Alternating syndromes at different levels. Alternating syndromes

The disease is characterized by damage to the cranial cerebral nerves, conduction disorders of motor and sensory functions.

Multiple alternating syndromes are caused by circulatory disorders in the spinal cord system, the appearance of tumors with localization in the brain stem, especially after cranial injuries.

Stem symptom complexes are quite common, due to dysfunction of the nuclei or processes of the brain.

The main cause of the syndrome is changes in the functioning of the cerebral blood flow, in the event of tumors, injuries, in people with the disease - diabetes mellitus.

Paralysis or a cut of the extremities develops as a result of the cortical-spinal path, and cross-hemianesthesia - when the sensitive conducting channels of the lower brain stem are damaged.

Known Types of Syndromes

In neurology, the following alternating syndromes are distinguished:

  • bulbar diseases(with damage to the medulla oblongata) - the syndrome of Jackson, Avellis, Schmidt, Valenberg Zakharchenko, Babinsky Nageotte.
  • pontine disturbances(in case of violation of the bridge) - the syndrome of Gubler, Fauville, Raymond Sestan, Brissot.
  • peduncular syndromes(if there is a defect on the brain stem) - Weber, Claude, Benedict, Notnagel.

A sure sign of damage to the cerebellum - characteristic symptoms and approach to treating the disorder.

Causalgia is a symptom characterized by the appearance of burning pain at the site of damage to the peripheral nerves. How ?

Bulbar syndromes

The main bulbar alternating syndromes:

  1. Jackson disease characterized by damage to the hypoglossal nerve and paralysis of the limbs on the opposite side. There are deviations of the tongue to the side, or its complete atrophy. Sometimes its fibrillar twitches are observed with muscle excitability. The person cannot speak clearly, stutters and swallows half of the words. It is almost impossible to make out the patient's speech.
  2. Avellis syndrome affects the glosso-pharyngeal nerves, paralysis of the palate and vocal folds, swallowing disorder occurs. In such patients, eating is painful, liquid food enters the nasal passage, and solid food hardly enters the intestines, while the patient often coughs and chokes when eating.
  3. Schmidt's disease consists of previous symptoms and vocal cord paresis. A person cannot talk, hardly eats food.
  4. Wallenberg Syndrome Zakharchenko manifested by the appearance on the side of the focus of symptoms, damage to the vagus nerve, a disorder of muscle sensitivity throughout the face. In such cases, the patient's eyes, cheeks, nose are distorted, while he sees poorly, breathes and hears. Appearance in a short time is distorted beyond recognition.
  5. Babinski Nageotte disease consists of cerebellar signs in the form of lesions of the olive-cerebellar pathway. The patient does not develop muscles. He hardly moves, the whole body is weakened and exhausted.

Pontine violations

All types of the disease are manifested by paralysis of the facial nerve, distortion of the outer shell of the face.

Pontine alternating syndromes:

  1. Gubler syndrome- this is a pathological process associated with circulatory disorders in the paramedial arteries, lagophthalmos, severe lacrimation occurs.
  2. Fauville disease occurs due to thrombosis of the basilar artery, with metastases of cancer and sarcoma. There is strabismus, the optic nerve expands. In a patient, one eye becomes larger than the other, it may not close at all when blinking and during sleep.
  3. Raymond Sestan's disease manifested by paresis of the eyeball region, sensory disturbances during movement, hemiparesis on the opposite side. Such people can lie on a doctor's bed in one position for years, not daring to turn half of their torso.
  4. Brissot syndrome distorts the facial muscles on the side of the facial nerve, there is a distortion of the pyramidal path. There is irritation of the cells of the roots or the nucleus of the facial nerve, reflex spasms appear in the opposite area of ​​​​the lesion.

Brain peduncle lesions

Peduncular Syndromes:

  1. Weber-Pobler disease develops on the basis of pathological processes in the area of ​​\u200b\u200bthe legs of the brain, due to impaired hemorrhage of the ischemic type. And also when squeezing the legs with a developing tumor.
    Clinical signs of the disease are paralysis of the muscles of the face, tongue and limbs according to the central type. Symptoms are due to a complete or partial cut of the oculomotor nerve. In case of muscle damage, the eyeball deviates towards the temple, and “looks” in the opposite direction of the paralyzed limbs. If the pathology also captures the optic tract, then hemianopia occurs. The patient develops an enlarged strabismus, he sees poorly and hardly distinguishes colors. The phareic component, clonus of the hands and feet may also develop, and over time, violations of the flexion carpal protective reflexes will be observed.
  2. Claude syndrome (red nucleus)- captures the fibers of the oculomotor nerve, due to damage to the branches of the posterior cerebral artery, which supplies the lower sections of the red nucleus. Atherosclerosis and syphilitic endarteritis are common causes of the disease.

General picture of symptoms

There is a set of signs characteristic of all types of the syndrome:

  • century;
  • dysarthria;
  • swallowing disorder;
  • partial or complete ophthalmoplegia;
  • distortion of the eye opening;
  • complete or partial paralysis of the face.

