CRANIAL NERVES

From Big Medical Encyclopedia

CRANIAL NERVES

[nervi craniales (PNA), nervi capitales (JNA), nervi cerebrales (BNA); synonym; head nerves, cranial nerves] — the nerves departing from a brain in number of 12 couples; innervate skin, muscles, bodies of the head and neck, and also a number of bodies of chest and belly cavities.

The first references of Ch. - m of N meet in Erazistrat's works (4 — 3 centuries BC) and Gerofila (Nego-philos, 3 century BC). According to Erazistrat's representations in a brain «the sincere pneuma» is formed, edges follows from it on nerves. The same idea of functions of nerves including Ch. - m of N, K. Galen adhered. Cranial nerves were described in 1543 by A. Ve-zaly, details of their structure were specified in the subsequent by K. Varoly, Vyessan (R. Vieussens, 4641 — 1715), Vrisberg (H. Wrisberg, 1739 — 1808), I. Prokhaska, Arnold (F. Arnold, 1803 — 1890). Recently the main attention is paid to studying vnutristvolno-go Ch.'s structures - to m of N, structure of nervous conductors, Ch.'s development - m of N.

Specifics of formation and a structure of cranial nerves in phylogeny and ontogenesis it is caused by features of development of the head that is in turn connected with laying of sense bodys and branchiate arches (with their muscles), and also a reduction of myotomes in the head. In the course of Ch.'s phylogenesis - m of N lost an initial segmented arrangement and became highly specialized., So, the I couple (olfactory nerve) and the II couple (optic nerve) formed by shoots of internuncial neurons represent the nerve pathways connecting an olfactor organ and an organ of sight with a brain. The III couple (third cranial nerve), the IV couple (a block nerve) and the VI couple (the taking-away nerve), to-rye developed in connection with head pre-ear myotomes, the muscles of an eyeglobe which are formed in these myotomes innervate. These nerves on the origin and function are similar to ventral roots of spinal nerves. V, VII, IX and X couples by origin and to the nature of branching are visceral branchiate nerves since innervate skin, muscles of the corresponding visceral branchiate arches, and also contain visceral motive fibers, the innervating glands and bodies of the head and neck in the structure. A specific place is held by the V couple (trifacial), to-ry is formed by means of merge of two nerves — the deep eye, innervating skin of the forefront of the head, and actually trifacial innervating skin and muscles of a mandibular arch. The deep optic nerve in the form of an independent nerve is found only in kistepery fishes. The VII couple (facial nerve) innervates at fishes the bodies of a sideline and a muscle derivative of a hypoglossal arch; at land vertebrata — superficial muscles of a neck; at primacies — mimic muscles. From a facial nerve in development the VIII couple (eighth cranial nerve) which is carrying out a specific innervation of an acoustic organ and balance stands apart. The IX couple (glossopharyngeal nerve) and the X couple (vagus nerve) — typical branchiate nerves. Cyclostoma, fishes and amphibiouses constantly have only listed above ten couples of Ch. - m of N of the XI steam — the eleventh cranial nerve consisting of visceral motive nerve fibrils develops only at the highest vertebrata by isolation of a caudal part of a vagus nerve. The XII couple (hypoglossal nerve) arises for the first time at amniot as a result of merge of roots, to-rye are allocated from spinal nerves.

In ontogenesis at a human embryo a bookmark Ch. - the m of N occurs at a stage of formation of head somites. Ch.'s part - m of N are somatic and visceral sensitive, and also somatic and visceral motive conductors. I and II couples develop as outgrowths from walls of final and intermediate brain bubbles (see the Brain). Development of other ten couples of Ch. - m of N happens similar to development of ventral (motive) and back (sensitive) roots of spinal nerves (see. Spinal cord). Motive components Ch. - m of N form by germination in laying of muscles of the head of bunches of nerve

fibrils from formed in a trunk part of the developing brain of cellular accumulations — laying of motive kernels (see Kernels of the central nervous system). Sensitive components Ch. - m of N form as a result of germination of bunches of nerve fibrils, to-rye are shoots of the neuroblasts which are in germinal nerve knots of the corresponding nerves.

