A pathology characterized by cell death in the spinal cord or brain is an organic lesion of the central nervous system. With a severe course of the disease, the human nervous system becomes inferior, he needs constant care, because he cannot serve himself, perform labor duties.

However, when timely detection organic disorder, the prognosis is quite favorable - the activity of the affected cells is restored. The success of treatment is the complexity and usefulness of the treatment, the implementation of all the recommendations of the doctor.

Organic damage to the central nervous system has another name - encephalopathy. Its signs can be detected in most people after 65-75 years, and in some cases even in children - with toxic damage to the structures of the head. In general, experts divide the pathology into congenital and acquired forms - according to the time of traumatization and death of nerve cells.

Classification of pathology:

• Due to appearance: traumatic, toxic, alcoholic, infectious, radiation, genetic, discirculatory, ischemic.
• By time of appearance: intrauterine, early childhood, late childhood, adults.
• By the presence of complications: complicated, uncomplicated.

In the absence of an obvious reason for the death of nerve cells and the symptoms accompanying this process, there is an unclear ROP of the central nervous system (residual organic lesion of the central nervous system). nervous system). At the same time, specialists will recommend additional examination methods in order to correctly classify the disease.

Causes of ROP in children

As a rule, an organic lesion of the central nervous system in children is a congenital pathology, which can be caused by acute severe or mild, but prolonged oxygen starvation of the site, which is formed during intrauterine development of the brain. Excessively long births. Premature abruption of the placenta - the organ responsible for feeding the baby inside the uterus. A significant weakening of the tone of the uterus and subsequent oxygen starvation of tissues.

Less often, the cause of irreversible changes in the nerve cells of the fetus are infections carried by a woman - for example, tuberculosis, gonorrhea, pneumonia. If infectious agents have penetrated the protective membranes of the uterus, then they have an extremely negative effect on the course of pregnancy, especially at the stage of formation of the central head system.

In addition, the appearance of residual organic brain lesions in children can lead to:

• birth trauma - when the fetus passes through the birth canal of a woman;
• the propensity of the expectant mother to use tobacco, alcohol products;
• daily inhalation by a pregnant woman toxic substances- work in hazardous industries with high levels of gas pollution in the premises, for example, in paint and varnish factories.

The mechanism of development of ROP of the CNS in a child can be imagined as a distortion of information during cell division due to breakdowns in the DNA chain - brain structures are formed incorrectly, may become unviable.

Causes in adults

In most cases, specialists indicate various external causes as provoking factors for residual damage.

Traumatic brain injuries - for example, car accidents, household injuries. Infectious lesions - the main microorganisms of the viral nature of Coxsackie, ECHO, as well as herpes viruses, staphylococci, HIV infection. Intoxication - a person's use of alcoholic beverages, drugs, tobacco, or frequent contact with salts heavy metals, taking certain subgroups of medicines;

Vascular disorders - for example, ischemic / hemorrhagic strokes, atherosclerosis, various anomalies of cerebral vessels. Demyelinating pathologies - most often indicate multiple sclerosis, which is based on the destruction of the sheath of nerve endings. Neurodegenerative conditions are mainly syndromes that occur in old age.

Increasingly, neoplasms - tumors - lead to organic lesions of the central nervous system. In the case of rapid growth, they put pressure on neighboring areas, injuring the cells. The result is an organic syndrome.

Symptoms in children

Signs of damage in babies can be observed from the first days of life. Such children are characterized by tearfulness, irritability, poor appetite and anxious intermittent sleep. In severe cases, episodes of epilepsy are possible.

At an early stage, it is difficult to identify an organic lesion of the central nervous system even for a highly professional neuropathologist, since the movements of the baby are chaotic, and the intellect is still underdeveloped. However, p With careful examination and questioning of parents, you can establish:

• violation of the muscle tone of the baby - hypertonicity;
• involuntary movements of the head, limbs - more intense than it should be in children of the same age;
• paresis / paralysis;
• violation of the movements of the eyeballs;
• sensory dysfunctions.

Closer to the year, organic lesions of the central nervous system will be indicated by symptoms:

• lagging behind in intellectual development - the baby does not follow the toys, does not speak, does not fulfill the requests addressed to him;
• a pronounced delay in general physical development - does not hold his head, does not coordinate movements, does not make attempts to crawl, walk;
• increased fatigue of children - both physical and intellectual, failure to assimilate the training program;
• emotional immaturity, instability - rapid mood swings, self-absorption, moodiness and tearfulness;
• various psychopathy - from a tendency to affects to severe depression;
• infantilism of the personality - the increased dependence of the baby on the parents, even in household trifles.

Timely detection and comprehensive treatment of CNS lesions in childhood makes it possible to compensate for negative manifestations and socialize the baby - he studies and works with his peers almost on a par.

Symptoms in adults

If residual CNS damage in adults is due to vascular changes, it will appear gradually. Others may notice a person's increased absent-mindedness, memory loss, and intellectual capabilities. As the pathological disorder worsens, new symptoms and signs are added:

• - long, intense, in different parts of the skull;
• nervousness - excessive, unreasonable, sudden;
• dizziness - persistent, of varying severity, not associated with other pathologies;
• jumps in intracranial pressure - sometimes up to significant numbers;
• attention - scattered, difficult to control;
• movements - uncoordinated, unsteady gait, fine motor skills suffer, up to the inability to hold a spoon, book, cane;
• epilepsy - attacks from rare and weak to frequent and severe;
• mood - changes rapidly, up to hysterical reactions, antisocial behavior.

Residual organic damage in adults is often irreversible, since its causes are tumors, injuries, and vascular pathologies.

A person's quality of life is reduced - he loses the opportunity to take care of himself, perform work duties, becomes a severely disabled person. To prevent this, it is recommended to seek medical help in a timely manner.

Diagnostics

With the manifestations of symptoms of an organic lesion of the central nervous system, a specialist will definitely recommend modern methods of laboratory, as well as instrumental diagnostics:

• blood tests - general, biochemical, for antibodies to infections;
• tomography - the study of brain structures through a variety of radiographic images;
• brain tissue, as well as blood vessels;
• electroencephalography - detection of a focus of pathological brain activity;
• neurosonography - helps to analyze the conductivity of brain cells, reveals small hemorrhages in the tissue;
• analysis of cerebrospinal fluid - its excess / lack, inflammatory processes.

According to individual needs, the patient will need to consult an ophthalmologist, endocrinologist, traumatologist, infectious disease specialist.

Only by examining the organic lesion of the central nervous system from all sides, the doctor gets the opportunity to draw up a complete scheme drug therapy. Success in the fight against a negative state is the timely and complete establishment of provoking causes, as well as the implementation of all prescribed therapeutic measures.

Treatment tactics

Elimination of an organic lesion of the central nervous system is not an easy task, which requires maximum efforts from both doctors and the patient himself. Treatment will require time and effort, as well as finances, since the main emphasis is on rehabilitation - spa courses, specialized training, acupuncture, reflexology.

Only after the main cause of brain damage has been established, it needs to be eliminated - to restore blood circulation, improve nerve conduction of impulses between cells, remove a tumor or a blood clot.

Subgroups of medicines:

• means for improving local and general blood circulation - nootropics, for example, Piracetam, Phenotropil;
• corrective medications mental processes, suppression of perverse cravings - Phenozepam, Sonopaks;
• sedatives - on a plant / synthetic basis.

Additional procedures:

• massage - correction of muscle activity;
• acupuncture - impact on the nerve centers;
• physiotherapy treatment - magnetotherapy, electrophoresis, phonophoresis;
• swimming;
• psychotherapeutic impact - classes with a psychologist to establish connections between the patient and the surrounding people, society;
• speech correction;
• specialized training.

The ultimate goal of therapeutic measures is to maximize the condition of a person with organic lesions of the central nervous system, improve his quality of life and adapt to the disease. Of course, the main burden of caring for such a patient falls on the shoulders of his relatives. Therefore, doctors also work with them - they teach the skills of administering drugs, the basics of gymnastics, and psychological behavior.

With due diligence, as well as patience, a positive result and return will be obvious - the manifestations of residual encephalopathy will be minimal, life will be active, and self-care will be the maximum possible for the level of damage. ROP is not a sentence at all, but a severe test that can and must be overcome.

Perinatal damage to the central nervous system is a pathology that includes a group of various conditions that, under the influence of negative factors, adversely affect the spinal cord or brain of a newborn.

To date, there is no clear terminology that describes PCNS in newborns. Until the 1990s, they used the classification proposed by Yakunin Yu. Ya., where terms were used that were not entirely appropriate from the point of view of modern medicine.

Thus, the term "perinatal encephalopathy" (literally means "brain weakness") indicated persistent, almost irreversible changes in the nervous system. But many perinatal disorders are reversible. In the initial period of life, the brain has enormous compensatory capabilities and is able to fully recover even with pathology of moderate severity.

And the term "impaired cerebral circulation" was associated by neurologists with strokes and had no clear signs. Over time, it began to be called "cerebral ischemia." Separate conversation about hypertensive-hydrocephalic syndrome. Intracranial hypertension is diagnosed all the time, while measuring CSF pressure is quite difficult, and the diagnosis is often made on the basis of symptoms that are quite common for babies in the first weeks of life: chin trembling, irritability, shuddering, superficial sleep, anxiety and screaming. As a result, children unreasonably take serious drugs from an early age.

However, perinatal lesions do exist and should not be ignored. Pathology in severe form is really dangerous for the life of the baby. According to some estimates, between 5 and 55% of newborns are diagnosed with PCNS. This difference is explained by the inclusion here of mild forms of disorders in this period. Basically, this is a problem of premature babies, since body weight at birth directly affects the formation and functioning of the nervous system.

The diagnosis is relevant only for babies of the first year of life (that's why it is called "perinatal"; the word indicates the time close to birth). By the time the baby reaches 12 months, a different diagnosis is made, based on the totality of the symptoms present.

How the disease develops

We advise you to read: Consequences of cerebral ischemia in newborns

There are three phases (periods) of perinatal damage:

• acute - from birth or even from the prenatal period to the 1st month of life;
• restorative; it is divided into early (2-3 months) and late (4-12 months, in premature babies up to 24 months);
• outcome of the disease.

Each interval has its own clinical picture and manifests itself in the form of certain syndromes. From how they are expressed, they judge the severity of the disease. Consider their features.

Acute period

1. Hypertension-hydrocephalic syndrome. cerebrospinal fluid accumulates in the ventricles of the brain due to a violation of its outflow - thus increasing intracranial pressure. Parents or doctors may notice a rapid increase in head circumference, as well as a protrusion of the fontanel. Indirectly, the development of hydrocephalus is indicated by frequent regurgitation, more like vomiting, eye nystagmus, poor superficial sleep.
2. Convulsive syndrome. Rarely occurs in the form of twitching of the arms, legs and head, episodic shuddering.
3. Vegetative-visceral syndrome. It is manifested by a marble skin tone (since the tone of peripheral vessels is impaired), problems from the gastrointestinal tract and the cardiovascular system.
4. apathy syndrome. The vital reflexes of sucking and swallowing are weakened, and motor activity is reduced along with reduced muscle tone.
5. Increased neuro-reflex excitability. It is characterized by muscular dystonia: the tone can be either increased or decreased; reflexes fade longer than usual, the chin trembles in children, especially when crying, which now and then occurs for no apparent reason. The baby sleeps superficially. Syndrome accompanies mild degree the severity of the disease.
6. coma syndrome. Occurs as a result of severe depression of the central nervous system and indicates a difficult situation for the newborn. An infant who has fallen into a coma is placed in intensive care in an unconscious state, since there are no signs of coordinating brain activity.

muscle weakness - warning sign

Recovery period

The early recovery period is misleading, because it seems that neurological disorders become less pronounced, muscle tone returns to normal, and reflexes are restored. But after a while the clinical picture worsens again. It should be noted that this situation occurs only when CNS damage has been diagnosed in newborns of moderate and severe form.

