TOPICAL DIAGNOSIS

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TOPICAL DIAGNOSIS

of defeats nervously y with and - with t e m y — definition of localization and prevalence patol. the center (centers) in a nervous system on the basis of assessment of the disturbances of functions of a nervous system revealed at comprehensive examination. In this regard the extreme importance in Etc. belongs to representations and specific data on localization of functions in c. N of page (see the Cerebral cortex).

The doctrine about localization of functions in a nervous system began to develop intensively in the second half of 19 century. The big contribution to development of this direction was made by I. P. Pavlov's works, I. M. Sechenova,

III. Broun-Sekara, II. Brock, G. Th. Fritsch, J. E. Hit-zig, Shtillinga (V. Stilling), C. Golgi, P. Fleksiga, Deyters (O. F. Page of Deiters), A. Alzheimer, O. Vogt, etc. on anatomy and physiology of a nervous system of animals and the person. The foundation of semiotics of nervous diseases was laid in 70 — the 90th years 19 century by V. M. Bekhterev, A. Ya. Kozhevnikov,

B. K. Roth, G. Dyushenn, A. Vyul-pian, Zh. Sharko, V. Erb, K. Vernike, to-rye for the first time gave the detailed analysis of a sindromologiya of nervous diseases on the basis a wedge, observations and synthesis of data morfol. researches. Further improvement of methodology of the topical diagnosis is connected with works of domestic scientists of G. I. Rossolimo, JI. O. Darkshevich, V. A. Muratov, M. I. Astvatsaturov, L. V. Blum-nau, I. I. Rusetsky, A. M. Grinsh-teyn, I. N. Filimonov, B. S. Doy-pikov, M. B. Crolles, M. S. Margulies, E. K. Sepp, A. V. Triumfov,

C. N D avidenkov, A. R. Luriya, N. K. Bogolepov, E. V. Schmidt, etc. also formation of neuropathology as separate clinical discipline (see Neuropathology).

Qualitatively new step in understanding of anatomo-functional relationship in a nervous system is caused wide in recent years and r imeiyen is mute it ro x Ira rg ichesk their

methods of treatment, and also implementation in clinic of direct methods of a research of a brain with use of the implanted electrodes (see. Microelectrode method of a research) and pharmakol. means of the directed action.

The topical diagnosis is a result of deductive logical process and includes the analysis of data nevrol. survey and results of objective methods of a research. In the solution of questions Etc. the data concerning a current patol have importance. process with a special focus on constancy of a combination of separate signs of defeat of a nervous system and dynamics of formation of characteristic simp-tomokomileks. Definition of localization patol. the center is an integral part of the diagnosis of diseases of a nervous system.

The topical diagnosis provides the correct assessment of character in neuropathology nevrol. symptoms. It is conditionally possible to allocate several options nevrol. frustration. The symptoms of loss which are a consequence of organic lesion of a nervous system are characterized, as a rule, by constancy of disorder of function, a cut is confirmed also by data of an objective research; these symptoms arise at the destruction of this or that nerve center or conduction paths connecting this center with the periphery. At defeat of the efferent centers and systems symptoms of loss are often combined about so-called «plus symptoms», or symptoms of release. The level of the organization of a nerve center, the more regulatory mechanisms is more difficult it combines, and at its defeat a variety «plus symptoms» considerably increases. Emergence of symptoms of release is connected with disintegration of the regulating activity of a nervous system (see. Nervous system, physiology), when avtomatizm of the lowest order come into effect; in parallel komnensatorny reactions form, to-rye can be also referred to symptoms of release. Symptoms of irritation arise at excitement of nerve centers, irritation of conduction paths various patol. processes (tumors of a brain, encephalitis, meningitis, systemic infections, intoxications, etc.) also have non-constant character. In development of these symptoms the important role belongs to disturbances haemo and likvorodiiamik, to frustration of a metabolism in tissue of a brain. Symptoms of loss and irritation are quite often observed at the same time therefore establishment of their true essence and definition of their value for Etc. requires detailed knowledge of anatomy and structurally functional relationship in a nervous system.

Analysis nevrol. symptoms allows to reveal focal or diffusion defeat of a nervous system.

The topical diagnosis of focal disturbance is under construction on the basis of objective, constantly combined patol. signs, existence to-rykh can be explained with disturbance of anatomo-functional relationship in a certain area of a nervous system. Focal damages of a brain are typical for tumoral and pseudo-tumoral processes, disturbances of blood circulation in certain vascular pools and other processes. The concept «focal symptom» is relative as any local patol. process cannot proceed separately, without causing reaction from other parts of the nervous system, edges are represented by uniform functional whole. Degree of manifestation of focal symptoms depends on speed of development, prevalence and character patol. process, and also from age of the patient. At various acute states (e.g., a hematencephalon) focal symptoms can not come to light a long time owing to a diaschisis (see); at slow development patol. process (e.g., growth of a glioma of a brain) focal symptoms can not come to light a long time owing to development of compensatory brain mechanisms (in particular at children). Development of focal symptoms is connected not only with direct damage of this or that area of a brain, but also with the shift of hmozgovy structures, with liquorodynamic frustration (symptoms at distance) and DR-

Diffusion defeat of a nervous system is, as a rule, characterized by the symptoms caused by defeat not of one any or several certain areas of a brain, and widespread defeat of a nervous system.

Along with organic symptoms at diseases of a nervous system observe also so-called functional frustration. At the same time it is not possible to reveal objective signs of focal damage of a brain, however disturbance of regulation of its certain functions takes place. Such disregulyatorny manifestations quite often arise after heavy somatopathies, mental shocks, cherepnomozgovy injuries, and also in connection with fiziol. shifts in an organism during certain age periods, napr, in pubertal. Functional frustration can sometimes be early manifestations of organic lesions of a nervous system.

