Organic emotionally labile disorder is a mental disorder that occurs after complications of pregnancy or childbirth, severe infection, or organic brain disease (trauma, tumor, stroke). Characterized by pronounced emotional incontinence and lability (instability, rapid change) of a person’s mood.
The diagnosis and treatment of this disorder should be carried out jointly by a psychiatrist (or psychotherapist) and a neurologist.
The disorder is also called asthenic (from the Greek asthenia - weakness, impotence). In addition to constant and severe mood swings, patients are characterized by general weakness, fatigue, headache, and dizziness. A person may get tired after 2-3 hours of work, cannot stand a full day of work, and several times a day there is a need to lie down to rest.
According to the international classification of diseases, ICD-10 is coded as F06.68 - “Organic emotionally labile asthenic disorder due to mixed diseases.” Its most common causes include:
- head injury
- pregnancy and childbirth of the mother, which occurred with complications (toxicosis, threat of miscarriage, eclampsia)
- severe condition of the child after birth (for example, the baby was given mechanical ventilation), severe illnesses/infections of early childhood
- vascular diseases of the brain (atherosclerosis, hypertension, cerebrovascular accidents - strokes)
- epilepsy
- brain tumors
- HIV infection
- neurosyphilis and other neuroinfections, encephalitis (inflammation in the brain)
- intoxication with drugs, alcohol
- consequences of anesthesia
Description of residual organic damage to the central nervous system
As you know, the central nervous system is a coherent system in which each of the links performs an important function. As a result, damage to even a small area of the brain can lead to disruption in the functioning of the body. In recent years, damage to nervous tissue has been increasingly observed in pediatric patients. To a greater extent, this applies only to born babies. In such situations, a diagnosis of “residual organic damage to the central nervous system in children” is made. What is it and is this disease treatable? The answers to these questions worry every parent. It is worth keeping in mind that such a diagnosis is a collective concept that can include many different pathologies. The selection of therapeutic measures and their effectiveness depend on the extent of the damage and the general condition of the patient. Sometimes residual organic damage to the central nervous system occurs in adults. Often, pathology occurs as a result of previous injuries, inflammatory diseases, and intoxication. The concept of “residual organic damage to the central nervous system” implies any residual effects after damage to nerve structures. The prognosis, as well as the consequences of such a pathology, depend on how severely the brain function is impaired. In addition, great importance is attached to topical diagnosis and identification of the site of damage. After all, each of the brain structures must perform certain functions.
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.
Causes of residual organic brain damage in children
Residual organic damage to the central nervous system in children is diagnosed quite often. The causes of nervous disorders can occur both after the birth of a child and during pregnancy. In some cases, damage to the central nervous system occurs due to complications of childbirth. The main mechanisms for the development of residual organic damage are trauma and hypoxia. There are many factors that provoke nervous system disorders in a child. Among them:
- Genetic predisposition. If parents have any psycho-emotional disorders, then the risk of their development in the baby increases. Examples include pathologies such as schizophrenia, neuroses, and epilepsy.
- Chromosomal abnormalities. The cause of their occurrence is unknown. Incorrect DNA construction is associated with unfavorable environmental factors and stress. Due to chromosomal abnormalities, pathologies such as Down's disease, Shershevsky-Turner syndrome, Patau, etc. occur.
- The impact of physical and chemical factors on the fetus. This refers to unfavorable environmental conditions, ionizing radiation, and the use of drugs and medications.
- Infectious and inflammatory diseases during the formation of the nervous tissue of the embryo.
- Toxicoses of pregnancy. Late gestosis (pre- and eclampsia) is especially dangerous for the condition of the fetus.
- Impaired placental circulation, iron deficiency anemia. These conditions lead to fetal ischemia.
- Complicated childbirth (weakness of uterine contractions, narrow pelvis, placental abruption).
Residual organic damage to the central nervous system in children can develop not only during the perinatal period, but also after it. The most common cause is head trauma at an early age. Risk factors also include taking drugs that have a teratogenic effect and narcotic substances during breastfeeding.
