Nervous system lesions. Damage to the nervous system due to influenza
What is Influenza encephalitis
Influenza (toxic-hemorrhagic) encephalitis- spicy inflammatory disease brain and its membranes.What causes influenza encephalitis?
Influenza enphephalitis is caused by influenza viruses A1, A2, A3, B. It occurs as a complication of viral influenza. The influenza virus is a pantropic virus; None of the known influenza virus strains has true neurotropic properties. It is known that the influenza virus has toxic effect on receptors of blood vessels, in particular brain vessels. Pathogenetic mechanisms for influenza infection are neurotoxicosis and discirculatory phenomena in the brain.
Pathogenesis (what happens?) during Influenza encephalitis
In the brain, vascular congestion, thrombovasculitis, small diapedetic and focal hemorrhages, and perivascular infiltrates are detected.
There is hyperemia and swelling of the substance and membranes of the brain with small diapedetic hemorrhagic foci, destructive changes in ganglion cells and myelin fibers. In cases of hemorrhagic influenza encephalitis, small focal and extensive hemorrhages in the brain substance are detected.
Symptoms of Influenza Encephalitis
Defeat nervous system occurs in all cases of influenza and is manifested by headache, pain when moving eyeballs, muscle pain, weakness, drowsiness or insomnia. All these symptoms relate to general infectious and general cerebral symptoms. regular flu. However, in some cases, damage to the nervous system occurs in the form of influenza encephalitis, which develops more often at the end of the disease, even after 1-2 weeks. after him. In this case, the patient’s well-being deteriorates again, the temperature rises, and general cerebral symptoms occur ( headache, vomiting, dizziness), mild meningeal symptoms. Against this background, signs appear focal lesion brain, which are usually not clearly expressed. Possible damage to the peripheral nervous system in the form of tertiary and greater neuralgia occipital nerves, lumbosacral and cervical radiculitis, defeats sympathetic nodes. IN cerebrospinal fluid show slight pleocytosis and a moderate increase in protein content; cerebrospinal fluid pressure is increased. Leukocytosis or leukopenia is determined in the blood.
The clinical expression of influenza encephalitis cannot be reduced to any one more or less typical type. Most frequent forms influenza encephalitis are acute hemorrhagic encephalitis, diffuse meningoencephalitis and limited meningoencephalitis (so-called arachnoiditis).
Acute hemorrhagic encephalitis. The disease begins with signs typical of influenza infection: weakness, malaise, chills, discomfort V various parts bodies, especially in small joints, upper catarrh respiratory tract. Headache occurs more often than with normal flu. Expressed temperature reaction This does not always happen, so a person often continues to work and is treated on an outpatient basis.
About a week after the first signs of influenza illness appear, insomnia develops, a feeling of anxiety and unaccountable fear arises, and vivid visual and auditory hallucinations of frightening content appear.
Severe motor agitation is especially characteristic of hemorrhagic encephalitis. At first, it seems to be justified: patients defend themselves from imaginary danger inspired by fear and hallucinatory experiences, enter into arguments with hallucinatory images, rush to flight and can hardly be kept in bed.
Subsequently, motor excitation takes on the character of meaningless, involuntary hyperkinesis: patients perform swimming movements and stereotypically move their legs. As the disease progresses, hyperkinesis intensifies and stunned consciousness occurs, reaching stupor and coma.
Diffuse meningoencephalitis. Meningoencephalitis is often observed with toxic form influenza and, according to many authors, is nothing more than a secondary reaction to infectious toxicosis.
Toxic meningoencephalitis clinically resembles hemorrhagic encephalitis, but is characterized by a more benign course, frequent remissions and usually ends in recovery.
The most characteristic symptom of toxic meningoencephalitis, besides the usual neurological disorders(oculomotor disorders, headaches, vomiting), is an anxious-depressive mood. Patients cannot explain what inspired this feeling of anxiety in them. Subsequently, as if for the second time, a violation of the interpretation of the surrounding situation arises; patients begin to feel that something is being plotted against them. They claim that loved ones and the medical staff caring for them have dramatically changed their attitude towards them. Thoughts about imminent violent death appear. This delusional mood is supported not only by a feeling of anxiety, but also by often occurring auditory and visual hallucinations. Patients usually hear unpleasant remarks, swearing, threats, ambiguous jokes, the voices of their loved ones behind the partition, etc.
