Syndromes of violation of the function of the right hemisphere of the brain. Signs of damage to the right hemisphere of the brain. Features of ischemic stroke of the right side

The syndromes of the defeat of the right (subdominant) of the hemisphere are not yet sufficiently studied. The method of cutting the corporest body (with the cut of the cornistic body and supplying irritations into the right hemisphere. Calling objects is impossible, the ability to directly perceive objects and diffuse distinction of the meaning of words): Sirry-confirmed that any hemisphere is carried out by the joint work of both hemispheres, each of which contributes. In the construction of mental processes, their own contribution.

The right hemisphere has nothing to do with speech activities, and its defeat even quite extensive does not affect speech processes. Subdomed hemisphere is less involved in providing complex intellectual functions and ensuring complex forms of motor acts. (right-handed with defeat of the right hemisphere does not show pronounced violations of active speech, letters (logical thinking, understanding of logical of grammatical structures, formal logical operations, it is saved and the score), reading even in cases where these lesions are located within the temporal, dark-occipital, Premotor zones that in the case of lesion of the left hemisphere causes aphasia. The right hemisphere has a smaller functional defraension of the cortical structures compared to the left: the disorders of the skin and deep sensitivity of the right hand are caused by the defeats of the post-central departments of the left hemisphere, the same disorders of the skin and kinesthetic sensitivity in the left hand They may occur with significantly more scattered lesions of the cortex of the subdominant hemisphere. Khuylings Jackson (1874): The right hemisphere is directly related to perceptual processes and is an apparatus providing more direct, visual form of a relationship with the outside world. Right hemisphere Related to the analysis of the information that the subject receives from its own body and which is not associated with verbal - logical codes. The role of the right area of \u200b\u200bdirect consciousness.

* Upper Syndrome Secondary Areas - Disorders of the Body Scheme (left part) - somatoagnosia- the recognition of the recognition of their own parts of the body and the location of their friend is tactile

* The defeat of medium dark - one-sided spatial agnosia - ignoring the left side of the body.

* The defeat of the rear deep departments of the right n - left-sided fixed gemianopsy (violation of fields of vision).

* Apraxia dressing - Violations of the feelings of your body, parts seem either very large or disproportionately small.

* Constructive agnosia and apraxia (Tro-inability to assemble in a single whole) - Gnostic disorders. ? Simultan agnosia? (Balinte syndrome) - the dark-occipital departments. The patient correctly perceives only one image, since the volume of perception is narrowed, cannot perceive the whole, only parts. + Ataxia is a dislarous inconsistent eye movements.

* Violation of the recognition of objects with the defeat of the rear departments of the right hemisphere, the loss of their families. - facial agnosia- Do not recognize relatives. + Paragnose-uncontrolled guessing, when evaluating the object.

The functions of the right hemisphere include the overall perception of their identity - anosognosia - Do not notice them, not critical to your own defects.

* Deep changes in personality and consciousness - the perception of the situation as a whole becomes defective since there are no signals from the body, the phenomenon of disorientation in the world around the world, time, the confusion of the immediate consciousness, multi-clime and resonance (since verbal-logical processes are preserved).

Chapter 15 The highest mental functions and signs of their disorder. Some big brain lesions syndromes

15.1. General provisions

Among the numerous functions performed by the brain, a very important place is occupied by the implementation of higher mental activities, which has a particularly high level of development. The information entering the projection zones of the large brain cortex, its definite processing and the formation of sensations lead to the fact that in associative zones based on their analysis and synthesis, as well as comparison with the preceding life experiences extracted from the annals of memory, more complex categories are formed - concepts and the ideas necessary to understand the validity and formation of an adequate understanding of the situation and the implementation of mental processes.

Congenital abilities, gaming and labor skills, accumulating life experience provide the formation of higher mental functions (PF), manifested, in particular, high level of opportunity to knowledge and ability to commit complex motor acts, i.e. to development gnosis(from Greek gnosis - knowledge, recognition, subject perception) and praxis(from Greek. Praxis - action). The improvement of the Gnosis and Praxis led to the possibility of forming a new stage of the development of mental activity in a person. Speech, languagethey contributed to the development of abstract thinking - the highest achievement of nature that contributes to the fact that the person who mastered the speech was able to achieve an exceptional position among the living beings inhabiting land.

15.2. Functional Asymmetry Hemispheres of Big Brain

The doctrine of the inter-brave asymmetry takes the beginning from 1861, when the French doctor P. Broca (Broca P., 1824-1880) established the presence of a so-called Motor Center for Speech in the left hemisphere of the brain. Research of subsequent years has made it possible to create an idea of \u200b\u200bthe difference in the participation of the left and right hemispheres in mental activities. Hemisphere, from which the speech function primarily depends, began to be called dominant. Most people had left hemispera.

Understanding the functional differences between the role of the right and left hemispheres of the brain in the formation of a person's psyche contributed to the examination of patients undergoing operations: 1) prefortional leukotomy - the rest of the ways connecting the frontal semi-guns with subcortical formations developed in 1935 by E. Moniza (Moniz E. , 1874-1955) for the treatment of patients with affective psychosis and schizophrenia; 2) the dissection of the corn body - the splitting of the brain in order to treat epilepsy. In 1949, for the development of these operations, the Portuguese neurosurgeon E. Monets was awarded the Nobel Prize.

In the 60s of the XX century. Studies of the brain after commissioner spent a professor of psychology of the University of California (USA) R. Sperry (Sperry R.). He found that after the molding body dissection, the processes in each hemisphere proceed independently, as if two people were operating - each with their life experience. In each hemisphere, their functions are presented: in the left - speech, letter, account, in the right - perception of spatial relations and not differentiable identification. For these studies, R. Sirery in 1981 received the Nobel Prize.

A group of neuropsychologists led by A.R. has made a great contribution to the development of the problem of intermetrous asymmetry. Luria (1902-1977), working on the basis of neurosurgery them. N.N. Burdenko in the 50s-70s.

The functional asymmetry of the left and right hemispheres can be viewed as an evolutionary acquisition, reflecting the person achieved by the person extremely high levels of functional differentiation of its brain. According to one of the hypotheses with the advent of the incarnations of abstract thinking and speech in the distant ancestors of a modern man, these features took over the left hemisphere. In this regard, the right hand associated with the left hemisphere gradually became more active and at the same time strong and clever. Abstract thinking and speech, being in interdependence, gradually improved and acquired more importance to humans.

In the right of hemisphere, the function of specific thinking, perception and differentiation of non-sound sounds, music was obtained. It is believed that the right hemisphere has the advantages in ensuring self-consciousness, in the implementation of orientation in the external space, in recognizing people according to individual features of the person, voice, in the design of subject action.

In the formation of a functional asymmetry of cortical fields of a large brain in the process of ontogenesis and the subsequent development of the child, heredity is essential. It is recognized that the part of people, as a rule, has a peculiar rotation of mental functions and then the dominant can be the right hemisphere. However, in most cases, the asymmetry of the hemispheres are not so pronounced as the right-hander, while often the rapprochement of the functionality of the right and left hand is often noted, and in this case they speak about ambidextrics.

In practice, sometimes it is necessary to find out the right of the patient or left of the patient, and thus approximately determine which of its hemispheres should be recognized by dominant. Methods of such differentiation are several. It can be clarified which hand in a patient is stronger, on what hand the fingers of the brush are stronger and clever. The strength of the hands of hands can be checked by a cycular dynamometer. It should be checked what kind of hand the patient prefers to cut bread, light the match, etc. Contra-

the lateral dominant hemisphere The hand usually turns out to be from above, if the patient applauds, folds his hands on the chest ("in Napoleonic"). The thumb of this hand usually turns out to be from above, if you ask the patient to bring brushes so that the fingers of one of them are between the other fingers. On the side opposite to the dominant hemisphere, the so-called push foot is usually provided.

In 1981, N.N. Bragin and TA Dobrozova proposed the classification of functional asymmetries. Displays of motor activity The right and left half of the body in it is considered as motor asymmetry. The unequivocarcy of the perception of objects located on the right and to the left of the sagittal plane of the body is indicated as sensory asymmetry. Finally, the specialization of the right and left hemispheres of the brain in the implementation of various forms of mental activity is recognized asymmetry of mental functions.

In the process of development of PVF one of the hemispheres called dominant (usually left), specializes in providing abstract thinking and speech - functions characteristic of only a person. The left hemisphere, besides, turned out to be leading in the formation of the most complex abstract mental processes. The development of the right hemisphere creates opportunities to improve concrete thinking, capture and adequately evaluate the features of speech intonations, perceive and differentiate non-heine sounds, in particular sounds of music. Right hemisphere provides a common, visual and spatial perception (Table 15.1).

Table 15.1.Intermetal asymmetry

Some modern psychologists and physiologists (Batuev AB, 1991, etc.) believe that a person with the prevalence of leaf-haired functions to the theory has a greater vocabulary and actively enjoyed it, it is inherent in vital activity, purposefulness, the ability to predict events. "Relupported" man with specific types of activity, he is slow and closer, but endowed with the ability to finely feel

tweese and worry and prone to contemplation and memories. Normally, for most people, the two of these extreme manifestations of behavior and psyche is characterized.

There is an opinion (Kostandov E.A., 1983) and that a healthy person has complementary cooperation between both hemispheres and the advantage of the function of one of them is manifested only at a certain stage of this or that type of neuropsychic activity. It is noted that, apparently, the right hemisphere faster than the left, processes the incoming information. The visual-spatial analysis of incentives is first carried out in the right of the hemisphere, and then transmitted to the left, where the final highest, semantic analysis and the awareness of these incentives occurs.

Currently there are grounds for the generalization of accumulated information about intermetrack asymmetry and determining the value of this asymmetry for human mental activity. TA Dobrochova, N.N. Bragin et al. In 1998, on the basis of literary and own materials on this issue, they concluded that the brain asymmetry can be represented as a manifestation of its functional maturity. It increases in childhood, ensuring the normal mental development of the child, reaches a maximum of mature age, determining the effectiveness of his mental activity possible for this person, and is leveled at late age, which is manifested by a gradual decrease in mental productivity.

15.3. Violations of higher mental functions

The asymmetry of the functions of the hemispheres of the large brain leads to very significant features of the clinical picture in patients with the lesion of the left or right hemispheres of the big brain (Table 15.2). Knowledge of these features can contribute to clarifying a topical diagnosis.

Table 15.2.Features of violations of mental functions when defeating the left and right hemispheres of a large brain

Ending table. 15.2.

In case of violations of the development of a large brain or its defeat, the disorders of higher mental functions arise, in particular the Gnosis, Praxis and speech, and their implementation is largely determined by the peculiarities of the activities of certain associative zone of large brain. The defeat of these zones of the cortex leads to the development of options for violation of the gnosis, Praxis, speech, memory. These disorders are known as agnosia, apraxia, aphasia, amnesia.

15.3.1. Agnosia

Agnosia - Gnosis Disorder - Violations of understanding and recognition of items and phenomena arising from the disorder of the functions of higher Gnostic (cognitive) mechanisms that ensure the integration of elementary sensations, perceptions and the formation of integral images into consciousness. The term "agnosia" was introduced in 1881 by the German physiologist G. Munk (Munk H., 1839-1912).

Agnosia is multivariate, most of them are sensitive.

Sensitive agnosia - the impossibility of recognition and understanding of objects and phenomena based on individual sensations (non-hearing alarm, taste, tactile, visual, etc.) or their synthesis. Such forms of agnosia are usually associated with the defeat of the associative territories of the cortex nearby from the corresponding projection zones. They can be combined with orientation disorder in place and time.

The consequence of sensitive agnosia is disorders of complex sensitivity, in particular two-dimensional and three-dimensional-spatial feelings. These violations occur when damaged to the bark of the lower departments of the parietal lobe and manifest themselves in contralateral limbs.

Spatial agnosia - disorientation in the space or ignoring part of the surrounding space, usually its left half with a pathological focus in the right darken share. The patient at the same time reads the text only on the right half of the page, only the right side of the image syruits it.

Hearing, or acoustic, agnosia - a variant of sensitive agnosia, in which the disorder of recognition of audible sounds is manifested. In cases of impact of associative fields in the localization zone of the cortical end of the auditory analyzer in the dominant hemisphere, more often on the left, violated background - matter hearing, and in connection with this, an understanding of hearing speech. The defeat of similar cortical fields on the right leads to a violation of the possibility of recognizing non-chosen subject sounds. (rustling of foliage, murmur stream, etc.), learn and reproduce musical melodies (amusy), and the perception of the melody of hearing (including its own) speech, its timbre, is disturbed.

intonation, which ultimately can manifest violation of recognition of a familiar person "by voice" and lead to an inadequate assessment of audible statements, since the meaning of speech is determined not only by the composition of words, but also by the intonation with which they are pronounced.

Spectative agnosia - Disorder of the synthesis of individual visual sensations and in connection with this the inability or difficulty recognizing objects and their images with preserved eyesight. It is especially difficult to recognize the subject according to its conditional (contour, bar, fragmentary, etc.) of the image (Fig. 15.1), it is difficult, in particular, the recognition of the above contour images (Popper Pictures). The visual agnosia occurs when defeating the cortex of the grid and dark areas (fields 18, 19, 39). With visual agnosia, the patient is unable to draw a given object, since it has a holistic perception of its image (Fig. 15.2). Options of visual agnosia are visual-spatial agnosia, facial agnosia, apperpety and associative agnosia.

Spectator-spatial agnosia, or spatial apractagneous - Spectative agnosia, in which the patient is experiencing difficulties in the preparation of the idea of \u200b\u200bspatial relations between objects. This leads to a violation of the ability to differentiate the left and right, to errors in determining time on the clock of the clock, when working with a contour card, to violating the possibility of orientation on the terrain, the preparation of the plan of the room, etc., and the patients usually have signs of spatial apraxia. Arises when defeating the tertiary associative

Fig. 15.1.An example of an image of objects with intersecting circuits (Fig. Palmeter) used to identify visual agnosia.

Fig. 15.2.Detection of spatial agnosia.

and - the patients offered to the patient; B - Attempts to copy these drawings with patients with the defeat of the right parosk share, ignoring the left half of the space.

the zones of the dark-occurring sections of the cortex usually right hemispheres of the brain. Described the French neuropathologist P. Marie (1853-1940).

Facial agnosia (transpagnosis) - visual agnosia manifested unrecognition of individuals or portrait images (drawing, photography, etc.) acquaintances relatives or well-known people (Pushkin A.S., Tolstoy L.N., Gagarin Yu.A., etc.), and sometimes in photography or in the mirror the patient cannot recognize himself. At the same time, familiar people, he often recognizes clothes, vote. This is a sign of the defeat of the bark of the secondary associative zone in the right-hand of the dark-packen area. Described in 1937 H. Hoff and O. Petzel.

