9.1. Brain stem

In classical leadership in neurology, the trunk of the brain (TRUNCUS CEREBRI) attributed all its departments other than the large hemispheres. In the book "Man's Brain" (1906) L.V. Blush (1861-1928) The brain barrel calls "All brain departments from visual bugs to an oblong brain inclusive." A.V. Triumphs (1897-1963) also wrote that "the brain barrel includes an oblong brain, Varoliev Bridge with a cerebellum, the legs of the brain with quadruses and visual bumps." However, in recent decades, the brain is only an oblong brain, the brain bridge and the middle brain. In the subsequent presentation, we will follow this, which has been widespread in practical neurology, definition.

The brain barrel has a length of 8-9 cm, a width of 3-4 cm. The mass is small, but its functional value is extremely important and diverse, since the viability of the body depends on the structures located in it.

If the brain is present in horizontal position, on its sagittal cut, 3 "floors" are defined: base, tire, roof.

Base (Basis)goes to the slope of the occipital bone. It constitutes downwards (efferent) conducting pathways (cortical and spinal, corticone, cortical-bridges), and in the brain bridge - also occupy the cross position of bridge-cerebellary connections.

Covered (Tegmentum)it is customary to call a part of the trunk, located between its base and the containers of the spinal fluid (SMG) - the fourth ventricle, the brain water supply. It constitutes motor and sensitive cores of cranial nerves, red nuclei, black substance, ascending (afferent) conducting ways, including spinctalamatic paths, medial and lateral loops and some of the efferent extrapyramidal pathways, as well as the reticular formation (RF) trunk and their connection.

Roof the brain trunk can be conventionally recognized by the structures located above passing through the barrels of the Codemates. In this case, it would be possible, although it was not accepted, to attribute the cerebellum (in the process of onto genesis, it is formed from the same brain bubble as the brain bridge, chapter 7 is dedicated to him), rear and front brain sails. The roof of the midbrain is recognized as a plate of Quirchmia.

Brain Stem - Continuation of the Upper Department spinal cord, preserving elements of the segmental structure. At the level of the oblong brain core

(Lower) Spinal Path trigeny nerve (The kernel of the descending root of V of the cranial nerve) can be considered as a continuation of the rear horns of the spinal cord, and the core of the sublard (XII cranial) nerve is the continuation of his front horns.

As in the spinal cord, the gray substance is located in the depth. It consists of a reticular formation (RF) and other cellular structures, and core nerve cores are included. Among these cores distinguish motor, sensitive and vegetative. Conditionally, they can be considered as analogs of the front, rear and lateral horns of the spinal cord. Both in the proportion nuclei of the barrel, and in the front horns of the spinal cord are motor peripheral neurons, in sensitive nuclei - the second neurons of the paths of different types of sensitivity, and in the vegetative nuclei of the trunk, as in the side horns of the spinal cord - vegetative cells.

Card nerves trunk (Fig. 9.1) can be considered as analogs of spinal nerves, especially since some of the cranial nerves, like the spinal cerebral, are mixed according to the composition (III, V, VII, IX, X). However, part of the cranial nerves only motor (XII, XI, VI, IV) or sensitive (VIII). Sensitive portions of mixed cranial nerves and VIII cranial nerve in their composition have nodes (ganglia), located outside the trunk, which are analogues of the spinal assemblies, and like them also contain the bodies of the first sensitive neurons (pseudo-monopolar cells), the dendrites of which go to the periphery, and axons - To the center, in the substance of the brain barrel, where and end in cells of sensitive cores of the trunk.

Motor cranial nerves of the trunk and motor portions of mixed cranial nerves consist of axons of motorcycles whose bodies make up motor kernels located at different levels of the brain. Motor nuclei cells of cranial nerves receive pulses from the motor zone of large semi-guns mainly on axon of central motor neurons, which make up cortical nuclear conductive pathways. These paths, appropriate to the corresponding motor nuclei, make partial crossings, and therefore each motor core nerve core receives pulses from the cortex of both cerebral hemispheres. The exception to this rule is only those cortical nuclear bonds, which are sent to the bottom of the nucleus of the facial nerve and to the core of the sub-language nerve; They make a practically full cross and thus transmit nerve impulses to the specified nuclear structures only from the bark of the opposite of the brain hemisphere.

The trunk is also located reticular formation. (Formatio Reticularis),related to the so-called nonspecific formation of the nervous system.

9.2. Reticular brain stem formation

The first descriptions of the reticular formation (RF) brain stem were made by German morphologists: in 1861 K. Reikhert (Reichert K., 1811-1883) and in 1863 O. Daters (Deiters O., 1834-1863); From domestic researchers, a great contribution to its study introduced V.M. Bekhterev. The Russian Federation is a combination of nerve cells and their processes located in a tire of all levels of the barrel between the cranial nerve cores, oliva passing here by afferent and efferent conductive paths. To the reticular formation sometimes

Fig. 9.1.The base of the brain and the root of the cranial nerves. 1 - pituitary 2 - olfactory nerve; 3 - speed \u200b\u200bnerve; 4 - Overall nerve; 5 - block nerve; 6 - a leakage nerve; 7 - Muscular root of a triple nerve; 8 - sensitive root of a trigeminal nerve; 9 - facial nerve; 10 - intermediate nerve; 11 - Pre-door-ulitskaya nerve; 12 - Language nerve; 13 - a wandering nerve; 14 - added nerve; 15 - Podium-voltage nerve, 16 - spinno-nomocheses of the addition nerve; 17 - oblong brain; 18 - cerebellum; 19 - Triple nerve; 20 - brain leg; 21 - visual tract.

some medial intermediate brain structures are also worn, including the media cores of Talamus.

The cells of the Russian Federation are different in the form and magnitude, the length of the axons are located primarily diffusely, in places form clusters - nuclei that ensure the integration of pulses coming from the nearby cranial kernels or penetrating on collaterals from the appropriate and efferent conducting paths passing through the barrel. Among the bonds of the reticular formation of the brain, the cordical, spinal-reticular paths between the Russian Federation with the formations of an intermediate brain and the string of the System, the cerebellar-reticular pathways can be considered essential of the brain. The process of cells of the Russian Federation form affreaded and efferent connections between centered nerve centers contained in the trunk tire and projection conductive paths included in the composition of the trunk tires. According to collaterals from the cerebral passing through the brain, the impulses receive "rechargeable" its impulses and performs the battery and generator of energy. It should be noted the high sensitivity of the Russian Federation to humoral factors, including hormones, drugswhose molecules reach it hematogenic.

Based on the results of the research of Magun and D. Morutsi (Mougound N., Morruzzi D.), published in 1949, it is believed that a person has the top departments of the Russian Barrel of the brain have connections with the crust of large semi-sharing and regulate the level of consciousness , attention, motor and mental activity. This part of the Russian Federation was named: ascending nonspecific activating system(Fig. 9.2).

Fig. 9.2.The reticular formation of the trunk, its activating structures and ascending paths towards the crust of large hemispheres (scheme).

1 is the reticular formation of the brain barrel and its activating structures; 2 - hypothalamus; 3 - Talamus; 4 - big brain bark; 5 - cerebellum; 6 - afferent paths and their collaterals; 7 - oblong brain; 8 - brain bridge; 9 - medium brain.

The ascending activating system includes the kernels of the reticular formation, located mainly at the level of the middle brain, to which collaterals from ascending sensitive systems are suitable. The nerve impulses of polysinaptic conductive paths that occur in these nuclei, passing through the intralaminar kernels of the thalamus, the subtalalamic kernels towards the crust of large hemispheres, have an activating effect on it. The ascending effects of non-specific activating reticular system are of great importance in the regulation of the tone of the large hemispheres, as well as in the regulation of sleep and wake processes.

In cases of damage to the activating structures of the reticular formation, as well as in violation of its bonds with large hemispheres, there is a decrease in the level of consciousness, mental activity, in particular cognitive functions, motor activity. There are manifestations of stupidity, general and speech hypocinezia, akinetic mutism, sopor, coma, vegetative state.

As part of the Russian Federation there are separate territories that received elements of specialization in the process of evolution - a vasomotor center (depressor and pressor zones), a respiratory center (expiratory and inspiratory), a vomit. RF contains structures affecting somatopsychosis integration. The Russian Federation provides the maintenance of vital reflex functions - respiration and cardiovascular activities, takes part in the formation of such complex motor acts as coughing, chichanye, chewing, vomiting, combined operation of the spectavatic device, general motor activity.

Ascending and descending influences of the Russian Federation on various levels of the nervous system, which are "configured" by it to perform a particular function. By maintaining a certain tone of the cortex of large hemispheres of the brain, the reticular formation itself is experiencing controlling the effect on the side of the cortex, which thus obtaining the ability to regulate the activity of its own excitability, as well as affect the nature of the effects of the reticular formation on other brain structures.

The descending effects of the Russian Federation on the spinal cord are primarily affected on the state of the muscular tone and can be activating or lowering muscle tone, which is important for the formation of motor acts. Usually, the activation or inhibition of ascending and downward influences of the Russian Federation is carried out in parallel. So, during sleep, which is characterized by the inhibition of ascending activating influences, there is a braking and descending nonspecific projections, which manifests itself, in particular, a decrease in muscle tone. The parallelism of the influences propagating from the reticular formation on ascending and downward systems is also noted with due to various endogenic and exogenous causes of comatose states, in the origin of which the leading role is given to the dysfunction of non-specific structures of the brain.

At the same time, it should be noted that in pathological conditions, the interaction of the functions of ascending and downward influences may have more complex. Thus, with epileptic paroxysms, with davidenki hydrontic syndrome, arising from usually due to the coarse lesions of the brain, the oppression of the functions of the crust of large hemispheres are combined with an increase in muscle tone.

All this indicates the complexity of the relationship of the functions of various structures of the reticular formation, which can lead both synchronous ascending and downward influences and their disorders with the opposite orientation. At the same time, the Russian Federation is only part of a global integrative system, including the limbic and cortical structures of a limbicienticular complex, in cooperation with which the organization of life and targeted behavior is carried out.

RF may participate in the formation of pathogenetic processes that are the basis of some clinical syndromes arising from the localization of the primary pathological focus not only in the trunk, but also in the brain departments located above or below it, which is explained from the point of view of modern ideas about the vertically constructed functional Systems operating on the principle of feedback. Communications of the Russian Federation have a complex vertical organization. The basis of it is neural circles between the cortical, subcortical, stem and spinal structures. These mechanisms take part in ensuring mental functions and motor acts, and also have a very important impact on the state of the functions of the autonomic nervous system.

It is clear that the peculiarities of the pathological manifestations associated with violation of the functions of the Russian Federation are depending on the nature, prevalence and severity of the pathological process and on which departments of the Russian Federation were involved in it. The dysfunction of the limbic-reticular complex, and in particular the Russian Federation, may be due to many harmful toxic, infectious effects, degenerative processes in brain structures, brain blood supply disorders, intracranial tumor or brain injury.

9.3. MEDULLA

Medulla (Medulla Oblongata)- Direct continuation of the spinal cord. The conditional boundary between them is located at the level of a large occipital opening; It passes through the first cerebrospinal roots, or the area of \u200b\u200bthe crossroads of the pyramid paths. The oblong brain has a length of 2.5-3 cm, in shape it looks like a tilted truncated cone; Sometimes it is called a bulb (Bulbus).The lower part of the oblong brain is located at the level of the edge of the large occipital opening, and the upper, wider, borders with the brain bridge. The conditional boundary between them takes place at the level of the middle of the occipital bone.

