Psychologist instead of antipyretics. How to calculate thermoneurosis?

The temperature has remained at just over 37°C for several weeks. Wait to swallow antipyretics or worse, antibiotics. Perhaps the reasons for this condition are psychological.

Our expert is a leading researcher in the laboratory of pathology of the autonomic nervous system of the Research Institute of Neurology of the Research Center of the First Moscow State Medical University. I. M. Sechenova, Doctor of Medical Sciences Elena Akarachkova :

For a prolonged increase in temperature against the background of emotional problems, there is a special term - thermoneurosis. Neurologists are involved in its correction. However, before this diagnosis is confirmed, the patient will have to go a long way, and must first contact a therapist.

On a note

Prolonged fever is often experienced by:

Women during menopause . Hormonal changes cause an imbalance in the autonomic nervous system, and at this time women are prone to depression and anxiety.

Lovers of strength exercises . After heavy exercise, lactic acid is produced in the muscles. If there is a lot of it, tissue metabolism is disrupted, which leads to a local increase in temperature. In a healthy person it does not last long. But, if there are problems with autonomic regulation, overtraining can become a provoking factor that will lead to long-term low-grade fever.

Sensitive children .
The situation when a child goes to school after the holidays, and a few days later his temperature suddenly rises, is quite common. Involvement in the educational process is stress, due to which the autonomic nervous system fails. Source

Symptoms of vegetative-vascular dystonia

VSD syndrome can be of a constitutional nature, occurs against the background of endocrine changes, or develops with organic lesions of the central nervous system. Signs of constitutional VSD are:

• sweating;
• rapid change in skin color;
• fluctuations in heart rate and blood pressure;
• causeless rises in temperature to 39.0-37.10.

Patients do not tolerate physical and mental stress and changing weather conditions well.

The VSD syndrome, which developed during puberty against the background of endocrine dysfunction, is characterized by the following manifestations:

• vegetative-vestibular crises, which begin with dizziness and occur with a predominance of vagoinsular symptoms;
• hunger, thirst, libido;
• thermoregulation disorders, pathological paroxysmal drowsiness;
• attacks of temporal lobe epilepsy.

Hypothalamic syndrome is characterized by various combinations of autonomic, endocrine, metabolic and trophic disorders, which are caused by damage to the hypothalamus and its closest connections. Characteristic symptoms of VSD in women in the acute stage:

• ·early menopause;
• changes in the thyroid gland of hypothalamic origin;
• acromegaloid phenomena.

The electroencephalogram reveals changes that indicate the involvement of deep brain structures in the process. Damage to the hypothalamus is characterized by sleep and wakefulness disorders in the form of difficulty falling asleep, drowsiness during the day and superficial restless sleep at night.

When the connections between the hypothalamus and the temporal lobes of the brain are damaged, symptoms of temporal lobe epilepsy appear:

• aura 1–3 minutes with sensations of peristalsis, nausea, abdominal pain;
• pain in the heart area, rapid heartbeat, arrhythmia;
• labored breathing;
• increased salivation;
• involuntary chewing, swallowing;
• sweating followed by loss of consciousness and tonic-clonic convulsions.

If connections with the brain stem are affected, neurologists determine dilation of the pupils, dysfunction of the reticular formation with signs of narcolepsy, a neurological disorder in which a person loses the ability to control his own condition), cataplexy (a state of sudden loss of muscle tone while fully maintaining consciousness). Patients' sleep and wakefulness are disturbed.

The similarity of some symptoms of VSD with signs of endocrine diseases is the reason why doctors at the Yusupov Hospital conducted additional examinations. The manifestation of adrenergic crises creates the need to exclude pheochromocytoma. To exclude it, patients undergo suprarenography, pyelography, computed tomography, and scintigraphy. A urine test is performed during an attack to determine the level of catecholamines.

With VSD, there are no organic changes in all body systems; at the same time, functional disorders are determined, especially in the cardiovascular and digestive systems. Symptoms of VSD are most pronounced during an exacerbation.

Patients present the following complaints:

• weakness, fatigue, lethargy, especially in the morning;
• unpleasant sensations, discomfort or stabbing, pressing, burning, squeezing pain in the heart area of ​​varying intensity;
• sensations of lack of air, dissatisfaction with inhalation, cough;
• anxiety, sleep disturbances, restlessness, irritability, excessive concentration of attention on the unpleasant symptoms of one’s illness;
• frequent headaches, dizziness;
• increased sweating;
• lability of blood pressure and vascular tone.

