Hypoxic damage to the central nervous system. Hypoxic ischemic lesion of the central nervous system

The central nervous system is responsible for the functioning of all organs. Disruption of the brain leads to irreversible consequences, as a result of which control over the body is lost. Organic damage to the central nervous system can be mild in everyone, but only serious stages require proper treatment.

Organic damage to the central nervous system in adults

The statement of such a diagnosis indicates an inferiority of the brain. Its damage is the result of prolonged use of medications, alcohol abuse and drug use. In addition, the cause of the disease are:

• injuries received;
• Availability cancerous tumor;
• infection;
• excessive physical exercise;
• exposure to stress.

Symptoms of organic lesions of the central nervous system

With the development of pathological processes, apathy, a decrease in activity, and a loss of interest in life are observed. Along with this, indifference to one's own outward appearance and sloppiness. However, sometimes the patient, on the contrary, becomes too excitable, and his emotions - inappropriate.

The following signs are also distinguished:

• forgetfulness, difficulty in remembering names and dates;
• deterioration of intellectual abilities (violation of writing and counting);
• loss of the former functions of speech, manifested in the inability to link words into sentences;
• hallucinations and delusions are possible;
• in the daytime;
• decreased visual acuity and hearing.

With the development of the disease, a significant deterioration in the protective properties of the body is observed, therefore, such consequences of organic damage to the central nervous system as:

• meningitis;
• neurosyphilis;
• and other serious infections.

As a rule, the disease progresses and later becomes the cause of social disaptation and dementia.

Diagnosis of organic lesion of the central nervous system

Timely detection of the disease allows you to start treatment and stop its further development. The patient undergoes a tomography of the brain. Upon detection of vascular damage and the simultaneous manifestation of impaired cognitive functions, it is concluded that a diagnosis has been made.

Treatment of organic lesions of the central nervous system

No specific treatment for the disease has been developed. Basically, there is a fight against symptoms, during which the patient is prescribed drugs to normalize blood flow in the brain and eliminate depression. Brainwork recovers when changing lifestyle, diet, which is especially necessary for some liver diseases, atherosclerosis and alcoholism.

The central nervous system is exactly the mechanism that helps a person grow and navigate this world. But sometimes this mechanism fails, “breaks down”. It is especially scary if this happens in the first minutes and days of a child's independent life or even before his birth. Why the child's central nervous system is affected and how to help the baby, we will tell you in this article.

What it is

The central nervous system is a close "bundle" of two most important links - the brain and spinal cord. The main function that nature has assigned to the central nervous system is to provide reflexes, both simple (swallowing, sucking, breathing) and complex. The central nervous system, or rather, its middle and lower parts, regulate the activities of all organs and systems, provide communication between them. The highest section is the cerebral cortex. She is responsible for self-awareness and self-awareness, for the connection of a person with the world, with the reality around the child.

Violations, and consequently, the defeat of the central nervous system, can begin even during the development of the fetus in the mother's womb, or it can occur under the influence of certain factors immediately or some time after birth.

Which part of the central nervous system is affected will determine which functions of the body are impaired, and the degree of damage will determine the degree of consequences.

Causes

In children with disorders of the central nervous system, about half of all cases are due to intrauterine lesions, doctors call this perinatal pathologies of the central nervous system. Moreover, more than 70% of them are premature babies, which appeared earlier than the prescribed obstetric term. In this case, the main root cause lies in the immaturity of all organs and systems, including the nervous one; it is not ready for autonomous work.

Approximately 9-10% of babies born with lesions of the central nervous system were born on time with a normal weight. The state of the nervous system, experts say, in this case is affected by negative intrauterine factors, such as prolonged hypoxia, which the baby experienced in the womb during gestation, birth trauma, as well as the state of acute oxygen starvation during difficult delivery, metabolic disorders of the child, which began even before birth, infectious diseases suffered by the expectant mother, complications of pregnancy. All lesions caused by the above factors during pregnancy or immediately after childbirth are also called residual organic:

• Fetal hypoxia. Most often, babies whose mothers abuse alcohol, drugs, smoke or work in a hazardous industry suffer from a lack of oxygen in the blood during pregnancy. The number of abortions that preceded these births is also of great importance, since the changes that occur in the tissues of the uterus after termination of pregnancy contribute to the disruption of uterine blood flow during subsequent pregnancy.

• Traumatic reasons. Birth trauma can be associated both with the incorrectly chosen tactics of delivery, and with medical errors during the birth process. Injuries also include actions that lead to a violation of the central nervous system of the child after childbirth, in the first hours after birth.
• Fetal metabolic disorders. Such processes usually begin in the first - early second trimester. They are directly related to the disruption of the activity of the organs and systems of the baby's body under the influence of poisons, toxins, and some medicines.
• Infections in the mother. Diseases caused by viruses (measles, rubella, chickenpox, cytomegalovirus infection and a number of other ailments) are especially dangerous if the disease occurs in the first trimester of pregnancy.

• Pathology of pregnancy. The state of the child's central nervous system is influenced by a wide variety of features of the gestation period - polyhydramnios and low water, pregnancy with twins or triplets, placental abruption and other reasons.
• Severe genetic diseases. Usually, pathologies such as Down and Evards syndromes, trisomies and a number of others are accompanied by significant organic changes in the central nervous system.

At the current level of development of medicine, pathologies of the central nervous system become obvious to neonatologists already in the first hours after the birth of a baby. Less often - in the first weeks.

Sometimes, especially when organic lesions mixed genesis, the true cause cannot be established, especially if it relates to the perinatal period.

Classification and symptoms

The list of possible symptoms depends on the cause, degree and extent of the brain or spinal cord lesions, or the associated lesion. Time also affects the outcome. negative impact- how long the child was exposed to factors that affected the activity and functionality of the central nervous system. It is important to quickly determine the period of the disease - acute, early recovery, late recovery or the period of residual effects.

All pathologies of the central nervous system have three degrees of severity:

• Lightweight. This degree is manifested by a slight increase or decrease in the muscle tone of the baby, converging strabismus can be observed.

• Average. With such lesions, muscle tone is always reduced, reflexes are completely or partially absent. This condition is replaced by hypertonicity, convulsions. Characteristic oculomotor disorders appear.
• Heavy. Not only motor function and muscle tone suffer, but also internal organs. If the central nervous system is severely depressed, convulsions of varying intensity may begin. Heart and kidney problems can be severe, as can development respiratory failure... The intestines may be paralyzed. The adrenal glands do not produce the right hormones in the right amount.

According to the etiology of the cause that caused problems with the activity of the brain or spinal cord, pathologies are divided (however, very conditionally) into:

• Hypoxic (ischemic, intracranial hemorrhage, combined).
• Traumatic (birth trauma to the skull, birth spinal lesions, birth pathologies of peripheral nerves).
• Dysmetabolic (kernicterus, excess in the blood and tissues of the child of the level of calcium, magnesium, potassium).
• Infectious (consequences of the mother's infections, hydrocephalus, intracranial hypertension).

Clinical manifestations different types lesions are also significantly different from each other:

• Ischemic lesions. The most "harmless" disease is cerebral ischemia of the 1st degree. With her, the child demonstrates disorders of the central nervous system only in the first 7 days after birth. The reason most often lies in fetal hypoxia. At this time, the baby can observe relatively mild signs of excitation or depression of the central nervous system.
• The second degree of this disease is placed in the event that if violations and even convulsions last more than a week after birth. The third degree can be talked about if the child has constantly increased intracranial pressure, frequent and severe convulsions are observed, and there are other autonomic disorders.