Apperpety Lisouera Agneosia - Option of visual agnosia. The patient can perceive simple figures, such as the ball, but it will not recognize complex images due to the limitation of visual perception, it recognizes only the individual signs (size, form, color, etc.). However, the synthesis of these elements, and therefore, and the recognition of the subject in general is not available. Entitled "Apperpety spiritual blindness" this form of ag-nucleation was described in 1898. H. Lissauer.

For associative visual agnosiasick with the help of vision, it perceives objects or their images, but not able to relate them to their former experiences, recognize and define their appointment. Patients are often confused with some kind of similarity objects or their images, such as glasses and a bike. It is very difficult to recognize the silhouette, stylized or contour drawings, especially in cases of imposing the last friend

on a friend (Popper Pictures). All these defects of visual perception are clearly manifested when the survey is carried out under conditions of time deficiency (0.25-0.5 C), recorded with a tachistoscope. Disease usually it is manifested in the defeat of the dark-occipital region of the right hemisphere of the brain. This form of visual agnosia described in 1898 N. Lissauer as an associative spiritual blindness. A.R. Luria (1973) believed that the basis of the syndrome is not optical agnosia, but rather paragneosis.

Syndrome Balinta- form of visual agnosia, manifested by the "psychic paralysis of the gaze", in which the patient cannot perceive simultaneously several substantive images at once. Frequently combined with apraffsis of the gaze. Sick it is not able to look at the specified direction, turn the eyes towards the object that produced in the peripheral part of the field of view. More often it is found in bilateral or right-sided ischemic foci in the thorough-occipital region. The insufficiency of "visual attention" is manifested by the inability to see two or smaller objects at the same time located at some distance from each other (simultaneous agnosia). If the subject turned out to be in sight, the patient sees it, but does not perceive everything else, while it is difficult for him to understand the architectonics visible, for example, seeing the cross, the patient cannot point out his center (crossroads), draw the clock clock, cannot perceive The situation as a whole, understand the storybook, etc. Balinte syndrome is usually combined with an optical attaccia - in an inability to indicate the subject or take it into hand controls due to disorientation in space. Sometimes the manifestations of aproxia are also noted. Described the syndrome in 1909. Hungarian psychoneurologist R. Balint (1874-1929). Usually it occurs when bilateral damage is predominantly the low-industrial-occipital region large hemispheres.

Somatoagnosia- Autotopagnosia, violation of the diagram of your body. Its options are anosognosia, finger agnosia. Somatoagnosia - violation of the perception of the image of your own body, which consists of early age on the basis of tactile, kinesthetic, visual and other sensations. The violation of the body scheme leads to inadequate perception of its own body, partial parts of which on the opposite pathological heart can seem modified in size and form (Metamorphopsy and its varieties - macro and micromorphopsy). Perhaps the feeling of superfluous (third) hands or feet (pseudopolimelia) or absence ("loss") of any part or the entire half of the body (anosognosia, the agnostic syndrome of Babinsky, Redlich syndrome), usually left, and can be considered as a variant of one-sided spatial agnosia. Somatoagnosia is observed when damaged to the bark of the parietal share (fields 30 and 40) is usually in the right hemisphere. When localizing the focus in a similar zone of the left hemisphere, mooring is 7 times less frequently. This pathology can be a sign of organic lesion of the thalamimen system (tumor, stroke, contusion center, etc.), it is usually combined with hemiparem, a severe general state. Somatoagnosia can be one of the manifestations of the delinealization and depersonalization in epilepsy, schizophrenia, etc.

Somatoagneosia option can be considered finger agnosia- Sensitive agnosia, at which the inability of the patient is manifested, to call and show the fingers of his hand on the task. It is usually noted with the damage to the dark-occipital region of the left hemisphere.

Apraqulica is a disorder of arbitrary targeted actions, motor skills when the components of their elementary movements are preserved.

Normally acquired motor skills depend on the previously generated movement schemes that are remembered and can reproduce under the relevant circumstances. Any conscious activity consists of stages. The first of them is the urge to action arising in the stimulating situation. Most people (in right-hander) encourage the action and inclusion of a previously learned scheme of the motor act and its implementation conjugate with the state of the left packer-temporal area, there is a connection with the left primestant zone controlling the movement of the right hand, and from there via a corrosive body with a motor zone of the right hemisphere controlling the movement of the left limbs. In this regard, the defeat of the median sections of the corpulent body leads to aproxia in the left limbs, the defeat of the same dark-temporal region can lead to a total apraxia (Fig. 15.3).

Fig. 15.3.The formation of apraxia in the left hand during the damage to the corpus body.

1 - bark of the left parietal lobe; 2 - pathological hearth; 3 - precentral shock, hand projection zone; 4 - Cortico spinal paths; 5 - peripheral motnelone in the neck thickening of the spinal cord.

Apraqulica can be detected when performing patients with certain motor acts (the patient should show how it enjoys a comb, toothbrush, etc., repeat the gestures of the doctor, to carry out certain simple actions on the verbal task). In 1900, at the proposal of H. Liepmann (1863-1925), they allocate an ideator, engine and constructive apaction. In the future, their other forms were also described. Especially significant in the study of aproxials and other disorders of higher mental functions recognized the work of the domestic neuropsychologist A.R. Luria and his schools.

Ideator apraxia or apraquession plancharacterized i can not create a plan of consecutive actions, required to perform an emerging previously complex motor act, while the patient is not able to correlate its actions. However, if such an action was urged earlier, it can be performed automatically due to the already established reflex mechanisms. Pathology is described by the German psychiatrist H. Lipmann as consequence of the defeat of the premotor zone of the bark of the frontal share of the dominant hemisphere big brain.

Ideomotor apraxia - apraxia at which violated action on the task (Squeeze a fist, light match, etc.), while these actions are performed correctly when performing automated motor acts acts. It is especially difficult for the patient to imitate action with missing items: to show how it is stamped in a glass of sugar, how to use a spoon, hammer, comb, etc. The disease is we follow the lesion of the crust of the premotor zone of the dominant hemisphere of the big brain. When localizing a pathological focus on the left of the right-hander, an ideomotor apraxia is bilateral. If the focus is localized in the right dark area or in the middle third of the corpulent body, the ideomotor apraxia is manifested only to the left.

Motor,or kinetic, apraxiacharacterized violation of the implementation of the motor act with the saved possibility of its planning,

in this case, impracticable and imitation actions, as well as on the task. However, the movements carried out fuzzy, awkward, often excessive, poorly coordinated. The patient cannot perform symbolic movements (pursue a finger, give honor, etc.). Sometimes this pathology is combined with motor aphasia and agraphic and it manifests itself more often in the right hand in the defeat of the lower departments of the left frontal-parietal area.The roar described in 1805 N. Liepmann (1863-1925).

Motor apraxia option is lobland Apraqual- consequence of violation of the possibility of programming and performing a sequential series of movements. Manifested by the disorder of their pace and smoothness, violation of the "kinetic melody", necessary for this purposeful action. There is a tendency to the motor tracing (repetition of the elements of the motor act or the entire movement), general muscle tension. The patient cannot dismiss a series of strong and weak rhythmic blows in a certain sequence, with a letter to repeat individual letters or their elements. Lobland Apraqulica - manifestation of the defeat of the prime region of the frontal share.

Constructive apraxia - apraxia at which it is difficult to place items in two-dimensional and three-dimensional spaces, in this case, the patient cannot be folded in the whole of parts, for example, a given figure from matches or mosaic, cubes, fold the drawing from its fragments, etc. Similar features

the patient's ties cannot be performed both on the task and as a result of the imitation. Usually occurs with the loss of ability to normal orientation in space in cases the lesions of the bark of the angular isputs, the region of the internally furrow and the adjacent sections of the occipital lobe.

Apraquess of dressing (Brain syndrome) - dressing disorder due to the fact that the patient confuses the side of the clothes, it is usually especially difficult to wear a left sleeve, left shoe. Apraquess dressing - option of constructive apraxia, wherein foci of defeat it is often localized in the right dark-occipital region. The syndrome described the English neurophysiologist W. Brain (born in 1885).

Kinesthetic, or afferent, apraxia - Manifestation defeasure of the cortex of the parietal region, adjacent to post-central urge, at the site of the opposite side of the body, projected by the nearest fragment of the rear central ispuncture, is accompanied by a disorder of subtle differentiated movements. It is a consequence of the deficit of information on the position of body parts in space (violation of reverse affamentation), which leads to the disorder of movements. During the period of active movement, the patient cannot control the course of its implementation, so the movement becomes uncertain, fuzzy, the movements that require considerable complexity are especially difficult. Kinesthetic apraxia includes elements of ideomotor and kinetic aprakssees. Kinesthetic (afferent) apriccia described in 1947 a domestic neuropsychologist A.R. Luria.

A variant of the kinesthetic apraxia is oral apraxia,the manifestation of muscle functions involved in the provision of speech, swallowing, leads to a violation of speech by the type of afferent motor aphasia.

Spatial apraxia - disorder of spatially oriented movements and actions. It manifests itself, for example, when simulating the movements of the doctor's hands, which is opposite the patient in Ged's samples (H. Head, 1861-1940).

Apraqulicity of the gaze- Lack of arbitrary movements of eyeballs on the parties while maintaining involuntary movements of the gaze. For example, the patient cannot turn the eye on the task, but watches eyes behind the moving subject.

Apraquess walkingcharacterized violation of walking in the absence of motor, proprioceptive, vestibular disorders, it is observed in the defeat of the bark of the frontal fraction (premotor region).

15.3.3. Afani.

Afaja (from Greek. A - denial + Phasis - speech) - generalizing the designation of speech disorders arising from people with a preserved articulator and sufficient hearing, in which partially or completely loses the opportunity to actively use the speech to express thoughts and feelings or (and) to understand the audience. In attachment, the grammatical and lexical structure of speech is disturbed. The term "Afazia" introduced in 1864 the French doctor A. Trusso (Trusseau A., 1801-1867).

The purposeful study of the speech function began in the second half of the XIX century. In 1861 P. Broca (Broca P.) described a violation of the ability to speak, arising from the defeat of the rear departments of the third frontal gingerbread (center

Brock). In 1873, K. Vernika (Wernicke K.) found that with a violation of the functions of the rear third of the upper temporal winding (center of the Wernik), the understanding of speech was broken. The first of the modes mentioned forms of the speech disorder was the name of the motor (efferent, expressive) aphasia, the second - sensory (afferent, impressive). At the same time, it was noted that aphasias usually arise in the pathological process in the left hemisphere of the brain, which is the leading (dominant) in most people-right-handers. In the same hemisfer, in the future, in 1914, sections of the bark were described, the defeat of which leads to the electoral violation of reading - Alexia (the corner of the parietal lobe) (Dejerine JJ, 1914) and letters - Agrafy (the rear departments of the middle headquarters) (Exner s ., 1881).

In 1874, the German doctor K. Wernicke (Wernicke K., 1840-1905) and in 1885, the Swiss doctor L. Lichtheim (Lichtheim L., 1845-1928) proposed an amphazy classification that was recognized as classical. The authors sought to reflect the possible features of aphasia in it, found in cases of lesions of various zones of the dominant hemisphere. They were allocated 7 forms of aphasia, of which 2 main: Cork motor and sensory. The remaining 5 forms of Afapa were considered as a consequence of violation of links between brocade centers and Wernik (conductor apartments), between these centers and the hypothetical center of concepts (transcortic motor and sensory amphius) and the defeat of the projection fibers, which are attributed to the main speech centers: subcortic motor and sensory amphias .

In 1908, K. Wilson (Wilson K.) and in 1913, Lipmann (Liepmann H., 1863- 1925) were considered the main forms of Afani as peculiar options for Apraquest and agnosia, which met serious objections. H. Jackson (Jackson JH, 1834-1911), who focused a lot of attention to the highest mental functions and methods of their research, and for the diseases of the brain, came to the conviction that the will, memory, thinking, are elements of consciousness and cannot be localized on Some kind of brain area. He was the first among neurologists who proclaimed a dynamic approach to the emergence of his defeat. The city of Hed (Haed H.) was adhered to such a point of view, which proposed to consider the violations of speech, relying primarily on the achievements of linguistics. Like H. Jackson, he denied the opportunity to associate those or other features of speech function with certain parts of the brain. They were allocated 4 forms of Afani: verbal, nominative, syntactic and semantic.

In the 60-70s of the XX century. A.R. Luria has developed an aphasian classification based on the results of the synthesis of morphological, syndromological and linguistic concepts. The classification was formed in the process of constant communication with neurosurgical patients and, thus, a clinical testing was held. A.R. Luria highlighted 3 forms of impaired expressive speech (motor aphasia): afferent (kinesthetic), efferent (kinetic) and dynamic, as well as 2 forms of imperative speech: sensory and semantic aphasia; In addition, he recognized the existence of amnesian aphasia.

Afferent motor Alfa arises in case of damage to the central departments of the dominant hemisphere (the lower part of the cortical fields 1, 2, 5, 7, partially 40), receiving information from the proprigororeceptors of the spectamial apparatus and providing the ricesthetic framework of articulation. With the defeat of the specified brain department, there is a violation of coordination

the work of the muscles involved in the formation of speech, and errors appear when pronouncing individual speech sounds, first of all homorgans, i.e. with similar phonetic features (for example, advanced "T", "D", "H"; slotted "sh", "Shk", "s", "x"; lip "p", "b", "m").

In this regard, an expressive speech is unbearable, it arises numerous sound replacements, which makes it incomprehensible to others, the very same patient is not able to control it due to a peculiar sensative attack in structures that ensure the formation of speech. The afferent motor aphasia is usually combined with oral (pebnaya-tale) apraxia (inability to reproduce in the task of movement with tongue and lips, which require considerable accuracy - to place the language between the upper lip and teeth, etc.) and is characterized by a violation of all types of speech products ( Speech spontaneous, automated, re-, name). Detailed information about afferent motor aphasia is represented in the monograph E.N. Vinar (1971).

