Oppenheim syndrome. Diseases of the nervous system: the Oppenheim reflex

Rice. 32. pyramidal syndrome. Ways of causing pathological reflexes. Carpal pathological reflexes: 1 - analogue of the Rossolimo reflex; 2 - Zhukovsky reflex; 3 - Jacobson's reflex - Weasel. Extensor and flexion foot pathological reflexes: 4 - Babinsky's reflex; 5 - Oppenheim reflex; 6 - Schaeffer reflex; 7 - reflex Gordon; 8 - Rossolimo reflex; 9 - ankylosing spondylitis 1; 10 - Zhukovsky reflex; 11 - Bekhterev II reflex. Ways of causing the main pathological protective reflexes: 12 - test Marie - Foix

stop clonus, kneecaps and brushes - rhythmic muscle contractions in response to stretching of the tendons - are the result of sharp increase tendon reflexes. For severe injuries pyramidal path clonus often occurs spontaneously when changing the position of the limb, when touched, when trying to change the posture. In less severe cases, the induction of clonus requires a sharp stretching of the tendons, which is achieved by rapid dorsiflexion of the patient's foot (foot clonus), hand (hand clonus) or sharp abduction of the patella down (patella clonus). Pathological reflexes. There are carpal and foot (flexion and extensor) pathological reflexes, as well as reflexes of oral automatism (Fig. 32). Carpal pathological reflexes are characterized by the fact that when different ways their evocation occurs reflex slow flexion of the fingers. The carpal analog of the Rossolimo symptom - the examiner applies a short, jerky blow to the tips of the II-V fingers of the patient's hand, which is in the pronation position, with his fingertips. Zhukovsky's symptom - the examiner strikes with a hammer in the middle of the patient's palm. Symptom of Jacobson-Lask - the examiner strikes with a hammer on the styloid process. Foot pathological reflexes are divided into flexion and extensor. Flexion reflexes are characterized by slow flexion of the toes (similar to pathological carpal reflexes). Rossolimo's symptom - the examiner with his fingertips delivers a short blow to the tips of the II - V toes of the subject's foot. Zhukovsky's symptom is caused by a hammer blow in the middle of the sole at the base of the fingers. Ankylosing spondylitis I is caused by a hammer blow to the rear of the foot in the region of the IV-V metatarsal bones. Ankylosing spondylitis II is caused by a blow of the hammer on the heel of the subject. The extensor reflexes are characterized by the appearance of extension thumb feet; II - V fingers diverge fan-shaped. Babinsky's symptom - the examiner passes the handle of the neurological hammer or the blunt end of the needle along the outer edge of the sole. Oppenheim's symptom - the examiner holds the back surface of the middle phalanx of the II and III fingers along the anterior surface of the lower leg of the subject. Gordon's sign is caused by contraction calf muscle subject. Schaeffer's sign is caused by compression of the Achilles tendon. Poussep's sign is caused by streak irritation along the outer edge of the foot. In response, the little finger is abducted to the side. protective reflexes. With pain and temperature stimulation of a paralyzed limb, it involuntarily withdraws (it bends from a straightened position, and unbends from a bent position). For example, with a sharp painful flexion of the toes, a triple flexion of the leg occurs in the hip, knee and ankle joints (Bekhterev's symptom - Marie - Foix). Synkinesia - involuntary arising friendly movements that accompany the performance of active movements. They are divided into physiological (for example, waving the arms while walking) and pathological. Pathological synkinesis