Cerebral insufficiency (CN) is currently considered as a set of syndromes resulting from acute central nervous system dysfunction, usually caused by cerebral ischemia or swelling. This concept has its own semantics, both clinical and pathophysiological, which is used to describe disorders and disorders at different periods of a stroke.
Features
The brain is reliably protected by the cranium against adverse environmental conditions. Being an organ of regulation of all physiological processes occurring in the body, it uses colossal volumes of nutrients. Brain mass is only 1-3% of the total human body weight (approximately 1,800 g). But for its good work, 15% of the total blood volume (about 800 ml) must constantly flow through the vessels feeding the organ. It metabolizes up to 100 g of glucose per day.
That is, the normal functioning of the brain will occur only in case of adequate blood supply, with a large amount of nutrients, oxygen and a complete absence of toxic substances for humans. Plus, there must be a constant and adequate outflow of venous fluid.
Etiology (reasons)
A powerful system of self-regulation of cerebral blood flow provides excellent adaptation to labile environmental conditions.
With hypoxia, which is caused, for example, by acute bleeding, the influx of CNS biological fluid remains normal. In these situations, a powerful compensatory reaction is triggered by forced centralization of this system, which is aimed, first of all, at increasing the blood supply to the Vilisian (cerebral) circle and, as a result, maintaining normal circulation as a whole.
With hypoglycemia, the body expands the vessels that feed the brain. Because of this, the flow of glucose to the organ increases. But metabolic acidosis leads to an increase in blood outflow in order to quickly remove metabolic products from it.
With a significant brain damage or insufficiency of regulatory mechanisms, hypercompensatory reactions occur. Because of what, there is a violation of the regulation of blood flow in the vessels that supply biological fluid to the cranial cavity. Under such conditions, this area is a closed trap for the brain. Thus, even the slightest increase in the contents of the cranial cavity by at least 5% leads to profound impairment of consciousness and regulation of higher nervous activity.
Excessive blood supply to the vessels of the brain leads to hypersecretion of the vascular plexuses of the cerebrospinal fluid. As a result, brain compression is the last, edema develops, which leads to a disturbance in the regulation of vital functions, circulation of biological fluid in the vessels.
Traumatic compression of brain tissue, circulatory disturbances, edema, increased pressure in the cranial cavity, changes in cerebrospinal fluid dynamics (i.e., cerebrospinal fluid circulation) lead to significant disorders of the central nervous system. This is manifested, first of all, by clouding of consciousness.
Cerebral failure
Causes of the disease in children:
- placental abruption, which eventually leads to fetal hypoxia of the fetus;
- severe infectious diseases during pregnancy, of course, affect the normal development of the embryo;
- psycho-emotional overload of the mother;
- adverse environmental situation in the country;
- unbalanced nutrition;
- bad habits;
- infectious diseases in childhood;
- the effect of radiation (ionizing radiation);
- hemolytic disease of the newborn;
- anesthesia, which is mandatory for cesarean section;
- intrapartum trauma;
- head injuries;
- sedentary lifestyle and lack of exercise;
- premature birth.
Pathogenesis
The main pathogenetic factors in the development of this pathology include:
- Intranatal injuries
- intrauterine infections;
- hypoxia during the intrapartum period.
Since the mental organ needs a large amount of oxygen, a slight deficiency can cause massive damage to the nervous tissue. The consequences of intra- and perinatal pathology may be delayed cerebral edema. And also vegetovascular dystonia and cerebral insufficiency. The latter, in fact, is also a delayed manifestation of organic brain damage.
Clinical symptoms of residual cerebral insufficiency in children
With this violation, different conditions can be observed. Astheno-vegetative syndrome is manifested by the following clinical symptoms:
- fast fatiguability;
- lethargy;
- drowsiness;
- weakness;
- headache.
Nerve tics:
- the patient has involuntary movements.
Violation of autonomic regulation:
- excessive sweating due to a malfunction in the normal operation of the sweat glands of the feet and palms;
- dysregulation of blood flow in the terminal parts of the cardiovascular system.
Meteorological dependence (i.e., a strong dependence of a person’s physical condition on weather conditions and time of year):
- possible loss of consciousness;
- tachycardia (accelerating heartbeat);
- change in blood pressure.
