Alternating syndromes with damage to the medulla oblongata. Alternating syndromes. Weber, Fauville, Jackson, Zakharchenko syndrome. Syndromes in diabetic neuropathy
The brain stem includes
1. midbrain- located between the diencephalon and the pons and includes
A. Roof of the midbrain and handles of the superior and inferior colliculi- the formation of two pairs of mounds located on the roof plate and divided by a transverse groove into upper and lower. The pineal gland lies between the superior colliculi, and the anterior surface of the cerebellum extends above the inferior colliculi. In the thickness of the hillocks lies an accumulation of gray matter, in the cells of which several systems of pathways end and arise. Some of the fibers of the optic tract end in the cells of the superior colliculus, the fibers from which go into the tegmentum of the cerebral peduncles to the paired accessory nuclei of the oculomotor nerve. The fibers of the auditory tract approach the inferior colliculi.
From the cells of the gray matter of the roof of the midbrain, the tegnospinal tract begins, which is a conductor of impulses to the cells of the anterior horns of the spinal cord of the cervical segments, which innervate the muscles of the neck and upper shoulder girdle, which ensure head turns. The fibers of the visual and auditory pathways approach the nuclei of the midbrain roof and there are connections with the striatum. The tegnospinal tract coordinates reflex orienting movements in response to unexpected visual or auditory stimuli. Each colliculus passes into a white ridge in the lateral direction, forming the handles of the upper and lower colliculi. The handle of the superior colliculus, passing between the thalamic cushion and the medial geniculate body, approaches the external geniculate body, and the handle of the inferior colliculus goes to the medial geniculate body.
Defeat syndrome: cerebellar ataxia, damage to the oculomotor nerve (paresis of upward and downward gaze, divergent strabismus, mydriasis, etc.), hearing impairment (unilateral or bilateral deafness), choreoathetoid hyperkinesis.
B. Brain stems- located on the lower surface of the brain, they distinguish between the base of the cerebral peduncle and the operculum. Between the base and the tire there is a pigment-rich black substance. Above the tegmentum lies the roof plate, from which the superior and inferior cerebellar peduncles go to the cerebellum. The tegmentum of the cerebral peduncle contains the nuclei of the oculomotor, trochlear nerves and the red nucleus. The pyramidal, frontopontine and temporopontine pathways pass through the base of the cerebral peduncle. The pyramidal one occupies the middle 2/3 of the base. The frontopontine tract runs medially to the pyramidal tract, and the temporopontine tract passes laterally.
V. Posterior perforated substance
The cavity of the midbrain is the cerebral aqueduct, which connects the cavities of the third and fourth ventricles.
2. hindbrain:
A. Bridge- located on the slope of the base of the skull, it distinguishes between the anterior and posterior parts. The anterior surface of the bridge faces the base of the skull, the upper one takes part in the formation of the anterior sections of the bottom of the rhomboid fossa. Along the midline of the anterior surface of the bridge there is a longitudinally running basilar groove, in which the basilar artery lies. On both sides of the basilar groove there are pyramidal elevations, in the thickness of which pyramidal tracts pass. In the lateral part of the pons are the right and left middle cerebellar peduncles, connecting the pons to the cerebellum. The trigeminal nerve enters the anterior surface of the pons, at the origin of the right and left cerebellar peduncles. Closer to the posterior edge of the bridge, in the cerebellopontine angle, the facial nerve exits and the vestibulocochlear nerve enters, and between them there is a thin trunk of the intermediate nerve.
A greater number of nerve fibers pass through the thickness of the anterior part of the bridge than in the posterior part. The latter contains more clusters of nerve cells. In the anterior part of the pons there are superficial and deep fibers that make up the system of transverse fibers of the pons, which, crossing along the midline, pass through the cerebellar peduncles to the pons, connecting them to each other. Between the transverse bundles are longitudinal bundles belonging to the system of pyramidal tracts. In the thickness of the anterior part of the bridge lie the own nuclei of the bridge, in the cells of which the fibers of the cortical-pontine tracts end and the fibers of the cerebellopontine tract, going to the cortex of the opposite hemisphere of the cerebellum, originate.
