Increased intracranial pressure in infants (intracranial hypertension) is a pathological condition that, as a rule, is not an independent disease, but is a sign of a number of diseases.
This is a dangerous condition that can cause serious complications, so it is advisable for parents to be aware of what intracranial hypertension is, why it occurs, how it manifests itself, and what to do when you find signs of illness in a child.
Cranial pressure (unlike arterial pressure, which can be checked at home) cannot be measured at home. If an infant’s intracranial hypertension is suspected, it should be immediately shown to the doctor, since the pathology is most quickly and effectively treated at an early stage, before the development of irreversible effects. In the absence of timely, adequate treatment, intracranial hypertension can lead to mental retardation, loss of vision, paralysis, epilepsy and other neuropathies, and in severe cases, to death.
In infants, increased intracranial pressure is manifested by a decrease in sucking activity, tension and bulging of fontanelles, in which there is no pulsation, dilation of the head veins, increased muscle tone, and a loud cry.
Signs of intracranial pressure in infants
Symptoms of intracranial pressure in infants are not specific and may occur in certain other pathological conditions.
In infants, increased intracranial pressure is manifested by a decrease in sucking activity, tension and bulging of fontanelles, in which there is no pulsation, dilation of the head veins, increased muscle tone, and a loud cry. Anxiety in children with intracranial hypertension usually increases in the evening and in a horizontal position. The child may refuse to feed (in the process of sucking there is an increase in intracranial pressure), which causes weight loss.
Symptoms of intracranial hypertension may increase slowly (as a rule, this option is observed in children aged 2 months to 6 months, in some cases up to a year), or develop rapidly (usually in children older than a year).
Slowly growing symptoms: frequent regurgitations after eating, abundant vomiting several times a day, regardless of food intake, frequent crying for no apparent reason, superficial sleep, disproportionate head enlargement not corresponding to the age norm, divergence of the seams between the bones of the skull, developmental delay (children later begin to hold their heads, sit, crawl).
The rapid increase in intracranial pressure in children is manifested by non-stop vomiting, convulsions, loss of consciousness. If such symptoms occur, you should immediately call an ambulance.
Headache with intracranial hypertension in newborns and infants usually appears in the morning. In the upright position, the pain decreases or disappears altogether, as the circulation of the cerebrospinal fluid improves.
If an infant’s intracranial hypertension is suspected, it should be immediately shown to the doctor, since the pathology is most quickly and effectively treated at an early stage, before the development of irreversible effects.
In case of violation of the outflow of cerebrospinal fluid due to organic obstacles, the child may develop impaired sense of smell, vision, sensitivity, and motor functions. In some cases, endocrine pathologies are noted (overweight, stunted growth, diabetes mellitus). In an infant with intracranial hypertension, limb tremor is often observed, chin tremor, strabismus, impaired consciousness.
Often parents consider frequent nosebleeds to be a sign of increased intracranial pressure in a child. Dr. Komarovsky recalls that this symptom is not related to intracranial hypertension, and most often serves as a manifestation of inadequate hydration of the nasal mucosa.
Causes and risk factors
The immediate causes of increased intracranial pressure in the newborn are increased release of cerebrospinal fluid, a low degree of its absorbability, impaired circulation in the cerebrospinal fluid pathways, and an increase in the volume of tissue fluid or blood. Intracranial hypertension develops with meningitis, encephalitis, hydrocephalus, stroke, head injuries, injuries with damage to the cervical blood vessels, abscesses, and severe diabetes.
- history of intrauterine hypoxia,
- pathological childbirth,
- maternal toxicosis in the last trimester of pregnancy
- infectious diseases suffered by the mother during pregnancy
- early life injury
- abnormal development of the brain and / or cerebral vessels.
In order to understand what treatment is required for a child with intracranial hypertension, it is necessary to determine the exact diagnosis, since this condition is usually a secondary pathology.
In case of violation of the outflow of cerebrospinal fluid due to organic obstacles, the child may develop impaired sense of smell, vision, sensitivity, and motor functions.
When symptoms of intracranial hypertension are detected in children, consultation of a pediatrician (general practitioner), neuropathologist, and ophthalmologist is required.
Probable violations of intracranial pressure in a child in some cases can be suspected at the prenatal stage of development when examining a pregnant woman and detecting intrauterine hypoxia of the fetus. Ultrasound on the last trimester of pregnancy allows you to identify vascular changes that can lead to oxygen starvation and subsequent intracranial hypertension in a child.
Serious pathologies (for example, hydrocephalus), which can cause increased intracranial pressure in newborns and infants, are often determined by a neonatologist during a baby's examination immediately after birth. The pathological condition may be suspected during a routine inspection.
For the diagnosis of intracranial hypertension, an ultrasound examination of the brain (neurosonography) may be needed - an affordable and safe method that makes it possible to estimate the size of the ventricles of the brain as an indirect sign of cranial pressure.
