Intracranial hypertension syndrome ICD code 10. Hypertension syndrome: causes and methods of treatment. Causes, treatment and prognosis for cerebral dystonia

The name of the disease consists of two Greek words “over” and “tension”. Characterized by increased intracranial pressure.

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

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

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

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

All-Russian classifiers

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

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

International classifiers

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

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

Symptoms and signs

For timely initiation of therapy for intracranial hypertension, it is important to recognize the disease. To do this, you need to understand how it proceeds, how it is characterized, and what to pay attention to.

Symptoms manifest differently in children and adults.

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

• Frequent vomiting not associated with food intake.
• Intermittent sleep.
• Restlessness, crying and screaming for no apparent reason.
• Swollen fontanelles without pulsation.
• Muscle hypertonicity.
• Increase in head size, protruding forehead.
• Dehiscence of cranial sutures.
• Syndrome, the so-called setting sun.
• Visualization of veins on the head.
• Developmental delay from age norms.

In children aged 1 to 2 years, the process of overgrowing of the fontanelles stops, which leads to more severe symptoms. Fountaining vomiting, fainting, and convulsions are observed.

Over the age of 2 years, the child may complain of headache, feel pressure in the eye area from the inside of the skull. The patient's tactile sensations, smell perception are impaired, vision is reduced, and motor function is impaired.

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

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

• Attacks of severe headache, which worsens in the evening.
• Nausea.
• Irritability.
• Fatigue with minor exertion.
• Dizziness and fainting states.
• Dark circles under the eyes.
• Increased sweating, so-called hot flashes.
• The pupils do not react to light.

This condition needs treatment.

Diagnostics

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

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

Treatment

Therapy is carried out using several methods:

• Medication, which consists of prescribing diuretics to remove fluid from the body. The use of sedatives, painkillers, antipsychotic and nootropic drugs, vitamins.
• The surgical method allows you to divert the cerebrospinal fluid or clear the path for its drainage.
• Not drug therapy requires adherence to a salt-free diet and drinking regimen. A complex of exercise therapy, acupuncture, and massage are prescribed.

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

Drugs

The following medications are used in the treatment of ICH: levulose, caffeamine, sorbilact, mannitol.

Stagnation forms, which causes pressure on the brain.

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

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

Factors of influence

The most common causes of intracranial hypertension are:

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

Indirect causes provoking the disorder:

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

In adults, the following factors are also identified:

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

Excess weight may be an indirect cause of intracranial hypertension

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

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

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

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

Symptoms

Based on the influencing factors, the following group of symptoms of intracranial hypertension found in adults has been identified:

• headache;
• “heaviness” in the head, especially at night and in the morning;
• vegeto vascular dystonia;
• sweating;
• tachycardia;
• fainting state;

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

Signs of intracranial hypertension in a child are separately identified, although a number of the listed symptoms also appear here:

• congenital hydrocephalus;
• birth injury;
• prematurity;
• infectious disorders during fetal development;
• increase in head volume;
• visual sensitivity;
• dysfunction of the visual organs;
• anatomical abnormalities of blood vessels, nerves, brain;
• drowsiness;
• weak sucking;
• loudness, cry.

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

The disorder is divided into several types. Thus, benign intracranial hypertension is characterized by increased cerebrospinal fluid pressure without changes in the state of the cerebrospinal fluid itself and without stagnant processes. Visible symptoms include swelling of the optic nerve, which provokes visual dysfunction. This type does not cause serious neurological disorders.

Intracranial idiopathic hypertension (refers to chronic form, develops gradually, also defined as moderate ICH) is accompanied by increased cerebrospinal fluid pressure around the brain. Has signs of the presence of an organ tumor, although in fact there is none. The syndrome is also known as pseudotumor cerebri. The increase in cerebrospinal fluid pressure on the organ is caused precisely by stagnant processes: a decrease in the intensity of the processes of absorption and outflow of cerebrospinal fluid.

Diagnostics

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

1. First, you need to measure intracranial pressure. To do this, special needles connected to a pressure gauge are inserted into the spinal canal and into the fluid cavity of the skull.
2. An ophthalmological examination of the condition of the eyeballs is also carried out to determine the blood content of the veins and the degree of dilation.
3. Ultrasound examination of cerebral vessels will make it possible to determine the intensity of the outflow of venous blood.
4. MR and CT scan are carried out in order to determine the degree of rarefaction of the edges of the ventricles of the brain and the degree of expansion of the fluid cavities.
5. Encephalogram.

Computed tomography is used to diagnose intracranial hypertension

The diagnostic set of measures in children and adults differs little, except that in a newborn, a neurologist examines the condition of the fontanel, checks muscle tone and takes measurements of the head. In children, an ophthalmologist examines the condition of the fundus of the eye.

Treatment

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

Treatment of intracranial hypertension can be conservative or surgical. Benign intracranial hypertension may not require any therapeutic measures at all. Unless in adults, diuretic medication is required to increase fluid outflow. In infants, the benign type goes away over time, the baby is prescribed massage and physiotherapeutic procedures.

Sometimes small patients are prescribed glycerol. Oral administration of the drug diluted in liquid is provided. The duration of therapy is 1.5-2 months, since glycerol acts gently and gradually. In fact, the medicine is positioned as a laxative, so it should not be given to a child without a doctor’s prescription.

If medications don't help, bypass surgery may be needed.

Sometimes a spinal puncture is required. If drug therapy does not bring results, it may be worth resorting to bypass surgery. The operation takes place in the neurosurgery department. At the same time, the causes of increased intracranial pressure are eliminated surgically:

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

At the slightest suspicion of the development of ICH syndrome, you should immediately see a specialist. Especially early diagnosis with subsequent treatment are important in children. Failure to respond to a problem in a timely manner will result in various disorders, both physical and mental.

The information on the site is provided for informational purposes only and does not constitute a guide to action. Do not self-medicate. Consult your healthcare provider.

G93.2 benign intracranial hypertension

ICD-10 diagnosis tree

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

Diseases and syndromes related to ICD diagnosis

Titles

Description

Symptoms

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

With a significant increase in intracranial pressure, disturbances of consciousness are possible, seizures, visceral-vegetative changes. With dislocation and herniation of brain stem structures, bradycardia, respiratory failure occur, pupillary response to light decreases or disappears, and systemic blood pressure increases.

