Nervous forms of rheumatism

Rheumatic lesions are noted in all departments of the Central and peripheral nervous system, and the clinic has approved the proposed in. A. Miheev, the term "neurotraumatism".
Morphological changes in the nervous system in rheumatoid arthritis are similar to those found in other organs and tissues at rheumatism and also at other collagenoses.
Basically this defeat the system of connective tissue, including vascular walls (Fig. 6-8). Molignee swelling, fibrinogene changes and hyalinosis represent the stages of connective tissue and it is interstitial, cell-free part. On the background of marked destruction of vascular walls with violation of hemodynamics there are inflammatory changes of varying intensity in the form of endarteritis and periarteriit. Such changes are more frequent in small vessels of the brain. Vasculitis accompanied by corresponding changes in the brain tissue, but they can be discovered (to a lesser extent) in cases when there are no clinical manifestations of neurotraumatism. Thrombosis of vessels and emerging phenomena anoxia in places of localization of vascular disorders cause thrombotic and acrobatically foci of softening of the brain tissue at the fall of cardiac activity.
Vasculitis are the main symptoms of rheumatism in the brain, spinal cord and, as a rule, strikingly revealed during the next rheumatic fever, particularly sharply presents when they revocations the course of the disease, which can even be observed hemorrhagic meningoencephalitis. In all forms of rheumatic process often there are small periarterial hemorrhage and edema as a matter of the brain and meninges. Sometimes there are parenchymal or subarachnoid hemorrhage.
Classification lesions of the nervous system in rheumatoid arthritis is based on the clinical and pathomorphological data centuries Mikheev). It includes, on the one hand, vascular brain with local signs caused by thrombosis of some branches of the internal carotid or vertebral artery (mainly middle cerebral or basilar artery), subarachnoid and parenchymal hemorrhage, embolism in brain vessels and Transient small strokes; on the other hand,- inflammation of the brain and spinal cord type of meningoencephalitis of different localization, encephalomyelitis, cerebral and spinal arachnoiditis and radiculitis. Most frequently encountered encephalitis with predominant localization in striped bodies of the brain, commonly observed in children and called small horei. A frequently observed lesions hypothalamic region with the characteristics of cerebral pathology (long hyperthermia, polydipsia and polyuria, rise in blood pressure, profuse sweating, anorexia, rhythm sleep and emotional changes, increased anxiety, fears, hypochondriac mood, hysterical behavioral traits). Emerging on the background of sharp attacks of headaches, which are based on violations of liquorrhea with the development of hypertension syndromes, with sudorazdelochnyjj giperkinezami was named diencephalic epilepsy.
In patients with rheumatism very often marked disorders of the autonomic nervous system: wet and cold hands and feet, marble color of skin, lability of vasomotor, the propensity to allergic reactions.
Apparently, due to the diffuse vascular changes with symptoms of hypoxia in rheumatoid arthritis often observed neurasthenic symptoms, and sometimes mental disorder until expressed psychosis (in most schizophrenia-like psychosis). Anoxic Genesis mental changes in patients with rheumatic heart disease confirmed observations I. A. the EP Nevzorova over these patients before and after surgery commissurotomy. The same reason you can explain and epileptiform seizures in patients with rheumatism.
A thorough investigation of gas exchange in patients with mitral epilepsy", which is described in mitral stenocereus Vice E. I. Lichtenstein and N. B. Mankovsky, revealed hypoxia. Some of these patients was observed narcoleptic attacks, all unconscious States with palpitations and severe weakness, and further and tonic convulsions; at others - attacks like diencephalic character and even momentary loss of consciousness.
Foster (C. Foster), who studied the relationship between convulsive seizures and rheumatic heart disease, came to the conclusion that seizures in people who have had rheumatic fever, more often than the rest of the population; in families, the members of which are convulsive States or migraine, posttraumatische seizures were observed in 6 times more often, than in families, not burdened in this respect. Not quite right to call seizures rheumatism "rheumatic epilepsy"; it is better to speak about epileptiform seizures and conditions. The successful result from the simultaneous treatment and Antirheumatic anticonvulsant drugs confirms rheumatic the Genesis of this symptomatic epilepsy.
Diagnosis of neurotraumatism not always easy, as one the presence of rheumatoid arthritis in a patient cannot unconditionally to explain pathological conditions throughout his life.
Having endocarditis, heart disease usually help in the diagnosis, however, a well-known cases, not to mention small trochaic, where with focal neurological symptoms like everything starts disease, rheumatism and where the heart damage, apparently, is not captured in the beginning, unfolds against the backdrop of the current nervous suffering.
Thus, if we should not be too broad in a patient with rheumatism to explain all the symptoms only rheumatism, it is impossible to underestimate the impact of rheumatism on the nervous system. Diagnostic difficulties can help the immune response, electrophoretic study of protein fractions, cupping the sample.
Prognosis and treatment depend largely on the state of somatic sphere of the patient, and the size of the lesion, if we are talking about thrombotic or embolic the softening of the brain. Because a significant role in the development of the nervous rheumatism play circulatory and hemodynamic disorders, neurological symptoms are often unstable and transitory.
Permanent brain and spinal syndromes rheumatic origin require persistent therapy, sometimes with the use of steroid hormones. In General any specific treatment different from those used in therapeutic clinic, no. In the case of hypertensive liquor paroxysmal should dehydration therapy; when epileptiform seizures along with shows in some cases Antirheumatic therapy to apply and anti-convulsants; in cases of cerebral pathology - diphenhydramine, bellaid, steroid therapy.

Fig. 6. Molignee swelling of the walls of the arterioles.
Fig. 7. Hyalinosis precapillaries bottom IV heart.
Fig. 8. Bulging and proliferation of endothelial on the limited part of the vessel.