11.3.2.5. Rheumatic encephalitis is an infectious-autoimmune disease in which, along with damage to the joints and heart, the central nervous system is involved in the process. In rheumatic encephalitis, there is diffuse damage to the cerebral cortex, subcortical nodes, brain stem and meninges.

4. Encephalitis Encephalitis is inflammation of the brain associated with infection, intoxication or injury. Infectious encephalitis is caused by viruses, bacteria and fungi.1. Viral encephalitis arises as a result viral infection(arbovirus, herpes virus,

21. Encephalitis Encephalitis is inflammation of the brain. Classification.I. Primary encephalitis. Viral:1) arboviral, seasonal, transmissible (spring-summer tick-borne; Japanese mosquito; Australian; American); 2) viral without clear seasonality (enteroviral

2. Encephalitis Encephalitis is inflammation of the brain. Classification.I. Primary encephalitis.1. Viral:1) arboviral, seasonal, transmissible:a) tick-borne spring-summer; b) Japanese mosquito; c) Australian; d) American; 2) viral without clear seasonality

Encephalitis Encephalitis is a disease characterized by inflammation of the brain caused by pathogenic microorganisms. Recipe* For encephalitis, meningitis and inflammation of the arachnoid membrane of the brain (arachnoiditis), you should drink an aqueous infusion of valerian root, and

Lethargic encephalitis (commonly known as Zombie disease) refers to viral diseases and has a biphasic course, also accompanied by pathological drowsiness and disturbances in eye movements.

In the acute phase, the patient falls into something similar. In addition, other neurological symptoms are observed.

A detailed description of the disease was first carried out in 1917 by the neurologist Economo. Due to this, the disease received its second name.

Currently, Economo's encephalitis is not diagnosed as often as it was during the First World War (when there was a real epidemic), and cases of the disease appear only sporadically.

The course of the disease has 2 forms - chronic and acute. A characteristic feature the first is progressive brain damage, accompanied by disorders and altered psyche.

At acute form activates inflammatory process in the area of ​​the medulla. The time separating both stages from each other can range from several months to several years.

Factors provocateurs

Until now, it has not been possible to identify the true causative agent of lethargic encephalitis. Doctors make only a few assumptions based on the fact that the disease is caused by a certain virus that is initially found in human saliva or mucus.

The peculiarity is that the alleged virus is not able to function outside the human body.

According to scientists, the initial target of the virus is the CNS (central nervous system), the penetration of the virus into which occurs through the upper respiratory tract.

As a result of a large accumulation of the pathogen nerve cells undergo changes, which is accompanied by repeated viremia. Against this background, the first clinical signs of Economo’s disease begin to appear.

Chronic and acute clinic

Common signs of the disease include:

• aching, moderate headaches;
• muscle tissue soreness;
• attacks of nausea and vomiting;
• general weakness;
• depression.

The patient is accompanied by a feeling of weakness and apathy.

After primary symptoms a period of fever ensues, which can last up to 14 days. It is at this time that neurological symptoms are observed that indicate the presence of Economo encephalitis.

A person feels drowsy all the time. Even after waking up, the patient falls asleep again, regardless of the place where he is. This condition can last for three weeks.

Some people suffering from encephalitis lethargica, on the contrary, experience insomnia.

The acute stage of epidemic encephalitis Economo begins to develop with an increase in temperature to 38 degrees and symptoms similar to the flu.

One of the typical ones is oculoletargic syndrome. It is characterized by:

• increased drowsiness, as well as sleep disturbances - the patient suffers from insomnia at night, and sleeps during the day;
• eye mobility disorders characterized by strabismus, diplopia, and upward gaze;
• unilateral palsy of the sixth or seventh pair of cranial nerves.

All these symptoms taken together form the Economo triad. In addition, vegetative types of disorders are also inherent in the acute course of the disease:

• increased greasiness and facial hyperemia;
• hyperhidrosis;
• hypersalivation.