The patient's diagnosis is established along with the Benedict and Weber syndromes; an individual form of this type of alternating disease is very rarely manifested.

Benedict syndrome

Benedict syndrome (upper side of the red nucleus) - affects the nuclei of the oculomotor nerve, sometimes medial loop. It is characterized by strabismus, mydriasis, eyelid trembling, hemiparesis.

Possible violations of associated eye movements, gaze deviation towards the focus of the disease. Increased overall muscle tone, tendon reflexes, hemorrhage of the posterior cerebral artery in metastatic cancer.

Notnagel's pathology

Notnagel's disease (four-colonial) - occurs with extensive damage to the midbrain and its partial base. The main cause of the occurrence is a pituitary tumor, which, when expanded, compresses the red nuclei and the upper legs of the cerebellum.

TO clinical signs ataxia should be attributed. Due to the development of the disease, central paresis of the facial and hypoglossal nerves appear.

A person does not speak well, his speech becomes slurred, it is difficult to pronounce consonants, and he also does not hear well or does not understand the speech of the interlocutor at all.

There are also eye symptoms, there is a bilateral ophthalmoplegia, medriz, ptosis. Visual impairment occurs gradually, pupillary reactions first change, then gaze paralysis appears (the patient looks up).

Later, internal paralysis of the rectus and superior oblique muscles joins.

Syndromes in diabetic neuropathy

A syndrome develops on the basis of unilateral damage to the brain stem in traumatic brain injuries, peripheral paralysis on the side of the lesion in combination with conduction disorders.

The clinical picture includes isolated or extensive paresis of the lateral angle of the lesion.

The extraocular muscles are innervated and hemiparesis occurs.

Vertigohemiplegic syndrome is a disorder of the vestibular apparatus and the motor area of ​​the brain, characterized by severe tinnitus, horizontal nystagmus in one direction, and distortion of facial muscles.

There is no pulsation at the site of the lesion carotid artery.

The nature of the pathological process can be judged by the dynamics of symptoms, signs of disorders often develop gradually, the boundaries of the focus correspond to the zone of vascularization.

With a hemorrhage in the brain stem, symptoms may increase due to reactive edema, accompanied by respiratory disorders, cardiac activity, and vomiting.

In the acute period, muscle tone decreases, certain facial features are distorted, speech changes, it becomes slurred and scattered.

Midbrain Syndromes

Symptoms include internal, external and total ophthalmoplegia, the patient's gaze down, converging strabismus. Discoordination of eye movements, the presence of limb paresis. As well as disorders of balance, hearing, vision, swallowing and speech functions.

The red core syndrome is manifested by symptoms of damage to the third pair of cranial nerves on the side of the focus.

It is noted, excessive reflex movements, with sharp sound irritations.

Patients may shudder in their sleep for no apparent reason, be afraid of every rustle, moan, throw up their arms and legs, and not control facial movements.

Signs of impaired activity of the brain bridge:

Vegetative-trophic disorders include:

Syndromes of dysfunction of the medulla oblongata

The clinical picture can be very diverse, in addition to the above syndromes, there is a violation of sensitivity, paralysis of the limbs, failures in coordination of movement, disorders in the work of the cardiovascular system.

Summary

In view of the many varieties of alternating syndromes, the main guarantee of their successful treatment is timely diagnosis and a professional approach to therapy.

Modern technologies make it possible to determine the localization of the lesion with high accuracy and timely prevent its further development.

Alternating syndromes are focal neurological syndromes of damage to the brain stem, in which signs of peripheral damage to the cranial nerves of one side are combined with conduction (motor or sensory, cerebellar, extrapyramidal) disorders on the opposite side (from lat. alternans- opposite).

Alternating syndromes are subdivided according to the level of damage to the brain stem as follows:

- alternating syndromes of the medulla oblongata;

– alternating bridge syndromes;

– alternating midbrain syndromes;

– peduncular (peduncular) alternating syndromes.


Alternating syndromes of the medulla oblongata

Jackson Syndrome (hemiplegia alternans hypoglossica). It is characterized by peripheral paralysis of the muscles of the tongue (XII) and contralateral central hemiparesis, in some cases - loss of muscle-articular and vibration sensitivity, cerebellar ataxia. Branch thrombosis is a common cause of the syndrome. a. spinalis anterior.

Avellis syndrome (hemiplegia alternans ambiguospinothalamica, due to defeat nucl. ambiguus). It is characterized by paralysis of the soft palate and vocal cords (IX, X), often atrophy of half of the tongue on the side of the lesion (XII), contralateral spastic hemiparesis, hemianesthesia. It is clinically manifested by a swallowing disorder, choking when eating, dysarthria and dysphonia.

Schmidt syndrome. Manifested by a peripheral lesion of all cranial nerves of the caudal group (IX, X, XI, XII) in combination with contralateral hemiparesis and hemianesthesia. Clinically, unilateral paralysis of the soft palate, vocal cord, atrophy of the tongue, sternocleidomastoid and trapezius muscles are noted.

