Clinical Neuroscience

[Neurological complications of congenital vitium]

PÉTER Ágnes1, SZUTRÉLY Gyula1

NOVEMBER 01, 1959

Clinical Neuroscience - 1959;12(11)

[62 patients with congenital vitium were observed. Of these, 41 underwent regular neurological and 28 EEG examinations. Neurological complications were found in more than 50% (23) of the 41 cases, a higher percentage than the average reported in the literature. It is our hypothesis that to understand the pathomechanism of neurological lesions associated with congenital vitium, patients should be divided into two groups : 1) those in whom cerebral lesions are due to altered haemodynamic conditions and 2) those in whom hypoxaemia is the impairing factor. We analysed the clinical signs produced by hypoxaemia in our patient population and inferred the hypoxaemic tolerance of the brain. In our patients with non-cyanotic congenital vitium (4), we observed signs of reversible functional alteration of the nervous system on load, reversal of the shunt. However, this acute hypoxaemia led to irreversible damage in only one patient with vitium associated with sacer. In our neurologically negative cyanotic patients (6), we attributed the absence of symptoms to compensatory factors (vasodilatation, polyglobulia, etc.) for hypoxaemia. We found that polyglobulia does not parallel the degree of hypoxaemia. It is likely that these two compensating factors interact to varying degrees. Our neurologically negative cyanotic patients provide evidence that chronic hypoxaemia does not imply chronic hypoxydosis. We divided our cyanotic neurologically positive patients into 2 main groups, the complicated compensated adapted and the decompensated adapted. The former group includes 2 patients with cerebral abscesses. These are examples of damage caused by factors that confer adaptation. We have also found symptoms of cerebral anaemia as an acute manifestation of adaptations decompensated to exertion in our cyanotic patients. However, in these patients, unlike in non-cyanotic patients with vitium, we detected a certain percentage of irreversible lesions in the form of abnormal EEG even without loss of consciousness. We found two basic types of adverse effects of chronic hypoxaemia. Both are mainly reflected in EEG lesions. One is the consequence of serial loss of consciousness, the other is the cumulative effect of reversible impairment induced by acute hypoxaemia.]

AFFILIATIONS

  1. Budapesti Orvostudományi Egyetem Neurológiai Klinika és az Országos Cardiologiai Intézet Gyermek Osztály

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