The brain in HIV-infected is subject to special danger. It is not only about progressive oncological neoplasms, but also about meningitis and other inflammatory processes. What is the pathology data arise, and which of them are the most common?

Why is the brain defeat when HIV and what does it lead to?

Cells of HIV infection fall through blood. In the early stages, this is expressed by inflammation of the hemisphere shell. The so-called meningitis is expressed in acute pain, which does not subside for several hours, as well as a strong fever. All this occurs in the acute phase of the immunodeficiency virus. How does HIV affect the brain, what can happen later? Infected cells are actively multiplied and divided, causing complex encephalopathy with an unclear clinical picture. At the later stages of brain damage in HIV can take a completely different character. They go to oncological diseases that are asymptomatic at the first few steps. This is fraught with a fatal outcome, because it is impossible to start a quick treatment in this case.

Common types of brain damage in HIV infection

Here are the most common pathologies that can develop in people with immunodeficiency virus after the affected cells fall into the hemisphere and the surrounding fabrics:

• Associated dementia. In healthy people, she can manifest after sixty years. If the organism is firmly settled with HIV infection, the defeat of the brain of this type is developing regardless of age. The classic manifestations of this psychomotor disorder - dementia, partial or complete loss of cognitive ability and so on.
• Meningitis in HIV-infected people may occur both at the initial stages and in the acute phase. It happens aseptic or bacterial. The first - most often is infectious form. Its causative agent may not only be a human immunodeficiency virus, but also other viruses related to him, for example herpes or cytomegalovirus. The lesion of the shell in this disease can lead to a fatal outcome in improper treatment.
• Associated encephalopathy. Often manifests children infected with AIDS. In addition to the high intracranial pressure, such signs are characterized as an increased muscle tone, mental delay.
• Sarcoma Caposhi is a serious and dangerous disease for which the main localization in brain fabrics is characteristic. It is worth noting that the numerous areas of the skin are also affected with such pathology. Small neoplasms, resembling ulcers can cover face, limb, heaven and other areas of the oral cavity. Such a change in the brain is diagnosed with HIV, AIDS is exclusively visually. Experienced specialists in the field of medicine assure that it is extremely difficult to confuse the sarcoma of capos with other diseases, so the biopsy fence is not needed. It is impossible to cure this disease, you can only slightly stop its symptoms or time to suspend the spread of rashes.

Please note that if the HIV-infected disease has gone into the brain, it is necessary for strict control of the doctor, as well as strict compliance with all the prescriptions. This will help keep the quality of life and significantly extend it.

A fairly popular complication that meets with HIV infection is.

HIV today is one of the most dangerous diseases, and it is impossible to cure it. To understand why this happens, you should find out what.

Light with HIV are susceptible to special danger. This disease very quickly affects these organs. In this case, the forecast in such cases may not always be.

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Diagnosis and treatment of neurological manifestations of neurospide

The disease of the human immunodeficiency virus can occur in the form of a hidden wearing of the virus, as well as in the form of an acquired immunodeficiency syndrome, which is the extreme stage of HIV.

With the development of HIV and AIDS, almost all human body systems are affected and affected. The main pathological changes are concentrated in nervous and immune systems. Defeat nervous system When HIV is called neurospide.

It is likely to be observed in approximately 70% of patients, and watched%.

Causes and pathogenesis

So far, the pathogenetic mechanisms of the effects of HIV on the nervous system are not fully studied. It is believed that neurospide arises due to direct and indirect influence on the nervous system.

There is also an opinion that the reason lies in the disturbed regulation of the response process from the immune system. A direct impact on the nervous system is carried out through penetration into cells that carry the CD4 antigen, namely neuroglia cerebral tissue, lymphocyte membrane cells.

At the same time, the virus can penetrate the hematostephalic barrier (physiological barrier between the blood and central nervous system). The reason for this is that viral infection increases the permeability of this barrier, and the fact that in its cells there is also CD4 receptors.

It is believed that the virus can penetrate into the cells of the brain at the expense of cells capable of capturing and digest bacteria that easily pass the hematorencephalic barrier. As a result of this, only neuroglia is amazed, neurons, due to the fact that they do not have CD4 receptors, they are not damaged.

However, due to the fact that there is a connection between the glial cells and neurons (the first served the second), the function of neurons is also violated.

As for the indirect effect of HIV, it is happening in various ways:

• as a result of the rapid reduction in immune protection, infections and tumors are developing;
• presence in the body of autoimmune processes, which are related to the production process of antibodies to nerve cells that have built-in HIV antigens;
• the neurotoxic effect of chemicals that produce HIV;
• as a result of the destruction of the endothelium of cerebral vessels by cytokines, which leads to disorders in microcirculation, hypoxia, which causes the death of neurons.

Primary and secondary neurospide

There are two groups of neurological manifestations that are associated with HIV infection: primary and secondary neurospide.

In case of primary neuropide, HIV affects the nervous system directly. There are several basic manifestations of the primary form of the disease:

Secondary neurospide is due to opportunistic infections and tumors that develop in a patient AIDS.

Secondary manifestations of the disease are expressed as follows:

Most often in patients with neurospered, such tumors are observed in the CNS:

Features of a clinical picture

Primary neurospide proceeds often without manifestation of symptoms. In rare cases, the symptoms of a neurological nature may appear for 2-6 weeks from the time of HIV infection. During this period, patients have a fever of unclear genesis, an increase in lymph nodes, skin rashes. At the same time appear:

1. Aseptic meningitis. Occurs u small number Patients with HIV (about 10%). The clinical picture is similar to serous meningitis. With aseptic meningitis in the spinal fluid, the level of CD8 lymphocytes is growing. When viral meningitis has another cause of appearance, the number of CD4 lymphocytes is growing. In rare and severe cases, it can lead to mental illness, disturbances of consciousness.
2. Acute radiculoneuropathy. Caused by inflammatory electoral damage to the myelin shell of the roots of the cranial and spinal nerves. This condition is manifested in tetraprez, disorders of sensitivity by polyneuric type, root syndrome, damage to facial and eye nerves, bulbar syndrome. Symptoms begin to appear and gradually become more intense as a few days and a few weeks later. At the occurrence of stabilization of the condition over the distance, a decrease in the intensity of symptoms begins. Only 15% of patients remain the consequences after acute radiculonia.

Separate forms of neurospide make themselves to know in the open stage of HIV infection:

1. HIV Encephalopathy (AIDS Dementia). The most frequent manifestation of neurospide. There is a presence of behavioral, motor, cognitive disorders. Approximately 5% of Patients HIV Encephalopathy is a primary symptom, speaking, about the presence of neurospide.
2. HIV myelopathy. It is expressed in violation of the function of the pelvis organs and the lower spastic parapere. A feature is slow leakage and differences in the severity of the manifestation of symptoms. This disease is diagnosed with about a quarter of people with HIV.

Establishing diagnosis

Nearrospide is often found quite often, in most patients with HIV, so all the infection media it is recommended to undergo a regular inspection at the neurologist. HIV Encephalopathy is initially manifested in violations of cognitive functions, so it is necessary in addition to the study of neurological status, also to carry out a neuropsychological examination.

In addition to the main studies that are patients with HIV, it is necessary to refer to the diagnosis of neurospide to the tomographic, electrophysiological and liquorological methods of the study.

Patients can also be aimed at consulting neurosurgeon, psychiatrist, as well as other specialists. The effectiveness of the treatment of the nervous system is analyzed for the most part using electrophysical research methods (electromyography, electronomyography, and the study of caused potentials).

Violations in the nervous system at neurrypide, as well as the study of their flow, and the results of therapy, are investigated using computer and magnetic resonance imaging.