On the ventral surface of the oblong brain in the sagittal plane passes a deep longitudinal front median gap (Fissura Mediana Anterior),the continuation of the eponymous spinal cord slice. On the sides of it, elevations are elevations - pyramids consisting of corticospinomy pathways, including axons of central motioneons. Behind and laterally, the pyramids on each side of the oblong brain is located at Lower Olive (Oliva Inferior).From the pyramid located between the pyramid and the Olive Frost (Sulcus Lateralis Anterior)the roots of the ply (xii) nerve come out. Behind Olive is the rear lateral furrow (Sulcus Lateralis Posterior),through which the rejected brain takes place the roots of the added, vagus and languagehloxy (XI, X and IX) nerves.

At the bottom of the dorsal surface of the oblong brain between the rear median furrows and the rear side grooves there are two longitudinal rollers, consisting of the spinal cords who came here on the rear rods of the spinal cord with the fibers of gentle and wedge-shaped beams. In connection with the deployment of the central channel of the spinal cord in the fourth ventricle of the brain rollers, formed from gentle and wedge-shaped beams, diverge on the parties and end with thickening (Tuberculi Nuclei Gracilis et Cuneatus),appropriate location of the same name (gentle and wedge-shaped) nuclei consisting of second neurons of propriceceptive sensitivity paths.

Most of the dorsal surface of the oblong brain is the lower triangle of the IV brain ventricular bottom - a rhombid fossa, which is limited to the bottom, and from above - the top legs of the cerebellum. If the angles of the diamond pits of the ABSD, as proposed by L.V. Blumenau (1906), to connect direct lines of AC and BD, indicating the point of their intersection E, and then carry out the bisector of the ABD angle and designate the points of its intersection of the lines AE and AD letters N and F and from the point n, to lower the line, parallel line AD crossing the line AB at point G, then triangles and quadrangle created within the rhombid fossa can be represented, which allow it to be projected on it located in the caudal part of the brain barrel core core nerves (Fig. 9.3).

It can be noted that the HVV triangle is engaged in the elevation located above the core of the sub-band (XII cranial) nerve, and is denoted as the triangle of the core of the sub-speaking nerve (Trigonum Nervi Hypoglossi).In the triangle GHB is a deepening (FOVEA INFERIOR, or FOVEA VAGI).Under it is a rear parasympathetic core wandering nerve. Therefore, the triangle of the GHB is also called a triangle of a wandering nerve (Trigonum Nervi Vagi).The outer part of the rhombid fossa in the zone inscribed in it, the AFHG quadrilater occupies an elevation, which is above the kernels of the auditory (VIII cranial) nerve, and therefore it is called the hearing field (Area Acustica)and his raised center is indicated as a hearing tubercle (Tuberculum Acustici).

The white substance of the oblong brain consists of conductive paths, some of which passes through it with a transit, part is interrupted in the cores of the oblong brain and its part of the Russian Federation or begins on its structures. Cork-spinal (pyramid) paths pass through the base of the oblong brain, participating in the formation of the pyramids in its composition, and then make an incomplete cross. The cortical-cortical rind fiber crossing the fiber immediately fall into the spinal cord lancetral curtains; The fibers of this path that do not participate in the formation of the cross, are included in the front spinal rope. Both switched on the opposite direction and the fibers of the cortical-spinal path left on their side, as well as other efferent connections descending from various head structures

Fig. 9.3.Geometric diagram of a rhombid pamph (on L.V. Blumenu). Explanations in the text.

Fig. 9.4.The location of the cranial nerve nuclei in the brain barrel (A, B). Motor kernels - red; Sensitive - green.

the brain in the spinal cord is directed to the peripheral motors in the front horns of the spinal cord.

The structure of the oblong brain is unidentally at different levels (Fig. 9.4). In this regard, for a more complete and systematic acquaintance with the structure of the oblong brain, we consider the structure of transverse sections produced through the caudal, medium and oral departments (Fig. 9.5). In the future, the transverse sections of the bridge and mid-brain will be described with the same purpose.

Lower part of the oblong brain. When studying the transverse cut of the caudal part of the oblong brain (Fig. 9.6), attention is noted that its structure here has a significant resemblance to the spinal cord. The remains of the spinal cord horns are still preserved, in particular its front horns, which, as if cut off from the main mass of the central gray matter with pyramidal fibers, subjected to the cross, and heading the spinal cord headings. From the outer part of the front horns, the first front spindy roots exit, and from the founding cells of the front horns - axons forming cerebral root Xi cranial nerve. The central part of the gray substance at this level occupies the lower department of the reticular formation of the brain stem.

The side pieces of the cut are mainly ascending and downward conductive pathways (Tractus Spinothalamicus Lateralis Et Medialis, Tranti Spinocerbellaris Dorsalis et Ventralis et al.), occupying the situation at this level close to the one that is peculiar to them in the spinal cord.

Fig. 9.5.Levels of brain slices.

I - a cut of the oblong brain at its border with the spinal cord; II - cut of the oblong brain at the level of its middle part; III - a cut of the oblong brain at the level of the upper part; IV - cut on the border of the oblong brain and the bridge; V is a cut at the level of the middle third of the bridge; VI - slice at the level of the middle third of the bridge; VII - Sing at the level of the front bugs of Quirchmia.

Fig. 9.6.The cut of the oblong brain on the border of it with the spinal cord. 1 - gentle beam; 2 - wedge-shaped beam; 3 - core of a gentle beam; 4 - the kernel of a wedge-shaped beam; 5 - the kernel of the downward root V nerve; 6 - rear horn; 7 - nucleus of the XI nerve; 8 - front horn; 9 - rear spiniebellar path; 10 - Cross-spinal crossing (pyramid) paths.

Along the outdoor departments of the rear horns on the cut-down cutting brain, the spinal path of the trigeminal nerve (descending spine V of the cranial nerve), surrounded by cells that make up its kernel. The upper part of the cut is occupied here by the rear rockets of the spinal cord by wedge-shaped and delicate beams, as well as the lower parts of the cores in which these bundles end.

The middle part of the oblong brain (Fig. 9.7). The base of the cut is occupied by powerful pyramids. (Pyramides).In the covers of the oblong brain at this level there are XI kernels, and slightly above - the kernel of XII cranial nerves. In the back of the cut, the large sizes of the kernel of gentle and wedge-shaped beams are located, in which the first neurons of the paths of deep sensitivity are completed. The axons in these cell nuclei go ahead and medially, and in front of the initial segment of the central spinal cord channel and the surrounding gray substance. These axons (Fiber Arcuatae Internae),going from one and the other sides passing through the sagittal plane, completely crossed together with each other, thus forming the upper, or sensitive, the cross, also known as the crossing of the loop (Decussatio Limniscorum).After crossing the components of its fibers take the upward direction and form medial loops (Lemnisci Medialis), which are behind the pyramids on the sides of the midline.

Fig. 9.7.The cut of the oblong brain at the level of its middle part.

1 and2 - the kernels of gentle and wedge-shaped beams; 3 - core of the spinal root of a trigeminal (V) nerve; 4 - cross-making paths; 5 - the core of the addition (IX) nerve; b - spinocerabellar paths; 7 - the core of the sublard (XII) nerve, 8 - spinatelamic path; 9 - the pyramid path; 10 - rear longitudinal beam.

The remaining conducting paths occupy a position approximately similar to their position on the previous cut.

Top of the oblong brain (Fig. 9.8). Here, the central canal of the spinal cord is deployed in the fourth ventricle, and the slice passes through the lower triangle of the rhombid fossa, which makes it up. Education, which in the lower part of the oblong brain was located above the central channel, are now spread to the sides and occupy the posterior cuts. In the lateral part of the tire, the dissected lower olive is visible, the substance of which on the cut resembles a folded bag.

The bottom of the fourth ventricle lifted ependim cells. Under the ependim layer, there is a central gray substance, in which the kernels of the XII cranial nerve are located near the midline on both sides. The duck from each of them is the rear core of the wandering nerve (Nucleus Dorsalis Nervi Vagi), and even laterally visited by cells, the crosslinked bunch of fibers, known as a single beam. The surrounding cells make up the nucleus of a single path (Nucleus Tractus Solitarii).Near it is a small-cell vegetative saludative core

Fig. 9.8.Sing of trunk at the level of the top of the oblong brain. 1 - medial longitudinal beam; 2 - the kernel of the XII nerve; 3 - rhombid pumpets, 4 - vestibular nerve nuclei; 5 - rear cores of nerve; 6 - the core of the total sensitivity of the nerve; 7 is a single beam core (taste core); 8 - rear spiniebellar path; 9 - mutual core; 10 - the nucleus of the downward root V nerve; 11 - front spinal cerebellar journey; 12 - Lower Olive; 13 - cortical-spinal (pyramid) path; 14 - Medial loop.

(Nucleus Salivatorius).The lower part of the single path nucleus and the salivatoral nucleus refers to the thumbnail, and the upper one to the intermediate nerves.

In the depth of the reticular formation in the center of the tire there is a large-cell core, which is as orally continuing the kernel Xi of the cranial nerve. This is a motor core, the lower part of which belongs to the IX, and the top to X cranial nerves. In this regard, the kernel is called a mutual or double kernel (NUCl. Ambiguus),a axes of cells of the lower part of this nucleus are the cranial part of the addition nerve.

The kernels of gentle and wedge-shaped beams on this cut dissected at the level of their upper pole, the dimensions of them are small here. On the kernel of the wedge-shaped journey, the outer arcuate fibers are enjoyed, which are the continuation of the rear spin-plated bundle of the Flexig, participating in the formation of the lower cerebulic leg. In its formation, the fibers of the OlivoCorebellar path are taken from olive, most of which are pre-passed on the opposite direction.

There are medial loops between olivia. The post from them is the medial longitudinal bundles and covered spinal pathways, which come from the roof nuclei of the middle brain in the spinal cord. Through the side departments, there are other long conductive paths that are not interrupted in the oblong brain. The dimensions of the reticular formation compared to the levels of the previous

cuts continue to grow. The reticular formation is fragmented by crossing it in different directions by nerve fibers.

In the highest departments of the oblong brain on the border with the bridge, the width IV ventricle reaches a maximum. Due to the fact that the thickness of the lower cerebulic legs located on the sides of the rhombid fossa is already large here, the dimensions of the cut-off brain at this level are the largest. In addition to the already mentioned formations of the oblong brain, the lower sections of the cranial nuclei of the bridge occupy a large place, the description of which will be presented when considering this brain stem department.

9.4. The cranial nerves of the oblong brain 9.4.1. Additional (XI) nerve (n. Accessorius)

The added nerve has a cranial and cerebrospinal part, and therefore it can be said that it occupies a transitional position between the spinal and cranial nerves. It could be called spinal cranial. Therefore, we start a description of the cranial nerves from it (Fig. 9.9).

Additional nerve is motor. His the main long motor core is formed the cells of the base of the front horns with II -С V spinal cord segments. The axons of the spinal core cells of the Xi cranial nerve exit from the indicated spinal cord segments between the front and rear spinal roots and the side of its surface, gradually combine, form the spinal root of the addition nerve, which the takes

Fig. 9.9.Appendix (XI) nerve and its connection.

