Tests to detect pyramidal insufficiency. Pyramidal insufficiency in children Right-sided pyramidal syndrome

Pyramidal insufficiency is a syndrome. In other words, a set of certain

symptoms. They are generated by disturbances in the pyramids, the anatomical sections of the medulla oblongata responsible for voluntary muscle contractions. It is through them that the signal passes from the cerebral cortex to the desired part of the spinal cord. Therefore, this section of the NS is called the pyramidal tract. Damaging factors such as tumors, inflammation, trauma, some infections and hemorrhages can disrupt impulse transmission along some part of this path and lead to movement disorders. Theoretically, a competent neuropathologist is able to determine exactly where the problem arose and prescribe adequate treatment. Almost more and more often, after an examination or computer study, based on implicit signs, or even complaints from the mother, the doctor diagnoses the baby with “pyramidal insufficiency” and recommends, at best, observation, and at worst, a standard set of medications “for everything” (“ Diakarb", "Eufillin", "Actovegin", etc.)

Is it dangerous?

Despite the fact that there is no diagnosis of pyramidal insufficiency, the syndrome itself can suggest serious damage to the nervous system. In particular, this may be paralysis or paresis (incomplete immobility). If the patency of central motor neurons is impaired, muscle spasticity or increased tone is observed (in the arms - flexor muscles, in the legs - extensors), hyperreflexia, and synkinesis. If the pathway is incompletely damaged, for example, right-sided pyramidal insufficiency may occur, its manifestations: visual disturbances, nystagmus, decreased intelligence. However, not all children in whose medical card a similar record appears, there are noticeable deviations. In addition, for some of them everything returns to normal over time. Why? The fact is that in infants there are frequent cases of delayed myelination of nerve fibers. That is, the growth of neurons with a special membrane that improves conductivity occurs at a low rate due to hypoxia suffered by the child or diseases of the cardiopulmonary sphere. But at the same time, the diagnosis of “pyramidal insufficiency” may hide serious problems leading to persistent paresis and paralysis. It is especially dangerous if the lesion is visualized on ECHO diagnostics of the brain or computed tomography. The prognosis in this case is very serious.

Pyramidal insufficiency: treatment

Since the main manifestation of PN is hypertonicity of certain muscle groups, treatment is aimed at relieving it. Small child carries out its cognitive development through movements, if they are limited, then the whole process begins to proceed with a delay. The neurologist should prescribe medication specifically for specific disease, for example, obstetric paresis of the arm or neuritis of the facial nerve, as well as massage and physiotherapy. A complex approach will help relieve your baby from these problems. As a rule, the diagnosis is removed by one year.

Ballerina's symptom, walking on tiptoes or on tiptoes, equinus planting of the feet - all these are names for one pathology - syndrome pyramidal insufficiency. The disorder can be caused by a large number of reasons, but is always accompanied by moderate/severe muscle dystonia with hypertonicity of the foot and leg. Pyramidal insufficiency with bilateral dystonia is usually observed in newborns and children in the first year of life, and is less commonly diagnosed in children 2-3 years of age.

Why does pyramidal insufficiency occur?

The medulla oblongata is responsible for complex reflexes. It is part of the brain and connects the latter to the spinal cord. The organ consists of anatomical cells - pyramids. Hence the name - pyramidal.

When these cells are damaged, movement disorders occur. It is worth noting that in medicine there is no diagnosis “ pyramidal, or pyramidal, insufficiency" However, it is given to many children and is not always justified.

The cause of the development of pathology in a child is perinatal mechanical or ischemic injury cervical region spinal cord. When the blood circulation of the cervical thickening and the brain stem is disrupted, a gross deviation of the muscle tone of the flexors in the limbs is formed.

The severity depends on the severity of the lesion. The arms become stiff, and with more widespread ischemia, a disturbance is observed in the legs - when the baby is placed on his legs, he firmly rests on his toes (distal parts of the foot).

Symptoms and signs

Key symptoms of pyramidal insufficiency:

  • Trembling chin;
  • Hand tremors;
  • Throwing the head back;
  • Poor grasp reflex;
  • Difficulty holding objects;
  • Curling your toes in a standing position;
  • Walking on your toes.

In children under 2-3 months of age, this condition does not cause concern, since they have natural muscle hypertonicity. When the vertical position of the body becomes physiological due to age, and the baby does not walk normally, it is necessary to determine muscular dystonia - main symptom pyramidal insufficiency or spastic paresis lower limbs.

