Alternating syndromes: symptoms, types, causes, diagnostic methods. What do alternating syndromes hide in themselves? Syndromes of dysfunction of the medulla oblongata

Alternating syndromes(lat. alterno- alternate; synonyms: alternating paralysis, cross paralysis) - syndromes that combine damage to the cranial nerves on the side of the focus with conduction disorders of motor and sensory functions on the opposite side.

Etiology and pathogenesis

Alternating syndromes occur with damage to one half of the brain stem, spinal cord (Brown-Sekara syndrome), as well as with unilateral combined damage to the structures of the brain and sensory organs. Various alternating syndromes can be caused by circulatory disorders in the spinal cord and brainstem, tumor processes localized in the brainstem, and traumatic brain injury. The most common stem symptom complexes are characterized by lesions on the side of the focus of one or more cranial nerves of the peripheral type (due to damage to their nuclei or roots), as well as conduction disorders on the opposite side (hemiparesis, hemiplegia, hemianesthesia, hemiataxia, etc.) due to damage fibers of the pyramidal tract, medial loop, cerebellar connections, etc.

Allocate bulbar, pontine, peduncular and mixed alternating syndromes depending on the location of the focus (which is important to clarify the localization of damage).

Bulbar alternating syndromes

Jackson syndrome(medial medullary syndrome, Dejerine's syndrome) is observed with a half lesion of the lower part of the medulla oblongata, and is characterized by a combination of peripheral paralysis of the hypoglossal nerve and central hemiparesis of the extremities on the opposite side. Peripheral paralysis of the hypoglossal nerve: atrophy of the same half of the tongue (thinning and folding of the mucous membrane), fascicular twitching. When protruding, the tongue deviates towards the lesion of the nucleus or nerve. Standard: when the left genio-lingual muscle is contracted, the tongue is pushed forward and to the right, when the right is contracted, vice versa. If the right nerve is affected, then with the contraction of the left genio-lingual muscle, the tongue is pushed to the right (to the side of the lesion).

Avellis syndrome(Palatopharyngeal paralysis) develops with damage to the nuclei of the glossopharyngeal, vagus and hypoglossal nerves and the pyramidal tract. It is characterized from the side of the focus by paralysis of the soft palate and pharynx.

Schmidt syndrome characterized by a combined lesion of the motor nuclei or fibers of the glossopharyngeal, vagus, accessory nerves and the pyramidal pathway. It manifests itself from the focus of paralysis of the soft palate, pharynx, vocal cord, half of the tongue, sternocleidomastoid and upper part of the trapezius muscle.

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, the occurrence of perverted temperature sensitivity. Occurs when the posterior inferior cerebellar artery is damaged.

Babinski-Najotte syndrome occurs with a combined lesion of the inferior cerebellar peduncle, olivocerebellar tract, sympathetic fibers, pyramidal, spinothalamic tracts and medial loop. It is characterized from the side of the focus by the development of cerebellar disorders, Horner's syndrome.

Pontine alternating syndromes

Miyar-Gubler syndrome(medial bridge syndrome) occurs when the nucleus or fibers of the 7th pair and the pyramidal path are damaged. On the side of the focus - peripheral paralysis of the mimic muscles: the face is asymmetrical, the muscles of the healthy half pull the skin of the face to their side, the racket symptom, the absence of nasolabial and frontal folds, the weakness of the mimic muscles of the upper and lower floors (atrophy, hypotrophy, hypotension, hyporeflexia, fibrillation and fasciculations ). Lagophthalmos (incomplete closure of the palpebral fissure due to paralysis of the circular muscle of the eye); symptom of eyelashes (when you try to close your eyes, the eyelashes remain in sight); Bell's phenomenon - when you try to close your eyes, the eyeballs run up. There are no autonomic disorders (taste is normal, lacrimation, salivation and swallowing reflex are normal. Dysacusia. On the opposite side - central hemiparesis or hemiplegia.

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 - central hemiparesis or hemiplegia.