Efferent motor aphasia - Corollary damage to the lower departments of the premotor zone in the rear of the lower frontal windows (brocade zone: cortical fields 44 and 45). The articulation of individual sounds is possible, however, switching from one speech unit to another is difficult. Speech of the patient slowed down, he is a few, there is a bad articulation, requiring significant efforts from it, speech is replete with numerous literal and verbal persversions (repetitions), what manifests itself, for example, disorder of the ability to alternate individual syllables (ma-pa-ma-pa). Because of the passing of auxiliary words and the case endings, the speech sometimes becomes "telegraph". With pronounced manifestations of this form of Afapa, it is possible formation of patients with "speech empoles" - the repetition of some words (often faded), which the patient welcomes "not to the place", while transmitting his attitude towards the situation with this. Sometimes the patient can repeat after the examination separate wordsHowever, it cannot repeat the phrase, especially unusual, deprived of meaning. Nominative speech function (calling objects), active reading and writing is violated. At the same time, a relatively preserved understanding of oral and written speech. The fragmentation of the fragmentary automated speech, singing (the patient may knock the melody).

Patients tend to realize the presence of speech disorder and sometimes they are seriously experiencing the presence of this defect, showing a tendency to depression. With the efferent Motor Afahana Brock on the side of the subdominant hemisphere usually there is hemiparesis, in this case, the severity of the pan is more significant in hand and on the face (on Brachiofacial type).

Dynamic Motor Athazia arises with the damage to the prefrontal region of the Kepened from the Brock zones (fields 9, 10, 11, 46), is characterized by a decrease in speech activity, initiatives. The reproductive less suffer significantly less (repetition after the examining words, phrases) and automated speech. The patient is able to articulate all the sounds, pronounce words, but it has been reduced to speech motivation. This is particularly clearly manifested in spontaneous narrative speech. Patients, as it were, reluctantly enter into speech contact, they are simplified with them, reduced, depleting due to difficulty maintenance in the process of speech communication of a sufficient level of mental activity. Activation of speech in such cases is possible by stimulating influence on the patient, in particular conversation on the topic,

having a high degree of personal significance for the patient. This form of amphias is described A.R. Luria. It can be explained as a consequence of reducing the effects on the cortical structures by the activating systems of the reticular formation of oral sections of the brain stem.

Sensory aphasia, or acoustic-Gnostic Afazy, arises if the zone is damaged by the Wernik, located next to the cortical end of the auditory analyzer in the back of the upper temporal winding (field 22). At the heart of sensory amphias - speech recognition disorder in general sound stream due to violation of phonderatic hearing (Phone units, with which its components are differentiated and identified, and its components are differentiated; in Russian speech, in particular, the belling and deafness, impact and impacting), and there is a violation of sound and alphabetic analysis and the alienation of the meaning of words.

When sensory aphasia is lost and the ability to repeat words. The patient cannot correctly call familiar items. Along with violation of the oral speech of the patient, the ability to understand the speech in writing, to reading. In connection with the disorder of the phonderatic hearing, the patient with sensory aphasia makes mistakes when writing, especially when writing a dictation, while first of all the replacement of letters reflecting shock and unstressed, solid and soft sounds. As a result, his own written speech of the patient, as well as oral, seems meaningless, but the handwriting can be unchanged.

In the typical, isolated sensory amphiasis of the manifestation of hemiparesis on the side opposite to the dominant hemisphere, may be absent or being weakly pronounced. but uppervadrant hemianopsy is possible due to the involvement in the pathological process, passing through the temporal share of the brain, the lower part of the visual radiation (a bunch of Graciole).

Semantic Afaja arises in case of damage to the bottom dark slices (fields 39 and 40). It is manifested by the difficulties of understanding any complex on the construction of phrases, comparisons, return and attribute logic-grammatical revolutions expressing spatial relations. Sick does not focus in the semantic value of prepositions, adverbs, endings: under, above, before, for, above, bottom, lighter, darker, etc. It is difficult for him to understand how phrases differ: "The sun is illuminated by the earth" and "the earth is illuminated by the Sun", "Brother Father" and "Father Brother", give the right answer to the question: "If

Vanya goes after Petya, then who goes ahead? ", Draw a triangle in a circle on the instructions in a circle, cross over square, etc.

Amnesian (anomic) Afaja it is observed in damage to the rear departments of the dark and the temporal fraction of the left hemisphere, mainly the angular winding (fields 37 and 40), and manifests itself in the inability to call items; At the same time, the patient can correctly speak about their purpose (for example, when the surveyer asks to call the demonstrated pencil, the patient declares: "Well, this is what they write," and usually seeks to show how it is done). Tip helps him remember the necessary word denoting the name of the subject, while it can repeat this word. In the speech of the patient with amnesian aphasia, there are few nouns and many verbs, while the active speech is running, the understanding of both oral and written speech is preserved. The accompanying hemipreps on the side of the subdominant hemisphere is uncharacter.

Total Ampazia - the combination of motor and sensory aphasia: the patient does not understand the speech addressed to him and at the same time turns out to be unable to actively pronounce words and phrases. It develops more often in extensive brain infarches in the left medium cerebral artery basin and is usually combined with severe hemiparesis on the side of the subdominant hemisphere.

One of the leading modern aphaziologists M. Crichley (Critchley M., 1974) proposed to take into account often found in the manifestation clinic minimal dysfassiumor preaffatiain which the speech defect is manifested so easy that during the usual conversation it can remain unnoticed for both the speaker and for his interlocutor. Preaffatia is possible both with increasing brain pathology (atherosclerotic encephalopathy, brain tumor, etc.), and in the process of restoring disturbed functions after stroke, brain injury, etc. (residual dysfassium). Its identification requires particularly thorough research. She is it can manifest itself in the form of speech inertness, aspontaneity, impulsivity, reduce the ability to quickly and easily select the necessary words, the use of predominantly words encountered in the patient's dictionary with a high frequency. More rare words are remembered with difficulty and with delay and the patient often replaces them more often, albeit with the words less suitable in this context. In the speech of patients become abundant "beaten" words and phrases, speech "stamps", familiar speech turnover. Not finding the exact words and phrases in time, the patient seeks to substitute words ("Well, here is this thing as her") and thus compensate for the insufficiency of the quality of their speech by excessive amounts of speech products, and therefore there is an emergency multi-abscomise. If the individual tasks at the same time the patient performs correctly, then the exercise of the serial task (for example, the index finger of the right hand touch the bridges, the left hand to take themselves for the right ear and close the left eye) difficult. The verbally presented material of the patient unsuccessfully interpreted and inaccurately repeats, difficulties arise when explaining the meaning of such generally accepted expressions and proverbs, as "golden hands", "take a bull for the horns", "in the still waters of devils are found," etc. Difficulties are possible when transferring objects relating to a specific class (animals, colors, etc.). Speech disorders are often detected when drawing up a sick oral or written story on the picture or on a given topic. In addition to other difficulties, in the process of communication with the patient, the uncertainty of perception of verbal task may be noted and due to this slowness of reactions to it.

Methods of identification of aphasia. In order to identify the aphasia, expressive speech is checked: spontaneous speech (the participation of the patient in a dialogue, the ability to give specific answers to questions), an automated speech (transfer of the seasons, days of the week, months, etc.), the calling of objects and their images, re-speech - Repeat after the exams surveying, slut, explosive, advanced, lifting-lingual consonants and sounding, having a different phonetic basis: "B-P", "T-D", "Mr.", "Pa-Ba", "Yesa", "TO-TO"), repetition simple words ("Table", "Forest", "Thunder"), more difficult words ("Constitution", "shipwreck"), various phrases, patches ("Clara stole corals", "Thirty-Third Artillery Brigade", etc. .). When checking an impressive speech, it should be verified in understanding the sick meaning of individual words and phrases (it should show the subjects called the subjects, parts of the body, images in the pictures, explain the difference between sounding like sounding words, for example, "baking-kidney-daughter"). Also checked understanding of patients of simple and more complex tasks: touch the left hand of the right ear, knock on the table three times. To check the phhematic hearing, the ability of the patient to distinguish between the close phonons ("sa-for", "yes-ta") is revealed, an understanding of the meaning of phrases with a complicated logic-grammatical structure similar to those given in paragraph of semantic aphasia is checked.

Aphias can be combined with another neuropsychological and focal non-vcrological symptoms: Alexia, Agrafia, Akalkulia, Apraxia, Agnosia, Dysarthria, Speech Akinesome, Afonia, signs of pyramidal insufficiency. Therefore, to determine the topical and nosological diagnosis, it usually arises the need for a complete neurological and neuropsychological examination of the patient, and if necessary and additional studies (neurophysiological, radiological, etc.).

In the diagnosis of aphasia, the level of intellectual development of the patient should be taken into account, the condition of its hearing, the general condition and the level of consciousness during the survey period. It is possible to differentiate the manifestations of Afia from dysarthria, Afony, Mutism, Alalia. It should be borne in mind that the nature of speech may vary with the development of dementia and various forms of mental pathology and has in these cases features that distinguish it from Afani.

Afaja is usually combined with reading violations (Alexy) and letters (aggrants), whereas with Afony and dysarthritia they are uncharacteristic. The patient in such cases can usually write and read, while in the first case there is a voicedness of the voice, in the second there is a definition of pronunciation, but the patient has no violations of understanding of speech to him and reading "to itself" corresponds to the level of intellectual development and The general condition of the patient.

It should also be noted that the dysarthria that manifests itself only with the dysfunction of the spectional apparatus is possible in the defeat of various levels of the brain. With damage to the cortex of a presenter winding of a dominant hemisphere is possible cork dysarthria characterized by phonetic and articulation disorders.

15.3.4. Alexia

Alexia- Acquired reading disorder, which in most cases can be considered as a consequence of aphasia. With relatively light manifestations of Afaja, reading is possible, but at the same time there are missions and

perestovka letters (literal paraciaxia), skipping and change of words (verbal paraciaxia), misunderstanding. In severe cases of aphasia, reading both aloud and it becomes impossible.

Alexia, in combination with the agrafic, in the absence of a afatic disorders, may be a consequence of one of the options for visual agnosia, known as alphabetic agnosia. It occurs when damaged to the bark of the back of the angular winding of the parietal lobe (field 39) of the dominant hemisphere, at the same time, the patient when reading and writing does not recognize the letter or is mistaken with differentiation of the letters similar to drawing (I-N-P, 3rd, sh-sh, etc.). There is also a disorder of adequate perception of numbers, music signs. This form of pathology is known as optical, or parietal, aphasia. Described it in 1919. Austrian psychiatrist O. Petzl (Potzl O., 1877-1962).

Alexia is extremely rarely found, in which the pathological hearth is in the cortex of the medial part of the occipital share and in the roller of the corn body. Alexia in such cases is accompanied by right-sided hemianopsy and agnosia on colors.

15.3.5. Agrafy

Agrafy - acquired violation of the ability to write correctly in form and meaning while the necessary motor functions required for this.

It is usually combined with aphasia (except for cases of alphabetic agnosia) and Alexia. With the pronounced manifestations of Afapa, the patient is not at all able to write, in lighter - the letter is possible, but the literal and verbal paragraphs are revealed, which manifest themselves with replacement, passes, permutations of letters and words. Sometimes, usually, with the defeat of the rear sections of the middle frontal windows of the left hemisphere (field 6), isolated agrafic.

15.3.6. Akalkulia

Under the defeat of the rear departments of the dark-temporal area of \u200b\u200bthe dominant hemisphere, Akalkulia is possible - a violation of the ability to conduct counting operations, especially based on internal spatial circuits, in particular the operating of multi-valued numbers in which the value of each figure is determined by its discharge. Akalkulia is often combined with semantic aphasia and optical alexia. Described the Swedish pathologist F. Henshchen (F. Henschen, born in 1881).

15.3.7. Amnesia

Memory is a complex mental process characterized by fixation, fixing (consolidation), maintaining and subsequently extracting and reproducing unconscious information and perceptions that occur on it, representations, thoughts. The memory provides the ability to accumulate experience, knowledge, contributes to an understanding of newly incoming information by comparing it with previously acquired information. It allows you to place all events along the time axis.

The types of memory are different: short-term (operational, fixing) and long-term, mechanical and logical (meaning), arbitrary and emotional.

Memory Disorder - Hymnezia or Amnesia (Greek. Amnesia - forgetfulness, memory loss) - a violation of one or another level of the process, referred to as the memory, or all the components of its elements.

It manifests itself in particular in Corsakovsky syndrome, described in 1889 S.S. Korsakov in patients with alcoholism. At the same time, the syndrome, as written by S.S. Korsakov, "The memory of the recent is almost extremely upset, whereas the impressions are remembered quite well." Current information in such cases is usually preserved within 2 minutes, after which "erased".

Violations of preserving the previously learned information or recall, extract, as well as the senses of time and the order of the past events associated with this rafament (replacement of memory failures in fiction, which is perceived by the patient as a probable fact), paramnezia (generalized name of false memories and memory failures).

Amnesia usually occurs with the damage to the mediobal \u200b\u200bsections of the hemispheres of a large brain, especially Paragipocampia and other structures that make up a hippocampus circle, or a Circle of a Papita, also including the brain arch, the medial structures of the Talamus and the deputyid body. Understanding how information can be saved in memory and extract it, has not yet been achieved. It is assumed that the place of long-term storage of information are protein brain cell molecules, possibly gliya cells, most likely astrocytes.

Global memory disorders have modally-nonspecific character. Modally-specific forms of amnesia are possible. The main ones are visual (figurative, iconic) and hearing amonesia, with the first of them in the patient there is an impossibility of presenting a visual image of a person or subject, with the second - to save sounds, intonation, melody in memory.

Variants of memory violations are retrograd and antegradine amnesia, more often manifested after the crank-brain injury. Retrograde is an amnesia preceding the event, antegrade amnesia - a disorder of memory, manifested after the event. An event that causes these disorders is usually ancient brain injury accompanied by loss of consciousness. Anterograde amnesia is a combination of retro and antegradine forms of memory violation. Episodic (periodic) amnesia is also possible.

Chronic, the progressive disorder of memory can be combined with the manifestations of dementia. Such a combination is characteristic of toxic and discharge encephalopathy, presets and senile psychosis, in particular with Alzheimer and Peak diseases (see chapter 26).

15.3.8. Other disorders of higher mental functions

It should be noted that violations of higher mental functions are possible not only when the bark of the big brain is damaged. They may be a consequence of a reduction in the level of consciousness arising, in particular, when defeating

the core of the large hemispheres of the structures of the reticular formation at the level of the middle brain and their bonds with the bark passing through the paraventricular departments of the brain and its white substance. Disorders of these structures underlie the syndrome of akinetic mutism, dynamic aphasia, vegetative state.

The reason for the reduction in the level of consciousness, and at the same time the narrowing of the circle of interests, the disorders of intellectual-e-functional functions and motor activity may not only be the primary damage to the nervous system, but the somatic diseases of the somatic diseases, general infections, metabolic disorders, endogenous and Exogenous intoxication.

15.4. Large brain lesion syndromes 15.4.1. Signs of the defeat of the frontal share

Opnimy syndrome can be a consequence of the disorder of many mechanisms involved in the formation of behavioral and higher mental functions.

