Intracranial hypertension, moderate symptoms in adults

Headache can be a symptom of many serious diseases. Intracranial hypertension is an increase in intracranial pressure due to head injuries, hemorrhages, inflammation of brain tissue and the development of tumors.

To avoid complications, you need to promptly seek help from the Yusupov Hospital, where the pathology will be diagnosed and treated.

The quality of services provided in the hospital is at the European level. All diagnostic and treatment procedures are performed using the latest medical equipment. The rooms are equipped with maximum comfort for patients.

Do not put off going to the doctor and for any manifestations of increased intracranial pressure, seek help from highly qualified doctors at the Yusupov Hospital.

Intracranial venous hypertension: causes

Often a headache can be caused by a cold, lack of sleep, or overwork. It appears due to increased intracranial pressure. If headaches become permanent and severe, this is a signal to contact the Yusupov Hospital.

Benign intracranial hypertension is an increase in pressure inside the skull that is not associated with any pathological process in the body. Headaches occur due to taking certain medications or due to obesity.

In a healthy person, the volume of the brain consists of certain proportions of the volumes of its fluids and tissues - cerebrospinal fluid, blood and interstitial fluid. When the volume of one of these components increases, the blood pressure in the cranium increases.

If the outflow of cerebrospinal fluid from the skull is disrupted, the volume of cerebrospinal fluid increases and the pressure increases. An increase in the total volume of brain fluids leads to hemorrhages with the formation of hematomas.

The difference in fluid pressure can lead to displacement of brain structures relative to each other. This pathology leads to partial or complete disruption of the normal functioning of the nervous system.

With cerebral edema, an increase in the volume of brain structures occurs and intracranial hypertension is diagnosed.

Causes

The most common causes of hypertension in adult patients are:

Primary hypertension

traumatic brain injuries resulting from accidents, especially with the formation of intracranial hematomas;
circulatory disorders in the brain caused by stroke, the formation of blood clots in the sinuses of the dura mater of the brain;
tumor processes in the cavity of the cranium, including metastases from neoplasms localized in neighboring areas;
infectious and inflammatory diseases (encephalitis, suppuration, meningococcal infection);
congenital abnormal structure of cerebral capillaries, parts of the brain or the skull itself (closure of the channels through which cerebrospinal fluid flows from the brain);
metabolic disorders and poisoning by chemicals (lead and mercury vapors, ethyl alcohol, carbon monoxide, own decay products, for example, with cirrhosis of the liver);
pathologies leading to disturbances in the outflow of blood from the venous network (heart defects, tumors in the neck, mediastinum, diseases of the bronchopulmonary system occurring against the background of obstruction).

Of course, not all the reasons that provoke a pathological increase in pressure levels inside the skull are listed. Other factors are less common and require a diagnostic examination to determine them.

Why does pathology occur in children?

The development of the disease in children is caused by a violation of the outflow of liquor fluid from the brain structures, which increases the level of pressure in the cranial cavity. The pathological condition is provoked by the following reasons:

lack of oxygen while in the womb and passing through the birth canal;
birth injuries with damage and even rupture of the cerebral cisterns - during caesarean section and removal of the newborn from the birth canal with forceps;
congenital anomalies - Arnold-Chiari syndrome, when the occipital lumen of the medulla oblongata narrows, due to which the cerebrospinal fluid does not flow from the cranial cavity;
poisoning by toxins and asphyxia - when harmful substances pass through the blood-brain barrier and affect the fetus, a lack of oxygen is created, affecting some of the brain cells;
infectious diseases, such as meningitis and brain tumors;
spinal injuries in the cervical region;
cerebral hemorrhages - they are provoked by injuries during childbirth and hemorrhagic vasculitis.

When the functioning of the thyroid gland is impaired or excessive production of hormones by the adrenal cortex, the blood vessels that supply different parts of the brain are affected. They undergo spasm, which is why intracranial hypertension gradually develops.

The indirect cause of the syndrome is considered to be excessive body weight in infants and obesity

Intracranial hypertension: symptoms in adults and children

Intracranial hypertension syndrome manifests itself in different ways, depending on the location of the pathology that causes increased intracranial pressure, as well as on the stage of the disease and the speed of its development.

Moderate intracranial hypertension manifests itself as:

headaches;
dizziness;
attacks of nausea and vomiting;
clouding of consciousness;
seizures

Signs of intracranial hypertension as the pathology develops are often expressed by visual impairment. With greatly increased intracranial pressure, loss of consciousness, impairment of hearing, speech, smell, etc. may occur.

Depending on the nature of the displacement of the lobes of the brain, arterial hypertension, disruption of breathing and normal heart function may be observed. In women of reproductive age, intracranial hypertension syndrome can develop due to menstrual irregularities, during pregnancy, obesity, or as a result of taking certain medications. Pathology can develop against the background of infectious diseases, in particular syphilis.