In cases where first place in clinical picture It is not hallucinatory experiences that occupy the place, but depressive-paranoid phenomena; the disease occurs with less pronounced neurological signs of meningoencephalitis and tends to have a protracted course. Meningo-encephalitis with delirious-depressive syndrome usually ends in remission within several weeks.
Limited meningoencephalitis. Limited meningoencephalitis appears to be the most frequent illness brain with influenza. Due to various localizations The clinical picture of these meningoencephalitis lesions is characterized by significant polymorphism. There are frequent cases when such meningo-encephalitis is transmitted to the legs and acute stage illness, nothing except the usual signs of influenza infection is noted. After the disappearance of acute phenomena, symptoms of focal damage to the cerebral cortex are detected, which in acute period usually masked by general clinical signs of influenza infection.
IN childhood limited meningoencephalitis often has the so-called psychosensory form. The acute period of the disease is characterized by a sudden onset and daily increases in temperature or fluctuations throughout the week from 37 to 39°. As a rule, severe headaches with nausea and vomiting are observed.
Catarrhal phenomena in the form of a runny nose, cough, as well as sore throat and various painful sensations, especially in the abdominal area, are observed in the acute period with noticeable consistency and are taken for the usual picture of influenza. At the height of the acute period, stunned consciousness and episodic visual hallucinations develop. Patients complain of darkening, fog and smoke in the eyes, a feeling of weightlessness, unevenness of the floor surface, soil, metamorphopsia.
Neurological symptoms include convergence paresis and vestibular disorders, from somatic disorders- etherocolitis and hepatitis.
In general, the prognosis for the psychosensory form of limited meningoencephalitis is good. Acute symptoms disappear and children return to school. Long-term asthenia is often observed. However residual effects in this form they occur quite often and consist mainly in the fact that when subsequently exposed to any external factors (repeated infections, intoxication, injuries), psychosensory disorders renew.
Flow favorable. The disease lasts from several days to a month and ends with complete recovery. In the acute period of influenza, severe damage to the nervous system may develop in the form of hemorrhagic influenza encephalitis. The disease begins apoplectiformly with a high rise in temperature, chills, impaired consciousness up to coma. General epileptic seizures are often observed. Focal symptoms are characterized by significant polymorphism. Traces of blood are found in the cerebrospinal fluid. The course of this form of influenza encephalitis is severe. Comes often death. After recovery, severe neurological disorders usually remain.
Diagnosis of influenza encephalitis
IN cerebrospinal fluid an admixture of blood is detected, the protein content exceeds 1 - 1.5 g/l. Lymphocytic pleocytosis is determined (0.02*109/l - 0.7*109/l).
Treatment of Influenza Encephalitis
Antibiotics (penicillin, aureomycin, etc.) should be prescribed in combination with dehydrating (25% magnesium sulfate solution, 40% glucose solution, Lasix) and desensitizing (diphenhydramine, pipolfen) agents, calcium gluconate, rutin, ascorbic acid acid, thiamine chloride, sedatives (bromides, seduxen, trioxazic, etc.).
Prevention of Influenza Encephalitis
An important means of preventing influenza neurological complications is primarily the prevention of influenza itself, which is carried out through influenza vaccination. A person sick with the flu should be released from work until the body temperature normalizes and catarrhal symptoms disappear. Along with anti-influenza drugs, drugs that increase protective forces body, provide nutrition with high energy value, good care, room ventilation, etc.
Which doctors should you contact if you have influenza encephalitis?
Infectious disease specialist
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Influenza encephalitis
What is Influenza encephalitis -
Influenza (toxic-hemorrhagic) encephalitis- acute inflammatory disease of the brain and its membranes.
What provokes / Causes of Influenza encephalitis:
Influenza enphephalitis is caused by influenza viruses A1, A2, A3, B. It occurs as a complication of viral influenza. The influenza virus is a pantropic virus; None of the known influenza virus strains has true neurotropic properties. It is known that the influenza virus has a toxic effect on vascular receptors, in particular brain vessels. Pathogenetic mechanisms for influenza infection are neurotoxicosis and discirculatory phenomena in the brain.
