Neurosonography (NSG) is a term applied to the study of the brain of a young child: a newborn and an infant until the fontanel closes using ultrasound.

Neurosonography, or ultrasound of the child’s brain, can be prescribed by a pediatrician at the maternity hospital or a neurologist at a children’s clinic in the 1st month of life as part of screening. In the future, according to indications, it is carried out on the 3rd month, on the 6th month and until the fontanelle closes.

As a procedure, neurosonography (ultrasound) is one of the safest research methods, however, it should be carried out strictly as prescribed by the doctor, because Ultrasonic waves can have a thermal effect on body tissue.

At the moment, no negative consequences from the neurosonography procedure have been identified in children. The examination itself does not take much time and lasts up to 10 minutes, and it is completely painless. Timely neurosonography can save the health and sometimes even the life of a child.

Indications for neurosonography

The reasons for requiring ultrasound scanning in the maternity hospital are varied. The main ones are:

• fetal hypoxia;
• asphyxia of newborns;
• difficult labor (accelerated/protracted, with the use of obstetric aids);
• intrauterine fetal infection;
• birth injuries of newborns;
• infectious diseases of the mother during pregnancy;
• Rhesus conflict;
• C-section;
• examination of premature newborns;
• detection of fetal pathology on ultrasound during pregnancy;
• less than 7 points on the Apgar scale in the delivery room;
• retraction/protrusion of the fontanelle in newborns;
• suspicion of chromosomal pathologies (according to a screening study during pregnancy).

The birth of a child by cesarean section, despite its prevalence, is quite traumatic for the baby. Therefore, children with such a history are required to undergo NSG for early diagnosis of possible pathology

Indications for ultrasound examination within a month:

• suspicion of ICP;
• congenital Apert syndrome;
• with epileptiform activity (NSH is an additional method for diagnosing the head);
• signs of strabismus and diagnosis of cerebral palsy;
• head circumference is not normal (symptoms of hydrocephalus/dropsy);
• hyperactivity syndrome;
• injuries to the child's head;
• delay in the development of the infant's psychomotor skills;
• sepsis;
• cerebral ischemia;
• infectious diseases (meningitis, encephalitis, etc.);
• rickety shape of the body and head;
• CNS disorders due to a viral infection;
• suspicion of neoplasms (cyst, tumor);
• genetic developmental abnormalities;
• monitoring the condition of premature babies, etc.

In addition to the main causes, which are serious pathological conditions, NSG is prescribed when a child’s fever lasts for more than a month and has no obvious cause

Preparation and method of conducting the study

Neurosonography does not require preliminary preparation. The baby should not be hungry or thirsty. If the baby has fallen asleep, there is no need to wake him up; this is even welcome: it is easier to ensure that the head remains still. The results of neurosonography are issued 1-2 minutes after the completion of the ultrasound.

You can take baby milk and a diaper with you to place your newborn baby on the couch. Before the NSG procedure, there is no need to apply creams or ointments to the fontanel area, even if there are indications for this. This worsens the contact of the sensor with the skin and also negatively affects the visualization of the organ being studied.

The procedure is no different from any ultrasound. A newborn or infant is placed on a couch, the place where the skin comes into contact with the sensor is lubricated with a special gel substance, after which the doctor performs neurosonorgraphy.

Access to brain structures with ultrasound is possible through the large fontanel, thin temple bone, antero- and posterolateral fontanelles, as well as the foramen magnum. In a child born at term, the small lateral fontanelles are closed, but the bone is thin and permeable to ultrasound. Interpretation of neurosonography data is carried out by a qualified physician.

Normal NSG results and interpretation

Interpretation of diagnostic results consists of describing certain structures, their symmetry and echogenicity of tissues. Normally, in a child of any age, the brain structures should be symmetrical, homogeneous, and have appropriate echogenicity. In the neurosonography transcript, the doctor describes:

• symmetry of brain structures - symmetrical/asymmetrical;
• visualization of grooves and convolutions (must be clearly visualized);
• condition, shape and location of the cerebellar structures (tentory);
• condition of the medullary falx (thin hyperechoic stripe);
• presence/absence of fluid in the interhemispheric fissure (fluid should be absent);
• homogeneity/heterogeneity and symmetry/asymmetry of the ventricles;
• condition of the cerebellar tentorium (tent);
• absence/presence of formations (cyst, tumor, developmental anomaly, change in the structure of the brain matter, hematoma, fluid, etc.);
• the state of the vascular bundles (normally they are hyperechoic).

Table with standards for neurosonography indicators from 0 to 3 months:

Options	Norms for newborns	Norms at 3 months
Lateral ventricles of the brain	Anterior horns – 2-4 mm. Occipital horns – 10-15 mm. Body – up to 4 mm.	Anterior horns – up to 4 mm. Occipital horns – up to 15 mm. Body – 2-4 mm.
III ventricle	3-5 mm.	Up to 5 mm.
IV ventricle	Up to 4 mm.	Up to 4 mm.
Interhemispheric fissure	3-4 mm.	3-4 mm.
Large tank	Up to 10 mm.	Up to 6 mm.
Subarachnoid space	Up to 3 mm.	Up to 3 mm.

The structures should not contain inclusions (cyst, tumor, fluid), ischemic foci, hematomas, developmental anomalies, etc. The transcript also contains the dimensions of the described brain structures. At the age of 3 months, the doctor pays more attention to describing those indicators that should normally change.

Pathologies detected using neurosonography

Based on the results of neurosonography, a specialist can identify possible developmental disorders of the baby, as well as pathological processes: neoplasms, hematomas, cysts:

1. Choroid plexus cyst (does not require intervention, asymptomatic), usually there are several of them. These are small bubble formations containing liquid - liquor. Self-dissolving.
2. Subependymal cysts. Formations whose contents are liquid. They occur as a result of hemorrhage and can occur pre- and postpartum. Such cysts require observation and, possibly, treatment, since they can increase in size (due to failure to eliminate the causes that caused them, which may be hemorrhage or ischemia).
3. Arachnoid cyst (arachnoid membrane). They require treatment, observation by a neurologist and control. They can be located anywhere in the arachnoid membrane, can grow, and are cavities containing liquid. Self-resorption does not occur.
4. Hydrocephalus/dropsy of the brain is a lesion that results in dilatation of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, observation, and control of the NSG over the course of the disease.
5. Ischemic lesions also require mandatory therapy and dynamic control studies using NSG.
6. Hematomas of brain tissue, hemorrhages into the ventricular space. Diagnosed in premature babies. In full-term infants, this is an alarming symptom and requires mandatory treatment, monitoring and observation.
7. Hypertension syndrome is, in fact, an increase in intracranial pressure. It is a very alarming sign of a significant shift in the position of any hemisphere, both in premature and full-term babies. This occurs under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome is associated with an excess amount of accumulated fluid (CSF) in the brain space.

If any pathology is detected by ultrasound, you should contact special centers. This will help you get qualified advice, make a correct diagnosis and prescribe the correct treatment regimen for your child.

However, looking at the sheet describing the ultrasound results, you involuntarily get scared, seeing a lot of unfamiliar words and incomprehensible numbers standing next to each other. What do they mean? The answer can be given by a competent specialist when deciphering the results, as well as a neurologist. One of the indicators that may be alarming is the widening of the interhemispheric fissure in an infant. How dangerous is this condition and whether it needs to be treated somehow - let's figure it out.

About the gap between the hemispheres

There is a gap between the hemispheres of the brain, the anatomical dimensions of which on average are up to 3 mm. But in some of the children it may be greater - then in most cases they talk about the anatomical features of development.

Of course, if the interhemispheric fissure is widened and also filled with fluid, this may indicate the development of diseases such as rickets, intracranial pressure, and hydrocephalus. But the diagnosis is never made on the basis of neurosonography results alone. The clinical picture as a whole is taken into account.

The doctor may ask the following questions:

• how the child sleeps, how many hours a day, at what intervals he wakes up;
• how often does the baby spit up?
• how restless his behavior is, whether there are causeless tantrums lasting more than 5 minutes;
• does the baby react to changes in atmospheric pressure, does sharp sounds scare him, how are things going with his reflexes;
• Does the baby have signs of rickets: enlarged fontanel, large forehead, smooth nape (without hairs).

With the help of neurosonography, you can look into the child’s brain, but it is important that the results are correctly interpreted, otherwise the study becomes meaningless

The dimensions of the head circumference are also taken into account (if they persistently increase, there are reasons to suspect the development of hydrocephalus), the condition of the skin (is there a marble pattern), how well do the fontanelles heal, is there strabismus or Graefe’s symptom, when the eyes roll in such a way that the white of the eye is clearly visible .

Reasons for increasing the gap

So, an enlarged gap in a baby, exceeding the so-called norm, can manifest itself as a hereditary feature passed on from parents or close relatives.

It can also occur due to:

• fetal hypoxia during pregnancy;
• accumulation of fluid between the cerebral hemispheres;
• birth injuries, for example, during caesarean section or during childbirth using obstetric aids.

Is it necessary to treat

Often, mild gap enlargements do not require any treatment.

Therapy is not carried out in cases where an increase in the interhemispheric fissure in an infant is the only disturbing factor.

If symptoms accompanying the clinical picture of a disease are identified, various groups of medications can be prescribed.

For example, if there are signs of rickets and the newborn lives in a climate zone where there is little light, additional vitamin D is prescribed.

