This syndrome is named after the person who first established the relationship between the combination of thrombophlebitis and cancer of internal organs - the French doctor Andre Trousseau. A typical symptom of spasmophilia – “obstetrician’s hand” – is named after him. Trousseau syndrome refers to paraneoplastic processes, and links together spontaneous migrating thrombophlebitis and advanced cancer of the esophagus or other internal organs (usually the stomach, liver).

Paraneoplastic processes are processes occurring in the body of elderly people (they occur much less frequently in young people), which develop during cancer, but are in no way related directly to the tumor itself - that is, neither to its metastases, nor to its growth. Such nonspecific reactions occur in response to those changes that arise due to the presence of an altered, neoplastic, essentially foreign process for the body.

Reasons

There are several causes of Trousseau syndrome. One of them lies in the excessive formation of thrombus-forming factors. Almost any tumor, starting from a small size, produces fibrinopeptide A, which, when detected, can be a marker of a tumor of internal organs - this is due to the fact that the quantitative indicators of fibrinopeptide A and the size of the tumor are associated with a fairly high degree of accuracy.

The second reason is a change in hemostasis in cancer patients according to the type of external coagulation mechanism - that is, after substances that are not part of its composition (in this case, tumor cells) enter the blood. Tumors are a constant source of tissue thromboplastin, as well as a special “cancer procoagulant” that converts coagulation factors VII and X into serine proteinase.

Most often, this symptom appears with tumors of the gastrointestinal tract.

Symptoms

As is often the case in medicine, the discovery of this syndrome is associated with the death of the author himself. Andre Trousseau had been studying neoplastic pathology for a long time, and had already noticed signs of spontaneous thrombosis. Since the relationship between thrombosis and tumors was obvious to Trousseau, he assumed that he himself had it, especially since there were not too obvious, but nevertheless alarming symptoms. And so it turned out - Andre died of stomach cancer.

Tumors of internal organs do not always make themselves felt with typical symptoms. And people often tend to reduce the significance of what they consider to be terrible complaints and symptoms. The tumor grows, its external influence on the body increases, and pareneoplastic processes are provoked. If phlebothromboses are formed in different places, are difficult to treat, or even cannot be treated at all, if there are thromboses of large arteries not associated with any diseases known to the patient, a cancerous tumor should be assumed.

Diagnosis and treatment

Diagnosis must be thorough. Increased thrombotic processes, constant changes in blood parameters, indicating changes in coagulation factors. It is necessary to conduct a blood test for the presence of fibrinopeptide A and other coagulation factors, and also pay attention to all nonspecific complaints that the patient has. A thorough diagnosis will also be required to determine the location of the tumor.

There is no specific treatment for Trousseau's syndrome (as well as other paraneoplastic processes). They can only clinically weaken or regress with successful treatment (even palliative treatment).

Forecast

Entirely depends on the prognosis of the tumor and the possibilities of its radical treatment.

DO YOU WANT TO QUIT SMOKING?

Then download the smoking cessation plan.
With its help it will be much easier to quit.

– a disease of young children, characterized by impaired mineral metabolism, increased neuromuscular excitability, and a tendency to spastic and convulsive states. Latent spasmophilia is manifested by contraction of the muscles of the face, hand (“obstetrician’s hand”), short-term cessation of breathing in response to provocation; obvious spasmophilia occurs in the form of laryngospasm, carpopedal spasm and eclampsia. The diagnosis of spasmophilia is confirmed by the presence of hypocalcemia, hyperphosphatemia, and a connection with rickets. Treatment of spasmophilia includes assistance with general convulsions and laryngospasm, prescription of calcium supplements, and adequate therapy for rickets.

General information

Spasmophilia (infantile tetany) is a calciopenic condition accompanied by a spastic state of the muscles of the face, larynx, limbs, and general clonic or tonic convulsions. Spasmophilia is detected mainly at the age of 3 months to 2 years, i.e. in the same age range as rickets, with which infantile tetany has an etiological and pathogenetic connection. Just a few years ago, spasmophilia in pediatrics was quite common, but a decrease in the incidence of severe forms of rickets has led to a decrease in the number of cases of infantile tetany. Spasmophilia develops in 3.5 - 4% of children suffering from rickets; somewhat more often in boys.

Clinical manifestations of spasmophilia in the form of laryngospasm or general convulsions with loss of consciousness and respiratory arrest require any medical specialist and parents to be able and willing to provide emergency care to the child. A prolonged tetanoid state can cause damage to the central nervous system, subsequent delay in the child’s mental development, and in severe cases, death.

Causes of spasmophilia

Spasmophilia is a specific disorder of calcium-phosphorus metabolism that accompanies the course of moderate or severe rickets. The pathogenesis of spasmophilia is characterized by a decrease in the concentration of total and ionized blood calcium against the background of hyperphosphatemia and alkalosis. An increase in the level of inorganic phosphorus in the blood can be facilitated by feeding the child cow's milk with a high concentration of phosphorus and insufficient excretion of excess phosphorus by the kidneys; hypoparathyroidism. In addition to calcium-phosphorus metabolism, hyponatremia, hypochloremia, hypomagnesemia and hyperkalemia are noted in spasmophilia.

The clinic of spasmophilia usually develops in early spring with the onset of sunny weather. Intense UV exposure to a child's skin causes a sharp increase in the blood concentration of 25-hydroxycholecalciferol, the active metabolite of vitamin D, which is accompanied by suppression of the function of the parathyroid glands, changes in blood pH, hyperphosphatemia, increased calcium deposition in the bones and a critical drop in its level in the blood (below 1 .7 mmol/l).

Hypocalcemia causes increased neuromuscular excitability and convulsive readiness. Under these conditions, any irritants (fear, crying, strong emotions, vomiting, high fever, intercurrent infections, etc.) can provoke a convulsive attack in the child.

