Symptoms of increased intracranial pressure - treatment: medicines, diet, surgical methods - complications of increased intracranial pressure

Idiopathic intracranial hypertension - increased intracranial pressure

The syndrome of intracranial hypertension is an increased intracranial pressure on a number of potential causes, such as: current impairment spinal fluid (hydrocephalus), infection, obstacle blood outflow or brain tumor.

Not so long ago, before introducing CT and MRI into medical practice, the brain tumors were diagnosed on the basis of a neurological inspection. One of the frequent combinations was a combination of chronic headaches and signs of edema spectator nerves When examining the eye bottom.
In English literature this syndrome is called false brain tumor Since these signs are present, but there are no tumors. Syndrome idiopathic Intracranial hypertension is caused by an increase in the volume of the brain as a result of the accumulation of fluid in its tissues. The reason for this phenomenon is unknown. An increase in volume leads to an increase in intracranial pressure.

The reason for the appeal to the doctor in this disease is usually chronic headache and transient violations of vision.

Symptoms of intracranial hypertension

Headache

Headache is universal with intracranial hypertension. The character of headaches and its intensity is very individual. Headache is often present at night. At the same time, the presence of night pain is not necessarily. The pain can be like local and involve the whole head.

The intensity of the headache varies from mild to medium gravity, only occasionally it can be intense. The character of pain can be pulsating, driving, or described by patients as a feeling of hoop around the head. Often there is an increased sensitivity to the light.

The basic quality of headaches in intracranial hypertension is its constancy. Although, even this quality is not too universally.

The presence of an inexplicable chronic headache is only suspicious, but not enough to form this diagnosis. Depression, chronic lack of sleep for any reason, and sleep apnea cause identical headache.

Short-term violations

Attacks of short-term loss of vision, as if a television screen turned off for a moment, "Sparks in the fields of sight" or short-term violation of the type of sensation that you look through a muddy glass, are not rare.
They are often provoked by changes in the position of the head or body (especially the slopes or transition to vertical position) And lasts from seconds to minutes. Short-term violations of vision can occur both in one and both eyes.

All these visual symptoms are temporary phenomenon and they do not imagine any danger. Nevertheless, the main potential complication of intracranial hypertension is the loss of one or another part of peripheral vision.
In exceptional cases, with a strong increase in intracranial pressure, a serious decrease in visual acuity is possible up to blindness.

Prolonged visual disorders are a potentially irreversible process that requires urgent intervention.

Normally, we do not notice the so-called "blind spot", which is formed by a small "blind" section of the retina at the venue of the visual nerve. The swelling of the optic nerves can make a blind spot more noticeable, which leads to a sense of movement on the periphery of the visual field.

Twist in the eyes

Film in eyes is another typical early symptom of intracranial hypertension. The increase in the volume of the brain squeezes the nerves supplying glasses. As a result, there is a bone in the eyes. Two must disappear when closing any of the eyes.

Most often the VI nerve is damaged on both sides, each of which takes the eye towards the direction of the temple on its side. In this case, the cooler is horizontal, i.e. Images are side by side. Because the eyes are turned to the nose, the junction is enhanced when looking into the distance.

Massive edema of optical nerves can lead to a retina edema. In this case, there is a distortion of the form of objects (metamorphycia). For this reason, there is sometimes a feeling of "doubles" even in one eye. The swelling of the optic nerve should be visible on the eye of the eye bottom.

Other symptoms

The pulsating noise in the ears also often happens with intracranial hypertension.

Causes of idiopathic intracranial hypertension

Idiopathic Intracranial hypertension is called in cases where there is no explanation to increasing intracranial pressure to find. The word "idiopathic" itself means, in fact, the absence of a certain reason. Additional volume is created by an increase in the volume of the brain itself, which delays the liquid in its tissues. Why is it unknown.

There are some risk factors contributing to the development of intracranial hypertension, but they are not mandatory for the development of the disease. Here are some of them: Iron deficiency, pregnancy, disease thyroid gland, chronic renal failure.
Drugs such as tetracyclines, overdose of vitamin A, corticosteroids, hormonal contraceptives, sulfonamides, tamoxifen, cyclosporine and some others can cause an increase in intracranial pressure.