Babinski-Najotte syndrome. It is characterized by cerebellar disorders on the side of the focus - hemiasynergy and lateropulsion, as well as nystagmus and sympathetic disorders on the face, including Horner's syndrome. On the opposite side, spastic hemiparesis, pain and temperature hemianesthesia are determined.

Wallenberg-Zakharchenko syndrome. Several variants of this syndrome have been described. In a typical case, pain and temperature anesthesia on the face occurs on the side of the lesion (lesion of the descending root of the V pair), paralysis of the soft palate and vocal cord (IX, X), Horner's symptom complex, vestibular-cerebellar disorders (nystagmus, ataxia); on the opposite side - pain and temperature hypesthesia on the trunk and limbs (hemiparesis is possible).


Alternating bridging syndromes

Miylard-Gubler syndrome (hemiplegia alternans facialis). Occurs when the pathological focus is localized in the ventral part of the base of the bridge. In this case, the nucleus or fibers of the facial nerve suffer, as well as the pyramidal path passing here. It is clinically manifested by peripheral paresis or paralysis (prosopoplegia) of the facial muscles (VII) on the side of the lesion and contralateral central hemiparesis.

Brissot-Sicara syndrome (hemispasmus facialis alternans). Manifested by facial hemispasm on the side of the focus and contralateral central hemiparesis. Topically similar to Miyyar-Gubler syndrome. Facial hemispasm is a consequence of irritation of the nucleus of the facial nerve.

Fauville syndrome (hemiplegia alternans abducento-facialis). IN clinical picture syndrome - peripheral paresis of the mimic muscles (VII) on the side of the focus and paresis of the external rectus muscle (VI) of the eye of the same name, on the opposite side - central paresis of the arm and leg.

Gasperini syndrome. Occurs with a unilateral lesion of the anterior part of the rhomboid fossa. The nuclei of the trigeminal, abducent, facial and vestibulocochlear nerves (V, VI, VII, VIII), as well as the fibers of the medial loop and partially posterior longitudinal bundle, are affected. The pyramidal pathway does not suffer from this syndrome. It is clinically manifested by peripheral paresis of the muscles innervated by the facial, abducens and motor portion of the trigeminal, decreased sensitivity on the face and hearing loss on the side of the lesion. Sometimes nystagmus and Horner's symptom complex join. On the opposite side - conductive hemihypesthesia.

Raymond-Sestan syndrome. It is characterized by lesions of the pons involving the pyramidal tract, medial loop, posterior longitudinal fasciculus, cerebellopontine tracts in the middle cerebellar peduncle. It is clinically manifested by cerebellar disorders on the side of the focus (homolateral asynergia), gaze paralysis towards the focus, contralateral hemiplegia and hemianesthesia.


Alternating midbrain syndromes

Midbrain lesions are rarely unilateral. characteristic clinical manifestations stem lesions at the level of the midbrain are oculomotor disorders, sleep disorders, motor and mental activity, cerebellar and pyramidal symptoms, pseudobulbar syndrome.

Hertwig-Magendie sign. It consists in a different standing of the eyeballs in a vertical plane. On the side of the pathological focus, the eye is deviated downward and slightly inward, and on the opposite side, upward and outward.

Parino syndrome. It is observed with bilateral damage to the tegmentum and the roof of the midbrain in its upper section, at the level of the superior colliculus. Manifested by paresis or paralysis of upward gaze, weakness or delayed convergence, partial bilateral ptosis, miosis, decreased photoreactions. In this case, the movements of the eyeballs to the sides are not disturbed.

Notnagel syndrome. Clinically manifested by bilateral ophthalmoplegia, lack of pupillary response to light, mydriasis, ptosis, hearing loss. A variety of cerebellar disorders are not uncommon, sometimes symptoms of a bilateral pyramidal lesion join. Nothnagel's syndrome most often occurs with tumors, especially the pineal gland.

Alternating peduncular syndromes

Weber syndrome (hemiplegia alternans oculomotoria). It is characterized by paralysis of the muscles innervated by the oculomotor nerve (III) on the side of the lesion, contralateral spastic hemiplegia or hemiparesis of the extremities, as well as central disorders of the facial (VII) and hyoid (XII) nerves. It is possible to attach hemianopsia when the external geniculate body is involved in the pathological process.

Benedict syndrome. There is paralysis of the muscles innervated by the oculomotor nerve (III), contralateral intentional trembling in the extremities and choreoathetosis, sometimes with the addition of hemianesthesia. The syndrome develops when the lower part of the red nucleus is damaged, as well as the fibers of the dentate-red nuclear pathway adjacent to it.

Claude Syndrome. The combination of paralysis of the muscles innervated by the oculomotor nerve with extrapyramidal hemihyperkinesis in opposite limbs.


