IVANO-FRANKIVSK NATIONAL IVANO-FRANKIVSK NATIONAL MEDICAL UNIVERSITYMEDICAL UNIVERSITY

AnatomoAnatomo--Physiological Physiological

Peculiarities of the Peculiarities of the Nervous System in Nervous System in Children. Semiotics Children. Semiotics of the Main Diseases of the Main Diseases

of the Nervous of the Nervous System in Children.System in Children.

Plan of the lecturePlan of the lectureAnatomical peculiarities of the structure of Anatomical peculiarities of the structure of the brain.the brain.Peculiarities of the structure of the spinal Peculiarities of the structure of the spinal cord.cord.Peculiarities of the functioning of the Peculiarities of the functioning of the nervous system in children.nervous system in children.Methods of investigation of the nervous Methods of investigation of the nervous system.system.Semiotics of nervous system disturbances.Semiotics of nervous system disturbances.

Significance of the function of central nervous Significance of the function of central nervous system (CNS) in a childsystem (CNS) in a child

The most important period in the formation of nervous The most important period in the formation of nervous system and intellect of a person is - childhood.system and intellect of a person is - childhood.Development of nervous system is the result of Development of nervous system is the result of interrelations of genetic factors and external interrelations of genetic factors and external influences:influences:

- number and development of neurons; - number and development of neurons; - number and development of axons and their synapses.- number and development of axons and their synapses.

The number of neurons and their morphological peculiarities are genetically stipulated. The formation of synaptic relations is mainly connected with external factors - the character of caring and nutrition, bringing up and stimuli.

Peculiarities of the development of Peculiarities of the development of nervous activity in childrennervous activity in children

Development of nervous system in the early Development of nervous system in the early childhood is decisive for the whole following childhood is decisive for the whole following life, for the ability of creative activity, for the life, for the ability of creative activity, for the ability to study and regulate emotions.ability to study and regulate emotions.The nervous system has a wonderful ability for The nervous system has a wonderful ability for the development and renovation of its the development and renovation of its functions, but this potential is critically limited in functions, but this potential is critically limited in time.time.Only in the first 3 years of life such abilities are considerable, and after10 years they become fully exhausted.

Peculiarities of the development of Peculiarities of the development of central nervous system (CNS) in childrencentral nervous system (CNS) in children

Critical period for the unfavourable influences are the first 18 Critical period for the unfavourable influences are the first 18 months. In this time negative influence, or absence of positive months. In this time negative influence, or absence of positive stimuli produce the future disturbances and diseases.stimuli produce the future disturbances and diseases.The most dangerous for the development of the child’s The most dangerous for the development of the child’s intellect are combined reasons: absence of the proper caring intellect are combined reasons: absence of the proper caring and nutrition, unfavourable hygienic and ecological conditions, and nutrition, unfavourable hygienic and ecological conditions, presence of family stresses, lack of medicines, etc.presence of family stresses, lack of medicines, etc.Effectiveness of influence on the development of healthy Effectiveness of influence on the development of healthy nervous system and correction of its disturbances directly nervous system and correction of its disturbances directly depend on the time of treatment or prophylactic intervention. depend on the time of treatment or prophylactic intervention. The earlier the measures are taken the fuller and better is the The earlier the measures are taken the fuller and better is the result.result.

The most important functions of The most important functions of the nervous system:the nervous system:

The main importance of the nervous system is supplying The main importance of the nervous system is supplying the best adaptation of the organism to the influence of the best adaptation of the organism to the influence of the environment and making its reactions as one whole the environment and making its reactions as one whole thing;thing;Normal interaction of the organism with the Normal interaction of the organism with the environmental conditions;environmental conditions;Making the behavior according to the conditions of life;Making the behavior according to the conditions of life;Combining and regulation of all functions of the Combining and regulation of all functions of the organism, its organs, tissues, cells and intracellular organism, its organs, tissues, cells and intracellular structures;structures;Starting action of functioning (contractions of the Starting action of functioning (contractions of the muscles).muscles).

