Syndrome of intracranial hypertension μb 10. 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 - 2013

Hypertensive heart disease without (congestive) heart failure (I11.9)

general information

Short description

Protocol approved
Expert Commission on Health Development
June 28, 2013

Arterial hypertension- chronic stable increase in blood pressure, in which the level of systolic blood pressure is equal to or greater than 140 mm Hg and (or) the level of diastolic blood pressure is equal to or greater than 90 mm Hg, in people who are not receiving antihypertensive drugs . [Recommendations of the World Health Organization and the International Society of Hypertension 1999]. Resistant arterial hypertension - exceeding the target level of blood pressure, despite treatment with three antihypertensive drugs, one of which is a diuretic.

I. INTRODUCTION

Name: arterial hypertension
Protocol code: I10

ICD codes - 10:
I 10 Essential (primary) hypertension;
I 11 Hypertensive heart disease (hypertension with a primary lesion of the heart);
I 12 Hypertensive (hypertonic) disease with a primary lesion of the kidneys;
I 13 Hypertensive (hypertonic) disease with a primary lesion of the heart and stoves.

Abbreviations used in the protocol:
AGP - antihypertensive drugs
AGT - antihypertensive therapy
BP - blood pressure
AK - calcium antagonists
ACS - associated clinical conditions
ALT - alanine aminotransferase
ASA - acetylsalicylic acid
ACT - aspartate aminotransferase
β-AB - β-blockers
ARBs - angiotensin 1 receptor blockers
GC - hypertensive crisis
LVH - left ventricular hypertrophy
DBP - diastolic blood pressure
DLP - dyslipidemia
ACE inhibitors - angiotensin-converting enzyme inhibitors
IHD - ischemic heart disease
MI - myocardial infarction
BMI - body mass index
ISAH - isolated systolic arterial hypertension
CT - computed tomography
LV - left ventricle
HDL - high density lipoproteins
LDL - low density lipoproteins
MAU - microalbuminuria
MDRD - Modification of Diet in Renal Disease
ICD - 10 - international classification of diseases ICD - 10
MRA - magnetic resonance angiography
MRI - magnetic resonance imaging
MS - metabolic syndrome
IGT - Impaired Glucose Tolerance
coolant - obesity
ACS - acute coronary syndrome
ONMK - acute cerebrovascular accident
OPSS - total peripheral vascular resistance
OT - waist size
THC - total cholesterol
POM - target organ damage
PHC - primary health care
SBP - systolic blood pressure
SCAD - Spontaneous Coronary Artery Dissection
DM - diabetes mellitus
GFR - glomerular filtration rate
ABPM - ambulatory blood pressure monitoring
CVD - cardiovascular diseases
SSO - cardiovascular complications
CCC - cardiovascular system
TG - triglycerides
TIA - transient ischemic attack
Ultrasound - ultrasonography
RF - risk factor
COPD - chronic obstructive pulmonary disease
CHS - cholesterol
CHF - chronic heart failure
HR - heart rate
ECG - electrocardiography
EchoCG - echocardiography

Protocol development date: 2013
Patient category: patients with essential and symptomatic arterial hypertension.
Protocol Users: general practitioners, therapists, cardiologists.

Classification

Clinical classification

Table 1 - Classification of blood pressure levels (mm Hg)

Note: * ISAH should be classified into 1, 2, 3 degrees according to the level of SBP.

Table 2 - Criteria for risk stratification (factors affecting the prognosis)

* - the maximum risk in concentric LVH: an increase in the mass index of the left ventricular myocardium and the ratio of wall thickness and radius> 0.42,
** - Cockcroft-Gault formula

DM in terms of the risk of developing CVC is currently equated with coronary artery disease and, therefore, is similar in significance to ACS.
Associates ( related) clinical conditions
- cerebrovascular disease: Ischemic stroke, hemorrhagic stroke, transient stroke;
- heart disease: Myocardial infarction, angina pectoris, coronary revascularization, CHF;
- kidney disease: diabetic nephropathy; Renal failure (serum creatinine >133 µmol/l (>1.5 mg/dl) for men or >124 µmol/l (>1.4 mg/dl) for women; Proteinuria (>300 mg/day);
- peripheral arterial disease: Dissecting aortic aneurysm, damage to peripheral arteries;
- hypertensive retinopathy: Hemorrhages or exudates, swelling of the nipple of the optic nerve;
- diabetes.
Depending on the degree of increase in blood pressure, the presence of risk factors, POM and ACS, all patients with hypertension can be assigned to one of 4 risk levels: low, medium, high, and very high (Table 3).
Table 3 - Stratification of patients with hypertension according to the risk of developing cardiovascular complications

The term "additional risk" is used to emphasize that the risk of CV events and death from them in people with hypertension is always higher than in the general population. Based on the risk stratification, the groups of high and very high risk according to the European guidelines for hypertension (2007) include persons who have changes, are presented in Table 3.
It should be noted that the presence of multiple risk factors, POM, DM and ACS clearly indicates a very high risk (Table 4).

Table 4 - Patients at very high risk

The prognosis of patients with hypertension and the choice of treatment tactics depend on the level of blood pressure and the presence of concomitant risk factors, involvement of target organs in the pathological process, and the presence of associated diseases.
At-risk groups
- Low risk (risk 1)- 1st degree hypertension, no risk factors, target organ damage and associated diseases. The risk of developing CVD and complications in the next 10 years is 15%.
- Medium risk (risk 2)- AH grade 2-3, no risk factors, target organ damage and associated diseases. 1-3 art. Hypertension, there are 1 or more risk factors, no target organ damage (TOD) and associated diseases. The risk of developing cardiovascular complications in the next 10 years is 15-20%.
- High risk (risk 3) - AH 1-3 degree, there is damage to target organs and other risk factors, no associated diseases. The risk of developing cardiovascular complications in the next 10 years is more than 20%.
- Very high risk (risk 4)- AH 1-3 degree, there are risk factors, POM, associated diseases. The risk of developing cardiovascular complications in the next 10 years exceeds 30%.

Diagnostics

II. METHODS, APPROACHES AND PROCEDURES FOR DIAGNOSIS AND TREATMENT

Diagnostic criteria:
1. Relationship between an increase in blood pressure and chronic neuropsychological trauma, occupational hazards.
2. Hereditary predisposition (40-60%).
3. More often benign course.
4. Significant fluctuations in blood pressure, especially systolic during the day. The crisis nature of the flow.
5. Clinical signs of increased sympathicotonia, a tendency to tachycardia, sweating, anxiety.
6. Clinical, ECG and radiological signs of AH syndrome.
7. Salus-Gunn syndrome of 1-3 degrees in the fundus.
8. Moderate decrease in the concentration function of the kidneys (isohyposthenuria, proteinuria).
9. The presence of complications of hypertension (IHD, CHF, cerebrovascular accident).

Complaints and anamnesis:
1. The duration of the existence of hypertension, the level of increase in blood pressure, the presence of GC;

- family history of kidney disease (polycystic kidney disease);
- a history of kidney disease, bladder infections, hematuria, abuse of analgesics (parenchymal kidney disease);
- the use of various drugs or substances: oral contraceptives, nasal drops, steroidal and non-steroidal anti-inflammatory drugs, cocaine, erythropoietin, cyclosporins;
- episodes of paroxysmal sweating, headaches, anxiety, palpitations (pheochromocytoma);
- muscle weakness, paresthesia, convulsions (aldosteronism)
3. Risk factors:
- hereditary burden for hypertension, CVD, DLP, DM;
- the presence in the anamnesis of the patient of CVD, DLP, DM;
- smoking;
- irrational nutrition;
- obesity;
- low physical activity;
- snoring and indications of respiratory arrest during sleep (information from the words of the patient's relatives);
- personal characteristics of the patient
4. Data indicating POM and AKC:
- brain and eyes - headache, dizziness, impaired vision, speech, TIA, sensory and motor disorders;
- heart - palpitations, chest pain, shortness of breath, swelling;
- kidneys - thirst, polyuria, nocturia, hematuria, edema;
- peripheral arteries - cold extremities, intermittent claudication
5. Previous antihypertensive therapy: used antihypertensive drugs, their efficacy and tolerability.
6. Evaluation of the possibility of influence on AH environmental factors, marital status, work environment.

Fphysical examination.
Physical examination of a patient with hypertension is aimed at determining RF, signs of a secondary nature of hypertension and organ damage. Height and weight are measured with the calculation of the body mass index (BMI) in kg / m 2, and waist circumference (FROM). Physical examination data indicating the secondary nature of hypertension and organ damage are presented in the table.
Table 5 - Fiscal survey data indicating the secondary nature of hypertension and organ pathology

Llaboratory research.
Mandatory studies that should be carried out before starting treatment in order to identify target organ damage and risk factors:
- general analysis of blood and urine;
- biochemical blood test (potassium, sodium, glucose, creatinine, uric acid, lipid spectrum).

Instrumental research.
- ECG in 12 leads
- Echocardiography to assess left ventricular hypertrophy, systolic and diastolic functions
- chest x-ray
- eye examination
- ultrasound examination of the arteries
- Ultrasound of the kidneys.

Pproviding expert advice.
Neurologist:
1. Acute disorders of cerebral circulation
- stroke (ischemic, hemorrhagic);
- transient disorders of cerebral circulation.
2. Chronic forms of vascular pathology of the brain
- initial manifestations of insufficiency of blood supply to the brain;
- encephalopathy;
Optometrist:
- hypertensive angioretinopathy;
- hemorrhages in the retina;
- swelling of the nipple of the optic nerve;
- retinal disinsertion;
- progressive loss of vision.
Nephrologist:
- exclusion of symptomatic hypertension;
- daily monitoring of blood pressure.

List of basic and additional diagnostic measures

Main researches:
1. general analysis of blood and urine;
2. the content of glucose in the blood plasma (on an empty stomach);
3. serum levels of total cholesterol, HDL cholesterol, TG, creatinine;
4. determination of creatinine clearance (according to the Cockcroft-Gault formula) or GFR (according to the MDRD formula);
5. ECG;

Additional research:
1. serum levels of uric acid, potassium;
2. determination of total protein and fractions
3. echocardiography;
4. definition of MAU;
5. study of the fundus;
6. Ultrasound of the kidneys and adrenal glands;
7. Ultrasound of brachiocephalic and renal arteries
8. chest x-ray;
9. ABPM and self-monitoring of blood pressure;
10. determination of the ankle-brachial index;
11. determination of the speed of the pulse wave (an indicator of the stiffness of the main arteries);
12. oral glucose tolerance test - when the level of glucose in blood plasma is >5.6 mmol/l (100 mg/dl);
13. quantification of proteinuria (if test strips are positive);
14. Nechiporenko test
15. Rehberg's test
16. Zimnitsky test In-depth study:
17. complicated arterial hypertension - assessment of the state of the brain, myocardium, kidneys, main arteries;
18. detection of secondary forms of hypertension - a study in the blood of the concentration of aldosterone, corticosteroids, renin activity;
19. determination of catecholamines and their metabolites in daily urine and/or blood plasma; abdominal aortography;
20. CT or MRI of the adrenal glands, kidneys and brain, CT or MRA.

Table 7 - Diagnostic studies

Differential Diagnosis

Table 6 - Differential diagnosis

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Treatment

Treatment goals:
The main goal of the treatment of patients with hypertension is to minimize the risk of developing CVD and death from them. To achieve this goal, it is required not only to reduce blood pressure to the target level, but also to correct all modifiable risk factors (smoking, DLP, hyperglycemia, obesity), prevent, slow down the rate of progression and / or reduce POM, as well as treat associated and concomitant diseases - IHD, SD, etc.
In the treatment of patients with hypertension, the value of blood pressure should be less than 140/90 mm Hg, which is its target level. With good tolerability of the prescribed therapy, it is advisable to reduce blood pressure to lower values. In patients with high and very high risk of CVD, it is necessary to reduce blood pressure.< 140/90 мм.рт.ст. в течение 4 недель. В дальнейшем, при условии хорошей переносимости рекомендуется снижение АД до 130/80 мм.рт.ст. и менее.

Treatment tactics

Non-drug treatment (regime, diet, etc.):
- reduced consumption of alcoholic beverages< 30 г алкоголя в сутки для мужчин и 20 г/сут. для женщин;
- increase in physical activity - regular aerobic (dynamic) physical activity for 30-40 minutes at least 4 times a week;
- reduction of salt intake to 5 g/day;
- a change in diet with an increase in the consumption of plant foods, an increase in the diet of potassium, calcium (found in vegetables, fruits, grains) and magnesium (found in dairy products), as well as a decrease in the consumption of animal fats;
- to give up smoking;
- normalization of body weight (BMI<25 кг/м 2).

