Benign intracranial hypertension usually passes spontaneously after discontinuation of oral contraceptives. If the disease develops without taking such contraceptives, its course is also extremely dynamic and can go spontaneously. In severe cases, dehydration therapy with glycerol, veroshpiron is performed, vascular therapy is indicated. Apply means such as stegeron, theonikola, Cavinton. Recommended drugs that improve venous outflow, - troxevasin, gliovenol.
Treatment is aimed at reducing intracranial pressure and alleviating symptoms with repeated lumbar punctures and taking diuretics (acetazolamide 250 mg 4 times / day inwards). The headache is stopped with the use of NSAIDs or antimigraine drugs. Patients with obesity are recommended measures to reduce body weight. With progressive loss of vision against the background of repeated lumbar punctures and drug therapy, decompression (fenestration) of the optic nerve shells or lumbo- peritoneal shunting is indicated.
Intercranial hypertension is treated with drugs of several groups, each of which has both advantages and disadvantages.
The following hypertensive solutions can be shown with the development of intracranial hypertension
Mannitol, 20% rr, IV 400 ml, single or Sodium chloride, 7.5% r, in / in 200 ml, once.
However, it should be remembered that, firstly, the dehydrating effect of hypertonic solutions is realized mainly through the dehydration of intact brain matter, and secondly, after the end of the drug effect, a so-called "recoil phenomenon" can occur (increase in intracranial pressure to values even exceeding initial).
The therapeutic effect of saluretics (furosemide) in a condition such as intracranial hypertension is less pronounced than in hypertensive solutions. Nevertheless, their use is justified in combination with osmodiuretics, tk. Allows to reduce the risk of development of the "recoil phenomenon":
Furosemide iv 20-60 mg, once (further periodicity of administration is determined by clinical expediency). Dexamethasone is the drug of choice in the therapy of peritumoral edema of the brain: Dexamethasone IV / 12-24 mg / day, once (further periodicity of administration is determined by clinical expediency). However, its use for the treatment of intracranial hypertension in patients with severe TBI and ischemic strokes is not effective.
Acute intracranial hypertension, developed during neurosurgical interventions, is effectively treated with the use of barbiturates and the creation of a brief pronounced hyperventilation:
Thiopental sodium IV bolus 350 mg, once, then if necessary several times iv bolus in a total dose of up to 1.5 g.
In order to monitor the effectiveness of conservative therapy, a regular ophthalmologic examination with obligatory perimetry is carried out, since checking only the visual acuity is insufficient to prevent the irreversible loss of visual functions.