home Audience 5 Consequences of damage to the central nervous system in newborns. Hypoxic ischemic damage to the central nervous system

Consequences of damage to the central nervous system in newborns. Hypoxic ischemic damage to the central nervous system

The central nervous system is precisely the mechanism that helps a person grow and navigate in this world. But sometimes this mechanism malfunctions and “breaks.” It is especially scary if this happens in the first minutes and days of a child’s independent life or even before he is born. We will talk about why a child’s central nervous system is affected and how to help the baby in this article.

What it is

The central nervous system is a close “ligament” of two important links - the brain and spinal cord. Main function, which nature assigned to the central nervous system - providing reflexes, both simple (swallowing, sucking, breathing) and complex. The central nervous system, or rather, its middle and lower sections, regulate the activities of all organs and systems, ensure communication between them. The highest section is the cerebral cortex. It is responsible for self-awareness and self-awareness, for a person’s connection with the world, with the reality surrounding the child.

Disorders, and consequently, damage to the central nervous system, can begin during the development of the fetus in the mother’s womb, or can occur under the influence of certain factors immediately or some time after birth.

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

Causes

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

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

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

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

Pathologies of pregnancy. The state of the child’s central nervous system is influenced by a variety of features of the gestation period - polyhydramnios and oligohydramnios, pregnancy with twins or triplets, placental abruption and other reasons.
Severe genetic diseases. Typically, pathologies such as Down and Edwards syndromes, trisomy and a number of others are accompanied by significant organic changes in the central nervous system.

At the current level of development of medicine, CNS pathologies become obvious to neonatologists already in the first hours after the baby is born. Less often - in the first weeks.

Sometimes, especially with organic lesions of mixed origin, the real reason it is impossible to establish, especially if it is related to the perinatal period.

Classification and symptoms

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

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

Easy. This degree is manifested by a slight increase or decrease in the baby’s muscle tone, and convergent strabismus may be observed.

Average. With such lesions, muscle tone is always reduced, reflexes are completely or partially absent. This condition is replaced by hypertonicity and convulsions. Characteristic oculomotor disturbances appear.
Heavy. Not only motor function and muscle tone suffer, but also internal organs. If the central nervous system is severely depressed, convulsions of varying intensity may begin. Problems with cardiac and renal activity can be severe, as well as the development respiratory failure. The intestines may be paralyzed. The adrenal glands do not produce the necessary hormones in the required quantities.

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

Hypoxic (ischemic, intracranial hemorrhages, combined).
Traumatic (birth injuries of the skull, birth spinal lesions, birth pathologies of peripheral nerves).
Dysmetabolic (kernicterus, excess levels of calcium, magnesium, potassium in the child’s blood and tissues).
Infectious (consequences of infections suffered by the mother, hydrocephalus, intracranial hypertension).

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

Ischemic lesions. The most “harmless” disease is grade 1 cerebral ischemia. With it, the child demonstrates central nervous system disorders only in the first 7 days after birth. The reason most often lies in fetal hypoxia. At this time, the baby can observe relatively mild signs of excitement or depression of the central nervous system.
The second degree of this disease is diagnosed when if disturbances and even seizures last more than a week after birth. We can talk about the third degree if the child has constantly increased intracranial pressure, frequent and severe convulsions are observed, and there are other autonomic disorders.

Typically, this degree of cerebral ischemia tends to progress, the child’s condition worsens, and the baby may fall into a coma.

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

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

Traumatic lesions, birth injuries. If during the birth process doctors had to use forceps on the baby’s head and something went wrong, if acute hypoxia occurred, then most often this is followed by a cerebral hemorrhage. During birth trauma, the child experiences convulsions to a more or less pronounced degree, the pupil on one side (the one where the hemorrhage occurred) increases in size. Main sign traumatic damage to the central nervous system - increased pressure inside the child’s skull. Acute hydrocephalus may develop. The neurologist testifies that in this case the central nervous system is more often excited than depressed. Not only the brain, but also the spinal cord can be injured. This most often manifests itself as sprains, tears, and hemorrhage. In children, breathing is impaired, hypotension of all muscles, and spinal shock are observed.
Dysmetabolic lesions. With such pathologies, in the vast majority of cases, the child has increased blood pressure, seizures, consciousness is quite clearly depressed. The cause can be determined by blood tests that show either a critical deficiency of calcium, or a lack of sodium, or another imbalance of other substances.

Periods

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

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

Restorative. It can be early or late. If the baby is aged 2-4 months, then they talk about early recovery, if he is already from 5 to 12 months, then about late recovery. Sometimes parents notice disturbances in the functioning of the central nervous system in their baby for the first time in the early period. At 2 months, such toddlers hardly express any emotions and are not interested in bright hanging toys. In the late period, the child noticeably lags behind in his development, does not sit, does not walk, his cry is quiet and usually very monotonous, without emotional coloration.
Consequences. This period begins after the child turns one year old. At this age, the doctor is able to most accurately assess the consequences of a central nervous system disorder in this particular case. Symptoms may disappear, but the disease does not go away. Most often, doctors make such verdicts per year on such children as hyperactivity syndrome, developmental delay (speech, physical, mental).

The most severe diagnoses that can indicate the consequences of central nervous system pathologies are hydrocephalus, cerebral palsy, epilepsy.

