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gl lNvATAMiNrutul
MlNtsrERUtEDUcAIIEI
Prol' dr' doc' tlvlu POPOVICIU
Prof. dr. doc' CONSTANTIN ARSENI

sEtvllol"offi
LA BOALA)
(DE LA SIMPTOM

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fl rlo^ooolcA - lucuitlll

BEMIOLOSI-N NEU ROLOGICA

PRETATA
Probleme d,e cl,iagnosti,c topograJic pi. etiopatogenie Ln: l,eziunile nerailor cranieni,, paralizii,
tulburdri d,e tonus muscul,ar,, ataaii,, migadri
inoolunlare, lulburdri de sensibilitate,tindroame
algiae, tulbnnd,ri troJice, agnoeii, aJazii,, apraoii,
tulburd,ri de conptiittld, gi gtsihoorganice,

Pd,rereanoastrd, baza,tdpa o eaperienld,6nd,elunltatd' estacd orice semiologied,i.norice domeni.umedical

rute bi,nauenitd, iar d,u1td,apari,l,ia sa se {Lftee?tii cu
erd,bilaresd, aind, o akd, semiologie cu acela,siproJil.
Orice semiologiepoale li a4tusd, 4,tr,mriate feluri. pi.
cste ind,epend,entdile altarilia ao , nui a tratatalor iJe
aul,a7i, profil. Deoarece 4n literaturt med,icald,uniwrrald, sdrtl d,estul de pwline semiologii - noi ored,em
ritr sl,nt mai. d,i.ficil de sois d,eaiturl tra,tat - e bine a
w scrie cl.tr rnai. rnult, cd,ci fiecare clinician, d,apd,
rtttt4tcytf,ia
Si enperi,enla3&, o Da scrie nntr-un alt mod
d( {ltnd,ire.
Nu trabuie sd, surprindd, pe nimeni, apari,tia
uoe ci $emiologii. Neurologice, d,ugtd,ce dtrinele librdrii.l,or au odzut 4n acapti.ultimi d,oi.ani llratatwl nostru
d,oN ettrologlienn cinci uolurne. Aceastd,carte a noaatrd
pinq da.fapl, sd, umple un gol e*istent:l,n aetiaitatea
th pi au pi o, nxed,ieilorneurologi,. neu,rochirurgi ',,si
okiat da fl,l,tespecia,litd'li,- medicind' generald, inler,niil,il o,tt,alte cuvi,nte oricd,rui' clinici'an ind'iferent d,e
ptojill yeaum Fi tn a,ctiDitatea,d'in 4nad!'d,m'i'ntuluniacfd'l/j.r pi !)ostuniaersitrar'Ne-anz gtropus sd aborddm,
o alNd'morl'al,i'tata,mai practicd'.,
ln pogini,l,o o,oestea,
nai qfioCan'ld,,itre anpunere a rnatari('lul,ui serniologic,
?lrrnlnil da I,a dmptomul' iaolal, tau tn' conteatul.rnai
hrg pl alungtnd La boald, In nocaato oonstd'noulalao,.
ll - ortdql|n nod - nli0l6tNta odrlii nonntre, 0iti'lortt'1,

,t)u,putoa,lnltlni toala noilalitd,l'il'aila bnbinnra n ll,nt.

o sinl,aal,ila ternneou lllo diagnottia, oara
Tttomotror,
d,a
td-l orientezainreiliat 4,ntr"o ileci,zi,ediann,orfliad,
atlcc'
urgenld pi,,itnTtldoit,[nlr-o atitud'i'nel,arapuulicd'
I'n sistamatizarea
tatd. XmTinim, grrin munco d'epusd'
praat'ied'
dndalungatd'
a,castui,material cara refleotd,o
tra patul bolnamr,lui, 4,ntr-o asid'ud, actioi,tafiaalinicdl
un d,eaidaat major, dltctatrd'e misiwnea med'isttlu'i
practiciatt,: ajulorarea bol,naawlui. Nd'd'd,iilui'mcd'
prin acea,std,carte ne aom Jace wtili nobi'lei' sarai,ni'
cnrene std,tn fald,, 4n sistemulnou d'ed'sistenld'med'ical,d,
d,i.npatria noastrd,.
AAIORII

CUPNI,NB
l. lrlr|durnto
cioslonl
l, ln)lrlnmc di dloUnostlc topogrnllc tl etloPAtogonloh lezl[Dlle ncrvll'ol
I
.
lr.rtologld
:t,1.
Percchli
t.t, l,utologl{ Pclechil a II-a
"
'
"
' r "
l.ll, l:robl0nlo dc diagno6tic ln exottalmii
otorii
oculo
patologie
sistemelor
tn
dlagnostic
)
dc
'
' ' '
Itrottlor
l.l.
l.h, Prohlorno de dlagnostlc lr! patologia nelvului trigemen
Li lrroblGt o dc diag:nostic ld patologiA nervului laeial
(cochlear)
' ' '
L?. lintltlnnrc de diagnostic in patologia nervului scustic
g,l, t robklrno do diagnosttc tn patotogis slctomului vestibular
t,g, l1$ltonrc dc dlagnostic in patologia nervulul Slorofaringian ' ' ' ' '
l.ltl, I'robl no dc diagno8tic ln patologia nrvulul pneumogastric ' ' ' '
l,ll. lrobl' rtr de di{gnostic ln patologia nexvului spinal
Lll. t|rot,l(uc dc diagnostic tn patologia nervului hipoglos
paraliziilo! rnultiple ale nervlor
'J,lil, lrro}|lrnrc do diagnostic in patologia
r'flrrlr!rl bulbari
l, }ltrtlrtlr do dlo0trostlc In parallzti
ll,l, llrDlofltrcu scnlologic{ a delicitelor motolil
11,2,ltllnrh0roo t0lsclor pareze sau Paralizll
!l,il, I'rohl{ttlo do dlognostic etiologic ai topograllc ln divo$e pamli'ii ' ' '

721
183
13S
194
19t
168
i08
170

L Fmlhrnr dn dlo0nostleh tulhurirlle tonusulul mu6euhl

a,l, llholonlllo musaulare .
a,t, lllDfrtorllo mucoulqre .
do dlo0trostlc h ottrxll
l, litltenl$
ll,l, FrobLrrno do mctodologie seiniologica
}1, PmllloDro do dlegnostic etioDatogonlc ti topogratic
tEvohtlt[lr
ao ilhgnorilo tn semlolo0la ml|oitllof
l, ltrotlmr

0
t0
TO
t6
g?
40
78
84
92
0tt
11r
116
t 18
[10

r80
180
[81
' ' '

101
191
100
,08

l, ?nltror dr dle0Do.tlo h tolburlrllc do i'rtlb lrob

do sandologlo
t,t. nloonundlrl mctodoloSlao
?,3. Froblomo d0 dlsgno0tlctopogtqllc $ otlopqtogenlc'
?,!1.Froblono do dlngnoltlcottologlotn dlvo!'so ilndtoamc atglco
' ' ' ' '
l trulhur do lth0Do.tl0 tn iuuurtrlllc troll0o do orhhr lirlor|'
t,i, ?ulbt|rdrl trotloo alo plolll, al6 frnelclor $ ilo lo'uturllor $ol ' ' ' '
l.!. T lburirl tt0tlor orteo0rtrlcuhr!
l tl. Tdb$rirl trollco nrurol|lo$

210
t10
,16
It6

' '

'

||l, !llDrrlhrorlllc
1,9, l)lrtonlllo
l.S,0onvul.tllo

246
,46
!{t
t02

9 . l "o l, lonrn

dth x,^ti.
'tn
11.l. A gln)z ii l r l . r r c t i t o
l ).:1 . t J noz i i i c v i z u a l c
:r.;J . glloz ii L ! : r u ( i i t i \ c

I n r r 0 r ,o ztl

270
27(t
275
276

l )..1 .A t jnoz ii l e i n l a g i n i l o r . c o r p o r a lc
I0. l|rubll.|Do dc diagnostic in
tulburdlite d0 vorbiro gi lD afrzil
t().1. c t ls iiica r c a t u l b u r : i r i l o r
d e vo r b ir c

2'.19
2',7S
275

1O.2.l ulbur.;iriale rnrisiunii si arliculirii

cuvintelor

Io.:1. ' l Ulbrr f i r i r i i r ] t r c p l i c i ,

r, . r L.rlc

co n r p r r jh cDsiu n ii,Io r Dr u tir ii

si rfxp}esici

siurbolurilor

I t. |||rttrnr(! dr,d i l , D o s l i c i t l l r pr a \ii

l l .l . I )f f i| lit i i
I 1.2. l, l\ iur)cn u l l l p r a r i i i l o i . .
l l .:1 . lirrJ l, l(. r l i i c c . . t 1 c a p l ,a r iir i
l i: . Prrbleln( rlr { l i r l l n o r t i ( i n
l u tb u r ir ile ite co n lti( a ti ( r u n o stilr i)
l :1 .1. l, rir)ril) i j l f r n f i { ) l t o t o p i { r csr r r io to g ice J
d e d ia g u o stic e tio lo g i c si topogr:rti c
I il. l i rl b ur' t iri t )ri h o r , r r f t r i . r , .

:1,,,1",
lll]..i
:1.:J . Sirx
lro

,' (tiro.lr ieziunitc

,tiIlp,,";", *.,1r...;";.;
*u.,,,*,,,,i., ,,""0l"i

l | r t , ( l 1 r i ! ( i e l e z i u r i ir 1 n u clcii b a za li
l i l .i l . s ; ndr. )u r r x , ( h t c c l r l L : ziu n i
co r ticu ic
I:1 ..1.SiI (lrrJ l l r c i h t f r t r j c z i rn j
d ilu zu
l :l .l ). l. iiudroa n r c ( t l t c ( l r l o z i ur i situ ste
D .\,.r r ia tc e tr jc

282

1.INTRODUCERE

295
;J02
J02
315
:\,17
3.19
:i51
352

Penlru a veni in spdjinul rnedicului practician neurolog

ll, llll llrr)plfssii scriem
I en?,iologie
neurologicdd,eurgenlii, itt <:lra
rl'r rrrr .r rrrr prezenti,m^ceasita
in mod analitic ttiversele semne subiective ;i
,,r'r,, tr\ r.ir,irr numeroaselesemiologii clasice,ci sd,sugeri,m qi si, coltil_
'..
r rrrr rrrrrIIr1,IlIlposibilit5,ti diagnostice sindromatice qi de boa,li,,porninri
,lr lr , rrrr.lrrqirrelementarS, cu alte cuvinte Sd,potnim de ln sint|tltrnt,
,l | ,rlrr'., rr ll, boaliirla diagnosticul neurologic, care si, perrlliijti iur(r(lirLl
rillrr,.r rrrrr.irr,iil,rrdini
practice,de urgentf. .Irebuie sd pornirn dc la irlrtlr,
r.r ,lr,,"r', lrrrrl nelrrologic necesitd,cunoa$tereaunei semiologii prlcisr.,
r r I rr.,,r, ,r urrli discipline aproapo matematice.
| | , lr,,, I rrrl,ua5, metodele paraclinice modeme de rrrin,cDrrrcrzrc
L| ,r,
' rr ''rli ll[ {iaele (electloencef:}lografiaclasici, $i cea inrlrogii(ilir
, rl,, 1,"1, rrrri dc informatici, scintigrafia cereblali,, ecoenctlrilonr.rr
I.irr,
rr , rl' rr\ , rligal,ii ultlasonice, angiografia celebrald,, studiul cfixrirrlrri
lr,,t,t,l,', lrrr'rrrnot'ncefalografia
clasici ii frac.fionatl, angiogll,{irrspi,r ,l , , l,, lrorrriogllfi:r cu rirultrplelesale adjuvante, elcctrodiagloslilrrl
rlr lrrrrrrlr,r'r'rirlo dctec!ie si indeosebielcganta,miri{ica, spcctacuLlltsr
r,,r,,'j,r.,trirr,irrli rornputelizat:'i
) au liirgit considerabilcimpll ilc inrros
lt1, 1,, ,,, ,i rt(,l[]gio fi in neurochir.urgie.Cu toa,1e&coste&,c)itl,itot,(,I
iuitr.it,
lr,r rrr lr.rlrrr(i;i plccizie nu pot sd,,,dctrongzs',exandlul clinic, rr rli,rrti
,r,,,,,r, rr rr:rr'irilrrlri,
fine{.etlebuirr si, rliri jcze al,it indic:r,{iilo
nr.l,,rlolrr
l', ,, 1,||,.,, \ l)r'riolniti SuS,ciii fi iusta,it)tofpr.cltt,c
lt cer'C0t?il,ii
insirr.rrrr0n
I lr ' 1,r i, ((( l{,{ i.rl(,rlcl(jdf, (:,t:Li;lrc,clitricianulntr ltolltc llpsi, rrl nrt
rlin cinrliul rlr, ltrplli, trrtl,otlologicrll(xl(r.11,
|,,,r1r,lr ,,r'IrrrrirIrrL)'
rlru:nioi
(xtlij{t)i')) rlr"r,iillrr nrol'odologillrtlrxl0r'rrii.
trr lrrrrl. lr
Nrr
lr.olrrrir
',lirsrr,l,

' ,r rr i rl r,r' r l rtl l rIrv l Ii , i tr:ri l l0 r lf 1t r lt lc, isc vlt , 1: kt o t t t r t r xit r t t r , t t llit t i0
trl r i . trl r r,rrrr ci ti 0 i tr rrui srrt ir $ii, ( xi( 't t l. ( r zt .1xr 0lir r it . iir r rlr l gr |lt ir r t , r . sl, i',
t,rl rtl r' r | | III:| (,Ii | | i ru.t.l rrrr l tr' l rtrit . r r f r . r r lt I t lr . .

l ' l l l tr' l i trtri i n.l l n.nrl t t tii ( r t t r lcot r lr i vir t lit 't ', t t t t t i r t lt 't i glilt it lr ') , r : it t l
l " ,l I' rtrl rrr.r' rrrrvti l ,r' ol l rrc livo r t r , t t lr zit t t t i t ir t lt t cr , l: r I ilr '. llillt r t ir t , llt t o
l trl rl ,r , .| | |r| | | | | r(' i I 11i:rl l r, i tr[.r '( ii gct r ollt lo lt r r l, pt 'ot lt t r t 't ll ilr lt t t lt t t r il t t t r vtilr '
r,l l ,r, l rrr 11/rrrr ruorri rrgor,r r r r r 'l: r lilrSr
'. '1xr l, ir r lJlt r i t t t lt t it t gr t t 't t r r cf llilr ,( pt t t t t
l rrrl ,. l trl rr,r' rrrl rrrrsr' ,l rrtrl ilr ') , ( . 1( jr , f r r lif t \r , ir t t l'ict ', t t t ct t it t gilr r r r 1t ir I t r I I r icr '.
l l l ' l ' trtttl ttl i sntr: (l ( t!l, r r t . il, ir lii t : t : lu. l, iorr:,,t t r livlr so I r t 'r t lizilr 'i r yi k'
rtrrrr , l rr' l rrr rrr i rrl rrtrrl l rt r r :lrr ,illr t t t ir lci r ir zll( f , ( '( lt 't it ( tl, I lt t t r t r t lit u'illl zt r r r i
rl l ,r. l nr,, l l rrcl rrl i rrkr l l rtrr ci cit r t r t if ir r t , r lt noit lr t lui ( cu lt 'zilt r r t l f ikr t i'lr r l
rl l r,,i rl t\ | | l r. | |(,| | r'()| | i | ()r' l xrlilit |'ici I i, ov( t r l, lliLl,ou sl|plit inr 'f l, t , ii st , ct t t t t lit lc
osr niilo po$t - lr : t um a l ioo pl) 1, t '( ! ( it t lloit I lt
C' PROBLEME
DE DIAGNOSTIC
TOPOGRAFICrt rr \ rl r. ,rIl ;rr.Ii vr' ). l Jrrcoli r ur( x)
nt lr llovii, ur i, lr , bulllului t t lllt cl'iv r yi/ sr t , t t
r1lrr l .rrrrrrl l rrrrrurrri l ctLl i , I ) lir
4. $I ETIOPATOGENIC
iN LEZIUNILE
rr Irl rrrIr'Ir.Ir,Iololluclivrr. AllcoI'i ba,ndelotcle ol1'active pot' Ii lozrr,l'oplitt
NIiRVILORCRANIENI
l l r,,ru. pl rrl i ;ri Lr rni ci ul c slonojdului. Jlxist l sil, t t a{ii in t 'at t t r it t ot t t st t l
it|"r Irl'.rr''r1ii rroUr'ochiru] gio c, ridicarca lobuluj frrrulal pttillo ltftrt'l,a
I rrr t rrI r.Ir' I r.I r, rrllrrr,livtr, (iilro se atlal po l:a!a, inl:orioru'i, a, lobulni orbilrrr.
A l l ,.,,rt, l rrrrrrurl i srrrcl c, dat li leziunilo vasculluc lot ir nt l'olr r lupl, ur N'
Intlad,ucere, Fatoiogia nervilor cranieni este deosebit
n'||r ,r lrrrrir 1r|rIicrrIrrIrrivnscular provcnilj diu artur:l oerobralil ruti;trl'ittit
I l't.
Irogu,l;ri,
de
rl,rial5,,
atit
stb
proceselor
ryi
morbide xesponsa
.aspeetul
r,r,
(Dr*loix
r
1l)l-;$,
r.
rlr.
r';i
frilrtt'fla,
rr
vrrscrrlrrtizeazii
bulbul
olfactiv
$t[r aslrcct,rrlcontiguratiiloi ;i al contextelor patologice
fi
'.it, fi
I l l ' rl l rl {, l \l rl r16r.scu,
1l }?5) .
.\r:r.:r,:,t,ir,
.\cr.irtrir,ir
comploxitc,te patologrot,
oomplo-xrrc,re
patologict, d.e
de multe
multc ori luxuriantx
luxuiianti, si,
qi cler
' | ' rrrrrrrrrrIrrrrrrr'cl| cani o-cer ebr alo pot ploduco r nosm ii, hiposnr ii, t l: r l
(l(,1;{runrnatrr,
,.,r1,'\
pe dc o parte de pozilia strategic[ a nuolei]or de
i i ha luoina, lii olf aot ive.
rl
rr,u tlo 1;crminarein trunchiul cerebial ;i in iorma.tiunile
Ir| | | | f trrr, r.rrr:ostrriS
l,r,l lrrrrl,. lr:rzci craniului artreneazl tlcstul ilrl frecvent hipo- srttr
rulitoonto &cestora,
.l l l l rnl l rl l

porrl;o-ocrebelos,
in stlnca
rrtrrrorfiirnrgicalc.

2.1,PAT0L0GIA
PERECHII
t tNERVUir
0LFACTIV)
ll.l.l. tn prozonlaunor disosmiila indivizi la caroun eorocr6xam

rrorrrolol;lo
lrxt[ intogritatea neuronilor gi n ciilor ollaetivo, esto vorba
dlrosrrrii rlo nnturd
("Miloqescu,1925; Chusid, 19?0 ; Rir
_rinolog,ied
- Acestoa se caractorizoa,zd,
llll"r9.;l'opoyiciu.Fi Pascu,
1.980),
pril'anos

ryi hiJrosrnlirespiratorii (unilaterale sau bilatralo) provoctto ale

rori,at|, e ra. impioclici accesul curentului respirator-la zona olfactivtr
l,) rtonozoii sinoohiinaza,le;b) hipertrofii ale cornotolornazaloi o)

pozo
pozo
(r:ol rn&l
(oot
mir,i &desea
mir,i
&desea rdectato);
inJectate) : cl)
infectato);
d) deviarii
de;viatii do
de Bept
scrt: i e)
c't rinite
rinifa'c.iacuto
devialii
rlo
l,llzo (t:ol
orouitlrl do divorse naturi I f). ozen*.; g) reactii alergice uazalo; h) tum

""""ir
;j
if 'rii.'# fil,.rdsTH' .#.J,T,ii
i:
ii
ll'i;
iii;,
.t
.
"i'.]t-i"i#
j) sl;il,r'i.dupl,
intorvenfii
rvellrr o,orruJgrcato
po etajul supeiior iazal qi pe sin
ohirurgicalo po
nrrr.i;; l()
rr)
fiuli

diverso dorogld,ri
dorssH,ri respiratorii.
resDiratorii.

produse prin aleetarea neuronilor ollaotivi gi a

. 2:1,2, Disosmii
ollnctivo.
?.1.2.1:.Dieosmia (anosmi a, hiposmia gi eaentualparovnio),
ituttalowd, brutal y.i astaJi9 un ilaturAld, Jie'ile obicei bilaterald,'ie
nrtgr,r:lrrlt rrill.oir,r'rrlrrlr,tor.!iuni:
ltl

1,11111111111rr
11iN i ccol l i n i ( 1958, oit a, {, i dc }I iloqescu, 1975) a, u ar i, lt t l
i,ll | | ||| i , | | I rI I t .rr r.rrlcfalopatiilor posttraumat'ico oonsecut'ivo ltziunilot'r'olt
'
ItDl,,rllrl, 1rr,zrrrl:i in contextul clinic tulburlri scnzorialc, inclusiv aartsrnii
1rrr rrprti xi m at iv 10o/ o din t r aum at ism ele clllnio- cor ol) UlL'
Ittul l t,rl rrrl rt,
fl ' l r ' I
l l i ,rl ,)ntl ttt
r(l r:ul ur ( cer cbr a, Le
ant leneazi, r ar 'eor i t ulbr t lir li r ) llir r '
\rrrrrrl r.i rrrrl rrrl rti ol cI ochzia pediculului vasculal pr ovollil, ( liI l
l l tr,
rttl r' rrr r, l l rl rl rr l rrl r,ri ol rl i , calo vascular izazi, bulbul olf llel iv ( I ) r xlloir
tl l ,l l r, r, r, l l rl rH , (l i l rr{i rl e 1! liloqescu,1975) , poat e pr oduc{) r ln( , Blnjo.
lll Itrh
nrlo.t:iut.lii (cu atropirri,, cu rnodinX, cocainii, sulfutir, (l('
r,rrrfrrrrr,, r ) rir .!lri,.i/(rlostnarceXi,(e se pot flolda cu hipo- s:ru ltltostrtii
| | rl l l ,l l "r

il

:' | 'I' l)ivt:flttiu (unosmia, hiposm,iaFi eaenlualparosmia) cu,'inut lntt' ltrti rt prr4tnwit:d. ridicii ulrrlitoarr:lc problomo ct'io-po,togonioo:
lll 'l'trll'tt,trt ,l.f,rt'titt ola-ziw ,,fiaiologice", Sunescenla
po&tc 6it ror,llrr,rr, lrrlr" r'lllr( (i$, i'ot|8('(ntivirprocoselor'fllnolico alo neuronilol olfa,o"
lf vf ;l rrlr lrrrrlriurrilor rru,slom. Unele std'ri,Jiziologicelo femai (graoiili.Itlrt ttun,,ftu::tl / rrrrlleneirzii,uneo porturbtrr'i ln perccplia, milosurilor'.
Fh I lrrnrttri, rlr, l)il(li, hi;xrrosntiir din primul tlimostru de gravidittttrl
l,tllbull lrlpruurirrrlirr rr,lrloik,ir,1i al l,rcilll trimcstru, cu roverBibilita,totu
l{tlhr| ||ur(,1lr,r
ollitrrtivl dtrprinrrqtr.nr,
ff) l,nr,ll luli lynualt (r, (liab(ll,ul, ur'('mia,pa,ludiBInul,homopnl,iilo
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o t lt lt t t liir calt tnt lulonillf i, N,( l( , t ''
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. lriret,c.u,nainate
Wr!ir|. Crizeleepilepucecarede
unor mj
'itzil lrntt lx.l.(,(,p{,jin
srrrrrdrrr':,
rr/ir,,,rr'i{,r([
,i J"-"j:"'il'.j?tS^fl*:llfot slrt iare tz- rloTo

'}:::
i]ji,
:l$::fl
i:,r;l:
;:;,lili*riiiii:niis
rllTf;,],
{l{,!,'ff
{t'.'rl)$r,:
rrr{,r,,,'gimioi
r-i.".-a"p"[,"g;,Jfi.;i:;h#","r",ryHr
;*; ;ilffi 'sT, ;tl
:i,'i'

rura
li:Ii: (,lll;,
r "tc.1
:J':
i i :ll,'#i;
::,-f +
"ff:T,'*
Il:i'iil'
,11i;il;ti,i.'i;i''I:;.fff;
#.it;;'";il:';;'ffi"f,1,",iii'161i,[ii;)r

ru:
"iT
qil
fl',,i?.fl
i:l:lil,'lli:,,11:;l';:ii-':;ilil;,'i"'t#iT[ll1'"u0"",i11Y,;m:.yffil"il
llrji tl;itil* iti,s'#,
#,#
:1,i
tiliibili:rgiliid

r'Iptrrlt{\ o(lol:trll,ji ln oursul

14

I It

2,!. l'l1I)lnXllA l,l,)Rlri(]llrr tr-l

(NlillvUt,
ot,1,l0)

lr lr l i( 'ilr li'll
rrrvcl l tl rl c i trl l rrtl i r, vi rsrrhr tr r , lt t t it 't t r ,it t t t clt ', I it t ll, lit r 'I t ilt llt I t I l,
l rr.rrrl u ,i rrfi trrl ronrttl l xxl tl i olm r t r lr l, r olr t t llr ir t '( t t r r lilit o; t i'ilr i't 'r 'lr olr t t llt lt l'I ) .
dr po. Tt ilo
A J I\pi l i tu. (si ttrl totttrtl t r t lt r iu jr t , r t lohr t lharsuu sindr ont . r t l.
(r'ttt.lrinu.rtsulnrc'u,li) (llintrr, l115!; l\'llttrolcxrrtt, ll)fil{1
rliavrrostie
rdinic' lopogruricsi .tiopatogenic n, ttili ttl,t1||,i0/ousti,
,,,,',,i;;;l'rli;ll$;rlt'
1u,:rlrrfi t.ttrilitt,tuirl?iHilu l)illlrfr'lllt si rrrrilizcltzi't,tta,t"r lrtlbtrrtit"i, lltilr lrzitr
rrrl " i trl l urrtatori j < l e tu,vtill, in1t , r 's1, if ial1'it t xllr hullr lr r 'li, : r t ) Ar r t t ilit lt 'ir
uizuote
r r:rrrrrl sr:ade
in cil, cva zilt : , ut t ilai. t 'lr t l, slt t l lr illt
ii
totdoaruta l ap it l, lt llt al,
sepot exprimain urmatoarete
l.r;rl (cga,l sau jnegal), pini lr o drarnntici arntntrozil; ll) (lirrrprrl vizrrrrl
'11llll{ffiJi,Jcaititlii
lll .4nbliopio lepl.czjntdtlimjnuarer acuitrilii
, rir. rlrr ollicei ingustat concentric, dar uncori tloar sectolial 1sitrtt st ttlnltttt,'
vizurle.
ll\ Cecitalea silsiu amauroza reDrezintd, nicrrl,,roo rnnoti .,
l,lrirrt ccntlalc), vedelea macular'[ liind mai rcspectati,; o) ilitttItll rrtrr
rrr:rlic cste foarte a terat (cu moclificS,ri ale cir,rpulilor ct'ttmlftir,tr,lltt st,,r
lrilatoal[ (6i in accepliuneia,
l,,irrr{f pontru culori, cu discromatopsii qi chiar acronliltopsitr I'olrtli);
c*orectEiinli*iX,-piiiiizt;ne'
ce.nt.",u
,lr \rlrrptarea la intuneric este loarte deficitari I e) Adcscn lo1'oltsii '1i tltr
..io
D) Ilemerabpia reprezinti iliminualea acuitelii
, rr ll rrtilci,rile globilor cculari I f) Pronunlat edern pa,pila'r, prrpilrr,Iiittrl
*,
l.l spl:c Seara.
r,,.rr,,,
lrrlblre, tumefiat5, cu conturuli foarte qtelse, cu sll'ii (r1| I ' I I Ii t'I t l i | |r{'
"irort"
,,.rrrl,ii-rozate. Manifesti,rile edematoase peripapiltlle se itrt'itttl ltrr zott,
,r;rri rrLr cimpului oftalmoscopic, r'ealizind aspectul rlc ,,ntrlttorrrtirtilri,".
invizibilc ( llisr r t , l1) l': l;
' ,,rrr1i rrJl cpapi l ei deveni nd , in accst c sit ualii,
.,,.itri1i, {ininelseamaindeos?binc.rmai.oarete-;i.;l,iii,
g)
Yelele ; i t ,II I t i IIt tr ' It ' st t r l
\1.
n()l
('
s(i
u,
19?1)
D
uke
E
l
d
el
Sco1,
t
,
1958;
;
$i
r.rrulal fundului de ochi gi pi,strarear"tf"iofui p'r!i"ar iiJpiltir",i
inecat
e
in
t,r.rri
r.
rl
i
htate
qi
slnt
et lcm ul lt t r t sir '1 lt ) lt r
si
nuoase
,
ar
t
er
ele
la tuminri.
,
si ctstttlrtlt', r'l'r'tt
i
pedpapilale
hemoragii
l,,:rr'('l(i
papilare
se
obscrr''X
$i
... l') !):l!r"*,atoysja_peytyyalb negru fi tentru iulori reprezintri
zone
t
lc
t
't
lt r t t t llt 't t t t iI r r I lil t t t
tl
,,l
vast
e
i
rsl
l
ccte
trombozd
velt
la,
s:
i
cu
de
in-considerare,'inirucit
aceasiapoaresd,l
:l:,1l,,,1o'1'"]T3"jlrlt-,*:.ll?1
cr,rr,rlio scrio de lezinni ale chiasmei
l rrrrrl :rcr.storl ezi uni ; i ) C o af e, ct ar eavit r osult i se po: ll, o r ( r lr lizr lilr l) r r lt ilil, r '
$
lrr, lrlii (,\,[anolescu,1958) ; j) fn forma de ner-r'i1,Lopticil trtlt'tttrtlortsrirtlttl;r
i!.2.1.1. Amb_Iiop.iile
:!./,,.1.1.
"in "ail'*
Amblioniile
si,amaurozele
am.turncplo "pti"b
n.alra
<; a,,t,-..,]*^
acute si
sul.tacute
;i,
se iatilnesc in
rrl r:rl rrnrr.l i cul ari descri si i dc Rcnar d ( cit at t le Riscr ', . t 95! ) , ', ir r cllr r l nlr l ir r
rors(| ir1(:(i1i1tni,
de diverse etiotogii qi cu vdriate tocatizXri pe
clitc
;,ri rrrrl i o rnasi vi , tumcfi clc, cu ilspect t 1c , , nr Lcir t cii'" lN' it t lt 'r t t lr t ct r t lr r
:.4.2.l.l.1. AJecJiunile in lamatorii ale nerl)I.tlui,
r I rLri,rr'il canalului op1,ic.
wtic
:!.:4.l. /. l. l. Perinct:ritele,optice (nearitele
lrr lrr!r unui tablou dc papilit[ trebuio sii plecizitrrl .lut,lrttii r lio1ul,,
rr.lrlczirriiio irrIllLrnl.r,t,io
Drim:rri, a, tecilor nprl
//ri
r l )r' i n i nvesti ga.{ ,i isi si em at r iccqi r ninulioase: a. ) inlcc( ii kx, r t L' r r lt t l. r t r :
,,
rlrr olrir,ci,r,xtcrrsicirrlui pr.ocesinflamatrol Ae fa'r"eilinld"'Ja"
.i" fa
r rr,l ,ri ,i l l i te, coroi di t, pl i igi per f or at e inf cct at e alc glt t lr t t lt t i oct t i: r t ) ;
(
l') rrrrzii,o (anterioare, sfenoitialc qi ctmoitlale postcrirllurr) I tr) rrlirr'littrrr
r:ii]'ll:1,',;.1":i:,1^'j;'l:1.'.",':'si:l_::t11i.obi$nuilisinttacteitiepiugenc
lr r\ ul
r rru
tl l l,rl ,rro r, i, r lc it
rc l i n g i taa-SUpUrJlivi cprr.bro_spinalri i
ir illlii,
illl in nn|lrngrl
rrrII:rrrrrri ol i ial e urechi i me dii; t l) f ocar e dent ar e I c) ost oit t r I l) r r , lr r ii", r lr r
t,
-di fuzi uni
l(|i.|
o u; r Jr
rrl sr r l ((t,ut({r
l) r r k c ll)
s c nol-tt.
t. 19?1).
lrjl(lcr
ldcr sli
1 i l||l|st.
Sc
fir Scott,
l 9 7 l ). Este
E s l c vorba
v o rb a de ainzltfi in
trl, ; r1) inlrc!,ii generale (scarlatinl, variol[, folrrl'i,liloirlii, rlill'r'r ir', gli;rrr.
lrrl rr;rtir' :r|. rrrrr
rr'.rrcningite bazaie bacierie.ne1inc1u-sii
iaclarc S I
,,,Lrri rl i i -un, ti fos exantema t ic et c. ) ; h) papilit c lL, ll1( r $ilt l f it ll) ir ( llll( ,I t i, l
'rniiai,ato"ti
i'.1,):.,.'.',ii,'flll
lil)..1::ll::tsauale,altor p"occs"
rt' :rrr,rr,,5j i n scl eroz:l i n plici it llusr 'lu ocult t r ', it L lix: nillgo- cll( x llllil( :
l.l:1,',','f,':1,1
1
,il:]:l:rl:lij:_"1,"T:
sinuzjie
sfenoidar"
i,'alarc,se
r.r.
r1 rrrltrr{ii virotice ncurot'ropc (o{tralmonculoln itrlilrii, lrollrt lrti l)rrvirr;
;
::'l:
;:1,r,
I
ll
r'tinicc:
perinevrita
jl;:1,:1:
, r' , r' l rrl otni c-l i todemi el i ni za nt c; I t er pcs zost e: 'I cr r cr ialil, o; I t t t 't t iI t I '; iicr t r , t t lt '
l]l,i::,..1:llr,
, , 1rlr l ri p
rrr.rrllt t ll' 1, .
"pii.a"".iiaJii"#c;ilr;I
,i , ,l i v| ' i so nai uri ).
|)iIr11rrosl,icrrJ
trsto orientat de: contextul general
lil N c1)ritct,apticd, refrahulhard &clttii' :tan' stthur"utii (t;lndnntttrl 7r'slt
/,,r/
s{ , < uracteri zeaaX , i Ir plincipilr , sPt r l t lt r osclr it t r t lt l piLlt ikrt li, t 'r 'illt
-irn"eor,
/
pollrurli
r"rre cx_plic:iambliopia * $i cu la*traiua
.
*
a
ved
rl
rrrl
b:rri l , pri n l i ps:l sa r r r I isclef ia, m or lif icii, r ilol t t ] t ir xl, ivc r r llr t lt r t t r st r r t
l
rrri
,rcrrllrr,|r,).
r.rrtr':rL.)lrr r,rz,rl
cu,zlrlriirprr
ili"i qi
dispari,tiei
a vecleiii centiale se lnsiJeaza o
ti-;-;.d.;ii
|
rrr
i tchi mb pri n prczo nl'll ilr alilor l, t t lbut i i vizt t lt Lr lt t t it '{iot I I t hr .
l ' r(
a-eclematui
pupitr" ;"riuiloio" q,
;i consecin{d
!txtrioristici
:lllj,,.ll.',11:1,
f,ln
I
clinil : lt) l)cl)Ii, l)l'ujr(f, itt c,ilcvu, ziL' trrrlizitttitt tlr' ,,
('l' llr'{.
I it l)j' J o .
"
,l l r.r,r' r, rl l l rnati c:i a tcrti 1 t if ii vizr t lt lt r , pir r ii' l: l ct 't t ilr t 'lr t(rt t t t t r t t t t lt zii) t r ot t t
1,1l :i , cl ri l rl ctt rl i sprtri {,i ir ,pt r tcoplit r i I t lt nilt lt it . st '; lr ) ilt r it r lr r t 'r 'lrlt r r t t ilir {ir
, trt ir r sr l{, i1iit lir lt lgii or lr ilt lr t r slt lt lt r , t iot 'lt ilir , t r ',r 'sr t
r ri rr:rl ,rci i { ,r pt' ouxl tt,l i i si
..r'rr.1;rl. neyritc optice) iealizeaa:i.tabtorii
r ' lr 'r il
r,r' l rrl (' sl l ,l r tl t' t,l l rtql l l ri l o l t lr t i r iililo gk r ilol t t ( lt llllr i ; r i) iJ( r ai( l'll( 'rv1\
t1escciiuJ
afecrdrii
vu,ur"ti"i""-,iitrirJ"f"Si."
;t;;;'fr
up0rc: pc pl.rma
por
. i Ll rl i ,r,rIl .i { (i i l rfitrtrtti
t
""".*. *,:.:i."
l i col o t t t t t ct t lt 'i llt , t t r r t t i t lit r t t , t lsit t t li, t t t t lr lt i 31r ; 1lt t t l,
li:::f:.lll,f13"ll:
.rr|r
il.i,",
I
cl.recuprinde ptpila ".r-""l"i
.irrrl:llrrrllrarJ,
n(.r.1
ul opii(1lrirr;iI:r'zuuartc i
| | Jr' l ro,rl (f :rl ]ol rrrri i trl rr' { r , int llt t l vizt t lll ( lt 't t t t t t t t 't t t lc , , t t I l't ill'i t t lt r r llt r l
l vllsclor centratc atc t"ctrncrin lcrv "i(10_.LZ mln), realizindri-so
siud
l )l t| i r' | ,l LIll iLi i''r : oli, ll) 71) . llt r cr r l i t it r t I I ot t t t r I I '( 'I t ||ir |( r ll( \
l r rrrr :rri rr!r' i )'
Nrrl(,Jiol',i*xt,abuJbar, p4lilita sau sinrlrol.ul dri
_
,l r,:rr. l rr.rri rrl rrrtl l t,i ; rl ) 1' t r cr r zt t t ilr . Fiit r 'r 1, , ( t l : r I r , r 'I I t t r , : rit t lt l, gt t lt t i t t t , tt
lrilpil. rr.vrilr;.i,.domz
I.rrsii,ircrr1,l'l'
srrusrrlliriltrfii;il' (r)r:r lx)r{rrt,r', r.rr.olrrrlrr:'ii,irrl,itrsr,i
l \'lt t t r t t lt
st 't t , llt l'l"i) ,$( ' ilt lllt lllr zli ( ) illr lillll! ) zll lolll
rlrrI
l ,,l ( vl i l i i | | i rtIri | r,Ii .i i ' '

"i'#trXl:::iu^K:T:##,ffi:-ii"$:iilrTi,l":?Xr*,J
,,,'',,iJrv'ffi
tlllLLi,'#'ii?'ifdi""lffi
"'f"""11?Y1
i?:{?::;,;,i:!:,"'i##ii

#,l:'tiH"
i'_lTi,$"",i,",1
r:I l'lr!{,?i'[]i,'i1iii."1iL,slf
se
j:311",
se
Lci' oiieiene#iea
tap ae
]jlj,,lltu'l]:l;.,o:11 llry:fant
"':?n

"fiff,
,1.,,,ir1.,1i,!.1.,,fl"'l:.it'i,
J"i,*"
-l'iTl,:*gx,"ll,';ji,:l*$"1

l6

l't

l)l.lfl,,ll

r''I'l

,,,l.

irrol'L,\ir! l)'J)illt,l.ri ryi rnitl.irr,zrl (rr.v.ll,,

r.rrl,r'l'rlllnritr

r r r r . r r l i r r rr r ', ( r ( . r r r \\r Ii r r ,,1 r r i .r ';.)

h t l , , t r t " 'l 'r ,
l t r r .tttr x':r r t:r tt.i r r ,ttr ,ttr t
ll,,j:l]1l,,",11::l:lll.1:.fii.,":1t,,;tlri;r1;,,,1'r,",,'',Liii,,i,,li'i,rii','r,,,r,ir,,r.rmrno
rr.r'rrrrliL,r.rrllr
un.',,,.,,,r,i,,
ri,",i,],iiuir,',1*i'iili;ifi'i,,i;;;',;,i;i;lllir",l"'T.llll
t r l t *'. ,
.r 1,rr, ..\tfilit,
I
r r r i .r i v r \1 .'t l |r ,r .i l ,i tl r i l :l r , v.r r r r r l i l l r i ,l r l l r l i r r i r r ,
.(
.r .r.
slrLl.rr
rt,rLt,ir

. |rl{'(x)lor.itr.
o
| {' { || | )| I r Dlpih'1.1,,
prr
li1,_(lr.
rtr. ,,fricci
obicei

t"mporatit,
f'enrpo.a
lrih
t,i. it,ii.,,,;;;i'
rt'i rr,llir,ro
,;;,,,,,.,,,
rrn riisnraf
nn
rliscrot
,j1lf,;'rt,'t,it,,.
(tt.s.'-ryi.Ashrvorrh,
rsos,'oit*U'd;"ijor.,"
iir,r""
gi Scott,
I n71).

;;i^1xrs.to|io.rl
c) ; .e) Oftalinoneu"rpj:llte ft;;i;'t"ib;;;;;
ty no".
virotic(.(ruieotd,
parolirtild
or.ioiil'ur,c"ira"e
:]ll,l Ii:l.l-,1
\':tlrorr.it,,
zonil zoster, variceld,l--bacteriene
"piau-i.;,
(diverse), riclettsiene qi
(in special mataria, 'irip,a,no^*]r;r- qi;;Aiiiiloza)
t,rr,l(.,,,{'irr(.
; s)

, l t r r l , ,, r t r rr t , . I r i . r r r .r'r';r
r ;:i i , r i .
l ) ( ) l ,.tt.l l r l i l .i .r r l l ,i i ( i r l r r r l i ;r g tr ,si ,i . r i i l i r 'r ,l r
'. t k r
r ' l ', r l 'r t r t . r , . i r l l l , t'i i i r r r r r l l , .r t .i l i tr l 'r r l r .l r
\,1 ,( i ( ,1 ,( r.H
i l t,r , l l ,'i tv
llBt '
; t , ; r , 'r l r
I t r l : r t'r l r i r ':t tl r l r l i tr g r r 0 sl l r ,, ( i r r i tr r l sr .r r r tl tr{l o t,ttl i ,l n ) l tr r ,L ,
l l l r t ', t r
pllt.lll
l 'r r l r r l : r r r r I r I r o Ir i r .i r .tl r r r r ;r i l l r ,tr s,l r r i i l .r r r l l ,z:r
vl ,'{\t {x,l 't,i tl t. :l
. 'l ,
r
t t r l r r . r r r , I r r r r | . r l , r l r l r . , r .|l r 'r ||u l r r fl i r i l l r l Isl o l i r a r ,l ,0 r ,r l ,i r r s, .l ,r ,r r r ,Lsi
lrl lrull

r.', lr,.rrr,,r'irAiil,,
ilini,.llll{lr,r)itsrr
pr, irril.g
;ri Iilrr,l,rrrixl,irrsrr
Sll. ll:, l,:,1,,
lllltl'rl r,lrrr,r,, lrrrir l:r 1x.r'rli,r'ir,,
rl. lrlrr'u.rrl v.tr.Lrr,(.rr.lrr,rrrrri t,, irrlri
l ||

Fl i tl ,

ltt

'l'rrlrlrlrrikt clinice descriseanterior (vezi 2.2.1,.1.1.)pot fi

rcalizate
tlc t lli .lu,ckri:

chirrinii(in scopteiap_eltic
sauabofiFj qi p"oauceamaul
|r'r| iiir, :r,rrblir4rii,
irrsolite;i de suiclitate,re_marcatd
OulA ieqireatiin
.trr,(';trrr'r,l,oirHli,
rlo citeva
Examenuloftalmologicarald,ciieva elo.
're, nouropatiitoxicu , asiecf
rrnrrtr.rliti,r'rrrrl,irr,lo.tu,ff
de alte
isclemic aI rer^r,r.l,rrr.o
paloarea F.O.; TACR^estemult crescut[.
cu
lllll''l
i'',
,Iiliforme,.
I'rrlril.hr sirrl,

inl,0nsmidriatice, iar reflexul fotomotor este atrotit.

Nrur,,,u,tr1.1r,.oTtticedin
barbitu.
.alte_into,ri,calii
'aciri
.(optgchin, f"iiix mas,'etc.)
t ilr.,., irl (lo.
ialicilic, snli"itnti
'r
',.r,r.lrln,bromuri, injtoform,
sini
Irrr'tr' :r,u,rrri'itolrft! cu cele chininice, dal,oriti *u'""oirro"i'o.
;;;G;;i
v;r.r.rrl:r.r.,.
rrsrrpr.rr.
cclrrlelor_ganglionare din reiind ,i ,r"pau fiLruioa'n"uI
v,r;u,r.(\frrrrrrlr.sr.t',
t.Di8). N.europatid.
opticd din intoiiealii iautd araenineld
rmporr:)nle, cu evolufie spre amaurozi in citeva zile,
,i1]li'.,.r.,.,,r:,r..,1,,'l]],'(,1)u

!1.,l:::l9ll.l"Irn,!,yii,,cu.srrimtorareaconeertrici a cimpurilorvi]
llill,i,.,
z : rr, . , (.l t i rl r: llt lt a Unet m p o rta n te a l ro fi i O p ti C e .
por realiza nevrite-optice, inctusiv papilte.
jl) ,,r,i::1,::.i^i
,,:!!r!!ci
1 | r'n.?rscnutt
rascutarepot produce

retinopal,ii;i retinopipilite ede.

r (.1.1)tr*r,
.^r'u r.tllizeazl dramntije
-ambliopii_amauroze, carc tiebuie cu
grij:r rtili'r.r.rr.{i:rl.r.rlc
prpilitc :.r,) Rrtinopatiie
din atrrusiieria si d,in hipo_
r|'|tittt||tttr t'rttttuln,L sii (loClarlfczo
inrpol.tanteexSUdltopl,pilurt,qi pCri.
F :llrilirtl'(.(l(.tll'uIs(',.prr.clun
1i lcmor.:rIii,cJr,(.tntr,.nclzl: sr,,irtr:ri
ma-uivo

:frr\ I'r'{rf,flf ; lt)

I toDtl)tt3(lt' r(

oeSe S(.,1.0
Afterinle gO lrtS0l,r,S0rl0 irr rIll,ul.oz{},

'

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I952

\ | rrI I i I rrrI i Irr,Ir tlc. .lucl,ori etiopatogenici ai nevritelor optice

dc noi (Popoviciu $i Pasou, 1980),pe
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:r Ir||rIr|.r'r|irs(|
publictilc indeosebide Dukc-lJkler SI Sco
sirtrlii slrr,listicc,
(r1rir):
ll l"ttt rt\i itt.lltuutl.ar.i.Lor:ali ,1i ai B.i[.C. .. a) Uveitc si I'etinite i
l r ) lrrtrr'(i i ir r lr , r rr r llr ilr r r.c ; c ) ,\Io n i n g i te o to n i c e (i ndeosebi brci l ara gi
lr , lri :r);rl l
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tr.ri,.r r,, rlr' ; l) 'l'()\oplltsruozir,;g) Tubelculoza, fic prin lropagare, directi/
rlr. Lr ri lrrclrrlilr vooirrc (proceso tbo intra-ocula,re, iridociclite, osteite etc,),
lr,. rlr' lrr o rrrcrrirrgil,iitbo bl,ztli,, {tretermlnii,ferromenc de ne.t-r'iti, gi rI0
t)(.rrr,vr il;r oplicir,, clrirn dc pl.pilitd, (Sverdlick, 1964, citai de l)uke-Eklof
rrr ll ,ri l, l!)7l). li,ll,rl\rli ljoitte dctermina un tuberculom Solitar masiv
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,,,,tr,,,.,,'
( l l l o l l ( l r ' l r l l l l l l l l vr '
i .r
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l) . 1 r'r':rl i z ; rlr c t r r ilr L' gi; r,rrl l | r' rl i ' ri l l l i o 0 -1 ri | l trri rl rr,l i r,rl r.rrr,rrrL:r
rl r, l l ,l rrl ,,vi r
|lt i.L l rn {'rl (1 1) , 1I t )i, t ' r r l rr s | rrs O c i i tz i , d j } u n (1 , rl c r| rl r,r.r,r,l i rri < r,o hcrrr
pllrirr rlrr I)Nr'1olol)lrsijriJi o rrmaurozi:i, prin atrol jri opiilr'i, rlr. :r<,r,r;a6i
pltr'l
rr r I r'ocrrsrr
l istdrernir: (catc intcr.eseazii,artera ofi,lt,irrrici,).

ll\ Ilol.i. .sistem,icali toaico-metabolice: a) Diabel,ul lealizcazi, neulr

lrrl irr,rrlrl,ici, dirbctic5,,. relatatii, destul de frecvent in evolulia diabetuh
rr.r,rrtrlir,hiirr.,cu, se_ml
al bolii (Skillern qi lackhar"t,' 19i9 ; Duk
-inilial optic5, diabeticl (retrobulbarl, adeiea
l,llrltr si Scott, 1971)-.Nevrita
ci:rlii ,ri crr ,,pu,pitjti,',) nu este atit toxicii, ci mai alegrabe
froclusi,
rrrcclrrisnro vl,soulare. Apare in diabetul zaharat cri acid6zi,. anro-a
.rrri.rrsiv lrl biirbali, este dc obicei bilateratd,, cu evolu{ie cronic6; re;lizil
re:'irlcrtir vr:derii (cu scotom central, inilial pentru culori, in Bpecial
rrllr:rsllrr, ultorior gi pentm alb-negm). ModiJicirile 'papilare (
rrl,r' o rlccololare cu predominanll temporald,, la ilebut iuilnalu-se in
'.r l, n{)monr, ('rlomatoas{'i b) AnenriiJe, in lpecial a.ne-miapernisir
;rlrxirro ndeseu novrite- (neuropatii, n.n.) retrobulbare (Oliva;ius, 1961
.ltrru'n, 11,6I
.r(,lH('lr,
pofineur'onatiil
11)61- citati de Duke-Elder $i
19?1); c)
cj pol
Si Scott, 1971);
rrrrLlil,iorlrle, oarenlrare-,
rur,r'rl,ronllro,
oarentriale-,o'rsmetabolrce
diqmetabolice pot atecta
qi' nervii
afecta qi
nerwii optici
(:
o
rrrirrozrrlo(lin pclagr5,, din beri-beri, din deficientele tle vita,rnini, B,;
lilro|Irlvinls din su-ferinlele rligestive cu fenomen ile malabsorbliil
rrlrrrr4rr,l,iilela etilici).
lt) Sutcri.nlele endocrine (tireotocicoza),
l;)_ l,olin.euro?aliile paraneoplaaire pot implica qi neuropa,tii
r-rrlrtrr)rli opii.
lI) ln trlt,imii ani se relateazi, aparilia de tabloud clinice de
p:rlii (irrclusiv.l,abloruide ,,neulomielitd,optici,r' asem5nltoa.r,e
cu s
rrrr.lrrf )r'r'io) itr b<tl.ilcde colagen,cc, dc ef emplu in lupusul eritema
(A.l)ril $. Vl ils(ltnenbcrg,
qi co1eb., l9?2; Shephcril
-19?6;-Fulford
cirl:rlr..llrTl ; \-ii:t|. ;i r'ulrb.,
lg73).
ll 'ltor:itt u:oqene fi.end,o.gene(ambliapii gi &md,uroBeto(xice S_al
.
).
rl.r.r'iri rr.lrrrr.rrrfiIarl,oli toxici, care pot, sii prorluci, nevrite (nouiopatii)
l.rrricr., rljrr
,clro lt)(fnliorilm pe^coi mai importanli (clupi ,\hnoGscui
l{rIri 11iI)rrlc l,)klt'r qi Scott, 1971):
r) N icol.irtu,delorrninii, cele mai frecvcnte amblioDii toxicc.
rrrrrl rl rrnrxriirzi'r
cu intoxiclli etilici. Arnbliopja tnbagicii este'b
lrr r{'oiorrr
r'rr
rl'oiorrr rurnhal
rurnlral (inilial pontru
pontTu rosu
r'o$uqi verdc)
r.erdc) caxe
cale u-iterior se poat
I
ox
Irrrrlr spro zonrlo_peliferice, indoosabi-tmporale superioare. Uieoli
rii, rrpalri
palri rnili
rrii,
rnili multo
mullio Bcotoame
Bcotoame centr.alo
centrftle cu rtrargili
mareini difuze
difuze (Duke_Elriei
{Dr:ke-Etd
lirrrrl,l, Mi l ) .

b) Al<nolul ?rilic produce ,,amblyopi& potal,orum;', probabit pdn

I ilxrvil rrntinozil,IJ, cu tablou clinico-oftalmoltgic a.semlnd,1.or
eu nevrito

opi,iri), din intoxicalia tabagicd, cu ovolutie oonici, Rple al,rolie oDtic{,

t) Al.utolul. metdlk prodrtce mai ales ,rnevlite" (neuropatii, n.t,)
opl,irlr u,rruttrcu:lmbliopio soverl, lar care BoaBo{iuii I miihiazl, parezo $l;
rrrrrrrchilor'(,xtrinscci oculari (cu diplopie, divl'se strabisme qi thztr pol.
prrlrllli),) gi alltr l.ulburiri ncur.o-psihice.
d) N uropalii
opticl ?rin dioerce alt.e mecan.i:tnteloui<urmetabolkn
tnllolJttttrl-rr,u mai dercris in: auJlrril$lutinnc, tlrnoli (nour.opa,l,ia
r.4lt;io6
prlrunouphzitrrl),In trrtnrr,htmoragiilol mtsivo, lrr grtll,i(lil lt,l,rf,In ptrion.
r|r,lo drr la,ut,tr,l,irr
olrr,
'.1.4

