Urgent neurological syndromes. Film 1. (1987)

The ambulance dispatcher accepts the call.

A team of doctors is leaving for a call.

The call is associated with the patient's paralysis.

A cartoon explaining the nature of human movement and possible causes of paralysis.

Interview by the doctor of the patient and relatives.

The doctor performs an express diagnosis.

After the study of the somatic status, the definition of the movement disorder syndrome follows.

Paralysis can be detected with the help of Barre samples.

Muscle strength is determined by resisting the doctor's efforts to a given movement in different muscle groups.

Deep hemiparesis.

Muscle tone is being investigated.

Investigation of tendon and periosteal reflexes.

The study of the reflex sphere leads us to determine the nature of the paralysis to the central or peripheral type it belongs.

Central paralysis is characterized by hyperreflexia, but in the acute stage of the disease there is often a decrease in tendon and periosteal reflexes.

Confirmation of the central paralysis syndrome is the appearance of pathological reflexes.

The Babinsky reflex is of the greatest importance in urgent neurology.

The next step is to establish a topical diagnosis, i.e. localization of the lesion.

A cartoon explaining the places of local damage to the nervous system.

The smoothness of the nasolabial fold in combination with hemiparesis indicates brain damage.

The next level is the brain stem.

The preservation of the functions of the oculomotor nerves excludes the pathology of the upper parts of the brain stem.

Symptoms of damage to the midbrain in another patient.

Alternating Weber syndrome.

This is unilateral ptosis, this is divergent strabismus, this is a restriction of the movement of the eyeball on the side of ptosis in combination with hemiparesis on the opposite side.

Weber's syndrome is observed when the midbrain is affected, where the nuclei of the oculomotor nerve are located and the corticospinal pathway passes, which is part of the pyramidal pathway.

Cartoon explaining the defeat of the midbrain.

Exploring the function of facial muscles, we continue to search for the lesion.

Paralysis of the lower part of the face on the hemiparesis side excludes pathology in the middle sections of the trunk.

If the function of the facial muscles of the entire half of the face is impaired and the patient has hemiplegia on the opposite side, then it is possible to diagnose the alternating Millard-Gubler syndrome.

A cartoon explaining the causes of the syndrome.

The patient has a deviation of the tongue towards paralyzed limbs.

Deviation of the tongue in the opposite direction from the paralyzed limbs, Jackson's syndrome, indicates a more severe lesion.

A cartoon explaining the causes of Jackson syndrome.

In the case of the examined patient, the trunk is not affected.

Sensitivity is being investigated for further localization of the focus.

If the inner capsule is affected, there should be a decrease in all types of sensitivity on the paralyzed side, as well as homonymous hemianopia.

The patient's sensitivity and visual fields are not changed.

The focus in the inner capsule is excluded.

Consequently, the focus is located in the area of the anterior central gyrus.

Cartoon explaining the search for the source of damage.

Since the patient has hemiparesis and lesions of the facial and sublingual nerves of the central type on the right, the focus captures the entire anterior central gyrus of the left hemisphere.

After the topical, a nosological diagnosis is made.

Taking into account the vascular history, arterial hypertension, acute development of clinical symptoms, an undifferentiated diagnosis of acute cerebral circulation disorder in the left hemisphere is made.

Prescribing medications by a doctor.

Hospitalization of the patient.

The ambulance dispatcher takes another call.

Injury.

The patient fell off the Swedish wall, his back hurts.

Examination of the patient.

Injection of pain medication and hospitalization.

The task of express diagnostics in this case is to determine the neurological syndrome and the lesion.

A cartoon explaining the variants of the lesion with such symptoms.

Since the strength in the hands is preserved, the lesion in the upper neck and in the area of cervical thickening can be excluded.

The syndrome of lower sluggish paraplegia is revealed.

In the acute stage of spinal cord injury with damage to the pyramidal system, there is a decrease in tendon reflexes.

The appearance of pathological reflexes indicates a lesion of central neurons on both sides and allows you to exclude a focus in the lumbar thickening, therefore the lesion is located higher at the thoracic level.

The location of the focus can be clarified with the help of a study of pain sensitivity, which is lost.

The border of analgesia is two to three segments below the level of the focus.

The next step is to clarify the distribution of the focus along the diameter of the spinal cord.

A cartoon explaining the brown-sikar syndrome.

An example of a patient with such a syndrome.

A patient with an injury has a loss of all types of sensitivity on both sides below the lesion and bilateral pyramidal symptoms, which indicates complete transverse damage to the spinal cord at the level of the mid-thoracic segments, probably due to a spinal fracture.

Conducting drug therapy prescribed by a doctor.

Hospitalization.