Usually this degree cerebral ischemia tends to progress, the child's condition worsens, the baby may fall into a coma.

• Hypoxic cerebral hemorrhage. If, as a result of oxygen starvation, the child has a hemorrhage inside the ventricles of the brain, then at the first degree there may be no symptoms and signs at all. But already the second and third degrees of such hemorrhage lead to severe brain damage - convulsive syndrome, the development of shock. The child may fall into a coma. If blood gets into the subarachnoid cavity, then the child will be diagnosed with overexcitation of the central nervous system. There is a high likelihood of developing dropsy of the brain in an acute form.

Bleeding into the main substance of the brain is not always noticeable at all. Much depends on which part of the brain is affected.

• Traumatic lesions, birth trauma. If during childbirth the doctors had to use forceps on the baby's head and something went wrong, if acute hypoxia occurred, then most often this is followed by a cerebral hemorrhage. With a birth injury, the child has convulsions to a more or less pronounced degree, the pupil on one side (from the one where the hemorrhage occurred) increases in size. The main feature traumatic injury central nervous system - increased pressure inside the child's skull. Acute hydrocephalus may develop. The neurologist testifies that in this case the central nervous system is more often excited than suppressed. Not only the brain, but also the spinal cord can be injured. This is most often manifested by sprains and tears, hemorrhage. In children, breathing is disturbed, hypotension of all muscles, spinal shock are observed.
• Dysmetabolic lesions. With such pathologies, in the overwhelming majority of cases, the child has high blood pressure, convulsive seizures are observed, the consciousness is quite pronouncedly depressed. Blood tests that show either a critical calcium deficiency, sodium deficiency, or other imbalance of other substances allow to establish the cause.

Periods

The prognosis and course of the disease depends on the period in which the baby is. There are three main periods in the development of pathology:

• Spicy. The violations have just begun and have not yet had time to cause serious consequences. This is usually the first month of a child's independent life, the neonatal period. At this time, a baby with lesions of the central nervous system usually sleeps poorly and restlessly, often cries for no apparent reason, he is excitable, can flinch without irritation even in sleep. Muscle tone is increased or decreased. If the degree of damage is higher than the first, then reflexes may weaken, in particular, the baby will begin to suck and swallow worse and weaker. During this period, the baby may begin to develop hydrocephalus, this will be manifested by a noticeable head growth and strange eye movements.

• Recovery. Maybe early and late. If the baby is at the age of 2-4 months, then they talk about early recovery, if he is already from 5 to 12 months old, then about the late one. Sometimes parents notice disturbances in the functioning of the central nervous system in their baby for the first time in early period... At 2 months, such babies almost do not express emotions, are not interested in bright hanging toys. In the later period, the child noticeably lags behind in his development, does not sit, does not walk, his cry is quiet and usually very monotonous, emotionally uncolored.
• Consequences. This period begins after the child is one year old. At this age, the doctor is able to most accurately assess the consequences of a violation of the central nervous system in this particular case. Symptoms may go away, however, the disease does not go away. Most often, doctors such children in a year make such verdicts as hyperactivity syndrome, developmental delay (speech, physical, mental).

The most difficult diagnoses that can indicate the consequences of CNS pathologies are hydrocephalus, cerebral palsy, epilepsy.

Treatment

It is possible to talk about treatment when CNS lesions are diagnosed with maximum accuracy. Unfortunately, in modern medical practice there is a problem of overdiagnosis, in other words, every baby whose chin trembled during a month during the examination, who eats and sleeps restlessly, can easily be diagnosed with cerebral ischemia. If a neurologist claims that your baby has lesions of the central nervous system, you should definitely insist on complex diagnostics, which will include an ultrasound of the brain (through the fontanelle), computed tomography, and in special cases- and x-rays of the skull or spine.

Each diagnosis, which is in some way associated with lesions of the central nervous system, must be diagnostically confirmed. If signs of a violation of the central nervous system are noticed in the hospital, then the timely assistance provided by neonatologists helps to minimize the severity of possible consequences. It only sounds scary - CNS lesions. In fact, most of these pathologies are reversible and must be corrected if detected on time.

Usually used for treatment medicines improving blood flow and blood supply to the brain - large group nootropic drugs, vitamin therapy, anticonvulsants.

The exact list of drugs can only be named by a doctor, since this list depends on the causes, degree, period and depth of the lesion. Drug treatment newborns and infants are usually provided in a hospital setting. After the relief of symptoms, the main stage of therapy begins, aimed at restoring the correct functioning of the central nervous system. This stage usually takes place at home, and a great responsibility falls on the shoulders of parents to comply with numerous medical recommendations.

Children with functional and organic disorders of the central nervous system need:

• therapeutic massage, including hydromassage (procedures take place in water);
• electrophoresis, exposure to magnetic fields;
• Vojta therapy (a set of exercises that allow you to destroy reflex wrong connections and create new ones - correct ones, thereby correcting movement disorders);
• Physiotherapy for the development and stimulation of the development of the senses (music therapy, light therapy, color therapy).

Such influences are allowed for children from 1 month old and should be supervised by specialists.

A little later, parents will be able to master the techniques. therapeutic massage and independently, but for several sessions it is better to go to a professional, although this is quite an expensive pleasure.

Consequences and predictions

Forecasts for the future for a child with lesions of the central nervous system can be quite favorable, provided he receives prompt and timely medical care in the acute or early recovery period. This statement is true only for mild to moderate lesions of the central nervous system. In this case, the main predictions include complete recovery and restoration of all functions, slight developmental delay, subsequent development of hyperactivity or attention deficit disorder.

At severe forms forecasts are not so optimistic. The child may remain disabled, and deaths are not excluded in early age... Most often, lesions of the central nervous system of this kind lead to the development of hydrocephalus, to infantile cerebral palsy, to epileptic seizures. As a rule, some internal organs also suffer, the child is observed in parallel chronic diseases kidney, respiratory and cardiovascular system, marbled skin.

Prophylaxis

Prevention of pathologies from the central nervous system in a child is a task future mother... At risk are women who do not leave bad habits while carrying a baby - smoke, use alcohol or drugs.

All pregnant women must be registered with an obstetrician-gynecologist in the antenatal clinic. During pregnancy, they will be offered three times to undergo the so-called screening, which identifies the risks of having a baby with genetic disorders from this particular pregnancy. Many gross pathologies of the central nervous system of the fetus become noticeable even during pregnancy, some problems can be corrected with drugs, for example, violations of the uteroplacental blood flow, fetal hypoxia, the threat of miscarriage due to a slight detachment.

A pregnant woman needs to monitor her diet, take vitamin complexes for expectant mothers, not self-medicate, be careful about various medications that have to be taken during the period of bearing a child.

This will help to avoid metabolic disorders in the baby. You should be especially careful about the choice of the parental home (the birth certificate, which all pregnant women receive, allows you to make any choice). After all, the actions of the personnel during the birth of a child play an important role in the possible risks of the appearance of traumatic lesions of the central nervous system in a baby.

After the birth of a healthy baby, it is very important to regularly visit a pediatrician, to protect the baby from injuries to the skull and spine, to make age-appropriate vaccinations that will protect the baby from dangerous infectious diseases, which at an early age can also lead to the development of pathologies of the central nervous system.

In the next video, you will learn about the signs of a nervous system disorder in a newborn, which you can determine on your own.

