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Children's cerebral paralysis (cerebral palsy) occurs on average with a frequency of 1.5 per 1000 children, leads to disability due to the defeat most often of the musculoskeletal system. It ranks third in the frequency of lesion after congenital diseases and the effects of polio and is 0.8-1% of all orthopedic diseases in children.

For the first time as the nosological unit of the PPC described Little in 1853. He combined clinical symptoms, characterized by increased spasticity of the muscles of the limbs, motor disorders, flexion and leading joint contractures, severe equineral deformations of the feet and a violation of the child's psyche, in a disease that later became known as Little's disease. . True disease includes children's cerebral paralysis and paresses arising from generic injury or premature birth. In 1893 S. Fread introduced the term "cerebral spastic paralysis»For all manifestations of spastic paralysis on the basis of prenatal, intranatal and postnatal causes.

Congenital reasons contributing to the development of cerebral spastic paralysis include the defects of brain development, often in combination with the anomaly of the skull formation, as well as hereditary diseases, chronic infectious diseases of the mother, toxicosis of pregnant women, toxoplasmosis, and bleeding at the mother during pregnancy, etc.

Prenatal factors include the presence of the fetus. Ceplens of Cerebral Paralysis Related Cerebral Cerebral Disorders include a circulation disorder in the brain during childbirth (large fetal head, narrow pelvis), brain injuries (during the imposition of forceps or other obstetric receptions), asphyxia of the fetus (during the placenta reference or when increasing placenta, etc.).

The postpartum causes of the development of cerebral spastic paralysis may be injuries in the first days and months of life due to bruises, concussion and compression of the brain, as well as infectious diseases of the type of meningitis, encephalitis, meningoencephalitis, etc.

At the heart of the pathogenesis of the disease lies the primary violation of the activities of the cerebral cortex caused by either the generic injury or inflammatory process. The most often orthopedists are dealing with patients who suffer from the consequences of intranatal and postnatal injuries.

In terms of gravity of the disease and clinical symptoms of such patients are divided into three groups: 1) with a light degree of spastic pares; 2) with a medium degree and 3) with a sharply pronounced spastic pares.

Patients of the first groups are self-made, serve themselves, the intelligence of most of them is not disturbed. They study at school and universities, then work (Fig. 1).

Fig. one. Patient Palsy: Left-sided spasta hemiparesis

Patients of group II can move with the help of crutches or with the help of outsiders. Self-service is difficult for them, they can not sleep independently and can not be careless. There is a violation of intelligence, speech, vision, hearing, contractures of the joints and vicious positions of the limbs. At school, such patients will not attend such patients, to introduce them to special work very hard.

Patients of the III groups can not move even with the help of outsiders, are not able to serve themselves. In a significant number, their psyche, speech, vision, memory suffer sharply. There are persistent contractures and vicious positions of the limbs. The degree of contractures and muscle spasticity are different, and with excitement and attempt to move, they increase (Fig. 1).

Despite the different degree of muscle spasticity and pares, the clinical picture of spastic paralysis is characteristic. The upper limbs are given to the body, the forearm is in the position of the pronation and bending in the elbow joints, the brush is in the position of the palm bending, the fingers are compressed in the fist, the first finger is given. The thigh is rotated inside and is in the position of bending and bringing in the hip joint. As a result of the spasm of the leading muscles, both knee joint rubs each other, and sometimes they crossed. In the knee joints - mostly flexible contractures, and feet - in the position of plantar bending and varetle lead. Often there is a bilateral spastic planefoot. The gait is typical: a support for the front stops of a stop due to a pronounced building (sole bending), the lower limbs are bent in the knee and hip joints, the legs are thrown into the mouth, the knees are drunk on each other, the feet "brazen". The upper limbs are shown to the body, bent in elbow and ray-tailed joints, fingers - in the position of bending contractures. It is characterized by a view of a patient with cerebral spastic paralysis: squint, unclipped mouth, saliva. With severe disease, the disease is pronounced, hypercines, athettos. Depending on the localization and prevalence of the lesion of the head of the brain, monopares (one upper or one lower limb) are possible, hemipreps (one-sided damage torso and limbs), parapreps (lesion of the lower extremities) and quadripreps (lesion of the upper and lower extremities).

The diagnosis of cerebral spastic paralysis for the first time to put life for the first time. However, the appearance of spastic disorders of the limbs, crossing the legs, the tendency to the bending positions of the lower limbs, the extensive positions in the elbow joints allow you to suspect this pathological state. The child is lagging behind in mental development from peers. By the year, flexitive-leading contractures appear in the lower limbs and flexion-adjustment settings of the upper limbs. At the age of 1-1 1/2, it is not difficult to diagnose. If the child has not learned to sit and serve himself, then the forecast for the restoration of the limb function is unfavorable. Along with motor disorders (change in the strength and tone of muscles, the volume of movements and the velocity of motor reactions, a decrease in muscle performance, a violation of coordination, the presence of pathological reflexes and an increase in tendon reflexes), such children have accompanying symptoms of cranial nerve disorders, violation of speech, psyche, disorder Extrapyramidal system functions.

Treatmentchildren with cerebral spastic paralymps are predominantly palliative, since the root cause associated with changes in the brain is dismissed. Treatment is aimed at reducing muscle rigidity, elimination of contractures and assistance in movement.

Treatment is divided into general and orthopedic.

General treatment.Little and mentally retarded children spend only passive exercise, older children are active and passive exercise. For them, games are important in medical institutions and at home, so parents are specially trained by the methods of LFC. Classes should include respiratory, corrective, rhythmic exercises, stretching and muscle strengthening, walking training.

Simultaneously with the FTLC, FTL (electric and susbanding, hydrochief, ozteritotherapy, paraffin therapy) is used.

Medical treatment is aimed at reducing muscle tone. Prescribed the drugs of glutamic acid, middokalm, dibazole, tropacine (reduces the excitability of m-cholinoreceptors), etc., as well as vitamins of group B and E. Special attention should be paid to the development of intelligence.

Orthopedic treatmentit is divided into non-orpeable and operational. It begins with the first months of the child's life and continues during the entire growth period.

Inoperative treatment consists in correcting the contractures of the limbs with the help of stage gypsum bandages, an or plaster bandage apparatus with distractional hinge devices mounted in them. After eliminating contractures, it is necessary to fix the limbs in orthopedic apparatus or shoes with high rigid beert, and at night to lay them into plaster-covered nitroloma or polyethylene tires and cribs. If the child has a sharp spasticity of the muscles, the limbs are fixed in bubbly leather apparatus with hinges, and simplicable devices apply with light lesions.

Elimination of contractures and setting such children to feet with the help of crutches or devices significantly improve their physical and mental state.

Operational treatment.Types of surgical interventions can be divided into six groups:

1) on the brain;

2) on the spinal cord;

3) on the vegetative nervous system;

4) on peripheral nerves;

5) on muscles and tendons;

6) on the bones and joints.

Only the last three types of operations found use, since the first three types are ineffective and give high mortality.

Operations on peripheral nerves, muscles and tendons, bones and joints have strict testimony and are produced between the ages of 5 and older.

Indications for the operation - the unsuccessfulness of non-efficient treatment under the following conditions:

1) a sharp muscle spasm, increasing when walking;

2) persistent contractures;

3) the presence of deformation of the upper or lower limbs that does not violate statics and walking.

At the same time, the doctor should be based on clinical data general status Patient, degree of disorders of intelligence and severity of deformations.

Operations on the lower limbs.In a spastic dislocation in the hip joint, it is possible to open.

The deadlines for immobilization in the gypsum hip bandage are lengthened to 2 months.

With bending-leading contractures, the hips show the branch of the thigh flexors from the top front and lower front iliac apartments and the myotomy of the hip adductors. With the pronounced muscle spasticity, the adductors' tenotomy is shown in combination with resection of the front branch of the locking nerve (Fig. 2). To correct contractures, use the device or gypsum bandages with distraction-hinge devices mounted in them.

Fig. 2. Access for resection of a locking nerve: A - in-part in Chandler; B - Ethotized Vishnevsky: 1 - obturatorius; 2 - t. Adductor Longus;3 — fascia Pectinea;4 — t. Pectineus.

To eliminate the rotation of the hip inside, the dernotation exposure osteotomy of the femoral bone is shown.

One of the methods of eliminating flexing contractures in the knee joints is the operation of the EGGERS (Fig. 3).

Fig. 3.Scheme of the operation of the EGGERS. Moving points attaching shin bends on femoral mysteries

To eliminate the equineral (plantar) flexions of the foot apply interventions on the tendons, muscles and bones: this is a Z-shaped lengthening of the heel tendon, or the surveillance operation (separate conveying of the icy muscle), or the triple arthrodes of the foot in children over 8 years old.

