Increased intracranial pressure in children (intracranial hypertension)

Increased intracranial pressure (ICP), or intracranial hypertension, is a fairly common clinical situation. It is believed that it is diagnosed mainly in children of early and preschool age. In fact, this problem is quite relevant for adults, because in them, intracranial hypertension syndrome can appear secondary to many diseases. And in the vast majority of cases, the diagnosis of increased ICP is based on a set of indirect signs.

Intracranial hypertension - symptoms

Symptoms of intracranial hypertension (ICH) may depend on the person's age. Infants with ICH may have different symptoms than older children or adults with the condition.

Intracranial hypertension in an adult

Symptoms of intracranial hypertension in adults include:

pupils do not react to light
headache
behavior change
decreased vigilance
drowsiness
muscle weakness
difficulties with speech and movement
vomit
blurred vision
confusion

As elevated ICP progresses, a person may lose consciousness and fall into a coma. Intracranial hypertension can damage the brain if given emergency treatment.

Intracranial hypertension in a child

A child with intracranial hypertension may experience the same symptoms as adults. In addition, the shape of the head may change. Increased ICP can cause the sutures of the baby's skull to separate and this can be manifested by a bulging fontanel.

What is hypertension in children?

Classification and clinical picture

Depending on the level of increase in intracranial pressure, intracranial hypertension syndrome is divided into the following degrees:

light;
average;
expressed;
heavy.

Intracranial hypertension, which is based on extracerebral processes, often accompanies symptoms of increased pressure in other localizations (for example, arterial, pulmonary or portal hypertension).

The presence of intracranial hypertension in infants, including newborns, can be suspected if there is an increase in head size, motor restlessness, frequent regurgitation not associated with food intake, difficulty falling asleep or, conversely, drowsiness. The increase in head circumference per month with intracranial hypertension in the first half of the year exceeds 1 cm in a full-term newborn, and 2 cm in a premature baby. Such symptoms can be supplemented by divergence of cranial sutures, tension or bulging of the large fontanel, Graefe's reaction when changing body position, hyperreflexia with expansion of reflexogenic zones, and an increased level of general excitability is characteristic.

Children older than one year with intracranial hypertension complain of frequent headaches spreading throughout the head, of varying intensity, occurring mainly in the morning. They can get worse when coughing, sneezing, straining and changing body position. Often such phenomena are accompanied by nausea not associated with food intake and vomiting, which brings temporary relief. Symptoms of visual disturbances are also typical for the syndrome of increased intracranial pressure: limited visual fields, double vision, blurred vision. In addition, there may be signs of decreased memory and attention, general absent-mindedness and excessive physical activity. Objectively, patients can detect scotomas, hemianopsia, insufficiency of the oculomotor nerves, general hyperesthesia, increased tendon reflexes with expansion of their zones, staggering in the Romberg position and symptoms of autonomic dysfunction - bradycardia, central hyperthermia, increased salivation, lability of blood pressure.

Disease in children under one year of age

The main reason for the development of intracranial hypertension in infants is congenital pathologies or injuries received during childbirth. In the first few weeks of life, symptoms gradually increase, and problems with the baby’s health become obvious. But this is not how the disease manifests itself in everyone. Due to an unclosed fontanel and an enlarged head, the symptoms may be blurred, which significantly complicates the diagnosis.

Signs of the disease in babies under one year of age:

crying for no apparent reason;
swelling of the fontanelles;
periodic vomiting;
divergence of sutures on the skull;
very short sleep;
the veins are clearly visible;
the forehead protrudes unnaturally.

The presence of two symptoms simultaneously indicates the development of the disease. In this case, parents need to contact a neurologist.

After a certain time, the fontanel overgrows, and the symptoms become pronounced. Convulsions may occur, and short-term loss of consciousness is possible. In this case, hospitalization in a hospital is necessary.

Surgery can be used to significantly alleviate the condition of infants. This procedure is necessary for congenital malformations of the brain.

The presence of two symptoms simultaneously indicates the development of the disease. In this case, parents need to contact a neurologist.

