REFLEXES PATHOLOGICAL (Latin reflexus turned back, reflected; Greek pathos suffering, a disease + logos the doctrine) — the reflexes arising owing to the changed activity of a nervous system.
I. P. Pavlov (1898) called patol. reflexes negative trophic reactions of a mucous membrane of an oral cavity of dogs with the damaged abdominal wall, assuming that organic disturbance of reflex bonds is their cornerstone. In parallel concept patol. a reflex arose in nevrol. to clinic. In 1896 Zh. Babinsky published the research «About a So-called Pyramidal Sign of a Thumb of a Leg», having called this sign patol. a reflex, pathognomonic for defeat of a pyramidal way. Zh. Babinsky laid the foundation for the period intensive a wedge, studying of motive disturbances. The various reflex phenomena which are arising at diseases of a nervous system and absent at most of healthy people were described by Schäffer (M. Schaffer, 1899), Goffmann (J. Hoffmann, 1900), Mendel (To. Mendel, 1901), G. I. Rossolimo (1902), G. Oppengeym (1902), B. M. Bekhterev (1901, 1903, 1904, 1906), Zelder (F. Solder, 1902), Gordon (A. Gordon, 1904), Redli-h (E. Redlich, 1908), Jacobson (L. Jacobsohn, 1908), M. N. Zhukovsky (1910), Fua (Ch. Foix) and P. Mari (1910), J. G. Radovici and G. Marinesku (1920), S. N. Davidenkov (1921), M. I. Astvatsaturov (1922), L. M. Pussep (1923), I. I. Rusetsky (1935), C. I. Karchikyan (1936), Vartenberg (R. Wartenberg, 1941), N. K. Bogolepov (1953), etc.
Numerous wedge, descriptions, and also data experimental patofiziol. researches approved idea of Genitive as about the reflex which is carried out patholologically by the changed nervous system. However there is also other point of view, according to a cut of Genitive can arise in not changed nervous system under the influence of inadequate, superstrong irritants, as .opredelyat a paradoxicality of responses. Both points of view can ^ыть are acceptable if to define Genitive with biol. positions as the reflex which is breaking adaptation of an organism to conditions of the environment and having negative biol. value for an organism (see. Reflex ).
In a wedge, practice the term «pathological reflexes» is used more narrowly, hl. obr. for designation of those instinctive reflexes (see), to-rye are found at patol. changes of a nervous system with the accepted methods nevrol. inspections also help with diagnosis. The main Genitive, ways of calling, their manifestation and diagnostic value are given in the table.
Among unconditional Genitive the big group is made by patholologically strengthened, modified reflexes which are available normal. Their emergence is caused by deficit brake and dominance of the activating influences of a reticular formation on phasic motor-neurons of a spinal cord (see. Pyramidal system , Cerebellum ), observed at defeat of a reticulospinal way, brake zones of a reticular formation of a brain trunk and their afferent bonds with a cerebral cortex, basal kernels, a cerebellum. Increase in excitability of alpha motor-neurons and reduction of mezhsinaptichesky braking promotes spread of activation in a spinal cord. As a result of it phasic reflexes, to-rye normal approach on electrophysiologic indicators monosinaptichesky, become polisinaptichesky, their stage of latency increases, the bigger number of muscles is involved in the reflex answer. On interneyrona emergence of so-called inverted reflexes is explained by spread of activation. E.g., the blow in a sinew by the four-head of a muscle of a hip can cause not extension, but bending of a shin.
The adductor reflex of a hip can be carried to such Genitive. At blow to an entocondyle of a hip the leg is slightly normalized to the centerline. At increase in excitability of a reflex arc (e.g., at the central paralysis) this adductor reflex can be caused not only from area of an entocondyle of a hip, but also at blow by a hammer on a crest of an ileal bone of the opposite side and on a tibial bone (an adductor reflex of Mari), on a heel of the extended leg (an adductor reflex of Balduchchi), on an Achilles tendon, on an internal anklebone of a shin. JT. G. Chlenov in 1925 described the dorsal adductor reflex caused by effleurage in juxtaspinal area. Vartenberg, M. B. Crolles on the basis of the analysis of extensive literature and own observations came to a conclusion that all adductor reflexes are normal own reflexes of adductors of a hip with widely irradiating reflexogenic zone and are observed at defeat pyramidal system (see). The same observations were made to rather broad irradiation of a zone akhillova of a reflex (see) at pathology of a nervous system.
