Ectopia of the cerebellar tonsil: causes, symptoms, diagnosis, therapeutic measures

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. Quite often, the clinical picture of 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 enters the BZ, often medulla oblongata, as well as its ventricle. 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 are located not only the tonsils, but also the entire cerebellum along with the 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 channel 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 disruption of 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 during sneezing, severe cough and general tension of 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.

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 role in this." key role, causing people to feel extreme discomfort if someone gets too close to them,” said lead author Daniel P. Kennedy, as quoted by the California Tech University press service.

The amygdala was already known to scientists as an area of the brain associated with strong negative emotions - anger and fear, but until now no one had been able to identify its connection with everyday human interactions.

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 This mental disorder is now obvious,” Kennedy concluded.

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Types of anomalies

Type I is characterized by the location of the tonsils below the level of the foramen magnum. This pathology is usually detected in adolescents and adults. It is often accompanied by an accumulation of spinal cerebrospinal fluid in the central canal, where the patient’s spinal cord is located.
Type II is characterized by manifestation immediately after birth. In addition, in addition to the tonsils, in the second type of pathology, the cerebellar vermis with part of the medulla oblongata and the ventricle emerge into the foramen of the occipital part. The second type of anomaly is much more often accompanied by hydromyelia than with the pathology described in the first case. In most cases, this pathological deviation is associated with congenital hernias formed in various parts of the spinal cord.
Type III is distinguished by not only the tonsils descending through the hole, but also the cerebellum along with the tissues of the medulla oblongata. They are located in the cervical and occipital regions.
Type IV is an underdevelopment of cerebellar tissue. This pathology is not accompanied by their displacement in the caudal direction. But the anomaly most often accompanies congenital cyst, located in the cranial fossa, and hydrocephalus.

increased tone of the cervical muscles;
speech dysfunction;
deterioration of the organs of vision and hearing;
deviations when swallowing;
frequent dizziness accompanied by noise in the head;
a feeling of rotation of the environment;
brief fainting;
pressure changes during sudden movements;
tongue atrophy;
hoarseness of voice;
breathing and sensory disorders different parts bodies;
attacks of numbness;
disorders in the pelvic organs;
weakening of the muscles of the limbs.

attacks of “shooting” pain in the neck muscles with increased tension or coughing;
frequent pain in the head area;
attacks of dizziness and fainting.

Diagnostic methods

debilitating headaches that cannot be relieved by medications.
an increase in brain manifestations leading to disability.

Chiari malformation type 1 can be asymptomatic throughout life. And the third type of pathology almost always leads to fatal outcome, if not implemented timely treatment. If neurological signs of the first or last type of disease appear, it is very important to carry out timely surgery, because the resulting lack of neurological functions will be poorly restored, even if the manipulations are successfully carried out. According to various sources, the effectiveness surgery observed in approximately half of the episodes.

Arnold-Chiari malformation is a congenital defect in the development of the rhombencephalon. This anomaly is manifested by a discrepancy between the sizes of the posterior cranial region and the brain components located in it. As a result, this leads to the fact that part of the tonsils of the cerebellum and brain descends into the foramen magnum, where they are pinched.

Causes of development of Arnold-Chiari malformation

According to statistics, this pathology is observed in 3-8 people out of every 100 thousand.

To date, the exact cause of the development of Chiari malformation has not been identified. Most likely, the manifestation of this disease is accompanied by the following three factors:

traumatic damage to the sphenooccipital and sphenoethmoidal part of the clivus as a result of birth trauma;
congenital osteoneuropathy with a hereditary factor;
hydrodynamic impact of cerebrospinal fluid into the walls of the central canal of the spinal cord.

What anatomical changes occur with Arnold-Chiari malformation?

With this pathology, the cerebellum is located in the posterior cranial fossa.

Fine Bottom part The cerebellum (tonsils) should be located above the foramen magnum. In Arnold-Chiari malformation, the tonsils are located in spinal canal, that is, under the foramen magnum.

The foramen magnum serves as a kind of boundary between the spine and the skull, as well as between the spinal cord and the brain. Above this hole is the posterior cranial fossa, and below it is the spinal canal.

The lower part of the brain stem (medulla oblongata) passes into the spinal cord at the level of the foramen magnum. Normally, cerebrospinal fluid (CSF) should circulate freely in the subarachnoid spaces of the spinal cord and brain. These subarachnoid spaces are connected to each other at the level of the foramen magnum, which ensures the free outflow of cerebrospinal fluid from the brain.