MorphologicalMorphological peculiarities of the brain peculiarities of the brain

The brain - the organ, playing important role in life activity of a The brain - the organ, playing important role in life activity of a person, it is the organ of adaptation to the conditions of the person, it is the organ of adaptation to the conditions of the environment.environment.The mass of the brain is 10% of the body mass of a newborn The mass of the brain is 10% of the body mass of a newborn child (about 350-400g), in children at the age of 16-17 years - child (about 350-400g), in children at the age of 16-17 years - 2,5% of body mass (about 1300-1400g). To 2 years the child’s 2,5% of body mass (about 1300-1400g). To 2 years the child’s brain mass is equal to that of an adult person. Different areas of brain mass is equal to that of an adult person. Different areas of the brain develop unevenly (frontal and parietal parts develop the brain develop unevenly (frontal and parietal parts develop more quickly than temporal and occipital parts). In newborns and more quickly than temporal and occipital parts). In newborns and preschool children the brain is shorter and wider. Up to 4 years preschool children the brain is shorter and wider. Up to 4 years the growth of the brain in length, width and height is almost the growth of the brain in length, width and height is almost even, and from 4 to 7 the most intensive is the growth of its even, and from 4 to 7 the most intensive is the growth of its height.height.

Concerning the chemical composition of the brain tissue the Concerning the chemical composition of the brain tissue the early age is characterized by gelatin like consistency, a large early age is characterized by gelatin like consistency, a large amount of water, less contents of lipids and fats. With age the amount of water, less contents of lipids and fats. With age the water amount decreases, accumulation of lipids, proteins, water amount decreases, accumulation of lipids, proteins, especially cerebrosides takes place. The consistency becomes especially cerebrosides takes place. The consistency becomes solid. solid. The cells of brain cortex in newborns keep the embryonic The cells of brain cortex in newborns keep the embryonic character of structure up to 5 months of life. There are about character of structure up to 5 months of life. There are about 14-16 mld of them. They are characterized by the large 14-16 mld of them. They are characterized by the large nucleus, a large number of nucleic acids, absence of dendrites. nucleus, a large number of nucleic acids, absence of dendrites. In pyramid cells and black substance there is no pigment. The In pyramid cells and black substance there is no pigment. The cells of Purkine are absent. In older age children gradual cells of Purkine are absent. In older age children gradual maturation of cells takes place, their number is the same as at maturation of cells takes place, their number is the same as at birth. In 3 months Purkine cells appear.birth. In 3 months Purkine cells appear.

The structure of neuron in The structure of neuron in older age children and adultsolder age children and adults

NucleusNucleus

AxonAxon

Dendrites Dendrites

Peculiarities of central nervous system (CNS) Peculiarities of central nervous system (CNS) at an early ageat an early age

For the moment of birth of the child 25% of For the moment of birth of the child 25% of the whole number of all types of cells of the the whole number of all types of cells of the nervous system are formed (neurons – nervous system are formed (neurons – almost about 100%), to 6 months - 66%, to almost about 100%), to 6 months - 66%, to the end of the 1the end of the 1stst year -90-95%; year -90-95%;Neurons in newborns are less in sizes, they Neurons in newborns are less in sizes, they have less surface covered with synapses have less surface covered with synapses and lower potential of rest, axons are shorter and lower potential of rest, axons are shorter and their diameter also is less;and their diameter also is less;

Peculiarities of central nervous Peculiarities of central nervous system (CNS) at an early agesystem (CNS) at an early age

Energetic supply of neurons (ATF) is Energetic supply of neurons (ATF) is imperfect, during lasting activity soon imperfect, during lasting activity soon exhaustion takes place;exhaustion takes place;Amplitude of electrical potential of neurons Amplitude of electrical potential of neurons action is less, refraction phase is longer. A action is less, refraction phase is longer. A nerve fiber of a newborn can take in 1 sec not nerve fiber of a newborn can take in 1 sec not more than 4-10 impulses (in adults -300-more than 4-10 impulses (in adults -300-1000);1000);

Peculiarities of central nervous Peculiarities of central nervous system (CNS) at an early agesystem (CNS) at an early age

