There are many well-known brain diseases that everyone has heard of. For example, multiple sclerosis, stroke or encephalitis, but such a thing as organic brain damage often leads to a stupor. This term is not spelled out in the international classification of diseases, but it is with these words that many diagnoses associated with brain damage begin. What is it, what are the symptoms of pathology and its causes?

Organic brain damage is not an isolated disease, but an irreversible process in the brain tissues, which began due to the development of one of the diseases of this organ. In fact, organic changes in the brain structure are the result of damage, infection or inflammatory process in the brain.

What are the reasons?

Organic lesions can be congenital or acquired, the reason for their occurrence depends on this. In the case of the congenital "organic" of the brain, the reasons for such a process can be the following factors:

• premature placental abruption;
• infectious diseases pregnant;
• the intake of alcohol, drugs or smoking of the expectant mother;
• fetal hypoxia;
• difficult childbirth, possible trauma to the head of the fetus during them;
• atony of the uterus;
• taking illegal medications during pregnancy;
• genetic breakdowns, etc.

Acquired organic changes in the brain can occur for a number of other reasons, including:

• traumatic brain injury (contusion or concussion, skull fracture, etc.);
• vascular pathologies: atherosclerosis, strokes, encephalopathy;
• persistent circulatory disorders in the brain;
• infectious pathologies: meningitis, encephalitis, abscess;
• intoxication with drugs or alcohol;
• Parkinson's disease, Alzheimer's;
• brain tumors;
• defeat nervous system herpes virus;
• vasculitis, etc.

The severity of the pathology

The peculiarity of organic lesions is that their appearance is not accompanied by pronounced symptoms. The clinical picture is growing gradually, so many patients may not even suspect that they have a similar problem.

So, if we talk about the perinatal period, when the organic matter in the child is congenital, its symptoms can occur in preschool age or even at school. Most often, the disease is accompanied by a general developmental delay, including speech, memory and perception.

Organic brain damage is conventionally divided into three degrees, depending on the severity of the course and the globality of the pathological process. There are three degrees:

• the first, it is an easy degree. In this case, no more than 20% of the brain tissue is affected. As a rule, such changes do not greatly affect everyday life and may go unnoticed;
• the second degree is medium. The destruction of the brain reaches from 20 to 50%, in this case, neurological symptoms are expressed and treatment of the patient is required;
• third degree - severe. Damage reaches 70%, the destruction process becomes uncontrollable. The clinical picture of psycho-neurological disorders is pronounced, drug treatment aimed at maintaining human life, but is not able to stop this process.

Clinical picture

Since organic lesions are the consequences of individual pathologies of the brain and central nervous system, therefore clinical picture can be extensive and varied. It is difficult to say exactly how the disease will manifest itself in a specific case, but the main groups of symptoms can be distinguished, for example:

• focal lesions. This group includes all musculoskeletal disorders, for example, paresis or paralysis of the limbs, vegetative-trophic disorders, atrophy of the optic or facial nerve, which is accompanied by strabismus, loss of vision or facial distortion;
• cerebral symptoms. Most often, it is formed as a consequence of the transferred infectious diseases of the brain, the growth of a tumor or cyst. Among these symptoms: severe headaches, vomiting not associated with food intake, fainting, dizziness, high intracranial pressure, the development of hydrocephalus, the latter mainly in children;
• mental disorders. Decreased intelligence, up to dementia, loss of memory, partial or complete amnesia.

If we consider the symptomatology separately for each disease, it will be different and the rate of increase of such symptoms will also be different. For example, in the case of a stroke, when blood circulation in the brain is disturbed due to a rupture or blockage of a vessel, the symptoms of damage appear immediately and after the consequences of the stroke are eliminated, organic changes still remain. Often this is a violation of diction, paralysis of the limbs on the one hand, memory impairment, etc.

Diagnostics

The most popular diagnostic methods in recent years are studies using neuroimaging. For example, MRI or agniography with contrast. These instrumental methods I help to examine in detail the state of the brain structures. MRI allows you to see the presence of:

• aneurysm;
• tumors;
• cysts;
• determine the extent of the lesion, for example, after hemorrhage.

Thanks to agniography with contrast, it is possible to assess the state of the vessels. See places of narrowing of the walls of blood vessels or their blockages, as well as places of ruptures, etc.

In addition to instrumental studies, additional tests are carried out to determine cognitive impairments, such as impairment of memory, concentration, speech, etc.

Treatment

Therapy for brain disorders has never been easy. This is a whole complex of various measures aimed at inhibiting the processes of destruction and suppressing the symptoms that have arisen. It is not the organic lesion of the brain itself that is treated, but the pathology that preceded it. In many cases, if treatment is started on time, organic damage can be avoided. Of course, in some cases, they are inevitable even when timely treatment, for example, with extensive stroke, pathological changes will be observed in any case. They can be expressed, both in speech, memory or attention disorders, and in motor activity, often in unilateral paralysis.