' llt ( 1.llr t t t r ii t t t t t t t t 'iI I r I i

, I N t' tttnl ,ql i l ' !,pl i tt ii lt r it t t t t l. lr t t 'iir lr t cr lf lr ( 'r rll'l)
( , ll
l l ,l l ,trtrr' l t 1rl ,i r rrrrl rl i l ti tr r ic r r r : 'llt r sr ,r,lr r cir , t lr it lc r 'l, r r . ) 1i sr r llll\ ll, lllil'lljl,
I
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t lt r plr lr ilil'li''
tIrl ,l t,,1,rr ,' ,r' ,r," ,1,,,r,'(rr r t lt r r [ l) ' {llll pol[ 1, ( rI 't r t llizlr t'.1i.it 'slxNll'r t
i i ,,' ,,,,' ,,,r,irl . Itttrl l o.r'i r r r r iir l'r r Jizii ( xlt l[ ( t I x) l'{) r ii qi t lt r I t t l, t r t lxllt {'ir " llr r t
I t ivr r lt t l
rl rr rr r' r rrl l c ttl t,tti frr sll-it l liilt r , t lt t t t t lsllr t l'o: r 't llill( ir $lt t t gt t it t o, llt '
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llr' t t ivr 'lt t l lt ( r lvllllli olt t it l sint '. r ilt r ', lr t t lit r r lt t s"
l l l ttl r:rl r,l i i l rtr.rrfu - i. lr t : "'t
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Ir ,,1t, rr.nrro rt,.ttrri Lt git t o( lo $llf of it lliii, ct r lilt l l'.
lr) ,\r'r,rrtr,/rroltlitrt tit'r ir:a ;ilsatt i trtu'ttttlol1irn, cu'. srttt ,lrird rrkrlil
,u ,' t,' ,,' ,, tntdt.i pl i i l ,!. , 'lI ') . I "or liiir t nult o I it 'vr lilc olt i'icr o.1xr 1'sii' r r pr r t r iI
,rt l rr ,,,trl ,' rl ttl i tl ,,,ti ,t t t ct ^lir lt t lt t it lilt it r lt 'cl'iolr sr rsit ll I X) slill[ ( f ( i( ilr ll${i( l( 'H
llllt li lllr r r ( r lr llllllr l
1r,, l tr 1,.rr.rrrrl | (1{ i ors|)
; b) ( ) iuo t lollt pliclt lit r ir r t 'ir zilr lii r l
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r lit t
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izo
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t lt '
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1,,t, rrr,l ,
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(M c Alf ir r qi g, , lr r t , . , llt ?: t ; Nilt r . 'sl<r 'lr t ilt t r t t
rrrrtr.
u,,| ' ,,, ,.1,,'
' r' ttrl
.trl$.,1tl ,

11)'il-i
S.rr,l'5o.g-\\7,Llh.itn,
I Srrr.llx't'
r',i,i , rli;l'; i,,'tri,i-;i'tt1a5.,'J9?+;
O liilr r r r r r tlll{il};

,
; Sclr r r f cli \ j
' t l rrr' 1,r., l i )7i t, t9?l ' ,; t r lr , t on'e, r i coJ. r r lr .l1l?'l
tOi 4 ) ; t l) 1lr iLr , 1i,llllli) ( 'r olr st t r t lr iI r ' r 'pl'icc llll l{! lt lllr ) H( 1
l rr, ,,,, i 1i r' ,,l l r' 1r.,
i{' l\'l''
,r,, l, , r rrir*'rtttistticttr,ioilitogrlrii",r',ir, S.ll. li lrici-lllr .vrllrt(lN'zi' spnr
([(1.,t'tulzii Itrrpttrtrizrtlri
,p'ice
:titt
ttearttr:Le
l,rr,lriotofico
rri,rrIilirriililr
of
rfr1t

rlo
,,,,'1",i ,"i Li,',iilt,'irt il'i',t," ,i i t"1., .*u,strtatc iir clr'zurilcbillo tlolittil'tr
(rB1'{r
('llro
ill
i.tt
cvolttlir'r,
nil' ;t,, i,,,1,,,tt,t,rlcci, o otnritili,t inrlelungatd,
(lJrr'llrlS'M'
rii
opticri
rLt'vlitlr'
ilitrh6
i:t'lrr,(ii
ovllnl,ua,lelt,
ni ni'rru"izirzt,
111it,r1r.i
ll r1, ry llirrkrr, lll?it) .
o sclio (lo lno(llllil'i'l'ido trll'o
ii.il,i!. Morlitirtfirilotinlpului vizrtll oforrii,
lor,

rr rrru.ll,rrur,.(]i!I.(l nO p0t fUrniZA, Ctll rUli

a'tl0SOA,l)I'l{)iSO OOR'SpOnlt(llt['{!

i
cll'-osiovont'ruii Jattt'or
i'; ,'1,',;;;';':;;;d,,'iliii',,-t.' *iii- t,iietetiatenionattt,
l
l
l
cl
l
tn
l
n
a
.
c
l
r
r
c
.i
t l t " r " r l 'u n n i a i
t)(.
D l l fe r n
-"
i.c alterdrea otnptt.tu
'i.,,:i:,:;;i'i,,iprli,,ip,rit"tnodat
ittili srm,oloui
"nt'gttrt'lrzl
(tlu![ ]\ri$Ili,rJi
p.t o,,'., lu
t'l-rt,rlt!r
Ttal'oktgiac
",,rrr1,r)ndonlela
'l{)??; 'It,isir, flriZ; 'etnrsiA, 19?0; t)rrke-liklor qi St:rtt'l
r,,t,rlr,' lllli?,
lIirr (lrH. l);
tuhtll'driN
''' r.t.l) orhi'r'tt,rrtirrru'mJcranlitltii"
, c:lro rctrliztltt'zi',r'I).ed(tca
ttrtrrr
novt'it'r'l'
lr)
(prqrilitil);
jL
1,11g,,t
: r4 novi:itil,opfi,IL xtrr,birllrrr,r'il'
r,ir,zi'1,
1q1.
Ir llr,rr ii l c) iHl'irrio,
tlltoi lt'zitttti tIottI1tIt'I
' :1.:1.!.o orhirc lal,/jldtntilttu.tld, l0 tllt.l,oltr6to
(

r. rr| | t

tl rrrv ol rl i tr (t llr lt lxolr i

lr ir 't t lt llt l'klil, l't t t t xt t 'lt lii gt t t t i t t I I I It rt tt 'rI I i r' ) '

t t r t t t ln t t nil. alt ul, it lt t lr o lt t lt 't lit t t t ot tt t lt vt t lt li ollir r

' :' .:.' ,:1, IIn ttrtol ,o'nt
,
| |' |, I t| r' | | \ ' ,
: l. t

'' :' :!-4. Iln tT)|,.r'ttt'

|ll'rr t tlvtrllllr0t'ptrttl,ttt
unl'rdl hrttttirttto,xiahrtlttt'ttrtirtt
| | l ,' rl r| | (\ l oorr,l i zl rLi1xr
r, 0hi rr st t llt olt
, f it r i! - l) r r t nt t lllr r r t 'i, lt llil' lt t t t t r t t 'ilo t lt lt '1
| ,rrt t rI rt rrrri i, 1lt,ti,ult,1xrsloliorttil, a, cltitstntri, tlntlo trHl,ttlocttl tlo i I Icrtl (!illl l{!
rl liltrr'lor trrttlttllltr, 1x11,prodtlco ttlr $(ltlt,rtttt hctttirrtlttl,tlt'l $t l (x)lllnll
Irlrrt rrrlr o lll,oll,r'u jroi'ltcrfcri u, vtrlolii (Il,cllv, t!)(i2 I Wilsotr li lr'rJ(x)ll(!l
r'il,rr,[,irlo I ) ttl<c'lt]ltkrt r,{i Scotir, l.(}71.)lllllr{

clM P VTZUAL

I 12

I
\3

' :1.:1.lt. lln ;tu,l,onrc(lntTaLhernia'n.opsi,ahontonim oiJl(r 1'(\vollll'ot lxrrl'

l|tr r, lIziIr(, Irxra,liza,tir,
1xr zona postolitl:rrii il chiasrnci olllitrt', 1lo ltlt'tttlr'
l . l r r,l rl i c:' i , ol i 1rr l xrl uI o ccipit al.

cAt ontcE

njj*iHiilifiiii,l
ll l;':1lt;i'i,''mliii,{i"',';;,

Fasciculd(' rol!
:: nlzfllt Dl'rl(n,.
lr ' r I r , r . , r lt r r t ( r 't , , r ,

'.:'.i!.1;. Il nnian opsiiLe hetaro'nimeb'item'poru,lese ittliltLcsc itt [r:irrttilr

t,t, tlrtrttr rrlr t irr,sm.eioytlice, t."alizttte in special de ttl'tniii.<r:lttltr rllixt{,itttli;
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, tl,rir iiirloliol prirl sp;tiul intcrpetiuncular, ott ctttnplitnlr t eit t rI t i It r'ttt tt't
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1 l , r r r r l r r r t r l o t v i z r t i r l r ' l xl tl t' si i tttt r r vi tl t'l r {i t'ztr Ittr ttti l tttr tl tsi l t. l tt sttl ti tttl r .
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', , ,r, ,r r l , , 1 r 1i r ', l r r r p i i : r , ,l ti l r 'i ""
;i l i 'r 'r i r i r l ,i r r r r i l .'.r ;r i r r i ''
;;,.
Il
(
'
r
r
sl l tzi i l r l l l t) l l l l i r
l i |'r r tr r 'r l r .
r t r l t , r t r r l i 'l c t
ir,,.'
'"
r r l cr xr r r t i tt:ti n r l t'tttn u l
' l : I l . l 'l l a t t t i t t i i t i l r'l tr r ttr d i tr i t:r tttl i l e si 'l b so l tr l
(
1
117?):
r
r
o
l
l
r
l
r
'
1 t t r , , l t t t t , r r r I o s l i c t : t l 'l i izr i l c tl l Ar sl tti 1 i
i i l l l l 'tl o r '
l t , , l t t t l t t t o t t t d ) 'i r t , : t l i xl ' :r ttti tl l i ( i
I
l r r l tr!
t )I I t I | | I t t t I t 't | | r 'r l r t otr ':tzi i vl r l i l r ( i i l r ' 1 r l 'r 'si tttti i.i tr I't'Ito IIti L Ittr '' L t
'
r
l i t]
l
l
l
l
(
\
p
t'r
'tl
ti
l
i
tr
tl
c
i
i
:
r
l
t
t
t
,r
l
l
,
C r L , t , l r l ) r l r 1 : r l ( . I t r r ', rIr r ,.Ii b i Ii IIr 1 r ''Ir I t ' o

,,;,,1|:tzi,r,1
n::Lmduisa,ua unuiadin p;";r.ttl;;;;ati (fonr
i,li
,,,,,
r,l r) ,'r,,,
r,,lr,'ri,,"r,"'"'"",";;il"l,,Y"1'i"'H,fliliiil
:1:."1X,'.i:"li:i;;

l rr.z iur r i iDt r J or bita re :

ale nerYului optic (glioame, lnot
,ii,r
.:r(,rnr(,.
r,r,..,.r,rt.r.lio,,,o",
{,'it?,ir.ti^.,,-^ p""li.iioi.-;:'fi.ffi;;il:rl"r1*lTi",xt";lli,
-^-,.^,,1:30ri
ili,;.,lj;l:11,'.'"i,lll..,ill::1,""^lll{,i
l,.l;r.rrr;111.,
fr""';;;;" "pri.1_"in,ii,i"""oiiioiuo.,I",,r

i;;g,"'ii,i."if1i,r'ilt'Hii#j'rJi;ll
rrrr){
r',,i,-i:r'r(.ti.'staze),
lli l:ourn,"vin.
1;urotiL,rofiri";;l;1 ;;; ihtfingh,,,,,

p"oces"
io"ito'iitorii
[cet,,ti
i,;li']l)ii,]lll;'i'.i,*j,iJffi:"?Hff;jiilr"groa'n"'
ale ochillui : d.iversctumori, facomatoze,glaucom,
,,,,,1i*1,,1,,1'ri,,r,i

jilirtr,iy?:1g!f-t$d*e{;"#^{#:#y:!;:*{i
::ttr#"i:i,l
;,l,lii

.rurr. l r,onl
o-orbitare,
mctistize,sarcoame.
etc.); ny li"ffii""i.#irql,
trrrr:,)r'r(r(dr.rlo(xic
lrouto-orbitare
; c) I,eziuni'i"til,m"i"G paraorhi
, 1( . I r . , I I I | .I i t .| . . o.t
'

'

'

r.ii r,. I lrc es o) .

II,l t);ntl.trntii
...,., .,

prin,

cranio-e.mefalici:

factori
a1
-pt.otluse'
:,l,r.rnl rofle
bitc ate-sinu,s\rlui
liOit",
'"iloii;;;r;;fi;;S.,'""Yi;,filli
:rrrrli.r';
:l]';l ::]:,',,lr)
i.i] tioti \.itsc.l'ro
,
"""""oor,-r"r1fr

.tist"iui" a"i"lllixT#Il"i"rrit"i
i',r.,,l*,,
ti),rurrrori
intro""n"i"nl,
i
::.',:.il,l:ll::l
, t,,,,
t,rrrrr.r,i
tlc ariri, clesfenoial,

tumori-_;il;fTril;i"ii;i;;ilii
'r,.,..'tir*.,
grionme,siil".,i,tsi;";;;"."-kiJiit.
ro""ri,n,,i
::l',;11:l;1.,1:,1:!:1,:,'1.:1l_qit,i:
r'1 \r rlr,,r'rrr:rlii
,.r..r'ioce'cbrale:
iii'sto"gu_w"r
Ir.:rt: trrr ti,',,titirt.Lirusen:ir Trr"il"i;;i;;;;;^i;Jrl
urnaiis'nr,.-.,;l,i;;;"#"'lo, hcm:rl.,l

iIlrJ||r:t1,,sr r.rl ntduralt.

l\ t l ,).' , lt r r t t nii pt , r t 6 p D r,i tt

J a rl o ri ,i s tc mi c i ;

a) A fecgi uni r:rrl ,

,1",';;i1,,,,,:l,l:: ,,1*tisrir;"r,f
.u-.liiiii"iocrinr.
i l,j,,ij;:i".) Iroli,s,r,.EJuine
;:rt.riatr
1tril
1r.u".-iiit"rii#);'il';#;!ii"l;,.\l'l{ilil

],,':ll:1j1.]:
, r L'r|,r11rirrII{,
y(,s.clall\-o
r.egc[al,ivosltn)a1ice
sillrlalice
LL,I|'',.,',',I':'l:
rIrri rt,i) .,i

f) Boii conEenitale (e\oftdlmia, |r,rrl'r

; f)Bol)
o,,ir

; ) | )isyri,zia,
Iiilu,ri',sii,, lui riichte;;re;iitii^'f
"noE"oit^l"'{oJfta,lmir,
i.s,c"rri"iicotat,.,r rrl
x".
c:to.f,luluzti
:
ful
a)
Co-nstitufionale
; b) Sindrorrrrrtrrr
,,,",,) 1..,,,,",i:.f:..:t

li,"r'rrir'rl
It,r'rrrr'r,rr
.rof1r:t'nio
t".,r,i

I r | , ; rl ) \l )l lz ii

llr , l) { , lr ) tj l o r o r.b i i ,i rri

"*i-;
.

"iliiJiiitli.,tin"

porr,r.u,,,,i

i.ll.il. I,irrrrrrclrrl conrplex al llnoi

crioflalinii solicilir:
" .il. ii. l.
l,l.rtt tn t tt rtI t,linh:
' : . , : i.,' i. 1./. .l nltttttr:tr n t int t liot r : t ii, t iolir r r lt r . s o
.
r r r or I I r I i I I r I i | r , r [ i . t||s I.i rl rl
rl c l ro lrr{ir' (r ' , r rr 1i 1111, q
, I,r., r : t r r . . ir : i, i rr I r.r.rr r i I r, rrI I i ) . , i , , , 1,i ,, , , , 1, . f, , , f , , i r ( | ( t l t l | r
'| l
"ll ;

r,1r'.
1,, 1r, , i, .1 rlr.o|iuirr| or.liilrrljirl. r,r.rrr.rrrl.orrflrrrirrrri
;iit, ";,, ,, ., ; ,, , , 11
.,t lt,l,t,,t.irilr rtrt|,i,,|,,r1itr,.
rk, lirlrlottlclirrir i,i oIlltlrtrrrlogir',
irr Irrrrrr(ic
'l
ttt
Ftr'
iif
t'

1 1 1 1l r l r r r r t's p :r 1 o l 1 r g i r ' t t I I: t t I t I t I ri I
I r , , , l , r r z : r I t t r r r r r l l l 'i l r l o l r l r l r i l i l "l t'
sr ' l ttr tt
r r " r 'r r p ,
l I r I I i I i I l r 'l r ' .\r 'st'r r i 1 i l r r l r r l r ' ( tl l l i s r r ' l r 'r '' l !l "i i ) '

r r l l r r ti l r i l o l
, I i , t rI t rt r1t rt. l i i s i t t r l t l r' tl . o t l r i l r ', :r l t' l i tttl r 'l r r t i l r' l ' r i i r l rr l r' ;i
:r l l n l tt
Ii
|''r
'
I ' r , , , i l , r l l l r t t t r t l c . l )l r ( 'i Ij r ( l r r ;q ti r l i i :'l r ' 1 '' r ''
rlr
.r 't'Ir i IIL ti '
Il ,:
'
l
r
'l
'l
r
'
:|"tt
'l
l , l ) : r : / , r , 'l : 'l l l . t ll r .:r l r ''l tl l 'l i l i l ''r
|'
|"r
"'iIIIIi
"l l l '' | ||||
"":|"il r .l i i o tl r i l r tr " Ii
l
o
ttto
tl
t
i
tr
l
|i
r
Ir
'r
r
!r
''
r
li
ttttr
l
r
'
i
t
r
, , , , 1 , , , , t r , r 'i r t r i r 'l l (
! r r r l i ( ) q l i l l i i r tl t' ;;l i tttr i l {'t l I ' t | | I |{ )! I I | | ' fi
r r l t : r r i i r ',
1,,,,
1 ' I t rI I t | ,tI t | | | i | ( t t \ttl t:;l ttttl tr r l r t'tttl tr ttl : ' rt I I i I r rtI t' I t 1i r' ' l l l Ir r II1 I:tItI'
t t t rro t.t t I r' 1: l l ' r
, r t l , r r , . r t l r 't l o r l l : r l t r ' , , t 1, ' l rt t : t , : r t l l t i o r 'l l tl i i l r r l r r l i r l i r 'tr r ', 1 'r L '
i . t r I r i ( I | | | 'l l I i I l l r '.
t,r r,,
I I ) l t t l r t , r t t l , t l r t l t t rI t r r'
r 'r 'o "r 'r r l i ' o tl r r l :r t'r r ' r l r r ''tt|r 'l r L l 'r i 'tl r l i r ., r r |.l tr l t
': l t r r i , r l r :
't I I l t l t 't t t t t
I r '.1i ,

| , r r r r , r ; , t rr I i I

il\

l l l l :l

,IIII||||III

rt 7 : I I : I

:i i !

,",,,,111
,iij.i,:jl'i;l{l;ll;l',ll:l,lll;;
Iilj;,,)ll?:iliiiiii,X,t,,1ll:il;llll,,,,l;l;,,il,,,li.Jl
"""'li''il,l,1;,;l;;,,:,'',:r;i,),';,,:),,,,,,,":;,:,i;f1i;;-.,!\-df;llll'":i
r.4. pfioBLEME
Dti DIAGNostrrc
INRPATOLOGIA
SISTEMHL0R

rrrttN tl t,i ttl itt P rrrl rl i zl rt (Hlu ll Hr , luilt ilr , r r r r llr illr l, o r r lr , ,I I 1t ir r r r iI r I lt
1 lt f cllilol.
trl i r' ,l rt{i l tr fi :rzrrIi l o rl c
lr r r lr r llzii rrrrI I I,i 1I Irr) . , \ t r csl, cir r r lr t lr r r nr r lilillr lr , xr ,
l)olllo Ail)lt(jiit, foarto oxaal, ftt rrJtrl()t'ril pt[.irrrot1'
r'rr,rrrii
rrltr i irri l,.iilst,r,r',
l rr:ttr.l a l i nri i r. ti i ne[ fi z iolr gi|r , : : r ) , {r r l, ( . r . ior
_ 45. ; [ r r t ( . t
I.i :
I
,
r
,
r
.
r
l
, r i rrl cr.i or- 50" ; d) inf i, r olr r zir l
: li- , {0": t , ) nr r zr t l _ 4. - , ".
Bl I.i.miloreo ctmpului d( not it0lp ;tt pt.;t)irea,bin<,t.t,la1i.:-p
.1i,.
, :r rrr ctzul in care ochiul sdnii,toseste fixator, del afecta,t va suicri lirrril,rrir,a,
rrri;cirilor in maniera indicatd, mai sus. |n cazr in care ot,liul lxrllrrv
cnI'c_fixator, o-chiul sind,tos ya prezenta o extind.ere a cimpulrri rlrr Iixrr(,io

iu,.tlircclia ,,liperacliunii', miqchiului sinergiccontrllaicrl) ,clrri lirrI i \l (Lal ,

;,r"*.rm,m
:ififf*liflri,ilffi
i;$tiFrl
fu",x[

Cl T.imitareacfmpului rL. motilitqte oculard,coniuaatr;.11,,1

ilillir'll
pxpjoreazl prin in.pccla.rea-ex"curslilor
volun
rd
sc
gl,biLr|
"'rrjuga.ld
or, t3rl t0.col]lItzllede p-rivte in sus, in ios.la dreapl,a la stingrr,
5i
Ir.t.r.rIrr
,,i lil solicilarea bolnavului de a rrrmdr"iun obieci caic sc dcilnii.lzr'i
ir,
rlivct,sedireclii: orizontal, vertical, oblic qi in plan medio-sagitlal
(corrvrrr.
r('nt{ ).

i';ffi
**l,-;'pg,f
f
*l*fftl',i"lffi
;3Hl*T.1
jiril"lr',',","ff j$ti:p1r,ir"*:r
,riri;r

ilft{i,:}}}"{*;1$

2.4.1.2. El utliul ntotilitd!ii canjuoole aulttmalico-refletr utilizcirz:'i

rlr'tli procedee: a) Deplcsareain cimpril vizual a unui obihct-1cst
lumino*,
,)l'servindu-se ulmdxirea acestuia prin miqcirile globilor oculari (,,tloll's
lui
''\,'..movements") ; b) Modificarea pasiv5 a pozil.jii r.apuJui(maLrr.vi,:r.
Alrjou.anine),la care subiectul arelendinta ile a'-simeirline globii ucrrl:tri
Itr pozif ia ,,primard,' (,doll's bcrd fenomehon"). lisifel, ia roiarer crrprrlui
rtrre dreapta, globii oculari tind sd, rd,mind,in pozitia anterioa,r,ri,,
ori a,ll,o
, trvilie, fali
nou_a.poziliea capului, .ror privi s'prcstinga. l_i rotirr.rr.
.de
,'rrpuJui spre stinga, globii oc}lari r.or av"tr,o
rielativX':splt dr.cl;rlr,.
,,p-ozltrlc
Lrr }tiperextensiacapr.rJui,
globli ocrdrri vorliua ilozifia relaliv infoririirlrl,
r:rr'l[r flexiulea .apului, aceslia ror lua pozilia rcjrtiv' srrlcr ionri. Ll| llr(li
t[trea capului pe un um5,r sau pe celdJali, sc vor produce^miqc?ilitonjugfl,t,0
tr'llr'-tccu ca^ra_clcr
ghaior, in sins orar cind calui csm aplccll spo rtir.i1l.rr.
rl,rituterior.cind eapul
aplecat spre stinga.^Seva ruriri,ri qi cirmxrrr,ll,ir1,
-este
rl|llrre Iimrtalea ml$crr
or cojrjngxlo r.olullarc 5i rr.fle:r.cu rri.t:rgllrrrst
prin cscitarer labfujtriiciprix teslcl,.clnsicc(rolltor.ii,lc|rrricc).
;,r',rvocai

jiilililtf
t:flr.rriffi'ft;ffi
ri
ld'*f
T-pfroq:*ffi
jiri'i,r1ir,J'llidnilltl[lFt*l::r;i"ilr3rp;;1:;i*:""*r::
,,,,,'"iljli:ilil,iIii;,n:Ttj"i,{'fiii1"fii.
T\;:ii,,ilx."lljy,,
;l ilil:lixl

iiiljinrl:ii;rril{}1l*#il}:ryfffi$il,r1if#*#r,lxrY

Uii:i,ii*i**i$*,ii,;'tr'{it'1fi;,'{#:ffi{f;;i;g$

... ?:4.1.4. Stud,iul d,erialiei paralitice a globut,ni.oautar (Strati.smul,).

slr abismrl se.exploreazS,urmdrind pozilia "globilor oc.;ula,ri
ia privirr:l ln
lllli.Di 14.priyirea in toate dil'ecliite. Sr.&bisial
1sl.ratitic(tlctutirit,1tn.rutr,.,,tni,tent").se. ca,racterizeazl prin laptul cX sc acrentncaz:i, rniitrri, r,o
1xr
l,rilrr:wuliqi dirijeazd,privirea in rlircitria,mrqchiulni fl,Ileota,ti.
i,ukrm lnlilli
trltrLitoarIe-tiprr-ri de strabism a) donr:ergmt,prin
rnrr6chilor
llaralizil
llnlrlctori; b) Diaergent, priu paraljzia, nli6chitrii: atlituctrx.i; o) iu1,ru
tt ticnl. (.surcumrergent)1 prin paralizia mrrqChilol colxrlll,orj rl) l\lrr.,;
tt tttcttr (subsumaugcnl), plil paralizia mu"schilorrirliciilot'i.
I$to necesar ca strabismul (cirrd rru es1,o
}r'ca cvitlcnt) sli,fi{\ rf)iilrr)inl1
rrlif.lrrin testuldruia!.ieiltrimtrr (eincIurhiul-Iixl.tr11,ca{6'1,,.1
silliil(}$),(.1t
rri.lrrin lesiriZdetialiei secuntlare(cirxl ocliul rfccl,or cstc ilralor), ovtr:riul,l
trf jliziniln-so Ei p arirnetrul, lu,i I' i)rst.er.

r'
i
iii:ii:
;i
*fl
t
+ury$ffi*ffiffi
,,v:"
,,i,,:
,iiiiit-i|'i,::,*i#iilii$#*:#11lt
*;,;
-iii
' 'i:',ii;lilr'u*l,,i
,ll1#i:i''',1fl'
ll;iil;ill'lx;''
d1?"iih:,,,"',,,,,'
, . :;..t.I. l.,\ttrrl irrl uotilildlii,

:,,,:iii:,:i[,i,!!i:,:ii,i,,,,:i,,ii,|inri'i:i{;*|;;,-*,1,

2.4J,4, Iiwmin-qrca pftilid t'ottt1t

tttsrtttr i I a MInl?ti,ri rr gfirrlrr.i,1.irrr
t t ltltta du rcguln: ,,boln:lvnl i;i thr<r'r,ltprrltrrolrrirrrrlclrt.r,ri'lrorrtir'rlit
,.ltittl pu,rolizol;tt,ln lncolctttr,a,
ta rl. it t,.,nJ,(,ltHlt,
Itttrrr{rilt
lrtt4rlrirrltt

l0

4t

, \ t t llr' 1, llir( l{,lrllll rilr l) r t it lr t r ( ' lr ( il( f c il, l) ul ir lr l r , r r r r l i r r r r l r o r l r r i i l l i t tl i r t l l t l

ltl
r'rt ltolrll trtlr r r r oc lr ii. l, r r lir l, lt oz ililr qt , l l l x \ 1 1 1 q 1 t . 1 .
1
1
1
1111,
.
li i l r,
l r ( , 1 t 1 1 11 1
rir rr l i r i (. (lr1 (l1 1.l,l, rl\l,rrrt t i t lr r 0lt li. i ( r s t , o ooit 1[ 1r q l q , 1 1 ; q 1 1r1. r, , r . i l q l l l i , i ]
,rrprrl rri 11i lr gilltlu i,
r.rrrrl jz , ir u[- - r uini
os la oopii
rrslrr.r,l,rrl clirLirr rj.e
, l rr I l i I rrlis" o{,ltlltr', rllr (1 ll oit I ir ( : ' l r edlr ( t ibi- l ( pl. ill l i | i i l
lrl) stnului sau

r lrrIlrrr,{ici utrrlrlrirrlrris1cll,r t.leirlo-mestoi{lian)lRiior, iOlZ ; Aneni

1i lo lrrh., 11)67
).

1.1.1.5. lltumenul d,iplop,iei. Diplopia (perceplia a clouL imagini alo

rrrui sirrsul oltiect) apare doar in leziunile oculomotorilor cu strabism
,rIr,or0orni1,otrt",fiind absenti,jn strabiBmele,,concomitentet'.De obicei,
'olrrrrvrrl rlisliugc cu uqur,in!d,,in majoritatea cazurilor, imaginea ,,ade'rilrr,lir' (rrdicii,cea,perceptt5, d9. o_chiulnorma,l), care este n15, imobiii,
Si
rrir.:r.nr.rrrfi pozitia calului, fa!5 de ,,imaginea falsd,t', care este mai puliri
llrilrrcii,oarc,mai pulin neti, d.ar mai ales mobiH in raport cu deplasXiile
rl iv irii (Iiisur. 1952).
ln diagnosticul $i tn interf)retarea d,iplopiei,trebuie si se tin?l seama
lrr rrlrrrii,l,oart>loprdncipii. (Riser, 1952 I Sachsenweger, 1966, 1969) :
r) Irrirginol care trpar{ine ochiului afectat (imaginea ,,fals5tt) estetotdea;una
fullirrcrrlrii il dieclia_ de acliune a mlgchiului paraliza.t,, de piltl5, sprg
lrrr:r,1rl,rr,
strbiectului, dacd abd.uctorul drept este in cauzi, I b) Oaracteiul
[r rrrobilitlto estc deosebit de important, in sensrt cd, ,,indepd,rta,r'ea"
r,|,rl rkrrrii,Lna,gini este mai mare Ia dirijarea privirii in direcfia de acliuno
rrrrrrichiuhriparalizat; c) Oinat privirea este astfel diriiati, incit.cele
orrl irrrir,rrirri$int indepf,rtate la maximum, imaginea cea mai perifericd)
lrrrltitrc ochiului afectat.
mai preais al iliplopiei se practici, testul d,ed,iltlopie (al,
. I)rul,nr, sl,ud,i,u,l
li(lt i t.tlotul.(). Acosta se ofectueazfi solicitlacl bolnavului s5, fixeze gi sd,
rrrriirc:rsri trrr ltr.ivirea (capul fiind fixat) o sursd,lumitroasd,de mici,
rlr'rr$il,ll.c(tlir,crirl uloi luminflri) rDezatd ]a o distante de 4 m. Do
rlilr, i r lr.( r ,rr,hirrlrridrept de ptascrzi o sticld rosie,prin carc Sursa
rrrrirrorrsii,
rrltlrc coloratri.Apoi sursa luminoasS,va fi aleplasati,in directie
lizorrl,rr,ll,v(x1,i(n1,1,
;i oblici. Bolnavul va relata pozilia qi direclia depiaprcc[m qi distanla dintre ele. Una dintr.e imagini (fib6
irii irrrrr,ginilrr.,
rrr r,rrsir.,
r'r,s|i'ctiy cca,falsf,) se indepi,rteazi de cea rea15,mai mult sau
rrri pr(,irr, in l:urr(rtiede direcfia privirii. Astfel, rlistalta rtintre imagini
, rrrirrrrql,rr
1xrrnrisurri ce bohavul pli'veqte in ctireclia cle acliuno a mu$tirrltti lt,lirci
rtt.
po:.,t,(',li
(produsdde afeetareamuschilor ztbductori
l)i1rlo1rir,
ot'irontdl.d
rrrIrIrrrrIoli),rertica,Id,(prorlus[ rle a,fectareamuqchilor rialic[tori sau
rl,rr|il,rrIi)
,".ioblicii (ft!1. i,8,9).
l)rlir inrir,gilloit{alsri i.lparede aceeaqiparte cn ochiul afectat vorbirn
':ln'o o d.illtltic h,ononimd, (sau, d,i,rectd,
), iar dacl a,ceasti,imagine fal$d,
l, l,lrr.:rt:rrh, l|rrtr'il (x.hiuluisADitos,volbim despreo d,iplopti
I helero; tt,,r(s,rrr itt( rtt(iyti ).1n goncral,itiplopi* homonimilsc a5oeirlzilc utr
nrlrirrrr corrvo!'!loril,i)r diplopia hei,eronim,i(incruci$atd,)- cu 'ut striti-

N lil
s

IN IN

IN I

+a

*a)l Moo
v l .q K

-01@,,
b

Fi?. 7. lnvestigalia unei diplopii priD paraliziea nelvului aotor ocular (xlfr|l (lr('l)l'
ochilLl sting fiind normal:
pc'e relr'znkli
i' llnii 'ln
.StiLla r6ie s-! Dllsl in fdta o.hi. ui Prrc ?d lnagnra @lorait F tufL
l mJ 8 i ' e a ro ' i e s " d P p l r. e ? e rr a l l r'', n l D u l r' s
a " o d i i ' l P n h o mo ri n
c onti nr ,o.Se i .r s " r v a'c a eLo
'oi
u
d
Fl
rr!
i
d
h t l ' r'
O
!
(h
i
!
h
l
d
F
s
a
d
Fa
p
i
r,
.
d
i
c
d
t
"
n
l
i
'
a
l
P
a

l
i
t
i
e
Li r bol nav Ll D r i v es l es D r e D ar t.a
P J r' 1 e d
a c @ . i t a z j t i F d i E r8 i n i l . r: i , , d ' * " t i d e n u s d r' . l . r. t l n 1 i , ' l
.tr r gar a" o i i ptopi e or i ani al A j ,n" i sre , . u
pLn
drPrfr3:
spre
lEvrJ'
rn l -l r. i h ' L r! :
$ f i r i . . n F a f rs rt d r" .
,Ac eea.ii nv es r i r a!i e,d" r ,r i ,l a ro : n ' . c a t l a i a . ' i r
" , . rri ' n i -l rI
l I t r Fi s P r' o 5 2 l
d FP l " /

aa t

n$
u w
"el
UH
u8

H
t{

H
n

I
;, eita,J

r,-" I tf,Vt,,
o s( ) l V//tL l n t,
\.4,'/
\_.//
|

ttt rr r l i t ' r rlgott l.

l)( liltlii,: I)i,plo7ti,(,

o|izont.aldh,unzon.i,mii
poato fi prodllsi, do luloz:r,
rrlrlrirrltrirllrpl, r,siorrrtltr l:r 0,IJ., ilc la, 0.S. s:lu do Ia,a,lnbiiochi. l)rurjl,
lt,girrrlrsc rlo;li,r'lcuzrlir rLrlrIlts:lltl,srrrsci)utrrinolse slrtr (1t{.il,l)trit,
(,sjn
rrrl,rrl,
rlllpltrl rrr l'rr rlrrilr,()..1).lrr sitrrattill
rrol(,rario,
tst,cnfocl;;l{r
tlrr,lrfittl
IrrrrrrL, I:r (),iJ. Nli,r'irrlr([iitll,r(,(,irlirrllc irnrr.girri
lrr lnrlttrlrrxoir;rrli rlrr

|tg.8. Diplopie priD p:uRlizir nrutchiultri

d]'ept intern, carc se :lIL'i llllr-ulr u$or slri'
lrisnr divergent (sprc drcnpta). Stlcln fo$i(
s{ rlld plasattr 1lr fnfa oohiului palrllril
t , i l 'l o p i l l r 's l , r i | | c l u c i ) u t , i |r l i r tr x,r i ,rr'
r1,lr)mlI iri roflt (tnrr(r1,fi {lLr lilrii ol)ll(f)
nr. {ll)llrs(:rrzilslr(j !ttltlIrt, oltlntl rlllrl l),,1_
r I d /l /sf/, l l l s:l ) .
'r r \ r l J i r i \ 'f f l o $ ! r c r l 1 l r 8 n (

Iri 0. ,. 1)i pl 0l )i c geuc tal i r tl c l l l |nrl l z Ir IIrt

drol )t i rrh' r' i or d0 l )l ttl rr rl f,.i r!trt.
dri l l ui
s ti rl i r rr)i i r s
Il rs rrl i n l x l t r,fl tl ul l rl l l rt!l
l l rl 1. l rl IrU i D ( r r ol i )rx l i i l rr rol [ (ti r!||c nl i l (:rl
l i ni i ) s ,. i |, I)|r|,I,:|2n\l )tf l " i ' f. I r l l l l l IIl ||
rl rrl l ( r (1l t)ri \i |rr :rr i l l rl l ri rl n i [,,r\
tl
rl rr' , rl r, rrl rl r ((l rrl rr ,l i t$rrl , l l l l :r).

r l, ljl rl l l l r'
ill

;i

lt t l r i t t i i ,

tt('

t t ] r lt,ir

lr ,t1 iIlr ,l

ltttil) jlr ,t

( ll,r ,l,l t

l :rl .tl
l )i p l u lt it r

t't i.illilti

I I t I t ) t) tIit) | ;| .

r ,tilc

r .{ r illizilliL

(.rl r||r

Iri

ri rl i i ,

r l,,

l r..rrrrrL,..r rj r,l ){r1.)r

l ll r r r r l (\ Ir () . 1) . , r lr . lr ( ) . u .. i i l u r tk , l ri i r,rn b i i
o c l ti . .\sl i r i ,,]l ,,,,, ,,,,,,ui l i l e
r t rslr r.rr(r,rrz li r lr r llllr s r r l c rrs rrl r,r,j "l tr-rrti tru a s c
* i ,a " .fi a,.,1,i ,,,,i l (, i l i {.ti cl
.
, l: t
r r, lli,
( 11r 1( lt t l) l l i ri 1 i 1 1 1 1 1O .S . l n s i ti te !i rl i rrl ,r:sri ,
lt l rrl, , ('i csl
r,ezul ti i ,ci ,
I. r rlr rr'l rriri .r ' 1ir . i ir r lt ' ir r rr (J .r).
i i ti a g i -*rlrol"tr_
"
,u l c i
i .del fi rtoazi
..r'r'l rl.plrrsi.li ruLsci lrrrniLroase-A.1
" i uclirec_tii
a
1n ambele
" ' s"
ateotarea
rr l r ilol rl r,r'1 r liit r t or ni.

s$'l

,li:"lli:",:';,:#:;'#;:;,,:::!,,t:;,,","_3;',?'"J't,Jj'lil;,"i"
iyJffiil

Tru

wao

dttl

EE

rut

-l::::iiii.qinH't,iiiilt*,:,*.#ii,:;:,?#;,rl*,ru;11;,1*"*1".ru;; #
d

r .r, I:r slirrg,,. Sc sta'ilegte ciircc.tiadc A"pfi*.r.

, i"iJ"i'i ir,,_oo*u

I;sS

t,r;lril:1ilriiiii,ll,$l1x-"#:'oin{ff
,;t*m:"*|i",:,*;lTg"%f.?
paralizie
"r."

:ll,rliliii;;t:i',ii,Jillll.t""ir.:'*-##
ji,i":;:-..#,J,jljf
;I r

,,,ii,,ii,'i,
riiicr
t'i". aparli:re mqchildr
;?d;L1'JJJ
fr#ii:flf #friH
.l"r, u t,rrrr.i.rkfiicicnla^;,,#ilX
conoriioi,i, ia"-iaca distanta
.rlrr lrr,irr.lintu.taspre in sus, este-vorbacle. p"";rt;;di;;#il;
lnr rlorri irrrrr,gini,
prin inclinz

rrr,rrr{r,lr,s
sc ilnlunc ileterm,,inarea.
ochiuluipi a mu-;ctttului
aJectat.Astfat,
c vollrl rlr ochiul drcpt, daci, imagineaiann
lrosle)est",ma, jos sau

,, I --T-----l
b,
I

1
I
I

Jriq. .17.Diplopie generatd de paralizia

rniEchiului drept superior de Partea dreaptA.
Sti;]a coloraLl s-a plasat ln fata ochiului
paralizai. Imaginea colorate se depiaseazl
snrc in sus, cu atit mai mu1t, cu cit privirea
spre ln sus 5i spre dreapLa'
sc
j e -lrii"azri
p o i t c r e m a r c a . i o b l i ci l a te a i m a g i n i i
''oloiale spre slincu (dupi Rirer' 1952)'

genrrJ Ld d. l ' rr rl j r i l
Fi g. ,?. D i pl opi c
.
muqc hi ul ui obl i " marc (s ru onl l r s "Ir' r r(' r '
de partea c l reaptd, c nre h nl oti rror' rtl rrl
j" '
depl :c eaz e gl obul oc ul ar In af' uJ s i l rr
i rl i l i fnl
S ti c l a c ol orati (l i ni i obl i c e) s ' i
inaintea oehinlui PamliTrrt '

f"?:,iff;"|;;H"Jil"f,,",1J"J;'"ffi,,f1
rerpecbi_v
oblicirl

mare sau dreptul irfe'_

rror pp de o prr le (coboriforia.i globnlui
I n.
.-r,
*
oc.ular)
Mu dreptul superiorsi-oblicr
]
lq
p:.
--.:....., I
|
.rl1'!, qo a.l1,ip.Irtc lridicitori/. Asrlel,
orca_drptolrr
verticalflso lccenlrreazi,
,".... I /_
I
|
r!rs.
la
iit".rl
ridicarea
hdh
sursei
luminoase(sau1aritti_
I
lO
carea_
capului), ochi l fiinal in adrluctie,
muqchiul afectat esteobticut mic (/2.q.JOjl
dcpistarcapdrtii paralii1,i",oi_
llntry
tarmo,ogrjDbtlizcazd"
si prob& lui Eottrnannqi Bielcho.n-sky
: dacf,indepirlarer,
imaginilor se mx,re$teprin inelinareacapului la d.reapta, inseamnd,ci, oblicul
/i Ess
pic sting este palalizat, ln sittratia in
,/--\ | ./h.
carediplopianu seaccentueazi,
in aceastd,
o'(
\ | /////An n-\
I I V/////t
pozilie
cleadduoliea ochiului,estrevorba
\*..
Yal
de paraliziadreptului superior (fig. l1).
I
Daci, diplopia se accentueazdla cofori_
/ r , l ,i l rl r, pi(i $( f n * r r I I d c p l r r a l i z ia
' h llll ,ri l | ri( r)l)ll(:( s
obllc inflrlior)
lea sursei luminoase (sau la coborirea
, I r . lrI rl f . I t ii, (l n r c L l n r D a l t r o r m sl
capului), ochiul fiintl iu arlclucl;re,rnuryr r r rzn{l i , lrrl r)r: u l r t rl n o L r i r ' [t l h su s.
I r ',rl i r r t l lrl s lt l I o l n [ c d o d ) t u lu i
chiril poralizatcsteoblicul maro i,11,,g.
tZ ),
l l/ ll,
Ilrdf l)rlf lrlr o l i n l l r ; t i l l c o lo in
sohimbrlacii,diplopia nu so rcoclrtru-.
r1r lt, I|l l x lI lil nlt r t r ( : l d ( l b o l u l v u l
, l lr ' l I M t i
irzil jn lcou,sti,pozifio, a[unci lllul1(jhiul
I l i t I r ' r \ I g n ( d t r t) {
r'
r.
,
/ti
11)5.t),
rrsl,orlr0llt,rrlitrl'rilior,
Irrrrll,lizDli
_

m,,
m,, ',o1
-o1

2./r.2. Paralizia nervului oeulomotor eomun

in cadrul paraliziilor perechii I Ill-tt' I

Existii,,srisesitualii sen'iologice
slrlr rtlir'
(inconpleld
po$iald
.'t oarali2iaertrinseed
) cu alectarea uJrttrll
(cu
rfr^r'lrrt'r
completd'
rl,,itir." . o..tili u:.irinsi"i iil p)arat'iziit'ertrinsecd
(cu aflctlr'('r' ilr'rrr
iri*""'*t*ilifi"
;'c\ Ttaraliziai rt\rinsecd""trinsi'cij
ridtra rei : d) paralizia totald'(cu printl"l'rr :rlri
;, il;;"ill*ii
;; pilocor'st
intrinseci); e, r) irt mllort ctt.frr.trr'i
qi,
&iGi".i.ii
; ;;;;;;i;ii
"*lei
poate fi : wnilateraLd'sau bil'axatatd
p6tn"nii
a
rrr-a
i;;;;"s;;;;;i*iiri"

o-.ptond
2.4.2.1. Paralizia tctald' a nenu'lui oculomotoraomtLmilmpliax'
a
ilo
a'o{iuno
dirocliilein
imobil
glob
ocular
oo*rrieta ;i un
jos fi ind tol'ttqi itttt triu
""f""fr"aie
(mi;ci'rile
inferior
arupi
i"i"t",
ati,
i'rr(.rirr""
-".ii*"i
bbuc-mar'')|i drc'prsulx'ri'r
rnuqcbiului
,:ii*]"p"!u't" "Tir";"
St:rabi.imulttivirsent csbe foarte'evidenb, irr rliplopia cste orizontllfi ;r
ptpita este midriabicl $i ,,fixa", nercacfiolrirnl lr lttmitrii
i'"i"-ii*i,.
Ir! flcomodare gi la converAoo!6.

osl'o ltlllll
a nerawlui ocuLomotot coT'?lzzr,
2.4.2.2. Itaralizirt' parliatrd,
'corirplel,ri.
tttltttrrrtxt
cil'
fllrl'lll
rolinut
l)iur trcbuio
,no,iireoventl ,fecit oca
lrl th'btrlt
ulcc Irtin nl,rlrlitrlincompleL (prr'rlirLll
i,,itriitil
.lir'
prrrIirrlort
p:Lrlrlizii
Ar:r'sl:r'
",,i"ttt,ltr:
I'ii
.,',,,u
i,i,,..r.i""ii. ii,:'i"-i',,i*ui
1x'.'t 1r:rr:r'lizici'
ll),nN
$lrb
srt'tt
rl'rtrttti,
;;;;;ili,t blli,i,, s,,h t'rtrtil llzitrtrii 'iinoi sing.r.
lrol'vr)lr'
rrllllltl'i
rnttll,,t
tttr!i
ttr
tl.rr
iiii rr ,,*,,i,,ii vrr,r,itbil.rlo nrlr*rr*
^f(nJli[,tr)
vrrrirllriLl'tl ltit'tozohttHrlll l'lrrll
irr,bl,rrrlitltl iltl'trtrttltt'ttr
il,i,',ilii'li','n,,
'',',,fizol,zr1,

l r,"rrl. r rl. rrrrrrl.lrr rlr, lr l . r r lr ( l. t . r ' , r lr . r , 1r i ir I . r ' i' r ' , r l 'r , 1 r l r r r

; rtr rrrlr| trlo r' l:r Jrlr"rl r lr r . r I I t I , r ' I I r I I ||( , .
: ' . ! : ' ,:.
t lt t t t t l l t I

!'t!,ljltltr

t)t ttl tU )l (,l t)t

t lt t lit r ut t t * lir : l47t , t t 1t o. [ iapL t : l i q x r l t r y t t t t ,

t ( ) l,lt

rr ,,lrlr,

1t

r, ,.,,i/

1t,tt.,ti;:iilc

:'.1.:!..;.1.I'uruli.,:iilc lronculare itint ijelc tn:li lutnet,oil.se,in specia!

|rrrr :rl,,,ii',i (.11t.se (lezvolt;i la nir,elul bazei craniului (J,hnsi,ori qi
l'r',1I .lollriou, l1)6?i liucker, 1966; Riser, 19i2; popriviciu
li l?ascu,
I : lr;0). li. rrrl r'li'gc
ilrt,rL]citnerYll ocu]or:rrotorcor1tunp:i}isoqte tt,unchiul
'iL,
( f'r',1'r'irll)l ir li) ila$oioulc,
leziunik: ,,rad,iculare,1
lil accsl,rrivr:l ltaiizcazL
:rl,. i.r'i l'lltill(' si irLcualealo muschilol oculomotorj.il schirnb, l.rrlte
It ttt,tlt. lrr ',i.t,drr[,lrttttchiului rertos prod'c o ]tt.alizie lotali'i dc pcrtcho
l l l. r u (,\(1{il,1ifri'ibrelol pentru mUsculatura ocularii intrinse0i. care
..ri. l,r(
o olul'ciite protectie specialirin lozirLnileblza.le.ltrin ;i:rptrrl
r':r r.lr. 'r'rirr(lc
rr, rrlli silrrLl,trintr-o pozi!ie arialir ir.r interionrl nervrrhri. doar
Itrltrtlr ttsittntrr ittltut't antirttd plotlucintl
1l r , l ri ,r' liliigilr r , 1! ) 50 ).

a.fectaroa pfr,(iorrr lt

llce\loI[L

'' l.:.'.;;.1.1. I)u.ru.li''"i([rcnrcttlard izolutd, singu,latri a nrrvu]ui o0.rlo, ,1,,r' (l,r''r

p,rric lii r.r,aliza1,iido procesc nevritice, meningitice (iriclusiv
lrrr,lrlr'), r'rrlr,ori do alie pluceBe bazale (dupii culrr rom r.etlea), ri:r, de
olrrr li, lrlirr \'(rrit)iilit1c1llcestui terv cu ceilalti nervi oculon$tori fii (,n'tlti
rr, r'r r r.ltrrriIrri, sc rt'lllizeazI sindrolrne tt.otLctrhrc r.-\1r.ilrre\"r,it,\in]e
ale.
l, rr i ,, ' r lt i; r li r lr . r r , r' \ i (.l ttri ,,r.i .
:'.1.:!.:j.l.:.'_,\inrlntu,utt tronc:ttlr.r,t
r: entraneuoJ)iale d,c It::i.tttti rnullifie
, 1, tr, rri l nr t ir , t r i ( r u, r:o i n l e re s a re as i a m o to ta c u l arl l l tl i {:o.t,tu,n,):
\t ll itrtttrr, oIt rtl..tn
oltk:aiaii- Se ltie ci, trunchiul lerr.rilui oculoritotor.
i.,'||||l|r \rrr{l lrr (,l|lll,lt(,1]
(1lt 1,r'ei:ulcle (:uttCra bazilar5, a;r1.era.
cerelir,loaSli
rrlrr.r'rrrrir ril ;uJr.r'l r,t'r,r,lrlal:jllosLcrioari). Aceste configuleirii topog.allice
t , r'rrrl l l z r lr ( ' ir r r r , r ' r r rl rrij rr a rrc r-r,i s me l cq i i n p ro cesel c l j ,ero- sf al teri oI l "1, ll, '

ll'. :l. l..t,rt

I,.l' ..

n lir

s( . r ,\ir li( ,1

,t

n ti,trntttr

,,:! rl rtt6ptl l i

.t l i n

lrlr ,,rrl r l ir r ir , r r l r r nr it .r i ri c v rj s rrti ,rrl t, e c c s tr,rr' -]a " . .-l U i gr" ti ,,c,ftai rni pl egi ci ,
r1'.,r'r.r|. ,lri.r'i irr rr.lriliilio sa,uadolesilcnli, (tiickerst:iff, 19{l+), lr, siiliiircti
, , r',.rrrrrrr l, r , r . r jt ' t r llr
t ilig ro tl o a s o ,l i e ta m i l i a l e , fi e p erson:rl e. I{ i gl en:r, oftal
r rr, ,| 'l I r, rr I I ) : r i( . s ii l11r ' t,l l (fz 0 s a sl i r n i ' m c rz erl u p i i O n i grel ti si rnpl i . Il nrerOa
, l, l ,,l ,l , r r , r ir 1r ' ir r r r r ls i rtrl rl ,,rrr.l !:.r r,;1 c u n i l a te ra i l , cu i ol l l i i z:i r.e or1;i i i l i
||r ;r,,rr0r I r i( I r I iiI , i r , i | l td j 0 ro N l ]l ' { rv c tte x , i l p :rrc c obi cet 1l r cri zrl . cU
il, , l,rt l ',1 . ( 1 r li t , r r t . r r |irtrl ,u .
l tu l s :ri i l , ,rrl e s r.tii u, s rl rL r tl cr gr..r1,tisi r-i i r' si i tul i ,
1, , "r,.
rr ' r
I
l J u l (...\l
r,-.1 , fr o ,.,.t, ,,,.,,,,,i ;1,,,.
.,.i rrt,rz"tl :1,r.
' r ( t , ir . , r t , - ,
, , l. l ,l ;'i r., , ( , r r ) t r r lilui( ,l i r:rrtrrrru ti rl s i r0 a l i z o a z l -r,
.te l mai fr,({ rr1:er}t
o ati gcre
, r rrrrl rl lr:r-: r I r , r ' r ' r , lt iilr t rl l .rt, rc s p trc ti ri d u n c o ri i n e l vl l i i ti i :r1.r,i nseci i .l
, { o,
,lf l, .:r l \ r r . i r r 1lr r , r i rrl i tL t| r.r:s ti l ,0
rn u l t n l i ri l l t,, ai l csi rt, i t.rl soci rti | cu
.rlr r;,,.r'i :r 1r lr . r ' r , lr iil I l1 ri . In rrn d c c a .z rrl i p o a i .c fi i n1,(,i (,fi l l ri
, rrci .rul
, 'Jl: rl rr( (\ \ ' ir lr lr r i ( ) r l) { ri r(' rl )., l 1 } (i l ); .[1 .l rr.< u 1
r,.. 96$).S -rrLrrl t,s,ri i s l i rl Lnr:.
r rrr r( '" r':r'i r ( ' 1r ' r ' r z r l.r lt |rr,i p ri rr rl i Il o p i i 1 r,t:c i ioi :r,trr , l .l i l i i rl rucl ' i , sl Lr [0r,i rr0
rrllrrtr: rrl r., r ll r r r ir lr r . r r iri
i rn g rJ i 6 i ri ri ;' i r.r,rri
o il l :rl rrroIl r,i ri ti (l l < l l L:z5i S ol l rarli r, l l l ti l, ) - , , \ li' r , i, r r ll l rrrr,r,r' i Irr ,IIrrr| o rIrl rIrrl rrr.
i I i r[r1ori l i i rrrrri l rl rrrr:l l i r
'
. u, r ,ri o l l {r r ' \ ' i, it r Llr r ic rl rrl l o l j rrl l l r< ri rv t,r' i ro sl l,c l ti i r.rr :rt.l cl r rl rrrrrl i tl l i
rrl, 'r'''r, ,,i ' r . lr ' r ' z r r r lr r lr r.r' r.ti irl i l :rl ' (i rri .rIr,rrrrrIi Irti(\\,:rl rl r rri (),l rrl ri rl r,,
ll) t ; l l t.
4t l

l i \ l l r t t t l r t ttttr r l r l r ' l tttr tt,r ,,r t'tt,ttt; \ttl ) t't i ( 'ttti t ( N tttt r l , l ,ttl r t :.1 |tt,,i i 'r l i )
rrt tl I t , rrt t t t r' , ( l l l l ) l l r r l l l r r l l l l l l l 'i l zl l ( l i r ,r ', t' l l t
t . ( , l l i / r 'i t z r i . r l r ' 1 r r 1 r 1 ,r r l u r r r l l r .
| o l r r l r . " l l ) ( i l l ; l i i r i ,l . l l l .,i l ) :
i\) fiirult'onl1ti. t:lu,si tlt l,rttltr. x.ltttrtidulii, rtl. lui lirrhtttt I)trtir1ttrurt| :it'
c a i t a {r t e r i z e a T . [ ]xi u 1 ,1 '( ] l ) l r l r l l i zi l ' l l ( l cl o l 1 ,1 |i l l ( l r vi o ( 'l l l 1 ]1 l Io i ( ni . i l l i r i L l l i r l ( '
Sc r e :i l i ztl r tzi i : l l l l Ji l l 'r i ( '\( ) l l i r l l l ) i ( '
a f e c t a r ( 'a f f ) n c o n r i te n ti r , ti o l l a h u i o u l u i '
( u q o l r e d u c l i b il i ) ,, p to zi , p a l p e b r a l i ,
o l ta l m o p l e g i r ' ( r 'tr vJo l r ( ,( 'IIIi II ( I) ||II) I( '|'
imobil lrin 1lalalizia le.rechilor III' lYSi YI), trxttliticitri 1)lrl)iLrl!' (lirilril:i
areactir.-i la luminii Si la acomodare), hipo - silit lnestozi(r itr 1r'r'ilo|irtl

oftalmicdui, reflox cornean abolit' dureri in teritoliul llorl'rrltri rtllrtltttic.