• All types of traumatic brain injury
• Traumatic meningeal hematomas
• Traumatic intracerebral hematomas
• Fractures of the bones of the vault and base of the skull
• Spinal cord injury
• Consequences of severe craniocerebral and spinal injuries

Traumatic brain injury - mechanical damage to the skull and intracranial formations - the brain, blood vessels, cranial nerves, meninges.

The frequency of traumatic brain injury and the severity of its consequences attach great social importance to the problem. Traumatic brain injury is predominantly received by the most active and important in social and labor relations the contingent of the population - persons under 50 years of age. This also determines large economic losses due to high mortality, frequent disability of the victims, as well as temporary disability.

The main causes of traumatic brain injury- road traffic accidents, falls, industrial, sports and domestic injuries.

Brain damage can result from:
1) focal damage, usually causing contusion (contusion) of the cortical regions of the brain or intracranial hematoma;
2) diffuse axonal damage involving the deepest parts of the white matter.

Traumatic Brain Injury Symptoms:

Depending on whether during the injury the integrity of the skin of the skull and its tightness is preserved or they are violated, craniocerebral injuries are divided into closed and open.

Closed traumatic brain injury traditionally divided into concussion, bruise and compression; conditionally, they also include a fracture of the base of the skull and cracks in the vault, while the skin is intact.

TO open traumatic brain injury include fractures of the bones of the cranial vault, accompanied by injury to the adjacent soft tissues, fractures of the base of the skull, accompanied by bleeding or liquorrhea (from the nose or ear), as well as wounds of the soft tissues of the head with damage to the aponeurosis. If the dura mater is intact, an open craniocerebral injury is referred to as non-penetrating, and if its integrity is violated, it is referred to as penetrating.

Traumatic brain injury by severity, they are divided into 3 stages: light, medium and heavy. Mild traumatic brain injury includes concussion and mild brain contusions; to moderate severity - moderate brain contusions; to severe - severe brain contusions, diffuse axonal damage and compression of the brain.

By the nature of the brain lesion, there are focal(arising mainly from shock and shock biomechanics of a head injury), diffuse(arising mainly from acceleration-deceleration injury) and combined damage.

Traumatic brain injury can be isolated(there are no extracranial injuries); combined(at the same time there is damage to the bones of the skeleton and / or internal organs), combined(different types of energy act simultaneously - mechanical, thermal, radiation, chemical, etc.).

According to the peculiarities of the occurrence of traumatic brain injury, it can be primary(when the impact of mechanical energy is not due to any immediately preceding it cerebral disorders) and secondary(when the impact of mechanical energy is due to an immediately preceding cerebral catastrophe causing the patient to fall, for example, with an epileptic seizure or stroke).

Traumatic brain injury can be received for the first time or repeatedly, i.e. be the first or second, third, etc.

During traumatic brain injury, there are acute, intermediate, long-term periods. Their temporal and syndromological characteristics are determined primarily clinical form traumatic brain injury, its nature, type, age, premorbid and individual characteristics of the victim, as well as the quality of treatment.

A concussion is characterized by a triad of symptoms: loss of consciousness, nausea or vomiting, retrograde amnesia. Focal neurological symptoms are absent.

Brain contusion diagnosed in cases where general cerebral symptoms are supplemented by signs of focal brain damage. The diagnostic boundaries between concussion and contusion of the brain and a minor contusion of the brain are very unstable, and in such a situation the term "concussion-contusion syndrome" is the most appropriate, indicating the degree of its severity. Brain contusion can occur both at the site of injury and on the opposite side by the counter-impact mechanism. The duration of loss of consciousness during a concussion is in most cases from several to tens of minutes.

Mild brain contusion... It differs by switching off consciousness up to 1 hour after injury, complaints of headache, nausea, vomiting. In the neurological status, rhythmic twitching of the eyes when looking to the sides (nystagmus), meningeal signs, and asymmetry of reflexes are noted. On radiographs, fractures of the bones of the cranial vault can be detected. In the cerebrospinal fluid - an admixture of blood (subarachnoid hemorrhage).

Moderate brain contusion... Consciousness turns off for several hours. Loss of memory (amnesia) for the events preceding the trauma, the trauma itself and the events after it is expressed. Complaints of headache, repeated vomiting. Revealed short-term breathing disorders, heart rate, blood pressure. There may be mental disorders. Meningeal signs are noted. Focal symptoms are manifested in the form of an uneven size of the pupils, speech disorders, weakness in the limbs, etc. Craniography often reveals fractures of the vault and base of the skull. With lumbar puncture - significant subarachnoid hemorrhage.

Severe brain contusion... It is characterized by prolonged switching off of consciousness (lasting up to 1-2 weeks). Revealed gross violations vital functions (changes in heart rate, pressure level, respiratory rate and rhythm, temperature). In the neurological status, there are signs of damage to the brain stem - floating movements eyeballs, swallowing disorders, changes in muscle tone, etc. Weakness in the arms and legs, up to paralysis, and seizures can be detected. Severe contusion is usually accompanied by fractures of the vault and base of the skull and intracranial hemorrhages.

Compression of the brain implies the development of a traumatic hematoma, often epideral or subdural. Their timely diagnosis suggests two unequal situations. With a simpler one, there is a "bright period": the patient who has regained consciousness after a while begins to "load" again, becoming apathetic, lethargic, and then soporous. It is much more difficult to recognize a hematoma in a patient in a coma, when the severity of the condition can be explained, for example, by a contusion of brain tissue. The formation of traumatic intracranial hematomas as their volume increases is usually complicated by the development of tentorial hernia - protrusion of the brain squeezed by the hematoma into the opening of the cerebellar tentorium through which the brain stem passes. Its progressive compression at this level is manifested by damage to the oculomotor nerve (ptosis, mydriasis, divergent squint) and contralateral hemiplegia.

Fracture of the base of the skull inevitably accompanied by a contusion of the brain of one degree or another, characterized by the penetration of blood from the cranial cavity into the nasopharynx, into the periorbital tissues and under the conjunctiva, into the middle ear cavity (otoscopy reveals a cyanotic color of the tympanic membrane or its rupture).

Bleeding from the nose and ears may be due to local trauma and is therefore not a specific symptom of a skull base fracture. Equally, the "eyeglass symptom" is also often the result of a purely local trauma to the face. Pathognomonic, although not necessary, the leakage of cerebrospinal fluid from the nose (rhinorrhea) and ears (otorrhea). Confirmation of the outflow of cerebrospinal fluid from the nose is the "teapot symptom" - a clear increase in rhinorrhea when the head is tilted forward, as well as the detection of glucose and protein in the nasal discharge, according to their content in the cerebrospinal fluid. Fracture of the pyramid temporal bone may be accompanied by paralysis of the facial and cochleovestibular nerves. In some cases, paralysis facial nerve occurs only a few days after the injury.

Along with acute hematomas, a skull injury can be complicated by a chronically increasing accumulation of blood above the brain. Usually in such cases there is a subdural hematoma. As a rule, such patients - often elderly people with impaired memory, suffering, in addition, alcoholism - are admitted to the hospital already in the stage of decompensation with compression of the brain stem. Trauma to the skull, which was many months ago, is usually not severe, the patient is amnestied.

Traumatic Brain Injury Treatment:

The main goal of traumatic brain injury therapy is to minimize secondary brain damage, since the primary damage is not treatable.