It is quite logical that a child who has undergone this pathology will develop late. Later than his peers, he will hold his head, sit and walk. Later, the first smile, interest in the world around will appear. All delays in motor and mental development should encourage parents to once again show the baby to a neurologist, although children with such a diagnosis are already registered with him.

Also, if intensive drug therapy is used during the acute period, then in the recovery phase, emphasis is placed on physiotherapy, massage courses, and psychocorrection.

Outcome of the disease

The results of the therapy are brought closer to the age of one. With a favorable prognosis, the following consequences may persist:

• delayed development of speech skills, motor and mental state;
• hyperactivity and attention deficit - the child cannot concentrate on the subject being studied for a long time, has difficulty remembering new things, tends to show aggression and impulsivity;
• cerebroasthenic syndrome (expressed in a sense of anxiety, superficial sleep, manifestation of hysteria, meteorological dependence).

The severe course of the disease leads to the development of:

• epilepsy;
• children's cerebral palsy;
• hydrocephalus.

Cerebral palsy - a consequence of severe damage to the central nervous system

In figures, the options for the development of the outcome of the disease can be expressed as follows: 30% - complete recovery, 40% - functional disorders, about 30% are organic disorders, in rare cases death comes.

Causes

Speaking about the causes of depression of the nervous system, there are 4 main factors contributing to the development of the disease:

Our habits affect the future of our children

1. Acute hypoxia. Oxygen starvation can begin even during fetal development due to chronic maternal diseases (diabetes mellitus, nephropathy), placental insufficiency or infection. The development of hypoxia is quite possible during childbirth, if they are rapid or protracted, the position of the fetus is not head, placental abruption has occurred, etc.
2. Traumatization. Occurs during delivery due to unprofessional actions of the staff or due to other circumstances (narrow pelvis, large head size, cord entanglement, breech presentation).
3. Toxic-metabolic damage. It develops if the metabolism is disturbed in the baby's body or the mother used toxic products (drugs, nicotine, certain drugs, alcohol) during the gestation of the fetus.
4. Viral or bacterial infection.

Severity

• Light. Muscle tone is moderately increased or decreased. Strabismus, Graefe's symptom, slight reflex excitability. The chin is trembling. Signs of depression may alternate with excitement.
• Average. Inhibition of reflexes, rare seizures, restless behavior, disorders of the cardiac system, gastrointestinal tract and kidney function. The symptoms of oppression predominate over the symptoms of arousal.
• Heavy. Respiratory and cardiac disorders, low Apgar score, the condition requires resuscitation.

Diagnostics

A neurologist can send the child for a consultation with an ophthalmologist and for additional examinations. What are their advantages and disadvantages?

Neurosonography

An affordable, safe and widely practiced method for examining the structures of the cranium using ultrasound. The procedure is performed by a special apparatus through an open fontanel. The study can be done in deeply premature babies in the intensive care unit, even if they are connected to artificial lung ventilation.

Neurosonography allows you to see the degree of filling of the ventricles of the brain and suggest for what reasons brain activity suffers. The disadvantage of the study is that any area with altered echogenicity can be mistaken for pathology. Also, the accuracy of the study is affected by the condition of the baby (he is calm or crying) and even how the sensors are attached.

Computed tomography and MRI

It happens that neurosonography did not reveal severe pathologies, and symptoms of CNS depression are present. Then a study is scheduled using magnetic resonance or computed tomography. This method is more informative, it allows you to "look" into the most remote corners of the brain, evaluate its smallest structures.

MRI is a modern diagnostic method

Important Rule: during the study, the child should not move. Therefore, before the procedure, he may be given special medications.

EEG and dopplerography

Electroencephalography helps to see the bioelectric brain activity, evaluate the pulsation of the vessels. That's just the brain in the perinatal period is immature, and the study must be carried out more than once, comparing the indicators. With the help of dopplerography, blood flow in the vessels is assessed.

Treatment

The task of the medical staff is to establish the fact of violations of the central nervous system as soon as possible and begin treatment even in the maternity hospital. Recall that the first month of life is the most decisive, when the maturation of nerve cells and the full replacement of those who died after oxygen starvation are possible.

PCNS in the acute period is treated in the ward intensive care. The baby is placed in a special incubator and all efforts are directed to maintaining the heart, kidneys and lungs, eliminating convulsions, cerebral edema. During this period, treatment is indicated with medicines that improve cerebral circulation normalizing the outflow of cerebrospinal fluid. At the same time, doctors take a responsible approach to choosing the dosage of drugs, especially when it comes to premature babies with a small weight. There is a round-the-clock observation by neonatologists. A neurologist can be invited for a consultation directly to the intensive care unit.

When the condition returns to normal, the infant is transferred to the neonatal pathology unit or to the neurological unit for further treatment. Reflexes gradually return to normal, the work of the heart muscle and gastrointestinal tract stabilizes, ventilation of the lungs improves. The choice of therapeutic drugs is aimed at eliminating the existing syndromes.

Recovery period

Rehabilitation activities during the recovery period include a course of massage, electrophoresis, therapeutic exercises. Swimming is very helpful. On the one hand, it relaxes muscle tone, on the other hand, it strengthens the muscle corset. Massage elements will differ depending on the type of movement disorders. With hypertonicity, a relaxing massage is shown. And with muscle hypotension, massaging is designed to relax the limbs and activate the muscles of the back, abdomen, arms and legs.

Several massage courses are an indispensable condition during the recovery period

Warm baths have a beneficial effect on the nervous system. And if you add a decoction of motherwort or pine needles to the water, you get a balneotherapy with a sedative effect. The healing effect of heat is used in the treatment with paraffin and ozocerite, applying applications to the affected areas.

Doctors strongly recommend trying to maintain lactation during this difficult time. Why? Yes, because milk contains everything necessary to protect the baby from infections and allows him to quickly strengthen the immune system. Milk and motherly affection help to reduce stress and improve emotional state. When a newborn is placed in the intensive care unit, he is fed with a bottle or through a tube. To conserve milk, pump regularly. Attach the baby to the breast as soon as possible.

A child who has had a perinatal CNS lesion should be protected from loud sounds, overheating or excessive cooling, sources of infection (let only healthy relatives and friends into the house). In general, he should be as comfortable as possible to adapt to the environment. For psycho-correction, music therapy, tactile stimulation are used, parents are taught to interact with the baby, evaluate his reactions. All actions are aimed at maximizing the quality of life of the child and his social adaptation.

mladeni.ru

What a mother should know about perinatal CNS damage in a child

Pathological changes in the child's brain, formed during fetal development or during passage through the birth canal, are called perinatal lesions of the central nervous system. There are many causes of perinatal CNS damage in newborns, there is a variety clinical manifestations and consequences.

Modern medicine has great potential for diagnosing and treating such conditions. CNS damage in newborns and consequences - are there any reasons for mothers to be afraid of this pathology?

Varieties of pathology

There are many types of morphological damage to the substance of the brain during fetal development and childbirth. They differ in the mechanism of occurrence, in the clinical course, in the possible consequences. Perinatal lesions of the central nervous system resulting from oxygen starvation of brain cells:

• cerebral ischemia of three degrees of severity;
• hemorrhages in the brain;
• traumatic and non-traumatic damage to the brain substance.

Lesions that arose as a result of metabolic disorders:

• bilirubin encephalopathy;
• hypoglycemic damage;
• damage due to an imbalance of minerals;
• toxic lesions of medicinal and infectious nature.

Sometimes there may be a perinatal CNS lesion of mixed origin - with a combination of several factors at the same time.

Symptoms of CNS damage in newborns depend on the mechanism of their occurrence. With oxygen starvation, three degrees of severity of the pathology are distinguished.

The first degree is characterized by:

• excessive excitability of the child;
• increase in physical activity;
• restless sleep;
• constant regurgitation while feeding.

This condition is completely reversible, all signs disappear after two weeks. With the second degree of severity:

• respiratory disorders in the form of frequent superficial movements of the chest;
• skin cyanosis; cardiopalmus;
• decrease in the strength of physiological reflexes;
• muscle hypotonia and decreased motor activity.

These signs also regress completely, but after more long time- during two months.

In the third degree of severity, the child's condition is critical:

• disturbed breathing and heartbeat;
• skin is pale with a gray tint;
• atony of the muscles of the limbs;
• lack of physiological reflexes;
• focal symptoms begin in the form of nystagmus of the eyes;
• possible development of coma.

Hemorrhages in the substance of the brain are manifested by focal lesions corresponding to the localization of the hemorrhage. This often results in coma. Metabolic disorders lead to almost the same symptoms as hypoxic conditions.

Important! The severity of the signs will depend on the level of metabolic disorders - the amount of free bilirubin, blood sugar, and the concentration of minerals.

The neonatologist usually notices the first changes in the child's condition. He conducts an examination immediately after birth and assesses the degree of hypoxia. Metabolic disorders are diagnosed later, after laboratory tests. Cerebral hemorrhage can be suspected by the presence of focal symptoms, and the diagnosis is confirmed using imaging techniques - usually a computed tomography.

The consequences of perinatal CNS damage primarily depend on the severity of the condition.

1. A mild degree, subject to full treatment, does not leave any consequences.
2. The second degree of severity - the symptoms can completely regress, but in the future, with the addition of certain somatic diseases, neurological manifestations are possible, which are the result of the pathology transferred in the neonatal period. The most frequent manifestation is asthenoneurotic syndrome - disorders of the nervous system, manifesting a change in behavior. The child becomes overly capricious, motor activity increases, sleep is disturbed, excessive irritability is observed.
3. Severe lesions - with third-degree hypoxia, hemorrhages, severe bilirubin encephalopathy - subsequently manifest as serious developmental defects. Among them are:

• late physical development of the child;
• violations of motor function;
• delay mental development;
• speech disorders;
• decrease in skill learning.

Principles of treatment

Treatment of perinatal lesions of the central nervous system - the basic principle is its immediate onset, immediately after the diagnosis is clarified. Immediately after birth, correction of impaired vital functions should be carried out. important functions body - respiration and cardiac activity.

At the same time, detoxification therapy is carried out to restore the activity of nerve cells. After the elimination of the main symptoms, restorative treatment should be carried out. Used decongestant, infusion therapy, sedatives, anticonvulsants and nootropics.

Conclusion

Pathology of the nervous system in the neonatal period is not always a favorable condition. Some mothers should prepare to raise a child with developmental disabilities varying degrees gravity. However, proper upbringing and treatment will make it possible to correct these deviations as much as possible and achieve a good learning ability of the child.

golmozg.ru

Perinatal damage to the central nervous system: symptoms and treatment of PCNS

The phrase perinatal period itself suggests that perinatal CNS damage develops in an unborn child, that is, a fetus.

