What better relieves dizziness with RS. Otoneurological disorders in multiple sclerosis
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Vascular diseases of the brain
Vascular diseases of the brain rarely cause symptoms of lightheadedness.However, with vertebrobasilar insufficiency, dizziness can often occur.
If this dizziness is episodic or paroxysmal, it is believed that the patient has a peripheral labyrinth pathology.
Dizziness caused by a decrease in blood pressure in the vessels supplying the vestibular nuclei and nerve fibers in the brain stem. Sudden cases of falling without loss of consciousness are characteristic of basilar insufficiency and are certainly associated with a sudden deterioration in blood flow in the vestibular system.
In patients with vertebrobasilar insufficiency, occlusions of extracranial vessels occur in approximately 50% of cases. It is important to note that about half of patients with vertebral artery stenosis also have carotid artery stenosis.
Subclavian steal syndrome (stenosis or occlusion of the proximal subclavian artery with retrograde blood flow through the vertebral artery) was found in approximately 3% of patients with signs of basilar artery insufficiency.
With vertebrobasilar insufficiency, dizziness is very common. It is only part of the symptom complex that is characteristic of ischemic lesions of the brain stem, and is rarely an isolated symptom.
Dizziness can often be accompanied by vomiting and blurred speech. Hearing loss and ringing in the ears rarely occur with vertebrobasilar insufficiency; this can be of great help when differential diagnosis.
When examining a patient with transient symptoms of dizziness, it is necessary to take into account the factors that predispose to the development of vascular pathology of the brain. Only with the help of arteriography it is possible to finally establish the site of the vessel stenosis. If the diagnosis of stenosis is beyond doubt, arteriography is performed for diagnostic purposes to determine the operability of the identified stenosis.
Multiple sclerosis
Dizziness is the leading symptom of multiple sclerosis in approximately 10% of patients; in almost 1/3 of cases, this symptom occurs during the course of the disease. Sudden pronounced rotational or vertical dizziness may be accompanied by nausea, vomiting, prostration, which suggests the presence of a labyrinthine disease.More often, patients with multiple sclerosis complain of imbalance or dizziness when changing body position.
In patients with multiple sclerosis, nystagmus is almost always found. Horizontal nystagmus is more common, but a significant number of patients also have vertical or rotational nystagmus, which indicates a pathological process in the brain stem.
Bilateral ophthalmoplegia is a practical pathognomonic sign of multiple sclerosis. Its diagnosis is made in cases when the abducens nerve of the eye (III pair) does not function or functions insufficiently, while the adductor nerve of the eye (VI pair) functions normally.
With ENH, gross nystagmus can be detected, probably due to the pathology of the vestibular nuclei. This symptom usually indicates an interruption of the medial longitudinal bundle, which is almost always caused by a demyelinating disease in the case of a bilateral lesion. Asynchronous eye movements, especially with maximal sideways gaze, can also indicate multiple sclerosis.
This disease usually begins between the ages of 20 and 40. Laboratory methods there is no confirmation of the diagnosis of multiple sclerosis, it is made solely on the basis of the clinical picture. When laboratory research only an increase in the level of gamma globulin in the cerebrospinal fluid or an increase in the middle zone of the colloidal gold accumulation curve is detected.
Neurological diseases
Many neurological diseases may manifest as dizziness. Not only neuromas auditory nervebut other intracranial tumors can also cause dizziness; these include neoplasms of the pons and cerebellum, such as meningioma, hemangioma, pia mater cyst.In differential diagnosis, one should not forget about other types of intracranial formations, for example, arteriovenous aneurysms.
Dizziness can also occur with migraines. In typical cases, all migraine attacks are accompanied by an aura, sometimes by scotomas, less often by hemianopsia. Previously described dysarthria, ataxia, paresthesia, diplopia, or visual field disturbance may accompany dizziness.
If dizziness is accompanied by sharp boring pains in the back of the head and vomiting, the diagnosis of migraine is beyond doubt. After falling asleep, the patient usually wakes up healthy, without any signs of residual neurological or otological pathology. More than half of migraine patients have a family history of this disease.