In some cases, magnetic resonance or computed tomography is used (usually to exclude serious intracranial pathology), echoencephalography. Magnetic resonance or computed tomography is used infrequently, as for obtaining high-quality images it is necessary to ensure the continued immobility of the child, which can be difficult. Usually, if such a diagnosis is necessary, general anesthesia is used in children, which can adversely affect the child’s condition.
To clarify the diagnosis may require an x-ray examination of the brain, spinal puncture.
Intracranial hypertension develops with meningitis, encephalitis, hydrocephalus, stroke, head injuries, injuries with damage to the cervical blood vessels, abscesses, and severe diabetes.
An important step in the diagnosis is ophthalmoscopy. During examination of the fundus of the eye during intracranial hypertension, there is swelling of the optic nerve head, the dilatation of the fundus veins.
Treatment of increased intracranial pressure in children
First of all, it should be borne in mind that if an intracranial hypertension is suspected, and even more so when the intracranial hypertension is proven in a child, self-medication is unacceptable. This condition can be a sign of a serious illness, and the elimination of symptoms without eliminating the cause can lead to aggravation of the patient's condition, the development of complications and death.
Treatment of intracranial hypertension in infants is complex, depending on the cause and severity of the condition, conservative and surgical methods are used.
Drug therapy is the use of diuretic and decongestants (diacarb is often prescribed, which, according to reviews, shows good results in newborns and infants), neuroprotective drugs. After reducing intracranial pressure, therapy consists in treating the underlying disease.
If intracranial pressure in infants is increased against the background of hydrocephalus, tumors, hematomas, surgery may be required.
Surgical treatment consists in removing a neoplasm or shunting - creating an artificial pathway for the outflow of cerebrospinal fluid. As the child grows and grows, it may be necessary to lengthen the tube several times to allow cerebrospinal fluid to drain.
The main treatment can be supplemented by physiotherapeutic techniques, massage, folk remedies (herbal remedies, etc.). However, any treatment must be coordinated with your doctor.
An important step in the diagnosis is ophthalmoscopy. During examination of the fundus of the eye during intracranial hypertension, there is swelling of the optic nerve head, the dilatation of the fundus veins.
A good therapeutic effect in some cases has therapeutic swimming. Children with intracranial hypertension are recommended to spend more time outdoors.
The duration of treatment of intracranial hypertension in infants is on average from 3 months to six months.
The prognosis depends on the timeliness of the detection of pathology and treatment, as well as on the primary disease.
We offer for viewing a video on the topic of the article.
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
Found a mistake in the text? Select it and press Ctrl + Enter.
Human bones are four times stronger than concrete.
In order to say even the shortest and simplest words, we will use 72 muscles.
An educated person is less susceptible to brain diseases. Intellectual activity contributes to the formation of additional tissue, compensating for the diseased.
Work that is not to the person’s liking is much more harmful for his psyche than lack of work at all.
If your liver stopped working, death would have occurred within 24 hours.
A person taking antidepressants will in most cases suffer from depression again. If a person copes with depression by his own strength, he has every chance to forget about this state forever.
Allergy drugs in the United States alone spend more than $ 500 million a year. Do you still believe that a way to finally defeat an allergy will be found?
During sneezing, our body completely stops working. Even the heart stops.
74-year-old Australian resident James Harrison has become a blood donor about 1000 times. He has a rare blood group whose antibodies help newborns with severe anemia survive. Thus, the Australian saved about two million children.
Scientists from the University of Oxford conducted a series of studies in which they concluded that vegetarianism can be harmful to the human brain, as it leads to a decrease in its mass. Therefore, scientists recommend not to exclude fish and meat from their diet.
Millions of bacteria are born, live and die in our intestines. They can be seen only with a strong increase, but if they come together, they would fit in a regular coffee cup.
Dentists appeared relatively recently. As early as the 19th century, it was the responsibility of an ordinary barber to pull out sore teeth.
In the UK, there is a law according to which a surgeon may refuse to perform an operation on a patient if he smokes or is overweight. A person should give up bad habits, and then, perhaps, he will not need surgery.
The highest body temperature was recorded in Willie Jones (USA), who was admitted to hospital with a temperature of 46.5 ° C.
In an effort to pull the patient out, doctors often go too far. For example, a certain Charles Jensen in the period from 1954 to 1994. survived over 900 neoplasm removal operations.
Each person may face a situation where he loses a tooth. This may be a routine procedure performed by a dentist, or a consequence of injury. In each and.
What is ICP in a child?
Intracranial pressure is caused by an excess (hypertension) or lack of (hypotension) amount of cerebrospinal fluid that protects brain tissue from damage. It is called liquor. Often, this problem occurs due to prolonged oxygen starvation of brain cells. Intracranial pressure in the newborn, which is slightly elevated, is normal. After some time, as a rule, it normalizes without intervention.