1 - the spinal root of the addition nerve; 2 - cerpent roots of the addition nerve; 3 - trunk of an additional nerve; 4 - jugular hole; 5 - the inside of the addition nerve; b - the lower node of the wandering nerve; 7 - the outer branch of the addition nerve; 8 - breast-curable-cottage muscle; 9 - trapezoidal muscle. Red, engineering neural structures are indicated; Blue - sensitive vegetative, green - parasympathetic, purple - afferent vegan.

walking direction and enters the cavity of the rear cranial fossa through a large occipital hole from axons. In the rear cranial fossa, cerebral (cranial) root, consisting of neurons located at the bottom of the double (mutual) kernel, joins the spinal roaster. next to the neurons of the wandering nerve (X of the cranial nerve). The cerebral flavor of the XI cranial nerve can be considered as part of the motor portion of X of the cranial nerve, as it actually has a common motor core and general functions.

Forming after the fusion of cerebral and spinal roots XI cranial nerve comes out of the rear agent of the oblong brain below the root X of the cranial nerve. Formed after this barrel XI of the cranial nerve comes out of the skull cavity through the jugular hole (Foramen Jugularis). Thereafter the fibers of the cranial part of the clerk nerve trunk are connected to the X cranial nerve, and the rest spinal part called the outer branch of the addition nerve, descends on the neck and innervates the breast-curable-bed-like muscle (m. sternocleidomastoideus) and the upper part of the trapezoid muscle (m. Trapezium).

The damage to the spinal core or the stem of the XI cranial nerve and its branches at any level leads to the development of peripheral paralysis or the pan of these muscles. Over time, their atrophy occurs, leading to asymmetry, detected with an external inspection, while shoulder on the side of the lesion is lowered, the lower corner of the blade is departed from the spine. The shovel turns out to be a biased dust and up ("wonderful" blade). The "shutter" is difficult and the ability to raise the hand above the horizontal level. Due to the excessive "sagging" shoulder on the side of the defeat, the hand turns out to be longer. If the patient suggest stretch your arms in front of him so that the palms touch each other, and the fingers were elongated, the ends of the fingers on the side of the lesion protrude forward.

Parameres or paralysis of the breast-curable-bed-like muscle leads to the fact that when the head turns on the sore side, this muscle is badly contacted. Reducing its strength can be revealed, having resistance to turning the head to the side opposite to the defeat, and a little up. The decline in the force of the trapezoid muscle is clearly detected if the survey will put his hands on the shoulders of the patient and will resist their active raise. With bilateral defeat of the XI cranial nerve or its spinal core, the tendency to hang the head on the chest is noted. The lesion of the XI cranial nerve is usually accompanied by a deep, minor, hard-lying pain in the hand on the side of the lesion, which is conjugate with the recalculation of the articular bag and the ligament apparatus of the shoulder joint in connection with paralysis or part of the trapezoid muscle.

The disorder of the XI function of the cranial nerve may be due to the damage to the peripheral motor neurons in patients with tick-borne encephalitis, poliomyelitis or side amyotrophic sclerosis. The defeat of this nerve on both sides leads to the development of a symptom of a hanging head, which can also be due to the disorder of the function of neuromuscular synapses during myasthenia. Damage to the addition nerve is possible with craniteractic anomalies, in particular, with Arnoldakiari syndrome, as well as during injuries and tumors of the same localization. In case of irritation of the cells of the spinal core of an additional nerve in the muscles inexedable muscles, fascicular twitching, milestones are possible.

Peripheral neurons that make up the spinal core xi of the cranial nerve receive pulses of cortical-spinal and cortical nuclear paths, as well as by extrapyramine coat and spinal, predvevo-spinal conductive paths and on the medial longitudinal beam, on both sides, but mainly with the opposite Parties. In this regard, the change in the impulsation coming from the central neurons to the peripheral motor neurons of the spinal nuclei of the XI cranial nerve, can cause spastic paresis innervated by these nerve transverse muscles, more pronounced on the side opposite to the pathological process. It is assumed that the change in the spinal nucleus of the Xi cranial nerve of the nerve pulses entering the peripheral neurons can cause hyperkinesis by the type of spastic curve. There is an opinion that the cause of this form of hyperkinosis may also be irritation of the spinal root of the addition nerve.

9.4.2. Podium (XII) nerve (n. Hypoglossus)

Podium nerve is motor (Fig. 9.10). Its core is located in the oblong brain, while the upper part of the nucleus is under the bottom of the diamondy hole, and the bottom goes down along the central channel to the level of the start of the crossroads of the pyramidal paths. The core of the XII cranial nerve consists of large multipolar cells and a large number of fibers located between them, which it is divided into 3 more or less separate cellular groups. The axons of the xii cerulic nerve cage cells are collected in bundles that penetrate the oblong brain and emerging from its front side groove between the lower olive and the pyramid. In the future, they leave the skull cavity through a special hole in the bone - the channel of the sub-speaking nerve (Canalis Nervi Hypoglossi),located above the side edge of a large occipital opening, forming a single barrel.

Coming out of the skull cavity, the XII cranial nerve passes between the jugular vein and the inner carotid artery, forms an attachment arc, or a loop (ANSA Cervicalis), passing here in close proximity to the branches of the spinal curtains coming from the three top neck segments of the spinal cord and innervating muscles, Attached to the sub-band bone. In the future, the sub-band nerve turns forward and shares on the pagan branches (RR. linguales)innervirovy language muscles: podium-language (m. hypoglossus)shiliant-speaking (m. Styloglossus)and chore-pagan (m. geniooglossus),as well as longitudinal and transverse muscles of the tongue (m. longitudinalis and m. TRANSVERSUS Linguae).

With the defeat of the XII cranial nerve, peripheral paralysis or paresis of the age of the same name occurs (Fig. 9.11), at the same time, the language in the oral cavity is shifted into a healthy side, and when tugging out of the mouth, it deviates towards the pathological process (the language "shows to the hearth"). This happens due to the fact that m. Genioglossus.a healthy side pushes a gomolateral half of the language forward, while the paralyzed half of the half fell behind and the language turns out to be turned in its direction. The muscles of the paralyzed side of the tongue over time are atrophy, thinned, while the relief of the language on the side of the lesion changes - becomes folded, "geographical".

Fig. 9.10.Podium (XII) nerve and its connection.

1 - the core of the sub-speaking nerve; 2 - Subject channel; 3 - meningeal branch; 4 - connecting branch to the upper cervical sympathetic node; 5 - connecting branch to the lower node of the wandering (x) nerve; b - upper cervical sympathetic node; 7 - the lower node of the wandering nerve; 8 - connecting branches to two first spinal nodes; 9 - internal carotid artery; 10 - internal jugular vein; 11 - Shiliant muscle; 12 - vertical muscle language; 13 - upper longitudinal muscle language; 14 - transverse muscle of the language; 15 - lower longitudinal muscle language; 16 - chore-tongue muscle; 17 - chore-pellet muscle; 18 - Podium-tongue muscle; 19 - shield-speaking muscle; 20 - Greater-subsidized muscle; 21 - breast-thyroid muscle; 22 - upper abdominal muscular muscles; 23 - lower abdomen of the explosive-lift muscle; 24 - cervical loop; 25 - the lower roof root; 26 - the upper root roof root. Red-color denotes branches derived from the oblong mold, purple - from the cervical spinal cord.

Fig. 9.11.The lesion of the left sub-speaking nerve along the peripheral type.

One-sided paralysis of the language almost does not affect the acts of chewing, swallowing, speech. At the same time, there are manifestations of signs of the pan of muscles, fixing the larynx. When swallowing, in such cases, the larynx shift is noticeable to the side.

In the case of bilateral damage to the kernels or stems of the XII cranial nerve, the full paralysis of the muscles of the language (glossy), then it turns out to be sharply thinned and motionless lying on the pt diaphragm. There is a speech disorder in the form of anartree. With a bilateral pares of muscle muscles, articulation by type of dysarthria is disturbed. During the conversation, it seems that the mouth is full of the patient. The pronouncement of consonant sounds is particularly violated. Glossoplegia also leads to the difficulty of receiving food, as the patient is difficult to promote the food lump in the throat.

If peripheral paresis or language paralysis is a consequence of gradually progressive lesions of the kernel of the XII cranial nerve,that is characteristic appearance in language on the side of the pathological process fibrillar and fascicular twitching.Defeat of the XII cereal nerve nuclei is usually accompanied by peripheral (sluggish) paresium circular muscles of the mouth (m. Orbicularis Oris), in which the lips become thinner, they appear wrinkles converging to the oral gap ("briquette"), the patient is difficult to whistle, blend the candle. This phenomenon is explained by the fact that the bodies of peripheral motnelones whose axons are used in the composition of the VII (facial) cranial nerve to the circular muscle of the mouth, are located in the core of the XII cranial nerve.

If the lower engine of the motor cortex of a large hemisphere or cortical nuclear conductive paths are affected,

carrier pulses from the bark, in particular to the kernel of the XII cranial nerve, then (as the cortical nuclear fibers suitable for this core make almost complete cross) on the side opposite to the pathological process, central partares of muscle muscles occurs (Fig. 9.12). Language when tugging from the mouth turns out to be turned to the side opposite to the pathological hearth

Fig. 9.12.The lesion of the left sub-speaking nerve in the central type.

in the brain, there are no tongue atrophy and fibrillar twitching in it is absent. The central paresis of the tongue is usually combined with the central paresis of the facial nerve and manifestations of central hemiparesis on the same side.

The reduction in the muscle strength of the language arising from their paresay can be checked if the surveyant will ask the patient to press the tongue on the inner surface of its cheek, and at the same time will resist this movement, pressing on outdoor surface patient cheeks.

The signs of bilateral damage to the nuclei and the stems of the XII cranial nerve are usually combined with the manifestations of the function of the functions of other cranial nerves of the bulbar group, and then the clinical picture of more complete bulbar syndrome occurs; The violation of the functions of cortical-nuclear conductive pathways going to the motor nuclei of these nerves is manifested by pseudobulbar syndrome, which is a manifestation of the central paresium or paralysis of the muscles innervoable by them.

9.4.3. Wandering (x) nerve (n. Vagus)

Nervus vagus is mixed (Fig. 9.13). It contains motor, sensitive and vegetative (parasympathetic) fibers. In accordance with this in the X Skull Nerva system there are 3 main kernels located in the covers of the oblong brain. Motor kernel - double(NUCl. Ambiguus),the upper part of it refers to the IX cranial nerve, and the lower - to the X cranial nerve and to the cerebral part of the XI cranial nerve. Sensitive kernel(NUCL. SENSORIUM)also in general for IX and X cranial nerves. In addition, in the system X of the nerve there is own kernel - rear core of a wandering nerve(NUCL. DORSALIS NERVI VAGI),located under the bottom of the IV ventricle, outside from the top of the nucleus of the sub-speaking nerve. It comprises small vegetative cells and it is directly related to the innervation of most internal organs and that's why sometimes it is called visceral.

The X cranial nerve comes out of the posterior groove of the oblong brain and is directed to the jugular hole through which, together with the IX and XI, the skull cavity leaves. In the zone of the jugular hole on the trunk X of the cranial nerve are located upper knot (Ganglion Superius),and 1 cm below, already outside the skull cavity - nizhny Knot (Ganglion Inferius).Both of these nodes are analogues of the spinal nodes and part of the sensitive portion of the X cranial nerve. They contain the bodies of the first neurons of sensitive ways, their axons are sent to the oblongable brain to the mentioned sensitive kernel, and dendrites are on the periphery.

Below the jugular hole on the section X of the cranial nerve, which is between these nodes, the fibers of the added nerve are connected to its motor portion, which constitute its cerebral root and are axons of peripheral motnelones that are part of the double kernel.