The so-called bending manual reflexes of foot which are shown the same bottom bending of fingers at irritation of a sole, the back of foot, area of an ankle joint (Rossolimo's reflexes, Bekhtereva, Zhukovsky — Kornilov, Bing-II, etc.), it is necessary to consider as result of increase fiziol. a bending reflex of fingers, to-ry it is normal poorly expressed at most of healthy people.
On hands at central paralyzes, paresis (see) it is possible to find a number of reflex phenomena, to-rye represent strengthening of the proprioceptive reflexes which are available normal, but poorly expressed. Treat their number: Bekhterev's reflex — Jacobson — Caress, carpal and metacarpal and palmar reflexes of Bekhterev, a bending reflex of Bogolepov, flexion and manual Vartenberg's reflexes, Tremner's reflexes — Rusetsky, Zhukovsky — Kornilov, Klippe-lya — Veylya, Leshchenko, Bakhtiarov.
Other group of Genitive is represented by the reactions which normal are absent at adults, but which are observed at early stages of ontogenesis, reflecting themselves function of evolutionarily more ancient parts of the nervous system. In process of development of c. N of page these reactions join in the difficult automated functions. At pathology of c. the N of page occurs as if a disinhibition of these primitive reflexes. Carry a Babinski's reflex to this group of reflexes (see. Babinsky reflex ), being one of the most constant signs of defeat of pyramidal system.
Along with a Babinski's reflex there is a numerous group of reflexes, the shown extension of a thumb or all fingers of foot. Carry to them: Schäffer, Oppengeym, Gordon, Redlikh's reflexes, Grossman, Rumyantsev, Chaddok, Bing-I, Bittiger's reflex. All these reflexes have increase in reflex irritability of a razgibatel of a thumb in the basis. Mechanisms of such selective hyper excitability at the level of a spinal cord remain unknown.
Extensive reflexes of a thumb of foot are the earliest symptoms indicating organic lesion of c. N of page and, in particular, pyramidal system. From them the Babinski's reflex has the greatest diagnostic value, to-ry can arise even before the expressed changes of a muscle tone. To group patol. the-foot reflexes testimonial of defeat of pyramidal system, carry also Pussep and Gnudi's reflexes.
The big group of the reflexes which are absent normal at adults is made by reflexes of oral automatism (see. Bulbar reflexes ), the suctions characterizing as if return to phylogenetic ancient act and captures of food. Reflexes of oral automatism can be as proprioceptive, arising in response to percussion (hobotkovy reflexes of Bekhterev — Epstein, Toulouse — Vyurpa, etc.), and eksterotseptivnsh, appearing in response to shaped irritation or hiting at of area of lips or a mucous membrane of a mouth (a reflex of food of Oppengeym, a hobotkovy reflex of Genneberg, etc.).
The distanza-oral reflexes described by S. I. Karchikyan (1949) are shown by protrusion of lips in a tubule at approach of a subject to a face of the examinee. Sometimes the sucking or deglutitory movements join protrusion of lips. Nek-ry patients have a distanza - the oral reflex is shown not by reduction of lips, but opening of a mouth. This reflex, according to P. S. Babkin, can be observed normal up to 7 years, and not just in the first months of life as it was considered earlier.
The search reflex is caused shaped irritation of area of lips and the skin surrounding them. Response — opening of a mouth and turn of the head towards the put irritation. The reflex normal dies away by 1 — 1,5 years; existence it at adults testifies about patol. process in a nervous system. N. K. Bogolepov described it at the patients with disturbances of cerebral circulation who are in coma (a buccal and oral symptom of Bogolepov).