In Arnold-Chiari malformation, the tonsils are located under the foramen magnum, which impedes the free flow of cerebrospinal fluid between the brain and spinal cord. The cerebellar tonsils block the foramen magnum like a plug, which significantly impairs the outflow of cerebrospinal fluid and leads to the development of hydrocephalus.

Types of Arnold-Chiari malformation

In 1891, Chiari identified four main types of pathology and described each in detail. Doctors still use this classification today.

1 type It is characterized by a descent of the structures of the posterior cranial fossa below the plane of the foramen magnum.
Type 2, which is characterized by caudal dislocation lower sections skull, 4th ventricle and medulla oblongata. This is often accompanied by hydrocephalus.
Type 3 This type of disease is quite rare and is characterized by gross caudal displacement of all structures of the posterior cranial fossa.
Type 4, when cerebellar hypoplasia occurs without its downward displacement.

The third and fourth types of Arnold-Chiari malformation cannot be treated and, as a rule, lead to death.

In the vast majority of patients (about 80%), the Arnold-Chiari malformation is combined with syringomyelia, a spinal cord pathology characterized by the formation of cysts in it, which contribute to the development of progressive myelopathy. Such cysts form when the structures of the posterior cranial fossa descend and as a result of compression of the cervical spinal cord.

Symptoms of Arnold-Chiari malformation

This pathology is characterized by the following clinical signs:

loss of temperature and pain sensitivity upper limbs;
pain in the cervical-occipital region, aggravated by sneezing and coughing;
loss of visual acuity;
loss of muscle strength in the upper limbs;
frequent dizziness, fainting;
spasticity of the lower and upper extremities.

For more advanced stages Symptoms of Arnold-Chiari malformation include a weakened pharyngeal reflex, episodes of apnea (temporary stops in breathing) and involuntary rapid eye movements.

This disease is fraught with the development of the following complications:

Paralysis of the nerves of the skull, entrapment of the cervical spinal cord, dysfunction of the cerebellum, occurring against the background of progressive signs of intracranial hypertension.
It happens that this pathology is associated with skeletal defects: occipitalization of the atlas or basilar impression (funnel-shaped depression of the craniospinal joint and clivus).
Foot deformities, spinal abnormalities.

Sometimes the Arnold-Chiari malformation is asymptomatic and is detected only during a general examination of the patient.

Diagnosis of Arnold-Chiari malformation

The main method for diagnosing this disease today is MRI of the chest and cervical spinal cord and MRI of the brain. MRI of the spinal cord is done primarily to detect syringomyelia.

Treatment of Arnold-Chiari malformation

If the disease has only one symptom - pain in the neck, then treatment of Arnold-Chiari malformation is mainly conservative. Therapy includes various regimens using muscle relaxants and non-steroidal anti-inflammatory drugs.

If the effect of conservative treatment insufficient or completely absent during 2-3 months of treatment, and also if the patient has symptoms of neurological deficiency (weakness and numbness of the limbs, etc.), then the doctor, as a rule, suggests surgery for Arnold-Chiari anomaly.

The main purpose of surgery for Arnold-Chiari anomaly is to minimize the infringement of nerve endings and tissues and normalize the outflow of cerebrospinal fluid, for which the size of the posterior cranial fossa is slightly increased in volume. As a result of surgery, Arnold-Chiari malformation completely disappears or decreases headache, partially restored motor functions and sensitivity of the limbs.

The information is generalized and is provided for informational purposes. At the first signs of illness, consult a doctor. Self-medication is dangerous to health!

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.

This is why changing the correct location of these cerebellar corpuscles is so important. 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 occurrence of a reflex reaction of fear and the analysis of signals coming from sensitive receptors.
The medial-central complex is the so-called “output” of the basal ganglia. This formation is responsible for emotional arousal.
Medial cortical complex.

Normally, 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

The most common location disorder encountered in clinical practice is ectopia of the cerebellar tonsil. Pathology implies their descent into the foramen magnum, as well as a decreased condition of the tonsils.

Basically, this condition occurs mainly in adults, aged approximately 30-40 years. It is diagnosed accidentally, 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. Quite often, the clinical picture of 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. This problem is mainly caused by congenital hernias localized in the spinal cord.
Type 3 is an even more serious anomaly. In this case, below the foramen magnum are located not only the tonsils, but also the entire cerebellum along with the 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 impact of cerebrospinal fluid on the walls of the central canal of the spinal cord.

Return to contents

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 disruption of the normal functions of the nerve endings inside the skull. The strength of 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, and 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 are 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 in various parts of the body;
severe weakening of the muscles of the limbs.

Return to contents

Diagnostic methods

To diagnose this disease, a neurological examination, a complete history taking, and various instrumental examinations are often used.

