Central paresis 7-12 pairs. VII pair - facial nerves. Types of nerves and pathology

Table of contents of the subject "Cranial nerves.":

1. Branches of the facial nerve (n. Facialis) in the facial canal. Large stony nerve, n. petrosus major. Drum string, chorda tympani.
2. The rest of the branches of the facial nerve after leaving the styloid foramen (foramen stylomastoideum). Intermediate nerve, n. intermedius.
3. The vestibular cochlear nerve (VIII pair, 8 pairs of cranial nerves), n. vestibulocochlearis. Parts of the preverlitic nerve.
4. Glossopharyngeal nerve (IX pair, 9 pair of cranial nerves), n. glossopharyngeus. Glossopharyngeal nerve nucleus.
5. The branches of the vagus nerve in the head and cervical part n. vagus.
6. The branches of the vagus nerve in the chest and abdominal part n. vagus. Recurrent laryngeal nerve, n. laryngeus recurrens.
7. Accessory nerve (XI pair, 11 pair of cranial nerves), n. accessorius.
8. Oculomotor nerve (III pair, 3 pairs, third pair of cranial nerves), n. oculomotorius.
9. Block nerve (IV pair, 4 pair, fourth pair of cranial nerves), n. trochlearis.
10. Abducens nerve (VI pair, 6 pair, sixth pair of cranial nerves), n. abducens.
11. Olfactory nerves (I pair, 1 pair, the first pair of cranial nerves), nn. olfactorii.
12. Optic nerve (II pair, 2 pair, second pair of cranial nerves), n. opticus.

N. facialis (n. Intermedio-facialis), facial nerve, is an mixed nerve; as a nerve of the second branchial arch, it innervates the muscles that have developed from it - all mimic and part of the sublingual and contains efferent (motor) fibers emanating from its motor nucleus to these muscles and afferent (proprioceptive) fibers emanating from the receptors of the latter. It also contains taste (afferent) and secretory (efferent) fibers belonging to the so-called p intermediate nerve, n. intermedius(see below).

According to the components that make it up, n. facialis has three nuclei embedded in the bridge: motor - nucleus motorius nervi facialis, sensitive - nucleus solitarius and secretory - nucleus salivatorius superior. The last two nuclei belong to nervus intermedius.

N. facialis comes out to the surface of the brain laterally along the posterior edge of the bridge, on the linea trigeminofacialis, next to n. vestibulocochlearis... Then he, together with the last nerve, penetrates the porus acusticus interinus and enters the facial canal (canalis facialis). In the canal, the nerve first goes horizontally, heading outward; then in the area of ​​hiatus canalis n. petrosi majoris, it turns at a right angle back and also runs horizontally along the inner wall of the tympanic cavity in its upper part. Having passed the limits of the tympanic cavity, the nerve bends again and descends vertically downward, leaving the skull through the foramen stylomastoideum.

In the place where the nerve, turning back, forms an angle ( knee, geniculum), the sensitive (taste) part of it forms a small nerve knot, ganglion geniculi (knee knot). When leaving the foramen stylomastoideum, the facial nerve enters the thickness of the parotid gland and divides into its terminal branches.

Instructional video of the anatomy of the facial nerve and the projection of its branches

The nerves that extend from and enter the brain are called cranial nerves. Their distribution and brief description are separately considered in the next article.

Types of nerves and pathology

Several types of nerves are distinguished:

• motor;
• mixed;
• sensitive.

The neurology of the motor cranial nerves, both sensory and mixed, has pronounced manifestations that specialists can easily diagnose. In addition to isolated damage to individual nerves, those that belong simultaneously to different groups can be affected. Thanks to the knowledge of their location and functions, it is possible not only to understand which nerve is damaged, but also to localize the affected area. This becomes achievable due to special techniques using high-tech equipment. For example, in ophthalmological practice, using modern technology, it is possible to find out the state of the fundus, optic nerve, determine the field of vision and foci of prolapse.

Good values ​​are revealed by carotid and vertebral angiography. But more detailed information can be obtained using computed tomography. With it, you can see individual nerve trunks and identify tumors and other changes in the auditory, optic and other nerves.

The study of the trigeminal and auditory nerves became possible thanks to the method of cortical somatosensory potentials. Also in this case, audiography and nystagmography are used.

The development of electromyography has expanded the possibilities for obtaining more detailed information about the cranial nerves. Now it is possible to investigate, for example, the reflex blinking response, spontaneous muscle activity during facial expressions and chewing, palate, and so on.

Let us dwell in more detail on each of the pairs of these nerves. There are 12 pairs of cranial nerves in total. The table where all of them are given is indicated at the end of the article. In the meantime, let's consider each of the pairs separately.

1 pair. Description

This includes from the group of sensitive. In this case, the receptor cells are scattered in the epithelium of the nasal cavity in the olfactory part. Thin nerve cell processes are concentrated in the olfactory filaments, which are the olfactory nerves. From the nasal nerve it enters the cranial cavity through the openings of the plate and ends in the bulb, from where the central olfactory pathways originate.

2 pair. Optic nerve

This pair includes the optic nerve, which belongs to the sensitive group. The axons of neurons here exit through the ethmoid plate from the eyeball with one trunk, which enters the cranial cavity. At the base of the brain, the fibers of these nerves converge on both sides to create the optic chiasm and tracts. The tracts go to the geniculate body and the thalamus of the cushion, after which the central visual pathway is directed to the occipital lobe of the brain.

3 pair. Motor nerve

The oculomotor (motor), fiber-created nerve runs from those nerves in the gray matter under the aqueduct of the brain. It passes to the base between the legs, after which it enters the eye socket and innervates the eye muscles (except for the superior oblique and the outer straight line, other cranial nerves, 12 pairs, are responsible for their innervation, the table indicating which clearly illustrates all of them in aggregate). This is due to the parasympathetic fibers contained in the nerve.

4 pair. Block nerve

This pair includes (motor), originating from the nucleus under the aqueduct of the brain and emerging to the surface in the region of the cerebral sail. In this part, a cross is obtained, a rounding of the leg and penetration into the orbit. This pair innervates the superior oblique muscle.

5 pair of 12 pairs of cranial nerves

The table continues with the trigeminal nerve, which is already mixed. In its trunk there are sensory and motor nuclei, and on the base - their roots and branches. Sensory fibers originate from the cells of the trigeminal node, whose dendrites create peripheral branches that innervate the scalp in front, as well as the face, gums with teeth, ocular conjunctiva, mucous membranes of the nose, mouth, tongue.
Motor fibers (from the root of the trigeminal nerve) connect to the mandibular nerve branch, pass and innervate the masticatory muscles.