Causes

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

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

The most common dislocation syndromes are:

* displacement of the cerebral hemispheres under the falciform process.

* displacement of the cerebellar tonsils in the foramen magnum.

When the cerebrospinal fluid pressure increases to 400 mm water. (about 30 mm), cerebral circulation and cessation of bioelectrical activity of the brain are possible.

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

Short description

Benign intracranial hypertension (BIH) is a heterogeneous group of conditions characterized by elevated ICP without evidence of an intracranial lesion, hydrocephalus, infection (eg, meningitis), or hypertensive encephalopathy. ADHD 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 obese women of childbearing age is 19/37% of cases are registered in children, 90% of whom are aged 5–15 years, very rarely younger than 2 years. Peak development of the disease is 20–30 years.

Symptoms (signs)

Clinical picture Symptoms Headache (94% of cases), more severe in the morning Dizziness (32%) Nausea (32%) Changes in visual acuity (48%) Diplopia, more often in adults, usually due to paresis of the abducens nerve (29%) Neurological disorders usually limited to the visual system Papilledema (sometimes unilateral) (100%) Abducens nerve involvement in 20% of cases Enlarged blind spot (66%) and concentric narrowing of visual fields (blindness is rare) Visual field defect (9%) Initial form may accompanied only by an increase in the occipito-frontal circumference of the head, often goes away on its own and usually requires only observation without specific treatment Absence of disorders of consciousness, despite high ICP Concomitant pathology Prescription or withdrawal of glucocorticosteroids Hyper-/hypovitaminosis A Use of other drugs: tetracycline, nitrofurantoin, isotretinoin Sinus thrombosis Dura mater SLE Disorders menstrual cycle Anemia (especially iron deficiency).

Diagnostics

Diagnostic criteria CSF pressure above 200 mm water column. Composition of the cerebrospinal fluid: decreased protein content (less than 20 mg%) Symptoms and signs associated only with increased ICP: papilledema, headache, absence of focal symptoms (acceptable exception - abducens nerve palsy) MRI/CT - without pathology. Acceptable exceptions: Slit-like shape of the ventricles of the brain; Increased size of the ventricles of the brain; Large accumulations of cerebrospinal fluid above the brain in the initial form of ADHD.

Research methods MRI/CT with and without contrast Lumbar puncture: measurement of cerebrospinal fluid pressure, analysis of cerebrospinal fluid at least for the protein content of CBC, electrolytes, PT Examinations to exclude 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 (dural sinus thrombosis) or partial obstruction, Behcet's syndrome Meningeal carcinomatosis.

Treatment

Diet tactics No. 10, 10a. Restrict fluid and salt intake Repeat a thorough ophthalmological examination, including ophthalmoscopy and visual field testing with assessment of the size of the blind spot Observation for at least 2 years with repeated MRI/CT to exclude a brain tumor Discontinuation of drugs that can cause ADHD Weight loss body Careful outpatient monitoring of patients with asymptomatic ADHD with periodic assessment of visual functions. Therapy is indicated only in 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 the pressure of the cerebrospinal fluid); if ineffective, the dose can be increased to 320 mg/day Acetazolamide 125–250 mg orally every 8–12 hours If ineffective, dexamethasone 12 mg/day is additionally recommended, but the possibility of weight gain should be taken into account.

Surgical treatment is carried out only in patients resistant to drug therapy or with threatening vision loss Repeated lumbar punctures until remission is achieved (25% after the first lumbar puncture) Lumbar shunting: lumboperitoneal or lumbopleural Other methods of shunting (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. Loss of vision is possible without previous headache and papilledema.

Synonym. Idiopathic intracranial hypertension

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

Application. Hypertension-hydrocephalic syndrome is caused by an increase in cerebrospinal fluid pressure in patients with hydrocephalus of various origins. It manifests itself as headache, vomiting (often in the morning), dizziness, meningeal symptoms, stupor, and congestion in the fundus. Craniograms reveal deepening of the digital impressions, widening of the entrance to the sella turcica, and an intensification of the pattern of diploic veins.

Arterial hypertension ICD 10

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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 (hypertension primarily affecting the heart) I 11

With (congestive) heart failure I 11.0

Without (congestive) heart failure I 11.9

Hypertensive (hypertensive) disease with predominant kidney damage I 12

With renal failure I 12.0

Without renal failure I 12.9

Hypertensive (hypertensive) disease with predominant damage to the heart and kidneys I 13

With (congestive) heart failure I 13.0

With predominant damage to 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

Vegetative-vascular dystonia code according to ICD-10

Home -> Types of VSD -> Vegetative-vascular dystonia code according to ICD-10

The fact is that the International Classification of Diseases (ICD 10) does not include diseases such as vegetative-vascular dystonia and neurocirculatory dystonia. Official medicine still refuses to recognize VSD as a separate disease.

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

For example, with VSD according to hypertensive type may be diagnosed with arterial hypertension (hypertension). Accordingly, the ICD-10 code will be I10 (primary hypertension) or I15 (secondary hypertension).

Very often, VSD 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 must be made by a psychiatrist or neuropsychiatrist.

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

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 if the patient’s blood pressure is higher normal level. Further, any hypertension requires the necessary set of additional examinations to determine the cause, identify the affected organ, stage and type of disease.

There is no difference between the terms “hypertension” and “hypertension”. It is a historical fact that in the USSR hypertension was what was called hypertension in Western countries.

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

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

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

What is considered hypertension?

To distinguish normality from pathology, the numerical values ​​​​of the International Society of Hypertension are taken as a basis. They are distinguished taking into account the measurement of upper and lower pressure in mm of mercury:

• optimal blood pressure is below 120/80;
• normal blood pressure - below 135/85;
• the normal threshold before blood pressure increases is 139/89.

Degrees arterial hypertension:

• 1 degree -/90-99;
• 2nd degree -/;
• 3rd degree - above 180/110.

Systolic hypertension is defined separately when the upper pressure is above 140 and the lower pressure is less than 90.

