Increased intracranial pressure in a child

Increased intracranial pressure in a child (arterial hypertension, intracranial hypertension) is a common disorder that can be a sign of various diseases. Intracranial pressure increases with brain tumors, hydrocephalus, neuroinfections (meningitis, encephalitis), intracerebral effusions, traumatic brain injuries, some hereditary pathologies and other diseases.

The development of arterial hypertension in a child is especially dangerous. Unstable pressure readings can cause serious abnormalities in brain development: mental retardation, blindness, paralysis and other pathological conditions.

Increased intracranial pressure is not always a sign of disorders. It can increase with everyday activities: defecation, coughing, stressful situations, suckling at the mother's breast, lifting heavy objects. It is not dangerous for the child. If intracranial pressure increases regularly and is permanent, parents and their child should seek medical help.

What is the essence of increased intracranial pressure?

The brain is washed externally and internally by cerebrospinal fluid (CSF). It nourishes, washes and protects brain structures from mechanical influences, maintains optimal intracranial pressure, and also regulates metabolic processes between blood and brain.

Liquor constantly circulates in the ventricles of the brain, inside the skull and other spaces of the spinal cord and brain. In certain areas, liquid accumulates, flows out and, having been distributed over other spaces, is absorbed back. There is a certain balance between the absorption and release of cerebrospinal fluid. If more fluid is released than is absorbed or less is absorbed than is released, or there are obstacles to the outflow of cerebrospinal fluid, the fluid begins to accumulate in a certain place, which causes intracranial pressure.

Since the brain is located in a closed cavity of the skull, the accumulated fluid begins to compress the brain, causing an increase in pressure. In this case, the child may experience episodic attacks of headaches.

Intracranial hypertension is not a rare case in infants. The cause of hypertension in a child from birth can be an intrauterine infection or hypoxia, neuroinfection, birth trauma, congenital defects or prematurity. Such children grow up with elevated levels of hypertension from an early age and get used to them, so they do not complain of headaches. The child may experience excessive excitability, lack of concentration and slow formation of certain mental functions (speech, walking, memory, writing, counting, logic, phonemic hearing). Therefore, if any disturbances in the functioning of the nervous system are detected, you should consult a doctor and undergo the necessary examinations.

Prolonged exposure of the brain to cerebrospinal fluid leads to its reduction. At the same time, the number of liquid cavities increases. This condition is called hydrocephalus. It is accompanied by partial replacement of brain matter with cerebrospinal fluid. In severe clinical cases, newborns experience a disruption in the development of nervous system functions and develop cerebral palsy (cerebral palsy). Severe hydrocephalus is treated with a brain shunt. In most cases, using osteopathic techniques, it is possible to get rid of this disease without surgery.

Signs of increased intracranial pressure in older children

In a child of an older age category, arterial hypertension is manifested by the following symptoms:

• Nausea, vomiting. Occurs against the background of irritation of the membranes of the medulla oblongata. The difference between vomiting in hypertension and vomiting in poisoning is that it does not bring relief.
• Pain behind the eyeballs. They are formed due to the effect of cerebrospinal fluid on the orbital area.
• The appearance of ribbons, flashes, double vision. This occurs as a result of irritation of the optic nerves.
• Attacks of headaches that get worse in the evening and at night.
• Restless sleep, irritability, tearfulness.

Why is unstable intracranial pressure dangerous?

The lack of appropriate treatment for hypertension can provoke the appearance of epileptic seizures and the death of certain parts of the brain due to oxygen deficiency. Chronic increased intracranial pressure, even with minor fluctuations from the norm, negatively affects the activity of the central nervous system. At the same time, signs of nervous exhaustion develop quite quickly, such as sleep disturbance, irritability, fatigue, as well as a decrease in intellectual and physical activity.

The greatest danger with unstable pressure is congestion in the optic discs, which can cause atrophy of nerve tissue, a sharp drop in vision and even complete uncorrectable blindness.

