Which doctor is needed with a small meore. Small Chorea in children, symptoms and treatment

The basis of this disease is the rheumatic lesion of the brain vessels. Properly subcortex brain nodes are affected. Chorea You can call the rheumatic rock. Very often, the disease is combined with rheumatic lesions. Children are most often affected, and girls are sick more often.

The beginning is expressed by nonresko. The first symptom is the increase in motor activity (hyperkines): children spill the contents of plates and cups, drop the spoon from the hands, the gait is broken, the handwriting changes (letters become uneven, jumping). The child often makes grimensions, moves it somewhat frosted and unnatural. Usually at this time adults and teachers regard the behavior of the child as a prank and often punish it.

With the development of the process, the hyperkinesis is enhanced, the movements become uncomordinated, nehydramics. In terms of face, the eyebrow is marked, pulling the mouth in one direction, the language twitching is observed. When involving the muscles of the neck, naval, inclined or extensive head movements appear. Gradually, all major muscle groups are involved in the pathological process. The case sometimes comes to the so-called motor storm, depriving the child's ability to move and serve themselves.

With the appearance of the first signs of the disease, it is necessary to apply as soon as possible and survey on. The child is assigned a strict bed mode with additional clocks of sleep (since long-term hypercines tires the child and deprive it). The patient gives soothing drugs. The treatment of chores should be directed primarily on the treatment of the main disease, which caused it (encephalitis, etc.). (E.G. Zhugov)

Additional information from the Big Soviet Encyclopedia

Chorea (From the Greek Chor? Ia - Dance) is the type of hyperkinase, which is manifested by fast climbing limbs, winking, combosions, etc. arises with organic lesions of some subcortex brain departments. The most frequent form of Korea is a small ferret, or Korea Sidenchem, which is usually developing in children and adolescents as one of the manifestations. In addition to hyperkinosis, it is characterized by a decrease in muscle tone, asthenic manifestations (violation, tear, irritability, etc.). Malaya Chorea is usually favorable, but relapses are possible. T.N. Big Korea is hysterical choreiform coupling, observed in the Middle Ages as a mass phenomenon, represents only historical interest.

The so-called Late Korea-Kharai Huntington (was described in 1872 by the American psychiatrist J. S. Huntington) - refers to hereditary-degenerative diseases; It is inherited by autosomal dominant type, it is often manifested at the age of 35-40 years, characterized by a chronic progressive course. Muscle tone is reduced in some cases, in others - elevated (rigid form). The most important feature Hohae Huntington - mental disorders in the form of apathy, reducing memory and intelligence, unstable delusional ideas, hallucinations, etc. Gradually develops deep dementia. Along with the defeat of the subcortex departments at H. Huntington, they are found atrophy of the cerebral cortex.

For the treatment of small chores apply antimorphism (salicylates, etc.), sedatives and (diphrolol, suprastin, etc.) means. At late chorea, aminezine is prescribed, reserpine, and with a rigid form - cholinolitic agents (cyclodol, etc.), L-Dopa, Midtan. (V. A. Karlov)

For more information about Korea, read in the literature:

• Alosov N. N., Khora Huntington, in the book: Multi-volume manual on neurology, vol. 7, L., 1960;
• Zucker M. B., infectious diseases of the nervous system in children, M., 1963;
• Gittik L. S., Mala Chorea, ki? B, 1965.

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Malaya Korea (Chorea Sidengama) is a subsection of rheumatic etiology, which is at the heart of the development of which lies the defeat of the subcortex nodes of the brain. Characteristic symptom The development of pathology in humans is a violation of motor activity. Deals hit predominantly young children. Girls are sick more often than boys. The average duration of the disease is from three to six months.

Views

Classify several stages of the course of the disease:

• latent (hidden). Under the latent stage, Small Korea passes absolutely asymptomatic, which makes it difficult to diagnose;
• incense. At this stage, small chorea proceeds with less pronounced symptoms. But you can already notice the twitching of the facial muscles and twitching the limbs;
• sharp. Under the acute stage, all the symptoms are pronounced pronounced and require immediate treatment;
• recurrent. In this case, after a while, Small Chorea can again hit a person again.

Etiology

The main reason for the development of small chores is the infection of the hemolytic streptococcus group A.

Risk factors for illness:

• genetic predisposition in children;
• (inflammation connective tissue);
• psychological trauma;
• increased excitability of the nervous system;
• complication after respiratory diseases ();
• immunodeficiency;
• caries.

Most often, this ailment is striking children from 6 to 15 years.

Symptoms

At the initial stages of the symptoms of the development of small chores may be less pronounced. They may also be absent with the hidden form of the ailment. The duration of the course of the disease depends on the state of the patient, the characteristics of its body, the severity of pathology and the reasons that the progression of Malaya Korego provoked. It is important at first symptoms of the disease to immediately turn to a highly qualified doctor who can prescribe adequate treatment.

