Diseases of the nervous system. Perinatal lesions of the central nervous system in newborns

No living organism can work without organs responsible for the transmission of impulses through nerve cells. The defeat of the central nervous system has a direct effect on the functionality of brain cells (both spinal and brain) and leads to disorders of these organs. And this, in turn, plays a primary role in determining the quality of human life.

Types of lesions and their characteristics

nervous system human body called a network of cells and nerve endings located in the structure of the brain. The functions of the central nervous system are to regulate the activity of any of the organs individually and of the whole organism as a whole. With damage to the central nervous system, these functions are disrupted, which leads to serious failures.

Today, all problems with the nervous system are divided into the following types:

• organic;
• perinatal.

Organic damage to the central nervous system is characterized by pathomorphological changes in the structure of brain cells. Depending on the severity of the lesion, 3 degrees of pathology are determined: mild, moderate and severe. Usually, mild degree damage can be observed in any person (regardless of age), without affecting health and quality of life. But moderate and severe degrees are already signaling serious disturbances in the activity of the nervous system.

It suggests damage to the structure of cells located in the brain in newborns and children of the first year of life, which occurred during the perinatal period. This time includes antenatal (from the 28th week of pregnancy to delivery), intranatal (the moment of birth) and neonatal (the first 7 days of the baby's life) periods.

What factors contribute to the occurrence of damage?

Organic lesions may be acquired or congenital. Congenital injuries occur while the fetus is in the womb. The following factors influence the occurrence of pathology:

• the use by a pregnant woman of certain types of medicines, alcohol;
• smoking;
• illness during pregnancy infectious diseases(tonsillitis, flu, etc.);
• emotional overstrain, during which stress hormones attack the fetus;
• exposure to toxic and chemical substances, radiation;
• pathological course of pregnancy;
• unfavorable heredity, etc.

Acquired lesions may develop as a result of mechanical injuries child. In some cases, such a pathology is called residual. The diagnosis of residual organic damage to the central nervous system is established by a doctor when there are symptoms indicating the presence of residual effects of brain disorders after birth injuries.

AT last years the number of children with residual effects of residual lesions is increasing. Medicine tends to attribute this to unfavorable environmental situation in some countries of the world, chemical and radiation pollution, young people's passion for bioadditives and medicines. In addition, one of negative factors considered inappropriate use caesarean section, in which both the mother and the child receive a dose of anesthesia, which does not always have a good effect on the state of the nervous system.

The most common cause of perinatal disorders is acute asphyxia (oxygen starvation) of the fetus during childbirth. It can occur due to the pathological course of childbirth, with wrong position umbilical cord, manifest itself in the form of cerebral hemorrhages, ischemia, etc. The risk of perinatal damage increases many times in children born prematurely, or during childbirth outside the maternity hospital.

The main manifestations of damage

The main symptoms of the lesion depend on its type. As a rule, patients have:

• increased excitability;
• insomnia;
• daytime enuresis;
• repetition of phrases, etc.

Children have a decrease in immunity, they are more likely than their peers to suffer from various colds and infectious diseases. In some cases, there is a violation of coordination of movements, deterioration of vision and hearing.

Signs of perinatal damage completely depend on the type of brain damage, its severity, the stage of the disease and the age of the child. So, the main symptoms of damage in children born prematurely are short-term convulsions, inhibition of motor activity and impaired respiratory functions.

Newborns born on time suffer from both inhibition of motor activity and increased excitability, manifested in irritated screaming and anxiety, convulsions of considerable duration. 30 days after the birth of the baby, lethargy and apathy are replaced by an increase in muscle tone, their excessive tension, the position of the limbs is incorrectly formed (clubfoot occurs, etc.). In this case, the occurrence of hydrocephalus (internal or external dropsy of the brain) can be observed.

With lesions of the spinal cord, the symptoms completely depend on the location of the injury. Yes, when injured nerve plexuses or spinal cord in the cervical spine, the appearance of a condition called obstetric palsy looks typical. This pathology characterized by inactivity or sagging of the upper limb on the side of the lesion.

With lesions related to the average degree, there are signs such as:

• constipation or frequent stools;
• violations of thermoregulation, expressed in the body's improper response to cold or heat;
• bloating;
• pallor of the skin.

A severe form of perinatal damage to the central nervous system (PPNS) is characterized by a delay in the development and formation of the psyche in a baby, which are already noted within 1 month of life. There is a sluggish reaction during communication, a monotonous cry with a lack of emotionality. At the age of 3-4 months, the child's movements can acquire persistent disorders (like cerebral palsy).

In some cases, PCNS are asymptomatic and appear only after 3 months of the baby's life. A signal of concern for parents should be an excess or insufficiency of movements, excessive anxiety, apathy of the baby, immunity to sounds and visual stimuli.

Methods for diagnosing and treating injuries

It is quite easy to diagnose congenital organic lesions of the central nervous system in children. Experienced doctor can determine the presence of pathology, just by looking at the face of the baby. The main diagnosis is established after a series mandatory examinations, which includes an electroencephalogram, a rheoencephalogram and an ultrasound of the brain.

To confirm perinatal disorders, ultrasound of the brain and dopplerography of blood vessels, radiographs of the skull and spinal column, and various types of tomography are used.

Treatment of organic and residual-organic lesions of the central nervous system is very long process, mainly based on the use of drug therapy.

Nootropic drugs are used that improve the functionality of the brain, and vascular medicines. Children with residual organic lesions are assigned classes with specialists in the field of psychology and speech therapy, during which exercises are performed to correct attention, etc.

With a severe degree of perinatal disorders, the baby is placed in the intensive care unit at the maternity hospital. Here, measures are taken to eliminate violations in the work of the main body systems and convulsive seizures. Intravenous injections, ventilation of the lungs and parenteral nutrition can be carried out.

Further treatment depends on the severity of damage to cells and structures of the brain. Commonly used medical preparations with anticonvulsant action, dehydration and improving the nutrition of the brain means. The same medicines are also used in the treatment of a baby in the first year of life.

The recovery period (after the first year of life) is characterized by the use of non-drug therapy. Rehabilitation methods such as swimming and exercises in water, physiotherapy and massage, physiotherapy, sound therapy (healing a child with the help of music) are used.

The consequences of organic and perinatal disorders depend on the severity of the pathology. With proper treatment, recovery is possible or residual effects in the form of deviations in the development of the child: speech delay, motor function delay, neurological problems, etc. Full rehabilitation in the first year of life gives a good chance of recovery.