The diagnosis is confirmed by the presence of high tendon reflexes, the Babinski reflex persisting for 2-3 months, revival of the tendon reflexes of the hands, delayed reduction of others (automatic gait, automatic crawling, Moro, etc.).

Pyramidal insufficiency syndrome can be detected in an infant using a kind of test: the baby is placed on his stomach, the shin is bent halfway at the knee, and it is deeply palpated (palpated) calf muscles, examine the tone of the buttocks. IN in good condition muscle tension is the same.

If there is a violation, the calf muscles are tense, the buttocks are in a state of hypotension or normal tone. The pathology often affects the rectus femoris muscles: the legs bend excessively at the hip joints, and when brought to the tummy, they are difficult to straighten in a child lying on his back.

Features of deviation

Pyramidal insufficiency diagnosed in children is dangerous because it entails functional disorders called syndrome motor disorders(HAPPY BIRTHDAY). In such children, adjustment reflexes and motor skills are formed late, that is, their development will be delayed (the child will sit up late, crawl, walk, etc.).


Essentially, such a diagnosis means a motor disorder, but treatment can only be prescribed on the basis of other symptoms and after determining the cause of the disorder.

Almost always the diagnosis pyramidal insufficiency" is placed in the case when other signs of pathology have not appeared or are absent at all. That is, it is pointless to prescribe any treatment.

Tumors, inflammatory processes, some congenital pathologies and infections, hemorrhages are the main causes of insufficiency, or rather, it is their symptom and secondary disorder. Considering which part of the body has stopped moving normally, the neurologist accurately determines the affected area of ​​the pyramidal system.

The main diagnostic method is used CT scan. The procedure allows you to accurately determine the lesion in a matter of minutes.

In any case, before prescribing treatment, the doctor must make an accurate, or, one might say, officially existing diagnosis. For example, movement disorders can be provoked by minimal brain dysfunction, encephalopathies, and liquor hypertension syndrome.

Real neurological pathologies may occur:


  • birth injuries;
  • congenital diseases of the nervous system;
  • brain damage as a result of hypoxia during childbirth (oxygen deficiency);
  • infectious diseases;
  • tumors;
  • abscesses in the spinal cord or brain;
  • disturbances in the production and outflow of cerebrospinal fluid;
  • encephalitis and meningitis, causing hydrocephalus.

All of the listed pathologies have characteristic symptoms and specific treatment methods, therefore it is impossible to prescribe any serious medical measures based on just one movement disorder. For example, tilting the head back is one of the signs of meningitis, but no one makes a diagnosis based on the symptom alone.

Treatment of children with pyramidal insufficiency

If none of the listed diagnoses is confirmed, then the violation can be eliminated without medications. Mainly assigned various procedures physiotherapy. Massage is widely used. Both the help of a qualified specialist and the involvement of parents are necessary.


An experienced massage therapist will relieve tone and strengthen muscles. Massage courses usually take place every six months. Parents should do special preventive exercises with their child every day.

Gymnastics, swimming, exercises for coordination of movements have a beneficial effect on the body as a whole and on motor activity in particular.

This applies to both adults and children. Vitamins and medications that improve energy metabolism may be prescribed. It is worth noting that you need to choose a special orthopedic shoes when the baby tries to walk. It should have a hard back and a closed front.

If any disease is discovered that has led to a disorder, treatment is directed both at its elimination and at secondary disorders; it is necessary to relieve the symptoms of pyramidal insufficiency, especially in children.

The following drugs may be prescribed:

  • Improving metabolic processes in nerve cells, for example, “Nootropil”, “Encephabol”, “Cerebrolysin”, “Aminalon”, glutamic acid;
  • To improve the conduction of nerve impulses, “Dibazol”, “Proserin” are prescribed;
  • Vasoactive agents for microcirculation;
  • Substances that normalize muscle tone (eg. “Baclofen”, “Mydocalm”, “Lioresal”);
  • Vitamin E and group B.