b. Medulla- the anterior surface is located on the slope of the skull, occupying its lower section up to the foramen magnum. The upper border between the pons and the medulla oblongata is the transverse groove, the lower border corresponds to the exit point of the superior root filament of the 1st cervical nerve or the lower level of the decussation of the pyramids. On the anterior surface of the medulla oblongata there passes the anterior median fissure, which is a continuation of the fissure of the same name in the spinal cord. On each side of the anterior median fissure there is a cone-shaped cushion - the pyramid of the medulla oblongata. The fibers of the pyramids, through 4-5 bundles in the caudal section, partially intersect each other, forming the decussation of the pyramids. After decussation, these fibers travel in the lateral funiculi of the spinal cord in the form of the lateral corticospinal tract. The remaining, smaller part of the bundles, without entering the decussation, passes in the anterior cords of the spinal cord, constituting the anterior corticospinal tract. Outside the pyramid of the medulla oblongata there is an elevation - the olive, which is separated from the pyramid by the anterior lateral groove. 6-10 roots of the hypoglossal nerve emerge from the depths of the latter. The posterior surface of the medulla oblongata takes part in the formation of the posterior sections of the bottom of the rhomboid fossa. In the middle of the posterior surface of the medulla oblongata there is a posterior median sulcus, and outward from it there is a posterior lateral sulcus, which limits the thin and wedge-shaped fascicles, which are a continuation of the posterior cord of the spinal cord. The thin fascicle passes at the top into a thickening - the tubercle of the thin nucleus, and the wedge-shaped fascicle - into the tubercle of the sphenoid nucleus. The thickenings contain thin and wedge-shaped nuclei. In the cells of these nuclei the fibers of the thin and wedge-shaped bundles of the posterior cord of the spinal cord end. From the depths of the posterior lateral sulcus, 4-5 roots of the glossopharyngeal, 12-16 of the vagus and 3-6 cranial roots of the accessory nerve emerge onto the surface of the medulla oblongata. At the upper end of the posterior lateral sulcus, the fibers of the thin and wedge-shaped fasciculi form a semicircular thickening - the rope body (inferior cerebellar peduncle). The right and left inferior cerebellar peduncles border the rhomboid fossa. Each inferior cerebellar peduncle contains fibers of the pathways.
3. IVVentricle. It communicates above through the cerebral aqueduct with the cavity of the third ventricle, below with the central canal of the spinal cord, through the median aperture of the fourth ventricle and two lateral ones with the cerebellocerebral cistern and with the subarachnoid space of the brain and spinal cord. The IV ventricle is surrounded in front by the pons and medulla oblongata, and behind and laterally by the cerebellum. The roof of the IV ventricle is formed by the superior and inferior medullary velum. The bottom of the IV ventricle is formed by a rhomboid fossa. A median groove runs along the length of the fossa, which divides the diamond-shaped fossa into two identical triangles (right and left). The apex of each of them is directed towards the lateral recess. A short diagonal runs between both lateral recesses and divides the rhomboid fossa into two triangles of unequal size (upper and lower). In the posterior part of the superior triangle there is a facial tubercle formed by the internal knee of the facial nerve. In the lateral corner of the rhomboid fossa there is the auditory tubercle, in which the cochlear nuclei of the vestibulocochlear nerve lie. The medullary stripes of the fourth ventricle extend transversely from the auditory tubercle. In the area of the rhomboid fossa, the nuclei of the cranial nerves lie symmetrically. The motor nuclei lie more medial to the sensory nuclei. Between them are the vegetative nuclei and the reticular formation. In the caudal part of the rhomboid fossa is the triangle of the hypoglossal nerve. Medial and slightly lower from it there is a small dark brown area (triangle of the vagus nerve), where the nuclei of the glossopharyngeal and vagus nerves lie. In the same section of the rhomboid fossa, the respiratory, vasomotor and vomiting centers are located in the reticular formation.
4. cerebellum- a department of the nervous system involved in automatic coordination of movements, regulation of balance, accuracy and proportionality (“correctness”) of movements and muscle tone. In addition, it is one of the highest centers of the autonomic (autonomic) nervous system. Located in the posterior cranial fossa above the medulla oblongata and the pons, under the cerebellar tentorium. Two hemispheres and the middle part located between them - the worm. The cerebellar vermis provides static (standing), and the hemispheres provide dynamic (movements in the limbs, walking) coordination. Somatotopically, the muscles of the trunk are represented in the cerebellar vermis, and the muscles of the limbs are represented in the hemispheres. The surface of the cerebellum is covered by a layer of gray matter that makes up its cortex, which is covered with narrow convolutions and grooves that divide the cerebellum into a number of lobes. The white matter of the cerebellum is composed of various types of nerve fibers, ascending and descending, which form three pairs of cerebellar peduncles: inferior, middle and superior. The inferior cerebellar peduncles connect the cerebellum to the medulla oblongata. In their composition, the posterior spinocerebellar tract goes to the cerebellum. The axons of the dorsal horn cells enter the posterior section of the lateral funiculus on their side, rise to the medulla oblongata and along the inferior cerebellar peduncle reach the cortex of the vermis. Nerve fibers from the nuclei of the vestibular root pass here, which end in the tent core. As part of the inferior cerebellar peduncles, the vestibulospinal tract runs from the tent nucleus to the lateral vestibular nucleus, and from it to the anterior horns of the spinal cord. The middle cerebellar peduncles connect the cerebellum to the pons. They contain nerve fibers from the pontine nuclei to the cortex of the opposite hemisphere of the cerebellum. The superior cerebellar peduncles connect it to the midbrain at the level of the roof of the midbrain. They include nerve fibers both to the cerebellum and from the dentate nucleus to the roof of the midbrain. These fibers, after crossing, end in the red nuclei, where the red nuclear spinal tract begins. Thus, mainly the afferent pathways of the cerebellum pass in the lower and middle cerebellar peduncles, and the efferent pathways pass in the upper ones.
The cerebellum has four paired nuclei located in the thickness of its medulla. Three of them - jagged, cork-shaped and spherical - are located in the white matter of the hemispheres, and the fourth - the tent core - in the white matter of the worm.
Alternating syndromes occur with unilateral damage to the brain stem and consist of damage to the cranial nerves on the side of the lesion with the simultaneous appearance of paresis (paralysis), sensitivity disorders (conductor type) or coordination on the opposite side.
