What it is
Graefe's symptom, accompanied by other neurological disorders, signals problems in the functioning of the central nervous system. Many people, trying to independently study this issue, often confuse the concepts of “syndrome” and “symptom” of Graefe in adults and infants. In fact, Graefe's sign (Gs) refers to a neurological symptom that can occur in certain diseases affecting the nervous system, and Graefe's syndrome (Gs) is a collection of neurological symptoms associated with hypertensive-hydrocephalic disease.
Having noticed the presence of pathology in a patient, the specialist assesses his general condition and begins to look for neurological abnormalities in order to establish the correct diagnosis and immediately begin correcting the activity of the central nervous system.
Graefe's symptom is not a disease, but only a manifestation of a neurological disorder or disease, which the doctor must identify.
Causes of Alzheimer's Disease
Alzheimer's disease causes chemical changes in the brain that cause brain cells to die. As brain cells die, a person gradually loses the ability to think and care for himself. That is why this neurodegenerative disease is classified as a progressive pathology. Researchers are constantly learning new facts about brain chemistry. This has led to the development of medications that help reduce the severity of some symptoms of the disease. Modern drugs can significantly improve the condition of patients and increase their quality of life. However, there is still no medicine that can cure the disease completely.
Alzheimer's disease usually occurs in people over 65 years of age. The risk of getting sick increases with age. Family history may also be a risk factor, but the most common form of the disease is not associated with genetic predisposition.
Main symptoms
In medicine, the eyes are not only the organ of vision, which allows us to receive 90% of information from the surrounding world. Their condition allows us to assess the health of the patient’s nervous system. Normally, if a person looks down, his pupil descends in this direction along with the iris. In this case, the eyelids lower unconsciously, clearly following the movement of the eyeball.
The presence of neurological abnormalities makes adjustments to this established scheme: when the eyeball or head moves between the eyelid and the iris, the sclera is visible. This is how Graefe’s symptom manifests itself, first described by a German ophthalmologist back in the 19th century. It looks like this: if the baby looks straight, then there are no visual problems with the eye, but when he gets scared, surprised, or lowers his eyes, a white stripe 2-3 mm wide is visible above the iris. This picture resembles bulging eyes, and for an unprepared person it seems very creepy.
Causes of pathology
Unfavorable conditions can provoke Graefe's symptom in newborns, for example:
- pathological pregnancy;
- difficult, late, protracted labor;
- prematurity;
- birth injury;
- intrauterine oxygen deficiency with fetal growth retardation;
- infectious diseases of the genitourinary system in the mother with subsequent infection of the child;
- congenital brain abnormalities (cyst, dropsy, underdevelopment of brain structures);
- chronic illnesses;
- hereditary predisposition;
- endocrine disorders.
The causes of SpH in adults and elderly people may be hidden in:
- persistently increased level of intracranial pressure;
- infectious diseases affecting parts of the brain (meningoencephalitis, malaria);
- stroke (recent and long ago);
- traumatic brain injuries;
- thyrotoxicosis;
- tumor formations related to brain structures, cancer;
- disrupted metabolic processes.
Main reasons
One of the causes of setting sun syndrome is hypoxia or birth injuries. Its development can be affected by:
- pathologies in the mother that developed late in pregnancy;
- exacerbation of chronic diseases during pregnancy;
- bradycardia or ischemia;
- infectious diseases.
Such a deviation may also appear against the background of illnesses suffered by the baby himself:
- encephalitis or meningitis;
- disturbances in the functioning of the endocrine system;
- spinal cord injuries;
- trauma at birth;
- brain cyst;
- disruptions in the hormonal system.
After diagnosis, the baby is observed by a pediatrician, but in most cases the symptoms completely go away within a few weeks.
Conditions in which Graefe's symptom occurs
In case of prematurity, SpH goes away on its own as the nervous system matures. However, this condition is most often associated with the presence of neurological diseases, which must be identified and treated as soon as possible.
Hydrocephalus
Graefe syndrome in adults and newborns most often causes SpH. This pathology develops when the membranes of the brain secrete a large amount of cerebrospinal fluid and do not have time to absorb it back. In this case, cerebrospinal fluid (CSF) accumulates and puts pressure on the brain tissue, causing severe neurological symptoms. In addition to the strip of sclera in the eyes, the main symptoms of hydrocephalic disease in newborns are:
- weakening of innate reflexes (difficulty with sucking and swallowing, decreased strength of the grasping reflex);
- tremor of the chin and limbs;
- strabismus;
- spitting up like a fountain;
- muscle hypotonia, leading to difficulties in holding the head, drooping arms and legs, lack of physiological flexion-extension hypertonicity);
- marbling of the skin, blueness of the nose, lips and earlobes;
- a noticeable increase in head circumference (in children under one year);
- swelling of the optic discs;
- protrusion of the fontanel.