How often do you hear the phrase from parents: “No need to talk about insufficiency, my eldest child also had a “pyramid” and he walks perfectly!”
What kind of syndrome is this?
First I would like to tell you in 2 words about pyramid system and its main function. So, in my opinion, it will be clearer what the defective functioning of this part of the central nervous system can lead to.
Pyramid system is a young education that has especially developed in humans. The segmental apparatus of the spinal cord (the connection of certain segments of the spinal cord with a controlled group of muscles, an area of ​​skin, etc.) appears early in the process of evolution, when the brain is just beginning to develop, and the cerebral cortex has not yet been formed. The pyramid system means a complex nerve cells with their axons (processes), through which a connection between the cortex and the segmental apparatus is formed. Thus, the pyramidal system puts the central nervous system program into action - voluntary movement!!! We must remember that the “pyramid” is not only “walking legs” and “grasping hands”, but also control of the function pelvic organs, as well as our facial expressions + eye movements, ability to chew and speak.

When central motor neurons are damaged, central paralysis occurs (incomplete loss of movement is called paresis).

The main signs of central paresis:

1.Hypertension or muscle spasticity.
The tone of the flexors increases in the arms, and the extensors in the legs (the arm is bent and brought to the body, the leg is straightened and “elongated”);
2.Increased deep reflexes (hyperreflexia);
3. Associated movements or synkinesis.
Reflex movement in the affected limb with tension in healthy muscles;
4.Pathological reflexes.

Reasons leading to dysfunction pyramid system there are many, but according to the nature of the damage there are only two options:
*violation of the integrity of the pyramidal tract: central neuron in the GM cortex - axon - peripheral neuron in the spinal cord;
*change in the structure or destruction of the axon “sheath”, the so-called myelin sheath, which improves the conduction of nerve impulses.

Why is the diagnosis heard so often? pyramidal insufficiency syndrome in young children??? And why, after such a serious conclusion, is there most often no permanent impairment of movement function???

The answer to these questions exists!!!

The main reason for the development of pyramidal insufficiency in children under 1 year of age is a slowdown in the rate of myelination of the nerve fiber, i.e. immersing it in a special case to improve conductivity. Most often, these are the consequences of hypoxia (oxygen starvation) suffered in utero or during childbirth; also, severe pneumonia, heart defects and other diseases suffered during the newborn period, accompanied by cardiopulmonary insufficiency, cannot be discounted.

To treat or not to treat???

It definitely needs treatment!!!
There is only one reason - hypertonicity of certain muscle groups, as one of the signs of pyramidal insufficiency, a big obstacle to the normal motor development of the child; he will acquire skills with a delay, and cognitive activity the baby is carried out only through movement!!!
Rehabilitation activities (massage, physiotherapy) and drug treatment, prescribed by a neurologist will help your baby cope with difficulties.
And most importantly, under diagnosis pyramidal insufficiency may be hiding serious problem, leading to persistent dysfunction. If during neuroimaging - neurosonography (ultrasound of the brain), computed tomography and brain there is a visible lesion, then the prognosis is usually serious.
Trust your doctor.
Be healthy!!! :)

Movement is one of the most important functions of a living organism, including humans. With its help, we carry out both simple and complex movements, movements that require a minimum of force and a lot of effort from us.


All the variety of movements is carried out nervous system, in particular its departments responsible for this function, such as the pyramidal system, extrapyramidal and cerebellum with its connections with the cerebral cortex and the spinal cord.


Let's focus on the pyramid system. Thanks to it, we can carry out any movements we want, we can stop the movement at any time, change it. It’s so simple that we don’t even think about it, and we get the impression that the movement is original. Although this is not true. Everything we do meaningfully originates in the cerebral cortex. The brain is an amazing system that is responsible for great amount functions in the body, including the one we are talking about here. Whatever the function, it has its representation in the cerebral cortex.


You know that there are cerebral hemispheres, as well as gyri. There is also a division into the cortex and subcortical system. The Kara consists of six layers, each layer is a group of specific cells responsible for the following functions:


the third and fourth layers are sensitive, the fifth and sixth are responsible for movements, the fourth and second are for analyzing information from the senses, and the first layer connects individual areas and areas. In the fifth layer there are Betz cells or giant pyramidal cells, they were named so for their shape and comparatively large sizes. Each nerve cell has a body and two types of processes through which it connects with other cells. The axon is the only one, it is long and practically does not branch; it connects with other neurons located far from the cell body, as well as directly with organs, in our case with muscles. Another type of processes is dendrite; on the contrary, it has a small length and a large number of processes, connects with cells located nearby.