Pathogenesis (what happens?) during Influenza encephalitis:
In the brain, vascular congestion, thrombovasculitis, small diapedetic and focal hemorrhages, and perivascular infiltrates are detected.
There is hyperemia and swelling of the substance and membranes of the brain with small diapedetic hemorrhagic foci, destructive changes in ganglion cells and myelin fibers. In cases of hemorrhagic influenza encephalitis, small focal and extensive hemorrhages in the brain substance are detected.
Symptoms of Influenza encephalitis:
Damage to the nervous system occurs in all cases of influenza and is manifested by headache, pain when moving the eyeballs, muscle pain, adynamia, drowsiness or insomnia. All these symptoms are general infectious and cerebral in the case of ordinary flu. However, in some cases, damage to the nervous system occurs in the form of influenza encephalitis, which develops more often at the end of the disease, even after 1-2 weeks. after him. In this case, the patient’s health deteriorates again, the temperature rises, general cerebral symptoms (headache, vomiting, dizziness), and mild meningeal symptoms occur. Against this background, signs of focal brain damage appear, which are usually mildly expressed. Possible damage to the peripheral nervous system in the form of neuralgia of the tertiary and greater occipital nerves, lumbosacral and cervical radiculitis, damage to the sympathetic nodes. The cerebrospinal fluid shows slight pleocytosis and a moderate increase in protein content; cerebrospinal fluid pressure is increased. Leukocytosis or leukopenia is determined in the blood.
The clinical expression of influenza encephalitis cannot be reduced to any one more or less typical type. The most common forms of influenza encephalitis are acute hemorrhagic encephalitis, diffuse meningoencephalitis and limited meningoencephalitis (so-called arachnoiditis).
Acute hemorrhagic encephalitis. The disease begins with symptoms typical of influenza infection: weakness, malaise, chills, discomfort in various parts of the body, especially in small joints, catarrh of the upper respiratory tract. Headache occurs more often than with normal flu. A pronounced temperature reaction does not always occur, so a person often continues to work and is treated on an outpatient basis.
About a week after the first signs of influenza illness appear, insomnia develops, a feeling of anxiety and unaccountable fear arises, and vivid visual and auditory hallucinations of frightening content appear.
Severe motor agitation is especially characteristic of hemorrhagic encephalitis. At first, it seems to be justified: patients defend themselves from imaginary danger inspired by fear and hallucinatory experiences, enter into arguments with hallucinatory images, rush to flight and can hardly be kept in bed.
Subsequently, motor excitation takes on the character of meaningless, involuntary hyperkinesis: patients perform swimming movements and stereotypically move their legs. As the disease progresses, hyperkinesis intensifies and stunned consciousness occurs, reaching stupor and coma.
Diffuse meningoencephalitis. Meningoencephalitis is often observed in the toxic form of influenza and, according to many authors, is nothing more than a secondary reaction to infectious toxicosis.
Toxic meningoencephalitis clinically resembles hemorrhagic encephalitis, but is characterized by a more benign course, frequent remissions and usually ends in recovery.
The most characteristic symptom of toxic meningoencephalitis, in addition to the usual neurological disorders (oculomotor disorders, headaches, vomiting), is an anxious-depressive mood. Patients cannot explain what inspired this feeling of anxiety in them. Subsequently, as if for the second time, a violation of the interpretation of the surrounding situation arises; patients begin to feel that something is being plotted against them. They claim that loved ones and the medical staff caring for them have dramatically changed their attitude towards them. Thoughts about imminent violent death appear. This delusional mood is supported not only by a feeling of anxiety, but also by often occurring auditory and visual hallucinations. Patients usually hear unpleasant remarks, swearing, threats, ambiguous jokes, the voices of their loved ones behind the partition, etc.
In cases where the first place in the clinical picture is occupied not by hallucinatory experiences, but by depressive-paranoid phenomena, the disease proceeds with less pronounced neurological signs of meningoencephalitis and tends to have a protracted course. Meningo-encephalitis with delirious-depressive syndrome usually ends in remission within several weeks.