occurs in a paralyzed limb with damage to the pyramidal tracts and is due to the loss of inhibitory influences from the cerebral cortex on intraspinal automatisms. During the first month of life in a child, physiological extensor synkinesis is determined - the so-called triple extension. It consists in the extension of the limbs, body and head with pressure on the soles. The Perez reflex, described in Chapter 10, can also be attributed to the synkinesis of infancy. Pathological synkinesis is divided into global, coordinating and imitation. Global synkinesis is a contraction of the muscles of the paralyzed limbs, which manifests itself in the usual movement for their function, which occurs when the muscle groups are strained on the healthy side. For example, when trying to rise from a prone position or get up from a sitting position on the paretic side, the arm is bent at the elbow and brought to the body, and the leg is unbent. Coordinator synkinesis - when you try to make a movement with a paretic limb, another movement involuntarily appears in it. Tibial synkinesis (Strumpell's tibial phenomenon) - when you try to flex the lower leg, the foot and thumb dorsiflexion occurs. Pronator synkinesis - when trying to bend the paretic arm in elbow joint simultaneous pronation of the forearm occurs. Radial synkinesis - when you try to compress the paretic hand into a fist, dorsiflexion of the hand occurs. Imitative synkinesis is an involuntary repetition in the paretic limb of those movements that are performed in a healthy limb. Raymist's synkinesis - if the examiner resists the adducting and abducting movements of the healthy leg of the patient, then similar movements appear in the paretic leg. The decrease or absence of skin reflexes (abdominal), observed: on the side of paralysis, is explained by the fact that the segmental reflex arc of skin reflexes functions only in the presence of a stimulating effect of the cerebral cortex. With central paralysis, this connection can be broken. Central paralysis is often also accompanied by disorders of urination and defecation. The centers of urination and defecation are located in the gray matter spinal cord at level 1 - III lumbar and II - IV sacral segments. Voluntary control of urination is provided due to the connections of these centers with the cerebral cortex. Cortical innervation is carried out along the paths passing in the lateral cords of the spinal cord near the pyramidal tract, therefore, bilateral damage to the latter is accompanied by a disorder of pelvic functions. With a central disorder, periodic urinary incontinence is observed (reflex emptying of the bladder when it is stretched by urine, occurring periodically, without voluntary control), sometimes urinary retention, imperative urge to urinate (see Chapter 5). The scheme of the two-neuron motor cortico-muscular pathway excludes the combination of peripheral and central paralysis (Table 2). The defeat of the second neuron always entails the development of peripheral paralysis, regardless of the state of the pyramidal pathway. So, with damage to the gray matter of the spinal cord at the level of the lumbar enlargement, lower paraplegia of the peripheral type will inevitably occur, regardless of the presence or absence of damage to the overlying lateral cords with pyramidal tracts. In practice, however, one has to deal with diseases (for example, amyotrophic lateral sclerosis), in which symptoms are revealed that are inherent in both central and peripheral paralysis: a combination of atrophy and grossly expressed hyperreflexia, clonuses, pathological reflexes. Table 2. Symptoms of central and peripheral paralysis

