MKB 10 state after a convulsive attack. Emergency Medicine: Convulsive Syndrome

FEBRILE SEALS honey.
Febrile seizures occur in children under 3 years of age when the body temperature rises above 38 ° C in the presence of a genetic predisposition (121210, R). Frequency - 2-5% of children. The predominant gender is male.

Options

Simple febrile seizures (85% of cases) - one attack of seizures (usually generalized) within a day lasting from a few seconds, but not more than 15 minutes
Complex (15%) - several episodes during the day (usually local seizures) lasting more than 15 minutes.

Clinical picture

Fever
Tonic-clonic seizures
Vomiting
General excitement.

Laboratory research

First episode: determination of the level of calcium, glucose, magnesium, other serum electrolytes, urinalysis, blood culture, residual nitrogen, creatinine
In severe cases - toxicological analysis
Lumbar puncture - if meningitis is suspected or the first episode of seizures in a child over 1 year old.
Special studies. EEG and CT of the brain 2-4 weeks after an attack (performed with repeated attacks, neurological diseases, afebrile seizures in a family history or in the case of the first manifestation after 3 years).

Differential diagnosis

Febrile delirium
Afebrile convulsions
Meningitis
Head injury
Epilepsy in women combined with mental retardation (* 300088, K): febrile seizures may be the first sign of the disease
Sudden cessation of anticonvulsant intake
Intracranial hemorrhage
Coronary sinus thrombosis
Asphyxia
Hypoglycemia
Acute glomerulonephritis.

Treatment:

Management tactics

Physical methods of cooling
Patient position - lying on the side to ensure adequate oxygenation
Oxygen therapy
Intubation, if necessary.

Drug therapy

The drugs of choice are acetaminophen (paracetamol) 10-15 mg / kg rectally or by mouth, ibuprofen 10 mg / kg for fever.
Alternative drugs
Phenobarbital 10-15 mg / kg IV slowly (respiratory depression and arterial hypotension are possible)
Phenytoin (diphenin) 10-15 mg / kg IV (possible cardiac arrhythmia and arterial hypotension).

Prevention

Acetaminophen (paracetamol) 10 mg / kg (by mouth or rectally) or ibuprofen 10 mg / kg by mouth (at body temperature above 38 ° C - rectally)
Diazepam -5 mg before the age of 3 years, 7.5 mg - from 3 to 6 years or 0.5 mg / kg (up to 15 mg) rectally every 12 hours up to 4 doses - at a body temperature above 38.5 ° C
Phenobarbital 3-5 mg / kg / day - for long-term prophylaxis in children at risk with a burdened history, multiple recurrent seizures, neurological diseases.

Course and forecast

Febrile seizure does not delay
physical and mental development or death. Risk of recurrence
attack - 33%.

ICD

R56.0 Convulsions with fever

MIM

121210 Febrile convulsions

Handbook of diseases. 2012 .

See what "FEBRILE SHIMS" is in other dictionaries:

Febrile epileptic seizures - - seizures of epilepsy with a febrile state in childhood. Often such seizures are associated with high, early-age seizure readiness and may not have a continuation in the form of epilepsy. The possibility that such convulsions ... ...

Febrile seizures, simple - - episodic tonic or clonic convulsions that occur during a febrile state and are not associated with epilepsy ... Encyclopedic Dictionary of Psychology and Pedagogy

Convulsions - I Convulsions are involuntary muscle contractions of a continuous or intermittent nature. Distinguish according to the mechanism of S.'s development epileptic and non-epileptic; by the duration of muscle contraction, myoclonic, clonic and tonic: by ... ... Medical encyclopedia

Convulsions - - involuntary contraction of a certain muscle group or all muscles of the body, both tonic and clonic. It was found that clonic seizures are associated with the excitation of the subcortical structures of the brain (striated nucleus, dentate nucleus, ... ... Encyclopedic Dictionary of Psychology and Pedagogy

Convulsions - Involuntary muscle contraction. Depending on their continuous or intermittent nature, distinguish between tonic and clonic S. By origin, S. are distinguished cerebral and spinal. Caused by: anoxia (for example, during fainting), ... ... Explanatory Dictionary of Psychiatric Terms

Febrile spasm - convulsions at the height of body temperature in children. In particular, febrile seizures ... Encyclopedic Dictionary of Psychology and Pedagogy

EPILEPSY - a chronic neuropsychiatric disease characterized by a tendency to recurrent sudden seizures. There are different types of seizures, but all of them are based on abnormal and very high electrical activity of nerve cells ... ... Collier's Encyclopedia

Honey. Epilepsy is a chronic disease of the brain characterized by repeated seizures resulting from excessive electrical activity of a group of neurons in the brain. Etiology Idiopathic (primary, essential, ... ... Handbook of diseases

Fermentopathies - (enzyme [s] (Enzymes) + Greek pathos - suffering, illness; synonym for enzymopathy) diseases and pathological conditions caused by a complete absence of enzyme synthesis or persistent functional deficiency of the enzyme systems of organs and tissues. ... ... Medical encyclopedia

Epilepsy - ICD 10 G40.40. G41.41. ICD 9 345 ... Wikipedia

The occurrence of seizures in an adult or a child is a signal of a serious pathological process in the body. When making a diagnosis, the doctor uses the ICD 10 code for convulsive syndrome to correctly draw up medical documentation.

