Cerebral ischemia in newborns - symptoms, treatment methods, consequences. Development factors and stages of cerebral ischemia

Cerebral ischemia in a newborn is one of the most serious problems pediatric neurology, have not yet been developed effective methods pathology therapy. The prognosis of the course of the disease directly depends on the severity and timeliness of the treatment started.

The only reason for the development of cerebral ischemia is a violation of the blood supply to the child’s brain during pregnancy and childbirth. There are two forms of the disease: partial (hypoxia) and complete (anoxia). Designate this problem in a newborn, the term is usually “hypoxic-ischemic encephalopathy”, which means damage to brain tissue due to insufficient oxygen supply. Among the most common and dangerous species Encephalopathy includes periventricular ischemia, affecting the vessels of the brain and having serious consequences for the child, up to development of cerebral palsy and epilepsy.

The mechanism of development of cerebral ischemia in newborns is as follows. With sufficient blood supply to the body, oxygen is distributed evenly between all organs and tissues. In the event of a short-term disruption of blood flow, oxygen flows primarily to vital organs - the heart and brain, and other body systems experience its deficiency. If it continues, the blood supplies oxygen primarily to the heart, and the brain tissue gradually begins to die. The longer the condition continues oxygen starvation brain, the more severe the consequences for the child.

Circulatory deficiency in a newborn baby occurs in the following situations:

1. Unfavorable pregnancy
   – any acute and chronic illnesses of the mother, including hormonal disorders;
   – preeclampsia, eclampsia and gestosis;
   – detachment and damage to the placenta, pathology of the umbilical cord;
   – lack of water;
   - bad habits;
   – use of prohibited medicines;
   – age less than 18 and over 35 years.
2. Complications during childbirth
   – childbirth before 37 or after 42 weeks;
   – prolonged/rapid labor;
   – long waterless period;
   – large blood loss;
   – umbilical cord entanglement;
   – artificial stimulation of labor.
3. Other factors
   – hereditary predisposition to neurological disorders;
   – some pathologies of the cardiovascular system in the fetus.

The risk of cerebral ischemia increases in the case of long-term drug treatment for infertility. According to statistics, in almost two thirds of infants the first signs of brain pathology are noted even during the period intrauterine development, and a small proportion of cases develop after childbirth.

Types of pathology

Cerebral ischemia in newborns is different to varying degrees gravity:

1. The first (mild) degree is characterized slight increase muscle tone and increased tendon reflexes. During the first 3–7 days after birth, the baby experiences increased drowsiness, lethargy, or excessive agitation. In some cases, there is a slight tremor of the chin and limbs, dysfunction gastrointestinal tract, profuse regurgitation. Usually the symptoms go away on their own and do not pose a threat to the health and development of the child.
2. The second (medium) degree is accompanied by decreased muscle tone and the extinction of some innate reflexes. Convulsions and sudden short-term holds of breath occur. If therapy is started in a timely manner, the prognosis is generally favorable, up to complete cure.
3. The third (severe) degree is expressed in the absence of the required reflexes, decreased tone, severe convulsions of the body and limbs, hydrocephalus of the brain, organs of hearing and vision. In most cases, the child cannot breathe on his own and does not respond to external stimuli.

Diagnosis of ischemia

Typically, cerebral ischemia in a newborn is diagnosed in the first hours after birth. The disease is confirmed by testing innate reflexes, and its severe course usually detected by the naked eye. Serious disorders and severe severity are indicated by low Apgar scores within 5 minutes after birth (from 0 to 3) and visible symptoms disturbances in the functioning of the brain and other internal organs.

In addition to external examination, in order to confirm the disease and determine the severity, the following research methods are used:

• general blood test with assessment of coagulation and quantification electrolytes and dissolved gases (with hypoxia, high content carbon dioxide in the child's body);
• magnetic resonance imaging, which allows you to assess the degree of damage to brain and central nervous tissue;
• Ultrasound of the head, which helps to exclude the presence of edema and vascular damage;
• electroencephalography – reveals hidden convulsions.

Consequences

When talking about the prognosis of the disease, one should take into account its severity, timeliness and success of prescribed therapy. Cerebral ischemia of the 1st degree in a newborn, as a rule, ends safely. Long-term consequences include the following:

• hyperactivity;
• increased excitability;
• irritability, tearfulness;
• difficulty falling asleep.

Cerebral ischemia of the 2nd degree is characterized by more severe complications: headaches, sleep disturbances, nervous disorders. Such children are much more difficult to adapt to their environment, develop more slowly than their peers and experience learning difficulties.

Severe cerebral ischemia is fatal in almost half of the cases. Complications are common among surviving children: cerebral palsy, epilepsy, autism, mental retardation. Only 10% of children with a complicated form of the disease, even with timely medical care, do not have significant complications.