In most cases, however, we are talking about idiopathic intracranial hypertension, in which the cause is missing.

And although there is no known cause and no syndrome idiopathic intracranial hypertension occurs young women with significantly overweight In the overwhelming percentage of cases.

Diagnosis of intracranial hypertension

Ophthalmological examination

The cardinal find on the fundus when increasing intracranial pressure - swelling of the oily nerves on both sides. The lack of such puts the diagnosis of intracranial hypertension in doubt.
The study of the fields of view can reveal the increase in the blind spot and the variety of variations of defects of field fields.
Overall problems, if present, most often limited to an insufficient eye lead towards the temple on both sides.

Neurological examination

Neurological examination is normal, with the exception of eye disorders described above. The presence of fallen findings on a neurological examination requires the exception of other reasons for increased intracranial pressure.

MRI brain

MRI Examination in idiopathic intracranial hypertension in most cases is normal. The goal of MRI is the elimination of tumors, infections and hydrocephalus. Sometimes MRI should be done with contrast.

Finds, which would be eliminated, would confirm idiopathic intracranial hypertension, does not exist. Some anatomical features themselves are insignificant, can indirectly confirm the fact of increasing intracranial pressure.
This is a Turkish saddle with a stunt syndrome, a flattening of eyeballs, a liquid around the optical nerves, narrow for the age of brain ventricle or narrowing venous sinuses. They can all be present healthy people And absent with idiopathic intracranial hypertension.

Thrombosis of venous sinuses is able to cause similar idiopathic intracranial hypertension symptoms. MP Hosight and CT head with contrast will help this diagnosis.

Spinal puncture

The spinal transparent puncture in suspected intracranial hypertension is made only with one goal - measuring the pressure of the spindy fluid. All other laboratory indicators in idiopathic form should be normal. If not, then the cause of the symptoms is different.

The fluid pressure is above 250 mm in adults and\u003e 280 mm of the water column in children is considered increased.

The technique of cerebrospinal puncture plays a fundamental role. In order to measure pressure, it should be done while the patient is horizontally on its side. Improper technique can lead to artificially overestimated results. The pressure of the spinal fluid is constantly changing. In complete people, pressure is usually higher even normal. The spinal transparency puncture is suitable for the diagnosis of intracranial hypertension. However, only on the basis of increased pressure in the absence of other typical symptoms of intracranial hypertension, this diagnosis is not placed.

Treatment of idiopathic intracranial hypertension

Weight loss

The fact that the reduction of body weight reduces the swelling of the optic nerves - this famous factproved by numerous studies. And although this method has an effect, swelling optical nerve Drops slowly. There is a correlation between the degree of weight loss and its therapeutic effect. On average, the loss of at least 6% of the body weight is required to relieve substantial edema of optical nerves.

Weight loss is a mandatory, but not the only necessary component of treatment. Despite the decline in the edema of the optical nerve, one diet is not enough to improve the forecast in terms of loss. normal vision. To improve the forecast, a combination of diet and drugs is required.

Drug treatment

The treatment of idiopathic intracranial hypertension is aimed at reducing intracranial pressure.
Acetazolamide (diakarb) is used most often. This is a carboanhydrase inhibitor with light diuretic activity. It reduces intracranial pressure by reducing the amount of spinal fluid produced.

Studies show that acetazolamide is capable not only to reduce the edema of optic nerves, but also, with time, in combination with weight loss, reduce peripheral impact defects.

The dose of acetasoloamide has to use quite high. The initial usually 1 gram per day, divided into two receptions. If necessary, the dose can be raised to 4 grams per day if transferred.

The most frequent side effect is numbness and the feeling of goosebumps (often pronounced), which is most often experienced in the upper half of the body. Less often, fatigue and intestinal disorders are observed. Long reception can lead to renal stones and enhance the liver enzymes in blood tests.