6 pair. Abducens nerve

The next pair included in the 12 pairs of cranial nerves (the table refers it to the group of motor nerves) includes it starts from the cell nuclei in the pons, penetrates the base and moves forward to the orbital fissure from above and further to the orbit. It innervates the rectus muscle (outer).

7 pair. Facial nerve

This pair consists of the facial nerve (motor), created from the cellular processes of the motor nucleus. Fibers begin their journey in the trunk at the bottom of the fourth ventricle, pass around the nucleus of the fourth nerve, descend to the base and exit into the cerebellar pontine angle. Then it moves to the auditory opening, into the facial nerve canal. After the parotid gland, it is divided into branches that innervate the facial expressions and muscles, as well as a number of others. In addition, one branch extending from its trunk innervates the muscle located in the middle ear.

8 pair. Auditory nerve

The eighth pair of 12 pairs of cranial nerves (the table classifies it as sensory nerves) consists of the auditory, or vestibular cochlear nerve, which includes two parts: the vestibular and cochlear. The cochlear part consists of dendrites and axons of the spiral node located in the bony cochlea. And the other part departs from the vestibular node at the bottom of the ear canal. The nerve on both sides connects in the ear canal to the auditory nerve.

The fibers of the vestibule end in those nuclei that are in the rhomboid fossa, and the cochlear - in the cochlear nuclei of the pons.

9 pair. Glossopharyngeal nerve

The table of cranial nerves continues with the ninth pair, which is represented by sensory, motor, secretory and taste fibers. There are close connections with the vagus and intermediate nerves. Many nuclei of the nerve in question are located in the medulla oblongata. They are common with the tenth and twelfth pairs.

The nerve fibers of the pair are combined into a trunk that leaves the cranial cavity. For the posterior third of the palate and tongue, this is the gustatory and sensory nerve, for the inner ear and pharynx - the sensitive, for the pharynx - the motor, for the parotid gland - the secretory.

10 pair. Nervus vagus

Further, the table of cranial nerves continues with a pair consisting of the vagus nerve, which is endowed with different functions. The trunk starts from the roots in the medulla oblongata. Coming out of the cranial cavity, the nerve innervates the striated muscles in the pharynx, as well as in the larynx, palate, trachea, bronchi and digestive organs.

Sensory fibers innervate the occipital region of the brain, the external auditory canal, and other organs. Secretory fibers are directed to the stomach and pancreas, vasomotor - to the vessels, parasympathetic - to the heart.

11 pair. Description of the accessory nerve

The accessory nerve presented in this pair consists of an upper and a lower section. The first leaves the motor nucleus of the medulla oblongata, and the second - from the nucleus in the horns of the spinal cord. The roots connect to each other and emerge from the skull along with the tenth pair. Some of them go to this vagus nerve.

It innervates the muscles - sternocleidomastoid and trapezius.

12 pair

The summary table of the cranial nerves ends with a pair with. Its nucleus is at the bottom of the medulla oblongata. Coming out of the skull, it innervates the lingual muscles.

These are the approximate diagrams of 12 pairs of cranial nerves. Let's summarize the above.

Look at the list showing the cranial nerves, 12 pairs. The table is as follows.

Conclusion

This is the structure and function of these nerves. Each pair plays a vital role. Each nerve is a part of a huge system and depends on it in the same way as the entire system - on the functioning of individual nerves.

Cranial nerves, also called cranial nerves, are formed from nerve tissue in the brain. There are 12 pairs with different functions. Different pairs can contain both afferent and efferent fibers, due to which the cranial nerves serve both for transmission and for receiving impulses.

The nerve can form motor, sensitive (sensory) or mixed fibers. The exit point for different couples is also different. Their function is determined by the structure.

The olfactory, auditory, and optic cranial nerves are formed by sensory fibers. They are responsible for the perception of relevant information, and the auditory is inextricably linked with the vestibular apparatus, and help to provide orientation in space and balance.

The motor ones are responsible for the functions of the eyeball and tongue. They are formed by vegetative, sympathetic and parasympathetic fibers, due to which the functioning of a certain part of the body or organ is ensured.

Mixed types of cranial nerves are formed simultaneously by sensory and motor fibers, which determines their function.

Sensitive FMN

How many brain nerves does a person have? 12 pairs of cranial nerves (cranial nerves) depart from the brain, which are capable of innervating to various parts of the body.

The following cranial nerves perform the sensory function:

• olfactory (1 pair);
• visual (2 pair);
• auditory (8 pair).

The first pair passes through the nasal mucosa up to the olfactory center of the brain. This pair provides the ability to smell. With the help of the medial beams of the forebrain and 1 pair of FMN, a person develops an emotional-associative reaction in response to any odors.

Pair 2 originates in ganglion cells located in the retina of the eye. Retinal cells respond to visual stimuli and transmit it to the brain for analysis using a second pair of PMN.

The auditory or vestibular cochlear nerve is the eighth pair of FMN and serves as a transmitter of auditory stimulation to the appropriate analytical center. This pair is also responsible for the transmission of impulses from the vestibular apparatus, thereby ensuring the functioning of the balance system. Thus, this pair consists of two roots - vestibular (balance) and snail (hearing).

Motor FMN

The motor function is carried out by the following nerves:

• oculomotor (3 pairs);
• block (4 pair);
• discharge (6 pair);
• facial (7 pair);
• additional (11 pair);
• sublingual (12 pairs).

3 pair of FMN performs the motor function of the eyeball, provides pupil motility and movement of the eyelid. At the same time, it can be attributed to the mixed type, since the motility of the pupil is carried out in response to sensitive stimulation by light.

4 pair of cranial nerves perform only one function - this is the movement of the eyeball down and forward, it is responsible only for the function of the oblique muscle of the eye.

6 pair also provides movement of the eyeball, more precisely, only one function - its abduction. Thanks to pairs 3,4 and 6, a full circular movement of the eyeball is carried out. 6 pair also provides the ability to take your eyes to the side.

7 pair of cranial nerves are responsible for the mimic activity of the muscles of the face. The nuclei of the cranial nerves of the 7th pair are located behind the nucleus of the abducens nerve. It has a complex structure, thanks to which not only facial expressions are provided, but also salivation, lacrimation and gustatory sensitivity of the front of the tongue are controlled.

The accessory nerve provides muscle activity in the neck and shoulder blades. Thanks to this pair of FMNs, head turns to the sides, lifting and lowering of the shoulder and reduction of the shoulder blades are carried out. This pair has two nuclei at once - cerebral and spinal, which explains the complex structure.