Statement of the topical diagnosis demands knowledge of the main symptom complexes and their options arising at damage of certain parts of the nervous system.

The topical diagnosis of damage of a spinal cord (see) includes assessment of segmented disorders of the movements, sensitivity and vegetative functions, and also conduction disturbances of movements and sensitivity there is lower than the level of defeat. On the basis of the available symptoms determine level patol. the center, its distribution in the cross and longitudinal directions. The structural disturbances which are localized in a myelencephalon, the varoliyevy bridge (see the Bridge of a brain) and legs of a brain (see the Mesencephalon), involve in patol. process of a kernel of cranial nerves (see). Symptoms of defeat of these or those kernels testify to the level of localization of the center. Defeat of a motive kernel or coming from fibers it is usually combined with defeat of close located motive or sensitive ways. Peripheral paresis of the muscles innervated by cranial nerves on the party of the center of defeat and conduction disorders of the movements and sensitivity on the opposite side are characteristic of half defeat of a trunk of a brain and carry the name of «an alternating syndrome» (see. Alternating syndromes). Damages of a medulla (see) are followed among other symptoms by bulbar paralysis (cm.) l. Bilateral nadjyaderny iatol. processes cause pseudobulbar paralysis (see). The topical diagnosis of damage of a cerebellum (see) is made at disorder of coordination in the form of the static and locomotory ataxy (see) which is observed on the party of the center of defeat, and also a nystagmus (see) and a cerebellar dysarthtia (see).

The disorders of sensitivity (see) which are especially expressed in distal departments of extremities, so-called thalamic pains and a gi-iyerpatiya on the party opposite to the center are characteristic of damage of a thalamus (see). Disturbances of muscular and joint sensitivity are shown by a sensitive ataxy. Quite often there are also atetoidny movements (see the Athetosis), violent laughter and crying.

Syndromes of defeat of basal kernels (see) consist of complex changes of a tone of muscles and a physical activity (see. And mio static symptom complex, Hyperkinesias, Parkinsonism, Ekst of rapiers amide system).

The topical diagnosis of defeat of various departments of a hypothalamus (see) is based on the analysis of disturbances of water-salt, fatty, protein and carbohydrate metabolism, functions of a dream, thermal control, functions endocrine and internals, disorders of emotional reactions (see. Hypothalamic syndrome).

Defeat of the internal capsule (see the Brain) is shown by a hemiplegia (see), a hemianaesthesia and a hemianopsia (see) on the party opposite to the center of defeat.

The topical diagnosis of damage of a cerebral cortex (see the Cerebral cortex, the Brain) is put in the presence of symptoms of irritation (see. Jacksonian epilepsy), combination of signs of disturbance of cortical departments of analyzers to disorder of the highest cortical functions (gnozis, praksis, speech, memory, thinking). Because the highest cortical functions are reflection of difficult integrative activity of a brain in general, definition of the location patol. the center in a cerebral cortex presents great difficulties, to-rye sometimes can be overcome only by means of complex researches.

The topical diagnosis of defeat of a peripheral nervous system (see) put on the basis of the motive, sensitive and vegetative frustration corresponding to anatomic distribution of zones of an innervation of peripheral nerves, textures, roots of spinal nerves.

Modern Etc. has, in addition to nevrol. survey, such methods of a research as a computer tomography back and a brain (see the Tomography computer), a pneumoencephalography (see), an angiography (see. A cerebral angiography), an ekhoentsefalografiya (see), an electroencephalography (see), radio isotope scanning (see), an electromyography (see), and also special the loony about l., otonevrol., neuroophthalmolum. by methods of a research, with the help to-rykh the data specifying localization patol can be obtained. center and character nevrol. symptoms.

Bibliography: Badalyan JI. O. Children's neurology, M., 1975; Bekhterev V. M. Bases of the doctrine about functions of a brain, century 1 — 7, SPb., 1903 — 1907; Blum to a na of L. B. A brain of the person, M. — L., 1925; Bogolepov N. K. Semiotics and diagnosis of nervous diseases, M., 1973; Green -

matte A. M. Ways and centers of a nervous system, M., 1946; Darkshevichl. O. Kurs of nervous diseases, t. 1, M., 1922; M. B. and Fedorov E. A. Crawl. Main neuropathological syndromes,

M., 1966; The Course of nervous diseases, under yued. G. I. Rossolimo, M. — L., 1927; The Multivolume guide to neurology, under the editorship of N. I. Grashchenkov, t. 1, book 1, page 9, M., 1955; Sechenov I. M. Reflexes of a brain, M., 1961; Trium

of A. V f. Topical diagnosis of diseases of a nervous system, L., 1974;

Adams R. D. a. Victor M. Principles of neurology, N. Y., 1981; In

r o-d a 1 A. Neurological anatomy in relation to clinical medicine, N. Y. a. o., 1974;

De Jong R. N. The neurologic examination, Hagerstown, 1979; Guyton A.C. Structure and function of the nervous system, Philadelphia a. o., 1972; Handbook of clinical neurology, ed. by P. J. Vinken a. G. W. Bruyn, v. 1, Amsterdam a. lake * 1975; Handbook of neurological diagnostic methods, ed. by F. Me Dowell, Baltimore, 1960; J a n z e n R. Neurologische Diag-nostik, Therapie, Prognostik fur Arzte und Studierende, Stuttgart, 1975; Neurology, ed. by R. N. Rosenberg, N. Y. a. o., 1980.

L. O. Badalyan.

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