Experts note that if within one month the child’s symptoms do not subside or increase, brain activity is not restored and the disease has an unfavorable prognosis.

Treatment

The primary goal of therapy is to restore normal cerebral circulation and preventing the development of irreversible complications. Specific treatment does not exist, in each case an individual approach is applied depending on the characteristics of the pathology and the presence of concomitant diseases.

At mild degree dysfunction, the standard treatment is to prescribe a general massage that stimulates normal blood flow. Therapy for grade 2 ischemia in newborns, in addition to massage, usually requires the use of drug therapy that restores normal work vital organs. Treatment for severe disease includes the following:

• prescribing medications to prevent the development of seizures and medications to support the child’s heart function;
• artificial ventilation;
• hypothermia to preserve brain tissue;
• special massage and exercises for cerebral palsy.

Rehabilitation takes from 2–3 months to several years. Children who have suffered from moderate to severe illness are registered with a neurologist. They are prescribed physical therapy, physiotherapy, and swimming in the pool. If necessary, children are prescribed additional course therapy with nootropics, vascular drugs, herbs, homeopathic remedies. and disorders of the musculoskeletal system, wearing special restraint devices is prescribed: corsets, splints, orthopedic shoes. In some situations, it is necessary to conduct classes with speech therapists and defectologists.

Cerebral ischemia in newborns is preventable. In order to minimize the risk of serious pathology in the child, a pregnant woman should follow the following recommendations:

• comply with the instructions of the supervising doctor;
• prevent exacerbation of chronic diseases;
• take tests and undergo research on time;
• don't neglect physical exercise, walk more;
• eat well and get enough sleep;
• lead healthy image life.

If it was not possible to avoid the problem, it is important to take measures to eliminate it as soon as possible. It is much more effective to eliminate the disease itself at an early stage than to treat its consequences.

Ischemia in a newborn (cerebral ischemia) develops when there is insufficient supply of oxygenated blood to the baby’s brain. Nervous tissue reacts extremely sensitively to oxygen starvation, so disruption of the blood supply quickly leads to the development metabolic disorders and brain damage.

In the first stages, perinatal hypoxia (oxygen starvation) promotes the redistribution of blood flow between organs to maintain sufficient cerebral blood supply.

However, prolonged deficiency of O2 in the blood (hypoxemia) and progressive hypercapnia (increased concentration of carbon dioxide in the blood) contribute to impaired vascular autoregulation and the development of cerebral hypoperfusion (decreased blood flow in the cerebral vessels).

Important. Hypoperfusion is main reason severe cerebral ischemia in newborns, accompanied by the development of HIE (hypoxic-ischemic encephalopathies).

For reference. Cerebral hypoperfusion is diagnosed when the rate of cerebral blood flow decreases below 10 ml per 100 g of tissue per minute. As a rule, such changes are specific to premature babies.

A decrease in SMC leads to damage to endothelial cells and a sharp narrowing of the capillaries of the brain. As a result of this, the resistance of the vascular bed to blood flow increases, contributing to:

• disruption of autoregulation of blood supply;
• significant worsening of ischemia in the newborn;
• development of hypoxic-ischemic encephalopathy (HIE).

The term HIE implies the presence acute injury GM, as a result of hypoxia (oxygen starvation) and ischemia (lack of blood supply). That is, the term cerebral ischemia in newborns is considered to have a broader meaning, including both primary O2 deficiency and impaired cerebral perfusion.

Neonatal cerebral ischemia also includes ischemia caused by blue-type congenital heart defects (Ebstein's anomaly).

For reference. HIE involves a variant of ischemia with pre-existing damage to brain cells. Therefore, the term hypoxic-ischemic encephalopathy is used more often in clinical practice.

The severity of damage to brain structures is determined by the duration and severity of hypoxia and ischemia, as well as primary cause oxygen starvation of tissues.

Cerebral ischemia in newborns. Causes

In the vast majority of cases, ischemia in a newborn is perinatal, that is, it occurs in the womb. Less commonly, it is a consequence of asphyxia during childbirth.

Cerebral ischemia is more typical for premature babies, since their vascular system is not yet fully formed. In full-term babies this diagnosis is rare.

