Case history F06.61 Organic emotional-labile disorder due to vascular disease of the brain. InternetAmbulanceMedical portal More about neurology

– Yan Evgenievich, what caused the creation of the Pain Treatment Clinic? What are its features?

– Multidisciplinary clinic "Health 365" has been operating in Yekaterinburg since 2008. Today it consists of five divisions in different areas of the city, including our Pain Treatment Clinic. This is a complex that brings together expert doctors with special training in the field of pain treatment. We use special techniques, laboratory methods and equipment, our activities are regulated by general rules and approaches to the diagnosis and treatment of pain, and internal management.

There are many manifestations of pain, and its effective treatment requires a systematic multidisciplinary approach. Chronic pain is dangerous because the longer it exists, the more difficult it is to treat; over time, it leads to the development of very complex structural changes in the central nervous system.

Often, patients turn to specialized specialists to get rid of pain, and they begin to walk in circles: from a therapist to a neurologist, from him to a surgeon, then to a neurosurgeon, a psychologist, and again to a therapist. A multisystem approach disproportionately increases cure and remission rates for various diseases

Our clinic is focused on the diagnosis and treatment of syndromes such as headaches and back pain, pain in the limbs, joints, as well as in the coccyx, sacrum and pelvis - a total of five basic areas. Our Clinic staff includes neurologists, therapists, neurosurgeons, ultrasound doctors, chiropractors, and massage specialists. Including three candidates of medical sciences, which once again confirms the level of qualifications of the staff.

– How is pain treated in your clinic? What innovative techniques and equipment are used?

– It all starts with an appointment with a doctor, who provides assistance in relieving acute symptoms of pain and recommends to the patient diagnostic tests, laboratory and instrumental, necessary for an accurate diagnosis of the cause of pain. After which complex treatment is prescribed - from the use of drug therapy and physiotherapy to invasive treatment - various blockades under ultrasound control, neurosurgical operations. Chronic pain disorder is often accompanied by anxiety and depressive disorders, so psychotherapy and psychopharmacotherapy may be included in the structure of our care.

Treatment also includes various non-drug methods. For common causes of pain (consequences of sports injuries, diseases of the musculoskeletal system), an innovative method such as kinesio taping is used. In accordance with certain anatomical rules, dense adhesive tapes are placed on the patient’s skin, which support the skin, fiber, muscles, relieve certain areas of the body, improve blood supply and lymphatic drainage, thereby significantly reducing pain. Another innovative method is plasma lifting. Plasma, which is obtained in concentrated form from the patient’s own blood, is separated from the blood, enriched with platelets and biologically active substances and injected, for example, into the tissue around a diseased joint. This plasma has good restorative and anti-inflammatory properties. In our clinic, both traditional devices, such as magnetic therapy devices, magnetic laser, ultrasound, amplipulse, and innovative equipment are actively used for physical procedures. For example, the Sympatocor-1 device is used to relieve migraine attacks and preventive treatment of headaches. It successfully and permanently relieves a person from repeated attacks of pain, subsequently reducing their frequency and intensity.

– What kind of pain do patients come to you with most often?

– Headaches and back pain are more common, closely followed by joint pain. If necessary, we use MRI (magnetic resonance imaging) to accurately diagnose the causes of such pain. An accurate and timely diagnosis means a lot for prescribing the correct treatment and saves the patient from going through agony. Our diagnostic complex, in addition to MRI, includes various types of ultrasound. The clinic, the only one in the city, performs ultrasound of peripheral nerves. This is very important when diagnosing compression of nerves, the so-called “tunnel syndromes”, for example, carpal tunnel syndrome, cubital tunnel syndrome, it allows you to see the localization and cause of compression of the nerve trunk. We carry out expert ultrasound diagnostics of the condition of the vessels of the head and neck. Very often, such a study makes it possible to verify the causes of headaches, such as impaired venous outflow, vertebrogenic compression of the vertebral arteries, muscle tension, and dysregulation of vascular tone. This provides a point of support for the general practitioner and neurologist. They gain a lever with which to solve a situation of severe, recurring pain, from which the patient sometimes despairs of finding relief and resigns himself. As a result of accurate diagnosis, we find this cause, which often responds well to treatment.