In this case, treatment is necessary in any case. Since only correctly selected drug treatment, as well as physiotherapy procedures, will help partially make the patient's life easier and reduce the risk of relapse.

Since organic disorders are irreversible to get rid of them completely, alas, it will not work, the treatment in this case is palliative and is lifelong.

Regarding the drugs required for treatment, they are prescribed individually, depending on the disease and its consequences. Self-treatment in this case, it is categorically contraindicated and can lead to a deterioration in the patient's well-being.

Organic lesions of the brain, if they were started, cannot be stopped. This is a slowly progressive pathological process leading to degenerative changes in the structure of the brain. The main task of therapy is to slow down this process as much as possible and reduce clinical manifestations that prevent a person from living fully. Organic changes in the brain require lifelong systematic therapy.

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Unspecified encephalopathy is a class VI disease (diseases of the nervous system), which is included in the G90-G99 block (other disorders of the nervous system) and has a disease code G93.4.

Description of the disease

Encephalopathy is a non-localized disease of the brain. It is expressed by the death of nerve cells due to circulatory arrest, oxygen deprivation and disease.

To diagnose diseases, specialists need to find out the pronounced location of the lesion, the localization of the disease in the gray or white matter of the brain, as well as the degree of impaired blood flow. If the cause of the disease could not be established, then encephalopathy is called unspecified (idiopathic, that is, arising independently). The most common is vascular.

Causes of the disease

Unspecified encephalopathy (according to ICD-10 diagnosis code G93.4) ​​is classified into two types: congenital and acquired. Congenital is divided into prenatal (when damage occurs while still in the womb) and perinatal (in the event that the damaging factor acted in the last weeks before the birth of the baby or immediately after it). This type of pathology is caused by:

• defects consisting in abnormal processes of the development of the brain;
• metabolic disorders in the body caused by genetic factors;
• if a damaging factor acted on the baby during pregnancy;
• traumatic brain injury that occurs in a baby during childbirth.

Mitochondrial encephalopathy

Mitochondrial unspecified encephalopathy in infants is classified into a separate group of congenital diseases. It is formed as a result of dysfunctions and structures of mitochondria.

Acquired encephalopathy

Acquired encephalopathy is classified into several types due to various damaging factors:

• Post-traumatic injury is the result of moderate and severe head injuries (for example, falls from a height, head injuries in athletes, road accidents, etc.). With this type of disease, various lesions of the frontal nerve tissue and atrophic changes (drying out and reduction of the brain), hydrocephalus are observed.
• Toxic encephalopathy, unspecified in adults, occurs as a result of poisoning with various toxins: alcohol, high doses of pesticides, heavy metals, gasoline, etc. It mainly manifests itself in various kinds of nervous and mental disorders (insomnia, anxiety, irritability, hallucinations, prolonged headaches, etc.).
• Radiation is the result of ionizing radiation of the body with radiation sickness. With this pathology, various neurological disorders are observed.
• Metabolic occurs due to metabolic disorders in the background of disease internal organs: liver, kidney, pancreas. It manifests itself depending on the properties of the underlying pathology.
• Vascular encephalopathy. The cause of the occurrence may be an addiction to bad habits, old injuries, atherosclerosis, diabetes, radiation exposure and other factors that cause brain hypertension. Signs of this type of disease are: loss of structure and integrity of consciousness, frequent headaches, depressive conditions, partial loss of one's own memory.
• Hypoxic is the result of prolonged oxygen starvation. Leads to serious neuralgic complications.

And these are not all varieties.

In children

There is an unspecified encephalopathy in children. So, due to traumatic effects in the womb, infections or other reasons, residual encephalopathy is diagnosed in older children. The venous form is a particular type of vascular, which is manifested by stagnation venous blood in the brain due to a violation of its outflow.

Metabolic encephalopathy is divided into several more types:

• Bilirubin is found only in newborn babies. It develops against the background of incompatibility of the blood of the mother and the fetus, as well as due to infectious toxoplasmosis, jaundice, diabetes mellitus in the mother. It appears general weakness, decreased muscle tone, poor appetite, belching, vomiting.
• Gaia-Wernicke encephalopathy occurs due to vitamin B1 deficiency. Side conditions can develop due to alcohol dependence, severe vitamin deficiencies, HIV, malignant neoplasms. It mainly manifests itself as a hallucinogenic syndrome, anxiety conditions.
• Leukoencephalopathy is manifested by a violation white matter brain. The disease is progressive. Appears after an infection due to a decrease in the protective functions of the body.
• Atherosclerotic develops mainly due to a violation of lipid metabolism in the body. It is manifested by increased fatigue, weakness, dizziness, headaches, sleep disorders, and withdrawal.

