Neurologist at SM-Clinic spoke about intracranial pressure

Why is pressure inside the skull needed, why can it be elevated, and how does this indicator relate to blood pressure? What are the norms and when is blood pressure dangerous to health and life, how to feel it and how to reduce it, let's talk with an expert ALENA PARETSKAYA
Pathophysiologist, immunologist, WHO expert POLINA PETROSYAN Neurologist at SM-Clinic, specialist in cerebrovascular diseases and headaches

What is intracranial pressure

The brain is surrounded by a fluid called cerebrospinal fluid, which nourishes and protects nerve cells.
Cerebrospinal fluid is continuously produced and flows away from the skull, thereby maintaining a constant pressure. This is intracranial pressure - a certain force that puts pressure on the brain and the walls of the skull. This pressure is changed in mmHg. Art., and normally it is from 10 to 15 mm. If it is higher, this is a reason to be wary, and if the pressure exceeds 25 mm Hg. Art., this can be dangerous for brain function. If the value is more than 35 mmHg. Art. Severe and irreversible changes in the brain are possible - such situations are considered critical.

Classification of conditions accompanied by low blood pressure.

1. Physiological hypotension is low blood pressure, which is a variant of the norm or is temporary.
2. Hypotension as an individual variant of the norm, i.e., a feature of a given person that does not cause him discomfort.
3. Hypotension due to increased training (in athletes).
4. Hypotension is adaptive (in residents of highlands, tropics and subtropics).
5. Pathological hypotension is a disease whose main manifestation is low blood pressure, a condition that requires diagnosis, mandatory treatment and observation.
6. Neurocirculatory hypotension (primary, which is an independent disease, most often caused by impaired vascular tone and vascular function).
7. Idiopathic orthostatic hypotension. An independent disease, the main symptom of which is a drop in pressure when changing body position.
8. Symptomatic (secondary) hypotension:
   acute form (with shock, collapse, fainting, allergic reaction);
9. chronic form;
10. a form with severe orthostatic syndrome, that is, with severe dizziness when changing body position.
11. Reduced blood pressure in diseases of the nervous system.

Causes of intracranial pressure in adults

Increased intracranial pressure (ICP) is not an independent disease, but a syndrome.
Doctors sometimes call it intracranial hypertension. Pressure inside the brain (similar to arterial pressure) fluctuates when the head is tilted back and forth or to the sides, during physical activity or sneezing. But it can increase to serious numbers in case of pathologies, and there are many of them. “ICP (intracranial pressure) occurs as a result of an increase in the volume of intracranial contents (cerebrospinal fluid or cerebrospinal fluid), tissue fluid, or the appearance of foreign tissue (tumors, cysts, brain abscess), says neurologist Polina Petrosyan.

In addition, the causes of increased ICP may be:

• traumatic brain injury;
• tumor;
• intracerebral hemorrhage;
• neuroinfections (encephalitis, meningitis).

“The cause may also be long-term use of drugs from the group of hormonal contraceptives, corticosteroids or antibiotics,” adds Dr. Polina Petrosyan.
Pressure increases because fluid is either produced in excess (for example, due to an infection that has spread to the brain or its membranes), or because fluid flows out of the skull through special pathways less easily. If volumetric processes develop in the cranial cavity (for example, a tumor grows or hemorrhage occurs), there will be less space for fluid, and its pressure will also increase.

Hypotension of training

Another form of hypotension that occurs in athletes and simply trained people is training hypotension. But reduced vascular tone does not play a role here, it’s just that the body of such people is constantly under increased stress and therefore is accustomed to working in an “economical” mode.

The main complaints with hypotension are decreased performance, irritability, bad mood, memory may deteriorate, the person becomes distracted, and finds it difficult to concentrate. Emotional instability, increased sensitivity to bright light or loud speech predominates. Headaches and dizziness are common manifestations.

Headache is often associated with fluctuations in atmospheric pressure, large meals, and prolonged standing. The pain is usually localized in the occipital region or frontal region, feels like heaviness, and as the pain increases, the patient feels as if there is “pressure from the inside” on the skull. Sometimes you may experience a feeling of heaviness in the stomach, bitterness in the mouth, loss of appetite, nausea, belching, heartburn, flatulence, constipation - that is, almost all gastrointestinal disorders. In addition, hypotensive men may have reduced sexual potency, and women often experience menstrual irregularities. However, menstruation is often painful.

Hypotonic people often feel tired even after just waking up. They have difficulty waking up in the morning, even after a long sleep, feeling sleepy. Activity and performance return to normal only after 2-3 hours, weakening again during the day. The peak activity of hypotensive patients usually occurs in the late afternoon. With increased physical activity, people with hypotension may experience an increase in pulse and heart rate, and sometimes there are unpleasant sensations in the heart area and shortness of breath, which sometimes make a person suspect that they have angina pectoris or other serious illnesses.

Many hypotensive people constantly yawn, but not because they are tired, but because they “don’t have enough air,” which sometimes causes fainting or darkening of vision when suddenly moving from a horizontal to a vertical position. Sensitivity to weather changes is also a hallmark of people with low blood pressure. Most often, they do not tolerate heat very well, and even worse is the autumn or spring off-season with cloudy weather and low atmospheric pressure. Such people feel best on sunny and frosty winter days with high atmospheric pressure or on warm sunny days in late spring or early autumn. In addition, hypotensive patients are sensitive to weather changes and changes in climatic conditions.

