Factors of development and stages of cerebral ischemia. Cerebral ischemia and its consequences for the newborn

Cerebral ischemia is a disease associated with insufficient saturation of brain tissue with oxygen. The pathology is classified as congenital if it develops in the first days of a child’s life, and in 70% of cases the process begins as early as later pregnancy or childbirth. Cerebral ischemia is considered chronic if it is diagnosed in older patients, most often in the elderly. Cerebral ischemia of the 1st degree in a newborn is the most light form The disease is divided into 3 degrees, depending on the severity of symptoms and prognosis.

Diagnosis and treatment of ischemic brain disease is carried out by a pediatrician. When identifying the first symptoms, it is important to promptly determine and eliminate the cause of the disease, since hypoxia (insufficient blood supply) leads to necrotic changes in tissues, serious pathologies nervous system, coma and even fatal outcome. The prognosis is favorable with timely initiation of treatment, if the brain has not yet been subject to changes and is able to develop according to age.

Causes of development of cerebral ischemia

Clinical signs of cerebral ischemia in infancy develop due to insufficient oxygen supply to tissues; pathology can occur during pregnancy or during childbirth. The most common factors that can provoke ischemia:

• complications during childbirth (umbilical cord entanglement, caesarean section, birth injuries, long labor);
• blood clotting pathologies, thrombosis;
• infectious diseases of the mother during pregnancy;
• chronic diseases of the respiratory, cardiovascular, genitourinary systems of the mother;
• Availability bad habits at the mother's;
• congenital pathologies of the fetus (heart defects, patent ductus arteriosus);
• birth of premature babies.

The disease can develop in older children and adults due to atherosclerosis, thrombosis, increased blood pressure, inflammatory vascular diseases. Such pathologies impede the blood supply to the brain and the supply of oxygen to the tissues.

Symptoms of the disease

The first symptoms of cerebral ischemia in a newborn appear during the first days of life. Depending on the severity of damage to brain tissue, degrees of the disease are distinguished.

Symptoms of cerebral ischemia grade 1

Ischemia of the first degree is the mildest form of pathology, it mainly manifests itself during the first week of life. The clinical signs of the disease are weak, which does not always make it possible to recognize it in infancy and prevent the development of complications.

• Severe headaches, which in newborns can be suspected by constant restlessness and sleep disturbances.
• Slight increase muscle tone: muscles are tense, dense on palpation. The degree of muscle tension is determined by the doctor, since hypertonicity is normally observed in all newborns.
• Increased response when testing tendon reflexes. It will be informative to determine the knee reflex, which is carried out by tapping with the tip of your fingers in the area of ​​the elbow pits, knees or heel tendon.

In the first days of life, the child is under constant supervision of a pediatrician, who assesses the degree of his development and checks the functionality of all organ systems. Despite the fact that it is not easy to identify coronary disease at this stage, this will help to prescribe a treatment regimen in a timely manner and prevent the development of complications.

In adults, the disease initial stage manifested by emotional instability, insomnia, severity of unconditioned reflexes, which are characteristic only for infants, migraines, impaired coordination of movements, gait. Changes in the first stage are considered reversible if they can be eliminated within a week.

Symptoms of cerebral ischemia grade 2

Clinical signs of grade 2 cerebral ischemia appear during the first day of a child’s life. This dangerous form, in which there is a risk further pathologies development of the central nervous system.

Manifestations of grade 2 pathology in newborns:

• Periodic pauses in breathing during sleep are noted, so the newborn should be constantly under medical supervision. The child makes no attempt to inhale, the pulse slows down, and the lips begin to appear blue. Apneas (holding your breath) that last more than 15 seconds are considered dangerous.
• Weakening of muscle tone. The muscles are soft on palpation, the limbs are straightened.
• Weakening of innate reflexes. When assessing the reactivity of the nervous system in a newborn, they examine unconditioned reflexes(grasping, sucking). If the reaction to irritation is weak, this may indicate functional disorders brain tissue.
• The baby's skin may become pale, marbled or bluish.
• Hydrocephalic syndrome may occur, where the head becomes enlarged due to fluid accumulation in the brain. Intracranial pressure is increased, the syndrome is accompanied by headaches.
• Fainting conditions caused by a violation neural connections, increased pressure.

Stage 2 ischemia in a newborn is a dangerous form of the disease that leads to disruption of the formation of brain tissue and the development of vital reflexes.

In adults, the pathology is manifested by worsening symptoms, apathy, constant headaches, inability to concentrate on any task, as well as problems with coordination of movements. Shown hospital treatment, if necessary, surgery is prescribed to remove the blood clot.

Symptoms of cerebral ischemia grade 3

Changes taking place in the central nervous system at the third stage, can lead to irreversible consequences. Due to insufficient blood supply, areas of necrosis form, and brain tissue cannot perform vital functions. important functions. In a newborn, this form of the disease is noticeable already during the first hours of life.

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1. Complete absence of innate reflexes, the child does not respond to stimuli.
2. When certain areas of the brain are damaged, problems with independent breathing, eating, light perception, and heart rhythm disturbances occur.
3. A sharp increase in intracranial pressure indicates a difficulty in the flow of blood into the brain tissue.
4. Coma may occur, sudden losses consciousness.
5. Convulsive syndrome is manifested by involuntary contraction of individual muscle groups.

Ischemia of the 3rd degree poses a threat to the child’s life and can affect his further development and lead to consequences such as retardation in physical or mental development.

In adults, this form of the disease is expressed by impaired mental activity, loss of consciousness, difficulty eating, urinary incontinence and other signs of damage to brain cells.

Treatment of cerebral ischemia

Therapeutic measures are prescribed by the pediatrician based on clinical signs, severity of the disease and the patient’s age. Treatment of cerebral ischemia in newborns is carried out in a hospital under the supervision of a doctor; in extreme cases, resuscitation is necessary. The disease can pass without consequences in the early stages and lead to serious complications, with untimely intervention at stage 3, death is possible.