Sunset syndrome in adults differs from symptoms in newborns, accompanied by:
- frequent attacks of morning headaches radiating to the temples;
- nausea, vomiting;
- attacks of dizziness;
- feeling of constant fatigue;
- difficulty moving the eyeballs and head;
- pale skin;
- the presence of hypertonicity of the muscles of the limbs;
- the appearance of strabismus;
- deterioration of attentiveness, memory, mental activity.
Intracranial hypertension
Intracranial pressure can increase when:
- hydrocephalus;
- venous stagnation, when blood accumulates and compresses the meninges;
- cerebral edema;
- proliferation of tumor formations.
In children, this syndrome manifests itself clearly:
- lack of appetite and weight loss;
- lethargy, moodiness;
- slow overgrowth of the fontanel;
- divergence of cranial sutures;
- bulging and pulsating fontanel;
- muscle hypertonicity;
- seizures;
- spitting up like a fountain.
In adults, symptoms of ICP look like this:
- headache;
- deterioration of vision and memory;
- attacks of dizziness;
- absent-mindedness and inattention;
- drowsiness, lethargy;
- surges in blood pressure.
Kernicterus
Severe damage to brain tissue due to the toxic effects of “indirect” bilirubin often causes SpH. This condition in children is caused by:
- incompatibility of Rh blood;
- toxoplasmosis;
- jaundice of newborns;
- diabetes mellitus in the mother;
- birth injuries;
- sepsis.
Despite the diverse causes of the pathological process, its signs are always the same:
- weakness;
- monotonous crying;
- muscle hypotonicity;
- refusal to eat;
- stiff neck;
- signs of cerebral palsy.
The rapid increase in clinical symptoms leads to a sharp deterioration in the baby’s condition, which can lead to death.
Children with kernicterus should be observed by a neurologist for at least a month. They need rehabilitation to help restore lost brain functions.
Graves' disease
Graefe's symptom in children is often encountered with the development of thyrotoxicosis. The disease is transmitted from a sick mother to the newborn. With toxic goiter, the baby receives a huge amount of immunoglobulins through the umbilical cord, which remain in his blood for up to a year. They are gradually eliminated from the body. Signs of thyrotoxicosis in infants:
- goiter;
- hyperexcitability;
- increased sweating;
- insatiable appetite;
- frequent vomiting and diarrhea leading to weight loss;
- various disorders: Mobius syndrome, the “rising” sun symptom, protrusion of the eyeballs;
- early ossification of cranial sutures.
Symptoms
The main and sometimes only sign of pathology is a white strip of sclera between the iris of the eye and the upper eyelid, noticeable when the patient looks down. If there are no additional symptoms, the disease is considered not dangerous and goes away on its own.
Parents need to show their child to a doctor if bulging eyes and a white stripe above the iris are not the only symptoms.
Graefe syndrome in children is manifested by the following clinical signs:
- Hyporeflexia - decreased grasping and swallowing reflexes,
- Hypotonia - decreased tone of the muscles of the limbs,
- paroxysmal convulsions,
- Small trembling of the whole body,
- With a wandering glance,
- We cry silently,
- Clearly expressed convergent strabismus,
- Decreased visual acuity,
- Changes in the structures of the fundus,
- Frequent regurgitation
- Nystagmus,
- Cyanosis of the skin of the extremities and nasolabial triangle,
- Marbled color of the entire skin,
- Rapid shallow breathing,
- Tachycardia,
- Throwing back the head
- A bulging and tense fontanel,
- Opened seams of the skull,
- Increased head circumference.
As the child grows and develops, the nervous system, like all other organs, is strengthened, and the synthesis of cerebrospinal fluid and intracranial pressure are normalized. The progressive course of the pathology ends with the penetration of cerebrospinal fluid into the venous system, which leads to deafness, blindness, and retardation in psychophysical development. In the absence of timely treatment, the syndrome is complicated by paralysis or epilepsy.
Clinical picture of pathology in adults:
Headaches radiating to the forehead, eyebrow, temples and occurring at night,- Signs of dyspepsia - nausea and vomiting,
- Paroxysmal dizziness,
- General weakness, lethargy, drowsiness,
- Difficulty lowering your eyes
- Hypertonicity of the muscles of the limbs,
- Walking on toes
- Diplopia,
- Slowing down the thinking process
- Impaired memory and concentration.