For the illness, the following symptoms are characterized:

• increased body temperature 37-38 (in rare cases);
• violation of coordination of movements;
• coupling the facial muscles (blinking, twisting the corner of the mouth, grimacing);
• spontaneous clogging of legs and hands (nervous ticks);
• cracling shoulders;
• cutting the head;
• insomnia (sleep mode violation);
• breach of the gait (dancing gait);
• violation of the language speech (fuzzy wording of outlined words);
• memory violation;
• irritability;
• increased excitability (nervousness, aggression);
• convulsive seizures;
• constant weakness and drowsiness;
• impairment of hearing and vision;
• difficulty in swallowing.

Diagnostics

The success of subsequent treatment depends on how early alert was detected. Diagnostics includes the following laboratory and instrumental techniques:

• . It is used to find out the exact content of markers. streptococcal infection in organism. This will help not only confirm the diagnosis, but also to identify the cause of its progression. For the appointment of the further treatment plan, this is very important;
• EEG (electroencephalogram) - modern technique assessments of the state of the brain;
• EMG (electromyography);

Treatment

Treatment of this disease includes several stages. First of all, it will be necessary to eliminate all factors that adversely affect mental condition patient. It is in identifying and eliminating the reasons that violate peace. Most often, the irritants are sounds, bright lighting and so on. Patient recommended bedding. Also, doctors prescribe a diet that provides for limited consumption of products with a high carbohydrate content. Children are not recommended physical exercisewhich may complicate the course of the disease. The treatment of Koreo Sidengam is recommended in the hospital's conditions, but at a light course of the disease, the patient may be at home.

The patient must prescribe medication treatment. The therapy uses the following synthetic medicines:

• sedative and tranquilizers are used to normalize the operation of the central nervous system (central nervous system);
• acetylsalicylic acid;
• butadiene;
• dIDEDROL;
• calcium preparations;
• vitamins of group B and multivitamins;
• antibiotics;
• antihistamines;
• in difficult situations for treatment can be applied hormonal drugs (Rarely used to treat children).

Prevention

The prevention of the disease is the timely rehabilitation of the oral cavity and nasopharynx, especially with an angina. It is necessary to diagnose and cure rheumatism in a timely manner (if there is such), since the disease is often developing on its background. It is important to conduct a healthy lifestyle and eat right.

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Diseases with similar symptoms:

The edema of the brain is a dangerous state characterized by excessive accumulation of exudate in the tissues of the organ. As a result, its volume gradually increases and intracranial pressure is growing. All this leads to a violation of blood circulation in the body and to the elimination of its cells.

Syndrome chronic fatigue (COP. SHU) is a state in which mental and physical weakness arises, due to unknown factors and the last half a year. Chronic fatigue syndrome, the symptoms of which are supposed to be somewhat related to infectious diseasesIn addition, it is closely connected with the accelerated pace of life of the population and with the increased information flow, literally converting per person for the subsequent perception.

Chorea It is considered a childhood, which predominantly arises in children aged 5 to 16 years. During it, involuntary increased motor activity occurs.

The disease is neurological, while manifested by rheumatic infection. Psycho-emotional disorders are pronounced in children who are sick.

Pathology is treatable, it should be understood that therapy itself may take a long period of time. If not to take measures in a timely manner, then forecasts for the child will be extremely unfavorable.

Small chorea in children is considered in their essence rheumatic encephalitis. It strikes the brain directly affects the basal ganglia. If the disease arose at an early age, then approximately after 25 years it may be recurrence. That is why people will be forced to adhere to preventive MerSo that you can eliminate the likelihood of a repetition of small chore.

It should be noted that the problem is able to provoke different factors. At the same time, the main of them is progression in the body of infection. The risk group includes children from 5 to 15 years. It is worth noting that during this period the body is weak, therefore, subject to many diseases.

Most often, small chorea is diagnosed with girlsAt the same time, they should have a thin body, as well as too sensitive psyche. In this case, the diseases are susceptible to the boys, so the parents are important to show caution, because it is important to reveal the symptoms of the alend in a timely manner.

You can allocate a number of factors that provoke the appearance of small chores:

• Lack of weight. And asthenicity can be natural, and even in this case, it can lead to the development of pathology.
• The presence of infection caused by streptococci. This may also contribute to the appearance of Malaya Khore.
• Caries, who did not begin to treat in a timely manner. When the appearance of dental diseases, it is important to consult a doctor in time so that you can improve your condition.
• Various psychological factors. Small ferret can be the consequence of such injuries.
• Tangibly low level of the immune system. Parents need to ensure that everything is in order with this indicator. Otherwise, the appearance of rheumatic chorea.
• The presence of hymorite and tonsillitis. Such diseases also need to begin to treat in time, otherwise they can lead to the formation of small chore.
• Increased sensitivity of the central nervous system. A similar feature of a child can lead to the fact that he will have a small ferret.
• Increased tendency to viral diseases. Even if the child is often cold, he still can face rheumatic chorea.
• Progression of respiratory infection. Launch such diseases is dangerous, because they are able to lead to different violations, including involuntary movements.
• Hereditary predisposition. If at least one of the parents suffered from Malaya Khore, then the child can face it.
• Hormonal malfunctions in the body. They can lead to different negative consequences, and one of them is rheumatic ferret.