Cerebral ischemia in newborns may be associated with:

• maternal pathologies leading to fetoplacental insufficiency:
  • anemia,
  • diabetes,
  • coagulopathies accompanied by a tendency to thrombosis,
  • thyroid disease (thyroid gland),
  • kidney pathologies,
  • endometriosis,
  • myometrial hypoplasia,
  • hypovolemia,
  • hypoxemia,
  • Congenital heart defect,
  • low or high blood pressure,
  • late gestosis, including preeclampsia and eclampsia;
• intrauterine infections of the fetus;
• infection or infection during childbirth;
• umbilical cord compression (during childbirth or due to true umbilical cord knots) and fetal suffocation;
• membrane attachment of the umbilical cord;
• thrombosis of umbilical cord vessels or large umbilical cord cysts;
• umbilical cord prolapse;
• acute placental insufficiency;
• placental abruption;
• low placenta previa;
• bleeding during childbirth;
• asphyxia due to excessive contractions;
• injuries during childbirth, including those due to a narrow pelvis;
• uterine rupture.

Risk factors for ischemia in a newborn are divided into antenatal and intrapartum.

Antenatal factors include:

• mother's age is over 35 years old,
• premature and prolonged labor,
• non-compliance by the mother with the principles of a healthy lifestyle (smoking, drinking alcohol or taking drugs during pregnancy),
• refusal to see a doctor, as well as the presence of:
  • endocrine diseases (especially diabetes);
  • long-term toxicosis;
  • threats of abortion;
  • multiple pregnancy;
  • infectious and inflammatory diseases (especially in the second and third trimester of pregnancy);
  • autoimmune pathologies.

Intrapartum risk factors for cerebral ischemia in newborns include:

• acute maternal hypoxia during childbirth (development of shock, decompensation of chronic somatic pathologies, etc.);
• abnormal presentation of the fetus;
• use of obstetric aids (forceps, vacuum extractors);
• disturbance of fetoplacental circulation due to eclampsia, tight entanglement of the umbilical cord, short umbilical cord, true umbilical cord nodes, umbilical cord prolapse, etc.;
• uterine rupture;
• emergency caesarean section;
• discoordinated labor;
• rapid, rapid or prolonged labor.

Ischemia in a newborn. Pathogenesis of development

Compensatory vasopressor factors contribute to:

• increase in tone peripheral vessels fruit,
• the occurrence of tachycardia,
• increase in IOC (minute blood volume),
• increase in reflex motor activity.

Further progression of hypoxia contributes to:

• exhaustion compensatory mechanisms,
• decrease in heart rate (development of bradycardia),
• inhibition of motor activity,
• loss of ability for cerebral autoregulation,
• worsening cerebral hypoperfusion,
• as a result - ischemia of the newborn.

Attention! The loss of the ability to autoregulate in premature babies occurs much faster than in full-term babies.

Violation of compensatory mechanisms for maintaining blood flow leads to the fact that the brain becomes extremely vulnerable to fluctuations in blood pressure. This significantly increases the risk of severe intraventricular hemorrhage (IVH).

Intrauterine ischemia can lead to:

• intrauterine growth retardation,
• fading pregnancy,
• I'll miscarry.

It should also be noted that severe ischemia in a newborn contributes to the disruption of the rheological properties of blood and an increase in its viscosity. Therefore, in children with severe hypoxia and asphyxia, pronounced hypercoagulation is observed on the first day.

Normally, all newborns have moderate thrombogenic activity of the system, but on the third day it decreases. In premature babies with ischemia, hypercoagulation is more pronounced and lasts longer.

Severe ischemia in a newborn, accompanied by severe hypercoagulation, may be complicated by disseminated intravascular coagulation.

Attention! Severe hypoxia and ischemia promote accelerated anaerobic metabolism of glucose, leading to a sharp decrease in the synthesis of adenosine triphosphate (ATP). This leads to the opening of sodium, calcium and potassium channels, the flow of water and electrolytes into the neurons of the brain, causing early cytotoxic cerebral edema.

Pathogenesis scheme

The main symptoms of ischemia in a newborn

Reflexes are impaired, muscle tone is reduced. There is tremor of the chin and limbs, frequent shudders. Seizures may develop.

Oculomotor symptoms (nystagmus, exophthalmos), pulsation of the large fontanel may appear.

Characterized by periodic short-term pauses in breathing (apnea).

Important. IN severe cases, depression of consciousness is possible, up to the development of coma.

Severity of ischemia

Cerebral ischemia in a newborn, grade 1 (mild), is characterized by reversible disorders. It manifests itself:

• slight increase in muscle tone,
• revitalization of tendon reflexes,
• weak, sluggish sucking,
• refusal to eat,
• frequent regurgitation,
• anxiety,
• We cry constantly.

Sometimes lethargy and drowsiness may occur (more typical for premature babies).

Cerebral ischemia in a newborn, stage 1. is not accompanied by profound neurological disorders and is distinguished by the fact that all symptoms normalize within 3-4 days after birth.