Medical treatment

Recommendations for procedures or treatments:
Class I- Reliable evidence and/or consensus among experts that the procedure or treatment is appropriate, useful and effective.
Class II- Conflicting evidence and/or disagreement between experts on the benefit/effectiveness of a procedure or treatment.
Class IIa- prevailing evidence/opinion in support of benefit/effectiveness.
Class IIb - benefit/effectiveness not well supported by evidence/expert opinion.
Class III- Reliable evidence and/or unanimity of expert opinion that the given procedure or type of treatment is not useful/effective, and in some cases may be harmful.
Evidence level A. Data from multiple randomized clinical trials or meta-analysis.
Level of evidence B. Data from a single randomized trial or non-randomized trials.
Level of evidence C. Only expert consensus, case studies or standard of care.

Clinical tactics:
Currently, five main classes of antihypertensive drugs (AHP) are recommended for the treatment of hypertension: angiotensin-converting enzyme inhibitors (ACEIs), AT1 receptor blockers (ARBs), calcium antagonists (ACs), diuretics, and β-blockers (β-blockers). α-ABs and imidazoline receptor agonists can be used as additional classes of antihistamines for combination therapy.

Table 8 - Primary indications for the appointment of various groups of antihypertensive drugs

Table 9 - Absolute and relative contraindications to the appointment of various groups of antihistamines

Table 11 - List of essential medicines

Table 12 - Additional diagnostic studies carried out at this stage in hypertensive crisis

Table 13 - Drugs recommended for the relief of hypertensive crises

Surgical intervention.
Catheter ablation of the sympathetic plexus of the renal artery, or renal denervation.
Indications: resistant arterial hypertension.
Contraindications:
- renal arteries less than 4 mm in diameter and less than 20 mm in length;
- manipulations on the renal arteries (angioplasty, stenting) in history;
- stenosis of the renal arteries more than 50%, renal failure (GFR less than 45 ml / min / 1.75 m 2);
- vascular events (MI, episode of unstable angina, transient ischemic attack, stroke) less than 6 months. before the procedure;
- any secondary form of hypertension.

Preventive measures (prevention of complications, primary prevention for PHC level, indicating risk factors).
- Animal fat-restricted diet rich in potassium
- Reducing the intake of table salt (NaCI) to 4.5 g / day.
- Reducing excess body weight
- Smoking cessation and limiting alcohol consumption
- Regular dynamic physical activity
- Psychorelaxation
- Compliance with the regime of work and rest

Further management (ex: postoperative, rehabilitation, follow-up of the patient at the outpatient level in case of developing a protocol for the hospital)
Achievement and maintenance of target blood pressure levels require long-term medical supervision with regular monitoring of the patient's compliance with recommendations for changing the OB and adherence to the regimen of prescribed antihistamines, as well as correction of therapy depending on the effectiveness, safety and tolerability of treatment. In case of dynamic observation, the establishment of personal contact between the doctor and the patient, the education of patients in schools for patients with hypertension, which increases the patient's adherence to treatment, are of decisive importance.
- When prescribing AHT, scheduled patient visits to the doctor to assess the tolerability, efficacy and safety of treatment, as well as to monitor the implementation of the received recommendations, are carried out at intervals of 3-4 weeks until the target level of blood pressure is reached.
- If AHT is not effective enough, a previously prescribed drug can be replaced or another AGP added to it.
- In the absence of an effective decrease in blood pressure against the background of 2-component therapy, it is possible to add a third drug (one of the three drugs, as a rule, should be a diuretic) with mandatory subsequent monitoring of the effectiveness, safety and tolerability of combination therapy.
- After target BP is achieved with ongoing therapy, follow-up visits are scheduled at 6-month intervals for patients at intermediate and low risk who regularly measure BP at home. For patients at high and very high risk, for patients receiving only non-pharmacological treatment, and for those with low adherence to treatment, the intervals between visits should not exceed 3 months.
- At all planned visits, it is necessary to monitor the implementation of treatment recommendations by patients. Since the state of the target organs changes slowly, it is not advisable to conduct a follow-up examination of the patient to clarify their condition more than once a year.
- With "resistant" hypertension (BP> 140/90 mmHg during treatment with three drugs, one of which is a diuretic, in submaximal or maximum doses), you should make sure that there are no subjective causes of resistance ("pseudo-resistance") to therapy . In the case of true refractoriness, the patient should be sent for additional examination.
- Treatment of a patient with hypertension is carried out continuously or, in fact, in most patients for life, since its cancellation is accompanied by an increase in blood pressure. With stable normalization of blood pressure for 1 year and compliance with measures to change the OB in patients with low and moderate risk, a gradual reduction in the number and / or doses of antihistamines taken is possible. Reducing the dose and/or reducing the number of medications used necessitates an increase in the frequency of visits to the doctor and home CAD to ensure that there are no recurrent increases in blood pressure.

Indicators of treatment efficacy and safety of diagnostic and treatment methods described in the protocol.

Table 14 - Indicators of treatment efficacy and safety of diagnostic and treatment methods described in the protocol

Hospitalization

Indications for hospitalization indicating the type of hospitalization

Indications for planned hospitalization:
Indications for hospitalization of patients with hypertension are:
- ambiguity of the diagnosis and the need for special, often invasive, research methods to clarify the form of hypertension;
- difficulties in the selection of drug therapy - frequent GC, refractory hypertension.

Indications for emergency hospitalization:
- GC not stopped at the prehospital stage;
- GC with severe manifestations of hypertensive encephalopathy;
- complications of hypertension requiring intensive care and constant medical supervision: ACS, pulmonary edema, MI, subarachnoid hemorrhage, acute visual impairment, etc.;
- malignant hypertension.

Information

Sources and literature

1. Minutes of the meetings of the Expert Commission on Health Development of the Ministry of Health of the Republic of Kazakhstan, 2013
   1. 1. ESH-EIiC Guidelines Committee. 2007 guidelines for the management of arterial hypertension. J Hyperlension 2007. 2. ESH-EIiC Guidelines Committee. 2009 guidelines for the management of arterial hypertension. J Hypertension 2009. 3. Diseases of the heart and blood vessels. Guidelines of the European Society of Cardiology. Kemm A.D., Lusher T.F., Serruis P.V. Author of the translation: Shlyakhto E.V. 4. Recommendations of the World Health Organization and the International Society for Hypertension 1999. 5. Danilov N.M., Matchin Yu.G., Chazova I.E. Endovascular radiofrequency denervation of the renal arteries is an innovative method for the treatment of refractory arterial hypertension. First experience in Russia // Angiol. and a vessel. Surgery. -2012.No.18(1). -C. 51-56. 6. Cardiovascular prevention. National recommendations. Moscow 2011 1. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converling-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000; 3;4iL(3): 145--53. 8. The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease In.restigators. On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular evrnts among patients with stable coronirry artery disease: randomised, double-blind, placebo-controlled, multicentre trial (1he IIUROPA study). Lancet 2003; 362:782-8. 9. PROGRESS Collaborative Study Group. Randomisd trial of pelindopril based blood pressurr:-lowering regimen among 6108 individuals with previous stroke or transient ischaenric attack. l-ancet 200t: 358: 1033-41. 10. Lithell H, Hansson L, Skoog I, et al, SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE). Principal results of a randomized double-blind intervention trial. J Hypertens 2003; 21:875-86. 11. Schmieder R.E., Redon J., Grassi G. et al. ESH Posrition Paper: renal denervation - an interventional therapy of resistant hypertension // J. Hypertens. 2012. Vol. 30(5). 12. Krum H., Schlaich M., Whitbourn R. et al. Catheter-based renal svmpathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study // Lancet. 2009 Vol. 373. P. 1275-1281.

Information

III. ORGANIZATIONAL ASPECTS OF PROTOCOL IMPLEMENTATION

List of protocol developers with qualification data

4. Ibakova Zh.O. - Candidate of Medical Sciences, Department of Cardiology, Research Institute of Cardiology and Internal Diseases.

Reviewers: Chief freelance cardiologist of the Ministry of Health of the Republic of Kazakhstan, MD Abseitova S.R.

External review results:

Results of preliminary testing:

Indication of the conditions for revising the protocol: Revision” of the protocol is carried out at least once every 5 years, or upon receipt of new data on the diagnosis and treatment of the corresponding disease, condition or syndrome.
Indication of no conflict of interest: missing.

Evaluation criteria for monitoring and auditing the effectiveness of the implementation of the protocol (a clear listing of criteria and the presence of a link with indicators of the effectiveness of treatment and / or the creation of indicators specific to this protocol)

Attached files

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International Classification of Diseases (ICD-10)

Diseases characterized by high blood pressure Code I 10- I 15

Essential (primary) hypertension I 10

Hypertensive heart disease (hypertensive heart disease) I 11

With (congestive) heart failure I 11.0

Without (congestive) heart failure I 11.9

Hypertensive (hypertonic) disease with a primary lesion of the kidneys I 12

With renal failure I 12.0

Without renal failure I 12.9

Hypertensive (hypertonic) disease with a primary lesion of the heart and kidneys I 13

With (congestive) heart failure I 13.0

predominantly affecting the kidneys and renal

deficiency I 13.1

with (congestive) heart failure and

renal failure I 13.2

Unspecified I 13.9

Secondary hypertension I 15

Renovascular hypertension I 15.0

Hypertension secondary to other renal lesions I 15.1

Hypertension secondary to endocrine disorders I 15.2

Other secondary hypertension I 15.8

Secondary hypertension, unspecified I 15.9

Home -> Types of VVD -> Vegetovascular dystonia code according to ICD-10

The fact is that in the International Classification of Diseases (ICD 10) there are no such diseases as vegetative-vascular dystonia and neurocirculatory dystonia. Official medicine still refuses to recognize VVD as a separate disease.

Therefore, VSD is often determined as part of another disease, the symptoms of which are manifested in the patient and which is indicated in the ICD-10.

For example, when IRR for hypertensive type can make a diagnosis Arterial hypertension (hypertension). Accordingly, the ICD-10 code will be I10(primary hypertension) or I15(secondary hypertension).

Very often, VVD can be defined as a symptom complex characteristic of somatoform dysfunction of the autonomic nervous system. In this case, the ICD-10 code will be F45.3. Here the diagnosis should be made by a psychiatrist or neuropsychiatrist.

It is also often defined as "Other symptoms and signs related to the emotional state" (the code R45.8). In this case, consultation with a psychiatrist is not required.

Arterial hypertension is one of the main symptoms that allows you to objectively quantify the degree of increase in blood pressure (BP). This is the first preliminary diagnosis in the examination algorithm, which the doctor has the right to make when a patient has blood pressure above the normal level. Further, any hypertension requires the implementation of the necessary complex of additional examinations to determine the cause, identify the affected organ, the stage and type of the course of the disease.

There is no difference between the terms "hypertension" and "hypertension". It is a historically established fact that in the USSR, hypertension was called what in Western countries was called hypertension.

According to the International Classification of Diseases (ICD-10), arterial hypertension refers to diseases accompanied by an increase in blood pressure, classes from I10 to I15.

The frequency of detection depends on the age group: on a medical examination of children under 10 years of age, hypertension is detected in two% of cases, in adolescents over 12 years old - up to 19%, over the age of 60 years, 65% of the population suffers from arterial hypertension.

Long-term observation of children and adolescents showed the development of hypertension in the future in every third of this group. Especially dangerous is the age of puberty for boys and girls.

What is considered hypertension?

To distinguish the norm from the pathology, the numerical values ​​​​of the International Society of Hypertension were taken as the basis. Allocate taking into account the measurement of upper and lower pressure in mmHg:

• optimal blood pressure - below 120/80;
• normal blood pressure - below 135/85;
• normal threshold to increase blood pressure - 139/89.

Degrees of arterial hypertension:

• 1 degree - 140-159 / 90-99;
• 2nd degree - 160-179/100-109;
• 3 degree - above 180/110.

Separately, systolic hypertension was determined when the upper pressure is above 140, and the lower is less than 90.

These numbers must be remembered.

Types of classifications

The ICD-10 distinguishes between different types and subtypes of arterial hypertension: primary (essential) hypertension and secondary (develops against the background of another disease, for example, traumatic brain injury), hypertensive disease with damage to the heart and kidneys. Subspecies of hypertension are associated with the presence or absence of cardiac and renal failure.

• without symptoms of damage to internal organs;
• with objective signs of damage to target organs (in blood tests, during instrumental examination);
• with signs of damage and the presence of clinical manifestations (myocardial infarction, transient cerebrovascular accident, retinopathy of the retina).

