I-Brainstem kunye nolawulo lwe-4 | El Paso, TX.

Umthetho we-4 we ingqondo: Indlela eyenziwe lula yokuqonda i-brainstem anatomy kunye ne-brainstem vascular
syndromes kwi-non-neurologist.

Umthetho we-4 kunye ne-Brainstem

Umgaqo wesi-4 yindlela elula ephuhliswe ukunceda �abafundi be-neurology� ukuba bakhumbule i-anatomy ye-brainstem kwaye ngaloo ndlela iimpawu ze-brainstem vascular syndromes ezahlukeneyo. Njengabafundi bezonyango, sifundiswa i-anatomy eneenkcukacha ye-brainstem enenani elididayo lezakhiwo ezinamagama anomdla afana ne-colliculi ephezulu, iminquma engaphantsi, i-cranial nerve nuclei kunye ne-median longitudinal fasciculus. Enyanisweni xa sisenza uhlolo lwemithambo-luvo sivavanya nje ezimbalwa kwezi zakhiwo. Umgaqo we-4 uyakuqonda oku kwaye uchaza kuphela iindawo ze-brainstem esizivavanya ngokwenene xa sisenza uvavanyo lwe-neurological. Ukunikezelwa kwegazi kwi-brainstem kukuba kukho amasebe e-paramedian kunye namasebe amade ajikelezayo (i-anterior inferior inferior cerebellar artery (AICA), i-posterior inferior cerebellar artery (PICA) kunye ne-cerebellar artery ephezulu (SCA). kwi-syndromes ye-brainstem ye-medial (okanye i-paramedian) kunye nokuvalelwa kwamasebe ajikelezayo kubangela ukuba i-syndromes ye-brainstem ye-lateral i-syndromes ngezinye izihlandlo zibonwa kwi-vertebral occlusion ye-unilateral.

Naliphi na ilinge lokwenza izinto zibe lula kakhulu libeka umngcipheko wokuphazamisa abo bathanda iinkcukacha kwaye ndicela uxolo kwangethuba kwi-anatomists phakathi kwethu, kodwa ngaphezu kweminyaka eyi-15 le ngcamango ilula incede abafundi abaninzi kunye nabahlali ukuba baqonde, ngokuphindaphindiweyo okokuqala, ingqondo i-anatomy kunye nee-syndromes zeklinikhi ezinxulumene nazo.

Kumgaqo wesi-4 kukho imigaqo emi-4:

1. Kukho izakhiwo ezi-4 kwi-�umgca� ukuqala nge M.
2. Kukho izakhiwo ezi-4 kwi Icala qaleni S.
3. Kukho i-4 ye-cranial nerves kwi-medulla, i-4 kwi-pons kunye ne-4 ngaphezu kwee-pons (2 kwi-midbrain).
4. Iimotor nuclei ezi-4 ezikumgca ophakathi zezo zahlule ngokulinganayo ku-12 ngaphandle ko-1 kunye no-2, oko kukuthi u-3, 4, 6 kunye no-12 (5, 7, 9 kunye ne-11 kwi-brainstem esecaleni).

Ukuba unokukhumbula le migaqo kwaye uyazi ukuba uhlolisise inkqubo ye-nervous, ngakumbi neentsholongwane, ngoko uya kukwazi ukuxilonga i-brainstem vascular syndromes ngokulula.

Umzobo we-1 ubonisa i-cross-section of the brainstem, kule meko kwinqanaba le-medulla, kodwa ingcamango ye-4 ye-lateral kunye ne-4 yezakhiwo ze-medial nazo zisebenza kwiipons, kuphela izakhiwo ze-4 ze-medial zihambelana ne-syndromes ye-vascular syndromes.

Izakhiwo ezi-4 eziPhakathi kunye neNtsilelo eNxulumeneyo zezi:

1. The Mi-otor pathway (okanye i-corticospinal tract): ubuthathaka becala lengalo kunye nomlenze.
2. The MI-edial Lemniscus: ilahleko esecaleni yecala lokungcangcazela kunye neprioception engalweni nasemlenzeni.
3. The MI-edal longitudinal fasciculus: i-ipsilateral inter-nuclear ophthalmoplegia (ukusilela kokunyuswa kwe-ipsilateral eye ukuya kwimpumlo kunye nenystagmus kwelinye iliso njengoko lijonge ecaleni).
4. The MI-otor nucleus kunye ne-nerve: i-ipsilateral ilahleko ye-cranial nerve echaphazelekayo (3, 4, 6 okanye 12).