These numbers need to be remembered

Types of classifications

ICD-10 distinguishes various 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. Subtypes of hypertension are associated with the presence or absence of heart and kidney failure.

• no symptoms of internal organ damage;
• 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, retinal retinopathy).

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

• transient - a one-time increase in blood pressure was noted during a stressful situation, there were no changes in internal organs, the vessels in the fundus were without pathology, the pressure returned to normal on its own without treatment;
• labile - more stable, does not decrease on its own, requires medications, narrowed arterioles are detected in the fundus, left ventricular hypertrophy is detected during cardiac examination;
• stable - high persistent blood pressure numbers, pronounced cardiac hypertrophy and changes in the arteries and veins of the retina;
• malignant - begins suddenly, develops quickly to high level Blood pressure that is difficult to treat (especially characterized by an increase in diastolic pressure up to) sometimes manifests itself as complications: myocardial infarction, stroke, retinal vascular angiopathy.

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 - appear clinical complications hypertension.

Why does hypertension develop?

In Russia, doctors continue to use the division of hypertension (hypertension) into hypertension and symptomatic hypertension that arises from various diseases 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 increased blood pressure. But in 90% of cases, true hypertension is confirmed.

Let's look at the causes of arterial hypertension and the distinctive symptoms of various diseases.

Children also have their blood pressure measured.

Neurogenic hypertension - develops with damage to the brain and spinal cord as a result of disruption of the function of control over vascular tone. It manifests itself in injuries, tumors, and cerebral vascular ischemia. Characteristic symptoms: headaches, dizziness, convulsions, drooling, sweating. The doctor detects eye nystagmus (twitching of the eyeballs), a bright skin reaction to irritation.

Nephrogenic (renal) hypertension is possible in two types.

• Renal parenchymal - formed during inflammatory diseases of the renal tissue ( chronic pyelonephritis, glomerulonephritis, polycystic disease, renal tuberculosis, kidney stones, traumatic injury). Hypertension does not appear in initial stage, and when chronic renal failure develops. The patients are young, have a malignant course, and do not have damage to the brain or heart.
• Vasorenal - depends on damage to the vessels of the kidneys. In 75% of cases, it is formed due to atherosclerotic changes, leading to narrowing of the renal artery and impaired nutrition of the kidneys. More than possible quick option due to thrombosis or embolism of the renal artery. In the clinic, lower back pain predominates. There is no response to conservative therapy. Urgent surgical treatment is required.

Adrenal hypertension 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 and norepinephrine. The course of the disease is characterized by crises with high blood pressure numbers, 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 syndrome is a tumor that produces glucocorticoid hormones, manifested by obesity, a round, moon-shaped face, persistent high blood pressure, a benign, crisis-free course.

Pathology of the endocrine system includes hypertension due to thyrotoxicosis (increased thyroid function). Complaints of palpitations are typical, heavy sweating. Upon examination, changes in the eyeball (exophthalmos) and hand tremors can be detected.

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

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

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

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

• Absence of predominant lesions in the “working” age group. Symptomatic hypertension occurs more often in young patients under 20 years of age and in elderly patients over 60.
• More typical is a rapid increase in blood pressure and the development of persistent arterial hypertension (tendency to a malignant course).
• By carefully questioning the patient, signs of other relevant diseases can be identified.
• Difficulty selecting standard drug therapy suggests an atypical form of hypertension.
• A significant increase in lower pressure is more typical for kidney disease.

Diagnostics

Diagnosis of symptomatic hypertension comes down 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 identify kidney diseases, blood tests are performed 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, and radioisotope scanning of the kidneys.

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

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

It is mandatory to study the heart (ECG, ultrasound, phonocardiography, Doppler observation), the fundus of the eye, 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 following scheme:

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

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

For symptomatic hypertension, the same treatment is prescribed, but the main focus is on the effect on the affected organ that caused the increase in blood pressure.

In the case of renal parenchymal hypertension, treatment of the inflammatory process and renal dialysis in case of failure are carried out. Conservative therapy will not help in the treatment of vascular changes. Surgery to remove the blood clot, balloon dilatation, placement of a stent in the renal artery, or removal of part of the artery and replacement with a prosthesis is required.

Video about resistant hypertension:

Treatment endocrine pathology associated with a preliminary determination of the level of specific hormones and the prescription of replacement therapy or antagonist drugs, restoration of the electrolyte composition of the blood. Lack of treatment effect requires surgical removal tumors.

Narrowing of the aorta rarely leads to a severe course of the disease; it is usually detected and treated promptly 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, development of heart failure;
• cerebrovascular accident (stroke);
• damage to the blood vessels of the retina, leading to blindness;
• the appearance of renal failure.

Prevention of arterial hypertension requires from childhood healthy eating, without excesses, limiting animal fats and increasing 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 effective treatment.

Secondary hypertension ICD 10 code

Classification and treatment methods for hypertension

Hypertension, or hypertension, is an increase in systolic and diastolic pressure, a violation of the regulation of blood circulation. The development of pathology is provoked by dysfunction of higher centers of vascular regulation. Among arterial hypertension, hypertension occurs in 95% of cases, the remaining 5% are symptomatic hypertension.

Causes

Blood pressure increases due to stress, when the higher nerve centers of the brain produce excessive amounts of hormones. As a result, a person experiences spasm of peripheral arterioles, retention of sodium ions and fluid in the blood. This leads to an increase in blood volume in the vessels and a sharp increase in blood pressure. Next, blood viscosity increases, the walls of blood vessels thicken, the lumen decreases, chronic high blood pressure forms, and arterial hypertension becomes stable.

According to the International Classification of Diseases ICD-10, arterial hypertension is coded I10 (primary) and I15 (secondary). In ICD-10, hypertension is classified as diseases belonging to classes I10 to I15.

Risk factors for hypertension:

• diseases of the kidneys and urinary system;
• diabetes;
• smoking;
• excessive alcohol consumption;
• hereditary predisposition;
• salt abuse;
• lack of magnesium in the body;
• lack of vitamin D;
• chronic stress;
• intoxication with harmful metals when working in hazardous industries;
• sedentary lifestyle and lack of physical activity;
• taking hormonal contraceptives;
• pauses in work respiratory system during sleep.