Motor and sensitive portions of X of the cranial nerve provide innervation of transverse muscles of the upper digestive and respiratory systems: a soft palate, a throat, a larynx, a native. From the branches of the X cranial nerve, which is from the base of the skull and on the neck, the most largest are the following.

Fig. 9.13.The wandering nerve (x) and its connection.

1 - the nucleus of a single path; 2 - the core of the spinal pathway of the trigeminal nerve; 3 - double core; 4 - the rear core of the wandering nerve; 5 - spinal roots of the addition nerve; 6 - meningeal branch (in the subitatorial space); 7 is an ear branch (to the rear surface of the ears and an outer auditory passage); 8 - upper cervical sympathetic node; 9 is a sip of plexus; 10 - muscle lifting a chicken curtain; 11 - muscle tongue; 12 - Labor-sizzet;

13 - Labor-Public muscle; 14 - pipe-sizzet; 15 - Upper pharyngeal constructor; 16 - sensitive branches to the mucous membrane of the bottom of the pharynx; 17 - upper guttural nerve; 18 - BRAIN-COLICE-CHILDROIDE MUZNE; 19 - trapezoidal muscle; 20 - lower guttural nerve; 21 - lower assembly of the pharynx; 22 - Pisnostechovoid muscle; 23 - Crapal muscles; 24 - Piecepalo-shaped muscle; 25 - lateral PersdnaPalovoid muscle; 26 - rear PersdianPalovoid muscle; 27 - esophagus; 28 - right plug-in artery; 29 - Returnal Guttural Nerve; 30 - breast heart nerves; 31 - Heart plexus; 32 - Left Wandering Nerve; 33 - Aortic arc; 34 - diaphragm; 35 - esophageal plexus; 36 - Clawed plexus; 37 - liver; 38 - gall-bubble; 39 - Right kidney; 40 - small intestine; 41 - Left kidney; 42 - pancreas; 43 - spleen; 44 - stomach. Red, engineering neural structures are indicated; blue - sensitive; Green - parasympathetic.

Meningheal branch (r. Meningeus)- sensitive, participates in innervation predominantly solid brain shell Rear cranial pocket.

Own branch (r. Auricularis,the nerve of Arnold) is sensitive, innervates the rear wall of the external auditory passage and the rear surface of the auricle.

Upper guttural nerv (n. Laringeus Superior)the muscles of soft nose innervators, pharyngeal and hand-shaped muscles, are involved in sensitive innervation of the larynx and the palmist. In neuralgia, the upper gentle nerve is characterized by the attacks of painful pain from a few seconds to a minute, localized in the area of \u200b\u200bthe larynx, sometimes accompanied by cough. When palpation on the side surface of the larynx under the thyroid cartilage, a pain point (jacket zone) is marked, the pressure on which can cause an attack.

Returning guttural nerv (n. Laringeus Recurrens)- right returning nerve goes on the front back of the subclavian artery, left - Aortault arc. Then both nerves rose between the trachea and the esophagus, participate in their innervation and reach the larynx.

The final branches of recurrent nerves are called lower gentle nerves, they anastomize with the upper gangny nerves. The neuropathy of the return gastric and lower gentle nerve is manifested by paralysis of voice ligaments, other muscles of the larynx, except for the pisteless muscle. As a result, when damaged to the branch X of the cranial nerve and its branch - a return Gundy nerve, as well as its continuation - the lower gentle nerve - may voiced voice dies - dysphonia in the form of hoarse voices without dysfagia (symptom of orthnest) due to the password process, the password and paralysis of the voice bundle detected during laryngoscopy.

The defeat of both returnable hot nerves causes Afonia and respiratory string. Such dysphony (or aphony) can be a consequence of aortic aneurysm, mediastinal tumors, transferred operations on the neck or mediastinum, but often the causes of the neuropathy of the return gentle nerve cannot be installed.

After the removal of the specified branches, the remaining, consisting mainly of parasympathetic fibers, part of the vagus nerve, located between the inner, then the total carotid arteries on one side and the jugular vein - on the other, penetrates chest. Passing through the chest

X The cranial nerve gives bronchial and breast heart branches and then through the esophageal hole of the diaphragm abdominal cavity. Here X cranial nerve is divided into front and rear wandering trunks (Truncus Vagalis Anteror et Truncus Vagalis Posterior); numerous branches (gastric, curious, kidney and other branches) provide sensitivity and parasympathetic innervation (innervation of smooth muscles, digestive glands, urinary system, etc.).

When defeating the wandering nerve in proximal Department There is a hanging of a soft nose on the side of the pathological process; It turns out to be fixed or strain less than a healthy side. The roaming curtain during the lantern shifts into a healthy side. As a rule, on the side of the lesion X of the cranial nerve tongue (Uvula) rejected into a healthy side, reduced or no pharyngeal and chicken reflexes are reduced. They are checked on both sides with a spatula, spoon or folded paper sheet, which the score touches the rear wall of the pharynx or to a soft nubble.

A bilateral decrease in the functions of wandering nerves may determine the manifestations of bulbar syndrome, in particular, the disorder of speech in the form of Afony and dysfagia is a violation of swallowing, lying in liquid food - a consequence of a pad of a soft nose, a roasting curtain, the epiglotter, pharynx. The weakening of the swallowing reflex leads to a cluster in the oral cavity saliva, food residues. Parishes of phares and decreased cough reflex contribute to the obturation of the upper respiratory tract with the subsequent occlusion of the bronchi, which leads to the disorder of respiration and the development of obstructive pneumonia.

The irritation of the parasympathetic portion of the wandering nerves can lead to bradycardia, broncho- and esophagospasms, pylorospasm, to strengthen the peristalticism, vomiting, improving the secretion of the gonduct of the digestive tract, and over time and to the possible development of ulcer of the stomach and duodenum. The defeat of these nerves leads to respiratory disorders, tachycardia, oppression of the secretion of the ferrous apparatus of the digestive tract etc. Pronounced bilateral disorder parasympathetic innervation Internal organs can lead to the death of a patient in connection with the disruption of respiration and cardiac activity.

The cause of the lesion X of the cranial nerve may be siringobulbium, lateral amyotrophic sclerosis, intoxication (alcoholic, diphtheria, in the pione of lead, arsenic), it is possible to squeezing the nerve at cancer pathology, aortic aneurysm, etc.

9.4.4. Language (IX) nerve (N. Glossopharingeus)

Language nerve is mixed. It contains motor, sensitive, including flavors, and vegetative parasympathetic fibers.

In accordance with this, the IX cranial nerve system includes located in the oblong brain kernels: Motive (NUCL. Ambiguus)and core common species Sensitivity (NUCL. SENSORIUS)- common for IX and X cranial nerves, as well as core of taste sensitivity - core of a single path (NUCl. Solitarius)and parasympathetic secretor core - lower salivaeotativative nucleus (NUCL. SALVATORIUS),common for IX cranial and intermediate nerves.

The IX cranial nerve comes out of the posterior groove of the oblong brain, which is behind the lower Olive, and goes to the jugular hole, passing through which he leaves the skull cavity (Fig. 9.14).

Muscular portion of the IX cranial nerve innervates only one muscle - Cellothelnaya (m. Stylopharingeus), lifting a throat.

The bodies of first sensitive neurons, providing impulses of common species and taste sensitivity, are in the analogues of the spinal ganglia - in upper(Ganglion Superius)and nizhny(Ganglion Inferius)nodes located near the jugular hole. Dendrites of these neurons

start in the rear third of the tongue, a soft nurse, a yawn, a sip, the front surface of the Nastestrian, as well as in the auditory (Eustachiyeva) tube and the drum cavity, participating in ensuring common types of sensitivity in them, and on the back third of the language also taste sensitivity. Axons of the same pseudo-monopolar cells in the root of the IX cranial nerve penetrate into an oblongable brain, then those that carry out impulses of general types of sensitivity are suitable for the corresponding kernel; And those on which the impulses of taste sensitivity are transmitted - to the bottom of the nucleus of a single path.

In these nuclei, sensitive impulses switched on second neurons,whose axons are moving to the opposite direction participating in the formation of the medial loop, and finish in the Talalamic nuclei, where are there third neurons. Axons of third neurons of sensitive ways of system IX cranial nerve pass as part of a medial sensitive loop, the hips of the inner capsule, a radiant crown and end in the bottom of the cortex of post-central winding (Fibers transmitting impulses of general types of sensitivity) and in the crust around the island (Fibers conductive impulses of taste sensitivity, their unilateral damage does not lead to a disorder of taste sensitivity).

It should be noted that the impulses arising in the receptor apparatus in the zone of sensitive innervation of the wandering, triple and intermediate innervation of the wandering, triple and intermediate nerves are also underway to the projection zones of the cortex.

Parasympathetic salivatolation fibers, cell axons embedded in the lower part of the salivary nucleus, located in the lateral seal of the tires of the oblong brain, through the branch of the language nerve - nerve drum and small rocky nerve - reaches an ear parasympathetic node (Gangl. Oticum).From here there are postganglionary parasympathetic fibers, which through the anastomosis go to the branch of the trigeminal nerve (N. Auriculotemporalis)and innervat the parole gland, providing its secretory function.

With damage to the language nerve the difficulties of swallowing are noted, a violation of the sensitivity of common species (pain, temperature, tactile) soft nose, the oz, the upper part of the pharynx, the front surface of the nastestrian, the rear third of the tongue. Due to the disorder of propriceceptive sensitivity in the language, the feeling of its position in the oral cavity may be disturbed, which makes it difficult to chew and swallowing solid food. In the rear third of the tongue, the perception of taste sensations is disturbed, mainly the feeling of bitter and salty. In addition to the language nerve, the perception of taste provides the system of intermediate nerve and its branch - drum string (Chorda Tympani).

Fig. 9.14.Language (IX) nerve.

1 - the nucleus of a single path; 2 - double core; 3 - lower salivaeotelitative core; 4 - jugular hole; 5 - the upper node of the alveal nerve; 6 - lower node of the alveal nerve; 7 - connecting branch with an ear branch of a vagus nerve; 8 - the lower node of the wandering nerve; 9 - upper cervical sympathetic node; 10 - carotid sinus calf; 11 - carotid sinus and his plexus; 12 - general carotid artery; 13 - sinus branch; 14 - drum nerve; 15 - facial nerve; 16 - crankshabchany nerve; 17 - big rocky nerve; 18 - Cooking knot; 19 - ear knot; 20 - parole iron; 21 - Small rocky nerve; 22 - hearing pipe; 23 - deep rocky nerve; 24 - internal carotid artery;

25 - Sleepy-drum nerves; 26 - Shiliant muscle; 27 - connecting branch with facial nerve; 28 - cylinder muscle; 29 - sympathetic plexus; 30 - motor branches of the wandering nerve; 31 - pharyngeal plexus; 32 - branches to the muscles and mucous membrane of the pharynx and soft nose; 33 - sensitive branches for soft sky and almonds; 34 - taste and sensitive branches to the back of the tongue. Red, engineering neural structures are indicated; blue - sensitive; green - parasympathetic; Violet - sympathetic.

With a decrease in the functions of the IX cranial nerve, the patient sometimes complains about some dryness in the mouth, but this feature is inconsistent and unreliable, since the decrease and even stopping the function of one parotid gland can be compensated by other salivary glands.

Irritation by the pathological process of the IX cranial nerve may cause pain in the zea, the rear wall of the pharynx, language, as well as in the auditory tube and the eardrity. These sensations may have a permanent or fitful character. In the latter case, development is possible in the patient neuralgia IX cranial nerve.