Analysis of the cerebrospinal fluid is also prescribed, the fence of which occurs with the help of a lumbal puncture. If in a patient, in addition to manifestations of neurological nature, lowering the amount of CD4 lymphocytes, in the analysis of the spinal fluid, the protein level is increased, the glucose concentration is reduced, the lymphocytosis is moderate, then we are talking about the likelihood of neuroscope.

Comprehensive treatment

Treatment of neurospide and the relief of its development is inseparable with the treatment of HIV infection, and make it the basis. Patients prescribe antiretroviral therapy medical preparationswhich have the ability to pass through the hematorecephalic barrier, and as a result of which block the development of HIV, stop an increase in immunodeficiency, reduce the intensity and degree of manifestation of symptoms of neurospide, reduce the likelihood of infections.

The most studied is the use of staudine, zidovudine, azidotimidine, abacavir. Since drugs are toxic enough, the appointment should occur with the consent of the patient, and according to the individual program.

It is also necessary to carry out the treatment of each specific neurpide form:

Also effective is the use of plasmferresis, corticosteroid therapy. Treating tumors may require surgical intervention, and a neurosurgeon is needed.

In the situation of early detection of neurospide (at the primary stages), and the presence of adequate treatment of manifestations of a neurological disease, there is the possibility of slowing the development of the disease. Often, the cause of death in patients with neurosprises is a stroke, the presence of opportunistic infections, malignant tumors.

This section is created to take care of those who need a qualified specialist without disturbing the usual rhythm of their own life.

Beaming brain with HIV infection

The article describes the features of pathogenesis and clinical flow Insults in HIV positive patients.

The nervous system is affected by a human immunodeficiency virus in 80-90% of cases, even in the absence of characteristic changes in peripheral blood and other organs. Moreover, in 40-50% of cases, neurological complications are the first manifestations of HIV infection symptoms, i.e. The patient learns about his first manifestations of neurospide precisely according to the problems with the nervous system (strong impairment of memory, weakening attention and ability to be concentrated, decrease in intelligence, progressive dementia, hemorrhagic and ischemic strokes, etc.).

Numerous complications in patients with symptoms of HIV infection can be caused:

Diverse opportunistic infections, and even

By the on-site effect of antiretroviral drugs

In the brain of patients with HIV infection, virus strains that infect cells that have CD4 receptors on their surface are found. They damage the white brain substance with the help of neurotoxins produced by activated or infected with the virus with their own cells. In addition, infected cells inhibit the growth of new nerve cells in the cerebral cortex, i.e. Have a neurotoxic effect.

As an example, we present the statistics of observations of 1600 patients with symptoms of HIV infection at the age of 35-45 years. The number of strokes in HIV positive patients exceeded the statistics of unreleased people more than 30 times!

Thus, it can be concluded that patients with symptoms of HIV infection are in a group of high stroke risk.

The main forms of violations that are observed in HIV positive persons are a large ischemic stroke of white and gray brain substance, or a lot of minor ischemic strokes regressing within 2-3 weeks.

Since the CD4 receptors are located in various cells of the head and spinal cord, almost the entire central nervous system of man is exposed to HIV attack. And after strokes of varying severity, destruction contributes to secondary damage to the nervous tissue.

In patients with injection use of narcotic drugs, allergies for foreign substances are superimposed on these lesions and damage the walls of vessels with minor foreign impurities, which leads to a narrowing of the vessel's lustration and its thrombosis with a further possible ischemic stroke or a breakdown of the vessel.

Due to the neglect of the sterility of injections, purulent-septic complications are not uncommon.

In patients, long-consuming drugs, there is often an expansion of the small veins of all parts of the brain, the walls of the vessels are clogged and partially stretched and rare, small hemorrhages and thrombosis are frequent. It can be said that "preparation" to ischemic stroke was carried out on 5, nothing was missed!

In patients with symptoms of HIV infection, it is quite often observed or ischemic stroke, or a transformation of ischemic stroke into hemorrhagic. The primary hemorrhagic stroke itself occurs quite rarely. Sometimes spontaneous spinal hemorrhages occur.

Hemorrhagic stroke It is more common in patients with metastases of sarcoma capsos in the brain.

Conducted in one of the American clinics for 10 years of study showed that the number of strokes in people with symptoms of HIV infection increased by 67%. (All strokes were ischemic.) At the same time, the number of strokes decreased by 7% in the control group (patients not infected HIV).

All patients are strongly reduced by immunity: 66.7% of patients had the CD4 level below 200 / μl, 33.3% - 200-500 / μl.

HIV encephalopathy symptoms and development forecast

Slowly progressive HIV infection affects not only the body's immune system. The virus applies to all vital organs of the human body. In nine cases out of ten, the virus affects the nervous system of the patient, HIV-encephalopathy develops.

What is HIV?

The immunodeficiency virus causes irreversible changes in the cell structure, as a result of which the body loses the ability to resist other infectious diseases.

The virus can live in the body a long period - up to fifteen years. And only after such a long time, the development of immunodeficiency syndrome will begin.

The number of virus carriers every year steadily grows. Ways of transmission of the virus - exclusively from a person to man, animals are not a carrier and even in laboratory conditions could not be instilled in the animal, with the exception of some monkeys.

The virus is contained in fluids of the human body. HIV infection paths:

• unprotected sexual contacts;
• blood transfusion;
• from the sick mother to the child.

The possibility of transmitting a domestic virus, air-droplet or with saliva has not yet been proven. The virus is transmitted only through blood or sex contacts. The risk group is homosexuals, drug addicts and children of patients with parents.

Infection of the child occurs by passing the baby by the generic paths as well as breastfeeding. Nevertheless, quite a lot of cases described when HIV positive mothers were born absolutely healthy children.

Symptoms HIV and diagnostics

Due to long incubation periodThe symptomatic definition of the virus is inappropriate. Infection can be diagnosed only by the laboratory method - this is the only way to reliably determine the patient's HIV status.

Since the virus strikes the patient's immune system, the symptoms and prediction of the disease are quite vague and characteristic of various diseases. The initial signs are similar to the symptoms of ARVI or influenza:

• difficulty breathing;
• pneumonia;
• sharp weight loss;
• migraine;
• violation of violation;
• inflammatory diseases of the mucous membranes;
• nervous disorders, depressive states.

When the virus is transferred from the infected mother to the infant, the disease develops very rapidly. Symptoms rapidly grow, which can lead to death in the first years of the child's life.

Development of the disease

The disease does not appear immediately. From the moment of infection with the virus to the development of the immunodeficiency, a dozen years can pass. The following stages of the disease are distinguished:

• incubation period;
• infectious period;
• latent period;
• the development of secondary diseases;
• AIDS.

The incubation period is called a period of time, between human infection and the ability to determine the presence of a virus in the blood laboratory methods. As a rule, this period lasts up to two months. During the incubation period, the presence of a virus in the patient's blood is impossible to identify when analyzing.

After incubation, the infectious period occurs. In this period of time, the body actively tries to fight the virus, so symptoms of infection appear. As a rule, patients noted fever, signs of influenza, infection respiratory tract and gastrointestinal tract. The period lasts up to two months, but the symptoms are present in each case.

During the latent period of development of the disease, symptoms are absent. During this period of time, the virus affects the cells of the patient, but does not show itself. This period can last for a long time, rightfully.

The latent period of finding the virus in the body is replaced by the stage of attachment of secondary diseases. This is due to a reduction in lymphocytes responsible for the body's immune defense, as a result of which the patient's body is not able to repulse various causative agents of the disease.