The perinatal period (from 28 weeks of pregnancy to 7 days of a child's life) is one of the fundamental stages of ontogenesis, that is, the individual development of the body, the "events" of which affect the occurrence and course of diseases of the nervous system and internal organs in children. Of greatest interest to parents, obviously, are the methods of rehabilitation of children with perinatal lesions of the central nervous system (CNS), that is, the restoration of impaired functions. But first, we consider it important to acquaint you with the causes that can lead to perinatal lesions of the central nervous system in a child, as well as with the diagnostic capabilities of modern medicine. Rehabilitation will be discussed in the next issue of the magazine.

The modern classification of perinatal lesions of the CNS is based on the causes and mechanisms that lead to disorders in the work of the CNS in a child. According to this classification, four groups of perinatal CNS lesions are distinguished:

1. hypoxic lesions of the central nervous system, in which the main damaging factor is the lack of oxygen,
2. traumatic lesions, in this case the leading damaging factor is mechanical damage tissues of the central nervous system (brain and spinal cord) during childbirth and in the first minutes and hours of a child’s life,
3. dysmetabolic and toxic-metabolic lesions, while the main damaging factor is metabolic disorders in the child's body in the prenatal period,
4. damage to the central nervous system in infectious diseases of the perinatal period: the main damaging effect is exerted by an infectious agent (usually a virus).

It should be noted here that doctors often deal with a combination of several factors, so this division is somewhat arbitrary.

Let's talk in more detail about each of the above groups.

Group 1 perinatal CNS lesions

First of all, it must be said that hypoxic lesions of the central nervous system are most common. The causes of chronic intrauterine fetal hypoxia are:

• diseases of a pregnant woman (diabetes, infection, anemia, high blood pressure, etc.),
• polyhydramnios,
• oligohydramnios,
• multiple pregnancy, etc.

The causes of acute hypoxia (i.e. occurring during childbirth) are:

• disorders of uteroplacental circulation with premature detachment of the placenta,
• heavy bleeding,
• slowing of blood flow during compression of the fetal head during childbirth in the pelvic cavity, etc.

The duration and severity of hypoxia, and, accordingly, the degree of CNS damage are determined by the degree of toxicosis, exacerbation in the mother during pregnancy concomitant diseases especially the cardiovascular system. The fetal CNS is most sensitive to the lack of oxygen. With chronic intrauterine hypoxia, a number of pathological changes are triggered (deceleration of the growth of brain capillaries, an increase in their permeability), which contribute to the development of severe respiratory and circulatory disorders during childbirth (this condition is called asphyxia). Thus, asphyxia of a newborn at birth in most cases is a consequence of fetal hypoxia.

II group of perinatal CNS lesions

The traumatic factor plays a major role in spinal cord injuries. As a rule, there are obstetric aids that injure the fetus (recall that obstetric aids are manual manipulations performed by the midwife taking delivery in order to facilitate the removal of the head and shoulders of the fetus) with a large fetal mass, narrowed pelvis, incorrect insertion of the head, breech presentation, unjustified use of perineal protection techniques (perineal protection techniques are aimed at restraining the rapid advancement of the fetal head along the birth canal; on the one hand, this protects the perineum from excessive stretching, on the other hand, the time spent by the fetus in the birth canal increases, which, under appropriate conditions, aggravates hypoxia), excessive rotation of the head during its removal, traction behind the head during the removal of the shoulder girdle, etc. Sometimes such injuries occur even during a caesarean section with a so-called "cosmetic" incision (a horizontal incision on the pubis along the hairline and a corresponding horizontal incision in lower segment uterus), as a rule, insufficient for gentle removal of the child's head. In addition, medical procedures in the first 48 hours (eg, intensive mechanical ventilation), especially with small preterm infants, can also lead to the development of perinatal CNS lesions.

III group of perinatal CNS lesions

The group of metabolic disorders includes such metabolic disorders as fetal alcohol syndrome, nicotine syndrome, narcotic withdrawal syndrome(that is, disorders that develop as a result of drug withdrawal, as well as conditions caused by the action on the central nervous system of viral and bacterial toxins or drugs administered to the fetus or child.

IV group of perinatal CNS lesions

In recent years, the factor of intrauterine infection has become increasingly important, which is explained by more advanced methods for diagnosing infections. Ultimately, the mechanism of CNS damage is largely determined by the type of pathogen and the severity of the disease.

How do perinatal CNS lesions manifest themselves?

Manifestations of perinatal CNS lesions vary depending on the severity of the disease. Yes, at mild form at first, there is a moderate increase or decrease in muscle tone and reflexes, the symptoms of mild depression are usually replaced by excitation with tremor (trembling) of the hands, chin, and motor restlessness after 5-7 days. With moderate severity, depression (more than 7 days) is more often noted in the form of muscle, weakening of reflexes. Sometimes convulsions, disturbances of sensitivity are noted. Vegetative-visceral disorders are often observed, manifested by dyskinesia of the gastrointestinal tract in the form of an unstable stool, regurgitation, flatulence, dysregulation of the cardiovascular and respiratory systems(increased or decreased heart rate, muffled heart sounds, respiratory rhythm disturbance, etc.). In severe form, pronounced and prolonged depression of the central nervous system, convulsions, severe disorders of the respiratory, cardiovascular and digestive systems predominate.

Of course, even in the maternity hospital, a neonatologist, when examining a newborn, must identify perinatal lesions of the central nervous system and prescribe appropriate treatment. But clinical manifestations can persist even after discharge from the hospital, and sometimes intensify. In this situation, the mother herself may suspect "malfunctions" in the work of the child's central nervous system. What can alert her? We will list several characteristic signs: the child’s frequent anxiety or his inexplicable constant lethargy, regular, trembling of the chin, arms, legs, unusual eye movements, fading (the child seems to “freeze” in one position). A frequent syndrome in the case of CNS damage is also hypertensive-hydrocephalic syndrome - in this case, signs of increased intracranial pressure should alert, rapid increase head circumference (more than 1 cm per week), opening of the cranial sutures, an increase in the size of the fontanelles, and various vegetative-visceral disorders can also be noted.

If you have even the slightest suspicion, be sure to consult a neurologist - after all, the earlier treatment is started or its correction is carried out, the greater the likelihood of a complete restoration of impaired functions.

