Consequences of early residual organic damage to the central nervous system with cerebrasthenic, neurosis-like, psychopath-like syndromes. Organic mental infantilism. Psychoorganic syndrome. Childhood hyperactivity disorder with attention deficit. Mechanisms of social and school disadaptation, prevention and correction of residual effects of residual organic cerebral insufficiency and childhood hyperactivity syndrome.

Residual organic lesions of the central nervous system

Lecture XIV.

What type do you think the family of a child with schizophrenia, whose medical history is given in the previous lecture, belongs to?

What specialist do you think is the leader in correctional work with an autistic child?

EARLY RESIDUAL ORGANIC CEREBRAL INSUFFICIENCY in children - a condition caused by persistent consequences of brain damage (early intrauterine brain damage, birth trauma, traumatic brain injury in early childhood, infectious diseases). There are serious reasons to believe that in recent years the number of children with consequences of early residual organic damage to the central nervous system has been increasing, although the true prevalence of these conditions is not known.

The reasons for the increase in residual effects of residual organic damage to the central nervous system in recent years are diverse. These include environmental problems, including chemical and radiation contamination of many cities and regions of Russia, poor nutrition, unjustified abuse of medications, untested and often harmful dietary supplements, etc. The principles of physical education of girls - expectant mothers, whose development is often disrupted due to frequent somatic diseases, a sedentary lifestyle, restrictions on movement, have also changed in many ways. fresh air, feasible housework or, on the contrary, excessive participation in professional sports, as well as due to the early start of smoking, drinking alcohol, toxic substances and drugs. Poor nutrition and heavy physical work of a woman during pregnancy, emotional distress associated with an unfavorable family situation or an unwanted pregnancy, not to mention the use of alcohol and drugs during pregnancy, disrupt its normal course and negatively affect the intrauterine development of the child. The result of imperfect medical care, primarily the lack of any understanding of the medical contingent of antenatal clinics about the psychotherapeutic approach to a pregnant woman, full-fledged patronage during pregnancy, informal practices of preparing pregnant women for childbirth and not always qualified obstetric care, are birth injuries that disrupt the normal development of the child and subsequently affecting his entire life. The introduced practice of “planning childbirth”, “regulating childbirth” is often taken to the point of absurdity, turning out to be useful not for the woman in labor and the newborn, but for the staff of the maternity hospital, who have received the legal right to plan their rest. Suffice it to say that in recent years, children are born not predominantly at night or in the morning, when they are supposed to be born according to biological laws, but in the first half of the day, when tired personnel are replaced by a new shift. Excessive enthusiasm also seems unjustified caesarean section, in which not only the mother, but also the baby is sufficiently long time receives anesthesia, which is completely indifferent to him. The above is only part of the reasons for the increase in early residual organic lesions of the central nervous system.

In the very first months of a child’s life, organic damage to the central nervous system manifests itself in the form of neurological signs that are detected by a pediatric neurologist, and familiar external signs: trembling of the arms, chin, muscle hypertonicity, early holding of the head, tilting it back (when the child seems to be looking at something behind your back), anxiety, tearfulness, unjustified screaming, interrupted night sleep, delayed development of motor functions and speech. In the first year of life, all these signs allow the neurologist to register the child for the consequences of birth trauma and prescribe treatment (Cerebrolysin, cinnarizine, Cavinton, vitamins, massage, gymnastics). Intensive and properly organized treatment in mild cases, as a rule, has a positive effect, and by the age of one year the child is removed from the neurological register, and for several years the child raised at home does not cause any particular concern to the parents, with the possible exception of some delay in speech development. Meanwhile, after placement in a kindergarten, the child’s characteristics begin to attract attention, which are manifestations of residual organic damage to the central nervous system - cerebrospinal fluid, neurosis-like disorders, hyperactivity and mental infantilism.

The most common consequence of residual organic cerebral insufficiency is cerebrasthenic syndrome. Cerebrasthenic syndrome is characterized by exhaustion (inability to concentrate for a long time), fatigue, mood instability associated with minor external circumstances or fatigue, intolerance loud sounds, bright light and in most cases is accompanied by a noticeable and long-term decrease in performance, especially with significant intellectual load. Schoolchildren show a decrease in memorization and retention of educational material in memory. Along with this, irritability is observed, taking the form of explosiveness, tearfulness, and capriciousness. Cerebrasthenic conditions caused by early brain damage become a source of difficulty in developing school skills (writing, reading, counting). A mirror character of writing and reading is possible. Speech disorders are especially common (delayed speech development, articulatory deficiencies, slowness or, conversely, excessive speed of speech).

Frequent manifestations of cerebrasthenia may be headaches that occur upon awakening or when tired at the end of classes, accompanied by dizziness, nausea and vomiting. Often such children experience transport intolerance with dizziness, nausea, vomiting, and a feeling of lightheadedness. They also do not tolerate heat, stuffiness, and high humidity well, reacting to them with a rapid pulse, an increase or decrease in blood pressure, and fainting. Many children with cerebrasthenic disorders cannot tolerate merry-go-round rides and other spinning motions, which also lead to dizziness, lightheadedness, and vomiting.

In the motor sphere, cerebrovascular disease manifests itself in two equally common variants: lethargy and inertia or, on the contrary, motor disinhibition. In the first case, children look lethargic, they are not active enough, they are slow, they take a long time to get involved in work, they need much more time than ordinary children to comprehend the material, solve problems, do exercises, and think about answers; the mood background is most often reduced. Such children become especially unproductive in activities after 3-4 lessons and at the end of each lesson, when tired, they become drowsy or tearful. They are forced to lie down or even sleep after returning from school, in the evenings they are lethargic and passive; with difficulty, reluctantly, and take a very long time to prepare homework; Difficulty concentrating and headaches worsen when tired. In the second case, fussiness, excessive motor activity, and restlessness are noted, which prevents the child not only from engaging in purposeful educational activities, but even from games that require attention. At the same time, the child’s motor hyperactivity increases with fatigue and becomes more and more disordered and chaotic. It is impossible to involve such a child in the evenings. sequential game, and in school years- preparing homework, repeating what has been covered, reading books; It is almost impossible to put him to bed on time, so from day to day he sleeps significantly less than he should for his age.