Reflexes of oral automatism are brightly expressed at bilateral defeat of corticonuclear ways and are characteristic for pseudobulbar paralysis (see).
The big group of Genitive in a face and the head is made by the reflexes which are available in an abeyance is normal and amplifying at pathology of the central motive routes, motor and premotorny area of a cerebral cortex. Carry to them: a mandibular reflex, a mental reflex of Bekhterev, a nazolabialny reflex of Astvatsaturov, a nazomentalny reflex Sim-kovicha, a labiomental reflex, etc. (see. Bulbar reflexes ). These reflexes are often combined with reflexes of oral automatism.
The phylogenetic community between «capture by a mouth and a brush» is available in the palmar and oral reflex of newborns described by P. S. Babkin (1955). As a rudiment of it phylogenetic and ontogenetically an ancient reflex consider a palmar and mental reflex of Marinesku — Radovich, expressed in reduction of a mental muscle at shaped irritation of a palmar surface of a brush, especially to area of the tenor. According to the scientists who described it, the reflex is characteristic of organic lesions of a brain, in particular it is observed at injuries of a frontal lobe, pyramidal and kortiko-bulbar ways.
At damages of frontal lobes of a brain, a corpus collosum, less often than temporal area observe a grasp reflex (Yani-shevsky's reflex — Bekhtereva, a phenomenon of an automatic persuasive hvataniye). The reflex is caused shaped irritation of a palm in the basis of fingers, or hiting at of a palm or to fingers of a brush. At the same time the patient takes a subject, squeezes it in a hand and strong holds so that sometimes quite long time it is impossible to unclench a brush. The grasp reflex can be spontaneous and appears without special irritation of a palm of the patient: the last grabs and with a force holds all can touch (a blanket, a sheet, etc.). With biol. the points of view consider a grasp reflex as result of a disinhibition phylogenetic of the ancient mechanism a lasagna. The Distantny grasp reflex — attempt to take the subject shown at distance («magnetic reaction of Schuster») is observed at damage of a frontal lobe.
Denny-Brown (D. Denny-Brown, 1956) distinguishes 3 types of a grasp reflex at various localization of the center in a nervous system. The first look — the hvataniye caused by weak hiting at of any part of a palm (an exteroceptive reflex); response is palpation, and then tightening of fingers. Such reflex appears at damage of a frontal lobe of a kpereda from the field 6 and 8 (see. Very tectonics of a cerebral cortex ). The second look — the proprioceptive reflex caused by pressing on area of a palm between a big and index finger. Response is tension of long sgibatel of fingers. The reflex appears at damage fields 6 and 8 of a cerebral cortex and a part of the zone crinkle relating to a frontal lobe.
The third type of a grasp reflex represents the reflex arising from proprioretseptor of muscles of a shoulder in response to their stretching. Synergy between sgibatel and abductors of a shoulder and sgibatel of fingers is the cornerstone of a reflex. It is observed at defeat of the field 4 cerebral cortex. At the child in process of formation of a brain it is possible to observe all three types of a grasp reflex.
A bottom grasp reflex of Goldstein, also as well as a grasp reflex of a palm, observe at damage of frontal lobes of a brain (is defined normal at children till 1 year). It is caused the weak pressure of the finger-tips of a hand of the researcher upon a bottom surface of the basis of the toes inspected, lying on spin; at the same time observe bending of all fingers of tonic character, the sole for several seconds takes the concave form, then is returned to initial situation. R. M. Goldstein believed that this reflex can be one of precursory symptoms of defeat of bark of frontal lobes of a brain.
At damages of a spinal cord observe group of Genitive, called protective (see. Protective reflexes ). They are revealed at sharp pain and temperature stimulations and carried to patol. to exteroceptive reflexes.
Pathological postural and tonic reflexes arise at disturbances of difficult mechanisms of regulation poses (see), at various levels of integration of motive system. In maintenance of a pose the important role belongs to reflex mechanisms of regulation of a muscle tone. The muscle tone is considered as the condition of neuromuscular system characterized by a high level of activity of tonic myotatic contraction.