Congenital intracranial pressure
There are two types of ICP: congenital and acquired. More difficult in the treatment of congenital intracranial pressure in infants is a consequence of birth trauma, complications during pregnancy. To say in advance whether there is a risk of the presence of this disease in a baby is not possible. During the examinations there may be no prerequisites for ICP, but according to general statistics, every fifth child has such a pathology. Acquired intracranial pressure in an infant occurs as a result of encephalitis, meningitis, or injury.
Signs of ICP in infants
Every mother dreams of a healthy baby, so it is important to be able to prevent the occurrence of the disease, to notice its symptoms in a timely manner, because difficulty in outflow of cerebrospinal fluid can give the newborn a lot of inconvenience and pain. Many new parents rejoice in the activity of their offspring, are touched when the baby bends or shakes his head, and do not think that these may be the first alarm bells.
Symptoms of intracranial pressure in infants:
- frequent awakenings at night,
- hyperactivity, irritability,
- Premature failure of the breast
- profuse regurgitation, vomiting,
- involuntary movements of the eyeball,
- frequent causeless crying
- head rotation
- strong reaction to changing weather
- lag in physical, psycho-emotional development,
- dropping the head back.
Veins on the head in infants
Young mommies often get scared, complain to the doctor that there are visible veins on the head of the infant. There is nothing terrible in this phenomenon, because the skin of a newborn is thinner than that of any adult, and the layer of subcutaneous fat is insufficiently developed. Over time, the venous mesh will become less noticeable. In some cases, the veins swell and swell, which can be a sign of a poor outflow of cerebrospinal fluid: you need to consult a neurologist as soon as possible so that he can order the test and the necessary tests.
Sometimes the first sign of ICP is a high, bulging forehead in infants, with some overhanging of the skull at the back of the head. Often it is confused with dropsy. If you notice a similar deviation, look at the photos of children with this diagnosis and pay attention to the violation of the pediatrician during the examination. This may be a sign of other diseases, such as hydrocephalus or rickets.In any case, do not panic, and ask for an additional examination of the baby to make sure there is no danger.
The divergence of the seams of the skull in infants
The peculiarity of the skull of the newborn lies in the mobility of the bone plates. This is necessary to make it easier for the child to pass through the birth canal. Sometimes there can be a discrepancy of cranial sutures in babies, which comes back to normal in a few months, and the fontanelle grows. If this does not happen, be sure to consult with the pediatrician watching the child. He should conduct a study of the structure of the head, estimate the size of the gaps between the plates and prescribe the necessary preventive measures or treatment.
Intracranial pressure in children under one year can cause many difficulties and health problems in older age. The success of treatment depends primarily on the timeliness of the assistance provided. To identify ICP in a child, it is important to carefully monitor his behavior, especially in the first 2-3 weeks of life. Sometimes it is very difficult to notice the first signs of the disease.
Causes of intracranial pressure in newborns:
- hypoxia (oxygen deprivation caused by cord entanglement or other problems)
- strong toxemia throughout pregnancy
- placental abruption or its rapid maturation,
- severe childbirth, birth trauma,
- careless medication during pregnancy,
- brain tumors
- hemorrhage into the cranial cavity,
- serious birth injury.
How does the intracranial pressure in infants
Increased intracranial pressure in a child is manifested by strong anxiety, a sharp change in mood and hyperactivity. If your baby often cries for no reason, think: maybe this is one of the symptoms of ICP associated with a headache due to increased pressure. In addition, the baby may refuse to breast, often and abundantly to regurgitate, turn his head and roll his eyes.
Sometimes the pressure rises temporarily, then it normalizes, so the discomfort is difficult to notice. In this case, the main symptom remains crying for no apparent reason and restless behavior, which is often attributed to colic and other problems of infancy. Remember that normally babies up to 2 months should spend most of their time in a state of sleep, crying only with discomfort due to a wet diaper or hunger. If your child wakes up more than 3 times a night, constantly crying and arching, this is a serious reason to visit a pediatrician.
How to determine the intracranial pressure in infants
Proper diagnosis of intracranial pressure in children begins with a visual inspection and measurement of indicators such as head volume and fontanel size: in a one-year-old child, it must fully grow together. Another important point in the survey - check muscle tone and reaction of the baby. These methods in 99% of cases help in time to notice the deviation of indicators and recognize the violation. For the purpose of additional security measures, an ultrasound of the brain tissue is assigned to almost every child through the fontanal opening, and in some cases an encephalogram or tomography.
How to treat intracranial pressure in infants
Remember: the treatment of intracranial pressure in children is prescribed by a neurologist only after a special ultrasound examination or tomography, symptoms alone are not enough to take medications. Only after making sure that the diagnosis is correct, the children are given Actovegin injections, and the older children Glycine tablets. They improve the absorption of glucose by brain cells, as well as normalize metabolism and have a positive effect on sleep.