– What age patients predominate in your clinic?

– Pain in the cities is getting younger: a person sits at the computer all week without straightening up, and on the weekend he abruptly switches to classes in the gym or on the ski slope. And then he goes to our clinic complaining of back pain. With age, the incidence of diseases of the musculoskeletal system increases, including spinal osteochondrosis, deforming osteoarthritis, and damage to muscles and ligaments. Simple general tips to prevent the development of such diseases: try to lead a healthy lifestyle and promptly seek advice from specialists. Regarding the type and intensity of necessary physical activity. Of course, movement is life, but it is very important that it does not cause pain, but joy. Patients often come to us with complaints of pain in the extremities, in particular in the wrists and wrist joints, where the nerves lie closely together with the tendons. Inflammation occurs due to stress from prolonged routine work, for example, when working with a wrench, driving for a long time in a chair and steering wheel that is not adjusted in height and depth, when playing the piano, or working at an inconveniently located computer keyboard.
Such pain can often make a person disabled. In this case, it is necessary to carry out a therapeutic and diagnostic blockade, treat the nerve directly, administer drugs that block pain, relieve inflammation and swelling, prevent further destruction of the nerve, and in some cases, perform neurosurgical intervention on the nerve. When performing pain blockades, our clinic uses high-tech methods: under the control of an ultrasound sensor (this is called ultrasound navigation) or an X-ray image in real time, a needle is brought exactly to the affected area, through which the necessary medicine is administered. The possibilities of such visualization during blockades practically eliminate the possibility of accidental damage to nerves and surrounding tissues and blood vessels and ensure increased safety of the procedure. Thanks to the pinpoint precision of administration, we are able to reduce the dose of the administered drug, thereby reducing the risks of developing unwanted reactions that are possible when administering high doses of the drug.

– How financially accessible are the clinic’s services to patients?

– Our clinic operates in the compulsory health insurance (CHI) system, since a large number of diseases accompanied by pain are included in the compulsory medical insurance system. The clinic also has a voluntary health insurance (VHI) department. According to current legislation, a doctor must advise a patient about the possibility of receiving free medical services. From a medical point of view, complexity and timeliness are of particular importance: if a patient undergoes an ultrasound today and an MRI six months later, this reduces the effectiveness of treatment to zero. We have developed special programs with significant discounts on sets of diagnostic procedures and pain treatment methods. At the same time, high-tech services, by definition, cannot be very cheap.

– In what directions will the clinic develop this year?

– In the coming years, our clinic will continue to introduce new types of medical services for the diagnosis and treatment of pain. These include various types of electrical neurostimulation, physiotherapy, new methods of neuroimaging, ultrasound, x-ray assistance, navigation in the treatment of pain syndromes. There will be a widespread introduction of minimally invasive operations, neurosurgical, low-traumatic procedures, which will allow surgical treatment of the cause of pain in 2-3 days. Further training for our doctors is planned; they will master related specialties, new treatment techniques, including diagnostic and invasive ones. We will also develop connections with other clinics and scientific schools specializing in the treatment of pain, both in our country and abroad. Our goal is to relieve our patients from any pain, from walking through torment: comprehensively, effectively and safely.

The neurological service provides qualified specialized care at the outpatient and inpatient stages, based on the rule of continuity in patient treatment.

Composition of the Neurology Department

In the hospital, care for patients with diseases of the nervous system is provided on the basis of: 1st Neurological Department - General Neurology with beds for patients with multiple sclerosis And 2nd neurological department for patients with acute cerebrovascular accidents.

The clinic receives: interdistrict department of paroxysmal conditions And interdistrict department of multiple sclerosis.

Branch staff

The staff of the neurological service consists of neurologists with extensive experience in medical work and specialized training necessary for the use of modern technologies in medicine, a physiotherapist, exercise therapy, experienced nurses who are high-class professionals with sufficient experience in neurological practice.

