What pathologies are in the cerebellum. Inflammatory diseases of the cerebellum. Cerebellar disorders: causes, symptoms, signs, treatment

(cerebellum) - a part of the brain related to the hindbrain. Participates in the coordination of movements, regulation of muscle tone, maintaining posture and balance of the body.

The cerebellum is located in the posterior cranial fossa posterior to the medulla oblongata and the pons, forming part of the roof of the fourth ventricle. Its upper surface faces the occipital lobes of the cerebral hemispheres, from which it is separated by the cerebellum. Below, the cerebellum approaches the foramen magnum. The projection of the cerebellum on the surface of the head is located between the external occipital protrusion and the bases of the mastoid processes. The mass of the cerebellum of an adult is 136-169 g.

The cerebellum consists of an unpaired middle part - the worm (vennis) and paired hemispheres (hemispheria cerebelli), covering the brain stem. The surface of the cerebellum is divided by numerous fissures into thin sheets that run approximately transversely along the hemispheres and the vermis. Horizontal fissure (fissura hdnzontalis) separates the upper and lower surfaces of the cerebellum. Within the lobes, the leaves of the cerebellum are grouped into lobules, and the lobules of the vermis correspond to certain lobules of the hemispheres.

The surface of the cerebellum is covered by the cortex.

The blood supply to the cerebellum is carried out by the superior, inferior anterior and inferior posterior cerebellar arteries. Their branches anastomose in the pia mater, forming a vascular network, from which branches branch into the cortex and white matter of the cerebellum. The veins of the cerebellum are numerous, they merge into big vein brain and sinuses of the dura mater (straight, transverse, petrosal).

The cerebellum is the central organ for coordinating movements, coordinating the activities of synergistic and antagonist muscles involved in motor acts. This function of the cerebellum, which regulates voluntary movements, along with the regulation of muscle tone, ensures the accuracy, smoothness of purposeful movements, as well as maintaining the posture and balance of the body.

Research methods:

Clinical methods include the study of movements, gait, conducting special tests to identify static and dynamic ataxia, asynergy, the study of postural reflexes, the study of muscle tone.

To identify gait disorders, plantography and ichnography are used (a method for studying the gait and shape of the feet from their prints obtained when walking on a sheet of paper superimposed on a metal track covered with paint). To clarify the nature of M.'s lesion, the same methods are used as in the study of the brain.

Pathology:

The main clinical sign of damage to the cerebellum is static and dynamic ataxia on the side of the pathological focus, manifested by violations of the center of gravity and balance of the body when standing, walking, dysmetria and hypermetria, misses during targeted movements, adiadochokinesis, intentional trembling, speech disorders in the form of chanting, tearing at syllables (the so-called cerebellar dysarthria), handwriting changes in the form of megalography, nystagmus.

If the connections between the cerebellum and the cerebral cortex are disrupted, changes in complex statokinetic functions can occur with the syndrome of astasia-basia (astasia - the inability to stand, abasia - the inability to walk). At the same time, the active movements of the lower extremities are not disturbed in the patient in the prone position, there are no paresis. An important sign damage to the cerebellum is asynergy (disturbances in the friendly activity of muscles when performing movements), changes in postural reflexes, in particular in the form of a spontaneous pronator phenomenon.

In patients with damage to the cerebellum and its connections, hyperkinesis may occur: if connections with the dentate and red nuclei are disturbed, choreoathetosis and the so-called rubral tremor in the extremities on the side of the pathological focus develop; with damage to the connections of the dentate nucleus v lower olive - myoclonus of the tongue, pharynx, soft palate. On the side of the lesion of the cerebellum, the muscle tone of the limbs decreases or is absent, as a result of which, with passive movements, hyperextension in the joints and excessive movements in them are possible. Pendulum reflexes may occur.

To identify them, the patient is seated on the edge of a table or bed in such a way that the legs hang freely, and cause knee reflexes. In this case, the patient's lower leg makes several rocking (pendulum) movements. The so-called magnetic reaction is often detected: with a light touch on the plantar surface thumb foot, stretching of the entire limb is observed.

All volumetric lesions of the cerebellum (tumors, hemorrhages, traumatic hematomas, abscesses, cysts) are characterized by a significant increase in intracranial hypertension due to occlusion of the cerebrospinal fluid spaces at the level of the fourth ventricle and opening, which causes the occurrence of hypertensive crises.

Malformations:

Allocate total and subtotal (lateral and median) cerebellar agenesis. Total agenesis is rare. It is usually associated with other severe malformations of the nervous system. Subtotal agenesis of the cerebellum is also, as a rule, combined with malformations of the brain stem (agenesis of the brain bridge, absence of the fourth ventricle, etc.). With cerebellar hypoplasia, a decrease in the entire cerebellum or its individual structures is noted.

Hypoplasia of the cerebellum can be unilateral and bilateral, as well as lobar, lobular. There are various changes in the gyri of the cerebellum: allogyria, macrogyria, polygyria, agyria. Dysraphic disorders are most often localized in the region of the cerebellar vermis, as well as the inferior medullary sail, and manifest as a cerebellohydromeningocele or slit-like defect in the structure of the cerebellum. With macroencephaly, hypertrophy of the molecular and granular layers of the cerebellar cortex and an increase in its volume are observed.

Clinically, cerebellar malformations are manifested by static and dynamic cerebellar ataxia, which in some cases is determined along with symptoms of damage to other parts of the nervous system. Characteristic violations mental development up to idiocy and the development of motor functions. Treatment is symptomatic

Cerebellar injury:

Open injuries of the cerebellum are observed in traumatic brain injury along with damage to other formations of the posterior cranial fossa and in most cases lead to death. With closed craniocerebral injuries, symptoms of a cerebellar lesion often develop due to its direct bruising or as a result of a counterblow. Especially often M. is damaged when falling on the back or bruising in the cervical-occipital region. At the same time, pain, hyperemia, swelling and compaction of soft tissues in the cervical-occipital region are noted, and a fracture is often found on craniograms. occipital bone.

In these cases, the symptoms of cerebellar damage are almost always combined with symptoms of brain stem damage, which can occur both due to contusion and due to the formation of acute, subacute or chronic epidural or subdural hematoma in the posterior cranial fossa. Hematomas of the posterior cranial fossa, as a rule, are unilateral (especially epidural) and develop as a result of damage to the veins. In rare cases, hydromas of the posterior cranial fossa (acute accumulation of cerebrospinal fluid in the subdural space) are formed.

Diseases:

Cerebellar lesions of vascular origin develop in ischemic and hemorrhagic strokes. Ischemic strokes and transient disorders cerebral circulation occur with thrombosis and non-thrombotic softening of the brain, as well as with embolism in the system of vertebral, basilar and cerebellar arteries. Focal cerebellar symptoms predominate in combination with signs of damage to the brain stem.

Hemorrhages in the cerebellum are characterized by a rapid increase in general cerebral symptoms with impaired consciousness (development of soporous or coma), meningeal symptoms, early cardiovascular, respiratory and other stem disorders, diffuse muscular hypotension or atony. Focal cerebellar symptoms are observed only with limited hemorrhagic foci in the cerebellum; with massive hemorrhages, they are not detected due to severe general cerebral and stem symptoms.

Dystrophic processes in the cerebellum are characterized by a gradual progressive increase in cerebellar disorders, which are usually combined with signs of damage to other parts of the nervous system, and especially its extrapyramidal part. Such clinical syndrome observed in Pierre Marie's hereditary cerebellar ataxia, olivopontocerebellar degeneration, Friedreich's familial ataxia, Louis Bar ataxia-telangiectasia.

Cerebellar lesions of infectious origin in most cases are a component of an inflammatory disease of the brain. At the same time, cerebellar symptoms are combined with signs of focal lesions of other parts of the brain, as well as with pronounced general infectious, general cerebral, and often meningeal symptoms. Cerebellar disorders can be observed with neurobrucellosis, toxoplasmosis. Often, damage to the cerebellum and its connections is observed in multiple sclerosis, subacute sclerosing leukoencephalitis.

Cerebellar abscess accounts for almost 1/3 of all brain abscesses. More often it has a contact otogenic origin, less often metastatic - from distant purulent foci. The process develops up to 2-3 months. The general serious condition of the patient is characteristic, pronounced neurological manifestations with the presence of general infectious, cerebral, sometimes meningeal symptoms. Cerebellar and other neurological symptoms are detected early on the side of the main pathological focus. Treatment is intensive anti-inflammatory and surgical.

Tumors and cysts:

The most common are astrocytomas, medulloblastomas, angioreticulomas, and sarcomas. There are also metastases in the cerebellum of malignant tumors of internal organs. The clinical picture depends mainly on the histological form of the tumor, the stage of development of the disease and the age of the patient. Astrocytomas and angioreticulomas, as a rule, have a benign course, medulloblastomas and sarcomas are malignant.