Often the cause of ICP is hypoxia (lack of oxygen). In this case, special water procedures and sedatives are prescribed as treatment. It helps to improve blood circulation and saturation of the brain with oxygen. As a rule, the pressure decreases after undergoing a course of such treatment. Otherwise, stronger medicines are prescribed.
The specialist must put the child on the account and set a second date of the visit for re-inspection. Often, he is appointed after the passage of an ophthalmologist, who must conduct a study of the fundus, and the course of children's massage, necessary for the overall improvement of the baby. After all the procedures described, a repeated measurement of the head circumference, ultrasound and visual inspection is carried out. If, as a result of the examination, the doctor makes a diagnosis, for some time your child will be registered with a mandatory inspection every six months.
In rare cases, an increase in the volume and accumulation of cerebrospinal fluid in brain tissue can be a serious danger and requires surgical intervention. The operation is performed under general anesthesia, some excess liquor is removed to normalize the pressure. Postoperative rehabilitation involves the use of auxiliary drugs and constant monitoring by a doctor.
Causes of ICP
ICP in infants occurs for several reasons. But this produces an excessive amount of cerebrospinal fluid.
Subsequently, the circulation in the spinal cord box is disturbed. This is a specific cavity in which the brain and blood and cerebrospinal fluid are located (the so-called cerebrospinal fluid).
First, the cerebrospinal fluid is produced in the vascular plexus. It is later transported to the skull via the spinal canal.
Then the cerebrospinal fluid washes the brain, thereby feeding it with oxygen and other beneficial substances.
For some period of time, he still continues to be in the so-called ventricles. But later leaves the skull due to venous sinuses.
Liquor is a vital fluid. After all, it protects the brain from possible damage and stress. She is always under some pressure. There is a continuous update and circulation from one zone to another.
One such cycle takes about 1 week. But sometimes there is a malfunction in the body, because of which the liquor accumulates in some area. Ultimately, increased intracranial pressure occurs.
Why does ICP occur in children?
Increased intracranial pressure in infants occurs as a result of a neurological problem.
Diseases such as hydrocephalus (in most cases of its congenital form) can be provocateurs.
Hydrocephalus - abnormal development of the brain. This process is caused by excessive accumulation of fluid in it.
In adults, the range of possible causes is much wider. The main diseases that provoke the development of ICP:
- brain aneurysm rupture,
- Chiari anomaly,
- diseases such as meningitis or encephalitis.
Among other reasons, the following should be noted:
- intoxication of the body,
- an excess of vitamin A,
- violation of metabolic processes. For this reason, insufficient fluid enters the blood,
- brain hypoxia
- stressful situations
But this is typical of adulthood. And intracranial pressure in infants occurs due to pathologies of a neurological nature. Usually there are no serious problems.
With timely treatment, the pressure stabilizes.
The main symptoms of ICP in a child
Symptoms are different. It all depends on what stimulated the pathological condition.
The age of the patient also matters.
Signs of intracranial pressure in infants may be:
- the child often regurgitates, and it does not depend on food intake or level of satiety,
- increased head size
- the oculomotor function is impaired,
- the baby is extremely restless (often crying for no apparent reason),
- a significant increase in the distance between the seams of the fontanel.
Usually elevated ICP is observed from the moment the baby is born. But often the baby gets it as a result of certain factors. For example, after the transferred infectious and inflammatory processes. Negative impact and stressful situations.
In the case of concussion or injury, this is a common symptom.
It is often noticeable that the size of the skull has increased significantly. In this case, it is worth measuring its size. For this ideal tailor's meter. It is important to remember that all signs do not necessarily indicate poor intracranial pressure. Therefore, it is important to conduct a professional diagnosis.
The clinical picture in the mature is similar to what happens in the case of adolescents. In men, a decrease in sexual function. But usually the symptoms vary depending on what is the main cause of the problem.
For example, when meningitis is the basis for a change in ICP, then such signs will be in addition to the feverish state or the malfunction of the motor function.
In the presence of any injuries are fainting. And with a tumor, there is a memory disorder and other problems characteristic of this disease.
Principles of treatment
Many people deal a devastating blow to health by applying the treatment methods popular among the people. But with intracranial pressure, this will not give any positive result. Moreover, the condition only worsen.
What not to do:
- take homeopathic remedies and various herbal remedies,
- abuse going to the bath or sauna,
- drugs that affect blood circulation can damage your health in this situation,
- You can not take any drugs. These include vitamin complexes. Only a doctor can determine the deficiency of a substance.
Increased intracranial pressure in infants is treated with the help of therapy aimed at stimulating blood circulation. In addition, it is important to increase the nutritional efficiency of the brain with nutrients. Sometimes there is a need for sedatives, as well as vascular agents.
A good effect can be achieved by resorting to physiotherapeutic procedures. These include: electrophoresis, laser treatment, dry immersion. Also prescribed diuretic drugs.
The main thing is not to engage in self-treatment. The course of therapy should be prescribed only by a neonatologist or a neurologist.