The International Classification of Diseases is used by doctors of various specialties around the world and contains all nosological units and premorbid conditions, which are divided into classes and have their own code.

The mechanism of the seizure

Convulsive syndrome occurs against the background of unfavorable factors of the internal and external environment, it is especially common in idiopathic epilepsy (epileptic seizure). The development of convulsive syndrome can also be provoked by:

• traumatic brain injury;
• congenital and acquired diseases of the central nervous system;
• alcohol addiction;
• benign and malignant tumors of the central nervous system;
• high fever and intoxication.

Disturbances in the work of the brain are manifested by paroxysmal activity of neurons, due to which the patient has repeated attacks of clonic, tonic or clonic-tonic seizures. Partial seizures occur when neurons in one zone are affected (they can be localized using electroencephalography). Such violations can occur for any of the above reasons. However, in some cases, when making a diagnosis, it is not possible to accurately identify the cause of this severe pathological condition.

Features in childhood

The most common manifestation of convulsive syndrome in children is febrile seizures. The most at risk of developing an attack are newborns and children under 6 years of age. If seizures recur in older children, it is necessary to suspect epilepsy and consult a specialist. Febrile seizures can occur with any infectious or inflammatory disease, which is accompanied by a sharp increase in body temperature.

In the international classification of diseases of the tenth revision, this pathology is under the code R56.0.

If your baby has twitching muscles against the background of fever, then you need to:

• call an ambulance team;
• lay the child on a flat surface and turn his head to one side;
• give an antipyretic after the seizure stops;
• supply fresh air to the room.

You should not try to open your child's mouth during an attack, as you can injure yourself and him or her.

Features of diagnosis and treatment

In ICD 10, convulsive syndrome is also coded R56.8 and includes all pathological conditions that do not belong to epilepsy and seizures of other etiology. Diagnosis of the disease includes a thorough history taking, an objective examination, and an electroencephalogram. However, the data of this instrumental study are not always accurate, so the doctor should also focus on the clinical picture and the history of the disease.

Treatment should begin with the elimination of all possible factors predisposing to the disease. It is necessary to stop alcohol abuse, remove the tumor of the central nervous system (if possible) by surgery. If it is impossible to establish the exact cause of the seizures, then the doctor prescribes symptomatic therapy. Anticonvulsants, sedatives, tranquilizers, and nootropics are widely used. Early seeking qualified medical care can significantly increase the effectiveness of treatment and improve the prognosis for the patient's life.

According to the criteria of the International Antiepileptic League, a first seizure (seizure) is one or more seizures that occur for the first time, which can be repeated within 24 hours, with full recovery of consciousness between them.

reference Information:

Conceptual definition of seizure and epilepsy (ILAE report, 2005) Epileptic seizure (seizure) is a transient clinical manifestation of pathological excessive or synchronous neural activity of the brain Epilepsy is a brain disorder characterized by a persistent predisposition to epileptic seizures, as well as neurobiological, cognitive, psychological and social consequences of this condition. This definition of epilepsy provides for the development of at least one epileptic seizure (note: a seizure associated with the effect of any transient factor on the normal brain, which temporarily lowers the seizure threshold, is not considered epilepsy).

Practical clinical definition of epilepsy... Epilepsy is a brain disorder corresponding to any of the following conditions: [ 1 ] at least two unprovoked (or reflex) epileptic seizures with an interval of\u003e 24 hours; [ 2 ] one unprovoked (or reflex) seizure and the likelihood of recurrent seizures corresponding to the overall risk of recurrence (\u003e 60%) after two unprovoked epileptic seizures over the next 10 years; [ 3 ] the diagnosis of epileptic syndrome (eg, benign epilepsy with centrotemporal adhesions, Landau-Kleffner syndrome).

Distinguish the first attack:

[1 ] epileptic - the transient appearance of signs and / or symptoms as a result of pathological or increased activity of neurons in the brain;
[2 ] acute symptomatic - an attack that develops with severe brain damage or in a clear time dependence on documented acute brain damage;
[3 ] distant symptomatic - a seizure that develops without an obvious provoking factor, but with the presence of a pre-seizure diagnosed serious brain damage, such as severe trauma or concomitant disease;
[4 ] progressive symptomatic - a seizure that develops in the absence of a potentially responsible clinical condition or outside the time interval for which acute symptomatic seizures are possible, and is caused by a progressive disorder (for example, a tumor or degenerative disease);
[5 ] psychogenic - transient behavioral disturbances without any cause of an organic nature (in the DSM-IV classification such an attack is classified as a somatoform disorder, while according to the ICD-10 classification [WHO, 1992], a similar attack is classified as dissociative seizures and belongs to the group conversion disorders.

read also the article: Psychogenic non-epileptic seizures (to the website)

Acute symptomatic seizures are episodes that occur in close temporal relationship with acute CNS damage, which can be metabolic, toxic, structural, infectious or inflammatory. The time period is usually defined as the first week after an acute condition, but can be shorter or longer. These seizures are also called reactive, provoked, induced, or situational seizures. For epidemiological studies, an accurate definition is mandatory, therefore the International Antiepileptic League recommends using the term - acute symptomatic seizures ( note: an acute symptomatic attack is a "provoked attack", therefore, even with a high risk of recurrence, the diagnosis of "Epilepsy" is not made [see. "Background Information" - Practical Clinical Definition of Epilepsy]).