After seven to fourteen days, hiccups may occur. Not always, but the following types can be observed:

• Also .

The acute form of the disease can last up to several weeks, and in in some cases much longer. Most patients, after remission, which can last up to 12 months, note the transition of pathology to chronic stage, which is characterized by the following clinical picture:

• promotion muscle tone by plastic type;
• rest and akinesia;
• the voice becomes monotonous and calm;
• the face takes on a mask-like appearance;
• apathy and depression are noted;
• Among vegetative disorders, hyperhidrosis and excessive salivation occur;
• mild oculomotor disorder may persist.

The diagnosis is made according to the medical history and neurological symptoms.

Difficulties of diagnosis and treatment

Economo's encephalitis is a fairly serious disease that not only cannot be fully treated, but also It is impossible to diagnose in a timely and correct manner, since the symptoms may resemble many viral pathologies.

A diagnosis is possible only if sleep disorders, psychosensory disorders and disruptions of oculomotor functions are identified. Such symptoms, together with elevated body temperature, usually help specialists draw the right conclusions regarding the existing pathology.

Accurate diagnosis is possible when carrying out, as a result of which different parts of the brain are examined. IN in this case the presence of encephalitis will be indicated by changes in the basal ganglia.

The chronic stage of the course is much easier to determine. Diagnosis is carried out by identifying a complex of diseases that arise as a result of the disease.

Treatment of Economo's encephalitis, as well as relief of concomitant neurological and mental disorders, seems to be one of the most difficult tasks in modern neurology and is not very effective.

A specific treatment method has not yet been developed. In the acute form of the disease, it is customary to prescribe the following drugs:

If available together with drug therapy Surgery and physiotherapy are used. Of the medications, the most positive effect is observed after taking a mixture containing an aqueous extract of spring adonis, scopolamine and sodium bromide.

Physiotherapeutic procedures consist of taking warm baths and doing therapeutic exercises.

In the last fifteen years there has been wide application surgical methods, the task of which is to destroy subcortical formations using ultrasound, electrocoagulation or liquid nitrogen.

In the acute course of the disease, convalescent serum and symptomatic drugs are used. Corticosteroids may also be prescribed.

Consequences and preventive measures

In 30% of cases, lethargic encephalitis, which occurs in the acute phase, ends fatal. The reason for this is respiratory dysfunction or heart failure.

Often after past illness In the acute form, some symptoms may be observed for a long time:

• depression;

If the disease occurs in childhood, mental disorders cannot be excluded.

The chronic form of the pathology is characterized by a progressive course. However, there were cases when the patient's condition stabilized. Concerning full recovery, then the prognosis is not reassuring.

Since to date no methods have been developed to isolate the virus that provokes the pathology, active prevention is not carried out.

Regardless of the fact that now only isolated cases lethargic encephalitis, we must not forget that there is always a risk of epidemiological manifestations.

Transmission of the pathogen is possible by airborne droplets. That is why the patient must be isolated until the symptoms disappear. acute manifestations diseases.

Treatment is always carried out only in a hospital setting. The room in which the patient was located must always be disinfected.

Epidemic encephalitis, according to the modern classification, belongs to the group of primary neurotropic allergic encephalitis (encephalitis A). Currently, four names for this encephalitis have been established: encephalitis lethargica, Economo's encephalitis, epidemic encephalitis and encephalitis A.

Epidemic encephalitis - causes, mechanism of occurrence and development (etiology and pathogenesis)

In 1917, almost simultaneously, a new organic disease of the brain was described in France and Austria. Cruchet (1926), Mathieu and Calmette (cited by Cruchet) reported outbreaks of subacute encephalitis that they observed in 1915-1916. among the soldiers of the French army in Commercy and Verdun during the 1st imperialist war. Economo observed a disease with similar clinical manifestations, which he described in 1917 under the name lethargic encephalitis. The basis for this definition was the pronounced drowsiness observed in patients.