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Alternating syndromes

symptom complexes characterized by a combination of damage to the cranial nerves on the side of the focus with conduction disorders and sensitivity on the opposite side. Occur when one half of the brain stem, spinal cord is damaged, as well as with unilateral combined damage to the structures of the brain and sensory organs. Various A. s. may be caused by violation cerebral circulation tumor, traumatic brain injury, etc.

The most common A. s. associated with lesions of the brain stem, manifested on the side of the focus by a violation of the function of the cranial nerves of the peripheral type (due to damage to their nuclei or roots) and conduction disorders on the opposite side (, hemiparesis, hemiataxia, etc. due to damage to the fibers pyramidal pathway, medial loop, spinothalamic pathway, cerebellar connections, etc.). To stem A. s. also applies to cross hemiplegia (of one arm and opposite leg), which occurs when there is a lesion in the area of ​​​​the intersection of the pyramidal tracts at the border of the medulla oblongata and spinal cord. Depending on the localization of the lesion in the brainstem, bulbar (a focus in the medulla oblongata), pontine (a bridge of the brain), and peduncular (a focus in the brain stem) are distinguished. There are A. pages associated with damage to several parts of the brain stem and extracerebral A. pages.

Alternating syndromes caused by unilateral damage to the sensory organs and various structures of the brain that have a common source of blood supply with them are called extracerebral A. s. As a rule, they occur in the pathology of one of the main vessels of the head and are associated with a secondary violation of circulation in the basin of its branches. In this case, several extra- and intracerebral lesions are formed in areas of impaired blood circulation.

Bulbar alternating syndromes. Jackson syndrome is caused by damage to the nucleus of the hypoglossal nerve and fibers of the pyramidal tract. On the side of the pathological focus, peripheral paralysis of the muscles of the tongue develops (deviation of the tongue towards the lesion, half of the tongue, sometimes fibrillar twitches in the tongue, degeneration when examining the electrical conductivity of the muscles of the tongue), on the opposite side - central hemiplegia or hemiparesis of the extremities.

Avellis syndrome occurs when the motor nucleus or motor roots of the glossopharyngeal and vagus nerve and the pyramidal path. On the side of the lesion, peripheral paralysis of the soft palate, uvula, vocal cord with impaired swallowing, phonation, speech () is detected, on the opposite side - central hemiplegia or hemiparesis.

Schmidt's syndrome is based on a combined lesion of the motor nuclei or fibers of the glossopharyngeal, vagus, accessory nerves and the pyramidal tract. On the side of the lesion, there is a peripheral soft palate, vocal cord, sternocleidomastoid and trapezius muscles, on the opposite side - central hemiplegia or hemiparesis.

The Babinski-Najotte syndrome is observed with a combination of damage to the inferior cerebellar peduncle, the olivocerebellar tract, sympathetic fibers, as well as the pyramidal tract, the spinothalamic tract, and the medial loop. On the side of the lesion, cerebellar disorders (hemiataxia, lateropulsion), Horner's syndrome are recorded (see Bernard-Horner's syndrome) , on the opposite side - central hemiplegia or hemiparesis, hemianesthesia.

Wallenberg-Zakharchenko syndrome is caused by damage to the motor nucleus of the vagus and glossopharyngeal nerves, the nucleus of the spinal cord trigeminal nerve, sympathetic fibers, inferior cerebellar peduncle, spinothalamic tract, sometimes pyramidal tract. On the side of the lesion, peripheral paralysis of the soft palate and vocal cord, a violation of superficial sensitivity on the face according to the segmental type, Horner's syndrome, ataxia are detected, on the opposite side - a violation of superficial sensitivity according to the hemitype, sometimes central hemiparesis.

Tapia syndrome occurs when there is a combination of damage to the nuclei or fibers of the accessory, hypoglossal nerves and the pyramidal tract. On the side of the pathological focus - peripheral paralysis of the sternocleidomastoid and trapezius muscles, muscles of the tongue, on the opposite side - central hemiplegia or hemiparesis.

Wolstein's syndrome is caused by damage to the oral motor nucleus of the glossopharyngeal and vagus nerves and the spinothalamic tract. On the side of the lesion - peripheral paralysis of the vocal fold, on the opposite side - hemianesthesia.

Pontine. Miyyard-Gubler syndrome is determined when the nucleus or root of the facial nerve and the pyramidal tract are affected. On the side of the lesion - unilateral peripheral paralysis of the mimic muscles, on the opposite side - central hemiplegia or hemiparesis.

Brissot-Sicard syndrome is caused by irritation of the nucleus of the facial nerve and damage to the pyramidal tract. On the side of the lesion - unilateral facial muscles, on the opposite side - central hemiplegia or hemiparesis.

Fauville's syndrome is observed with a combined lesion of the nuclei or roots of the facial and abducens nerves, the pyramidal tract, and the medial loop. On the side of the pathological focus - peripheral paralysis of the facial nerve, converging with the limitation of the movement of the eyeball outward, diplopia, on the opposite side - central hemiplegia or hemiparesis, hemianesthesia.

