After suffering cerebral ischemia (of any degree), the newborn must be seen by a neurologist. The consequences of cerebral ischemia can be very different, from minimal deviations in development to quite serious ones.
The prognosis depends to a large extent on the severity of the transferred hypoxia and the severity of encephalopathy.
So with Title Hypoxic-ischemic encephalopathy, the prognosis is favorable. with grade II – dubious (that is, a lot depends on the presence or absence of comorbidities and the characteristics of the child’s body) in grade III – The full recovery prognosis is usually unfavorable.
The Russian Association of Specialists in Perinatal Medicine has developed a classification of the effects of perinatal lesions of the nervous system in children of the first year of life.
According to this classification, the following types of effects of cerebral ischemia are distinguished:
- The consequences of cerebral ischemia-hypoxia grade I-II (transient perinatal hypoxic-ischemic encephalopathy).
The main clinical forms of the consequences of grade I-II cerebral ischemia:
- Benign intracranial hypertension
- Disorder of the autonomic nervous system.
- Hyperactive behavior, hyperactivity.
- Alteration / delay of motor development
- Combined forms of delay, mental retardation not specified
- Symptomatic convulsions and paroxysmal disorders caused by the situation.
- It should be noted that in cases of perinatal hypoxic-ischemic transenonic encephalopathy, neurological deviations are fully compensated in the first year of life. In some cases, severe functional impairment can not persist.
- Consequences of cerebral ischemia-hypoxia grade II-III (perinatal resistant (organic) posthypoxic damage of the central nervous system).
The main clinical forms of the consequences of grade II-III cerebral ischemia:
- Various forms of hydrocephalus.
- Organic forms of mental deterioration
- Infant cerebral palsy (PC)
- Symptomatic epilepsy and epileptic syndromes of early childhood.
- For stable perinatal, the posthypoxic damage of the central nervous system is characterized by the fact that neurological abnormalities are not compensated for 1 year. At the same time, the total or partial neurological deficit persists. This is the main difference between the transient (through) lesions of the central nervous system and the resistant ones (organic).
Consequences of ischemia-cerebral hypoxia 1-2 degrees
Benign intracranial hypertension
Clinical manifestations: the course of this complex of symptoms is subacute (the increase in symptoms occurs gradually). There is an increase in the circumference of the child’s head in the first half of the year, which is somewhat different from the norm. Throughout the term, the increase is observed in more than 1 cm (but not more than 3 cm), in premature babies more than 2 cm (but not more than 4 cm).
There is also a discrepancy between cranial sutures, tension and bulging of a large fontanelle, regurgitation, unrelated to feeding, increased excitability and irritability in a child, difficulty falling asleep, shallow sleep and the recovery of tendon reflexes.
Poll with benign intracranial hypertension
In NSG, most of the time, they reveal a moderate expansion of spaces containing liquor, increased pulsation of the large cerebral arteries.
- CT, MRI – moderate expansion of the lateral ventricles, subarachnoid spaces, interhemispheric fissure.
- Changes in the EEG, as a rule, do not have nosological specificity.
In the context of treatment, with this pathology, compensation for neurological disorders occurs at 3-6 months of life.
Disorder of the autonomic nervous system.
Instability (lability) of the heart rate and blood pressure (without taking physical activity into account). There is also a change in the color of the skin: “marbling”, a symptom of “Harlequin” (half of the body is red, the other is white), red and white dermographism expressed, cyanosis of the nasolabial triangle, “blue “Around the eyes. There may be gastrointestinal dyskinesias: regurgitation, vomiting, unstable stools (now diarrhea, now constipation), flatulence.
Many have postnatal hypotrophy.
At the same time, it must be taken into account that this symptom complex has a diagnostic value only with the exception of somatic diseases in a child.
- In this way, ECG, blood pressure and control of body temperature are mandatory. Perform cardiointervalography, remote thermography.
- In the EEG, the changes are not specific, there may be regulatory alterations in the sleep-wake cycle of variable intensity.
- In NSG – no structural changes are detected.
- Examination methods such as MRI, computerized tomography of the brain are performed only according to the indications.
Compensation for neurological disorders usually arrives at 3 to 6 months of life, in the context of therapy.
This pathology is characterized by: excessive motor activity, muscle dystonia, emotional lability. Children have an unstable concentration of attention and concentration, their rapid exhaustion. Children do not sleep well, their sleep is superficial, they often wake up.
Tremor and resuscitation of reflexes is often observed.
Examination of hyperirritability and hyperactivity syndrome.
On the EEG, there may be no deviations from the age norm. In a quiet state of wakefulness, one can observe a slowing down and disorganization of the main cortical rhythm, signs of delay in the maturation of BEA, as well as regulatory alterations of subcortical systems of variable severity.
In the NSG, structural changes are generally not detected.
Compensation for neurological disorders is also observed at the age of 3-6 months (in the context of ongoing conservative therapy).
Impaired motor development
A slight delay in terms of reduction (extinction) of the unconditional motor automatisms. A bit of delayed formation of age-related physiological motor reactions in a child: adjustment reactions, visual-motor interaction, manual activity (manual work), straightening reactions (preparation to stand up, walking), balance functions, walking.
As a result, children begin to hold their heads later, sit, crawl, stand, walk. Muscle tone disorders may occur in the form of hypotension, hypertonia or dystonia.
These violations are of a transitory nature and in the context of the corrective measures are compensated with 1-1.5 years.
Additional survey methods
According to the testimony (to exclude structural brain damage) spend the NSG, CT, MRI.
EEG: to evaluate the state of the bioelectric activity of the brain.
ENMG – to assess the state of neuromuscular conduction.
Combined forms of developmental delay.
The symptoms – signs of decreased emotional reactions, weak expression of the “revitalization complex” (when the child does not react emotionally with the mother or other relatives), low cognitive activity in the baby. There is a delay in the rate of formation of communicative reactions, speech skills, voluntary motor acts.
At the same time, muscle tone violations are rare.
This symptomatic puncture has a diagnostic value in cases in which other causes are excluded (rickets, metabolic disorders, etc.).
Symptomatic convulsions and paroxysmal disorders caused by the situation.
Clinical signs: Seizures, paroxysmal disorders, occurred for the first time after the neonatal period. The cause of the attack can be: fever, excessive excitement, pain, toxicosis, eksikoz, infectious process and others.
Attacks can manifest in the form of several seizures (clonic, tonic, tonic-clonic), as well as in the form of atonic paroxysms.
Characteristics of symptomatic crises.: they are transient in nature, they stop quickly or with the appointment of a symptomatic treatment, there is no stereotyped occurrence and occurrence of seizures (this is characteristic of epilepsy).
- EEG: to evaluate the state of the bioelectric activity of the brain.
- NSG: As a rule, no structural changes are detected in the brain.
- MRI and CT are performed according to the indications.
Transient hypoxic-ischemic encephalopathy is characterized by the fact that seizures (in the context of monotherapy with minimal doses of anticonvulsants) are absent for three months and are no longer repeated during the first year of the child’s life.
In addition, we must not forget that the brains of young children have a tremendous plastic and restorative capacity (restorative), and with all methods of rehabilitation treatment, very good results can be achieved.