Intra cranial pressure. Began part 2
From the point of view of modern, civilized, evidential medicine, the increased intra cranial pressure is one of manifestations of a number of diseases. Diseases rare and very serious. Once again I emphasize: intra cranial hypertensia not an illness, not an independent disease, but only symptom of other quite concrete and certain diseases.
In order that VChD considerably raised, certain preliminary conditions have to be realized, for example sharply increase production of a likvor that occurs at meningitis and encephalitis. Any defeats of substance of a brain: the stroke, a tumor, abscess, a trauma - also influence all three factors, determining the VChD level, - and production of a likvor, and its absorption, and its circulation. Excess production of a likvor can be observed also at some very serious violations of a metabolism, for example at very severe forms of diabetes.
Nevertheless, absolutely concrete illness when increase of VChD is quite perceived, - hydrocephaly is. Hydrocephaly is, as a rule, connected with congenital anomalies of a brain, very active development of SMZh ever takes place, or the return absorption of a likvor is broken, or owing to certain anatomic defects its circulation or when the combination of these factors takes place is broken. Sometimes hydrocephaly happens also not congenital, and arises as complication after very serious illness (meningoentsefalit, for example) and neurosurgical interventions.the superfluous or not finding a way out SMZh presses
At hydrocephaly on brain ventricles, they seriously extend, the consequence of all this is the prompt growth of the sizes of the head, the corresponding increase in the sizes of fontanels, a divergence of seams between skull bones. Hydrocephaly happens different degree of expressiveness. The compensated forms when mental development does not suffer and symptoms are shown moderately, treated conservatively, the special drugs which are reducing production of a likvor and intensifying its outflow, and at heavy options of an illness perform rather difficult neurosurgical operations.to
It is clear that hydrocephaly does not happen suddenly - i.e. walked to itself the child normal in every respect walked, and suddenly on you - out of the blue hydrocephaly happened. Hydrocephaly - an illness congenital, and its symptoms are shown in the first months of life.
As the main symptom of hydrocephaly - fast increase in the sizes of the head, measurement of a circle of the head are included into standards of any routine inspection, beginning, certainly, from the moment of the birth. Here it is very important to emphasize that not the concrete, expressed in centimeters size, namely dynamics of this indicator matters. I.e. ascertaining of that fact that at the boy Petya in 3 months the circle of the head is equal even 45 cm, - at all not an occasion to be depressed and to urgently rescue this boy. And here the fact that the circle of the head grew for the last month by 7 cm is already and is disturbing, and it is dangerous, demands both the serious relation, and active control. Once again I will emphasize - not treatments immediate, namely control. And if the tendency remains - then already and to take measures.
Nevertheless hydrocephaly to which we devoted the whole four paragraphs - the illness rather rare and meets frequency of 1 a case on
Here one more problem appears. When at the child in sizes the head, so increase of VChD everything quickly increases it is visible - as presses... And when all it seems as is normal, and the doctor looked and speaks - an elevated pressure, it is necessary to treat, how he learned about it? On the basis of what parameters, indicators, symptoms?
So far as concerns increase of arterial pressure at the grandmother, so here everything is seemingly clear - got the device (tonometer) measured - yes, a hypertension - 190 on 120. Treated, measured once again - we see, unambiguously it became better - 160 on 90 - means, treated not for nothing and the correct drugs... Plus to everything, improvement was not limited only to change of figures. To the grandmother it was really bad - the head hurt, could not even rise, and now where it, actually? In shop behind potato ran - well it precisely means what helped...at
A with VChD how to be - where to take the magic device that showed - here, mummy, look what VChD high. Here drugs - escape. You will come in a week, we will measure once again, there it will be visible.should recognize
I with grief here: there is no such device! Neither magic, nor real, nor expensive, nor cheap - any is not present!by
At all surprising progress of medical science, at all variety of the special equipment it is authentically possible to measure VChD only in one way: to enter a needle or into the spinal canal (a lumbar puncture), or into brain ventricles. After the likvor begins to follow from a needle, the elementary manometer - the graduated glass tubule is connected. Measurement is carried out by the same principle, as in the ordinary home spirit or mercury thermometer: level of liquid (likvor) corresponds to a concrete hyphen and concrete figure on a glass tubule. Pressure of cerebrospinal fluid can be measured in millimeters of a water column. By the way, it is necessary to notice that so far among scientists there is no unambiguous opinion concerning what VChD to consider normal. One claim that norm - from 80 to 140 mm w.g., others insist that borders of norm are much wider and pressure can quite fluctuate from 60 to 200 mm w.g. The given norms - for horizontal position of a body. If the patient sits, norms absolutely others.
But the main thing for us not in concrete figure, and in ascertaining of that fact that easy, available, convenient and at the same time reliable ways of measurement of VChD do not exist. It is clear that any talk on punctures in the conditions of policlinic - is simply frivolous.
, nevertheless, the inspection methods allowing to draw a conclusion about size VChD on a number of indirect signs Exist.
One of such methods - ultrasonic research (ultrasonography) of a brain. This method is not used at adults as the ultrasound cannot get through skull bones. At children a situation absolutely other as there is a fontanel - a remarkable window for ultrasound. Neyrosonografiya, namely ultrasonography of a brain so is called, - a method available and absolutely safe. He allows to estimate the sizes of ventricles of a brain, and increase in these sizes can be quite regarded as an indirect sign of the raised VChD. At the same time, as well as concerning a head circle, width of ventricles of a brain how many the loudspeaker of this indicator matters not so much.