The axons of Betz cells form a pyramidal tract, which, going down, connects with the extrapyramidal system, as well as with the subcortical nuclei, then in the brain stem it crosses to the opposite side, where it connects with the cells that are located in the spinal cord, from them a signal, according to them the axons go directly to the muscle fiber and the latter contracts. Nerve cells located in the spinal cord are located segmentally, i.e. each level of the spinal cord is responsible for a specific part of the body (the cervical spinal cord for the innervation of the arms, the thoracic spinal cord for the torso, and lumbar region by the legs)


As you can see, the system is very complex and in fact everything is done much faster than it is explained.


What happens when this system is violated at one or another level. Maybe. You've heard about paralysis; it can be spastic when muscle tone is increased and flaccid when, on the contrary, it decreases. In case of pyramidal insufficiency, i.e. when the Betz nerve cell itself or its axon is damaged, the neuron located in the spinal cord is disinhibited and it begins to send an excessive number of nerve impulses to the muscles. Muscle tone increases, reflexes increase, and tremors occur. This condition is called central paralysis, and with incomplete loss of voluntary movements - central paresis.


Flaccid paralysis or peripheral (with incomplete loss of function - paresis), occurs when a nerve cell in the spinal cord and its process is damaged. In this case, a decrease in muscle tone occurs, up to complete paralysis of the muscle, reflexes also decrease or disappear completely, and hypotrophy of the innervated area occurs.


Clinically, central paralysis (paresis) is manifested by trembling and tension in the limbs, increased tone, changes in the quality and quantity of free movements. With paralysis (paresis) in the legs, the gait changes. The leg does not straighten well, at the knee and hip joints, the foot is placed on the toe, and the impression of a “rooster gait” is created. If the hands are affected, then trembling occurs in them, movement requires a lot of effort, because muscle tone is increased. There is a malnutrition of the limb, malnutrition or atrophy occurs.

Methods for diagnosing pyramidal insufficiency.

Computed tomography of the brain and magnetic resonance tomography(CT and MRI of the brain).

When a pathological focus forms in the brain, in the area of ​​the pyramidal system, or when the blood supply to this area is disrupted, central paralysis occurs. This change can be seen by computed tomography of the brain (CT brain) and magnetic resonance imaging (MRI).


Moreover, MRI is a mandatory method of examination for epilepsy and seizures. According to the recommendation of the International League Against Epilepsy, CT is done as follows: additional method examinations or when it is not possible to do an MRI.


Electromyography.


Electromyography is a method for studying the neuromuscular system by recording the electrical potentials of muscles.


The functional element of skeletal muscle is the muscle fiber. Contraction of a muscle fiber occurs as a result of excitation arriving at it via motor nerve fibers.

When a muscle contracts, an electrical discharge occurs, which can be detected using special device– myograph. When muscle tone decreases or increases, a change occurs muscle contraction. When the tone decreases, the voltage decreases; when it rises, on the contrary, the amplitude of the wave of muscle contraction increases.


EEG study.


For cerebral palsy, birth trauma, consequences of strokes and injuries.


Almost everything central paresis and paralysis, especially with cerebral palsy, congenital and acquired in early age brain diseases are accompanied by hidden or obvious seizures.


Seizures further increase the area of ​​brain damage. It is very important to know that more than 65% of seizures occur during sleep. And therefore it is necessary to record an EEG during physiological, natural sleep! Especially the little ones. Convulsions are not constant, and therefore you should not calm down if they are absent from a short EEG recording. Long-term monitoring (video or Holter) is necessary. As a result, you can detect: changes of a widespread nature: in the form of the appearance of diffuse delta waves, as well as synchronization of Tata waves. Epileptiform activity may occur.

Ultrasound of the brain.


You can see the signs high blood pressure in the brain, which has an irritating effect and can cause central paralysis.


In treatment it is necessary to adhere to the principle: There is no such thing as too much movement!


The more you spend with the patient physical exercise, the more sense.


We will continue to talk about treatment in the next issue of the magazine.

Sitnikov I.Yu. 03/30/2006



Movement.

Pyramid system (system of voluntary movements).


