HYPOTHALAMUS

From Big Medical Encyclopedia

HYPOTHALAMUS [hypothalamus (BNA, JNA, PNA); grech, hypo-+ thalamos room; synonym: hypothalamus, hypothalamic area, podbugrovy area] — the department of a diencephalon located from top to bottom from a thalamus under a hypothalamic furrow and representing accumulation of nervous cells with numerous afferent and efferent bonds.

History

Since the middle of 19 century G.'s influence on various parties of life activity of an organism was studied (processes of adaptation, sexual functions, processes of exchange, thermoregulation, a water salt metabolism, etc.).

The big contribution to G.'s studying was made by domestic scientists. In the thirties 20 century A. D. Speransky with sotr. made animal experiments, imposing a glass bead or a metal ring on substance of a brain in the field of the Turkish saddle, hemorrhages and ulcers in a stomach and intestines resulted.

H. N. Burdenko and B. N. Mogilnitsky described developing of perforated stomach ulcer at neurosurgical intervention in areas III of a ventricle. A specific place is held by the researches conducted by N. I. Grashchenkov during the studying theoretical and a wedge, aspects of a role of G. at various frustration of a nervous system and internals.

In 1912 Ashner (V. of Aschner) 1928 of Sharrer observed an atrophy of gonads at dogs after G. V destruction (V. of Scharrer) found secretory activity of hypothalamic kernels. Holveg and Yunkman (W. Hohlweg, To. Junkman, 1932) established localization in G. of the sexual center, electric stimulation to-rogo in Harris's experiences (G. W. Harris, 1937) caused an ovulation in rabbits. In 1950 Hulme and Vittenstein (D. The m of Hume, G. J. Wittenstein) showed influence of hypothalamic extracts on secretion of adrenocorticotropic hormone. In 1955 Mr. Gillemin and Rosenberg (R. Guillemin, V. of Rosenberg) found in G. the so-called releasing factor — corticotropin (corticotropin-rileasing-factor). In the next years localization of kernels of some G. responsible for regulation of a metabolism and secretion of separate hormones was shown hypophysis (see).

The embryology, anatomy, histology

G. is phylogenetic the ancient education existing at all chordates. However designation of this department of a brain as a hypothalamus cannot be used concerning Cyclostoma and Selachii since visual hillocks for the first time form at a stage of amphibians. At G.'s birds has rather small size, but differentiation of its kernels is expressed rather well. He receives generally impulses from the olfactory centers, the striate body forming the most part of a neoncephalon at birds.

Fig. 1. The scheme of podbugorny area of a brain (kernels of a hypothalamus are designated in black color): 1 — nuclei corporis mamillaris; 2 — nucleus tiiberalis; 3 — hypophysis; 4 — hiasma opticum; 5 — nucleus supraopticus; 6 — nucleus paraventricularis; 7 — nucleus inferomedialis; 8 — nucleus superomedialis; 9 — sulcus hypothalamicus; 10 — nucleus posterior.

Reaches the highest development of G. at mammals. The embryo of the person at the age of 3 months on an inner surface of a thalamus has two furrows dividing it into three parts: upper — an epithalamus, average — a thalamus and lower — a hypothalamus. In further embryonic development thinner differentiation of kernels of G. comes to light and its numerous bonds form. Front border of G. is visual decussation (chiasma opticum), a terminal plate (lamina terminalis) and front commissure (commissura ant.). The back border passes behind bottom edge of mastoidal bodies (corpora mamillaria). Cellular groups G. without interruption pass Kperedi into cellular groups of a plate of a transparent partition (lamina septi pellucidi). Despite the small sizes G., its cytovery tectonics differs in considerable complexity. In G. the gray matter consisting hl is well developed. obr. from small cells. The groups of cells forming separate kernels of G. (fig. 1) lie in some sites. The number, topography, the size, a form and degree of a differentiation of these kernels vary at different vertebrata; at mammals usually distinguish 32 couples of kernels. Between the next kernels there are intermediate nervous cells or their small groups therefore fiziol. not only kernels, but also some internuclear Hypothalamic zones can matter. On group in G. conditionally distinguish three unsharply differentiated fields of accumulation of kernels: front, average and back.

