Peripheral and central paralysis of the mimic muscles and muscles of the language. Paralysis Mimic Musculature with ONMK (Differential Diagnostic Aspects) Treatment of Language Pare

Podium nerve innervates the muscles of the language (except m. Palatoglossusequipped X pair card nerves).

Inspection

The study starts from the inspection of the language in the oral cavity and when it is supervised. Pay attention to the presence of atrophy and bezkiculation. Faccsiculation - Draw-shaped fast irregular muscle twist. Language atrophy is manifested by a decrease in its volume, the presence of furrows and the folds of its mucous membrane. The fascicular twist in the language indicates the involvement in the pathological process of the nucleus of the sub-speaking nerve. One-sided atrophy of the muscles of the tongue is usually observed in tumor, vascular or traumatic lesion of the trunk of an approaching nerve at or below the level of the base of the skull; It is rarely connected with the intramedullary process. Bilateral atrophy, most often occurs during the disease of the motor neuron [lateral amyotrophic sclerosis (bass)] and Siringobulbia. To evaluate the muscle functions of the muscles, the patient is offered to flash tongue.

Normally, the patient easily shows the language; When tying it is located in the midline. Pares of the muscles of one half of the language leads to its deviation on the weak side (T. Genioglossushealthy side pushes the tongue towards the parethous muscles). The language always deviates in the direction of a weak half, regardless of whether the consequence of the outdantic or nuclear-lesion is the weakness of the muscle of the language. It should be verified that the deviation of the tongue is true, not imaginary.

The false impression of the presence of the deflection of the tongue may occur in the asymmetry of the face due to the one-sided weakness of the mimic muscles. The patient is offered to perform rapid movements of the tongue from side to side. If the weakness of the language is not quite obvious, asking the patient to press the tongue to the inner surface of the cheek and evaluate the power of the tongue, counteracting this movement. Pressure pressure of the language on the inner surface of the right cheek reflects the power of the left m. Genioglossus,and vice versa. Then the patient is offered to pronounce syllables with advanced sounds (for example, La La La). With the weakness of the muscle of the language, it cannot be clearly repulsed by them. To identify light dysarthria, the examined is asked to repeat complex phrases, for example: "Administrative experiment", "episodic assistant", "on Mount Ararat ripen a large red grapes" and others.

The combined lesion of the nuclei, the roots or trunks of the IX, X, XI, XII Course Course determines the development of a bulbar paralysis or a pares. The clinical manifestations of the bulbar paralysis are dysphagia (swallowing disorder and across food due to the pan of the muscles of the pharynx and the palmist); Nazolalia (vile shade of voice associated with the muscles of the muscles of a nebory curtain); dysphony (loss of voice sounding due to the passage of muscles involved in a narrowing / expansion of voice gap and voltage / relaxation of voice ligament); dysarthria (muscle paresis providing proper articulation); Atrophy and fasciculation of muscles of the language; the focus of the laborer, pharyngeal and cough reflexes; respiratory and cardiovascular disorders; Sometimes the sluggish paresis of the breast-curable and large and trapezoid muscles.

IX, X and XI nerves together come out of the skull cavity through the jugular hole, so one-sided bulbar paralysis is usually observed with the defeat of these cranial nerves tumor. Bilateral bulbarium paralysis can be due to polio and other neuroinfections, bass, bolbospinal amyotrophy of Kennedy or toxic polyneuropathy (diphtheria, paraneoplastic, with SGB, etc.). The lesion of neuromuscular synapses during myasthenia or muscle pathology in some forms of myopathies is the cause of the same violations of bulbar motor functions as in bulbar paralysis.

From the bulbar paralysis, which suffers from the lower motnelone (core of the cranial nerves or their fibers), pseudobulbar paralysis should be distinguished, which develops with bilateral damage to the top motor mechanone Corkovo - nuclear paths. Pseudobulberry paralysis - a combined violation of the functions of IX, X, XII pairs of cranial nerves, due to bilateral damage to the cortical nuclear paths going to their nuclei. The clinical picture resembles the manifestations of the bulbar syndrome and includes dysfagia, namolalia, dysphony and dysarthria. With pseudobulbar syndrome, in contrast to the bulbar, silent, silica, cough reflexes are preserved; Reflexes of oral automatism appear, the mandibular reflex increases; There are no violent crying or laughter (uncontrolled emotional reactions), hypotrophy and the light muscles are missing.

The etiological factors of the lesion of the sub-surge nerve: brain neoplasms, poliomyelitis, lateral amyotrophic sclerosis, compression in the sublard channel.

Symptoms of the lifting nerve

With the neuropathy of the sublard nerve, the weakness of the language appears when talking, the difficulty of swallowing. In the process of developing the disease, the weakness of the language increases. Depending on the level of nerve damage, central or peripheral paresis develops. Peripheral lesion occurs when the core of the sub-speaking nerve is damaged, as well as the nerve fibers emanating from it. The hypotension of the muscles of the language of the defeat, the surface of the tongue becomes wrinkled, uneven; Gradually appear muscle atrophy in the language. A distinctive feature - fibrillar twitching in the muscles of the language. The language is deflected towards the lesion. The nerve is heavier from two sides (20%) - the glossale (immobility of the language) occurs, a violation of speech in the form of dysarthria.

Diagnostics

Computer / magnetic-resonant tomography of the brain (the cause of the ply-speaking nerve compression) is carried out.

Differential diagnosis:

Neuralgia of the sub-speaking nerve.
Glossalgia in the neurosis of obsessive states, diseases of the gastrointestinal tract.
Hypertrophied skate bone with PEDGET disease.

Treatment of the lesion of the sublingual nerve

Anticholinesterase preparations, vitamins of group V.
Hygiene oral cavity.
Treatment of the main disease.

Treatment is assigned only after confirming the diagnosis by a specialist doctor.

Basic drugs

There are contraindications. Consultation of a specialist is necessary.

Prezero (inhibitor of acetylcholinesterase and pseudocholinesterase). Dosing mode: inside adults 10-15 mg 2-3 times a day; subcutaneously - 1-2 mg 1-2 times a day.
(complex of vitamins of group B). Dosing mode: Therapy begins with 2 ml intramuscularly 1 p / d for 5-10 days. Supporting therapy - 2 ml / m two or three times a week.

Dysarthria - speech pathology, which arises as a result of a violation of the transfer of impulses in the region nervous paths speech apparatus.

The severity of speech pathology depends on the localization and degree of damage to the peripheral and central nervous system, as well as directly depends on the intrauterine development of the child and on what age the primary defect is detected leading to the development of dysarthria.

Dysarthria manifests itself mainly as a pathological disorder of the articular apparatus due to various lesions of the cerebral structures and its departments. Manifests itself in the form of impaired muscle tone of the speech apparatus, voice science and respiratory systemWhat leads to underdevelopment of verbal means of communication and communication in general.