Under the defeat of the premotor region of the frontal fraction, pathological inertia, passivity, hypocinezia is characteristic. With a more massive damage to inert, mechanisms responsible for the formation of a program of action becomes. This leads to the replacement of complex motor acts on simplified, "field" forms of behavior or inert stereotypes, often combined with "foxes" (the feet are put on one line, "track in the trail") or with elements of the frontal ataxia - ataxia Bruuna (German neuropathologist BRUNS L., 1858-1916), Astazia-ASBAZY - symptom block (Franczu Neuropathologist BLOQ P., 1860-1096). Sometimes, with a frontal syndrome, a tendency to deviate the body appears during walking, which leads to the patient's instability and can lead to its fall - symptom Henner (Czech neuropathologist Henner K., 1895-1967).

The preferential defeat of the basal departments and the poles of the frontal share is accompanied by a disorder of attention, deficientity, can manifest itself with asocial actions.

In front of the frontal syndrome, the disorders of active perception, abstract thinking, switching from one type of action to another, and ordinary persevers - Repeat actions (polycinesia), when talking, the repetition of the same words, when writing - words or individual letters in the word, sometimes separate elements of the letter. In such cases, in response to a task to catch up with rhythm, for example, "strongly weakly - weakly", the patient carries out a series of uniform intensity of the tapping. Usually there is a decrease in criticism for its state - campbell syndrome (Austrian neuropathologist Campbell A. 1868-1937) and behavior, which are mainly determined by biological motivation.

The disorder of active perception leads to the fact that the patient judges what is happening impulsively, by random features, cannot differentiate the perceived information, to allocate the main link from it. It is difficult for him from a homogeneous background to highlight the specified figure, for example on chess

blackcraft black cross with a white center (test "Alon, 1923), to understand the content of a complex plot pattern, whose assessment requires active analysis and comparison of parts, creating hypotheses and their checks. The pathological process in the dominant hemisphere in the Brock area (fields 44, 45 ) usually leads to development afferent motor aphasia the lesion of the left premotor region can determine dynamic aphasia or phonetic-articulation disorders (cortical dysarthria). If the front part of the belt is stirred, speech aucinezia, dysphony, which in the recovery period is usually replaced by a whisper, and in the further hoarse speech.

In the event of a lesion of a frontal share on the opposite pathological spot, the party usually manifests itself grass Reflex Yanistevsky-Behetere (Yanishevsky A.E., born in 1873; V.M. Bekhterev, 1857-1927) - grasp and retention of the subject, which produces barn irritation of the skin of the palm at the base of the fingers. The tonic extension of the fingers is possible both on the foot with a stroke of her irritation - grasping symptom German (Polish neuropathologist Herman E.). Can also be positive symptoms of oral automatism. The combination of grabbing reflex and manifestations of oral automatism is known as symptom Stern. (German neuropathologist Stern K.). Sometimes a grabbing reflex is so pronounced that the patient has an involuntary desire to set the objects located at a distance and in sight - - symptom Schuster (German neuropathologist Schuster W., born in 1931). In front of the frontal syndrome, articular is usually caused reflexes Mayer and Lerie, bobbin reflex (Romanian neuropathologist Botez J., 1892-1953) - In response to barn irritation of the palm surface of the suspensed brush in the direction from the hypothenary to the base thumb There is a tonic flexion of the fingers, an increase in the progress of the palm and a small brush alignment; opported symptom Barre (French neuropathologist Barre J., 1880-1956) - Long-term frozen of the patient's hand in the situation she was given, even if this position is unnatural and inconvenient. Sometimes there is a tendency to the patient to frequent touchs to the nose resembling its wiping, - symptom Duffe. A sign of the defeat of a frontal share is the femur symptom Raslinsky (Domestic neuropathologist Razdolsky I.Ya., 1890-1962) - involuntary flexion and disgrace of the hip in response to the skin of the front surface of the thigh, as well as when tapping the hammer on the iliac row or on the front surface of the lower leg. On the side opposite to the affected hemisphere of the brain, the weakness of the mimic muscles is possible, more distincting at the bottom of the person - symptom Vincent (American doctor VENSENT R., Rod. In 1906), it is possible to note the unproficivity of arbitrary faithful movements with the preserved involuntary facial express symptom Monrada Crohn.

Under the lesions of the cortical center of the view, usually localized in the rear sections of the middle frontal windows (fields 6, 8), and sometimes with a pathological focus, quite distant from these sections of the cortex, there is a turn of the gaze in the horizontal direction, while in the sharpest period (epileptic seizure , stroke, trauma) The eye can be rotated in stronment of the pathological focus, in the future - usually in the opposite direction - symptom narrow (Swiss doctor PREVOST J., 1838-1927).

Two main variants of the frontal syndrome: apatico-abulic syndrome and binding psychomotor dismissal syndrome.

Apatico-abulic (apathy and bravery) syndrome it is characteristic of damage to the cell body, especially with the frontal-cell localization of the pathological process. (Bristow Syndrome,described by the English neuropathologist Bristowe J., 1823-1895). The apatico-abutic syndrome is a combination of passivity, misinterpretation and Abulia (bravery, indifference, which can only be partially overcome under the influence of intensive external incentives that have greater personal significance for the patient). Characteristic for the frontal-cell triad syndrome: Aspontaneity, Adina and Abulia - is known as sereysky syndrome,since the domestic psychiatrist M.Ya. Seryan (1885-1957).

Lyful mental dismissal syndrome, or brones-Yast-Riottsa syndrome (German neuropathologists BRUNS L., 1858-1916, and JasroWitz P.) is characterized primarily by excessive distribution of the patient, which in its actions is guided mainly by biological motivations, ignoring ethical and aesthetic norms. Characteristic, flat jokes, calabura and sharpness, carefit, carelessness, euphoria, loss of feelings of a distance in communicating with others, ridiculous actions, sometimes aggressiveness aimed at implementing biological needs. It is more often noted with the defeat of the basal departments and the poles of the brain. It may be due to the consequence of the meningioma of the anterior cranial (olfactory) fossa or the clay tumor of the front sections of the frontal fractions, as well as their contusion during crank-brain injury.

With the defeat of the frontal fractions in patients in serious condition, it is possible parajector or symptom Jacob (Described in 1923 German neuropathologist A. Jakob, 1884-1931), in which complex automated gestures arise, externally resembling targeted actions: picking up, rubbing, stroking, patting, etc. Under the central hemiplegia, parajecthes may occur on the side of the pathological focus, which is especially characteristic of the acute stage of the stroke, when parajection can be combined with hinking, psychomotor excitation, which is especially characteristic of parenchymathous-intraventric hemorrhage.

15.4.2. Signs of dumping liabilities

The defeat of the post-central isply is manifested by the sensitivity disorders in the corresponding part of the opposite half of the body. In case of irritation by a pathological source, for example, an extracerebral tumor, more often by meningooma, a sector of a post-central winding cortex in the corresponding part of the opposite half of the body usually appear paresthesias manifested in shape sensitive local epileptic jackson type paroxysms.

The lesion of the central winding causes in the corresponding part of the opposite half of the body of the hypalheses zone, and the propriceceptive sensitivity is usually disturbed to a greater extent. The latter circumstance may be the cause of the afferent pare, due to the disorder of impulsation receipt, ensuring reverse affamentation. As a result, in the zone of a deep sensitivity, the awkwardness of movements appears, which partly can be compensated by visual control over them.

If the function of the upper dark lolk (fields 7 and 5) is broken (fields 7 and 5), the so-called is possible dark paresis, for which the weakness in the opposite half of the body is characteristic or mainly in a more limited part of it - in hand (with damage to field 7) or in the leg (in cases of field damage 5), the Mimic muscles of parieta does not apply. It is characteristic that muscle weakness is primarily expressed in the distal part of the limb, the tone of the parethous muscles is somewhat reduced, tendon reflexes on the side side are not changed or somewhat increased, pathological pyramid signs are not detected. In the paretic part of the body, slowness and awkwardness of movements are possible, sometimes the ataxiasis of the postax is clearly manifested - the patient is not able to copy the paretic limb of motion, which demonstrates the doctor who has been in front of it. In the domestic literature of parietal paresis described in 1951, the neuropathologist L.O. Crested.

Dark paresis in combination with hemigipalgesia and a deep sensitivity impaired (mainly tactile and proprioceptive) in the parethic part of the body, as well as with a sensitive attack and apraxia on the side opposite to the pathological hearth, known as syndrome of the top Dark Solk Tom (French neuropathologist Tomas A. 1867-1953).

Under the defeat of other sections of the cortex of the parietal region, there is a dark touch syndrome, also known as syndrome Belite-Dezerina Museon (French doctors Verger M., born in 1915; Dejerine J., 1849-1917; as well as Mouzon P.). It is determined by the defeat of the associative zones of disorder of complex types of sensitivity: feelings of position, localization, tactile discrimination (detected at tuberga's sample)two-dimensional and three-dimensional spatial feeling (stereogen).

Lower Dilk Syndrome, or Krapfu-Kurtis Syndrome (Ameritian psychiatrist KRAPF E. and German doctor Curtis F., Rod. 1896), - Distribution of a three-dimensional-spatial feeling (asterognosis, described in 1894 German neurologist Wernicke K., 1840-1905), spatial and a constructive apraxia, a violation of the body scheme, and during the localization of the pathological focus on the left - the finger of agnosia, also the manifestations of amnesic and semantic aphasia, Alexia and the Agrafy in connection with the development of alphabetic agnosia.

The lesion in the left hemisphere adjacent to the lower part of the post-central winding of the structures of the lower dark slices, which are included in the composition of the neutral overhang may determine oral apriccia and the conjugate speech disorder according to the type of affective motor aphasia, due to the violation of the kinesthetic framework of the movements of the articulation apparatus.

With the pathological focus on the right possible ignoring the left half of the body and the surrounding space, the feeling of extra limbs (pseudo), the feeling of deformation and changes in the size of the left hands and legs, the conviction in the presence of the left of the additional limbs - lenza syndrome (German psychiatrist Lenz H., born in 1912).

Sometimes an autotopognosia occurs during the damage to the parietal share, in particular, the lack of protective reactions in response to pain stimuli - - schilder Scholydr Syndrome (American doctor Schilder P., 1886-1940, and STENGL K.).

In cases of damage to the dark-occipital region of the crust of the right hemisphere, it is possible apraktagnicity syndrome Ekaen (described in

1956 English Doctor Hecaen H.), which is a combination of left-sided spatial agnosia, autotopognosia, apractical disorders, in particular apriction of dressing due to a violation of topographic representations and concepts.

The damage to the cortex of the dark-temporal area of \u200b\u200bthe left hemisphere can determine the combination of sensory aphasia, alphabetic agnosia and Akalkulia - bianchi syndrome (Italian Psychiatrist Bianchi L., 1848-1927). Under the defeat of the dark-occipital region of the dominant hemisphere, an alphabetic agnosia, leading to Alexia and Agrafy, elements of amnistical aphasia, finger agnosia, and possibly hemianopsy - syndrome Dezharda (French neuropathologist Dejerine J., 1849-1917).

In case of irritation of the operence zone and the island of the Raily are characterized by involuntary chewing movements, combusting, licking, swallowing movements (Operating syndrome).

15.4.3. Signs of lesion of temporal lobe

The lesion of the temporal share of the dominant hemisphere is usually he leads to speech agnosia and a speech disorder according to the type of sensory aphasia, combined with Alexia and Agraphia, are less likely to show the manifestations of semantic aphasia. With the defeat of the rear sections of the temporal share, alphabetic agnosia is possible and caused by Alexia and Agrafy without aphasia, which are often combined with Akalkulia. The defeat of the right temporal share can be accompanied by a disorder of differentiation of non-heine sounds, in particular amusy. In such cases right-haired pathology sometimes leads to a disorder of adequate assessment of speech intonations facing patient speech. He understands words, but does not catch their emotional color, which usually reflects the mood of the speaker. In this regard, the joke or the affectionate tonality of speech facing patients are not captured. The result may be inadequate from its side of the reaction to the above.

When irritating the temporal share can be hearing, olfactory, taste, sometimes visual hallucinations, which are usually aura of seizures characteristic of temporal epilepsy. Temple epilepsy can manifest itself in the form of mental equivalents, periods of outpatient automatism, metamorphopsy - distorted perception of the size and shape of the surrounding items, in particular, microfotopsy macroles, in which all surrounding items are too large or unnaturally small, as well as the state of the delaimalization, in which the patient turns out to be a change in reality. An unfamiliar situation is perceived as a familiar, already visible (Deja Vu), already experienced (Deja Vecu), known - as an unknown, never seen (Jamais Vu), etc. In case of temporal epilepsy, severe vegetative disorders, inadequate emotional reactions, progressive personality changes, while epileptogenic focus is more often located in the medial structures of the temporal share.

The bilateral damage to the medobased sections of the temporal share, which are part of the Hippocampian circle, is usually accompanied by memory violations, first of all the memory for current events, similar to amnesia during Corsakov syndrome.

When the localization of the pathological foculation in the deep departments of the temporal share on the opposite side, the supervisage gomonimnaya congruent (symmetric) hemianopsy arises, conducted by the defeat of the visual radiation. During the defeat of the susceptible part of the almond body located in the depths of the susceptible divisions of the almond changes in emotional and mental spheres, vegetative disorders - an increase in blood pressure.

Famous in the literature clever-Bewsi Syndrome(inability to identify objects through vision or feeling and the desire arising with their mouths in combination with emotional disorders) was described in 1938 by American researchers - the neuropathologist H. Kluver and the neurosurgeon P. Bucy, who observed this pathology in the experiment on monkeys After removal from both sides of the medobased departments of temporal fractions. In the conditions of the clinic, this syndrome has not yet seen.

15.4.4. Signs of the defeat of the occipital share

The occipital proportion provides mainly visual sensations and perceptions. An irritation of the cortex of the medial surface of the occipital lobe causes photopsy in opposite half of the fields. Photopsy can be a manifestation of the visual aura, indicating the likely occipital localization of epileptogenic focus. In addition, the cause of photopsy can be the manifestation of pronounced angiodistonia in the cortical branch branches of the rear brain artery in the debut of the attack of ophthalmic (classical) migraine.

Destructive changes in one of the occipital shares lead to a complete or partial gomonimmable congruent hemianopsy on the opposite side,

at the same time, the defeat of the upper lip of the spur groove is manifested by the Lowerwender Gemian Pension, and the development of the pathological process in the lower lip of the same furrow leads to Verkhnekvaadrant Gemianopia. It is necessary to pay attention to the fact that even complete (edged) gomonimary hemianopsy is usually accompanied by the safety of central vision.