After closing of a fontanel can see and estimate the sizes of ventricles of a brain only by means of a tomography - computer (KT) or magnitno - resonant (MRT). At the same time a tomography - the method serious, unsafe, darling, it is applied infrequently - only at real suspicions on serious intra cranial pathology.
One more method - outdated, but still applied rather widely - an ekhoentsefalografiya (EKHOEG). By means of the special device (ekhoentsefalograf), by means of the same ultrasound, a number of parameters, including a pulsation of vessels of a brain is estimated. At the same time amplitude of fluctuations of an ultrasonic signal is considered as the indicator capable to give an assessment to VChD.Once again we emphasize
: all listed methods are not reliable, they do not state, do not claim, and only allow an opportunity, assume, allow to suspect increase of VChD.
Here also turns out as a result: the inspection methods existing today only give the doctor additional information to reflection, but cannot place points over i. Means, to rely to fall generally on concrete symptoms. There are problems: it to you not the grandmother who at an elevated pressure lies and at normal - runs on shops. This child juvenile, more precisely, low-monthly, which unreasonable and on anything specifically not complaining.
But problems not only at age and inability to point a finger at that place where hurts. The main problem is that practically all symptoms allowing to suspect increase of VChD at the child can occur at absolutely healthy children.
So, for example, the concern of the child, trembling of extremities, screaming can be manifestations of the raised VChD, but can quite not have to VChD in general any relation. And any mother can confirm it because to find the child, always quiet and at which ever nothing would shiver it is simply impossible. One more symptom of increase of VChD - squint, but is well-known that at children of the first year of life glazodvigatelny muscles and infantile squint pretty often the phenomenon physiological, i.e. absolutely normal are not created yet.Should recognize
, nevertheless: such words as “concern“, “trembling“, “screaming“ and “squint“, are not capable to frighten seriously average domestic mummy as at all very famous and are often applied in life.by
Quite another matter when from lips of the doctor are heard or in an out-patient card found such terrible expressions as “a symptom Gref“ or “a spontaneous reflex of Moro“, - here any more not to jokes and not to tranquility: it is clear that a situation serious.
we Will try to explain an essence of these wise words.
a symptom Essence Gref - lag of an upper eyelid at the movement from top to bottom an eyeball. In additional translation into Russian it means that when the child looks down, it is frightened, over an iris of the eye of eyes several millimeters of a white of the eye are visible. Looks as a goggle eye. If the child looks directly, then everything is normal.
the German ophthalmologist Living in the 19th century Gref described this symptom as typical for patients with a craw (damage of a thyroid gland). At people, a craw not of patients, the symptom Gref can also take place and be constitutional feature, it can be found in premature babies.
Moro`s Reflex, or an embrace reflex, - belongs to physiological reflexes of the period of a neonatality. Arises at blow to a table on which the child lies, at a sudden loud sound, at pat of the kid on buttocks or hips. The reflex consists of two phases. In the first the child leans back back, develops shoulders, and a helpless gesture is made in the parties. In the second phase it cramps hands on a breast. It is clear, that the spontaneous reflex of Moro is when no special external irritants existed, and the child of a hand throws back... But lack of “special external irritants“ - concept conditional. Because the office of the doctor - a new situation, an unfamiliar table, others aunt - the doctor can quite be such not so “special“, but quite significant irritant...with
It seems that we absolutely got entangled: promised to explain why the diagnosis of increase of VChD and treatment of it are so distributed, and came to the conclusions absolutely opposite. It appears, additional methods of research and data of survey in most cases do not allow to diagnose increase of VChD with confidence. And in situations when such confidence is present, the speech practically always goes about extremely dangerous diseases (hydrocephaly, meningitis, a tumor, cherepno - a brain trauma) and extremely disturbing symptoms (a sharp vybukhaniye of a fontanel, frustration of consciousness, vomiting, paralyzes).we Will sum up of
the main outcomes.
- the Raised VChD - not an illness, but a symptom of some diseases.
- Increase of VChD - rare and very dangerous symptom of rare and very dangerous diseases.
- Treatment of the raised VChD has no relation to out-patient medicine, practically always demands hospitalization and the urgent help.
in conclusion of article we will distract for a while from medicine and we will address to... to linguistics. The purpose - curious features of the use of the word “intra cranial“. The matter is that the phrase “intra cranial pressure“ in household communication medical of the grounded mummies meets less frequently. The word “pressure“ falls as superfluous, and everything is amicable “check intra cranial“, “treat intra cranial“ and “complain on intra cranial“.Similar pieces experts in the field of linguistics (linguists) call
conversion, or transition of one part of speech to another. Phenomenon this not so unique. Let`s remember at least “ice cream“, “aspic“ or is closer to medical subject - “laxative“, “ambulance“, “newborn“. Well, who tells “sleeping medicine“ now? Nobody says yes because and it is so clear about what the speech. Instead of “nursery“ - just “children`s“, instead of “a bakery a bench“ - the “bakery“ which already became habitual.
Main what conversion testifies to, - about extreme prevalence of a certain word. Conversion in relation to distressful intra cranial pressure - the phenomenon, alas, sad because confirms quite unpleasant tendency: too often began to speak about intra cranial pressure, unfairly often. With skill operates with this concept grandmothers on shops. They also will make the diagnosis on a head circle, more precisely, by the cap size and how to treat - too know. There is a strong wish that such conversion was in our life less. That the phrase “intra cranial pressure“ sometimes and on business was said by experts, and grandmothers about intra cranial did not know in general, having concentrated the attention on somnolent and jellied.