Diagnosis and treatment in the neurology department

The basic principle of the neurological service- effective highly specialized medical care; individual approach, professional care; high responsibility; psychological comfort and special care.

The neurological service deals with the diagnosis and treatment of various diseases of the nervous system: disorders of the brain and spinal cord, as well as the peripheral nervous system.

24-hour medical care is provided, emergency and planned patients are examined.

To accomplish the assigned tasks, all modern methods of laboratory and instrumental diagnosis of diseases of the nervous system are available, including: magnetic resonance and computed tomography of the brain and spinal cord, spine, duplex scanning of the main arteries of the head, electroencephalography.

Patients with vascular diseases of the brain undergo comprehensive treatment: vascular therapy, consultations with specialists, and any type of examination.

Each patient is treated according to modern recommendations and protocols of evidence-based medicine.

Activities

• treatment of acute cerebrovascular accidents and their consequences;
• treatment of patients with multiple sclerosis;
• diagnosis and complex treatment of diseases of the peripheral nervous system: neuropathy of the facial nerve, trigeminal neuralgia, etc., polyneuropathy of various origins;
• Parkinson's disease;
• osteochondrosis, spondyloarthrosis, disc herniations with pain and neurological manifestations.
• diagnosis and treatment of various types of dizziness;
• diagnosis and correction of the condition of patients with pathology of the autonomic nervous system;
• restless legs syndrome;
• neurological problems of cardiac patients, patients with metabolic syndrome, with

In its current understanding, neurology is a medical branch in which diseases of the nervous system (central and peripheral) are described and studied. Diagnosis of neurological diseases is difficult even for a highly qualified specialist. But thanks to the use of the latest medical technology, the possibilities for finding a reliable diagnosis are expanding. The modern center, which deals with neurology, has the latest equipment. They provide truthful information about diseases of the spinal cord and brain, congenital pathologies of the spinal column, etc. Based on the acquired information, he makes a conclusion about the patient’s basic condition and the necessary treatment methods. People with various neurological symptoms come to such medical centers.

The limited scope that describes modern practical medicine makes it difficult to both understand and diagnose most diseases. Doctors often limit themselves to their own area, losing communication with other possible conditions. In addition to diagnostic errors, this also leads to treatment errors.

The complete list of diseases is not based on the nervous system, as the popular saying goes, “all diseases come from the nerves,” however, during the development of diseases, the nervous system is involved, which can change or delay the picture of morbidity. Therefore, before doctors make a diagnosis, they first refer sick people to a neurologist for consultation.

History of neurology

Even before our era, the first sources on diseases of the nervous system were found. This was approximately 3 thousand years BC. Sensory disturbances and paralysis were found in patients. The ancient book of India, Ayur-Veda, noted fainting, seizures and headaches. The chronicles of Razi, Hippocrates and Ibn Sina present clinical descriptions of various neurological diseases, methods, as well as diagnostics of their treatment. Already at that time, the human condition was characterized as a brain disease, including migraine and epilepsy.

The rapid development of neurology as a science is associated with the rapid emergence of methods for analyzing the nervous system. T. Willisius and D. M. Morgagni in the Middle Ages were able to provide information that some neurological disorders were directly related to the structure of the brain. The main contribution to the development of such a doctrine of the morphological nature of the nervous system was based on the following names: Jacob Silvius, Adreus Vesalius, Constanzo Varolius. Descartes talked about the reflex and created a definition for it. These were the main principles of neurophysiology.

Causes of neurological diseases and their symptoms

Neurological diseases have various causes when they occur. An important component is heredity. Most neurological diseases primarily depend on systemic diseases of the internal organs. The presence of toxins, improper administration, and abuse of medications also cause neurological diseases. Metastatic cancer cells also provoke paraneoplastic and disease-related syndromes.

