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"lead": "Различают врождённое (присутствует при рождении или появляется в первые 6 месяцев) и приобретённое косоглазие.\r\n\r\nЧаще всего явное косоглазие является горизонтальным: сходящееся косоглазие (convergent strabismus или esotropia) и расходящееся косоглазие (divergent strabismus или exotropia); однако иногда может наблюдаться и вертикальное (с отклонением кверху — гипертропия, книзу — гипотропия).\r\n\r\nКосоглазие, в зависимости от того, косит один или оба глаза, делится на монокулярное и альтернирующее.\r\nПри монокулярном косоглазии всегда косит только один глаз, которым человек никогда не пользуется. Зрение косящего глаза чаще всего снижено. Мозг приспосабливается таким образом, что информация считывается только с одного, не косящего глаза. Косящий же глаз в зрительном акте не участвует, поэтому его зрительные функции снижаются. Снижение зрения от функционального бездействия косящего глаза называется дисбинокулярной амблиопией. Если восстановить зрение косящего глаза невозможно, косоглазие исправляется как косметический дефект.\r\nАльтернирующее косоглазие (косит то левый, то правый глаз, при этом величина отклонения от прямого положения примерно одинаковая) характеризуется тем, что человек смотрит попеременно то одним, то другим глазом, то есть хотя и попеременно, но использует оба глаза. Амблиопия если и развивается, то в гораздо более лёгкой степени.\r\nПо причине возникновения косоглазие бывает содружественное и паралитическое.\r\nСодружественное косоглазие возникает обычно в детском возрасте. Для него характерно сохранение полного объёма движений глазных яблок, равенство первичного угла косоглазия (то есть отклонения косящего глаза) и вторичного (то есть здорового), отсутствие двоения и нарушения бинокулярного зрения.\r\nПаралитическое косоглазие обусловлено параличом или повреждением одной или нескольких глазодвигательных мышц. Оно может возникнуть в результате патологических процессов, поражающих сами мышцы, нервы или головной мозг.",
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},
"code": "I61",
"name": "Внутримозговое кровоизлияние",
"icd_name": "Внутримозговое кровоизлияние",
"gender": 0,
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"periodicity": 1,
"slug": "i61_vnutrimozgovoe_krovoizliyanie",
"lead": "Нарушение здоровья, относящееся к группе цереброваскулярные болезни",
"description": "Внутримозговое кровоизлияние - локальное кровотечение из кровеносных сосудов в пределах паренхимы мозга, обусловленное разрывом патологически изменённых стенок церебральных сосудов или просачиванием плазмы и форменных элементов сквозь стенку сосудов.",
"etiology": "<p>К предрасполагающим факторам относят:</p>\r\n<ul>\r\n<li>Аневризма сосуда – выпячивание стенки сосуда вследствие ее истончения или растяжения.</li>\r\n<li>Сосудистая мальформация – аномальное строение и коммуникации сосудов головного мозга.</li>\r\n<li>Васкулит – воспаление стенки сосуда.</li>\r\n<li>Атеросклеротическое повреждение стенки сосуда.</li>\r\n</ul>\r\n<p> </p>\r\n<p>Однако одних только предрасполагающих факторов недостаточно. Для разрыва сосуда должен воздействовать инициирующий фактор:</p>\r\n<ul>\r\n<li>гипертонический криз (часто у пожилых);</li>\r\n<li>нарушения свертываемости крови;</li>\r\n<li>ряд наркотических веществ, которые нарушают тонус сосудов;</li>\r\n<li>внутриопухолевое кровоизлияние.