Cysts of the cerebellum (worm and hemispheres) can be dysgenetic or result from the organization of hemorrhages, heart attacks, abscesses. More often observed in tumors of the cerebellum, angioreticulomas, astrocytomas; they are located either inside the tumor, or adjacent directly to it. Syringomyelic cavities in the cerebellum are rare.

The set of symptoms may vary depending on the cause, but as a rule, it includes ataxia (impaired coordination of movements). Diagnosis is based on clinical findings and is often supplemented by neuroimaging and sometimes findings genetic testing. Treatment is usually symptomatic unless the identified cause is acquired and reversible.

The cerebellum is made up of three parts.

Archicerebellum (vestibulocerebellum): includes a flocculent-nodular lobe, which is located medially.
Mid-located worm (paleocerebellum): responsible for coordinating the movements of the torso and legs. The defeat of the worm leads to violations of walking and maintaining posture.
Laterally located hemispheres of the cerebellum (neocerebellum): they are responsible for the control of fast and precisely coordinated movements in the limbs.

Currently, more and more researchers agree that, along with coordination, the cerebellum also controls some aspects of memory, learning and thinking.

Ataxia is the most characteristic sign of a cerebellar lesion, but other symptoms may also occur.

Causes of cerebellar disorders

Congenital malformations are often sporadic and often part of complex syndromes (for example, Dandy-Walker anomaly) with impaired development of various parts of the central nervous system. birth defects development manifest early in life and do not progress with age. The symptoms they present with depend on the affected structures; at the same time, as a rule, ataxia is always observed.

Hereditary ataxias can have both autosomal recessive and autosomal dominant modes of inheritance. Autosomal recessive ataxias include Friedreich's ataxia (the most common), ataxia-telangiectasia, abetalipoproteinemia, ataxia with isolated vitamin E deficiency, and cerebrotendinous xanthomatosis.

Friedreich's ataxia develops due to the expansion of tandem GAA repeats in the gene encoding the mitochondrial protein frataxin. A reduced level of frataxin leads to excessive accumulation of iron in mitochondria and disruption of their functioning. Instability when walking begins to manifest itself at the age of 5-15 years, which is then joined by ataxia in the upper limbs, dysarthria and paresis (mainly in the legs). The intellect often suffers. Tremor, if present, is not pronounced. Depression of deep reflexes is also noted.

Spinocerebellar ataxias (SCAs) are most dominant ataxia. The classification of these ataxias has been repeatedly revised as new knowledge regarding their genetic characteristics has been gained. To date, at least 28 loci have been identified, mutations in which lead to the development of SCA. In at least 10 loci, the mutation consists in the expansion of nucleotide repeats, in particular, in some forms of SCA, an increase in the number of CAG repeats (as in Huntington's disease) encoding the amino acid glutamine is observed. Clinical manifestations are varied. In some forms of the most common SCA, multiple lesions of various parts of the central and peripheral nervous system are observed with the development of polyneuropathy, pyramidal symptoms of the syndrome restless legs and, of course, ataxia. In some SCAs, only cerebellar ataxia occurs. SCA type 5, also known as Machado-Joseph disease, is probably the most common variant of autosomal dominant SCA. Its symptoms include ataxia and dystonia (sometimes), facial twitches, ophthalmoplegia, and characteristic "bulging" eyes.

Acquired fortunes. Acquired ataxias are the result of non-hereditary neurodegenerative diseases, systemic diseases, exposure to toxins, or they may be idiopathic in nature. Systemic diseases include alcoholism, celiac disease, hypothyroidism, and vitamin E deficiency. Carbon monoxide, heavy metals, lithium, phenytoin and some types of solvents.

In children, the cause of the development of cerebellar disorders is often brain tumors, which, as a rule, are localized in the region of the middle sections of the cerebellum. In rare cases, children may experience reversible after a viral infection.

Symptoms and signs of cerebellar disorders

Symptoms	Manifestation
Ataxia	Wobbling gait with extended base
Discoordination of movements	Inability to properly coordinate precise movements
dysarthria	Inability to clearly pronounce words, slurred speech with incorrect phrasing
Dysdiadochokinesis	Inability to perform fast alternating movements
Dysmetria	Inability to control range of motion
Muscular hypotension	Decreased muscle tone
nystagmus	Involuntary, rapid fluctuations eyeballs in a horizontal, vertical or rotational direction, with a fast component directed towards the lesion in the cerebellum
scanned speech	Slow pronunciation with a tendency to have difficulty pronouncing the beginning of a word or syllable
Tremor	Rhythmic alternating oscillatory movements in the limb when it approaches the target (intentional tremor) or in its proximal muscle groups while maintaining a posture or holding weight (postural tremor)

Diagnosis of cerebellar disorders

Diagnosis is based on clinical findings, including a detailed family history, to the exclusion of possible acquired systemic diseases. Neuroimaging, preferably MRI, should be done.

Treatment of cerebellar disorders

Some systemic diseases and consequences of toxic exposure may be corrected. At the same time, treatment is usually only supportive.

Cerebellum is one of the most underestimated areas of the human brain. Among the functions carried out by him is the regulation and coordination of movements and postures. The term "cerebellum" comes from the Latin word "cerebellum", literally meaning "small brain".

The cerebellum plays a very important role in coordinating voluntary movements and regulating balance and muscle tone ().

human brain- this is an amazing device that independently, alone, performs many functions of the human body. The development of the brain helped man become the most developed living being on the planet. As part of the nervous system, the brain is divided into different regions, one of which is the cerebellum. Each area of the brain performs its own specific functions, including the cerebellum.

Location

The cerebellum is located posterior to the brain stem, making up the lower part of the brain. Above it is the cortex, and in front of it is a part of the brain stem called the pons. The cerebellum is divided into two hemispheres and has a cortex that surrounds these hemispheres.

The main function of the cerebellum is to provide smooth
and coordinated muscle movements...

Children are a good example of this.
The cerebellum, like other areas of the brain, can be "trained"...

Functions of the cerebellum

The first and main function of the cerebellum is to organize the complex information received by the brain. The cerebellum receives information from inner ear, sensory nerves and the visual-auditory system. It coordinates movements, as well as basic processes related to memorization and learning.

In addition, the cerebellum plays a very important role in the coordination of voluntary movements and the regulation of balance and muscle tone. If you receive any kind of brain injury or the development of brain cancer, it may work intermittently. This causes slowness and poor coordination of body movements, so people with cerebellar damage may wiggle or stagger when walking.

Injuries to the cerebellum in humans can lead to many problems. These problems include:

Asynergy: lack of coordination of movements.

Dysmetria: difficulty estimating distance and determining when to stop.

Adiadochokinesis: inability to perform fast alternating movements.

Intentional tremor: tremor (tremor) during certain movements.

Atactic gait: swaying and staggering when walking.

Hypotonicity: weakening, decreased muscle tone.

Ataxic dysarthria: unintelligible speech.

Nystagmus: abnormal eye movements.

Checking the functions of the cerebellum

There are certain neurological tests, which allow you to check the functioning of the cerebellum. The most commonly performed tests are:

Finger-nose test: The doctor points the patient to a finger and the patient must bring this finger to the nose. This test detects dysmetria, intentional tremor, and off-target hits.
Alternating hand movements.
Romberg test.
Gait check.
Checking the ability to balance.

As you can see, the main functions of the cerebellum are related to balance and balance. Other functions include maintaining muscle tone and coordinating voluntary movements and muscle activity.

Falls for no reason. Video.

Hidden possibilities of our brain Mikhail G. Veisman

The cerebellum: what can we lose with it?

The brain is made up of white substances and gray - everyone knows it. And one and the other is nervous tissue. Only white matter is formed mainly neurons, conducting a signal in one direction, and Gray matter comprises multipolar neurons. That is, capable of passing many signals in different directions.

The cerebral cortex consists entirely of white, and the inner, as it were, the basic part of the hemispheres, consists entirely of white.

In all the pictures of this organ, the hemispheres themselves are the first to catch our eye. And if you ask any person offhand, exaggeratedly draw the brain on paper from memory, he will definitely draw - again, their loved ones. In fact, with a purely external examination with the naked eye, you can see three large parts of the brain at once - a memorable look hemisphere, cerebellum(see fig. 3, p. 36) and brain stem(see Fig. 2, p. 25). To see many other details, the brain must either be turned over or cut along the furrow separating the hemispheres, since these two largest and most developed sections cover the rest like a hat.

