Increased or decreased intracranial pressure (ICP) is accompanied by a number of negative symptoms, including dizziness, headache, loss of consciousness, which significantly worsens the quality of life. With the introduction of modern diagnostic imaging techniques, the diagnosis of increased intracranial pressure has become more common. However, in some cases, this diagnosis is not justified, since this is not an independent pathology, but serves as a concomitant sign of disease. How to measure intracranial pressure and which method is the most informative?
Definition and physiological norms of ICP
Intracranial pressure is the pressure that is formed in the cranial cavity under the influence of several anatomical structures, namely: blood volume, intracerebral fluid and brain tissue.
Normally, intracranial pressure indicators fluctuate within the following limits:
- in adults (3-15 mm Hg);
- in children aged 1 to 15 years (3-7 mm Hg);
- in newborns and children under 1 year (1.5 – 6 mm Hg).
These values are typical for people at rest, since during physical activity accompanied by muscle tension, a short-term increase in values up to 50-60 mm occurs. rt. Art. The phenomenon is due to the activation of compensatory mechanisms for adequate functioning of the central nervous system. Manifestations of increased cerebral pressure are diagnosed when compensatory mechanisms are disrupted when they cannot cope with the increase in values.
Treatment
In the case of a secondary process in adults, the culprit of the disease may be atherosclerotic changes in blood vessels, obesity, hypertension, and hormonal dysfunction. It is important not only to cure the primary disease, but also to eliminate the symptoms of ICP. For this purpose medications are used:
- diuretics – Furosemide, Veroshpiron, Torasemide;
- nootropic drugs - Pantocalcin, Piracetam, Pantogam, Tanakan, they improve the supply of oxygen to the brain and the transfer of nutrients to it;
- sedatives - valerian extract, peony and motherwort tinctures, Novo-passit, Persen forte;
- stimulators of nerve cells in the brain - Glycine, Nervohel, they also improve sleep, memory, concentration and attention;
- vitamin complexes, as well as a course of injections of B vitamins to restore normal functions of the nervous system.
Treatment of intracranial pressure begins with proper diagnosis and clarification of the cause of the pathology.
If there is a need for additional medications, the doctor makes a prescription, and the patient must strictly follow the instructions and complete the full course of treatment. In addition to medications, physical therapy and physiotherapy (SMT, electrophoresis, magnetic therapy) help to remove signs of ICP. General massage, ozokerite applications, acupuncture and hirudotherapy work well to combat symptoms.
The patient also needs to adjust their lifestyle:
- get proper rest and sleep at least 8 hours a day;
- follow a diet with limited salt to eliminate fluid retention in the body;
- drink no more than 1.5 liters of water per day;
- eat a balanced diet, focusing on meat, fish products, vegetables, fruits, and grains;
- spend more time in the fresh air;
- protect yourself from stressful and conflict situations.
Moderate physical activity is the path to recovery from ICP.
Such measures will help prevent the progression of the disease and prevent the dangerous complications described above. If symptoms of ICP appear regularly, courses of treatment should be taken at least once every 6 months.
Increased intracranial pressure is not a death sentence. If you detect the disease in time, follow the doctor’s recommendations and change your lifestyle, you can successfully get rid of the acute signs of the disease within 6–12 months. People with diabetes mellitus, autoimmune pathologies, traumatic brain injuries and signs of arterial hypertension need to pay special attention to their health.
How to check intracranial pressure?
If a person suspects a change in intracranial pressure, he needs to know what signs accompany the syndrome and which doctor will help determine the disorder. Diagnosis of deviations in ICP indicators is carried out exclusively in medical institutions. Adults should consult a neurologist, since increased cerebral pressure can occur against the background of tumors, hematomas in the brain, and also develop against the background of a stroke and traumatic brain injury. As a rule, in adults, high ICP is a concomitant syndrome that occurs against the background of other diseases.
An examination in adults should be carried out if the following symptoms are observed:
Signs of intracranial pressure
- headache of a bursting nature without a specific localization;
- pain behind the eyeballs;
- increased intensity of headache in a horizontal position;
- attacks of nausea and vomiting not associated with food intake;
- severe weakness;
- changes in blood pressure;
- visual impairment.
Intracranial hypertension can be identified at home by the presence of the listed symptoms. With severe cerebral hypertension, patients experience fainting, speech dysfunction, chin tremor, panic attacks, and decreased heart rate.
Important! Diagnosis of increased intracranial pressure in children under one year of age is carried out during a routine examination by a neurologist. In most cases, neonatologists make a diagnosis of increased ICP, but in half of the infants it is incorrect.