Raymond-Sestan syndrome is caused by a combined lesion of the posterior longitudinal fasciculus, the pontine center of gaze, the middle cerebellar peduncle, the medial loop, and the pyramidal pathway. On the side of the lesion - choreoathetoid, gaze paresis towards the focus, on the opposite side - central hemiplegia or hemiparesis, hemianesthesia.

Peduncular alternating syndromes. Weber's syndrome occurs when the nucleus or root of the oculomotor nerve and the fibers of the pyramidal tract are damaged. On the side of the pathological focus - divergent strabismus, on the opposite side - central hemiplegia; central paralysis of the muscles of the face and tongue is also possible.

Benedict's syndrome is caused by damage to the nucleus of the oculomotor nerve, the red nucleus, the red nucleus-dentate fibers, and sometimes the medial loop. On the side of the lesion - ptosis, divergent strabismus, mydriasis, on the opposite side - intentional, sometimes hemianesthesia.

Claude's syndrome is determined by damage to the nucleus of the oculomotor nerve, the superior cerebellar peduncle. On the side of the pathological focus - ptosis, divergent strabismus, mydriasis, on the opposite side - ataxia, dysmetria, decreased muscle tone.

Notnagel's syndrome is caused by a combined lesion of the nuclei of the oculomotor nerve, the superior cerebellar peduncle, the lateral loop, the red nucleus, and the fibers of the pyramidal tract. On the side of the lesion - ptosis, divergent strabismus, mydriasis, cerebellar ataxia (one and two-sided), on the opposite side - choreoathetoid hyperkinesis, central hemiplegia, central paralysis of the muscles of the face and tongue.

Alternating syndromes associated with damage to several parts of the brain stem. Glick syndrome is caused by damage to the optic, trigeminal, facial, vagus nerves and the pyramidal tract. On the side of the lesion - peripheral paralysis (paresis) of facial muscles with their spasm, in the supraorbital region, decreased vision or difficulty swallowing, on the opposite side - central hemiplegia or hemiparesis.

Cross hemianesthesia occurs when the nucleus of the spinal tract of the trigeminal nerve is damaged at the level of the pons or medulla oblongata and fibers of the spinothalamic tract. On the side of the lesion - a disorder of superficial sensitivity on the face according to the segmental type, on the opposite side - a violation of superficial sensitivity on and limbs.

Extracerebral alternating syndromes. Opto-hemiplegic syndrome occurs with unilateral damage to the retina, optic nerve, motor area of ​​the cerebral cortex due to circulatory disorders in the system of the internal carotid artery (in the basin of the ophthalmic and middle cerebral arteries). On the side of the lesion - amaurosis, on the opposite side - central hemiplegia or hemiparesis.

Vertigohemiplegic syndrome is caused by a unilateral lesion of the vestibular apparatus and the motor zone of the cerebral cortex due to circulatory disorders in the system of the subclavian and carotid arteries with impaired circulation in the pools of the labyrinth (vertebrobasilar basin) and middle cerebral arteries. On the side of the lesion - in the ear, horizontal in the same direction; on the opposite side - central hemiplegia or hemiparesis.

Asphygmohemiplegic syndrome (syndrome of the brachiocephalic arterial trunk) is observed with unilateral irritation of the nucleus of the facial nerve, vasomotor centers of the brain stem, damage to the motor zone of the cerebral cortex. On the side of the lesion - spasm of mimic muscles, on the opposite side - central hemiplegia or hemiparesis. There is no common carotid artery on the affected side.

Topico-diagnostic value. Analysis of the symptoms of damage to the cranial nerves, sensory organs, conduction disorders in A. s. allows you to determine the localization and boundaries of the pathological focus. In clinical practice, A. s. can be observed with tumors of the brain stem and with disorders of cerebral circulation (brain). So, Jackson's syndrome occurs with thrombosis of the anterior spinal artery or its branches, Avellis and Schmidt syndromes - with circulatory disorders in the branches of the arteries that feed the medulla oblongata, and Wallenberg's syndrome - Zakharchenko, Babinsky - Najotte - in the basin of the inferior posterior cerebellar or vertebral artery, syndrome cross hemiplegia - with thrombosis of the spinobulbar arterioles. Pontine (bridge) syndromes of Fauville, Brissot - Sicard, Raymond - Sestan are detected with damage to the branches of the basilar (main) artery, peduncular syndromes - deep branches of the posterior cerebral artery, Claude's syndrome - anterior and posterior arterioles of the red nucleus, Benedict's syndrome - interpeduncular or central arteries and etc.

The dynamics of symptoms can be judged on the nature of the pathological process. So, with ischemic damage to the brain stem as a result of thrombosis of the branches of the vertebral, basilar or posterior cerebral arteries, A. s develop gradually, often without loss of consciousness; the boundaries of the focus correspond to the zone of impaired vascularization; hemiplegia or hemiparesis are spastic. At a hemorrhage in And. may be atypical, tk. the boundaries of the focus may not correspond to a specific vascular pool and may increase due to reactive cerebral edema around the focus of hemorrhage. Acute development of the focus in the bridge of the brain is accompanied by respiratory disorders, cardiac activity, vomiting. In the acute period, a decrease in muscle tone on the side of hemiplegia is determined as a result of diaschisis. .