Serobugorny kernels lie in the average area G., around bottom edge of the III ventricle (nucll. tuberales), arcuately covering a funnel (infundibulum). Up and a little lateralny from them large upper medial and lower medial kernels lie. The nervous cells making these kernels are not identical by the size. On the periphery small nervous cells are localized, and larger occupy the middle of kernels. Nervous cells upper medial and lower medial kernels differ from each other in a structure of dendrites. At cells of upper medial kernels dendrites are characterized by existence of a large number of long spinules, axons strongly branch and have numerous synoptic bonds. Serobugorny kernels (nucll. tuberales) represent the accumulations of small nervous cells of spindle-shaped or triangular shape which are localized around the bases of a funnel. Shoots of nervous cells of these kernels are defined in a proximal part of a pituitary leg to a median eminence where they come to an end with aksovazalny synapses on loops of primary capillary network of a hypophysis. These cells give rise to fibers of a tuberogipofizarny bunch.

The group of kernels of back area consists of scattered large cells among which accumulations of small cells lie. Also kernels of a mastoidal body belong to this department (nucll. corporis mamillaris), who act on a lower surface of a diencephalon in the form of hemispheres (steam rooms at primacies and unpaired at other mammals). Cells of these kernels are efferent nervous cells and give rise of one. from the major projective systems from G. in an oblong and spinal cord. The largest cellular accumulation forms a medial kernel of a mastoidal body. Kperedi from mastoidal bodies acts a bottom of the III ventricle in the form of a gray hillock (tuber cinereum) formed by the lamina of gray matter. This ledge is extended in the funnel passing into disteel-pom the direction in a pituitary leg and further in a back share of a hypophysis. The funnel is delimited from a gray hillock by not clearly expressed furrow. An expanded upper part of a funnel — a median eminence — has a special structure and peculiar vascularizations). From a cavity of a funnel the median eminence is covered by an ependyma, for a cut there is a nerve fiber layer of a gipotalamo-pituitary bunch and more fine fibers originating from kernels of a gray hillock. An outside part of a median eminence is formed by basic neuroglial (ependimny) fibers, between to-rymi numerous nerve fibrils lie. In these nerve fibrils and about them adjournment of neurosecretory granules is observed. In a periblast of a median eminence the network of capillaries providing blood supply of an adenohypophysis is located. These capillaries form the loops rising in thickness of a median eminence towards to nerve fibrils which go down to these capillaries.

Includes the kernels formed by the nervous cells which are not possessing secretory function and the kernels consisting of neurosecretory cells. Secretory nervous cells are concentrated by hl. obr. directly about walls of the III ventricle. On the structural features these cells remind cells reticular formation (see). Fiziol, data demonstrate that cells of this kind produce physiologically active agents promoting release of triple hormones from a hypophysis and called hypothalamic neurohormones (see).

Neurosecretory cells concentrate in front area G. where form from each party nadzritelny (nucl. supraopticus) and okolozheludochkovy (nucl. paraventricularis) kernels. The Nadzritelny kernel is located in posterolateral area from the beginning of a visual tract. It is formed by group of the cells lying along a corner between a wall of the III ventricle and a dorsal surface of visual decussation. The Okolozheludochkovy kernel consists of nervous cells of the large and average sizes, has an appearance of the plate lying between the arch (fornix) and a wall of the III ventricle, begins in the field of visual decussation and gradually rises kzad and up in the inclined direction.