In addition, 1% of patients with hypertension are diagnosed with endocrine diseases:

• deficiency or excess of thyroid hormones;
• pheochromocytoma - single tumors of the adrenal medulla;
• Cushing's syndrome - increased levels of glucocorticoid hormones of the adrenal cortex in the blood;
• primary hyperaldosteronism – clinical syndrome excessive production of aldosterone by the adrenal glands;
• Primary hyperparathyroidism is excessive production of parathyroid hormone.

With the development of hypertension, the permeability of the walls of blood vessels increases, and they become saturated with plasma. As a result, arteriosclerosis develops, which causes irreversible changes in the tissues of the body.

Classification

Classification according to ICD-10 includes several parameters:

• in terms of stability of blood pressure increase;
• in terms of increased diastolic pressure;
• in the course of development;
• on target organ damage.

Based on the level and stability of increased blood pressure, the following degrees of hypertension are distinguished:

• I degree – soft. There is a slight increase in pressure - from 140/90 to 160/99 mmHg. Does not require treatment, since blood pressure increases briefly and stabilizes on its own;
• II degree – moderate. Caused by an increase in blood pressure from 160/100 to 180/115 mmHg. To normalize blood pressure, drug treatment is required;
• III degree – severe. The blood pressure level reaches 180/120 mmHg and higher. It is characterized by a malignant course and is difficult to respond to medications.

During the course of the disease, with mild progression, three stages are distinguished:

• Stage I – transient. It is characterized by an unstable increase and decrease in blood pressure, fluctuating between 140/95–180/105 mmHg. Sometimes minor hypertensive crises are observed; there are no pathological disorders in the central nervous system and other organs;
• Stage II – stable. An increase in blood pressure from 180/100 to 200/115 mmHg is recorded. Hypertensive crises are appearing more and more often; examinations reveal organ damage and cerebral ischemia;
• Stage III – sclerotic. At this stage of hypertension, blood pressure rises to 230/130 mmHg and above. Hypertensive crises become severe and frequent manifestations, damage to internal organs is observed. Central nervous system disorders threaten the patient's life.

Depending on the predominance of lesions in the heart, brain and kidneys, the following clinical and morphological forms are noted:

• cardiac;
• renal;
• brain;
• mixed.

Symptoms

Hypertension, depending on the damage to target organs and the level of increase in blood pressure, the severity of the clinical picture changes.

At the onset of the disease, the patient complains of the following neurotic disorders:

• headache, which is localized in the back of the head or forehead;
• frequent dizziness;
• intolerance to loud noise or bright light for headaches;
• noise in ears;
• nausea;
• lethargy;
• tachycardia;
• sleep disturbance;
• rapid fatigue even after minor exertion;
• unpleasant tingling in the fingers, which is accompanied by loss of sensitivity in one of the fingers;
• chills in the lower extremities;
• intermittent claudication.

With the rapid development of the disease hypertension and a stable increase in blood pressure from 140/90 to 160/95 mmHg, the patient experiences the following symptoms:

Hypertensive crisis

As hypertension progresses, complications in the form of crises become more frequent and severe, lasting 3-4 days. There is an increase in blood pressure to high levels. During a hypertensive crisis, the patient notes:

• cold sweat;
• feeling of anxiety and fear;
• frequent headaches;
• chills;
• speech disorder;
• facial redness;
• swelling of the limbs;
• visual impairment;
• numbness of the mouth, lips and tongue;
• tachycardia;
• vomiting

Hypertensive crises at the initial stage do not lead to complications. Stable and sclerotic stages are complicated by myocardial infarction, hypertensive encephalopathy, renal failure, pulmonary edema and strokes.

Diagnostics

Analysis of the condition of a patient with suspected hypertension and hypertension is aimed at identifying a stable increase in blood pressure, excluding secondary hypertension, and determining the stage of the disease. The examination includes the following methods:

• thorough analysis of the medical history;
• blood pressure measurements throughout the day;
• biochemical blood test to determine the level of sugar, creatinine, cholesterol, potassium;
• blood test for corticosteroids, aldosterone and renin activity;
• urine analysis according to Zimnitsky, Nechiporenko, Rehberg test;
• fundus examination;
• EchoCG;
• MRI of the brain;
• Ultrasound of the abdominal organs;
• urography;
• aortography;
• CT scan of the kidneys and adrenal glands.

Treatment

Treatment of hypertension involves a set of measures aimed at:

• reduction in blood pressure to normal levels;
• prevention of organ damage;
• rejection of unfavorable factors that provoke the development of the disease.

Non-drug therapy

This method of treatment involves a number of measures aimed at eliminating unfavorable factors that cause the development of hypertension and preventing complications of arterial hypertension. They provide:

• body weight control;
• maintaining an active rhythm of life;
• performing physical exercises;
• quitting smoking and alcohol;
• reducing the consumption of fats, salt and carbohydrates;
• increasing the consumption of vegetable fats and fiber.

Patients are often prescribed natural supplements, which include the following components:

• magnesium. The lack of this element is one of the main reasons for the development of hypertension. Taking medications with high magnesium content in a short time improves health. The action of magnesium is aimed at stabilizing heart rate;
• taurine is a natural substance that has a powerful diuretic effect and relieves swelling. It perfectly complements magnesium in the fight against hypertension. Taurine is especially useful in the treatment diabetes mellitus and obesity, as it increases tissue sensitivity to insulin;
• Coenzyme Q10 lowers blood pressure and is an addition to other medications and supplements. Coenzyme improves the functioning of the heart muscles, gives vigor, and is the main natural substance in the treatment of cardiovascular diseases;
• hawthorn extract. The substance improves blood flow in peripheral small vessels and inhibits the production of angiotensin-II. It is recommended to take hawthorn for heart failure, tachycardia and angina;
• Garlic perfectly thins the blood and relieves tension in the blood vessels. It is recommended to eat every day to obtain positive result. Can be replaced natural remedy garlic extract in capsules;
• fish fat. Omega 3 fatty acids prevent the risk of myocardial infarction. It is recommended to eat fatty foods 2-3 times a week sea ​​fish or take the drug in capsules.