The main efferent structure is the central motor neuron, the Betz giant pyramidal cell of the 5th layer of the projection motor cortex (prerolandic gyrus and paracentral lobule, 4th field). The set of processes of Betz cells is part of the pyramidal tract. Most of The pyramidal tract ends in the formations of the extrapyramidal system - the striatum, globus pallidus, substantia nigra, red nucleus, as well as in the reticular formation of the brain stem, carrying out the interaction of these systems. Other fibers, especially thickly myelinated ones, starting from the Betz giant cells of the projection motor cortex, end on the dendrites of the peripheral motor neuron.


The motor neuron is located in two places - the anterior horns of the spinal cord and in the motor nuclei of the cranial nerve; 2 pathways are formed - corticospinal, corticonuclear.


The motor fibers of the corticonuclear tract at the border of the medulla oblongata and the spinal cord pass to the other side, run in the lateral cords of the spinal cord and end segmentally.


The functional principle of somatotopic localization is implemented in the projection cortex. Precentral gyrus. Anterior to the projection motor cortex is the premotor cortex, which forms actions from movements. And in front of the premotor cortex is the prefrontal cortex, responsible for the implementation of holistic activities. The premotor cortex is also part of the extrapyramidal system.

Defeat projection zone– central paralysis.


Premotor – disturbances of action (praxis).


Prefrontal – disorders of standing and walking.


Pyramidal insufficiency - spastic ataxia, Pierre Marie's disease.


Pyramidal insufficiency manifests itself in the form of increased tendon reflexes and periosteal reflexes, foot clonus, and increased muscle tone.


Hereditary cerebellar ataxia Pierre Marie.


Clinic: dysfunction of the cerebellum and its connections. Ataxia during coordination tests, gait disturbance, scanned speech, intention tremor, nystagmus.


Symptoms of pyramidal insufficiency, as well as visual and oculomotor disorders. Decrease in intelligence.


Treatment is symptomatic.

Pyramidal syndrome or pyramidal insufficiency syndrome is also called ballerina tiptoe syndrome or equinus foot placement.

This violation may be the result of a whole range of factors. In the vast majority of cases it is accompanied muscular dystrophy varying degrees associated with hypertonicity of the lower leg and foot.

Bilateral damage to the pyramidal tracts is usually diagnosed in newborns or children in the first year of life; less often it occurs in children two to three years old.

Anatomical certificate

The medulla oblongata, which connects the brain to the spinal cord, is responsible for complex reflexes. This organ consists of cells of a special pyramidal shape, which are called pyramids. That is why the syndrome is called pyramidal. Impaired coordination of movements is a consequence of damage to the above-mentioned cells.

It is curious that there is no official symptom of “pyramidal insufficiency”. However, it is given to young children - and not always justified.

The main reason for the development of such a pathology in an infant is mechanical or ischemic intrauterine injury to the cervical spinal cord. When blood flow in the cervical thickening and brain stem is disrupted, the muscle tone of the limb flexors undergoes a significant deviation from the norm.

The severity of the syndrome is directly dependent on the severity of brain damage. Light form insufficiency manifests itself in stiffness of the arms, and the more common ischemia adds to the symptoms of impaired motor activity of the lower extremities: when trying to put the baby on his feet, he stubbornly rests only on his toes, that is, the distal part of the foot works.

Pyramidal insufficiency syndrome in children

In babies in the first months of life, pyramidal syndrome usually manifests itself (they become very tense), the inability to hold their head, curling of their fingers when testing the step reflex (walking on their toes), and other similar signs.

Older children suffering from pyramidal syndrome may stand and/or tiptoe all the time, get tired quickly and constantly ask to be held. Some young patients do not want to walk at all and complain of pain in their legs. It is difficult for parents to separate complaints of this kind from simple whims, because two to three year olds cannot explain them clearly.

In the question of whether it is necessary to treat this disorder, the main thing is the severity of the problem. If the baby is slightly affected, you should simply see a local neurologist. It is also necessary to independently help the child with massage, baths and a specially designed set of physical exercises.

In case of more extensive damage or untimely or improper treatment the child may begin to lag behind the norms of motor development. In this case, it is possible that something not seen on initial examination signs of neurological deficit. Such children should begin treatment immediately.

It is important for parents of infants with pyramidal insufficiency to understand that “simple” tiptoeing in the absence of timely qualified help can develop into persistent disorders motor functions, sometimes reaching their complete failure.