In newborns and children of an early age there is increased In newborns and children of an early age there is increased amount of water in nervous cells and intercellular spaces. amount of water in nervous cells and intercellular spaces. Relatively high contents of liquid - “physiological Relatively high contents of liquid - “physiological hydrocephaly”, lateral ventricles are larger and widened, hydrocephaly”, lateral ventricles are larger and widened, Silwey water tube is wider than in adults; Silwey water tube is wider than in adults; - With age in cells the contents of nucleoproteids becomes - With age in cells the contents of nucleoproteids becomes less and increase of the contents of proteins, nucleic acids, less and increase of the contents of proteins, nucleic acids, lipoproteids takes place.lipoproteids takes place.

For the first year of life the total amount of lipids increases 3 times, and the level of cerebrolysins - 10 times.

Peculiarities of the central nervous Peculiarities of the central nervous system (CNS) in childrensystem (CNS) in children

The need of the cells of the brain in oxygen is The need of the cells of the brain in oxygen is 20 times larger than that of muscular tissues, 20 times larger than that of muscular tissues, so there is increased sensitivity of brain cells so there is increased sensitivity of brain cells to oxygen starvation, action of toxic to oxygen starvation, action of toxic substances, high intracranial pressure. substances, high intracranial pressure. Chronic hypoxia, intoxications, hydrocephaly Chronic hypoxia, intoxications, hydrocephaly lead to accumulation of degenerative lead to accumulation of degenerative processes in the nervous cells and in the processes in the nervous cells and in the future - to their atrophy and death. future - to their atrophy and death.

Morphological differentiation of Morphological differentiation of nervous cellsnervous cells

- the growth of axons;- their myelinization;- branching of dendrites;- formation of interneural synapses. The process of differentiation of nerve cells actually is completed up to 3 years.

Embryogenesis of the nervous Embryogenesis of the nervous systemsystem

The starting up of the nervous system takes place in the The starting up of the nervous system takes place in the first week of intrauterine development from the external first week of intrauterine development from the external sheet of the ectoderm with a shape of modular plate, sheet of the ectoderm with a shape of modular plate, and further on - modular tube. and further on - modular tube. In the 4-5 week of intrauterine development begins In the 4-5 week of intrauterine development begins organogenesis and differentiation of the nervous system.organogenesis and differentiation of the nervous system.From the nerve tube at first 3 and then 5 brain vesicles From the nerve tube at first 3 and then 5 brain vesicles are composed, from which during 2-3 months all the are composed, from which during 2-3 months all the sections of the brain are formed. sections of the brain are formed.

Embryogenesis of the Embryogenesis of the nervous systemnervous system

For the protection and nutrition the For the protection and nutrition the brain rests in cerebrospinal fluid brain rests in cerebrospinal fluid (liquor), which begins to circulate from (liquor), which begins to circulate from the 3the 3rdrd month of intrauterine period month of intrauterine period..

For the early age is characteristic high permeability of For the early age is characteristic high permeability of hematoencephalic barrier, less marked cerebral sulci and hematoencephalic barrier, less marked cerebral sulci and gyri of the cortex, absence of many of them. To 7 years sulci gyri of the cortex, absence of many of them. To 7 years sulci become deep, longer, branching up; the gyri - convex, become deep, longer, branching up; the gyri - convex, wide, massive; increases the number of tertiary sulci. wide, massive; increases the number of tertiary sulci. In newborn children a grey substance of the brain cortex is In newborn children a grey substance of the brain cortex is not separated from the white one, because the nervous not separated from the white one, because the nervous cells are localized in the limits of white substance. But cells are localized in the limits of white substance. But beginning with 3 years there is a strict differentiation of beginning with 3 years there is a strict differentiation of cortical cells. In 8 years the cortex is little difference of the cortical cells. In 8 years the cortex is little difference of the cortex of an adult person, but morphological formation lasts cortex of an adult person, but morphological formation lasts up to 22-25 years. up to 22-25 years.

