Acute cerebrovascular accident in children. Acute circulatory disorders in children Transient circulatory disorders

At birth, a significant restructuring of the circulatory system of the newborn occurs:

• The placental circulation stops, the vessels providing it (umbilical vein, venous duct, two umbilical arteries) cease to function, gradually turning into ligaments.
• The fetal openings are closed (ductus arteriosus, foramen ovale).
• In a newborn, the pulmonary arteries and veins begin to function.
• Synchronous atrial contraction switches to serial.
• Due to the increase in oxygen demand, cardiac output and systemic blood pressure increase.

• Circulation of the newborn | Transient circulatory disorders
• Circulation of the newborn
• Transient circulatory disorders
• Violation of cerebral circulation and liquor circulation in newborns
• Violation of cerebral circulation in newborns - causes and symptoms
• The cardiovascular system. Restructuring of blood circulation in a newborn
• Circulatory changes in the newborn
• Fetal circulation
• Features of the circulation of the newborn
• Changes in circulatory circles
• Fetal transient circulation
• Circulatory disorders in the newborn
• poor circulation of the brain in a newborn
• The problem of circulatory disorders of the brain, all about the causes and treatment
• Features of the blood supply to the brain
• Syndrome of cerebrovascular accident in newborns
• Violation of cerebral circulation in newborns: causes and symptoms
• Poor circulation of the brain, symptoms of pathology
• Signs of circulatory disorders
• Causes of circulatory disorders
• Causes of cerebral ischemia in a newborn
• Causes of cerebral ischemia
• How to treat cerebrovascular accident?
• Causes of the disease, symptoms, stages
• Headaches due to brain cyst
• Factors indicating the presence of a cyst
• Why is a brain cyst dangerous?

Features of blood circulation in a newborn

After birth, the blood circulation of the newborn as it adapts to extrauterine life conditions, significant changes in blood circulation occur, lasting several hours or days.

Following the initial decrease, pressure in the vessels of the systemic circulation increases with a simultaneous decrease in heart rate, which is due to an increase in vascular resistance after the cessation of placental circulation.

With the onset of pulmonary respiration, blood flow through the lungs increases by about 5 times. By the 2nd month of life, vascular resistance in the pulmonary circulation decreases by 5-10 times. The entire volume of cardiac output begins to pass through the lungs (only 10% in the prenatal period). This increases the venous return to the left side of the heart and, accordingly, increases the left ventricular output. At the same time, the pulmonary vessels of newborns retain the ability to narrow sharply in response to hypoxemia, hypercapnia, or acidosis.

After the onset of pulmonary respiration (in a healthy newborn at one hour of life), due to the contraction of smooth muscles, the arterial duct is functionally closed, and later (in 90% of children by about 2 months) its anatomical closure occurs. Small and large circles of blood circulation begin to function separately.

Closure of the ductus arteriosus and a decrease in the resistance of the vessels of the small circle are accompanied by a decrease in pressure in the pulmonary artery and the right ventricle.

Due to the redistribution of pressure in the atria, the oval window ceases to function. At about 3 months, it is functionally closed by the existing valve, then the valve adheres to the edges of the oval window. An integral interatrial septum is formed. Complete closure of the foramen ovale usually occurs by the end of the first year of life, but in about 50% of children and 10-25% of adults, a hole is found in the interatrial septum that passes a thin probe, which does not significantly affect hemodynamics.

The venous duct and umbilical vessels are overgrown by the end of the 2nd week of life.

Transient circulatory disorders

Consider what are transient circulatory disorders in newborns.

At birth, placental circulation stops, blood flow increases and resistance in the vessels of the lungs decreases, pulmonary hypertension disappears, fetal fistulas between the small and large circles of blood circulation - the oval window and arterial duct close. In case of violation of adaptation processes (in very premature babies, with SDR, hypoxia, infectious diseases, some congenital malformations, excessive infusion therapy, prolonged mechanical ventilation), fetal anastomoses may not close, which leads to the development of transient transient circulation disorders.

Symptoms of transient circulatory disorders

With an open ductus arteriosus, a shunt first occurs from left to right with a pathological discharge of blood from the large to the pulmonary circulation with overflow of the latter. The child develops pallor, apnea, tachycardia, during auscultation, a systolic murmur is heard along the left edge of the sternum, moist rales in the lungs. Pneumonia often develops. With the development of persistent pulmonary hypertension through the open ductus arteriosus and the open foramen ovale, blood is discharged from the small into the systemic circulation. Due to the shunt from right to left, the admixture of venous blood in the systemic circulation increases, which leads to persistent cyanosis, acidosis, and hepatomegaly.

Treatment of transient circulatory disorders

Treatment begins with the elimination of metabolic disorders and hypothermia, adequate oxygenation, up to mechanical ventilation. To accelerate the closure of the open ductus arteriosus, indomethacin is prescribed. In the absence of the effect of conservative therapy, surgical ligation of the open ductus arteriosus is performed.

Source: cerebral circulation and liquor circulation in newborns

Cerebral circulation disorders and acute liquor circulation disorders directly related to vascular changes are in most cases the same type of reaction of the newborn organism to various causal mechanisms that cause changes in the cerebral vessels. Causes of impaired cerebral blood and liquor circulation can affect the fetus in utero throughout the entire prenatal period or the newborn in the early neonatal period.

The most common cause of cerebral circulation disorders is chronic intrauterine hypoxia, which is based on various factors leading to pathological changes in the metabolic and respiratory functions of the placenta. Changes in the placenta often occur under the influence of acute (especially viral) and chronic infections, intoxications. Late toxicoses of pregnancy are of the greatest importance (E. Govorka, 1970; S. M. Becker, 1970, etc.).

Directly in childbirth, a violation of blood and cerebrospinal fluid circulation can be the result of acute asphyxia (hypoxia) or birth trauma.

Violation of cerebral circulation

With birth trauma, mechanical damage to the brain tissue of the fetus occurs during childbirth. In this case, damage to tissue structures can be in the form of ruptures, crush injuries, as well as local circulatory disorders with edema, venous congestion, stasis, thrombosis and bleeding (I. S. Dergachev, 1964; Yu. V. Gulkevich, 1964). The cause of mechanical damage may be an anatomical or clinical discrepancy between the size of the fetal head and the mother's pelvis, an incorrect position of the fetus; often damage to the skull is observed in breech presentation, rapid delivery. Mechanical damage may be the result of complicated obstetric operations - the imposition of obstetric forceps, vacuum extraction of the fetus, etc.

Depending on the severity of the damage, the trauma of the skull ends with functional changes or causes irreversible morphological lesions (foci of ischemic necrosis, extensive hemorrhages, etc.).

The morphological picture of vascular changes in the central nervous system with all the listed causative factors in most newborns is the same. Three phases can be observed in the morphological picture. The first phase of reversible vasospasm, caused by excitation of vasoconstrictors, leads to hyperproduction of cerebrospinal fluid and short-term initial phenomena of cerebral edema.

In the second phase, paralysis of vasoconstrictors and excitation of vasodilators develop. Dyscirculatory paralysis of vessels develops with stasis, cerebral edema, severe liquor-dynamic disorders and small-pointed diapedetic hemorrhages.

The third phase is characterized by significant cerebral edema and gross vasomotor disorders with hemorrhages in the membranes and substance of the brain (SL Keilin, 1957).

Hemorrhages in the brain in newborns are more often of venous origin. Depending on the localization, there are: a) epidural hemorrhages (between the inner surface of the bones of the skull and the dura mater), b) subdural with displacement of the bones and stretching of the sinus transversus et sinus sagittalis, often with damage to the venous vessels to tear or rupture of the cerebellar plaque, c) subarachnoid - the most frequent (up to 55%), d) in the ventricles and brain substance, and also e) mixed with different localization.

Actually, traumatic lesions in birth trauma of the skull are most often subdural hemorrhages, ruptures of the sinuses and cerebellar plaque.

Clinic. Depending on the clinical manifestations and morphological changes, there are three degrees of cerebrovascular accident (V. I. Tikheev, 1953).

In case of cerebrovascular accident of the 1st degree, clinical manifestations are characterized by mild and intermittent neurological symptoms: a moderate decrease or increase in spontaneous motor activity, some revival or inhibition of unconditioned reflexes, muscular dystonia, transient Graefe's symptom, small-scale tremor of the extremities. As a rule, these phenomena disappear by the 3-4th day after birth.

An analysis of the dynamics of the state of children with impaired cerebral circulation of the 1st degree shows that these conditions are based on liquorodynamic disorders with symptoms of cerebral edema, which linger on

3-4 days. Moderate cerebral edema is also noted in healthy newborns in the process of vascular adaptation of the brain, which is detected according to rheoencephalography data on the first day after birth. At the same time, the edema phenomena decrease on the 2nd day of life with complete normalization by the 3rd day.

4th day after birth (Yu. A. Yakunin, A. S. Rykina,

In children with cerebrovascular accident

I degree cerebral edema lingers correspondingly longer, despite the disappearance of clinical symptoms. Although these changes are functional in nature, they can leave behind increased "neuro-reflex excitability" (Yu. Ya. Yakunin, E. O. Yampolskaya,

1974) . In this case, it is expedient to speak of a hypertensive syndrome even with the short duration of intracranial hypertension, which determines the treatment tactics.

In case of violation of cerebral circulation of the II degree, the clinical picture shows marked anxiety, sleep disturbance, increased motor activity, transient hypertonicity, revitalization of tendon reflexes, tremor, spontaneous Moro reflex, Graefe's symptom.

In other cases, general lethargy, weakness, a decrease in unconditioned reflexes and muscle tone predominate. Against the background of excitation or depression, short-term convulsions of a clonic nature can be observed.

Such children often develop horizontal and vertical nystagmus, converging (rarely divergent) strabismus appears, and the hands acquire the position of "seal's feet". The limbs are in an extensor position, as is the head (with a tendency to hyperextension). When you try to bend the head, there is anxiety and a monotonous (hydrocephalic) cry, pulsation, and sometimes bulging of the fontanelles. In addition to Graefe's symptom, the "setting sun" symptom appears (Fig. 65). Such symptoms allow us to speak of hypertensive-hydrocephalic syndrome.

