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3,3, Heterogeneity of impellent disturbances.

Observation over patients in dynamics and an estimation of motor deficiency available for them have allowed to allocate a number of clinical symptoms, characteristic for this or that kind of impellent disorders: 1) m change]> і] іі емггоіо a tonus (both rising, and depression); 2) presence pli absence of a sweet chnoetl; 3) delicacy (paresis) and the amazed extremities; 4) presence or absence of a painful syndrome; 5) presence vegetativnoyotroficheskih disturbances, early contractures.

Observation over patients in our research has allowed to allocate some variants mliechpo-tonncheskih disorders (tab. 24).

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Table 24

Variants of is muscular-tonic disorders at patients transferred polusharnyj an ischemic stroke (by results of own researches).

Variants

Muscularly -

The topical

Disorders

The muscular

Tonus

Paresis Spastichnost Vegetatively - trophic] [Zrushennja, early contractures Pain
1 And + + + +
2 And + + - ■ +
3 t + yo
4 -
5 1 + І

- Substantial increase; f - slight increase; [-depression

■I - symptom presence; - - absence of a symptom; 1 - the symptom can

To be taped or not to be taped.

Estimation the neurologist »to a neck gjugo the status of patients in a debut иіпо: і en іі ggtsja and in dynamics has allowed to allocate іруппу patients with similar clinical implications. We observed 40 persons for whom were characteristic a high muscle tone; early developing spastichnost; the moderate or deep paresis. At 9 from them appreciable muscular ptergonpja it was accompanied expressed swastikas nostyo and muscular delicacy and has led to sharp restriction of movements in extremities, that in a consequence has led to development of contractures in 4 patients.

Contractures in the beginning of the formation had neurogenic character, and in a consequence - admixed. Razlitie contractures sharply limited possibility of rehabilitational actions.

The centre of ischemic damage in this case settled down in deep departments of hemispheres, affected subcortical kernels, area of an internal capsule., white substance of hemispheres of a brain.

The similar variant of impellent disorders can be carried to group of disturbances of any movements, assotsiirovannoj with sochetannym damage piramidnookstraiiramidiyh structures in which frameworks moleno to allocate two variants we of shechno-tonic disorders;

* The first - with the high muscle tone, expressed spaetnchnoetyp, a deep paresis, keshtrakturami, artralgicheskim a syndrome;

• the second - with the high muscle tone, moderated eiastichnostyo, the moderate or deep paresis beja developments of contractures, is possible a painful syndrome.

Appointment of relaxants and cupping of a painful syndrome led to clinical improvement of a condition of patients, though as a whole the forecast for vesstanovl сепія patsieegtov with such dvit^atedysymi naru L11 enijami the doubtful.

For 73 sick druoj groups the clinical picture was characterised by slight increase or a normal muscle tone; absence spallchnostn. A lung go a moderate paresis, Development of contractures of nanosecond is characteristic, Restoration of the lost functions at such papdontov occurred earlier and ez larger volume, than at patients of other groups. The forecast for restoration as a whole the favorable.

The ischemic Center in this case at 44 человек* settled down superficially - in a cortex of hemispheres nln subject white substance; at 15 patients the small centres located in paraventrikuljarnom white substance were visualised; at 11 patients — in deep departments of hemispheres; and 3 cases application nejrovizualizatsii has not allowed to tap the ischemia centre.

Such group of disturbances of any movements has been defined by us, as the is muscular-tonic disorders bound to damage piramidnyh of structures (first of all cortexes big a hemisphere and

Spending ways). In structure of this group following variants of disorders have been allocated:

• the third - with muscle tone slight increase, spastichnost does not develop or is expressed slightly, a paresis from deep to a lung, contractures Еіе the painful syndrome is characteristic, possible;

■ the fourth — is characterised by development of an easy paresis go absence of impellent deficiency,

During observation over patients we have taped 12 patients with the expressed depression of a muscle tone in a disease debut. The estimation of impellent disturbances p has shown to dynamics, that at four patients the muscle tone was restored further, three have died in the acute period of a stroke. At other five patients the hypomyotonia remained throughout all period of observation. Spastnchnost in this case did not develop, a contracture did not observe ps і ». However the animal force in the amazed extremities has been considerably lowered.