Scientists say that the cause of any type of unspecified encephalopathy is primarily brain hypoxia (lack of oxygen). This is due to the fact that the organ begins to wash worse with blood, excessive venous accumulations, edema, and hemorrhages appear. Anoxic encephalopathy can occur due to a low supply of nutrients to neurons and eventually stand out as a separate disease. Metabolic encephalopathy is a special case of toxic, when toxins are not eliminated, as a result of which they penetrate into the bloodstream.

There are several stages in the development of this disease. The following are distinguished by specialists:

• In the case of the initial or first stage, the patient's memory is reduced, he is irritable, does not fall asleep well and sleeps anxiously, and he also suffers from headaches.
• With the second nature of the disease is more pronounced, all symptoms are aggravated. In addition to headaches and sleep disturbances, the patient may complain of apathy and lethargy.
• At the third stage, serious changes in the brain are diagnosed, there are paresis, speech is impaired, vascular parkinsonism develops.

Symptoms

The manifestations of unspecified encephalopathy are very diverse depending on the severity, type, age and treatment used. As a rule, in the first stages of the disease, sleep disturbances, lethargy, daytime sleepiness, absent-mindedness, tearfulness, lack of interest, increased fatigue, decreased memory, and thinking abilities are noted. May also start to appear painful sensations, noises and ringing in the head, decreased auditory and visual functions, mood swings, impaired coordination, irritability.

What symptoms occur as the disease progresses?

In advanced cases, symptoms may progress, resulting in parkinsonism (slow movements in combination with tremors of the limbs) and pseudobulbar paralysis (manifested by impaired speech, chewing and swallowing functions). Also, do not forget that mental dysfunctions (depression, suicidal thoughts, phobias) may develop. Consider how encephalopathy, unspecified G 93.4, is diagnosed in infants and adults.

Diagnosis of unspecified encephalopathy

In order to correctly establish the form of the disease, the doctor must carefully analyze the patient's history of traumatic brain injury, intoxication, atherosclerosis, diseases of the kidneys, liver, lungs, pancreas, hypertension, radiation exposure, as well as acquired or genetic metabolic disorders.

For the diagnosis of encephalopathy, unspecified G 93.4, the following procedures are performed:

• General blood analysis.
• General urine analysis.
• Various metabolic tests (for the level of enzymes in the liver, glucose, electrolytes, ammonia, lactic acid, oxygen in the blood).
• Measurement of blood pressure level.
• CT and MRI (to detect brain tumors, various anatomical abnormalities, infections).
• Creatinine.
• Drug and toxin levels (cocaine, alcohol, amphetamines).
• Doppler ultrasound.
• EEG or encephalogram (to identify brain dysfunctions).
• Analysis for autoantibodies.

These are not all of the tests required to make a diagnosis. Only the attending physician can order specific tests based on the patient's symptoms and medical history.

Encephalopathy treatment

Treatment of unspecified encephalopathy is aimed at eliminating the underlying causes and symptoms that gave rise to the development of this disease. Basically, conservative and medical methods are used for treatment.

If the disease is acute, then treatment is primarily aimed at reducing intracranial pressure and eliminating seizures. For this, use artificial ventilation lungs, extrarenal blood cleansing, and nutrients are injected through a dropper.

Medicines

Subsequently, the patient is prescribed medications, which he must take for several months:

• various lipotropic medicines that contribute to the normalization of cholesterol and fat metabolism (dietary supplements with choline, methionine, carnitine, lecithin, "Lipostabil");
• drugs that prevent blood clots ("Ginkgo Biloba", "Aspirin", "Cardiomagnet");
• angioprotectors prescribed for various heart diseases to normalize the walls of blood vessels, movement and outflow of venous blood (Troxerutin, Detralex, Indovazin);
• neuroprotectors for the nutrition of nerve tissues (vitamins of group B, "Piracetam";
• tranquilizers and sedatives to relieve frequent nerve impulses in the affected neurons ("Sibazon");
• vitamins and amino acids;
• various performance stimulants.

Also, for a speedy recovery, physiotherapy procedures, acupuncture, walks, gymnastics, massage, and a certain rest regime are prescribed. What is the prognosis for the diagnosis of encephalopathy, unspecified?

Disease prognosis

All types of encephalopathy are characterized by vomiting, nausea, dizziness, and headaches. If there is a severe brain damage (or its edema), then the disease develops very acutely, dizziness appears, very strong headache, anxiety, visual impairment and more.

Typical complications of encephalopathy of unspecified origin are:

• coma;
• paralysis;
• convulsions.