Surgery

Severe intracranial hypertension in children can only be treated with surgical intervention: endoscopic perforation of the floor of the third ventricle. Using modern endoscopic instruments, the surgeon creates a channel between the bottom of the ventricle and the subarachnoid tissue cisterns. After such an intervention, complications rarely occur; there is no need for repeated operations. The main indication is established post-traumatic ICP.

Due to the fact that this pathology affects the most important system of the body, intracranial pressure in a child can cause the following problems:

Intracranial hypertension in children: what is it?

Intracranial hypertension can affect the development of disorders in the brain. To prevent the occurrence of concomitant diseases, it is necessary to detect it as early as possible. Children suffer from one of the following types of this pathology:

Slow increase in symptoms of the syndrome during the period when the fontanelles have not yet overgrown.
Rapid increase in symptoms after the first year of life or more. At this time, the fontanelles are already overgrown.

If intracranial hypertension develops in children under one year of age, characteristic symptoms often appear, which is why it is necessary to pay special attention to the child’s condition. Compensation processes occur as a result of the opening of the fontanelles. The head may increase in size.

To recognize the disease in the first months of a patient’s life, it is necessary to promptly detect the following signs:

A child’s crying, which does not indicate visible abnormalities, is not a consequence of already diagnosed diseases.
Swelling of the fontanel, lack of pulsation.
Vomiting, which occurs not only once a day, but more often.
Reduced sleep duration in a child up to catastrophic parameters.
Dehiscence of cranial sutures. The size of the skull increases too quickly, disproportionate to the age of the child. Disproportional formation of the skull bones, swelling of the frontal lobe.
Slow development. Parents often come to see a specialist because their children have been unable to learn to hold their head up or sit on their own for too long. Symptoms of intracranial hypertension are subsequently diagnosed.

If you notice these signs, there is no high probability that the baby suffers from intracranial hypertension syndrome. If two or more symptoms are detected, there is a need to undergo diagnostic tests and consult with your doctor.

When the fontanelles and cranial sutures become overgrown, the signs of this disease become more distinct, which is why they can be noticed at home. The following negative symptoms develop:

Cramps.
Vomiting that almost never stops.
Excited emotional state of the child.
Periodic loss of consciousness.

If you notice any of the following signs, you should call an ambulance as quickly as possible.

Intracranial hypertension syndrome can appear not only in children in infancy, but also in older people. If the child has already reached the age of 2 years, the following symptoms of intracranial hypertension in children may appear:

Pain in the head of a bursting nature. Children note the appearance of pressure in the eye area.
After the final awakening, when the child gets out of bed, the pain syndrome becomes less, then disappears completely, as the processes of cerebrospinal fluid outflow accelerate.
Pathologies in the functioning of the sensory organs that appear as a result of excessive accumulation of cerebrospinal fluid.
Vomiting.
The child does not grow to the expected parameters, and excess weight may accumulate.

When the fontanelles and cranial sutures become overgrown, the signs of this disease become more distinct, which is why they can be noticed at home. The following negative symptoms develop:

Causes of intracranial hypertension

Many factors can provoke the formation of characteristic symptoms. At the same time, the etiology often determines the further course of the disease, as well as its treatment tactics and prognosis. The causes of increased intracranial pressure can be both infectious agents and non-infectious problems.

An increase in ICP due to the formation of genetic abnormalities is widespread. In a number of diseases accompanied by changes in the normal structure of bones, the outflow of cerebrospinal fluid is disrupted, leading to the occurrence of symptoms. In such cases, signs of intracranial hypertension appear in the child already in the first months of life. The consequences of heart defects that develop in utero are characterized by a similar course. Among the reasons that can provoke an increase in pressure in the cranial cavity in infants are also birth injuries and infectious lesions. This condition is dangerous due to various complications, for example, delayed mental and physical development.

Symptoms of pathology

The symptoms of hypertension in childhood are very difficult to identify!

Most often, high blood pressure in children does not manifest itself as a sign of irritability.

