Alternating syndromes. Weber Syndrome, Fovilly, Jackson, Zakharchenko

These are syndromes that accompany one-sided focal lesions of the brain barrel, the overall scheme of which includes the defeat of the cranial nerve nuclei on the side of the focus and contralateral conductive (motor and sensitive) violations. Depending on the level of localization of the lesion, the bulbar (oblongable brain) is isolated, Pont-end (Varoliviyev Bridge) and Pendunkular (medium brain, brain leg) alternating syndromes.

Alternating the conclusted brain syndromes.

· Jackson syndrome (peripheral paralysis of the inlet nerve on the side of the brain lesion; spastic hemiplegia on the opposite side; loss of muscular-articular and vibration sensitivity; dysarthria; larynx muscle paresis; swallowing violations; cerebelchik ataxia on the side of the focus; the deviation of the language towards the defeat, atrophy and The pugishness of half of the language, fascicular twitching in it). Cause - branches thrombosis a. Spinalis Anterior.

· Avellis syndrome (soft sky paralysis and voice ligaments; Atrophic language changes on the side of the lesion; contralateral spastic hemiplegia; hemiagesests; Returning; dysarthria; dysphonia). The reason is the defeat of the twigs a. Fossae Lateralis Bulbi.

· Schmidt syndrome (peripheral paresis of the entire caudal group of cranial nerves - 9,10,11,12; contralateral hemiparesis and hemiagesests; one-sided paralysis of a soft sky and voice ligament; tongue atrophy, sternum-clarity and trapezoid muscles).

· Babinsky-press syndrome (cerebellar disorders on the side of the hearth - hemiaxyergia and laateropulsia; nystagm and sympathetic disorders on the face; the narrowing of the eye slot, enofallas - Bernard-Gorner syndrome; on the opposite side - hemiparesis, pain and temperature hemiagesthesia). The focus is usually on the border of the oblong brain and Barolic Bridge.

· Wallenberg-Zakharchenko syndrome (on the side of the defeat - paralysis of a soft sky and voice muscle; face sensitivity disorder on segmental type; Bernard-Gorner syndrome; on the opposite side - Gemiagesey on conductor type, less often hemiplegia; with extensive foci - respiratory disorders and heart - seeming activity).

Alternating Pontic Syndromes.

· Myiyar-gruel syndrome (peripheral passage of facial nerve on the side of the lesion; Central hemiparesis or hemiplegia of opposite limbs). It occurs during the localization of the pathological focus at the base of the bridge.

· Syndrome of Brisso-Sicar (irritation of the ton of the facial nerve with the development of tonic and clonic convulsions in the muscles of the face on the side of the defeat; hemiparesis or hemiplegia on the opposite side). The basis is the violation of blood circulation in the main artery or its branches.

· Fovilly syndrome (peripheral paresis of face musculature and outdoor direct muscles of the eye on the side of the lesion; hemiparesis or hemiplegia in the central type on the opposite side; converging squint due to the eye on the side of the defeat). The basis is the violation of blood circulation in the main artery or its branches.

· Hollow syndrome (peripheral paralysis of the facial and discharge nerve, motor portion of a triple nerve; loss of sensitivity on the face; reduction of hearing on the side of the lesion; Nistagm in the side of the opposite lesion; Bernara-Gorner syndrome; hemigipesthesia on the conductor on the contralateral half of the body and limbs) . The reason is a circulatory disorder in the front cerezyular artery pool.

· Raimon Sestan syndrome (cerebellar disorders on the side of the focus - Gomolateral Asiereria, paralysis of the eyes towards the hearth, contralateral hemiplegia and hemiagesestsia; hypercinesis). The reason is a circulatory disorder in the main artery or its branches, as well as tumors.

Alternating peduncular syndromes.

· Weber syndrome (glaze of the eye-eye nerve on the side of the lesion; contlatated - central hemiplegia or hemiparem limbs and torso; central paresis of facial and sub-speaking nerves; hemianopsy). It is observed in the damage to the base of the brain legs due to the stenosis of the rear brain artery and its branches, with syphilitic endarteritis, the aneurysis of the rear brain artery, with tumors, basal leptopakhimengitis.

· Benedict syndrome (on the side of the lesion - the paresis of the glaze nerve; contlatated - intentional trembling in the limbs and choreoaththetosis; hemiagesey). Developed by lesion of the red core. It occurs during thrombosis and hemorrhages in the branches of the rear brain artery and during cancer metastase.

Alternating syndromes

symptom complex characterized by a combination of lesion of cranial nerves on the side of the focus with conductive disorders and sensitivity on the opposite side. It occurs with the defeat of one half of the brain barrel, the spinal cord, as well as with a one-sided combined damage of the structures of the brain and senses. Various A. s. It may be caused by a violation of the cerebral circulation, a tumor, ancient brain injury, etc.

The most common A. p., Associated with the lesion of the brain trunk, manifested on the side of the focus, violation of the functions of the cranial nerves on the peripheral type (due to the defeat of their nuclei or roots) and the conductive disorders on the opposite side (, hemiparesis, hemi asthynce, etc. due to the lesion of the fibers pyramid path, medial loop, spinolamic Path, cerebellar connections, etc.). To stem A. s. The cross-hemiplegia (one hand and the opposite foot) appears, which occurs during the damage in the area of \u200b\u200bthe pyramid paths on the boundary of the oblong and spinal cord. In the dependence of the localization of the lesions of the lesion in the brain barrel, the bulbar (focus in the oblong brain), pontin (brain bridge), peduncular (focus in the brain leg) A. s. There are A. s., Associated with damage to several divisions of the brain stem and extracerebral A. s.