I-4 Lateral Structures kunye neNtsilelo eNxulumeneyo zezi:

1. The Siindlela zepinocerebellar: ipsilateral ataxia yengalo kunye nomlenze.
2. The SI-pinothalamic pathway: i-contra lateral utshintsho lwentlungu kunye nobushushu obuchaphazela ingalo, umlenze kwaye kunqabile ukuba isiqu.
3. The SI-nucleus ye-ensory ye-5: ukuguqulwa kwe-ipsilateral yentlungu kunye nobushushu ebusweni ekuhanjisweni kwe-5th ye-nerve cranial (le nucleus yinkqubo emide ethe nkqo eyandisa kwinqanaba le-pons phantsi kwi-medulla).
4. The Sindlela yovelwano: ipsilateral Horner's syndrome, oko kukuthi i-ptosis kunye nomfundi omncinci (miosis)

Ezi ndlela zidlula kubo bonke ubude be-brainstem kwaye zinokufaniswa �meridians of longitude � ngelixa imithambo-luvo eyahlukeneyo yecranial inokuthatyathwa �ukunxulunyaniswa kobubanzi�. Ukuba umisela indawo apho i-meridians yobude kunye nongqamaniso lwesibanzi zinqumlana, ngoko umisele indawo yesilonda.

Umzobo we-2 ubonisa inkalo ye-ventral ye-brainstem.

IiNeva ezi-4 zeCranial kwiMedulla zezi:

9 I-Glossopharyngeal: ilahleko ye-ipsilateral ye-pharyngeal sensation.
10 I-Vagus: Ubuthathaka obungenasiphelo kwipalatal.
11 I-Spinal accessory: ubuthathaka be-ipsilateral be-trapezius kunye nemisipha ye-sternocleidomastoid.
12 I-Hypoglossal: Ubuthathaka bolwimi.

I-12th cranial nerve yi-motor nerve kumgca ophakathi we-medulla. Nangona i-9th, i-10 kunye ne-11 ye-cranial nerves inee-motor components, azihluli ngokulinganayo kwi-12 (usebenzisa umgaqo wethu) kwaye ngoko ayizizo iintsholongwane ze-motor medial.

IiNerva ezi-4 zeCranial kwiiPons zezi:

5 I-Trigeminal: ukuguqulwa kwe-ipsilateral yeentlungu, ubushushu kunye nokukhanya okuchukumisayo ebusweni ngasemva ukuya kuthi ga kwisibini kwisithathu se-scalp kunye nokugcina i-angle yomhlathi.
6 I-Abducent: ubuthathaka obungabonakaliyo bokuhluthwa (intshukumo yecala) yeso.
7 Ubuso: ubuthathaka bobuso obungasecaleni.
8 Ukuva: kukungeva ngeendlebe.

I-6th ye-cranial nerve yi-motor nerve kwiipons.

I-7th i-motor nerve kodwa iphinde ithwale iindlela zokunambitha, kwaye usebenzisa umgaqo we-4 awuhluli ngokulinganayo kwi-12 kwaye ngoko ayiyiyo i-motor nerve ephakathi. Ingxenye ye-vestibular ye-nerve ye-8 ayifakiwe ukuze kugcinwe ingcamango elula kwaye ugweme ukudideka. I-nausea kunye nokuhlanza kunye ne-vertigo zihlala zixhaphake kakhulu ngokubandakanyeka koqhagamshelwano lwe-vestibular kwi-lateral medulla.

IiNerva zeCranial ezi-4 ngaphezulu kweePons zezi:

4 I-olfactory: ayikho kwi-midbrain.
5 I-Optic: ayikho kwi-midbrain.
6 I-Oculomotor: i-adduction ephazamisekileyo, i-supraduction kunye ne-infraduction ye-iso ye-ipsilateral kunye okanye ngaphandle komfundi odibeneyo. Iliso likhutshiwe kwaye liphantsi kancinci.
7 Trochlear: iliso alikwazi ukujonga phantsi xa iliso lijonge empumlweni.