The last, 12 pair of cranial nerves, is responsible for the movement of the tongue.

Mixed FMN

The following pairs of FMNs belong to the mixed type:

• trigeminal (5 pair);
• glossopharyngeal (9 pair);
• wandering (10 pair).

Facial FMN (7 pair) is equally often referred to as a motor (motor) and a mixed type, therefore, the description in the tables may sometimes differ.

5 pair - the trigeminal nerve - this is the largest FMN. It has a complex branched structure and is divided into three branches, each of which innervates different parts of the face. The upper ramus provides sensory and motor function of the upper third of the face, including the eyes, the middle ramus is responsible for the sensitivity and movement of the muscles of the cheekbones, cheeks, nose and upper jaw, and the lower ramus provides motor and sensory function of the lower jaw and chin.

The provision of the swallowing reflex, sensitivity of the throat and larynx, as well as the back of the tongue, is provided by the glossopharyngeal nerve - 9 pairs of FMN. It also provides reflex activity and salivary secretion.

The vagus nerve or 10 pair performs several important functions at once:

• swallowing and laryngeal motility;
• contraction of the esophagus;
• parasympathetic control of the heart muscle;
• ensuring the sensitivity of the mucous membrane of the nose and throat.

The nerve, the innervation of which occurs in the head, cervical, abdominal and thoracic regions of the human body, is one of the most complex, which determines the number of functions performed.

Pathology of sensitive FMN

Most often, damage is associated with injury, infection, or hypothermia. Pathologies of the olfactory nerve (the first pair of FMN) are often diagnosed in older people. Symptoms of a malfunction of this branch are loss of smell or the development of olfactory hallucinations.

The most common pathologies of the optic nerve are congestion, edema, narrowing of the arteries, or neuritis. Such pathologies entail a decrease in visual acuity, the appearance of so-called "blind" spots in the field of vision, and photosensitivity of the eyes.

The defeat of the auditory ridge can occur for many different reasons, but often the inflammatory process is associated with infections of the ENT organs and meningitis. The disease in this case is characterized by the following symptoms:

• hearing loss up to complete deafness;
• nausea and general weakness;
• disorientation;
• dizziness;
• ear pain.

Symptoms of neuritis are often accompanied by symptoms of damage to the vestibular nucleus, which is manifested by dizziness, balance problems and nausea.

Pathology of motor FMN

Any pathology of motor or motor FMN, for example, 6 pairs, makes it impossible to perform their main function. Thus, paralysis of the corresponding part of the body develops.

In case of damage to the oculomotor FMN (3 pairs), the patient's eye always looks down and protrudes slightly. It is impossible to move the eyeball in this case. Pathology of 3 pairs is accompanied by drying out of the mucous membrane due to a violation of lacrimation.

When the accessory nerve is damaged, muscle weakening or paralysis occurs, as a result of which the patient cannot control the muscles of the neck, shoulder and collarbone. This pathology is accompanied by a characteristic disorder of posture and asymmetry of the shoulders. Often, injuries and accidents are the cause of damage to this pair of FMN.

Pathologies of the twelfth pair lead to speech defects due to impaired mobility of the tongue. Without timely treatment, it is possible to develop central or peripheral paralysis of the tongue. This in turn causes difficulty in eating and speech impairment. A characteristic symptom of such a violation is the tongue extending towards the damage.

Pathology of mixed FMN

According to doctors and the patients themselves, trigeminal neuralgia is one of the most painful diseases. Such a lesion is accompanied by acute pain, which is almost impossible to relieve with conventional means. Facial nerve pathologies are often bacterial or viral. There are frequent cases of the development of the disease after hypothermia.

With inflammation or damage to the glossopharyngeal nerve, there is an acute paroxysmal pain that affects the tongue, larynx and shoots the face down to the ear. Often, pathology is accompanied by impaired swallowing, sore throat and coughing.

The tenth pair is responsible for the work of some internal organs. Often, her defeat is manifested by a disruption of the gastrointestinal tract and pain in the stomach. Such a disease can lead to impaired swallowing function and laryngeal edema, as well as the development of laryngeal paralysis, which can cause an unfavorable outcome.

Things to Remember

The human nervous system is a complex structure that ensures the vital activity of the whole organism. Damage to the central nervous system and PNS occurs in several ways - as a result of injury, with the spread of a virus or infection with the blood stream. Any pathology affecting the brain nerves can lead to a number of severe disorders. To prevent this from happening, it is important to be attentive to your own health and to seek qualified medical help in a timely manner.

Any damage to the cranial nerve is treated by a doctor after a detailed examination of the patient. Defeat, compression or inflammation of the cranial nerve must be treated only by a specialist, self-medication and replacement of traditional drug therapy can lead to the development of negative consequences and seriously harm the patient's health.

The facial nerve is mixed. The motor pathway of the nerve is two-neuronal. The central neuron is located in the cerebral cortex, in the lower third of the precentral gyrus. The axons of the central neurons are directed to the facial nerve nucleus, located on the opposite side in the pons of the brain, where the peripheral neurons of the motor tract are located. The axons of these neurons make up the root of the facial nerve.

The facial nerve, passing through the internal auditory opening, is sent to the temporal bone pyramid, located in the facial canal. Further, the nerve leaves the temporal bone through the styloid foramen, entering the parotid salivary gland. In the thickness of the salivary gland, the nerve is divided into five branches, forming the parotid nerve plexus.

The motor fibers of the VII pair of cranial nerves innervate the facial muscles of the face, the striatus muscle, the muscles of the auricle, the skull, the subcutaneous muscle of the neck, the digastric muscle (its posterior abdomen).

In the facial canal of the temporal bone pyramid, three branches extend from the facial nerve: the large stony nerve, the staped nerve, and the tympanic string.

The large petrosal nerve passes in the pterygopalatine canal and ends in the pterygopalatine node. This nerve innervates the lacrimal gland by forming an anastomosis with the lacrimal nerve after being interrupted in the pterygopalatine node. The large stony nerve contains parasympathetic fibers. The striatal nerve innervates the striatus muscle, causing its tension, which creates conditions for the formation of better audibility.

The drum string innervates the front 2/3 of the tongue, responsible for the transmission of impulses with a variety of gustatory stimuli. In addition, the drum string carries out parasympathetic innervation of the sublingual and submandibular salivary glands.

Symptoms of defeat. When motor fibers are damaged, peripheral paralysis of the facial muscles develops on the affected side, which is manifested by facial asymmetry: half of the face on the side of the nerve lesion becomes immobile, mask-like, the frontal and nasolabial folds are smoothed, the eye on the affected side does not close, the palpebral fissure expands, the angle of the mouth is lowered down ...