Once again, we emphasize that the diagnosis of your child will be made by a doctor. The diagnosis will reflect the presence of the CNS, if possible, a group of factors that caused its development, and the names of the syndromes, which include the clinical manifestations of CNS damage detected in the child. For example: "Perinatal damage to the central nervous system of hypoxic origin: syndrome muscular dystonia, syndrome of vegetative-visceral disorders". This means that the main cause of the damage to the central nervous system that developed in the baby was a lack of oxygen (hypoxia) during pregnancy, that during examination, the child revealed uneven muscle tone in the arms and / or legs (dystonia) , the child's skin has an uneven color due to imperfect regulation of vascular tone (vegeto-) and he has dyskinesia of the gastrointestinal tract (stool retention, or, conversely, increased intestinal motility, flatulence, persistent regurgitation), heart and respiratory rhythm disturbances (visceral disorders ).

Phases of development of the pathological process

There are four phases of the development of the pathological process in lesions of the nervous system in children during the first year of life.

First phase- the acute period of the disease, lasting up to 1 month of life, directly associated with circulatory disorders, can clinically manifest itself as a syndrome of depression or a syndrome of CNS excitation.

Second phase pathological process extends to the 2nd-3rd months of life, there is a decrease in the severity of neurological disorders: general state, motor activity increases, muscle tone and reflexes normalize. Improved electroencephalographic parameters. This is explained by the fact that the affected brain does not lose the ability to recover, but the duration of the second phase is short and soon (by the 3rd month of life) an increase in spastic phenomena may occur. The phase of "unjustified hopes for a full recovery" ends (it can be called the phase of false normalization).

Third phase- the phase of spastic phenomena (3-6 months of life) is characterized by the predominance of muscle hypertension (i.e., an increase in muscle tone). The child throws back his head, bends his arms at the elbows and brings them to the chest, crosses his legs and puts them on his toes when supported, tremor is pronounced, convulsive conditions are not uncommon, etc. Change clinical manifestations disease may be due to the fact that in this period there is a process of degeneration (the number of dystophically altered neurons increases). At the same time, in many children with hypoxic damage to the nervous system, the emerging progress in the second phase of the disease is fixed, which is found in the form of a decrease in neurological disorders.

Fourth phase(7-9 months of life) is characterized by the division of children with perinatal lesions of the nervous system into two groups: children with obvious neuropsychiatric disorders up to severe forms(20%) and children with normalization of previously observed changes in the nervous system (80%). This phase can be conditionally called the phase of the end of the disease.

Methods of laboratory diagnostics of perinatal lesions of the nervous system in children

According to experimental research, the brain of a newborn child in response to damage is able to form new neurons. Early diagnosis and timely treatment is the key to restoring the functions of the affected organs and systems, since pathological changes in young children, they are better amenable to reverse development, correction; anatomical and functional recovery is more complete than with running changes with irreversible structural changes.

Recovery of CNS functions depends on the severity of the primary injury. In the laboratory of clinical biochemistry of the Scientific Center for Children's Health of the Russian Academy of Medical Sciences, studies were conducted that showed: for laboratory diagnostics the severity of perinatal lesions of the nervous system in children, it is possible to determine the content of special substances in the blood serum - "markers of damage nervous tissue"- neuron-specific enolase (NSE), which is found mainly in neurons and neuroendocrine cells, and myelin-basic protein, which is part of the membrane surrounding the processes of neurons. An increase in their concentration in the blood of newborns with severe perinatal lesions of the nervous system is due to the intake of these substances therefore, on the one hand, the appearance of NSE in the blood makes it possible to confirm the diagnosis of "perinatal CNS lesion", and on the other hand, to establish the severity of this lesion: the greater the concentration of NSE and myelin-basic protein in the blood of the baby, the more severe the lesion in question.

In addition, the brain of each child has its own, genetically determined (only characteristic) structural, functional, metabolic and other features. Thus, taking into account the severity of the lesion and individual characteristics every sick child plays essential role in the processes of restoration of the central nervous system and the development of an individual rehabilitation program.

As mentioned above, the methods of rehabilitation of children with perinatal lesions of the central nervous system will be covered in the next issue of the journal.

Olga Goncharova, Senior Researcher
departments for premature babies
Scientific Center for Children's Health of the Russian Academy of Medical Sciences, Ph.D.

Discussion

Hello Olga, My daughter is already 1.2 months old. In the future, this disease will lead to neurosis or to surgery (sucking fluid from the head) Are there other methods of treatment and the forecasts for the future are so scary?

And what is the treatment for perenotal lesion of the nervous system, and more specifically, the syndrome of bilateral pyramidal insufficiency, as I understand it, that this syndrome is a consequence of the lesion itself????

I had a full-term baby and was diagnosed with perinotal CNS damage.
when I was already giving birth, the umbilical cord was tightened around the baby’s neck + the midwife pulled by the head, the baby was born and did not breathe - I even immediately realized that he was not screaming.
Now my child is already 8 years old and he has started to have difficulties with the assimilation of school material: can the diagnosis affect the attention and activity of the child?

I really would love to see a sequel! Has it been published somewhere?

For your information - the perinatal period starts at 22, not 28 weeks. It is surprising that the author does not know this.

Great article! Unfortunately, it's very important. I don’t know for sure, but openly the neurologist did not make any diagnosis for us. So, she said: "You had hypoxia." She prescribed the medicine "Caventon." So what? The child both shuddered and shuddered. He is already 3.5, and we sleep in overalls, because. swaddling does not recognize. And what to do next, I do not know! Who faced the same problem, plz write.

Good article, now I understand a lot

Dear Olga!
Was your article Perinatal lesions CNS" published anywhere else except for the magazine "9 months"
Sincerely,
Maria

Ladies and gentlemen!
Tell me, please, can a child be born with Children's cerebral palsy if he is full-term i.e. nine months.
Thank you in advance.

Unfortunately, this article is very relevant for me. Therefore, I was looking forward to the next issue of the magazine in order to read the promised continuation, I bought the issue immediately after its release, but alas ... they deceived it, it simply was not there. It's a pity, I used to consider this magazine very necessary, useful and the best.

They fall into normalization.
I realized that these 100% do not include healthy children at all.

I am confused by the division of children in the "resolution phase" into TWO groups: 20% - cerebral palsy, 80% - "normalization". But what about those who, fortunately, do not have obvious cerebral palsy, but retain certain neurological disorders?

Comment on the article "Perinatal lesions of the central nervous system"

The diagnosis of PEP is perinatal encephalopathy. PCNS, hyperexcitability. A child from birth to one year. Care and upbringing of a child up to a year: nutrition, illness, development. And in fact, after a while, I was already able to move his legs normally.

Discussion

I REPORT - we did not inject anything to the baby.
We consulted elsewhere - everything was within the normal range, if possible, they advised me to do another massage course.

