How to measure intracranial pressure at home and in the clinic
The content of the article:
- How to measure ICP in a child
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How to measure ICP in adults
Fundus examination for ICP measurement
- Video
How to measure intracranial pressure, and when is it necessary? This usually happens when a person begins to worry about the characteristic symptoms of his increase. Determining the pressure inside the cranium in the same way as determining blood pressure using a portable tonometer will not work.
It is possible to measure intracranial pressure only with the help of special devices
The process of measuring pressure inside the confined space of the skull is difficult; it is impossible to measure intracranial pressure at home. Why? The fact is that in the skull there is a special closed system of channels in which cerebral fluid circulates - cerebrospinal fluid. For one reason or another, it can press on the brain tissue, causing painful sensations and dysfunctions of various functions - just such a violation is called an increase in intracranial pressure (ICP). As you can see, in the closed space of the cranium there is no possibility of direct measurement of intracranial pressure, therefore, if you suspect an increase in it, you should consult a doctor.
How to measure ICP in a child
A state of persistent increase in intracranial pressure is most dangerous for children, especially when their age does not exceed 3 years. During childhood, brain structures grow and develop rapidly, and neural connections progress. If during this period the brain is in a compressed state, it will affect nutrition, the progression of brain structures, and in severe cases it can cause direct damage to the brain structures as a result of compression. The result can be both reversible (in the case of timely assistance) and irreversible consequences - developmental delays, neuropathy, pathological reflexes, etc.
Signs that should alert parents and serve as a reason for an extraordinary examination by a neurologist: constant anxiety of the child, frequent crying, irritability, poor appetite, divergence of the cranial sutures, in infants - bulging of open fontanelles. Older children may complain of pain behind the eyes and in the frontal lobe, which can radiate to the ears and back of the head. A common symptom is visual impairment, visual abnormalities in the form of flashes of light in front of the eyes, dark spots or ribbons. In the later stages, symptoms of exophthalmos are observed, Graefe's symptom is the presence of a white strip of the sclera between the upper edge of the iris and the upper eyelid, as well as spontaneous movements of the eyeball.
It is somewhat easier to check whether the level of pressure inside the skull in children corresponds to the age norm than in adults, due to the large number of cartilaginous elements in the skull, but this cannot be done at home because of the need to use special devices.
Which doctor can diagnose? Neurologist. To do this, resort to the following methods:
- neurosonography - ultrasound of the skull and brain structures, which is suitable for children with an open fontanelle. The method allows you to determine the state of the midline structures of the brain, its ventricles filled with cerebrospinal fluid, their displacement depending on the force of pressure. Then, based on the presence of displacement of certain structures, using special algorithms, a conclusion is made about the value of intracranial pressure;
- Doppler sonography - allows you to visualize the blood circulation in the vessels of the patient's brain, with its help you can assess all the rheological properties of blood - from density to flow rate. Using the resulting data, the pressure in the skull is determined by calculation;
- otoacoustic method - after measuring the amount of displacement of the tympanic membrane outward, the measurement result is interpreted as the value of intracranial pressure.
In addition, CT (computed tomography) and MRI (magnetic resonance imaging) results can be used to measure ICP.
How to measure ICP in adults
To determine the pressure of cerebral fluid in an adult, the same methods are used as in children, with the exception of neurosonography - the bone structures of an adult are impervious to ultrasound. In addition, rheoencephalography can be used. This method involves the conduction of harmless current by the fluid elements of the brain, followed by visualization - the graphs are shown in real time and change depending on the level of ICP.
A persistent increase in intracranial pressure in adulthood often signals the presence of organic pathology. In this case, in addition to non-invasive (not requiring direct intervention into the integrity of the cranium), direct, invasive methods can be used. They are performed strictly according to medical indications when a serious illness (for example, a brain tumor) is suspected, and involve penetration into the patient's cranium. Such diagnostics are carried out only in a hospital setting.
Invasive methods for measuring ICP include:
- subdural - the pressure under the dura mater is measured. It consists in the introduction of a special epidural screw under the skull bone, which is inserted through a hole previously made by the craniotomy. It is rarely used;
- epidural - after anesthesia of a certain area of the skull, trepanation is performed. Then the probe is inserted into the space under the dura mater, without damaging the soft tissues, and the pressure is measured;
- intraventricular - a special needle (intraventricular catheter) is inserted into the ventricles of the brain through a hole in the skull. The method makes it possible to measure ICP in dynamics for some time, as well as to quickly lower its level by pumping out the cerebrospinal fluid, therefore, in many cases it is preferable.
Invasive methods are used not only for diagnostic purposes, but also for treatment - fluid from the cranial cavities can be pumped out, thereby lowering the pressure, or an osmotically active drug can be injected inside.
Fundus examination for ICP measurement
One of the simplest, most affordable, fast and informative methods for determining ICP is fundus examination. The method consists in optical observation of structural and functional changes in the structure of the fundus and adjacent vessels, where characteristic signs of increased ICP are found. This study is carried out by an ophthalmologist.
The procedure is as follows. First, a relaxant is instilled into the eye, which causes relaxation of the ciliary muscle of the pupil, it expands as much as possible. This is necessary for a large field of view and better light beam transmission. Then, in a darkened room, the fundus formations are examined using a magnifying glass or an ophthalmoscope. The ophthalmoscope allows you not to resort to an additional source of illumination and automatically determines many optical parameters of the eye; for manual examination, the doctor will need a flashlight.
Ophthalmoscopy is one of the main methods to determine increased intracranial pressure
With a special frosted lamp, the doctor focuses a directional beam of light until a real clear picture of the fundus is displayed. What is a sign of increased cerebrospinal fluid pressure? Changes on the part of the optic nerve disc are considered reliable - its deformation, thickening or stratification. Also, the doctor pays attention to retinopathy, pathology of the retinal vessels, in which they are swollen, intersect almost at right angles, are unnecessarily visualized, wriggle. The condition of the tissues around the disc, their color, contours, and the presence of perifocal inflammation are assessed.
With the results of an ophthalmological examination, it is necessary to contact a neurologist for further diagnosis (identification of the root cause of increased ICP) or treatment.
Video
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Nikita Gaidukov About the author
Education: 4th year student of the Faculty of Medicine No. 1, specializing in General Medicine, Vinnitsa National Medical University. N. I. Pirogov.
Work experience: Nurse of the cardiology department of the Tyachiv Regional Hospital No. 1, geneticist / molecular biologist in the Polymerase Chain Reaction Laboratory at VNMU named after N. I. Pirogov.
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