Principles of treatment of patients with injuries of the central nervous system. Traumatic lesions of the central nervous system. Structural features of the nervous system of a newborn

Traumatic injuries of the central nervous system are among the most difficult as they are difficult to diagnose and often cause death at a young age. Clinically, closed, open (Fig. 5.5) and combined craniocerebral injury are distinguished.

According to the localization of the lesion of the nervous system, they are divided into: traumatic brain injury (TBI), spinal cord injury (PSCI), peripheral nerve injury (ESRD).

There are three degrees of severity of TBI:

I. Light TBI (concussion, mild brain contusion).

II. TBI of moderate severity (moderate brain contusion, subacute and chronic compression of the brain).

III. Severe TBI (severe brain contusion, acute brain compression, diffuse axonal brain damage).

Biomechanism of TBI. The biomechanics of the destructive effect on brain tissues involves a complex of primary factors, the leading of which are: 1) a shock wave propagating from the point of contact of the traumatic agent to the head through the brain to the opposite pole with rapid pressure drops at the points of impact and counter-strike; resonant cavitation; impact effect of skull deformation, as well as hydrodynamic impact of cerebrospinal fluid (CSF) 2) movement and rotation of the massive cerebral hemispheres relative to the more fixed brain stem in acceleration-deceleration injury).

Closed craniocerebral injury (CTBI) - this is damage to the skull and brain, in which there are no violations of the integrity of the integument

Rice. 5.5.

head, or there are bruises and wounds of the soft tissues of the head without damage to the aponeurosis. CTBI also includes fractures of the bones of the cranial vault, which are not accompanied by injury to the adjacent soft tissues and aponeurosis. With CBI, various forms of brain damage can be observed: concussion, focal brain contusions of mild, moderate, severe degree, compression by intracranial hematomas, etc.

Diagnosis of CTBI is based on the identification of the following signs:

♦ The fact of a blow to the head or on the head in anamnesis.

♦ Visually determined damage to the soft tissues of the head, bones of the skull.

♦ Visually determined signs of a fracture of the base of the skull.

♦ Violation of consciousness and memory.

♦ Headache.

♦ Symptoms of damage to the cranial nerves.

♦ Signs of focal lesions of the brain.

♦ Stem symptoms.

♦ shell symptoms.

Brain concussion - the mildest, but most common type of closed craniocerebral injury. Patients with concussion account for approximately 75-80% of all hospitalized patients with TBI.

Concussions include such types of traumatic lesions in which there are no macroscopic foci of destruction of the medulla, but functional and dynamic syndromes are clinically manifested with a predominance of cerebral, vegetative symptoms in the absence or presence of mild scattered, short-lived, unstable microsymptoms of brain damage.

Etiology and pathogenesis. In the case of a closed TBI, the trigger mechanism is a mechanical force, which entails a chain of pathological reactions, among which the main ones are disorders of neurodynamics, blood circulation, liquorodynamics and metabolism. The main target of the post-traumatic process are cell membranes and changes in the synaptic apparatus of the brain. Of paramount importance in the case of a concussion is the pathology of metabolism, its regulatory mechanisms. Disorders of phosphorylation, lactic acidosis, an increase in the concentration of superoxide radicals induce the processes of cellular intoxication and secondary-conditioned structural changes.

In the case of mild TBI, there is a rapid recovery of metabolic processes in the cerebral hemispheres and disorders in the diencephalic-stem regions of the brain.

Clinical course Concussions of the brain are divided into three periods: acute, intermediate and remote.

Acute period- the period of time from the moment of injury to the stabilization of impaired functions of the brain, organs and systems. Lasts up to two weeks. In this period, an acute period is distinguished (the period of disturbed consciousness).

Interim period- from the stabilization of general cerebral, vegetative, focal, general functions disturbed due to trauma to their complete disappearance or partial recovery, which lasts up to 1-1.5 months.

remote period after a concussion, it begins after an intermediate one, lasts indefinitely and can manifest itself as residual effects in the form of migraine-like pain, paresis, convulsive seizures, etc.

A characteristic symptom of a concussion is a disorder of consciousness. They can manifest themselves in the following forms: clouded, twilight state, stupor, loss of consciousness. Concussion is characterized by disorders of consciousness that last from 1-2 to 20-30 minutes.

Quite often (20-25%), memory disorders are detected: retrograde and congrade amnesia. Vegetative disorders are also observed quite often - nausea, vomiting, dizziness, fever, chills, noise in the head, headache.

During an objective examination, horizontal nystagmus, sometimes divergent strabismus, flattening of the nasolabial fold, bradycardia or tachycardia, revival or inhibition of reflexes, Marinescu-Radovich's symptom are revealed. Meningeal symptoms may be mild. Any TBI, including concussion, is accompanied by an asthenoneurotic syndrome (general weakness, lethargy, irritability, fatigue, sleep disturbance, appetite, etc.).

