (determine the approximate value):

• fundus examination (edema of the optic nerve head, desolation of arterioles);
• transcranial dopplerography;
• rheoencephalography (REG);
• MRI, CT.

Invasive methods of measuring ICP give accurate indicators, but require surgical procedures in a hospital:

• lumbar puncture (intracranial puncture is determined by the pressure of the cerebrospinal fluid);
• intraventricular catheter;
• placement of an epidural sensor (microsensory, fiberoptic, pneumatic);

Also used for children:

• neurosonography (NSG);
• echoencephaloscopy.

These techniques are carried out until both threads are closed (fusion of all cranial sutures).

Symptoms and signs of abnormalities

Intracranial hypertension (ICH) is a nonspecific syndrome, the cause of which is an increase in pressure in the intracranial cavity, compression of brain tissues, and their displacement relative to their normal location.

ICH is not a definitive diagnosis! This is only a nonspecific sign of the development of a dangerous disease.

When the level of intracranial pressure exceeds 20 mm Hg. Art., the lumen of the vessels narrows and the cerebral blood flow is disturbed, its perfusion, secondary cerebral ischemia develops with damage to the function of the central nervous system and vital organs.

ICP rises gradually, since at the first stages compensation mechanisms are activated, which temporarily keep intracranial pressure in the range of normal values.

With volumetric processes in the cranium, the initial defense reaction is the displacement of venous blood from the sinuses, then the rate of CSF production in the intracranial cavity slows down, it is squeezed out of the ventricles and subarachnoid spaces. Over time, the mass of brain tissue also gradually decreases (at first due to a decrease in the amount of intracellular fluid, then - atrophy).

The slower the volumetric process grows, the longer the symptoms of increased ICP will not appear.

At some point, compensatory mechanisms cease to cope and ICP progressively increases due to growth:

• intraventricular CSF pressure;
• the volume of intercellular fluid;
• lumbar spinal pressure.

Due to the deterioration of venous outflow, blood progressively accumulates in the sinuses, which further increases ICP. Without radical intervention in this vicious circle, changes become irreversible and lead to the death of the patient.

With ICH, the blood supply to the brain tissue is primarily disturbed.

Cerebral perfusion remains unchanged even with pronounced fluctuations in systolic blood pressure due to the mechanisms of autoregulation:

1. Myogenic - with the help of the vascular wall's own smooth muscle fibers. Works with drops in systolic blood pressure in the range of 80-180 mm Hg. Art.
   • Narrowing is caused by adrenaline, angiotensin-II, serotonin, prostaglandins E, bradykinin.
   • Expansion - acetylcholine, histamine, nitric oxide (NO), adenosine, GABA.
2. Humoral - through the influence of vasoactive substances on the muscular membrane of the arterioles.
3. Metabolic - an increase in perfusion indicators with an increase in the concentration of CO2 in the blood (for every millimeter, the blood flow rate changes by 6%).
   • High CO2 voltage (hypercapnia) causes vasodilation.
   • Decrease (hypocapnia) - vasoconstriction.

Brain tissue is extremely sensitive to changes in perfusion (volume and rate of passage of blood through organs) and is characterized by a number of features:

1. The main substrate of energy metabolism is glucose, which is broken down mainly in the presence of oxygen.
2. High intensity of consumption of O2. At rest, the brain processes about 20% of all oxygen that enters the body. Moreover, neurons absorb it six to seven times more intensively than other tissues.
3. Extreme sensitivity to energy supply limitation. A decrease in oxygen consumption even 18% below baseline causes fainting.

Signs of increased intracranial pressure in adults:

The state of intracranial hypotension is characterized by a decrease in ICP of less than 100 ml of water. The reasons for this phenomenon: a disruption in the functioning of the vascular plexuses that produce cerebrospinal fluid, or an accelerated outflow of cerebrospinal fluid outside the subarachnoid space.

A decrease in ICP accompanies various TBIs, coma, postoperative complications from removal of a spinal hernia, the emergence of cerebrospinal fluid fistulas, in the first 48 hours after a lumbar puncture.

Intracranial hypotension is characterized by:

• moderate cephalalgia in the occiput and crown;
• sometimes with nausea, dizziness with a sharp change in position in space;
• low blood pressure, tachycardia;
• weakness, lethargy, high lability of autonomic reactions.