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. The presence of birth injuries to the head and neck is also clarified.

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

Therapeutic measures

Treatment of ectopia cerebellar tonsils can be performed conservatively and surgically.

In the first case, they are engaged in removing unpleasant and painful symptoms. For this purpose, nonsteroidal analgesics, anti-inflammatory drugs, and muscle relaxants are used. If an inflammatory process occurs, it is possible to use antibacterial drugs.

At surgical impact The problem is addressed by eliminating all factors that cause compression of the brain. Also, as an auxiliary technique, cerebrospinal fluid is drained. This procedure allows you to reduce intracranial pressure and alleviate the clinical manifestations of the disease.

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The amygdala is a specific part of the brain that visually resembles the shape of a regular amygdala. Its dislocation is located deep in the temporal lobe of the brain; in Latin, “lobe” is called Lobus temporalis. Each hemisphere of the brain has its own amygdala. The importance of these tonsils is difficult to overestimate, because they are involved in the formation of emotions, are constituent element limbic structure.

In humans and many species of animals, it is this part of the brain that is responsible for the production of positive and negative emotions - pleasure, fear, anger and others. The size of the cerebellar amygdala has a direct relationship with respect to aggressive actions. This part of the brain is sexually dimorphic. For example, if a man has been castrated, the cerebellar tonsils decrease in size by 30%.

Doctors have proven that many mental illness associated specifically with the violation normal function cerebellar tonsils. In particular, the following diseases:

increased anxiety; autism; schizophrenia; bipolar disorder; various phobias.

In fact, a number of separately acting nuclei are called tonsils. Doctors combine them because these nuclei are close to one another. The main cores are:

basal lateral nuclei; medial central complex; medial cortical complex.

The basal lateral nuclei are necessary for the formation of the fear reflex. Signals to the nuclei come from sensory structures. But medially, the central complex is the output of the basal lateral nuclei and is necessary for the formation of emotional arousal.

Until recently, doctors were confident that with Urbach-Wiethe disease, the patient did not have such an emotion as fear. It is known that in patients with this disease, the cerebellar tonsils are destroyed. But more modern research and experiments have proven that such patients can still be frightened. This is possible by exposure to air and a large amount of carbon dioxide, through inhalation. However, the gas to air ratio must be at least 35%.

This amygdala is responsible for a large number of different responsibilities, for example:

The amygdala is responsible for motivation, i.e. motivation to action. waking up; fear and its emotional manifestations; various types of emotions; hormonal secretions; memory.

Thanks to the cerebellar bodies, a person is able to quickly and permanently remember emotional reactions to various kinds events. And since the amygdala is part of the limbic structure, a person has the ability to learn unconsciously. This feature distinguishes some types of animals.

The brain has a special structure; for this reason, incidents that are significant in terms of survival are recorded using strong emotion. After all, the main job of the brain is to care about survival. Accordingly, such an emotion activates internal mechanism, necessary so that a person does not forget this event. This information is located in long-term memory.

Unconscious learning can control the formation of conditioned reflexes. This learning occurs automatically and on an unconscious level. Because human reflexes are located in parts of the brain that are independent of thinking, they are difficult to rationalize. In carrying out its duties, the amygdala interacts with the hippocampus and basal ganglia. As a result of this interaction, incoming data is assimilated at a higher level.

Dystopia of the cerebellar tonsils is a specific descent of the cerebellar amygdala into the large foramen magnum. This pathology may be called Chiari malformation, it occurs when there is a caudal dislocation of the amygdala on the right or left side of the brain. The disease is characterized by decreased position of the amygdala.

Such standing of the tonsils in no way affects the patient’s life and does not cause concern. The child has this disease It is found extremely rarely; adults between 30 and 40 years of age are more susceptible to it. It is diagnosed by chance, during routine examinations or treatment of other problems.

This condition occurs due to congenital abnormalities when the volumes of the foramen magnum and the brain do not match. Ectopic tonsils may have another explanation and be secondary. This situation is likely when large number injuries or due to incorrectly taken lumbar punctures.

Symptoms of cerebellar tonsil ectopia are difficult to determine clinical method. But sometimes manifestations of a neurological nature are likely - pain in the neck during exercise or muscle tension. The pain occurs in the form of attacks. At the same time, pain in the head is possible, and sometimes dizziness is a concern. The greater the prolapse of the cerebellar tonsils, the more painful and noticeable the symptoms. If the amygdalae have dropped and become too low, syringomyelia may occur.