Acetazolamide belongs to the sulfonamide group, but its structure is very different from antimicrobial drugs. Therefore, the presence of allergies on sulfoniamides does not necessarily mean allergic to acetasolamide.

Some doctors are trying to use one of the anti-epileptic drugs, topiramate (tops), instead of diakarba. The logic is that the topiramate is also a carboanhydrase inhibitor. In addition, the long topiramate technique often leads to weight loss. His side effects Looks like diakarba, but Topiramate is transferred much worse.

Corticosteroids can temporarily reduce the symptoms of intracranial hypertension. However, they increase the weight and themselves are capable of increasing intracranial pressure.

Therapeutic spinal puncture

In emergency cases, with a sharp drop in view, the spinal points are made, not with the diagnostic, but therapeutic goal. As a result of the drainage of the spinal fluid, the symptoms of intracranial hypertension decrease, but temporarily.

Considering that about 500 ml of spinal fluid is produced per day, intracranial pressure rises very quickly until the previous level. However, this procedure buys some time to appoint other types of treatment.

Surgical methods for the treatment of intracranial hypertension

Surgical treatment is shown in the severe form of the disease and in cases of lack of effect of conservative treatment, as well as in the threat of vision loss.

Decompression ( FENESTRATION) Spectating nerve shells

The main goal of the procedure is to prevent the loss of vision. Headache itself is not a sufficient indication.

In the process of this procedure, several cuts in a solid cerebral shell surrounding visual nerves are produced. Thus, the drainage of the spinal fluid removes pressure from the visual nerves. This procedure is not too simple and is produced under general anesthesia.

Fenestration of the shells of the optic nerve is only on the one hand in some cases can solve the problem and on the opposite side. Initially a good effect may turn out to be short. About third cases, the vision again begins to deteriorate in 3 - 5 years.

Shunting of the spinal fluid

There are several variations of shunting in idiopathic intracranial hypertension. The idea of \u200b\u200bshunting consists in constant drainage of the spinal fluid.

Any of shunt is a tube with an elevated valve controlling the outflow depending on the level of pressure. One end of the tube is placed either into the cavity of the ventricle of the brain, or inside the spinal channel in the lumbar region. The other end of the tube drains the cerebrospinal fluid in pleural cavity (chest), peritoneal cavity (belly) or atrium (one of the heart chambers).

Each of the drainage options has pros and cons.
With intracranial hypertension of the ventricle of the brain, very small and not easy to get into them.
For this reason, lumboperitoneal shunting (spin - belly) in idiopathic intracranial hypertension is used more often.
The problem is that the lumboperitoneal pike (spin - stomach) is twice as much more often than the ventriculopheritoneal (head-belly).

The initial shunt effect is simply great. Improvement is observed in 95%. However, after 3 years the numbers fall twice.

Another problem is the violation of the function of the shunt, which occur about 75% for 2 years. So, you have to produce frequent revisions of the shunt.

The information on the site is provided solely with the educational goal. Please do not engage in self-medication! The final diagnosis of your health problems remains the prerogative of professionals in the field of medicine. Website material only helps you familiarize yourself with the potential methods of diagnosis and treatment of neurological diseases and increase the productivity of your communication with doctors. The site is updated as far as possible, taking into account recent changes in the approach to the diagnosis and treatment of neurological diseases. However, the author of articles does not guarantee immediate update of information as it arrives. I will be grateful if you share your considerations: [Email Protected]
CONTENT COPYRIGHT 2018. All Rights Reserved.
By Andre Strizhak, M.D. BayView Neurology P.C., 2626 East 14th Street, Ste 204, Brooklyn, NY 11235, USA

With a headache, every person faces sooner or later. A fairly common cause of frequent pain is intracranial hypertension. Increased intracranial pressure may be a consequence of an increase in the volume of liquor, blood or the interstitial liquid of the brain. Pathology is dangerous and requires timely treatment.

The term "intracranial hypertension" is used mainly by doctors. People, far from medicine, are more familiar to call a violation of "high intracranial pressure."