Ensuring there is enough oxygen in the room

Diuretics for hydrocephalus, in some cases shunting

Anticoagulants ─ blood thinning drugs

Surgical removal of blood clots

Elimination of symptoms of hydrocephalus (excessive accumulation of cerebrospinal fluid in the ventricular system of the brain): diuretics, shunt installation

During the rehabilitation period – electrophoresis, massage

At stage 1 of coronary disease, you can do without drug treatment. A restorative massage is performed by a pediatrician; this procedure is aimed at relaxing muscles, restoring blood flow and ensuring normal access of oxygen to the brain. It is also necessary to ventilate the rooms where newborns are located, this will help avoid the progression of the disease and the development of dangerous consequences.

In the most difficult cases, the child cannot breathe on his own and is unconscious. Emergency measures include tracheal intubation and connection to a ventilator. In such devices, air is supplied forcibly through an endotracheal tube or using a mask.

Duplex ultrasonography vessels - this is the most available method To detect blood clots in blood vessels, computed tomography or magnetic resonance imaging is also performed. During the operation, the blood clot is removed and normal circulation is restored. An alternative method is the administration of thrombolysis (a drug that dilutes the blood clot) directly to the site of its localization. During rehabilitation period Anticoagulants are used, which reduce blood viscosity and prevent the formation of new blood clots.

Hydrocephalic syndrome is dangerous for newborns, since a large amount of fluid compresses the brain tissue, disrupting its normal formation. Diuretics help remove excess fluid from the body; they can be used for minor swelling of the brain. In advanced cases surgically a shunt is installed through which the fluid is removed into the abdominal cavity, from where it is excreted naturally. After bypass surgery, the child is registered with doctors, who periodically check the location of the tube and replace it as the patient grows.

Vasodilator drugs are effective for increased intracranial pressure. They are prescribed by a doctor in combination with vascular strengthening agents, as well as cerebroprotectors (medicines that restore the structure of brain neurons).

Possible consequences of cerebral ischemia

At mild degree ischemia in newborns, cerebral ischemia passes without consequences, children develop on par with their peers. Even with timely initiation of treatment, patients with age may experience headaches, sleep or concentration problems, epileptic seizures, abnormalities mental development. With grade 3 ischemia, complications depend on the location of the affected areas of the brain and the area of ​​necrosis: motor disturbances up to complete paralysis and other signs of cerebral palsy. The clinical picture may improve with age as nerve cells have the ability to regenerate.

The prognosis for cerebral ischemia depends on the degree oxygen starvation, extent of lesions and timeliness of competent medical care.

• With 1 degree of ischemia, the prognosis is favorable. Children develop no different from their peers.
• At grade 2, the prognosis is questionable. 30–50% of patients may experience mental development disorders, 10–20% may experience minor complications in the form of high blood pressure.
• Up to 50% of cases of grade 3 ischemia in newborns are fatal. 80% of the remaining children develop disorders (cerebral palsy, autism), 10% have minor deviations mental development and 10% survive the disease without complications.

In any case, cerebral ischemia in newborns is treated by a doctor in a hospital. Based on the diagnostic results, an individual treatment regimen is prescribed, and after eliminating the cause of the disease and restoring the blood supply to brain cells, further development of complications can be predicted.

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Cerebral ischemia in newborns

Cerebral ischemia is a disease characterized by insufficient oxygen supply to the brain along with blood due to blockage of one or more blood vessels. Because of this, the newborn's brain cannot develop normally. In case of untimely medical intervention Bleeding may occur in the tissues and pathological changes may develop. Timing is what matters important role in the treatment of cerebral ischemia in newborns.

Signs and symptoms of cerebral ischemia in newborns

The disease manifests itself with obvious symptoms that attract attention.

• The child is easily excitable, cries for no reason, sleeps poorly, shudders, and has tremors.
• Muscle tone is reduced, the baby moves little, has difficulty sucking and swallowing.
• The fontanel is enlarged, intracranial pressure is increased due to the fact that fluid accumulates in the brain.
• Convulsions, twitching of the limbs and head, as well as comatose states with loss of coordination of movements and consciousness occur.
• The newborn's skin takes on a marbled hue.
• The functioning of the gastrointestinal tract is disrupted - bloating, constipation, and diarrhea are observed.

How does cerebral ischemia occur?

In 70% of cases, ischemia occurs in the fetus in the womb and is associated with the formation of a blood clot in one of the vessels supplying the brain, or with insufficient development of the vessel. Most often, the disease is diagnosed in premature infants who vascular system not yet fully formed.

As a result, an insufficient amount of blood enters the vital organ, and with it, oxygen. Delay in providing medical care leads to damage to larger areas of the brain, cerebral hemorrhage and other serious consequences.

Causes

In the vast majority of cases, the causes of cerebral ischemia in newborns are various disorders of gestation in recent weeks, as well as non-standard situations during childbirth.

• Detachment of the placenta or disruption of blood flow in it.
• Compression of the umbilical cord, suffocation of the fetus.
• Congenital heart defects.
• Circulatory problems.
• Intrauterine hypoxia.
• Infection during childbirth.
• Openness of the ductus arteriosus.
• Acute placental insufficiency.

Risk factors

Various vascular and neurological pathologies, problems with blood pressure (especially hereditary) in the mother should alert the doctor who is managing the pregnancy. Also, risk factors for cerebral ischemia in a child are:

• mother's age is more than 35 years;
• endocrine diseases;
• premature, prolonged labor;
• multiple pregnancy;
• late toxicosis;
• mother's non-compliance healthy image life;
• exacerbation of chronic or acute diseases in the mother during pregnancy.

Diagnostics

The disease is usually diagnosed within the first few hours.

The presence of pathology is indicated by deviations in testing reflexes, general analysis blood. Typically, the analysis shows an increased level of carbon dioxide in the body.

If obvious symptoms are detected serious illness magnetic resonance imaging is performed, as well as electroencephalography, which reveals hidden seizures and other abnormalities in the functioning of the brain.

Degrees of ischemia

Cerebral ischemia grade 1

A mild form, characterized by the presence of mild symptoms in the first 3-5 days after birth. Basically, it manifests itself in the form of:

• nervous excitement or depression;
• slight muscle tone;
• strengthening tendon reflexes.

The child is monitored by a doctor, and the symptoms gradually disappear without complications.