It should be noted that a certain anatomical and functional community of IX and X cranial nerves usually leads to the combination of their defeat and to the practical simultaneity of verification of their functions in the neurological examination process. Thus, checking the breadless and silent reflexes, it should be borne in mind that their decrease can be due to the lesion of both the X and IX cranial nerve (the afferent part of the reflex arc passes through the sensitive portion of the IX and X of the cranial nerves, the efferent - by the motor portion of X cranial Nerva, and the closure of the reflex arc occurs in the oblong brain).

9.5. Taste and disorders

Specialized receptors of taste sensitivity are located in taste ring and mushroom puet pieces and belong to chemoreceptors, as they react to chemicals dissolved in water, which is the main part of saliva. Separate chemoreceptors are in the mucous membrane of the soft and solid chicken, in the top of the epiglotter.

It should be borne in mind that various inensions of taste stimuli perceived by specific receptors located in the mucous membrane of the language preferably in this way: gorky - in the rear third of the language, salty - in the back of the tongue and in its lateral zones, sour - in the lateral sections of the top surface of the tongue and on the sides of it, sweet - In the front sections of the language. The middle part of the back of the tongue and the bottom surface is practically deprived of taste receptors.

The state of flavor sensitivity is checked separately for each of the four basic variants of taste (sour, sweet, bitter, salted). When checking the taste sensitivity to symmetrical parts of the tongue using a pipette or glass sticks, a solution of solution is applied, containing

the taste stimulus 1, while watching the drop does not spread through the language. After applying each drop of the patient, it should indicate one of the pre-written words reflecting his taste: "bitter", "salty", "sour" and "sweet", and after that carefully rinse the mouth. In the survey process can be identified: disorders of taste - disgusting lack of taste - agevia reduced taste sensitivity - hypathyism promoting taste - paragiavia the presence of a metal taste, often occurs when receiving some drugs - - fidageiewste

The violation of the taste sensitivity may indicate the damage to the language nerve or part of the intermediate nerve of the Vrysberg in the facial nerve. To identify topical neurological diagnosis, the detection of taste disorders may be essential. For the lesion of the IX cranial nerve, a bitter and salted perception disorder is more characteristic, detectable on the back third of the language.

The undoubted importance for neurological topical diagnostics has the disorders of certain types of taste sensitivity on a specific language of the tongue on the one hand, since sensitive disorders on both sides can be due to the oppression of the receptor apparatus due to the diffuse pathology of the mucous membrane of the language sheath and the walls of the oral cavity. The decrease in the brightness, clarity of taste sensations may be in the elderly due to progressive atrophy of the part of the taste puffs and a decrease in the secretion of saliva, which occur during aging and are provoked by the wearing dentures, especially inserted upper jaws, long-term tobacocco, long stay in depression. Disorder of taste is the possible consequence of the dryness of the mouth due to a violation of salivation, for example, for SHEGREEN DISEASE.

Hypathyism is often noted during the designation of the language, tonsillitis, glossite (in cases of hypovitaminosis A, Pellagra, with long-term treatment with antibiotics, during radiation therapy). Asevsia may be in patients with endocrinopathy phenomena (hypothyroidism, diabetes etc.), with family disavtonomy (Riley-Dei syndrome). In the illness of Addison, a significant exacerbation of taste is possible (hypergesship). Disagreements may be a consequence of the reception of many drugs: tetracycline, D-penicillamin, etcutol, antifungal drugs, Levodopa, lithium carbonate, cytotoxic agents.

9.6. Syndromes, including signs of lesion of the oblong brain and its cranial nerves

Dandy Walker Syndrome - Congenital vague of the development of the caudal department of the brain barrel and the worm of the ceremony, leading to the incomplete disclosure of the median (Majand) and the lateral (raw) apertures of the IV ventricle of the brain. Manifested by signs of hydrocephalus, and often hydromoseyl. The last circumstance

1 To test the taste sensitivity, you can use sugar solutions, salts, citric acid, quinine.

in accordance with the hydrodynamic theory of Gardner, the development of Siringomyelia, Siringobulbia may determine. The pronounced Deed-Walker syndrome is characterized by manifestations of functional insufficiency of the oblong brain and cerebellum, symptoms intracranial hypertension. The diagnosis by visualizing brain tissue methods - CT and MRI, while the signs of hydrocephalus are detected and, in particular, the expressed expansion of the IV brain ventricular, it is possible to identify the deformation of the indicated brain structures. Described in 1921. American neurosurgeons W. Dandy (1886-1946) and A. Walker (born in 1907).

Laruelle syndrome it is characterized by signs of intracranial hypertension, in particular, an intensive intense diffuse headache, contracture of cervical muscles, tonic convulsions, respiratory and serovascular disorders. Possible destruction of the edges of a large tilted hole (Symptom Baby).Described in the subittorial localization tumors Belgian neuropathologist M. Laruelle.

Anomaly Arnold-Kiaari-Solovtseva (See chapter 24).

Oscillopsy- Illusion of fluctuations in fixed items. Oscillopsy in combination with vertical nystagm, instability and vestibular dizziness is observed during cranitectural anomalies, in particular with Arnold Kiari syndrome.

Symptom of Oder- Voice's probing, sometimes aphonia as a result of a paresium or paralysis of voice ligaments caused by the defeat of the returnable gentle nerves. The reason may be squeezing their tumor of mediastinum, as well as a hypertrophied heart or left pulmonary artery With stenosis of the mitral valve. Described in 1897. Austrian doctor N. ORTNER (1865-1935).

Lermitta Monier Syndrome (Tsokanakis Symptom) - Swallowing disorder caused by the spasms of the muscles of the pharynx and esophagus arising from irritation of the wandering nerves by the pathological process on the basis of the skull or in the tissues of the neck and mediastinum. It is found, in particular, with a mediastinal tumor. French neuropathologists J. Lhermitte (1887-1959), Monier and Greek Physician Tsokanakis (Tsocanakis).

Long-catching nerve neuralgia (Sicar-Robino syndrome) - Acute attendant pain, starting at the root of the tongue or in almond and disperse on a chicken curtain, a throat, irradiating in the ear, into the lower jaw, in the neck. Pain attacks can be provoked by the movements of the language, swallowing, especially when taking hot or cold food. Pain attack lasts up to 2 minutes. Essential and symptomatic forms of neuralgia are distinguished. The cause of the disease can be the inflection (angilation) and the compression of the sub-speaking nerve at the place of its contact with the rear-litter edge of the cylinder muscle or squeezing the root of the nerve compacted by vertebral or lower cerebulosk arteries, as well as inflammatory and blastomatous processes or aneurysms in the rear crankname. Described French Neuropathologist R. SiCard (1872-1949), French Morphist M. Robineau

(1870-1960).

Drum plexus syndrome (Reachert syndrome) - attacks of acute pain in the depths of an external auditory passage, often irradiating to the ear, in the temple, sometimes into the homoolateral half of the face. Unlike the neuralgia of the Language nerve, there are no pains in language, almonds, nose, changes in salivation. In addition, the appearance of pain is not connected with

language language and swallowing. Usually accompanied by edema and hyperemia in the exterior auditory passage. Essential and symptomatic forms of the disease are distinguished. Described the syndrome when irritating the drum plexus in 1933. The American surgeon F. Reichert (born in 1894).

Cerebelchkovo-Brain Cistern Blocade Syndrome - the rigidity of the cervical muscles (head extensors), sharp pain in the occipital region, diffuse cutting headache and other signs of occlusal hydrocephalus (see chapter 20), are possible bulbar symptoms, in particular respiratory disorder, stagnant phenomena on the eye day and other signs of intracranial hypertension . Described in 1925 Lange and Kindler.

Syndrome of the jugular hole (Syndrome Verne, Sicar Coll Sycar) - a combination of signs of lesion of IX, X and XI cranial nerves, emerging from the cavity of the skull through the jugular hole. It occurs due to the fracture of the base of the skull passing through the jugular opening of the occipital bone, or the presence in the zone of the tumor hole, more often metastatic.

Described in 1918. French doctors: M. Vernet neuropathologists (1887-1974), J. SiCard (1872-1929) and otorhinolaryngologist F. Collet (1870-1966).

Retroparotite syndrome (Willar syndrome) - a combination of signs of unilateral lesions of the IX, X, XI and XII cranial nerves and the cervical sympathetic trunk, which leads to a combination of manifestations of Sicar-Cole syndrome and a horner syndrome. Usually indicates the extracranual location of the pathological process, more often in the retrotype space (tumor, lymphadenitis of the near-wing region). Described in 1922 the French neuropathologist M. Villaret (1887-1944).

Serzhan Syndrome- a combination of signs of damage to the wandering nerve or its branch - upper generous nerve with a horn syndrome in the pathological process (tumor, tuberculous focus, etc.) in the upper share of the lung. Described the French therapist F. Sergent (1867-1943).

Arnoldova Nerva Syndrome - The reflex cough caused by irritation of the outer auditory passage and the lower-beetles of the part of the eardrum - zones innervated by the ear branch of the vagus nerve, known as the nerve of Arnold.

The nerve is named by the German anatoma F. Arnold (1803-1890).

Engla Sterling Syndrome - congenital or acquired lengthening or curvature of the rogues of the sub-band bone, fibrosis of the shieldy-language folds, resulting in irritation of the X-XII cranial nerves on the same side. Possible attacks of staging of the muscles of the larynx, choking, the feeling of "turning" the language, the difficulty of the lantern and swallowing, the rotation head. With a chilovoid-pharyngeal type of this syndrome, sore throat (in a tonsillar fossa and almond), irradiating in the ear and in the region of the sub-speaking bone occur. With a semi-carotid type of syndrome, pain is usually in the forehead area, a soccer, in eye apple And from here I am radiating in the temple and the theme. The American dentist was described by E. Angle (1855-1930) and the Polish neuropathologist W. Sterling (born in 1877).

Retro-solment syndrome (Mac-Kenzi syndrome) - a combination of voice mastering (dysfony), swallowing disorders (dysfagia), hypotrophy and a tongue pan in which fibrillar twitching is possible. Occurs when the dual brain is damaged in the coated brain (related to IX and X systems and X of cranial nerves) and the sub-surround (XII) motor nuclei or axons included in their composition of motioneons forming the corresponding cranial nerves in

their exit from the oblong brain in the anterior side of the furrow between the lower Olion and the pyramid. Described the English doctor S. McKenzie (1844-1909).

Jackson syndrome - an alternating syndrome in which the pathological center is located on one side of the oblong brain, while the root of the sublard (XII cranial) nerve and the fiber of the cortical and spinal conductive pathway are affected, moving on the other side on the boundary of the oblong and spinal cord. It is characterized by the development on the side of the pathological focus of the peripheral pares or paralysis of half of the language, on the opposite side, the central hemiparegin or hemiplegia occurs. Described in 1864 English Neuropathologist J. Jackson (1835-1911).

Medial Medullar Syndrome (Dezlin Syndrome) - Alternating syndrome, in which peripheral paralysis of half of the language develops on the side of the pathological focus, and on the opposite side is central hemiparesis or hemiplegia in combination with a deep, vibration and reduction of tactile sensitivity. It usually occurs due to occlusion of the short branches of the basilar artery and the upper part of the anterior spinal artery that feeds the paramedian area of \u200b\u200bthe oblong brain. Described the French neuropathologist J.j. Dejerine (1849-1917).