Only severe cases may cause symptoms:

Headache;
Vomiting and dizziness;
Partial loss of vision;
Bleeding from the nose;
Hysteria and seizure.

Newborns with high blood pressure are reluctant to breastfeed, often cry and freak out, and are drowsy.

Pathogenesis

Three pathophysiological mechanisms are assumed to be involved in the development of the disease: an increase in circulating blood volume, an increase in cardiac output and an increase in total peripheral resistance. The first mechanism occurs with increased activity of the sympathetic nervous system. The second mechanism is typical for conditions after infusion therapy and is observed against the background of renal failure and excess mineralcorticoids.

The third pathogenetic link in the development of arterial hypertension in children is found with increased tissue sensitivity to catecholamines or with an increase in their concentration in the blood (for example, with pheochromocytoma), and also occurs with kidney tumors.

There is no unified classification of the degrees of increased blood pressure in children. Most often, domestic pediatricians rely on E. Nadezhdina’s classification, according to which three stages of arterial hypertension in children are distinguished.

Benign pathology

Normal intracranial pressure is its uniform distribution among the vessels, which determines the balance between the volume of cerebrospinal fluid, blood flow in the brain and its tissues. Under the influence of external or internal factors, it changes, but returns to normal on its own. Some processes occurring in the body can lead to an increase in pressure and the occurrence of intracranial hypertension.

Normally, a baby has about 50 ml. cerebrospinal fluid (CSF), and in adolescence - up to 150 ml. It puts slight pressure on brain structures. It is one of the organs that is quite sensitive to various external influences. Therefore, the task of cerebrospinal fluid is to mitigate the influence of extraneous factors on areas of the brain.

There is such a thing as benign intracranial hypertension in children. It refers to a condition characterized by increased pressure in the cranial cavity. All symptoms resemble a tumor in the brain, but on examination of the cerebrospinal fluid, the white blood cell and protein levels are within normal limits. On CT or MRI, the ventricles have normal size, location, and shape. In another way, this condition is called a false tumor.

The appearance of edema in tissues is possible due to injury, encephalitis, stroke, liver damage or intoxication. Disruption of the normal circulation of cerebrospinal fluid occurs when it is excessively formed and reabsorption (absorption) is difficult.

Symptoms of increased intracranial pressure

Clinical manifestations of intracranial hypertension are varied and depend on its cause.

There are several common signs.

Infants' head sizes grow rapidly. You can notice the features of its shape: a wide overhanging forehead, the predominance of the cerebral part of the skull over the facial part.
Widely open fontanels, their protrusion and pulsation, as well as large discrepancies in the cranial sutures. In children with intracranial hypertension, dilated saphenous veins in the head area attract attention.
Graefe's symptom, or the setting sun symptom, appears: the child has a visible white strip of sclera between the upper eyelid and the iris. The baby's eyes are wide open and his gaze looks surprised. The child may also tilt their head back while sleeping.
Characterized by constant, shrill, monotonous crying for no apparent reason, the so-called cerebral crying.
Children with intracranial hypertension develop persistent regurgitation.
In severe cases, the baby lags behind in development: he begins to hold his head up, sit, crawl, and speak later than his healthy peers.
Dangerous signs are the appearance of convulsions, trembling, and vomiting.
Irritability, lethargy, poor appetite, vomiting, shallow REM sleep are characteristic symptoms of intracranial hypertension in both younger and older children. Headaches appear during sleep and in the morning; during the day they are less pronounced.
Gradual personality changes, decreased school performance, dizziness, changes in visual acuity, double vision in older children suggest increased intracranial pressure.
With intracranial hypertension, which acutely appears after trauma to the brain and skull, loss of consciousness and coma are possible.

The neurologist also evaluates the child’s muscle tone, identifies focal neurological symptoms, and damage to the intracranial nerves.

Prevention

One of the main causes of the disease in children is fetal hypoxia and infections during intrauterine development. Therefore, a lot depends on the expectant mother. It is important to register with the antenatal clinic in a timely manner and undergo all examinations. If infection or hypoxia is detected, the necessary measures must be taken.

