Syndrome of intracranial hypertension code microbial 10. Signs and methods of elimination of intracranial hypertension

DHD is a diagnosis of exclusion.

Epidemiology In men, it is observed 2-8 times more often, in children - equally often in both sexes. Obesity is observed in 11-90% of cases, more often in women. The frequency among overweight women of childbearing age is 19/37% of cases are recorded in children, 90% of whom are aged 5–15 years, very rarely younger than 2 years. The peak of the disease is 20–30 years.

Symptoms (signs)

Clinical picture Symptoms Headache (94% of cases), more pronounced in the morning Dizziness (32%) Nausea (32%) Change in visual acuity (48%) Diplopia, more often in adults, usually due to abducens nerve paresis (29%) Neurological disorders usually limited to the visual system Optic disc edema (sometimes unilateral) (100%) Abducens nerve involvement in 20% of cases Increased blind spot (66%) and concentric narrowing of visual fields (blindness is rare) Visual field defect (9%) Initial form may be accompanied only by an increase in the occipital-frontal circumference of the head, often resolves on its own and usually requires only observation without specific treatment Absence of consciousness disorders, despite high ICP Concomitant pathology Appointment or withdrawal of GC Hyper-/hypovitaminosis A Use of other drugs: tetracycline, nitrofurantoin, isotretinoin Sinus thrombosis dura mater SLE Menstrual irregularities Anemia (especially iron deficiency).

Diagnostics

Diagnostic criteria CSF pressure above 200 mm of water. The composition of the cerebrospinal fluid: a decrease in protein content (less than 20 mg%) Symptoms and signs associated only with increased ICP: edema of the optic nerve head, headache, absence of focal symptoms (permissible exception - abducens nerve paresis) MRI / CT - no pathology. Permissible exceptions: Slit-like form of the ventricles of the brain Enlargement of the ventricles of the brain Large accumulations of cerebrospinal fluid over the brain in the initial form of DHD.

Investigation methods MRI / CT with and without contrast Lumbar puncture: measurement of CSF pressure, analysis of CSF for at least the content of protein TAC, electrolytes, PV Examinations to rule out sarcoidosis or SLE.

Differential diagnosis CNS lesions: tumor, brain abscess, subdural hematoma Infectious diseases: encephalitis, meningitis (especially basal or caused by granulomatous infections) Inflammatory diseases: sarcoidosis, SLE Metabolic disorders: lead poisoning Vascular pathology: occlusion (dura sinus thrombosis) or partial obstruction, Behçet's syndrome Membranous carcinomatosis.

Treatment

Diet management tactics No. 10, 10a. Restriction of fluid and salt intake Repeat thorough ophthalmological examination, including ophthalmoscopy and determination of visual fields with an assessment of the size of the blind spot Follow-up for at least 2 years with repeat MRI / CT to rule out a brain tumor Withdrawal of drugs that can cause DHD Weight loss body Careful outpatient monitoring of patients with asymptomatic DHD with periodic evaluation of visual functions. Therapy is indicated only for unstable conditions.

Drug therapy - diuretics Furosemide at an initial dose of 160 mg / day in adults; the dose is selected depending on the severity of symptoms and visual disturbances (but not on CSF pressure); if ineffective, the dose can be increased to 320 mg / day Acetazolamide 125-250 mg orally every 8-12 hours If ineffective, additional dexamethasone 12 mg / day is recommended, but the possibility of increasing body weight should be considered.

Surgical treatment is performed only in patients resistant to drug therapy or with imminent loss of vision Repeated lumbar punctures until remission is achieved (25% - after the first lumbar puncture) Bypass Lumbar: lumboperitoneal or lumbopleural Other methods of bypass (especially in cases where arachnoiditis prevents access to lumbar arachnoid space): ventriculoperitoneal shunting or shunting of a large cisterna Fenestration of the optic nerve sheath.

Course and prognosis In most cases, remission by 6-15 weeks (relapse rate - 9-43%) Visual disorders develop in 4-12% of patients. Vision loss is possible without prior headache and papilledema.

Synonym. Idiopathic intracranial hypertension

ICD-10 G93.2 Benign intracranial hypertension G97.2 Intracranial hypertension after ventricular bypass surgery

Application. Hypertensive-hydrocephalic syndrome is caused by an increase in CSF pressure in patients with hydrocephalus of various origins. It is manifested by headache, vomiting (often in the morning hours), dizziness, meningeal symptoms, stupor, and congestion in the fundus. On craniograms, deepening of digital impressions, expansion of the entrance to the "Turkish saddle", and an increase in the pattern of diploic veins are found.

Signs and methods of elimination of intracranial hypertension

Most often, intracranial hypertension (increased intracranial pressure) is manifested due to dysfunction of the cerebrospinal fluid. The process of producing cerebrospinal fluid is enhanced, due to which the liquid does not have time to fully absorb and circulate. Stagnation is formed, which causes pressure on the brain.

