Diseases

An apoplectic attack (stroke) is an acute cerebrovascular accident with a defect of cerebral function of a various degree. Stroke is the second (in terms of frequency) deadly disease after myocardial infarction. Consequences of stroke are catastrophic:

80% of patients die or become handicapped

In 50% of survivors - a second stroke occurs in the next 5 years of life

only about 10% of patients recover fully

After 55 years of age, the risk of stroke doubles every 10 years.

A stroke occurs during vessel constriction, embolism or rupture of blood vessels supplying the brain.

Most strokes are ischemic (cerebral infarction), i.e. the artery that carries blood to the brain is blocked by blood clots, its lumen is narrowed by an atherosclerotic plaque or it is constricted in some form (tumor, cyst, etc.). Brain cells therefore are deprived of oxygen, and if the adjacent arteries could not supply blood to this area, then within some minutes these neurons die.

The cause of a hemorrhagic stroke is effusion of blood. This occurs rarely but it is much more dangerous to life than ischemic stroke. In this case, a wall of a defective artery gets ruptured. This could be caused by an aneurysm or a damage to the vessel wall integrity because of atherosclerosis; an initiating factor could be associated with a rise of a blood pressure. As a result, blood overflows into the brain tissue. The cells die due to oxygen deficit because the spilled blood constricts surrounding tissues interfering with their normal functions. Half of the patients with hemorrhage in the brain die precisely because of this constriction.

Morbidity and mortality from stroke in Russia are the highest in the world. Every year in Russia there are about 400 thousand strokes. Ischemic strokes are the more common among them (approximately 80% of all stroke cases). There are fewer hemorrhagic strokes (15%) and subarachnoid hemorrhage strokes (5%). Mortality of stroke is high. 20-40% of patients die within the first month of the disease, and among the survivors, more than half of patients have a lasting disability.

Age is the main risk factor for stroke. Every year, stroke develops only in 1 out of 90 thousand people below the age of 75, while in an old age (75-84 years) it occurs in 1 of 4-5 people. At 45 years of age, the risk of stroke is relatively low for the next 20 years (it occurs in one of 30 people) but its probability at the age of 80 increases significantly (it occurs in one of four men and in one of five women).

In general, the risk of stroke in men is 30% higher than in women. However, this is characteristic only for the age groups from 45 to 64 years. At the age exceeding 65 the risk of stroke in men and women does not differ.

The main risk factors of stroke include arterial hypertension, heart disease, previous stroke, smoking, alcohol abuse, high blood cholesterol, and excessive salt intake. Risk factors also include atherosclerosis, psychicological trauma, negative emotions, poor diet, overwork, and lack of sleep. Many factors are influenced by each other; therefore their combination results in a significantly increased risk of disease rather than in a simple arithmetic addition of their independent action. In other words risk factors may work in synergy.

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Encephalopathies (discirculatory, hypertension-associated, posttraumatic, toxic, etc.) Encephalopathy literally means adisease of the brain. The phenomenon of encephalopathy often occurs as a complication of diseases, which are accompanied by impairment of blood supply to the brain, anoxia, and other degenerative processes in nerve cells caused by the action of toxins and other disorders. As a result, the brain cells - neurons get affected. The main causes of encephalopathy are: vascular diseases, brain injuries, atherosclerosis, hypertension, acute and chronic alcohol consumption, drugs and poison intoxications, neural infections and others.

Whatever the cause is, the clinical picture is almost the same in different patients. Typically, patients complain of headaches, fatigue, dizziness, head noises, muscae volitantes, and episodes of fainting. At the same time it is possible to observe reduction in performance efficiency, increase in fatigue, sleep disturbance, decrease in memory and intellect, and the ability to concentrate. It is also often possible to observe decrease in visual capacity, hearing, and motion coordination impairment. Patients may be in the state of annoyance, moody, complacent, or fussy.

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There are two groups of craniocerebral traumas - open and closed.