It is often difficult to identify neurological diseases as a result of the fact that their etiology is still unclear. In such diseases, visible damage to the atoms can be seen, but its source is difficult to determine. After all, it looks more like a condition than a disease. When diagnosing a neurological disease, the main thing is to choose the right research method, because treatment depends on it.

The emerging diseases are similar in manifestations and symptoms. The neurological type of the disease can be determined by the signs that appear in the patient:

The appearance of even one of these signs indicates that the person should be examined by a neurologist.

But it often happens that such symptoms are signs of other diseases of systems and organs. This is precisely what explains the strong connection between neurology and human anatomy.

Diagnosis and treatment

A diagnosis can only be made after a thorough examination, which includes several measures, and only your treating neurologist determines their necessity. These include:

The modern approach to the treatment of neurological diseases is due to the developed pharmacological industry and improved surgical equipment. In addition, the latest immunomodulatory drugs, stem cells, minimally invasive neurosurgery and stereotactic radiosurgery are used to treat pathologies.

Prevention of neurological diseases

If the central nervous system is healthy, then other organs are functioning properly. When the slightest malfunction occurs in the body, various complications and diseases arise. Because the treatment of neurological diseases is a very long and complex process, it is more important to keep it healthy than to treat it. To do this, professionals advise using basic recommendations that will help every person maintain their health.

The main factor for a healthy central nervous system in the human body is maintaining a healthy lifestyle. This definition includes:

• maintaining the correct regimen;
• healthy eating;
• long walks in the fresh air;
• good physical activity;
• giving up bad habits such as smoking or drinking alcohol.

As a result of the fact that neurological diseases are complications of infectious diseases, it is necessary to use preventive methods that prevent such symptoms. Timely vaccination is one of the methods for the prevention of infectious diseases.

Neurological diseases

Neurological diseases are pathological changes that occur in one area of ​​the nervous system and are classified as chronic diseases.

They are divided into two types:

• Extrapyramidal;
• Pyramid.

The extrapyramidal system is responsible for muscle tension, involuntary movements, posture and balance.

The pyramidal system - relates to the coordination of movements, reduces muscle reflexes and their tone. Sometimes neurological diseases can affect the external functions of the brain, affect memory, and lead to speech and perception disorders.

In medical practice, the most common neurological pathologies are:

More about neurology

HELP ME PLEASE! Vyacheslav. I am 31 years old. I want to ask:
1)Help. Council.
2) Get a consultation.
3) Or maybe you can suggest a clear plan of action in my situation.
Brief description of medical history and symptoms:
At the age of 19, I fell ill in the following way: while at the dacha (digging potatoes), I felt unwell all day. But it was necessary to work. And in the evening the following happened: while digging I felt that I was “turning off”, trembling in my body, weakness. Sat down.
I had a headache, a feeling that the blood in my head was “stopping,” a fever rose, and weakness increased. After returning home and resting
my health did not improve; on the contrary, my temperature reached 37.8 degrees.
The next day I went to the Central District Hospital (stanitsa). Hospitalized with a diagnosis of VSD. General analyzes with minor deviations. The state of health worsened, and cramps appeared in the spine and legs. Derealization. I went to the region in Tsen. Cons. Polycl. Hypatolomic syndrome was added to the diagnosis. Later, a consequence of neuroinfection, diencephalic syndrome, was added. So at that moment:
Diagnosis: Consequences of neuroinfection. Diencephalic syndrome with frequent hypothalamic crises. VSD. (At the same time, the diagnosis of the consequences of neuroinfection was made 5 months later in another city at a face-to-face consultation) And five months later they began to treat because before that, our local village doctors claimed that VSD is, in principle, normal (even with my symptoms) and recommended taking vitamins. In the region, in principle, too.
Treatment: chloracone, vinpocetine, benzonal, vitamins, lidase. From the treatment it became a little bit easier, but not much. Later they attributed: chloracone for a long time, vinpocetine for a long time. Then chloracone was replaced with phenazepam for a long time.
So I accepted:
1. phenazepam 1\ 4 t. 1-2 r. in a day
2. Vinpocetine 1t. 2 rub. in a day
3. Multivit 3 times a year in courses of 2 months
Gde-that in half a year the status was stabilized, even became better. Of the symptoms persisted - temperature (now daily without changing) 37, 2 degrees. -37.3 degrees. , weakness, pale pink stretch marks appeared on the shoulders and hips (Itsenko Cushing’s was not confirmed, we carried out all the studies). However, if I didn't take lekva for at least two days, it got worse. If he did not take vinpocetine, then his head became ill (tightened). If I did not take phenazepam, tension, anxiety, cramps appeared in the arms and legs, vegetative-vascular dystonia.
9 years have passed. During this time I gained 40 kg. with a height of 170 cm (there was a weight of 80 kg - it became 120 kg.).
I took medication, adapted to my illness, fought against weakness, and led an active lifestyle. I unlearned (in / about), I work (computer-system engineer), got married.