In the presence of pathology in the temporal lobe of the cortex, vestibular epilepsy may occur. Dizziness is the main symptom of a seizure. Temporal lobe lesions include tumors, arteriovenous aneurysms, cerebral microinfarctions, and post-traumatic softening.
Dizziness in these cases can be severe and accompanied by nausea and vomiting. Auditory hallucinations can sometimes be associated with vestibular symptoms. Usually such seizures are accompanied by an aura, and many patients develop large seizures later. In most cases, pathology is found on the electroencephalogram, although a normal EEG cannot exclude the diagnosis of vestibular epilepsy.
Temporomandibular joint neuralgia
Temporomandibular joint neuralgia (Kosten's syndrome) is classically described as lightheadedness, ringing in the ears, and tenderness in the temporomandibular joint. Palpation of the joint reveals significant pain when opening and closing the mouth.Palpation of the oral cavity may reveal a spasm of the pterygoid muscles. The diagnosis is usually made on the basis of the x-ray picture. The therapeutic effect is usually provided by dental measures to correct the occlusion.
Medications
When taking an anamnesis for a patient with dizziness, it is very important to find out what medications he has been taking recently. This important cause of vertigo is often overlooked by doctors. Dizziness is common side effect taking tranquilizers, psychostimulants, muscle relaxants and antihypertensive drugs, and it is not associated with true ototoxicity. Often, when using a particular drug, it is necessary to weigh the likelihood of all its side effects.Hyperventilation
Anxiety attacks causing hyperventilation can be a common cause of dizziness. With a careful history taking, it is fairly easy to identify this factor and differentiate it from other causes of vertigo. In many cases, an initial psychological assessment of the patient's personality is sufficient.In doubtful cases, you can conduct an electronystagmography to the patient, asking him to take several deep breaths in a row. In some cases, this reveals pathology on the ENG.
Other diseases
Orthostatic hypotension can sometimes cause dizziness, although most often it manifests itself in the form of fainting and weakness; blood pressure measurements while sitting, standing and lying down are usually helpful in making the diagnosis. Cataracts can cause dizziness due to decreased visual acuity.Some doctors believe that dysfunction of the thyroid gland and reactive hypoglycemia can cause dizziness, but this opinion is controversial. Diabetic neuropathyin particular, retinopathy, which causes decreased visual acuity, can lead to gait and balance disorders. Sometimes weakness can be caused by cardiac arrhythmias.
Functional vertigo
The diagnosis of functional dizziness is made only by the method of exclusion, when all other causes are rejected and all diagnostic methods have been tried, as well as after examination of the patient by an experienced psychiatrist.When to refer a patient to a specialist consultation
One of the most serious questions for a general practitioner is deciding how much a patient with a certain symptom complex needs a specialist consultation and how urgently. Although all the symptoms described in this chapter can help the doctor in the differential diagnosis, some of them are signs of an extremely serious pathology that require immediate attention to a specialist.If a patient with dizziness has concomitant paralysis of the facial muscles, their weakness, severe headache, diplopia, or ataxia, then he should immediately be referred for further examination and consultation. If the dizziness continues continuously for more than 4 weeks, the patient also needs to consult a specialist. Symptomatic treatment can mask a more serious condition.
Taylor R.B.
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Symptoms and signs of multiple sclerosis in men and women
When multiple sclerosis white matter ( that is, conductive nerve fibers) of almost any part of the central nervous system... Depending on the localization of the lesion, certain symptoms will be observed. General weakness and fatigue
The cause of weakness and increased fatigue on early stages the disease may be the development of an exacerbation stage, while in clinical remission, the patient may feel good.Weakness during an exacerbation of multiple sclerosis is associated with activation immune system, that is, with its increased activity. At the same time, a large number of biologically active substances are released into the systemic circulation, which affect the work of almost all organs and systems. In this case, the cells of the body begin to consume more energy ( even at rest), the patient's heartbeat and respiratory rate increase, the blood pressure in the vessels increases, the body temperature rises, and so on. All organs and systems work "to wear and tear", as a result of which, after a few hours or days, the compensatory capabilities of the body including energy reserves) begin to deplete. At the same time, a person's mood is significantly reduced, he begins to feel weakness, weakness, fatigue. His ability to work is also significantly reduced, in connection with which such a patient is shown bed rest.