Treatment

We can talk about treatment when lesions of the central nervous system are diagnosed with maximum accuracy. Unfortunately, in modern medical practice, there is a problem of overdiagnosis, in other words, every baby whose chin trembles during a monthly examination, who eats poorly and sleeps restlessly, can easily be diagnosed with “cerebral ischemia.” If a neurologist claims that your baby has lesions of the central nervous system, you should definitely insist on a comprehensive diagnosis, which will include ultrasound of the brain (through the fontanelle), computed tomography, and special cases- and x-ray of the skull or spine.

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

Treatment usually uses drugs that improve blood flow and blood supply to the brain - large group nootropic drugs, vitamin therapy, anticonvulsants.

Only a doctor can give an exact list of medications, since this list depends on the causes, degree, period and depth of the lesion. Drug treatment for newborns and infants is usually provided in a hospital setting. After relief of symptoms, the main stage of therapy begins, aimed at restoring proper functioning of the central nervous system. This stage usually takes place at home, and parents bear a great deal of responsibility for following numerous medical recommendations.

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

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

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

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

Consequences and forecasts

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

At severe forms the forecasts are not so optimistic. The child may remain disabled, and deaths cannot be ruled out. early age. Most often, lesions of the central nervous system of this type lead to the development of hydrocephalus, cerebral palsy, epileptic seizures. As a rule, some internal organs also suffer; the child simultaneously experiences chronic diseases of the kidneys, respiratory and cardiovascular systems, and marbled skin.

Prevention

Prevention of pathologies from the central nervous system in a child is the task of the expectant mother. At risk are women who do not give up bad habits while carrying a baby - smoking, drinking alcohol or using drugs.

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

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

This will avoid metabolic disorders in the baby. You should be especially careful when choosing a maternity home (the birth certificate that all pregnant women receive allows you to make any choice). After all, the actions of personnel during the birth of a child play a large role in the possible risks of traumatic lesions of the central nervous system in the baby.

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

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

This diagnosis is currently one of the most common. Organic damage to the central nervous system (CNS) in its classical content is a neurological diagnosis, i.e. is under the purview of a neurologist. But the symptoms and syndromes accompanying this diagnosis can relate to any other medical specialty.

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

Causes organic lesions divided into congenital and acquired. Congenital cases include cases when during pregnancy the mother of the unborn child suffered some kind of infection (acute respiratory infection, flu, sore throat, etc.), took certain medications, alcohol, or smoked. A unified blood supply system will bring stress hormones into the fetus’s body during periods of psychological stress of the mother. In addition, sudden changes in temperature and pressure, exposure to radioactive substances and x-rays, toxic substances dissolved in water, contained in the air, in food, etc., also affect.

There are several particularly critical periods when even a slight external impact on the mother’s body can lead to the death of the fetus or cause such significant changes in the structure of the body (and, including the brain) of the future person that, firstly, no medical intervention is possible correct, and secondly, these changes can lead to the early death of a child before the age of 5 - 15 (and usually the mother reports this) or cause disability from a very early age. And in the best case, they lead to severe brain deficiency, when even at maximum stress the brain is able to work at only 20-40 percent of its potential power. Almost always, these disorders are accompanied by varying degrees of disharmony. mental activity when, with reduced mental potential, positive character traits are not always sharpened.

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

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

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

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

The central nervous system regulates the functioning of all internal organs. And if it does not work fully, then the other organs, even with the most careful care for each of them separately, will not be able, in principle, to work normally if they are poorly regulated by the brain. One of the most common diseases of our time, vegetative-vascular dystonia, against the background of organic matter, acquires a more severe, peculiar and atypical course. And thus, not only does it cause more trouble, but these “troubles” themselves are more malignant in nature. The physical development of the body comes with any disturbances - there may be a violation of the figure, a decrease in muscle tone, a decrease in their resistance to physical activity even of moderate size. The likelihood of increased intracranial pressure increases by 2-6 times. This can lead to frequent headaches and various kinds of unpleasant sensations in the head area, reducing the productivity of mental and physical labor by 2-4 times. The likelihood of endocrine disorders also increases, increasing by 3-4 times, which leads to diabetes mellitus with minor additional stress factors, bronchial asthma, imbalances of sex hormones with subsequent disruption of the sexual development of the body as a whole (an increase in the amount of male sex hormones in girls and female hormones in boys), the risk of a brain tumor increases, convulsive syndrome(local or general convulsions with loss of consciousness), epilepsy (group 2 disability), disorders cerebral circulation in adulthood in the presence of hypertension of even moderate severity (stroke), diencephalic syndrome (attacks causeless fear, various expressed discomfort in any part of the body, lasting from a few minutes to several hours). Over time, hearing and vision may decrease, coordination of movements of a sports, household, aesthetic and technical nature may be impaired, complicating social and professional adaptation.

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

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Damage to the nervous system in newborns can occur both in utero (prenatal) and during childbirth (intrapartum). If harmful factors act on a child at the embryonic stage of intrauterine development, severe, often incompatible with life, defects occur. Damaging influences after 8 weeks of pregnancy can no longer cause gross deformities, but sometimes manifest themselves as small deviations in the formation of the child - stigmas of disembryogenesis.