Increased pressure in the skull may be due to:

• an increase in the volume of liquid (spinal fluid);
• hemorrhages in the brain;
• formation of tumors;
• violation of cerebral circulation.

Intramerican pressure (VCHD) is an important indicator for each person. The intracranial hypertension syndrome is a dangerous neurological pathology, which can lead to serious consequences.

Intracranial hypertension on the ICD-10 is indicated as G93.2, if it comes to benign pathology.

Intracranial hypertension can be both congenital and acquired disease. Children face this pathology at least than adults. None of intracranial hypertension is insured, therefore it is important to be able to recognize specific symptoms and consult a doctor in a timely manner. In suspected elevated intracranial pressure, one should first visit the neurologist and pass all surveys.

Causes of high intracranial pressure

The main cause of the development of intracranial hypertension is a change in the number of liquor or violation of the circulation of the cerebrospinal fluid. Such violations may be associated with cranopy and brain injuries, spinal damage, neurological pathologies.

Violation of the circulation of liquor leads to an increase in intracranial pressure

The second most prevalence is the cause of the development of hypertension of this type is a circulatory disruption. Intracranial hypertension may occur due to deoxygenated blood Store. Violation of blood flow to the brain, followed by blood stagnation in the venous region leads to an increase in the total circulating blood in the skull. The result becomes slowly growing headache and the development of a number of neurological disorders.

In the case of tumor brain neoplasms, an increase in the volume and density of the brain tissue is occurring, which also leads to an increase in pressure inside the skull.

All these pathological processes are a consequence:

• heavy cranial injuries;
• brain circulation disorders;
• neoplasms in the skull;
• inflammation of the brain shells;
• strong intoxication.

Quite often, the cause of the development of intracranial hypertension is cranial injuries, indirect signs which the patient may not immediately detect. At the same time, due to injury, the normal circulation of the liquor is disturbed and the intracranial pressure is gradually increasing. A concussion of the brain as a result of an accident or strong impact, heavy strikes head, bruises of skulls and hematomas can lead to the development of this dangerous pathology.

Intracranial injuries obtained during an accident may be at first not seen and manifest a later increase in pressure

The violation of the cerebral circulation, leading to the development of HFG (intracranial hypertension) in adult patients, is due to a stroke. The cause can also be thrombosis of the brain shell.

Malignant and benign neoplasms lead to an increase in the amount of cerebral tissue, the result of which can also be an increase in pressure inside the skull. Often RFG is diagnosed when cancer metastasising in the brain.

Inflammatory pathologies affecting the brain develop in people regardless of age. Meningitis, meningoencephalitis, encephalitis and brain abscess - all this leads to an increase in the volume of liquor and an increase in intracranial pressure.

Neurological disorders provoking changes in the circulation of liquor or venous stagnation can be a consequence of strong alcoholic intoxication, elevated metals or carbon monoxication.

Separately allocate an increase in intracranial pressure in people with pathology of the cardiovascular system. Congenital heart defects and severe violations of the cardiovascular system can lead to impaired blood circulation of the brain, as a result of which intracranial pressure increases.

Pathology of the cardiovascular system affect the normal functioning of the brain

Congenital pathologies and developmental anomalies as the cause of VFG

RFG can be both congenital and acquired pathology. No one is insured against this violation, elevated intracranial pressure is equally common in people of various age groups. If in adult patients, injuries or acquired pathologies often actually perform, children have a violation most often congenital.

Causes of HFG in children:

• damage to the skull during the passing paths;
• intrauterine hypoxia;
• strong prematurity;
• abnormalities of the skull structure;
• hydrocephalus.

Also, the cause of increased intracranial pressure can be infections transferred to the woman during pregnancy. A separate place is occupied by neuroinfection, which in babies are manifested by a whole neurological symptom complex, including increased intracranial pressure.

Idiopathic and chronic HFG

According to the nature of the flow and reasons for development, intracranial hypertension is divided into two types - chronic and idiopathic.