Cerebral ischemia in a newborn of the 2nd degree (moderate) is accompanied by a sharp decrease in muscle tone, lethargy and drowsiness, even to a state of lethargy. There is severe muscle hypotonia and a marked decrease in tendon reflexes.

The grasping, sucking, and Moro reflexes may be completely absent or extremely depressed.

The Moro reflex is tested by passively, suddenly stretching the baby's legs or by suddenly hitting the pillow with the baby's head on it. At the same time, in the first phase of the reflex, the child spreads his arms, half-bent at the elbows, and spreads his fingers. In the second phase of the reflex, the arms return to their original position.

Cerebral ischemia in a newborn, stage 2. also accompanied by periods of short-term stops in breathing (apnea), convulsions, trembling of the limbs and pronounced tremor of the chin.

If the severity of HIE symptoms decreases within two weeks and complete neurological recovery occurs, the prognosis is favorable.

Important. An unfavorable prognosis is supported by repeated deterioration that developed against the background of normalization of symptoms.

Cerebral ischemia in a newborn of the 3rd degree is characterized by severe depression of consciousness, the development of stupor or coma. There may be a complete lack of reaction to external stimuli (including physical ones). There are frequent apneas, irregular breathing, and the baby requires breathing support.

Tendon reflexes are absent, muscle tone is sharply reduced. Also characteristic is the absence of newborn reflexes (Moro, sucking, grasping, swallowing).

Oculomotor dysfunctions are noted due to damage to the cranial nerves (cranial nerves). Characterized by the presence of nystagmus, strabismus, exophthalmos, there are no friendly movements of the eyeballs.

The baby’s pupils do not react to light at all, or the reaction is weak.

Generalized seizures that are resistant to anticonvulsant therapy may occur.

Complications

• cerebral edema,
• severe heart rhythm disturbances,
• sudden increases in blood pressure,
• bleeding in the brain,
• development of DIC syndrome and multiple organ failure.

With prolonged intrauterine ischemia, intrauterine growth retardation is observed.

In the future, depending on the severity of damage to the brain, the following are possible:

• developmental delay (physical and mental),
• immune disorders (frequent infections),
• endocrine pathologies (high risk of developing diabetes mellitus),
• epilepsy.

Diagnosis of cerebral ischemia in newborns

The diagnosis of HIE is made on the basis of a physical examination, Apgar score, assessment of neurological status, as well as the functions of the respiratory and cardiovascular systems.

Also carried out:

• angiography of neck and brain vessels;
• magnetic resonance imaging and angiography;
• duplex scanning of brain vessels;
• electroencephalography (standard and amplitude-integrated);
• electrocardiography and ECHO-CG;
• transfontanelle ultrasonography GM (neurosonography);
• general and biochemical tests blood;
• blood pressure control;
• blood gases;
• examination by a neurologist, ophthalmologist, neurosurgeon and cardiologist.

Treatment

Therapy for children with HIE is aimed at:

• security optimal conditions for their further nursing;
• correction of disorders of the respiratory and cardiovascular systems; elimination of hemodynamic disorders;
• normalization of blood gas composition, elimination of electrolyte disturbances;
• preventing the development and eliminating existing seizures.

Further treatment is aimed at correcting developed complications and consequences. Can be assigned:

• exercise therapy courses, massage,
• drugs that normalize cerebral circulation (piracetam),
• vitamin therapy (group B),
• use of levocarnitine (Elcar).

Prognosis and consequences of cerebral ischemia in a newborn

The prognosis of the disease depends on the severity of brain damage. For mild ischemia, clinical symptoms subsides within three to four days, no significant complications are observed. A slight lag in weight gain and increased nervous excitability are possible.

For ischemia moderate severity, the further prognosis depends on whether the symptoms disappear within two weeks. In case of regression of symptoms, the further prognosis is favorable. If the symptoms do not disappear or continue to increase, as well as with severe ischemia, the prognosis is unfavorable.

In the future, developmental delays, mental retardation, cerebral palsy, autism, epilepsy are possible.

For reference. Prevention of the development of HIE in a newborn includes regular and careful monitoring of the baby’s condition, adherence by the pregnant woman to the principles of a healthy lifestyle (stop smoking, walks). fresh air, good nutrition etc.)

Cerebral ischemia is a disease characterized by insufficient oxygen supply to the brain along with blood due to blockage of one or more blood vessels. Because of this, the newborn's brain cannot develop normally. In case of untimely medical intervention Bleeding may occur in the tissues and pathological changes may develop. It is timeliness that plays an important role in the treatment of cerebral ischemia in newborns.

Signs and symptoms of cerebral ischemia in newborns

The disease manifests itself with obvious symptoms that attract attention.