After a few days, the symptoms of exacerbation subside ( during treatment it happens a little faster), in connection with which the patient's condition is gradually normalized, and the working capacity is restored.
Muscle weakness
Muscle weakness can occur both in the early stages of the disease ( during periods of exacerbations), and in advanced cases of multiple sclerosis. This is due to dysfunction of the white matter of the central nervous system ( CNS), that is, with defeat nerve fibersthat innervate the muscles.Under normal conditions, motor neurons are responsible for maintaining muscle tone and voluntary muscle contractions ( nerve cells of the so-called pyramidal system). When multiple sclerosis (especially with cerebral and spinal forms, characterized by a predominant lesion of the white matter of the brain and spinal cord) the conducting fibers of the neurons of the pyramidal system may be affected, and therefore the number of nerve impulses arriving at a particular muscle will also decrease. In such conditions, the muscle will not be able to normally ( fully) decrease, and therefore a person will have to make more efforts to perform any actions ( such as climbing stairs, lifting a heavy bag, or even just getting out of bed).
Damage to nerve fibers during an exacerbation of multiple sclerosis is associated with tissue edema that develops against the background of an inflammatory autoimmune process ( when the cells of the immune system attack the myelin sheath of the nerve fiber). This phenomenon is temporary and subsides after a few days or weeks, in connection with which the conduction of impulses along the nerve fibers is normalized, and muscle strength is restored. At the same time, in the later stages of the disease, irreversible damage to nerve fibers occurs, and therefore muscle weakness will persist and even progress ( intensify).
Paresis and paralysis
With multiple sclerosis, paresis and paralysis of various localization and varying degrees of severity can be observed ( in one or both hands, in one or both legs, in the arms and legs at the same time, and so on). This is due to the defeat of various parts of the central nervous system.Paresis is pathological condition, in which there is a weakening of muscle strength and difficulty in performing any voluntary movements. Paralysis is characterized by a complete loss of the ability to contract the affected muscles and move the affected limb. The mechanism of development of these phenomena is also associated with damage to the conducting fibers of the pyramidal pathway neurons. The fact is that with the progressive destruction of the myelin sheaths, there comes a moment when nerve impulses completely cease to be conducted through them. In this case, the muscle fiber, which was previously innervated by the affected neuron, loses its ability to contract. This disrupts muscle strength and accuracy in performing voluntary movements, that is, paresis develops. In this state, the movements in the limbs are partially preserved due to the activity of the remaining ( intact) motor neurons.
When all the neurons that innervate any muscle are affected, it will completely lose its ability to contract, that is, it will be paralyzed. If all the muscles of any limb are paralyzed, the person will lose the ability to perform any arbitrary movements with it, that is, he will develop paralysis.
It is worth noting that paresis of varying severity can be observed during exacerbations of multiple sclerosis, even on initial stages diseases associated with tissue edema and temporary impairment of impulse conduction along nerve fibers. After the inflammation subsides, the conductivity is partially or completely restored, and therefore the paresis disappears. At the same time, in the late stages of multiple sclerosis, paralysis is associated with irreversible destruction of the nerve fibers of the brain and / or spinal cord and is irreversible ( that is, remain with the patient until the end of life).
Spasticity ( spasticity) muscles
Spasticity is a pathological condition of muscles, characterized by an increase in their tone, especially when they are stretched. Spasticity can develop in a number of diseases associated with damage to the nerve cells of the central nervous system, including multiple sclerosis.Skeletal muscle tone is provided by the so-called motor neurons, which are located in the spinal cord. Their activity, in turn, is regulated by neurons in the cerebral cortex. Under normal conditions, neurons in the brain inhibit the activity of neurons in the spinal cord, as a result of which muscle tone is maintained at a strictly defined level. With the defeat of white matter ( conductive fibers) of the neurons of the brain, their depressing effect disappears, as a result of which the neurons of the spinal cord begin to send more nerve impulses to skeletal muscles. At the same time, muscle tone increases significantly.