Alternating syndromes caused by one-sided lesion of the senses and various brain structures that have common source of blood supply to them, are called Extracerebral A. s. As a rule, they arise in the pathology of one of the main vessels of the head and are associated with a secondary circulation impairment in its branches. This produces several extra- and intracerebral foci of lesion in the zones of impaired blood circulation.

Bulbar alternating syndromes. Jackson syndrome is due to the lesion of the core of the sub-speaking nerve and the fibers of the pyramidal path. On the side of the pathological focus, peripheral paralysis of the muscles of the language is developing (deflection of the language in the direction of lesion, half of the language, sometimes fibrillar twitching, rebirth in the study of the electrical conductivity of the muscles of the language), on the opposite side - the central hemiplegia or hemiparem limbs.

Avellis syndrome occurs with the damage to the motor kernel or the motor roots of the Language and wandering nerves and the pyramidal path. On the side of the lesion, the peripheral paralysis of a soft sky, tongue, voice fold With violation of swallowing, lamp, speech (), on the opposite side - central hemiplegia or hemiparesis.

Schmidt syndrome has a combined lesion of the motor nuclei or fibers of the languagehilic, wandering, added nerve and the pyramidal path. On the side of the lesion, there is a peripheral soft sky, voice fold, sternum-curable-bed-like and trapezoid muscles, on the opposite side - central hemiplegia or hemiparesis.

Babinsky's syndrome - press is observed when combining the lesion of the lower cerebulic leg, the olive path, the sympathetic fibers, as well as the pyramid path, the spinatelamic path, the medial loop. On the side of the lesion, cerebellar disorders are recorded (hemiacts, laateropulsia), Gorner syndrome (see Bernard - Gorner Syndrome) , On the opposite side - central hemiplegia or hemiparesis, hemiagesestsia.

Wallenberg Syndrome - Zakharchenko is due to the lesion of the motion core of the wandering and tongue nerve, kernel spinal Path Triple nerve, sympathetic fibers, lower cerebellar legs, spinatelamic tract, sometimes a pyramidal path. On the side of the lesion, the peripheral paralysis of a soft sky and voice fold is revealed, impaired surface sensitivity on the face along the segmental type, the city syndrome, ataxia, on the opposite side - a violation of the superficial hemiteness sensitivity, sometimes central hemiparesis.

Tapia syndrome occurs when a combination of the destruction of the cores or fibers of the added, sub-speaking nerves and the pyramidal path. On the side of the pathological focus - the peripheral paralysis of the breast-curable and large and trapezoid muscles, muscles of the tongue, on the opposite side - central hemiplegia or hemiparesis.

Volreyne syndrome is due to the damage to the oral duty station of the nuclear petroleum and wandering nerves and the spinctalamatic path. On the side of the damage - peripheral paralysis of voice fold, on the opposite side - hemiagesestsia.

Pontic.Miyar - Gubler's syndrome is determined by damage to the kernel or faces of the face nerve and the pyramidal path. On the side of the damage - one-sided peripheral paralysis of the Mimic muscles, on the opposite side - central hemiplegia or hemiparesis.

The sicar syndrome is due to the irritation of the facial nerve core and the defeat of the pyramidal path. On the side of the lesion - one-sided mimic muscles, on the opposite side - central hemiplegia or hemiparesis.

Fovilly syndrome is observed with a combined destruction of nuclei or faces of the facial and discharge nerves, a pyramid path, a medial loop. On the side of the pathological focus - the peripheral paralysis of the facial nerve, converging with the restriction of the movement of the eyeball of the KNETAY, diplopia, on the opposite side - central hemiplegia or hemipapes, hemiagesthesia.

Raymon - Sestan's syndrome is due to a combined lesion of the rear longitudinal beam, a bridge center of the gaze, a medium cerebellar leg, a medial loop, a pyramidal path. On the side of the defeat -, choreoathyoid, paressers of the gaze in the side of the hearth, on the opposite side - central hemiplegia or hemipapes, hemiagesey.

Pedoucular alternating syndromes. Weber syndrome occurs when the kernel is damaged or the root of the oxular nerve and the fibers of the pyramid way. On the side of the pathological focus -, divergent squint, on the opposite side - central hemiplegia; There is also central paralysis of the face and language muscles.

Benedict syndrome is due to the lesion of the kernel of the oculomotor nerve, the red core, red-nuclear-gear fibers, sometimes the medial loop. On the side of the defeat - ptosis, divergent squint, mydriasis, on the opposite side -, intente, sometimes hemiagesests.

Claude syndrome is determined by lesion of the kernel of the ocular nerve, the upper cerebelling leg. On the side of the pathological focus - ptosis, divergent squint, mydriasis, on the opposite side - ataxia, dysmetry, reduced muscle tone.

The syndrome of a notepaper is due to a combined lesion of the nuclei of the glazing nerve, the upper cerebulic leg, the lateral loop, the red core, the fibers of the pyramidal path. On the side of the lesion - ptosis, divergent squint, mydriasis, cerebelchik ataxia, (one and bilateral), on the opposite side - choreathetoid hyperkinosis, central hemiplegia, central paralysis of the face and language muscles.

Alternating syndromes associated with the defeat of several departments of the brain trunk. The horik syndrome is due to the defeat of the visual, trigeminal, facial, wandering nerves and the pyramidal path. On the side of the lesion - peripheral paralysis (paresis) of the Mimic muscles with their spasm, in the supraorbital region, a decrease in vision or, difficulty in swallowing, on the opposite side - central hemiplegia or hemiparesis.

Cross hemiasiasia is observed when the kernel is damaged to the core of the trigeminal nerve at the level of the bridge or the oblong brain and the fibers of the spinctalamatic path. On the side of the lesion - the disorder of surface sensitivity on the face along the segmental type, on the opposite side - a disturbance of surface sensitivity on and limbs.