I-3rd kunye ne-4th ye-cranial nerves yi-motor nerves kwi-midbrain.

Ngaloo ndlela i-medial brainstem syndrome iya kubandakanya 4 ms kunye ne-motor cranial nerve echaphazelekayo, kunye ne-lateral brainstem syndrome iya kubandakanya 4 s kwaye nokuba yi-9�11th ye-cranial nerve ukuba ikwi-medulla, okanye i-5th, i-7th kunye ne-8th ye-cranial nerve ukuba i-pons.

I-MEDIAL (PARAMEDIAN) I-BRINSTEM SYNDROMES

Makhe sicinge ukuba isigulana osihlolayo sine-brainstem stroke. Ukuba ufumana iimpawu eziphezulu ze-motor neurone engalweni kunye nomlenze kwelinye icala ngoko uyazi ukuba isigulane sine-syndrome yengqondo yengqondo ngenxa yokuba i-motor pathways i-paramedian kwaye iwela kwinqanaba le-foramen magnum (i-decussation yeepiramidi). Ukubandakanyeka kwendlela yemoto yi �meridian yobude�. Ukuza kuthi ga ngoku i-lesion ingaba naphi na kwinkalo ye-medial ye-brainstem, nangona ukuba ubuso buchaphazelekayo kufuneka bube ngaphezu kwee-pons eziphakathi, inqanaba apho i-nucleus ye-nerve ye-7.

I-motor cranial nerve �i-parallels of latitude� ibonisa ukuba isilonda sikwi-medulla (12th), iipons (6th) okanye midbrain (3rd). Khumbula ukuba i-cranial nerve palsy iya kuba yi-ipsilateral kwicala lesilonda kwaye i-hemiparesis iya kuba iphikisana. Ukuba i-lemniscus ephakathi nayo ichaphazelekayo ngoko uya kufumana ilahleko ye-contra lateral ye-vibration kunye ne-proprioception kwingalo kunye nomlenze (icala elifanayo elichaphazelekayo yi-hemiparesis) njengoko iikholomu zangasemva nazo ziwela okanye ngaphezu kwenqanaba le-foramen magnum. I-median longitudinal fasciculus (MLF) ngokuqhelekileyo ayichaphazeleki xa kukho i-hemiparesis njengoko i-MLF iphinde ibuyele kwi-brainstem.

I-MLF inokuchaphazeleka ibekwe yodwa �a lacunar infarct� kwaye oku kukhokelela kwi-ipsilateral internuclear ophthalmoplegia, ngokusilela kokunyuswa (ukushukuma ukuya kwimpumlo) yeliso elisecaleni kunye ne-nystagmus yamehlo ekhokelayo ekujongeni ecaleni kwelinye icala lesilonda ngaphakathi. iliso elisecaleni. Ukuba isigulane sinenxaxheba ye-MLF ekhohlo ngoko, xa sicelwa ukuba sijonge ngakwesobunxele, ukunyakaza kwamehlo kuya kuba yinto eqhelekileyo, kodwa ngokujonga ngakwesokudla iliso lasekhohlo aliyi kudlula umgca ophakathi, ngelixa bekuya kubakho i-nystagmus. iliso lasekunene njengoko lalijonge ekunene.

Umzobo we-3 ubonisa iimpawu zeklinikhi ze-syndromes yengqondo yengqondo.

I-LATERAL BRAINSTEM SYNDROMES

Kwakhona sicinga ukuba isigulana osibonayo sinengxaki yobuchopho, kusenokwenzeka ukuba sisilonda semithambo. I 4 s okanye �meridians of longitude� iya kubonisa ukuba ujongene nengxaki yengqondo esecaleni kunye neentsholongwane okanye �ukungqamana kwesibanzi� kuya kubonisa ukuba ingxaki ikwi-medulla esecaleni okanye esecaleni.