Since the flexor muscles in humans are more developed than the extensor muscles, the affected limb of the patient will be flexed. If a doctor or other person tries to straighten it, he will experience strong resistance due to the increasing tone of the muscle fibers.
It is worth noting that when the nerve fibers of the spinal cord are damaged, the opposite phenomenon can be observed - the muscle tone will decrease, as a result of which the muscle strength in the affected limb will decrease.
Convulsions
A spasm is a prolonged, severe and extremely painful contraction of a skeletal muscle or muscle group that occurs involuntarily ( not controlled by humans) and can last from a few seconds to several minutes. The cause of seizures in multiple sclerosis can be a violation of the regulation of muscle tone, which occurs against the background of the destruction of the white matter of the spinal cord ( especially with the spinal form of the disease). Another cause may be a developmental metabolic disorder in nerve fibers inflammatory process Around them. In this case, convulsions can be tonic ( when the muscle contracts and does not relax during the entire convulsive period) or clinical, when periods of strong muscle contractions alternate with short periods of muscle relaxation. At the same time, a person may experience severe pain in the muscles associated with impaired oxygen delivery and metabolic disorders in them.Cerebellar disorders ( tremor, impaired coordination of movements and gait, speech disorders)
The cerebellum is a structure of the central nervous system that is part of the brain. One of its main functions is the coordination of almost all purposeful movements, as well as maintaining the human body in balance. To perform its functions correctly, the cerebellum is connected by nerve fibers with a wide variety of parts of the central nervous system ( with the brain, spinal cord).One of the signs of cerebellar damage is tremor. Tremor is a pathological condition of the neuromuscular system in which there is a rapid, rhythmic tremor of the limbs ( arms, legs), head and / or entire body. In multiple sclerosis, the occurrence of tremor is associated with damage to nerve fibers that transmit information to the brain about the position of the body and its parts in space. At the same time, the centers of the brain responsible for specific purposeful movements cannot work normally, as a result of which they send chaotic signals to the muscles, which is the direct cause of pathological tremors ( tremors).
With multiple sclerosis, you may experience:
- Intentional tremor. The essence of the disorder lies in the fact that the tremor appears and intensifies when the patient tries to perform a certain, purposeful movement ( ). Initially ( when the patient begins to reach out to the mug) tremor will be absent, but how closer man will bring the hand closer to the mug, the more intense the shaking of the hand. If the patient stops trying to perform this action, the tremor will disappear again.
- Postural tremor. It occurs when the patient tries to maintain a certain posture ( for example, an outstretched hand in front of you). In this case, after a few seconds, a slight tremor will begin to appear in the hand, which will intensify over time. If the patient drops his arm, the tremor will disappear.
- Gait disorders. During walking, in the legs, arms, back and other parts of the body, there is a simultaneous, synchronous contraction and relaxation of certain muscle groups, which is coordinated by the cells of the cerebellum. If their connections with other parts of the brain are broken, the patient's gait is disturbed ( he begins to walk uncertainly, unevenly, his legs do not obey him, they become "wooden" and so on). In the later stages of the disease, the patient may completely lose the ability to move independently.
- Balance disorders. If the cerebellar functions are impaired, a person cannot stand in one place for a long time, ride a bicycle or perform other similar actions, since the control of the muscles responsible for maintaining balance is impaired.
- Movement coordination disorders ( ataxia, dysmetria). The essence of ataxia is that the person cannot accurately control the arms or legs. So, for example, trying to take a mug from the table, he can pass his hand past it several times, miss. At the same time, with dysmetria, a person's movements become sweeping, voluminous, poorly controlled. When trying to perform any action ( for example, take a mug from the table) a person cannot stop his hand in time, as a result of which the mug can simply be thrown to the floor with a sweeping motion. Both of these symptoms are also due to the fact that the cerebellum does not receive timely ( during) signals about the position of the limbs in space.