Extracerebral alternating syndromes. Optical-hemiplegic syndrome occurs with one-sided damage of the retina of the eye, the optic nerve, the motor zone of the large brain cortex due to circulatory disorders in the system of internal sleepy artery (in the eye basin and medium cerebral arteries). On the side of the defeat - Amavrosis, on the opposite side - central hemiplegia or hemiparesis.

The vertigohemiplegal syndrome is due to one-sided lesion of the vestibular apparatus and the motor zone of the large brain due to the circulatory disorders in the system of connectual and carotid arteries with a circulation impairment in the labyrinth basins (vertebobasilar pool) and medium cerebral arteries. On the side of the defeat - in the ear, horizontal in the same side; On the opposite side - central hemiplegia or hemiparesis.

Asfigmogmiplegal syndrome (shoulder arterial syndrome) is noted with one-sided irritation of the nucleus of the face nerve, vasomotor centers of the brain barrel, the damage to the motor zone of the big brain. On the side of the defeat - the spasm of the mimic muscles, on the opposite side - central hemiplegia or hemiparesis. On the side of the defeat there is no overall carotid artery.

Topic diagnostic value. Analysis of symptoms of damage to cranial nerves, sense organs, conductive disorders with A. s. Allows you to determine the localization and boundaries of the pathological focus. In clinical practice A. s. They may be observed in brain barrel tumors and with violations of the cerebral circulation (brain). Thus, Jackson syndrome occurs during thrombosis of the anterior spinal artery or its branches, Avellis and Schmidt syndromes - in case of impaired blood circulation in the branches of the arteries that eat the oblongable brain, and the Wallenberg Syndrome - Zakharchenko, Babinsky - Press - in the lower rear cerebelchkova or vertebral artery, syndrome Cross hemipilegia - with thrombosis of spinobulbar arterioles. Pontic (Bridge) Syndromes of Fovilly, Brisso - Sicar, Rimon - Sedan are detected by damage to the branches of the basilar (main) artery, peduncular syndromes - deep branches of the rear brain artery, Claude syndrome - the front and rear arterioles of the Red Kernel, Benedict's syndrome - interchanged or central arteries and etc.

The nature of the pathological process allows to judge the dynamics of symptoms. Thus, under the ischemic lesion of the brain trunk as a result of the thrombosis of vertebrate, basilar or rear brain arteries A. C, develop gradually, often not accompanied by loss of consciousness; The boundaries of the hearth correspond to the zone of disturbed vascularization; Hemiplegia or hemipapes have spastic. With hemorrhage in A. s. May be atypical, because The borders of the hearth may not correspond to a specific vascular pool and may increase due to the reactive edema of the brain around the hemorrhage. The acute development of the focus in the bridge of the brain is accompanied by respiratory disorders, cardiac activity, vomiting. In the acute period, the reduction of muscle tone on the hemiplegia side is determined as a result of diazhism .

Bibliography: Gusev E.I., Grechko V.E. and Bourdes GS Nervous diseases, from 185, M., 1988; Krol M.B. and Fedorova E.A. The main neuropathological syndromes, p. 132, M., 1966; Triumphs A.V. Diseases nervous system, from. 148, L., 1974.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Large Russian Encyclopedia. 1994 3. encyclopedic Dictionary medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

Watch what is "alternating syndromes" in other dictionaries:

Alternating syndromes - Alternating syndromes, are such a set of nervously pathological phenomena of functions of functions, when one part of them is externally expressed on one half of the body (for example, in the form of a right-hand paralysis or a laire of limbs), and ... ...

- (Lat. Alterno alternate; synonyms: alternating paralysis, cross paralysis) syndromes that combine the defeat of the skull brain nerves On the side of the focus with conduction disorders of motor and sensitive functions ... ... Wikipedia

Alternating syndromes - (Lat. Alter one of two syndrome) A group of neurological syndromes arising from the damage to the nervous tissue in the brain stem field. In this case, various combinations of paralysis and paresses of the cranial brain nerves and sensitivity disorders are observed ...

Alternating syndromes - (Greek. Alternus - crosswise) - signs of one-sided lesion of the brain stem. On the side of the lesion, there are violations of the functions of one or more cranial nerves along the peripheral type, on the other side - the conductive ... ... Encyclopedic Dictionary of Psychology and Pedagogy

Bridge Varoliev Syndromes Defeat - The combination of the central paresium or paralysis on the opposite side and the symptoms of the defeat of the cranial nerves along the peripheral type on the side of the area of \u200b\u200bdamage. The symptom complexes arising from this are defined as alternating syndromes (lat ... Encyclopedic Dictionary of Psychology and Pedagogy

- (TRUNCUS ENCEPHALI; Synonym for a cerebral barrel) part of the base of the brain, containing the core of the cranial nerves and vital centers (respiratory, vasodent and a number of others). S. G. M. It has a length of about 7 cm, consists of a mid-brain, ... ... Medical encyclopedia

Brain-bridge - (Klein Hirnbruckenwinkel, Angle Ponto Cerebelleuse, on Nekhim Angle Ponto Bulbo Cerebelleuse) occupies a kind of place in neuropathology, neurogistopathology and neurosurgery. The title of this is indicated by the angle between the cerebellar, oblong ... ... Big medical encyclopedia

I stroke stroke (latelage. Insultus attack) Acute violation of the cerebral circulation, causing the development of a persistent (saving more than 24 hours) focal neurological symptoms. During I., complex metabolic and ... ... Medical encyclopedia

BRAIN - BRAIN. Content: methods of studying the brain ...... . 485 Phylogenetic and ontogenetic development of the brain ............. 489 Bee brain .............. 502 The anatomy of the brain macroscopic and ... ... Big medical encyclopedia

The ratio of the eye nerve with eyeball and other nerves ... Wikipedia

it neurological violations, including one-sided lesion of cranial nerves and controlled motor and / or sensory disorders. A variety of forms is due to various levels of lesion. Diagnosis is carried out clinically during the neurological examination. To establish the etiology of the disease, the MRI of the brain is carried out, studies of cerebral hemodynamics, analysis of the liquor. Treatment depends on the origin of pathology, includes conservative, surgical methods, restorative therapy.

