Alternating Foville syndrome is a central paresis, which includes a unilateral lesion of the cranial nerves and opposite sensory and motor systems. Due to the fact that the lesions can be of various forms and dangers, experts distinguish an extensive group of syndromes. Diagnosis of the disease is through examination of the patient's neurological system. To obtain accurate results and establish a diagnosis, you need to use brain MRI, cerebrospinal fluid analysis and cerebral hemodynamics. In this case, the appointment of therapeutic therapy will depend on the overall clinical picture. For this, conservative, surgical methods and recovery therapy are used.
Definition of alternating syndromes
From the Latin language, alternating syndromes are translated as "opposite." This definition includes a complex of symptoms that are described by signs of damage to the cranial nerves with central motor and sensory disturbances in another part of the body. Since paresis extends only to one half of the body, it is called hemiparesis (from the Latin "half"). Because of the same symptoms in alternating syndromes in neuralgia, they are also commonly called "cross syndromes."
Reasons for the appearance
Alternating syndromes occur in humans as a result of half damage to the cerebral trunk.
Most often, the following factors lead to this:
- Stroke attack. The most common cause that leads to a neurological syndrome. In most cases, a stroke occurs due to thromboembolism, spasms in the spine, basilar as well as cerebral artery. Hemorrhagic stroke occurs with hemorrhage from certain vessels.
- The onset of extensive inflammation. These include: abscesses, meningoencephalitis, brain encephalitis of variable etiology with the spread of inflammation to the stem tissues.
- Getting traumatic brain injury. Most often, the alternating syndrome occurs after a fracture of the skull bones that make up the posterior cranial fossa.
- Symptoms of an alternating syndrome of extra-trunk distribution are most often detected with circulatory problems in the middle cerebral, general or internal carotid artery.
Distinctive features of the disease
Alternating Foville syndrome is characterized by damage to most of the face. Pathology extends to 6 pairs of cranial nerves in the peripheral type in the area of the lesion. Also, with Fowill's syndrome, peripheral paresis leads to paralysis of the eye and limbs on the opposite side of the affected part of the body. Such a disease is included in an alternative group. In more detail, you can consider Fowill's syndrome in the photo, which is presented above.
The disease in most cases occurs after thrombosis of the main artery. The syndrome was described in detail in 1858 by the French scientist and doctor of neurological diseases Fauville.
The main factors of defeat
Most often, some forms of infections lead to an alternating syndrome, among them Escherichia coli, streptococci, various bacteria, which spread mainly in two ways: hematogenous and contact.
Fauville syndrome in neurology appears hematogenously:
- due to metastatic abscesses that arise due to pneumonia, a pulmonary abscess, or infection of the valvular heart apparatus (endocarditis);
- with purulent lung damage, which is considered the most common among others;
- if you do not follow hygiene rules and do not comply with sanitary standards (the introduction of medications through a vein).
The source of the disease can only be determined in 80 percent of all cases. Symptoms of Foville syndrome are very pronounced.
Appearance by contact:
- due to the spread of purulent lesions in the oral cavity, pharynx, orbit, or in the sinuses;
- infections that appear as a result of open damage to the skull and the appearance of subdural hematomas.
Diagnostic measures
Diagnosis of Foville syndrome infection is performed through the following procedures:
- MRI or CT - help the doctor get more accurate and complete information about the lesion, are the main methods for diagnosing diseases of an infectious nature;
- examination of peripheral blood, determination of quality and components (red blood cells, hemoglobin, white blood cells);
- studies of possible malignant tumors in the body (tumors), as well as neoplasms that are in the stage of metastasis, chronic meningitis, stroke, hematoma;
- determination of the main source of infection of the patient.
Treatment
The choice of method for treating Fowill's syndrome will directly depend on the general condition of the patient, the characteristics of the syndrome and its form of neglect. Depending on these parameters, the attending specialist will determine exactly which treatment method is best used in a particular case. Specialists distinguish two methods of treating infectious lesions:
A conservative method of treatment includes medication. But it is important to remember that medications can not effectively affect the disease and get rid of the rapidly spreading infection, so they are rarely used in treatment.