Bell's phenomenon is noted - turning the eyeball upward when trying to close the eye on the affected side. Paralytic lacrimation is observed due to the absence of blinking. Isolated paralysis of the facial muscles of the face is characteristic of damage to the motor nucleus of the facial nerve.

In the case of attachment of the lesion of the pyramidal fibers to the clinical symptoms of peripheral palsy of the facial nerve, Miyar-Gübler syndrome is formed with central paralysis of the limbs on the side opposite to the lesion of the facial nerve).

With the defeat of the facial nerve in the cerebellopontine angle, in addition to paralysis of the facial muscles, there is a decrease in hearing or deafness, the absence of a corneal reflex, which indicates a simultaneous defeat of the auditory and trigeminal nerves. This pathology occurs with inflammation of the cerebellopontine angle (arachnoiditis), acoustic neuroma. The accession of hyperacusis and a violation of taste indicate damage to the nerve before the large petrosal nerve leaves it in the facial canal of the temporal bone pyramid.

The defeat of the nerve above the tympanic string, but below the discharge of the staped nerve is characterized by a disorder of taste, lacrimation.

Paralysis of the facial muscles in combination with lacrimation occurs when the facial nerve is damaged below the discharge of the tympanic string.

Only the cortical-nuclear pathway may be affected. Clinically, paralysis of the muscles of the lower half of the face is observed in combination with hemiparesis on the side opposite to the focus.

VIII pair of cranial nerves - vestibular cochlear nerve

The nerve consists of two roots: the cochlear, which is the lower, and the vestibule, which is the upper root.

Cochlear nerve is sensitive, auditory. It starts from the cells of the spiral node, in the cochlea of ​​the labyrinth. The dendrites of the cells of the spiral node go to the auditory receptors - the hair cells of the organ of Corti.

The axons of the cells of the spiral node are located in the internal auditory canal. The nerve passes in the pyramid of the temporal bone, then enters the brain stem at the level of the upper part of the medulla oblongata, ending in the nuclei of the cochlear part (anterior and posterior). Most of the axons from the nerve cells of the anterior cochlear nucleus cross, passing to the other side of the brain pons. A minority of axons are not involved in crossing.

The axons end on the cells of the trapezius body and the upper olive on both sides. Axons from these structures of the brain make up a lateral loop, ending in the quadruple and on the cells of the medial geniculate body. The axons of the posterior cochlear nucleus cross in the midline of the bottom of the IV ventricle.

On the opposite side, the fibers connect to the axons of the lateral loop. The axons of the posterior cochlear nucleus end in the lower mounds of the quadruple. The part of the axons of the posterior nucleus, not participating in the crossover, is connected to the fibers of the lateral loop on its side.

Symptoms of defeat.

With damage to the nerve at various levels, auditory hallucinations, irritation symptoms, hearing loss, and deafness may appear. Decreased hearing acuity or deafness on one side occurs when the nerve is damaged at the receptor level, when the cochlear part of the nerve and its anterior or posterior nuclei are damaged.

Symptoms of irritation may also be added in the form of a whistling sensation, noise, crackling. This is due to irritation of the cortex of the middle part of the superior temporal gyrus by various pathological processes in this area, for example, tumors.

The vestibule part. In the internal auditory canal is the vestibular node formed by the first neurons of the pathway of the vestibular analyzer. The dendrites of neurons form the receptors of the labyrinth of the inner ear, located in the membranous sacs and in the ampullae of the semicircular canals.

The axons of the first neurons make up the vestibular part of the VIII pair of cranial nerves, located in the temporal bone and entering through the internal auditory opening into the brain substance in the region of the cerebellopontine angle. The nerve fibers of the vestibular part end on the neurons of the vestibular nuclei, which are the second neurons of the pathway of the vestibular analyzer. The nuclei of the vestibular part are located at the bottom of the V ventricle, in its lateral part, and are represented by the lateral, medial, superior, and inferior.

The neurons of the lateral nucleus of the vestibular part give rise to the vestibular-spinal pathway, which is part of the spinal cord and ends on the neurons of the anterior horns.

The axons of the neurons of this nucleus form a medial longitudinal bundle located in the spinal cord on both sides. The course of the fibers in the bundle has two directions: descending and ascending. Descending nerve fibers are involved in the formation of a part of the anterior cord. Ascending fibers rise to the nucleus of the oculomotor nerve. The fibers of the medial longitudinal bundle are connected with the nuclei of the III, IV, VI pairs of cranial nerves, due to which impulses from the semicircular canals are transmitted to the nuclei of the oculomotor nerves, causing the eyeballs to move when the body position in space changes. There are also bilateral connections with the cerebellum, reticular formation, and the posterior nucleus of the vagus nerve.

Symptoms of damage are characterized by the following triad: dizziness, nystagmus, impaired coordination of movement. There is a vestibular ataxia, manifested by a shaky gait, a deviation of the patient towards the lesion. Dizziness is characterized by seizures lasting up to several hours, which may be accompanied by nausea and vomiting. The attack is accompanied by horizontal or horizontal rotator nystagmus. When a nerve is damaged on one side, nystagmus develops in the direction opposite to the lesion. With irritation of the vestibular part, nystagmus develops in the direction of the lesion.

Peripheral lesions of the vestibular cochlear nerve can be of two types: labyrinthine and radicular syndromes. In both cases, there is a simultaneous violation of the functioning of the auditory and vestibular analyzer. Radicular syndrome of peripheral lesion of the vestibular cochlear nerve is characterized by the absence of dizziness, but may be manifested by imbalance.

IX pair of cranial nerves - glossopharyngeal nerve

This nerve is mixed. The sensitive pathway of the nerve is three-neuronal. The bodies of the first neurons are located in the nodes of the glossopharyngeal nerve. Their dendrites end with receptors in the posterior third of the tongue, soft palate, pharynx, pharynx, auditory tube, tympanic cavity, anterior surface of the epiglottis.

The axons of the first neurons enter the brain behind the olive and end on the cells of the nucleus of the solitary pathway, which are the second neurons. Their axons intersect, ending at the cells of the thalamus, where the bodies of third neurons are located. Axons of third neurons pass through the posterior pedicle of the inner capsule and end in the cells of the cortex of the lower part of the postcentral gyrus.

