brain stem lesions
Introduction
Introduction The brain stem is composed of the medulla oblongata, the pons, and the midbrain. The lesions (such as tumors, injuries, vascular abnormalities, etc.) in any part are collectively referred to as brain stem lesions. Whether brain stem lesions can be cured or properly improved depends on the specific location of the patient's lesions, clinical symptoms, treatment effects, etc., and cannot be generalized.
Cause
Cause
1. Vascular disease: The symptoms of brain stem disease often occur in the vertebral-basal artery insufficiency. Clinically, there may be disturbance of consciousness, vertigo, stun and sputum.
2. Tumor: When a tumor occurs in the midbrain of the brainstem, progressive or bilateral oculomotor nerve palsy may occur. When the midbrain tumor is present, it is prone to lethargy, lethargy, and even coma. When the tumor is confined to the pons and the bilateral cortical brain stem bundle is damaged, pseudobulbar paralysis and central hypoglossal nerve spasm may occur.
3. Trauma: After the head is struck or other parts of the body are hit, the brain often hits the edge of the cerebellar hole or the slope of the occipital bone. Or cause a strong movement of the brain stem along the longitudinal axis of the brain stem.
4. Inflammation: Brain stem inflammation can cause diffuse edema and de-sheathing changes in the brain stem, glial cell proliferation, and mild changes in nerve cells.
Examine
an examination
Related inspection
Brain CT examination brain MRI examination EEG examination brain function imaging brain nerve examination
Midbrain symptom group
(1) Eye movement disorder: When one or both of the three parts of the oculomotor nucleus, the trochlear nucleus and the quadrilateral of the midbrain are affected, paralysis of the oculomotor nerve and the trochlear nerve occurs, and the two eyeballs are viewed from above and down. Hey, that is, Parinaud syndrome.
(2) Sensory disturbance: brain stem lesions invade both the medial collateral and the spinal thalamus bundle, and various sensory disturbances of the contralateral side of the lesion, including pain, temperature, touch and deep sensory disturbance.
(3) dyskinesia: in the brainstem lesions, the contralateral central facial nerve, hypoglossal nerve and central upper and lower extremity spasm appear. When the brain of the midbrain is lesioned, it often invades the intramedullary or extramedullary root of the oculomotor nerve, and Weber syndrome occurs, that is, the oculomotor palsy and the contralateral central palsy. In the midbrain red nucleus and substantia nigra injury, involuntary movement occurs, and the muscle tone is reduced or increased. When the brain is strong, the whole body muscle tension is significantly increased.
(4) Abnormal pupil: the nucleus of the oculomotor nerve and its fibers are damaged, the pupil of the diseased side is dilated, and the light reflection is weakened or disappeared.
(5) Claude syndrome: The dorsal midbrain is close to the lesions in the cerebral aqueduct, accompanied by damage to the cerebellar arm, and manifests cerebellar symptoms and signs such as ipsilateral oculomotor palsy and contralateral upper and lower limb ataxia.
(6) Mental and sleep disorders: The midbrain is damaged by the lesions of the midbrain, which is characterized by the midbrain illusion. The patient causes hallucinations or sensory hallucinations at dusk. If you see the animals, the human body, and the magnificent scenery, the patient's self-awareness is absent, and he often enjoys it, which may be accompanied by drowsiness and sensory disturbance.
2. Pebble symptoms
(1) Cranial nerve symptoms: The trigeminal nerve symptoms caused by pons lesions are mainly sensory disturbances on the lateral side of the lesion, the corneal reflex is reduced or lost, the ipsilateral masticatory muscles are atrophied and the muscle strength is weak, and the mandibular jaw is biased toward the affected side, and the abductor nerve is paralyzed. The eyeball is oblique.
(2) Sensory disturbance: The degree of sensory impairment varies, some are completely absent, and some are mildly reduced. Fecal sensory disturbances and facial sensations can be in a crossed state. The limb sensation is manifested as a separate sensory disturbance.