• The child is easily excitable, cries for no reason, sleeps poorly, shudders, and has tremors.
• Muscle tone is reduced, the baby moves little, has difficulty sucking and swallowing.
• The fontanel is enlarged, intracranial pressure is increased due to the fact that fluid accumulates in the brain.
• Convulsions, twitching of the limbs and head, as well as comatose states with loss of coordination of movements and consciousness occur.
• The newborn's skin takes on a marbled hue.
• The functioning of the gastrointestinal tract is disrupted - bloating, constipation, and diarrhea are observed.

How does cerebral ischemia occur?

In 70% of cases, ischemia occurs in the fetus in the womb and is associated with the formation of a blood clot in one of the vessels supplying the brain, or with insufficient development of the vessel. Most often, the disease is diagnosed in premature babies whose vascular system is not yet fully formed.

As a result, an insufficient amount of blood enters the vital organ, and with it, oxygen. Delay in providing medical care leads to damage to larger areas of the brain, cerebral hemorrhage and other serious consequences.

Causes

In the vast majority of cases, the causes of cerebral ischemia in newborns are various violations gestation in last weeks, as well as in unusual situations during childbirth.

• Detachment of the placenta or disruption of blood flow in it.
• Compression of the umbilical cord, suffocation of the fetus.
• Congenital defects hearts.
• Circulatory problems.
• Intrauterine hypoxia.
• Infection during childbirth.
• Openness of the ductus arteriosus.
• Acute placental insufficiency.

Risk factors

Various vascular and neurological pathologies, problems with blood pressure(especially hereditary) in the mother should alert the doctor who is managing the pregnancy. Also, risk factors for cerebral ischemia in a child are:

• mother's age is more than 35 years;
• endocrine diseases;
• premature, prolonged labor;
• multiple pregnancy;
• late toxicosis;
• failure of the mother to follow a healthy lifestyle;
• exacerbation of chronic or acute diseases in the mother during pregnancy.

Diagnostics

The disease is usually diagnosed within the first few hours.

The presence of pathology is indicated by deviations in reflex testing, general blood test. Usually the analysis shows increased content carbon dioxide in the body.

If obvious symptoms of a serious illness are detected, magnetic resonance imaging, and electroencephalography, revealing hidden convulsions and other abnormalities in the functioning of the brain.

Degrees of ischemia

Cerebral ischemia grade 1

Mild form, characterized by the presence of weak pronounced signs in the first 3-5 days after birth. Basically, it manifests itself in the form of:

• nervous excitement or depression;
• slight muscle tone;
• strengthening tendon reflexes.

The child is monitored by a doctor, and the symptoms gradually disappear without complications.

Cerebral ischemia grade 2

A dangerous form of the disease. It is characterized by:

• severe apnea (stopping breathing during sleep);
• decreased grasping and sucking reflexes;
• weak muscle tone;
• increase in head shape due to fluid accumulation;
• lack of coordination;
• loss of consciousness;
• changes in skin color.

Most often, grade 2 ischemia manifests itself in the first day of a newborn’s life, and symptoms can be observed for 2-4 weeks. At this time, the child is carefully monitored by doctors, and he undergoes a course of therapy. If necessary, carry out surgery to remove a blood clot.

Cerebral ischemia grade 3

The most severe form, in which:

• the baby has no reflexes;
• the child falls into a coma;
• heart rhythm is disrupted;
• blood pressure rises sharply;
• there are problems with independent breathing;
• strabismus is observed.

An experienced doctor can already determine the presence of signs and symptoms of grade 3 cerebral ischemia in the first 5 minutes of a newborn’s life. In this case, the child is sent to intensive care and, if necessary, connected to a ventilator.

Treatment of cerebral ischemia in newborns

The goal of treatment is to restore normal blood circulation in the brain tissues and prevent pathological changes and eliminate the consequences of ischemia. For stage 1 disease, treatment usually involves prescribing massage to improve blood circulation.

For diseases of the 2nd and 3rd degrees, drug therapy is used and surgical intervention to remove a blood clot in a vessel and restore the structure of the vascular bed. In difficult cases, the baby undergoes a rehabilitation course of intensive therapy.

Prognosis and consequences of cerebral ischemia

It is much more effective to eliminate ischemia itself after the birth of a baby than to treat its complications. Among the consequences of cerebral ischemia of the 2nd degree:

• sleep disorders;
• headache;
• irritability;
• isolation;
• physical inactivity.
• Stage 3 disease has severe consequences:
• attention deficit disorder;
• mental retardation;
• Graefe's symptom, etc.

If all actions to eliminate ischemia were carried out by doctors in a timely manner, then the symptoms disappear during the rehabilitation period, which usually lasts 6-12 months.