Depending on the prevailing changes in vascular tone, normotensive, hypotensive, hypertensive and mixed types of vegetative-vascular dystonia are distinguished. With the hypotonic type of VSD, signs of vascular insufficiency come to the fore. Blood pressure is below 100/60 mmHg. The patient is concerned about rapid fatigue, weakness, and a tendency to change blood pressure when moving the body from a horizontal to a vertical position. Fainting often occurs, preceded by darkening of the eyes and dizziness.

With the hypertensive type of VSD, blood pressure rises to more than 140/90 mm Hg. The leading complaints are:

• headache;
• fast fatiguability;
• rapid heartbeat, up to paroxysmal tachycardia.

In the area of ​​the heart, areas of increased pain sensitivity are sometimes identified. Hypotonic and hypertensive types of VSD are accompanied by redness of the skin of the neck and face, coldness of the extremities, and marbling of the skin pattern.

If the patient is bothered by pain in the heart area, sometimes sharp, burning, stabbing, often poorly localized, palpitations, a feeling of interruptions in the work of the heart - this is a cardiac type of VSD.

How to diagnose and how to treat?

As a rule, diagnostic measures for a child with a complaint of low-grade fever include hardware and laboratory research methods:

• examination of ENT organs using appropriate instruments;
• blood test: general, serological and biochemistry;
• sputum examination;
• if necessary, radiography and CT;
• Ultrasound diagnostics;
• echocardiography.

Based on the results of a comprehensive examination, the otolaryngologist makes a diagnosis and makes appropriate prescriptions.

Residents of Kaliningrad can make an appointment with a pediatric otolaryngologist by filling out a preliminary application on our website or calling: +7 (4012) 357-773 or +7 (4012) 973-100.

Neurotrophic form

The neurotrophic form includes various trophic disorders due to damage to the hypothalamus: trophic ulcers, focal or diffuse edema of different parts of the body (especially in combination with vegetative-vascular crises), brittle nails, osteoporosis, osteodystrophy, some types of alopecia /hair loss/. In its pure form, the neurotrophic form is rare, and trophic disorders are included in the structure of other forms of hypothalamic syndrome, more often in the neuroendocrine-metabolic form.

Development mechanism

Normally, the thermoregulation system, the central link of which is located in the hypothalamus, maintains a constant thermal balance, independent of the ambient temperature. High temperature is caused by an increase in heat production processes - increased breakdown of fats and carbohydrates with the release of energy, contractile muscle thermogenesis. The situation is aggravated in the case of heat transfer disorders: impaired sweat secretion, narrowing of skin blood vessels. Hypothermia is characterized by opposite changes: increased heat transfer, decreased heat production.

Fever, as a special reaction of the body to infectious and non-infectious causes, has a unique development mechanism. For its occurrence, it is necessary to accumulate pyrogens in the bloodstream - special chemical compounds that act on the thermoregulation center and provoke a rise in temperature. These substances include exogenous factors - decay products of microbial cells and exotoxins, as well as endogenous cytokines - special blood serum proteins that are pro-inflammatory mediators. At the same time, a balance is maintained between production and heat transfer.

Clinical manifestations

Attention! The main manifestation of this pathological condition is the appearance in the field of vision of floating spots, dots and stripes, which become visible when looking at light, bright objects:

• “spots” and opacities are of a constant nature, size and shape;
• such optical effects are noticeable when looking at light surfaces and are not detected in the dark or with closed eyes;
• in the presence of multiple opacities, increased fatigue, headaches, decreased contrast sensitivity and a gradual deterioration in visual acuity are often observed;
• As the disease progresses, individual stripes and spots can merge with each other, forming large conglomerates that cause loss of certain areas of the visual fields.

How to alleviate the child's condition?

Several recommendations will help your child cope with this unpleasant condition. They are aimed at increasing heat transfer and reducing heat production. In practice, this can be done as follows:

• provide the child with bed rest or a minimum of physical activity;
• try to control the child’s emotions, screams and tantrums contribute to an increase in temperature;
• feed the child as desired, do not insist on feeding if he does not want to eat;
• Monitor the temperature of food, it is also better to avoid hot drinks (no more than 40°C);
• maintain an optimal climate in the room, namely about 20° (+/-2°);
• Give your child plenty of drink, it can be water, compote, juice, tea with raspberries.

These tips will help your child cope with low fever. However, parents should monitor the situation so that if the child’s condition worsens, they can take adequate measures.

Establishing diagnosis

To accurately make such a complex diagnosis requires a high-quality and modern approach. After all, an increase in temperature without the presence of a viral infection or inflammatory process can be caused by other diseases.