With venous congestion, blood can accumulate in the cranial cavity, and with cerebral edema, tissue fluid can accumulate. Pressure on the brain can be exerted by a foreign tissue formed due to a growing neoplasm (including an oncological one).

The brain is a very sensitive organ; for protection, it is placed in a special liquid medium, the task of which is to ensure the safety of brain tissues. If the volume of this liquid changes, then the pressure increases. The disorder is rarely an independent disease, and often acts as a manifestation of a pathology of a neurological type.

Influencing factors

The most common causes of intracranial hypertension are:

• excessive secretion of cerebrospinal fluid;
• insufficient degree of absorption;
• dysfunction of pathways in the fluid circulation system.

Indirect causes provoking the disorder:

• traumatic brain injury (even long-standing, including birth), head bruises, concussion;
• encephalitis and meningitis diseases;
• intoxication (especially alcohol and medication);
• congenital anomalies in the structure of the central nervous system;
• violation of cerebral circulation;
• foreign neoplasms;
• intracranial hematomas, extensive hemorrhages, cerebral edema.

In adults, the following factors are also distinguished:

• overweight;
• chronic stress;
• violation of the properties of the blood;
• strong physical activity;
• the influence of vasoconstrictor drugs;
• birth asphyxia;
• endocrine diseases.

Excess weight can be an indirect cause of intracranial hypertension

Due to pressure, the elements of the brain structure can change position relative to each other. This disorder is called dislocation syndrome. Subsequently, such a shift leads to a partial or complete breakdown of the functions of the central nervous system.

In the International Classification of Diseases 10 revision, the syndrome of intracranial hypertension has the following code:

• benign intracranial hypertension (classified separately) - code G93.2 according to ICD 10;
• intracranial hypertension after ventricular bypass - code G97.2 according to ICD 10;
• cerebral edema - code G93.6 according to ICD 10.

The International Classification of Diseases, 10th revision, was introduced into medical practice in the Russian Federation in 1999. The release of the updated classifier of the 11th revision is provided for in 2017.

Symptoms

Based on the factors of influence, the following group of symptoms of intracranial hypertension, which occurs in adults, has been identified:

• headache;
• "heaviness" in the head, especially at night and in the morning;
• vegetovascular dystonia;
• sweating;
• tachycardia;
• pre-fainting state;

• nausea accompanied by vomiting;
• nervousness;
• fast fatiguability;
• circles under the eyes;
• sexual and sexual dysfunction;
• high blood pressure in humans under the influence of low atmospheric pressure.

Separately, there are signs of intracranial hypertension in a child, although a number of the listed symptoms also appear here:

• congenital hydrocephalus;
• birth injury;
• prematurity;
• infectious disorders during fetal development;
• an increase in the volume of the head;
• visual sensitivity;
• violation of the functions of the visual organs;
• anatomical anomalies of blood vessels, nerves, brain;
• drowsiness;
• weak sucking;
• shouting, crying.

Drowsiness may be one of the symptoms of intracranial hypertension in a child

The disorder is divided into several types. So benign intracranial hypertension is characterized by increased CSF pressure without changes in the state of the cerebrospinal fluid itself and without congestive processes. Of the visible symptoms, swelling of the optic nerve can be noted, which provokes visual dysfunction. This type does not cause serious neurological disorders.

Intracranial idiopathic hypertension (refers to the chronic form, develops gradually, is also defined as moderate ICH) is accompanied by increased CSF pressure around the brain. It has signs of the presence of a tumor of the organ, although one is actually absent. The syndrome is also known as brain pseudotumor. An increase in the pressure of the cerebrospinal fluid on the organ is caused precisely by stagnant processes: a decrease in the intensity of the processes of absorption and outflow of CSF.

Diagnostics

During the diagnosis, not only clinical manifestations are important, but also the results of a hardware study.

1. The first step is to measure intracranial pressure. To do this, special needles attached to a manometer are inserted into the spinal canal and into the fluid cavity of the skull.
2. An ophthalmological examination of the condition of the eyeballs is also carried out for blood filling of the veins and the degree of expansion.
3. Ultrasound examination of the vessels of the brain will make it possible to establish the intensity of the outflow of venous blood.
4. MRI and computed tomography are performed in order to determine the degree of discharge of the edges of the ventricles of the brain and the degree of expansion of the fluid cavities.
5. Encephalogram.

Computed tomography is used to diagnose intracranial hypertension

The diagnostic complex of measures in children and adults is not much different, except that in a newborn, a neurologist examines the condition of the fontanel, checks muscle tone and takes measurements of the head. In children, an ophthalmologist examines the condition of the fundus.

Treatment

Treatment of intracranial hypertension is selected based on the obtained diagnostic data. Part of the therapy is aimed at eliminating the factors of influence that provoke a change in pressure inside the skull. That is, the treatment of the underlying disease.

Treatment of intracranial hypertension can be conservative or surgical. Benign intracranial hypertension may not require any therapeutic measures at all. Unless in adults, in order to increase the outflow of fluid, a diuretic drug effect is required. In infants, the benign type passes over time, the baby is prescribed massage and physiotherapy.