Soon after these first descriptions, a gradual spread of this disease was noted throughout Europe, the Asian part of the USSR, Japan, India, New Zealand, North and South America.

In 1919-1920 Our domestic authors (Ya. M. Raimist, A. I. Geimanovich, B. N. Mankovsky, V. V. Seletsky) described the first cases of epidemic encephalitis in Ukraine (Odessa, Kharkov, Kiev), in 1921 - in Moslve (I. Yu. Tarasevich, G. I. Rossolimo, M. S. Margulis). These descriptions were produced independently, since during civil war and foreign blockades medical literature did not enter our country, and the works of Cruchet, Economo and others were not known to our scientists at that time.

After the pandemic (1920-1926), a widespread decrease in incidence was noted, but in 1924-1927. Some countries have seen a second wave. Since that time, only small sporadic outbreaks of epidemic encephalitis have occurred. The clinical picture gradually changed, and modern forms of the disease appeared.

Epidemic encephalitis occurs in different places globe, but more often in countries with a temperate continental climate and among urban residents than rural residents, it affects people of any age, but mainly young people, aged 20 to 30 years. The highest number of cases falls in the months of December-February.

The duration of the incubation period of epidemic encephalitis has not been precisely established. It is assumed that it can last from 14 days to 3 months. (S. N. Savenko).

IN different countries During individual outbreaks, the mortality rate was uneven, sometimes reaching 50% or higher. Currently, in sporadic cases of epidemic encephalitis, deaths are rare (from 1 to 10%, according to various authors).

Although there is not much data on the possibility of contact spread of the disease, it is still necessary to hospitalize patients in sporadic cases of epidemic encephalitis, isolate them in separate wards of neurological hospitals and observe the necessary personal preventive measures medical personnel. Persons in contact with the patient should be under clinical observation for up to 3 months.

Epidemic encephalitis, according to pathological studies obtained on the basis of its study during the epidemic, is a serous polioencephalitis, obviously distinguished by hematogenous spread in the human body. The predominant damage to the gray matter in the region of the cerebral peduncle and hypothalamus allows it to be classified as mesodiencephalitis. In the chronic stage of the classical form of epidemic encephalitis (parkinsonism), regressive changes occur not only in the mesodiencephalic region and in the subcortical formations - the pale nucleus, but also in the cerebral cortex.

Epidemic encephalitis - symptoms (clinical picture)

Clinical picture of epidemic encephalitis, like many others infectious diseases, has changed compared to the time of its first description. These changes have reached a significant extent. The emergence of new forms that were not observed during the epidemic, modifications in the course of the acute and partially chronic phase of the “classical” form, the failure of virological studies - all this complicates the diagnosis modern forms epidemic encephalitis.

The disease is usually divided into three periods: acute, intermediate and chronic.

The clinical picture during the pandemic was determined by the triad:

• general symptoms (malaise, headache, fever);
• sleep disturbance;
• oculomotor disorders.

However, at that time other clinical manifestations, for example, lesions of the facial, trigeminal and other cranial nerves, isolated clinical and tonic seizures and other symptoms. Atypical forms of the disease also existed during the pandemic, their number increasing in subsequent years due to a decrease in the number of cases of the typical “classic” form. Currently, atypical forms are becoming more and more frequent.

Returning to the clinical picture of the acute stage of epidemic encephalitis, in addition to the above-mentioned triad, other symptoms should be pointed out, namely: vestibular disorders, general muscle hypotonia and asthenia, various paresthesias, constant myoclonus, occasionally moderate pyramidal signs, mental changes (manic and depressive states, delirium, etc.).

The exact duration of the acute stage of the disease has not been established; it can last from several days to several months, followed by an intermediate stage, lasting from 1 month to 15 years. During this stage, complete or partial restoration of working capacity occurs.