Urgent care on the prehospital stage with traumatic brain injury
The outcome of a traumatic brain injury largely depends on the early assistance provided to the victim. The neurological status is assessed at this stage. Hypotension and hypoxia associated with traumatic brain injury occur in 50% of cases; hypotension accompanies systemic damage and can be caused by hemorrhagic complications and a decrease in vascular tone with damage to the brainstem; hypoxia occurs with hemopneumothorax or with obstruction of the airways (usually upper). The causes of obstruction can be coma and retraction of the tongue, the ingress of blood and aspiration masses into the respiratory tract.

Treatment activities are aimed at eliminating hypotension and hypoxia. Any patient with traumatic brain injury should be treated as having a full stomach, as there is a risk of aspiration of gastric contents into the tracheobronchial tree. Tracheal intubation should be performed by trained personnel at the scene of the accident, which reduces mortality in severe traumatic brain injury, and intravenous infusion should be initiated for fluid resuscitation. Indications for tracheal intubation: upper airway obstruction, loss of upper airway protective reflexes (GCS< 8 баллов), неспособность пациента обеспечить дренирование дыхательных путей, необходимость механической поддержки дыхания (тахипноэ >30 rpm). Some authors distinguish indications such as hypoxia (PaO2< 70 мм рт. ст.; SjО2 < 94%), гиперкапния (РаСО2 >45 mmHg Art.).

Spinal cord injury is reported in 10% of road traffic accidents. To avoid damage cervical spine, intubation with a neutral head position is recommended. Intubation is facilitated by the administration of succinylcholine (1 mg / kg) and lidocaine (1.5 mg / kg IV). During the procedure, the method of traction of the head by the mastoid processes along the vertical axis of the body (manual in line traction) is used, which prevents overextension and movement of the spine in the cervical spine, while the Selick technique (pressure on the thyroid cartilage) is used to prevent aspiration and vomiting. During transportation, inhalation of 100% humidified oxygen is carried out; if necessary, auxiliary ventilation of the lungs is carried out. The victim's neck must be immobilized with a rigid collar. The victim is placed on a special board, to which he is tied with belts, which prevents the movement of the spine during transportation. The immobilization board should be X-ray contrast, which allows you to carry out the necessary studies without shifting the victim.
At the scene, correction of hypovolemic shock begins with intravenous infusion of various solutions, after performing catheterization of the peripheral vein, 500-1000 ml of isotonic solution, or 50-100 ml of 10% NaCl solution, or 250-500 ml of colloidal solution are injected. The use of a hypertonic NaCl solution does not cause an increase in intracranial pressure. At the prehospital stage, the volume of intravenous infusion is limited in order to avoid pulmonary edema, increased bleeding and increased intracranial pressure with a sharp rise in blood pressure. Mannitol is not used in the prehospital phase. According to numerous double-blind selective studies, dexamethasone and methylprednisolone, prescribed in the early stages of traumatic brain injury in appropriate doses, do not improve clinical outcome.

Inpatient treatment of traumatic brain injury
Activities continue to support breathing and blood circulation. The neurological status according to the GCS, the size and response of the pupils to light, sensitivity and motor function limbs, other systemic injuries are assessed. The efforts of specialists should be directed to the prompt diagnosis and surgical removal of brain compression.

In 40% of cases of traumatic brain injury, intracranial hematomas are diagnosed. Early surgical decompression is imperative. With significant intracranial hemorrhage detected by CT examination, a delay in surgery within the first four hours increases mortality by up to 90%. Clinical indications to surgery - the classic triad: impaired consciousness, anisocoria and hemiparesis. However, the absence of these symptoms does not exclude a hematoma. A decrease in the GCS score during repeated neurological examination is of diagnostic value. A high probability of the presence of a hematoma is observed in elderly patients, alcoholics, with injuries received during a fall, a fracture of the skull bones (especially in the places where the meningeal vessels and venous sinuses pass).

At this stage, one of the most important tasks is the surgical reduction of intracranial pressure using decompression craniotomy. The displacement of the midline structures of the brain is a more reliable indicator for surgical intervention than the size of the hematoma. According to Ropper, an 8 mm displacement of the midline structures is associated with coma; by 6 mm - with deep stun. The operation is indicated when the midline structures are displaced by more than 5 mm, and the intracranial pressure is increased by more than 25 mm Hg. Art .; decrease in CPP by 45 mm Hg. Art. also serves as an indication for decompression craniotomy.

For the purpose of preoperative assessment of a patient with traumatic brain injury, attention should be paid to the following points:
- airway patency (cervical spine);
- breathing (ventilation and oxygenation);
- the state of the cardiovascular system;
- collateral damage;
- neurological status (GCS);
- chronic diseases;
- circumstances of the injury (time of injury, duration of unconsciousness, taking alcohol or drugs on the eve of the injury).

In order to prevent hernial protrusion and infringement of areas of the brain with increased intracranial pressure, prior to the provision of neurosurgical assistance, therapy is carried out aimed at reducing intracranial pressure. Usually, in order to avoid an increase in intracranial pressure, mannitol is used at a dose of 0.25-1 g / kg of body weight, rapidly intravenous infusion over 15-20 minutes. The peak decrease in intracranial pressure is observed 10-20 minutes after drug administration. A number of studies confirm the effectiveness of low doses of mannitol (0.25 g / kg) under the control of intracranial pressure, especially in cases where repeated administrations are required. In some hospitals, to reduce intracranial pressure in patients with traumatic brain injury, they use hypertonic solution NaCl, which markedly reduces the production of cerebrospinal fluid (CSF). With its use, a decrease in the volume of brain tissue and the volume of blood filling in the brain is noted to a lesser extent, the effect of lowering intracranial pressure is less lasting than when using mannitol. Bolus administration of concentrated 7.5% and 10% NaCl solutions (up to 6-8 ml / kg) more effectively reduces intracranial pressure and causes a lower risk of sodium retention in the body than drip administration of large volumes (equivalent in sodium amount) moderately hypertensive 2-3 % solutions. A 23.4% NaCl solution is successfully used for increased intracranial pressure refractory to mannitol. As a rule, the administration of NaCl is combined with the simultaneous administration of furosemide (2 ml of 1% furosemide is added to 200 ml of 10% NaCl).

Anesthetic management for traumatic brain injury
Before performing anesthesia, remember the basic principles of optimal anesthesia for traumatic brain injury.
1. Ensuring optimal brain perfusion.
2. Prevention of cerebral ischemia.
3. Refusal from drugs that increase intracranial pressure.
4. Rapid awakening of the patient after surgery.

Since there is a high risk of aspiration of gastric contents, crash induction should be used to prevent aspiration - rapid seguence induction and Celica. Performing crash induction includes:
- preoxygenation with 100% oxygen for 3-5 minutes (with preserved spontaneous breathing);

- induction into anesthesia - narcotic analgesic (5 μg / kg fentanyl), intravenous anesthetic (5-6 mg / kg sodium thiopental or 2 mg / kg propofol). Doses of anesthetics depend on the depth of impairment of consciousness and the state of hemodynamics. The more pronounced the disturbances in consciousness and hemodynamics, the lower doses are used. In patients with unstable hemodynamics, preference should be given to etomidate (0.2-0.3 mg / kg). Thiopental sodium and propofol are not indicated in patients with hypovolemia;

- precurarization with arduan (10% of the calculated dose) 5 minutes before the administration of a muscle relaxant with a rapid onset of action (ditilin). The increase in intracranial pressure caused by ditilin, short-term, single administration of this drug does not affect the outcome. In patients with paresis of the extremities (not earlier than a day after traumatic brain injury), hyperkalemia induced by ditilin may occur, in such cases, a non-depolarizing type of relaxant should be used;

- Selick's reception (pressure on the thyroid cartilage);

- tracheal intubation (laryngoscopy lasting less than 15 seconds). The position of the patient on the operating table with the raised head end by 30 degrees improves the venous outflow of blood from the brain.