In the central nervous system, in violation of cerebral circulation of the II degree, a more pronounced cerebral edema, dyscirculatory paralysis of blood vessels and small punctate hemorrhages are noted. Often there may be local edema in the region of the III and IV ventricles, which in the clinic is accompanied by bouts of secondary asphyxia.

Violation of cerebral circulation of the III degree is characterized by a very serious condition of the patient with a pronounced excitation, a piercing "brain" cry, "wide-open eyes" syndrome, strabismus, anisocoria, tonic or tonic-clonic convulsions. In some patients, increased excitability is replaced by adynamia, areflexia, vertical nystagmus, a symptom of "floating eyes", a violation of pupillary reactions; convulsions turn into opisthotonus; frequent’respiratory and cardiac disorders.

With a pronounced extensor posture of the limbs, the hands take a vicious pronator position, the hands in the “seal's feet” position are open, sometimes with horizontal opposition of the fifth finger; legs with a tendency to cross with a varus plantar or dorsi-extended foot.

The severity of the condition is due to a sharp edema and hemorrhages in the membranes and substance of the brain, pronounced ischemic changes (Fig. 66). With cerebrovascular accidents of the III degree, children often die with symptoms of general vascular insufficiency - shock. In survivors, against the background of general symptoms, focal disorders often appear.

In the clinic of cerebrovascular accidents in newborns in the first days after birth, general symptoms prevail and it is very difficult to differentiate cerebral edema from intracranial hematoma.

The presence of symptoms of intracranial hypertension in a child, combined with general lethargy, inhibition of neonatal reflexes and repeated tonic convulsions, indicating irritation of the brain stem structures, makes it possible to suspect subarachnoid hemorrhage (Fig. 68). The appearance against this background of asymmetry in the motor activity of the limbs, even without pronounced hemiparesis, suggests a hemorrhage into the substance of the brain.

With subdural hematoma, symptoms appear more often after an apparent “light gap. Attacks of secondary asphyxia, tonic or tonic-clonic convulsions (sometimes local in the limbs of one side), anisocoria, pulse asymmetry with a tendency to bradycardia on the contralateral side are characteristic. Hemiparesis is detected less frequently and later, after 2-3 days.

In a maternity hospital, and especially in a hospital, it is necessary to carry out differential diagnostics between cerebrovascular accident that occurred during childbirth due to asphyxia or mechanical birth trauma (or a combination of both) in a normally developing child in utero, and asphyxia layering on various intrauterine pathologies. Dysraphic stigmas - an incorrect ratio of the head and facial skeleton, deformation in the structure of the auricles, syndactyly, etc., allow one to speak to a certain extent

about an unfavorable embryonic period. The large size of the head at birth with a tendency to rapid growth from the first days after birth, frequent repeated polymorphic convulsions, pronounced manifestations of spasticity in the limbs immediately after birth - ■ allow us to think about prenatal meningoencephalitis or a violation of the formation of the brain and its cerebrospinal fluid. systems due to chronic hypoxia in the fetal period.

Often intrauterine cerebral insufficiency is detected in children with signs of intrauterine malnutrition.

In newborns with clinical signs of cerebrovascular accident, various additional research methods are currently used for differential diagnosis: spinal puncture, transillumination (diaphanoscopy), electroencephalography, rheoencephalography and echoencephalography, examination of the state of the retina and fundus.

Special attention should be paid to spinal puncture and changes in cerebrospinal fluid. Repeated convulsions are a direct indication for puncture in the maternity hospital. When performing a puncture, the fluid pressure is checked, which normally in newborns varies from 80 to 100 mm of water. Art.

In the unchanged cerebrospinal fluid of newborns, the number of cellular elements in 1 mm 3 ranges from 5 to 15-20, protein - from 0.165 to 0.33%, sugar, as a rule, not more than 0.5 g / l with a downward trend. In premature babies, the nature of the cerebrospinal fluid does not differ from full-term babies (Yu. N. Baryshnev, 1971). With subarachmoidal hemorrhage, fresh and leached erythrocytes are found in the cerebrospinal fluid, there may be an increased number of leukocytes with a change in their composition (the appearance of neutrophils), which sometimes makes it difficult to make differential diagnosis with the initial symptoms of purulent meningitis. The appearance of the cerebrospinal fluid is characteristic: with a massive hemorrhage, the color of meat slops.

Transillumination is simple and available in any maternity hospital. The examination technique consists in the illumination of the bones of the skull with a special lamp in a dark room. Normally, the glow around the lamp in the form of a corolla, in the region of the frontal and parietal bones does not exceed 1.5-2 cm, in the region of the occipital bones it is 1 cm. With edema, the corolla increases, which indicates hyperproduction of cerebrospinal fluid in the subarachnoid space.

Malformations of the brain (porencephaly, atrophy of various parts of the brain structures, progressive dropsy of the brain, etc.) are detected by violations of the luminescence in the form of penetration of the beam into the other hemisphere, the spread of the luminescence diffusely throughout the skull, etc.

In violation of cerebral circulation, changes in brain function can be detected using an electroencephalographic study. Depending on the severity of vascular and cerebrospinal fluid changes, the depth of cerebral edema and local damage, the EEG reveals a different degree of inhibition of the bioelectrical activity of the brain with the appearance of slow high-amplitude waves. The presence of a convulsive syndrome is confirmed by paroxysms of generalized both acute and slow high-amplitude waves (Yu. A. Yakunin,

1974) . The appearance of such waves without convulsive syndrome should be alarming in relation to intrauterine pathology.

With the help of rheoencephalography, it is possible to diagnose the state of blood filling of the brain vessels, their tone, as well as intracranial hemorrhages. The normal rheoencephalogram of a newborn by the end of the neonatal period has a steep anacrota, moderate roundness of the apex, a rapid descent of the catacrosis, and a dicrotic tooth (KV Chachava, 1969). The norm of the rheographic wave is 0.149 Ohm (average amplitude).

Cerebral edema with increased blood filling of the cerebral vessels is reflected in the rheoencephalogram. The most clear changes are detected with hemorrhages - subarachnoid hemorrhage is characterized by a distinct lengthening of the anacroga, an increase in the bulge or flatness of the catacrot (sometimes with interhemispheric asymmetry). With parenchymal hemorrhage, interhemispheric asymmetries increase - a decrease in blood circulation in one hemisphere. These changes are associated with difficulties in arterial inflow and venous outflow (Yu. A. Yakunin, I. A. Rykina, 1973).

Echoencephalography is a relatively new method for diagnosing skull formations. When analyzing echo-encephalograms, the shift of the M-echo signal reflected from the median structures of the brain is taken into account; ventricular index; position and shape of the M-echo with the number of additional impulses and hemispheric asymmetry of impulses; the quantity and quality of echo pulsations (reflected signals) with an estimate of the signal amplitude in percent (I. A. Skoruneky, 1968).

In healthy newborns, the M-echo shift is not observed; ventricular index is 1.6-1.8; the amplitude of echo pulsations is 30%, the growth factor is 0.18 + 0.01 (N. S. Kare, 1974).

Ultrasound echolocation can diagnose local and generalized cerebral edema, hypertension-hydrocephalic syndrome, and various types of intracranial hemorrhages. According to N. S. Kare, in children with hemorrhages, there is a displacement of the median structures of the brain (M-echo) by 1-6 mm, most often in the projection zone of the third ventricle. Subarachnoid-parenchymal hemorrhages practically do not give displacement (1.5-2 mm), with subdural hematoma, the M-echo is displaced by 4-5 mm.

Treatment of cerebrovascular accidents begins along with resuscitation in the delivery room - they provide adequate breathing and prevent secondary asphyxia.

Normalization of cerebral circulation is possible only under the condition of normalization of blood circulation in general. With severe hemodynamic disorders, treatment is carried out according to the principles set forth in the general part of this book.

To restore the hemo- and liquorodynamics of the brain, depending on the indications, dehydration therapy is carried out. In severe cases, cranio-cerebral hypothermia is indicated, which reduces the brain's need for oxygen, reduces edema, improves blood flow and microcirculation in the vessels of the brain (G. M. Savelyeva, 1973; K. V. Chachava, 1971, etc.). So, K.V. Chachava suggests performing cranio-cerebral hypothermia even before the birth of a child.

For this purpose, a vacuum cup is placed on the presenting head of the fetus - a suction cup. Cooling is carried out with vapors of liquid nitrogen, which enters the space between the outer and inner plates of the cup, while the temperature of the cerebral cortex drops to 20-30°C. Indications for fetal hypothermia: asphyxia after unsuccessful medical treatment, obstetric situations that exclude the possibility of urgent operative delivery (high standing of the head, insufficient opening of the cervix) (K. V. Chachava, 1971).

Cranio-cerebral hypothermia in a newborn is performed against the background of the use of neuroplegic and antihistamine drugs, most often sodium hydroxybutyrate with droperidol is used.

To cool the skin of the scalp of a child with running water at a temperature of 8-10 ° C, the domestic apparatus "Cold-2" (N. S. Baksheev, 1972) can be used. A shower unit is also used, from which water is poured onto the scalp, and the jet length should not exceed 3-4 cm. During cranio-cerebral hypothermia, the temperature in the ear canal (26-28 ° C) and in the rectum is constantly monitored ( from 30 to 32°C). The specified temperature corresponds to moderate (23-25°C) hypothermia of the brain (GM Savelyeva, 1973).

Diprazine in combination with chlorpromazine is the main agent that is part of the lytic mixture used to hypothermia and reduce the excitability of the nervous system, primarily the reticular formation of the brain (MD Mashkovsky, 1972). Doses of aminazine and diprazine in newborns range from 2 to 4 mg / kg per day, with their combined use, the dose is reduced by half.

When a convulsive syndrome appears, diazepam (p. 126) and phenobarbital (p. 111) are added.

Diazepam and especially phenobarbital as sedatives and anticonvulsants are used in combination with sodium oxybutyrate (GHB) and droperidol, and in milder cases alone.