Causes of the disease
It should be clarified that signs of ICP do not arise just like that; pathology always accompanies any diseases and abnormalities in the functioning of the body. Symptoms of the disease begin to appear due to the following reasons:
- congenital abnormal structure of capillaries and brain structures;
- obesity due to hypertension;
- diseases of the endocrine system;
- traumatic brain and birth injuries;
- infectious diseases - meningitis, mastoiditis, malaria, complications of otitis media and pneumonia;
- neoplasms, cysts and abscesses in the cranial cavity;
- osteochondrosis of the cervical spine;
- use of certain groups of medications - corticosteroids, tetracycline and sulfonamide antibiotics, oral contraceptives in women).
We must not forget about hereditary predisposition to the disease. If several relatives in the direct line suffered from signs of intracranial pressure, they can definitely appear in the heirs.
In children, cranial pressure increases as a result of an unfavorable course of pregnancy in the mother (if there was brain hypoxia in the fetus, asphyxia, damage by toxic substances). You can also develop the disease during a cesarean section or when pulling the baby out of the birth canal with forceps. All these factors contribute to increased production of cerebrospinal fluid and the development of hypertensive-hydrocephalic syndrome.
Measurement principles
The principles of measuring intracranial pressure differ significantly from measuring blood pressure. To date, there are no devices for quickly measuring ICP. Since the structural elements located in the cranium occupy a certain volume of the cranial cavity, determined by its parameters, therefore it cannot change. Due to the fact that the volume of the cranial cavity cannot be changed, the ratio of brain structures is constant.
Measuring intracranial pressure is difficult because there are not enough indirect parameters by which to determine the pressure in the cranium. Depending on the diagnosis, age and functional state of the body, visual examination methods or modern research methods are used to diagnose patients, which make it possible to use equipment to determine the reasons that provoked changes in brain pressure. Invasive techniques through surgery are used to establish clear pressure values.
Treatment options
Treatment tactics are structured as follows: eliminating the root cause of the disease, accelerating the natural outflow of cerebrospinal fluid, relieving symptoms. If hypertension is a temporary complication of any other disease, manual therapy is prescribed to help restore normal blood circulation. At the same time, the drinking regime is regulated and a set of exercises is prescribed to relieve pressure inside the head.
More complex anomalies require a course of medications aimed at accelerating the absorption of fluid and its removal to the outside. The basis of drug therapy is diuretics. In some cases, long-term or permanent (lifelong) use of such drugs is required.
In critical cases, when the disease poses a direct threat to life, surgical treatment is performed. If there is a tumor blocking the outflow of cerebrospinal fluid, the possibility of its removal is considered. To urgently reduce pressure, shunts are inserted into the skull to drain excess fluid.
Non-invasive research methods
Non-invasive methods are used at the initial stage of diagnosis; measurements are carried out using external hardware systems. They make it possible to identify pathological changes in brain structures, as well as diagnose cranial pressure. Non-invasive techniques are safe and painless. However, the assessment of indicators is indirect, since the data obtained as a result of the examination may be mistakenly taken for signs of increased ICP, namely the expansion of the interventricular gap and the ventricles themselves. These methods are necessary to establish the reason that provoked the change in indicators.
Fundus examination is the most informative method of non-invasive monitoring of intracranial hypertension
To identify increased cranial pressure in a clinic, a specific algorithm is used, including the following methods:
- Fundus examination. Detection of swollen optic discs in the fundus and expansion of the vascular network are signs of pathology that require additional research. In the absence of pathological changes, additional techniques are not required, since ICP is within normal limits.
- Tomography, ultrasound of the brain. They allow you to determine the cause of the disorder, but do not determine the exact amount of cranial pressure.
- Electroencephalography. Determines changes in brain electrical activity, indicating an increase in ICP indicators (chaotic excitation of structural elements of the brain, formation of high-frequency rhythms, diffuse changes).
- Otoacoustic examination. The technique is carried out through the ears. With cerebral hypertension, blood pressure values in the inner ear increase.
- Transcranial Dopplerography. Blood pressure is measured by determining the decrease in blood flow velocity resulting from the development of cerebral hypertension.
The results obtained during the studies do not provide an accurate picture of the indicators of cerebral hypertension; they are used to establish the primary diagnosis of the disease.
Prognosis and prevention
When driving at high speed, wearing a helmet is mandatory.
Photo: Paha_L / Depositphotos Increased intracranial pressure is most often associated with head injuries. To prevent them, you need to take precautions: wear a seat belt in a car, use a helmet when riding a bicycle, and reduce the risk of falls.
If there are signs of hypertension, you should see a doctor as soon as possible. The earlier treatment is started, the lower the risk of serious health consequences.
Invasive methods for monitoring ICP
To accurately diagnose cerebral hypertension, invasive methods are used; they are carried out through surgery, when a special sensor is inserted into the cranial cavity through a burr hole. The procedure is carried out in a hospital equipped with the necessary equipment. During the examination, there is a high risk of injury to the brain and spinal cord, so this method is used in extreme situations that require immediate confirmation of the diagnosis.