The issue of ventilation support during anesthesia is very problematic. It should be said that hyperventilation has long become a routine method of treating patients with traumatic brain injury due to the fact that it causes vasoconstriction of the arterioles of the brain and pia mater. It helps to reduce cerebral blood flow and volume, as well as intracranial pressure.

The known disadvantages of the method are hypoperfusion / ischemia (in already existing conditions of hypoperfusion) and inhibition of oxygen delivery due to a leftward shift of the oxyhemoglobin dissociation curve. When comparing patients who underwent hyperventilation with a decrease in PaCO2 to 24 mm Hg. Art., with the control group, where PaCO2 was reduced to 35 mm Hg. Art., a significant difference was revealed in favor of normoventilation, if we consider the clinical outcome 3-6 months after the injury. It has been proven that hyperventilation can have a beneficial effect in patients with increased cerebral blood flow, especially in young patients with predominant symptoms of cerebral edema with intact stem function. The effect of hyperventilation, which reduces intracerebral pressure, in patients with reduced cerebral blood flow (late phase of traumatic brain injury, acute phase in the elderly), if not absent altogether, is very limited. Moreover, in such situations, hyperventilation can have a deleterious effect and cause further local impairment of cerebral blood flow, which can fall below the ischemic threshold. It is usually recommended to continue mechanical ventilation in the postoperative period, since the maximum brain swelling occurs 12-72 hours after injury.

The most optimal method of anesthetic support in patients with traumatic brain injury should be considered an infusion of sodium thiopental at a rate of 4-5 mg / kg / h. This method is especially useful for patients with severe traumatic brain injury and coma.

In patients with mild traumatic brain injury, low doses of isoflurane or desflurane may be used to support anesthesia. One should only remember the need for moderate hyperventilation when using these inhalation anesthetics. Isoflurane and desflurane at a concentration of 1-1.5 MAC (minimum alveolar concentration is the alveolar concentration of an inhalation anesthetic, which prevents involuntary limb movements in 50% of patients in response to a standardized stimulus (for example, a skin incision) and does not cause a noticeable increase in intracranial pressure. and desflurane with prolonged use can interfere with the reabsorption of cerebrospinal fluid.

Nitrous oxide increases cerebral blood flow and the amount of air in the cranial cavity; therefore, its pure use in such operations is limited, although in a number of clinics N2O is used in combination with sodium thiopental infusion. This allows you to reduce the rate of infusion of the latter and, thus, ensure a quick awakening of the patient. When working with N2O in this category of patients, ventilation should be carried out in the mode of moderate hyperventilation (PaCO2 = 32 mm Hg) and turned off before closing the dura mater.

To maintain myoplegia, an antidepolarizing muscle relaxant is used (preferably vecuronium, but arduan is widely used). For the purpose of pain relief during the operation, opioids are administered. It has been established that fentanyl and sufentanil can increase intracranial pressure in traumatic brain injury. Maintaining blood pressure at a sufficient level with the use of opioids prevents an increase in intracranial pressure.

An important point during the operation before and after it is infusion therapy, which in patients with cerebral edema is somewhat different from that accepted in general anesthesiology and intensive care, although general principles persist. Infusion therapy should provide not only hemodynamic stability, but also adequate CPP, prevent an increase in venous pressure in the cranial cavity, maintain a stable osmolarity of blood plasma within 300-310 mosm / kg H2O and prevent the development of both hyperglycemia and hypoglycemia. The perfusion pressure of the brain should be maintained at 80-90 mm Hg. Art.

During operations for the removal of acute epidural and subdural hematomas, especially with rapid decompression, a significant decrease in blood pressure occurs, which can be aggravated by initial hypovolemia and bleeding. In case of systemic injuries, patients are often hypovolemic, and doctors' efforts should be directed to normalizing the BCC. Hypovolemia can be masked by hypoxia - sympathetic activation in response to increased intracranial pressure. To correct the initial hypovolemia, isotonic NaCl solution is transfused until blood pressure, heart rate and urine output are normalized. The hematocrit should be maintained at a level of at least 30% to avoid cerebral ischemia. Isotonic NaCl solution is the main and in most cases the only drug for patients with cranial cavity pathology. At the same time, it is important to remember that hypervolemia can increase cerebral edema and increase intracranial pressure.

The anesthesiologist should strive for early awakening of the patient after surgical intervention, which allows an early neurological examination. The presence of consciousness in the postoperative period greatly facilitates monitoring of the patient and allows early identification of the development of complications. Consciousness is the best criterion for assessing the patient's condition in the early postoperative period, but early awakening of the patient should not be an end in itself. If the patient's condition permits, extubation is performed at the end of the operation. Along with stable hemodynamics, normal temperature body and adequate breathing A mandatory criterion for early extubation is the restoration of the patient's consciousness. If an increase in cerebral edema, an increase in intracranial pressure is expected and hyperventilation is supposed to be used to reduce it, one should not rush to extubation.

The outcome of traumatic brain injury can be assessed no earlier than 6 months after the injury. According to Traumatik Coma Data Bank, 67% of patients admitted to hospitals with severe traumatic brain injury survive (excluding gunshot head injuries). Of this group of patients, only 7% have a good recovery on discharge from the hospital. Thus, almost all patients with severe traumatic brain injury have various neurological disorders.

Prognosis for traumatic brain injury. With a concussion, the vast majority of patients recover completely. The outcome of brain contusion and open skull injuries depends on the severity of the brain damage. In most cases, survivors have some kind of residual cerebral symptoms. Timely removal of the hematoma saves patients' lives; in many such cases, no significant residual symptoms remain. With severe brain damage, the mortality rate can reach 40-50%.

The appearance of a child in a family is fraught with a number of troubles and difficulties. First of all, young parents, of course, fear for the health of the newborn. So, at an appointment with a neurologist, with a high degree of probability, the baby may have the first diagnosis in his life - hypoxic-ischemic. What is it and when is it necessary to sound the alarm?

Perinatal pathology of the nervous system of hypoxic genesis

- a variety of pathological conditions that developed during the period from 22 weeks of gestation to 7 days of a newborn's life.

Interesting! Previously, the perinatal period was counted from the 28th week of pregnancy. A child born before this date was considered unviable. However, at present, when doctors have learned to care for newborns weighing 500 grams or more, the perinatal period has shifted to 22 weeks.

Depending on the mechanism of development of the disease, perinatal pathology can be:

• hypoxic;
• traumatic;
• dismetabolic;
• infectious.

In turn, hypoxic damage to the central nervous system manifests itself both (hypoxic-ischemic forms) and non-traumatic hemorrhages (hypoxic-hemorrhagic damage to the central nervous system). Combinations of ischemic and hemorrhagic hypoxic manifestations of perinatal pathology are possible.

Hypoxic-ischemic damage to the nervous tissue is one of the pathogenetic forms of perinatal pathology associated with insufficient oxygen supply to the cells.

Etiology of hypoxic damage to the central nervous system

Hypoxic damage to the central nervous system in newborns is determined by the effect on the fetus of a number of harmful factors. They can have a negative effect during pregnancy, directly generic activity and the first days of a baby's life.

