Bettolepsiya is the passing violations of consciousness stepping on dive of a fit of coughing. The syndrome is shown by kashlevy syncopes: short-term twilight awareness, a faint or the deep loss of consciousness which sometimes is followed by spasms, involuntary urinations and defecation. Methods of diagnostics of a bettolepsiya include inquiry, survey of the patient, functional tests, tool researches (an electrocardiography, an electroencephalography, a bronkhoskopiya). Treatment means performing the symptomatic therapy facilitating a condition of the patient and directed to elimination of displays of the main disease.
The term "bettolepsiya" was for the first time offered by the Soviet neuropathologist M. I. Holodenko in 1941 for interpretation of the paroxysms arising at height of kashlevy attacks. Pathology is observed quite seldom, makes no more than 2% of cases from among all types of paroksizmalny states. Bettolepsiya can meet under the names "kashlevo-brain syndrome", "kashlevy syncopes", "guttural dizziness", "respiratory attack", "kashlevy a faint". It is more often observed at persons with the phenomena of pulmonary heart failure. Mainly men of 45 years suffer and are more senior.
The state arises against the background of a sharp or chronic hypoxia of brain fabrics. The sharp aggravation of already existing lack of oxygen caused by a cough paroxysm becomes its immediate cause. Pathology can be shown at the following diseases:
- Chronic pulmonary pathologies (pulmonary heart, asthma, tuberculosis, emphysema of lungs). At these diseases there is a stagnation in a small circle of blood circulation, pulmonary heart failure develops further. At a dekompensirovanny current development of encephalopathy with tendency to convulsive faints is possible.
- Obstruction of airways (aspiration of foreign matters, whooping cough, sharp laryngitis). Is followed by a sharp brain hypoxia and long attacks of a severe cough which cause episodes of a kashlevy faint.
- Tserebrovaskulyarny frustration. Changes of brain vessels (vascular malformation, a compression of intra cranial and extra cranial veins, ChMT consequences) cause venous hyperaemia of a brain which can be followed by unconscious attacks. Violations of blood supply of a brain at pathology of extra-and intrakranialny arteries (cerebral atherosclerosis, a syndrome of a vertebral artery) threaten with development of a number of vestibular frustration, including consciousness loss.
- Damages of peripheral nerves. At neuralgia of the top guttural nerve pathological impulses lead to activation of the center of the wandering nerve and bradycardia. Sharply the volume of warm emission decreases, there is ischemia of a brain and an unconscious state.
Risk factors in development of attacks of violation of consciousness are smoking, drug addiction, excess weight. At intoxication the changes of a brain, its covers and a likvor leading to violation of activity of respiratory and cardiovascular systems happen alcohol and drugs.
The pathogenesis of a bettolepsiya is up to the end not found out. Usually paroksizmalny states arising at height of a kashlevy reflex have nothing in common with epilepsy. Most fully the changes happening at cough are explained by the haemo dynamic theory. Distinguish three phases of cough: inspiratory, kompressivny and expiratory. Intra chest and intra belly pressure therefore inflow of blood to heart decreases sharply increases in kompressivny and expiratory phases. It leads to reduction of warm emission and changes of pressure of a likvor in a head and spinal cord. Sharp increase in intra chest pressure is resulted by its increase in peripheral arteries, veins and cameras of heart that leads to venous stagnation and causes a bettolepsiya.
There are other mechanisms of development: stimulation of receptors of the wandering nerve, carrying out pathological impulses from reflexogenic areas of airways and jugular veins. Such influences lead to changes of work of a retikulyarny formation that is fraught with vazodepressorny reactions and sharp bradycardia with consciousness violation.
The bettolepsiya syndrome is completely not studied. Despite big prevalence of the diseases and states which are followed by cough, this simptomokompleks meets seldom. Its current can be grouped in clinical manifestations:
1. Short-term twilight disorder of consciousness. Usually several seconds last and does not demand the emergency help. In this case it is necessary to treat the main disease which caused this state.
2. A short faint at cough height. Most often lasts from 2nd to 10 seconds. Therapy of the main pathology is necessary.
3. Long loss of consciousness. Is complicated by spasms, an involuntary urination, defecation. It is often combined with organic damage of a brain with resistant consequences. As the burdening factors serve alcoholic, nicotinic intoxication, poisoning with drugs.