Rice. 33. The main syndromes of motor disorders in the defeat of the central and peripheral motor neurons. Localization of the lesion: I - right anterior central gyrus; (I - motor zone of the right inner capsule; III - midbrain; focus on the right; IV - bridge of the brain, focus on the right; V medulla oblongata, focus on the right; VI - VIII - cross of the pyramids; IX - half lesion of the spinal cord on the right in the lower thoracic region: 1 - cortical-nuclear pathway: 2-3 - cortical-spinal

This is due to the fact that a progressive degenerative or acute inflammatory process mosaically, selectively affects the pyramidal tract and cells of the anterior horn of the spinal cord, as a result of which the central motor neuron is affected for some muscle fibers (and central paralysis develops), for others - the peripheral motor neuron (peripheral motor neuron develops). paralysis). The progression of the process in amyotrophic lateral sclerosis leads to an increasing generalization of the damage to the motor neurons of the anterior horn, while hyperreflexia and pathological reflexes begin to gradually disappear, giving way to symptoms of peripheral paralysis (despite the continued destruction of pyramidal fibers). AT last years ideas about the pyramidal system have been largely revised, in particular, data have been obtained that the so-called pyramidal syndrome (central paralysis or paresis) is not the result of an isolated lesion of the pyramidal tract and is largely associated with simultaneous damage to the descending tracts extrapyramidal system. Experiments with cutting the pyramids of the medulla oblongata and pedunculotomy (cutting the pyramidal pathway in the brain stem) revealed only a slight impairment of motor functions in the form of a change (often a decrease) in muscle tone and a disorder of fine discrete movements of the hand (opposition of the thumb and forefinger, necessary to capture small objects), and these locomotor disorders were predominantly transient. Thus, an isolated lesion of the pyramidal tract does not cause those disorders that are clinically referred to as manifestations of the pyramidal syndrome, and, above all, does not cause the occurrence of spastic paralysis with tendon hyperreflexia. In evolutionary terms, the pyramidal pathway is one of the youngest in the central nervous system. It is absent in reptiles and birds, in which the reticulospinal system is the main motor function regulation system. The pyramidal path appears in higher vertebrates, and reaches its greatest development in animals that have fingers and are able not only to “grasp”, but also “collect”. The emergence of the pyramidal syndrome is associated with the involvement in the pathological process, along with the pyramidal path, of the fibers of the extrapyramidal system, originating from the motor zones of the cerebral cortex and closely related to the stem tonic and postural systems, including the red nucleus, the reticular formation, the vestibular apparatus, etc. In the isolated in the form of a pyramidal pathway, it has a facilitating tonic effect on spinal motor mechanisms. The impact of the pyramidal path on the anterior horn motor neurons is carried out through the insertion path (2 - to the arm, 3 - to the leg): 4 - the nucleus of the oculomotor nerve; 5 - core facial nerve; 6 - core Neurological syndrome: I - II - contralateral hemiplegia and defeat VII, XII nerves according to the central type; III - Weber's syndrome; IV - Miiyar-Gubler syndrome; V - Jackson's syndrome: VI - contralateral hemiplegia; VII - central paralysis of the arm on the side of the focus and contralateral central paralysis of the leg; VIII - homolateral hemiplegia; IX - homolateral mocells that do not have synaptic inputs from peripheral afferents, due to which the pyramidal control of motoneurons is relatively independent of segmental afferentation. Currently, among the fibers of the pyramidal pathway, there are thick, rapidly conducting fibers that provide fast (phasic) motor reactions, and thin, slowly conducting fibers that provide tonic regulation of voluntary movements. The data on the functional significance of the pyramidal pathway indicate that the classic "pyramidal syndrome" is caused by damage not only to the pyramidal pathway, but also to the accompanying pathways of the extrapyramidal system. At the same time, the pyramidal symptom complex is so stereotyped that it makes no sense in the clinic to divide it into true pyramidal