Daei, sint a;fectade$i fibrele simpatice oculal'e, apare o ltiozti ltrritrIIItctrIrrIIi
r1e cocainii. AceastS, tr,iozil ne indici, respectatea g^rurglionul i t'ilirtr' ;i, r'rr,
Dimpotrivii, aplril,ia midrir.zli rr(' rrltrrll^
.afare, o lr:zjune exttaorbitlri.
atenti:i rsllpra unei leziuni intr:rorbitarc, ct lldecta}.eafilrt't'loi' rh' Lr tl:rtr
.Elionul .1iliaf.
b\ Sintlromul de apen orbitd,l' al lui Jacob ti Eollcl sollmirri ('rr lrrl'('{rdentul, dar, lrin distrugerea soncomitellti, qi a giul'ii opti('t, s(' rtrltrt::;:io
leziune progresivii, de nerY optic cu cecital,e Trrogl'esiYri
r i^rtsolili'r si rlrr
chemo$js. Dxoftalmia estc mai lrronunlatl'i, rlecit irt siiltllottrlll llt(\lrtlltrll
.qi pulsltili, {prin comprimalea $i a Yonelor olliiillnicc).
Iractorii etiolol\ici care irebnie dccelati sint :
(peJlLllr sirrr;''ili.'
iriterven-iiile chirurgiotle
- L-actori traumatici:
.de exernplrri ; fractruile (,ralu'cnL' care intercseazli' ii orl)itn: lt:t|Itr|ilrr
.aripii mici a ,ifenoidrlui (cu afec{area ini.tialil a lel'fclililr' Ill ;i l\'. rlrlr
ultelior si a tligemennlui - Rollvet' 195?r citat tle Iloger fi ('trlrrl), ll,(il));
tractura crtstei supraorhitare (in aceasiin sittatie, oetit:ltcll lrlrr{,trtl{'ollrulm0piegi:l).
neoplasmele orbitare i tnclliltgioanlel(' ,'ii uli,r:rrrtllr'
- Iunrcrile:
eryului optlo: t, Inorile osoasc (osteoamo' rnot:lsl'Nze osoils(r, llllriot'r rrrl
.ostcocla"cte,chistuli osoa.se)t meningoencefllocel ; clistut i tlt't tttrtirtr'; lrr'li
prolifertitiyc dt sistcdr (grilluloame eoziuofile, boala, llLi Ilittll Sr,lttrllr,r'
Ch'jstiari, rrieloame, boala' lui Ilodgkin) ; turnoli tle l-ecjltiti,tti(1(ltttttot i rrlr'
r3inusuhli sfenoidal, tumori hipofiza.re; tumori n:tzol:ll'ilrgi{fl)c, itttlcosr'ltr
arcinoarne rpki{.xmoide, limfoe.pitelioame, hemangiot^pili:lirrrt'tito St t tt i
l'asarl si colab., 19i5), Aceste ultirne tumori rlazillc 1i tritzolrrt'ittr.1t('lr,
pot lenliza ilttii si'ndronu,trcleJosi Ttleriyopalnl i n i al I rri lir ht stttt siutlt,,nul.
,tl epl an\eu otb i. t $ d, lllt i Dejer u, in clt o se r cllizpuzr - rit t ii i r I l. zit lt t r r r tt t ct t t t lt t r
,{nlrilal superior qi a non'ulrri clnalul[i
]ierjgoi(lilr.lr (li,rxct' 1i .olrtlr.,
m
{- : t asfillr ir {}( t r t Llr t t t t r , ir li' l) lr 'r 'ir r ! '
191ir
)
ilm
or
i
q.
i
colab.
,
1969; S ri ni vts lt
;
'ntitlntr sau Df[,siallc l.
- tr-scli,ii l\usclllari: ltner'risn c]; iingiolnxr (ir spi,ciirl crrr.l ttorr'rr');
ti oI icc u:.esr caro t idir .
- Ll-ip crrt,'tee, cu ale1brtilat'orlfisulii or'bilnlc sttpt't'iurtt"r'.
ttJ Sintlrt'tnttL in.fracltnoidian al lai I)rtwl.tl st' tltl'rlrrlotizcrtzit pt itr
rci un0l o si n(h {) r }r ului do all\ ( n: l) it al, dt r cslt l}r {xlt ls ( l1r lllr / r / r ilr i! r r ,
< d.t.tl tt" ei ,catt) lillo ilf iar r Lasil, Llllt iI l piir t ( f ir ,lt lllt r l'ir ) lllii r r sit t t t st t lt t i( '||\ r '||||) r I ,
r.l rl q t,r1t!:a,zr i lllr t t l'izglt tr r lit t oit iir : lr llt lt 'iolll( f ( ( l( t t lll( lc l) l( , \ 'ilr ( f I I r' | | | | | | | i I t '||
r:j rrh' orri rrl tri)f r i Ff r ( '1, ( r l{rllr l r 'r t l r t l t ut t t t t lt t lt t i oI i ir '.
(l ) ,S i l //r ') / / / ?f lt lt r iislt r t t l. ir '7'1l1ttt. l7: noidr t liit t l lt r i , lr r &! l r '- r lc lcr r liz: t l,
ri r, l ,rl Irr(| ti cu lr t t t t r I t lr r lt lt 'f lt t r ' llllr lll' lt r l] lr r r ii, llI it t zr ) lr ir r lll) l lr lr r arr lllr r ,
:,rrrri ,tr
sl i ' trrri tlr r lr i. ; . islit t |r r l, 'lr llll't lt lllllli. i{t 'lt t ir t lolf iI r 'sll. r ; it t t illt I t ll r ilr lilr i)
lll, lV r r i \ ) , lt r ' I 't r t r l
,,rrrrlrl ,, l rl rl r , 'r 'lr ilr r t ( l, r r t t t r i r r llllil) 1": 1r clllI t iI r 'll,

4'I

irr ollr!l ln('pl(!grr,'

t'rttittrlt't'iztrttz'i1',ltl

It, Si.Ml,fomu|Lui .It'hrhn' | tllrli) H(\

t1*.7t1i'nauroytrtlirt
';;;l,l';,i;i;'l;;'ll;;;i;Ji,lliii:l'lil",llilllil,"Lilll,ll,il,li:i,i,ll;lll
^;,,i
lii:,;/,,1';11,,,",n
1,1rr,r,rirlri,tr ftrltrrirt l.irt'.''.ii'
rt,rrdloxirr.l)o l'rr,1rl,,
rrta,,rio'rtri
l'rlrrr), lll(il'')
r;i l(t ll1', lll{il.; \V( irrlt
I t) N iurl.nnn.ul,ilo ,nt

l"i
$i llosor' l!)(ill; {lilrlr,lr',1
likx,,iwirr
'
rt,Iosl; tloslrl'istkr Ifisclrot'-llriiAgl
,r' t'littttsu,lrti
de ar(xutltL
t; Bi)mtrom'u'l'
tl..r'i,ltrr
<,ttttttttt
(x)t'l)r.('Hilrrii
.crvttlui
(Lgiiffili se da;torc'Uo
'cltltttttttl,,t'
t[. sltitl'itt (rxlrttr
,,i'castailivus'lui, ca urttt:iro , proccsclol hrloc,it'lr.
ittsl'alaro rt' 1ta'l'rtlizit'i
hematorir subdulat q.a.i. Succcsiunea
-de
"eiebral,
lrritf iazr'i' ;-i
unilaterali
miozi tranziiorie
,,ste
I I [-rt'
'r'in5,toa.rea:
a perccltii l' 'rrpili'
paralizie
ptozd
palpebrali'
completi
in
final,
fixd itt t"'ttt'
Fischer:Briigi iiolo; a izolat dou5, forms clinic-e: a) lorma aau't'd',
i
naralizia ocirloniotorrllui este urtratd, ime4iat de pierderea o111lofliilrfoi
i,' Surn,nprogresiad,,
in care paralizia perechii a [II-l sc.ast.rci:rziitr tttrNI
lreplar cu somnolenli qi apoi cu piertlerea cunostrntol'
' H1 Bindromul Iotoia-Eunt' Olialm'oplegiadureroasd"(sitrtltrrtn-ttllir.
tosa-gi*t) reprezintd, entitatea nosologic-5,.incatc se-asociazii o oft;n'ltnopf"ei"
o ndrratgie brigeminalSde aceeagiparte' Tolos:r (I9j41 a. tk'rctir+
"u
itriimunfeeia, dur-eroasi la ul caz cu le'iunj peria.rteriulc :rlo ritirrrrrlrri
llunt gi colab. (1961) la qaso cazuri cu inflamalii gri ttrlo"r"otioini.-iut
lente ale sinusului ealvernos' Smith qi Taxtlal (1966) alr folo$il'
-rJomu de ,,sind.rom Tolosa-Ilultt', Ia cazurile care au lespuns tavoltltil
iermenut
ta tra'tamentui cu corticosteroizi. ln acest fel se pare ci' se t'intlo sit' srr
fac6 o clistinclie clari, fa!d, de alte sintlroame asemdnii'toarc, diu'.citrtr
iini produse de'leziuni, in s1]ecialtumoralo sau inflamatolii, care tttt ctrtltrltzii
oromnt la tratamentul cu torticosteroizi (Other. 1967; '\tilslcitr ;i [lottr'.
iio, ibzi; nnllf,lt". 19?3)' Lapresle qi Desi (197?) considct'ricii It'r'rttrrttttl
('!,t{) llll n(!
tle'sindroin Toiosajllunt trebuie folo8it numai la caz*rile la
etiologia'
poate stabili cu certitudine
Mai recent, I[unt (19?6) a stabilit urms,toarele criierii pclrl'm tLingttttx
ticul tle sindrom fotosa-nunt : a) Criteriwl, anat'omic: deficitul tttrtttolttgitt
prin leziuni la nivelul sinusului cavernos anterior qi nl fisru,ii
"*i"-prio",
ornitiale sun,jri"are. Structurile care pot fi implicate incltd nervii rttrttlo
oftalmic, fibrele pupiloiilatatoari parasimlrilf ico tt l trrt'trt' l l i i
*.io"i,
""ii"t
a IIf-a, qi fibrele pupiloconstricloaresimpatice ale ple\u1Li lttlritlilttrl,irIirltt.
b) Cri,t'eriut etiolioi6 qi' terapeu'tic: atingerea forrna{'iunikrr ilmittlil'rt csl'r'
iiatizatA de un iirodes inflamator granuloma'tos oronicr 1i botrigtt, citto
reaclioneazd, favorabil 1a corticoterapie.
Cafuu,I'notologioolsindrom,nt'lui'Iolow'Huntloa[()1:irtstl'olsist'rrttt;t
tiza't {I[unt, I961; 19?6; Lapreslo qi I}'''i. ll}77) : ir) rrl'rrrl itr I'trrltrrt(it
'i* ambele spxe; b) debutul mL ci'" lcciLt do ryirsl.ir(rlitr .tr1,iI:'itit'
o) (l('l)lll'lrl
"nufl
rrlo; it A""ua" a VI-;), cu predominlr,rtl,llll virsLtdonrii6cii;
(lo-?l
lllloi
llllrglrl
tti;n1to
ilaie fi nroelesiv, in citcv:l zile sau in inni tntLlto
()sto
lllllll'1r
olro
rlc
nai
<xtnsl,rlrtt'
debut
ce1
ii,ota-itrii; ii) seninul
oontx)lllil'(rrll(111
oftalmoplogici,
'Lrre're&'
br-usc, de obicci ct clt(rvr zilo ina,ittl,oa'
I
oIl':rlttt'1llt'gi.i
tItt':i
itr:rlrlrtLtu'
oaar*iu, *uu, iu rarc cirzurirll l,niirr lilrtlr
gontrraL',
r:tr.Irrlrt'ii'
slirii
([t'buleazi
:tli,,ralr'a
air'ctiunea
;i-;;r"i
Filr
rnodeTAtd;f) dUrerea esLellnilAtol:llii, 'crlr.'i;itrrI rl{1t(gttlii 1r!rrlt)rl.lll
oital*ic, raroo'i prezonLin{f i*,rliri'. ilr horrrir:rarrju;g) rlrrorilo
pnroxitttioo. qi. u'0o U)il'""i,o,"li.i
sin't severe, cu caracl,cr contitnru ii urt oxu'c"arbrtrri
:r,ti.,"r,nzii,ou na,t ll1rI trrllrrrrilr'i
tn t'ori
do eurLsibilil;rr'i'.
iii^iu ao
'5icri'ivo ttltxiltr qi ortr.''r{illtttl
lrrl,vltlrri
iirririf n-ffii-i",1lrri, urrtrrri hr i,r,r,iI,r,irrI
ir, ,*t .,1 rrurvrrlrri'lrra,lrdibul,.r;h) olil,n,hnollogit,1xrrr10li tlo rttit,itttttll,o
iiprii;i I ,rxtornn cornplri;ll, (liit rtirr r,rrzrrti)I li,ti'g.r'. oxt,rl.n.cll, izulnl;ll,

:tr,r::i,:,1:;t,;,*,ii#x;!i:x*[ffi
ffir:;li#j:P"*:Trl;:3:;
l' tii,;;ll,l;
;t;t*:ll,*lt,ru
til;,"l;l;fu".,?ftritlts#Hl;{i
^t"'ito"iuriliiifri".\i.ii
Ff
i"
p""uri,ia
perechilor
I ;;..;i'ii ']'l1l'|fili*,1:"'n'*"
Eoger
qicorab.,
1e0e
qideArseni
qicorab.,
,,,r,i,;j,:iill,JllI:i,,gl?j"t:
tr) t|,in.d,rornulanNerior-e,ste identic
cu sindromul de
. fisurX orbitard,
ri lrr,r,r{|lrrii,
(cu coafeCtare&qi
nervu]ui opU"l.'^--*
-a
tt) N,intlromul med,,iancoafecte?zd,
to.,i icuiomotorii 6i primele rloud,

j,lilil!lT:f;it*.1i{1'jx'H',",r"1,Hffi
j?rtl#
J:l:l:l
1r;ll"t*;;":nf,I;i
atecteazd,:.
toateramurire
,,,,,,j;l ll;iilj;fif'l
"#:mi:

ri:;,r;ni;,**uili::,,J,ffi
#i'"'#m'Fl:,-k*#?#i
;iil;litil;'li",ll:,T,1#**,ff
r rrrp | 'r.l i l i rr(| ( , r rI iic t ' im are ),

;Hr,i"#fd
i'*1116*:f1ti*_T,%trf

p
:ry,,,rr,,r,1,riirrri,li;l,,1if
?*1i"-?H1fl*T*1":i'fli*i"",S1llf
fml*:
seadaugr'
d pQ'tro'
l)ariantii,:

,,,,,,,,',t'1,t,,"'i,l,i"'i;'i,"0!,rll.on')

sindromut'
gtaratrise-

Ir't <ttori tli.ol,ollici :

,,,,,,,,1,1,,,'11i,11:,T,ill,;il,H11i,f,l"Jifig:'.ljx"l?,:i"tfdeosebi
"'anior,rin-

lol:rlr., l!t(il)); b) ll\rmori rn

tigt!,",",Lq;
i;,llll,,ll)(;ili,'ii,1,,,,,,".,,'*i*l,'iff-:"'i;"if,fl:x;"^'ii*iiL

,t,,,,ur,tr,u:ale arterai carotid,e(Jeftercol,

1958; Arseni qi colab.,
,r; ,.ri,.t
,l,t.u.t.t,Dtul.i,rzr
:il
c/c, incleosetri cr. realizarea de fistule
.
carotjrlo_ca.yerr,,'iu,.!
r.irrt irr.rrriolrgisrtalizrnzdLrapiO : ottalmopt"egli
?riftamli
puts:"tite
r,r LI||||,|||I||I\i,r'illonirrrlc(Iioger
irl colab., lgOiO)."
| ) 'l,nutlnfhltitt:le sin .sului caaernos
,tealiz(,azri : exottalmie masivd,,
,,ri.rrr IrrrIIrr.IrlrrI
rju (,xtensic
ftuni9 qf _p""
stare
lfrerespective
rrr,;rt
rlr,rrrir.i,p.rrvii, 5i Jcziunile
""gr""#iemporata,
Ae ocrriimoiori
trigemen.
$i
!) i.lll( lr.ro.ta,ea
infecJi,oase
: meningite t rrrtn, o.oiogite sifr_litice.
ti) ltol.i d,o sxrtarz.. mir{om. multiplu
(boala iui foft.1
5.*.
t,',) tlintlrr.trnn,l da hemiboad, (sindromul
lu,i Garaii, tintl,rotnul lt6
,
tttrttlriu yi Q rrn:itt,sutt, sind,romul
tui
io"tu realiza, in
..Bc.rtolotti-.Gairil,"i'
..rir,xl,{rl .lirriu rkr rna,sivll,
Bi r:xtcrrsivi,utu"t""" ii" o".Ji;i,'ieni,
qi p',ra_

conmn
(curorlizal,oa,
a" r"r,f,l'r""i ori;,nroprosii
lil:jl,l,,;iililli:11;lrrlui
t8

{o

lr:rrlrrlir Iit
loltrltr : r lr r , r , r , r . lt t |: r lllt r
( l/ il r lr r r r r . . l l l r r
r | r , r . r . r , : tt i l i ) t 1 l i r i l
i" r,,r' lr rr lt \ | :r { l.'., r lt r r , . : r z r r r . r ) ; ! : |l. t : t ir , I r , ||r l|l|l i r l r r . r l , , , r r r I r , I , r I
rIr. .riirr,,r,r,rr
r' , . rr' t
tr,,t ||r.rtIr)r r ||LI I LI I I ) |. I i i) ] llil|lir . r ! . ir l| | 1 t , .
. I l I II(,I 1| r , i l . r \
l,l r]t
/
I
I
I
I
' ir ol| t ]:rltl.t l:l', {lil ( , ir z ||r i)
Lr t ; r |jlr lr ilir : r ir , l r , , l l r j t l t t l | . r i t l l l | l l r . t j r z r l
rr. : rr, lirr .liu t Jltlirr |, ( , I I r , i|\ . j. r , . l) t 1. , r l. t t f ir( [ c
lr . / , : l r . . r 1 , . , r . , , , r r ,1 , , r l i , , r r l r r i , , ,
t,rtirz: r rrrrlrt :r rlr, l|z:t t r , r r s ir r r lr : r , iii, , r t lr r i
nlr u r r illl l r l ] ( , t , , , ', , r , . 1 , r , , , 1 r | t ,
1,ortl,. ll
rl,, ,.lirir
r |r ,
'l,lr lrlollr r ur I ir . r . lr r .I
l, , t ll, ir , , , , l , l , , , l , , i i s {, l }r ) i r r {f r {, l l }l l i , t l
I ilrrr!r'lt. :r.,,r'r'\ lilllj olt l, ic ( 1,.' {I ) ( [ ilr ,I(,,r;rtlli.
Zt U, i) it , t g r l r r t , . r ] , , r , I t l l i i 0 ,
Ou InrN;i,ii;
1 r. : r . r l,itiiir.i
rro ([ili( jir . ilor . I r r nt lr r lr r i dn oc hi
; lr) \,.S.lI. cste rirxlr,r,rrl
,

''r ' 'rli, | ',' riir, r.rzrr'ir. iur' {.\rnroDllr riehirrrrlui,...t,,to,,,,t,i,ri,rii

,r,,,i,.'
' !
. \ r,t,.lrt:r(j tl| li,r,iiozi rliscrcta (ll6 din
.r.|l
cazuriT;
ilr,ostirri
lr
iil,.
I ,r'.rr:lirrirr.r'rt:lrrr[ ,r.i.. t(t de_ proce'' in aflra G;rilri""";;;]]:;i;;';
,

,]:l.ll:.ll'].:lril_ll,,.lt,,,t,rrlt'rlfla
in unete
cazuri
ouilpr""et"coriiri,.,iii
],,,]i,l;1,,
'|| rr. t r , : r \ ' . . r . 1. o \.:r o o l ,.trrr.tj F a r.e n C io fl al rni ce
.i

l fl ,,r
l tui l S r,,i n
r',.lrrr,tlrl'l ; S,rrrllr.irrL.r.
si ltrrlpp, 19?3); n) sirr.pto_,ii"
pritil;;;i,,
-u
.,rr. .:i;rr:irrrirri p(rl p.ozcnl,,-rbmisiuni
spontan'e,- neori cu defit.it.
.f,i
rr.zrr rirrr.: (,) l:cnomcn.,lo
',: '.,,11',19,,,:
pol .reapFrolr jnterval, dr. lrrrrl
' ,.i'.,; ll urn:tglr, slulrlntn:tlologierispunde [rlorabil la ldmhistr:rrr.:r,
,,'l
or){Urilr(hr-seunoo4 o remisiune complerd, ilr
cil,ovrr,
i,llllli::, i'll:'!il},
,l::'.1:l:ljlll.rl
,,1
\riu'c:,I ezj: :^lapr.es
tesi Desi.reTi);r) rtinprrrrr.r
.,
::',,i::.1r,rl'Ntrlg,.lr. .r. disculi
,'. ,,,rl11,
Iie exislenla Lmui proces i:rfllm:rlol.
,|| rI rrII Ir,| |IiI |,'.t
I)fi 1rs.r.l.t,urno,l
1g73 ;' flult, iOfOl,
.(IIallpikc,
-Clanhyti" a ii,,,,i,
Jtr,r'r',,r'irrurrilrrrl| cil Ia clzrDile. Aeicrise Oe-Uathe*
0l.
{i
ri',rr,r,"rrr:rr,,r,rsi:r
criuici, a sindromllui rolosa-rrnirt poate-fiilSf
intilirir,ir
t I t (4 t ut ttt tt't r t ttt tn ) e care:,par prin afeCtarea
aceleagfzOnetopOUrl,li|r,
',, ilr. r':rr,{r
lrrrl'ri. sri,-ldiferenlie-m,,ieqi
a" di'iiiii,,f
. 'rritrlurlrl lrrrrl,r,isfcnoirl:ile( iloctton_Duvigueaud)
"""orie;t;-0.#Jit
b) Si"O"omut
;
lrrr ,r"Iri|,:rr,
(|IrII'rI,) ; c) Sindroamelesin.sului cavtrnos;
"1ru*ii,
cLl Sintlromrrl
rt,,
r:',,lrrrlrr.
(Jacoti) ; e) Sindromul pereielui extern al si,,r,
rrirr ,,ir,y(,rtr)s
lnrix) ; ii) S."l,lr.uryrt paratrig6minai al lui
'.i,rrrslirlr.irlalri
Raerl,,r,;
''ti'rrrIr''trrrrrrIrrri.(
rr) sinrtromirrtle dff'us aiiui-r,isoner-griilrg,,.
,l.olosir,-Hunt,
l) lrr ;rl;r,nr,sirrrlr.orrrrrltri
'rrrr.rrirxo;
a,cirui etiopatogenie a 1it$l
ri r rlrrl: rl:r rrlri srlri, o.ll alnoll( :
fi produsii,'tit d. crrrzr,
|to^te
..,.rl,.ril ll.,
r.rr ri rr. ,,^u"r,,r,rr!|]!o.t"t'eroasd

,.1:rl r., Il )17; lllhor nas si Yoss' 1970) .

i\lrrllirlrrraiiilo \::lsctlai'e reprezintir d.upti, 'I'horla's fi \''(tss (l1l';0)
,1,r,rri trIl ri i Y fO 91,, iin cazr ui, m lar ea f r ecvenl. i a accst o}r t f iit t t l r t lit 'r t r r r lr r
A rsr,ttj q; ,,i i 'ab. ( 197?) . bint r e acesi, car: r ller ir ism clt '. st t 1t t 'r t r lit r oir lict r r ''
' ' ,l ,
rl r:rl rl rri ri ,rl cs 1 a or ; iginea ar t er ei com llnicant c po'sbcr io: u( ',ll'lt lt {'ll{'r r zit
,,l t.rl rrrol rl t' gi i tl Lt r t r ', , , ise cu inst allr e r apidl, cu: r ; I oct al'it r r : t lr t sir ': i ili
r r t 't 'r r lr r i
,,,r' rl )l (,l i i ri ' pcr' cdr ii a I I I - a si cu dur or t - : localizat L pe
- t cr jf 'r t . ir ll
,,tt:ri rrri r,f[ri i si l se ir r soleasci dc r egr : lii t le t llbur iir i obit divo t lt 'sct t silr i
, ,1,. .'itr.vr'istu'le inliiaclinoidjenc (intr:rcaverno:nsc) silli' reslt,trsrtlril'
, , ,,llrrlrrropleuJi(ltllett)rt$o ctrro se inst:r'leaz5,prop5resi'l'(,,pst'tltLrltItrtIIlItI''1,
nevralgie trigtlrn-irrat'i tlttc lxrrtlr'
' ' ,, l,rrlulizic oculolnolorjo complt*il' $i o
qi
s,
:
,
r
com
paniaz'r id'' t r r lbr r lr 'ir ir t lr i. r r iir '
r
,
f
t
'llm
ic
n
et
vului
l
,oi
l
ori
rrl
' t, 1,:rri
o
gi:
isi
dolicom
eg: r t ': lrrr1ir li sr r t t . I isl t t lit
llar oot 'i st r p'r r r lc
"
' " rrsi l l i l i l al c
, | ,rl i rl o {.l l V r.r' nO ilSi.
lr ( t r r r l'r 'zr ' ( ll
l rrl i ' r1i i l c ol rt t it t ologit , r : ( : t r lest r l llr in int cr r n( 'lI iiI I
ulLoi
! Lr r.:t,\:{,1,t,os)
si nl sct nii, . lat c r lir r r r ir r ( , , . ] t ili [ ] t lf , ilrir L I iI |I r t 1t r t I r t t llit r r r l, t l
r' j i l , 11ti i ni ,ti t t t ilr t 'r t zLi: it t lt t liil, , r lr lt t nt r lr r i s; l't lr r lr ' 1: r tit t lr 'lt t r ' ilL r r r r r r l
i " ,l rl r.l (' j si nttzi l r '1r ',clr t t t ojt lit elc.
tl(t t tll't) tt'lttttt j
''.1.:1.:i.:1.I'ara,li:iile rutliL.'u,Ll;t'e
(i.tLt.ttr'tttttrrt'r:iu'lr,
1I
t
t
t
t
t
t
t t I t I 0lt t r . zI t t r r r '1: r lir 'r "
inllla,
r
nLit
or
ii
rrl i i l tot(i i tt l tzit lr t i vlt st lr t lit lo,
;i
t rf Ir(' ri rri Ll ri 0r t I iblr 'lr t I lr t 'r 'r 't t lt t i i) |lllolllol, o! ( 'olI lll11( : ll t r t t ( , l{'t t l t r t r t t ,
rl ,r i rrl l l l l fi tgl i ; i ct t ! lt st ir ltt lt llt r s( 'llzilil'( f si t t lollir ii' slr llt ioiol'i: r L' uir t r r r :
tl
;,, r, fl ri i rr Il l -l r so t r t r lr r |lr 'lcilzi ( 'll s( lt lllr t lit alt lilllLlr r ,t 'r i'l'lt lr it r t r r t ir lr r l"''
r
'(
'lt
lr
r
'lr
r
r
il'
sr r t t r lt r lt t llir t t iit 'i sct t zililI ii
rr,rl l ,rl l r(' tl c l tttt r lclt l't lst t
- 'ir /
,\l ,S i trr/t,,,r t t t i/lt r i ll r lnt ( : t it t r lr r t t nt r l'pr t lt r t t t ult 't l) t t t ( t t l( t lit t t t t 't lt lt t t l'
t,,,i ,t' rttrl rl t ' ti t: ir 'r lt r r lt t t r t t l, t t . t r t t r I t lt t t i1t I r ''1i,t r llt t t t , il : ; t t '1t r t r or r lrJ t t lr t t
, r,r u l ):l l rl l i zii' ilr silr r lr 'llr lii t lI I r I 't t I t t I t iol, t t (t lollt t lll li ( ) llr "r r r lr l11: 1 1': r r r
lr I ll- lt t lslc lr r llt lr r lr t t t lr r r t
1,,rrrr rl r,,:i r,)r' otrI 't I r , t I LI r 't 'ir IIr'rLllr r lizill llt lt lt ii
r ,l r.r rro tl l tl ot' r 'llt r l( '7il llii I il) r r 'lor I lt t li|r t llt l! r ll| ll( f i\ 'lt llli I ll r r r lt r r i" lr ll
sil sr 'l: l( i r lr jll'lr , , i
l ,r ,i r rI,r,i r.r,
1rl i r r lr iciolr r l ll( . 2( , 1{, ( , lllir 1.l, ) iiic ir r r 1I ot '|, I t I t i
l l , l l l {l i l (' r(' l l l ,i i fl it t lt t ' t 'rt ilr r hilt t l si' r ln'nt ll t lt r t , r |'r ; t 't i: i t t t lt i lr ll ' r li / r l1'r r i/
( "lllt r i) lllilir "l r r
,,t,l t' ,ttr l l tht
lLt it t t 'r r t t t , , li; nt r t t li ! t |t lt ( lt lt t l nt r . t t t t : t . lt lit ,
I ||r 't I r I ||{I ( ||t I I
r
l
r lr r r 'l'iir 'aiil( . li( . il t r r olr I
1' ,.rl i zi ,,i ol rrl ri r r I r , r . r , r , lr iiI lll|,
( li ir lr I
1,,11,rr trl rttsri . l ' ) r lt llr : r r t llr , , lr r lv : t it t r lt t t r r nt t ll t / r t l", ll|'t t ' t I t I r '
,

'i'ililli1,,":!:::,i!::,,i:,:,,{,i#[":,ii,,iil*fr,1i,\iJ,"?:rlif,fJJ,,,:flj;.'i;iililli
,,t,1,:,1
i'i :, i

r r'rrr';r'r,rirli irrr.r'rii. r)rrrariziir.ocuromotoriiqi ale

trig,r,i,,i,
rl\,r rl r, rrlrirr.iilr lr rLrrrrrjrrrn:itirll ir, vietii,
'erv'hii
la iroLnavi
caro
ar
fol.nr,
r :,r'r'rIr.rIirrIrcI
, sll rrrrrlillrr,i lrrir.n1.f )ff 1i1le1rtegja
sirrvinebrusssj n,,
, r,,t,t,tr':rzirirr.r:i'lr.yir._
orc, (.. i''lte orl cu ril.lerea trig"_,,"iii,,i-ii,.,
Iir..irlivtlt,sitr1,
1.r,,r,r."'tc,.
fi,, tle accea;ip:lrte,-iir:de,par,k,',
',,:rrl,:'li"
'

r l r ttItr r r r 'l l l l r l /r l r |
Ir |,
l r ) ( 'r r r t z r 'l r . r 't l r 'tttr r t Ir 'r i 'Ir |,
''IIIr Itttr r 1 r Ir ';1 r |r
, r t t t t t l t l o t t t r t t u t r r t/r 1 1 r to r 'r 'rI r ' l r .r l r ;r r r ', tttItI|'It tttIt{i i t:t r |tr l l r tr " tttl t t'l
,, I|ir.:r|( ).
r 'r r tr r r ' l r xr l r l i zt'l tzi i l i t tl i vt'l tr l i tl r l r tl l tti
l 'r r x t 't r r l t r c t ;tl tttsi t,
'r tl r i l l r l '
'l 'l tr ttr r l t:l si \ 'r r r - r l l l l i ( l )
r l I r r l I t r o i t l i t l l . s l t i t l O.i i i r ,:r t,"r 'r r 0 r r r r ,tr 'l r r l r zi l ti 'i 'tl ttl i i i
, r t ' , , r l i t t l o l : t l t t l ( ' r l l l zt;i {) l l l tl l r l cl ct ttti tti t, l r l i tl l l r tr o l l r r g i i l l l l l cl o r tst" "r 't:t '''
( l !r l
. , , r , , l , r r l r i i . . i r r r t t l l t l ttl tr l l ti ,,\tr i i 'r r i ;i co l r l b . ( 1 f) ? ? ) . U l t 1 IItItIo II1 i t.i( l ( r l i i l ";,
ttr
tz't
ttr
xr
l
tl
r
tsl
r
t
l
tl
l
l
l
i
r
l
r
t
i
r
L
r
:ttl
i
l
tr
l
t'
(
(
)
l
l
sti
i
i
l
i
l
,
fi o
t , ', , , , r r l . l I i , x p l t t L , s ir - e csto
(
iII *
i ',
I i c r l c r i r tta sta zc cl r e p r o vi r l d e l i l n t',o l r l l sttl ' l l r i l i I I I I | ' | ' i i t I
'r r : i : r t r ,
ttIr
Ittr
rr
Itt[t
l
ttr
"
(
n
l
e
tti
n
g
i
o
l
t
p r i m i ti ve
I r r L r ': t z i t t t t n o l i l t r
i n tr a cl a n i o n i ,
( 'l ( 1 ) ' l ,t'{'r l 'tl
o
0
i
d
e
l
r
n
o
j
(
l
o
tu
m
o
r
i
I t , , r i i r r r r r r , , c n r t t i o l i u t i n g i o a m e , '(osteoame,
co r d o a m e J
mieloame, silrcoallti) rrh' ) ('\r'rrcrri
r t rrrrrolil<' ,,ru,t*,, 1,r'imitive

, ,i
Dintrnerviibciiornoturr,
0t,l rlri
, ' l l , 1..,', ::.,it r.' '.:ir,t i:lt s.lf',,1i..ir',,]..1e?{)).
, . lv l l l )(l l to (,i rs , tu ,rrta ,1 ,

tl c p e l cchea l t ffl -:r,. D c l rrtrl l ,,

i'. rI r,! r'r.r . r r I I r r I r r r . I r Ir,.:i rl
i rri s .' i ^ l l i ,.'
re s l x tc td re :l .,.,sc* l Ituri i i rr1,r,i rr;.rr.r,r
t l: rrrr.rl . r i l) r ' r i, r 1) T i ). u r* rr.i s o p o ,tr: r' i rn a ,r' cr
dri :1. sri i i rrrrr Irri A l ,rl r,
r i. lr,.1! ;1 111( \ l; r rl1)
r , { ir i) .l i t,s 1 rl ' r,1 .r| r,rr
rrrrr* c l j l i tu r.i i n l ri nre(i ,l l tt:ol rrrri l ri rrrrrl l r,
, || |',.r| , , r. r| .r. r I rI r. r l tr.r.,ri rr- .i ,.r,1 :,1 r.
I
'
1 l ti .,;r. I| r l .al )Ll l c:i rrr.tt i r:r L| l rr,
L"'i I rr'rr( r r ' , lr r . r ' r " ir l.r
I' r* 1 ,' rr.r' rrl r' ;rl i i1 r 1 ,ru n (i h i uhrir)a.vi rl ' i r,(,rJ.rrrl .t
r r " il) 1' r r i' :lr
i ir' l (' i r ;r.r' i l i ' r' i rrri ,trrttrr,' ti i ,i l t..rrtl ti trgrrrrl ,rrl
',','',
Ii l r.r,l rrr.
'
i , ',I , i i i , ,'.'
I )l 'l :rlr r r r r lr ic grrrI r r r r.ro Il :ulItr rrr:ri Io s l , rl r,s r,r,i sr
i rr l rrrl i rl r, r,ol i $,1t,,l i ;t.
' I , rI rt t I i t tr,rrri i , I r oI ir ; r r I il rrIIrIrr,rrr,,| | ,i | | iIII(.i
i , i | ,Ir..
:,l l

t r l r , : r t l r , rr ,r |l r to i t( |,
l , , r l , r 'l | : r r 'r ' r : t r t r tl , :tti ,'tIi
,,,rrrl
r , , 't t I o t t t , , Ir !I ( i l r r tl r r l
,rr.rrr,.

ttr l ( .t|l r . ( r l i l : ) , l l ( . r r r 'l r .l ( 'l r '( ||||||tIIt IIIIII

r ,'t,l tt;r l ,'
Ir o IIIt ti r IIL tr '' r ':tr r ' Ir Itr tItti tttIr l l r tr r I
I rr' t I t t t t rI t t I t t I t t t ( N l cl t( l o l \l l , l !'r |)
,r l r r r 'o tttl

'.;i
;;;,;,;:r
:rir;m;
l:llririliiixt,,liilii;ilril;iri::iiii:r,li,,l,,ij11liil,'i'rl]rr11

t r ( 'l l r l i r
l r r r l r r r o r j l r zi i , i tr r r r ,l r r r l ) r 'o ( l l l so r L o l r .zl l 'o tr ti I,t'ttr r |.ttl i Ir tt'r {,r \'r Jl r {r t
l l l \ '( r 't l l i l l l '.
r l l i tl i z{.:r zi 'i
t J i n r . l n t t u l l l u n i tl ,r
I,,r .l r r l ,tl l ( Vi cl o l q i r ,o l r r l t,, l l ) i l ) ,
'\ )r t n l t o l o g i r r
. i t t r l t {r
ti .i tt i r l r r zi l r ,,l r o l i o cttctr l .a l i td , l r cttl ,r i Itr tttu r t:r ti ''i r sr p ,ti t'lt'i"
(:iintlrontul
Gttllrl ll rtnitlit:).
Sernuele eiLrtlitrirlc it,lc :rcrrsl,ui riitt-

t') b i nl.trl ttrtlt, nucltttl

t;;::''ili:ii,,l;iilfixr;,,iiiil[*"jlti4!ij1l{i"i1l;rlJl:,|':l'';]-:'"r
I :l;r'r,i;i;lillj;
';il;i;ji:[ji],iil,1j;.",:ii{i:[]:l,ffiiJ1,J*1-i,,i'{#;i;

rlrorr sint : a) oftalmrplt,gic [rilrrl,elalti in glatkr (lifoli1,(r; lr) sorrrrrolcritri: c) ataxie; it) lis1,:i,grnus;e) delir in faza acul;li rii stalo arrrtrcslilo
r,oufabulatoriein fazele tardile. Pzrraliz:iileocukimol,olilor sinl rrrrclrrirlr,,
incomplete sau ctlmplete, cu prezenla la peste 50]i din cazuli r lrlozci
|:rlpr'lrrale fi cu oxistenla rrneoti a t'ulburirilor pupilalo. Acrsl sinrlrorrr
1,s11'rrodus printr-un defic,it de tiamind, (etilism, tuibuliiri rnol,ulxrlilr').
B) Bintlromu,l I{estenbaum ( Bindronlul periapetlttataL) rcr,lizoir,zii rrrr
rontp\l, clinic constituit tlintr'-un sindrom Parinr"ud, la, c:ne sc rrsLrcirrzri,
irisf:rqmusdisju:rctiv, mioclonii oculo-retractorii, tulburiiri pupilaro ryipnllzc
rLuclea,re
ale perechilor III ;i IY.In acest sintlrom este aiectal,ii srrlrslrur{rr,
cem;ie pei iapcrluctala, nucleii oculomotori si barLtleletlL,
longil,rrriirrrrlii,
posterioarS,. Leziiutile cele mai fr"ecvente sint da natut'il infcclioasr'i s:r,rr
ischernicii, (ocluzii rle arterelor plandui posterior al pediculului rotr.urnrlrniler, sari ale ilsusi pediculu.lui retromamilar (Aqgian ryi Vuil, I l)5$ ;
Pop.r.icir, 1965 ; Popoviciu $i Afgian, 196E ; Aqgian li cola,l)., I l)71-i).
Zona responsabili de aparilia sindromului I{estenbaum este replczcnl rrl,lr,
de un sistern morfo'fu:rclional periapeductal mezercefalo-diencciir,lic, crrrtr
rrrc conexiuni cu nucleii oculomotorului qi cu centrii oculogiri din tnrntlrirrl
cerebral, prin comisura albii, posterioari qi prin bandcleta krngil,rrrlirrrlli,
posterioarl (Bentler, 1965; Taube qi colab. 1965; Pasik, 1965 I Sh rzor,,
1965 - citaii cie Popoviciu qi A,;gian, 1968). Popoviciu $i ADgirn (l lxis)
nu plopus - pontru fenomenul de ,,nistagmus retractorius" * torrrrrrrrrl
de ,,mioclonie oculoretractorie", ari,tind ci aceasta are ca, substrnt rnollirlogic leziuni vasculare sau infectioase, reversibile sau irevcr.sibile, ils('til,o
de multe oii de hipersomnii qi de mutisms akinetice (Popoviciu qi collb.,
1980).
C) Sindromrr,l Lgle (o vaiantd a sindromului Kestenbaum) Bo (litrrl(iteuzeazd, fie prin palalizie bilaterali, ile new oculomotor connnr (1n
midriazS,,sonuolertri fi uneori paralizia miqcd,rilor riculare cle vcrticir,lil;rrttr,
{ie prin spasm de convor'gentd,qi mioz6,. I:eziunile rcsponsabilo dtr }rorl.rrrxrlea acestui sindrom sint de naturi, inflamatorie sau.prolifclai,ivi,.
D) Leeiuni,le ttu,cleureala ocxr,lonxoton
,ui comun, tnai illos ookt rlo
naturd sifilitici, duc, la teducerea tonusului in murschii oculnri, irr sprr,irr,l
al ridicitorului pleoapei superioare qi, in conseciniai,,la a,parilia urroi pl,ozo
lalpebrale bilaterale. fL unel) cazuri, diferenlicroa fu,lii rlo sinrlrornrrl
Olaude Bernard-Ilorner este thficilS,.
E) Sindlornwl arterei. nuclatr,lwi, oculornotorull,wicornu.n (ALlllolli 4i
cola,b., 1952) implic5, afectarea n ucleului oculomotomlui oonrun, nn{,loii
(,omisurii posterioare gi conexiunilc vestibulo-cortir:a,lo.Artoril rrrr0lorrlrti
perechii a Il.I-a pare s5,tic o ramurti a artoroi sulorrsrrluihtonll, rrrxlrrrrl,iv
tu a,nastomozii intro artcra cc,rebeloasi, supotionril, {i itrbolr! corrrlrrir,lrl,
ix.rsber io i n'ir,.
'Ir) $iw)romnl Lwl Aaenlald, Sohuranberggi llu,m'pol,tli(nil;rr,trlo
Alsorri
ilirglu,r'u
lirilr,totar[, oir,r'llc1;or.iznlii
plin uxisl,rrtrf,u
csio o n rir,tt
6i <xlllb., 1.1)67)
rlo oirltrli, (ru o (lutitii;i'i,
lrrrxlio tlo 90 Noo rr(Lr,lrt r:l,r'oir,ll,ur.tr
rr:tzr),
lllrillizirr,
il;rl,ou,axngorrr,l,rl,
cornplol,it,rr ;tolrxrhiirt,ll.l.l, cu ir,r:l,iv
lr, rrrrrirorrln,t,ur.ii
lrrcr.(fottrrtrrrttttl
v:tlrfl,tlo rrcrr:r,sl,il
lrti rronrrttr).Anllirl,
,,rriclic" :r,l ooulorrlll,or.u

f,',i,,1',ir*rili**p,;ti*;.t,;ifiixr*ilfiit1{{;ll*
'r*ii;iliiltifi;riiifii:;#xrrn!:,;"!i,:":i',iiru#*,

;r,;;1iil;1;iif#l*li,r*""""**-;ii#!{;i;x$*l,4,fr*#r
i;,ij,,
gtt'1,,ru
i:iI;rii,IiiI
Iri
I
hr*li*rtl
st.,.ffi
;.}l
I I;,t,:Il';r:'':t,
ii,lj-;.;,t
*
5 $;*g*iiffi ;gi,hT,ii,,i

,:-i[t'id**,f*iir***"1,*n*i*l**rui:?',","l[
:l,:i;il,,,il-;,ii
*i,'illJ:?j**ffi:ii."i?:*""
"..,"."",i1{iitfli*s:;

I 'orrlrr Ii lrr.orhrs5i de tumori

aie glantlei pineale.

:uffi.r*?;
*",+,,grf:if
.ir,11;li,'lll{rii3i#i3{,,1fr{$Sl1"fu

*t+ffi$-**+*ffi
;lll,ir;i;.lirl;
iillllii;irj:lir,l",1",x'1"{lli*ii:i":"dl?:':il"J'"{"'rT;
li*':i*$*?i*ruTlfl
jffi,".it';;:;;Xg
otareamuscu.
l;:l:tjlliril;'{i,',ri,iffi
#j:ifiT!:i{{:{il1'.::.,rj'-,:f

i!4ffiiq1ll;giEil{iti
iili*i*
;*lffi
I,l::l:l::':l?l'1,:"il'l,il,,ii,,il,il,,',il,itli,"l';,ll,,l*ii,iS;jUruifii.,*f
rriiiil:in:ll
iiil*iff
i*ili
mrniil,-'lr'-*'i-ili
tlrft;t*'iti,liifi
t l r l"; t l )rrl ri l l, i 11ipr r r r r l- r trrr,rro rrr

5tl

It8

rrr'rr*'rrrrrri.
r'rrrJii
:r1r,,r'r,.rrii
lll'l\i'lll"lli',illii;l;'i:11i;;:;j1i1'1,,1::.'::lllrllll.'tLfi"

tl t'
l l l ttr r t'tr l ti i tt IIl r r
l r ) l 'l r l 'r t l i z i i t l l t'l '\'l l l l l l l r r r i r 'l i l l r r r r l i i tl i i r l tl r N 'l l
(
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( [( '( l l l sl l ti ( \i l to l 'r 'tl l ti i r t l V:l
ci
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po sl ,cl 'l o i r t:r :t l ttl r sl 'l ttt!'t'i o o n r l fi i l ) ( 'l 'i i l p ( r l l ttr l 'l tl c' l o zi tttl Il t
itr portiunea

:liji;li,illrili;l-.ll$r
iiilriri,ll,ir;ii,,ri
;rillrf
imi:lii;iiUiU_i,
jitit

jn*lttllr,,l
tiiii*l'l;
t*xxl* ;t:
iIriIrillli:in,ii;i lii
ltw
binccontr',tr'r
rs,,-*"'ris*iiiii''re?4;\,oiculescu
li",'1,,li,i.]'"ili?l;'i*t'rLitr
iJ,4.it. lhrolizia ncrvului paletie (trohlear)
:!..1.;1./.N n(r

de semic,Iogi,e

Nrrr.vrrl lrrrl,ctic (trohlear) iaerveazd,

mu;chiul
t:Lrlrrtlot,t lr,, produc
",,lro:r.tji

oblicul ma,re, care

fJSf
iff*"ur?#j":
ll,;ll;l;,-;li':till,:';itx",{if;i#ii#?;31[.i"_fi
('lriilr
.,

r prrr':r,rizic
d. gradmed.iua muqchiuruiobricmareeste
suficienti

vertislrd
a imaginilo"
liliill,iil,,'1,,1,1,',',,1,':Ji'i'ill#3fi
,!g-P.u"1':'
.*'"94di;
inciina'li
;j;

ol)rrsi.' I'^r'rr
i'tirl,' rrrrrrl.hiulriioblic rirrr<' tlo lrit't'lrtrt'
;;;"i";;;;td;";.1ii
Hi vrr
rr
nu(l(l'l'ti1'
leziuno
lizia bilaterald, izolalit rr ttt't'vrtlttipatt:tic inctici
1pp13pi
{i-ferenrirtd rL' .itrrItDtttttIfhgcodr|--ll"llwrI'
[x'rt'itrlr.ii
b\ Sindromut de ortcrd, cerebeloasdsuperioarri^(s.itrdronlll(I()IIj'Li1'IIiI'
*,,r]oi'in-" a tesmcBtului) este un sildrom inezclcefalic all'crrr'
lt.llt.
a#','t".tliii.
o""*"nii n-iv-u .oot"*latcralr' bemisindromcctt'lt"los olrrltlil
pil,r'trotl
d"
lrtn"Jf- *,i 1""iirin6rom senzitiv tle tip slringomk'Iic,
Ciaude Eernerd-Ilornor i It i ItI 1r'I'It I
leziunii. Se loate asocra ot *-d"o"l
Leziultile lntereseMi' lxxlttntrttlttl
*"*Oitni"'
*u.
hipoacuzie
si chiar o
"r,,oJ"io",-1"*"iscui
prrpil
r('
fibrelo
metliat, lemniscul latoral,
i;";;;;,
;i coliculii inferiori.
sirldromtr'l :ttt'h
c) Nucleul perechii a pa,tra mai poate fi implicat itt .

