Intracranial hypertension in children

Benign pathology

Normal intracranial pressure is called its uniform distribution on the vessels, which determines the balance between the volume of cerebrospinal fluid, blood flow in the brain and its tissues. Under the influence of external or internal factors, it changes, but independently returns to normal. Some processes in the body can lead to an increase in pressure and the occurrence of intracranial hypertension.

Normally, a baby has about 50 ml. cerebrospinal fluid (cerebrospinal fluid), and in adolescence - up to 150 ml. It puts a little pressure on the structures of the brain. It belongs to the organs quite sensitive to various external influences. Therefore, the task of the cerebrospinal fluid is to mitigate the influence of extraneous factors on the parts of the brain.

There is such a thing as benign intracranial hypertension in children. It is understood as a condition, a feature of which is an increase in pressure in the cranial cavity. All symptoms resemble a tumor in the brain, but when examining the cerebrospinal fluid, the level of leukocytes and protein is within normal limits. On CT or MRI, the ventricles are of the usual size, location, and shape. In another way, this condition is called a false tumor.

Causes

The reasons that provoke an increase in pressure in the cranial cavity are not divided into several groups. These include the following:

• volumetric formation in the cranial cavity.
• increased blood circulation in the brain associated with vascular problems.
• tissue edema associated with various diseases.
• violation of the normal circulation of cerebrospinal fluid.

In the presence of a mass in the tissues of the brain, a gradual compression of the structures occurs. Over time, there is a gradual increase in intracranial pressure with characteristic symptoms. These formations include a tumor, aneurysm, hematoma, cyst, abscess.

The next group is vascular pathology in the brain. An excess of blood in its tissues is associated with an increased inflow, which is observed at high body temperature or in conditions of an increased concentration of carbon dioxide. The same is noted with obstructed outflow, which is characteristic of discirculatory encephalopathy (chronic pathology of the brain against the background of insufficient blood flow to the tissues), and impaired outflow through the veins.

The appearance of edema in the tissues is possible with trauma, encephalitis, stroke, liver damage or intoxication. Violation of the normal circulation of cerebrospinal fluid occurs when it is excessively formed, difficulty in reabsorption (absorption).

Signs

The skull is a confined space, and any increase in brain structures results in an increase in pressure. The result is squeezing with impairments of varying severity and symptoms of varying severity. An increase in symptoms and an increase in the structures of the brain leads to their displacement and wedging into the foramen magnum in the cranial cavity. This entails the emergence of an intracranial group of complications that threaten the child's life.

In childhood, the less the child is, the longer specific symptoms of increased intracranial pressure may be absent. This is due to the greater elasticity and pliability of the seams between the bones and the softness of the tissues. For children of all ages, the following signs of hypertension occurring in the cranial cavity are characteristic:

1. Headache, which is intense and sharp during the acute process. The chronic course is characterized by a constant one, it increases periodically, with a gradual increase. A distinctive feature is the appearance of a feeling of pressure on the eyeballs, its localization in the fronto-parietal region, as well as symmetry. Older children (5 years and older) describe these sensations as a feeling of fullness in the head. When the eyeballs move, pain occurs in them. Most often, complaints appear in children at night or in the morning.
2. Nausea and vomiting in a fountain with a sharp appearance of intracranial hypertension.
3. Irritability, apathy, tearfulness.
4. The appearance of strabismus.
5. Convulsions.

Children under 3 years of age are characterized by hyperactivity that is not characteristic of them, walking on tiptoes, impaired mental development, and attention.

A rapid increase in hypertension can provoke the development of severe complications from many body systems. In some cases, depending on the severity of the condition or the severity of the process, the rapid course ends with the development of a coma.

The chronic form of intracranial hypertension differs from the acute variant in violation of the general condition of the child. Parents note the appearance of irritability, sleep disturbance, dependence on weather conditions, as well as the appearance of rapid mental and physical fatigue. Intracranial hypertension in children can also occur with crises. They are characterized by a sharp onset of headache, vomiting, and sometimes temporary loss of consciousness.

If an increase in intracranial pressure is associated with a violation of the flow of cerebrospinal fluid, then older children complain of the appearance of a feeling of fog before the eyes, double vision and a decrease in visual acuity. A child under one year old, with the appearance of the same cause of hypertension, begins to constantly be capricious, becomes irritable, cries, refuses to breast. After eating, vomiting is noted with a fountain.