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

A child can be adversely affected by various acute or chronic diseases of the mother, work in hazardous chemical industries or work associated with various radiations, as well as bad habits of parents - smoking, alcoholism, drug addiction.

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

Childbirth is a very important event for a child. Particularly great trials befall the baby if the birth occurs prematurely (prematurity) or rapidly, if labor weakness occurs or ruptures early amniotic sac and the waters run out when the baby is very large and they help him to be born special techniques, tongs or vacuum extractor.

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

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

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

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

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

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

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

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

The functioning of the brain largely depends on the state of the cerebral blood supply.

Weakness is often the root cause of such injuries. labor activity in a woman. In such cases, forced labor stimulation changes the mechanism of fetal passage through the birth canal. With such stimulated childbirth, the child is born not gradually, adapting to the birth canal, but quickly, which creates conditions for displacement of the vertebrae, spraining and tearing of ligaments, dislocations, and cerebral blood flow is disrupted.

Traumatic injuries to the central nervous system during childbirth most often occur when the size of the child does not correspond to the size of the mother’s pelvis, when the fetus is in an incorrect position, during birth in the breech presentation, when premature, low-weight children are born and, conversely, children with a large body weight, large size, because In these cases, various manual obstetric techniques are used.

When discussing the causes of traumatic lesions of the central nervous system, we should separately focus on childbirth using superimposition obstetric forceps. The fact is that even if the forceps are applied to the head flawlessly, intense traction on the head follows, especially when trying to help the birth of the shoulders and torso. In this case, all the force with which the head is pulled is transmitted to the body through the neck. For the neck, such a huge load is unusually large, which is why when removing a baby using forceps, along with brain pathology, damage to the cervical portion of the spinal cord occurs.

Special attention deserves the question of injuries to the child that occur during a caesarean section. Why is this happening? Indeed, it is not difficult to understand the trauma of a child as a result of passing through the birth canal. Why does a cesarean section, designed to bypass these paths and minimize the possibility of birth trauma, end in birth trauma? Where do such injuries occur during a caesarean section? The fact is that the transverse incision during a caesarean section in the lower segment of the uterus should theoretically correspond to the largest diameter of the head and shoulders. However, the circumference obtained with such an incision is 24-26 cm, while the circumference of the head of an average child is 34-35 cm. Therefore, removing the head and especially the shoulders of the child by pulling the head with an insufficient incision of the uterus inevitably leads to injury to the cervical spine. That is why the most common cause of birth injuries is a combination of hypoxia and damage to the cervical spine and the spinal cord located in it.

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

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

When a baby is born with central nervous system damage, the condition can be severe. This is an acute period of illness (up to 1 month), followed by an early recovery period (up to 4 months) and then a late recovery period.

Important To prescribe the most effective treatment for CNS pathology in newborns, it has a definition of the leading set of signs of the disease - neurological syndrome. Let's consider the main syndromes of CNS pathology.

Main syndromes of central nervous system pathology

Hypertensive-hydrocephalic syndrome

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

In hypertensive-hydrocephalic syndrome, either hydrocephalus, manifested by expansion of the ventricular system of the brain, or hypertension syndrome with increased intracranial pressure may predominate. When increased intracranial pressure predominates, the child is restless, easily excitable, irritable, often screams loudly, sleeps lightly, and the child often wakes up. When hydrocephalic syndrome predominates, children are inactive, lethargy and drowsiness, and sometimes developmental delays are noted.

Often, when intracranial pressure increases, children goggle their eyes, Graefe’s symptom periodically appears (a white stripe between the pupil and upper eyelid), and in severe cases there may be a “setting sun” symptom, when the iris of the eye, like the setting sun, is half immersed under the lower eyelid; sometimes convergent strabismus appears, the baby often throws his head back. Muscle tone can be either decreased or increased, especially in the leg muscles, which is manifested by the fact that when supporting oneself, one stands on tiptoes, and when trying to walk, one crosses the legs.

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

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

Movement disorder syndrome

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

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

Secondly, assessing muscle tone in various groups muscles. The doctor uses special techniques to identify a decrease or increase in muscle tone in order to choose the right treatment.

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

With increased muscle tone in the hands, the development of grasping ability of the hands is delayed. This is manifested by the fact that the child takes the toy late and grasps it with his entire hand; fine movements with the fingers are formed slowly and require additional training sessions with the child.

With an increase in muscle tone in the lower extremities, the child later stands on his legs, while relying mainly on the forefoot, as if “standing on tiptoes”; in severe cases, a crossing of the lower extremities occurs at the level of the shins, which prevents the formation of walking. In most children, over time and thanks to treatment, it is possible to reduce muscle tone in the legs, and the child begins to walk well. Like a memory of increased tone muscles may leave a high arch of the foot, which makes choosing shoes difficult.

Autonomic-visceral dysfunction syndrome

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

Convulsive syndrome

The tendency to convulsive reactions during the neonatal period and in the first months of a child’s life is due to the immaturity of the brain. Convulsions occur only in cases of spread or development of a disease process in the cerebral cortex and have many of the most various reasons which the doctor must identify. This often requires an instrumental study of the brain (EEG), its blood circulation (Dopplerography) and anatomical structures(ultrasound of the brain, computed tomography, NMR, NSG), biochemical studies.