Emergency care and principles of treatment. All patients with a preliminary diagnosis of concussion, which was established by BE (W) MD, must be hospitalized. Pre-hospital medical care consists in providing rest, according to the indications, the patient is transported with the imposition of a cervical collar (Fig. 5.6). Improvements in metabolic processes in the nervous tissue are achieved by intravenous administration of 20 ml 40 % glucose solution and 5-10 ml 5 % ascorbic acid solution. To normalize neurodynamic processes, a bromine-caffeine mixture (Pavlov's mixture) is prescribed.

Painkillers are used (analgin, baralgin, tramal, maxigan, etc.), desensitizing drugs (diphenhydramine, suprastin, tavegil), sedatives (sibazon, phenazepam) in medium therapeutic doses.

Dehydration mullions (25 % magnesium sulfate solution 10 ml intramuscularly, 2-4 ml 2% lasix solution, veroshpiron 50-100 mg, etc.) are effective, but their doses have certain features. In the case of a concussion, dehydration should be mild, as intracranial hypertension is usually not significant.

Energetic activation of brain activity is facilitated by the introduction of low doses of caffeine, vitamin therapy, ceraxon, piracetam, cerebrolysin, aminolon, etc.

Brain Contusion (BCM) characterized by focal macrostructural lesions of the medulla of varying degrees (hemorrhage, destruction), as well as subarachnoid hemorrhage, fractures of the bones of the vault and base of the skull. The frequency and severity of these manifestations largely correlates with the severity of the contusion. With TBI, edema and swelling of the brain are usually encountered, which can be local, cleansing, hemispheric, and generalized. With BGM, one or another change in the CSF-containing spaces (ventricular system, basal cisterns, convexital subarachnoid fissures) is observed, often a pronounced mass effect to one degree or another.

Clinically, there are 3 degrees of severity of MHM.

Minor brain injury clinically characterized by a loss of consciousness after an injury from a few to 15-20 minutes. When it is restored, complaints of headache, dizziness, nausea, etc. are typical. As a rule, retrograde, con-, anterograde amnesia, vomiting, rarely repeated, are observed. Vital functions are usually without pronounced disturbances. Moderate bradycardia or tachycardia may occur, sometimes arterial hypertension. Respiration and body temperature without significant deviations. Neurological symptoms are usually mild (clonic nystagmus, mild anisocoria, signs of pyramidal insufficiency, meningeal symptoms, etc.), mostly regressing by 2-3 weeks after TBI. With mild MHM, unlike concussion, fractures of the bones of the cranial vault and subarachnoid hemorrhage are possible. The stationary version of the diagnosis of such a patient delivered to BE (III) MD, namely, CT changes, is detected already in the first hours after TBI in the form of a low-density area (signs of local edema).

Moderate brain injury clinically characterized by loss of consciousness after an injury lasting from 15-20 minutes to several hours. Severe con, retro, anterograde amnesia. There may be repeated vomiting. There are mental disorders. Transient disorders of vital functions are possible: bradycardia or tachycardia, increased AT, tachypnea without disturbing the rhythm of breathing and patency of the tracheobronchial tree. Meningeal symptoms are often expressed. Stem symptoms are also noted: nystagmus, dissociation of meningeal symptoms, muscle tone and tendon reflexes along the axis of the body, bilateral pathological signs, etc. Focal symptoms are often observed due to the localization of brain contusion: pupillary and oculomotor disorders, paresis of the extremities, disorders of sensitivity, speech, etc. D. At the same time, on the basis of primary and secondary local examination, fractures of the bones of the vault and base of the skull, as well as significant subarachnoid hemorrhage, are diagnosed.

At the stage of early hospital care, CT scans in most cases reveal focal changes in the form of small high-density inclusions that are not compactly located in the hypodense area or a moderate homogeneous increase in density (which corresponds to small hemorrhages in the area of contusion or moderate hemorrhagic impregnation of the brain tissue without its gross destruction). In terms of observations with CT, only diagnostic areas of low density (local edema) are possible.

Severe brain injury clinically characterized by loss of consciousness after injury from several hours to several weeks. Often pronounced motor excitation. Severe threatening violations of vital functions are observed; stem neurological symptoms usually dominate (floating movements of the eyeballs, gaze paresis, multiple nystagmus, swallowing disorders, bilateral mydriasis or miosis, eye divergence along the vertical or horizontal axis, changing muscle tone, hormetonia, bilateral pathological foot signs, etc.), which in the first hours or days after TBI overlaps focal hemispheric symptoms. Paresis of the extremities (up to paralysis), subcortical disturbances in muscle tone, reflexes of oral automatism, etc. may appear. Generalized or focal epileptic seizures are sometimes observed. Focal symptoms regress slowly; frequent gross residual effects, primarily from the motor and mental spheres. Severe MHM is often accompanied by fractures of the vault and base of the skull, as well as massive subarachne - Far hemorrhages. Approximately in half of cases, severe MHM is accompanied by fractures of the vault and base of the skull.

With open TBI (HTBI) the integrity of the soft integuments of the head, including the aponeurosis and bones of the skull, is violated in conditions of brain damage.

There are impenetrable HFCT (with damage to the bones, but with the preservation of the integrity of the dura) and permeable (with damage to the bones, dura and brain).