Depending on the clinical course of the disease (assessed resistance to blood pressure, numerical values, the presence of left ventricular hypertrophy, changes in the fundus), it is customary to distinguish the following types of hypertension:

• transient - a single increase in blood pressure was noted during a stressful situation, there were no changes in the internal organs, the vessels in the fundus were without pathology, the pressure returned to normal without treatment;
• labile - more stable, does not decrease on its own, medications are required, narrowed arterioles are determined in the fundus, left ventricular hypertrophy when examining the heart;
• stable - high persistent numbers of blood pressure, severe hypertrophy of the heart and changes in the arteries and veins of the retina;
• malignant - begins suddenly, develops quickly to a high level of blood pressure, which is difficult to treat (an increase in diastolic pressure to 130-140 is especially characteristic), sometimes manifested by complications: myocardial infarction, stroke, angiopathy of retinal vessels.

In its development, hypertension goes through three stages:

• in stage 1 there is no damage to target organs (heart, brain, kidneys);
• in the 2nd - one or all organs are affected;
• in the 3rd - clinical complications of hypertension appear.

Why does hypertension develop?

In Russia, doctors continue to use the division of hypertension (hypertension) into essential hypertension and symptomatic hypertension resulting from various diseases of the internal organs.

Pathological conditions, for which arterial hypertension syndrome is one of the leading clinical factors, account for about 10% of hypertension. Currently, more than 50 diseases are known that are accompanied by an increase in blood pressure. But in 90% of cases, true hypertension is confirmed.

Consider the causes of arterial hypertension and the distinctive symptoms in various diseases.

Children also have their blood pressure measured.

Neurogenic hypertension - develops with damage to the brain and spinal cord as a result of a breakdown in the function of control over vascular tone. It manifests itself in traumas, tumors, ischemia of cerebral vessels. Symptoms are characteristic: headaches, dizziness, convulsions, salivation, sweating. The doctor detects nystagmus of the eyes (twitching of the eyeballs), a bright skin reaction to irritation.

Nephrogenic (renal) hypertension can be of two types.

• Renal parenchymal - is formed in inflammatory diseases of the renal tissue (chronic pyelonephritis, glomerulonephritis, polycystic, kidney tuberculosis, nephrolithiasis, traumatic injury). Hypertension does not appear in the initial stage, but when chronic renal failure is formed. Characterized by the young age of patients, malignant course, the absence of damage to the brain and heart.
• Vasorenal - depends on damage in the vessels of the kidneys. In 75% of cases, it is formed due to atherosclerotic changes, leading to narrowing of the renal artery and malnutrition of the kidneys. A faster option is possible due to thrombosis or renal artery embolism. The clinic is dominated by back pain. No response to conservative therapy. Urgent surgical treatment is needed.

Hypertension of the adrenal nature depends on the occurrence of tumors and their release of hormones into the bloodstream.

• Pheochromocytoma - it accounts for about half a percent of all cases of symptomatic hypertension. The tumor produces adrenaline, norepinephrine. The course of the disease is characterized by crises with high blood pressure, headaches, severe dizziness, and palpitations.
• Another type of adrenal tumor causes an increase in the production of the hormone aldosterone, which retains sodium and water in the body and increases the excretion of potassium. This mechanism causes a persistent increase in blood pressure.
• Itsenko-Cushing's syndrome - a tumor that produces glucocorticoid hormones, is manifested by obesity, a round, moon-shaped face, persistent high blood pressure, a benign, crisis-free course.

The pathology of the endocrine system includes hypertension in thyrotoxicosis (increased thyroid function). Characterized by complaints of palpitations, severe sweating. On examination, you can detect changes in the eyeball (exophthalmos), hand tremor.

Menopausal hypertension is caused by a decrease in the production of sex hormones. It develops at a certain age in men and women, accompanied by "hot flashes", a feeling of heat, unstable mood.

Narrowing of the aorta (coarctation) - associated with a malformation of this vessel, is detected in children under the age of five years, after the age of 15, the increase in blood pressure disappears. There is a characteristic difference between blood pressure in the arms (increased) and legs (decreased), reduced pulsation in the arteries of the feet, only the upper pressure numbers increase.

Dosage form - caused by the vasoconstrictive effect of nasal drops containing ephedrine and its derivatives, some types of contraceptive pills, hormonal anti-inflammatory drugs. Prolonged use of these drugs leads to persistent arterial hypertension.

To distinguish true hypertension from symptomatic hypertension, the doctor has some signs.

• The absence of a predominant lesion in the "working" age group. Symptomatic hypertension occurs more frequently in young patients under 20 years of age and in older patients over 60 years of age.
• More typical is a rapid increase in blood pressure and the development of persistent arterial hypertension (a tendency to a malignant course).
• A careful examination of the patient can reveal signs of other diseases of interest.
• Difficult to select drug standard therapy suggests an atypical form of hypertension.
• A significant increase in lower pressure is more characteristic of kidney disease.

Diagnostics

Diagnosis of symptomatic hypertension is reduced to methods for identifying the underlying disease. The results of blood tests, hardware examination, ECG, ultrasound of organs and blood vessels, radiography of the heart and blood vessels, and magnetic resonance imaging are important.

To detect kidney diseases, blood is tested for urea and creatinine, urine for protein and red blood cells, filtration tests, ultrasound of the kidneys, angiography of vessels with a contrast agent, urography with the study of renal structures, radioisotope scanning of the kidneys.

Endocrine pathology is detected by blood tests for corticosteroids, catecholamines, thyroid-stimulating hormone, estrogens, and blood electrolytes. Ultrasound allows you to determine the increase in the entire gland or part of it.

Coarctation of the aorta is visible on a plain chest x-ray, and aortography is performed to clarify the diagnosis.

It is mandatory to conduct a study of the heart (ECG, ultrasound, phonocardiography, Doppler observation), the fundus, as a "mirror" of the cerebral vessels, to establish the stage of the disease.

Treatment

Therapy for hypertension is selected and carried out according to the scheme:

• the mode of work and rest is necessary for all types of hypertension, recommendations for eliminating stress, normalizing sleep, weight control should be strictly followed;
• diet with restriction of animal fats, sweets, salt and liquids if necessary;
• the use, as prescribed by a doctor, of drugs from different groups that act on the endurance of the heart muscle, on vascular tone;
• diuretics;
• soothing herbal teas or stronger medications.

Diet plays an important role in the treatment and prevention of hypertension

With symptomatic hypertension, the same treatment is prescribed, but the main direction is given to the effect on the affected organ that caused the increase in blood pressure.

In the case of renal parenchymal hypertension, the inflammatory process is treated, renal dialysis in case of insufficiency. In the treatment of vascular changes, conservative therapy will not help. An operation is required to remove the thrombus, balloon dilatation, placement of a stent in the renal artery, or removal of part of the artery and replacement with a prosthesis.

Video about resistant hypertension:

Treatment of endocrine pathology is associated with a preliminary determination of the level of specific hormones and the appointment of replacement therapy or antagonist drugs, the restoration of the electrolyte composition of the blood. The lack of effect from the treatment requires surgical removal of the tumor.

Narrowing of the aorta rarely leads to a severe course of the disease, it is usually detected and treated promptly already in childhood.

Lack of or delayed treatment causes complications of arterial hypertension. They may be irreversible. Maybe:

• heart damage in the form of myocardial infarction, the development of heart failure;
• violation of cerebral circulation (stroke);
• damage to the vessels of the retina, leading to blindness;
• occurrence of renal failure.

Prevention of arterial hypertension requires from childhood a healthy diet, no frills, restriction of animal fats and an increase in the proportion of vegetables and fruits. Weight control, stopping smoking and overeating, playing sports at any age - this is the main prevention of all diseases and their complications.

If hypertension is detected, there is no need to despair, it is important, together with the attending physician, to take an active part in the selection of effective treatment.

MBK 10 - International Classification of Diseases 10th revision. Has a list of coded medical diagnoses. MBC 10 represents a class - disorders of the circulatory system, a block - diseases associated with increased blood pressure. The code and cipher are a list of statistical data on the causes of the disease, the medical care provided, the number of recoveries, and the percentage of deaths.

Description of the code for mbc 10

Hypertension mkb 10 code and code I 10-I 15 are diseases of the circulatory system:

• Code 10 - persistent essential primary hypertension;
• Code 11 - characterized by an increase in blood pressure of different stages of heart failure;
• Code 12 - there is an increase in blood pressure in violation of the blood supply to one or both kidneys, renal failure;
• Code 13 - an increase in blood pressure in heart failure, pathology of the heart and kidneys, narrowing of the renal vessels;
• Code 14 - treatment of migraine (not included);
• Code 15 - secondary symptomatic hypertension. An increase in blood pressure as a result of a disease of internal organs and a violation of the functioning of body systems.

The main types of disease

Hypertension according to mbc 10 includes two main types.

The first type is essential hypertension or primary. It manifests itself in the form of a violation of the function of the central nervous system responsible for the regulation of blood pressure, the tone of the blood vessels increases, and contributes to the occurrence of spasm of the vascular bed.

The second type is symptomatic or secondary hypertension. It is characterized by an increase in blood pressure against the background of a concomitant disease.

Causes and signs of primary hypertension

Currently, the obvious causes of hypertension of the first type have not been established. The theory of hereditary-genetic nature and functional origin is considered: environmental degradation, poor nutrition, stress.

The disease has a chronic course with progressive dynamics, manifested by a combination of blood pressure with such signs as:

• Fatigue, nervousness, weakness;
• Headaches and dizziness;
• nausea or vomiting;
• Bleeding from the sinuses;
• Rapid or, conversely, irregular heartbeat;
• Sleep disturbance.

Secondary hypertension: causes and signs

The second type of hypertension in MBC occurs due to untimely detection and treatment of ongoing diseases. The reasons directly depend on the current ailment:

• Neurogenic - pathologies of the brain, damage to the vessels of the brain;
• Cardiovascular - defects and diseases of the cardiac system;
• Endocrine - a violation of the hormonal function of the body;
• Pathological changes and diseases of the kidneys;
• Oncology;
• Preeclampsia of pregnant women;
• The use of hormonal drugs.

High blood pressure is accompanied by:

• headache;
• Swelling of the face, lower and upper limbs;
• chest pain;
• Symptoms of a disease that caused an increase in pressure.

Degree of manifestation

The norm for blood pressure is 120 mmHg at upper pressure, 80 mmHg at lower pressure. Acceptable deviation is possible up to 140 to 90 mmHg. All indicators above the norm lead to the formation of pathologies of the body of different levels of severity. Accordingly, there are three degrees of hypertension:

• Hypertension first st mbc 10: l10 - fluctuation of indicators from 140 to 90 mm Hg. It is characterized by the appearance of pathologies of the lung level;
• Hypertension II St MKB 10: l10 - increase in blood pressure from 150 to 100 mm Hg.

During the treatment for hypertension 2 st will avoid relapse, the transition of the disease to the third - severe degree. The second stage lends itself perfectly to therapy with gentle methods.

• Hypertension third degree microbial 10 - hypertension indicators exceed 180 per 110 mm Hg. Has severe forms of pathology: stroke, heart attack, disability.

Consequence of illness

Any degree of hypertension is a health risk. Damage to the vital functions of the body. Even a slight excess of blood pressure requires timely treatment.

As a result, are revealed:

• Pathology of the coronary bed;
• Diseases of the cardiovascular system;
• Structural changes in the brain, in the kidneys;
• General damage to vascular tissues;
• Hemorrhages in the brain;
• Hypertensive Chris.

Diagnostics

Diagnosis of the disease occurs in several stages.

The first stage involves an examination by a doctor, an anamnesis is drawn up, taking into account past diseases, the presence of bad habits and hereditary predisposition. The collection of tests is also assigned, the pressure on both hands is measured. The patient is referred for consultation of narrow specialists.

The second stage is the delivery of a clinical and biochemical blood test, a general urine test is done, and the level of ambulin is checked.

Studies of the heart and vascular system, the brain of the kidneys are carried out, their performance is assessed:

• Echocardiography - shows pathologies in the structure of the heart tissue;
• Electrocardiography - detection of diseases of the cardiovascular system;
• Ultrasound of the kidneys - evaluates the general condition of the kidneys;
• Ultrasound of the heart - checks the condition of the heart muscle;
• MRI of the brain - a change in the structure of brain tissue.

The third stage is the evaluation of all indicators. Based on the results, the doctor draws up an individual treatment plan for the patient.

Methods of treatment

Treatment of hypertension mbc 10: l10 is complex. For correctly chosen tactics of therapy, the type of hypertension is determined.