Surgery is used only with the formed capsule of the abscess (approximately 4 weeks after the onset of the first symptoms of the disease) and in the presence of a threat of displacement of the brain. Most often, surgery is used to conduct a truly effective and high-quality treatment.
The operation is performed by draining the abscess through an opening in the bone tissue: in this case, MRI or CT equipment is necessarily used. In some cases, the operation has to be performed a second time. During the recovery period after surgery, the doctor without fail prescribes the patient to take strong antibiotics in a large dosage.
Additional Syndromes
Weber's Syndrome is another alternating syndrome. It occurs as a result of the following processes:
- stroke;
- severe hemorrhage in the brain;
- the presence of tumors;
- inflammatory process in the shell of the brain.
With Weber’s syndrome, neurological pathologies extend to a greater extent to the base of the midbrain and to the nuclei or roots of the oculomotor nerve (the area that is responsible for the coordination of a person in space, including upright posture).
In the area of the lesion, lesions appear from the side of the visual system, on the opposite side there are problems with sensitivity and motor processes.
Lesion area
With Weber's syndrome, the pathology spreads unevenly. The following symptoms are present in the affected area:
- severe trembling of the eyelids;
- mydriasis - expansion of the pupil, which does not apply to the reaction to light;
- exotropia;
- in the eyes there is a double image of surrounding objects;
- difficulty focusing vision;
- displacement of the eyeball (bulge appears), sometimes the displacement occurs mainly on one side;
- complete or partial paralysis, which extends to the muscles of the eye.
The following symptoms are common on the other side:
- paralysis of the muscles of the face and tongue;
- problems with sensitivity;
- uncontrolled cramps in the limbs;
- problems with flexion of the hands;
- increased tone of the flexor muscles in the arm, extensor in the leg.
Parino's Syndrome
Parino's syndrome is a pathology in which a sick person cannot independently move the eye down or up, which leads to the development of tumor formation of the pineal gland, which occurs with compression of the vertical center of the gaze in the interstitial nucleus.
Pathology belongs to the group of disorders of mobility of the eye and pupil. The clinical picture of the disease includes the following symptoms:
- paralysis of the upper gaze;
- pseudo-pupils of Argyle Robertson (accommodative paresis occurs, while you can see the middle dilated pupils and determine the presence of dissociation brightly close);
- convergence-retraction nystagmus (in most cases occurs when trying to look up);
- retraction of the eyelids;
- conjugation of the gaze in one position.
Also, in some cases, problems with balance occur; bilateral edema of the optic nerve appears.
The main reasons for the appearance
Parino's syndrome appears due to injury to the spinal cord. Such a violation is caused by ischemic disorders or compression of the integument of the midbrain. Most often, the syndrome appears in the following people:
- young people who have previously been identified tumors in the midbrain or pineal gland;
- in women aged 20 to 30 years with the presence of multiple sclerosis;
- in elderly people who have received a stroke of the upper brain.
Other types of compression, damage or ischemia in these places can cause hemorrhage in the midbrain, obstructive hydrocephalus. Extensive aneurysms and neoplasms of the posterior cranial fossa can also serve as the beginning of Parino's syndrome.
Diagnostic measures are carried out in order to establish the main external signs of the disease. Also, the doctor sends the patient to undergo a complete clinical study to prevent any anatomical pathologies and other complications using the results obtained.
Therapeutic measures
Therapeutic therapy should first of all deal with the etiology of the syndrome. Bilateral recession of the lower rectus muscle helps to free the upper gaze, improve the convergence movement. Most often, specialists prescribe complex treatment using antibiotics and corticotherapy. If Parino's syndrome has a tumor origin, then surgery is taken for treatment.
The main danger of this syndrome is the defeat of neighboring parts of the body and the deterioration of the etiological condition. The main symptoms in most cases go away for a very long time, within a few months.
But there have been cases of rapid improvement in the patient's condition, normalization of intravenous pressure when using ventriculoperitoneal bypass surgery. Complications arise in rare cases and are mainly associated with the etiology of the disease - benign tumors can begin to change, and pathogenic pathogens spread to other parts of the central system.