Currently, the following modern forms of epidemic encephalitis are distinguished:

• lethargic or oculocephalic, closest to the form found during a pandemic, but still somewhat different from it;
• vestibular, also slightly different from that described by M. S. Margulis in 1921;
• pseudo-neurasthenic, a new form not observed during the pandemic;
• diencephalic or, more precisely, mesodiencephalic, also not described during the pandemic;
• hyperkinetic is a combined form that replaced the previously described monosymptomatic, tic, and myoclonic forms; it is distinguished by the presence of a variety of hyperkinesis, including mixed ones;
• influenza, also not described during the pandemic.

The modern lethargic (oculocephalic) form can begin acutely or subacutely, most often after influenza or catarrh of the upper respiratory tract with an increase in temperature from low-grade to high. It is found among modern forms, according to some authors (R. M. Balakleets, 1967; P. M. Alperovich, 1970), most often, according to others (A. Ya. Lovtskaya and E. E. Kostrova, 1957) - very rarely. The leading symptom is sleep disorders in the form of various degrees drowsiness. Drowsiness is sometimes replaced by a period of insomnia. The alternation of such periods can be repeated 2-3 times, each of them can last up to 3-4 weeks. Sometimes a dissomnic variant is noted - drowsiness during the day and persistent insomnia at night.

At the same time, there are mild oculomotor disorders, diplopia, slight ptosis, weakness of convergence, disturbances in conjugal movements of the eyeballs, lesions of the abducens nerve, and lesions facial nerve according to the peripheral type.

Autonomic disorders are expressed already in the first days of the disease in the form of facial grease, diffuse or local hyperhidrosis in the torso and head, and hypersalivation.

Particular attention should be paid to the variants of sleep disorders. According to our observations (M. G. Goldelman) and according to L. Ya. Shargorodsky, the hypersomnic variant in the lethargic form of modern epidemic encephalitis is often observed. However, drowsiness does not reach the same extent as was noted during the pandemic, when patients slept day and night for a long period (up to 1-2 months), and being awakened, for example, to eat, they soon fell asleep again, sleeping even while eating . The period of drowsiness lasted 10-15 days, longer - in very rare cases. The patient sleeps more at night than usual, goes to bed early, gets up late during the day, despite this there is a pronounced tendency to sleep, he falls asleep while reading, monotonous work operations, even while sitting. The drowsiness observed in patients, in its irresistibility and short duration, resembles narcoleptic attacks, but unlike narcolepsy, patients never sleep standing or while walking, and may fall if a drowsy state occurs during work.

The vestibular form was described back in 1921, but is now rare. Some researchers of modern epidemic encephalitis do not mention it at all (S. N. Savenko). A. Ya. Lovtskaya and E. S. Kostrova established a combination vestibular disorders with disorders of sleep and higher nervous activity such as neurasthenia, which allows us to speak of a mixed (vestibular-lethargic and pseudoneurasthenic) form of modern epidemic encephalitis. About such a combination of manifestations, if not three, then two clinical forms, with leading vestibular syndrome, B. I. Rudaya and V. D. Bilyk (1964), as well as E. F. Davidenkova-Kulkova and E. S. Kostrova (1957) are mentioned.

The vestibular form usually begins acutely, with dizziness, accompanied by nausea and vomiting, which sharply intensifies when trying to walk, and sometimes when turning the head and eye movements. Vestibular disorders occur in the form of severe paroxysms. The temperature is low-grade or normal. An objective examination reveals horizontal, less often vertical, or oral nystagmus and various disturbances of vestibular excitability.

Development vestibular syndrome may also be preceded by influenza or catarrh of the upper respiratory tract, usually there is general malaise, a feeling of weakness, pain in the limbs, headache for 2-3 days with normal or low-grade fever. Patients usually endure this condition on their feet without leaving work. The acute period lasts 2-3 weeks and its most painful manifestations disappear as a result of treatment. Under the influence of various unfavorable factors, short-term repeated exacerbations are possible.

The pseudoneurasthenic form was not described during the pandemic and in the first years after it. The first indication of its existence belongs to S. N. Davidenkoz and his employees A. Ya. Lovtskaya, E. S. Kostrova, who rightly noted that it is the most difficult to diagnose.