Epileptic, distant symptomatic, and progressive symptomatic seizures are "unprovoked seizures." An unprovoked seizure is a seizure or a series of seizures that develop over 24 hours in a patient over 1 month of age in the absence of provoking factors. Unprovoked seizures can be single or recurrent. Although all patients with solitary unprovoked seizures are likely to develop epilepsy, seizures recur in only half of cases. According to population studies, the risk of seizure recurrence within 1 year was 36 - 37%, within 2 years - 43 - 45%. After the second unprovoked seizure, the risk of developing the third reaches 73%, and the fourth - 76% (Anne T. Berg, 2008).

Acute symptomatic seizures differ from epilepsy in a number of important ways. [ 1 ] First, unlike epilepsy, the immediate cause of these seizures is clearly defined. When there is a clear temporal relationship, it is possible that conditions such as uremia, head trauma, hypoxia, or stroke, which always precede or develop concurrently with the seizure, are the causes of the seizure. A causal relationship is also confirmed in cases where an acute violation of the integrity of the brain or metabolic homeostasis develops in connection with a stroke. In many cases, more severe injury increases the likelihood of seizures. [ 2 ] Secondly, unlike epilepsy, acute symptomatic seizures do not necessarily recur when the conditions that caused them recur. [ 3 ] Third, although acute symptomatic seizures are an undeniable risk factor for developing epilepsy, they cannot be included in the definition of epilepsy, which requires 2 or more unprovoked seizures.

When a seizure develops for the first time, the following examination is recommended:

[1 ] General physical examination. [ 2 ] Neurological examination. Of the variety of symptoms, cyanosis and, to a lesser extent, hypersalivation (accompanying symptoms), tongue biting, and disorientation (symptoms that appear after a seizure) are reliable indicators of the epileptic nature of a seizure. Eyes closed during the tonic-clonic phase of the seizure support a dissociative (psychogenic non-epileptic) seizure with a sensitivity of 96% and a specificity of 98%. [ 3 ] Biochemical blood tests: complete blood count, glucose, urea, electrolytes (including calcium), creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase / prolactin; urinalysis toxicological tests (if necessary).

Except for children in the first 6 months of life who have hyponatremia (<125 ммоль/л) в 70% случаев сопутствует эпилептическим припадкам, метаболические нарушения (гипер- и гипогликемия, электролитные нарушения и др.) редко обнаруживаются у детей и взрослых при биохимическом/гематологическом скрининге после припадка.

To differentiate epileptic seizures and psychogenic non-epileptic seizures, it is advisable to determine the level of prolactin in serum (two-fold excess of the basal level or\u003e 36 ng / ml suggests either generalized tonic-clonic or complex partial seizures.

[4 ] Conducting an EEG. If a standard EEG recorded while awake is not informative, it is recommended to record an EEG in the background of sleep. An EEG recorded within 24 hours of a seizure is more likely to detect epileptiform activity than one recorded on subsequent days. In contrast, a slowdown in basal EEG activity 24 to 48 h after a seizure may be transient and should be interpreted with caution.

read also the article: Video EEG monitoring (to the website)

[5 ] Conducting computed tomography (CT) and magnetic resonance imaging (MRI) of the brain. Although pathological changes can be found in almost half of adults and 1/3 of children, the contribution of neuroimaging research methods is limited in patients with existing epileptogenic brain damage and / or partial seizures. There is no evidence that MRI is more informative than CT in emergency conditions, at least in children. The value of CT examination in the absence of pathological changes in neurological status was 5-10%. Despite the fact that up to 1/3 of children have pathological changes that are detected using neuroimaging, most of these findings do not affect further tactics of treatment and patient management, for example, the need for hospitalization and the appointment of further examination.

[6 ] Indications for examination of cerebrospinal fluid (CSF). Because of its high sensitivity and specificity, CSF examination is usually performed for febrile seizures accompanied by meningeal symptoms to rule out brain infection. In children under 6 months of age with impaired and incomplete recovery of consciousness in the CSF, pathological changes can be observed even in the absence of symptoms of irritation of the meninges. In contrast, the value of CSF testing in patients with a first non-ferrile seizure has not yet been determined.

Treatment... In the presence of a first acute symptomatic seizure (metabolic encephalopathy, acute CNS trauma in patients with a treatable underlying seizure condition), treatment of the underlying disorder is recommended. Symptomatic (antiepileptic) therapy for the first unprovoked seizure is inappropriate unless the seizure is status epilepticus. The decision to initiate antiepileptic treatment after a first seizure is highly dependent on the risk of relapse (patients with acute symptomatic seizures and a high risk of relapse should not be treated with antiepileptic drugs (AEDs) on a long-term basis, although such treatment may be warranted for the short term as long as the acute condition was not compensated; in the treatment of acute symptomatic attacks, it is advisable to use injectable forms for intravenous administration of AED, such as Konvulex, Vimpat, Keppra). Although this risk can vary significantly from case to case, it is highest in patients with abnormal EEG abnormalities and documented brain injury. Such situations also include a single epileptic seizure at least one month after a stroke, or a single seizure in a child with structural pathology, or a distant symptomatic seizure in the presence of epileptiform changes on the electroencephalogram (EEG). Another example is a specific epileptic syndrome with a persistent decrease in the seizure threshold, revealed after a single seizure. In general, the risk of recurrence is highest during the first 12 months and decreases to almost 0 2 years after the seizure. Studies consistent with evidence levels A, C have shown that treating the first unprovoked seizure reduces the risk of recurrence in the next 2 years, but does not affect long-term outcomes in both children and adults.