Symptoms of intracranial pressure in adults

In many cases, a slight increase in ICP may not manifest itself for a long time. If the pressure rises sharply or high enough, the following symptoms may occur:

• headache - it can be pressing or bursting, usually occurs in the morning, this pain has no clear localization, it can be felt in different parts of the skull;
• nausea and vomiting - they usually occur at the peak of the headache;
• drowsiness, malaise, general poor health;
• memory impairment (forgetfulness), attention disorders, problems with thinking;
• changes in the autonomic nervous system – surges in blood pressure, slow pulse, increased sweating;
• visual impairment up to complete blindness.

Symptoms may come on suddenly or develop gradually over weeks or months.

Motrin® for the treatment of headaches

Motrin® belongs to the group of non-steroidal anti-inflammatory drugs and provides a pronounced analgesic effect for headaches of various types and origins. This drug allows you to maintain the pain-relieving effect with just two doses per day: one tablet eliminates pain for 12 hours. The drug is intended for the symptomatic treatment of pain in adults and children over 15 years of age. Before using Motrin®, you should read the instructions for the drug and consult your doctor.

Up to contents

The information in this article is for reference only and does not replace professional advice from a doctor. To make a diagnosis and prescribe treatment, consult a qualified specialist.

Diagnostics

It is extremely difficult to suspect an increase in ICP based on external signs.
The doctor must know all the complaints and those facts from life that preceded the symptoms. This could be a hypertensive crisis, head injury, severe infection, kidney or liver problems. In order to confirm the diagnosis, the doctor will prescribe a number of studies to the patient: CT or MRI of the brain to evaluate the structure of all tissues of the skull, note the condition of the ventricles of the brain where cerebrospinal fluid accumulates;

• echoencephaloscopy to determine brain function;
• Ultrasound of the brain (mainly in children through the fontanelle);
• examination of the condition of the fundus by an ophthalmologist;
• spinal cord puncture with measurement of the pressure of the escaping cerebrospinal fluid (the cerebrospinal fluid itself is taken for analysis).

Infections

Some infectious diseases occur with virtually no symptoms, and their manifestations can easily be attributed to poor health associated with blood pressure. For example, if you are infected with the herpes simplex virus, cytomegalovirus, or Epstein-Barr virus, you may experience weakness, chills (due to a slightly elevated temperature), and pain in the head and muscles.

If it really was the herpes simplex virus, then within a day or two you will notice a rash on your lips (or on your genitals, in the case of genital herpes). With other infections, there may be no external symptoms at all, so the cause of the lethargic state will remain a mystery for a long time.

So those who have been tormented by symptoms of “pressure” for a long time, but motherwort and coffee do not help, should get tested for hidden infections.

Modern methods of treatment

In some cases, the patient does not require treatment; he is observed and treated for the underlying disease, which caused the increase in ICP.
If it is necessary to treat pathology, two approaches are used - conservative and surgical.

Conservative interventions are carried out for those patients whose ICP elevation is chronic and there is no significant deterioration of the condition over time. The basis of treatment is drugs that have a diuretic effect, which reduce the volume of fluid in the head. The specific medicine is determined by the level of pressure and the situation. In severe and acute processes, osmotic diuretics (mannitol) are used, in chronic cases - furosemide, hydrochlorothiazide, spironalactone. While taking them, you need to drink a potassium preparation - Asparkam, Potassium orotate, Panangin.

Surgical methods for treating increased ICP depend on the stage and severity of the disease. In acute situations, craniotomy is performed to reduce fluid pressure on the brain and drain excess fluid. Special shunts (tubes) are installed as planned, which drain fluid from the brain into the abdominal cavity.

How often should you check your blood pressure readings?

Blood pressure is usually measured when visiting a doctor (for example, a therapist). There is no need to specifically visit a specialist for this; it is enough to ensure that the pressure is measured at least once every 2 to 5 years, starting from the age of 18 (with normal blood pressure and no increased risk of cardiovascular diseases).

People over 40 years of age, and people 18–40 years of age at risk of high blood pressure, should have their blood pressure checked at a healthcare facility at least once a year. If a diagnosis of arterial hypertension has been established or a person has other risk factors for developing cardiovascular diseases, it is recommended to measure blood pressure more often and not neglect monitoring at home. Your doctor will help you choose a device for measuring blood pressure (tonometer).

For children 3 years of age and older, blood pressure is measured regularly during annual routine examinations.

Caution: The American Heart Association does not recommend the use of wrist- or finger-worn blood pressure monitors, which are less accurate.

If recommended, measure blood pressure at home twice a day on the left and right arm: in the morning before breakfast (but not immediately after waking up) and before taking any medications, and in the evening, preferably at the same time. In each case, you need to measure the pressure 2-3 times (at short intervals, 1-3 minutes) for a confident, accurate result. 30 minutes before, do not smoke, do not eat, do not drink coffee (and alcohol), do not exercise, and empty your bladder. During the measurement, you must sit in a comfortable position, leaning back in a chair or armchair, do not cross your legs and ankles, and do not talk. The arm on which the cuff is worn must be freed from clothing and held at heart level; it is most convenient to place it on a table or armrest of a chair. Don't forget to write down your measurement results.

Prevention of intracranial pressure in adults at home

Prevention of increased ICP is the prevention of various diseases affecting the cranial cavity.
This includes protection against infections that can affect the brain - vaccination against meningococcal and hemophilus influenzae infections, influenza vaccination. It is also necessary to treat various pathologies that can affect brain function. General recommendations are simple:

• follow a daily routine and lead the healthiest lifestyle possible;
• avoid head injuries;
• protect yourself from stress and nervous overload;
• Get enough sleep.