Rice. one. The cerebellum (M) is responsible for coordinating our movements: I - the cerebral cortex; II - thalamus; III - pons varolii; IV - medulla oblongata; V - spinal cord

The cerebellum is located under the "dome" of the hemispheres. If we talk about its location, focusing on its own head, then the cerebellum is located in the back of the head. It is connected by three pairs of legs to the corresponding sections of the main brain and also consists of two hemispheres (though expressed a little less clearly) and the so-called worm. The worm is responsible for maintaining the desired position of the body, while the hemispheres are more “busy” with precise and smooth movements of the limbs.

In other words, the cerebellum is responsible for coordinating the movements of the human body and the corresponding work of its muscles.(see fig. 1). And also - for their general tone and maintaining the balance of the body. Just? Yes, if you consider that each human step requires the participation of about 300 muscles ... And this is on a flat surface, without taking into account the need to balance or dance on the go! And then, is there a need to remind that we also speak and look with our muscles? That is, speech itself is formed, of course, in another “place” of the brain, and the processing of visual signals does not occur in the cerebellum. But for elementary articulation - pronouncing what we just thought of saying - we need the muscles of the mouth and pharynx, right? As well as in order to squint your eyes or adjust the lens to view near and far objects ...

So the work of the cerebellum is not at all easy, especially when you consider that most of the vital processes of the human body are associated with mechanical movements.

When the stomach digests food, it contracts. When the intestine finishes digesting the rest, it absorbs the substances and pushes the indigestible residue further to rectum, it also contracts, and this is called peristalsis. The heart contracts during work - as do the lungs, and the diaphragm (an elastic septum separating the stomach cavity from the chest) ... And laboratory experiments on dogs, the eternal martyrs of science, have repeatedly confirmed the onset of disorders of all these functions, as soon as scientists disrupt the cerebellum or remove it.

No, a complete cessation will not occur even with its complete removal, however, a number of complex violations will form. First of all, the work of the gastrointestinal tract will change radically - diarrhea, lack of appetite and a complex of symptoms of diabetes will appear. There will be difficulty in breathing, swallowing, speech will be disturbed (it will become, as it were, chanting in syllables). Gesticulation of a person with cerebellar lesions will become excessive or, on the contrary, incomplete - however, both effects are usually observed simultaneously. Will change to a staggering gait, dizziness will appear, inability to perform even the simplest sequence of movements - etc., etc.

More precisely, a person after the complete removal of the cerebellum is still unlikely to live longer than a day. The processes will not stop, but the strength and scale of the imbalance will surely be such that even narrowly focused intensive therapy will not help. In any case, no one has yet tried to conduct such experiments on humans, and the survival rate here is derived purely mathematically. At the same time, it is known and proven that partial removal of the cerebellum provokes a corresponding "bouquet" of symptoms, but only during the first 7-10 days. Subsequently, they weaken and occasionally disappear completely. The compensation mechanism of the brain is triggered, and the cortex of the frontal lobes of the cerebral hemispheres takes over the lost functions. But for this, the brain needs to feel at least a partial connection with the cerebellum (or what is left of it).

The fact is that the cerebellum serves as a kind of transitional bridge connecting the brain with the spinal cord. And the connection of this node with the spinal cord is even much stronger than with the brain. That is why the complete destruction of such a bridge will lead, at best, to complete paralysis, up to the inability to blink or move your lips. And at worst, a progressive arrhythmia of the heart muscle will quickly provoke a fatal outcome. From partial injuries of the cerebellum, the work of the extensor muscles most of all suffers.

In general, life without a cerebellum will seem difficult even to the most optimistic person. There is a disease ataxia(from Greek. "disorder", "confusion"), in which most of the necessary for normal operation cerebellar neurons. Most often, ataxia is inherited. And for such patients, elementary movements are of considerable difficulty. The need to pour water from a kettle into a glass, climb stairs, keep the body upright - all these rituals that fill our daily life are the subject of special training and hard work for them. So the disease is extremely serious. Let it not be fatal in itself, but it contains the germ of a mass of fatal accidents and domestic injuries in the most trivial circumstances for a healthy person.

As a result, in determining the role of the cerebellum modern science stopped at the views of L. A. Orbeli. It was this Russian physiologist who, back in 1949, was the first to suggest that the cerebellum functions as a regulator of the relationship between various parts nervous system. Simply based on the fact that most of the body's motor programs are disrupted, but not completely stopped. From which it was concluded that, scientifically speaking, the cerebellum is an integrative system of the brain. That is, it participates in the preparation of programs for the movement of the body for each specific situation. And it regulates the activity of certain organs (tissues) that should be involved in the intended event - be it a morning run, a meal or a scientific lecture.

Subsequently, this theory was supplemented by another important observation. Namely: injuries of the cerebellum provoke a disorder, including motor skills acquired by a person as a result of special training. That is, a skill, for example, like that of athletes or patients employed in certain areas of physical labor. Thus, the assumption arose that the very training of a person in such specific, not characteristic of most other people, movements also took place with the participation of the cerebellum.

Otherwise, the cerebellum is considered one of the most studied parts of the brain. Studied so well that the first simplest chip was even recently created and demonstrated in action - a computer analogue of the natural cerebellum.

The experiment was carried out by a team of Israeli scientists led by prof. M. Mintz from the University of Tel Aviv. A completely paralyzed white rat was retrained to blink using electrodes implanted in place of the destroyed cerebellum. During the experiment, impulses from intact sections of the rodent's brain were sent to a microscopic computer chip. He, in turn, deciphered them and passed them on to the central nervous system animal. The device demonstrated in Israel is by far the most primitive design of its kind possible. However, later Prof. M. Mintz proposes to "teach" the microchip to recognize other brain signals in order to expand its functionality.

However, the Tel Aviv researchers are not the first to conduct experiments of this kind.

In a journal published by the Center for Neuroengineering (Centre of Neural Engineering) at the University of Southern California (University of Southern California), Dr. T. W. Berger with co-authors presented an article - a report on the work already done. It was the result of his group's experiments to replenish the functions of another part of the brain - the hippocampus. This area is responsible for the transfer new information from short-term to long-term memory in both humans and animals. The equipment developed at the University of California is a much more complex design in terms of functionality. Laboratory mice in these experiments were trained to press two pedals. In this case, only pressing one of them was accompanied by a reward. Without a chip and with the hippocampus “turned off” by anesthesia, mice remembered the desired pedal for only a few minutes. But with the help of a computer and its ability to correctly recognize memory signals, scientists managed to develop the required skill in mice. Moreover, it turned out that the implantation of such a chip into a healthy rodent hippocampus significantly improved both the speed of memorization of pedals and the general properties of its memory.

If an even more visual comparison of the role of the cerebellum in the activity of the central nervous system is needed, then it is no secret to anyone that initially The computer was created in the image and likeness of the human brain. As well as most of the programs operated by modern digital technology. So, one of the utility programs of any computer is the so-called process manager. It distributes the order of execution of the main programs, the processor time and system resources that they can use. Most of all, the work of the cerebellum resembles the functions of such a process manager. Only its speed immeasurably exceeds the capabilities of any most powerful manager installed in an extensive corporate network. High technologies have never even dreamed of such a perfect balance of accuracy and speed!

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It can be caused by a variety of consequences. This is due to the fact that it is associated with almost all parts human body in particular with the nervous system. As a rule, numerous unpleasant symptoms and the appearance of problems with this organ are most often called cerebellar ataxia. It manifests itself in the form of coordination disorder, imbalance, etc. In this case, a person cannot stay in the same position for a long time.

Some of the symptoms of a cerebellar lesion can be detected with the naked eye. However, more complex hidden signs can be detected only with the help of special laboratory samples. The effectiveness of the treatment of these pathologies depends on the causes of lesions.

Main functions

The cerebellum performs great amount work. First of all, it supports and distributes which is necessary to keep the human body in balance. Thanks to the work of this organ, a person can perform a motor function. Therefore, speaking about the function and symptoms of a cerebellar lesion, the doctor, first of all, checks the person's coordination. This is because this organ helps maintain and distribute muscle tone at the same time. For example, by bending a leg, a person simultaneously tightens the flexor and relaxes the extensor.

In addition, the cerebellum distributes energy and minimizes the contraction of the muscles that are involved in the performance of a particular job. In addition, this organ is necessary for motor learning. This means that during training or developing professional skills, the body remembers which muscle groups contract and tighten.

If there are no symptoms of damage to the cerebellum, and its functioning is carried out in the normal mode, then in this case the person feels good. If at least one of the parts of this organ suffers from a lesion, then it becomes more difficult for the patient to perform certain functions, or he simply cannot move.