It has been observed that breastfed children almost never develop spasmophilia. The risk group includes premature babies, bottle-fed children, and those living in unfavorable sanitary and hygienic conditions.

Classification of spasmophilia

Depending on the clinical course, latent (hidden) and manifest (overt) forms of spasmophilia are distinguished, and the transition of latent tetany to overt tetany is not excluded.

Latent spasmophilia is detected exclusively during a special examination using mechanical and galvanic skin tests. In this case, characteristic symptoms arise (Khvostek, Erb, Trousseau, Lyust, Maslova).

Manifest spasmophilia can occur in the form of laryngospasm, carpopedal spasm and an attack of eclampsia.

Symptoms of spasmophilia

Latent form

The course of latent spasmophilia always precedes obvious one and can last several weeks or months. Children with a latent form of spasmophilia usually have signs of rickets: increased sweating, tachycardia, poor sleep, emotional lability, increased anxiety, fearfulness, and digestive disorders. The presence of a latent form of spasmophilia is indicated by the following symptoms:

Chvostek's sign(upper and lower) - twitching of the corner of the eye or mouth when tapping with a hammer or finger along the zygomatic arch or the angle of the lower jaw (i.e., the exit points of the branches of the facial nerve);
Trousseau's sign- compression of the brachial neurovascular bundle leads to convulsive contraction of the muscles of the hand, bringing it into the “obstetrician’s hand” position;
Lyust's sign– tapping in the area of the head of the fibula, in the projection of the exit of the peroneal nerve, is accompanied by plantar flexion and abduction of the foot to the side;
Erb's sign– when irritated by galvanic current with force
Maslov phenomenon– painful stimulation (injection) causes a short-term cessation of breathing in a child suffering from latent spasmophilia (in healthy children this reaction is absent).

Manifest spasmophilia

Laryngospasm, as a manifestation of obvious spasmophilia, is characterized by a sudden spasm of the laryngeal muscles, which often develops while the child is crying or for no apparent reason. A moderate attack of laryngospasm is accompanied by partial occlusion of the airways, pallor, and wheezing inhalation, reminiscent of whooping cough. In severe cases, occurring with complete closure of the glottis, cyanosis, cold sweat, short-term loss of consciousness, apnea for a few seconds occurs, followed by a sonorous exhalation and noisy breathing; the child calms down and falls asleep. Spasm of the laryngeal muscles with spasmophilia can recur several times during the day. In extreme cases, an attack of laryngospasm can lead to the death of the child.

Another manifestation of obvious spasmophilia is carpopedal spasm - a tonic spasm of the muscles of the hands and feet, which can last for hours or days. In this case, there is maximum flexion of the arms in large joints, bringing the shoulders to the body, flexion of the hands (fingers are gathered into a fist or bent like an “obstetrician’s hands” - fingers I, IV, V are bent; fingers II and III are extended); plantar flexion of the foot, toes tucked. Prolonged carpopedal spasm with spasmophilia can lead to reactive swelling of the dorsum of the hands and feet.

With spasmophilia, isolated spasms of the eye muscles (transient strabismus), masticatory muscles (trismus, neck rigidity), and smooth muscles (impaired urination and defecation) may also occur. The most dangerous are spasms of the respiratory muscles, leading to dyspnea, bronchospasm and respiratory arrest, as well as spasms of the heart muscle, which pose a threat of cardiac arrest.

The most severe form of manifest spasmophilia is eclampsia or a general attack of clonic-tonic convulsions. The development of an attack of eclampsia is preceded by twitching of the facial muscles, then the spasms spread to the limbs and muscles of the trunk. General convulsions are accompanied by laryngospasm, respiratory failure, general cyanosis, loss of consciousness, foam on the lips, involuntary urination and defecation. The duration of an eclampsia attack can vary from several minutes to hours. This form of spasmophilia poses a danger in terms of respiratory or cardiac arrest.

In children of the first 6 months. In life, spasmophilia most often occurs in the form of laryngospasm and eclampsia; at an older age - in the form of carpopedal spasm.

Diagnosis of spasmophilia

With an obvious form of spasmophilia, diagnosis is not difficult. The presence of clinical and radiological signs of rickets, complaints of muscle spasms and cramps are taken into account. To identify latent spasmophilia, appropriate mechanical or galvanic skin tests are performed to assess neuromuscular excitability. A child with spasmophilia is examined by a pediatrician and a pediatric neurologist.

The diagnosis of spasmophilia is confirmed by a biochemical blood test that reveals hypocalcemia, hyperphosphatemia and other electrolyte imbalances; blood CBS test (alkalosis).

Differential diagnosis of spasmophilia must be carried out with other hypocalcemic conditions, convulsive syndrome, true hypoparathyroidism, epilepsy, false croup, congenital stridor, whooping cough, etc.

Treatment of spasmophilia

An attack of laryngospasm or eclampsia requires emergency assistance to the child, and in case of respiratory and cardiac arrest, resuscitation measures. To restore spontaneous breathing during laryngospasm, splashing the child's face with cold water, shaking, patting the buttocks, irritating the root of the tongue, and providing access to fresh air can be effective. If ineffective, artificial respiration and indirect cardiac massage are performed, and a supply of humidified oxygen is provided.

For any manifestations of obvious spasmophilia, the administration of anticonvulsants is indicated (diazepam intramuscularly, intravenously or into the root of the tongue, sodium hydroxybutyrate intramuscularly, phenobarbital orally or rectally in suppositories, chloral hydrate in an enema, etc.). Also indicated is the intravenous administration of 10% calcium gluconate solution and 25% intramuscular magnesium sulfate solution.

With a confirmed diagnosis of spasmophilia, a water break is arranged for 8-12 hours, then until the symptoms of latent spasmophilia completely disappear, infants are transferred to natural or mixed feeding; older children are prescribed a carbohydrate diet (vegetable purees, fruit juices, tea with crackers, porridge, etc.).