- Handwriting disorders ( megalography). With megalography, the patient's handwriting also becomes sweeping, the written letters look large and stretched.
- Chanted speech. The essence of the pathology lies in the fact that during a conversation, the patient makes long pauses between syllables in words, as well as between words in a sentence. At the same time, he kind of puts an emphasis on each syllable in a word and on each word in a sentence.
Numbness of the limbs ( legs and / or arms, face)
Numbness in various parts of the body is one of the first signs of multiple sclerosis, especially in the spinal form of the disease. The fact is that under normal conditions different kinds sensitivity ( to warmth or cold, to touch, to vibration, to pain, and so on) are perceived by peripheral nerve endings located in skin... The nerve impulse formed in them enters the spinal cord, and from it to the brain, where it is perceived by a person as a specific sensation in a certain part of the body.With multiple sclerosis, nerve fibers responsible for conducting sensory nerve impulses can be affected. At the same time, at the beginning, a person may feel paresthesia ( feeling of tingling with needles, "crawling on the skin") in certain parts of the body ( depending on which nerve fibers were involved in the pathological process). In the future, in the zones of paresthesias, sensitivity may partially or completely disappear, that is, the affected part of the body will go numb ( the person will not feel touches or even pricks into the numb skin area).
Numbness can be observed in one, several or all limbs at once, as well as in the abdomen, back, and so on. Also, patients may complain of numbness of the skin of the face, lips, cheeks, neck. During an exacerbation of the disease, this symptom may be temporary ( which is associated with the development of inflammatory reactions and edema of nerve fibers) and disappear after the inflammatory process in the central nervous system subsides, while as multiple sclerosis progresses, sensitivity in certain parts of the body may disappear forever.
Muscle pain ( in the legs, in the arms, in the back)
Muscle pain in multiple sclerosis is relatively rare and can be caused by impaired muscle innervation and muscle atrophy ( decrease muscle mass ). Also, the cause of pain can be damage to the sensitive nerve fibers responsible for the perception of pain in any particular part of the body. In this case, patients may complain of back pain ( mostly in the lumbar region), pain in arms, legs, and so on. Pains can be sharp, stabbing or burning, pulling, sometimes shooting.Another cause of muscle pain can be the development of cramps and spasms ( extremely strong and prolonged muscle contractions). At the same time, metabolism in muscle tissue is disrupted, which is accompanied by the accumulation of metabolic by-products in it and the appearance of aching pains. The same pain can occur in the muscles when they are severely overworked, developing against the background of muscle atrophy.
Headaches and dizziness
Headaches can occur during an exacerbation of multiple sclerosis and subside simultaneously with the transition of the disease to a stage of remission or during treatment. The immediate cause of headaches is cerebral edema, which occurs against the background of the development of an autoimmune inflammatory process. The fact is that during the destruction of the white matter of the brain, the cells of the immune system are also destroyed, releasing many different biologically active substances into the surrounding tissues ( interleukins, histamine, serotonin, tumor necrosis factor and so on). These substances cause expansion blood vessels in the area of \u200b\u200baction, which leads to an increase in the permeability of the vascular walls. As a result, a large amount of fluid from the vascular bed passes into the intercellular space, causing swelling of the brain tissue. At the same time, the volume of the brain increases, as a result of which its membrane is stretched. Since it is rich in sensitive nerve endings, its hyperextension is accompanied by severe pain, which patients feel. In this case, the pain can be acute, pulsating or persistent, localized in the frontal, temporal or occipital regions.Sleep disorders ( insomnia or drowsiness)
These are non-specific symptoms that can appear at various stages of the disease. Sleep disturbances are not directly related to the progression of multiple sclerosis and to white matter damage in the brain or spinal cord. It is assumed that these phenomena may be a consequence of mental stress and psychological experiences associated with the presence of this chronic disease in the patient.Memory impairment and cognitive impairment
Cognitive functions are a person's ability to perceive and remember information, as well as reproduce it at the right time, think, interact with other people through speech, writing, facial expressions, and so on. In other words, cognitive functions determine human behavior in society. The formation and development of these functions occurs in the learning process of a person from his very birth to ripe old age. This is provided by the cells of the central nervous system ( brain), between which a lot of neural connections ( so called synapses).It is assumed that at the later stages of the development of multiple sclerosis, not only the nerve fibers are damaged, but also the neurons themselves ( bodies of nerve cells) in the brain. At the same time, their total number may decrease, as a result of which a person will not be able to perform certain functions and tasks. At the same time, all skills and abilities acquired in the process of life will also be lost ( including memory and ability to memorize new information, thinking, speech, writing, social behavior and so on).