The main diseases of the central nervous system in athletes are functional diseases, namely neuroses.

neuroses. Neurosis is a breakdown of higher nervous activity, which is based on an overstrain of the main nervous processes - excitation and inhibition (IP Pavlov). The reason for such a breakdown is acute or permanent mental trauma or mental overstrain. By these terms it is not necessary to understand any kind of shock (extremely strong negative emotions). So, mental overstrain can arise both as a result of strong and excessively frequent emotions caused, for example, by a series of responsible competitions, and as a result of monotonous training, requiring more and more internal efforts to continue them.

In other words, an etiological factor in the development of a neurosis can be any situation in which demands are made on the psyche for a sufficiently long time that exceed its reserves in relation to the strength and mobility of the main nervous processes. The simultaneous impact of several negative factors is especially unfavorable, for example, such as excessive sports stress, excitement and mental overload during exams, family and work conflicts, etc. If mental trauma occurs against the background of repetitive physical overstrain, intoxication from foci of chronic infection , malnutrition and malnutrition, abuse of nicotine and alcohol, then neuroses occur more often and more easily. There are the following main types of neurosis: neurasthenia, which, with appropriate negative influences, develops mainly in individuals with a balanced state of both signaling systems; psychasthenia, which under the same conditions develops in persons who have a predominance of the second signal system over the first (the so-called mental type, according to I.P. Pavlov), and hysteria, which, under the influence of adverse factors, develops mainly in persons who have the first the signal system prevails over the second (the so-called artistic type). There are also some types of neuroses that are not related to signaling systems: obsessive-compulsive disorder, fear neurosis, etc. As already mentioned, the state of overtraining, characterized primarily by a breakdown in higher nervous activity, is also a neurosis. The specific form of neurosis is determined by the individual characteristics of the athlete's psyche and the nature of the traumatic circumstances.

Athletes most often have to deal with neurasthenia and obsessive-compulsive disorder.

Neurasthenia (from the Greek neuron - nerve, asthenia - exhaustion). There are two forms of neurasthenia - hypersthenic and hyposthenic.

The hypersthenic form arises mainly due to the weakness of the process of active internal inhibition caused by its overvoltage. This primarily affects the patient's reactions to the environment - impatience, incontinence, anger, a tendency to tears, sleep disorders appear (it is difficult to fall asleep, sleep is superficial, with frequent interruptions, which causes drowsiness and a feeling of weakness during wakefulness). Not only mental, but also physical performance decreases, especially if it is associated with the performance of precise movements. For an athlete, this may be associated with a distortion of the technique of a complex exercise, which he previously knew well; Difficulties in mastering new technical skills that do not correspond to the athlete's qualifications.

In the hyposthenic form of neurasthenia, the manifestation of increased excitability is less pronounced and the clinical picture is dominated by weakness, exhaustion, lethargy.

Obsessional neurosis. It is characterized by various manifestations of obsession: the athlete is haunted by thoughts of inevitable failure in sports, school or work. Often there are unreasonable suspicions that he has some kind of serious illness, such as cancer (carcinophobia), etc. A feature of obsessive-compulsive states is the patient's ambivalent attitude towards his fears: on the one hand, he understands their groundlessness, on the other hand, he cannot overcome them .

The symptoms of neurosis described above are characteristic of a developed picture of the disease, which is relatively rarely observed in athletes. In them, it often manifests itself in more erased forms. However, neurosis, which is always a source of significant internal experiences and conflict situations in a sports team, should not be regarded as a mild illness.

In the prevention of neurosis in athletes, the correct dosage of physical and especially emotional stress is of great importance. Sports activity, which arouses interest, enthusiasm and enthusiasm, serves as an inexhaustible source of positive emotions that protect the nervous system from overstrain. On the contrary, monotonous workouts deplete the nervous system relatively quickly. A positive reaction on the part of the athlete is facilitated by a clear understanding of the specific tasks and goals facing him. However, when analyzing the causes of neurosis, one should not limit oneself to consideration only of conditions related to the field of sports: the cause of a neurosis manifested in the field of sports activity may be, for example, an unfavorable family or work environment.

In the treatment of neurosis, medications and physiotherapy are used. But often only one load reduction and,

most importantly, changing its character with the inclusion of outdoor activities give a good effect. In some cases, a break in training is necessary - usually for short periods (2-3 weeks).

To injuries of the central nervous system include damage to the brain and spinal cord.

Brain damage occurs with traumatic brain injury. It can be the result of blows inflicted on various parts of the skull, or falls on the head, as well as bruises on the head against surrounding objects.

Traumatic brain injury can be closed or open. Closed is called a craniocerebral injury, in which, regardless of whether the integument and soft tissues are damaged or not, the bones of the skull remain intact.

Traumatic brain injury is most common in boxing, cycling and motorcycling, football, hockey, skiing, but it is also observed in gymnastics, acrobatics, diving, athletics, etc.

Most skull injuries are accompanied by brain injuries, which are divided into concussion, brain contusion and brain compression. They can be isolated or combined with each other.

