MAIN NEUROLOGICAL SYNDROMES AND SYMPTOMS

Maltseva Marina Arnoldovna

Neurologist, specialist in the field of extrapyramidal pathologies, doctor of the highest category

Shabunina Ekaterina Mikhailovna

Neurologist, category 2

Migraine is a complex of symptoms and phenomena that cause unpleasant consequences if the lesion is not eliminated in a timely manner. Migraine may have a good combination with focal neurological symptoms. In addition, it is necessary to distinguish between such concepts as migraine with aura, in which neurological disorders are present, and migraine without aura.

What are these focal neurological symptoms?

Clinical signs are conventionally divided into three categories - general, mental, and focal neurological. Symptoms include high temperature, poor appetite, chills, headache and dizziness, drowsiness and weakness - these signs are characteristic of diseases that differ in cause, developmental features, and complications.

Focal neurological symptoms are a set of signs that the doctor studies in order to determine the exact location of the affected area of ​​the brain. Damage to the frontal lobe cortex is indicated by a sharp increase in muscle tone, speech disorder and the inability to perceive it, tremors of the head and limbs, as well as impaired coordination of movements.

If the parietal side of the brain is affected, the patient’s sensitivity and quality of brain activity decrease, and the patient loses the ability to write. The manifestation of epileptic seizures, sudden memory loss and the development of deafness with damage to the temporal lobe.

Mental symptoms predominantly accompany neurological symptoms and much less often develop as an independent pathology. Insomnia, chronic anxiety, and causeless irritability indicate a mental disorder.

Clinical picture

Symptoms appear suddenly as a result of head trauma. The duration of loss of consciousness is up to 20 minutes. Simultaneously with the disturbance of consciousness, symptoms of the disease appear (headache, dizziness, nausea, sometimes vomiting, weakness/numbness in one half of the body) for several hours or days. After regaining consciousness, confusion remains for 24 hours. Characterized by memory loss at the time of injury. Symptoms of the disease disappear within 2–3 weeks.

A neurological examination of the patient reveals impaired consciousness (90%), cerebral syndrome (90%), meningeal symptoms (40%), con-/retro-/anterograde amnesia (75%), friendly/unfriendly floating movements of the eyeballs (30%) , mild anisocoria, spontaneous nystagmus (50%), contralateral hemiparesis/hemihypesthesia (20%), increased muscle tone (30%), autonomic reactions (tachy/bradycardia, arterial hypertension) (40%).

Reasons for the development of pathology

The causes of neuralgic symptoms include:

• a malignant neoplasm that is localized in the brain parenchyma;
• traumatic brain injury;
• diseases of the nervous system of a degenerative nature;
• infections of various types;
• pathology of a neuron or group of nerve fibers;
• diseases of the circulatory system;
• stroke;
• cerebral palsy.

In addition to the main causes, there are also factors whose exposure increases the likelihood of developing neurological deficits. Such provoking factors include:

• advanced age of the patient;
• genetic predisposition to diseases of the nervous system;
• diabetes mellitus, which is characterized by weakened immunity;
• abnormal lipid metabolism, which leads to increased cholesterol levels in the blood;
• heart failure;
• chronic stress;
• passive lifestyle;
• abuse of bad habits.

In men, focal neurological symptoms often manifest as a result of an acute lack of the male sex hormone - testosterone. In women, the pathology manifests itself while taking contraceptive medications or poor hormonal therapy.

Symptoms

Types of neurological focal lesions

Depending on the location of the pathological focus, lesions of the frontal, parietal, temporal, and occipital lobes, cerebellum, limbic system, brain stem and spinal cord are distinguished. Each type of lesion is accompanied by a specific clinical picture.

Frontal lobe lesion

A sign of damage to the frontal lobe is considered to be a disorder of motor function, characterized by changes in gait, impaired muscle tone, and the development of epileptiform seizures—convulsions of the upper and lower extremities. A characteristic feature of the pathology is considered to be the manifestation of primitive reflexes in the patient.

If the pathological focus is localized in the frontal region, the patient experiences paralysis of one or simultaneously two limbs, head, and eyes. The symptom is accompanied by the manifestation of “frontal psyche” - a pathology that is characterized by the addition of causeless aggression, lack of initiative, and inhibition to the personal portrait: the patient is prone to committing antisocial acts.

Parietal lobe

The pathology precedes a disorder of sensitivity and perception, against which the patient develops visual neglect syndrome, which is characterized by the inability to concentrate attention on specific objects. When the parietal lobe is damaged, the patient also experiences impaired kinesthesia, which precedes the development of postural sensations.

If the lesion is localized in the parietal zone, the neurological deficit is aggravated by multiple disorders of intellectual function: the patient loses the ability to count, write, and read. The disease is often accompanied by geographic agnosia, which is characterized by the patient’s inability to navigate in space.