It is quite common for children to be diagnosed with idiopathic intracranial hypertension (benign) after taking the antibiotic tetracycline, high doses of vitamin A, or corticosteroids. There is no connection between increased intracranial pressure and the development of any disease.

Intracranial hypertension in newborns can occur for several reasons:

as a result of injuries received during childbirth;
due to an infectious disease of the mother occurring during pregnancy;
due to congenital hydrocephalus (dropsy) of the brain, that is, an increase in the volume of the ventricles.

In young children, intracranial hypertension has symptoms in the form of developmental disorders, rolling of the eyeballs, bulging of the forehead, and lack of reaction in the child to harsh light.

In older children, intracranial hypertension manifests itself as headaches, drowsiness, blurred vision, and strabismus.

Indirect signs of increased ICP

In adults and older children, indirect clinical signs of increased intracranial pressure include:

Headaches of a bursting-pressing nature. They are usually accompanied by a feeling of pressure in the bridge of the nose or from the inside on the eyeballs, often intensifying in the early morning hours when lying down. This is the most common and characteristic sign of increased intracranial pressure. Simple analgesics and NSAIDs are ineffective, and lowering the general (systemic) blood pressure level does not help either.
Increased meteosensitivity with deterioration of health when atmospheric pressure changes.
Functional disorders: mood instability with increased irritability, often with a tendency to tearfulness, increased fatigue, not always sufficient concentration, sleep disturbances.
Autonomic disorders: increased sweating, increased vascular pattern with periodic appearance of skin marbling and acrocyanosis.
Recurrent nosebleeds, spontaneous and often difficult to stop. Their appearance is associated with the activation of an emergency compensatory mechanism for regulating intracranial and blood pressure. But they are not observed in all cases; people with extensive and closely spaced venous plexuses in the walls of the nasal cavity are predisposed to them.
Dizziness. It is unstable, non-systemic, and usually disturbs when weather conditions change, neuro-emotional stress, or increased blood pressure.
Vomiting that does not have a clear connection with food intake and is not explained by any intoxication or pathology of the gastrointestinal tract. Moreover, it is not always accompanied by clearly defined nausea, does not lead to its relief and does not alleviate the condition.
Double vision, blurred vision. Such disorders are optional and transient; they occur during acute decompensation of intracranial hypertension.
Epileptiform seizures (convulsive and non-convulsive), and abortive forms are possible. They are uncommon and usually do not progress to status epilepticus.
Transient mental disorders. They appear only in a small number of people with intracranial hypertension and are usually associated with decompensation of liquor-dynamic disorders. These may be disturbances of perception (from illusory disturbances to true hallucinosis), disturbances of consciousness (confusion, stunnedness), asthenodepressive syndrome, dysphoria.

The presence of intracranial hypertension can be suspected based on the results of some studies. For example, dilated and congested veins in the fundus of the eye testify in favor of this pathology, especially in combination with a picture of papilledema.

And the EEG with increased intracranial pressure often reveals diffuse changes with signs of increased convulsive readiness of the cerebral cortex without specific focal epileptic activity. Moreover, such deviations are possible even in the absence of any history of attacks.

Intracranial hypertension: diagnosis

Types of pathology diagnostics include:

measuring intracranial pressure by inserting a needle into the fluid cavities of the skull or spinal canal with a pressure gauge attached to it.

tracking the degree of blood filling and dilation of the veins of the eyeball. If the patient has red eyes, that is, the eye veins are abundantly filled with blood and are clearly visible, we can talk about increased intracranial pressure;
ultrasound examination of cerebral vessels;
magnetic resonance and computed tomography: the expansion of the fluid cavities of the brain is examined, as well as the degree of rarefaction of the edges of the ventricle;
conducting an encephalogram.

NORMOTENSIVE HYDROCEPHALUS

Normal pressure hydrocephalus (NPH) is associated with impaired CSF absorption, and dilatation of the cerebral ventricles develops in the presence of normal intracranial pressure.

EPIDEMIOLOGY

The prevalence of NG is 1-2 cases per 1,000,000 people. In the practice of a neurologist specializing in patients with extrapyramidal diseases, as a rule, no more than a dozen patients are recorded per year. This type of hydrocephalus is more common in older people. The condition should be excluded in persons over 60 years of age with a combination of cognitive impairment (dementia), pelvic organ dysfunction (usually urinary incontinence) and walking impairment (lower body parkinsonism) - the Hakim-Adams triad. Due to the fact that in a significant proportion of cases, bypass surgery in the early stages leads to improvement in walking, it is important to suspect and confirm this condition in a timely manner.

CLINIC

The structure of cognitive impairment is dominated by frontal-subcortical disorders: decreased activity, apathy, and behavioral disorders. Walking disorders have been described as magnetic gait, gait apraxia, and frontal ataxia. Patients experience the greatest difficulty when starting to walk. The area of support is increased, the length and height of the step is reduced, the smoothness of movements is impaired, and there is a progressive slowdown in walking with each step. Patients always have postural instability; often, upon questioning, you can find out that there have been falls before.