I-infarct ye-brainstem yecala iya kubangela i-ataxia ye-ipsilateral yengalo kunye nomlenze ngenxa yokubandakanyeka SI-pinocerebellar pathways, ukuguqulwa kwentlungu kunye nobushushu ngenxa yokubandakanyeka SI-pinothalamic pathway, ilahleko ye-ipsilateral yeentlungu kunye nemvakalelo yokushisa echaphazela ubuso phakathi kokusasazwa SI-nucleus ye-ensory ye-nerve ye-trigeminal (ukubamba ukukhanya kunokuchaphazeleka ngokubandakanyeka kwendlela ye-spinothalamic kunye / okanye i-nucleus ye-sensory ye-nerve trigeminal). I-ipsilateral Horner's syndrome ene-ptosis kunye nomfundi omncinci (miosis) kungenxa yokubandakanyeka Sindlela yovelwano. Ithoni yamandla kunye ne-reflexes kufuneka zonke zibe yinto eqhelekileyo. Ukuza kuthi ga ngoku konke esikwenzileyo kukubeka ingxaki kwindawo esecaleni ye-brainstem; ngokongeza i-3 efanelekileyo ye-cranial nerves kwi-medulla okanye i-pons sinokubeka indawo yesilonda kulo mmandla wengqondo.

Iimbilini ezisezantsi ze-4 ze-cranial zikwi-medulla kwaye i-12th nerve iphakathi kwe-midline ukwenzela ukuba i-9th, i-10th kunye ne-11th iimbilini ziya kuba kwicala elisecaleni le-medulla. Xa ezi zichaphazelekayo, umphumo we-dysarthria kunye ne-dysphagia kunye nokukhubazeka kwe-ipsilateral ye-gag reflex kunye ne-palate iya kutsala ukuya kwelinye icala; ngamanye amaxesha kunokubakho ubuthathaka be-trapezius ye-ipsilateral kunye / okanye i-sternocleidomastoid muscle. Le yi-lateral medullary syndrome edla ngokubangelwa ukuvalelwa kwe-ipsilateral vertebral okanye i-posterior inferior inferior cerebellar arteries.

I-4 ye-cranial nerves kwiipons zezi: 5th, 6th, 7th kunye ne-8th. I-6th nerve yi-motor nerve phakathi kwe-midline, i-5th, i-7th kunye ne-8 ikwinkalo yecala le-pons, kwaye xa ezi zichaphazelekayo kuya kubakho ubuthathaka bobuso obungabonakaliyo, ubuthathaka be-ipsilateral masseter kunye nemisipha ye-pterygoid (imisipha evulekileyo). kwaye uvale umlomo) kwaye ngamanye amaxesha ubuthulu be-ipsilateral. I-tumor efana ne-acoustic neuroma kwi-angle ye-cerebello-pontine iya kubangela ubuthulu be-ipsilateral, ubuthathaka bobuso kunye nokuphazamiseka kwemvakalelo yobuso; kusenokubakho i-ipsilateral limb ataxia ukuba icinezela i-cerebellum ye-ipsilateral okanye i-brainstem. Indlela yovelwano idla ngokunzulu kakhulu ukuba ingachaphazeleka.

Ukuba kukho imiqondiso ye-lateral kunye ne-medial (i-paramedian) ye-brainstem syndrome, ngoko umntu kufuneka aqwalasele ingxaki ye-basilar artery, mhlawumbi kuvela.

Isishwankathelo, ukuba umntu unokukhumbula ukuba kukho iindlela ze-4 kumgca ophakathi oqala ngonobumba uM, iindlela ze-4 kwinkalo yecala yengqondo eqala ngonobumba S, i-4 ye-cranial nerves ephantsi ikwi-medulla, i-4 cranial ephakathi. imithambo-luvo kwi-pons kunye ne-4 yokuqala ye-cranial nerves ngaphezu kwe-pons kunye ne-3rd kunye ne-4th kwi-midbrain, kwaye i-4 ye-motor nerves eku-midline yi-4 eyahlula ngokulinganayo kwi-12 ngaphandle kwe-1 kunye ne-2, oko kukuthi i-3 , 4, 6 kunye ne-12, ngoko kuya kukwazi ukuxilonga i-brainstem vascular syndromes ngokuchaneka kwe-pinpoint.

P. GATES

Isibhedlele saseGeelong, iMpilo yaseBarwon, iGeelong, iVictoria, eOstreliya

IZALATHISO

1 Isahluko 7. I-Neurology. Ku: Williams PL, Warwick R, Dyson M, Bannister LH, ed. Grey's Anatomy, 37th edn. Edinburgh: Churchill Livingstone; 1989; 860'1243.