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"lead": "Дизартрия (из др.-греч. δυσ- — приставка, означающая затруднённость, расстройство + ἀρθρόω — «сочленяю, соединяю») — нарушение произносительной стороны речи, обусловленное недостаточностью иннервации речевого аппарата. При дизартрии, в отличие от афазии, ограничена подвижность органов речи (мягкого нёба, языка, губ), из-за чего затруднена артикуляция. У взрослых дизартрия не сопровождается распадом речевой системы: нарушением восприятия речи на слух, чтения, письма. В детском же возрасте дизартрия нередко приводит к нарушению произнесения слов и, как следствие, к нарушению чтения и письма, а иногда к общему недоразвитию речи. Выявление дизартрии требует неврологического обследования, по результатам которого назначаются лечение и логопедическая коррекция.Дизартрия не является самостоятельным заболеванием, хотя у некоторых больных может быть наиболее заметным проявлением поражения нервной системы. Наблюдается при травмах и опухолях нервной системы, нарушениях мозгового кровообращения, нейроинфекциях, демиелинизирующих заболеваниях и др. У детей дизартрия часто сочетается с другими проявлениями дизонтогенеза, вызванного действием пре- и перинатальных факторов, входит в структуру нарушений при детских церебральных параличах.Значительное нарушение звукопроизношения легко распознаётся, поскольку речь смазанная, глухая, часто с носовым оттенком («Говорит, как с кашей во рту»). Лёгкие нарушения артикуляции выявляются при специальном логопедическом обследовании.Форма дизартрии зависит от места поражения нервной системы. Предложены разные классификации дизартрий, однако основной и наиболее распространённой в мире является клинико-неврологическая классификация, предполагающая выделение 6 форм (и одной смешанной):\r\n\r\nвялая — обусловлена периферическим парезом или параличом мышц, принимающих участие в артикуляции, вследствие поражения языкоглоточного, блуждающего и подъязычного нервов и/или их ядер, а также нарушения нервно-мышечной передачи. Часто сочетается с расстройствами глотания. Является одной из составляющих бульбарного синдрома;\r\nспастическая — обусловлена двусторонним центральным парезом или параличом мышц, иннервируемых языкоглоточным, блуждающим и подъязычным нервами, вследствие двустороннего поражения передних центральных извилин и/или корково-ядерных путей. Является одной из составляющих псевдобульбарного синдрома;\r\nодносторонняя верхнемотонейронная — обусловлена преимущественно односторонним центральным парезом или параличом мышц, иннервируемых языкоглоточным, блуждающим и подъязычным нервами, вследствие одностороннего поражения передних центральных извилин и/или корково-ядерных путей;\r\nатактическая — обусловлена поражением мозжечка или его проводящих путей; характеризуется растянутой, скандированной речью с нарушением модуляции и меняющейся громкостью;\r\nгиперкинетическая — вид экстрапирамидной дизартрии, возникающий при поражении подкорковых узлов и их нервных связей. Является одним из вариантов гиперкинезов, часто сочетается с гиперкинезами другой локализации. Речь смазанная, невнятная с носовым оттенком, резко нарушена просодика, интонационно-мелодическая структура речи, её темп;\r\nгипокинетическая — вид экстрапирамидной дизартрии, возникающий при поражении подкорковых узлов и их нервных связей. Чаще всего наблюдается при паркинсонизме, характеризуется замедленной невыразительной речью, нарушениями модуляции голоса;\r\nсмешанная — часто наблюдается при травмах нервной системы, диффузном и многоочаговом её поражении, когда имеет место сочетание разных механизмов дизартрии.Диагноз дизартрии (МКБ-10: R47.1) устанавливается врачом (как правило, невропатологом). При этом учитывается заключение логопеда. Логопед, в свою очередь, исследует не только особенности и характеристики нарушения звукопроизношения, но и все другие стороны речи.