Between both called kernels numerous single neurosecretory cells or their groups are located. In an okolozheludochkovy kernel large neurosecretory cells are concentrated preferential in the expanded tail (a macrocellular part), and in the narrowed forefront of this kernel neurons of the smaller size prevail. The area of nadzritelny and okolozheludochkovy kernels is characterized by plentiful vascularization. Axons of neurons of okolozheludochkovy and nadzritelny kernels, forming a gipotalamo-pituitary bunch, reach a back share of a hypophysis where form contacts with capillaries. In a back share of a hypophysis neurohormones collect and come to a blood flow. The main feature of neurosecretory cells is existence of the specific (elementary) granules which are contained in different quantity both in the field of perikaryons and in shoots — axons and dendrites (see. Gipotalamo-gipofizarnaya system ). Neurosecretory cells of nadzritelny and okolozheludochkovy kernels are similar among themselves in a form and structure, but a certain differentiation is allowed; cells of a nadzritelny kernel produce preferential antidiuretic hormone (see. Vasopressin ), and okolozheludochkovy — oxytocin (see). Thus, G. is formed by a complex of neuroconduction and neurosecretory cells. In this regard the regulating G.'s influences are transmitted to effectors, including and to closed glands, not only through the hypothalamic neurohormones postponed with a blood flow and, therefore, acting gumoralno, but also on efferent nerve fibrils.

It is closely connected with the next structures of a brain conduction paths. With a neoncephalon of G. it is connected by a medial bunch, fibers to-rogo arise in an olfactory bulb, a head of a kernel having a tail, an amygdaloid nucleus and the forefront of a parahippocampal crinkle (gyrus parahippocampalis).

Possesses well developed and very complex system of afferent and efferent pathways. Afferent ways of G. are divided into six groups: 1) honor the medial bunch of a neoncephalon connecting a partition and preoptichesky area with all kernels of G.; 2) the arch which is system of the afferent fibers connecting bark hippocampus (see) with G.; the main part of fibers of the arch goes to kernels of a mastoidal body, another — to a partition and to the lateral preoptichesky area, the third — to other kernels of G.; 3) the talamo-pituitary fibers connecting generally medial and vnutriplastinochny kernels thalamus (see) with G.; 4) mastoidal pokryshechny a bunch, in Krom there are fibers ascending from mesencephalon (see) to G.; a part of these fibers reaches a limit in preoptichesky area and a partition; 5) a back longitudinal bunch (fasciculus longitudinalis dorsalis) bearing impulses from a brainstem to G.; the system of fibers of a back longitudinal bunch and mastoidal bodies provides communication of a reticular formation of a mesencephalon with G. and limbic system (see); 6) the pallido-hypothalamic way connecting striopallidal system from G. Ustanovlena also indirect cerebellar and hypothalamic connection, optiko-hypothalamic ways, vagosupraoptichesky bonds.

Efferent pathways of G. are subdivided into three groups: 1) the yarns of periventrikulyarny system (fibrae periventriculares) originating in back hypothalamic kernels go together through a periventrikulyarny zone in the beginning; some of them terminate in back and medial thalamic kernels; the majority of fibers of periventrikulyarny system goes to the bottom of a brainstem, and also to a reticular formation of a mesencephalon and a spinal cord (a reticular path of G.); 2) the mastoidal bunches originating in kernels of a mastoidal body of G. are divided into two bunches: mastoidal and thalamic (fasc. mamillothalamicus), going to front kernels of a thalamus, and mastoidal pokryshechny a bunch (fasc. mamillotegmentalis), going to kernels of a mesencephalon; 3) a gipotalamo-pituitary path — the shortest, but the bunch of axons of neurons of G. clearly outlined; these fibers originate in nadzritelny and okolozheludochkovy kernels and go through a pituitary leg to a neurohypophysis. The majority of functions G., in particular control of visceral functions, is carried out in these afferent ways. Except afferent and efferent bonds, in G. there is a komissuralny way. Thanks to it medial Hypothalamic kernels of one party come into contact with medial and to lateral kernels of other party.