Open injuries

In open injuries:

• the integrity of cranial bones and skin is violated
• because of the impact, a dramatic drift of brain tissue and cerebrospinal fluid occurs. This results in a chain of reflex vascular responses and cerebrospinal fluid circulation disorders. A spasm and paresis of cerebral vessels, anoxia and edema develops.

Closed injuries

In closed injuries a trauma occurs in the form of concussion, contusion, or compression of the brain.

• Concussion of the brain is type of a trauma when no persistent disorders of cerebration are observed. All symptoms that occur after concussion usually disappear with time (several days). Persistent preservation of symptoms is a sign of more serious brain damage.
• Brain compression
Brain contusion

Symptoms

• Symptoms of impairment of consciousness
• Symptoms of cranial nerve affection
• Symptoms of brain focal lesions
• Stem symptoms
• Meningeal symptoms

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Encephalitis is an inflammation of the brain tissue. Two types of encephalitis are recognized - the primary encephalitis, when the disease causative agent initially penetrates into the brain and affects it, and secondary encephalitis, when it is a complication of another disease.

The causes for encephalitis are mainly biological factors: viruses, bacteria -rickettsia, etc.-, fungi, and parasites. Physical, chemical and mechanical effects are also important.

Tick-borne encephalitis caused by arboviruses, and herpes encephalitis caused by herpes simplex virus are more common among primary encephalitises. People get ill with tick-borne encephalitis when they are bitten by ticks and small rodents with the virus, and when drinking raw milk from infected goats and cows. Foci of tick-borne encephalitis in Russia are located in the Far East, the Urals and Siberia. Generally older children get infected. Breakouts occur in May and June during the season of reproduction in ixodic ticks, which transmit the virus to people.

The disease begins abruptly; the period of malaise manifested by fever, nausea, loose stool; symptoms of upper respiratory tract infection may be the precursor of its development. Pains in the eyes and forehead, photophobia, possible epileptic seizures are characteristic for encephalitis. Consciousness is impaired; a patient is lethargic and sleepy, gives monosyllabic responses to questions. In severe cases he/she slips into coma.

After a while, paralysis and paresis of limbs, and stiff neck develop. In the blood it is possible to observe a moderate increase in leukocyte count, increased ESR. In the cerebrospinal fluid the lymphocyte count is increased to several hundred cells, protein - up to 2%; concentration of sugar is also increased. Herpetic encephalitis is very severe; it occurs mainly in children. The disease occurs with loss of consciousness and convulsions. There may be a herpetic eruption on different parts of the body. Often the death can occur during the first day of the disease. . Multiple necrotic changes are observed in the brain during autopsy.

Measles encephalitis occurs on days 3-5 of the disease. Temperature rise, possible convulsions, sudden paresis of limbs, impaired consciousness and even coma are reported. After the disease, some patients may have irreversible damage in the form of seizures, hemiparesis, and mental disorders.

Varicella and rubella encephalitis are reported mostly in young children. The first manifestations of the disease occur on day 2-8 after infection: disturbance of consciousness, paralysis of limbs, and loss of coordination. Post-vaccination encephalitis is accompanied by a rise in temperature to 39-40 ° C, loss of coordination, paralysis of limbs. A survey has revealed a connection of the disease with the recent vaccination.

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Autonomic neuropathy (synonyms: neuro-circulatory dystonia, cardiac neurosis, neurasthenia, psychovegetative syndrome, vegetative neurosis, cardioneurosis) is a disease characterized by the dysfunction of the vegetative (autonomic) nervous system (VNS), and functional (i.e., not organic) dysfunctions of almost all body systems (mostly cardiovascular). Autonomic neuropathy is an old term and is not recommended for use. This name is not used in the modern classifications of diseases.