Diet

Eating healthy and exercising is an important part of effectively treating hypertension. In the initial stages, the diet promotes complete recovery without the use of drug therapy. Some foods must be included in the diet, while others must be partially or completely excluded.

• lean meat of rabbit, turkey, boiled fish;
• dairy products;
• low-fat soups;
• porridge;
• vegetables and fruits, which contain potassium and magnesium;
• legumes;
• grain products made from durum wheat;
• nuts, seeds;
• from sweets: marshmallows, jam and marshmallows.

Restricted products:

• salt;
• animal fats (sour cream, butter);
• easily digestible carbohydrates;
• You should drink no more than 1.5-2 liters of liquid per day.

• coffee and other caffeinated products;
• smoked, salted, canned products;
• fatty and floury;
• alcohol;
• offal.

Drug therapy

Drugs for the treatment of hypertension are prescribed for life. The selection of appropriate medications is made individually, taking into account the patient’s examination results and the risk of complications. To the complex drug treatment The following groups of drugs are included:

• diuretics, or diuretics. Thiazide (weak) or loop (strong) drugs are more often prescribed. The drug indapamide is used as a vasodilator, although it is a weak diuretic;
• new generation beta blockers. The action of these drugs is aimed at weakening the effect of adrenaline and other hormones that accelerate the heart. They reduce the heart rate and the volume of blood transferred, thereby reducing the load on the heart. In addition, they reduce the risk of heart attack. Nebivolol or Nebilet, which constrict blood vessels, is often prescribed;
• ACE inhibitors block the production of a substance called angiotensin II, which constricts the walls of blood vessels. As a result, the vessels relax, the lumen increases and blood flow improves. ACE inhibitors prevent the occurrence of the first and recurrent heart attacks, and stop the development of renal failure. Patients are prescribed Lisinopril, Captopril, Enalapril, etc.;
• Angiotensin II receptor blockers are prescribed to patients with intolerance to ACE inhibitors. These are new generation drugs whose effects are similar to inhibitors. Among the effective ones are Losartan, Valsartan, Lorista H, Naviten;
• calcium antagonists. Improve blood flow by relieving tension in the walls of blood vessels. Some drugs in this group slow down the heart rate, others do not, and reduce the risk of heart attack and stroke. In most cases, Corinfar, Verapamil, Diltiazem, Nifedipine, etc. are prescribed;
• Antiadrenergic drugs increase the tone of the parasympathetic nerves, which relieves tension in the heart muscles, providing relaxation. As a result, the heart rate decreases and cardiac output decreases. Among the effective drugs are Pentamin, Clonidine, Raunatin, Reserpine, Terazonin;
• arteriolar and venous receptor dilators, among which are sodium nitroprusside, Dimecarbine, Tensitral.

Patients with increased rate diastolic pressure and severe attacks hypertensive crises Hospital treatment is recommended.

Treatment of the elderly

Hypertension in elderly people over 70 years of age has characteristics. Today, it is advisable to treat the disease, since the risk of myocardial infarction and stroke is reduced. Medicines can also be prescribed to people over 80 years of age, although the side risks from taking the drugs increase. This is due to the fact that elderly patients have weakened kidneys and concomitant diseases. It is recommended to start taking medications with half the dose, gradually increasing.

Many patients have isolated systolic hypertension, which is manifested by elevated systolic and normal diastolic pressure. It is important to correctly prescribe medications that will not affect normal indicators.

Prevention

Prevention of hypertension involves controlling risk factors. Moreover, the older the patient, the more attention it is recommended to pay healthy image life. Recommended:

• reduce salt intake;
• include physical education classes, jogging or race walking;
• limit alcohol consumption;
• increase your intake of plant foods, add green vegetables to your diet.

Secondary arterial hypertension: causes, symptoms and treatment

Secondary arterial hypertension is a pathological condition caused by disruption of the internal organs that take part in the regulation of blood pressure. Distinguish it from essential hypertension in that it is possible to establish the causes.

This type of disease in most cases has a malignant and progressive course and is practically not amenable to medical correction with antihypertensive drugs. High and persistent blood pressure is detected all the time.

Scientists have identified more than 70 different pathologies that can lead to the development of symptomatic disease. Differential diagnosis is required. But searching for the exact etiology takes a long time, which leads to severe damage to target organs.

Secondary hypertension accounts for up to 25% of cases of all ailments. For a favorable prognosis, it is necessary to quickly establish the pathophysiology of the abnormal process and eliminate it with adequate treatment.

Classification of the disease depending on the etiology of its occurrence

According to the International Classification of Diseases (ICD-10 code), arterial hypertension is a group pathological conditions, as a result of which chronically high blood pressure levels are diagnosed. The list of these ailments is quite extensive.

Secondary hypertension can be caused by taking certain medications. These include contraceptives for oral administration, non-steroidal anti-inflammatory drugs, tablets for the treatment of cardiovascular diseases.

If the increase in blood pressure is caused by a primary pathology of the brain, then a diagnosis of hypertension of central origin is made. It usually develops due to brain injuries and disturbances in central regulation. Other causes: cerebral hemorrhage, heart attack, encephalopathy.

The mechanisms of development of renal hypertension lie in impaired renal function:

• The renal arteries are affected. This reason is the most common. The kidneys play a dominant role in the regulation of diabetes and DD. If they receive little blood, they produce components that increase systemic blood pressure to support renal blood flow. The causes of impaired blood circulation are various: atherosclerotic changes, thrombosis, tumor neoplasms.
• Polycystic kidney disease is a genetically determined pathology that provokes gross transformations in the form of a large number of cysts, which leads to disruption of the functionality of the organ up to a severe form of renal failure.
• Long-term course of inflammatory processes in the kidneys. For example, the chronic form of pyelonephritis. This disease is rare, but not excluded.