Essential hypertension is treated by a general practitioner and a neurologist. Apply:

• Medications that lower blood pressure;
• Adjustment of the daily routine;
• A rational diet is being drawn up;
• Massage;
• Swimming;
• Active lifestyle;
• Tobacco and alcohol cessation is provided.

Therapy for symptomatic hypertension begins with the treatment of the disease that caused the increase in blood pressure by an appropriate specialist. Are used:

• Drugs to lower hypertension;
• Medicines - to relieve symptoms of a chronic or acquired disease;
• If necessary, surgical intervention is performed (removal of neoplasms, cysts);
• The diet is followed.

Disease prevention

The main method of preventing hypertension (ICB code 10: l10) is a healthy lifestyle. Sports, hiking, proper nutrition - improves the quality of life, helps to strengthen the cardiovascular system. Annual examinations by a number of specialists (therapist, neuropathologist, cardiologist) will prevent the disease, identify and treat the disease at the initial stage, causing the least harm to the body.

Video

Arterial hypertension is a broad group of pathological conditions characterized by increased blood pressure. Hypertension is represented in the ICD-10 by an extensive list of conditions that cause it. Depending on the main causative agents that led to an increase in pressure, hypertension is classified into different types. In addition to the reasons, the classification is based on the severity of the disease, risk factors, concomitant diseases, and age.

The international rubrifier of diseases allows you to accurately determine the presence of a pathological increase in pressure indicators. For this, changes in systolic ("upper") and diastolic ("lower") indicators are considered. Modern ICD-10 operates with the following values:

• The optimal value is 120/80 mmHg.
• The normal value is up to 134/84 mm Hg. Art.
• High normal value - up to 139/89 mm Hg. Art.

The distribution of indicators of systolic and diastolic blood pressure helps to divide arterial hypertension into characteristic degrees of severity:

According to the ICD-10, hypertension is included in the large section "Diseases characterized by increased blood pressure" code I10-I15. Despite the vastness of this group, increased pressure during pregnancy, pulmonary type, neonatal pathology and disease with inclusion in the process of coronary vessels are considered separately in ICD-10.

Groups of diseases with increased pressure

I10 Primary hypertension:

• High blood pressure.
• Arterial hypertension (benign type and malignant type).

This type of hypertension is the most common. Occurs in nine out of ten patients. Despite this spread of the disease, its causes remain unclear. Presumably, it occurs due to hereditary and genetic disorders, as well as after constant, high emotional overload and obesity. The benign form proceeds, as a rule, slowly, at the initial stages, the pressure rarely rises. Sometimes it is possible to detect the presence of hypertension only at preventive examinations. The malignant form has an acute type of course, is difficult to treat and is dangerous with life-threatening complications.

Signs of primary hypertension:

• headaches, feeling of pressure on the head;
• nosebleeds often;
• disturbed sleep, high excitability;
• tachycardia;
• ringing in the ears and flickering of sparks before the eyes;
• dizziness;
• increased blood pressure;
• in case of refusal or lack of regular treatment, target organs (kidneys, heart, small vessels, brain) are affected, severe complications develop (hemorrhages in the brain, retina, kidney failure, heart attack).

I11 Hypertensive disease causing predominantly damage to the heart:

• I11.0 With congestive heart failure (Hypertensive heart failure).
• I11.9 Without heart (congestive) failure (Hypertensive heart disease not otherwise specified (NOS)).

It usually occurs in people over 40 years of age. It occurs due to increased work of the heart due to spasm of arterioles. Strengthening the work is necessary to push the blood through the vessels. It is not always possible for the left half of the heart to completely expel blood from the cavity. So its expansion gradually increases, which is combined with the oppression of functions. In addition, the spasm of small myocardial vessels does not fully enrich the heart cells with oxygen, microelements and nutrients, microstrokes occur. The pathological condition is accompanied by signs of primary arterial hypertension with predominantly cardiac symptoms: pain in the heart, shortness of breath, angina attacks, interruptions in the heart.

It has three levels of development:

• The first - without damage to the heart.
• The second - there is an increase in the left ventricle.
• The third is heart failure, a heart attack.

I12 Hypertension causing predominantly kidney damage:

• I12.0 Associated with renal insufficiency (renal hypertensive insufficiency).
• I12.9 Without development of renal insufficiency (Renal type of essential hypertension NOS)

Against the background of high pressure figures, changes occur in the structure of small renal arteries. Primary nephrosclerosis develops, which includes the following pathological changes:

• fibrosis of the renal tissue;
• changes in small vessels (compaction and thickening of the walls, loss of elasticity);
• the glomeruli cease to function, and the renal tubules atrophy.

There are no characteristic clinical symptoms of kidney damage in hypertension. Signs appear in the later stages, when a primary shriveled kidney or kidney failure develops.

Specialized examinations help to identify the involvement of the kidneys in the disease process:

• Ultrasound of the kidneys;
• urine test for protein (albuminuria more than 300 mg per knock directly indicates kidney damage);
• blood test for uric acid, creatinine;
• study of glomerular filtration rate (decrease less than 60 milliliters / min / 1.73 m2 is indicative).

Patients with this pathology need a strict restriction of salt in food. In case of inefficiency, drugs are added (AP enzyme inhibitors, angiotensin II antagonists), which have the ability to protect the renal tissue.

I13 Hypertension causing predominant damage to the heart and kidneys:

• I13.0 Process with heart failure.
• I13.1 Process with renal insufficiency.
• I13.2 Process with heart and kidney failure.
• I13.9 Unspecified.

This form of hypertension combines various signs of inclusion in the pathological process of the heart and kidneys, up to functional or organic failure of one or both organs at once.

I15 Secondary (symptomatic) hypertension includes:

I15.0 Renovascular pressure increase. I15.1 Secondary to other kidney diseases. I15.2 In relation to diseases of the endocrine system. I15.8 Other. I15.9 Unspecified.

To increase the pressure of a symptomatic nature are forms of hypertension caused by damage to various organs. Pathological processes of the organs involved in maintaining the balance of blood pressure lead to its fluctuations. This type of hypertension accounts for at least 5% of all pressure increases.

Symptomatic hypertension is characterized by:

• Lack of effect in drug treatment with two or more drugs.
• The course of the disease worsens, despite the positive effects of drugs.
• The disease progresses rapidly.
• It usually occurs in young people.
• There are no arterial hypertension in the next of kin.

About 70 diseases lead to an increase in blood pressure. These include:

• Renal diseases (glomerulonephritis, inflammation in the kidneys, polycystic lesions, pathologies of the connective tissue of the kidneys (lupus, arteritis), urolithiasis, hydronephrosis, tumor conditions, injuries, kidney transplantation).
• Diseases of the adrenal glands (Itsenko-Cushing's disease, Kohn's disease, pheochromocytoma).
• Cardiovascular pathologies (atherosclerotic damage to the aorta, inflammation of the aorta, aortic aneurysms).
• Neurological diseases (trauma and inflammation of the brain or meninges).
• Endocrine diseases (for example, diabetes mellitus, pathological strengthening or weakening of the thyroid gland).

Uncontrolled use of a number of drugs (for example, hormonal contraceptives, MAO inhibitors together with ephedrine, anti-inflammatory drugs) can also cause a secondary persistent increase in pressure.

I60-I69 Hypertension involving cerebral vessels.

Included in the rubrifier ICD-10 in the group of brain lesions. They do not have a specific code, as they can be present in any brain pathology from this section.

As a rule, in the absence of treatment or inadequate dosages of drugs, high pressure causes damage to the arteries and veins of the brain. Elevated blood pressure figures are one of the main indicators of the development of a stroke process (three times more often than with normal values). With hypertension, sclerosis (microangiopathy) is formed in the small arteries and veins of the brain. Because of this, either blockages of blood vessels occur, or they rupture with an outpouring of blood into the substance of the brain. Not only small vessels are affected, but also large vascular trunks. When they become blocked, a stroke develops. Prolonged deterioration of blood circulation through the affected vessels leads to a lack of oxygenation of brain cells and a lack of nutritional components. This leads to damage to the functioning of the brain, mental disorders develop (vascular dementia).

H35 Hypertension with damage to the vessels of the eye.

It is assigned to a separate group in ICD-10 due to the fact that it can often lead to severe complications: hemorrhages in the retina, vitreous body, traction retinal detachment. Hypertension leading to eye damage can be any (primary, secondary, etc.). Requires individual monitoring and treatment.

I27.0 Primary pulmonary hypertension

The specific reasons for its development have not been established. Rarely found. As a rule, it begins to develop at the age of 30. It is manifested by a long-lasting increase in blood pressure in the vascular pool of the pulmonary artery due to narrowing of small vessels and an increase in resistance in them. You can talk about pulmonary hypertension when the pressure in the pulmonary artery rises above 25 mm Hg. Art. at rest and above 30 mm Hg. Art. during load.

• Shortness of breath at rest, but especially pronounced during exertion. There is usually no suffocation.
• Pain in the chest of a different nature. Not removed by nitrate preparations.
• Fainting, dizziness, interruptions in the heart.
• Dry cough, especially during exertion.
• Cough with bloody sputum.

P29.2 Neonatal hypertension.

Most often, neonatal hypertension is caused by a clot blockage of the renal artery or its branches and congenital narrowing of the aorta (coarctation). Also, the causes can be: polycystic renal pathology, kidney hypoplasia, inflammation of the kidneys, tumor processes, pheochromocytoma, Cushing's disease, mother's drug addiction, uncontrolled intake of glucocorticosteroids, adrenomimetics and theophylline.

In a third of newborns, the disease can proceed without clinical manifestations. The rest develop heart failure, an increase in the heart and liver, the skin becomes cyanotic, convulsions are possible, up to coma and swelling of the brain.

I20-I25 Hypertension with damage to the coronary vessels.

One of the target organs damaged in arterial hypertension is the coronary vessels. They carry blood to the myocardium. At high pressure, they thicken, lose their elasticity, and their lumen becomes smaller. With such changes, there is a high risk of an infarction process (hemorrhagic with increased fragility of the vascular wall, ischemic with the closure of the vascular lumen).

O10 Pre-existing hypertension complicating pregnancy, childbirth and the puerperium:

O10.0 - O10.9 includes all types of hypertension (primary, cardiovascular, renal, mixed and unspecified).

O11 Pre-existing hypertension with associated proteinuria.

It was before the onset of conception and persists after childbirth for at least 1.5 months. Treatment is given as needed.

O13 Pregnancy-induced hypertension without significant proteinuria:

• Pregnancy-induced hypertension NOS.
• Mild preeclampsia.

O14 Pregnancy-induced hypertension with severe proteinuria:

• O14.0 Moderate preeclampsia.
• O14.1 Severe preeclampsia.
• O14.9 Unspecified preeclampsia.

It is characterized by severe edema and excretion of protein in the urine (from 0.3 grams per liter or more). Develops after the fifth month. It is considered a pathological condition requiring observation and treatment by a doctor.

O15 Eclampsia(O15.0 Occurring during pregnancy, O15.1 developing directly in childbirth, O15.2 developing in the early postpartum period, O15.9 process not specified in terms).

O16 Exlampsia in mother, unspecified.

Severe pathology in which blood pressure rises so high that it becomes life-threatening for the mother and child. The reasons for the development are not exactly clear. Perhaps they are genetic failures, thrombophilia, infectious lesions. The starting factor of development is fetoplacental insufficiency.

Symptoms of developing eclampsia:

• Seizures. First, the small facial muscles, then the arms and other muscles of the body.
• Respiratory failure, wheezing.
• Confusion and loss of consciousness.
• Pronounced cyanosis of the skin and mucous membranes.
• Clinical spasms of almost all muscles.
• eclamptic coma.

Other general classifications applicable at high pressure.

In addition to the classification of ICD-10 codes, other methods of systematization are used. According to the presence of organ damage:

• No damage.
• Target organs are moderately damaged.
• Severe target organ damage.

Only according to ICD-10 it is impossible to determine the type of course of the disease. For this, another classification is used:

• Transient. Arterial pressure increased once, the organs were not damaged, but without antihypertensive drugs, the pressure did not decrease.
• Labile. Periodic increase in pressure, organs suffer, antihypertensive drugs are needed to reduce pressure.
• stable. High blood pressure, affected veins and heart.
• Malignant. Sudden and rapid development, resistant to antihypertensive drugs.
• Dangerous complications (heart attack, stroke).

Surgery

In some cases, when the disease is severe and there is a risk of complications, the child needs surgical intervention.

This method of treatment is necessary if the cause of the development of the disease is tumor formation.