Morphological peculiarities of the brain  

Morphological peculiarities of the brainMorphological peculiarities of the brain In the nerve fibers and cerebral cells of a newborn child myelinization is In the nerve fibers and cerebral cells of a newborn child myelinization is absent and begins after the birth. The most intensive process of absent and begins after the birth. The most intensive process of myelinizaton takes pace from the end of the 1myelinizaton takes pace from the end of the 1stst year - at the beginning year - at the beginning of the 2nd year of life. The process is finished by 3-5 years. The rate of of the 2nd year of life. The process is finished by 3-5 years. The rate of going of nervous impulses along unmyelinated fibres is 0,6-2m/sec, going of nervous impulses along unmyelinated fibres is 0,6-2m/sec, when along the myelinated fibres it is - from 10-15 to 15-35m/sec.when along the myelinated fibres it is - from 10-15 to 15-35m/sec.The major part of the cerebral cortex of a newborn is composed of 6 The major part of the cerebral cortex of a newborn is composed of 6 layers. The development of neurons in large hemispheres precedes layers. The development of neurons in large hemispheres precedes the appearance of sulci and gyri. In the first months of life neurons are the appearance of sulci and gyri. In the first months of life neurons are not only in grey but also in the white substance and already by 3 years not only in grey but also in the white substance and already by 3 years the structure of neurons is of little difference of neurons of an adult. the structure of neurons is of little difference of neurons of an adult. The brain cortex supplies the high regulation of all life supplying The brain cortex supplies the high regulation of all life supplying systems of the organism, and also complicated forms of speech and systems of the organism, and also complicated forms of speech and thinking activity. thinking activity.

Morphological peculiarities of Morphological peculiarities of the brainthe brain

Cerebellum of prolonged shape is located high. Cerebellum of prolonged shape is located high. Differentiation of its cortex takes place in 9-11 months, Differentiation of its cortex takes place in 9-11 months, due to this the child starts better orient in the space, due to this the child starts better orient in the space, coordination of his movements becomes better. A full coordination of his movements becomes better. A full formation of the cellular structures of cerebellum finishes formation of the cellular structures of cerebellum finishes by 7-8 years. by 7-8 years. Medulla oblongata is the most developed of all structures Medulla oblongata is the most developed of all structures of the brain. Due to this in a newborn are well expressed of the brain. Due to this in a newborn are well expressed vegetative reactions, which secure functions of vegetative reactions, which secure functions of breathing, blood circulation, digestion, etc.breathing, blood circulation, digestion, etc.

Morphological peculiarities Morphological peculiarities of the spinal cordof the spinal cord

The structure of the spinal cord is more completed and functionally The structure of the spinal cord is more completed and functionally mature in comparison with other sections of the CNS. Cerebrospinal mature in comparison with other sections of the CNS. Cerebrospinal reflexes are formed earlier than reflexes of the brain. reflexes are formed earlier than reflexes of the brain. The mass of spinal cord in a newborn comprises 2-6g, by 5 years it is The mass of spinal cord in a newborn comprises 2-6g, by 5 years it is doubled, by 20 years increases 8-9 times. Spinal cord comprises 1% doubled, by 20 years increases 8-9 times. Spinal cord comprises 1% of the mass of the brain in newborns and 2% in children of older age. of the mass of the brain in newborns and 2% in children of older age. The length of spinal cord is different in children of different ages: in The length of spinal cord is different in children of different ages: in newborns it finishes on the level of II-III lumbar vertebra, in the older newborns it finishes on the level of II-III lumbar vertebra, in the older age - on the level of I-II lumbar vertebra. The length of the spinal cord age - on the level of I-II lumbar vertebra. The length of the spinal cord in children is relatively larger than in adults. Cervical and lumbar in children is relatively larger than in adults. Cervical and lumbar thickening of spinal cord is absent. They start to express from 3 years thickening of spinal cord is absent. They start to express from 3 years age. Myelinization of pyramidal way begins in the newborn period and age. Myelinization of pyramidal way begins in the newborn period and is completed by 4 years of age.is completed by 4 years of age.