Bibliography: Gusev E.I., Grechko V.E. and Burd G.S. Nervous diseases, p. 185, Moscow, 1988; Krol M.B. and Fedorova E.A. Major neuropathological syndromes, p. 132, Moscow, 1966; Triumfov A.V. diseases nervous system, from. 148, L., 1974.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First health care. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what "Alternating Syndromes" is in other dictionaries:

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    Ponte Varoliyev's syndromes of defeat- a combination of central paresis or paralysis on the opposite side and symptoms of damage to the cranial nerves of the peripheral type on the side of the lesion. The symptom complexes that arise in this case are defined as alternating syndromes (lat. Encyclopedic Dictionary of Psychology and Pedagogy

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Alternating syndromes(Latin alternans - alternating; alternating paralysis, cross paralysis) - symptom complexes characterized by a combination of cranial nerve damage on the side of the focus with conduction disturbances of movement and sensitivity on the opposite side. Occur when one half of the brain stem, spinal cord is damaged, as well as with unilateral combined damage to the structures of the brain and sensory organs. Various AS can be caused by a violation of cerebral circulation, a tumor, a traumatic brain injury, etc. A gradual increase in symptoms is possible even without impaired consciousness, with the spread of edema or the progression of the process itself.

Bulbar alternating syndromes

  • Avellis syndrome(Palatopharyngeal paralysis) develops with damage to the nuclei of the glossopharyngeal and vagus nerves and the pyramidal tract. It is characterized from the side of the focus by paralysis of the soft palate and pharynx, from the opposite side - by hemiparesis and hemihypesthesia. (in the diagram - A)
  • Jackson Syndrome(medial medullary syndrome, Dejerine's syndrome) occurs when the nucleus of the hypoglossal nerve and the fibers of the pyramidal pathway are damaged. It is characterized by a paralytic lesion of half of the tongue from the side of the focus (the tongue "looks" at the focus) and central hemiplegia or hemiparesis of the extremities on the healthy side. (in the diagram - B)
  • Babinski-Najotte syndrome occurs with a combination of lesions of the inferior cerebellar peduncle, olivocerebellar tract, sympathetic fibers, pyramidal, spinothalamic tracts and medial loop. It is characterized on the part of the focus by the development of cerebellar disorders, Horner's syndrome, on the opposite side - hemiparesis, loss of sensitivity (In the diagram - A).
  • Schmidt syndrome characterized by a combined lesion of the motor nuclei or fibers of the glossopharyngeal, vagus, accessory nerves and the pyramidal pathway. Manifested from the focus of paralysis of the soft palate, pharynx, vocal cord, half of the tongue, sternocleidomastoid and upper trapezius muscle, on the opposite side - hemiparesis and hemihypesthesia. (In the diagram - B).

Wallenberg-Zakharchenko syndrome(dorsolateral medullary syndrome) occurs when the motor nuclei of the vagus, trigeminal and glossopharyngeal nerves, sympathetic fibers, the lower cerebellar pedicle, the spinothalamic tract, and sometimes the pyramidal tract are affected. On the side of the focus, paralysis of the soft palate, pharynx, vocal cord, Horner's syndrome, cerebellar ataxia, nystagmus, loss of pain and temperature sensitivity of half of the face are noted; on the opposite side - loss of pain and temperature sensitivity on the trunk and limbs. Occurs when the posterior inferior cerebellar artery is damaged. Several options have been described in the literature.

Pontine alternating syndromes

  • Raymond-Sestan syndrome noted with damage to the posterior longitudinal bundle, middle cerebellar peduncle, medial loop, pyramidal pathway. It is characterized by gaze paralysis towards the focus, on the opposite side - hemihypesthesia, sometimes hemiparesis. (On the diagram - A)
  • Miylard-Gubler syndrome(medial bridge syndrome) occurs when the nucleus or root of the facial nerve and the pyramidal tract are damaged. Manifested from the focus of facial paralysis, on the opposite side - hemiparesis. (On the diagram - B)

Brissot-Sicard syndrome occurs when the nucleus of the facial nerve is irritated and the pyramidal tract is damaged. It is characterized by facial hemispasm on the side of the focus and hemiparesis on the opposite side (In the diagram - A).
Fauville syndrome(lateral bridge syndrome) is observed with a combined lesion of the nuclei (roots) of the abducens and facial nerves, the medial loop, the pyramidal pathway. It is characterized from the side of the focus by paralysis of the abducens nerve and gaze paralysis towards the focus, sometimes by paralysis of the facial nerve; on the opposite side - hemiparesis and hemihypesthesia (In the diagram - B).