Regardless of the cause, it will be necessary to begin treatment in order to improve the human well-being. Small chorea requires a long-term treatment, and the earlier the person will start it, it will be better. It is necessary to know the basic symptoms of the disease, to understand what situations need to immediately contact the doctor. You should not wait until the health condition is greatly aggravated, and serious complications will appear.

Symptoms

First, it is worth noting that rheumatic chorea is different types. From this, the symptoms are directly dependent with which a person will face. In particular, the disease is the following forms: latent, undercover, recurrent, as well as acute. In the first situation, symptoms can manifest themselves very weakly or completely absent.

At the same time, the subacute and acute form appears as quickly as possible, so the signs of small chore will be difficult not to notice. As for recurrent type, it is characterized by outbreaks of pathology. At the same time, the child becomes better, then again worse.

It is necessary to consider the symptoms of small chores so that the disease can be in time in a timely manner:

• Involuntary movements, as well as muscle contractions that a child cannot control.
• Tangible lowering mouse tone, weakness.
• Increased activity of the Mimici. With a small chore, the child will often make a grimace.
• Lack of opportunity to stay in one pose.
• Patient is difficult to perform even simple actions with hands.
• Mental and emotional violations. With a small chore, a child can be too aggressive, capricious, and he is often observed with a fall asleep.
• The inability to lock your view at one point.
• During the unrest, a minor will begin to shive himself, soaking or perform other single-type manipulations.
• At the stress of the muscles of the larynx caused by a small chorea, the child can make strange sounds and even wheezing.
• Unexpected speech therapy problems. It may happen that the child will not be able to talk.
• The breach of the gait with a small meore is considered a natural symptom. The child will not be able to move away, it will bounce.
• A sharp increase in body temperature to 38 degrees.

Doctors note that rheumatic chorea can be suspected of basic symptoms. The child will have problems with gait, Mimic will change, as well as handwriting. In this case, it is necessary to consult a doctor, then the doctor will be able to confirm the presence of Korea Sidenham.

Diagnostics

If a child is suspected of rheumatic chorea, then it will be necessary to take diagnosis. For this, doctors prescribe a number of studies with which you can identify deviations. First of all, the patient is directed to magnetic resonance tomography. This study Allows you to understand if the child has a rheumatic chorea. Can also send to computer tomographyWith the help of which the brain analysis is carried out.

With a small chorea, a general blood test is essential, because deviations in the indicator can be detected. Patient can send to electroencephalography to understand whether there are disorders in cerebral activity. All research data allow you to understand whether a person has a man Sidenham.

Be sure the doctor as a whole will analyze the state of the child so that you can confirm or refute the diagnosis. Small chorea in children should be treated only under the control of a specialist so that you can achieve positive results.

Methods of therapy

If Korea Sidengama is in acute formThen it will be necessary to lie down in the hospital. The patient should comply with bed rest, and also be in a relaxed atmosphere. Fast recovery from Malaya Khorie will contribute to the dream, which is why doctors will calm the nervous system.

It is important to limit the physical activity of the patient. Doctors with Korera Sidengama often prescribe a pyramidon, as well as funds, which contains calcium. It is important to the patient to take vitamin complexes so that you can improve your well-being. Neighborhood treatment in rare cases can be carried out pituitary hormones.

If the child is already on the amendment, then it is recommended to knit, draw, sculpt or engaged to paint the shallow motor. At the same time, in the treatment of rheumatic chore, you should walk in the fresh air at least two hours in bitch.

Directly therapeutic procedures are designed improve blood supply to the Golobo Brain, as well as metabolism. Often we need to have an anti-inflammatory effect. To do this, at a small sodore, Sidenchem is often prescribed salted coniferous baths, an UHF of the frontal share, sodium electrophoresis salicylate, ultraviolet irradiation.

If the child was Korea Sidengama, then parents should revise the diet of its nutrition. It is important to add more vitamins, as well as products that contain protein. In particular, cottage cheese, fish, low-fat meat will be useful with rheumatic roaster, and milk.

In order to quickly cure chorea Sidengama, the child will need to receive more positive emotions. It is also necessary to constantly observe the doctor, because it is necessary to closely monitor the patient's condition. In most cases, the treatment of small chorea gives nice resultsIf a long time to exercise beneficial procedures for man.

Malaya Korea (Chorea Minor; Synonym: Korea Sidengama, Infectious Chorea, Rheumatic Chorea).

Etiology. Currently, the rheumatic nature of Malaya Khorea is not in doubt, the disease is considered as the most common and better studied form of rheumatic encephalitis. The development of small chores is often preceded by angina, rheumatic attack with the defeat of the heart, less often joints, but Small Chorea can be the first clinical manifestation of rheumatism.

The development of small chores should be considered as an active current rheumatic process, even if there are no other clinical manifestations (temperature, ROE, heart changes).

Prevalence. Small chorals most often sick children aged 5-15 years old, girls are about 2 times more often than boys. In the 15-25th age, almost exclusively women are solely, and for the most part These are recurrences of the Khorean observed in childhood. It is noted that the small choreas are more often ill, fragile, increased excitable children. In the warm, dry season of the manifestation of small chores are observed much less often than in the cold, rainy months.