• epilepsy;
• paralysis, various kinds of movement disorders;
• loss of brain functions, memory, intelligence;
• emotional instability, depression, mood swings;
• disability.

Organic brain damage

The diagnosis of organic brain damage (OPM) in children is a very common occurrence in pediatric practice... It is easier for a child with severe neurological pathology to put it in place than to understand the nature of the disease. However, experience shows that a thoroughly collected history, data of objective examination methods, as well as the results of laboratory and instrumental examinations, can clarify a lot in the diagnosis of both the pediatrician and the pathologist (in the event of the patient's death).

PMD is a broad concept with no established definition; it is a consequence of pre- and perinatal pathology, with the exception of genetic diseases and congenital malformations. Acquired infectious and non-infectious diseases, in particular, craniocerebral trauma, neuroinfections (meningoencephalitis), hypoxic conditions, the assessment of which is not included in the purpose of this article, can lead to similar OPM manifestations. Practical experience has shown the misuse of the AAR diagnosis. On the one hand, this is explained by the insufficient level of methodological capabilities, on the other, by the abundance of diseases that lead to OPM, and on the third, by the reluctance of some clinicians dealing with the treatment of intercurrent diseases in such children to delve into neurological pathology.

Since WMD is not included in International Classification Diseases of the X revision (ICD X), for its encryption, the faceless formulations “encephalopathy, unspecified” G93.4 or “brain damage, unspecified” G93.9 are used. There is also asphyxia in the ICD (in relation to the perinatal period), P20-21, birth injury, P10-11, and various intracranial hemorrhages, P52, and nosological units are not provided to indicate the consequences of these conditions. We list the main diseases most frequently encountered in the practice of pediatricians, which can be formulated in terms of ICD X as independent diagnoses:

• congenital malformations of the brain, Q00-07,
• thesaurismosis with central nervous system involvement, E70-83,
• intrauterine infections (toxoplasmosis, cytomegaly, tuberculosis, syphilis and others), A50, P35, P37, P39,
• child cerebral paralysis(Cerebral palsy), G80,
• hydrocephalus, G91.

The main ones in the diagnosis are: the mother's history, the course of pregnancy and childbirth, the condition of the placenta, the results of laboratory tests, dynamics clinical symptoms in a child, the topic of brain lesions and, in case of death of the child, the morphological picture of changes not only in the brain, but also in internal organs. This information helps to conduct differential diagnosis with other neurological diseases and determine the leading and secondary etiological factors of the disease.

Most significant reasons OPM in children are as follows:

1. Asphyxia. To establish it, a careful collection of anamnesis from the mother is necessary (decompensated heart defects, hypertonic disease, severe anemia, chronic diseases lungs, diabetes, toxicosis of pregnant women), as well as the course of labor, objective clinical data.
2. Intracranial birth injury. The main thing to pay attention to is the discrepancy between the size of the fetus and the birth canal, a long anhydrous period, a protracted or rapid course of the labor act.
3. Intracranial hemorrhages intra- and postnatal, primarily cerebral, intraventricular, subarachnoid. Such hemorrhages, as a rule, are associated with birth trauma or asphyxia during childbirth, however, they directly lead to OPM.
4. Intrauterine infections with damage to the central nervous system. In this regard, infectious (acute and chronic) diseases of the mother both before and during pregnancy are important, despite the fact that there is often no direct relationship between the severity of the disease of the pregnant woman and the fetus; prenatal fetal malnutrition, prematurity, chronic placental insufficiency. The spectrum of pathogens is very wide: protozoa, fungi, bacteria, mycoplasmas, ureaplasmas, chlamydia and, finally, numerous viruses (herpes simplex viruses, respiratory viruses, enteroviruses, rubella virus, human immunodeficiency virus and others). Some of them can enter the central nervous system antenatally, some intranatally and postnatally.
5. Hemolytic disease newborns, accompanied by "nuclear jaundice".
6. Toxic effects on the fetus during pregnancy.
7. Mixed etiology, which is most often observed, since the pathological conditions characteristic of the perinatal period are usually closely interrelated. We will briefly present the clinical data that can be detected with OPM, noting that with a variety of clinics, it is still possible to distinguish individual syndromes:
1. Cerebral palsy syndromes: spastic diplegia, double hemiplegia, hyperkinetic form, atonic-astatic form, hemiplegia.
2. Convulsive syndrome. With asphyxia in newborns, tonic and tonic-clonic seizures are most often noted. With intracranial hemorrhage, they are focal in nature. Their duration is usually short. They appear immediately (1-3 minutes) or soon after childbirth. After an acute period of asphyxia, seizures can stop and resume at the age of 1.5 - 2 months in connection with the onset of morphological changes in the brain. In traumatic brain injury, seizures are often of a partial nature: face, limb, or hemitip; also more often convulsions appear in this case after a few hours or even 2-3 days due to an increase hemorrhagic syndrome; further after a light interval from 2 months to several years convulsive syndrome may reappear. With nuclear jaundice, tonic convulsions with a transition to opisthotonus. With intrauterine infectious brain lesions, seizures can be of a different nature and occur, as a rule, after a light interval of several days after childbirth.
3. Oligophrenia varying degrees(retardation in psychomotor development), speech disorders and disorders of simple and / or complex sensitivity can occur in connection with all of the indicated etiological factors.
4. Secondary microcephaly - a decrease in the size of the skull begins after the birth of a child, the skull can be symmetrical, or it can be asymmetric.
5. Occlusive hydrocephalus.
6. Syndrome of minimal cerebral dysfunction - can begin in infants, and the most striking manifestations are noted in schoolchildren; is fundamentally characterized by moderately pronounced motor, speech and autonomic disorders.