About causes and symptoms

Pyramidal insufficiency in the legs in children can develop against the background of the following pathologies:

Externally expressed symptoms:

  • trembling of the chin, as well as legs and arms;
  • difficulty holding onto things;
  • throwing back the head;
  • poor finger control;
  • walking on tiptoes;
  • speech disorder;
  • reduced intelligence.

Pyramidal insufficiency syndrome in children cannot be diagnosed with 100% accuracy solely based on a medical examination. To obtain comprehensive data, you must pass all tests prescribed by your doctor. Only on the basis of their results is it possible to make a correct diagnosis.

"Adult" reasons

Pyramidal insufficiency is not a disease, but a syndrome. However, this does not prevent many doctors from classifying pathology as a disease and making an unambiguous diagnosis. Doctors often refer to it as or.

If pyramidal insufficiency syndrome in very young children may be a consequence of birth injuries or anomalies intrauterine development, then in adulthood the syndrome is most often observed in people suffering from oncological diseases or diseases of blood vessels or heart.

Pyramidal insufficiency in adults develops due to the following reasons:

  • inflammatory processes in brain tissue (or similar diseases);
  • pathological changes cerebral circulation(for example, due to transferred);
  • mechanical damage to the skull, resulting in disturbances in the transmission of nerve impulses;

Pyramidal syndrome in adult patients is an acquired pathology, the treatment of which involves eliminating not only the symptoms, but also the root cause of the disorder.

Clinical picture and diagnostic methods

To identify pyramidal syndrome in adults, a simple examination by a neurologist is not enough. The patient must undergo a series of modern diagnostic procedures. To obtain comprehensive information about the patient’s health status, the neurologist will need the results of the following examinations:

  • (prescribed if there is or suspicion of);
  • which helps to trace hidden seizures (in most cases they occur during sleep and therefore cannot be detected during an examination by a neurologist);
  • electromyography, which allows you to determine the electrical potential of muscles;
  • (if tumor formations are suspected).

Pyramidal insufficiency in adulthood also manifests itself in more noticeable symptoms that can be detected during a medical examination:

  • hypertension;
  • increased arms and legs;
  • full or partial different parts bodies;
  • violations of reflex activity, in particular, a decrease in its speed;
  • in some cases, especially if the damage has occurred to the hypothalamic-pituitary system, sexual dysfunction and increased body weight may be observed.

How to treat and is it necessary?

If pyramidal insufficiency is not accompanied by other, more serious diagnosis(from the lists above), physiotherapy procedures are sufficient to eliminate it. Massage is widely used to treat children. Professional massage therapist helps strengthen muscles and relieve hypertension. Parents perform a set of special preventive exercises with their child at home.

Swimming, gymnastics, exercises for coordination of movements, and balneotherapy (healing baths) also help to improve motor activity and strengthen the body. This recommendation relevant for both children and adults.

In addition, the doctor may prescribe vitamins that activate microcirculation, vasoactive substances or drugs to improve the metabolism of nerve cells (Cerebrolysin, Encephabol and others). Prozerin and Dibazol help normalize the conduction of nerve impulses. You can improve muscle tone with the help of vitamins E and B, as well as the drugs Baclofen, Lioresal and.

Neurosurgical therapy is prescribed if spinal or brain injuries or tumors occur. Surgery used for, as well as for thrombosis of extracerebral arteries.

Persons suffering from this pathology, especially children who are just learning to walk, need to wear special orthopedic shoes. It is distinguished by a closed front and a rigid back.

Also, parents of babies under one year old should remember: the child should not be put on his feet prematurely, and should not be put in a walker - this may interfere normal development feet. When the time will come, the baby will try to walk on his own - and he will definitely succeed!

For adults, for the treatment of pyramidal insufficiency, tangible physical exercise: running, swimming, walking, exercising physical therapy and sports. Excellent results gives, acupressure And .

If the syndrome occurs against the background of another disease, the main emphasis should be on healing from it. It is also important to restore the patient’s motor activity if there is paralysis. However, we should not forget about the need to relieve the symptoms of the described pathology; This is especially important for young patients.

To avoid something so unpleasant and dangerous with its complications pathological condition, as pyramidal insufficiency, it is necessary:

  • carefully monitor your health and the health of your children;
  • accept everything necessary measures to prevent injuries that can provoke the development of pathology;
  • promptly treat diseases that may cause the syndrome, and also take measures to prevent them.
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