Chronic intracranial hypertension is called HFG with uniquely revealed causes characteristic of symptoms and flow. It can be provoked by the cranial and brain injury, the generic injury, the inflammation of the brain shells or cancer.

The idiopathic is called HFG, the reasons for which it is impossible to reliably install. At the same time, various pathologies can act with factors provoking the development of the disease, only indirectly relating to the head or spinal cord or blood circulation system.

Etoiopathic or benign intracranial hypertension is diagnosed mainly in women aged 20 years. Doctors bind the risks of the development of this form of intracranial hypertension with existence of excess weight, hormonal and metabolic disorders, as the predominant majority of patients are fat young women with menstrual disorders.

Presumably idiopathic intracranial hypertension is secondary symptom The following pathologies:

• system red lupus;
• cushing syndrome;
• vitamin D;
• hyperthyroidism;
• iron-deficiency anemia;
• heavy renal failure.

Also, idiopathic RFG may be a consequence of long-term therapy with corticosteroids and tetracycles.

Symptomatics of pathology

Having understood what VCH is in adults and children, you should be able to promptly recognize the symptoms of intracranial hypertension in order to appeal to medical care on time.

With intracranial hypertension, symptoms depend on how much intracranial pressure increased.

The main sign of the disease is a headache. Moderate intracranial hypertension is manifested by periodic, and not constant headaches. With severe impairment, the headache is generalized, spreading to the entire head, painfully observed daily.

Headache - the main symptom of intracranial hypertension

In addition to headaches, the following signs are characterized for intracranial hypertension:

• nausea with vomiting;
• prostration;
• reduced performance;
• irritability and nervousness;
• noise and ringing in the ears;
• worsening memory;
• violation of the concentration of attention;
• reducing the clarity of view.

Indirect signs of intracranial hypertension - weight loss, the appearance of bruises under the eyes, a decrease in sexual entry, less often - cramps.

With an increase in intracranial pressure, there may be signs of vegetaryous dystonia. This symptom complex has more than 100 specific features, among which angina, shortness of breath, vision of vision and noise in the ears.

Patients with HBG suddenly note the increased meteo sensitivity, while the peaks of headaches can occur at the moment of a sharp increase in atmospheric pressure.

Headache at HBG is intensified at night and immediately after sleep. This is due to an increase in the volume of the brain fluid in the lying position. During the day, the headache is bottled throughout the skull, the intensity of pain syndrome may change. Quite often, simple analgesics do not have the expected therapeutic effect at HBG.

In adult patients, intracranial hypertension may be accompanied by sudden blood pressure surges. During the day, well-being can change repeatedly. Often, patients complain about the attacks of the disorientation, a pre-corrosive condition, the melting of flies in front of the eyes and a feeling of their own heartbeat.

Symptoms of benign hypertension are somewhat different from the chronic form of the disease. If, with chronic HFG, the headache torments the patient constantly, intensifying at night, painful syndrome with benign intracranial hypertension subsides at rest and enhanced when moving. Peak headache is observed with severe physical exertion.

The main feature of chronic intracranial hypertension is a violation of consciousness, a change in nature, deterioration of cognitive functions of the brain. With benign RFG, there are no such symptoms completely, the violation is manifested only by the headache increases at the time of loads.

Diagnosis of the disease

With suspected intracranial hypertension, consult with a neurologist. At first, the doctor will conduct a survey, check the reflexes and examine the patient. To confirm the diagnosis, you must pass several hardware studies. First of all, dopplerography of intracanial vessels is prescribed, to eliminate violations of the cerebral circulation.

Signs of intracranial hypertension are well visible using MRI - magnetic resonance tomography. This survey is the most informative. To eliminate inflammatory pathologies, the patient must be handed over a common and biochemical blood test. To eliminate damage to the skull and development of the HFG due to injuries, the X-ray of the skull and the cervical spine can be recommended.

Measuring intracranial pressure is carried out by lumbar puncture. It is a traumatic and unsafe procedure, during which a trepanitative hole in the skull is made, so it is prescribed only in particularly severe cases. Usually enough hardware research for diagnosis. To determine the composition of the liquor, a study of cerebrospinal fluid may be assigned. The analysis material is taken by conducting lumbar puncture.