For symptoms of intracranial pressure, special mild diuretics are prescribed to promote the outflow of fluid from the brain structures. At the same time, Asparkam or Diacarb (potassium preparations) are taken to prevent the development of hypokalemia and hypomagnesemia.

A child’s well-being is one of the most important indicators of his health.

drugs that improve cerebral circulation and a sedative at night. But this is only if there are warning signs indicating neurological disorders.

It is worth noting that “bad sleep” in itself in an infant is treated primarily not with medications, but by normalizing the daily routine. It is very important that you take walks in the fresh air every day, and that the room where the child sleeps is cool and fresh. It is necessary to analyze how calm the atmosphere is in the house: are there frequent quarrels, the habit of listening to music loudly or watching horror films - all this can negatively affect the baby’s psyche.

So, if in the conclusion of an ultrasound of the brain it is noted that the interhemispheric fissure in a child is enlarged, this is just a statement of the fact that it is wider than usual. The diagnosis of a specific disease is made not only on the basis of neurosonography, but also on the basis of specific complaints and real changes in behavior.

Expansion of the interhemispheric fissure in infants

The correct and timely development of all organs in newborns is the key to the health and normal adaptation of the child in the future, therefore, at such a young age, it is important to diagnose all abnormalities in a timely manner and take measures to eliminate them.

In the article you will learn what the diagnosis of “expansion of the interhemispheric fissure” in an infant means and for what reasons this happens.

When examining a newborn’s brain (ultrasound, neurography, tomogram), in addition to identifying other pathologies, doctors look at the size of the interhemispheric fissure. This distance is an anatomical feature of the baby; it is considered normal if less than 3 mm.

In infants, the interhemispheric fissure can be widened for reasons including:

• maternal illness during pregnancy;
• caesarean section during childbirth;
• Fluid accumulates between the hemispheres of the brain.

You should immediately seek advice from a pediatric neurologist if you notice that your baby:

• constantly excited;
• sleeps poorly;
• reacts to sharp sounds by screaming;
• shows anxiety when atmospheric pressure changes.

The expansion of the interhemispheric fissure is only one of the signs of some serious disorders, therefore, when diagnosing, doctors analyze the relationship of this symptom with other clinically pronounced nervous changes. In case of mild expansion of the gap or isolated expansion, treatment is not carried out, since these conditions are safe for the child; in other cases, it must be prescribed.

When fluid accumulates between the hemispheres of the brain, children are prescribed the following medications in combination:

• preparations for removing fluids;
• asparkam, which is a source of K and Mg for the body;
• vitamin D3, in case of vitamin D deficiency.

It is also worth noting that the presence of widening of the interhemispheric fissure in an infant is not a basis for diagnosing intracranial hypertension.

Thus, if your baby has an enlarged interhemispheric fissure, but at the same time he is developing correctly and is healthy, then there is no need to worry and be nervous, the most important thing is to undergo routine examinations with doctors on time.

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Encyclopedia of Ultrasound and MRI

Widening of the interhemispheric fissure in an infant: what to do?

How correctly a child’s organs and their systems are developed at the time of birth determines how he will adapt to life in the future and what his health will be like. It is for this reason that it is important to promptly identify all existing deviations and, if possible, eliminate them.

Interhemispheric fissure in infants: normal indicators, diagnostic methods

The size of the interhemispheric fissure is individual for each baby, but it should not exceed three millimeters.

Among the most accurate diagnostic procedures relating to the brain for children under one year of age is neurosonography. The procedure has been known since the nineties of the last century.

This is the same ultrasound, and the opportunity to examine the intracranial space is made possible by the fontanelles that every baby has. The sensor is lubricated with a special gel that ensures better glide over the baby’s head, and it is applied to these natural holes in the baby.

Ultrasound can detect serious brain pathologies or exclude them, as well as answer the question of why the interhemispheric fissure is enlarged. This study is inexpensive, very simple, does not require special training, but is quite informative. It makes it possible to identify even those disorders that arose in the prenatal period.

Enlargement of the gap between the hemispheres and the subarachnoid space in an infant: causes and consequences

The main reasons for the expansion of the interhemispheric fissure and subarachnoid cavity are:

• mother's illnesses during pregnancy;
• surgical delivery (caesarean section);
• accumulation of fluid between the hemispheres of the brain.

If this gap widens, the baby needs to be monitored: it is important to monitor whether it is expanding even more.

An urgent consultation with a pediatric neurologist is necessary if the child also has:

• sleep is disturbed;
• constant excessive stimulation;
• gets scared and screams from sharp sounds;
• often vomits like a fountain;
• a very serious sign of a disorder in the nervous system of an infant is squint and different pupils;
• excessive increase in head circumference;
• fontanelles protrude and slowly overgrow;
• eyes “roll out” or roll so that the white of the eye is visible;
• there are convulsions and frequent twitching of the chin and limbs;
• nosebleeds;
• marble patterns on the dermis;
• becomes restless to changes in atmospheric pressure.

Strabismus and different pupils in a child, as a sign of widening of the interhemispheric fissure

The expansion of the gap between the hemispheres and the subarachnoid space is not an independent disease, but only a symptom of some neurological pathologies, such as hydrocephalus (increased fluid content in the interventricular space) or intracranial hypertension.

Brain abnormalities, hemorrhages, cysts, and brain tumors may also be detected.

Not all of these diagnoses are dangerous, but children with such symptoms need to be constantly monitored.

A cyst in the brain of an infant is nothing more than a small bubble that is filled with fluid. Such a baby does not need treatment, but the growth of these cysts must be monitored.

Doctors are often concerned about a larger than average head size. But this does not mean that every such child will have a serious pathology. Large head sizes can be due to many reasons. For example, many parameters in our body are associated with heredity. If dad, mom or immediate relatives wear a size 60 hat, then why can’t the child have a head circumference larger than most of his peers.

The subrachnoid space is the cavity between the meninges of the brain and spinal cord. This cavity contains cerebrospinal fluid and cerebrospinal fluid. Normally, it contains about 140 ml of cerebrospinal fluid flowing from the fourth ventricle of the brain through special openings.

The subarachnoid cavity expands parallel to the circumference of the head. At the same time, the fontanelles protrude, and the timing of their overgrowth is delayed. If there is a local expansion of this space, this means that the circulation of the cerebrospinal fluid is impaired.

If such deviations are found in a child with an enlarged interhemispheric fissure, do not immediately panic. Most minor deviations in children mean absolutely nothing, because the child’s brain is actively developing during this period. If the specialist’s conclusions seem doubtful, you should undergo another ultrasound examination in another clinic, where these conclusions will either be confirmed or refuted.

Child neurology is a fairly young science, which is now constantly faced with problems of varying complexity. This is both a lack of high-quality equipment and a lack of well-trained specialists. Despite this, you should not take any doctor’s conclusions with hostility, because this is nothing more than just an opportunity to make sure of the complete health of your child, and, perhaps, to begin the necessary therapy on time.

In order to promptly identify pathology, infants are constantly under the supervision of a local pediatrician. At certain stages of their development, babies under one year of age should be consulted several times by various specialists.

This list also includes a pediatric neurologist who should be visited at one, three, six and twelve months. You should not neglect these consultations, so as not to reproach yourself later. Suspicion of a brain tumor and intracranial hypertension requires immediate hospitalization, serious examination and long-term treatment. Fortunately, most of the suspicions of neurologists most often remain suspicions, but their instructions should not be ignored.

Read more about neurosonography and other methods for diagnosing such pathology

Neurosonography lasts no more than fifteen minutes, and children usually tolerate it well. Some children may sleep through the entire procedure, which does not interfere with its implementation at all. But there are very capricious little ones who cannot be forced to lie still for even a minute; they may be irritated by the sensor, the new environment, or even the doctor conducting the examination. In this case, you need to take a pacifier, a drinking bottle or your favorite toy with you. An ultrasound examination is good because it is not tied to food intake, because it is known that some children cannot be made to endure several hours without eating or drinking.

This study can be done from the first day of life. The data is deciphered by a pediatrician or pediatric neurologist. Only a specialist can connect research data with an existing clinic and make a diagnosis.

If serious abnormalities are detected, sometimes it is necessary to resort to studies such as magnetic resonance imaging and computed tomography. These techniques are expensive and take much more time, so they are performed only after questionable or alarming results of neurosonography.

MRI is by far the most accurate of all known studies. With its help you can see a layer-by-layer image of the required area. But examining infants in this way is very difficult: during the procedure you need to lie still, but how can you require this from a child under one year old? But there are times when this research cannot be done without. If there is a serious need for an MRI, the baby will have to be given anesthesia.

Treatment methods

If the enlargement is slight, no treatment is carried out, but it is still necessary to examine the child periodically. If during diagnostic procedures an accumulation of fluid is detected in the subarachnoid cavity, treatment is prescribed.

Typically the list of prescribed drugs includes:

• substances that help remove excess fluid from the body;
• potassium and magnesium containing drugs;
• B vitamins;
• vitamin D3, if it turns out that the baby’s body lacks it.

If a strong and progressive enlargement of the subarachnoid cavity is detected, then all therapy consists of eliminating the cause that caused this disorder. If intracranial pressure is increased, then medications are prescribed to help reduce it (diuretics). If an infection has led to the pathology, then the small patient is prescribed a course of antibiotic treatment.

If a baby is diagnosed with hydrocephalus without a significant enlargement of the ventricles and the head as a whole, it should be remembered that in four out of five cases, it can compensate itself by the age of two. But you shouldn’t rely too much on this opinion, and if this diagnosis was confirmed by ultrasound in several clinics, then it is better to undergo the necessary treatment.