Neurological pathology

Due to the defeat of this important organ, a huge number of serious ailments can develop. If we talk about neurology and symptoms of damage to the cerebellum, then it is worth noting the most important danger. Damage to this organ leads to circulatory disorders. The appearance of this pathology can lead to:

Ischemic stroke and other heart diseases.
Multiple sclerosis.
Traumatic brain injury. In this case, the lesion should not always affect the cerebellum, it is enough if at least one of its connections is broken.
Meningitis.
type, as well as abnormalities caused in the nervous system.
Intoxication.
Overdoses of certain medications.
Vitamin B12 deficiency.
Obstructive hydrocephalus.

In lesions of the cerebellum are quite common. Therefore, first of all, it is necessary to visit a specialist in this particular area.

Cause of diseases of the cerebellum

In this case, we can talk about injuries, congenital underdevelopment of this area, circulatory disorders, the consequences of long-term drug use. Also, this can happen due to poisoning with toxins.

If a patient is diagnosed with a congenital defect in the development of this organ, then in this case we are talking about the fact that the person suffers from a disease called Marie's ataxia. This pathology refers to dynamic ailments.

Symptoms of damage to the cerebellum and pathways may indicate a stroke, trauma, cancer, infections, and other pathologies that occur in the nervous system. Similar ailments are experienced by people who have had a fracture of the base of the skull or damage to the occipital region of the head.

If a person suffers from atherosclerotic vascular disease, then this can also provoke a violation of the blood supply to the cerebellum. However, the list of all ailments does not end there. Defeat carotid artery and vascular spasms that turn into hypoxia can also provoke a similar condition.

In addition, it must be borne in mind that most often the symptoms characteristic of cerebellar damage occur in older people. This is due to the fact that their vessels lose their elasticity over time and are affected by atherosclerosis and cholesterol plaques. Because of this, their walls do not withstand strong pressure and start to break. Such hemorrhage provokes tissue ischemia.

Signs of pathology

If we talk about the main symptoms of damage to the cerebellum of the brain, then among them is precisely ataxia, which can manifest itself in different ways. However, most often a person begins to tremble in the head and the whole body, even with a calm position of the body. Muscle weakness and poor coordination of movements are manifested. If one of the hemispheres of the brain is damaged, then human movements will be asymmetrical.

Patients also suffer from tremors. In addition, there are severe problems in the process of flexion and extension of the limbs. Many have hypothermia. If symptoms characteristic of a cerebellar lesion occur, the patient may experience disturbances in the motor act. In this case, when moving towards a certain goal, a person begins to perform pendulum-inverse actions. In addition, a problem with the cerebellum can cause hyperreflexia, gait disturbance, and severe handwriting changes. It is also worth considering the varieties of ataxia of this organ.

Static-locomotor

In this case, violations are most pronounced when walking a person. Any movement brings the strongest load, because of which the body becomes weaker. In this case, it is difficult for a person to be in a position where the heels and toes of the legs are in contact. Difficulty falling forward, backward, or swaying sideways. In order to take a stable position, a person needs to spread his legs wide apart. It is observed very and outwardly the patient, in whom the symptoms of damage to the cerebellum appear, resembles a drunk. When turning, it can drift to the side, up to a fall.

To diagnose this pathology, it is necessary to conduct several tests. First of all, you need to ask the patient to walk in a straight line. If he has the first signs of static-locomotor ataxia, then he will not be able to perform this simple procedure. In this case, he will begin to strongly deviate in different directions or spread his legs too wide.

Also, in order to identify the main symptoms of cerebellar damage, additional tests are carried out at this stage. For example, you can ask the patient to stand up abruptly and turn 90° to the side. A person whose cerebellum is affected will not be able to perform this procedure and will fall. With a similar pathology, the patient also cannot move with an added step. In this case, he will dance, and the body will begin to lag behind the limbs a little.

In addition to clearly expressed problems with gait, there is a strong muscle contraction when performing even the simplest movements. Therefore, in order to determine this pathology, you need to ask the patient to stand up abruptly from a prone position. At the same time, his arms should be crossed on his chest. If a person is healthy, then his muscles will contract synchronously, he will be able to sit down quickly. When ataxia occurs and the first symptoms of cerebellar damage, it becomes impossible to simultaneously strain the hips, torso and lower back. Without the help of hands, a person will not be able to take a sitting position. Most likely the patient will simply fall back.

You can also ask the person to try bending backward while standing. At the same time, he must tilt his head. If a person is in a normal state, then in this case he will involuntarily bend his knees and straighten up in the hip region. With ataxia, this flexion does not occur. Instead, the person falls.

Dynamic cerebellar ataxia

In this case, we are talking about problems with the smoothness and dimension of human movements. This type of ataxia can be unilateral or bilateral, depending on which hemispheres are affected. If we talk about what symptoms are observed with damage to the cerebellum and the manifestation of dynamic ataxia, then they are similar to those described above. However, if we are talking about unilateral ataxia, then in this case, the person will have problems with movement or performing test tasks only in the right or left side of the body.

To identify the dynamic form of pathology, it is worth paying attention to some features of human behavior. First of all, he will have a strong trembling in the limbs. As a rule, it intensifies by the time the movement is completed, which the patient performs. Being in a calm state, a person looks absolutely normal. However, if you ask him to pick up a pencil from the table, at first he will reach out without any problem, but as soon as he starts to take the object, his fingers will begin to tremble violently.

When determining the symptoms of a cerebellar lesion, the diagnosis includes additional tests. With the development of this pathology in patients, the so-called overshooting and passing by are observed. This is due to the fact that human muscles begin to contract disproportionately. The flexors and extensors work much harder. As a result, a person cannot fully perform the simplest actions, for example, put a spoon in his mouth, button his shirt, or tie a knot in his shoelaces.

In addition, handwriting changes are a clear sign of this violation. Most often, patients begin to write large and uneven, and the letters become zigzag.

Also, when determining the symptoms of damage to the cerebellum and pathways, it is worth paying attention to how a person speaks. With the dynamic form of the disease, a symptom appears, which during medical practice called scrambled speech. In this case, the person speaks as if in jerks. It divides phrases into several small fragments. In this case, outwardly the patient looks as if he is broadcasting something to a large number of people from the podium.

There are also other phenomena characteristic of this disease. They also concern the coordination of the patient. Therefore, the doctor conducts a series of additional tests. For example, in the “standing” position, the patient should straighten and raise his arm to a horizontal position, take it to the side, close his eyes and try to touch his nose with his finger. Under normal conditions, it will not be difficult for a person to perform this procedure. If he has ataxia, he will always miss.

You can also try asking the patient to close their eyes and touch the tips of two index fingers to each other. If there are problems in the cerebellum, then the patient will not be able to match the limbs as needed.

Diagnostics

Considering the symptoms of cerebellar damage and research methods, it is worth paying attention to the fact that in case of any disturbances in the functioning of the brain, it is necessary to immediately contact a neurologist. He conducts a series of tests in order to clarify how a person's superficial and deep reflexes work.

If we talk about hardware studies, then it may be necessary to perform electronystagmography and vestibulometry. A complete blood count is required. If a specialist suspects an infection in the CSF, then a lumbar puncture is performed. Markers of stroke or inflammation should be checked. An MRI of the brain may also be required.

Treatment

The success of therapy directly depends on the causes of this pathology. Therefore, when talking about the symptoms and treatment of cerebellar lesions, it is worth considering the most common cases.

If the disease is accompanied by ischemic stroke, then lysis of blood clots is required. The specialist also prescribes fibrinolytics. To prevent the appearance of new blood clots, antiplatelet agents are prescribed. These include Aspirin and Clopidogrel. Additionally, you may need to take metabolic drugs. These include "Mexidol", "Cytoflavin" and others. These funds help improve metabolic processes in brain tissues.

In addition, in order to prevent a second stroke, it is necessary to take a course of drugs that reduce the amount of cholesterol in the blood.

If, when studying the symptoms and causes of damage to the cerebellum, the doctor determines that the patient is suffering from neuroinfections (for example, encephalitis or meningitis), then treatment with antibiotics is required.

Problems caused by intoxication of the body can be solved with the help of detoxification therapy. However, for this it is necessary to clarify the type and characteristics of the poison. In difficult situations, it is necessary to take immediate measures, so the doctor performs forced diuresis. In case of food poisoning, it is enough to perform a gastric lavage and take sorbents.

If the patient is diagnosed oncological disease, it all depends on its stage and type of pathology. As a rule, radiation and chemotherapy are prescribed for treatment. In some situations it may be necessary surgical intervention.

Also, experts prescribe drugs that can improve blood flow (for example, Kaviton), vitamin complexes, anticonvulsants and drugs that strengthen muscle tone.

Has a beneficial effect physiotherapy and massage sessions. Thanks to a special set of exercises, it is possible to restore muscle tone. This helps the patient recover faster. Physiotherapeutic measures are also carried out (therapeutic baths, electrical stimulation, etc.).

Also, considering the symptoms, causes and treatment of cerebellar lesions, it is worth paying attention to several more brain pathologies encountered in medical practice.