The last period of the development of the disease is AIDS. At this stage, the number of cells to ensure the full-fledged immune defense of the body reaches a critical value. The immune system completely loses the possibility of resistance to infections, viruses and bacteria, resulting in damage in the internal organs and nervous system.

Pathology of the nervous system with HIV

The damage to the nervous system with HIV infection is primary and secondary. A blow to the nervous system can occur both at the initial stage of the virus damage and due to the development of pronounced immunodeficiency.

Primary lesion is characterized by the immediate effect of the virus on the nervous system. This form of complications occurs in children with HIV.

Secondary lesions are developing against the background of immunodeficiency development. This condition is called secondary neuro-AIDS. Secondary lesions are developing due to the accession of other infections, the development of tumors and other complications caused by immunodeficiency syndrome.

Secondary violations may be caused:

• autoimmune body reaction;
• attachment infection;
• development of the tumor in the nervous system;
• vascular changes;
• toxic action of drugs.

The primary damage to the nervous system during HIV infection can be asymptomatic. It should be noted that often the defeat of the nervous system is one of the first symptoms of the manifestation of HIV infection in the patient. On early stages It is possible to develop HIV-encephalopathy.

Encephalopathy with HIV

Encephalopathy is called dystrophic brain damage. The disease is developing against the background of serious pathological processes in the body, for example, HIV-encephalopathy. The disease is characterized by a significant decrease in the amount of nervous tissue and the impaired functioning of the nervous system.

Often encephalopathy happens congenital pathology. Cases of encephalopathy are often found in newborn children with HIV.

The symptoms of this pathology differ depending on the severity of the lesion of the brain. Thus, all the symptoms are divided into three conventional groups, depending on the nature of the course of the disease:

• 1 stage - clinical manifestations are absent, however, with a laboratory study, a change in the structure of the brain tissue is detected;
• 2 stage - weathered brain disorders are observed;
• 3 Stage is characterized by pronounced disorders of a nervous nature and violation of cerebral activity.

The symptoms of encephalopathy with HIV are no different from the signs of this disease, which appeared against the background of other pathologies. Starting from the second stage of development of encephalopathy, the following symptoms are distinguished:

• permanent migraines and dizziness;
• mental instability;
• irritability;
• violation of mental activity: the weakening of memory, inability to concentrate attention;
• depressive states and apathy;
• violation of speech, facial expressions;
• disorders of consciousness, changes in nature;
• trembling fingers;
• impairment and hearing impairment.

Often, the symptoms are joined by a violation of sexual functions and loss of libido.

Dementia at HIV-infected

HIV-encephalopathy refers to a whole group of diseases characterized by cognitive disorders. These diseases are generalized called AIDS dementia (dementia).

HIV encephalopathy is often developing due to drug therapy. This form of the nervous system is observed in babies born with HIV.

Encephalopathy is subject to drug addicts and people abusing alcohol. In this case, the disease is developing due to the toxic effects of drugs and alcohol on the patient's nervous system.

The pathology of the nervous system in HIV is developing in each patient in different ways. Sometimes it is difficult to diagnose the presence of a violation at the initial stage. In this case, doctors pay special attention to depression, apathy or sleep disorders in the patient.

AIDS dementia expresses in different ways, but the outcome of any diseases of the nervous system with HIV is the lipstick. Thus, the final stage of the development of encephalopathy or other neurological violation in patients is a vegetative state. Patients develop a full or partial paralysis, the patient cannot independently serve himself and needs to care. The outcome of the progressive dementia in patients is a coma and death.

It should be noted that dementia in patients is rather an exception than the rule, it is found no more than 15% of patients. The development of pathological violations of mental activity occurs throughout a very long time. With pronounced immunodeficiency, dementia often does not have time to purchase a heavy form due to death.

Nevertheless, weakly exposed symptoms of cognitive disorders are observed in each second case of HIV infection.

Stage Dementia

Dementia is developing over a long period and consists of several stages. However, not every patient passes through all stages, in most cases, light cognitive disorders are observed.

Normally, patients have any impairment of psyche or motor activity. This is the perfect case in which the damage to the nervous system is not observed by the virus.

For a subclinical stage, a light cognitive violation is characterized, characterized by the changeability of mood, by the depressive state and disruption of the concentration of attention. Often, patients have an easy intensity of movements.

For a slight form of dementia, slow mental activity is characterized, the patient says and moves slightly slowed down. The patient fully serves itself without any assistance, but complex intellectual or physical activity causes some difficulty.

The next stage of development of dementia, average, is characterized by a violation of thinking, attention and memory. Patients still serve themselves independently, but already have serious difficulties with communication and mental activity.

In the hard stage, the patient with difficulty moves without assistance. There is a strong impairment of thinking, as a result of which any social interactions with others are very difficult. The patient does not perceive the information and is experiencing serious difficulties when trying to talk.

The final stage of the development of dementia is a vegetative coma. The patient is not able to perform elementary actions and cannot do without assistance.

Diagnostic methods

Since pathology causes a change in the volume of nervous tissue, the disease is diagnosed with the following methods:

Based on the lumba puncture, a decision is made to appropriate further research. This analysis allows you to identify the presence of changes in the nervous system.

MRI (magnetic resonance imaging) allows you to successfully identify the pathological changes in the white matter of the brain. To obtain an accurate picture, it is necessary to conduct a brain survey, as well as the neck and eyeball.

Rag (reoeczephalography) is a survey conducted by an invasive method by which it is possible to obtain complete information on the state of the main arteries and vessels of the patient's nervous system.

Dopplerography is appointed necessarily. This examination is necessary in order to assess the state of the brain vessels. Changes in encephalopathy primarily affect the main vertebrate and brain artery, changes in which shows Dopplerography.

Therapy and forecast

Avoiding the development of neurological impairment in HIV will help timely therapy of the underlying disease. As a rule, dementia caused by encephalopathy develops only in the absence of therapeutic treatment of the patient.

Any lesions of the nervous system in HIV are treated with the help of potent antiviral drugs (for example, Zidovudine).

To date, the best result of the treatment of diseases of the nervous system with HIV shows therapy of Waart. Such therapy is based on the use of both two groups of antiretroviral drugs at the same time.

Timely started treatment allows you to stop further development of encephalopathy and dementia. In some cases, it is possible to stop the progression of dementia, and in some - to delay the development of cognitive violation for a long time.

HIV-encephalitis also involves taking antidepressants to correct the mental state of the patient. At the initial stages of development of violation, depressive states and sleep disorders are noted in patients with whom it should be struggling with the help of special drugs.

It is impossible to say unequivocally about how forecast for patients in HIV-encephalopathy is impossible. It depends on the peculiarities of the damage to the nervous system and the brain in a particular patient.

Prevention of the pathologies of the nervous system

It is still not found out exactly how the virus provokes the development of the diseases of the nervous system. Nevertheless, AIDS Dementia is an urgent problem of HIV-infected people, which are becoming more and more every year.

Preventive methods against the development of encephalopathy and other changes in neurological nature does not exist. The patient should carefully refer to his own health. The reason for handling the clinic for help is the following states:

• depression and apathy;
• mental instability;
• frequent mood change;
• sleep disorders;
• headaches;
• violations of vision and hallucination.

Timely treatment will help to avoid, or significantly delay, the appearance of severe symptoms of dementia. However, the patient must help himself.

Together with medication therapy, the patient shows careful control of its own emotions. Patients should remain intellectually and physically active. To do this, it is recommended to be in society, play sports and give your own brain intellectual load. To stimulate the brain activity, the cultivating tasks, riddles, reading complex literature in large volumes are sick.