Clinical aspects

The main clinical feature in patients with the autonomic neuropathy is associated with the presence of multiple complaints, a variety of different symptoms and syndromes, due to the peculiarities of the pathogenesis involved in the hypothalamic structures. G.M. Pokalev describes about 150 symptoms and 32 syndromes of clinical disorders in patients with neurocirculatory dystonia (NCD). The most frequent symptoms of NCD: false angina, asthenia, neurotic disorders, headaches, sleep disturbances, dizziness, respiratory disorders, palpitations, cold hands and feet, autonomic-vascular paroxysms, arm shake, inner trembling, cardiophobia, myalgia, arthralgia, edema of tissues, palpitations, hot flashes in the face, low-grade fever, and faintness. The most stable symptoms: 1) false angina, 2) palpitations, 3) vascular dystonia, 4) autonomic dysfunctions, 5) respiratory disorders, and 6) systemic-neurotic disorders.

Basic clinical syndromes

Autonomic dysfunction syndrome - red dermographism, local sweating, zones of hyperalgesia in the atrial region, "spotty" hyperemia of the top half of thorax, acrocyanosis and hyperhidrosis of hands, tremor of hands, noninfectious low-grade fever, tendency to vegetovascular crises and temperature asymmetries.

Syndrome of mental disorders is associated with emotional lability, tearfulness, sleep disturbances, anxiety, cardiophobia. In patients with autonomic neuropathy it is possible to observe a higher level of anxiety; they tend to have self-accusation, and experience fear in decision-making. Personal values prevail over reality: hypochondria, and the decrease of activity in the period of disease. When making a diagnosis it is important to differentiate autonomic neuropathy from a panic disorder.

Symptoms of adaptation syndrome, asthenic syndrome are the following: fatigue, weakness, intolerance to physical and mental stress, and meteosensitivity. There is evidence that at the heart of asthenic syndrome there are transcapillary exchange disorders, reduction of the oxygen consumption by tissues and disorder of hemoglobin dissociation.

Hyperventilation (respiratory) syndrome is a subjective sensation of shortness of breath in the chest, need for deep breathing. In a number of patients it occurs in the form of a crisis, the clinical picture of which is similar to suffocation. The most common causes that provoke development of the respiratory syndrome are physical activity, mental stress, stay in a stuffy room, an abrupt change of heat to cold, and motion sickness. Along with the mental factors of breathlessness, a reduction in the compensatory adaption of respiratory function to a hypoxic stress is very important.

Syndrome of cardio-vascular disorders is associated with cardiodynia, fluctuations of blood pressure, pulse changes, tachycardia, functional murmurs, ECG changes, and arrhythmias.

Syndrome of cerebrovascular disorders: headaches, dizziness, buzzing in ears, head noises, tendency to faint. At the heart of their development there are cerebral angiodystonia, where the pathogenetic basis is the dysregulation of the brain vascular tone of a hypertensive, hypotonic or of a mixed nature. Some patients with a persistent cephalgic syndrome demonstrate dystonia not only of arterial, but also in venous vessels that is the so-called functional venous hypertension.

Syndrome of metabolic-histic and peripheral vascular disorders - tissue edema, myalgia, angiotrophoneurosis, Raynau`s syndrome. Disorders of transcapillary exchange and microcirculation cause the development of these symptoms .

Cardiac syndrome

Autonomic neuropathy of a cardiac type is the most common form. It may lead to a wrong diagnosis of an organic heart disease that in turn has serious consequences: separation from physical education and sports, unjustified exemption from military service, warning about pregnancy and childbirth, unnecessary tonsillectomy, unnecessary administration of thyreostatic, anti-inflammatory antianginal and other agents. The main cardiac syndromes are cardiological, tachycardial, brachycardial, arrhythmic, hyperkinesic.