MKB-10.

G46.3. Stroke syndrome in brain barrel (I60-i67 +)

General

Alternating syndromes got a name from Latin Adjective Alternernances, meaning "opposite". The concept includes symptom complexes characterized by signs of lesion of cranial brain nerves (CHMN) in combination with central motor (paresis) and sensitive (hypshethesis) disorders in the opposite half of the body. Since paresis covers half the body limbs, it is called hemiparesis ("Gemi" - half), similarly sensory disorders are denoted by thermal hemigipesthesia. Due to typical clinical picture Alternating syndromes in modern neurology have synonym for "cross-syndromes".

Causes of alternating syndromes

A characteristic cross-mounted neurological symptoms arises with a half defeat of the cerebral trunk. The basis of pathological processes may lie:

• Violations of cerebral blood circulation. Stroke The most common cause caused by alternating syndromes. Thromboembolism, spasm in the vertebral, basilar, brain artery, becomes an etio-reforator of ischemic stroke. Hemorrhagic stroke occurs during hemorrhage from the indicated arterial vessels.
• A brain tumor. Alternating syndromes appear with the direct lesion of the trunk of the tumor, when stemming structures are comprehended in size next to the neoplasm.
• Inflammatory processes: Encephalites, meningoencephalitis, brain abscesses of variable etiology with localization of inflammatory hearth in stem fabrics.
• Brain injury. In some cases, alternating symptoms are accompanied by fractures of the bones of the skull, forming the rear cranial fossa.

Alternative symptomsomplexes of the extravoltic localization are diagnosed with circulatory disorders in the middle cerebral, general or internal carotid artery.

Pathogenesis

The core of the cranial nerves are located in various departments of the cerebral trunk. Here the motor tract is held (the pyramid path), carrying the efferent impulsation from the cerebral bark to the neurons of the spinal cord, the sensitive path, conducting afferent sensory impulses from receptors, cerebellar journeys. Motor and sensitive conductive fibers at the level of the spinal cord form the cross. As a result, the innervation of half of the body is carried out by nervous ways passing in the opposite part of the trunk. One-sided stem lesion with simultaneous involvement in the pathological process of CHMN nuclei and conductive paths is clinically manifested by cross-symptoms characterizing alternating syndromes. In addition, the cross-symptoms occur with simultaneous damage to the motor cortex and the extravol part of the ChmN. The pathology of the middle brain is distinguished by a bilateral character, does not lead to alternating symptoms.

Classification

By the location of the lesion, there are extruded and stem syndromes. The latter are divided into:

• Bulbarbars are connected with the focal lesion of the oblong brain, where the kernel of the IX-XII cranial nerves are located, the lower legs of the cerebellum.
• Pontic - due to a pathological source at the level of the bridge with the involvement of the nuclei of the IV-VII nerves.
• Pedoucular - arise when the localization of pathological changes in the legs of the brain, where the red cores are located, the upper cerebellary legs are rooted III couple Chmn, pyramidal paths.

Clinic of alternating syndromes

The basis of the clinical picture is alternating neurological symptoms: the signs of the dysfunction of the CHMN on the side of the lesion, sensory and / or motor disorders from the opposite side. The damage to the nerves is peripheral, which is manifested by hypotone, atrophy, fibrillations of innervated muscles. Motor disorders are central spastic hemipreps with hyperreflexia, pathological stop signs. Depending on the etiology, alternating symptoms have a sudden or gradual development, accompanied by general-selling symptoms, signs of intoxication, intracranial hypertension.

Bulbarium group

Jackson syndrome is formed by damage to the XII (sub-speaking) nerve and pyramidal paths. It is manifested by peripheral paralysis of half of the language: the narrowed tongue devies in the direction of the defeat, atrophy is noted, the fasciculation, the difficulties of pronunciation of the articulated words. In the control limbs, hemiparesis is observed, sometimes - a loss of deep sensitivity.

Avellys syndrome is characterized by paresium of muscles of larynx, pharynx, voice ligaments due to dysfunction of the nuclear petroleum (IX) and the wandering (x) nerves. Clinically observed, voices, violations (dysphony), speech (dysarthria) with hemiparem, hemigipesthesia opposite limbs. The defeat of the nuclei of all caudal chmn (IX-XII pair) causes the version of the Schmidt, differing from the previous shape of the paresis of the stern and curable and large and trapezoid muscles of the neck. From the amazed side there is an omission of the shoulder, the restriction of the lifting of the hand is above the horizontal level. It is difficult to turn the head towards the paretic limbs.

The form of Babinsky-Press includes cerebellar attacks, Nistagm, Gorner Tiad, Cross-Paris and Surface Sensitivity Disorder. At Vallenberg-Zakharchenko variant, a similar clinic is detected, the dysfunction of IX, X and V nerves. It may leak without a pan of limbs.

Pontic Group

Miyar-Gubler syndrome appears in pathology in the field of the kernel VII pairs and fibers of the pyramidal path, is a combination of a facial pack with a hemiparesis of the opposite side. A similar localization of the focus, accompanied by irritation of the nerve nucleus, causes the shape of a sick-sickar, in which facial hemispanis is observed instead of the facial pass. The option of Fovilly is distinguished by the presence of a peripheral pack of Vi of the cranial nerve, which gives the clinic of a converging strabismus.