A) with damage to the cerebral peduncles:
1. Weber's alternating palsy - peripheral paralysis of the oculomotor nerve on the affected side and spastic hemiplegia on the opposite side
2. Benedict's palsy alternating - peripheral palsy of the oculomotor nerve on the affected side, hemiataxia and intention tremor on the opposite side
3. Claude's alternating syndrome - peripheral paralysis of the oculomotor nerve on the affected side, extrapyramidal hyperkinesis and cerebellar symptoms on the opposite side
B) if the bridge is damaged:
1. Alternating Foville's palsy - peripheral paralysis of the facial and abducens nerves (or paresis of gaze to the side) on the affected side and spastic hemiplegia on the opposite side
2. Alternating Millard-Gubler palsy - peripheral paralysis
Facial nerve on the affected side and spastic hemiplegia on the opposite
3. alternating Brissot-Sicard syndrome - spasm of the facial muscles (irritation of the nucleus of the facial nerve) on the affected side and hemiplegia on the opposite side
4. alternating Raymond-Sestan palsy - paralysis of gaze towards the lesion, ataxia, choreoathetoid hyperkinesis on the affected side, and on the opposite side - hemiplegia and sensitivity disorders.
B) with damage to the medulla oblongata:
1. Avellis syndrome - peripheral paralysis of the glossopharyngeal, vagus and hypoglossal nerves on the side of the lesion and spastic hemiplegia on the opposite
2. Jackson syndrome - peripheral paralysis of the hypoglossal nerve on the side of the lesion and spastic hemiplegia on the opposite side
3. Schmidt syndrome - peripheral paralysis of the hypoglossal, accessory, vagus, glossopharyngeal nerves on the affected side and spastic hemiplegia on the opposite side
4. Wallenberg-Zakharchenko syndrome occurs when the posteroinferior cerebellar artery is blocked and is characterized by combined damage to the IX, X nerves, the nucleus of the descending root of the V pair, the vestibular nuclei, the sympathetic tract, the inferior cerebellar peduncle, the spinocerebellar and spinothalamic tracts.
The brain stem, which includes the midbrain, pons, and medulla oblongata, contains long ascending sensory and descending motor pathways, as well as cranial nerve nuclei.
Due to the fact that the motor corticospinal (pyramidal) tract crosses below the brain stem, and the sensitive spinal-thalamic tract crosses in the spinal cord, unilateral damage to these pathways at the level of the brain stem leads to central muscle paresis and loss of sensitivity on the opposite side. away from the hearth. Lesions in the brain stem are also characterized by damage to the nuclei (or nucleus) of the cranial nerves, with the appearance of symptoms of their damage on the side of the pathological process. Therefore, a unilateral lesion in the brain stem is characterized by the occurrence of cross syndromes: symptoms of damage to the cranial nerve nucleus on the side of the lesion and central hemiparesis or hemiplegia, as well as conduction sensitivity disorders on the opposite side. Such syndromes are called alternating. The combination of symptoms of damage to the cranial nerve nucleus and pathways is of great importance for making a topical diagnosis, since it indicates damage not to the cranial nerve, but to its nucleus or fibers within the brain stem. Knowing the topography of the cranial nerve nuclei, it is possible to determine the localization of the pathological process in the brain stem.
Depending on the location of the pathological focus, alternating syndromes are divided into pedunculate (damage to the midbrain), pavement (pathology in the pons) and bulbar (damage to the medulla oblongata). Thus, with pathology in the cerebral peduncle, Weber and Benedict syndromes occur, and with damage to the pons, Millard-Gubler and Foville syndromes occur. These syndromes are described above.
When the medulla oblongata is damaged, alternating syndromes of Jackson, Avellis, Schmidt, and Wallenberg-Zakharchenko are most often observed.
Jackson syndrome is characterized by a combination of signs of peripheral nuclear palsy of the tongue muscles on the side of the lesion and hemiparesis or hemiplegia on the opposite side.
With Avellis syndrome, symptoms of damage to the glossopharyngeal and vagus nerves are detected on the side of the pathological focus, and on the opposite side - hemiparesis or hemiplegia of the limbs.
As a result of Schmidt's syndrome (damage to the medulla oblongata at the level of nuclei IX, X, XI pairs), paralysis of the vocal cord, soft palate, trapezius and sternocleidomastoid muscles on the affected side and hemiparesis of the opposite limbs are noted.
With an ischemic stroke in the basin of the posterior inferior cerebellar artery, alternating Wallenberg-Zakharchenko syndrome occurs. On the side of the lesion, paralysis of the soft palate and vocal cord is detected (the double motor nucleus is affected), a segmental dissociated disorder of pain and temperature sensitivity on the face (the descending root of the V pair or the nucleus of the spinal tract is affected), Bernard-Horner syndrome (pathology of the descending sympathetic fibers going to ciliospinal center), cerebellar disorders (the spinal-cerebellar tract is affected), and on the opposite side - a conduction disorder of pain and temperature sensitivity as a result of damage to the spinal-thalamic tract.