It should be remembered that the symptoms of the nervous system disorders are often not manifested to the late immunodeficiency stages. Nevertheless, in some cases, minor memory disorders and scattered attention, characteristic of encephalopathy, may appear until the first symptoms of the immunodeficiency appear. Medical therapy in HIV helps not only to extend the life of the patient, but also to avoid the development of pronounced dementia.

The information on the site is provided solely in popular-familiarization purposes, does not claim for reference and medical accuracy, is not a guide to action. Do not self-medicate. Consult your attending physician.

The article describes the features of pathogenesis and clinical flow of strokes in HIV positive patients.

The nervous system is one of the target organs that affects HIV infection. The virus enters the brain with infected cells. It is known that among the cells of the virus of the immunodeficiency is affected by only one cell out of 10,000, and in the brain tissue, HIV infects and kills each cellular cell.

The nervous system is affected by a human immunodeficiency virus in 80-90% of cases, even in the absence of characteristic changes in peripheral blood and other organs. Moreover, in 40-50% of cases neurological complications are the first manifestations of HIV infection symptoms. The patient learns about his first manifestations of neurospide precisely according to the problems with the nervous system (strong impairment of memory, weakening attention and ability to be concentrated, decrease in intelligence, progressive dementia, hemorrhagic and ischemic strokes, etc.).
More details about reducing memory for AIDS disease, you can read in the article: "8 of the main reasons for the deterioration and loss of memory with HIV AIDS disease"

Numerous complications in patients with symptoms of HIV infection can be caused:
- virus immunodeficiency
- metabolic disorders
- diverse opportunistic infections, and even
- by-effect Antiretroviral drugs

In the brain of patients with HIV infection, virus strains that infect cells that have CD4 receptors on their surface are found. They damage the brain white substance with neurotoxins produced by activated or infected with virus its own cells. In addition, infected cells inhibit the growth of new nerve cells in the cerebral cortex, i.e. Have a neurotoxic effect.

As an example, we present the statistics of observations of 1600 patients with symptoms of HIV infection at the age of 35-45 years. The number of strokes in HIV positive patients exceeded the statistics of unreleased people more than 30 times!
Thus, it can be concluded that patients with symptoms of HIV infection are in a group of high stroke risk.

The main forms of violations that are observed in HIV positive persons are a large ischemic stroke of white and gray brain substance, or a lot of minor ischemic strokes regressing within 2-3 weeks.
Since the CD4 receptors are located in various cells of the head and spinal cord, almost the entire central nervous system of man is exposed to HIV attack. And after strokes of varying severity, destruction contributes to secondary damage to the nervous tissue.

In patients with injection use of narcotic drugs, allergies for foreign substances are superimposed on these lesions and damage the walls of vessels with minor foreign impurities, which leads to a narrowing of the vessel's lustration and its thrombosis with a further possible ischemic stroke or a breakdown of the vessel.
Due to the neglect of the sterility of injections, purulent-septic complications are not uncommon.
In patients, long-consuming drugs, there is often an expansion of the small veins of all parts of the brain, the walls of the vessels are clogged and partially stretched and rare, small hemorrhages and thrombosis are frequent. It can be said that "preparation" to ischemic stroke was carried out on 5, nothing was missed!

In patients with symptoms of HIV infection, it is quite often observed or ischemic stroke, or a transformation of ischemic stroke into hemorrhagic. The primary hemorrhagic stroke itself occurs quite rarely. Sometimes spontaneous spinal hemorrhages occur.
Hemorrhagic stroke is more common in patients with camp sarcoma metastasis in the brain.
Conducted in one of the American clinics for 10 years of study showed that the number of strokes in people with symptoms of HIV infection increased by 67%. (All strokes were ischemic.) At the same time, the number of strokes decreased by 7% in the control group (patients not infected HIV).
All patients are strongly reduced by immunity: 66.7% of patients had the CD4 level below 200 / μl, 33.3% - 200-500 / μl.

Patomorphology. Morphologically direct defeat of HIV of the brain leads to the development of subacute gianthoelectric encephalitis with demyelination sites. In brain tissue, monocytes with a large amount of virus can be detected, penetrated from peripheral blood. These cells can merge, forming giant multi-core formations with a huge amount of viral material, which was the reason for the designation of this encephalitis as a giant meal. At the same time, the inconsistency of the severity of clinical manifestations and the degree of pathological changes is characteristic. In many patients with distinct clinical manifestations of HIV-associated dementia, only "pale" myelin and a weakly pronounced central astroglyosis can be detected.

Clinical manifestations. Symptoms of direct (primary) damage to the nervous system in HIV infection are classified in several groups.

HIV-associated cognitive-motor complex. INthis breakdown complex, marked earlier as AIDS dementia, now includes three diseases - HIV-associated dementia, HIV-AU -Os -Os-based myelopathy and HIV-associated minimal cognitive-motor disorders.

HIV-associated dementia.Patients with these disorders suffer primarily from violations of cognitive ability. These patients have manifestations of dementia (dementia) of a subcortical type, which is characterized by a slowdown in psychomotor processes, inattention, reducing memory, violation of the information analysis processes, which makes it difficult to work and the daily life of patients. It is more often manifested by forgetfulness, slowness, a decrease in the concentration of attention, difficulties with the score and reading. Apathy, motivation limit may be observed. In rare cases, the disease can manifest itself with affective disorders (psychosis) or seizures. In case of neurological examination of these patients, tremor is detected, slowing down fast, repetitive movements, stepling, ataxia, muscle hypertonus, generalized hyperreflexia, symptoms of oral automatism. In the initial stages, dementia is detected only with neuropsychological testing. Subsequently, the dementia can quickly progress to a severe condition. This clinical picture is observed in 8-16% of the AIDS patients, but when taking into account data of autopsy, this level increases to 66%. In 3.3% of cases, dementia may be the first symptom of HIV infection.

HIV-associated myelopathy.With this pathology, motor disorders predominate, mainly in the lower limbs associated with the damage to the spinal cord (vacuole myelopathy). There is significant SN the meaning isB-non-nigs. Improving muscle tone on spastic type, ataxia. Often detected and disorder can know elna Activity ^ However, weakness in the legs and violations of the gait are ~ 75th! ^ ^ Vittechlan. Motor disorders may affect not only the bottom, but also upper limbs. Conductivity disorders are possible. Myelopathy is rather diffuse than segmental character, therefore, as a rule, there are no "level" of motor and sensitive disorders. Characteristic absence of pain. In the cerebrospinal fluid, nonspecific changes in the form of pleytosis are noted, an increase in the content of common protein, it is possible to identify HIV. The spread of myelopathy among patients with AIDS reaches 20%.

HIV-associated minimal cognitive-motor disorders.This syndromocomplex includes the least pronounced violations. Characteristic clinical symptoms and changes in neuropsychological tests are similar to those in dementia, but to a much lesser extent. Often there is a forgetfulness, slowdown in mental processes, a decrease in the ability to concentrate attention, breach of gait, sometimes awkwardness in hand, personality change with the restriction of motivation.

Diagnostics. In the initial stages of the demide disease, it is detected only with the help of special neuropsychological ~ tё ~ stoves: in the subsequent typical clinical picture on the background of immunodeficiency, as a rule, makes it possible to make a diagnosis. In addition, symptoms are noted subighteous E.nedafalich. In case of CT and MRI studies, the brain atrophy is detected with increasing furrow and jelly . ] Daughters. At MRI, you can note the additional Fame Uzeid si.heat ^ in the white-substance of the brain associated with local demyelinization. These studies of the cerebrospinal fluid are non-specific, small Pleocytosis can be detected, a minor increase in protein content, an increase in the level of immunoglobulins of class G.

