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Infectious diseases of the nervous system

Infectious diseases of the nervous system are quite common. They are caused by bacteria, viruses, fungi, protozoa. Neurological disorders can develop as a result of direct penetration of the pathogen into the nervous system (neuroinfection). Sometimes they develop against the background of other diseases. The selectivity of brain damage during neuroinfection is due to the so-called neurotropism of infectious toxic agents. The term "neurotropism" refers to the affinity of an infectious pathogen to a nerve cell. Tropism of viruses is determined by the similarity of the structure of ribonucleic acids of the virus and nerve cells. This makes it possible for the virus to enter the cell; such penetration leads to disruption of intracellular metabolism or to the death of a neuron. In the development of infectious diseases of the nervous system, in addition to the tropism of the virus, an important role is played by changes in the permeability of the vessel walls, the state of the membranes of the brain and spinal cord, and the characteristics of the immune-biological protective properties of the body. Thanks to protective measures of the body, neuronal lesions are often reversible.

The development of the infectious process in the nervous system, as a rule, is preceded by the presence of the infectious agent in the blood. During this period, the permeability of the cerebrovascular barrier increases. As a result, the circulation of blood and cerebrospinal fluid is disturbed, metabolic changes in the brain tissue occur and brain edema develops.

The development of cerebral edema is associated with the appearance of cerebral symptoms, which prevail at the beginning of the development of the disease and are often ahead of the occurrence of focal symptoms of brain disorder. Cerebral symptoms include headache, dizziness, vomiting, seizures, and loss of consciousness. With the defeat of a particular department of the nervous system, focal symptoms occur.

The course of infectious diseases of the nervous system is different. Sometimes it is lightning fast and leads to death in the first hours or days of illness. In most cases, during the infectious diseases of the nervous system, an acute period is distinguished, a period of restoration of impaired functions and a residual period of the disease, i.e. period of consequences. Sometimes the disease can acquire a protracted, chronic course, even after a significant period after the action of the pathogen. The progression of the neuroinfection process is associated with immunological changes in the nervous system that developed in the acute stage of the disease. These changes are associated with the effects of allergies.

The true progression of the neuroinfection process should be distinguished from “pseudo-progression”. A false impression of progression can be observed in the residual stage of the disease in children. It is due to the fact that with age, increasing demands are made on the child, and the inferior nervous system cannot provide them functionally.

Infectious diseases of the nervous system often lead to persistent impairment of hearing, vision, speech, and intelligence. Correction of these disorders requires the joint efforts of doctors and teachers.

Meningitis. Meningitis is an inflammation of the meninges. The cause of the disease may be bacteria, fungi, protozoa, viruses. Distinguish between primary and secondary meningitis. In primary meningitis, inflammation of the meninges is not preceded by diseases of any other organs. Secondary meningitis occurs as a complication of other diseases (inflammation of the middle ear cavity, purulent processes in the face and head, traumatic brain injuries, tuberculosis, mumps, etc.). According to the clinical course, meningitis is divided into fulminant, acute, subacute and chronic. The course of meningitis depends on the nature of the pathogen, the reactivity of the patient, and the age of the patient. The main clinical manifestation of meningitis is the meningeal (sheath) syndrome, which includes headache, vomiting, general hyperesthesia, the patient’s specific posture and a number of other symptoms. Headache usually has a diffuse character and celebrated at any time of the day. It is caused by toxic and mechanical (due to increased intracranial pressure) irritation of the receptors of the meninges. Headache is accompanied by vomiting, which occurs suddenly or against a background of previous nausea. Vomiting is not associated with food intake and brings some relief. General hyperesthesia is observed. Touching the skin, visual and auditory influences are extremely unpleasant for the patient. General hyperesthesia is based on mechanical irritation of the sensitive roots of the spinal and cranial nerves by the cerebrospinal fluid overflowing the subarachnoid space. The posture of patients with meningitis is characteristic: the head is thrown back, the body is bent, the stomach is pulled, the arms are bent, and the legs are pulled to the stomach. This position of the patient is a consequence of reflex tonic muscle tension. This mechanism underlies other meningeal symptoms. Stiff neck muscles are detected when trying to bend the patient’s head to the chest. Let us name the symptoms observed with meningitis. Symptom of Kernig is the inability to straighten a leg in the knee joint, previously bent in the hip and knee joints. The upper symptom of Brudzinsky is involuntary bending of the legs in the knee and hip joints when the patient’s head is brought to the chest. The lower symptom of Brudzinsky is involuntary bending of the leg and knee in the knee. when unbending another. The symptom of suspending Lesage is determined in young children: a child raised under his arms, pulls his legs to his stomach and holds them for a while th position.