Since acute symptomatic seizures partly reflect the severity of CNS damage, it is clear that their occurrence is associated with a poor prognosis of treatment. However, the direct effect of acute symptomatic seizures on prognosis has not yet been proven.

In order to assess the risk of recurrence, make a differential diagnosis and decide on the appointment of treatment, it is necessary to consult a neurologist specializing in the problem of epilepsy. This is why all patients with a new-onset seizure should be consulted in specialized centers or offices (by an epileptologist) within 1 to 2 weeks after the seizure.

The diagnosis of epilepsy after a single unprovoked seizure, even with a high risk of relapse, does not always lead to therapy. The proposed practical definition of epilepsy (see above) supports initiation of treatment in a patient at high risk of relapse after a single unprovoked seizure. However, the decision to initiate treatment should be made on an individual basis, taking into account the patient's wishes, the risk-benefit ratio, and the available therapy options. The physician must balance the ability to prevent seizures against the risk of side effects of the drugs and the cost to the patient.

It should be further clarified that the diagnosis of epilepsy and the decision about treatment are two related but different aspects of the problem. Many epileptologists treat for some time after an acute symptomatic attack (eg, herpetic encephalitis) unrelated to epilepsy. Conversely, in patients with mild seizures, long seizure intervals, or refusal of treatment, therapy may not be given even with a definite diagnosis of epilepsy.

Febrile seizures occur in children under 3 years of age when the body temperature rises above 38 ° C in the presence of a genetic predisposition (121210, Â).

Frequency

- 2-5% of children. The predominant gender is male.

Code for the international classification of diseases ICD-10:

• R56. 0 - Fever seizures

Options

Simple febrile convulsions (85% of cases) - one seizure (as a rule, generalized) within a day lasting from several seconds, but not more than 15 minutes. Complex (15%) - several episodes during the day (usually local seizures) lasting more than 15 minutes.

Febrile seizures: Signs, Symptoms

Clinical picture

Fever. Tonic-clonic convulsions ... Vomiting. General excitement.

Febrile seizures: diagnosis

Laboratory research

First episode: determination of the level of calcium, glucose, magnesium, and other electrolytes in blood serum, urinalysis, blood culture, residual nitrogen, creatinine. In severe cases, toxicological analysis. Lumbar puncture - if meningitis is suspected or the first episode of seizures in a child over 1 year old.

Special studies

EEG and CT of the brain 2-4 weeks after the seizure (carried out with repeated seizures, neurological diseases, afebrile seizures in a family history or in the case of the first manifestation after 3 years).

Differential diagnosis

Febrile delirium. Afebrile convulsions ... Meningitis. Head injury. Epilepsy in women combined with mental retardation (* 300088, À): febrile convulsions may be the first sign of illness. Sudden cessation of anticonvulsant intake. Intracranial hemorrhage. Coronary sinus thrombosis. Asphyxia. Hypoglycemia. Acute glomerulonephritis.

Febrile seizures: treatment methods

Treatment

Management tactics

Physical methods of cooling. The position of the patient is lying on the side to ensure adequate oxygenation. Oxygen therapy. Intubation if necessary.

Drug therapy

The drugs of choice are paracetamol 10-15 mg / kg rectally or by mouth, ibuprofen 10 mg / kg for fever. Alternative drugs. Phenobarbital 10-15 mg / kg IV slowly (respiratory depression and arterial hypotension are possible). Phenytoin 10-15 mg / kg IV (possible cardiac arrhythmia and arterial hypotension).

Prevention

Paracetamol 10 mg / kg (by mouth or rectally) or ibuprofen 10 mg / kg by mouth (at body temperature above 38 ° C - rectally). Diazepam - 5 mg before the age of 3 years, 7.5 mg - from 3 to 6 years or 0.5 mg / kg (up to 15 mg) rectally every 12 hours for up to 4 doses - at a body temperature above 38.5 ° C. Phenobarbital 3-5 mg / kg / day - for long-term prophylaxis in children at risk with a burdened history, multiple recurrent seizures, neurological diseases.

Course and forecast

A febrile seizure does not lead to physical and mental retardation or death. The risk of a second attack is 33%.

