Cerebrovascular disease

The defeat of the cerebellum is a symptomatic complex of pathological conditions caused by damage to its or the membranes of the brain of the posterior cranial fossa (trauma, infarcts, swelling, leptomeningitis).

[1], [2], [3], [4], [5], [6], [7],

Causes of the cerebellar lesions

Of all tumoral formations of the brain, both benign and malignant processes, the defeat of the cerebellum is most often observed. Strokes and traumatic hemorrhages also most often damage the basal part of the brain (trauma is characterized by a mechanism of direct impact on the occiput). For inflammatory pathology, the transitions of the otogenic process, especially in mastoiditis, are characteristic of the posterior cranial fossa.

Structure of the cerebellum

The cerebellum is located in the posterior cranial fossa above the medulla oblongata and the brain bridge. From above, it is separated from the occipital lobes of the cerebral hemispheres by a cerebellum inscription. The surface of the cerebellar cortex is significantly enlarged by the deep parallel arcuate furrows that separate the cerebellum from the leaves. In the physiological plan, the ancient part (scrap and bundle), the old part (the worm) and the new part (hemisphere) are distinguished in the cerebellum.

In the white matter of the hemisphere and the cerebellum worm, there are several nuclei. The paired nucleus of the tent (nucl. Fastigii) is paramedically located, lateral from it are small islets of gray matter - the spherical nucleus (nucl. Globusus), even more laterally, going into the white matter of the hemisphere, the nucleated nucleus (nucl. Emboliformis). In the white matter of the hemisphere are the serrated nuclei (nucl. Dentatus).

The cerebellum has three pairs of legs. In the lower legs of the cerebellum pass the afferent (the posterior spinal-cerebellar path, from the upper nucleus of the vestibular nerve - the vestibulo-cerebellar tract, from the nuclei of the thin and wedge-shaped bundles - the bulbopoietic path, from the reticular formation - the reticulo-cerebellar path, from the lower olive tree - the olive- and efferent tracts (cerebellum-reticulo-spinal cord, cerebellum-vestibulo-spinal - through the lateral nucleus of the vestibular nerve, cerebellum-olivospinal), mainly associated with the structures of the cerebellar worm.

In the largest middle legs of the cerebellum pass the bridge fibers, which are part of the cortico-bridge path from the upper frontal gyrus and the lower parts of the occipital and temporal lobes to the cerebellar cortex. In the upper legs of the cerebellum pass an afferent path from the spinal cord (anterior spinal cord pathway) and a descending cerebellar-red-nuclear-spinal cord traveling from the dentate nucleus of the cerebellar hemispheres through the red nucleus to the anterior horn of the spinal cord.

[8], [9], [10]

Symptoms of the cerebellar lesions

The defeat of the cerebellum, or its conducting pathways, causes a rather pronounced symptom complex.

Ataxia is always at the forefront: a disturbance of the balance of the body at rest and walking (it swings like a drunk, especially twilight or darkness, the inability to perform simple orthostatic tests), static disturbances in walking; especially on uneven surfaces, steps, inclined planes, dynamic when performing involuntary movements, disproportionate movements (hypermetry); past-fall, adiadochokinesis (difficulty in alternating opposite movements), intentional tremor, nystagmus, speech disorder - chanted speech. The pathogenetic basis of all cerebellar manifestations is a violation of consistency in the actions of antagonist muscles (asynergy).

When a cerebellar worm is affected, synergies that stabilize the center of gravity are violated. As a result, balance is lost, trunk ataxia occurs, the patient can not stand (static ataxia); walks, widely arranging his legs, staggering, which is especially clearly seen with sharp turns. When walking, a deviation in the direction of the affected part of the cerebellum (homolateral) is observed.

When the hemispheres of the cerebellum are affected, ataxia of the extremities predominates, intentional trembling, misses, hypermetria (dynamic ataxia). Speech slowed down, chanted. Megalography (large with uneven handwriting letters) and diffuse hypotension of muscles are revealed.

In the pathological process of one hemisphere of the cerebellum, all these symptoms develop on the side of the lesion of the cerebellum (homolateral).

