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Damage to the nervous system in somatic diseases

Damage to the nervous system in somatic diseases (somatoneurology)

An important area of ​​neurology is integration with other clinical disciplines, which led to the isolation of a new section in medicine - somatoneurology. This section describes lesions of the nervous system in various somatic diseases. Knowledge of this pathology is important for doctors of any specialty.

In the XIX century V.M. Bekhterev, joint venture. Botkin, I.P. Pavlov, V.M. Sechenov developed the theory of nervousness, which emphasizes the main role of the nervous system in the life of the body. At the same time, not only the nervous system affects the function of internal organs, but also internal organs affect its state and activity, i.e., there is a direct and feedback relationship between them. Therefore, the clinic observes both neuropsychiatric disorders in case of somatic diseases and somatic disorders in diseases of the nervous system. In many cases, the pathology of the internal organs creates only a background against which the action of other etiological factors is activated - infection, intoxication, trauma, etc. Other factors also matter: bad habits, nature of work, stress.

Violations of the state of the nervous system in somatic diseases have much in common. At first they are mostly functional, and then organic, due to metabolic disorders (disorders of protein, carbohydrate, fat, vitamin, water-electrolyte and other types of metabolism), the influence of toxins and hypoxia of the nervous system. There are also distinguished reflex disorders associated with pathological impulses from the affected organ to the central or peripheral nervous system, which can lead to the development of repercussion and generalized reflex syndromes (autonomic dystonia, neurasthenia, reflex paresis, contracture, atrophy, etc.).

The central link in the pathogenesis of somatoneurological disorders is the dysfunction of the hypothalamus and pituitary gland. These structures of the nervous system are most susceptible to pathological effects, since the BBB is most permeable to various adverse factors. Therefore, one of the important conditions for the development of dysfunction of the nervous system in somatic diseases is considered to be a violation of the BBB function, which under physiological conditions provides only selective penetration of water and various metabolites into the brain. At the same time, its increased permeability creates conditions for the penetration into the brain of substances toxic to the vascular endothelium.

With excessive nervous tension, stress, organic lesions of the central nervous system, its regulatory effect on the lower parts of the autonomic nervous system and endocrine glands is disturbed.
Disintegration occurs first in the hypothalamic-pituitary region, and then in other structures of the limbic-reticular complex. This leads to a violation of the cortical-subcortical relationships, the emergence of a neurosis with characteristic emotional and vegetative manifestations. In the future, against the background of severe asthenia of the nervous system, manifestations of somatogenic (metabolic) encephalopathy increase, which are characterized by headache, nausea, dizziness, sleep disturbance, intellectual and mnestic disorders, narrowing of the patient’s interests, and a depressive state. In neurological status, convergence weakness, nystagmus, subcortical reflexes, pyramidal or extrapyramidal insufficiency, cerebellar tremor, hyperkinesis, convulsive attacks can be detected. The course of encephalopathy may be accompanied by the occurrence of ischemic or hemorrhagic foci in the brain with the corresponding focal symptoms. Sometimes the picture of encephalopathy is combined with manifestations of myelopathy or polyneuropathy. Along with the chronic development of neurological somatogenic pathology, acute variants of its occurrence are also possible. Most often, these are acute cerebrovascular accidents and a variety of paroxysmal changes. The severity of their course may be different.

Thus, the following variants of neurological syndromes in somatic diseases are distinguished: radicular, mono- and polyneuritic, neurasthenic, vegeto-dystonic, encephalopathy, myelopathy, encephalomyelopathy, acute cerebral and spinal circulation disorders, paroxysmal conditions.

In order to diagnose somatoneurological disorders, patients should undergo a comprehensive examination, which should include electrocardiography, echocardioscopy, ultrasound of the internal organs, extra- and intracerebral vessels, biochemical examination of blood, urine, bile, etc .; conduct electroencephalography, electromyography, CT, MRI of the brain or spinal cord.

Treatment should include the appointment of etiotropic, pathogenetic and symptomatic agents. It is necessary to adhere to the basic principle of treatment - the simultaneous effect on somatic diseases and neuropsychiatric disorders.
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Damage to the nervous system in somatic diseases

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