Operations on the upper limbschildren with spastic paralysis are one of the difficult problems. Operations on the bones and joints were not widely used. At the same time, actively apply operations on muscles and tendons. So, the elimination of the leading shoulder contracture can be achieved by intersection of the tendons of a large thoracic muscle, wide muscles of the back and a large round muscle. Flexibility of forearm contractures can be eliminated by the Tyube operation (Fig. 4). The bending installation of the brush can be eliminated by the operational or shortening of the bones of the forearm, or the arthrodesis of the ray-taking joint, or the transcendental teenage of the finger flexors through the metaphy of the radial dice along the chaklin.

Fig. four. Diagram of Operations of Tyube. Transformation of the Round Pronator in the Super: A - Normal Attachment of the Round Pronator; b - the place of attachment of the circular pronator after it is moved

In the treatment of patients with cerebral spastic paralysis, it is necessary to take into account the need for not only the restoration of the function of the victim limb, but also to the adaptation to self-service, and if possible, to work. To maintain the results of treatment, the patient is supplied with prosthetic and orthopedic products.

Traumatology and orthopedics. N. V. Kornilov

Under the progression of the pathological process, motor and sensitive functions gradually fade, which leads to full paralysis of the muscles on the affected side of the body - hemiplegia. The disease can be congenital and acquired. When untreated treatment leads to disability and loss of self-service skills. IN international Classification MKB 10 pathology diseases are assigned the G81 code.

The reasons

Hemiparez develops with violation of the operation of central motor neurons and axons. In other words, nervous cells and their processes are damaged, which are located in the head and spinal cord. In most cases, the pathological process is located in one of the hemispheres of the brain. Interesting is the fact that when localizing damage in the hemisphere on the right, the weakness of the muscles is formed in the left half of the body and vice versa. This is due to the anatomical crossroads of nerve fibers emanating from the brain at the level of transition oblong in the spinal cord.

To the main reasons, hemipracks include:

• ischemic and hemorrhagic stroke;
• brain tumor, hemorrhage in neoplasm;
• encephalitis (inflammation of brain tissue);
• card and brain injury;
• epileptic seizures;
• multiple sclerosis;
• diabetic brain lesion (encephalopathy);
• migraine;
• ONMK (acute violations of cerebral blood flow).

The clinical picture of hemiparesis differs depending on the lesion site in the brain

The listed causes cause the acquired form of the disease, which develops in adult patients. Children hemiparet is congenital in nature, it appears due to the vices of brain development or generic injury.

Clinical picture

According to clinical manifestations of the disease, it is possible to determine the localization of the pathological process and the severity of damage to the nervous tissue. The central nature of the disease confirms the spasticity of the muscles of the limbs on one side of the body. At the same time, the hand or foot is in a tense position, patients feel stiffness of muscles, lose the ability to do motor activity. On the contrary, the peripheral form of pathology, which develops during damage to the nerve fibers after exiting the spinal cord, is characterized by a decrease in muscle tone.

Depending on the damage to the right or left hemisphere of the brain, highlight right-hand and left-sided hemiparesis. Patients with older age is more commonly found by right-sided hemiparesis, and for children it is characteristic of the left-sided development of muscle weakness. The characteristic motor disorders due to muscle spasticity are developing 2-3 weeks after the onset of the disease and can increase throughout the year. Insufficient conservative treatment And the refusal of rehabilitation measures causes the progression of pathology, which leads to the formation of hemiplegia. The disease causes severe consequences in the form of a persistent contracture of muscles and joints - a person becomes disabled.

In the pathological process in the left hemisphere of the brain, paralysis arises in the right half of the body

The general symptoms of the disease include:

• constant headaches of different intensity over several weeks;
• general ailment, reduction in working capacity, weakness;
• worsening appetite, weight loss;
• periodic increase in body temperature;
• pain in the field of joints and muscles.

The most common right-sided and left-sided hemipreps in adults develops after stroke or acceleracy injury. With fockey damage to the brain fabric, impaired motor function appear and a decrease in the sensitive sphere on one half of the body. The patients are formed by the launch of the warn-manna - the foot is not a side of the defeat, it does not bended and when walking makes a semicircle through the side. This variant of the disease usually has a slight course and a favorable outcome to restore lost functions. With an extensive area of \u200b\u200bhemorrhage or damage to the nervous tissue, except motor disorders, the following neurological disorders are observed:

• changing speech (more often accompanies right-sided hemiparex);
• episodic epileptic seizures;
• violation of intelligence and learning ability;
• change of perception (agnosia);
• reducing the ability to target activities (aprages);
• emotional instability and personality disorder.

With a congenital form of the disease, left-sided hemiparesis develops, which becomes noticeable 3 months after the child's birth. In the initial stages of the disease, moderate changes in the motor ability of the limbs are observed:

• asymmetric hands and legs;
• weak passive and active movements of the affected limbs;
• in the position lying on the back of the thighs are in a splaspling state;
• brush hands compressed in a fist;
• weak support function on the pathology side.

The final diagnosis is approximately in the ages when children begin to walk independently and motor disorders become more visible. In severe cases, the disease occurs with violation of speech and intellectual abilities. An innate form of pathology refers to one of the forms of cerebral palsy.

Sometimes a children's spasta hemiparesis is developing, in which limbs are affected, while the hands suffer more often than legs. PRP Right-sided hemiparem in newborns develops less frequently resistant hemiparesis.

Medical tactic

To prevent the formation of complete paralysis of muscles - hemiplegia - it is necessary to prescribe treatment and rehabilitation in the initial signs of the disease. Therapy is most effective in the first year of the disease. In a later period, motor disorders are persistent and difficult to corrected. A complex of therapeutic measures is prescribed depending on the severity of clinical manifestations, age and the overall state of the patient.

The rehabilitation period restore the motor ability of the limbs

Conservative hemipreasing therapy includes:

• physiological laying of limbs with Longets to prevent the development of muscle contractures and joints;
• miorlaxants to reduce the tone of muscles and caused by spasticity of pain syndrome - Middokalm, Baclofen;
• preparations for improving the blood supply and normalization of trophics of nervous tissue - cerebrolysin, Cavinton, Milgamma;
• anticonvulsant tools - carbamazepine, valproic acid;
• physiotroporage - elkthroporesis, ultrasound, diadynamic currents;
• common and segmental body massage, point massage, reflexology;
• therapeutic physical culture (LFC) is a complex of dosage exercises to normalize the motor activity of affected parts of the body.

Assigns a psychologist, aimed at improving the emotional state and social adaptation of patients. In violation of speech, classes with a speech therapist are carried out. In severe cases, operational interference on affected muscles is used.

After discharge of a patient from a neurological hospital, it is necessary to regularly carry out a massage, which relaxes the spashed muscles, improves blood flow and metabolism on the affected side of the body. Use relaxing massage techniques using stroking, rubbing, kneading. To restore the motor ability of the limbs, the individual exercises of therapeutic physical education are developed in each particular case. Recovery largely depends on the timeliness of the treatment and volitional qualities of the patient, from his desire to defeat the disease.

The hemiparesis refers to a severe disease, which is accompanied by the muscular weakness of one half of the body and other neurological symptoms. The progression of the disease causes the formation of complete paralysis (hemiplegia). With timely therapy, the chances of restoring lost functions are large, otherwise pathology leads to disability and loss of self-catering skills.

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Hemiplegia (G81)

Note. For primary coding, this heading should be used only when hemipilegia (complete) (incomplete) is reported without additional clarification or it is argued that it has been established for a long time or exists for a long time, but its reason is not clarified. This heading is also used when encoding for multiple reasons for identifying hemiplegia types caused by any reason.

Excluded: congenital cerebral paralysis (G80.-)

In Russia, the International Classification of Diseases of the 10th Review (ICD-10) adopted as a single regulatory document for accounting for incidence, the reasons for the appeals of the population in medical institutions All departments, causes of death.

The ICD-10 has been introduced into the practice of health throughout the territory of the Russian Federation in 1999 by order of the Ministry of Health of Russia from 27.05.97. №170

A new revision (ICD-11) is planned to be planned in 2017 2018.

With changes and additions to WHO.

Processing and transferring changes © MKB-10.com

Codes of codes on the ICD-10

Child cerebral paralysis (cerebral palsy) develops mainly due to congenital brain abnormalities and is manifested in the form of motor disorders. Such a pathological deflection on the international classification of diseases (ICD) 10 revision has a G80 code. During the diagnosis and treatment of treatment, doctors are focused on it, so it is extremely important to know the cipher features.

Varieties of cerebral palsy on the ICD-10

Press Code on the ICD 10 has G80, but it has its subsets, in each of which describes a certain form of this pathological process, namely:

• 0 spastic tetraplegia. It is considered an extremely heavy variety of cerebral palsy and arises due to congenital anomalies, as well as due to hypoxia and the resulting infection during intrauterine development. Children with spastic tetraplegia have various defects of the structure of the body and limbs, as well as the functions of the cranial brain nerves. It is especially difficult for them to move their hands, so their labor activity is excluded;
• 1 spastic diploggy. This form is found in 70% of children's cases. cerebral paralysis And it is also called Little's disease. Pathology is manifested mainly in premature babies due to hemorrhage in the brain. For it, it has a two-way muscle damage and damage to the cranial brain nerves.