Any of these injuries causes more or less pronounced damage to the medulla, swelling and damage to nerve cells with a breakdown in their function, which manifests itself in vascular disorders (ruptures of capillaries, arteries and veins), sometimes in cerebral hemorrhage, leading to hypoxia, ischemia and necrosis its sections, in violations of the vestibular apparatus, brain stem and cortex.

The most characteristic symptom of a concussion is loss of consciousness. It can be very short - just a few seconds or last a long time - many hours and days. The longer the loss of consciousness, the more severe the degree of concussion (see below). Having regained consciousness, patients complain of heaviness in the head, dizziness, headache, nausea, weakness. They have sluggish and slow speech.

With more severe injuries, other symptoms of concussion are also determined: severe pallor, fixed gaze, dilated pupils and their lack of reaction to light, rare and shallow breathing, rare and weak filling of the pulse, sweat, vomiting and convulsions. In extremely severe cases of concussion, the victim, without regaining consciousness, may die from respiratory arrest due to damage to the medulla oblongata, in which, as is known, the respiratory center is located.

Very rarely, with concussions, mental disorders come to the fore: sharp excitement, confusion, hallucinations. These disorders usually resolve completely in a few days or weeks.

After a concussion, the so-called retrograde amnesia can be observed (the victim does not remember what happened to him before the injury), headaches, dizziness, vascular disorders can remain for a long time, manifested, in particular, in persistent arterial hypertension, heart rhythm disturbance, sweating, chilliness , and in the sphere of the psyche - in irritability, strong emotional excitability, memory impairment.

It is customary to distinguish between mild, moderate and severe degrees of concussion, depending on the duration of the loss of consciousness: in the first degree it lasts minutes, in the second - hours, and in the third - many days. The severity of other symptoms depends on the duration of the loss of consciousness.

All symptoms observed during a concussion are a consequence of circulatory disorders and molecular biochemical changes in the cells of the cerebral cortex and in the diencephalic stem centers, accompanied by inhibition in various parts of the central nervous system, and then a violation of the relationship between the cerebral cortex and subcortical formations. The manifestations of the latter include disorders of the function of stem and subcortical formations, the symptoms of which are nystagmus (oscillatory, involuntary movements of the eyeballs), respiratory disorders, difficulty swallowing, etc.

A brain contusion is a closed trauma to the skull, in which damage to the brain substance occurs. A blow to the head can result in both direct and indirect brain injury. Direct trauma means contusion of the brain in the area of application of force, for example, with a blow to the temple, contusion of the temporal lobe. Indirect trauma is a bruise of the brain in an area remote from the site of impact, for example, when hitting the lower jaw, a bruise of the brain in the region of the occipital bone. This is due to the fact that kinetic energy is transferred from the impact site to the skull, cerebrospinal fluid and brain, which is displaced away from the impact source and hits the inner surface of the skull bones. The resulting wave of cerebrospinal fluid in the ventricles of the brain can also damage the brain tissue in the area of their walls. Due to the displacement of the brain, ruptures of blood vessels can also occur. Then there is a hemorrhage, swelling of the brain and soft meninges and reflex vascular disorders.

A contusion of the brain, in addition to the symptoms characteristic of a concussion (but more pronounced), is characterized by the presence of signs of focal brain lesions in the form of paresis, paralysis, convulsions, sensitivity disorders on the side opposite to the bruise, and speech disorders. If a hemorrhage that occurs during a bruise is a consequence of damage to a large vessel, then a large hematoma is formed, which compresses certain parts of the brain, causing corresponding pathological changes in the body. The degree of brain disorders with brain contusion usually decreases significantly already in the first days, since they are based not only on the death of the nervous tissue, but also on some of its reversible changes (tissue edema, etc.). However, some of the disorders may remain forever. Such disorders are called residual.

With compression of the brain, a constant increase in the above symptoms is noted. At the time of injury, there may be symptoms similar to those of a mild concussion. However, a little later, headache, nausea, vomiting, and stupor begin to increase, which lead to loss of consciousness; paresis of the right or left side of the body occurs and increases, bradycardia, respiratory and circulatory failure appear.

A relatively favorable state in the time interval between the injury and the development of the symptoms described above is very characteristic of hematomas. Satisfactory state of health, which may be after the clarification of consciousness, sometimes serves as a reason for weakening the medical supervision of the victim. Symptoms of brain compression, which often lead to death, may appear several hours after the injury.

Traumatic brain injury in boxing requires special attention. If in other sports such an injury is an accident, an accident, then in boxing, the rules of the competition allow blows with a glove to the lower jaw, face, forehead and temples.

Traumatic brain injury includes knockout, knockdown and the state of "groggy" (knockdown standing) due to a blow to the head (boxing).

Most often in boxing practice, a knockout occurs when hitting the lower jaw. It causes dizziness, disorientation, falling and often loss of consciousness. The reason for the knockout in this case is a concussion of the brain, as well as otoliths of the vestibular apparatus, leading to irritation of the cerebellum and, in connection with this, to a loss of balance. Knockout with a blow to the temporal region occurs according to the mechanism of a typical concussion.

