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"code": "F02*",
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3
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"description": "",
"etiology": "<p>При различных заболеваниях в силу поражения коры головного мозга могут развиться психические расстройства в виде деменции. Это могут быть прогрессивный <a href=\"/symptom/paralich/\" title=\"Перейти на страницу симптома Паралич\">паралич</a>, очаговые заболевания мозга при инфекционных психозах.</p>",
"pathogenesis": "",
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},
"code": "F02*",
"name": "Деменция при других болезнях, классифицированных в других рубриках",
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3
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"slug": "f02*_demenciya_pri_drugih_boleznyah_klassificirovannyh_v_drugih_rubrikah",
"lead": "нейродегенеративное растройство в следствии болезни",
"description": "",
"etiology": "<p>При различных заболеваниях в силу поражения коры головного мозга могут развиться психические расстройства в виде деменции. Это могут быть прогрессивный <a href=\"/symptom/paralich/\" title=\"Перейти на страницу симптома Паралич\">паралич</a>, очаговые заболевания мозга при инфекционных психозах.</p>",
"pathogenesis": "",
"diagnostics": "<p>Диагноз ставится при наличии симптомов и данных исследования мозговых функций.</p>",
"treatment": "<p>Проводят лечение основного заболевания, симптоматическое лечение на основании клинических проявлений.</p>",
"prevention": "",
"clinical_picture": "<p>При прогрессивном параличе и других психозах может наблюдаться паретический тип слабоумия, который характеризуется снижением всех форм познавательной деятельности. Снижаются интеллект, память, внимание, поражаются чувства, ослабляется воля.</p>\r\n<p> </p>\r\n<p>При очаговых изменениях мозга развивается лакунарный тип слабоумия с поражением памяти с разными наслоениями, которые могут зависеть от локализации очагового поражения мозга.</p>\r\n<p> </p>\r\n<p>При эпилепсии может развиться концентрический тип слабоумия, который характеризуется сужением интересов больного на своей личности и функциях своего тела. Мышление больного при этом может быть замедленным. Больные склонны к «прилипанию внимания» к одним и тем же представлениям, что выражается в персервации, повторении одних и тех же слов.</p>\r\n<p> </p>\r\n<p>Для шизофрении и некоторых инфекционных заболеваниях характерен транзиторный тип слабоумия, при котором ослабление познавательной деятельности развивается крайне медленно.</p>\r\n<p> </p>\r\n<p>Олигофренический тип слабоумия, характеризующийся негативными симптомами (идиотия, имбецильность, дебильность).</p>",
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5150,
5243,
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]
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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",
"gender": 0,
"age_min": 0,
"age_max": 15,
"cause": [
3,
0,
1
],
"periodicity": 1,
"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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}
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