Peduncular alternating syndromes

  • Benedict syndrome (upper syndrome red nucleus) occurs when the nuclei of the oculomotor nerve, the red nucleus, red-nuclear-dentate fibers, and sometimes the medial loop are damaged. On the side of the focus, ptosis, divergent strabismus, mydriasis occur, on the opposite side - hemiataxia, eyelid trembling, hemiparesis without Babinski's symptom (In the diagram - B).
  • Foix's syndrome occurs when the anterior sections of the red nucleus and fibers of the medial loop are damaged without involvement of the oculomotor nerve in the process. In the syndrome, there is choreoathetosis, intentional tremor, a disorder of sensitivity according to the gemitype on the side opposite from the focus. (in the diagram - A)

  • Weber syndrome(ventral mesencephalic syndrome) is observed with damage to the nucleus (root) of the oculomotor nerve and fibers of the pyramidal pathway. Ptosis, mydriasis, divergent strabismus are noted on the side of the lesion, and hemiparesis is seen on the opposite side. (On the diagram - B)
  • Claude syndrome(dorsal mesencephalic syndrome, lower red nucleus syndrome) occurs when the nucleus of the oculomotor nerve, the superior cerebellar peduncle, and the red nucleus are damaged. It is characterized on the side of the lesion by ptosis, divergent strabismus, mydriasis, on the opposite side - hemiparesis, hemiataxy or hemiasynergy. (On the diagram - A)

Notnagel syndrome occurs with a combined lesion of the nuclei of the oculomotor nerves, the superior cerebellar peduncle, the lateral loop, the red nucleus, the pyramidal pathway. On the side of the focus, ptosis, divergent strabismus, mydriasis are noted, on the opposite side - choreoathetoid hyperkinesis, hemiplegia, paralysis of the muscles of the face and tongue.

Alternating syndromes associated with damage to several parts of the brain stem.

Glick syndrome due to damage to the optic, trigeminal, facial, vagus nerves and pyramidal pathway. On the side of the lesion - peripheral paralysis (paresis) of facial muscles with their spasm, pain in the supraorbital region, decreased vision or amaurosis, difficulty swallowing, on the opposite side - central hemiplegia or hemiparesis.

Cross hemianesthesia observed with damage to the nucleus of the spinal tract of the trigeminal nerve at the level of the bridge or medulla oblongata and fibers of the spinothalamic tract. On the side of the lesion - a disorder of surface sensitivity on the face according to the segmental type, on the opposite side - a violation of surface sensitivity on the trunk and limbs.


Extracerebral alternating syndromes.

Alternating syndrome at the level of the spinal cord - Brown-Séquard syndrome- combination clinical symptoms, developing with damage to half the diameter of the spinal cord. On the side of the lesion, there are spastic paralysis, conduction disturbances of deep (muscle-articular sense, vibrational sensitivity, pressure, weight, kinesthesia) and complex (two-dimensional, discriminatory, sense of localization) sensitivity, sometimes ataxia. At the level of the affected segment, radicular pain and hyperesthesia, the appearance of a narrow zone of analgesia and termanesthesia are possible. On the opposite side of the body, there is a decrease or loss of pain and temperature sensitivity, and the upper level of these disorders is determined several segments below the level of spinal cord injury.
With damage at the level of the cervical or lumbar thickening of the spinal cord, peripheral paresis or paralysis of the muscles innervated on the affected anterior horns of the spinal cord develops (damage to the peripheral motor neuron).
Brown-Sequard syndrome occurs with syringomyelia, spinal cord tumors, hematomyelia, ischemic disorders of the spinal circulation, injury, spinal cord contusion, epidural hematoma, epiduritis, multiple sclerosis, etc.
A true half spinal cord lesion is rare. Most often, only part of half of the spinal cord is affected - a partial variant in which some of its constituent signs are absent. In the development of different clinical variants, the localization of the pathological process in the spinal cord (intra- or extramedullary), its nature and features of the course, different sensitivity of the afferent and efferent conductors of the spinal cord to compression and hypoxia, individual features of spinal cord vascularization, etc. play a role.
The syndrome has a topical diagnostic value. Localization of the lesion in the spinal cord is determined by the level of violations of surface sensitivity.

Asphygmohemiplegic syndrome(syndrome of the brachiocephalic arterial trunk) is noted with unilateral irritation of the nucleus of the facial nerve, vasomotor centers of the brain stem, damage to the motor zone of the cerebral cortex. On the side of the lesion - a spasm of facial muscles, on the opposite side - central hemiplegia or hemiparesis. There is no pulsation of the common carotid artery on the side of the lesion.

Vertigohemiplegic syndrome due to unilateral damage to the vestibular apparatus and motor zone of the cerebral cortex due to circulatory disorders in the system of the subclavian and carotid arteries with impaired circulation in the basins of the labyrinth (vertebrobasilar basin) and middle cerebral arteries. On the side of the lesion - tinnitus, horizontal nystagmus in the same direction; on the opposite side - central hemiplegia or hemiparesis.