Hollow Syndrome is the defeat of the nuclei of V-VIII couples and a sensitive path. Notes facial Parese, converging squint, hystheses of the face, hearing loss, is possible Nistagm. Hemigipsthesia on conductor type was monitored, Motoric is not broken. The form of Raimon Sestan is due to the defeat of the motor and sensory tract, the middle cerebulic leg. Disceregia, Discordination, Hypermmetry are detected on the side of the focus, hemiparesis and hemiagesey - controlled.

Pedoucular group

Weber syndrome - core dysfunction III pairs. It is manifested by the omission of the eyelid, the expansion of the pupil, turning the eyeball in the direction of the outer corner of the eye, cross hemiparem or hemigipesthesia. The spread of pathological changes to the crankshaft adds visual disorders (hemianopia) to the specified symptoms. Variant Benedict - the pathology of the glasses is combined with the dysfunction of the red nucleus, which is clinically manifested by the intentional tremor, athettosis of opposite limbs. Sometimes hemiagesey is accompanied. At the option of a notepaper, oxide dysfunction is observed, cerebelchik ataxia, hearing disorders, controlled hemiparesis, hypercines are possible.

Composition alternating syndromes

Hemodynamic disorders in the system of the plug-in artery determine the appearance of a vertigohemiplegal form: the symptoms of dysfunction of the vestibulo-cochlear nerve (noise in the ear, dizziness, drop in hearing) and cross-hemiparesis. The optichemiplegal variant is developing at discirculation simultaneously in the ordown and medium cerebral artery. It is characterized by a combination of dysfunction of the optic nerve and cross-hemipaby. Asphigmogmiplegal syndrome occurs when the carotid artery occlusion. There is an opposite hemiparem hemispanism of the face muscles. Pathognomonic sign - no pulsation of sleepy and radial arteries.

Complications

Alternating syndromes, accompanied by spastic hemiparesis, lead to the development of contractures of joints, exacerbating motor disorders. Pares VII Couples causes a breakdown of a face that becomes a serious aesthetic problem. The result of the damage to the auditory nerve is the hearing loss, reaching the complete loss of hearing. The unilateral paresis of the glaze group (III, VI pairs) is accompanied by two-limit (diplopia), significantly worsening the visual function. The most terrible complications arise in progression of the defeat of the cerebral trunk, its distribution to the second half and vital centers (respiratory, cardiovascular).

Diagnostics

Install the presence and type of cross-syndrome allows an inspection of a neurologist. The data obtained enabled to determine the topical diagnosis, that is, the localization of the pathological process. Approximately judge the etiology in the course of the disease. Tumor processes are distinguished by progressional growth of symptoms for several months, sometimes - days. Inflammatory lesions are often accompanied by general-infectious symptoms (increase in body temperature, intoxication). When stroke, alternating symptoms arise suddenly, rapidly grow up, proceeding against the background of arterial pressure changes. Hemorrhagic stroke differs from the ischemic blurred atypical pattern of the syndrome, which is due to the absence of a clear boundary of the pathological focus due to pronounced perifocal processes (edema, reactive phenomena).

To establish the cause of neurological symptoms, additional studies are carried out:

• Tomography. MRI brain allows you to visualize an inflammatory hearth, hematoma, trunk tumor, stroke area, differentiate hemorrhagic and ischemic stroke, determine the degree of compression of stem structures.
• Ultrasound methods.The most affordable, fairly informative method of diagnosing violations of cerebral blood flow - ultrasound cerebral vessels. Receives signs of thromboembolism, local spasm of intracereblock vessels. In the diagnosis of occlusion of sleepy, vertebral arteries need a USDG extracranial vessels.
• Neurovalization of vessels.The most informative way to diagnose sharp brain circulation disorders is the MRI of the brain vessels. Vascular visualization helps accurately diagnose character, localization, degree of their defeat.
• Research of cerebrospinal fluid. Lumbal puncture is carried out in suspected infectious-inflammatory nature of pathology, in favor of which inflammatory changes in the liquor (turbidity, cytosis due to neutrophils, the presence of bacteria). Bacteriological and virological studies allow you to identify the pathogen.

Treatment of alternating syndromes

Therapy is carried out in respect of the underlying disease, includes conservative, neurosurgical, rehabilitation methods.

• Conservative therapy. Common events include the appointment of anti-voice, neuroprotective agents, the correction of blood pressure. Differentiated treatment is carried out according to the etiology of the disease. Ischemic stroke is an indication of thrombolytic, vascular therapy, hemorrhagic - to the appointment of calcium preparations, aminocaproic to-you, infectious lesions - to carry out antibacterial, antiviral, antimicotic therapy.
• Neuro surgery . It may be necessary when hemorrhagic stroke, damage to the blood supplying brain of the main arteries, volume formations. According to the testimony, the reconstruction of the vertebral artery, carotid endarterectomy, the formation of extra-intracranial anastomosis, the removal of the tumor of the trunk, the removal of the metastatic tumor, etc. The question of appropriateness surgical intervention It is solved together with the neurosurgeon.
• Rehabilitation. It is carried out by joint efforts of the rehabilitologist, a physician of the LFC, a massage therapist. Directed on the prevention of contractures, an increase in the volume of the motion of the paretic limbs, adapting the patient to its state, postoperative recovery.