Perinatal damage to the central nervous system (PPNS) is a diagnosis that implies a malfunction in the functioning of the fetal brain.

The entire period of the perinatal period is conditionally divided into three stages:

• from the 28th week until the moment of delivery, the antenatal period lasts;
• the process of childbirth itself is called the intranatal period;
• The neonatal period is the period from birth to the first week of life.

V modern medicine there is no exact name for the disease in case of damage to the central nervous system of the fetus, there is only a team, it is called PCNS or perinatal encephalopathy.

Perinatal damage to the central nervous system in newborns is manifested by disturbances in the functioning of the motor apparatus, speech and mental disorders.

With the development of medicine, they stopped using this diagnosis for children older than one month. After a month, the doctor must make an accurate diagnosis of the child. It is during this period that the neurologist accurately determines how badly the nervous system is damaged. Prescribes treatment and makes sure that it is chosen correctly.

The reasons why perinatal lesions of the central nervous system can develop are quite diverse, among the most popular:

All other causes of PCNS are situational and it is simply impossible to predict their occurrence to a greater extent.

Classification and varieties of syndromes

PPTSNS is conditionally divided into several periods, depending on the stage at which the violation was detected and how it manifested itself.

The acute period lasts from 7 to 10 days, it is extremely rare, but it can stretch up to a month. The period in which recovery occurs can last up to half a year. If the child's body recovers slowly, then this period can take up to 2 years.

Pediatric neurologists distinguish the following types of perinatal lesions of the central nervous system, depending on the accompanying symptoms and syndrome:

1. Violation of muscle tone, which is accompanied by a complex of disorders associated with breathing. This syndrome is diagnosed according to deviations from the norm, depending on the age of the newborn. In the initial period of a child's life, it is quite difficult to diagnose this syndrome, since in addition there is physiological hypertonicity.
2. Syndrome associated with sleep disturbance, twitching of the chin. This syndrome can be diagnosed only when flatulence is excluded.
3. Depression of the nervous system. This syndrome is diagnosed in children who are not active in the first months of their lives, they sleep a lot, they have low tone.
4. An unfavorable prognosis for a child if the syndrome of intracranial hypertension has developed. Its main signs are increased excitability and nervousness, while the fontanel begins to swell.
5. One of the most dangerous and severe syndromes with PTCNS is convulsive, it is he who is one of the most serious manifestations in perinatal lesions of the central nervous system. In addition, any attentive mother can notice deviations in the state of health of her child much faster than a neurologist, if only because she watches him around the clock and more than one day.

In any case, the baby, living the first year with any (even minimal, but not passing) deviations in the state of health, requires repeated consultations with specialists (if necessary - additional examination), careful observation and therapeutic measures if necessary.

Symptoms and diagnostic criteria

Not every mother who does not have a medical education will be able at first glance to distinguish and determine that her child has a perinatal CNS lesion.

But, neuropathologists accurately determine the disease by the appearance of symptoms that are not characteristic of other disorders that are characteristic of the smallest patients.

Symptoms of PCNS:

• when examining a baby, hypertonicity or hypotonicity of muscles can be detected;
• the child is excessively restless, anxious and agitated;
• the occurrence of shaking in the chin and limbs (tremor);
• the appearance of seizures;
• when viewed with a hammer, a violation of sensitivity is noticeable;
• the appearance of an unstable stool;
• changes in heart rate;
• the appearance of bumps on the skin of the child.

As a rule, after a year, these symptoms disappear, but then appear with new force, so run this situation just can't.

One of the most dangerous manifestations and consequences of PCNS in the absence of a response to symptoms is the suspension of the development of the child's psyche. The speech apparatus does not develop, there is a delay in the development of motor skills. Also, one of the manifestations of the disease can be cerebrosthenic syndrome.

There are several ways of developing perinatal CNS damage in newborns, depending on the cause and subsequent symptoms, the analysis of which allows you to make an initial diagnosis:

Complex of therapeutic measures

In the case when a child develops an acute period of the disease, he is first sent to the intensive care unit. Diuretics are used in case of suspected cerebral edema - dehydration therapy can be carried out.

Depending on what symptoms the baby is experiencing, with the right treatment, you can get rid of convulsions, disorders in the respiratory tract and the cardiovascular system, and muscle disorders.

If the disease is difficult, then the child is fed through a tube. To restore the main functions of the central nervous system, as well as to reduce the manifestation of neurological symptoms, the baby is prescribed a whole range of drugs:

• for the relief of seizures, a course of taking Radodorm, Finlepsin, Phenobarbital can be prescribed;
• if the child periodically burps, Motilium or Cerucal is prescribed;
• if there are violations of the locomotor apparatus, Galantamine, Dibazol, Alizin, Prozerin are prescribed;
• in order to reduce possible hemorrhages, it is recommended to use Lidaza.

Nootropic drugs can also be used in the treatment, which can restore trophic processes in the brain - Piracetam, Cerebrolysin, glutamic acid.

In order to stimulate the general reactivity, a newborn child is given a course of therapeutic massage and special gymnastics.

In the event that parents have found at least one of the signs of CNS lesions, an urgent need to consult a doctor. Do not forget that the development of each child is an individual process.

Such individual characteristics of each newborn child in each specific case play an important role in the process of restoring the functions of higher nervous activity.

Perinatal lesions of the central nervous system:

Danger and Consequences

There is an opinion among experts that if the central nervous system of the fetus has been affected, then it cannot be completely restored. But neurologists-practitioners argue the opposite. They say that if the disease is treated correctly, it is possible to achieve partial or complete restoration of the functions of the nervous system.

But even despite such an optimistic forecast, if you look at all diseases associated with the nervous system, then 50% of their total number leads to disability, while about 80% of it is allocated to perinatal damage to the central nervous system.

Preventive actions

In order for the baby to be healthy, you must:

• completely abandon alcohol, drugs, smoking;
• avoid infectious diseases during pregnancy;
• in case of indications, carry out heat treatment, due to which blood flow improves and tissues are warmed;
• as soon as the baby is born, you can attend the course underwater massage shower, which is carried out in warm water and has a beneficial effect on the development of muscle tone in the baby, but if this is not possible, you can perform a manual massage under water.

Read more

neurodoc.ru

Pathologies of the central nervous system in newborns | OkDoc

Pathologies of the central nervous system (CNS) in newborns are a large group of lesions of the spinal cord / brain. Such lesions can occur during fetal development, during childbirth and in the first days of life.

Table of contents: Causes of the development of CNS pathologies in newborns Classification of CNS pathologies in newborns - Hypoxic lesions - Traumatic lesions - Dysmetabolic disorders - CNS lesions in infectious diseases 3. Periods of the course of CNS pathologies in newborns - Acute period - Recovery period - Outcome of the disease 4. Diagnostic measures 5 Methods of treatment and rehabilitation - Rehabilitation period 6. Prevention of pathologies of the central nervous system in newborns

Causes of the development of CNS pathologies in newborns

According to statistics, up to 50% of newborns are diagnosed with perinatal pathologies of the central nervous system, because doctors often include transient disorders in the functioning of the central nervous system in this concept. If we consider the statistics in more detail, it will be found out:

• 60-70% of cases of diagnosing pathologies of the central nervous system in newborns occur at the birth of a premature baby;
• 1.5 - 10% of cases - on full-term children born in a timely and natural way.

The factor causing the appearance pathological changes in the work of the central nervous system in newborns, there can be absolutely any negative impact on the fetus during its intrauterine development. In general, doctors identify several main causes of the condition in question:

1. Fetal hypoxia. We are talking about oxygen starvation, when the blood of the child enters an insufficient amount oxygen from the mother's body. Hypoxia can also be provoked by harmful production (it is not for nothing that pregnant women are immediately transferred to lighter work), and infectious diseases transferred before pregnancy, and bad habits women (especially smoking). It greatly affects the oxygen supply to the fetus and the number of previous abortions - artificial termination of pregnancy provokes a violation of blood flow between the mother and fetus in the future.
2. Newborn trauma. We are talking about injury during childbirth (for example, when forceps are applied for medical reasons), in the first hours / days of a newborn's life. It is physical injury that is considered the least probable cause development of pathologies of the central nervous system in newborns.
3. Dysmetabolic processes in the newborn. Violations in the metabolic processes of the fetal body can occur due to maternal smoking, drug use, alcohol consumption, or forced intake of potent drugs. medicines.
4. Infectious diseases of the mother during childbearing. Pathological damage to the central nervous system occurs with direct exposure to the fetus of viral agents, pathogenic microorganisms.

Please note: regardless of whether the above factors were present, more often CNS pathologies in newborns are diagnosed in case of premature birth, in premature babies.

Classification of pathologies of the central nervous system in newborns

Depending on what causes provoked the development of disorders in the work of the central nervous system of the newborn, doctors also classify them. Each type is characterized by specific symptoms and nosological forms.

Hypoxic Lesions

Oxygen starvation of the fetus can lead to the following lesions of the central nervous system in newborns:

1. cerebral ischemia. The nosological form of this pathology is manifested in varying degrees severity of the course - cerebral ischemia of 1, 2 and 3 degrees of severity of the course. Clinical symptoms:

Please note: for the 3rd degree of severity of the course of the pathological condition under consideration, progressive depression of the central nervous system is characteristic - in some cases, the newborn enters coma.

1. Intracranial hemorrhages of hypoxic origin. Nosological forms are diverse:

• intraventricular hemorrhage type 1 degree - specific neurological symptoms, as a rule, are completely absent;
• intraventricular hemorrhage of the 2nd degree - convulsions may develop, often the newborn falls into a coma, there is progressive intracranial hypertension, shock, apnea;
• intraventricular hemorrhage of the 3rd degree - deep depression of the central nervous system (coma), shock and apnea, long convulsions, high intracranial pressure;
• subarachnoid hemorrhage of the primary type - doctors diagnose hyperexcitability of the central nervous system, focal clonic convulsions, acute hydrocephalus;
• hemorrhage in the substance of the brain - the appearance of specific symptoms depends only on the location of the hemorrhage. Possible: intracranial hypertension / focal convulsions / convulsions / coma, but in some cases, even such a serious violation of the central nervous system is asymptomatic.

1. The combination of ischemic and hemorrhagic lesions of the central nervous system. The clinical picture and nosological forms of this condition will depend only on the location of the hemorrhage, the severity of the pathology.

Traumatic lesions

We are talking about birth injuries that caused the development of pathological disorders in the work of the central nervous system. They are divided according to the following principle:

1. Intracranial birth trauma. It can manifest itself in several nosological forms:

• hemorrhage of the epidural type - the condition is characterized by high intracranial pressure (the very first sign), convulsive syndrome, in rare cases, doctors fix pupil dilation on the side of the hemorrhage;
• subdural hemorrhage - subdivided into supratentorial (asymptomatic course, but may appear partial convulsions, dilation of the pupil from the side of hemorrhage, progressive intracranial hypertension) and subtentorial (acute increase in intracranial pressure, progressive cardiac / respiratory disorders, depression of the central nervous system with the transition to a coma);
• hemorrhage of the intraventricular type - characterized by convulsions (multifocal), heart / respiratory failure, CNS depression, hydrocephalus;
• hemorrhagic infarction - the course may be asymptomatic, but may be manifested by convulsions, depression of the central nervous system with the transition to a coma, high intracranial pressure;
• subarachnoid hemorrhage - doctors diagnose acute external hydrocephalus, hyperexcitability and convulsions.