In general, we no longer went to the neurologist in the clinic, and she quit.
Now we have visited a new neurologist (bypassing doctors for a year) - the diagnosis has been completely removed, "there are no neurological pathologies"; everything that is supposed to be by age, he does.

They didn’t reach the massage - either they were looking for a neurologist, then the New Year holidays, then they took my daughter for 2 weeks to the devices, then the influenza quarantine began, the holidays came again, then they began to pass doctors by the year, but there are plans.

And so the baby went from 11 months, at 11.5 - confidently, without outside help.

Of the diagnoses, the main ones are other brain lesions and unspecified encephalopathy (I am writing from memory). Perinatal encephalopathy (PEP) is a collective diagnosis that implies a violation of the function or structure of the brain of various ...

Discussion

@@@@@
Listen to how much they say about the child and think, can he really have all this?! And then make a decision. Very often they say a lot so that they do not take children.

unspecified encephalopathy might be bullshit
May everything be fine tomorrow!

Perinatal encephalopathy (PEP) is a collective diagnosis that implies a violation of the function or structure of the brain of various origins ... Diagnosis and treatment of perinatal encephalopathy in a baby, risk factors for perinatal ...

Benign childhood epilepsy. Us yesterday in the neurological hospital in Pozharsky lane. made this diagnosis. After all, epilepsy often gives kickbacks in development. For example, go to the Solntsevo-NPC for helping children with congenital diseases of the nervous system and ...

Discussion

In my opinion, it is better to consult again than to bite your elbows later. After all, epilepsy often gives kickbacks in development. For example, go to the Solntsevo-NPC for helping children with congenital diseases of the nervous system and ... (very long name, I don’t remember exactly) registry 439-02-98
And in the book about your epilepsy it says:
age of manifestation - 3-12 years, peak -5-10 years
75% of cases in a dream, consciousness is preserved, manifests itself in the form of tremors, vocalizations, speech stops, salivation, guttural, incoherent sounds, and other distribution to the hand. Neurology - no features. psyche-without oddities. the prognosis is very favorable. Therapy is not always indicated. Means of first choice are valproate, sultiam, if unsuccessful, gabapentin. Carbamazepine, phenytoin, phenobarbital are contraindicated.
If the seizures are not too frequent and severe, only at night, it is reasonable to use moderate doses that are minimally burdensome for patients, given that the disease occurs during the most active period of learning and personality formation.

Damage to the nervous system in newborns can occur both in utero (prenatally) and during childbirth (intranatally). If harmful factors acted on a child at the embryonic stage of intrauterine development, severe, often incompatible with life defects arise. Damaging influences after 8 weeks of pregnancy can no longer cause gross deformities, but sometimes they manifest themselves as small deviations in the formation of the child - the stigmas of disembryogenesis.

If the damaging effect was exerted on the child after 28 weeks of intrauterine development, then the child will not have any defects, but some disease may occur in a normally formed child. It is very difficult to isolate the effect harmful factor separately for each of these periods. Therefore, more often they talk about the impact of a harmful factor in general in the perinatal period. And the pathology of the nervous system of this period is called perinatal damage to the central nervous system.

Adverse Influence the child may have various acute or chronic diseases mothers, work in hazardous chemical industries or work associated with various radiation, as well as bad habits parents - smoking, alcoholism, drug addiction.

A child growing in the womb can be adversely affected by severe toxicosis of pregnancy, the pathology of the child's place - the placenta, the penetration of infection into the uterus.

Childbirth is very important event for a child. Particularly great tests fall on the lot of the baby if the birth occurs prematurely (prematurity) or rapidly, if there is generic weakness, the fetal bladder bursts early and water flows out when the baby is very large and he is helped to be born with special techniques, forceps or a vacuum extractor.

The main causes of damage to the central nervous system (CNS) are most often hypoxia, oxygen starvation of various nature and intracranial birth trauma, less often intrauterine infections, hemolytic disease of the newborn, malformations of the brain and spinal cord, hereditary metabolic disorders, chromosomal pathology.

Hypoxia ranks first among the causes of CNS damage, in such cases, doctors talk about hypoxic-ischemic CNS damage in newborns.

Hypoxia of the fetus and newborn is a complex pathological process in which the access of oxygen to the child's body decreases or completely stops (asphyxia). Asphyxia can be single or repeated, of varying duration, as a result of which carbon dioxide and other incompletely oxidized metabolic products accumulate in the body, primarily damaging the central nervous system.

With short-term hypoxia in the nervous system of the fetus and newborn, only small disturbances of cerebral circulation occur with the development of functional, reversible disorders. Prolonged and repeated hypoxic conditions can lead to severe violations cerebral circulation and even to the death of nerve cells.

Such damage to the nervous system of the newborn is confirmed not only clinically, but also with the help of an ultrasound Doppler study of cerebral blood flow (USDG), ultrasound brain - neurosonography (NSG), computed tomography and nuclear magnetic resonance (NMR).

In second place among the causes of CNS damage in the fetus and newborn is birth trauma. The true meaning, the meaning of birth trauma is damage to a newborn child caused by mechanical action directly on the fetus during childbirth.

Among the variety of birth injuries during the birth of a baby, the neck of the child experiences the greatest load, resulting in various damage cervical spine, especially the intervertebral joints and the junction of the first cervical vertebra and occipital bone(atlanto-occipital articulation).

There may be shifts (dislocations), subluxations and dislocations in the joints. This disrupts blood flow in the important arteries that supply blood to the spinal cord and brain.

The functioning of the brain largely depends on the state of cerebral blood supply.

Weakness is often the root cause of these injuries. labor activity at a woman. In such cases, forced labor stimulation changes the mechanism of passage of the fetus through birth canal. With such stimulated childbirth, the child is born not gradually, adapting to the birth canal, but quickly, which creates conditions for displacement of the vertebrae, sprains and ruptures of ligaments, dislocations, and cerebral blood flow is disturbed.

Traumatic injuries of the central nervous system during childbirth most often occur when the size of the child does not correspond to the size of the mother's pelvis, with the wrong position of the fetus, during childbirth in breech presentation, when premature, underweight babies are born and, conversely, children with large body weight, large sizes, as in In these cases, various manual obstetrical techniques are used.

Discussing the causes of traumatic lesions of the central nervous system, it is necessary to dwell separately on childbirth using obstetric forceps. The fact is that even with the immaculate application of the forceps head, intense traction behind the head follows, especially when trying to help the birth of the shoulders and torso. In this case, all the force with which the head is pulled is transmitted to the body through the neck. For the neck, such a huge load is unusually large, which is why when the baby is removed with forceps, along with the pathology of the brain, damage to the cervical region of the spinal cord occurs.