Visual impairment ( retrobulbar optic neuritis, double vision)
Visual impairment may be one of the first or even the only signs of multiple sclerosis that appear many years before the development of other symptoms ( especially with the optical form of the disease). In this case, the cause of visual impairment is inflammatory lesion of the optic nerve ( retrobulbar neuritis), innervating the retina. It is the nerve cells of the retina that perceive the light that a person sees. The particles of light perceived by the retina are converted into nerve impulses, which are transmitted through the nerve fibers of the optic nerve to the brain, where they are perceived by humans as images. With optic neuritis, the destruction of the myelin sheath of the optic nerve fibers is observed, as a result of which the conduction of impulses along them slows down or stops altogether. One of the first clinical manifestations of this will be a decrease in visual acuity, and this symptom appears suddenly, against the background of complete well-being and without any previous disturbances.Other signs of optic neuritis include:
- violation of color perception ( a person will stop distinguishing them);
- pain in the eyes ( especially when moving the eyeballs);
- flashes or spots before the eyes;
- narrowing of visual fields ( the patient sees only what is directly in front of him, while peripheral vision gradually deteriorates).
It is also worth noting that one of the first signs of multiple sclerosis may be double vision ( diplopia). However, this symptom is much less common than optic neuritis.
Nystagmus ( eye twitches)
This is a pathological symptom that occurs as a result of damage to the nerves of the oculomotor muscles and a decrease in visual acuity. Its essence lies in the fact that the patient has frequent, rhythmic twitching of the eyeballs. Nystagmus can be horizontal ( when twitching occurs in a horizontal plane, that is, sideways) or vertical, when twitching occurs in a vertical plane. It is important to note that the patient himself does not notice this.To identify nystagmus, you need to stand in front of the patient, place an object or finger in front of his face, and then slowly move this object to the right, left, up and down. At the same time, the patient should follow the moving object with his eyes without turning his head. If at any point the patient's eyeballs begin to twitch, the symptom is considered positive.
Defeat of the tongue
The tongue itself is not affected in multiple sclerosis. At the same time, damage to the cerebellum, as well as the nerve fibers that provide the sensitivity and motor activity of the tongue, can lead to various speech disorders, up to its complete disappearance.Urinary disorders ( incontinence or urinary retention)
Functions pelvic organs are also controlled by the nervous system of the body, in particular by its autonomic ( autonomous) a department that maintains the tone of the bladder, as well as its reflex emptying when filling. At the same time, the sphincter of the bladder is innervated by the central nervous system and is responsible for its deliberate emptying. If the nerve fibers of any part of the nervous system are damaged, there may be a violation of the urination process, that is, urinary incontinence or, conversely, its delay and the inability to empty the bladder on its own.It is worth noting that such problems can be observed with damage to the nerves that innervate the intestines, that is, the patient may have diarrhea or prolonged constipation.
Decreased potency ( sex and multiple sclerosis)
Potency ( ability to have intercourse) is also controlled by various parts of the central and autonomic nervous system. Their defeat may be accompanied by a decrease in sex drive ( in both men and women), dysfunction of the penis, dysfunctions of the ejaculation process during intercourse, and so on.The effect of multiple sclerosis on the psyche ( depression, mental disorders)
With the progression of multiple sclerosis, certain mental disorders... This is due to the fact that the areas of the brain responsible for the mental and emotional state of a person are also closely connected with other parts of the central nervous system. Consequently, dysfunction of the central nervous system can affect the psychoemotional state of the patient.Patients with multiple sclerosis may experience:
- Depression - a long-term and persistent decline in mood, accompanied by indifference to the outside world, low self-esteem, and a decrease in working capacity.