</li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p>Основным патогенетическим фактором кровоизлияния являются артериальная гипертензия и гипертонические кризы, при которых возникают спазмы или параличи мозговых артерий и артериол. Обменные нарушения, возникающие в очаге ишемии (сниженного кровоснабжения), способствуют дезорганизации стенок сосудов, которые в этих условиях становятся проницаемыми для плазмы и эритроцитов – так называемое диапедезное кровотечение. Одновременное развитие спазма многих сосудистых ветвей в сочетании с проникновением крови в мозговое вещество может привести к образованию обширного очага кровоизлияния, а иногда и множественных очагов. В основе гипертонического криза может быть резкое расширение артерий с увеличением мозгового кровотока, обусловленное срывом его саморегуляции при высоком артериальном давлении. В этих условиях артерии утрачивают способность к сужению и пассивно расширяются. Под повышенным давлением кровь заполняет не только артерии, но и капилляры и вены. При этом повышается проницаемость сосудов, что приводит к просачиванию плазмы крови и эритроцитов. В механизме возникновения такого диапедезного кровотечения задействовано нарушение взаимосвязи между свертывающей и противосвертывающей системами крови. В патогенезе разрыва сосудов играют роль и функционально-динамические нарушения сосудистого тонуса. Паралич стенки мелких мозговых сосудов ведет к острому нарастанию проницаемости сосудистых стенок и выходу плазмы крови из сосудистого русла.</p>",
"diagnostics": "<p>Методом выбора в диагностике внутримозгового кровоизлияния является компьютерная томография головного мозга, позволяющая не только определить наличие внутримозговой гематомы, но и оценить её локализацию, распространённость и объём, выраженность отёка мозга и степень дислокации. Для диагностики небольших гематом в стволе мозга и изоденсивных веществу головного мозга («несвежих») гематом предпочтительна магнитно-резонансная томография.</p>\r\n<p>В случае невозможности проведения компьютерной томографии при отсутствии противопоказаний проводится исследование цереброспинальной жидкости, кровь в которой может свидетельствовать о кровоизлиянии в структуры задней черепной ямки или субарахноидальном кровоизлиянии. Небольшие кровоизлияния в подкорковые структуры головного мозга проявляются наличием эритроцитов в ликворе лишь через 2—3 суток</p>",
"treatment": "<p>Лечение больных с внутримозговым кровоизлиянием делится на два больших подвида: консервативное и хирургическое.</p>\r\n<p>Консервативная терапия проводится всем больным с внутримозговым кровоизлиянием и включает в себя поддержание функции дыхательной и сердечно-сосудистой системы. Как правило, пациентам показано подключение к аппарату искусственной вентиляции легких (ИВЛ). Внимание уделяют профилактике последующей тромбоэмболии, а также лечению сопутствующих заболеваний.</p>\r\n<p>Нейрохирургическое лечение назначается после проведения компьютерной или магнитно-резонансной томографии и показано в следующих случаях:</p>\r\n<ol>\r\n<li>Локализация гематомы позволяет провести ее хирургическое удаление (поверхностное расположение в полушариях мозга, мозжечок, ствол головного мозга).</li>\r\n<li>Разрыв сосуда, обусловленный аневризмой.</li>\r\n</ol>\r\n<p>Адекватное нейрохирургическое лечение должно быть проведено в первые два дня после начала заболевания.</p>\r\n<p>Также в некоторых случаях можно выполнить декомпрессивную трепанацию черепа для снижения давления и профилактики отёка – набухания головного мозга.</p>",
"prevention": "<p>Первичная профилактика включает в себя:</p>\r\n<ul>\r\n<li>Своевременное лечиние выявленной патологии сосудов.</li>\r\n<li>Недопущение развития гипертонической болезни.</li>\r\n<li>Избавление от избыточной массы тела.</li>\r\n</ul>\r\n<p>Задача вторичной профилактики заключается в недопущении возникновения повторного кровоизлияния. Этого можно добиться современной медикаментозной терапией, хирургическим вмешательством</p>\r\n<p> </p>",
