Ectopia of the cerebellar tonsil: causes, symptoms, therapeutic measures. The amygdala is responsible for controlling personal space

The cerebellar tonsils are extremely important anatomical and physiological formations responsible for the sensation and expression of emotions. Outwardly, they resemble the lymphoid tissue of the pharynx, but are located deep in the brain, namely in its temporal lobe. These cerebellar bodies are responsible for the production of all strong emotions, such as fear, anger or pleasure.

Various pathologies of the tonsils can cause deviations in their functions, affect a person’s psycho-emotional health and provoke the occurrence of a number of diseases, which often include:

anxiety syndrome;
a large number of possible phobias;
autism;
bipolar personality disorder;
schizophrenic manifestations.

That's why the change correct location These cerebellar corpuscles have such an important role. The same applies to cases of low position of the tonsils.

What are tonsils and where are they located?

Basal-lateral nuclei- associated with the emergence reflex reaction concerns and analysis of signals coming from sensitive receptors.
Medial-central complex- is the so-called “output” of the basal ganglia. This education responsible for emotional arousal.
Medial cortical complex.

IN in good condition The cerebellar tonsils are located above Chamberlain's line (velo-occipital line). However, when certain pathologies occur, they can fall below the foramen magnum.

Pathological conditions of the tonsils

Most frequent violation locations found in clinical practice, is an ectopia of the cerebellar tonsil. Pathology implies their descent into the foramen magnum, as well as depressed state tonsils.

Basically, this condition occurs mainly in adults, aged approximately 30-40 years. It is diagnosed by chance, during routine medical examinations or during the treatment of other diseases. In children, ectopia of the tonsils is diagnosed extremely rarely.

This pathology is usually divided into two types: dystopia and Arnold-Chiari malformation. As for the second option, in this case it is customary to distinguish between four types of disease:

Type 1 – involves the location of the tonsils below the level of the foramen magnum. Most often it is determined in adolescents, as well as in adults under the age of 30. Often clinical picture The disease is accompanied by an accumulation of cerebrospinal fluid in the central canal, which contains the spinal cord.
Type 2 – refers to intrauterine developmental anomalies. Here the picture is not very favorable, since in addition to the tonsils, the cerebellar vermis, often the medulla oblongata, and also its ventricle enter the BZ. Mostly this problem is caused by congenital hernias localized in the spinal cord.
Type 3 is an even more serious anomaly. In this case, below the foramen magnum, not only the tonsils are located, but also the entire cerebellum along with medulla oblongata. These anatomical and physiological formations completely change their location and occupy the occipital and cervical regions.
Type 4 – there is underdevelopment of the cerebellar tissues. In this case, no displacement occurs. However, there is often hydrocephalus, as well as a congenital cyst located in the cranial fossa.

Causes of ectopia of the cerebellar tonsils

The causes of dystopia of the cerebellar tonsils are still not known and have not been fully studied. As for the Arnold-Chiari anomaly, its causes are as follows:

excessive use, during pregnancy, of various medications;
smoking, as well as drinking alcohol and drugs at the same stage;
frequent viral and colds(especially rubella).

As for fetal developmental anomalies, it is customary to highlight:

reduction in the size of the posterior cranial fossa;
increase in BZO.

Acquired problems that contribute to dystopia include:

traumatic brain injuries of a child received during the birth canal;
hydrodynamic shock cerebrospinal fluid along the walls of the central canal of the spinal cord.

Symptoms

It should be noted that the most common pathology is the first type. It is often accompanied by the appearance of liquor-hypertensive syndrome, as well as a violation normal functions nerve endings inside cranium. Force possible violations depends on the stage of the pathological process.

In general, liquor-hypertensive syndrome is accompanied by frequent pain in the back of the head, the patient also suffers from pain in the neck. There is a tendency for the symptom to intensify with sneezing, severe coughing and general tension in the neck muscles. Vomiting may occur, which is in no way related to food intake and, accordingly, does not bring relief.

A large number of other manifestations are possible:

increased muscle tone in the neck;
disturbance of normal speech;
significant decrease in visual and hearing acuity;
difficulty swallowing;
attacks of severe dizziness;
short-term loss of consciousness;
All sudden movements accompanied by surges in blood pressure;
atrophy of the tongue muscle;
decreased voice timbre and hoarseness;
abnormalities in respiratory function;
problems with tactile sensitivity and numbness various areas bodies;
severe weakening of the muscles of the limbs.