Particular attention should be paid to the issue of injuries to the child that occurs during caesarean section. Why is this happening? Indeed, it is not difficult to understand the traumatization of a child as a result of its passage through the birth canal. Why does a caesarean section, designed to bypass these paths and minimize the possibility of birth trauma, end in birth trauma? Where do such injuries occur during caesarean section? The fact is that the transverse incision during caesarean section in the lower segment of the uterus should theoretically correspond to the largest diameter of the head and shoulders. However, the circumference obtained with such an incision is 24-26 cm, while the circumference of the head of an average child is 34-35 cm. Therefore, removing the head and especially the shoulders of the child by pulling on the head with an insufficient incision of the uterus inevitably leads to injury of the cervical spine. That is why the most common cause of birth injuries is a combination of hypoxia and damage to the cervical spine and the spinal cord located in it.

In such cases, they speak of hypoxic-traumatic damage to the central nervous system in newborns.

With a birth injury, cerebrovascular accidents often occur, up to hemorrhages. More often these are small intracerebral hemorrhages in the cavity of the ventricles of the brain or intracranial hemorrhages between meninges(epidural, subdural, subarachnoid). In these situations, the doctor diagnoses hypoxic-hemorrhagic lesions of the central nervous system in newborns.

When a baby is born with CNS damage, the condition can be severe. This is an acute period of the disease (up to 1 month), followed by an early recovery period (up to 4 months) and then a late recovery period.

Importance to appoint the most effective treatment pathology of the central nervous system in newborns has the definition of a leading set of signs of the disease - a neurological syndrome. Consider the main syndromes of CNS pathology.

The main syndromes of CNS pathology

Hypertension-hydrocephalic syndrome

When examining a sick infant, the expansion of the ventricular system of the brain is determined, detected by ultrasound of the brain, and an increase in intracranial pressure is recorded (given by echo-encephalography). Outwardly, in severe cases with this syndrome, there is a disproportionate increase in the size of the cerebral part of the skull, sometimes asymmetry of the head in the case of a unilateral pathological process, divergence of cranial sutures (more than 5 mm), expansion and strengthening of the venous pattern on the scalp, thinning of the skin at the temples.

In hypertensive-hydrocephalic syndrome, either hydrocephalus may predominate, manifested by the expansion of the ventricular system of the brain, or hypertension syndrome with increased intracranial pressure. With the predominance of increased intracranial pressure, the child is restless, easily excitable, irritable, often screams loudly, sleep is sensitive, the child often wakes up. With the predominance of hydrocephalic syndrome, children are inactive, lethargy and drowsiness are noted, and sometimes developmental delay.

Often, with an increase in intracranial pressure, children goggle their eyes, Graefe's symptom periodically appears (a white strip between the pupil and upper eyelid), and in severe cases, there may be a symptom of the "setting sun", when the iris of the eye, like the setting sun, is half immersed under the lower eyelid; sometimes convergent strabismus appears, the baby often throws his head back. Muscle tone can be either low or high, especially in the muscles of the legs, which is manifested by the fact that when supported, he stands on tiptoe, and when he tries to walk, he crosses his legs.

The progression of the hydrocephalic syndrome is manifested by an increase in muscle tone, especially in the legs, while the support reflexes, automatic walking and crawling are reduced.

In cases of severe progressive hydrocephalus, seizures may occur.

Syndrome movement disorders

The syndrome of movement disorders is diagnosed in most children with perinatal pathology of the central nervous system. Movement disorders are associated with nervous regulation muscles in combination with an increase or decrease in muscle tone. It all depends on the degree (severity) and level of damage to the nervous system.

When making a diagnosis, the doctor must solve several very important questions, the main of which is: what is it - a pathology of the brain or a pathology of the spinal cord? This is of fundamental importance, since the approach to the treatment of these conditions is different.

Secondly, the assessment of muscle tone in various groups muscles. The doctor uses special techniques to detect a decrease or increase in muscle tone in order to choose the right treatment.

Violations of increased tone in different groups lead to a delay in the emergence of new motor skills in a child.

With an increase in muscle tone in the hands, the development of grasping ability of the hands is delayed. This is manifested by the fact that the child takes the toy late and grabs it with the whole hand, fine finger movements are formed slowly and require additional training sessions with the child.

With an increase in muscle tone in the lower extremities, the child later gets up on his legs, while leaning mainly on the front sections of the feet, as if “standing on tiptoe”, in severe cases, crossover occurs. lower extremities at the level of the shins, which prevents the formation of walking. In most children, with time and treatment, it is possible to achieve a decrease in muscle tone in the legs, and the child begins to walk well. Like a memory of increased tone muscles, a high arch of the foot may remain, which makes it difficult to choose shoes.

Syndrome of vegetative-visceral dysfunctions

This syndrome manifests itself as follows: marbling of the skin due to blood vessels, violation of thermoregulation with a tendency to an unreasonable decrease or increase in body temperature, gastrointestinal disorders - regurgitation, less often vomiting, a tendency to constipation or unstable stools, insufficient weight gain. All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are associated with impaired blood supply to the posterior parts of the brain, in which all the main centers of the autonomic nervous system are located, which provide guidance for the most important life-supporting systems - cardiovascular, digestive, thermoregulatory, etc.

convulsive syndrome

The tendency to convulsive reactions during the neonatal period and in the first months of a child's life is due to the immaturity of the brain. Seizures occur only in cases of spread or development of a disease process in the cerebral cortex and have many different causes that the doctor must identify. This often requires instrumental research of the brain (EEG), its blood circulation (Dopplerography) and anatomical structures (ultrasound of the brain, CT scan, NMR, NSG), biochemical research.

Convulsions in a child can manifest themselves in different ways: they can be generalized, capturing the whole body, and localized - only in a certain muscle group.

Seizures are also different in nature: they can be tonic, when the child stretches out and freezes for a short time in a certain position, as well as clonic, in which the limbs twitch, and sometimes the entire body, so that the child may be injured during convulsions. .

There are many options for the manifestations of seizures, which are revealed by a neuropathologist according to the story and description of the child's behavior by attentive parents.

lyami. Correct staging diagnosis, that is, determining the cause of the child's seizures, is extremely important, since the timely appointment of effective treatment depends on this.

It is necessary to know and understand that convulsions in a child during the neonatal period, if serious attention is not paid to them in time, can become the beginning of epilepsy in the future.