With an increase in intracranial pressure, an important stage of diagnosis is to eliminate autoimmune pathologies, for example, a red lupus, which can act as the cause of the development of idiopathic or benign RFG.

MRI - informative and at the same time a non-immature diagnostic method

Treatment of HFG

With intracranial hypertension, treatment depends on the cause of the development of the violation. Treatment of intracranial hypertension and VHF in adults begins with differential diagnosis to identify the exact causes of the development of the disease.

If tumor neoplasms have caused, the patient shows surgical intervention. Removal of the neoplasm quickly normalizes intracranial pressure, due to a decrease in the amount of brain fluid, therefore additional drugs are not required for the normalization of the HCD. However, this is true only for benign neoplasms, since malignant pathologies can not always be removed surgically.

With internal hematomas, blood is poured into the skull, which leads to an increase in pressure. If such a violation was revealed at MRI, a minimally invasive operation was carried out to remove the spell blood. The result becomes fast normalization of intracranial pressure.

Inflammatory diseases of the shells of the brain are treated with antibacterial drugs. Medicinal products Impact drip or make injections into the subarachnoid space. When carrying out such puncture, a small part of the cerebrospinal fluid is extracted for further analysis, and a small wound is formed at the point of puncture. Removal of a part of the cerebrospinal fluid contributes to an instantaneous decrease in intracranial pressure to normal values.

Treatment of benign WFG

With such intracanic pathology as a benign intracranial hypertension, specific treatment is not carried out, it suffices to identify and eliminate the cause that can be in autoimmune or hormonal disorders. In excess weight, intracranial pressure gradually decreases as weight loss, and headaches pass.

Often, benign intracranial hypertension develops during pregnancy. In this case, treatment is not prescribed, the pressure will come to the norm after delivery, as the amount of fluid decreases in the brainstorms and throughout the body.

Specific therapy aimed at reducing intracranial pressure, no. HFG is treated by eliminating the cause that served to increase the number of liquor and an increase in intracranial pressure. Diuretics can be applied to reduce the number of circulating fluid. The following drugs are prescribed:

• Furosemide;
• Laziks;
• Diakar;
• Acetazolamide.

Preparations take short three-day courses, making a break for two days. Accurate dosage Selected by the doctor individually for each patient. During pregnancy, the doctor may assign a diet and reducing the amount of the received fluid to reduce intracranial pressure.

Receiving diuretics allows you to bring extra liquid from the body and reduce arterial pressure. At the same time, the rate of production of cerebrospinal fluid decreases, which means that intracranial pressure gradually falls. This is true only if the cause of intracranial hypertension was an increase in the volume of cerebrospinal or brain fluid, but not injury, hematoma and tumors.

With benign RFG, it is necessary to reduce the consumption of fluid to one and a half liters per day. This applies not only to ordinary drinking water, but also any liquid dishes, including juices and soups. Simultaneously with this diet and physiotherapyleading to a decrease in intracranial pressure.

Physiotherapy treatment methods are prescribed to adult patients - magnetotherapy or cerheth-collar zone electrophoresis. Such methods are advisable to apply with the moderate severity of the symptoms of the HFG.

It is important to get rid of water surplus in the body

Surgical methods

An increase in intracranial pressure is a dangerous state that can progress. If a conservative treatment Does not bring the expected result, resort to surgical methods, the purpose of which is to reduce the products of the liquor. Shunting is applied for this.

The shunt is inserted into the brain's liquor space through the hole. The other end of the artificial vessel is excreted into the abdominal cavity. A permanent outflow of an excess of liquor into the abdominal cavity is carried out through this tube, which reduces intracranial pressure.

Infrequently resorted to the shunt, as the procedure is conjugate with a number of risks. Indications for shunting:

• constant increase in intracranial pressure;
• high risk of developing complications;
• hydrocephalus;
• the ineffectiveness of other methods to reduce the HCD.