Pathological anatomy. Deadly outcomes in rheumatic chores are rarely observed and occur with severe rheumatic destruction of the heart or from random causes. The brain is eaten, marked focal fibrosis with a soft cerebral shell.

Histologically in the brain usually discover the disorganization of the connective tissue of the walls of small vessels and capillaries in the form of a mukoidal swelling, fibrinoid transformation, sclerosis and hyalinose, developing against the background of increased tissue and vascular permeability. With a large duration of the disease in the crust and other brain departments, small scars are found - foci of capillarofibrosis (Fig. 1).

In small vessels and capillaries, endothelium proliferation occurs, endovasculitis, microtromboms are observed. Party features such as dystonia vessels with their apologies, invagination or aneurysmatic vehicle protrusion, hyperemia, stakes, the formation of hyaline thrombus and perivascular edema. About modified vessels develop the focal breakage of the nerve cells with the reproduction of the Glia.

In terms of cases, with rheumatic roasters, there are productive encephalitis with the formation of inflammatory nodules in the brain tissue - nonspecific glyogornul, consisting of lymphoid cells, histiocytes, single neutrophils and glios elements (Fig. 2).

Vascular and inflammatory changes in the roaster are localized in subcortical nodes (striped and tail of bodies, visual bug), in the hypothalamic region, brain legs, middle and oblong brain, but often apply to the bark and other brain departments.

Many authors attach great importance to the dystrophy of small nerve cells of subcortical nodes and the inner grainy layer of the cerebral cortex, in which chromatolysis, caryocytolysis with the formation of shadow cells, hydropic dystrophy, lipofuscin deposition, neuralophagia.

The pronounced hyperplasia of the glial elements is also found: proliferation and hypertrophy of astrocytes, reproduction of dense and drainage cells of oligodendrogelium, significant hyperplasia and microglia dystrophy.

In cases of acute malignant flow rheumatic chorey vascular, inflammatory and dystrophic changes Received most clearly. The micronosis of the brain substance arise, the diapell hemorrhages localized in subcortical nodes and brain trunk, Ameboid forms of astrocytes appear.

With roaster and nephoretic hyperkinosis in children, changes in the nerve fibers in the form of swelling, vaculation and the formation of end flasks (Fig. 3) are attracted special attention (Fig. 3), localized in subcortex nodes, the subtalalamine region, average and oblong brain. Nervous fibers of other brain departments remain unchanged. In the acute course of the disease, a deeper damage to nerve fibers is occurring up to segmental decay. Similar changes in nerve fibers are not found in rheumatism flowing without chore. Apparently, it is the defeat of nerve fibers of certain brain departments that is a morphological substrate of ferret and nephoretic hypercines. Vascular, inflammatory and dystrophic brain changes are nonspecific. They are also observed in rheumatism without a chore and determine the diversity of clinical forms and manifestations of the ferret disease.

On changes in the internal organs with a meore, see rheumatism.

Pathogenesis Malaya Khores is considered from the position modern ideas About rheumatism as a chronic autoamellergic lesion of connective tissue, mainly its interstitial substance, with secondary changes in parenchymal organs. IN nervous system With small roore, its connecting components are also affected - vessels, brain shells, Plexus Chorioideus style. Nervous cells and fibers suffer from the second time. The value in the pathogenesis of small chores is not only morphological changes, but also functional disorders of vascular reactivity and tone of vessels. In many patients with methods of plethysmography (Fig. 4) and oscillography, low tone of peripheral vessels and increased vasomotor lability are revealed. The diffusion of cerebral lesions with a small burner is detected by electroencephalography, and the dependence is noted not from the severity of clinical symptoms of the disease, but from the duration of the disease with rheumatism.

Fig. 4. Picture plethymogram of a sick small chorea. Pronounced wave-like curve. Low vascular tone. Deep reactions in response to cold irritation.

Fur and symptoms. Clinical symptoms of small chores are developing gradually; Most patients with normal temperature and the absence of pronounced blood changes. Increase temperature, high ROE is observed in patients with current rheumloard. Heart changes, most often endocarditis with defeat mitral valve, there are approximately half of the patients with Malaya Chorea. Complex therapy of rheumatism and seasonal prevention (Bicyllin, aspirin) significantly changed clinical forms And the course of rheumatism: much less often there are severe heart lesions, the number of attacks and active forms has decreased.

Small ferret - first clinical manifestation Rheumatism in many children. Changes in the heart, mostly not news, can be found later, sometimes in a few years. In a significant portion of patients with small choirs, the heart changes are expressed only to a small expansion of its boundaries, functional noise at the base, irregular contractions, and all these violations are reversible and can completely stop. Most patients have the lability of vasomotors, positive symptoms of the pinch, harness, positive cannas, which is explained characteristic of rheumatism increased permeability of vessels. The excitability of vasomotors is also raised. Blood without features, sometimes there is a moderate leukocytosis, lymphocytosis, eosinophilia, a slight decrease in the content of hemoglobin and the number of erythrocytes. Roe is normal, sometimes moderately accelerated. There are no changes in the urine.