Differences in women

Female patients often have so-called "benign (idiopathic) intracranial hypertension" (DICH). This is a symptom complex characterized by:

• symptoms of increased ICP (up to visual disturbances);
• with lumbar puncture, the pressure of the cerebrospinal fluid exceeds 200 ml of water. Art .;
• cerebrospinal fluid with normal cellular and electrolyte composition;
• no focal neurological disorders;
• the ventricular system is of a standard type, sometimes slightly enlarged;
• according to the results of MRI, EEG, angiography, there are no organic brain diseases;
• with severe ICH, the patient retains consciousness;
• often accompanied by pathologies of neuroendocrine regulation (hypothalamic obesity, menstrual irregularities);
• all other causes of intracranial hypertension are excluded.

The provoking factors of this type of hypertension have not yet been studied, but the development of DVHD syndrome is associated with many pathological processes:

• obesity II-III degree;
• hypertension during pregnancy;
• menstrual irregularities;
• late gestosis of pregnant women, preeclampsia;
• decreased function of the parathyroid glands;
• Addison-Bimmer disease;
• lack of vitamin C;
• decompensated diabetes mellitus, ketoacidosis;
• taking medications (Retinol, Tetracycline, oral contraceptives, glucocorticosteroids, psychotropic substances);
• advanced chronic renal failure;
• iron deficiency anemia, leukemia;
• autoimmune conditions.

The main symptom of HDC is headache, its intensity varies throughout the day. It is generalized, with a peak in the morning, cephalalgia, which increases with straining, coughing. The next symptom is visual disturbances that are identical to other types of ICH.

During a headache attack, there is a short-term fogging, narrowing of the visual fields, diplopia, an increase in the area of ​​the blind spot.

DICH resolves spontaneously in most patients, but tends to become chronic or relapse in 40% of cases.

For two years, such patients should regularly undergo examination by a neurologist and MRI of the brain for differential diagnosis with organic pathology.

However, the consequences of a long-term increase in ICP can be catastrophic for vision, from a slight decrease in acuity or narrowing of the fields to complete blindness with atrophy of the optic nerve.

Diagnostics

The degree of ICH, depending on the value of intracranial pressure, is divided into:

1. Norm (3-15 mm Hg).
2. Weak (16-20 mm Hg).
3. Medium (21-30 mm Hg).
4. Expressed (31-40 mm Hg. Art.).
5. Strongly expressed (above 41 mm Hg).

Intracranial hypertension develops due to:

1. Formation of additional volumes.
   • Neoplasms.
   • Hemorrhages (hematomas).
   • Abscesses.
   • Aneurysms.
   • Cysts (parasitic, post-infectious), ventriculitis.
   • Edema of the brain caused by infection, autoimmune, endocrine, metabolic diseases.
2. Strengthening the production of cerebrospinal fluid.
   • Inflammatory diseases (meningitis, encephalitis).
   • Endothelial tumors (epindymomas, vascular plexus papillomas).
3. Violations of absorption and evacuation of CSF from the ventricular system with occlusion of its various parts.
   • Tumors, cystic formations.
   • Thrombosis.
   • The adhesion process.
   • Diseases of accumulation (Niemann-Pick).
4. Violations of the outflow of blood from the cranial cavity.
   • Compression of veins due to craniostenosis.
   • Osteochondrosis of the C3-C7 area.
   • Consequences of TBI, meningitis, metastatic lesions of the meninges.

Estimated scope of diagnostic measures for a patient with ICH:

• examination by a neurologist;
• MRI or CT of the brain;
• ophthalmologist consultation;
• perimetry;
• fundus snapshot;
• examination by a neurosurgeon;
• lumbar puncture;
• electroencephalography;
• angiography of the vessels of the head;
• analysis of cerebrospinal fluid;
• general clinical studies of blood, urine, biochemistry;
• Ultrasound of the abdominal cavity organs, small pelvis, kidneys;
• chest x-ray;
• if necessary, examination by a therapist, cardiologist, endocrinologist;
• according to indications - positron emission tomography.

Treatment

Optimal treatment for ICH is to address the root cause of increased intracranial pressure.

The patient is recommended to follow a healthy lifestyle:

• being in the fresh air more often (unhurried walks will saturate the brain with oxygen and improve blood circulation);
• eat rationally;
• sleep with the head end raised;
• avoid gardening and field work with a tilt of the body and exposure to the open sun;
• give up tobacco and alcoholic beverages;
• refrain from visiting the sauna, taking hot baths;
• refrain from driving a car and controlling complex devices.