Simultaneously with this therapy, to improve brain nutrition and reduce tissue oxygen demand, repeated administration of ATP intramuscularly and intravenously in a 1% solution of 10 mg per injection and cocarboxylase 8 mg/kg intramuscularly and intravenously with glucose is indicated.

To improve metabolic processes in the brain, the inclusion of biostimulants is shown: glutamic acid, gammalon, however, their use is possible not earlier than 5-7 days, in cases that occur with depression of the central nervous system, especially in children with prenatal pathology. In the presence of excitement, these drugs are given against the background of phenobarbital, carefully, since with an increased convulsive readiness of the child, they can provoke convulsive seizures.

To combat cerebral edema, hypertonic solutions are used, which increase the osmotic pressure of the plasma and contribute to the flow of fluid from the brain and other tissues into the blood (this increases the excretion of fluid through the kidneys). A decrease in intracranial pressure under the action of hypertonic solutions is accompanied by an increase in cerebral blood flow, which leads to the restoration of brain functions. Widely used hypertonic glucose solutions reduce blood pressure by 14% and for a short time (35-40 minutes), so it is rational to use them only simultaneously with plasma, which enhances the anti-edematous effect of glucose (I. Kandel, M. N. Chebotarev, 1972) . In newborns, 8-10 ml / kg of 15-20% glucose solution is used simultaneously with plasma.

For the purpose of dehydration, drugs with a high osmotic gradient to the blood-brain barrier, which have a pronounced diuretic effect, are prescribed. The leading drug in this group of osmodiuretics is mannitol (p. 106).

Glycerin (glycerol) is a trihydric alcohol, administered orally in a 50% solution with glucose or sugar syrup and given in '/g teaspoon 2-3 times a day.

By the end of the first day, in the absence of mannitol, saluretics are prescribed. In newborns, furosemide is more commonly used.

The independent action of diuretics in cerebral edema is less effective than in combination with hypertonic solutions, therefore it is advisable to combine diuretics with the administration of plasma and glucose.

In milder cases, to relieve cerebral edema, it is advisable to include 0.2 ml / kg of a 25% magnesium sulfate solution. In order to reduce cerebral edema and restore

Source: cerebrovascular accident in newborns - causes and symptoms

Particularly susceptible to asphyxia during childbirth is a fetus that has experienced intrauterine hypoxia during a complicated course of pregnancy: toxicosis, prematurity or overmaturity, maternal diseases during pregnancy - infectious, as well as some others (for example, cardiovascular).

The most common form of NMC in newborns is intracranial hemorrhage (60% of acute cerebrovascular accidents in newborns). The longer and deeper the oxygen starvation of the brain, the greater the hemorrhage and the more serious the consequences.

Source: system. Restructuring of blood circulation in a newborn

Heart in a newborn, it is relatively large and amounts to 0.8% of body weight, which is somewhat higher than the similar ratio in adults (0.4%). The right and left ventricles are approximately equal. Their wall thickness is about 5 mm. The atria and great vessels are somewhat larger than the ventricles.

The increase in the mass and volume of the heart occurs most intensively in the first 2 years of life and in adolescence - from 12 to 14 years, and also from 17 to 20 years.

In all periods of childhood, the increase in the volume of the heart lags behind the growth of the body as a whole. In addition, the sections of the heart increase unevenly: the atria grow more intensively up to 2 years, from 2 to 10 years - the whole heart as a whole, after 10 years the ventricles increase mainly.

Up to 6 years, the shape of the heart is usually spherical, after 6 years it approaches an oval, characteristic of adults. Up to 2-3 years, the heart is located horizontally on an elevated diaphragm: the right ventricle is adjacent to the anterior chest wall, which mainly forms the apical cardiac impulse.

By the age of 3-4, due to an increase in the chest, a lower position of the diaphragm, and a decrease in the size of the thymus, the heart takes an oblique position, while simultaneously turning around the long axis with the left ventricle forward, and from that time on, the cardiac impulse forms mainly the left ventricle. The projection of the apex of the heart in a newborn is located in the fourth intercostal space, by 1.5-2 years it shifts to the fifth. The upper border of the heart gradually descends.

The boundaries of the heart in children are compared with age norms in groups: up to 2 years, from 2 to 7 years, from 7 to 12 years.

Table Borders of relative cardiac dullness in children of different ages

Right parasternal line

Inward from the right parasternal line

Right edge of sternum

1.5-2 cm outward from the mid-clavicular

0.5-1.5 cm outward from the mid-clavicular line

0.5-1 cm medially from the mid-clavicular line

The size of the heart is larger in boys at all age periods, except for the years when girls grow faster. After this age, the mass of the heart in boys again increases more intensively. The left parts of the heart grow especially intensively. The growth stimulator of the left ventricle is the increasing vascular resistance and blood pressure. The mass of the right ventricle in the first months can decrease by almost 20%, which is explained by a drop in resistance in the lungs due to the shutdown of the ductus arteriosus.

Simultaneously, tissue differentiation occurs. The myocardium in a newborn is an undifferentiated syncytium. Muscle fibers are very thin, slightly separated from each other. Weakly expressed longitudinal fibrillarity and transverse striation. A large number of small, poorly differentiated nuclei. Connective and elastic tissue are poorly developed. In the first 2 years of life, the thickness and number of muscle fibers increase, the number of nuclei of muscle cells decreases with an increase in their size. Septal septa and transverse striation appear. By the age of 10, the histological structure of the heart is similar to that of adults. Kgodam ends the development of histological structures of the conduction system of the heart.

Coronary vessels up to 2 years of age are distributed according to the loose type, from 2 to 6 years - according to the mixed type, after 6 years - according to the adult, main type. The lumen and wall thickness (due to the intima) of the main vessels increases, and the peripheral branches are reduced. Abundant vascularization and loose fiber surrounding the vessels create a predisposition to inflammatory and degenerative changes in the myocardium. Sclerosis and myocardial infarction at an early age are very rare.

In young children vessels relatively wide, thin-walled, muscle and elastic fibers in them are underdeveloped. The lumen of the veins is approximately equal to the lumen of the arteries. The veins grow more intensively and by the age of 15-16 they become 2 times wider than the arteries. The aorta up to 10 years is narrower than the pulmonary artery, gradually their diameters become the same, during puberty the aorta exceeds the pulmonary trunk in width.

Capillaries in children are well developed, wide. They have an irregular shape (short, twisted), their permeability is much higher than in adults. The width and abundance of capillaries predispose to stagnation of blood, which is one of the reasons for the more frequent development of certain diseases in children in the first year of life, such as pneumonia and osteomyelitis.

By the age of 12, the structure of the vessels is the same as in adults. Differentiation of the arterial and venous network is manifested by the development of collateral vessels, the appearance of a valvular apparatus in the veins, and an increase in the number and length of capillaries.

Changes in some functional parameters are closely related to age-related anatomical changes in the parameters of the cardiovascular system in children.

The speed of blood flow in children is high, with age it slows down, which is due to the elongation of the vascular bed as the child grows and the decrease in heart rate.

Arterial pulse more common in children than in adults; this is due to faster contractility of the child's heart muscle, less influence on the cardiac activity of the vagus nerve. The branches of the vagus nerve complete their development and become myelinated by the age of 3-4 years. Until this age, cardiac activity is regulated mainly by the sympathetic nervous system, which is partially associated with physiological tachycardia in children of the first years of life:

In newborns 140-160 in 1 min

By 1 year in 1 minute by 5 years - 100 in 1 minute

By 10 years - in 1 min

By 12-13 years old - in 1 minute

The pulse in childhood is characterized by great lability. Crying, crying, physical stress, a rise in temperature cause its noticeable increase. For the pulse of children, respiratory arrhythmia is characteristic: on inspiration it quickens, on exhalation it becomes less frequent.

Arterial pressure(BP) in children is lower than in adults. It is lower the younger the child. Low blood pressure is due to the small volume of the left ventricle, the wide lumen of the vessels and the elasticity of the arterial walls. To assess blood pressure, age tables of blood pressure are used. In a full-term newborn, systolic blood pressure is mm Hg. Art. The approximate level of maximum blood pressure in children of the 1st year of life can be calculated by the formula: 76 + 2n, where n is the number of months (76 is the average systolic blood pressure in a newborn).

In older children, the maximum blood pressure is approximately calculated by the formula: 100 + n, where n is the number of years, while allowed

fluctuations 15. Diastolic pressure is 2/3 - 1/2 of systolic pressure.

Blood pressure should be measured not only on the arms, but also on the legs. BP values ​​in the lower extremities exceed those in the upper ones by approximately 10 mm Hg.

After the birth of a child, a restructuring of blood circulation occurs:

The placental circulation stops;

The main fetal vascular communications are closed (at first functionally, and then obliterated).

The vascular bed of the pulmonary circulation is fully included in the bloodstream;

Due to the increase in oxygen demand, cardiac output and systemic vascular pressure increase.

After the first breaths, the lungs expand, the resistance of their vessels decreases, and the blood from the right ventricle in full rushes to the lungs, where it is enriched with oxygen, and goes to the left atrium, left ventricle and aorta. With the onset of pulmonary respiration, blood flow through the lungs increases by about 5 times, the entire volume of cardiac output passes through the lungs, while in the intrauterine period - only 10%. By the 2nd month of life, vascular resistance in the pulmonary circulation decreases by 5-10 times.

At about 3 months, the foramen ovale is functionally closed by the existing valve (due to an increase in pressure in the left atrium), and then the valve increments to its edges. Thus, an integral interatrial septum is formed. Complete closure of the oval window occurs by the end of the first year of life.

From the moment of the first breath, the arterial duct, due to the contraction of the smooth muscles of its wall, functionally closes (in a healthy newborn by the hour of life), later (by about 2 months) it

anatomical closure. The blood flow also stops along the venous duct, which is gradually obliterated. The small and large circles of blood circulation begin to function separately.

Violation in the process of normal closure of the fetal pathways of blood flow leads to the formation of some congenital heart defects.