A certain traumatic effect on the brain is exerted by frequent blows to the head of boxers, which do not end in a knockout, knockdown or “groggy” state. Such blows can lead to organic changes in the cells of the brain and the blood vessels that feed it.

In most cases, loss of consciousness in boxers after a blow to the head is short-lived and does not cause any disorders in the function of the nervous system subsequently. However, even with a short-term loss of consciousness, more severe brain damage cannot be completely excluded: its bruises and the formation of a hematoma, followed by compression of the brain. There are cases when a boxer died a few hours after a knockout from compression of the brain by a gradually increasing hematoma.

When providing first aid for traumatic brain injuries, it is necessary to give the victim a position with a slightly raised head and put cold on his head, and in case of respiratory and circulatory disorders, use medications (cordiamin, caffeine, camphor, lobeline, etc.).

In all cases of brain damage, urgent hospitalization of the victims for a period of 2 weeks to 2 months is indicated. Transportation should be as gentle as possible. Examination of the victim and the appointment of therapeutic measures should be carried out by a neuropathologist or neurosurgeon. On the first day, careful monitoring of the victim is necessary (this is especially true for those who have received a knockout). With hematomas, in the case of an increase in the phenomena of compression of the brain, surgical intervention is performed.

Often, soon after a traumatic brain injury, especially a repeated one, athletes experience various post-traumatic disorders: headache, dizziness, increased fatigue, sleep disturbances, etc.

After a number of years (5-10-15 or more) after a traumatic brain injury, serious pathological changes in the brain may appear. This is the so-called post-traumatic encephalopathy syndrome, which can manifest itself in various forms. Especially often this brain damage occurs in boxers with great experience who have received a large number of blows to the head, knockouts and knockdowns (the so-called "boxing disease").

Encephalopathy can show up several years after boxing has stopped. Its signs are various symptoms of mental disorders and organic brain damage. Mental disorders at first can be expressed in the appearance of a boxer's state of euphoria (excitation, unnatural gaiety), replaced by apathy, lethargy. Then there is a gradual change in character: arrogance, a sense of superiority, then hot temper, arrogance, resentment and suspicion, and then memory impairment, a decrease in intelligence, up to dementia. To refer to this condition in psychiatry, there is a term "dementio pugilistica", which means "dementia from fisticuffs." Along with a mental disorder, various symptoms appear that indicate an organic brain lesion: movement disorders, trembling of various parts of the body, a mask-like face, increased muscle tone, speech disorders, paresis, etc. In these boxers, electroencephalography and pneumoencephalography revealed pronounced changes indicating for diffuse atrophy of the cerebral cortex. The reason for this, apparently, is repeated, even minor, concussions of the brain, accompanied by hemorrhages and subsequent cicatricial changes.

The resumption of sports after a traumatic brain injury is allowed only after a complete recovery, established on the basis of a thorough medical examination by a neuropathologist.

Adult boxers (masters of sports and sportsmen) after a knockout are allowed to train no earlier than a month later, older boys - no earlier than 4 months, younger ones - no earlier than 6 months. Adult boxers who have suffered two knockouts can start training no earlier than 3 months, and those who have suffered three knockouts - no earlier than a year after the last knockout (provided that there are no neurological symptoms).

To prevent knockouts in boxing, good technical training of a boxer, perfect mastery of defensive techniques, as well as clear refereeing and timely termination of the fight with a clear advantage of one of the boxers are of great importance.

To prevent brain injuries in all sports, it is necessary to keep a strict record and a thorough analysis of the causes of injuries of the central nervous system, strictly observe the timing of the start of training and participation in competitions. Training of boxers, hockey players, cyclists, motorcyclists, ski jumpers and skiers without protective helmets is not allowed.

Spinal cord injuries in athletes are observed in the form of concussions, bruises, compression, partial and complete ruptures of the substance of the brain or its membranes. The mechanisms of injury are as follows: overstretching of the spinal cord with excessive flexion and extension of the cervical spine; compression or transection of the spinal cord in case of fractures and dislocations of the cervical, thoracic or lumbar vertebrae (when hitting the head against the bottom of a pool, pond, when falling on the head, when performing various wrestling techniques); damage to the vessels of the spinal cord or its membranes when the spine hits the ground or the spine, for example, with a boot, a throwing projectile. Most often, spinal injuries occur during wrestling, gymnastics, acrobatics, weightlifting, equestrian sports, diving, skiing, football and hockey.

With a concussion of the spinal cord, there are no gross anatomical changes, there are only small hemorrhages and swelling of the tissues. Typical symptoms are a temporary violation of conduction, slight weakness of the muscles of the limbs, mild changes in sensitivity, dysfunction of the pelvic organs. These symptoms appear immediately after the injury, but quickly smooth out and disappear after 1-3 weeks.