The pathological picture (in the event of a child's death) also makes it possible to carry out differential diagnostics in such situations and often clarify the nature of the suffering. With severe asphyxia in the perinatal period, as a rule, the so-called hypoxic-ischemic encephalopathy occurs. It has several options.

1. With prolonged, gradually developing hypoxia, generalized and cortical necrosis occurs with damage to the cerebral cortex and cerebellum. The most vulnerable are cells of the 3rd, 5th and 6th layers of the cortex and Purkinje cells; necrosis of the brain stem nuclei often develops. Clinically - mental underdevelopment, cerebral palsy, epilepsy.
2. Periventricular leukomalacia - multiple small foci of necrosis in the periventricular white matter. Clinically, spastic diplegia.
3. The defeat of the border arterial zone is ischemia of the parieto-occipital region, hemorrhagic infarction often develops. The clinic correlates with the area of ​​the lesion.
4. The defeat of the zones of arterial blood supply is manifested by necrosis in the areas of vascularization of the main cerebral arteries. False porencephaly develops, with multiple necrotic cavities, the term multicystic encephalomalacia is used.

The consequences of the described processes are false cysts of the corresponding localizations, as well as foci of gliosis and glial scars. Moreover, the postponed asphyxia is characterized by multiple cysts. Traumatic birth injury manifests itself primarily in different localization of hemorrhages in the central nervous system. The outcome of cerebral hemorrhages is resorption with the formation of cysts, in the wall of which siderophages and hemosiderin can be found.

With the consequences of nuclear jaundice, dystrophy and necrosis of neurons occurs, as well as focal gliosis in the subthalamic nuclei, ammon horn, pallidus pallidum, inferior olive, and the dentate nucleus of the cerebellum. Often described changes in non-infectious etiology of OPM are accompanied by secondary changes. These include:

• secondary microcephaly, which differs from congenital in a relatively uniform decrease in the size of the skull;
• occlusive hydrocephalus due to proliferation of glial elements, blockage by organized blood coagulation, inflammatory detritus;
• secondary microgyria due to the collapse of the nervous tissue after necrotic changes, it is usually expressed unevenly and asymmetrically.
• histologically, foci of neuronal loss, violation of the architectonics of the cortex, the body of dead neurons.

In the absence of an infectious factor, these changes, except for hydrocephalus, do not progress after formation. I would like to emphasize once again that the described processes can be combined in different combinations and do not always correspond to the severity of asphyxia or birth trauma.

From a practical point of view, OPM combines a large number of diseases and syndromes that have their own etiology and require special therapeutic approaches. The diagnosis of OPM is not nosological and should be made only in cases when it is not possible to determine its nature using available methods.

Antonov P.V., Cand. honey. sciences,
head of the pathological department
children's infectious diseases hospital №5 named. N.F. Filatova,
St. Petersburg.

The diagnosis of organic brain damage (OPM) in children is a very common occurrence in pediatric practice. It is easier for a child with severe neurological pathology to put it in place than to understand the nature of the disease. However, experience shows that a carefully collected anamnesis, data from objective examination methods, as well as the results of laboratory and instrumental examinations, make it possible to clarify a lot in the diagnosis of both the pediatrician and the pathologist (in the event of the patient's death).

AAR is a broad concept with no established definition. It is a consequence of pre- and perinatal pathology, with the exception of genetic diseases and congenital malformations. Acquired infectious and non-infectious diseases, in particular, craniocerebral trauma, neuroinfections (meningoencephalitis), hypoxic conditions, the assessment of which is not included in the purpose of this article, can lead to similar OPM manifestations.

Practical experience has shown the misuse of the AAR diagnosis. On the one hand, this is explained by the insufficient level of methodological capabilities, on the other, by the abundance of diseases that lead to OPM, and on the third, by the reluctance of some clinicians dealing with the treatment of intercurrent diseases in such children to delve into neurological pathology.