The occurrence of residual organic brain damage in adults
In adulthood, signs of residual organic damage are observed less frequently, however, they are present in some patients. Often the cause of such episodes is trauma received in early childhood. At the same time, neuropsychic abnormalities are long-term consequences. Residual organic brain damage occurs for the following reasons:
- Post-traumatic illness. Regardless of when the damage to the central nervous system occurs, residual symptoms remain. These often include headaches, seizures, and mental disorders.
- Condition after surgery. This is especially true for brain tumors, which are removed using nearby nerve tissue.
- Taking drugs. Depending on the type of substance, the symptoms of residual organic damage may differ. Most often, serious disorders are observed with long-term use of opiates, cannabinoids, and synthetic drugs.
- Chronic alcoholism.
In some cases, residual organic damage to the central nervous system is observed after inflammatory diseases. These include meningitis and various types of encephalitis (bacterial, tick-borne, post-vaccination).
Mechanism of development of central nervous system lesions
Residual damage to the central nervous system is always caused by unfavorable factors that preceded it. In most cases, the basis for the pathogenesis of such symptoms is cerebral ischemia. In children, it develops during the period of intrauterine development. Due to insufficient blood supply to the placenta, the fetus receives little oxygen. As a result, the full development of nervous tissue is disrupted, and fetopathy occurs. Significant ischemia leads to intrauterine growth retardation and the birth of a child before the gestational age. Symptoms of cerebral hypoxia can appear already in the first days and months of life. Residual organic damage to the central nervous system in adults often develops due to traumatic and infectious causes. Sometimes the pathogenesis of nervous disorders is associated with metabolic (hormonal) disorders.
Syndromes with residual organic damage to the central nervous system
In neurology and psychiatry, several main syndromes are distinguished, which can occur either independently (against the background of a brain disease) or be regarded as a residual lesion of the central nervous system. In some cases, a combination of these is observed. The following signs of residual organic damage are distinguished:
- Cerebrasthenic syndrome. Its manifestations are considered to be increased fatigue, unsatisfactory mastery of the school curriculum, general weakness, tearfulness, and mood changes.
- Neurosis-like syndrome. It is characterized by the development of phobias, enuresis (uncontrollable urination at night), and motor agitation (tics).
- Hyperactivity and attention deficit disorder. It is observed in children of primary and secondary school age.
- Encephalopathy. The main manifestations are sleep disturbance, loss of memory, and perseverance. In severe cases, focal neurological symptoms and seizures are observed.
- Psychopathy. Characterized by disobedience and aggressiveness. In adulthood – mood lability, hysterical reactions, antisocial behavior.
Most often, cerebral hypoxia leads to diffuse symptoms, when the listed syndromes are combined with each other and are not very pronounced. The predominance of focal symptoms is rarely observed.
Representation of residual encephalopathy according to ICD-10
Residual encephalopathy is a brain pathology due to the death of CNS cells
As noted above, residual encephalopathy is a lesion of the central nervous system, which is expressed in the death of brain cells and the consequences that follow this process.
Diagnoses with the name of this disease are not very uncommon in neurological practice, so its consideration has always been relevant to the general public. Factors in the development of pathology can be completely different phenomena - from injuries to birth defects, but in any case, cell death will be of a residual nature (that is, persistent).
ICD-10, the basic international classifier of human diseases, considers residual encephalopathy rather controversially, giving doctors and ordinary people the opportunity to characterize this disease with different codes.
In general, the pathology is assigned the coding “G93.4”, which equates it to any encephalopathy of unspecified pathogenesis.
However, if certain factors are present, the diagnosis of “residual encephalopathy” can be considered under other codes, namely:
- G93.8 (damage to central nervous system cells in the brain under the influence of radiation)
- T90.5 (traumatic pathogenesis of nerve cell death)
- T90.8 (traumatic pathogenesis of nerve cell death)
In most medical institutions, neurologists assign the described coding to residual encephalopathy. In addition to the classification according to the ICD, when making a diagnosis of the disease in question, doctors must indicate the reasons for its development and the nature of its manifestation.