Sometimes glycerol is prescribed for small patients. Oral administration of the drug diluted in a liquid is provided. The duration of therapy is 1.5-2 months, since glycerol acts gently, gradually. In fact, the medicine is positioned as a laxative, therefore, without the appointment of the attending physician, it should not be given to the child.

If medications do not help, then bypass surgery may be needed.

Sometimes a spinal puncture is required. If medical therapy does not work, it may be worth resorting to bypass surgery. The operation takes place in the Department of Neurosurgery. In parallel, the causes that caused increased intracranial pressure are eliminated surgically:

• removal of a tumor, abscess, hematoma;
• restoration of a normal outflow of cerebrospinal fluid or the creation of a detour.

At the slightest suspicion of the development of ICH syndrome, you should immediately see a specialist. Especially early diagnosis with subsequent treatment is important in babies. Late response to the problem will subsequently result in various disorders, both physical and mental.

Other disorders of the brain (G93)

Porencephalic cyst, acquired

Excluded:

• periventricular acquired cyst of newborn (P91.1)
• congenital cerebral cyst (Q04.6)

Excluded:

• complicating:
  • abortion, ectopic or molar pregnancy (O00-O07, O08.8)
  • pregnancy, childbirth or delivery (O29.2, O74.3, O89.2)
  • surgical and medical care (T80-T88)
• neonatal anoxia (P21.9)

Excludes: hypertensive encephalopathy (I67.4)

Benign myalgic encephalomyelitis

Compression of the brain (trunk)

Infringement of the brain (trunk)

Excluded:

• traumatic compression of brain (S06.2)
• traumatic compression of brain, focal (S06.3)

Excludes: cerebral edema:

• due to birth trauma (P11.0)
• traumatic (S06.1)

Radiation-induced encephalopathy

If it is necessary to identify an external factor, use an additional external cause code (class XX).

In Russia, the International Classification of Diseases of the 10th revision (ICD-10) is adopted as a single regulatory document for accounting for morbidity, reasons for the population to apply to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. №170

The publication of a new revision (ICD-11) is planned by WHO in 2017 2018.

With amendments and additions by WHO.

Processing and translation of changes © mkb-10.com

Intracranial hypertension code μb 10

Causes, treatment and prognosis for cerebral dystonia

Cerebral dystonia is a disorder of the autonomic nervous system, in which organs and tissues are supplied with insufficient oxygen. The disease occurs both in adults (up to 70% of cases) and in children (up to 25%). Males suffer from this disease more often than women.

Symptoms of the disease

Symptoms of cerebral dystonia are different. This condition is one of the manifestations of vegetovascular dystonia.

1. intracranial pressure.
2. Disorders from the nervous system - irritability, tearfulness. Headache and dizziness, muscle twitches (tics) are possible. The appearance of tinnitus is characteristic, sleep suffers, unsteadiness of gait is noted.
3. Fluctuations in pressure in the direction of increasing or decreasing.
4. Puffiness of the face and swelling of the eyelids.
5. Nausea, sometimes vomiting.
6. Rapid fatigue, general weakness, decreased performance.

Causes of the disease

In children, vascular dystonia is formed due to a discrepancy between the rate of development and the level of maturity of the neurohormonal apparatus, and also if there is a hereditary predisposition.

In adults, the causes of the disease are:

1. Exhaustion of the body due to intoxication, trauma or previous infectious diseases.
2. Sleep disturbances, which are manifested by early awakening in the morning, difficulty falling asleep for a long time or insomnia.
3. Spleen, depressed mood, constant fatigue.
4. Wrong diet, unhealthy diet.
5. Lack of physical activity or, conversely, too active lifestyle.
6. Imbalance of hormones during childbearing and menopause in women, and puberty in adolescents.
7. endocrine disorders.
8. Having bad habits.
9. Squeezing of the vessels of the neck with osteochondrosis, as a result of which the flow of blood to the brain is disturbed.
10. Sudden change in climate or time zone.
11. Bad environment in the region.

Diagnosis and treatment of the disease

To establish such a diagnosis as dystonia of cerebral vessels, you need to consult a neurologist, therapist, surgeon, endocrinologist, cardiologist. It is these specialists who will help to exclude organic diseases and confirm or refute the presence of vascular dystonia.

In the process of diagnosis, the following examinations are carried out:

1. Urinalysis and blood tests.
2. Functional examinations, including electrocardiography, duplex scanning of the vessels of the head and neck; transcranial dopplerography may be needed.
3. X-ray of the spine (cervical), skull.
4. In some cases, one cannot do without tomography (computer and magnetic resonance imaging).

