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DEFEAT OF NERVOUS SYSTEM AT RHEUMATISM

Rheumatism - an infectious-allergic disease affecting the cardiovascular system. The disease is based on changes in the connective tissue in the form of its edema and structural damage. Involvement in the pathological process of the heart muscle and cerebral vessels is the cause of disorders of the nervous system. The nature of neurological disorders can be different and is determined by the degree of cerebral circulation and its preferential localization.

Cerebrasten disorders are observed in the early stages of the disease. Anxiety and impressionability are noted. Children are not capable of prolonged stress. Marked fatigue and rapid exhaustion. Patients complain of headache, poor sleep, dizziness, poor appetite. Children become whiny and irritable, do not tolerate loud sounds and bright light. Declines in school performance.

Other neurological disorders observed in rheumatism include sensory disturbances. Most often they manifest themselves in the form of visual perception disorders. Children complain about the doubling of objects, changes in their shape, size, the appearance of a grid or fog in front of their eyes. The perception of one’s own body is less often disturbed.

Children with anxiously-suspicious traits of character may experience obsessive fears - phobias. Other neurotic manifestations in patients with rheumatism include hysterical manifestations. Their appearance contributes to increased suggestibility of patients. Under the influence of negative emotions, most often insults due to unfulfilled desire, they have marked bouts of a sharp decrease in muscle tone, accompanied by excessive movements, laughter or crying. Sometimes these attacks occur due to the desire to attract the attention of staff or other people.

In more severe forms of neurorevmatism, epileptiform seizures may occur. Cramps are different and often combined with hysterical manifestations.

One of the most common forms of rheumatic diseases of the nervous system is small chorea.

With a small trochee, predominantly subcortical formations - striatum, optic tubercle, red nuclei - suffer. Pathological changes can be found in the cerebral cortex, the diencephalic region, the cerebellum. The child becomes irritable, not attentive, sleeps worse. Violent movements appear. Initially, they only introduce some confusion in the normal activities of the child. The patient makes unexpected touches at the time of writing, “plops” while pronouncing words, makes grimaces. The first manifestations of minor chorea surrounding are often evaluated as pranks of a child. If at the same time the child is called to order or punished, the symptoms of the disease increase.

Imperceptible at first violations are becoming more distinct and obvious. Violent movements can occur in any muscle groups. The patient is in motion all the time. With pronounced hyperkinesis, he cannot maintain balance and is forced to lie. Speech becomes blurred, explosive, loses smoothness; in severe cases, it is completely absent. Due to contractions of the chewing and pharyngeal muscles, the eating process is disturbed. Sometimes violent movements are observed in only one half of the body (hemichorrhea).
With a small chorea, one or several uniquely acting muscles can contract simultaneously; the muscles that are opposite in function are never reduced at the same time. This leads to the fact that at any stage of development the choreic hyperkinesis always has the character of separate random movements. These hyperkinesis are complex and never repeat the usual motor stereotypes, for example, such as scratching, blinking eyes, nose sniffing, etc. Hyperkinesis increases with excitement ^; in a dream disappear. In the early stage of the disease, there are several ways to detect hyperkinesis. The patient is asked to stand quietly in the Romberg position. Then they offer to close their eyes, open their mouth, stick their tongues out, connect the fingers of the right and left hands, etc. In the neurological status (except for violent movements) there is a decrease in muscle tone, a decrease or increase in tendon reflexes. Due to the disruption of the usual rhythms of movement, a picture of focal disorders arises. Changes in higher cortical functions are observed, especially memory for current events. Emotional disturbances are very characteristic of minor chorea. Sometimes they occur long before the development of hyperkinesis.

Patients become capricious, angry, irritable, show unmotivated stubbornness, move away from their peers. Sometimes there is a pronounced mental arousal.

At the height of the disease, choreic psychosis can be observed characterized by agitation, anxiety, fear, disorientation of orientation, hallucinations (often frightening character), euphoria, alternating apathy, lethargy and depression. The duration of psychosis is variable. Psychoses are also peculiar to non-choraeic forms of rheumatism.

The course of minor chorea is benign, however, relapses occurring during the exacerbation of chronic tonsillitis and new attacks of rheumatism are possible.

The diagnosis of minor chorea is made if specific immunological and biochemical changes characteristic of rheumatism, rheumatic heart disease, inflammatory changes in the blood count are detected.

In case of disorders of the nervous system, an active antirheumatic therapy is used in combination with the treatment of foci of chronic infection and, in addition, they use agents that reduce hyperkinesis.

Children who have suffered a rheumatic lesion of the nervous system, are naked under medical supervision. In our country there is a wide network of specialized institutions (institutes, clinics, departments of hospitals, sanatoriums) in which they treat and prevent rheumatism. Advances in the treatment of this disease have significantly reduced the frequency and severity of disorders of the nervous system.

An important role in the adaptation of such children is played by teachers. Teachers of the mass school need to find ways of an individual approach to children who have suffered rheumatism. These children should be given an extra day off. In addition, it is necessary to reduce the amount of written work and give them a relatively longer time to complete. When evaluating written works, one should not focus on the features of handwriting.
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