In addition to these syndromes, other alternating syndromes are also observed in clinical practice, the symptoms of which may include signs of damage to the nuclei of the cranial nerves and other structures of the brain stem. They occur when there is a violation of cerebral circulation, inflammatory or tumor processes in the brain stem and are of great topical and diagnostic importance.
Alternating syndromes symptom complexes characterized by a combination of damage to the cranial nerves on the side of the lesion with conduction disorders and sensitivity on the opposite side. They occur with damage to one half of the brain stem, spinal cord, as well as with unilateral combined damage to the structures of the brain and sensory organs. Various A. s. can be caused by cerebrovascular accident, tumor, traumatic brain injury, etc. The most common are A.s. associated with damage to the brain stem, manifested on the side of the lesion by dysfunction of the cranial nerves of the peripheral type (due to damage to their nuclei or roots) and conduction disorders on the opposite side (hemiparesis, hemiataxia, etc. due to damage to the fibers pyramidal tract, medial lemniscus, spinothalamic tract, cerebellar connections, etc.). To stem A. s. also applies to cross hemiplegia (one arm and the opposite leg), which occurs when there is a lesion in the area of the intersection of the pyramidal tracts at the border of the medulla oblongata and the spinal cord. Depending on the location of the lesion in the brain stem, there are bulbar (focus in the medulla oblongata), pontine (pons of the brain), peduncular (focus in the cerebral peduncle) A. s. There are A. s. associated with damage to several parts of the brain stem and extracerebral A. s.
Alternating syndromes caused by unilateral damage to the sensory organs and various structures of the brain that have a common source of blood supply are called extracerebral A. s. As a rule, they occur due to pathology of one of the main vessels of the head and are associated with a secondary disruption of circulation in the basin of its branches. In this case, several extra- and intracerebral lesions are formed in areas of impaired blood circulation. Bulbar alternating syndromes. Jackson syndrome is caused by damage to the nucleus of the hypoglossal nerve and the fibers of the pyramidal tract. On the side of the pathological focus, peripheral paralysis of the tongue muscles develops (deviation of the tongue towards the affected side, half of the tongue, sometimes fibrillary twitching in the tongue, degeneration when studying the electrical conductivity of the tongue muscles), on the opposite side - central hemiplegia or hemiparesis of the limbs. Avellis syndrome occurs when the motor nucleus or motor roots of the glossopharyngeal and vagus nerves and the pyramidal tract are damaged. On the affected side, peripheral paralysis of the soft palate, uvula, vocal fold with impaired swallowing, phonation, speech () is detected, on the opposite side - central hemiplegia or hemiparesis. Schmidt's syndrome is based on a combined lesion of the motor nuclei or fibers of the glossopharyngeal, vagus, accessory nerves and pyramidal tract. On the affected side, peripheral soft palate, vocal fold, sternocleidomastoid and trapezius muscles occur, on the opposite side - central hemiplegia or hemiparesis. Babinski-Nageotte syndrome is observed with a combination of damage to the inferior cerebellar peduncle, olivocerebellar tract, sympathetic fibers, as well as the pyramidal tract, spinothalamic tract, and medial lemniscus. On the affected side, cerebellar disorders (hemiataxia, lateropulsion), Horner syndrome (see Bernard-Horner syndrome) are recorded. ,
on the opposite side - central hemiplegia or hemiparesis, hemianesthesia. Wallenberg-Zakharchenko syndrome is caused by damage to the motor nucleus of the vagus and glossopharyngeal nerves, the nucleus of the spinal tract of the trigeminal nerve, sympathetic fibers, the inferior cerebellar peduncle, the spinothalamic tract, and sometimes the pyramidal tract. On the affected side, peripheral paralysis of the soft palate and vocal fold, impairment of superficial sensitivity on the face of the segmental type, Horner's syndrome, ataxia are detected, on the opposite side - impairment of surface sensitivity of the hemitype, sometimes central hemiparesis. Tapia syndrome occurs when there is a combination of damage to the nuclei or fibers of the accessory, hypoglossal nerves and pyramidal tract. On the side of the pathological focus - peripheral paralysis of the sternocleidomastoid and trapezius muscles, muscles of the tongue, on the opposite side - central hemiplegia or hemiparesis. Volestein syndrome is caused by damage to the oral part of the motor nucleus of the glossopharyngeal and vagus nerves and the spinothalamic tract. On the affected side there is peripheral paralysis of the vocal fold, on the opposite side there is hemianesthesia. Pontine. Millard-Hübler syndrome is determined by damage to the nucleus or root of the facial nerve and the pyramidal tract. On the affected side there is unilateral peripheral paralysis of the facial muscles, on the opposite side there is central hemiplegia or hemiparesis. Brissot-Sicart syndrome is caused by irritation of the nucleus of the facial nerve and damage to the pyramidal tract. On the affected side there is one-sided facial muscles, on the opposite side there is central hemiplegia or hemiparesis. Foville syndrome is observed with combined damage to the nuclei or roots of the facial and abducens nerves, pyramidal tract, and medial lemniscus. On the side of the pathological focus - peripheral paralysis of the facial nerve, converging with limited