Symptoms of hypertension may become noticeable within a few days after birth.
Increased intracranial pressure in the newborn is successfully normalized with the help of therapeutic massage.
Opinion of Dr. Komarovsky
First of all, the doctor notes that intracranial pressure often changes regardless of age. And this problem is successfully solved. It is necessary to build on normal indicators, taking into account the phase of the wakefulness of the child. During sleep, cerebrospinal fluid moves more slowly along the spinal cord.
Even minor problems such as coughing or indigestion affect the coefficient of intracranial pressure. In this vein, a parallel can be drawn between blood pressure and intracranial pressure. The latter is more difficult to control due to specific diagnostics.
The exact result can be obtained by introducing a special needle into the spinal canal. But this version of the survey is extremely dangerous. For children, it is used in exceptional cases.
Modern studies have shown that increased intracranial pressure is a symptom of many diseases. But the main disease that stimulates ICP is hydrocephalus. It is of varying degrees of severity. This is a congenital treatment problem that needs to be addressed as early as possible. One of the first signs is expressed in a marked increase in the head. And not so much the size, but the dynamics of change. But hydrocephalus is quite rare.
As for newborns, ICP is rarely increased. But it is fraught with serious consequences. Therefore the help of physicians and hospitalization is necessary. In rare cases, surgery is required. But the priority is the use of medicines.
What can be complications?
In the absence of timely treatment, complications are possible that threaten health much more than ICP. The child may begin to develop. Pathology associated with increased intracranial pressure is not common. But these children often have poor development compared to their peers.
With the advanced stage of hydrocephalus, the risk of brain damage increases. Physical disability is possible. But such a disease does not mean that a person cannot lead a habitual life for everyone. An important role is played by the correct treatment system.
In the absence of qualified assistance, a child from childhood will suffer from a headache. Psychomotor impairments are disturbed, and the emotional state is unstable.
As a prophylaxis of ICP in infants, constant walks in the fresh air are recommended. This normalizes the emotional state of the child. In addition, a sufficient amount of oxygen has a positive effect on the state of the liquor.
It is necessary to provide a full complex of vitamins for the child. It is especially difficult at artificial feeding. It is important to remember that the child is susceptible to any strong sound. Therefore, the atmosphere around should be calm.
In the case of ICP in young children do not need to panic. This disorder is resolved with proper treatment. But do not try to deal with this problem yourself. It is also important to pay attention not only to clinical symptoms, but also to changes in the behavior and mood of the child.
In most cases, this problem can be detected at home. And after it is worth to pass the diagnosis in the clinic. Also, do not refuse hospitalization. Home treatment is not as effective.
Increased intracranial pressure and its danger
A fluid (cerebrospinal fluid, or cerebrospinal fluid) is circulated inside the skull, which is formed from blood in special vascular plexuses located in the ventricles of the brain. Intracranial fluid plays the role of a shock absorber, softening the shaking of the brain and spinal cord during movement of the person, the blows of the head. In addition, the cerebrospinal fluid is a carrier of nutrients and oxygen from the blood to the cells of the central nervous system. The pressure exerted by the cerebrospinal fluid on the brain is called intracranial.
Normal intracranial pressure (ICP) in children and adults
ICP is not a constant for humans. It may slightly increase during physical and psychoemotional stress, exposure to external stimuli. In a small child, ICP changes if he cried, did not sleep, was tired, froze or, on the contrary, overheated. Normal performance should not go beyond certain limits.
Normal ICP indicators (in the prone position) are equal to the following values:
- for newborns 1.5-6 mm. Hg Art.,
- for children 1-14 years 3-7 mm. Hg Art.,
- for adults 3-15 mm. Hg Art.
A temporary increase that occurs when breastfeeding, coughing, crying is not a sign of pathology. The danger is constantly increased intracranial pressure in infants.
Consequences of increased ICP in children
If time does not pay attention to the manifestations of pathology and do not treat the baby, he will lag behind in physical and mental development. He will be tormented by severe headaches, possible visual impairment, coordination of movements. Subsequently, the child will suffer from epilepsy, mental disorders.
The baby may experience respiratory arrest, loss of consciousness, and impaired motility, if the cause of the increase in ICP is infringement of the cerebellum. Violation of the outflow of intracranial fluid leads to the emergence of such a serious illness as hydrocephalus (brain dropsy).True, this pathology occurs very rarely (approximately in 1 child out of 2-4 thousand).
Competent timely treatment, as a rule, leads to the normalization of ICP index, after which the child will develop fully.
The reasons for the temporary increase in ICP in a newborn baby can be:
- severe maternal pregnancy (late toxicosis, detachment of the placenta),
- too prolonged childbirth
- hypoxia caused by umbilical cord fetal neck.
Signs of impaired circulation of intracranial fluid appear in infants in the first few days. After the body gets stronger and the factors that caused it, cease to have a harmful effect, the pressure, as a rule, returns to normal for about six months.