The main source of arterial blood supply of kernels of G. are branches of an arterial circle of a brain which provide the isolated plentiful blood supply of separate groups of kernels of. G.'s vessels differ in high-permeability for krupnomolekulyarny proteinaceous connections. The interrelation between G. and an adenohypophysis is carried out through vessels of portal system, edges has the features (see. Gipotalamo-gipofizarnaya system ).

The physiology

G. comes to the forefront in implementation of regulation of many functions of the whole organism, and first of all constancy of internal environment (see. Homeostasis ). — the highest vegetative center which is carrying out difficult integration and adaptation of functions of various internal systems to complete activity of an organism. It has essential value in maintenance of optimum level of a metabolism (proteinaceous, carbohydrate, fatty, water and mineral) and energy, in regulation of temperature balance of an organism, activity of digestive, cardiovascular, secretory, respiratory and endocrine systems. Under G.'s control there are such hemadens as a hypophysis, thyroid, sexual, a pancreas, adrenal glands, etc.

Fig. 2. The general scheme of regulation of endocrine system by the principle of a feed-back: the hypothalamus (1) — cosecretes polypeptide neurohormones (rileasing-hormones) which stimulate secretion of triple hormones of a hypophysis (2), the last cause secretion of hormones peripheral closed glands (3) and affect peripheral bodies and fabrics (4), hormones of a hypophysis and peripheral closed glands exert impact on a hypothalamus, reducing its secretion as a feed-back (long — 5 and short — 6).

Regulation of triple functions of a hypophysis is carried out by release of the hypothalamic neurohormones coming to a hypophysis through portal system of vessels. Between G. and a hypophysis there is feed-back (fig. 2), with the help the cut is regulated their secretory function. The principle of a feed-back (feedback relation) is that at increase in secretion of hormones hemadens secretion of hormones G. (decreases see. Neurohumoral regulation ). Release of triple hormones and leads a hypophysis to change of functions of closed glands which secret gets to blood and to affect in turn G. V G. seven hypothalamic neurohormones activating and three — the triple hormones of a hypophysis inhibiting allocation can is revealed. They are widely used in clinic for the purpose of diagnosis of diseases of hemadens. It is considered to be that the front area G. is directly involved in regulation of allocation of gonadotrophins. Most of researchers considers the center regulating thyritropic function of a hypophysis, the area located in perednebazalny part G., below an okolozheludochkovy kernel, stretching from nadzritelny kernels in front to arkuatny kernels of a kzada. Localization of the areas which are selectively controlling adrenocorticotropic function of a hypophysis is studied insufficiently. A number of researchers connects regulation of AKTG with back Area. The Hungarian school J. Szentagothai connects regulation of AKTG with premamillyarny area. The maximum concentration of AKTG — a rileasing-factor is found in the field of a medial eminention. Localization of the areas G. participating in regulation of other tropny hormones of a hypophysis remains not clear. Functional isolation and differentiation of hypothalamic zones on their participation in monitoring tropny functions of a hypophysis cannot be carried out rather accurately.

Numerous researches showed that the front area G. exerts the stimulating impact on sexual development, and back area G. — braking. At patients with pathology of hypothalamic area disturbance of functions of a reproductive system is observed: sexual weakness, disturbance of a menstrual cycle. Many cases of bystry puberty as a result of excessive irritation a tumor of area of a gray hillock are known. At the adiposagenital syndrome connected with defeat of tuberalny area G. disturbances of sexual function are observed.

Participates in regulation carbohydrate metabolism (see); damage of back departments of G. causes a hyperglycemia. In certain cases at G.'s damage excessive obesity as result of a polyphagia is observed. Obesity or a cachexia develops usually at defeat of an upper medial kernel and serobugrovy Area. The role of nadzritelny and okolozheludochkovy kernels in origins of not diabetes mellitus is shown (see. Diabetes not sugar ).

Is important in maintenance of optimum; temperatures of a body scheme (see. Thermal control ).