Diagnostic methods

For diagnostics of this disease A neurological examination, a complete medical history, and various instrumental examinations are often used.

A neurological examination is to identify the following disorders: unsteadiness of gait, decreased sensitivity, difficulty swallowing and rhythmic vibrations of the whites of the eyes when trying to move in one direction or another (nystagmus).

When collecting anamnesis, they find out when the patient experienced pain in the head and neck, loss of tactile and temperature sensitivity, with the performance of certain movements. Also check availability birth injuries head and neck.

Often, the attending physician gives a referral for an MRI.

The amygdala (amygdala, amygdala, cerebellar amygdala, Latin corpus amygdaloideum) is a set of neurons almond-shaped located deep in the medial temporal lobe

Why is it needed?

It is a structure of the limbic system that is involved in many of our emotions and motivations, especially those related to survival. It is proven that she plays key role in processing emotions such as fear, anger, joy. The amygdala is also responsible for storing memories, and is where memories are stored in the brain. It is believed that it determines how big an emotional response a particular event causes.

Functions:

The amygdala is involved in a number of body functions, including:

Awakening
Autonomic reactions associated with fear.
Emotional reactions.
Hormonal secretions
Memory.

In humans and animals this subcortical structure brain is associated with reactions of fear and pleasure. Its size is positively correlated with aggressive behavior in different species.

Conditions and illnesses such as anxiety, autism, depression, PTSD stress disorder and phobias are suspected to be associated with abnormal functioning of the amygdala, due to damage, developmental problems, and neurotransmitter imbalances.

In humans, it is the most sexually dimorphic brain structure and is reduced by more than 30% in men after castration.

Recent research has shown a possible correlation between brain structure, including differences between hemispheric relationships, and connectivity patterns in the amygdala, as well as sexual orientation. Homosexual men tend to exhibit more female patterns in the amygdala than heterosexual men. Likewise, homosexual women tend to show more masculine patterns in the amygdala than heterosexual women.

It was noted that amygdala couplings spread more rapidly in the left amygdala in homosexual men, which was also observed in heterosexual women. But the possibility of forming a person’s individual sexual orientation during the period intrauterine development and the newborn has not yet been determined.

Social interaction

Amygdala volume is positively correlated with both size (number of contacts a person has) and complexity (number of various groups to which a person belongs) social networks. People with larger tonsils had more and more complex social networks. They are also better able to make accurate social judgments about other people. One might speculate that larger amygdalae predict greater emotional intelligence.

Scientists have found that the feeling of personal space and discomfort from being too close to someone is determined by the work of a certain area of the brain - the so-called amygdala, which can be used to study and treat autism and other types of mental disorders, the authors of the study published in the journal believe. Nature Neuroscience.

"Respecting others' personal space is a critical aspect of human social interaction that we follow without thinking. Our work suggests that the brain's amygdala plays a key role in this, causing people to feel intense discomfort if someone gets too close to them ", said the lead author of the publication, Daniel P. Kennedy, as quoted by the press service of the California Institute of Technology in the United States.

The amygdala was already known to scientists as an area of the brain associated with strong negative emotions- anger and fear, but so far no one has been able to identify its connection with the everyday interaction of people.

The discovery of specialists from the California Technological University became possible thanks to work with a unique patient - a 42-year-old woman with extensive bilateral damage to the amygdala. There are only a few people in the whole world with such severe disturbances in the structure of this lobe of the brain.

This woman has difficulty recognizing threat and fear in the expressions of the people around her and cannot clearly judge which of those around her should be trusted and which not. In addition, this patient shows excessive friendliness towards everyone around her without exception, and therefore easily crosses the line that people call personal space.

In their new fairly simple experiments, a group of scientists asked 20 volunteers representing a wide variety of ethnic groups and social classes to determine the closest comfortable distance to the experimenter. To do this, volunteers stood opposite the person and approached him until they began to feel discomfort from being too close.

The unique patient in all of these experiments approached the researcher at a distance of about 0.34 meters, while healthy volunteers stopped an average of 0.64 meters from the scientist. At the same time, the patient did not experience discomfort, even being nose to nose with the experimenter.

