Epidemic encephalitis

Description:

Epidemic encephalitis — chronically current infection. After an acute stage of a disease process usually does not come to an end and accepts a sluggish current. Therefore in a clinical picture of this disease it is accepted to distinguish acute and chronic forms. We will also adhere to this division further.

Though various authors described separate cases of epidemic encephalitis in infantile (T. P. Sim dream, M. M. Model) and early children's age, nevertheless earlier the disease of epidemic encephalitis meets rather seldom. Unlike other infections of a nervous system epidemic encephalitis at adults is observed more often than at children.

Symptoms of Epidemic encephalitis:

Clinic of an acute stage of a disease of a polimorfn. The patient becomes sluggish, sleepy, complains of a febricula, a headache, temperature increase and the catarral phenomena are noted, but sometimes they are so insignificant that pass unnoticed, and the child has a disease standing. Such cases present great difficulties for diagnosis and often timely are not distinguished. At high temperature also consciousness disturbance is noted.

The most often found symptoms of an acute stage of epidemic encephalitis the following.

The frustration of a dream which is shown in different forms and different degree. Frequent it is only drowsiness, but there is also a deep sleep which is externally poorly differing from normal (there is only no miosis, characteristic of a normal dream; sometimes there are no movements of the eyes accompanying a pripodnimaniye a century). The patient often sleeps without interruption, but he can be woken. This dream differs from the soporous state developing at encephalitis of other etiology markedly. Along with drowsiness sleeplessness is observed. The dream rhythm perversion — drowsiness and sleeplessness is sometimes noted in the afternoon at night. The last type of frustration in a chronic stage of encephalitis meets more often than in acute.

Eye frustration (squint, a ptosis, irregular shape of pupils, an anisocoria, a diplopia, is more rare a reflex immovability of pupils) belong to early and constant symptoms. From cherepnomozgovy nerves most often are surprised front, hypoglossal and a motive branch of a trifacial.

Motive disturbances are characteristic not only for acute, but also of a chronic stage. Disturbances of a mimicry, a muscle tone, the katalepsy phenomenon are most often observed. Children especially often have various hyperkinesias (choreiform, choreic, myoclonic). At a myoclonic form hyperkinesias can appear in all muscles or in certain areas, especially in muscles of a stomach and hips. Hyperkinesias develop sharply, have the nature of severe, bystry, tolchkoobrazny clonic spasms. Unlike choreic hyperkinesias myoclonic hyperkinesias do not disappear in a dream. At the babies having the increased readiness for the convulsive phenomena, epidemic encephalitis quite often begins with the general spasms, Krom of clonic spasms, the tonic tension of all muscles and attacks reminding small attacks are noted.

Disorders of breath at children also happen more often than at adults is (M. B. Tsuker). Disturbance of frequency and a respiratory rhythm, a myoclonia of respiratory muscles and the respiratory tikoobrazny movements are observed. Also violent cough, sneezing, spitting can be carried to the last.

Vegetative frustration (greasiness of the person, the raised sialosis, perspiration, vasculomotor frustration) are frequent in an acute stage, but they are most expressed in the chronic period of a disease. Endocrine disturbances early are found in children quite often also. Also vestibular frustration (a nystagmus, dizziness) belong to symptoms of the acute period.

Disorders of sensitivity are expressed by paresthesias and pain of the central origin (thalamic pains).

All-brain frustration, from them most often headaches; the meningeal phenomena are observed seldom, mainly at children of chest age.

The research of cerebrospinal fluid in an acute stage finds sometimes slight increase of pressure, small increase in protein, the increased content of sugar.

Psychopathological symptoms do not take the main place in a picture of an acute stage of epidemic encephalitis at children. As well as at other acute infections, the most frequent are delirious states. The night delirium is especially characteristic: consciousness is dulled, children are dvigatelno uneasy, see frightening pictures ("some people with sticks came to kill", "the uncle with terrible eyes looks", "enormous animals creep"), hear how they behind windows shout. The mood alarming and timid and usually corresponds to the maintenance of hallucinations.

At more severe forms of epidemic encephalitis the speech motor excitement reaching sometimes big force is observed. Children continuously rush about on a bed, scatter everything that comes into the view, tear linen, cry out separate words. At the same time choreic hyperkinesias, a tremor, myoclonias are frequent, is more rare — the atetoidny movements. Motive excitement in many cases is accompanied also by speech excitement: the child utters separate words not clearly, choking, repeating same a tear or the phrase.

Predictively these forms with sharp excitement concern to the heaviest — big loss of forces from long motive excitement at a hyponutrient quite often leads to exhaustion.