Other Defeats of the CNS associatedfrom HIV infection . In children, the primary damage to the central nervous system is often the earliest symptom of HIV infection and is denoted as the progressive HIV-associated encephalopathy of children. For this disease, a delay in development, muscle hypertension, microcephalus and calcification of basal gan

Treatment. In addition to the fight against directly retrovirus, a specific treatment of a particular infectious disease is carried out, developing on the background of immunodeficiency. The combinations of immunomodulators and antiviral drugs are actively used. For example, recombinant alpha interferon (dose from 3,000,000 to 54,000,000 me) independently or in combination with retrovir or vinblastine is used in the treatment of Caposhi sarcoma. Among the antiviral agents for the treatment of opportunistic virus infections, the acyclovir is the most effective, an analogue of a purine nucleoside, which, after transformation in the body of a person in the acyclovir trifosphate, the biosynthesis of the virus DNA. The viral form of the Timidinkina-Shl enzyme (the point of the acyclovir application) is associated with a drug of 1,000,000 times faster than a person enzyme. Essential administrations are used more often: 5-10 mg / kg after 8 h 5-10 days, depending on the severity of the lesion. The side effects are sufficiently pronounced, especially the dangerous crystal-location, observed more often with intravenous administration, so the drug is introduced slowly for an hour on the background of abundant drinking, which should be taken into account when treating encephalitis with edema brain. Less often uses the Rabin type - an analogue of a purine nucleoside, which inhibits the DNA poly-merase, i.e. This drug is also effective only against DNA-containing viruses. A predominantly intravenous method of administration is used for 12 hours. When using Vidarabab, the following adverse reactions are possible: Parkinson-like tremor, ataxia, myoclonies, hallucinations and disorientation, while increasing the dose is possible panti-singing. Antiviral drugs in severe cases combined with Perez plasma. In some cases, the combination of antiviral drugs with interferons is effective.

With fungal infections, in particular cryptococcal meningitis and histoplasmosis, amphotericin V. This polyenic antibiotic is associated with a specific protein of the membrane membrane of mushrooms and the simplest, deforming it, which leads to the output of potassium and enzymes and the cell death. It is often used intravenously at 0.1 mg in 1 ml of a 5% glucose solution, an endoomumbal administration can be effective. The drug is highly toxic, the most dangerous disorder of the kidney function is most dangerous. Therefore, it is recommended to use it only with complete confidence in a serologically confirmed diagnosis.

In case of toxoplasmosis, the CNS use a combination of chlorine (pyrimeta mine) and short-acting sulfanimides (sulfazine, sulfadiazine, sulfadimezin). These drugs affect the exchange of folic acid, having a joint bactericidal effect. With tuberculosis lesions, conventional dosages of anti-tuberculosis drugs are used. Preference is given to a well penetrating via BEB isoniazid (300 mg per day per OS), rifampicin (600 mg per day per OS) and streptomycin (0.75 g intramuscularly 6 times a day) are less commonly). The Lymphoma CNS is amenable to aggressive radiation therapy, without which the death of the patient may occur within 2 weeks. Medicia treatment Patients with her Rupid should be combined with full nutrition to maintain body weight, nutritional issues should be considered already when the positive response to HIV is discovered. Some types of low protein diets can be dangerous for such patients, as humoral immunity is suppressed.

Common symptoms. Symptoms of increasing intracranial pressure are most pronounced in tumors causing occlusion of liquor pathways (tumors of the rear cranial fox, brain ventricles), tumors temporal (often accompanied by brain dislocation and violation of liquorocirculation at the level of the tentatorial opening), tumors, squeeze the main ways of venous outflow (parasagittal meningioma).

Headache -often the first tumor symptom caused by an increase in intracranial pressure. Headache can be a general, not having a clear localization. It occurs due to irritation of a solid cerebral shell, which is innervantroinder, wandering and language nerves, and vessel walls; violation of venous outflow in diploy bone vessels. For hypertensive syndrome, morning pain is characteristic. Over time, pain is enhanced, become permanent. The predominance of pain in any area of \u200b\u200bthe head can be a symptom of the local exposure to the tumor on a solid brain sheath and vessels.

Vomot- One of the characteristic symptoms of increasing intracranial pressure. It happens repeated, often at the height of the headache. It should be noted that vomiting can be a local symptom of a tumor acting on the bottom of the IV ventricle.

Stagnation of optic nerves- One of the typical and vivid manifestations of intracranial hypertension. First, short-term binding of vision arises, it can enhance at voltage, physical exertion. Then the visual acuity begins to decline. The final result is "blindly, as a result of the so-called secondary atrophy of the visual nerves.

Epileptic seizures- an increase in intracranial pressure and concomitant changes in blood circulation of the brain can be the cause of common epileptic seizures. However, the appearance of seizures, especially focal, is the result of the local exposure to the tumor

Mental disordersin the form of lethargy, apathy, reducing memory, disability, irritability can also be caused by an increase in intracranial pressure.

Dizziness,arising from patients with brain tumors may be a consequence of stagnant phenomena in the maze.

The consequence of intracranial hypertension can be changes in cardiovascular activities (increase arterial pressure, Branch Dicardia) and respiratory disorders.

Pituitary tumors

A special group is made up pituitary tumors.In turn, they can be divided into hormonally activeand hormonal-inactivetumors.

The symptom complex, developing with these tumors, is very characteristic. It develops from the symptoms of the impaired pituitary function (its hyper-or pituitary), reduction of vision due to the compression of the visual nerves and the visual cross. Large tumors with severe in-travertation growth may affect the hypothalamic deposits of the brain and even disrupt the outflow of the cerebrospinal fluid from the ventricular system, causing compression IIIventricle.

Hormonally active pituitary tumors rarely achieve a large value, as they cause characteristic endocrine symptoms that contribute to their early recognition.

Depending on the type of endocrine active cells, of which the tumor is formed, the prolactinsection of adenoma is distinguished; adenoma producing growth hormone; Aktg-secreting and some other tumors.

Prolactinsection adenoma (prolactinoma)call lacto-real, impaired menstrual cycle and some other symptoms.

Adenoma, producing growth hormone,in young age, the cause of giantism, and in adult patients cause characteristic symptoms of acromegaly: an increase in the size of the brushes of the hands, stop, degradation of the person, the increase in the internal organs.

For ACTH-secreted adenomascushing syndrome is developing: an increase in blood pressure, characteristic sediments of body fat, Striae Gravidarum, girsutism.

Many of these tumors are detected in the initial stage, when their size does not exceed a few millimeters, they are fully arranged within the Turkish saddle - these are microenomes.

In hormonal-inactive adenomas, squeezing pituitary, there are symptoms of pongopituitarism (obesity, a decrease in sexual function, a decrease in operability, pallor of skin cover, low blood pressure, etc.). Often, these tumors flow almost asymptomaticly until they grow far beyond the Turkish saddle and will not be the reason for vision.

Method complex (radiography, computed tomography, MRI, research levels of various hormones) allows you to determine the type of pituitary tumor, its size and direction of growth. One of the most typical diagnostic signs - Callery expansion of a Turkish saddle, which is easily detected with craniographies, CT and MRI studies (Fig. 13.16).

Treatment. The growth of small prolactinsection tumors of the pituitary gland can be suspended with the help of drugs - agonists dopami-on (bromocriptine).

In most cases, the most reasonable treatment method is the surgical removal of the pituitary tumor. Small pituitary tumors, preferably located in the Turkish saddle, or tumors with moderately pronounced supraselligar growth, are usually removed using transnasal-transphenoidal access (raid tumors from normal pituitary tissue and radically remove it. At the same time, X-ray control is carried out to determine the penetration of tools In the cavity of the skull and the radicality of the removal of the tumor.