Symptoms to Seek to a Pediatric Neurologist

Summing up all that has been said, we briefly list the main deviations in the state of health of children with which it is necessary to contact a pediatric neurologist:

If the child sluggishly sucks the breast, takes breaks, gets tired at the same time. There is choking, leakage of milk through the nose;

If the newborn often spits up, does not gain enough weight;

If the child is inactive, lethargic or, on the contrary, too restless and this anxiety increases even with minor changes environment;

If the child has a trembling of the chin, as well as the upper or lower extremities, especially when crying;

If the child often shudders for no reason, falls asleep with difficulty, while sleep is superficial, short in time;

If the child constantly throws back his head, lying on his side;

If there is too fast or, conversely, a slow increase in head circumference;

If the child's motor activity is reduced, if he is very lethargic, and the muscles are flabby (low muscle tone), or, conversely, the child is as if constrained in movements (high muscle tone), so that even swaddling is difficult;

If any one of the limbs (arm or leg) is less active in movements or is in an unusual position (clubfoot);

If the child squints or goggles, a white stripe of sclera is periodically visible;

If the baby constantly tries to turn his head in only one direction (torticollis);

If the spread of the hips is limited, or, conversely, the child lies in the frog position with the hips separated by 180 degrees;

If the child was born by caesarean section or in breech presentation, if the child was used obstetric forceps if the baby was born prematurely or with a large weight, if entanglement of the umbilical cord was noted, if the child had convulsions in the maternity home.

Accurate diagnosis and timely and correctly prescribed treatment of the pathology of the nervous system are extremely important. Damage to the nervous system can be expressed to varying degrees: in some children from birth they are very pronounced, in others even severe disorders gradually decrease, but do not disappear completely, and on long years non-rough manifestations remain - these are the so-called residual phenomena.

Late manifestations of birth trauma

There are also cases when at birth the child had minimal impairments, or no one noticed them at all, but after a while, sometimes years, under the influence of certain loads: physical, mental, emotional - these neurological disorders manifest themselves with varying degrees expressiveness. These are the so-called late, or delayed, manifestations of birth trauma. Pediatric neurologists in daily practice most often deal with such patients.

What are the signs of these consequences?

Most children with late manifestations show a pronounced decrease in muscle tone. Such children are credited with "innate flexibility", which is often used in sports, gymnastics, and even encouraged. However, to the disappointment of many, it should be said that extraordinary flexibility is not the norm, but, unfortunately, a pathology. These children easily fold their legs into the “frog” position, easily do the splits. Often such children are gladly accepted into the rhythmic or artistic gymnastics section, into choreographic circles. But most of them do not endure heavy loads and are eventually expelled. However, these activities are enough to form the pathology of the spine - scoliosis. It is not difficult to recognize such children: they often clearly show a protective tension of the cervico-occipital muscles, often there is a slight torticollis, the shoulder blades stick out like wings, the so-called “pterygoid shoulder blades”, they can stand at different levels, like the shoulders. In profile, it can be seen that the child has a sluggish posture, a stooped back.

By the age of 10-15, some children with signs of trauma to the cervical spine in the neonatal period develop typical signs of early cervical osteochondrosis, the most characteristic symptom of which in children is headaches. The peculiarity of headaches in cervical osteochondrosis in children is that, despite their different intensity, the pains are localized in the cervical-occipital region. As they grow older, the pains often become more pronounced on one side and, starting in the occipital region, spread to the forehead and temples, sometimes they radiate to the eye or ear, intensify when turning the head, so that a short-term loss of consciousness may even occur.

Headaches in a child are sometimes so intense that they can deprive him of the opportunity to study, do something around the house, force him to go to bed and take analgesics. At the same time, some children with headaches have a decrease in visual acuity - myopia.

Treatment for headaches, aimed at improving the blood supply and nutrition of the brain, not only relieves headaches, but also improves vision.

The consequences of the pathology of the nervous system in the period of the newborn may be torticollis, certain forms of scoliotic deformities, neurogenic clubfoot, flat feet.

In some children, enuresis - urinary incontinence - can also be a consequence of birth trauma - just like epilepsy and other convulsive conditions in children.

As a result of fetal hypoxic trauma in the perinatal period, the brain primarily suffers, the normal course of maturation of the functional systems of the brain, which provide the formation of such complex processes and functions of the nervous system as stereotypes of complex movements, behavior, speech, attention, memory, and perception, is disrupted. Many of these children show signs of immaturity or violations of certain higher mental functions. The most common manifestation is the so-called Active Attention Deficit Hyperactivity Disorder and Hyperactive Behavior Syndrome. Such children are extremely active, disinhibited, uncontrollable, they lack attention, they cannot concentrate on anything, they are constantly distracted, they cannot sit still for several minutes.

They say about a hyperactive child: this is a child "without brakes." In the first year of life, they give the impression of very developed children, as they are ahead of their peers in the development - they begin to sit, crawl, and walk earlier. It is impossible to keep a child, he certainly wants to see and touch everything. Increased motor activity is accompanied by emotional instability. At school, such children have many problems and difficulties in learning due to the inability to concentrate, organize, and impulsive behavior. Due to low efficiency, the child does homework until the evening, goes to bed late and, as a result, does not get enough sleep. The movements of such children are awkward, clumsy, and poor handwriting is often noted. They are characterized by auditory-speech memory disorders, children do not learn material from hearing well, while the violation visual memory are less common. They often meet Bad mood, thoughtfulness, lethargy. It is difficult to involve them in the pedagogical process. The result of all this is a negative attitude towards learning and even a refusal to attend school.

Such a child is difficult for both parents and teachers. Behavioral and school problems growing like a snowball. In adolescence, these children have a significantly increased risk of developing persistent behavioral disorders, aggressiveness, difficulties in relationships in the family and school, and deterioration in school performance.

Functional disorders cerebral blood flow especially make themselves felt during periods accelerated growth- in the first year, in 3-4 years, 7-10 years, 12-14 years.

It is very important to notice the first signs as early as possible, take measures and treat them early. childhood, when the development processes are not yet completed, while the plasticity and reserve capabilities of the central nervous system are high.

Domestic obstetrician Professor M. D. Gyutner in 1945 rightly called birth injuries of the central nervous system “the most common folk disease».

In recent years, it has become clear that many diseases of older children and even adults have their origins in childhood and are often a late retribution for an unrecognized and untreated pathology of the neonatal period.

One conclusion should be made - to be attentive to the health of the baby from the moment of his conception, to eliminate all harmful effects on his health as soon as possible, and even better - not to allow them at all. If such a misfortune happened and a pathology of the nervous system was detected in a child at birth, it is necessary to contact a pediatric neurologist in time and do everything possible so that the baby fully recovers.