Many children with the consequences of early residual organic cerebral insufficiency exhibit features of dysplasia (deformation of the skull, facial skeleton, ears, hypertelorism - widely spaced eyes, high palate, irregular teeth growth, prognathism - protruding upper jaw, etc.).

In connection with the disorders described above, schoolchildren, starting from the first grades, in the absence of an individual approach to education and routine, experience great difficulties in adapting to school. They sit through lessons more than their healthy peers and are even more decompensated due to the fact that they need longer and more complete rest than ordinary children. Despite all their efforts, they, as a rule, do not receive encouragement, but, on the contrary, are subjected to punishment, continuous comments and even ridicule. After a more or less long time, they stop paying attention to their failures, interest in studying drops sharply, and a desire for easy pastime appears: watching all television programs without exception, playing outdoor games on the street and, finally, a craving for the company of their own kind. At the same time, direct skimping and neglect of school activities already occur: absenteeism, refusal to attend classes, escapes, vagrancy, early drinking, which often leads to home thefts. It should be noted that residual organic cerebral insufficiency significantly contributes to the rapid emergence of dependence on alcohol, drugs and other psychoactive substances.

Neurosis-like syndrome in a child with residual organic damage, the central nervous system is characterized by stability, monotony, stability of symptoms, and its low dependence on external circumstances. In this case, neurosis-like disorders include tics, enuresis, encopresis, stuttering, mutism, obsessive symptoms- fears, doubts, apprehensions, ? movements.

The above observation illustrates cerebrasthenic and neurosis-like syndromes in a child with early residual organic damage to the central nervous system.

Kostya, 11 years old.

Second child in the family. Born from a pregnancy that occurred with toxicosis in the first half (nausea, vomiting), threat of miscarriage, edema and increased blood pressure in the second half. Childbirth 2 weeks premature, born with a double entanglement of the umbilical cord, in blue asphyxia, screamed after resuscitation measures. Birth weight 2,700 g. He was attached to the breast on the third day. He sucked sluggishly. Early development with a delay: began to walk at 1 year 3 months, pronounces individual words from 1 year 10 months, phrasal speech - from 3 years. Until the age of 2, he was very restless, whiny, and suffered from colds a lot. I was observed by a neurologist for up to 1 year regarding trembling of the hands, chin, hypertonicity, seizures (2 times) at high temperatures against the background of acute respiratory disease. Until the age of 2, he was very restless, whiny, and suffered from colds a lot. He grew up quiet, sensitive, sedentary, awkward. He was overly attached to his mother, did not let her go, took a very long time to get used to kindergarten: he did not eat, did not sleep, did not play with the children, cried almost all day, refused toys. Until the age of 7, he suffered from bedwetting. He was afraid to be alone at home, fell asleep only by the light of a night light and in the presence of his mother, was afraid of dogs, cats, sobbed, resisted when he was taken to the clinic. At emotional stress, colds, troubles in the family, the boy had blinking and stereotypical shoulder movements, which disappeared when small doses of tranquilizers or sedative herbs were prescribed. Speech suffered from incorrect pronunciation of many sounds and became clear only at the age of 7, after speech therapy sessions. I went to school at the age of 7.5, willingly, quickly got to know the children, but hardly spoke to the teacher for 3 months. He answered questions very quietly, behaved timidly and uncertainly. I was tired by the 3rd lesson, “lying” on my desk, could not assimilate the educational material, and ceased to understand the teacher’s explanations. After school he went to bed himself and sometimes fell asleep. He taught lessons only in the presence of adults, and often complained in the evenings about headache, often accompanied by nausea. I slept restlessly. I could not stand riding in a bus or car - I experienced nausea, vomiting, turned pale, and began to sweat. Felt bad on cloudy days; At this time, I almost always had a headache, dizziness, decreased mood, and lethargy. In the summer and autumn I felt better. The condition worsened under high loads, after illnesses (acute respiratory infections, tonsillitis, childhood infections). He studied with "4" and "3", although, according to others, he was distinguished by fairly high intelligence and good memory. He had friends and walked alone in the yard, but preferred quiet games at home. He began studying at a music school, but attended it reluctantly, cried, complained of fatigue, was afraid that he would not have time to do his homework, and became irritable and restless.

Starting from the age of 8, as prescribed by a psychiatrist, twice a year - in November and March - he received a course of diuretics, nootropil (or Cerebrolysin in injections), Cavinton, and a sedative mixture. If necessary, an additional day off was assigned. During the treatment, the boy's condition improved significantly: headaches became rare, tics disappeared, he became more independent and less fearful, and his academic performance improved.

In this case, we are talking about pronounced signs of cerebrasthenic syndrome, appearing in combination with neurosis-like symptoms (tics, enuresis, elementary fears). Meanwhile, however, with adequate medical supervision, correct treatment tactics and a gentle regime, the child fully adapted to the conditions of school.

Organic damage The central nervous system can also be expressed in psychoorganic syndrome (encephalopathy), characterized by a greater severity of disorders and containing, along with all the above-described signs of cerebrasthenia, memory loss, weakening of intellectual productivity, changes in affectivity (“incontinence of affect”). These signs are called the Walter-Bühel triad. Incontinence of affect can manifest itself not only in excessive affective excitability, inappropriately violent and explosive expression of emotions, but also in affective weakness, which includes a pronounced degree emotional lability, emotional hyperesthesia with excessive sensitivity to all external stimuli: the slightest changes in the situation, an unexpected word cause irresistible and uncorrectable violent emotional states in the patient: crying, sobbing, anger, etc. n. Memory impairments in psychoorganic syndrome vary from mild weakening to severe mnestic disorders (for example, difficulties in remembering momentary events and current material).

In psychoorganic syndrome, the prerequisites for intelligence are, first of all, insufficient: decreased memory, attention and perception. The amount of attention is limited, the ability to concentrate decreases, absent-mindedness, exhaustion and satiety with intellectual activity increase. Violations of attention lead to a violation of the perception of the environment, as a result of which the patient is not able to grasp the situation as a whole, capturing only fragments, individual aspects of events. Impaired memory, attention and perception lead to weakness of judgment and inference, which is why patients appear helpless and clueless. There is also a slowdown in the pace of mental activity, inertia and rigidity mental processes.; eThis manifests itself in slowness, getting stuck on certain ideas, and difficulty switching from one type of activity to another. Characterized by a lack of criticism of one's capabilities and behavior with a careless attitude towards one's condition, loss of a sense of distance, familiarity and familiarity. Low intellectual productivity becomes apparent with additional workload, but unlike mental retardation the ability to abstract is preserved.