The degree of social adaptation is quite high in this form, especially in the absence of mental retardation and, if possible, fully work with your hands.

• 2 hemiplegic appearance. It occurs in premature babies due to hemorrhage in the brain or because of various congenital brain anomalies. A hemiplegic form is manifested in the form of one-sided lesion of muscle tissues. Social adaptation depends mainly on the degree of severity of motor defects and the presence of cognitive disorders;
• 3 Discinetic appearance. There is such a kind of predominantly due to hemolytic disease. For the disclinistic type of cerebral palsy, damage in the extrapyramid system and the auditory analyzer are characterized. Mental abilities are not affected, so social adaptation is not violated;
• 4 Ataxic type. It develops in children due to hypoxia, anomalies in the structure of the brain, as well as due to injury obtained during childbirth. For this species, the cerebral palsy is characterized by ataxia, low muscle tone and speech defects. Damage is localized mainly in the frontal share and cerebellum. Adaptation of children with an attaccine form of the disease complicated by possible mental retardation;
• 8 mixed type. For this type, the combination of several types of cerebral palsy is simultaneously. Brain damage at this diffuse character. Treatment and social adaptation depends on the manifestations of the pathological process.

Code of the ICD 10 revision helps doctors to determine the form of the pathological process and assign the correct treatment regimen. For ordinary people These knowledge can be useful to understand the essence of therapy and know possible options for the development of the disease.

The information on the site is provided solely in popular-familiarization purposes, does not claim for reference and medical accuracy, is not a guide to action. Do not self-medicate. Consult your attending physician.

Congenital and acquired hemiparesis

Hemiparem in medicine is called a condition that is characterized by partial paralysis of the muscles of the face and body. The hemiparem appears as a result of injuries and pathologies of the head or spinal cord, the result of which is becoming one-sided paralysis. Pathology can be congenital or acquired, and in children, and in adult patients. With timely complex therapy, the disease is amenable to treatment, but in the launched state, the hemiparesis causes a person with disabilities. In the international classification of hemipareve disease, the Code of ICD 10 - G.81 was assigned.

Causes of development

The establishment of the root cause of the manifestation of symptoms of hemiparesis is the basis for the appointment of effective therapy. Pathology develops as a result of the following factors:

• A stroke is the most common cause of hemiparesis. When stroke often, the vessels break occurs, as well as the tomb of the blood cloud from the wall. After the stroke, the patient must constantly be under the supervision of a doctor to avoid complications, one of which is hemiparesis.
• Increasing in the volume of the neoplasm, which appears after a stroke. A growing tumor negatively affects healthy brain cells, which often provokes a violation of normal activity. The reason is excessive pressure on certain parts of the brain.
• Oncological disease. Cancer tumor flowing in slow motion mode, often provokes the appearance of hemiparesis.
• Injuries and bruises of the brain.
• Encephalitis arising due to infection or negative factors (toxic poisoning, allergic reactions).
• Physiological state after epilepsy. Hemiprepsy is able to develop if after epileptic attacks in humans are manifested by spasms that violate the normal functionality of the brain.
• Migraine. Chronic flow Migraines (especially under the hereditary factor) provokes the development of symptoms of hemiparesis.
• Complications for sugar diabetes. The pathology provoke spasmodic states and convulsions that are characteristic of endocrine diseases.
• Scattered sclerosis - pathology is characterized by the destruction of brain protective shells and nerve damage.
• Atrophy of the cortex of the brain. Hemiparez develops due to neuron dying.
• Congenital shape of hemiparesis, as well as cerebral palsy.

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With congenital hemiparesis, hereditary diseases and generic injury are important. In the elderly, partial paralysis is associated with preceding circulatory diseases and their complication, stroke. In most embodiments, age patients diagnose right-sided hemiparesis, in which the motor activity and sensitivity of the right side of the body are disturbed.

There are cases of "pseudopara" (light hemiparesis), when symptoms of pathology begin to manifest themselves because of frequent nervous disorders or stress. This form of the disease does not require any treatment, since after the elimination of provoking factors, the symptoms disappear without a trace.

Left-sided and right-sided hemiparesis in children is more often formed in the form of congenital pathology. Most often the main cause of the state is the diagnosis of cerebral palsy.

Clinical picture

The manifestations of the hemiparesis clinic depends on the location of the pathogenic focus, as well as the severity of the brain damage. If there is a slow development of the disease (moderate hemiparesis), then in the first months, the patient is growing muscular tone. The result becomes stiffness of movements caused by the voltage of the muscles of the limbs.

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• violation of perception;
• violation of speech functions;
• the emergence of emotional and personal disorders;
• impaired sensitivity at the place of lesion;
• development of one-sided or bilateral immobility;
• epileptic attacks.

The following physiological deviations protrude as common signs of hemiparesis:

• headaches;
• temperature increase;
• lack of appetite;
• pain in the muscles and joints;
• general weakness of physical and emotional nature;
• a sharp decline in body weight.

For left-sided hemipresses are characterized by such symptoms as:

• violation of logical connections;
• violation of the ability of the account, analysis;
• violation of speech functions.

With right-sided hemiparesis manifests itself:

• disorientation in space;
• violation of color perception and image;
• the emergence of three-dimensional perception.

With a congenital form of pathology, the main symptoms appear in about 3 months after the child's appearance. At the initial stages of the development of pathology, the kid manifests itself:

• asymmetry when driving hands and legs;
• motor weakness and passivity of affected limbs;
• lying on his back, the child "spreads" the hips on the sides;
• the handles brushes are almost always compressed into the cam;
• weak reference function of the lower limb on the side of the lesion.

The final diagnosis of the doctor is defined approximately. With complicated form of the disease, there is a violation of the development of speech and intellectual abilities in a child.

In some cases, a child can develop spastic hemiparesis when limbs are amazed, but their hands suffer more than legs.

Diagnostic methods

The methods of diagnosis of pathology included:

• generally clinical laboratory examination (delivery of urine and blood tests);
• doppler of brain vessels;
• electroencephalography.

When diagnosing a diagnosis, the doctor necessarily defines the cause of the disease, which greatly affects the nature of treatment.

Qualified treatment and methods of therapy

To prevent full paralysis, hemiparet treatment must begin as early as possible. Treatment in children must begin in the first year of life. After a year, the result is more difficult to achieve, since the main functions have already been formed. Often, after detection of hemiparesis, the child is hospitalized, and after they send to a rehabilitation center for a long time.

The therapeutic technique depends on the severity of pathology, on the characteristics of the structure of the body, the age of the patient. As a rule, the overall treatment of hemiparesis includes:

• the purpose of Miorlaxantes - Middokalm - a decrease in the tone of muscles provoked by pain syndrome;
• reception of drugs that improve the blood supply of the brain - cerebrolysin;
• reception of anticonvulsants - carbamazepine.

A doctor may be appointed and other drug therapy, which depends on the complexity of pathology. Together with drugs, hemipreb treatment includes:

• the procedure that provides for the laying of the limb with the help of Langeta, which prevents the development of contractures;
• physiothereders - ultrasound, dynamic current, electrophoresis;
• massage in hemiparesis - point, reflex, segmental, common;
• therapeutic physical culture - the exercises that promote the normalization of motor activity of the affected limbs are included in the LFC complex.

The patient shows the consultation of a psychologist, which allows to normalize the emotional state of the patient and serves as excellent social adaptation. As a comprehensive treatment, a spellopian consultation is prescribed (if there are speech defects).

The use of alternative techniques - acupuncture, shiatsu, needleflexotherapy also brings good results with systematic use. A huge role in the treatment is played by the patient itself. If it makes a methodically doing exercises, he does not work with specialists, there will be no progress to progress, and it will gradually disappear completely.

Hemiparem (hemiplegia)

Hemiparesis ("Central") - paralysis of the muscles of one half of the body as a result of the damage to the appropriate upper motorcycles and their axons, that is, motor neurons in the anterior central is usual or cortico-spinal (pyramidal) path usually above the level of the neck thickening of the spinal cord. Hemiparesis, as a rule, has cerebral, rarely spinal origin.

Neurological differential diagnosis, as a rule, begins to be built taking into account the cardinal clinical features that facilitate the diagnosis. Among the latter, it is useful to pay attention to the course of the disease and, in particular, on the features of his debut.

The speed of development of hemiparesis is an important clinical sign that allows you to speed up the diagnostic search.

Suddenly developed or very fast progressive hemiparez:

1. Stroke (the most common cause).
2. Volume formations in the brain with pseudo-hypotion.
3. Card and brain injury.
4. Encephalitis.
5. Positive state.
6. Migraine with aura (hemiplegic migraine).
7. Diabetic encephalopathy.
8. Multiple sclerosis.
9. Pseudoparez.

Subacute or slowly developing hemiparesis:

1. Stroke.
2. Brain tumor.
3. Encephalitis.
4. Multiple sclerosis.
5. Atrophic cortical process (Mills Syndrome).
6. Hemipreps of stem or spinal (rare) origin: injury, tumor, abscess, epidural hematoma, demyelinizing processes, radiation myelopathy, in the picture of Brown-Secary's syndrome).