The mechanism of heat waste is connected with function of front Area. Destruction of back departments of G. causes decrease in body temperature.

Regulates function of sympathetic and parasympathetic parts of the autonomic nervous system, their coordination. The back area G. participates in regulation of activity of a sympathetic part of century of N of page, and average and front — parasympathetic department since stimulation of front and average areas G. causes parasympathetic reactions (an urezheniye of serdtsebiyeniye, strengthening of a vermicular movement of intestines, a tone of a bladder, etc.), and irritation of back area causes sympathetic reactions (increase of heartbeat, etc.). Between these centers there are Reciprocal bonds. However accurately it is difficult to differentiate the centers in G.

Studying of hypothalamic level of regulation of a feeding behavior showed that it is carried out as a result of reciprocal interactions of two food centers: lateral and ventro-medial hypothalamic kernels. Activation of neurons of lateral G. causes formation of food motivation. At bilateral destruction of this department of G. the food motivation completely is eliminated, and the animal can die from exhaustion. Increase in activity of a ventro-medial kernel of G. reduces the level of food motivation. At destruction of this kernel the level of food motivation considerably increases, the hyperphagia, a polydipsia and obesity is observed.

Vasomotor reactions of a hypothalamic origin are closely connected with a condition of century of N of page. The different types of arterial hypertension (see arterial hypertension) developing later G.'s stimulations are caused by the combined influence of sympathetic department of century of N of page and release of adrenaline from adrenal glands. However in this case it is impossible to exclude also influence of a neurohypophysis, especially in genesis of steady hypertensia that is confirmed by experimental data when the arterial hypertension caused by stimulation of back area G. decreases after electric destruction of a medial eminention. The regional vasomotor reactions developing after destruction of preoptichesky area differ from the general vasomotor reactions observed after stimulation of back area

of G. G. — one of the main structures participating in regulation of change of a dream and wakefulness (see. Dream ). Wedge, by researches it is established that the symptom of a lethargical sleep at epidemic encephalitis is caused by damage of. G.'s damage caused a dream and in an experiment. For maintenance of a condition of wakefulness the back Area has crucial importance. Extensive destruction of average area G. led to a condition of a long dream at animals. The sleep disorder in the form of a narcolepsy is explained by defeat of a rostral part of a reticular formation of a mesencephalon and G. Poluchena the experimental data (P. K. Anokhin, 1958) demonstrating that the dream as result of braking of cortical activity develops as a result of release of hypothalamic educations which remain active during the entire period of a dream.

Is under the regulating influence of a cerebral cortex. Neurons of bark, obtaining information on a reference state of an organism and the environment, exert the descending impacts on all subcrustal structures, including and on the centers G., regulating the level of their excitement. Bark of big hemispheres exerts the braking impact on Functions. The acquired cortical mechanisms suppress many emotions and primary motives forming with participation of. Therefore the decortication quite often leads to development of reaction of «imaginary rage» (expansion of pupils, a piloerektion, tachycardia, increase in intracranial pressure, a sialosis etc.).

With fiziol, a number of features has the points of view, and first of all it concerns its participation in formation of the behavioural reactions of an organism important for preservation of constancy of internal environment. G.'s irritation leads to formation of purposeful behavior — G. food, drinking, sexual, aggressive, etc. the leading role in formation of the main inclinations of an organism belongs (see. Motivations ).

by Fig. 3. Scheme of selective chemical sensitivity of receptor cells of hypothalamic area: each of cells And, B, In, reacts only to change of a specific factor of blood. At change in blood of a factor and only the cell is excited And, at change of a factor in — only a cell of Century.