With the first breaths coincide in time and profound changes in the blood circulation of the newborn. In the fetus, pulmonary arteriole resistance is very high, and as a result, blood flow through the lungs is minimal (only 5 to 10% of cardiac output). In contrast, total peripheral vascular resistance in the systemic circulation is low, mainly due to low placental vascular resistance. The low partial pressure of oxygen in the fetal blood (about 25 mmHg), together with locally produced prostaglandins, keep the ductus arteriosus open. The blood expelled by the right ventricle is predominantly discharged from right to left, from the pulmonary artery to the aorta through the ductus arteriosus due to the high resistance of the pulmonary vessels. Another right-to-left shunt is made through the foramen ovale. The pressure in the left atrium in the fetus is low due to the small amount of blood coming from the lungs, while the pressure in the right atrium is relatively high due to the large volume of blood returning from the placenta. The difference in pressure within the atria keeps the foramen ovale open and allows blood to flow directly from the right to the left atrium.

The first breaths lead to increased pulmonary blood flow and closure of the foramen ovale. The resistance of the pulmonary arterioles drops sharply due to vasodilatation during the expansion of the lungs, an increase in paO2 and a decrease in paCO2. Due to the inhalation of air in the alveoli, an interface between air and liquid is created and, as a result, a surface tension force, under the influence of which the alveoli tend to escape; this force is counteracted by elastic forces in the chest. As a result of all these processes, interstitial pressure in the lungs decreases, tissue pressure on the pulmonary capillaries decreases, and pulmonary blood flow increases even more.

As soon as pulmonary blood flow is established, venous return from the lungs increases, and pressure in the left atrium rises accordingly. When air breathing begins, in response to an increase in paO2, the umbilical arteries spasm. Placental blood flow decreases or stops, and, accordingly, blood return to the right atrium decreases. There is a decrease in pressure in the right atrium while simultaneously increasing it in the left; therefore, as soon as air breathing begins and pulmonary blood flow increases, the foramen ovale closes.

Shortly after birth, resistance to blood flow in the systemic circulation becomes greater than in the lungs, i.e. there is a situation opposite to the intrauterine period. Therefore, the direction of blood flow through the patent ductus arteriosus is reversed, creating a shunt of blood from left to right.

This state of circulation, in which pulmonary blood flow is established, placental blood flow stops, and blood flows from left to right through the open ductus arteriosus, is called transient circulation. It lasts from the moment of birth (when intensive pulmonary blood flow begins and the functional closure of the oval window occurs) for about a day; then the ductus arteriosus closes. The blood that enters the ductus arteriosus and the vessels that feed it (vasa vasorum) from the aorta has a high paO2, which, along with changes in prostaglandin metabolism, leads to narrowing and closing of this duct. From the moment when the ductus arteriosus closes, blood circulation finally occurs according to the adult type; both ventricles are connected in series and there are no large shunts between the pulmonary and systemic circulations.

Within a few days after birth, in the presence of pathological stress factors, the newborn can restore the intrauterine type of blood circulation. Asphyxia with hypoxia and hypercapnia cause narrowing of the pulmonary arterioles and expansion of the ductus arteriosus; as a result, the above processes proceed in the opposite direction, which leads to a right-to-left shunt through the newly opened ductus arteriosus and foramen ovale. As a result, the newborn develops severe hypoxemia. This condition is called persistent pulmonary hypertension, or persistent fetal circulation.

Treatment in this situation is to control the conditions leading to pulmonary vasoconstriction (eg, pure oxygen breathing).

Article "Changes in blood circulation in a newborn" from the section Care of newborns

Source: blood circulation in a newborn

A feature of the fetal circulation is the presence of one circle of blood circulation, and the developing organism receives oxygen through the placenta. To bypass non-functioning lungs, the foramen ovale and ductus arteriosus work. After birth, a structural rearrangement occurs for the transition to pulmonary respiration. In the presence of heart defects, blood flow in the heart, lungs, brain and internal organs is disturbed.

Fetal circulation

The main differences in hemodynamics in the fetus are that it functions:

• blood circulation through the placenta;
• low-intensity pulmonary blood flow;
• additional blood flow through the foramen ovale and ductus arteriosus.

The placenta is the main source of nutrients, its blood contains about 70% oxygen. Normally, as the fetus develops, the placenta increases its respiratory surface, and hemoglobin acquires a greater ability to bind oxygen.

The oval window is located in the interatrial part of the septum, through which part of the blood from the placenta goes to the left chambers of the heart, bypassing the lungs, which do not function. This blood flow nourishes the neck, brain and spinal cord. After childbirth, the need for shunting disappears, and the hole first closes, and then completely overgrows by the end of the year.

The ductus arteriosus connects the main artery of the lungs and the aorta. The main load in the fetus falls on the right ventricle (placental and own blood enters it), so the pulmonary artery receives a large amount of blood and dumps it through the duct into the aorta. Normally, it closes on the first day.

And here is more about the transposition of the great vessels in babies.

Features of the circulation of the newborn

The main hemodynamic differences after the birth of a baby are associated with the onset of pulmonary respiration and the redistribution of the load in the heart - from the right to the left sections.

Changes in circulatory circles

After the first breath, the blood flow in the vessels of the lungs increases dramatically and the resistance of the arteries and veins in them decreases by about the same amount. Since the volume of blood flow in the left atrium increases, and in the inferior vena cava decreases, the pressure between the atria changes - in the left it becomes higher. Under the influence of these factors, the valve of the oval window closes the hole and stops the movement of blood.

In most children, in the future, the window becomes completely overgrown with connective tissue, which leads to its complete disappearance, but sometimes this happens only partially, or the hole does not overlap. Then, with strong straining (crying, screaming, coughing), the discharge of blood resumes.

Spasm of the aortic duct occurs in the first hours after birth under the influence of an increase in oxygen pressure in the blood. If the breathing of a newborn for some reason weakens, then the walls of the vessel straighten again. Complete overgrowth of it occurs by the end of 2 months of life.

Thus, the circulatory system of an infant acquires the features of an adult due to the following changes:

• cessation of placental blood flow after clamping the umbilical cord;
• shutdown of the main messages - Botallov duct, oval window;
• ventricles direct blood to different circles of blood circulation;
• the inclusion of breathing through the lungs and the expansion of blood vessels in them;
• increased need for oxygen;
• increased blood flow;
• increase in blood pressure.

Fetal transient circulation

The hemodynamic type of blood movement that the fetus had is called fetal. It functions for several hours after birth. At this time, there is little blood flow through the foramen ovale and ductus arteriosus. An interesting feature is the bilateral passage of blood, synchronized with the phases of the cardiac cycle.

These partial communications between the parts of the heart are designed to reduce the load on the myocardium and pulmonary vessels, they enable the child to adapt to a new type of blood circulation. Features of the transition period is the possibility of the following symptoms:

• blue fingertips, lips, nasolabial triangle, which increase with crying or physical activity of the baby;
• murmur over the region of the heart at the beginning of systole or before the end of ventricular contraction.

Circulatory disorders in the newborn

Due to aggravated heredity, diabetes mellitus, exposure to pregnant women of infections, radiation, intoxication, including nicotine, alcohol or drugs, anomalies in the structure of the heart occur. This may appear as:

• untimely closure of openings and physiological ducts;
• improper formation of valves;
• underdevelopment of parts of the heart;
• abnormal location of the main vessels.

Due to the fact that the blood circulation of the fetus and the newborn have fundamental differences, during the period of gestation, the development of the child may not cause concern, but after childbirth, deviations occur immediately or after a while. The severity and speed of occurrence of circulatory disorders are influenced by:

• the timing of the closure of the oval window and the Botallian duct;
• severity of pulmonary hypertension;
• the direction and amount of blood flow through the valves;
• the condition of the baby (term, weight, the presence of oxygen starvation, concomitant diseases, infections).

The main sign of heart disease is an unnatural pallor of the skin or blue (cyanosis). Therefore, all vices are divided into "white" and "blue".

The first are characterized by the discharge of blood from the arterial network to the venous network - from the left to the right heart. The pulmonary circulation circle is filled with blood, hypertension increases in it, and the arteries of the large circle are poorly filled, which causes a decrease in the nutrition of the internal organs and the brain. Increasing heart failure leads to the death without surgery of almost half of the children in the first year of life.

Watch the video about blood circulation in newborns:

With "blue" defects, the discharge of blood is noted in the opposite direction, blood circulation in the lungs decreases and, accordingly, oxygen saturation of the blood. Due to oxygen deficiency, a bluish tint of the skin and mucous membranes appears. To improve gas exchange and tissue nutrition, an additional network of vessels is quickly formed.

Therefore, with such anomalies in the structure of the heart, despite the fact that there is a significant change in intracardiac and systemic hemodynamics, the child's condition can be satisfactory as long as the myocardium copes with the increased load.

Source: cerebral circulation in a newborn

The problem of circulatory disorders of the brain, all about the causes and treatment

For the normal functioning of the brain, a large amount of blood is required, which is a natural transporter of oxygen. Damage to the main arteries, venous and jugular veins, due to the development of thrombosis, embolism, aneurysm, etc. leads to serious oxygen deficiency, tissue death and the loss of certain vital functions for the body. Violation of the blood circulation of the brain is a serious pathology that requires urgent treatment.

Features of the blood supply to the brain

According to the most rough estimates, the human brain contains about 25 billion nerve cells. There is a hard and soft shell, gray and white matter.

The brain consists of five main sections: terminal, posterior, intermediate, middle and oblong, each of which performs its necessary function. Difficulty in the blood supply to the brain leads to failures in the coordinated work of the departments, the death of nerve cells. As a result, the brain loses certain functions.

Initially, the symptoms of poor circulation are of little intensity, or are not observed at all. But as the disorder develops, the clinical manifestations become more apparent.

Eye pain - the intensity of the pain syndrome increases during the day. The pain increases with the rotation of the eyeballs and the attempt to concentrate the focus.

Dizziness - a lack of blood supply causes disturbances in the parts of the brain responsible for orientation in space, the ability to control the body. Cell death and tissue atrophy leads to dizziness.