Betten's disease

This pathology belongs to the category of hereditary diseases. It doesn't occur very often. At the same time, a person has all the signs of cerebellar ataxia, which are recorded in babies in the first 12 months of life. Manifest serious problems in coordination, the child cannot focus his eyes, muscle hypotension appears.

Some children begin to hold their heads on their own only by the age of 2-3 years, later they begin to talk and walk. However, in most cases, after a few years, the baby's body adapts to the pathology, and the signs of cerebellar damage cease to be obvious.

Holmes' cerebellar degeneration

With progressive, the dentate nuclei are most damaged. In addition to the standard signs of ataxia, patients have epileptic seizures. However, this pathology usually does not affect the intellectual abilities of a person. There is a theory that this pathology is hereditary, but there is no exact scientific confirmation of this fact today.

Alcoholic cerebellar degeneration

A similar pathology appears against the background of chronic alcohol intoxication. In this case, the cerebellar vermis is affected. First of all, when diagnosing an ailment, patients have problems with the coordination of the limbs. Sight and speech are impaired. Patients suffer from severe memory impairment and other brain activity problems.

Based on this, it becomes obvious that problems with the cerebellum appear against the background of other pathologies. Although neurological problems most often lead to ataxia, this is not the only factor that affects a person's health. Therefore, it is important to pay attention to the symptoms in a timely manner, contact a qualified specialist and conduct a diagnosis. Simple tests can be performed at home. However, after that, you need to consult a doctor, identify the main cause of the appearance of an unpleasant disease and begin immediate treatment with drugs and physiotherapy.

Usually, cerebellar ataxia is accompanied by chanted speech, intentional trembling, postural tremor of the head and trunk, and muscle hypotension. Diagnosis is carried out using MRI, CT, MSCT, MAG of the brain, dopplerography, analysis of cerebrospinal fluid; if necessary - genetic research. Treatment and prognosis depend on the causative disease that caused the development of cerebellar symptoms.

Cerebellar ataxia

Cerebellar ataxia is a symptom complex that includes specific disorders of static and dynamic human motility and is pathognomonic for any diseases of the cerebellum. The same type of motor coordination disorders occur both in congenital defects of the cerebellum and in a variety of pathological processes in the cerebellum: tumors, multiple sclerosis, strokes, inflammatory and degenerative changes, toxic or metabolic damage, external compression, etc. The degree of their severity varies significantly depending on on the location and size of the affected area of the cerebellum.

The nature of the disease can be judged by the symptoms associated with ataxia, as well as the features of the onset and course of pathological changes. The latter was the basis for the classification, which is used in their practice by many specialists in the field of neurology. According to it, cerebellar ataxia is distinguished with an acute onset, with a subacute onset (from 7 days to several weeks), chronically progressive (developing over several months or years) and episodic (paroxysmal).

Causes of cerebellar ataxia

Most common cause Acute ataxia of the cerebellar type is an ischemic stroke caused by embolism or atherosclerotic occlusion of the cerebral arteries, which supply, among other things, the tissues of the cerebellum. Hemorrhagic stroke is also possible, traumatic injury cerebellum as a result of a head injury or its compression by an intracerebral hematoma. Acute cerebellar ataxia can develop with multiple sclerosis, Guillain's syndrome, postinfectious cerebellitis and encephalitis, obstructive hydrocephalus, various acute intoxications and metabolic disorders.

Subacute cerebellar ataxia most often occurs as a symptom of an intracerebral tumor (astrocytoma, hemangioblastoma, medulloblastoma, ependymoma) located in the cerebellum, or meningioma of the cerebellopontine angle. Its cause may be normotensive hydrocephalus due to subarachnoid hemorrhage, meningitis, or brain surgery. Cerebellar ataxia with a subacute onset is possible with an overdose of anticonvulsants, vitamin deficiency, endocrine disorders (hyperparathyroidism, hypothyroidism). It can also act as a paraneoplastic syndrome in malignant tumor processes of extracerebral localization (for example, lung cancer, ovarian cancer, non-Hodgkin's lymphomas, etc.).

Chronically progressive cerebellar ataxia is often the result of alcoholism, etc. chronic intoxication(including substance abuse and polydrug addiction), slow-growing tumors of the cerebellum, genetically determined cerebral degenerative and atrophic processes with damage to the tissues of the cerebellum or its pathways, a severe form of Chiari anomaly. Among genetically determined progressive ataxias of the cerebellar type, Friedreich's ataxia, Nefridreich's spinocerebellar ataxia, Pierre-Marie's ataxia, Holmes's cerebellar atrophy, and olivopontocerebellar degeneration (OPCD) are the most well-known.

Cerebellar ataxia with a paroxysmal course can be hereditary and acquired. Among the causes of the latter indicate TIA, multiple sclerosis, intermittent obstruction of the cerebrospinal fluid, transient compression in the region of the occipital foramen.

Symptoms of cerebellar ataxia

Ataxia of the cerebellar type is manifested by sweeping uncertain asynergic movements and a characteristic unsteady gait, during which the patient spreads his legs wide for greater stability. When you try to go along one line, there is a significant swing to the sides. Ataxic disorders increase with abrupt change direction of movement or the rapid start of walking after getting up from a chair. Sweeping movements are the result of a violation of their proportionality (dysmetria). Both an involuntary stop of a motor act before its goal is achieved (hypometry), and an excessive range of motion (hypermetry) are possible. Dysdiadochokinesis is observed - the patient's inability to quickly perform opposite motor acts (for example, supination and pronation). Due to impaired coordination and dysmetria, a change in handwriting that is pathognomonic for cerebellar ataxia occurs: macrography, unevenness and sweeping.

Static ataxia is most evident when the patient tries to stand in the Romberg position. For the pathology of the cerebellar hemisphere, a typical deviation, and even a fall, towards the lesion, with changes in its median structures (worm), a fall is possible in any direction or backward. Carrying out a finger-nose test reveals not only a miss, but also an intentional tremor accompanying ataxia - a trembling of the fingertip, which intensifies when it approaches the nose. Testing a patient in the Romberg position with open and closed eyes shows that visual control does not significantly affect the results of the tests. This feature of cerebellar ataxia helps to differentiate it from sensitive and vestibular ataxia, in which the lack of visual control leads to a significant aggravation of impaired coordination.

As a rule, cerebellar ataxia is accompanied by nystagmus and dysarthria. Speech has a specific "cerebellar" character: it loses its smoothness, slows down and becomes intermittent, stress goes to each syllable, which makes it look like a chant. Often, cerebellar-type ataxia is observed against the background of muscle hypotension and a decrease in deep reflexes. When causing tendon reflexes, pendulum movements of the limb are possible. In some cases, titubation occurs - a low-frequency postural tremor of the trunk and head.

Diagnosis of cerebellar ataxia

Since the pathology of the cerebellum can have a wide variety of etiologies, specialists from various fields are involved in its diagnosis: traumatologists, neurosurgeons, oncologists, geneticists, endocrinologists. A thorough examination of the neurological status by a neurologist makes it possible to determine not only the nature of the cerebellar ataxia, but also the approximate area of the lesion. So, the pathology in the cerebellar hemisphere is evidenced by hemiataxia, the one-sided nature of coordination disorders and a decrease in muscle tone; about the pathological process in the cerebellar vermis - the predominance of walking and balance disorders, their combination with cerebellar dysarthria and nystagmus.

In order to exclude vestibular disorders, a study of the vestibular analyzer is carried out: stabilography, vestibulometry, electronystagmography. If an infectious lesion of the brain is suspected, a blood test for sterility is done, and PCR studies are performed. Lumbar puncture with a study of the obtained cerebrospinal fluid allows you to identify signs of hemorrhage, intracranial hypertension, inflammatory or tumor processes.

The main methods for diagnosing diseases underlying the pathology of the cerebellum are neuroimaging methods: CT, MSCT and MRI of the brain. They allow to detect tumors of the cerebellum, post-traumatic hematomas, congenital anomalies and degenerative changes cerebellum, its prolapse into the foramen magnum and compression during displacement of adjacent anatomical structures. In the diagnosis of ataxia of a vascular nature, MRA and Dopplerography of cerebral vessels are used.

Hereditary cerebellar ataxia is established by the results of DNA diagnostics and genetic analysis. The risk of having a child with a pathology in a family where cases have been noted can also be calculated. this disease.

Treatment of cerebellar ataxia

Fundamental is the treatment of the causative disease. If cerebellar ataxia has an infectious and inflammatory origin, it is necessary to prescribe an antibacterial or antiviral therapy. If the cause lies in vascular disorders, then measures are taken to normalize blood circulation or stop cerebral bleeding. For this purpose, in accordance with the indications, angioprotectors, thrombolytics, antiplatelet agents, vasodilators, anticoagulants are used. With ataxia of toxic origin, detoxification is performed: intensive infusion therapy in combination with the appointment of diuretics; in severe cases- hemosorption.

