RU2195156C2 - Method for screening diagnostics for severity degree of birth trauma of cervical vertebral department and spinal cord in neonatals - Google Patents

Abstract

FIELD: medicine, children's neurology. SUBSTANCE: estimation is carried out in points for complaints, disorders of cranial innervation, nonspinal unconditioned, pathological unconditioned, unconditioned spinal reflexes, muscular tonicity, active movements in limbs, vertebral syndrome. At the total of points ranged 20-14.5 a severe degree is diagnosed, in case of 14-8.5 - average degree and at 8-4.5 - a light degree of the disease is concluded on. The method enables to shorten the time for neurological trial and objectivize its results. EFFECT: higher efficiency.

Description

 The invention relates to medicine, in particular to pediatric neurology and can be used for screening diagnostics of the severity of birth injury of the cervical spine and spinal cord in infants.

 A known method is the screening assessment of neurological symptoms in preschoolers 3-7 years old, where, in order to objectify the results of a neurological examination, a formalized map of the scoring of neurological symptoms is developed taking into account their severity and significance in the general neurological status. Assessment of neurological symptoms takes 15 minutes and is conducted according to 42 parameters (Osipenko T.N. Psychoneurological development of preschool children. 1996, p. 252-254).

 The disadvantages of the method include a large number of evaluated parameters, which complicates the application of the method in conditions of mass outpatient examination of patients.

 In addition, the symptoms of vertebral syndrome, which are necessarily present during birth injury of the cervical spine and spinal cord, are not taken into account.

 For this reason, the method cannot be used for screening diagnostics of the severity of birth injury of the cervical spine and spinal cord in infants.

 The closest in technical essence, the achieved effect to the claimed method and selected as a prototype is a method for assessing the severity of a pathological neurological sign in points, used to diagnose disorders of neurological development in young children. Diagnosis is by 81 parameters (symptom), each of the symptoms is assessed according to a 4-point system, followed by calculation of the resulting score, where based on the total pathological neurological score, a division by degrees of severity occurs (N. Ermolenko, Clinical, psychological and electrophysiological analysis of disorders neurological development in young children. Almanac "Healing" Issue 4, 2000, p. 156).

 The reasons that impede the achievement of the technical result indicated below when using the known prototype method include the fact that the method also does not take into account the symptoms of vertebral syndrome during birth injury of the cervical spine and spinal cord and contains a large number of evaluated parameters that do not allow the method to be used for screening diagnostics the severity of a birth injury to the cervical spine and spinal cord on an outpatient basis during a mass neurological examination of patients.

 All of the above disadvantages do not allow screening diagnostics of the severity of birth injury of the cervical spine and spinal cord in infants.

 The problem to which the claimed invention is directed, is to provide a method for screening diagnosis of the severity of birth injury of the cervical spine and spinal cord in infants.

 The technical result is the objectification of the results of a neurological examination of patients with birth injury of the cervical spine and spinal cord with a distribution of their severity depending on the severity of the pathological neurological symptom, as well as reducing the time of the study on an outpatient neurological appointment.

The specified technical result in the implementation of the invention is achieved by the fact that in the known method of screening diagnosis of the severity of birth injury of the cervical spine and spinal cord in infants by assessing the severity of the pathological neurological symptom in points, the patient's condition is assessed by 9 clinical parameters, including symptoms vertebral syndrome, where the sum of the scores from 20 to 14.5 indicates a severe degree of the disease, from 14 to 8.5 - an average degree of the disease, from 8 to 4.5 - a mild degree and disease
Severity - Total Points
Heavy - 14.5-20
Medium - 8.5-14
Easy - 5-8
The analysis of the prior art by the applicant, including a search by patent and scientific and technical sources of information, made it possible to establish that the proposed method is not known and should not be explicitly studied from the prior art, i.e. meets the criteria of "novelty" and "inventive step".

 The proposed method can be applied in any medical institutions involved in the diagnosis of birth injury of the cervical spine and spinal cord in infants.

 The method is as follows.

During a clinical examination of a patient with a birth injury of the cervical spine and spinal cord, parameters are evaluated in points:
1. Patient complaints:
No complaints - 0
Inactive complaints - 0.5
Active complaints - 1
2. Cranial innervation.

Violated - 1
Minor violations - 0.5
Not broken - 0
3. Vertebral syndrome:
Missing - 0
Present - 1-4
(The total score was expressed depending on the presence of the following four components of this syndrome:
position and movement of the head;
the presence of asymmetry, tension or shortening of the cervical muscles, neurodystrophic changes in the muscles of the neck with a symptom of muscle crepitation;
violation of the relationship of the spinous or transverse processes during palpation;
pain during palpation of the cervical spine.

4. Spinal unconditioned reflexes:
Dramatically oppressed or absent - 3
Changed (reduced or asymmetric) - 2
Slightly changed - 1
Age norm - 0
5. Unconditioned reflexes are not spinal:
Changed - 1
Slightly changed - 0.5
Age norm - 0
6. Pathological reflexes, including during unreduced unconditioned reflexes:
Expressed - 1
Slightly expressed - 0.5
Missing - 0
7. Tendon reflexes:
sharply changed, i.e. reduced (absent) or increased to clonus - 3 points;
changed, i.e. asymmetric, reduced or increased - 2 points;
slightly changed - 1 point;
within normal limits - 0 points.

8. Muscle tone:
Dramatically changed (severe hypertonicity or hypotension) - 3
Changed - 2
Closer to normal - 1
Age norm - 0
9. Active movements in the limbs (limbs) and the trunk, including those that are formed by age:
Missing - 3
Changed (decreased or increased with hyperkinesis) - 2
Slightly changed - 1
Within the age norm - 0
Example. Patient K. 1 month.

 He was admitted with active complaints of restriction of movement in the neck, the preferential position of the head on one side was 1 point. From the side of the cranial nerves there is a periodic transient convergent strabismus and asymmetry of the palpebral fissures - 1 point.

 Active movements in the left hand are slightly reduced - 1 point, due to dystonia of the tone in it - proximal increase and distal hypotension, dystonia with a tendency to hypertonicity in the legs - 2 points. Vertebral syndrome is manifested by moderate soreness during palpation of the vertebrae C3, C4, asymmetry of the posterior cervical muscles and the predominant position of the head in one direction - 3 points. Unconditioned reflexes are spinal - asymmetrical - 2 points, non-spinal - changed - 1 point. Tendon reflexes are reduced distal from the left hand and raised from the legs - 2 points. Pathological reflexes from the legs are slightly pronounced - 0.5 points. The total pathological score of neurological disorders is 13.5. The average severity of this patient was determined.

 Using the method of screening diagnostics of the severity of birth injury of the cervical spine and spinal cord in infants allowed differentiated treatment and objective monitoring of the dynamics of symptoms in these patients.

Claims (1)

 A method for screening diagnostics of the severity of a birth injury of the cervical spine and spinal cord in infants, including assessing the severity of a neurological symptom in points, characterized in that when examining complaints, craniocerebral innervation, non-spinal unconditioned reflexes, pathological unconditioned reflexes, the degree of their disturbances is evaluated in 0; 0.5; 1 point in the study of unconditioned spinal reflexes, muscle tone, active movements in the limbs - 0; 1; 2; 3 points; and vertebral syndrome is assessed by the presence of four of its symptoms - 0; 1; 2; 3; 4 points and with a total score of 20 to 14.5 diagnose a severe degree, from 14 to 8.5 - a moderate degree, from 8 to 4.5 - a mild disease.