Hypertension of the brain in infants

Intracranial hypertension in an infant is much more pronounced than after 1 year of life. The following features are characteristic:

1. Bulging fontanelle and divergence of the bones of the skull. This is due to the presence of fontanelles. The accumulation of cerebrospinal fluid most often occurs in the forehead or vertex, and therefore a disproportionate increase in head volume is a frequent sign of increased intracranial pressure and the appearance of hydrocephalus (accumulation of fluid in the brain).
2. Due to intracranial hypertension, enlarged veins on the forehead and temples are noted.
3. With an increase in pressure in the cranial cavity, the normal functioning of the oculomotor nerve is disrupted. As a result, strabismus is noted when examining the baby.

Parents should be alerted by frequent regurgitation, in addition to which is joined by constant crying and the child's tendency to lower his head down.

Diagnostics

To establish the fact of increased intracranial pressure, a set of studies is used. Normally, it is between 70 and 200 mm. water Art. Already at the stage of intrauterine development, a thorough diagnosis of the fetus is carried out to determine hypoxia. Then, immediately after birth, an examination is carried out at the perinatal center to exclude the presence of hydrocephalus. After discharge from the hospital, scheduled visits to the local pediatrician are mandatory. At this stage, the mother can share her concerns about the condition of her baby. Cerebral hypertension is established on the basis of the following studies:

• examination by an ophthalmologist;
• X-ray of the skull;
• ECHO encephalography;
• lumbar puncture;
• CT or MRI;
• neurosonography;
• Doppler ultrasound of cerebral vessels.

Children with suspected increased intraocular pressure must be examined by an ophthalmologist. Direct ophthalmoscopy examines the fundus through a previously dilated pupil using drops. Hypertension in the cranial cavity is established in the presence of edema of the optic nerves. In addition to them, an examination of the macula, blood vessels, and accessible parts of the retina is performed.

X-ray of the bones of the skull (craniography) establishes the presence or absence of damage associated with congenital causes, trauma and surgical interventions. A feature of the technique is the performance of survey images in 2 projections. To get targeted shots, it is important to fix the child's head in the desired position using special pads or bandages. In the presence of arousal, sedation is preliminarily carried out. Excessive physical activity makes it impossible to obtain high-quality images.

ECHO with the help of ultrasound allows you to detect pathological formation in the tissues of the brain, which is the cause of high intracranial pressure. To avoid interference, before the examination, the scalp at the places where the sensors are installed is lubricated with a contact gel. Such a study is carried out for children in serious condition, weakened. Intracranial hypertension leads to atrophic processes in the tissues of the brain and a deterioration in the conduction of nerve impulses, which is recorded by the sensors of the ECHO apparatus.

A lumbar puncture is done to determine if hypertension is present. The needle is inserted at the lumbar level into the epidural space. The procedure is prescribed necessarily if there is a suspicion of an injury or an infectious disease. The correct posture of the child, which must be taken, is lying on its side with the knees brought to the stomach. Pain relief is given before the procedure to reduce pain. The pressure is judged by the rate of flow of the cerebrospinal fluid. To measure it accurately, a needle and a water pressure gauge are used. After collecting the cerebrospinal fluid, the child should be given plenty of water to drink and ensure bed rest for 3-4 hours in the prone position.

CT and MRI are non-invasive methods for diagnosing the pathology of any organ. They allow you to examine the tissue layer by layer and find the process that is causing the increase in intracranial pressure in the child.

The advantage is the absence of discomfort during the procedure. One of the most common methods of examination for the detection of congenital pathology of the nervous system is neurosonography. To obtain results, it is carried out through the fontanelle. In the presence of emergency indications, neurosonography is performed on the first day after birth. The advantage of the study lies in the possibility of carrying out the technique in children in serious condition.

Routine examination involves positioning the ultrasound probe on the fontanelle major. The smaller its size, the smaller the area will be able to be examined using neurosonography.

An additional method in children is considered to be an ultrasound scan of the vessels of the head, which is based on the use of ultrasound.

During the procedure, you can get an image of the damaged vessel, but there is no way to establish the cause of the violations. Before the child undergoes a study, on the day of the ultrasound scan, drugs are canceled except for those that are vital to him.

The duration of the procedure usually takes up to 30 minutes. After its completion, the doctor receives data on the rate of blood flow through the arteries feeding the brain tissue and veins, the task of which is to carry out its outflow.

Increased intracranial pressure leads to the development of dangerous complications for the child's health. Clinical symptoms can be mild, which is important to take into account and provide assistance in time. Depending on the cause, the signs of intracranial hypertension build up slowly or quickly, they must be stopped in time.