Limited meningoencephalitis. Limited meningoencephalitis appears to be the most common brain disorder associated with influenza. Due to the different localization of the lesion, the clinical picture of these meningoencephalitis is characterized by significant polymorphism. There are often cases when such meningo-encephalitis is carried on the legs and in the acute stage of the disease nothing except the usual signs of influenza infection is noted. After the disappearance of acute phenomena, symptoms of focal damage to the cerebral cortex are detected, which in the acute period are usually masked by general clinical signs of influenza infection.
In childhood, limited meningoencephalitis often has the so-called psychosensory form. The acute period of the disease is characterized by a sudden onset and daily increases in temperature or fluctuations throughout the week from 37 to 39°. As a rule, severe headaches with nausea and vomiting are observed.
Catarrhal phenomena in the form of a runny nose, cough, as well as sore throat and various pain sensations, especially in the abdomen, are observed in the acute period with noticeable consistency and are taken for the usual picture of influenza. At the height of the acute period, stunned consciousness and episodic visual hallucinations develop. Patients complain of darkening, fog and smoke in the eyes, a feeling of weightlessness, unevenness of the floor surface, soil, metamorphopsia.
Neurological symptoms include convergence paresis and vestibular disorders, and somatic disorders include erocolitis and hepatitis.
In general, the prognosis for the psychosensory form of limited meningoencephalitis is good. Acute symptoms disappear and children return to school. Long-term asthenia is often observed. However, residual effects in this form are quite common and consist mainly in the fact that when subsequently exposed to any external factors (repeated infections, intoxication, trauma), psychosensory disorders resume.
Flow favorable. The disease lasts from several days to a month and ends with complete recovery. In the acute period of influenza, severe damage to the nervous system may develop in the form of hemorrhagic influenza encephalitis. The disease begins apoplectiformly with a high rise in temperature, chills, impaired consciousness up to coma. General epileptic seizures are often observed. Focal symptoms are characterized by significant polymorphism. Traces of blood are found in the cerebrospinal fluid. The course of this form of influenza encephalitis is severe. Death often occurs. After recovery, severe neurological disorders usually remain.
Diagnosis of influenza encephalitis:
An admixture of blood is detected in the cerebrospinal fluid; the protein content exceeds 1 - 1.5 g/l. Lymphocytic pleocytosis is determined (0.02×109/l - 0.7×109/l).
Treatment of Influenza encephalitis:
Antibiotics (penicillin, aureomycin, etc.) should be prescribed in combination with dehydrating (25% magnesium sulfate solution, 40% glucose solution, Lasix) and desensitizing (diphenhydramine, pipolfen) agents, calcium gluconate, rutin, ascorbic acid acid, thiamine chloride, sedatives (bromides, seduxen, trioxazic, etc.).
Prevention of influenza encephalitis:
An important means of preventing influenza neurological complications is, first of all, the prevention of influenza itself, which is carried out through influenza vaccination. A person sick with the flu should be released from work until the body temperature normalizes and catarrhal symptoms disappear. Along with anti-influenza drugs, you should use drugs that increase the body's defenses, provide food with high energy value, good care, ventilation of the room, etc.