Optic-hemiplegic syndrome occurs with unilateral damage to the retina, optic nerve, motor zone of the cerebral cortex due to circulatory disorders in the system of the internal carotid artery (in the basin of the ophthalmic and middle cerebral arteries). On the side of the lesion - amaurosis, on the opposite side - central hemiplegia or hemiparesis.

Unilateral focal lesions of half of the brain stem are accompanied by alternating syndromes (AS): dysfunction of the cranial nerves on the side of the lesion and conduction disorders (motor, sensory) on the opposite side. Weber's syndrome (lesion in the region of the nuclei or fibers of the III nerve): symptoms of damage to the oculomotor nerve on the side of the focus, contralateral central hemiplegia and central paralysis of the muscles of the face and tongue (involvement of the corticonuclear pathways to the nuclei of the VII and XII nerves). Benedict's syndrome (the focus is at the same level, but more dorsally, with the involvement of the black in-va and the red nucleus in the process with the relative preservation of the pyramidal path): on the side of the focus - peripheral paralysis of the oculomotors, on the opposite side - intentional temitremor. With a larger focus, it is also possible to damage the conductors of the lemniscus medialis, passing outward from the nuclei of the oculomotor nerve, with the addition of violations of superficial and deep sensitivity according to the gemitype on the side opposite to the lesion to the Benedict symptom complex. Claude's syndrome is a combination of peripheral paralysis of the oculomotor muscles (the nucleus of the third nerve) with impaired coordination of movements, hemihyperkinesis and muscle hypotension on the opposite side (superior cerebellar peduncle). Notnagel's syndrome is observed with extensive lesions of the midbrain with involvement of the nuclei of the oculomotor nerve, upper cerebellar peduncles, lateral loop, pyramidal and cortical-nuclear pathway and is characterized on the side of the lesion by ataxia, peripheral paresis of m. oculomotorius, mydriasis and hearing impairment (usually on both sides), hemiparesis with central paresis of the muscles innervated by the VII and XII nerves. AC in the defeat of the bridge. Miyar-Gubler syndrome (damage to the nucleus or fibers of the VII nerve and pyramidal tract): peripheral paralysis of the mimic muscles on the side of the lesion and central hemiplegia on the opposite side. Fauville's syndrome (a more extensive lesion involving the pathological process of the nucleus or fibers of the VI nerve): Miyar-Gubler symptom complex and paralysis of the abductor eye muscle (convergent strabismus, diplopia, failure to bring the eyeball outwards). The Brissot-Sicard syndrome is characterized by a spasm of the facial muscles on the side of the lesion (irritation nuc. fascialis), contralaterally - spastic hemiparesis (lesion of the pyramidal tract). Raymond-Sestan syndrome is caused by a combined lesion of the posterior longitudinal fasciculus and the pontine center of gaze, the middle cerebellar peduncle, the medial loop and the pyramidal tract, there is paresis of the gaze towards the lesion, ataxia, choresotetoid hyperkinesis, contralateral spastic


hemiparesis and hemianesthesia. Grene's syndrome (damage to the core of the superficial sense of the V nerve and spinothalamic pathway): prolapse over the senses

(pain and temperature) on the face according to the segmental type on the side of the focus, contralaterally - prolapse on top. feelings on the conductive type on the trunk and limbs. AS in lesions of the medulla oblongata. Jackson's syndrome - a lesion at the level of the nucleus of the hypoglossal nerve: on the side of the focus, peripheral paralysis of the muscles of the tongue, contralaterally central hemiplegia. Avellis syndrome is caused by a combined lesion of nuc. ambiguus or associated fibers of the IX, X nerves and the pyramidal path: on the side of the focus, there is paresis of the vocal cord, soft palate, trapezius and sternocleidomastoid muscles, contralaterally - spastic hemiparesis. Wallenberg-Zakharchenko syndrome: on the side of the lesion - symptoms of involvement in the nuc process. ambiguus (paralysis of the soft palate and vocal cord), descending sympathetic fibers to the smooth muscles of the eye (p. Bernard-Horner), rope body (vestibular-cerebellar races), nuc. spinalis (distance of feelings on the face), on the opposite side, loss of pain and temperature feelings (damage to the fibers of the spinal-thalamic pathway). The syndrome is observed in violation of blood circulation in the basin of the posterior inferior cerebellar artery. Tapia syndrome is caused by a combined lesion of the nuclei or fibers of the XI, XII nerves and the pyramidal tract: on the side of the focus, paralysis of the trapezius and sternocleidomastoid muscles and half of the tongue, contralateral spastic hemiparesis. Volshtein's syndrome is caused by a combined lesion of the oral nuc. ambiguus and spinothalamic pathway: on the side of the focus, vocal cord paresis, contralaterally - hemianesthesia of superficial sensation. AS associated with damage to several parts of the brain stem include Gluck's syndrome, which is characterized by a combined lesion of the II, V, VII, X nerves and the pyramidal pathway; on the side of the focus, paresis of mimic muscles with spasm, pain in the supraorbital region, decreased vision or amaurosis, difficulty swallowing, contralateral spastic hemiparesis.