To eliminate hypocalcemia, calcium gluconate is prescribed orally. After normalization of blood calcium levels and disappearance of signs of spasmophilia, antirachitic therapy is continued. During the recovery period, gymnastics, general massage, and long walks in the fresh air are indicated.

Prognosis and prevention

Identification and timely elimination of latent tetany allows one to avoid the clinical manifestation of spasmophilia. If timely assistance is provided for seizures and adequate correction of electrolyte disturbances, the prognosis is favorable. In extremely rare cases, in the absence of timely emergency care, the death of a child may occur due to asphyxia and cardiac arrest.

In its main provisions, primary prevention of spasmophilia repeats the prevention of rickets. Breastfeeding plays an important role in preventive measures. Secondary prevention of spasmophilia consists of treating the latent form of tetany, monitoring blood calcium levels, prophylactically taking calcium supplements, and conducting anticonvulsant therapy for 6 months after a seizure attack.

Spasmophilia (tetany) is a painful condition in which there is increased neuromuscular excitability with a tendency to convulsions and spastic manifestations, usually detected in early spring during a period of increased insolation. Occasionally occurring in adults, spasmophilia primarily affects children aged 6 months to 3 years, premature babies and those who are bottle-fed or mixed-fed. Spasmophilia occurs when there is a calcium deficiency in the child’s body and is often combined with rickets.

Causes of spasmophilia in children

Spasmophilia develops as a result of a lack of calcium in the blood due to taking high doses of vitamin D in the treatment of rickets or with increased insolation and excessive formation of this vitamin in the skin. Its overproduction in the body has a negative effect on the functions of the thyroid gland, provokes the absorption of calcium and phosphorus salts in the intestine and their further reabsorption (reabsorption) in the renal tubules, which causes alkalosis. Active deposition of calcium in the bones leads to a decrease in its amount in the blood - hypocalcemia, and also increases neuromuscular excitability, leading to seizures.

Symptoms of latent spasmophilia

The disease can have a hidden (latent) or obvious form. The latent form of spasmophilia in children is very difficult to determine - they are actually healthy, they have normal physical and psychomotor development, but they often show symptoms of rickets. There are a number of symptoms characteristic of spasmophilia that confirm its latent form. Let's name some of them:

Chvostek's sign. It is characterized by contraction of the facial muscles when lightly tapping the cheek between the corner of the mouth and the earlobe along the trunk of the facial nerve;
Weiss's sign. It is characterized by the occurrence of contraction of the muscles of the forehead and eyelids when tapping with a percussion hammer in the area of the edge of the orbit from the outside;
Trousseau's sign. When the shoulder is intensively pulled with a tourniquet or cuff, a convulsive contraction of the hand muscles occurs in the overtightened arm. This leads to the position of the hand in the form of an “obstetrician’s hand”. Convulsions in spasmophilia are preceded by a feeling of numbness and pain in the fingers;
Maslov's symptom. In children suffering from spasmophilia, unlike healthy ones, when a needle is pricked in the leg, not only rapid breathing is observed, but also apnea (short-term cessation of breathing) recorded by a pneumograph.

The latent form of spasmophilia in children is determined quite often. Under the influence of certain factors, such as fear, vomiting, sudden exposure to sunlight, or an increase in temperature due to an infectious disease, it can become obvious. If spasmophilia is detected, treatment must be carried out immediately.

Clinical picture and symptoms of obvious spasmophilia

An obvious form of spasmophilia in children can be expressed by laryngospasm, carpopedal spasm, eclampsia, or a combination of them:

Laryngospasm. One of the most common forms of spasmophilia, also called “birthmark,” is characterized by a sudden acute narrowing of the glottis, with its possible partial or complete closure, which occurs during crying or fright. With moderate manifestations of laryngospasm, the child’s skin turns pale, cold sweat appears, and a change in voice occurs with hoarse or sonorous inhalation. The attack can last up to 2 minutes, then when breathing is restored, the child falls asleep. In the absence of adequate treatment for spasmophilia, attacks can be repeated; during severe laryngospasm, complete cessation of breathing and loss of consciousness are sometimes observed; in the most severe cases, death is possible;
Carpopedal spasm. Symptoms of spasmophilia in this form of the disease are tonic spasms of the hands, feet and face. In this case, the child has bent arms at the elbows, drooping hands with the characteristic Trousseau symptom, bent legs and feet. Attacks of spasmophilia can last from several minutes to several hours, with reactive swelling of the hand and foot appearing; spasms of the respiratory muscles are also possible, threatening to delay and stop breathing, and spasms of the heart muscle with possible cardiac arrest;
Eclampsia. The rarest and most dangerous form of spasmophilia, manifested by attacks of clonic-tonic convulsions that spread to the entire musculature. With a mild course, facial muscle spasms, the appearance of cyanosis, intermittent breathing and numbness of the child are characteristic. During a severe attack of spasmophilia, convulsions of the whole body, loss of consciousness, tongue biting, involuntary urination and defecation occur; the attack can last up to 25 minutes. In severe cases, respiratory and cardiac arrest is possible; eclampsia most often affects children in the first year of life.

These forms of spasmophilia pose a threat to the health and life of children and require emergency medical care for immediate resuscitation.

Spasmophilia in adults

Spasmophilia in adults is much less common than in children; it can be caused by the following reasons:

Surgical operations to remove the parathyroid glands;
Hemorrhages;
Tumors that have a negative effect on the thyroid gland.

In some cases of spasmophilia in adults, its etiology remains unknown. Factors that provoke the detection of the disease in a latent form include pregnancy, lactation, infectious diseases, and nervous strain. To prevent attacks of spasmophilia, it is recommended to avoid stressful situations, be able to control your breathing and relax, and include foods containing calcium, magnesium and phosphorus in your diet.