Psychoorganic syndrome can be temporary, transient in nature (for example, after a traumatic brain injury, including birth trauma, including birth trauma, neuroinfection) or be permanent, chronic property individuals in the long-term period of organic damage to the central nervous system.

Often, with residual organic cerebral insufficiency, signs appear psychopath-like syndrome, which becomes especially obvious in prepubertal and pubertal age. Children and adolescents with psychoorganic syndrome are characterized by the most serious forms of behavioral disorders caused by pronounced change affectivity. Pathological character traits in this case are mainly manifested by affective excitability, a tendency to aggression, conflict, disinhibition of drives, satiety, sensory thirst (desire for new impressions, pleasures). Affective excitability is expressed in a tendency to excessively easily develop violent affective outbursts that are not adequate to the reason that caused them, in attacks of anger, rage, and impatience, accompanied by motor agitation, thoughtless, sometimes dangerous for the child himself or others, actions and, often, narrowed consciousness. Children and adolescents with affective excitability are capricious, touchy, overly active, and prone to unbridled pranks. They shout a lot and get angry easily; Any restrictions, prohibitions, remarks cause violent protest reactions in them with viciousness and aggression.

Together with the signs organic mental infantilism(emotional-volitional immaturity, uncriticality, lack of purposeful activity, suggestibility, dependence on others) psychopathic-like disorders in a teenager with residual organic damage to the central nervous system create the preconditions for social disadaptation with criminal tendencies. Offenses are often committed by them in a state of alcohol intoxication or under the influence of drugs; Moreover, for such a teenager with residual organic damage to the central nervous system to completely lose criticism or even amnesia (lack of memory) of the criminal act itself, a relatively small dose of alcohol and drugs is enough. It is necessary to note once again that children and adolescents with residual organic cerebral insufficiency develop dependence on alcohol and drugs faster than healthy ones, leading to severe forms of alcoholism and drug addiction.

The most important means of preventing school disadaptation in residual organic cerebral insufficiency is the prevention of intellectual and physical overload by normalizing the daily routine, correct alternation of intellectual work and rest, and eliminating simultaneous classes in general education and special schools(musical, artistic, etc.). Residual effects of residual organic damage to the central nervous system in severe cases are a contraindication for enrollment in school specialized type(with in-depth study of a foreign language, physics and mathematics, gymnasium or college with an accelerated and extended curriculum).

With this type of mental pathology, in order to prevent educational decompensation, it is necessary to timely introduce an adequate drug course of therapy (nootropics, dehydration, vitamins, lungs sedatives etc.) with constant supervision by a psychoneurologist and dynamic electroencephalographic, echoencephalographic, pathopsychological control; early start of pedagogical correction taking into account the individual characteristics of the child; individual lessons with a defectologist; socio-psychological and psychotherapeutic work with the child’s family to develop correct, adequate attitudes and ideas about the child’s capabilities and his future.

HYPERACTIVITY IN CHILDREN. There is also a definite connection with residual organic cerebral insufficiency in childhood. hyperactivity, which occupies a special place, first of all, in connection with the pronounced school disadaptation caused by it - educational failure and (or) behavioral disorders. Motor hyperactivity is described in child psychiatry under different names: minimal brain dysfunction (MMD), motor disinhibition syndrome, hyperdynamic syndrome, hyperkinetic syndrome, childhood attention deficit hyperactivity syndrome, active attention disorder syndrome, attention deficit syndrome (the latter name corresponds to the modern classification).

The standard for assessing behavior as “hyperkinetic” is a set of the following signs:

Physical activity:

1) physical activity is excessively high in the context of what is expected in this situation and in comparison with other children of the same age and intellectual development;

21) has an early onset (before 6 years);

32) has a long duration (or constancy over time);

43) is found in more than one situation (not only at school, but also at home, on the street, in the hospital, etc.).

4) motor activity is excessively high in the context of what is expected in this situation and in comparison with other children of the same age and intellectual development;

Data on the prevalence of hyperkinetic disorders vary widely - from 2 to 23% of the child population (recently there has been a clear tendency towards an unjustifiably extensive diagnosis of this condition). Hyperkinetic disorders that occur in childhood, in the absence of preventive measures often lead not only to school maladaptation - poor academic performance, repetition, behavioral disorders, but also to severe forms of social maladaptation, far beyond the limits of childhood and even puberty.

Hyperkinetic disorder usually manifests itself in early childhood. In the first year of life, the child shows signs of motor excitement, constantly fidgets, makes a lot of unnecessary movements, which makes it difficult to put him to sleep and feed him. The formation of motor functions occurs in a hyperactive child faster than in his peers, while the development of speech does not differ from normal periods or even lags behind them. When a hyperactive child begins to walk, he is distinguished by speed and an excessive number of movements, uncontrollability, cannot sit still, climbs everywhere, tries to get different objects, does not respond to prohibitions, does not sense danger or edges. Such a child very early (from 1.5-2 years old) stops sleeping during the day, and in the evening it is difficult to put him to bed due to the chaotic excitement that grows in the afternoon, when he is completely unable to play with his toys, do one thing, and is capricious. , plays around, runs. Falling asleep is disrupted: even when physically restrained, the child continuously moves, tries to slip out from under the mother’s arms, jump up, and open his eyes. With severe daytime arousal, deep night sleep with long-lasting enuresis may occur.

However, hyperkinetic disorders in infancy and early childhood preschool age are often regarded as ordinary liveliness within the framework of normal child psychodynamics. Meanwhile, restlessness, distractibility, satiation with a need for frequent changes impressions, the inability to play independently or with children without persistent organizational assistance from adults. These features become obvious in older preschool age, when the child begins to prepare for school - at home, in the preparatory group kindergarten, V preparatory groups secondary school.