Metabolism of neurons of. it is selectively sensitive to the content of these or those substances in blood, and at any change of their contents these cells come to a condition of excitement. Hypothalamic neurons are sensitive to the slightest deviations of pH of blood, tension of carbonic acid and oxygen, the maintenance of ions, especially potassium and sodium, etc. So, in a supraoptic kernel of G. the cells selectively sensitive to change of osmotic pressure of blood, in a ventro-medial kernel — contents of glucose, in a front hypothalamus — sex hormones are found. Thus, G.'s cells perform function of the receptors perceiving change of a homeostasis and have ability to transform humoral changes of internal environment to nervous process, biologically painted excitement. The centers G. are characterized by the expressed selectivity of excitement depending on various changes of composition of blood (fig. 3). G.'s cells can selectively be activated not only at change of certain constants of blood, but also nervous impulses from the relevant bodies connected with this requirement. G.'s neurons possessing selective reception in relation to the changing constants of blood work on trigger type (see. Trigger mechanisms ). Excitement in these cells of G. arises not at once as soon as any constant of blood changes, and through a certain time term when their excitability increases to a critical level. Thus, cells of the motivational centers G. are characterized by frequency of work. If change of a constant of blood is supported is long, then in this case excitability of neurons of G. quickly rises up to the critical size and the condition of excitement of these neurons is supported on a high level all the time while there is a change of a constant which caused development of process of excitement. The constant impulsation of neurons of G. is eliminated only when the irritation causing it disappears, i.e. the maintenance of this or that factor of blood is normalized. Functioning trigger, mechanisms G. is considerably dragged out in time. Excitement of one cells of G. can arise periodically in several hours as, e.g., at a lack of glucose, others — in several days or even months as, e.g., at change of maintenance of sex hormones. G.'s neurons not only perceive changes of indicators of blood, but also transform them to the special nervous process creating the behavior of an organism in the environment directed to satisfaction of internal requirement.

Extensive bonds of G. with other structures of a brain promote generalization of the vozbuzhdeniye arising in cells of. First of all excitement from G. extends to limbic structures of a brain and through kernels of a thalamus on front departments of bark of big hemispheres. The zone of distribution of ascending activating G.'s influences depends at most initial irritation of the centers. During the strengthening of excitement of the centers G. devices of a reticular formation are activated. All these ascending activating influences of the hypothalamic centers excited by internal requirement of an organism also define emergence of a condition of motivational excitement.

The descending G.'s influences provide regulation of functions of hl. obr. in century of N of page. But at the same time an important component in implementation of descending G.'s influences also hormones of a hypophysis are. Thus, G.'s influences both ascending, and descending are carried out in the nervous and humoral way (see. Neurohumoral regulation ). Much attention in connection with G. Selye's concept about reaction «stress» is paid to the descending G.'s influences (see. Adaptation syndrome , Stress ). Existence of the braking influences of various kernels of G. on mono - and polisinaptichesky spinal reflexes is established. At irritation of a complex of mamillary kernels increase in activity of motor-neurons of a spinal cord is in certain cases noted.

Is in continuous cyclic interactions with other departments of a subcortex and a cerebral cortex. This mechanism is the cornerstone of G.'s participation in emotional activity (see. Emotions ). Special value of the centers G. in activity of the whole organism allowed P. K. Anrkhin and K. V. Sudakov (1968,1971) to suggest about "peytsmekerny" (a peytsmeker — a releaser) roles of this structure of a brain in formation biol, motivations. Thanks to the fact that to hypothalamic the nervous and humoral alarm system about various internal requirements is addressed to departments they also gain value of «peytsmeker» of motivational vozbuzhdeniye. According to this representation, Hypothalamic «peytsmeker» thanks to the ascending activating influences define a power basis of motivational vozbuzhdeniye.

Neurons of the motivational centers G. have various chemical specifics, edges is defined by selective use in their metabolism of special chemical substances. And these chemical specifics of G. remain in the ascending influences activating it at all levels, providing qualitative biol, an originality of behavioural acts. So, administration of adrenolytic substances (aminazine) possible to block selectively mechanisms of activation of a cerebral cortex at nociceptive irritation. Activation of a cerebral cortex at food excitement of hungry animals is selectively blocked by cholinolytic drugs. Neurotropic substances with the specific mechanism of action thanks to existence of the heterochemical organization of the hypothalamic centers can selectively block various mechanisms G. participating in formation of such conditions of an organism as hunger, fear, thirst etc.