The motor pathway is two-neural. The first neuron is located in the lower part of the precentral gyrus. Its axons end on cells of the double nucleus on both sides, where the second neurons are located. Their axons innervate fibers of the stylopharyngeal muscle. Parasympathetic fibers originate from the cells of the anterior part of the hypothalamus, ending on the cells of the lower salivary nucleus. Their axons form the tympanic nerve, which is part of the tympanic plexus. The fibers end on the cells of the ear node, the axons of which innervate the parotid salivary gland.

Symptoms of the lesion include a violation of taste in the posterior third of the tongue, loss of sensitivity in the upper half of the pharynx, and gustatory hallucinations that develop when the cortical projection areas located in the temporal lobe of the brain are irritated. Irritation of the nerve itself is manifested by burning, varying intensity pains in the area of ​​the root of the tongue and tonsils lasting 1-2 minutes, radiating into the palatine curtain, throat, ear. The pain provokes talking, eating, laughing, yawning, head movement. A characteristic symptom of neuralgia in the interictal period is pain around the angle of the lower jaw on palpation.

X pair of cranial nerves - vagus nerve

The vagus nerve is mixed. The sensitive pathway is three-neuronal. The first neurons form the nodes of the vagus nerve. Their dendrites end with receptors on the dura mater of the posterior cranial fossa, the mucous membrane of the pharynx, larynx, upper trachea, internal organs, the skin of the auricle, the posterior wall of the external auditory canal. The axons of the first neurons end on the cells of the nucleus of the solitary pathway in the medulla oblongata, which are the second neurons. Their axons end on cells in the thalamus, which are the third neurons. Axons of third neurons pass through the inner capsule, terminating in the cells of the cortex of the postcentral gyrus.

The motor pathway begins in the cells of the cortex of the precentral gyrus. Their axons end on the cells of the second neurons located in the double nucleus. The axons of the second neurons innervate the soft palate, larynx, epiglottis, the upper part of the esophagus, and the striated muscles of the pharynx.

The autonomic nerve fibers of the vagus nerve are parasympathetic. They start from the nuclei of the anterior part of the hypothalamus, ending in the vegetative dorsal nucleus. Axons from the neurons of the dorsal nucleus are directed to the myocardium, smooth muscles of internal organs and blood vessels.

Symptoms of defeat.

With damage to the vagus nerve, paralysis of the muscles of the pharynx and esophagus develops, a violation of swallowing, leading to the ingress of liquid food into the nose. The patient develops a nasal tone of voice, it becomes hoarse, which is explained by the paralysis of the vocal cords. In the case of bilateral lesions of the vagus nerve, the development of aphonia and suffocation is possible. When the vagus nerve is damaged, the activity of the heart muscle is disrupted, which is manifested by tachycardia or bradycardia when it is irritated. These disturbances in the activity of the heart will be expressed in bilateral lesions. In this case, a pronounced violation of breathing, phonation, swallowing, cardiac activity develops.

XI pair of cranial nerves - accessory nerve

The motor pathway of the accessory nerve is bineuronal. The first neuron is located in the lower part of the precentral gyrus. Its axons enter the brain stem, bridge, medulla oblongata, passing through the inner capsule and ending at the level of the anterior horns CI – CV of the spinal cord on both sides.

The fibers of the second neuron leave the spinal cord at the CI – CV level, forming a common trunk, which enters the cranial cavity through the foramen magnum. There, the common trunk connects with the fibers of the motor double nucleus of the X pair of cranial nerves and together with them leaves the cranial cavity through the jugular opening. After the exit of the fibers of the accessory nerve, the trapezius and sternocleidomastoid muscles are innervated.

Symptoms of defeat.

With unilateral damage to the nerve, it is difficult to lift the shoulders, the turn of the head in the direction opposite to the lesion is sharply limited. In this case, the head deviates towards the affected nerve. With bilateral nerve damage, it is impossible to make head turns in both directions, the head is thrown back.

When the nerve is irritated, a muscle spasm of a tonic nature develops, which is manifested by the appearance of spastic torticollis (the head is turned in the direction opposite to the lesion). With bilateral irritation, clonic convulsions of the sternocleidomastoid muscles develop, which is manifested by hyperkinesis with the appearance of nodding movements of the head.

XII pair of cranial nerves - hypoglossal nerve

The nerve is purely motor. The pathway consists of two neurons. The central neuron is located in the cortex of the lower third of the precentral gyrus. The fibers of the central neurons end on the cells of the hypoglossal nerve nucleus from the opposite side, passing before this through the inner capsule of the brain in the region of the pons knee, the medulla oblongata.

Nuclear cells of the XII pair of cranial nerves are peripheral neurons of the pathway. The nucleus of the hypoglossal nerve is located at the bottom of the rhomboid fossa in the medulla oblongata. Fibers of the second neurons of the motor pathway pass through the substance of the medulla oblongata, and then leave it, leaving in the area between the olive and the pyramid.

Motor fibers of the XII pair provide innervation to the muscles located in the thickness of the tongue itself, as well as the muscles that move the tongue forward and downward, up and back.

Symptoms of defeat.

If the hypoglossal nerve is damaged at various levels, peripheral or central paralysis (paresis) of the muscles of the tongue may occur. Peripheral paralysis or paresis develops when the nucleus of the hypoglossal nerve or nerve fibers emanating from this nucleus are damaged.

In this case, clinical manifestations develop in half of the muscles of the tongue from the side corresponding to the lesion. Unilateral damage to the hypoglossal nerve leads to a slight decrease in the function of the tongue, which is associated with the interlacing of the muscle fibers of both its halves.

More severe is bilateral nerve damage, characterized by glossoplegia (paralysis of the tongue). In case of damage to a section of the pathway from the central to the peripheral neuron, central paralysis of the muscles of the tongue develops. In this case, there is a deviation of the tongue in the direction opposite to the defeat. Central paralysis of the muscles of the tongue is often combined with paralysis (paresis) of the muscles of the upper and lower extremities on the same side.