Starting from grade 1, hyperdynamic disorders in a child are expressed in motor disinhibition, fussiness, inattention and lack of perseverance in performing tasks. At the same time, there is often an increased background mood with overestimation own capabilities, mischief and fearlessness, lack of persistence in activities, especially those requiring active attention, the tendency to move from one activity to another without completing any of them, poorly organized and poorly regulated activity. Hyperkinetic children are often reckless and impulsive, prone to accidents and injuries. disciplinary action due to violations of the rules of conduct. They usually have disrupted relationships with adults due to a lack of caution and restraint, and a low sense of self-esteem. Hyperactive children are impatient, do not know how to wait, cannot sit still during a lesson, are in constant undirected movement, jump up, run, jump, and if necessary to sit still, constantly move their legs and arms. They are usually talkative, noisy, often good-natured, constantly smiling and laughing. Such children need a constant change of activity and new experiences. A hyperactive child can consistently and purposefully engage in one activity only after significant physical exertion; At the same time, such children themselves say that they “need to unwind”, “reset their energy.”

Hyperkinetic disorders appear in combination with cerebrasthenic syndrome, signs of mental infantilism, pathological personality characteristics, more or less expressed against the background of motor disinhibition and further complicating the school and social adaptation of a hyperactive child. Often hyperkinetic disorders are accompanied by neurosis-like symptoms: tics, enuresis, encopresis, stuttering, fears - long-lasting common childhood fears of loneliness, darkness, pets, white coats, medical procedures, or quickly arising obsessive fears based on a traumatic situation.

Signs of mental infantilism in hyperkinetic syndrome are expressed in play interests characteristic of an earlier age, gullibility, suggestibility, subordination, affection, spontaneity, naivety, dependence on older or more self-confident friends. Due to hyperkinetic disorders and traits of mental immaturity, the child prefers only play activity, but it does not captivate him for a long time: he constantly changes his opinion and direction of activity in accordance with who is near him; he, having committed a rash act, immediately repents of it, assures adults that “he will behave well,” but, finding himself in a similar situation, again and again he sometimes repeats harmless pranks, the outcome of which he cannot foresee or calculate. At the same time, because of his kindness, good-naturedness, and sincere repentance for his deeds, such a child is extremely attractive and loved by adults. Children often reject such a child, since it is impossible to play productively and consistently with him because of his fussiness, noisiness, desire to constantly change the conditions of the game or move from one type of play to another, because of his inconsistency, variability, and superficiality. A hyperactive child quickly gets acquainted with children and adults, but also quickly “changes” friendships, striving for new acquaintances and new experiences. Mental immaturity in children with hyperkinetic disorders determines the relative ease of occurrence in them of various transient or more persistent deviations, disruption of the process of personality formation under the influence of unfavorable factors - both micro-social-psychological and biological. The most common in hyperactive children are pathological character traits with a predominance of instability, when the lack of volitional delays, dependence of behavior on momentary desires and drives, increased subordination to outside influence, lack of ability and reluctance to overcome the slightest difficulties, interest and skill in work come to the fore. . The immaturity of the emotional-volitional personality traits of adolescents with an unstable variant determines their increased tendency to imitate forms of behavior of others, including negative ones (leaving home, school, foul language, petty theft, drug abuse). alcoholic drinks, drugs).

Hyperkinetic disorders in the vast majority of cases are gradually reduced by the middle of puberty - at 14–15 years. It is impossible to wait for the spontaneous disappearance of hyperactivity without taking corrective and preventive measures due to the fact that hyperkinetic disorders, being mild, borderline mental pathology, generate severe forms school and social disadaptation, leaving an imprint on the entire future life of a person.

From the very first days of school, the child finds himself in the conditions of having to follow disciplinary standards, evaluate knowledge, show his own initiative, and form contact with the team. Due to excessive motor activity, restlessness, distractibility, and satiation, a hyperactive child does not meet the requirements of the school and in the coming months after the start of school becomes the subject of constant discussion in the teaching staff. He receives comments and diary entries every day, he is discussed at parent and class meetings, he is scolded by teachers and school administration, he is threatened with expulsion or transfer to individual education. Parents cannot help but react to all these actions, and in the family a hyperactive child becomes the cause of constant discord, quarrels, disputes, which gives rise to an education system in the form of constant penalties, prohibitions and punishments. Teachers and parents are trying to restrain his physical activity, which in itself is impossible due to physiological characteristics child. A hyperactive child disturbs everyone: teachers, parents, older and younger brothers and sisters, children in the classroom and in the yard. His successes, in the absence of special correction methods, never correspond to his natural intellectual abilities, that is, he learns significantly below his capabilities. Instead of the motor relaxation that the child himself talks about to adults, he is forced to sit for many hours, completely unproductively, preparing his homework. Rejected by family and school, a misunderstood, unsuccessful child sooner or later begins to openly skimp ? neglect school. Most often this happens at the age of 10-12, when parental control weakens and the child gets the opportunity to use transport independently. The street is full of entertainment, temptations, new acquaintances; the street is diverse. It is here that a hyperactive child never gets bored; the street satisfies his inherent passion for a continuous change of impressions. Here no one scolds or asks about academic performance; here peers and older children are in the same position of rejection and resentment; new acquaintances appear here every day; Here, for the first time, the child tries the first cigarette, the first glass, the first joint, and sometimes the first injection of a drug. Due to suggestibility and subordination, lack of momentary criticism and the ability to predict the near future, children with hyperactivity often become members of an antisocial company, commit criminal acts or are present at them. With the layering of pathological character traits, social disadaptation becomes especially deep (even to the point of registration in the commission for minors, the children's room of the police, before the judicial investigation, a colony for juvenile offenders). In prepubertal and puberty Almost never being the initiators of a crime, hyperactive schoolchildren often join the criminal ranks.

Thus, although the hyperkinetic syndrome, becoming especially noticeable already in early preschool age, is significantly (or completely) compensated during adolescence by reducing motor activity and improving attention, such adolescents, as a rule, do not achieve a level of adaptation corresponding to their natural characteristics , since they are socially decompensated already at primary school age and this decompensation in the absence of adequate corrective and therapeutic approaches can increase. in the absence of adequate corrective and therapeutic approaches. Meanwhile, with proper, patient, constant therapeutic, preventive and psychological-pedagogical work with a hyperactive child, it is possible to prevent deep forms of social disadaptation. IN mature age in most cases, signs of mental infantilism, mild cerebrasthenic symptoms, pathological character traits, as well as superficiality, lack of purposefulness, and suggestibility remain noticeable.

A pathology characterized by cell death in the spinal cord or brain – organic damage to the central nervous system. In severe cases of the disease, a person’s nervous system becomes defective; he needs constant care, since he cannot care for himself or perform work duties.

