SYNDROMES OF LESIONS IN THE BRAIN STEM AND CRANIAL NERVES
Brief anatomy of the brain stem
Brain stem consists of the medulla oblongata, pons and midbrain. From below, brain stem is limited by Xiaspinal roots, coming from the segment C1, from top is optic tract on their way to the intersection of thevisual lateral geniculate body (Fig. 6).Medulla oblongata ( ) represents lower (caudal) part of the brain stem and is,between the spinal cord and the pons. On its ventral part but both sides of the median fissure iselevated the pyramid, of which there are pyramidal (cortico-spinal-cerebral) tract. On dorsal part of the medulla oblongata but both sides of the median fissure are visible elevation of Burdach's nucleusand soft nucleus, which is the second neuron of deep sensory tract and Rhomboid fossa. Most caudalpart of medulla oblongata exit accessory nerve, part of the roots of which originates from the cervicalsegments, and then departs hypoglossal, vagus and glossopharyngeal nerves. At the border of theconnection of medulla oblongata and the pons in cerebellopontine angle in the brain stem entervestibulocochlear and facial nerves. in the ventral part goes abducens nerve.Pons (
)
includes fibers connecting the hemispheres of the cerebellum, which served as itsname. Pons is situated between medulla oblongata and midbrain. Its ventral part is cushion and includetwisted fibers going from pons to cerebellum (2
nd
part of cortico-cerebellopontine tract), as well as thecortico-spinal (pyramidal) tract. On lateral side, transverse fibers form the base of the pons middle crus(pedunculus) cerebri of the cerebellum, above which there is a place where trigeminal nerve exit. The mainpart of the dorsal part of the pons is Rhomboid fossa.Mesencephalon
(
)
represents the upper (oral) part of the brain stem. Ventral part of themidbrain is the brain stem, which includes the cortico-spinal and cortico-pons tract. The roof of themidbrain is formed by two symmetrical upper and lower colliculus, which contain the nucleus, respectivelyperceive visual and auditory impulses. Between the roof of the midbrain and the crus (pedunculus) cerebriof the brain are the nucleus of the oculomotor and trochlear nerves, nucleus ruber and substansia nigra.From the interval between the crus (pedunculus) cerebri of the brain, go oculomotor nerves. From thedorsal surface of the midbrain go troclear nerves.In the brainstem are nuclei of cranial nerves, other clusters of neurons, and are ascending and descendingpathways. In brain stem is the reticular formation, neurons which have bilateral relations with the cortexand basal ganglia of the cerebral hemispheres, nuclei of cranial nerves, cerebellum and spinal cord. Part of the nuclei of the reticular formation, mainly localized in the midbrain and the pons, has an activating effecton the cortex of cerebral hemispheres and is important in the maintenance of consciousness, the regulationof the rhythm of sleep and wakefulness. Another group of nuclei of the reticular formation of the pons andthe medulla affect autonomic-visceral functions (respiratory center, vasomotor center) and the motoractivity of the spinal cord.Defect of the brain stem appears dysfunction of cranial nerves (CNs), or other clusters of neurons (rednucleus, substantia nigra or other), as well as symptoms pathways (motor and sensory). Extensive damageto the brain stem causes disorder of consciousness and death due to disrupted vital functions (respiratoryand circulatory). Damage even in small parts of the midbrain reticular formation of nuclei can causedisorder of consciousness. Any damage to half of the trunk of spinal appears as alternating syndrome:disturbance of function of CNs on the affected side and the central hemiparesis and hemihypoesthesia onthe opposite side of the trunk to the extremities (due to destruction of motor and sensory pathways).Description of the major syndromes is given in alternating syndromes of disturbance of CNs.
I pair of cranial nerves, olfactory nerve,
n. olfactorius,
olfactory systemsBrief anatomy.
Olfactory irritation is perceived by sensitive cells (olfactory receptors), mucous membrane of the upper part of the nasal cavity, which form the olfactory fibers passing through openings in the ethmoidbone and goes along to the olfactory bulb. These fibers per se form olfactory nerves. Axons of olfactorysecond neurons, form the olfactory bulb form the olfactory tract, which the excitation reaches the amygdalaof temporal lobe (third neurons) and from them goes to the anterior parahippocampal gyrus (projection andassociation areas of the field of smell).
Investigations of olfactory function
are carried out with aromatic substances (tincture of valerian, camphoroil, etc.) separately in each of the nose entrance.
Reduced sense of smell (hypo-osmia/sphresia) or loss (anosmia)
occurs in 1% of the population aged until60 years and more than 50% of people aged over 60 years. Patients are often unaware of the loss of smell,and complained of breach of taste, in which the perception of odors plays large role. In 2/3 cases of hyposphresia or anosmia are caused rhinogenous diseases, sinusitis, head trauma, degenerative-dystrophicchanges in olfactory neurons in older people. Less likely, bilateral anosmia caused by degenerative diseasesof the nervous system (Alzheimer's, Parkinson's), epilepsy, somatic (hypothyroidism, kidney disease,diabetes) and mental illness. Unilateral hypo- and anosmia could be the first and only symptom of tumorsand other pathological processes on the basis of the frontal lobe (shown in detecting computer or MRI of the head). Transiet distortion of smell is possible during pregnancy, poisoning by chemicals andschizophrenia. Olfactory hallucinations (feeling of absence of odor) may occur in pathological processes(most tumors) in of the temporal lobe, they may be a manifestation of an epileptic seizure.
II pair of cranial nerves, optic nerve,
n. opticus
and visual systemBrief anatomical data.
The visual impulses are perceived by retina as an ordered cluster of specialized cells.Retina has three layers of neurons: the first - rods and cones, the second - the bipolar cells, the third -ganglionic cells. Diagram of the visual system is shown in Fig. 7. 7. In rods and cones, light informationthrough photochemical reactions is converted into pulses that propagate successively to other sections of the neurons. Axons of ganglion cells form optic nerve, which penetrates into the cavity of the skull. At thelevel of the optic chiasma or chiasmata opticus
,
fibers from the inner (nasal) part of the retina pass to theopposite side, the fibers from the outer (temporal) half of the retina remain on their side. As a consequence,in the optic tract
(tractus opticus)
,
forms after the intersection, in which is located fibers from the temporalpart of the retina of his eye and nasal part of retina of the other eye. - Therefore, right optic tract conductimpulses from the left visual fields, in the left visual tract - from the right visual fields. Optic tract terminatesin the lateral geniculate body, where the excitation is transferred to the next (fourth) neurons. Axons of these neurons pass through the posterior part of hind femur internal capsule and in the temporal andoccipital lobes form radiatio optica, which ends in sulcus calcarinus of occipital lobe (first projection of visualfield). In other divisions (mid-sections and the outer surface) of the occipital lobe is the analysis andrecognition of visual images (second visual field).
Investigation of view.
Visual acuity was tested with the help of special tables, which have alphabets orsimple shapes.The fields of view can be precisely measured using a special device (perimeter). To estimate the field of view,you can use a simpler technique. The patient is asked to close one eye and hand to fix their view on onepoint, for example on the investigator that is sitting oppositely. The researcher moves the hammer of theperimeter because of the patient's head to the center of his moles from different points of view (right, left,top and bottom) and asks the patient to indicate when he saw the hammer. After examination of one eye,another eye is examined. The normal boundaries of fields of view (in white) are: external - 90 °, internal -
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Lesions of the Brain Stem and I, II Cranial Nerves
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