Поскольку дизартрия не является самостоятельным заболеванием и может наблюдаться при многих расстройствах нервной системы, содержание и очерёдность лечебных мероприятий определяются врачом после установления клинического диагноза, с учётом возраста и состояния больного. Во многих случаях требуется комплексное (лечебное и логопедическое) воздействие.\r\n\r\nВ детской логопедической практике важная роль отводится общему развитию всех сторон речи: словаря, грамматического строя, фонематического слуха, поскольку дети, страдающие дизартрией, испытывают в школьные годы трудности в усвоении письменной речи. В некоторых случаях целесообразно обучение таких детей в дошкольном периоде в логопедических группах детского сада.",
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},
"code": "G80",
"name": "Детский церебральный паралич",
"icd_name": "Детский церебральный паралич",
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3,
0,
1
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"slug": "g80_detskiy_cerebralnyy_paralich",
"lead": "заболевание, сопровождающееся отсутствием произвольных движений в конечностях у детей",
"description": "",
"etiology": "<p>Если есть <a href=\"/symptom/parez/\" title=\"Перейти на страницу симптома Парез\">парез</a> или <a href=\"/symptom/paralich/\" title=\"Перейти на страницу симптома Паралич\">паралич</a>, надо определить, где произошло повреждение – в коре головного мозга или в нервных клетках спинного мозга. Повреждение центрального двигательного нейрона в коре головного мозга приводит к развитию центрального спастического паралича.</p>\r\n<p> </p>\r\n<p>При повреждении двигательных клеток передних рогов головного мозга развивается картина периферического вялого пареза или паралича конечности. Основная причина ДЦП – перинатальные повреждения центральной нервной системы.</p>",
"pathogenesis": "",
"diagnostics": "<p>Диагноз ставит детский невролог на основании исследования: </p>\r\n<ol>\r\n<li>Рефлексов;</li>\r\n<li>Мышечного тонуса;</li>\r\n<li>Речевого и психического развития;</li>\r\n<li>Данных инструментальных методов диагностики:</li>\r\n</ol>\r\n<ul>\r\n<li>МРТ или нейросонографии;</li>\r\n<li>ЭЭГ;</li>\r\n<li>электромиографии.</li>\r\n</ul>\r\n<p>В диагностике участвуют и другие специалисты: офтальмолог, психиатр, ЛОР, ортопед, эпилептолог. Обязательна консультация генетика, в некоторых случаях – инфекциониста.</p>",
"treatment": "<p>Терапия должна начинаться рано, чтобы «приучить» мозг к нормальным сигналам от конечностей и туловища, развить те участки мозга, которые ответственны за речь, выполнение целенаправленных действий.</p>\r\n<p>Применяются:</p>\r\n<ol>\r\n<li>Массаж;</li>\r\n<li>ЛФК;</li>\r\n<li>Гравитационные приспособления;</li>\r\n<li>Физиотерапия;</li>\r\n<li>Работа с логопедом, психологом;</li>\r\n<li>Медикаментозная коррекция спастических нарушений, судорог, психических нарушений;</li>\r\n<li>Хирургическая коррекция сухожильных, костных, мышечных нарушений;</li>\r\n<li>Операции на структурах подкорки, стимуляция спинного мозга;</li>\r\n<li>Санаторно-курортное лечение.</li>\r\n</ol>\r\n<p>Прогноз</p>\r\n<p>ДЦП – неизлечимое заболевание. При значительном поражении мозга оно может приводить к глубокой инвалидности, в некоторых случаях больные могут учиться в обычных школах, ВУЗах, работать.</p>",
"prevention": "<p>Важно раннее выявление, наблюдение за группами риска (наличие хронической артериальной гипертензии, ожирения, хронического пиелонефрита у женщины) и адекватная терапия плацентарной недостаточности (с развитием или без развития гестоза) — как одной из самых частых причин, выбор надлежащего способа ведения родов</p>",