Treatment of spasmophilia

When diagnosing spasmophilia in children, the age of the child, the time of year, the presence of signs of rickets are taken into account; laboratory tests determine the symptoms of hypocalcemia, hypophosphatemia, and metabolic alkalosis.

In the treatment of spasmophilia, relief of convulsive syndrome is carried out with the help of anticonvulsants - seduxen, relanium, magnesium sulfate, gamma-aminobutyric acid. To restore calcium levels in the blood and eliminate alkalosis, use a 10% solution of calcium gluconate and 3-5% ammonium chloride. Subsequently, vitamin therapy is carried out, and after normalization of calcium levels in the blood, therapeutic doses of vitamin D are prescribed.

If an attack of laryngospasm develops, before the ambulance arrives, it is necessary to lay the patient on a hard surface, ensure rest and access to air, sprinkle the face and body with cold water, ammonia or other means to cause irritation of the nasopharyngeal mucosa. To stop an attack of spasmophilia, doctors administer a solution of calcium and magnesium intravenously, and sedatives intramuscularly. If the measures taken are ineffective and there is no breathing, tracheal intubation is necessary, as well as indirect cardiac massage when it stops.

Prevention of spasmophilia consists of timely diagnosis and adequate treatment of rickets.

Spasmophilia. Spasmophilia (Infantile tetany) Additional ways to check antispasmodic symptoms

Trousseau) - 1) (syn. Trousseau phenomenon) - a tonic spasm of the hand that occurs in response to pressure in the area of the neurovascular bundle on the shoulder; a sign of spasmophilia or tetany; 2) development of acute thrombophlebitis of large veins in cancer of internal organs.

“Obstetrician’s hands”? This is when fingers 1, 4, 5 are bent and you cannot move them normally. When the nerves of the hand are damaged.

or carpal tunnel syndrome. What is it?

This is completely called the Wernicke-Mann pose. Occurs with hemiparesis (paresis of one half of the body), characteristic of damage to the central motor neuron.

Trousseau syndrome

This syndrome is named after the person who first established the relationship between the combination of thrombophlebitis and cancer of internal organs - the French doctor Andre Trousseau. A typical symptom of spasmophilia - “obstetrician’s hand” - is named after him. Trousseau syndrome refers to paraneoplastic processes, and links together spontaneous migratory thrombophlebitis and advanced cancer of the esophagus or other internal organs (usually the stomach, liver).

Reasons

Most often, this symptom appears with tumors of the gastrointestinal tract.

Symptoms

As is often the case in medicine, the discovery of this syndrome is associated with the death of the author himself. Andre Trousseau had been studying neoplastic pathology for a long time, and had already noticed signs of spontaneous thrombosis. Since the relationship between thrombosis and tumors was obvious to Trousseau, he assumed that he himself had stomach cancer, especially since there were not too obvious, but nevertheless alarming symptoms. And so it turned out - Andre died of stomach cancer.

Tumors of internal organs do not always make themselves felt with typical symptoms. And people often tend to reduce the significance of what they consider to be terrible complaints and symptoms. The tumor grows, its external influence on the body increases, and pareneoplastic processes are provoked. If phlebothromboses form in different places, are difficult to treat, or even not treatable at all, if there are thromboses of large arteries not associated with any diseases known to the patient, a cancerous tumor should be assumed.

Diagnosis and treatment

There is no specific treatment for Trousseau's syndrome (as well as other paraneoplastic processes). They can only clinically weaken or regress with successful treatment (even palliative treatment).

Forecast

Entirely depends on the prognosis of the tumor and the possibilities of its radical treatment.

7 reasons why you can't quit smoking.

Convulsive syndrome

In this article we will talk about cramps. First of all, about what pathological conditions they are typical for.

Cramps themselves are not a disease, but a symptom, and therefore they are not treated. What do they do with them, you ask? The answer is: they stop it, or, in simple terms, remove it.

What should you do if a child has seizures? First of all, call an ambulance. Doctors will administer anticonvulsants and take the child to the hospital or leave him at home under the supervision of a local pediatrician.

Remember that it is PROHIBITED to transport a person with seizures. This is fraught with complications. Therefore, do not demand immediate hospitalization from emergency doctors and do not allow them to take the child away until the condition stabilizes. If the convulsions were so short-lived that you did not even have time to get scared, much less call for help, do not forget about them. Be sure to see your doctor as soon as possible. We hope our article will help you navigate a difficult situation.

So, cramps are involuntary muscle contractions caused by irritation of certain brain structures that control movement. Seizures are divided into epileptic and non-epileptic. This division is important because these two groups have a completely different approach to treatment.

There are also tonic - more persistent and slow convulsions and clonic - fast, fragmentary. They can also have a mixed character - tonic-clonic. Although these names are not easy, in reality these 2 types of seizures are clearly distinguishable. Anyone who has seen both at least once in his life will never confuse them.

Most often, convulsions are a reflection of epileptic seizures. In this case, they can be generalized (general) or focal (local). Partial seizures involve seizures in one limb or on one side of the body. They indicate an area of the brain that is affected by arousal. During generalized seizures, the entire cerebral cortex, which is responsible for movement, is irritated, so all the muscles of the body are seized with convulsions. We will talk about epilepsy in more detail in future articles.

Now let's return to non-epileptic causes of seizures.

Febrile seizures. The most common seizures in children are febrile, i.e. caused by a rise in body temperature above 38 C. As the temperature rises, the metabolism in the brain cells and its blood supply change. The consequence of this is an increase in convulsive readiness. Typically, convulsions occur on the first day of a rise in temperature during infectious diseases: influenza, sore throat, etc. They look like twitching of the limbs against the background of loss of consciousness and an increase in the general tone of the body. The attack lasts 3-5 minutes and most often occurs once. The risk group is all children aged 9 to 20 months. What should you do in such a situation?

1. Call an ambulance.

2. Turn the child on his side, expose him as much as possible and keep him calm. Don't scream trying to bring him to consciousness.