Endocrine hypertension develops as a result of a disorder of the endocrine system. The pathogenesis is as follows:

1. Itsenko-Cushing's disease. The etiology is based on the destruction of the adrenal cortex, which leads to increased production of glucocorticosteroids. As a result, the load inside the blood vessels increases in a person, and characteristic signs of the disease are present.
2. Pheochromocytoma is a pathology that affects the adrenal medulla. It is relatively rare in medical practice. Usually leads to hypertension of a malignant and progressive course. Due to compression of the tumor neoplasm, a release of adrenaline and norepinephrine into the blood is observed, which leads to chronically high DM and DD or a crisis course.
3. Conn's disease, a tumor localized in the adrenal glands, provokes an increase in the concentration of aldosterone. Hypokalemia develops and blood pressure rises. Feature: medications with antihypertensive effect have practically no effect.
4. Thyroid gland dysfunction.

Cardiovascular hypertension is caused by many diseases. These include congenital narrowing of the aorta, patent ductus arteriosus, aortic valve insufficiency, late stages chronic failure.

Very often, secondary degrees of arterial hypertension appear against the background of kidney failure. This condition is characterized by persistently high blood pressure, which is caused by impaired circulation in the organs.

Clinical manifestations of secondary hypertension

The symptoms of arterial hypertension of primary and secondary nature are different; accordingly, there are different approaches to treatment. In the first case, the disease has all the signs of hypertension, but the etiology remains unknown. In the second case, there are symptoms of hypertension + manifestations that are characteristic of a specific disorder in the body.

The clinic in the second case will be mixed. In each individual presentation, signs and symptoms will vary significantly. Some experience a short-term increase in blood pressure up to critical values, others experience a persistent slight increase, etc.

Doctors note that the disease changes a person’s emotional background and character, not for the better. Therefore, if a loved one has become irritable, hot-tempered, or their mood changes sharply, then this is how the body signals illness.

Symptoms of increased blood pressure:

• Intense headaches.
• Impaired visual perception (deterioration of vision, spots and spots before the eyes).
• Dizziness, tinnitus.
• Nausea, sometimes vomiting.
• General malaise (weakness and lethargy).
• Increased heart rate and pulse.
• Swelling of the lower extremities and face (especially in the morning).
• Feelings of anxiety, emotional lability.

The most pronounced clinical manifestations occur against the background of the neurogenic form of hypertension. The patient complains of severe tachycardia, incessant headaches, increased sweating, convulsive state(rarely).

With hypertension of an endocrine nature, specific completeness manifests itself. That is, a person’s face and body become fat only, while the upper and lower limbs remain the same. Usually diagnosed in women during menopause.

Due to renal hypertension, severe headaches occur, vision deteriorates significantly, heaviness in the head, and a feeling of one’s own heartbeat appear.

Signs that distinguish the primary form of the disease from the secondary:

1. Sudden onset of disease.
2. Young age up to 20 years or after 60 years of age.
3. Persistent increase in DM and DD.
4. Rapid progression of pathology.
5. Low effectiveness or complete lack of effect from drug treatment.
6. Sympatho-adrenal attacks.

In some cases, an increase in blood pressure is the only symptom of symptomatic hypertension. Additionally, only signs of the underlying disease appear.

Differential diagnosis of symptomatic hypertension

Diagnosis of secondary hypertension is a complex process. It is necessary to differentiate increased blood pressure from many other diseases. An unspecified diagnosis may cost human life. Diagnostic measures are complex.

First of all, the clinical manifestations that the patient complains about are taken into account. If there is a suspicion of a secondary form of the disease, then a comprehensive examination is carried out, during which diseases that contribute to an increase in arterial parameters are gradually excluded.

TO general research include: urine and blood analysis, ultrasonography blood vessels, determination of heart pathologies, ultrasound of the kidneys. Each form of hypertension is diagnosed according to a special principle.

In the nephrogenic form, the patient exhibits sediment in the urine. If fever and pain in the joints occur, then they speak of periarteritis - the disease affects many systems, including the kidneys. If only fever and an increase in diabetes and diarrhea are present, then infectious processes in the urinary system are suspected.

If endocrine disorders are suspected, the hormonal background is examined - catecholamines in urine and blood and the amount of thyroid hormones are determined.

In kidney disease, the diastolic value often increases. Hemodynamic hypertension is characterized by an isolated increase in systolic number. With endocrine genesis, in most cases, systolic-diastolic hypertension is detected.

Features of the treatment of secondary hypertension

Conservative therapy is selected individually, taking into account the characteristics of the patient’s condition and the specifics of the concomitant disease. When kidney pathologies are detected, surgical intervention is often resorted to.

Often surgery is the only solution if pheochromocytoma, cancer, or corticosteroma are diagnosed. If a tumor is detected in the pituitary gland, therapy is carried out using laser radiation or radioactive methods.

Be sure to prescribe pills that are aimed at eliminating the underlying disease. The treatment regimen is supplemented by several antihypertensive drugs to normalize blood pressure. One drug does not help lower blood pressure, only combinations.

Depending on the cause, treatment may be as follows:

• For pathology of the adrenal glands, surgical treatment is recommended.
• If there are inflammatory processes in the kidneys, antibiotics and anti-inflammatory drugs are prescribed.
• For problems with the thyroid gland, hormonal treatment is carried out. Only under the supervision of a doctor.
• If the pathogenesis is caused by a heart defect or severe narrowing of the aorta, then cardiac surgery is required. Be sure to prescribe medications for heart failure.
• At dosage form adjust prescriptions, replace medications by similar means without such side effects.
• Against the background of hypertension of central etiology, if possible, it is necessary to achieve compensation for the primary disease. For example, for a brain tumor - surgery, for a stroke - conservative therapy.

To reduce blood pressure readings on a tonometer, antihypertensive drugs from different groups are prescribed. These are angiotensin-converting enzyme inhibitors, beta-blockers, diuretics, calcium antagonists, etc. The treatment regimen is always individual. Additionally, tablets are prescribed in accordance with the existing disorder. To thin the blood - Aspecard.

The key to successful treatment is competent and timely differential diagnosis, which allows you to avoid complications in the future.

There are several types of disease: renovascular (congenital narrowing of the vessels of the renal artery) and renal arterial hypertension.

Prevention of secondary hypertension

There are many preventive measures for symptomatic disease. However, the main recommendation for hypertensive patients is timely treatment of any diseases. If your health worsens, there is alarming symptoms, you must immediately contact a medical facility.