Patients present complaints identical to those of patients suffering from neurasthenia in the hypersthenic phase or the phase of irritable weakness. They report irritability fatigue during normal work, sleep disturbances in the form of insomnia. When collecting anamnesis, it can be established that the onset of the disease is associated with a short acute period, occurring in the form of influenza, lasting 2-3 days with slight increase temperature, which is most often carried on the legs. There is no data indicating the development of the disease in connection with negative effects on higher nervous activity or psychogeny. Oculomotor disorders are mild. Significant asthenia is noted - “pathological laziness” (A. Ya. Lovtskaya, E. S. Kostrova), mild autonomic disorders, mainly in the form of moderate hyperhidrosis and hypersalivation. B. N. Mankovsky, A. A. Ammosov and others mention increased muscle fatigue of the myasthenic type.

S. N. Davidenkov described a pseudoneurasthenic form of epidemic encephalitis with violent movements, which, unlike obsessive actions in neuroses, are carried out without any meaning and are not accompanied by internal struggle. Patients remain indifferent to these movements and make no attempts to hold them or stop them. These violent movements do not have an emotive connotation, unlike the obsessive actions that are characteristic of neuroses.

According to our observations (M. G. Goldelman), the mesodiencephalic form of modern epidemic encephalitis is characterized by a predominance in the clinical picture of symptoms indicating a change functional state hypothalamus. The disease debuts with hypohalamic crises or hypothalamic epilepsy. Crises can be sympathetic, parasympathetic or mixed. At the same time, mild oculomotor disturbances and more pronounced sleep disorders are observed in the form of alternating periods of hypersomnia and insomnia, only prolonged hypersomnia, or only insomnia. In the first days of the illness, there is also a short-term and mild headache, the temperature remains normal. However acute period can occur without signs of hypothalamic pathology - crises can develop several months after the acute period, or simultaneously with the first signs of postencephalitic parkinsonism. In addition, this form is characterized by the presence of signs of neuromuscular syndrome of hypothalamic pathology - in the form of periodically occurring severe fatigue when walking and minor muscle efforts (morning toilet, making the bed, eating, etc.).

The severity of hypothalamic pathology usually leads to misdiagnosis infectious diencephalitis or diencephalic syndrome, as was the case in all our observations (M. G. Goldelman). Only when symptoms of parkinsonism appear is it diagnosed correct diagnosis. The chronic stage in our patients with the meso-diencephalic form developed within 1.5 to 4 years after the acute period.

It can be assumed that the meso-diencephalic form occurs more often than is diagnosed. Among patients with the pseudoneurasthenic form, there are obviously also patients with the meso-diencephalic form. Thus, describing the pseudoneurasthenic form, A. Ya. Lovdkaya and E. S. Kostrova noted pronounced asthenia, “pathological laziness,” according to their definition, autonomic disorders and senestopathy, which are actually manifestations of hypothalamic pathology

In the anamnesis, in patients with the hyperkinetic form, as well as in other forms of the disease, it is possible to identify an acute period in the form of a short-term flu, expressed in headache, drowsiness, and slight malaise with low-grade fever. Occasionally the temperature rises to higher numbers, but may remain normal. This type of flu usually occurs 1-3 months before the first violent movements appear.

B.I. Rudaya and V.D. Bilyk point to short-term dizziness, thalamic pain and hiccups, which occur at the onset of the disease even before the appearance of significant hyperkinesis of the limbs and subsequently persist against their background. Hyperkinesis in this form of the disease is of a varied nature: choreic, myoclonic, athetoid or torsion-dystic.

Hyperkinesis can act as organic symptom: hiccups, violent movements in the fingers of one hand, forced turning of the head, spasms of the facial muscles, etc., but can also be generalized.

Sometimes it is not possible to identify a febrile period in the anamnesis, and hyperkinesis acts as the first symptom of the disease, but in such cases they are soon joined by some other manifestations - drowsiness or insomnia, autonomic disorders (hyperhidrosis or hypersalivation, mild vestibular and oculomotor disorders).

