RU2162655C2 - Method for determining midbrain pathology in children - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves studying direct reaction to light stimulus. Pupil behavior is followed. The pupil narrowing and gradually widening next to it being observed, middle brain pathology is considered to be the case. EFFECT: enhanced accuracy of topic diagnosis.

Description

 The invention relates to medicine, in particular neurosurgery and neurology, and can be used to determine pathology in the midbrain in children at a time when damage to the midbrain is minimal and other symptoms may not be detected.

 There is a method of determining pathology in the midbrain (Badalyan L. O. "Pediatric Neurology". M.: Medicine., 1984, p. 136), adopted by us for the prototype, in which the patient is planted so that the face is turned to the source light, and offer to fix the gaze at a distant point. The researcher closes both eyes of the patient with his palms, which leads to the expansion of the pupils. Then he quickly takes one arm away and observes a direct reaction of the pupil to the light. There is a narrowing of the pupil, which indicates the absence of pathology in the midbrain. Violation of the reaction of the pupils to the light indicates pathology in the midbrain. However, with minimal damage to the midbrain, there may be no disturbance in the reaction of the pupils to light.

 The invention is aimed at creating a method for determining pathology in the midbrain, which allows to increase the accuracy of topical diagnostics.

 The essence of the method is to study the direct reaction of the pupils to light, and with the expansion of the pupils after their narrowing, the pathology in the midbrain is determined.

 The direct reaction of the pupils to the light is carried out by a reflex arc, which consists of the afferent (sensitive) path and the efferent (motor). The sensitive pathway is the optic nerve, the motor pathway is the oculomotor nerve. They are connected at the level of the midbrain, namely in the quadrupole, more precisely in the anterior bilimia, where impulses from the optic nerve pass through the insertion cells of the quadrupole into the oculomotor nerve. The reaction of the pupils to light can be carried out with normal function of the above paths. Even with minimal pathology in the midbrain, the reaction of the pupils is disturbed.

 The inventive method differs from the prototype in that if, after narrowing of the pupil, its expansion occurs, pathology in the midbrain is determined.

 The method is as follows. The patient is planted facing the light source and asked to fix his gaze at a distant point. Then they close the patient’s eyes with their palms and abruptly move one arm away, while observing the pupil - it narrows. If after this the pupil begins to expand, then this indicates a pathology in the midbrain.

 The proposed method for determining pathology in the midbrain in children was developed and passed clinical trials at the Russian Research Institute of Neurosurgery named after prof. A. L. Polenov in 21 patients.

 We give examples - two extracts from the medical history.

Example 1
Patient A, 14 years old (East. 1151-97), was admitted to the institute 2/12 - 97 with complaints of decreased sensitivity and weakness in the left limbs.

 She became ill in February 1997, when there was numbness in her left thigh, which lasted for several seconds. Numbness attacks began to recur. In March, numbness seized the entire left leg, and after a while the left arm. At the end of June, the left leg weakened, and in the middle of July, the left arm. In August, a double vision appeared in the eyes horizontally.

 Objectively: the condition is satisfactory. The right palpebral fissure is already left, when looking to the right, horizontal fine-spreading nystagmus of one right eye is revealed. The pupils are wide, the direct reaction of the pupils to the light is alive. After narrowing, the pupils gradually expand. Left-sided hemiparesis is determined. Diffuse atrophy of the muscles of the left leg, left foot less than the right. The hand and forearm of the left hand are thinner than the right. Deep reflexes on the left extremities are higher, pathological reflexes of Babinsky and Model-Ankylosing spondylitis on the left are caused, abdominal reflexes are low, on the left below. All types of sensitivity are reduced on the left side of the body. The coordination in the left extremities is broken. On the fundus of the initial congestive disks of the optic nerves.