Sometimes motive excitement is expressed more sharply: children try somewhere to run, loudly shout, swear, tear and break everything that gets to them on the way, are aggressive. Such states are usually observed before going to bed, but sometimes happen also in the afternoon. The sudden beginning, often the same sudden end and the subsequent condition of a heavy adynamy, slackness are characteristic of them. These states meet also in acute, but is more often in a chronic stage of encephalitis.

At teenagers the clinical picture of an acute stage of epidemic encephalitis is more various. Shizofrenopodobny syndromes (crazy and hallucinatory frustration) are sometimes observed.

Duration of the acute period of epidemic encephalitis various: from 2 weeks to 2 — 3 months. The feverish state usually proceeds from several days to 2 — 3 weeks; temperature falls gradually.

After an acute stage there comes the period when at the child the changes reminding conditions of a postinfectious adynamy (irritable weakness, a capriciousness, slackness) are noted, and then encephalitic process passes into a chronic stage.

The clinic of a chronic stage of epidemic encephalitis is more various, than at an acute stage. A number of new symptoms joins the residual phenomena of the acute period.

Parkinsonism picture, characteristic of chronic stage of epidemic encephalitis (frustration of a dream, oculomotor disturbances, vegetative symptomatology in the form of greasiness of the person, a sialosis), and also typical mental disturbances (slowness of mental processes, an adynamia, a lack of an initiative, importunity, impulsiveness) confirm the diagnosis of epidemic encephalitis.

This form which call adynamic at children's age meets seldom. More often it is observed at teenagers.

The intelligence at epidemic encephalitis suffers only in more hard cases, a thicket when the disease began at early children's age. But also at rather safe intelligence these children cannot study. They sharply weakened activity, an initiative. Function of attention is especially broken: its stability, ability to switching and distribution are lowered. Studying of features of intellectual disturbances at children and teenagers, is long having epidemic encephalitis, finds insufficiency of thinking which can be considered as result of a delay of mental development in many cases. But also at safe intelligence discrepancy between ability of judgment and lack of the critical attitude towards itself and surrounding, contrast between rather developed judgment and roughly broken behavior attracts attention. Also the sharp exhaustion of intellectual activity, an emotional oskudneniye are evident. Patients often make an impression indifferent to everything, the people interested in nothing. However at them explosions of irritability and impulsiveness are frequent. At judgment of degree of emotional safety of these children it is necessary to be careful not to see emotional poverty where it is only about the complicated expression of emotions, braking of expressive movements. The senior children and teenagers have a suppressed mood and various reactive frustration quite often develop in connection with awareness of the inferiority.

Sometimes in a clinical picture various forms of persuasive states — fear to catch, ache, fear for health of parents, the persuasive account, sterile sophistication figure prominently. Also persuasive movements — combing and a scratching of a body are observed. Quite often children put themselves in such a way heavy, painful damages as cannot resist to these uncontrollable aspirations.
Changes of character with a picture of psychopatholike behavior after epidemic encephalitis at children and teenagers are described by M. O. Gurevich, M. S. Pevzner, M. P. Andreyev, L. S. Yusevich, etc.

The course of epidemic encephalitis is diverse. Both easy abortal forms, and heavy, already in an acute stage leading to death meet.

Existence of an aggravation and remission are characteristic of epidemic encephalitis. Quite often the aggravation is followed by slight increase of temperature, strengthening of vegetative symptoms and a sleep disorder. After aggravations (the proceeding several days or weeks) often there are new symptoms: hyperkinesias, disorders of behavior. Also long remissions within several years are possible. Along with the expressed forms considerably also atypical, abortal forms meet more often.

At such various current both polymorphism of clinical options of a disease, and various weight of mental disturbances is quite natural. Along with small mental disorders severe forms when the child or the teenager as a result of a disease becomes a disabled person meet, loses an opportunity to adapt to life.

The forecast of epidemic encephalitis is always serious. Abortal cases come to an end safely. At the same time the progreduated nature of process does not give a guarantee from the subsequent recurrence even after long remission.

Katamnestichesky data are various at different authors. According to M. O. Gurevich, about a half of the persons who had encephalitis continue a normal way of life though working capacity them is usually reduced. Changes of character of a rack are also persistent. However some authors specify that in cases of psychopatholike behavior at epidemic encephalitis in about 3 years there occurs improvement: impulsive tension decreases, the dream improves. The further course of a disease of that is worse, than at younger age it began.