and extrapyramidal components. Classical representations are quite acceptable for their use in topical diagnostics. Symptomocomplexes of motor disorders arising from the defeat of various parts of the motor pathways. Peripheral nerve damage causes peripheral paralysis. There is atrophy of the muscles innervated by this nerve, atony (hypotension) of this muscle group, loss of reflexes. Due to the fact that the peripheral nerves are mixed, along with movement disorders, pain, sensory disturbances and autonomic disorders in the zone of innervation of this nerve. With damage to the anterior roots, peripheral paralysis of the muscles innervated by this root develops, fascicular twitches. Damage to the anterior horns of the spinal cord causes peripheral paralysis in the zone of innervation of this segment. Its features are early occurrence atrophy, reactions of degeneration, the presence of fibrillar twitches The anterior horns of the spinal cord contain various groups of cells that innervate the corresponding muscles. Defeat separate group cells leads to atrophy, atony of certain muscles (mosaic lesions). As a result of damage to the anterior horns of the spinal cord on both sides in the segments C5-Th, (cervical thickening), peripheral paralysis of the hands occurs (upper paraplegia or upper paraparesis). Damage to the anterior horns of the spinal cord on both sides at the level of the lumbar thickening causes peripheral paralysis lower extremities(lower paraplegia or paraparesis). With the defeat of the lateral funiculus of the spinal cord (tractus corticospinalis), central paralysis of the muscles develops below the level of the lesion. When the process is localized in the thoracic spinal cord, paralysis of the leg occurs on the side of the focus, when the process is localized above the cervical thickening, central paralysis of the arm and leg occurs. The defeat of the cauda equina causes peripheral paralysis of the lower extremities, a disorder of urination of the peripheral type, a disorder of sensitivity in the perineum and lower extremities. Sharp pains, asymmetry of symptoms are characteristic. Due to the defeat of the cerebral cone, there is a loss of sensitivity in the perineal region, a disorder of urination of the peripheral type (true urinary incontinence). With damage to the spinal cord at the level of L1-2-Si (lumbar enlargement), flaccid paralysis and anesthesia of the lower extremities, central urination disorder develop. The result of the Lesions of the thoracic region (Thj-Th) are spastic paralysis of the lower extremities, central urination disorder, violation of all types of sensitivity according to the conduction type. Damage to the spinal cord at the level of Sb - Th, (cervical thickening) causes peripheral paralysis of the lower extremities, impaired sensitivity of the conduction type, and central urination disorder. With damage to the spinal cord at the level of C, - C4, tetraplegia and loss of all types of sensitivity below the level of the lesion, paresis or paralysis of the diaphragm, central urination disorder (retention, periodic urinary incontinence) develop. The defeat of the pyramidal tract in the area of ​​the pyramidal decussation leads to paralysis of the arm on the side of the focus, the legs - on opposite side(Fig. 33). Damage to the pyramidal tract in the brain stem causes central hemiplegia on the opposite side. Usually they are involved in the process of the kernel cranial nerves or their roots, which is accompanied by the occurrence, in addition to contralateral hemiplegia, peripheral paralysis of the muscles of the tongue, face, eyeball on the side of the localization of the focus (alternating syndrome). Alternating syndromes allow you to determine the localization of the lesion of the brain stem. For example, with a focus in the midbrain region, homolateral peripheral paralysis of the muscles of the eye (the nucleus of the III nerve, its root) is combined with contralateral hemiplegia. As a result of damage to the pyramidal tract in the internal capsule, uniform hemiplegia occurs on the opposite side. At the same time central lesion VII and XII pairs of nerves (due to a concomitant interruption of the corticonuclear pathways leading to the motor nuclei of the brainstem). The defeat of the anterior central gyrus is the cause of monoplegia (monoparesis). Irritation of the anterior central gyrus causes epileptic convulsive seizures. Seizures can be local (Jacksonian epilepsy) or generalized.