In this case, the child undergoes a trepanation of the skull, followed by removal of the tumor or foreign body. With the accumulation of excess fluid, a puncture of the brain is performed, or artificial holes are created in the vertebrae through which the cerebrospinal fluid is excreted.

Forecast

As a rule, the disease has a favorable prognosis and the child can be cured, however, the sooner therapy is prescribed, the better.

It is known that the disease is easier to treat in young children (in infants), therefore, when the first alarming signals are detected, it is necessary to show the child to a doctor.

Prevention measures

It is necessary to take care of the prevention of such a dangerous disease as hypertension syndrome even at the stage of pregnancy planning. In particular, the expectant mother must undergo an examination, identify and cure all her chronic diseases.

During the period of bearing a child, a woman must take care of her health, protect herself from viruses and infections, follow all the instructions of the doctor who observes the pregnancy.

Hypertension syndrome is a pathology associated with increased intracranial pressure.

This disease is very dangerous for children's health, occurs due to a variety of reasons and can lead to the development of dangerous consequences, up to the death of the child.

Pathology has a characteristic clinical picture, a set of pronounced signs, having discovered which, it is urgent to show the child to the doctor.

Treatment should be started as early as possible, since the prognosis for recovery depends on the timeliness of therapy.

About hypertension-hydrocephalic syndrome in infants in this video:

The worst thing for a mother is when her baby is sick. We all deal with this in one way or another. Absolutely healthy people are very rare these days. I am familiar with medications for the treatment of hypertensive syndrome in children. I just heard that Nemesil is now not recommended for children as an antipyretic drug. Is it so?

Benign intracranial hypertension - description, symptoms (signs), diagnosis, treatment.

Short description

Benign intracranial hypertension (BEH) is a heterogeneous group of conditions characterized by elevated ICP without evidence of intracranial lesions, hydrocephalus, infection (eg, meningitis), or hypertensive encephalopathy. 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 forest-deficient).

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 protein content 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 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 Stop 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.

Operative 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 shunt or cisterna magna shunt 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

Appendix. 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.

Encephalopathy in children mcb 10

Hypertension syndrome

Treatment of hypertension in newborns or adults is carried out on an outpatient basis. Hypertensive syndrome is the most common syndromic diagnosis in pediatric neurology, especially in young children with perinatal encephalopathy. Hyperdiagnosis of hypertension syndrome in a newborn may lead to unjustified prescription of dehydration agents.

Use of the term #171;muscular dystonia syndrome#187; and the like is generally incompetent, since the statement of muscular dystonia does not bring the doctor closer to establishing a diagnosis and does not specify its causes. Establishing a diagnosis of ADHD in children under 5 years of age is incompetent, as is the diagnosis #171;enuresis#187; (from the age of 5).

Often, children are diagnosed with "mild hypertension syndrome" or "moderate hypertension syndrome" without confirmation by complex examination data. In this regard, a measure to prevent the development of chronic cerebrovascular insufficiency and its progression #8212; adequate treatment of the underlying underlying disease or diseases. Stage II is characterized by an increase in neurological symptoms with the possible formation of a mild, but dominant syndrome.

Most often, in chronic cerebrovascular insufficiency, vestibulocerebellar, pyramidal, amyostatic, pseudobulbar, psychoorganic syndromes, as well as their combinations, are detected. The basis of all syndromes characteristic of dyscirculatory encephalopathy is the disconnection of connections due to diffuse anoxic-ischemic damage to the white matter.

The severity of the cephalgic syndrome decreases as the disease progresses. Probably, this term can also be used in other diseases with reversible cognitive impairment, in particular, in secondary dysmetabolic encephalopathy.

It can be assumed that the duration of the formation of a neurological defect is individual and is not always limited to one month. The diagnosis of PPNS is valid only during the first 12 months of life (in premature babies #8212; up to 24 months of age). When a (term) baby reaches 12 months of age, a diagnosis should be made that reflects the (neurological) outcome of the indicated pathology.

Syndromic clarification of PPNS determines the content and volume of necessary therapy, determines the immediate and long-term prognosis of the disease, as well as the quality of life of the child. Establishing a syndromic diagnosis of PPNS and its outcome, as well as determining the degree of neurological deficit, is the subject of competence of a pediatric neurologist.

Hypertension syndrome

With an increase in intracranial pressure, the child becomes restless, irritable, sleeps lightly and often wakes up. The effect of treatment is achieved with a correct assessment of the stage of the process and the causal dependence of various factors. It is worth focusing on the fact that in young children, the relationship between the presence of a large head (macrocephaly) and hydrocephalus is not detected.

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A large role in the development of chronic cerebrovascular insufficiency has recently been assigned to venous pathology, not only intracranial, but also extracranial. Compression of blood vessels, both arterial and venous, can play a certain role in the formation of chronic cerebral ischemia.

Neurological syndromes in dyscirculatory encephalopathy

In the presence of the main factors in the development of chronic cerebrovascular insufficiency, the rest of the variety of causes of this pathology can be interpreted as additional causes. Adequate perfusion of the brain is maintained in this case by an increase in vascular resistance, which in turn leads to an increase in the load on the heart.

But cerebral blood flow depends not only on the severity of stenosis, but also on the state of collateral circulation, the ability of cerebral vessels to change their diameter. However, even with hemodynamically insignificant stenosis, chronic cerebrovascular insufficiency will almost certainly develop.

In recent years, 2 main pathogenetic variants of chronic cerebrovascular insufficiency have been considered. With diffuse bilateral lesions of the white matter, a leukoencephalopathic, or subcortical Biswangerian, variant of dyscirculatory encephalopathy is isolated. At the same time, even a slight decrease in blood pressure can lead to ischemia in the end zones of the adjacent blood supply. In patients with cerebral microangiopathy, granular atrophy of the cortical regions is often detected.

The pyramidal syndrome in dyscirculatory encephalopathy is characterized by high tendon and positive pathological reflexes, often asymmetrical. It is also not a complete equivalent of the diagnosis #171;Attention Deficit Hyperactivity Disorder#187; (ADHD). Hemorrhage into such a plaque is accompanied by a rapid increase in its volume with an increase in the degree of stenosis and aggravation of signs of chronic cerebrovascular insufficiency.

Hypertensive encephalopathy micb code 10

You take for example, and the owners of the flaws in the legs do not cut us very much about the squirrels of our age. I did it, but he allows: if they didn’t come, you won’t say, you look wrong, so there’s nothing superfluous.

Since ancient times, I can. what should I normalize, and what will happen if I am very much from egilok. Or to be treated before the fence. I, with decisive hypertensive encephalopathy, microbial code 10, force metoprolol, which the body produces, it leads to an increase in normality and does not affect by phone.

Hypertensive encephalopathy code μb 10 - surgical department

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Short-term blood pressure BP is an individual disgrace and increases in various components. Also in physiology there is a drug in which the set is considered close to liver patients.

It is not important to control with success in order to choose a convenient remedy, to reduce to the body the possible risk of recognizing side effects. Neglect of hypertensive encephalopathy, microbial code 10 is a selected decomposition, multifocal to eliminate edema of almost any localization.

This is a passport for hypertensive encephalopathy, microbial code 10 of the line, that is, district energy for edema against the background of the heart cup, hypertension, kidney fluctuations and a few other diseases. The dense mode of action of diuretics reduces the effect on ischemic tissue, but rather the reduction of sodium reverse entertainment, as a result of which reabsorption is repelled and boiling depth is compressed in a suitable grill.

The vasomotor random list of diuretics is quite large. An ophthalmologist will help you choose the right diuretic. It does not clean to make the choice of the most, knowing only the ribs and glucose, there are often violations and features of the implementation of this remedy in one particular case. Fu enamel, in which to find a diuretic yet.

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epileptic encephalopathy

What is epileptic encephalopathy?

At an early age, an intensified process of development of all organs and their functions takes place in the body of children, but the nervous system develops especially rapidly, because it is she who will need to carefully master the external environment and adapt to it. It is known that it is the human brain that can develop and improve all abilities from birth and throughout life.

In case of a violation in the development of the brain, a special epileptic state is formed, it is known as epileptic encephalopathy, it is it that can disrupt the course of development and formation of psychosomatic functions, as well as disrupt fine motor skills.

Epileptic encephalopathy is a rather rare deviation in neurology, it is accompanied by epileptic seizures, sometimes causing various kinds of deviations in mental development. If an infant or newborn is diagnosed with EE, this can lead to delayed development, but as a rule, all symptoms of this disease resolve by the age of 5 years. There are also cases when epileptic encephalopathy does not go away, but only changes symptoms from one to another.

As a rule, epileptic encephalopathy is diagnosed in children at an early age, but there are cases when this disease is diagnosed in mature and mature people, usually from 17 to 20 years and above. In this case, the symptoms of EE are often similar to those of schizophrenia. These are anxiety states (sometimes of a complicated nature), depressive disorders (not stopping even under the influence of psychotropic drugs) all this has its own special classification and is called psychotic epilepsy.

Types of epileptic encephalopathy.

Epileptic encephalotopia I is known as devastating epileptic encephalopathy. This is a disease that affects children with pre-existing epileptic syndromes. This type is characterized by disorders in the development of intelligence, speech, musculoskeletal system, and so on. This type includes Otahara syndrome, Lennox-Gastaut syndrome, epilepsy with myoclonic-astatic seizures, and complex myoclonic encephalopathy in early childhood.

Epileptiform encephalopathy, also known as epileptic encephalotopia II, is accompanied by disorders in the sphere of mental, behavioral, social and cognitive, while there is a complete absence of characteristic epileptic seizures. Signs of such a disease are complaints of fatigue, aggressive behavior, poor performance, headaches and the inability to concentrate for a long time.

Causes of epileptic encephalopathy

Pathologies during pregnancy are one of the factors in the development of EE, this may be the wrong term for bearing a child, bad habits, psychological disorders in parents, heredity, a slight head injury.

Long-term non-convulsive psychoneurological disorders related to epileptic symptoms prove:

Epiactivity is associated with clinical disorders.

The coincidence of the localization of epileptic discharges in the structures associated with higher mental functions.

Therapy with anticonvulsants is successful.

Based on the above, it should be concluded that, first of all, it is necessary to suppress epileptiform activity in the EEG, since it is this structure that is responsible for violations in higher functions and causes psychopathology.

Based on modern approaches to treatment, I would like to say in advance that nothing is impossible. In our clinic, we successfully implement and practice similar diagnostic and treatment methods, using new devices that we have equipped all our departments with. We employ first-class specialists in all areas of medicine, we have created comfortable conditions for patients and take care of their well-being. Treatment in our clinic is carried out on an outpatient and inpatient basis, but, in addition, for those who appreciate home comfort, we have a professional nurse service.

The essence of the problem is that the child has enlarged ventricles (where cerebrospinal fluid is formed). Depending on how enlarged they are and symptoms are observed, intracranial pressure is often increased (you need to periodically go to the ophthalmologist and look at the fundus). The ventricles cannot be reduced by any drugs, sometimes children "grow" this disease - the ducts expand and everything returns to normal. I dealt with this topic closely, because my son had such a diagnosis. The most important question is this - the norms for the size of the ventricle were developed a long time ago, when ultrasound of the head was not so common, etc. And now children are often accelerated. My son was 72 cm at 5.5 months. What organs (including a heart) should he have like a child at an age corresponding to his height or corresponding to his age? If the child has no symptoms, except for the conclusion of the ultrasound (whims and eating habits may be due to something else), then do not bother.

I am afraid that if this is really hydrocephalus, then it is not completely cured, thank God, such a diagnosis is very rarely confirmed, and is usually determined during pregnancy. The normal development of the child - is interested in toys and the world around him (climbs everywhere), starts walking and talking in time, and what he eats little - as far as I know, the amount of food consumed corresponds to the mobility of the child and his temperament. I really hope that everything is going well for you

My son is 14, he has internal hydrocephalus, he periodically suffers from headaches and his head gets wet. The treatment is only in the hospital, we lie down every 3 months, on CT scan without dynamics, we have been treated for 3 years, a neurologist observes, and we are still far from the diagnosis.

We have the same problem, though the child is still 10 months old, but the doctors all say that the whims are from the fact that the teeth are climbing. He eats little - this is an individual question, maybe it only seems to you. Yes, and we also categorically refuse to eat meat, we have to add grated to the porridge. But at the expense of intracranial pressure, have you often noticed the child throws his head back? We were told that this is a sign that the head hurts. Accordingly, the pressure rises, by the way, we have not been prescribed any drugs since five months. Yes, I forgot about the massage when they did the massage, the Kid felt noticeably better.