Diverse CNS lesions with a small burner can be grouped into the following typical triad symptoms: changes in psyche, ferret hypercines and a decrease in muscle tone.

The changes of the psyche refer to the early, the first manifestations of the Khaleva, but correctly evaluate them only when they are pronounced hyperkinesov, because the in itself observed in the nerity-like syndrome ( increased irritability, symptomy, tearfulness, unmotivated mood change, "whims", scattered, forgetfulness, inattention, sometimes not peculiar to patient stubbornness, restless and nonsense sleep with slow falling and easy awakening) inherent in many diseases, especially in children. Affective flashes may arise through the slightest occasion. The episodic states of psychomotor excitation with disorders of consciousness, hallucinations, delusional ideas are described. Psychosensory disorders with a small burner are expressed by a violation of optical-spatial synthesis.

Gradually, motor disorders are joined and enhanced with these phenomena - awkwardness and inaccuracy of movements, motor anxiety, grimacing, hypercines. Changes the handwriting, the letter becomes sloppy, the blots appear, blots, the slip of the letters, the unevenness of them in magnitude. The violent movements are expressed in the muscles of the face, neck, torso, in the proximal and distal departments of hands and legs. Hypercines are gradually growing in intensity and increasingly difficult to perform targeted movements. Not only a letter, but also walking, independent food, even the opportunity to take and keep the subject in hand. The spread of hyperkinesis on the muscles of the larynx causes a violation of speech, which becomes a lubricated, dysartrich, sometimes whispering. The patient relates sometimes might, inseparable sounds. With severe forms, patients are completely stopped talking to say (Khleic Mutism). Hyperkinosis interferes with arbitrarily narrowing the tongue, and if it is possible, it cannot hold it with a dried patient.

Emotional tension, especially unpleasant emotions, sharply enhances hypercines. In the dream, they stop, but it is difficult to fall asleep to the patient, since the hyperkinesis is prevented by him. Symptoms of language and eyelids are characteristic - the inability to keep the tongue with the closed eyes. When inhaling the wall of the abdomen is drawn instead of normal protrusion (symptom of mobile). The difficulty of fixing the gaze leads to permanent movements. eye apples: They "run" in different directions all the time. The severity of violent movements is very different: from extremely sharp ("motor storm" or "mad dance") up to barely notable, detected only with a special study.

Muscular hypotension is also expressed in varying degrees. In cases with a very sharp decline in muscle tone hyperkinosis, there are little expressed and maybe even absent. With the so-called Chorea Mollis - a soft, paralytic chorea - there is a picture of pseudoparasay, when the patient cannot perform active movements due to muscle atony. Hypotension at low meore is due not only to structural changes in the above-mentioned brain departments, but also functional disorders of the oversegmental apparatus, above all downward systems reticular formation Barrel and intermediate brain. If hypercines and muscle hypotension are expressed only in one half of the body, the disease is called hemichorea.

A known correlation between changes in the psyche and focal disorders of the CNS is noted: the condition of the sharp mental excitation is more often observed in patients with roughly pronounced hyperkinases, and general lethargy, apathy, notionlessness - in patients with few pronounced hyperkinosis and noticeable muscle hypotension.

Tender reflexes in patients without rudely pronounced muscle hypotension remain preserved. With cutting muscular atony, tendon reflexes are not caused, although the reflex arc is structurally saved. For small chores are characterized by changes in the knee reflexes: 1) Gordon's symptom: after hitting the hammer on the tendon of the two-chapter muscle, the foot is frozen in a position of extension due to the tonic tension of this muscle; 2) the penduline character of the knee reflex with re-socking the leg with a gradual decrease in the amplitude of the movement.

Sensitive disorders at small chore is not observed. In some patients, pains are expressed in joints, muscles, occasionally in the course of nervous trunks. The function of the sphincters is not violated. Eye bottom normally. In severe cases, the embolia of the central artery of the retina is described.

The spinal fluid is usually not changed. In single observations, a slight increase in liquor pressure and a slight increase in cytosis was noted. Lumbal puncture is not made by most patients with small chorea, since there is no need for the diagnosis in this need, and the increased excitable patients react to the enhancement of hyperkinesov to any causing irritation.

Electricencephalography with a small burner reveals diffuse the insufficiency of alpha rhythm throughout the core, the predominance of irregular slow waves, the presence in some cases of separate spike-like oscillations. In patients with hemichoreans, the EEG changes are expressed in both hemispheres. In case of clinical recovery, the EEG normalization in most patients does not occur. Changes in bioelectric activity of the brain are more pronounced with a significant limitation of disease with rheumatism and during the relapses of Malaya Khore. In cases where Small Chorea is the first manifestation of rheumatism in a child, EEG may be normal.

During the Malaya Khore, periodic strengthening and subsidiaries of neurological symptoms are noted. The most lengthy occurrence with the very slow and gradual development of clinical manifestations at their small severity. The more sharply expressed muscle hypotension, the slower the disease proceeds; Chorea Mollis has a protracted, multi-month course. Molds with relatively rapidly developed hyperkinases are most favorable and quickly stopped and without a sharp reduction in muscle tone.