In additional experiments, the scientists used magnetic resonance imaging to study the activity of the amygdala of volunteers who, at the request of the scientists, thought about whether the experimenter was directly next to the tomograph or was controlling the experiment from the next room. While inside the tomograph, the volunteer had no way of knowing where the scientist actually was. In these experiments, scientists also became convinced that even thinking about a person being too close is enough to activate the amygdala.

The amount of personal space varies greatly in communities of people united by different cultures, this difference is most clearly manifested when comparing Western countries with Eastern countries. The authors of the article believe that the formation of such a concept as personal space is influenced by personal experience and culture of communication between people also occurs with the participation of the amygdala. This same area of the brain can “adjust” personal space if a person gets into unusual situation or finds himself in a foreign country for a long time with a different culture of communication.

“We are most interested in studying the functioning of the amygdala in people with autism, who often have to painstakingly explain what personal space is and why it should be respected. Of course, disturbances in the functioning of the amygdala cannot explain all the symptoms of autism, but the contribution of the amygdala in it mental disorder is now obvious,” Kennedy concluded.

Cerebellar amygdala- a rounded lobe of the cerebellar hemisphere, occupying the anteromedial part of its lower surface along the edge of the vermis.

Tonsils

Tonsils- clusters lymphoid tissue in the throat. There are paired palatine and tubal tonsils, as well as unpaired lingual and pharyngeal tonsils ( rice.). Besides, in different departments In the pharynx there are small accumulations of lymphoid tissue in the form of individual granules and strands, which together with M. form a protective barrier - the so-called pharyngeal lymphadenoid ring. Having a common structure with other lymphoid organs, M. perform similar functions - hematopoietic (production of lymphocytes) and protective (participate in the formation of cellular and humoral immunity).

The palatine muscles (first and second muscles) are located between the palatoglossus and velopharyngeal arches in the tonsillar niches. The lateral surface of the palatine muscles, facing the wall of the pharynx, is covered with a connective tissue capsule, along which there is a layer of loose paratonsillar tissue. Partitions (trabeculae) extend from the capsule, dividing the palatine tonsils into lobules. Trabeculae carry blood vessels and lymphatic vessels, nerves. The free (medial) surface of the palatine membranes is uneven and consists of folds of the mucous membrane, in the lamina propria of which there are numerous lymphatic follicles. There are 10-20 depressions - almond crypts, or lacunae, opening on the surface as almond dimples. Crypts significantly increase the free surface area of the tonsils. Normally, they contain saprophytic microflora; in case of pathology, a large amount can be found in the crypts. pathogenic microorganisms, pus and caseous-purulent masses (plugs). Largest sizes The palatine tonsils reach age 8-13, and after 30 years they undergo gradual age-related involution.

The pharyngeal M. (third M., Cannon's tonsil) is located in the vault of the pharynx, occupying the upper and part back wall her bow. It is represented by several transverse folds of the mucous membrane, covered with ciliated epithelium. The stroma of the pharyngeal M. is connected to the pharyngeal-basilar fascia of the pharynx.

Lingual M. (fourth M.) is located on the root of the tongue posterior to the circumvallate papillae. The median sulcus and septum of the tongue divide lingual tonsil into two halves. It has a tuberous surface, shallow crypts, at the bottom of which ducts open salivary glands, covered with stratified squamous epithelium.

Tubal tubes (fifth and sixth tubes) are located near the pharyngeal opening of the auditory (Eustachian) tube. In size they are significantly inferior to other M.

The tonsils are supplied with blood from the ascending pharyngeal, facial, maxillary and lingual arteries - branches of the external carotid artery. Venous outflow is carried out into the veins of the pterygoid and pharyngeal venous plexuses, into the lingual, facial and internal jugular vein. Lymph enters the internal jugular The lymph nodes. M. receives innervation from the glossopharyngeal, lingual, vagus nerve, pterygopalatine ganglion and sympathetic trunk.

Research methods include posterior rhinoscopy (Rhinoscopy) (for examining the pharyngeal and tubal M.), pharyngoscopy (Pharingoscopy) (for examining the palatine M.) and indirect laryngoscopy (Laryngoscopy) (for examining the lingual M.). To examine the crypts and determine the nature of their contents, they are probed, palpated and washed.

Pathology. Developmental defects include accessory lobules or additional palatine m. on one or both sides. Treatment, as a rule, is not required in these cases.