1. Injury spinal cord during childbirth. There is a hemorrhage in the spinal cord - an anguish, stretching. It can either be accompanied by a spinal injury or proceed without this moment. The clinical picture is characterized by impaired functioning respiratory system, sphincter dysfunction, movement disorders, and spinal shock.
2. Trauma of the peripheral nervous system during childbirth. Nosological forms and symptoms:

• damage to the brachial plexus - there is a flaccid paresis of the proximal part of one or both arms at once in the case of the proximal type, flaccid paresis of the distal upper limbs and Claude Bernard-Horner syndrome in the distal type of damage. Total paralysis may develop - there is paresis of the total part of the arm or both arms at the same time, a violation of the respiratory system is possible;
• damage to the phrenic nerve - often occurs without any pronounced symptoms, but respiratory disturbances may be observed;
• traumatic injury facial nerve- in a child, during a cry, the mouth warps in a healthy direction, the nasolabial folds are smoothed out.

Dysmetabolic disorders

First of all, doctors consider transient metabolic disorders:

In newborns, dysmetabolic disorders of the central nervous system may also appear against the background of toxic effects on the fetal body - for example, if the mother was forced to take potent drugs, did not exclude alcohol, drugs and tobacco. In this case, the clinical picture will be as follows:

• convulsions - rare, but this syndrome may be present;
• hyperexcitability;
• depression of the central nervous system, turning into a coma.

CNS lesions in infectious diseases

If during pregnancy a woman was diagnosed with cytomegalovirus infection, toxoplasmosis, rubella, herpetic infection or syphilis, then the probability of having a child with pathologies of the central nervous system increases significantly. There are some infectious diseases that can contribute to the development of problems in the work of the central nervous system after the birth of a child - sepsis, Pseudomonas aeruginosa, streptococcal and staph infections, candidiasis and others.

In case of CNS lesions of infectious etiology, the following symptoms:

• intracranial hypertension;
• hydrocephalus;
• focal disorders;
• meningeal syndrome.

Periods of the course of pathologies of the central nervous system in newborns

Regardless of what causes the development of CNS lesions in newborns, experts distinguish three periods of the disease:

• acute - falls on the first month of a child's life;
• restorative - can take place from 2 to 3 months of a baby's life (early) and from 4 months to 1 year (late);
• outcome of the disease.

For each of the listed periods, characteristic signs are inherent, which may be present separately, but more often appear in original combinations individually for each child.

Acute period

If the newborn has mild damage to the central nervous system, then hyperexcitability syndrome is most often diagnosed. It manifests itself as a sharp start, disturbances in muscle tone (it can be increased or decreased), trembling of the chin and upper / lower extremities, unmotivated crying and shallow sleep with frequent waking up.

In case of violations of the central nervous system of moderate severity, there will be a decrease in muscle tone and motor activity, a weakening of the reflexes of swallowing and sucking.

Please note: by the end of the first month of life, hypotonia and lethargy are replaced by increased excitability, uneven coloration of the skin (marbling of the skin) appears, and disturbances in the digestive system are noted (constant regurgitation, flatulence, vomiting.

Very often, the acute period of the disease is accompanied by the development of hydrocephalic syndrome - parents may note fast growth head circumference, protrusion of the fontanel, divergence of the cranial sutures, restlessness of the newborn and unusual eye movements.

Coma can occur only with very severe damage to the central nervous system in newborns - this condition requires the immediate help of medical professionals, all medical measures carried out in the intensive care unit of a medical institution.

Recovery period

If up to 2 months the child looked absolutely healthy, the parents did not notice any strange / unusual syndromes, then the recovery period can proceed with pronounced symptoms:

• facial expressions are very poor - the baby rarely smiles, does not squint, does not show any emotions;
• lack of interest in toys and any other items;
• the cry is always weak and monotonous;
• baby talk and "cooing" either appear with a delay, or are completely absent.

Please note: it is the parents who should pay attention to the above symptoms and report them to the pediatrician. The specialist will prescribe a full examination of the child, send a small patient for examination to a neurologist.

Outcome of the disease

By the age of 12 months, the symptoms of CNS pathologies in newborns almost always disappear, but this does not mean that the lesions described above have disappeared without any consequences. The most common consequences of damage to the central nervous system in newborns include:

• hyperactivity syndrome, accompanied by a lack of attention - memory impairment, learning difficulties, aggressiveness and tantrums;
• delayed speech, psychomotor and physical development;
• cerebroasthenic syndrome - characterized by meteorological dependence, disturbing sleep, sudden mood swings.

But the most severe, complex consequences of CNS pathologies in newborns are epilepsy, cerebral palsy and hydrocephalus.

Diagnostic measures

It is very important for a correct diagnosis to conduct a correct examination of the newborn and observation of his behavior / condition in the first hours of the baby's life. If you suspect pathological lesions of the central nervous system, it is advisable to prescribe a comprehensive examination:

Methods of treatment and rehabilitation

Help for newborns with CNS pathologies is necessary in the first hours of life - many disorders are completely reversible, there is an immediate start to rehabilitation / treatment.

The first stage of assistance

It consists in restoring the working capacity of vital organs and systems - we recall that in almost all types / forms of pathologies of the central nervous system of newborns, heart / respiratory failure and problems in the kidneys are manifested. With the help of medicines, doctors normalize metabolic processes, relieve the newborn from convulsive syndrome, stop swelling of the brain and lungs, and normalize intracranial pressure.

Second round of help

Very often, after providing emergency measures to help a newborn with CNS pathologies, visible signs disappear even in the maternity hospital, often the child's condition returns to normal. But if this does not happen, then the patient is transferred to the neonatal pathology department and continues treatment/rehabilitation.

The second stage of assistance involves the appointment of drugs that act to eliminate the cause of the pathologies in question - for example, antiviral, antibacterial agents. At the same time, therapy is prescribed aimed at restoring brain activity, stimulation of maturation of brain cells, improvement of cerebral circulation.

The third stage of assistance

If the newborn shows significant improvement in the condition, then it is advisable to switch to non-drug treatment. We are talking about massages and physiotherapy procedures, the most effective of which are:

• physiotherapy;
• therapy by "position" - installation of splints, "collars", styling;
• specially designed cycle of exercises in water;
• hydromassage;
• imitation of weightlessness;
• Voight therapy;
• vibration massage;
• paraffin therapy;
• alternating magnetic field;
• color therapy and light therapy;
• electrophoresis.

Please note: the third stage of assistance with the successful passage of the first two full-term babies is assigned at 3 weeks of life, and for premature babies a little later.

rehabilitation period

Doctors discharge a child with diagnosed pathologies of the central nervous system for outpatient treatment only in case of positive dynamics. Many experts believe that it is the rehabilitation period outside the medical institution that plays an important role in the further development of the child. Much can be done with drugs, but only permanent care. Mandatory need:

• protect the baby from harsh sounds and bright light;
• create an optimal climate regime for the child - there should not be sudden changes air temperature, high humidity or dry air;
• protect the baby from infection as much as possible.

Please note: with mild to moderate central nervous system damage in newborns, doctors do not prescribe drug therapy in the second stage - usually it is enough to provide urgent medical care and recovery normal functioning vital organs and systems. In the case of diagnosing severe CNS lesions in newborns, some drugs are prescribed in courses and at an older age, during outpatient treatment.

Prevention of pathologies of the central nervous system in newborns

Most often, the pathologies under consideration are easy to predict, so doctors strongly recommend taking preventive measures even at the stage of pregnancy planning:

Secondary prevention is considered to be the provision of full assistance when pathologies of the central nervous system in newborns are already detected, preventing the development of serious consequences.

At the birth of a child with pathologies of the central nervous system, you should not panic and immediately record the newborn as disabled. Doctors are well aware that timely medical care in most cases gives positive results- the child is fully restored and in the future is no different from his peers. Parents just need a lot of time and patience.

Tsygankova Yana Alexandrovna, medical observer, therapist of the highest qualification category.

Despite the variety of causes leading to perinatal damage to the nervous system, three periods are distinguished during the course of the disease:

• acute - 1st month of life);
• recovery, which is divided into early (from the 2nd to the 3rd month of life) and late (from 4 months to 1 year in full-term ones, up to 2 years in premature ones);
• outcome of the disease.

In each period, perinatal injuries have different clinical manifestations, which doctors are accustomed to distinguish in the form of different syndromes (a set of clinical manifestations of the disease, united by a common feature). In addition, a combination of several syndromes is often observed in one child. The severity of each syndrome and their combination make it possible to determine the severity of damage to the nervous system, correctly prescribe treatment and make predictions for the future.

Syndromes of the acute period

Syndromes of the acute period include: CNS depression syndrome, coma syndrome, increased neuro-reflex excitability syndrome, convulsive syndrome, hypertensive-hydrocephalic syndrome.

With mild CNS injuries in newborns, the most common is syndrome of increased neuro-reflex excitability which is manifested by a startle, increase (hypertonicity) or decrease (hypotension ^ muscle tone, increased reflexes, tremor (trembling) of the chin and limbs, restless superficial sleep, frequent "causeless" crying.

With moderate CNS damage in the first days of life, children often have CNS depression in the form of a decrease in motor activity and a decrease in muscle tone, a weakening of the reflexes of newborns, including sucking and swallowing reflexes. By the end of the 1st month of life, CNS depression gradually disappears, and in some children it is replaced by increased arousal. With an average degree of CNS damage, disturbances in the functioning of internal organs and systems are observed ( vegetative-visceral syndrome) in the form of uneven skin coloration (marbling of the skin) due to imperfect regulation of vascular tone, disturbances in the rhythm of breathing and heart contractions, dysfunction of the gastrointestinal tract in the form of unstable stools, constipation, frequent regurgitation, flatulence. May be less common convulsive syndrome, in which paroxysmal twitching of the limbs and head, episodes of shuddering and other manifestations of convulsions are observed.

Often in children in the acute period of the disease there are signs hypertensive-hydrocephalic syndrome, which is characterized by excessive accumulation of fluid in the spaces of the brain containing cerebrospinal fluid, which leads to increased intracranial pressure. The main symptoms that the doctor notes and that parents may suspect are the rapid growth rate of the child's head circumference (more than 1 cm per week), the large size and bulging of the large fontanelle, the divergence of the cranial sutures, anxiety, frequent regurgitation, unusual eye movements (a kind of trembling of the eye apples when looking away to the side, up, down - this is called nystagmus), etc.

A sharp inhibition of the activity of the central nervous system and other organs and systems is inherent in the extremely difficult condition of the newborn with the development comatose syndrome(lack of consciousness and coordinating function of the brain). This condition requires emergency care in intensive care.

recovery syndromes

In the recovery period of perinatal lesions of the central nervous system, the following syndromes are distinguished: increased neuro-reflex excitability syndrome, epileptic syndrome, hypertensive-hydrocephalic syndrome, vegetative-visceral dysfunction syndrome, movement disorders syndrome, psychomotor developmental delay syndrome. Long-lasting violations of muscle tone often lead to the appearance of a delay in psychomotor development in children, tk. violations of muscle tone and the presence of pathological motor activity - hyperkinesis (involuntary movements caused by contraction of the muscles of the face, trunk, limbs, less often the larynx, soft palate, tongue, external eye muscles) prevent the performance of purposeful movements, the formation of normal motor functions in the baby. With a delay in motor development, the child later begins to hold his head, sit, crawl, walk. Poverty of facial expressions, late appearance of a smile, reduced interest in toys and objects environment, as well as a weak monotonous cry, a delay in the appearance of cooing and babble should alert parents in terms of mental retardation in the baby.