Cardialgic syndrome

It occurs in almost 90% of patients. Cardialgias are associated with increased susceptibility of CNS to interoceptive stimuli; physicians consider them as sympathalgias. Once arisen, cardialgias remain through self-suggestion or a conditioned reflex. Pains can be of different nature: constant aching, or pinching in the apex of the heart, intense permanent burning sensation in the heart, permanent attacks of cardialgia, a paroxysmal short pain or pain arising in connection with a physical activity, but not preventing the continuation of the activity. Exercise tolerance tests and drug tests assist undoubtedly at the time of diagnosis. When changing the terminal QRS complex on the ECG, the exercise tolerance test in the functional cardialgia results in a short-term reversal of the T wave, and in patients with CHD it worsens. Drug tests in the first case also result in a short-term reversal and in the second case they do not. Help is provided by the invasive methods, as well as the dynamics of lactate during atrial pacing.

Tachycardia syndrome

It is characterized by an increase in automaticity in sinoatrial node (SA-node) with a rise in the heartbeat to 90 or more per minute. Very often the syndrome is based on the rise of the sympathetic tone, rarely on the decrease of the vagal tone. Sinus tachycardia significantly restricts physical performance of patients, confirmed by the graduated exercise test. The heart rate reaches submaximal values for this age group already during light exercises - 50-75 W. In sinus tachycardia, the heart rate at rest rarely exceeds 140-150 beats per minute. Brachycardia syndrome involves heartbeat slowing to 60 beats per minute or less due to the reduction of the automatic function of the SA-node, which results from the increase in the vagal tone. The criterion of sinus bradycardia should be associated with a heart rate fall to 45-50 beats per minute or less. A bradycardia variant occurs much less frequently. In a more pronounced bradycardia there may be complaints about headaches and precardiac pains, dizziness during a rapid trunk extension or transition to orthostasis, propensity to presyncope and syncopal states. It is possible to define other vagoinsular signs: low cold tolerance, hidrosis, cold hands and feet, hyperhidrosis, cyanosis of the hands with a skin pattern similar to marble, and spontaneous dermographism. The ECG may show "giant" ("vagal") T waves in precordial leads, especially in V2-V4.

Arrhythmia syndrome

The patients with autonomic neuropathy secondary to the arrhythmia syndrome have extrasystole more frequently; rarely do they have supraventricular forms of paroxysmal tachycardia, and very seldomly they have paroxysmal atrial fibrillation or atrial flutter. Rhythm disturbance in functional disorders of the heart usually can be differentiated with light myocarditis (non-rheumatic and rheumatic), or symptoms such as myocardial dystrophy, reflex actions on the heart (osteochondrosis, pathology of the gall bladder), and hyperfunction of the thyroid gland.

Hyperkinetic cardiac syndrome

The hyperkinetic cardiac syndrome is an independent clinical type of autonomic neuropathy. Like other cardiac syndromes, it refers to centrogenous autonomic disorders. The final link in its pathogenesis is associated with the increased activity of the beta-1-adreno receptor in myocardium secondary to and because of the sympathoadrenal prevalence. As a result, a hyperkinetic type of circulation with the characteristic hemodynamic triad is formed: 1) increase in the stroke and cardiac output far exceeding the metabolic needs of tissues, 2) increase in the velocity of blood ejection out of the heart, and 3) a compensatory decrease in the total peripheral vascular resistance. This is the only form of functional heart disease, which is more common in boys, especially of military age.

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Asthenia (Greek. Ασθένεια - impotence, weakness) is known as an asthenic condition, an asthenic syndrome, asthenic reaction, neuro-psychological weakness. It is a painful condition characterized by aa propensity for fatigue and weakness with extreme mood instability, weakening of self-control, impatience, restlessness, sleep disturbance, loss of ability for long mental and physical activities, intolerance to loud noises, bright lights, and strong odors.

Asthenia occurs as a result of debilitating diseases of internal organs, infection, intoxication, emotional, mental and athletic overexertion in improperly organized labor, leisure, nutrition, and in nervous and mental diseases. Asthenia, developing due to a nervous overexertion, worries, difficult and often long experiences and conflicts, is called neurasthenia.