Which doctors should you contact if you have influenza encephalitis:
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Other diseases from the group Diseases of the nervous system:
| Absence epilepsy Kalpa |
| Brain abscess |
| Australian encephalitis |
| Angioneuroses |
| Arachnoiditis |
| Arterial aneurysms |
| Arteriovenous aneurysms |
| Arteriosinus anastomosis |
| Bacterial meningitis |
| Amyotrophic lateral sclerosis |
| Meniere's disease |
| Parkinson's disease |
| Friedreich's disease |
| Venezuelan equine encephalitis |
| Vibration disease |
| Viral meningitis |
| Exposure to ultra-high frequency electromagnetic fields |
| Effects of noise on the nervous system |
| Eastern equine encephalomyelitis |
| Congenital myotonia |
| Secondary purulent meningitis |
| Hemorrhagic stroke |
| Generalized idiopathic epilepsy and epileptic syndromes |
| Hepatocerebral dystrophy |
| Herpes zoster |
| Herpetic encephalitis |
| Hydrocephalus |
| Hyperkalemic form of paroxysmal myoplegia |
| Hypokalemic form of paroxysmal myoplegia |
| Hypothalamic syndrome |
| Fungal meningitis |
| Decompression sickness |
| Childhood epilepsy with paroxysmal activity on EEG in the occipital region |
| Cerebral palsy |
| Diabetic polyneuropathy |
| Dystrophic myotonia Rossolimo–Steinert–Kurshman |
| Benign childhood epilepsy with EEG peaks in the central temporal region |
| Benign familial idiopathic neonatal seizures |
| Benign recurrent serous meningitis of Mollare |
| Closed injuries of the spine and spinal cord |
| Western equine encephalomyelitis (encephalitis) |
| Infectious exanthema (Boston exanthema) |
| Hysterical neurosis |
| Ischemic stroke |
| California encephalitis |
| Candidal meningitis |
| Oxygen starvation |
| Tick-borne encephalitis |
| Coma |
| Mosquito viral encephalitis |
| Measles encephalitis |
| Cryptococcal meningitis |
| Lymphocytic choriomeningitis |
| Meningitis caused by Pseudomonas aeruginosa (pseudomonas meningitis) |
| Meningitis |
| Meningococcal meningitis |
| Myasthenia gravis |
| Migraine |
| Myelitis |
| Multifocal neuropathy |
| Disorders of the venous circulation of the brain |
| Spinal circulatory disorders |
| Hereditary distal spinal amyotrophy |
| Trigeminal neuralgia |
| Neurasthenia |
| Obsessive-compulsive disorder |
| Neuroses |
| Femoral nerve neuropathy |
| Neuropathy of the tibial and peroneal nerves |
| Facial nerve neuropathy |
| Ulnar nerve neuropathy |
| Radial nerve neuropathy |
| Median nerve neuropathy |
| Nonfusion of vertebral arches and spina bifida |
| Neuroborreliosis |
| Neurobrucellosis |
| neuroAIDS |
| Normokalemic paralysis |
| General cooling |
| Burn disease |
| Opportunistic diseases of the nervous system in HIV infection |
| Skull bone tumors |
| Tumors of the cerebral hemispheres |
| Acute lymphocytic choriomeningitis |
| Acute myelitis |
| Acute disseminated encephalomyelitis |
| Brain swelling |
| Primary reading epilepsy |
| Primary damage to the nervous system in HIV infection |
| Fractures of the skull bones |
| Landouzy-Dejerine scapulohumeral-facial form |
| Pneumococcal meningitis |
| Subacute sclerosing leukoencephalitis |
| Subacute sclerosing panencephalitis |
| Late neurosyphilis |
| Polio |
| Poliomyelitis-like diseases |
| Malformations of the nervous system |
| Transient cerebrovascular accidents |
| Progressive paralysis |
| Progressive multifocal leukoencephalopathy |
| Becker's progressive muscular dystrophy |
| Progressive Dreyfus muscular dystrophy |
| Progressive Duchenne muscular dystrophy |
| Progressive muscular dystrophy Erb-Roth |
| Radiation damage to the nervous system |
On the fourth day flu diseases Victor’s temperature was already normal. However, the doctor extended the sick leave for another three days. "Since there is free time, why not go ice skating?” - he decided. And went to the skating rink.
Two days later, a headache suddenly appeared and dizziness began. And so, instead of going to work in a week, the young man fell ill for a whole month.
The headache often recurred in the future, and was sometimes accompanied by nausea. Several years have passed since then, but Victor has not yet gotten rid of periodic attacks headache.
It is perhaps difficult to name any other disease as well-known and as insidious as. No other infection produces so many varied and sometimes very severe complications that affect the nervous system. And many, unfortunately, forget that the flu is not only a runny nose, cough and fever.
Penetrates into the cells of the surface layer of the respiratory tract. By settling in these cells, it disrupts, however, not only their activity. Toxic substances - toxins formed as a result of the active reproduction of viruses and the death of the cells themselves, also cause a kind of poisoning of the body - intoxication.