VII pair - The facial nerve is mixed in function, contains motor, sensory and secretory fibers

The motor fibers innervate all the facial muscles of the face, the muscles of the ear circumference, the occipital, stylohyoid, posterior abdomen of the digastric muscle, the platysma. The motor nucleus of the nerve is embedded in the pons of varoli on the border with the medulla oblongata. The axons of this nucleus bend around the nucleus of the 6th pair under the bottom of the 4th ventricle and form the inner knee of the 7th pair. At the base of the brain, the facial nerve exits in the cerebellopontine angle, then goes through the internal auditory canal into the fallopian canal. Here the nerve makes another bend (outer knee). From the pyramid of the temporal bone, the nerve leaves through the styloid opening, penetrates the parotid salivary gland and crumbles into the terminal branches. In neurological practice, these branches are divided into 2 groups: one innervates the upper facial muscles, the other - the lower ones. In the area of ​​the facial nerve canal, a branch leaves the nerve trunk to the stapes muscle, which is an antagonist of m in its function. tensor timpani

Central neurons for the facial muscles are located in the lower part of the precentral gyrus. The axons of these cells go through the radiant crown, the knee of the inner capsule, the base of the brain stem. To innervate the upper mimic muscles, the fibers approach the peripheral nucleus of both their own and the opposite side. Fibers, on the other hand, to the part of the nucleus that innervates the lower part of the facial muscles, completely pass to the opposite side. Thus, with a unilateral lesion of the central motor neuron, paralysis occurs not of all, but only of the lower mimic muscles of the opposite side. The upper group of facial muscles receives impulses from both hemispheres, therefore, on the side of the paralysis, only a slight expansion of the palpebral fissure can be seen. The central lesion of the facial muscles is often combined with the paresis of the same name of the hand (facio-brachial paresis) or the entire half of the body (hemiparesis). If the nucleus or trunk of the nerve is damaged, all the facial muscles of the same half of the face are paralyzed

The second portion of the facial nerve, containing sensory and autonomic fibers, passes through the base of the brain between the motor part and pair 8. Many authors call this part of the facial nerve the intermediate nerve of Vriesberg (13 pair).

The peripheral sensory neuron is represented by ganglion geniculi cells located in the fallopian canal in the area of ​​the external knee of the facial nerve. The dendrites of these cells go along with the motor fibers, then move away from it, participating in the formation of the drum string (chorda timpani), some of them end in taste buds in the mucous membrane of the anterior 2/3 of the tongue. The axons of the geniculate node accompany the main trunk of the 7th pair, enter the medulla and end with synaptic connections with the cells of the nucleus tractus solitarii - a continuation of the glossopharyngeal nerve nucleus

The intermediate nerve contains effector secretory fibers to the sublingual and submandibular salivary glands. These fibers start from the nucleus salivatorius superior, located in the pons. Its axons first go in the common trunk of the facial nerve, then pass into the tympanic string and form synapses with the ganglion submandibulare neurons. The fibers of these cells end in the salivary glands. As part of the large stony nerve, parasympathetic secretory fibers pass to the lacrimal gland. Secretory fibers form the efferent parts of the reflex arches of lacrimation and salivation. Their afferent part is formed by the trigeminal and glossopharyngeal nerves.

Examination of the facial nerve; examination of the face (there may be asymmetry of the facial muscles already at rest, when talking, smiling, laughing). There may be slight muscle twitching or hyperkinesis. Then the patient is asked to wrinkle his forehead, draw his eyebrows, wrinkle his nose, puff out his cheeks, show his teeth, whistle. The strength of the circular muscle of the eye is also evaluated.

Paresis of this muscle causes the impossibility of complete closure of the palpebral fissure (lagophthalmos); when trying to close the eyes, the eyeball moves upward (Bell's symptom). Lagophthalmos is usually accompanied by lacrimation, but with high nerve damage, there may be dry eyes. When the nerve is damaged above the discharge of the stapedial nerve, hyperacusis is observed (increased perception of sounds, especially low sounds) and a taste disorder in the anterior 2/3 of the tongue.

For the differential diagnosis of peripheral and central lesions, not only the distribution of the affected muscles is taken into account, but also the change in the electrical excitability of the nerve and muscles. With peripheral paralysis, a degeneration reaction and a decrease in the corneal and superciliary reflexes are found.

VIII pair - The vestibular cochlear nerve unites two functionally different sensory parts of the cochlear part. Sound waves are perceived by a special organ of Corti - receptors, to which the dendrites of the spiral node approach. The axons of the cells of this node go in the internal auditory canal along with the vestibular nerve. Coming out of the pyramid of the temporal bone, the nerve is located in the cerebellopontine angle and plunges into the brain stem at the posterior edge of the pons. The fibers of the auditory nerve end in two auditory nuclei: ventral and dorsal. vestibular ganglion spiral ganglia

From the neurons of the ventral nucleus, the axons are divided into 2 bundles: most of them go to the opposite side and end in the upper olive and trapezoidal body, the smaller one fits the same formations on their side. The axons of the superior olive and the nucleus of the trapezoidal body form a lateral loop that rises upward and ends in the inferior quadruple and in the internal geniculate body. Some of the fibers of the lateral loop are interrupted in special cells located along the loop itself (the nucleus of the lateral loop itself).

The axons of the cells of the dorsal nucleus go to the bottom of the rhomboid fossa and at the level of the midline plunge into depth and pass both to the opposite side and to their side (striae acusticae) and then join the lateral loop, in contact with the neurons of the posterior geniculate body. Thus, already in the lateral loop there are auditory conductors from both ears.

From the cells of the inner geniculate body, the axons pass through the posterior femur of the inner capsule, then, in view of the auditory radiance, end in the transverse Heshl gyrus of the temporal lobe (fields 41, 42, 20, 21, and 22). The fibers that perceive low sounds end in the oral sections of the gyri, and high ones - in the caudal sections.

Research methodology - study of spoken and whispering speech for each ear - audiometry - test with a tuning fork - Consultation with an otoneurologist

Vestibular part. Vestibular nerve receptors are located inside the ampullae of the three semicircular canals and in two membranous sacs (sacculus and utriculus). Otolith devices are the ends of the dendrites of the cells of the Scarpa vestibular node, located deep in the ear canal. The axons of these cells form the vestibular nerve, which follows the path of the auditory nerve and penetrates the brainstem.

Near the bottom of the rhomboid fossa, the fibers are divided into ascending and descending branches and end in four nuclei - medial, lateral, superior and inferior. The ascending branch approaches the superior vestibular nucleus of ankylosing spondylitis, a small part of it contacts the nucleus of the cerebellar roof (nucleus fastigii). The descending branches end in the lower nucleus of Roller, in the medial triangular nucleus of Schwalbe and in the lateral nucleus of Deiters.