Cerebral ischemia grade 2

A dangerous form of the disease. It is characterized by:

• severe apnea (stopping breathing during sleep);
• decreased grasping and sucking reflexes;
• weak muscle tone;
• increase in head shape due to fluid accumulation;
• lack of coordination;
• loss of consciousness;
• changes in skin color.

Most often, grade 2 ischemia manifests itself in the first day of a newborn’s life, and symptoms can be observed for 2-4 weeks. At this time, the child is carefully monitored by doctors, and he undergoes a course of therapy. If necessary, surgery is performed to remove the blood clot.

Cerebral ischemia grade 3

The most severe form, in which:

• the baby has no reflexes;
• the child falls into a coma;
• heart rhythm is disrupted;
• blood pressure rises sharply;
• there are problems with independent breathing;
• strabismus is observed.

An experienced doctor can already determine the presence of signs and symptoms of grade 3 cerebral ischemia in the first 5 minutes of a newborn’s life. In this case, the child is sent to intensive care and, if necessary, connected to a ventilator.

Treatment of cerebral ischemia in newborns

The goal of treatment is to restore normal blood circulation in the brain tissue, prevent pathological changes and eliminate the consequences of ischemia. For stage 1 disease, treatment usually involves prescribing massage to improve blood circulation.

For diseases of the 2nd and 3rd degrees, drug therapy and surgery are used to remove a blood clot in the vessel and restore the structure of the vascular bed. In difficult cases, the baby undergoes a rehabilitation course intensive care.

Prognosis and consequences of cerebral ischemia

It is much more effective to eliminate ischemia itself after the birth of a baby than to treat its complications. Among the consequences of cerebral ischemia of the 2nd degree:

• sleep disorders;
• headache;
• irritability;
• isolation;
• physical inactivity.
• Stage 3 disease has severe consequences:
• attention deficit disorder;
• mental retardation;
• Graefe's symptom, etc.

If all actions to eliminate ischemia were carried out by doctors in a timely manner, then the symptoms disappear during the rehabilitation period, which usually lasts 6-12 months.

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Cerebral ischemia. Let's help the child wisely!

Grade 1 cerebral ischemia in a newborn is a disease in which a lack of oxygen leads to damage to areas of the brain. The second name for this disease is hypoxic-ischemic encephalopathy or HIE.

Grade 1 HIE has become a common disease and is increasingly observed in newborns. The above diagnosis can be one of the most serious problems in the normal development of the child.

Stage 1 of the disease indicates a mild form of the disease and most often manifests itself in a newborn child in stages of nervous depression or, conversely, excitement. With timely response from perinatologists, the disease passes quickly and without consequences for little patient.

Cerebral ischemia of the 2nd degree in newborns is a moderately severe condition of the child, in which convulsions, shudders and twitching of arms and legs are added to the depression or excitation of the central nervous system.

At proper care and treatment of the newborn, timely assistance, stage 2 HIE is completely curable and leaves no consequences in the future.

Causes of development of hypoxic-ischemic encephalopathy

Perinatologists identify factors leading to the occurrence of the 1st degree of the disease. Let's list them:

• the presence of diseases in a fertile woman. It is worth observing the manifestations of chronic pathologies with special care;
• The age of the expectant mother plays a major role in the occurrence of this disease. Lack of oxygen in the fetus (hypoxia) can occur in a woman giving birth who is too young or in a woman who becomes pregnant after 35 years;
• The lifestyle of the expectant mother plays a direct role in the development of cerebral ischemia. Drinking alcohol, smoking, drug addiction, non-compliance with the daily routine is only a fraction of the harmful factors;

Causes of development of cerebral ischemia of the 2nd degree

This degree of the disease has more expressed reasons manifestations of the disease, mainly associated with serious pathology in a pregnant woman.

• the presence of toxicosis, especially late;
• oligohydramnios;
• problems with the umbilical cord, placenta;
• premature birth, as well as childbirth at a late age;
• Stage 2 HIE can also occur during childbirth;
• systematic increase in blood pressure in the expectant mother, in particular taking antihypertensive drugs during gestation;
• damage at the time of delivery;
• infection of the fetus.

It has been noted that children born to women under 17 years of age and over 40 years of age have brain pathology in 85% of cases.

Symptoms of stage 1 disease in a newborn

With this degree of disease, the symptoms in a newborn baby are minor:

• the child shudders. Trembling can be observed throughout the baby’s entire body, or separately from the head or upper and lower extremities;
• such a child’s sleep is disturbed, crying is observed, for no apparent reason;
• when the central nervous system is depressed, lethargy may, on the contrary, be observed, partial absence motor activity, impaired or weakened sucking or swallowing of food;
• Facial asymmetry may be visually noticeable, and sometimes squint appears.

Symptoms of stage 2 HIE in newborns

Stage 2 of the disease is more severe than the first and is manifested by significant impairments:

• CSF fluid collects in parts of the brain, so-called hydrocephalus. Intracranial pressure is higher than normal; The head takes irregular shape, becomes similar to a pear fruit, and greatly increases in size;
• in more severe cases, the baby may experience unconsciousness, coordination of movements is severely impaired or completely absent. Convulsions are present, they may be complicated by respiratory arrest;
• The color of the baby’s skin changes, it becomes “marbled”. There are also visible changes in the organs gastrointestinal tract which manifest themselves in the form of bloating, flatulence, diarrhea or constipation;

Complications and consequences of stage 1 disease in a newborn

Considering the mildness of the disease and the timeliness of the prescribed treatment, it is possible to completely eliminate the occurrence of complications. You just have to follow what is done in the hospital. It is worth violating the treatment plan and taking appointments strictly according to the prescribed schedule.

Complications and consequences of grade 2 cerebral ischemia in newborns

With the 2nd degree of the disease, even with the most correct and timely treatment, the following complications may occur:

• mental retardation of the child in development;
• changes in sleep patterns, which will manifest itself as insomnia at night, and drowsiness during the day;
• frequent irritability and fatigue;
• causeless headaches;
• isolation, reluctance to take part in collective games, ignoring communication with peers;
• difficulties in the educational process;
• physical inactivity. Such children may remain in one place or in a certain position for more than five minutes.