Temporal lobe

The clinical picture indicating damage to the temporal region consists of the following symptoms:

1. Memory disorder – amnesia, frequent déjà vu.
2. Development of multimodal hallucinations.
3. The presence of tinnitus causes the formation of auditory hallucinations.
4. The occurrence of partial seizures.
5. The development of sensory aphasia, which is characterized by the patient’s inability to perceive the speech of surrounding people.

Another characteristic symptom of damage to the temporal lobe is the gradual development of deafness, which is not accompanied by damage to the ear parenchyma.

Occipital lobe

Damage to the occipital region precedes a disorder of the visual analyzer, against the background of which the patient develops illusions (microscopy and macroscopy) and hallucinations in the form of zigzags and bright flashes. This type of neurological deficit is also accompanied by visual agnosia, due to which the patient ceases to recognize familiar objects and colors, and a gradual deterioration of vision.

Cerebellum

Damage to the cerebellum is characterized by a disorder of motor coordination and manifests itself in the form of ataxia - awkward, chaotic movements of the torso, arms, and legs. Another specific symptom is tremor, the development of which implies the patient’s inability to control fine motor skills.

Limbic system

Damage to the limbic system precedes partial or complete loss of long-term memory and is also exacerbated by the inability to create new memories. A disorder of the limbic system is dangerous because the pathology leads to disruption of the olfactory function and a decrease in emotionality, against the background of which the patient develops apathy.

Brain stem

Damage to the brain stem is indicated by various disorders of motor and sensory functions. The degree of manifestation of symptoms depends on how many nuclei of cranial nerve fibers were affected.

Symptoms of brain damage

When disorders occur in the brain, the anomaly is manifested by a complex of signs associated with the etiology and origin of the disease, which are combined into general cerebral syndromes. The reason for their formation is the excitation of the meninges and vascular walls, an increase in the volume of the substance and an increase in intracranial pressure. Also, the appearance of visible disorders is caused by liquorodynamic disorders. The conditions most often develop with brain injuries, pressure surges, intoxication and neoplasms. Symptoms of cerebral syndrome include:

• Impaired consciousness. It manifests itself in a mild degree, which is accompanied by drowsiness, lethargy (somnolence is often observed in tumor processes). Sometimes it appears in the form of stupor, when a person continues to react to stimuli and pain; during intoxication, confusion, delirium and hallucinations occur. In severe cases, coma occurs when the ability to move and perform reflex activity is lost, and dysfunction of the heart and breathing is observed.
• Headache. The symptom is a common sign of neurological disorders. Based on the causes of pain, they are divided into mechanical, toxic and circulatory. The nature of the manifestations differs according to specific disorders.
• Dizziness. Observed in hemodynamic disorders, vascular anomalies, diffuse changes.
• Vomit. The syndrome often accompanies neurological pathologies, is often accompanied by nausea, and sometimes brings relief to the patient.
• Convulsive attacks. Usually they act as a symptom of a focal lesion; in the general cerebral manifestation, the condition is characteristic of cerebral edema and stroke.

Each syndrome is divided into specific symptoms that indicate the extent and cause of the damage. But to make an accurate diagnosis, it is impossible to determine the pathological segment, so in neurology, specialists also rely on focal symptoms.

Focal lesion

Focal lesions cause neurological deficits in the areas of the brain where the lesion occurred. As a result, symptoms of local disorders of a specific brain segment appear:

• Changes in the frontal lobe of the cortex are characterized by increased muscle tone, gait instability, paralysis of the limbs and head, speech disorder, changes in personality characteristics, and seizures.
• In case of malfunctions in the parietal lobe, a loss of the ability to count, write and read, and tactile sensitivity is detected. A person cannot determine the position of the body in space.
• With damage to the occipital lobe, vision suffers, sometimes to the point of complete loss, illusions and hallucinations arise, and the patient ceases to recognize surrounding objects and faces.
• With lesions in the temporal region, the defects affect the quality of hearing and the appearance of noise is observed. Memory impairment, amnesia, auditory hallucinations, and epileptic seizures are possible.
• When the cerebellum is damaged, there is a disorder of coordination of movements and fine motor skills, nystagmus.

Focal symptoms make it possible to determine the site of pathology; they often appear in combination with general cerebral syndromes, which indicate diffuse anomalies.

Traumatic brain injury

To demonstrate obvious symptoms, a strong traumatic factor is required; TBI includes bruises, compression and penetrating wounds. The severity depends on the type of damage:

• A concussion is characterized by moderate and minor manifestations of cerebral syndromes, which manifest themselves in the form of dizziness, pain, nausea, and sometimes vomiting.
• Brain contusion is characterized by a more serious clinical picture: loss of consciousness, severe vomiting, headaches. Focal symptoms may appear.
• Compression entails areas of demyelination, necrosis, ischemia, and the condition can cause edema or hematoma that forms due to bleeding.

Therefore, in the latter case, evidence of focal damage clearly appears.