Hydrocephalus is dangerous because if the head has become greatly enlarged under fluid pressure, its size will not return to normal even after surgical treatment. Vision may also decrease to the point of blindness, the child may be delayed in development, speech and other important body functions may be impaired.

If treatment for this formidable disease is started in time, then its outcome is quite favorable.

Thus, if a child has an enlarged gap between the hemispheres, but develops normally, sleeps peacefully, and is not too restless, most likely there is no reason to worry. But you should not neglect consulting a doctor.

Widened interhemispheric fissure

As the doctor told me, glycine eliminates the side effects of Pantogam. but the child still behaved inappropriately from time to time, his sleep was disturbed, and he became somewhat wild. We didn't finish drinking.

The diagnosis includes hydrocephalus, but the doctor explained that it is just a symptom, we just have atrophy, and the void was filled with fluid ((((

And you also had these (like nods?) Depakine did not suit them, they took Keppra for three weeks there were no cramps, now they have appeared again (((

we simply lost consciousness with blueness, lasted about a minute. many problems go away in children by the age of one year, I really believe that it will pass for us too, and I wish the same for you)))

Has your gap healed?? We have this problem right now:((

Yes, everything went, everything is ok! We wish the same for you too.

don't remember when? Thank you! Doesn't it affect development?

I can’t say for sure the last ultrasound was done at 8-9 months. It was also about 9-10mm, then I lagged behind the child and didn’t worry, it’s developing normally and thank God! This happens to many people, it goes away, the main thing is not to let it grow further!

Olga, hello. Although a lot of time has passed, I wanted to ask: how is your child developing? Are there any consequences of expanding the MPS? We are now 6 months old and have a mpsh of 7.5 mm.

The girls did an ultrasound of the brain last week, my Lala spits up, but not often and not a lot anymore, + she cries in her sleep. Sometimes when she wakes up she gets very scared and shakes. It’s because of my complaints that we get an ultrasound They prescribed it, but in the maternity hospital everything was done perfectly! We now have a 3.2 MSc at 9 months. In the frontal region it is 9.9 x 14.3 mm. SAP 4 mm. in the frontal region. In conclusion: US is a picture of widening of the MS and SAP, more in the anterior sections. Tanakan 40 mg was prescribed. 1/4 t., 2 r -1 month. Phenibut 0.25 1/4 t. 2 rub. -1 month if there is no effect within 2 weeks, Diacarb 0.25 1/4 t. 1 time in the morning, Asparkam 1/4 t., 3 times - 3 days. Who was prescribed these drugs, how does the child tolerate it? although everything is individual, after all... did the treatment help? I'm very worried about the baby

We are also dilated. In a month it was 5 mm. We took diacarb with asparkam. Now we are almost 5 months old, today we had another ultrasound, the result was 5.6 mm, it was larger. They prescribed a course of treatment again.:(((

Ultrasound signs of expansion of the interhemispheric fissure, lateral ventricles of the brain (

Comments

Hello! Yes, we visited 3 neurologists, they all said that there is no panic, and no treatment is required, ttt, the fontanel is normal, just watch for now and that’s all

They told us the same thing.

Well, nothing for now, but is your child restless?

He seems normal, not a brawler and doesn’t really bother us.

Well, thank God, this is the main thing, really..

We were born at 41 weeks, there was no hypoxia during labor... where did all this come from (the head grows proportionally...

All these symptoms disappear by one year. If the child does not lag behind in development, treatment other than massage is not required. Ultrasound monitoring in six months should decrease. Don’t give your child pills unnecessarily; there’s no point in healing him. I hope they gave you a medical advice from vaccinations?

We went to do an ultrasound ourselves, but they didn’t do it for us at the clinic, like they did it at the maternity hospital, now at 3 months. That's why we'll just go to the doctor. And how long should they be given a recusal?

This all passes, but it takes a long time. Therefore, very often there is no point in doing an ultrasound. In theory, they should give a recusal of up to a year, but in reality they don’t, since they have coverage and a bonus. It’s better to write a refusal yourself before a year. When everything goes away, decide on vaccinations.

Damn, we weren’t given this at the maternity hospital (((the doctor recommended doing it because they suspected ICP.. I heard about vaccinations that you really shouldn’t do them.. Thank you!

The youngest has 10 mm dilatation of the lateral ventricles (per year). Moreover, this was an accidental discovery - they did an ultrasound after she ran into a joint - there was a hematoma all over her forehead. Before and after this, I and the doctors had no complaints about the child. So don't panic ahead of time.

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We also had an expansion of the bladder up to 4.5 mm, but we had a lot of things. We were cured and are now healthy. I wish the same for you.

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If left untreated, there will be consequences. I’m telling you this not as a neurologist, but as an ultrasound doctor

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Tell me please! the child is 3.5 months old, the neurologist sent him for neurosonography, the conclusion is very frightening: ventriculomegaly of 1-2 degrees, widening of the interhemispheric fissure, external subarchoidal space (4.5 mm). The neurologist said it was still a cyst. I prescribed diacarb, asparkam and intramuscular injections, the next appointment is only at 6 months, I am very worried, the child spits up, sometimes a lot, and may react to the weather. Tell me, has anyone encountered this, how scary is it and what could be the consequences?

Be sure to go to Karnaukhova. She is a good specialist. We saw her until 7 months, the child was absolutely healthy. In vain they say that she supposedly prescribes expensive treatment for everyone. If the child is healthy, there are no complaints. I came to her with a whole sheet of questions. she explained everything in detail.

Facts and misconceptions of perinatal neurology

Key words: perinatal encephalopathy (PEP) or perinatal damage to the central nervous system (PP CNS), hypertensive-hydrocephalic syndrome (HHS); dilatation of the cerebral ventricles, interhemispheric fissure and subarachnoid spaces, pseudocysts on neurosonography (NSG), muscular dystonia syndrome (MDS), hyperexcitability syndrome, perinatal convulsions.

Turns out. more than 70-80%! Children in their first year of life come for consultation to neurological centers about a non-existent diagnosis - perinatal encephalopathy (PEP):

Child neurology is a relatively new field, but it is already going through difficult times. At the moment, many doctors practicing in the field of infant neurology, as well as parents of infants with any changes in the nervous system and mental sphere, find themselves “between two fires.” On the one hand, the school of “Soviet child neurology” is excessive diagnosis and incorrect assessment of functional and physiological changes in the nervous system of a child in the first year of life, combined with long-outdated recommendations for intensive treatment with a variety of medications. On the other hand, there is often an obvious underestimation of existing psychoneurological symptoms, ignorance of general pediatrics and the fundamentals of medical psychology, some therapeutic nihilism and fear of using the potential of modern drug therapy; and as a result - lost time and missed opportunities. At the same time, unfortunately, a certain (and sometimes significant) “formality” and “automaticity” of modern medical technologies lead, at a minimum, to the development of psychological problems in the child and his family members. The concept of “norm” in neurology at the end of the 20th century was sharply narrowed; now it is intensively and not always justifiably expanding. The truth is probably somewhere in the middle.

According to the perinatal neurology clinic of the NEVRO-MED medical center and other leading medical centers in Moscow (and probably in other places), so far, more than 80%. Children in their first year of life are referred by a pediatrician or neurologist from a district clinic for a consultation about a non-existent diagnosis - perinatal encephalopathy (PEP):

The diagnosis of “perinatal encephalopathy” (PEP) in Soviet child neurology very vaguely characterized almost any dysfunction (and even structure) of the brain in the perinatal period of a child’s life (from about 7 months of intrauterine development of the child and up to 1 month of life after childbirth), arising as a result of pathologies of cerebral blood flow and oxygen deficiency.

Such a diagnosis was usually based on one or more sets of any signs (syndromes) of a probable nervous system disorder, for example, hypertensive-hydrocephalic syndrome (HHS), muscular dystonia syndrome (MDS), hyperexcitability syndrome.

After conducting an appropriate comprehensive examination: clinical examination in combination with analysis of data from additional research methods (ultrasound of the brain - neurosonography) and cerebral circulation (Dopplerography of cerebral vessels), fundus examination and other methods, the percentage of reliable diagnoses of perinatal brain damage (hypoxic, traumatic, toxic-metabolic, infectious) is reduced to 3-4% - this is more than 20 times!

The most bleak thing about these figures is not only the certain reluctance of individual doctors to use the knowledge of modern neurology and conscientious delusion, but also the clearly visible psychological (and not only) comfort in the pursuit of such “overdiagnosis.”

Hypertension-hydrocephalic syndrome (HHS): increased intracranial pressure (ICP) and hydrocephalus

Until now, the diagnosis of “intracranial hypertension” (increased intracranial pressure (ICP)), is one of the most commonly used and “favorite” medical terms among pediatric neurologists and pediatricians, which can explain almost everything! and at any age, complaints from parents.

For example, a child often cries and shudders, sleeps poorly, spits up a lot, eats poorly and gains little weight, eyes widen, walks on tiptoes, his arms and chin tremble, there are convulsions and there is a lag in psycho-speech and motor development: “it’s only his fault - increased intracranial pressure." Isn't that a convenient diagnosis?

Quite often, the main argument for parents is “heavy artillery” - data from instrumental diagnostic methods with mysterious scientific graphs and figures. Methods can be used either completely outdated and uninformative / echoencephalography (ECHO-EG) and rheoencephalography (REG) /, or examinations “from the wrong opera” (EEG), or incorrect, in isolation from clinical manifestations, subjective interpretation of normal variants during neurosonodopplerography or tomography.