The congenital form of the pathology often accompanies deviations in the development of the fetal nervous system. Such anomalies can be detected by ultrasound examination, which is performed in the third trimester of pregnancy. Timely diagnosis of the disease helps to significantly improve the prognosis of therapy.

Children who have intracranial hypertension should grow up in a calm environment, eat well, and receive the care they need. Of particular importance for such children is a clear daily routine, long walks in the fresh air, and physiotherapeutic procedures. This will accelerate the maturation of the nervous system and stabilize blood pressure.

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Diet

Modern children cannot imagine their life without fast food, chips, crackers and convenience foods. But they are the ones who provoke an increase in cholesterol in the blood and, as a result, atherosclerosis, obesity, and diabetes.

Eating fatty, fried and salty foods leads to increased blood pressure, so it should be, if not completely eliminated, then at least limited. Be sure to reduce the amount of flour and confectionery products.

When composing your child’s diet, give preference to grain bread, fresh vegetables and fruits, dietary types of meat and fish. Dairy products should be low in fat.

Pay attention to the patient's drinking regime. Instead of plain water, give tea made from rose hips, hibiscus, mint and valerian. They help strengthen blood vessels.

Try to spend more time with your children outdoors. Don't forget about physical activity. It is very important for the full development of the body.

Causes of occurrence in infants

The normal volume of cerebrospinal fluid in an infant is 50 ml. An increase in this amount and the occurrence of intracranial hypertension (ICH) can be caused by the following factors, some of which already exist at the intrauterine stage of the baby’s development:

infections suffered by the expectant mother during pregnancy;
intrauterine hypoxia;
deep prematurity;
birth trauma or early life trauma that damaged the cervical vessels;
congenital anomalies;
genetic predisposition;
illnesses suffered by the baby, for example, meningitis.

If we are talking about pressure on the brain from cerebrospinal fluid, then the term cerebrospinal fluid hypertension is used, which has 3 mechanisms of occurrence:

Types of intracranial hypertension

There are two types of intracranial hypertension in children:

slowly developing - occurs in children of the first year of life, during the period when the fontanelles are still open;
rapidly developing - occurs in children after the fontanelles become overgrown

An acute condition develops over several days and requires immediate medical attention.

In infants

With intracranial syndrome (increased intracranial pressure), the baby most often becomes whiny, restless, his sleep is disturbed and he vomits profusely. Also, with increased intracranial pressure, infants’ appetite worsens, and many even begin to lose weight.

Whims, anxiety, late development - this is a reason to consult a doctor

A common occurrence is developmental delay. The child does not hold his head up well and begins to roll over from side to side late. In addition, the pathology may be accompanied by convulsions, and in severe cases, throwing the head back.

Sudden nausea and vomiting;
Frequent mood swings;
Dizziness and drowsiness;
Congestion in the fundus of the eye;
Increased fatigue.

Surgical intervention

If intracranial hypertension in a child is severe, the doctor will refer him for surgery. During the procedure, endoscopic perforation of the floor of the third ventricle is performed. The surgeon creates a special channel that helps remove excess fluid in the brain.

After surgery indicated for HPV in young children, complications are extremely rare. Therefore, after such treatment, only in isolated cases is repeated surgery required.

Severe cases may require surgery

To protect a child from a dangerous pathology, parents should do the following:

Causes of increased intracranial pressure

Conditions that can lead to increased ICP:

traumatic brain injury, which is often the result of a blow to the head
hydrocephalus
cerebral edema
bleeding or accumulation of blood in the brain
cerebral aneurysm
a brain infection such as meningitis or encephalitis
stroke
high blood pressure
a brain tumor
drug interactions
seizures
epilepsy
hypoxemia, oxygen deficiency in the blood

ICH can result from child abuse. This can lead to the development of a brain injury known as shaken baby syndrome. This condition can occur if an adult shakes the child vigorously to stop him from crying.