In some cases, complications of stage 2 disease can lead to disability.

Diagnosis of grade 1 cerebral ischemia in a newborn

TO diagnostic procedures include:

• blood analysis. It will indicate the level of decrease in oxygen in the blood, and carbon dioxide, on the contrary, can increase in the blood to its maximum level. The blood pH shifts to the acidic side.
• examination methods using computed tomography and magnetic resonance imaging, as a rule, do not reveal any abnormalities.

Examination for grade 2 cerebral ischemia in newborns

In babies, the same indicators of decreased oxygen and increased carbon dioxide are present in the blood as in the first degree.

An MRI of the brain shows small lesions, a type of cyst, in the brain tissue.

When diagnosed using CT, a reduced density of the meninges (tissue) itself can be detected.

Doppler encephalogram shows a decrease in the level of blood flow in the bloodstream cerebral artery. In full-term babies, blood flow is reduced in the middle part of the artery, and in premature babies - in the anterior part of the artery.

It would be useful to undergo a full laboratory test, which will help diagnose concomitant pathologies in the early stages.

Treatment of disease of 1st degree of severity

The main direction in the treatment of stage 1 HIE is to restore impaired blood circulation to the baby’s brain as quickly as possible. Remove the effects of oxygen starvation and preserve intact areas of the brain.

Appropriate treatment is selected for each small patient individually, depending on the signs of the disease, his weight at birth, and the delivery pattern ( natural way birth or caesarean section), the presence of intrauterine pathology.

Grade 1 (mild), most often does not require special drug treatment, the main thing is to create the most comfortable conditions for the baby. Ventilation and prevention of seizures are the main criteria for treatment of this degree.

Treatment of grade 2 disease of HIE

The second degree occurs more aggressively in a newly born child.

Drug treatment

Drug treatment consists of mandatory prescription of anticonvulsants. They are prescribed based on the weight and age of the baby.

To level out the manifestations of edema, a “diuretic” is indicated, most often it is Lasix or furosemide. Good effect They will give you drugs designed to stimulate metabolism in cells.

Auxiliary treatment

Sometimes pediatricians prescribe massage (relaxing). It will significantly improve blood flow to the organ suffering from the disease and increase metabolic processes. Since children with this pathology often lag behind in physical education. development, they are shown classes with an instructor in therapeutic exercises. After simple training, parents will be able to continue studying at home.

Working with a psychologist, speech therapist, and increased attention to the development of the child are far from unnecessary methods of treating pathology and preventing its complications.

ethnoscience

Traditional medicine must be approached with great caution, because infants are capable of giving an inadequate reaction to the usual compositions of medicines. Yes, and with the selection of dosages, annoying mistakes can occur, with far-reaching unpleasant consequences.

Preventive measures for cerebral ischemia in newborns

After discharge from the maternity or somatic department, children suffering from cerebral ischemia of 1st and 2nd degrees are registered at the clinic at the place of residence.

Every month up to a year of age, and if complications arise after an illness, then up to three years, the baby should be shown to a neurologist every month.

Once every six months, if necessary more often, an examination using CT or MRI should be performed.

Every six months, children with second degree hypoxic-ischemic encephalopathy should be prescribed a course of nootropic and diuretic drugs.

Parents should learn to constantly monitor their child, observe his behavior, manner of communication, monitor sleep and waking hours. Particular attention must be paid to understanding the world around us. All these observations, which are worth remembering or writing down, must be told during an examination by a neurologist in order not to miss any abnormalities in the nervous system.

If small child There is increased irritability or aggressiveness; you should not provoke it. The same applies to external stimuli: a loud TV, noisy companies, entertainment venues. Under no circumstances should the child be allowed to become irritated, lose his temper, or become overexcited.

It is best to take frequent walks fresh air, away from the noise of passing cars, this way his nervous system will recover faster.

In most cases, children with HIE grades 1 and 2 may be slightly behind in physical development. They begin to hold and raise their heads later and shoulder girdle, also later master the skills of sitting and standing. Therefore, it is recommended to do a relaxing massage and special therapeutic exercises to strengthen muscles.

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Cerebral ischemia: symptoms and treatment

Cerebral ischemia - main symptoms:

• Headache
• Mood swings
• Weakness
• Dizziness
• Convulsions
• Speech Impairment
• Fainting
• Drowsiness
• Heartache
• Memory impairment
• Tearfulness
• Darkening in the eyes
• Impaired concentration
• Increased intracranial pressure
• Enlargement of the head
• Decreased muscle tone
• Unsteady gait
• Feeling of pulsation in the head
• Moodiness
• Increased muscle tone

Cerebral ischemia is a disease that is a progressive disruption of the blood supply to brain tissue, which leads to oxygen starvation of this organ. The main risk group is newborn babies. This condition often develops during intrauterine development of the fetus or directly during labor. As for adults, their illness develops against the background of other diseases and an irrational lifestyle.

The severity of symptoms will depend on the severity of cerebral ischemia. The main clinical signs encountered in any variant of the course are attacks of headaches, frequent mood swings, impaired coordination of movements and dizziness.

The diagnostic process is aimed at performing instrumental examinations of blood vessels, as well as wide range other procedures, including a thorough physical examination of the patient.

Treatment of this disease is often limited to the use of conservative methods, but in some cases they resort to surgical intervention.

According to international classification In diseases, such pathology has a special significance. It follows from this that the ICD-10 code will be P91.0.

Etiology

Insufficient blood supply and disruption of the process of oxygen supply to the brain are caused by the influence of a large number of unfavorable factors, which will differ in infants and adults.

Most often, cerebral ischemia is diagnosed in infancy, which is provoked by the following disorders and pathological conditions:

• premature placental abruption;
• acute placental insufficiency, which also causes fetal hypoxia;
• prolonged labor;
• compression of the umbilical cord, which can occur during contractions or pushing;
• the presence of congenital heart defects;
• improper blood supply to the heart;
• development respiratory failure in infants born prematurely;
• the occurrence of sepsis, which affects the decrease in blood tone after the birth of the baby;
• patent ductus arteriosus;
• profuse internal hemorrhages;
• problems with blood clotting.