outward movement of the eyeball, diplopia, on the opposite side - central hemiplegia or hemiparesis, hemianesthesia. Raymond-Sestan syndrome is caused by combined lesions of the posterior longitudinal fasciculus, pontine center of gaze, middle cerebellar peduncle, medial lemniscus, and pyramidal tract. On the affected side - choreoathetoid, gaze paresis towards the lesion, on the opposite side - central hemiplegia or hemiparesis, hemianesthesia. Peduncular alternating syndromes. Weber syndrome occurs when the nucleus or root of the oculomotor nerve and the fibers of the pyramidal tract are damaged. On the side of the pathological focus - divergent strabismus, on the opposite side - central hemiplegia; Central paralysis of the muscles of the face and tongue is also possible. Benedict's syndrome is caused by damage to the nucleus of the oculomotor nerve, the red nucleus, red nucleus-dentate fibers, and sometimes the medial lemniscus. On the affected side - ptosis, divergent strabismus, mydriasis, on the opposite side - intention, sometimes hemianesthesia. Claude's syndrome is determined by damage to the nucleus of the oculomotor nerve, the superior cerebellar peduncle. On the side of the pathological focus - ptosis, strabismus, mydriasis, on the opposite side - ataxia, dysmetria, decreased muscle tone. Nothnagel syndrome is caused by combined damage to the nuclei of the oculomotor nerve, superior cerebellar peduncle, lateral lemniscus, red nucleus, and pyramidal tract fibers. On the affected side - ptosis, divergent strabismus, mydriasis, cerebellar ataxia (unilateral and bilateral), on the opposite side - choreoathetoid hyperkinesis, central hemiplegia, central paralysis of the facial and tongue muscles. Alternating syndromes associated with damage to several parts of the brain stem. Glick syndrome is caused by damage to the optic, trigeminal, facial, vagus and pyramidal tract nerves. On the affected side - peripheral paralysis (paresis) of the facial muscles with their spasm, in the supraorbital region, decreased vision or difficulty swallowing, on the opposite side - central hemiplegia or hemiparesis. Cross hemianesthesia is observed when the nucleus of the spinal tract of the trigeminal nerve is damaged at the level of the pons or medulla oblongata and fibers of the spinothalamic tract. On the affected side there is a disorder of superficial sensitivity on the face of a segmental type, on the opposite side there is a disorder of surface sensitivity on the limbs. Extracerebral alternating syndromes. Optical-hemiplegic syndrome occurs with unilateral damage to the retina, optic nerve, and motor area of the cerebral cortex due to circulatory disorders in the internal carotid artery system (in the basin of the ophthalmic and middle cerebral arteries). On the affected side there is amaurosis, on the opposite side there is central hemiplegia or hemiparesis. Vertigohemiplegic syndrome is caused by unilateral damage to the vestibular apparatus and motor zone of the cerebral cortex due to circulatory disorders in the system of the subclavian and carotid arteries with impaired circulation in the labyrinthine (vertebrobasilar basin) and middle cerebral arteries. On the affected side - in the ear, horizontal in the same direction; on the opposite side - central hemiplegia or hemiparesis. Asphygmohemiplegic syndrome (brachiocephalic arterial trunk syndrome) is observed with unilateral irritation of the nucleus of the facial nerve, vasomotor centers of the brain stem, and damage to the motor zone of the cerebral cortex. On the affected side there is a spasm of the facial muscles, on the opposite side there is central hemiplegia or hemiparesis. On the affected side there is no common carotid artery. Topical diagnostic value. Analysis of symptoms of damage to cranial nerves, sensory organs, conduction disorders in A. s. allows you to determine the localization and boundaries of the pathological focus. In clinical practice, A. s. can be observed with tumors of the brain stem and with disorders of cerebral circulation (brain). Thus, Jackson syndrome occurs with thrombosis of the anterior spinal artery or its branches, Avellis and Schmidt syndromes - with impaired blood circulation in the branches of the arteries supplying the medulla oblongata, and Wallenberg-Zakharchenko syndrome, Babinsky-Nageotte syndrome - in the basin of the inferior posterior cerebellar or vertebral artery, syndrome cross hemiplegia - with thrombosis of spinobulbar arterioles. Pontine (bridge) syndromes of Foville, Brissot-Sicart, Raymond-Sestan are detected when the branches of the basilar (main) artery are affected, peduncular syndromes - deep branches of the posterior cerebral artery, Claude syndrome - anterior and posterior arterioles of the red nucleus, Benedict syndrome - interpeduncular or central arteries and etc. The nature of the pathological process can be determined by the dynamics of symptoms. Thus, with ischemic damage to the brain stem as a result of thrombosis of the branches of the vertebral, basilar or posterior cerebral arteries, A. s develop gradually, often not accompanied by loss of consciousness; the boundaries of the lesion correspond to the zone of impaired vascularization; hemiplegia or hemiparesis have spastic. With hemorrhage in A. s. may be atypical, because the boundaries of the focus may not correspond to a specific vascular basin and may increase due to reactive cerebral edema around the focus of hemorrhage. Acute development of a lesion in the pons of the brain is accompanied by breathing disorders, cardiac activity, and vomiting. In the acute period, a decrease in muscle tone is determined on the side of hemiplegia as a result of diaschisis .