Under the dysarthria, there is a disorder of phonderatic perception and lexico-grammatical speech, as well as underdevelopment of the PPT (higher mental functions).

Factors affecting the development of violations

Psychosomatic and psychomotor development of a child is the most difficult process, since any negative factor may affect its development negatively. These adverse factors include:

intrauterine infectious damage;
intrauterine oxygen deficiency;
cNS intoxication;
manifestations of toxicosis;
birth ahead of time;
birth injury.

Together with the intrauterine development and congenital features of the central nervous system, the social environment is played by a substantive role in development, which it is capable of providing a supporting and stimulating function for the development of a child and, on the contrary, to provide an oppressive, depriving.

So, after birth, transferred, which leads to intoxication not only the CNS, but also the brain.

Such adverse factors cause organic lesion of the peripheral and central nervous system, as a result of which violations of cognitive processes, hearing, vision, motility are observed. So, is observed in cases in more than 80% of cases.

Development of violations in childhood

Due to numerous studies and studying the dynamics of the development of neurological states of the child in the postnatal period, the specialists claim that wearing a mixed specific character, since the lesions are characterized by localization in different parts of the brain.

The following most commonly encountered forms of dysarthria in children are distinguished:

Spastic paretic He has all signs in adults. The main symptoms: a phonetic speech is broken; weak articulation apparatus; the complexity of reproduction of arbitrary movements; high tone of the muscles of the speech apparatus; the presence of violent movements; Permanent steady tremor, the child is not able to arbitrarily open the mouth. The development of this form of violation is characterized by the late advent of rustling, lepture and sound suspension. In the later stages of development, speech remains unbearable, passive, monotonous. Before implementing an articulation movement, the muscle tone sharply increases, leading to the spasm - the language is delayed back and turns into a com.
Hyperkinetic form The disorders are characterized by a jump-shaking and unstable muscle tone of the articular apparatus, as a result of which it is manifested in the form of dysarthria and disconesia. Superior damage is observed, as a result, speech respiratory disorder occurs, as well as the manifestation of the instability of speech sounds. This form of dysarthria is amenable to correction.
ATONIO-ASTABASTIC The form is observed most often at. Symptomatics is characterized by mixed signs: violation of the speech apparatus - a thin sharp tongue, sluggishly located at the bottom oral cavity, language is not allowed; There is a sagging and loss of the sensitivity of both cheeks; It is a tricky, it is accelerated, it slows down. There is a rapid change in voice modulation, we are chanted chant, chopped and accompanied by shouts. In children with this type of dysarthria, there are violations of the pronunciation of sounds from simple to complex. Training and correction proceeds difficult, since such children have no criticality of the situation.

Early diagnosis of dysarthria in children

Before making a formulation of such a diagnosis as a dysarthria speech, specialists are focused, first of all, indicators indicating a certain level of development of motor skills of a child, its functional features of the psyche and speech apparatus.

Coverage and accounting above the listed indicators allows specialists to adequately evaluate the total clinical picture and reveal disorders and deviations in the central nervous system of the child.

In the period from a newborn with the transition to infancy, three main phases of the development of psychomotor activity are distinguished:

The generally accepted information about the phased formation of the central nervous system and the Baby PPF allow specialists to identify in a timely manner.

Crying a child with organic lesions of the central nervous system and brain differ efficiently from crying a healthy child, and is accompanied by the following signs:

weakness;
short-term;
uniformity, without intonation and bells;
without a pronounced reason;
suddenness.

Symptoms of dysarthria include such signs that are manifested in the breastfeeding process:

sluggish sucking;
incomplete capture of the nipple;
milk flows out of the oral cavity;
milk flows out of the sinuses;
chilling.

Violation is accompanied by enhanced and stable search for proper articulation. So, the speech of the patient in the search is constantly interrupted, breaking the smoothness of speech. Sometimes such searches are replaced by the type of stuttering. Total speech picture:

lubricated;
dissected;
intense.

In turn, 2 subtype of afferent dysarthria distinguishes in neurophysiology according to classification:

Partares of articulation muscles. There is a disorder of the movement of the tip of the tongue, which violates the pronunciation of "F", "W", "P", with complex violations - "C", "Z", "L". It is not remembered and is not held in engine memory; one or another position of the language. In such situations, articulation movements are performed only with visual control, in its absence, patients are trying to perform such a movement with the help of hands, namely, their hands are torn, sent, lowered and raise it.
Articulative. There is an increased tone of the muscle tip of the tongue, so the pronunciation of only front-speaking sounds is disturbed. Often in the speech of the patient you can hear the difficulties of transition from one sound to another.

Establishing diagnosis

The survey in the dysarthria is carried out mainly by a neurologist, while the conclusion of the speech therapist and the flaw detection is taken into account.

Before you diagnose, the age and physiological features of the child are taken into account. The conclusion of the neuropathologist is based on the history of the mother, the paintings of the pregnancy and the presence of affected areas of the brain.

The peculiarities of the impaired articulation apparatus, the state of speech and mimic muscles, the nature of respiratory flow and its volume are investigated. To form an accurate diagnosis, hardware diagnostics are carried out, namely, electromyography.

The speech therapist is building an opinion on the basis of rhythm, the tempo of the child's speech. Assesses the clarity of the pronunciation of sounds, as well as the synchronization of the voice formation.

The defectologist assesses the lexical system of the child's speech and phonderatic perception.

Basic methods of speech development correction

Preventive and therapy begins after deep diagnosis. The timely implementation of diagnosis and treatment will eliminate the adverse development of the child's psychomotor.

A corrective program for children with dysarthria is drawn up on the basis of the results obtained through a comprehensive examination.

The main correctional method for dysarthria is a speech therapy massage, the purpose of which is the normalization of muscle the tone of the peripheral articulation apparatus.

For children with normal psychophysical development, as well as without pathological manifestations associated with the musculoskeletal system, which are diagnosed with dysarthria, self-massage technique is carried out.

For self-massage, a special speech therapy brush is used, which is put on an index finger of a child. With this massager, the child is proposed to make several exercises:

stroking cheeks, tongue, sky and gums in all directions;
make circular movements with brush in the oral cavity.
hold the brush at the level of the lips at a distance of 2-3 cm and ask the child to reach the brush of the tongue;
try with a brush in the mouth to pronounce the words "Wat", "Vase", "Water".

Self-massage activate the motor and muscle sensitivity of the articulation apparatus. The muscles of the speech apparatus during the exercises are in the tone, which stabilizes the basic function of the speech apparatus - articulation.

How to make a speech therapy massage with dysarthria - master class with video:

Articulating gymnastics

Articulating gymnastics is appointed to children who, along with dysarthria, there are disruptions of small and large motility.