"clinical_picture": "<p>Симптомы кровоизлияния делятся на две группы: общемозговые и очаговые.</p>\r\n<p>Быстрое прогрессирование общемозговой симптоматики в самом начале говорит о неблагоприятном прогнозе, ведь параличи и другие неврологические нарушения просто не успевают развиться.</p>\r\n<p>К общемозговым симптомам относят:</p>\r\n<ol>\r\n<li>Сильную головную боль, а в случае субарахноидального кровоизлияния – резчайшую, до крика, по типу «удара».</li>\r\n<li>Тошноту и рвоту, иногда рвоту без предшествующей тошноты, «фонтаном». Это говорит о раздражении кровью ядер черепно-мозговых нервов и о резком повышении внутричерепного давления.</li>\r\n<li>Головокружение.</li>\r\n<li>Покраснение лица и конечностей, «апоплексическое» лицо.</li>\r\n<li>Постепенное угнетение сознания, сонливость, затруднение контакта, пациент «загружается», в тяжёлых случаях развивается мозговая кома.</li>\r\n<li>Появление эпилептиформных судорог, что может говорить о прорыве крови в желудочки мозга, в тяжёлых случаях – потеря сознания, появлении анизокории – расширения зрачка с одной стороны, что говорит о том, что головной мозг подвергся сдавливанию и смещению, развилось состояние его отёка – набухания. В таком случае очень вероятно вклинение миндаликов мозжечка в большое затылочное отверстие, паралич жизненно важных центров кровообращения и дыхания, расположенных в продолговатом мозге и летальный исход.</li>\r\n</ol>\r\n<p>Если пациент остался жив, ситуация стабилизирована, то через некоторое время вследствие гибели нейронов становятся заметны очаговые симптомы, которые зависят от локализации кровоизлияния. Это могут быть:</p>\r\n<ol>\r\n<li>Контралатеральные (противоположные стороне поражения) полные параличи и частичные (парезы) мышц конечностей и лица.</li>\r\n<li>Расстройства речи (афазия), как при восприятии, так и при произнесении речи. В первом случае афазия именуется сенсорной (чувствительной), во втором – моторной (двигательной). Так как речь человека чрезвычайно сложна, то чаще всего имеется сенсомоторная афазия, выраженная по-разному.</li>\r\n<li>Различные глазодвигательные расстройства (отведение яблока в сторону, т. е. нарушение взора), анизокория (зрачки разного диаметра).</li>\r\n<li>Снижение чувствительности на различных участках, нарушение чувствительности, онемение.</li>\r\n<li>Недержание мочи и кала.</li>\r\n<li>Различные нарушения психики, адекватности поведения, памяти, целенаправленности действий, интеллекта. Это случается при кровоизлиянии в лобные доли. Например, пациент может вначале встать, затем помочиться, а уже затем расстегнуть штаны и зайти в туалет. Такой симптомокомплекс именуется «лобной психикой».</li>\r\n<li>Симптомы раздражения оболочек (менингеальная симптоматика), с напряжением затылочных мышц, свето – и звукобоязнью, общей гиперестезией.</li>\r\n<li>Гипертермия, или повышение температуры тела вследствие изменения установочной точки температуры тела «отказом центра терморегуляции». Злокачественная гипертермия чрезвычайно опасна, и свидетельствует о неблагоприятном течении заболевания.</li>\r\n</ol>",
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{
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"code": "I61",
"name": "Внутримозговое кровоизлияние",
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"lead": "Нарушение здоровья, относящееся к группе цереброваскулярные болезни",
"description": "Внутримозговое кровоизлияние - локальное кровотечение из кровеносных сосудов в пределах паренхимы мозга, обусловленное разрывом патологически изменённых стенок церебральных сосудов или просачиванием плазмы и форменных элементов сквозь стенку сосудов.",
