Cerebral insufficiency (CI) is currently considered as a set of syndromes resulting from acute dysfunction of the central nervous system, usually caused by cerebral ischemia or swelling. This concept has its own semantics, both clinical and pathophysiological, which are used to describe disorders and disorders during various periods of stroke.
Features
The brain is reliably protected by the cranium from adverse environmental conditions. Being the organ of regulation of all physiological processes occurring in the body, it uses colossal amounts of nutrients. The mass of the brain is only 1-3% of the total body weight of a person (approximately 1,800 g). But for its good work, 15% of the total blood volume (about 800 ml) must constantly flow through the vessels that feed the organ. It metabolizes up to 100 g of glucose per day.
That is, the normal functioning of the brain will occur only in the case of adequate blood supply, with a large amount of nutrients, oxygen and the complete absence of substances toxic to humans. Plus, there must be a constant and adequate outflow of venous fluid.
Etiology (causes)
Powerful system of self-regulation of cerebral blood flow provides excellent adaptation to labile environmental conditions.
In case of hypoxia, which is caused, for example, by acute bleeding, the flow of biological fluid of the CNS remains normal. In these situations, a powerful compensatory reaction is activated due to the forced centralization of this system, which is aimed primarily at increasing the blood supply to the Willisian (cerebral) circle and, as a result, maintaining normal circulation as a whole.
In hypoglycemia, the body dilates the blood vessels that feed the brain. Because of this, the supply of glucose to the body increases. But metabolic acidosis leads to an increase in blood outflow in order to quickly remove metabolic products from it.
With significant damage to the brain 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, at least by5% leads to profound impairment of consciousness and regulation of higher nervous activity.
Excessive blood filling of the cerebral vessels leads to hypersecretion of the vascular plexuses of CSF. As a result, the brain is squeezed by the latter, edema develops, which leads to a disorder in the regulation of vital functions, the circulation of biological fluid in the vessels.
Traumatic compression of brain tissues, impaired blood supply, edema, increased pressure in the cranial cavity, changes in cerebrospinal fluid dynamics (that is, cerebrospinal fluid circulation) lead to significant disorders of the central nervous system. This is manifested, first of all, by clouding of consciousness.
Children's cerebral insufficiency
Causes of disease in children:
- placental abruption, which eventually leads to intrauterine fetal hypoxia;
- Severe infectious diseases during pregnancy certainly affect the normal development of the embryo;
- psycho-emotional overload of the mother;
- unfavorable environmental situation in the country;
- unbalanced diet;
- bad habits;
- infectious diseases in childhood;
- effect of radiation (ionizing radiation);
- hemolytic disease of the newborn;
- anesthesia, which is mandatory for caesarean section;
- intranatal trauma;
- traumatic brain injury;
- sedentary lifestyle and physical inactivity;
- preterm birth.
Pathogenesis
To the mainpathogenetic factors in the development of this pathology include:
- intranatal injury;
- fetal infections;
- hypoxia during the intranatal period.
Since the thinking organ needs a lot 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. As well as 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:
- fatigue;
- sluggishness;
- drowsy;
- weakness;
- headaches.
Nervous tics:
the patient has involuntary movements
Violation of autonomic regulation:
- excessive sweating due to a malfunction in the normal functioning 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 seasons):
- possible loss of consciousness;
- tachycardia (accelerated heartbeat);
- change in blood pressure.
Vestibular disorders:
- nausea thatin extreme cases it leads to vomiting;
- motion sickness in vehicles and on swings.
Lability of the psycho-emotional sphere of a person:
- slight irritability;
- mood lability (frequent change);
- capriciousness.
Photophobia (intolerance to bright light).
Disorders of motor activity. As a rule, it is manifested by two conflicting syndromes. The first arises as a result of the predominance of inhibitory processes in the brain. The second is the result of excessive activation, which leads to inadequate functioning of the structures responsible for holding attention (these are structures such as the thalamus).
Also, with residual organic cerebral insufficiency, lethargy is characteristic:
- it is difficult to motivate such children for some kind of work;
- if they do agree to the task, they do it very slowly;
- it is difficult for them to switch between different tasks at the same time.
Either hyperactivity:
- children have great difficulty keeping their attention;
- are very restless, up to ADHD (Attention Deficit Hyperactivity Disorder).
Diagnosis
As practice shows, there are few positive clinical symptoms to make a final diagnosis, it is recommended to conduct additional laboratory and instrumental examinations.
Among them are:
- measurementintracranial pressure (with this pathology, the indicator will be increased);
- echoencephalography;
- electroencephalogram (to determine convulsive readiness);
- ophthalmoscopy.
What is typical
Most children who receive this diagnosis have abnormalities that are visible to the naked eye:
- wrong head shape;
- missing or deformed 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 restorative therapy and a local effect on pathologies directly in the brain.
This treatment for chronic and acute cerebral insufficiency syndrome includes:
- normalization of hemodynamics;
- restoration of normal respiratory activity;
- normalization of metabolic processes;
- local impact on pathology:
- restoring the normal functioning of the BBB (blood-brain barrier);
- increased hemodynamics in the brain;
- edema treatment.
According to modern standards, the main in the treatment of cerebral 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 the treatment must 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.
The following drugs are widely used in modern clinical practice:
- "Troxevasin";
- "Venoruton";
- "Corvitin";
- "Aescusan";
- "L-Lysine Aescinate".
To improve the rheological properties of blood in the cerebral circle, patients are recommended 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 circulating blood volume. 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";
- "Rheosorbilact";
- "Acesol".
Rehab
Treatment and rehabilitation after acute cerebral insufficiency should be individual, timely and necessarily comprehensive.
Such events will be most effective only if the patient feels supported not only by medical personnel, but also by their relatives and psychologists. This will help in the shortest possible time to restore the former rhythm of life and performance, regardless of the severity of organic brain damage.
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;
- LFK (therapeutic physical culture);
- occupational therapy.
When diagnosing delayed complications of cerebral insufficiency, it is imperative to create such living conditions in which the patient would not feel limited.
Rehabilitation in children is much easier and more efficient due to the high level of regenerative processes in them and significant opportunities for neuroplasticity. Therefore, as a rule, they do not experience 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 his usual rhythm of life.