Correction is carried out using a specialist and includes the following exercises:

Passive massage hands - Stroking hands from the outer and inside, compressing-staining cams with resistance, quick movement from the tip to the base of the finger.
Active massage hands - patting a brush by the hand of a specialist, circular movements of the brush with a brush lead to the right, then to the left, alternate bending and extension of the fingers.
Language massage. To relax the muscles of the language, the specialist asks the child to turn the tongue, usually the language in children with dysarthria has high tensions, it has a large similarity with a lump. Specialist with a special spatula begins to pat on the tongue, under the influence of what language is relaxing for some time, softens. Such an exercise is repeated 3-4 times, the language of the language will not accept the rolling position. After several classes, this exercise is carried out on exposure and fixation of the relaxation of the language, lips, cheeks.

Stopping the sound "C" and "P" for dysarthria

Development of articulation motility

This technique is aimed at the activation of the muscles of the speech apparatus as a whole:

passive movements of the language - pulling the language forward, back, top, down;
circular movements in the lips clockwise and counterclockwise;
pulling lip into the tube, stretching lips into a smile;
stop lips under the sounds "A", "s", "u", "y";
chewing movements, open and close the mouth, swallowing saliva;
simultaneous and alternate cheek inflation.

Vibration gymnastics

This activation-oriented technique voice ligaments. For this, the child is asked to bring one hand to the larynx speech therapist, another to his larynx. A specialist longly pronounces the sound of "M" and asks the child to feel how the larynx specialist begins to vibrate, then asks the child to repeat the sound and fix the vibrations of his larynx.

Next, a series of exercises for short sounds is carried out, on intonation by vowel sounds, to increase and decrease the sound. Thanks to this technique, the child restores speech breathing, and the voices modulation is activated, the power of the sound.

Setting the right breathing

Respiratory development techniques are held in order to expand the ability of the breathing apparatus. Work on the development of speech respiration is due to the following exercises:

Formation of a long breath and exhalation through the mouth. Respiratory exercises are carried out by a specialist, indicating that a diaphragm-ripe breathing should be made to implement this exercise. Then the specialist helps the child to repeat the exercise.
Expansion of the physiological possibilities of the child for speech exhalation. This technique begins with the removal of voltage in the shoulder belt, then setting the press in the abdominal cavity and only then a series of smooth speech is organized. A short offer is selected, and it is proposed to repeat it in the process of one continuous exhalation.

Expansion of diaphragmal breathing

This technique is carried out in the lying position. At the first stage, the child needs to relax all the muscles. Then plug the game techniques:

Exercise "Inhale-exhaling". Any gaming activity is given, in the process of which a deep breath should be taken and a long exhalation.
Exercise "Repeat Melody". This technique should also be carried out in a game form. For this, it is necessary with the help of vowels to develop at first the melodic characteristics of the voice of the child. Next teach to intonate, then form a vote. For example, in exhalation, the sound "A" is exhaled, the specialist needs to be monitored so that the sound is uttered continuously during the exhalation, as well as not to be accompanied by additional exhalations.
Vote You can form with the help of changing the height of the voice. For example, with sounds - "O", "A", "Y", "and" convey emotions, such as surprise, joy, regret, etc.

To prevent the development of dysarthria in a child, you need to pass inspections from a neuropathologist from the first days of the child's life.

Inspection of the specialist is very important even in cases where the child has no violations and brain lesions. For the development of dysarthria, it is sufficient if the pregnancy flows heavily or was observed frequent and stable toxicosis.

Timely appeal to specialists will help level or eliminate signs of violations in speech.

XII Couple - Podium-free nerve (p. Hypoglossus). The nerve is predominantly motor. Its composition goes sprigs from the pagan nerve that have sensitive fibers. The motor path consists of two neurons. The central neuron begins in the cells of the lower third of the presenter sinking. The fibers derived from these cells pass through the knee of the inner capsule, the bridge and the oblong brain, where they end in the core of the opposite side. The peripheral neuron originates from the nucleus of the sub-speaking nerve, which is in the oblong brain doorsally on both sides of the middle line, at the bottom of the diamondy yam. The fibers from the cells of this core are sent to the thickness of the oblong brain in the ventral direction and extend from the oblong brain between the pyramid and olive. The function of the approximate nerve is the innervation of muscles of the language itself and muscles moving the tongue forward and down, up and forth. Of all these muscles for clinical practice, it has a particular importance to the pebbing, which put forward and down and down. The XII nerve is related to the upper sympathetic node and the lower node of the wandering nerve.

Research methodology. The patient is suggested to launch the tongue in the kernel of the XII pairs are located cells from which fibers are innervating the circular muscle of the mouth. Therefore, with nuclear defeat of the XII couples, thinning, the folding of the lips arise, the whistle is impossible.

Symptoms of defeat. With damage to the kernel or fibers from it outgoing, there is peripheral paralysis or paresis of the corresponding half of the tongue. The muscle tone drops, the surface of the tongue becomes uneven, wrinkled. If the core cells suffer, fibrillary twitching appear .. When progressing, the tongue is deflected towards the affected muscle due to the fact that the chore-tongue muscle of the healthy side pushes the language forward and medial. With bilateral defeat of the sub-speaking nerve, paralysis of the language (Glos-Squeegee) is developing. At the same time, the language is fixed, the speech is ineffective (dysarthilation) or it becomes impossible (anarterium). It makes it difficult to form the formation and movement of the edible lump, which violates the food process.

It is very important to differentiate the central paralysis of the muscles of the language from the peripheral. The central paralysis of the muscles of the language occurs during the defeat of the cortical nuclear path. Under the central paralysis, the language deviates to the side opposite to the lesions. Usually, there are paresis (paralysis) of the muscles of the extremities, also opposite to the lesion. With peripheral paralysis, the language is deflected towards the focus of the defeat, there are atrophy of half of the language and fibrillar twitching in the event of a nuclear lesion.

The core of the facial nerve is in the rear sections of the bridge, on the border with the oblong brain. Axon envelopes the core of the discharge nerve, it comes out of the brain with the root in the region and a bridge corner with VUI. It is included in the canal of the temporal bone + xiii steam, there are 3 twigs, it comes out of the children to the odds, permeates the parole gland and innervates the face muscles. Ethiology: injuries, vascular (ischemic disorders of the facial nerve), tumorly composed. The clinic depends on localization. No sensitivity disorders. Facial nerve lesion clinic: as a result of peripheral paralysis (kernel lesion, fibers in the bridge or nerve trunk) stationary half of the face: The skin of the forehead is not going to the fold, the eye is not closed, the mouth of the mouth is lowered, the nasolabial fold is smoothed. Can not throw teeth, inflate cheeks, grind your eyes, frown eyebrows. Rogped and abrasion reflexes fall out, 1/2 facial mask, Lagofalm (when trying, not a closing holy eye), symptom of eyelashes (on the healthy side of the eyelashes are completely fastened in the horn eyelids, and on the amazed-and the tips are visible), Bell symptom (ch. Yab. Up), tear, smoothness of nasolabial fold on the side of the defeat.