If there are no neurological complaints, then the adult or child may not be treated. However, even if the situation is moderate, because there are no signs, it is advisable to keep patients under the supervision of a doctor. It is important to monitor indicators so that their norm does not change and the disease does not develop.

You can avoid surgery if you start treatment on time.

With minor symptoms, prolapse, or in other words herniation of the tonsils, can be treated with conservative methods. Painful sensations are eliminated with the help vascular agents, non-steroidal drugs from inflammation, through muscle relaxants. It will be important to adhere to the prescribed lifestyle.

Surgery (removal) is sometimes the most effective method of therapy for patients whose cerebellar tonsil has dropped below permissible level. The same applies to situations where the pathology is too extensive and the tonsils are inflamed.

The amygdala can be removed by increasing the size of the cranial fossa and wedging into the meninges.

When surgery necessary:

constant headache that does not go away after taking medications; an increase in the number of focal manifestations that provoke disability.

MRI is considered the best way to diagnose pathology. X-rays and computer tomography do not show the whole picture of the disease.

If an ectopia of the amygdala is found in the right or left hemisphere of the brain, then do not worry too much. The pathology does not cause concern and does not require treatment. However, only a doctor can make such a decision.

The descent of the cerebellar tonsils into the foramen magnum or cagal of the spinal cord is called dystopia. And sometimes this pathology is called Chiari malformation. As a rule, such a disease does not entail significant disorders or obvious symptoms and has no reason to worry the patient. Often this pathology manifests itself after reaching 30–40 years of age. It is usually discovered during examinations for other reasons. Therefore, you should know about this disease so that it does not come as a surprise to the patient.

In order to understand what it is low position cerebellar tonsils, you need to clearly know clinical symptoms and how pathology is detected. And since this condition is accompanied by frequent headaches, you must first establish their cause, and then begin treatment. This disease is detected by MRI.

Cerebellar dystopia, as a rule, is a congenital pathology. It occurs when an organ is displaced during the embryonic period. It occurs secondary only when frequent punctures are performed or with lumbar injuries. No other causes of this disease have been identified.

The tonsils of the cerebellum are very similar to those found in the larynx. IN normal position they are located above the BZO of the skull. And deviations in their development and position can lead to not only dystopia. The most common occurrence is prolapse of the cerebellar tonsils below the level of the skull.

Until now, Chiari disease is a pathology, the causes of which neurologists have not come to a common opinion. Some are of the opinion that this anomaly occurs when the size of the fossa behind the cranial outlet to the spinal canal decreases. This often leads to such consequences during the growth of tissues that are located in the box. They exit into the occipital exit canal. Other experts believe that the disease begins to develop due to an increase in the volume of brain tissue in the head. In this case, the brain begins to push the cerebellum and its tonsils through the posterior cranial fossa into the occipital cranial foramen.

Causes the progression of a pronounced anomaly and its transition to the “clinic”, such as hydrocephalus. At the same time, the overall size of the brain increases, especially the cerebellar tissue. Chiari pathology, together with the underdeveloped ligamentous apparatus of the brain, is accompanied by dysplasia of bone tissue. Therefore, any traumatic brain injury often leads to an increased decrease in the level of location of the tonsils and cerebellum.

There are such types of abnormal deviations as dystopia and Chiari malformation.

In turn, Chiari disease is divided into four different types:

Type I is characterized by the location of the tonsils below the level of the foramen magnum. This pathology is usually detected in adolescents and adults. It is often accompanied by an accumulation of spinal cerebrospinal fluid in the central canal, where the patient’s spinal cord is located. Type II is characterized by its manifestation immediately after birth. In addition, in addition to the tonsils, in the second type of pathology, the cerebellar vermis with part of the medulla oblongata and the ventricle emerge into the foramen of the occipital part. The second type of anomaly is much more often accompanied by hydromyelia than with the pathology described in the first case. In most cases, such a pathological deviation is associated with congenital hernias formed in various parts of the spinal cord. Type III is distinguished by not only the tonsils descending through the hole, but also the cerebellum along with the tissues of the medulla oblongata. They are located in the cervical and occipital regions. Type IV is an underdevelopment of cerebellar tissue. This pathology is not accompanied by their displacement in the caudal direction. But the anomaly is most often accompanied by a congenital cyst located in the cranial fossa and hydrocephalus.

Types II and III often appear in combination with symptoms of dysplasia nervous system, for example, with heterotopia of the brain tissue of the cortex, foramen cysts, etc.

The most common among the anomalies is the pathology of the first type. With it, the manifestation of liquor-hypertensive syndrome is often possible, as well as cerebellar-bulbar and syringomyelic phenomena, disruption of the functioning of nerve endings inside the skull.