The deterioration began like a bolt from the blue. Or maybe it's a new disease.
Before this, some kind of wild brain fatigue appeared (as if the brain was exhausted to the limit). Rest did not bring tangible relief. I began to have a headache (pain from overwork) and increased weakness.

On 11/15/07 I was walking to work with my colleagues, and a little while before work I felt increasing weakness, dizziness, and almost fell. The next day, severe general weakness (I can’t stand for more than 10 minutes) appeared in the afternoon, I started feeling dizzy, and had a “flu-allergic” state.
I contacted the Central District Hospital. The local therapist gave a referral to the region in Tsen. Cons. Polycl. to an endocrinologist and neurologist.
UAC:
Er 5, 6x10, Hv 177, c 0.94 L 4, 8x10, EO, p 2, s 68, l 24, m 6, ROE 6,
glucose 5.1, amylase 48, AST 14.6, ALT 26.6, creatine 112,
urea 5.33, uric acid 395.8, K 4.93, Na 140.8, Ca 2.71,
cholesterol 4, 8, B lipopr. 4, 4, Bilirubin cont 23, 5, straight 2. 5

OAM:
Ep 0-1-2, l 0-1-2 oxalates in large quantities.

MRI:
Study mode: FSE
A series of tomograms showed no intracerebral pathological foci.
The ventricles and cisterns are of normal shape and size, symmetrical.
The pituitary and craniovertebral regions are without features.
The right maxillary sinus is filled with exudate to its entire volume.
The subarachnidal space is not changed.

EEG:
Conclusion:
No pathological activity was recorded. Light changes of a regular nature. The influence of rdx on the cortex is enhanced.

Consultation with specialists:

Endocrinologist:

Diagnosis:
Neuroendocrine syndrome with impaired fat metabolism of skin trophism. Symptomatic arterial hypertension.

Neuropathologist:
At first, myasthenia gravis was suspected, but it was not confirmed.
Diagnosis: Hypothalomic syndrome with paroxysmal psycho-vegetative attacks. Violation of fat metabolism. Symptomatic arterial hypertension.

Purpose:
Observation by a neurologist and endocrinologist for men and women.

There was no effect from the treatment. My health began to deteriorate sharply.
Hospitalized at the Central District Hospital:
Diagnosis:
Cerebral arachnoiditis with impaired cerebrospinal fluid dynamics. Hypothalomic syndrome. Osteochondrosis of the cervical spine. (At the same time, the diagnosis was made in another city and copied word for word by the doctors of the Central District Hospital).

Treatment:
Trental in/in, mexidol in/in, cerebrolysate in/in, aloe in/in, vinpocetine in/in, mildronate in/in.
Discharged. There was no effect from the treatment. My health continues to deteriorate.

I take: Cavinton, neuromultevit, mildronate, phenazepam.