Clinical manifestations can differ not only at different patients, but also each attack can get different options of a current from separately taken patient. Paroksizmalny states - kashlevy syncopes - arise at peak of a kashlevy reflex. Similar simptomokompleks are observed also at laughter, sneezing, a natuzhivaniye, at a raising of weights and so forth. The prodromalny phenomena (predsinkopalny states) in the form of dizziness, noise in ears, violations of sight, hyperaemia of the person which subsequently is replaced by cyanosis, swellings of veins of a neck at cough can precede them. In some cases some harbingers can be absent.
Bettolepsiya is followed by attacks of severe convulsive cough at which height signs of violation of consciousness or a faint appear. Usually emergence of an attack is not connected with position of a body. Cough can provoke a pungent smell, cold air. Duration of twilight consciousness or a deep faint fluctuates from several seconds to 2-5 minutes. At peak of cough consciousness loss usually is followed by falling, most often patients recover without assistance.
The bettolepsiya can sometimes be followed by spasms which have local character: for example, twitchings of the top or lower extremities. Integuments get a grayish and cyanotic shade, plentiful sweating appears. The biting of language at an attack usually is not observed. In rare instances the bettolepsiya leads to an incontience of urine and a calla. At organic damages of a brain kashlevy syncopes can be replaced by small epileptic seizures which do not depend on cough.
In the postsinkopalny period neck pain, a headache can be felt. The patient complains of the general weakness, dizziness which pass eventually. The condition of an oglushyonnost and loss of memory observed during epipristup are not peculiar to a bettolepsiya. In the absence of the burdening factors of a consequence do not cause mental violations.
At a bettolepsiya seldom there are complications. They are usually connected with the main disease which caused a syndrome. One of serious consequences is the accruing pulmonary heart failure. Violations of blood circulation in a brain can lead to permanent defeat of cerebral fabric – hypoxemic encephalopathy. During a kashlevy faint there is a danger of getting injured when falling from height of own growth.
The correct diagnosis requires the comprehensive kliniko-tool examination allowing to establish the reason of kashlevy sinkop, and also to otdifferentsirovat them from other diseases. The diagnostic algorithm includes:
- Consultations of experts (therapist, neurologist, pulmonologist, cardiologist). On reception disease history, character of attacks, their communication with cough is studied. The great value is attached to fizikalny methods. At survey the attention to the general condition of the patient, feature of the constitution (tendency to obesity) is paid.
- Vagusny tests (Valsalva's test, test with pressing on a carotid sine). Are carried out for the purpose of modeling of pathogenetic mechanisms of a sinkopalny state.
- EFI of cardiovascular system. The ECG allows to reveal the pathological processes in heart indicating existence of pulmonary heart failure. In some cases load tests and daily ECG monitoring are used.
- EEG. Gives the chance to record the pathological impulses recognizing certain sites of a brain that is extremely important for an exception of organic cerebral defeats. Functional tests are used for identification of the centers of convulsive activity.
- Methods of assessment of bronchopulmonary system (radiodiagnosis, endoscopy of airways). The X-ray analysis of lungs is applied to detection of chronic diseases of respiratory organs, pulmonary heart. By means of a trakheobronkhoskopiya detection and extraction of foreign matters of a trachea and bronchial tubes is made.
When performing differential diagnostics it is necessary to exclude the consciousness loss caused by orthostatic hypotension, occlusion of brain vessels, epilepsy. Episodes of loss of consciousness at these states are not connected with a kashlevy reflex in any way.
Treatment of a bettolepsiya
During an attack, at a stage of the pre-medical help to the patient, it is required to provide inflow of the arterial blood enriched with oxygen to a brain. For this purpose it is necessary to lay the patient on a back, to hang the head and to raise the lower extremities, to provide free breath and access of fresh air.
Medical assistance consists in the actions directed to reduction of developments of stagnation in a brain, elimination of violations of work of cardiovascular system by introduction of cardiotonics, vasoconstrictive means, and also the medicines improving bronchial passability. At bradycardia enter atropine. Further the patient can be hospitalized in office of neurology or pulmonology for therapy of the main disease.
Forecast and prevention
For prevention of paroksizmalny states it is necessary to watch over the health, at emergence of symptoms of a bettolepsiya in due time to ask for medical care. The diet as excess body weight is one of risk factors is of great importance. It is necessary to avoid the conditions promoting development of faints: long cough, overfatigue, long stay in a standing position, strong tension, sharp movements by the head. Well good rest, gymnastic activity and sport, a hardening influences an organism.