The virus can sometimes directly affect certain parts of the nervous system. Hence the chills, headache, general weakness, pain in bones, muscles and joints, aches, pain that occurs when moving the eyeballs, increased sweating. These symptoms indicate that influenza infection strikes first vegetative department nervous system. It is this department that regulates the functions of all internal organs, systems of the body and ensures its relationship with the external environment.
Under the influence of toxins, the walls of brain vessels in certain areas can become necrotic (destroyed), which sometimes causes multiple hemorrhages into the substance of the brain or under the meninges. At this time, the patient may experience impaired consciousness, seizures, and paralysis of various localizations.
Most common complication after influenza- so-called arachnoiditis. Name of the disease in to a large extent conditional. The fact is that arachnoid the brain - arachnoid - has no vessels, and, strictly speaking, there should be no inflammation in it. In addition, any inflammatory process is not limited to any membrane at all.
Usually, when we say “arachnoiditis,” we mean a slight inflammation meninges In essence, this is the same meningitis, but limited and manifests itself mildly. The disease never has such severity as, for example, purulent meningitis, involving in the process all the membranes of the brain and spinal cord along their entire length.
The origin of arachnoiditis can be very different, including infectious, traumatic, reactive. Concerning inflammatory process, then most often it is caused by drift into the meninges bacterial infection from purulent foci in the paranasal cavities or ear. At the site of the developed inflammation, in a limited space, the meninges seem to stick together. But if the inflammation takes over increasingly larger areas, then several such foci are formed, and individual sections of the membranes can even peel off, forming cavities, something like cysts, filled with cerebrospinal fluid - cerebrospinal fluid. Such lesions remain stuck together for a long time, and the accompanying symptoms are detected in patients almost constantly.
The “adhesive process” leads not only to disruption of the circulation of cerebrospinal fluid along the membranes of the brain, but also to disruption of its absorption into the venous network (due to the fact that part of the membranes of the brain is blocked). And if so, then with any other disease, for example with the flu, when the load on vascular system becomes larger, disturbances in the circulation of cerebrospinal fluid intensify. The result of this is often an increase (and sometimes a decrease) in cerebrospinal fluid pressure, and hence an increase in a number of symptoms: headache, dizziness, nausea, weakness.
So in this case arachnoiditis- this is a consequence of a bacterial infection activated under the influence of viruses, either obvious or for the time being remaining hidden.
Timely treatment chronic diseases nose, ear, throat, teeth - an effective measure to prevent complications of influenza. Naturally, they occur much more often in those who suffer from the flu on their feet and do not seek help from a doctor. Such people harm not only themselves, but also those around them, as they become spreaders of infection.
Those who have previously suffered meningitis, arachnoiditis or encephalitis should be especially careful. For them, the flu is more dangerous. During the epidemic, these people need to immediately take the most energetic preventive measures: Take an influenza vaccine or another doctor-recommended medicine, such as rimantadine.
Try to visit places less during the epidemic large cluster people, observe the rules of personal hygiene more carefully than usual.
It is very important to remember that a drop in temperature, good health, even an apparent restoration of performance, usually observed towards the end of the first week of illness, do not yet indicate complete recovery. Only your doctor can decide when you should start working.
K. Umansky, professor
Doctors' attention has long been focused on damage to the nervous system caused by influenza. The view of its genesis was influenced by the history of the discovery of the causative agent of influenza: influenza for 40 years (until the influenza virus was discovered) was considered a bacterial disease, the cause of which was often the Afanasyev-Pfeiffer hemophilus influenzae.
In the last century, damage to the nervous system due to influenza was divided according to neurological symptoms into:
- Primary symptoms caused by the penetration of the pathogen into different departments nervous system.
- Secondary symptoms caused by exposure to toxic factors.
- Episodes of exacerbation under the influence of influenza of diseases that existed before.
There was another classification, which was accompanied by other neurological disorders, which were observed in the usual clinical picture of influenza, for example, neurotoxicosis, complications of influenza affecting the nervous system.
When assessing clinical material, the question remains open regarding pathogenetic mechanism damage to the nervous system caused by influenza. Scientists receive new evidence and study it. Since the last century, science has advanced quite far and therefore this issue, thanks to new methods of virological research, one of which is the method of fluorescent antibodies, as well as direct determination of the localization in tissues of the viral antigen, will be resolved after some time.