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

Convulsions are also different in nature: they can be tonic, when the child seems to stretch out and freeze for a short time in a certain position, as well as clonic, in which twitching of the limbs and sometimes the entire body occurs, so that the child can be injured during convulsions .

There are many variants of manifestations of seizures, which are identified by a neuropathologist based on the story and description of the child’s behavior by attentive parents.

lyami. Correct positioning diagnosis, that is, determining the cause of a child’s seizure, is extremely important, since the timely prescription of effective treatment depends on this.

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

Symptoms that should be addressed to a pediatric neurologist

To summarize all that has been said, let us briefly list the main deviations in the health status of children, for which it is necessary to contact a pediatric neurologist:

If the baby sucks sluggishly, takes breaks, and gets tired. There is choking and leakage of milk through the nose;

If the newborn burps frequently and does not gain enough weight;

If the child is inactive, lethargic or, on the contrary, too restless and this restlessness intensifies even with minor changes environment;

If the child has trembling of the chin, as well as the upper or lower extremities, especially when crying;

If the child often shudders for no reason, has difficulty falling asleep, and the sleep is superficial and short in duration;

If the child constantly throws his head back while lying on his side;

If there is too rapid or, conversely, slow growth in head circumference;

If reduced physical activity a child if he is very lethargic and the muscles are flabby (low muscle tone), or, conversely, the child seems to be constrained in his movements (high muscle tone), so even swaddling is difficult;

If one of the limbs (arm or leg) is less active in movements or is in an unusual position (clubfoot);

If a child squints or goggles, a white stripe of sclera is periodically visible;

If the baby constantly tries to turn his head in only one direction (torticollis);

If the hip extension is limited, or, conversely, the child lies in a frog position with the hips separated by 180 degrees;

If the child was born by caesarean section or in a breech presentation, if obstetric forceps were used during childbirth, if the baby was born prematurely or with a large weight, if the umbilical cord was entangled, if the child had convulsions in the parental home.

Accurate diagnosis and timely and correctly prescribed treatment of nervous system pathology are extremely important. Damages to the nervous system can be expressed to varying degrees: in some children they are very pronounced from birth, in others even severe disturbances gradually decrease, but do not disappear completely, and mild manifestations remain for many years - these are the so-called residual phenomena.

Late manifestations of birth trauma

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

What are the signs of these consequences?

Most children with late manifestations show a marked decrease in muscle tone. Such children are credited with “innate flexibility,” which is often used in sports, gymnastics, and even encouraged. However, to the disappointment of many, it should be said that extraordinary flexibility is not the norm, but, unfortunately, a pathology. These children easily fold their legs into the “frog” pose and do the splits without difficulty. Often such children are gladly accepted into rhythmic or artistic gymnastics sections and choreographic clubs. But most of them cannot bear the heavy workload and eventually drop out. However, these activities are enough to develop a spinal pathology - scoliosis. It is not difficult to recognize such children: they often clearly exhibit protective tension in the cervical-occipital muscles, they often have mild torticollis, their shoulder blades stick out like wings, the so-called “wing-shaped shoulder blades,” they can stand at different levels, like their shoulders. In profile, it is clear that the child has a sluggish posture and a stooped back.

By the age of 10-15, some children with signs of trauma to the cervical spine in the neonatal period develop typical signs of early cervical osteochondrosis, the most characteristic symptom of which in children is headaches. The peculiarity of headaches with cervical osteochondrosis in children is that, despite their different intensity, the pain is localized in the cervical-occipital region. As you grow older, the pain often becomes more pronounced on one side and, starting in the occipital region, spreads to the forehead and temples, sometimes radiating to the eye or ear, intensifying when turning the head, so that a short-term loss of consciousness may even occur.

A child’s headaches are sometimes so intense that they can deprive him of the ability to study, do anything around the house, and force him to go to bed and take analgesics. At the same time, some children with headaches exhibit a decrease in visual acuity - myopia.

Treatment for headaches, aimed at improving blood supply and nutrition to the brain, not only relieves headaches, but also improves vision.

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

In some children, enuresis - urinary incontinence - can also be a consequence of birth trauma - just like epilepsy and other convulsive conditions in children.

As a result of hypoxic injury to the fetus in the perinatal period, the brain is primarily affected, and the normal course of maturation is disrupted functional systems brain, which ensure the formation of such complex processes and functions of the nervous system, such as stereotypes of complex movements, behavior, speech, attention, memory, perception. Many of these children show signs of immaturity or disorders of certain higher mental functions. The most common manifestation is the so-called active attention deficit hyperactivity disorder and hyperactive behavior syndrome. Such children are extremely active, disinhibited, uncontrollable, they lack attention, they cannot concentrate on anything, they are constantly distracted, and cannot sit still for several minutes.

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

Such a child is difficult for both parents and teachers. Behavioral and school problems grow like a snowball. During adolescence, these children have a significantly increased risk of developing persistent behavioral disorders, aggressiveness, difficulties in relationships in the family and school, and deterioration in school performance.

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

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

Back in 1945, the domestic obstetrician Professor M.D. Gütner rightly called birth injuries to the central nervous system “the most common folk disease».