DIFFERENTIAL DIAGNOSIS

However, other diseases with cognitive and motor impairments may have a similar pattern of impairments. When carrying out differential diagnosis, the following are considered: vascular dementia (discirculatory encephalopathy stage III), Parkinson's disease with dementia and dementia with Lewy bodies, Alzheimer's disease. The main diagnostic method is MRI of the brain. The examination reveals the expansion of the lateral ventricles, the rounded shape of their anterior horns, and the smoothness of the relief of the cerebral cortex. It is important to use the Evans ventricular-hemispheric index, which is the ratio of the distance between the most distant points of the anterior horns of the lateral ventricles to the largest internal diameter of the skull. Ventriculomegaly is diagnosed if the index exceeds 0.31. NG is characterized by changes in the periventricular white matter, similar to leukoaraiosis (see above). Their severity correlates with the degree of cognitive impairment].

Figure 2 MRI signs of cerebral atrophy (A) in Alzheimer's disease and (B) normal pressure hydrocephalus

At first glance, the images are quite similar, but the image on the right shows the rounded shape of the horns of the lateral ventricles and the smoothness of the sulci of the cerebral hemispheres.

Figure 3 Gliotic and atrophic changes after traumatic brain injury, replacement hydrocephalus

Intracranial hypertension: treatment, drugs

Increased intracranial pressure can lead to a decrease in the patient’s intellectual abilities and disruptions in the normal functioning of internal organs. Therefore, this pathology requires immediate initiation of treatment aimed at reducing intracranial pressure.

Treatment can only be carried out if the causes of the pathology are correctly diagnosed. For example, if intracranial hypertension occurs due to the development of a tumor or hematoma of the brain, then surgical intervention is required. Removal of a hematoma or neoplasm leads to normalization of intracranial pressure.

When increased intracranial pressure is a consequence of inflammatory processes in the body (meningitis, encephalitis, etc.), then the only effective method of treatment is massive antibiotic therapy. In this case, antibacterial drugs can be injected into the subarachnoid space in combination with the extraction of part of the cerebrospinal fluid.

Therapy is aimed at reducing the release of cerebrospinal fluid while simultaneously increasing its absorption. For this purpose, patients are prescribed diuretics.

Quite often, treatment does not require taking any medications. A set of gymnastic exercises is developed for the patient, the implementation of which leads to a decrease in intracranial pressure. Adjustments are also made to the diet and a drinking regime is developed individually. Light manual therapy, acupuncture and physiotherapy have a beneficial effect. The effectiveness of non-drug treatment is observed within the first week from the start of therapy.

In case of postoperative, congenital cerebrospinal fluid block or other severe cases, surgical treatment is indicated. The most common type of surgical intervention is bypass surgery, that is, the insertion of a special tube with one end into the abdominal cavity or heart cavity, and the other into the cerebrospinal fluid space of the brain. Thus, excess cerebrospinal fluid is constantly removed from the skull, leading to a decrease in pressure.

When intracranial pressure increases at a very high rate and the patient’s life is threatened, urgent measures are required to save the patient. In this case, the patient is injected intravenously with a hyperosmolar solution, artificial ventilation is performed, the patient is put into a medically induced coma, and excess cerebrospinal fluid is removed by puncture.

The most aggressive treatment measure, which is resorted to in the most difficult cases, is decompressive craniotomy. At the time of the operation, a skull defect is created on one or both sides so that the brain does not rest against the bones of the skull.

Intracranial hypertension can be completely eliminated if the causes that caused it (tumor, poor blood flow, etc.) are eliminated.

Treatment of intracranial hypertension at the Yusupov Hospital

Intracranial hypertension is a pathological condition caused by diseases of the brain and not only. The pathology requires mandatory treatment to avoid the development of numerous and irreversible consequences. Do not delay going to the doctor for any manifestations of increased intracranial pressure.

Doctors at the Yusupov Hospital have extensive experience in treating intracranial hypertension. The quality of services provided in the hospital is at the European level. All diagnostic and treatment procedures are performed using the latest medical equipment. The rooms are equipped with maximum comfort for patients. You can make an appointment with a doctor by phone.

Prevention and prognosis

The outcome of liquor-hypertensive syndrome depends on the underlying disease, pressure level and adequate surgical therapy. In severe cases, the patient's death is possible. ICP of unknown origin responds well to therapy. If a child remains in this state for a long time, the most severe complication may be mental retardation.

Preventive measures that prevent the development of intracranial hypertension include: current diagnosis and treatment of intracranial neoplasms, dyscirculatory disorders, regular use of blood pressure-normalizing drugs in the chronic course of the disease, adherence to a daily routine, proper management of pregnancy and obstetric care.