*n ii il*iii

opifiznnr'

2.&.4. Paralizia nervului oculomotor extorn

;;I :;Illj;il;ir,il,#[Ii$:1ff:i!i".'" i;iff

1tild-1#l
:;ll;iili'l',1;,,11:;1i.,:l1;*gT{,i;;ff
:i'TT,:'^'f

ile lcziuni
tt":riipia"ctati sili,sizd'rimut tectl piotlus

2-4.4.7.Bum'at d'ed'atesemiologiae

il
;rliiri:l,tl;iir,;iiril:l.;lriu,*r,;'an'l*lxl*:i*#lii*#

r;;;q1,;1;riiiiiurriLi,rhn1ir,:{lir:lrr{,rf*ir#jirilnti

P erecheaaYl- ae$t eaf ect at 5, in30- 500/ u. t lint t lat t lt lt . l'zt lr ilt llllt t . l'
llXll)'
implicn paralizii ale mugchilor oculomotori (!hrad31- 5i Schlczingtrr''

citiigi-ad Popoviciuqi Pascu' 1980; Ilatsud:r,1'q63)'

rtl'rt'rJi
Dinl'opia este bornolaterali 5i orizont'alii" Firlszr'inrrgittt'.ttrt'iL
s.
irl)r'i.)'r.
jos,
u.gor
colror.lrL.
\r
se incieb1iteazi,orizontal itr privirca in
priJr

ii""tii'i.", r" ttt. Aiest ultim finomensc explicS' I" !(tnlirrlrr

li:.;f,:i#,1i:""..""'t'lTirui"?llTHHii#,f*.tiilii
"l#Jii'r
i#il"ei"a ;li .""unre""t" lr privir'u in jos ;i tit,div15t1n1;t
l::t1:':l:r.:lll
riiir'il;
l'.11.]ll.::
csle convergr.nl,iar mi$c.'.or d(' iru(tllopclr. l{l.r'rrlrrr
in Susl Srrabisn?al
1,,
ll
;
i'
11,,:,:i:1
i l;1,,,:1,
11),lillil::;l
1'll
;,r\{;1*?J,?*1.1ijli
esie lirnitat5."Capul-este-rotal'compcn'satll1:' -l:ll.li1
l lilil
rr ,..rr.rrlt':rlrrjiziikrl r.rrrhi- in
iartr s_auinstalilt ,i s""i" d"'iiipr*_ sau lipo""i""'r.ip."il"
rlt'opl'trltti
"l",,,ll,,i];lii':i,,:l;lilr,ii';Trlli3i*;+i*i":i"i*i""
mod gr,,hat ;; echilibrii intre hipor;a'c{'iunr:u'
.;;';;;iil";;i"
para,iziei
,i;l;ll"i",,"lllil;ll"llll
-.rtopt..r"i
cxtornctopartoa
afecral 5. i n

t t t drt tl'iugnosl,icetiogtntoienic toltograf

ic 6tt pa.al.iziile
,si
, , ,.,,ii l,',",j,',,,,',',',,:'"lt
t,.,. ,',,.:,r,,,i,iilt,t,rl)rcu,l.are.
inso!,esc jle-cjieni pa.rali-aiilepercchii
,.., ,
ii

jllil,,,','l,,ii"ii]",liiilil,,,ili,/"lilnll"9""oas
i"i't"i
' (rcrrers;n)i'i"-'i"a"ui""r
,rj"{X1",'
si
,.,,,,,,rr
,r,,r.,,.,1,rrrrir,
,,,,,.,"o.,lXiulil""lt,ll,

roilcr;i
'u'.:n-

( t ( l lt lllgil r lr r r : r r ; l
par ezel, ' dc per cchc VJ do gr ad lr r cr llll ll

i"t".i' iiirrp"'ritri"n""
pctrlru
carurifd
""nirliouitut
initi;lo
dacfl teziunile

:lp"*1'

Jll
-::iitt.l
{tt'.lllli'l
slirl}rlrl'
prirnrl rlatil in :lccast'iililzi! osl'ttllr('u
au ?ost tlrcpLc satt stingi'

ti'tt1to'rnli;iilrt
pt t'oTtogra[i'a
2.4.4.2. Problemade dinllnostice'ti'o'pntogen'itt
neruultti oculotflotor artern.
A)Para|.iziilalron'tn,arc,sitttflelcventittl'ilrti|tl,r1ll1;rrril,i1|'rr;rltrlttirlit
ttcrltltitttttl'tttt
ou"n"fr6r-,r-iii-o'ai t, t,rrs"rrl o.l m,i lung dirrtr. 1,.fi norvii
vttlttrr'irltil
trut,i
rxil,.
nr{uri.
1)l
rliforif.
rt*
!"pii*t rn f,,i.',i,t
;i;;;;";"r.i-j
tnzonainca,rctrcotpur,,,,-*fitt""t'1'otnporl'ltlltriqiltil'trrrrrtlolttsittttxttl
cavetnos.
a)Pt'oaesauuS|lll'I'(t.(11t,'sittct'r'ulrtt:ttlttttlttl'ot"'rltttttn,portxlllott'tlVli"r'itii lirrttic :tIrrrlrirtli'rttt rtr ( sd lttittt:' Arlf..l' ittlol'tt'
til,
( I ' I I r :l 'r ( !t) ( \'
t
"-,riuiuu,i,
"ao.
t , , r z i l 't r , - l , L t ( '{r ,'l tt'i l l 1 l i .r i r kr i ttl .t'vi ttt'ttl o ttttl L tl r i t.r L t'l tti , t I t ' i I | ' I '
llitr rItr|.'Itt'||'tI
{ra,rul lrn1;r*o.iiilrr,i'r,pl 4i rr,r,hr'ulrt,biritrt,itlilil itttrrttt,irtrt't'I'
('iu'ot'l(l{!
rrfl{tr.i
tt
lrl6rrlll'
ir,lli"t
s.
l)(r
li:n'ti. Itt s!tlltslll 'llv('rlr's
tt lx)l llli(]l'll tlotvttl txtttlttltlttl'rtt'
',llt'l'(rll
itl,tirrtc, I li llr i,r'tttl,ttAiLtt'pro(t('x(ul ttl'ttudtrotlt

,lll'li,!:r:l;i;i;ii;'trltTi.t#'iT*fflti,rli!i:,r-1J*?:{'l,1'r'4
;fil"ill,,;lli;,,tt]:",:;#;;,:;y3ilii";;;i;
jii:,i['t,Hf
iii,tii'l
:i:;Kili;E:f:::i#,,Jffi,/,,:i1l
:n,liil
lL?"li
iiili,r'li,,if:i:;i!i':,,,{:i:'i
1l !\tratiziih:
)
nttderr,rr:rlp
IVa sinl gr'(trt(l(r(li[('r!'rrtiitl;
,trr il(\ r1(lt(\
lr,rr.rlir,rrr
;,,|i:j;li:Ji:'.rr
^,,,,
t

{! r 1 i ( ! l 'l l , u l l ( ', o l 'i l ti l a ,l 't'r l tl .

l5

l-l
l,lll'ililiifiilr;iritiJii,iiiii::rlliiilr;lil;l;l"ll';11,i:'il1'll1;t
l;li;"i;11,,:ilil,
r'rrrl'r't,''r(
:rtr'r't'rt'
Ni
rtrtzir:tttt
rt''r1i.''"'.'".''''
gi l o,

.a,t' i tl uroidit r ( lt ot r nr , l, llt t ) i'i l) l

lr , usir r ollr , b. ,t lXi0; lii) g( , r qi colr r , lr . ,

r.969).
h) Paralizia percclriirr V I ir :r,llilrerle :r,scnrorcrr
Si.irt sinilrttnu,l.,liutlti
^
pi 4n, celLal ,uirl\tlui or:bttar.
sJewidale
i).Tu.mori ale fosti 1tl,ru'ir1o-Ttalatine
ptotTLa ltilroestezio qi rrcvlrlgirr
.
jn
teritoriu-l ramu-r.ii 1r,.ll-1, l ncrvului trigcmcn, hiposecrc!,io lrr,r'irnali,
si pa.ralizia ner.vului oculomoror e:lern.
j) Paralizia cronici a neryului oculomotor exl,ern poate consl,itrri
prinrul semn aI unei lu,mori din regiunea tli nl,rt drful stincii yi sirt.r.r,tlrt
L
carernt (Sakalas qi colab., 19?5).
. B ) Paralizi,ile rad,iculare (intranearaniale ectranucleare) a1tlr. (rrl
mai fi'ecr-ent
ale porliunii ventrale a protuberan{,oi.
-in,,lezitni
,\ ind;rotnul
]Iitlard-Gublei esie lrodus iie leziuni ischemicc itr l,tl.il,o
riul arterclor medianeale alterei bazilare. Clinic se traduce prin tnrrirlizirr
facia,li si de ncrt, oculomotor extern ipsilateral, cu herniplcgic tli. 1rrr,r.L,'rr,
opusl'i_.Forma clasici a acestni sindrom are u:rele variantc, h funclic rto
extinderea leziunii: a) dac5, leziunea se intinde posterolatcrrr,l ryi iirfi,rrr.
seazi nucleul sru riid:icina principali, a trigemcnului, la tabloul cljrrio
amiirtil se-adaugi fcnomene senzitive de tip ilgic sau parestczic pc Lcrrri,
fala homohtelali ; b) dacri leziunea se intinde nurnai in diroclic 1xrsh,
rioa,r:i si afecteazd,pa[glica 1ui Reil, realizeazraqi un sindroru sctrziliv
alte-rn; c) dacl, leziuncase intinde in direcfie medi.rnir.qi cupr.ildr: trolvrrl
oculornotor ertern de partea opusi,, apmc o parelizie si a acr.stlri nrtv ;
cl) rnar::ileziunea se intinde in diledlia crlotci plotubeiantirL,, alirol,rrrz:i
qi n:untleleta longiturlinald, posteriod,ri,.
Q ) Pu,raliziile nuclearesint in gener,alrare ;i aprl rnri eltu irrprr,rrrril,
cu al.ctarea altor sttuoturi neryoase din \-ecinr:i,iit r.. .\stlr.l. Dlirillizirr
nuclenri, de ocu-lomotorexterrt apare aproape tot(lc:runa lsocilrti t'rr 1,rr
ralizie facialiL periferici..
Nucleul perechii a lrl-a sc :rfLi aproape elc rr:rrtrul porrtin l,onl,frt
plivir..l ipsilateralir,de la care o cale tlc asociatiecorxlticc,prirr intrrr.nrrrrl
irrl
bantlt'letei lotgitudinale postelioare, la nuclirul pcltlu nrn;clrirrl rlr.rpl,
oxtern de partea opusti,.Acst ccntru ponti estc Nd{rserllfccttt (lc lcziunee care inteleseazi,nucleul oculomotorului cxtcln, qa incit, po lirrgr"l
paratizia de nuqchi rircpt cxtelrr, :ll):ll.e;i o paralizic rr prilir.ii lir,1,i,r'rr,lo
rlo
ilc|p11r.i
prrt' qi tlerilfia coniugatir I globilor ocrrlitri rlc prrrtcrl,oprrsi.
O rfr.clltne limitet.i h norvul facial si alxtucerlsilc rrcrct;i lrarltr {i fiiri,
pararLlizja
miqci,ritorconjueatc r1r,latcrialil:rt,r,sugcr,c;rzio loziirrrulcni,r.;rll,
la m:rllinca infcrioat.ri
;r ltrrniii, lndo lctsiti rloi no'l-i lliliisr:sl lr,rrrrclrirrl
certl,r,rl foarle :lplr,4c lrtrul do r:itlirlrl1,.t)llnllizirr,rirrtleu,rii irilrrl,rrlrrli
de ootlornotol ertenr nu txtc rlr.ii, rlacr'ii:irrcurslrrrrlr rlo lattl rrl ri, cli rkri
('oncornilr.trl;
trucleise giscsc in apr',11itrr'.
s(rlLsoci:lzii
llrrlalizilrrrriscir.ilor
rle la-crilltate ;i plr';rlizir rrrrilrrtcllliisirrrlriluict'rrli Irrri:r,liipuiliilicri.
at Sinrlromttl lui (lus?tiui (sittrlln,ntl ilot;;o-[t lu.or:a
urLulftl lrqnt: .
tttlui pontin) s(' lrlllit(i1(nizl'llzi
(t.llIti(ji V,
rlt.fioil
lrl
tt('l\.il()r
1rIirri,t.rrIr
TI,YII qiYItrIrl, lrurl,r':r
llzirrrrii,lrrl)rrrlrilir|^ scrrsilriliiirlr'l,r'r.rnoll!:.r'zill,
de pi,rfor,ol)r tsii,(1('\'iil1
il illolrilol oirrrlltlisl)l\. 1)itt1r!ll
sililolrsli rii lirlrrgrnus {ilrc bfi1c tlr 1|rr,lr':r
lr,zitrrrii(l{r,rrlr.rrlriilrl1i \-lrsrrlgil,lllir?: ,l,rrrrr
r|()rrisi .Nlonl,rrrtN,l'i,
l!r(i0).
lt\ Sintl.tonrt,l.
Lu.[ ll,utturtntl(*irrltrnu.l urrrrltl tl lt,ilnht't'(nl(i) \rl
tliU'irrllt'fizu
,zii 1rt.itt
lt \'1.:r rlr' 1Ir1l1,1q
lr.zirrrrrisi Drrrr
llrr,rrlizirr1l(\n,('lrii

;l,i;i';'iiih.lill;lill,i,',J;illiij;l',1,;ii;*;l
,,,,,(,,:,,i{,,,,
,
rr:,;,,,,,,,
l,'l';,iliiil,j;l:;iiillill;jl,

stincii
te,n.
#:;';:::,:,i",!'i:w*.,t,f3,wi.
l,:,.,!,:.).!:':"r::i,'!::':i;j!:,li:",,#H::^

;i,,,i;-iir;:i*zui*$*"#ti+*i*$ffiiluts,i+rffi

i-isrr*,t*i*i+g***g'l'am':ln*}i;ffi

jl.ii,l,i;l'lil'i,:ii:,'i?*ffi
lr"*",:i:t":*;*lii;)*T""*,tT.ff
"i,:":#;

;,,:1i:iliimk#;il**i5xrl?*atr,':ur#fff
::
;l;;,ll;;ir-l,,lll#Tif i,:,ilTiiT,?fiii"*k*t"li:x

"l'":#i::tlfi
ri;i;itr1*llr*rl*l"l'ai*ffi
*"!*;l{6ryffi.,##i
rli'll-li,:*l',::*;,:,lh$.t"i"rli,*xJi""';ii#.#o"",."*,..,
'"'n"ii"i,

ll;;ii:l;:lll;:ll''ll'i'l;,iliih"3
,*t":1rgoame
'runo'"i

.i""ii"",fr"

,l.'',,';,il;lll'1,*f
'.,il;1,i{x'ffi
i1t"#:?",'"'":HtJf,[gilii*1',?l;,

r;:'lr;;r,
li:l:rljrrilnir#rl*i:",ffi
1;i:{"g:#qJ#$t?
i,
:,ii'Illi1,ji
;i,iii[,*31g
I';I
rl,.;l1ii'1illl::t,,tr:,*!#itr#::*#"*{,ffi
"k::rilr*11#x"ii;*t
.;x?d,Ti:Tif"::,ff;:H:

pu"ro'J,ili,io,."u.
r,ezi.nea
;ll,I ' ];l ; l";i';;;l'ii";:"r"..1;?;
fll,t"-l" ^u"."';i

1,'.,,;11:r,iilir;ii.,Uil{-$1$l=qitr#,*i':iI:}{1.+l
$
trigenicu':L
i'tii
l'.:'n**"
$"'JiT,'""!
i'i,liii:i I lil;ririlii?*ii,
ffi ,'[l jd'jff'I' i
j,tI
jlt',lltiliil;l
i'dtr{trf*lil,Hi

Lr,,,,il,il
iiliit

Ijii1,liiriili
i'ili*i

iil;r
ilnriliix#"*n*
iipl4*1n,htikirilH
r.Hrr* irrfr
)vlrriru
rrrr4ig,,rr,ri,
z.rirz.frr(\rr
irrli,r,{ii
rrxl'rrr,,;:ill,ll'l'lil'lJll,'r

[$

l l t r r t rr I i t t o z i l , d ( ' l ) i ttl l i r o l r r H i i .

rt

(ollllrtropklliik' ittlortttttlt'nro)
:1,4.!i.lhrnllziilrr ittlctrrur'k'rtrr'
rlill I(rza,r'oll
I )i I tII II' II' I t' i lotrgiltttli
t'r'zttll,ii,
o,ltnl.n11lt11iil.r 'iul(t't'ttt:l(xt.t't
( lltt'lr'1t't'olr,
siltt
rrrrlr.jroilIcliirrrlr'.
t'st'trfirt)r'
itlo palaliziik-rt'ittlt'lltttrrlt'itltr
( sr t.lrs('lrw(,grfr',ll)(i9) : a) rrt soltiul drept illtern este para,liz.Il,]rcntr'l]
(,rlrr.iugalri,
tle lRtclr'titatr:, insi, funclioneaz5,norrnal in timpul
|||rr1r'iri(.r|
r,,rrirllglrr{r'i ; ll) prozerrla nistagmusului tlisociai, singular sau_prepolgcl.rrl lrr,orrlriul oiro privefte in afarri; c) prezerlta paralolismului glo}lilor
,r'rrlrrli lrr plivilca, inainte, in ciuda parezei bilatelale a muqohiului drept
r ll l (.l l r.

'in

pozlina (indeosebi vasculare) se poi intilni doui forrle

1.,'.:irrn,ile
i ilrrlrrlrr rIo oltalmoplegii jnternucleare:
1rrrr
| ) (),lltlnto1tlegiu i.nternttalrard,anlet'ioa'rd, cea tnai frt'r,r'cntil, aparl+
,,;r ,r ,,orsr.r,itrtiia leziii'ii fiblelc)l care leagii nuclcul pcrcchii t ffl-a, cu
(r'rlr'Il Donl,itI petttru mi;ca.r'eaoonjugat5' orizontal:"1rle partea oi:us[
(lrlrlr,ll rrscrtrtlrlrtr:ale bandeletei longitudinale lostf ioare). Clittic sir
|', |||rrIr';i,lrr plivil'ca lateraid, paralizia muqchiului drept irtteln (de p,rt'tca
tliptopieincruciEatb,
r rrrlr.sr.rrllilrrzittnca,),
$i lrjstaguus ulizontal la othiul
r':rr',.pr'irlsic irr lrfrrii. AJoste lenomone se explicr'i?r'iir 1ri'tnl ci, nrtcleul
;rr,rrllrr rrrrryrlriuldropt intern nu primeqte impulsrrl'i pentrt mileatea'
r.orrirri:,rrIi1,
lrrl,rtrrJi,rle ln centrul pontin de partca ol)trs:i.Pe de altii pnrte,
rrrrr,lorl rrrrlvrrlrti rlbdncens primeqte impdsuri cerebrale qi vestibuJare
r; rrri IrrI r,r'rrIrr fi r sl,lit funcl,ioneazi normal. Convergenia se produce, intrucit
r:rrrlr. l)r.r1r'u rc('rstir, mifiare nu trc ?rin centrul pontin aI mi;clrii la1'erale
,'{,| | i ||ri rrI r' . I)rrrri leziurrea este bi1il,terald, apal'e o paralizie a adducl,iei
l,lolrrrlui rrrrlar irt arnbelc sensu'i (dar cu conservarea convergen{ei)l
| | iIi I i r:fi| |rrIr.rIrr liot'alo din ochii afla{,i in abduc.tie li nistagmus lt} privircir.
rrr rr|11.\iN1irglnusul opi,olri etic qi indus prin excitalrie vestibultril cvi
rlr'rrlr:zir list)rrsrli tliferite la cei rloi ocli (Bender,1969' cita,t de Popor rcrrrsi l'rrsr,tt,l{).B0).
li ) | ).llrtltrtrryilrlti( internucle d, Ttoslerioard'este adesea greu tle _diag_r,rtrri.
i) 1rrr,r':rlizie
supranuclearl a, perechii a Vf-a este foarte dificil
rll rlil!.r'r'rr(,ilr,t,
lil{ii, tlo o afingerela nivelul nuclear sau radicula,ra' net'r-ului
\ t (llrllrlri si rtlab.. f9;$). I{u$chiul drept intern de partea nelezai':isc
r'.rrr1rrrrIiirrolrrlL),iri schimb ml;chiul dfopt exterl de partea ]cziunii rni
lrrr! iionllilzi'i irr r.tu'srilInisci ilor dc late,ralil,ate.In aceastl' formi'l sint
l,'zrrlr'lilrlr,lc rk,srrr,trrlentc
ale bandeletelorlongituclinalcposterioale {ile ltr
{.r'rirrl porl'ilr rr1rnilciit'ilor dc }ateralitate la nucleul tr'bducensde aceea';i
lrirr'lr').(l)rvllg(,r11ll,srr llrotlrroc rrormal, NistagmusLrlorizontal aprlre de
olrrtsi,lcziurrii l:t ooliittl c:Lre?rjveqte in aflrii
;rirr'lr,rr
intlc celr tlouli forrne se facc pf ii'l lruliza' compr,tr'tlrii
l)ili,f('r1,ii^r'(,rr
( irlr, itr:ti{)llrlrzii,in seng orizorLtal.Astl.el, in forma antu ioiir;lt
rrrrrrrr'IriIor'
rlr r,1rlrrl r,r lc|rr il(f l)lutea leziunii funcliolleazi normirl, in tirup oe clrcptul
rrlr'r'|| rlr' |rrr'l0rl oltttsli cste I)al'alizat pentru miqcareaconjugatil,de l:r,telrlilrrlr. s1rlr. l)lltetu lcziunii, insL fulc{,ioneazi, norirral in convergeltit'
Irr lirrrrrr posl t,r'iriai'ii, rtmhii drtpli jntcrni :ru o arti'r-itate normalil, a1,it
N rnai
r:it
i11timpul corn-ergen1,oi.
rrr lirrrlrrrl rrrir;r'r'iliirkr l.rLclt.tlit,:tte,
"ri
pcrttlr'u.
mi;carea tl'lrtterlr'r,l)lrl('\l{,1'rrrLr prtr' 1t,ir
loziunii cstc pat'alizal
tltl ltalirlizil,ptr4llitt zisi
Ii tli'lirt'ctt('ia,iir,
r':rlilirir'.lfrrlrrlr lrorict'ioilt'ii
1xrrr1,o
(krllrrtrl 1i
I t 1 r| tt' t' lt ii rt \ lir ttttttlit i lt r ilt lt ' llr ' lI t lt l s f it t t t t lt t t ' t 'l l t 'i ) i l 'i l l f i f i t .
(lllillt rrrt rrtrL llrl , : t , lt r r lt lr t t t l, ' t t t r it t r r lr t gir ' , r ' s l r ' l l l i r i l o g i r , s f i t 'r '1 i r t I l r l
'' o l r rlr,

5u

t
ll

il
1
I

dc ,,o1lrrInto1tl,6ir'
rllllrtlrllrll'ii tL' :rlxlrlr'('il"'(1i trtt lxrslctiort'ti)
1r't'trr.ttii
t
t
t
t
tr,Ir':t t ri tltl rltltl.utrlitl"(1i lttt ltttllrirlltl'il)'
tlr
llt,irllrtoll
ltrgic
i
t
1
r
t
'
'
1i
,,o
lt)
l)iaqnostic etiologio: 'rr'/rto;-rl'in pliici eslr' (1:l'llzilti(rll'tttrti lt'trtrvtrtll'ri
l of lalmoplegiilor inicrttttclt,iur, ttlti- sau bilater:lltr; lr) lczitttriltrvirs(rllilt(t
se iau irLconsiderarein tjotttoxtul clinic (Ifa ingtorr si cttlab., l1)61i;\!rllHll
;i lloyt, 1969; Cogan, 19?0; tr'dtzsch, 19?1; Gonyoa' 11f74)
CJ Oltalmoplegiile internucleare pot si apari' de ambth piirli,.trsr.t
ciirtrlu-seqi o oaiecare asinergiea globilor oculari, precum ,1ipitt'rr'liziirtlrr
prir.irii veiticaie, 1l sus, ale globilor ocdari (prin extcnsia lozittttiltrl lrott.
iinc in paltct'| inferioarS, a rnezencefalului (Cogan gi colab., 11)5()-- r'iirt,l'i
r L'. iiotlechtel, lC6j).
2,/r.6. Paraliziile oculogire suprarruclearc

lr

. L'ezi.ltlile suptanuclt'ilt t rrrtttt

2.4.6.1, Sumat d,e iJ'ata semioloylice
afecteazij, mecanismele miqclrilor conjugate se traaluc sentiologic ltt itt :
a ) Dim,imtarea *atr abolirea mi;cdrilor conju'gate oolunl,arc s(r (lirril'(t'
ierizcazi, prin paralizii de tatera,litate, de ve*icalitate sau dc collv('l'gll lI r'i'.
ln funcfid de iopografia leziunii, bolnavul nu poate sI'-;i dirijcze gkrbii
oclllari ia comandi intr-o anumit[ clil'eclie. De asemenea, drurii rt[rrtt('itt'
pacientilor este atraBrispre un obiect cale nu se afld, in fata krt',.lti.trtt 1i
pot deplasaochii pentru a-l privi. Eristl $i o cresterell ,,tonicii;i'l'ii" ttlttrl
chilor antagoniqti, care duc Ia o devialie a globilor ocul&ri de l)rrl(rir, ol)rr$ .
\r apal fenomenc rliplopice
refletelor de .fitalic st' pttxltttrrr ;ttitt
Dlec&nismelor
b ) Itttensifi,aareo,
*,r itllil sLtlrcolr
pielclereaconti'olului inhibitor. ln mod normal, iirlrtt
trolul r-oinfei qi ochii pot fi miqcali de la un obiect ia a[1,uItltpii, rLrlitr(ri.
!n p.r''rliziile supranu-cl"are,bolnavul lu poate sri-li tr2rnslix\ror,ltii tlr'
pe un obiect pe altul Ia comand5, insd poate uuniti i [u obiotrl; orttrr so
rni;ci. in direcl.iaparaliziei. De asemenea,se pot e!'identjtl uicllrsji Lrilllrrfr'
rolrnalo la stirnLrlarea labirinticii. Pie}derea rnisciil'ilor vollllll,iIrrr irl('
globilcr ocula,ri, cu lespectarea trtulor mi;cirilor ooulal'o r{rflo\(', $(\
riurnegte pseudo-oftalnnplegie.Paratiziilc m\ciLrilor dc ltttttrlitrtlt', rrtr
pistr:.rer -conrergiltei, indicii o leziune corticdld'sar pe c(idl. tnrl,ittol'tt
11ult,
inainte ca acestea si, a,tingi centrii subcorticali. In untlc cazttti, ilt rrrt'tr'
contloltl voluntar se pirde, reflexele de fixalic pot dovdii t tt' i tI It i I tIrI I' ,
prir-irea se,,ancoreazi" de un obiect, lncit o mi;cart ultcriorl'rilIlll lxrirlr'
li fir.urtri decit tiupi, ce se elimili irnpulsrltile lctirticno (itrcltitlt,tlrt rrt,tt
acoperirea ochilor). :Lceste situa'!ii ar1 fost dcnul]Iil;r' ,,a'l!1t,1:it o()ttl'!ri
tttolorie'1(Goldstein li Cogan' 1965).
rlrr Irt. lrrlrititrl'
t ) Intensi.ficutearcll(.relor proprioaeptiu cillo l)or'11{ls('
tlcilsul)lilllll(lf ilt)r
si de la rnurschiigitului epa'e atunoi cincl leziunt'lrsc:rllr-t'
pontini ai sistemului l'estibulal. Astfel, tle piklir la lttr clz lilcrtt'trttrilt'ritill
voluntrro itL sus sau spre dreapta sint irrrfosiJ]il{',lLrltriiinsi ('rt,l)lll('sl,r'
sttlr tttt tttt$lti rr{ttl
br s'r (oborit sau illtori sl)rt! sl,inga, otrlrii str r.ott'it.zri
in srrsi1islr'(f {lrolrpt,it,ct':t1xli ilt Illo(l aul,ornfl1sii srrt t' i rtI'rI It t'tIii, ltt lrozililr
ttt|tliltlthr<'il,rrr
t't'll0xt'ltr
Irrt'rrt'izotll;fii. Ilsl,t'.lcnonenttl
,,oohilotilt Ttityttt;i'".
icr', dlr,cil,llliri{ilrlil' crr,pllltli r^s14'lrt'tts<rii,;i rlt, crli;t't'i t trp ttl st tt i lr'
LrrLrilirtl
l r l o p l i o g r r p {, ivr , tl c
t l l ; , r r r r u i k 'ttti i ,.

l tt, tti l cl ttl

IIl IIfj ( IIi I( ||

.'tl l ttl ti j '

r l l r r ,r i , ttti ;t:l ttt'i t, t'i tl r ttl ttt

l')11

t t'rtnt4 lttt

l)t

lt t ilt ) t . . x I lt , t lit /

ir r r J r li|l. r:

( It )I |(I()l | | i I (' | | I sc lt t r t t lt t lr r r r r l. t r r l L, lr lr ilr l ( 'r ll. lllglllii ; l glr r lt ilr lt r x, t t lr r t t

i n (l i rcl l i l l ol i r t sii llt r r lizir . r ; r rr r r lr L.
l )ccrl sl r1ja libr elol or , r r louilr ' pr , t r it t t t ni; cr iit 'ilr ,( ( nl, jr lgr r l( 'I lt , i'r 'r ': t llil: r
Iri l el !eduncular inf er ior ' f i lxlr r l, ilr st t pur ir t t) alr : t t n t ol i; t qt ol't 'alt l;it r : lr r
bilirc:r, diagnosticului topogralic al It-'zitrnilor'.Astlcl, iIrtrclnpcrc:l Iilrl''1,,r'
deasupra incruciqirii induce pitlalizia milcilii latcralo slfc ?l11crl' (il)rrfi,.

,, ,,,:;,1,,,,1'lll"-i1:';1"','i,"'j1i:.'i,ii,'iiill;lli,il,l,l,i;-;,,l,,i,"
llil,li,;i,i,,,1,,:iii,;,,'l,iil;

rl.rrrrrrrr'r':rzi
, r.zirrrr.r'rr':rrr'r'li.rrrolr,,iitl"",';,r"
r',,iil],,,,,,,",u
'riscririlo'
ll,ii,.;.iiir...i,rili"li
:i':li'i,';,',;:ill;);;:;i,l',;;l:]'ili.-:1il,i;:;,,r.ziunei,

",,ri,""" sintpii'r"1.te
,,,,1,,,,,,,,i,.
,i,,.;i.,,,;i,;;,;''il;';ili"Ji
T,;:i:i:".
;|?1iil11:#
tt ) t,tix:iir.itc

,,,.
r rr

l' l)| (.1, |lrt0

da .u,tmd,riresint l,estatesofi"itilJ
laci"ntuhi

se tnis c t j, di;

si1 jireze

rita, la aproxirnativ
60 t,rl irr
r,,r,,,,,.r,ir,,,l.irl,,i;,;.,ilil|":;:ll:i^tu:!"i"

,r;riir,,.,,1,,i"i,,,-ioai.i'T1il::"ffi.'i:-Jii:tfiil?"1i?llff:lif;,yui*or'i
,

) 'l'rxttt!.ntet:u.n,is.mului,d.e
l.ixuJie: piLcierhul csio sol;i,;tat
pri\ i.:, r'rrrlr'('l)1i
rJl-fat. cramirxtoruiui, ilmp in care
.roA.airu;o,rrL uir",;.
,ii'iul
,,l,rr'.t;r l,(,rili,r'i',
.imltului vizual (#i;r:arit:a,"ii"ii, _"ii),'i_,s*
dc lLi,l*il)i).
tr rr,,rt rrl.trurl, st:
ltroduceo rniscare
r 11r'rr.r!'' rr.r'srr:irnisciiri s.gereazii -a privilii iplr stinlnlui r,e:jljr,!.Li\,.
o t,,ri*"
t"ri"""ur,i cr-iiLr.
;rrir_
r( rrr'|r
(''!*1r' rrc re'einrui
occipital oi ","u'li i,riir" i rre rir,,:*:.
'|",
t
\t,4t,
,
tt( t ttttt'p)
"i""riit
gen,rri..,
examinatolul cr'le
borr[r\'rLrui si_i rlr,rnr, .. . " .,'
('.rr. (e

ii, I

',,

,'i,;.;'rrr,

rni..:j5.
lerNir fatraochitorip,:" .,io,i,,;",,ia"iiiiii

) 'l'r-'xlurau
farei l.ente( tl"stctgnustrlttittptoltittetic.Utl ect:ul tiriutcat
,t
|' ,, t)t'/t
\l'rticaie de curo.i dileritc este
in Ilta pacrelt,rrlr, i.r.
.str soricil,atsii tiui,p'ir-irea u't 'riicat
r'i"
pe ceni,.lr er,-r11'r{rr
,, rlrri, ii'rt) irr salp ngeslj,
"ruJ'"u"..t,,ir'i
esti miscat-l;^il#;,i;;jtr.u
direci,ii.ln
,.,rrriitr l{)t.lrlll(j apari: nistagmu-"ul
-- '
optokinetic.
) ,. , ,, , ,.,, ttirttt0tnusul.ui,_;c11t!Uuia,r
rotator srLr\ tlistq(nt| ).tllui
t ..,.!
tttt , t t t . :.rt ',,
l .t .,
. t , ( l i r 1,( _ i r n l r ot,la l]t
^

r) r, irrr,,.lr,rraliziti

; ,"nu"u,-#iiii:,:?".,?,::t;,",i,",,x"::,r11:ij:;;;illi;
, sirrt,J)ri_..1rate,
-rii.,,iia-',1;;;;;,"
\,,,lrr,rtr'
leziu,rcltr.t
arc,tui r.eUr"i"
ur_nuclcut
' l1iI rl,tihrrtlr (ncrvulr,,estilul
_,.r t,,fr,l,ni iui Deitet,s

i"iilI
lltllli,li
;li,lLl];,Il;?:ii:;lJ,Jl;L';';,1'f,1i,'"_,ii;1;tl":l,";:lfll:
rrrr,rrrr.rl'rl, (J(,llsltllrl
'r._,i..,.'.,i

nucleilur nervilor,
.oculoin"t""i- aral
\, .1rl)rlr1 ( sI{l ilrlrft. ln_prezenfaparaUril".
iril21i"r"lJali'prs,irii llri,r:rale
, Ir r,r ,r| | iI I( . r| jl:rrt,rr ulechii protluce
'
numai rniqciili tenie. afe ochiuhii.
:'. t.( i.:.1. l, uihl tu e rIe di a
ElttostictoltograJia .,si etir.tpat
ogenic

,,,,,
,.,!,:,'i;,,i
,,1
,,,',;::'i',:i;li,{:i:,:,:,,;"x!;i:1,i.:,1:,^1i,,r"'1;,*;T:l:.fiH:T,,;"_,:
. l ' r.rlr' t ' lt, rlrrr lt <,r^ trlt.iloi O Lt t t lo

.,,,,ir,ri
;iliid;illli"ftlrliii'iTlift:J.,,*"TT;l'Ii
',,rrr,r'.1,;;
ii"i,.li,?i];

;iI;r;,
:
r1
l,
i,
lli:liilui#]rliixnsft,,;li
[mlri#"1*,uffi
I i 1;1,
i
r , r rrl ,rrl i riI r , or r t ir lir ljr r a; rtb tl c t,

l t ' rrrjli' r' r )lilriilo:lsii.lrr

illr ir llr , , lr r r r , : r l. iz , iilr , pr , J lilii
llrrrrhtst. f[(] lozil,lri in
I l l l l i llul lllr,lrr,trl r,itrl r ir . r llr : r lli I t t lt i
lt lt t lli' t L' r ' it r i 'l r l p r o t l t l s L r r l q
l, ziLtlj
r , rrN r(' rr(. r..
| ) I ',tt'lli.:iil(
n tis : r r r ilt t . |, , , t |it |||, |t |
, , t i. , , t t lr r lr . ( r i 4 t l ) , , ) 4 . 1 t 1 t t , l i . t , ; l l t ,
)
I , :r l I r I j z rr I r, rrri,r,Irr,r I r . r rl ir . lt r lr . t , t r lillr lr .
, . , , r r , l, r r r i r r i I rI rr |:i i | | i I i I : I I r, .L I r r i r ,
,
( ' , t.r, l r,ol.il.,rtr
rrll l,lolr r lr r l olr r lr l, r , lr l r , 1r r , , r l t , , : r ; , 1 :Jr l
fi,, . i,r,, i,,,,i,i
ll t )

c.iilar aculolttc:
I:i{/.
1 1 . L t . i u l ri i e
: Ne!rc!
.l : N.Eon
mezo.cialnr hcDicrrltrrnrr ;
.artnrl
:rdliocnl:rrat.r;
-B
l i . ri re rn i a . c l l o n '
C : \ . r{ o n n e T. . e l a l n i x l . . ! l o n r. l . r, ] ri i . o n r: n ; 7 -' I ' . h l i z i c
l.rt ll:i .\tdn : I - Pi.rli2ie n!(l.arr .onjlgali | ., - I-rerialic conjrrgai' lrnr leTirx'
_crnisJ'r('
itTnD'
tunjlgat:
Dc;irlie
)pNte'di.il
4
lrin

i n 1,i rrr1r
cc i ri l lclu1t elca' 1ot sr b t lccusalie cat r zet zlj,plr llizir i lr t it t il ii lr r llt . r l'
ci 1rr, rtct,ou5 ilt lr t '1r '.
Itr fttttcl ir r t lt , lr t tt t lizlt lt 'it lt , zit r t r ii 1i r lr r pt it t t kr t 't , r tlt' llot s] r 't t r rtlt t t t r ''t
r : 't lt 'r t '; 'it l lr t i lilt t t r i t l. t 'sir t r ! t 'olt t t t t I' r or illt ' ( lil. i l: i . i
vrri rsr.rl rrvt' r, iI r r 'i1lt I rst
l l g. I l ).

:r). , { ir r r l. r , r r it r llt ' t' ti l l t rttl r' t,i rt (tn ti l l Iri r $ i ? l .I t,nl at.)r,rrl r,
.
l rr..rl rtnrl 0
I' rrri l ' . r ' : iilul olr r lo ;i l r' rL .i rs u l rr,i r,l rrn l c j s j l l i i (tnl i l L,x l tr rri vr,l i rr,psul rr,r).
l i ,, rrr:r r r ili. r lii 1r r ir r l ,r' -ol rrrri r,l i z i r,
rl c l l rl c l l l i l a te a ])fi vi ri i , rj l l ([{ fvi oi (]r\gl ol ,rl ,'r ,, r ' ul: r . r ' i,r r r r r or.iq i i i r l l l )l l u i , s l )r' (,tr)a rte al ezi uni i (bol l raytrl i ;i pri vi tqte
Ii 'zrrr.:r ) , l: L r . : u' r . s (.rrs o c i l l z i -r,
() p a t,? l l i z i ofa c i a i 5 tl e ti p central
,i o hemi _
lrlcgir'.rtc l)itll,(fr ollnsir lczinnii. L,eziulile cauzale sint hemoragiile, infalrct r.l r. i .i lr r r r ur r ilr c m i s fc ri e e .
Nlrrriii'stiir.ilo inverse, ilitative, pleced aleviatii conjrgate alo globilor
.
,,, rrlrli (rrrruor,isi alc capului) sprc
lartea oprrsil (confotm legii lui pr6vost
I

'll

tl( ll )llZ\').

It\ '{inrln,nul Fot,ille m ijlocitt, (protuberanlial superi,or

) cste realizat
(1, 1,,,:rl,ir iilrlelor ocnlogire dup5, incruciDare astfel globii
oculari sint
$i

I l!1,
. Sl lltoulnele
Lui FoDiItre:
/.l .L 'r!l l l i rrh l rl i l ./r .Ir l&l!,ui\,r r lonlnor ii( oculosnc) jr .- r ilr r ec ol ti c odr dur e
lr ,) vr lt. por tjh( xr t*; Z _ Si r r tr dm r t l Lj i F ov i l ) c p.{nr nel l rd rn , l .!.h l )j i,- SLr ||,J"nl
rh L l i,t r Ir r yn{ ; ,t -' r :ir ' r ,t
t!i ltvil.
l) r nr l u.r nl i r t i nfc .i or ,
' ' Ir t

rl ,"r i l r{, i- lor r ils l) t . r ,l) r l r' l (,i l ,.l l )l i tr1

l r,z i rtn i i . I)rrn rl i zi l ,l :tri tt,i i i r,stc
,
rl c l i l l oq11r,l r,l
,r r.i ('l t l' lii,it r r ; r r ' r . r r rrl0 tr I rr,I rr i ; I Ir,; I i I r, rl r' l rrrr' l r.rrrr1rrrsl l r' zi rrrri i (l rol i rrrvrrl i ;i
l ,t rvo l lr , t lr , lr llr ( , 1r , ;rrtl rrl i z l rl ,rr).
0 :l

ot t
S xl .rotttu l f l( r gr t t nt t l-( lr Nltttt ( lillt llt ) llllll 'supct 'i( n't ll- lt 'glt t l't r lt t lt t i ltt rtlr'
ttrijlocill' lrt'
lrovillo
tttt
sirLrj'rotn
sorrtirrlirgir',
in
conljexl,ul
t,in) culrirrdtr,
gl'5rrli

;;;ililii';tti
l,;'i;;;;;it
leziunii.
parlea
olusl
de
-'

c,'i,'l,t,il's'ipsilatoral
f i hotrliliipo.sl'r'zi'

'",'is;,,air,rr1 fstiTll In.fPrioi (ptolltl)rtta!ial itll.'.itttl crlr gr'ttlt;rl

ptitr p;rlirlr/r:'
O" l"riooi ,i".ailol oculogiri-ub inciucjsarpii st malrilc'\lI
globilur
o(:rllirrinl)11'
a
coniugatir
alevjereririi:i.iiirrt" pn,1oaleziunii, cu
jnfeliol
,.rr
s. loir,. rsocia.$i urr siI(lr','t'l
i'r,1"^i'-ii,gi SioO,omufTorlillc
tl'
siluirii sislemelo' tle asoci{rlio:rlr'.irlr.
fif;iijt.r-"dijnj"tI ilin'"nua

bilalerale,iirs:i i'og^ltr' irtt

p"tl"e sint aclesea
ii'iiiiiii"X#"i, oil"iiriir"
-irnpulsruili'
rostibulale silt pierilute'
risnunsulile
' *"-.'i"o*firiifn li
pot irnbrlca, lirirrt

i"cdmpt"te ale privirii de latiralitateorizorlh, c"."i i-pn" cintl globii oculrri silrt itttlrtrlrlrrii
nistrE
"tii,r,ii
paraliziei.
ln diieclia
I'itt
I'iraliaiile migcdrilor conjugo'te tle tertic:ttlilate (sintlttittrttl
!)
jll'rlischtrwil s' h
"u'?Jrlunlt"
comisulii albe posterioare, alc nucllilor lui
Lllrtr'lrrrrr.i
.i Crial si ale iubstrn(ei cenuEiipcriapedu('lirl(din reglllll{'a r rttrrI rrl.'
litt
ucloa'r'
aoietlo"i p.ino tibrele ocirlomor'o'ii bupran
;;"r;l';t.;;;i
(ar\':r'
si'-'"
L;ltiur!i
vcrlicalp'
iiir:'riiliilTj.'i;l o pu'i-li,i"ryivirii
(:tx rr'l
r'r'l('
iar
i.n-'us,
pr-ivilii
paralizia
prorl'uc
inri-aor"rio' (craniait
mai posterioare (cautlal) realizeazi parallzla prwrr]r rn Jos'
rt'
fn cazul in care pa'ralizia migcirilol, conirgate de vertiur'lilrt'1't'
irr
lta'ttthrl.lrt
gdseqte
se
purlotizia miqcAritor orizontale, teziuiica
din regiuner 1ep12li 1J.5olli qi Srrlli' llrtil
"*o"irn'*
r"i'"ii'iur"i5cle veit icalitate nrr apar in leziunilc 'irt;:ttl:tt'
paializiil,'
Si;"i,bl;;i;i .i""tio"io"ii
in leziunile care a'fecteazi' zotlil l)r{'l"r
ntmai
ci
sup'eriori,
r-"
Bnderl1)(i1r)
i.rx"oli*fifo"
ibt}t;.rttltli. colabl,tooz; Pasikqi colab' 1966;
oxtrltrlrrrtt
imposibilitalcl
prin
Sindromul Parinaud se mani{e)t;
portlr'lr
ocuJari'
globilot'
a
-hlr
dr.
coborir('
rolr"Ariiol de titlicare;i1 sau
paralizio
itttrttttilrigcare de verticali{ate' lntr-o
,n"iiiA-.ti."'
i"ii
rr'.|rit
rtpui
in
sit'''
priririi
"";,Jf.ia"i'iiiriit"ri it:"cl,"nr,afcctarca
i,i"ti.
tat
l'ir'trk'trir
jos
foartc
"el
apare
in
numai
to ti.p ce
i; ilb;];; ;;;! ;i
lrr l1r
ilr_?irir,", il--ll.s L asociizi rdesea cu absenla rcaclici l)ulilxl.(i
(lollv('l'g('rr1rr
dtr
'
;i; miclriazS, relativ2i li tu menlinelea ree-c{ici
;;t-.
It''"
tlisprtt'i{'irl
jos,
plus
ln
rparc
in
privire
Daci,'*;';ierd; si iniqcareade
modirii qi a oonvergenlei.
llll(l{'irf rl
ReEiuncr precolic(llal'lnsle fl':.rl'lcaplorpr. do uumJrlo\lll
{{'
I rr
'rt(rt'iirzii
..indlomul
Pat inaur[
rn si, ca alal.-'
itl
lidicrilrx'
"",lotrrJi-Gi'ctm
l"
l)l(r()tr l
a rrilu', in special a llruscbitLlui
;;;;;;-;i;.
o;;"}ii
(x)ltvtf'gr'rrl.r
tr
'
rl.'omodal
a1e
Sr
i'ncrioare ii tleficite in )ol,ilitatcp.lupilei,
-ebt{i
il"
krzitrnilt'
i()tlir'Li
excepl
a
I\''-i
p""".hii
.In
A'r:oli;"ll-a' rr"t*lrl.i
;i;cdrile t1eurmirile pot ti pristri't^e,in tirtrli.l,t' trtiq|r'i.r'il'
;;;';;ljidt
i"t oinitt''" DiIlopia 1'o'rt''Ii 1r'oz't'tit irr ParrrliziilrL'v.r'1"
i.,i."i;"
tlirlitqttl't
satt vestibttlalr'tttu ittrlttr''
tiiri",- ,st,it,',rtareaopl orl 'irLeiic,-r
lerl,ical.
Sintctizincl4llpjgtlinlitr.r':l1Ltr.i,Il{'ILdcr'(]{)U|r)iLlillli(jiiil||,iu'll'llxIiI
.,t91,
lsi'ciit,ttttnlsntiIrrlti tttttllr,rlitttttltti'l'l'trittr'l''
lloi,4elqrl.iculitatosir
,,ris,,,i:
s:rtt ltit'ttlctt'itr'('gt,rrrlrtiltttpilltt'lrt
tliirrirrrtleit
:
a,)
t;ii;ii,,;";i,,t;irlorii
(1r)rr\'('r'gt'rr{'('i
; | ) ('
b) sp:tritrrsittt
i;;;;;i;i,;; i'i;; r'otr*trtgr:til,ir;
I
I
I
III I |)|||1
I
I
f1
l!rlrllrtl'
tlislrtAtttlls
i,'r', ittr,lttsit,'ir't'rtlizia
vitlirrllrlt,ir riqoirilol nisl,rrgrrr
r i: l

r||rInrirl.Firrii rrifl. vrlIrlr..( lrii. (1r'iz('l('rt'Il(,{.if.rir,|t{rr

rr]n)(i(hl(1(rllll{.(',
:rr(,ti.li, slttr^rl. r gil.r(t.,.irr\.rr,l,.ir.si (1. r,,t.ilil,, trrlli,rr.,,,.r
rlri rrrtrrStiirr(,i,
Ar'fhl"
irrlrlirrrc.sivi 1lr,,v.rri{,i
rlrrrl.zirrri iriliac(r}l,o
"r'iz. rirrl 1r'rxlrrsr'(lr'sr
criilrrl r.or.l
iro trtrr,ltrartpr'trl lrr rrrJ;r,iirilc
coi r.iugat
ci
(rlst)ilatliru firls1ri, irr- lr;rrril,ia uror urisrr:ili (x,llrlrc
l,)
)
r,lipidc $i
.
lr;r.li.(., rtislilg,l'irk'sntt nri,rr.l,rri.c,-in specialorizc,.ialt.,tllr. qi v-ortical'e
srrrr
.rrrlirl,r,ii,ir'etliat inairrlr,rle a fixa un obiect (u'tel de,,tremordo
lrrr'lrxrrrr"'). ,\r,cste.miqciri pot fi acompaniate de tlemor il capului.
()lrr.(,k)lriir rr fos1,descrisrli,.in
dir-e'se cncefalite, iiinel prod'si, de i6ziuni
rrL,olivtri bulbar.e;i a,lenucleilor ditla{i din cei.ebcl(Jicnder, 1969i.
l,') ,ll i.oclouiileritmice ole globitor oculari pot upiire:l in leziuni ale
rrtl l, l i rIirrr:ttrlirr.cerebel.
rrle ruclctrlui roiu. oli\-ei' lrrrllralesi7sau ale
r'r'r'rrr1r.lr,r'
lrrlrunorrrbroolir-ure.Se manifesti, prin contraclii riimice ale
llnlrilol or,trlali ('u o flecvenld, de 50"-90 pe lfinut, clrora'Ii *" o*o"i*rii,
rrr rr.r.lrrqiri1,rn,tnioclonii ale.palalului mdale, ale f01ei,Iinlbii, faringeluij
lr,'r.rrr'r('lri,
rl irLl'r'lgn*rluisi chi:rr ale membrelor. Dc 'rrrrilte' miocl6niile
rl|,Iri|'r'.rrrrllr'i silr1,$e'de diferenl,iatde nistag'mus,i.si. o 'ri'
elaJizi, clinici
rrr:rrlrllrrlli rrc alllri, cii nu eristi, fa.z[ lelti_
(i )
p|in
;lqilatiu alobiloroculuri,(,,ocular bobb:ng',) se craracterizeazii
rrrrlr'rrliirrvolrrrrtrrr.c
sincrone ale ochilor 1n ios,-cu reyenirea,imetliati in
lrrrzi{io rrOr.rnrlii.A fost- d.escrisi,in leziuni iiisiructi\-c intinse alc protu_
lr.r:rrr(r.i(Jrishcr,19e4).ln leziuni ce,rebeloase
s-au d.e"qclis
mi6ciiri ini-oltnlrrrr. si Ir.IrrlrrlIrr,u
r.i ni$ciiri oriznntale ale globilor.ocdari, cu apa{iti:r in
r,r(,l|||i,ilr llrriDul lirririi ur[ri obiect.
:i.1.7. I'roblcnre de diagnostie etiolo.{tie in palalogia sistemelor
0rtrl0|[{rI0tii
irr lcristl tt ,prinriltalelorrouze ale olal no,plegi,ilorprezinti,
.'l'r't,r.r,rt'rr
rrrrrL'osr,bilirrlr,r,trs
pr,actic,cr rltale procerld.mla u"sintczit,etiopaiogenich
(rlrrpri .,\r'slrrisi r.olali., 19?? ;i Popor.iciu si Fa,scu, lgg0). in.feclios-ulet
gtce acute si srlbttcltte:
..:!..1,.7..1.l)oli. .inJec!base ;i
rr) || rrrrI'I irIi I Ir 'r-i.riticepr.imitir.e(t-pidernicrii,
z,,siiriani, ubici, prin arbo_
.1..). b) )lncefalite
necundare(rariceld, vari'olii, rrijeoli,,
'r'rrsrrr.i
'ir'o1ico infectioas:'i,gripi
|rr.rl irlili rlrirl'rnictr, n)onontl'.leozri
elc.). c) Encetalite
rli. I''r'srr.linl*(iiilor generalo Ifebr'i, litoidri, scar.lafini, lrise 'conYulsivd,r
iir,;rIirrltrrii,ltrtrrtttrurnii, richetis jr'ze, malar.ie ttc.) al) Nc.11ingiteacpte sau
rrrrlrirrrrrlr.(r'cningococic5,_.}ncumococici,
t uber'cuJoasii,,
s#itis rr]o.niogor;rs.rrLr' rri..) tr) J.)oliradic,loneuopa,Lii (polirad.iculoirer.-ritd,
Guillar-nlli'r.(t1 r,{li,i{'tk)z(:prrnneoplazice etc.). f) Nevrite interstil ir}lc secunda,re
rrrrrrrirrlr'<rl,ii
rl0 r'ccini"lato (sirr zitc,_o-tite,ostei1,e,abceseetc.). g) Nevritc
rlir..ltrslrl
.u',r' h,li . inlcc{,i.lrso.(tlifteria, botrilismul, tetriniiiul, s.a.)
lr) Nr*r'il. irnr'ro,k*c,i.. (lt.slvlr.crinale:
asa-ziscle
,,p,r'aiiziirccurenic,ial6
r't I ll( J t

ctallli

It

01 c.) .