Bibliography: Gusev E.I., Grechko V.E. and Burd G.S. Nervous diseases, p. 185, M., 1988; Krol M.B. and Fedorova E.A. Basic neuropathological syndromes, p. 132, M., 1966; Triumphov A.V. diseases of the nervous system, p. 148, L., 1974. 1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.
See what “Alternating syndromes” are in other dictionaries:
ALTERNATING SYNDROMES- ALTERNATING SYNDROMES are a set of neuropathological phenomena of loss of functions, when one part of them is externally expressed on one half of the body (for example, in the form of right-sided paralysis or paresis of the limbs), and... ...
- (lat. alterno alternate; synonyms: alternating paralysis, cross paralysis) syndromes that combine damage to the cranial nerves on the side of the lesion with conduction disorders of motor and sensory functions... ... Wikipedia
Alternating syndromes- (lat. alter one of two syndrome) a group of neurological syndromes that occur when nerve tissue is damaged in the brain stem area. In this case, various combinations of paralysis and paresis of the cranial nerves and sensory disturbances are observed...
Alternating syndromes- (Greek alternus - cross) - signs of unilateral damage to the brain stem. On the side of the lesion, dysfunction of one or more cranial nerves of a peripheral type is observed, on the other side - conductive... ... Encyclopedic Dictionary of Psychology and Pedagogy
Most Varoliev's lesion syndromes- a combination of central paresis or paralysis on the opposite side and symptoms of peripheral damage to the cranial nerves on the side of the lesion. The symptom complexes that arise are defined as alternating syndromes (lat... Encyclopedic Dictionary of Psychology and Pedagogy
- (truncus encephali; synonymous with brain stem) part of the base of the brain, containing the nuclei of the cranial nerves and vital centers (respiratory, vasomotor and a number of others). S. g. m. has a length of about 7 cm, consists of the midbrain, ... ... Medical encyclopedia
Cerebellopontine angle- (Klein hirnbruckenwinkel, angle ponto cerebelleuse, according to a certain angle ponto bulbo cerebelleuse) occupies a unique place in neuropathology, neurohistopathology and neurosurgery. This name refers to the angle between the cerebellum, oblongata... ... Great Medical Encyclopedia
I Stroke Stroke (late Latin insultus attack) is an acute disorder of cerebral circulation, causing the development of persistent (lasting more than 24 hours) focal neurological symptoms. During I. complex metabolic and... ... Medical encyclopedia
BRAIN- BRAIN. Contents: Methods for studying the brain..... . . 485 Phylogenetic and ontogenetic development of the brain.............. 489 Bee of the brain.............. 502 Anatomy of the brain Macroscopic and ... ... Great Medical Encyclopedia
The relationship of the oculomotor nerve with the eyeball and other nerves ... Wikipedia
a symptom complex characterized by dysfunction of the cranial nerves on the side of the lesion and a disorder on the opposite side of the body of motor (central paralysis or paresis), conductive sensory and coordination functions. Alternating syndromes occur due to pathological processes in the brain stem. In their purest form they are observed in vascular diseases of the brain; are more clearly identified when the brain softens in the area of the branches of the vertebral, main and posterior cerebral arteries (indicated in each syndrome). With hemorrhages, the alternating syndrome is somewhat obscured, since perifocal manifestations are usually more pronounced. The course of the disease with hemorrhage into the trunk is in most cases extremely severe, quickly leading to death. With brain stem tumors and brain stem encephalitis, in some cases a typical alternating syndrome can be observed, but more often the clinical picture goes beyond one syndrome. Alternating syndromes are divided into peduncular (brain peduncle), pontine (pons), bulbar (medulla oblongata).
Peduncular syndromes. Weber's syndrome is expressed by complete or partial paralysis of the oculomotor nerve on the side of the lesion (ptosis, mydriasis, impaired movements of the eyeball, lack of reaction of the pupils to light); on the opposite side - hemiplegia with central paralysis of the facial and hypoglossal nerves. The syndrome occurs when a branch of the posterior cerebral artery is damaged. Benedict's syndrome - complete or partial paralysis of the oculomotor nerve on the affected side, on the opposite side - intention tremor, choreoathetoid movements, mild hemiparesis. The syndrome is observed when a branch of the posterior cerebral artery is affected. Claude's syndrome (inferior red nucleus syndrome) - complete or partial paralysis of the oculomotor nerve on the affected side, on the opposite side - cerebellar symptoms. Damage to the paramedian trunk artery. Foix's syndrome (superior red nucleus syndrome) is not truly alternating. On the opposite side from the focus there is cerebellar intention tremor, periodically combined with choreic hyperkinesis, a sensitivity disorder.
Pontine syndromes. Foville syndrome on the side of the lesion is a lesion of the abducens and facial nerves, combined with paralysis of gaze towards the lesion, on the opposite side there is a sensitivity disorder. Milyar-Gubler syndrome - damage to the facial nerve on the side of the lesion, on the opposite side - hemiplegia. Brissot-Sicard syndrome is a spasm of the facial muscles on the side of the lesion, hemiplegia on the opposite side. Raymond-Sestan syndrome - paresis of gaze towards the lesion, ataxia, on the opposite side - hemihypesthesia, hemiparesis. Gasperini syndrome - damage to the abducens, facial, trigeminal and auditory nerves on the affected side, on the opposite side - a sensitivity disorder. All pontine syndromes result from damage to the branches of the basilar artery.