Features of the subsequent formation of cranial nerves at the person are connected preferential with terms of development and extent of myelination of nerve fibrils. Fibers of motor nerves are myelinized before mixed and sensitive. The exception is made only by fibers vestibular (preddver-ache) parts VIII of couple, to-rye by the time of the birth are almost completely myelinized. Ch.'s myelination - m of N advances myelination of spinal nerves. At the age of 1 — 17 g of years almost all nerve fibrils Ch. - m of N are covered with myelin covers. Final formation of a gasserov of a node of a trifacial happens by 7 years, the glossopalatine and wandering nerves — still later. In newborns in motive Ch. - m of N quite often find accumulations of ganglionic cells of spinal type, to-rye later 4-year age gradually disappear, but separate cells remain sometimes and at adults.

With age in process of growth of the head length and diameter of trunks of Ch. - m of N increase. Their thickening partially goes due to increase in amount of connecting fabric to epineuriums and endonevriya. At senile age the amount of connecting fabric in an endonevriya decreases, and in epineuriums, on the contrary, increases. In general Ch.'s changes - the m of N connected with involution submit to patterns of age reorganization of nerves (see).

In cranial nerves afferent fibers quantitatively considerably prevail over efferent. As a part of Ch. - the m of N only on one party enters a brain apprx. 1,5 million afferent fibers (from them about 1 million nerve fibrils fall to the share of an optic nerve), and leaves it apprx. 100 thousand efferent fibers.

The m of N does not have uniform classification of Ch.-. Depending on preferential intra barreled structure allocate motor nerves (III, IV, VI, XI and XII couples), the innervating muscles of an eye, language, grudinoklyuchichno-mastoidal and partially trapezoid muscles; the mixed nerves (V, VII, IX and X couples) containing everything functional components except for motive somatic nervous conductors; nerves of sense bodys —

I and II couples, to-rye in connection with features of an origin and structure combine in separate group. Conditionally carry to this group of sensory nerves also the VIII couple on the ground that the eighth cranial nerve provides a specific innervation of an acoustic organ and balance (see Sense bodys).

All Ch. - m of N, except for I and II couples (see. The optic nerve, the Olfactory nerve), are tied with a brain trunk, in Krom their motive, sensitive and vegetative kernels are located (see the Autonomic nervous system). So, kernels III and

IV couples of Ch. - m of N are located on average a brain (see), kernels V, VI, VII, VIII

couples — are preferential in a tire of a varoliyev of the bridge (see the Bridge of a brain), kernels IX, X, XI, XII couples — in a myelencephalon (see). Places of an exit of Ch. - m of N from a brain or an entrance (fig. 1) to it are connected with the same departments of a brain. Everyone Ch. - m of N takes certain place of escaping of a head cavity.


Fig. 1. The diagrammatic representation of a basal surface of a brain of the person with the indication of places of an exit of cherepnomozgovy nerves: I \an olfactory nerve, 11 — an optic nerve, III — a third cranial nerve, IV — a block nerve, V — a trifacial, VI — the taking-away nerve, VII — a facial nerve, VIII — before - a door and cochlear nerve, IX — a glossopharyngeal nerve, X — a vagus nerve, XI — an eleventh cranial nerve, XII — a hypoglossal nerve; 1 — an eyeglobe, 2 — a temporal share, z — a leg of a brain, 4 — va-roliyev the bridge, 5 — a cerebellum, 6 — a myelencephalon, 7 — a spinal cord.

The anatomy, physiology and methods of a research separate Ch. - m of N are stated in articles the Olfactory nerve (see), the Optic nerve (see), the Third cranial nerve (see), the Block nerve (see). The trifacial (see) which is Taking away a nerve (see), the Facial nerve (see) Before a door and cochlear nerve (see), the Glossopharyngeal nerve (see), the Vagus nerve (see), the Eleventh cranial nerve (see), the Hypoglossal nerve (see).

Pathology. Disturbance of functions of each cranial nerve at different levels of its defeat is shown by accurate symptomatology, the analysis a cut plays an important role directed by the clinical and topical diagnosis of diseases of a nervous system. Distinguish syndromes of the isolated defeat separate Ch. - m of N, syndromes of complex defeat of nadjyaderny conductors, kernels and fibers Ch. - m of N in a brain trunk with simultaneous involvement in patol. process of conductors of motive, sensitive, extrapyramidal and vegetative systems (so-called cross, or alternating, syndromes) and, at last, syndromes of the combined defeat of several Ch. - m of N at extra brain localization of process in a head cavity (sometimes and out of a skull). Klien, picture of the isolated defeats of cranial nerves is described in articles devoted separate Ch. - m of N.

