with the and an opposite side order ultram. The only thing that it is possible to note at a hemilesion of a forward central gyrus or tractus cortico-bulbaris is a deviation of tongue at высовывании it towards a weak muscle (in this case, at the central paresis, aside, opposite to the lesion centre). Alalias thus does not come.
But at a bilateral lesion of the central impellent neurones all symptom-complex of bulbar disorders acts in the same kind in what it is observed at bulbar localisation of process. Unlike the last, it wears the name of the pseudobulbar. Disturbances of functions in both cases will be identical; however at pseudobulbar, as well as at any central paralysis, there are no atrophies and a reaction of degeneration; reflexes of oral automatism, contrary to a bulbar paralysis, will be taped here with special intensity (the chapter II).GROUP OF NERVES MOSTO-MOZZHECHKOVOGO OF THE ANGLE
The basic nerves of a mosto-cerebellar angle (tab. 10) are n. facialis (VII nerve) with n. intermedius Wrisbergi (XIII nerve) and n. acusticus (VIII nerve). To the same group often carry leaving in immediate proximity n. abducens (VI nerve) and n. trigeminus (V nerve). At processes in the field of a mosto-cerebellar angle (for example, at tumours), besides VII and VIII nerves, are quite often involved in process and these nerves. VI pair will be surveyed in group of third cranial nerves.
VII pair, n. facialis - a motor nerve. A kernel n. facialis it is located deeply enough in the bottom department варолиева the bridge, on its border with an oblong brain (an ohm. Fig. 23,24 and 50). The fibers which are starting with cells of a kernel, rise dorsally to a bottom of a rhomboidal fossa and bend around from above the kernel located here n. abducentis (VI nerve), forming a so-called knee (internal) a facial nerve.
Fig. 28. A course of a facial nerve.
VII - a facial nerve; XIII - n. intermedius (Wrisbergi); VIII - an acoustical nerve; N. The river s. m. - nervus petrosus superficialis major; N. stap. - nervus stapedius; Pes ans. - pes anserinus; Ch. tymp. - chorda tympani; G. genie. - ganglion geniculi; For. styl. mast. - foramen stylomastoideum.
Further fibers are referred downwards and leave a root on the basis between the bridge and an oblong brain (fig. 22 see), латеральнее olivas, in a mosto-cerebellar angle (together with n. intermedius Wrisbergi and n. acusticus), following in a direction to porus acusticus internus. In the basis meatus acusticus facial and врисбергов depart from acoustical and enter in canalis vpxl facialis Fallopii (fig. 27 see). Here, in пирамидке a temporal bone, VII nerve again forms a knee (external) and, at last, leaves a skull through foramen stylo-mastoideum, being parted on a number of final branches («a goose pad», pes anserinus). N. facialis is a motor nerve of a facial musculation and иннервирует all mimic мышпы (except m. levator palpebrae superioris - III nerve), m. digastricus (a back paunch), m. stylo-hyoideus and, at last, m. stapedius and m. platysma myoides on a neck. On an appreciable extent the fellow traveller of a facial nerve is n. intermedius Wrisbergi, named also XIII черепномозговым a nerve. It is a nerve admixed, having centripetal sensitive, is more exact - gustatory, and centrifugal secretory слюноотделительные than a fiber. On the value it is in many respects identical to a glossopharyngeal nerve with which has the general kernels. Sensitive gustatory fibers begin from cells ganglion geniculi, located in genu canalis facialis, in the temporal. Bones. They go on periphery together with n. facialis no фаллопиеву to the channel also leave last in structure chorda tympani (fig. 28); later they enter system of a trigeminal nerve and through r. lingualis n. trigemini reach tongue, supplying with the gustatory terminations its forward two thirds (a back third иннервируется from a jazyko-pharyngeal nerve). Axons of cells n. intermedii from ganglion geniculi together with n. facialis enter in mosto-mozzhechkovom to an angle into a cerebral trunk and come to an end in general with IX nerve a “gustatory” kernel - nucleus tractus solitarius.
Secretory слюноотделительные fibers of XIII nerve start with the general with IX nerve nucleus salivatorius and pass together with n. facialis, leaving canalis facialis as a part of the same chordae tympani; they иннервируют submandibular and sublingual sialadens (glandula submaxillaris and glandula sublingualis).