In a clinical picture of epidemic encephalitis the manifestations similar with schizophrenic are quite often noted. In an acute stage — it is hallucinatory and crazy frustration, at the chronic slow course of process — the reminding schizophrenic psychopatholike manifestations. Often it complicates recognition of a disease. Difficulties are especially big at easily proceeding forms of epidemic encephalitis at teenagers when patients sharply react to changes in themselves and complain of decrease of the activity, loss of ability to work and worry as earlier. Increase similarity to schizophrenia even more feeling of coercion about which patients, an aspontannost, slackness, aspiration to passive existence also often speak. But, in spite of the fact that these two diseases have many similar clinical manifestations, nevertheless at epidemic encephalitis the thinking originality, typical for schizophrenia, never meets paralogicality, characteristic of it, a paradoxicality and fancifulness. Changes of the personality are observed also at epidemic encephalitis. But there are no dissociation, characteristic of schizophrenia, splitting of emotional experiences. The relation to the world, people and an own disease at the teenagers having encephalitis, other than at patients with schizophrenia. At small interest to people around and the seeming otgorozhennost they have no real autism, negativism. Persuasive states can take place both at epidemic encephalitis and at schizophrenia, however at encephalitis they are more elementary, is closer to violent states. Disturbances of a psychomotor rhythm, a tendency to jamming often are the cornerstone of them (iteration), and it is frequent also touch frustration, paresthesias, pains of the central character (thalamic hyperpathias).

Crazy manifestations at epidemic encephalitis are also often connected with touch disturbances, a hyperpathia. They. are less resistant, than at schizophrenia, and usually have character of katestetichesky nonsense which origin is closely connected with pathological feelings (V. A. Gilyarovsky, R. S. Povitskaya).

Emotional impoverishment, characteristic of patients with epidemic encephalitis, lack of affection for someone. The differential diagnosis in such cases also happens hard. The big diagnostic importance have existence typical for schizophrenia disorders of thinking, autism. At epidemic encephalitis there is no elaborate, strange, spread-out behavior, but the phenomena of automatism, importunity, "pristavuchesta" act more sharply. Epidemic encephalitis is spoken well also by the disturbances of intellectual activity characteristic of an organic disease: an exhaustion, a lack of spontaneity, bent to "sticking", repetition of the same words and movements. Disturbance of instinctive life is noted thus and at other disease, but at epidemic encephalitis they it is more rough, more elementary, there are no elements of splitting of inclinations, characteristic of schizophrenia.

In diagnostically hard cases everything solves the analysis of a neurologic picture of a disease — disturbances of the motive sphere, characteristic of epidemic encephalitis, oculomotor symptoms, vegetative frustration. In an acute stage results of a research of cerebrospinal fluid are important: at epidemic encephalitis increase in content of sugar is noted. Also the anamnesis indicating existence of an acute stage of a disease with the expressed frustration of a dream is of great importance for the diagnosis of epidemic encephalitis.

Reasons of Epidemic encephalitis:

The causative agent of epidemic encephalitis is not opened yet, but is established that it concerns group of the filtered viruses. Patients can serve as transmitters, and it is possible, and healthy carriers of a virus. A number of pilot studies proves that at many people this virus lives in a nasopharynx, without causing any pathological phenomena, but under the known conditions owing to change of reactivity of an organism gains neurotropic properties, gets on perineural spaces of nerves of a nasopharynx into subarachnoid spaces of a brain.

Treatment of Epidemic encephalitis:

In an acute stage of a disease of specific methods there is no treatment for the present. Appoint antibiotics, with the increased intracranial pressure apply various means of dehydration. In a chronic phase of a disease various atropinic drugs, mainly, Cyclodolum, Dinezinum are shown. At the same time use B6 vitamin — to small children in 1% - number solution, to the senior children in 2,5 — 5% - number solution.

In an acute stage of epidemic encephalitis mental disorders are limited to motive concern and perseverations. Psychopharmacological drugs in this stage are appointed rather seldom.

For treatment of mental disorders in a chronic stage of epidemic encephalitis it is very important to use drug which does not strengthen parkinsonism phenomena. Chlordiazepoxide (Elenium) and diazepam (Seduxenum) are in this respect most adequate. They are not only tranquilizers, but also muscle relaxants, relax skeletal muscles therefore their use does not constitute danger of increase in a muscle tone and developing of parkinsonism.

Chlordiazepoxide works soothingly, reduces motive concern, reduces emotional tension and alarm. Doses vary depending on age. Diazepam unlike Elenium renders both the big activating and promoting effect. Therefore for treatment of mental disorders at epidemic encephalitis diazepam is one of the best remedies.

In a late stage of epidemic encephalitis children and teenagers have also psychopatholike frustration. At these patients not only emotional impoverishment, but also morbid attractions (vagrancy, theft) is noted. Such states will badly respond to treatment tranquilizers. They should be stopped aminazine.