PERINATAL DESTRUCTION OF THE CENTRAL NERVOUS

SYSTEM
Perinatal lesions of the nervous system - a group of pathological conditions resulting from
exposure to the fetus (newborn) adverse factors in the antenatal period, during childbirth and in
the first days after birth.

TERMINOLOGY

Common terminology of perinatal lesions of the nervous system is absent. Usually use the term
"perinatal encephalopathy", "cerebrovascular accident", "cerebral dysfunction", "hypoxic-
ischemic encephalopathy, etc. The lack of common terminology associated with homogeneous
clinical picture with different mechanisms of brain damage due to the immaturity of the newborn
nervous tissue and its propensity to generalized reactions in the form of swelling and
hemorrhagic and ischemic events, manifested symptoms of cerebral disorders.

CLASSIFICATION

Classification of perinatal lesions of the nervous system provides for the allocation period, the
adverse factors, the dominant etiological factor, the period of the disease [acute (7-10 days,
sometimes up to 1 month in very preterm), early recovery (up to 4-6 months), late recovery (up
to 1 -2 years), residual effects], the severity (for the acute period - mild, moderate, severe) and
the major clinical syndromes.

Etiology and pathogenesis

The main cause of brain damage in the fetus and the newborn - hypoxia, developed during
unfavorable pregnancy, asphyxia and birth trauma accompanying, HDN, infectious and other
diseases of the fetus and the newborn. Emerging during hypoxia hemodynamic and metabolic
disturbances lead to the development of hypoxic-ischemic lesions of the substance of the brain
and intracranial hemorrhage. In recent years much attention in the etiology of perinatal CNS
lesions give VUI. Mechanical factor in the perinatal brain damage is of less importance.

The main cause of spinal cord injuries - traumatic obstetrical benefits in heavy fruit, inserted the
wrong head, breech presentation, excessive turning heads in the conversion, truck-tion of the
head, etc.

Clinical picture

The clinical picture of perinatal brain lesions depends on the period of the disease and severity
(Table 6-1).
 In the acute period more likely to develop syndrome of CNS depression (lethargy, lack of
exercise, hyporeflexia, diffuse muscle hypotonia, etc.), less frequently, central nervous system
hyperexcitability syndrome (increased spontaneous muscle activity, surface restless sleep, tremor
of the chin and limbs, etc.) .

In the early recovery period reduced the severity of cerebral symptoms and signs become
apparent focal brain damage. The main syndromes of early recovery period following.

-- The syndrome of motor disorders manifested muscular hypo-, hyper-shek dystonia, paresis
and paralysis, hyperkinesia.

-- Hydrocephalic syndrome (Fig. 6.1 inset) reflected an increase in head circumference, gapping,
and an increase in bulging fontanelles, the expansion of the venous network on the forehead,
temples, scalp and the predominance of the size of the cranial dimensions of the facial.

-- For vegetative-visceral syndrome characterized by abnormalities of microcirculation (marble

and pale skin, transient akrotsia-Host, cold hands and feet), disorders of thermoregulation,
gastrointestinal dyskinesia, the lability of the cardiovascular and respiratory systems, etc.

In the late recovery period is gradually normalize muscle tone, static functions. Completeness
of recovery depends on the degree of CNS lesions in the perinatal period.

Children during the residual effects can be divided into two groups: the first - with the obvious
neuropsychiatric disorders (20%), second - with the normalization of neurological changes
(80%). Nevertheless, the normalization of neurological status may not be equivalent to cure.

Table 6-1. The clinical picture of perinatal brain lesions of varying severity

Degree Clinical symptoms

gravity
Light Increased neuro-reflex excitability, a moderate increase or decrease in muscle tone and
reflexes. Horizontal nystagmus, esotropia. Sometimes after 7-10 days of symptoms of mild
CNS depression are replaced by excitation with hand tremor, chin, restlessness

Average Usually first symptoms CNS depression, muscle hypotonia, hyporeflexia, shifting a few days
hypertonicity of muscles. Sometimes there are brief convulsions, anxiety, hyperesthesia,
oculomotor disorders (symptom Grefe, a symptom of "sunset" and the horizontal and
vertical nystagmus, etc.) . There are often vegetative-visceral violation

Weightlifting Pronounced cerebral (sharp CNS depression, convulsions) and somatic (respiratory, heart,
kidney, intestinal paresis, hypoadrenalism) Violations

The clinical picture of spinal cord injury depends on the location and extent of injury. When
massive hemorrhages and ruptures of the spinal cord develops spinal shock (lethargy, adynamia,
pronounced muscular hypotonia, a sharp inhibition or absence of reflexes, etc.). If the child
survives, it becomes more clear symptoms of local lesions - paresis and paralysis, disorders of
sphincter function, loss of sensitivity. In children, the first years of life is sometimes very
difficult to determine the exact level of injury because of the difficulty identifying the sensitive
border violations and the difficulties of differentiation of central and peripheral paresis.

DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS

Diagnosing is based on histories (social and biological factors, the health of the mother, her
obstetric and gynecological history, during pregnancy and childbirth) and clinical data and
confirmed by instrumental studies. Widely used Neurosonography. They help in the diagnosis of
X-ray examinations of the skull, spine, if necessary - CT and MPI Thus, in 25-50% of infants
with ke-falogematomoy detect a crack of the skull, with the generic spinal cord injury - a
dislocation or fracture vertebrae.

Perinatal CNS lesions differentiate from congenital defects and hereditary metabolic disorders,
most amino acids (apparent until several months after birth), rickets [rapid increase in head
circumference during the first months of life, muscle hypotonia, autonomic disturbances
(sweating, marbling, anxiety) are associated more often than not with the beginning of rickets,
but with hypertension-hydrocephalic syndrome and vegetative-visceral disorders in perinatal
encephalopathy].

9-3029

TREATMENT

Treatment in the acute period

Basic principles of treatment of cerebrovascular disorders in the acute period (after resuscitation)
as follows.

The elimination of brain edema. To this end, a dehydration therapy (mannitol, GHB, albumin,
plasma, laziks, dexamethasone, etc.).

Elimination or prevention of a convulsive syndrome (Seduxen, 'phenobarbital, difenina).

Reducing the permeability of the vascular wall (vitamin C, rutin, calcium gluconate).

Improvement of myocardial contractile capacity (carnitine chloride, magnesium products,

Panangin).

Normalization of the metabolism of nervous tissue and increase its resistance to hypoxia
(glucose, dibasol, alpha-tocopherol, aktovegin).

Creating a sparing regime.

Treatment in the recovery period

During the recovery period in addition to conducting posindromnoy therapy treatment aimed at
stimulating the growth of brain capillaries and improve trophics damaged tissue.

Stimulation therapy (vitamins B, B 6, Cerebrolysin, ATP, Aloe).

Nootropics (piracetam, Phenibut, Pantogam, entsefabol, kogitum, glycine, limontar, biotredin,

Aminalon, etc.).

To improve the cerebral circulation appoint angioprotektory (cavinton, Cinnarizine, trental,

Tanakan, SERMION, instenon).

With increased excitability and convulsive readiness to spend Seda-operative therapy

(Seduxen, phenobarbital, radedorm).

Physiotherapy, massage and therapeutic exercise (gymnastics).

Children with perinatal lesions of the CNS should be under the supervision of a
neurologist. Required periodic courses of treatment (2-3 months twice a year for several years).

PREVENTION

Prevention of perinatal lesions of the nervous system is primarily in the prevention of

intrauterine fetal hypoxia, beginning with the first months of pregnancy. This requires the timely
removal of the adverse socio-biological factors and chronic diseases of women, identifying early
signs of pathological pregnancy. It is also important measures to reduce the descent of injury.

FORECAST

The prognosis of perinatal lesions of the central nervous system depends on the severity and
nature of damage to the CNS, completeness and timeliness of medical interventions,

'He was formerly widely used term TORCH-syndrome. In the present time it is used rarely, since it includes
only five diseases: toxoplasmosis, syphilis, rubella, tsitomega-Leah and herpes.

Severe birth asphyxia and intracerebral hemorrhage often ended lethally. The severe
consequences in the form of gross violations of psychomotor development formed rare (3-5%
full-term and in 10-20% of very preterm children). However, almost all children with perinatal
brain damage, even mild, long remain minimal brain dysfunction symptoms - headaches, speech
disorders, tics, poor coordination of fine movements. They are characterized by an increased
neuro-psychological exhaustion, "the school disadaptation.
Consequences of spinal cord injury at birth depend on the severity of damage. With massive
hemorrhages newborns die within the first days of life. I survived the acute period of a gradual
recovery of motor functions.