The adenoma of the pituitary gland with severe supra and para-selayal growth is removed using frontal or forehead-but-temporal access.

Rimming the frontal share, the surgeon reaches the area of \u200b\u200bthe visual cross. Spectating nerves and chiasm are usually sharply shifted by a tumor overlooking the Turkish saddle. The adenoma capsule is opened between visual nerves and remove the intrakap-sinal tumor with a surgical spoon and by aspiration. When the tumor is propagated, parasselly in the cavernous sine or retroselly into the inter-discharge tank, the operation becomes complex and risky primarily due to the fusion of the tumor of the carotid artery and its branches.

With partial removal of the tumor, it is advisable to conduct radiation therapy. The irradiation is also shown in the recurrent growth of the tumor.

Cerebellum tumors.These tumors can be both benign (astrocytes, distinguished by slow growth), and malignant, infiltratively growing (medulosylastoma). And astrocytomas, and especially medulloblastoma are more common in childhood.

The cerebellum tumors often affect the worm, perform the cavity of the IV ventricle and squeeze the brain barrel. In this regard, the symptoms are due not to so much (and often not only) by the defeat of the nuclei and the cerebellum's conducting paths, how much to compress the brain stem.

The peculiarity of the cerebellum tumors is that they often lead to a violation of the outflow of the cerebrospinal fluid, closing the yield of the ventricle or squeezing the brain water supply.

Rapidly increasingly increasing occlusion hydrocyphalia lateral and III ventricles leads to the dislocation of the brain with the danger of acute infringement of the brain barrel in the field of a tentatorial hole.

By itself, the tumor developing in the cerebellum leads to an increase in its volume and may cause inclination in both the tentatorial and the V. Zatylching hole.

The initial symptoms of the cerebellum tumor are often breach of coordination, ataxia, adiadocynez, a decrease in muscle tone. Especially, especially with cystic or fast-growing tumors, symptoms of squeezing the structures of the bottom of the IV ventricle may appear: Nistagm (more often horizontal), bulbar disorders, vomiting and hounds. In the development of the infringement of the brain barrel in the occipital opening, there is a breath disorders up to its stop, the violation of cardiovascular activity: bradycar-diya, an increase in blood pressure with its subsequent fall.

Astrocitoma cerebellumin contrast to the coarse astrocyt, they can be well excluded from the surrounding tissue of the cerebellum, contain cysts (Fig. 13.19). Histologically, these tumors belong to the most benign type - pilocyte astrocytomas that are found mainly in childhood.

In computed tomography and MP tomography, tumors with clear contours and cysts contained in them are detected (Fig. 13.20).

These tumors can be radically removed along the border with a cerebellum cloth, which is siled, but is not extended by a tumor. Operations can lead to a complete recovery of a patient or long, long-term remission.

Along with this, there are infiltratively growing cerebellum tumors, some of which germinate in the brain stem.

On a computed tomogram, the tumor is distinguished by fuzziness, blurring outlines. In these cases, only a partial resection of the part of the tumor is possible, which is most different from normal cerebellum tissue.

Removal of the astrocytoma of the cerebellum, as well as other tumors, is carried out by trepanation of the rear cranial fossa, usually using the median section of soft tissues in the cerinous-occipital region.

Hemangioblastoma (angioneticulms)- ornate vascularized tumors, often leading to cystovation (in 70% of cases). Most of the hemangioblast is located in the gemisting of the cerebellum or a worm. Occasionally, the tumor is located in the area of \u200b\u200bthe oblong brain and the bridge. Hemangioblastoma may also affect the spinal cord. More often hemangioblastoma develops aged 30-40 years. It must be borne in mind that approximately 20% of the tumors are multiple and are a manifestation of hypel Lindau disease ( healthy disease autosomal dominant type). In these cases, in addition to the tumors of the central nervous system (cerebellum, spinal cord), the retina, tumors and cystic changes in the kidneys and other internal organs, polycythemia are often detected.

In the formation of cyst, there is sometimes a rapid development of the disease with the advent of the formidable symptoms of the stem of the brain.

Treatment. The surgical removal of the solitary hemangioblastic cerebellum in most cases leads to almost complete recovery of patients.

In some cases, the main part of the neoplasm represents cyst, the very tumor at the same time is negligible and can remain unnoticed. In this regard, after emptying, cycles need to thoroughly examine from the inside all its walls to detect a tumor, which is characterized by bright red color.

It is difficult to remove solid tumors, especially those implemented in the barrel: these tumors are very rich in blood supply and, if at the beginning of the removal does not "turn off" the main blood supply sources, the operation may be very traumatic. In case of Hippel Lindau disease, recurrences of the disease are possible due to the multifocal tumor growth.

Medulovoblastoma- malignant, rapidly growing tumors occurring mainly in childhood. Meduloblastoma, localized in the rear cranial fossa, make up 15-20% of all brain tumors in children. More often the medulloblastoma develops from the worm, fills the IV of the ventricle, can infiltrate it from the bottom and grow into the barrel, early leads to a violation of the outflow of the cerebrospinal fluid from the IV ventricle and hydrocephalus. Metastasis for liquor spaces (Fig. 13.21).

The most typical symptoms are headache, vomiting, ataxia in the limbs, gait, nistagm. Under the germination of the bottom IV ventricle, bulbar symptoms appear, impaired sensitivity on the face, and eye disorders. In computed tomography, a tumor is detected, located in the region IV ventricle, the worm and medial parts of the cerebellum (it is usually inhomogeneous), and the signs of the hydrocephalic expansion of the side and IIIventricles.

Treatment. Surgical treatment consists in the maximum complete removal of the tumor (only areas are not deleted to the brain barrel) and the restoration of the normal circulation of the cerebrospinal fluid.

The tumor often has a soft consistency, and its removal is carried out by aspiration by conventional or ultrasonic suction. After the operation, irradiation of the rear cranial fossa is carried out in combination with the overall irradiation of the head and spinal cord in order to prevent tumor metastasis. A positive result can be obtained from the use of chemotherapy (drugs of nitrosouroevine, vincristine, etc.).

Acute inflammatory demyelinating polyradiconeuropathy (Guienen-Barre syndrome).Described by French neuropathologists in Guyen and J. Barre in 1916. The cause of the disease remains not solid enough. Often it develops after the prior sharp ^ brake. Perhaps the disease is caused by a filtered virus, but since it is not highlighted so far, most researchers are considered to be an allergic nature. The disease is considered as an autoimmune with the destruction of nervous tissue, secondary with respect to cellular immune reactions. Inflammatory infiltrates are found in peripheral nerves, as well as roots combined with segmental demyelinization.

Clinical manifestations. The disease begins with the appearance of general weakness, increasing body temperature to subfebrile numbers, pain in the limbs. Sometimes pains are clothing. The main distinguishing feature of the disease is muscular weakness in the limbs. Parentesia appear in the distal hands and legs, and sometimes around the mouth and in the language. Heavy sensitivity arises rarely. Weakness of facial muscles may occur, the defeat of other cranial nerves and vegetative violations. The damage to the nerves of the Bulbar-Noi Group during respiratory resuscitation may result in death. Motor disorders earlier arise in the legs, and then apply to hands. There are damage to predominantly proximal limbs; At the same time, there is a symptom-plex resembling myopathy. Nervous trunks are painful during palpation. There may be symptoms of tension (Lasega, Nerry).

Vegetative violations are especially pronounced - cooling and chlorinity of distal limbs, acricyanosis, hyperhydroposis phenomena, sometimes there are hyperkeratosis soles, nail fragility.