ICD-10. R56. 0 Convulsions with fever

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Class VI. Diseases of the nervous system (G00-G47)

This class contains the following blocks:
G00-G09 Inflammatory diseases of the central nervous system
G10-G13 Systemic atrophies predominantly affecting the central nervous system
G20-G26 Extrapyramidal and other movement disorders
G30-G32 Other degenerative diseases of the central nervous system
G35-G37 Demyelinating diseases of the central nervous system
G40-G47 Episodic and paroxysmal disorders

INFLAMMATORY DISEASES OF THE CENTRAL NERVOUS SYSTEM (G00-G09)

G00 Bacterial meningitis, not elsewhere classified

Included: arachnoiditis)
leptomeningitis)
meningitis) bacterial
pachymeningitis)
Excluded: bacterial:
meningoencephalitis ( G04.2)
meningomyelitis ( G04.2)

G00.0 Influenza meningitis. Haemophilus influenzae meningitis
G00.1 Pneumococcal meningitis
G00.2 Streptococcal meningitis
G00.3 Staphylococcal meningitis
G00.8 Meningitis due to other bacteria
Meningitis caused by:
friedlander's wand
Escherichia coli
Klebsiella
G00.9 Bacterial meningitis, unspecified
Meningitis:
purulent NOS
pyogenic NOS
pyogenic NOS

G01 * Meningitis in bacterial diseases classified elsewhere

Meningitis (at):
anthrax ( A22.8+)
gonococcal ( A54.8+)
leptospirosis ( A27. -+)
listeriosis ( A32.1+)
lyme disease ( A69.2+)
meningococcal ( A39.0+)
neurosyphilis ( A52.1+)
salmonellosis ( A02.2+)
syphilis:
congenital ( A50.4+)
secondary ( A51.4+)
tuberculosis ( A17.0+)
typhoid fever ( A01.0+)
Excludes: meningoencephalitis and meningomyelitis with bacterial
diseases classified elsewhere ( G05.0*)

G02.0* Meningitis in viral diseases classified elsewhere
Meningitis (caused by a virus):
adenoviral ( A87.1+)
enteroviral ( A87.0+)
herpes simplex ( B00.3+)
infectious mononucleosis ( B27. -+)
measles ( B05.1+)
mumps ( B26.1+)
rubella ( B06.0+)
chickenpox ( B01.0+)
shingles ( B02.1+)
G02.1* Meningitis with mycoses
Meningitis (at):
candidal ( B37.5+)
coccidioidomycosis ( B38.4+)
cryptococcal ( B45.1+)
G02.8* Meningitis in other specified infectious and parasitic diseases classified elsewhere
Meningitis due to:
african trypanosomiasis ( B56. -+)
chagas disease ( B57.4+)

G03 Meningitis due to other and unspecified causes

Included: arachnoiditis)
leptomeningitis) due to other and unspecified
meningitis) causes
pachymeningitis)
Excluded: meningoencephalitis ( G04. -)
meningomyelitis ( G04. -)

G03.0 Non-pyogenic meningitis. Nonbacterial meningitis
G03.1 Chronic meningitis
G03.2 Benign recurrent meningitis [Mollare]
G03.8 Meningitis due to other specified pathogens
G03.9 Meningitis, unspecified Arachnoiditis (spinal) NOS

G04 Encephalitis, myelitis and encephalomyelitis

Includes: acute ascending myelitis
meningoencephalitis
meningomyelitis
Excludes: benign myalgic encephalitis ( G93.3)
encephalopathy:
NOS ( G93.4)
alcoholic genesis ( G31.2)
toxic ( G92)
multiple sclerosis ( G35)
myelitis:
acute transverse ( G37.3)
subacute necrotizing ( G37.4)

G04.0 Acute disseminated encephalitis
Encephalitis)
Encephalomyelitis) post-immunization
Identify the vaccine if necessary
G04.1 Tropical spastic paraplegia
G04.2 Bacterial meningoencephalitis and meningomyelitis, not elsewhere classified
G04.8 Other encephalitis, myelitis and encephalomyelitis. Postinfectious enznphalitis and encephalomyelitis NOS
G04.9 Encephalitis, myelitis, or encephalomyelitis, unspecified. Ventriculitis (cerebral) NOS

G05 * Encephalitis, myelitis and encephalomyelitis in diseases classified elsewhere

Includes: meningoencephalitis and meningomyelitis in diseases,
classified elsewhere

If it is necessary to identify the infectious agent, use an additional code ( B95-B97).

G06.0 Intracranial abscess and granuloma
Abscess (embolic):
brain [any part]
cerebellar
cerebral
otogenic
Intracranial abscess or granuloma:
epidural
extradural
subdural
G06.1 Intravertebral abscess and granuloma. Abscess (embolic) of the spinal cord [any part]
Intravertebral abscess or granuloma:
epidural
extradural
subdural
G06.2 Extradural and subdural abscess, unspecified

G07 * Intracranial and intravertebral abscess and granuloma in diseases classified elsewhere

Brain abscess:
amoebic ( A06.6+)
gonococcal ( A54.8+)
tuberculous ( A17.8+)
Granuloma of the brain with schistosomiasis ( B65. -+)
Tuberculoma:
brain ( A17.8+)
meninges ( A17.1+)

G08 Intracranial and intravertebral phlebitis and thrombophlebitis

Septic (s):
embolism)
endophlibis)
phlebitis) intracranial or intravertebral
thrombophlebitis) venous sinuses and veins
thrombosis)
Excludes: intracranial phlebitis and thrombophlebitis:
complicating:
abortion, ectopic or molar pregnancy ( O00 -O07 , O08.7 )
pregnancy, childbirth or the puerperium ( O22.5, O87.3)
non-purulent origin ( I67.6); non-purulent intravertebral phlebitis and thrombophlebitis ( G95.1)

G09 Consequences of inflammatory diseases of the central nervous system

Note This heading should be used to indicate
conditions primarily classified in the headings

G00-G08 (excluding those marked with *) as the cause of consequences that are themselves attributed to
Other headings Consequences include conditions specified as such or as late manifestations or consequences that exist for a year or more after the onset of the condition that caused them. When using this heading, it is necessary to be guided by the relevant recommendations and rules for coding morbidity and mortality given in section 2.