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STRIOPALLIDAR SYSTEM. RESEARCH METHOD. SYNDROMES OF DEFEAT The cortico-muscular pathway, discussed in the previous section, provides an arbitrary contraction of one or another muscle. However, a single complete motor act, no matter how primitive it may be, requires the coordinated participation of many muscles. The simplest movement - raising the arm - is provided by the contraction of the muscles of the shoulder girdle, but at the same time the muscles of the trunk and lower extremities, restoring the correct position of the center of gravity of the body. The quality of movement depends not only on the type and number of muscles that implement it. Often the same muscles are involved in the implementation of various movements; the same movement can, depending on the conditions, be performed either faster or slower, with more or less force. Thus, to perform a movement, it is necessary to involve mechanisms that regulate the sequence, strength and duration of muscle contractions and regulate the choice of the necessary muscles. In other words, a motor act is formed as a result of a consistent activation of individual neurons and fibers of the cortico-muscular pathway, consistent in strength and duration, that gives orders to the muscles. This inclusion is ensured with the participation of almost all motor systems of the brain and, above all, the extrapyramidal system and its striopallidar division. The extrapyramidal system includes the structures of the cerebral cortex, subcortical ganglia, cerebellum, reticular formation, descending and ascending pathways. Arbitrarily performing this or that action, a person does not think about which muscle should be included in the required Lyoment, does not keep in his conscious memory a consistent working scheme of a motor act. Habitual movements are made mechanically, imperceptibly for attention, the change of some muscle contractions by others is involuntary, automated. Motor automatisms guarantee the most economical use of muscle energy in the process of performing a movement. A new, unfamiliar motor act is energetically more wasteful than the usual, automated one. The swing of a mower's scythe, the blow of a blacksmith's hammer, the running of the musician's fingers - to the limit honed, energetically stingy and rational automated movements. Improvement of movements - in their gradual economization, automation, provided by the activity of the striopallidary system. The striopallidary system is divided according to its functional significance and morphological features into striatum and pallidum. The caudate nucleus and the shell are combined into a striatal system. The pale ball, black substance, red nucleus, subthalamic nucleus make up the pallidar system. Pallidum contains a large number of nerve fibers and relatively few large cells. The caudate nucleus and putamen include many small and large cells and a small number of nerve fibers. There is a somatotopic distribution in the striatal system: in the oral sections - the head, in the middle - the arms and trunk, in the caudal sections - the legs. There is a close relationship between the striatal and pallidar systems. The striatal system is more "young" than the pallidar one, both in phylogenetic and ontogenetic terms. It first appeared only in birds and is formed in humans by the end of the prenatal period, somewhat later than the pallidum. Pallidar system in fish and striopallidar. in birds they are the highest motor centers that determine the behavior of the animal. Striopallidar devices provide diffuse, massive movements of the body, coordinated work of all skeletal muscles in the process of movement, swimming, flight, etc. The vital activity of higher animals, humans requires a finer differentiation of the work of motor centers. The needs of movements that are purposeful, productive in nature can no longer be satisfied by the extrapyramidal system. In the forebrain cortex, a higher apparatus is created in the course of evolution, coordinating the coordinated function of the pyramidal and extrapyramidal systems that direct the execution of complex movements. However, having moved to a subordinate, “subordinate” position, the striopallidary system did not lose its inherent functions. The difference in the functional significance of the striatum and pallidum is also determined by the complication of the nature of movements in the process of phylogenesis. "Pallidary" fish, moving in a state of suspension in the water with throwing, powerful movements of the body, should not "concern" about saving muscle energy. The needs of such a motor act are fully satisfied by the work of the pallidary system, which provides movements that are powerful and relatively accurate, but energetically wasteful, excessive. A bird forced to do a tremendous amount of work in flight and not being able to suddenly interrupt it in the air, must have a more complex motor apparatus, prudently regulating the quality and quantity of movements, the striopallidary system. The development and inclusion of motor systems in human ontogenesis follows the same sequence. Myelination of the striatal tract ends only by the 5th month of life, therefore, in the first months, the pallidum is the highest motor organ. The motility of newborns has obvious "pallidar" features. The movements of a child up to 3 - 4 years old and the movements of a young animal (puppy, deer, hare, etc.) have a great similarity, which consists precisely in excess, freedom, and generosity of movements. The richness of the child's facial expressions is characteristic, also indicating a certain predominance of "pallidarity". With age, many human movements become more and more habitual, automated, energetically prudent, stingy. The smile stops being constant expression faces. The degree, solidity of adults is the triumph of the striatum over the pallidum, the triumph of the sober prudence of automated movements over the wasteful generosity of the still “inexperienced” striopallidary system of the child. The process of learning any movement, aimed at automating a motor act, has two phases. During the first phase, which is conditionally called pallidar, the movement is excessive, excessive in strength and duration of muscle contraction. The second phase of movement rationalization consists in the gradual development of the energy-efficient, most efficient (with a minimum expenditure of Forces) method of movement that is optimal for a given individual. The striopallidary system is the most important tool in the development of motor automatisms, which in an adult are purposefully selected and implemented by the higher cortical centers of praxis.