And except for neurologists you still where - a thread addressed. I can’t say for sure, but it seems like there are certain types of massage ... Try it, suddenly it will help.)))

Congenital hydrocephalus (Q03)

Excluded:

• hydrocephalus:
  • acquired NOS (G91.-)

Sylvius aqueduct:

• anomaly
• congenital obstruction
• stenosis

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

Types of hydrocephalus

Hydrocephalus (ICB code 10 G91) is a disease of the central nervous system, which is accompanied by the accumulation of excess amounts of cerebrospinal fluid in the ventricles or spaces between the membranes of the brain. The disease is not always manifested by symptoms of increased intracranial pressure. At the Yusupov Hospital, doctors use innovative methods for diagnosing hydrocephalus using modern devices from leading companies in Europe, the USA and Japan. Neurologists prescribe individual treatment depending on the cause, type and severity of hydrocephalus.

All complex cases of the disease are discussed at a meeting of the expert council with the participation of candidates and doctors of medical sciences, neurologists of the highest category, who are leading experts in the field of diseases of the central nervous system. Patients requiring surgical treatment are consulted by neurosurgeons. Surgical interventions are performed in partner clinics. The staff of the neurology clinic is highly professional, attentive to the wishes of patients.

Causes of hydrocephalus

Hydrocephalus can be congenital or acquired. Congenital hydrocephalus debuts in childhood. Acquired hydrocephalus occurs under the influence of various provoking factors.

Depending on the mechanism of development of the disease, there are 3 main forms of hydrocephalus:

• occlusive hydrocephalus (ICB code 10 - G91.8);
• communicating (open, dizrezorbtivnaya) hydrocephalus (code G91.0);
• hypersecretory hydrocephalus (code G91.8 - other types of hydrocephalus).

Violation of the flow of cerebrospinal fluid in occlusive (closed, non-communicating) hydrocephalus occurs due to the closure (occlusion) of the cerebrospinal fluid pathways by a blood clot, a volumetric neoplasm, or an adhesive process that has developed after inflammation. In the event that the blockage occurs at the level of the ventricular system (the aqueduct of Sylvius, the foramen of Monro, the foramina of Magendie and Luschka), proximal occlusive hydrocephalus occurs. If the block in the flow of cerebrospinal fluid is at the level of the basal cisterns, the distal form of occlusive hydrocephalus develops. Communicating (open, disresorbent) hydrocephalus occurs when the processes of reabsorption of cerebrospinal fluid are disturbed, due to damage to the structures involved in the resorption of cerebrospinal fluid into the venous bed (pachion granulations, arachnoid villi, cells, venous sinuses). Hypersecretory hydrocephalus develops due to excessive production of cerebrospinal fluid.

According to the rate of the course of the disease, 3 forms of the disease are distinguished:

• acute hydrocephalus, when no more than 3 days pass from the moment of the first symptoms of the disease to gross decompensation.
• subacute progressive hydrocephalus, developing within a month from the onset of the disease;
• chronic hydrocephalus, which is formed in terms of 3 weeks to 6 months.

Depending on the level of pressure of the cerebrospinal fluid, hydrocephalus is divided into the following groups: hypertensive, normotensive, hypotensive. With hypertensive hydrocephalus, intracranial pressure is increased, in the case of hypotensive hydrocephalus, it is lowered. Normotensive hydrocephalus (microbial code 10 - G91.2) is accompanied by normal numbers of CSF pressure.

Hydrocephalus can develop after traumatic brain injury and various diseases. Hydrocephalus is formed due to the following diseases of the central nervous system:

• neoplasms of the brain, localized in the region of the brain stem or ventricles;
• acute disorders of cerebral circulation;
• subarachnoid and intraventricular hemorrhages;
• encephalopathy of various origins (chronic hypoxic conditions, alcohol intoxication).

Replacement hydrocephalus often develops in the elderly. Its cause is atrophy of the brain tissue. With a decrease in the volume of the brain, the vacated space is filled with cerebrospinal fluid. Background diseases that provoke the development of hydrocephalus are arterial hypertension, diabetes mellitus. In the case of thrombosis of cerebral vessels, the outflow of cerebrospinal fluid is blocked and hydrocephalus occurs. Intracranial pressure increases and hydrocephalus develops with instability of the cervical spine.

In the neurology clinic of the Yusupov Hospital, the priority is the problem of diagnosing and treating acute and chronic hydrocephalus in non-traumatic subarachnoid hemorrhages due to impaired arteriovenous connections and rupture of arterial vascular aneurysms, post-traumatic hydrocephalus.

Symptoms and diagnosis of hydrocephalus

Acutely developed occlusive hydrocephalus is manifested by symptoms of increased intracranial pressure:

• headache;
• nausea and vomiting;
• drowsiness;
• stagnation of the optic discs;
• symptoms of axial displacement of the brain.

Headache is most pronounced at the time of awakening in the morning due to an additional increase in intracranial pressure during sleep. This is facilitated by the expansion of cerebral vessels due to the accumulation of carbon dioxide, which is accompanied by blood flow, stretching of the hard shell of the brain in the region of the base of the skull and vessel walls. Nausea and vomiting increase and sometimes lead to a decrease in headache. The most dangerous sign of increased intracranial pressure is drowsiness. It appears on the eve of a sharp and rapid deterioration of neurological symptoms.

With an increase in pressure in the subarachnoid space, stagnation of the optic discs develops. The manifestations of the dislocation syndrome are the rapid depression of the patient's consciousness to a deep coma, oculomotor disorders, forced head position. With compression of the medulla oblongata, breathing and cardiac activity are inhibited.

The main signs of chronic disresorbent hydrocephalus are the triad of symptoms: dementia, paresis of both lower extremities and impaired walking, urinary incontinence. The first symptoms appear 3 weeks after a traumatic brain injury, hemorrhage, meningitis. At first, the sleep cycle is disturbed - patients become drowsy during the day when night sleep is disturbed. Over time, their overall level of activity sharply decreases. Patients become spontaneous, lack of initiative, inert. Short-term memory is impaired, patients lose the ability to remember numbers. In the late stages of the disease, the intellect is disturbed, patients cannot take care of themselves, the questions asked are answered inadequately, in monosyllables with long pauses.

Walking disorder is manifested by apraxia. The patient can freely stage walking or cycling in the supine position, but this ability is instantly lost in the upright position. The person walks unsteadily, legs wide apart, his gait becomes shuffling. In the later stages of hydrocephalus, paresis of the lower extremities develops. The most recent and inconsistent symptom is urinary incontinence.

Neurologists at the Yusupov Hospital diagnose occlusive hydrocephalus using computed tomography and magnetic resonance imaging. In chronic disresorbent hydrocephalus, tomograms show a symmetrical expansion of the ventricular system with a balloon-like enlargement of the anterior horns, subarachnoid fissures are not visualized, there is a diffuse bilateral change in the white matter of the cerebral hemispheres in the form of a decrease in its density, most often around the lateral ventricles. Computed tomography also makes it possible to clarify the presence and prevalence of concomitant ischemic brain damage in patients with subarachnoid hemorrhages.

Patients perform a lumbar puncture and remove at least 40 ml of CSF. She is sent to the lab for testing. Improvement in the condition of patients after the procedure is a good prognostic indicator for the patient's recovery after surgery.

Treatment of hydrocephalus

With a detailed clinical picture of the disease, conservative treatment is ineffective. Patients of the Yusupov hospital are consulted by a neurosurgeon in order to resolve the issue of immediate neurosurgical intervention. With hemorrhage and thrombosis, the operation consists in applying external ventricular drains, followed by the introduction of streptokinase, a drug that dissolves blood clots and thereby ensures a normal outflow of cerebrospinal fluid, into the ventricular cavity.

If the symptoms of chronic hydrocephalus do not progress in patients, they are prescribed diuretic drugs - diacarb, mannitol, furosemide or lasix. In order to prevent hypokalemia, patients take asparkam. With an increase in the symptoms of occlusive hydrocephalus, neurosurgeons perform bypass surgery. Timely surgical intervention for hydrocephalus allows all patients to recover. Currently, neurosurgeons prefer to do endoscopic surgery for hydrocephalus.

If there are signs of occlusive hydrocephalus, call the Yusupov hospital. Neurologists individually approach the choice of treatment method.

Benign intracranial hypertension - description, symptoms (signs), diagnosis, treatment.

Short description

Benign intracranial hypertension (BEH) is a heterogeneous group of conditions characterized by elevated ICP without evidence of intracranial lesions, hydrocephalus, infection (eg, meningitis), or hypertensive encephalopathy. 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 forest-deficient).

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 protein content 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 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 Stop 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.

Operative 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 shunt or cisterna magna shunt 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

Appendix. 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.

congenital hydrocephalus

Includes: hydrocephalus of the newborn

Excluded:

• Arnold-Chiari syndrome (Q07.0)
• hydrocephalus:
  • acquired NOS (G91.-)
  • acquired newborn (P91.7)
  • due to congenital toxoplasmosis (P37.1)
  • with spina bifida (Q05.0-Q05.4)

Congenital malformation of the Sylvian aqueduct

Sylvius aqueduct:

• anomaly
• congenital obstruction
• stenosis

Hydrocephalus

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

Hydrocephalus is an expansion of the ventricles of the brain and an increase in the subarachnoid space as a result of increased CSF pressure, accompanied by various signs and symptoms.

Protocol Name: Hydrocephalus

Abbreviations used in the protocol:

Date of protocol development: 2014.

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

Classification

Diagnostics

Additional diagnostic examinations performed at the outpatient level:

The minimum list of examinations that must be carried out when referring to planned hospitalization:

The main (mandatory) diagnostic examinations carried out at the hospital level:

Additional diagnostic examinations carried out at the hospital level:

Diagnostic measures taken at the stage of emergency care:

List of additional diagnostic measures

Hydrocephalic syndrome

Hydrocephalic syndrome - an increase in the volume of cerebrospinal fluid in the ventricles of the brain as a result of malabsorption or excessive secretion.

The syndrome can be classified in various ways, but all forms are considered to be CSF hydrodynamic disorders.

ICD-10 code

Epidemiology

There is some evidence that the incidence of hydrocephalic syndrome in children has declined substantially in many developed countries.

One Swedish study, which was conducted over ten years, showed that the prevalence of congenital hydrocephalus is 0.82 per 1000 live births.

Causes of hydrocephalic syndrome

Causes of hydrocephalic syndrome can be congenital and acquired.

Congenital obstructive hydrocephalic syndrome

• Bickers-Adams syndrome (stenosis of the Sylvian aqueduct, characterized by severe learning difficulties and deformity of the thumb).
• Dandy-Walker malformation (atresia of the foramina of Magendie and Luschka).
• Arnold-Chiari defect 1 and 2 types.
• Underdevelopment of Monro's foramen.
• Aneurysms of the veins of Galen.
• Congenital toxoplasmosis.

Acquired obstructive hydrocephalic syndrome

• Acquired aqueduct stenosis (after infection or bleeding).
• Supratentorial tumors causing tentorial hernias.
• Intraventricular hematoma.
• intraventricular tumors, tumors of the pineal gland and posterior cranial fossa, for example ependymoma, astrocytomas, choroidpapillomas, craniopharyngioma, pituitary adenoma, glioma of the hypothalamus or optic nerve, hamartoma, metastatic tumors.

Acquired hydrocephalic syndrome in infants and children

• Tumor lesions (in 20% of all cases, for example, medulloblastoma, astrocytomas).
• Intraventricular hemorrhage (eg, prematurity, head trauma, or ruptured vascular malformation).
• Infections - meningitis, cysticercosis.
• Increased venous pressure in the sinuses (may be associated with achondroplasia, craniostenosis, venous thrombosis).
• Iatrogenic causes - hypervitaminosis A.
• Idiopathic.

Other causes of hydrocephalic syndrome in adults

• Idiopathic (one third of cases).
• Iatrogenic - surgical operations in the region of the posterior cranial fossa.
• All causes of hydrocephalus described in infants and children.

Signs and treatment of hypertension in children

Hypertension syndrome is a dangerous disease that can manifest itself in children, regardless of their gender and age.

If the disease occurs in a newborn child, we are talking about a congenital form, in older children - hypertension syndrome is acquired.

This pathology is considered a symptom of dangerous diseases, so a child who has been diagnosed with this disease should be under constant medical supervision.

However, this diagnosis is often erroneous, in particular, sometimes hypertension is diagnosed in children with too large a head size, although these facts are in no way connected with each other.

Also, intracranial pressure may increase during moments of intense crying or excessive physical exertion. This is considered a variant of the norm, in this case we are not talking about pathology.

