Benign intracranial hypertension: causes, symptoms, diagnosis, treatment

Benign intracranial hypertension (idiopathic intracranial hypertension, pseudotumor brain) is manifested by increased intracranial pressure without signs of volumetric formation or hydrocephalus; CSF composition is unchanged.

This pathology is more common in women of childbearing age. The prevalence is 1/100 000 among women with normal body weight and 20/100 000 among obese women. Intracranial pressure significantly increased (> 250 mm H O); the exact cause is not established, the headache is presumably due to the difficulty of cerebral venous outflow.

[1], [2], [3], [4], [5], [6]

What causes benign intracranial hypertension?

Intracranial hypertension is common in patients with volumetric brain formations. The causes of benign intracranial hypertension are not fully known. There is a connection with a long reception of oral contraceptives.

There is a disruption in the production and reabsorption of cerebrospinal fluid with the phenomena of edema and swelling of the brain, which are both intracellular and intercellular in nature. The role and disruption of the normal functioning of the blood-brain barrier also plays a role.

The causes of the syndrome of intracranial hypertension:

• presence of an additional intracranial volume due to the tumor;
• violation of the outflow of cerebrospinal fluid with the development of occlusive hydrocephalus;
• presence of peritumoral edema of the brain.

Elimination of the first two reasons is the task of a neurosurgeon. A neuroscientist can only affect a third cause.

Symptoms

Typically, almost daily generalized headache of variable intensity, sometimes accompanied by nausea. Possible short-term fog and diplopia, due to unilateral or bilateral paresis of the VI pair of cranial nerves. The fall of the visual fields starts from the periphery and in the early stages is imperceptible to the patient. In the future, there is a concentric narrowing of all fields of vision, loss of central vision with the probability of developing complete blindness. Neuroendocrine pathology, as a rule, includes cerebral obesity and the irregularity of the menstrual cycle. More often observed in women 20-40 years.

Diagnostics

A preliminary diagnosis of benign intracranial hypertension is based on the clinical picture of the disease, the final one is based on MRI data, preferably with magnetic resonance venography, and a lumbar puncture showing increased intracranial pressure at the beginning of the manipulation and normal CSF composition. In rare cases, certain drugs and diseases can cause a clinical picture, similar to idiopathic intracranial hypertension.

Data EEG, CT, angiography pathology does not determine. The ventricular system, as a rule, is normal, there is a slight increase in the ventricles of the brain.

It is necessary first of all to exclude the tumor brain process.

[7], [8], [9]

Treatment

Benign intracranial hypertension usually passes spontaneously after discontinuation of oral contraceptives. If the disease develops without taking such contraceptives, its course is also extremely dynamic and can go spontaneously. In severe cases, dehydration therapy with glycerol, veroshpiron is performed, vascular therapy is indicated. Apply means such as stegeron, theonikola, Cavinton. Recommended drugs that improve venous outflow, - troxevasin, gliovenol.

Treatment is aimed at reducing intracranial pressure and alleviating symptoms with repeated lumbar punctures and taking diuretics (acetazolamide 250 mg 4 times / day inwards). The headache is stopped with the use of NSAIDs or antimigraine drugs. Patients with obesity are recommended measures to reduce body weight. With progressive loss of vision against the background of repeated lumbar punctures and drug therapy, decompression (fenestration) of the optic nerve shells or lumbo- peritoneal shunting is indicated.

Intercranial hypertension is treated with drugs of several groups, each of which has both advantages and disadvantages.

The following hypertensive solutions can be shown with the development of intracranial hypertension

Mannitol, 20% rr, IV 400 ml, single or Sodium chloride, 7.5% r, in / in 200 ml, once.

However, it should be remembered that, firstly, the dehydrating effect of hypertonic solutions is realized mainly through the dehydration of intact brain matter, and secondly, after the end of the drug effect, a so-called "recoil phenomenon" can occur (increase in intracranial pressure to values even exceeding initial).

The therapeutic effect of saluretics (furosemide) in a condition such as intracranial hypertension is less pronounced than in hypertensive solutions. Nevertheless, their use is justified in combination with osmodiuretics, tk. Allows to reduce the risk of development of the "recoil phenomenon":

Furosemide iv 20-60 mg, once (further periodicity of administration is determined by clinical expediency). Dexamethasone is the drug of choice in the therapy of peritumoral edema of the brain: Dexamethasone IV / 12-24 mg / day, once (further periodicity of administration is determined by clinical expediency). However, its use for the treatment of intracranial hypertension in patients with severe TBI and ischemic strokes is not effective.

Acute intracranial hypertension, developed during neurosurgical interventions, is effectively treated with the use of barbiturates and the creation of a brief pronounced hyperventilation:

Thiopental sodium IV bolus 350 mg, once, then if necessary several times iv bolus in a total dose of up to 1.5 g.

In order to monitor the effectiveness of conservative therapy, a regular ophthalmologic examination with obligatory perimetry is carried out, since checking only the visual acuity is insufficient to prevent the irreversible loss of visual functions.