Traditional medicine

In the early stages, with slowly progressing ICH, benign hypertension, drug treatment of increased intracranial pressure at home is possible. This type of therapy can only relieve symptoms for a while, but not eliminate the cause.

A patient with ICH is advised to limit the intake of salt (up to 6 g) and liquid (less than 30 ml / kg / day), coffee, adhere to diet No. 10 according to Pevzner.

The main group of drugs is diuretics:

1. Loop - "Furosemide" 160-320 mg / day, "Trifas" 10-20 mg / day;
2. "Acetazolamide" ("Diacarb") 125-250 mg 2 r / day together with tablets "Asparkam" or "Panangin".
3. Osmotic (used in a hospital) - "Mannitol" 0.25-1 g / kg intravenously drip for an hour.

In case of insufficient effect - glucocorticosteroids ("Dexamethasone" 12 mg / day).

The lack of positive dynamics from drug therapy for eight weeks is an indication for surgical correction.

Types of operations for ICG:

1. Periodic lumbar puncture (temporary measure).
2. Bypass procedures (creating an artificial outflow of CSF into the abdominal cavity or heart).

Folk remedies

Only the doctor analyzes all the symptoms, carries out the necessary diagnostic measures and prescribes the optimal treatment.

Phytotherapeutic agents quickly reduce ICP, but are ineffective as an independent treatment.

Traditional medicine considers folk remedies as adjuvants, which somewhat alleviate symptoms and improve the patient's well-being.

Before using any herbs, you need to make sure that they are not allergic to them.

Herbal remedies that eliminate fluid, reduce cerebral edema:

• Birch;
• cowberry;
• St. John's wort;
• kidney tea;
• ordinary motherboard;
• strawberries;
• lavender;
• horsetail;
• mulberry;
• lemon and garlic;
• plantain;
• nettle;
• motherwort.

They are combined and prepared in various ways - they are steamed, tinctures or decoctions are made. The main condition is to strictly follow the instructions on the package and not exceed the dose.

Such treatment is not expected to have a quick effect. Perceptible changes from herbal medicine occur no earlier than three weeks after taking herbal preparations.

Features in children and adolescents

In children, the main reason for the increase in ICP is hydrocephalus (excessive accumulation of cerebrospinal fluid in the intracranial cavity, which is manifested by the expansion of the pathways for evacuation of cerebrospinal fluid, cerebrospinal fluid hypertension and a decrease in the mass of brain tissue).

The main causes of hydrocephalus in newborns are:

1. Congenital defects in the development of the central nervous system.
2. Postponed intrauterine infections.
3. Birth trauma, deep prematurity.
4. Congenital tumors and malformations, benign cysts.

In older children - previous TBI or infectious and inflammatory diseases of the brain, tumors.In 20% of young patients, the cause of hydrocephalus cannot be established.

If the ICP increased even before the fusion of the skull bones, the brain part of the head grows progressively in the baby, the bone sutures diverge, the skin becomes thinner and the veins on the scalp swell, the anterior crown bulges out. When percussion on the bones of the skull, a sound is heard that resembles the crackle of a broken ceramic vessel. The baby lags behind in development, with time, apathy, drowsiness, and decreased appetite progress.

Conservative treatment of increased ICP in adolescents is acceptable only in the early stages with compensated hypertension without neurological disorders. The drug of choice - "Acetazolamide" ("Diacarb"), and in the age dose in combination with "Asparkam" or "Panangin".

In all other cases, surgery is indicated:

• installation of a cerebrospinal fluid system (ventriculo-peritoneal or atrial);
• neuroendoscopic perforation of the fundus of the third ventricle;
• ventriculocisternostomy.

The choice of the operation method depends on the patient's age, ICP level, degree of compensation, tissue condition at the implantation site.

Conclusions

Do not rely on traditional methods or completely ignore the terrible symptoms.

Treatment of increased intracranial pressure in adults and children should be supervised by several specialists (neurologist, therapist, ophthalmologist).

Increased ICP is a wake-up call. In the vast majority of cases, it indicates the development of a dangerous disease. Signs of ICH are a reason to immediately seek medical help.