"etiology": "<p>К предрасполагающим факторам относят:</p>\r\n<ul>\r\n<li>Аневризма сосуда – выпячивание стенки сосуда вследствие ее истончения или растяжения.</li>\r\n<li>Сосудистая мальформация – аномальное строение и коммуникации сосудов головного мозга.</li>\r\n<li>Васкулит – воспаление стенки сосуда.</li>\r\n<li>Атеросклеротическое повреждение стенки сосуда.</li>\r\n</ul>\r\n<p> </p>\r\n<p>Однако одних только предрасполагающих факторов недостаточно. Для разрыва сосуда должен воздействовать инициирующий фактор:</p>\r\n<ul>\r\n<li>гипертонический криз (часто у пожилых);</li>\r\n<li>нарушения свертываемости крови;</li>\r\n<li>ряд наркотических веществ, которые нарушают тонус сосудов;</li>\r\n<li>внутриопухолевое кровоизлияние.</li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p>Основным патогенетическим фактором кровоизлияния являются артериальная гипертензия и гипертонические кризы, при которых возникают спазмы или параличи мозговых артерий и артериол. Обменные нарушения, возникающие в очаге ишемии (сниженного кровоснабжения), способствуют дезорганизации стенок сосудов, которые в этих условиях становятся проницаемыми для плазмы и эритроцитов – так называемое диапедезное кровотечение. Одновременное развитие спазма многих сосудистых ветвей в сочетании с проникновением крови в мозговое вещество может привести к образованию обширного очага кровоизлияния, а иногда и множественных очагов. В основе гипертонического криза может быть резкое расширение артерий с увеличением мозгового кровотока, обусловленное срывом его саморегуляции при высоком артериальном давлении. В этих условиях артерии утрачивают способность к сужению и пассивно расширяются. Под повышенным давлением кровь заполняет не только артерии, но и капилляры и вены. При этом повышается проницаемость сосудов, что приводит к просачиванию плазмы крови и эритроцитов. В механизме возникновения такого диапедезного кровотечения задействовано нарушение взаимосвязи между свертывающей и противосвертывающей системами крови. В патогенезе разрыва сосудов играют роль и функционально-динамические нарушения сосудистого тонуса. Паралич стенки мелких мозговых сосудов ведет к острому нарастанию проницаемости сосудистых стенок и выходу плазмы крови из сосудистого русла.</p>",
"diagnostics": "<p>Методом выбора в диагностике внутримозгового кровоизлияния является компьютерная томография головного мозга, позволяющая не только определить наличие внутримозговой гематомы, но и оценить её локализацию, распространённость и объём, выраженность отёка мозга и степень дислокации. Для диагностики небольших гематом в стволе мозга и изоденсивных веществу головного мозга («несвежих») гематом предпочтительна магнитно-резонансная томография.</p>\r\n<p>В случае невозможности проведения компьютерной томографии при отсутствии противопоказаний проводится исследование цереброспинальной жидкости, кровь в которой может свидетельствовать о кровоизлиянии в структуры задней черепной ямки или субарахноидальном кровоизлиянии. Небольшие кровоизлияния в подкорковые структуры головного мозга проявляются наличием эритроцитов в ликворе лишь через 2—3 суток</p>",
"treatment": "<p>Лечение больных с внутримозговым кровоизлиянием делится на два больших подвида: консервативное и хирургическое.</p>\r\n<p>Консервативная терапия проводится всем больным с внутримозговым кровоизлиянием и включает в себя поддержание функции дыхательной и сердечно-сосудистой системы. Как правило, пациентам показано подключение к аппарату искусственной вентиляции легких (ИВЛ). Внимание уделяют профилактике последующей тромбоэмболии, а также лечению сопутствующих заболеваний.</p>\r\n<p>Нейрохирургическое лечение назначается после проведения компьютерной или магнитно-резонансной томографии и показано в следующих случаях:</p>\r\n<ol>\r\n<li>Локализация гематомы позволяет провести ее хирургическое удаление (поверхностное расположение в полушариях мозга, мозжечок, ствол головного мозга).</li>\r\n<li>Разрыв сосуда, обусловленный аневризмой.</li>\r\n</ol>\r\n<p>Адекватное нейрохирургическое лечение должно быть проведено в первые два дня после начала заболевания.</p>\r\n<p>Также в некоторых случаях можно выполнить декомпрессивную трепанацию черепа для снижения давления и профилактики отёка – набухания головного мозга.</p>",