Before a specialist diagnoses thermoneurosis, he must exclude the following diseases and conditions:

• disruption of the thyroid gland;
• pregnancy;
• chronic tonsillitis;
• tuberculosis;
• caries and many others.

If the doctor excludes all other options for elevated body temperature, then a diagnosis of thermoneurosis is made. However, only a neurologist can make such a precise diagnosis when a dysfunction of the hypothalamus is identified.

Aspirin test

The most effective method for diagnosing thermoneurosis is to use Aspirin, the intake of which reduces body temperature only if there is a focus of inflammation in the body.

Therefore, if after taking Aspirin the temperature does not decrease, then the likelihood of this particular disease is high.

To make an accurate diagnosis, the examination must be comprehensive. After all, an increase in body temperature can even be caused by malignant neoplasms.

Additional examination methods

The specialist should prescribe the following studies:

• encephalogram;
• ultrasound diagnostics;
• visits to specialized specialists such as a gynecologist, endocrinologist and infectious disease specialist;
• Conducting laboratory blood tests for the presence of infections.

Neuroendocrine-metabolic form | Hypothalamic syndrome

The neuroendocrine-metabolic form of the hypothalamic syndrome is characterized mainly by endocrine disorders due to loss or increased secretion of hormones of the anterior pituitary gland.

The following diseases may occur.

Diabetes insipidus

1) diabetes insipidus (polyuria, polydipsia, dry mouth, general weakness);

Adiposogenital dystrophy

2) adiposogenital dystrophy - Pechkranz-Babinsky-Fröhlich syndrome (nutritional obesity, increased appetite, hypogenitalism, general weakness, various endocrine disorders);

Frontal hyperostosis

3) frontal hyperostosis - Morgagni-Stewart-Morel syndrome (hyperostosis of the internal plate of the frontal bone, amenorrhea, obesity, virilism);

Juvenile basophilism

4) juvenile basophilism - prepubertal basophilism (obesity, increased blood pressure / arterial hypertension /, stretch marks / stretch marks / on the skin;

Pituitary cachexia

5) pituitary cachexia - hypothalamic-pituitary cachexia, panhypopituitarism, Simmonds syndrome (rapid decrease in body weight by 1.5 - 2 times with the development of cachexia / exhaustion /;

Malignant exophthalmos

6) malignant exophthalmos - exophthalmic ophthalmoplegia (slowly progressive exophthalmos without thyrotoxicosis, at first it can be one-sided, oculomotor disorders, more often external ophthalmoplegia, diplopia, possible keratitis, atrophy of the optic discs);

Precocious puberty

7) premature puberty (pubertas praecox) - more often manifested in girls by the early development of secondary sexual characteristics, often combined with the following symptoms: high growth, bulimia, polydipsia, polyuria, sleep disturbance (insomnia), changes in the emotional-volitional sphere / children become rude, cruel, evil, have a tendency towards vagrancy, theft, antisocial violations/;

Delayed puberty

delayed puberty – occurs mainly in boys during adolescence and is manifested by female-type obesity, hypogenitalism, lethargy, and decreased initiative;

Gigantism

9) gigantism is a disease that is characterized by the presence in adolescents and children of open epiphyseal growth zones with excessive secretion of self-tropic hormone (STH), height in boys and young men reaches more than 200 cm, and in girls and women more than 190 cm;

Acromegaly

10) acromegaly - Marie syndrome, or Marie-Lery syndrome - is a neuroendocrine syndrome caused by a significant increase in the secretion of somatotropic hormone of the anterior pituitary gland; the syndrome was first described in 1886 by P. Marie; and in most cases it is associated with an eosinophilic pituitary adenoma, sometimes acromegaly can develop after traumatic brain injury, intoxication, infection, stressful conditions; there is an increase in the size of the hands, feet, facial skeleton, nose, tongue, ears, and internal organs;

Dwarfism, dwarfism

11) nanism / dwarfism / - (nanos - dwarf) is a clinical syndrome manifested by extremely short stature (compared to the gender and age norm), occurs relatively often, causing mental distress in both the child and his parents, especially against the background acceleration in other children, often manifests itself in combination with other developmental defects (hydrocephalus, microcephaly, mental retardation, eye changes), in patients with chromosomal syndromes (Down disease, where, along with dwarfism, there are multiple developmental anomalies);