In addition, negative factors affecting the body of a pregnant woman significantly increase the likelihood of cerebral ischemia in newborns. These include:

• addiction to bad habits;
• indiscriminate use of medications;
• exposure to radiation or exposure to chemicals;
• unfavorable environmental conditions;
• poor nutrition.

• the course of endocrine pathologies;
• the presence of neurological diseases in the medical history;
• eclampsia and preeclampsia;
• heavy bleeding or fever that develops during labor;
• rapid labor, namely faster than 2 hours;
• the gestational age at the time of birth is less than 37 or more than 42 weeks;
• emergency caesarean section.

In an adult, such a pathology is most often secondary in nature, which means that it occurs against the background of other diseases, in particular:

Also, blood and oxygen deficiency can be caused by previous surgical interventions that a person has undergone, which lead to a decrease in blood pressure.

Classification

The main division of the disease suggests the existence of several variants of the course, namely:

• cerebral ischemia of the 1st degree - characterized by mild symptoms. However, if the disease is diagnosed at this stage and appropriate treatment is carried out, then the likelihood of complications will be minimal;
• cerebral ischemia stage 2 - clinical signs will be more striking than at the previous stage, and attacks will be longer. If symptoms are identified in a timely manner, there are still chances for a successful outcome and full recovery;
• cerebral ischemia of the 3rd degree - differs in that the symptoms are so severe that all therapeutic manipulations are carried out only in intensive care conditions. This is the most dangerous form of pathology, leading to irreparable consequences.

In addition to the above forms of the disease, it is also divided into:

• acute cerebral ischemia - it is advisable to refer only to newborns, since in adults it is often secondary in nature and has a sluggish course;
• chronic cerebral ischemia is the most common type of disease, because oxygen starvation and insufficient blood supply to the brain develops quite slowly.

Symptoms

The intensity of clinical signs is directly dictated by the severity of the disease. For example, with cerebral ischemia at the first stage the following will be noted:

• slight increase in muscle tone;
• increased tearfulness and capriciousness of children;
• constant drowsiness and weakness of the baby;
• decreased appetite;
• inability to concentrate;
• memory impairment;
• strengthening of tendon reflexes;
• frequent mood changes.

It is worth noting that in premature infants, a mild course of the disease may be expressed not in increased, but in decreased reflexes and muscle tone.

As the pathological process progresses to degree 2 in newborns or adults, the changes will be more severe and severe. In some cases, patients lose their ability to work and need care. Thus, symptoms will include:

• significant memory impairment;
• unsteadiness of gait;
• limb weakness;
• lack of coordination;
• sluggishness of Moro reflexes in children - this includes throwing out the arms, throwing back the head, as well as the sucking and grasping reflex;
• frequent attacks of apnea;
• increasing head size;
• weakening of muscle tone;
• attacks of loss of consciousness;
• deterioration in the ability to plan one’s future actions;
• severe headaches and dizziness;
• increased intracranial pressure;
• convulsive seizures.

The third stage of cerebral ischemia is characterized by the following clinical manifestations:

• short-term sudden fainting;
• speech disorder;
• “rushes” of blood in the head, leading to pulsation in the temples;
• pain in the heart area;
• numbness or coldness of the hands and feet;
• darkening of the eyes;
• loss of all simple reflexes and coma in infants;
• development of strabismus and nystagmus;
• sharp fluctuations in blood pressure;
• paresis and paralysis;
• increased sensitivity to light;
• problems with eating and breathing independently;
• urinary incontinence;
• frequent falls while walking;
• dementia;
• inability to perform simple self-care procedures.

Depending on what symptoms are present in the clinical picture, the treatment tactics for cerebral ischemia will differ.

Diagnostics

If the above symptoms occur, you should seek qualified help from a neurologist as soon as possible. The diagnosis is established on the basis of clinical complaints that arise during ischemic attacks, as well as data from laboratory and instrumental examinations. Thus, primary diagnosis provides for the clinician to perform the following manipulations:

• familiarization with the history of the disease, the course of pregnancy and labor - this will enable the doctor to understand what pathological factor influenced the occurrence of oxygen starvation and insufficient blood supply to the brain;
• study of life history;
• a thorough physical examination, examining the general appearance of the patient, assessing his gait and visual fields. This also includes measuring heart rate and blood tone;
• a detailed survey of the patient or his relatives - to compile a complete symptomatic picture and determine the severity of such a disease.

Cerebral ischemia in a newborn or adult requires the following instrumental procedures:

• ECG and EchoCG;
• spondylography;
• Doppler ultrasound of cerebral arteries;
• vascular angiography;
• Dopplerography;
• ultrasonography, CT and MRI of the brain.

Among laboratory research worth highlighting:

• general clinical blood test;
• blood sugar determination;
• blood biochemistry - to assess the lipid spectrum.

Cerebral ischemia must be differentiated from:

Treatment

To date, no specific treatment tactics for such a disease have been developed, which means that there are no special medications, IVs or physiotherapeutic procedures that can replace or restore dead brain tissue. However, there are methods to help the patient rehabilitate.

With a mild course of the disease and mild symptoms, the most effective will be:

• therapeutic massage course;
• pine and oxygen baths;
• taking statins and tranquilizers;
• gentle diet;
• use of vitamin complexes.

Treatment of the second stage of the disease includes:

Most severe form the disease is treated with:

• intubation or artificial ventilation of the lungs;
• surgical excision of blood clots;
• relief of symptoms of hydrocephalus, which is carried out by taking diuretic drugs and shunting;
• vasodilators, anticonvulsants and anticoagulants;
• electrophoresis and massage;
• physical therapy.

Possible complications

Insufficient supply of oxygen and blood to the brain is fraught with the following consequences:

• chronic sleep disorder;
• development of epilepsy;
• mental disability;
• frequent headaches;
• difficulties in learning and finding work;
• disability.

Prevention and prognosis

To reduce the likelihood of cerebral ischemia in infants or adults, the following preventive recommendations are used:

• control over adequate pregnancy management;
• complete cessation of bad habits;
• avoiding stress and nervous tension;
• proper and balanced nutrition;
• combating obesity;
• conducting active image life;
• timely diagnosis and treatment of any pathologies that can lead to cerebral ischemia;
• taking medications in accordance with the clinician’s recommendations;
• Regularly undergoing a complete preventive examination at a medical institution.