1-Arachnoidal granulations, 2 - Chorioidal plexus, 3-A duct, connecting lateral ventricles, 4 - the third ventricle, 5-”Silvi-duct”, 6-the forth ventricle and Luschka foramen, 7- Foramen Magendi

Circulation of liquor in children

Indices of cerebrospinal fluid in children of different agesIndices of cerebrospinal fluid in children of different agesIndices

Color and transparency

Pressure, mm H2O

Amount of Liquor, ml

Cytosis in1 mcl

Type of cells

Protein, g/L

Pandi reaction

Sugar,mmol/L

Newborns

Xantochromic,transparent

50-60

5

To 15-20

Lymphocytes,Isolated neutrophils

0,35-0,5

+or ++

1,7-3,9

1-3 months Colorless, transparent

50-100

40

To 8-10

Lymphocytes

0,2-0,45 +

2,2-3,9

4-6 months

Colorless, transparent

50-100

60

To 8-10

Lymphocytes

0,18-0,35

- or +

2,2-4,4

Over 6 months

Colorless, transparent

80-150

100-200

To 3-5

Lymphocytes

0,16-0,25 -

2,2-4,4

Functional peculiarities of CNS Functional peculiarities of CNS in childrenin children

In children of an early age is characteristic functional In children of an early age is characteristic functional weakness of the nervous system. Impulses, coming weakness of the nervous system. Impulses, coming from receptors, cause lasting, sometimes unlimited from receptors, cause lasting, sometimes unlimited inhibition. The main vital functions of a newborn are inhibition. The main vital functions of a newborn are regulated by diencephalon (thalamopalidary system’s regulated by diencephalon (thalamopalidary system’s pericortical centers).pericortical centers). As far as maturation of the cortex goes on movements As far as maturation of the cortex goes on movements become more strict, purposeful; subcortical nodes stay become more strict, purposeful; subcortical nodes stay as regulators of the tone of muscular groups.as regulators of the tone of muscular groups.

Functional peculiarities of CNS Functional peculiarities of CNS in childrenin children

To the moment of birth the sense organs are structurally formed, To the moment of birth the sense organs are structurally formed, but functionally immature.but functionally immature.The organs of vision and hearing are laid up and develop in parallel The organs of vision and hearing are laid up and develop in parallel with the development of CNS. In newborns is observed with the development of CNS. In newborns is observed physiological photophobia (the first 2 weeks), heterotropia (1physiological photophobia (the first 2 weeks), heterotropia (1stst-2-2ndnd month) nystagmus; absence of widening of pupils under strong month) nystagmus; absence of widening of pupils under strong painful irritants (in the 1painful irritants (in the 1stst year of life), low keenness of sight (0,02- in year of life), low keenness of sight (0,02- in first half year; 0,1 - up to 1 year; 1,0 - to 5 years).first half year; 0,1 - up to 1 year; 1,0 - to 5 years).Taste organ functions already at the time of birth, to 4,5 months it is Taste organ functions already at the time of birth, to 4,5 months it is differentiated completely. Strict odors are differentiated by the baby differentiated completely. Strict odors are differentiated by the baby in the first months of life. Touch organ, a feeling enough in the first months of life. Touch organ, a feeling enough differentiated, because irritation of the skin causes in a child a differentiated, because irritation of the skin causes in a child a general reaction, like uneasiness. On pain irritation a baby reacts general reaction, like uneasiness. On pain irritation a baby reacts with local and general reaction.with local and general reaction.

Methods of nervous system Methods of nervous system examinationexamination

During examination of the nervous system are widely used During examination of the nervous system are widely used special methods, which help to assess the state and special methods, which help to assess the state and function of separate structural formations of the nervous function of separate structural formations of the nervous system, and also instrumental methods.system, and also instrumental methods.Examination of the position of the baby.Examination of the position of the baby.Examination of the head.Examination of the head.Examination of cranial nerves.Examination of cranial nerves.Examination of physiological reflexes.Examination of physiological reflexes.Examination of tendinous reflexes.Examination of tendinous reflexes.Methods of examination of vegetative nervous system.Methods of examination of vegetative nervous system.