In 1950, lesions of the nervous system were divided into two stages: early and late. These diseases were grouped by clinical signs(hemorrhagic encephalitis with focal signs, meningoencephalitis with diffuse signs, subarachnoid hemorrhage, peripheral nerve damage, serous meningitis, asthenic syndrome), which does not give an idea of their origin. But this classification is considered more valuable than others because it contains exact information about the localization of the lesion.
Early pathological processes occurring in the nervous system, caused by influenza, are classified as toxic reactions (develops at the onset of the disease). Late pathological processes classified as allergic reactions (usually develops towards the end of the first week of the disease, possibly later, during a second wave of temperature reaction).
Due to incorrect assumptions about the origin of influenza, there is a possibility of misjudging the nervous system changes that were observed in people who died from various viruses flu When the sectional material was studied, the changes that were caused bacterial inflammation, were found only in cases of complicated influenza. The main changes were severe circulatory disorders: multiple perivascular plasmorrhages and hemorrhages, degenerative changes in the walls of blood vessels, cerebral edema. Destruction nerve cells if there were any, they were too insignificant; they could not explain how severe the disease was.
Because the picture observed by the researchers did not fit the generally accepted picture bacterial symptoms flu, scientists abandoned the hypothesis that the infection directly affects the central nervous system.
The changes were similar to those that occur under the influence of toxins, so these complications of influenza were attributed by researchers to toxic lesions. Lack of knowledge about aspects and nuances of morphology viral lesions caused an ambiguous attitude towards the idea of possible action the causative agent of influenza directly on the blood vessels, tissues and membranes of the brain.
Etiology and pathogenesis. Currently, influenza is divided into two various shapes: epidemic, viral flu and endemic, seasonal influenza, or upper respiratory tract catarrh. The first of them is caused by various strains of influenza, occurs with lesions of the nervous system and, with good reason, is considered in the group of neuroinfections.
Already in 1934, V.V. Dekhterev wrote that it was almost impossible to consider separately all the complications in the neuropsychic sphere after the flu, since this would require revising almost all sections of neuropathology. Only typhus, in his opinion, stands ahead of the flu as etiological factor lesions of the brain and its membranes. Among these complications of influenza, he places first place post-flu serous meningitis and meningo-encephalitis. As influenza epidemics grew, damage to the nervous system became increasingly common.
Pathological anatomy. There is hyperemia of the substance and membranes of the brain with hemorrhagic and sometimes inflammatory foci, mainly in the area gray matter brain Diapedetic hemorrhages and edema are observed in the meninges and throughout the brain. Inflammatory in nature changes are detected in the vegetative nodes. Vascular changes in the meninges can occur with significant productive changes, giving a picture of arachnoiditis. Pathomorphological changes in the brain during influenza in children early age more pronounced. There are widespread prolapses of ganglion cells with acute destructive changes, however, without the formation of large foci. In myelin fibers, according to N. A. Maksimovich, dystrophic changes and their separation by edematous fluid are found. In place of the demyelinated fibers, which look like stripes of clearing, one can find an accumulation of oligodendrogliocytes in almost parallel rows in the form of “columns”. This picture is so characteristic that it helps to establish a diagnosis. The vessels of the brain and meninges are dilated and surrounded minor hemorrhages, especially in the area of the cerebral cortex and brainstem. In some cases, necrosis of the vascular walls with small areas of softening was found.
Significant changes are also found in cases of hemorrhagic influenza encephalitis: small focal and extensive hemorrhages and infiltration cerebral vessels, perivascular edema, extravasation near vessels, degenerative changes ganglion cells, glial proliferation, degeneration nerve fibers. Based on the nature of the neuropathological picture, influenza is considered not as encephalitis, but as encephalopathy.
Clinic. According to both domestic and foreign authors, the most characteristic feature influenza diseases of the nervous system is a clinical polymorphism. During some epidemics, influenza diseases of the peripheral nervous system are described in the form of radiculitis, neuritis, neuralgia, disorders of the autonomic nervous system, during others - damage to the central nervous system in the form of encephalitis, meningo-encephalitis, diencephalitis, arachnoiditis, myelitis.