U the centre of damage of cerebral substance had these patients the essential sizes and had character subtotalyjupo porazhenim hemispheres. Presence of the extensive centre of an ischemia causes massive sochetannoe damage piramidnyh and eksgrapiramidnyh structures, fast development and long existence diashiza, and also a phenomenon g a sloe фері і1 lccko n d with lff¾re ї і that ї shch and,

We have defined the given variant of is muscular-tonic disorders, how

• the fifth — the muscle tone is lowered., spastnchnost does not develop, a paresis as a rule the expressed. Century force muscular gi lo ї opium probably development argropatnj.

From nine survived patients seven persons to the extremity of the first year from has employed a stroke were dependent og the help of associates. Thus, it is long an existing hypomyotonia is prognostically adverse sign for restoration days that. Gel ache functions.

And and we did not meet the impellent disorders bound to the isolated lesion ekstrapjaramidnoj of system ours issledi van.

Special lpimanie we have given postnnsultnomu to a painful syndrome. Into its structure enter;

* The central painful syndrome bound to damage of eisodic structures of a brain at any level, but more often in the field of a thalamus;

* postittsultnye zrgr platn і ї, arising owing to trophic disturbances in joints paretnchnyh extremities. Most often meet artrapatni a humeral joint or a syndrome of "a painful shoulder» in which basis lay not only trophic disturbances, but also an exit of a column of a humeral bone from an articulate hollow because of a stretching of an articulate bag;

* The painful muscular spastic strictures bound with accruing muscular elaetichnosttys.

Among our patients postinsultnyj the painful syndrome was observed at six patients, At five it has been bound to a syndrome of "a painful shoulder», at one patient thalamic pains became perceptible. Development artropatin can lead to development of contractures at which because of sharp morbidity in the field of joints it is considerably limited active and passive movements that interferes with restoration of impellent functions.

Presence of the expressed is muscular-tonic disorders, postinsulytjugo bolenogo a syndrome, artropety, contractures leads to aggravation of a peripheric component of the central paresis. It develops fie only as a result deofferentatspi and deafferentatspi, on also as a result of development of dystrophic muscular disorders (so-called central, or cerebral, amiatrofii), and also occurrence of a pas a background of a stroke or a decompensation of tunnel conditions, developments of regional changes of soft tissues.

Thus, the syndrome impellent disturbance ігри polusharnom an ischemic stroke can be classified as follows:

1. On patomorfologncheskomu to the factor:

1. On prensdeg і ie prajmu t цесі ve npo and і iram id 11 y h структур*

2. Sochetannoe damage piramidnyh and ekstrdliramvdnyh brain structures.

3. Damage mainly ekstra piramidnyh structures,

II. On klinnko-patogenegi to an accurate variant:

1. Piramidnyj.

2. Spastic.

3* Atonic,

4. Ci that stet to-artropati cheski j

3. The minimum impellent disturbances.

Heterogeneity of a syndrome of impellent disturbances dictates tactics of the differentiated approach to treatment of the given pathological CONDITION. At the expressed rising of a muscle tone, razvptiet postipsultvoj spastnchnosti application of relaxants (tizanidin, Tolperisonum, Baclofenum) is necessary. At formation конірактур. A syndrome of "a painful shoulder» prescribe nesterojadnye resolvents (Voltarenum, diclofenac, movalis). Thalamic pains stop a prescription of antidepressants, anti the consul santov.

Except the specified methods of medicamental correction pshroko are used physiotherapy (electrotreatment, thermal procedures; masses;; magnetic stimulation, etc.), medical gymnastics, kinezioterappja. Taking into account development of the listed pathological syndromes in the first months after the transferred stroke not medicamental treatment should be early, long, complex. Certainly, mentioned above strategy are applied within the limits of the standard differentiated therapy and shemicheskogo shkulta.

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A source: Provotorov Valery Aleksandrovich. VARIANTS And DYNAMICS of is muscular-TONIC DISTURBANCES AT polusharnom the ISCHEMIC STROKE. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg. 2008

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  1. 1.2. Ways of an estimation of impellent disturbances.
  2. 1.1. The characteristic of impellent disturbances at ischemic p pl up gl rnom insul te.
  3. 1.3. Restoration of impellent functions.
  4. 3.2.1. Dynamics of restoration of impellent disorders.
  5. ways of creation of heterogeneity
  6. graphic heterogeneity
  7. construction of function of heterogeneity
  8. morphological heterogeneity endotelija the person
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