3. Remove all hazardous items to prevent injury. The child must be in a safe place (corners of the bed, etc., in this case there is danger).

4. Provide access to fresh air.

The examinations that you will undergo after such an episode include a visit to a neurologist and EEG recording. Don't get scared ahead of time. The presence of febrile seizures most often does not indicate any nervous disease at all. It is necessary to get checked, since 20% of such children are subsequently diagnosed with epilepsy.

Tetany. Tetany is caused by a decrease in calcium levels in the blood. A lack of calcium leads to increased excitability of the nervous tissue, as a result of which a series of discharges occur in it. Tetany is easy to recognize. Spasms of the hands and feet are characteristic. The spasm of the hand looks like an “obstetrician’s hand” - flexion in the metacarpophalangeal joints and extension in the interphalangeal joints, flexion in the radial and elbow joints. If the spasm affects the leg, then the foot and toes bend towards the sole with an inward turn. The danger of tetany is that laryngospasm (spasm of the glottis) may develop, making breathing difficult. If your seizures resemble tetany, tell your doctor. To begin with, he will conduct several functional tests, and then send you to analyze your hormone levels. The most common cause of tetany is insufficiency of the parathyroid glands. However, it can be observed during hyperventilation (deep breathing) in patients with neuroses and renal failure. It may also be associated with decreased magnesium levels or fluctuations in blood potassium levels. This applies mainly to sudden changes in concentrations, for example, with intravenous administration of drugs containing these electrolytes.

Multifocal myoclonus – jerky, irregular convulsive movements. They often appear in the context of confusion or daze. Such myoclonus may be accompanied by tremors and twitching. Usually occurs as a consequence of metabolic or toxic encephalopathy. In children it appears mainly as a consequence of apnea at birth.

In younger children, epileptic seizures are easily confused with affective-respiratory attacks. Affective-respiratory attacks occur as a consequence of intense screaming in an offended or frightened child. They are characterized by holding the breath while inhaling, followed by blueness, loss of consciousness, decreased muscle tone, or generalized tonic muscle tension. Sometimes against this background short-term clonic twitching occurs. After a few seconds, breathing, and with it the screaming, resumes. Confusion persists for a minute, after which the child returns to the interrupted activity. Seizures are observed mainly in children from 6 months of age. up to 4 years and then disappear without a trace. The main therapy is psychological correction of the behavior of mother and child.

Often the “convulsions” are demonstrative – hysterical. In this case, they are bizarre, without a clear change in the tonic and clonic phases with arching of the body, kicking, moaning, screaming. It is characteristic that all this happens with unchanged consciousness. Help - remove the audience for whom the concert is given.

Brief clonic convulsions may occur during fainting. This happens when a fainting person does not get the opportunity to fall (sitting in a chair, on public transport). In this case, the fainting prolongs and, as a result, short-term convulsions occur. Their duration in this case does not exceed several seconds.

It is necessary to distinguish convulsions from hyperkinesis. These are involuntary violent movements associated with the defeat of the system responsible for the smoothness, economy and emotional coloring of movements. There are several types of hyperkinesis: tremor (shaking), dystonia, chorea, athetosis, ballism, tics, etc. We will describe the most common ones. Surely you have seen such patients on the street. You should not be afraid of them - basically, they have adequate mental and psychological development, they themselves suffer from their defect. So, dystonia is involuntary slow repetitive movements, rotation, flexion or extension of various parts of the body with the formation of pathological postures. Chorea is a continuous stream of fast, nonrhythmic, chaotic jerks. Athetosis – slow worm-like movements in the arms and body. Sometimes athetosis looks like a corkscrew twist.

Read about the epileptic nature of seizures in the next article.

Obstetrician syndrome

In the medical literature, Trousseau's symptom refers to two conditions:

Recurrent thrombophlebitis in cancer of internal organs (it is, however, more often called Trousseau's syndrome). Thrombophlebitis affects both superficial and deep veins, often changes location (thrombophlebitis migrans) and manifests itself as chains of painful nodules along the affected veins. Veins are affected haphazardly, simultaneously or sequentially. Trousseau syndrome develops due to changes in the level of prothrombin during a malignant neoplasm.

It is observed, as a rule, with adenocarcinomas of the pancreas or lung, as well as the stomach, breast or prostate gland. Trousseau described it in 1861, and in 1867 he discovered it as one of the manifestations of pancreatic cancer, which ultimately killed him.

Carpal spasm (hand spasm during tetany). It is often associated with foot flexor spasm (carpopedal spasm), extension posture, and opisthotonus.

During carpal spasm, the wrist flexors and finger extensors contract. The thumb is bent and brought to the palm, the rest are bent at the metacarpophalangeal joints, but straightened at the interphalangeal joints. The hand takes a position similar to that given to it by the doctor performing a vaginal examination, which is why Trousseau called carpal spasm “the hand of the obstetrician” (in French, main d’accoucheur).

Under what conditions is the “obstetrician’s hand” symptom observed?

For any predisposing to tetany: alkalosis, hypocalcemia, hypomagnesemia, hypophosphatemia.

How to provoke carpal spasm to reveal hidden tetany?

Press the shoulder with the sphygmomanometer cuff until the pulse disappears in the radial artery for 5 minutes. For hypocalcemia, the sensitivity of this test is 66%, but in 4% of cases the result is false positive, so it does not replace the determination of serum calcium levels.

Instead of provoking carpal spasm, you can determine Chvostek's symptom, which indicates increased excitability - twitching of the facial muscles when the temporal bone is tapped in front of the auricle at the exit point of the facial (VII cranial) nerve.

The sensitivity of Chvostek's sign for latent tetany is low (27%), and the false-positive rate is very high (19-74% in children and 4-29% in adults).

Who is Trousseau?

