Increased anterior fontanelle tension

Introduction In the early stage of increased intracranial pressure in infants and young children, the tension of the anterior iliac crest can be increased, the cranial suture is separated, and the percussion is like a broken kettle. The cerebrospinal fluid pressure measured by the lumbar puncture in the lateral position exceeds 1.92 kPa, which is the increase of intracranial pressure. If there is a series of clinical manifestations such as headache, vomiting, visual impairment and papilledema, it is called intracranial pressure increase syndrome.

Cause

According to the history of the disease and the onset of the disease, the findings of the medical system and nervous system examination, the necessary laboratory tests, and the initial determination of the lesions and causes of increased intracranial pressure are entirely possible. The common causes are as follows:

(1) Craniocerebral trauma: intracerebral hematoma and brain contusion and laceration.

(B) intracranial tumors and intracranial metastases.

(C) cerebrovascular disease: cerebral hemorrhage, subarachnoid hemorrhage and cerebral infarction.

(4) Intracranial inflammation and brain parasitic diseases: various encephalitis, meningitis, brain abscess, cerebral sac cysticercosis, brain trematode disease, and echinococcosis.

(5) craniocerebral malformations: such as skull base depression, narrow cranial disease, aqueduct malformation, congenital cerebellar tonsil malformation and so on.

(6) Increased benign intracranial pressure.

(7) Cerebral hypoxia: sudden cardiac arrest, pulmonary encephalopathy, continuous status of epilepsy, etc.

(8) Others: liver and kidney function exhaustion, blood disease, hypertensive encephalopathy, various poisoning, anaphylactic shock, etc.

an examination

Related inspection

Brain CT examination

Increased intracranial pressure has acute subacute and chronic points. Generally, the disease with slow course of disease has many symptoms such as headache, vomiting, and papilledema. It is not difficult to initially diagnose the increase of intracranial pressure. The acute and subacute brain diseases are short-lived, the disease develops rapidly, and there are many degrees of disturbance of consciousness, and there is no obvious papilledema. It is often difficult to diagnose the increase of intracranial pressure at this time. The following examinations are needed. determine.

(A) fundus examination: before the appearance of typical papilledema, often the fundus vein filling expansion, pulsation disappeared, microvascular bleeding in the fundus, visible gray and white radial lines on the upper and lower edges of the nipple.

(2) In the early stage of increased intracranial pressure in infants and young children, the tension of the anterior iliac crest can be increased, the cranial suture is separated, and the percussion is like a broken kettle.

(C) dehydration test treatment: 20% mannitol 250 ml rapid intravenous infusion or furosemide 40 mg intravenous bolus, if headache, vomiting and other symptoms are alleviated, the possibility of increased intracranial pressure is greater.

(D) imaging examination: the skull flat film can be found in the skull inside the plate to increase the market or / and the saddle back to absorb some signs of the primary disease. Cerebral angiography has considerable diagnostic value for cerebrovascular disease, most of the intracranial space-occupying lesions. Conditional feasible CT scan and MRI (magnetic resonance) examination, it is a safe and reliable means of detecting intracranial lesions for acute, subacute intracranial hypertension without obvious papilledema. For patients with suspected severe intracranial hypertension, especially acute, subacute onset with localized brain damage symptoms, blind blind examination should be avoided. Only under the subarachnoid hemorrhage diagnosed as encephalitis or meningitis and without localized brain damage, lumbar puncture can be performed after adequate preparation.

Differential diagnosis

The increase in the tension of the front squat needs to be identified as follows:

(1) Craniocerebral injury: Brain contusion, cerebral edema and intracranial hematoma caused by any cause of craniocerebral injury can increase intracranial pressure. Increased intracranial pressure can occur in the early stage of acute severe craniocerebral injury. A small number of patients can appear later, such as chronic subdural hematoma. After craniocerebral injury, patients often quickly enter a coma with vomiting. Hematoma in the brain can occur due to hemiplegia, aphasia, and seizures depending on the location. Cranial CT can directly determine the size, location and type of intracranial hematoma, as well as intraventricular hemorrhage that cannot be diagnosed by cerebral angiography.

(B) cerebrovascular disease (cerebrovascular disease): mainly hemorrhagic cerebrovascular disease, hypertensive cerebral hemorrhage is the most common. Generally, the onset is more urgent, and the increase in intracranial pressure is reached within 1-3 days. Patients often have varying degrees of disturbance of consciousness. It is characterized by headache, dizziness, vomiting, limb paralysis, aphasia, incontinence and so on. There is often a significant increase in blood pressure at the time of onset. Most patients have positive meningeal irritation. Cerebrospinal fluid pressure is increased and often bloody. Brain CT can determine the size of the bleeding and the location of the bleeding.

