BETTOLEPSY (Greek betto to cough + lepsis a hvataniye, an attack) — disorders of consciousness, sometimes in combination with spasms, developing at height of a tussive attack. The disturbances of blood supply of a brain caused by increase in intrathoracic pressure and a hyperventilation are their cornerstone. Are more often observed at patients with pulmonary and cordial not sufficiency (see. Pulmonary heart ) and venous stagnation in a brain (venous encephalopathy).
Still A. Klementovsky (1856) paid attention to development of a venous hyperemia of a brain at convulsive cough. During cough I. F. Tsion (1873) explained Posineny faces with the fact that blood from veins cannot come to vessels of a thorax.
At the children who died of whooping cough, veins of a brain are expanded, sine are overflowed with blood. The unconscious states described as respiratory attacks happen also during crying, and in time laughter, especially at children (M. B. Tsuker, 1947). A. Trousseau observed the «eclamptic attacks» connected with venous stagnation in a brain at patients with whooping cough.
Sharko (J. The m of Charcot) described also «guttural tabic crises» to which in 1881 the St. Petersburg doctor Shershevsky paid attention. It was talked of fits of coughing with goose breathing at which the patient almost fainted, fell also its epileptiform spasms were observed. The attack repeated to 6 times a day. The throat, across Sharko, is that spazmogenny zone, the irritation a cut can cause an attack. Weight of a current of B. is various, death is possible. Laringoskopicheski during an attack observed closing of a glottis. Sharko described also «guttural dizzinesses» at different diseases.
The patient during cough suddenly faints and falls, but soon recovers. Epileptiform spasms which can be limited to some one area of a body are sometimes observed. Usually the attack quickly comes to an end without the period of mental disturbances, as at epilepsy.
Govere (W. R. Gowers, 1896) described the elderly patient with heavy cough on the soil hron, bronchitis and emphysema. At height of a fit of coughing of the patient flushed, short-term general clonic spasms without loss of consciousness developed, or spasms had epileptoidny character, or there came the loss of consciousness without spasms. Such observation of Govere describes out of communication with a spasm of a throat in chapter devoted to a hyperemia of a brain.
In works of later time it is almost not mentioned disturbance of consciousness at cough. By 1949 only 177 patients from porridges were described by the left faints. N. K. Bogolepov (1971) describes respiratory and cerebral epileptic seizures at patients with bronchial asthma, neuralgia upper mountains - a secret nerve, distinguishing a coma and algichesky
form B. M. And. Holodenko (1941, 1963) who offered the term «bettolepsy» observed over 100 patients with this syndrome.
In B.'s pathogeny a number of factors plays a role:
1. The increase during cough of intrapleural pressure leading to delay of a pulmonary blood-groove, reduction of cordial emission and fluctuations of pressure of cerebrospinal liquid.
2. Individual sensitivity of a brain to a hypoxia and to changes of an acid-base condition of blood (the respiratory alkalosis arising or amplifying during a hyperventilation at cough), especially at a pulmonary heart, emphysema of lungs, bronchial asthma, at disturbances of outflow of blood in system of an upper vena cava.
3. The impulses coming to a brain from reflexogenic zones of respiratory tracts, an upper guttural nerve, carotoid-sinus receptors, aortas, jugular veins.
4. The excitement of the center of a vagus nerve at sharp build-up of pressure in a thorax leading to sharp bradycardia up to development of a syndrome of Morganyi — Adams — Stokes (see. Morganyi-Adams-Stokes syndrome ).
5. The burdening circumstances — internal (various organic diseases of a brain) and external (alcoholic, nicotinic and other intoxications).
Clinical manifestations of B. can be several options: 1) the short-term twilight consciousness coming during cough; 2) a syncope at cough; 3) a deep loss of consciousness in combination with myotonia during cough, sometimes — an incontience of urine and a calla.
The current and B.'s outcome depend, generally on the general somatic condition of the patient. At patients with hron, insufficiency of cerebral circulation because of atherosclerosis, an idiopathic hypertensia B.'s attack can lead to structural damages of a brain with resistant effects.
Treatment is directed to a basic disease. B.'s attack passes usually without foreign intervention in several seconds or minutes. Purpose of antibechic drugs is shown. If during an attack bradycardia is registered, appoint atropine. Also actions for reduction of venous stagnation in a brain are carried out (bloodlettings, the cardiotonic drugs, means improving passability of bronchial tubes; surgical treatment at mechanical obstacles to venous outflow).
Bibliography: Bogolepov N. K. Clinical lectures on neuropathology, page 387, M., 1971; Bogolepov N. K. and E r about - cinchona L. G. O clinical options of a bettolepsy, Doctor, business, No. 1, page 74, 1966; The Multivolume guide to neurology, under the editorship of G. N. Davidenkova, t. 6, page 270, M., 1960; Holodenko M. I. Disorders of venous blood circulation in a brain, M., 1963, bibliogr.
M. I. Holodenko.