Drug therapy for vascular dystonia involves the use of various groups of drugs to improve the functioning of the autonomic nervous system. These include:

1. Calming drugs containing barbiturates, bromides, valerian and hawthorn.
2. Means for improving blood circulation in the brain.
3. Drugs affecting the autonomic and central nervous systems - antidepressants, antipsychotics, hypnotics, nootropics, psychostimulants based on caffeine.
4. Vitamin complexes, antioxidants, diuretics, calcium preparations, adaptogens with extract of eleutherococcus, magnolia vine, ginseng can also be used.
5. To reduce the excitability of the autonomic nervous system and improve processes, doctors prescribe Glycine. This amino acid helps to improve metabolic processes in the brain. As a result, the asthenoneurotic component of dystonia becomes less pronounced.

Massage, acupuncture, herbal medicine, physiotherapy and water treatments are shown as an addition to treatment for vascular dystonia.

Rest and treatment in a sanatorium can be used as rehabilitation for a disease.

If the patient has been diagnosed with vascular dystonia, doctors recommend:

1. Follow the daily routine. Every day a person should sleep at least eight hours. Sound sleep helps to normalize blood pressure.
2. Frequently ventilate the room in which you sleep. Alternate physical and mental stress. Spend as little time as possible in front of the computer. At least two hours a day to walk in the air.
3. Do physical exercises, go swimming, ride a bike, ski, skate. During training, avoid exercises with a range of movement of the head and torso, sharp turns.
4. Temper. Every day, wipe the body with a damp towel. Perform hydromassage, take a contrast shower. Coniferous-salt and radon baths will benefit.

Success in the treatment of the disease largely depends on the psycho-emotional state of the patient. Learn the rules of relaxation, take part in auto-training, use methods of psychological relief.

Consequences of the disease

As a rule, the disease at the initial stage does not harm health and does not lead to serious consequences. However, the symptoms of the disease interfere with normal work and study, cause anxiety and fatigue.

The disease in the chronic form is severe, and if not properly treated, it can lead to the development of hypertension, coronary disease, and subsequently to stroke and myocardial infarction.

Timely and competent treatment is the key to success. After the therapy, in 90% of cases, the symptoms of the disease disappear, sleep and appetite are normalized, and the adaptive abilities of the body are restored.

Syndrome of intracranial hypertension in children and adults

Intracranial hypertension is increased pressure in the skull. Intracranial pressure (ICP) is the force with which intracerebral fluid presses on the brain. Its increase, as a rule, is due to an increase in the volume of the contents of the cranial cavity (blood, cerebrospinal fluid, tissue fluid, foreign tissue). ICP can periodically increase or decrease due to changes in environmental conditions and the need for the body to adapt to them. If its high values ​​persist for a long time, the syndrome of intracranial hypertension is diagnosed.

The causes of the syndrome are different, most often these are congenital and acquired pathologies. Intracranial hypertension in children and adults develops with hypertension, cerebral edema, tumors, traumatic brain injuries, encephalitis, meningitis, hydrocephalus, hemorrhagic strokes, heart failure, hematomas, abscesses.

Intracranial hypertension is classified according to the causes of its development:

• Acute. Occurs with strokes, fast-growing tumors and cysts, brain injuries. Occurs suddenly, often fatal.
• Moderate. It is periodically observed in persons with vegetovascular dystonia and in healthy people with meteosensitive dependence. The pressure inside the skull usually rises with a sudden change in weather.
• Venous. It is associated with a violation of the outflow of blood from the cranial cavity, which occurs when the veins are compressed in osteochondrosis and tumor processes, when the lumen of the veins is closed by blood clots.
• Benign intracranial hypertension (DHD), or idiopathic. This form has no obvious causes of occurrence and develops in healthy people.

Main symptoms

Signs of intracranial hypertension can vary from person to person. The most characteristic are the following:

• Headache. This is the main symptom of pathology, most often occurring in the morning. The headache is usually bursting, it may be accompanied by nausea and vomiting, aggravated by coughing, sneezing, bending over.
• Violation of vision. Manifested by fog and double vision, impaired clarity, pain, aggravated by rotation of the eyeballs, the appearance of flies and flickering before the eyes.
• Drowsiness and lethargy.
• Hearing impairment. Its decrease, crackling or feeling of fullness in the ears.

The appearance of these signs in adults, adolescents and children does not yet indicate the development of intracranial hypertension, but requires a mandatory examination.

Increased ICP can also have indirect symptoms, including:

• sleep disturbance;
• nosebleeds;
• trembling of fingers and chin.

Intracranial hypertension in children

Increased ICP in children leads to disturbances in the development of the brain, so it is important to detect the pathology as early as possible.

In children, two types of pathology are distinguished:

1. The syndrome slowly increases in the first months of life, when the fontanelles are not closed.
2. The disease develops rapidly in children after a year, when the seams and fontanelles are closed.

In children under one year old, due to open cranial sutures and fontanelles, the symptoms are usually unexpressed. Compensation occurs due to the opening of the sutures and fontanelles and an increase in the volume of the head.