Disease outcomes

By the age of one year, in most children, the manifestations of perinatal lesions of the central nervous system gradually disappear or their minor manifestations persist. Common consequences of perinatal lesions include:

• delayed mental, motor or speech development;
• cerebroasthenic syndrome (it is manifested by mood swings, motor restlessness, disturbing restless sleep, meteorological dependence);
• Attention Deficit Hyperactivity Disorder is a disorder of the central nervous system, manifested by aggressiveness, impulsivity, difficulty concentrating and maintaining attention, learning and memory disorders.

The most unfavorable outcomes are epilepsy, hydrocephalus, cerebral palsy, indicating severe perinatal CNS damage.

In the diagnosis, the doctor must necessarily reflect the alleged causes of damage to the central nervous system, the severity, syndromes and the period of the disease.

In order to diagnose and confirm perinatal CNS damage in children, in addition to clinical examination conduct additional instrumental studies of the nervous system, such as neurosonography, dopplerography, computed and magnetic resonance imaging, electroencephalography, etc.

V Lately The most accessible and widely used method for examining children in the first year of life is neurosonography (ultrasound examination of the brain), which is performed through a large fontanelle. This study is harmless, can be repeated both in full-term and premature babies, allowing you to monitor the processes occurring in the brain in dynamics. In addition, the study can be carried out on newborns in serious condition, who are forced to be in the intensive care unit in incubators (special beds with transparent walls that allow you to provide a certain temperature regime, control the condition of the newborn) and on a ventilator (artificial respiration through the apparatus). Neurosonography allows assessing the state of the substance of the brain and cerebrospinal fluid (brain structures filled with liquid - cerebrospinal fluid), identify malformations, and also suggest possible reasons damage to the nervous system (hypoxia, hemorrhage, infection).

If a child has severe neurological disorders in the absence of signs of brain damage on neurosonography, such children are prescribed more accurate methods for studying the central nervous system - computed (CT) or magnetic resonance (MRI) tomography. Unlike neurosonography, these methods allow us to assess the smallest structural changes in the brain and spinal cord. However, they can only be carried out in a hospital, since during the study the baby should not make active movements, which is achieved by administering special medications to the child.

In addition to studying the structures of the brain, it has recently become possible to assess blood flow in the cerebral vessels using Doppler ultrasound. However, the data obtained during its implementation can only be taken into account in conjunction with the results of other research methods.

Electroencephalography (EEG) is a method of studying the bioelectrical activity of the brain. It allows you to assess the degree of maturity of the brain, to suggest the presence of a convulsive syndrome in a baby. Due to the immaturity of the brain in children in the first year of life, the final assessment of EEG parameters is possible only if this study is repeatedly conducted in dynamics.

Thus, the diagnosis of perinatal lesions of the central nervous system in a baby is established by the doctor after a thorough analysis of data on the course of pregnancy and childbirth, on the condition of the newborn at birth, on the presence of disease syndromes identified in him, as well as data from additional research methods. In the diagnosis, the doctor will necessarily reflect the alleged causes of damage to the central nervous system, the severity, syndromes and the period of the disease.

Why do CNS disorders occur?

Analyzing the causes leading to disturbances in the work of the central nervous system of a newborn, doctors distinguish four groups of perinatal lesions of the central nervous system:

• hypoxic lesions of the central nervous system, in which the main damaging factor is hypoxia (lack of oxygen);
• traumatic lesions resulting from mechanical damage to the tissues of the brain and spinal cord during childbirth, in the first minutes and hours of a child's life;
• dysmetabolic and toxic-metabolic lesions, the main damaging factor of which are metabolic disorders in the child's body, as well as damage as a result of the use of toxic substances by a pregnant woman (drugs, alcohol, drugs, smoking);
• lesions of the central nervous system in infectious diseases of the perinatal period "when the main damaging effect is exerted by an infectious agent (viruses, bacteria and other microorganisms).

Help for children with CNS damage

In connection with the possibilities of early diagnosis of perinatal lesions of the central nervous system, the treatment and rehabilitation of these conditions should be carried out as early as possible so that the therapeutic effects occur in the first months of the baby's life, when the disorders are still reversible. It should be said that the ability of the child's brain to restore disturbed functions, as well as the capabilities of the whole organism as a whole, are very high precisely during this period of life. It is in the first months of life that the maturation of nerve cells of the brain to replace those that died after hypoxia is still possible, the formation of new connections between them, due to which in the future the normal development of the organism as a whole will be determined. I would like to note that even minimal manifestations of perinatal CNS lesions require appropriate treatment for prevent adverse outcomes of the disease.

Assistance to children with CNS injuries is carried out in three stages.

First stage involves the assistance provided in the maternity hospital (delivery room, intensive care unit, neonatal intensive care unit) and includes the restoration and maintenance of the functioning of vital organs (heart, lungs, kidneys), normalization of metabolic processes, treatment of CNS damage syndromes (oppression or excitation , convulsions, cerebral edema, increased intracranial pressure, etc.). It is at the first stage of care that the main treatments for children with severe CNS injuries are medication and intensive (for example, mechanical ventilation) therapy.

On the background of treatment, the condition of babies gradually improves, however, many symptoms of CNS damage (impaired muscle tone, reflexes, fatigue, anxiety, dysfunction in the lungs, heart, gastrointestinal tract) may persist, which requires the transfer of children to second stage of treatment and rehabilitation, namely - to the department of pathology of newborns and premature babies or to the neurological department of the children's hospital.

At this stage, drugs are prescribed aimed at eliminating the cause of the disease (infections, toxic substances) and affecting the mechanism of the development of the disease, as well as drugs used to treat certain syndromes of CNS damage. These are drugs that improve the nutrition of nerve cells, stimulate the maturation of brain tissue, improve microcirculation 2 and cerebral circulation, reduce muscle tone, etc. later) a course of massage can be prescribed with the gradual addition of therapeutic exercises, electrophoresis sessions and other rehabilitation methods.

After the end of the course of treatment, most children are discharged home with recommendations for further observation in a children's clinic ( third stage of rehabilitation). A pediatrician, together with a neuropathologist, and, if necessary, with other narrow specialists (oculist, otolaryngologist, orthopedist, psychologist, physiotherapist, etc.) draws up an individual plan for monitoring the child in the first year of life. During this period, non-drug methods of rehabilitation, such as massage, therapeutic exercises, electrophoresis, are becoming increasingly important. impulse currents, acupuncture, thermal procedures, balneotherapy (therapeutic baths), swimming, as well as psychological and pedagogical methods of correction aimed at developing motor skills, speech and the psyche of the child.

If the damage to the central nervous system is not severe and the baby is discharged from the maternity ward home, it is important to create a therapeutic and protective regimen during the acute period of the disease. And this means protecting the child from unnecessary irritants (loud sound of the radio, TV, loud conversations), creating conditions for thermal comfort (avoiding both overheating and hypothermia), not forgetting to regularly ventilate the room in which the baby is. In addition, it is necessary to protect the child as much as possible from the possibility of any infection, limiting visits to the newborn by acquaintances and relatives.

Particular attention should be paid proper nutrition, as it is a powerful healing factor. Breast milk contains all the necessary nutrients for the full development of the child. Early transition to artificial feeding leads to an early onset and more frequent development of infectious diseases. Meanwhile, the protective factors of mother's milk are able to partially compensate for the lack of their own immune factors during this period of development, allowing the baby to direct all his compensatory abilities to restore impaired functions after hypoxia. And the biologically active substances, hormones, growth factors contained in breast milk can activate the processes of restoration and maturation of the central nervous system. In addition, maternal touch during breastfeeding is an important emotional stimulant that helps reduce stress, and therefore, a more complete perception of the world around children.

Premature babies and babies born with severe CNS damage are often forced to be fed through a tube or bottle in the first days of life. Do not despair, but try to save breast milk by expressing it regularly and giving it to your baby. As soon as the condition of your crumbs improves, it will definitely be attached to the mother's breast.

An important place in the recovery period is occupied by therapeutic massage and gymnastics, which normalize muscle tone, improve metabolic processes, blood circulation, thereby increasing the overall reactivity of the body, and contribute to the psychomotor development of the child. The course of massage includes from 10 to 20 sessions. Depending on the severity of the CNS lesion in the first year of life, at least 3-4 massage courses are performed with an interval of 1-1.5 months. At the same time, between courses, parents continue to practice therapeutic exercises with the child at home, having previously learned during the classes.

Methods of massage and therapeutic gymnastics depend, first of all, on the nature of motor disorders, the characteristics of changes in muscle tone, as well as on the prevalence of certain syndromes of CNS damage.

Thus, in hyperexcitability syndrome, techniques are used to reduce general excitability (swaying in the fetal position or on a ball) and muscle tone (relaxing massage with elements acupressure). At the same time, in children with signs of depression of the nervous system, a strengthening massage of the muscles of the back, abdomen, gluteal muscles, as well as relaxed arms and legs is used.

Massage and therapeutic gymnastics create favorable conditions for general development the child is accelerated by the development of motor functions (mastering such skills as raising and holding the head, turns on the side, stomach, back, sitting, crawling, walking independently). Particular importance is given to classes on inflatable objects - balls, rolls (rollers). They are used to develop vestibular functions, help to relax tense and strengthen relaxed muscles, water. In this case, the exercises are carried out in ordinary baths, their duration at first is 5-7 minutes and gradually increases to 15 minutes. At the beginning of the course, it is desirable to undergo training with a medical instructor, and then it is possible to conduct classes in a home bath. Water not only tones weak muscles and relaxes tense ones, stimulates metabolism and blood circulation, has a hardening effect, but also has a calming effect on the baby's nervous system. It should be noted that an increase in intracranial pressure in children is not a contraindication to swimming - in this case, diving should only be excluded.

It is also possible to carry out a stimulating underwater shower-massage in warm bath. At the same time, water entering through a wide tip under low pressure (0.5 atmospheres) has a massaging effect on the muscles. To do this, a stream of water is slowly moved from the periphery to the center at a distance of 10-20 cm from the surface of the body. This massage is carried out in a hospital or clinic.

Among the water procedures that have therapeutic effects, for children with perinatal lesions of the central nervous system, balneotherapy is used - taking therapeutic baths. Due to the peculiarities of the skin in children (high permeability, rich vascular network, an abundance of nerve endings - receptors), therapeutic baths are especially effective. Under the action of salts dissolved in water, blood circulation and metabolism in the skin, muscles and the whole body are enhanced. Parents can carry out these procedures on their own at home, having received the recommendations of a doctor. Salt baths are prepared at the rate of 2 tablespoons of sea or common salt per 10 liters of water, water temperature 36°C. They take procedures from 3-5 to 10-15 minutes every other day, the course of treatment is 10-15 baths. In excitable children, it is often recommended to add coniferous baths to salty baths, as well as baths with decoctions of valerian, motherwort, which have a calming effect on the central nervous system.

