Alternating syndromes

Alternating syndromes (cross syndromes) - violation of the functions of cranial nerve on the side of the lesion in conjunction with the Central paralysis of limbs or provodnikovym disorder sensitivity on the opposite side of the body. Alternating syndromes occur when the brain (with vascular disease, cancer, inflammatory processes).
Depending on the location of the lesion possible, the following types of alternating syndromes. Paralysis of the oculomotor nerve on the side of the lesion and hemiplegia on the opposite side with the defeat of the leg of a cord (syndrome Weber). Paralysis of the oculomotor nerve on the side of destruction, hyperkineses and cerebellar symptoms on opposite side with the defeat of the Foundation of the leg of a cord (syndrome Claude). Paralysis of the oculomotor nerve on the side of the lesion intentsionnogo shake and horeoatetoidnye movement in limbs opposite side with the defeat of medial dorsal Department of the middle brain.
Paralysis peripheral facial nerve on the side of the lesion and spastic hemiplegia or hemiparesis on the opposite side (syndrome of Millar - Gubler) or paralysis peripheral facial and efferent nerves on the side of the lesion and hemiplegia on the opposite side (the syndrome Favilla); both syndrome - with the defeat of the bridge (saralieva). Defeat language-pharyngeal and vagus nerves, causing paralysis of the soft palate, the vocal cords, upset swallowing and others on the affected side and hemiplegia on the opposite side with the defeat of the side of the Department of the medulla oblongata (syndrome Avellana). Peripheral paralysis hypoglossal nerve on the side of the lesion and hemiplegia on the opposite side with the defeat of the medulla oblongata (syndrome Jackson). Blindness on the affected side and hemiplegia on the opposite side when hardening embolus or thrombus internal carotid artery (optical-hemiplegics syndrome); the lack of momentum to radiation and brachial arteries left and hemiplegia or hemianesthesia right with the defeat of the arc of the aorta (aortic-subclavicular-carotid syndrome Bogolepov).
Treatment of the underlying disease and symptoms of brain lesions: breathing, swallowing, heart activity. In the recovery period is used neostigmine, vitamins, exercise therapy, massage and activating other methods.

Alternating syndromes (lat. alternare - to reverse, rotate) - symptoms, characterized by a violation of the functions of the cranial nerves on the side of the lesion and the Central paralysis or paralysis of limbs or provodnikova disorders of sensitivity on the opposite side.
Alternating syndromes occur when lesions of the brain: the medulla oblongata (Fig. 1, 1, 2), bridge (Fig. 1,3,4) or the legs of the brain (Fig. 1, 5, C), and with the defeat of the cerebral hemispheres in the circulatory disorders in the system of the carotid arteries. More precise localization of process in the trunk is determined by the presence of lesions of craniocerebral nerves: paresis or paralysis occurs on the side of the hearth in the destruction of nuclei and roots, i.e. for peripheral type, and is accompanied by muscle atrophy, the reaction of degeneration in the study of elektrovozoremontnij. Hemiplegia or hemiparesis develop due to injury traumatic spinal (pyramid) paths in the vicinity of the affected cranial nerves. Hemianesthesia opposite the hearth of the limbs is a consequence of damage to the conductors of sensitivity that goes through the middle loop and Spino-thalamic way. Hemiplegia or hemiparesis appear on the opposite the hearth side because the pyramid is the way, and sensitive wires crossed below the lesions in the trunk.
Alternating syndromes are separated according to localization of a lesion in the brain stem to: a) bulbar (with the defeat of the medulla oblongata), b) podlinnye (with the defeat of the bridge)) peduncularis (with the defeat of the leg of a brain), g) extracerebral.
Bulbar alternating syndromes. Syndrome Jackson characterized by peripheral paralysis hypoglossal nerve on the side of defeat and hemiplegia or hemiparesis on the opposite side. Occurs when a thrombosis. spinalis ant. or its branches. Syndrome Avellana characterized by lesions of the IX and X nerve paralysis of the soft palate and the vocal cords side of the hearth and hemiplegia on the opposite side. See a swallowing disorder (ingress of liquid food in the nose, podergivani when eating), dysarthria, and dysphonia. The syndrome occurs when the defeat of twigs artery side holes of the medulla oblongata.
Syndrome Babinski - Nagata consists of cerebellar symptoms in the form of gematurii, genuinely, laterifolia (due to damage to the bottom cerebellar legs, olivocerebellar fibers), Misa or syndrome of Horner on the side of the hearth and hemiplegia and hemianesthesia at the opposite extremities. The syndrome occurs when the defeat of the vertebral artery (artery side of the pit, lower back cerebellar artery).

Fig. 1. Schematic of a typical localization of lesions in the brain, behind the emergence of alternating syndromes: 1 - syndrome Jackson; 2 - syndrome Zakharchenko Wallenberg; 3 - syndrome Millar - Gubler; 4 - syndrome Favilla; 5 - Weber syndrome; 6 - syndrome Benedict.