The first type of pathology is characterized by the following symptoms:

• the child often and for a long time cries for no reason;
• fontanelles swell, pulsation is not heard in them;
• vomiting occurs several times a day;
• the baby sleeps little;
• cranial sutures diverge;
• the skull is not large for its age;
• the bones of the skull are formed disproportionately, the forehead protrudes unnaturally;
• veins are clearly visible under the skin;
• children lag behind in development, later they begin to hold their heads and sit;
• when the child looks down, a white stripe of the white of the eyeball is visible between the iris and the upper eyelid.

When fontanelles and cranial sutures overgrow, manifestations of intracranial hypertension become pronounced. At this time, the child develops the following symptoms:

In this case, you must definitely call an ambulance.

The syndrome can also develop at an older age. In children from two years of age, the disease manifests itself as follows:

• in the morning, on waking, bursting headaches appear that press on the eyes;
• when lifting, the pain weakens or recedes due to the outflow of cerebrospinal fluid;
• the functions of the sense organs are disturbed due to the accumulation of cerebrospinal fluid;
• vomiting occurs;
• the child is stunted, overweight.

Diagnosis in children

The diagnosis can be made at three stages: in the prenatal period, at birth, during routine examinations of infants.

To identify pathology in a child, the following steps are necessary:

• examination by a pediatrician;
• examination by an ophthalmologist;
• consultation with a neurologist;
• NSG (neurosonography);
• brain x-ray;
• MRI and characteristic MR signs.

Treatment

The method of treatment is chosen by the doctor depending on the manifestations of the disease. With mild symptoms, non-drug therapy is indicated, which includes:

• special diet and drinking regimen;
• therapeutic exercises and massage;
• physiotherapy;
• swimming;
• acupuncture.

Pathology of moderate severity is treated with drugs. In severe cases, surgical intervention is indicated, which consists in creating channels for the outflow of cerebrospinal fluid.

The outcome of treatment will depend on whether it was started in a timely manner.

Intracranial hypertension in adults

Symptoms in adults are determined by disturbances in the functioning of the central nervous system caused by pressure on the brain. These include:

• pressing pains in the head in the second half of the night and in the morning;
• nausea, vomiting in the morning;
• decrease or increase in blood pressure;
• tachycardia;
• sweating;
• increased fatigue;
• nervousness;
• blue circles under the eyes, a pronounced venous pattern on the skin under the eyes;
• meteosensitivity, worsening condition when the weather changes;
• hallucinations;
• after taking a horizontal position, there is an increased release of cerebrospinal fluid and a slow reabsorption, hence the severity of symptoms in the second half of the night and in the morning.

If symptoms persist for a long time, encephalopathy may develop.

In addition, residual encephalopathy may develop, the occurrence of which is due to damage to the nervous tissue. It usually progresses slowly and signs of brain dysfunction increase gradually. Residual encephalopathy is manifested by mood swings, sleep disturbances, headaches, dizziness, and general weakness.

Diagnostics

Measurement of intracranial pressure is possible only in an invasive way. To do this, you need to insert the needle, to which the manometer is connected, into the spinal canal. The diagnosis is made by identifying symptoms that indicate intracranial hypertension. This is done through the following types of surveys:

• examination by a neurologist;
• lumbar puncture;
• fundus examination;
• brain x-ray;
• rheoencephalography.

Adult Treatment

The syndrome of intracranial pressure requires immediate treatment, otherwise the body will not be able to function normally. With increased ICP, intelligence decreases, which affects mental performance.

The essence of symptomatic treatment is to reduce the production of cerebrospinal fluid and to increase its reabsorption. For this, diuretics are used.

If diuretic therapy fails, corticosteroids are prescribed along with vasodilators and barbiturates. Steroid drugs help to reduce the permeability of the blood-brain barrier. Troxevasin is used to improve the outflow of venous blood, and drugs from the group of non-steroidal anti-inflammatory drugs and anti-migraine drugs are used to relieve pain. In addition, vitamins and medications may be indicated to improve the transmission of neuronal impulses.

With a mild form of the disease, special exercises and a special drinking regimen are usually prescribed to reduce pressure in the cranial cavity. With the help of physiotherapy, the venous bed in the head is unloaded. With the help of these measures, it is possible to reduce intracranial pressure and reduce symptoms within a week, even without taking diuretics, which an adult may not always take constantly.

Most often, a lumbar puncture is used to mechanically remove a small amount (no more than 30 ml at a time) of CSF. In some cases, improvement occurs the first time, but, as a rule, more than one procedure is needed. The frequency of carrying out is one manipulation in two days.

Another option for surgical intervention is shunting, or the implantation of tubes through which the outflow of CSF will be carried out. This method has a more pronounced and lasting effect.

Intracranial hypertension can be eliminated only if the cause of its occurrence, that is, another disease, is eliminated.