Armand Trousseau () - one of the greatest figures in Parisian medicine of the 19th century. He was the first in France to perform tracheostomy, introduce thoracentesis, and coin the term “aphasia.” He was an excellent clinician and educator, renowned as a lecturer who presented clinical observations with the grace of a novelist, and as an ardent advocate of bedside clinical teaching.

It was Trousseau who introduced into widespread use such eponyms as Addison's disease, Graves' disease and Hodgkin's disease. He was deeply respected and loved by students and colleagues. His students include Potin, Lasegue, Brown-Séquard and da Costa. In addition, Trousseau was involved in political activities. He was a participant in the revolution of 1848, one of the creators of its legislative body.

His advice to students remains relevant 150 years after his death: “Watch the practice of many doctors; Do not unconditionally assume that your teacher is always right, that he is the best. Don't be shy about admitting your own ignorance. In fact, recognition of it is on the tip of every doctor’s tongue. Do not exaggerate your medical merits by mastering scientific facts. They are only a condition for future professional achievements, allowing you to take the next step to the heights of mastery.”

Who is Khvostek?

Frantisek Chvostek () - an Austrian surgeon originally from the Czech Republic, in 1867 he described the symptom named after him. In addition to surgery, he studied and treated diseases of the nervous system, including experimental research in the field of electrotherapy.

Obstetrician syndrome

During spasm, the arm is in a state of extension, the forearm is bent in semiflexion, and the shoulder is in a state of adduction (Trousseau's symptom - the obstetrician's hand).

On the lower extremities there is increased extension of the thigh and lower leg with flexion of the foot and toes. In severe cases, cramps can involve all the muscles of the face, causing it to become distorted. The face takes on a characteristic expression, the forehead is wrinkled, the lips are contracted and protruded forward. The muscles of the eyes, tongue, larynx, and the diaphragm also take part in a spastic attack. With spasms of the muscles of the larynx, which is more often observed in children, laryngospasms occur, with suffocation, cyanosis; with prolonged spasm, severe asphyxia appears with loss of consciousness, which can be fatal. Often, patients with chronic hypoparathyroidism experience trophic disorders: dry skin, brittle bones, hair loss, cataracts, significant weight loss. Patients often experience tachycardia, arrhythmia, and pain in the heart area of a compressive nature. The electrocardiogram reveals an increase in the QT interval, which is caused by hypocalcemia.

A constant symptom of hypoparathyroidism is a violation of mineral metabolism - hypocalcemia up to 5-6 mg%, hyperphosphatemia up to 7-10 mg%, hypocalciuria and hypophosphaturia. Impaired function of the organ of vision is expressed in impaired convergence, eyelid spasms, diplopia, nystagmus and the development of cataracts. During an attack, you can observe constriction or dilation of the pupils and a slower reaction. With spasm of the intercostal muscles, abdominal muscles and diaphragm, significant respiratory distress is observed.

The autonomic nervous system is in a state of increased excitability with a tendency to vasomotor phenomena.

Dysfunction of the gastrointestinal tract is expressed in increased peristalsis, constipation followed by diarrhea, and increased secretion of gastric juice. Gastric or duodenal ulcers may often develop.

According to the clinical course, acute, chronic and latent forms of parathyroid tetany are distinguished.

In the acute form of tetany, attacks are often repeated, last a long time, and can occur unexpectedly.

The development of tetany in acute form after any trauma and strumectomy indicates complete or almost complete shutdown of the function of the parathyroid glands. The acute form of tetany can end in recovery or become chronic, depending on the nature of the disease, treatment, etc. This form has a less severe course, attacks are rare. In its origin, provoking moments, overheating or hypothermia, physical activity, mental trauma, pregnancy, and acute infections are important.

Seasonal exacerbations and diseases occur in spring and autumn. Often, patients with chronic hypoparathyroidism exhibit trophic disorders: dry skin, brittle nails, hair loss and weight loss. Changes in the teeth are reduced to enamel defects; teeth break and crumble easily.

Recognition of idiopathic latent hypoparathyroidism presents certain difficulties. This form is characterized by the absence of spontaneously occurring attacks, which can occur under the influence of various provoking factors. Idiopathic tetany more often occurs at a young age, men are more often affected. The presence of changes in calcium and phosphorus metabolism typical of hypoparathyroidism gives grounds to classify idiopathic tetany as a parathyroid form associated with congenital inferiority of the parathyroid glands.

Complaints from patients with a latent form of tetany are usually associated with cardiac disorders: they complain of palpitations, chest pain, a feeling of tightness in the chest, headaches, fainting, and often complain of goosebumps crawling in their fingers. Physical and x-ray examinations of internal organs reveal no changes. The simplest way is to identify Chvostek's symptom, which is based on increased excitability of the facial nerve when it is mechanically irritated. In response to irritation, the upper lip twitches (Khvostek I), or the upper lip and nose (Khvostek II), or twitching of the corner of the mouth is added (Khvostek III).

Diagnosis and differential diagnosis. It is necessary to think about the possibility of hypoparathyroidism if patients, after partial removal of the thyroid gland, experience signs of topical seizures. When making a diagnosis, one should also differentiate tetany from hysteria and epilepsy. In patients with hysteria and epilepsy, calcium and phosphorus metabolism disorders are not found.

One should also keep in mind hypoglycemic convulsions, in which characteristic symptoms are observed: a feeling of hunger, weakness, and pale skin. The question is resolved by examining blood sugar and calcium levels.

Treatment of hypoparathyroidism. When treating an attack of tetany, it is necessary to administer 10 ml of 10% calcium chloride intravenously, 2-4 ml of parathyrsocrine intramuscularly.

Intravenous administration of a 10% solution of calcium chloride or a 10% solution of calcium gluconate usually quickly stops an attack of convulsions during tetany, which is very important for laryngospasm, when this is the main measure during first aid.

Depending on the duration and frequency of attacks, injections of calcium chloride and parathyroid hormone are recommended 2-3 times a day under the control of calcium levels in the blood.