Bulbar syndromes. Wallenberg-Zakharchenko syndrome - on the side of the lesion, damage to the trigeminal nerve of the segmental type (anesthesia of the pharynx, larynx, hypoesthesia on the face), vagus (paresis of the soft palate and vocal cord), cerebellar disorders, Claude Bernard-Horner syndrome - on the opposite side of the disorder movement and sensitivity (pain and temperature). May be accompanied by breathing problems. There are several (4-5) typical symptom complexes within the general syndrome. Occurs when the vertebral artery and the inferior posterior cerebellar artery extending from it are damaged. Schmidt's syndrome - damage to the glossopharyngeal, vagus and accessory nerves on the affected side, hemiparesis - on the opposite side. Similar symptoms of damage to the IX, X, XI nerves, but without motor disorders on the opposite side, constitute the anterior torn foramen syndrome (Bernet). Avelisse syndrome is a lesion of the glossopharyngeal and vagus nerves on the side of the lesion, hemiplegia on the opposite side. The syndrome occurs when the artery of the lateral fossa (a branch of the vertebral artery) is damaged. Babinski-Nageotte syndrome - cerebellar symptoms (ataxia, asynergia, lateropulsion and Claude Bernard-Horner syndrome) on the side of the lesion; on the opposite side - hemiplegia and hemianesthesia. It is observed when the vertebral artery is damaged (the artery of the inferior posterior cerebellar and lateral fossa). Jackson syndrome is a peripheral paresis of the hypoglossal nerve on the side of the lesion, hemiplegia on the opposite side. Damage to the anterior spinal artery. A number of authors classify cross-paralysis as alternating syndromes: paralysis of the arm on one side and paralysis of the leg on the other. There may also be reverse relationships. The lesion is in the lower part of the medulla oblongata (the area where the pyramidal tracts cross). Damage to the cranial nerves in alternating syndrome is peripheral (nucleus, root). Alternating syndromes make it possible to determine the localization of the pathological process along the length and diameter of the brain stem. Combined damage to the optic nerve on one side with hemiplegia on the other (oculohemiplegic syndrome) is not the result of damage to the brain stem and will be described in detail when describing the internal carotid artery syndrome (see Cerebral Arteries).
In this case, on the affected side there is a dysfunction of one or more cranial nerves of a peripheral type, and on the other side conduction disorders develop (hemianesthesia, hemiparesis, hemitremor, hemiplegia).
The main cause of alternating syndrome is cerebral circulation disorders; less commonly, these syndromes occur with tumors, injuries, aneurysms, inflammatory diseases of the brain and in patients with diabetes mellitus.
Benedict's syndrome (syn. alternating paralysis syndrome)
The syndrome occurs as a result of a pathological process in the medial-dorsal part of the midbrain at the level of the red nucleus and the cerebellar-rednuclear tract with the preservation of the paramidal fasciculus.
The causes of the lesion are thrombosis and hemorrhage in the posterior cerebral artery, metastasis of tumors.
On the affected side, extrapyramidal hyperkinesis in the limbs and cerebellar ataxia occur. On the side opposite to the localization of the lesion, mild spastic hemiparesis and tremor of the lower extremities develop. Against the background of hemiparesis, increased tendon reflexes are observed. In addition, there is an increase in overall muscle tone.
Eye symptoms caused by complete or partial paralysis of the oculomotor nerve. Ptosis occurs on the side of the pathological focus. There is a deviation of the eyeball towards the lesion; there may be disturbances in associated eye movements during convergence and the direction of gaze up or down.
A differential diagnosis of this syndrome is made with the following syndromes: Claude, Weber-Gubler-Gendrin, Millard-Gubler, Fauville, Nothnagel.
Weber-Pobler (Jublé)-Gendrin syndrome (syn. peduncular alternating syndrome)
The development of the syndrome is associated with a pathological process located directly in the region of the cerebral peduncles, which occurs as a result of hemorrhages, ischemic cerebral circulation disorders, as well as neoplasms. In addition, the signs of this syndrome may be caused by dislocation compression of the cerebral peduncles by a tumor located at a distance.
Clinical signs and symptoms. Due to damage to the facial and lingual nerves, as well as the pyramidal tract, central paralysis of the muscles of the face, tongue and limbs occurs on the side opposite the pathological focus.
Eye symptoms are caused by complete (ophthalmoplegia, ptosis, mydriasis) or partial (damage to only the intraocular muscles or individual extraocular muscles) paralysis of the oculomotor nerve. Symptoms of paralysis occur on the side of the pathological focus. In case of damage to the extraocular muscles innervated by the oculomotor nerve, the eyeball deviates towards the temple and “looks” towards the pathological focus, “turning away” from the paralyzed limbs. If a pathological process - for example, an aneurysm of the anterior cerebral artery - involves the optic tract or the external geniculate body, homonymous hemianopsia occurs.
Millard-Gubler (Jubler) syndrome (syn. alternating inferior hemiplegia)
Unilateral damage to the ventral part of the pons involving the nucleus or bundle of fibers of the facial nerve, the root of the abducens nerve and the underlying pyramidal tract leads to the development of this syndrome.