Code of the ICD-10

Suddenly developed or very fast progressive hemiparesis

Stroke

Meeting a patient with acute hemiplegia, the doctor usually assumes the presence of a stroke. There are strokes, of course, not only in older patients with arteropathy, but also in young. In these rare cases, it is necessary to eliminate the cardiogenic embolism or one of the rare diseases, such as fibrous muscular dysplasia, rheumatic or syphilitic angiite, sledon syndrome or other diseases.

But before, it is necessary to establish whether stroke ischemic or hemorrhagic (arterial hypertension, arteriovenous malformation, aneurysm, angioma), or there is venous thrombosis. It should be remembered that sometimes the hemorrhage in the tumor.

Unfortunately, there are no other reliable methods of differentiation of the ischemic and hemorrhagic nature of lesion at stroke, except for neurovalization. All other indirect evidence mentioned in textbooks are not quite reliable. In addition, a subgroup of ischemic stroke, which seems to be called both hemodynamic disorders due to extraseciented arterial stenosis and a cardiogenic embolism, or arterio-arterial embolism due to the ulceration of plaques in extra-or intracerebral vessels, or local thrombosis of a small arterial vessel. These different types of stroke require differentiated treatment.

Volume formations in the brain with a pseudo-hypotion

Acute hemiplegia can be the first symptom of brain tumor, and the cause, as a rule, is hemorrhage into a tumor or surrounding tissues from the rapidly emerging inner vessels of the tumor with an infallible arterial wall. The increase in the neurological deficit and a decrease in the level of consciousness, together with the symptoms of generalized half-hearted dysfunction, are sufficiently characteristic of "apopletic glioma". In the diagnosis of tumor with pseudo-hypothesia, neurovalization methods have invaluable assistance.

Card and brain injury (CMT)

CMT is accompanied by external manifestations of injury and is usually clear the situation that caused the injury. An eyewitness survey is desirable to clarify the circumstances of the injury, since the latter is possible when the patient falls during the epileptic seas, subarachnoid hemorrhage and falls from other reasons.

Encephalitis

According to some publications, about 10% of cases, the beginning of encephalitis has a stroke similarity. Usually, the rapid deterioration of the patient's condition with a disturbance of consciousness, grateful reflexes and additional symptoms that cannot be attributed to the large artery basin or its branches, requires urgent surveys. Diffuse disorders are often detected on EEG; Neurovisualization methods during the first few days may not detect pathology; In the analysis of the lycvore, a slight plea-virocytosis is often revealed and an easy increase in protein level at a normal or elevated level of lactate.

The clinical diagnosis of encephalitis is facilitated if meningoencephalitis or encephalomyelitis occurs, and the disease is manifested by a typical combination of common-oxide, meningeal, general-selling and focal (including hemiparesis or tetrapapes, damage to cranial nerves, violations of speech, attactic or sensitive disorders, epileptic seizures) neurological symptoms.

Approximately 50% of cases, the etiology of acute encephalitis remains unexplained.

Positive state

Sometimes epileptic attacks remain unnoticed by surrounding, and the patient can be in a coma or in a state of confusion, having a hemiplegia (with some types of epileptic seizures). It is useful to pay attention to the bite of the tongue, the presence of involuntary urination, but these symptoms are not always present. An eyewitness survey is also useful, inspection of the patient's things (for the search for anti-epileptic drugs), if possible, a phone call home or to the district clinic at the place of residence of the patient to confirm the epilepsy according to the outpatient card. In the EEG made after the attack, "epileptic" activity is often detected. Partial seizures leaving the transient hemiparesis (paralysis of Todd) can develop without aphasia.

Migraine with aura (hemiplegic migraine)

Young patients have complicated migraine is an important alternative. This is a migraine version, in which transient focal symptoms, such as hemiplegia or aphasia, appear to one-sided headache, and, like other symptoms of migraine, periodically repeated as anamnesis.

The diagnosis is set relatively easily if there is a family and (or) personal history of repeated headaches. If there is no such anamnesis, the pathognomonic combination of symptoms constituting a severe neurological deficit, and focal disorders on EEG will be detected during the examination.

It is possible to rely on this symptoms only if it is known that they are due to half-blooded dysfunction. If the basilar migraine (vertebobasilar pool) occurs, the normal results of neurovalization still do not exclude more serious cerebral suffering, in which violations on the EEG may also be absent or be minimal and bilateral. In this case, the ultrasonic doppler of the vertebral arteries has the greatest value, since pronounced stenosis or occlusion in the vertebrobasilar system is extremely rare in the presence of normal ultrasound data. In case of doubt it is better to perform an angiographic study than to miss a cross-vascular defeat.

Diabetic metabolic disorders (diabetic encephalopathy)

Sugar diabetes can be the cause of acute hemiplegia in two cases. Hemiplegia is often observed with non-confone hyperosmolarness. Focal and generalized violations are recorded on EEG, but neurovalization and ultrasound data are normal. Diagnostics is based on laboratory studies, which should be widely used in hemipilegia of unknown etiology. Adequate therapy leads to a rapid regression of symptoms. The second possible reason is hypoglycemia, which can lead not only to segregates and confusion state, but sometimes to hemipilegia.

Multiple sclerosis

Scattered sclerosis should be suspected of young patients, especially when a sensorine hemiplegia has a sharp arise with ataxia, and when the consciousness is completely saved. At EEG often identifies minor violations. With neurovalization, the area of \u200b\u200bthe reduced density is detected, which does not correspond to the vascular pool, and is not, as a rule, the surround process. The caused potentials (especially visual and somatosensory) can significantly help in the diagnosis of multi-grade damage to the CNS. The data of the study of the liquor also help the diagnosis if the IgG parameters are changed, but, unfortunately, the spinal fluid may be normal during the first exacerbation (s). In these cases, the accurate diagnosis is established only upon subsequent study.

Pseudoparesis

Psychogenic hemiparesis (pseudoparez), which developed acutely, usually appears in the emotionic situation and is accompanied by affective and vegetative activation, demonstrative behavioral reactions and other functional and neurological signs and stigmas facilitating diagnostics.

Subacute or slowly developing hemiparesis

Most often, such violations are due to a cerebral lesion level.

The causes of weakness of this type are the following:

Stroke

Vascular processes, such as stroke in development. Most often there are gradual progression. This reason can be suspected based on the age of the patient, gradual progression, the presence of risk factors, noise over the arteries due to the stenosis preceding vascular episodes.

Brain tumors and other volumetric processes

Intracranial volumetric processes, such as tumors or abscesses (most often there is progression for several weeks or months) is usually accompanied by epileptic attacks. Under menigomas, there may be many years of epileptic history; As a result, the volume process leads to an increase in intracranial pressure, headache, increasing mental disorders. Chronic subdural hematoma (mainly traumatic, sometimes confirmed by an easy injury in history) is always accompanied by headache, mental disorders; Relatively non-neurological symptoms are possible. There are pathological changes in spinal fluid. The abscess on the abscess appears in the presence of a source of infection, inflammatory changes in blood, such as the acceleration of ESP, rapid progression. Because of the hemorrhage to the tumor, symptoms are suddenly emerging, rapidly growing to hemisindrome, but not similar to stroke. This is especially characteristic of metastases.

Encephalitis

In rare cases, acute hemorrhagic herpes encephalitis can cause a relatively rapid (subacute) hemisindr (with severe cerebral disorders, epileptic attacks, changes in the spinal fluid), soon leading to a comatose state.

Multiple sclerosis

Hemiparem can develop within 1-2 days and be very heavy. Such a picture is sometimes developing in young patients and is accompanied by visual symptoms, such as retrobulbar neuritis and busty episodes. These symptoms accompany urination disorders; Often the paleness of the optic nerve disk, pathological changes in visual caused potentials, nystagm, pyramid signs; Remiterating current. In the spinal fluid, an increase in the number of plasma cells and IgG. Such a rare form of demyelination, as the concentric sclerosis of the ballo, can cause a subacute hemisindrom.

Atrophic cortical processes

Local One-way or Asymmetric Cork Atrophy of the Presencentral Area: Disruption of motor functions can be slowly increasing, sometimes years are needed for the development of hemiparesis (Mills paralysis). The atrophic process is confirmed in computed tomography. The nosological independence of Mills syndrome has been questioned in recent years.

Processes in the field of brain and spinal cord

The lesions of the brain trunk in rare cases are manifested by increasing hemi syndrome; The processes in the spinal cord, accompanied by hemiparem, are even less common. The presence of cross-symptoms is proof of such localization. In both cases, the most frequent cause There are volume lesions (tumors, aneurysm, spinal spondylosis, epidural hematoma, abscess). In these cases, hemiparesis is possible in the picture of Brown-Secary Syndrome.

Where does it hurt?

What is bothering?