High blood pressure in young children: symptoms of the disease

Increased intracranial pressure can be manifested by the following pathological disorders and symptoms:

• Severe crying, restlessness. A distinctive feature of unstable intracranial pressure is that throughout the day the child may feel well and be relatively calm. In the evening and at night the baby begins to cry and becomes restless. This is due to the anatomy of the cerebrospinal fluid and venous systems. The baby lies down more at night and in the evening. As a result, venous outflow slows down, and the veins of the skull and brain become congested. As a result, the volume of cerebrospinal fluid increases, which provokes the development of arterial hypertension.
• Difficulty falling asleep, frequent waking up, sleep disturbance. The listed symptoms are also due to the structure of the venous and cerebrospinal fluid systems.
• Nausea, attacks of vomiting, profuse, frequent regurgitation. These clinical manifestations are reflex. High intracranial exposure provokes irritation of the membranes of the medulla oblongata, which is responsible for nausea and vomiting. It should be borne in mind that frequent regurgitation in a child can be caused by swallowing air during feeding and overfeeding. Therefore, it is not recommended to draw conclusions about intracranial hypertension based on symptoms alone. However, this pathology cannot be excluded either.
• Increase in head volume. The accumulation of cerebrospinal fluid in the cerebrospinal spaces can lead to divergence of the sutures of the cranial bones, enlargement of the frontal part of the skull, enlargement of the fontanelles and disproportionate size of the head.
• The appearance of a venous network under the scalp. With hypertension, excessive filling and stagnation of blood occurs in the venous network. This provokes expansion of the saphenous veins, which makes them visually noticeable.
• Graefe's symptom. It manifests itself as a dysfunction of the oculomotor nerves, which occurs against the background of birth trauma or high blood pressure. The eyeballs periodically begin to deviate downward, and the sclera becomes visible between the upper eyelid and the edge of the iris.
• Refusal to feed. In infants, intracranial pressure physiologically increases, which leads to increased pain. The result of refusal to feed a child is a lack of weight gain.

Disturbances in psycho-emotional and physical development. This can be caused by insufficient feeding and the presence of damaging factors on the brain.

Treatment of increased intracranial pressure with osteopathy

Living with hypertension for a child is unpleasant and harmful to health.
Under the influence of increased compression, brain structures cannot function normally. This causes atrophy of the white brain fluid, followed by a decrease in intellectual abilities and dysregulation of internal organs. To avoid the above complications, treatment of hypertension should begin as early as possible. To alleviate the child’s condition and normalize intracranial pressure, it is important to restore the balance between the absorption and production of cerebrospinal fluid. Traditional medicine uses diuretics for this. Osteopathy treats arterial hypertension in children using safe manual techniques that normalize the level of cerebrospinal fluid without surgery or drug therapy. Osteopathic techniques are aimed at unloading the venous bed of the head and eliminating pinching of blood vessels by the vertebrae.