However, if an organic disorder is detected in a timely manner, the prognosis is quite favorable - the activity of the affected cells is restored. The success of treatment is the complexity and completeness of the treatment, the implementation of all the doctor’s recommendations.

Another name for organic damage to the central nervous system is encephalopathy. Its signs can be detected in most people after 65–75 years of age, and in some cases even in children - with toxic damage to the structures of the head. In general, experts divide pathology into congenital and acquired forms, based on the time of trauma and death of nerve cells.

Classification of pathology:

• Due to appearance: traumatic, toxic, alcoholic, infectious, radiation, genetic, discirculatory, ischemic.
• By time of appearance: intrauterine, early children, late children, adults.
• Based on the presence of complications: complicated, uncomplicated.

In case of absence obvious reason death of nerve cells and the symptoms accompanying this process, there is an unclear ROP of the central nervous system (residual organic damage to the central nervous system). In this case, experts will recommend additional methods examinations to correctly classify the disease.

Causes of ROP in children

As a rule, organic damage to the central nervous system in children is a congenital pathology, which can lead to acute severe or mild but prolonged oxygen starvation area formed during intrauterine development of the brain. Excessively long labor. Premature abruption of the placenta, the organ responsible for feeding the baby inside the uterus. Significant weakening of the tone of the uterus and subsequent oxygen starvation of the tissues.

Less commonly, the cause of irreversible changes in the nerve cells of the fetus are infections suffered by the woman - for example, tuberculosis, gonorrhea, pneumonia. If infectious agents have penetrated the protective membranes of the uterus, they have an extremely negative impact on the course of pregnancy, especially at the stage of formation of the central cerebral system.

In addition, the following can lead to the appearance of residual organic brain lesions in children:

• birth injuries - when the fetus passes through birth canal women;
• the tendency of the expectant mother to use tobacco and alcohol products;
• daily inhalation of toxic substances by a pregnant woman - work in hazardous industries with high indoor gas pollution, for example, in paint factories.

The mechanism for the development of CNS ROP in a child can be imagined as a distortion of information during cell division due to breakdowns in the DNA chain - brain structures are formed incorrectly and can become unviable.

Causes in adults

In most cases, experts indicate various external causes as provoking factors for residual damage.

Traumatic brain injuries - e.g. car crashes, domestic injuries. Infectious lesions– the main microorganisms of the viral nature are Coxsackie, ECHO, as well as herpes viruses, staphylococci, HIV infection. Intoxication – human consumption of alcoholic beverages, narcotic drugs, tobacco, or frequent contact with salts heavy metals, taking certain subgroups of medications;

Vascular disorders - for example, ischemic/hemorrhagic strokes, atherosclerosis, various anomalies brain vessels. Demyelinating pathologies - most often indicate multiple sclerosis, which is based on the destruction of the membrane nerve endings. Neurodegenerative conditions are mainly syndromes that occur in old age.

Increasingly, neoplasms – tumors – lead to organic damage to the central nervous system. When rapid growth, they put pressure on neighboring areas, injuring the cells. The result is an organic syndrome.

Symptoms in children

Signs of damage in babies can be observed from the first days of life. Such children are characterized by tearfulness, irritability, poor appetite and troubled, intermittent sleep. In severe cases, episodes of epilepsy are possible.

At an early stage, it is difficult for even a highly professional neurologist to identify organic damage to the central nervous system, since the baby’s movements are chaotic and the intellect is still underdeveloped. However, Upon careful examination and questioning of parents, it is possible to establish:

• violation muscle tone baby - hypertonicity;
• involuntary movements of the head and limbs - more intense than should be the case in children of the same age;
• paresis/paralysis;
• disturbance of eyeball movements;
• malfunctions of the sense organs.

Closer to the year, symptoms will indicate organic lesions of the central nervous system:

• lagging behind in intellectual development - the baby does not follow toys, does not speak, does not fulfill requests made to him;
• severe delay in general physical development - does not hold his head up, does not coordinate movements, does not attempt to crawl or walk;
• increased fatigue of children - both physical and intellectual, failure to master the educational program;
• emotional immaturity, instability - rapid mood swings, self-absorption, capriciousness and tearfulness;
• various psychopathy - from a tendency to affect to severe depression;
• infantilism of the individual - increased dependence of the baby on the parents, even in everyday trifles.

Timely detection and comprehensive treatment of central nervous system lesions in childhood makes it possible to compensate negative manifestations and socialize the baby - he learns and works almost equally with his peers.

Symptoms in adults

If residual damage to the central nervous system in adults is caused by vascular changes, it will manifest itself gradually. People around may notice a person’s increased absent-mindedness, decreased memory, and intellectual capabilities. As it gets worse pathological disorder New symptoms and signs are added:

• – long-lasting, intense, in different parts of the skull;
• nervousness – excessive, unreasonable, sudden;
• dizziness - persistent, of varying severity, not associated with other pathologies;
• horse racing intracranial pressure– sometimes up to significant numbers;
• attention – scattered, difficult to control;
• movements are uncoordinated, gait is unsteady, suffers fine motor skills, up to the inability to hold a spoon, book, cane;
• epilepsy - seizures from rare and weak to frequent and severe;
• mood changes quickly, up to hysterical reactions and antisocial behavior.

Residual organic damage in adults is often irreversible, since its causes are tumors, injuries, and vascular pathologies.

A person’s quality of life is reduced - he loses the ability to care for himself, perform work duties, and becomes deeply disabled. To prevent this, it is recommended to apply for timely medical care.

Diagnostics

If symptoms of organic damage to the central nervous system appear, the specialist will definitely recommend modern methods of laboratory and instrumental diagnostics:

• blood tests - general, biochemical, for antibodies to infections;
• tomography - research brain structures through multiple x-rays;
• brain tissue, as well as blood vessels;
• electroencephalography – identifying the focus of pathological brain activity;
• neurosonography – helps analyze the conductivity of brain cells, detects small hemorrhages in the tissue;
• analysis of cerebrospinal fluid - its excess/deficiency, inflammatory processes.

According to individual needs, the patient will need to undergo consultations with an ophthalmologist, endocrinologist, traumatologist, and infectious disease specialist.

Only after examining the organic damage to the central nervous system from all sides does the doctor have the opportunity to draw up a full-fledged drug therapy regimen. Success in the fight against a negative condition is the timely and complete identification of the provoking causes, as well as fulfillment of all assigned therapeutic measures.