Shunting refers to emergency measures that apply for the absence of alternatives.

Possible complications of WFG

HFG is a dangerous pathology that requires timely diagnosis and treatment. Otherwise, chronic RFG can lead to complications, some of which are incompatible with life.

One of the most likely complications at high intracranial pressure is the squeezing of the disk of the optic nerve followed by its atrophy, which leads to the full and irreversible loss of vision.

High intracranial pressure can lead to the development of a brain stroke. This complication may end with a fatal outcome. Heavy intracranial hypertension causes damage to brain tissues, which entails a violation of nervous activity and can threaten the patient's death.

In particularly severe cases, the disease leads to the development of hydrocephalus. The high pressure of the lycvore on the brain leads to loss of vision, impaired breathing, deterioration of cardiac activity, the development of convulsive seizures. There are cases when intracranial hypertension became an impetus for the development of epilepsy.

The forecast depends on how timely the treatment has begun. With uncomplicated intracranial hypertension, even with a condition for a timely adopted measures, no one is insured against negative consequences. It is possible to develop mental disorders, changing speech, paralysis. Among the neurological disorders, which are observed in intracranial hypertension, allocate disruption of reflex activity, short-term paresa, local disruption of skin sensitivity. If because of high pressure The cerebellum is amazed, it is possible to develop problems with coordination of movements.

With a benign RFG, the forecast is favorable. Timely appeal to the neurologist, therapy of diuretics and treatment of the cause of increasing intracranial pressure allow you to get rid of headaches without negative consequences. In the remaining cases, the forecast depends on the timeliness of therapy and what brain zones are damaged due to HBG.

The prevalence among women normostas is 1 per 100,000, but in women suffering from obesity, this figure is above 20 per 100,000 people. An increase in intracranial pressure is revealed. The reason is unknown, the role of violation of venous ocean from the brain is assumed.

Symptoms and signs of idiopathic intracranial hypertension

Almost all patients make complaints for almost daily attacks of generalized headache with fluctuating intensity, sometimes accompanied by nausea. Sometimes transient visual disorders are developing, diplopia (due to the violation of the function of the 6th pair of cranial nerves) and pulsating ringing in the ears. Vision loss begins with periphery, and patients may not notice it for a long time. Strike blindness is the most serious complication of this pathology.

Often revealed bilateral edema of the nipples of optic nerves; A small part of patients edema is one-sided or absent at all. In some asymptomatic patients, the edema of the nipples of optic nerves is discovered during routine ophthalmoscopy. In case of neurological examination, you can reveal parires of a discharge nerve.

Diagnosis of idiopathic intracranial hypertension

• MRI with Vosinusiography.
• Lumbal puncture.

The presumptive diagnosis is established on the basis of a clinical picture of the disease, and then confirmed by neuralization (preferably the conduct of MRI with veinsinusography) and the lumbar puncture, at which the increase in the pressure of the leacor leakage and the normal composition of the CCH are revealed. Clinical picture, reminiscent of idiopathic intracranial hypertension, can cause some diseases and the use of certain preparations.

Treatment of idiopathic intracranial hypertension

• Acetazolamide.
• Reducing body weight.
• Preparations used in the treatment of migraine, especially Topiramat.

The purpose of treatment is to reduce intracranial pressure and facilitating headaches. Acetazolamide carboanhydrase inhibitor (250 mg inside four times a day) is used as a diuretic. Patients suffering obesity, recommend measures to reduce body weight, which can reduce intracranial pressure. Information about the need for multiple lumbest punctuations is contradictory, but in some cases it is shown (for example, when there is a threat of violation of vision). All possible reasons (preparations and / or illness) of this state are corrected. Preparations used in the treatment of migraine (especially Topiramat, which also inhibits carboangendresses), can stop the bouts of headaches. NSAIDs are used as needed.

In the event that, despite the activities carried out, vision worsens, shows the conduct of shunt operations (lumboperitoneal or ventriculipperitoneal), the ossratus of the shell of the optic nerve or endovascular stenting of venous vessels. Conducting bariatric operations can help patients with obesity, which in other ways cannot reduce their body weight.