Hereditary ataxias do not yet have a radical treatment. Metabolic therapy is mainly carried out: vitamins B12, B6 and B1, ATP, meldonium, ginkgo biloba preparations, piracetam, etc. To improve metabolism in skeletal muscles, increase its tone and strength, patients are recommended massage.

Cerebellar and posterior fossa tumors often require surgical treatment. Removal of the tumor should be as radical as possible. When establishing the malignant nature of the tumor, an additional course of chemotherapy or radiotherapy is prescribed. With regard to cerebellar ataxia due to occlusion of the CSF pathways and hydrocephalus, shunt operations are used.

Forecast and prevention

The prognosis depends entirely on the cause of cerebellar ataxia. Acute and subacute ataxias caused by vascular disorders, intoxication, inflammatory processes, with timely elimination of the causative factor (vascular occlusion, toxic effects, infection) and adequate treatment, can completely regress or partially remain in the form of residual effects. Chronically progressive, hereditary ataxias are characterized by an increasing aggravation of symptoms, leading to the patient's disability. Ataxias associated with tumor processes have the most unfavorable prognosis.

Preventive in nature is the prevention of injuries, the development of vascular disorders (atherosclerosis, hypertension) and infection; compensation of endocrine and metabolic disorders; genetic counseling when planning a pregnancy; timely treatment of the pathology of the cerebrospinal fluid system, chronic cerebral ischemia, Chiari syndrome, processes of the posterior cranial fossa.

Cerebellar ataxia - treatment in Moscow

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Cerebellar injury in stroke

Cerebellar stroke, risks in the absence of treatment examination in pathology

Cerebellar stroke in medicine is the most dangerous lesion among other types of lesions. The cerebellum is a region in the brain that is responsible for proper coordination and balance of the body. A stroke in this part occurs when the blood flow in it is disturbed.

Sometimes this pathology can be confused with the stem form of a stroke, since both organs are located in the central nervous system in the neighborhood, but during a stem stroke, a bundle of nerves is damaged directly in the stem section.

By appearance the cerebellum resembles a round-shaped process located on the back of the head close to the spine. His work is very important for the functioning of the whole organism:

Movement coordination.
Functioning of the optic nerve.
The work of the vestibular apparatus, balance, coordination and orientation in space.

What can cause an attack?

Pathology is formed under the condition that the supply of oxygen to the brain is interrupted or due to internal hemorrhage in the brain.

Cerebellar stroke is classified into two main types - hemorrhagic and ischemic. The ischemic type is much more common - in 75% of all cases of the disease, and is provoked by an unexpected deterioration in blood flow to the brain, which causes the formation of necrosis in the tissues. This process can be triggered by the following factors:

A large blood clot that forms in another part of the body interferes with blood flow in the vessels that are responsible for nourishing the brain.
A blood clot that has formed in an artery that carries blood towards the brain.
Breakthrough of a blood vessel, which is responsible for the flow of blood to a particular part of the brain.
Sudden fluctuations in blood pressure.

It is important! The causes of the hemorrhagic form of a stroke are ruptures in the blood vessels, provoking hemorrhages in the brain.

Symptoms indicating a stroke in the cerebellum

Symptoms of a cerebellar stroke develop unexpectedly and include the following manifestations:

Loss of coordination in the movements of the arms, legs and the whole body.
Difficulty in walking, imbalance of the body in space.
Abnormal disturbances of reflexes.
Trembling of limbs.
Nausea with vomiting.
Vertigo.
Intense headache.
Speech disorders and swallowing difficulties.
Disturbances in the sensations of pain and body temperature.
Hearing disorders.
Visual disturbances are rapid eye movements that can hardly be controlled by the person himself.
Problems with the work of the eyes, for example, a fallen eyelid.
Loss of consciousness.

If a person develops at least one of the listed signs, then it is better to immediately contact a specialist, since it is the brain tissues that are characterized by a rapid rate of death.

What is needed for effective diagnosis of the disease?

The consequences of a cerebellar stroke can be deplorable if a diagnostic examination of the patient's body is not carried out in time. Due to the fact that a cerebellar stroke becomes an unexpected unpleasant surprise, the doctor must make the correct diagnosis as soon as possible. Tests include:

Computed tomography is a type of x-ray examination that uses a computer to take pictures.
Angiography is a type of computed tomography that allows you to study the state of blood vessels in the neck and brain.
An MRI is a test that uses magnetic radiation to take pictures of the brain.
Tests to establish the norm of the functioning of the heart.
An ultrasound form of dopplerography - sound waves are used to determine the condition of the blood vessels.
Blood tests.
Kidney test.
A test to check the ability to swallow normally.

Organization of a suitable treatment process

If each of the listed symptoms of cerebellar stroke is subjected to abnormal influences, then doctors, in order to save the patient's life, prescribe him the organization of treatment in a hospital. Treatment of a cerebellar stroke involves the elimination of embolism, blood clots, blood clots and scarring of blood vessels in the cerebellum. For this, the appropriate medications to help thin the blood, control arterial pressure, treat abnormalities of fibrillation in the heart.

It is important! In almost half of all cases, the doctor prescribes surgical operation. If we are talking about the ischemic form of stroke, then doctors redirect the blood flow to the blocked vessel, eliminate the clot and then carry out difficult process removal of fat deposits in the carotid artery. In addition, stenting and angioplasty are often organized as operations that expand the lumen of the arteries.

With the development of a hemorrhagic form of stroke, surgery may involve trepanation of the skull and removal of part of it to reduce intracranial pressure. In addition, a special plug is placed in the aneurysm and severe bleeding is stopped.

The consequences of a cerebellar stroke are that, as a rule, after the development of a severe form of the disease, it is almost impossible to completely return to a person the functions he has lost. The main assistant in treatment is an optimistic attitude and concern for the patient. Thus, every year, the patient must go to spa treatment subject to the mandatory completion of a whole course of rehabilitation procedures - this is physiotherapy exercises, massages, reflexology, etc.

The prognosis of the disease already in the first minutes of the attack will depend on the location of the lesion, on the size and number of existing foci, as well as on the untimely started medical process. With the formation of a large number of lacunar foci, the transformation of cerebellar infarction and the hemorrhagic form of stroke occurs.

Adverse factors in the manifestation of a stroke are the advanced age of the patient, a persistent rise in body temperature, that is, damage to the thermoregulatory center in the brain, cardiac arrhythmia, somatic diseases in their decompensation, depression of the patient's consciousness, pronounced cognitive impairment, advanced angina pectoris.

Cerebellar stroke

Cerebellar stroke, early recognition of which can save the patient's life.

Cerebellar infarction is the result of thrombosis or embolism of the cerebellar arteries, extending from the vertebral or basilar artery. It is manifested by hemiataxis and muscle hypotension on the side of the lesion, headache, dizziness, nystagmus, dysarthria and signs of concomitant lesion of the trunk - limitation of eyeball mobility, weakness of facial muscles or impaired facial sensitivity on the side of the lesion, sometimes hemiparesis or hemihypesthesia on the opposite side.

As a result of rapidly growing edema, compression of the trunk with the development of coma and wedging of the tonsils of the cerebellum into the foramen magnum with a fatal outcome are possible, which can only be prevented surgical intervention. It should be borne in mind that cerebellar hemiataxia may be a manifestation of a more favorably developing medulla oblongata infarction, which also causes Horner's syndrome (miosis, drooping of the upper eyelid), decreased sensitivity on the face, paramuscular muscles of the larynx and pharynx on the side of the lesion, and impaired pain and temperature sensitivity according to the hemitype on the opposite side (Wallenberg-Zakharchenko syndrome).

Hemorrhage in the cerebellum is more often caused by arterial hypertension and is manifested by a sudden intense headache, vomiting, dizziness, ataxia. Rigidity of the neck muscles, nystagmus, sometimes - restriction of the movement of the eyeballs in the direction of the lesion, inhibition of the corneal reflex and paresis of the mimic muscles on the side of the lesion appear. Oppression of consciousness increases rapidly with the development of coma. As a result of compression of the trunk, an increase in tone in the legs and pathological foot signs are added. In some cases, death can be prevented only by surgical intervention (hematoma evacuation).

Emergency care is limited to pain relief. For this, analgesics and non-steroidal anti-inflammatory drugs, sometimes corticosteroids, are administered parenterally. In the acute period, immobilization of the limb is necessary. Subsequently, it is important physiotherapy and physiotherapy procedures that prevent the development of a "frozen" shoulder.