Treatment tactics

Eliminating organic damage to the central nervous system is not an easy task, which requires maximum effort from both doctors and the patient himself. Treatment will require an investment of time and effort, as well as finances, since the main emphasis is on rehabilitation - sanatorium courses, specialized training, acupuncture, reflexology.

Only after the root cause has been established brain damage, it needs to be eliminated - to restore blood circulation, improve nerve conduction of impulses between cells, remove a tumor or blood clot.

Subgroups of medications:

• means for improving local and general blood circulation - nootropics, for example, Piracetam, Phenotropil;
• medications for correcting mental processes, suppressing perverted desires - Phenozepam, Sonopax;
• sedatives – plant/synthetic based.

Additional procedures:

• massage – correction of muscle activity;
• acupuncture - effects on nerve centers;
• physiotherapeutic treatment – ​​magnetic therapy, electrophoresis, phonophoresis;
• swimming;
• psychotherapeutic influence - classes with a psychologist to establish connections between the patient and surrounding people, society;
• speech correction;
• specialized training.

The ultimate goal of treatment is to maximally improve the condition of a person with organic lesions of the central nervous system, improve his quality of life and adapt to the disease. Of course, the main burden of caring for such a patient falls on the shoulders of his relatives. Therefore, doctors also work with them - they teach them the skills of administering medications, the basics of gymnastics, and psychological behavior.

With due diligence and patience positive result and the benefits will be obvious - manifestations of residual encephalopathy will be minimal, life will be active, and self-care will be the maximum possible for the level of damage. ROP is not a sentence at all, but an ordeal that can and must be overcome.

The central nervous system (CNS) is the main part of the human nervous system, which consists of a collection of nerve cells. In humans, it is represented by the spinal cord and brain. The departments of the central nervous system regulate the activities of individual organs and systems of the body, and generally ensure the unity of its activities. With lesions of the central nervous system, this function is disrupted.

Damage to the central nervous system can occur in a child both during fetal development (perinatal) and during childbirth (intrapartum). If harmful factors affected the child at the embryonic stage of intrauterine development, then severe defects incompatible with life may occur. After eight weeks of pregnancy, damaging influences will no longer cause gross disturbances, but sometimes slight deviations appear in the formation of the child. After 28 weeks of intrauterine development of a child, damaging influences will not lead to developmental defects, but a normally formed child may develop some kind of disease.

Perinatal damage to the central nervous system (PP CNS)

This pathology is most often registered in children of the first year of life. This diagnosis implies a dysfunction or structure of the brain of various origins. CNS PP occurs during the perinatal period. This includes antenatal (from the 28th week of intrauterine development until the onset of labor), intranatal (the act of childbirth itself) and early neonatal (the first week of the child’s life) periods.

Symptoms of CNS PP include increased neuro-reflex excitability; decreased muscle tone and reflexes, short-term cramps and anxiety; muscle hypotonia, hyporeflexia; respiratory, cardiac, renal disorders; paresis and paralysis, etc.

The occurrence of perinatal CNS damage is influenced by following reasons: somatic diseases of the mother, malnutrition and immaturity of the pregnant woman, acute infectious diseases during pregnancy, hereditary diseases, metabolic disorders, pathological pregnancy, as well as unfavorable environmental conditions.

According to their origin, all perinatal lesions of the central nervous system can be divided into:

1. Hypoxic-ischemic damage to the central nervous system. Hypoxic-ischemic damage to the central nervous system occurs due to a lack of oxygen supply to the fetus or its utilization during pregnancy or childbirth;
2. Traumatic damage to the central nervous system. Traumatic damage to the central nervous system is caused by traumatic damage to the fetal head at the time of birth;
3. Hypoxic-traumatic damage to the central nervous system. Hypoxic-traumatic damage to the central nervous system is characterized by a combination of hypoxia and damage cervical region the spine and the spinal cord located in it;
4. Hypoxic-hemorrhagic damage to the central nervous system. Hypoxic-hemorrhagic damage to the central nervous system occurs during birth trauma and is accompanied by cerebral circulation disorders, including hemorrhages.

In recent years diagnostic capabilities children's medical institutions have improved significantly. After one month of a child’s life, a neurologist can determine exact character and the degree of damage to the central nervous system, as well as predict the further course of the disease, or completely remove suspicion of brain disease. The diagnosis can be characterized either by complete recovery or the development of minimal CNS disorders, or by severe diseases that require compulsory treatment and regular monitoring by a neurologist.

Treatment of the acute period perinatal lesions CNS is performed in the hospital. Drug therapy, massage, physiotherapy and physiotherapeutic procedures, acupuncture, as well as elements of pedagogical correction are used as the main treatment of the disease.

Organic damage to the central nervous system

This diagnosis means that a person's brain is defective to a certain extent. Pathomorphological changes occur in the brain substance. A mild degree of organic damage to the central nervous system is inherent in almost all people and does not require medical interventions. But the moderate and severe degree of this disease is already a disruption of the nervous system. Symptoms include freezing spells, sleep disturbances, increased excitability, easy distractibility, repetition of phrases, and daytime enuresis. Vision and hearing may deteriorate, and coordination of movements may be impaired. Human immunity decreases, and various colds occur.

The causes of organic damage to the central nervous system are divided into congenital and acquired. The first include cases when during pregnancy the mother of the child suffered an infection (acute respiratory infection, flu, sore throat), took certain medications, smoked and drank alcohol. During periods of psychological stress in the mother, the unified blood supply system can transfer stress hormones to the fetus’s body. The impact is caused by sudden changes in temperature and pressure, exposure to radioactive and toxic substances contained in the air, dissolved in water, food, etc.

Diagnosing organic damage to the central nervous system is quite simple. An experienced psychiatrist can determine the presence or absence of organic matter by looking at a child’s face. However, the types of disorders in the functioning of the brain are determined by laboratory diagnostics, which is based on a series of procedures that are harmless to the body and informative for the doctor: ultrasound diagnostics brain, electroencephalogram, rheoencephalogram.

Treatment of organic matter is a very long process. It is mainly medicinal. To treat organic damage to the central nervous system, medications are used. For example, nootropic drugs can improve brain activity. Vascular drugs are used.