Komarovsky about ICP and hydrocephalic syndrome

For yourself, so as not to lose. Maybe it will be useful to someone else

Komarovsky about ICP and hydrocephalic syndrome

It is simply impossible to imagine a woman interested in children's health issues who has not heard of intracranial pressure - ICP. Phrases like “we have intracranial” or “we treat intracranial pressure” have become so firmly entrenched in the vocabulary of the average visitor to a children's clinic that many have simply stopped thinking about the meaning of these words. Nevertheless, the frequency of conversations, the frequency of diagnosis and the frequency of treatment do not at all indicate that the very concept of “intracranial pressure” or the diagnosis of “increased intracranial pressure”, in turn, is understandable to the broad masses of workers. Although at first glance everything seems obvious. And the essence of the problem (from the point of view of the average person) looks something like this. There is a head. There is a brain inside, blood vessels, there is pressure in the blood vessels - everyone knows this - both grandmother and grandfather have pressure. But grandparents have damaged hearts, but for a child everything is different. The heart is healthy, but the pregnancy was unsuccessful, there was not enough oxygen during childbirth, or the umbilical cord got wrapped around, or some other illness happened, or he hit his head, or they gave him the wrong medicine - so the vessels were damaged, now the pressure in the head is high, hence the heap problems: headache, crying, doesn’t listen to mom, doesn’t sleep well, trembles chin, jerks leg, walks on tiptoes, speaks poorly (wrongly), fights in the sandbox, sucks thumb, refuses to eat and dozens, if not hundreds of other consequences of these injuries -promotions. And since the above complaints and symptoms are possible to one degree or another in almost every child, the presence of, in fact, an epidemic of intracranial pressure becomes easily explained, and this epidemic is gaining momentum. Of course, doctors are actively fighting this, and most children recover safely - thanks to medicine, or as the classic used to say: “Glory, glory to Aibolit! Glory to the good doctors! A doctor’s attempt to approach the problem of intracranial pressure competently, in a modern way, and to treat it like in the best clinics in the world cannot be implemented. Because the epidemic of ICP treatment that has swept the CIS countries is limited to these countries. That is, our overseas friends are somehow disconnected from this topic - either they misunderstand and do not care about the neurological health of children, or they do not diagnose it, or their children are different? There must be something wrong here: how can there be a disease that pediatric neurologists in our clinics detect in at least 50% of children (this is the most optimistic figure), and at the same time a disease that is completely absent outside the CIS . No, the phrase ICP exists, its increase is discussed in scientific articles, moreover, tactics to combat this very dangerous phenomenon are being studied, but the list of conditions accompanied by an increase in ICP is very small, and these are increasingly such terrible horror stories that can be easily made conclusion: having increased ICP, you can sooner end up in the intensive care unit than wait in line for an appointment with a pediatric neurologist at the district clinic. That is, globally, here and there, the approaches to ICP are fundamentally different: there it is a very rare, very dangerous (life and health threatening) condition, usually requiring hospitalization and emergency care, but in our country it is an extremely common disease, easily diagnosed, almost always easily treatable and almost always on an outpatient basis. No, something is definitely wrong here. And it seems that we need to figure it out: either we don’t understand something, or we are being misled together, or our children are special - not like those in the rest of the world. Since the last statement seems extremely unlikely, and you don’t really want to be lost and misunderstood, let’s consider the topic slowly and in order. So, what is ICP and where does it come from? What is the pressure on what and how does it all come out? In the cranial cavity there is a brain, there is blood, there is a special fluid called cerebrospinal fluid (CSF). Liquor is formed from the blood in special choroid plexuses, circulates, washing the brain and spinal cord, after which it is again absorbed into the blood through special venous sinuses. Liquor performs a number of important functions; without these functions, normal brain function is simply impossible. Liquor does not stand still, but just like blood, it moves all the time. There are vessels for blood movement. For the movement of cerebrospinal fluid, there are special anatomical cavities - the ventricles of the brain and the spinal canal. This is, so to speak, elementary, or, to be more precise, superficially primitive anatomical and physiological information. But now we can understand where intracranial pressure comes from. So, a certain liquid is constantly being formed and is constantly being absorbed. You probably already remembered school mathematics with problems about a swimming pool and two pipes - the same is true with liquor. It flows out of one pipe (choroid plexuses), and flows into another pipe (venous sinuses). While it flows, it puts pressure on the walls of the pool (the inner surface of the ventricles of the brain and the spinal canal). That, in fact, is all. Now for some obvious conclusions. Everyone has intracranial pressure, just like everyone has noses, hands and butts. The phrase “my child has an intracranial condition” is at least ridiculous and certainly does not indicate that this child has something that others do not have. Another question is that a specific figure indicating the value of ICP in a specific period of time is not a stable concept, which, in fact, follows from the fact that ICP changes all the time. Both the formation of CSF, and the speed of its movement, and the activity of absorption depend on many factors: whether the child is sleeping or awake, lying, sitting or standing, silent or screaming, normal body temperature or elevated, and in general what the temperature around is - comfortable, or hot, or Cold. The connection between the ICP level and all of the above parameters does not seem obvious at first glance, but an elementary illustration: if the room is hot and the child is actively sweating, blood thickening occurs, as a result, the rate at which the choroid