:!.4.'i.il. ltili ,tdaholiut: il)

{)li (irirextirlc (}ri' deliicil, (lc i iirrrlinri'
:r.i rl rr ir , o|' ir r ir 'lr, c ir l rrs r,,r' l ri t.rc .), | )i rr,b r,1
z i;rl i l ri r(. g) ,{ rrr.rrri ' .rl ) l ?ol l i i r.i cl
)1. 1. 7. ii.I t t lr. t : .i rru l i ir' ,u tu rttr.. rr,)l l o 1 i rl i r,r, (pl rrrrrl r ;.rr.). l r) Fi rrl nl rl rl l
|'t g i l trIr , ( t t t ot r r r it l t l 0 (| l rr' l l | | r,l Il l s l ,l t,rr(,r,
rrr.g l rtroI0sf0t.i l ' i rsl | i r ot,i i -i l Io(,t(,ttxt
(,1 r,.). r' ) \ l. . , r lr r r r r . rl l 1 \l .rl i .l trrr,rrl rr:rs r.
( | rIrI,) ri | |I |,i I ,I ,, (| i I,i I:IIi .I,, l r.rrr' ,l ri l i
(l ti

I) tl l r tt' ttttt l t'

. r r r l r r , i r r I t r I l i | 'o t'i tl tr l tto ttttttttl l tt,,,',tr l i r zr ', i t'l tl i ttti l l i tl i l 'r r o l 'l t ) ' r ')
I r l l l l l l l l 'i i l n\Z l l .

'''1 'i '. . 1 . 1 't '''i u tti l .I|!( l t],ttl ':|||Itt|',l r ( !( 1 i h r n t.,l ',t1 ti i r ,.'t'.r Itt'i r l r 'sl r ttr Ir .
u tTo l 'i r l i tw '
l r q t t c l t i r r r r l c l r r itl . i l t) tl n tn 'r i stttr '.'l \'' l r r i i o r '''!'i r r r r .tci t- u 'n r r :i "w e l t
r h ' D "z i I i r t
i
"
|'r
r
tr
r
{
i
tr
i
l
i
tr
tr
tl
'tl
o
g
i
r
''
o
si
ttr
l
tl
, ,t t t ,t , l i t r, , i rl i r u , t) to r l u ( '
'l(i il 'r
i 'l'ctr
l
l
r
t'l
; r l l s|.r r l
a \1 .( a ) l r r l r '1
t , r ' 1 , t , . l l i r '. i r t r , l l i j i x; ( i 'g r r l t 'i N l r r tttr l . t9 6 l l ;

t'o!'i ltot'vii octtLrtttttl.ri

. , i,i,'l'., lrrtri, l.9t.r, 197?) : ctkt untirioare leze:r'zil
I lt
a
ltt-a)
pcrethii
ll,
,si tlltntttlt't tI i'It I ttt it It
,,,,,1,,,sr,I'ti
t,,ttiu.rl superio,uii
Lok)rl
t l)t1\rllrrl
trr;','rrrlrrrrItri)
; tde rniitoaiilezeai5,la fet to!'i nervii,oulllulr
'1,,ii',,'ri, it,Jtili
'
rormu:i ale trigerncndui ; uieltisrnt'lc ptttteri'oaroloztt"tr'ir
rrr r,lrirrilr,
n('r'\'uloculomotor;rteru (VI) $i rrel'vultrigeruetLirI l()lrrliltll'r.'
,,,,,;;;;i,;-'_,;
_i rrri sindrom claude Bernard llolner ([t'ziurLet,1rrit,$lo;tt"Zl\r
s'upt'aclinoitlieutpttl lt'zrt ttt
aarotid'i'ene
,,,a,,'ii,",'*i,*",t'i,'rrn).Anet:rism,ele
de urterd tiont'lttI it:Qrt'lt1
Att'eurismele
comtltt.
,,,,,,i ir,,lal tt,', t'tLl oculomotor
plin plozii' pllptilt'llii' lrlr'ftirtlii
cloar
atlcseamanitesta
s1'
,',,,,ti,,:;,,,,r:A 11rL
jrlr:rlizii txrtttltitrrt'l'r"
rrr trrlitlr'i..'lnrtrisnte[,enrtereibazilurt poi protltce
sinrlrt,tttI'rtritt:trtrl
oLi
ttlt
hrrllt
d.
f
I-.r,-ia"
,t. ,,,,,i,".i,i1u,,
rr lll-.r, .,i
't'r"ntt'lt
^
n.ite ie tt.iJeritcetiutuqii' t't
A
i;;;;,:,;,';i;
' '
',Lt
' si tl 'tt',t,u-r'iri,talirr".
r
r
(
t
olido'(
t
t
Dcr
t
t
oust
lni ( Llt Pr t t u^. t ) t 'isl e
tt,l ,rl r

itnle ctalt it,cttctfulice : t1 -F\'mtrrri clrrtritrlto itlt' ltrtzt't

l!.1.?,5. '1't'{trunttt
in. n) nlllzir r '
,,,,,,i ,i i r,i * i l * r,i r le or bit ei. b) Coniuzii cer ebr alt '. I ) c pilt lt 'r ,

, , ; ,'l;;:;ii iiffiil;il

pi l"*

iniit"i paralizii izolat'e^*lt' ltet'rx'hiirt \/ l rt'

(x'l'1rl)rllltl
,rrt ttltlltlizii multiplc l)a,l'ttil'lc (le oculomotoli' ln coli'ttzilt
r lili'r il")
gr
r
r
r
k
inlr
'11'\
11(
i.
(
ir
L
,.,, 1." ,,," i ,:rl ,, i'i, 1, : , l', , i; ; i'l ct r ob'll, pot I i
r
t
r
ijlo.
it
t
r
1c
et
:
r
'j
lt
t
t
lr
't t t t . t t
c*it
r
it
'n.
I
t
:
r
.
t
t
t
r
il.
," ,' ,,i 'r',;;;i;;1i,,";,;;';r.ir,t,:
.,,' u t , , i, , , , 'r , i' it r
u v I rr
pc.'(1hii
trururriirl('
iit oi vt, ,l-n'urteo..i
i.,; ; ' tl i i
erl('ltr
4l
hitlrr,'tlinarnico'
, 1 l,lli'rl ttrcll'al posttlrlumal.it. d-) nlecrnirtrru
vr
t
t
i:
t
lt '
lt
t
r
t
i
ic{'
ulnal
1t
'r
'll
lii
pcdl,
't
t
')
o{ulopi
lln(
a le.
r' ' .,' ,u,,,ai ;r," .i "
l'o"t t l'r

,,,,;,i;;;;'iiiiii" 'int,ilizi; p, r'ite'ic't',duclcrire,srrrltr'-$i ilrt(t'rIu(rl(rrr'r1')

lir'
''.,1.7.6..PrtrcseL( enptttlsite itttracruniene plothrc rtlll'lt'lrnoplr'gii
illlll
1i)l'lllllt
tlrlor'
itrtlirtci;
(( )rrru ('rrilllre ttiltx',ti,
Iio*ilut
l)I'ill rlcPlasar.t'a
'hil; ( '; i', '1,
g
',rr
ilt l, r 'ilcr . l I I illn I i ( - r \ lscr r i 1i ( x) lr ! l)' llXii''
l ' ,,,," ,-,,,' ," f
i, t it ,
rr/ l , l l i ??) :
t [ r r t r lt t kr '
l ) Il i ttrl t,r. t t sit t t x'il,l] lt t ilollulillt lil lr r r lr lr ' r h lr : t llLit t it lr it t 'r lizii
ct
'a'll'
sr
t
't
t
lr
ili
, ' 1,,' i ,' i tl ' ;i ;' ,,iir i ii lN, r t ct r ii i0 Jl- r , ur r ilir lclir l: i'
rlt'llil'lt' xitrl'
:1 Silrtlrrlrrrrll do tlllltir sjirrLrlitlitlli 1i sint[r'otttul dr' rtlrtrx
t
r
'\
oils(
r
' lll( 'l'ir sl'ilz( 'r
t
t
t
'1't
t
t
t
r
ot
sli'r
r
oidali,
,, r,l i z:i l r,tl tt tttt l t it tgit iilnlt l r le r lr ilt i
t
'1t
"
it
t
golt
t
i
t
t
:
r
zr
t
liit
lt
ll'
l rrrrrrl i l tl rr si t t t t st t tilr t t ',
lr ll( 'llr I lll
i I)' | ' trror . iI r , hilxr lizr r lt , r . r 1cr . itt t 'izttt, t r t xt lr t lt r it t lii |l( 'l'( 11( dr '
lot
t
t
t
t
i'or
i'
r
t
t
r
ot
't
t
palr
r
lizii
r
r
s1li'l
,,,,,u,i t,i i
1xr 1 ; t t r t r lt t t 'o
1i
i " -',t lfr ',
usgit t lt r t t 'lr r
t r lit I t i: t zii I ] II t'Ir I i I |(' :i
cn
t
t
t
r
t
't
lr
i
t
lt
lr
t
t
la
lt,lilt
,t) (' r'"l itrri
lt ol
'
t r t t 'vlt lt t {it r pt t t gt 't 'r ir ll
1,,,.,,,,,,',1i l rrl t it l ir ist lr lt t 'll-(r1, : t r ct r 1i Ar scllir llX; 0) t
,1,r' , l rtrl tl i zi t' r t t t t lt lt r t ii lt lxr t 'ir clt ii lr lll- it '
t t lo glr t lr ilol'
l ,; ' l ,rrrrrolilI I olr ulr r i lt or r i: r l lr ol lt lr r vr t citt,L'vicr i t 'ot r . it t 1; ill( l
, , 1t r t s, 'il''zit r r r ii, it t illt zr r lt rit t ci'i. r r l. qi i. it . livt " I 'ir '
,r rl .r:i , l i (' i l r'
i l ' , l ri | r' i {,,r,l | zit t t'rr iit t l'tlr'rl t llt zt t lt t I r t t r lir t ' lt 'zir t t t it lt . '
(i ) ' l ' ul l tor il( r I lllt t lt t i lr t r licl: t l lxr l f J'lt ( 'r ll llt r viI l'i r . t I t I , it t ii; r irr Illr , glDlr ilot
,,r,rrl rrl t rl rr | t:t t lllt r llr t t sil k'zit t t t t t .

tt7

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l t rl i .l ,.i l. sn.hsl .* )tl .i rrrl ,i l ;r,l rri rr str.rtl
.
,o || IIr |r r . ||\ : || oli, r l p rrn i l ri l rIrrl r,rrrl r. rr rl rrl ri l i r ,orrrl xrrroi r
l ,i r,si sl ,rrrrrrrl rri
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l :tl i t ( s it t r ; r r r t i. s i l l l l l n l r,i ' rl ,i rtrr.;rl r.r..r' r.:r1 Irr,{.i rrr,h.zi rrrtr.:r
r,;rrr.,, l ,r,ul rl rr
:rrrl l |tit t l: r ( lr . t I : ir il I(. :l I | | | , | || .|| , |.. A ..l l i .l , s I I L { | | I I |( r, l r. r.rrl i rrr.rgi | r.
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r(rr r ] r . s t r t it z r c t r l l ro d u c | o rrl t;r(l { i tr
l )u l )i l c i , i n ti mp u) S l tl )sl j A l | i ,ellt, rl i "
i rl i rr.r ' { ilc r ii, r ir nlrr,L i " n mi rrrr.l ,i r.r,
o i i i l rri ;i . I)e cel e mai rnul to ol i , IIi rorruI| i i IIr
; r lo pup i l c l o r.s l rrL Ir' ,,,h r" (,ti c d o l czi uni rl c
.i rsi l | rl ,| ' li ,,Il l rrl ,
l:
:1.'l r,r
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r ' . Z llllu r t p Sl m D a l ,tC L tl U i .
,\rii,s/arrlr l" cu)e ,,Jecteaad actiritatea pard,simp(
ix(i si se folosoFtc
,.,\)
.1 ,D rr
) r ' r r ii,r 1, . r . ar ? rfT re n l ru
d i n g n u s [i c u ] d i l c re n i i l l al aD oLnal i i l ot,d,,mi l ,i nto
IrrrIi l : r li . . ir r l par a s i mp a f i c o m i m o l .i c e S i p trasi mpai i col i ti cc. l ri nl tc cr.l o
't)tt)u\ntputLu)ntmctrcp emmtim |
physoswrnhLa (ezeina) O,Zi
% Uo_
rlrrlr'lrr rrrrochi normalo contrac_ti;-madmai;
^)
a pupiGlor

;$ f Aolir$iio
.r,'lllil I ",, i)r.oducer.rzrctiule similari,ezerineifins5 Ae 'ittensitate
-mli

lfll''rl Ir:) rtttttcotl_nasollttie 2,5

7o.nuproduce nici o modificare ia o pupil),
ror'r||irt:r.
tlr (rzII iD care inervr-ti,
r.pflrasimpatielosteixtrerultd, m sihii
c,,rslriclr)t'i rlevin mai sonsibili
o/o-va'proriuco
_$! astfcl hetacolinn 2,5
r,,rrr.
rli, ri,. lrlpilrr.ri1 rll Ceg maj loloiitd
.s/rslonldp,trusintpiticot.iiica
esie
rlt uttttt,ltt tt hldrobromi"d5o/o.ln rimp de 40_60 minute de lt inslilrLre:],
Ir| )|, |:| | | r,| , II |{' i . cr pupili normalii se dilrlr] la maximum. DacJ inervabia,
:,rr.t,:rlr|i r'.ir. irrl reruptir rlilalrrrr.resfe tnici salti)b;:eati.

r l o tti i l tttl ti l c
( ) r l i f l l r r r r ti i r l r r i tttl r l l ,'l l ' r r r r r r i ttl r c r I i I t I t t t I I I r' I I I l l l o t
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t , ', , , , r i r r i i , t : t l t l tr vi r tc Etlt t t t t i l i rr :t I t r I t
p u r e L i a d ', t'tt;t'r ii t[t'l '1 t':l zl 'i r cttl tttl
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l r ', , .

i , ,' ' ,,,,,r,,i i ,ri i i i r t r L inhibi! , ii a, ct r it r ului co'st r ict or , co. s{j( r ul'i'r ' lt 'zit t t r il. t '
,,rr,,r.rrrrroL,rr[rAr
r .Lizucor i: j calo sc accent ueazi, in t im lul diJr Lt iir ii lr t t lr il. 'i
( 't 'il.{r r l( '
r l , rl l rrl ri t' r' i l rl odusi, de lt ziuli ale sir npat icului' in t ilr lp r x
par
asil)
r
l)
r
'li(
'lr lr r i"
lezir
ii
,' ,,,,,. 1,, t,i rr,l r ir l cont r acliei est e consecinla
:',t.ti.,t. -/,Iidriaza (creFterea dium'etrultti ltttTtilo'r pesle 4'. 5 tttttt.)
(lil'll1 il lrr
r',,.rt, lr rrrt,ilniltj,si in conditii nolrnale. Astfel, pupila trstc nlai
:
r
r
lolescenr
i'
ll'
m
opi,
I
a
,,'
i,
I:r l ri t l'r r li,
' ' ,,'
l l l ' .i trtti ulr ciilur t 'lt lit r
ll i(t.t'i.a,f;(t
Qrtaur(i,icii se nallilestri prin faptul cti ltupilrt' lrr oclr ittl
,,r l' { Hl(f irrk'sca' Inai mare decil, ]a ochiul s;nil'tos Acela6i fl]rroltlotr Ntr
bilateral[', apart rt tttith'i:rzii
li irr rrhiul ambiiopic. ll :rmautoza
'ui,t,,,i,,i,'
l ,r rrtrrl ri i ttt l tt.

ff;1t111.11('"_rlstanlelpe4rpaleclpd:doctiDitatp(tsi/,.?d/icdsicaresefojoscflc lll Ltritt"rti ula centrilor li cdilor inJerioare

,
(l
tb aolire,^cer
mri urilizari e,.tecoco;na4o7o.Insiilareade parru
| ) .lll idri.ur(, tr)araliticii (patrlizia ah-solrrli :I prrpilci) irl)irrrl cir
. ],,.,]l:ii,li
(i
''(.r
t'rr,rlor'
l
qi/,surr
rr,
r.
r
r'liu nrtzenct.fll
lr,
ii i n sr cul conjuDctivrl produce, in motl normal, d ilai:r,rr.a
, , , rr r, r. i i rI i i. a l(^zil[r-ilor centruiiri pulilal
'r'r 'irr sa2u1
'i itr cnre inerratia sifopati;n'este
'1rrrr:rsir
|,tt1rrlrr"ri.
intrerupte in afarn,
rLpatico' Dacri lozjulei estc localizati proxi la'l tlc grrrr*litl
, t,,,.r,1,.
.ir' l.r'rllli ..lr'\os corrtt'ril,acestfenome.'nu apare. Dacd,exisi$
,,,,t ,,1,' ,r' lrtri thi: r ) a loat e sli nu I ie colr plclli''-il I t im p. ce o lczint t o r r I ilr t r 'lrrt
o activitato
-cocainei
(
r t r r ilizr r t t zr rr r
;.r:rr'.rrirrrprri,i.i.
11'suuti,ef,cctuldilatator .aI
r r r l cili: r l si r r elvii
este slab. Se poaiu
1,,,,,l 1,,,t,gl i ,,ttlt ,(tgingiior
'o
- ''iliali,
slt t r li) 1tn'ytlktir'' ttptti,
t.t tt't ..t..ltt')rtt.lIl
gangliutt,ltri stelol cU 5 rnl rle procain:t hictl"ooloricil ol..
nelini$"
\t'
tt
irsibla
1,,',r,,,,ri ,,r,,,.,itr,,tiii-La lnce4ut
rtr |'oD{tr(||lrol rtrl(.,l)ltpilrrdevino miOtiCddit cauza aCtiurii parasimp;_
lu r luschii cilii': i' so lr it 't 't lt rsi lt t r t t t t t r r
,,rl ,l r ,' tt Il i tttk' r 't r a f i a l: ibr dlor pent
',[le,nr
lrr' rrlrrl

l.,l lll rlurlo,[.oq.i(

tt.tilizd,rii probelctr colirelor este urmltoarea ; a) Dd,od,
lt t.tlt t ltr t :tlt'.tttith i.atiLrii,se ta testa in primul lincl cu metacolin i, 2,i t/o. Api_
lr{r:r pr;rilrr ( r
demonstreazL o leziune parasimpatici:" Liisa
i)rriirr',r n\:rtlltt'lsir.ic1-iei
puprlare ]trage atentia asupra unei Stiri de excltatiO
rLrrrrIrrrIi.ii,
r,r*. |.rN{r ti confirmatl printr-rin-bkrcai aI ga'gliouului iiefii
rrlrrl,r:,:r.r.,t 1,11,('r{rler
api-(ind
ia pupilei)'; ni \icA pupUa isii
,co-nsirici
r/,','./,,,,..sr..\1',sljrrL.primul rind
cu homaLropixdioo. ln clzrt in car,l
mrdrirtici, rvem dc,r frce cu o slare d.ccrcilllrilitrto
l)rrl'rl:rrlr.v||r'.1i,:r11"
,l' jri:.::
iar rtaci se md:e$te pu1i1,
l,;ll:l
ll
:l:icu1i,
le aflaim in fa,1aui;;
ir(,,rrr,
r'r ir trlrunulur
simpatic. Du1ri-trecereaefectrlui homatropinei,'pulenl
rrr'{ r r.r (lo{liritril,.Darli pupila se dilati in mod oviclentr probibil
li-ziuaca
r,rrrrI rrrI irriii,sc ir,i'lir,in caclrul S.N.C., iar dac[, acest fenomen nu se
Droduco,
l.zrrrrr.rrs. grist.rjl{'irr:r,ftta S.N.C.,I* nivel'l f.ibrelorple- sau posl;gangliotrrrlr,( N1r:rlrtirrr,
ltltif)).
:.)..1.,\.,:j.
,lti:rx:urit (iuHt ,lit lt,t, ytTilard)-'ln rnod rxrr.rrn,l,pupilr.lo
" rl('r(x.'rr\ii rrriilirrrr'
*r,'l
rrglrll r stirntli. llacil prrlilcJr,irr
1i I0rrclirrrr.nzil

Al i tfr'(l{ f r t , f r : llt i.srilr l i l l g l t,l ,, tr. l x ri tl n r l rtl l ti tl rr q tttt,i :pt1xt,i,,rf4

t / 1.r,rii ;rr
, rl :rri l ,
rtrr,r.I;r I iI r r I lir
ir l) ir r ( ' u r l i rrrIrrl t,r,l l r,rr,l o r.1 rrr1 ri l rrr,r,,
i tvotn o /l xi :or,/)f//rr./i ri (,1
'l i'.

,t.,,,.. 1,,1:til,urytlegie internd,)' iir ilrtr''o llttinrri' trzi jjol',sii' alrrtlii' fiorrrt(r
(1;:rr\r
li('(ri,{rrrzil
,1, ,t,r,',"ilrrr,",rirpii,1r'i,a pereihii :r, III-n. Nu toli,e lcziurtjlt
im
plicr
r
I
ibr
el'1'r
r
1li1'r
r
''r
t
r
sit
i|1't
l:
t
1. ( l''llt lt t t t r t l'
poi
(|
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r,rr\| | l
tl l ol l l t) li( l'Ioonlult
'
rrrr,l .rr l rri l ,)rlit iger - Wr : st pir a, l llult . 1cr r z. ro, qlli'i1'r ll"' i''pogt r t lit r ii st '1t lt
, rt lcr'itrttrt tl.ttdcfitii it, l,tt't'
i ,t.1 lll .:l(lr..l rxrinpltx*lrLi nu.1ut1'
'cUlott'tol.t'tt
plt
llt
silr llr lt lit 'i l) it t I or t l't lt ' o
r l rr, rr l l l -rl , i )oir t , o I 'oNpo{}lll'noof il] i colllir i
| ' rl l trr.l tl | (' tv| | | lI it lr lt t |olr t t t l; t llcont t t t t l. lt . it t t ] t lsil|ilr r 'r 'llllut t 'lt sir t t ; t ; t 1ir , t . , . llt t , ''
l t t ir 'r 'lt t l glit t uI ilr t r t llt t ir . ililt t ,'; i ir I t r r 't . yi|. r t 't . ililr t . i
r' r , | ,.r| | .i l tl i ' r,llt |t l st llt lt l': t ,llt
l ,rr' :rl i zi ;r lr r r lr illt r : ii,ir r so{i1i r k'olilr ilt t olr l'gii li( ill1( 'sr r t l( 11( 'r lit '(pl! nlr t f ( l
,t, , 1,,{,ti i:rl rr sisl, qt t r llr r i lt ot v( Js, l'( ) ll( ! sir r r l, llt : 'i,it t : it lt lt r llt lillt lr 'llt t '11i, 'r ,
, , ,, I.rl ol xrl i rrrt t il't illt ,lt t t t r , t it r lt 't r i,(|I I(' t' I II I i 1i I llo$1'\ 'ilc{'it Liii' \ 'ill l( lr l| ' zr r lr ir
li t t ( llr li lr
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r l('zirr,ilc nuclrarer oftalmollegia e..tc'riri porrle Ii completir,,i'sii..irr.

,,1ii rr rL' rrftnhnoplegie.intcrnri. r\c.rLstadil rumil rplre r:rreori sillgurii.
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rrrrrl,rrlilr.l)upilo-dilrtatoare. Acest fenomen a,pere in contextul sirdro.
rrrrrlri lrri Portrfour du Pctit,. care cuprinde: midriazi, lf,rgirca farrloi
I rrr| |rr.IrI irIrr ;i u;olr.ir. cxo1tamie._LTnc.orise asociazli ou vasdcorrstric{,io,
r.rir|'r'r'rr1.rrrpt'lltruii qi hiperhidroza lemifelei ipsilaterale. Midriazr 'rrrr
r|r' rI| l)lIirrrrirna,rc,nu siltt scmne_de paraliiir., ial reflertrl fotomotor
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sint prtrz,ente,sal doar uqor diminuate. ln leziuni progr.rl
irir r', slrrrlirrll,.clirninrr. dc irita'fie simpaticil trece intr-un stadiu d;deii(iit,
i irrrptri i. si , l)irrj1iir consecutiviia miozei paretice in conte)itul sintlrotn.u
lui
('lr,tlt l, ) n.trtd-Ilornr:r,crne estc lniti stabil qi mult mai frecvent intilrril,,
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lr,r;rlrrlrri llrll lr ctilo:,lneicgtvicale,traumatismo ver"te6romedulnre
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rl.rrrrlr', irr .ilr(l{r'ul si in tubelculoza Tirfului prrlrnonrr, in ttmori mrxlirw
Lirr:rIr',rilirrgorrrirlio,tnttfltlite si trtmnri cerebrl.le.
llll l,i:irrtti (ltt cenlt'ihl' gi crl,ilortu:perioot
a
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1r.rr1,'llio)r!irr*1,ioxpe.imentalprirr inllibitia co]11.,1.i
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lrl stirnuliirii cortoxnlui ft.oltal !i :r,Ihip.1,rr,
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lrrrrrrr
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in stimulirr,oat
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tri.

ti ) ') 'tt tt t ttt.i I t' ltr)d)t, l.r, rruri iiltrs (jcle srlratdrtOriaje, e\etcitii el:rtl,,
vrrr', ; r ) , i1.ir , r r l[ ir l]rrl )j l { ri ,tl rrc o ri fr" ul i n s o c i e l e a de rnodi fi ci ri a]e aaLi vi l ;i ,(,i l
r rr.rrrl, ;rrtr :rlr. r'cl'ltrrclol totornotorii. S-a flescris midriazi c6ntralat,rrl*iir
rrr trr r r r or , lr
i , { r r l: rl( ' $ i u r i o rn p o rrro c c i p i ta l e .A rs eni ryiJl otez (19?1) au d(,srt.i } r
,.r'.r, 1, , : r r { . 1.r r r . r l] l i i fi ri l rrrp i l a ,rc ; u ,) i n i ,rL rnol i l ei rontal c: mi ozri i psi l rrl ,r,
r rl r.. : r r o, r ' l; r lr t l ti l ttts l o n rl ,i o l U tri m trl :i ; b) i n tnmOr.i l e temporui ,, (i rr
r.', rlr . l. r , . ir r r r r ' : r 1 r' rrrr.h i rrl u ic c l rb ri rl s i tu de herl i o t1e l ob tcmprl nrl ) :
rrrrrl r r : r z rrr[ r r lr l. t r r l i ; c ) i tr t,u l i :l r)ri l {o] trc i p i t:r,l c: mj tl r.i azrirl
, c pl r.tei r rrprN i t.
trrrrr ! r r ' r ; r l) r t r ll tto fi l o i n fi l ti rl ,i rre d 0 ttu n chi cer{!brl l l : a[i z0rrrrIi r, r,rr
rr,,7 r ii t r r r ir ir il tz i i p s i l l l rtftl fi (i 1 r ? 5 o 1 , (1i n 0[z]n.i ); t,) i n hrrrnl i otrrrrl
,..tr.: r r lr r r : r l: lr r ,ir r r u rl rrrlrrL
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Ir'l r lll( \ r ' r r lr ilr r r IIrIri trItric r,trIrn l l ; t) t' l t l trr ml l toi ttncl c sul xl rn,l rl ot11,{ .l l i r,:
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l: r | , ) i l l : r .

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rl rrl ri Itrr,rurt,rr,ri stttr' r' r.trtti ,nr' tr
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l ! r / r l r rrr, r 'r I r . s i i t rrr { i i , tr r i t l l i l r zl i 1 r rirl r rItl r tIr i 5 1 r |o r r l tr i l r r o i i si r l r '|l r tci l
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I\', \'l si IIl .
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i r tc[a u tTtti t, M '( ti ( r 4 .ttt) r tttti !. tts.l i r ;t, ttl
| , , l . r l \ r l r r : r l ( ' :.tk' i ttl r t,ti ( tt!i i l o r u l t:o tl i a t, ( \1 b ( t]L i l tt) 'i t t ti l l l ( 'l l r r l l ( ' fl /r '\
r , r , , ( ) r r r i r l l i l r zi i r r r u r i tr u tl i i tl r l r r t i tt xl o 1 ttt,la r .n l i u tt ( ,l r tr l l i ttt,r t '.i l i ttl r t r r ,
l '1 1 , ,) l f l i i D r l rttl tr ',r 2 i r r r /i fi ( l h ( !l n tSto L r N ,l r ttl l i l i t'
l l ttl tl e l ) 1 1 'zl ,r r l r r( ) r r r r r si r ':r
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I it tt l r ';i u n i l o r i ti l a ti tt'
It'cti i .l o r 'p 'u l ti l o u n :tl 'ti r :l o ttr : ( l ttr r tsi tr t
( si l ttl i ( t') .
r r l t':i tr n i l o t l n r d i tl
tl t ci r ,i l o r p u p i l ,o r l i l tl a l o tr tr

i n .l e r i .o a r a
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l l i o . u s,p r r sii cr i p l i tt Iczi u tti i ti l r tl i vt
't )
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i r r , r l r r l i l l i r 'p i r k,tr ti r l i , r tr r r i n g i l t . i ttl i 'c1 i i :tl c si r tttsu h ti ( r i tvt'1 'tl o s. l ( 'zr r l l r l
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t,r,, ,

l r : i t r . r ti

('lursi(I,I ()70).

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p l i tr l czi tttr i r l c ( {'l l 1 r 'r i l l ti ;i ci i kr t
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, r r r r r r ' l i s c p ro l r r sr i ci l r : r 'tr ,sl t'tt'r t rr r l r 1rI i i t I r I i I r i i ( tt l l r x) l l tr ) ( l l l l '( ', \'l r sr ) tl i l :IIr r i r l
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, 1 r , r r r r r i i i t rl t'r r o cr r l l r tr ', <.r 'r 'sl r ,r 'r 'r Ir
r 'ttt1 r ctr t1 tL ti i |j i st,l i t[l 'tcr t l t i l l rfi l r rr : r I rl r
l r , r r r r l ', l l i ( l c i l r ,( '( '1 t[j l r r t'l r . l tt;l i l l tl tl t
tl .c t'ti i 'r ti tti i tr ti tl tr i ctr tti tti t l tti r l tr r r T:r
,l
r r r r l r r . S i tttl tr r tr r n l ( 'l r r ttt[r ' Ii ct tu i l tl l l o ttl 'r ' t'si c r l l ct'l t' ttl l tr l l r l l l l , .r l
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l t \ 1 i ) t ) u : h i tl
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r ; 1 . , . r . r r r 1 . l r rIi L i i , si l i l i s, I,r r r tttl to zr t r tt'l "t't'i r ct l tl r Itr l {'r ;tl l
r r r r l l t'l ( 'r {xl {l ) r '
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I'
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, i 'l i r ') .
r i l r ttl l r r r t( . r i ( ' j r l r r r ) l r 'r r
l \ lr l l i \ tl i tt r i i tttl tti l i tttr 'l t'l ) l t) 1 l l l ) ( 'l i l l l l ,i i r l ( f
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si tl r ,r .'ttr l i :tt 1 ttti ,,ttr r , ,i ( r l 1 o :L l { l l r r r l l l r l r ' r r r r
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i n i ttt,',tt,
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r r r l r r l 1, I rLr rr i t r t t I I t i l j i r l o u r tl l ;r l l r tr t I ( i ';i tttIr o tr r III l 'r l I tr .:t$ i 'l l r l l i r r l ) 1 ',r 1 r, r !r 'r 'l r r
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fi l urol (j fnrr,1rri ,i 1i rrrri rrrrrr,rl r,si
rr(l r'r ir r ir lr r lNlil, ic i e s tt tl tr s (,tl l l n l l t tn : ri obi $l l ui 1.
'.'.'l .,\ "/). lI rd,,iJic ti r i,le d,i,nanticii,p tt il.jr c
tr)
ll 'l'ttlht.cdrile relleaului ;folomotor apar ca lezultat al leziilii oljcir.ci
1,,rr'(irrrrirlirr comlticata sa cale, fie peTea uJercliii, fic pe ccrr, c/r,ilir.lri,
lr rrilrlul un etiurLilot mezeuccfalice. Existii" dozd eucnlital,i[iiti:
.1.)
.l'ural.i.tii 'pztpilure &sacial.ecu trulburdri de uerlere, L.l ulrriu.(, :r,
rrtt)r' l(.zirrri carc afecteaz5, atit fibrele pupilare, cit qi fi].licle opti$f,
l)(!
I|:||(|r.L.rrIlor comun (intre retini,, rii zona d.inaintc:I coryibr g;nicril;t,i
, \l,r'ri, lrr)do fibrele pupiiat:e se alespart cle cele optice) i
:t\ I'u'rulilia pu?ile,rd, amaurotici, rezulti, dintr-o leziune tlistraetivii,
,r'rrl)lcl,i rr lctinci sau a nervului optic. Se pierdo rcr,ctia tlirect:-r,si
corr
'.rr,. : , 1: r . l: r lr Lm ir ri , l n ri m p u l s l i m u l i i ri i p a i t i i ochi ' ]ri i
i rrsrr s,.
' fer.l al ,
lrr iir.irzii, r'.110(ilr'corLsensua,lila stinrulare; luminoasti a ochiului'si,ni'rl,r)$.
I rr llz i.rrrrilo. r.rniLrtorale, rlc obice:i prrpila F"stedilatati (midriaza arn:ruloticii
),
rrrl l r . llc r r r l r lr : lt c o n to d a l e e s te n o rm a l .
lr) I'rrroza, pupilarl ambliopic:i apare in cazurile i]t care leziunilr
rr.l irrr,i srrrr ,kr'.r'.lui
optic slnt irrcompletc. Rc:r,ctia lulilar:i la I'ntirrl
..i. l..l:'i 5i p.rrlurigit.i, a'tit cea dircctri. cit
6i cea coirsensriald.ln lczirurilrr
unrl;ril rrl(', (x)lll,rincfiia,consensuali oblinuti, prin si;imu1::r,reaochirrlrri
rirrrrl,s .irl. rr'r,i nrla.c rlocit r.ir,spunsuldircct la lurninii. pareza pupil .ii,
i r| | | | )| i(| | ' ;r' i i rr iirs1,d.solisii iu nc-r'ritelerctrobulbarc, leuropatiile dlabd;ir*,
r r rrrr r lr lir r lr ilrI lr lr r r g i r,l ' r_
llit.ir l('zil'r.rt .iiikrr a,lirro.tc se g!'tseftc Ia nivelul chiasrnoi uptirr.
I r : r r r r IIi' I . I ' r ' r)rrrr(' r' ,r' r.l l tr-ro l cp u p i l a re sl nt pi crdnte nunl ai Ii ! sl i r)l I
.:rrr
Irrr 'r I r . r r r ir , ' I ir r r ' |' r r' ,' rr' I' ' . i , i l c o s l ,oc d rru ti i , lY cm o heni :l nopsi e i rs{)oi l rti i
rtr ,'r ltttli
ii ltttpiltrl h urt..iurt
oltsice (rtrxti-,ia hcmialopsicir, :t_ llti 1,Vll
trrr'l , l | ,r' :,ri rrrri Irr ccrrl llr.lo trlo
o lr,rralirie yr,pil u,rd, in.
^clilsrnei 11roduc
,,rtttrtrl,
ri ,rtlr hil(tt)?oftr,lc, i.'
i,ianp co lezirlrLilelatcrale ilr'chilsrrL.i
lttttrt rt lt,rttli ir 1ru,yt.i.l,a.rd,
i.n, aimpurilc uizualc hinaxtl e.
l: ) l'rtltli ii prtltilu,re Jd,rci tt,tlblh,dri tle uetlare, ca, Llrmitt.c ir rrrr()r.
l i .| |Il ,r l, i l|r r i. r , lr l o Iu p i Iu c , rc l s p c c ti v d rrp l i ce so pl ,oduce i fus1}i ri ;i | r,r,
l rr olr ir r , r ' r lr r r , ir l trl r.t { ,I:l c x u l l l i p u l j l a ,r.
:t) l',rnli:.itt. i:t;kr.l.,il rellr.t uLui
.lolomolor (pupila tL: tip Ar.l.t4
.
' rIi| rr'lirr
,,ri r
I'r'r'r ,r r I r , ' rrrrrrr i.I r':ri,r' i (ri r' ri o ]rri r : r;r,.fl c x i r.
1 t' rl i l ,i rf rr hrrri rri i (rr,ti i
rl r r , , , r r ; I . r r I I r r I rIIil ).
)i s l ,ll l j l o fl ,rc a C l ,i e i p u p i l U c pol tt;r,u1,(,(l .r)l ,ot
:)l )l ,ol ri l l i r,
,r l )i r l' i' r . il t r . r r il, r rl ;i iv i z i u L l c ,,\Ii o z i .r,(o u rti ,s p uns foar.1,r,:
sl l rl r l l r, l i ' n' ri .r
I r,rt i, r ilr iz t ) ( x ll iit sj l l l , l i (fl tl n oc l i n i c o o i tr0 :tc o rnpani l l zi i i tl tl ol r,l tc i trr,l tl i rrl ri l
r r,'r,l ri. r l, : r l: r ,lr r r ir r : r.rr,p u p i l l l o 1 1u t1 g c l 1l jrs o l i a l,i i -qigrr fl .cl ,i i l nrrri l l t
1rtr1ri l 1| rr.,
i i ,ttl r,' t t t r l
lnt t ll l trl u rl " tttt i trs ,{ .;1 . ? i -.-1 00i )1, rIi ' r .i rzrrr.i l . i l ,i si l .i l i ,r
tt, tr.r ir t r s lr r . r . ir r l rrl rc s s i
;rrr' :rl i z i c g trrrc l l l i Ini g1l qsi 1,;1.' l rr sl ,rr,rl i i L,i rrci
r ' ' . llr \ , lr l.l: r lr rrrri rr:rl rrrrrl ,ol i k rrrl 5 i i rrIIo r rr1I| r,I.
l 'r'
l )rr r,,l l rrl rl ri rrrrrl l l rrri ,
'rl ,r ,
l r:r':rl r / r ir r z , , l: r l: i : r 1 1 .l l r\l l l l ti l i l l Q rr)l rl 0 r 0 s l ,| l r i l l tl ,rrr;tl i i .l .l rrrr rl | l | r,i r.,,;rzrtti
,l l t,i rl|l. t i|t ||A |r lt ' ll I i rI I rr,r' I IIrI rr rI rri IIr I r,r.Ir| . i rr tr| r,sl ri l ,rIr{ i i , i rrrtrr
i j | ri l l | | tu.
l , rrrr or , lr ir t l : r lr . ri: r l rrrr o l ,(rr)(fl r ri l i rl )l l tfi rl i l c r l , l l l rrrrri ri :i ,i rr;rtr| ,i Ii rI,| | | | sIII
't It

, , , r r . , t r l t t : r I l l ri l r ..
l)jr(r
lr rr
r
l r r r r r tl r 'r r zr ,r r 'l ttttl r r r tttr l o :t, t;r r l r ttr r l ttl
, l r l r l r " . l , r ' l r t r .z, tr i ,r tt l ttr r l r ,,
,,1 , o r r l ( r t r tr l tl l r .Ir ':r Ir IL tti . i i l tt{: r l l r r r r 'fr tr r r
, | , : r r 'r 'l r r r i r rf i l tr r r {,i r ', r tr 1 r r tl r l r r L :r . l ,r r Ir l i l r ':i :l r tr r r tl fr ]i ,i ci t,;tl i tttttl l ttr ':t r r l r tr tl tti
r , r 'l r r l t t t t l r t o tl ttr r r r .o ttl l r r r ( t,. l r r t,r t ,, l r ttl r i !r t, i tr l i r r r l r r u ' i I It i tt i t tItt l I r o r 'l tr tt
, r r r l r t r : i l o s il 1 ( l l l ( f( , ( ,( |||i l i l ( r tIr r :r n r l r r 'Ir t l ttt;ti l r '.
l , , r r r r t l k 'z i tttti i i tt l i i tr tl to tr r ttI r \r 'g \'l J Ii o l r t'tl so tl r l ,r l l i l l l l i i sl i l i r r r o r r l t0
, , . : r i . i i c r l i u l ( i {'l m a i p l i [u zi l 'i l :r l l r .zi ttti i i se r l l l i l a tti l t']ttl r i i i l o t tttl z, ttl r
'
J , , ' i r l {' r ( 'l l cxu l u i fo to u r o to l ', ( i l t ( L ( r ) scb i l e l l r r i vcItr ] ( xr l r ti i i l l t i i Ir ) r l cr i o r r r l '
r : r l s t t l r s l , rL tL l j o ico n n $ i i p o r i l ) {) d u cti ,l c, C i tl ti r , ttto {i tti 0 i t to l l r r r ttl r r i r l r '
, r rr o t l l i t c - r o rr yo i g o n ,l i , se g i sa ,l te m a i vcn tr n l fi csti o r 'csp tct'r l i i . Il i r ) z:r ,
''
r , , i , \ 1 'r r 1 i r r l i l rl i l i i ,
fi b r o l o r l tL l p i |r - tl i l r tl 'i tl l ,:r tr ',
e ste l r o d u si n d c a ti l ) g e l e l

r', r,obolitrtl de la regiunea tuberiand, trece in fatra corrjstu'ii l)osl,r'r'iorrrl'.

f icr(lor{rir singulari, a reflexului lotomotor (sindrr.,n 'ltrllll litfurlst,tt
i,/r, l so porutc intilni in: tumori mezencefalictr, cn(rcti[lii,i' lrrl'rttgir,ri,
,lLrlx,l za,ltultt, poU oencefaliti , sclerozi, mtltiplir,, a,lconli$nr, zrrttrl zrrrrl'r,t,
r r.llrll,i,islno Oranio-ccrebrale, In acuste cilzuri fr.rlorlr(.ltl,r sirrl trrrilrrll
.r1,..Iiiril, rniozli, li?i,rica pupJla si, fie cxcentlici, fi ru)rcgltl:r1ri,i:rt r',islrLtrr
rl lr liolnNl,i'opini:i )ste evident ;i rapicl.
I l)'lttt [bu,r iir iLe r eJlelx*lui. [,a'intuneric
liclilextrl pupilo-tlilatator la intuleric este Inult rnrli vttlttcrrrlril itr
,,,rr' l i ti i pel ol o gice c: , rccl
, pupilo- const r ict or I a lunf nil. - t \ t nbulosit t l r r lr olil.
,rr l .zi trl ri l t: ciilor com ule f izuale $i pupilar e, insl pot t i ir ] t t r '{r r Jr r lr '( lilr 'r 'r l
I l,.ziurLilc de trunchi cor,cbr: .
pulilar'ri a lrlrui ochi osto ([ i I r] i r I rIi t I l L iiiur
lrr oazril in cale ac1,ivit2r1n'.1,
,1,(,lirii, r'efiexul consensual la intuneric, pro\.onit rlu lit cclilrt'll, ollrr,
l ' ,,l l l r' (l onri ria r c&t ivit at ea p1t ] r ilar : ii ( sem nt t l lni ) I ar cus ( it r nr ) . lt : t r t
,, lrrrl slir iitos este stimulat qi cdiilalt este it,oop(x'i1,pttlilrt, rir'tttrtIo:r:i:r
, ,,orLI,r'r,iri,ri
nolinal. DacA se ilumineazi, oohiul zrfocl,rt1,;i ccliil:rll, r'rlr,
,,,1,r' ri l i ,al l i {r c nr m ai o r er , ct ie m inim alil, , 11t r ] Lii, tde
i o ( 1illli1lr '1r
st lt pt it r zr r
,, r, r'. Airr.sl semrl a fost doscris in neuitele t'ctrobu.l,lrur?.
'1.'t
llll
tlln r,rd,ril.e rel'l,eltnllLi. de a,ptt'opierc (tlc ul:trnndlrc )
.\llolilL';L jzolllt:i l pupilooonstrioliei ll ltlivitt'tt aprtltltrr /sirr/torrr
rti itt
lnttll IJri*:r'!totL itn:r:rsu.l,
) a fos1, tiesorisii ilI olt(xfllirliirl,(,1)i([('ttri(jai
r' rrrrrlisr )t|r (ilt,]iio]l{r clt intelesat'o1l ol'bitci.
NV) lrlrrrliri Tnrpil.uri:lon,icc
;,i trrl rr;i r ; r t lpupilci lr olr icr :colt sLi in: t lit lt 'illziL, t clilt >. lit Lt t nur lot sllt b,
," l r' :rc{ j i i l )lli) iluil, kt r t ii, it r 1; it ir pt t l r t t llr ixt t lt t i llo lt pt r t lt it r lr ; ii lt t llr t t t 'r ir i
! |

rr'()Il |()(Ii IJ r' .

;l r i (l (,s( . r 'islni. liyr u, r i t lc t r t ] r t i0 Tt r t , lt ilu. rttot

i r . i. oit :r t ) ( t t t r , r o{io it t lt t
rrri l rr, l rrrr r ir r ir ( si't t t lr ot t t l ll t sNTt ln, tP'it
, - t r ) ; lr ) r r t t car {io lt r lilzillir
lr r ,
,,,r, r' !r' rl r ( sindr t ut r l Nur , n. gt r ')qi t r ) int it zit lclt , sr t , t tit hr lit t lt t lir r , Lit , iI r i( r r
,l I trl l rl !r)i rr i, cii, r yi lr r ,r , ot t vr , r 'i;ll1, ii ( r int lr t t wt t , l,l. t t i,; lr l, ir : su, t .ttr,l lr t i ll r ill
il r
i ,,r ,1.i 1r. qr: r lcr li colc llc! l, ipt r r i r kr pt t lr ilc 1, ot r ir , tr:t 'plt 'zit t l'ii nuir r l,
,, ' l , rrrsi I rrI I rrrr': 'il i , it r t r lr , t t t r ul r t t t Lr lt i, r rlisDt t liut jlr r pt t I illt r ' r jt t l t lt t r t i
rr:,1. ri rrl l r ir r r lilr ', I ic ir r r 1r I lt t t t r ', lic r , i( 'lJlu'lli.
,\i nl t,,,ttt t l lui lt lir : ( sr t r . t r l lt r i ll t it . l. / , lrils ) r 't r I r lir r r I r r;,r r lit t ; , ; rrt t, s; r t 'ol, t t l
rl i prrl ri l ;i l o r r ilir , 1i t I it r r it r t t r r t lr r ,sir t t ir , l'r r lil( : r t r , llr r r r , lr r r (' , r lr x'ln't t r lit r lili( , .
l ' rrIrl :r l rrrri r. : rr lit t lt ilt lt r r t t t t t l Ar lil cir lc t t t r xlr , t r t l r lillt , llr l: i, ,r t , |lt t 'r 'I t lt vt 't t l,
rrrrrIr: I r' r'rrI {s( t "i, r lir r |r r zt l| i) . liclr f ( ir r , 1r uI illr t 'ii l: t lt t r t irr :i t lit |r l: j lji r xr r r lr , t t

't't

ru rl :r r . il r r lr r ?ir ll, l (.trl l rl rl r , rl r l :r o l l ri rrl :rl i .r,l :ri l i l i )tl ti tl l l :t rl r' l

rL :rtt: r lol.( loI r s I t ir r (i :r l r g rrl :rr:rl r , , | | | \ r' I I ' (.| | | i I l )0:l i c Ii :tl l N i ' rIl l l tl l l t l i )l ttl l .
trrrrl l r r r i|lz ilr lii, S ir rrl to rrrrrl \rl r .r l ,rrl ,l < ' rl r,r.itrl
s i ri l l l | s l i r l l ' | | ' l i tr rl r.r:rrl l r.
rr i l l i :r \ 1lr lr . r |( (I(,I{' I t r: I i I r| | | I I 1 i ' r' r l :r rrrro c l r i si l t l l oi l l r (,{ .l ti l i l l i . l ,r' zi rrri l r,
r|rl )r)Dr r ill) ilr fl, ( ' |l|u s j l t(l r()n rrrl \rl rr' l ro l Ii s ituttl ( i rr: si si t' rrrrrlri l nl )rl i {,
Iti l ro l : ilr r r r r r s , ( 1( t le \i l u ti l (' l ri l ro l l rl rrrrro D rc z c l rcefal i co,
I,{' gi uri (' l t Ii t(,h (rl l l i t,
,,:rrrriI iot r r r(I, iliir r . . l)u D i i ,H Iu ti ]l :l l l s i (i u rl a l d (19ti 8) k' zi uni l r, gl l rgl i r)ri ul tu
,rl ri rr r iI ir iji) lc s r ] ! i d e l e z i u n j i rr g i rrrg l i o n i i s p i tal j , fapl i rral c l rI r,xpl i Irr fr
: rr.l l r . r . i: rI r si. ( r { )ci na l i n o a F J. i
iu rtisl.trtfia i)tltsc,ulat'd ntiotolticd, (boala lui Steinolt) lr [os1, (k'N('ri$rl
urr'(,ri {) l)upili mjotir:li cu contraclie lelt5, Ei slabi,la lumini fi cotrl'('r.g-cr
r1ii .
lt) ll,i.?,pltsul 'lLtpiiar ciJnsti'l inttlo serie de tniscriri allcrnllnl;r, r,rrlrirlr,
rll' r,rrrl|rrol,ie {i dc dil:r.1atiopupilar.c clonice Si ritmice, amlli, |Ji d{'stnil rl',,
r{ r'lrlirl0, cNre intol'cseazil irisul atit in lepaus, cit mai alos la ,,lrrovocln clr,"
rrrirrr,rrliIrrr'
l)Lrpilare (de piltli,, cn ocdzia eJplorirjl reflernlui fotornolor.).
\{,('ri Ji'roul'Il p{)lrio e\ista irr sta{e ,,frnstii" qi lil unii subiecti ltorlrrit,li,
rl :rr' .r. r r J r s lt ' r ' i ir r t l e o s e l tii n : a ) p a l a l i z i i l e o cul omotorri l ui corrun ]l {i cl l (.
ri l rr,r lr ' r ' s ilr nr11r
, ) c o l e c , l 1 re s ,s c l c ro z i i i n l l i c i (oa un fel al e ,,ni stl gnuN
prrrlrilrrr'")(liis(!', l9ll2) ; c) miastenil gr.r,\-is; d) rl1]eori f:il.ii valoale scnrir)
l .r' i l ri r lc lit r iir i ( 1lis tr,, 1 l )i ? ).

)I],. I'IT0III]IiMI]I)I' DIA(iNOSTIC

iN PATOLOGIANIIRVULU] TRIGI,]MI]N
:!.ir.l. Ntvralrtrit lriryerrrinalii
''.;t l-1. \'rt.trtlrlirr.lri4c,ntinriri,)primitil)ii11sr.r,u, i,marir1)(irnproprirr
,,pt
il, rrlril:r rrror ,.irIioIIIIIicIi)I)
irotrsliluieo cniitate patologicli(sarrmai lrirrr,
r ,'t til;rlr 1r:rirrlrqilr'),
clrr,, ttupi Arseli si Opresctl(19i[]) .qert'fet'i,l:r,

:rl . | l l , lI r lr ' |||i||: r Lr r :1 1 1 ,1

i 1,1 | .I
1 1 1 I1 ,"tirID c i c ri te rii : :r) si nl t l l al ' oxi sti ce; l l )
rrrt I,r. r , r . r r I r iI r ' i ( i) ri rl l l i l rtc l a l o I
1 1 )s i n t Fri ri ct l ocal i zi i tc i n teri tor.i rrl
trr,'r'rr rr r : r l: r . ) r I r . i i ri i ri s o i i to d a s t' ri rn ed e s u f(l ,i rrt1iorgaui c:i (tl i n parl l ' rr
Irr,'r.r, r r r r r r lr r ri r r iill l ti u l s r.rL z i t,i r.,
d i i r p a rte a a l i tor ncn' i cl .:i ni eni sai l l l l
l ,,r r lr ' r , . lr r i r r r , r r l o l r' rq i c c ).
I)u t)i i ,{ 1 s e r} i [i O ]j rescu (19i !]), tl rrcl cr fi i r,rl
,,'rr rrlr ' , . r i: rr ' r r il s jt rl rl r)l l l i u l t c ti o b o a J i ,,i tn 1xl t1,csi i exi sl e o ,ti )fi ti i l i i l
, , l . u rlr ! . l, r rr r r r r. . | i l rri l i -ri " (D ri rrl rr.i ,)[i (i ..a , rj i tn])1a]r]tal i cl ' Jl L ncnl tl gi ci
rrr,,.r ir r ; r lr . iir : r . r ' r ' rl i l r.l rz ri i ,s l l i ' l i d c ta c i i ,,r -,$tci uta, si Lt{ ,{ ,i t,si}} (} i l l l ' i tt,
l rr rl i l ,,r r , r r lr rlii ir r lir l rru l :r;rr z ;i s i r,,p l i rl i i i r.i rr),1i :r,ti ,or.i
cii ol ogi ,.J i i i Lnttrrrrir
rr, l , l r ir ior i, r r 1i< , cs irl rrra i p rri .h o l i l l l ' n tc , n a i grc,Lrdtrccl al ri Lrsj (l { r l rl l l l r,
,,rr rl rnlr ' iir r , ( ' \ r ' s c t r i s i (rl x ' c s (fu , l 9 i f)).
l r l; r i: ur i' i t r c tr' :tl q i i l ,r' i 1 ]c 1 n i n a lr1
0 o l r,l ul i i ,,l ri tJi i ti \rfi " , 1t1,1)Ll i si
1'l
rr. rr lrlrlr, rllt r tntlqnisnt,l, putorrcnic ii,cl,iotx'azi ll, tt.i,lt'[,t:ottltttI lt'.1,r'l
rl , \ Ii l \r' ll) s : r r r i; r r lc o s r' l ri l a , rti t:c ' i ,p e rti ;fd i c (c-r1,r' i l rrct
l l rri rd).
l ,l r lr ' por ilr il ir r s l rrrl i rrl l r,tl rri , l l t,i rr rn i .j J o itci rl rol fcci i ornl rr rl r^i rri r,sl i
lr(rr', rlir s { . ( f li( l( ' lli( . 2 (f o s r,t' i i ' < l r' ./i rrl .rr?tl:,s l x )l sl l ri l i rl .r' IrI' orIrrrrcIr,Ir
l rrol
si tl t, l i ' nrrrnr.rrcrl f l rrrl i ,
l)rtxu |(f r lt f t lr . t t r ir ' lit ti z trl r,,rl r, s i rl rl rs o IrrrrIr,rrrIrI('
lrrl rrri :r lr r i rri r.l ; t \ r)rri t l i i j l l i l i \:{ ,ttr i l r' rl rl (.l tl c rrl i l rr,i rrrrrl rti
rrr.rrrr
rrr i Ii rl r' rrri l rrI
f r' : | | | |, I rr| | rt | | lt r i { lr r l l r' . r' trrrrrrl i l c i IIII| .| ,Ir., Iri rl ti rri l l t, l rl rrzi l i r,rrl ,\r,r' rrlr
'i tl

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1 | r r . r i r r r l i i d e a ce e a q i p a tte .
l tstl tr i r l tr r r l tl l r ( r i 1 r ( 'vl r l l r l i l ti l f r r r r
. \ ) B i . t d r o m u l [tti . Gr a d e n i g o i tr l l i ci

1,,rrr o l ara lizic a per echii : l Yt r - ir '.