Dorsolateral syndrome of the oblong brain (Wallenberg-Zhaharchenko syndrome, lower rear cerebulic artery syndrome) - Alternating syndrome resulting from ischemia in the lower rear cerebulic artery pool. It is manifested by dizziness, nausea, vomiting, Icota, dysarthria, voting disappointment, swallowing disorder, reduced phase reflex, while on the side of the lesion there are hyptestesias on the face, a decrease in the root reflex, paresis of soft noise and muscles of the pharynx, hemi-attack, Gorner syndrome, nystagm when viewed In the direction of the lesion focus. On the opposite side, a decrease in pain and temperature sensitivity on hemitep is revealed. Described in 1885 German doctor A. Wallenberg (1862-1949), and in 1911 the domestic doctor MA Zakharchenko (1879-1953).

Syndrome Avellisa - an alternating syndrome that occurs due to the lesion of the oblong brain at the level of the location of the double kernel, which is revealed to the IX and X cranial nerves. With Avellis syndrome on the side of the pathological focus, paralysis or paresis of a chicken curtain, voice bundle, esophagus muscles are developing. Dispony and dysphagia appear, and on the opposite side - central hemiparesis, sometimes hemigipesthesia. Described in 1891 German otorinolaryngologist G. Avellis (1864-1916).

Schmidt syndrome- Alternating syndrome, in which the defeat of the oblong brain leads to the fact that the peripheral paralysis of soft nose, pharynx, voice ligament, sternum-clarity muscles and the upper part of the trapezoid muscle (consequence of the lesion of IX, X, XI, XI of the cranial nerve develops on the side of the pathological spot ), and on the opposite side - central hemiparesis, sometimes hemigipesthesia. Described in 1892 the German doctor A. schmidt (1865-1918).

SISTAN-SHENE SYNDROM - Alternating syndrome occurring in the lesion of the oblong brain at the level of the double kernel. It is manifested by paralysis or part of muscles, innervated IX and X by cranial nerves, cerebellar insufficiency and signs of the city of Gorner on the side of the pathological focus, and on the opposite side - conduction disorders (central hemiparem, hemigipesthesia). Described in 1903. French neuropathologists E. Cestan (1872-1933) and L. Chenais (1872-1950).

Syndrome Babinsky-Press - Alternating syndrome, in which the side of the pathological focus arises the lesion of the lower cerebulic leg, the olive-cooled path and sympathetic fibers, as well as the pyramid, spinatelamic paths, the medial loop. On the side of the lesion, cerebellar disorders are noted (hemiactsia, hemiaxyergy, leaselscence), Gorner syndrome, on the opposite side - central hemiplegia (hemipapes) in combination with hemiagesthesia (hemigipesthesia). Described in 1902. French neurologists J. Babinski (1857-1932) and J. Nageotte (1866-1948).

Volleyshtein syndrome - Alternating syndrome, in which the top of the double kernel and the spinctalamal path is affected in the coated brain. On the side of the pathological focus, paresis of voice ligament is revealed, and on the opposite side - a disturbance of pain and temperature sensitivity. Described German doctor K. Wollestein.

Tapia syndrome- alternating syndrome due to the lesion of the oblong brain, in which the sideways of the pathological focus arises the defeat of the nuclei or the roots of XI and XII of the cranial nerves (peripheral paralysis of the sternum-clerical and trapes and trapezoid muscles, as well as half of the language), and on the opposite side - central hemiparesis . Described in 1905. When thrombosis of the bottom rear cerebellar artery, the Spanish otorhinolaryngologist A. Tapia (1875-1950).

Syndrome Grenouwa - an alternating syndrome, in which the lower core of a trigeminal nerve and a spitlamic path suffers on one side of the oblong brain. Gomolaterally manifests itself by the disorder of pain and temperature sensitivity by segmental type on the face, contrast - rally - impaired pain and temperature sensitivity on the conducting type on the body and limbs. I described the German doctor A. Groenouw (1862-1945).

Syndrome defeat pyramids - Isolated lesion of the pyramids located on the ventral side of the oblong brain, through which approximately 1 million axons, constituting the actual cortical-spinal pathway, leads to the development of the central, mostly distal tetrapab, while more significant paresis of hands. Muscle tone in such cases is low, the pyramidal pathological signs may be absent. The syndrome is a possible sign of a tumor (more often than meningioma), a skate base of the skull (Blumenbachova Skate).

9.7. Boulevard and pseudobulbar syndromes

Bulbarium syndrome, or bulbar paralysis, - Combined lesion of the bulbar group of cranial nerves: language inheritant, wandering, added and subel. There is a violation of the functions of their nuclei, roots, trunks. It is manifested by a bulbar dysarthria or anartree, in particular a nasal touch of speech (Nazolalia) or a loss of voice sounding (Aphonia), a disorder of swallowing (dysphony). Atrophy, fibrillary and fascicular twitching in the language, "briquette", manifestations of a sluggish pan of breast-curable and large-sighted and trapezoid muscles. Typically fade away, sip and cough reflexes. Especially dangerous respiratory disorders and cardiovascular disorders.

Bulbar dysarthri - Speech disorder due to sluggish paresium or paralysis providing her muscles (muscles of the language, lips, soft nose, pharynx, larynx, muscles, lifting the lower jaw, respiratory muscles). The voice is weak, deaf, depleting. Vowels and ringing consonants are stunned. The speech timbre is changed by the type of open bent, lubricated the articulation of consonant sounds. The articulation of the slot consonants is simplified (D, B, T, P). Selective disorders of the pronouncement of the mentioned sounds are possible due to the variability of the degree of sluggish pan of individual muscles of the spectavatic machine. Speech slowed down, quickly tires the patient, speech defects are realized, but it is impossible to overcome them. Bulbar dysarthria is one of the manifestations of bulbar syndrome.

Syndrome Brissoit is characterized by the fact that the patient with the bulbar syndrome periodically, more often at night, there is a total trembling, pale skin, cold sweat, respiratory disorders and blood circulation, accompanied by the state of anxiety, vital fear. It is probably a consequence of the disc function of the reticular formation at the brain barrel level. Described the French neuropathologist E. Brissaud (1852-1909).

Pseudobulberry syndrome, or pseudobulberry paralysis, - Combined violation of the functions of a bulbar group of cranial nerves, due to bilateral damage to the cortical nuclear paths going to their nuclei. The clinical picture at the same time resembles the manifestation of the bulbar syndrome, but the paresa is central (the tone of the parethous or paralyzed muscles is increased, there is no hypotrophy, fibrillary and fascicular twitching), and the pharyngeal, roasting, cough, the mandibular reflexes are increased. In addition, the severity of reflexes of oral automatism is characterized, uncontrolled emotional reactions - violent crying, less often - violent laughter.

Pseudobulbar dysarthri - Speech disorder due to central paresium or paralysis providing its muscles (pseudobulberry syndrome). Voice is weak, sipid, hoarse; The tempo of speech slowed down, the timbre of it is vigilant, especially when they pronounce consonant with complex articulation structure (P, L, W, W, H, C) and vowel rear rows (E, and). Flicer consonants and "p" are usually replaced by slotted consonant sounds, which is simplified. The articulation of solid consonant sounds is disturbed to a greater extent than soft. The ends of words are often not negotiated. The patient is aware of the defects of articulation, actively tries to overcome them, but at the same time the tone of muscles, providing speech, and the increase in the manifestations of dysarthria increases. Pseudobulbar distemper is one of the manifestations of pseudobulbar syndrome.

Reflexes of oral automatism - A group of phylogenetically ancient proprioceptive reflexes, in the formation of their reflex arcs participate V and VII cranial nerves and their kernels, as well as cells of the kernel XII cranial nerve, whose axons innervate the circular muscle of the mouth. Are physiological in children under the age of 2-3 years. Later, the braking influence of the subcortical nodes and the bark of the large hemispheres are rendered. With the defeat of these structures of the brain, as well as their links with marked cranial nerve cores and reflexes of oral automatism are manifested. They are caused by irritation of the oral part of the face and manifest themselves to pull the lips - a sucking or kiss movement. These reflexes are characteristic, in particular, for the clinical picture of pseudobulbar syndrome.

Fig. 9.15.Trump reflex.

Trump Reflex (Oral Reflex Bekhtereva) - involuntary repulsion of the lips in response to a slight tapping by the hammer on the upper lip or on the lips of the examined finger (Fig. 9.15). Described the domestic neuropathologist V.M. Bekhterev (1857-1927).

Reflex (sucking reflex Oppenheim) - The appearance of sucking movements in response to the lip barn irritation. Described the German neuropathologist H. Oppengeim (1859-1919).

Wurup-Toulouse Reflex (Würpa Light Reflex) - involuntary pulling of the lips reminiscent of

slow motion arising in response to the barn irritation of the upper lip or her percussion. This is one of the reflexes of oral automatism. The French doctors were described by S. Vurpas and E. Toulouse.

Oral reflex Oppenheima - Chewable, and sometimes swallowing movements (except for a sucking reflex) in response to barn irritation. Refers to reflexes of oral automatism. Described the German neuropathologist H. Oppenheim.

Reflex Escherich- a sharp pulling of lips and pour them in this position with the formation of the "goat muzzle" in response to irritation of the mucous membrane of the lip lip or cavity. Refers to reflexes of oral automatism. I described the German doctor E. Escherich (1857-1911).

Reflex "Bulldog" (Reflex Yanishevsky) - Tonic closure of the jaws in response to irritation by the lip of the lip, a solid neba, gum. Refers to reflexes of oral automatism. Usually manifests itself with the defeat of the frontal stakes of the brain. Described the domestic neuropathologist A.E. Yanishevsky (born in 1873).

Nazolabial reflex (nasolabial Reflex Actitzaturova) - Reducing the circular muscles of the mouth and protrusion of the lips in response to the tapping of the hammer on the back or the tip of the nose. Refers to reflexes of oral automatism. Described the domestic neuropathologist M.I. Actitzaturov (1877-1936).

Oral reflex Gennaberg - Reduction of the circular muscles of the mouth in response to irritation with a solid snub. I described the German psychoneurologist R. Genneberg (1868-1962).

Distant oral reflex Karchikyan-mortar - Pulling the lips when approaching the lips of a hammer or any other subject. It is worn to symptoms of oral automatism. Described domestic neuro-pathologists I.S. Karchikyan (1890-1965) and I.I. Solutions.

Distant oral reflex Bogolepov. After causing a trunk reflex, the approach of the hammer to the mouth leads to the fact that it opens and freezes in the position of "preparedness for feeding food". Refers to reflexes of oral automatism. Described the domestic neuropathologist N.K. Bogolepov (1900-1980).

Distant chin reflex Babkin - Reducing the chin muscles when approaching the face of the hammer. Refers to reflexes of oral automatism. Described the domestic neuropathologist P.S. Babkin.

Liberal Reflex - Reducing the chin muscles in lips irritating. It is a sign of oral automatism.

Lumbela reflex fishing - Intensive closure of the open mouth when hit by a hammer over a soldier, laid across lower jaw on her teeth. It can be positive when bilateral damage to cortical nuclear tract. Described the domestic doctor Ya.V. Fishing (1854-

1909).

Clonus Lower Jaw (Dana Symptom) - Clonus of the lower jaw when tapping a hammer on the chin or along a spatula, laid on the teeth of the patient's lower jaw who is ajet. It can be detected at bilateral damage to cortical nuclear paths. Described American

ch.L doctor. Dana (1852-1935).