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

One conclusion must be drawn - to be attentive to the health of the baby from the moment of conception, to eliminate, if possible, all harmful effects on his health in a timely manner, and even better, to prevent them altogether. If such a misfortune occurs and a pathology of the nervous system is detected in the child at birth, it is necessary to contact a pediatric neurologist in time and do everything possible to ensure that the baby makes a full recovery.

Central nervous system diseases include a variety of underlying causes and symptoms. This is due to the fact that the human central nervous system is characterized by its branching. Each part of it represents a unique structure. Any changes in the functionality of the nervous system can affect the entire body as a whole.

Common CNS diseases

Today, there are about 30 main diseases associated with the central nervous system. Some of them are extremely rare, while others are quite common.

Main diseases of the central nervous system:

Arachnoiditis. The disease is represented by an inflammatory process involving the arachnoid membrane of the brain.
Insomnia.
Parkinson's disease. It is a slow but progressive condition characterized by inhibited movements and muscle rigidity.
Increased intracranial pressure.
Hemorrhagic stroke. This condition is characterized by impaired blood circulation in the brain, resulting in rupture of blood vessels and hemorrhage.
Headache.
Cerebral palsy. This disease is associated with, which does not progress.
Ischemic stroke. Characterized by acute cerebrovascular accident.
Sciatica.
Lumbago. Painful lumbago localized in the lumbar region.
Meningitis. Inflammation involving the lining of the brain.
Myasthenia. A condition characterized by pathological fatigue is capable of progression.
Migraine. This is an attack of acute headache that may be accompanied by nausea and vomiting.
Myelitis. This disease is infectious and affects the spinal cord.
Myopathies.
Muscle tone disorders in children.
Neuralgia. It affects the peripheral nerve.
Neuritis.
Neuropathy.
Radiculitis.
Multiple sclerosis.
Encephalitis.

These diseases arise due to damage to one or another part of the nervous system. Each disease is characterized by its own unique symptoms and requires a special approach.

Types of CNS diseases

All diseases associated with the human nervous system are divided into several types:

vascular;
infectious;
chronic;
hereditary;
traumatic.

Vascular diseases are among the most dangerous diseases. They can make a person disabled and lead to death. This category includes circulatory disorders in the brain. The most common type is ischemic stroke.

Infectious diseases. They develop as a result of entering the body pathogenic microorganisms. The human brain and nervous system come under their negative influence. Today, encephalitis has become particularly widespread.

Chronic diseases develop due to damage to the nervous system by infections. Particularly widespread are myasthenia gravis and sclerosis. The course of the disease is long-term, and the damage is systemic in nature.

Hereditary diseases are related to chromosomes. People suffering from these ailments are characterized by dementia and musculoskeletal disorders. It falls into this category.

Traumatic injuries develop as a result of injuries and bruises. A concussion falls into this category.

Today, the following diseases of the nervous system are more common:

Below will be presented detailed information about every disease.

Cerebral palsy (CP)

Cerebral palsy is an inability to further progression. The disease develops due to intrauterine developmental disorders. It is possible that during pregnancy the expectant mother experienced late toxicosis, a herpetic virus or toxoplasmosis.

Difficult childbirth and birth trauma can affect the development of cerebral palsy. All this causes oxygen starvation in the child. As a result of this process, the development of parts of the brain occurs. Today it is possible to accurately determine the cause of the appearance cerebral palsy impossible.

The disease can be detected in the first minutes of a baby’s life. Symptoms depend on the severity of the lesion. Typically, the child has a delay in movement, he cannot hold his head well and he is constantly overcome by convulsions. If these symptoms appear, you should immediately go to see a doctor.

At cerebral palsy child develops slowly and has poor motor activity. It is impossible to put the baby on his feet; he cannot stand on his entire foot. Increased muscle tone can completely immobilize the child. The baby is developmentally delayed and difficult to train.

Meningitis and ischemic stroke

This disease is characterized by inflammation of the meninges. It can be infectious, microbial and traumatic. Tuberculosis of the central nervous system falls into this category. For any type of meningitis, meningeal syndrome. It is characterized by a persistent increase in intracranial pressure. A person is pestered by a strong headache accompanied by a feeling of pressure on the eyes and ears. Symptoms are often accompanied by nausea, vomiting and increased irritability to light and sounds. Meningitis is characterized acute onset. The increase in body temperature occurs instantly.

Primary meningitis can occur due to pathogenic exposure harmful microorganisms. They can develop against the background of chickenpox, herpes and rubella. Often bacterial meningitis flares up in places of localization large quantity of people. It is transmitted mainly by airborne droplets.

Secondary meningitis. May develop against the background of sinusitis, boils located on the face, and acute otitis. It is often provoked by a lung abscess and frontal sinusitis.

This disease in any form requires immediate treatment. Tuberculosis of the meninges and central nervous system can be fatal.

Ischemic stroke is the most common cerebrovascular disease, accompanied by the development of disability and the occurrence of fatal outcome. Ischemic stroke is an acute circulatory disorder in the brain. Occurs in 85% of all cases. The disorder is divided into hemodynamic and lacunar strokes.

The first type is characterized by the occurrence of prolonged spasm cerebral vessels. This happens due to the lack of necessary nutrients. A stroke can develop due to high blood pressure.