(3) hypertensive encephalopathy (hypertensive encephalopathy): Hypertensive encephalopathy refers to sudden and severe rise in blood pressure that causes acute and comprehensive brain dysfunction. Common in acute hypertension, acute and chronic nephritis or eclampsia, occasionally due to pheochromocytoma or taking monoamine oxidase inhibitors while taking tyramine-containing foods, lead poisoning, Cushing's syndrome. Frequently, the blood pressure suddenly increased significantly to 33.3/20 kPa (250/150 mmHg), and the increase in diastolic blood pressure was more significant than systolic blood pressure. Symptoms of increased intracranial pressure such as severe headache, nausea, vomiting, and neck stiffness often occur at the same time. Neuropsychiatric symptoms include visual impairment, hemiplegia, aphasia, epilepsy-like convulsions or limb muscle rigidity, and disturbance of consciousness. The fundus may have hypertensive fundus, retinal artery spasm, and even retinal hemorrhage, exudate, and optic nerve head edema. CT examination showed cerebral edema and narrowing of the ventricles. The electroencephalogram shows diffuse slow waves, loss of alpha rhythm, and no response to light stimulation. Generally do not do lumbar puncture examination.

(4) intracranial tumors (intracranial tumours): can be divided into primary intracranial tumors and metastases formed by malignant tumors from other parts of the body to the brain. The common feature of intracranial pressure caused by brain tumors is the chronic progressive typical intracranial pressure. Although the symptoms may be slightly up and down during the course of the disease, the general trend is gradually increasing. A small number of patients with increased chronic intracranial pressure can suddenly turn into an acute attack. According to the tumor growth site can be accompanied by different symptoms, such as changes in visual field of vision, pyramidal tract damage, seizures, aphasia, sensory disturbances, mental symptoms, cerebellopontine angle syndrome. Head CT can identify the location and nature of tumor growth.

(5) brain abscess (brain abscess): often have primary infections, such as otogenic, nasal or traumatic. At the beginning of blood supply, there may be systemic symptoms of acute inflammation, such as high fever, chills, meningeal irritation, increased white blood cells, blood sedimentation, and increased lumbar vertebrae. However, after the abscess maturity period, the above symptoms and signs disappeared, only the increase of chronic intracranial pressure, with or without focal neurological signs. The course of brain abscess is generally shorter and the mental retardation is more serious. CT scans often show a circular or oval density that reduces shadows. After the contrast agent is injected, the edge image is significantly enhanced. The thin, smooth ring density increases the shadow, and the low-density brain edema around the abscess is more pronounced.

(6) Brain infections diseases: Brain infections are inflammatory diseases of the brain and meninges caused by bacteria, viruses, parasites, rickettsia, and spirochetes. Acute or subacute intracranial pressure increased, a small number of manifestations of chronic intracranial hypertension, often with symptoms of infection, such as fever, general malaise, increased blood and so on. Some cases have conscious disturbances, confusion, myoclonus and seizures. In severe cases, they develop into deep coma within a few days. In some cases, mental disorders may occur, manifested as sluggishness, decreased speech movements, slow response or anxiety, incoherent speech, frequent interruptions in memory and orientation, and even illusions, hallucinations, delusions, and embarrassment. The symptoms of the nervous system are various, and the important features are frequent focal symptoms such as hemiplegia, aphasia, bilateral oblique deviation, partial epilepsy, and involuntary movement. Others may have neck stiffness, meningeal irritation and so on. Cerebrospinal fluid often has inflammatory changes, such as cerebrospinal fluid leukocytosis, increased protein, or decreased sugar or chloride, positive complement test. There is an inflammatory change in the head CT.

(7) hydrocephalus: due to various reasons, the cerebrospinal fluid in the ventricular system is increasing, and the brain parenchyma is correspondingly reduced. When the ventricle is enlarged and accompanied by increased intracranial pressure, it is called hydrocephalus, also known as progressive. Or high pressure hydrocephalus. The clinical manifestations are different at different times. Infant hydrocephalus is mainly manifested by the rapid increase of the head in the weeks or months after the birth of the baby. At the same time, the portal is enlarged and raised, the tension is high, the cranial suture is separated, the head shape is rounded, and the skull is thin and soft. The head percussion is "broken pot sound", the severe one has a sense of tremor when percussion, and the frontal scalp vein is engorged. The skull is very large and the skull is small. The two eyes are turned down to reveal the sclera above. The child is weak, slow, irritating, and difficult to lift the head. There may be symptoms such as seizures, nystagmus, ataxia, increased muscle tone in the extremities or palsy. Ventricular angiography showed a marked enlargement of the ventricles. CT examination can detect tumors, accurately observe the size of the ventricles, and show the degree of edema around the ventricles.

(8) Benign intracraunial hypertension: also known as "pseudo-brain tumor", the patient has only symptoms and signs of increased intracranial pressure, but no space-occupying lesions exist. The cause may be arachnoiditis, otogenic hydrocephalus, venous sinus thrombosis, etc., but often can not be found. Clinical manifestations, in addition to increased chronic intracranial pressure, generally no focal signs.

(9) Others: The increase in intracranial pressure caused by systemic diseases is also quite common in clinical practice. Such as infection with toxic encephalopathy, uremia, water and electrolytes and acid-base balance disorders, diabetes coma, hepatic coma, food poisoning. The progression of these diseases to the severity can lead to increased intracranial pressure. A clear diagnosis can be made in combination with the history of the disease and the systemic examination.

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