Nespool Reflex Guiena - Closing the eye when tapping a hammer on the back of the nose. It can be called with pseudobulbar syndrome. Described the French neurologist G. Guillein (1876-1961).

Palm-chin reflex (Reflex Marine-Radovichi) - Later exterructive skin reflex (compared to oral reflexes). The reflex arc closes in striatum. The braking of the reflex provides the bark of large hemispheres. Caused by barn irritation of the skin of the palm in the elevation of the thumb, while on the same side there is a reduction in the chin muscle. Normally causes in children up to 4 years of age. In adults can be called in cortical pathology and damage to cortical-subcortical, cortical nuclear ties, in particular with pseudobulbar syndrome. Described Romanian neuropathologist G. Marinesku (1863-1938) and French doctor I.G. Radovici (born in 1868).

Violent crying and laughter - A spontaneously arising, non-validary suppression and does not have adequate causes of the Mimic, inherent in crying or laughter, not contributing to the resolution of the internal emotional stress. One of the signs of pseudobulbar syndrome.

The role of brain activity in the life of a person is huge. The brain of the highest mammal regulates all the important functions and consists of 2 parts - the spinal and head. The head contains 5 compartments, one of which is an oblong brain. It controls the vegetative nervous system.

Structure

The human brain (lat. Myelencephalon) is just a part of the brain. Located this department between the dorsal and middle, in the rear cranial fossa. It is a thickened continuation of the spinal cord. It looks like a bow of a bow, which is grown behind and has a small bulge in front. This department connects the cerebellar part and the bridge with the help of special processes.

Below, this site smoothly flows into the spinal department. The lower line is determined by the output by the upper root thread of the 1st cervical nerve. From above, it borders with a Varoliski bridge. From him this part separates the perpendicular bulbar-bridge of furridge. The longitudinal size of this section is 2.5-3.2 cm, transverse - 1.5 cm, front-facing - 1 cm.

The structure of this department is heterogeneous, it consists of a gray and white substance. Inside there is a grayish substance. It is surrounded by the smallest nuclei. White substance is located outside. It surrounds a grayish substance. White part consists of short and long fibers.

Long fibers are passing transit in the spinal cord path. They crossed in the pyramid area. In the rear cores of the rear cadets there are body of neurons upwards of fibers. The processes of these neurons go from the oblong cerebral department for Talamus. The fibers form a medial loop that crosses in the oblong brainstone. In this department there are 2 intersection of long conducting paths.

Briefs include bunches of fibers that connect with each other with a gray nucleus. The cores of the oblong cerebral section are connected to the neighboring brain departments.

External structure

The outer front of the oblong cerebral area is a ventral surface. It consists of paired cone-shaped side fractions that expand up. They are formed by the pyramidal paths and have the median gap. Near the pyramids are olives. They are separated from the pyramids of the furrows, which is a direct continuation of the opposite groove of the spinal cord. The transition of furrows from the spinal cosette to the continued smoothed by outer arcuate fibers.

The back exterior is a dorsal surface. It looks like two cylindrical thickening, which are separated by the median furrows. This is part of the fibrous beams that are connected to the spinal cord.

On the dorsal side there are two beams: thin and wedge-shaped. They end with tubercles of a thin and wedge-shaped nucleus. On the dorsal surface there is the lower part of the rhinestone fossa and the lower legs of the cerebellum. Here is the rear vascular plexus.

Between the ventral and dorsal surface are the side surfaces. They have furrows that originate in the spinal cord.

Internal structure

The inner structure coordinates such functions: exchange processes, blood circulation, breathing, movement, equilibrium. On the cross section of the oblong cerebral department produced at olive level, the grooves emerging from the spinal cord are visible. There are pyramidal paths between them.

Outside the pyramids are small tubercles. These are Olives. Inside them there are lower olive cores. They are a convolve plate of gray substance. Olive cores are associated with cerebellum kernels and are responsible for the balance and activities of the vestibular apparatus. Between them are fibers. Between the pyramid and olive there is anterior furrow.

In the posterior departments undergo rising paths, which bind the bottom of the brain with the upper departments. In the dorsal part of the oblong cerebral area there are nuclei of a wandering, tongue-silica, added accelera brain nerve.

The ventral part of the oblong cerebral department is a reticular formation. It is formed due to the weave of nerve fibers and the nervous cells between them. The motor part of the reticular formation contains centers controlling respiration and blood circulation.

Tasks

The main task of the oblong brain, based on the features of its structure and the functions performed, is to provide various reflexes. These include: protective, digestive, cardiovascular, tonic, as well as those responsible for ventilation of light and muscle tone.

How protective reflexes are valid:

• if you get into the stomach poison or poor-quality food, a vomit reflex is triggered;
• if dust gets into the nasopharynx, sneezing occurs;
• the mucus released in the nose protects the body from bacteria and viruses;
• kashchal attacks clean the bronchi from mucus;
• tearing and blinking protects eyes from foreign objects, and cornea - from drying out.

In this part of the brain there are nervous centers responsible for many reflexes: digestion, breathing, muscle tone, sucking, blinking, cardiovascular, thermoregulation. This department participates in the processing of information coming from all body receptors. It also controls the movement and thought processes.

The respiratory management center works like this: neurons are excited under the influence of chemical stimuli. The center itself consists of several groups of neurons, which relate to different areas of the oblong brain.

The tone of the vessels is controlled located in the oblong brainstone by a vesselovatory center, which works with the hypothalamus. Chewing occurs when irritating the oral cavity receptors. In the oblong cerebral department, salivation is regulated, due to which the volume and composition of saliva is controlled.

Functions

Functions that regulate the oblong brain are important for human organism. If this body is amazed during injuries or strokes, a person can stop, the heart, which will entail a fatal outcome.

What are the functions of the oblong brain and what is his physiology?

The oblong brain department performs such basic functions:

• reflex;
• conductive;
• sensory.

8 pairs of cranial nerves leave it (from 5 to 12). This department has a direct sensitive and motor connection with the periphery. According to sensitive fibers, impulses from the scalp receptors of the head, nose, taste receptors, mucous membranes of the eye, from hearing a hearing, larynx receptors, tracheas, and lungs, from the vestibular apparatus, as well as from perceiving interior digestive and cardiovascular systems.

The functions of the oblong brain of a person:

• regulation of complex unconditional reflexes responsible for protecting the body (sneezing, cough, vomiting, tearing);
• ensuring complex unconditional reflexes associated with digestion (swallowing, sucking, salivation);
• regulation of protective and indicative reflexes, speech, hearing and facial expressions;
• ensuring breathing and blood circulation automatism;
• support for equilibrium torso and muscle tone.

Through the cores of the oblong cerebral area are reflex arcs, providing cough reflexes, sneezing, tears. In the cores themselves, there are centers that are responsible for the act of swallowing, the activity of digestive glands, hearts, vessels, respiratory regulation.

The reflex functions of this organ are determined by the fact that there are nuclei kernels and there are accumulations of nerve cells. The cores are connected with each other and form centers of various reflex acts.

The functions of reflexes are divided into 2 types: paramount and minor. Respiratory and vascular centers are vital primary centers, as a number of respiratory and heart reflexes are closed in them.

In this brainstone, important reflex centers are laid. Each center regulates the activities of a certain organ. Information from the stimulus is transmitted through nervous fibers. They fall into an oblong brain department. There is a signal processing and their analysis. From the centers, the impulses are transmitted to the authorities and cause changes in their activities, for example, enhancing activity or braking.

Through the oblong brain, such reflexes are carried out:

• protective;
• tone muscles;
• digestive;
• cardiovascular;
• breathing;
• vestibular;
• motor.

The reflex function of muscle tone and maintaining posture is performed not only by this brainstone, but also by other nervous structures. This authority provides motor functions on the reflex level, and also involved in the commission of arbitrary movements. Protective reflexes - sneezing, vomiting, swallowing - are carried out thanks to the centers located here. The main purpose of such centers is the coordination of neurons.

The conductor function lies in the following: in the oblong brain there are ascending and descending spinal cord fibers: corticospinal, spinal thalalamic, ribrouspinal. With these paths, information is transmitted to the brain departments and treated pulses back to the organs.

In this part, the beginning of olivospinal, vestibular licorpinal and reticulous-permanent paths originate. They provide the tone and coordination of muscle reactions. In this organ, corvering cordorecular paths from the bark are completed, as well as the upward fibers of proprioceptive sensitivity from the spinal cord.

Various brain departments - bridge, cerebellum, medium brain, hypothalamus, Talamus and Bark have bilateral connections with an oblong brain. Thanks to such connections, this body is involved in the regulation of the tone of skeletal muscles, the analysis of sensory irritations.

The cross-section of the oblong brain represents a different picture depending on the level on which it is conducted.

At the level of the lowest department of the oblong brain, the incision largely resembles the relationship between the gray and white substance existing in the upper neck segments of the spinal cord. However, there are essential, very important features. The rear horns are moved away from the edge of the cut, since the fibers of the rear roots are no longer entering. The extreme border of the rear horns is here the substantia gelatinosa, to which the fibers of the descending bundle of a trigeminal nerve are suitable. A group of nerve cells located at the base of the front horn gives rise to the root of the addition nerve (XI). The location of the spinal beams remains the same as in the spinal cord. In the area of \u200b\u200bthe rear poles, the cores of thin and wedge-shaped beams are clearly visible. Especially characteristic of this level of the Pyramid (Decussatio Pyramidum), which occurs on the front surface of the oblong brain.

The cut, spent at the level of the nucleus of the sub-speaking nerve, already a little resembles the painting of the cross section of the spinal cord: there are no front horns, only certain groups of cells of the cores of additional and sub-speaking nerves occupy their place; There are no rear horns; The remainder of the rear Horn, presented by the cells of Substantiae Gelatinosae, is pushed towards the massive cores of thin and wedge-shaped beams. Powerful bundles of internal arc-fibers - Fibrae Arcuatae Internae are associated with these nuclei - switch to the opposite direction and in front of the central channel are crossed with the same fibers of the other side. This is the so-called upper cross, or the crossover loops, - Decussatio Lemniscorum. After crossing the fibers form a medial loop - Lemniscus Medialis.

On the cross-section of the oblong brain at the level of the lower third of the rhombid fossa, the nucleus of the puzzling and vagus nerves is visible: Nucleus Dorsalis, Nucleus Ambiguus, Nucleus TR. Solitarii, Nucleus Salivatorius Inferior (N. IX).

In the upper term of the oblong brain, where the rhombid fossa forms the side protrusions, the Pedunculi segue-Belares Inferiores (rope bodies) occupy the lateral peripherals of the cut, as well as the nucleus, is clearly visible. vestibulocochlearis. On the middle line of the oblong brain, throughout the long, it occurs its cross-various fiber systems. This place is called seam - raphe.

Conductive paths of the oblong brain are the continuation of the paths described in the spinal cord.

Cranial nerve cores are located mainly in the dorsal departure of the oblong brain, sensitive conductors - on the middle floor it, motors - in the most central department itself.

An oblong brain is the continuation of the spinal cord, the top boundary of the first cervical vertebra (C 1) is the place of its place. In shape, it resembles an inverted cone with a truncated top and has relatively small dimensions: the average length is 25 mm, the width at the base is 22 mm, the thickness is 14 mm. Weigh the oblong brain on average about 6 grams.