Diagnosis with hemiparere

General general examination (general and biochemical), blood test; hemoroological and hemochaguing characteristics; Analysis of urine; ECG; In indications - the search for hematological, metabolic and other visceral disorders), CT or (better) MRI of the brain and the cervical spinal cord; study of liquor; EEG; caused by the potentials of different modalities; Ultrasonic Doppler Main Arteries Head.

What do you need to examine?

How to examine?

What tests are necessary?

Who to contact?

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, specialty - "Therapeutic business"

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Another type of cerebral paralysis (G80.8)

general information

Short description

Child cerebral palsy (cerebral palsy) - A group of syndromes, which are a consequence of damage to the brain arising in the perinatal period.

A characteristic feature of the cerebral palsy is a variety of motor disorders that are manifested by paralysis, disincordination of movements are often combined with various speech disorders, psyche, sometimes epileptic seizures.

PPP - polyethological disease of the brain, which may occur during the period of its intrauterine formation, during the period of childbirth and newborn, as well as in the postnatal period. PPP is the most common cause of child disability (30-70%), among which in the first place - disease nervous system. In most cases, the physical condition of the patients is improved, but restrictions of activities are preserved: reducing the possibility of movement, speech disorders and others.

According to the literature, the frequency of cerebral palsy in the population is 2 per 1000 newborns; According to L. O. Badalyan (1987) - from 3 to 6 cases per 1000 born. The main reasons for the centers are associated with the processes of development of pregnancy and the generic act (perinatal period): chronic diseases of the mother, infectious diseases, medication reception during pregnancy, premature genera, prolonged generic activity, a hemolytic disease of the newborn, a campus of cord and others.

Protocol "Cerebral palsy"

Code of ICD-10:

G 80.0 Spastic Cerebral Paralysis

Congenital spasta (cerebral)

G 80.1 Spastic diplegegia

G 80.2 Children's hemiplegia

Classification

Classification

G 80 Child cerebral palsy.

Included: Little's disease.

Excluded: Hereditary spastic paraplegia.

G 80.0 Spastic cerebral paralysis.

Congenital spastic paralysis (cerebral)

G 80.1 Spastic diplege.

G 80.2 Children's hemiplegia.

G 80.3 Discinetic cerebral paralysis.

G 80.8 Another kind of children's cerebral paralysis.

Mixed cerebral paralysis syndromes.

G 80.9 Child cerebral paralysis is unspecified.

Classification of cerebral paralysis (K. A. Semenova et al. 1974)

1. Double spastic hemiplegia.

2. Spastic diploggy.

3. Hemiparesis.

4. Hyperkinetic shape with subforms: double athettos, athettosal ballism, choreatetomethosa, ferretic hyperkines.

5. ATONICAL-ASTATICAL Form.

By severity lesions: easy middle severity, severe form.

Period:

Early recovery;

Late recovery;

Residual period.

Diagnostics

Diagnostic criteria

Complaints On the delay in psychoreche and motor development, motor disorders, involuntary movements in the limbs, seizures of convulsion.

In history - perinatal pathology (presence, asphyxia in childbirth, generic injuries, Lucky conjugation jaundice, intrauterine infections, etc.), suffered neuroinfection, ONMK, CMT in early childhood.

Physical examinations: Motor disorders - paresis, paralympus, contractures and refractory in joints, hypercines, delay in psycho-speech development, intellectual failure, epileptic attacks, pseudobulbar disorders (violation of swallowing, chewing), pathology from the bodies of vision (squint, atrophy of optic nerves, nystagm ).

For spastic shape, cerebral palsy is characteristic:

Increase muscle tone in the central type;

High tendon reflexes with advanced reflexogenic zones, stop clocks and patella;

Pathological reflexes: Babinsky, Rossolimo, Mendel-Bekhtereva, Oppenheim, Gordon, Schaeffer. Among them are most constantly detected by Reflex Babinsky.

For the hyperkinetic form of cerebral palsy is characteristic:hyperkinesisa - ferret, atteetoid, choreathetoid, double athettos, torsion dystonia.

At the age of 2-3 months, "dystonic attacks" appear, characterized by a sudden increase in muscle tone during movements, with positive and negative emotions, loud sounds, bright light; accompanied by a sharp cry, severe vegetative reactions - sweating, redness of the skin and tachycardia.

Tendon reflexes in most patients of ordinary livelihood or somewhat revived, pathological reflexes are not detected.

Hyperkineses in the muscles of the language appear at the age of 2-3 months of life, earlier than hyperkinesis in the muscles of the body - they appear in 4-6 months and become more pronounced with age. Hypercines are minimal alone, disappear in a dream, enhanced with arbitrary movements, provoked by emotions, are more pronounced in the position on the back and standing. Speech disorders are hyperkinetic character - dysarthria. Mental development is disturbed less than with other forms of cerebral palsy.

For the atony-astatic form of cerebral palsy is characteristic:

1. Muscular tone is sharply reduced. Against the background of the general muscular hypotension, the tone in the upper limbs is higher than in the lower limbs, and the movements in the upper part of the body are more active than in the bottom.

2. Tender reflexes are high, pathological reflexes are absent.

3. Recurring in the knee joints, placulous feet.

4. In the mental sphere, 87-90% of patients have a pronounced reduction in intelligence, the violation of speech is cerebellum.

Laboratory research:

1. Common blood test.

2. Common urine analysis.

3. Cal on the eggs worm.

4. IFA on toxoplasmosis, cytomegalovirus - according to indications.

5. Definition of TSH - by testimony.

Tools:

1. Computed tomography (CT) of the brain: there is a different atrophic process - expanding the side ventricles, subarachnoid spaces, cortical atrophy, porencephalic cysts and other organic pathology.

2. Electricencephalography (EEG) - the overall disorganization of rhythm, low-voltage EEG, peaks, plaster, generalized paroxysmal activity is revealed.

3. EMG - by testimony.

4. MRI brain - according to the testimony.

5. Neurosonography - in order to exclude internal hydrocephalus.

6. Okulist - the study of the eye dna reveals the expansion of the veins, the narrowing of the arteries. In some cases, congenital atrophy of the optic nerve, squint, is found.

Indications for expert advice:

1. The speech therapist is to identify speech disorders and their correction.

2. Psychologist - to clarify mental disorders and their correction.

3. orthopedic - identification of contractures, solving the issue of operational treatment.

4. Prosthetist - to provide orthopedic assistance.

5. Okulist - inspection of the eye bottom, detection and correction of the eye pathology.

6. Neurosurgeon - in order to eliminate neurosurgical pathology.

7. Physician physician is the appointment of individual classes, stacking.

8. Physiotherapist - to appoint physiotherapeutic procedures.

Minimum survey at hospital:

1. Common blood test.

2. Common urine analysis.

3. Cal on the eggs worm.

Main diagnostic measures:

1. Common blood test.

2. Common urine analysis.

3. speech therapist.

4. Psychologist.

5. Okulist.

6. Orthopedist.

7. Prosthetist.

9. Physician physician.

10. Physiotherapist.

11. Computer tomography brain.

List of additional diagnostic events:

1. Neurosonography.

2. Neurosurgeon.

3. MRI brain.

4. IFA on toxoplasmosis.

5. IFA on cytomegalovirus.

6. Infectnessist.

8. Cardiologist.

9. Ultrasound of the abdominal organs.

10. Genetic.

11. Endocrinologist.

Differential diagnosis

Treatment abroad

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Treatment

Tactics of treatment

It is extremely important to suspect or make a diagnosis in the first year of life, since the child's brain has a huge potential to compensate for the damage. The brain of the child is extremely plastic, so you need to try to stimulate his restoration possibilities. IN comprehensive treatment PDCs include drugs, leaf, orthopedic assistance, different kinds Massage, reflexotherapy, physiotherapeutic procedures, classes with a speech therapist and a psychologist. Restorative therapy is most effective in patients in the early recovery period, the earlier to start a warning or decrease in the development of pathological phenomena, the greater the effect of therapeutic measures.

The basic principles of treating cerebral palsy in the restorative period:

1. Using medication tools, reducing the excitation zone and the reduction of muscle tone. Fight against the delay of tonic reflexes and pathological tone of muscles.

2. To achieve the formation vertical position The child, his movements and manual manipulations, the upbringing of standing skill, movement initially with an extraneous help, and then independently or with the help of crutches, sticks, orthopedic shoes, toys, devices.

3. Improving overall mobility and coordination of movements.

4. Promoting the normalization of mobility in the joints and performance of the muscles, eliminating the contractures of the joints.

5. Training and careport and equilibrium training.

6. Stimulation of cognitive and psycho-speech development, mental development and upbringing the right speech.

7. Training in vital, applied, labor skills, upbringing self-service skills.

Purpose of treatment:

Improving motor and psycho-speech activity;

Prevention of pathological poses and contractures;

Acquisition of self-service skills;

Social adaptation, the appearance of motivations;

Saving seizures seizures.

