HYPERTENSIVE SYNDROME (grech, hyper-+ lat. tensio tension, tension; a syndrome) — the symptom complex caused by the stable or progressing increase in intracranial pressure. Tumors, abscesses, parasitic diseases of a brain, craniocereberal traumatic defeats (hematomas, bruises of a brain), hypostasis — swelling of a brain of various etiology (ischemic, toxic, neurogenic), and also the diseases leading to disturbance of outflow of liquid from ventricular system of a brain or balance between its products and a resorption (various forms of hydrocephaly, inflammatory diseases of a brain and its covers) cause G.'s development by page.
Clinical features of G. of page considerably depend on the mechanism of development of intracranial hypertensia. At localization of processes far from likvorny communications of G. of page develops gradually, and its intensity considerably is defined by rate of increase of pressure in a head cavity. When intracranial hypertensia is caused by blockade of outflow tracts of cerebrospinal liquid (a tumor, commissural process), G. is shown by page in the form of heavy attacks which are designated as gipertenzionno-gidrotsefalny or occlusal gidrotsefalny a syndrome (see. Occlusal syndrome).
The most characteristic wedge, symptoms at G. of page — a headache, nausea and vomiting. In late stages mental disturbances can appear.
The headache («arching», «breaking off») amplifying at physical. tension, arises at early stages of development of G. of page. In the beginning it has pristupoobrazny character, amplifying in the mornings. In process of development of a disease the headache accrues and becomes a constant. Quite often it is shown in the form of strong attacks. Attacks of headaches are followed by the expressed vegetative reactions (disturbances of thermal control, the increased perspiration), disorders of cardiovascular activity and breath. Strengthening or easing of a headache can be depending on position of the head and a body in this connection patients usually aim to keep optimum edgewise position or on spin. The pathogeny of a headache at G. is connected by page with irritation of receptors of the sensitive nerve fibrils put in a firm meninx, in walls of venous sine and intracranial blood vessels.
Vomiting at G. of page develops usually at later stages of its development. More often it arises in the mornings, on an empty stomach and quite often after a postural change of a body and is followed by dizziness. Sometimes shortly before approach of vomiting there is poorly expressed nausea. Frequency of vomiting depends on G.'s expressiveness of page, and its emergence is connected with irritation of nerve terminations and kernels of a vagus nerve. At considerable intracranial hypertensia with the phenomena of stagnation in a labyrinth there is reflex vomiting for pulse counting, going from his receptors to the emetic center in a myelencephalon. Such vomiting is followed by severe dizziness.
Mental disorders at G. are observed by page usually at late stages of its development and shown by decrease in intelligence and changes of the personality. At development of hypertensia gradual disturbance of consciousness («devocalization») is noted, a cut in the subsequent passes into a sopor and then into a coma. During hypertensive attacks the sudden loss of consciousness can be observed, edges is replaced by its complete recovery. One of the main pathogenetic factors of the specified frustration are changes of a brain blood-groove under the influence of the increased intracranial pressure.
Taha - or bradycardia also arises at late stages of development of G. of page. Bradycardia is, as a rule, noted in an end-stage of a disease. Disturbances of breath (change of depth and frequency) arise usually during an occlusal gidrotsefalnykh of attacks.
For G.'s identification by the village at a wedge, inspection use a number of special tool methods (a research of an eyeground, a X-ray analysis of a skull, an electroencephalography, tonometry of cerebrospinal liquid, a pneumoencephalography and a serial angiography). These methods allow to reveal degree and the nature of defeat, and also perspective of conservative or surgical treatment.
Changes on an eyeground in the form of congestive nipples or a secondary atrophy of optic nerves are the most important and objective indicators of G. of page (see. Eyeground ). Congestive nipples usually arise along with a headache, periodic vomiting or dizziness. In certain cases, especially at children, they can appear much earlier. Rate of increase and expressiveness of congestive nipples is defined by speed of increase in intracranial pressure, its extent and duration of existence. At slow increase in intracranial pressure developments of stagnation on an eyeground develop gradually, within several weeks or months. However in cases of acute development of hypertensia congestive nipples can reach considerable expressiveness within several days, at the same time they are followed by retinal apoplexies. At late stages of a disease the secondary atrophy of optic nerves develops. Apparently, the congestive nipple is a consequence of difficulty of venous outflow and circulation of liquid on perineural spaces with the increased intracranial pressure.
On roentgenograms of a skull (see. Skull, radiodiagnosis ) signs of increase in intracranial pressure are expressed as deepening of manual impressions in bones of a calvaria, osteoporosis of a dorsum sellae, deepening of pakhionovy poles etc. At children's age, in addition to these signs, there is an increase in the sizes of the head, thinning and expansion of cranial seams, smoothing of a relief of bones of a skull.
At a pneumoencephalography (see. Encephalography ) quite often there is no contrasting of subarachnoid spaces over parencephalons and there is a narrowing of tanks of the basis of a brain. At the page which is sharply expressed to G. the air entered endolyumbalno does not get into subarachnoid spaces.
At a cerebral serial angiography (see. Cerebral angiography ) lengthening of phases and time of a brain blood-groove is found. The last the it is more, than vyrazhenny G. of page. At the closed forms of hydrocephaly there is an expansion of a front brain artery, tension and straightening of average.
On EEG (see. Elektroentsefalografiya ) at the beginning of a disease appear a dizritmiya at safety of a reduced alpha rhythm, acute potentials, frequent fluctuations, low unstable delta waves; in process of G.'s deepening by the village dominance of delta waves increases. At the page expressed to G. on all areas of both cerebral hemispheres slow waves of the big period steadily dominate (1 — 2,5 fluctuations in 1 sec.) in the absence of alpha and beta fluctuations.
At intracranial hypertensia pressure of cerebrospinal liquid measured in strictly horizontal position of the patient can increase to 700 — 800 mm w.g. However height of pressure of cerebrospinal liquid — size very changeable and its single measurement not always reflects true degree of intracranial hypertensia.
Conservative treatment of sick G. of page consists in use of dehydrating agents of osmotic or diuretic action.
Surgical treatment is directed to elimination of the reasons which caused G.'s development by page (an oncotomy, abscess of a brain, a hematoma, recovery natural or creation of roundabout outflow of cerebrospinal liquid).
See also Intracranial pressure .
Bibliography: Problems of neurosurgery, intracranial гипертензия# under the editorship of> A. I. Arutyunov, t. 2, Kiev. 1955; Cerebral blood flow and intracranial pressure, Proc * 5-th Int. symp. on cerebral blood flou-regulation, metabolism, etL, by C. Fie-schi, pt 1 — 2, Basel, 1972; Intracranial pressure, ed. by M. Brock a. H. Dietz, B., 1972.
A. P. Romodanov, Yu. A. Zozulya.