 Based on the anamnesis and objective data, the diagnosis was made: a tumor of the right visual tubercle. The presence of dilated pupils after narrowing with a direct reaction of the pupils to light gave reason to believe that the patient has a pathology in the midbrain. This is indicated by the nystagmus of one right eye. Therefore, a tumor of the right optic tubercle affects the midbrain, and this, in turn, indicates the location of the neoplasm in the posterior regions of the optic tubercle, i.e., it is possible to clarify the topical diagnosis. During the operation, it was found that the tumor captures the posterior-lateral sections of the right visual tubercle. After the operation, a neurological examination of the patient showed that the expansion of the pupil after narrowing disappeared when examining the direct reaction of the pupils to light, the horizontal nystagmus of one right eye disappeared. This is due to the cessation of the tumor of the optic tubercle on the midbrain. Thus, our proposed method helps to identify pathology of the midbrain in children and increases the possibility of topical diagnosis.

Example 2
Patient L, (source. 913-97), 13 years old, entered the institute 23 / 6-97 with complaints of a headache of a pressing nature, of varying intensity, which occurs almost daily and lasts up to 6-7 hours, and seizures starting with a sensation of “coma” in the epigastric region. The “com” rises up to the throat and falls, at this time the patient turns pale. Sometimes, after this, she faints and speaks without meaning, moreover, she pronounces the words correctly. He regains consciousness, feels a headache. Seizures last 2-3 minutes and are repeated daily. Speech impairment is noted.

 In 5 months. mother noticed that the child began to smack for 2-5 s, and then fell asleep. This was repeated once a week, once a day. By the year, the smacking stopped. In 2 years, he fell from a tree, found a concussion. After that, seizures resumed, which already began with a sensation of “coma”. They were repeated 1 time in 2-3 months. By 5 years, seizures increased up to once a month. At 7 years old, they sometimes ended in loss of consciousness. At 10 years old, seizures became daily, and for 13 years speech became worse.

 An objective study revealed elements of amnestic aphasia. Sick left-handed. According to the claimed method, a direct reaction of the pupils to light was studied. It was found that after narrowing, the pupils dilate. Movements in the limbs in full, the strength in the arms and legs is 5 points, muscle tone is not changed. The deep reflexes on the hands of medium vivacity are uniform, the knees are animated, uniform, the Achilles - medium vivacity, uniform, plantar - live, uniform, abdominal - live, uniform. With a finger-nasal test - intentional tremor on the left, does not stand well on one leg, both on the left and on the right.

 EEG reveals common changes in biopotentials with some prevalence in the right hemisphere. Stem formations are involved in the process.

 The fundus and visual field are not changed, visual acuity of 1.0 in both eyes. Volumetric formation of the medial divisions of the right temporal lobe is determined on CT.

 Based on the anamnesis, objective data, and additional research methods, it was found that the patient has a tumor that is localized in the right temporal lobe, comes from the hippocampus and reaches the cortex. The expansion of the pupils after narrowing, according to the claimed method, made it possible to talk about pathology in the midbrain, which is the result of the effect of the neoplasm on the midbrain. Therefore, it is located in the middle-posterior parts of the temporal lobe.

 On July 4, 1997, osteoplastic trepanation of the skull was performed in the right frontotoparietal-temporal region. In the middle and posterior third of the temporal lobe, a voluminous formation, cystically degenerate, gray-pink in color, emanating from the hippocampus and performing the entire cavity of the lower horn, was found. Histological examination revealed pilocytic astrocytoma. Thus, our proposed method allowed us to detail the topical diagnostics. It should be noted that there were no symptoms suggesting pathology in the midbrain, except for the expansion of the pupils after their constriction in the study of the direct reaction of the pupils to light. Therefore, we can say that our proposed method for determining pathology in the midbrain in children is reliable.

Claims (1)

 A method for determining pathology in the midbrain in children, characterized in that they examine the direct reaction of the pupil to light and after narrowing, if its gradual expansion occurs, then pathology in the midbrain is determined.