OCCLUSAL SYNDROME

From Big Medical Encyclopedia

OCCLUSAL SYNDROME (late lat. occlusio locking, hiding; syndrome; synonym: occlusal gidrotsefalny syndrome, gipertenzionno-gidrotsefalny syndrome) — the clinical symptom complex arising at blockade of outflow tracts of cerebrospinal liquid in connection with development of the internal closed hydrocephaly. The wedge, symptoms of a disease are described by Bruns (L. Bruns, 1902) at cysticercosis of the fourth ventricle and received the name of a syndrome of Bruns.

The etiology and a pathogeny

the Most frequent reasons of O. of page — tumors, parasitic cysts, abscesses, intracerebral hematomas, acute and hron, inflammatory processes, and also defects of development of ventricular system and an atlantozatylochny joint, to-rye can lead to blockade of likvorny ways. Disturbance of outflow cerebrospinal liquid (see) can occur at the level of ventricles, interventricular foramens, the cerebellar and brain tank (see. Ventricles of a brain ). As a result of occlusion in ventricles a large amount of cerebrospinal liquid accumulates, ventricles extend, raises intracranial pressure (see).

O.'s expressiveness of page depends on the nature of okklyuziruyushchy process, level and extent of occlusion, rate of its development defining efficiency of compensatory reactions. Treat temporary recovery of passability of outflow tracts of cerebrospinal liquid at slow increase of pressure in ventricles the last, its resorption through expanded network of subepen-dimarny veins, a spontaneous rupture of walls of ventricles, children have a discrepancy of seams and increase in the size of the head.

Clinical picture

the Main wedge. O.'s symptoms of page — attacks of a severe headache, edge it is provoked by the sharp movement, a natuzhivaniye and is followed by vomiting, bradycardia, peripheral vasomotor reactions. Trunk tonic can accompany heavy occlusal crises spasms (see), disorders of breath; deaths are frequent owing to dislocations of a brain (see) and a hemodynamics in a brainstem. The characteristic sign of O. of page — forced position of the head, and sometimes and all trunk, a cut of the patient accepts during an attack. Various provisions of the head create conditions for outflow of cerebrospinal liquid. At a ducking forward or down the message between the fourth ventricle and the mozzhechkovomozgovy tank improves, at its zaprokidyvaniye — between the third and fourth ventricles. The ducking to a shoulder (usually towards the center) is observed at volume focal processes in hemispheres of a cerebellum or the tank of a side pole of a great brain. Out of an attack the head is fixed in the sparing situation, its turn is made along with the movement of a trunk. Forced position of the head not always represents the active choice of the pose alleviating suffering; at irritation of vestibular nuclei and a reticular formation of a brainstem it is implemented by cervical and tonic postural reflexes. In addition to the main signs of O. of page, it is necessary to consider also other symptoms characteristic of this or that localization of occlusion. At defeat of side and third ventricles disturbance of consciousness and a dream is observed. At pathology in the field of a water supply system of a brain various chetverokholmny symptomatology develops: at development of a tumor in dorsal departments a chetverokholmiya, it is close to the centerline, paresis of a look up, paresis of convergence, expansion and deformation of pupils, lack of their photoharmose and accommodation comes to light. With involvement in process of back hills hearing up to full deafness decreases. At localization of process in one half of a trunk the listed symptoms are observed on the party of a tumor. If the tumor a chetverokholmiya extends in deep departments, the ptosis of an upper eyelid, loss of movements of an eyeglobe up, inside and down appears.

The diagnosis

the Diagnosis is based on existence of characteristic attacks of headache and others a wedge, symptoms. O.'s recognition by the village is promoted by detection of congestive disks (nipples) of an optic nerve (see. Congestive nipple ), data ekhoentsefalografiya (see), pointing to expansion of cerebral cavities, and rentgenol. signs of occlusal hydrocephaly (see). That fact that pressure of cerebrospinal liquid in ventricles of a brain is higher, than in a spinal cord also will demonstrate to blockade of likvorny ways, and the level of protein content in it will be normal or lowered.

Treatment

Treatment depends on the nature of the process which caused occlusion. At arachnoiditis (see), to a horioependimatita (see), encephalitis (see) antiinflammatory therapy is carried out. At tumors, cysts, hematomas, abscesses, and also in the presence of commissures as a result of the postponed injury or an inflammation the operational treatment directed to elimination of occlusion and recovery of passability of outflow tracts of cerebrospinal liquid is carried out. At impossibility of radical operation the palliative operations creating sideways of outflow — a ventrikulo-tsisternostomiya, perforation of a final plate or operation with removal of cerebrospinal liquid from ventricles are undertaken (see. Hydrocephaly ). At bad occlusal attacks it is necessary to lay down. ventriculopuncture (see) for the purpose of unloading of ventricular system. This operation is obligatory at disturbance of breath; it shall be carried out along with the resuscitation actions. At often repeating occlusal attacks and for a preparation for surgery establish a long drainage of side ventricles on Arendta (see. Hydrocephaly ). At all stages of treatment of O. of page active is shown dehydrational therapy (see).

Forecast serious. It is defined by an opportunity or impossibility of elimination of occlusion and depends on its level and character patol, process.

See also Hypertensive syndrome .



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A. L. Dukhin.

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