Mild forms of pathology in adults can be treated with folk remedies:

• Grind garlic and lemons, add water, let it brew for a day. Strain and take a tablespoon for two weeks. One and a half liters of water will require two lemons and two heads of garlic.
• Mix equal amounts of crushed leaves of hawthorn, mint, eucalyptus, valerian and motherwort. Pour vodka (0.5 l) with a tablespoon of the mixture, leave for seven days. Strain and take 20 drops three times a day for a month.
• Pour clover flowers with vodka (0.5 l) and leave for two weeks. Strain and take three times a day, a tablespoon diluted in half a glass of water.
• Dried lavender leaves (tablespoon) chop and pour boiling water (0.5 l), leave for an hour. Strained infusion drink a tablespoon half an hour before meals for 1 month.

Separately, it should be said about benign intracranial hypertension (code G93.2 according to ICD 10). This is a temporary increase in ICP without signs of infection, hydrocephalus, hypertensive encephalopathy, and may be caused by hormonal changes, obesity, hypovitaminosis, thyroid disease, pregnancy, hormone intake, and other factors.

The main difference between DHD and the pathological form of the disease is the absence of signs of depressed consciousness. Typically, patients complain of headaches, which are aggravated by coughing and sneezing.

Most often, benign intracranial hypertension does not require specific treatment and resolves on its own. Diuretics can be prescribed, which are usually enough to normalize the pressure. In addition, it is recommended to limit the amount of fluid consumed, follow a salt-free diet and perform special exercises.

Diet

Nutrition and drinking regimen should help ensure that the body cannot accumulate fluid. To do this, you must adhere to the following rules:

• exclude salt from the diet;
• refuse smoked and flour;
• do not drink purchased juices and carbonated drinks;
• do not drink alcoholic beverages;
• refrain from fast food.

Conclusion

Treatment of intracranial hypertension should begin as early as possible. The unfavorable course of the disease leads to a rapid loss of vision. In the advanced stage, optic nerve atrophy is irreversible. If the pathology is not treated, the consequences can be sad: the pressure on the brain will increase, its tissues will begin to shift, which will inevitably lead to death.

Causes of sinus bradyarrhythmia, treatment methods

Sinus bradyarrhythmia is a disease that occurs in all age categories of patients and is characterized by a significant decrease in the number of heartbeats. In a healthy person, the pulse rate fluctuates within beats per minute. With this pathology of the heart, the indicators can vary from 40 to 59 contractions, in extremely severe cases, bordering on the risk of an extensive cerebral infarction, from 30 to 39.

What causes bradyarrhythmia?

Sinus bradyarrhythmia is divided into two types: moderate and severe, depending on the main indicators of the pulse. In the first case, the heart rate does not fall below 50 beats, in the second - below 40. Often, moderate bradyarrhythmia can also occur in people who regularly play sports and be a normal physiological phenomenon due to the adaptation of the cardiovascular system to constant stress.

Despite the fact that during a standard medical examination, a person suffering from a low heart rate looks quite normal, there is still a direct threat to his health. What is sinus bradyarrhythmia? First of all, this is hypoxia of all internal organs and vital systems, including the brain. The main danger lies in the fact that the heart does not cope with its task and a sharply reduced pulse can lead to clinical death, for example, in a dream.

The sinus node is responsible for the frequency of contractions and rhythm, its damage of a degenerative and inflammatory nature leads to depression of cardiac activity. The appearance of sinus bradyarrhythmia in children is due to increased tone of the vagus nerve due to pathological changes in the myocardium. In addition, factors provoking the onset of the disease in infants and adolescents can be:

• hypothermia (usually in infants and children under three years of age);
• intracranial hypertension;
• transferred viral and infectious diseases with complications;
• genetic predisposition;
• hormonal disorders (usually in adolescents);
• angina, pneumonia.

Medications that affect heart rate can disrupt the automation of sinus rhythm. In adults, the causes of bradyarrhythmia can be:

• severe atherosclerosis;
• previous myocardial infarction or stroke;
• inflammatory changes in the tissues of the heart;
• obesity of the second and third degree;
• sedentary lifestyle;
• vascular thrombosis;
• cardiosclerosis (most common in older people);
• cardiac ischemia;
• hypothyroidism;
• infectious and viral diseases.

In addition to the above reasons, arrhythmia is often found in various pathologies of the thyroid gland, vegetovascular dystonia and diseases of the gastrointestinal tract.

Diagnostics

During a medical examination, the type of bradyarrhythmia can be established, which can be physiological and organic. Sinus bradycardia belongs to the class of this pathology, therefore, this diagnosis often appears in the conclusions of a medical examination. At the same time, a reduced level of heart rate is observed, but sinus rhythm is maintained. Bradycardia is most often found in athletes.

If a child or adult has the characteristic symptoms of bradyarrhythmia, and the measurement of the pulse rate gave below normal values, you should immediately seek medical help. In case of a critical drop in heart rate, it is necessary to call an ambulance. In stationary conditions, an electrocardiogram will be performed. If it shows a clear violation of the heart rhythm and prolonged intervals between ventricular contractions, the patient is hospitalized. Then he will have to undergo ultrasound diagnostics of the heart, repeated ECG and daily monitoring of blood pressure jumps. After identifying the type of bradyarrhythmia, treatment will be prescribed appropriate to the diagnosis.