Since OMP is not included in the International Classification of Diseases X revision (ICD X), for its encryption, use the impersonal formulations "encephalopathy, unspecified" G93.4 or "brain damage, unspecified" G93.9. The ICD also contains asphyxia (in relation to the perinatal period), P20-21, birth trauma, P10-11, and various intracranial hemorrhages, P52, and nosological units are not provided to indicate the consequences of these conditions.

We list the main diseases most frequently encountered in the practice of pediatricians, which can be formulated in terms of ICD X as independent diagnoses:

• congenital malformations of the brain, Q00-07,
• thesaurismosis with central nervous system involvement, E70-83,
• intrauterine infections (toxoplasmosis, cytomegaly, tuberculosis, and others), A50, P35, P37, P39,
• children's cerebral (cerebral palsy), G80,
• hydrocephalus, G91.

The main ones in making the diagnosis are: the mother's history, the course of pregnancy and childbirth, the state of the placenta, the results of laboratory tests, the dynamics of the child's clinical symptoms, the topic of brain lesions and, in the case of the death of the child, the morphological picture of changes not only in the brain, but also in internal organs. This information helps to make a differential diagnosis with other neurological diseases and to determine the leading and secondary etiological factors of the disease.

The most significant causes of AAR in children are as follows:

1. Asphyxia. To establish it, a careful collection of anamnesis from the mother is necessary (decompensated heart defects, severe, chronic lung diseases, s pregnant), as well as the course of labor, objective clinical data.
2. Intracranial birth injury. The main thing to pay attention to is the discrepancy between the size of the fetus and the birth canal, a long anhydrous period, a protracted or rapid course of the labor act.
3. Intracranial hemorrhages intra- and postnatal, primarily cerebral, intraventricular, subarachnoid. Such hemorrhages, as a rule, are associated with birth trauma or asphyxiation during childbirth, but they directly lead to OPM.
4. Intrauterine infections with damage to the central nervous system. In this regard, infectious (acute and chronic) diseases of the mother both before and during pregnancy are important, despite the fact that there is often no direct relationship between the severity of the disease of the pregnant woman and the fetus; prenatal fetus, prematurity, chronic placental. The spectrum of pathogens is very wide: protozoa, fungi, bacteria, mycoplasmas, ureaplasmas, chlamydia and, finally, numerous viruses (simple a viruses, respiratory viruses, enteroviruses, rubella virus, human immunodeficiency virus, and others). Some of them can enter the central nervous system antenatally, some intranatally and postnatally.
5. Hemolytic disease of the newborn, accompanied by "nuclear jaundice".
6. Toxic effects on the fetus during pregnancy.
7. Mixed etiology, which is most often observed, since the pathological conditions characteristic of the perinatal period are usually closely interrelated.

We will briefly present the clinical data that can be detected with OPM, noting that with a variety of clinics, it is still possible to single out individual syndromes:

1. Cerebral palsy syndromes: spastic diplegia, double hemiplegia, hyperkinetic form, atonic-astatic form, hemiplegia.
2. Convulsive syndrome. With asphyxia in newborns, tonic and tonic-clonic seizures are most often noted. With intracranial hemorrhage, they are focal in nature. Their duration is usually short. They appear immediately (1-3 minutes) or soon after childbirth. After an acute period of asphyxia, seizures can stop and resume at the age of 1.5 - 2 months in connection with the onset of morphological changes in the brain. In traumatic brain injury, seizures are often of a partial nature: face, limb, or hemitip; also more often convulsions appear in this case after a few hours or even 2-3 days in connection with an increase in hemorrhagic syndrome; then, after a light interval from 2 months to several years, the convulsive syndrome may reappear. With nuclear jaundice, tonic convulsions with a transition to opisthotonus. With intrauterine infectious brain lesions, seizures can be of a different nature and occur, as a rule, after a light interval of several days after childbirth.
3. Oligophrenia of varying degrees (retardation in psychomotor development), speech disorders and disorders of simple and / or complex sensitivity can occur in connection with all of the indicated etiological factors.
4. Secondary - a decrease in the size of the skull begins after the birth of a child, the skull can be symmetrical, or maybe asymmetric.
5. Occlusal.
6. Syndrome of minimal cerebral dysfunction - can begin in infants, and the most striking manifestations are noted in schoolchildren; is fundamentally characterized by moderately pronounced motor, speech and autonomic disorders.

The pathological picture (in the event of the death of the child) also makes it possible to conduct differential diagnosis in such situations and often clarify the nature of the suffering. With severe asphyxia in the perinatal period, the so-called hypoxic-ischemic occurs, as a rule. It has several options.

