Intracranial hypertension( increased intracranial pressure), hydrocephalus - Causes, symptoms and treatment. MF.
May 31, 2018
The brain tissue is very sensitive to mechanical influences. Therefore, nature placed the human brain apart from the bone box( skull) in a protective liquid medium( subarachnoid fluid spaces) and provided it with internal fluid cavities( ventricles).Thus, the brain is actually weighed in a liquid - cerebrospinal fluid( other names are cerebrospinal fluid or CSF).Liquor is located in the cavity of the skull under certain pressure. It is the pressure of the cerebrospinal fluid called intracranial pressure of .
The normal level of intracranial pressure is very important for a person's well-being. Increased intracranial pressure is not an independent disease, but a symptom of many neurological diseases.
Causes of increased intracranial pressure
All fluid spaces and ventricles are interconnected by ducts. Liquor constantly circulates. In some parts of the brain it is secreted, and then flows through the liquor channels to other parts of the brain, where it is absorbed into the bloodstream. A complete refreshment of the cerebrospinal fluid occurs on average 7 times a day.
Excessive accumulation of CSF causes an increase in its pressure on the substance of the brain. This is called an increase in intracranial pressure( intracranial hypertension).
Three common causes of chronic increase in intracranial pressure:
1. CSF is allocated too much;
2. the cerebrospinal fluid is not fully absorbed;
3. discontinuity of the pathways of circulation of the cerebrospinal fluid.
To increase intracranial pressure and hydrocephalus lead:
- craniocerebral trauma( even very old, up to birth trauma, concussion, brain contusions);
- meningitis or encephalitis;
- congenital features of the structure of the central nervous system( Arnold-Chiari anomaly, idiopathic intracranial hypertension, etc.);
- poisoning( including drug and alcohol);
- circulatory disorders in the vessels of the brain( eg, ischemia, encephalopathy, osteochondrosis of the cervical spine);
- intracranial volumetric processes( brain tumors, brain envelopes, cerebral hemorrhages and intracranial hematomas).
If intracranial pressure is increased significantly and for a sufficiently long time, the fluid cavities of the brain can expand - this extension is called hydrocephalus .Since the cranial cavity is a closed space, the expansion of the liquid cavities of the brain occurs due to a decrease in the mass of the brain substance itself. This process can have a negative impact on health.
MR-tomogram of the normal brain. Gray color depicts the substance of the brain, white - liquor. The normal size of the fluid spaces of the brain( they are slit-shaped).The ventricles are visible inside the brain. Subarachnoid spaces - a white border around the brain.
MR-tomogram with intracranial hypertension and hydrocephalus. The result of insufficient treatment of increased intracranial pressure. There is an excessive accumulation of cerebrospinal fluid inside the brain( in the form of a butterfly) and outside the brain( wide white border).The volume of the brain substance is reduced - the atrophy of the brain from the pressure of the liquid.
Symptoms of increasing intracranial pressure
The increased pressure on the substance of the brain can disrupt the work of the central nervous system. Hence the characteristic symptoms:
· Severity in the head or headaches that build up in the morning or in the second half of the night;
· In severe cases, nausea and / or vomiting may occur in the morning;
· Vegeto-vascular dystonia( sweating, falling or rising blood pressure, palpitations, pre-patching conditions, etc.) is a practically mandatory symptom;
· Fatigue, "stupor", easy exhaustion at work or study load;
· "Bruises" under the gasses( if you stretch the skin under the eyes in the area of "bruise" you see enlarged small veins);
· There may be a decrease in sexual desire, potency;
· If the human body is in a horizontal position, the cerebrospinal fluid is more active, and absorbed more slowly, therefore intracranial pressure and its symptoms have the property of reaching a peak in the second half of the night or in the morning;
· Intracranial pressure is higher, the lower the atmospheric pressure, so the deterioration is associated with a change in weather.
Diagnosis of intracranial hypertension and hydrocephalus is established by physicians based on characteristic symptoms and based on data from special studies, such as brain imaging.
Diagnosis if there is a suspicion of increased intracranial pressure( intracranial hypertension), hydrocephalus
Direct measurement of intracranial pressure is possible only by inserting a special needle into the liquid cavities of the skull or spinal canal with a manometer connected to it. Therefore, a direct measurement of intracranial pressure due to the invasiveness of the procedure is not applied.
Symptoms of changes in intracranial pressure in children and adult patients are revealed in the following examination procedures:
- neurological examination
- MRI of the brain
- examination of the fundus
- lumbar puncture
- radiography of the skull bones
- REG( rheoencephalography)
About increasing intracranial pressure, Based on the following data:
- Expansion, tortuosity of the veins of the fundus is an indirect but reliable sign of increased intracranial pressure;
- Expansion of the fluid cavities of the brain and dilution of the medulla at the edge of the ventricles of the brain, clearly visible in computerized X-ray tomography( CT) or magnetic resonance imaging( MRI);
- Infringement of outflow of a venous blood from a cavity of a skull, established by means of ultrasonic vascular researches.
- decrease in pulse wave in REG( with rheoencephalogram)
As far as the brain suffers from increased intracranial pressure, it can be judged from EEG data.
The gold standard of instrumental examination of patients is the evaluation of symptoms, data of the tomography of the brain and picture of the fundus and EEG.
Echoencephalography( Echo-EG) gives indirect and not always reliable data on increased intracranial pressure, it is less reliable than CT and MRI, so this method is rarely used.
Intracranial hypertension. Hydrocephalus - treatment
The human brain under the influence of excessive pressure can not normally work, moreover, there is a slow atrophy of white brain matter, and this leads to a slow decrease in intellectual abilities, a violation of the nervous regulation of the internal organs( hormonal disorders, arterial hypertension, etc.).Therefore, it is necessary to take all measures for the speedy normalization of intracranial pressure.
In the treatment of increased intracranial pressure, it is important to reduce the excretion and increase absorption of the CSF.Traditionally, it is customary to prescribe diuretics for this purpose. However, the continued use of diuretics is not always acceptable to the patient.
The methods of treatment directed on normalization of intracranial pressure without medicines are applied. This is a special gymnastics to reduce intracranial pressure( used by the patient independently), individual drinking regimen and small changes in nutrition, unloading the venous bed of the head with the help of methods of soft manual therapy, acupuncture and physiotherapy.
Thus, a sustained reduction in intracranial pressure is achieved without a constant intake of diuretics, after which the unpleasant symptoms gradually decrease. The effect is usually noticeable already in the first week of treatment.
Elevated intracranial pressure can be cured only if the disease that caused this symptom is treated.
Surgical treatment of hydrocephalus
In very severe cases( eg, a cerebrospinal fluid block after neurosurgical operations or a congenital cerebrospinal fluid block) surgical treatment is used. For example, a technology has been developed for implanting tubes( shunts) to drain excess CSF.
PS: Dehydration of the body( vomiting, diarrhea, high blood loss), chronic stress, vegetative-vascular dystonia, depression, neurosis, diseases accompanied by impaired blood circulation in the vessels of the brain( eg, ischemia, encephalopathy, cervicalosteochondrosis).