Symptoms of the disease

Sometimes people with a moderate form of bradyarrhythmia can live their whole lives without noticing its presence, since it manifests itself only in the form of a slightly lowered heart rate. A pronounced degree of pathology is accompanied by the following conditions:

• prostration;
• dizziness;
• darkening in the eyes
• distraction;
• loss of coordination;
• decreased visual acuity;
• cold sweat;
• BP jumps.

With a sharp decrease in heart rate, blood pressure can drop to a critical level, which will cause arrhythmic shock. In some cases, there is an abrupt cessation of blood circulation, which leads to involuntary emptying of the bladder and intestines.

Sinus bradyarrhythmia in a child is most often detected by chance, since it rarely has a pronounced clinical picture. But in severe cases, there may be:

• sudden loss of consciousness;
• blurred vision;
• chest pain;
• chronic fatigue, lethargy;
• lack of appetite.

If during inhalation the heart rate increases, and on exhalation the heart rate slows down sharply, this indicates the presence of respiratory bradyarrhythmia. If you hold your breath, its signs should disappear. If this does not happen, then this is not a respiratory sinus bradyarrhythmia.

Is it possible to play sports and serve in the army with bradyarrhythmia?

Sinus bradyarrhythmia has its own ICD code (International Classification of Diseases) - R00.1 and refers to pathologies that are divided into physiological and organic. If the disease does not have pronounced symptoms and is the norm for a particular person (with good physical fitness), then he will be drafted into the army. If during the medical examination it was proved that bradyarrhythmia is organic (is the result of serious disorders in the body), then the conscript is released from military duty.

With this disease, classes that involve moderate cardio loads (for example, running) are not forbidden, but strength training should be abandoned.

Treatment

Sinus bradyarrhythmia in adolescents in most cases does not require treatment, as it does not have pronounced symptoms and is a consequence of hormonal imbalance, characteristic of adolescence. In other cases, with moderate bradyarrhythmia, general strengthening drugs are prescribed in the form of tinctures and vitamin complexes.

With a pronounced form of the disease, a person is hospitalized and prescribed drugs that accelerate the conduction of the heart (for example, Nifedipine). "Prednisolone", "Eufillin", the hormone dopamine, atropine and adrenaline are administered intravenously.

If the heart rate is below 20, then urgent resuscitation measures are required. With constant fainting, a pacemaker is installed by doctors through a simple surgical operation. But it is used only in critical situations, when no other drugs can stop bradyarrhythmia attacks.

Forecast

If organic bradyarrhythmia is not treated, then clinical death may occur due to sudden cardiac arrest. Also, this disease provokes the development of thromboembolism, which in turn leads to heart attack and stroke.

With physiological bradyarrhythmia (for example, in athletes or in adolescence in children), the pathology has a favorable prognosis, since in most cases it does not have any effect on the cardiovascular and other body systems.

Intracranial hypertension: ICD code 10

The name of the disease consists of two Greek words "over" and "tension". It is characterized by an increase in intracranial pressure.

The human brain controls all the functions of the body and needs reliable protection, which is provided from the outside by the cranium, and from the inside by cerebral fluid, called cerebrospinal fluid. It consists of 90% water, 10% protein inclusions and cellular substance in equal proportions. Its composition and consistency are similar to blood plasma. Liquor washes the brain and serves as a shock absorber that protects against bruises, concussions and other mechanical damage.

Description

Since the skull is a limited space in which the brain and the fluid surrounding it are located, a certain pressure is created in it. Normally, it in newborns is from 1.5 to 6 mm of the water column. For children under the age of 2 years - 3-7 mm. In adults, it is kept in the range from 3 to 15 mm.

Intracranial hypertension ICD code 10 is a disease that is diagnosed when the pressure level rises to 200 mm of water column.

It can increase with hyperproduction of cerebrospinal fluid, poor absorption of cerebral fluid, for reasons that prevent normal outflow, the presence of tumors and edema.

All-Russian classifiers

The international classifier in Russia was introduced in 1999, its revision is planned for 2017.

According to the current ICD, benign intracranial hypertension is defined as a complex of polyetiological symptoms, which is caused by an increase in ICP in the absence of pathological neoplasms and signs of hydrocephalus.

Classifiers international

According to ICD 10, the disease received the following classification codes:

• G2 benign intracranial hypertension.
• G2 ICH after ventricular bypass.
• G 6 - cerebral edema.

Symptoms and signs

For the timely initiation of therapy for intracranial hypertension, it is important to recognize the disease. To do this, you need to understand how it flows, what it is characterized by, what to look for.

Symptoms vary between children and adults.

The difficulty in determining the signs of the disease in infants is that the child cannot express his complaints. In such a situation, parents should carefully monitor the behavior of the baby. If the baby has the following signs, then we are talking about intracranial hypertension.