- Euphoria - an inexplicable state of mental comfort, satisfaction, in no way connected with real events.
- Syndrome chronic fatigue - a pathological condition in which a person feels tired and tired throughout the day ( including immediately after waking up), even if it does absolutely no work.
- Violent laugh / cry - these symptoms are very rare and only in advanced cases of the disease.
- Hallucinations - a person sees, hears or feels something that does not exist in reality ( this symptom is also extremely rare and usually in the acute onset of multiple sclerosis).
- Emotional lability - the patient has mental instability, vulnerability, tearfulness, which can be replaced by increased irritability and even aggressiveness.
Does multiple sclerosis have high fever?
With multiple sclerosis, a slight ( up to 37 - 37.5 degrees), less often - pronounced ( up to 38 - 39 degrees) increased body temperature. This may be due to an autoimmune inflammatory process, during which cells of the immune system attack the myelin sheath of nerve fibers. In this case, immunocompetent cells are destroyed, releasing biologically active substances into the environment. These substances, as well as cellular debris, can stimulate the center of thermoregulation in the brain, which is accompanied by increased heat production and an increase in body temperature.It is worth noting that an increase in body temperature can be caused not only by the autoimmune process itself, but also by other factors. So, for example, a viral or bacterial infection can be the root cause of an exacerbation of multiple sclerosis, while an increase in temperature will be due to the body's response to the invasion of a foreign agent. At the same time, after the exacerbation of the disease subsides, as well as during the stage of clinical remission, the patient's body temperature remains normal.
How does the exacerbation proceed ( attack) multiple sclerosis?
In the vast majority of cases, the disease has an acute onset, which is provoked by the influence of various factors ( for example, a viral or bacterial infection).The first signs of an exacerbation of multiple sclerosis may be:
- deterioration in general well-being;
- general weakness;
- increased fatigue;
- headaches;
- muscle pain;
- increased body temperature;
- chills ( shivering throughout the body, accompanied by a feeling of cold);
- paresthesia ( feeling of showing or crawling in various parts of the body) etc.
After a few days, the signs of the inflammatory process subside, general state the patient is normalized, and signs of damage to the central nervous system disappear ( after the first attack, they usually go away completely and without a trace, while with repeated exacerbations, disturbances in sensitivity, motor activity and other symptoms may partially persist).
It should be noted that sometimes the disease begins with a subacute form. In this case, the body temperature may rise slightly ( up to 37 - 37.5 degrees), and the general signs of the inflammatory process will be mild. Symptoms of damage to individual nerve fibers may appear in 3 - 5 days, but they will also disappear without a trace after a certain period of time.
Can nausea occur in multiple sclerosis?
Nausea is not characteristic feature disease, although its appearance may be associated with the peculiarities of the course or treatment of pathology.Nausea in multiple sclerosis can be caused by:
- violation of the digestive function;
- improper nutrition;
- taking certain medications ( for the treatment of the underlying disease);
- depression ( in which the motility of the gastrointestinal tract is disturbed, which is accompanied by stagnation of food in the stomach).
Why do people lose weight with multiple sclerosis?
Weight loss is a characteristic, however, nonspecific symptom observed in the later stages of the disease. The main reason for this can be considered a violation of the patient's motor activity, which is accompanied by a decrease in muscle mass. Other reasons include improper diet, long periods of fasting ( for example, if the patient cannot serve himself or herself, and there is no one to bring him food), frequent exacerbations of the disease or the primary progressive course of multiple sclerosis ( the development of the inflammatory process is accompanied by the depletion of the body's energy reserves and a decrease in body weight).Features of multiple sclerosis in children and adolescents
The first signs of the disease in children and adolescents practically do not differ from those in an adult. At the same time, it should be noted that the primary progressive form of multiple sclerosis is extremely rare in children ( one of the most difficult). In most cases, the disease is remitting in nature ( with alternating periods of exacerbations and clinical remissions), and severe complications are also relatively rare. The main problems of children and adolescents with multiple sclerosis are mental and emotional disorders ( frequent depression, chronic fatigue syndrome, increased fatigue, and so on).The development of the disease ( and its transition to the stage of secondary progression) is observed, on average, 25-30 years after the diagnosis was made, after which the course of multiple sclerosis does not differ from that in older patients.