Unhappy mothers of such children involuntarily, at the suggestion of doctors (or voluntarily, feeding on their own anxiety and fears), pick up the flag of “intracranial hypertension” and for a long time end up in the system of monitoring and treatment of perinatal encephalopathy.

In fact, intracranial hypertension is a very serious and quite rare neurological and neurosurgical pathology. It accompanies severe neuroinfections and brain injuries, hydrocephalus, cerebrovascular accident, brain tumors, etc.

Hospitalization is mandatory and urgent!!!

Intracranial hypertension (if it really exists) is not difficult for attentive parents to notice: it is characterized by constant or paroxysmal headaches (usually in the morning), nausea and vomiting not associated with food. The child is often lethargic and sad, is constantly capricious, refuses to eat, he always wants to lie down and cuddle with his mother.

A very serious symptom can be strabismus or difference in pupils, and, of course, disturbances of consciousness. In infants, bulging and tension of the fontanelle, divergence of the sutures between the bones of the skull, as well as excessive growth of the head circumference are very suspicious.

Without a doubt, in such cases the child must be shown to specialists as soon as possible. Quite often, one clinical examination is enough to exclude or preliminarily diagnose this pathology. Sometimes additional research methods are required (fundus examination, neurosonodopplerography, computed tomography or magnetic resonance imaging of the brain)

Of course, expansion of the interhemispheric fissure, cerebral ventricles, subarachnoid and other spaces of the cerebrospinal fluid system on neurosonography (NSG) images or brain tomograms (CT or MRI) cannot serve as evidence of intracranial hypertension. The same applies to cerebral blood flow disorders isolated from the clinic, identified by vascular Dopplerography, and “finger impressions” on a skull x-ray

In addition, there is no connection between intracranial hypertension and translucent vessels on the face and scalp, walking on tiptoes, trembling hands and chin, hyperexcitability, developmental disorders, poor academic performance, nosebleeds, tics, stuttering, bad behavior, etc. etc.

That’s why, if your baby has been diagnosed with “PEP, intracranial hypertension”, based on “goggle” eyes (Graefe’s symptom, “setting sun”) and walking on tiptoes, then you shouldn’t go crazy in advance. In fact, these reactions may be characteristic of easily excitable young children. They react very emotionally to everything that surrounds them and what happens. Attentive parents will easily notice these connections.

Thus, when diagnosing PEP and increased intracranial pressure, it is naturally best to contact a specialized neurological clinic. This is the only way to be sure of the correct diagnosis and treatment.

It is absolutely unreasonable to begin treatment of this serious pathology on the recommendations of one doctor based on the above “arguments”; in addition, such unreasonable treatment is not at all safe.

Just look at the diuretic drugs that are prescribed to children for a long time, which has an extremely adverse effect on the growing body, causing metabolic disorders.

There is another, no less important aspect of the problem that must be taken into account in this situation. Sometimes medications are necessary and the wrongful refusal of them, based only on the mother’s (and more often than not the father’s) own conviction that medications are harmful, can lead to serious troubles. In addition, if there really is a serious progressive increase in intracranial pressure and the development of hydrocephalus, then often incorrect drug therapy for intracranial hypertension entails the loss of a favorable moment for surgical intervention (shunt surgery) and the development of severe irreversible consequences for the child: hydrocephalus, developmental disorders, blindness , deafness, etc.

Now a few words about the equally “adored” hydrocephalus and hydrocephalic syndrome. In fact, we are talking about a progressive increase in intracranial and intracerebral spaces filled with cerebrospinal fluid (CSF) due to the existing! at that moment of intracranial hypertension. In this case, neurosonograms (NSG) or tomograms reveal dilations of the ventricles of the brain, interhemispheric fissure and other parts of the cerebrospinal fluid system that change over time. Everything depends on the severity and dynamics of the symptoms, and most importantly, on the correct assessment of the relationships between the increase in intracerebral spaces and other neural changes. This can be easily determined by a qualified neurologist. True hydrocephalus, which does require treatment, like intracranial hypertension, is relatively rare. Such children must be observed by neurologists and neurosurgeons at specialized medical centers.

Unfortunately, in ordinary life such an erroneous “diagnosis” occurs in almost every fourth or fifth baby. It turns out that some doctors often incorrectly call stable (usually slight) enlargement of the ventricles and other cerebrospinal fluid spaces of the brain hydrocephalus (hydrocephalic syndrome). This does not manifest itself in any way through external signs or complaints and does not require treatment. Moreover, if the child is suspected of having hydrocephalus based on a “large” head, translucent vessels on the face and scalp, etc. - this should not cause panic among parents. The large size of the head in this case plays practically no role. However, the dynamics of head circumference growth is very important. In addition, you need to know that among modern children it is not uncommon to have so-called “tadpoles” whose heads are relatively large for their age (macrocephaly). In most of these cases, infants with large heads show signs of rickets, less often - macrocephaly due to the family constitution. For example, dad or mom, or maybe grandpa has a big head, in a word, it’s a family matter and doesn’t require treatment.

Sometimes, when performing neurosonography, an ultrasound doctor finds pseudocysts in the brain - but this is not a reason to panic at all! Pseudocysts are single round tiny formations (cavities) containing cerebrospinal fluid and located in typical areas of the brain. The reasons for their appearance, as a rule, are not reliably known; they usually disappear by 8-12 months. life. It is important to know that the existence of such cysts in most children is not a risk factor for further neuropsychic development and does not require treatment. However, although quite rare, pseudocysts form at the site of subependymal hemorrhages, or are associated with perinatal cerebral ischemia or intrauterine infection. The number, size, structure and location of cysts provide specialists with very important information, taking into account which, based on a clinical examination, final conclusions are formed.

Description of NSG is not a diagnosis! and not necessarily a reason for treatment.

Most often, NSG data provide indirect and uncertain results, and are taken into account only in conjunction with the results of a clinical examination.

Once again, I remind you of the other extreme: in difficult cases, sometimes there is a clear underestimation on the part of parents (less often, doctors) of the child’s problems, which leads to a complete refusal of the necessary dynamic observation and examination, as a result of which the correct diagnosis is made late, and treatment does not lead to the desired result.

Undoubtedly, therefore, if increased intracranial pressure and hydrocephalus are suspected, diagnosis should be carried out at the highest professional level.

What is muscle tone and why is it so “loved”?

Look at your child’s medical record: is there no such diagnosis as “muscular dystonia”, “hypertension” and “hypotension”? - you probably just didn’t go with your baby to the neurologist’s clinic until he was a year old. This is, of course, a joke. However, the diagnosis of “muscular dystonia” is no less common (and perhaps more common) than hydrocephalic syndrome and increased intracranial pressure.

Changes in muscle tone can be, depending on the severity, either a variant of the norm (most often) or a serious neurological problem (this is much less common).

Briefly about external signs of changes in muscle tone.

Muscular hypotonia is characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity may be limited; palpation of the muscles is somewhat reminiscent of “jelly or very soft dough.” Severe muscle hypotonia can significantly affect the rate of motor development (for more details, see the chapter on movement disorders in children of the first year of life).

Muscular dystonia is characterized by a condition where muscle hypotonia alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in individual muscle groups (for example, more in the arms than in the legs, more on the right than on the left, etc.)

At rest, these children may experience some muscle hypotonia during passive movements. When trying to actively perform any movement, during emotional reactions, when the body changes in space, muscle tone increases sharply, pathological tonic reflexes become pronounced. Often, such disorders subsequently lead to improper development of motor skills and orthopedic problems (for example, torticollis, scoliosis).

Muscular hypertension is characterized by increased resistance to passive movements and limitation of spontaneous and voluntary motor activity. Severe muscle hypertension can also significantly affect the rate of motor development.

Violation of muscle tone (muscle tension at rest) can be limited to one limb or one muscle group (obstetric paresis of the arm, traumatic paresis of the leg) - and this is the most noticeable and very alarming sign, forcing parents to immediately consult a neurologist.

It is sometimes quite difficult for even a competent doctor to notice the difference between physiological changes and pathological symptoms in one consultation. The fact is that changes in muscle tone are not only associated with neurological disorders, but also strongly depend on the specific age period and other characteristics of the child’s condition (excited, crying, hungry, drowsy, cold, etc.). Thus, the presence of individual deviations in the characteristics of muscle tone does not always cause concern and require any treatment.

But even if functional disorders of muscle tone are confirmed, there is nothing to worry about. A good neurologist will most likely prescribe massage and physical therapy (exercises on large balls are very effective). Medicines are prescribed extremely rarely.

(syndrome of increased neuro-reflex excitability)

Frequent crying and whims with or without cause, emotional instability and increased sensitivity to external stimuli, sleep and appetite disturbances, excessive frequent regurgitation, motor restlessness and shuddering, trembling of the chin and arms (etc.), often combined with poor growth weight and bowel dysfunction - do you recognize such a child?

All motor, sensitive and emotional reactions to external stimuli in a hyperexcitable child arise intensely and abruptly, and can fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for and grab objects. Typically, children show a keen interest in their surroundings, but increased emotional lability often makes it difficult for them to communicate with others. They are very impressionable, emotional and vulnerable! They fall asleep extremely poorly, only with their mother, they constantly wake up and cry in their sleep. Many of them have a long-term reaction of fear when communicating with unfamiliar adults with active reactions of protest. Typically, hyperexcitability syndrome is combined with increased mental exhaustion.