The damage to the convexital bark of the occipital share (fields 18, 19) may determine the violation of the visual perception, the appearance of illusions, visual hallucinations, the manifestation of visual agnosia, the Balint syndrome.

In cases of violation of the function of tamocorcular conductive paths, in particular visual radiation, may appear riddoha Syndrome. It is characterized by a decline in attention, violation of orientation on the ground, the ability to accurately localize visible items. The difficulty of understanding the position of the subject in space is increasing if the subject is on the periphery of the fields. Patients do not realize their defect (peculiar anosognosia). Gomonimi hemigipopsy or hemianopsy are possible, but the central sight is usually saved. Syndrome described in 1935. English doctor G. Riddoch (1888-1947).

2. Neuropsychological syndromes of damage to the occipital brain departments

The occipital region of large hemispheres of the brain provides, as you know, the processes of visual perception. At the same time, the actual visual perceptual activity (visual gnosis) is ensured by the work of the secondary departments of the visual analyzer in their relationship with the dark structures. With the defeat of the occiput and dark departments of the brain (both the left and right hemispheres), various violations of visual-perceptual activity are arising, primarily in the form of visual agnosies. Recently, data on the role of the roles and medical departments of the brain in the processes of visual perception were obtained, since the latter may be disturbed during the localization of the pathological process on the medial surface of the occipital brain sections. It should be noted that the diversity of the described variants of violation of visual-perceptual activity is determined by the passage of its defect in relation to various types of optic material (real objects, their images, colors, alphabetic and digital symbols, faces of familiar people, etc.) and various levels of exercise of visual Perception as complex targeted activities based on the actualization of the past experience formed in the ontogenesis (the actualization of visual representations, a holistic complex simultaneous perception of visual incentives, the possibility of conscious identification of visually presented objects, the establishment of intraimodal bonds between the various characteristics of information entering the visual analyzer, and intermodal connections, necessary to categorize visual incentives on speech and mental levels). For the diversity of manifestations of visual-perceptual disorders, no doubt, there are various brain factors to provide this lead in the structure of human mental activity of reflection, analysis and psychological qualifications of which is carried out yet at the level of the description of clinical and psychological phenomena. The cause of such an empirical approach is the absence of a single theory that summarizes the structural and dynamic characteristics of the visual perception and takes into account the complex multi-level structure of this function, including its brain structural and functional organization. The impaired sensory components of the visual function does not, as a rule, to disorders of the actual perception, to defects of the substantive reflection of the external environment. Even with significant violations of visual acuity, even with a sharp narrowing of the fields of view (up to the formation of a "tubular" field of view), the visual perception does not lose its subject matter, although its high-speed characteristics may deteriorate, since it is necessary additional time To adjust the visual system to perform a perceptual task. In these cases, we can talk about high compensatory possibilities of a visual system that provide orientation in the subject matter with a pronounced sensory deficiency. The only exception is one-sided visual-spatial agnosia (OPA) arising from the damage to the deep or convexidal departments of the right hemisphere of the brain, which has such recording equivalents as a fixed left-sided gomonimary hemianopsy or left-sided visual ignoring syndrome. In the most pronounced forms of development of this pathology, a systemic defect is found in the form of "non-perception" of those components of the visual stimulation, which fall into the left visual field. This can be seen when the patient is working with the subject images, when referring objects and even in an independent patient figure, i.e., when actualizing visual representations. The visible world and its image seems to fall into two halves: a reflected (right visual field) and non-reflectible (left), which significantly distorts the process of visual perception. Ignoring the left half of the visual field can be detected not only when perceiving and copying subject images, but also in such activities as an independent drawing, time estimate on the clock and even reading the text in which only the "visible" right field of view is perceived. The distortion of the content of the text, the nonlapic, which arises does not affect the visual activity of the patient, which is implemented formally, without attempting to correction. To the above, add three provisions important in the diagnostic aspect should be added. First, OPA may occur in the absence of data on hemianopsy. In these cases, its manifestations are observed both in the deployed form and in the form of a "trend" to visual ignoring, the consequence of which such changes in the visual gnosis, as a text offset when writing to the right side relative to the edge of the paper sheet; Listing the objects depicted in the album not to the right, but in the opposite direction; The passage of individual words of the left edge of the text (with correction in the case of their meaningful importance), etc. It is characteristic that such symptoms may be observed in the defeat more broadly than only the rear heights of the right hemisphere, zones, including the localization of the pathological process in the frontal area. Secondly, in some cases, the opa may occur with the defeat of the left hemisphere of the brain in combination with other symptoms indicating the subdominant features of the work of the left hemisphere from this patient. Thirdly, the opa often acts as a polymodal syndrome, manifested in perceptual ignoring not only the left visual field, but also of the motor, and tactile, and the auditory sphere, i.e., affecting the perception of all incentives entering the analyzer systems of the right hemisphere of the brain, and Related to the left, relative to the scheme of the own body of the subject, half of the space. The very name of this phenomenon is "one-sided spatial agnosia" - emphasizes its systemic nature, the inclusion of phenomenon into the pathology of various modalities and, which is very important, its complex structure, which is based on the formation of which is a spatial radical. In this sense, OPA in a number of visual agnosies occupies a special place as a particular manifestation of a more complex (possibly in the level of integration of spatial functions) of the syndrome. Why often clinicians and psychologists talk about opa in connection with the visual system? To a large extent, this is explained by the availability of a clinical and experimental vision of this phenomenon in visual-perceptual samples. However, it is easy to detect in the tactile sphere (ignoring the stimulus is a touch to the left hand with a synchronous touch to the right), in a motor (ignoring the left hand in two-handed samples) and the auditory (ignoring the incentives for the left ear in the dichotic audition method). OPA is found in the patient's behavior; The patient does not use the left hand, "forgets" to wear slippers on the left foot, it stumbles on the items located on the left, when moving in space, etc., the formation mechanisms of this phenomenon are still unclear. Attempts to attribute it to violations of attention, in our opinion, unproductive. More interesting, although quite schematic, may be an explanation of this clinical phenomenon in terms of the "psychological sewn" and distorted inner painting of the disease. Moreover, it is almost always opa combined with anosognosia. In addition, recently an idea of \u200b\u200bthe attitude of the right hemisphere to individual semantic formations in the personality structure is developing. The latter circumstance may be the cause of distortion when defeating the right hemisphere of the inner picture of the disease in its sensory and personality-estimated components. Independent diagnostic importance in neuropsychological practice is other types of visual agnosions: subject, simultaneous, facial, symbolic and color. The subject agnosia occurs with the defeat of the "wide zone" of the visual analyzer and can be characterized either as the lack of the recognition process, or as a violation of the integrity of the subject of the subject with a possible identification of its individual characteristics or parts. The impossibility of visual identification of the object externally can manifest itself as a listing of individual fragments of the object or its image (fragment) and the exhaustion of only individual features of the object insufficient to its full identification. According to these two levels of manifestation of the subject agnosia, examples will be: identification of the image "points" as a "bicycle", because there are two circles combined by crossbars; Identification of the "key" as a "knife" or "spoons", with a support for the selected signs "metal" and "long". In both cases, as A. R. Luria indicates, the structure of an act of visual perception is incomplete, it is not based on the entire set of signs needed and sufficient for visual identification of the object. For its part, we would like to note not only the incompleteness (fragmentation) of the visual perception, but also the distortion of the actual perception itself compared with the norm, where the identification of the object is carried out simultaneously, simultaneously. Expanded, "reasoning" form of visual perception, which it acquires in the syndrome described here, in healthy people can only be seen in complicated conditions for identifying unfamiliar objects, i.e. objects, the image of which is absent in the individual memory of the person. It is impossible to exclude that one of the mechanisms of the subject agnosia may be a violation of the epistemic level of the visual analyzer, which prevents the comparable of the cash stimulus with its equivalent in memory. The subject agnosia may have a different degree of severity - from the maximum (agnosia of real objects) to the minimum (difficulty identification of contour images in the roaring conditions or when overlaying each other). As a rule, the presence of a deployed subject agnosia indicates a bilateral damage to the occipital systems. With one-sided lesions of the occipital brain departments, you can see differences in the structure of the visual subject agnosia. The lesion of the left hemisphere is more manifested by a violation of the perception of objects by the type of enumeration of individual parts, while the pathological process in the right of the hemisphere leads to the actual absence of an act of identification. Interestingly, at the same time, the patient can estimate a visually presented subject for its meaningful characteristics, responding to the questions of exploring the attitude of this subject to the "living - non-living", "dangerous - non-hazardous", "warm - cold", "large - small", " naked - fluffy "and t. D. Differentially diagnostic signs of robust and subject agnosies is the slowdown in the object identification process, as well as a more accurate assessment of patients with schematic images compared to realistic, and narrowing of the volume of visual perception, a private and more coarse manifestation of which is a simultaneous agnosy, highlighted as an independent violation of visual perception. . Before switching to the description of this form of visual disorders, we note that in the case of one-sided lesion of the "wide visual zone" you can see a modally-specific impaired of arbitrary memorization of graphic incentives, which manifests itself in a narrowing of the reproduction with the lesion of the left hemisphere and the most clearly acts as the introduction interfering task. Modally-specific episposition defect in the visual sphere When defeating the right hemisphere, it is detected in the difficulties of reproducing the procedure for following the elements included in the storage sequence of graphic material. Simultan agnosia occurs with bilateral or right-hand lesions of the grinding and dark departments of the brain. The essence of this phenomenon in the extreme terms consists in the impossibility of simultaneous perception of several visual objects or the situation in the complex. Only one object is perceived, more precisely, only one operational unit of visual information is processed, which is currently the object of attention of the patient. For example, in the task "Put a point in the center of the circle" the failure of the patient is detected, since simultaneous perception is required in the relationship of three objects: the circle circle, the center of its area and the tip of the pencil. The patient also "sees" only one of them. Simultan agnosia does not always have such a distinct severity. In some cases, only difficulties are observed in the simultaneous perception of the complex of elements with the loss of any details or fragments. These difficulties can manifest themselves when reading, when referring or with an independent figure. Often, simultaneous agnosia is accompanied by a violation of eye movements (ataxia of the gaze). One-sided lesion of the left-handed wasteland area can lead to a violation of the perception of symbols, characteristic of the familiar patient of language systems. The possibility of identifying letters and numbers is disturbed while the preservation of their writing (symbolic agnosia). It should be noted that in its pure form, the letter and digital agnosia occurs quite rarely. Usually, with a wider defeat with the "capture" of the actually dark structures with their function of spatial analysis and synthesis, not only perception is violated, but also writing and writing off the graph. Nevertheless, it is important that this symptom has left-hand localization. Facial agnosia, on the contrary, manifests itself with the defeat of the right hemisphere of the brain (middle and rear departments). This is a selective gnostic defect, it may occur in the absence of subject and other agnosions. The degree of its severity is different: from violation of memorization of persons in special experimental tasks, through the unrecognizing familiar individuals or their images (photographs) to the unrecognizing itself in the mirror. In addition, it is possible to selectively violate or actually facial gnosis, or memorizing persons. What is the specificity of the "face" as a visual facility compared to the subject? It seems to us that the perception of a person, firstly, determined by very subtle differentiations of a holistic object ("persons unclear expressive") with the similarity of the main signs (2 eyes, mouth, nose, forehead, etc.), which is usually not subject to analysis, If everything is in order in the face. The interpretation of the violation of the facial gnosis due to the deficitivity of a holistic perception of the object is confirmed by the data on the difficulties of the game of chess, which have a place in patients with the defeat of the right hemisphere, previously played in chess patients note that they cannot assess the situation on a chessboard as a whole, which leads to disorganization This activity. Secondly, in the perception of the face there is always a contribution of the individuality of the perceive, seeing his own person, subjective, even if these are portraits of famous people. The specifics of the perceived egg and in its unique integrity reflecting the individuality of the "sample" and in relation to the perceiving to the original. Above mentioned the role of the right hemisphere in immediate, sensual processes, about his "meaning" function. At a minimum of these grounds, it becomes a clear breakdown of the perception of persons with the defeat of exactly the right hemisphere of the brain. The least studied form of violation of visual perception is color agnosia. However, so far have been obtained some data on color perception disorders when defeating the right hemisphere of the brain. They manifest themselves difficulties in differentiation of mixed colors (brown, purple, orange, pastel colors). In addition, it is possible to note the color recognition violation in the real subject compared to the safety of the recognition of colors that are presented on separate cards. In conclusion of the description of the syndromes of violation of the visual perception, it should be said that, despite their rather subtle analysis in a clinical neuropsychological aspect, there are enough "white spots" in this area, the main of which is the definition of factors whose violation of the local lesions of the brain leads to the formation of such A variety of disorders of visual-perceptual activity.

N. N. Bragin, T. A. Dobrokhotova

Syndromes and their clinical characteristics

Paroxysmal
The main feature is the parliamentality of occurrence. These states suddenly watery and quickly break.

Rightphanies

Hallucinatory
False perceptions of what is not in fact. Abnormal, tactile, incident, olfactory, taste hallucinations are possible. Humorsmen are expressed in the imaginary rhythmic sounds - municipal melodies, natural noise - birds singing, the noise of the surf. The olfactory and taste hallucins arising usually with the damage to the deep departments of the temporal share of the right hemisphere have an unpleasant, painful nature.

Derealization
The perception of the surrounding world by changed, devoid of reality. Patients are possible in various sensations of this change: other than in reality, painting in the world; larger than habitual experience, light brightness; distortions of spatial outlines, contours, size, forms of objects (sometimes different in size, architectural solution of the house and other structures are pre-assembled by similar, not distinguish between themselves). We can consider the feeling of immobility, the dead, the dedication of the world, when all moving (including surrounding people) is perceived by patients with immobilized.

Symptom "already seen"
The instant feeling that now the relevant real situation is "already experienced", "already visited", "already hearing", although there was no such situation in past memories.

"Never seen"
The feeling opposite to the previous one. A well known, many times seen, worried about the situation is perceived by the patients as "unfamiliar", "never seen", alien.

"Stop time"
An instant feeling that time "stopped". This sensation is usually combined with a extreme variation of the dramatization. Colors in the perception of the patient become dull; Volume, three-dimensional items - flat, two-dimensional. The patient at the same time perceives itself as if losing-PHIM communications with the outside world surrounding people.

"Stretching time"
In the sensations of the patient, the time is experienced as "stretching", longer than habitually in the past experience. This sensation is sometimes combined with the opposite (compared to the previous phenomenon) changes in the perception of the whole world. Flat, two-dimensional is represented by bulk, three-dimensional, "alive, moving", and gray-white - color. The patient usually becomes relaxed, complacent or euphorical.