The prognosis of the disease directly depends on the severity of its course. For example, cerebral ischemia of the 1st degree has the most favorable outcome - complete recovery is observed, and complications do not form. When the disease progresses to stage 2, consequences develop in every 2 patients. The most severe version of the disease is fraught with death in 50% of cases and no complications in only 10% of patients.

If you think that you have cerebral ischemia and the symptoms characteristic of this disease, then a neurologist can help you.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Encephalopathy of the brain is a pathological condition in which, due to insufficient supply of oxygen and blood to the brain tissue, the death of its nerve cells occurs. As a result, areas of decay appear, blood stagnates, small local areas of hemorrhage form, and edema of the meninges forms. The disease mainly affects the white and gray matter of the brain.

Glucose in human body plays the role of an important source of energy. This universal fuel, contrary to popular belief, is found not only in sweets: glucose is found in all foods containing carbohydrates (potatoes, bread, etc.). Normal level Blood glucose is approximately 3.8–5.8 mmol/L for adults, 3.4–5.5 mmol/L for children and 3.4–6.5 mmol/L for pregnant women. However, sometimes there are pathological conditions when blood glucose levels differ significantly from normal. One such condition is hypoglycemia.

A brain tumor is a disease characterized by cancerous damage to the meninges, nerve endings, skulls. This type of disease is very dangerous, because if it is started and the operation is not performed in time, then everything will lead to death.

Arterial hypotension is a fairly common pathology, which is characterized by persistent or regular presence of tonometer readings below 100 per 60 millimeters of mercury in a person. The disease can occur at any age, which is why it is also diagnosed in children and women during pregnancy.

Bradycardia is a type of pathology in which the sinus rhythm, controlled by the sinus node, that is, the direct “driver” of the rhythm, is disrupted. Bradycardia, the symptoms of which are a decrease in heart rate (in terms of beats per minute), is defined as sinus bradycardia with reduced automaticity in the sinus node.

With help physical exercise and abstinence, most people can do without medicine.

Symptoms and treatment of human diseases

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Modern medicine has reached a level of development where children with the most serious pathologies receive hope for life. However, among newborns there is still a high level of mortality and disability from cerebral ischemia and asphyxia.

Concept of cerebral ischemia

Cerebral ischemia in newborns is a pathology in which the normal blood supply to the brain is disrupted. However, in infants this process occurs very rarely on its own (for example, with congenital heart defects). Most often, children are diagnosed with hypoxic-ischemic encephalopathy, which consists of damage to brain cells due to insufficient blood supply and the amount of oxygen supplied.

Causes of the disease

The main causes of cerebral ischemia in children can be several factors:

• A drop in blood pressure after childbirth due to sepsis or heavy bleeding for liver injuries or bleeding disorders;
• during intrauterine development or asphyxia during childbirth is observed in cases of acute placental insufficiency (see), during long labor, or if the child’s umbilical cord is pinched during contractions and pushing;
• Respiratory failure after birth, which occurs with heart defects, in premature infants, with open ductus arteriosus or if blood flow to the heart is disrupted.

The process of development of pathology in infants

Oxygen that travels with the blood to all organs human body, is the most important factor for life. If there is not enough of it in the blood, a redistribution of blood flow occurs. The heart and brain receive the most oxygen-rich blood, while other organs suffer from an acute lack of oxygen.

If asphyxia is not eliminated in time, the body becomes unable to cope with the pathology on its own, and too little oxygen is not enough for the functioning of nerve cells, which gradually begin to die. In this case, the disease develops. Moreover, a favorable or unfavorable prognosis for a child directly depends on how many brain cells and tissues have died. In some cases, hypoxia even causes bleeding in the brain, which significantly reduces the child's chances of survival.

Main risk factors

The development of cerebral ischemia in a newborn can be caused by a number of associated factors:

• The course of the birth process. The risk of pathology increases if the woman had bleeding during pregnancy or at the time of childbirth, was carried out, during childbirth the patient had heat(more than 38 degrees). Besides, associated factors may be the duration of pregnancy (before 37 or after 42 weeks), underweight child, rapid labor (lasting less than two hours) or lack of medical care during delivery.
• The maternal condition can also cause cerebral ischemia in the newborn. In particular, if a woman suffers from epilepsy or neurological diseases (the risk group also includes patients who have close relatives with similar diseases), has previously treated infertility and has pathologies of the endocrine system.
• The course of pregnancy. In the presence of pathology of the placenta, preeclampsia and eclampsia, the risk of developing ischemia increases.

However, it should be taken into account that all these factors only increase the likelihood of developing cerebral ischemia, but are not accurate indications for the onset of pathology. For example, uterine bleeding, low fetal weight and pathologies of the placenta are interconnected and often lead to emergency delivery through).

But even the presence of all these factors does not provide an exact guarantee of the development of pathology, and lead to illness only in a small percentage of infants. It is also worth noting that approximately 70 percent of children with this disease had disorders during intrauterine development, another 25 percent had problems immediately at the time of birth, and only a few children began to suffer from cerebral ischemia after birth.

Degrees of the disease

There are several degrees of cerebral ischemia, distinctive features which are given in the table below.

Main signs of hypoxia or severe ischemia

In the first minutes of life, doctors examine the baby and assess his condition using the Apgar scale. If after five minutes after birth the child received from zero to three points, there is every reason to diagnose hypoxia. In addition, symptoms of the pathology may include coma, weakness or lack of muscle tone and tendon reflexes, or disruption of other organs (particularly the liver, heart and lungs).

The degree of the disease is determined by the doctor when examining the child, and initial data on his condition is obtained immediately after birth, guided by the Apgar scale:

The general condition of the newborn is determined in the first and fifth minutes after birth. The first test indicates the need for resuscitation, and the second determines the presence of hypoxic brain damage.

Differences in the course of the disease for full-term and premature babies

Asphyxia and associated brain damage differ depending on whether the baby was born at term. The earlier the birth occurs, the higher the risk of periventicular leukomalacia (PVL). This pathology represents the death white matter brain, which is located near the ventricles of the organ. Dead cells are replaced by cysts, and this process in most cases leads to dementia and, which were born before 31 weeks.