Normal tonic and phasic reflexes are interconnected and coexist during autokinesias. Both types of reflexes join in the difficult mechanism of regulation of a pose and the automated movements. Ratio distortion of tonic and phasic influences on muscles is an origin of a number of Genitive, the postural and tonic reflexes carried in group.
Patol. increase in tonic myotatic contractions causes increase in a muscle tone. The mechanism of increase in a muscle tone at defeat of a pyramidal way and extrapyramidal (reticulospinal) fibers, close to it, is caused by an ukhmensheniye of brake influences of a reticular formation and indirectly through it a cerebral cortex and basal kernels on gamma motor-neurons and tonic alpha motor-neurons of a spinal cord. The ratio of the brake and activating influences on and and - motor-neurons depends on the level of defeat of a nervous system. It in many respects defines a pose of the patient. At pathology at the level of oral departments of a brain trunk when the ratio of impulses on tonic motor-neurons sharply moves towards strengthening, the maximum increase in a tone of extensor muscles — a pose is observed cerebrate rigidity (see).
Labyrinth and cervical tonic reflexes represent reflex changes of a tone under the influence of proprioceptive irritations, coming from muscles and joints of a neck and from labyrinths. These reflexes are noted at newborns, and then are as if reduced, joining in more high-organized reactions of straightening and balance. Disturbance of integration of postural and tonic reactions leads to a disinhibition of labyrinth and cervical tonic reflexes. A delay of their involution at children of early age in connection with pathology of c. the N of page is the negative factor which is slowing down formation of any activity and static functions. M. B. Crolles (1966) believed that trunk mechanisms of a tone can «rastormazhivatsya» at damage of various parts of the nervous system and first of all frontal mosto - cerebellar ways.
The tonic labyrinth reflex is shown by sharp increase in an ek-stenzorny muscle tone in a dorsal decubitus and fleksorny — in a ventral decubitus. The reflex is reflection phylogenetic of ancient dependence of a muscle tone on the provision of labyrinths of a vestibular mechanism.
The symmetric tonic cervical reflex reflects dependence of a muscle tone on a condition of propri-oretseptor of muscles of a neck. Extension of the head increases ex-tensor spasticity of muscles, leading to falling back. Bending of the head causes increase in a tone of muscles of sgibatel, and the patient falls forward.
The asymmetric cervical tonic reflex — at turn of the head is noted increase in a tone of muscles of razgibatel of those extremities to which the face and flexor muscles of extremities to which the nape is turned is turned. There is a so-called «pose of the fencer».
Carry so-called placing reaction of Magnus to postural and tonic reflexes. The passive dorsiflexion of a brush and foot causes sharp strengthening of a tone of razgibatel in muscles of the corresponding extremities. At the same time reflex extension of a forearm and shin and vice versa is observed, at palmar bending of a brush and bottom bending of foot reflex bending of a forearm and shin — so-called negative placing reaction is observed.
Placing reaction is a physiological reflex at children of the first month of life. Further it joins in more difficult mechanism of formation of a basic tone. Placing reaction is found at damages of a cerebellum and its bonds, at injuries of frontal lobes.
The clinic observes as well other postural and tonic reflexes with involvement in the answer of more narrow groups of muscles, napr, a postural reflex of Vestfal, a phenomenon of a shin of Fua — Tevenara.
Patol. interoceptive reflexes represent responses, inexpedient for an organism, from internals on various, usually sverkhs ilny irritants. Examples of such reflexes are a pulmokoronar-ny reflex (a cardiac standstill at irritation a foreign body of an outside wall of a pulmonary artery), a renorenal reflex (a spasm of an ureter at irritation of other ureter an urinary stone), a gepa-tokoronarny reflex (a spasm of coronary vessels during an attack of hepatic colic). In emergence of these reflexes an important role is played by disturbance of functional relationship in to the autonomic nervous system (see).
Table. MAIN PATHOLOGICAL REFLEXES, WAYS of CALLING, THEIR MANIFESTATION AND DIAGNOSTIC VALUE
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L. O. Badalyan.