Prediction and prevention

Accordingly, alternating syndromes can have a different outcome. Hemiparesis leads to the disability of most patients, full recovery Observed in rare cases. A more favorable forecast has limited ischemic strokes in the case of quickly started adequate treatment. Recovery after hemorrhagic stroke is less complete and longer than after ischemic. Prognostically complex are tumor processes, especially metastatic genesis. Prevention nonspecific, consists in timely effective treatment cerebrovascular pathology, prevention of neuroinfection, CMT, oncogenic influences.

Alternating syndromes - a violation of the function of the cranial brain nerves (III, Yii, IX, X, XI, XII) and the cerebellum on the side of the lesion in combination with hemiparesis or hemigipesthesia on the opposite side - alternating syndromes or tetrapapes and inter-identical ophthalmoplegia (brain lesion).

Classification depends on what level the kernel is struck:

1. Bulbarny (defeat at the level of the oblong brain):

- Jackson syndrome is clinically manifested by a combination of peripheral paralysis of the sub-speaking nerve (XII) on the side of the brain lesion with spastic hemiplegia on the opposite side, in terms of cases of loss of muscular-articular and vibration sensitivity. Dysarthria, larynx muscle paresis, swallowing disorders, cerebellar attacks on the side of the focus can be celebrated. The deviation of the tongue is observed towards the lesion, atrophy and the bugberry of half of the language, the fascicular twitching in it. Frequent cause The development of the syndrome is the thrombosis of the branches a. Spinalis Anterior, so called. aa. Sulci Bulbaris.

Wallenberg Syndrome - Zakharchenko (Person's hyptestesia, Symptom of Gunner (Ptoz, Mioz and Enofalm), Package Muscle Pares, Mozyrole Ataxia, Weakness of the melting and trapezoid muscles on the side of defeat and hemigipesthesia (without the involvement of the face) on the opposite side (lateral infarction of the oblong brain)

2. Pedoucular (lesion at the level of the legs of the cerebellum):

• weber syndrome is characterized by paralysis of the ooo eye nerve (III) on the side of the lesion, contlatated - central hemipilegia or hemiparem of the limbs and torso, as well as central pares of facial (VII) and sub-band (XII) nerves. Perhaps the addition of hemianopsy when involving in the pathological process of the lateral crankshaft. Weber syndrome is observed in the damage to the base of the brain legs due to the sofa of the rear cerebral artery and its branches, with syphilitic endarteritis, the aneurysms of the rear brain artery, with tumors, basal leptopamenengitis. It is possible to localize the pathological process, for example, syphilitic gum, in brain shears, followed by propagation on the leg of the brain.

3. Pontic (bridge lesion):

• Fovilly syndrome. In this case, the syndrome observes the defeat of the nuclei of the facial and discharge nerve (VII, VI) with the phenomena of the peripheral pack of the face muscles and the outermost muscle of the eye on the side of the lesion, as well as hemipapes or hemiplegia on the central type on the opposite side. Characteristically converging squints due to the eye on the side of the defeat. In the obstruction of the Circumference branches of the main artery.
• Miyyar- Grub's syndrome: defeat 7 pairs of the CHMN and the pyramidal path.

Alternating syndromes (Latin Alternus - alternating, changing; synonym: alternating paralysis cross-paralysis) - symptom complexes characterized by a violation of the functions of the cranial nerves on the side of the lesion (paralysis or paresis) and the central paralysis or parishes of the limbs or conduction disorders of sensitivity on the opposite side. The alternating syndromas include cross-hemiplegia (see) - paralysis of one hand and the opposite leg and cross hemiagesthesia - the sensitivity disorder on one side of the face and hemiagesthesia on the opposite half of the body and limbs.

There are alternating syndromes: 1) on the topics of the lesion - the legs of the brain, the bridge, the oblongable brain, is also possible extracerebral localization; 2) by clinical syndromam - Motor, sensitive, combined with impaired function of cranial nerves, hyperkinosis and others; 3) on the etiology of the disease - circulatory disorders, tumors, injuries and other; 4) for the flow - protsed, regulations.

The localization of the focus in the brain barrel is manifested by the symptoms of the defeat of the cranial nerves (on the side of the focus).

Paralysis or parishes of limbs on the side opposite to the lesion is developing due to damage to the cortical spinal (pyramid) path. Cross hemiasiasia on the body and limbs opposed to the pathological heart rate occurs during damage to sensitive conductive pathways (middle loop, spin-thalalamic tract). Hemiplegia or hemipapes and hemiagesests appear on the opposite focus of the side of the side because the pyramid path and sensitive conducting paths are crossed in the lower brain stem department.

Alternating syndromes are separated according to the localization of the lesion focus in the brain trunk: a) bulbar - with the defeat of the oblong brain; b) Pontoons - with the damage to the bridge; c) Pedukular - with damage to the legs of the brain (color fig. 1-6).

Bulbar alternating syndromes

Jackson syndrome, or HEMIPLEGIA ALTERNANS HYPOGLOSSICA, is characterized by the symptoms of the lift nerve on the side of the focus of the lesion and hemipilegia or the hemiparesis of the limbs on the opposite side. On the side of the focus, the symptoms of the peripheral paralysis of the sub-speaking nerve are found: the deflection of the tongue towards the lesion, the atrophy of half of the language, sometimes fibrillating twitching in the language, regeneration of the muscles of the language.

Syndrome Avellisa It is characterized by the symptoms of the lesion of the luggage-pharyngeal and wandering nerves on the side of the focus of the lesion and hemipilegia or the hemiparesis of the limbs on the opposite side. Paralicate or paressers of a soft sky and voice fold on the face of the focus, a swallowing disorder (liquid food falls into the nose, the patient is accompanied by eating), dysarthria and dysphony.