Liquor-hypertensive syndrome is pain in the back of the head and neck muscles, which intensifies during sneezing, coughing or straining the neck muscle tissue. Often the pain is accompanied by vomiting that is not associated with eating. Many symptoms of the pathology appear depending on the position of the cerebellar tonsils relative to the opening located in the occipital fossa of the skull. Also observed:

increased tone of the muscles of the cervical spine; disturbances in speech functions; deterioration in the functioning of the organs of vision and hearing; deviations when swallowing; frequent dizziness, accompanied by noise in the head; a feeling of rotation of the environment; short-term fainting; pressure changes during sudden movements; atrophy of the tongue; hoarseness of voice; disorders breathing and sensitivity of different parts of the body; attacks of numbness; disorders in the pelvic organs; weakening of the muscles of the limbs.

Anomalies of types II and III have similar symptoms, noticeable from the first moments after the birth of the baby. The second type accompanies noisy breathing, as well as unexpected attacks of respiratory arrest, neuroparesis of laryngeal tissues. Deviations in the swallowing process are also observed.

Signs of dystopia are rarely obvious. But neurological manifestations are still possible:

attacks of “shooting” pain in the neck muscles with increased tension or coughing; frequent pain in the head; attacks of dizziness and fainting.

If the prolapse of the tonsils is severe, sometimes there is a widening of the canal connecting the brain and spinal cord, and cavities form around the canal.

Diagnostic methods

Main modern method diagnosing dystopia is MRI. In this case, neither CT nor X-ray studies provide a complete picture of the pathology.

No tests are suitable for diagnosing Chiari syndrome. standard methods such as EEG, EchoEG or REG, because they do not allow an accurate diagnosis. An examination by a neurologist will also not determine the anomaly. All these methods can only show suspicion of high blood pressure inside the skull. X-rays of the skull should also not be done, since they only show abnormalities of bone tissue that may accompany pathology. Therefore, before the introduction of tomography into diagnostic practice, diagnosing this disease was problematic. Modern diagnostic methods make it possible to accurately determine the pathology.

In the case of high-quality visualization of the bone tissue of the vertebral junction, methods such as MSCT or CT do not provide a sufficiently accurate picture. The only reliable way to diagnose Chiari malformation today is MRI.

Since conducting research with this method requires immobility of the patient, small children are immersed in artificial sleep with the help of medications. An MRI of the spinal cord is also performed. It is aimed at diagnosing any abnormal abnormalities in the functioning of the nervous system.

Conservative treatment methods are possible only for very minor deviations. It all depends on what the patient’s condition is at the time of going to the doctor. In this case, treatment is aimed at relieving painful symptoms with non-steroidal medications or muscle relaxants. Correction of the regime is also necessary.

The only one effective method Treatment for extensive deviations is surgical intervention, which consists of expanding the cranial fossa and plastic surgery of the dura mater tissue.

Indications for surgical treatment are:

debilitating headaches that are not relieved by medications. an increase in brain manifestations, leading to disability.

If the abnormal deviation occurs without any noticeable signs, no treatment is required. In cases where painful sensations in the area of the neck and back of the head conservative therapy, in which analgesics and aseptic agents are used medicinal substances, as well as muscle relaxants.

When Chiari malformation is accompanied by neurological dysfunction or when a conservative course of therapy does not produce results, surgery is prescribed.

Often when treatment courses for Chiari syndrome, the method of craniovertebral decompression is used. The operation involves widening the opening of the occipital part by removing part bone tissue, cutting off the cerebellar tonsils and parts of two vertebrae of the neck. Thanks to this, the turnover of cerebrospinal fluid in the brain tissue is normalized as a result of a patch made from an allograft or artificial material. Sometimes Chiari syndrome is treated with a shunt, which allows cerebrospinal fluid to drain from the central canal. Through surgery, cerebrospinal fluid can be drained into the vessels of the chest or peritoneum.

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 contain blood and lymphatic vessels and 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). The palatine tonsils reach their largest size at 8-13 years of age, and after 30 years of age 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 pharyngobasilar 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 lingual septum divide the 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 manifest as syphilitic sore throat (tonsils are enlarged, with easily ulcerated, sharply outlined 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. With transitional cell carcinoma and lymphoepithelioma, the initial symptoms are difficulty swallowing (if pharyngeal M. is affected, difficulty breathing through the nose), a feeling in the throat foreign body, increase in M. Later, pain occurs, radiating to the neck, ear, and 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 of the palatine tonsils along with the connective tissue capsule, used for chronic tonsillitis in case of ineffectiveness of conservative methods or 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 activity is 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.