Raymond-Sestan syndrome noted with damage to the posterior longitudinal bundle, middle cerebellar peduncle, medial loop, pyramidal pathway. It is characterized by paralysis of gaze towards the focus.

Brissot syndrome occurs when the nucleus of the facial nerve is irritated and the pyramidal tract is damaged. It is characterized by facial hemispasm from the focus.

Gasperini syndrome occurs when the pons operculum is damaged and is characterized by a combination of damage to the auditory, facial, abducent and trigeminal nerves on the side of the pathological focus.

Peduncular alternating syndromes

Weber syndrome(ventral mesencephalic syndrome) there is damage to the nuclei and roots of the third pair of cranial nerves (oculomotor nerve) and the pyramidal pathway. On the side of the lesion: ptosis, mydriasis, divergent strabismus, diplopia, disturbance of accommodation, exophthalmos. On the opposite side: central hemiparesis, paresis of the muscles of the face and tongue, and hemihypesthesia.

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. Ptosis, divergent strabismus, mydriasis occur on the side of the lesion, and intentional tremor and choreoform (rubral) hyperkinesis occur on the opposite side.

Benedict syndrome noted with damage to the nuclei of the oculomotor nerve, the red nucleus, red-nuclear-dentate fibers, and sometimes the medial loop. On the side of the focus, ptosis, divergent strabismus, mydriasis occur, on the opposite side - hemiataxia, eyelid trembling, hemiparesis (without Babinsky's symptom).

Notnagel's 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 - choreatetoid hyperkinesis, hemiplegia, paralysis of the muscles of the face and tongue.

Central hemiparesis of the extremities

A generalized description of the changes that occur on the opposite side, with alternating syndromes, regardless of the location of the lesion.

On the opposite side: spastic hypertonicity, with a predominance of the phasic component, is characterized by the “jackknife” phenomenon, the Wernicke-Mann posture, clonus of the feet and hands, hyperreflexia and expansion of reflexogenic zones, the appearance of pathological reflexes (on the hand - Rossolimo, Zhukovsky, Bekhterev; on the foot - Babinsky, Rossolimo). Pathological synkinesias (global [accompanying massive movements (coughing, sneezing), involuntary movements of the paralyzed limb are observed]); coordinating [involuntary friendly movements in the paralyzed limb when performing voluntary movements in healthy muscles functionally associated with paralyzed ones]; imitation [the paralyzed limb involuntarily repeats the movement healthy, although the same movement cannot be voluntarily performed.] Pronounced protective reflexes: shortening protective reflex;

Diagnostics

The diagnostic value of alternating syndromes lies in the ability to localize the lesion and determine its boundaries. For example, Jackson syndrome occurs when thrombosis of the anterior spinal artery or its branches, Avellis and Schmidt syndromes develop when blood circulation is disturbed in the branches of the artery that feeds the medulla oblongata, and Wallenberg-Zakharchenko and Babinski-Najotte syndromes develop in the basin of the inferior posterior cerebellar or vertebral artery. Pontine syndromes of Fauville, Brissot, Raymond-Sestan occur when the branches of the basilar artery are affected, peduncular syndromes - deep branches of the posterior cerebral artery, Claude's syndrome - the anterior and posterior arterioles of the red nucleus, Benedict's syndrome - the interpeduncular or central arteries, etc.

The change in symptoms characterizes the cause of the pathological process. Ischemic damage to the brain stem, for example, as a result of thrombosis of the branches of the vertebral, basilar or posterior cerebral arteries, leads to the gradual development of alternating syndromes, not even accompanied by loss of consciousness. The borders of the focus in this case correspond to the zone of circulatory disorders, hemiplegia or hemiparesis are spastic in nature. Hemorrhages in the brainstem can lead to the occurrence of atypical alternating syndromes. This is due to the fact that, in addition to the area of the damaged vascular pool, the surrounding brain tissues are also involved in the process due to the development of peripheral edema. Acute development of the focus in the pontine zone is accompanied by respiratory disorders, cardiac activity, and vomiting. In the acute period, a decrease in muscle tone on the side of hemiplegia is determined.