Instrumental methods of CNS Instrumental methods of CNS examinationexamination

Craniography – is used for determining the defects of the cranial bones, changes Craniography – is used for determining the defects of the cranial bones, changes in its internal shape, pathological disturbances in the brain, congenital failures of in its internal shape, pathological disturbances in the brain, congenital failures of development. In specialized institutions often are used methods of contrast X-Ray development. In specialized institutions often are used methods of contrast X-Ray of the brain and spinal cord. Pneumoencephalography, ventriculo- ; angiograpgy.of the brain and spinal cord. Pneumoencephalography, ventriculo- ; angiograpgy.Exoencephalography- based on the ability of intracranial structures, which have Exoencephalography- based on the ability of intracranial structures, which have different acoustic resistance, partially beat off directed on them ultrasound. different acoustic resistance, partially beat off directed on them ultrasound. Neurosonography.Neurosonography.Ultrasound dopplerography.Ultrasound dopplerography.Electroencephalography.Electroencephalography.Reoencephalography – registration of changes of electrical resistance of the brain Reoencephalography – registration of changes of electrical resistance of the brain during going on through it changing current of high frequency and low during going on through it changing current of high frequency and low power. power. Electrical resistance and conductivity of tissues depend on their blood Electrical resistance and conductivity of tissues depend on their blood filling, so this method is directed on the study of cerebral blood filling, so this method is directed on the study of cerebral blood circulation.circulation.Computerized tomography, nuclear-magnetic resonance tomography – Computerized tomography, nuclear-magnetic resonance tomography – for diagnostics of tumors, abscesses, hematomas.for diagnostics of tumors, abscesses, hematomas.

Neurovisualization of brain structures with a method of magnetic resonance tomography (MRT)

Neurovisualization of brain structures with a method of magnetic resonance tomography (MRT)

Patient C., 2 months. Sagittal projection of the brain.Patient C., 2 months. Sagittal projection of the brain. Grey and white substance of the brain have no differentiation. Grey and white substance of the brain have no differentiation.

Hypoplasia of cerebellum. Hypoplasia of cerebellum.

Hemimegalencephaly - uneven enlargement of the sizes of Hemimegalencephaly - uneven enlargement of the sizes of brain hemispheres, occipital lobe is located to the right of brain hemispheres, occipital lobe is located to the right of

medial line in 1,8 cm.medial line in 1,8 cm.  

Laboratory methods of researchLaboratory methods of research

general blood analysisgeneral blood analysislumbar puncture lumbar puncture

Methods of investigation of Methods of investigation of vegetative nervous systemvegetative nervous system

investigation of local dermographism. investigation of local dermographism. Hachure Hachure irritation of the skin is done with a dull subject. In 5-irritation of the skin is done with a dull subject. In 5-20 sec on the site of irritation appear lines with the 20 sec on the site of irritation appear lines with the color which depends on the vascular reaction. color which depends on the vascular reaction. White dermographism indicates on the increased White dermographism indicates on the increased tone of sympathetic section of nervous system, red tone of sympathetic section of nervous system, red color - parasympathetic. White dermographism color - parasympathetic. White dermographism disappears earlier (in 8-10 sec), the red one can be disappears earlier (in 8-10 sec), the red one can be wide and lasts up to 3 min and more. wide and lasts up to 3 min and more.   

It is important to remember !!!It is important to remember !!!

A general mental development of a A general mental development of a

child in 50% is going on in the first 4-5 child in 50% is going on in the first 4-5

years of life; in 30%- from 5 to 8 years; years of life; in 30%- from 5 to 8 years;

the resting 20% - from 8 to 17 yearsthe resting 20% - from 8 to 17 years of of

age.age.

Syndrome of consciousness Syndrome of consciousness disordersdisorders

Some kinds of consciousness disorders are Some kinds of consciousness disorders are differentiated:differentiated:- Dizziness- Dizziness - the most widespread kind of paroxysmal - the most widespread kind of paroxysmal violation of consciousness.Mechanism – acute violation violation of consciousness.Mechanism – acute violation of cerebral blood circulation with the development of of cerebral blood circulation with the development of deep hypoxia. Characteristic are: loss of consciousness; deep hypoxia. Characteristic are: loss of consciousness; sharp paleness of skin covering; slow respiration.sharp paleness of skin covering; slow respiration.- Somnolency- Somnolency – the baby is lying with closed eyes – the baby is lying with closed eyes unchanging the position forunchanging the position for long time. Contact is long time. Contact is possible with the use of sharp and strong irritation possible with the use of sharp and strong irritation (bright light, strong sound). (bright light, strong sound).