With a spinal cord injury, hemorrhage, swelling and softening of individual sections of the nervous tissue occur, causing severe dysfunction. Immediately after the injury, the conduction of the spinal cord is disturbed, which persists for a long time. In the first days, a syndrome of complete violation of the conduction of the spinal cord is usually observed: paralysis below the level of contusion, anesthesia, urinary retention and defecation. Then complications can join: bedsores, pneumonia, etc. Subsequently, depending on the severity of the injury, in some cases there may be a complete restoration of the function of the spinal cord, in others, pathological changes remain for life.

Compression of the spinal cord may occur due to pressure on it of bone fragments in a fracture of the spine or as a result of an increase in subthecal hematoma during rupture of the vessels in this area. In the latter case, the compression progresses as the hematoma increases, which is characterized by an increase in motor and sensory disturbances below the level of injury, as well as an increase in disorders of the pelvic organs. Prolonged compression of the spinal cord can lead to irreversible changes.

With closed fractures and dislocations of the spine, there may be a partial or complete rupture of the spinal cord with a complete transverse conduction disorder, characterized by paralysis of both arms or both legs or all limbs. Below the injury site, all types of sensitivity are absent (for example, the victim does not even feel the passage of urine and feces), bedsores, swelling of the lower extremities, etc. develop rapidly.

First aid for spinal injuries is as follows: you must carefully put the victim on any hard flat surface face up and transport to a medical facility. In no case should you plant him or allow him to do it himself, as there is a danger of damage to the spinal cord.

Spinal cord injury in most cases to disability.

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

Causes of the development of CNS pathologies in newborns

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

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

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

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

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

Classification of pathologies of the central nervous system in newborns

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

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

cerebral ischemia. The nosological form of this pathology manifests itself in different degrees of severity of the course - cerebral ischemia of 1, 2 and 3 degrees of severity of the course. Clinical symptoms:

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

Intracranial hemorrhages of hypoxic origin. Nosological forms are diverse:

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

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

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

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

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

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

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

First of all, doctors consider transient metabolic disorders:

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

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

CNS lesions in infectious diseases

If during pregnancy a woman was diagnosed, or, then the likelihood of having a child with pathologies of the central nervous system increases significantly. There are some infectious diseases that can contribute to the development of problems in the work of the central nervous system after the birth of a child - streptococcal and staphylococcal infections, and others.

With lesions of the central nervous system of infectious etiology, the following symptoms will be revealed:

intracranial hypertension;
hydrocephalus;
focal disorders;
meningeal syndrome.

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

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

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

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

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

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

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

Very often, the acute period of the disease is accompanied by the development of hydrocephalic syndrome - parents may note a rapid increase in head circumference, protrusion of the fontanel, divergence of cranial sutures, anxiety of the newborn and unusual eye movements.

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

Recovery period

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

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

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

Outcome of the disease

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

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

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

Diagnostic measures

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

Methods of treatment and rehabilitation

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

The first stage of assistance

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

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

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

The third stage of assistance

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

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

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

protect the baby from harsh sounds and bright light;
create an optimal climate regime for the child - there should be no sudden changes in air temperature, high humidity or dry air;
protect the baby from infection as much as possible.

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

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

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

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

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

An organic lesion of the central nervous system (CNS) is a diagnosis that indicates that the human brain is in an unstable state and is considered defective.

As a result of such lesions in the brain, dystrophic disorders, destruction and or their necrosis occur. Organic damage is divided into several degrees of development. The first stage is inherent in most ordinary people, which is considered the norm. But the second and third require medical intervention.

Residual damage to the central nervous system is the same diagnosis that shows that the disease appeared and persisted in a person in the perinatal period. Most often it affects babies.

From this we can draw an obvious conclusion. Residual organic lesions of the central nervous system are disorders of the brain or spinal cord that were obtained during the period when the child is still in the womb (at least 154 days from the date of conception) or within a week after his birth.

Damage mechanism

One of all the "inconsistencies" of the disease is the fact that this type of disorder belongs to neuropathology, but its symptoms may belong to other branches of medicine.

Due to an external factor, the mother experiences failures in the formation of the phenotype of cells that are responsible for the usefulness of the list of functions of the central nervous system. As a result, there is a delay in the development of the fetus. It is this process that can become the last link on the path to CNS disorders.

Regarding the spinal cord (as it also enters the central nervous system), the corresponding lesions may appear as a result of improper obstetric care or inaccurate head rotations during the removal of the child.

Causes and risk factors

The perinatal period can also be called a "fragile period", because at this time, literally any adverse factor can cause the development of CNS defects in an infant or fetus.

For example, medical practice has cases that show that the following causes cause organic damage to the central nervous system:

In addition, the development of pathological changes can be influenced by the use of various dietary supplements or sports nutrition. Their composition can adversely affect a person with certain characteristics of the body.

Classification of CNS lesions

Perinatal damage to the central nervous system is divided into several types:

Hypoxic-ischemic. It is characterized by internal or postanal lesions of the GM. Appears as a result of the manifestation of chronic asphyxia. Simply put, the main cause of such a lesion is oxygen deficiency in the body of the fetus ().
traumatic. This is the type of damage that a newborn receives during childbirth.
Hypoxic-traumatic. This is a combination of oxygen deficiency with trauma to the spinal cord and cervical spine.
Hypoxic-hemorrhagic. Such damage is characterized by trauma during childbirth, accompanied by a failure of the blood circulation of the brain, followed by hemorrhages.