SYSTEM ATROPHIES, AFFECTING PREVENTLY THE CENTRAL NERVOUS SYSTEM (G10-G13)

G10 Huntington's disease

Chorea of \u200b\u200bHuntington

G11 Hereditary ataxia

Excluded: hereditary and idiopathic neuropathy ( G60. -)
cerebral palsy ( G80. -)
metabolic disorders ( E70-E90)

G11.0 Congenital non-progressive ataxia
G11.1 Early cerebellar ataxia
Note: Onset usually in persons under 20
Early cerebellar ataxia with:
essential tremor
myoclonus [Hunt's ataxia]
with preserved tendon reflexes
Friedreich's ataxia (autosomal recessive)
X-linked recessive spinocerebellar ataxia
G11.2 Late cerebellar ataxia
Note: Onset usually in persons over 20
G11.3 Cerebellar ataxia with impaired DNA repair. Teleangiectatic ataxia [Louis-Bar syndrome]
Excluded: Cockayne syndrome ( Q87.1)
pigmented xeroderma ( Q82.1)
G11.4 Hereditary spastic paraplegia
G11.8 Other hereditary ataxia
G11.9 Unspecified hereditary ataxia
Hereditary cerebellar (s):
ataxia NOS
degeneration
disease
syndrome

G12 Spinal muscular atrophy and related syndromes

G12.0 Children's spinal muscular atrophy, type I [Werdnig-Hoffmann]
G12.1 Other hereditary spinal muscular atrophies. Progressive bulbar palsy in children [Fazio-Londe]
Spinal muscular atrophy:
adult uniform
infant form, type II
distal
youth form, type III [Kugelberg-Welander]
scapular-peroneal shape
G12.2 Motor neuron disease. Familial motor neuron disease
Lateral sclerosis:
amyotrophic
primary
Progressive:
bulbar palsy
spinal muscular atrophy
G12.8 Other spinal muscular atrophies and related syndromes
G12.9 Spinal muscular atrophy, unspecified

G13 * Systemic atrophy predominantly affecting the central nervous system in diseases classified elsewhere

G13.0* Paraneoplastic neuromyopathy and neuropathy
Carcinomatous neuromyopathy ( C00-S97+)
Neuropathy of the senses in the tumor process [Denia-Brown] ( C00-D48+)
G13.1* Other systemic atrophies, affecting mainly the central nervous system, with tumor diseases. Paraneoplastic limbic encephalopathy ( C00-D48+)
G13.2* Systemic atrophy with myxedema, affecting mainly the central nervous system ( E00.1+, E03. -+)
G13.8* Systemic atrophy, affecting mainly the central nervous system, with other diseases classified elsewhere

EXTRAPYRAMIDAL AND OTHER MOTOR DISORDERS (G20-G26)

G20 Parkinson's disease

Hemiparkinsonism
Trembling paralysis
Parkinsonism, or Parkinson's disease:
NOS
idiopathic
primary

G21 Secondary parkinsonism

G21.0 Malignant neuroleptic syndrome. If necessary, identify the medicinal product
use an additional external cause code (class XX).
G21.1 Other forms of secondary drug-induced parkinsonism.
G21.2 Secondary Parkinsonism Caused by Other External Factors
If it is necessary to identify an external factor, an additional code of external causes (class XX) is used.
G21.3 Postencephalitic parkinsonism
G21.8 Other forms of secondary parkinsonism
G21.9 Secondary parkinsonism, unspecified

G22 * Parkinsonism in diseases classified elsewhere

Syphilitic parkinsonism ( A52.1+)

G23 Other degenerative diseases of basal ganglia

Excludes: polysystem degeneration ( G90.3)

G23.0 Hallerworden-Spatz disease. Pigmented pallidary degeneration
G23.1 Progressive supranuclear ophthalmoplegia [Steele-Richardson-Olshevsky]
G23.2 Striatonigral degeneration
G23.8 Other specified degenerative diseases of the basal ganglia. Calcification of the basal ganglia
G23.9 Unspecified basal ganglia degenerative disease

G24 Dystonia

Includes: dyskinesia
Excludes: athetoid cerebral palsy ( G80.3)

G24.0 Dystonia due to drugs. If necessary, identify the medicinal product
use an additional external cause code (class XX).
G24.1 Familial idiopathic dystonia. Idiopathic dystonia NOS
G24.2 Idiopathic nonfamilial dystonia
G24.3 Spastic torticollis
Excludes: torticollis NOS ( M43.6)
G24.4 Idiopathic oral-facial dystonia. Mouth-facial dyskinesia
G24.5 Blepharospasm
G24.8 Other dystonias
G24.9 Dystonia, unspecified. Dyskinesia NOS