In the acute period of influenza, a sharp headache, dizziness, sharply aggravated by optical irritations, lack of appetite, dyssomnia, pain in the lower back, arms and legs, and radicular pain are usually observed. Some patients are sharply excited and talkative, while more often patients are lethargic, apathetic, and depressed. In the febrile period - amnesia phenomena and depressive-anxiety syndrome - in the postfebrile period.
During an objective examination, many patients experience herpes labialis and meningism with stiffness of the neck muscles, Kernig's sign, pain when pressing on the trunks of peripheral nerves and hypoesthesia or, conversely, hyperesthesia along the radicular or peripheral type. A picture of non-purulent serous meningitis is also observed.
Influenza “encephalitis” most often occurs as disseminated meningo-encephalitis, or rather meningo-encephalosis. With “meningo-encephalitis” there is headache, dizziness, staggering when walking, meningeal symptoms, impaired coordination, anisoreflexia, mild lesions of the cranial nerves, sleep disturbance, sometimes psychosensory disturbances, disturbance of spatial relationships, autonomic disorders - sweating, lability of vasomotors, changes in skin temperature. The outcome is usually favorable after 1-2 weeks.
Sometimes vascular changes so pronounced that they talk about hemorrhagic form influenza encephalitis. The course is acute with sudden onset fever. Meningeal symptoms are pronounced, focal symptoms in the form of hemiplegia, speech disorders, incoordination of movements, epileptic seizures. There is often death.
Influenza encephalitis in childhood often occurs with sudden loss consciousness, tonic-clonic convulsions, delirium, hallucinations, agitation; children rush around the bed, scratch, bite. As a rule, they have a favorable course.
Cerebral arachnoiditis is one of the frequent complications flu The clinical picture of arachnoiditis is determined by the localization of the productive process. It could be arachnoiditis convex surface brain, arachnoiditis of the base of the cerebral peduncles, cerebellopontine angle, chiasmatic region. Thus, in the clinical picture, against the background of general asthenia with sharp headaches, there is either cortical symptoms with possible Jacksonian-type seizures, or basal syndrome with damage to the cranial nerves, or tumor syndrome of the cerebellopontine angle, or, finally, an increasing drop in visual power with opticochiasmatic arachnoiditis.
In the post-influenza period neurological symptoms in some cases they are like a continuation of the flu, layering on influenza symptoms, in other cases they arise some time after the flu. There are also cases when, after suffering from influenza, not complicated by a disease of the nervous system, symptoms of a disorder of the autonomic nervous system with autonomic lability remain for several weeks, for example in the form excessive sweating, feeling of lightness chills, low-grade fever, palpitations, arrhythmia, anorexia.
Differential diagnosis. The difficulty of diagnosing influenza encephalitis is that influenza may be concomitant with or provoking encephalitis of another origin.
At differential diagnosis It should be taken into account that persistent headaches can be accompanied by acute developing inflammation paranasal cavities, cerebral tumor, and the radiograph is not always decisive, since catarrhal inflammation of the air cavities may not produce dark spots x-ray, and a tumor is diagnosed on an x-ray mainly only if there is bone damage skulls Great importance when establishing a diagnosis, they have epidemiological data and virological studies.
Prevention and treatment. An important means of prevention is influenza vaccination. The serum proposed for treatment by A. A. Smorodintsev is effective in the first days of the disease; its action is strictly selective depending on the type of virus. Intravenous infusion of a solution of methenamine (40%) with glucose (40%) is used. ascorbic acid. At severe forms encephalitis in children, on the first day of the disease, gamma globulin is administered intramuscularly (at the rate of 0.5 g per 1 kg of body weight). For asthenic post-influenza conditions, restorative and tonic treatment, oxygen therapy, and physiotherapy are carried out. In cases of influenza arachnoiditis with chronic course with exacerbation, treatment is carried out with antibiotics (aureomycin, penicillin). If this treatment for arachnoiditis is unsuccessful and symptoms of “pseudotumor” are detected, the question of surgical intervention may arise.