1. With prolonged, gradually developing hypoxia, generalized and cortical necrosis occurs with damage to the cerebral cortex and cerebellum. The most vulnerable are cells of the 3rd, 5th and 6th layers of the cortex and Purkinje cells; necrosis of the brain stem nuclei often develops. Clinically - mental underdevelopment, cerebral,.
2. Periventricular leukomalacia - multiple small foci of necrosis in the periventricular white matter. Clinically, spastic diplegia.
3. The defeat of the border arterial zone - the parieto-occipital region, often develops hemorrhagic infarction. The clinic correlates with the area of ​​the lesion.
4. The defeat of the zones of arterial blood supply is manifested by necrosis in the areas of vascularization of the main cerebral arteries. False porencephaly develops, with multiple necrotic cavities, the term multicystic encephalomalacia is used.

The consequences of the described processes are false cysts of the corresponding localizations, as well as foci of gliosis and glial scars. Moreover, the postponed asphyxia is characterized by multiple cysts.

Traumatic birth injury is manifested primarily in different localization of hemorrhages in the central nervous system. The outcome of cerebral hemorrhages is resorption with the formation of cysts, in the wall of which siderophages can be found,

Any form of encephalopathy requires severe treatment and a responsible approach of doctors and patients to their own condition. Unspecified encephalopathy is a special type of diagnosis that is made with a lack of information to 100% confirm the exact form of pathology.

ICD-10 defines unspecified encephalopathy with the G93 number. Synonym - acquired unspecified encephalopathy.

The diagnosis has specific features:

• placed when it is not possible to clarify with additional research;
• pediatricians often find symptoms of unspecified encephalopathy in newborn infants;
• in 80% of cases, the diagnosis is not confirmed after 2-3 years;
• men get sick more often than women by 21%;
• the accuracy of the diagnosis is higher if it is made at 5 or 65 years of age (peaks of disease identification).

The unspecified form of the disease requires additional examinations and is not confirmed in all cases. Most often, true encephalopathy is found in middle-aged and elderly people.

Classification of forms

When making a diagnosis, signs of the disease are taken into account. At the first stage, unspecified encephalopathy is confirmed less often, since pathology is not detected during examinations, while cerebral changes are already present.

The second degree of severity allows for a faster diagnosis, as patients show mild to moderate signs of the disease. At the third stage, severe neuralgic disorders are noticeable and the diagnosis is confirmed even without additional examinations.

The specificity of unspecified encephalopathy is such that, depending on the type of disease (intoxication, infectious), the type of stages also changes. In the acute course of infectious pathology, the first degree almost immediately passes into the second or third.

Causes of the disease

Any encephalopathy - unspecified or confirmed - can be either congenital or acquired. Congenital abnormalities are associated with several factors. The first one is prenatal, it is characterized by fetal injuries and other negative factors affecting the embryo. The second is perinatal, caused by childbirth, as well as adverse effects after birth.

Most often, these forms of encephalopathy develop as a result of:

• trauma to the skull, received during the passage of the fetus through the birth canal;
• metabolic diseases inherited from parents;
• anomalies in the development of the nervous system and brain;
• alcoholism, drug addiction, infectious diseases of the mother during pregnancy.

There is also a more accurate classification of encephalopathies, the types of which can occur in an unspecified form. A form such as metabolic is divided into several subspecies. They can be associated with other disorders, for example, vascular: cholesterol plaques narrow the lumen and cause metabolic disorders.

Medical researchers believe that the main cause of any encephalopathy is cerebral hypoxia.

Diagnosis of the disease - multistage, difficult process time consuming. You cannot rely on the results of one analysis, since other disorders can be hidden under any type of encephalopathy. And pathology can never arise as an independent disease.

Development mechanism

For a more accurate understanding of what is unspecified encephalopathy, you need to consider the development mechanism:

• Is happening... It is caused by vascular spasms and other disorders in the work of organs, the circulatory system.
• Metabolic disorders... Cells do not receive enough nutrients, atrophy and degeneration begins.
• Overgrowth of foci... Demyelinated foci are formed, dying tissue in the white matter of the brain.
• Arise... At first they become small, single, then grow.
• Edema and stagnation ... The formation of these signs leads to the death of large areas of the brain.

Gradually, a person loses cognitive functions, the nervous system suffers. Launched encephalopathy does not respond to treatment, the lost parts of the brain are not restored.

The brain reacts very quickly to any changes, since this organ contains a minimum supply of oxygen. As soon as it ceases to be enough, pathological processes immediately develop.