Children are often diagnosed with “residual damage to the LES.” Residual organic damage to the central nervous system occurs in children mainly as residual effects of birth injuries and brain disorders. Manifests itself as a disorder of associative thinking, and in more severe cases neurological disorders. Treatment is prescribed by a doctor. Various elements of pedagogical correction and concentration exercises are used, and sessions with a psychologist and speech therapist are useful.

The consequences of damage to the central nervous system depend primarily on the degree of the disease. It is possible that a complete recovery may occur, as well as a delay in the child’s mental, motor or speech development, various neurological reactions, etc. It is important that during the first year of life the child receives full rehabilitation.

Help children with diseases affecting the central nervous system

At the moment, there are no children with this diagnosis in the care of our foundation. However, you can help sick children with other diagnoses!

The central nervous system is the main regulator of the functioning of the entire body. After all, in the cortical structures of the brain there are departments responsible for the functioning of each system. Thanks to the central nervous system it is provided normal operation everyone internal organs, regulation of hormone release, psycho-emotional balance. Under the influence of unfavorable factors, organic damage to the structure of the brain occurs. Pathologies often develop in the first year of a child’s life, but can also be diagnosed in adults. Despite the fact that the central nervous system is directly connected to the organs thanks to nerve processes (axons), damage to the cortex is dangerous due to the development severe consequences even in the normal state of all functional systems. Treatment of brain diseases should begin as early as possible; in most cases, it is carried out for a long time - over several months or years.

Description of residual organic damage to the central nervous system

As is known, the central nervous system is a coherent system in which each of the links performs important function. As a result, damage to even a small area of ​​the brain can lead to disruption in the functioning of the body. In recent years, damage nerve tissue increasingly observed in patients childhood. To a greater extent, this applies only to born babies. IN similar situations A diagnosis of “residual organic damage to the central nervous system in children” is made. What is it and is this disease treatable? The answers to these questions worry every parent. It's worth keeping in mind that similar diagnosis is a collective concept that can include many various pathologies. The selection of therapeutic measures and their effectiveness depend on the extent of the damage and the general condition of the patient. Sometimes residual organic damage to the central nervous system occurs in adults. Often the pathology occurs as a result of previous injuries, inflammatory diseases, intoxication. The concept of “residual organic damage to the central nervous system” implies any residual effects after damage nerve structures. The prognosis, as well as the consequences of such a pathology, depend on how severely the brain function is impaired. In addition, great importance is attached to topical diagnosis and identification of the site of damage. After all, each of the brain structures must perform certain functions.

Causes of residual organic brain damage in children

Residual organic damage to the central nervous system in children is diagnosed quite often. The causes of nervous disorders can occur both after the birth of a child and during pregnancy. In some cases, damage to the central nervous system occurs due to complications of childbirth. The main mechanisms for the development of residual organic damage are trauma and hypoxia. There are many factors that provoke nervous system disorders in a child. Among them:

1. Genetic predisposition. If parents have any psycho-emotional disorders, then the risk of their development in the baby increases. Examples include pathologies such as schizophrenia, neuroses, and epilepsy.
2. Chromosomal abnormalities. The cause of their occurrence is unknown. Incorrect DNA structure is associated with unfavorable factors external environment, stress. Due to chromosomal abnormalities, pathologies such as Shershevsky-Turner syndrome, Patau syndrome, etc. occur.
3. The impact of physical and chemical factors on the fetus. This refers to unfavorable environmental conditions, ionizing radiation, and the use of drugs and medications.
4. Infectious and inflammatory diseases during the formation of the nervous tissue of the embryo.
5. Toxicoses of pregnancy. Late gestosis (pre- and eclampsia) is especially dangerous for the condition of the fetus.
6. Impaired placental circulation, Iron-deficiency anemia. These conditions lead to fetal ischemia.
7. Complicated childbirth (weakness of uterine contractions, narrow pelvis, placental abruption).

Residual organic damage to the central nervous system in children can develop not only during the perinatal period, but also after it. The most common cause is head trauma at an early age. Risk factors also include taking drugs that have a teratogenic effect, and narcotic substances during breastfeeding.

The occurrence of residual organic brain damage in adults

In adulthood, signs of residual organic damage are observed less frequently, however, they are present in some patients. Often the cause of such episodes is trauma received in early childhood. At the same time, neuropsychic abnormalities are long-term consequences. Residual organic brain damage occurs for the following reasons:

1. Post-traumatic illness. Regardless of when the damage to the central nervous system occurs, residual symptoms remain. These often include headaches, seizures, and mental disorders.
2. Condition after surgery. This is especially true for brain tumors, which are removed using nearby nerve tissue.
3. Taking drugs. Depending on the type of substance, the symptoms of residual organic damage may differ. Most often, serious violations are observed when long-term use opiates, cannabinoids, synthetic drugs.
4. Chronic alcoholism.

In some cases, residual organic damage to the central nervous system is observed after inflammatory diseases. These include meningitis, different kinds encephalitis (bacterial, tick-borne, post-vaccination).

Mechanism of development of central nervous system lesions

Residual damage to the central nervous system is always caused by unfavorable factors that preceded it. In most cases, the basis of pathogenesis similar symptoms is cerebral ischemia. In children, it develops even during the period. Due to insufficient blood supply to the placenta, the fetus receives little oxygen. As a result, the full development of nervous tissue is disrupted, and fetopathy occurs. Significant ischemia leads to intrauterine growth retardation and the birth of a child before the gestational age. Symptoms of cerebral hypoxia can appear already in the first days and months of life. Residual organic damage to the central nervous system in adults often develops as a result of traumatic and infectious causes. Sometimes the pathogenesis of nervous disorders is associated with metabolic (hormonal) disorders.

Syndromes with residual organic damage to the central nervous system

In neurology and psychiatry, several main syndromes are distinguished, which can occur either independently (against the background of a brain disease) or be regarded as a residual lesion of the central nervous system. In some cases, a combination of these is observed. The following signs of residual organic damage are distinguished:

What could be the consequences of residual organic damage?

The consequences of residual organic damage to the central nervous system depend on the degree of the disease and the approach to treatment. For mild disorders, it is possible to achieve full recovery. Severe damage to the central nervous system is dangerous due to the development of conditions such as cerebral edema, spasm of the respiratory muscles, and damage to the cardiovascular center. To avoid such complications, constant monitoring of the patient is necessary.