The birth of a child is one of the most joyful events in a person’s life. But, unfortunately, sometimes the joy is overshadowed by the fact that the baby enters the world with diseases acquired before birth. One of possible pathologies called cerebral ischemia. This sonorous and incomprehensible phrase literally means insufficient blood supply to the brain.

The consequences of cerebral ischemia for a child can be very serious. However, parents should not panic if the pediatrician made this diagnosis immediately after birth. The disease can manifest itself in different ways. Often this condition in infants goes away without treatment.

Cerebral ischemia develops not only in the youngest, but also in the oldest. Based on age gradation, the disease is divided into the following types:

• congenital – CI of newborns;
• acute;
• chronic.

Congenital cerebral ischemia

Cerebral ischemia in newborns in most cases begins at later months pregnancy and directly during childbirth. Reduced blood supply (ischemia) to the brain leads to insufficient oxygen supply (hypoxia) to the tissues. Cerebral ischemia in a newborn is classified into 3 degrees, each of which has its own signs and consequences for the baby.

Cerebral ischemia grade 1 in a newborn

The mildest form of pathology. Clinical picture lubricated. Experienced pediatricians it is determined by a complex of three characteristics.

1. The baby is experiencing changes in behavior. The child is worried, often cries, despite drowsiness and lethargy, and does not sleep well.
2. There is some tension in the muscles.
3. Tendon reflexes are higher than normal.

Premature babies have two latest sign look different: muscle tone and tendon reflexes, on the contrary, are reduced.

There is no need to treat the baby; a restorative massage is usually enough. It is performed to relax the muscles, improve blood flow and oxygen supply to the brain. The room where the newborn is located must have enough oxygen, so it is recommended to ventilate it more often.

The prognosis is positive. The baby develops, keeping up with his peers.

Cerebral ischemia grade 2 in a newborn

The future for babies doesn't look so bright. Mental abnormalities are observed in almost half of the cases. 20% suffer from increased intracranial pressure. Cerebral ischemia grade 2 in a newborn has the following symptoms:

• breathing disorders during sleep;
• muscle weakness;
• weakened grasping and sucking reflex;
• pale skin with a bluish tint or a red-bluish pattern;
• possible enlargement of the head (hydrocephalic syndrome).

Treatment of cerebral ischemia of the 2nd degree in newborns is combined. Drugs are used to dilate blood vessels, against convulsions, reduce blood clotting, remove excess fluid in hydrocephalus, electrophoresis and massage. If necessary, surgical intervention is performed

Cerebral ischemia grade 3 in a newborn

A severe form of pathology in which the important functions brain In most cases, the following manifestations are recorded.

1. There is no reaction to external stimuli.
2. The child is unable to breathe or eat on his own.
3. Involuntary convulsions are observed.
4. Intracranial pressure is sharply increased.
5. Hydrocephalic syndrome is present.

The newborn has no chance of survival without emergency medical care. The baby is connected to the device artificial respiration. Surgically blood clots are removed. A shunt is installed to remove cerebrospinal fluid in the ventricles of the brain. Vasodilators, diuretics, and anticoagulants are prescribed.

However, immediate health care often unable to save the life of a newborn. In the third degree, the consequences of cerebral ischemia in newborns are extremely severe. Every second child does not survive. About 80% of survivors suffer from autism and childhood cerebral palsy, another 10% have minor psychical deviations. And only one in ten subsequently develops normally.

Causes

A disruption of the blood supply to the brain and the supply of oxygen to its cells occurs when one or more of the following factors are present:

• pathology of placental circulation;
• prematurity;
• Congenital heart defect;
• too fast or long labor;
• damage to the umbilical cord during childbirth;
• introduced infections;
• bleeding caused by various injuries.

Prevention

Since treatment of cerebral ischemia in newborns does not produce positive results in all cases, disease prevention in the expectant mother becomes important. Kit preventive measures simple

1. Lead a healthy lifestyle: do not smoke, do not drink alcohol, do not follow a strict diet, but at the same time do not overeat, do regular exercise.
2. Visit antenatal clinic, treat infectious and other diseases.

Chronic cerebral ischemia

Chronic cerebral ischemia develops in older and older people. As with congenital cerebral ischemia, 3 degrees of the disease are classified.

Symptoms

Chronic cerebral ischemia manifests itself depending on the stage of development.