Symptoms according to severity

In children, residual organic damage is difficult to see with the naked eye, but an experienced neurologist, already at the first examination of the baby, will be able to determine the external signs of the disease.

Often this is an involuntary trembling of the chin and arms, restless condition of the baby, (lack of tension in the muscles of the skeleton).

And, if the lesion is severe, then it can manifest itself with neurological symptoms:

paralysis of any limb;
violation of eye movements;
reflex failures;
vision loss.

In some cases, symptoms can only be noticed after undergoing certain diagnostic procedures. This feature is called the silent course of the disease.

General symptoms of residual organic lesions of the central nervous system:

unreasonable fatigue;
irritability;
aggression;
mental instability;
changeable mood;
decrease in intellectual abilities;
constant emotional excitement;
inhibition of actions;
pronounced dispersal.

In addition, the patient is characterized by symptoms of mental infantilism, brain dysfunction and personality disorders. With the progression of the disease, the complex of symptoms can be replenished with new pathologies, which, if left untreated, can lead to disability, and in the worst case, death.

Necessary set of measures

It is far from a secret that diseases of such a degree of danger are difficult to cure by single methods. And even more so to eliminate residual-organic lesions of the central nervous system, and even more so, the appointment of complex treatment is necessary. Even with a combination of several therapies, the recovery process will last quite a long time.

For the correct selection of the complex, it is strictly necessary to contact your doctor. Usually, the complex of prescribed therapy includes the following set of measures.

Treatment with drugs of different directions:

psychotropic drugs;
antipsychotics;

External correction (treatment with external stimulation):

massage;
physiotherapy (laser therapy, myostimulation, electrophoresis, etc.);
reflexology and acupuncture.

Methods of neurocorrection

Neurocorrection - psychological techniques that are used to restore impaired and lost functions of the GM.

In the presence of speech defects or neuropsychiatric disorders, specialists connect a psychologist or speech therapist to the treatment. And in case of manifestation of dementia, it is recommended to seek help from teachers of educational institutions.

In addition, the patient is registered with a neurologist. He should be regularly examined by a doctor who treats him. The doctor may prescribe new drugs and other therapeutic measures as the need arises. Depending on the severity of the disease, the patient may need constant monitoring of relatives and friends.

We emphasize that the treatment of residual organic lesions of the central nervous system during the period of acute manifestation is carried out only in a hospital, and only under the supervision of a qualified specialist.

Remember! Timely treatment of organic lesions of the central nervous system can stop the development of complications, reduce the consequences of the disease, eliminate symptoms and completely rehabilitate the human nervous system.

Rehabilitation is in the hands of the mother and doctors

Rehabilitation measures for this disease, as well as for its treatment, should be prescribed by the attending physician. They are aimed at eliminating the formed complications in accordance with the age of the patient.

With the remaining movement disorders, physical methods of influence are usually prescribed. First of all, it is recommended to do therapeutic exercises, the main idea of which will be aimed at "revitalizing" the affected areas. In addition, physiotherapy relieves swelling of nerve tissues and restores muscle tone.

Delays in mental development are eliminated with the help of special drugs that have a nootropic effect. In addition to pills, they also conduct classes with a speech therapist.

Use to reduce activity. Dosing and the drug itself should be prescribed by the attending physician.

Should be eliminated by constant monitoring of the cerebrospinal fluid. Pharmaceutical preparations are prescribed that increase and accelerate its outflow.

It is very important to eradicate the disease at the first alarm bells. This will enable the person to lead a normal life in the future.

Complications, consequences and prognosis

According to the experience of physicians, an organic lesion of the central nervous system in children can cause the following consequences:

In children, such disorders quite often affect adaptation to environmental conditions, manifestations of hyperactivity, or, conversely, chronic fatigue syndrome.

Today, the diagnosis of "residual-organic lesion of the central nervous system" is made quite often. For this reason, physicians are trying to improve their diagnostic and therapeutic abilities.

The exact characteristics and features of a certain type of lesion make it possible to calculate the further development of the disease and prevent it. In the best case, you can completely remove the suspicion of the disease.

This diagnosis is currently one of the most common. An organic lesion of the central nervous system (central nervous system) in its classical content is a neurological diagnosis, i.e. is in the competence of the neuropathologist. But the symptoms and syndromes accompanying this diagnosis can refer to any other medical specialty.

This diagnosis means that the human brain is defective to a certain extent. But, if a mild degree (5-20%) of "organics" (organic damage to the central nervous system) is inherent in almost all people (98-99%) and does not require any special medical interventions, then the average degree (20-50%) of organics is not just a quantitatively different condition, but a qualitatively different (fundamentally more severe) type of disturbance in the activity of the nervous system.