Syndrome of consciousness Syndrome of consciousness disordersdisorders

- Sopor- - Sopor- a sick child is lying still, amimical, a sick child is lying still, amimical, does not react on irritations. does not react on irritations.

Unconditioned reflexes are kept.Unconditioned reflexes are kept.

Coma –Coma – a full loss of consciousness, absence of a full loss of consciousness, absence of active movements, loss of sense, loss of active movements, loss of sense, loss of reflectory functions, absence of reaction on reflectory functions, absence of reaction on external stimuli, violation of respiration, external stimuli, violation of respiration, cardiovascular system activity and homeostasis. cardiovascular system activity and homeostasis.

Hydrocephaly syndromeHydrocephaly syndromeThis is enlargement of ventricular system of the brain and This is enlargement of ventricular system of the brain and subarachnoidal areas due to enlarged amount of liquor. Liquor in subarachnoidal areas due to enlarged amount of liquor. Liquor in the brain is connected with its hyperproduction and disorder of its the brain is connected with its hyperproduction and disorder of its resorption. Disorder of liquorodynamics can be connected with resorption. Disorder of liquorodynamics can be connected with anomalies of the CNS, inflammation of meninges, traumas.anomalies of the CNS, inflammation of meninges, traumas.The main clinical symptoms are: enlargement of the head volume, The main clinical symptoms are: enlargement of the head volume, thinning of the bones of the skull. Paresis, tremor of extremities, thinning of the bones of the skull. Paresis, tremor of extremities, atrophy of visual nerve and some others. There is decrease of atrophy of visual nerve and some others. There is decrease of protein in the liquor.protein in the liquor.Hydrocephaly can be congenital and acquired. In congenital Hydrocephaly can be congenital and acquired. In congenital hydrocephaly there are multiple anomalies of the facial skeleton: hydrocephaly there are multiple anomalies of the facial skeleton: facial skeleton is decreased, the forehead is high. There is marked facial skeleton is decreased, the forehead is high. There is marked vascular reticulum, the skin is thin, stretched. The child is lagging vascular reticulum, the skin is thin, stretched. The child is lagging in psychic development. At the same time there can be high in psychic development. At the same time there can be high development of some psychic functions: mechanical memory, development of some psychic functions: mechanical memory, talent to music, drawing, etc.talent to music, drawing, etc.

HydrocephalyHydrocephaly

CraniostenosisCraniostenosisPre-time closing of osteo and parietal sutures leading to Pre-time closing of osteo and parietal sutures leading to decrease of the skull, its deformation, high intracranial decrease of the skull, its deformation, high intracranial pressure. Is met very frequently - 1:1000.pressure. Is met very frequently - 1:1000.Pathogenesis - violation of metabolism, causing Pathogenesis - violation of metabolism, causing accelerated bony synthesis, violation of vascularization accelerated bony synthesis, violation of vascularization of bones and meninges.of bones and meninges.Clinical picture - headaches, congestion phenomena in Clinical picture - headaches, congestion phenomena in eye bottom. Exophthalm can take place. Convulsions, eye bottom. Exophthalm can take place. Convulsions, high liquor pressure – up to 500mm/Hg..high liquor pressure – up to 500mm/Hg..

Craniostenosis -Craniostenosis - in craniogram marked in craniogram marked thinning of the bones of the skull with thinning of the bones of the skull with increased finger like grooves is seenincreased finger like grooves is seen

Encephalitic syndromeEncephalitic syndrome..