Except n. Wrisbergi, on a known extent accompany a facial nerve and secretory слезоотделительные the fibers beginning from a special secretory kernel, VII nerve being near to a kernel. Together with n. facialis these fibers enter in фаллиопиев the channel which soon, and leave as a part of the item petrosus superficialis major. Further слезоотделительные fibers buy cipro are included into system of a trigeminal nerve and through n. lacrimalis (V nerve) reach plaintive glands. At a lesion of these fibers there is no dacryagogue and dryness of an eye is observed.
A little bit more low отхождения n. petrosus superficialis major separate from. A facial nerve also leave фаллопиев the channel and fibers n. stapedii. At a lesion иннервируемой by it of the muscle with the same name it is observed hyperakusis (the unpleasant, strengthened perception of a sound, especially low tones).
Below the named two branches leaves the osteal channel and separates from a facial nerve chorda tympani - continuation n. Wrisbergi with its gustatory fibers for forward two thirds of tongue and слюноотделительными for submandibular and sublingual glands (fig. 28 see).
The lesion of VII nerve causes a flaccid paralysis of a mimic musculation (prosopoplegia). Already at simple survey sharp asymmetry of the person (fig. 29) is evident. The amazed party маскообразна, cords of a forehead and a nasolabial cord here are smoothed, the main cleft is wider, the mouth angle is lowered. At наморщивании a forehead on the paralysis party it is not formed cords (it is amazed m. frontalis); at зажмуривании the palpebral fissure is not closed (lagophtalmus) because of delicacy m. orbicularis oculi. Thus it is visible отхождение an eyeball up (Bell’s phenomenon), and on the lesion party more than on healthy. At a lagophthalmia the strengthened dacryagogue usually (about an exception see more low) is observed. At показывании teeth the mouth angle on the amazed party is not delayed кзади (m. risorius), does not strain m. platysma myoides on a neck. Whistle is impossible, speech (m is a little complicated. orbicularis oris). As well as at any flaccid paralysis, the reaction of degeneration is observed, lost or weakened надбровный a reflex (and corneal).
It is necessary to define height of a lesion of a facial nerve depending on symptoms accompanying a described picture.
At a lesion of a kernel or fibers in a cerebral trunk (fig. 28 see) the lesion of a facial nerve is accompanied by the central paralysis or a paresis buy rimonabant of extremities of an opposite side (alternating syndrome Mijar-Gublera), sometimes with lesion joining n. abducentis (syndrome Фовилля).
Root lesion n. facialis in a place of its exit from a cerebral trunk it is usually combined with a lesion n. acustici (deafness) and other symptoms of a lesion of a mosto-cerebellar angle (fig. 22 see). The paralysis of a facial nerve in these cases is not accompanied by a dacryagogue (dryness of an eye), taste disturbance in forward two thirds of tongue becomes perceptible, dryness in a mouth can be felt. Hyperakusis it is not observed because of сочетанного lesions of VIII nerve.
At processes in the field of the osteal channel to genu n. facialis, i.e. Above отхождения n. petrosi superficialis majoris, simultaneously with a paralysis dryness of an eye, taste and salivation disorder (fig. 28 see) become perceptible also; from hearing here it is observed hyperakusis (a lesion of fibers n. stapedii). At a lesion in the osteal channel more low отхождения n. petrosi, the same disorders of taste, salivation and hyperakusis are observed together with a paralysis, but instead of dryness of an eye there is a strengthened dacryagogue. In case of a lesion of a facial nerve in the osteal channel more low отхождения n. stapedii and above chordae tympani (fig. 28 see) the paralysis, a dacryagogue, taste and salivation disorders are observed. At last, at a nerve lesion in a bone more low отхождения chordae tympani or already after its exit from a skull through foramen stylo-mastoideum the paralysis with a dacryagogue without those accompanying symptoms about which there was a speech at higher lesions is observed only.
The most frequent are last cases with peripheric localisation of process, and the paralysis usually happens unilateral. Cases diplegiae facialis are rare enough. It is necessary to notice, that at a flaccid paralysis of a facial nerve, especially in the disease beginning, pains in the person, in an ear and in its circle (it is especially frequent in the field of a mastoid) are very often observed.