These are neurological disorders, including unilateral cranial nerve damage and contralateral motor and/or sensory disorders. The variety of forms is due to different levels of damage. Diagnosis is made clinically during a neurological examination. To establish the etiology of the disease, an MRI of the brain, studies of cerebral hemodynamics, and analysis of cerebrospinal fluid are performed. Treatment depends on the genesis of the pathology, includes conservative, surgical methods, restorative therapy.

ICD-10

G46.3 Stroke syndrome in the brain stem (I60-I67+)

General information

Alternating syndromes got their name from the Latin adjective "alternance", meaning "opposite". The concept includes symptom complexes characterized by signs of damage to the cranial nerves (CN) in combination with central motor (paresis) and sensory (hypesthesia) disorders in the opposite half of the body. Since paresis covers the limbs of half of the body, it is called hemiparesis (“hemi” - half), similarly, sensory disorders are denoted by the term hemihypesthesia. Due to the typical clinical picture, alternating syndromes in modern neurology are synonymous with "cross syndromes".

Causes of alternating syndromes

A characteristic crossover neurological symptomatology occurs with a half-damage of the cerebral trunk. Pathological processes may be based on:

Cerebral circulatory disorders. Stroke is the most common cause of alternating syndromes. The etiofactor of ischemic stroke is thromboembolism, spasm in the system of the vertebral, basilar, and cerebral arteries. Hemorrhagic stroke occurs when hemorrhage from these arterial vessels.
A brain tumor. Alternating syndromes appear with direct damage to the stem by a tumor, with compression of the stem structures by an adjacent neoplasm that increases in size.
Inflammatory processes: encephalitis, meningoencephalitis, brain abscesses of variable etiology with localization of the inflammatory focus in stem tissues.
brain injury. In some cases, alternating symptoms are accompanied by fractures of the bones of the skull that form the posterior cranial fossa.

Alternating symptom complexes of extra-stem localization are diagnosed with circulatory disorders in the middle cerebral, common or internal carotid artery.

Pathogenesis

The nuclei of the cranial nerves are located in different parts of the cerebral trunk. The motor tract (pyramidal path) also passes here, carrying efferent impulses from the cerebral cortex to spinal cord neurons, a sensory tract that conducts afferent sensory impulses from receptors, and cerebellar pathways. Motor and sensory conductive fibers at the level of the spinal cord form a decussation. As a result, the innervation of half of the body is carried out by nerve pathways passing in the opposite part of the trunk. A unilateral stem lesion with simultaneous involvement in the pathological process of the nuclei of craniocerebral nerves and conducting tracts is clinically manifested by cross-symptoms characterizing alternating syndromes. In addition, cross-symptoms occur with simultaneous damage to the motor cortex and the extrastem part of the cranial nerve. Pathology of the midbrain is characterized by a bilateral nature, does not lead to alternating symptoms.

Classification

According to the location of the lesion, extra-stem and stem syndromes are distinguished. The latter are divided into:

Bulbar - associated with a focal lesion of the medulla oblongata, where the nuclei of the IX-XII cranial nerves, the lower legs of the cerebellum are located.
Pontine - due to a pathological focus at the level of the bridge with the involvement of the nuclei of the IV-VII nerves.
Peduncular - occur when pathological changes are localized in the legs of the brain, where the red nuclei, the upper cerebellar legs are located, the roots of the III pair of cranial nerves, pyramidal tracts pass.

Clinic of alternating syndromes

The clinical picture is based on alternating neurological symptoms: signs of cranial insufficiency dysfunction on the side of the lesion, sensory and/or motor disorders on the opposite side. Nerve damage is peripheral in nature, which is manifested by hypotonia, atrophy, fibrillation of the innervated muscles. Movement disorders are central spastic hemiparesis with hyperreflexia, pathological foot signs. Depending on the etiology, alternating symptoms have a sudden or gradual development, accompanied by cerebral symptoms, signs of intoxication, intracranial hypertension.

bulbar group

Jackson syndrome is formed when the nucleus of the XII (hyoid) nerve and pyramidal tracts are affected. It is manifested by peripheral paralysis of half of the tongue: the protruding tongue deviates towards the lesion, atrophy, fasciculations, and difficulty in pronouncing difficultly articulated words are noted. In the contralateral limbs, hemiparesis is observed, sometimes loss of deep sensitivity.