Syndrome Babinsky-Press It consists of cerebellar symptoms in the form of hemiatakexia, hemiasinergia, laateropulsia (as a result of damage to the lower legs of the cerebellum, the olivo-cerebelling path), Miosa or Bernard-Gorywood syndrome on the side of the focus of defeat and hemiplegia and hemiagesey on opposite limbs.

Schmidt syndrome It consists of symptoms of the lesion of the puppy-pharyngeal, wandering and added nerves. Paralicit or paresis of voice fold, soft sky, trapezoidal and breast-curable and large-sighted muscles on the side of the lesion, as well as the hemiparesis of the limbs on the opposite side are determined.

Syndrome Wallenberg-Zakharchenko It is characterized by the appearance on the side of the focus of the symptoms of the damage of the wandering nerve (paralysis or paressers of a soft sky and voice fold), a trigeminal nerve (disorder of sensitivity on the face along the segmental type, Fig. 1), sympathetic fibers of the eye (Bernard syndrome - Gunner), spin-cerebellary paths (hemiatakexy, decrease in muscle tone, asiergia movements), and with an extensive focus in reticular formation, the oblong brain is the respiratory disorder, cardiovascular activity, on the opposite side (due to the defeat of the spin-thalamic path in the side cords of the oblong brain), hemianalgesia and hemiterenesia from the level of CIII or below are detected; When defeating the pyramidal path - hemiplegia (rarely).

Tapia syndrome - manifests the symptoms of the lesion of the added and sub-speaking nerves on the side of the focus. The paralysis of the breast-curable and large and trapezoid muscles is determined, the peripheral paralysis of the sublingual nerve, and on the opposite side - hemiplegia.

Glike syndrome It is characterized by the appearance of symptoms of damage to the facial nerve - peripheral paralysis of mimic muscles with their spasm (Fig. 2); a wandering nerve with difficulty swallowing; The head of the trigeminal nerve (pain in the supuraorbital region) and the optic nerve (amavricosis or lowering vision) on the side of the focus, and on the opposite side, hemiplegia develops as a result of the defeat of the pyramidal path.

Volripe Syndrome Manifested by the transient paralysis of voice fold, and on the opposite side - hemiagesey.

Pontic alternating syndromes

Miyyar Gubler Syndrome, or HEMIPLEGIA ALTERNANS FACIALIS, is manifested by peripheral paralysis of the facial nerve on the side of the focus (Fig. 3) and spastic hemiplegia on the opposite side.

Syndrome of Brisso Sicar It is characterized by a spasm of mimic muscles (irritation of the cells of the facial nerve core) on the side of the lesion and spastic hemiparesis or the hemiplegia of the limbs on the opposite side.

Fovillya syndrome - Abducence-facial alternating hemiplegia - is expressed by the lesion of the facial (peripheral paralysis of the Mimic muscles on the same side) and the discharge (condensed squint) of the nerves in combination with the paralysis of the gaze on the side of the pathological focus (Fig. 4) and hemipilegia, and sometimes hemiagesey (Middle Defection loops) limbs on the opposite side.

Reimon Sestan Syndrome manifested by paralysis or paresis combined movements eye apples In the direction of the focus of the lesion, ataxia and choreathytohydrate movements, hemiagesey (impaired hemiteness sensitivity) and hemiparesis on the opposite side (Fig. 5).

Pedoucular alternating syndromes

Weber Syndrome It is characterized by paralysis of the glaze nerve on the side of the lesion (ptosis, divergent squint, mydriasis) and hemiplegia with the muscles of the muscles and persons in the central type (the defeat of the cortico nuclear path) on the opposite side. The syndrome develops with pathological processes on the basis of the leg of a large brain.

Benedict syndrome It consists of a paralysis of the oculomotory nerve on the side of the focus of the lesion and choreoethletosis and the intentional trembling of the opposite limbs (the defeat of the red nucleus and the cerebulic-reddigore path).

Notnamelet syndrome Includes triad symptoms: cerebellar ataxia, paralysis of the eye nerve, hearing disorder (one-sided or bilateral deafness of central origin). Sometimes hyperkinosis (ferret or atteetoid), parisses or paralysis of the limbs, central paralysis of facial and sub-speaking nerves can be observed.

Claud Syndrome It is characterized by paralysis of the glaze nerve on the side of the focus of the lesion and cerebellar phenomena (violation of the coordination and friendly nature of movements), as well as a decrease in muscle tone on the opposite side. Sometimes the dysarthria and swallowing disorder is observed.

Fua Syndrome It consists of cerebellar symptoms, intensive tremor, choreoathyoid movements, sensitivity disorders and changes in visual fields on the side opposite to the focus of the lesion.

Alternating syndromes characteristic of the intra-collar process may occur during the squeezing of the brain barrel. Thus, the Weber syndrome develops not only in pathological processes (hemorrhage, intra-column tumor) in the middle brain (Fig. 6, 1), but also when squeezing the legs of a large brain (Fig. 6, 2). Compression dislocation syndrome of grinding legs of a large brain, occurring in the presence of tumor of the temporal share or pituitary gland, can manifest itself to the lesion of the glazic nerve (mydriasis, ptosis, divergent squint and other) on the side of compression and hemiplegia on the opposite side.

Sometimes alternating syndromes manifest themselves mainly crosswise sensitivity disorder (Fig. 7). So, Reimon Sestan syndrome is manifested by a paralysis of the view in the direction of the focus and the alternating nature of the sensitivity disturbance. On the face, the sensitivity is impaired by segmental type due to the lesion of the sensitive tower of the trigeminal nerve on the side of the focus, and on the body and limbs - on the opposite side (the defeat of the median loop and the spin-thalamic path).