Cross, or alternating syndromes (see), have important topiko-diagnostic value. Alternating syndromes with damage of oculomotor and block nerves demonstrate localization of the center of defeat in area of a mesencephalon (see), with damage of the trigeminal, taking-away, facial and preddverno-cochlear nerves —

existence of the center of defeat in the varo-liyevy bridge (see the Bridge of a brain), with damage of the glossopalatine, wandering, additional and hypoglossal nerves — in a myelencephalon (see). Such topical division is a little conditional since kernels of facial and preddverno-cochlear nerves are located on border of a varoliyev of the bridge and a myelencephalon, sensitive kernels of a trifacial — throughout a brain trunk, and a kernel of an eleventh cranial nerve — actually already in the first cervical segments of a spinal cord.

The symptom complexes caused by defeat of extra brain departments of several Ch. - m of N, in certain combinations and the sequence of emergence of disturbances develop at various patol. processes intracranial, and sometimes and extracranial localization. The most widespread are included below in a wedge, practice the syndromes caused by the combined defeats of Ch. - m of N. On the basis of identification of syndromes of the combined defeats of extra brain departments of cranial nerves it is possible to make not only the topical diagnosis, but in a certain measure and the clinical diagnosis of a tumor, aneurism, inflammatory process in the field.

Syndrome of hemilesion of all che - turnip and brain nerves in the field of a base of skull (a synonym: the syndrome of a half of a base of skull, a syndrome of an intracranial gemipolinevropatiya, a hemiplegia of cranial nerves, R. Garcin's syndrome) is described in 1926 by R. Garcin. It is characterized by defeat of roots of Ch. - m of N, on one half of a base of skull, degree and the sequence of development of a syndrome depend on initial localization patol. process, its nature and features of distribution. At the same time all functions Ch. - m of N (motive,

sensitive, vegetative) long for peripheral type. Conduction disturbances of movements and sensitivity, and also developments of stagnation on an eyeground at this sindrokhm are absent. Increases in intracranial pressure and patol. changes of cerebrospinal liquid also, as a rule, are not observed. The syndrome develops at sarcomas of a base of skull, metastasises of various tumors in a meninx on a lower surface of a brain, at it-roleykemii (see Leukoses), the extracranial tumors growing from a nasopharynx, subordinate clauses (okolonosovy, T.) bosoms of a nose, parotid gland p extending to a base of skull through its various openings (round, oval, fragmentary, jugular, etc.).

Syndrome of a front cranial pole (synonym: the bazalnolobny syndrome, Foster's syndrome — Kennedy) is described in 1911 by Kennedy (F. Kennedy; see Kennedy a syndrome). It is characterized by the combined damage of olfactory and visual nerves. It is shown by primary atrophy of an optic nerve with decrease in sight (sometimes to a blindness) on one party, a congestive nipple (a disk, in T.) an optic nerve — on another, disturbance of sense of smell at first on the party of defeat, then (sometimes) and on other party; occasionally there are disturbances of mentality characteristic of damage of a frontal lobe of a brain (silliness, slovenliness, etc.). The syndrome develops at intracranial tumors, hematomas, craniocereberal injuries with a bruise of a brain of basofrontal localization, meningiomas of area of an olfactory triangle, abscesses of a frontal lobe, and also at the supranazal-ny tumors destroying bones of a front cranial pole and squeezing the structures located in it. A symptom of a tumor or other volume process in a head cavity is preferential hemilesion (especially in an initial stage), usually not inherent to inflammatory processes — basal meningitis (naira., syphilitic), entsefa-litakhm, etc.