Nausea - accompanied by vomiting, dizziness. At the same time accompanied by several of the above symptoms. It is one of the signs of a stroke.

Noises in the ears - symptoms of poor

Syndrome of cerebrovascular accident in newborns

In newborns, there are two types of cerebrovascular accident: transient (without focal changes in the nervous tissue) and focal (accompanied by the appearance of a pathological focus). Focal disorders of cerebral circulation in the perinatal period are divided by nature into hemorrhages, ischemia (heart attacks) and hemorrhagic infarcts. Differential diagnosis should be carried out with congenital anomalies of the central nervous system and infectious diseases of the nervous system

Hypoxia (decreased oxygen concentration in the blood) and ischemia (decreased cerebral blood flow) can lead to temporary dysfunction of the central nervous system and cause chronic neurological disorders and developmental delay.

Severe hypoxic-ischemic encephalopathy may be a systemic disease syndrome triggered by asphyxia. Severe ischemic encephalopathy is accompanied by acidosis, ischemic lesions of the kidneys, myocardium, and gastrointestinal tract develop.

It is caused by various methods: a blow to the surface on which the child lies, at a distance of 15 cm from his head, raising the extended legs and pelvis above the bed, sudden passive extension of the lower extremities. The newborn moves his arms to the sides and opens his fists - the 1st phase of the Moro reflex. After a few seconds, the hands return to their original position - phase II of the Moro reflex. The reflex is expressed immediately after birth, it can be observed during the manipulations of the obstetrician. In children with intracranial trauma, the reflex may be absent in the first days of life. With hemiparesis, as well as with obstetric paresis of the hand, an asymmetry of the Moro reflex is observed.

Treatment of ischemic encephalopathy

Violation of cerebral circulation in newborns: causes and symptoms

Violation of cerebral circulation in a child. It is known that rehabilitation is faster and more efficient in those children with whom parents regularly and persistently engage in medical procedures, gymnastics and swimming, and follow the regimen prescribed by the doctor.

Violation of cerebral circulation (CVC) - insufficiency of blood supply to the brain due to damage to the vessels of the brain and (or) as a result of pathological changes in the composition of the blood.

Fetal hypoxia - oxygen deficiency of fetal tissues, which causes a complex chain of damage to the structure of cells, changes in metabolism and energy in the cells and tissues of the body.

Asphyxia is a condition caused by a sharp increase in hypoxia during childbirth. It is manifested by severe disorders of the nervous system and blood circulation of the child.

Intracranial hemorrhage is a manifestation of intracranial birth trauma, in which hemorrhage occurs in the substance of the brain and its membranes, causing pathological changes.

Perinatal encephalopathy (PEP) is a collective term for a group of neurological disorders resulting from underdevelopment or damage to the brain in the perinatal period (the last 12 weeks of pregnancy and the first week of life). In most cases, PEP is caused by several factors.

The most common cause of NMC in newborns and infants is oxygen deficiency of the brain (hypoxia), which occurs due to birth asphyxia, birth trauma, congenital heart disease, malformations of cerebral vessels, and intrauterine infection. Premature placental abruption, rupture of the vessels of the umbilical cord, umbilical cord wrapped around the child, massive blood loss, placenta previa can lead to asphyxia in childbirth.

Poor circulation of the brain, symptoms of pathology

The human brain requires a large amount of blood, which naturally transports oxygen. Poor circulation of the brain occurs due to violations of the arteries, blockage of blood vessels and the development of blood clots. This pathology is considered serious, because its consequences lead to the death of tissues and the cessation of vital functions by the brain. If you find symptoms that indicate poor circulation, you should immediately send to a specialist for an accurate diagnosis.

Signs of circulatory disorders

According to scientists, the human brain includes a large number of nerve endings and cells. Their violations lead to a variety of pathologies and diseases, as a result of which some brain functions are lost.

The first signs of circulatory disorders may not be traced at all or be so insignificant that they can be confused with a common migraine. After a while, the symptoms of brain dysfunction manifest themselves more and become visible and obvious. Symptoms of poor circulation are:

In many cases, these signs are associated with psychological problems and disorders of the human nervous system. They show up for no reason. Symptoms come on quickly and disappear quickly. It is important to know that if you find the slightest deviations, you should contact a neurologist who will prescribe the necessary treatment.

Causes of circulatory disorders

The circulatory system has a very complex structure. The transport of oxygen and other substances is carried out with the help of arteries. Normally, the brain should receive about 25% of all oxygen supplied. In order for it to function normally, 15% of the blood in the human body is required. If these volumes are not met

Causes of cerebral ischemia in a newborn

Cerebral ischemia in a newborn develops due to oxygen starvation, which occurs with poor cerebral circulation. To be more precise, only a condition in which an insufficient amount of oxygen enters the brain is called hypoxia, and a complete cessation of the supply of oxygen to the brain is called anoxia.

The development of cerebral ischemia in a newborn is a serious problem, since it leads to irreversible consequences; no medicines have yet been found that can help a little man cope with this serious disease without dangerous consequences for the body. Existing methods of treatment of such pathology in newborns are not effective enough.

Causes of cerebral ischemia

The causes of ischemia in newborns and adults are different. In adults, the cause of cerebral ischemia can be atherosclerosis of cerebral vessels - a disease in which fatty deposits grow on the walls of blood vessels, gradually narrowing their lumen. Most often, ischemia of the cerebral vessels occurs precisely because of atherosclerosis, less often due to other causes that caused thrombosis of the cerebral vessels.

Cerebral ischemia in newborns usually develops due to hypoxia, which can occur during pregnancy or childbirth. It is especially worth fearing the development of this disease in a child in mothers over 35 years old.

violation of the uteroplacental circulation, which leads to the necrosis of some parts of the brain of the newborn;

metabolic disorders - from mild (changes are still reversible) to severe (the onset of irreversible changes in the substance of the brain followed by the death of neurons);

Registering a baby at the place of residence is the direct responsibility of his legal representatives, and you can go through the procedure without long standing in lines and endless manual filling of paperwork.

syndrome of increased neuro-reflex excitability

How to treat cerebrovascular accident?

Violation of cerebral circulation belongs to the group of diseases of the cardiovascular system (code according to MBC-10 IX). Treatment of such diseases should be strictly under the supervision of a physician.

However, in the chronic stage, as well as during the rehabilitation period, treatment with folk remedies for cerebrovascular accident is simply necessary. It is part of the complex for the restoration of the body.

Causes of the disease, symptoms, stages

Cerebral circulation is an ideal system that works on the principle of communicating vessels. If more blood is needed in a part of the brain, the vessels transfer blood there from other parts. When the demand decreases, blood volumes return to standard parameters.

This allows you to optimally supply all parts of the brain and spinal cord with blood in the quantities needed by the body and solve the problem of blood supply, for example, during physical exertion or sports.

Imagine what happens if a stream is blocked with a stone. The water will begin to erode the channel and eventually spill over the floodplain. The same thing happens with vessels.

If in any of the vessels obstructions are formed in the form of blood clots, embolisms, cholesterol plaques, then the blood begins to circulate poorly, the pressure on the walls of the vessels increases, and this can end with a stroke, cerebral hemorrhage or cerebral infarction (acute lack of blood supply to certain parts of the brain) .

These reasons can work in a complex or individually, and this is a signal that it is urgent to deal with the prevention of cerebrovascular accidents.

Almost every child has chapped lips from time to time. Parents need to know why a child has chapped lips in order to prevent an unpleasant phenomenon if possible, and what to do if the lips crack.

These symptoms may

Headaches due to brain cyst

Factors indicating the presence of a cyst

A cyst in a person’s head is a fairly well-known pathology, under certain circumstances, threatening health and life, as it often goes without symptoms. Only occasionally the patient experiences a slight aching pain and some pressure. So what is a brain cyst, what are the features of this disease and its treatment, let's figure it out.

A cyst in the brain is a benign, blister-like growth that accumulates fluid. It is congenital and acquired. The location of the cyst can be very different, regardless of the age and social status of the patient.

A small tumor does not threaten a person, but it is desirable to get rid of a large one. A growing formation with an increase in size will put more pressure on the brain, thereby disrupting the functions of the body.

It is quite difficult to identify a cyst in the brain at the initial stage. However, at the slightest suspicion or accidental discovery, you must definitely contact the appropriate specialist. It is he who will determine how dangerous it is for your life and prescribe treatment. By following all the doctor's instructions, you will protect yourself from serious consequences.

There are many reasons that affect the formation of a cyst in the head in an adult, unless the pathology is congenital. Here are the most common reasons:

Why is a brain cyst dangerous?

When the pathology is in a neglected state and cannot even be treated by surgeons, or you do not want to treat it, you should know that sooner or later you may experience such unfavorable signs:

That is why it is important to identify the disease and its causes at an early stage. Moreover, in this case it is easy to get rid of the brain cyst. Treatment at this stage involves only taking medications that can dissolve

For the normal functioning of the brain, a large amount of blood is required, which is a natural transporter of oxygen. Damage to the main arteries, venous and jugular veins, due to the development of thrombosis, embolism, aneurysm, etc. leads to serious oxygen deficiency, tissue death and the loss of certain vital functions for the body. Violation of the blood circulation of the brain is a serious pathology that requires urgent treatment.

Features of the blood supply to the brain

The brain consists of five main sections: terminal, posterior, intermediate, middle and oblong, each of which performs its necessary function. Difficulty in the blood supply to the brain leads to failures in the coordinated work of the departments, the death of nerve cells. As a result, the brain loses certain functions.

Signs of circulatory disorders of the head

The symptoms of the disease include:

If the blood circulation of the brain is disturbed, oxygen starvation occurs, provoking a gradual increase in the intensity of symptoms. Each of the manifestations may indicate a number of other diseases and requires a mandatory referral to a neurologist.

Causes of obstructed blood supply to the brain

For normal operation, the brain needs to receive about 25-30% of the oxygen that enters the body. The supply system includes about 15% of the total volume of blood in the human body.

Inadequate circulation has symptoms that allow you to establish the presence of certain disorders.