In full-term babies, asphyxia more often leads to damage gray matter, but the further consequences of the disease will depend on the number of dead cells. If asphyxia occurs in an acute and severe form, the brain stem, which is responsible for breathing and heartbeat, may be damaged, which can lead to the death of the child.

What are the consequences of the disease?

Depending on the degree of cerebral ischemia, the consequences of the pathology develop:

• The severe form of the disease in half of the cases ends in death in the first days of the baby’s life. But death may occur later from pneumonia or other infectious diseases. In most cases (80 percent) of surviving children, severe disorders are observed (dementia, cerebral palsy), and only ten percent have moderate complications, and the same number of newborns do not suffer from any consequences of cerebral ischemia.
• Cerebral ischemia 2 (moderate) degree severity, causes serious consequences in approximately half of the patients, while in the rest the complications are moderate ().
• Cerebral ischemia 1 (mild) often ends without any consequences for the baby.

Diagnostic methods

Often, signs of cerebral ischemia appear already in the first days after birth. A mild degree is characterized by complete disappearance of symptoms, while a severe degree of the disease may stop for a while, followed by a sharp deterioration in the baby’s health. Therefore, if cerebral ischemia is suspected, doctors perform numerous diagnostic procedures:

Initial examination

Immediately after birth, the child should be examined by a doctor and assessed his condition on the Apgar scale (taking into account weight, height and the presence of reflexes).

Analyzes

MRI

If a moderate or severe degree of the disease has been diagnosed, the child is often prescribed an MRI to examine the structures of the brain. Mild disease rarely requires this diagnostic procedure.

Ultrasound

Despite popular belief, ultrasound does not accurately determine brain hypoxia. In some cases this procedure allows detection of hemorrhage or swelling, so other examinations are required for an accurate diagnosis.

Electroencephalography (EEG)

This is a very important examination for newborns with severe cerebral ischemia. This method allows you to detect hidden seizures, assess the activity and degree of damage to brain cells, and also select the correct drugs for further treatment.

Treatment methods

There is no conservative treatment for cerebral ischemia, since it is impossible to replace dead brain cells with viable ones. However, children with similar disease maintenance therapy is prescribed, which makes it possible to rehabilitate and prevent the progression of the disease.

The acute course of the disease, moderate and severe, is diagnosed almost immediately after the birth of the child, when his condition is assessed using the Apgar scale. If in the first two minutes of life the baby does not begin to breathe on his own or through an oxygen mask, resuscitation procedures are carried out, which include:

• Artificial ventilation and intubation allows you to restore spontaneous breathing within a few minutes. After this, the baby is handed over to the mother and is constantly monitored. If longer resuscitation is indicated, the newborn is placed in the intensive care unit, where breathing, circulation, gas levels and blood sugar are monitored.
• Cardiac support is also necessary, because if there is insufficient oxygen supply to the brain, the heart begins to suffer. To maintain proper heartbeat, Dopamine and Dobutamine are prescribed.
• To prevent additional brain damage due to seizures, the child is prescribed anticonvulsants Phenobarbital and Phenytoin.
• Hypothermia has recently been considered effective method reducing the rate of brain cell death. The body temperature is lowered by several degrees, but this procedure must be carried out under the constant supervision of a doctor, and the child must be gradually warmed up.

Since moderate and severe degrees of cerebral ischemia threaten serious consequences due to brain changes (minor deviations: attention deficit, or disability: cerebral palsy, dementia), it is necessary to treat the consequences of cerebral ischemia. However, the list of medications, regardless of the complications of ischemia, is very limited and includes anticonvulsants (if seizures persist) and muscle relaxants to relieve spasms of the limbs in cerebral palsy.

There are no more medications to combat the effects of ischemia. However, other means can contribute to a child’s development:

• The child should spend more time in nature, communicate with peers and adults;
• In the early stages of development of cerebral palsy, a special massage is required, which can only be performed by qualified specialists;
• To develop speech, perseverance and attention, it is necessary to visit a speech therapist;
• Older children are prescribed physical therapy;
• In order for the child to maintain correct posture, it is necessary to use special devices for its correction (rollers, strollers, splints).

Ineffective treatments and diagnostics

In our country, pediatric neurology is developing very slowly, which is why outdated methods are used to treat PEDs. There are some features of newborns that may be mistaken for manifestations of cerebral ischemia:

• If a pediatrician examines a sleepy or frightened child, he may be too excited or lethargic, which gives reason to mistakenly assume the presence of cerebral ischemia;
• Newborns and children under six months old have some features that are also sometimes mistaken for manifestations of the disease: increased muscle tone, periodic shudders or Graefe's symptom.

It is incorrect diagnosis that causes the prescription of certain medications that do not bring any benefit. healthy baby, and children with hypoxia are not helped to fight the consequences of the disease.

To avoid taking unnecessary medications, here are some: short list:

• on plant based(valerian, motherwort);
• Vascular (Cinnarizine, Cavinton);
• Any homeopathic medicines;
• Actovegin, Cortexin, Cerebrolysin;
• Nootropic drugs (Piracetam, Picamilon, Phenibut).

All these remedies have no proven effectiveness. IN best case scenario they simply won't provide any benefit and, at worst, can cause serious side effects.

Preventive agents

To prevent the development of cerebral ischemia, to the expectant mother It’s better to start preventing the disease in advance:

• Plan a pregnancy;
• For complications during pregnancy, hospitalization is recommended;
• During pregnancy, you need to regularly undergo all tests and undergo routine ultrasound;
• Before conception, give up bad habits;
• Take iron supplements as prescribed by your doctor;
• Be screened for infections before and during pregnancy.

Common questions from parents

• The child was diagnosed with first degree ischemia, but the symptoms disappeared after a few days. How high is the risk of serious consequences?

In newborns with the first degree of ischemia, recovery occurs quickly and without consequences for development. For babies with moderate and severe degrees, the prognosis is given depending on the manifestations of the disease.