M. injuries associated with burns and wounds are usually combined with injuries to the pharynx (pharynx). Foreign bodies can penetrate into the muscle tissue, causing pain when swallowing (see Foreign bodies).

In children, hypertrophy of the palatal M. is often observed, which is often combined with hypertrophy of the pharyngeal M. (see Adenoids). In most cases, palatal hypertrophy is not accompanied by inflammatory changes, but can lead to difficulty breathing and interfere with food intake. Treatment is prescribed only when the indicated functional disorders. Usually, restorative therapy is carried out, and if it is ineffective, surgical treatment is performed.

M.'s inflammation can be acute (see. Sore throat) and chronic (see. Chronic tonsillitis). Inflammatory changes in M. also develop in acute infectious diseases - diphtheria, scarlet fever, infectious mononucleosis and etc.; M.'s defeat up to the occurrence of ulcerative and necrotic processes is observed in blood diseases - leukemia, lymphogranulomatosis.

M.'s tuberculosis in most cases is secondary in nature and is observed in patients with pulmonary tuberculosis. It often occurs hidden under the guise of chronic tonsillitis. The diagnosis is made taking into account the medical history based on morphological and bacteriological research. Specific treatment (see Tuberculosis (TB)).

Syphilitic lesions of M. can occur at any stage of the disease. At primary syphilis One tonsil is affected (chancroid and regional lymphadenitis develop). Secondary syphilis may appear syphilitic sore throat(tonsils are enlarged, with easily ulcerated, sharply defined bluish-red lesions or oval plaques with a red rim). With tertiary syphilis, the formation of gummas is possible. The diagnosis is made on the basis of bacteriological and serological studies. Specific treatment (see Syphilis).

M.'s tumors are benign and malignant. Benign tumors include epithelial tumors - papilloma (Papilloma) and non-epithelial tumors - fibroma (Fibroma), angioma, lipoma (Lipoma), neuroma, chemodectoma, myoma. They are characterized by slow growth and are often asymptomatic. When greatly increased, they may cause difficulty swallowing and breathing. Treatment is surgical.

Malignant epithelial tumors include Cancer, incl. lymphoepithelioma; among tumors of nonepithelial origin, lymphosarcoma (Lymphosarcoma), reticulosarcoma, angiosarcoma, and chondrosarcoma are distinguished. Majority malignant tumors M. (with the exception of transitional cell carcinoma and lymphoepithelioma) is characterized by slow growth and is clinically manifested by moderate hyperemia of the M. and its slight compaction. For transitional cell carcinoma and lymphoepithelioma initial symptoms are difficulty swallowing (if the pharyngeal M. is affected, breathing through the nose is impaired), a feeling in the throat foreign body, increase in M. Later pain joins, radiating to the neck, ear, lower jaw. Subsequently, as the tumor ulcerates and disintegrates, bleeding occurs. Rapid development of metastases is observed, both in regional and distant lymph nodes, tumor spread to surrounding tissues, and invasion into the cranial cavity. Diagnosis is based on results histological examination biopsy material. Combined treatment.

Operations on the tonsils include tonsillectomy and tonsillotomy. Tonsillectomy - removal palatine tonsils together with a connective tissue capsule, used for chronic tonsillitis in case of ineffectiveness conservative methods or in case of complications (see Chronic tonsillitis).

Tonsillotomy - partial removal palatine tonsils, is used when there is severe hypertrophy (often in combination with adenoidectomy) or contraindications to tonsillectomy. The operation is performed using a tonsillotome, usually under local anesthesia. In the first two days after surgery, patients are prescribed bed rest, then (for 3-6 days) home regimen, gentle nutrition; physical exercise allowed no earlier than 14-15 days after surgery.

Bibliography: Human Anatomy, ed. M.R. Sapina, vol. 2, M., 1986; Multi-volume guide to otorhinolaryngology, ed. A G. Likhacheva, vol. 3, p. 208, M., 1963; Preobrazhensky B.S. and Popova G.N. Angina, chronic tonsillitis and diseases associated with them, M., 1970, bibliogr.; Soldatov I.B. Nervous apparatus tonsils in normal and pathological conditions, Kuibyshev, 1962, bibliogr.

encyclopedic Dictionary medical terms M. SE-1982-84, PMP: BRE-94, MME: ME.91-96.