The presence of such manifestations in a child is just a reason to contact a neurologist, but in no case is it a reason for parental panic, much less drug treatment.

Constant hyperexcitability is not causally specific and can most often be observed in children with temperamental characteristics (for example, the so-called choleric type of reaction).

Much less frequently, hyperexcitability can be associated and explained by perinatal pathology of the central nervous system. In addition, if a child’s behavior is suddenly disrupted unexpectedly and for a long time for virtually no apparent reason, and he or she develops hyperexcitability, the possibility of developing an adaptation disorder reaction (adaptation to external environmental conditions) due to stress cannot be ruled out. And the sooner the child is examined by specialists, the easier and faster it is possible to cope with the problem.

And, finally, most often, transient hyperexcitability is associated with pediatric problems (rickets, digestive disorders and intestinal colic, hernia, teething, etc.).

There are two extremes in the tactics of monitoring such children. Or an “explanation” of hyperexcitability using “intracranial hypertension” and intense drug treatment often using drugs with serious side effects (diacarb, phenobarbital, etc.). Or complete neglect of the problem, which can subsequently lead to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disorders) in the child and his family members, and will require long-term psychological correction.

Of course, it is logical to assume that an adequate approach lies somewhere in between.

Separately, I would like to draw the attention of parents to seizures - one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures do not occur often in infancy, but they are sometimes severe, insidious and disguised, and immediate drug therapy is almost always necessary.

Such attacks can be hidden behind any stereotypical and repetitive episodes in the child’s behavior. Incomprehensible shudders, head nods, involuntary eye movements, “freezing,” “squeezing,” “limping,” especially with a fixed gaze and lack of response to external stimuli, should alert parents and force them to turn to specialists. Otherwise, a late diagnosis and untimely prescribed drug therapy significantly reduce the chances of treatment success.

All circumstances of the seizure episode must be accurately and completely remembered and, if possible, recorded on video for further detailed description at the consultation. If convulsions last a long time or are repeated, call “03” and urgently consult a doctor.

At an early age, the child’s condition is extremely changeable, so developmental deviations and other disorders of the nervous system can sometimes be detected only during long-term dynamic monitoring of the baby, with repeated consultations. For this purpose, specific dates for planned consultations with a pediatric neurologist in the first year of life have been determined: usually at 1, 3, 6 and 12 months. It is during these periods that most serious diseases of the nervous system of children in the first year of life can be detected (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.). Thus, identifying a specific neurological pathology in the early stages of development makes it possible to begin complex therapy on time and achieve the maximum possible result.

And in conclusion, I would like to remind parents: be sensitive and attentive to your kids! First of all, it is your meaningful participation in the lives of children that is the basis for their future well-being. Do not treat them for “supposed illnesses,” but if something worries and concerns you, find the opportunity to get independent advice from a qualified specialist.

An ultrasound showed that the child has an enlarged interhemispheric fissure

Is there any liquor in it? (water)

Liqueur is not water, it's blood! but if it’s water, it’s more dangerous!

%) cerebrospinal fluid is not blood. what are you writing?

Liqueur is not water, it's blood!

Liqueur is not water, it's blood! but if it’s water, it’s more dangerous!

CSF is not blood. what are you writing?

Liquor is a liquid medium circulating in the cavities of the ventricles of the brain, liquor-conducting tracts, and the subarachnoid space of the brain and spinal cord. The total content of cerebrospinal fluid in the body is ml.

the neurologist prescribed diacarb + asparkam 1/4 tablet 2 times a day according to the schedule of 2 days we drink 3 breaks, course 1.5 months

Cavinton 1/4 tablet, course 1 month

The pills are good, it definitely won’t get any worse, there’s definitely only a positive effect. 😉 I would do a course of treatment

The pills are good, it definitely won’t get worse

Dilated ventricles, interhemispheric fissure and other parts of the cerebrospinal fluid system on a neurosonogram (NSG) or tomograms

Sleep and behavior disorders

Hyperactivity, attention deficit, bad habits

Mental, speech and motor development disorders, poor academic performance

- “marble” skin pattern, including on the head

- “finger impressions” on a skull x-ray

Tremor (shaking) of the chin

Walking on tiptoes

Hypokalemia, myasthenia gravis, convulsions, skin hyperemia, paresthesia, tinnitus, loss of appetite, metabolic acidosis, itching. With long-term use - nephrourolithiasis, hematuria, glycosuria, hemolytic anemia, leukopenia, agranulocytosis, disorientation, disturbance of touch, drowsiness, nausea, vomiting, diarrhea, allergic reactions, paresthesia.

Nausea, vomiting, diarrhea, abdominal pain, ulceration of the gastrointestinal mucosa, bleeding from the gastrointestinal tract, flatulence, dry mouth; AV blockade, paradoxical reaction (increased number of extrasystoles), bradycardia, decreased blood pressure; phlebitis, venous thrombosis, dyspnea, skin itching, hyporeflexia, dizziness, paresthesia; myasthenia gravis, asthenia, increased sweating. With rapid intravenous administration - hyperkalemia, hypermagnesemia. Overdose. Symptoms: hyperkalemia (muscle hypotonicity, paresthesia of the extremities, slowing of AV conduction, arrhythmias, cardiac arrest). Early clinical signs of hyperkalemia usually appear when the K+ concentration in the blood serum is more than 6 mEq/L: sharpening of the T wave, disappearance of the U wave, decreased S-T segment, prolongation of the Q-T interval, widening of the QRS complex. More severe symptoms of hyperkalemia - muscle paralysis and cardiac arrest - develop at a K+ concentration of 9-10 mEq/L. Treatment: orally or intravenously - NaCl solution; IV ml of 5% dextrose solution (sIU of insulin per 1 l); if necessary, hemodialysis and peritoneal dialysis.

Decreased blood pressure. Rarely - tachycardia, extrasystole, slowing of intraventricular conduction. With parenteral administration: dizziness, feeling of heat, flushing of the facial skin, nausea, thrombophlebitis at the injection site.

Table of norms for ultrasound of the baby’s brain and interpretation of neurosonography in children

Neurosonography (NSG) is a term applied to the study of the brain of a young child: a newborn and an infant until the fontanel closes using ultrasound.

As a procedure, neurosonography (ultrasound) is one of the safest research methods, however, it should be carried out strictly as prescribed by the doctor, because Ultrasonic waves can have a thermal effect on body tissue.

At the moment, no negative consequences from the neurosonography procedure have been identified in children. The examination itself does not take much time and lasts up to 10 minutes, and it is completely painless. Timely neurosonography can save the health and sometimes even the life of a child.

Indications for neurosonography

The reasons for requiring ultrasound scanning in the maternity hospital are varied. The main ones are:

• fetal hypoxia;
• asphyxia of newborns;
• difficult labor (accelerated/protracted, with the use of obstetric aids);
• intrauterine fetal infection;
• birth injuries of newborns;
• infectious diseases of the mother during pregnancy;
• Rhesus conflict;
• C-section;
• examination of premature newborns;
• detection of fetal pathology on ultrasound during pregnancy;
• less than 7 points on the Apgar scale in the delivery room;
• retraction/protrusion of the fontanelle in newborns;
• suspicion of chromosomal pathologies (according to a screening study during pregnancy).

The birth of a child by cesarean section, despite its prevalence, is quite traumatic for the baby. Therefore, children with such a history are required to undergo NSG for early diagnosis of possible pathology

Indications for ultrasound examination within a month:

• suspicion of ICP;
• congenital Apert syndrome;
• with epileptiform activity (NSH is an additional method for diagnosing the head);
• signs of strabismus and diagnosis of cerebral palsy;
• head circumference is not normal (symptoms of hydrocephalus/dropsy);
• hyperactivity syndrome;
• injuries to the child's head;
• delay in the development of the infant's psychomotor skills;
• sepsis;
• cerebral ischemia;
• infectious diseases (meningitis, encephalitis, etc.);
• rickety shape of the body and head;
• CNS disorders due to a viral infection;
• suspicion of neoplasms (cyst, tumor);
• genetic developmental abnormalities;
• monitoring the condition of premature babies, etc.

In addition to the main causes, which are serious pathological conditions, NSG is prescribed when a child’s fever lasts for more than a month and has no obvious cause

Preparation and method of conducting the study

Neurosonography does not require preliminary preparation. The baby should not be hungry or thirsty. If the baby has fallen asleep, there is no need to wake him up; this is even welcome: it is easier to ensure that the head remains still. The results of neurosonography are issued 1-2 minutes after the completion of the ultrasound.

You can take baby milk and a diaper with you to place your newborn baby on the couch. Before the NSG procedure, there is no need to apply creams or ointments to the fontanel area, even if there are indications for this. This worsens the contact of the sensor with the skin and also negatively affects the visualization of the organ being studied.

The procedure is no different from any ultrasound. A newborn or infant is placed on a couch, the place where the skin comes into contact with the sensor is lubricated with a special gel substance, after which the doctor performs neurosonorgraphy.

Normal NSG results and interpretation

Interpretation of diagnostic results consists of describing certain structures, their symmetry and echogenicity of tissues. Normally, in a child of any age, the brain structures should be symmetrical, homogeneous, and have appropriate echogenicity. In the neurosonography transcript, the doctor describes:

• symmetry of brain structures - symmetrical/asymmetrical;
• visualization of grooves and convolutions (must be clearly visualized);
• condition, shape and location of the cerebellar structures (tentory);
• condition of the medullary falx (thin hyperechoic stripe);
• presence/absence of fluid in the interhemispheric fissure (fluid should be absent);
• homogeneity/heterogeneity and symmetry/asymmetry of the ventricles;
• condition of the cerebellar tentorium (tent);
• absence/presence of formations (cyst, tumor, developmental anomaly, change in the structure of the brain matter, hematoma, fluid, etc.);
• the state of the vascular bundles (normally they are hyperechoic).