the lesion of the nucleus is on the side of the lesion of the Parameres of the face, the limbs of the opposite side of the opposite side - alternating hemiplegia "(paralysis of Miyar-Gubler) + County squint (paralysis of Fovillya), damage to the root - Parisses of the face, dizziness, rumor decline, shaky gait, athockey, nystagm. pyramidic - Bone bone -1 branch) Large rocky nerve, innervates the lacrimal gland - paralysis of the face, dry eye. 2 branch) innervates the swordless - hyperactus (improving sound perception) 3 branch) Chorda Tympani - innervates salivary glands, feel per 2/3 Language -Connection of taste Self-and, HyperSolyvation. Goose foot - Personal paresis, tearing. The central type of paralysis as a result of the loss of cortical nuclear ties: paralysis of the face muscles is limited to the lower half and combines with the hemiplegia. The eye closes completely and the forehead is molded well, but the front From this side, it fails and the mouth is thrown into a healthy side. It is treated well: elimination of the cause of the disease.

GCS (preliminarial 30-60 mg), for removing the Furymemide edema, thermal procedures.

XII Couple, P. Hypoglossus - Motor nerve. The core of Hypoglossi is located at the bottom of the diamondy pits, is located dorsally in the depth of Trigonum N. Hypoglossi, the tail of its department, it reaches the book to 1-1 of the cervical segment (Fig. 49, 50, see Plots; 51). The roots (number 10-15) come out between the pyramids and olives of the oblong brain (see Fig. 48) and merge into a common stem that comes out of the skull through Canalis Hypoglossi. N. Hypoglossus is a motion nerve. In case of damage, it develops peripheral paralysis or paresis of the corresponding half of the language with atrophy and thinning of the muscles (with damage to the nucleus, fibrillar twitching is also observed). When tonging the language, it is rejected by the end of his own in the direction of the affected muscle. This is because m. Genioglossus Healthy side, putting forward the tongue forward stronger, shifts the language towards weak half (Fig. 52). The one-sided lesion of the language (Hemiglossoplegia) does not cause notable violations of the functions, which is explained by the significant weave of muscle fibers of both half, i.e. The last time for the middle line on the other side. Bilateral defeat ^ zyku (glossloplegia) leads to a violation of speech, which ^ becomes an inadequate, insufficiently understandable, braid (dysarthris ^); In easy cases, it is possible to detect only when they pronounce it difficult to articulate words (for example, "serum from prokubvashi"). With full bilateral defeat of the language, it becomes impossible (anarterium); Language is fixed, can not be dried out of the mouth. It is clear that the process of food is sharply difficult. The food lump cannot be moved to the mouth for Zheva ^ ^ ^ move to the sip for swallowing.

With the same in the same picture of the peripheral paralysis, resulting from damage to the kernel, root or nerve, the lesion level is usually possible to set more accurately. For chronic progressive processes in the core itself, fibrillar twitching has already been said. In addition, at the nuclear point of the XII nerve simultaneously affects (isolated from the rest of the front muscles) m. Orbicularis Oris (thinning, folding lips, impossibility of whistle). This circumstance may be allegedly explained by the fact that motor fibers for the circular muscle of the mouth, going to the periphery as part of the facial nerve, begin with cells located in the nucleus of the Hypoglossi nucleus, and suffer in the event of a defeat. Finally, with the defeat of a more peripheral department of the nerve itself, after exiting it from the skull cavity, the lesion of muscles fixing the larynges can be attached to the tongue atrophy, inner-visible to the upper cervical nerves, anastomosing with p. Hypoglossus. When swallowing in this case, the shift of the larynx to the side is noticeable.

№31 scarm sclerosis.

Scattered sclerosis. Demyelinizing disease, Har-Xia Multi-profit lesions, a remote course with steady progression, demyelinization with the preservation of neurons, are affected by the people of young age (16-18-40 years), a pivotalized disease, a prevalence of 2-70 per 100,000 Nordic oblasts, in the south seldom. Causes: 1) An autoimmune process, latent viral info (measles, ospa, steaming, simple herpes-translation viruses (the titer A / t increases. Septic impact of several viruses leads to the debut of the disease-ia. Slow infrared ns (multiple sclerosis (Virus latently exists in Org-E (integrated forms of the genome of the virus and class and person (manifestation of h / s for a long time (Clinic incubation periods). 2) the state of im-sis-y - a - genetically defective (violation of the coding of the Ig chain). 3) ECOTAKTS, geographical. Pathogenesis: Virus (Trigger mechanism, launches the process) Embeding into the cells and Oligodendrogelia Mielina shell, forms compounds with it in it against them begin to be produced by a / t (A / M-A / T. Melina (destruction, destruction, myelin proliferation , vascular pro-e (formation of I plaques of multiple sclerosis (fresh-eye-reading while maintaining axial cylinders, edema, stas, infiltrate, (scarring (old plaques - scars, MB full recovery Melina and then symptoms disappear). M remain old, new appears - constantly

; Progressive process. Clinic: diverse (multicagitality) in children rarely. Begin with

of other disorders (transient blindness, blurredness)

pat-ia cerebellum (plow, trembling)

disappearance of abdominal ref-ssmid disorders

(stiffness in the legs, high Ref-s in the legs, pat-ie signs, clonical) violation in SIS-E

urination (delay, for accomplishment, effort is required, imperative urge)

zMOT disorders (Euphoria, Pat-aya Funity, MB Depression)

safety disorders (numb)

vegetative endocrine disorders (potency violation, menstrual cycle). Classification forms:

the derekropinal (head and spinal cord) is all spinal shape, more often at the breast level (lower spastic parapaperse, no abdominal Ref-s, stiffness in the legs, a violation of the FUI-AI pelvic organs) cerebral shape: cerebelchikovskaya (pity, intentional jitter, chant speech , violation of the handwriting, nistagm) optical (reduction, disappearance of vision for some time, retrobulbar neuritis clinic) stem (clinic of lesion of chmn and conductive disorders in limbs) Cork (euphoria, mental disorders, epipridges, central paralysis) (from 2 to 40) Diagnostics: OAK (lymphocytosis-beyond,

lymphopenia - Reception)

increased aggregation of thrombocyte

MRI of the head and spinal cord (reveals foci of demyelinization)

CT, B. acute period Inflammatory changes in the liquor.