Tumor

Neoplasms in the brain do not reveal themselves in the early stages; as they grow, malignant foci enlarge, compress neighboring areas, grow into nearby tissues, destroying them, and causing the appearance of symptoms. Sometimes general cerebral symptoms are the first to manifest: morning headaches, vomiting that does not bring relief, psychomotor agitation. With the growth of education, focal syndromes become known; their manifestations are diverse, the specificity is determined by the localization of the tumor in the brain segment, the number and origin of the elements.

Stroke

Ischemia or hemorrhage during a stroke forms a lesion, which leads to the occurrence of cerebral and focal syndromes. The clinical picture depends on the department of pathology and the degree of damage, as well as on the type of circulatory disorder. Symptoms that may occur:

• dizziness and bursting headaches;
• attacks of nausea and vomiting;
• speech and coordination disorder;
• numbness of the facial muscles, limbs, paresis and paralysis;
• loss of consciousness, coma;
• blurred vision, double vision, oculomotor dysfunction;
• muscle rigidity, cramps.

Hemorrhagic stroke causes swelling and displacement of structures in the brain and is characterized by rapid development. Ischemic manifestations increase more slowly - several hours, sometimes days.

Inflammation

Primary inflammation in the brain is caused by infectious agents; the condition is usually accompanied by intense headache, fever, nausea and severe vomiting. Symptoms caused by the introduction of pathogenic flora into brain tissue (encephalitis) are accompanied by:

• pain in joints and muscles;
• disorder of movement functions, including the eyes;
• impaired swallowing, loss of sensitivity;
• problems with articulation;
• skin hyperesthesia;
• confusion or loss of consciousness;
• convulsions.

For meningitis (inflammation of the meninges), neurological disorders come to the fore in the form of increased tone (rigidity) of the skeletal muscles responsible for neck extension and hip flexion, as well as contraction of the facial muscles during percussion with a hammer, photophobia.

The meningeal symptom complex is inherent in hemorrhages in the meninges, intracranial hypertension, space-occupying formations, intoxication, and can occur with neurotoxicosis.

Toxic damage

Focal changes in the brain due to exposure to toxins lead to multiple damage to blood vessels and nervous tissue. Signs of encephalopathy differ with different types of toxic substances and the degree of exposure to the body. Poisoning is indicated by:

• dizziness and headache;
• increased blood pressure;
• noise in ears;
• weakness and loss of consciousness from lethargy to coma;
• drooling and vomiting;
• loss of sensation;
• tremor and disorders in the musculoskeletal system;
• blurred vision and loss of function.

In severe cases, changes in intelligence, convulsions, and hallucinations are noted. Depending on the type of poisoning, symptoms may increase gradually, sometimes rapid development of the condition is observed.

Diagnosis of brain lesions

The manifestation of signs of focal neurological symptoms is a reason to visit a doctor. In order for the doctor to obtain a holistic clinical picture, the patient provides him with information about the period of occurrence of specific symptoms, the frequency and nature of their manifestation, as well as recent illnesses.

In order to accurately determine the localization of focal deficiency and the extent of its spread, the following research methods are used:

1. Puncture and analysis of cerebrospinal fluid. During a laboratory study of the cerebrospinal fluid, the doctor evaluates its color, consistency and smell, determines the amount of protein and electrolytes, the level of acidity, and also studies the cellular composition. By analyzing the spinal substance, the doctor identifies pathologies such as syphilitic and meningeal syndromes.
2. Rheoencelography is aimed at assessing the condition of cerebral vessels.
3. Electroencephalography reveals foreign bodies of a malignant nature, hematomas, as well as other pathological foci on the surface of the cerebral cortex.
4. Echoencephalography studies brain structures in order to detect pathological changes in their parenchyma.
5. Electroneuromyography is used as a diagnosis for patients who have suffered a stroke, an infectious disease, or suffering from Parkinson's disease. The procedure allows you to determine the degree of skeletal muscle disorder.

In the course of diagnosing focal neurological symptoms, neuroradiological research methods are also used, which include radiography, magnetic resonance imaging, and craniography. It is advisable to use these procedures in cases of mechanical damage to the vertebrae, traumatic brain injury, or stroke.

Evaluation of patients with advanced neurological deficits involves the use of positron emission tomography, a procedure that can detect abnormal changes in the cerebral cortex and determine their size.

Treatment of neurological disease

The treatment method is determined by the attending physician, taking into account how neurological symptoms develop and what complications they are accompanied by. The intensity of the manifestation depends on factors - the rate of necrosis of nerve fibers and the degree of disruption of the relationship between neurons - treatment is aimed at the formation of new neural connections that can perform the function of dead cells.

In order to normalize neural connections, the patient is prescribed medications that help increase the neurotrophic effect, neurometabolics and neuroprotectors. The drugs have a stimulating effect on the process of restoring brain activity and ensure the formation of new information circuits.

If the development of focal neurological symptoms is provoked by a circulatory disorder, the patient is prescribed such groups of medications as nootropics, vascular drugs and anticoagulants. If a neurological deficit has formed against the background of a malignant process, the pathology is treated by administering hormonal drugs, as well as surgery.