From the lateral nucleus of Deiters, the axons form the vestibulospinal bundle of Leventhal, which on its own side along the lateral cords approaches the motor cells of the anterior horns. Part of the fibers from this nucleus is directed to the medial longitudinal bundle of its own and the opposite side and contacts in the nuclei of the oculomotor nerves

n. oculomotorus Upper n. trochlearis n. abducens Medial Lateral Inferior tr. vestibulospinalis lateralis fasciculus longitudinalis medialis

From the Schwalbe and Roller nuclei, the axons also approach the nuclei of the oculomotor nerve of the opposite side, to the nucleus of the abducens nerve, and from the ankylosing spondylitis nucleus - to the nucleus of 3 pairs of the same side. Through these vestibulo-oculomotor bundles, impulses are transmitted from the vestibular receptors to the external muscles of the eye. These fibers are part of the posterior longitudinal bundle and end at the cells of the Darkshevich nucleus and the interstitial nucleus of Cajal. The axons of the neurons of these nuclei transmit impulses to the thalamus, the pallidary system and to the cortex (temporal, partially parietal, frontal lobes).

There are numerous connections of the vestibular system with the cerebellum and cells of the reticular formation of the trunk, as well as with proprioceptive conductors from the spinal cord.

Balance regulation and orientation of the head and body in space are provided through the medial longitudinal bundle, in which there are connections between the vestibular nuclei, the external muscles of the eye, the cerebellum and the spinal cord. In addition, the vestibular system has been found to play an important role in the perception of gravity.

Examination of the vestibular system In the anamnesis, attention is paid to the presence of dizziness, disturbances in balance and gait, and the tolerance of driving in transport. Another important symptom is vestibular nystagmus: it is possible to differentiate it from cerebellar nystagmus with the help of special caloric, rotational and galvanic tests; disturbance of the vestibular reaction leads to vestibular ataxia: a tendency to tilt and fall towards the affected labyrinth. There is no intentional tremor vegetative reactions: nausea, vomiting, changes in pulse and blood pressure, sometimes fainting Vestibular symptoms appear with damage to the inner ear, vestibular nerve, brain stem

Traditional diagnostic tests for vertigo Romberg's test (used since 1846) The patient stands with his feet together and his eyes closed. The normal person stands upright, and the patient with dizziness deviates from the upright position, trying to compensate for the feeling of movement that he feels. He leans in the direction on which there is a maze defeat. Barany index test (used since 1910) The patient sits on a chair in front of an object. He is asked to close his eyes and point to the object several times. If the function of the labyrinth is impaired, the patient has the illusion of movement of the object, and he misses.

Babinski-Weil test (used since 1913) The patient with his eyes closed several times takes five steps forward and five steps back within 30 seconds. If there is a unilateral vestibular lesion, the patient's route will be star-shaped. Unterberg's test (used since 1938) The patient stands with his eyes closed and stretches his arms forward, holding them horizontally. Then he walks in one place for one minute, lifting his knees up as far as possible. If there is a vestibular lesion, the patient rotates around his own axis.

IX pair - Glossopharyngeal nerve This is a mixed nerve, mainly sensitive. Its motor portion is very small, it innervates only one stylopharyngeal muscle. The bodies of peripheral neurons form the upper part of the nucleus ambiguus (shared with pair 10). It is located in the middle part of the medulla oblongata. The axons of these cells go out between the olive and the rope body, from the cranial cavity they go out through the jugular foramen and approach the muscle

Central neurons are located in the lower part of the anterior central gyrus, their axons are part of the corticonuclear pathway and end at both nuclei. Therefore, if one cortico-nuclear neuron is damaged, swallowing is not impaired. Paralysis of one stylopharyngeal muscle is rare and only with damage to the nerve itself. In this case, the patient has difficulty swallowing solid food.

The nerve also contains sensory fibers. The first neurons are located in two nodes - ganglion jugularae superius et inferius. The dendrites of these cells branch out in the posterior third of the tongue, soft palate, pharynx, pharynx, anterior surface of the epiglottis, auditory tube, and tympanic cavity. Fibers from the lower node go to the taste buds of the posterior third of the tongue, and the axons penetrate the medulla oblongata and end in the taste nucleus (nucleus tractus solitarii). The axial-cylindrical processes from the upper node carry the conductors of general sensitivity, in the medulla oblongata they approach another nucleus - the nucleus alae cinereaa. The axons of both nuclei pass to the opposite side and, as part of the medial loop, go to the thalamus (ventral and medial nuclei).

Fibers of the third neuron pass through the posterior femur of the inner capsule and end in the cortex around the islet of Reil. Fibers of taste sensitivity go to both halves of the thalamus and reach both cortical zones, therefore, if one of the cortical ends of the analyzer is damaged, the taste is not disturbed

Taste testing is carried out using aqueous solutions. It should be borne in mind that normally the sensation of sweetness is better perceived by the tip of the tongue, sour - from the lateral surfaces, bitter - from the posterior third, salty - from the lateral regions and the posterior third of the tongue. In the complex perception of taste, receptors of the 5th pair take part - the sensation of pungent taste is associated with mild irritation of pain receptors agesia - loss of taste hypogeisia - reduction of parageia - false taste sensations.

Occasionally, neuralgia of pair 9 is observed: in the tonsils, the back of the pharynx, the back of the tongue and in the depths of the ear. Pain of considerable intensity occurs in attacks from several seconds to minutes. The interval between attacks can vary. Usually one nerve (right or left) suffers. As part of 9 pairs, there are also vegetative fibers for the parotid gland

X pair - The vagus nerve has multiple functions. It carries out not only the innervation of the striated muscles of the digestive and respiratory tracts, but is also the parasympathetic nerve of most internal organs.

The motor fibers for the muscles of these areas start from the nucleus ambiguous cells (common nucleus for pairs 10 and 11). The axons of these cells form the nerve roots that emerge from the medulla oblongata between the olive and the cord body, and from the cranial cavity through the jugular opening together with the glossopharyngeal nerve, innervate the muscles of the soft palate, pharynx, larynx, epiglottis, upper esophagus, and vocal cords. Central neurons are located in the lower part of the precentral gyrus, their axons go as part of the cortico-nuclear pathway to both nuclei located in the medulla oblongata.

As a result, with unilateral damage to the central neuron, no disturbances in the function of this nerve are observed. When a peripheral neuron (nucleus or nerve itself) is damaged, swallowing disorder (dysphagia) and voice (dysphonia) occur. As part of the 10 pair, there are also motor fibers for the smooth muscles of the internal organs (bronchi, esophagus, gastrointestinal tract, vessels). They start from the cells of the parasympathetic nucleus nucleus dorsalis nervi vagi.

Peripheral sensory neurons are located in two nuclei - upper and lower. They are located in the trunk of the vagus nerve at the level of the jugular foramen. The dendrites of the ganglion cells end in the occipital parts of the dura mater, the external auditory canal, on the posterior surface of the auricle, in the soft palate, pharynx and larynx. The axons of the ganglion cells form 10-15 filaments that enter between the olive and the cord body and end in tractus solitarii. The axons of the cells of this nucleus pass to the opposite side and, as part of the medial loop, go to the thalamus, where 3 neurons are located. Axons go to the lower part of the postcentral gyrus (cortex of the larynx and pharynx).