1. The first stage of the disease is signaled by the fact that the patient begins to quickly get tired under mental stress, and he has mild problems with memory, hearing, and vision. Sleep disturbances, headaches, and general weakness are noted. Mood changes quickly without significant reasons. Most people attribute these signs not to illness, but to age.
2. Chronic cerebral ischemia of the 2nd degree is characterized by increasing problems. In particular, there is a sharp decline memory and performance. Dizziness occurs even with the simplest movements. Constant weakness persists, sometimes cramps occur. Negative changes occur in personal terms.
3. Chronic cerebral ischemia at the final stage leads to organic brain damage and serious violations brain activity. The patient loses the ability not only to perform intellectual work, but also to perform simple actions, for example, self-care. Dementia develops. Either minor strokes or major strokes occur. Due to impaired cerebral circulation, failure of the left ventricle of the heart may develop. And with acute left ventricular failure, the development of cardiac asthma and pulmonary edema is very likely.

Causes

There are two causes of chronic cerebral ischemia:

• atherosclerotic lesions of the arteries supplying the brain;
• arterial hypertension.

Atherosclerosis of the coronary and cerebral arteries is caused by cholesterol deposits on the walls of blood vessels. Cholesterol plaques disrupt normal blood flow in the body. Arterial hypertension is characterized by persistent high blood pressure. Both diseases are common, especially among older people. Leads to them genetic predisposition, and unhealthy lifestyle.

Both diseases have extremely negative effects on the brain. For example, they can cause cerebrovascular insufficiency, when focal lesions of small vessels occur in the brain.

Treatment and prevention

Treatment of chronic coronary disease brain combined. Drug treatment is mainly practiced to expand the lumen of the arteries, improve blood supply to the brain and slow down the development of the disease (pentoxifylline, nimodipine, piracetam, etc.). Prevention is also aimed at this (giving up bad habits, healthy eating, moderate physical activity). With progressive damage to the main arteries of the head, surgical intervention is used.

Causes and treatment of chronic ischemic cerebral disease

Chronic cerebral ischemia occurs due to blockage of the cerebral vessels of the brain or their long-term narrowing. The result is gradual damage to brain tissue, which leads to microinfarctions, and also causes the formation of significant territorial brain infarctions.

• Causes
• Symptoms
• Stages of development
• Diagnostics
• Features of treatment
• Forecasts

As statistical data show, the relevance of chronic cerebral ischemia occurs in 70 cases out of 100. As for appropriate preventive measures and proper treatment, they directly depend on the immediate activity of the patients. Thus, it is mental disorders and central nervous system, have a direct impact on ability to work.

The most common causes of this disease are diabetes mellitus, myocardial disease, and atherosclerotic lesions of the vessel walls. Among other things, factors such as problems with microcirculation, which most often appear as a result of an increase in blood viscosity, should not be ignored. They also cause blockage small arteries and the occurrence of blood clots.

Causes

As modern medical practice shows, chronic cerebral ischemia can be caused not only by primary, but also by secondary causes. Let's look at them in more detail:

• With improper development of the arteries of the brain, as well as the vessels involved in big circle blood circulation As a rule, such anomalies do not have pronounced symptoms and begin to actively progress at the moment when any significant changes occur in the vascular system, and appropriate treatment is not carried out;
• The presence of pathology in the venous system. These can be all kinds of thrombosis and thrombophlebitis;
• Diseases of the spine that cause disturbances in the blood circulation of the arteries and their untimely treatment. Such diseases include hernia intervertebral discs, osteochondrosis and others;
• Appearance in circulatory system And internal organs amyloid (insoluble protein);
• If you have any blood disease.

Symptoms

How timely chronic cerebral ischemia is detected and prescribed correct treatment, the consequences directly depend. It is for this reason that you should immediately pay attention to the appearance of the following symptoms:

• recurrent or constant headaches;
• feeling of heaviness in the head;
• periodic dizziness;
• decreased attention, which may gradually progress;
• memory deterioration with subsequent progression;
• the appearance of problems with sleep;
• the appearance of disturbances in coordination of movements, especially when walking;
• emergence of emotional instability and instability.

Essentially, the weaker the blood supply to brain neurons becomes, the more cerebral ischemia progresses, leading to the development of heart attacks.

Stages of development

Depending on the symptoms and various clinical signs, we can distinguish 3 main stages of the disease:

1. The initial (1st) stage is accompanied by headaches, memory loss, periodic dizziness, partial sleep disturbances, emotional instability, as well as a feeling of weakness throughout the body, without any neurological symptoms;
2. Subcompensation (2nd stage). Its main features are the progression of symptoms characteristic of stage 1, as well as a gradual change in personality. An apathetic attitude towards most events arises, depressive state, the range of interests sharply decreases. Among other things, mild impairment develops, oral automatic reflexes deteriorate and motor coordination disorders appear;
3. Decompensation (stage 3). It is characterized by severe disorders of the nervous system caused by multiple heart attacks, severe impairment of motor coordination, psychoorganic and other syndromes that were not characteristic of the 1st and 2nd stages. The patient begins to gradually develop vascular dementia(sharp decline in intelligence level, disruption of social adaptation).