Asthenia may occur in the initial period of internal diseases (eg, coronary heart disease), may accompany diseases as one of its manifestations (eg, peptic ulcer, tuberculosis and other chronic diseases), or arise as an after-effect of an acute illness (pneumonia, influenza).

Symptoms of asthenia depend on the underlying disease causing it. In atherosclerosis, it is possible to observe disturbances of memory and tearfulness, various headaches and discomfort in the region of the heart in hypertension. Symptoms of asthenia are typical for the primary period of schizophrenia. Clarification of the asthenia features often helps to recognize an underlying disease.

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Epilepsy (Greek επιληψία epilēpsía, from epilambánō - seize, attack) is one of the most common neurological diseases. According to modern theories epilepsy is a heterogeneous group of diseases, which clinically is characterized by repeated convulsive seizures. The basis of the pathogenesis of this disease is associated with paroxysmal discharges in the neurons of the brain. Epilepsy is characterized mainly by typical repeated seizures of various types. There are also equivalents of epileptic seizures in the form of sudden mood disorders (dysphoria) or specific disorders of consciousness (clouded consciousness, somnambulism, trance), as well as a gradual development of personality changes characteristic for epilepsy and (or) characteristic epileptic dementia. It should be noted that if these mental changes occur (that happens in a minority of cases), it means epilepsy. In some cases, it is also possible to observe epileptic psychoses, which occur abruptly or chronically, and are manifested by such affective disorders as fear, grief, malignancy or high-ecstatic mood, as well as by delusions, and hallucinations. If the occurrence of epileptic seizures has a proven relationship with a somatic pathology, then we talk about anepisyndrome of some underlying disease. In addition, it should be noted that it is often necessary to include the so-called “temporal lobe epilepsy” as part of epilepsy, when the convulsive focus is localized in the temporal lobe. This selection is determined by the characteristics of the clinical presentation typical for the localization of a convulsive focus in the temporal lobe of the brain.

The attack of an epileptic seizure depends on a combination of two factors of the brain: the activity of a convulsive focus (also known as an epileptic focus) and general brain preparedness for convulsions. Sometimes an epileptic seizure is preceded by an aura (a Greek word meaning “breath”, “breeze”). The manifestations of the aura are very diverse and depend on the location in the brain, and which function is impaired (i.e., on the localization of the epileptic focus). Additionally, one or another body state may trigger an epileptic seizure (epileptic seizures associated with the onset of menses, epileptic seizures attacking only hora somni). In addition, an epileptic seizure can be provoked by a number of environmental factors (eg., flickering light).

An epileptic focus is the result of organic or functional lesion of the brain caused by various factors (insufficient blood flow (ischemia), perinatal complications, head injury, systemic or infectious diseases, tumors and anomalies of the brain, metabolic disorders, stroke, or toxic effects of various substances). At the area of the structural damage there is a scar (where there is sometimes a cavity filled with fluid (cyst)). In this place, an acute swelling and irritation of the nerve cells of the motor zone can periodically occur that results in the tic of skeletal muscles, which in the case of generalized excitation in the cerebral cortex resulting in loss of consciousness.

Paroxysmal readiness is the probability of a rise in a pathological (epileptiform) excitation in the cerebral cortex above the threshold, which regulates the anticonvulsant system of the brain. The threshold can be high or low. When the threshold is high (high convulsive readiness) even a small amount of activity in the focus can result in an expanded convulsive seizure. Paroxysmal readiness of the brain may be so great that it results in a short loss of consciousness even in the absence of the focus of the seizure pattern. When the threshold is low (low convulsive readiness) , even with a very strong focus of epileptic activity, there are partial seizures not accompanied by loss of consciousness. The possible causes of a low threshold are the fetal cerebral hypoxia, birth hypoxia or a genetic predisposition (the risk of epilepsy in the offspring of patients with epilepsy is 3-4%, which is 2-4 times higher than in the general population).

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