Intracranial hypertensia

Description:

Intracranial hypertensia (VChG) (other - Greek ὑπερ-  — super + lat. tensio — tension) — increase in pressure in a head cavity. It can be caused by brain pathology (a craniocereberal injury, tumors, intracraneal hemorrhage, entsefalomeningity, etc.). Results from increase in volume of intracranial contents: cerebrospinal fluid (liquor), an intercellular lymph (wet brain), blood (venous stagnation) or emergence of foreign fabric (for example, at a brain tumor).

Symptoms of Intracranial hypertensia:

Formation of a clinical gipertenzionny syndrome, the nature of its manifestations depend on localization of pathological process, its prevalence and speed of development. Clinically the syndrome of VChG is shown by a headache, quite often forced position of the head, nausea, vomiting. Disorder of consciousness, convulsive attacks are possible. At long existence vision disorders join.

Objective symptoms of intracranial hypertensia are swelled nipples of optic nerves, increase in pressure of cerebrospinal liquid, typical radiological changes of bones of a skull. It is necessary to consider that these signs appear not at once, and after a long time (except increase in pressure of cerebrospinal liquid).

At substantial increase of intracranial pressure disorder of consciousness, convulsive attacks, visceral and vegetative changes are possible. At dislocation and a vklineniya of trunk structures of a brain there are bradycardia, breath disturbance, reaction of pupils to light decreases or vanishes, system arterial pressure increases.

Reasons of Intracranial hypertensia:

At increase in volume of any of the above-stated elements there will be an increase in pressure in a head cavity.

At wet brain there is an increase in volume of tissue of brain and respectively intracranial hypertensia develops. Obturation of likvorny ways causes disturbance of outflow of liquor from a head cavity, its accumulation (obturatsionny hydrocephaly) and respectively intracranial hypertensia. Intracraneal hemorrhage with formation of a hematoma also leads to increase in intracranial pressure.

At increase in intracranial pressure in one of areas of a skull there is an area of a distenziya that leads to the shift of structures of a brain rather each other — dislocation syndromes develop. This pathology is zhizneugrozhayushchy and can lead to the death of the patient.

The most often met dislocation syndromes are:

    * shift of parencephalons under a crescent shoot,
    * temporal and tentorial shift,
    * cerebellar and tentorial shift,
    * shift of almonds of a cerebellum in foramen magnum.

At increase in pressure of liquor to 400 mm w.g. (about 30 mm of mercury.) the stop of cerebral circulation and the termination of bioelectric activity of a brain are possible.

Treatment of Intracranial hypertensia:

It is necessary to approach with care tactics of treatment of intracranial hypertensia, the reason is not defined it yet. The origin of hypertensia defines tactics of the doctor. Apply osmotic diuretics to bystry cerebral decompression (for example, Mannitolum on 0,25-1 g/kg in/in kapelno within 10-15 min., if necessary repeatedly each 6 h during 1-2 days with gradual cancellation during 2-4 days) and loopback diuretics (furosemide on 20-40 mg in/in or 3 times in oil a day). Corticosteroids (dexamethasone on 8-12 mg in/in, then on 4 mg in/in or 3-4 times in oil a day) are shown mainly at brain tumors, but are ineffective at a craniocereberal injury or strokes. Their action is shown not earlier than in 12 h. In critical situations at threat of a vklineniye in the conditions of intensive care unit punctures of ventricles resort to artificial ventilation of the lungs in the hyperventilation mode, to use of barbiturates. It is necessary to control onto an acid-base state and to avoid administration of the solutions containing a large amount of free liquid (for example 5% of solution of glucose).