Approximately half of the patients with small choirs recurrences, the occurrence of recurrence is usually preceded or an aggravation of the rheumatic process. Recurrement most often occurs after 1-2 years. The number of recurrences is different: from one to two to many. With improvement general status, mental disorders are gradually smoothed by a decrease in hyperkinesis, but after recovery, the state of asthenization in people who have suffered a small chorean remains for a long time. With cataneissical examination of such patients, various neurotic disorders are detected: headaches, dizziness, increased fatigue and irritability.

The diagnosis of small chores is made primarily on the basis of the gradual development of hypercines and a reduction in muscle tone in the presence of changes from psyche and vascular disorders. Rheumatism or frequent anchins in history confirm the diagnosis, but it should be remembered that Small Chorea is often the first clinical manifestation of rheumatism.

From other forms of rheumatic encephalitis with hyperkinosis, small chorea is characterized by muscle hypotension and the character of violent movements. From hyperkinesis of neurotic origin, small chores allow to differentiate rheumatic history, heart changes, increased vessel permeability, gradual development without a clear connection with psychogenic factors.

Forecast with a small burner is favorable. Female outcomes are rare and caused by chorea, but a severe heart lesion. Complex therapy and seasonal anthevatic prophylaxis reduce the possibility of relapses of small chores and allow you to more favorably regard the forecast for both heart lesions and with respect to residual neurological phenomena.

Treatment - see below.

Fig. 1. The scar of collagen and reticuline fibers in the cerebral cortex (Impregnation on Sinisarev).
Fig. 2. loose clay nodules in the taper body (coloring on the nissile).
Fig. 3. swelling, vaculation and the formation of end flasks in nerve fibers subcortical nodes (impregnation with silver in Avtsyna).

Also: Korea Sidengama, Malaya Chorea, Saint Witt dance

Version: MedElement disease reference

Rheumatic Chorea without the involvement of the heart (I02.9)

Cardiology

general information

Short description

Rheumatic ferret - This is a syndrome that develops when defeated by Streptococcus Group A Basal Ganglia Gangliya (nervous knot) - cluster of nerve cells
which are located in the deep layers of both cerebral hemispheres, which leads to chaotic and involuntary body movements and limbs.

Rheumatic chorea as a monosindrome of the disease is noted in 5-7% of patients.

Classification

Depending on the picture clinical flow Malaya Khores allocate:

1. Classicalflow option.

2. Atypicalterritory:
- erased, small-axipput, sluggish form of the disease;
- paralytic small chorea;
- Pseudo-systemic Small Chorea.

Types of disease:
- latent (hidden);
- subacute;
- acute;
- recurrent.

Etiology and pathogenesis

Ethiological factor - in-hemolytic streptococcus group A.

The pathogenesis of Malaya Khore is associated with a pathological immune response to streptococcal antigens. At the same time, the production of autoantiboders reacting with antigens of striards Striardine - belonging to a striped body (pair accumulation of a gray substance in the thicker of a large brain hemispheres)
Neurons. The increase in the permeability of the hematostephalic barrier is a necessary condition for the interaction of antibodies with nerve tissue antigens.

With the burner, the process is localized, mainly in subcortical nodes. In particular - in the striped body Striped body (striatum) - pair of gray substance in the thickness of a large brain hemispheres, consisting of tail and lentilicular nuclei, separated by a white substance layer - an inner capsule
(Corpus Pallidum) in the upper legs of the cerebellum, in the red core. Inflammatory changes are detected in other segments of the brain.

Epidemiology

Rheumatic chorea is one of the main symptoms of acute rheumatic fever, which occurs with a frequency of 5 to 36%.
Children aged 5-12-13 years old are sick, predominantly girls. After 20 years, Korea is extremely rare.

Risk factors and groups

Children anemic, with an asthenic constitution and an increased excitability of the nervous system are predisposed to this disease.

Clinical picture

Cymptoms, flow

Clinical symptoms of small chores are developing gradually; In the majority of patients - at normal temperature and the absence of pronounced blood changes.

Characteristic clinical symptoms of small chore

Hyperkinesia.
Different with the following features: nehydramichny, non-sterotype, resemble arbitrary movements, are accomplished with ease, constant. Hypercines are enhanced when performing active movements and during emotional reactions; become weaker in a state of static and mental peace; During sleep, stop.

In a patient, a child in a state of wakefulness, a variety of unnecessary movements are almost constantly observed, which have an involuntary, non-member-righteous, nehydramine. Such violent movements cover muscles torso, limbs, faces, language, neck. As a result, the child cannot sit quietly and moves all the time on the chair: at-rises; bends, turns and straightens the body; changes the position of the limbs; Makes unnecessary movements head, tongue, grimacing.
With pronounced hyperkinases, the sick child can also calmly stand or go. It is in constant movement, as if danating, while not only the legs remain in something, but also other parts of the body.
When patients with small choreans are collected together, their movements make the impression of a kind of ho-level dance, from where the name of the disease occurred ("Chorea" - from Greek. "Dance").