In the inter-iristune period, calcium supplements are prescribed in the form of a 10% solution of calcium chloride, one tablespoon 3 times a day, or calcium gluconate in tablets, 3-4 tablets a day. At the same time, an alcohol solution of vitamin D2 in ME is prescribed orally 2 times a day.

The diet of patients should contain a large amount of calcium, and therefore dairy products are recommended.

DIC syndrome in obstetrics

Pregnant women are considered one of the most vulnerable categories of patients, who are susceptible not only to infectious and respiratory diseases, but also to various disorders in the functioning of internal organs. Pregnant women may experience complications from the nervous, vascular and digestive systems, as well as endocrine disorders that develop against the background of changes in hormonal levels. Negative changes can also occur in the hematopoietic system, as well as hemostasis - a biological system that ensures the vital functions of the body, maintains the liquid state of the blood and promotes the rapid restoration of the skin and mucous membranes after damage.

DIC syndrome in obstetrics

A fairly common pathology of hemostasis during pregnancy is DIC syndrome. This is the process of active leaching of thromboplastin (an external stimulator of the coagulation process) from tissues and organs, which leads to impaired blood clotting. In medical practice, this condition is called “disseminated intravascular coagulation.” The syndrome is dangerous due to its asymptomatic course and the rapid development of systemic coagulopathy, therefore all pregnant women should be observed by a gynecologist or obstetrician-gynecologist at their place of residence throughout the entire pregnancy.

Why do hemostasis disorders occur during pregnancy?

Minor disorders of hemostasis, accompanying signs of disseminated intravascular coagulation, can be explained by physiological processes occurring in a woman’s body during pregnancy, but in the vast majority of cases (more than 94%), such symptoms are the result of certain pathologies.

Fetal death

One of the causes of acute DIC at any stage of gestation is intrauterine fetal death and pregnancy loss. This can happen for a number of reasons, but the most common ones are:

maternal intake of toxic drugs and potent drugs;
amniotic fluid embolism (amniotic fluid entering the pulmonary arteries and their branches);
placenta previa or abruption;
acute alcohol or drug intoxication of the fetus;
tumors of the outer cellular layer of the placenta (trophoblast).

One of the causes of pathology is fetal death

Miscarriage of pregnancy can occur at any stage, but disseminated intravascular coagulation syndrome appears only 4-6 weeks after antenatal fetal death. The pathology is complicated by acute intoxication and a high risk of toxic products entering the systemic bloodstream, which can lead to the development of sepsis and bone marrow inflammation.

It is possible to determine a frozen pregnancy in the early stages only with the help of an ultrasound examination, as well as a blood test for the level of human chorionic gonadotropin, which will be significantly lower than the gestational norm. After weeks, fetal death can be suspected by the absence of movements and heartbeat.

Important! DIC syndrome of the 4th degree can lead to the death of a woman, therefore, if there are any signs indicating a possible termination of pregnancy, you must immediately contact the pregnancy pathology department at the regional maternity hospital.

Preeclampsia and initial signs of preeclampsia

Preeclampsia (“late toxicosis”) is the most common pathology of pregnant women, encountered by almost 60% of women. Preeclampsia has three main signs that allow diagnosing the pathology at an early stage:

a stable increase in blood pressure with a weak response to drug correction;
detection of protein or traces thereof in urine;
swelling on the face and limbs, most often having a generalized form.

High blood pressure during pregnancy

Women diagnosed with gestosis should be under constant supervision of specialists, since progressive forms of pathology can cause the development of preeclampsia - a cerebral circulation disorder against the background of late toxicosis in the second half of pregnancy. Another danger of gestosis is damage to endothelial cells (single-layer flat cells covering the surface of the cardiac cavity, lymphatic and blood vessels). If the integrity of the endothelium is compromised, disseminated intravascular coagulation syndrome may develop, requiring close monitoring and timely emergency care.

Symptoms of gestosis during pregnancy

Other reasons

The causes of DIC syndrome may be of infectious origin. Infection of the amniotic fluid, prolonged bacterial infections of the internal organs of the mother, which increase the risk of bacteria and their toxins entering the bloodstream - all this can cause coagulation disorders and systemic coagulopathy, so it is important to treat any diseases of an infectious nature in a timely manner and follow all doctor’s orders. Some women refuse to take antibiotics, believing that they may harm the unborn child, but it has long been proven that the consequences of using antimicrobial drugs are much milder compared to possible complications if the infection gets to the fetus.

90% of children have no symptoms after birth due to intrauterine infection

Other causes of acute disseminated intravascular coagulation may include:

surgical operations performed during pregnancy with blood or plasma transfusion (the risk increases if blood incompatible with the group or Rh factors was used for the transfusion);
damage to red blood cells or platelets;
prolonged uterine bleeding leading to the development of hemorrhagic shock;
uterine rupture;
atony of the uterine muscles (decreased muscle tone);
medical massage of the uterus.

Infectious diseases, burns, skin injuries, shock conditions of various origins, pathologies of the placenta can also cause coagulopathy, so it is important for a pregnant woman to undergo the examinations prescribed by the doctor on time and take the necessary tests.

Symptoms: when should you see a doctor?

The danger of DIC syndrome lies in its practically asymptomatic course. In most cases, pathology can only be determined after laboratory diagnostics, which can determine hematological disorders (changes in blood chemical parameters). With grade 3 and 4 disseminated intravascular coagulation syndrome, a woman may experience specific symptoms, the main of which is a hemorrhagic rash. It looks like a small pink or light red spot, is localized on the surface of the epidermis and appears as a result of rupture of small blood vessels and hemorrhage under the skin.