The hyperkinetic form is characterized by a rapidly progressive course, which leads patients to disability long before the disease enters the chronic stage. The particular severity of the hyperkinetic form of modern epidemic encephalitis is noted by P. M. Alperovich and B. I. Rudaya (1970).

It is appropriate to compare the influenza (abortive) form of modern epidemic encephalitis with the abortive forms of poliomyelitis or serous meningitis. With it, general infectious manifestations are observed without symptoms indicating damage to the nervous system. There is a usual clinical picture of influenza or catarrh of the upper respiratory tract with normal or elevated temperature. This period of illness is often endured on one's feet or requires cessation. labor activity for 1-2 days. Subsequently, the development of the clinical picture of parkinsonism begins. It appears that this occurs without a preceding acute period. S. N. Savenko noted this type of development of the disease in the majority of patients he observed in recent years.

P. M. Alperovich and B. I. Rudaya also classify as abortive forms such cases when, in the acute period, short-term drowsiness, transient diplopia, and sometimes hiccups are noted. These phenomena quickly disappear and are replaced by other symptoms: diencephalic, neurotic, and through different periods time, the development of parkinsonism begins. However, such cases cannot be classified as abortive forms, since already in the acute period they have symptoms indicating damage to the central nervous system.

A group of Bulgarian authors (S. Bozhinov et al., 1967) has identified in recent years a special form of epidemic encephalitis, characterized by a summer-autumn seasonality, an acute onset with a febrile state and a two-three-wave temperature curve. With this form, parkinsonism syndrome develops even in the acute period, which subsequently sometimes undergoes a relatively rapid reverse development. In addition to benign forms, there are also severe forms that end in death.

Epidemic encephalitis - diagnosis

Diagnosis of the lethargic form of modern epidemic encephalitis is not difficult. However, with the dissomnic variant with persistent insomnia, diagnostic errors are possible, especially if it is the only manifestation of the disease, which can occur if the patient performs work under significant neuropsychic stress. This type of sleep disturbance is mistakenly taken for manifestations of neurasthenia. The appearance of at least minor oculomotor disorders and secretory disorders (hyperhidrosis in the face or torso, hypersalivation, greasiness of the face) allows a correct diagnosis to be made. With neurasthenic neurosis, there are no oculomotor disorders, and hyperhidrosis, if it occurs, is generalized, but is especially pronounced on the palms. There is no hypersalivation or facial greasiness. During the hypersthenic phase of neurasthenic neurosis, vascular disorders are observed in the form of hot flashes - regional redness, accompanied by a feeling of heat, regional blanching, etc.

The vestibular form of modern epidemic encephalitis can be mistaken for arachnoiditis or a tumor of the posterior cranial fossa. These diseases are not associated with a specific autumn-winter seasonality. With them, congestion in the fundus and changes in the x-ray of the skull develop quite quickly (increased digital impressions, osteoporosis in the area of ​​the large foramen magnum- symptom of I. S. Babchin). Headache due to a tumor is severe, and occlusive crises similar to Bruns' attacks may occur. It should be borne in mind that the transition of a brain tumor of any localization from the stage of compensation to the stage of sub- and decompensation is often associated with the influence of additional harmful factors, which include, in particular, any infection. The association of the disease with infection, therefore, should not be taken into account in the differential diagnosis as a symptom indicating only encephalitis. Like the vestibular phase of encephalitis, the first symptoms of a tumor of the posterior cranial fossa may be preceded by a short-term febrile period due to influenza, sore throat, catarrh of the upper respiratory tract, etc. EEG and EchoEG can provide some assistance in differential diagnosis.