Among the methods of physiotherapy most often used medicinal electrophoresis, pulsed currents, inductothermy, ultrasound, etc. The introduction of medicinal substances into the body using direct current (electrophoresis) improves blood circulation in tissues and muscle tone, promotes the resorption of inflammatory foci, and when exposed to collar zone improves cerebral circulation and brain activity. Impact of impulse currents various characteristics can have both excitatory and inhibitory effects on muscles, which is often used in the treatment of paresis and paralysis.

In the treatment of perinatal lesions of the central nervous system in children, local thermal procedures (heat therapy) are also used by applying ozocerite (mountain wax), paraffin or sandbags to the affected areas. Thermal effects cause tissue warming, vasodilation, increasing blood circulation and metabolism, in addition, recovery processes are activated, muscle tone decreases. To do this, pre-heated to 39-42 ° C, ozokerite is applied to the site of exposure, covered with a blanket and left to act for 15-30 minutes, depending on age. Procedures are carried out every other day in the amount of 15-20 per course of treatment.

Impact on particularly sensitive points in order to stimulate reflexes is carried out using the method of acupuncture. In this case, the effects can be carried out with an acupuncture (used in acupuncture) needle, pulsed electric current, laser radiation or a magnetic field.

With the onset of the recovery period of the disease, it is necessary to gradually expand auditory, visual, emotional contacts with the baby, as they are a kind of non-drug "nootrophs" - stimulants for the developing brain. These are toys that develop rugs and complexes, books and pictures, individually selected musical programs recorded on a tape recorder, and, of course, mother's songs.

However, it should be remembered that excessive enthusiasm for early development programs can lead to fatigue and disruption of the baby's not yet fully strengthened nervous system. Therefore, show moderation and patience in everything, and even better - do not forget to discuss all undertakings with your doctor. Remember - the health of your child is in your hands. So do not spare the time and effort to restore the injured baby.

New medicine for the rehabilitation of the baby

The new methods of rehabilitation of children with CNS lesions include the method of soft vibration massage in weightlessness (rehabilitation bed "Saturn"). For this, the child is placed on an individual diaper in a “pseudo-liquid” heated to the required temperature from glass microballoons moving in bed under the influence of air flow. A buoyancy effect is created (close to intrauterine), in which up to 65% of the child's body surface is immersed in the "pseudo-fluid". At the same time, the soft massage effect on the skin of the microballoons leads to irritation of the peripheral nerve endings and the transmission of impulses to the central nervous system, which ensures the treatment of paralysis.

Another of the new rehabilitation methods is the “dry immersion” method, which also creates the effect of a partial imitation of the prenatal state of the child. In this case, the babies are located on a plastic film lying freely on the swaying surface of water with a temperature of 35 ~ 37 ° C. During the session, excited children calm down, often fall asleep, which contributes to a decrease in muscle tone, ”while children with CNS depression are somewhat activated.

1 Perinatal - referring to the period starting a few weeks before the birth of the child, including the moment of his birth and ending a few days after the birth of the child. This period lasts from the 28th week of pregnancy to the 7th day after the birth of the child.

2 The movement of blood through the smallest vessels of the body in order to better deliver oxygen and nutrients to the cells, as well as remove the products of cell metabolism

Every expectant mother is afraid of the pathologies of pregnancy and childbirth and wants to prevent them.

One of these pathologies is fetal hypoxia and hypoxia during childbirth, which can lead to disturbances in the functioning of many organs and tissues, including the brain.

The consequences of such injuries can affect a long time, sometimes a lifetime.

Causes of hypoxic CNS damage in a newborn

The central nervous system is the first to suffer from a lack of oxygen, which can be caused by various factors during pregnancy and childbirth. It can be:

During pregnancy:

Gestosis in the later stages;

Premature abruption of the placenta, the threat of termination of pregnancy;

Heart defects in the mother and fetus;

Maternal anemia;

Lack or excess of amniotic fluid;

Maternal intoxication (drug, occupational, smoking);

Rh-conflict of mother and fetus;

Infectious diseases of the mother;

During childbirth:

Entanglement of the umbilical cord on the neck of the fetus;

Weakness labor activity;

Protracted childbirth;

Bleeding in the mother;

Birth injury of the neck.

As you can see, most of the dangerous factors affect the health of the baby even before birth, and only a few during childbirth.

To aggravate the course of pathologies of pregnancy, leading to hypoxic damage to the central nervous system in a newborn, can overweight, chronic diseases mother or her too young or too mature age (under 18 or over 35). And with any of the types of hypoxia, the brain is affected in the first place.

Symptoms of brain damage

In the first hours and days after birth signs of disorders in the cardiovascular system come to the fore, and the symptoms of hypoxic damage to the central nervous system begin to manifest themselves later.

If the brain damage is caused by pregnancy pathology, then the child may be lethargic, he has weakened or completely absent reflexes, which should be in a healthy newborn. With a pathology that arose during childbirth, the child does not immediately begin to breathe after birth, the skin has a bluish tint, the frequency respiratory movements lower than normal. And in the same way, physiological reflexes will be reduced - by these signs one can suspect oxygen starvation.

At an older age brain hypoxia, if it was not cured in time, manifests itself as a slowdown in psycho-emotional development up to severe forms of dementia, motor disorders. In this case, the presence of organic pathology is possible - brain cysts, hydrocephalus (especially often occurs with intrauterine infections). Severe hypoxia of the brain can lead to death.

Diagnosis of hypoxic CNS damage in a newborn

First diagnostic procedure, which is carried out for all newborns immediately after birth, is an assessment of his condition on the Apgar scale, which takes into account such vital important indicators like breathing, heartbeat, skin condition, muscle tone and reflexes. A healthy child scores 9-10 points on the Apgar scale, signs of hypoxic CNS damage can significantly reduce this indicator, which should be the reason for more accurate examinations.

Doppler ultrasound allows you to assess the state of the blood vessels of the brain and identify them congenital anomalies, which can become one of the causes of fetal and newborn hypoxia.

Ultrasound, CT and MRI of the brain can reveal various organic pathologies of the nervous system - cysts, hydrocephalus, areas of ischemia, underdevelopment of certain departments, tumors. The difference in the principles of action of these methods allows you to see the most complete picture of brain damage.

To assess damage to the functions of the nervous system, neurography and myography are used - these are methods based on the impact on muscle and nerve tissue with an electric current, and allowing you to track how they react to it. different areas nerves and muscles. In the case of congenital hypoxic damage to the central nervous system in a newborn, this method allows us to understand how much the peripheral nervous system has suffered, and how great the child’s chances for full physical development are in this case.

Additionally assigned biochemical analysis blood tests, urinalysis to detect biochemical disorders associated with cerebral hypoxia.

Treatment of hypoxia in newborns

Treatment for hypoxic brain injury depends on its cause and severity. If hypoxia occurs during childbirth and is not accompanied by an organic pathology of the brain, blood vessels, heart, lungs, or spine, then, depending on the degree, it can either go away on its own within a few hours (mild form, Apgar 7-8), or require treatment in an oxygen chamber with normal or high blood pressure(hyperbaric oxygen therapy).

Organic pathology, which is the cause of permanent hypoxia of the brain (defects of the heart, respiratory system, neck injuries) is usually treated surgically. The question of the possibility of surgery and its timing depends on the condition of the child. The same applies to the organic pathology of the brain (cysts, hydrocephalus), which occurs as a result of intrauterine fetal hypoxia. In most cases, the earlier the operation is performed, the more chances the child has for full development.

Prevention of hypoxic brain damage

Since the consequences of intrauterine fetal hypoxia are extremely destructive for the child's brain in the future, a pregnant woman needs to be very careful about her health. It is necessary to minimize the impact of factors that can disrupt the normal course of pregnancy - avoid stress, eat well, exercise in moderation, give up alcohol and smoking, visit antenatal clinics on time.

With severe gestosis, as well as with the appearance of signs of premature detachment of the placenta and the threat of termination of pregnancy - abdominal pain, bloody discharge from the genital tract, a sharp decrease in blood pressure, sudden nausea and vomiting for no reason - you should immediately consult a doctor. It may be recommended to lie down for preservation - this recommendation should not be neglected. The complex of therapeutic measures carried out in the hospital will help to avoid severe fetal hypoxia and its consequences in the form of congenital pathologies of the brain.

Ultrasound, which is done in the last weeks of pregnancy, reveals such potentially dangerous conditions as entanglement of the umbilical cord, which during childbirth can prevent the baby from taking the first breath, breech or lateral presentation, which is also dangerous because hypoxia of the newborn will develop during childbirth. To correct dangerous presentation, there are sets of exercises, and if they are ineffective, a caesarean section is recommended. It is also recommended for entanglement with the umbilical cord.

Measuring the size of the fetus and pelvis of a woman allows you to determine the anatomically and clinically narrow pelvis - a discrepancy between the size of the pelvis and the size of the head of the child. In this case, natural childbirth will be very traumatic for both mother and baby, or may be completely impossible. The safest method of delivery in this case is a caesarean section.

During childbirth, it is imperative to monitor the intensity of contractions - if it becomes insufficient for a quick delivery, labor is stimulated. A prolonged stay of the fetus in the birth canal can lead to the development of cerebral hypoxia, since the placenta no longer supplies oxygen to the body, and the first breath is possible only after birth. To avoid this condition, physical exercises to prepare for childbirth allow.

Consequences of early residual-organic lesions of the central nervous system with cerebrasthenic, neurosis-like, psychopathic-like syndromes. Organic mental infantilism. Psychoorganic Syndrome. Attention deficit hyperactivity disorder in children. Mechanisms of social and school disadaptation, prevention and correction of residual effects of residual organic cerebral insufficiency and child hyperactivity syndrome.

Residual organic lesions of the CNS

Lecture XIV.

What type, in your opinion, is the family of a child with schizophrenia whose case history is given in the previous lecture?

What do you think, which specialist is the leader in corrective work with an autistic child?

EARLY RESIDUAL-ORGANIC CEREBRAL INSUFFICIENCY in children - a condition caused by persistent consequences of brain damage (early intrauterine brain damage, birth trauma, traumatic brain injuries in early childhood, infectious diseases). There are serious reasons to believe that in recent years the number of children with the consequences of early residual organic lesions of the central nervous system has become more and more, although the true prevalence of these conditions is not known.

The reasons for the increase in the residual effects of residual-organic damage to the central nervous system in recent years are diverse. These include environmental troubles, including chemical and radiation contamination of many cities and regions of Russia, malnutrition, unjustified abuse of drugs, untested and often harmful dietary supplements, etc. The principles of physical education of girls - expectant mothers, have also changed in many respects, the development of which is often disturbed due to frequent somatic diseases, a sedentary lifestyle, restrictions on movement, fresh air, feasible housework or, conversely, excessive professional sports, as well as due to for early initiation of smoking, drinking alcohol, toxic substances and drugs. Improper nutrition and heavy physical labor of a woman during pregnancy, mental experiences associated with an unfavorable family situation or unwanted pregnancy, not to mention the use of alcohol and drugs during pregnancy, disrupt its proper course and adversely affect the intrauterine development of the child. The result of an imperfect medical care, first of all, the absence of any ideas of the medical contingent of antenatal clinics about a psychotherapeutic approach to a pregnant woman, full-fledged patronage during pregnancy, informal practice of preparing pregnant women for childbirth and not always qualified obstetric care, are birth injuries that disrupt the normal development of the child and subsequently affect the entire his life. The introduced practice of “planning childbirth”, “regulating childbirth” is often brought to the point of absurdity, being useful not to the woman in labor and the newborn, but to the staff maternity hospital who has received the legalized right to plan his vacation. Suffice it to say that in recent years, children are born not mainly at night or in the morning, when they are supposed to be born according to biological laws, but in the first half of the day, when a new shift takes over from tired staff. An excessive passion for caesarean section also seems unjustified, in which not only the mother, but also the baby for quite a long time receives anesthesia, which is completely indifferent to him. The above is only part of the reasons for the increase in early residual organic lesions of the central nervous system.