Symptoms of pathology

Encephalopathy proceeds slowly, and at least 3-6 months must elapse from the onset of the disease to achieve the first symptoms. but acute types are characterized by an accelerated course... On early stage regardless of the type of disease, certain signs are found:

• difficulties in the implementation of mental activities that have not previously caused problems;
• problems with step-by-step activities;
• decreased memory;
• severe sleep disturbances that lead to daytime sleepiness and nocturnal insomnia, the patient has nightmares;
• severe fatigue even when doing familiar things that used to be enjoyable;
• extraneous tinnitus, dizziness, headaches, constantly disturbing the patient;
• after stress, the patient feels an incredible loss of strength and emptiness;
• character becomes hot-tempered, mood often changes, irritability and tearfulness appear;
• the patient suffers from visual and hearing impairments.

At the initial stages of the disease, the patient maintains a normal state of health, and changes begin mainly when the weather conditions change. Affects the symptomatology of stress, anxiety and mental overload.

Dysfunctions of the nervous system develop slowly, beginning with a disorder of coordination and weak seizures. Keeps getting worse mental condition: apathy develops, the circle of interests narrows, memory, speech, attention suffer. Dementia is the end of encephalopathy.

Each type of encephalopathy, which may initially have been unspecified, has its own symptoms.

Vascular form

It develops in the elderly due to vascular problems, less often in adults 30-50 years old. Vessels of the neck, head, upper half of the body suffer. At stage 2, it is manifested by pronounced neurological symptoms: shuffling, instability, tremor, urinary disturbance, disorientation.

Appears at different ages due to trauma, accompanied by severe nausea and headaches, as well as severe fatigue. Medications give relief only for a while. Falling attacks, seizures, asthenia, as well as problems with mental activity are possible.

Hypertensive form

Appears in hypertensive crisis or from constant exposure high pressure... It is characterized by fuzzy speech, muscle weakness, and pronounced slowness when moving. Patients may have head tremors, and swallowing functions deteriorate.

Venous form

Symptoms affecting memory and intelligence, as well as thought processes, predominate. In the hot season, with venous encephalopathy, chills may appear. The patient is worried about coughing, heaviness in the head. Facial puffiness and pallor may appear.

Toxic form

Unspecified toxic encephalopathy is characterized by convulsions, a feeling of dullness, and problems with breathing and circulation. Nausea, weakness, and pressure drops, combined with difficulty controlling urination or defecation, can be chronic.

Severe poisoning in almost all cases is accompanied by loss of consciousness, hallucinations, delirium. With an advanced form of the disease, death often occurs.

Alcoholic form

Included in the group of intoxication encephalopathy, accompanied by delirium tremens (delusions and hallucinations). If the disease proceeds in a chronic form, then after several months of constant alcohol consumption, tremors, weakness, anxiety, depression and personality decay appear.

Leukoencephalopathy

A form of the disease in which nausea appears, severe pain in the head, a person suffers from hallucinations, phobias and obsessive fears. All functions of the brain are suppressed.

It proceeds with bouts of confusion. A person becomes slow, it is difficult for him to be given such processes as speech and performing everyday activities. Over time, drowsiness, hallucinations develop, the patient falls into a coma.

Acute encephalopathy

Rarely leaks in unspecified form... Severe and extensive brain damage appears, which means its early death after a stroke or edema. Symptoms acute form overlap with other diseases and do not give an accurate diagnosis without additional research.

Unspecified encephalopathy is most often diagnosed in babies under 6 months of age. However, it can only be confirmed after analyzes.

In a child, the disease proceeds in 3 degrees:

Easy... Crying, excitability and constant anxiety appear. Sleep worsens, stress levels rise, appetite decreases, and vomiting increases. Muscle tone changes significantly, sometimes squint develops.

Average... The work of the nervous system deteriorates: pressure rises, convulsions and hydrocephalus appear. The child's skin becomes marbled, the eyes become slightly closed, as in the syndrome of the "setting sun". The child almost always presses his arms and legs to the body. Constant crying and insomnia develops.

Heavy... There is a complete suppression of brain functions, impaired consciousness. The kid falls into a coma. In most cases, death occurs.

Childhood encephalopathy is often a complication. In adults, they also develop in 80% of cases.

Forecast

If a person has experienced encephalopathy, and therapy was provided on time, then the risk of complications is minimal. Here are the most common consequences of the disease: paralysis and paresis, convulsions, strabismus, metabolic disorders, excess weight, epilepsy.

In severe forms, movement problems almost always develop, epilepsy and mental abnormalities occur. The patient is put on.

Worst consequences has toxic, unspecified it almost never happens. The treatment of the disease is complicated by the fact that the symptoms in all its forms are almost the same, and even modern diagnostic methods do not allow us to accurately determine the cause of the pathology.

Unspecified encephalopathy is not a disease, but a diagnosis preceding a detailed study of the patient in order to formulate a more accurate verdict. In order to notice the disease in time and prevent its development, you need to undergo a full medical examination at the first signs and get an opinion from several doctors.