Non-drug treatment:

1. Common massage.

2. LFC - individual and group classes.

3. Physiotherapy - ozocenite applications, SMT, magnetotherapy.

4. Conductive pedagogy.

5. Classes with a speech therapist, psychologist.

6. Igloreflexotherapy.

7. Adeli costume.

8. Ippotherapy.

Medicia treatment

Recently, the preparations of nootropic series are widely used - neuroprotectors, in order to improve metabolic processes in the brain. Most of nootropic drugs, in connection with their psychostimulating action, are appointed in the first half of the day. The duration of treatment courses by nootrops is from one to two or three months.

Cerebrolysin, ampoules 1 ml in / m, piracetam, ampoules 5 ml 20%, tablets 0.2 and 0.4, ginkgo-biloba (tanacanan), tablets 40 mg, pyritinol hydrochloride (encephol), dragee 100 mg, suspension - 5 Ml contains 80.5 mg of pyritinol (comparison compartment of the pyritinol hydrochloride).
Encephol - minimum of contraindications is allowed to use from the first year of life. Dosing of the suspension (with a content of 1 ml of 20 mg of encefabol) for children 3-5 years old Dose 200-300 mg dose (12-15 mg of body weight) are prescribed to 2 reception - in the morning (after breakfast) and day (after day sleep and afternoon) . The duration of the course is 6-12 weeks, a long-lasting technique is advisable, which increases the performance and ability to learn, the highest mental functions are improved.

Actovegin, ampoules 2 ml of 80 mg, dragee-forte 200 mg of active substance. Neurometabolic preparation containing exclusively physiological components. Children are appointed in Dragee-Forte, reception to meals by ½ -1 dragee 2-3 times a day (depending on the age and severity of the symptoms of the disease), up to 17 hours. Duration of therapy 1-2 months. Instenon, tablets (1 tablet contains 50 mg of elegant, 20 mg of hexobundine, 60 mg of fillina). Multicomponent neurometabolic preparation. The daily dose is 1.5-2 tablets, prescribed in 2 receptions (in the morning and day) after eating. To eliminate side effects, gradual dose increases is recommended for 5-8 days. The duration of treatment is 4-6 weeks.

In spastic forms of cerebral palsyin practice, myiospazolytics are widely used: Tolperison, Tizandine, Baclofen.
Tolperison (Middokalm) is a muscle relaxant central action, it has a membrane-prompt activity, due to which it suppresses the formation and conduct of the action potentials in the hypersulated brain barrel motnelones and in peripheral nerves.
The mechanism of action is associated with the inhibitory effect on the caudal part of the reticular formation, the suppression of pathologically increased spinal reflex activity and exposure to peripheral nerve endings, as well as central n-cholinolytic properties. Also also has a vasodilant action. This leads to a decrease in an abnormally high muscle tone, reduces pathologically elevated muscle tone, muscle rigidity, improves arbitrary active movements.
Middokalum suppresses the functions of the activating and brake reticulosperial paths and inhibits the mono-and polysinactic reflexes in the spinal cord.
Dosage mode: children from 3 months. up to 6 years old, middokalms are prescribed in the daily dose at the rate of 5-10 mg / kg (in 3 receptions during the day); at the age of 7-14 years - in a daily dose 2-4 mg / kg; Adults of 50 mg - 150 mg (1-3 dragee) 3 times a day.

Tizandine (Sirdalud) is a central action minepaszyolitic. The main point of the application of its action is in the spinal cord. It selectively suppresses polysinactic mechanisms responsible for increasing the muscle tone, mainly by reducing the emission of exciting aminoxils from intermediate neurons. The drug does not affect neuromuscular transmission.
Sirdalud is well tolerated and effective in spasticity of cerebral and spinal genes. It reduces resistance to passive movements, reduces spasms and clonic convulsions, and also increases the force of arbitrary cuts.

Baclofen - Miorlaxant of the central action; Gaba receptor agonist. Inhibited mono and polysinapotic reflexes, apparently, by reducing the release of exciting amino acids (glutamate and aspartate) and terminals, which occurs as a result of stimulation of the presynaptic GABA receptors. Against the background of the use of the drug, the motor and functional activity of patients increases.

Angioprotectors: Vinpocetin, Cinnarizin.

Group vitamins B: thiamine bromide, pyridoxine hydrochloride, cyancobalamid; Neuromulititis is a special complex of group vitamins in with directional neurotropic effect; Neurobex.

Vitamins: folic acid, tocopherol, retinol, ergocalciferrol.

Anticonvulsants with epileptic syndrome: Valproic acid, carbamzazazepine, diazepam, clonazepam, topamax, lamotrine.

With a combination of cerebral palsy with hydrocephalus, hypertensive-hydrocephallated syndrome shows the purpose of dehydration funds: acetosolamide, furosemide, at the same time potassium preparations: Panangin, Asparkamka, Potassium orotat.

With severe concern, neuro-reflex excitability syndrome are prescribed sedatives: new-passite, noofen, medicine with citral.

In recent years, botulinum toxin is used in spastic forms of cerebral palsy in order to reduce the spasticity of individual muscle groups. The mechanism of action of the toxin of botulism (drug dysport) is to brake the release of acetylcholine in neuromuscular synapses. The injection of the drug leads to spastic muscle relatives.
The main indication for the purpose of dysport in children with different forms of cerebrals is the equinrary deformation of the foot. The introduction of dysport is technically simple and not accompanied by significant side reactions.
The standard dose of dysport per procedure is 20-30 mg per 1 kg of body weight. Maximum allowable dose in children 1000 units. The average dose for each oscracule muscle head is 100-150 units., for chibaloid and rear tibial muscles - 200 units.
Injection technique: 500 units. Distports are divorced in 2.5 ml of physiological solution (so on 1 ml of solution contains 200 units. drug). The solution is introduced into the muscle into one or two points. The effect of the drug (relaxation of spastic muscles) begins to appear on the 5-7th day after the administration of the drug with the achievement of the maximum effect to 10-14 days.
The duration of the Miorosanta is individual and varies from 3 to 6 months. After administration. Distports should be entered into a comprehensive scheme as early as possible before the formation of the contractures of the joints.

Preventive actions:

Prevention of contractures, pathological poses;

Prevention of viral and bacterial infections.

Further maintenance: Dispensary accounting from a neuropathologist at the place of residence, regular exercises of the Flamm, training of parents massage skills, LFC, orthopedic styling, childcare with cerebrals.

List of basic medicines:

1. Actovegin ampoules of 80 mg, 2 ml

2. Vinpocetin, (Cavinton), Tablets, 5 mg

3. PiRsets in ampoules of 5 ml of 20%

4. Pyridoxine hydrochloride ampoules 1 ml 5%

5. Folic acid, Tablets 0,001

6. Cerebrolysis, ampoules 1 ml

7. Cyanocobalamin, ampoules 200 μg and 500 μg

Additional medicines:

1. Aevit, capsules

2. Asparkam, tablets

3. Acetosolamide, 250 mg tablets

4. Baclofen, Tablets 10 mg and 25 mg

5. Valproic acid, syrup

6. Valproic acid, tablets 300 mg and 500 mg

7. Gingo-Biloba, Tablets 40 mg

8. Glycine, Tablets 0.1

9. Hopantic acid, (Pantokalcin), Tablets 0.25

10. Diazepam, ampoules 2 ml 0.5%

11. DISTURAL, AMPUILS 500

12. Carbamazepine, Tablets 200 mg

13. Clonazepam, Tablets 2 mg

14. Convalex, capsules 150 mg, 300 mg, 500 mg, solution in drops

15. Lookinzhin, Tablets 25 mg and 50 mg

16. Magne B6, Tablets

17. Neuromidin, Tablets 20 mg

18. New Passitis, Tablets, 100 ml Solution

19. Noofen, Tablets 0.25

20. Panangin, Tablets

21. PiRsets, Tablets 0.2

22. Pyritinol, suspension or tablets 0.1

23. Tiamine Bromide Ampoules, 1 ml 5%

24. Tizanidine (Sirdalud), Tablets 2.4 and 6 mg

25. Tolpirison, (Middokalm) ampoules 1 ml, 100 mg

26. Tolpirison, Dragee 50 mg and 150 mg

27. Topamax, Capsules 15 mg and 25 mg, Tablets 25 mg

28. Cinnarizin, Tablets 25 mg

Treatment Efficiency Indicators:

1. Improving motor and speech activity.

2. Reducing muscle tone in spastic forms of cerebral palsy.

3. Increase the volume of active and passive movements in the parethous limbs.

4. Saving seizures of seizures with accompanying epilepsy.

5. Reducing hypercines.

6. Acquisition of self-service skills.

7. Replenishment of the active and passive stock of words.

8. Improving the emotional and mental tone of the child.

Hospitalization

Indications for hospitalization: Motor disorders, paresis, paralysis, retreat of psychomotor and speech development from their peers, seizures of convulsion, hypercines, contractures, refractories in the joints

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 239 of 04/07/2010)
   1. L.O. Badalyan Children's neurology.1975 Moscow Directory of the Child Psychiatrist and Neuropathologist Edited by LA Bulachova. Kiev 1997 L.Z. Kazantseva. Rett syndrome in children. Moscow 1998 Clinic and diagnosis of children's cerebral paralysis. Educational and methodical manual. Zhukabaeva S.S. 2005.