"clinical_picture": "<p>Различают монопарезы или монопараличи одной конечности, гемипарезы или параличи (поражение одной руки и ноги с одной стороны), верхний парапарез (<a href=\"/symptom/paralich/\" title=\"Перейти на страницу симптома Паралич\">паралич</a> обеих рук), нижний парапарез (поражение обеих ног), тетрапарез (<a href=\"/symptom/paralich/\" title=\"Перейти на страницу симптома Паралич\">паралич</a> и ног, и рук).</p>\r\n<p>Симптомами спастического пареза являются повышение мышечного тонуса, высокие сухожильные рефлексы, патологические стопные знаки.</p>\r\n<p>Вялые парезы и параличи характеризуются понижением мышечного тонуса, снижением сухожильных рефлексов с последующей атрофией мышц. При вялом парезе поражаются самые нижние отделы кисти, характерны поза «тюленьих» лапок, когда обе кисти свисают, «поза лягушки» – ноги распадаются в стороны, симптом отпадающей стопы, симптом пяточных стоп. Спастические парезы и параличи сопровождаются крепко сжатыми в кулачок руками, руки согнуты в локтевых суставах, отмечается тугоподвижность в конечностях, при пробе на разведение ног отмечается повышение тонуса в ногах, в тяжелых случаях ноги совсем не разводятся, туго приведены друг к другу и даже заходят одна за другую (симптом перекреста). Очень важным симптомом является симптом цыпочек. При постановке ребенка на ноги ребенок встает на цыпочки, нередко перекрещивает ноги. Симптом цыпочек сохраняется очень долго, при грубых параличах остается практически навсегда, иногда это мешает ходить.</p>",
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"description": "Гемиплегия – неврологический синдром, проявляющийся полным отсутствием произвольных движений в верхней и нижней конечности на одной стороне. ",
"etiology": "<p>К органическим причинам гемиплегии относятся: </p>\r\n<ul>\r\n<li>Нарушение кровообращения головного мозга (кровоизлияние в мозг, спазм сосудов мозга, тромбоз мозговых сосудов);</li>\r\n<li>Воспалительные заболевания головного мозга (абсцесс мозга, арахноидит);</li>\r\n<li>Опухоли головного мозга; </li>\r\n<li>Нарушение обусловлено повреждением двигательной пирамидной системы мозга. </li>\r\n</ul>\r\n<p>Функциональная гемиплегия вызвана истерией и является симптомом диссоциативного расстройства. </p>\r\n<p>К факторам риска гемиплегии относятся: </p>\r\n<ul>\r\n<li>Заболевания сердца и сосудов в пожилом возрасте;</li>\r\n<li>Травмы мозга в анамнезе;</li>\r\n<li>Роды с осложнениями (риск для детей);</li>\r\n<li>Заболевания крови;</li>\r\n<li>Переедание;</li>\r\n<li>Алкогольная и наркотическая зависимость, курение.</li>\r\n</ul>",
"pathogenesis": "<p>Анатомический субстрат развития гемиплегии – поражение на различных уровнях пирамидного пути, по которому передача нервного импульса осуществляется в верхне-нижнем направлении: от клеток коры головного мозга через его структуры к мотонейронам (двигательным нервным клеткам), располагающимся в передних рогах спинного мозга. </p>\r\n<p>В нижнем отделе (хвостовом, или каудальном) продолговатого мозга волокна пирамидного тракта совершают частичный перекрест, поэтому, как правило, поражение левой половины тела говорит о повреждении структур правого полушария (и наоборот, если повреждение располагается ниже перекреста – гемиплегия определяется на стороне повреждения). </p>",