With the roaster there are disorderly hypercines, which can occur in various combinations and sequences. A characteristic picture of such hypercines may look like this: the child crosses his hands on his chest, then can lay them behind his back, hides his hands in his pockets, he holds his shoulders, performs movements in the elbow or shoulder joint, can turn his head to the side or throw back, opens his mouth, Slips the tongue, clicks the tongue, lifts eyebrows, pulls his lips ahead or stretches them into a smile, then can grind eyes, raise eyebrows, etc ..

Although a variety of movements are performed easily, their constant presence is very tired of the child. Therefore, the patient is looking for the opportunity to free themselves from involuntary movements for any time interval: trying to "frozen" in some position, sometimes a child with the weight of his body presses his hands, as if trying to calm them down. However, these actions usually do not give results, and the more attention is paid to the exemption from hyperkinesov, the more severe their severity becomes. With emotional tension or active movements, hypercines are enhanced. At the same time, they stop during sleep and decrease in the establishment of mental and statistical peace.

Violation of active movements
The movements are not coordinated, the patient cannot retain persistent positions, the joint work of muscles of synergists and antagonists is broken, it is upset about ( Exposive speech Exposive speech - a neultie speech, in which on the background of delays, stretching sounds and words, there are peculiar verbal "emissions", characterized by a jump-shaking acceleration, involuntarily forced sound volumes
, Mutism Mutism is the lack of speech communication of the patient with the surrounding confidence of the speech apparatus, the failure of speech
).

Volievable movements are made non-deft and impetuously. The smoothness and accuracy of movements are broken, dysmetry appears, angular, squeezed, disproportionate, non-coordinated movements are observed. The patient is not able to perform some accurate targeted movements (write, combed, fasten buttons, perform a finger-nasal and knee-healing pro-need).
Sick chorea, a child is usually not able to fix a look (can't look at one pre-metr longer than 3-4 seconds), can not keep the tongue outstretched hand or brush ("sympathy of the eye and the language" Filatov).
The inability to maintain persistent positions is also manifested by testing the hand: the patient is asked to shake his hand, while on his part there are several multi-alone institutions.
For active movements of sick choreans, a typical violation of the collaboration of the muscles of antagonists (cannot be made by alternate opposite, rapid movements).
Exist characteristics Horore breathing - in patients sometimes there is a paradoxical movement of the diaphragm and muscles of the front abdominal wall, indicating a violation of the joint work of muscles of synergists (symptom of mobile - when inhaling the diaphragm rises, and abdominal wall drawn).
In some cases, patients with choirs are marked by speech disorders.

Violation of muscular tone

Characteristic manifestations: Tonus and muscle strength reduced, hypotension is observed Hypotension - reduced muscle tone or muscle layer of the hollow organ wall.
and dystonia, the tone varies quickly and unevenly (poses, hypercinesis).
It is possible to determine the hypotension when inspection and palpation of muscles, as well as when testing passive movements.
If you raise the patient choirs a child by the shoulders, then it seems that his head "fails" in the shoulders ("Symptom of the Deck Shoulders").
Hyperflexia (excessive flexion of joints) and hyperextension (excessive extension in the joints) are also manifestations of a reduced muscle tone.

Violation of reflexes

Reflexes are reduced and uneven, there is a positive symptom of Gordon-2 (when the knee reflex is caused, more prolonged than in a healthy, extension of the lower leg).

Change psyche("Neurotic a ferret")
Typical manifestations: reducing the strength and mobility of the main nervous processes - excitation and braking; development of fatigue, lethargy, apathy, scattered and inattention; Possible sleep disorders.

Violation of vegetative reactions - Irritation of both departments, the phase of sympathetic and Vagotonia.

Diagnostics

Tool methodsallowed only non-specific data for rheumatic chore, therefore, they are auxiliary in the diagnosis of the disease.

1. Electromyiography for the study of biopotentials of skeletal muscles. With the burner there is a lengthening of potentialsand asynchrony in their occurrence.

2. Electroencephalogram To identify diffusely slow-bearel bioelectric activity of the brain.
3. Kt., MRI, positron emisy tomography To identify focal changes in the brain.

Laboratory diagnostics

Determination of Streptococcal infection in the body:
- antisteptolysin-o;
- rheumatoid factor;
- cyclic citrulin peptide;
- C-reactive protein.

Differential diagnosis

Kharya Genretton
It may arise at any age, but most often the beginning of the disease falls at the age of 35-42. Characteristic manifestations: ferretic hyperkinesis, personal violations, dementia.
The development of the disease is gradual. Sometimes it is difficult to catch the appearance of the first violent movements, which more often appear in the field of the face and resemble arbitrary motor automates (opening of the mouth, frowning, licking lips, leading the language, etc.).
As the disease progressing, hyperkinesis appears in the hands ("playing on the piano fingers") with its subsequent generalization, a violation of gait and statics.
Jointing further violations of speech (hyperkinetic dysarthria) and swallowing prevent full-fledged nutrition and communication. Patients decrease criticism to their state, the memory (short-term and long-term) is worsening, domestic self-service finds, and development is developing. Deep reflexes are usually revived on their feet, in third cases, clones are identified, typical muscular hypotension.