Optimizing your daily routine. This allows you to give the body the necessary rest and restore strength after daytime activity. It is recommended to sleep 8 hours a day and take breaks during heavy work.

Physical activity helps all organs and systems function normally. In case of hypertension, it is approached carefully. Some sports can provoke a sharp jump in blood pressure to critical levels.

The most important preventative measures:

1. Avoid stress.
2. Hiking.
3. Normalization of metabolism.
4. Losing body weight (if overweight or obese).
5. Rejection of bad habits.
6. Reducing salt intake.

Symptomatic hypertension is a complex pathology that requires special attention from medical specialists, careful diagnosis and effective method therapy. The problem is relevant, since the disease is practically not amenable to conservative correction.

Lack of treatment leads to a number of serious complications - heart failure, cerebral hemorrhage, swelling of internal organs. Subsequently, they can lead to disability and death. In the malignant form of hypertension, the prognosis is unfavorable.

A specialist will tell you everything about hypertension in the most clear and informative way in the video in this article.

Please note that all information posted on the site is for reference only and

not intended for self-diagnosis and treatment of diseases!

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Hypertension syndrome - dangerous illness, which can manifest itself in children regardless of their gender and age.

If the disease occurs in a newborn child, we are talking about 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 kept under under constant medical supervision.

However, this diagnosis is often erroneous; in particular, sometimes hypertension syndrome is diagnosed in children with too big head size, although these facts are in no way related to each other.

It may also increase during periods of intense crying or excessive physical activity. This is considered a variant of the norm; in this case we are not talking about pathology.

General information

The cranium has a constant volume, however the volume of its contents may vary.

And if any formations (benign or malignant) arise in the brain area, excess fluid accumulates, appear, intracranial pressure increases. This phenomenon is commonly called hypertension syndrome.

The disease can develop rapidly or be sluggish. 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 causes the child significant discomfort, constant significantly worsen the quality of life of a small patient.

ICD 10 code - G93.

Causes

Hypertension syndrome may occur in children of different ages . Depending on the age, the causes of the disease vary.

In newborns

In children and adolescents Clinical picture Hypertensive syndrome in newborns and older children can be different, however, the signs of the disease are always clearly pronounced. In newborns In children and adolescents The child constantly refuses the mother's breast. Moodiness, frequent crying for no reason. During sleep or at rest, a quiet, drawn-out groan is heard as you exhale. muscle tissue. Decreased swallowing reflex. Convulsions (do not occur in all cases). Trembling of limbs. Severe strabismus. Copious regurgitation, often turning into vomiting. Violation of the structure of the eye (appearance of a white stripe between the pupil and upper eyelid, hiding the iris of the eye with the lower eyelid, swelling of the eyeball). Tension of the fontanel, divergence of the skull bones. Gradual excessive increase in head size (by 1 cm or more per month). Severe headaches that occur mainly in the morning (painful sensations are localized in the temples and forehead). Nausea, vomiting. Pressing sensation in the eye area. Sharp pain that occurs when changing the position of the head (turning, tilting). Dizziness, disturbances in the functioning of the vestibular apparatus. Pallor of the skin. General weakness, drowsiness. Muscle pain. Increased sensitivity to bright lights and loud sounds. Increased tone of the muscles of the limbs, as a result of which the child’s gait changes (he moves mainly on his toes). Impaired concentration, memory, decreased 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 organ tissue. As a result intellectual development decreases child, the process of nervous regulation of the activity of internal organs is disrupted, which, in turn, leads to a loss of their functionality. In advanced cases, when large brain stems are compressed, a coma and death may occur. Diagnostics To identify pathology, only a visual examination and questioning of the patient is not enough, so the child must undergo a detailed examination, which includes: X-ray of the skull; EchoCG; rheoencephalogram; angiography; puncture and examination of accumulated cerebrospinal fluid. Treatment options Treatment of the disease can be conservative(using medications), or surgical. The second option is prescribed only as a last resort, in severe cases of the disease, when there is a risk of developing serious complications, or when drug treatment is ineffective. Conservative In addition to taking medications prescribed by the doctor, the child should maintain a special diet and lifestyle. In particular, it is necessary to reduce fluid intake as much as possible (while avoiding dehydration of the body), and also eliminate foods that contribute to fluid retention in the body (for example, salty, smoked, pickled foods, strong tea and coffee). Contraindicated excessive physical activity. As additional treatment massage and acupuncture are prescribed to help relieve pain. Admission required medications, such as: Surgery In some cases, when the disease is severe and there is risk of complications, the child requires surgery. This treatment method is necessary if the cause of the development of the disease is tumor formation. In this case, the child undergoes craniotomy with subsequent removal of the tumor or foreign body. At accumulation of excess fluid They perform a brain puncture, or create artificial holes in the vertebrae through which cerebrospinal fluid is drained. 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 (infants), therefore, upon detection of the first alarm signals, you need to show the child to the doctor. Prevention measures Take care to prevent this dangerous disease like hypertension syndrome, necessary even at the stage of pregnancy planning. In particular, the expectant mother must undergo examination, identify and treat 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, and follow all the instructions of the doctor monitoring 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 wide variety of reasons and can lead to the development dangerous consequences, up to the death of the child. The pathology has a characteristic clinical picture, a set of pronounced signs, upon detection of which it is necessary to urgently show the child to a doctor. Treatment should be started as early as possible, since the timeliness of therapy the prognosis for recovery depends. About hypertensive-hydrocephalic syndrome in infants in this video: We kindly ask you not to self-medicate. Make an appointment with a doctor!

Intracranial hypertension (ICH),ICD-10 code – G93 (other brain lesions (BM))– this is a symptom complex caused by an increase in intracranial pressure (in the cranium) over 15 mmHg. or 150 mm.water column, measured in a lying position.

The cranial cavity is limited by bones and in it GM neurons occupy about 600 ml, glia - 800 ml, extracellular fluid - about 130 ml; and blood takes up about 150 ml.

An increase in intracranial pressure occurs when a certain critical volume is reached. At the same time, it was noted that a small increase in the amount of cerebrospinal fluid does not cause hypertension, but if the volume of the brain increases, or in the cranial cavity appears extensive education, then the pressure will definitely become high.