• Frequent vomiting not related to eating.
• Intermittent sleep.
• Anxiety, crying and screaming for no apparent reason.
• Swollen fontanelles without pulsation.
• Muscular hypertonicity.
• An increase in the size of the head, protrusion of the forehead.
• Divergence of the cranial sutures.
• Syndrome, the so-called setting sun.
• Visualization of veins on the head.
• Delay in development from age norms.

In children from 1 to 2 years old, the process of overgrowth of fontanelles stops, which leads to more pronounced symptoms. Gushing vomiting, fainting, convulsions are observed.

At the age of over 2 years, the child may complain of a headache, they feel pressure in the eye area from the inside of the skull. The patient has impaired tactile sensations, odor perception, reduced vision, impaired motor function.

In addition, intracranial hypertension is accompanied by endocrine disorders, obesity, and diabetes mellitus.

In adult patients, intracranial hypertension is characterized by the presence of the following symptoms:

• Attacks of severe headache, which is worse in the evening hours.
• Nausea.
• Irritability.
• Fatigue on light exertion.
• Dizziness and faintness.
• Dark circles under the eyes.
• Increased sweating so-called hot flashes.
• The pupils do not react to light.

This condition needs to be treated.

Diagnostics

Before prescribing therapy, it is necessary to conduct a thorough examination of the patient and establish the causes of intracranial hypertension, since in some cases effective therapy is not possible without eliminating the underlying causes.

Diagnosis of ICH is carried out using modern methods of hardware research, these are encephalography, neurosonography, Doppler, CT and MRI. In addition, consultations are held with a neurologist and an ophthalmologist.

Treatment

Therapy is carried out in several ways:

• Medication, which consists in the appointment of diuretics to remove fluid from the body. The use of sedatives, painkillers, neuroleptic and nootropic drugs, vitamins.
• The surgical method allows you to divert the cerebrospinal fluid or free up paths for its withdrawal.
• Non-drug therapy involves adherence to a salt-free diet and drinking regimen. A complex of exercise therapy, acupuncture, massage is prescribed.

In addition, symptomatic therapy is carried out to reduce pain and associated symptoms.

Preparations

In the treatment of ICH, the following medicines are used: levulose, caffetamin, sorbilact, mannitol.

G93.2 Benign intracranial hypertension

ICD-10 diagnosis tree

• g00-g99 class vi diseases of the nervous system
• g90-g99 Other disorders of the nervous system
• g93 other brain lesions
• G93.2 Benign intracranial hypertension(Selected ICD-10 diagnosis)
• g93.1 anoxic brain injury, not elsewhere classified
• g93.3 Fatigue syndrome after a viral illness
• g93.4 Encephalopathy, unspecified
• g93.6 cerebral edema
• g93.8 other specified lesions of brain
• g93.9 brain injury, unspecified

Diseases and syndromes related to ICD diagnosis

Titles

Description

Symptoms

Objective signs of intracranial hypertension are edema of the nipples of the optic nerves, increased pressure of the cerebrospinal fluid, typical x-ray changes in the bones of the skull. It should be borne in mind that these signs do not appear immediately, but after a long time (except for an increase in the pressure of the cerebrospinal fluid).

With a significant increase in intracranial pressure, a disorder of consciousness, convulsive seizures, and visceral-vegetative changes are possible. With dislocation and wedging of the brain stem structures, bradycardia, respiratory failure occur, the reaction of the pupils to light decreases or disappears, and systemic arterial pressure rises.

Causes

With cerebral edema, an increase in the volume of brain tissue occurs and, accordingly, intracranial hypertension develops. Obstruction of the cerebrospinal fluid pathways causes a violation of the outflow of cerebrospinal fluid from the cranial cavity, its accumulation (obstructive hydrocephalus) and, accordingly, intracranial hypertension. Intracranial hemorrhage with hematoma formation also leads to increased intracranial pressure.

With an increase in intracranial pressure in one of the areas of the skull, a distension area appears, which leads to a displacement of the brain structures relative to each other - dislocation syndromes develop. This pathology is life-threatening and can lead to the death of the patient.

The most common dislocation syndromes are:

* displacement of the cerebral hemispheres under the falciform process,.

* displacement of the cerebellar tonsils in the foramen magnum.

With an increase in the pressure of the liquor to 400 mm of water. (about 30 mm) possible arrest of cerebral circulation and the cessation of the bioelectric activity of the brain.

Benign intracranial hypertension in children

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)

Version: Clinical protocols of the Ministry of Health of the Republic of Kazakhstan

general information

Short description

Expert Commission on Health Development

Benign intracranial hypertension is a polyetiological symptom complex caused by an increase in intracranial pressure in the absence of signs of mass formation or hydrocephalus.

Protocol name: Benign intracranial hypertension in children

Abbreviations used in the protocol:

Date of protocol development: 2014.

Users of the protocol: pediatric neuropathologist, pediatrician and general practitioner, emergency and emergency physicians.

Classification

Classification by etiological factors