Organic brain damage: causes, symptoms, treatment

The main feature of our time is an accessible information space in which everyone can contribute. Medical sites on the Internet are often created by people who are vaguely related to medicine. And, when it comes to specific diagnoses, for example, diabetes mellitus or thrombophlebitis, you can glean useful knowledge from the article.

But when search engines try to find a problem or something unclear, knowledge is often lacking and confusion begins. This fully applies to such a topic as organic brain damage.

If you take a serious reference book on neurology and try to find a diagnosis such as organic damage to the central nervous system (that is, the brain and spinal cord), you will not find it. What is it? A passing disease or a more complex disorder leading to irreversible changes in the structure of the central nervous system in adults and children? Or is it a whole group of diseases? There are many questions, we will try to start from the position of official medicine.

Place of pathology in the ICD

Each case of any disease, both a functional disorder and a life-threatening condition, must be submitted to medical statistics and encrypted, receiving the ICD-10 code (International Classification of Diseases).

Is there a place in the ICD for “organic” CNS? By the way, doctors often shorten this name to “OPCNS” .

If you look carefully at the entire section of nervous diseases (G), then everything is there, including “unspecified” and “other” lesions of both the central and peripheral nervous systems, but there is no such disorder as “organic brain damage”. In the section of psychiatry in the ICD there is the concept of “organic personality disorder”; it is associated with the consequences of severe diseases of the nervous system, such as diseases such as encephalitis, meningitis or stroke, which can be life-threatening.

The reason for this is understandable: it’s easier for psychiatrists. A person’s personality is an integral structure, and it may have a persistent disorder of individual components, but at the same time the personality suffers as an indivisible category, since it cannot be “divided” into its component parts.

And the central nervous system can also suffer, while the damaging factors can be firmly established, the pathogenesis of the disorder, signs are known, and there is a final separate diagnosis. Therefore, even just on the basis of the official classification of diseases, it is possible to draw a conclusion and create a definition of what this mysterious pathology is.

ORGANIC PSYCHOLOGY: RELEVANT, NECESSARY, USEFUL

ORGANIC PSYCHOLOGY: RELEVANT, NECESSARY, USEFUL

G. Y. UZILEVSKY

EAGLE

Zinchenko V.P. Osip Mandelstam’s Staff and Mamardashvili’s Pipe: To the Beginnings of Organic Psychology. M.: New School, 1997. 336 p.

Currently, Russian psychology and pedagogy are on an extremely difficult stretch of the road, which is characterized by the desire to rethink the Soviet period of their functioning and identify promising areas of development, at the center of which is such an extremely interesting and fascinating phenomenon as Man. In this regard, the appearance of a new monograph by V. P. Zinchenko, dedicated to the zone of immediate and more distant development of cultural-historical psychology and psychological theory of activity, at the origins of which stood L. S. Vygotsky, is very timely.

Already the table of contents (the book consists of an address to the reader, an introduction, four chapters, an afterword, a list of used literature) makes the reader far from indifferent to the content of the unusual narrative, since the titles of the chapters (“From classical to organic psychology,” “Prolegomena to poetic anthropology,” “The Genome of Human Development”, “Cultural-Historical Psychology in Search of Spirituality”) involve him in a surprisingly interesting scientific voyage that opens up new horizons in the knowledge of Man. At the same time, the reader easily and freely enters the complex world of cultural-historical psychology with its problems and contradictions due to the fact that the author of the monograph managed to present the material in an exceptionally vivid form by referring to the works of many great poets and philosophers.

The disclosure of the prospects for the immediate and distant development of cultural-historical psychology was undertaken by the author in a truly fascinating and unexpected way: through the magical crystal of the poetic creativity of O. E. Mandelstam and the prism of the subtle paradoxical philosophical heritage of M. K. Mamardashvili. First of all, it should be noted that

V.P. Zinchenko managed to brilliantly fulfill one of the objectives of the monograph - to remove the opposition between the objective and the subjective, the material and the ideal, which was carried out by vulgar materialism not only in epistemology, but also in psychology.