[11], [12]

Diagnostics of the cerebellar lesions

Samples that characterize the damage to the cerebellum and dynamic ataxia:

1. heel-knee (performed lying on his back with his eyes closed) - suggest lifting your leg and getting your heel in the patella (misses); hold on the front surface of the shin towards the heel (slides);
2. heel-fist - under the heel of the doctor puts his own fist and asks to raise his leg and again lower his fist (misses);
3. finger-nasal (with the fingers closed with the index finger at the swing of the hand to reach the tip of the nose - a slip);

1. finger-finger - first with the open, and then with the closed eyes offer the index finger, get another (with the eyes open it is easy, with the closed misses).

Samples that characterize the damage to the cerebellum and static ataxia (held standing, with eyes closed, but with absolute insurance by the doctor, in the event of a patient falling) - are aimed at identifying resistance (this group includes the whole complex of orthostatic tests):

1. with widely spread legs, staggering with a large inclination towards the affected part of the cerebellum is noted, it is especially pronounced when turning the trunk from side to side;
2. Romberg's posture - standing with his eyes closed (stops closed), stretches his arms forward - deflection or fall towards the affected hemisphere or in any direction in pathology (cerebellar worm); with a fuzzy picture, a sensibilization test of Romberg (or suggest putting one foot in front of the other or bending at the knee);
3. ataxia-abasia symptom - the patient can not move himself, but within the bed all active movements are preserved.

Samples that characterize the damage to the cerebellum and kinetic ataxia:

• tonic - decreased muscle tone (flabbiness, lethargy);
• walking - ask to go 2-3 m without support in a straight line: can not walk, when walking, moves legs forward, and the body lags behind, carries out intricate movements with the legs making the gait atypical;
• Magnus-Klein symptoms ("magnetic reaction")
  • with careful touching to the foot, sipping is observed along the whole limb;
  • in young children, when the head is turned to the side, the legs are bent in the knee or hip joints on the side to which the head is turned; on the opposite side, the limb, on the contrary, unbends;
• asynergic symptoms of Babinsky
  • standing offer to bend backwards, throwing back his head, - falls;
  • lying down offer to sit down - swinging and raising their legs, then jerks up;
  • sitting offer to stand on their feet - swings, then rises.

Other samples characterizing the defeat of the cerebellum:

1. synergistic - when looking up, there is no tipping of the head; with strong handshakes, there is no extension in the wrist joint, there is no wrinkling of the forehead;
2. aodio-docoquine - carry out pronation and supination of the hands simultaneously - on the side of the motion damage slowed down;
3. dismetric -
   • With extended forward and diluted fingers, the palms rotate sharply, excessive rotation on the side of the injury;
   • a symptom of Ozhekhovsky - the patient firmly leans on the palm of the doctor, with a sharp removal of the support, the patient leans forward (healthy, on the contrary, deviates back);
4. dysarthria - chanted speech with emphasis on each syllable;
5. Stewart-Holmes symptom - a person fixes a supine arm bent with the elbow joint, the doctor tries to unbend it and sharply removes the hand, the patient strikes his chest, as he can not slow down the movement of his hand;
6. symptom Tom-Zhumanti (grasping) - a man grabs an object, already at the beginning of grasping, he very widely opens his hand;
7. Tom's symptoms:
   • if you push a person standing sideways, it will cause a raising of the foot on the side of the impact and a fall in the opposite direction;
   • lying on the back of the patient several times bred and lead bent knees, then abruptly released - on the side of the lesion, the limb is involuntarily diverted;
   • in the standing position, the person should lean to the side; on the healthy side, the extensor's tone is raised and the leg is pulled to the opposite side, this does not happen on the side of the injury;
   • a person moves like a pill because of the rigidity of the muscles of the trunk, is noted when the worm is injured;
8. a symptom of Foix-Thevenar - with a slight push into the piles forward or backward the patient easily loses balance, in a healthy person the balance is maintained.

Examination of patients who have a cerebellum lesion should be performed in a neurosurgical hospital - with the involvement of a neurophysiologist, otoneurologist and ENT doctor, neuromuscular.

[13], [14], [15], [16], [17]