Information

List of developers:

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Children's cerebral paralysis is a complex of diseases in which the child's functional activity has been violated. Manifestations and symptoms of cerebral palsy. Pathology can cause heavy motor disorders or provoke mental deviations in a child. In the international classification of diseases, pelvis is designated by the G80 code.

In medicine, cerebral palsy is a broad concept covering many diseases. It is mistaken to believe that cerebral palsy is exclusively motor violations in a child. The development of pathology is associated with violations in the work of the structures of the brain arising in the prenatal period. A feature of the PPC is not a progressive chronic character.

• Spastic cerebral paralysis (G80.0)
• Spastic diplegegia (G80.1)
• Children's hemiplegia (G80.2)
• Discinetic cerebral paralysis (G80.3)
• Ataxic CPU (G80.4)

In addition, the PPC group includes diagnoses that include rare types of cerebral paralysis (G80.8) and unspecified pathologies (G80.9).

Any form of cerebral paralysis is provoked by the pathologies of nerve cells. Deviation occurs in the intrauterine period of development. The brain is an extremely complex structure, and its formation is a long process, which can affect negative factors.

Often, children's cerebral paralysis provokes complications, due to which the patient's condition deteriorates. In medicine, unagreering diagnoses are compared in false progression - a pathological process, in which the symptoms of cerebrals are aggravated due to concomitant diseases.

Thus, the classification of MKB 10 cerebral palsy distinguishes several types of diseases that occur in the prenatal period and become the cause of severe mental and physical disorders.

Causes of development

Deviations in the work of the brain, leading to the development of cerebral palsy, can occur in any stage of the intrauterine period. According to statistics, the development of deviations most often occurs between 38 and 40 weeks of pregnancy. There are also cases when the pathological process develops in the first days after birth. During this period, the cerebral of the child is extremely vulnerable, and may suffer from any negative impact.

Paranoid schizophrenia: symptoms, causes and treatment methods

Possible causes of centers:

In general, in medicine there are various causes of cerebral palsy associated with disorders in the process of carrying or negative impact on the children's body after birth.

Vegeta dystonia on mixed type: concept, causes, as well as methods of diagnosis and treatment

Symptoms of palsy

The main manifestation of the PPC is a violation of motor activity. Mental deviations in the child are diagnosed much later when the active development of cognitive processes occurs. Unlike motor disorders that can be diagnosed directly after birth, mental disorders are diagnosed at the age of 2-3 years.

Diagnosing a cerebral palsy after birth is quite difficult, since the child during this period there are practically no motor skills. Most often, the diagnosis is confirmed on the residual stage starting in 6 months.

Pathology is accompanied by the following symptoms:

In general, exist various symptoms Pieces arising at the early stages of pathology.

Epilepsy Disability: Disability Group Description

Diagnosis and treatment

Specific methods of diagnosis of cerebral palsy does not exist, since at an early age the nature of the development of the main motor skills is individual. To confirm the diagnosis requires a long monitoring of the child, in which multiple deviations in the development (both physical and mental) are noted. In rare cases, the patient is prescribed MRI to identify violations in the work of the brain.

Treatment of cerebral palsy - a long integrated process, which is aimed at restoring the functions due due to brain disorders, abilities. It should be noted that pathology is not amenable to full cure. The degree of severity of symptoms and their influence on daily life The patient depends on the form of cerebral palsy.

The greatest efforts from parents are required in the period of 7-8 years, when the accelerated brain development is observed. In this period, the disturbed brain functions can be restored due to disabouted brain structures. This will allow the child to be successfully socialized and practically not different from others.

It should be noted that cerebral treatment involves the development of communication skills in a child. The patient is recommended to regularly visit the psychotherapist. In order to physical rehabilitation, physiotherapy procedures are used, especially massages. If necessary, drug therapy is prescribed, including drugs to reduce muscle tone, improved cerebral circulation.

Thus, the cerebral palsy cannot be complete, however, with the right approach, the symptoms of pathology become less pronounced, thanks to which the patient has the opportunity to live a full-fledged life.

PRP - a group of common diseases, provoked, which occur during the period of intrauterine development, during childbirth or in the first days of life. Clinical manifestationsThe method of treatment and forecasts depend on the form and severity of pathology.

Dec 27, 2017 Violetta Leak

3.5.3. CEREBRAL PALSY

Child cerebral palsy (cerebral palsy) (paralysis cerebralis infantilis.) — A collective term that combines a group of chronic non-progressive syndromes arising due to brain damage in intrauterine, perinatal and early neonatal periods. Palsy is characterized by persistent expressed engine, speech, behavioral disorders, mental delay, the formation of a pathological postural stereotype.

PPC is a severe disabled disease, leading to significantly pronounced restrictions of vital activity, which is the main reason for the formation of disability in the children's population. The prevalence of this pathology is 2-2.5 cases per 1000 children. The number of cases steadily increases every year. The disease is 1.3 times more common among boys, diagnosed in 90% of cases under the age of 3 years.

The final diagnosis can usually be set after a year when motor, speech and mental disorders become apparent. Criteria for diagnosis: an immanent flow, a combination of clinical picture Diseases of paralysis and paresses of various distributions, hyperkinetic syndromes, speech, coordinator, sensory disorders, cognitive and intellectual decrease.

Epidemiology: The prevalence of this pathology is 2-2.5 cases per 1000 children. The disease is 1.3 times more common among boys, diagnosed in 90% of cases under the age of 3 years.

Etiology and pathogenesis: The main reasons for the development of cerebral cereals are the antenatal causes (the age of mothers, extragenital diseases, drug therapy and professional hazards, alcoholism and smoking of parents, the immunological incompatibility of the mother and the fetus, antiphospholipid syndrome in the mother), violations of the normal course of pregnancy at the various timing (toxicosis , interrupt threats, placenta pathology, multiple pregnancy, surgical interventions, anesthesia during pregnancy, prematurity, premature birth, etc.), intranatal causes (long-term b / water period, the pathology of the generic paths, instrumental objects, operational delivery, rapid labor etc.); Postnatal period (neonatal convulsive attacks, traumatic and infectious brain lesions, toxic lesions (bilirubinic encephalopathy), hypoxia, etc.). In addition, many authors indicate for a clear connection of a cerebral palsy with low body weight. In the pathogenesis of the PPC, along with the immediate damage of the motor zone of the cerebral cortex, subcortical formations and the pyramidal path, is of great importance to the damage of the perivnricular region (air defense) by type perivnricular lekomolation; as well as atrophic and subatrophic processes in the cerebral cortex (more often in front and temporal departments), violation of the blood supply of brain and liquorodynamic violations [Nikitina M.N. , 1999, Mezhenina E.P., Kachev V. A., 2001].

Classification Reflects mostly features of motor disorders. In our country is often used classification according to K. A. Semenova (1978),according to which it is distinguished by: spastic diplege, double hemiplegia, hyperkinetic shape, an atony-astatic form, hemiplegic form.

According to the ICD-10Seven groups of cerebral palsy (G80) are distinguished depending on the localization of the affected structures (hereditary spastic paragliding is excluded - G11.4):

G80.0 Spastic Cerebral Paralysis

Congenital spastic paralysis (cerebral)

G80.1 Spastic diplegegia (Little disease);

G80.2 Children's hemiplegia

G80.3 Discinetic cerebral paralysis

Atteetoid cerebral palsy

G80.4 Ataxcic Cerebral Paralysis

G80.8 Other kind of children's cerebral paralysis

Mixed cerebral paralysis syndromes

G80.9 Children's cerebral paralysis

Allocate the following stageschildren's cerebral paralysis: early stage (up to 4-5 months): general heavy condition, vegetative violations, nystagm, convulsions, intracranial hypertension, motor disorders syndrome; initial chronic residual stage (from 5-6 months to 3-4 years): proceeds against the background of residual phenomena. Resistant neurological disorders are formed - persistent muscle hypertension (during spastic forms); plucky residual stage (after 3 years). Characterized by the formation of persistent dezadapoting syndromes various degrees severity.

1. Static disorders syndrome (spastic paresis, hyperkinesis, ataxia, contracture and deformation of the joints); In the process of rehabilitation, complete compensation is movement without support, in a sufficient pace, regardless of distance; deformation of the limbs are absent; Subcompensation - movement with a distance limit, if there is an additional support; partial compensation - sharply limited option movement, more often only within the apartment; Decompensation or lack of compensation is a complete inability to move.