The main reasons for the development of fetal and newborn hypoxia are:

• genetic factors (chromosomal diseases and gene mutations);
• physical factors (environmental pollution, radiation, chronic hypoxia);
• chemical factors (drugs, household and industrial substances, chronic alcohol intoxication);
• alimentary factors (quantitative or qualitative starvation, lack of protein, vitamins and microelements);
• diseases of the mother (infections, endocrine pathology, somatic diseases women);
• pathology of pregnancy (gestosis, placental insufficiency, umbilical cord abnormalities);
• pathology in childbirth (prolonged and rapid labor, weakness of labor, placental abruption, umbilical cord prolapse).

The mechanism of development of ischemic damage to the central nervous system

Unfavorable factors provoke a decrease in the saturation of red blood cells with oxygen and lead to hypoxia. Under such conditions, the vascular wall begins to compensate for changes, increasing its permeability to better supply tissues with oxygen. Due to this, the pressure in the vessels decreases, and ischemic zones are formed.

On the other hand, under conditions of hypoxia, glucose begins to decompose to lactic acid. Acidosis with irritation of the nuclei is formed vagus nerves and the respiratory center of the medulla oblongata. As a result, during labor, the activation of intestinal motility, the release of meconium and the parallel aspiration of the contents of the birth canal and amniotic fluid are provoked. This further aggravates hypoxia, more actively forming ischemic damage to the central nervous system in newborns.

The clinical picture of ischemic lesions of the central nervous system in newborns

The manifestations of hypoxic-ischemic damage to the central nervous system in newborns depend on the degree of damage, the number of ischemic foci and their localization. Neurological syndromes of hypoxic lesion can manifest themselves:

• depletion of central nervous system functions;
• increased neuro-reflex excitability;
• hypertensive-hydrocephalic syndrome;
• convulsive paroxysms;
• delayed psychoverbal and motor development.

In practice, you can find individual elements or a combination of several syndromes, and a transition from one clinical manifestation to another is also possible.

Important! Many parents mistake the first manifestations of cerebral ischemia for the characteristics of the baby's character. If a child is inactive and constantly sleeps or, conversely, is restless and cries a lot, it is imperative to consult a pediatric neurologist.

Cerebral ischemia degrees and their consequences

Ischemic forms of CNS damage in newborns are classified into three degrees, depending on the severity of cerebral pathology:

• easy;
• moderate severity;
• heavy.

I degree

The first degree is mild ischemia. The newborn is characterized by lethargy, turning into hyperexcitability. There is no gross focal symptomatology in the neurological status. There may be a slight increase in unconditioned reflexes, their spontaneous manifestations are possible.

As a rule, after a few days, the symptoms stop and are observed full recovery... At present time is running overdiagnosis of mild ischemic lesions of the central nervous system.

This is due to the impossibility of completely eliminating non-gross hypoxic-ischemic damage to the nervous tissue. The abundance of risk factors for the disease, the blurring of the clinical picture of first-degree cerebral ischemia and the absence of its consequences allow the doctor to establish such a diagnosis for almost every newborn.

II degree

Second degree - the moderate severity of cerebral ischemia is characterized by depression of the central nervous system for at least 12 hours. Asymmetric muscular hypotonia, weakness of motor activity, suppression of reflexes are observed. Seizures are possible. The forecast of this form is not definite.

III degree

Third degree - severe cerebral ischemia. After birth, the child's state of consciousness is assessed as stupor or coma; artificial ventilation is required. Diffuse muscular hypotension, lack of spontaneous motility is noted. Postnatal seizures are common. Observed. The consequences of hypoxic-ischemic damage to the central nervous system of the 3rd degree are the most severe. When these children survive, they have severe neurological damage.

Diagnostics of the ischemic lesion of the central nervous system

The diagnosis of cerebral ischemia is established by a neonatologist directly in maternity hospital or a pediatric neurologist at the local polyclinic. In this case, the conclusion should be based on complaints from the parents, the characteristics of the anamnesis, data on the course of pregnancy and childbirth, the state of the child after birth.

To assess the specificity of damage and the severity of the disease, they resort to additional clinical and instrumental examination methods. These include:

• general clinical research;
• neuroimaging (CT and brain);
• EchoES, REG, EEG;
• consultation with an ophthalmologist, speech therapist, psychologist.

Remember! None of diagnostic procedures cannot exclude cerebral ischemia, even if its signs were not found during the study.

Treatment of cerebral ischemia of newborns

Treatment of hypoxic-ischemic lesions of the central nervous system will depend on the degree of cerebral ischemia and the clinical picture of the disease. The main stages of the fight against perinatal lesions of the nervous system of hypoxic genesis are as follows:

• ensure airway patency and adequate ventilation of the lungs;
• restoration of adequate brain perfusion;
• observance of the protective regime with the prevention of cooling, overheating, secondary infection;
• correction of metabolic and electrolyte disorders;
• neuroprotection and neurotrophic therapy;
• if necessary, anticonvulsants;
• treatment of the consequences of the disease (medicines, massage, physiotherapy exercises, kinesiotherapy and physiotherapy, acupuncture, pedagogical correction).

Damage to the nervous system in newborns can occur both intrauterinely (prenatally) and during childbirth (intrapartum). If harmful factors acted on the child at the embryonic stage intrauterine development, there are severe, often incompatible with life vices. Damaging influences after 8 weeks of pregnancy can no longer cause gross deformities, but sometimes they are manifested by small deviations in the formation of the child - stigmas of dysembryogenesis.

If the damaging effect was exerted on the child after 28 weeks of intrauterine development, then the child will not have any defects, but some kind of disease may occur in a normally formed child. It is very difficult to isolate the impact of a harmful factor separately in each of these periods. Therefore, they often talk about the impact of a harmful factor in general in the perinatal period. And the pathology of the nervous system of this period is called perinatal damage to the central nervous system.

Various acute or chronic diseases of the mother, work in hazardous chemical industries or work associated with various radiation, as well as harmful habits of parents - smoking, alcoholism, drug addiction can have an adverse effect on the child.

A child growing in the womb can be adversely affected by severe toxicosis of pregnancy, pathology of the child's place - the placenta, and the penetration of infection into the uterus.

Childbirth is a very important event for a baby. Especially great trials fall on the share of the infant if childbirth occurs prematurely (prematurity) or rapidly, if there is birth weakness, the fetal bladder bursts early and water flows out when the baby is very large and they help him to be born with special techniques, forceps or a vacuum extractor.

The main causes of damage to the central nervous system (CNS) are most often - hypoxia, oxygen starvation of various nature and intracranial birth trauma, less often intrauterine infections, hemolytic disease newborns, malformations of the brain and spinal cord, hereditary metabolic disorders, chromosomal pathology.

Hypoxia ranks first among the causes of damage to the central nervous system, in such cases, doctors talk about hypoxic-ischemic damage to the central nervous system in newborns.

Hypoxia of the fetus and newborn is a complex pathological process in which the access of oxygen to the child's body decreases or completely stops (asphyxia). Asphyxia can be single or repeated, varying in duration, as a result of which carbon dioxide and other under-oxidized metabolic products accumulate in the body, damaging primarily the central nervous system.

With short-term hypoxia in the nervous system of the fetus and newborn, only small disturbances of cerebral circulation occur with the development of functional, reversible disorders. Long-term and repeated occurrence of hypoxic conditions can lead to severe disorders of cerebral circulation and even to the death of nerve cells.

Such damage to the neonatal nervous system is confirmed not only clinically, but also with the help of ultrasound Doppler examination of cerebral blood flow (USDG), ultrasound examination of the brain - neurosonography (NSG), computed tomography and nuclear magnetic resonance (NMR).