In the very first months of a child’s life, an organic lesion of the central nervous system manifests itself in the form of neurological signs that are detected by a pediatric neurologist, and all the familiar external signs: trembling of the hands, chin, muscle hypertonicity, early holding of the head, tilting it back (when the child seems to be looking at something behind your back), restlessness, tearfulness, unjustified screaming, interrupted night sleep, delay in the formation of motor functions and speech. In the first year of life, all these signs allow the neuropathologist to register the child for the consequences of birth trauma and prescribe treatment (cerebrolysin, cinnarizine, cavinton, vitamins, massage, gymnastics). Intense and right organized treatment in non-severe cases, as a rule, it has a positive effect, and by the age of one the child is removed from the neurological register, and for several years a child brought up at home does not cause much concern for parents, with the possible exception of some delay in speech development. Meanwhile, after being placed in a kindergarten, the child's features begin to attract attention, which are manifestations of a residual organic lesion of the central nervous system - cerebrasthenia, neurosis-like disorders, hyperactivity and mental infantilism.

The most common consequence of residual organic cerebral insufficiency is cerebrosthenic syndrome. Cerebrosthenic syndrome is characterized by exhaustion (inability to concentrate for a long time), fatigue, mood instability associated with minor external circumstances or fatigue, intolerance to loud sounds, bright light, and in most cases is accompanied by a noticeable and prolonged decrease in working capacity, especially with significant intellectual stress. Schoolchildren have a decrease in memorization and retention of educational material in memory. Along with this, irritability is observed, taking the form of explosiveness, tearfulness, capriciousness. Cerebrosthenic conditions caused by early brain damage become a source of difficulty in developing school skills (writing, reading, counting). The mirror character of writing and reading is possible. Speech disorders are especially frequent (delay in the development of speech, articulatory deficiencies, slowness or, conversely, excessive speed of speech).

Frequent manifestations of cerebrosthenia may be headaches that occur upon awakening or when tired at the end of lessons, accompanied by dizziness, nausea and vomiting. Often, such children have transport intolerance with dizziness, nausea, vomiting, and a feeling of lightheadedness. They also do not tolerate heat, stuffiness, high humidity, reacting to them with a rapid pulse, an increase or decrease in blood pressure, and fainting. Many of the children with cerebrosthenic disorders cannot tolerate merry-go-rounds and other twisting movements, which also result in dizziness, lightheadedness, and vomiting.

In the motor sphere, cerebrosthenia manifests itself in two equally common variants: lethargy and inertia, or, on the contrary, motor disinhibition. In the first case, children look lethargic, they are not active enough, they are slow, they get involved in work for a long time, they need much more time than ordinary children to comprehend the material, solve problems, do exercises, think about answers; the mood background is most often reduced. Such children become especially unproductive in activities after 3-4 lessons and at the end of each lesson, when tired, they become drowsy or whiny. They are forced to lie down or even sleep after returning from school, in the evenings they are lethargic, passive; with difficulty, reluctantly, for a very long time preparing homework; difficulty concentrating and headaches are aggravated by fatigue. In the second case, fussiness, excessive motor activity, and restlessness are noted, which prevents the child from not only engaging in purposeful educational activities, but even playing a game that requires attention. At the same time, the child's motor hyperactivity increases with fatigue, becomes more and more disorderly, chaotic. Such a child cannot be attracted to consistent play in the evenings, and in school years- to the preparation of homework, the repetition of the past, reading books; he almost fails to get to bed on time, so that from day to day he sleeps much less than his age.

Many children with the consequences of early residual organic cerebral insufficiency have features of dysplasia (deformation of the skull, facial skeleton, auricles, hypertelorism - widely spaced eyes, high palate, abnormal growth of teeth, prognathism - protruding upper jaw, etc.).

In connection with the disorders described above, schoolchildren, starting from the first grades, in the absence of individual approach in training and mode, they experience great difficulties in adapting to school. They are more than their healthy peers, sit through the lessons and decompensate even more, due to the fact that since they need a longer and good rest than ordinary children. Despite all efforts, they, as a rule, do not receive encouragement, but, on the contrary, are subjected to punishments, continuous remarks and even ridicule. After a more or less long time, they stop paying attention to their failures, interest in learning drops sharply, and there is a desire for an easy pastime: watching all television programs without exception, outdoor games, and, finally, craving for the company of their own kind. At the same time, there is already a direct neglect of schoolwork: absenteeism, refusal to attend classes, runaways, vagrancy, early drinking, which often causes home theft. It should be noted that residual organic cerebral insufficiency greatly contributes to the rapid emergence of dependence on alcohol, drugs and other psychoactive substances.

neurosis-like syndrome in a child with a residual organic lesion of the central nervous system, it is characterized by stability, monotony, stability of symptoms, and its low dependence on external circumstances. In this case, neurosis-like disorders include tics, enuresis, encopresis, stuttering, mutism, obsessive symptoms- fears, doubts, fears, ? movement.

The above observation illustrates cerebrasthenic and neurosis-like syndromes in a child with early residual-organic lesion of the CNS.

Kostya, 11 years old.

The second child in the family. He was born from a pregnancy that proceeded with toxicosis of the first half (nausea, vomiting), the threat of miscarriage, edema and increased blood pressure in the second half. Childbirth for 2 weeks ahead of time, was born with a double entanglement of the umbilical cord, in blue asphyxia, screamed after resuscitation. Birth weight 2,700 g. Attached to the breast on the third day. He sucked sluggishly. Early development with a delay: he began to walk at the age of 1 year 3 months, utters individual words from 1 year 10 months, phrasal speech - from 3 years. Until the age of 2, he was very restless, whiny, and had a lot of colds. Up to 1 year old, he was observed by a neurologist for trembling of the hands, chin, hypertonicity, convulsions (2 times) with high temperature on the background of acute respiratory disease. Until the age of 2, he was very restless, whiny, and had a lot of colds. He grew up quiet, sensitive, inactive, awkward. He was overly attached to his mother, did not let her go from him, got used to kindergarten for a very long time: he did not eat, did not sleep, did not play with children, cried almost all day, refused toys. Until the age of 7, he suffered from nighttime urinary incontinence. He was afraid to be alone at home, fell asleep only by the light of a night lamp and in the presence of his mother, was afraid of dogs, cats, sobbed, resisted when he was taken to the clinic. With emotional stress, colds, troubles in the family, the boy had blinking and stereotypical shoulder movements, which disappeared with the appointment of small doses of tranquilizers or sedative herbs. Speech suffered from the incorrect pronunciation of many sounds and became clear only by the age of 7, after speech therapy classes. I went to school from the age of 7.5, willingly, quickly got acquainted with the children, but almost did not talk to the teacher, for 3 months. He answered questions very quietly, behaved timidly, uncertainly. Tired by the 3rd lesson, "lying" on the desk, could not absorb educational material, ceased to understand the explanations of the teacher. After school he went to bed and sometimes fell asleep. Lessons taught only in the presence of adults, often in the evenings complained of a headache, often accompanied by nausea. Slept restlessly. He could not stand the ride in the bus and the car - nausea, vomiting were noted, he turned pale, covered with perspiration. Felt bad on cloudy days; at this time, the head almost always hurt, dizziness, decreased mood, and lethargy were noted. In summer and autumn I felt better. The condition worsened at high loads, after diseases (acute respiratory infections, tonsillitis, childhood infections). He studied at "4" and "3", although, according to others, he was distinguished by a fairly high intelligence and good memory. He had friends, walked alone in the yard, but preferred quiet games at home. Started studying at music school, but visited her reluctantly, cried, complained of fatigue, was afraid that he would not have time to do his homework, became irritable, restless.

Starting from the age of 8, as prescribed by a psychiatrist, twice a year - in November and March - he received a course of diuretics, nootropil (or cerebrolysin in injections), cavinton, and a sedative mixture. If necessary, an additional day off was assigned. In the process of treatment, the boy's condition improved significantly: headaches became rare, tics disappeared, he became more independent and less fearful, and his academic performance improved.

In this case, we are talking about pronounced signs of cerebrasthenic syndrome, acting in combination with neurosis-like symptoms (tics, enuresis, elementary fears). Meanwhile, however, with adequate medical supervision, the right tactics treatment and a sparing regimen, the child fully adapted to the conditions of the school.

Organic damage to the CNS can also be expressed in psychoorganic syndrome (encephalopathy), characterized by a greater severity of disorders and containing, along with all the signs of cerebrosthenia described above, memory loss, a decrease in the productivity of intellectual activity, a change in affectivity (“affect incontinence”). These features are called the Walter-Buhel triad. Affect incontinence can manifest itself not only in excessive affective excitability, inadequately violent and explosive manifestation of emotions, but also in affective weakness, which includes a pronounced degree of emotional lability, emotional hyperesthesia with excessive sensitivity to all external stimuli: the smallest changes in the situation, an unexpected word cause the patient has irresistible and uncorrectable stormy emotional states: crying, sobbing, anger, etc. n. Memory impairment in psychoorganic syndrome ranges from mild impairment to pronounced mnestic disorders (for example, difficulties in remembering momentary events and current material).

With a psychoorganic syndrome, the prerequisites for intelligence are insufficient, first of all: a decrease in memory, attention and perception. The amount of attention is limited, the ability to concentrate decreases, absent-mindedness, exhaustion and satiety with intellectual activity increase. Violations of attention lead to a violation of the perception of the environment, as a result of which the patient is not able to cover the situation as a whole, capturing only fragments, separate aspects of events. Violations of memory, attention and perception contribute to the weakness of judgments and conclusions, which is why patients give the impression of helpless and stupid. There is also a slowdown in the pace of mental activity, inertia and rigidity of mental processes .; This manifests itself in slowness, getting stuck on certain ideas, in the difficulty of switching from one type of activity to another. Characterized by the lack of criticism of their abilities and behavior with a careless attitude to their condition, loss of a sense of distance, familiarity and familiarity. Low intellectual productivity becomes apparent with additional workload, but unlike mental retardation, the ability to abstract is preserved.

The psychoorganic syndrome can be temporary, transient (for example, after a craniocerebral injury, including birth injury, neuroinfection) or be a permanent, chronic personality trait in the long-term period of organic damage to the central nervous system.

Often, with residual-organic cerebral insufficiency, signs appear psychopathic syndrome which becomes especially obvious in prepubertal and pubertal age. For children and adolescents with psychoorganic syndrome, the most serious forms of behavioral disorders are characteristic, due to a pronounced change in affectivity. Pathological character traits in this case are mainly manifested by affective excitability, a tendency to aggression, conflict, disinhibition of drives, satiety, sensory thirst (desire to receive new experiences, pleasures). Affective excitability is expressed in a tendency to excessive easy onset violent affective outbursts that are not adequate to the cause that caused them, in fits of anger, rage, passion, accompanied by motor excitement, thoughtless, sometimes dangerous for the child himself or those around him, and, often, narrowed consciousness. Children and adolescents with affective excitability are capricious, touchy, overly mobile, prone to unbridled pranks. They shout a lot, get angry easily; any restrictions, prohibitions, remarks cause them violent reactions of protest with malice and aggression.