2. Syndromes of violations of expressive and written speech: Dysarthria, Alalia, Dysgraphy, Dysxia, etc.

3. Disorders of sensory functions: violations of vision (squint, nistagm, amblyopia, cortical loss of field fields); hearing impairment (hearing loss of varying degrees);

4. Hypertensional-hydrocepal syndrome of various severity;

5. Paroxysmal disorder syndrome;

6. Cognitive disorder syndromes (psychoorganic syndrome, etc.);

7. Behavior disorders and personal disorders (neurosis-like, psychopathoid disorders, hyperactivity, impulsiveness);

8. Intellectual decrease (various degrees of mental backwardness);

9. Violation of the function of the pelvic organs (attenuation or lack of control).

Clinical characteristics of individual forms of centers:

Spastic double hemiplegia (tetraplegia) - One of the most severe forms of cerebral palsy, is found in 2% of cases. It is clinically characterized by a spastic tetraparez, while due to the high muscle tone, a pathological posture is formed: the hands are bent in the elbow and raying joints, are shown to the body, the legs are bent in the hip joints, bent or, on the contrary, dismissed in the knee joints, are rotated inside, hips are shown. Such children are not able to hold the vertical pose, sit, stand, walk, hold their heads, form pronounced pseudobulbar symptoms, rybism, atrophy of the visual nerves, impairment of hearing. Due to hypertensive syndrome, the contractures of the joints, bone deformities of the body and limbs arise. In half cases, this disease is accompanied by generalized and partial epileptic paroxysms. This form is prognostically unfavorable.

Spastic diplegegia (Little disease G80.1): The most common form of cerebral shape (60% of cases) is developing, as a rule, due to intraventricular hemorrhages. It is characterized by the development of uneven tetrapabin with a predominant lesion of the lower extremities, sometimes in combination with athettoid and / or choreathuteoid hyperkinosis, attaxia. Accompanied by stabism, atrophy of the visual nerves, reduced hearing, dysarthria. Intellect, as a rule, does not suffer. In children with this form of cerebral palsy, pathological motor stereotype is formed. The shock formulation of the foot on the support is noted, the depreciation function of walking is disturbed, i.e. There is no slight bending of legs in the knee joint in the phase of the median support. This increases the shock load on the joints of the lower extremities, which leads to the early development of arthrosis of the joints (dysplastic arthrosis). This form is favorable for overcoming mental and speech violations.

Children's hemiplegia (hemiplegic form G80.2) It is characterized by one-sided defeat of the limbs. Children has a violation of stative dynamic functions due to asymmetry of poses, the occurrence of paralytic scoliosis, the backlog in the growth of paralyzed limbs, anatomical shortening of the struck hands and legs. This form is accompanied by disorders of speech functions according to the type of pseudobulbar dysarthria, mental disorders are possible, the occurrence of epileptic paroxysms.

Discinetic cerebral paralysis:hyperkinetic (discnetic) form (G80.3.) Formed, as a rule, after transferred to the so-called. "Nuclear jaundice." Accompanied by disorders of statitional functions due to ferretical, atteetoid, torsion hyperkinesis, violation of speech, mental delay, decrease in hearing, violation of the functions of the autonomic nervous system. Intelligence in most cases does not suffer, this causes a favorable forecast for social adaptation and learning.

Ataxcic cerebral paralysis (ataxy form G80.4) It is characterized by the following manifestations: muscle hypotension, ataxia, various symptoms of cerebellar ashin, intente tremor, dysarthria.

Thus, in patients with cerebral diseases arise in life limitations due to violations of vestibular functions (equilibrium, coordination of movements, kinsthesia (disorder of the sensation of movement, weakening of proprioceptor from muscles, tendons, joints)); perception anomalies - ignoring the affected limbs in 50% of children with hemiplegia; cognitive violations (violation of attention, memory, thinking, emotional sphere) in 65% of children; mental retardation of more than 50% of children with cerebral palsy; disorders of expressive and written speech in the form of dysarthria, alalia, dyslexia, deprigraphy, etc.); behavior disorders and personal disorders (violation of motivation, neurosis-like and psychopathoid disorders, hyperactivity, impulsiveness); delays in the pace of motor and / or psychoretical development; symptomatic epilepsy (in 50-70% of cases); violations of vision (squint, nystagm, amblyopia, cortical loss of field fields); hearing impairment (hearing loss of varying degrees); hypertensional hydrocephalic syndrome; diffuse osteoporosis; violations from cardiovascular and respiratory systems; Urological disorders (hyperreflexia bladder, deloading-sphincter dissimerigria), developing in 90% of patients; Orthopedic pathology: shortening limbs, violation of posture, scoliosis, joint contractures, etc.- are observed in 50% of children suffering from cerebrals.

Required data when directions on ITU: Conclusion of a neurologist, epileptologist, psychiatrist, oculist (research of the eyeboard and fields), Surdian, orthopedic, pediatrician, speech therapist; EPO with an assessment of intelligence; states of mental processes and personality; Echo ehg, EEG, RG (according to indications), CT and (or) MRI brain.

Indications for the Direction on ITU: the presence of a resistant motor defect (spastic paresis, hyperkines, ataxia, contractures and deformation of the joints) from moderate to significantly pronounced degree; The combination of motor disorders of various degrees of severity with the presence: persistent moderate and pronounced disorders of expressive and written speech; persistent moderate and pronounced disorders of sensory functions; lungs (absans, simple partial, myoclonic seizures) and heavy seizures (large convulsive seizures, secondally generalized partial seizures - Jackson, astatic, outpatient automates); persistent moderate and severe cognitive disorders (psychoorganic syndrome, etc.); persistent moderate and pronounced syndromes of the "personal" register (nerity-like, psychopath-like disorders, hyperactivity, impulsiveness); intellectual insufficiency of varying degrees; Indications for directions to ITU in the presence of mental and paroxysmal disorders, see section - " Medical and social expertise and rehabilitation of disabled children with mental disorders and behavior disorders "and in the section -" Epilepsy ".

Criteria for disability: Resistant moderate, severe or significantly pronounced disorders of neuromuscular, skeletal and associated with the movement (statineamic), language and speech, sensory functions, urinary function, etc., leading to the limitation of self-service, independent movement, communication, training, the ability to control their behavior defining The need for social protection of the child.

The quantitative system of assessing the severity of persistent violations of the functions of the human body in percent is presented in Table 72.

Table 72.

Quantitative system of assessing the severity of persistent violations of the functions of the human body in percent

For children's hemiplegia (hemipartic form) PRPs are observed disorders of minor functions (10-30%), temperate (40-60%), pronounced (70-80%), significantly pronounced (90-100%): Static function - from insignificant to significantly pronounced degree, violations of linguistic and Speech functions - from insignificant to a pronounced degree, disorders of mental functions - from insignificant to a pronounced degree.

Forspastic diplegegia (diplegic form)Palilation of functions are observed (40-60%), pronounced (70-80%), significantly pronounced (90-100%): a static function from moderate to significantly pronounced, violation of language and speech functions of a pronounced degree, violation of mental functions expressed degree.

For discinetic (hyperkinetic) form

For spast cerebral paralysis (double hemipilegia, spastic tetraprezen)there are violations of functions significantly pronounced (90-100%): the static function of a significantly pronounced degree, violation of the linguistic and speech functions of a pronounced degree, violation of the mental functions of a pronounced degree.

For atronically-astatic form Palsy There are violations of the functions pronounced (70-80%) and significantly pronounced (90-100%): the static function from pronounced to significantly pronounced, violation of the linguistic and speech functions of a pronounced degree, violation of mental functions of a pronounced degree.

Rubric on the ICF.: main functions - b117 intelligent functions; B126 Temperament and personal functions, B140 Fighting functions, B144 - Memory functions; B310- B 399 Voice and speech functions; B 710-789 Neometric, skeletal and associated function.

Medical rehabilitation : Reconstructive surgery According to the testimony: Achilloplasty, shortening osteotomy, transplanting of tendons, arthropeses, tenets, arthroplasty, neuroectomy, etc.; restorative therapy: drug therapy with drugs stimulating brain metabolic processes that reduce muscle tone that reduces hypercines that improve neuromuscular transmission, stimulating the metabolism in muscle tissue, which improve microcirculation, stimulating regeneration; In especially difficult cases, the use of injections of botulinum toxin (botox or dysport) into muscle-agonists in order to reduce the tone of muscles involved in the construction of a pathological motor stereotype in patients with spastic forms of cerebral palsy; symptomatic therapy of major disadaptation syndromes (anti-kvulsants, proofreaders of behavior, etc.); physiotherapy, physiotherapy, massage, needleflexotherapy; The method of dynamic proprioceptive correction is wearing a gravitational costume (therapeutic suits "Adele", "Gravistat", "Spiral", "Atlant"); spa treatment In the absence of contraindications.

Technical means of rehabilitation: with a pronounced and significantly pronounced violation of the static, sensory function, the functions of the urinary system are shown to ensure the disabled person with technical means of rehabilitation: wheelchairs for children with cerebral palsy (indoor and pleasure), walkers; Supporting canes, toilet chairs; Mattresses and pillows anti-shirt; absorbent underwear, diapers, learning and development of the ability to carry out everyday self-service, etc.; Others can apply technical means for self-service and movement, etc., included in state guarantees (for example, various types of orthosis, appliances for dressing, undressing and capturing subjects); Technical means according to GOST R 52079-2006, not included in state guarantees.