Table with standards for neurosonography indicators from 0 to 3 months:

Occipital horns – mm.

Occipital horns – up to 15 mm.

The structures should not contain inclusions (cyst, tumor, fluid), ischemic foci, hematomas, developmental anomalies, etc. The transcript also contains the dimensions of the described brain structures. At the age of 3 months, the doctor pays more attention to describing those indicators that should normally change.

Pathologies detected using neurosonography

Based on the results of neurosonography, a specialist can identify possible developmental disorders of the baby, as well as pathological processes: neoplasms, hematomas, cysts:

1. Choroid plexus cyst (does not require intervention, asymptomatic), usually there are several of them. These are small bubble formations containing liquid - liquor. Self-dissolving.
2. Subependymal cysts. Formations whose contents are liquid. They occur as a result of hemorrhage and can occur pre- and postpartum. Such cysts require observation and, possibly, treatment, since they can increase in size (due to failure to eliminate the causes that caused them, which may be hemorrhage or ischemia).
3. Arachnoid cyst (arachnoid membrane). They require treatment, observation by a neurologist and control. They can be located anywhere in the arachnoid membrane, can grow, and are cavities containing liquid. Self-resorption does not occur.
4. Hydrocephalus/dropsy of the brain is a lesion that results in dilatation of the ventricles of the brain, as a result of which fluid accumulates in them. This condition requires treatment, observation, and control of the NSG over the course of the disease.
5. Ischemic lesions also require mandatory therapy and dynamic control studies using NSG.
6. Hematomas of brain tissue, hemorrhages into the ventricular space. Diagnosed in premature babies. In full-term infants, this is an alarming symptom and requires mandatory treatment, monitoring and observation.
7. Hypertension syndrome is, in fact, an increase in intracranial pressure. It is a very alarming sign of a significant shift in the position of any hemisphere, both in premature and full-term babies. This occurs under the influence of foreign formations - cysts, tumors, hematomas. However, in most cases, this syndrome is associated with an excess amount of accumulated fluid (CSF) in the brain space.

If any pathology is detected by ultrasound, you should contact special centers. This will help you get qualified advice, make a correct diagnosis and prescribe the correct treatment regimen for your child.

Post date: 06.12.2011 11:40

vetch

Hello! Please tell me what these data indicate. Subarachnoid space 2mm. interhemispheric fissure 6mm. Ventricular system, all parameters 3mm. The tank in the sagittal plane is 2.6 mm. Dopplerography: PMA RI 0/54? OA-RI 0.52. Vein of Galena speed 12 cm per second.
Is it worth taking asparkam if you have vitamin D deficiency? THANK YOU IN ADVANCE!

Post date: 06.12.2011 21:29

Papkina E.F.

Vika, expansion of the interhemispheric fissure is a sign of fluid accumulation between the hemispheres of the brain. In such cases, diacarb is usually prescribed to drain excess fluid along with asparkam to prevent the excretion of potassium and magnesium salts, which it contains.
If there is a lack of vitamin D, vitamin D3 or other drugs (Vigontol, fish oil) are prescribed, but asparkam is not needed in this case.

Post date: 12.03.2012 16:42

Guest

Hello! Please explain, we were diagnosed with mild dilactation of the bodies of the lateral ventricles, is this very scary?

Post date: 13.03.2012 21:08

Papkina E.F.

Mild dilatation of the bodies of the lateral ventricles does not require therapy and is not dangerous for the child.

Post date: 04.05.2012 18:02

Irina

Hello. We did an ultrasound of the brain. The ultrasound specialist said that there is some widening of the interhemispheric fissure. We are 4 months old - the width of the interhemispheric fissure is 8mm. What does this mean? I'm very worried

Post date: 05.05.2012 22:14

Papkina E.F.

Irina, isolated widening of the interhemispheric fissure does not threaten anything bad.

Post date: 06.07.2012 11:07

Anastasia

Hello, does the child have a 7mm interhemispheric fissure, should this be treated or can a massage be used?

Post date: 07.07.2012 20:31

Papkina E.F.

Anastasia, if no other pathology is identified and the child is developing normally, then medication treatment is not required.

Post date: 21.08.2012 13:00

Guest

We are 6 months old. The interhemispheric gap is 6mm. Is this dangerous and does it need to be treated somehow? The neurologist said you can drink lingonberries, is that true?

Post date: 23.08.2012 21:59

Papkina E.F.

This is not dangerous if the child develops normally.

Post date: 02.09.2012 22:38

Guest

Good evening! The child had an ultrasound scan of the brain. Ventricular index 31% interhemispheric fissure 7.3 width of the bodies left 20 right 20, depth of the anterior horns left 7.8 right 8.4 width of the posterior horns left 4.8 right 5.4 width of the 3rd ventricle 9.6 blood flow pl Galena 14.8 . Tell me, do you need treatment? The child is developing normally.

Post date: 05.09.2012 22:03

Papkina E.F.

According to ultrasound data, there are manifestations of intracranial hypertension. Contact a neurologist, he will check whether the child’s reflexes and development correspond to his age. If there are deviations, treatment is required.

Post date: 05.09.2012 22:32

Guest

Thank you very much!

Post date: 19.09.2012 11:02

Julia

Good afternoon The child had an ultrasound scan of the brain. We are 9 months old. MP is 8 mm, Anterior horns vs 4.6 vd 4.6 Occipital horns 15.8 and 16.3. third ventricle 4.1 Cystene magna slit-shaped. Subarachnoid space on the right 6.3 on the left 6.3. The speed of blood flow in the vein of Galen is 10.6 (it decreased more). The child is developing well, there are no abnormalities. Decipher it please. They did the ultrasound 8 times. They drank Diacarb, the tank was 6*12, it closed and the mps increased (it was 5mm). They told us to drink Diacarb again. Is this correct, if outwardly we were told everything was fine with him, or the ultrasound is not normal. Thanks in advance

Post date: 24.09.2012 21:29

Papkina E.F.

Yulia, if there are no deviations in the child’s development, then based on the enlargement of the bladder alone, treatment is not indicated.

Post date: 26.09.2012 09:54

Julia

Thank you very much for your answer! Can I have one more question? We noticed that the Subarachoidal space on the right is increased 6.3 on the left 6.3. It does not require treatment. And what does it mean.

Post date: 26.09.2012 19:36

Papkina E.F.

Julia, this means a moderate accumulation of fluid on the outer surface of the brain and between the gyri. Treatment is required only if the child is lagging behind in motor or emotional development.

Post date: 29.09.2012 05:08

Angelica

Hello! My son is 1 year old. Do an ultrasound of the brain today: The structures of the brain are developed according to gestational age. The pattern of convolutions is differentiated. The subarachnoid space is expanded - 6 mm. The interhemispheric fissure is widened -6.2 mm. The cavity of the transparent septum is 3.5. Lateral ventricles: Depth of anterior horns right - 5 left - 5, depth of bodies right -8, left -7, width of occipital horns right -13 left -14. The choroid plexuses of the lateral ventricles are homogeneous. The width of the 3rd ventricle is -3. Depth 4 ventricles -3. Large tank -5. Subcortical ganglia: echogenicity, echostructure on the right and left - b/o, Periventricular region: echogenicity, echostructure on the right and left - b/o. Please tell me what does this all mean? What consequences might there be? What to do anyway. Nothing like this is visible in the child; he is developing normally. I'm very worried. Thank you very much in advance.

Post date: 03.10.2012 21:12

Guzel

Hello! My child is 8 months old. They did an ultrasound of the brain. The interhemispheric fissure is widened to 3-4 mm in all. At 7 months there were febrile convulsions that lasted 4 minutes. and didn't happen again. The doctor prescribed Picamilon, Vintocetin and Cortexin injections. She also prescribed a long-term dose of Depakine. I read the instructions for the medications and was horrified by the side effects. Is the child’s condition dangerous and is it worth taking these medications? The child is very active and develops normally. THANK YOU in advance!

At the birth of a child, many parents are faced with such a concept as the expansion of the interhemispheric fissure. In some cases, such a phenomenon carries indicators within the normal range, while in others, medical intervention is necessary.

To try to understand what the interhemispheric fissure is and its expansion, we suggest that you familiarize yourself with the information below.

• Interhemispheric fissure: what is it?

  Before delving into knowledge about this phenomenon, it is necessary to immediately highlight that expansion of the interhemispheric fissure within normal limits is not any pathology , but is considered only some anatomical feature of the child.

  So what is an extension? This is a condition in which there is an enlargement located between the two hemispheres of the child’s brain, otherwise known as dilatation. This phenomenon can be found both in the maternity hospital and at 5 or 6 months of birth.

  In medical practice, dilatation can be physiological and not require special attention, as well as deviations from normal indicators, i.e., indicate the accumulation of fluid between the hemispheres of the brain.

  In order to understand what is normal and what is deviation, there are special indicators that doctors rely on when observing a child. But at the same time, you should always remember that situations are different; you should always look only at pathological clinical manifestations that may threaten the baby’s health, as well as the results of additional diagnostics.

  How is diagnosis made and normal indicators?

  Normal indicators of the interhemispheric fissure

  These are the data that doctors rely on when diagnosing.