In second place among the causes of damage to the central nervous system in the fetus and newborn is birth trauma. The true meaning, the meaning of birth trauma is damage to a newborn baby caused by mechanical impact directly on the fetus during childbirth.

Among the variety of birth injuries during the birth of a baby, the baby's neck experiences the greatest stress, resulting in various injuries of the cervical spine, especially the intervertebral joints and the junction of the first cervical vertebra and the occipital bone (atlanto-occipital joint).

There may be shifts (dislocations), subluxations and dislocations in the joints. This disrupts blood flow in the important arteries that supply blood to the spinal cord and brain.

The functioning of the brain is highly dependent on the state of the cerebral blood supply.

Often the root cause of such injuries is the weakness of labor in a woman. In such cases, forcedly applied rhodostimulation changes the mechanism of passage of the fetus through birth canal... With such stimulated labor, the child is born not gradually, adapting to the birth canal, but quickly, which creates conditions for displacement of the vertebrae, stretching and rupture of ligaments, dislocations, and disturbed cerebral blood flow.

Traumatic damage to the central nervous system during childbirth most often occurs when the size of the child does not correspond to the size of the mother's pelvis, when the fetus is in the wrong position, during delivery in the breech presentation, when premature, low birth weight babies are born and, conversely, children with large mass body, large size, since in these cases various manual obstetric techniques are used.

When discussing the causes of traumatic lesions of the central nervous system, one should separately dwell on childbirth using the imposition of obstetric forceps. The fact is that even with the impeccable application of the forceps on the head, intense traction for the head follows, especially when trying to help the birth of the shoulders and torso. In this case, all the force with which the head is stretched is transmitted to the body through the neck. For the neck, such a huge load is unusually great, which is why when removing the baby with forceps, along with the pathology of the brain, damage to the cervical spinal cord occurs.

Particular attention should be paid to the issue of damage to a child that occurs during a caesarean section. Why is this happening? Indeed, it is not difficult to understand the trauma to a child as a result of his passage through the birth canal. Why does the caesarean section operation, designed to bypass these paths and minimize the possibility of birth trauma, ends up in birth trauma? Where do these injuries come from during a cesarean section? The fact is that a transverse incision for a cesarean section in the lower segment of the uterus should theoretically correspond to the largest diameter of the head and shoulders. However, the circumference obtained with such an incision is 24-26 cm, while the circumference of the middle child's head is 34-35 cm. Therefore, removing the head and especially the child's shoulders by pulling the head with an insufficient incision of the uterus inevitably leads to injury to the cervical spine. That is why the most common cause of birth trauma is a combination of hypoxia and damage to the cervical spine and the spinal cord located in it.

In such cases, they talk about hypoxic-traumatic damage to the central nervous system in newborns.

With birth trauma, cerebral circulation disorders often occur, up to hemorrhages. More often these are small intracerebral hemorrhage in the cavity of the ventricles of the brain or intracranial hemorrhage between meninges(epidural, subdural, subarachnoid). In these situations, the doctor diagnoses hypoxic-hemorrhagic lesions of the central nervous system in newborns.

When an infant is born with CNS damage, the condition can be severe. This acute period illness (up to 1 month), followed by early recovery (up to 4 months) and then - late recovery.

Essential for the appointment of the most effective treatment pathology of the central nervous system in newborns has the definition of the leading complex of symptoms of the disease - neurological syndrome. Let's consider the main syndromes of CNS pathology.

The main syndromes of CNS pathology

Hypertensive-hydrocephalic syndrome

When examining a sick infant, the expansion of the ventricular system of the brain is determined, detected by ultrasound of the brain, and an increase in intracranial pressure is recorded (given by echo-encephalography). Outwardly in severe cases with this syndrome, there is a disproportionate increase in the size of the cerebral part of the skull, sometimes asymmetry of the head in the case of a unilateral pathological process, divergence of the cranial sutures (more than 5 mm), expansion and strengthening of the venous pattern on the scalp, thinning of the skin on the temples.

In hypertensive-hydrocephalic syndrome, either hydrocephalus, manifested by the expansion of the ventricular system of the brain, or hypertensive syndrome with an increase in intracranial pressure, may prevail. With the predominance of increased intracranial pressure, the child is restless, easily excitable, irritable, often screams loudly, sleep is light, the child often wakes up. With the predominance of hydrocephalic syndrome, children are inactive, lethargy and drowsiness are noted, sometimes developmental delay.

Often, with an increase in intracranial pressure, children goggle, the Gref symptom periodically appears (a white strip between the pupil and upper eyelid), and in severe cases, there may be a symptom of the "setting sun", when the iris of the eye, like the setting sun, is half submerged under the lower eyelid; sometimes a convergent squint appears, the baby often throws his head back. Muscle tone can be either decreased or increased, especially in the muscles of the legs, which is manifested by the fact that he stands on his “tiptoes” when he supports him, and when he tries to walk, he crosses his legs.

The progression of hydrocephalic syndrome is manifested by an increase in muscle tone, especially in the legs, while the reflexes of support, automatic walking and crawling are reduced.

In cases of severe, progressive hydrocephalus, seizures may occur.

Movement Disorders Syndrome

The syndrome of movement disorders is diagnosed in most children with perinatal pathology of the central nervous system. Movement disorders associated with a violation of the nervous regulation of muscles in combination with an increase or decrease in muscle tone. It all depends on the degree (severity) and level of damage to the nervous system.

When making a diagnosis, the doctor must decide on several very important issues, the main of which is: what is it - a pathology of the brain or a pathology of the spinal cord? This is fundamentally important because the approach to treating these conditions is different.

Secondly, it is very important to assess muscle tone in different groups muscles. The doctor uses special techniques to detect a decrease or increase in muscle tone in order to choose the right treatment.

Violations of increased tone in various groups leads to a delay in the emergence of new motor skills in the child.

With an increase in muscle tone in the hands, the development of the grasping ability of the hands is delayed. This is manifested by the fact that the child takes the toy late and grabs it with the whole brush, fine finger movements are formed slowly and require additional training sessions with the child.

With an increase in muscle tone in the lower extremities, the child later stands on his legs, while resting mainly on the front parts of the feet, as if "standing on tiptoe"; in severe cases, the lower extremities cross at the level of the shins, which prevents the formation of walking. In most children, over time and thanks to treatment, it is possible to achieve a decrease in muscle tone in the legs, and the child begins to walk well. As a memory of increased tone muscles can remain a high arch of the foot, which makes it difficult to select shoes.

Autonomic-visceral dysfunction syndrome

This syndrome manifests itself as follows: marbling of the skin caused by blood vessels, a violation of thermoregulation with a tendency to an unreasonable decrease or increase in body temperature, gastrointestinal disorders - regurgitation, less often vomiting, a tendency to constipation or unstable stools, insufficient weight gain. All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are associated with impaired blood supply to the posterior parts of the brain, in which all the main centers of the autonomic nervous system are located, which provides guidance for the most important life-supporting systems - cardiovascular, digestive, thermoregulatory, etc.

Convulsive syndrome

The tendency to convulsive reactions during the neonatal period and in the first months of a child's life is due to the immaturity of the brain. Convulsions occur only in cases of spread or development of a painful process in the cerebral cortex and have many different causes that a doctor must identify. This often requires carrying out instrumental research work of the brain (EEG), its blood circulation (dopplerography) and anatomical structures (ultrasound of the brain, computed tomography, NMR, NSG), biochemical studies.