Auxiliary method - caused by potentials (hearing, visual) treatment: GKS to remove inflammation, neuromet. and vasoactive therapy.

fighting Demelinization (Reemerization)

Immunosuppression in exacerbation Glkzhocorticoid therapy - Metal PER OS Metal PER OS, pulserates - 3 days in 500-1000 mg of Metal Metalnisalone, h / s laziness in / 2-3 times (5-6 thousand mg per course) MB gastrointestinal bleeding | (Almagel), anaphylactic shock, fragility of bones, arrhythmia (preparations K +), Euphoria, joining secondary IIF-II. Plasmoforesis (removal of A / M-A / T) 5 procedures in the first 2 weeks, then 6 weeks of 1 procedure in the week of cytostatics are rare, because Many side effects, "Mmunomodulation during remission (warning the exacerbation) interferon (reduces the frequency of exacerbations by 30%) Bethefero Kapaxol (polypeptide 4 amino acids - \ false target (similar to Miyash), it is precipitated by a / t (myelin protection from a / t) ribepho stimulants - thymoline, thiactivin + hyperbaric oxygenation glycinotherapy (amino acids)

reducing the muscle tone (unclean, Poklafen): Correction of pelvic disorders (symptomatic therapy) 1 Retrobulbar neuritis. Retrobulber neuritis-eye-reading nerve-eye-eye nerve on a plot behind the eyeball to Hiazma. In children, young people. Etiology: Infra-Zabr-ia, sober-iah in the eye, orbit, sinuses.

The debut of multiple sclerosis depends on the Baby's im

We look at MRI, if the foci of demyelinization (we treat as sclerosis. Clinic: a decline in vision pain behind the eyeballs or when they are moving from several days to several (8) weeks. Restores eye disorder of color vision central skatema. Defeat is one-sided in the eye-free. , MB.

disc pale Treatment: ------ // -

GKS Retrobulbarno + V / B or Per OS)

№34 MIASTENATION

Morphology of muscles is a moderate degenerative atrophy and unaware lymphocytic infiltration with plasmaragia phenomena. Pathogenesis: Miasthenic symptoms occur in the berar poisoning - the collection of anticholinesterase means (prozerne). The essence of the miasthenic defect in the conduction disorders at the level of neuromuscular synapse, because For the synoptic communication of m / in nerve fibers and muscle, acetylcholine is needed, the blockade of acetylcholine synthesis (insufficiency of its stock is necessary. In addition, there is a / t to mosin in the serum and to the actomyosine complex, which indicates a change immune status. Most likely, these changes are due to the pathology of the fork gland. Clinic: The disease begins after infection, injury, operations during pregnancy. Development can be gradual or sudden. Women are more often sick of 20-30 years, sometimes the disease begins in children and old age. Remissions are possible up to several years. The main symptom is weakness and pathological fatigue muscles, characterized by the selective lesion of individual muscle groups. This is more often muscular groups innervated by eye-minded nerves, a boulevard group of nerves. There may be weakness in the muscles of the neck, torso, limbs. May be generalized forms. Patients in the morning feel cheerful, after a few hours the condition deteriorates - they descend the eyelids, the cooler in the eyes, less pickup and quiet speech, weakens the mimic muscles, the patient cannot chew food, the swallowing is disturbed. Greater weakness increases. Muscle tone, even with a common condition, unchanged. Temor and skin reflexes do not oppress. The function of the pelvic organs is not changed. Sensitivity does not suffer. With long-term disease, muscle atrophy may develop. The condition is improving after rest. A special danger represents a violation of the function of the respiratory muscles. In case of exacerbation of the disease (miasthenic crisis), if the patient is not timely assistance, it can die from asphyxia. The occurrence of a miasthenic crisis is caused by the infection of respiratory tract, physical overwork, drugs (chinin, coarara, aminazine), pregnancy, without reasons.

Creery treatment: Prezero 0.05-1 ml 0.05% in / in (prozerne p / k, oxazl in candles

Diagnostics: clinic, sample with prozero (p / k 1-2 ml 0.05% prozergen - improvement of the state of C / s 20-30 min.), Miasthenic reaction (decrease and damping of muscle response during repeated.

№26 Tumor Gol.m.

Malignant tumors: speedgrowth is high, the maturity of the cell elements is small, the character of the growth of Nnoflitrian. Metastasis. (Primary tumors beyond the limits of NA are not metastasized, because BCB; Likvorny spaces (immature radon cells with ventricles, but a small percentage) tumors: benign and segregative.

Clinic (diffuse goals, nausea, vomiting in the morning hours - p. Vagus, violated venous outflow - pain orbits, transfers, heads) Bruns crises (in the ventricle movable) difficulty Facvore outflow - an increase in the PCF - forced head position, sharp goal ., nausea, vomiting when plugging Melengial; impata in the form of voltage of the 1thyl muscles and a symptom of Kerniga. The squint is somewhat bilateral. Objectively (ophtop bottom - stagnant disc of optic nerve, decompensation, atrophy, x-ray -; Other changes, diffuse tsugostening of the bones of the arch, recess 1mok, bone resorption, uneven resorption (finger pressure). New ways of blood outflow are supplied. Expansion of venous graduates, channel expansion DNPloetical EN (strengthening of the venous pattern. The tumors of the frontal share - psyche disorder, patients with apathetic, uninimal, the memory is worsened, thinking is disturbed, non-critical, flat jokes, ridiculous actions, frontal ataxia, grabbing reflex, bilateral anosmna. Not violated. Symptoms of the tumor of the temporal share --vestibular disorders. Feeling instability, rotation of surrounding items, dizziness. Bright hearing, visual, olfactory and flavoring. Memorization disorder. If the tumor is in hypocampis, the tumor of the left temporal share is sensory aphasia.

tumor of the occipital shadow-agemianopsy, visual agnosia, at left-sided - Alexy, tumors of subcortical nodes - long time Asymptomatic, hypercines, hemipreps, hemipilegia, hemipsyopsy flow.

tumors of the brain barrel (bridge and long brain - spastic and tetrapreza, the defeat of the CHMN, the bulbar paralysis) of the epiphyse tumor - in children a picture of "brief sexual yawning.

Adenoma pituitary - BIMPMEROAL hemianopsy and primary atrophy of the visual nerves at the expense of a compression .. Osteoporosis of the backrest of the Turkish saddle, the extension of the entrance, the seat recess. Clinically-endocrine disorders with a violation of exchange, sledding of 3 ventricle Insecual diabetes, bulimia focal symptoms) Secondary vascular disorders at distance and dislocation, mixed fabric (stem syndrome, causes of death with a dislocation tumor and secondary stem syndrome

Lumbal puncture with a tumor goal is contraindicated. (o. infection), the threat of dislocation.

Angiography with vascular tumor, germination of the vessel tumor

CT, MRI. Tumor tissue density is more than surrounding fabric.

If doubt the contrast

Therapeutic tactics: Hir-th way. The radiation and cheeotherapy is not independently held.

The MB pituitary tumor is treated with radiation therapy.

Low-differentiated Zlokach. Tumor - chimotherapy, kindly. -

Surgical (culinary and crimeotherapy resistant).