Coagulation of blood flowing from the uterine cavity

Other signs that may indicate the need to seek medical help include:

frequent nosebleeds in the absence of injuries or other damage;
bleeding gums (provided that the woman does not suffer from inflammatory periodontal and periodontal diseases, as well as gingivitis);
bruises that form on various parts of the body without exposure to any damaging factors;
uterine bleeding and spotting;
poor wound healing;
bleeding at injection sites.

Nosebleed

A woman may also feel constant weakness, her performance is impaired, and increased drowsiness appears. With frequent bleeding, constant headaches, dizziness, and a feeling of pressure in the temporal and occipital areas are noted. All these signs are a reason for carrying out diagnostic measures, so if they occur, you should immediately consult a doctor managing the pregnancy.

Target organs in DIC syndrome

Symptoms of pathology depending on the stage

In total, there are 4 stages of DIC syndrome, each of which has its own clinical features. For a more accurate diagnosis and determination of the pathogenesis of existing disorders, the doctor needs to collect a complete anamnesis and conduct laboratory diagnostics.

Table. Stages of disseminated intravascular coagulation syndrome and their symptoms.

Hand in spasm is in a state of extension, the forearm is bent in semiflexion, and the shoulder is in a state of adduction (Trousseau's symptom - the obstetrician's hand).
On lower limbs There is increased extension of the thigh and lower leg with flexion of the foot and toes. In severe cases, cramps can involve all the muscles of the face, causing it to become distorted. The face takes on a characteristic expression, the forehead is wrinkled, the lips are contracted and protruded forward. The muscles of the eyes, tongue, larynx, and the diaphragm also take part in a spastic attack. With spasms of the muscles of the larynx, which is more often observed in children, laryngospasms occur, with suffocation, cyanosis; with prolonged spasm, severe asphyxia appears with loss of consciousness, which can be fatal. Often, patients with chronic hypoparathyroidism experience trophic disorders: dry skin, brittle bones, hair loss, cataracts, significant weight loss. Patients often experience tachycardia, arrhythmia, and compressive pain in the heart area. An electrocardiogram reveals an increase in the QT interval, which is caused by hypocalcemia.

Permanent symptom of hypoparathyroidism is a violation of mineral metabolism - hypocalcemia up to 5-6 mg%, hyperphosphatemia up to 7-10 mg%, hypocalciuria and hypophosphaturia. Impaired function of the organ of vision is expressed in impaired convergence, eyelid spasms, diplopia, nystagmus and the development of cataracts. During an attack, you can observe a narrowing or dilatation of the pupils and a slow reaction. With spasm of the intercostal muscles, abdominal muscles and diaphragm, significant respiratory distress is observed.
Autonomic nervous system is in a state of increased excitability with a tendency to vasomotor phenomena.

Functional disorders gastrointestinal tract are expressed in increased peristalsis, constipation followed by diarrhea, and increased secretion of gastric juice. Gastric or duodenal ulcers may often develop.
According to the clinical course, acute, chronic and latent forms of parathyroid tetany are distinguished.

In acute tetany attacks are often repeated, last a long time, they can occur unexpectedly.
Development tetany in acute form after any injury and strumectomy, it indicates complete or almost complete shutdown of the function of the parathyroid glands. The acute form of tetany can end in recovery or become chronic, depending on the nature of the disease, treatment, etc. This form has a less severe course, attacks are rare. In its origin, provoking moments, overheating or hypothermia, physical activity, mental trauma, pregnancy, and acute infections are important.

There are seasonal exacerbation, diseases in spring and autumn. Often, patients with chronic hypoparathyroidism exhibit trophic disorders: dry skin, brittle nails, hair loss and weight loss. Changes in the teeth are reduced to enamel defects; teeth break and crumble easily.

Recognition of idiopathic is hidden ongoing hypoparathyroidism presents known difficulties. This form is characterized by the absence of spontaneously occurring attacks, which can occur under the influence of various provoking factors. Idiopathic tetany more often occurs at a young age, men are more often affected. The presence of changes in calcium and phosphorus metabolism typical of hypoparathyroidism gives grounds to classify idiopathic tetany as a parathyroid form associated with congenital inferiority of the parathyroid glands.

Complaints patients with a latent form of tetany are usually associated with cardiac disorders: they complain of palpitations, chest pain, a feeling of tightness in the chest, fainting, and often complain of goosebumps crawling in their fingers. Physical and x-ray examinations of internal organs reveal no changes. The simplest way is to identify Chvostek's symptom, which is based on increased excitability of the facial nerve when it is mechanically irritated. In response to irritation, the upper lip twitches (Khvostek I), or the upper lip and nose (Khvostek II), or twitching of the corner of the mouth is added (Khvostek III).

Diagnosis and differential diagnosis. It is necessary to think about the possibility of hypoparathyroidism if patients, after partial removal of the thyroid gland, experience signs of topical seizures. When making a diagnosis, one should also differentiate tetany from hysteria and epilepsy. In patients with hysteria and epilepsy, calcium and phosphorus metabolism disorders are not detected.
It should also be kept in mind hypoglycemic cramps, in which characteristic signs are observed, a feeling of hunger, weakness, pale skin. The question is resolved by examining blood sugar and calcium levels.

Treatment of hypoparathyroidism. When treating an attack of tetany, it is necessary to administer 10 ml of 10% calcium chloride intravenously, 2-4 ml of parathyrsocrine intramuscularly.
Intravenous administration 10% calcium chloride solution or 10% calcium gluconate solution usually quickly stops an attack of convulsions during tetany, which is very important for laryngospasm, when this is the main measure during first aid.

Depending on duration and the frequency of attacks, calcium chloride and parathyroid injections are recommended to be carried out 2-3 times a day under the control of calcium levels in the blood.
In the inter-iristune period Calcium preparations are prescribed in the form of a 10% solution of calcium chloride, one tablespoon 3 times a day, or calcium gluconate in tablets, 3-4 tablets a day. At the same time, an alcoholic solution of vitamin D2 is prescribed orally, 50,000-75,000 IU 2 times a day.