Methods of a research

the Elektroentsefalografichesky method. By results of an elektroentsefalografichesky research of defeat (see. Elektroentsefalografiya ) can be subdivided into four groups: the first group — lack of deviations or the minimum deviations from normal EEG; the second group — falloff of an alpha rhythm up to its disappearance; the third group — emergence on EEG of a teta-rhythm, especially in connection with repeated afferent irritations; the fourth group — pristupoobrazny disturbances of EEG in the form of emergence of the changes characteristic of a dream; this EEG type characterizes diencephalic epilepsy. At the syndromes described above comparative assessment of EEG does not find specificity.

Pletizmografichesky researches (see. Pletizmografiya ) reveal a wide range of changes — from a condition of vegetative vascular instability and paradoxical reaction to a full areflexia (see) that corresponds to degree of manifestation of functional or organic lesions of kernels of. At researches of century of N of by means of a motive method with a speech reinforcement it was established that at all forms of pathology of G. interaction between bark and a subcortex is sharply reduced.

At patients with G.'s defeat irrespective of its reason (a tumor, an inflammation, etc.) the maintenance of catecholamines and histamine in blood can increase, the fraction increases alpha globulins and the fraction decreases beta globulinovaya, the level of excretion of 17 ketosteroids changes. At various forms of defeat of G. disturbances of skin temperature and sweating clearly are shown.

Pathology

In a hypothalamus there are both functional disturbances, and irreversible changes of its kernels. First of all it should be noted a possibility of various extent of defeat of kernels (preferential nadzritelny and okolozheludochkovy) at diseases of hemadens.

The injuries of a brain leading to redistribution of cerebral liquid can also cause changes in the hypothalamic kernels located near an ependyma of a bottom of the III ventricle.

Pathomorphologically these changes concern first of all neurons and especially accurately come to light during the coloring across Nissl (see Nissl a method) and Gomori's method. They are expressed by the phenomena of a tigroliz, a neyronofagiya, vacuolation of protoplasm, formation of cells of shadows. Owing to a hyperpermeability of walls of vessels at infections and intoxications Hypothalamic kernels can be exposed to pathogenic influences of the toxins and chemical products circulating in blood. Neuroviral infections are especially dangerous. The most often found inflammatory processes of G. — basal meningitis of a tubercular origin and syphilis. Granulematozny inflammations (Beck's disease), a lymphogranulomatosis, leukemia, and also vascular aneurisms of various origin belong to rare forms of defeat of G. From G.'s tumors most often meet various type of a glioma, defined as astrocytomas; cranyopharyngiomas, ectopic pinealomas and teratomas, and also the suprasellyarny adenomas of a hypophysis located over the Turkish saddle, meningiomas and cysts.

Clinical manifestations of dysfunctions of a hypothalamus

At G.'s defeat allocate the following main syndromes.

1. Neuroendocrinal, shown obesity with characteristic redistribution of a hypodermic fatty tissue (a crescent-shaped face, a thick neck and a trunk, thin extremities), osteoporosis with bent to a kyphosis of a backbone, dorsodynias and a waist, disturbance of sexual function (an early amenorrhea at women and impotence at men), growth of hair in the face and a trunk at women and teenagers, a hyperpegmentation of skin, especially in places of folds, existence of crimson atrophic strips on a stomach and hips (striae distensae), arterial hypertension, periodic hypostases, the general weakness and increased fatigue. A kind of the specified syndrome is Itsenko — Cushing a disease (see).

Other manifestations of a neuroendocrinal syndrome — diabetes not sugar (see), Pituitary cachexia (see), adiposogenital dystrophy (see), etc.