The pathological process in this area may be associated with circulatory disorders in the paramedian arteries (hemorrhages, thrombosis). With the development of a tumor of the pons (most often glioma and much less often cancer metastasis, sarcoma, solitary tubercles), a slow gradual development of the syndrome is observed.
Clinical signs and symptoms. On the affected side, signs of peripheral paralysis of the facial nerve appear, while central hemiparesis or hemiplegia is observed on the side opposite the lesion.
(module direct4)
Ocular symptoms are caused by damage to the abducens and facial nerves. On the side opposite the pathological focus, signs of damage to the abducens nerve appear - paralysis of the external rectus muscle, convergent paralytic strabismus, diplopia, which intensifies when looking towards the affected muscle. On the contrary, symptoms of damage to the facial nerve are observed on the side of the pathological focus - lagophthalmos, lacrimation.
Monakov syndrome
The syndrome occurs due to damage to the pyramidal tract above the internal capsule with involvement of the oculomotor nerve in the process.
Clinical signs and symptoms. On the side opposite the lesion, hemiparesis, complete or partial dissociated hemianesthesia, hemichoreoathetosis or hemiballismus occur.
Eye symptoms are caused by damage to the oculomotor nerve, the symptoms of which (ptosis, partial external ophthalmoplegia) occur on the affected side. On the side opposite to the lesion, homonymous hemianopsia is observed.
Nothnagel syndrome (syn. quadrigeminal syndrome)
The syndrome occurs with extensive lesions of the midbrain involving the roof, tegmentum and partly the base of the brain - the quadrigeminal plate is affected; red nuclei or superior cerebellar peduncles, nuclei of the oculomotor nerves, medial geniculate bodies, central gray matter in the circumference of the aqueduct of Sylvius. The main cause of the pathological process is pituitary tumors.
Clinical signs and symptoms. At the onset of the disease, signs of cerebellar damage appear: ataxia, intention tremor, choreiform or athetoid hyperkinesis; There is a decrease in hearing on both sides or only on the side opposite to the localization of the lesion. In some cases, spastic paresis of the limbs develops. Due to bilateral pyramidal lesions, central paresis of the facial and hypoglossal nerves occurs.
Eye symptoms caused by damage to the oculomotor nerves. Bilateral ophthalmoplegia, mydriasis, and ptosis are observed. In the case of a unilateral lesion, the symptoms are more pronounced on the side opposite the lesion. Eye symptoms increase gradually. First, changes in pupillary reactions occur. Subsequently, vertical gaze paralysis appears (usually upward, less often downward), followed by paralysis of the internal rectus and superior oblique muscles. Ptosis develops later than other symptoms.
Claude's syndrome (syn. red nucleus, inferior syndrome)
The pathological process in this syndrome is located at the base of the legs and involves the fibers of the oculomotor nerve. The development of the syndrome is caused by damage to the branches of the posterior cerebral artery - the middle and posterior arteries of the red nucleus, which supply blood to the lower parts of the red nucleus. The most common causes of vascular damage are atherosclerosis and syphilitic endarteritis.
Clinical signs and symptoms. Due to damage to the superior cerebellar peduncle or the red nucleus itself on the side opposite to the lesion, intention tremor occurs. In some situations, choreiform hyperkinesis, dysarthria and swallowing disorders develop.
Eye symptoms. As a result of damage to the oculomotor and sometimes trochlear nerves, partial ophthalmoplegia is observed on the side of the pathological focus.
Differential diagnosis of the condition in question is carried out with Benedict and Weber-Gübler-Gendrin syndromes.
Alternating syndromes in diabetic neuropathy
The development of the syndrome is caused by unilateral damage to the brain stem involving the cranial nerves, including the oculomotor nerve. Characteristic is the development of peripheral paralysis on the affected side in combination with conduction disorders on the opposite side. It is possible to develop one of two variants of the clinical course of this syndrome in patients with diabetic neuropathy.
The clinical picture of the disease in the first case includes isolated paresis or paralysis of the abducens nerve on the affected side.
In this case, on the opposite side there is mild hemiparesis, sometimes with hemihypesthesia.
The second variant of the syndrome is a combined lesion of the abducens nerve and branches of the oculomotor nerve innervating the extraocular muscles on the affected side. Just as in the first case, hemiparesis occurs on the opposite side.
Foville syndrome (syn. ion alternating syndrome)
With this syndrome, there is a unilateral location of the pathological process in the region of the lower part of the pons of the brain. The causes of the disease may be thrombosis of the basilar artery, circulatory disorders in the paramedian or long circumflex arteries, pontine glioma, cancer metastases, sarcoma, etc.
Clinical signs and symptoms. Characteristically, lesions of the facial nerve occur on the opposite side of the lesion with symptoms of peripheral paresis of the facial muscles, hemiparesis or hemiplegia and hemianesthesia (or hemitypesthesia) of the central type.
Eye symptoms. Due to peripheral paralysis or paresis of the abducens nerve on the affected side, paralytic convergent strabismus and gaze paralysis towards the lesion occur. In some cases, lagophthalmos is observed on the affected side - the result of damage to the facial nerve.
Loading...