"Lost of the sense of time"
The feeling disclosed by the patients in other expressions: "There is no time as if there is no", "freed from the oppression of time." This is always accompanied by the changed perception of the whole world. Objects and people seem more contrasting, in the emotional perception of patients - "more pleasant."

"Slowing time"
The feeling that time "flows slower". The perception of the whole world, movements of people and pre-metals changes. People are represented by "puppet, non-residents", their speech is "government". Patients nazas-lad "slowed" on the basis of the fact that the movements of people are perceived slow down, their faces are "sullen."

"Acceleration of Time"
The feeling opposite to the previous one. The patient time seems to be current more quickly than it was habitually in the past perceptions. In the perception of the patient, the entire world around the world and his own "I" is changed. The world is like "not natural", "unreal", people are perceived as "fussy", very fast moving. Worse than in the usual condition, feel your body. Errors determine the time of day and the duration of events.

"Return time"
The feeling refined by the patients in the following expressions: "Time flows down", "time goes in a rolling direction", "I go back in time." The surrounding world is perceived by the surrounding world and with the samp of the patient. Interesting is the rude fallacy of reproduction of the newest events already experienced; second - a minute ago the events took place as former "long ago"

Palinopsy
Designated as "Visual Perseveration". This phenomenon is close to the previous one. Already, the situation in real reality, as if delayed in the field of view of the patient. In pain, this phenomenon can be combined with a violation of the left field of view, a decrease or loss of topographic memory.

Depersonizational
Within the framework of depersonalization syndrome, various options for the changed perception of a sobernant "I" are described. May be perceived by a changed somatic or mental "I"; It is possible to unite the other.

Somatic depersonalization
It occurs more often. It is expressed in another than the familiar patient through the past perceptions, re-loving or sense of its own body or different parts. Worse feels the whole body or only left parts. At maximum severity, patients are ignored (not perceived) left parts of the body, more often; The patient does not use left hand, if even weakness in it is insignificant. Sometimes the feeling of body integrity is disturbed; It (or individual parts) "increases" or "reduces-XI". Perhaps the feeling of multiplicity, for example, the patient seems to be that he has one (le-Way) hand, but a few hands; At the same time, often the patient is unable to distinguish between them its own - the one that is in reality.

Mental depersonalization
It is expressed in the changed experience of his "I", my personality, relationship with the surroundings, emotional contact with people. Patients say they lose feelings, lose contact with all the people around us, while using the phrase: "I'm leaving for another space, and everything remains in this space," I become an extraneous observer, "without" all feelings "I look at the fact that "Happens in this space."

Total depersonalization
Includes the change in perception and somatic and mental "I", which, as it were, are observed again when the patient comes out of the attack. The simultaneous appearance of the feelings of the "alien" of his own voice, "the physical splitting of the body for the smallest particles," the splitting of the mental "I": "All parts of the body exist at this time, as it were, and with their own" I ", in addition to the general" I ".

Two-challenging experience
The state when the patient continues to perceive the surrounding validity; Sometimes it is accepted only that there is to the right of the patient. At the same time, there is a second stream of experiences in the form of involuntary revival, as if repeatedly playing in the consciousness of a particular period of time. In his consciousness, the patient is as it were, as it were, at the same time in two worlds: in the real world, and in the world, which was in the last time of the patient. The patient and himself identifies in consciousness, with the same side, with what it is now and here (in the present time and space), and on the other side, which was in a particular segment of the past time.

"Flash experienced"
The condition falling into which, the patient ceases to perceive what is in reality (in the objective present and real space) and in his mind, as it were, it would be all returning to some time of the past time. In the consciousness of the patient, all events that were in the past are played and they are experiencing patients in the true sequence. The patient perceives himself as he was in that stretch of last time.
Oneiroid
This refers to a short-term transient onairoid state. The patient ceases to perceive himself and the surrounding world as they are in objective time and space. In the consistency of the patient, it is experiencing a different, unreal world, more often - the world of fantastic events (flights to space, meetings with aliens). In retrospective (after leaving the attack), the description of the patient of a different world looks unnecessary spatio-temporary supports. At the time of the experience of the initiation of the majority often experiences a feeling of weightlessness. It is close to "gravitational illusions", described as a subjective experience of changing the mass of its own body, which is explained by the activation in the cross-fishing brain of those ingrams, which captured the experience of subjective sensations with short-circuit changes in body weight.

Emotional and affective disorders syndrome
Three violations are possible:
a) attacks of sadness, fear or horror (with temporal lesion localization), combined with visceoo-vegetative disorders, olfactory and taste hallucinations;
b) euphoria with relaxation (with damage to the dark-occipital departments);
c) the condition of the emotionalness is a transient interruption of an affective tone (with temporal-racially occipital lesion), combined often with the phenomena of the delinealization and depersonalization.

Levopolushapes

Hallucinatory
Most often there are auditory - verbal hallucinations. Patients hear voices, Owl-king them by name or informing something. Hallucinations can be multiple: the patient is heard at once a lot of votes, it cannot disassemble the content that these voices say.

Syndromes of speech violations
Transient (motor, sensory, amnesic) aphasis, suddenly coming and quickly roding. Such transient violations of speech at the time of the attack occur in patients more often at the moment when no change in paroxysms are observed.

Disorders of thinking
We often arise two opposite states:
a) "Drops of thoughts" - the feeling of emptiness in the head, as if "stopped the formation of thoughts" Externally, at the time of the attack, the patient looks anxious, confused, on the face - the expression of bewilderment;
b) "violent thoughts", "influx of thoughts", "whirlwind of thoughts" - a sense of sudden appearance in the minds of thoughts not related to content with current mental activities; Sometimes it is more, "like a zipper," there are many thoughts, "preventing each other", "the head flops from these thoughts"; No thought ends, has no finished content; These thoughts are experienced with a tint of pain, violence, involuntaryness - the impossibility of free from them until the attack is complete.

Memory disorders
Two extreme options are possible:
a) "failure of memories" is helplessness, failure to remember the necessary words, the names of loved ones, even their age, place of work, is accompanied by confusion, anxiety;
b) "violent memory" - painfully a painful feeling of the need to remember something, but it remains unattainable awareness of what is subject to the memoil; This inaccessibility of awareness of the subject of memories is combined with anxious sensation, the fear of something that with the patient something "should happen."

Absan
Turning off the patient from conscious mental activity, which he was busy up to the bottom. The posture in which he found a patient attack is preserved. All signs of attention in the appearance of the patient disappear; The look becomes fixed, the face is "stone". Little a moment and the interlocutor can take a forced pose natural. He himself, he does not remember the happening; At the attack of Absan, as a rule, complete amnesia comes. For a long time, the attacks may not be noticed by the patients themselves and ocker. We become apparent as they are complicated by adding speech and other phenome-new.

Psychomotor seizures
Last minute, hours, rarely - a few days. Flipping into the attack, the patient continues to be asset. Makes a variety of actions, sometimes a complex and consistent psychomotor activity. From the twilight states of consciousness, these seizures are distinguished by small expediency and a smaller sequence of actions: patients rushes to run somewhere, begin to shift from the place of extremely tea heavy items. Acts and actions are accompanied by shouts, usually deprived of meaning. The behavior of the patient becomes ordered only on the outlet of the attack, which amne-zia comes.

Twilight disorder of consciousness
Suddenly the coming and suddenly the unreleased state of changed consciousness, for which ha-rakterna, the implementation of complex consistent psychomotor activity, ending with a socially significant result, as well as amnesia to the attack. Conditionally you can distinguish between two options:
a) being in the twilight state of consciousness, patients continue to implement the program that was conscious to the onset of this state;
b) flowing into the twilight state of consciousness, patients commit actions and actions, never in their intentions, alien to their personalities; These actions are determined by psychopathological experiences - hallucinatory, delusional, arising together with the onset of the changed state of consciousness. The first option coincides with the condition known as the "Ambulator Automation". In the second embodiment, malice, irritation, anger, aggressiveness are possible.

Emotional, affective disorders syndrome
Many of the paroxysmal states listed above (transmitting aphasis, violent thoughts and memories, etc.) are usually accompanied by an anxiety affect, confusion. Independent paroxysms can be called, at the time of which patients are experiencing an anxiety affect; This Mo-ment become fussy, intersective, impatiently engaged. Express fears: "Something should happen to me." These fears are always facing the future.

Non-paroxism

Rightphanies

Confabulant confusion
Violation of consciousness, in which the patient disoriented in space and in time so that the real reality now perceives through the content of the past time. This is expressed in abundant confibulations: as what happened just (in the hospital), the patient calls events that once in the past and in some other place (at work, at home, etc.). Patients do not remember anything from what is happening may be engaged in restless. The words "here" and "now" are deprived of meaning.

Korsakovsky syndrome
The syndrome necessarily includes disorientation in space and time. Sometimes painful disoriented and relative to their own personality; Amnesia - fixing, retrohanterograde; confabulation (in response to the question, for example, what was engaged in the patient in the morning, events that took place many years ago) could be called; false recognition (in the surrounding faces of the patient "recognizes" the faces of their loved ones and calls them the names of these people); Emotional-personal changes (patients are relaxed, complacent or even euphoric, multi-forming, detect anosognosia and, with the evidence of the full helplessness of patients to all others, themselves consider themselves healthy); Disorders of perception of space and time (so, in the morning the patients may say that it is already in the evening; they are mistaken in the direction of the wolves in determining the duration of events). Korsakovsky syndrome is often combined with left-sided hemiparesis, hemiagesey, hemianopsy, as well as ignoring the left space.

Left-sided spatial agnosia
It is characterized by the cessation of perception (ignoring) events that occur to the left of the patient. All incentives are ignored by patients: visual, auditory, tactile. Patients feel poorly feeling their body or not perceive it at all, more often this refers to the left parts, especially to the left hand. Ignore the left part of the text when reading, the left side of the paper when drawing, etc. Patients with Euphoric, relaxed; Anosognosia is found.

Tsucky depression
It is characterized by longing, motor and ideator intensity. Such a triad of symptoms usually arises with the defeat of the temporal department of the right hemisphere. The patient is not allowed, says quietly, slowly; The face froze in the same position.

Pseudological
Patients show a tendency to mention or even describe in detail how the events that happened to them are in reality who did not have places. As a rule, patients do not benefit from such pseudological statements. Patients are usually multiple and complacent, quickly come into contact with the surrounding people.

Emotional personal changes
The most often pronounced trend towards the predominance of a complacent or euphoric structure, inadequate condition of the patient, his severity. Criticism is reduced. Often, the unconsciousness and denial of their disease, the pain of the state is anosognosia. Sometimes Euphoria is pronounced with motor activity up to disturbance; Patients of merry, multicast, moving, although they can detect left-sided hemiplegia, blindness and other signs of deep insolvency.

Sleep and dream disorders
Frequent instructions of patients to increase the number of dreams: "Impression is as if I see all night." Sometimes color dreams are noted. Patients often note that it is difficult for them to distinguish what was in a dream, from what happened in reality. In some patients, stereotypical repetitions of the same sleep are noted.

Periodic psychosis
Reminds TIR, where states resembling hypomaniacal and depressive are periodically repeated. They differ in greater severity of the actual emotional component, but greater activity; With a "good" condition, patients are highly active, productive, sleep very little; With the "bad" states - sluggish, sleeplows, tires.

Levopolushapes

Discovered
In the center of the syndrome - the weakening of verbal (verbal) memory. The patient forgets words, names, phone numbers, actions, intentions, etc. Forgetting does not reach the degree of impossibility of reprofitting the necessary information. The patient has an understanding of the defect and the active desire for compensation. They start notebook records, write down everything that is subject to memorization.

Anxious depression
It is characterized by anxiety and motor anxiety, confused. Patients are as it were in continuous search for motor peace; Change the situation, get up, sit down and rises again. Sighs, are intensely looked around, peering in the face of the interlocutor. Express concerns that something should happen to them.

Dead syndrome
In the center of the syndrome - a violation of thinking with errors of judgments that cannot be corrected. Patients are becoming increasingly suspicious, incredulous, disturbing. Suspected those surrounding in the unfavorable attitude towards them, the intention of harm (to poison, disfigure, badly impact on them). Externally, the patient is tense. Sometimes refuses food, drugs.

Changes in speech
Even before the appearance of aphasia, there may be speech aspotation with the lack of motivation to speech activity or increasingly becoming reservations when patients are replaced by others and do not notice it. It is becoming increasingly unfolded, single one.

Sleep and dream disorders
Recovery of dreams. Sometimes sick disappearance of dreams as one of the signs of changes to their sleep and dreams are observed.

Emotional and personal changes
Under the defeat of the frontal departments, patients are less and less initiative, aspontanes; temporal - everything is more disturbing, tense, confused; It comes as if to increase the vigilance of patients, they are constantly mobilized. Under the defeat of the rear departments of the left hemisphere, it is usually dominated by sufferer from-tenaks in the mood of patients.

Table of syndromes arising from the electoral
Defeat of the right and left hemispheres of the brain (in the right hand)

© N. N. Bragin, T. A. Dobrozhotova

Dumplines of the brain on a functional role are divided into three zones:
Top Dark Oblast
Lower raco area
temporal

The upper and lower dark areas bordered with a post-central zone (overall sensitivity), i.e. The cortical center of the skin-kinesthetic analyzer. At the same time, the lower dark area is adjacent to the region of the representation of the extra- and interoceptors of the hands, faces and speech articulants. The temporo-dark-occipital sequence is the transition between the kinesthetic, hearing and visual cortex zones (TRO zone, the rear group of tertiary fields). In addition to the integration of these modalities, there is a complex synthesis in subject and speech types of human activity (analysis and synthesis of spatial and "quasi-spatial" object parameters).

Syndrome disorders of somatosensory afferent synthesis (CASS)

This syndrome occurs with the defeat of the upper and lower dark areas, the formation of the components of its symptoms is the violation of the synthesis of the synthesis of peelingline (afferent) signals from extra- and proprioceptors.

1.Low-rise SACAS Disorder Syndromethere is a damage to post-central mid-ventilation secondary areas of the cortex, which borders with the zones of the representative office of the hand and speech apparatus.