2. Neurodystrophic syndrome it is characterized by the change of a salt metabolism, destructive changes in skin and muscles which are followed by hypostases and an atrophy kozhn, neuromyosites, periodically coming intra joint hypostases; skin is dry, shelled with strips of stretchings, the itch, rashes are observed. Also osteomalacy is noted, calcification, a sklerozirovaniye of bones, formation of ulcers, decubituses, bleeding on the course went. - kish. a path and in a parenchyma of lungs, passing hypostases of a retina of an eye.

3. Vegetovascular syndrome it is characterized by expansion of small veins on a face and a body, the increased fragility of vessels, bent to hemorrhages, high-permeability of walls of vessels, various vegetovascular paroxysms, including the migraines which are followed by increase or decrease in the ABP.

4. Neurotic syndrome it is shown by peculiar hysterical reactions and psikhopatol, states, and also disturbances of wakefulness and a dream.

The listed syndromes can be shown both at functional disturbances, and at organic lesions of kernels of. If the vegetovascular syndrome is noted at functional changes, then neurodystrophic — at crushing organic lesions of kernels of average area G., sometimes front and back its areas. The neuroendocrinal syndrome is shown in the beginning as result of functional disturbances of kernels of front area G., organic lesions of the mentioned kernels join further.

Treatment

At pathology of hypothalamic area three types of treatment are applied.

1. A roentgenotherapy small doses in limits (50 r) 6 — 8 sessions on area G. at the inflammatory nature of defeat or existence of sharply expressed allergic state. At good secretory function of kidneys radiation should be accompanied with purpose of small doses of diuretics. The roentgenotherapy is shown at the expressed vegetovascular syndrome, at neuroendocrinal, in an initial stage of its development.

2. Hormonal therapy in the form of mono-therapy or in combination with a roentgenotherapy. Use of a cortisone, Prednisolonum or their derivatives, and also AKTG shall be followed by careful overseeing hormonal function of adrenal glands. Also drugs of sex hormones of a thyroid gland are used, attempts of use ri leasing hormones are carried out.

3. Introduction by method of an ionogalvanization in a mucous membrane of a nose of various chemical substances at the minimum current 0,3 — 0,5 and; duration of the procedure 10 — 20 min. About 30 sessions are usually held. At ionogalvanyzashchsh use 2% solution of calcium chloride, 2% solution of oryzamin, 0,25% solution of Dimedrol, solution of ergotamine or Phenaminum. Ionogalvanization is incompatible with a roentgenotherapy. In some cases apply the means reducing intracranial pressure, operating on processes of braking or excitement in bark and a subcortex (phenobarbital, bromides, caffeine, Phenaminum, ephedrine). In all cases the careful individual choice of forms of treatment is necessary.

Operational treatment is carried out at G.'s tumors by the standard methods of operations on brain (see).


Bibliography: Baklavadzhyan O. G. A hypothalamus, in book: The general and private fiziol. nervn. systems, under the editorship of P. K. Kos-tyuk, etc., page 362, L., 1969; r and shch e of the Tax Code about in N. I. Podbugorye (hypothalamic area), in book: Fiziol, and patol, diencephalic area of a brain, under the editorship of N. I. Grashchenkov and G. N. Kassil, page 5, M., 1963, bibliogr.; about N e, the Hypothalamus, its role in physiology and pathology, M., 1964, bibliogr.; With e of N of t and about - thaw I., etc. Hypothalamic regulation of the forefront of a hypophysis, the lane with English, Budapest, 1965; Sh and de Dzh. and F about r d the Lake. Fundamentals of neurology, the lane with English, M., 1976, bibliogr.; H e s s W. R. Hypothalamus und Thalamus, experimen-tal-dokumente, Stuttgart, 1956, Bibliogr.; The hypothalamus, ed. by L. Martini a. o., N. Y. — L., 1970; Schreider Y. The hypothalamo-hypophysial system, Prague, 1963, bibliogr.

B. H. Babichev, S. A. Osipovsky.

Яндекс.Метрика