Lacunar type occurs due to motor or sensory impairment. Atherosclerosis, hypertension and blood diseases can provoke a stroke.

The symptoms of a stroke should be known to every person. It is characterized by numbness of a part of the body, severe headache, nausea and vomiting. Speech is often impaired and a person’s smile is distorted. If these symptoms appear, you should immediately call an ambulance. Hospitalization of the victim should occur no later than 2 hours.

Neuralgia and migraine

Neuralgia is damage to a peripheral nerve. This condition is characterized by the appearance of acute, burning and unbearable pain at the site of the lesion.

Neuralgia can occur against the background of hypothermia, persistent inflammatory diseases, injuries and tumors. Demyelinating processes lead to the disease.

A migraine is a severe pain attack that affects part of the head. The temporal region is most often affected. Strong pain syndrome accompanied by nausea and vomiting. Irritability to light and sounds is often noted. Migraine attacks most often affect young women aged 25-35 years. The mechanism of development of the disease is not known to this day.

Provoking factors can be severe physical and emotional overload. The development of the process is influenced strong odors, loud sounds and overheating in the sun. Migraines often occur due to alcohol consumption, poor nutrition. Women are susceptible to this effect during menstruation and while using hormonal contraceptives. People whose activities are of an active social nature are also susceptible to the disease.

Myasthenia gravis and encephalitis

Myasthenia gravis is autoimmune disease, which is characterized by disruption of the functioning of neuromuscular junctions. During of this disease the immune system a person begins to produce antibodies that work against their own body.

Women are susceptible to this disease; a special peak of development is observed at the age of 20-40 years. The main symptoms are muscle weakness of the eyes, double vision and excessive fatigue after physical work.

In 40% of cases, the eye muscles are affected; over time, the symptoms are supplemented by speech and swallowing disorders. Weakness in the limbs often occurs.

The body’s own antibodies, which begin to be produced and act against itself, can lead to the development of myasthenia gravis. A woman suffering from this disease can pass it on to her baby through the placenta.

Encephalitis is an inflammatory disease of the brain. The causative agent of the disease is a filterable virus. To date, it has not been identified. Encephalitis is transmitted by airborne droplets. The acute stage is characterized by damage to the basal ganglia. Chronic course promotes the development of toxic-degenerative process.

The acute stage is characterized by periods of drowsiness and insomnia. The development of vestibular problems is possible. A person is plagued by attacks of dizziness, nausea and vomiting. Malaise with elevated body temperature is often observed.

The chronic stage is characterized by parkinsonism and sleep disorders. The person’s movements are constrained, and there is tremors in the limbs. The speech is quiet, a mental disorder is possible.

Methods for eliminating diseases and their prevention

Treatment of the central nervous system depends on the type of disease and symptoms manifested. In most cases, intensive care is necessary. It is carried out exclusively in a hospital setting.

If you have ailments such as migraines or severe headaches, you should use both painkillers and sedatives.

Treatment must necessarily have a complex course.

Special medications aimed at improving metabolic processes in the brain.

Tumors of the central nervous system are removed by surgical intervention. In addition to surgery, chemotherapy is used to reduce the size of the tumor.

Injuries to the central nervous system are eliminated depending on their complexity. Therapy in this case is aimed at restoring normal performance. Treatment is often complemented by psychotherapy.

Correct preventive measures will help you avoid central nervous system diseases. The first step is to start treating infections in the body on time. They are able to penetrate parts of the nervous system and lead to disruption of their performance. You should lead a healthy lifestyle by eliminating bad habits, in particular smoking, alcohol and drug use. Human nutrition must be complete. Compliance with sleep and wakefulness is an important preventive criterion. It is necessary to avoid stressful situations and be less nervous. Correct prevention and timely treatment of diseases will avoid serious consequences for the body.

From this article you will learn the main symptoms and signs of damage to the nervous system in a child, how damage to the central nervous system in a child is treated, and what causes perinatal damage to the nervous system in a newborn.

Treatment of nervous system damage in a child

Some children are so worried on the eve of exo-amen that they literally get sick.

Drugs for the treatment of the nervous system

Anacardium is a drug for the treatment of the nervous system.

As soon as a child sits down to write, he loses all self-confidence and remembers absolutely nothing.

Argentum nitricum is a drug for the treatment of the nervous system.

On the eve of the exam, the child is hurried, excited, irritable and nervous.
Diarrhea on the eve of an exam.
The child may ask for sweets.

Gelsemium is a drug for the treatment of the nervous system.

Weakness and trembling on the eve of an important event or exam.
Diarrhea is possible.

Picric acid is a drug for the treatment of the nervous system.

For good students who have studied hard but can no longer continue teaching - they would even like to throw away their textbooks.
The child is afraid that he will forget everything during the exam.
The child is very tired from studying.

Potential and number of doses:

One dose of 30C the evening before the exam, one in the morning and one just before the exam.

Symptoms of nervous system damage in a child

Most diseases of the nervous system at an early age are accompanied by delayed psychomotor development. When diagnosing them, the assessment of the presence of neurological syndromes, as well as the identification of lesions of the nervous system, is of key importance.