Intracranial pressure, constantly increased, is a condition that indicates a congenital (possibly inherited) pathology of brain development, the presence of a birth trauma of the head, the formation of a brain tumor. As a result, impaired production and outflow of cerebrospinal fluid from the skull. The pressure can also be high if the brain has a hemorrhage in the newborn.
“Minimal cerebral dysfunction” (a pathology in which a child over 6 months old has a stably increased ICP) is not necessarily a sign of a serious illness. But the fact is that the child has a weakened nervous system, and any stress can provoke an even greater increase in intracranial pressure and deterioration of health. Therefore, the baby should be under the supervision of a neurologist, twice a year to undergo preventive treatment. It is necessary to take care of his nervous system, avoid stressful situations.
Under these conditions, the baby will develop normally, his mental abilities will not be affected.
Signs of an acquired imbalance in the circulation of intracranial fluid may occur in an infant as a result of severe infection of the brain and the occurrence of inflammatory diseases such as encephalitis and meningitis. Causes of pathology can be bruises to the head, head injuries, as well as surgery on the brain.
Violation of the outflow of cerebrospinal fluid leads to the fact that it accumulates in the skull. Up to about 1 year of age in a child, the bone plates in the area of the fontanelles are displaced, since they are only interconnected by a soft webbed tissue. This anatomical feature facilitates the passage of the fetus through the birth canal.
Under the pressure of the cerebrospinal fluid that accumulates due to a violation of its outflow, the bones of the skull diverge, which leads to an unusual increase in the head. The child has hydrocephalus.
Addition: Early overgrowth of the spring located on the crown of a nursing infant may also cause an increase in ICP, although this does not always lead to the occurrence of dangerous consequences. Most likely, the cause is the individual feature of its development, and the state of the body will quickly return to normal.
Signs of increased ICP in infants
The fact that the baby has increased intracranial pressure can be guessed by the peculiarities of its behavior and development. Parents are not recommended to draw independent conclusions, observing any deviations from generally accepted norms in a child. Not always their appearance speaks of pathology. But you should report your suspicions to a doctor who is able to recognize the symptoms of a true disease.
The most characteristic manifestations of impaired circulation of intracranial fluid are the following:
- Atypical movement of the eyeball (a symptom of Grefe). When a child looks straight, the eye looks normal. If he looks down, then the protein is slightly visible above the pupil, so the eye appears bulging. This phenomenon occurs due to the fact that the synchronism of the movement of the eyeball and the upper eyelid, which descends later and does not have time to close the protein, is disturbed.
- Lack of reflex Moro. This innate reflex is manifested (including in a dream), if the baby is frightened by a sharp sound, knocking on the surface on which it lies. At the same time, he involuntarily throws his head back, throws the handles to the side, spreading his shoulders, opening his fists. Then he again takes the usual pose. Such a reaction occurs in a child up to about 4 months. If it is absent, it may indicate a brain hemorrhage or edema.
- Frequent waking up (more than 3 times) at night and prolonged crying. Up to 2 months, the baby usually sleeps most of the day. If he often wakes up, the headache may be the cause.
- Early failure of the chest, constant regurgitation, vomiting.
- Trembling of limbs and frequent rotation of the head (the child involuntarily tries to get rid of a headache).
- Swelling of the veins on the head. This is a dangerous sign that should not be ignored. But at the same time, it should be remembered that in children the skin is thin and delicate, the venous pattern is expressed in a healthy child. With age, blood vessels become less noticeable.
- Too rapid increase in the head, acquiring a characteristic shape: the forehead becomes bulging and large, the back of the head sticks out.
- Untimely overgrowth of the fontanel (however, individual deviations from the usual terms are possible even with the normal state of health of the infant).
These symptoms, combined with increased excitability and lag in physical development indicate the presence of increased ICP.
Methods for the diagnosis of ICP in infants
A neurologist who suspected that a child has high ICP is prescribed an examination, and you can clarify the assumptions about the causes of the pathology and also measure the pressure of intracranial fluid on the brain. Mother and child are referred to an ophthalmologist, who, after examining the baby’s fundus, will be able to notice signs of increased ICP (retinal veins, swelling of the eye nerve). After this, it becomes clear that further, more detailed examination is necessary.
A sufficiently informative research method is neurosonography (ultrasound of the brain). The resulting image clearly shows characteristic changes in the size of the ventricles of the brain, as well as its other structures. For children whose spring is not overgrown, an ultrasound transducer is applied to the crown.
Using the method of ultrasound (Doppler ultrasound) of the vessels of the neck and brain detect circulatory disorders, which caused an increase in ICP.
One more technique using ultrasound is used - echoencephalography. On the surface of the head move 2 sensors. At the same time receive a two-dimensional image of the brain.