In fact, the entire book is aimed at revealing the organic connection between the material and the ideal, external and internal, flesh and spirit, anatomical and physiological and functional, being and meaning... At the same time, the spiritual principle permeates the entire scientific narrative from beginning to end.

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It is appropriate to say that the text of the monograph is polymorphic and multi-valued; while reading it, the reader can come to his own unexpected assumptions and assessments. For example, while enjoying reading “Prolegomena to Poetic Anthropology,” I unexpectedly came to the conclusion about the powerful interaction of genetic and semantic codes that determine the “givenness” (according to A.F. Losev) of the external and internal forms of personality.

Appeal to the heritage of the great scientists of the 20th century. — M. M. Bakhtin, N. A. Bernstein,

A. F. Losev, A. A. Ukhtomsky, P. A. Florensky and others - as well as the poetic work of O. Mandelstam and B. Pasternak allowed the author to fill the concept of “functional organ” with new content in the context of cultural-historical psychology and theory of activity , “interiorization” and “exteriorization,” to reveal the vertical of a person’s spiritual development, the problem of action and free action, the transition from action to personality - “a historical person, aware, understanding his place in history and acting in his time” (p. 205) .

Being, as it were, inside cultural-historical psychology, V. P. Zinchenko could not ignore the comprehension of culture as an ideal form, the interpretation of the transformation and reversibility of its internal and external forms, the establishment of the role of the latter in interiorization in the context of the thoughts of M. K. Mamardashvili, O. E. Mandelstam, P.A. Florensky, G.G. Shpet and other thinkers, which undoubtedly made a significant contribution to the development of this direction in psychology.

In connection with the above, it seems to us relevant, necessary and useful that the new name proposed by the author of the monograph (according to P. A. Florensky) of cultural-historical psychology, namely organic psychology, which can influence the development of this direction. Let us note, for example, that representatives of cultural-historical psychology did not consider the semiosphere of culture in its variability, did not analyze the relationship between the development of human nature and culture, although culture, in addition to its positive influence, had and is having a negative impact on the understanding of the essence of Man. It should also be noted that this direction has not studied the influence of Human nature on his thinking, intelligence and

etc., which is very important when developing innovative pedagogical technologies. In other words, it is necessary to fill the classical principle of conformity with nature in teaching the individual with new content.

In our opinion, organic psychology, by uncovering various organic connections between nature, man and culture, will be able to make a worthy contribution to the understanding of Man, his personality and activities.

In conclusion, it is necessary to say about the design of the book: it is well illustrated, and numerous drawings made using computer graphics are distinguished by their undoubted grace and accessibility.

In my opinion, the new monograph by V.P. Zinchenko will find a great response in the minds and hearts of not only psychologists, but also representatives of other disciplines, directions and specializations who study the phenomenon of Man from positions other than psychology.

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Definition of OPCNS

Organic brain damage is a persistent disorder of both the structure of the brain and its individual functions, which manifests itself in various symptoms, is irreversible, and is based on morphological changes in the central nervous system.

This means that all brain diseases in adults and children, including young children, can be divided into two large groups:

• functional disorders. They do not have any morphological substrate. In simple words, this means that, despite complaints, according to all examination data, MRI, lumbar puncture and other research methods, no pathological changes are detected.

Such diseases, for example, include vegetative-vascular dystonia with diencephalic crises, or migraine headaches. Despite a thorough ultrasound of both the cerebral vessels and the vessels of the head and neck, no pathology may be detected. This is due to a sharp change in vascular tone, which leads to severe, throbbing pain with nausea and vomiting, against the background of normal test results.

• organic pathology. It “leaves traces” that are discovered many years later. All the pathophysiological mechanisms of its occurrence are known: for example, acute ischemia, or perinatal damage to the central nervous system in a child of the first year of life. Persistent changes are caused by the inflammatory process, both on the membranes of the brain and in the brain itself.