The syndrome of olfaktoge-N and t and l in N y y (a synonym Kallmann's syndrome) is described by F. Kallmann in 1944. It is characterized by lack of sense of smell owing to defeat of olfactory nerves and kokhmpleksy the endocrine frustration causing a delay of sexual development (a secondary or hypogonadotropic hypogonadism with an eunuchoidism at men). The mechanism of defeat of the I couple of Ch. - m of N. the hypophysis which is combined with disturbance of gonadotropic function (see), it is not completely clear. In a crust, time assume hereditary character of this syndrome (cases of a consanguineous relation of parents of patients are described).

Fissura orbitalis superior syndrome (synonym: fissurae orbi-talis superioris syndromum, a syndrome of a sphenoidal crack) is described by E. Pichon in 1924 and Custer nomas (M. Casteran) in 1926 Mr. of Harakte


rno. 2. Diagrammatic representation of the right half of a base of skull (dorsal view): the shaded circle showed localization of the center of defeat at a fissura orbitalis superior syndrome; figures III—VI specified roots oculomotor, block, / branches of the trigeminal and taking-away cranial nerves which are in the center of defeat.

it rizutsya by the combined hemilesion of the oculomotor, block, taking-away nerves and the I branches of a trifacial leaving through an upper orbital crack a head cavity in a cavity of an eye-socket (see the Eye-socket, the Ophthalmoplegia). It is shown full (more rare partial) by paralysis of muscles of an eyeglobe (a ptosis of an upper eyelid, a full ophthalmoplegia, a mydriasis and lack of its reaction to light), pains and decrease in sensitivity (or anesthesia) in the field of an innervation of the I branch of a trifacial (a cornea, an upper eyelid, a half of a forehead). Most often the syndrome develops at tumors and hyperostoses in the field of an upper orbital crack, at a syphilitic periostitis of wings of a wedge-shaped bone, etc. (fig. 2).

The syndrome of fish-traps and N y for of l and z-N and c y (a synonym a syndrome the Beater) is described by Rollet in 1927. The wedge, manifestations of a fissura orbitalis superior syndrome from a simptomakhma of damage of the optic nerve which is leaving an eye-socket and passing through the visual channel (canalis opticus) in a head cavity is characterized by a combination. Along with symptoms of defeat III, IV, VI cranial nerves and the I branches of a trifacial (see above) on the same party develop a blindness owing to an atrophy of an optic nerve. The syndrome arises at patol. the processes extending from area of an upper orbital crack in top of an eye-socket, causing a compression of an optic nerve or disturbance of venous outflow from orbital veins; in the latter case also secondary glaucoma usually develops (see). Most often defeat is caused by the retrobulbar tumor, osteomyelitis of bones of an eye-socket, tumors burgeoning from cavernous (cavernous, T.) a sine in an eye-socket.

The syndrome unilateral oftalmonevral-and h e with to and y (a synonym Godtf-redsen's syndrome) is described by E. Godtfredsen in 1944. Its distinctive feature is the combined defeat of Ch. - m of N. It begins with defeat of the II branch of a trifacial; in the subsequent the I branch of a trifacial, an optic nerve are involved in process the taking-away nerve, oculomotor, block. In protsess also sympathetic perivascular texture of an internal carotid artery (an internal sleepy texture) is involved that causes disturbances of a sympathetic innervation of an eye on the party of defeat. Clinically the syndrome is shown by neuralgia of a maxillary nerve (see the Trifacial), symptoms of damage of the nerves innervating muscles of an eyeglobe (since taking away), the progressing decrease in sight on one eye, development of a syndrome of Bernard — Horner (narrowing of a palpebral fissure, a miosis, an enophthalmos) on the party of defeat (see Bernard — Horner a syndrome). The syndrome is caused by germination of extracranial malignant tumors (usually tumors of area of a nasopharynx) through a round opening in a head cavity, and then in an eye-socket.

The syndrome of a sidewall cavernous with and N a mustache and (a synonym a syndrome of an outside wall of a cavernous bosom) is described by Fua (S. Foix) in 1920. It is characterized by the combined defeat of Ch. - m of the N

innervating muscles of an eyeglobe (III, IV, VI), and the I branches of a trifacial passing in a sidewall of a cavernous sine to an upper orbital crack and an eye-socket. (See above) differs from a fissura orbitalis superior syndrome in initial damage of the taking-away nerve (the meeting squint, a diplopia) and the I branches of a trifacial (sharp pains in an eye-socket, a half of a forehead) with the subsequent accession of damage of oculomotor, block nerves and development of a full ophthalmoplegia (with - m). Usually the syndrome is caused patol. process in an average cranial pole (a tumor of a temporal share, a hypophysis, a cranyopharyngioma, sarcoma of a base of skull, purulent process basically, or wedge-shaped, a bosom, etc.). influencing from the outside a cavernous sine with the anatomic educations concluded in it.