Symptoms:
Asterognosis (impaired identification of items to the touch)
"Tactile agnosia of the object texture" (more rough form of astergenesis)
"Finger agnosia" (inability to identify their own fingers with closed eyes),
"Tactile Alexia" (inability to identify numbers and letters, "written" on the skin)

Possible:
Speech defects in the form of afferent motor aphasia, manifested in the difficulties of articulation of individual speech sounds and words in general, in mixing close articles
Other complex motor disorders of arbitrary movements and actions on the type of kinesthetic aprage and oral apraxia

2. Upper Sandrome Disorder Casasmanifested by the disorders of the gnosis of the body, i.e. Violations of the "body scheme" ("Somatoagnosia").
More often the patient is poorly focused on the left half of the body ("hemisomatoagneosia"), which is usually observed in the damage to the dread area of \u200b\u200bthe right hemisphere.
Sometimes the patient has false somatic images (somatic deceptions, "somatoparagnosis") - the sensations of "someone else's" hands, several limbs, a decrease, increasing body parts.

With right-sided defeats, their own defects are often not perceived - "anosognosia".

In addition to the Gnostic Defects in the CASS syndromes, with damage to the parietal region, modern-specific violations of memory and attention are consistent.
Violations of tactile memory are detected when memorizing and the subsequent recognition of the tactile sample.

The symptoms of tactile inators are manifested by ignoring one (more often on the left) of two simultaneous touches.

Modally-specific defects (gnostic, scents) make up primary symptoms of damage to the dumpy post-central cortex areas; And motor (speech, manual) disorders can be considered as secondary manifestations of these defects in the engine sphere.

Syndrome impairment of spatial synthesis

Also known as "TRO syndrome" - the lesion syndrome of the tertiary temporochny-occipital bark departments, which provide simultaneous analysis and synthesis on a higher above-normal level ("quasi-spatial" in the Luria).

The defeat of the TRO zone is manifested in:
Orientation violations in the external space (especially on the right - left)
Defects of spatial orientation of movements and visual spatial actions (constructive apraxia)

In visual-constructive activities, there are lateral differences that are easy to detect in samples for drawing (or copying) of various objects. Significant differences take place when drawing (copying) of real objects (house, table, person) and schematic images (cube or other geometric constructions). At the same time, it is important to evaluate not only the final result of performing a visual-structural problem, but also the dynamic characteristics of the execution process itself.

In the process of drawing (copying) patients with a lesion of a TRO zone:
right Hemisphere Brainperform the drawing, depicting its individual parts first, and only then bring to the whole
at leafy focivisual-structural activity unfolds in the opposite direction: from whole to detail

At the same time, for patients with the defeat of the right hemisphere, a tendency to draw the realistic parts of the drawing (hair, a collar in a person, crossbar at the table, curtains, a porch at home, etc.), and for the leaf-colored patients - to drawing schematic images.

With robust foci speed-constructive activityit suffers more deeply, as evidenced by the violation of the integrity of the copied or independently depicted pattern. Often, the details are taken out of the contour, "applied" to it in random places. It is often often observed such structural errors as the impellation of the figure, the violation of symmetry, proportions, the ratio of the part and the whole. The presence of a sample not only does not help the patient with the defeat of the right hemisphere (unlike the left-hand), but it often makes it difficult and even disorganizes visual-constructive activities.
In addition to the listed symptoms, the symptoms of the agnosia, mirror copy, Akalkulia, the finger agnosia, speech disorders ("Semantic Afaja", "Amnesian Afaja") appear when defeating the TRO zone.

Violations are noted logical operations and other intelligent processes. For patients, it is characterized by difficulties in operating with logical relations requiring elements in some conditional, not visual space (quasi-space) for their understanding of the correlation.

The latter includes specific grammatical constructions, the meaning of which is determined:
End of the words (Father's brother, father of brother)
ways of their arrangement (dress hung paddle, paddle jerked dress)
Prepositions reflecting the reversal of events in time (summer in front of the spring, spring in front of the summer)
The incompatibility of the real movement of events and the word order in the sentence (I had breakfast after reading the newspaper), etc.

Intellectual disordersdisrupted violations of visual-figurative thinking processes (such as a mental manipulation of volumetric objects or tasks for "technical" thinking). Such patients cannot read the technical drawing, sort out the device of the technical mechanism.

The main manifestations also include violations related to operations with numbers (arithmetic tasks). Understanding of the number is associated with a rigid spatial grid for placing the discharges of units, tens, hundreds (104 and 1004; 17 and 71), operations with numbers (account) are possible only when the number and "vector" of the operation in memory (addition - subtraction; multiplication - division). The solution of arithmetic tasks requires an understanding of the conditions containing logical comparative designs (more - less on so much, for so many times, etc.).
All listed violations are particularly distinct at left-sided lesions (in right-handers). With right-sided defeats in TRO syndrome there are no phenomena of semantic aphasia; There are somewhat different violations of the account and visual-shaped thinking.

Neuropsychological syndromes of damage to the occipital brain departments

The occipital region of the greyal hemispheres of the brain ensures the processes of visual perception. At the same time, visual gnosis is ensured by the operation of the secondary departments of the visual analyzer in their relationship with the dark structures.

With the defeat of the occiput and dark departments of the brain, both the left and right half, there are various violations. visual-perceptual activityFirst of all in the form of visual agnosies.

Spectative agnosies depend on the side of the brain lesion and the location of the focus within the "wide visual sphere" (18-19 fields):
With lesion right Hemispheremore often there are color, facial and optical-spatial agnosia
With lesion left hemispheremore often there are letter and subject agnosia

Some researchers believe that the subject agnosia in its unfolded form is usually observed in bilateral lesions.

Violations of recognition of letters(The defeat of the left hemisphere in right-handers) in its coarse form is manifested in the form of an optical Alexia. One-sided optical Alexia (ignoring more often than the left half of the text) is usually associated with the defeat of the occiput-dark departments of the right hemisphere. The event suffers from the second time.
Modally-specific violations of visual attention are manifested by the symptoms of ignoring one part of the visual space (more often on the left) with a large amount of visual information or with simultaneous presentation of visual incentives to the left and right visual semi-breaking.

In the case of one-sided defeat of the "wide visual zone" You can see a modally-specific impaired of an arbitrary memorization of a sequence of graphic incentives, which manifests itself in a narrowing of the reproduction with the lesion of the left hemisphere and most clearly acts as the interfering task.

Modally-specific epispical defect in the visual sphereunder the damage to the right hemisphere, it is found in the difficulties of playing the order of the elements included in the memorable sequence of graphic material.

Violations of visual memory and visual representations are usually manifested in pattern defects. The drawing decays more often with right-sided foci of lesion.

Independent place occupy disorders of optical-spatial analysis and synthesis. They are manifested in the difficulties of orientation in the external space (in their room, on the street), in the difficulties of visual perception of spatial signs of objects, orientation in the maps, in the schemes, in hours.

Defects spectator and visual-spatial gnosisit is often detected only in special sensitized samples - when viewed by crossed, inverted, embedded figures, with brief exposure of the image.

Speat-spatial disorders can manifest in the motor sphere. Then the spatial organization of motor acts suffers, resulting in a spatial (constructive) motor aprage.
It is possible a combination of optical-spatial and spatial disorders - aproatoagneosia.

An independent group of symptoms in the damage to the dark-occipital bark(on the border with temporal secondary fields) make up violations of speech functions in the form of optical-enestic aphasia. At the same time, the remembrance of words denoting specific items is violated. This disintegration of visual objects of objects is reflected in the drawings and violations of some intellectual operations (mental actions).

Thus, in neuropsychological syndromes of damage to the rear sections of the large hemispheres of the bark:
Gnostic
Murals
Motors
Speech symptoms
Conditioned violations of visual and visual-spatial factors.

Neuropsychological syndromes when defeating the temporal departments H.

Temporable brain departments:
Record with the primary and secondary fields of the auditory analyzer, but there are also so-called nuclear zones (T2-zones in Luria), which provide other forms of mental reflection.
In addition, the medial surface of the temporal fraction is part of the limbic system involved in the regulation of needs and emotions, is included in the memory processes, provides activation components of the brain. All this causes a variety of symptoms of an impaired PPE with the defeat of various departments of the template area relating to not only acoustic-perceptual functions.

1. Neuropsychological syndromes of lesions of lateral departments of the temporal area

With the defeat of the secondary departments of the template region (the T1-nuclear zone of the beam of the sound analyzer in the Lururia) is formed hearing syndrome, acoustic agnosia in speech (left hemisphere) and spheres (right hemisphere). Speech acoustic agnosia is also described as sensory aphasia.

Defects of acoustic analysis and synthesis in the non-sphere appear:
In violations of identification of household noise, melodies (expressive and impressive amusion)
In violations of identification of votes on the floor, age, diving, etc.

The functions provided by the joint work of the temporal departments of the right and left hemispheres of the brain include an acoustic analysis of rhythmic structures:
Perception of rhythms
Holding rhythms in memory
Reproduction of rhythms on the sample (samples for audaneous coordination and rhythms)

Due to the violation of the phramethic hearing, a whole range of speech functions falls:
Letter (especially under dictation)
reading
Active speech

Violation of the sound side of the speech leads to a violation of its semantic structure. Arise:
"Alienation of the meaning of words"
Secondary intellectual activities related to speech semantics instability

2. Neuropsychological syndrome of the defeat of "extraordinary" convexital departments of temporal shares of the brain

With the defeat of these devices arise:
Syndrome Acoustic-Mural Atlas (left hemisphere)
Disorders of the auditory non-verbal memory (the right hemisphere of the brain)

Especially clearly modally-specific violations of lubber memory act in interfering activities that fills the short time interval between memorization and reproduction (for example, a small conversation with patient).

The defeat of the symmetric departments of the right hemisphere of the brain leads to memory violations on non-eject and musical sounds. The possibility of individual identification of votes is violated.

3. The syndromes of the defeat of the medial departments of the temporal area

As already mentioned, this brain zone has a relationship, on the one hand, to such basal functions in brain and mental reflection, as an emotionally consumer sphere, and thereby - to regulation of activity.

The sides, with the defeat of these systems, there are top-level disorders of the psyche - consciousness, as a generalized reflection of the current situation in its relationship with the past and the future and in this situation.

Focal processes in the medial departments of temporal fractions are manifested:
affective disorders by the type of exaltation or depression
Paroxysmasms of longing, anxiety, fear in combination with awareness and experienced vegetative reactions
As symptoms of irritation, disturbances of consciousness may arise in the form of absans and such phenomena, Khak Deja Vu and Jamais Vu, orientation violations in time and place, as well as psychoseensory disorders in the auditory sphere (verbal and non-verbal hearing deceptions, as a rule, With a critical attitude to them with a patient), distortion of taste and olfactory sensations

All these symptoms can be revealed in a conversation with patients and in observing behavior and emotions in the survey process.

The only experimentally studied violation associated with the pathology of the Medical Departments of the Temporary Area is memory violations.

They are have modally-nonspecific characterThe type of anterograd amnesia (the memory for the past before the disease remains relatively intact), combined with orientation violations in time and place. They are referred to as amgelish (or Korsakovsky) syndrome.

Sick aware of the defect and strive to compensate by active use of records. The volume of immediate memorization corresponds to the lower boundary of the norm (5-6 elements). 10 words memorizing curve has an explicit tendency to rise, although the process of learning is stretched over time. However, when the interfering task is introduced between the memorization and reproduction of the interfering task (solve the arithmetic problem), distinct violations of the actualization have just been converged.

Clinical and experimental data allow us to talk about the main mechanism for the formation of amnestic syndrome - pathological brakes of traces interfering effects. Consider memory violations due to changes in the neurodynamic parameters of the brain in the direction of the predominance of brake processes.

It is characteristic that with the defeat of this level, memory violations protrude in the "clean" form without attracting the reproduction of side elements. The patient either calls several available actualations of words, noting that the rest he forgot, or says that he forgot everything, or amuses the fact of memorization of the preceding interference. This feature indicates the safety of reproduction control.

In addition to the sign of modal nonspecificness, the described memory disorders are characterized by the fact that they "Capture" various levels of the semantic organization of the material(series of elements, phrases, stories), although the semantic designs are remembered somewhat better and can be played using prompts.

There is reason to consider Korsakovsky syndrome as a result of a bilateral pathological process.but it is finally proven. It is only possible to recommend not to be limited to the study of novic disorders, but to look for (or exclude) signs of the unilateral deficit in other mental processes.

4. Syndromes lesions of basal departments of the temporal area

The most common clinical model of the pathological process in the basal departments of the temporal systems are tumors of the wings of the main bone in the left or right of the hemisphere of the brain.

Left-sided location of the focusit leads to the formation of syndrome of irregularities of lubber memory, different from a similar syndrome under acoustic-snealing aphasia. The main thing here is the increased inhibacity of verbal traces of interfering effects (memorization and reproduction of two "competing" rows of words, two phrases and two stories). The noticeable narrowing of the volume of lubber perception is not observed, as well as the signs of aphasia.

In this syndrome, there are signs of inertia in the form of a repetition when playing the same words.

In samples for reproduction of rhythmic structures, patients with difficulty are switched during the transition from one rhythmic structure to another; There is a pervertation execution, which, however, is amenable to correction.

It is impossible to exclude that pathological inertness in this case It is related to the influence of the pathological process either on the basal departments of the frontal shares of the brain, or on the subcounting structures of the brain, especially since at this localization, the tumor can break the blood circulation in the system of subcortex zones.

The deep location of the pathological focus in the temporal areas of the brain It detects not so much primary disorders as the disorder of the functional state of the system of systems included in the temporal areas, which in the situation of clinical neuropsychological examination is manifested in the partial depletion of the functions associated with these zones.

In fact, in conditions of debit of function, genuine violations of phonderatic hearing occur, which cannot be considered as a result of the actual cortical insufficiency, but should be interpreted in connection with the influence of the deep-sized focus on the secondary departments of the temporal area of \u200b\u200bthe left hemisphere of the brain.

Similarly, with depth tumors, other symptoms characteristic of the described syndromes of focal pathology in the temporal brain departments may appear.

The dissociation between the initially accessible performance of the samples and the appearance of pathological symptoms during the period of "load" to the function gives grounds for concluding about the preferential influence of the deep-sided focus on convexital, medial or basal structures in the left or right hemisphere of the temporal areas of the brain.

The second important thing in the diagnostic aspect concerns the difficulties to determine the local zone of the defeat of the right temporal share. It should be borne in mind that the right hemisphere compared to the left detects the less pronounced differentiation of structures for the individual components of the mental functions and the factors that provide them. In this regard, the interpretation of the syndromes obtained during the neuropsychological examination and the components of their symptoms in a narrow sense should be more careful.

Neuropsychological syndromes in the defeat of the frontal brain departments

The frontal brain departments provide self-regulation of mental activity in its components such as:
Icobalization in connection with the motives and intentions
Formation of the program (choice of funds)
Control over the implementation of the program and its correction
Dumping the result of the result with the initial task.