Acute incoordination of movements can be caused by damage to the cerebellum or its connections in the trunk (cerebellar ataxia), nerve fibers that carry deep sensitivity (sensitive ataxia), the vestibular system (vestibular ataxia), frontal lobes and related subcortical structures (frontal ataxia). It can also be a manifestation of hysteria.

Acute cerebellar ataxia is manifested by impaired balance, walking and coordination of movements in the limbs. Damage to the median structures of the cerebellum is accompanied by nystagmus, dysarthria according to [. ]

The differential diagnosis is carried out with cervical radiculopathy, which is not characterized by gross muscle atrophy, but is characterized by increased pain when moving the neck and straining, irradiation of pain along the spine. It is important to exclude diabetes mellitus, which can manifest as shoulder plexopathy, vasculitis. In a similar way, herpes zoster sometimes begins, but the appearance of a characteristic rash after a few days resolves diagnostic difficulties. A somewhat different localization of pain is observed in the syndrome [. ]

Acute lumbalgia can be triggered by trauma, lifting an unbearable load, unprepared movement, prolonged stay in a non-physiological position, hypothermia. Most often, it occurs against the background of the current degenerative process in the spine (spinal osteochondrosis). intervertebral disc gradually loses water, shrinks, loses its shock-absorbing function and becomes more sensitive to mechanical stress.

The cerebellum and coordination disorders

The cerebellum is a part of the brain that is responsible for the coordination of movements, as well as the ability to ensure the balance of the body and the regulation of muscle tone.

Basic functions and disorders of the cerebellum

The very structure of the cerebellum is similar to the structure of the cerebral hemispheres. The cerebellum has a cortex and a white substance underneath, which consists of fibers with cerebellar nuclei.

The cerebellum itself is closely connected with all parts of the brain, as well as with the spinal cord. The cerebellum is primarily responsible for the tone of the extensor muscles. When the function of the cerebellum is impaired, characteristic changes appear, which are commonly called "cerebellar syndrome". At this stage in the development of medicine, it has been revealed that the cerebellum is related to the impact on many important functions of the body.

With damage to the cerebellum, various disorders can develop motor activity, vegetative disorders appear, and muscle tone is also disturbed. This happens due to close connection cerebellum with brain stem. Because the cerebellum is the center of coordination of movements.

The main symptoms of damage to the cerebellum

When the cerebellum is damaged, the muscles are disrupted, it is difficult for the patient to keep the body in balance. To date, there are the main signs of cerebellar disorders of coordination of movements:

intention tremor
voluntary movements and slow speech
the smoothness of the movements of the arms and legs is lost
handwriting is changing
speech becomes scrambled, the placement of stress in words is more rhythmic than semantic

Cerebellar disorders of coordination of movements are expressed in gait disturbance and dizziness - ataxia. Difficulties may also arise when trying to get up from a lying position. The combination of simple movements and complex motor acts is disturbed, as the cerebellar system is affected. Cerebellar ataxia causes the patient to stagger, which is characterized by staggering from side to side. Also, when looking away to the extreme position, a rhythmic twitching of the eyeballs can be observed, this is how a violation of the movement of the oculomotor muscles is manifested.

There are different types of ataxia, but they are all similar in one main feature, namely impaired movement. The patient has statistical disturbances, even if he is pushed, he will fall without noticing that he is falling.

Cerebellar ataxia is observed in many diseases: hemorrhages of various origins, tumors, hereditary defects, poisoning.

Cerebellar congenital and acquired diseases

Diseases associated with the cerebellum are congenital and acquired. Marie's hereditary cerebellar ataxia is a congenital genetic disease of the dominant type. The disease begins its manifestation with impaired coordination of movements. This is due to hypoplasia of the cerebellum and its connections with the periphery. Often such a disease is accompanied by a gradual manifestation of a decrease in intelligence, memory is disturbed.

During treatment, the type of inheritance of this disease is taken into account, at what age the first symptoms, changes, deformations of the skeleton and feet appeared. There are also several more options for chronic atrophy of the cerebellar system.

Doctors usually prescribe to a patient with such a diagnosis conservative treatment. This treatment can significantly reduce the severity of symptoms. During treatment, you can significantly increase the nutrition of nerve cells, as well as improve blood circulation.

Traumatic brain injury can lead to acquired cerebellar disease when a traumatic hematoma occurs. Having established such a diagnosis, doctors perform a surgical operation to remove the hematoma. Also, damage to the cerebellum can cause malignant tumors, the most common of these are medulloblastomas, as well as sarcomas. A stroke-infarction of the cerebellum can also be the cause of hemorrhage, which occurs with atherosclerosis of blood vessels or a hypertensive crisis. With such diagnoses, surgical treatment of the cerebellum is usually prescribed.

Currently, transplantation of individual parts of the brain is not possible. This is due to ethical considerations, since the death of a person is ascertained by the fact of brain death, therefore, when the owner of the brain is still alive, he cannot be an organ donor.

Cerebellar stroke: causes and treatment

A cerebellar stroke occurs when the blood supply to an area of the brain is interrupted. Brain tissue that does not receive oxygen from the blood and nutrients dies quickly and this leads to the loss of some body functions. Because a stroke is dangerous state for human life and requires emergency medical care.

There are two types of cerebellar stroke:

The most common form is ischemic cerebellar stroke, which occurs as a result of a sharp decrease in blood flow to the brain area. In turn, this condition can cause:

a clot that blocks the flow of blood to a blood vessel
a clot (thrombus) that has formed in an artery that carries blood to the brain
when a blood vessel ruptures and cerebral hemorrhage occurs

The consequences of a cerebellar stroke are: excessive sweating uneven breathing excessive pallor increased heart rate unstable pulse flushing of the face. To dissolve the clot that caused the ischemic stroke, emergency treatment. Also, medical attention is needed to stop bleeding during a hemorrhagic stroke.

During the treatment of ischemic cerebellar stroke, medications, which help dissolve blood clots and prevent their formation, prescribe medications that thin the blood to control blood pressure, for the treatment of irregular heart rhythms. To treat ischemic cerebellar stroke, your doctor may perform surgery. It is strictly forbidden to self-medicate, because the wrong approach to the problem can cause a worsening of the condition.

Cerebellum

Pathology

In diseases of the cerebellum, three groups of symptoms appear: 1) depending on the damage to the tissue of the cerebellum itself; 2) from the involvement in the process of formations located near the cerebellum within the posterior cerebral fossa (stem syndrome and dysfunction of the cranial nerves); 3) from involvement in the process of supratentorially located departments of the central nervous system. When the neocerebellar regions are affected, cerebellar symptoms develop, and when the so-called vestibular regions are affected, cerebellar-vestibular symptoms develop. With progression local lesion(tumors) cerebellar-vestibular symptoms are the result of damage to the cerebellar tissue only in initial stages diseases; in the future, they mostly arise due to the involvement in the process of the central vestibular formations located in the brain stem regions.

To cerebellar symptoms include cerebellar hypotension, impaired coordination of limb movements, cerebellar incision (asthenia, adynamia), hyperkinesis (tremor and myoclonus), speech disorders of cerebellar origin; to the cerebellar-vestibular - violations of statics and gait, Babinsky's asynergy.

Cerebellar hypotension. The severity of muscular hypotension increases in accordance with the increase in damage to the cerebellar cortex and, possibly, with the involvement of the dentate nucleus in the process. The increase in tone and its complex irregular distributions, which are sometimes observed with damage to the cerebellum, are largely associated with the involvement of stem formations in the process.

Disturbance of coordination of movements of extremities. The term cerebellar ataxia (in relation to specialized movements of the limbs) combines a number of symptoms indicating a violation of the regulation of motor acts, their coordination. These symptoms include: a violation of the range of a motor act (dysmetria, hypermetry, hypometry), errors in its direction, a violation of the pace (slowness). Impaired coordination of movements is one of the components of the hemispheric cerebellar syndrome. At the same time, it is more clearly detected in the upper limbs, which is associated with a special development in humans of fine specialized asymmetric movements of the upper limbs.

Cerebellar paresis (asthenia, adynamia). With damage to the cerebellum in acute and chronic forms of the disease, a decrease in muscle strength is observed homo-lateral to the lesion and is a consequence of impaired tone.

Hyperkinesis. With lesions of the cerebellum, the following types of hyperkinesis occur: 1) ataxic, or dynamic, tremor that appears with active movements in the limbs; it includes the so-called intentional tremor, which increases when the goal is reached; 2) myoclonus - rapid twitching of individual muscle groups or muscles observed in humans in the limbs, neck and swallowing muscles. Choreic-athetotic movements in the limbs with lesions of the cerebellum are rare; they are associated with the involvement of the systems of the dentate nucleus in the process. Also, twitching in the muscles of the neck and myoclonus of the soft palate and pharyngeal walls rarely occur. Myoclonus occurs when stem formations are involved in the process.