Therefore, if the patient’s complaints can be “linked” to any specific disease or brain damage in the past, and also if these complaints are associated with disturbances in the structure of the brain substance (for example, according to MRI data), which are persistent, then The patient is given a diagnosis, for example:

“Organic brain disease of complex origin: a residual period of extensive ischemic stroke in the middle cerebral artery, severe right-sided hemiparesis, motor aphasia, consequences of closed craniocerebral injury, post-traumatic encephalopathy, moderate cognitive impairment against the background of severe cerebral atherosclerosis.”

As you can see, there is “no place to put samples.” Usually, after such a main diagnosis there is a list of related ones: hypertension, diabetes, obesity, and so on. But it is immediately clear what reasons led to the development of OPCNSL.

We have given an example of organic damage to the central nervous system associated with stroke and trauma, occurring against the background of atherosclerosis in an elderly person. What diseases in general are associated with the subsequent appearance and development of organic disorders?

Types of organic lesions

In order not to bore the reader with a detailed description of diseases that “leave” a lasting mark on the patient’s life in the form of organic brain damage, we will briefly list these reasons.

You just need to remember that all the diseases listed below can be cured without a trace, without any consequences . In addition, the patient may have persistent changes in the structure of the brain, for example, a cyst of the septum pellucidum in a child, or calcification of the caudate nucleus, which may be an incidental finding on an MRI performed just for fun.

So what does this mean that the patient has an organic lesion? This is where the most interesting part of the story begins: purely formally, morphologically, from the point of view of pathological anatomy - yes. But, since the patient does not complain, neurologists do not give him any diagnosis. In addition, if these changes in the brain occurred quietly and asymptomatically, and one of the following diagnoses was not documented, then the basis for OPCNSL does not seem to exist.

Therefore, an organic lesion is identified in the presence of structural changes and corresponding complaints and symptoms . Individual components are “not taken into account.”

However, there is one disease in which there may be no significant changes according to neuroimaging data, and the diagnosis will still sound like OPCNSL. This is a long-term (20-30 days) stay of the patient in a comatose state caused by a metabolic rather than a destructive coma. This period is quite enough for lifelong disorders to appear caused by hypoxia, which cannot be “seen.” So, here is a list of the most common reasons:

• acute cerebrovascular accidents. These include ischemic and hemorrhagic strokes, intracerebral hemorrhages, and, to a lesser extent, subarachnoid and subdural hematomas. If the hematoma is removed in a timely manner, everything can go away without a trace. In addition, there are disorders of the spinal and cerebrospinal circulation. Spinal stroke with consequences is also a sign of OPCN;
• Parkinson's disease, parkinsonism syndrome, hyperkinesis, damage to the basal ganglia: globus pallidus, putamen, substantia nigra, caudate and red nucleus (subcortical structures have amazing names);

• episyndrome. It should be clarified that true epilepsy is not OPCNSL, since it occurs “from nowhere”, and it is called “cryptogenic” or “genuine”. If there are seizures as a manifestation of another disease - for example, parasitic cysts (cysticercosis of the brain), or after a depressed fracture of the bones of the calvarium, with impaired consciousness, mental syndromes - this is an episyndrome;
• meningitis, arachnoiditis, encephalitis and meningoencephalitis, especially purulent (for example, meningococcal and pneumococcal in young children). The morphological substrate for the occurrence of persistent disorders is the formation of adhesions on the membranes, as well as inside the liquor-conducting tracts (with ependymatitis and ventriculitis). With encephalitis - destruction of certain areas of the cortex, with replacement by connective tissue;
• specific infections: neurosyphilis, tuberculosis;
• herpetic lesions of the nervous system, poliomyelitis;
• secondary damage to systemic collagenoses (for example, rheumatism). In children and adults, vasculitis, meningitis, encephalitis and encephalomyelitis may occur;
• brain tumors;
• parasitic infestations;
• injuries, including penetrating injuries, brain contusion and diffuse axonal injury;
• toxic damage (salts of heavy metals, alcoholism).

In addition, systemic diseases of the whole organism, such as atherosclerosis, in its cerebral form, leading to dementia, and persistent cognitive disorders, which were previously called intellectual-mnestic, can lead to organic damage.

It is interesting that true diseases of the central nervous system with an unknown cause (multiple sclerosis, amyotrophic lateral sclerosis, hereditary diseases in children) - despite the severe symptoms and early, aggressive onset - are not called organic lesions.