Typical protein-cell dissociation in cerebrospinal fluid. The level of protein reaches 3-5 g / l. The high concentration of protein is defined both with lumbar and occupycal puncture. This criterion is very important for the differences between the hyena barre syndrome from the spinal tumor, in which high protein concentrations are detected only with lumbar puncture. Cytosis not more than 10 cells (lymphocytes and monocytes) in 1 μl.

The disease is usually evolving for 2-4 weeks, then the stabilization stage comes, and after that - improvement. In addition to acute forms, subacute and chronic. In the overwhelming majority of cases, the outcome of the disease is favorable, but there are also forms flowing along the type of Landry ascending paralysis with the distribution of paralysis on the muscles of the body, hands and bulbar muscles.

Treatment. The most active method of therapy is the Perez plasma with intravenous administration of immunoglobulin. In patients partially remove the blood plasma, returning uniform elements. Also glucocorticoids are also used (prednisone 1-2 MK / kg per day), antihista mineral resources (DIMEDROL, Supratine), vitaminotherapy (group B), anticholinesterase preparations (prozerne, galanamine). It is important to care for patients with careful control over the condition of respiratory and cardiovascular systems. Respiratory failure in severe cases can develop very quickly and leads to death in the absence of adequate therapy. If the patient has the lungs life capacity turns out to be less than 25-30 % estimated respiratory volume or there are bulbar syndromes, intubation or tracheotomy is recommended for artificial pulmonary ventilation. The pronounced arterial hypertension and tachycardia will be stopped by using calcium ion antagonists (Corinthar) and beta-adrenoblockers (propranolol). In the arterial hypotension, fluids are introduced intravenously in order to increase the intravascular volume. It is necessary every 1-2 hours to gently change the position of the patient in bed. Acute urinary delay and expansion bladder Could cause reflex disorders leading to blood pressure and pulse oscillations. In such cases, the use of a permanent catheter is recommended. In the recovery period, Iproducts are prescribed to prevent contractures, massage, ozokerite, paraffin, four-chamber baths.

Acute myelit

Melite - the inflammation of the spinal cord, in which both white and gray is affected.

Etiology and pathogenesis. Eliminate infectious, intoxication and traumatic myelites. Infectious myelites can be primary caused by neurovirus (Herpes zoster, polio viruses, rabies) caused by tuberculosis or syphilitic defeat. Secondary myelites arise as a complication of common infectious diseases (measles, scarletin, typhoid, pneumonia, influenza) or a purulent focus in the body and sepsis. In primary infectious myelitis, the infection spreads hematogenically, the brain is preceded by viremia. In the pathogenesis of secondary infectious myelites, autoimmune reactions and hematogenic drift of infection in the spinal cord play the role. Inxication myelites are rare and may develop due to severe exogenous poisoning or endogenous intoxication. Traumatic myelites occur at the open and closed injuries Spine and spinal cord with the addition of secondary infection. There are no cases of post-depository myelitis.

Patomorphology. Macroscopic brain substance flabby, empty, empty; On the context, the drawing "Butterflies" is smeared. Microscopically, hyperemia, swelling, minor hemorrhages, infiltration by shaped elements, cell death, the disintegration of myeline are found in the field.

Clinical manifestations. The picture of myelita is deployed sharply or undercoins against the background of general-infectious symptoms: increase temperatures up to 38-39 ° C, chills, indisposition. The neurological manifestations of myelitis begin with moderate pain and paresthesia in the lower limbs, back and chest bearing the root character. Then, for 1-3 days, high-speed motor, sensitive and pelvic disorders appear and reach the maximum.

The nature of neurological symptoms is determined by the level of the pathological process. In the mixture of the lumbar portion of the spinal cord, peripheral parapapapers are observed, pelvic disorders in the form of true incontinence of urine and feces. In the mix of the thoracic part of the spinal cord there are spastic paralysis of legs, pelvic violations in the form of urine delay and feces passing into incontinence. With suddenly developing transverse mixtures, muscle tone, regardless of the localization of the hearth, can be low for some time due to dia-shiz phenomena. With damage to the spinal cord at the level of the cervical thickening, the top sluggish and lower spastic paraplegia develop. Myelitis in the upright part of the spinal cord is characterized by spastic tetra, nzhmey, damage to the diaphragmal nerve with respiratory disorder sometimes with boulevard disorders. Sensitivity disorders in the form of hypersthesia_Iniesthesia are carrying: conductive character is always with an upper bound, corresponding to the level of affected segment. Quickly, sometimes during the first days, develops lying on the sacrum, in the region of large spit, femur bones, stop. In more rare cases, the inflammatory process covers only half of the spinal cord, which is manifested by a clinical picture of brown-secarar syndrome.

The forms of subacute necrotic myelitis are described, for which the defeat of the lumbosacral part of the spinal cord is characterized, followed by the spread of the pathological process upwards, the development of bulbar disorders and death. In the cerebrospinal fluid during myelitis, elevated protein content and pleaocytosis are found. Among the cells can be polynuclear and lymphocytes. During lyrics, no protein probes. In the blood, there is an increase in ESP and leukocytosis with a shift to the left.

The course and forecast. The course of the disease is acute, the process reaches the greatest severity in a few days, and then for several weeks remains stable. The recovery period lasts from several months to 1-2 years. Faster and earlier the sensitivity is restored, then the functions of the pelvic organs; Motor disorders regress slowly. Often there are resistant paralyts or parish limbs. The most severe and forecast are cervical myelitis due to tetraplegia, the proximity of vital centers, respiratory violations. The forecast in the Mielites of Nizhnegorudnaya and Lumbar-sacral location is adversely as a result of severe defeat, poor restoration of the functions of pelvic organs and in connection with this, the addition of secondary infection. The prognosis is also unfavorable in Stepsepsis and Sepsis due to the bedding.

Diagnosis and differential diagnosis. The acute principle of the disease with the rapid development of the transverse damage of the spinal cord against the background of the general infectious symptoms, the presence of inflammatory changes in the cerebrospinal fluid in the absence of the block makes the diagnosis of a fairly clear. However, it is very important to diagnose epidritis in a timely manner, the clinical picture of which, in most cases, indistinguishable from the symptoms of myelitis, but in which urgent surgical intervention is required. In doubtful cases, it should be resorted to exploratory laminectomy. In the diagnosis of epidurites, it should be borne in mind the presence of an purulent focus in the body, the appearance of root pains, the incisional compression syndrome of the spinal cord. Acute polyradiculoneuritis Guien - Barre is different from myelita lack of conductive disorders of sensitivity, spastic phenomena and pelvic disorders. For spinal cord tumors, a slow flow is characterized by the presence of protein-cell dissociation in a cerebrospinal fluid, a block with liquorodynamic samples. Hematomyiel and hem-thorahius arise suddenly, are not accompanied by a temperature lift; In hematomethyelia, the gray matter is affected; If the hemorrhage occurred under the shell, meningeal symptoms arise. In history, you can often identify instructions on the injury.

Acute transverse damage to the spinal cord needs to be differentiated from an acute impairment of spinal blood circulation. It is possible to suspect multiple sclerosis, but it is characterized by selective lesion of white substance, often fast and significant regress of symptoms in a few days or weeks, the presence of signs of scattered damage to the spine and brain. Chronic meningomyelitis is characterized by a slower development, the absence of temperature increase and is often due to syphilitic lesion, which is established with the help of serological reactions.