  Method of examination

  In order to determine whether there is an expansion of the interhemispheric fissure, a diagnosis called. This is the latest research method, which is carried out on children under 1 year of birth. In this diagnostic, echographic visualization of the brain is clearly visible, and the examination itself is done using ultrasound sensors through natural openings, namely the posterior or anterior fontanelle, and temporal region.

  

  Neurosonography can be performed immediately in the maternity hospital during complicated births. The following reasons are considered indications for research:

  • asphyxia or hypoxia of the baby;
  • difficult delivery with the use of special medications;
  • emergency or planned caesarean section;
  • Rh conflict between mother and child;
  • premature pregnancy;
  • protrusion or retraction of the fontanelle;
  • complicated pregnancy (viral or infectious diseases, etc.);
  • birth trauma of a child at birth or infection;
  • The child's Apgar score was less than 7 in the delivery room.

  In addition, neisonography is also done at older ages as part of a screening examination. Also, a similar medical study is carried out at the age of 3 months and 6.

  There is no need to be afraid of this research. It is absolute and only takes about 10 minutes of time. Diagnostics is carried out only by a qualified specialist who can decipher the data received and, if necessary, give an opinion on additional tests.

  During the procedure, the baby does not experience any pain and does not need a further recovery period. Therefore, parents do not need to worry about the prescribed diagnosis once again.

  What symptoms may be present?

  Each child is individual, and therefore his development may not be the same as that of other children.

  Many mothers pay attention to even minor symptoms and begin to panic. However, it is worth noting a number of symptoms that may be present in infants:

  1. The child is hyperactive and constantly excited.
  2. After every meal, the mother notices that the baby is burping.
  3. When resting or crying, the chin trembles.
  4. There is a marbled pattern on the skin, that is, blue or red stripes are clearly visible on the white skin.
  5. The baby goggles his eyes or, on the contrary, rolls them.
  6. The child is very sensitive to weather changes.
  7. Cysts or feet are moist even if the baby is dressed for the weather.
  8. The fontanel bulges, pulsates, and quickly or slowly closes.
  9. Tremor (shaking of hands).
  10. The baby begins to react strongly to changing external conditions or stimuli (strong sound, bright light, etc.).
  11. The child's sleep is disturbed and he often wakes up restless at night.
  12. You notice that the child has begun to walk on tiptoes, etc.

Key words: perinatal encephalopathy (PEP) or perinatal damage to the central nervous system (PP CNS), hypertensive-hydrocephalic syndrome (HHS); dilatation of the cerebral ventricles, interhemispheric fissure and subarachnoid spaces, pseudocysts on neurosonography (NSG), muscular dystonia syndrome (MDS), hyperexcitability syndrome, perinatal convulsions.

It turns out... more than 70-80%! Children in their first year of life come for consultation to neurological centers about a non-existent diagnosis - perinatal encephalopathy (PEP):

Child neurology is a relatively new field, but it is already going through difficult times. At the moment, many doctors practicing in the field of infant neurology, as well as parents of infants with any changes in the nervous system and mental sphere, find themselves “between two fires.” On the one hand, the school of “Soviet child neurology” is excessive diagnosis and incorrect assessment of functional and physiological changes in the nervous system of a child in the first year of life, combined with long-outdated recommendations for intensive treatment with a variety of medications. On the other hand, there is often an obvious underestimation of existing psychoneurological symptoms, ignorance of general pediatrics and the fundamentals of medical psychology, some therapeutic nihilism and fear of using the potential of modern drug therapy; and as a result - lost time and missed opportunities. At the same time, unfortunately, a certain (and sometimes significant) “formality” and “automaticity” of modern medical technologies lead, at a minimum, to the development of psychological problems in the child and his family members. The concept of “norm” in neurology at the end of the 20th century was sharply narrowed; now it is intensively and not always justifiably expanding. Probably the truth is somewhere in the middle...

According to the perinatal neurology clinic of the NEVRO-MED medical center and other leading medical centers in Moscow (and probably in other places), until now, more 80%!!! children in their first year of life are referred by a pediatrician or neurologist from a district clinic for a consultation regarding non-existent diagnosis - perinatal encephalopathy (PEP):

The diagnosis of “perinatal encephalopathy” (PEP) in Soviet child neurology very vaguely characterized almost any dysfunction (and even structure) of the brain in the perinatal period of a child’s life (from about 7 months of intrauterine development of the child and up to 1 month of life after childbirth), arising as a result of pathologies of cerebral blood flow and oxygen deficiency.

Such a diagnosis was usually based on one or more sets of any signs (syndromes) of a probable nervous system disorder, for example, hypertensive-hydrocephalic syndrome (HHS), muscular dystonia syndrome (MDS), hyperexcitability syndrome.

After conducting an appropriate comprehensive examination: clinical examination in combination with analysis of data from additional research methods (ultrasound of the brain - neurosonography) and cerebral circulation (Dopplerography of cerebral vessels), fundus examination and other methods, the percentage of reliable diagnoses of perinatal brain damage (hypoxic, traumatic, toxic-metabolic, infectious) is reduced to 3-4% - this is more than 20 times!

The most bleak thing about these figures is not only the certain reluctance of individual doctors to use the knowledge of modern neurology and conscientious delusion, but also the clearly visible psychological (and not only) comfort in the pursuit of such “overdiagnosis.”

Hypertension-hydrocephalic syndrome (HHS): increased intracranial pressure (ICP) and hydrocephalus

Until now, the diagnosis of “intracranial hypertension” (increased intracranial pressure (ICP)) is one of the most commonly used and “favorite” medical terms among pediatric neurologists and pediatricians, which can explain almost everything! and at any age, complaints from parents.

For example, a child often cries and shudders, sleeps poorly, spits up a lot, eats poorly and gains little weight, eyes widen, walks on tiptoes, his arms and chin tremble, there are convulsions and there is a lag in psycho-speech and motor development: “it’s only his fault - increased intracranial pressure." Isn't that a convenient diagnosis?

Quite often, the main argument for parents is “heavy artillery” - data from instrumental diagnostic methods with mysterious scientific graphs and figures. Methods can be used either completely outdated and uninformative /echoencephalography (ECHO-EG) and rheoencephalography (REG)/, or examinations “from the wrong opera” (EEG), or incorrect, in isolation from clinical manifestations, subjective interpretation of normal variants during neurosonodopplerography or tomography.

Unhappy mothers of such children involuntarily, at the suggestion of doctors (or voluntarily, feeding on their own anxiety and fears), pick up the flag of “intracranial hypertension” and for a long time end up in the system of monitoring and treatment of perinatal encephalopathy.

In fact, intracranial hypertension is a very serious and quite rare neurological and neurosurgical pathology. It accompanies severe neuroinfections and brain injuries, hydrocephalus, cerebrovascular accident, brain tumors, etc.

Hospitalization is mandatory and urgent!!!

Intracranial hypertension (if it really exists) is not difficult for attentive parents to notice: it is characterized by constant or paroxysmal headaches (usually in the morning), nausea and vomiting not associated with food. The child is often lethargic and sad, is constantly capricious, refuses to eat, he always wants to lie down and cuddle with his mother.

A very serious symptom can be strabismus or difference in pupils, and, of course, disturbances of consciousness. In infants, bulging and tension of the fontanelle, divergence of the sutures between the bones of the skull, as well as excessive growth of the head circumference are very suspicious.

Without a doubt, in such cases the child must be shown to specialists as soon as possible. Quite often, one clinical examination is enough to exclude or preliminarily diagnose this pathology. Sometimes additional research methods are required (fundus examination, neurosonodopplerography, computed tomography or magnetic resonance imaging of the brain)

Of course, expansion of the interhemispheric fissure, cerebral ventricles, subarachnoid and other spaces of the cerebrospinal fluid system on neurosonography (NSG) images or brain tomograms (CT or MRI) cannot serve as evidence of intracranial hypertension. The same applies to cerebral blood flow disorders isolated from the clinic, identified by vascular Dopplerography, and “finger impressions” on a skull x-ray

In addition, there is no connection between intracranial hypertension and translucent vessels on the face and scalp, walking on tiptoes, trembling hands and chin, hyperexcitability, developmental disorders, poor academic performance, nosebleeds, tics, stuttering, bad behavior, etc. etc.

That’s why, if your baby has been diagnosed with “PEP, intracranial hypertension”, based on “goggle” eyes (Graefe’s symptom, “setting sun”) and walking on tiptoes, then you shouldn’t go crazy in advance. In fact, these reactions may be characteristic of easily excitable young children. They react very emotionally to everything that surrounds them and what happens. Attentive parents will easily notice these connections.

Thus, when diagnosing PEP and increased intracranial pressure, it is naturally best to contact a specialized neurological clinic. This is the only way to be sure of the correct diagnosis and treatment.

It is absolutely unreasonable to begin treatment of this serious pathology on the recommendations of one doctor based on the above “arguments”; in addition, such unreasonable treatment is not at all safe.

Just look at the diuretic drugs that are prescribed to children for a long time, which has an extremely adverse effect on the growing body, causing metabolic disorders.

There is another, no less important aspect of the problem that must be taken into account in this situation. Sometimes medications are necessary and the wrongful refusal of them, based only on the mother’s (and more often than not the father’s) own conviction that medications are harmful, can lead to serious troubles. In addition, if there really is a serious progressive increase in intracranial pressure and the development of hydrocephalus, then often incorrect drug therapy for intracranial hypertension entails the loss of a favorable moment for surgical intervention (shunt surgery) and the development of severe irreversible consequences for the child: hydrocephalus, developmental disorders, blindness , deafness, etc.