№20 hypotalaxual syndromes

The hypothalamic syndrome is a combination of vegetative, endocrine, exchange and trophic disorders caused by the defeat of the hypothalamus. The indispensable component of the hypothalamic syndrome is neurosundochen disorders.

Etiology. The causes of the hypothalamic syndrome may be acute and chronic neuroinfection, cranial and brain injury, acute and chronic intoxication, brain tumors, brainwater failure, mental injury, endocrine disorders and chronic diseases of internal organs.

Clinical manifestations. Most often, the lesion of the hypothalamus is manifested by vegetally represented neuroendocrine disorders, disorders of thermoregulation, sleep disorders and wakefulness. Patients have a common weakness, increased fatigue, pain in the heart of the heart, a sense of air shortness, an unstable stool. During the examination, the increase in tendon and periods of other reflexes, asymmetry arterial pressure, His oscillations with inclination to increase, tachycardia, pulse lability, increased sweating, tremor of the eyelids and fingers of elongated hands, tendency to allergic reactions, expressed dermographism, emotional disorders (anxiety, fear), sleep disorder.

Against the background of permanent vegetative disorders arise vegetiovascular paroxysms (crises). We usually provoke emotional stress, changing weather conditions, menstruation, pain factors. The attacks arise more often in the afternoon or at night, come across without harbing. The duration of the attack from 15 -20 mne to 2 -3 h or more. Crimzes can be sympatheadar, vaginsular and mixed. Disorders of thermoregulation more often occur during the defeat of the front of the hypothalamus. It is characterized by a long subfebrile body temperature with a periodic increase of it up to 38 to 40 "C in the form of hyperthermic crises. The blood does not detect changes characteristic of inflammatory processes. The use of amidopyrin in such patients does not reduce temperature. Thermoregulation disorders are dependent on emotional and physical disorders. Voltage. So, in children, they often appear during school classes and disappear during the holidays. Patients poorly carry sharp changes in weather, cold, drafts, there are emotional and personal disorders, mainly a hypochondriac type. Neuroendocrine disorders develop against the background of vegetative violations, Violations of fatty, carbohydrate, protein, water-salt metabolism occur, bulimia or anorexia, thirst, sexy disorders are noted. Neuroesevroperative exchange ENNSHYUGLG Yatsenko-Buching, adiposogenital dystrophy of Freilich - Babinsky (Veinelene, hypogenitalism), snatchy (cachexia, Depression), inexpensive diabetes (polyuria, polydipsy, low relative density of urine). There are signs of hypo-or hyperthyroidism, climax early.

For hypothalamic disorders is characteristic chronic flow With inclination to exacerbations. When recognizing hypothalamic syndrome, it is necessary to determine its etiology and a leading component. Matter the results of special samples (sugar curve, sample in winter). Thermometry at three points, electroencephalography of the hypothalamic syndrome should be differentiated from feochromocytoma (tumor of chromaffine tissue tissue), the main feature of which are paroxysmal blood pressure lifts to high digits on the background of constant arterial hypertension; In the urine, especially during attacks, the high content of catecholanns is found. To clarify the diagnosis, it is necessary to conduct an ultrasound, computed tomography of adrenal glands. Treatment. Treatment should include: i) Funds selectively influencing, on the condition of sympathetic and parasympathetic tone, - Beloid (Bellapp), adrenolics (pyrroxyan), beta-adrenolisters (indisted), cholinolitics (platoophylin, beautician drugs), gangliplays; 2) Psychotropic drugs - antidepressants (amitriptyline, prozak, Lerivon), Anxiolitics (Ksanaks, clonazepam); 3) Loculants (vitamins C, group B, metabolic preparations), 4) drugs for the treatment of the underlying disease (absorbing,

anti-inflammatory means), for carrying disinfecting therapy, hemodez, glucose, isotonic sodium chloride solution).

№25 Meningit

inflammation of the shells of the head and spinal cord. Lepomingitis is distinguished - inflammation of soft and web cerebral shells and phakimenyngitis-inflammation of a solid cerebral shell. In the clinic under Terelic "Meningit", the inflammation of soft brain shells is usually nowhere. Meningitis is distributed in various climatic zones. Meningitis causative agents can be a variety of pathogenic microorganisms. Viruses. Bacteria and simplest.

Classification. By the nature of the inflammatory process in brain shells And changes in the cerebrospinal fluid distinguishes serous and purulent meningitis. In serous meningitis atcerebrospinal fluid predominate lymphocytes, with purulent - advantage tweyoneetrofilnce Pleasytosis. The pathogenesis distinguishes feathers and secondary meningitis. Primary meningitis develops without prior increasing infection or nfectoic disease of the body of the body, the secondary is the complication of general or local infectious disease. The localization of the process is generalized and limited meningitis, on the basis of the brain -Basal, on the convex surface -Conxetal, depending on the developed and the investment, separating, the vulnerable LNMPocytic choriomeninthythitis caused by the Echo enteroviro and the cokes, epidemic vapotitis, etc.), fungal (candidoid. Dr.) and protooye meningitis. Newborn meningitis is more often caused by streptococci Group B, Escherichia xyiat the age of 1 year - Haemophilias Influenzae, have more older children and adolescents ■ Meningokokok, and the elderly teages - streptococcus pneumonia (Streptococcus Pneumonia).

Pathogenesis. There are three ways of infection of meningeal zbolochech: 1) contact propagation with a sheepdiered cranial brain and well-spinal injuries, in fractures and cracks of the base of the skull, accompanied by liquor; 2) perinancial and lymphogenic distribution of pathogens on meningeal shells with an existing purulent infection of the appropriate sinuses, the middle ear or the predominal "process, eyeball, etc.; 3) hematogenous distribution; sometimes meningitis is the main or one of the manifestations of bacteremia. Entrance gate Infections in meningitis are the mucous membrane of the nasopharynx, the bronchi, the gastrointestinal tract with the occurrence of naphorgites, angina, bronchitis, gastrointestinal disorders and the subsequent hematogenic or lymphogenic spread of the pathogen and getting it into brain shells. Pathogenetic mechanisms include inflammation and stack of brain shells and Often adjacent brain tissue, discirculation in brain and shell vessels, a hypersecine of the cerebrospinal fluid and the delay in its resorption, which leads to the development of brain water and an increase in intracranial pressure, the irritation of the brain shells and the roots of the cranial and spinal nerves, and Also the overall impact of intoxication.

Patomorphology, with acute purulent meningitis, brain shells are infected directly or through blood flow. The bistro infection and diffusely spreads throughout the subarachnoid space of the head and spinal cord. Subarachnoid space is filled with green-yellow purulent exudate, which can cover the whole brain or is located only in its furrows. With local infection of shells, purulent inflammation may be limited. There is a swelling of shells and brain substances. Cork veins are filled with blood. Brainmeas are constructed due to internal hydrocephalius. Microscopically, inflammatory infiltration is revealed in soft brain shears, initial stage It is entirely consisting of polymorphic nuclear, and then lymphocytes and plasma cells are detected. In hemispheres, changes are small, with the exception of perivascular body infiltration. The internal hydrocephalus is most often due to the inflammatory adhesion of the cerebelchikovo-brain cyster, which prevents the outflow of the cerebrospinal fluid. In serous viral meningitis, there are a father of the shells and matter of the brain, the expansion of likvarny spaces.