Syndrome of a lacerated foramen (synonym: foraminis lacerum syndromum, G. Jefferson's syndrome) is described by G. Jefferson in 1937 as nevrol. the defeat developing at aneurism of an internal carotid artery in the field of a lacerated foramen on a base of skull. Weight of the combined damage of visual, oculomotor, block and trigeminal nerves at this syndrome depends on the size of aneurism. Clinically the syndrome is shown by a headache in frontal and orbital areas, feeling of the pulsing noise in the head on the party of defeat, a passing or resistant ptosis of an upper eyelid (see the Ptosis) and a diplopia (see), the exophthalmos sometimes pulsing (see), a mydriasis, a papilledema, a hypesthesia of a cornea, half of a forehead, cheek.

Cavernous syndrome (synonym: the syndrome of a cavernous bosom, a syndrome of a cavernous sine, Bonnet's syndrome) is described Bonn (P. Bonnet) in 1955. Combines a wedge, symptomatology of four syndromes which are separately described above — a fissura orbitalis superior syndrome, a syndrome of top of an eye-socket, a syndrome of a sidewall of a cavernous sine and a syndrome of a lacerated foramen.

The century, a hyperemia and a chemosis of an eye is shown by a full ophthalmoplegia, pains and decrease in sensitivity in a zone of an innervation of the I branch of a trifacial, a unilateral exophthalmos with hypostasis (hemoz). It is caused by usually volume educations (a meningioma, a gumma, aneurism, etc.), to-rye are located in a cavernous sine, squeeze Ch. - m of N and break venous blood circulation in orbital and facial veins. At development of a syndrome owing to thrombosis of a sine (see Thrombosis of vessels of a brain) symptoms of a septic state can be noted (see Sepsis); at aneurism of an internal carotid artery in a cavernous sine or in case of an arteriosinusny anastomosis the pulsing noise in the head on the party of defeat is quite often noted; the exophthalmos can also be pulsing. At long developments of stagnation on an eyeground (see) and distribution of process of a cavernous sine on the channel of an optic nerve the damage of an optic nerve leading to a blindness and also secondary glaucoma develops. At limited inflammatory process in a cavernous sine patol. the symptom complex usually quickly regresses under the influence of antiinflammatory treatment and therapy by glucocorticoid hormones. In this case the cavernous syndrome is designated as a syndrome of Toulouse — the Khanty.

Syndrome petrosfeno-idalny spaces and (synonym: the petrosfenoidalny syndrome, Zhako's syndrome) is described by Zhako (M. Jacod) in 1921. Idiosyncrasy of a syndrome is decrease in hearing owing to disturbance of passability eustachian (acoustical, T.) pipes, development of the combined hemilesion of the oculomotor, block, taking-away nerves, I and II branches (sometimes and the III branches) a trifacial, an optic nerve. The syndrome consists of unilateral deafness, a ptosis, the meeting squint (see), a mydriasis on the party of defeat, paresthesias, pains, and then and decrease in sensitivity on a face (in zones of an innervation of I and II branches of a trifacial), paralysis of masseters (see), decrease in sight. The syndrome is caused most often by growth of a malignant tumor from a nasopharynx or a laryngopharynx, sarcoma of the Eustachian tube extending through a lacerated foramen in a head cavity, in a cavernous sine. At limited distribution of process to head cavities can not arise damages of an optic nerve and not develop paralysis of masseters.

Paratrigeminal syndrome (synonym: paratrigeminal-ny paralysis of a sympathetic nerve, G. J. Raeder's syndrome) is described by G. J. Raeder in 1918. It is characterized by the combined defeat of a sympathetic perivascular texture of an internal carotid artery and located in close proximity to it a gasserova (trigeminal, T.) a node or I and II branches of a trifacial (see). It is shown by the unilateral pristupoobrazny pulsing headache, pains and paresthesias of a half of a forehead, eye, cheek on the struck party, incomplete (sometimes full) Bernard's syndrome — Horner also on the party of defeat. It is caused limited patol. processes of various character (a tumor, inflammatory processes, injuries) on a base of skull, near a gasserov of a node; can develop at aneurisms of an internal carotid artery of the same localization.