9 ) Si.trilntmul ?aratf i,lleminctl td I'tti .Raer.lrtrsr' (rillrlirl('r'izcrtzit pt ttt
,, rrtl ti t i rt 1 eli1, t t lilt l ncnr ului olt alr nic) r ligl't llLi, sit t t I t 'lr t t t l'lr r r t r lr ' l] r 'r '
r.rri lllnrr
$i paraiizii alc fcrechii n YI-ll.
l0 ) f i.ndrontn,l tle r,:isplnlie ?eLro-sfenoidd,l'ii ul lrt''i''lu''ul t lrtliz' rtz:t
t, :ri rrti i nul l ,i plc t 'le ncr r . i cr at r icni: pcl: chilc I l, lI I , lV ; i Y, 1r r 'lr t it r r plr r r r
rlr'irrlu-s(. felralgia o{i,ahnicri ii }irratljzia, dc pcnrlrtr l ll.
o'r'nn! ii It .trtlt t'i.t)rt ttltttrt
11) ,lnetrism.elc de (|'rterd. bo'zil'arti ;i. ntal,.f
l r rlrlsirl.ri dj n fosa cerebrali, po.<tet'ioalri)pot sri rilll,llzczcrt)gii t t' i g1rIt rt i t rI rIr' rI r'
r,y, rrrrri ' al gi c,it t sol. it cuneor iSir loheinisliasr t r f r lci: t l( , \ r sct r i; i( ) Pr l's( 1r l, llr ; 1) )
l!) Lea tn,i,leinflarnatorii lot fi l:tlctr)ri (rl,llzirli (l{r ll(rvrrrlsi; irlil, ttl
i , rrrri l tti gtm it r l l, r Tif elic, r : il, f i in ce1c0nt lr 'l] ( - '\ lscni f i olt r ( lsr lr r , lllill) l rr si ui i i nul lr t llunint Ll pdiJer it i t r t ni l, im : [ ) Ar t r hw) id"iltlr lr t lt nt
titxtrd, (tio tnrghi 1rottlo -ccrcl:cltts \ti jurtapolrtirr(') ; lt) 1'r'tlutoirliltlr
1'.'::it
t,,r rrlr ; <t\ Zrtt,u postcr g8tlcria'tt(i po.'Ltedoclan$il,violt'l(ic ll('vl rllgii l t itl<rlrri
i. t r t t bit r t 'i r r lr : r r l
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--po 1.mni;t,,llo l)l(roiLl)tr'Irrr('r)tlr,'t ,
, , ,lt!iil, lt()rpeticil - bittc outLtisctLtir,
, r i rl l nl qi po t . er it ot 'iul cilLlt , t r ir tlll n: L. 't ilt luht i i] lll) cli{) r . St r it sr t t r ir t zrr r, t
r lt r r \ : r
l ,Ll rrr.rl rzi t' pc t er il liul r ( r sp( xlt 'iv,t 1e m t llt c or i I i li( 'lr liilli' I ll( ] ( r llr lr r iii'
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;,,.rri sl l r o ,,(l i sir si. czio
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t lict tI it : i ) ( liisr r ', l1}5: l) <r ' it t l, ilt r . r ll
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pr
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, t:rri l orr| j o }ir . l. - \ nlor r '{1( 'ilii( lo,
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,,,,i Ir.rrl i rot 'lr I <.i, ii ir t r r t r liJt t lr t ir li( o I ) ( , s1, - 11'll'lllll1i1,ltitr xl,
, t,,' ,rr1i r,i ri rl ti l'i) r ir r lilllii, i ( , \ r nolr i si ( ) 1t ir 't r r r t l,ll) il) ) .
l .l ) l ,r::': i. uniltnuck: ilor r lr or 'i4it t r : ; i r r l. r t . lilt nI r t inlr t t , - h't t lbopr olt t lt , t t r, '; irr r r
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l , r,l rr rrrl rr.t
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,,,., l l l r ri rl rl r li I rc t t t i I l tt rtrI II r ; r ', , , t m lqit I t 'ir 1rnt t t t lii' r lit t llt , llr t oz; tt t t l'l r t r
( liir r 'r ', l1lj, : i)
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fi
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l ti g t'ttti ttl l l ,:tr l tr r ';r '
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lr.rrorislir.), (llllirlil
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l ti r i r Itr r tt:r l ,
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', r t f ; r o r '{i
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l , r ( i r i t 't l s i l l l t ii i l r Ir 'i to tl tl l tl c i i i r i l sl ) tl ]]su l l '1 ) ,1 ( ta l ) i l l l t 1i i I rt t Irt t 1ri t t I r l l r l l r 'r r r zi r
, l , : r . l t r o r i i t r t tl .
u tl ![l ( l ( ]ttl r t) r t) 'Jtt( n tl i b ttl tl ti t :{' l r r r r r l . r r r r r
l l l N i n r ln tttu l
i tttr r o $ l i l t
tl l L l r 'l 'i zo l r r si ttl r l r ' ttr r r t l tr r t|r t
r r l r ', l i
p r i t r ( l u r '{'r i r 'tr r 'r tt'a cl tt ttc\ta l {i r '.
si tl r '1 r l tr :' ' t' tt
r l L r r : r 1 r r , i r t l |1 1 1 1 '1 j i 1st'
r l tl tl tl i zcl L zi i r r sl tt'i l i r tJ l l l ( 'i tl l l i fL l l l l l
, 'r I l I I i l l ( " r i r ( 'l l u l l ti . Sl r tttl l t:tl g l i $ i r I]l ]1 {l l l l ( ' It t t t i I ' t t I I i t 't ' l ii cr r 'l r i l l r l i i l r r tr i t ' l r r l
, r t , r r l r t l i c i 1r 'r l tl x) t{) l }}N l l ( l i l ) u l r tr '{', ( 'i L l ( r ( 's1 ( 'sl 'l l si l ) i l i l i t ttto l r i l i z:tt' r 'r l 'r r l
( Jto r tl l r l r ti l l o t i r ttt' r tt'tt t'i i r t r l i l l i ttr l o r r l r l r r r r r '
|t\ .lrlttiir:
l tu 1 to |tl r .i
l
)
i
1
r
'i
l i l ( n " si tl l l t( 'r i l tl ( fl i l ,l l sr '!tn t'tr I r r ':'r r l l l ) r 'l l r r 'r i l l i r )
l
t
r
l
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Fl
tl
)
l
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,l
tl
l
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l,rLrl
r r '1 r r r ' r . r l r 'o vi l l tl r t {l ( '( i 0 ( l .c l l l l i ;i st'<,r tt'i ttl t'l i zci l zi i l l ) i tl {'r 'l 'l l l '( r \ l r ) l cl r l :t
. , 1 , l r r . t r I ri I I r I i ,i .I r I t l , l 0 t,r r l i zl r l i 1 r t,rI l .rI I rri r riI r r i i r r I cg i tl tr i l r l l ,t'ttI l r rr t'ir l r '. tr r t','tt
,r
l i l : r r l I s i i i Ii sr tl r l i 'l r Ii l r '. r \s1 r |r r i ttl :r l 'l i '1 1 'l o l l t'ttt1 ,tr t'i tl r '( 'tl r '( 'r r |r r ( 'l { r r i i l r ':
!r 'Il i l
| , r r " r r l r {r r r l ( ,.
t'i L l i tL '. i t t rri ' t t t i rt t: t t l t ' , l i l r tt l t'l l L l l '( Itr l l i i l 'l l t l tl tl l tr l t r '. \l r r r i
, 1 , r t t r 'l o r 'l r i i z i i ti Ir IIr 'l i r II( '( 1 r t
IItt'o 1 i r i tItI 1 r Ii tr l i l i i I ti i l r l t'l l l ( 'i r i l 'r 'tr r r r r r r r j 'r t
r l l r r i ( ') l : t t 'r |r r r tl tl i i l I r i r | r 'r 1 i l l {l i i ( l ( ' l l rl l l i (' t }l i l 'l ) r 1 ' zo l r t l r ' {'r '' \ r |i r l ! i .l
'r
l1lii2).
,lr:Lr lr" irllll
l l l ttti l t:L Ir i tII ( l i i sl r ',
l l i tr \t I
r ,t\1 l tl t!tt) i .tt:,t!i l r '::i 1 l 1 t\!su l i l 4 l ttl i r
t r l l l I i t t i rr l r l i i ,.'i tl r r l tl q i i
l i t'tl ttl
tt'.l
tl
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; l ) , \ in r l to tttttl l t'i It,,ttttIr t|r ti r
,
l l r r . i o t t t r t ti ttr ;r ' r 'r r |r tt'l Iti zr ':tz:1 l ) ti l l l !( 'l l r i ( IN l ti i \i r ) l ( 'l l l ( , tr :l l {' r ttl ttt':r
, r '. i r i r r l l i cr rt r I t r rIrr I l t rt L l - i tr l r r tr , r l l o l r i cl i l tttr l l tl , l ) l i l l . l l ( N 'r 'r n ' I|( 'i 'IIIt II|''
t
r l | , r ( i r r {l I r '. ,' I tl l , tl ,r r ':r 1 l r l r '{r 'r r r l r ' l i t r r r tt,'ttt fi r ! l ( 'l o l i i ( r r tt Ii i Iti tr r :r Ir ')
l))
, 1 , l r r r l l : r ( i i ( l l i r 'r 'r 'r :r i r tl r ' :ttl t t, l r r l l l ttr Ir o tIIIt', l r r ci l r l r r 1 i l r l l l i i l l l l l l r ;
r u i l ttl tttt l ,xtr l t r l , 1 1 r r ' :tti i l l t. II|( IIi ||i 'r '|' r r r i .i l r r ri r ', l 'r '
itntiltrrltlq)ilt'
'tl l r 'l r l
t , r r 'j , , , r 'r r I l r) t. r ':r 'i r r l ( r 'r 7 ,:r 7 ,t ;'r 'i l r :t.r 'r l r ' ( I1 t|| |||:ti i I ( l l ( 'r l t'l l l l l 't l r l l ;i :l l l l
l 1 r r l ;r ( '
l tttttl I
i It"
ItttI;,|I Ir r r '. r 'l l Iti l i l l tft
I , r , r I o r r t r r r : t t r I l r ttt:t l ;t tr ,l r tl

lt:l

fi3

r,r(rl' rrl. lll llrrli r. lr olr r t r r r r l r r r ilr , r lr r r , . r ir r l vl : t r , r r l t l r l l t r . t l r l .

i.l. ill.ii.t,lt,
t | r1rr, llt
I r,lllr. I I I r' , ' | . I| ,i ' | | I : r lr r , r r l, lr
l: r lr r r l l r : r t 'r , \ r . r . r , r r r l r l r r r . r , t L , , r rj i t f
nrirL lI J||lIl lil () oll
r r r lr r , r r r t r , r r r r r t t li,
lll
t ' t t t . i , r/ rl i i l r 7x t lit t t , , t l, ( t ir r ( r . , llt l) : t ) s i u l , c r . l r . l l i r i \ : l , i i t , l r i l i , ( , i r ,
| , )| | | , ' IilIi{' (( r/(l ll(,i ill( ' , r ' lt ( l { , r ' t \ r lir lr . l, ( , 1t ,( [ ll r i l l i
( l l ( l {, f r {. i ]{l l l r , i l r l ( . i h \ r l I
, , r' r' ) rlr i'irlilillr' l(lirrl I rr rrI i rrrr r r i r. r ' l|r 1l c lr ( , r r ir c 1 o r ( l o i r l s u l i i s i r l r ( l r f i I | r
,
l)rt|l
: lrlri.
irrs()1ii(. ll{l( f s r l { lr t l, : llr , ( lr . l( , lt r iLlt L o }t r r t '\ 1 ) i l s i i s i l l j i r r r l l l i l s r . : r ,
r,rrr,r' lr r1 (, (l!,1 ilti,(,1 ) r poS1, ( f l. ior , ir r z 0r r c lo oc c i p i t t l c ,
p o t r i f t L , t j r , : r , l r : r ,r . 1 , r . , ,
lrrr; rll
i r1 rr.o fl{ii. s f t ll r - ic c v c t , s l) . ( \ ' l r na, i ade s e l c k t r n ( r t r i . i r l c ( , r r ( , s t o t r j ; l i {!
r' , 1, r.r,rirI.r'IrIriI,Iezis h, nt
la c : t hn r t elc obis nu i t e , c u u n e c r ) l r r l ) i l n i | r r r i , r l ,
: r t r\ r it lrl)S('fllV.

:j-5.:!. llrrnrlizia norvulti. trigemen (paralizia masticatorie) so (iiu,ir(l

t rt rrt rr,ii ll jlr dcli:ltil, tnatiilarul.ui inferior sple pantea pn.ftliza,tiii ((rll
,,(:rzrirrl('s(lrirlot'iigtll.ii) in caz de paralizie unilatera,li (nuclealir,silrr
],(;ri
lr'r'r,.ir
) l l,r,igcrlorului (prin aclilrrel predominatrtF :_r,
rnuschiului ptt:r;iqoi
rlrir) (.\1,(,tn (x)ntil,ltla,tetal
sini,tos), prin rtrofia mugchilor na,iticirl,r,fi
(|r.IrIIlr||irIsi rrLesotcr),
plin diminua;reafortei de stringere a, maxil:rr.rrlrrj
rrrl,,rior' ;i ptirr rlirnirLualcasau abolilea refterului maseteuo.
Sr.r[:.rlrrrrr;teur\or'proceseinl,rapontine(tumori, tuberculoame, gl)r|tr.,
,
lrrrlrrx'rrlllllil,r, {.1.) sau :nnor lezi'Llnifdd,iculalteale rd,d[cinii m;tol,ii l,
I ti Ir' IrIr'r)|I I rI i (ptocrrseneo{olmatiye sau traumatice bazale) sau tron(rtrtu.tj
' r,'r'rrrlrri rrlrrrrlibnlar
:r1,.
(trauntatice, tumolale etc,), .patalizia u,niltlt
r',r/a;r,rrcrlrrltri lricemcn poate.apdrea Si_incontextul unol suter.inlornll
lll'l{ rl(' |r'r'\ i (J'Nlri0i. Paralizia biloterald,a trigemenului se poate rcalizir
rr r:r(lr,.l rr1'l' srt{rrinte bulbo-pontine (scleroz:i,laterali1 amiotrofi.ii,,
rrlr,rirr, rk. s.lrYoziillbclalii amiotrcficd,,diverseproccseintraner-ut,_r
iu,L,)
,irr :rl llrot rrrli,r,irrlc
llaz:rlcextinso (tle obicei tumornle).

l .l i ,i i . I' rrrr t lr z. r iloI r r iir lr r

:' .1;.::.1 !,'t , t li: iilr ' . lt t r ir r lr t t l! t t t lt ( st t llr t t t t t t t l't t t t ) j'r r ! i r l'r r r r l( r 'r '
rrrr(' rtfU l l )r' i t: r r ) I it r r it : r t cr t l, ilt r llizif i iir l, t 'ti{r , r ir ll lr r llil lr r ll|| l; r I ir t lr t lr t i
(l trr lt t l r . t lt t , r r i, 'r t li't r lr r t 'r rt t t , l't ir '( lr r t t . zii lr r . ir r lr i) ; r r ) , '\ ir , r r i. t r ': r
' rl r' ,rrrr' ;l rl
lllll l( '; ( [ ) l'ilslt t r t r r r lilr
, , i l r)r' i )l tr(' zollt , t lt r sir r llt t : lt t l) ir lllt ii( [ lll {i( r il, ( l( : ( 'il'si
Ii l 1' r, cl 0| 1r,0J] r i0glilli( , ( ,ir, lli) ( liii( iit il( r ' I l'llt l\ ( ', ijr . nz{) f ilt lr .sr t t t llllr lr t lt l
t tit r t lr t r r ilt lil'st r t llit llt lt lr l'il ilollt llll ill t , t t r lilii v, lr
rr' , ; r' ) Ihr..t'i t t r : t r sr : t t llt
,,,rr:rl r., rl It:rl l r r r '{, ( lf llioi{it l r llllijclr ilor l) or i( nl1li, lll t lt i; llllt 'olt 't 't t t o{t r r t t : t I I t
t rrroi l ot al riilr ill . c{robsclr ii ii. t t t t m t r it lt l invt r t 's: lt ist r lt t t 'lt ' lt r i'1"r 'r 'ii"t r r l
r : r 'lr r
r,rrl {,, (l l r tl (, i'iir il;r . 0li1it lnal. O 0onlt t zir l cu lozilllli i'lll}lir nllr : lclr 'r ( lxr
ocI ziot it l ir r cur 's, l vilI ( l( f ai. ii l) il*r liziilo. I ir . ir , lo
| ;rl ' ti i i (:1o , . ir r
( lcL 1, ip I lt ll, I : iI ilct r f t i bolt r lr i, r t liur t f lr ll I lllr ( 11i( 'ir 'llr
t.rrrr r,l i ol ogi tr ( it ui, 't or
1' ,l .t' l l ttrst:ttl llr esll] ) ( 'r 'ioilt o lolt lcar in: l 1llc( 'odt r1) {!c( 'iL'N gr lll) ( 'l( 't ' lt llli( ll1,r," i rrl i .ri rl :tt'r 'qi,ur i a1. lr e, in sl, lr r liilt 'llivlllr silt ot le lclit llt 'r 't r rl'oir lr r I ) ( 'r sisiil'
( Ll|f ( ' r ll'( 'lllir
,rrrrl cl i oj t, rrrIsr , ii] ar , siinilil] ( 11.( f1] ( lit i l) alr lr lizil!supr llllll( , 1( . lr f li)
,.rrrrri D N l c si ull l) ll ist ot ilr : r l lllllii polt c pl'lf Y{r lli or i( i( ' ( r ) lr lllz't ''
t tr lt r llr ', t r r '
l ' ;rr' :tl i zi a llet , i: lli lclt t t 'ali, ( llit olil, ii Llziur lii ijbr r lor s Lt pLlt rllt
( [ ( ] ci, ] f ir t t t sl; oolillr ( lll.par t ialii a 1: t t lil t t lui sr llt r 'lit ] l' r r r r t l. r
,,' r:rr,tt,r' i zr" rr zii,
, rrllrirrIii, jttorvalfl ttc taciatrlt supofiol avilld o l o Llt(iz(!lltiilrlf trtrlirrltli
r, rIIrI r,r,IrI ii . Astlel, lxtlnavuL po:11,cillor.01iIruritol 1i ltu l)rozi|l l,it lrtgoll,rtlrrtir,,
rrr ri ri sci ti l e a ulji) r nu, 1i( x) , r 'ollor(0r is, clc li1( Li) asilnclnin, , 'li''I i{'ii ( li''r iDr r '
,r,i^ tll;tolitil ilti;cEli1:lil,iitr[ilot' rnol,ot'ii rlllt.{)rnlto, oa'lorrvollllliiiuii Iiilril
rrrr' ,t,i l i ntct' .si. t ii
'f . it 1, i, , ", du'i culn ar n lillt ir t t il' t r ut i sus, st r t 't t t t slr t 'i: ir lr r
pirrl,c (xt prr,ralizia,Irr,irirr'li''llrl r11r,
,1,r,:r,io h.rniplcgie lr.stii'irl1ii,tlir rt't.retrali
(plin
1r:rsoll]zrrec.tt'lrtrrl., i'ttttrori
srtfori.]c
' rrtrr 1'ra..r,liziiila,cirllcc.n1r'alc
citrr4lir,,'ritl:llo, ltsitlrrrl.irt lr'{"r
t, l, irt .u,r'e, prirL ir rt.r't:sittt'lt 1i.,.iiilor
( ;r(1iontuerlzii,(,u oca,ziil' c\l-)rosiei elnotioni[lo.
:.1.6.t.2. t.)ard.ieiile Jnt:ial,a y iJi'rice (frin l''zitiIIi rrrt(1ltriit'('rii itrlr'rl
( lr ' \ 'r lt lo lopout r r lir it r :
' l .:rl r' l l r" l li {r 'ul'al' dit r l, ut r cl
r\) -f'oroli:rri faria!,a peri,fet'i,ceprirt lPniu.lli ttttt:lcure. [r]si'r' r'rrtlr:r rl''
,rr,,ri
r ii' lt t it t r ': t lr r r 'lo
r ni
l,
ttttt,l t: ului iLt r vuhii f icit l ii l) or '1iunolli111r 'r t 1i(ir
1,,i i uri (vl ,!( 1ulilr t , l, um olale' inI lr inat or ii ot c. ) . 1ir iL( {isi, ( 'siir r r r ( it r ( \
L,l ;,rLi i )(l o ohict i, lir r r r liziei f aei: ile, o lcziut Lt : t ,lilt , soioLilt t lt1tIi I' Ii I t t i t I rrI , cr r 'tr ,
,:t\i r,t' uzi t o lt t 'nLipleplicalli( t 'nii, aalicli opusi, lozir lir ii ( ; i t ! 't r i ir r r t r r lizr lr
L rrrl r.), l i l oalt - se lt ot a"r oeia qi t ulbur lif i d( ' sor lsil) ili[ 11( ]lx!
- h( r lr r i( ''r I l'lll
,;,rrs(j ' i ' l i ,ziur t e: riir ilor scnzil, iYc) ; i, d. t r r 1. lt r lli r r r lr li, ( r<i. i, Jr r z, it r r rt ir r .
illlt f lt l{' r ll'
(
jf
lt
llicnir
t
t
ivt
'r
'st
'lll
.
!
jlr
(
[
r
o:
ilr
x)
r 1i ,(l { j l r(' t1 'j
or i'c collt ur eaz?i
r r rrrrl l ti cl i cl rt 'it 1.
ll) !'ant,li:;i'i, Juuialt: p ari,Jtt'it:e pritu Le2iulli iu.;lranuclcnrt l'r' lrrtzrr'
l :,1,t,rI rrr.r
rri o l0ilit t r t lit r ir : r i, ilt r r t r of iziologice lj I ) e I ) l'z: 1,lt t t t lt t r lt r t lr lt r r r {ir r , 1,, fo Itort ; l, rsllt
r i. ul, lof ) olJr Q I 'i|ll, l lczjllllii t t t r t 'r 't llr t i I r r {'i: r l'
' lr ili r / t iiyr osl
\,' . l (' l )rrl xf lit ll( ( ir t t |it lc sit r i': icr lt t l liiolir niilii ( s|t r l, ir slt t l lt r i S{1lt iI t r r t ") ,
ri
( i( lius ( 'iir lrr gisir : ir r'lil o 5i r lcI i t or r |t t sl ir ') ,
l r,l i rl l | ri ]l cr0lot ir r t t , '1r 'lr r t r ltiililJ)
trrrl rrtl s| ttri lr ililii( ii gr r r . lt r livr ', I ) i1'( r 1r l) lsi lr r lt t t it 'lt t r lt 't r it r r $r t ; l'ot t t t 'liI r t
rrri i l rrl i rl i (( lr : lr lr cr ', ll) ii'; 'l'r r ir r t lr 'lt r i r , ollt }. , ll) {i'/ ; I 't t llr r , lll?l; I 'l1t 't
\ r, r| r ri l ' i rs( lr ! lt ) 3( ) ) l, r 'zir r t r il( .ilr llll, lll( il{'lll1f 1xr l, I i gr t t lr : t lt l lr slli'l llit t
l rl r, tl tl lr r ' : r l: r lr r t t r t r ' {'l'r t llr t r lt , ll) ( i{); I 'ollovir r it t 1i I 'r t lr r t t , ll}i'io) :
1,rrrr,
'

,Ii I,III)III,I.]I\'II,]
I)IJ I)IA(iNOSTIC
iN PAIOLO{.I]A
NER\TULUI
IIACIAL
:l.li.l. Irrrost,i1;atilscrniologici .,1jnervullii faciai ulnrireqte :
| ) l',t.idt)ti().ur,t(ntn,elorclinice d,eTtare*i sau d,eytarali.zie.faci il,
.r, rrtrr I rir. x|rt::tu
.faai,all)f in probcle bine ounoscul,eale era,xrc1rl. i
t,tttt ,,t rlt' t.t rr,rtt,r'n.rt,l,tr,,i
di,ttr.tmit:,
,lsupra cir'ora nu ilsisti,rn irici.
I: ) l,)rllt))ut'(ionutdtJ.ir:iril,or ] lnd,{odrelorreJlem (Ilist\,7 t1}i2; ll,lr
r r.r'rrr.r.,
lt)lilt; llrpoyii,ir fi l.,asou,I9g0) : a) rcllext na,zo_lluJpdrll,llr)
;
r, l, rrl .r'Irir,rrIrr'rrIrri
rxrhirLhri;o) r'{rflexull,siho-palpd)ral; rl) rrrrllrrrrrl
r'r lrlr, Prrl;x'lrlrrl
rrl lrri llcclilurcl. 1 e) roflexr corr]orr,D;
I) rr:llc.rrrlrrirzrr.
lrrrlrr,rrl; !J r.r"ll{rxui
ruu;chiuhristaporlius;h) r,cfloxclortc clipil.
| ) ltt::lqt't:uttusluljl.i,(lllpi m{ltodelc oxluse r1c rlri irr
,,, .rrlrrirrlrlrr
l\r'rrrolorlir.)'
(l'{)l)r)vii,ill$i t,Nsru, l1i,$0).
l) )
l 'l )
, l;r ri c rr l
lttttl rtl o t
811

'l t.\l(t.t1!.tnli.tvrliri.,
' l' t x t , lt t ' lr r l rtt.l i :,i rl u rl i a:r: rr) r:x rrrrri rr i .i l r. rk, r,l .rrl ,r,,rrl i i ' drr.r
l i tr
lI . I t r , { iiI , r t r ll rl r,l c rrl rrrc r' tr{ i , 1 l r) r.rrrr rrrrl rrrII,)l \l (i ; r,) rrr]i .Irrr,I1,r,Ir,
r lr , llr lr ' t r { lr tr r' 0 ItrIIrr,r'rtt l t!fl .t,o l l ,.]r,.

1 n r l ,'l r t1 1 tr 'ru l , l ', tti l tr t:r l t:ti r n ttt

t t r I t t I i t t t I I t t t tt ' I t r l r '
tl t tr n l l h r l ttttl tt r tn Iu :l o :; ( i r r r l l o l o l ti
: r ) 'l 't r t t t pttl ,
'
i
l
r
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;r l ,i r l r ,) p l ,l , l r Ic|l ;l
,
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l
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f i , . r \ l t . [ ] r l i r ', I t I '
;'
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l 't t ) a t :t

t|tl

r.l rrr' r'\ l l:r, rrrl. tlrr : r lr r r r r r . . r r I r l, , , lr r , , r

.
; , : r lt r l r . | r , l ; r i , r r l t r r , | l r . I I | | I I i r I I . I i I I i | .
lr), lt r rr lrrtrrlr. yn n.r ; t l, i t r | , r tt t , rI , ,, |
| t |t , l( , l) t ! ) ( {. - t {. I | | I I I I r . ;| | r r i . r r f r || : 1 i , I Z ; l
|
:ttl, ( r l! illrzrt I;rt,i: r I c I r iI I r I r , r l I r . , r r r ,
I , r , { li j r l l ) . , i ] r l l , r . I l ) : r J . l l i r : i i t r r t l i l r l r .
rll rtclr j t,t:lli(.1 i.
r \ t t t ir r lir r r 1, , , lr r r ,r li, l, .
r r . l l l i r " l r " . 1r, , I r r I rI I rr, t rI I I r rr. r r . i I , . I r
rlr' . lilr l,;rrrrllr (ilillr r iu
lilr lr , ,
r r r r r r r 1r i, . l, , r h , r l i r r , r r , . L , l i r r l o ! : i i ( r i l r l r r . , , .
Itrlr. r' r,1.,rr..
lrr.ii.r') , s lr r . r , ' ir l. z r , lr , ll. r ir r ilr . r , l s i I i i I , I r I r 'r I ; . , l 1 ) {i l ) . r . r r r . r r r ,
rrrrrloz|lI iIlillll|li\(,rli lr r z c
s . : r . _\ ( . , , s 1i.lll. o( . ( , r - , ! (, ,; r i u \ ( {, 1 ) l i i r
lxrlirk,r |ii,,lor.
r 1rolir.11 rli1,1 1l1 11 11, t ' r . i1(
s i ior
nr ( ' lr ir r r il( l( , t . J pot }r o d u c u L d " r , , , , , ,
l)itr.rrlizit

l:r.r;rl:riz,lrlr'i- I'rrr.rrlizir,
firci,l.i, ,r,i.,n,:rL
l,;"f",,11i

l,," ,, ti'pr,,,,,,,,,,,,,,,,,..

r,:| |1 :r
i
' 1i111 -q l i l " :i r l ,Ol j l trl i , l On ,.t.r,i l (,.t ) ,u ; r., r. t ,r, rI I rrrr r,.,,, .,rr.rr
r rl.i, 1"
r,' .l rlr,lr
l ilt ( lr . r,.s , l l | | i r d e fry rfU l r.i i n l ezj U rri l r. l rol ,\ul i l t(.;i tl l
I r.r,rtt.ttr'lt I Iil tl I c lrlril uhcranl i si stinca temporaluJu i, l:l semnole
di:
iI
l :r.rrl rr r l r r loc ir r z li tl e o l ti c r.i s i s e n l l to d e .' l e zi une a al tot ncl l r 1l,lrtltiz
trl rrr,,trr
(\, \'1, \ I I I ) ,
ln( , ({ rn t s i n ro d i fj c r' l r.ja_l e L .C .R ., i ar i n cazul l )roc{,s(,l ol
| | | I(|(. | | r1( |I r.I {. tio spal:iu - scnne. dt hilx,t,telsilne jntlacr.:utjatil;
(j) l)i
rri ' I i ()rrI i{' I rI (l('vilr(' irrsi rrrrri dil icil irr lari'lc sitnaifii tte ,pe:ratirii
ltit,l
Juciut(i
It rrrtt , t,rr' 1xr1:si :tIr,.i itr trnrle
Jornt de distroJie nlus;ularai,,di,prli.ntio:,iti
::t rl t , r ir t s lt , nit , ( lllt , l ,t (,_ \l )l n (,' :l tc n t s rtrp ],i ri de contextul
cl i ri i c al l xrl i i
rl t l rtt. : t .
ll l, it t 1, , l. .trtl ri .l u ri rrt .x i ttu -tcp n ,.,i mnt
,yl 4,,1i
Jol i dt qol gti o
, .l
' u t'tl ( " t lt t , t t ; u, t ' , t : ,t1 t1 rtrr1 ,i t,rl n l fi ). S r.n rrr,.l r.r.l j ni r.o.j rrti urrl l l rsC rnl i rr:r
l ,:rrr,rr r . r ' 1. lr lc u,tri s i rrrl ro rrt d . tn .j g h i p o n t o_ce.ebcl os. ptl Il ftl i zi a :l l i * ,
l ,:rz,
r r lr r i( ' l rri l ul ' l i i n c l y a l i i d e i ' a c i a l , ra cl re sc asoci azi i tul
, brrri n
r gil
Ii r(' r' Il I r'r
rI rr(''r)' r.1rr'".rrr,
si ilfccla.ca $rstului in ceb doud tleimi alteriollrr.
rrl ,' l i rrrlr ii. lI llt lr ll{ ' !i i z l i s c a s ri c j a z i i s i h i p o a cuzi o.
l,lr rrrl i rrr'il i lo lrr[io]ogigt' alc lir z,,i (,1,J1iuluj alt.porliunji pietroe,sl lr
.
fi
,, trl Ii lr , r r r |, r ' lr l 1r .l r.r' i rL ,rrl i rrL i ,l ttrrc { l c r.t.. zi l tnr., di e fl ectrtri
sau ri l l ,r,
f rrrll(' rlrrIri-r('r,rrr.rr,1r'r'isI ir. .,rtrt pror:csesitttGtela {tce*tn.il:el: tnetringio:rrrr.,
l r rr"l rl, ) r r , ilr , . lr : r ll l trl i .l .l r.. ()s 1 (,i 1 (,
te ml o ra l c, C .:l tl j nOl ntC rtU mi l i cl l i
r
i ,rr , , lt | | |l., I '( I I( | | I III I I I (' , r e ti ts l ,a z c
dt h car' ci troarrrI
'
l lol cni te
r r r,l l r ' llr , : r liz ; u i { ,| ' Irt.r,r' rrl r.,l l )(i l )).
l l I ) I t it r t ilI s i l trrrl r' ,i ttl tt: l l o l t0 l i o n u l g e ni r: Iri pi ori qi nea rutrt.tttrr
r1.. arLi setancl c cri ri rr.
'',rl t, t r r t t lt . ir l : t r t rrttrl i tr"(i' , 1 )o tri u n . L x u .1 )1 ' ..lr)edi
' rl C ,S C rj se
.rl , :r, r ' r lr r l llz lt r i s i n l l i l rt' 1 r' l rs g rri n i tq l rtt C rr r.gl c ).
rt1' r.i qr,.
l ':,r:l ri ,r ir l: r . r l: r . s 1 r. rrs ' r,i l ri i i r,rr l l l .r,:rte a e r stul ui
l )o r,cl o tl oui . trci rrri
:,rrl , ri ):r . , li' I ir r r lr ii,
(' r ri f(.fl rrre :l s l l l i v i l l l c i , c n hi pcl aauzi c si r,.r al tcrrr.r,rr
lr,tr.i
l: u. r r l: r lr , r , rrrtl q .rrn g l j o n ri lg c n j c n l fl t e s te deosebi i , (l o tfect:t1. N l l
'. ,, l L t r lr lr ipo : irU l l l l i rr Z j f. l .e $ D c c ti rri n l l ,. l i carc:l :ri t()],tLct.\i ri | rr]]i Irri ,
, r i 'i .l ) ir
lr r r lr r r rilr rl t. c rr l tr,:' 1 rezso s tc r..T \.0 c t,scl epal ol og,i cc | cs1ttrrrs:rl ri l .
r'1 , || lI r r , r r l^ r . t .l (' trrr,r,l i o l l i r1 ,t,
i t]Ite t,i o t,)]rt c:ut sc i dl tri ei .t l )i rrl ri i :ti :r
l :r.r:,1 ;rlr r r ' : rr t iololic r.l i ti .i l Iu j l l c l 1 . D i tg -n ()s ti cl l l ani l i ()nl i c sri l l rrztl
rzri 1x,
i i rrl rl r l{ . r r l r l I I r cl j rrIIri .i t,il,l g rrs l ,rrl u i ,a l s a l i vl _l i ti si l t.l l l zl l l l ti .
l l ) l, : ir t t t i/ r : : t ti trrrl r d .i ttrt[.,l u l i itl c rto " t:trl
f]pn1nt. tl ut(i hi 1tlrl, .t!l r,l i ttr,
,1 ,'t I't,, ' nt t t l . lr , ! t i t lt ,L l tl l tl c u t)d u .l i n tl )l tl u l ri i
i rn pol l i rrrrr.i ri nl i ,l rsi ;r1r,rl i
rJr l l r r r r lr ir . r iit lr l i i , l l i ti tl i z i t, l :rl i ;rl :-rr, :l r{ j ti tzi -l i l t rl i trri rrrl u.r,lrl
t rrr rrl ,rr
l,r.r',;r
rrr r : r l, ulr rri. i r r r r r l i v rri i " i ,.l i p s t' s r l rd l I,' ,i i l i k , il r l i i r,r,i nl rrr' 4i l ri l x' r' rr.rrzrrr..
I 'i rI r l rz r r lr r lir r lii iiilii l l i o l o c i (,rl c l i rri l i s i ,i o l a z r)sl { ' r.ri rr I ccl c rrr:rii rl ri srrrri l r,,
rl rrt l tr' lr t r c r ii t r l r l i rrrl i l r s i l rt l tl l r'
N l (, rrrr,t,l ri i rrr,,rl i i ,
l ,l o (j c s { r: i l ti l ti i
r, Ir'rl Ir,I r I oI Lr I r Ir 'I,I I II I | |I I I i s I rI{, IrI rri I[r,rr1l It
0 s l l t I )l t t.t,i ti 0i i i (,l .i l \,r,f]t(,t..Mi i I ;
ll rl ro r i lir t r , r i l' il. ( ' 1, l l l ti (t).
l ') l, r ' ' it t nilt : , il trtl t d i tl rrl .l tl i tl t ' i rtrttl r ,or:t.tl tr
I i ttt 1tt rtt tt | /I / (l t l rrr
Jrtrtrl l r i | | | t':r(,I || r| :r| :i ) i rr l t,o rl r' l r' z i rttrr r o trr I,l l ti rr rrrl l rl :t l l ul l i ztr, l tL,ri rl r,
I t{;

, r r r r l o 1 r :r rr l r ,;r r . l r r r L r r l r l ttr r 'l r ti r \ l :l r 'r r .l l r ,l ,r r .i L l '

1rr, .llr. ltrll, rr rr
\ ll,
l , r t r r . r i r 'l t t t t l r r j ,. 1 , 1 'r ,r r 1 r r.i i 'r r r l I |} l r .z,i ttttc l :
r r ,r ,r l l ti y|1 , l |o L ,l l ||,L i l ,r (l l l
, r i , r | | | | r | ; r I | r ' l r l i l .r r r r I l , r ,
\r l r r l :i p r tl i r tttr . r l i r '\'ttl tti l ;tl i r tl l r o i r ,l l l t
lllirrll
l r r i .t.r .i r r l cr l i i
r .i r l r . l l 'l r ttttr tIi r r u r 'Il '( ,tl r 'l
l i r l , l r ,.r 1 ,,

r:|{;t. | 1)?:l).
l l ) l t:i tr nilr ' : : ilt r t r l, r li: : ir r l lt t t t i. t l( 4qt t r slilonu; loir ! i'r nd. ilr ! , r lu( r l
t,rrl rrl i zi c Irrrillii, izol; r lr i, r lr r l r u lolt lr lr , t t t ut ( 'sl( ' ill( "( r lill it r 1. r 'r glclt lot r t t l
,,r rr.r' rl i rf l tl lr ( 'r niI ( '1r 'i,r . r r it r lczit t t r ic silr t t Llo ] ] I lLi l) r t ) r iilI |ll. I lr l I 'i ir r I r 'it r r r
rr rl , : rr) l rl rrclir r ni ir r lilir r l, r 1olii,lr ur ur nilc I i t r allnlr 1icc
r ilir r {l( 'i lr r r lolr r lr 'I
I l ri l ol i rl {. r lla\ ilaluhr i inlllior si ah loiii pLlot ir lir lr'ilc
( ' iii r cir 'or ulL\ r l: r 'r ,;
, r rrl\ r'iic tlo ilir.crsc neiur'l (f irol,isc sau ilrir) altc inf{x1ii' lr)r1.'lrri1:rurt,lr(l
rl) (iornplesi ri d(f alte niiiLrri (de pildri, ?lr'.rlizil, lirxrialll pritr rr;rlr
'.l, ):
,.,r1.ir (l(, ior'*.ps sar,r chi?f ln'in uaitelc spont:util 1:[ r{) llli$cIt).
:!.(i.2..1. Probl eme de d,iagnorli,c etiologi(; i.n pqr'trliziil.e tu.cialt, p, ri..[t
\) 1'araliziile,faci.ale in.feclioure sint rrr t, mti frccvenlo t|'til
rrr'
, r|rl|r lLltritlltiL, dor.i:dinrlu -.rt-'in ultimii ani cii, IOlj oxi til! tlrlrn{'rorr{,
rrl c,,1i i rcspo[ sabilc de pr ot iLr cer eirpar alizii] or laciulc ( ( lr alr t r i'( , , lll7l;
i orrl ,' r' , 11)7 4i 'I ': r in( lel $i colab. , 19, i?; Popovit iu qi [ ?t r , st , r r191J0,
l1l8l)
,
\:rili'1, l)oi; ji)1n'r'1'orri
diverse infectii b*ctcrieno acutc sN,n(,ri)lLi(x',\'i rirrIt
,,rl i orrri trl i tiil, , yir \ r sur i gliilalt ', t r unlef olse elit er ovilusuli ( lr ) ( h0, 1l, r
.rr,l i i c s.a,), r l'bor . if r uu'i, nixor innt ui,
\ - ilu- qr d m onor ill: lr . ozr i ir r f i'r '1r
Ill,irlrr lxri lt
';rrr'. r'ilttsttl lrt'r'yrt,it,, \'irlrsul herlles zostor $.[. l)rllizii
rr i rl rri t,c ;i i rr pr ililldicukr t ieyf it olr G uillain- I lln'r i, plcct t t n I i ir \ ': uir r lr 'll
rr, rri rrrl ol rtrl, lllit o. llLr llc t lir Lt r r , pr llaliziile f acillc l) {) r ill( ni, . '. ; r sr rzi', r ' , , r r
tr,Ii rr" ' si rrl ir i r . 'lr lihit ir ] 11'( lt ior t se,
iit l f elor nt , t iul ( lo il( f vr o( l{r (ili't r r l lr l
l r( rrt[ 1' si (,,r L'jia1i1, cel ur ir i ar lcse: t ,o r I elr yit ii,f nciaLi, insolil, li r l( . ( nli. r ur l
i i ,r' r.1 (' rvull: i it r lpet l[ ot [ 1 1r l1 Jlr r llopo. Tnl t o cu, zur i, l) r I lr liziir I ir ( f r r lr l
, ri l rl l rrttl l ur i ot iit lor ' $j, r 'csllcr , lit ', Lnm l ir lt st oi( Li1o.
inclusiv unr : lc l) t r llizii I r cr r l, '
Il ) l ,tnr lt plllilizii {. t ollcr \ - i {ilillli( t r i
l rrl ri l i ol oglt zisr , , ,it lir ipt l ic<, ) ' r t lo lt r i lleil - - it t r <t lt lt ) t t r ni( t r lt lt ) int t t t t l
\1, (l r)\' (' r'r i si I ') s1r 'r 'cz,1l) 71) .
l ' ,) l ' orl! i: iilr . lir r : ir t . l. r : lr uot t r t licr sint ( 1c( 'lulr sr l( ', 'll lllt ( , 1t lli r r ll I r t r zcr
r' .rrri rl r' i , Nlc osllui lt r t t poliil r ii illt ' ll) ir , \ lr ) i( [ cii ( '] ( ' lx) i ili) iir '{'iri, {llr lli ( 'r t
r' : ri rri i i srrr ir l si ; iit r l t lcllir r iiir . t ,i I ) r lr liziil( , llciit lt t 'r ' ll) ilr ' ( lll, il ll l, zil.
l c l ;r l l i rurrriist r r sit t i t la1r , t I t 'lt t r t t r t t lir liilr '( li] I ( r lliillt ll llt r ir r l gi t t vit r r lr 1r . r ,
'

:i lLllri.

l vt) t) t\!.l t'r i ttl

N l l I 'u . t r tl i :i i l t.l i u ti u l .t
l r tr xl ttr r r tl c l tn r t) ti h tn i q ttt ( l r tr l l r t
l tttr to t i g _ l tl ttti r tr , tt( 'tl ti l !o i l tr l ( ', i u r r ttt|i Il r r 'r t
l r r r l r , rr r r 0 i t l r ', l r ti ^ tl i tl g i o r l l tl |,
r r f i i " ; r r ') s r r r r t,tu l i q n t ( cttr t.i ,to i i r r ( ,, l r tt!r l |i l r n ^ l r sl i r l i ( 1 ( ') .
r i t' i ttl i l r tcsc i r t: tl t;tl r r ,l ,,
l t , 1 I 'r l n r ti :i i i r
.l r r r i r r l l r l i n Iu l .i l t si xl r n ti u
| | | | | ' r | | , l r . r ; I r Ir l ' rr r' I r.r' i rrI i i , r r l r .to i r i i |l l 'r ,tj ( ) st,l |t'o zi ( 1 r t'i tr l fzi ttn i \'a N |l tl l \t|'
r r r 1 r 'r r r r r i r i r rl ( r .r 1 .l ,r 'r l ) , l r .ttl l tr ti i , l r r r tl r t l tti tr l r i tl g l i i tr , l ,{'fi :t1 1 r 'r i i l t r to tl o u l r t,
'r ': r r r r l o r r l r l o z:t l tti Wr .r 1 r .tt't ;.;t.
( .l r i r i i , r l i t,l t,q i r ) ( l r tn r l i :i l
l tti l l l )
l t l l t t t t li .:;u .l r r ti tl i
,,i tl i q t,tl i ci i "
r l o l tt Tr ti tt r '''.L ,l ttr l tttr t
r , 1 , r 'r 'z i r r l i i o r r l r ,r 'l i tr tr r .tr l r ,:r l r .i r l i ;tt,tr n l i l
st'si r r l i i l r 'l l l
tl|tlttllt
tl i tl ) tl tt!t r r i , r ' l tt l ttr ,ttl ', 1 ",'ii ',, r l i tt i r r r r l t' t:tztttl l r , r L .
l t o ti l 'i l i l ttl i
l r . r r r r l r z i i I r r r 'r Ir Ir . r .r IIr I r tl r .l tl ,r ' ttr ,:l l ( ,r ,,o r r r r |r r r l l r l i zi i l ,r r Ii r l r i t.l i r ,l ,r g i r , 1 ttr ,<r tr l l ,
r l tr r l ti
. , rr I ro I rrr I i l r , ' 1, r l i r r l r r 'l i r l r r :r r l tr r l :r l n l tr r ti l r tt{i ttr ' l xr i l i l r r tr si r l l r tl r r
'l ':r i ct tr l t, l 1 l {l l l ; Wo l l i ,tttr r ttt,
, r I t o 1 r I r i i l r r I { ' t i r I }|.t | ,| , , l 1 ) / i : l 'i r l r l t'1 , l l l 'i Ii

1l't

'l'11l'l,,
lrr'i r'r . ir l { l, r r r , . r r r , . r . l. t r , |1, . : r ; r r r r r , l i z i r r l t l , i t r l : r r r I i o 1 r I r I r r , i I r
,11i, l)
Ittr li.ll r,rl. l(.1)t1r(. ' 1, ; t llr r l, , , r
1r . r r r lr . i, lr . r ir li r : l ( r 'l , l i , I I | | | | : I I {, |,: I I a|,,
r| lr' rr' :lr ]r, (1l.rr || r'r l( f it |ir r lr t r r l, r r r . r r r r r r r ll r r . r r r r t
t r c r t t o l . r , i r r s r r t t , l , l r t'r, li l.,.t l
lrlril' ll:ri ll'trigrr:i, lr lt
I |r |ijt ' |) i||Lr iJ , 1, . r r r r r j , , . , r 1 r , , . , , , , , 1 , t , , i . , , l l l l ) r , i r f r l l t l r .
l(l:rtri. :,iurn iir'{ll r[c l r r ] r r ir ij l: t r t r lc r r . r r r r llr r lc t r z iid t r t o t i l l r r l r , t : r r t , o l r s c r , r r l . i r : r
,,1i,'r , irr,.'rrr 1,r lr . lr r. - . i r r r , 1, .; . , . , l r . , r.r.rr r L. .1 , , , . , , ,
i,r,.i,,1-ir:,)(,rirt) r,r,,,)tr.
: 1.;
I \ \t:,.
.
t..r lr r r t l ulL r |. , ir r r , r : , t r t |' tl i u l t , n 6 6 1 , 1 , , y , , l ; r r l r , l r r r l s r
' , ir./rir ,

rrtLl:rl.rrzr'i
ryirlr't'ri i' colduct.l audil.iv e,\tern si in zona,r,eiroarrr.io'Jrrr.r.i,
,'r'(. l'(!,({L riri citora zile insialarea par.aliziei,
cnre ap:rre de
iri
trrrrlr rlr ltt 4li dc ore. riebutul fiind la nivelul
orbiiuiarului 'eg'lli,
buzr,lor..
'l'ir\ ( r'rr(.r'(1t)tit)):r. rjtat cd 60
boid.rf ,, ilintre
doal urr
",ufe,rii,
,.1,1,',
"."qii
" r'r'vrrr,sibil
rle co'd'ccre ,Jiziologicir,,',
A".i ,i"i ,rli.""p.tibili tlr .
r rr rlr.r.rir.rr'rirplctii,in citova sijptrrmini.I-iestulde 40f
s,teri 6 d,_.gencr.sr'r,rl: r:rL ri,,rlrilrrri irlt slr completi, cu denervaldo
"consecutivii, flr:.rr|l| ti r:rlr'$t.tlor.i.r.u impnsibjlit:rrrdc rcfrr.n|i.comnlr,1i. a tnlrslr lt,csl,itr,
r rrrl irrilrrl:r-:'Ir'orlo rolrlcrur,l. g:,rde \c,,iJbilo O".n1,r"ijr.iri
ii'ii,.
-uneori
,irrrI.rrcIrrr.l'i,,
.u dtlo''.a,re:i f(,t_eiqi
cu terrome.'ul ,,to"ri_lto. .i,,
r rrrrrrlilr'. Itolnrvii cu ul simplu
ibloc,'tle conducere,nervoasi prezintii,
tr.r,rrrrri
siirrrl.o rlisbzrlIati1,dt jrrurciul de origine zJ
coartla tirn_
p:rrrrrlri .ri lrr,rr1.51i,,prgul cle,sl,irnulare
""l"J"i a trmbii ri,minr
anodic;,gatr,:urici^
(i(. :lrnllelcpitrli (l.av_elner.,
1969). itr schimb, bolnavii care
ll,'1.,y;.'
.l' ,,.*,'r
r\,,
ir,r (tr.n,.l\l||or,ulnplelJ.d,,Oh;cni
plcziotri rrn prziqdc sLimt arr.
',r'llr
,li, : , u

l, i'11
ch[ ir r J ip, i ds l. t - , . puI q la s l i r n r r l l r . , . a g . r l \ i l n i . r . r a n o d i c l ,
., rrttr,tt., -r.||1..-i||l
trr. ] |i.-lnr-ne: t , ccstia ecuzi hiperacuzie prin aboliret
rcflexului
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:]..;. I'II0ItLIINIIiJ)I' I)IAGNOSTIC

IN PATOLOGIANERVULUI
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, , , , . , r 1 , i , i t , n r | t,s, cv0 l r ti r r r I i tr l r l U 'e l tr l 0 tt va Jr tl i l t. l ti p t:r :Il i r r |r r r i r .r '. l l r :l r 'r ']l r \
, , r z r r t i . c l r r i , t 'r ttti sl i l g l tt{}l tt'i l l l l l l ,- |o l tl 'r r tl vi tl cr tl i l t o l ti l tr n tl 'l l l 'l i r i l r ti o l r l l r r
, , r r l i c i i I t i I rr I t ' t I t I i i , tl tr tr l ti r ,t'i si t r tl l t i r r i i'
:tt l tttl
t ) l t r t t T u txttto j i l i r 1 i i tt si i tr r l t'r 'a r l l 8 l ItN ttto .l i l .i tt. .1 t( l tto |ttt(
r ) tl '.i i l :r l
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t,,,,i
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ittl.srirt
', , i r l t r i
( r ( 'l i I1 1 !', l ) l l r ( 'r i l ( 'zl l l r l
'r 't
t l i r r r i i t t t l t l i , l r r l l r r l l i i l i r L ' r 'r 'I t i I i I I l t t , l r i l r ti l i l to i i r l l i t'r ',
(
l
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(
r
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l xtp l r l :r l r '
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l \ l r l , 'r , g ( 1 ',
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r 'r 'to si r r r i l :r Ir 'i IIr tIr IIi Ii ,
l
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r l l l i l r l r l l i l l tl r '
r
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, orrlr,

t 0$
rt!