Now a few words about the no less “adored” hydrocephalus and hydrocephalic syndrome. In fact, we are talking about a progressive increase in intracranial and intracerebral spaces filled with cerebrospinal fluid (CSF) due to the existing! at that moment of intracranial hypertension. In this case, neurosonograms (NSG) or tomograms reveal dilations of the ventricles of the brain, interhemispheric fissure and other parts of the cerebrospinal fluid system that change over time. Everything depends on the severity and dynamics of the symptoms, and most importantly, on the correct assessment of the relationships between the increase in intracerebral spaces and other neural changes. This can be easily determined by a qualified neurologist. True hydrocephalus, which does require treatment, like intracranial hypertension, is relatively rare. Such children must be observed by neurologists and neurosurgeons at specialized medical centers.

Unfortunately, in ordinary life such an erroneous “diagnosis” occurs in almost every fourth or fifth baby. It turns out that some doctors often incorrectly call stable (usually slight) enlargement of the ventricles and other cerebrospinal fluid spaces of the brain hydrocephalus (hydrocephalic syndrome). This does not manifest itself in any way through external signs or complaints and does not require treatment. Moreover, if the child is suspected of having hydrocephalus based on a “large” head, translucent vessels on the face and scalp, etc. - this should not cause panic among parents. The large size of the head in this case plays practically no role. However, the dynamics of head circumference growth is very important. In addition, you need to know that among modern children it is not uncommon to have so-called “tadpoles” whose heads are relatively large for their age (macrocephaly). In most of these cases, infants with large heads show signs of rickets, less often - macrocephaly due to the family constitution. For example, dad or mom, or maybe grandpa has a big head, in a word, it’s a family matter and doesn’t require treatment.

Sometimes, when performing neurosonography, an ultrasound doctor finds pseudocysts in the brain - but this is not a reason to panic at all! Pseudocysts are single round tiny formations (cavities) containing cerebrospinal fluid and located in typical areas of the brain. The reasons for their appearance, as a rule, are not reliably known; they usually disappear by 8-12 months. life. It is important to know that the existence of such cysts in most children is not a risk factor for further neuropsychic development and does not require treatment. However, although quite rare, pseudocysts form at the site of subependymal hemorrhages, or are associated with perinatal cerebral ischemia or intrauterine infection. The number, size, structure and location of cysts provide specialists with very important information, taking into account which, based on a clinical examination, final conclusions are formed.

Description of NSG is not a diagnosis! and not necessarily a reason for treatment.

Most often, NSG data provide indirect and uncertain results, and are taken into account only in conjunction with the results of a clinical examination.

Once again, I remind you of the other extreme: in difficult cases, sometimes there is a clear underestimation on the part of parents (less often, doctors) of the child’s problems, which leads to a complete refusal of the necessary dynamic observation and examination, as a result of which the correct diagnosis is made late, and treatment does not lead to the desired result.

Undoubtedly, therefore, if increased intracranial pressure and hydrocephalus are suspected, diagnosis should be carried out at the highest professional level.

What is muscle tone and why is it so “loved”?

Look at your child’s medical record: is there no such diagnosis as “muscular dystonia”, “hypertension” and “hypotension”? - you probably just didn’t go with your baby to the neurologist’s clinic until he was a year old. This is, of course, a joke. However, the diagnosis of “muscular dystonia” is no less common (and perhaps more common) than hydrocephalic syndrome and increased intracranial pressure.

Changes in muscle tone can be, depending on the severity, either a variant of the norm (most often) or a serious neurological problem (this is much less common).

Briefly about external signs of changes in muscle tone.

Muscular hypotonia characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity may be limited; palpation of the muscles is somewhat reminiscent of “jelly or very soft dough.” Pronounced muscle hypotonia can significantly affect the rate of motor development (for more details, see the chapter on movement disorders in children of the first year of life).

Muscular dystonia characterized by a condition where muscle hypotonia alternates with hypertension, as well as a variant of disharmony and asymmetry of muscle tension in individual muscle groups (for example, more in the arms than in the legs, more on the right than on the left, etc.)

At rest, these children may experience some muscle hypotonia during passive movements. When trying to actively perform any movement, during emotional reactions, when the body changes in space, muscle tone increases sharply, pathological tonic reflexes become pronounced. Often, such disorders subsequently lead to improper development of motor skills and orthopedic problems (for example, torticollis, scoliosis).

Muscular hypertension is characterized by increased resistance to passive movements and limitation of spontaneous and voluntary motor activity. Severe muscle hypertension can also significantly affect the rate of motor development.

Violation of muscle tone (muscle tension at rest) can be limited to one limb or one muscle group (obstetric paresis of the arm, traumatic paresis of the leg) - and this is the most noticeable and very alarming sign, forcing parents to immediately consult a neurologist.

It is sometimes quite difficult for even a competent doctor to notice the difference between physiological changes and pathological symptoms in one consultation. The fact is that changes in muscle tone are not only associated with neurological disorders, but also strongly depend on the specific age period and other characteristics of the child’s condition (excited, crying, hungry, drowsy, cold, etc.). Thus, the presence of individual deviations in the characteristics of muscle tone does not always cause concern and require any treatment.

But even if functional disorders of muscle tone are confirmed, there is nothing to worry about. A good neurologist will most likely prescribe massage and physical therapy (exercises on large balls are very effective). Medicines are prescribed extremely rarely.

Hyperexcitability syndrome

(syndrome of increased neuro-reflex excitability)

Frequent crying and whims with or without cause, emotional instability and increased sensitivity to external stimuli, sleep and appetite disturbances, excessive frequent regurgitation, motor restlessness and shuddering, trembling of the chin and arms (etc.), often combined with poor growth weight and bowel dysfunction - do you recognize such a child?

All motor, sensitive and emotional reactions to external stimuli in a hyperexcitable child arise intensely and abruptly, and can fade away just as quickly. Having mastered certain motor skills, children constantly move, change positions, constantly reach for and grab objects. Typically, children show a keen interest in their surroundings, but increased emotional lability often makes it difficult for them to communicate with others. They are very impressionable, emotional and vulnerable! They fall asleep extremely poorly, only with their mother, they constantly wake up and cry in their sleep. Many of them have a long-term reaction of fear when communicating with unfamiliar adults with active reactions of protest. Typically, hyperexcitability syndrome is combined with increased mental exhaustion.

The presence of such manifestations in a child is just a reason to contact a neurologist, but in no case is it a reason for parental panic, much less drug treatment.

Constant hyperexcitability is not causally specific and can most often be observed in children with temperamental characteristics (for example, the so-called choleric type of reaction).

Much less frequently, hyperexcitability can be associated and explained by perinatal pathology of the central nervous system. In addition, if a child’s behavior is suddenly disrupted unexpectedly and for a long time for virtually no apparent reason, and he or she develops hyperexcitability, the possibility of developing an adaptation disorder reaction (adaptation to external environmental conditions) due to stress cannot be ruled out. And the sooner the child is examined by specialists, the easier and faster it is possible to cope with the problem.

And, finally, most often, transient hyperexcitability is associated with pediatric problems (rickets, digestive disorders and intestinal colic, hernia, teething, etc.).

There are two extremes in the tactics of monitoring such children. Or an “explanation” of hyperexcitability using “intracranial hypertension” and intense drug treatment often using drugs with serious side effects (diacarb, phenobarbital, etc.). Or complete neglect of the problem, which can subsequently lead to the formation of persistent neurotic disorders (fears, tics, stuttering, anxiety disorders, obsessions, sleep disorders) in the child and his family members, and will require long-term psychological correction.

Of course, it is logical to assume that an adequate approach is somewhere in between...

Separately, I would like to draw the attention of parents to seizures - one of the few disorders of the nervous system that really deserves close attention and serious treatment. Epileptic seizures do not occur often in infancy, but they are sometimes severe, insidious and disguised, and immediate drug therapy is almost always necessary.

Such attacks can be hidden behind any stereotypical and repetitive episodes in the child’s behavior. Incomprehensible shudders, head nods, involuntary eye movements, “freezing,” “squeezing,” “limping,” especially with a fixed gaze and lack of response to external stimuli, should alert parents and force them to turn to specialists. Otherwise, a late diagnosis and untimely prescribed drug therapy significantly reduce the chances of treatment success.

All circumstances of the seizure episode must be accurately and completely remembered and, if possible, recorded on video for further detailed description at the consultation. If convulsions last a long time or are repeated, call “03” and urgently consult a doctor.

At an early age, the child’s condition is extremely changeable, so developmental deviations and other disorders of the nervous system can sometimes be detected only during long-term dynamic monitoring of the baby, with repeated consultations. For this purpose, specific dates for planned consultations with a pediatric neurologist in the first year of life have been determined: usually at 1, 3, 6 and 12 months. It is during these periods that most serious diseases of the nervous system of children in the first year of life can be detected (hydrocephalus, epilepsy, cerebral palsy, metabolic disorders, etc.). Thus, identifying a specific neurological pathology in the early stages of development makes it possible to begin complex therapy on time and achieve the maximum possible result.

And in conclusion, I would like to remind parents: be sensitive and attentive to your kids! First of all, it is your meaningful participation in the lives of children that is the basis for their future well-being. Do not treat them for “supposed illnesses,” but if something worries and concerns you, find the opportunity to get independent advice from a qualified specialist.