The reason for the development of pathology is:

Whatever caused circulatory failure, the consequences of violations are reflected not only in the activity of the brain itself, but also in the work of internal organs. The result of therapy is influenced by the accuracy of the established cause - the catalyst and the timely elimination of violations.

Why are the problems of poor blood flow in the brain dangerous?

• Ischemic stroke - accompanied by nausea and vomiting. With a focal lesion, it affects the work of individual internal organs. It affects the motor and speech function.
• Hemorrhagic stroke - violations are provoked by blood that has entered the brain area. As a result of increased pressure, the brain is compressed, tissues are wedged into the occipital foramen. The high rate of blood flow in the vessels of the brain leads to a rapid deterioration of the patient's condition. Hemorrhagic stroke is the leading cause of death.
• Transient ischemic attack is a temporary lesion. You can restore blood circulation with the help of medications that improve brain activity and stimulate hematopoiesis.
  Transient attack occurs mainly in elderly patients. The attack is accompanied by impaired motor and visual function, numbness and paralysis of the limbs, drowsiness and other symptoms.

Violation of the blood flow of the brain in children

Critical is the change in the total rate of cerebral blood flow over 10%. In this case, there is a change in the tension of oxygen and carbon dioxide, which leads to serious disturbances in brain activity.

In both adults and children, the brain is supplied with blood by several main arteries and vessels:

• The middle cerebral artery supplies blood to the deep parts of the brain and the eyeball. The internal is responsible for the nutrition of the cervical region, scalp and face.
• The posterior cerebral artery supplies blood to the occipital lobes of the hemispheres. Small blood vessels help in the task, feeding directly the deep parts of the brain: gray and white matter.
• Peripheral circulation - controls the collection of venous blood from the gray and white matter.

Control over the operation of the system is carried out due to a complex mechanism of regulation. Since the brain tissues continue to develop after the birth of a child, new synapses and neural connections are constantly appearing, any disturbances in the blood circulation of the brain in a newborn are reflected in his mental and physical development. Hypoxia is fraught with complications at a later age.

When solving a mathematical problem or any other mental load, an increase in the speed parameters of blood flow through the cerebral arteries is observed. Thus, the regulation process is triggered by the need for more glucose and oxygen.

Why do newborns have problems with the blood supply to the brain

What is dangerous for the baby impaired blood supply to the head

The complexity of therapy lies in the fact that when prescribing drugs that improve blood circulation in the vessels of the brain, the doctor must take into account the effect of drugs on the still fragile structures of the child's life: the gastrointestinal tract, the nervous system, etc.

The consequence of a lack of blood supply is:

1. Weak concentration.
2. Problems in learning.
3. Borderline intellectual disability.
4. The development of hydrocephalus and cerebral edema.
5. Epilepsy.

How to check the blood supply to the brain

Any drugs, pills, injections and other drugs are prescribed only after a complete examination of the patient and the determination of the problem that has affected the deterioration of the blood supply to the brain.

How and how to improve cerebral circulation

What improves blood circulation, what drugs

New generation drugs are constantly emerging that have fewer negative side effects. Prescribes drug therapy exclusively by the attending physician. Self-medication is strictly prohibited!

How to improve blood flow without drugs

Folk remedies to improve blood supply to the brain

Herbs that improve blood flow can cause bleeding. Before taking herbal tinctures, it is recommended to consult with your doctor.

Breathing exercises to improve circulation

Like any effective remedy, exercise without proper supervision and preparation can be dangerous. The first lessons should be carried out together with the instructor.

Breathing exercises are present in yoga and other oriental gymnastics. Effective methods were also developed by compatriots. So, the Streltsova method deserves special mention, which allows you to quickly restore lost brain functions.

Exercises and gymnastics

The following types of gymnastics are optimally suited:

1. Yoga.
2. Qigong.
3. Pilates.
4. Pool activities, swimming.

Diet for poor cerebral circulation

What foods improve blood flow

1. Fatty fish.
2. Seafood.
3. Dairy.
4. Vegetables and fruits, especially rich in iron vitamins.

Food that is harmful to the blood supply to the brain

The following are subject to the ban:

1. Sugar.
2. Sweets and flour products.
3. Smoked and fatty foods.
4. Flavoring additives and synthetic seasonings.
5. Carbonated and alcoholic drinks.

Alcohol and cerebral circulation

Alcohol abuse is detrimental to a person. With prolonged abuse, there is a high probability of developing a hemorrhagic stroke, leading to death.

According to a recent study published in Stroke: Journal of the American Heart Association, moderate consumption improves blood flow, while excessive consumption causes brain cells to atrophy.

In newborns, there are two types of cerebrovascular accident: transient (without focal changes in the nervous tissue) and focal (accompanied by the appearance of a pathological focus). Focal disorders of cerebral circulation in the perinatal period are divided by nature into hemorrhages, ischemia (heart attacks) and hemorrhagic infarcts. Differential diagnosis should be carried out with congenital anomalies of the central nervous system and infectious diseases of the nervous system

Hypoxia (decreased oxygen concentration in the blood) and ischemia (decreased cerebral blood flow) can lead to temporary dysfunction of the central nervous system and cause chronic neurological disorders and developmental delay.

Severe hypoxic-ischemic encephalopathy may be a systemic disease syndrome triggered by asphyxia. Severe ischemic encephalopathy is accompanied by acidosis, ischemic lesions of the kidneys, myocardium, and gastrointestinal tract develop.

Clinic of ischemic encephalopathy

B) Moderate severity
(due to hypoperfusion of the brain against the background of arterial hypotension)
- poor sucking, swallowing, abnormal crying
- drowsiness, weak susceptibility to external stimuli
hypotension, decreased Moro reflex

It is caused by various methods: a blow to the surface on which the child lies, at a distance of 15 cm from his head, raising the extended legs and pelvis above the bed, sudden passive extension of the lower extremities. The newborn moves his arms to the sides and opens his fists - the 1st phase of the Moro reflex. After a few seconds, the hands return to their original position - phase II of the Moro reflex. The reflex is expressed immediately after birth, it can be observed during the manipulations of the obstetrician. In children with intracranial trauma, the reflex may be absent in the first days of life. With hemiparesis, as well as with obstetric paresis of the hand, an asymmetry of the Moro reflex is observed.

B) heavy
There are already signs of cerebral edema
- deep muscle hypotension
- loss of stem functions (pupillary reflex, spontaneous eye movements)
- increased intracranial pressure due to cerebral edema for more than 24-48 hours.

D) Seizures
Seizures associated with hypoxic-ischemic encephalopathy usually develop within 12-48 hours.
- epileptic nature (with changes in the EEG)
- not of an epileptic nature (no EEG changes)

Treatment of ischemic encephalopathy

The results of the course of cerebral ischemia in newborns

Hemorrhages in newborns according to localization are divided into subdural, subarachnoid, periventricular, intraventricular, parenchymal, cerebellar.

More common in premature babies (except subdural), accompanied by neurological symptoms (decrease in muscle tone, hyporeflexia, bradycardia, bradypnea, hypodynamia), tonic-clonic convulsions are possible. As the cerebral hemorrhage progresses, nystagmus appears, floating movements of the eyeballs, dysphagia, and cardiovascular and respiratory failure gradually increases. These symptoms are due to increasing compression of the trunk and outflow of the brain.

The diagnosis is verified by detecting blood in the cerebrospinal fluid. Localization of the focus can be established using electroencephalography of the brain and computed tomography of the brain.

Treatment (pathogenetic)
1. Dehydration of the nervous tissue and a decrease in intracranial pressure (mannitol, sorbatol, glycerol, lasix, dexamethasone)
2. Correction of hemostasis (vikasol, aminocaproic acid, calcium preparations)
3. Elimination and prevention of convulsive syndrome (droperidol, phenobarbital, diazepam in the absence of respiratory disorders)
4. Elimination of arterial hypotension and hypovolemia (hemodez, albumin)
5. Normalization of heart rate (sulfocamphocaine) and respiration (etimozol)
6. Reducing the permeability of the vascular wall (ascorbic acid, rutin, calcium gluconate)
7. Normalization of the metabolism of the nervous tissue and increasing its resistance to hypoxia (glucose, ATP, alpha-tocopherol, dibazol, sodium hydroxybutyrate, mexidol)

Insufficient nutrition of the brain is called circulatory disorders, which can be caused by various factors. Lack of timely therapeutic treatment can lead to irreversible consequences, up to death.

People at risk need to know the symptoms and treatment of cerebrovascular accident.

Show all

Causes of pathology

The most common cause of cerebrovascular accident is hypertension. Due to the increased level of pressure, the vessels undergo changes and lose their elasticity, which causes slow blood circulation. Even the slightest fluctuation in pressure leads to a disproportion between the need and the amount of blood delivered to the brain.

The second cause of the disease is atherosclerotic plaques in the vessels. They attach to the walls of arteries and veins, reduce their lumen, and when platelets settle on them, a blood clot is formed - a thrombus. The danger of blood clots is that, growing, they can completely block the blood flow, or, breaking off, clog the vessels in the brain, resulting in an acute cerebrovascular accident - a stroke.

Prolonged stress and chronic fatigue syndrome are also causes of the development of the disease in adulthood.

The blood circulation of the brain in children is disturbed much less frequently than in adults. This is due to the fact that atherosclerosis is extremely rare in childhood, their vessels are more elastic and not subject to changes that occur in hypertensive patients.

That is why the causes of cerebral circulatory disorders in children are different from those that provoke poor blood flow in adults.



The main causes of NCM are intrauterine fetal hypoxia, severe pregnancy, protracted labor, infections suffered by the mother during gestation. The blood circulation in the baby is affected by the mother's lifestyle during pregnancy: prolonged stress, bad habits, malnutrition. Also provoking factors are congenital diseases of the cardiovascular system, pathologies of the vessels of the brain and spinal cord, early arterial hypertension.

These causes can cause circulatory disorders in adulthood, but, as a rule, these conditions are detected at birth or in the first years of a child's life.