With arachnoiditis of the posterior cranial fossa, changes on the radiograph do not reach the same degree of severity as with a tumor of the same location. The onset of the disease is associated with influenza, sore throat, tonsillitis, especially processes in the inner ear, or, finally, closed injury brain Oculomotor disturbances are usually absent or mildly expressed, there are no sleep disorders and no autonomic disturbances typical of epidemic encephalitis. Under the influence of anti-infective dehydration and resorption therapy, a significant and persistent improvement is noted, sometimes a remitting course.

A clinical picture similar to some extent to the vestibular form of epidemic encephalitis can be caused by a transient disorder cerebral circulation in the vertebrobasilar system with cervical osteochondrosis, cerebral atherosclerosis, pathological tortuosity of the carotid arteries and hypertensive or hypotonic vascular disease. However, they do not have a history of an acute period with fever and sleep disorders, and the disease is not seasonal. At hypertension arterial pressure with transient disorders of cerebral circulation, it increases above normal figures (pressor type of vascular crisis), regional cerebral hypertension can also be detected (determining the brachiotemporal coefficient), there are changes in the fundus typical for hypertension, and increased pressure in the central retinal artery. With cerebral atherosclerosis, other signs of this suffering are noted: memory impairment, emotional lability, tearfulness with positive and negative emotions, oral automatisms, sclerotic changes in the fundus, changes in the blood - hypercholesterolemia, changes in the lecithin-cholesterol index, an increase in the amount of lipoproteins, sometimes changes in the coagulation properties of blood, characteristic changes in the rheoencephalogram.

With cervical osteochondrosis, vestibular disorders usually occur acutely, often due to a change in head position - sharp turns or tilting your head back. At the same time, patients feel a crunching sensation in cervical vertebrae and pain in the occipital region, neck, temples. The final diagnosis is made on the basis of radiography cervical region spine.

With the pseudoneurasthenic form of modern epidemic encephalitis, differentiation from neurasthenia is necessary. The absence of a psychotraumatic situation, data indicating the occurrence of a disturbance in the balance of nervous processes under the influence of functional influences on higher nervous activity, the presence of mild oculomotor disorders and a febrile period in the past (flu, malaise with a slight increase in temperature, etc.) helps to make the correct diagnosis. Sometimes, with this form of encephalitis, violent movements may occur, but unlike the latter in neuroses, they do not have an emotive coloring (S. N. Davidenkov).

The diencephalic form of modern epidemic encephalitis should be distinguished from infectious diencephalitis of various etiologies. With neuroviral diencephalitis, already in the first days of the disease, against the background of fever and severe headache, the nature of which indicates liquor hypertension, pronounced trophic and metabolic-endocrine disorders, disorders various types metabolism (G.D. Leshchenko et al., M.G. Goldelman), and with influenza and rheumatic diencephaligas, already in the first days of the disease a distinct vegetative-vascular syndrome takes shape, often with hypothalamic crises of a sympathetic, parasympathetic or mixed nature (M. G. Goldelman, A. R. Rakhimdzhanov, etc.). Vegetative asymmetries are noted. In the first place in the clinical picture are pronounced neurosis-like manifestations, most often of the hypersthenic type, less often of the hysterical syndrome. Differential diagnosis can also be difficult because the same type of sleep disorders can be observed. However, with diencephalitic disorders, sleep disturbances do not reach the same degree of severity and duration as with epidemic encephalitis. The time of onset of the disease should also be taken into account. Neuroviral diencephalitis, like diencephalitis of other etiologies, are multiseasonal diseases.

Carrying out a differential diagnosis between this form of epidemic encephalitis and diencephalitis in some cases is extremely difficult, and only the appearance of the first symptoms of parkinsonism allows a correct diagnosis to be made.

In case of hyperkinetic form (hiccups, blepharospasm, spasms of facial muscles, etc.) differential diagnosis with hysterical neurosis. With the latter, there is a history of psychogenia, a conflict situation, no acute period, sleep disturbance, oculomotor disorders (diplopia, convergence disorders, etc.), no vestibular disorders, no organic symptoms at all, and no seasonality of the disease. Hyperkinesis increases significantly during examination of patients and decreases with distraction.