Together with symptoms organic mental infantilism(emotional-volitional immaturity, uncriticality, lack of purposefulness of activity, suggestibility, dependence on others) psychopathic disorders in a teenager with residual organic damage to the central nervous system create the prerequisites for social disadaptation with criminal tendencies. Offenses are often committed by them while intoxicated or under the influence of drugs; moreover, for a complete loss of criticism or even amnesia (lack of memory) of the criminal act itself, such a teenager with residual organic damage to the central nervous system needs a relatively small dose of alcohol and drugs. It should be noted again that in children and adolescents with residual organic cerebral insufficiency, addiction to alcohol and drugs develops faster than in healthy people, leading to severe forms of alcoholism and drug addiction.

The most important means of preventing school disadaptation in residual organic cerebral insufficiency is the prevention of intellectual and physical overload by normalizing the daily routine, the correct alternation of intellectual work and rest, and the exclusion of simultaneous classes in general education and special schools (music, art, etc.). Residual effects of residual organic damage to the central nervous system in severe cases are a contraindication for admission to a specialized type of school (with in-depth study of a foreign language, physics and mathematics, gymnasium or college with an accelerated and expanded curriculum).

With this type of mental pathology, for the prevention of educational decompensation, it is necessary to timely introduce adequate drug course therapy (nootropics, dehydration, vitamins, light sedatives, etc.) with constant supervision of a psychoneurologist and dynamic electroencephalographic, echoencephalographic, pathopsychological control; early start pedagogical correction taking into account the individual characteristics of the child; classes with a defectologist on an individual basis; socio-psychological and psychotherapeutic work with the child's family to develop correct, adequate attitudes and ideas about the child's capabilities and his future.

HYPERACTIVITY IN CHILDHOOD. A certain connection with residual-organic cerebral insufficiency in childhood is also hyperactivity, which occupies a special place, first of all, in connection with the pronounced school disadaptation caused by it - educational failure and (or) behavioral disorders. Motor hyperactivity is described in child psychiatry under various names: minimal cerebral dysfunction (MMD), motor disinhibition syndrome, hyperdynamic syndrome, hyperkinetic syndrome, attention deficit hyperactivity disorder in children, active attention disorder syndrome, attention deficit disorder (the latter name corresponds to the modern classification).

The standard for assessing behavior as "hyperkinetic" is a set of the following features:

Physical activity:

1) physical activity is excessively high in the context of what is expected in this situation and in comparison with other children of the same age and intellectual development;

21) has an early onset (before 6 years);

32) has a long duration (or constancy in time);

43) is found in more than one situation (not only at school, but also at home, on the street, in a hospital, etc.).

4) motor activity is excessively high in the context of what is expected in this situation and in comparison with other children of the same age and intellectual development;

Data on the prevalence of hyperkinetic disorders vary widely - from 2 to 23% of the child population (recently there is a clear trend towards unreasonably broad diagnosis of this condition). Hyperkinetic disorders that occur in childhood, in the absence of preventive measures, often lead not only to school disadaptation - poor progress, repetition, behavioral disorders, but also to severe forms of social disadaptation, far beyond childhood and even puberty.

Hyperkinetic disorder, as a rule, manifests itself already in early childhood. In the first year of life, the child shows signs of motor excitation, constantly spins, makes a lot of unnecessary movements, because of which it is difficult to put him to bed and feed him. The formation of motor functions occurs in hyperactive child faster than his peers, while the development of speech does not differ from normal time or even behind them. When a hyperactive child begins to walk, he is characterized by speed and an excessive number of movements, uncontrollability, cannot sit still, climbs everywhere, tries to get miscellaneous items, does not respond to prohibitions, does not feel danger, edge. Such a child very early (from 1.5-2 years old) stops sleeping during the day, and in the evening it is difficult to put him to bed due to the growing chaotic excitement in the afternoon, when he cannot play with his toys at all, do one thing, is naughty , playing around, running. Falling asleep is disturbed: even when physically restrained, the child is constantly moving, trying to slip out from under the mother's arms, jump up, open his eyes. With pronounced daytime arousal, a deep night's sleep with long-term incessant enuresis may occur.

However, hyperkinetic disorders in infancy and early childhood school age are often regarded as ordinary vivacity within the framework of normal child psychodynamics. In the meantime, restlessness, distractibility, satiety with the need for frequent changes of impressions gradually increase and begin to attract attention, the impossibility of playing alone or with children without persistent organization of organizational help from adults. These features become already apparent in the senior preschool age, when the child begins to prepare for school - at home, in the preparatory group kindergarten, in the preparatory groups of a comprehensive school.

Starting from the 1st grade, hyperdynamic disorders in a child are expressed in motor disinhibition, fussiness, inattention and lack of perseverance when performing tasks. At the same time, there is often an increased background of mood with an overestimation of one's own capabilities, mischief and fearlessness, insufficient perseverance in activities that especially require active attention, a tendency to move from one activity to another without completing any of them, poorly organized and poorly regulated activity. Hyperkinetic children are often reckless and impulsive, prone to accidents and disciplinary action due to violations of the rules of conduct. They usually have broken relationships with adults due to lack of caution and restraint, low self-esteem. Hyperactive children are impatient, do not know how to wait, cannot sit during the lesson, are in constant non-purposeful movement, jump up, run, jump, if necessary, sit still, constantly move their legs and arms. They are, as a rule, talkative, noisy, often complacent, constantly smiling, laughing. Such children need a constant change of activity, new experiences. A hyperactive child can consistently and purposefully engage in one thing only after significant physical exertion; at the same time, such children themselves say that they "need to discharge", "discharge energy."

Hyperkinetic disorders act in combination with cerebrasthenic syndrome, signs of mental infantilism, pathological personality traits, to a greater or lesser extent expressed against the background of motor disinhibition and further complicating school and social adaptation hyperactive child. Often, hyperkinetic disorders are accompanied by neurosis-like symptoms: tics, enuresis, encopresis, stuttering, fears - long-lasting ordinary childhood fears of loneliness, darkness, pets, white coats, medical manipulations, or quickly emerging obsessive fears based on a traumatic situation.

Signs of mental infantilism in hyperkinetic syndrome are expressed in the game interests inherent in an earlier age, gullibility, suggestibility, submissiveness, affection, spontaneity, naivety, dependence on older or more self-confident friends. Due to hyperkinetic disorders and features of mental immaturity, the child prefers only play activity, but even it does not capture him for a long time: he constantly changes his mind and direction of activity in accordance with who is near him; he, committing a rash act, immediately repents of it, assures adults that “he will behave well”, but, getting into a similar situation, repeats again and again sometimes harmless pranks, the outcome of which he cannot foresee, calculate. At the same time, due to affection, good-naturedness, sincere repentance for what he has done, such a child is extremely attractive and loved by adults. Children, on the other hand, often reject such a child, since it is impossible to play productively and consistently with him because of his fussiness, noisiness, the desire to constantly change the conditions of the game or move from one type of game to another, because of his inconsistency, variability, superficiality. A hyperactive child quickly gets to know children and adults, but also quickly “changes” friendships, in an effort to make new familiar acquaintances and new experiences. Mental immaturity in children with hyperkinetic disorders determines the relative ease of occurrence in them of various transient or more persistent deviations, violations of the process of personality formation under the influence of adverse factors - both microsocial-psychological and biological. Most frequently found in hyperactive children there are pathological character traits with a predominance of instability, when the lack of volitional delays, the dependence of behavior on momentary desires and inclinations, increased subordination to outside influences, lack of skill and unwillingness to overcome the slightest difficulties, interest and skill in work come to the fore. The immaturity of the emotional-volitional personality traits of adolescents with an unstable variant determines their increased tendency to imitate the forms of behavior of others, including negative ones (leaving home, school, foul language, petty theft, drinking alcohol, drugs).

Hyperkinetic disorders in the vast majority of cases are gradually reduced by the middle of puberty - at 14-15 years. It is impossible to wait for the spontaneous disappearance of hyperactivity without taking corrective and preventive measures due to the fact that hyperkinetic disorders, being a mild, borderline mental pathology, give rise to severe forms school and social disadaptation, leaving an imprint on the whole future life of a person.

From the very first days of schooling, the child finds himself in the conditions of the need to follow disciplinary standards, assess knowledge, show his own initiative, and form contact with the team. Due to excessive motor activity, restlessness, distractibility, satiety, a hyperactive child does not meet the requirements of the school and in the coming months after the start of studies becomes the subject of constant discussion in the teaching staff. Every day he receives comments, diary entries, he is discussed at parent and class meetings, he is scolded by teachers and the school administration, he is threatened with expulsion or transfer to individual education. Parents cannot but react to all these actions, and in the family a hyperactive child becomes the cause of constant discord, quarrels, disputes, which gives rise to a system of education in the form of constant penalties, prohibitions and punishments. Teachers and parents are trying to restrain his physical activity, which in itself is impossible due to the physiological characteristics of the child. A hyperactive child interferes with everyone: teachers, parents, older and younger siblings, children in the classroom and in the yard. His success in the absence special methods corrections never correspond to his intellectual natural data, that is, he studies much worse than his abilities. Instead of motor discharge, which the child himself tells adults about, he is forced to sit for many hours completely unproductively preparing lessons. Rejected by family and school, misunderstood, unsuccessful child sooner or later begins to frankly skimp ? neglect school. Most often this happens at the age of 10-12, when parental control weakens and the child gets the opportunity to use transport on his own. The street is full of entertainment, temptations, new acquaintances; street is varied. It is here that the hyperactive child is never bored, the street satisfies his inherent passion for a continuous change of impressions. Here no one scolds, no one asks about academic performance; here peers and older children are in the same position of rejection and resentment; new acquaintances appear daily here; here, for the first time, the child tries the first cigarette, the first glass, the first joint, and sometimes the first shot of the drug. Due to suggestibility and subordination, the lack of momentary criticism and the ability to predict the near future, children with hyperactivity often become members of an antisocial company, commit criminal acts or are present at them. When pathological character traits are layered, social disadaptation becomes especially deep (up to registration in the commission on juvenile affairs, the children's room of the police, before the trial, the colony for juvenile offenders). In prepubertal and pubertal ages, almost never being the initiators of a crime, hyperactive schoolchildren often join the criminal ranks.

Thus, although the hyperkinetic syndrome, becoming especially noticeable already at a younger preschool age, is significantly (or completely) compensated during adolescence due to a decrease in motor activity and improved attention, such adolescents, as a rule, do not reach the level of adaptation corresponding to their natural data, since they are socially decompensated already at primary school age, and this decompensation may increase in the absence of adequate corrective and therapeutic approaches. in the absence of adequate corrective and therapeutic approaches. Meanwhile, with proper, patient, constant treatment-and-prophylactic and psychological-pedagogical work with a hyperactive child, it is possible to prevent deep forms of social disadaptation. In adulthood, in most cases, signs of mental infantilism, mild cerebrosthenic symptoms, pathological character traits, as well as superficiality, lack of purposefulness, and suggestibility remain noticeable.