Ultrasound examinations are absolutely painless and safe. Accurate indications of ICP are not obtained with their help, but with high probability it is possible to confirm the presence of pathology in the brain state. In the most difficult cases, methods of computed tomography are used.
It is extremely rare, only when it is absolutely necessary, that ICP is measured by inserting a special needle with a sensor into the spinal canal or into the ventricles of the brain.
Treatment with increased ICP in infants
The treatment is to eliminate the causes of impaired circulation of intracranial fluid. Medications are prescribed only with full confidence in the diagnosis. Means are safe for infants. Doses are selected individually.
To reduce intracranial pressure, infants are prescribed diuretics (furosemide), agents to reduce the production of intracranial fluid, such as diakarb or triampur. Nootropic drugs (piracetam, cavinton) are used in the treatment. They improve blood circulation in the brain, accelerate the metabolism. Improving the nutrition of the brain helps to restore its normal functioning.
Neuroprotective drugs (glycine) are prescribed. They are needed to strengthen the nervous system.
Children are also given sedatives that help regulate sleep. It is recommended to walk a lot with the baby, to do special gymnastics with it. Swimming has a beneficial effect on the psyche of a child.
In case of emergency, surgical treatment is carried out, for example, the removal of a brain tumor or the removal of an anatomical defect. When hydrocephalus produces shunting of the brain - surgical restoration of blood flow in its vessels (elimination of ischemia).
In special cases, the drainage of fluid from the cranium is done using a catheter inserted into it or abduction of excess cerebrospinal fluid into the abdominal cavity.
After the treatment, the baby must be periodically re-examined, especially closely monitor its development, paying attention to the slightest deviations. It is important to remember that treatment should be timely, and only qualified specialists should appoint it. You can not rely on folk remedies and home methods of self-treatment.
Wordplay and concept substitution
This is one of the most mysterious phenomena of our, domestic pediatrics - the constant exaggeration of the topic of increased intracranial pressure. "Our" health workers find this ailment in almost every young child (and especially the infant), whose parents complained to the neuropathologist about too much hysterical crying, chin trembling, rolling eyes and similar "oddities" in the baby’s behavior. Doctors meticulously examine children, listen to disturbing complaints from their parents, and then talk to the scientist squint: "Obviously, the child has increased intracranial pressure," and prescribe some drugs to stimulate brain activity (most often glycine) or diuretic drugs.
Familiar script? The similar situation is observed everywhere. This is a typical example of “overdiagnosis” in our country: when you or your child are prescribed treatment for what is by its nature an absolutely normal physiological process.
It is difficult to put it even clearer and more accessible to parental understanding than the well-known pediatrician, Dr. Komarovsky, said: “If your child eats normally, sleeps more or less normally, actively moves and develops within the norm - then he has no pathologically increased intracranial pressure, of course not! Children with real elevated ICP will never be met on the playground, they are in hospitals, and most often in intensive care. ”
Intracranial pressure: an excursion into science
What is intracranial pressure and why should he not stand still?
In order to understand the difference between the imaginary and the real elevated ICP, it is necessary to understand how the human skull works and what it is.
So, the skull is a cavity. In this cavity are the brain, blood (and, accordingly, blood vessels), as well as cerebrospinal fluid - cerebrospinal fluid. Liquor is produced in the choroid plexus, enters the skull through the spinal canal, then washes the brain (bringing it nutrition, oxygen, moving hormones, etc.), is temporarily retained in the special ventricles, and then leaves the skull through the so-called venous sinuses.
These three vital components of our heads are present there not somehow, but in a strictly defined proportion (in medicine, this is called the Monroe-Kelly Doctrine): the brain occupies 85% of the skull space, blood - 8%, and liquor - 7%. The sum of the pressures of all three components is our normal intracranial pressure.
The key role in the ICP state is played by the fact that blood and cerebrospinal fluid in the cranial cavity are not statically present (like the brain), but move all the time. But at different speeds! For example, when the baby's body is at rest - the movement of cerebrospinal fluid and blood is normal - respectively, and the pressure inside the skull is also moderate. But as soon as the baby pays well, the speed of fluid movement increases, which means that the intracranial pressure rises for a while. But do not panic! It rises within the normal range. It is important to understand: there is no pathology in such a fluctuation of ICP. In any case, as long as it independently and without problems returns to normal.
What can cause ICP to increase pathologically?
Everything is extremely simple, especially for those who remember the physics course for the 8th grade. There is a skull - a bone cavity, which is not able to stretch, increasing in size, and then shrink. Therefore, when inside the skull one (or several) of the three components that “live” in it (medulla, blood and cerebrospinal fluid) increases in size - the pressure inside this cavity increases dramatically.
- The brain may increase due to a tumor or inflammatory process,
- Blood may increase due to hematoma from traumatic brain injury.
- Liquor may increase due to the impossibility of the outflow of fluid through the venous sinuses.