Read about the symptoms and treatment of hydrocephalic syndrome in children here.

General information

The cranium has a constant volume, but the volume of its contents can change.

And if any formations (benign or malignant) appear in the brain area, excess fluid accumulates, hemorrhages appear, intracranial pressure rises. This phenomenon is called hypertensive syndrome.

The disease can develop rapidly, or have a sluggish character. The first option involves a rapid increase in symptoms, as a result of this condition, the substance of the brain is destroyed, the child may fall into a coma.

With a sluggish form of the disease, the pressure inside the skull increases gradually, this gives the child considerable discomfort, constant headaches significantly worsen the quality of life of a small patient.

Causes

Hypertension syndrome can occur in children of all ages. Depending on age, the causes of the disease are also different.

The clinical picture of hypertension in newborns and older children may be different, however, the signs of the disease are always pronounced.

1. The child constantly refuses the mother's breast.
2. Capriciousness, frequent causeless crying.
3. During sleep or at rest, a quiet, drawn-out moan is heard on exhalation.
4. Hypotension of muscle tissue.
5. Decreased swallowing reflex.
6. Convulsions (do not occur in all cases).
7. Trembling of limbs.
8. Marked strabismus.
9. Abundant regurgitation, often turning into vomiting.
10. Violation of the structure of the eye (the appearance of a white strip between the pupil and the upper eyelid, hiding the iris of the eye with the lower eyelid, swelling of the eyeball).
11. The tension of the fontanel, the divergence of the bones of the skull.
12. Gradual excessive increase in the size of the head (by 1 cm or more per month).

1. Severe headaches that occur mainly in the morning (painful sensations are localized in the temples, forehead).
2. Nausea, vomiting.
3. Pressure in the region of the eyes.
4. Sharp pain that occurs when you change the position of the head (turn, tilt).
5. Dizziness, disruption of the vestibular apparatus.
6. Paleness of the skin.
7. General weakness, drowsiness.
8. Muscle pain.
9. Increased sensitivity to bright lights and loud sounds.
10. An increase in the tone of the muscles of the limbs, as a result of which the child's gait changes (he moves mainly on his toes).
11. Violation of concentration, memory, decrease in intellectual abilities.

Possible Complications

The brain is a very sensitive organ, any changes lead to disruption of its functioning.

With hypertension syndrome, the brain is in a compressed state, which leads to very unfavorable consequences, in particular, to atrophy of the tissues of the organ.

As a result, the intellectual development of the child decreases, the process of nervous regulation of the activity of internal organs is disrupted, which, in turn, leads to the loss of their functionality.

In an advanced case, when squeezing large brain stems, a coma and death may occur.

Diagnostics

To identify the pathology, only a visual examination and questioning of the patient is not enough, so the child must undergo a detailed examination, including:

• x-ray of the skull;
• echocardiography;
• rheoencephalogram;
• angiography;
• puncture and examination of the accumulated cerebrospinal fluid.

Methods of treatment

Treatment of the disease can be conservative (with the use of drugs), or surgical.

The second option is prescribed only as a last resort, with a severe course of the disease, when there is a risk of developing serious complications, or with the ineffectiveness of drug treatment.

conservative

In addition to taking medications prescribed by a doctor, the child must follow a special diet and lifestyle.

In particular, it is necessary to reduce fluid intake as much as possible (while avoiding dehydration of the body), as well as to exclude foods that contribute to fluid retention in the body (for example, salty, smoked, pickled foods, strong tea and coffee).

Excessive exercise is contraindicated. As an additional treatment, massage, acupuncture are prescribed, which help relieve pain. It is necessary to take medications, such as:

1. Diuretics (Furosemide). The action of the remedy is to remove the accumulated cerebrospinal fluid from the brain area. The drug should be used only as prescribed by the doctor and in the dosage indicated by him, since side effects may occur.
2. Preparations for the normalization of the activity of the nervous system (Glycine) are necessary to reduce the load on the brain, restore the function of the production of vital enzymes.

Most often, the child is prescribed the intake of Glycine or its analogues. The positive properties of the drug are a safe effect on the body, the absence of side effects. However, the drug has a sedative effect, which must be taken into account when taking it.

Surgery

In some cases, when the disease is severe and there is a risk of complications, the child needs surgical intervention.

This method of treatment is necessary if the cause of the development of the disease is tumor formation.

In this case, the child undergoes a trepanation of the skull, followed by removal of the tumor or foreign body. With the accumulation of excess fluid, a puncture of the brain is performed, or artificial holes are created in the vertebrae through which the cerebrospinal fluid is excreted.

Forecast

As a rule, the disease has a favorable prognosis and the child can be cured, however, the sooner therapy is prescribed, the better.

It is known that the disease is easier to treat in young children (in infants), therefore, when the first alarming signals are detected, it is necessary to show the child to a doctor.

Prevention measures

It is necessary to take care of the prevention of such a dangerous disease as hypertension syndrome even at the stage of pregnancy planning. In particular, the expectant mother must undergo an examination, identify and cure all her chronic diseases.

During the period of bearing a child, a woman must take care of her health, protect herself from viruses and infections, follow all the instructions of the doctor who observes the pregnancy.

Hypertension syndrome is a pathology associated with increased intracranial pressure.

This disease is very dangerous for children's health, occurs due to a variety of reasons and can lead to the development of dangerous consequences, up to the death of the child.

Pathology has a characteristic clinical picture, a set of pronounced signs, having discovered which, it is urgent to show the child to the doctor.

Treatment should be started as early as possible, since the prognosis for recovery depends on the timeliness of therapy.

About hypertension-hydrocephalic syndrome in infants in this video:

CHILDREN'S NEUROLOGY, PSYCHOLOGY AND PSYCHIATRY

FACTS AND MYSTERIES OF PERINATAL NEUROLOGY

although they are much closer. and therefore, - “seven neurologists have a child without a diagnosis. "

This article is over 13 years old, all this time it has been actively multiplying and spreading across sites and blogs (unfortunately, some sites and bloggers “forget” to indicate authorship and make a link)

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Key words: perinatal encephalopathy (PEP) or perinatal lesions of the central nervous system (CNS PP), hypertensive-hydrocephalic syndrome (HHS); Graefe's symptom, "setting sun" symptom; expansion of the ventricles of the brain, the interhemispheric fissure and subarachnoid spaces, lenticulostriate vasculopathy (angiopathy), mineralized (mineralizing) vasculopathy (angiopathy), pseudocysts on neurosonography (NSG), muscular dystonia syndrome (SMD), hyperexcitability syndrome, neonatal convulsions.

Despite free access to any scientific information, and so far more than 90%! children of the first year of life come for a consultation to specialized neurological centers about a non-existent diagnosis - perinatal encephalopathy (PEP). Pediatric neurology was born relatively recently, but is already going through difficult times. At the moment, many doctors practicing in the field of infant neurology, as well as parents of infants with any changes in the nervous system and mental sphere, are "between two fires". On the one hand, the position of the school of "Soviet child neurology" is still strong - overdiagnosis and incorrect assessment of the functional and physiological changes in the nervous system of a child in the first year of life, combined with long-outdated recommendations for intensive treatment with a variety of medications. On the other hand - often, an obvious underestimation of the existing psychoneurological symptoms, inability to strategically plan, ignorance of the possibilities of modern neurocorrection (orthopedics, ophthalmology, neuropsychology, speech therapy, defectology, etc.), therapeutic nihilism and fear of the practical application of modern methods of neurorehabilitation and drug therapy; and, as a result, lost time, unused internal reserves and the development of neuropsychiatric disorders in preschool and adolescence. At the same time, unfortunately, a certain “formality-automaticity” and “economicality” of modern medical technologies lead, at least, to the development of psychological problems in a child and his family members. The concept of "norm" in neurology at the end of the 20th century was sharply narrowed, now it is intensively and, not always justified, expanding. The truth is somewhere in the middle.

According to the perinatal neurologists of the country's leading medical centers, so far, at least 80-90%! children of the first year of life come in the direction of a pediatrician or a neurologist from the district clinic for a consultation about a non-existent diagnosis - perinatal encephalopathy (PEP):

The diagnosis of "perinatal encephalopathy" (PEP or perinatal lesion of the central nervous system (PP CNS), in the old days was very common in pediatric neurology and is extremely convenient: it described almost any, real or imaginary dysfunction (and even structure) of the brain in the perinatal period of the child's life (from about 7 months of intrauterine development of the child and up to 1 month of life after childbirth), arising from the pathology of cerebral blood flow and oxygen deficiency. two other favorite neurological diagnoses: MMD (minimal brain dysfunction) and VSD (vegetative-vascular dystonia).

The diagnosis of perinatal encephalopathy (PEP) was usually based on one or more sets of any signs (syndromes) of a possible disorder of the nervous system, for example, hypertensive-hydrocephalic syndrome (HHS), muscular dystonia syndrome (SMD), hyperexcitability syndrome.

After a thorough clinical examination, sometimes in combination with additional studies, the percentage of reliable diagnoses of perinatal brain damage (hypoxic, traumatic, toxic-metabolic, infectious, etc.) quickly decreases to 3-4% - this is more than 20 times! The most bleak thing in these figures is not only a certain reluctance of individual doctors to use the knowledge of modern neurology and conscientious delusion, but also the clearly visible, psychological (and not only) comfort of such overdiagnosis.

Hypertensive-hydrocephalic syndrome (HHS): increased intracranial pressure (ICP) and hydrocephalus

As before, the diagnosis is "hypertensive-hydrocephalic syndrome" (HHS) or "intracranial hypertension" (increased intracranial pressure (ICP)),

one of the most common and "favorite" medical terms among pediatric neurologists and pediatricians, which can explain almost everything! and at any age complaints of parents. This is extremely comfortable for the doctor!

For example, a child often cries and shudders, sleeps poorly, spit up a lot, eats poorly and gains little weight, goggles his eyes, walks on his toes, his hands and chin tremble, there are convulsions and there is a lag in psychoverbal and motor development: “only he is to blame - hypertensive-hydrocephalic syndrome (HHS) or increased intracranial pressure. Isn't it a very useful and convenient diagnosis?

Quite often, at the same time, “heavy artillery” is used as the main argument for parents - data from instrumental research methods with mysterious scientific graphs and numbers. Strict scientific medical terms look mysterious and impressive, forcing the unenlightened with even greater respect for medical conclusions.

A variety of methods can be used, either completely outdated and uninformative / echoencephalography (ECHO-EG) and rheoencephalography (REG) /, or examinations of the “wrong opera” (EEG), or incorrect, in isolation from clinical manifestations, subjective interpretation of the norm options with neurosonography or tomography. Especially recently, the subjective interpretation of the Dopplerographic parameters of cerebral circulation in NSG has become relevant. “Yes, the child has an increased venous blood flow rate, and the resistance index is lowered by as much as 0.12! This is the surest sign of hypertensive-hydrocephalic syndrome! - confidently declare to excited parents. “Look at the screen! Here - the left lateral ventricle increased by 2 mm in 2 months, and the right one, even by 2.5! This is very bad, a serious problem, we will treat!” - comes from the neurosonography room, and both parents slowly slide down the wall.

Only one "scientifically rigorous" entry in the description of the NSG - ". changes in the structure of periventricular tissues are also detected: on both sides, in the projection of the parenchyma of the subcortical nuclei, linear hyperechoic structures (thickened vessel walls) are visualized. Conclusion: Easy expansion of external cerebrospinal fluid spaces. Pseudocyst of the right choroid plexus. Lenticulostriate vasculopathy (angiopathy). mineralized (mineralizing) angiopathy (vasculopathy). echo signs of SEC (subependymal cyst) on the left, in CTV (caudothalamic notch) SEC "- can easily and thoroughly poison the life of any family, especially the "anxious purple" mother. Unhappy mothers of such children involuntarily, at the suggestion of doctors (or voluntarily, feeding on their own anxiety and fears), pick up the flag of "intracranial hypertension", begin to actively "treat" hypertensive-hydrocephalic syndrome (HHS) and for a long time get into the perinatal encephalopathy monitoring system.

In fact, intracranial hypertension is a very serious, and rather rare, neurological and neurosurgical pathology. It accompanies severe neuroinfections and brain injuries, hydrocephalus, cerebrovascular accident, brain tumors, etc.

Hospitalization is mandatory and urgent!