plexuses produce cerebrospinal fluid decreases. It is clear that many manifestations of a wide variety of diseases will, in turn, affect the level of ICP - vomiting, coughing, prolonged crying, painful sitting on the potty due to constipation, and much, much more. And in this aspect, the analogy between blood pressure and intracranial pressure may be quite appropriate. In an absolutely healthy child who does not suffer from hypertension at all, the level of blood pressure can fluctuate within a fairly wide range. I went for a run, cried, laughed, got scared - it got better; fell asleep, calmed down, caught my breath - it went down. But the concrete and obvious physiological fact of fluctuations in blood pressure does not make anyone want to run after a child with a tonometer and constantly correct this pressure. The situation with ICP is exactly the same, but logic and common sense do not answer the elementary question: why is so much attention paid to the level of ICP and its fluctuations? Why is talk about ICP so popular, and its supposed treatment so widespread? We will give the answer a little later, but now let's talk about really increased intracranial pressure (synonym - intracranial hypertension). From the point of view of modern, civilized, evidence-based medicine, increased intracranial pressure is one of the manifestations of a number of diseases. Rare and very serious diseases. I emphasize once again: intracranial hypertension is not a disease, not an independent disease, but only a symptom of other very specific and definite diseases. In order for ICP to increase significantly, certain preconditions must be met, for example, a sharp increase in the production of cerebrospinal fluid, which occurs with meningitis and encephalitis. Any damage to the brain substance: stroke, tumor, abscess, injury - also affects all three factors that determine the level of ICP - the production of cerebrospinal fluid, its absorption, and its circulation. Excessive production of cerebrospinal fluid can also be observed in some very serious metabolic disorders, for example in very severe forms of diabetes. Nevertheless, there is a very specific disease when the increase in ICP is quite noticeable - hydrocephalus. Hydrocephalus, as a rule, is associated with congenital abnormalities of the brain, when either there is a very active production of CSF, or the reabsorption of cerebrospinal fluid is impaired, or due to certain anatomical defects its circulation is impaired, or when a combination of these factors occurs. Sometimes hydrocephalus is not congenital, but occurs as a complication after very serious diseases (meningoencephalitis, for example) and neurosurgical interventions. With hydrocephalus, excess or non-exitable CSF puts pressure on the ventricles of the brain, they seriously expand, the consequence of all this is a rapid increase in the size of the head, a corresponding increase in the size of the fontanelles, and separation of the sutures between the bones of the skull. Hydrocephalus comes in varying degrees of severity. Compensated forms, when mental development does not suffer and symptoms appear moderately, are treated conservatively, with special medications that reduce the production of cerebrospinal fluid and activate its outflow, but in severe cases of the disease, rather complex neurosurgical operations are performed. It is clear that hydrocephalus does not happen suddenly - that is, a normal child in all respects was walking, and suddenly hydrocephalus happened to you - out of the blue. Hydrocephalus is a congenital disease, and its symptoms appear in the first months of life. Since the main symptom of hydrocephalus is a rapid increase in head size, measuring head circumference is included in the standards of any preventive examination, starting, of course, from the moment of birth. It is very important to emphasize here that it is not the specific size expressed in centimeters that matters, but rather the dynamics of this indicator. That is, stating the fact that the boy Petya at 3 months has a head circumference of as much as 45 cm is not at all a reason to become depressed and urgently save this boy. But the fact that the head circumference has grown by 7 cm over the past month is already alarming and dangerous, and requires both serious attitude and active control. Let me emphasize once again - not immediate treatment, but control. And if the trend continues, then measures should be taken. Nevertheless, hydrocephalus, to which we devoted four whole paragraphs, is a rather rare disease and occurs with a frequency of 1 case in 2-4 thousand children. And problems with intracranial pressure are detected in almost every second child - a paradoxical situation... Here another problem looms. When a child’s head quickly increases in size, the increase in ICP is visible to everyone - it’s so pressing... And when everything seems to be normal, and the doctor looks and says - high blood pressure, it needs to be treated, then how did he know about it? Based on what parameters, indicators, symptoms? When it comes to an increase in blood pressure in a grandmother, everything seems to be clear here - they took out a device (tonometer) and measured it - yes, hypertension - 190 to 120. We treated it, measured it again - we see that it has definitely become better - 160 to 90 - that means they were treated for good reason and with the right medications... Plus, the improvement was not limited to just changing the numbers. Grandma was really unwell - she had a headache, she couldn’t even get up, but now where is she, exactly? I ran to the store to get some potatoes - well, this certainly means that it helped... And what to do with the ICP - where can I get a magic device to show - here, mommy, look how high the ICP is. Here are the medicines - save yourself. Come back in a week, we'll try it on again, we'll see. And here we have to sadly admit: there is no such device! Neither magical, nor real, nor expensive, nor cheap - there is none! With all the amazing progress of medical science, with all the variety of special equipment, ICP can be reliably measured in only one way: insert a needle either into the spinal canal (lumbar puncture) or into the ventricles of the brain. After the cerebrospinal fluid begins to flow out of the needle, a simple pressure gauge is connected - a graduated glass tube. The measurement is carried out according to the same principle as in a regular home alcohol or mercury thermometer: the level of liquid (CSF) corresponds to a specific line and a specific number on a glass tube. Cerebrospinal fluid pressure is usually measured in millimeters of