The relative "pallidarity" of the child is due not only to the immaturity of the striatum, but also to the fact that the child is still in the stage of motor learning in its first, pallidar phase. The older the child, the more more motor acts are automated, that is, they have ceased to be "pallidar". Along with this, the immaturity of the striatum and the predominance of "pallidarity" in newborns are, as it were, planned in advance, since it is precisely "pallidarity" that a child needs in the first period of extrauterine life. The striopallidary system has numerous connections: paths connecting the formations of the striopallidary system; pathways connecting the striopallidar system with the final motor pathway and muscle; mutual connections with various parts of the extrapyramidal system and the cerebral cortex, and, finally, afferent pathways. There are several ways to deliver impulses from the striopallidar system to the segmental motor apparatus: 1) the Moscow red nuclear-spinal pathway from the red nuclei; 2) vestibulo-spinal tract from the vestibular nucleus; 3) reticulospinal tracts from the reticular formation; 4) tectospinal (cover-spinal) path from the quadrigemina; 5) paths to the motor nuclei of the cranial nerves. The striopallidary system responsible for the involuntary performance of motor acts must receive comprehensive information about the state of muscles, tendons, the position of the body in space, etc. (Fig. 34, 35).

Rice. 34. Extrapyramidal Afferent systems that serve the striopallidum (information impulses from the “collector of sensitivity” - the thalamus, from the cerebellum, the reticular formation, corrective signals from the cortex, etc.) create rings together with efferent pathways feedback with a continuous stream of informing and corrective, commanding signals. The circulation of impulses does not stop, uniting all motor and afferent systems into a single whole. Rice. 35. Block diagram of the influence of the extrapyramidal system on the spinal motor neuron.

When the nuclei of the extrapyramidal system and their connections are damaged, various symptoms occur. The main ones are hypotonic-hyperkinetic and akinetic-rigid syndromes. Violations of the extrapyramidal system are manifested in the form of changes in motor function, muscle tone, vegetative functions, emotional disorders. Rice. 36. Striopallidar syndromes. A - posture of the patient with akinetic-rigid syndrome; B - postural phenomena: a - Westphalian; E - hemitremor; 1 - caudate nucleus; 2 - shell: 3 - pale ball; 4 - black matter; 5 - subthalamic nucleus; 6 - red core.

The human nervous system has never been fully understood by doctors and scientists. Humanity is gradually beginning to understand medical words like reflex, axon, or nerve impulse.

But in every field of activity there are those who, in fact, turned science around and made a significant contribution to the development of the medical industries. Academician Pavlov, who gave an explanation of the physiology of human reflexes, can be safely attributed to such people. By doing this, he allowed others to look at the world with different eyes. As a result of his discovery, active development industries such as psychiatry and neurology. BUT further development contributed scientists, for example, Oppenheim.

Pathologies: neurological reflexes

The Oppenheim reflex is a neurological disease. This means that a healthy person will not observe these signs. Pathological Oppenheim reflexes can be checked by pressing a finger on tibia movements from the bottom up, after which contraction and stretching upwards will begin on the big toe of the foot.

This sign is similar to the Babinski reflex (when stroking the back of the leg, the same phenomenon will be visible). in neurology, as a rule, are paired. Now many other signs are distinguished (Gordon, Hirshberg, Zhukovsky), but in practice the symptoms are not checked by a specialist, it is enough to check only three.

Characteristics of the Oppenheim reflex

Pathological foot extensor reflex is associated with a failure in the cerebral hemispheres. It indicates a malfunction of the efferent conduction of the nerve impulse directly to the reflector organs.

Often, failures in the extrapyramidal system imply an Oppenheim reflex. Based on this, the first stage in the development of neurodegenerative dementia is suggested. Thanks to this, it is possible to start treatment in a timely manner and keep the disease at the initial stage.

As a rule, this disease is considered Parkinson's disease, which provokes damage to the efferent innervation. As a result, even paralysis of the skeleton can occur, and after the heart muscle. It should be understood that such an ailment develops and occurs in the region of the motor nuclei from the bottom up.

Signs of Oppenheim's syndrome in the eye area

The main symptom of this disease is vegetative colic in the eyeball. it burning pain, which applies to all vegetalgia and appears in the form of a painful paroxysm, which lasts about half an hour or more. In some cases, O Ppenheim reflex, in which the duration of the painful paroxysm is about 7 days. The patient has a feeling that something is squeezing the eyeball out of the orbit. The pain comes and spreads over the temple and forehead.