Extracerebral alternating syndromes

Optical hemiplogic syndrome [Radovichi and Lasco (A. Radovici, F. Lasco, 1948)] is manifested by a violation of the function of the optic nerve (blindness) and spastic hemiplegia on the opposite side. Pathognomonic syndrome for the inner carotid artery thrombosis and its branches. At the same time, due to violation of blood circulation in the eye artery, there is a violation of vision, in the middle brain artery - hemiplegia or hemiparesis.

Vertigo hemiplegic syndrome During the discirculation in the system of the connectible artery, it is characterized by dizziness and noise in the ear as a result of circulatory disorders in the internal hearing artery (branch of the front cerebulic artery) on the side of the focus and hemiplegia and hemiparesis on the opposite side (due to blood circulation disorder in the branches of the carotid artery).

Asfigmo hemiplegic syndrome It occurs when the overall carotid artery or the shoulder-head barrel occurs. At the same time, on the side of the damage, there is no ripple on these vessels and their branches, and on the opposite side - hemiplegia or hemiparesis.

Topic diagnostic value

Study of signs of defeat of the cunning nerves and other focal symptoms With alternating syndromes, it allows you to determine the localization and boundaries; The focus, that is, to establish a topical diagnosis. Thus, Jackson syndrome occurs during thrombosis of the anterior spinal artery or its branches; Avellis syndrome - with damage to the branches of the artery of the side fossa of the oblong brain; The Babinsky-Press syndrome is the arteries of the side fossa or the bottom rear cerebellar artery, as well as the Wallenberg-Zakharchenko syndrome, developing with the damage arteries (Fig. 8. 1-3) (with an extensive focus in the Dorso-lateral region of the oblong brain); Fovilly's syndrome - under the core artery thrombosis; Cross hemiplegia syndrome - at a focus in the area of \u200b\u200bthe crossroads of the pyramid paths due to the thrombosis of spin-bulbar arteriols. Claude and Foi syndromes are developing with the defeat of the front and rear arterioles of the red nucleus (the branch of the rear brain artery); Claude syndrome - with the damage to the glaze nerve and the rear section of the red nucleus (the lower syndrome of the Red nucleus), and the fua syndrome - with an isolated lesion of the front department of the red nucleus (the upper syndrome of the red nucleus) without engaging in the process of the ooo nerve. Benedict syndrome occurs during the localization of the focus in the medial-dorsal port of the midbrain (the pyramid path remains not affected) - the defeat of the interpentricular or central branches. The syndrome of a lamelight is due to the lesion of the tire of the midbrain - a circulatory disorder in circuser and retromamillary arteries; Reimon Sestan Syndrome - with a bridge tire damage.

The study of the dynamics of symptoms allows you to determine the nature of the pathological process. Thus, in case of ischemic softening of the brain, as a result of the thrombosis of vertebrate arteries, the main or rear cerebulic artery (rye. 8), alternating syndromes are developing gradually, without accompanied by the loss of consciousness, and the boundaries of the hearth correspond to the violated vascularization zone. Hemiplegia or hemiparesis is usually spastic. When hemorrhages in the barrel alternating syndrome can be atypical, since the boundaries of the hearth do not correspond to the vascularization zone and increase due to edema and reactive phenomena in the circumference of hemorrhage.

With acute foci in the bridge of alternating syndromes, it is usually combined with respiratory disorder, vomiting, violation of the heart and tone of vessels, hemiplegia - with muscle hypotension as a result of diazhism (see).

Alternating syndromes may occur with the damage to the spinal cord (see Brown-Secary Syndrome).

Identification of symptoms of alternating syndromes helps the clinician when conducting differential diagnosis (See Table.). With alternating syndromes caused by the damage to the trunk vessels, surgical treatment (thrombimectomy, vascular plastic and the other) is shown.

Bibliography

Bogolepov N. K. Violations of motor functions with vascular lesions of the brain, M., 1953, bibliogr.; He is Comatous states, M., 1962; He, some neurological syndromes, multicam. Guide for neurol., Ed. S. N. Davidenkova, vol. 2, p. 308, J., 1962, Bibliogr.; Zakharchenko M. A. Vascular diseases of the brain barrel, Tashkent, 1930; AVLIS G. Klinische Bciträge Zur Halbseitigen Kehlkopflähmung, Berl. Klin., HFT 40, S. 1, 1891; Babinski et nageotte, Syndrome Caractérisé Par Une Hémiplégie, Une Hémianesthésie du Côté Opposé à la lésion, Une Hémiasynergie, Une Latéropulsion, UNE Myosis Homonyme, Ann. Oculist. (Paris), № 127, p. 380, 1902; Brissaud E. Lecons Sur Les Maladies Nerveuses, p. 385, P., 1899; CROUZON O. TROUBLES DE LA MOTILITE, HEMMLEGIE, IN CN: PRAT, NEUROL., PUBL. Par P. Marie, p. 462, P., 1911; D Éj Érine J. Semiologie des affections du Systeme Nerveux, p. 214, P., 1926; RADOVSI A. ET LASSO F. UNE HEMIPLEGIE ALTERNE INCONNE, L "ÉHEMIPLEGIE ALTERNE OPTICO-PYRAMIDALE PAR TROMBOSE CAROTIDIENNE, PRESSE M ÉD., T. 56, P. 573, 1948; Schmidt A. Casuistische Betrage Zur Nervenpathologie, DTSch. Med. WSCHR., S. 606, 1892; Wallenberg A. Neuere Fortschritte in Der Topischen Diagnostic Des Pons Und der Oblongata, Z. Nervenheilk., BD 41, S. 8, 1911; Weber N. A CONTRIBUTION TO THE PATHOLOGY OF THE CRRAR CEREBRI , Med.-Chir. Trans., V. 46, p. 121, 1863.

N. K. Bogolepov