This is due to the fact that when intracranial pressure increases, especially due to the presence of a space-occupying process, the difference in pressure begins to increase between different areas inside the skull that separate duplications of the dural (dura) mater (MO), including the posterior cranial fossa and subarachnoid (subarachnoid) space of the spinal cord (SC).

As a result, a displacement of one or another section of the brain tissue occurs from an area of ​​higher pressure to a region of lower pressure through natural openings, which are formed by the dural MO (the tentorium of the cerebellum and the falx of the brain), or by bone formations (the foramen magnum).

That is, wedging (or herniation) of the brain develops with further infringement of the substance of the brain, compression of nearby sections and arteries, which leads to ischemia of certain areas of the brain, and a violation of the outflow of cerebrospinal fluid appears due to the blockade of its conducting pathways, which further aggravates the pathological process.

Three variants of cerebral herniation syndrome

• Under the falx GM with displacement of the cingulate gyrus under its lower edge. It occurs more often than other types, but symptoms in almost all cases cannot be identified;
• Transtentorially with displacement of the inner part of the temporal lobe (often the uncus of the parahippocampal gyrus) into the depression formed by the tentorium of the cerebellum, where the midbrain(CM). In this case, the oculomotor nerve and the SC itself are compressed, less often the posterior cerebral artery (PCA) and the upper parts of the brain stem;
• In the area of ​​the cerebellum, which leads to a displacement of its tonsils into the space of the foramen magnum.

Benign intracranial hypertension (more common in children and young women)

Stands out separately rare disease – benign intracranial hypertension (BICH), ICD-10 code – G93.2.

In this case, it mainly affects young women and children who are overweight. The cause is not fully known, there are no changes in the size of the ventricles, no obstacles to the flow of cerebrospinal fluid and changes in its composition, there is no intracranial space-occupying process.

In some cases, the superior sagittal (sagittal) or transverse sinus becomes blocked, which is combined with obesity and increased or decreased thyroid function.

Less commonly, the disease appears due to excessive intake of vitamin A, during treatment with gluocorticosteroids, oral contraceptives, and some antibacterial drugs(nalidixic acid - especially in children, nitrofurans, tetracyclines), hormonal drugs (danazol). The disease also occurs in pregnant women, after childbirth and in those suffering iron deficiency anemia. For the most part, the cause of ADHD remains unknown (idiopathic).

Statistically, based on its causes, intracranial hypertension occurs more often in men, with the exception of benign ICH, which affects females, including children.

Causes

Cause its appearance:

• The presence of a space-occupying formation inside the cranial cavity (benign and malignant neoplasms, various types hematomas);
• Increase in itself or with benign intracranial hypertension;
• An increase in the amount of cerebrospinal fluid (hydrocephalus);
• An increase in blood volume when there is an increase in carbon dioxide in it (hypercapnia) blood vessels significantly expand (vasodilate).

A separate syndrome is distinguished primary increased ICP due to DHF with or without fundus edema and secondary:

• in the first place are traumatic brain injuries;
• tumors;
• meningoencephalitis;
• thrombosis of the venous sinuses;
• somatic diseases such as kidney disease, thyroid disease and systemic lupus erythematosus (SLE);
• taking medications (nevigramone, anabolic steroids, etc.).

Clinical signs (symptoms)

The main manifestations of ICH consist of the symptoms of the underlying disease that caused it (increased basal metabolism, body temperature, blood pressure, heart rate with hyperthyroidism) and the main manifestations of the increase in pressure in the cranial cavity itself:

• cephalalgia, or. They are expressed in the morning, because... ICP increases during sleep due to the accumulation of carbon dioxide and compensatory vasodilation of the brain vessels. At the same time, due to the influx of blood, the walls of the arteries and the dural membrane itself at the base of the skull are stretched;
• nausea with or without vomiting. Also characteristic feature it intensifies in the morning, and cephalgia after vomiting decreases or disappears altogether;
• drowsiness, which is a warning sign due to the rapid and significant worsening of neurological symptoms;
• disturbances of consciousness varying degrees heaviness if the upper sections of the trunk are compressed;
• swelling of the optic discs due to increased pressure in the subarachnoid space that surrounds the nerve and disturbances in axoplasmic transport. At the beginning, the retinal veins dilate, then the disc protrudes with the development of hemorrhages along its edge (“tongues of flame”), which over a long period leads to complete blindness;
• diplopia (doubling of objects) due to compression of the abducens nerve (ON);
• mydriasis (pupil dilation) with paralysis eye muscles(ophthalmoplegia) on the affected side and hemiparesis on the other side due to compression of the parahippocampal gyrus;
• ischemia of the occipital cortex and hemianopsia (blindness of half the visual field on both sides) due to compression of the posterior cerebral artery;
• arterial hypertension with bradycardia (Kocher-Cushing syndrome);
• Cheyne-Stokes type breathing disorder;
• forced forward tilt of the head due to compression of the bulbar part of the brain;
• stiffness of the neck muscles due to irritation of the dural meningeal membrane - as a manifestation.

In young children with cephalgia, the general condition is disturbed, they become restless and capricious; in newborns and children up to one year old, the fontanelles become tense and bulge significantly; As the condition progresses, the child’s consciousness is impaired, he becomes lethargic, adynamic, and even develops into a coma.

Treatment (medicines)

The main principle of treatment for ICH is etiological, that is, elimination of the original cause that caused it. If necessary, an intracranial formation (tumor or hematoma) is removed, or the liquor system is shunted (for hydrocephalus). If the function of the respiratory system and consciousness is impaired, tracheal intubation with artificial ventilation (ALV) is performed, parenteral nutrition is established, and the water-electrolyte composition is balanced.

In preparation for surgical treatment in order to reduce ICP, osmotic diuretics (mannitol, glycerol) are used, which promote the transition of water from extravascular spaces into the blood plasma; glucocorticosteroids (dexamethasone) to restore the blood-brain barrier (BBB); loop diuretic(furosemide).

With benign intracranial hypertension, recovery occurs on its own after a few weeks or months.

The same conservative therapy is successfully used, and to reduce pressure on the optic nerve, decompression of the optic canal is performed.