I)'l'ulhuritril.u
l) il\t,lburrfu
ih naurot)ollnl
l,lM olinntolar,iocpo0 irrrlrlir:t ln ooutontt{
rrlitrif 1i rrultrilosl,r'1,r.i
vtrr'ligirrorr,xr,r,
lrrsrr(il,rr
t.[orrrullo ori r[rr
rLt zgurrurl,o
zgornol,rlrr,rrriou.
rrrrti1111.
Lrr.c 5i rkl i,ul[rulrit'i do ocltililrrrr, (11,llnnitro iL ltrror Iti pot'c.soitrtbilitil
fl
lirlri li t t lictr (ovitlcn!itt bile l:l prrrlrir,ur lolioii,).

cronica (trtritr rkrzrxrhililrrele hidro-clcctrolitico ou rc.pc[.

s). N e,fritele_.
cnsiulti cFl Dra lichidelor orralolilnfl,iooqi prin hemoragiilolabirirrtice)lxlt
rri rlrrl,trllrine crize vertiginoase, urroori de tip rndnidriforrn.
lt) llt,iirile. alergice.prodttc, adesea $i leziuni ale urechii intcrno, cU
rtislrtrol,ii labirirrtice qi m:r,nifesti,rivertiginoase (Williams, 1056, oilnt
rL' 1!likr;oscu,1978).
ll) It'orme particulara d,eaertij labirintic. Este bine cunoscut faptul ol
ir rrlirltl, do procescle patologice amintite anterior, mai existl o selie tlo
rrorrrlifii specia,le,caro favodzeaz5, aparilia ulor crize vertiginoase I
t\') l'ertijul _f,&roMsticd,in ,,rdul d,ema,re1'se traduce printr-o simpto.
rrrrl okrgio complex5,,dominatii, tle vertij cu alur5,paroxisticd qi tle feno one
rlrrrrovcgctative (grea!i,, . vd,rsd,turi,- paloare, lipotimii, midriazii eto.).
" senzalii de instabilitate,
Yr,r.1;i.jrr1
eorrstii, in
sau d.e riisturnare (rotatiol
lorrsr'r'tt.ivctangajului produs pe marea rgilaLi.. Aparjtia crizelor'rlo
lrrll,i,j rlirr ri,ul de mare a fost cxplicatii prin fenomene hidrodirramicodo
rlr'lrlrrsrutrlrruta,Li a lichidului eldolimfiltic, aare tuctiolteazi,asupra ftl)fl.
nrt,rrlrriotolitic. Yertijul din riul t1c mare se insole;te qi de hipotonsiur0
rr.r'lrrlirr,li,
grelruli, vtirsiituri, hipersalivahie,._diaree
gi transpirafii rcci 6l
rir, oJricoi oodeazil,dupii, inceiarea excita!iilox de cilLtorie.
b) ll utij,al. d,!,n,,rd,u] de at:ionl'apare ca ;i riiul rle mare, la acoloir,rll
lrrl,r,grliirlo indivizi $ensibili,traducindu-seprin vertij pr,roxistic sill.glrlr,
sir,trlriooill,i;(,tl itlte semnevestibulare.In cazul zborului cu ayionul mai DotJ
rrll'rrt,rrurrrroli scnza&ii bru$te de vertij, insolite de durere :r,uriculu,t
rl,
irrl,r,rr|riryirlLrsrr|tlitato uni- sau bilateralS,,prin rl,ero-otit5,
la indivizii cu
(l?iquet qi Piquet, 1965, citati de Stoica, 19?B).
rrrirrl lllrirr IInilit1,('ral
,4tkt.
I'J..
d.e..
Dertij ,.labirintic:. vertijul de ascensor, vert,ijrrl
.lo'tna
.

rlrllrrrrinnl;rlo unornaliilcrle retraclie(astigmatism,hipcrmetropie,miopio

mioflo

vcrl,i.iulonlcl)1,i:rl,
vertiiul ino
inotitor.ilor.Ultimele slni, in roalitui
ol,c,),
rrl,c,),vcrl,i.iul
onlcl)t,i:rl,vertijul
rlitrrlo,
o.
l',rlru.r,rrrl,i.ic.
lil. ,,1,'ttlsol,o
wrtija't sint amefeli in infelesul cei mai trannl gl

l u yi ttl ,t t lt t i :
rr,) fir,lttr:lo_voltije de. origine c:i,rdio-vasculari,(boala Arla,ln-Stokotr,
I rn tl i u tt ' t liilo sinuzale, aritmiile, tahicardiile, stenozcloaortict, eic.):
b) l'llst*r vr*tije din unele sti,ri prodrornalcale anumitor crizo d0

rrpiloltsio
I
o) llrlsolo vcrtijo ds origine psihici, (indeosebi din std,rile fobice):
r[)..1)r.r,l,solo
vertij_e do carzd, oculnrl din tllburii,rile do rofraofie, in unolo
grulrrJiziiu,lo rnuqchilor'oculari, la, indivizii cale poartl lontilo ncC0l0l.
prrrrzrl
l,orlruviciului ds rcfrlc{,ie q,a.);
c) I'u,lstrkrvortijo dupii hiperventilalie ;
f) tu,lsrrlevorti;ic prin tulburriri de statici, (a,st,ilzo-a,bnz
ice - ln tftboa,
ttr l,ulbtrrll,rilctlo <:oordonarode natur5, cersboloa,sii):

g) faholo vortijo (lin st5,rilo hipoglicemico{i din hipomeflocbivitatol

(l'opovioiutii colab,,1.978;Popoviciugi Pasou,1081).
sinocrrrotidifl,nli,
rt ila orillina wstibulatlt (d,in tind,roq,
2.8,i,2, Munfeak\riIt oarl,'i
11iru'a'x
molo rotrolahrinlin| ) B\nl:'pro(luse (lc sufsrin|iaugfvIlrrl yostibul&r,rl0
(thoot[, (prlntr-un prooottdo norritifi stlu do notuolr&tlo), .lioilrlI root{,
[06

(rl'(i.),ll'(r1
tti, citrltlritrtr
t[o vtlcittilhrlo: t,ttttt
lrtrirurrur'l(ltlitt 1u'oot'lio
lrtrrgitl
tlo ,,sitttlttllrtrol,rol:tltit'ittlitrt'.
tirr(\il,
Jl('t'vlrlui
vcx(,ibt.tlar
liorrll,riryitlotittrtrit'ca,
I 'ur liaul ar il,d!,i stmiologice:
Vtti jul aestibulatr( denumit Si.rel'rolaltirinti.c
J oste tnai lttl{itt ittlltts,
rrrri puliri zgomotos fi rnai putin calactclistio drxrit crrl laltirittfic. I'ort1r'
ifolmr oll (!\lc('t'Jrilrilrl
rrrsii,si, aib5 un caracter pa,roxistic,de 1;iprndni<)l
r,rilcririlccapului. I)urata accstui vcltij vestibultlr (qi a sitrpl,otttclotrrsrr
,rirrlc) cste variabilX, in functiet de natula fa'cl,orulrtiet'ittlttglic,crtt tlrr
sau chittr o irtcxciiabililltlrr vcsli
'rlricci antrcneazi, o hipoexcitabilil,ato
par
tle
lqzali.
il
lor
',r.lrrt
J! osibili.t d,!i 7tal,ol ogiee :
A ) N etritelaaestibularcinfaJioctse(luessecundar$i ttrl,iar, IrrtloI,irIiLii
, lridcmicii,, herpes zostcr, febr5. tifoidri, tifos cx:urtomal,ic, In(rtilrgili
lolt#rospinali microbian[, meuingiljc virotice, mcniugitc tultt'tcttiortsr',
ripii, difterie, malarie, rujeoli, brucelozli etc.), I)etalicm rloltr cil'r,r'rr;
Neurita ustibulard si.filiticd' (satt neurolabirinl,itu l'uetiad'), I'tl, nni
,rli ^)in ultimii ani, cste produs:i prin mecanismcdc rrre jugo-virsoulll'ilfi
rrr stadiile secundare$i tor'liruc ale bolii Si oste car:lctorizattipritr vt,r'l,iil
,1,,lrlare Yiolen{5,,crr eri&ccrblri la miEci'r'ileoapului, olr hipo:l( uzic f i
',ll
q,rrriluriin urechi. Pe lingil lista-gmus qi rlcvialia bralclor, se ovi(l(,lrl ir z.ri
,' ltipoe:citabilit al c vcslib lari.
I:) Meningoneurifut oestibulard,u,rliditd' sc pro{luce llr ll)roxil}nli\
l, -10 zile cle la a,par:itiapa.rot,itliteicpidcmictt, asociinrltt'sr'rn,\rli ri (l
tcziune concomitenl,i, a facialului, e\'cntual si :r' itltor' lrcr.vi cll|rri{rtli.
uncori bruta.le,sin1,doclinn$al,e
lrirt lczirtttirrrrvli
' trr,nifestirilsvestibuJaa'e,
l, co, rneningeale,precum Di plin r:dtlm consccut,ivtlot'cgliirilol cirrrrrlrrlolii
lrrriferice intraiabilintice. Se realizcazzi astifel utl sintlronr tlirl coclrlco
prin acufeno, hipoa'cuzic gi rna ifost,ili \,('sli' r'sl,ibular,care debuteazil
lrrrlnre,Ilipoacuzia poate li uni- sau bilateralii, de tip percelllie,cu ovolu{,i,.
lrrlrirlii,,uneori pini la sulditate (uneori definitivl, all;oorit'oversibili,orlrrli
(.r vindecarea infecliei urliene). Scmnele vesl,ibulare se tr:ltluc pritt ulizc
r rutiginoase (uneori foarte violente), nistag lxs, tulburri,ri rlo cchilibru 6i
hipoexcitabiliiate vestibulard.
c) N earita cockleo-aestibul0ii zonatoasd, (hcrpes zostcr) csto [oir,r1,('
r':r,rii ln forma acutii, veltijuJ apa,re brusc, ltr crize, oda,1,[cu il,1)l,t'it,ir,
rrr[ptiei, in contextul scmiologic al unui Findrom vestibular aru)()]rioH,
rrrr duratii de 3*8 zile. Se poate asocia o hipoacuzie do pcrccpl,io, rldrli{cir,
,,r'olutiv5,rpinii la suralitate totali, $i definitivS. Unoori, instr, sinrlronrrrl
vrlstibular estefoalttl discret, cu ame.felimoderate,pc prinl plan sil,utudrr-sc
rllt]o simptomc ale herpcsului zost'er cefalic'
dJ Sdndromul l,ui, V ogt-I{oy unagi, vorosimil dc originr: virol,icri, tsrrr,ilr,z6,I ncvritl'i, oochlco-vostibularli, (cu sualitate qi crizc verl,igiJlol,so),
uvoit[ l)ilatoreltr, vitiligo' rrloleoio 5i polioztr.
a\ Sind,romuLl,u,t Il arada, fourtc ril,r, tot tle la,tuni virol;icl, ol[.rr
t,Bomlun[totcu I)t'$ft{loltl,ul,rntxliittd ilt plus qi dt)t{lillirr:(lo r(11,i}rI.
.lr'ritlll (l(! l'rt't:vtrttl.oirr rrnck' f[ri, sn
I\ Ilteninllo-net.nt-hrtrcnlrnalt,
llltr, ct'l ttttt'itttlt'uoll,ttxttcirtlou lczhrrri
tr.rrrltr0TLin Slnthom ooohloo-vrtt'l,il)l
rlrlltinlo do rrorvi ofttolortl El ou Sotnllotlc polirmlicttlotrcvlil[ 1,tloroa,
orr
sinrlrrirrr liolridiuu do lln Oullll,ln'ltu'r'r{.

107

ill tIt' Ii'tt ttII t It IIi, prrlr1t'lii'liltsllt;;r'rr'

rlrt ltttlu rlr, oti,:ittrrotrrtilltliistrrtzrt'l
violclrt,.
Ioillto
ilr". rr.isl,ii,rrr
lrr tttt rristtlgtnus
r'r'i
,,, Drrcii itL sintlromui-vestibular lierift-Tio itrt'ihrirrLrlislilrglrrrrsrtl
ttisLrg
.ctrirltlii'
vestibulirl de ollgilitl
r,rrrrla,i
-si/sau lotator, in sindromrd
,rrs.] isi,c atlesea,,schimbltor de sens" (a'dici,bate in m:ri r'ulttr tlit'rrrl'ii)
ri. i:, Irlus, aparc nlstagmusul Yertical, care nu so intilncfjlo IrirIiotiIt'iiiitr
r llr iiele perifericc.
i, irr sindrom'l vesl,ibularcentral, directia cilderii corptllLti[it' lrr.lrir
ii{,}rrl)its rlr cste influentlti de schimbirile de pozi!,ie trlo (r:l'luLli
r ?"n aceste sirrrlroiuile centra'lo se pot remarca nodilicr-lti It i IIt'I t' I'i rI i I
t:r, ;,i',1iek.instrumentale ltic hipoexcitabiliiate, fio hipere\oitllbilil'rtlt')'
in pl5'ti, in ca;reaproape con'strt'ttiso itti'ilrrrrlll
' ' ii'r trcmplt in scleroz:r'
,, lripr:rc-r:citabilitatelt toa'te probele.
1ti Ne dentteazii,doar nturile crize aerliginoasecu grea!'irsi vr'1'l'rii'l'ttti'
('irr('liot li Incori intitnito qi in unete vertije centralet.ca de pild'-l'irr ritr
<llolr-r:ielevasoulare bu.lbo-pnntine (Wa1lenberg, Geli, R:rynond 1k'r'jlrrrl
(lt!
r (:t,-.tan-Chenais
), in scleroza in plxci (uneori)r in lrnolc cllfi)ftllil(r
in nneLettrmori de fosit'posttrttttlt'trr,
tIrirLr,iiicerebral, in sii'ingnbulbiesi
'serniologicapare q:io hiport'cuzitr(p|irr
r,lrri ill{,s aturci'cind" in contextul
lr.zirili ,isocialeak-.tncleilor cochleari), situaJ,iicarc poi pf{:}te'lt[ (jr]1rl:lrzii
, ri . rdroamele vcstib'da,re periferice.
i, in sindroanele veslibular:ecentrale reactiile nistilgnrki{),,itt rl'rttr'
itt trrtztrl
l,rri',i:'sintraie (Oarvthorncqi co1ab.,1969; liiser, 1952)' -{stlel,
r,1,",'lirriituturor nucleilor r;l)stibulari, nistagmrlsnl baie in trtrti ttrttilr'
,lirll:rii. c1a,rkrziulea ueciom:inanti a rluia djntre :rccqNimrclci lrtrrrrcrr'
st' pretlomine intr-o anuniti, t'li}eo!,ie'hi silrrrr{'irrrtr
, ',',''il-ititirgi"iisul
r'r,i,ste :r{e"ctatln singrr nutdtlll vestibultlr, pui,cm intiltti llli llislirsrrrrrrl
ttrt ttirl'rtt1
,,,r Ir)rnlil p'.r;'". Astfef lezitnea lucleLrlui lui ]leit'ers 1tt'ottircu
IllslirlllrrrrI
11ll
dteu]lill:i
rru.r o|izontelr ia.l o lcziune bulbo-ponl,inl
\ (.ii ir:11st.x predominant, reriical, Cintl lezirurilc irilotesc'ilzi cotttisttlrt' prt;;I t'
lol't|1r
I i(,i r ir-,se p-ot itttilt-ti dii.erso tipuri de nistagmus, t1:rt prcilttrtrirLr"t'
rr I rirlrnltul vortical.
;) E:{isten{,a,leziunilor t*,ltibol^t" oerltralc osl,t' lti'st:Llri fi Irlirr
risiagmusului p,:ldulai, c:l.lc nn sil itLtiltrttlie tricirlrlltlli iit lczirr
1'',,tilr,1;1

,r{.
ri,,,r,,,.i,,,2:,
,ri,,
i,i.* ,;,i,,illill,,,l,,,i;il:il;il,il'l,i;,]]li;ll,,ll,l);.j,,;i1ii,,,,;
li ) ,\ t,u t.t\)(liilr
r ( : t lil

rxriirllriri''iiri
;.li.r'r
l' rir;ii';illi'lrt*i,ll,,i*-r:,
tilf,"li''j.

,n,,,r,.r:,,
,.(r,,
, t', ;,.,,;;;,;,i,,.:',iq,:ilil:],,]:lil.,Ill,^u;;.;1,'
.,,.,,,,:,
'':1,,
din unhrtoiditrtrttr unohi n.,,,t,(tt,i),t,,\
,t,tl
, ,,,,1,,i,,,"1i,1",,0''r':t',:,'ii,:i:

z,:rri,,
rrr,
r,,rj^:,
i*p"t d"*,1.i.11;::li:"[Jill
iit;l :,;illi:l;,;l,n:l.

,sice,r,er,er,j'.
,r"',1'i"i,itin
:ll:,,;,',:i'l","t"""lli,rti;_r,i1i,".9*tbul;Lr
,iiiri;,l,\

.,iii,i,,,
;;; ;irtii;,d;1;*:*i*|j{{,|"",iti:i,Li;ttr1
iii:,lili*i "'i,gi,

fii-{rr
;;;rrr,;rl',l,lll',
Jil#3;[*i
#"r#hfif:f
i:.#'tl#!'{i11ifu
""""i;'i'li;i;;l;i:l';llfj:,ili*",precizate
ci,rai.lliiii,f
larse'ri;:
illi,ii:
#":ft
;,,'lil',lii
llt;;,;;*;lll;;;,irij#t#l,i#il""ii'l_;il","#1,ffi

*t'i.ifr.lllJ
pie'os,,.oar
iz,,
,,,,r,,i,,
l;i,llllllruj'*i;,f;#4;:.,*ri"''#
ii,,,i,jii'";,;,:;;i;.'r;;';i',lfr'H;,ii:,";li.iti::.1ll,1.iJj"::-'iogic:1,,r
,,ebtibt,t.,,,,,
'!',,fi;iii,lil',11,,'ff:;:{f;iii',,ii*i,i
,ii.y:.'yy1';,i
u;i!lil,l,!:,0{;,,,"u',
(I tlDt()r'i, llrt)(,(,s.,rL |glr ngj, ai; 1. ,

,r.:rrr.,..).
r,,,,r,.,,,",,,,,Jtf
l'lii]j.,ii'
{;j}ffi,.'i[1;i$?,#1ilili

.j r

lr\r ti,rl{)1 , I orlil > r r lai. i.

lllfiif,ril,li
, ,,,,"i,i,'l,i"ii,'i",fii,
,,,
ii,:i:,iili:{L:,,!",,i{,'!,,,ii,j,i,i)1,1;1ui,,,
i;;;;"-;;i
iuror
zir,,
:
,i
l:,;,;,1'l:,',,',li,l',
3i,.1yt,.1111i,r,,-,Li','*..
ll;,,:i'i;1,,?:';,f

:r
i
i;r
r
;,
;
,i,lriri,r,rr
r
t1t;hfr
i
ii
;
*ifr:iitilfl,'iiffi;l
"ir
j'i1,"Jii;l,1ll;
';:l;
ll;l;;l
,li:l,i;l;l;:",,,;nllfl1ijf,illiiili;ll,..,iili"'J'l,il'1i?;ll,T;
,) 11, ji(rlifolicc.

)lt'0t'me eti{)'pa,logex.icetle manifcsNd"ri t:etliltittotse ae]tLrttl0:

l'tt'Liir.tl' cr:rtltt.rl
rerl'igittoasa tle ori,gittt: lxn n'ttlit:ti'
/) I'arotisnt:h
dc tlt-rsigutatriit, in trit:;tiirti'ttrll' tri .,r.r'lilr
iu
ttrtr;i.rl;ic constl
-ssrl"ratir.t
, r t r l 'l l u l r r i .
{) r l tr i tr a l i ,i tr r l r l i l ,l {,t i r vo l ti j r tl L ti n r ti r l i i 't'i l i r tr t L l l r ttttttr tl i r r
( ) 1 ;i 'r 'r ( 1 l l ' l l ) 'r ':l l
, , , r : i '. r i n l i l s r l scr tzl l r i i l r .l tl i r r :t l l r l i i ' .'r iti c i o tr ti i ( ''\tr r u .r i ;i
tn i l tr i l l r ';t'i ti \'r ]l i 'i i l i r r o i r 'r r '
l l i r l l i {- l o t : i t : u .t [ ') to ,ti u r tt!r tr ..i ttn l i tt sr : p o l i l r l i l l ti
r 'r , ) l L r ( 1 l t {x ) l i fr i l l r , vttl i ,i tr ) , tl l tti r r l .i t$ tl L l t i i r tr - o l l r ttz:tl i . l l tr i tt'si q tttr tl r l l r
i l i fl 'r ) .l l i i
i r r l ) r r r ''l i .i r l l
r r r r r L c t s , l t s . r i i ti i
i r tt .r 'l l i l r '', 1 t'IIII;ti :i i
''i
'i i l ttl tl r r ,
i ttl i l tti ttr l t r l l 'i l l tr i r l i r q r tl tl s {l t' !'r ) fi l i r "
r , , , t i r ', t : r 't 'o ti
', ,
l r t'r l r r /r tti i
Vl r 'l i .i tl l
d t r tti r l i n t
t]l t"tti i r ;l d tt,
: ! ) l / r : r l i i t tl
|) ||tt) ti ||i i ||
( ) I) l i l i !r Ij r '( 'r r r l l l ,i i i tr r l i l 'r 'tst'l r r
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, , r , ', i , , , t t r r ,
l l l r i r L i ,r 'i l r ,l ttt l r l l l tl i .l L l r r i :l i r r r r l r r l i {i i l l ttt r :ttc l tl r r ttr ',
l r : r i i j r r l r r u r t l l l tttl
l l l l l l r tl i I I ) | |( I( )| | | | I't ' I I I'
r l ( r 'i l {l '/:l l l l l ( l \l l l
r r i l r l t ; l r 'r t i i r r z i l r l i ttr r r t tr l l l l :r l ) L ti i l i l
l l r l r l tl l r ';r l 1 i l l tl r r
r
l
l
l
r
r
)
l
r
'l
i
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l
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l
f
l i ,l r tr tr l l tti i ,r l l l l ,l l r l l ,
1 , , : r i , r , . , , l t r , r l ,l |
t r i r 'r r r 0 l :r r '1 ,'r 'i :r l |r 'l
, . r r , i r l rr rr, r, rI rI I r I , I r L tr l !r '1 ,.r \ r 'tl l ,{'1 . r 'r r l r .1 'r r r r l tl ,
' '

, , ,1ll,l:.iil,l,lii,::,;i'j;i:,:li;iJlli,i;i,;;i,,i,lli,'i,;ii,l,iiiillil,li,,i,,T;;t,j,i:;1,,,1
1i;i;;i;'.;i;;ii;
o(,,1,,,,rr,o,,r,\
ill l;11';ll;;,'r,:'",,1;lt;ilil,ilifl,r,iv,,srir,rri,rr1.

,,,iiil..'l;-iiil;l;i,:':lJi,,i:,il;il;lillll:;,;l;j;llll;
i j ,,1: ,,..{,\..,iroii,i,

,lt;;;t:r
ii;;,:il,,iii,,llil,l,l,llil:li:,i,lilil,,lil,:t;i:,'lll;,:;i;,,tl,l,il;i,,tijlii'l;"1i;iil,il
,,,,,r11),,1i,,'ljli;;,'l;l;1';;ll,,lllllt',1'l',;j,ll;iiiljlili;,ilt;,,ii;ll,",Jt,lll;;1,;';ill,,i;;,liij
: l l frl l

tt

r ' r r r r llr lr r l rrrrrri s i 4 rl trrr,i t,t.,tl i b ttl (t,t.i r.,,r,,,,r,i ;,i .'

lrrl l rrl r\lr ( ir l 1r . ir r

I r r ' ,rIrr.Ir' i rrrrI' rIrrrr.rrI:rIrr
li
.f,,,:,.,i i j
' r,rri rtri i rr
l0 l t

i rr l i rrrl .,rrr' l

t{)11
,,1&,1

lr.lr'..l'r,ziLur..
(l''1r' vi.irr r,,i..lrrtr., llt;lt, ll)??, Jl)l{0; }1r1xrvi.irrri l,ir,s.rr,
'8tl:i) )t sir'inltltbulbia )llil,l|il!,81,!iIij(r
\ or,l,ig,irorsosc plitrsoirrzi!
trrllrn.!
"
1rrirri,r' sirrrpl,'rncloinitialc, pulirr<l ,,pii,rtlt,Jic'in crize foail,o vi'l*nlr, iri.
rr r,i,lL(,ulrllur ufoalc, aproapc ioldcartrra accentuate la schirlbiirilrr
dt
t,dr rr' :[I, (.1]pllrur$r asoclat(.cu julbuliri de ec]ilibrr.
I ) I )t lt ttconertarfte tulbu{rile
vestibu,lare apar in pesi;e 90}i, rlirr
,rrzrrri, rrrilnilrlstindu-sesub forrua unor crize vertiginoasg
cu ahuri'rnttrrillilirlrrril, i!.speciai in cursul.py.seulilorevojhtive -ale sclerozeiruultiplc,
,.1:"r',rrrrr.l,ri
,.Liar ca sjmplo.nle.inilialo.
Crizejcviolenic. br.u1rt,.,sj;,i rrLrr,.
\ | ,rr,,trl l IISII |
DUitlora[,de ojJjcei olizottal;i schimbilrr1'rlo.oUs,
'.Stc.
rIi|| |rIrr.r)||si1(,.t1(.,1
stu |otalor. inso{i1dc l ulburiri dc ocbiljbrrr.Ur:cot,j,
rlrrl.r,itr'irruci par.ezecie ooulomotor citern, putern constata un
rljrior.iit,lt rtoltriculat,
'istagrirni
,..ltgc. oetu|lelc sp_itao-eerebeloase
pierra_Xlarte, L]t, boale lxti,
,,
,f.)
,l
I t u\t! t, rh .:t
di.', rstlcJut'nede altoJii cerebeloctsr
puD apjrca accc,.^Teiti_
,1.n
.
|.clorl-tntc.
clt duraLc dc la {.itora minutc
''r):r,\{'t
Iini la citcr i.i,zilt.,
ir,rioqlriLlo
olt ttaxie ccrebeloasii,D-icu nistagmus, cao", -,1" obicei, eiito oril
,,trl:-1,l,ib.{r.r',ri
ii lcnt, pctbisijnd si inrie g,izelc icrtisiuoo-i. p,ot
, i|l',r'r{
{ .,.1
Ioirtu] li sitrl rornl{l,le,.darde mu_licot.i ilrala J hilrer|xcifabili_
"t,,
lrLl(1,l)ll,ild fi:u.nizaohiar unple indicat. cle diagnostic prec6aela
adtli,ii
lrr('r i r ir'('sirn],tiomai,ici
din familia rerfiectivi (Fh cox'si L"i*tl -igil;i.
ti
.4l
cr:tiurtite
aentriculului
at ly_tca qglio'arne'qi .[i"t*i
)
.
*ri.l.*ii
r.r rlc vcrl,r'icul IV, glioame de trunchi cerebral,,alte tumorl buibo-pontiitcj
iilr rrrri()(i'iiri tr,pt'oapetotdea.unade tulburi,ri cleechilibru, nirtagmu s
d'izont,o:
: rt;r,lot \
divcrsei*Lnnc de tlirr_rrLi
',rli(,irl,\'i.tsiiLuli,semneCn!.pbcloase,
,<i,.(r(.||]
,' rr.,)rrlr,
f'ol,rlar, ]si n]alifegtet,i vertiginoaSe il] c,lize, tle obicei
rL (,|ii,r|,lI|L{)
si acccnl,uatede sclimbiriJe de p6zilie ale capului. Se
I;rritt
r'\ i(l('rtiii,hir,u- st:,' i'excitabiritatevestibulird t'" p""t
rrl u rrcoli JriJxtacrtzie.
"r.'i".i"""i"ilt,ir",
I'rrr.rrritrlr ax1;ansive vel.Tiene qi rle ventric'l al lv-lea p'ezi'tii
cel
rruri lqflr;r,1,irr contcxtul clinic
6i iindrom,ut lui Bruns, arr"
,tin
i. y,l1
dc crifatcc
qi""osti
vir.Jtult,
'1.'1]ll::l::l.i;.1

,L'('li!l('{,,
ir,i\ir(,11i(:,
Bljxlcsltl}lilluil:i,rii, tlo cokr rnlli rtttl{;tlttf i, sotrttttrdo lltt'cllttrr
ru rlclvilor octtlomotori, ott rliplolritr.
tti i,ri,.lorn. (aI .lui .!'iytlty ), tlr'ii td'ittlttgitr
c) B'inrlromut Ttseutlontti
r,r..tz*tii. se c*ractdrizc:lzrr,t,r'irr inanitcit;rri ver"liginoascirrst*lrl'r' rru'irl,
il,r,, :m,i nrrtin brul,al decib-in boala Mdn.idre.
S1 VeitlSul paroai'sti'cepiteptia,. tr'orna cea mxi pctent:r' do vtrrli.i
psihoselttoritt'l.ii
lraroxlsiic epil'epnii este repr6zedtat:a de criaa tampo,ali'
.er :aiie lle ineleal,i 3i-rostogolire(Arseni ii colab" 1978; Grsl':uttl'
",t,
r:r;r r -vd"iijo1
F6Joviciu ri colab., 1976i Stoica' 1978; Popoviciu \siPascu' l(lii{)'

ii,,'r

.lueptic {,oatoil apgl

.sponran(in cazulcxisl'r'tr1r'i

{ie
'.
urrrt j octr cll eploEetrtreoseuitde adtivl, fie in mod rellex, sub itrllttctt(rt
'o.siibulrtu, care realizeaza cxacerbrrea paroxislicl :r
.i,'nr
"""it*iii
l'ocaru-lui.
lrestibutogatud'
V erri.iwl'enitepl,r'c(epiteBsi'a
) poate fi cliferen{'iat tlo rrllo
'de 'vertij - cu ' aluri paroxistici, (Sloica 1969' 1978; S:t'gt't'
torruc , lilicc
.
,i . uirb., f'glO; Gastaut, I973; fopoviciu ii colab" 1976.;.PrinciPrulcl'r
de diattiostic diterpn!itl, sint : a) alterarca cunotIin{er i o) 1l'Fr'r'rlrrr'
'i:tite;ir (Iie-independent,fie altermndcu alte siulptomc cliticc (lo ('l'r
rcrLiiului
i,';"'";;d;rH,-tie
ci si buli, in cadrul unei crize epileptice convulsiv.
i
g'*o.triizat"l
: it couslabareaanolraliilor EEG pr'rorist ilr',r'pi
.,
''ul*
lclrtice
cu* loealizars ieinporalS,. Traseele EIQ po! prezent'a' dt':Lll'lr'l'
iol'rue iritative cu sediu temporal qi in perioaclele intercritice'
9. Exi.std, insX gi oerlije tenporale ne.eltileptice(in tumori, .altct'tit"
l.r'rLum*iiJme de lob ternpor6,I), caie apar in crize cu durati mai ltlttgii'
rlrr rliteori sint aproape lerminente qi-au ulele-caractere clinioc pit'rl'itrtt'
t,r,rle.
Astfel, bolnaivii idcedrci, senzalii .le ghalie, alorid.ica,resau dc loltot il'r''
(L(! irrrllr
rlu rle proiectie in diferitele pianuri ale spaliu1ui' inso.lite sau nu
r,,nolCiostaut, 19?3; Popoviciu qi colab., 19?6; Popoviciu $i Pascu' l1)$o;
| 9E1).

-!r,t..,,posrurat",.r-iolcLrtfinsorir
I rr :L l 'i r . r ' r lr ,t.ir , j( . hlm
l )j i r' l c d o p o z i i i c A l e c a p uIU i . B ol na.i ,,ul
i ;i

mt.nti rrrl
,:r.1,rrl
rrrr,,trit
1i I rrrisc{oda{I cri coipul 1in.,,-60""*
i"i.,,lt"i_
r r,r,lr, ).
".,lil"ii-..ii"i
7) Nut,rnnitatestibulard(Dr1 Hallpi,le, 1962 Cawthorne colftb.,
$i
llrt;1,;l\I i I' |.,r'ri(.I| , ISZg)cuprindeB $formetlinice : ;
uas,t[bulurd
p^ro1triu.-.zi.sd
esteo afecl,iunobenignl, cri inoi"
, ..,::!,.\'::::,,,:!ta
,
(30-5qde_ani), careinterescaidneuronifvestibular.i,
lji. ".t I Ll iii!l]9 i$ulte
Debureazi,brusc prin crize vertiginoasocri
::l:
:l.ilill'
1ll;lll.! $r i.cr-qenr4,.
rr('||s||
t"lr,rr.
in citcva ore sauzile,ciup' carcdisparc.-Nuluting0
Irrogrcslvir
rri. irxIrr,I r'i,irl,onsitatea crizelor Mdniire, dar qr6bek
(ir..i;;T;
l'l,N( l) .virltrnli*zii,
".*tii;6;; de
sindrom veslribur'arcu-rripoexcitibitiitate
lar1,*r
rtli rrrllr,l,tl.
'n

rertigittoasd,satt tsr.rlijulrpidentic(Cirxthurne r.,rlrr,lr.,

_ . l,)- -ryr'i'r"a,r'ila
5i
llll;1,; N ir.ls,.rr
;i .rrlrLb.,cil.t(i rirr lVil,r;,1scu,'lC?g)
lt,joro t.,,s,., irrl,ir'i,ii
"',i;,Ji"r:itrto$ti.?!
r';rin.rl irrrir'{i's .rr rulrru'irri r','spi.ati,r.ii
t(, Fi .'
iili",i
,r||||rr'rrIr|('
rrrtrr( r'rIr'r'fr|Iili.r'.
T'ru't.r'ific o irrfcr'{,ic
vir,tic,ir,lilrill(r s,i:"ir
ri rlrr lrlrri.i'1'rzrr,li.hirrilnli, rim{ooita'ri,,-aqa ir,,it'in"t-.i.,"i.rr',,at
;i rr,i rrr
l'rtrIrrrr.rrcr.l:uIiIr.
(l)rrr nl, T\rnoviliu ruilrll., I{rCf llifur'tiir,sr,u
;
.5i
ryir,olllr.,
lrr{lir).'l!r,lrt.rlr'riri( (').hri'rrr rr:urriii'r*li.ritl.ir;li',i,,in,,,-!i,i:rullr,
r;.ir.nitrrri,
I t0

IN PATOINGIANIIRVULUI
DE DIAGNOSTIC
2.f)..PROBLtsMI]
GLOSOFARINGIAN

2.9.1. Invcstigaria semiologiei a nervului glosofaringianilnlrlicri':

a\ Entrnenwl fwnc!i.ei motorii.: Se celcetcazti'motilitatca ptrrcLt'ltti
r,,,tt.r1io" al tr,rinfetui, tlcglutilia pentru Folitle' cYcntuala plczettfi a'
.r rnuLtluicoltiuci tl lui Ycrncf.
It\ Itrnu'menulfitnalict sanzitiar, &nalizind scn$ibilittte:r' ltorr:ltrltti
t,onl.rriLrtl flrirrg,lrri ;i ir,tlrjiLrr llnrigd:llicnc'
ttr:n:nrialoconstii,irr investig&ii1l'.glsl'ulrti.ltt
t:,\ lil,t;urnr:rt'rt'L
.[tr'na!iei,
(tltt , s,iu(riol'u.i,, lrttltr,sobi1o r:litrinl't)'
lim5ii
,r,
t,,,i,nu.'ili rsii'.i,
'.r,r'il
nrtt't'!irril)ltroi'jtlt\
irl ltltrct'it'tr':t
ultetdirir ('(,trHl,i-t

i\ l': \t unul. Iunoliri

sitliv$rlrr{'K{'ilitlllrgrtBl,l!l,rvr.
qi rr rr.llr.xttlrri
,1lriIo ,r:r,rr
hiIr.rrrr.ri.li''ilulivrtr';1)
t,t,t'[n,llttrlu
{\\ lt){.tuLu

turingirvte.
ll I

t'ttrtvrttt
r'i.rrrrtlir
rl,.s,.hirtr.r,r.,r
srr'ir.r'i..carr':r,il,ll."i,,;,.!;,''i1.,i:ill,";,i;1.],';.'.""'

pr^ r'rissIrthilc,,sl,o
lli:rgllrsi'icrrl
!.lf.i!. Novrrrllliuglosolttritrl;irrrrri.
.st
itt ltttr,lir' (l(' {'clc /rrl Jt']'ttt(cLlture:
1(,lrf1[
ullot' l)rlr'l,iotllllritlilir
attii lt t'i.ttl,i,tirii satr, Ttrint.ard (est'rl'ilr'lii ilt
l) Nnrrutgia glosoJu'in11i
I r,r'rnirr.rlogia riecbi teime,n care f'olluie abandonat) afecteazd ill go]ll'rtr,l
lrrrlrrrvii peste 40 tte ani. putind insi Bli apar5' ;i la tineri.
t)('l)nlnl bolii cste de cele mai mdte ori brutal, iu llini, siililtal'o
rrllrrrrrlir. lntre prima crizd' durcroas5, si -urmi,to-al:ea pot trece cittvll
r:itrlirrritrisau cifcva 1uni, perioacli,va'riintl mult de la caz la caz. Criztilrr
rnnilorr(f rlevin din ce in ce mai flecvente.
l)llr'rror debuterzd brusc, violent, la baza limbii sau intr-o zonii' ditt
l,,irr rrnristhlia tii. Locnl durerii maximale se afli' in regiu:reafarirgiarl iii
"inelr-ati, rle nervnl glosofaringian' I)nrexea qi zonele
tlo
lrrigrrrrli
"s:ie
ilrrrli.r'o sint sl,rict localiza;teuDilatelal (Arsenl fi Oprescu.1979; Dcptui$
| 1l{;8).I,l'i{rl(son(1963,citat de Arseni $i Oprescu'1979).astahilit klcalizalerr
rlrrr,'iii irr lrd. ,o1u?,in funclie de {or:ma clinici: a) in forma tlctsir:d':lir'
lrrzrr lirrrbii, in regiunea arnigda,liani, cu iraclieri^spre.timpan' ruri"ljlll
rrrrrrrrlilrrrlrt6i lggiunca submarilar5:t:J ln.forma fat'.i,ngianii:in regiuncit'
rrliirl(l,rliirnrj,'" r) \tt fonnu ti.mpanicii satt' oti.cd: in rcgiunc'a awicrrlari' prolurr(lil, s:ru nr condlictul lutlitiv exte.rn; d) in marile ytatotisme il''trcreu'
ir';rrlinsj .in zotre m:ri iltinsc, respectiY rlai inferioaro fa'tlii't1e ccltl
rr,,rrl,r'
i,.lrrlrrlc ttrai ils (Arseni li Oprescr, 19?9)' Bolnavii '"1i(hel'eaz5'dlrroreil
,.rr j'iiirl tk'oseLtitile violeirtS,'5i de ahoce, lscmuilrl-o cu o ,,lolitlr:ii clo
devtlic" etc. In rare sit a;lii, durerea estc apreciatii ca o
|rrlil,". .^rtrrsoc
'rlist'onfot
t (BoJrm qi Strang, 1962 ; -Bues, 196ts,,cit'a;li dtr
,, riz,,ii,. ,[,,
()l)r{rsctl,
l9?9).
Durata unei orize csie la debttul bolii de 20*il0
ili
'\r'rr,rii
cltrerli cst'tr
lncetarca
bolii.
rlrlr-se nrilol1,t odat5, cu cvolntia
',',,,rrr,i,l,
fiilcl asitriintelpl}loxist-ice
intel']'aleJe
ci,
d
ebul,ul
si
lrrl,rrlrl.ilrr l:t'tLft,iiort
de la uI boln:w
r-al'iez5,
du]eloasc
intru
crizele
ioliktle
libcrtl
I't'l
1rIrrrrrirIitur.
zilc. Roala!o:Il()
irr rrll,rrl,rhr lrr,cil,oi,rtItrirutte 1tini,1acitevil orc s:l* Lliteva,
(ca;t llttl'
dur:ite
qi
variabile
oa
remisiuni
rlttltroastl
,,i,rlrri itr l,ttscttt'i
:I|l||,1r, t)r,r;r lrr' I -i atLi). Clizclo apaT tlc cele m:ri multe ori ziull. cltt
jn fazole alvinsa,te2llobolii De asentenea,clizt'ltt
,1,'t,,'i,,'itirrs:isi tton,Dtc:t
se relct,i la intervale de tjmp valinbil'
iit
slh't,,
care
;r, lr.,i,r1r'ul)r
"d.eneTralgie glosofaringianri presrlpinl0
corect
filrthi.liIrtr ilittrtttotl'i,r:t,t.ltti'
rrrrrLrlir',':r
lrolrLrir.tjltLiin timpul unei crizor anlliza facl,orilorcaxedetermjllil'
(,,trigger zones") (Arrrlrrrli{irrrlizci qi locatrizareizonelor declartqatoa,r'e
qi
1981)'
Pascu.r
r,:rri si {}lrlcsctt,19?9;Popoviciu
Illrriirirol), pacieirtului in timpul crizelor-permite ollscrvarea crisptirii
Ir,tr,i. rr,rrtrr'l:iti i iuloluntarc a miinii ta nivelul zonei inferioare t[ ltilei fi
,rllr. l:r,r'illr.,, sa,u sDre urcche, intrerupexea masticaliei etc' Fenomcrl:lo
r I ,,, ,rr,, ,t , ,ri i i :.i.rrtl'lr r' ."i se pot manift'stnpt in inroSirr':rhomifotr'i fi pritr
'
grrt'ii tlc partca- dulolii. In tirnpul crizci- tlurerorlsc bohrnvji
rrscirciuncrr
F,l,irr.(l(! rrbicei, olisltrti, cu fncit:s imobil ,si a'plccfl1iinainl;or pclltl'u ll
lrr,ililrr srrrrlg,r'crsnlivei. ln alte (iazrlrirbolnavul iqi montinc callul a'llooatt
sn,rtili aptrtd,01 mina' urochon
nrtts.ttlllttra h 1;r'r'txrcrvicalli,
rrr :r rrrlii.r:r,
rrr,rri
r'\1'\rl)'
r':rttltlttl
llll(li1:iv
lurlitllrgtr,illl
1i/slrtt
it.r',,grrntrl,
rcfirozinlir'o (lllpilr
ttprtt'i{'irr
cliz|lot
frtol,ot'ilot'tln,trr
Atrtlizit,
Irr'cipil,i!
tgiitnt'[.
trLcnl srrlorrtrrtitttiliitttttli lrrrlnltv(ilt llr'vtillgi{rglonolilt't'it
it rxrt'l,tt,rr(i
ltt
tl
HJrt'tri:t'l
tlt'iztrlot',
tl|!rllllnqltttrn'
t"",, tttlottlrltlitt
l)r,,rrlrrlilirr
iorrlil tttt
'',,,
:rl{i
Irrolot'i
ttrfii,.;'i,ttrtlrtlrr,rLrglttlifirri,r'risl'ii'rii
r:ttl
ii,rti i,l,'1,1"
Dr',',tr,rl,l,
1tt"'rri
lt:rsrtltti,
ltlsrrrt'rrttIlrtl'ttl
criz,'l,rl: rriitrrr:ti'ttli,Hl'riitlttl,ttl,
, trr,,Ir',',ipil,t rtprrtr(irr
,16

I I:t

' '"f"l"."ir',llrJ",i]:i:$ri*:"t:i*l,,iiii;li:;li':

;l:rll#i::*'l#::;l#y#til'itli;*r"*l!tri:,i
lflf,
:o*:i
jtr

ulr,irri'r :tiriril;i,
,t ilrrt::;rx;li
liri:
lil
i*lxmil'
;i;i;;;i;;

rcsiuncrmtt-'r
ral r"nduclrrl:'ldit;i'ctt'r'r' -'i

l''I
i:;'
lo::'jl'I|
'III:Ii

*:l :;ir *nl'';:;l::

[:4tkly;l

'
ti o' or"nolrt'ingologicc
-"' s-,,n
"tn;oi
*'t;n#: r:i",.#*r:":il,i:!i:il
caz*i
rles'is
liii$ *i:iilli::

,,ili L.

j[i:i]]
ji,d{
:ili,:t',tlii*1"'!i?Fi:Li
;iltrui
t"*yil".:ji,."""',f
1.}i;r
lii.,irri
1e?8
r rrrrrrrr
p"p"'i.".;i e;o]]1"
l?il"].i*tT;-ti*[:ii".:i!H1':rgil';

'S:ll*:ii);*,""r1,-q,e:Ld,";';?,,:?;.i
ll;1i,T;"#!'::ffij'l;,.'""""
"1,irl,cr
motrorii salr gusia Ye'

];lj
;*tlti'{,,j;{,;:i;,^r,.|,0;'il,i,ll;,i,',!l:;i,!:I
rrs :'
dc'l
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jlr; I ill;l
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iihi#hiili'"H::*;:*$#,*u!'*;
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ltiLi':iil;tii,:lit"i

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sind'r om,ttl nel"D'u|Il't LarN1

rk' rk' gl rrl ,i {, il'slr livci 1i lr lt it t t

";;illl;ll'll],':iii
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t1 1 1 1 "1 :""r r i ' r r l r r {r l r

l :r '- l ttfr l i r r ;i l r l l l F( 1 - r

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I \,,l t't, r

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rr,,

,,ii|ItIJlii,'r
l)tll,r,ltoilir!v:tltilll,r,. Hltt(lt.rIrIluI
I,sl,(!(1()ItI t)I(,I,it,l, rLt u l,tri_irr
cltitr1(':t,Nir'
.lr s:u(ii|nl.o
vior(f r,r',rsrrr,rirrrirrri,
(lu tl$urintiro novr'tlrgiL\gl(]solr!t:rrigirr,
\i, IoNllt'oIiv,tr rrlir:{irrrrr,
li. bo s,:rnudc tliagnost,io
cst0
1,,.itfll,lli
rlr|| ,'r'(..
r,..l)r'r.,vor.iitr-r,
in_punclul lllrirrgrrlrrisuperior, adicd,intre ci}nu] car1,ir:tjr rr' Lrn( 1.[ fr osul l]roi.l. lloba rlccisivd este alcoolizarea
nrvului, cr,r,o
l'l||rl|rr rltllerca,. Uneori se constal,ti asocierea
sindromului laringritri
rrpcliur' ou sindromul cle ganglion sfenopalatin.
I I ) Neuralgia glosofuringianii secund,ard(simptomatici)
g]os.ofaringir,ni,s^eoundari,se d.eosebegte
ctini,c d,e aea,primari,
. ..t ):.1.1..:l*l
rin :rL(,al'cte
t'r'
elemnnte:&) fond drrreroscontinuu,pe cale se supropull
pr,ro\isbice: Lr) tlurolqa, nrr at idqi - intcnsitateb, dctci
' Ii.i,r:r,rlr.r.[rrrcroasc,||||.r,'\ l:llglll pnm rf lr : c) dulerca so .localizeazii
aproaDctorclpaunaitr
,:.,,
al. g-ibul i. crr iradieri r,uricutare si frr:r,ndibul*r.e;rt.1
1'11
lj^,pro.,ly-dc,,' ,.',lr\t:Lt,i
ltipo- calr tnrstozi:l lojii.amigdaliencsi a rngiunii farlngie'n,.:
r') r'ris1;i 5i semne de afectare lsociatd ii trunchi.tui dotor ar neryuru i
rllosofrrliirgian; f) se a,sociazaqi semne din partea altor nervi
cranicni
rr\ ( r,rrrlr; g) sc constati, extindelea ariei durcrolse peste limitele
anato, ,. j,;1l
glooof*ringiao ; h ) evoturia cs[e progrfsivi,
cu agrav:]r(,rr,
"
,ll:.1I"]!i
. | ' \.rrl,t.r.r''":li
r':lpld:i r simplomat ologioi, fdri rcmisiuni.
l |l ,.rrrrtiL
unor lorrnp ll.ipice.si incompletclj, dcb t, sirnptoma{ologirr,
t,, t r:rlri' i glosOlalingipnC
recundar.r'eSLedc cele mai *r,Lt" OIj SuJiCir.llii
rr| , ir'l:rcl('1lst,lCu.l\lUIfe tot me rlp nevralgie glOSOfa
r.ingiani1S{.Cundrui.
prri irrsi rlcbuta cu tablou cJinic rle ncvraigie
i;i" aceste motiv(!
1l;im;r;.
11rrrl)11'r.i
tz.'t cii orice ,er'ralgic glosofaria-ngidnJ,irebuic consirlerati, rlo
ll rr,,''(
n,rmzridrrpi efectuCreain\.obIjo:]I.iilorparaclinit,,.
1.'rll .r
1 lnlynrlar;,ri
r '||) |,t' r'r.:t
Ulnr l(.zUll.bc rteqafi\ o o vom cOnSidr.r*pr.jmit,iv;,
('ttu,xclc acle mai ft ccvenJe aie rrcwalgiei
gloso{aririgiene secun{larlr
ilP t./r bazei.ctortiulai liuai alei ,;1";" -pi';"; .i,'
..',::.1
.:.."\
.t"".':t:!j':"^:lJ
!7lilt
tll..(.'il,lr'
b) tr&umdlismelecranienei c\ arahnoid,itelecen:r)ttrt: (),{,Un..r'rnolrflngc);
t(,tt,crce
7unrcti: meningioame, neurinoanie : e\ anel)tisme ulr\
|rr,r'rrIirIr,i
(jl,lrunc i t) i,nfec,tiilocaie, indeosebi amigda,iie;e
etc.
I II ) N eualgiu glosofaringiand,
,,Junc!,ionald,, (simpatalgia)
,\r,r':r,stii,llormd, d.e ne\Tc,lgie glosofaringiani, se caracterizeazd,
mirr
rI rr!.r r cr rritt,totjercle arsur:i, 1.1b:r,zalimbii si in
regiulea trUgq"ii*ei'
ai,
r,ir,rlr{.r,{'rll}ro trompa lui Eustachio, spre ur-echeafoedie,
oar Dl spre alto
(
zrrr.r ir'o depii,qescteritoriul nervuluiglosofaringian. Std,rea
dd dii;;i;;i;
-tilidi;
:t,lr.ltrLvilrl r[r.viuomai prosnant:Lin-1ifrp-u]clegtilt,iliei-..
in Soi;'.
l'lrr:r.rii :urrirrrprcsinunui"corp sir{in.'Din ,1;;;;;;;
c,cesl,i
n:}ci{!nt.i
r,U LUSC.
Ir|'r'rrrrrirsl,lLsnlt'trltr-oglenc
rn ineerCxrilelor de a Climila l.co"nrit
rri,r'riirr)'..fi.,za!ia

do arsur.X
se-.asociazi
O"-rii"ti" *i
;;;ilriili""1i
nu
po_f
fi.obiectivate
raun er"-ui""
al gusi";;i:
l'1.'1,'j:.l,,i.ll,lli._u-tii,,care
|,r! | r,irtr! ctzrrlrtc se noteinzl ,li rut conte_xtnewotic, care
"du"t
Joac6 un rol

irtrl)orlrltul;
in intrerincrm clur.erlor.

i,l.9.ll.-Puraliziarrorvului glosoftringian
I,,l,l'rrtizi|,
nurvului uk,*"1:11_iilti,l.r=
so
l)rir: disfagioponNru
itlitrtc[1,o ilo]irlo ; tr:lftlliziru rnr
-m.r,nifesti1

.l ) ' l ' utt,tt , , , t il" d, f ullulit i, 1t t t lit : 'lit l' r "'t r : 'li l rt ir' . \ r' rrrrrrrl t |l r r r 'r r
rrrrIr,,tl i tttl . l ' :r't : uljzi:ri,nr r . 'tiiir r lr r i lt it t r 'l t ir 'l'r t '111"t ir r lr r l |; r 't it t I ''I t I i lr llr 't liL'': l
l,'t',lrtl5ar'lra;ri dcsfiiquralicl"'plimrLirti f itrrli rtl-tlrrelrrii{ici 1rt'ttlltt rrolirli' llt'
'
,,f',iiiii, a"id,,t.toasi poato'antr'"n1, lllil,iurr(l{ r('rt ruli.trtlttlrlttl' itr Lt'tittc'r"
r,, ,l*r"t iezi'nilor b-ilaterale at nt'n t,hri glostrlu.i n gi lrr, l,ttllrtrtri''ilrr rl.
t t lt t r
,1..:.l rrl i ti . si nl qr lr e. S- a sr 'm nal: ll. {Ll' asf ll! {'nc1, u lnot [ ili' it 't r ': t ' lit r t l't
t
lc
culio
t
t
'zot
t
:
ut
r lr r \ '
,,i o - . liii"r t n* aspeclului l: r 'tinqolui 1r 'r 'i
' ,i i i i ' i i ' i "
B )P aruti ziat t i. uselt 'iuluicot lslt t r : t or super ior alJar it t gt t ht 'i'ilol; r 'r 't t t in: r
,r,.r' ri J' c, i al .r t l, - " a i: r , r ing't ui ] r Lt lt liz&1, si'r ' 1'alior L sJnill. r r r 'r r f i l'r llir r
A. nn\ 1. ( lnllI il) |l, l. c|\ {. I I J: '{''. |||||{'iI Z'I
' r .' us (sci l i nl ] coI t jU, i l, i ] ui \ / c] 'r clJ) .
or t it elea hr in3' lr : i . r I lr lr : l ilr '1'
Ja
{onom
clor
.
'o"
sl]
ll
5i
rr, r,r,tounti a
, r a''

jiliotic:, comlrnsatorio,, ccl'r.l,lli rrrrrsrlri

aiw*e repeiie p"in
r
"i,J'-ii"ii
de
f,ri,iirgi.ti. Rett-exuifaiingiain partea paralizatrircslc cljrttilttt:ti'siuttit,lxrlil.
prrrr
A) Tulburririle de scttsibilitateli senzorialese cal1i(rleiiz{ilz'i
r'tt
litrrlrii,
:r
pc
inge
pe
fri,r
t,ipociiezie sau anesl,czie
;i
Jre19c3 lonftlir'rt'ti
lrifr slfl aSuc;io 1'cnrttl atner, in 5l'al'l{ \'l!lul Iirrrlli'l
Pa,ralizii]cunilater'alcsau bilat(j]'aleizol:lte alc nttvltlui glosolru|itrllilttt
,,irrt'exceptioaale,ele in'riininc]xse rnai {r't'cvcnt inpletttri ('tr lrrrr':lliziirrl('
rrclvilor invccinai;i.

patoltttit,q NliRVlll',tll
2.10.PR0BL,EI|uDu IIIAGN0STICiN
PNI'UilOGAS1'RIC

2.10.1. Invcstigelia serniologici a ltrvului vag (X) i[r}litrii':

A) Dsanterutl futtclie.i ntotoriisomalirt:constil in exattritlnttll tttol'tli
r ,tii vxJuilraiatufrli 6i i la:'ingelui,prcturn 5i a deglut'ilioi (pcrrlrrr lir'lrirlt')'
pozi(iru
Enanzeit'I sinlia : vilul palatr:Iui se elamineazii' aprcciitldtt i
clcttl'ttrt'
11N1slio
a
evcltu:
1i
r,t,,i,"i.'"u.ttu"asi sirnetri*,r'iiulti, prccum ;i
llo iriqc[r' inrl'oluntare velo-palaiile.
trr'rl'ir
Daamenul d'inantic: r'om {ace aprecit'1i*supla trrolilil'lilii ir:ult',
(tt:r''
lroc:rlr'
allurrito
promrnl;c
sir,
r(J.Ltru care se cere bolna,vului
'.'I('''')'
licrnn, vi'luluir l[etr' ntin]irrildu,-sc l'c lil]ir)' ltr(tliit'rrii'
ii."^A"t"t*lU,
"i
se remarci u asiuret.ie a *i'luTi, ttt .ttlr't irt'll' ri:t'tli
trileziuni unilaterale
(rxllttrillr'i'r'i
cu ltctjar <1eplrtta sllrritoasi'. ln.1ill)lul
,fi,"iu"*, i-pr"u"I
rlclt'r'
IIiI:r'i.'tItIr'
ttlt tla iLsimcltici Lr'zittttilc
s'r.rtlnatt'i l.tct','nl
sil'rrr
"',,titlt;tii,
inr'r''alil
prr'1i,
liind
accsta
i,iiiil'li iiirri"*" ,i nirr"tuiln ambelc
c()lI [Ta0tre.
, ijliji' r r t : lt r lilit i. r '
D t.Ql U ti !t Ai; e r . lam ir r t r r , zlir lr lr d lr ollt ar t t lt t i sit l) ( 11,{'llr , l/
'r. l l t tIr t t . : r , I iclt it lr 'lr r t
.
r
r
r
il*1,
,
r
'r
ul'.
r
ir
,
(
r
l'Nl.
ir
li
u
i
r.
zir
r
ni
,t,.,ont,." l u
l{'zl
{l(
'lt
lN(
"
l1l
(
lr
'r
'liLlr
\
iLt
lt
':
r
'
l
t lt nt i
't r olr iLs
,i ,rr i ri i r u.11,'. n, rl., t llt 1t : ult r ', ',t ll
'l1l
( lin r uI llll
do l) ii1t . u) r ( l, r t r r r ; r r I ir r lli ir - t r : uh|r . . {1lr ilr ,
,
,,i i i t,i Jri l at * r,,nt , rliohidr
lit . lr jr l. lr r '. [ ) {r it s. r l( ''( r l, lr l
i , , iir r , , , ll, t . , sl il, . t i, , it , r r l r lcgir
,i ,,r,i
'Jr rrl)ii{i.
i'iril
(
'ii.
llr 'lilr gt 'lt t t r t t st t lit licii t lr r
,l ,,gi ,rt , iiit 'i, t t t '1'r 'r r 'l'rl!' t r r r r lt : r '
rl tt' i l ,i"rri f,r*
'
r
r
I
:
I
r,I r.'r',.r,Ii L ixnr 1nih,l,cl1tlil tL
r.rr
1.ziur,r,'
lrr
r,rr,1xr.i,
l
i,'u,'niir, ir,?rr,,,i r,:ir,lirr i
trr,tvtrl ti vl l g ( si, r r llilll , , t t t iit t r ir r i lt t i Ar lr t t r r ", r l. s. t ir t lr r 'Lt r l't t li, . il'it 'l' t lr r
l ' ol rovi oi tt | ti | ! r , l| r r , l{lsl) .