Disability due to residual organic damage

Treatment must begin as soon as the appropriate diagnosis is established - “residual organic damage to the central nervous system.” Disability for this disease is not always assigned. In case of pronounced disorders and lack of treatment effectiveness, a more accurate diagnosis is established. Most often this is “post-traumatic brain disease”, “epilepsy”, etc. Depending on the severity of the condition, disability group 2 or 3 is assigned.

Prevention of residual organic damage to the central nervous system

To avoid residual organic damage to the central nervous system, it is necessary to be observed by a doctor during pregnancy. If there are any deviations, you should seek medical help. You should also refrain from taking medications and bad habits.

This diagnosis is currently one of the most common. Organic damage to the central nervous system (CNS) in its classical content is a neurological diagnosis, i.e. is under the purview of a neurologist. But the symptoms and syndromes accompanying this diagnosis can relate to any other medical specialty.

Means this diagnosis that the human brain is to a certain extent defective. But, if a mild degree (5-20%) of “organics” (organic damage to the central nervous system) is inherent in almost all people (98-99%) and does not require any special medical interventions, then the average degree (20-50%) of organics is not just a quantitatively different condition, but a qualitatively different (fundamentally more severe) type of disorder of the nervous system.

The causes of organic lesions are divided into congenital and acquired. Congenital cases include cases when during pregnancy the mother of the unborn child suffered some kind of infection (acute respiratory infection, flu, sore throat, etc.), took certain medications, alcohol, or smoked. A unified blood supply system will bring stress hormones into the fetus’s body during periods of psychological stress of the mother. In addition, sudden changes in temperature and pressure, exposure to radioactive substances and x-rays, toxic substances dissolved in water, contained in the air, in food, etc., also affect.

There are several particularly critical periods when even a slight external impact on the mother’s body can lead to the death of the fetus or cause such significant changes in the structure of the body (and, including the brain) of the future person that, firstly, no medical intervention is possible correct, and secondly, these changes can lead to the early death of a child before the age of 5 - 15 (and usually mothers report this) or cause disability from the very beginning. early age. And in the very best case scenario lead to severe brain inferiority, when even at maximum stress the brain is able to work at only 20-40 percent of its potential power. Almost always, these disorders are accompanied by varying degrees of severity of disharmony of mental activity, when, with reduced mental potential, positive qualities of character are not always sharpened.

This can also be facilitated by taking certain medications, physical and emotional stress, asphyxia during childbirth (oxygen starvation of the fetus), protracted labor, early placental abruption, uterine atony, etc. After childbirth severe infections(with pronounced symptoms of intoxication, high temperature etc.) up to 3 years can give rise to acquired organic changes in the brain. Brain injuries with or without loss of consciousness, long or short general anesthesia, drug use, alcohol abuse, long-term (several months) independent (without prescription and constant supervision of an experienced psychiatrist or psychotherapist) use of certain psychotropic drugs can lead to some reversible or irreversible changes in brain function.

Diagnosis of organic matter is quite simple. A professional psychiatrist can already determine the presence or absence of organic matter by the child’s face. And, in some cases, even the degree of its severity. Another question is that there are hundreds of types of disorders in the functioning of the brain, and in each specific case they are completely different. special combination and connections with each other.

Laboratory diagnostics are based on a series of procedures that are quite harmless to the body and informative for the doctor: EEG - electroencephalogram, REG - rheoencephalogram (examination of cerebral vessels), ultrasound doppler (M-echoEG) - ultrasound diagnostics of the brain. These three examinations are similar in form to an electrocardiogram, only they are taken from a person’s head. CT scan with its very impressive and expressive name, it is actually capable of identifying a very small number of types of brain pathology - a tumor, a space-occupying process, an aneurysm (pathological dilation of a brain vessel), dilatation of the main cisterns of the brain (with increased intracranial pressure). The most informative study is the EEG.

Let us note that practically no disorders of the central nervous system disappear on their own, and with age they not only do not decrease, but intensify both quantitatively and qualitatively. The mental development of a child directly depends on the state of the brain. If the brain has at least some damage, then this will certainly reduce the intensity mental development child in the future (difficulty in the processes of thinking, memorization and recall, impoverishment of imagination and fantasy). In addition, a person’s character is formed distorted, with varying degrees of severity of a certain type of psychopathization. The presence of even small but numerous changes in the child’s psychology and psyche leads to a significant decrease in the organization of his external and internal phenomena and actions. There is an impoverishment of emotions and some flattening of them, which directly and indirectly affects the child’s facial expressions and gestures.

The central nervous system regulates the functioning of all internal organs. And if it does not work fully, then the other organs, even with the most careful care for each of them separately, will not be able, in principle, to work normally if they are poorly regulated by the brain. One of the most common diseases of our time - vegetative-vascular dystonia against the background of organic matter becomes more severe, peculiar and atypical course. And thus, not only does it cause more trouble, but these “troubles” themselves are more malignant in nature. The physical development of the body comes with any disturbances - there may be a violation of the figure, a decrease in muscle tone, a decrease in their resistance to physical activity of even moderate magnitude. The likelihood of increased intracranial pressure increases by 2-6 times. This can lead to frequent headaches and various kinds unpleasant sensations in the head area, reducing mental and physical labor 2-4 times. There is also an increased likelihood of endocrine disorders increases 3-4 times, which leads to diabetes mellitus with minor additional stress factors, bronchial asthma, imbalances of sex hormones with subsequent disruption of the sexual development of the body as a whole (an increase in the amount of male sex hormones in girls and female hormones- in boys), the risk of developing a brain tumor increases, convulsive syndrome(local or general convulsions with loss of consciousness), epilepsy (group 2 disability), cerebrovascular accidents in adulthood in the presence of hypertension, even medium degree severity (stroke), diencephalic syndrome (attacks causeless fear, various expressed discomfort in any part of the body, lasting from a few minutes to several hours). Over time, hearing and vision may decrease, coordination of movements of a sports, household, aesthetic and technical nature may be impaired, complicating social and professional adaptation.

Organic treatment is a long process. It is necessary to take vascular medications twice a year for 1-2 months. Related neuropsychiatric disorders also require their own separate and special correction, which must be carried out by a psychiatrist. To monitor the degree of effectiveness of organic treatment and the nature and magnitude of changes in the state of the brain, monitoring by the doctor himself at the appointment and EEG, REG, and ultrasound are used.

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