No. Contractures - The resistant tonic voltage of the soys, extinguishing the restriction of movements in the joint. Distinguished in the form of flexing, extension, pronatory; on localization -Contracting brushes, foot; Monoparaplegal, three and quadriplegic; According to the method of manifestation, resistant and non-permanent in the form of tonic spasms, by the term of the path after the development of the pathol. Process - Early and Late; due to patient-east-reflex, antalgic; Depending on the defeat of various departments of Nevne. Break-pyramid (hemiplegal), extrapyramid.,: spinal baraplegal), meningial, during the defeat of the periphe. nerves. For example of the facial earlier contracture-Gamesonia. Character-Cya periodic tonic spasms in all limbs, manifestation of pronounced protective reflexes, dependence on NNTero and exteroceptive irritations. Late hemiplegic contracture (Vernika-Mann's posture) - Exercise the shoulder to the body, bending forearm, bending and pronation of the brush, the extension of the hips, shin and the sole flexion of the foot; When walking, the foot describes the semicircle. Semiotics DVNNT-X. Disorders. Having revealed on the basis of a study of the volume of active movements and their strength, the presence of paralysis or a pan, due to the disease nerve, system, determine Har-EP: due to the lesion of the central or periphy. Motor neurons. ; Central-Paul, paralysis or spacious, lesions of the center, motor rates at any level of the cortical and spin-out path. With damage to the periphe. Motonightons at any participation (front horn, root, plexus and periphe.ner) occurs. or sluggish paralysis. Center, Motioneron The Defeat of Motor Objects of Big Hemispheres or Pyramid Path leads to the termination of the transfer of all pulses to carry out arbitrary movements from this part of the cortex to the front corrosion horns as a result of the paralysis of the relevant sobs. This means that paralysis is internally sluggish. Reflex will recover days and weeks. When this happens, muscle fibers will become more sensitive to stretching than before. This manifests itself in the arm folders and leg extensors. The hypersensitivity of the stretch receptor is caused by damage to the extrapyramidal paths, which end in the cells of the front horns and activate the gamma-motoneurons, innervant intraphus muscle fibers. As a result, the impulse is changed along the feedback rings, which regulates the length of the sovereign, consequently, the hand flexors n leg extensors turn out to be fixed as soon as possible (the position of the minimum. Length). The patient loses the ability to arbitrarily slow down the hyperreactive saccastic paralysis always testifies to damage. CNS, i.e. head or spin brain. The result is the loss of the most subtle arbitrary movements (in the hands, fingers, on the face). Symptoms:]) reduced strength with loss of thin movements; 2) spastic increase in tone (hypertonus); 3) improving proprioipersive reflexes with or without clonus; 4) reduced or loss of exteroceptive reflexes (abdominal, cremaster, solebed); 5) the appearance of pathol. Reflexes (Babinsky, Rossolimo et al.); b) sewn reflexes; 7) Patol. Summer movements; $) no rebirth reaction. Symptoms depends on the localization of the lesion in the central motor neuron. With the defeat of the presenter sinking - focal epileps. Sigging (Jackson epilepsy) in the form of clonic seizures and central paresis (or paralysis) limbs on the propheter side. Paler feet points to the defeat of the upper third of the amusing, the hands of the middle third, half of the face and the tongue - her lower third. In diagnosis, it is important to determine where clonic convulsions begin. Causes, starting in one limb, are moving to other sections of the same half of the body, that is, it goes in the order of the centers in a presenter urinet. Subcorcultive (radiant crown) defeat, contralateful hemiparesis in hand or leg depends on the location of the focus: if the hand suffers to the lower half, to the upper leg. Defection Inta. Capsules: conveyance hemiplegia. The defeat of the pyramidal path causes the cintractric paralysis, first sluggish, because the defeat has a shock-like action on the periphy. neurons, it becomes a spastic chi.a few hours or days. Defeating the cerebral barrel (the leg of the brain, the brain bridge, the oblongable brain) is accompanied by the defeat of the cranial nerves on the side of the hearth and hemiphels on the opposite. If the patient is in a comatose state, produce a symptom of the rotated bed of the foot. On the side of the opposite focus of the lesion, the stop is turned the dust. We make the maximum turn of the stop of the bed - the symptom of Bogolepov. On the healthy side of the stop immediately returns to its original position, and on the side of the lesion remains turned the dinner. Perep.Motoneron. Damage can capture the front horns, front roots, periphe. nerves. In the affected muscles, neither arbitrary or reflex actual actual is detected. Muscles are hypotonic, areflexia. Several ") weeks - atrophy, and rebirth of paralyzed satellites. With the defeat of the front horns, muscles suffer, innervated from this segment. Front horns can be involved in the pathol. Process with acute polio, lateral amyotrophic sclerosis, spinal muscular atrophy, siringomyelia, hematomyeli, Melitis, violation of blood supply. spinal cord. The paralysis of the root Har-Ra is developing when there are damaged of several coqueened roots. The defeat of many peripheuses leads to common sensitive! Motor and vegetative disorders, in distal separation limbs, bilateral. Patients complain of paresthesia and pain. Sensitive violations of the type "socks or" gloves ", sluggish muscle parasites with atrophy, trophic skin lesions. Polyneurite or polyneuropathy, arising from intoxication (lead. TIF), MTN Ceremony's legs. A neighbor. Mosgery with medium brains. Middle-moving into the bridge, NNJ. Cerebellum with an oblong, brain.