Before use, you must consult with a specialist.SMOLENSK MEDICAL ALMANAC No. 1 (1)
diabetes - in 16 (40%), stress was noted - in 7 (17.5%) and smoking - in 6 (15%). Before admission to the SOCB 11 (27.5%) patients received continuous therapy to correct concomitant chronic diseases, 29 people (72.5%) did not take medications. The largest percentage of cases of nosocomial strokes in a hospital were in the departments: emergency cardiology - 9 people (22.5%), endocrinology - 8 (20%), adult neurological - 5 (12.5%). Patients who had a stroke for the first time - 24 (60%), a secondary stroke - 16 (40%). The overall mortality of all strokes was 25%, the mortality of nosocomial infections was 30%.
Findings. Nosocomial stroke is a common pathology. Patients with nosocomial infections, as a rule, women, with arterial hypertension, aged 70 and older, with a history of stroke. On the one hand, nosocomial infections in these patients can potentially be diagnosed faster, which can contribute to a faster start of treatment, but at the moment in patients who have suffered a stroke during hospitalization, the prognosis is much worse, most likely due to the underlying underlying disease. the period of its exacerbation. Therefore, it is necessary to further improve the prevention of the underlying disease, both primary and secondary, including the components of antihypertensive, antithrombotic, lipid-lowering therapy.
Dizziness in multiple sclerosis
V.A. Novikova, E.A. Kovaleva Scientific adviser - prof. N.N. Maslova
Smolensk State Medical University Department of Neurology and Neurosurgery
Goal. To study the clinical and psychological characteristics of patients with multiple sclerosis with complaints of dizziness, to determine the severity of dizziness. Materials and methods. We examined 23 patients (21 women and 2 men) with a diagnosis of multiple sclerosis. Clinical method research included neurological examination with an emphasis on conducting coordination tests. Psychological examination was carried out using the scale of self-assessment and assessment of anxiety by C. Spielberger and L. Khanin and the Beck depression questionnaire. The severity of vertigo was assessed using the Dizziness Handicap Inventory scale for vertigo. Results. Complaints of unsteadiness while walking were presented by 95.7% of the surveyed, complaints of dizziness - 82.6%. According to the results of testing on the Dizziness Handicap Inventory scale, 34.8% of patients noted that a typical episode of dizziness was severe, 8.7% had mild episodes of dizziness, and 30.5% experienced moderate dizziness. When performing coordination tests in 22 patients, coordination disorders of one degree or another were revealed. When assessing the test results on the scales of C. Spielberger and L. Khanin high level reactive anxiety was found in 17 patients (74%), in 5 (21.7%) - moderate anxiety and in 1 (4.3%) - low anxiety. High personal anxiety was found in 18 patients (78.3%), in 5 (21.7%) - moderate anxiety. When using the Beck questionnaire, 4 patients (17.4%) had mild depression, 3 (13.0%) had moderate depression, 8 (34.8%) had moderate and 1 (4.3%) had severe.
Findings. Vestibulo-atactic disorders were found in the majority of patients with multiple sclerosis (95.7%). Almost 44% of patients noted that a typical attack of dizziness during an exacerbation is so pronounced that it significantly limits the daily activity of patients and reduces the quality of life. The use of the scales of Ch. Spielberger and L. Khanin made it possible to quickly conduct a quantitative assessment of the severity of anxiety disorders: a high and moderate level of reactive anxiety was detected in 95.7% of patients, in 100%, a high and moderate personal