"diagnostics": "<p>Поскольку патология обладает специфической симптоматикой, с установлением правильного диагноза зачастую не возникает проблем. Однако для дифференциации различных форм необходим комплексный подход. </p>\r\n<p>В первую очередь необходимо: </p>\r\n<ul>\r\n<li>ознакомиться с историей болезни – для установления основного патологического этиологического фактора; </li>\r\n<li>собрать и проанализировать жизненный анамнез – для выявления возможных причин формирования врожденной разновидности болезни; </li>\r\n<li>провести тщательный физикальный осмотр; </li>\r\n<li>осуществить комплекс неврологических тестов – таким образом специалистом осуществляется определение состояния рефлексов и мышц больной руки и ноги; </li>\r\n</ul>\r\n<p>Лабораторные исследования в данном случае включают в себя: </p>\r\n<ul>\r\n<li>общий и биохимический анализ крови; </li>\r\n<li>микроскопическое изучение спинномозговой жидкости; </li>\r\n<li>общеклинический анализ мочи. </li>\r\n</ul>\r\n<p>Инструментальных методы включают проведение: </p>\r\n<ul>\r\n<li>электромиографии; </li>\r\n<li>КТ и МРТ головного мозга – помогает отличить между собой центральную форму с альтернирующей разновидностью; </li>\r\n<li>доплерографии сосудов головного мозга; </li>\r\n<li>электроэнцефалографии; </li>\r\n<li>люмбальной пункции – для получения ликвора. </li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p>При комплексной терапии гемиплегии применяются: </p>\r\n<ul>\r\n<li>Препараты, улучшающие обменные и трофические процессы в нервной ткани; </li>\r\n<li>Нейропротекторы - это средства, которые предупреждают повреждение нейронов мозга, обусловленное действием патогенного фактора; </li>\r\n<li>Миорелаксанты - препараты, расслабляющие мускулатуру; </li>\r\n<li>Антиоксиданты - препараты, нейтрализующие окислительное действие свободных радикалов; </li>\r\n<li>ингибиторы холинэстеразы, витамигы группы В - препараты, способствующие передаче нервного импульса; </li>\r\n<li>физиотерапевтическое воздействие (массаж, электрофорез, кинезотерапия, ЛФК). </li>\r\n</ul>",
"prevention": "<p> К общим профилактическим рекомендациям относятся: </p>\r\n<ul>\r\n<li>контроль над адекватным протеканием беременности; </li>\r\n<li>полный отказ от вредных привычек; </li>\r\n<li>правильное и сбалансированное питание; </li>\r\n<li>умеренная физическая активность (ЛФК); </li>\r\n<li>избегание травм головы и спинного мозга; </li>\r\n<li>своевременное обнаружение и лечение патологических этиологических факторов (в частности, наиболее частой причины – ишемического инсульта), которые могут привести к развитию такой проблемы; </li>\r\n<li>регулярное прохождение полноценного профилактического осмотра в медицинском учреждении с посещением всех клиницистов. </li>\r\n</ul>",
"clinical_picture": "<p>Симптомы центральной гемиплегии: </p>\r\n<ul>\r\n<li>полное отсутствие активных движений в пораженных конечностях, мимических мышцах на стороне, противоположной поражению; </li>\r\n<li>спастический гипертонус мышц; </li>\r\n<li>симптом складного ножа (мышечное сопротивление при попытке пассивно согнуть конечность пациента в коленном или локтевом суставах, после преодоления начального сопротивления сгибание происходит без затруднений); </li>\r\n<li>повышение сухожильных и надкостничных рефлексов в парализованных конечностях;</li>\r\n<li>снижение брюшных рефлексов на стороне гемиплегии; </li>\r\n<li>снижение глубокой и поверхностной чувствительности (тактильной, температурной, болевой, давления); </li>\r\n<li>снижение суставных рефлексов (Лери, Майера); </li>\r\n<li>патологические рефлексы конечностей (Бабинского, Гордона, Оппенгейма, Шеффера, разгибательные Редлиха и Россолимо, Бехтерева – Менделя, Жуковского и др.); </li>\r\n<li>выявление рефлексов спинального автоматизма; </li>\r\n<li>содружественные синкинезии (непроизвольные мышечные сокращения и движения, сопутствующие активному двигательному акту). </li>\r\n</ul>\r\n<p>При периферической гемиплегии мышечный тонус понижен (возможно сочетание спастических изменений мышечного тонуса с гипотонией), рефлексы также снижены на стороне поражения. Мимические мышцы в данном случае в патологический процесс не вовлекаются. </p>",
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