Symptom of ankylosing spondylitis - a grimace of pain on the corresponding half of the face that occurs when tapping on the zygomatic arch.
The symptom of landing is the inability to sit in bed with legs straightened.

The most permanent and mandatory sign of meningitis is inflammatory changes in the cerebrospinal fluid, characterized by an increase in the number of cells and a moderately pronounced increase in protein content (protein-cell dissociation). Changes in cerebrospinal fluid make it possible to diagnose meningitis even in the absence of pronounced meningeal symptoms, as is often the case in young children (clinically asymptomatic, cerebrospinal meningitis).

Depending on the nature of the inflammatory process and changes in the cerebrospinal fluid, meningitis is divided into purulent and serous.

Purulent meningitis is caused mainly by bacteria - meningococcus, pneumococcus, staphylococcus, streptococcus, Escherichia coli, Proteus, Pseudomonas aeruginosa, etc. In purulent meningitis, the meninges are impregnated with a serous-purulent effusion located on the convex surface of the brain and its base. If treatment is not carried out, then by the 4th – 8th day a purulent effusion condenses, settles on the meninges and changes their structure. Inflammation can spread to the membranes of the spinal and cranial nerves, the inner lining of the flares, the substance and blood vessels of the brain. Pathological changes in the meninges with untimely and improper treatment can lead to blockage of cerebrospinal fluid spaces, impaired production of reverse absorption of cerebrospinal fluid, and the development of hydrocephalus. Meningeal syndrome with purulent meningitis usually develops against the background of pronounced signs of intoxication, that is, poisoning with poisons and other metabolic products of bacteria. Such signs include increased respiration and palpitations, lack of appetite, pallor or grayish tint of the skin, cyanosis of the nasolabial triangle, anxiety or lethargy, and indifference of patients. With erased, abortive forms of purulent meningitis, symptoms of general intoxication may come to the fore. In acute and fulminant flow due to the development of cerebral edema, sometimes in the first hours of the disease, impaired consciousness and, at the same time, convulsive attacks can be noted. Such seizures sometimes develop into an epileptic status - a condition in which convulsive seizures follow one after another.

The course of purulent meningitis and the nature of the consequences largely depend on the timeliness and nature of the treatment. With early and rational therapy, the condition of patients improves significantly on the 3rd - 4th day of illness; complete normalization occurs by the 8th-15th day. In these cases, after purulent meningitis, children may experience mild residual effects in the form of increased excitability and exhaustion of the nervous system, emotional instability, impaired concentration, and hydrocephalic syndrome. With a late diagnosis and improperly conducted therapy, a prolonged course of purulent meningitis is possible, leading to gross disturbances in the structure of the meninges, cerebrospinal fluid discirculation, and other complications. Increased secretion of cerebrospinal fluid, a violation of its reverse absorption, as well as violations that impede its normal movement in the ventricular system and sub-arachnoid space, are the causes of the development of hydrocephalus. Hydrocephalus is most often observed with meningitis in young children. Approximately 20% of children who have undergone purulent meningitis show signs of focal lesions of the nervous system: epileptiform convulsions, convergent and divergent strabismus, facial paresis, deafness, vegetative-metabolic disorders, motor disorders, mental retardation.

Serous meningitis is caused mainly by viruses. Pathomorphological changes with them are less severe than with purulent meningitis. In the meninges, a serous inflammatory process is observed, the main characteristic of which is edema and plethora of blood vessels. In the clinical picture of serous meningitis, in contrast to purulent, signs of intoxication are less pronounced. The leading symptoms are increased intracranial pressure: frequent vomiting, headache, agitation, anxiety. Less commonly observed lethargy, adynamia, lethargy.

The outcome of the disease and the nature of the residual effects depend on how early they begin and how rationally the treatment is carried out. The child who has undergone meningitis needs a sparing and improving regimen, healthy sleep in the fresh air, and good nutrition. The child’s activities should not be monotonous for a long time. It is necessary to alternate mental and physical activity. The child should be given vitamins, as well as drugs that improve the metabolism in the brain tissue and enhance the supply of oxygen to the brain.
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Infectious diseases of the nervous system

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