Avellis syndrome is characterized by paresis of the muscles of the larynx, pharynx, vocal cords due to dysfunction of the nuclei of the glossopharyngeal (IX) and vagus (X) nerves. Clinically observed choking, voice disorders (dysphonia), speech (dysarthria) with hemiparesis, hemihypesthesia of opposite limbs. Damage to the nuclei of all caudal cranial nerves (IX-XII pair) causes the Schmidt variant, which differs from the previous form by paresis of the sternocleidomastoid and trapezius muscles of the neck. On the affected side, there is a drooping of the shoulder, limitation of raising the arm above the horizontal level. Difficulty turning the head towards the paretic limbs.

The Babinski-Nageotte form includes cerebellar ataxia, nystagmus, Horner's triad, crossover paresis, and superficial sensory disorder. With the Wallenberg-Zakharchenko variant, a similar clinic is revealed, dysfunction of the IX, X and V nerves. It can proceed without paresis of the limbs.

Pontine group

The Miylard-Gubler syndrome appears with pathology in the region of the nucleus of the VII pair and fibers of the pyramidal tract, is a combination of facial paresis with hemiparesis of the opposite side. A similar localization of the focus, accompanied by irritation of the nerve nucleus, causes the Brissot-Sicard form, in which facial hemispasm is observed instead of facial paresis. Fauville's variant is distinguished by the presence of peripheral paresis of the VI cranial nerve, giving a clinic of convergent strabismus.

Gasperini's syndrome - damage to the nuclei of V-VIII pairs and the sensitive tract. Facial paresis, converging strabismus, facial hypoesthesia, hearing loss are noted, nystagmus is possible. Hemihypesthesia of the conduction type is observed contralaterally, motor skills are not disturbed. The Raymond-Sestan form is due to damage to the motor and sensory pathways, the middle cerebellar peduncle. Dyssynergia, discoordination, hypermetry are found on the side of the focus, hemiparesis and hemianesthesia - contralaterally.

Peduncular group

Weber's syndrome - dysfunction of the nucleus of the third pair. It is manifested by omission of the eyelid, dilated pupil, turning of the eyeball towards the outer corner of the eye, crossed hemiparesis or hemihypesthesia. The spread of pathological changes to the geniculate body adds visual disturbances (hemianopsia) to the indicated symptoms. Benedict's variant - the pathology of the oculomotor nerve is combined with dysfunction of the red nucleus, which is clinically manifested by intentional tremor, athetosis of the opposite limbs. Sometimes accompanied by hemianesthesia. With the Notnagel variant, oculomotor dysfunction, cerebellar ataxia, hearing disorders, contralateral hemiparesis, and hyperkinesis are possible.

Extrastem alternating syndromes

Hemodynamic disturbances in the system of the subclavian artery cause the appearance of vertigohemiplegic form: symptoms of dysfunction of the vestibulo-cochlear nerve (noise in the ear, dizziness, hearing loss) and crossed hemiparesis. The opticohemiplegic variant develops with discirculation simultaneously in the ophthalmic and middle cerebral arteries. It is characterized by a combination of optic nerve dysfunction and crossed hemiparesis. Asphygmohemiplegic syndrome occurs when the carotid artery is occluded. There is hemiparesis of the facial muscles opposite to hemiparesis. A pathognomonic sign is the absence of pulsation of the carotid and radial arteries.

Complications

Alternating syndromes, accompanied by spastic hemiparesis, lead to the development of joint contractures that aggravate motor disorders. Paresis of the VII pair causes a distortion of the face, which becomes a serious aesthetic problem. The result of damage to the auditory nerve is hearing loss, reaching a complete loss of hearing. Unilateral paresis of the oculomotor group (III, VI pairs) is accompanied by doubling (diplopia), which significantly worsens visual function. The most formidable complications arise with the progression of the brain stem lesion, its spread to the second half and vital centers (respiratory, cardiovascular).