What cannot cause OPCNS?

Of course, all diseases that are characteristic of the peripheral nervous system cannot be the cause of organic damage to the central nervous system. Such diseases include:

• osteochondrosis with radicular symptoms (except for the development of myelopathy);
• compression-ischemic neuropathies and other lesions of peripheral nerves.

Clinic

As readers have already guessed, the symptoms and signs of the above diseases are very extensive and varied. However, they can be grouped into several main syndromes:

• focal lesions. These include paralysis, paresis, sensory disturbances and symptoms of vegetative-trophic disorders. Here almost all private neurology: from paresis of the facial nerve and strabismus to urinary incontinence;

• cerebral symptoms. It is characterized by symptoms such as persistent, widespread morning headaches, “cerebral” vomiting without nausea, and progressive decrease in vision. It occurs as a result of increased cerebrospinal fluid pressure and hydrocephalus develops (for example, in children). These symptoms appear after meningitis, meningoencephalitis, and also in connection with the growth of tumors and cysts;

• signs of mental disorders, symptoms of early decline in memory and intelligence. Often accompanies encephalitis, parasitic cysts and the development of episyndrome.

Residual organic damage: causes and symptoms

Residual organic damage is the consequences that appear after damage to brain structures in the perinatal period (from 22 weeks of pregnancy to 7 days after birth).

Despite the fact that premature pregnancy is not a mandatory indication for organic brain damage, a weakly developed nervous system is very vulnerable to any unfavorable factors, and since the neuromuscular response has not yet been formed, pathological processes may occur.

The causes of residual organic damage are:

• diseases at the chromosome level;
• insufficient consumption or supply of oxygen to the mother’s body and associated hypoxia of the fetal brain;
• radiation;
• ecology;
• use of medications or cleaning products;
• poisoning of the expectant mother with alcohol or drugs;
• poor nutrition, expressed in insufficient consumption of micro or macro substances;
• acute or chronic diseases of women;
• pathology of pregnancy.

Any of these factors can lead to slow growth of the baby, which will provoke organic brain damage in children.
The clinical picture of this lesion appears immediately after birth, which can be determined not only by a neurologist. There is a noticeable violation of muscle tone, trembling of the hands, excitement, and the formation of voluntary movements is delayed. With more serious damage, it is possible to determine which area of ​​the brain is damaged. There is another option when neurological abnormalities can only be detected using hardware methods. This kind of flow is called silent.

Despite the difficulty of diagnosis, this silent pathology does not require treatment. It is important to undergo regular examinations and monitor changes.

How residual organic damage manifests itself:

1. Cerebrasthenic syndrome . It is characterized by rapid fatigue, loss of strength, sudden mood swings with a predominance of tearfulness and irritability, and lack of adaptation to any stress.
2. Neurosis-like syndrome . It manifests itself as various phobias, urinary incontinence and nervous tics.
3. Encephalopathy.
4. Psychopathy.
5. Organic-psychic infantilism.
6. Minimal brain dysfunction . It manifests itself as hyperactivity, which results from a lack of attention.

Early diagnosis helps to begin early treatment that will stop the progression of the pathological process and restore the functioning of the nervous system. If the negative factor continues to act, the condition may worsen or the treatment may become ineffective.

Diagnostics

As has already become clear, the diagnosis of OPCN is not a sudden discovery of “something in the head” against the background of complete health. This is a whole history of the treatment of a disease that may have been cured, but the consequences remained – both in terms of complaints and in terms of an objective assessment of the functioning of the nervous system.

In recent years, neuroimaging techniques have been widely used: computer and magnetic resonance imaging, angiography with contrast, myelography . Of course, diagnosing cognitive impairment and consequences from higher cortical functions involves, for example, testing for memory, attention, concentration, vocabulary, exhaustion, and so on. The results are also important for making the diagnosis of OPCNSL.

Clinical picture of acute hypertension

There are practically no specific symptoms that appear with organic brain damage. This is due to the fact that any manifestation depends on the underlying disease, which led to brain damage.