water. By the way, it should be noted that until now there is no clear opinion among scientists regarding what ICP should be considered normal. Some say that the norm is from 80 to 140 mm of water. Art., others insist that the normal limits are much wider and the pressure may well fluctuate from 60 to 200 mm of water. Art. The given standards are for a horizontal body position. If the patient is sitting, the norms are completely different. But the main thing for us is not a specific figure, but a statement of the fact that there are no simple, accessible, convenient and at the same time reliable methods for measuring ICP. It is clear that any talk about punctures in a clinic is simply not serious. However, there are examination methods that allow one to draw a conclusion about the value of ICP based on a number of indirect signs. One such method is ultrasound examination of the brain. This method is not used in adults because ultrasound cannot penetrate the skull bones. In children, the situation is completely different, since there is a fontanel - a wonderful window for ultrasound. Neurosonography, which is what ultrasound of the brain is called, is an affordable and absolutely safe method. It allows you to estimate the size of the ventricles of the brain, and an increase in these sizes can well be regarded as an indirect sign of increased ICP. At the same time, as with head circumference, it is not so much the width of the ventricles of the brain that matters, but the dynamics of this indicator. After the fontanel is closed, the size of the ventricles of the brain can only be seen and assessed using tomography - computed tomography (CT) or magnetic resonance imaging (MRI). At the same time, tomography is a serious, unsafe, expensive method, it is used infrequently - only in cases of real suspicion of serious intracranial pathology. Another method - outdated, but still widely used - is echoencephalography (EchoEG). Using a special device (echoencephalograph), using the same ultrasound, a number of parameters are assessed, including the pulsation of the blood vessels of the brain. In this case, the amplitude of oscillations of the ultrasonic signal is considered as an indicator capable of assessing ICP. We emphasize once again: all of the listed methods are not reliable, they do not state, do not confirm, but only admit the possibility, suggest, allow one to suspect an increase in ICP. This is the result: the examination methods that exist today only give the doctor additional information to think about, but they cannot dot the i’s. This means that you have to rely mainly on specific symptoms. This has its own problems: this is not your grandmother, who, when her blood pressure is high, lies down, and when her blood pressure is normal, runs around shopping. This is a young child, or rather a little month old, who is unreasonable and does not complain about anything in particular. But the problems are not only due to age and the inability to point with a finger to the place where it hurts. The main problem is that almost all the symptoms that make it possible to suspect an increase in ICP in a child can occur in completely healthy children. For example, a child’s restlessness, trembling of limbs, and screaming may be manifestations of increased ICP, but may well have nothing to do with ICP at all. And any mother can confirm this, because it is simply impossible to find a child who is always calm and who never shakes anything. Another symptom of increased ICP is strabismus, but it is well known that in children of the first year of life, the extraocular muscles have not yet formed and infant strabismus is often a physiological phenomenon, that is, absolutely normal. It should, however, be recognized: words such as “anxiety,” “trembling,” “screams,” and “squint” are not capable of seriously frightening the average domestic mother, since everyone hears them and often uses them in everyday life. It’s a completely different matter when such terrible expressions as “Graefe’s symptom” or “spontaneous Moro reflex” are heard from the doctor’s lips or found in the outpatient card - there is no time for jokes and no time for calm: it is clear that the situation is serious. Let us try to explain the essence of these wise words. The essence of Graefe's symptom is the lag of the upper eyelid when the eyeball moves downward. In an additional translation into Russian, this means that when a child looks down and gets scared, several millimeters of the white of the eye are visible above the iris. Looks like a bulging eye. If the child is looking straight, then everything is fine. The German ophthalmologist Graefe, who lived in the 19th century, described this symptom as typical for patients with goiter (damage to the thyroid gland). In people who do not have goiter, Graefe's symptom can also occur and be a constitutional feature; it can be found in premature infants. The Moro reflex, or hug reflex, refers to the physiological reflexes of the newborn period. Occurs when hitting the table on which the child is lying, with a sudden loud sound, or when patting the baby on the buttocks or thighs. The reflex consists of two phases. In the first, the child leans back, turns his shoulders, and spreads his arms to the sides. In the second phase, he brings his arms together on his chest. It is clear that the spontaneous Moro reflex is when there were no special external stimuli, and the child throws back his hands... But the absence of “special external stimuli” is a conditional concept. Because such a not at all “special”, but quite significant irritant may well be a doctor’s office - a new environment, an unfamiliar table, a strange aunt-doctor... It seems that we are completely confused: we promised to explain why the diagnosis of increased ICP and its treatment are so common, but we came to conclusions that are completely opposite. It turns out that additional research methods and examination data in the vast majority of cases do not allow one to confidently diagnose increased ICP. And in situations where such confidence is present, we are almost always talking about extremely dangerous diseases (hydrocephalus, meningitis, tumors, traumatic brain injury) and extremely disturbing symptoms (sharp bulging of the fontanel, disorders of consciousness, vomiting, paralysis). Let's summarize the main results. 1. Increased ICP is not a disease, but a symptom of certain diseases. 2. Increased ICP is a rare and very dangerous symptom of rare and very dangerous diseases. 3. Treatment of increased ICP has nothing to do with outpatient medicine and almost always requires hospitalization and emergency care.