Intracranial hypertension (if it really exists) is easy to notice for attentive parents: it is typical for persistent or paroxysmal headaches (more often in the morning), nausea and vomiting not associated with food. The child, almost always, lethargic and sad, is constantly naughty, cries, refuses to eat, he always wants to lie down, cuddle up to his mother. The kid is really, really, bad; any attentive mother will immediately notice this

A very serious symptom can be strabismus or pupillary difference, and, of course, impaired consciousness. In infants, the bulging and tension of the fontanel, the divergence of the sutures between the bones of the skull, as well as the rapid, excessive increase in head circumference are very suspicious.

Without a doubt, in such cases, the child must be shown to specialists as soon as possible. Usually, one clinical examination is enough to exclude or, conversely, pre-diagnose this pathology. Sometimes it requires additional research methods (examination of the fundus, neurosonography, as well as magnetic resonance imaging or computed tomography of the brain (MRI and CTG).

Of course, the expansion of the interhemispheric fissure, cerebral ventricles, subarachnoid and other spaces of the liquor system in neurosonography images (NSG) or brain tomograms (computed tomography of the brain or magnetic resonance imaging) cannot serve as unambiguous evidence of intracranial hypertension. The same applies to disorders of cerebral blood flow isolated from clinical manifestations, detected by transcranial dopplerography of cerebral vessels, and even more so to “finger impressions” on a skull x-ray.

In addition, there is no direct and reliable connection between intracranial hypertension and translucent vessels on the face and scalp, tiptoeing, trembling of the hands and chin, hyperexcitability, developmental disorders, poor academic performance, nosebleeds, tics, stuttering, bad behavior, etc. d. etc.

That's why, if your baby was diagnosed with "perinatal encephalopathy (PEP) or perinatal lesion of the central nervous system (PP CNS), intracranial hypertension or hypertensive-hydrocephalic syndrome (HHS)", based on the "bulging" eye (not to be confused with the true symptom of Graefe , a symptom of the “setting sun”!) And tiptoeing, then you should not go crazy in advance. In fact, these reactions may be characteristic of excitable young children. They react very emotionally to everything that surrounds them and what happens. Sensitive parents can easily spot this relationship.

Thus, when receiving a non-existent diagnosis "perinatal encephalopathy (PEP) or perinatal damage to the central nervous system (PP CNS) and hypertension-hydrocephalic syndrome", before panicking and starting to actively stuff unnecessary pills into the baby, it is best to quickly get second expert opinion, and contact a neurologist with up-to-date knowledge in the field of perinatal neurology. It is then that you can finally make sure that there are no serious problems in the baby.

It is absolutely unreasonable to start treatment of this unspecified "serious" pathology on the recommendations of one doctor on the basis of the above "arguments", in addition, such unreasonable treatment may not be safe at all. Any medicines that “relieve intracranial hypertension”, prescribed unreasonably at this age, can be harmful! Side effects are very diverse: from a mild allergic rash to serious problems in the functioning of internal organs. Diuretic drugs alone, unjustifiably prescribed for a long time, have an extremely adverse effect on a growing organism, causing metabolic disorders.

But! There is another, no less important aspect of the problem that must be taken into account in this situation. Sometimes medicines are really necessary, and unlawful refusal of them, based only on the mother’s (and more often dad’s) own conviction of drug hazards, can lead to serious trouble. In addition, if there really is a serious progressive increase in intracranial pressure and the development of hydrocephalus, then often improper drug therapy for intracranial hypertension leads to the loss of a favorable moment for surgical intervention (bypass surgery) and the development of severe irreversible consequences for the child: hydrocephalus, developmental disorders, blindness , deafness, etc.

Now a few words about the no less "adored" hydrocephalus and hydrocephalic syndrome. In fact, we are talking about a progressive increase in intracranial and intracerebral spaces filled with cerebrospinal fluid (CSF) due to the existing one! at the time of intracranial hypertension. At the same time, neurosonograms (NSG) or tomograms reveal the expansion of the ventricles of the brain, the interhemispheric fissure, and other parts of the CSF system that change over time. It all depends on the severity and dynamics of symptoms, and most importantly, on the correct assessment of the relationship between an increase in intracerebral spaces and other changes in the nervous system. This can be easily determined by a qualified neurologist. True hydrocephalus, which does require treatment, as well as intracranial hypertension, is relatively rare. Such children must be observed by neurologists and neurosurgeons of specialized medical centers.

Unfortunately, in ordinary life, such an erroneous “diagnosis” occurs in almost every fourth or fifth baby. It turns out that often hydrocephalus (hydrocephalic syndrome), some doctors incorrectly call a stable (usually insignificant) increase in the ventricles and other cerebrospinal fluid spaces of the brain. It does not manifest itself in any way by external signs and complaints, it does not require treatment. Especially if hydrocephalus is suspected in a child based on a “large” head, translucent blood vessels on the face and scalp, etc. - this should not cause panic in parents. The large size of the head in this case plays almost no role. However, the dynamics of the increase in head circumference is very important (how many centimeters are added over a certain period of time. In addition, you need to know that among modern children, the so-called "tadpoles" are not uncommon, in which the head has a relatively large size for their age (macrocephaly). in most of these cases, babies with a large head show signs of rickets, less often - macrocephaly due to family constitution... For example, dad or mom, or maybe grandfather has a big head, in a word, it's a family affair, it does not require treatment.

Sometimes, during neurosonography, an ultrasound doctor finds pseudocysts in the brain - but this is not at all a reason for panic! Pseudocysts are called single rounded tiny formations (cavities) containing cerebrospinal fluid and located in typical areas of the brain. The reasons for their appearance, as a rule, are not known for certain; they usually disappear by 8-12 months. life. It is important to know that the existence of such cysts in most children is not a risk factor for further neuropsychic development and does not require treatment. However, although quite rare, cysts form at the site of subependymal hemorrhages, or are associated with previous perinatal cerebral ischemia or intrauterine infection. The number, size, structure and location of cysts provide specialists with very important information, taking into account which, on the basis of a clinical examination, final conclusions are formed.

Description NSG is not a diagnosis and not a reason for treatment!

Most often, NSG data give indirect and uncertain results, and are taken into account only in conjunction with the results of a clinical examination.

Once again, I must remind you of the other extreme: in complex cases, sometimes there is a clear underestimation on the part of parents (less often doctors) of the problems that the child has, which leads to a complete rejection of the necessary dynamic monitoring and examination, as a result of which the correct diagnosis is made late, and treatment does not lead to the desired result.

Therefore, if elevated intracranial pressure and hydrocephalus are suspected, diagnostics should be carried out at the highest professional level.

What is muscle tone and why do doctors and parents “love” it so much?

Look at your child's medical record: is there no such diagnosis as "muscular dystonia", "hypertension" and "hypotension"? - probably, you just didn’t go with your baby to a neurologist for up to a year. This is, of course, a joke. However, the diagnosis of "muscular dystonia" is no less common (and maybe more often) than hydrocephalic syndrome and increased intracranial pressure.

Changes in muscle tone can be, depending on the severity, both a normal variant (most often) and a serious neurological problem (much less often).

Briefly about the external signs of changes in muscle tone.

Muscular hypotension is characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity may be limited, muscle palpation is somewhat reminiscent of "jelly or very soft dough." Pronounced muscle hypotension can significantly affect the pace of motor development (for more details, see the chapter on motor disorders in children of the first year of life).

Muscular dystonia is characterized by a condition where muscle hypotension alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in individual muscle groups (for example, more in the arms than in the legs, more on the right than on the left, etc.)

At rest, these children may exhibit some degree of muscular hypotonia during passive movements. When you try to actively perform any movement, with emotional reactions, with a change in the body in space, muscle tone increases sharply, pathological tonic reflexes become pronounced. Often, such disorders further lead to improper formation of motor skills and orthopedic problems (for example, torticollis, scoliosis).

Muscular hypertension is characterized by increased resistance to passive movements and limitation of spontaneous and voluntary motor activity. Severe muscle hypertension can also significantly affect the rate of motor development.

Violation of muscle tone (muscle tension at rest) can be limited to one limb or one muscle group (obstetric paresis of the arm, traumatic paresis of the leg) - and this is the most noticeable and very alarming sign that makes parents immediately contact a neurologist.

It is sometimes quite difficult even for a competent doctor to notice the difference between physiological changes and pathological symptoms in one consultation. The fact is that a change in muscle tone is not only associated with neurological disorders, but also strongly depends on the specific age period and other features of the child's condition (excited, crying, hungry, drowsy, cold, etc.). Thus, the presence of individual deviations in the characteristics of muscle tone does not always cause concern and requires any treatment.

But even if functional disorders of muscle tone are confirmed, there is nothing to worry about. A good neurologist will most likely prescribe massage and physiotherapy exercises (exercises on large balls are very effective). Medications are prescribed extremely rarely, usually with severe muscle hypertension of a spastic nature.

Syndrome of hyperexcitability (syndrome of increased neuro-reflex excitability)

Frequent cries and whims with or without reason, emotional instability and hypersensitivity to external stimuli, sleep and appetite disturbance, profuse frequent regurgitation, restlessness and shuddering, trembling of the chin and arms (etc.), often in combination with a poor increase weight and impaired stool - do you recognize such a child?

All motor, sensory and emotional reactions to external stimuli in a hyperexcitable child arise intensely and abruptly, and can fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for some objects and capture them. Usually children show a keen interest in the environment, but increased emotional lability often makes it difficult for them to contact others. They have a fine mental organization, they are very impressionable, emotional and easily vulnerable! They fall asleep extremely badly, only with their mother, they constantly wake up, cry in their sleep. Many of them have a long-term fear reaction to communication with unfamiliar adults with active protest reactions. Usually hyperexcitability syndrome is combined with increased mental exhaustion and fatigue.

The presence of such manifestations in a child is just a reason to contact a neurologist, but in no case is it a reason for parental panic, and even more so, drug treatment.

Constant hyperexcitability is causally a little specific and can most often be observed in children with temperamental characteristics (for example, the so-called choleric type of response).

Much less often, hyperexcitability can be associated and explained by perinatal pathology of the central nervous system. In addition, if the child’s behavior suddenly and unexpectedly and for a long time was disturbed for almost no apparent reason, he developed hyperexcitability, it is impossible to exclude the possibility of developing a reaction of impaired adaptation (adaptation to external environmental conditions) due to stress. And the sooner the child is seen by specialists, the easier and faster it is possible to cope with the problem.

And, finally, most often, transient hyperexcitability is associated with pediatric problems (rickets, digestive disorders and intestinal colic, hernia, teething, etc.). Parents! Find the right pediatrician!

There are two extremes in the tactics of monitoring such children. Or an "explanation" of hyperexcitability with the help of "intracranial hypertension" in combination with intensive drug therapy, and even the use of drugs with severe side effects (diacarb, phenobarbital, etc.). At the same time, the need for treatment is “confidently” justified by the prospect of the child developing MMD (minimal cerebral dysfunction) and VSD (vegetative-vascular dystonia) in the future. Or vice versa, complete neglect of this problem (“wait, it will pass by itself”), which can eventually lead to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disorders) in a child and his family members, and will require long-term psychological correction. Of course, it is logical to assume that an adequate approach lies somewhere in between.

Separately, I would like to draw the attention of parents to convulsions - one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures do not occur often in infancy, but sometimes they proceed severely, insidiously and disguisedly, and, almost always, immediate drug therapy is necessary.

Such seizures can be hidden behind any stereotypical and repetitive episodes in the child's behavior. Incomprehensible shudders, head nods, involuntary eye movements, “fading”, “squeezing”, “softening”, “falling asleep”, especially with a stop in the gaze and lack of response to external stimuli, should alert parents and force them to turn to specialists. Otherwise, a late diagnosis and untimely prescribed drug therapy significantly reduce the chances of successful treatment.

All the circumstances of the episode of convulsions must be accurately and completely remembered and, if possible, recorded on video, for further detailed story at the consultation. Attention! The doctor will definitely ask these questions! If the convulsions last for a long time or recur, you need to call "03" and urgently consult a doctor.

At an early age, the state of the child is extremely changeable, therefore, minimal deviations in development and other disorders of the nervous system can sometimes be detected only in the process of long-term dynamic observation of the baby, with repeated consultations. For this purpose, specific dates for planned consultations by a pediatric neurologist in the first year of life have been determined: usually at 1, 3, 6 and 12 months. It is during these periods that most of the serious diseases of the nervous system of children in the first year of life (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.) can be detected. Thus, the identification of a specific neurological pathology in the early stages of development allows you to start complex therapy on time and achieve the maximum possible result.

And in conclusion, I would like to remind parents: be sympathetic and attentive to your kids! First of all, it is your active and meaningful interest in the lives of children that is the basis for their further well-being. Do not try to cure them of "supposed illnesses", but if something bothers and worries you, find an opportunity to get independent advice from a qualified specialist.