Development

In the process of ontogenesis, the oblong brain develops from the nervous tube. The fifth week of embryonic development is the stage of three brain bubbleswhere he originates from the diamond-shaped brain, Rhombencephalon. The morphological features of the relief of the oblong brain are due to metamorphoses in the process of organogenesis. The side walls of the nervous tube become thicker, and the dorsal wall, on the contrary, it is thinned and remains only in the form of a thin plate with a layer of ependymal epithelium and adjacent to it outside the vascular shell of the IV ventricle.

Structure

Now let's talk about the morphological component. In the oblong brain, the ventral, dorsal and side sides are distinguished, as well as white and gray matter. Let's start considering the terrain of the parties and important anatomical entities that are located there.

The most variable in its structure is a dorsal surface. In the center of it there is a rear median furrorous, Sulcus Medianus Posterior. There are two beams on the sides of her: a thin beam of a goal and a wedge-shaped bundle of the Burdach is the continuation of the rear coams of the spinal cord. On both sides, laterally from a wedge-shaped beam, there are sideways that in the middle of the oblong brain form small thickening, they are called the lower legs of the cerebellum, Pedunculus Cerebellaris Inferior. A triangle-shaped platform is formed between these legs - this is the lower half of the rhinestone. It is important to note that this structure is allocated only anatomically.

Now go to the side surfaces. Laterally from the pyramid is the front lateral furrorous, Sulcus Anteriolateralis, which is also the continuation of the same name of the groove on the spinal cord. Next after it are located olives, Olive. Olives are rear lateral furrows, Sulcus Posteriolateralis, which has no analogues on the spinal cord. From her will leave the roots of cranial nerves: added (n. Accessorius Xi steam), wandering (n. Vagus x steam), languagehloxy (N. Glossopharyngeus IX steam).

Finally, on the ventral side there are pyramids of the oblong brain, Pyramides Medullae Oblongatae. They are located on the sides of the front median slit, Fissura Mediana Anterior, which is the continuation of the stunning furrow on the spinal cord. On the border with the spinal cord of the fiber, the pyramids crossed out, forming the crossing of the pyramids, Decussatio Pyramidum.

Nuclei

Now let's talk about the inner structure of the oblong brain. It consists of gray and white substance. The gray substance is represented by nuclei, and white by nerve fibers of the longitudinal direction, which consequently form downward paths. But first things first.

Let's start studying the internal structure from the gray matter. In form, it differs from that in the spinal cord: here it is represented exclusively by nuclei. Traditionally, they are divided into four groups:

The first group: a thin and wedge-shaped core. They are located in the eponymous tubercles and are terminal neurons of fibers of thin and wedge-shaped beams. An important feature here is the course of fibers. The main part of the axons of these cores with a single beam is directed ventral, and then on the opposite side and up. In the field of the median line, these fibers form the crossing of medial loops, Decussatio Lemniscorum Medialium. The end of the medial loop is on the Talamus kernels, which causes the second name for a beam of the goal - the bulbar and Talalamic tract, TR. Bulbothalamicus. The remaining axons make up the other path - bulbar and cerebellar, tr. BulBocerelAllaris. These fibers go in the direction of the kepent, go to the ventral surface of the oblong brain near the front median slit, envelp the pyramids and in the composition of the lower legs of the cerebellum enter it.

The second group of nuclei is the olive core. From the bark of the hemispheres of a large brain and from the red nuclei of the middle brain are nervous fibers to the olive kernels. Here, as in the previous group, the junction is controlled, that is, most of the axons goes to the opposite direction and enters the cerebellum in the composition of its lower legs, forming an olivo-cerebellar path, TR. Olivocelebellaris. The remaining part of the axons will form a downward olivo-spinal path, TR. Olivospinalis.

Slightly more than Oliva is the third group of kernels of the core of the reticular formation, Nuclei Formation Reticularis. It is known that the oblong brain is a rather important part of the CNS, since it contains nervous centers of complex respiratory reflector acts, heartbeat, the tone of the tone of vessels and muscles. Representatives of these centers are large nuclei of the reticular formation. There are also present, so-called nonspecific nuclei, which are inserted neurons of the segmental apparatus of the brain stem.

The fourth nuclei group is represented by the core nerve core nerves of the IX-XII pairs. All of them are located on the rear surface of the oblong brain, closer to the cavity of the IV ventricle. Let's start with the XII pairs of the sub-speaking nerve, its kernels lie in the region of the sub-surround triangle, in the medial part of the lower angle of the diamondy hole. Rostrally (above) lies the core of the addition nerve, n. Accessorius. In the oblong brain on the dorsal surface, within the triangle of the vagus nerve, a small area is distinguished - gray wing, Ala cinerea. It contains the projection of the vegetative parasympathetic dorsal nucleus of the wandering nerve, Nucleus Dorsalos Nervi Vagi. Even above, the tress nucleus of the wandering nerve is a vegetative parasympathetic kernel of the IX pair, n. Glossopharyngeus is the lower saliva nucleus, Nucleus Salivatorius Inferior. Laterally from the vegetative nuclei, which we just considered, lies the structure of an elongated form, containing sensitive kernels for the X and IX pair of cranial nerves - this is the core of a single path, Nuclei Tractus Solitarii. Next, an interesting moment is followed, in most textbooks it says that the double core, Nucleus Ambiguous, is common for two pairs of cranial nerves - X and IX pairs, but it is not quite accurate. There is information that it is common to three pairs, so Nucleus Ambiguous is a motor core also for XI pairs, n. Accessories. It has a projection in the field of the rear median furrow, in the lower division of the rhombid pumme. On this we complete the consideration of the gray substance and go to the white.

White substance of the oblong brain consists of nerve fibers of the longitudinal direction. These fibers are divided into two types: afferent, carrying information to the nerve structures of the CNS (ascending) and afferent, carrying information on the periphery, to the working bodies and tissues (descending).

Rising fibers advantageously go from the spinal cord. Already known to us by Golly and Bourdach bundles, which are located on the sides of the rear median groove, end on the neurons of the same nuclei and make up the upstream paths: boulevard thalalamic and boulevard cerebellar. Closer to the lateral surface are the front and rear spinal cerebelling paths: the beams of Govers and Flexig. The first goes laterally and enters the cerebellum in its lower leg, and the Ventral Bunda of Govers, which should be controlled (makes the cross), bypassing the Talamus, continues to the bridge. MEDIALLY FROM GRAVER BEAM LIVES THE SPINTAME WAY, TR. Spinothalamicus, which carries the second name - Lemniscus Spinalis, the spinal loop. It combines the fibers of the same paths that go on the sides and in the front in the spinal cord.

The main weight of the paths is the fibers going down. Downward fibers are the paths that begin with various motion cores of the brain.

The downstream paths are divided into pyramidal and extrapyramidal, and the last, in turn, on the old and new ones. Through the oblong brain there are pyramidal and old extrapyramidal paths. The first group of paths include: Cortico-spinal, TR. corticospinalis, and subsequently - TR. Corticospinalis Lateralalis et Anterior. The largest descending path is cortico-spinal, tr. CorticOSPinalis lies on the ventral surface of the oblong brain. Before entering it, he goes on his side, and after it makes the cross and goes in the side rope of the spinal cord already under a different name - TR. Corticospinalis lateralalis. The small part of the fibers that entered the crossroads continue their way in the front corticle, forming the front cortical-spinal tract, TR. CorticOSPinalis Anterior.

On the dorsal surface there are two beams that contain in themselves the vehochetically conductive nervous system: rear and medial longitudinal beams, Fasciculus Longitudinalis Posterior Et Medialis. The medial longitudinal beam is an important associative path that binds the cores of the nerves of the eye muscles among themselves, which causes the closure of the reflex of the combined turn of the head and the eye towards the sound at the level of the oblong brain.

The old extrapyramidal paths passing through the oblong brain include: the roof-spinal path, TR. Tectospinalis, reticular-spinal path, TR. Reticulospinalis, a predestre-spinal path, TR. Vestibulospinalis, Red-cereal-spinal path, tr.rubrospinalis. Roof-spinal path, TR. Tectospinalis, lies in front of the medial beam. Dorsalier from the pyramid is the reticular-spindy path, TR. Reticulospinalis. Laterally lies the predver-spinal path, TR. Vestibulospinalis, and the medial of the spinal thalia path passes the red-core-spining path, Tr.RuBrospinalis. Functional anatomy These paths causes the performance of complex reflex acts, for example: in fast motor reactions in response to unexpected stimuli or can participate in the braking of the muscular neurons of the spinal cord.

On this we completed the consideration of the main pathways going through the oblongable brain. Also there are paths that bind sensitive core nerve cores (IX and X pairs) with large brain integration centers are nuclear-thalamic paths, TR. Nucleothalamicus and nuclear cerebellar, TR. NucleoCerebellaris. In the aggregate, they will provide overall sensitivity in the head of the head and are responsible for obtaining information from interiorsceptors.

Functions

After a detailed study of all important structures of the oblong brain, namely, its morphological components and transit routes can be concluded about the basic functions of the oblong brain:

1. Sensory - perception of afferent influences from receptors and their processing

2. Conductor - carrying out nerve impulses through the oblongable brain to other divisions of the central nervous system and to effector structures

3. Reflex - at the level of the oblong brain, important vital reflexes are closed: the organization and regulation of respiration and blood circulation, maintaining postures and protective reflexes (cough, sneezing, vomiting)

4. Integrative - on the neurons of the oblong brain programmed algorithms of complex regulatory processes, which need interaction with other centers of other departments of the nervous system.

Historically, the formation of the central nervous system led to the fact that the human brain is a kind of center of vital functions, such as respiratory management and the work of the cardiovascular system.

Location of oblong brain

Like the remaining brain departments, the oblong brain is located in the cavity of the skull. It takes a small space in its occipital part, at the top of the border with the Barolic Bridge, and the book through a large occipital opening without a clear boundary moving into the spinal cord. Its front median gap is a continuation of the spinal cord stalls of the same name. In an adult, the length of the oblong brain is 8 cm, its diameter is about 1.5 cm. In the initial departments, the oblong brain has an elongated shape, reminiscent of the spinal thickening. Then he seems to be expanding, and in front of its transition to the intermediate brain, massive thickens deploy from it in both directions. They are called the legs of the oblong brain. With their help, the oblong brain is connected to the cerebellum hemispheres, which, as it were, "sits" on his last third.

Internal structure of the oblong brain

Both externally and internally, this brain department has a number of features characteristic only for it. Outside it is covered with a smooth epithelial shell, which consists of satellite cells, inside it - numerous wired paths. Only in the region of the last third there are clusters of neurons nuclei. These are respiratory centers, the control of the tone of vessels, the work of the heart, as well as some simple congenital reflexes.

Appointment of oblong brain

The structure and functions of the oblong brain define its special place in the entire nervous system. It plays an important role as a binder of all other brain structures with the dorsal. So, it is through it that the cerebral bark receives all the information about the contacts of the body with surfaces

In other words, thanks to the oblong brain, almost all tactile receptors work. Its main functions include:

1. Participation in regulating the work of the most important systems and organs. In the oblong brain there are a respiratory center, a vascular motorized center and a cardiac rhythm regulation center.
2. The implementation of some reflex activity with the help of neurons: the blinking of the eyelids, cough and sneezing, vomit reflexes, as well as adjusting tears. They relate to so-called protective reflexes that ensure the ability of the human body to resist harmful factors external environment.
3. Providing trophic reflexes. It is thanks to the obligated brain that the children of the first years of life have a resistant sucking reflex. Also here include vital reflexes of swallowing and secretion of digestive juices.
4. Finally, it is this brain department that is considered the most important link in the formation of sustainability and coordination of a person in space.