The study consists in assessing the sonority and timbre of the voice (maybe aphonia - silent whispering speech). Laryngoscopy allows you to establish paralysis of the vocal cords. Find out how the patient swallows solid and liquid food. Examination of the soft palate reveals its lag in phonation on the affected side and deviation of the tongue to the healthy side. The palatine and pharyngeal reflexes are also reduced. With an incomplete defeat of 10 pairs, there are cardiac arrhythmias (tachycardia), respiratory disorders and other internal organs

XI pair - Accessory nerve (accessorius Willisii). This is a purely motor nerve. The bodies of peripheral neurons are located in a column at the base of the anterior horns of 1-6 cervical segments. The axons of these cells form 6-7 thin roots, which extend to the lateral surface of the spinal cord and merge into one common trunk. It rises up, through the foramen magnum enters the cranial cavity and leaves it through the jugular foramen, innervates the sternocleidomastoid and trapezius muscles. Central neurons are located in the middle part of the precentral gyrus between the area of ​​the head and the arm, they are part of the cortico-nuclear pathway, make a partial intersection at the level of the medulla oblongata, descend to the cells of the nerve nucleus. Unilateral damage to the central neuron leads only to mild paresis of these muscles

The sternocleidomastoid muscle turns the head in the opposite direction and up. The trapezius muscle raises the shoulder girdle. To investigate the function of these muscles, resistance is assessed. When the nucleus or trunk of the nerve is damaged, atrophy and paresis of the corresponding muscles are observed. The shoulder girdle on the affected side is lowered. Symptoms of irritation are manifested by clonic twitching of the head in the opposite direction, teak-like twitching of the shoulder, and nodding movements. Unilateral tonic spasm causes torticollis.

XII pair - Hyoid nerve Peripheral motor neurons are located under the bottom of the rhomboid fossa in the medulla oblongata and in the upper cervical segments. The axons of these cells penetrate between the pyramids and olives with several thin roots and merge into a common trunk, which exits the skull through the canal of the hyoid nerve in the lateral part of the occipital bone. These fibers innervate the muscles of the tongue.

Central neurons are laid in the lower part of the anterior central gyrus (tongue zone), axons are part of the cortico-nuclear bundle and at the level of the medulla oblongata pass to the opposite side to the nucleus

The study begins with an examination of the tongue in the mouth, then ask to stick out the tongue behind the line of the teeth. With unilateral damage to the nerve, atrophy of the same half of the tongue is observed. There may be fascicular twitching, which indicates the localization of the process in the nerve nucleus. When protruding, the tongue will deviate to the sore side, since healthy muscles push the tongue more strongly. The circular muscle of the mouth can also suffer to a mild degree, since part of the axons of the nerve at the periphery passes into the facial nerve.

With a bilateral lesion, the tongue becomes atrophic and immobile (glossoplegia). Speech is upset, the food lump in the mouth is not pushed. Unilateral damage to the corticonuclear beam leads to a deviation of the tongue in the opposite direction. Atrophy and fasciculations do not happen with this.

Bulbar and pseudobulbar paralysis A characteristic feature of the topography of the brain stem is the accumulation of the nuclei of the cranial nerves in a small space. This especially applies to the nuclei of 5, 9, 10, 12 pairs in the medulla oblongata. These nuclei can be involved in a relatively small pathological focus. In particular, this leads to the development of peripheral paralysis of the tongue, pharynx and larynx.

Clinically, this is manifested by swallowing disorder - dysphagia, loss of sonority of the voice - dysphonia, impaired pronunciation of articulate sounds - dysarthria. This symptom complex is called bulbar syndrome. Disorders of swallowing, phonation and articulation can also appear with damage to both hemispheres of the brain, when the cortico-nuclear pathways to these cranial nerves are destroyed. This syndrome is called pseudobulbar. Bilateral damage to central neurons is accompanied by the appearance of symptoms of oral automatism: proboscis, nasolabial, distance-oral, palmar-chin Marinescu - Radovici.

Alternating syndromes In pathological processes in the brain stem, an alternating symptom complex occurs - a syndrome characterized by dysfunction of the cranial nerves on the affected side and motor (and sometimes sensory) disorders on the opposite side

Turning off the nucleus or axons of nerve cells causes peripheral paralysis of the corresponding muscles. Often the focus of the lesion captures the pyramidal, dorsal-thalamic, bulbothalamic tracts passing nearby. In its purest form, alternating syndromes are observed in vascular diseases of the brain. Alternating syndromes are usually divided according to the level of damage to the brainstem.

Syndromes of damage to the medulla oblongata Wallenberg-Zakharchenko syndrome - occurs when the posterior inferior cerebellar artery is blocked. It is characterized by a lesion of 9, 10 pairs, the descending nucleus of the 5 pair, the descending sympathetic tract, the lower cerebellar peduncle, the spinal thalamic pathway, the RF, the vestibular nerves and the vomiting center. Clinically manifested by paralysis of half of the muscles of the pharynx, soft palate and vocal cords, Horner's syndrome, cerebellar disorders, impaired sensitivity on the face of the bulbous type on the affected side, on the opposite side dissociated sensory disorders. The patients have dizziness, nausea, vomiting. Nystagmus. Avellis syndrome - paralysis of the soft palate and vocal cord on the side of the lesion and hemiparesis on the opposite side

Syndromes of lesion of the pons Varoli Syndrome Milyar-Gubler - peripheral paresis of facial muscles on the side of the focus and hemiplegia on the opposite side. Fauville's syndrome - paresis of the facial muscles, the abducens nerve on the side of the focus and paresis of the limbs on the opposite side. Raymond-Sestan syndrome - ataxia and choreoathetoid movements on the side of the focus, hemiparesis and sensitivity disorders on the opposite side

Syndromes of damage to the midbrain Weber's syndrome - ptosis, mydriasis, divergent strabismus, impaired movement of the eyeball up, down, medially on the side of the focus, and on the opposite side - hemiparesis of the central type. Benedict's syndrome - on the side of the lesion, there is paralysis of the oculomotor nerve, on the opposite side there is mild spastic hemiparesis in combination with choreoathetosis and intentional tremor in the paralyzed limbs. Parino's syndrome - upper paresis of the gaze, impaired convergence, partial bilateral ptosis on the side of the focus, on the opposite side there may be pyramidal symptoms.