Main causes of pathology
A variety of factors and causes can cause pathology
Since residual encephalopathy refers to versatile lesions of the central nervous system that persist for a long time in the brain, there are many causes for this disease.
The main causative factors of pathology include:
- birth and congenital anomalies (with perinatal lesions)
- brain injuries (for traumatic lesions)
- pathologies of brain development - Arnold-Chiari malformation or hydrocephalus, for example (with dysontogenetic lesions)
- previous neuroinfection (with neuroinfectious lesions)
- previous neurosurgical operations (for acquired lesions)
- a number of serious diseases of the body and brain in particular (stroke, diabetes, disorders of the liver or kidneys, etc.)
It should be noted that the reasons discussed above are only a relatively small part of the factors that can provoke the development of residual encephalopathy.
This disease, under certain circumstances, can also arise under the influence of other factors traumatic to the central nervous system, which, after the end of their effect on the human body, leave corresponding neurological symptoms.
Signs and symptoms of brain damage
The severity and nature of the symptoms of residual encephalopathy directly depend on the severity of the damage to the central nervous system. Since there are a huge number of causes and types of this disease, the signs of its manifestation can be varied.
Symptoms depend on the location of the main lesion
The main and most common symptoms of persistent encephalopathy include:
- chronic headaches
- dizziness and other disturbances in coordination of movements
- increased weakness
- severe fatigue when doing normal activities
- frequent mood swings
- sleep problems
- memory impairment
- weakening of thinking abilities
- increased frequency of limb spasms
With severe brain damage, the signs of the disease are often supplemented by:
- Parkinson's syndrome
- increased arterial and intracranial pressure
- epileptic seizures
- pseudobulbar syndrome
Assessing the symptoms manifested when identifying residual encephalopathy plays an important role, but in the absence of other diagnostic methods it is often meaningless.
As practice shows, it is almost impossible to accurately identify this disease solely at the stage of collecting an anamnesis.
For high-quality and most accurate diagnosis, it is also important to identify neurological deficits through instrumental research methods. Otherwise, the patient’s complaints are only indirect signs of residual encephalopathy, which are definitely not enough to begin therapy for this particular pathology.
Clinical picture of CNS damage
Most often, symptoms of residual organic damage to the central nervous system appear some time after exposure to an unfavorable factor. With perinatal fetal hypoxia, disturbances can be noticeable already in the first month of life. Depending on the extent of the damage, the following symptoms may be observed:
- Minor damage to nervous tissue: tearfulness, poor sleep, memory loss. At school age, a child may experience attention deficit hyperactivity disorder, a tendency to hysterical states, and phobias.
- Damage to the central nervous system of moderate severity has such manifestations as constant crying, breast refusal, convulsive syndrome, and enuresis.
- In severe cases, focal neurological symptoms are observed. This includes muscle weakness, paresis and paralysis of the limbs, delayed physical and mental development, generalized convulsions, etc.
Residual organic damage to the central nervous system: code according to ICD-10
Like all pathologies, disorders of neuropsychic development have a specific code in the international classification of diseases. It is worth understanding the broadness of the concept of “residual organic damage to the central nervous system.” The code (ICD-10) for this pathology is G96.9. This code means the diagnosis “unspecified damage to the central nervous system.” In more specific cases, the ICD-10 code changes to a specific nosology.
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.
Residual organic damage to the central nervous system: treatment of pathology
Treatment of residual organic damage is aimed at strengthening the nervous system and rehabilitating a person in society. It is important to understand that the patient’s loved ones must be patient. With the right approach, treatment can significantly improve the prognosis of the disease. Nootropic, sedatives, antipsychotics, tranquilizers and psychostimulants are used as drug therapy. To improve cerebral circulation, solutions of Piracetam, Curantil, and Cerebrolysin are prescribed. Physiotherapeutic treatment, massage, and bioacoustic correction of the brain are also indicated.
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.