It is rare to find reflex irradiation, it implies the development of pain in the back of the head, shoulder girdle. At the time of the attack, the patient has conjunctivitis, accompanied by lacrimation and fear of light. Often the symptoms appear in the evening or at night. Acute period implies the presence of daily attacks, after which there should be an interictal stage. As a rule, the disease occurs in a certain season - in spring or autumn.

Sometimes such symptoms can be provoked by complications after surgery. The development of the disease can be facilitated by cold effects on the face and head, as well as constant stress.

Symptoms at the physiological level

The sign shows irreversible changes in the area of ​​efferent innervation. And such a phenomenon occurs due to the impact of a finger on the bone, after which the signal is received by sensory reflexes associated with the brain. At first, they follow in the area and only then they enter the motoneuron site of the brain.

The Oppenheim reflex lies in the fact that at the time of the passage of a nerve impulse, the body must react. Since the neurons of the extrapyramidal system are damaged, the signal does not reach the organ in full, so the spinal reflex is involved in the work. It consists in the extension of the big toe.

There is also another version of this pathology. It consists of the following: since nerve cells produce the synthesis of dopamine, then in the process of neuronal dementia, the required amount of its synthesis is simply absent. Based on what there is no signal from the central nervous system, the links are broken reflex arc. Spinal human reflexes are connected to the activity, which in healthy person are not observed.

Treatment

initial stage treatment of the Oppenheim reflex is the differential diagnosis of brain disorders. Due to the simplicity and accessibility of the procedure, every neurologist will be able to deliver correct diagnosis and provide competent treatment. Therapy consists in stopping paroxysms. For these purposes, symptomatic medications, including vitamins, are prescribed.

The disease manifests itself with frequent attacks sharp pains in the region of the eyeball or behind it. Patients develop lacrimation, redness of the conjunctiva of the eye, photophobia, often develop conjunctivitis and keratitis. On palpation, the soreness of the eyeball is determined.
Differential Diagnosis
Oppenheim's syndrome should be distinguished from neuralgia of the nasociliary nerve. The difference is that with the defeat of the ciliary node, a limited lesion of one area of ​​​​the orbit and the appearance of typical herpetic eruptions in the skin of the nose and forehead.
Treatment
During a painful attack, it is recommended to instill 0.25% dicain solution into the eye, 2 drops 1 time per day for 5-7 days; inside the following medicinal mixture: 0.1 g of spasmolitin, 0.015 g of diphenhydramine, 0.025 g of chlorpromazine, 0.25 g of glutamic acid, 0.015 g of sodium caffeine benzoate, 0.02 g of papaverine hydrochloride, 0.3 g of glucose (1 powder 2 times a day day). Vitamins B(, Bg) are used
In the infectious nature of the disease are assigned
antibiotics, sulfonamides. sick senior age group anti-sclerotic therapy, antihypertensives, nootropics are recommended.
Damage to the submandibular and sublingual nodes
The submandibular node is connected with the lingual nerve by the anterior and posterior roots. The posterior root mainly consists of parasympathetic secretory fibers coming from the superior salivary nucleus, the inferior sympathetic root is composed of fibers from the plexus of the external maxillary artery. As part of front spine submandibular node afferent vegetative fibers are located in the sympathetic pathways of the upper cervical node, passing through the submandibular node and not interrupted in it, join the lingual nerve, following with it to the tissues of the tongue.
Peculiarities clinical manifestations
The defeat of the submandibular node is characterized constant pain in the submandibular region and tongue, intense pain paroxysms periodically occur with a frequency of 1 time per day or 1 time per week, lasting 10-50 minutes. Pain may radiate to lower jaw, temple, occiput, neck, upper lip. In the submandibular triangle, a painful point can be determined. During an attack of pain, salivation may increase, sometimes xerostomia may occur.
The defeat of the hyoid node, associated with the lingual nerve and the plexus of the hyoid artery, manifests itself dull pains in the sublingual region, tongue and, to a lesser extent, in the submandibular region. Pain can radiate to different parts of the face. With bouts of pain, both increased salivation and dry mouth can occur. pain point also located in the submandibular triangle.
characteristic feature damage to both nodes is
Xia appearance pain attacks after taking rich food. Pain in this case is localized in the region of the tip of the tongue and in adjacent areas
Treatment
Treatment of patients with pathology of the submandibular and sublingual nodes is aimed at eliminating pain. In the acute period, analgesics, tranquilizers, ganglionic blocking agents are prescribed, including ganglionic blockades with a 0.5-1% solution of novocaine, 5-20 ml for 10-15 days. When the exacerbation subsides, courses of B vitamins, physiotherapy procedures: inductothermy, galvanization are necessary.