Hypoexcitability syndrome - a symptom of damage to the nervous system

Hypoexcitability syndrome is characterized by low motor and mental activity of the child, prolonged latent period the occurrence of all reflexes (including congenital ones), hyporeflexia, hypotension. The syndrome occurs predominantly due to dysfunction of the diencephalic-limbic parts of the brain, which is accompanied by vegetative-visceral disorders.

Hypoexcitability syndrome develops with perinatal brain damage, some hereditary and congenital diseases (Down's disease, phenylketonuria, etc.), metabolic disorders (hypoglycemia, metabolic acidosis, hypermagnesemia, etc.), as well as with many severe somatic diseases.

Hyperexcitability syndrome - a symptom of damage to the nervous system

Hyperexcitability syndrome is characterized by motor restlessness, emotional lability, sleep disturbance, strengthening of innate reflexes, lowering the threshold of convulsive readiness. It is often combined with increased muscle tone and rapid neuropsychic exhaustion. Hyperexcitability syndrome can develop in children with perinatal pathology of the central nervous system, some hereditary fermentopathies, and metabolic disorders.

Syndrome intracranial hypertension- a symptom of damage to the nervous system

The syndrome is characterized by increased intracranial pressure, often combined with dilation of the cerebral ventricles and subarachnoid spaces. In most cases, there is an increase in the size of the head, divergence of cranial sutures in infants, bulging and enlargement of the large fontanel, disproportion between the brain and facial departments skull (hypertensive-hydrocephalic syndrome).

The cry of such children is piercing, painful, “cerebral.” Older children often complain of a symptom such as headache, although this complaint is not specific to of this syndrome. Damage to the VI pair of cranial nerves, the “setting sun” symptom (the appearance of a clearly defined strip of sclera between the upper eyelid and the iris, which creates the impression of the eyeball “falling down”), spastic tendon reflexes are late symptoms of persistent intracranial hypertension.

When percussing the skull, the sound of a “cracked pot” is sometimes detected. Sometimes horizontal, vertical or rotatory nystagmus appears.

Perinatal damage to the nervous system

Perinatal damage to the nervous system - group pathological conditions caused by exposure of the fetus (newborn) to adverse factors in the antenatal period, during childbirth and in the first days after birth.

There is no uniform terminology for perinatal lesions of the nervous system. The terms “perinatal encephalopathy”, “cerebrovascular accident”, “cerebral dysfunction”, “hypoxic-ischemic encephalopathy”, etc. are usually used.

The lack of a unified terminology is due to the uniformity of the clinical picture with different mechanisms of brain damage, which is due to the immaturity of the nervous tissue of the newborn and its tendency to generalized reactions in the form of edematous, hemorrhagic and ischemic phenomena, manifested by symptoms of cerebral disorders.

Classification of perinatal lesions of the nervous system

The classification involves identifying the period of action of the harmful factor, the dominant etiological factor, the period of the disease [acute (7-10 days, sometimes up to 1 month in very premature infants), early recovery (up to 4-6 months), late recovery (up to 1-2 years) , residual effects], degree of severity (for the acute period - mild, moderate, severe) and main clinical syndromes.

Causes of perinatal lesions of the nervous system in children

The main cause of brain damage in the fetus and newborn is hypoxia, which develops during an unfavorable course of pregnancy, asphyxia, and also accompanies birth injuries, tension-type headaches, infectious and other diseases of the fetus and newborn. Hemodynamic and metabolic disorders that occur during hypoxia lead to the development of hypoxic-ischemic lesions of the brain substance and intracranial hemorrhages. In recent years, much attention has been paid to IUI in the etiology of perinatal CNS damage. The mechanical factor in perinatal brain damage is less important.

The main cause of spinal cord lesions is traumatic obstetric care during large mass fetus, incorrect insertion of the head, breech presentation, excessive rotation of the head during its removal, traction by the head, etc.

Signs of perinatal lesions of the nervous system

The clinical picture of perinatal brain lesions depends on the period of the disease and severity (table).

In the acute period, the syndrome of central nervous system depression often develops (the following symptoms appear: lethargy, physical inactivity, hyporeflexia, diffuse muscle hypotonia, etc.), less often the syndrome of central nervous system hyperexcitability (increased spontaneous muscle activity, superficial restless sleep, tremor of the chin and limbs, etc.). d.).

In the early recovery period, the severity of cerebral symptoms decreases, and signs of focal brain damage become obvious.

The main syndromes of the early recovery period are as follows:

The syndrome of motor disorders is manifested by muscle hypo, hyper dystonia, paresis and paralysis, hyperkinesis.
Hydrocephalic syndrome is manifested by an increase in head circumference, divergence of sutures, enlargement and bulging of the fontanelles, expansion of the venous network on the forehead, temples, scalp, and a predominance of the size of the brain skull over the size of the facial skull.
Vegetovisceral syndrome is characterized by microcirculation disorders (marbling and pallor of the skin, transient acrocyanosis, cold hands and feet), thermoregulation disorders, gastrointestinal dyskinesia, lability of the cardiovascular and respiratory systems etc.

In the late recovery period, normalization of muscle tone and static functions gradually occurs. The completeness of recovery depends on the degree of damage to the central nervous system during the perinatal period.