It is in such cases that the symptom of increased intracranial pressure is mentioned, which in itself will not return to normal until the concomitant factors change: the surgeon removes the tumor, the fluid is not pumped out by means of a shunting operation, the hematoma is removed and .P.
There is a disease, but not about your honor
Thus, if we are talking about increased intracranial pressure seriously and responsibly (let's say - at a civilized medical level), then parents should know the following: in reality, increased ICP is always a symptom for extremely serious and dangerous diseases.. In other words, it is not an independent disease that can be cured with any pills or pills. A constant companion of family disasters like:
- Severe head injury,
- Severe neuroinfectious disease (meningitis, encephalitis, etc.),
- Congenital hydrocephalus (a disease in which the exchange of fluid in the brain is disturbed, and which occurs on average with a frequency of 1: 4000 newborns),
- Brain tumor,
In most cases, all these circumstances lead to a deep disability of the child. But, fortunately, all these diseases are hundreds and even thousands of times less likely than local neurologists say a verdict against our children - increased intracranial pressure.
Even with a very disturbing symptom in a baby (for example, such as rolling eyes, standing up on tiptoes, throwing back the head during strong crying or lasting hysterics, etc.) there can be no talk about dangerous and pathological increased intracranial pressure in a child.
My baby is hyperactive. Is this due to increased ICP?
Among today's kids, every third is marked as “hyperactive.” Capricious, poorly soothing, explosive, hysterical, “restless”, with a lack of attention - all these definitions perfectly describe the current generation of children, which is just beginning its life path.
The first symptoms of hyperactivity occur even in infancy (long-term tantrums, intense crying, sleep disturbances), then at the age of about 6 years, a peculiar peak of hyperactivity occurs, after which it gradually fades away. But one third of babies - this syndrome persists until the period of puberty, and in some - for a lifetime.
Parents of such “disinhibited” children always ask themselves: is my baby's hyperactivity related to the syndrome of increased intracranial pressure? And others do not even doubt, but to the slice they are sure of the answer: yes, the ICP is to blame for everything!
In reality - none of the manifestations of hyperactivity has nothing to do with intracranial pressure. The real causes of hyperactivity in children are:
- Heredity. According to the supervision of doctors, all hyperactive children have someone from the parents with the same syndrome.
Heavy labor. Most often it is a long, protracted labor, with a lack of oxygen or asphyxia.
Intracranial pressure in children: signs and anti-symptoms
If any specialist in the clinic offers you to measure the intracranial pressure in a child with a certain device - do not agree. In reality, modern medicine knows only 2 ways to measure intracranial pressure, and both of them are related to the opening of the skull.
Nevertheless, there are some external signs that may indicate that the infant has increased ICP (which, in turn, as we have said a good hundred times, may be a symptom of one of their dangerous diseases).
In infants and toddlers up to a year, the main signs of increased ICP are:
- Exceeding the growth rate of head circumference,
- “Pulling out” the fontanel (when it is not delayed as it should be, but on the contrary, it sticks out)
- The divergence of the bones of the skull,
How to measure the circumference of the baby's head?
To find out the true indicators of the baby’s head circumference, you should place a flexible ruler (tailor’s meter will do) strictly above the eyebrows - in front, and at the highest point of the head - in the back.
On average, the head circumference of newborn babies is 34 cm, and then increases (on average!) By 1 cm every month. That is, for the first year of life, the baby’s head adds about 12 cm.
It is very important to know: none of the listed signs of increased intracranial pressure is an obvious reason for making a diagnosis of "increased ICP". Symptoms should be manifested in a complex and supported by subsequent studies - for example, ultrasound of the brain and others.
Remember symptoms of increased intracranial pressure are NOT:
- Slow closing fontanel,
- Any developmental delays ("late" began to roll over, sit down or walk, does not speak, does not speak, etc.),
- Shudder, jitter, or tremor (handles, legs, or lips),
- Hyperactivity Syndrome
- Disturbed sleep or appetite,
Treatment of increased ICP
Before listing methods of treatment, it makes sense to clearly explain to parents how it is NOT customary to treat increased intracranial pressure in civilized medicine. So, treatment of ICP is irrelevant:
- Dietary supplements,
- Homeopathic remedies
- Vitamins and massages,
- Drugs that affect blood circulation and metabolism in the brain (which also includes glycine),
Everything that parents should know about the treatment of increased ICP can be summarized in two main points:
- 1 If the diagnosis is “imaginary” (that is, the very case when a neuropathologist in the domestic clinic treats any infant hysteria for the so-called increased ICP) - no medication is needed. It will take a little time - and the pressure is normalized by itself.
- 2 If the diagnosis is real (that is, it is present accompanied by such dangerous diseases as neuroinfection, a brain tumor, severe head injury or congenital hydrocephalus) - no medicine or alternative medicine to reduce ICP will simply help. Here “heavy artillery” comes into force and the aces of their work are neurosurgeons, traumatologists, and resuscitation specialists.