At the moment (29.02.08): Constant headaches (tearing my head) that cannot be relieved by anything other than strong painkillers.
The right half of the head and the left half of the face go numb. Weakness (immobilized). Nausea. Vision worsened (I see as in water). Temperature 37, 1. Face swells. My eyes and eye muscles hurt (I can hardly turn to the sides). Hearing has deteriorated and constantly whistles, makes noise in the head and ears. Dulled sensation of the body. Moderate (tolerable) cramps in different parts of the body. Speech disorders occasionally occur (never happened before). Vertigo (lying, sitting). Slight trembling of limbs. Hypothalomic crises. Feeling of intoxication. Psychologically, I am very worried.
I hope very much for your help.
What analyzes are necessary - I will show.

A neurologist is a specialist who treats a wide variety of pathologies of the nervous system. He deals with pathologies of the spinal cord and brain, with the peripheral nervous system. The word “neurology” is a compound one. It comes from two Greek words: neuron, which means "nerve", and logos, which means "science". This means that a neurologist studies everything related to the human nervous system. One should not assume that this science is only interested in pathology. It also deals with the normal nervous system, all its aspects:

• anatomy,
• histology,
• physiology,
• biochemistry.

What are they doing?

Neurologists accept patients with pathological processes in the nervous system, as a result of which the metabolism of the nervous system can be disrupted, as well as the blood-brain barrier changing. They also deal with the spinal cord and brain, thalamus, spine, and nerves.

You should seek help from a doctor of this specialization for the following diseases:

• stroke;
• epilepsy;
• osteochondrosis;
• vegetative-vascular dystonia;
• sciatica;
• radiculitis;
• pinched sciatic nerve;
• intervertebral disc herniation;
• hypertensive encephalopathy;
• chronic circulatory failure;
• neuralgia and other numerous diseases;
• trigeminal neuralgia;
• tumors of the brain and spinal cord;
• neuritis;
• neurological complications;
• neuropathy and polyneuropathy;
• epilepsy attacks;
• consequences of traumatic brain injuries.

His responsibilities include identifying not only the disease itself, but also the causes that lead to disruptions in the functioning of the nervous system; it is especially important to identify the source of the lesion. It is necessary to assess the degree of disease of the nervous system and detect related pathologies of other organs and systems.

What symptoms should you contact?

There are many reasons for visiting a neurologist in Moscow. You may be tormented by:

• insomnia and sleep disorders,
• dizziness,
• noise in the head and ears,
• migraines and headaches (temporary and permanent),
• facial pain,
• memory impairment,
• chronic fatigue syndrome,
• dizziness,
• walking and falling disorders
• back pain of various origins,
• sleep disorder,
• hearing and sensory impairments (temporary and permanent),
• visual impairment (temporary and long-term),
• memory loss,
• deterioration of the sense of smell and so on.

In addition to clinical tests, a neurologist in Moscow can send for additional examinations, such as:

• electroneuromyography and electroencephalography;
• rheoencephalography and echoencephaloscopy;
• radiography of the skull and spine;
• myelography;
• CT, MRI and so on.

Where are doctors of this profile trained?

In order to become a professional neurologist and practice in Moscow, you must not only undergo training in the relevant departments at one of the Moscow universities, but also have qualities such as compassion, attentiveness and kindness. You can get an education in this field of medicine at such universities in Moscow as:

• RNIMU named after. N. I. Pirogova,
• Federal State Institution "Educational and Scientific Medical Center" of the Administration of the President of the Russian Federation,
• RUDN University,
• RMAPO,
• RGMU,
• MGMSU and others.

Famous Moscow specialists

The term “neurology” was first introduced into use in the mid-17th century by the famous English anatomist Thomas Willis. Thus, it is not the most ancient science. Doctor Kozhevnikov is recognized as the founder of Russian neuropathology. In the middle of the 19th century, he opened a neurological department for the first time in Russia.

His talented students, who became brilliant neurologists in Moscow and Russia, were outstanding scientists and doctors: Rossolimo, Pribytkov, Darkshevich, Korsakov, Sukhanov, Muratov, Minor, Roth, Rybakov. The research they did formed the basis of their training and gave birth to a whole cohort of eminent metropolitan doctors, among whom Vernadsky, Chaplygin, Timiryazev, Lebedev, Serbsky, Mogilnitsky and others especially stood out.