Cerebral circulation in children and adults is disturbed due to the following reasons:

• Heart failure, chronic diseases of the heart and blood vessels.
• Clamping of blood vessels by the cervical vertebrae.
• Traumatic brain injury, brain surgery.
• Vasomotor disorders of the nervous system.
• infectious vasculitis.
• Thrombophlebitis.
• Severe intoxication with medications and narcotic drugs.
• Diseases of the endocrine system.
• Systemic and rheumatoid diseases.
• Diabetes.
• Overweight.

Regardless of the cause of impaired circulation, lack of nutrition affects not only the brain, but also all organs and systems of the body. Therefore, it is important to eliminate provoking factors in a timely manner and take measures to improve blood flow.



Classification by type

Cerebral circulation disorders are divided into two types: chronic (HNMK) and acute (ONMK).

Chronic cerebrovascular accident develops slowly, gradually affecting the brain tissue, leading to disruption of its functions and irreversible damage. The main causes of its development are arterial hypertension, vascular atherosclerosis, heart failure.



Despite the fact that stroke is considered an "senile" disease, it also occurs in childhood. Among children with cerebrovascular accidents, about 7% had a stroke.

ONMK is divided into 2 types:

1. 1. Ischemic stroke - there is a blockage of the arteries of the brain, as a result, acute hypoxia occurs, necrotic lesions are formed, as a result of which brain cells die.
2. 2. Hemorrhagic stroke - there is a rupture of blood vessels in the tissues, hematomas are formed, pressing on the adjacent areas of the brain.

Separate from strokes, another type of acute disorder is distinguished - subarachnoid hemorrhage, in which there is a rupture of blood vessels between the membranes of the brain. Most often, all this type is caused by traumatic lesions of the cranium, less often by internal factors: aneurysm, vasculitis, chronic diseases of the vascular system.





General symptoms

Signs of cerebrovascular accident are classified into 2 types:

1. 1. Focal - these include hemorrhagic changes, infarction of cerebral vessels, hemorrhages between the membranes.
2. 2. Diffuse - characterized by minor hemorrhages, cysts, tumors, small necrotic foci.



Any of the pathologies associated with poor blood flow has its own special signs, but there are also general symptoms that are characteristic of all diseases:

• Impaired coordination.
• Sudden headaches.
• Dizziness.
• Numbness of limbs and face.
• Violation of cognitive functions.
• Decreased vision and hearing.
• Hyperexcitability, nervousness, outbursts of aggression.
• Decreased memory, intellectual abilities.
• Sensation of noise in the head.
• Fast fatiguability.
• Decreased performance.

These symptoms can appear both individually and in combination. And if three signs are observed at the same time, it is urgent to consult a doctor.

Symptoms of cerebrovascular accident of acute and chronic forms manifest themselves in different ways, so they should be considered separately.





Chronic circulatory disorders

Chronic NMC develops gradually, there are three stages of its progression with an increase in symptoms. For encephalopathy - an organic lesion of the brain, the following symptoms are characteristic:

1. 1. At the first stage, the manifestations are mild. First, there is rapid fatigue, headache and dizziness. The patient begins to sleep restlessly, becomes irritable and distracted, notices a memory disorder.
2. 2. At the second stage, coordination is disturbed: the gait becomes uncertain, shaky, hand tremors may be observed. Memory becomes even worse, concentration of attention decreases, forgetfulness and irritability progress.
3. 3. The third stage is characterized by noticeable disturbances in motor functions, unrelated speech, dementia develops.



Symptoms of encephalopathy in infants:

• Lack of sucking reflex.
• Disturbed sleep, causeless crying.
• Increased or decreased muscle tone.
• Disturbed heartbeat.
• Belated first cry.
• Strabismus.
• Hydrocephalus.

In older children, there is a reduced activity of the child, poor memory, delayed mental and speech development.

Also chronic disorders include cervical myelopathy, its three stages are accompanied by certain signs:

1. 1. The first or compensated stage is accompanied by increased fatigue, weakness and slight weakness in the muscles.
2. 2. At the subcompensated stage, muscle weakness progresses, reflexes and sensitivity decrease, muscle spasms occur.
3. 3. At the last stage, there are: paralysis, paresis, disruption of the organs, the almost complete absence of reflexes.



The disease may be accompanied by fever and fever. It is worth noting that the symptoms can manifest themselves in different ways, depending on the severity of the disease and the state of the human body. The presence of chronic pathologies contributes to a more rapid progression of CNMC.

Signs of an acute course of the disease

According to statistics, about 70% of patients did not feel the symptoms of a stroke, the only thing that felt tired and weak, but attributed this to general malaise. There is the concept of "microstroke", in which the patient feels a sharp headache, faints, feels numbness of the limbs, but does not attach any importance to this, especially since after rest the condition improves. And the patient does not even suspect that he has suffered a transient ischemic attack or a lacunar stroke that affects vessels of small diameter.



Transient ischemic attack is a violation of cerebral circulation with rapidly disappearing symptoms.

Symptoms of this condition:

• A sharp decrease in the clarity of speech.
• Strong headache.
• Visual impairment of a short duration.
• Loss of coordination.

With lacunar stroke, there are no pronounced symptoms, which is difficult to diagnose, and threatens with serious consequences.



What the patient may feel:

• Slight incoherence of speech.
• Movement disorders.
• Tremor of hands and chin.
• Involuntary movements of the hands.

These conditions require urgent medical intervention to avoid irreversible consequences.

With ischemic and hemorrhoidal stroke, the symptoms are more pronounced. The main signs are a sharp, often throbbing, headache, a distortion of the muscles of the face to one side, and a sharp violation of motor functions.

Other signs:

• Sharp pain on one side of the head.
• Dizziness.
• Expansion of one pupil (from the side of the stroke).
• Incoherent speech.
• Decreased vision, double vision.
• Numbness of the face or limbs.
• Nausea.
• Sharp weakness.

The severity of symptoms varies from person to person. Three tests can be performed to identify signs of acute circulatory disorders:

1. 1. Ask to smile.
2. 2. Raise both hands.
3. 3. Say your name.

With a stroke, the patient will not be able to smile evenly - the smile will be skewed, one arm will remain in place or will rise much more slowly. Speech will become slurred or disappear completely. The manifestation of these symptoms requires urgent hospitalization.

How to determine stroke in children?

The symptoms of stroke in children are similar to those in adults, but there are some special differences. You can suspect a stroke in newborns if you have the following signs:

• Cramps of the limbs.
• Swollen fontanel.
• Respiratory failure.
• Lag in development.
• Involuntary rhythmic eye movements.



The risk group includes children with intrauterine growth retardation, born in rapid labor, with congenital diseases of the heart and blood vessels.

In children of younger preschool age, the symptoms of a stroke are the same as in adults, but the difficulty in diagnosing is that babies cannot always complain of feeling unwell.

When to be concerned:

• Speech deteriorates sharply, or the child stops talking completely.
• There are involuntary movements of the limbs.
• One of the pupils is greatly dilated.
• Motor functions are impaired or completely absent.
• There is a hearing loss.
• The perception of speech is sharply reduced.
• The occurrence of seizures.
• Involuntary defecation and urination.



An older child may complain that his head hurts, he feels numbness in his arms or legs, he sees flies in front of his eyes. If these signs are present, parents should put the child to bed and call an ambulance.

Therapy Methods

Treatment of cerebrovascular accident requires a long time. Therapeutic actions are aimed at ensuring a normal level of blood circulation, normalizing blood pressure, lowering cholesterol levels, maintaining a normal amount of electrolytes, removing edema and eliminating the causes of the disease.

The first stage of inpatient care includes the removal of life-threatening conditions, intensive therapy is carried out with the help of painkillers, antioxidants, anticonvulsants.

What drugs are prescribed:

1. 1. If the cause of the disease is too thick blood and a tendency to thrombosis, anticoagulant drugs are prescribed: Curantil, Fragmin, Clexane, Curantil, Thrombo ACC. For children, Heparin injections are most often chosen.
2. 2. Calcium channel blockers - improve microcirculation, relax arteries, prevent the formation of blood clots. These include: Veropamil, Finoptin, Lomir, Gallopamil, Bepredil, Forid. Children these drugs are contraindicated, and they are prescribed only as a last resort.
3. 3. Antispasmodic drugs: Noshpa, Drotaverine hydrochloride. They relieve vascular spasms, due to which blood flow improves and blood pressure decreases.
4. 4. Vasoactive drugs inhibit platelets, dilate blood vessels and improve intercellular metabolism of the brain. Means of this group: Vasobral, Nicergoline, Sermion. In childhood, Cinnarizine, Vinpocetine, Eufillin.
5. 5. Neurotropic and nootropic drugs for children and adults are mandatory. They relieve the effects of hypoxia, improve intercellular metabolism, promote the formation of new vascular plexuses. In addition, they have a positive effect on cognitive functions, restore speech, memory, improve psycho-emotional mood. The most effective means: Cerebrolysin, Cortexin, Piracetam, Encephabol, Gliatilin, Mexidol, Pantogam.



Timely treatment of the chronic form will help to avoid complications and the occurrence of acute cerebrovascular accident. Unfortunately, in most cases, stroke leaves consequences, and requires constant supportive treatment.

In some cases, when blood circulation is disturbed, an operation is prescribed. The main indications for surgery:

1. 1. Extensive hemorrhages and hematomas.
2. 2. Blockage of blood vessels by thrombi and atherosclerotic plaques.
3. 3. Tumors and cysts of the brain.
4. 4. Damage to blood vessels.
5. 5. Lack of positive dynamics from conservative treatment.

There are several types of interventions, and the attending physician decides which one to choose based on the severity and cause of the disease. The prognosis after surgery is usually positive, provided that the patient complies with all recommendations during the rehabilitation period.



As a conclusion

In order for the treatment to have a positive effect, it is necessary to adhere to a healthy lifestyle, give up bad habits, and engage in physiotherapy exercises. You should give up junk and fatty foods, reduce stress and get more rest.