Symptoms

In infants, intracranial hypertension has the following symptoms:

Dehiscence of cranial sutures.
Bad dream.
Constant crying for no reason.
The bones of the skull are disproportionate, with the frontal part protruding too much.
The head exceeds the normal size parameters for its age.
The child slows down in development (begins to sit or hold his head up much later than his peers).
Frequent vomiting.
Swelling of the fontanelles, in which pulsation cannot be felt.
Veins appear prominently under the scalp.

Any symptom from the list individually cannot directly indicate the presence of a disease, but the combination of some of them is a reason for an urgent visit to a specialist.

Since hypertension is accompanied by a sharp increase in the volume of the head, while the cranial sutures tend to stretch, the signs of the disease are less noticeable. But immediately after the fontanelles close, the disease begins to progress rapidly, causing physical suffering to the child, which parents cannot help but notice. Symptoms become as follows:

Sensory organ disturbances.
Sudden vomiting not associated with food poisoning.
Retarded growth and mental development.
Excess weight.
Cramps.
Expanding headaches with pressure on the eyes.
Loss of consciousness.
Aggression and anxiety.

These manifestations are clear indicators of disruption of the brain with a disorder of the central nervous system, which in itself poses a threat to the health and life of the child and requires immediate seeking help from a medical institution. In cases where intracranial pressure increases very quickly, you need to urgently call an ambulance, otherwise there is a risk of the baby’s death.

Intracranial hypertension - diagnosis

If you experience symptoms of ICH, you should consult a doctor immediately. The doctor will measure the ICP, the normal range of which is less than 20 mmHg. If ICP rises above this level, a person may experience symptoms of ICH. To diagnose ICH, the doctor will ask whether the person has:

blow to the head
diagnosis of brain tumor

The doctor may then:

neurological examination to study a person's feelings, balance and mental state
spinal tap to measure cerebrospinal fluid pressure
CT scan, which produces images of the head and brain

After these initial tests, the doctor can use MRI scans to look at the person's brain tissue in more detail.

Intracranial hypertension - treatment

If ICH is diagnosed, your doctor will reduce the pressure inside the skull to reduce the risk of brain damage. The doctor will then begin to treat the underlying causes of high blood pressure.

Treatments to reduce ICP include:

draining excess cerebrospinal fluid with a shunt to relieve pressure on the brain
medicines that reduce brain swelling, such as mannitol
surgery to remove a small section of the skull and relieve pressure

A doctor may give a person a sedative to reduce anxiety and lower blood pressure. The patient may also require respiratory support. Your doctor will monitor your vital signs throughout your treatment. In rare cases, a doctor may put a person with high ICP into a medically induced coma to treat their condition.

Treatment

Treatment consists of eliminating the cause of the disease. Normalization of the daily routine, high-quality proper nutrition of the child is required, physiotherapeutic techniques are possible: massage, swimming, acupuncture, and so on.

In case of infectious diseases, a set of measures is carried out aimed at reducing swelling of brain tissue. For this purpose, loop (Furosemide) and osmotic diuretics are used. Potassium-sparing diuretics (Spironolactone) are suitable for daily use. Metabolic drugs, nootropics (Piracetam), vasodilators (Nicotinic acid) and other groups of drugs are also prescribed.

In severe cases, surgical treatment is indicated. Special drains are made to drain cerebrospinal fluid.

Prevention of intracranial hypertension and its complications

ICH can't always be prevented, but you can reduce the risk of some underlying conditions that can increase it.

Stroke

A stroke can cause increased ICP. A person can reduce their risk of stroke in the following ways:

taking steps to reduce high blood pressure
to give up smoking
blood sugar management
cholesterol control
regular exercise

High ariel pressure

High blood pressure can cause increased ICP. A person can maintain healthy blood pressure by:

losing weight if you are overweight
avoiding medications that increase blood pressure
healthy, balanced diet
reducing salt intake
regular exercise

Head injury

Head trauma can cause increased ICP. Some examples of how a patient can reduce the risk of head injury include:

avoid extreme sports or dangerous activities
wear a helmet for activities such as cycling
Always wear a seat belt in a car