Perinatal pathology of the nervous system.

Pathogenic factors:

1. Maternal diseases: pulmonary, cardiovascular diseases, infections, intoxication, toxicosis, metabolic disorders, some viruses.
2. Obstetric pathology: premature detachment of the placenta, anhydrous period, entanglement with umbilical cord, improper presentation of the placenta, narrow pelvis.
3. Obstetric manipulations: displacement, extrusion, stimulation, epidural anesthesia.
4. Chemicals, radiation, drugs ...
5. Genetic factors and chromosomal abnormalities.

Childbirth in water: violation of adaptation at all levels.

The earlier the impact of a negative factor occurred, the more pronounced the negative consequence.

The most common cases are:

Hypoxia, asphyxia of the newborn. It occurs in 4-6% of cases, the most common cause of death of newborns. Hypoxia causes gross metabolic disorders. With a long-term violation - atrophy of the medulla. It starts almost immediately. If the degree of hypoxia is medium, then dystrophic changes are noted up to 15 years.

3 stages:

1. On Apgar scale 6-7 points - cyanosis, motor anxiety, depression of the unconditioned reflex, hand tremor. The obvious signs are kept 3-4 days. Later manifested in 6-7 years.
2. Average Apgar 5-6 points. It threatens: tremor of the legs, jerking, ticking, bradycardia, cyanosis, or inhibition of or slowing down of reflexes. After 2-3 days the reflexes can be expressed too strongly: hypotonia or hypertonia.
3. Apgar 1-4 points - earthy shade, arrhythmia, breathing or shallow, or rapid, or absent. Possible seizures, tremor, reflexes are absent. Horizontal or vertical nystagmus (jumps of the pupils). Hypotension. Drowsiness may be replaced by anxiety, convulsions.

Hydrocephalus.

Expansion of the ventricular systems of the brain and subarchal spaces due to an excess amount of cerebrospinal fluid. There is either a violation of the production of fluid, or a violation of the mechanism of reverse suction. Danger - squeezing the medulla. Normal - chest + 2 cm = normal size of the head.

With changes - the phenomenon of stagnation in the fundus up to atrophy of the optic nerve. There are several forms of hydrocephalus:

1. Open and closed
2. Acute or chronic
3. Outdoor or indoor
4. Compensated (no symptoms) or decompensated (there are symptoms: convulsions, head increased in size, tremor, reflexes disturbed, impaired coordination, increased tone or tone fluctuations).

Intracranial birth injury.

In the process of childbirth. In 10-12% of cases - is the cause of death.

1. Mechanical head injury. Hazard: hematoma. Hypoxia also occurs. If between the caudate nucleus and the helix hemorrhage - vegetative-trophic functions are upset. Deep subcortical hemorrhages have very serious consequences, even death.
2. Rapid labor (normal labor last 8-12 hours). The bones of the skull are shifted too much. Often subdural hematoma. Squeezing the brain. Hypoxia increases, the cranial sutures diverge, the fontanel swells. With prematurity, intraventricular hemorrhages may occur, unconditioned reflex depression occurs, fever, nystagmus and floating movements of the eyeballs, disruption of vegetative-trophic functions. Most often fatal.
3. Prolonged labor (20 hours or a long anhydrous period). Weak generic activity. Often small multiple hemorrhages in the cerebellum, trunk, hemispheres. Inhibition of reflexes, convulsions, vomiting, epileptic seizures, ZPR varying degrees.
4. Forceps or vacuum extraction. Often in preterm or medical error. Often there is a subarchal hemorrhage. Many small vessels are torn. It looks like the symptoms of meningitis. May not appear immediately, may be in 3-4 days. Sleep, vomiting, regurgitation, increased tone, anxiety, tremor, strabismus, symptoms of increased intracranial pressure are disturbed. If there is a rupture of the vein of Galen or a direct synapse (at the base of the brain), then convulsions, breathing disorder, floating gaze, nystagmus, heart failure.

Disembryogenesis:

1. Megaloencephaly - a large number of glions, but few neurons. The mass and volume of the brain is normal or more. It occurs 1 in 5000 cases.
2. Holoprocephalus - combined with cyclopia, split lip, etc. The brain is not split into the hemispheres and the ventricles are also like one cavity.
3. Lysencephaly - a violation of the migration of neurons and they accumulate in the gray matter. The normal layer of cells is absent (the brain is smooth, without convolutions).

Often there are cases:

• PEP - perinatal encephalopathy
• NDC - neurocirculatory dystonia
• SPNRV - a syndrome of increased neuro-reflex excitability.