Diagnostics

To establish the presence and type of cross syndrome allows examination by a neurologist. The data obtained make it possible to determine the topical diagnosis, that is, the localization of the pathological process. Approximately to judge the etiology can be on the course of the disease. Tumor processes are distinguished by a progressive increase in symptoms over several months, sometimes days. Inflammatory lesions are often accompanied by general infectious symptoms (fever, intoxication). In stroke, alternating symptoms occur suddenly, increase rapidly, and occur against the background of changes in blood pressure. Hemorrhagic stroke differs from ischemic stroke by a blurred atypical picture 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 of the brain allows visualizing the inflammatory focus, hematoma, stem tumor, stroke area, differentiating hemorrhagic and ischemic stroke, and determining the degree of compression of stem structures.
ultrasonic methods. The most accessible, fairly informative method for diagnosing disorders of cerebral blood flow is ultrasound of the cerebral vessels. Detects signs of thromboembolism, local spasm of intracerebral vessels. In the diagnosis of occlusion of the carotid, vertebral arteries, ultrasound of extracranial vessels is necessary.
Vascular neuroimaging. The most informative method for diagnosing acute cerebrovascular accidents is MRI of cerebral vessels. Visualization of blood vessels helps to accurately diagnose the nature, localization, degree of their damage.
Study of cerebrospinal fluid. Lumbar puncture is performed if an infectious-inflammatory nature of the pathology is suspected, which is evidenced by inflammatory changes in the cerebrospinal fluid (turbidity, cytosis due to neutrophils, the presence of bacteria). Bacteriological and virological studies can identify the pathogen.

Treatment of alternating syndromes

Therapy is carried out in relation to the underlying disease, includes conservative, neurosurgical, rehabilitation methods.

conservative therapy. General measures include the appointment of decongestants, neuroprotective agents, correction of blood pressure. Differentiated treatment is carried out according to the etiology of the disease. Ischemic stroke is an indication for thrombolytic, vascular therapy, hemorrhagic stroke - for the appointment of calcium preparations, aminocaproic acid, infectious lesions - for antibacterial, antiviral, antimycotic therapy.
Neurosurgical treatment. It may be required for hemorrhagic stroke, damage to the main arteries supplying the brain, and volumetric formations. According to indications, reconstruction of the vertebral artery, carotid endarterectomy, formation of an extra-intracranial anastomosis, removal of the trunk tumor, removal of a metastatic tumor, etc. are carried out. The question of the advisability of surgical intervention is decided jointly with a neurosurgeon.
Rehabilitation. It is carried out by the joint efforts of a rehabilitator, a physiotherapist, a massage therapist. It is aimed at preventing contractures, increasing the range of motion of paretic limbs, adapting the patient to his condition, and postoperative recovery.

Forecast and prevention

According to the etiology, alternating syndromes can have a different outcome. Hemiparesis leads to disability in most patients, complete recovery is observed in rare cases. Limited ischemic strokes have a more favorable prognosis in the case of promptly initiated adequate treatment. Recovery after a hemorrhagic stroke is less complete and longer than after an ischemic one. Tumor processes, especially of metastatic genesis, are prognostically difficult. Prevention is nonspecific, it consists in the timely effective treatment of cerebrovascular pathology, the prevention of neuroinfections, TBI, and oncogenic effects.

Hemorrhagic stroke

Parenchymal hemorrhage. Etiology. hypertension (80-85% of cases). atherosclerosis, blood diseases, inflammatory changes in cerebral vessels, intoxication, beriberi and other causes.

Pathogenesis. Hemorrhage in the brain can occur by diapedesis or as a result of rupture of the vessel.

There are hemorrhages of the hematoma type and the type of hemorrhagic impregnation.

Clinic. In the clinic of cerebral hemorrhages, three periods are distinguished: acute, recovery and residual (the period of residual effects).