It happens that in the maternity hospital or a little later, at a pediatrician's appointment, a newborn child is given complex diagnoses regarding the state of the central nervous system (CNS). What is hidden behind the words "hypertensive-hydrocephalic syndrome" or "vegetative-visceral dysfunction syndrome" and how can these conditions affect the health and development of a child? Is it possible to treat CNS lesions? Natalya Pykhtina, a specialist in pediatric rehabilitation, is the head of the clinic of the same name.

The doctor receives the first information about the state of the central nervous system in the first minutes and hours after the baby is born, even in the delivery room. Everyone has heard of the Apgar scale, according to which the viability of a child is assessed by five main visible signs - heartbeat, skin color, respiration, reflex excitability and muscle tone.

Why is it important to correctly assess the motor activity of an infant? Because it provides information about the state of the spinal cord and brain, their functionality, which helps to recognize both minor deviations and serious pathologies in time.

Thus, the greatest attention is paid to the degree of symmetry of limb movements: their pace and volume should be the same on both sides, that is, the left arm and left leg and the right arm and leg, respectively. Also the doctor who conducts initial inspection newborn, takes into account the clarity and severity of unconditioned reflexes. So the pediatrician receives information about the activity of the baby's central nervous system and finds out whether it functions within the normal range.

Damage to the central nervous system in a child occurs in two ways - in utero or during childbirth. If developmental abnormalities arose in the fetus during the embryonic stage of intrauterine development, then they often turn into defects that are incompatible with life, or extremely severe and not amenable to treatment and correction.

If the damaging effect was on the fetus after, this will not affect the child in the form of gross deformity, but may well cause minor deviations that will have to be treated after birth. Negative effects on the fetus in the later stages - after- in the form of defects it will not manifest itself at all, but it can become a catalyst in the event of diseases in a normally formed child.

It is very difficult to predict which specific negative factor and at what period of pregnancy will cause irreparable damage to the fetus. Therefore, the expectant mother needs to be extremely careful and monitor her health even before the moment of conception. Preparing for pregnancy is an important stage in family planning, because the mother’s bad habits, as well as her chronic diseases, hard work and an unhealthy psychological state, can affect the child’s health.

It is important for the future life of the child and how exactly he will be born. It is at the time of childbirth that there is a danger of damage in the second way - intranatally. Any improper intervention or, conversely, the lack of timely assistance is highly likely to negatively affect the baby. At risk - premature birth, as well as childbirth at the scheduled time, but rapid or, conversely, protracted.

The main causes of CNS damage in newborns are oxygen starvation, which leads to hypoxia, and birth trauma. Less obvious and diagnosable causes are less common: intrauterine infections, hemolytic disease of the newborn, malformations of the brain and spinal cord, hereditary metabolic disorders or chromosomal pathology.

Doctors distinguish several syndromes of CNS pathology in newborns.

Hypertension-hydrocephalic syndrome- this is an excessive accumulation of cerebrospinal fluid in the ventricles and under the membranes of the brain. To identify this syndrome in an infant, an ultrasound of the brain is performed and data on an increase in intracranial pressure are recorded (according to echoencephalography - EEG).

In pronounced severe cases with this syndrome, the size of the cerebral part of the skull disproportionately increases. As you know, children are born with movable bones of the skull, which grow together in the process of development, therefore, with one-sided pathological process of this syndrome, there will be a divergence of the cranial sutures, thinning of the skin in the temporal lobe and an increase in the venous pattern on the scalp.

If a child has increased intracranial pressure, he will be restless, irritable, easily excitable and tearful. Also, the baby will not sleep well, goggle and tilt his head back. Perhaps the manifestation of a symptom of Graefe (a white strip between the pupil and the upper eyelid). In more severe cases, there may also be a symptom of the so-called "setting sun", in which the iris of the eye, like the sun at sunset, is half immersed under the lower eyelid. Also sometimes appears convergent.

With reduced intracranial pressure on the contrary, the child will be inactive, lethargic and drowsy. Muscle tone in this case is unpredictable - it can be either increased or decreased. The baby can stand on tiptoe when supported, cross the legs when trying to walk, while the reflexes of support, crawling and walking in the baby will be reduced. Seizures can also often occur.

Muscle tone disorders

Movement Disorder Syndrome- pathology of motor activity - is diagnosed in almost all children with intrauterine abnormalities in the development of the central nervous system. Only the severity and level of damage differ.

When making a diagnosis, the pediatrician must understand what the area and localization of the lesion is, whether there is a problem in the functioning of the brain or spinal cord. This is a fundamentally important question, since the methods of treatment differ radically depending on the established pathology. Also of great importance for the diagnosis is the correct assessment of the tone of various muscle groups.

Violation of the tone in various muscle groups leads to a delay in the appearance of motor skills in an infant: for example, the child later begins to take objects with the whole hand, finger movements are formed slowly and require additional training, the child later gets up on his feet, and the decussation of the lower extremities prevents the formation of proper walking.

Fortunately, this syndrome is curable - in most children, due to proper treatment, there is a decrease in muscle tone in the legs, and the child begins to walk well. Only the high arch of the foot can remain in memory of the disease. This does not interfere with normal life, and the only difficulty is choosing comfortable and well-fitting shoes.

Syndrome of vegetative-visceral dysfunctions characterized by a violation of thermoregulation in a child (body temperature rises or falls without visible reasons), exceptional whiteness of the skin associated with disruption of the vessels, and gastrointestinal disorders(regurgitation, vomiting, tendency to constipation, insufficient weight gain in comparison with the indicators taken as the norm).

All these symptoms are most often combined with hypertensive-hydrocephalic syndrome and are directly related to disorders in the blood supply to the posterior parts of the brain, where all the main centers of the autonomic nervous system are located, which govern the life-supporting systems of the body - digestive, thermoregulatory and cardiovascular.

convulsive syndrome

The tendency to convulsions in the first months of a child's life is due to the immaturity of the brain. Seizures occur only in cases where there is a spread or development of a disease process in the cerebral cortex, and have many different causes.

In every specific case the cause of the convulsive syndrome should be identified by the doctor. An effective assessment often requires a number of studies and manipulations: an instrumental study of the brain (EEG), cerebral circulation (Dopplerography) and anatomical structures (ultrasound of the brain, computed tomography, MRI, NSG), as well as biochemical blood tests.

From the point of view of localization, convulsions are not the same - they are generalized, that is, covering the entire body, and localized, which are associated with individual muscle groups.

Convulsions are also different in nature: tonic, when the child seems to stretch out and freeze for a short time in a certain fixed position, and clonic, in which there is a twitching of the limbs, and sometimes the entire body.