Develops as a consequence of encephalitis - Develops as a consequence of encephalitis - inflammation of the brain. In this inflammatory changes inflammation of the brain. In this inflammatory changes in neurons and nerve fibers take place. Disorder of the in neurons and nerve fibers take place. Disorder of the brain can be the result of toxic or allergic disorder of the brain can be the result of toxic or allergic disorder of the walls of cranial vessels. walls of cranial vessels. Etiologic factor - viruses or microorganisms. Etiologic factor - viruses or microorganisms. Clinical picture - headaches, vomiting, failure of Clinical picture - headaches, vomiting, failure of cardiovascular and respiratory systems. High arterial cardiovascular and respiratory systems. High arterial pressure. Psychic disturbances can also be present.pressure. Psychic disturbances can also be present.

Meningeal syndromeMeningeal syndromeThis syndrome can develop in meningitis. Meningitis are This syndrome can develop in meningitis. Meningitis are differentiated as purulent (meningococcus, differentiated as purulent (meningococcus, pneumococcus) and serous (viral). pneumococcus) and serous (viral). Clinic - headaches, vomiting, hyperestasis, stress, Clinic - headaches, vomiting, hyperestasis, stress, pulsation of a large vertex.pulsation of a large vertex.Positive meningeal symptoms of Kerning, rigidity of Positive meningeal symptoms of Kerning, rigidity of occipital muscles. upper, medium and lower of occipital muscles. upper, medium and lower of Brudzinski, Lesazh, Bechterev (in percussion of Brudzinski, Lesazh, Bechterev (in percussion of zygomatic arc headache increases and pain grimace zygomatic arc headache increases and pain grimace appears on the face).appears on the face).

Syndrome of neurotoxicosisSyndrome of neurotoxicosis

Meningeal syndrome can be observed Meningeal syndrome can be observed also in neurotoxicosis - unspecific reaction also in neurotoxicosis - unspecific reaction of CNS on toxins, which are in the of CNS on toxins, which are in the organism. Most frequently this syndrome organism. Most frequently this syndrome develops in children of an early age due to develops in children of an early age due to excessive permeability of hemato-excessive permeability of hemato-encephalic barrier.encephalic barrier.

Children’s cerebral paralysis Children’s cerebral paralysis (CCP)(CCP)

The name comes from that in CCP the moving activity is The name comes from that in CCP the moving activity is violated. Besides, hearing, eyesight are decreased. There violated. Besides, hearing, eyesight are decreased. There are defects in speech, lagging in psychic development.are defects in speech, lagging in psychic development.CCP can be: spastic, dyskinetic, ataxic, mixed.CCP can be: spastic, dyskinetic, ataxic, mixed.Spastic type of CCP Spastic type of CCP – strong contraction of muscles is – strong contraction of muscles is prevailing. Mostly are violated the lower extremities. There prevailing. Mostly are violated the lower extremities. There is crossing of the legs.is crossing of the legs.Little syndrome Little syndrome - spastic diplegia is the most - spastic diplegia is the most widespread type of CCP. Frequent disturbance of the widespread type of CCP. Frequent disturbance of the lower extremities. The baby cannot take a toy. Psychic lower extremities. The baby cannot take a toy. Psychic development is violated.development is violated.

Children’s cerebral paralysis Children’s cerebral paralysis (CCP)(CCP)

Diskinetic type of CCP Diskinetic type of CCP – presence of quick , – presence of quick , uncoordinated movementpurpousless movements, uncoordinated movementpurpousless movements, accompanied with increase of muscular tone. Clinical accompanied with increase of muscular tone. Clinical manifestation mostly concerns the upper extremities. manifestation mostly concerns the upper extremities. Partial manifestations -tremor, rigidity, dystonia. In Partial manifestations -tremor, rigidity, dystonia. In dystonia there is hypertension of muscles, especially of dystonia there is hypertension of muscles, especially of the trunk muscles.the trunk muscles.- - Ataxic type of CCP - violation of coordination, Ataxic type of CCP - violation of coordination, nistagm.nistagm.- In the mixed type in patients - In the mixed type in patients there is combination of there is combination of several types of disorders, characteristic of cerebral several types of disorders, characteristic of cerebral paralysis.paralysis.

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