Acute period characterized by general symptoms. The disease begins during the day, acutely, without precursors, with apoplektiform development of a coma, characterized by a complete loss of consciousness, lack of active movements, loss of response to external stimuli and a disorder of vital functions, as well as sensitive and reflex spheres.

On examination, the patient noted hemiplegia.

Paralyzed limbs fall when raised. The foot on the side of the paralysis is rotated outwards. Deep reflexes are not called. On the paralyzed limb, there is a symptom of Babinsky, sometimes other pyramidal signs. The eyes and head are turned in the opposite direction to the focus (“the patient looks at the focus. The nasolabial fold on the side of the lesion is smoothed, the corner of the mouth is lowered, the cheek “sails” when breathing. Vomiting often occurs. Breathing is disturbed.. The pulse is slow or rapid, tense. Blood pressure is high Involuntary urination and defecation is noted.Already in the first or second day, a central one may develop.Due to swelling of the brain and its membranes, rigidity of the occipital muscles, symptoms of Kernig, Brudzinsky and other meningeal symptoms may develop.Hemorrhages appear in the fundus of the eye.A particularly severe clinical picture develops with hemorrhages in the ventricles of the brain

paraclinical the examination reveals: in the blood - leukocytosis, lymphopenia (0.08-0.17). In urine - low relative density, protein, sometimes erythrocytes and cylinders. The cerebrospinal fluid flows out under increased pressure, red blood cells are found in it. It increases the content of protein (up to 1000-5000 mg/l) and cells. Pleocytosis

Consciousness clears up very slowly, and as you exit the coma, and then the soporous state, focal symptoms become more and more clearly manifested, which depend on the location of the hemorrhagic focus. Due to the most frequent location of hemorrhage in the subcortical-capsular region, they are expressed in hemiplegia, hemianopsia, hemianesthesia. Speech disorders (aphasias) join these symptoms in case of damage to the left hemisphere.

Restoration of movements begins with the leg, then the arm, and the movements first appear in the proximal limbs.

Clinic. Subarachnoid hemorrhages usually develop suddenly, without warning. Patients have an excruciating headache, giving the impression of a "blow to the head." Simultaneously with the headache, vomiting appears, often dizziness. Consciousness may be lost for a short time (several minutes, rarely hours

The psyche is broken. There may be confusion, stupor, drowsiness, stupor, or, conversely, a sharp psychomotor agitation. Epileptiform seizures are possible.

After a few hours or on the second day, meningeal symptoms appear. With basal localization of hemorrhage, signs of damage to the cranial nerves (ptosis, strabismus, double vision, paresis of facial muscles, sometimes bulbar syndrome) are characteristic. When the hemorrhage is located on the upper lateral surface of the brain, signs of irritation of the cortex predominate, there may be Jacksonian seizures, abduction of the head and eyes to the side, monoparesis, symptoms of Babinsky, Gordon, Oppenheim, decreased tendon and periosteal reflexes.

Body temperature rises on the second or third day of the disease. In the blood, leukocytosis is noted with a shift in the white blood formula to the left, sometimes there is albuminuria and glycosuria.

Lumbar puncture for subarachnoid hemorrhage is performed for diagnostic and therapeutic purposes. The cerebrospinal fluid flows out under high pressure and contains a significant admixture of blood. Pleocytosis is characteristic, which reaches 1000-1 b 6 in 1 liter or more.

For the course of subarachnoid hemorrhage, relapses are characteristic.

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. can be caused by cerebrovascular accident, 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 nerves and the pyramidal tract are affected. On the side of the lesion, peripheral paralysis of the soft palate, uvula, vocal fold 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 tract of the trigeminal nerve, sympathetic fibers, the inferior cerebellar peduncle, the spinothalamic tract, and sometimes the 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 when the branches of the basilar (main) artery are affected, 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 hemorrhage focus. 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 is determined on the side of hemiplegia as a result of diaschisis. .

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

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - 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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Alternating syndromes- (Latin alter one of two syndromes) a group of neurological syndromes that occur when the nervous tissue is damaged in the brainstem area. At the same time, various combinations of paralysis and paresis of the cranial nerves and sensory disturbances are observed ...

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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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