Diagnostics

In most cases, chronic cerebral ischemia can be diagnosed using a history of the disease itself and its careful analysis. Neurological and neuropsychological symptoms, as well as various cardiological studies (ECG, EchoCG and others) are of no small importance.

MRI of the brain on days 1, 3 and 28 after stroke

They will allow you to install the real reason progression of the disease. Among other things, it is recommended to use laboratory methods diagnostics necessary to exclude or confirm somatic pathology.

For a full examination of brain tissue, it is necessary to do an MRI or CT scan, an ultrasound scan, or other specialized research.

Among other things, you should pay special attention to the amount of sugar, cholesterol and other substances in the blood. After all tests and studies, appropriate treatment is prescribed.

Patients who have the 1st, or, in other words, initial stage diseases, in most cases, suffer from periodic headaches, which over time can intensify and occur more often. Among other things, there is often noise and heaviness in the head.

Sleep problems appear and memory deteriorates. A patient with stage 1 suffers from fatigue and increased weakness, becomes more irritable. From time to time, there may be disturbances in the coordination of movements and unstable emotional condition. Another symptom of stage 1 is a decrease in interest in learning, as well as bad memory to recent events.

Series of CT scans of the brain

The 2nd stage of the disease is characterized by a significant intensification and progression of symptoms that appear from time to time in the 1st stage. Memory deterioration becomes more obvious and can progress every day. It becomes more and more difficult for the patient to concentrate his attention on a particular action, and also gradually loses the ability to plan and control his actions.

At stage 2, personal and emotional disorders increasingly occur, a depressive state develops, and the ability to criticize decreases. As a rule, it is at the 2nd stage that adaptation in social and professional terms is disrupted. But, along with the above disorders, the patient retains the ability to care for himself independently.

This stage combines the symptoms of stages 1 and 2, which begin to progress sharply. It becomes more and more difficult for the patient to control his movements and control muscle contraction.

At this stage, frequent fainting and epileptic seizures. The person begins to lose interest in everything that is happening, and also becomes more inhibited. In most cases, patients completely lose the ability to self-care and become maladapted socially and in everyday life, which was not observed in stages 1 and 2.

Features of treatment

The main goal of treating chronic cerebral ischemia is to prevent the progression of various brain disorders, as well as to prevent possible small strokes and exacerbations, or, in other words, crises. Treatment of the disease is both therapeutic and primary preventive in nature. It includes the following steps:

• A gradual increase in physical activity, giving up alcohol and tobacco, as well as changing your diet, making correction possible arterial hypertension without the use of drugs. In some cases, medications are prescribed. This stage is very important for the 1st and 2nd stages of the disease;
• Constant monitoring of blood sugar and cholesterol levels. If necessary, assigned special diet. If there is no effect, correction is carried out with medication;
• Treatment of disorders and processes associated with somatic character and being accompanying;
• Prescription of drugs that have vasodilating effects. The effect of such treatment directly depends on how severely the brain is damaged. Otherwise, sensitivity to drugs is minimized or simply absent. In most cases, it is relevant for patients with 1st and 2nd degrees of the disease. Among other things, patients are prescribed medications to prevent the formation of blood clots;
• Appointment appointment medicines, aimed at enriching the brain with oxygen and restoring normal blood circulation, preventing seizures, as well as improving the properties and characteristics of blood.

Forecasts

All changes must be adjusted accordingly. Special attention should be given associated ailments, which often occur in severe forms.

If the 1st and 2nd stages of the disease, chronic cerebral ischemia is already over, and the disease is advanced, or, in other words, the patient sought help very late, this indicates that multiple micro-strokes and damage have already occurred in the brain. In such a situation, the prognosis will be extremely unfavorable. As a rule, the patient becomes disabled or dies.

Thanks to the achievements modern medicine Today, patients with chronic cerebral ischemia have the opportunity to promptly identify the disease and receive appropriate treatment. Unfortunately, such people are forced to be observed by specialists throughout their lives and from time to time undergo comprehensive examination and appropriate treatment. Ignoring all or even some of the recommendations can have fatal consequences and lead to a cerebral infarction.

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A disease in which the heart rate decreases is called sinus bradyarrhythmia. Pathology can appear at any age. Violation heart rate starts from sinus node. The main problem in diagnosing the disease is that in general the cardiovascular system appears healthy, and disorders are quite difficult to detect. Along with this, the body constantly suffers from hypoxia, which is caused by bradyarrhythmia.

Extensive medical section Cardiology is the study of pathological processes in the functioning of the cardiovascular system in adults and children.

Causes and mechanism of development

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