Speech disorders in diseases of the cerebellum are observed in three forms: cerebellar bradilalia and scanned speech, bulbar, mixed. With bulbar disorders, expressed even in mild degree, it is difficult to decide whether in this case, in addition to them, speech disorders are also of cerebellar origin. Only in rare cases, with mild symptoms of damage to the IX and X pairs of cranial nerves, the severity of scanned speech can suggest its cerebellar origin. In scanned speech, the stresses are not placed according to the meaning, but are separated by even intervals.

Static and gait disorders that occur in patients with cerebellar disease may be the result of damage to the cerebellar-vestibular formations located in the cerebellum, as well as vestibular formations located in the brain stem. At the same time, statokinetic disorders can be of varying intensity - from a barely noticeable stagger when standing, walking (with a slight spread of the legs) to pronounced forms of trunk ataxia, when the patient is able to neither stand nor sit and falls back or to the side without support. To severe violations gaits include a staggering gait with widely spaced legs, zigzag dodging or dodging in a certain direction from a given direction; at the same time, the impression of “drunk gait” is often created.

Asynergy (or dyssynergy) is the impossibility of simultaneous joint, or synergistic, execution of a complex movement. If a healthy person is laid on his back with crossed arms and offered to take a sitting position, he will do this without difficulty, since simultaneously with the bending of the body, the legs and pelvis are fixed to the support plane. A patient with asynergy cannot do this, because due to the lack of synergy of the muscle groups that bend the trunk and fix the pelvis and lower limbs, instead of the body, both legs rise, or one leg on the side of the lesion.

cerebellum provides muscle tone, body balance, coordination, accuracy and proportionality of movements. Consists of two hemispheres and a worm. The muscles of the trunk are represented in the worm, and the muscles of the limbs are represented in the hemispheres. The worm provides static coordination of movements (posture), and the hemispheres provide dynamic coordination (limb movements, walking). The cerebellum is connected to the spinal cord, cortex and brain stem by three pairs of legs: lower, middle and upper. Through the lower and middle legs, the cerebellum receives information about the position of the body in space, through the upper legs it sends impulses to the spinal cord, the extrapyramidal system and the cerebral cortex. As a result, information from the proprioceptors of the body is combined in the cerebellum with information from the cortex and the extrapyramidal system, which ensures smooth and precise movements. Symptoms of damage to the cerebellum Damage to the cerebellum is manifested by impaired coordination of movements, balance and muscle tone due to inconsistency in the work of antagonist muscles. Damage to the cerebellum is characterized by: ataxia; "drunk" gait (shaky, with legs wide apart); nystagmus - rhythmic twitching of the eyeballs when fixing the gaze; cerebellar dysarthria (speech chanted: slow, monotonous, in syllables); intentional trembling (trembling in the limbs when moving, especially when approaching a target); adiadochokinesis; megalography (large, uneven handwriting); dysmetria; dizziness; decreased muscle tone

6. Sensitivity, its types. The structure of the pathways of sensitivity.

Sensitivity is the body's ability to respond to signals from external environment, own organs and tissues. Irritations are perceived by receptors. The receptor is a sensor located in the skin, mucous membranes, muscles, ligaments, internal organs and blood vessels. It reacts to stimuli and encodes them into nerve impulses. There are three types of receptors: 1 exteroreceptors- perceive pain, temperature and tactile irritations of the skin and mucous membranes; 2. proprioreceptors- provide information about the relative position of body parts; located in the musculoskeletal system: muscles, tendons, ligaments, joints; 3 interoreceptors- react to pressure and the chemical composition of the blood and the contents of the gastrointestinal tract; located in the internal organs and vessels. According to the types of receptors, the following types are distinguished general sensitivity: § superficial (pain, temperature, tactile); § deep (muscular-articular, vibrational, pressure, mass); § complex types of sensitivity (two-dimensional-spatial, discriminatory, stereognosis, kinesthesia, sense of localization); § interoceptive (sensitivity of blood vessels and internal organs). In addition to general sensitivity, there are special sensitivity arising in response to irritation from the outside of special sense organs. This sensitivity includes sight, hearing, smell, taste. The structure of the pathways of sensitivity. Sensory impulses are carried by peripheral nerves. These nerves, with the exception of the intercostal ones, form plexuses in their proximal section: cervicobrachial and lumbosacral. The cells of the first neurons of all types of sensitivity are located in the intervertebral node. Their dendrites are peripheral nerves follow to the receptors of the trunk and limbs. The axons of the first neurons go to the spinal cord as part of the posterior root. Fibers in the spinal cord various kinds sensitivities diverge. Conductors of deep sensitivity enter the posterior funiculus of the spinal cord of their side, rise to the medulla oblongata and end on the cells of the second neuron (the nucleus of Gaulle and Burdach). The axon of the second neuron passes to the opposite side and rises to the thalamus, where the third neuron is located. Surface Sensitivity Conductors as part of the posterior root, they enter the posterior horn of the spinal cord, where the second neuron is located. The axon of the second neuron passes to the opposite side and rises to lateral funiculus to the thalamus (third neuron). Starting from the thalamus, the pathways of deep and superficial sensitivity are common - the axon of their third neuron ends in the posterior central gyrus.

7. Syndromes of sensitive disorders, their diagnostic value.

Peripheral- with damage to peripheral nerves and nerve plexuses. It is manifested by hypesthesia or anesthesia of all types of sensitivity in the zone of innervation of the nerve or plexus. Multiple lesions of peripheral nerves (polyneuropathy) causes a symmetrical disorder of all types of sensitivity in the distal extremities in the form of "gloves" and "socks". Segmental- with damage to the posterior roots, posterior horns or sensory nuclei of cranial nerves. With the defeat of the posterior roots in the zone of their innervation, all types of sensitivity are disturbed, pain appears along the course of the root. When the posterior horns are affected, a dissociated type of sensitivity disorder occurs: superficial sensitivity drops out while deep preservation. Conductor- occurs below the lesion of sensory pathways in the brain or spinal cord. In this case, deep sensitivity is disturbed on the side of the pathological focus of the same name, and superficial - on the opposite side.

Inflammatory diseases of the cerebellum usually occur in the background of disease of the whole brain, and the symptoms of cerebellar involvement are components of the overall clinical picture of CNS involvement. There are the following three forms of inflammatory diseases of the brain and its membranes with predominant localization of the process in the posterior cranial fossa, manifested by symptoms of meningoencephalitis: 1) with the presence of occlusion at the level of the posterior cranial fossa; 2) with the manifestation of a moderately pronounced syndrome of increased intracranial pressure, but without threatening occlusive seizures; 3) without severe symptoms increased intracranial pressure.

In chronic inflammatory processes in the brain and its membranes with occlusion at the level of the posterior cranial fossa, a productive inflammatory process expressed to varying degrees in the pia mater and chronic periventricular encephalitis with internal dropsy are detected. In the region of the median opening of the ventricle (apertura mediana ventriculi quarti), proliferation of adhesions and often fusion of dense adhesions of the tonsils of the cerebellum between themselves and the brain stem are revealed. In the cavity of the IV ventricle, the growths, spreading, spread from the bottom of the rhomboid fossa to the hind sail and tightly close the median opening from the side of the IV ventricle.

In the vast majority of cases, an undoubted connection between the development of the disease and a previous infection is established. Quite often there is a temperature reaction; characteristic of inflammatory process changes in the leukocyte blood count are rare. The composition of the cerebrospinal fluid depends on the period of the inflammatory process. In the subacute period, moderately pronounced cytosis is observed with slightly increased or normal amount squirrel. In the chronic course of the disease without exacerbation, the cerebrospinal or ventricular fluid has a composition that is normal or characteristic of hydrocephalus. Usually, in inflammatory diseases, both posterior cranial and cerebral symptoms are less pronounced than with tumors located in the posterior cranial fossa. Pronounced and persistent remissions and regression of the disease under the influence of rest and anti-inflammatory treatment are observed. Often there are cases when inflammatory diseases are very similar in clinical course to tumors of the posterior cranial fossa (see below) and it is difficult to make a differential diagnosis between them.

If conservative treatment is ineffective, the syndrome of increased intracranial pressure progresses and difficulty in cerebrospinal fluid circulation manifests itself, an operation to open the posterior cranial fossa is indicated. The detection of occlusion at the level of the median opening of the IV ventricle serves as an indication for dissection of the cerebellar vermis with opening of the cavity of the IV ventricle, which restores the outflow of fluid from the ventricular system into the basal cisterns and subarachnoid space. If during the operation it turns out that the difficulty in CSF circulation is associated with difficulty in outflow within the cavity of the IV ventricle or the cerebral aqueduct, Thorkildsen's operation is performed (see Hydrocephalus).