You can measure cerebral pressure using an invasive method if you have the following indications:
- intracranial hemorrhage;
- stroke;
- hydrocephalus;
- meningitis of an infectious nature;
- posthypoxic encephalopathy.
Important! Thanks to cerebral pressure monitoring, it is possible to coordinate perfusion pressure, which reflects the effectiveness of cerebral hemodynamics, and also makes it possible to evaluate the results of decongestant therapy.
Depending on the location of the drainage system, indicators are measured using the following techniques:
- intraventricular;
- intraparenchymal;
- subdural;
- subarachnoid.
Intraventricular technique
The earliest method of cranial pressure control. The main advantage is the possibility of drainage of cerebrospinal fluid and direct endolumbar administration of medications.
External ventricular drainage
The procedure for measuring ventricular pressure is carried out using a strain gauge. The technique is easy to interpret the results and does not require the use of expensive equipment. This procedure is not only diagnostic, but also therapeutic, since it allows you to control cranial pressure by draining the cerebrospinal fluid.
Parenchema method
During the study, the sensor is installed through the trefination hole in the parenchyma of the medulla to a depth of no more than 2.5 cm. This method is preferable, since the data obtained during the study are more consistent with the readings of intraventricular pressure.
Epidural technique
Direct technique for monitoring ICP using sensors. The technique is based on the introduction of special devices into the cerebral ventricles, which make it possible to measure cerebral pressure values to set accurate pressure.
The following examination systems are used:
- Microsensory. The tensor apparatus is introduced into the required brain area, after which the information converted into electrical signals is reflected on the monitor.
- Fiber optic. Additionally, a drainage system is connected, which allows a moderate reduction in cerebral pressure values.
- Pneumatic. A catheter with a latex balloon filled with air is installed.
What are the risks of increased intracranial pressure? Complications and consequences
The brain is the highest energy system in the human body. It needs approximately five times more oxygen than the heart. Therefore, the quality of blood supply to the brain is a vital indicator that depends on two parameters - blood pressure and intracranial pressure. At constant blood pressure, the lower the intracranial pressure, the better the blood supply to the brain. If for some reason intracranial pressure increases, this proportionally worsens the blood supply to the brain, and ischemia develops. Therefore, high intracranial pressure is a dangerous condition that can cause the following complications:
- reduction and complete loss of vision;
- convulsions;
- acute cerebrovascular accident;
- depression and/or disorder of consciousness;
- depression of respiratory and circulatory function.
Important! With a rapid increase in intracranial pressure, there is a threat of death. If the symptoms are severe or appear sharply, suddenly and rapidly increase, you need to call an ambulance.
Diagnostic methods for children
As a rule, cranial pressure in a child can be determined using neurosonography (ultrasound), which is performed through the fontanel. This examination is safe and painless. It is used to examine young children and allows you to accurately determine the functional state of the ventricles of the brain. An increase in their volume is a sign of increased intracranial pressure.
Neurosonography procedure in young children
In older children, when the fontanelle has already closed, computed tomography and magnetic resonance imaging are used to visualize brain structures. Studies make it possible to establish the blood supply of blood vessels, the state of liquorodynamics and the presence of neoplasms.
Today, an echoencephalogram is also widely used, with the help of which most indicators are assessed, including the pulsation of cerebral vessels. During the study, the amplitude of oscillations of the ultrasonic signal is taken as a basis, due to which the ICP is assessed. The disadvantage of the method is the inaccuracy and unreliability of the results obtained.
Diagnostics
What should you do if an adult or child shows signs of increased ICP, especially on a regular basis? Seek advice from a neurologist and undergo the necessary examination. In severe cases of the disease, rather dangerous and complex techniques are used, for example, puncture of the cerebral ventricles and insertion of catheters into the sites of cerebrospinal fluid circulation.
A puncture of liquor fluid from the spinal vertebral region is also performed. This measure is necessary if an acute or latent neuroinfection is suspected. Examination methods require appropriate equipment, completely sterile conditions and highly qualified specialists, so they are not used so often. What causes high intracranial pressure is now clear, but how else can a correct diagnosis be made?
There are simpler and safer research methods for this:
- Ultrasound of cerebral vessels;
- Magnetic resonance imaging;
- CT scan;
- neurosonography (NSG);
- examination of the fundus by an ophthalmologist.
During an ultrasound examination, the attending physician is able to determine approximate indicators of intracranial pressure and evaluate the structures of the brain for congenital abnormal structure. MRI and CT scans provide information about the presence of changes in the cavities of the brain containing cerebrospinal fluid - whether they were damaged or ruptured during traumatic brain injuries. A fundus examination is indicated for all patients with suspected high ICP - it shows changes in the size of the capillaries of the apples, small hemorrhages on the surface of the retina, and vascular spasms.