Vestibular disorders:
- nausea, which in extreme cases comes to vomiting;
- motion sickness in transport and on a swing.
Lability of the psycho-emotional sphere of a person:
- mild irritability;
- lability of mood (its frequent change);
- moodiness.
Photophobia (intolerance to bright light).
Violations of motor activity. As a rule, it manifests itself in two conflicting syndromes. The first arises as a result of the predominance of inhibition processes in the brain. The second is the result of excessive activation, which leads to inadequate functioning of the structures responsible for maintaining attention (these are structures such as the thalamus).
Also, with residual organic cerebral insufficiency, inhibition is characteristic:
- it is difficult to motivate such children to do some kind of work;
- if they nevertheless agree to the tasks, they do it very slowly;
- they find it difficult to switch between different tasks at the same time.
Or hyperactivity:
- children have great difficulty maintaining attention;
- They are notable for their strong restraint, including ADHD (attention deficit hyperactivity disorder).
Diagnostics
As practice shows, for the final diagnosis there are few positive clinical symptoms, it is recommended to conduct additional laboratory and instrumental examinations.
Among them are such as:
- measurement of intracranial pressure (with this pathology, the indicator will be increased);
- echoencephalography;
- EEG (to determine seizure readiness);
- ophthalmoscopy.
What is characteristic
Most children who receive this diagnosis have abnormalities that are visible to the naked eye:
- irregular shape of the head;
- absence or deformation of the ears and teeth;
- abnormally large distance between the eyes;
- prognathism.
Treatment
The following treatment regimens are the result of many years of world practice in the treatment of this type of pathology.
According to modern protocols, the treatment of cerebral insufficiency should be carried out in two main directions. This is a general strengthening therapy and a local effect on the pathology directly in the brain.
Such treatment for chronic and acute forms of cerebral insufficiency syndrome includes:
- normalization of hemodynamics;
- restoration of normal respiratory activity;
- normalization of metabolic processes;
- local effects on pathology:
- restoration of the normal functioning of the BBB (blood-brain barrier);
- increased hemodynamics in the brain;
- treatment of edema.
By modern standards, the main drug in the treatment of brain edema is the appointment of the following drugs:
- osmodiuretics;
- saluretics;
- glucocorticoids.
As practice shows, taking one of the above groups of drugs in monotherapy does not give a significant clinical effect, so treatment must necessarily be combined.
Also, the use of bioflavonoids at the prehospital stage greatly increases the effectiveness of further therapy, since they affect a significant number of links in the pathobiochemical process of the development of this pathology.
In modern clinical practice, the following drugs are widely used:
- Troxevasin;
- Venoruton;
- Corvitin
- Aescusan
- "L-lysine escinate."
To improve the rheological properties of blood in the cerebral circle, patients are advised to take anticoagulants under the control of the prothrombin index. Especially this group of drugs is effective in cerebral insufficiency, which arose as a result of impaired venous outflow.
Infusion therapy is mandatory when this pathology occurs due to an acute decrease in the volume of circulating blood. In a situation where acute intoxication is the cause of the disease, the appointment of detoxification therapy is considered a necessary measure. As a rule, the following solutions are used for these purposes:
- Trisol
- "Reosorbylact";
- Acesol.
Rehabilitation
Treatment and rehabilitation after acute cerebral insufficiency should be individual, timely and necessarily comprehensive.
Such events will be maximally effective only if the patient feels the support of not only medical personnel, but also his family and psychologists. This will help to restore the former rhythm of life and working capacity in the shortest possible time, regardless of the severity of organic brain lesions.
What is recommended
It is necessary to create social conditions in which the patient will feel as comfortable as possible. The following components must be included in the complex of rehabilitation measures:
- drug therapy;
- Exercise therapy (medical physical culture);
- occupational therapy.
When diagnosing delayed complications of cerebral insufficiency, it is mandatory to create such living conditions in which the patient would not feel limited.
Rehabilitation in children is much easier and more effective due to the high level of regenerative processes in them and significant opportunities for neuroplasticity. Therefore, as a rule, they have no delayed complications.
Conclusion
Cerebral insufficiency is a complex disease and requires constant monitoring by specialists. Only complex treatment can alleviate the patient’s condition and at least partially return him to the usual rhythm of life.