You can identify symptoms that will be characteristic of almost all concomitant pathologies:

• decreased activity;
• apathy, lack of interest in something;
• sloppiness appears.

Memory loss is a rarer symptom, but also occurs. Patients may forget the names of their relatives or friends, or their appearance. There is a violation of counting and people will not be able to list the numbers from 1 to 10 or remember the sequence of days of the week.

Violations of writing and speech are manifested in the rearrangement of syllables and words. In the most severe cases, a person will not be able to speak independently, but will only be able to repeat a small phrase that he hears. Emotionally, there are several possible outcomes.

Or the person becomes kind of unemotional, reacting to everything too calmly, which can’t help but be noticeable. Or, on the contrary, the manifestation of emotions is inadequate and perverted. Hallucinations may occur.

Treatment

There is a certain paradox: OPCNS are persistent and lifelong. Timely and competent treatment of the cause, or underlying disease, can lead to the fact that the organic lesion simply does not form. On the other hand, if a massive focus of necrosis has already appeared in the brain due to a major stroke, then this change occurs immediately and forever, since it is determined by the pathogenesis of the disease itself.

If it is unknown whether there will be any consequences or not, then they are not talked about yet: therefore, while a person is sick, for example, with meningitis, and this underlying disease is being treated, then there is no diagnosis of OPCNSL, and there is nothing to treat.

Only after a year or more, if the complaints persist, the presence of an organic lesion is detected, and the treatment also becomes “chronic” in nature. Organic consequences and changes tend to occur in waves, with periods of exacerbations and remissions. Therefore, the treatment is palliative. Sometimes they say that symptomatic treatment is carried out, since this process is lifelong. You can get used to it, but you can get rid of it only by transplanting a new head.

Perinatal organic damage

Perinatal damage is a condition that occurs when adverse factors influence the still unformed brain of the fetus or newborn:

• complications during pregnancy;
• injuries during childbirth;
• asphyxia;
• diseases of infectious nature;
• blood diseases in newborns.

These reasons will contribute to the appearance of hypoxic-ischemic brain lesions and intracranial hemorrhages. Such complications often lead to residual lesions, which can appear very quickly or, on the contrary, constantly and slowly progress.

Perinatal childhood organic brain lesions have the following symptoms:

• headache;
• irritability;
• dizziness;
• increased excitability;
• insomnia;
• decreased concentration;
• surges in intracranial pressure.

All these symptoms are not constant values ​​and can progress. Deterioration of the condition can lead to diseases such as cerebral palsy, neuropathies of various origins, hydrocephalic syndrome, and epilepsy.

However, it is worth noting that some pathologies can be reversible with the right lifestyle and nutrition. Therefore, it is very important to consult a doctor for help at the initial stages in order to begin treatment as early as possible and in the future forget about any manifestations of organic brain damage.

Description and development of organic personality disorder

The main and most important condition for diagnosing an organic personality disorder is the presence in the anamnesis of any damage to the brain tissue of a mechanical, infectious or other origin. The more significant and widespread the damage, the more severe the symptoms of organic personality disorder will be.

If the affected area is small, the remaining cells can compensate for its function, and the person will not feel difficulties in cognitive processes, thinking, or speaking. But in the case of severe emotional stress or other stressful situations, such an illness can go into the decompensation phase with the unfolding of the classic clinical picture of an organic personality disorder.

The disease develops over many years, and some become accustomed to the personality changes. At some stage, the disorder reaches social maladjustment, and in this case it is much more difficult to help the patient. Therefore, prescribing and receiving appropriate treatment will give a person precious time for a quality life.

The mechanism of development of an organic disorder is hidden at the cellular level. Neurons damaged by disease or injury lose their ability to perform their functions fully, and signals are delayed. Naturally, other brain cells will try to take over part of the function of the injured area, but this is not always possible, especially if the affected area is quite large. First of all, thought processes, cognitive function, and intelligence suffer.

Exact statistics cannot be confirmed, since organic personality disorder occurs as a comorbidity with many others. Often it is not even diagnosed due to the severity of the underlying diagnosis.