Convulsions in a child can manifest themselves in different ways: they can be generalized, seizing the whole body, and localized - only in a certain muscle group.

Convulsions are also different in nature: they can be tonic, when the child, as it were, stretches out and freezes on a short time in a certain position, as well as clonic, in which there is a twitching of the limbs, and sometimes the whole trunk, so that the child may be injured during seizures.

There are many options for the manifestations of seizures, which are identified by a neuropathologist from the story and description of the child's behavior by attentive parents.

lami. The correct diagnosis, that is, determining the cause of the child's seizure, is extremely important, since the timely appointment of effective treatment depends on it.

It is necessary to know and understand that convulsions in a child during the neonatal period, if serious attention is not paid to them in time, can become the onset of epilepsy in the future.

Symptoms to be referred to a pediatric neurologist

Summarizing all that has been said, we will briefly list the main deviations in the state of health of children, with which you need to contact a pediatric neurologist:

if the baby suckles sluggishly, takes breaks, gets tired at the same time. Choking, milk flowing through the nose is noted;
if the child has a weak cry, and the voice has a nasal tone;
if the newborn often spits up, does not gain enough weight;
if the child is inactive, lethargic or, on the contrary, too restless and this anxiety increases even with minor changes in the environment;
if the child has chin trembling, as well as upper or lower limbs, especially when crying;
if the child often shudders for no reason, has difficulty falling asleep, while sleep is superficial, short in time;
if the child constantly throws his head back while lying on his side;
if there is too fast or, conversely, slow growth of the head circumference;
if the child's physical activity is reduced, if he is very sluggish, and the muscles are flabby (low muscle tone), or, conversely, the child seems to be constrained in movements (high muscle tone), so that swaddling is even difficult;
if one of the limbs (arm or leg) is less active in movements or is in an unusual position (clubfoot);
if the child squints or goggles, a white stripe of the sclera is periodically visible;
if the baby is constantly trying to turn his head in one direction only (torticollis);
if the thighs are restricted, or, conversely, the child lies in the frog position with the hips apart 180 degrees;
if the child was born by caesarean section or in breech presentation, if obstetric forceps were used during childbirth, if the baby was born prematurely or with a large weight, if an umbilical cord entanglement was noted, if the child had convulsions in the parental home. Accurate diagnosis and timely and correctly prescribed treatment of the pathology of the nervous system are extremely important. Damage to the nervous system can be expressed to varying degrees: in some children, they are very pronounced from birth, in others, even severe disorders gradually decrease, but they do not disappear completely, and long years non-coarse manifestations remain - these are the so-called residual phenomena.

Late manifestations of birth trauma

There are also cases when at birth the child had minimal disturbances, or no one noticed them at all, but after a while, sometimes years, under the influence of certain loads: physical, mental, emotional - these neurological disorders manifest themselves with varying degrees severity. These are the so-called late, or delayed, manifestations of birth trauma. Pediatric neurologists in daily practice deal most often with such patients.

What are the signs of these consequences?

Most children with late manifestations show a marked decrease in muscle tone. Such children are credited with "innate flexibility", which is often used in sports, gymnastics, and even encouraged. However, to the disappointment of many, it should be said that extraordinary flexibility is not the norm, but, unfortunately, a pathology. These children easily fold their legs into the "frog" pose, do the splits without difficulty. Often, such children are happily accepted in the rhythmic or artistic gymnastics section, in choreographic circles. But most of them cannot stand heavy workloads and are eventually deducted. However, these activities are enough to form a pathology of the spine - scoliosis. It is not difficult to recognize such children: they often clearly show the protective tension of the cervico-occipital muscles, often have a slight torticollis, the shoulder blades stick out like wings, the so-called "pterygoid shoulder blades", they can stand on different levels as are the shoulders. In profile, it can be seen that the child has a sluggish posture, stooped back.

By the age of 10-15, some children with signs of injury to the cervical spine during the neonatal period develop typical signs of early cervical osteochondrosis most characteristic feature which children have headaches. The peculiarity of headaches with osteochondrosis in children is that despite them different intensity pains are localized in the cervico-occipital region. As they grow older, the pain often becomes more pronounced on one side and, starting in the occipital region, spreads to the forehead and temples, sometimes radiates to the eye or ear, increases with head turns, so that a short-term loss of consciousness may even occur.

Headaches in a child are sometimes so intense that they can deprive him of the opportunity to exercise, do something around the house, force him to go to bed and take analgesics. At the same time, some children with headaches have a decrease in visual acuity - myopia.

Treatment for headaches, which aims to improve blood supply and nutrition to the brain, not only relieves headaches, but it also improves vision.

The consequences of the pathology of the nervous system in the neonatal period can be torticollis, certain forms of scoliotic deformities, neurogenic clubfoot, flat feet.

In some children, bedwetting - urinary incontinence - can also be due to birth trauma - just like epilepsy and other seizure conditions in babies.

As a result of hypoxic trauma to the fetus in the perinatal period, the brain first of all suffers, the normal course of maturation is disrupted. functional systems brain, which provide the formation of such complex processes and functions of the nervous system as stereotypes of complex movements, behavior, speech, attention, memory, perception. Many of these children show signs of immaturity or disorders of certain higher mental functions. The most common manifestations are the so-called attention deficit hyperactivity disorder and hyperactive behavior syndrome. Such children are extremely active, disinhibited, uncontrollable, they have no attention, they cannot concentrate on anything, are constantly distracted, cannot sit still for several minutes.

They say about a hyperactive child: this is a child “without brakes”. In the first year of life, they give the impression of very developed children, as they are ahead of their peers in the development - they begin to sit, crawl, and walk earlier. It is impossible to restrain a child, he certainly wants to see, touch everything. Increased physical activity is accompanied by emotional instability. At school, such children have many problems and difficulties in learning due to the inability to concentrate, organize, and impulsive behavior. Due to low efficiency, the child does his homework until the evening, goes to bed late and, as a result, does not get enough sleep. The movements of such children are awkward, awkward, and poor handwriting is often noted. They are characterized by hearing and speech memory disorders, children poorly absorb material from hearing, while visual memory impairments are less common. They often have a bad mood, thoughtfulness, lethargy. It is difficult to involve them in the pedagogical process. The consequence of all this is a negative attitude towards learning and even refusal to attend school.

Such a child is difficult for both parents and teachers. Behavioral and school problems are snowballing. In adolescence, these children significantly increase the risk of persistent behavioral disorders, aggressiveness, difficulties in relationships in the family and school, and deterioration in school performance.

Functional disorders of cerebral blood flow especially make themselves felt during periods accelerated growth- in the first year, 3-4 years old, 7-10 years old, 12-14 years old.

It is very important to notice the first signs as early as possible, take action and carry out treatment already in early childhood, when the development processes are not yet completed, while the plasticity and reserve capabilities of the central nervous system are high.

Back in 1945, the domestic obstetrician Professor M. D. Guetner rightly called the birth damage to the central nervous system "the most common national disease."

In recent years, it has become clear that many diseases of older children and even adults have their origins in childhood and are often a late payback for unrecognized and untreated pathology of the neonatal period.

There is only one conclusion to be drawn - to be attentive to the baby's health from the moment of its conception, to eliminate all harmful effects on his health as soon as possible, and even better, to prevent them altogether. If such a misfortune occurs and the child has a pathology of the nervous system at birth, it is necessary to consult a pediatric neurologist in time and do everything possible so that the baby recovers completely.