Osteopathic approach to the treatment of intracranial pressure in a child

Osteopathic methods in the treatment of arterial hypertension in children are successfully used in cases where high intracranial compression of brain structures is caused by impaired venous blood circulation.

During osteopathic treatment, three mechanisms are simultaneously activated to improve the outflow of blood from the cranial cavity:

• Restoring the patency of venous vessels at the points of their exit from the cranium and in the area of ​​the neurovascular bundle;
• Impact on parts of the nervous autonomic system;
• Normalization of the suction functions of the chest.

Also, the use of these methods makes it possible to achieve effective results in the complex treatment of arterial hypertension in the absence of indications for surgical intervention. In this case, the osteopath uses manual techniques aimed at restoring the craniosacral rhythm.

The course of osteopathic treatment and the number of manual therapy sessions are determined by the doctor, taking into account how old the child is and what symptoms accompany the disease. The positive effect of osteopathy treatment is visible after just a few sessions.

To achieve stable and long-term results in the treatment of increased intracranial pressure, osteopathic techniques are recommended to be combined with other conservative methods (physiotherapy, therapeutic exercises, adherence to eating and drinking regimes).

Causes of intracranial pressure - description, factors

The main etiology is a violation of the outflow of fluid into the brain. The condition worsens if the brain

• blood from the veins arrived in a larger volume;
• a lot of spinal substance got in.

Intracranial compression exists in the form of:

1. Hypertension, when the pressure rises to 20 or 25 mmHg and fluid enters the brain in the walls of the skull:

• spinal;
• tissue due to brain tumors;
• blood with stagnation in the veins;
• foreign during the period of brain tumors.

The reasons that cause increased intracranial pressure in the patient are: situations of traumatic injury (TBI), tumors, effusion of blood inside the skull, meningoencephalitis (the brain is affected), hydrocephalus (“dropsy” due to cerebrospinal fluid), excess weight, excess fluid, as well as others factors when cerebrospinal fluid increases.

An increased degree of pressure on the brain (over 40 mmHg) threatens human life.

If pressure on the brain increases in adults, it is necessary to undergo examination and rule out a malignant tumor.

2. Intracranial hypotension, when the pressure on the brain, on the contrary, is reduced.

In this case, the prerequisites are:

• the state of destruction of the bones of the skull, membranous membranes, which are caused by injuries, combined with an outpouring of cerebrospinal fluid;
• taking dehydrating diuretic medications in larger quantities than necessary;
• loss of cerebrospinal fluid due to lumbar puncture or external drainage of the lateral ventricles of the brain.