(ganglionitis of the ciliary node) - an inflammatory lesion of the ciliary autonomic ganglion, the leading manifestation of which is ocular autonomic pain, accompanied by lacrimation, conjunctival hyperemia, serous rhinitis and photophobia. The disease can be complicated by the development of keratitis, iridocyclitis, conjunctivitis. Diagnosis of Oppenheim's syndrome allows a typical clinic and soreness of the trigger points of the orbit; in difficult cases - diagnostic injection of lidocaine or novocaine in the area of ​​the ciliary ganglion. Treatment Algorithm includes the use of painkillers eye drops, anti-inflammatory and symptomatic remedies, physiotherapeutic methods and reflexology.

General information

Ciliary (ciliary) autonomic ganglion located behind the eyeball in the fatty tissue of the orbit near the trunk optic nerve. Its diameter is about 2 mm. The ciliary ganglion consists of parasympathetic neurons that receive innervation from the preganglionic fibers of the branch oculomotor nerve. Sensory fibers of the nasociliary nerve and sympathetic fibers from the internal carotid plexus pass in transit through the ganglion. Short ciliary nerves emerge from the ciliary ganglion, which include both parasympathetic fibers, which are processes of ganglion neurons, and sensitive and sympathetic fibers passing through it.

The ciliary nerves go to the back of the eyeball and pass through it. albuginea; innervate the muscles of the pupil and the membranes of the eye, including the cornea. Interestingly, the sphincter of the pupil and ciliary muscle receive innervation only by parasympathetic fibers, and the pupil dilator - only by sympathetic fibers. In this regard, with violations of the autonomic innervation with a predominance of parasympathetic system pupil constriction (miosis) is observed, with greater excitation of sympathetic fibers - pupil dilation (mydriasis).

Vegetalgia paroxysm usually occurs in the evening or at night. The acute period is followed by a series of daily attacks, then the long interictal stage is possible. Usually, Oppenheim's syndrome is characterized by the seasonality of exacerbations typical of vegetalgia - spring, autumn.

Diagnosis of Oppenheim's syndrome

Objectively, in patients with Oppenheim's syndrome, there is a sharp pain when pressing on inner corner eyes, projection exit points of the supraorbital nerve (border of the medial and middle 1/3 of the supraorbital margin) and nasociliary nerve (medial point of the orbit). Depending on the predominance of excitation of parasympathetic or sympathetic fibers, patients have Horner's syndrome or Petit's syndrome. The first includes a triad of signs: miosis, drooping of the upper eyelid and enophthalmos, the second - mydriasis, exophthalmos and expansion of the palpebral fissure.

A neurologist can diagnose ganglionitis of the ciliary node. However, to examine the condition of the eyeball, consultation with an ophthalmologist is required. The latter performs a visual acuity test, perimetry and examination of the structures of the eye (ophthalmoscopy, biomicroscopy, diaphanoscopy). Ophthalmological examination It is aimed both at identifying the pathology that caused Oppenheim's syndrome and at diagnosing changes in the eyeball resulting from ganglionitis.

In a difficult diagnostic situation, a blockade of the ciliary ganglion is performed - a retrobulbar injection of lidocaine or novocaine into the region of the node. Cupping pain indicates the correctness of the diagnosis.