• The child underwent a brain ultrasound at 1 month, which showed a recovery period after perinatal encephalopathy and After consulting a neurologist, a threat of cerebral palsy due to chin tremor was established and the drug Pantogam was prescribed. How serious is this diagnosis?

Because there is only one symptom of suspected cerebral palsy, the child is likely to develop normally. A severe form of ischemia is often diagnosed in the maternity hospital, and an ultrasound report without accompanying symptoms cannot be a reason for an accurate diagnosis of ischemia. Pantogam is not very effective, and also not safe drug. It is much better to give the child a massage and encourage his physical activity.

• Is it necessary to refuse vaccinations if a child has been diagnosed with residual effects of perinatal encephalopathy?

Firstly, this diagnosis is not correct, since it does not reflect the baby’s condition. And secondly, if cerebral ischemia was diagnosed after birth, then it is not a contraindication to vaccinations, but on the contrary - vaccination becomes a necessary measure to protect the baby.

Cerebral ischemia is when an insufficient amount of blood enters the brain, resulting in oxygen starvation of neurons. Because of this, the functioning of the nuclei of the brain substance and disturbances in biochemical processes occur, and the transmission of signals from the brain center is disrupted.

We can conclude that this type of ischemia is damage to the blood vessels of the brain.

Namely, blood retention occurs, and as a result, tissue dysfunction, and if the ischemia is prolonged, then tissue damage occurs. The conduction of impulses by neurons is disrupted if oxygen saturation reaches 60%, and gradually stops completely.

With cerebral brain damage, the following may occur:

Depending on the course of the disease, the following forms are divided:

Causes and development factors

The reasons for the development of cerebral ischemia include:

An important factor in the development of cerebral ischemia is hypertension. Especially when blood pressure rises sharply and is expressed in hypertensive crises, destruction of small vessels occurs.

That is, their walls become saturated with plasma proteins and begin to grow connective tissue. And as a result of this, the lumen of the vessel narrows, the artery loses its elasticity. This process is very similar to atherosclerotic lesions.

Also worth noting harmful influence bleeding disorders, as this results in the formation of blood clots.

All these factors contribute to the development of acute and chronic forms of cerebral ischemia. As a result of impaired blood circulation, brain hypoxia occurs. This process is activated due to spasm or sharp narrowing, as well as due to blockage of the artery.

When a disturbance due to any disease occurs for a long time, tissue necrosis develops. That is, a heart attack.

It should be noted factors that contribute to the development of cerebral ischemia, risk group:

As for the reasons for the occurrence of this pathology in newborns, it manifests itself even during intrauterine development, as well as in in rare cases may occur due to birth injuries.

Stages of disease development

Cerebral ischemia in chronic form develops in 3 stages:

• I degree of development;
• II degree of development;
• III degree of development.

Cerebral ischemia grade 1

At this stage, the body works through a compensatory function. If the pathology is diagnosed at this stage, treatment will not take much time and effort. And also after timely treatment There are no complications or consequences of pathology.

Symptoms of stage 1 disease include general weakness, chills, fast fatiguability, insomnia is possible, and anisoreflexia often appears.

Anisoreflexia is a reflex asymmetry, in which reactions appear that indicate irritation of the periolabial and oral zones.

In this case, a person can exhibit kissing and sucking movements with his lips. Such a violation indicates a disorder of neural brain connections.

Other nervous disorders are also noted, for example, a person often displays aggression, irritability, rapid mood swings, and depression.

As for cognitive disorders, a inhibited state appears, a decrease in mental aspiration, that is, a person loses the desire for knowledge, absent-minded attention, memory impairment, and often the person simply becomes forgetful. Dizziness, headaches, and tinnitus also occur.

Cerebral ischemia grade 2

This stage of the disease is also called subcompensation; subcompensation occurs in the case when the person previously did not pay attention to characteristic symptoms, and also if curative therapy turned out to be ineffective.

In this case, the symptoms of grade 1 worsen significantly. People with such disorders are unable to engage in usual activities, as it becomes increasingly difficult to concentrate. And the simplest actions are difficult.

TO general symptoms Coordination disorders may also be added, often in the form of ataxia; the person shows indifference to everything. Intellectual impairments also appear, which contributes to personality degradation.

Already at stage 2, a person’s condition worsens significantly, quite serious mental disorders appear, and often he can no longer independently carry out the usual manipulations (self-care).

Ischemia grade 3

This period is called decompensation. In this case, the brain is severely affected, and a heart attack or multiple heart attacks occurs.

The symptoms of the pathology are severe. The patient cannot walk independently, and may also experience fainting, urinary incontinence, swallowing dysfunction, mental disorders and, as a result, behavioral disorders.

As a complication, in the chronic form, Parkinson's syndrome develops, which can even lead to dementia.

Therapy of the disease

Therapeutic therapy for cerebral ischemia consists of eliminating the symptoms of the pathology and preventing progression, that is, so that a stroke does not occur or ischemia does not develop in a chronic form.

In the chronic form of the disease, treatment with these drugs occurs in courses, about 2 times a year. As a rule, the course of treatment lasts 2 months.

Before starting therapy, the patient must be prescribed therapeutic diet, the patient must give up bad habits, and the person must be protected from stress and emotional disorders.

For cerebral ischemia, the following drugs are prescribed:

• Antioxidants. These drugs dilate blood vessels, as a result of which blood flow to the brain is restored, and they are also effective in treating pain.
• Antiplatelet agents.
• Vasoactive agents.
• Nootropic drugs. These drugs help restore mental activity, help improve memory.

Also, quite often the patient is prescribed antidepressants in order to relieve anxiety, fear, etc. Such drugs are also necessary for the chronic form.

For ischemic stroke drug therapy consists of taking thrombolytic drugs that are administered intravenously.

This is necessary to dissolve the blood clot. Drugs to lower blood pressure and neuroprotectors are also used to improve brain nutrition. Antiarrhythmic drugs needed if heartbeat broken.

Surgical treatment consists of removing the blood clot from the vessel. This involves inserting an umbrella-like device into the artery. It captures the formed blood clot and then the doctor removes it.

Surgical treatment is performed if drug therapy has failed. Carotid artery stenting and carotid endarterectomy can be used.