A syndrome to top sh to and pyramids of a temporal bone (a synonym: petrosum-syndromum, Gradenigo's syndrome) is described by J. Gradenigo (see t. 15, additional materials) in 1904. It is characterized by the combined damage of the taking-away and trigeminal nerves on one party, it is rare also damage of oculomotor, block and facial nerves. Develops at otogenic or viral infections (see the Petrositis), fractures of base of the skull (for more details see Gradenigo a syndrome).

The syndrome of internal acoustical pass (a synonym Lyanits's syndrome) arises at the combined hemilesion of facial and preddverno-cochlear nerves at the level of internal acoustical pass. It is shown by symptoms of peripheral defeat of a facial nerve at this level (see. Facial nerve), decrease in hearing and noise in an ear on the party of defeat, in later stages — change of vestibular excitability (instability, dizziness). It is caused most often by a neurinoma of a cochlear root of an eighth cranial nerve (see).

Hunt's syndrome (synonym:

geniculatum-syndro-mum, neuralgia of a cranked node, Hunt's neuralgia) — defeat of a cranked node (a node of kolenets, T.) and a trunk of a facial nerve (see) in the fallopian (front) channel. The syndrome is caused a neurivirus - ache by an infection, as a rule, it is combined with defeat of an eighth cranial nerve at this level, sometimes and a trifacial, and also cervical nodes of a sympathetic trunk on the party of defeat. The wedge, a picture depends on extent of involvement in process of the listed anatomic educations (see Hunt a syndrome). Sometimes in a symptom complex vestibular frustration with the expressed dizziness, a nystagmus — Frankl-Hokhvart's syndrome prevail.

Syndrome of a jugular foramen (synonym: foraminis juqularis syndromum, a syndrome to Verna) is described to Verna (M. by Vernet) in 1916. Includes simptokhma of the unilateral combined damage of the glossopalatine, wandering and additional nerves leaving a head cavity through a jugular foramen (fig. 3). At the same time there is a flaccid paralysis of muscles of a soft palate, a throat, throat, grudino - clavicular and mastoidal and trapezoid muscles on the party patol. center; disturbance of flavoring sensitivity in the field of a root of language, decrease in sensitivity of a soft palate, a mucous membrane of a back wall of a throat, pharynx, a front surface of an epiglottis, an Eustachian tube, drum cavity on the party of defeat. Besides, on the party of defeat droop of a soft palate, shift of a back wall of a throat in the healthy party, omission of a shoulder girdle are noted (belts of upper extremities,


Fig. 3. Diagrammatic representation of the right half of a base of skull (dorsal view): the shaded circle showed localization of the center of defeat at a syndrome of a jugular foramen; figures IX—XI specified roots of the glossopalatine, wandering and additional cranial nerves which are in the center of defeat, the I—VIII, XII — roots of other cranial nerves.

T.). The head of the patient is turned in the party opposite to defeat, the chin is raised. The voice is usually hoarse, with a nasal shade; swallowing of firm food is complicated; the reflex of a soft palate and a gag reflex on the party of defeat are absent; tachycardia, desires to cough, suffocation are sometimes observed. The syndrome is caused patol. processes on a base of skull, in the field of a jugular foramen, is more often growth of tumors (generally than sarcomas of a base of skull), thrombosis of sine of a firm meninx (see Thrombosis of vessels of a brain) with distribution of process on area of an upper bulb of an internal jugular vein, phlebitis of large veins of a neck, phlegmon submaxillary (podnizh-not maxillary, T.) sialadens, fractures of base of the skull. In the latter case, when the line of a change passes not only through a jugular foramen, but also through the channel of a hypoglossal nerve (see), the syndrome to Verna — Sikara — the Call — a combination of signs of defeat of cranial nerves in the field of a jugular foramen with a unilateral flaccid paralysis and an atrophy of muscles of language develops (language oktlonen towards defeat).