Three parts of the cerebellum are isolated: 1) Archchabellum (Klochkovo-nodal zone) - The ancient part of the cerebellum consists of a nodal and a shirt of the worm; associated with the vestibular system; 2) Paleocebellum (old cerebellum consists of anterior lobe, just a bow and The back of the body of the cerebells afferent fibers in Paleoz. Compared from the dorsal and (sensorcinal circumference of the crust. Hemispheres; 3) Neocebellum (new formation of the brain.) Consists of worm and hemispheres, thin movements (skillful) are coordinated by neocebellum. The cerebellum receives sensitive information from various CNS Division. Associated with all the movements, because the kernels serve effectary formations in regulating feedback rings. Ere. Coordination of motion regulation of muscle tone. Archored. Gets information about the spatial position of the head from the vestibular system and the movements of the head from the receptors of semicircular channels. Those of the cerebelochek modulates the spinomy Motor pulses, which ensures that equilibrium maintenance does not depend on the position or body movements, damage to the Klochkovo-nodal zone leads to a violation of equilibrium and instability during standing (Astasia) and walking (abasion). The cerebellar attacksia is the repetition of the inability of the muscular troupe to the coordinated action (Asinigria) Paleocebellum receives afferent impulses from the spinal cord h \\ e front and rear spinal clook and from an additional wedge-shaped core of the C-Wedge-sharewing path. The pulses modulate the activity of anti-gravity muscles of H provide a tone for straightime directing. The combined effect of Paleoz. And the archite provides control of the skeletal muscle tone and the thin, synergistic coordination of agonists and anthonists, and as a result is normal! Static and gait. There are dynamic attacks (when performing arbitrary movement "limbs, especially the upper), static (violation of equilibrium in the standing position and sitting) and static-locomotive (standing and walking disorders). The cerebulic ataxia is developing with a stored deep sensitivity and manifests itself in a dynamic and static form. . Samples for detecting dynams, ataxia, palpanish, heel-knee, finger-finger. Samples for static. AtaTsia: Har-but breach of the gait ■ The patient goes widely puts the legs, "walking drunk", can not stand. Romberg's trial. Samples on Identification of dysmetry (disproportion of motion) n hyperthyres, with dysmetry movement excessive, stops too late, performs intermittently, with unnecessary speed. Example: the patient cannot in advance to spread the fingers according to the volume of the item offered. Then the small volume is offered and closes Pour them than required. Patient offered to stretch hands forward palm Yami up, then rotate hands down the palms down. On the affected side, the patient made the movement slower and with excessive rotation. If the movement is carried out in a larger volume, then it is hypertery. Example: with the age-knee. The patient puts the foot on the goal.

Lumbago (sharp) - suddenly arising acute pain (More often at the moment of physical stress), having a clear localization in the lumbar-sacral region. The patient in these cases can not move. At the first manifestations of the pathological process, Lumbago can be relocated independently after a few minutes. Sometimes lumbosacious pain without irradiation is poorly expressed and pass almost unnoticed. Characteristic clinical symptoms in Lyumbago and Lumbalgia are the smoothness of the lumbar lordosis or the appearance of the so-called reflex cyfosis, the symptom of the triangle of the plot muscle (the symptom of Levingleston), which is characterized by its voltage, the sensation of the strut, turning into dull pain, as well as the symptom of the square muscle of the lower back (Syptom of Salia and Williams), resembling a symptom of Levingstone, combined with an additional enhancement of pain and the inability because of this deeply breathe. Movements in the lumbar spine are limited (there is a blocking of one or several motor segments between the vertebrae). The pain is enhanced when the vertebrals are pressing on the spinish processes and in paravertebral points, as a rule, at the level of disk damage. Less often meet other reflex syndromes. Thus, with a vegetative-irritative syndrome, pain is localized in muscles, bones and joints related to the appropriate sclero- and miotomas, in combination with the impaired heat product, vasoconstriction, etc. Sometimes when O. observed the convulsive syndrome of the calf muscle (type Krampi), inter-part syndrome Bonds and bostrupp syndrome (inter-satellite neoarthritis). In the latter case, painful nature in the damage zone becomes more intense when extending and transferring weights, lumbar lumbays is often enhanced. Other clinical variants of the syndromes of this group are also possible, for example, sacrolling symployment-ilemitrithic syndrome, chronic perigonarttro (neurosteofibrosis of the knee joint region or its own case - a pond syndrome), a tipped liga syndrome (neurosteofibrosis of its attachment places), a small-terchanone nerve channel syndrome (often accompanied by The secondary non-bubbling part of the perontal muscle group), the syndrome of the neurotrophic peripotosis of the ridge of tibia is characterized by sclerotomic pains in the tibia, increasing at night.

35. Neuropathy of the main nestors of the lower limbs The defeat goes at the level of the head of a small bone. Compression arises with the wrong position of the limb (those who like to sit on foot) ■ Pathogenetic factors of Yavl-Sah. Diabetes, disproteinemia, vasculitis, etc. Clinic: The weakness of the back of the foot, weakens the turn of the foot of the bed, numbness of the outside of the legs and foot. Patients walk spanking stop. The sensitivity is reduced in the outer region. The surface of the leg and foot, the weakness of bending the foot and fingers. If the nerve is damaged behind the internice and on the foot in the zone of the preformed channel - pain, tingling along the sole and the base of the fingers of the foot, numbness atthis oblast. With the damage to the medial branch of the plantar nerve - not pleasant sensations in the medial part of the foot, with the lateral branch - by the side surface of the foot. Research is possible in the medial or outer surface of the foot. Sedal nerve can be squeezed with a spashed pear muscle. The pain burning, strong, is associated with paresthesides, apply to the outer surface of the leg and foot. Harm, the strengthening of pain at the inner rotation of the thigh, with his leg bent in the hip and knee joints. When palpation, pain is enhanced. The neuropathy of the femoral nerve is due to the detour in the place of exit in the region of the groove bundle. Patients complain of pain in the groin, irradizing the apparent surface of the thigh and lower legs. Due to sensitive and motor disorders, it comes to numbness of the skin on an innervorate plot and hypotrophy, s \\ m atrophy of the four-headed muscles of the thigh,

Treatment: In the absence of an effect on physiotherapeutic treatment, blockade, local administration of hormones ^, indications arise for the chirome decompression of the compressed nerve.

24. 50% - Nizhnemoid disks are affected by the bowl. Compression 30-40%, but begins with reflex syndromes. The radius of the disks in the lumbar department increases (L1-L II 1: 2). Anomalies: transitional vertebrae, anomalies of the articular tropism, the absence of arcs, can occur spondnollisase (the displacement of one vertebrae relative to the other).

Reflex syndromes are sharp ools, there may be subacute or chronic pear muscle syndrome (version of the tunnel syndrome). Compression monoDicular: m \\ b Construction tails compression toemergency operations - Bolt, broken. Functions of pelvic organs. Fur compression syndrome (L 5, S 1) -bol in the back surface of the hip, 1 finger of the foot, the symptom of the weakness of rebeling 1 of the foot. Diagnostics; Changes in the volume of active and passive movements, deformity of the spine, vegetative rs. Required: RG b Spidrop and side projections, functional pictures-hypermobility in the position of bending and extension - change of physiologist. Flexions (smoothness of the cervical and lumbar lurosis, scoliosis). It is possible to use myelography - defect filling (hernia). Axial computed tomography of NMR in several premixes.

Treatment 1) Unloading of the spinal sensation - blockades, orthopedics, physiotherapy, manual therapy. 2) surgical. Absolute readings - compression up to 6 hours, myelogrify block. Relative - compression in the lack of effect from conservative treatment in Th. 2-3 carrying; Unstable, compression bone structures. 2 approaches; Rear access (minimum intervention under the control of vision). or front access (the body of the vertebra is removed, is replaced by a transparent).