Benign (imperative) hereditary chorea without dementia
Begins in breast or early childhood. A generalized chorea appears, which is terminated only during sleep. For this disease is characterized by normal intellectual development Patients, as well as an unpressuring current, unlike the juvenile Huntington. In adulthood is a possible decrease in the severity of the ferretic hyperkinosis. The disease is inherited by autosomal dominant type.

Metabolic diseases
Chorea can be caused by a large number of acquired or hereditary metabolic disorders. Often, metabolic disorders in pregnancy (or treatment with estrogens) or thyrotoxicosis perform as the reason for Kharie. The symptoms of the disease are usually fully regressed after the resolution of pregnancy, stopping the taking estrogen or with adequate treatment of thyrotoxicosis.

Pandas syndrome
Unlike rheumatic chorea for this syndrome, the severity of psychiatric aspects is typical (combination obsessive thoughts and obsessive movements), as well as a significantly faster regress of symptoms of the disease against the background of one adequate antiordinate therapy.

C Extent Red Wolf or Other Collagenoses
Khorora can be the initial symptom of these diseases or arise against the background of their deployed clinical picture. Khorora can also act as a remote manifestation malignant neoplasm, arising from antitumor antibodies that can cross-react with striated antigens.

Complications

Heavy flow of rheumatismp ramenly 5-10% of patients causes the development of signs of more diffuse brain involvement with the development of confusion of consciousness, delirium Deliry - mental disorderflowing with a violation of consciousness (from the stattered state to coma)
and sometimes comatose state.
In the literature, it is often possible to find information about the possibility of development in patients with chorea epileptic seizures, edema discs spectator nervesneuropathy card nervesHowever, in recent years, such complications are not observed.

Treatment abroad

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Treatment

From the moment of diagnosis is prescribed treatment with antibiotics for the purpose of eradication of streptococci groups and from the nasopharynx. The drug selection is antibiotics of a penicillin row. Recommended daily doses for children - 400-600 thousand units, adults - 1.5-4 million units. In the intolerance of penicillins, macrolides or lincoosamides are prescribed.

Anti-inflammatory therapy is also carried out using non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticosteroids (GKS).
Used npvp:
- diclofenac or indomethacin in the initial mac-simultal dose of 2-3 mg \\ kg \\ day;
- less often - acetylsalicylic acid at a dose of 0.2 g \\ year of life (but not more than 1.5-2 g \\ day).
The duration of the course of treatment NSAIDs is an average of 2.5-3 months. The first 3-4 weeks of the NSAID are prescribed in the maximum dose, then the dose is reduced by one third and is accepted for 2 weeks, after a dose decreases to half of the maximum and the drug is taken another 1.5 months.

Of GKS.most often used prednisone at a dose of 0.7-0.8 mg \\ kg \\ day. (not more than 1 mg \\ kg \\ day.). The daily dose is 15-25 mg, depending on age and is distributed, taking into account the daily biorhythm.
The duration of the course of treatment is 1.5-2 months. The drug in the full dose is assigned to 10-14 days (before obtaining a clinical effect), then the dose is reduced by 2.5 mg (1 \\ 2 Table) every 5-7 days.
For a while hormone therapy Prescribed preparations of potassium (Panangin, Asparkamka). After hormones, the treatment of NSAIDs (either in combination with them in 1 \\ 2 doses).

With a roaster flowing without other symptoms of acute rheumatic fever, the use of GCS and NSAIDs is recognized practically not effective. In this case, more appropriate purpose psychotropic drugs -neuroleptics (aminazine 0.01 g / day) or tranquilizers from a benzodiazepine group (diazepam 0.006-0.01 g / day). With pronounced hyperkines, a combination of these means with anticonvulsant preparations (carbamazepine is 0.6 g / day).
Electroson, coniferous baths, vitamins B6, B1 are also prescribed. - prevention of recurrence of rheumatic fever by preventing re-streptococcal infection. The greatest effect has a continuous round-wild monthly introduction intramuscularly 1,500,000 units Bicillin-5.

In the absence of rheumatic heart lesions secondary prophylaxis It should be carried out for no less than 5 years.

Information

Sources and literature

1. Belyaeva L.M., Khrustaleva E.K. Cardiovascular diseases in children and teenagers, Minsk, 2003
   1. p.385.
2. Rheumatic diseases / ed. Nonovaya V.A., Bunchuk N.V.- M., Medicine, 1997
   1. p.520.
3. Rheumatology. National Guide / edited by Nononova E.L., Nononova V.A., 2008
   1. p.400-419
4. "Acute rheumatic fever at the turn of the centuries" Belov B. S., " medical Journal", 1999, T7. No. 18., p.694-698
5. "Acute rheumatic fever: the current state of the problem" Belov B.S., Russian Medical Journal, 2004, T.12, No. 6, p. 33-42

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