Children in the period of residual effects can be divided into two groups: the first - with obvious psychoneurological disorders (about 20%), the second - with normalization of neurological changes (about 80%). However, normalization of the neurological status cannot be equivalent to recovery.

Increased neuroreflex excitability, moderate increase or decrease in muscle tone and reflexes. Horizontal nystagmus, convergent strabismus. Sometimes, after 7-10 days, symptoms of mild depression of the central nervous system are replaced by agitation with tremors of the hands, chin, and motor restlessness.

Usually, symptoms of central nervous system depression, muscle hypotonia, and hyporeflexia appear first, followed by muscle hypertonicity after a few days. Sometimes short-term convulsions, anxiety, hyperesthesia, oculomotor disorders (Graefe's symptom, "setting sun" symptom, horizontal and vertical nystagmus, etc.) appear. Vegetovisceral disorders often occur. Severe cerebral (severe depression of the central nervous system, convulsions) and somatic (respiratory, cardiac, renal, intestinal paresis, adrenal hypofunction) disorders. The clinical picture of spinal cord injury depends on the location and extent of the lesion. With massive hemorrhages and ruptures of the spinal cord, spinal shock develops (lethargy, adynamia, severe muscle hypotonia, severe depression or absence of reflexes, etc.). If the child remains alive, then local symptoms of damage become more clear - paresis and paralysis, dysfunction of the sphincters, loss of sensitivity. In children of the first years of life, it is sometimes very difficult to determine the exact level of damage due to the difficulties of identifying the boundaries of sensory disorders and the difficulties of differentiating central and peripheral paresis.

Diagnosis of perinatal lesions of the nervous system

The diagnosis is based on anamnestic (sociobiological factors, the state of health of the mother, her obstetric and gynecological history, the course of pregnancy and childbirth) and clinical data and is confirmed instrumental studies. Neurosonography is widely used. Help in diagnosis X-ray studies skull, spine, if necessary - CT and MRI. Thus, in 25-50% of newborns with cephalohematoma, a skull fracture is detected, and in case of birth injuries of the spinal cord, vertebral dislocation or fracture is detected.

Perinatal lesions of the nervous system in children are differentiated from congenital malformations, hereditary disorders metabolism, more often amino acids (manifest only a few months after birth), rickets [rapid increase in head circumference in the first months of life, muscle hypotonia, autonomic disorders (sweating, marbling, anxiety) are often associated not with the onset of rickets, but with hypertensive-hydrocephalic syndrome and vegetative visceral disorders in perinatal encephalopathy].

Treatment of perinatal lesions of the nervous system in children

Treatment of damage to the nervous system in the acute period.

The basic principles of treatment for cerebrovascular accidents in the acute period (after resuscitation measures) are as follows.

Elimination of cerebral edema. For this purpose, dehydration therapy is carried out (mannitol, GHB, albumin, plasma, Lasix, dexamethasone, etc.).
Elimination or prevention of convulsive syndrome (seduxen, phenobarbital, diphenine).
Reduced vascular wall permeability (vitamin C, rutin, calcium gluconate).
Improving myocardial contractility (carnitine chloride, magnesium preparations, panangin).
Normalization of the metabolism of nervous tissue and increasing its resistance to hypoxia (glucose, dibazol, alphatocopherol, actovegin).
Creating a gentle regime.

Treatment of damage to the nervous system during the recovery period.

In the recovery period, in addition to syndromic therapy, treatment is carried out aimed at stimulating the growth of brain capillaries and improving the trophism of damaged tissues.

Stimulating therapy (vitamins B, B 6, cerebrolysin, ATP, aloe extract).
Nootropics (piracetam, phenibut, pantogam, encephabol, cogitum, glycine, limontar, biotredin, aminalon, etc.).
To improve cerebral circulation, angioprotectors are prescribed (Cavinton, cinnarizine, trental, tanakan, sermion, instenon).
In case of increased excitability and convulsive readiness, sedative therapy is carried out (seduxen, phenobarbital, radedorm).
Physiotherapy, massage and physical therapy (physical therapy).

Children with perinatal lesions of the central nervous system should be under the supervision of a neurologist. Periodic courses of treatment are required (23 months twice a year for several years).

Prevention of perinatal lesions of the nervous system

Prevention consists primarily of preventing intrauterine fetal hypoxia, starting from the first months of pregnancy. This requires timely elimination of unfavorable socio-biological factors and chronic diseases of the woman, identification of early signs of the pathological course of pregnancy. Measures to reduce birth injuries are also of great importance.

Treatment prognosis

The prognosis for perinatal lesions of the central nervous system depends on the severity and nature of the damage to the central nervous system, the completeness and timeliness of treatment measures.

Severe asphyxia and intracerebral hemorrhages often result in death. Severe consequences in the form gross violations psychomotor development are rarely formed (in 35% of full-term and 10-20% of very premature children). However, almost all children with perinatal brain damage, even mild degree, signs of minimal brain dysfunction- headaches, speech disorders, tics, impaired coordination of fine movements. They are characterized by increased neuropsychic exhaustion, " school maladjustment".

The consequences of spinal cord injury during childbirth depend on the severity of the injury. With massive hemorrhages, newborns die in the first days of life. Those who survive the acute period experience a gradual recovery of motor functions.