G25 Other extrapyramidal and movement disorders

G25.0 Essential tremor. Family tremor
Excludes: tremor NOS ( R25.1)
G25.1 Drug-induced tremor
If it is necessary to identify the medicinal product, use an additional code of external causes (class XX).
G25.2 Other specified forms of tremor. Intentional tremor
G25.3 Myoclonus. Drug-induced myoclonus. If it is necessary to identify the medicinal product, use an additional code of external causes (class XX)
Excluded: facial myokymia ( G51.4)
myoclonic epilepsy ( G40. -)
G25.4 Chorea due to drug
If it is necessary to identify the medicinal product, use an additional code of external causes (class XX).
G25.5 Other types of chorea. Chorea NOS
Excluded: chorea NOS with heart involvement ( I02.0)
chorea of \u200b\u200bHuntington ( G10)
rheumatic chorea ( I02. -)
Sydenchen's chorea ( I02. -)
G25.6 Drug-induced tics and other organic tics
If it is necessary to identify the medicinal product, use an additional code of external causes (class XX).
Excluded: de la Tourette's syndrome ( F95.2)
tick NOS ( F95.9)
G25.8 Other specified extrapyramidal and movement disorders
Restless legs syndrome. Constrained person syndrome
G25.9 Extrapyramidal and movement disorder, unspecified

G26 * Extrapyramidal and movement disorders in diseases classified elsewhere

OTHER DEGENERATIVE DISEASES OF THE NERVOUS SYSTEM (G30-G32)

G30 Alzheimer's disease

Includes: senile and presenile forms
Excluded: senile:
brain degeneration NEC ( G31.1)
dementia NOS ( F03)
senility NOS ( R54)

G30.0 Early Alzheimer's
Note Onset of illness usually occurs in persons under the age of 65
G30.1 Late Alzheimer's
Note Onset of illness usually occurs in persons over the age of 65
G30.8 Other forms of Alzheimer's disease
G30.9 Alzheimer's disease, unspecified

G31 Other degenerative diseases of the nervous system, not elsewhere classified

Excludes: Reye's syndrome ( G93.7)

G31.0 Limited atrophy of the brain. Pick's disease. Progressive isolated aphasia
G31.1 Senile degeneration of the brain, not elsewhere classified
Excludes: Alzheimer's disease ( G30. -)
senility NOS ( R54)
G31.2 Alcohol-induced degeneration of the nervous system
Alcoholic:
cerebellar:
ataxia
degeneration
cerebral degeneration
encephalopathy
Alcohol-induced disorder of the autonomic nervous system
G31.8 Other specified degenerative diseases of the nervous system. Gray matter degeneration [Alpers disease]
Subacute necrotizing encephalopathy [Leig's disease]
G31.9 Unspecified degenerative nervous system disease

G32 * Other degenerative disorders of the nervous system in diseases classified elsewhere

G32.0* Subacute combined degeneration of the spinal cord in diseases classified elsewhere
Subacute combined degeneration of the spinal cord with vitamin deficiency AT 12 (E53.8+)
G32.8* Other specified degenerative disorders of the nervous system in diseases classified elsewhere

DEMYELINIZING DISEASES OF THE CENTRAL NERVOUS SYSTEM (G35-G37)

G35 Multiple sclerosis

Multiple sclerosis:
NOS
brain stem
spinal cord
disseminated
generalized

G36 Another form of acute disseminated demyelination

Excludes: post-infectious encephalitis and encephalomyelitis NOS ( G04.8)

G36.0 Neuromyelitis optic [Devik's disease]. Demyelination with optic neuritis
Excludes: optic neuritis NOS ( H46)
G36.1 Acute and subacute hemorrhagic leukoencephalitis [Harst's disease]
G36.8 Another specified form of acute disseminated demyelination
G36.9 Acute disseminated demyelination, unspecified

G37 Other demyelinating diseases of the central nervous system

G37.0 Diffuse sclerosis. Periaxial encephalitis, Schilder's disease
Excludes: adrenoleukodystrophy [Addison-Schilder] ( E71.3)
G37.1 Central demyelination of the corpus callosum
G37.2 Central pontine myelinolysis
G37.3 Acute transverse myelitis in demyelinating disease of the central nervous system
Acute transverse myelitis NOS
Excluded: multiple sclerosis ( G35)
optic neuromyelitis [Devik's disease] ( G36.0)
G37.4 Subacute necrotizing myelitis
G37.5 Concentric Sclerosis [Balo]
G37.8 Other specified demyelinating diseases of the central nervous system
G37.9 Demyelinating disease of the central nervous system, unspecified

Episodic and Paroxysmal Disorders (G40-G47)

G40 Epilepsy

Excluded: Landau-Kleffner syndrome ( F80.3)
seizure NOS ( R56.8)
status epilepticus ( G41. -)
Todd's palsy ( G83.8)

G40.0 Localized (focal) (partial) idiopathic epilepsy and epileptic syndromes with seizures with focal onset. Benign pediatric epilepsy with peaks on EEG in the central temporal region
Pediatric epilepsy with paroxysmal activity and no EEG in the occipital region
G40.1 Localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with simple partial seizures. Attacks without changes in consciousness. Simple partial seizures with secondary
generalized seizures
G40.2 Localized (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures. Seizures with altered consciousness, often with epileptic automatism
Complex partial seizures leading to secondary generalized seizures
G40.3 Generalized idiopathic epilepsy and epileptic syndromes
Benign (s):
myoclonic epilepsy of early childhood
neonatal seizures (familial)
Childhood epileptic absences [pycnolepsy]. Epilepsy with large seizures on waking
Juvenile:
absence epilepsy
myoclonic epilepsy [impulsive small seizure, petit mal]
Non-specific epileptic seizures:
atonic
clonic
myoclonic
tonic
tonic-clonic
G40.4 Other types of generalized epilepsy and epileptic syndromes
Epilepsy with:
myoclonic absences
myoclonus-astatic seizures