The role of frontal fractions in the organization of movements and actions is due to the direct links of its front departments with a motorbate (motor and premotor zones).

Clinical options for disorders of mental functions at local pathology of frontal fractions:
1) rebound (premotorny) syndrome
2) prefrontal syndrome
3) basal abnormal syndrome
4) The syndrome of the defeat depth departments of frontal fractions

1. Syndrome of violation of the dynamic (kinetic) component of movements and actions in the defeat of the rearless brain departments

Many mental functions can be considered as processes deployed in time and consisting of a series of sequentially replacing each other links or subprocesses. Such, for example, a memory function consisting of fixing stages, storage and updating. This stage, especially in movements and actions, was called a kinetic (dynamic) factor and is ensured by the activities of the rearless brain departments.

The kinetic factor contains two main components:
Change of the stakes of the process (deployment in time)
smoothness ("melodiousness") of transition from one link to another, assumeing timely reflection of the previous element, the inconsistency of the transition and the absence of interruptions

The central disruption of the damage to the rearhead area is the efferent (kinetic) apraxia, which in the clinical experimental context is estimated as a violation of dynamic Praxis. When memorizing and performing a special motor program, consisting of three consistently replacing each other movements ("fist - edge - palm"), distinct difficulties are detected in its execution when it is correct to memorize the sequence at the verbal level. Similar phenomena can be seen in any motor acts, especially where the radical change of elements is most intensively represented - there is a disabling of the letter, violations in the playback samples of rhythmic structures (serial tapping becomes as if torn; they appear extra, noticed patients, but difficult to access Correction strikes).

With massive degree of syndrome severitythe phenomenon of motor elementary persversions appears. The violent, conscious patient, but inaccessible to turning the playback of the element or cycle of motion prevents the continuation of the implementation of the motor task or its termination. So, with the task of "draw a circle", the patient draws a repeated repeated image of the circle ("Motok" of circles). Similar phenomena can be seen in the letter, especially when writing letters consisting of homogeneous elements (Mishina Machine).

The defects described above can be seen when performing motor tasks as right and left. Wherein:
left and leaf focidetermine the emergence of pathological symptoms and in the counter and in the ipsilateral hearth leaning
pathology in the rearbed departments of the right hemisphere of the brainmanifests only in the left hand.

All listed symptoms are most distinctly associated with the leaf and leap localization of the pathological process, which indicates the dominant function of the left hemisphere against the succisively organized mental processes.

2. The syndrome of violations of regulation, programming and control of activities during the defeat of the prefrontal departments

Prefortional brain departments refer to tertiary systems that are found late and in philo, and in ontogenesis. The leading sign in the structure of this frontal syndrome is the dissociation between the relative preservation of the involuntary level of activity and the deficiency in the arbitrary regulation of mental processes. Hence, behavior is subordinate to stereotypes, stamps and interpreted as the phenomenon of "response" or "field behavior".

Here special place is the regulatory apraxia, or apraxia of the target action. It can be seen in the tasks for the execution of conditional motor programs: "When I knock on the table once, you raise right handWhen two times - lift your left hand. " Similar phenomena can also be seen in relation to other motor programs: a mirror uncorrectable execution of the sample of the Hand, the echopractic performance of a conflict conditional reaction ("I will raise my finger, and you will raise a fist in response).

The regulatory function of speech is also broken- Speech instructions are absorbed and repeated by patients, but does not become the lever, with which the controls and correction of movements are monitored. The verbal and motor components of the activity will be separated, cleaves each other. So, the patient, whom they ask to squeeze the hand of the investigative twice, repeats "squeeze twice", but does not move. To the question why he does not fulfill the instructions, the patient says: "Squeeze twice, already done."

Thus, for prefortional frontal syndrome, it is characteristic:
Violation of an arbitrary organization
Violation of the regulatory role speech
Inactivity in behavior and when performing the tasks of neuropsychological research

This complex defect is particularly clearly manifested in motor, as well as intellectual meal and speech activities.

A good model of verbal logical thinking is countable serial operations (subtraction from 100 to 7). Despite the availability of single subtraction operations, in a serial account, the task is reduced to replacing the program by fragmentary actions or stereotypes (100 - 7 \u003d 93, 84, ... 83, 73 63, etc.). Moon the patients are violated in the link of their arbitrariness and focus. Of particular difficulty are for patients with tasks that require consistent memorization and reproduction of two competing groups (words, phrases). Adequate reproduction is replaced with an inert repetition of one of the groups of words or one of 2 phrases.

With the defeat of the left frontal lobe Especially clearly acts violation of the regulatory role of speech, depletion of speech products, a decrease in speech initiative. In the case of rolling defeats, there is dismissal permission, the abundance of speech products, the readiness of the patient quasilogically explain its mistakes.
However, regardless of the side of the defeat, the speech of the patient loses its meaningful characteristics, includes stamps, stereotypes, which, with routing foci, gives it the painting of "resonance".

More roughly with the defeat of the left frontal share manifests life; Reducing intelligent and meal functions.
At the same time, the localization of the lesion focus in the right frontal share leads to more pronounced defects in the field of visual, non-verbal thinking.

Violation of the integrity of the assessment of the situation, the narrowing of the volume, the fragmentation characteristic of the relaxing dysfunction of the previously described brainstones, is fully manifested with the frontal localization of the pathological process.

3. Emotional-personal syndrome and meal disorders when defeating basal departments of frontal fractions

Features of the frontal syndrome here are due to the bond of basal departments of frontal fractions with the formations of the "visceral brain". That is why changes in emotional processes are on the first plan.

Evaluation of its disease, cognitive and emotional components of the inner picture of the disease in patients with the defeat of the basal departments of frontal fractions take a dissociated natureAlthough at the same time each of them does not have an adequate level. Leaving complaints, the patient speaks no matter how much of itself, ignoring significant symptoms (anosognosia).

General mood background with right-sided localization of the process at the same time:
complaimable-euphoric
manifests itself frorthy agent affective sphere

The damage to the basal departments of the left frontal share is characterized by a general depressive background of behavior, which, however, is not caused by the true experience of the disease, the cognitive component of the inner picture of which is absent in the patient.

In general, the emotional world of patients with logo-basal pathology is characterized by:
Definition of affective sphere
The monotony of its manifestations
Insufficient criticality of patients in a situation of neuropsychological examination
inadequate emotional response

For basal frontal localities, a peculiar violation of neurodynamic parameters of activity, characterized, seemingly paradoxical the combination of impulsiveness (dismissal) and rigiditywhich give the syndrome of the disorder of the plasticity of mental processes (in thinking and epispical activity).

Against the background of modified affective processes in the neuropsychological study, the distinct gnosis disorders, Praxis and speech are not detected.
To greater extent, the functional insufficiency of the basal departments of frontal fractions is affected by intellectual and nixing processes.

Thinking: The operational side of the thinking remains preserved, but it is violated in the link of the systematic control over the activities.

By performing a sequence of thought operations, patients find:
Impulsive slipping on side associations
go away from the main task
Show rigidity if you need to change the algorithm

Memory: The level of achievements fluctuates, but not due to changes in productivity, but by the prevalence in the reproduction product, then another part of the stimulus material. Luria It figuratively denotes the phrase: "The tail pulled out - the nose was stuck, the nose pulled out - the tail was lying." Thus, a reclamation story consisting of two accent parts, the patient impulsively reproduces its second half, close to time by the time of actualization. The re-presentation of the story may, due to the correction, provide patients with reproduction of its first half, slowing down the possibility of transition to the second part.

4. Syndrome of memory violations and consciousness when defeating the medial departments of frontal brain shares

Medical departments of frontal fractions are included by Luria in the first brain block is an activation and tone unit. At the same time, they are included in the complex system of front brain, therefore the symptoms that are observed, acquire a specific color in connection with those violations that are characteristic of the defeat of the prefortional departments.

With the defeat of medial departments, two main symptoms complex are observed:
Violation of consciousness
Memory disorder

Violations of consciousness are characterized by:
disorientation in place, time, in its illness, in self
Patients cannot accurately name their stay (geographical paragraph, hospital)
Syndrome of the station occurs often - in the orientation a special role here is acquired by random signs, when the patient in the type of "field behavior" interprets the situation of its location

So, lying under the grid (due to psychomotor excitation) of the patient to the question where he is, is responsible that in the tropics, because "Very hot and mosquito net." Sometimes there is a so-called dual orientation when the patient who does not feel the contradictions, responds that it is located simultaneously in two geographic locations.

Time orientation violations are noticeable:
In estimates of objective time values \u200b\u200b(date) - chronology
In estimates of the subjective parameters - chronogneosia

Patients cannot name the year, month, number, time of year, their age, the age of their children or grandchildren, the duration of the disease, the time of staying in the hospital, the date of operation or the length of time after it, the current day or day of the day (morning, evening).

The symptoms of disorientation in the most pronounced form are found in bilateral lesions of the medial departments of the frontal shares of the brain. However, they also have specifically lateral features:
For defeat of the right hemispherethe brain is more commonly encountered by a dual orientation in place or ridiculous answers about the place of their stay associated with the confable interpretation of environmental elements. Disorientation in time by type of chronogneosia violation is also more characteristic of the ruling patients. The chronology can remain preserved.

Disorders of memory with the defeat of the medial departments of frontal fractions are characterized by three features:
Modal nonspecificness
violation of the delayed (in interference conditions) playback compared to the relatively saved direct reproduction
violation of the selectivity of reproduction processes

According to the first two features, earth disorders are similar to the memory disorders described above under the damage to the medial sections of the template region (hippocampus), as well as its defects that are characteristic of the damage to the hypothalamic-diancephal region.

Violation of the epistemic function applies to memorizing material of any modality, regardless of the level of the semantic organization of the material. The volume of immediate memorization corresponds to the indicators of the norm in their middle and lower bounds. However, the introduction to the interval between memorizing and reproducing the interfering task has a retroactive inhibitory effect on the possibility of playback. With the similarity of these signs of an episitive defect at various levels of the first block of the brain, the defeat of the medial departments of frontal fractions contributes to amnesia its features: a violation of the selectivity of reproduction associated with the lack of control under the actualization. In the reproduction product, "pollution" (contamination) appear due to the inclusion of incentives from other memorable rows, from the interfering task. When reproducing the story, confabulation is in the form of inclusion of fragments from other semantic passages. A consistent memorization of two phrases "An apple tree grew in the garden for a high fence." (1) "On the edge of the forest, the hunter killed the wolf." (2) Forms in the process of actualization phrase: "In the garden for a high fence, the hunter killed the wolf." Contamination and confabulation can be represented and extraxperimental fragments from the past experience of the patient. In essence, we are talking about the inability to reflect uncontrollably pop-up side associations.

Right-sided lesions are characterized by:
More pronounced confibulations - correlates with speech separation
Violations of selectivity concern and actualization of past experience (for example, lizing the characters of the novel "Eugene Onegin", the patient constantly joins them on the acting individuals of Oman "War and Peace".).
There is a so-called. "Amnesia to the source" (the patient involuntarily reproduces the previously memorable material on a random tip, but not able to arbitrarily remember the fact of the memorization itself. For example, the digestive motor stereotype "one hit to raise the right hand, two - left", after the patient's interference It can not arbitrarily remember what kind of movement it was performed. However, if you start tapping on the table, it quickly actualizes the former stereotype and begins to lift my hands alternately, explaining this with the need to "move under hypocinezia".).).
The interfering task can lead to alienation, failure to recognize the products of its activities (showing the patient with his drawings or the text written by him after some time, sometimes you can see his perplexity and the inability to answer the question: "Who is drawn?").

Left-sided lesions of medial-frontal departmentsHaving described all the above general signs, including violations of the electoral reproduction, look less pronounced in terms of presence of contamination and confancy, which, apparently, is due to the overall life and non-profitability of activity. At the same time, there is a prefigible deficiency in memorizing and reproducing the semantic material.

5. Syndrome damage to the deep departments of the frontal shares of the brain

Tumors located in the deep depths of the frontal brain shares, exciting subcortical nodes, are manifested by massive frontal syndrome, central in the structure of which are:
Rough violation of targeted behavior (aspontative)
Replacing the current and adequate performance by systemic persversions and stereotypes

Practically, with the defeat of the deep departments of the frontal fraction there is a complete disorganization of mental activities.

Aspontaneity of patients is manifested by a gross violation of the motivational and consumer sphere. Compared to the otherwise, where the initial stage of activity is still present and patients are formed under the influence of instructions or internal motivations intention to fulfill the task, aspontantia characterizes, first of all, a violation of the first, initial stage. Even biological need for food, water does not stimulate spontaneous patient reactions. Patients are untidy in bed associated with this body discomfort also does not cause attempts to get rid of it. The "rod" of the personality is disturbed, interests disappear. In this background, the estimated reflex is stamped, which leads to a clearly pronounced phenomenon of field behavior.

Replacing a conscious action program a well-streaming stereotype that does not have any attitude to the main program is the most typical for this group of patients.

In experimental study of patients, despite the difficulties of interaction with them, you can objectify the process of stereotype. Their violent nature should be emphasized, the deep impossibility of turning out the actualized stereotype once. The basis of their occurrence is not only the pathological inertness, which is observed and with the defeat of the premotor region, but obvious stagnation, rigidity, the trapidity of those forms of activity that managed to cause a patient.

Elementary entertainmentThe premotent-subcortical zone occurring in this syndrome is especially pronounced in this syndrome. At the same time, system travelers are also arising as violent reproduction of the action method template, its stereotyping. The patient, for example, after performing the action of the letter during the transition to a task, draw a triangle draws it with the inclusion in the contour of the elements of the letter. Another example of system entertainment is the impossibility of performing the instruction to draw "two circles and cross", since here the patient has a four-time circle. The stereotype quickly forming at the beginning of the execution ("two circles") turns out to be stronger than verbal instructions.

We should not forget about the radical of the radical of the radical characteristic of all deep tumors(specific for a certain area of \u200b\u200bthe brain) mental function with increasing load on it, in particular, with the duration of operation within one system of action.

With regard to the syndrome of deep frontal tumors, this provision is important in the fact that aspotion and coarse peasements may arise quite quickly, already in the process of working with patients.

Deeply arranged processes in the frontal brain departments capture not only subcortical nodes, but also lobno-Diecephalusproviding ascending and descending activating influences.

Thus, in essence, with this location of the pathological process, we have a complex complex pathological changes In the work of the brain, leading to the pathology of such components of mental activity, as:
Goaling
programming
Control (actual frontal bark departments)
Tonic and dynamic organization of movements and actions (subcortical nodes)
Energy Support Brain
Regulation and activation (Lobno-diancephallations with both activating influences)