The causes of organic lesions are divided into congenital and acquired. Congenital cases include cases when, during pregnancy, the mother of the unborn child suffered any infection (ARI, influenza, tonsillitis, etc.), took certain medications, alcohol, and smoked. A unified blood supply system will bring stress hormones into the body of the fetus during periods of psychological stress of the mother. In addition, sudden changes in temperature and pressure, exposure to radioactive substances and X-rays, toxic substances dissolved in water, contained in the air, in food, etc. also affect.

There are several especially critical periods when even a slight external impact on the mother's body can lead to the death of the fetus or cause such significant changes in the structure of the body (including the brain) of the future person that, firstly, no medical intervention correct, and secondly, these changes can lead to early death of a child before 5-15 years of age (and mothers usually report this) or cause disability from a very early age. And in the best case, they lead to the appearance of a pronounced inferiority of the brain, when even at maximum voltage the brain is able to work only at 20-40 percent of its potential capacity. Almost always, these disorders are accompanied by varying degrees of disharmony of mental activity, when, with a reduced mental potential, far from always positive qualities of character are sharpened.

This can also be facilitated by taking certain medications, physical and emotional overload, asphyxia during childbirth (oxygen starvation of the fetus), protracted labor, early placental abruption, uterine atony, etc. After childbirth, severe infections (with severe symptoms of intoxication, high fever, etc. .) up to 3 years are able to generate acquired organic changes in the brain. Brain injury with or without loss of consciousness, long or short general anesthesia, drug use, alcohol abuse, long-term (several months) self-administration (without the prescription and constant supervision of an experienced psychiatrist or psychotherapist) taking some psychotropic drugs can lead to some reversible or irreversible changes in the functioning of the brain.

Diagnosis of organics is quite simple. A professional psychiatrist can already determine the presence or absence of organics by the face of a child. And, in some cases, even the degree of its severity. Another question is that there are hundreds of types of disorders in the functioning of the brain, and in each specific case they are in a very special combination and connection with each other.

Laboratory diagnostics is based on a series of procedures that are quite harmless to the body and informative for the doctor: EEG - electroencephalograms, REG - rheoencephalograms (study of cerebral vessels), UZDG (M-echoEG) - ultrasound diagnostics of the brain. These three examinations are similar in form to an electrocardiogram, only they are taken from a person’s head. Computed tomography, with its very impressive and expressive name, is actually capable of revealing a very small number of types of brain pathology - a tumor, a volumetric process, aneurysm (pathological expansion of a brain vessel), expansion of the main brain cisterns (with increased intracranial pressure). The most informative study is the EEG.

It should be noted that practically no disorders of the central nervous system disappear by themselves, and with age, not only do not decrease, but increase both quantitatively and qualitatively. The mental development of a child directly depends on the state of the brain. If the brain has at least some defectiveness, then this will certainly reduce the intensity of the child's mental development in the future (difficulty in the processes of thinking, memorization and recall, impoverishment of imagination and fantasy). In addition, the character of a person is formed distorted, with varying degrees of severity of a certain type of psychopathization. The presence of even small, but numerous changes in the psychology and psyche of the child leads to a significant decrease in the organization of his external and internal phenomena and actions. There is an impoverishment of emotions and their flattening, which is directly and indirectly reflected in the facial expressions and gestures of the child.

The central nervous system regulates the work of all internal organs. And if it works defectively, then the rest of the organs, with the most careful care of each of them separately, will not be able to work normally in principle if they are poorly regulated by the brain. One of the most common diseases of our time - vegetative-vascular dystonia against the background of organic matter acquires a more severe, peculiar and atypical course. And thus, it not only causes more trouble, but these "troubles" themselves are of a more malignant nature. The physical development of the body goes with any disturbances - there may be a violation of the figure, a decrease in muscle tone, a decrease in their resistance to physical exertion, even of a moderate magnitude. The likelihood of increased intracranial pressure increases by 2-6 times. This can lead to frequent headaches and various kinds of unpleasant sensations in the head area, which reduce the productivity of mental and physical labor by 2-4 times. Also, the likelihood of endocrine disorders increases by 3-4 times, which leads, with minor additional stress factors, to diabetes mellitus, bronchial asthma, imbalance of sex hormones, followed by a violation of the sexual development of the body as a whole (an increase in the amount of male sex hormones in girls and female hormones - in boys), the risk of developing a brain tumor, convulsive syndrome (local or general convulsions with loss of consciousness), epilepsy (group 2 disability), cerebrovascular accident in adulthood in the presence of even moderate hypertension (stroke), diencephalic syndrome (attacks of unreasonable fear, various pronounced unpleasant sensations in any part of the body, lasting from several minutes to several hours). Hearing and vision may decrease over time, coordination of movements of a sports, household, aesthetic and technical nature is disturbed, making it difficult for social and professional adaptation.

Organic treatment is a long process. It is necessary to take vascular preparations twice a year for 1-2 months. Concomitant neuropsychiatric disorders also require their own separate and special correction, which must be carried out by a psychiatrist. To control the degree of effectiveness of the treatment of organics and the nature and magnitude of the resulting changes in the state of the brain, the control of the doctor himself at the reception and EEG, REG, and ultrasound is used.

Make an appointment