Parents should carefully monitor the child in the first months of life, because. convulsions in children can be the beginning, if you do not immediately contact a specialist and do not carry out competent treatment. Careful observation and a detailed description of the resulting seizures by the parents will greatly facilitate the doctor's diagnosis and speed up the selection of treatment.

Treatment of a child with CNS damage

Accurate diagnosis and timely correct treatment of CNS pathology is extremely important. Children's body very susceptible to external influence on the initial stage development, and the procedures received in time can radically change the future life of the child and his parents, allowing at the earliest stages with relative ease to get rid of problems that can become very significant at a later age.

As a rule, children with pathologies early age appointed drug therapy in combination with physical rehabilitation. Therapeutic exercise (LFK) is one of the most effective non-drug methods rehabilitation of children with CNS lesions. A properly selected course of exercise therapy helps to restore the child's motor functions, using the adaptive and compensatory capabilities of the child's body.

Comment on the article "CNS lesions in children: what are they?"

organic lesion of the central nervous system - in all my children. Everyone develops differently. IMHO, taking a child from DD means being prepared for behavioral disorders, poor study, theft, damage and loss of things, tantrums ..... I don’t know if you can find a healthy DD in the full sense of this ...

Discussion

organic damage to the central nervous system in all my children. Everyone develops differently. IMHO, taking a child from DD means being prepared for behavioral disorders, poor study, theft, damage and loss of things, tantrums ..... I don’t know if you can find healthy in the DD in the full sense of the word. They get there either because of their health, or because of their health (both physical and mental) bio... What lends itself to education, is brought up, what does not lend itself - fall in love) how difficult? - exactly as much as you are ready, as far as you can accept (or not accept) it with any

My child has an organic lesion of the central nervous system. Expressed in mild form of cerebral palsy and some learning difficulties. And my child was diagnosed with an organic lesion of the central nervous system, paraparesis, and a disability from a year and a half. Disability was removed at the age of 6, and this spring, a neurologist removed her from ...

Discussion

Looks like we're doing an MRI tomorrow. And on Friday - a psychiatrist and a neurologist. In DD they gave me a lot of guilt - why do you need to do this, what kind of checks are these, etc., etc. I'm stupid - on my own. Thank you from the bottom of my heart girls. I myself did not expect such support and was very touched. I will write how and what as soon as something new.

I am not a doctor. At all. Therefore, my reasoning is completely philistine. So: in my opinion, residual organic lesion is a very general diagnosis. Manifestations should depend on the extent and localization of the lesion. And they can be from "does not understand anything, drools" (sorry for the incorrectness), to "nothing is noticeable at all." The first option is clearly no longer a threat to the girl. The child is adequate, obedient, reads poetry, role-playing games plays ... So, I think, everything that could have happened - has already manifested itself in this "poor study." Is it critical for you? What if it's hard to study? What if he doesn't go to university? If in the most extreme case will learn in correction?
This is, in principle, a real prospect for many adopted children. Not a fact, a child taken at a younger age, you will not get the same problems at school.
In general, since my child is almost like this (studies with difficulty, after grade 1 he couldn’t do anything), but wonderful and beloved, I feel sorry for the girl. Somehow, in the discussion, they almost put an end to it. :(A good girl. Although, of course, it's up to you to decide.

Discussion

depends on the background, and even more on the perspective. any child, sick or healthy, in a favorable psycho-social environment is much more likely to grow up a good man than under poor initial conditions. Children with health problems bring no less, and maybe even more joy than healthy children. unless, of course, completely dissolved in worries, problems and the search for the best solutions.

Just like on the Internet - from nothing terrible to vagrancy, suicidal tendencies, etc. Look at the children. If something is bothering you, contact the experts. Sorry for the internet diagnosis, but I think your kids look good.

CNS damage. Medicine / children. Adoption. Discussion of adoption issues, forms of placement of children in families, education Please tell me what is a CNS lesion without a psychic lesion. in an Internet has found only about perinatal damage of TsNS. it's one and...

Discussion

look at a specific child, if necessary, do an MRI to determine whether you are able to raise this child or not. Or maybe defeat only on paper. Anything can happen.

I have a child from special DR. There was PEP, there was an organic lesion of the central nervous system. There are problems, but almost the norm :) In general, with good care, treatment and, naturally, at home, all this can be reduced to nothing.

CNS lesions in children: what are they? Is it possible to treat CNS lesions? Says a specialist in children's rehabilitation Natalya And my child was diagnosed with an organic lesion of the central nervous system, paraparesis, and a disability from a year and a half.

The defeat of the central nervous system, ZPR. Medicine / children. Adoption. Discussion of adoption issues, forms of placement of children in families, raising foster children, interaction with guardianship Regarding the distinction between mental retardation and mental retardation, use baby test Veksler and drawing test.

Discussion

Such diagnoses are found in 90% of children at home.
How serious they are in a particular child - only a doctor can tell. Quite often, this is some kind of reinsurance, it can be written for some kind of additional payments for the maintenance of children, for placing the child in the appropriate hospital (you need to put the abandoned child somewhere). In the same way, one should not immediately be intimidated by names like "DR for children with CNS lesions", etc.
First of all, it is necessary to talk with the DR doctor - quite often the information is quite objective.
You can also visit a child in the DR with a "girlfriend" - a neurologist who can say something by looking at the child and reading his card.
If you take a doctor with you, it’s not possible - you can copy some pages from the child’s card (if they allow) (it’s good to have a digital camera with you for this purpose, because there is most likely no photocopier there) - and go to the pediatric neurologist yourself, show a copy of the card and talk about how serious it is.

Discussion

There is a brain institute where they teach according to the Bronnikov method. I’m not special at all, a friend studied there, told me what wonderful results there are. I can ask if it's worth it for your problems to go there. Or maybe you already know about them?

Well, we can assume that we also have an organic lesion, after a cerebral hemorrhage and subsequent hydrocephalus, there is hypoplasia of the corpus callosum, a diffuse lesion white matter etc. I don’t know about others, but official medicine couldn’t offer us anything except the standard vascular therapy and light nootropics in the hope that the remnants of the affected areas will "sort themselves out", redistribute functions, etc. This process was somewhat stimulated by the treatment of Koreans on the street. ak. Pilyugin, by the way, I saw children with them who also have problems with the cerebellum, there was some progress, but this is all individual. What city do you live?

CNS damage. My friend had a premature baby (32 weeks) as a result of placental abruption; suffered severe hypoxia, they even say that some lobules in the brain (I don’t understand well what is meant) have died.