In order not to miss the onset of serious neurological pathology, when the first clinical signs appear, you must consult a doctor and undergo a full examination.
Diagnostic methods
To make a diagnosis, laboratory and hardware examination methods are used:
- Ultrasound (neurosonography of the brain), EEG, EchoEG, REG, examination by an ophthalmologist assessing the condition of the vessels of the visual organs and fundus of the eye - if hydrocephalus is suspected.
- X-ray, lumbar puncture, general neurological examination - if increased intracranial pressure is suspected.
- Scintigraphy, hormone analysis, ultrasound of the thyroid gland for Graves' disease and the presence of endocrine problems in the mother. With thyrotoxicosis, the level of total T4 and T3 will be elevated.
- Depending on the symptoms of the disease, the following are additionally used: a general analysis of feces and urine, assessing the functioning of internal organs;
- Dopplerography is a method that allows you to examine cerebral vessels and determine the speed of blood flow;
Having received the examination results, the specialist makes a diagnosis and prescribes appropriate treatment.
Therapeutic measures
If Graefe’s symptom in infants is not accompanied by concomitant pathologies affecting the field of neurology, then the prognosis for recovery is positive. The patient's condition does not require medical intervention. The problem should go away without a trace as the baby ages if the following measures are observed:
- established daily routine;
- compliance with personal hygiene rules;
- breastfeeding (if possible);
- visiting a massage parlour;
- physiotherapy.
All this will help strengthen the baby’s nervous system.
If a patient is diagnosed with diseases that cause SpH, then treatment is carried out by a neurosurgeon, neurologist, ophthalmologist, and endocrinologist. This or that disease can be overcome in a comprehensive manner with the help of medications, physiotherapy, and diet.
The treatment protocol for neurological pathologies may include the following medications:
- diuretics, which remove excess fluid from the body naturally (for ICP and hydrocephalus);
- nootropics that normalize the functioning of the central nervous system and metabolic processes occurring in brain tissues and structures;
- multivitamins that strengthen the body's defenses;
- drugs that increase vascular tone and normalize cerebral circulation;
- sedatives;
- antiviral and antimicrobial medications;
- thioreotoxic drugs and radioactive iodine (for thyrotoxicosis).
Not only the health, but also the patient’s ability to live a full life depends on the results of drug treatment. Therefore, the doctor selects the medicine in accordance with the individual characteristics of the body, carefully monitoring reactions to the drug and possible negative effects.
If Graefe's syndrome cannot be treated with medications, surgical intervention (bypass surgery) is used, in which accumulated cerebrospinal fluid is constantly pumped out of the skull.
The following procedures can help improve the patient's condition:
- acupuncture;
- electrophoresis;
- physiotherapy;
- magnetic therapy;
- blue spectrum phototherapy (for kernicterus).
Traditional medicine can also be used to treat neurological disorders, but home recipes should be used after consultation with a specialist. So the most popular means are:
- mint infusion with the addition of hawthorn berries and eucalyptus oil;
- infusion of nettle leaves and grass;
- a decoction of dry or freshly picked plantain leaves;
- decoction of licorice root;
- infusion of motherwort, hawthorn, peppermint, valerian, thyme.
Treatment using folk remedies
In newborns, traditional medicine helps normalize the condition of the setting sun symptom. However, these prescriptions should not be considered as primary therapy. They should be used simultaneously with drugs of official medicine in order to increase efficiency.
The following folk remedies help to successfully overcome the signs of setting sun syndrome:
- boiled plantain leaves (you can use both dry and fresh);
- mulberry decoction;
- mint infusion with the addition of a small amount of eucalyptus essential oil and hawthorn berries;
- lemon;
- garlic;
- infusion of string and nettle.
All of these remedies normalize intracranial pressure and effectively combat the symptoms of pathology.
Possible complications
If you do not pay attention to the symptoms of neurological diseases and do not carry out appropriate treatment, serious complications may develop:
- hearing and vision loss;
- urinary and fecal incontinence;
- delayed psychophysical development in children;
- convulsive syndrome (epilepsy);
- paralysis, paresis of limbs;
- coma;
- death.
In order to prevent serious consequences and avoid problems in the future, it is necessary to visit a neurologist in a timely manner and follow all his recommendations. Graefe's symptom is not considered a disease, but its early detection makes it possible to detect hidden neurological pathologies that require emergency medical intervention.