Impaired blood circulation of the brain is a disease that requires constant monitoring. If the patient has such a diagnosis in the anamnesis, he needs to visit a neurologist and a therapist twice a year, as well as undergo examinations: EEG, ECG, complete blood count, platelet count, vascular ultrasound, and others according to indications.

Cerebral circulation disorders (CVD) in children are much less common than in adults. In childhood, there is no atherosclerotic lesion of the cerebral vessels, there are no changes in the vessels characteristic of hypertension, the vessels of the brain are elastic, the outflow of blood from the cranial cavity is not disturbed. Thus, the causes of cerebral circulatory disorders in children differ from those in adults.

Etiology

Among the causes of vascular disorders in children are the following factors:

Diseases of the blood.

Traumatic lesions of blood vessels and its membranes.

Pathology of the heart and violation of its activity.

Infectious and allergic vasculitis (rheumatism).

Diseases with symptomatic arterial hypertension.

Vasomotor dystonia (angiospasm, perverse vascular reactivity).

Diseases of the endocrine organs.

Hypertonic disease.

Children's form of atherosclerosis of cerebral vessels.

Toxic lesions of the vessels of the brain and its membranes.

Compression of cerebral vessels with changes in the spine and tumors.

Congenital anomalies of cerebral vessels.

Various causative factors occur at different periods of a child's development with varying frequency. So, during the neonatal period, NMC are caused more often by intrauterine hypoxia in severe and complicated pregnancy, asphyxia during childbirth, and birth trauma. In the first year of life, NMC is caused by anomalies in the development of the vascular and cerebrospinal fluid systems; in preschool and school years, blood diseases, infectious-allergic vasculitis, heart defects are of particular importance; during puberty, early arterial hypertension is of particular importance.

The nature of cerebral vascular damage in children can be as follows:

Thrombosis of the vessel.

Embolism.

Reduced blood flow due to narrowing, bending, compression of the vessel by the tumor.

Rupture of the vascular wall in trauma, hemorrhagic diathesis, aneurysms.

Increased permeability of the vascular wall in inflammatory changes in blood vessels, blood diseases.

Pathogenesis

The basis of most vascular disorders of the brain is hypoxia - lack of oxygen in the tissues. The brain is extremely sensitive to oxygen depletion. The brain receives 15% of all blood per minute, and 20% of all blood oxygen. The cessation of blood flow in the brain for at least 5-10 minutes leads to irreversible consequences and the death of neurons.

As a result of hypoxia, the activity of many brain homeostasis systems is disturbed. The activity of the vasomotor center is disrupted, the regulation of the tone of the vessel wall is disrupted. Both cerebral vasodilation and vasospasm occur. As a result of hypoxia, incompletely oxidized products accumulate in the brain, and tissue acidosis develops. This, in turn, leads to aggravation of cerebrovascular accident. The permeability of blood vessels increases, blood plasma leaks outside the vascular wall, edema of the brain substance forms, venous congestion occurs, venous outflow from the cranial cavity is disturbed, which in turn increases perivascular edema.

Violation of cerebral circulation is accompanied by a violation of the activity of the cardiovascular system (cerebro-cardiac reflex and cardio-cerebral reflex). Central respiratory failure may occur, which exacerbates hypoxia.

If cerebral hypoxia is reversible, then they speak of transient ischemia, if the changes are irreversible, then a cerebral infarction occurs. Cerebral infarction may be in the form of white softening. When a diapedetic hemorrhage occurs, a red softening of the brain substance occurs. When blood vessels rupture, a hematoma type of hemorrhage occurs. Hematomas can be in the substance of the brain and under the membranes - subdural, epidural.

Violations of cerebral circulation are acute and chronic. Acute cerebrovascular insufficiency includes crises and strokes, chronic cerebrovascular insufficiency is of three degrees.

Cerebral vascular crises are temporary, reversible disorders of cerebral circulation, accompanied by reversible neurological symptoms. Crises often precede a stroke and are "signaling" disorders.

The clinical picture is dominated by cerebral symptoms:

1. Brief loss or confusion.

2. Headaches.

3. Dizziness.

4. Epileptiform seizures.

5. Vegetative disorders in the form of sweating, cold extremities, blanching or redness of the skin, changes in pulse and respiration.

The following focal symptoms may occur:

1. Hemiparesis.

2. Hemihypesthesia.

3. Facial asymmetries.

4. Diplopia.

5. Nystagmus.

6. Speech disorders.

Focal symptoms depend on the localization of discirculation. It keeps for several hours.

There are generalized and regional cerebral vascular crises.

Generalized vascular crises often develop against the background of an increase or decrease in blood pressure. At the same time, cerebral and vegetative symptoms predominate. Focal are expressed to a much lesser extent.

In case of regional vascular crises, discirculation develops in the basin of the carotid arteries or the vertebrobasilar system.

Discirculation in the basin of the carotid arteries is manifested by the following symptoms:

Transient hemiparesis and hemiplegia.

Hemihypesthesia.

Paresthesia.

Short-term speech disorders.

Visual disturbances.

Visual field disturbances.

With discirculation in the vertebrobasilar system, the following occurs:

Dizziness.

Nausea.

Noise in ears

Unsteadiness when walking.

Nystagmus.

Loss of vision.

Dyscirculatory disturbances in the IBS occur with a sharp change in the position of the head.

In childhood, the cause of paroxysmal disorders of cerebral circulation is the syndrome of vegetative dystonia with angiospastic disorders. It occurs more often in girls in puberty and manifests itself in the form of periodic attacks of headaches, dizziness, nausea, fainting. These conditions occur during excitement, overwork, in a stuffy room, with a sharp change in the position of the body. There is a poor tolerance to travel in transport. These children are characterized by pronounced vegetative symptoms, emotional lability, and unstable blood pressure.

Stroke is extremely rare in children. Most often, its cause at this age is thromboembolism with heart defects, hemorrhages with blood diseases.

There are ischemic and hemorrhagic strokes.

Ischemic stroke

There are acute and recovery stages of a stroke.

Ischemic stroke occurs as a result of thrombosis, embolism or vasoconstriction of the brain.

Thrombotic infarction develops gradually. Characterized by previous transient ischemic attacks, "flicker" of focal symptoms before the onset of cerebral infarction. Thrombotic infarction occurs with atherosclerosis of cerebral vessels.

The clinical picture of thrombosis is characterized by the following symptoms:

Paleness of the skin.

Consciousness is preserved.

Moderately expressed cerebral symptoms.

Focal neurological symptoms develop slowly.

Increased blood clotting is determined.

There is no blood in the cerebrospinal fluid.

Embolic cerebral infarction occurs in people with rheumatic heart disease, atrial fibrillation, lung diseases, and fractures of tubular bones.

Symptoms of embolic infarction:

Acute development (apoplectiform).

Pale or bluish complexion.

Normal or low blood pressure.

Atrial fibrillation.

Suddenly there are respiratory problems.

Focal neurological symptoms suddenly appear.

Hemorrhage in the brain is parenchymal (into the substance of the brain), subarachnoid, epidural, subdural, intraventricular.

Symptoms of hemorrhagic strokes are as follows:

Apoplectiform onset with acute development of cerebral coma.

Cyanosis and purple-red hue of the skin.

High BP.

Respiratory failure.

Leukocytosis in the blood.

Decrease in blood viscosity.

Decreased blood clotting properties.

Blood in the cerebrospinal fluid.

With a breakthrough of blood into the ventricular system, a special symptom appears - hormetonia. These are cramps in the limbs, which increase synchronously with breathing. Hormetonia is a prognostically unfavorable sign, tk. mortality in intraventricular hemorrhages reaches 95%.

Focal neurological symptoms in hemorrhagic strokes occur several days after the hemorrhage and depend on the pool of impaired circulation.

One of the complications in the occurrence of a stroke is the development of cerebral edema and herniation of the brain. A hernia occurs when the temporal lobe protrudes into the notch of the cerebellum. This results in compression of the midbrain. As a result, there may be a violation of the movements of the eyeballs and the development of vasomotor and respiratory disorders.

Subarachnoid hemorrhage occurs in children when an aneurysm of the vessels of the circle of Willis ruptures. The cause may be trauma, infectious lesions of the nervous system, hemorrhagic syndromes, blood diseases.

Symptoms of subarachnoid hemorrhage:

Sharp headache.

Seizures.

meningeal symptoms.

Psychomotor agitation.

A sharp rise in blood pressure.

Blood in the cerebrospinal fluid.

Signs of hemorrhage in the fundus.

Leukocytosis in the blood.

In the acute period of the disease includes activities:

Stabilization of the activity of the cardiovascular system.

Normalization of breathing.

Fight against cerebral edema.

Relief of epileptic seizures.

Regulation of acid-base balance.

General activities include the following measures:

Nursing.

Prevention of bedsores.

Prevention of pneumonia.

Prevention of thromboembolism.

Prevention of renal failure.

To normalize breathing, they resort to suction of mucus from the airways, intubation, and tracheostomy.

To normalize the activity of the cardiovascular system, cardiac glycosides (korglion, strophanthin, digoxin), potassium preparations, aminofillin, diuretics are used.

Of particular importance is the correction of blood pressure. With its sharp increase, rausedil, eufillin, dibazol, ganglioblockers are prescribed. With a decrease in blood pressure, vasotonic agents (norepinephrine, adrenaline, mezaton, cordiamin), glucocorticosteroid hormones (prednisolone, hydrocortisone) are prescribed, solutions are administered.

To combat cerebral edema, dehydrating drugs (lasix, uregit, glycerin, mannitol) are prescribed.

With ischemic strokes, differentiated treatment is carried out:

Vasodilators (eufillin, complamin, no-shpa).

Anticoagulants for embolic strokes (heparin, warfarin).

Antiplatelet agents (chimes, aspirin, plavix).

Thrombolytic drugs in the first 3-6 hours of a stroke (streptolysin, tissue plasminogen activator).

In the treatment of hemorrhagic strokes, the following treatment is carried out:

Aminocaproic acid.

Dicynon.

Vikasol.

In the recovery stage, treatment is carried out aimed at restoring lost functions:

Massage.

Physiotherapy.