Syndrome Schmidt is the sum of the paralysis of the vocal cords, the soft palate, trapezoidal, Grupo-clavicle-liners muscles on the affected side (IX, X and XI nerves), and hemiparesis the opposite limb.
Syndrome Zakharchenko Wallenberg is characterized by paralysis of the soft palate and the vocal cords (defeat of wandering nerve), anesthesia, pharynx and larynx, disorders of sensitivity on the face (the defeat of the trigeminal nerve), accompanied by Horner syndrome, gematuria on the side of the hearth with the defeat of cerebellar ways, respiratory distress (with extensive focus on the elongated brain), in combination with hemiplegia, analgesia and thermoesthesia on the opposite side. The syndrome occurs when thrombosis of the lower back cerebellar artery.
Podlinnye alternating syndromes. The syndrome of Millar-Gubler consists of peripheral paralysis of the facial nerve on the side of the hearth and spastic hemiplegia on the opposite side. The syndrome Favilla is expressed by the paralysis of the facial and efferent nerves (in combination with the paralysis of the eye) on the side of the hearth and hemiplegia, and sometimes hemianesthesia (defeat secondary loops) opposite extremities. The syndrome may develop as a result of thrombosis main artery. Syndrome Reymond - Castana manifests itself in the form of paralysis combined movements of the eyeballs on the affected side, ataxia, and horeoatetoidnye movements, hemianesthesia and hemiparesis on the opposite side.
Peduncularis alternating syndromes. The Weber syndrome is characterized by paralysis of the oculomotor nerve on the side of the lesion and hemiplegia with the palsy of the muscles of the face and tongue (defeat kortiko-nuclear path) on the opposite side. The syndrome is caused by processes on the basis of the leg of a brain. Syndrome Benedict consists of paralysis oculomotor nerve on the side of defeat and choreoathetosis and interlinage shake the opposite extremities (the defeat of the red kernel and dentatorubral the way). The syndrome occurs when localization center in medial dorsal Department of middle brain (pyramid path is not affected). Syndrome Notnagel includes a triad of symptoms: cerebellar ataxia, paralysis oculomotor nerve disorder ear (unilateral or bilateral deafness Central origin). Sometimes there may be hyperkinesia (choreiform or athetoid), paresis or paralysis of the extremities, Central paralysis VII and XII nerves. The syndrome is caused by damage to the tires mid-brain.
Alternating syndromes typical for vnutrisustavnogo process can occur when the compression of the brain stem. So, Weber syndrome develops not only in pathological processes (bleeding, nutritiology tumor) in the midbrain, but the compression of the legs of the brain. Compression, dislocation syndrome is the compression of the legs of the brain that occurs when there is a tumor of the temporal lobe or pituitary region, can be manifested by the defeat of the oculomotor nerve (midriaz, ptosis, divergent strabismus and others) on the side compression and hemiplegia - on the contrary.
Sometimes alternating syndromes are manifested mainly cross-disorder sensitivity (Fig. 2, 1, 2). So, thrombosis of the lower back cerebellar arteries and arteries side holes can develop alternating sensitive syndrome Reymond, manifested anesthesia person (the defeat of a downward root of the trigeminal nerve and its kernel) on the side of the hearth and hemianesthesia - on the opposite (defeat average loops and spinothalamic the way). Alternating syndromes may occur in the cross hemiplegia, which is characterized by paralysis of the arms on one side and legs, on the other. Such alternating syndromes occur when the hearth in the area of intersection of the pyramidal tract, thrombosis spinobulbar arterioles.


Fig. 2. Scheme of hemianesthesia: 1 - dissociated hemianesthesia with the disorder sensitivity on both sides of the face (more on the side of the hearth), with the softening in the area of vascularization of the rear lower cerebellar artery; 2 - hemianesthesia with dislozierung disorder of pain and temperature sensation (syringomyelia type) with a limited focus softening in zalivnoe region.

Extracerebral alternating syndromes. Optical-hemiplegics syndrome (alternating hemiplegia, in conjunction with violations functions of the optic nerve) occurs when a blockage embolus or thrombus intracranial segment of the internal carotid artery, characterized by blindness as a result of blockage of the ophthalmic artery? the exhaust from internal carotid artery, and hemiplegia or hemiparesis opposite the hearth of limbs due to softening of the brain substance in the field of vascularization of the middle cerebral artery. Vertigonline syndrome when discirculative in the system subclavian artery (N. K. Bogolepov) is characterized by dizziness and noise in the ear as a result of discirculative in hearing artery on the side of the hearth, and on the opposite side - the side hemiparesis or hemiplegia due to disorders of blood circulation in the branches of the carotid artery. Estigma - hemiplegics syndrome (N. K. Bogolepov) reflex occurs at a pathology of extracerebral Department of the carotid artery (syndrome brachiocephalic trunk). However, on the occlusion brachiocephalic trunk and subclavian and carotid arteries no pulse on the carotid and radial artery, reduced blood pressure and observed facial muscles spasm, and on the opposite side - hemiplegia or side hemiparesis.
Learning the symptoms of craniocerebral nerves when alternating syndromes allows to determine the localization and the border of the hearth, i.e. a set of topical diagnosis. Study of the dynamics of symptoms allows to determine the nature of the pathological process. So, in ischaemic softening of the brain stem as a result of thrombosis of the branches of the vertebral arteries, primary or posterior cerebral artery alternating syndrome develops gradually, not accompanied by loss of consciousness, and the boundaries of the hearth correspond zone violated vascularization. Hemiplegia or hemiparesis are spastic. When bleeding in the trunk of alternating syndrome may be atypical, since the boundaries of the center does not correspond to the area of vascularization and increase due to the swelling and reactive phenomena in a circle hemorrhage. When acute emerging lesions in the Pons varolii alternating syndrome is usually combined with respiratory distress, vomiting, disorders of the heart and vascular tone, hemiplegia - with hypotonia as a result, deschisa.
The selection A. S. helps the Clinician when carrying out differential diagnosis for which is set the complex of symptoms. When A. S., caused by defeat of the great vessels, surgical treatment (trabantenstube, vascular plastic and others).