Childhood cramps. Lennox-Gastaut syndrome. Salaam teak. Symptomatic early myoclonic encephalopathy
West syndrome
G40.5 Special epileptic syndromes. Epilepsy, partial, continuous [Kozhevnikova]
Epileptic seizures associated with:
alcohol consumption
use of medicines
hormonal changes
sleep deprivation
exposure to stress factors
If it is necessary to identify the medicinal product, use an additional code of external causes (class XX).
G40.6 Unspecified grand mal seizures (with or without minor seizures)
G40.7 Minor seizures, unspecified without grand mal seizures
G40.8 Other specified forms of epilepsy. Epilepsy and epileptic syndromes not defined as focal or generalized
G40.9 Epilepsy, unspecified
Epileptic:
convulsions NOS
attacks of NOS
seizures NOS

G41 Status epilepticus

G41.0 Status epilepticus grand mal (convulsive seizures). Tonic-clonic status epilepticus
Excludes: epilepsy, partial, continuous [Kozhevnikova] ( G40.5)
G41.1 Epileptic status of petit mal (small seizures). Absence status epilepticus
G41.2 Complex partial status epilepticus
G41.8 Other specified status epilepticus
G41.9 Unspecified status epilepticus

G43 Migraine

Excludes: headache NOS ( R51)

G43.0 Migraine without aura [simple migraine]
G43.1 Migraine with aura [classic migraine]
Migraine:
aura without headache
basilar
equivalents
familial hemiplegic
hemiplegic
from:
an aura in case of acute
long-lasting aura
typical aura
G43.2 Migraine status
G43.3 Complicated migraine
G43.8 Another migraine. Ophthalmoplegic migraine. Retinal migraine
G43.9 Migraine, unspecified

G44 Other headache syndromes

Excludes: atypical facial pain ( G50.1)
headache NOS ( R51)
trigeminal neuralgia ( G50.0)

G44.0 Syndrome of "histamine" headache. Chronic paroxysmal hemicrania.

"Histamine" headache:
chronic
episodic
G44.1 Vascular headache, not elsewhere classified. Vascular headache NOS
G44.2 Tension type headache. Chronic tension headache
Episodic tension headache. Tension headache NOS
G44.3 Chronic post-traumatic headache
G44.4 Drug-induced headache, not elsewhere classified
If it is necessary to identify the medicinal product, use an additional code of external causes (class XX).
G44.8 Other specified headache syndrome

G45 Transient transient cerebral ischemic attacks [attacks] and related syndromes

Excludes: neonatal cerebral ischemia ( P91.0)

G45.0 Vertebrobasilar arterial system syndrome
G45.1 Carotid artery syndrome (hemispheric)
G45.2 Multiple and bilateral cerebral artery syndromes
G45.3 Transient blindness
G45.4 Transient global amnesia
Excludes: amnesia NOS ( R41.3)
G45.8 Other transient cerebral ischemic attacks and associated syndromes
G45.9 Transient cerebral ischemic attack, unspecified. Cerebral artery spasm
Transient cerebral ischemia NOS

G46 * Vascular cerebral syndromes in cerebrovascular diseases ( I60-I67+)

G46.0* Middle cerebral artery syndrome ( I66.0+)
G46.1* Anterior cerebral artery syndrome ( I66.1+)
G46.2* Posterior cerebral artery syndrome ( I66.2+)
G46.3* Stroke syndrome in the brain stem ( I60-I67+)
Syndrome:
Benedict
Claude
Fauville
Miyard-Juble
Wallenberg
Weber
G46.4* Cerebellar stroke syndrome ( I60-I67+)
G46.5* Purely motor lacunar syndrome ( I60-I67+)
G46.6* Purely sensitive lacunar syndrome ( I60-I67+)
G46.7* Other lacunar syndromes ( I60-I67+)
G46.8* Other vascular syndromes of the brain in cerebrovascular diseases ( I60-I67+)

G47 Sleep disorders

Excludes: nightmares ( F51.5)
sleep disorders of non-organic etiology ( F51. -)
night horrors ( F51.4)
sleepwalking ( F51.3)

G47.0 Disturbances in falling asleep and maintaining sleep [insomnia]
G47.1 Disorders in the form of increased sleepiness [hypersomnia]
G47.2 Violations of the cyclicity of sleep and wakefulness. Sleep phase delay syndrome. Disruption of the sleep-wake cycle
G47.3 Sleep apnea
Sleep apnea:
central
obstructive
Excluded: Pickwick syndrome ( E66.2)
sleep apnea in newborns ( P28.3)
G47.4 Narcolepsy and cataplexy
G47.8 Other sleep disorders. Kleine-Levin syndrome
G47.9 Sleep disorder, unspecified