(3) Exercise paralysis: more than the opposite side of the lesion appears hemiplegia. In the lower part of the pons, facial nerve palsy appeared on the disease side, hemiplegia occurred on the contralateral side, and abductor nerve paralysis was still present on the lesion side.
(4) cerebellar symptoms: cerebellar symptoms are one of the important symptoms of pons, pons and cerebellum are closely related, ataxia lesions on the lesion side of the ataxia and other cerebellar symptoms.
(5) Mental and sleep disorders: cerebral bridge lesions may cause mental disorders, mental decline and sleep disorders due to damage to the brainstem reticular structure. At first, apathy, lethargy, grief and easy crying, followed by good movements, the language eats.
Medullary symptom group
(1) Limb sputum: When the medullary pyramidal beam crosses the lesion above, the central iliac crest appears in the contralateral upper and lower extremities, with increased muscle tone, hyperreflexia, and positive pyramidal tract sign. When the lesion is at the intersection of the cone, the upper and lower limbs are crossed, the upper limb is paralyzed, and the contralateral lower limb is paralyzed.
(2) Sensory disturbance: When the medullary lesion damages the sensory conduction pathway, there is a separation sensory disturbance of the contralateral limb. When the lesion damages the bilateral medial collaterals, bilateral deep sensory disturbances may occur.
(3) Cranial nerve disorders: When the medullary lesions occur, symptoms of damage to the cranial nerves by XI, X, XI, and XII may occur. It is characterized by difficulty in swallowing, hoarseness, and atrophy of the tongue.
(4) cerebellar symptoms: medullary lesions invade the rope-like body, the ipsilateral cerebellar symptoms occur, manifested as hypotonia, unstable balance, and the patient dumped to the diseased side.
(5) autonomic symptoms: one side of the medullary lesion may appear Horner's sign, that is, the eyeball invagination, pupil and eye cracks become smaller. Often accompanied by sweat, excessive secretion of saliva. Respiratory rhythm disorders can occur in the medullary respiratory center injury, and even respiratory arrest occurs. Cardiovascular central disorders manifest as cardiac rhythm disorders and elevated blood pressure.
(6) Psychiatric symptoms: Patients with bulbar lesions may develop paroxysmal anxiety and often develop at night. Some have illusion and misidentification.
Diagnosis
Differential diagnosis
Brain-occupying lesions: Intracranial space-occupying lesions, which refer to a certain space in the cranial cavity that is occupied by focal lesions, causing clinical focal neurological symptoms, signs, and increased intracranial pressure. This lesion is called intracranial mass. Sexual lesions, also known as brain occupying lesions.
Signs of brain stem damage: After brain stem injury, in addition to the manifestations of local cranial nerve damage, disturbance of consciousness and motor dysfunction are often severe, and there may be failure of respiratory and circulatory function, which is life-threatening.
Brain dysfunction: refers to the brain function caused by certain causes can not be fully played, or can not make the body implement normal conscious emotional activities, thus having a certain impact on the body.
Brain stem infarction: vertebral basilar artery and its branches have atherosclerosis, or arterial embolism, spasm, inflammation leading to stenosis of the lumen, ischemia caused by circulatory disorders.
Brain stem bleeding: Head movements sometimes have headaches, dizziness, sweating, and often coma for long periods of time in severe cases. Most of the brain stem bleeding occurs in the pons. CT showed a mass, round or elliptical high-density shadow; CT value was 40-80HU; single or multiple (mostly single); the lesion edge was clear. If the amount of bleeding is large, the brain stem can be thickened, the density is increased, and the bridge pool and the ring pool are narrowed or disappeared. It can also break into the fourth ventricle and back up, causing the third ventricle and the midbrain aqueduct to change into a ventricle. , volume expansion, forward breakthrough, there may be blood in the bridge pool, ring pool, saddle upper pool. When a small amount of bleeding, attention should be paid to the identification of the volumetric effect of the posterior cranial fossa.