"prevention": "<p>Первичная профилактика включает в себя:</p>\r\n<ul>\r\n<li>Своевременное лечиние выявленной патологии сосудов.</li>\r\n<li>Недопущение развития гипертонической болезни.</li>\r\n<li>Избавление от избыточной массы тела.</li>\r\n</ul>\r\n<p>Задача вторичной профилактики заключается в недопущении возникновения повторного кровоизлияния. Этого можно добиться современной медикаментозной терапией, хирургическим вмешательством</p>\r\n<p> </p>",
"clinical_picture": "<p>Симптомы кровоизлияния делятся на две группы: общемозговые и очаговые.</p>\r\n<p>Быстрое прогрессирование общемозговой симптоматики в самом начале говорит о неблагоприятном прогнозе, ведь параличи и другие неврологические нарушения просто не успевают развиться.</p>\r\n<p>К общемозговым симптомам относят:</p>\r\n<ol>\r\n<li>Сильную головную боль, а в случае субарахноидального кровоизлияния – резчайшую, до крика, по типу «удара».</li>\r\n<li>Тошноту и рвоту, иногда рвоту без предшествующей тошноты, «фонтаном». Это говорит о раздражении кровью ядер черепно-мозговых нервов и о резком повышении внутричерепного давления.</li>\r\n<li>Головокружение.</li>\r\n<li>Покраснение лица и конечностей, «апоплексическое» лицо.</li>\r\n<li>Постепенное угнетение сознания, сонливость, затруднение контакта, пациент «загружается», в тяжёлых случаях развивается мозговая кома.</li>\r\n<li>Появление эпилептиформных судорог, что может говорить о прорыве крови в желудочки мозга, в тяжёлых случаях – потеря сознания, появлении анизокории – расширения зрачка с одной стороны, что говорит о том, что головной мозг подвергся сдавливанию и смещению, развилось состояние его отёка – набухания. В таком случае очень вероятно вклинение миндаликов мозжечка в большое затылочное отверстие, паралич жизненно важных центров кровообращения и дыхания, расположенных в продолговатом мозге и летальный исход.</li>\r\n</ol>\r\n<p>Если пациент остался жив, ситуация стабилизирована, то через некоторое время вследствие гибели нейронов становятся заметны очаговые симптомы, которые зависят от локализации кровоизлияния. Это могут быть:</p>\r\n<ol>\r\n<li>Контралатеральные (противоположные стороне поражения) полные параличи и частичные (парезы) мышц конечностей и лица.</li>\r\n<li>Расстройства речи (афазия), как при восприятии, так и при произнесении речи. В первом случае афазия именуется сенсорной (чувствительной), во втором – моторной (двигательной). Так как речь человека чрезвычайно сложна, то чаще всего имеется сенсомоторная афазия, выраженная по-разному.</li>\r\n<li>Различные глазодвигательные расстройства (отведение яблока в сторону, т. е. нарушение взора), анизокория (зрачки разного диаметра).</li>\r\n<li>Снижение чувствительности на различных участках, нарушение чувствительности, онемение.</li>\r\n<li>Недержание мочи и кала.</li>\r\n<li>Различные нарушения психики, адекватности поведения, памяти, целенаправленности действий, интеллекта. Это случается при кровоизлиянии в лобные доли. Например, пациент может вначале встать, затем помочиться, а уже затем расстегнуть штаны и зайти в туалет. Такой симптомокомплекс именуется «лобной психикой».</li>\r\n<li>Симптомы раздражения оболочек (менингеальная симптоматика), с напряжением затылочных мышц, свето – и звукобоязнью, общей гиперестезией.</li>\r\n<li>Гипертермия, или повышение температуры тела вследствие изменения установочной точки температуры тела «отказом центра терморегуляции». Злокачественная гипертермия чрезвычайно опасна, и свидетельствует о неблагоприятном течении заболевания.</li>\r\n</ol>",
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