Syndrome retropar about-tidnoy area (a synonym: the syndrome of back pharyngeal area, a syndrome Villar) is described Villar (M. by Villaret) in 1916. Includes symptoms of the unilateral combined damage of the glossopalatine, wandering, additional, hypoglossal nerves and cervical nodes of a sympathetic trunk. It is shown clinically by a syndrome to Verna — Sikara — the Call (see above) and Bernard's syndrome — Horner (see Bernard — Horner a syndrome) on the party of defeat. Sometimes paresis of mimic face muscles owing to defeat of extracranial branches of a facial nerve joins. The syndrome is caused various patol. the processes localized behind a parotid gland (abscesses, tumors, inflammatory infiltrates, injuries, etc.), involving the listed above Ch. - m of N.

The syndrome of a mostomozzhechkovy corner is described by X. Cushing in 1917. Includes hemilesion of roots front, an eighth cranial nerve and the intermediate nerve passing between them. Depending on the sizes patol. the center and the direction of distribution of process (see the Mostomozzhechkovy corner) damages of the trigeminal and taking-away nerves and disorder of cerebellar functions on the party of the center (see the Cerebellum), pyramidal symptoms on the party opposite to the center can join (see. Pyramidal system). The main wedge, manifestations: decrease in hearing and noise in an ear, dizziness, a flaccid paralysis of mimic muscles (face muscles, T.), a hypesthesia, pains and paresthesias in a half of the face, unilateral decrease in flavoring sensitivity on front 2/3 languages, paresis of a direct lateral muscle of an eye with the meeting squint and a diplopia. At impact of process on a brain trunk there is a hemiparesis on the party opposite to the center, a cerebellar ataxy (see) on the party of the center. The syndrome is most often caused by a neurinoma of a cochlear root of an eighth cranial nerve, cholesteatomas, hemangiomas, a cystous arachnoiditis, leitomeningi-volume of a mostomozzhechkovy corner. Limited damage only of nerves of a mostomozzhechkovy corner (VII and VIII nerves) is quite often caused by aneurism of a basilar artery.

A syndrome of bulbar paralysis (see. Bulbar paralysis) — a symptom complex which arises at the combined defeat of roots or trunks of the glossopalatine, wandering and hypoglossal nerves as inside, and out of a head cavity. At the same time the speech (a dysarthtia, an aphonia, a nasal shade of a voice), swallowing (dysphagy) is violated that the pas ralichy muscles of a soft palate, a throat, a throat, language is caused to a perifa riches by Kym. The atrophy of muscles of one half of language is observed, there are no gag reflex and a reflex from a soft palate on the party of defeat. On the same party sensitivity in a zone of an innervation of the affected nerves is broken. Tachycardia, short wind are possible. The syndrome is most often caused by tumors and inflammatory processes in the field of a back cranial pole; bilateral defeat sometimes develops at a diphtheritic polyneuritis, at Giyen's polyneuropathy — Barret, etc. (see the Polyneuritis).

The diagnosis of this or that syndrome of defeat is made on the basis of a characteristic combination of signs of defeat of close located Ch. - m of N and adjacent intracranial structures (the principle of an anatomic syntopy). Wedge, the diagnosis shall be confirmed with results of additional researches, first of all to a kraniografiya (see). For this purpose do the special aim pictures revealing changes of bone structures in area patol. process — expansion or narrowing of an upper orbital crack, the channel of an optic nerve, expansion of internal acoustical pass, change of contours and the sizes of round fragmentary or jugular openings, etc. (see the Skull). At a syndrome of a mostomozzhechkovy corner, a syndrome of a lacerated foramen, and also at the cavernous syndrome caused by aneurism of an internal carotid artery or a carotid and cavernous anastomosis, the angiography has great diagnostic value (see Vertebralnaya an angiography, the Carotid angiography). The heads given to the computer tomography (see the Tomography computer) allowing to reveal tumors of a cavernous sine, top of an orbit, kranioorbitalny tumors, the centers of a bruise of a brain, etc. have undoubted diagnostic value. However at the extra brain processes of basal localization which often do not have big distribution, the computer tomography is not so informative, as at intracerebral processes.

Treatment and the forecast depend on localization patol. process, its weight and character of a current.

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