Treatment. In all cases, antibiotics of a wide spectrum of action or sulfonamides of the highest doses for ^ mixtures of pain should be prescribed and antipilers are shown at high temperatures. Glucocortshshysoids are used in a dose of 50-100 mg per day. Gili equivalent doses of dexamethasone or triamcinolone), ACTG at a dose of 40 units twice a day for 2-3 weeks with a gradual decline in "dose. Special attention should be paid to preventing the development of legs and ascending urogenital infection. . For_Profilaxpension, often arising over bone protrusions, the patient must be laid on a circle, under the heels to put cotton pads, to change the body with camphor alcohol daily, change the position. When there is a breakdown, necrotic tissues are excised and impose bandages with penicil-linovsky or tetracycline ointment, Masub Vishnevsky. . To prevent the formation of laying ones and after their appearance, ultraviolet irradiation of the buttock, sacrum, stop is carried out.

In the first period of the disease, urine delay sometimes can be overcome by applying anticholinesterase preparations; If this turns out to be insufficient, the catheterization of the bladder with washing

it is antiseptic solutions.

TR has defendance. Determined by the localization and prevalence of the process, the degree of violation of motor and pelvic functions, sensitive disorders. In acute and subacute periods, patients are temporarily disabled. With good restoration of functions and the possibility of returning to work, the hospital sheet can be extended to practical recovery. With residual phenomena in the form of a minor lower paraward with the weakness of sphincter, patients are installed IIIa group of disability. With moderate lower parapapese, the violation of the gait and the statics of patients cannot work under normal production conditions and are recognized as disabled groups of group II. If patients need constant outsiders (paraplegia, tetrapreza, violations of the functions of pelvic organs), they establish the I group of disability. If within 4 years of restoration of disturbed functions does not occur, the disability group is established indefinitely.

Plexopathy

The most common causes of lesions of the shoulder plexus (Plexopathy) are injury when dislocate the head of the shoulder bone, a knife wound, highly imposed on the shoulder harness for a long time, plexus injury between the collar and I edge or head of the shoulder during operations under inhalation anesthesia with their heads laid down , the pressure of the spoon of obstetric tongs on the plexus in newborns or stretching the plexus during rowor separating manipulations. The plexus can be squeezed with a bone corner after a fracture of the clavicle with staircase muscles (Nafziger Syndrome), cervical ribs.

AIDS disease is transmitted by a virus (HIV), which has a lymphotropic and neurotropic property. This means that the virus is able to harm the nervous system, causing diseases such as neuropathy, HIV encephalopathy, dementia, psychosis.

Finding into the human body, the virus spreads over the tissues for several days. When the acute inflammatory phase subsides, the disease goes into a sluggish process that lasts for several years. After stage, the intensive breeding of the virus begins. In this period, the stage of clinical manifestations of other diseases begins:

• fungal;
• bacterial;
• oncological.

The immune system of an infected person is gradually destroyed. The disease ends with a fatal outcome in a few years.

Loosity of the nervous system

The medicine is called symptoms of HIV Encephalopathy in different ways: AIDS-dementary syndrome, neurospide, HIV-associated neurocognitive disorders. Initially, patients revealed disorders of the nervous system associated with cytomegalovirus infection, tuberculosis, candidiasis. As the mechanisms for lesion, the CNS began to highlight the primary damage to the nervous system.

Some patients retain their mental health for a long time. However, violations are gradually aggravated and mental disorders appear as a result. The pathologies are explained by several factors:

• stress from the diagnosis;
• reception of drugs against HIV;
• fast penetration of the virus in brain tissue.

The severity of the flow of neurocognitive disorders is divided into several stages:

1. Asymptomatic. Patients cannot fulfill complex professional tasks. The rest of the symptoms are little affected by the quality of life.
2. Lungs. Patients have problems in professional activities, in communicating with others, in the performance of household work.
3. Heavy. The patient becomes disabled. As weathered, a person loses the ability to serve himself.

In addition to mental disorders, patients develop atrophic and inflammatory processes In brain tissues. It is often developing HIV encephalitis or meningitis. HIV has a patient with and encephalitis, signs of these pathologies are manifested. Diseases often cause patients' death.

It is important to know! The rate of destruction by the neuron virus depends on such factors as: injuries, drug use, current inflammatory processes, tuberculosis, renal and liver failure.

Development of HIV Encephalopathy

Dementia develops due to damage to cerebral cells by a virus. Patients are affected by neuroglial cells (astrocytes), microglia cells are damaged, which are actively involved in the fight against infection and inflammation. Among other reasons are allocated to accelerate the death of neurons (). In patients, the electrolyte balance in the brain fabrics is disturbed.

Pathological processes are cyclical and depend on the state of the patient's immune system. Perhaps this circumstance explains the development of dementia in some patients.

In the future, other inflammatory processes are joined to the destruction of neurons. Brain fabrics begin to actively attack microbes, viruses, fungal infection, simplest. In patients as a result of intoxication, microcirculation in brain tissues is disturbed, which leads to an increase in intracranial pressure, a decrease in blood oxygen content.

The patient's brain begins to collapse. This process can last from several months to several years. However, on the background of tuberculosis, mycoplasmosis and other infections, the process of brain destruction is accelerated. The prediction for the patient's life is unfavorable, which is calculated in several days or weeks.

Manifestations of HIV Encephalopathy

Patients appear obsessive-compulsive disorders. Patients can study for a long time and examine their body, they are pursued by obsessive memories of sexual relations, which led to infection, leave the thoughts about death, anxiety for loved ones.

In some cases, delirium is developing (madness). Usually the first symptoms appear at night and do not let the patient within a few hours or days. The main manifestations of Delia are:

• violation of orientation;
• unrecognizing itself and surrounding;
• reducing the concentration of attention;
• scattered;
• psychomotor excitation;
• fright;
• aggression.

Usually the patient becomes easier during the day, but at night, the delirium can manifest itself again. Violation of consciousness in the patient is accompanied by temporary memory loss. During the attacks, patients experience senseless repeating actions, fantasies.

Important! Delia is often developing in patients who use psychotropic drugs, medicines from HIV, alcohol and drugs. The risk of psychological impairment increases if the patient develops meningitis, cytomegalovirus encephalitis, bacteremia, sarcoma capsis, hypoxia.

In addition to mental disorders, each second patient develops convulsive syndrome. Usually observed in patients with cytomegalovirus infection, oxygen deficiency, liver diseases and kidney. In some cases, convulsions cause drugs. At the carriers of HIV infection may appear aphasia, violation of attention and memory.

One of the severe complications of Encephalopathy is dementia. Each fifth patient is usually found. In patients, dementia is manifested by the following symptoms:

• deterioration of cognitive function;
• decline;
• memory loss;
• coordination disorders;
• apathy;
• fast fatiguability;
• irritability.

Dementia in HIV patients quickly progresses, does not treat itself and leads to a fatal outcome. In the later stages of the disease, AIDS-dementary syndrome is developing on the background of fungal or viral infection. Intellect decreases in patients.

Important! AIDS dementant syndrome more often develops in persons with toxoplasmosis, meningitis, lymphoma.

Pathology is a consequence of acute encephalopathy. Patients first appear drowsiness, indisposition, convulsions. Next joined forgetfulness, unstable gait, urinary incontinence, mood swings, motor disorders, depression.

Patient violations of patients encourage them to do "unreasonable" actions. This complicates the treatment and maintenance of the quality of life of the patient at the proper level. The destruction of cerebral tissue leads to the fact that some patients appear risky behavior, which threatens their lives.

Other deviations in behavior include addiction to alcohol and drugs, risky sexual behavior (leads to HIV transmission), a tendency to violence.

Conclusion

So what underlies HIV Encephalopathy, and what is the prognosis for patients? First, the defeat of the nervous system in HIV is already an axiom, since the nervous tissue is inclined to damage the virus and suffers from the first years of the development of the disease. Secondly, in any case, the virus penetrates through the blood-brain barrier. Forecast for the life of patients in the destruction of the brain is unfavorable.