Itsenko-Cushing's disease

12) Itsenko-Cushing's disease (pituitary basophilism, Cushing's disease) develops due to excessive release of adrenocorticotropic hormone (ACTH) by the pituitary gland; first described by N. M. Itsenko and H. W. Cushing; occurs more often with basophilic pituitary adenoma, traumatic brain injury, inflammatory diseases of the brain, long-term use of large doses of corticosteroids or ACTH, manifested by symptoms of hypercortisolism (uneven obesity, moon-shaped face, fat deposits in the neck, upper half of the body, skin trophic disorders, osteoporosis , increased blood pressure, amyotrophy in the proximal limbs, intracranial hypertension, pyramidal and brainstem symptoms);

Lawrence-Moon-Bardet-Biedl syndrome

13) Lawrence-Moon-Bardet-Biedl syndrome is a hereditary diencephalic-retinal pathology, which includes Lawrence-Moon syndrome (first described in 1866 by JZ Laurence and R. Ch. Moon) and Bardet-Biedl syndrome (first described by G. Bardet in 1920 and A. Biedl in 1922), the type of inheritance is autosomal recessive and polygenic determination, the main symptoms of Lawrence-Moon syndrome are mental retardation, pigmentary retinopathy, hypogenitalism, spastic paraplegia, Bardet-Biedl syndrome - mental retardation, pigmentary retinopathy, hypogenitalism, obesity, polydactyly.

Symptoms of VSD in the acute stage

The cardiovascular symptom complex in VSD is manifested by the following symptoms:

• changes in heart rate;
• lability of blood pressure;
• pathological vasomotor reactions (redness, cyanosis, pallor of the skin, hot flashes, chilliness of the feet and hands).

In the acute stage, burning, stabbing, pressing, throbbing pain or discomfort in the heart area is observed.

The respiratory symptom complex is manifested by increased ventilation (rapid deep breathing), psychogenic shortness of breath (sniffling, yawning, coughing, periodic deep breaths). Hyperventilation always accompanies anxiety. Shortness of breath is accompanied by dissatisfaction with inhalation, a feeling of lack of air, intermittent breathing, and a feeling of stopping breathing. In the acute stage, muscle spasms and a crawling sensation around the mouth and in the distal limbs occur. Neurologists define Chvostek's symptom - contraction of the muscle that raises the corner of the mouth when tapped in the projection of the facial nerve. Hyperventilation may cause the following symptoms:

• headache;
• fainting state;
• pain in the heart area;
• heart rhythm disturbance;
• abdominal pain, combined with increased peristalsis, nausea, and belching of air.

The gastrointestinal symptom complex is characterized by a disorder of the functions of the digestive organs. May exhibit the following symptoms:

• disturbances of appetite, motility of the esophagus, stomach or intestines;
• psychogenic dysphagia (difficulty, discomfort during the act of swallowing or the inability to take a sip);
• vomiting;
• feeling of heaviness in the epigastrium;
• transient flatulence (bloating);
• diarrhea;
• pain in the abdominal cavity.

The thermoregulatory symptom complex is manifested by an increase or decrease in temperature, chill syndrome. The vasomotor symptom complex consists of several symptoms:

• pallor, cyanosis of the skin;
• chilliness of hands, feet;
• sensations of hot or cold flashes;
• changes in dermographism (weak mechanical irritation of the skin when carried out with a blunt object causes a trace in the form of inflamed swelling);
• increased sweating of the palms and feet.

The genitourinary complex is characterized by cystalgia (frequent, painful, imperative urination in the absence of pathology of the urinary system or changes in urine) and sexual dysfunction (impaired erection or ejaculation in men, vaginismus or anorgasmia in women with preserved or reduced libido, painful menstruation). Hormonal fluctuations, including endocrine changes in the body after childbirth, and postpartum stress provoke an exacerbation of VSD symptoms.

The neurotic symptom complex is manifested by the following symptoms:

• fatigue;
• asthenia;
• low threshold of pain sensitivity;
• sleep disorders;
• irritability;
• senestopathies (pain in the heart, a feeling of dissatisfaction with inhalation, a burning sensation in different parts of the body).

VSD occurs with a wave-like increase and decrease in the manifestations of symptom complexes. This is due to changes in etiological factors and living conditions of the patient. An exacerbation of VSD may occur in the fall. Symptoms of the disease are most pronounced during a “vegetative storm” or crisis.

What diseases can fever indicate?

We list possible diseases from simple to the most serious, which are manifested by low-grade fever:

• infectious diseases in chronic form: sinusitis, tonsillitis, otitis media, herpes;
• oncological: leukemia, lymphoma, hepatoma, etc.;
• autoimmune: arthritis, vasculitis, lupus, scleroderma;
• endocrine and metabolic disorders: diabetes mellitus, thyrotoxicosis, hyperthyroidism, pheochromocytoma, etc.;
• digestive tract infections: gastroenteritis.