To assess the effectiveness of the treatment of therapy, frequent repeated ophthalmic examinations are necessary (including the quantitative definition of field fields); The measurement of visual acuity is not sensitive to evaluating the increasing loss of vision.

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Key features

• increased GFD and swelling of the optic nerve in the absence of intracranial volumetric education
• analysis of the CSC and neurovalization data (CT and MRI) are normal
• usually passes on their own, but often there are repeats, some of the patients have chronic flow
• is the prevented cause of blindness (often constant) as a result of atrophy of the visual nerves
• the risk of blindness does not have a reliable correlation with the duration of symptoms, swelling of the disk, g / b, acute view of Snellen or the number of recurrences

Idiopathic intracranial hypertension ( IL) (Other names: pseudo-turn of the brain or benign intracranial hypertension and still a number of outdated names) is a mixed group in which various statescharacterized by elevated PBF in the absence of signs of intracranial volumetric education, HCF, infection (for example, chronic fungal meningitis) or hypertensive encephalopathy.

Some authors (although not all) do not include patients with intracranial hypertension as a result of thrombosis of foolish sines. IVG is a diagnosis that is set by the method exceptions. Distinguished juvenile I. adult forms. Pathogenesis is not fully known.

4 diagnostic criteria:

1. cCH pressure:\u003e 20 cm H 2 O (pressure\u003e 40 is rare). Some authors recommend that the pressure is\u003e 25 H 2 o, to accurately eliminate healthy people
2. the composition of the CSC: the normal level of glucose and cellular composition. The amount of protein is normal or in cases reduced (<20 мг%)
3. subjective and objective symptoms of only an increased GFF, i.e. The swelling of the optic nerve disk, g / b, the lack of focal symptoms (maybe paralysis of the discharge nerve)
4. normal data of neurovalization studies (CT or MRI); Only the following changes are allowed:
1. sometimes there may be sleeping ventricles (frequency at hvg is not higher than in the appropriate age group) or an empty Turkish saddle
2. with infantile form, there may be large ventricles and a large amount of liquid over the brain

Epidemiology

1. ♀: ♂ \u003d 2-8: 1 (with juvenile form)
2. obesity occurs in 11-90% of cases, at ♂ not so often (in ♀ with obesity can be an elevated level of estron)
3. the frequency of IVG among women with obesity in childbearing age is 19-21 / 100.000 (while among the entire population its frequency is only 1-2 / 100.000)
4. the peak of occurrence falls on the 3rd decade (limits: 1-55 years). 37% of cases fall at the children's age, of which 90% of which are 5-15 years old. In infancy it is rare
5. often passes spontaneously (recurrence frequency: 9-43%)
6. heavy visual disorders arise in 4-12% of cases. Their occurrence does not depend on the duration of symptomatics, the degree of edema of the disk of the optic nerve, g / b, bolds and the number of relapses. The best way to control the status of vision and detection of its violations is perimetry

Clinical presentation

· subjective Symptoms (Complaints)

A.G / B (most frequent symptom): 94-99%. Sometimes it is stronger in the morning

B. Dizziness: 32%

C. Nausea: 32%

D. Violation of visual acuity

E. Diplopia (more often occurs in adults, usually as a result of Parish Vi nerve): 30%

F. Pulsating noise in the head: 60%

G. Retrobulbar pain when driving eyeball

· objective symptoms (usually limited to the visual system)

A. The swelling of the optic nerve drive: almost 100% (sometimes unilateral)

B. Parakeas of the discharge nerve: 20%

C. Increased blind spot (66%) and concentric narrowing of peripheral fields of view (with the primary presentation of blindness is very rarely)

D. The defect of the fields of view: 9%

E. With infantile form, there can be only an increase in the circle of the head, which often passes independently and requires only observations without special treatment.

F. Suspicious lack of violation of the level of consciousness despite the high HCD.

Greenberg. Neurosurgery