0i,,,,,",;*,,1';;ii,;h,,1:ii',,;iiiiiiliiiilllli';Iill,iil'ilJ'lfffi;,yilliiilll,fl!,lfiii$flllli

t lil rbil,
;ltt.l

I I li'

tf
I ') .t ( | I I t i I t I I

lt

i,lr

l,r

j1

t,i t1l

lll

1ol 1r.l ,i i

l,lr r r r L tl
i j i tfl l t.l r,l ,l l l tl
,t ,
. t ' i tt4 tltti
tl )r,l l .; r i,
r r ll||r |lr |ilr u ri ,s l ri t,;ri { | t.rr,.r rr r,, l r.rrtl r ri ([o l ,l l s(,. l \,
1fu Jr| r,r,i zrr| r,:r
L rri rru i rr,rrrr.r, i : ,,,rti c i i r r.rl n o,\i urron l l ,r.i l gi rt,rri ,,.
iir
,: ']:l l l: ] : : i, l:lr: r ilr
] , r.ir
i' tr ,, )r rrr..l t(,)ti ' .i { 1 , ,r,rl .l r()i (l
i irol .i tert.i d, l 1ur,r,nuri 1i l .i r,r.r.i
;i
l i l ,:,1
'z
ir
,
r
i'
'i ,. | 'rr: r lr ( . : r i' , . , . r i g u ti tr..u l rrri l rrl ;r r,:r1 ,i ,i ;;1 l ] ti m!,uj r6rbi ri i ,
l ri r.r.rL.r.r.:r
|,'.,r,||I I, , |. . r t li. llr . . , , , n s fa l | l !rl u _ s e s i trrj l , rr.::r.i
de respi rrrti ,,. l ,;rr:rl i zj i l r. ,l r.
iIrirIIr(|L()|i pr.oduc modifici,t i accir.tlrte
Oe tona,tic'lpiirl, ln ldorrir,), r.rr
I rrir| | |r'rl r r(r lrln lralii. Palariziile dt'rbd.ctc'i
realizcazi,' r:r.ir{
cont},i1,,dise,,i.t{l
,,1:

,,, ,.,.,,,j,i..I] ,rporrioletlrbrLriir:i

i..pi""i"rii /in s1,,".i:rl
:rt,,
I
:,'l1l
:]u.i
Tn parxliziilero t rlo u riil: rlo ra t ,\,.,, r(. , . : l
j , , l ] l ]ii,.ll; i u.r 'r r.il,o-eo.._ii-stridor..
' rr,.r'r,l [[ir, vox1r1a,Iiri. mociificirri.er.idente
de rcspiralie;i cu refltrrrl
1". i rs(' r)irsi,r'irt.prraiiziite totare b nteraG-p"o&oJ
'ilrlil'rii'i
'ir"ind,iiri"iLri sevcrc:
rkr 1bira1lie
pir:i 1a afo'ie, rips:urctteiirtiri
iii." qr dispnec.rr
i l r'r(i ()1
, inili a, les

i r i n s p i ra fi c .
).ll,,n1,1,,ryt f.trnc!-iei 'se*zitite sornatice ce.ceteazti
sensibilitat t,:r,
., .l|
', :| |.rr , r . lr r r , ( . t lL l r I m u (,o !.F ;u ,. a c | c s i L ri lo erpto:.l r.i . cl i ni ,.,,: z,,n;r

,'::.l l ,Tl:!:.1 p(,r.err.:e

,,o:rcriorat c o n , lirc rL rlrrirrit irir
c rrc r: rr,
; , , , . , . ',,',,',',:l,l
l , sulcljoari a pilierului
rIr'rrrcr
r.rill]Juipalatului, frringclt.,
i'1.,;1,,li' '',
| | I
. . , , t t , r t . t t t ft ,tn ,.t;,; i .{ 1 , tt \,1 .| n l )i u 1,rnr,i fl r.l r. i l ,.l rrl rri rtl oLri r.
| ,
,l ts r' rtr: s i rr rl ro r In i l (.- \o (o,.ul or,:rrrl i ac. si l rorr,r.o
j ,,,,], . , ' , , , , . . 1, l, , , *' , ' 1l r.
,'. , , l. ' . . 1, ' ! , " t - ; ' . 1 !i i to r u .e g e ' ,:' ;,
(1,1trasi 4pn;i se). l n Iezi utti
, ,
g n te
,, ' , l
. ]. 1l ttn
i ..,, i rc n e o l ,,r..i . * i.ra
r r1;' 6gp
' '
z
e
.,i
e
1" . ,l j .l :,gi .,r r hi ,.:irrl i ,..
, .j, , ,, ,r rl "' r lr { '"' : 1
i, '{,'."l
lr r r ur i z rr. rl t( " ti l l a l i ' 1 ,.p a * i l i z i a acut} , bi hter;h
l netyrrl rri
,
, , ; : , . 1: .
o :i - i n c o _ rl p i l .i l ,i :- { .r,.i .j u r ,,. Ior rj ,l .on i u,:rrl .,.:zi .i
,.;
] , ll, ] ^

,,1,.,,::i
'',.1,""',lt',lil,..lii:l;l:|,':
l';",1;'l;ll'','
"...;;,,,'
;:"i,:1,:,;,,
ill,

rr'rrr lr(.it liislrrr;rsrrrilorcll],diot-rlscrim:qi

cercbral (popor.,icingi criiair.,
( I(|| IIII,i{I,
llrri;
Il}? lj) .

I.li).:1, l\ rrvralqia vagdi

Nr.rr,:rl.,iirrI'r|;rrlli s0 crt,racti,r,izeirzi prin parosismc
algice c:\ir iiplrr
, r 1, , r, r , rr r r t . J , .r li, lr il rrrrj ,.
rl n L l l L rl :i ,r..,g . i ,r
f t,l ,rrn,,,,0 t rrn( nl i l .i l
"
f
,, r:,r' ' r , , r :r ' . , . i
" .i r ci i i Li tl c popovi ci u
l, i.r' rn :t.u /{ -r ^ l : I' o d d . l 0 t, x.
ii

exattria nerrrlgiiiorlilgtle esrctlifi<,ili,

l,,l
lll .ili:] .,.llllll::1j',1".,
' "',,r' r,: rr,r (. :rtrilstLDno:clcpe care

le lealizeazi, ramulile periferico llri

:r'r,i rri
Irr ]'unitrilc altor ner..vrcr..l]ri,:li i (irt(kroucbi cu iervLrl
gloso_
.
|.r, r| ,IIII 'r('r'v
r I I I 1r ilt iill^r ; J l l o d i n
c
c
t,r_
i
cl
-l
e
(U
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c*
si
si
cnLrrl
fi
rrrrl,rriir. trr ir(x,st s1.irsintrri ' .in
i i r[:i
..i n i l r
diqoirtie
a,;i".in LtoritrLr{m1,r.t.ii
si
t'tt tt'tttrt r rl,r'1r irf{) si un irnrorr:rlt
"irritg'i,;i
conriingcnt
d" fit it iiitr
i1r.s'irrr'i rr,rrr t r .
",l""'l
| ) l)i.:r:tlt.::irt,ttnn,u,ti.i tttr,t,irulureu nenulu.i,ldq
rr, liosl rlcsrt.isi, rlrr
\ r.r'rrrl ( . ii, r r l, , i[ ( ' I I . ! .r]{ .,)i l l r, 1 1 )1 ,,} ) c o n s tti
i .,rtr_,i ' ,ti , ri ,* ,, l or:rl i zrti i i rr
,
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jriroii1,r.i'uncuri
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do
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sertltoliir.i
"n"i,

i 'rl|
1Ilrlr(\
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.' | ' i\|.tt.t'1t|t1
itt,ll|'
ll|i,
1l, |lit lr , |l , i{ ; it r r r r r 0 r ,
r'l||:1, i-i(f
r.ii|'|'ltl'rl|'
r l0r
' iz|||,
r , ;t r' 'Zii
(lt ,iflltSt)
t , i] |
(tt rrl; rr1lr'r'lrrl;1rrr,rL rr l, lr ir , : r liz llr . iir . 1t
r . r , t lir t r r r . lr ' llr I ir r g i , , , i i il I r r o r i S r r r r r
,,,r i,,i|,|li,,l,(,fil,t,r!
t *' r, t 11, iir,/rl.. illrt.r,
lr , r . l i' r r . ir |) r , , l r r r r r lr i lli ir r l. r . r , i i i r r r , i il t"'i ; l i l r l r t r .
l ) r r 'r , r i h ^
,
r t trl, i I i r ' I I rr rir; r I r, rrL,r r r l, r . r r l. r lr . , lr r liliir
, , ir i, , r , 1' , 1 , , , , , , I i r , . I i , , , , l i r r r l r r , r . r l r ,
l lrl

1' l ttt Li rr,tttrrr lr ll lr lit t r r . t r lir tr '- lr . I r iI r L'I oI r , r , I r |: Ll) t t r , r r . t rr r r : r r , ir t r ;lri lr . I r , . r ir l

l tl rr I l l o zr r r : r r lir r lr r r r lr r , iillr lt r l lilr r ir l ; i o: r r r l lt r oir l, lor r r r c: ur . r r , r 'vll
l rrl rl ti rrrr ;rrr|r . r 'ior ,slt . iilllll. {"I I r t I I r I ) I , iir I I II i r,I I i rI i l r | |rI ( , ,r . zi ! iq. lt il. r \ r , r , : r r l: r
f(rt. i l /r' pol i l r r . l'r ir lilui 0 , , 1|ig. ; i|t ' z0t r ( , ", ii
iill|sl{, ziit lo|lr ir i sr r lr I r r r rr
rl l tri i rrr. I)i ut r r cit l) 1) lt . l{.I i ( ll\ r l; t lt iit lii sir r r lr g|it r lt l, ii 1) l, it ro|ir r | ir . il: r ( i,
rrl i i L, j rl i i rr z or t r , git t r lr ii ( t r isr ', iollr ir , r . , ( iij( : it 1, ) .Lir r r r r r ll, ilr ollr ili, r lr r llr . r . : r
rrr' l n cttacl , t , t 'r 'elat ir . pct r r r ur I t ii, r ; L.rt slr cclbiI i pilf l) \ iil i( x. . 'ir r iir r r lr r r l
i ' r' i zi .Iol rrti l r lor . iit r rilr r r . er . or r sli
r . i lilr Lilt iJii,lxr lr llr . r r l r l, lt Lr l, ir r llr r jl, r , r r ili r r r r
rU l , L U rcori apiL| elt iso t lc ( l( 1. t 1s{l
dt ilt ioilr jil, ir i slt t it r [ 0 r 'i0lr 'r r lo, r . r lr I r , r '
trrrl l tk' tl ccrt Jt il ( I iisr : i', 1. 91i2) .I ) ur . r 'l'it at hn t 'it zi zilc r lr r r ilr liir r r ir i. r "r r r
rrri rtl i l rri ngologic nr : Lt vir k'ir ljlr zi sonur e uir it clir . c. _\ lit t li, r lr r r , r 'r 'ill c r
,:l | r. :el ' l l oY lit lgic apai'in: . lur ingilr : ir c. . r t esit u clr r r r ict , ( r J0 r llr lr r r . lrlr ilr r r l.
''ttill|'i), dtp.i rnl i,7r{r;/ecloz,iir.ln irr lLn;.rrl urror I'rlft/:tr (gt,ipr'i clir)- lti:r
" l ro:l l ti i l poz.it it 'se lt it z. lt zr 'i,lr r ( t ilr ': it t er ul( ]dur ci. ji. r lr t I r,t ' r I i { rtr I i rrr,I r r . . i|'
rl rrti i l r di " ql t nr i! in accst eil it r r lr I ] a l: nest czir i loclt L'lr li, , r . ir r lr r i ir r r ir ( li: r r r
l l l ['I'l '-]I.

f . 10,3. Paralizia nervutrui ilner{mo{Jatstri(i

.l ' ru' el i zi l r ic] , t - ldui ] }lcur nogasi. r ic sr , r r r illif e"r l, irI t 'i'l 1. 111] ) it r itt it
i r ) l( ) r '||,
{.r!zrlir-n si t'{,gola1tir1'.l)unli:irt
ttttil.airrqlit, rlr.urcJa, iu^rrtiillt|rrlizil' v|1{'
r li. pir lt r l, , \ ir r iior r , ir ) . \ , r r . , , r r
I' rl rrti l ri L (hcrniviil t izut , liil; ot ot r . liir , 1li t l'r r , , {iir
rl r' \ i l rl ni l zoi )at , i) : iiill t ullt ur ': ili 'ir r r XcghL1
it ir Llir . lhir l, Jor .r,, Lrlr dlr i: ur , r rlr r r ' 1r , .
,rrr. S t' cri trst at ii o ir em iar l: i0zir 'il r . ilullr i l) ill|1 uillt ir L ir |jir r , l iI I I r , I L|. r I , I
ij'. , il r lr lr lr . r
1r;l rel i l or alicl'ior i si lt ost r "r 'ir li, t ) t 1, cluJlr i lt jiult ililii
l :rIi trgcl uj . Il rlil, i. ul r r cLopllal iJl {'slo ( i; nlir lt iLl silr t air 0liL llr . I lr , t r 'r r lI r : r l. r r .
i ,' : i i tttl !e bi .l t!t ; 'uI t 1t : 'cxLt tl:t tt ] ir Lt ;iili i. ilr t rl it r r L. . girl til ir Jit lririr lr r r. l rr llr r r ': r r
L I l i )l ri i i !1r rl diiilolr i{) r t Lr : r lir t ir . . ll'r illlL; 'r lt ilc \ i'11 llli\ '( ' , lir r lr r r r r r l , ;
l ' l ri i r' t' i tl i ri r, 1|( 't t '|l t r i
, r lr r r. r |r l , ,
- , '; t 1]{'0|; l- iiit ir }: L|: I I }|I I ii] . i|li, it i. ilr lo, , ii I t
l t l ot ji cr r lr ior iI o1t ir , 11ic,r ic r r olr :lni r r r r illr ' ( l, i r , il ir ll, . ll
.i l ri l l .l l ri ).ri I'it s.) ir
,,l rl .
;l.l{}./.r" l!oain hri iloska:n { hipelroikrclilll nt tir sitrourrolirlir rrlil irr
i r| i i i r1cl r' el za i in Jr r ilf iLt l I i: r il lt r . ir r nt : , n. i. lr sli! t i sit r t , , p, t l, , . r ir r ': r |r , r 'l r , U
i rrtl rl !i tra1;i tloglaJt ti] ilur r i- Lt lo t r or t lI r , sir ir r r , lr sir t r r sr r lf i r . ir ] ( , i, ( liir ir r . l, r 'l
rrl {l i r" i rl ual i z: Lt lt i it r nLr ' ( ( ] ir 'f t r r . iil ; i . 11; policir r , llr i: l i ( 1) l, lr l i t r lt ) ', . . i;
I\)pr,\,i (l i l : si Pr ur Ll, 11) E1) :
.l ) Ti f)u L r auul ( r nr dic; iLt lt ,if
il ur 'J so ( ll, r 'ir ill
u izoilzil lilir r lr p; r r , ilir , r r r llr
Tr rl t,l ruttrl 0r r t r t 1llr ] : r irsir
, i ) lr r ir r ir t J,
lr , r 'lit 'iiii t lot r I tI t r r i, iiI r I r{,' r ) r ( |iit r . r r ., t r |r ' lr 0i
rrrr' t11,l ri tl i l rt r ioir r . r t ll1iut . cll
, {[ ilt . t ] ii vr r ljlr ir ilir ( l- , lf r , , 1'f ) . li iI i r llr . r r r r r
,t i nr,r' l r l rti u iir llr tt lir i , , r . t iolzii , 1i lit r ir t r l lr r t r n; r J sr l, r 'r lllr illiil, r '. . , \ l'. ot ) ili
rrrtut, ri ctt(rtvrr Lor rt ,r lt li( lr t uonl, oll: li r ilt t t lLt hniir islr 'r t llr .lt r , r r r lr r , r r ir iilii 1r 1r . r 'r l
r,x,.,l .ol i ,l ro1rr , r c (1i r I i I j I)i rI I ri I )i I r l : i, t . l ciir ot , it it l; , r ll{, i sc ir r r , lr ir lr .ir r I 'r llr .
i :) ' f i ;l tt. it t t : , it , t |t , I t t r r ; r tri', r , ir sir i ilr r r lliiililr , ir i; r r , ior silr r ir r r lr . r ', : r 1, . ,
. , j. ill, t lr r Jr ii,r , , 'r r ill ir r lr ilr r sir r or r r r . ol, ir lit r r r : r rrtIrrIr,.rttIl ttI,
r lr hl i ( I j1I ir , r '{I irilLlr
\rtr l l ttrrrtti li': llr 'it it lt t lit r l it r l'I t t r , I r I : r I ot I r r lr li'ot r ir ii. ilr sir lir l l ,r'rrr r,rr i i r. r l ,
r,l l rr i ,ri l rrl l rr 1r llr r ) r r I r iI li r lr , r t r lllr r r lit r li.
tl ) ' l ' i 1tu l,t , r t t lt , r l st , r . t ; r ll, . r ilr , r r zt r I t ir r r I ir r I r r r r r r r lr ': rt l: ilii r l. r lr r r r
i
r.rr'
1:i .1rir' I rI r. r'r' i |, l, r ) lt t iilt lr r i I | | I Iilrrr| | i rr' 1 ) 1llr ) lr {) 1, . ir lli
r i r lir t r , , : r r r r r '( r , li,i, r t l
.rl
l rur' :rri rl rt tr.rllt L', , , i r lt ir t lot t vt t llii r ll lilr r 'pr ir , plir . . r \ r 'r . r ilr ' lllnr r . l( ,
:rrni , i rrl l trr,trlr lr , r lr r r ir . r r r . r 'r , : r lr 'rrrr t r r r r r lr r r cr r ', , I r r I i: r r , .

1t'l

!,rr, 1,.[0lJt,ilMtt
t)tdl]ll(;N(]s1,t(i
lN t,A,tut,o(ilA
Nt,RVUt.,Ul
sPlNAt,
(A00liSl)ll;l'l,jlfl,ljllllA A XI-l)

't,;,,t.1,"j:"^T"lFl1inserniotogicina rrrrr,ttui
spi,ralimpti,.,i
impr
.j"_iiglgsr:r, nermruispirrat
icri:
I Jl'l;,1"\'::,::l^"*:,
I'i|amctlut clnuc
''|
nentmLrannna internd, i nurvrtrii-il)i,,at
est,t,
trt cu cel
practicat
practicat
cel
p&tru compolenta
p&tru
compolenta
motorie
motorie
;;""Jrir,iiilll"Sli
a nervului r)leumol;li:liil
I ilri(]. ""
ill

tro(x1$il,il,
ll'rrlro(rsl,outittlo urgolrt'it,.ltr etlzttt'ilo an dabltl lonl,-ptogrettt',
.rlrrrc strirkrr', dispnoe qi tlisfonii pinir, ltl a'fottit'. Iltllllcxttl (lo l;uso osl 0
, iiur irrurit suu chiar abolit.
D ) f'aralizia neraultti sphtal et'tern'so lllrt,llifcsLilprin ssnlno (lrll
grrrtr*' mr6ohiului sternocleldomastoidian ryi tlrpez do llcocil,lsipil,ll,o.
I'ara,lizia unilaterald, a muschiului, sternoaleidomastoidtal,so ruanilirulf[
irr primul rind prin qtergerea retiefului musculat a'tit in repaus, cit.qi lrt
"tirnpul miqcd,rilor de inclinare qi flectare a capului do parten lozitttrii.
l)e asemenea, muqchiul prezintii o hipotonie marcatl qi atunci clnd lx:l
llllvul intoarce capul de partea sinitoas5, qi examinatorul se oputut ,l,cottt(i
rrriqcd,ri.
Uaeori sd poatelvidenlia Di o ahofie de gtadc diforitc a' nrttqchirtii.,
lLri"Ilin cauza actriunii sternocteidomastoiclianului de partea.oprrsir,l"ozitrn
partea
Paralizia
unilntclrr,lii,
sinS,toasf,'
poate
fie'ugor
inclinat
ci,tre
si
oapul
lu,inuiciriului sternbcleidomastoiilian nu impieteazd, prea mltlt miqrrfililn
,,apului din ca.uza intelvenliei celorlalli mugchi ai gitului. In clzttl lt:rrtr'
liziei bilaterale, capul se afii, in u$o&r[ extensie, iar bolnavul oxtrcttl,tl,t:t.t
groutate flexia capului.
Parali.aia muqchiului trupez re,alizeaziaurmS,torul tnblou cliltir: : rr,)
rrrrrlrul rle partoa lezati estecoborit qi proiectat inainte I b) mugincir ir,trh'
Iiuaril a portiunii superioarea trapezului este qtearsd,; c) spD0iulsuJrrltohlvicrrlar.eite hdincit, iar r:laviculaapare mai bine reliofatd,$i paro proi{joltlliri
tllai te; tl) coborirea scapulei; e) cleviereain afarir,a marginii- spittrllo ir,
on,uplaiului; f) diticultatea efectud,riimiqcirii de abduclio 6i .tlo t'itlicl,r'r'
a briilulni; g) imposibilitatea de ridicare ,,in coa,te" dirl. pozil,irlllllllnl,;
h) rlificultatea efcctuirii miqci,rilor din articulalia nm:iruluil i) 1l,r't'gctlrt,
r:,lieiului qi hipotonia muqchiuln) trapez; i) a,trofia,tnu;ohittltti l,rrtlcz
llurulizia sittgulatd'a neraului spiual este raril. lJfl, :lllrtto rlo ttlrltrrri
i. rrlrrerLnd,
cu paralizia ultimilor nervi bulbui (in spccial ctt port'rltilo tt,
tn i n nli al,t
I X-a ii a X-a) (vezi in continuare), 'loluli, procesecaresegd'sesc
ttlrof)iere a foram,enu,Ltrimagnuln ;if sau' u, regiuttii, cetuicule $tt,lcriottrr
(lr)carcosteomielibice,pahimeningita specific5,qi nespocificft)pttt prtttlttco
Adesorl, oparul'iilo tn
lrrlalizii nnilaterzlle sa'it ltilaterale de nerv spinal,
itqiunea cerui,aaldlnaltd (ca, tle pildi', sec{iunea spinalului in tortiut'1i*)
silrt rosponsabiletle proclucereaparaliziilor nervultli sltittttl' Ane,tritmttl
rcrlebraLecalo se dezvolii) il canalul slritltll superior pott,e t:otttlrrimtl
^rterei
10(|6)'
norvtrl spinal qi poate si plovoace o paraliz,ietrrrilatoral.i'(ljor'loohl;ttl'

ii';"':i:l'';'?'i;ll*,i,,5x*TiffiJJ':i
iil:i::ilI
;;:lllili#;
li'iriii:i;l'1
:1.11.3.lraralizia nervului spinal

ir;,i,i*ii,:q-$*ll#":$|liii,:,yli::,*imiti;$::t{^*Ti*:

jni
,,iil,i*i+*!#_*ii#_',E,5,1,:*ri:;t'*r{jrft,:ffi
tij!:j:i'
rtrv;w::;v;r:;i
ir I lrl,or nii). C drcirLoltlul liroidi

!.i,il;:'Jt
;i:r
ii:,
trtr'",::*
"i,###,:fll{f
'ffi
*'f::'u1":*$,,i:il,#:::fi ):;*'J'1T:Ha
;i';li,:',\"Yf
"'#,fi

utrvului.""*"nt
i.iir,rr
rrcrroui\,
nri
-oi'co*ilJi'ir'rfiL),',"o!!,lJ1f?t1,fl.1

illl,l-llHl-""lHlglinn:Ysx$itni"';''i;;i";;;;ilifr:'J#il.i|#i:
i r.zr,ipsirarc*ri ;;;;i;-;.f.il-ii #, i;:i: ?:#,,Ir#; *:,Ttli
1
r. 'orur.rrl;pr[tluCe "

YoCestlirlet
*"
1i"""?,
iii,*l"ll;i,li:r".i,",1;,,f,1,J#lH":T;iil,f,H,,,:$it
lll,ll;iylii,-',l,,.
I'a.ralitia
bi.IateraLiide nt

ri:,iliii11fii,n,lilii!:y;;,*f
i"#t{{i,TEH"{,#l1,;b*nuiindeeir
,ri,',,,,ii,ii'"i,i,n,i"i:;;;';^;:;ii:,:'tr::^;i",iltfgT"fi
,:lyitd:'-l",Pml:

Ftg, 77a,
"Astr'{te lch,rnatice ale examenulu.d
lalrjngoscopic:

tr\,

@
I lj8

NDRVUI/UIHIPOOLOS
IN PATOIOGIA
9.12. PROBLI]MD
DF]DIAGNOSTIC
n norvrrlrrihipolllos(XtI) lmXrllod:
somiolofliolt
9.1L1. lnvostigutria
I ) ( )hsurva,t,irr
1,ozi1;ici
."i a nn;rootuluilimbii in sboretls rolf&ultrrln
gitutt.
I) Inrplorarso mol,illtillli Umbll, solloitlndu.ssbolnavdul rl1,oroouto
,routo mtgodrllo podblle on t Imbn.

'lr0

t
l, ' , l,l\'
ti|llr|r'll ir r |, li( . I I i|( || I r r r r lr r r . 1r . r r lI r r s t t | . l , r , i l l ( l ( . r t , l l l r l l 'l i i l r , t .
Hi| lr l)ilill0 titlr'.
OIrsllr"lr,{ilr ; r r . t ' z t ' r r l, r , ir lr , lt r < r t llr r lij
.//,/
r l| ! . )I I llI lt(,-

il i c . \ 'e n i u l l

rrrri.

, l r l l {}r . u l t i r . r r , l

:1.l:1.:!. llaralizia nervului hipoglos

.l 1 1'o.rulizia u,nil alerald, tuiertru,lui
iti.ytoglas; realizeazi\ o dtr:irtit.
Irr' 1 r: r . i. ir- s iinit oas i i a ,v i rl u l u i Ii rn b i i ,,i n s i n u , ,. D aci bol n[r.rr] cf(.t.t{ r{ .i rz:r
Ir',rlIrrzirr Iirniiii, wir.lul il(,csteiit est.j {let'iat spre par.trr boil}rtvii. [)l,ilr
r( ttturrir lt[isd]iulrd
de p:rr'lea opus:i ]eZiunii. I]c :rse:lt,,i,orr,
-Eenioglos
l:rl.rl .*'(l'ill] al li rbii
fot]Illeazit o curbiL Lu corca\-itateit, spl,e ilrit,1,(.ir
r :irrlloirfi. -\t:castii deriabie esto produsri
ijrin actinneil mrifohinhti r{ii{).
,'l()ir *) ;(l ; r(,!(,:1tueaz:i in tiinlpul cfor.tLrrilor
de t ducc iitnba cic 1[r,r.1rrrr
irrl trrrril. Lint lx r es t c { ttro fi a l (i ti e tl a d t,* p a r' n l i z i rl l iLqi prezi nti i pl i l ' i .,Ji ,i bi l .
;r. rrrlrr':rlriri ljrnbii. 11 hernijinba rrlettal i: se poi remarc,a,.Jasci::r.lu!,,i.i
tnt\t tt[/t)t: irr coridi{,ii1i:in cr.r'oieziirle:r sc:rllli lr, nivelul ntc]trdii ne}i.liiui
lr1r,r,:los. l)fil irittitia {.rroliirI
a ilctonelronik;t,.
1t ) N'rrroli::irl itil.atert;ld, a er,nri.ui ]ti,ito1lios praiar:e tuil.lirlrj
iirrrrlr,rrri l, r'r'Ive al(.. t|r{rllliti,iii jirntrii. Acessta-nu pca.ig fi .r:ri;catr),r-ilnir"o
i'ril, rrr ;rliii, rtici inirrrNr-rl 6i nir:i in aftrr.agnl,ii. Atr.ofia iidrbii este bilrt('.
r:rl:r, rl. r,r,l.'.ti
rr tll,{: o'i ca rnuitipJe li e\.ialette flscictlatii *tusrt irlr.,
\p tr si lrt tr:t'ii,ri, t!e mostica.rtie, deqlt,:ti!,;e
lsi tle pranut$*re ro consou.jtt:lttr.
rrt(,t
afectat,
gcnelal,
!n
tL, er:erlelrsi
afcc.tiuni sa Sipeieijjlil(,
. . llill(1il:r!11.1
I l',. \ sj -\ l, !l'r cr,r.rnt.o.tismele
craniot:erebrc(l.ecit frac1,lrti rie itazli pot-1,:t,Dtlncr,
t:tt' t\t t t!.1(\:)tit
()(! 3i't1.gukt]"ri
$, nen:ui'ui hiitogios. Attetsriti,nttl qlte;:ai 1),,1{h;(lt,
r,rtl' r'r':tlizlrrr 1:rr:rlizic nlilat,jr1r.li. a nerr-ulai hipoglos. lez;unile reqit.tn.ii
t.t) t itltlt' ;ttq[te pot aft'cta re.rvi.rl ]ripoglios in poltiunea sa extracnrria Ilj,.
lrr ;rr,.,r.1r,
r,orrtliiir' rr: 1,t'itrrlc si sitnpatitul l.reriiclrrrl,id,lrn si llsist:im tra rrtr
irrlrlrtr r,ljlii, soltprll dia pal,lizie ir11jl:tpri.li. p" 11.,tr-uh.Li
ltiljOgios ;i rin_
rI|rrrr ('lr nl<, JlerI rartl-Tfutrtrl de a,ceeasi paute (Taverneri f.-Oel;.'
:iirit.tr;r,Lrrlhial)otte
lcsla s1i lrodtor: o henia_trofie a lin):ii, rrr.r,r,
.r l i l .IrI r ' : r r r r r r lls or irl ri c u l .u l b u ri i ri l l e rt,ti s i bi i i tate i :r regi tnea' tl ' i g.
D r,,rrL r lI i,.\tl(tt)1tt lrrtt:.yui.aL
anti-ttiro.ficd (q.L4.)
st si,nd,roameletle tt-.[,.A. 1xtl,
,
rlr'lrrrlrr ,,rr ,i. ltzitr.'ro dc iipoglos, da,r de obicei se asociazil
\si sentno {lo
l.zirriLc rr cr,lollu,lti rcl:vi irulbari, preonnr
[i simptome piramitlale.
lr' irr,uil.rtLtnrtor*l,c fi it'ur.*t1{ttice ale g6,u,rii, cont'l,il.ieneanlerioare ttrl,.s,tv
rrr':rzrrrrrl.rirrrir lrcrvului hipoglos (sinclroilul lui oollet). rreziuni trmorrlo
r,i I.rrrrrrr:rIi.r'rrl. glj,ruii c'lrlili.ne qi ale gd,r;rii ruptc postc.xioarerea[iz{)lr,zi,
:,t,rl|o)ttul. ..tr.tlil.o-qnu,riiru,pl.i pottefiaurd, al lui S,icu,ril,aslpra ci,ruia, l.orrr
rnrri l;i|zirr, rlind vom {lllorda, ;i sindrou,m.elebulbare ct lntofestl,olt
'r,vr,rri
rrr.r'vrrl r r i I t ilt ogk r s .
lu l,rrttrliil.e lt .l?b,[e].ototrrli{'(.lt superi,()are fto
lot obsor,va, l)llrlilizii
rl c n l 'r' v ll il) 0gl( |s .
l 'rr r t l. i: iilr lint lr i i d t o t' i ti ttr' t,tn l ,t,u ,lpdl,i rr l rrzi rrrrii rl o fi tsci (xl l tl l l ti q..rri _
r'u l :r'l rI s r ir r s o{ r , s tr:tc rrl ,r' o l i iu l ,u fi l )r' i l l ti i i rrrrrscrrl l l ,nr.Irczi rrrri l sIi l l r,i ,r,1l l 1
:rl . I rrg rl irrrrI rrI rr i r r r r |ir
| rrrrrrl .Irrl r,r'
l rr* l rrr' 1 ' . tl i n r.t i ndttrttru[?* ut& tn,Lb(,r so
li
rr ,tri l 'r . , 1lir
. lir r ir , lr r , i rr | ,trIIrrr| ri Iil ' rrIrrr{ i o rtItIii rrrrJr.l l t:trrl rr,i trl r,r,r.sl trrl[t| tsl i r':r(i :r, r llj, llli( it r 6i rrl l i l rrl :rl l rr rrrv i rrl ,r,l o r' .

| :t0

:.1;i.l,Itt)IJLEltuD|ll]IAGNUS,II0iN|,4'trtt,rlrit,tl,^li^1,IZll|,()|tMtl|,1.1|'|.|,:
AI.,ENIIRVIL0R 0ltANll'lNI lllll'ltAlil
crt itloctirri mllltii]lc tlc
3.i3.1. Atoeliuai extranelraxialo
0r:rnie i bulbari.

ttorvilor

:li
;i1'*:1i4i*?,'rf
ilTi'lli#,{l,",,;ir;#*ht,ilHiTffi
;iir1;'
uul'l
::::uiir'lr
{iif'.'i'l::'r;l
"-.iili,Hiitimixa
rl:;:";i,"q.;,,;,;r;#:;;l,l;*;*f
{li$ffi iti',illl*,il,,i;,lilll,,

#*:',lillfl**;i,l'll-"*4i!tiT"i$i$:ltil,*t^
l;":il:r
o1,T,,.",

'u,.'',,'
"i,,,r
illi:,:j;jtiti:tiJ11lJtfi1":ii'iii1H!!:HTi::,:,,:.,j

,
$Hil$jiti#fi'iffi
jli?'#ll;rmiril
iii*#;!,*{,*"i[i$1i
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ffi';:l,t?;;);,H..**,ffi
.,.t

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r r 'b r "'r r e r ' '

:,"'w|*,::iil:!,;;i]t'.#ltlil".:,:1:1.i;,ttlla!::,i

:*$i'.ii;Hffi
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lr*.
tr*,'*iffi
;,iT$";',J'ff
$iJ,:f
:*ifjl!:::#;t"#;il:,i#{iln+u:r
:,i'i
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l;,,;
tll,:*#j*jy
r'
rll :l.nliTl"til,1"lr,'"",1';:',;tll,;,ll;j,_l;;
,,,,,,",,
l;l;ll;
'*'',l:";!E;,!,"ii;;,J,"i,,i","i,iiii;i;ril6l;i1li
il;,,;l,J;;
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1ii1i{tl1i,'"*ff
itii:{:'
ffi.fl"*iihti
i,,il,l,,
;
tii,i"'.lit|),,T,','l,l,i:;":t::::i:,,,i
r"rr '' 1,,i,,.,l,rl,
i"i,rl,')','r
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,',:,'ij':.:1lij''
t'#;lil,;,,,Li,l,tl,;,,!,|'li,,l,i,i.)lii'ijili,;,,":,"1,,;",

lniti;i
nn#i;i:lfii
lirjj'i'i',{riilllii'
.;fy'f,i:i
,,,,,
Wiil
.,''
lllllllllI ;l;li;li,
'"' p,i/i,i'tr

ii;;:ll:iilll'l:
'l:l,,ljf
l':il.;l.lil,
'lliill1:'ii,';:irllli'l:"
llllllllllllll,,lll;,li,llllllllll'
ltlil,,:l'';l:,,;11,,'1,
I , , , : i I 1 , 1 , , ', t , i t,g ,ttIr tIt.ttIi Ii ''

r i r r l r r l tr l r l r ')

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l.lil .lt\Dnt.l l.ui t \ r Lnt ir lt

r . r t r , lr r , r r lr r r r lc J ( . z j t l t i

llljl,

illo

l,jlr rt,il

r,il 5i r.ll l rrr, (r l rrrrrrtr,) :r lru,yulrriXl (slritltl).l)irr

.r.
1,,,,1r]",ir),
;,r;rrr,t
, rll,:liil.
' , . \ (' u{ t,.
sr.rrrrlr,tlr{,, I ir

s ilr lr , olr ll
lur , \ \ ( llis s oils o c i l t z i o l t l r i r l i z i o
tt:iil;Llr,
l :l . l il llr ,{.trrt,rt ,lr,t U( , lr : jr l, , t : ls lr , i( lt : l i r r lp e z .
tl 0Or;attti :r :r ..Jrti.
t,,,r,' ,:.,.' ,:,.t.,;.-.1-,.t,tli: it t , r c op. t t ut lt t i, , 11i, , , t , , : '
l, iit u , r ; i
, t ; o ) 'a g ; r : i c i r , i . , , , : r ; :
,
,I rir : l||Il r,mUl nlonellc LL.

I ) f iudrtntttl l.ii,Iackson
produs cie obieei cle o icziunc r-rqirrrlrorrrrlrriillcr,ior, (llcrifolrn) al-este
vagului $i a nervului JripogJos(Llotri:r:si
,',Lrlr., ll)(il); Pr.rpoviciusi Fascu, iOSfy. in, simptcrniatotSgia
sindrornrJui

I r, r',rl.rrr,rrrrui scr,nitlt'seadaugS
,i p"*iiri"-d-ii-rrfil,-ii'actorii
it;utoiril

,l :,r r i. , _r i, , : : , r i L 1 n l r. ,[o u ,l ,r' n d ru rn r,,

t]r{ c.d(.nl c.
t, ) ,\ittrl*nnit.[ l.Lti Collet-R,card cst,. proihu de
ieziuni c't,c alfr]f,itii,ii,t
r' r,,.,,|r*i l itr.rlrloltc for:na,liunile car.c tr-cc pril
{or.arlcnul jtgular (l:llinr
r rl,lrr lr.r1.r,j'lir':-r,)qi can:rlli carotidiatl r,ocirr, rrroti'pent'*
care sr l:ra.i
lLl rl r{i l l r f i , . t ini{ t . otn n l ri i ,s ,p i n l i c i c a n rl l l c ,-g a uti rtpti
T,otteri
oqt.tiu! l tri
r ,,llr'l t\itrrd-l'enrcd:'. L'ontirtirl
scmioJogi6 ilrl,l;r,ii icliurrea ::soiji:rr.r ir.
. , t r r r p|r ' , c h i rl c u e rv i .c ra n i e rri (T X,' l i , X I si )i II) i ]]u,i r rn,lr|rrj
Ji ri ,"l
r 'l,lirrtr(',
,,rr.
: ,)
dtslitli^, pllr:iiizic {aringialri ru set}]nrl coli,i]i|l r:,,1.iLri
.\
i r( 1 . t lr lr l' - f lu t il( , z i c l n tre i me a
l o Sto i i c a ri!, a l i rnbi i , pal ai i zi | . l {]10_
.r
i.rl i rl i rri , l, r ilal; z it c o rz i i v o c :rl c , h e m i g l o ,.o 1 l e 3 i c rrtroti a l i r' bi i , rrrei :urtr
1i
I o.l)iuiriizio ipsilatcr:r1[ a rrru;chiJcrritr.qlez
fi s i (1,[otleiclomai.ir:,id illr"
l t,
j
jindr.or,,
.lor,ii t:{iolc,rjiciai aceslu complicrt
l]oi- fi riilra- ,qali d;rr;.o't ,,,t'-, t1:.dc ol'i{ixc oticii,
larotirlianii,, a}e bazei craniului, ileia.
'
r:r. ,',
ri r', irfl,.r,)jrilt
u c, r(,lnonrirtoasc, reticuloz0 (J:oala lui Jiodghin),.tuir:rori
, rrrglri ;rr;rrlrr,ccrr,.Jtelos
cu ortensie bazaii,, tumori epiclermoitc, coriloanrr,
,,r,r rrl lip il lr lc 6. ir , ,
t,utttnrr.titsalc
(plirr fr:]ctu,i ale bazei crarriului, pril pld,gi,
,'i lo( 1 r , t
1r,itr
. .,..|.t)
r'l r(..r1|
llt r n a rrrttr a l b e e tc .).
t.j l'tt)(tr( rtst:u.Lan
e ::tncvristne i1c arto.ei carotide sit'ate sub bazll
, ri.rirl*i1 .r{r\ Ii''c
ale artcrci.r'ertebr.ale ;i bazilarc, Ilebite
;i trombofle_
, 1 r. rl r'.r r r r li jr r gllr r,ro ,tu n o l i g J o n ti c c j ri g rrl a l e
l i ri qx,ci al j .
i i :,h ri n l i l ,,.
u i j l c , .;l,uzi i (. j ,ro[rsyatc, r..l 1l i 1r.
,,..,1
, it llr
,tuulnt
,,'.: t.1,
,,1,':tr'',r,l. . 'l_r
,r ulr' r,-,,! L ,..l tj i r.. o c , i p i trl c ;i r,l c La;,rj i rar.i u1i 1i .
* n^n
r'rr-','r,l , t
lir t r ' . t t r ztl t,, i l .tI.t,o i d :l (,,b :l z rl t.. n:eni nE o rrtl i (.ul i tc.;,i ,l i rt_
/ ', ri r)r, \ i , . { r ' t lt r |n. , (l rtr,t,.l tl j l { ,i
z i s i n rl t,o m i ,l l ui l rj S hcr r.l l i S et. It,2;
l, ',,' r',.i. r , r l; , 1, .llr
. CC. : [i r.rz s ; IIo l t!.r ,.r. Ig i L ]. 1,, :rl ,ro;1,,. i ul e sr!
rr1i ,l ,,
| :(| r| l ]lt { , . . I t , , r . r } , .t^ c i .l l l Z i tl o
l )o l U l l e l ,i ,,r s i sc e:ti ni l i i ;: sJ i . i l :zfZr.
rii.rrrr i riolir r . l( j; i lik r l i c n ' i l o l o c u l o m o to r.i
i i e hi ar al e tni ul or ri el vi l or,
r:rrrrrri ( r ilr rlt ol lll C i l l .c i n ),
t') , \ it r lr lt t . t t t i
l , i l l aref se Oat,:l otel l ' lt * l rttl i u .r' d ro -T .ta ro l i d i a na L h
. ': : I I.r.r r r r . ' ' , t , I r . u, . rJ r.
1 ,i rr;.l i i i i a l ," trl l i n ,l r,r p a tt,u 1e,.r.chide l r.rri cr.,r
r'r'rr (',,r r .
i|1' t |' lll j ' r,,{ \ { r,,tr( ((" o l i r r.Si ,,A| rl / l .l l rtn S :l tdfonr { I:l | l rl (.
| ' ,':rtrt
, ' r ' t . , r r . \ ' { l j tl , i ,.U (}
J j i n J l i z j o IrC j l l i J.
l,'rrtlor.i.irl'it!loti(i. silrl re|'rlcz,etrtr1i dc afectilrni lclci,rlizatcin
.
sp".r,liI
ir ] i1r r .irr i/ ilr r r t ,tl ro p a r,,l i d i rn i r) I ra ru n : ri i str rL, L) i unl orl (l j ;u,i l .
;
,t ltfl
tr,yrrlt
r,l r, rt' l ) ( , lr J t . it r. lc
il r r r r rl i q rrr,,tu l rro r-itl r, \l l l rl j j l .rr, trz;i l |
i i l rrtr.rr_
l l ,)st(,l ,j oi l ,ro,
r ; I rtl :Irt)|, r r r ilr r ir 1r r r I i i ,Iro rrl l r l l o rh l i i rr, trl ,i c rrl rrzr,, rroi
htl i Ii rrrl ,rrfi i rj ,rl r.
, , J rrl l i rrc r r lr l: r z ir , i1;
r , ) p ro l l s c i n l l l rtr:rl o i ,i i Ir,rrl c ( 1ri rI.rI 1i rI i1r,, rtl rcl r, i .:u,i rr

I ' l r' l r(. r (| , 1( il', r.l(f..).

) ,\ ittrlt t' ttttt I ltti ' l' , r 1t , t t ( llr r t J r : r |lr liz it t r llos o l l t t . i t r g i t r r r i {. ) t r . r i r . , l {r . i l f
1
, ,,
r" zrrrr'' ||i|||rIi ||J| |' llr r ' r ' ! r I Ul. r ' ir r t t lr |t , r t r t ilt r i r r l t . r r t t t : t i LI r rrt r
rrr rrI I r I r , 1 1
''i

t2\

ri ttrl Irttto r1i tr: r lt t l r ii lr lx) lllr , r r l r Ir'rI i ' r trI ri t t I ' i ;i | | !i I i()I I I I I I I i 1, 1r ilir I r r r ( l I 'll, l,
l 1).1| i ; l i i sl t, 1l) iiLl; llr por icit t r . t l': t , ; r r t t . , lt ) ijl) [ i s{' r r r r r llt r llt izt 'r t zii1t t 'it t
si i tit ot ilt I tr,I rt i I i t rrI rri , pr nt ) izic il) $ilr li; ( f r it liiil, ( r r lt '7ii vit . illr t ( ( 'll
l rtt' rl l i ,,,i rt,
i l rl ri ,rrri t, vi i l ul u i palz[ t ului qi r r I r r I ir r gcllt i) li ( , \ - cr ] t . uilll) i'ir l l] r r lr r ljzi( 'r r s( , ( r i: r lr l
I rtttt;chi l or st er nocloit lolir ir s r it lian si t r ; lpt : 2. Ut t oor i I u1 li r r lil, llt , {i r t
itcrvii simpatici celvicali, o1t sindrom Cltrtdc liol'nrlr(l lkrl'tti't (liory I I,t
rol al t., 1.969).
tr' actoti i et icloyli. crsint
i : : '. ) I r aum alici, in speci: t 'l, Ll r Lir r , lr t l qil, t t lr t r ;
h) Fat:tori, ttt.tno"ralipi c,tinpresi,ti (turnori ale glaridttor ptLlrrlitlr', 1f i'ilrrtlozr',
lrctastaze l,:.,cele,adencpatii, llmfosarcorrno s.a.) ; c) l:'utlori iilllrtutrrl0tr
(par{}ii(lite) :iircese, celirlite q.a.).
3) ,\i xtl rr; m r l, de hem ibazt i ( sit t dNt nLul [ t t i G alr : in, sit ulnt nt ul lr r i( it r t ]
'Lain
;i {ioci.n sau sindromul lui Bertololti'G arain ).
'1'ablott'l'semiolagic este constitutt tlin po'ral,illi l:rt11i;rlr: tlt' trlt i I
{'ra}iicni, in {olmele lipicc qi completc fiintl aiccl,:rte tttrtttr c|li' Il1 l'r'r'' r'lrt
tLc nenri cr:lnleni <le o p:trte, da.t cu clemsili-c s(xnioloiliot) ll.o tLrirrtl, I rr|i:r
1;i l e, i n funcl i c cle sediLr tinil;
ial el leziunii. il f olt nt 'lo int 'ot r t lt lt 'lr rr lt 'r t t r
r
rlrotn t1o iii:nihazri. tttlii ncrvi cr:iiricni 'q1ni,cruli:i1,i (f1'{'ill rrrrlil.rtit'rt l. r
inti ftecyentil), i:lr nltlrior afect*rorl l]ervilol ci'lnicl]i sc {rtrro lil'tlitt rrlr'
rintcro-postfl';or, fie riin srns }ostoio-alltotjoi', oll plirxlet'i'rl iirilirll,i lir' '
rrcrviit)l; c1':1ni{,nirlin fosa oerebralai mijlocic, fie I ultilttlol
ijlllrl(l lrltl, lrl
(1r r:ri ' Ti crarL ioni ( I Jlom or r t i si cr ) 1: t b. ,195i, cit a1 ide. I logcr f ii i'olr r J, . ,llll; 1r r '
iri lite situt,irii, ito llot :lio!:ita li unul sa'.1lillri:illilllli n(llvi rtitlli{flIi {i,' i)irllr ir,
;,ontloittterali, (Arsol]i 1i col:r.b." 19?3; Iloiler iri c(trlJ-), 11){i1i)
Gr;lcirt tL'-t srr sl)rrr,rl('rr'
liultir ;remc, itr tvolttfiil sildrotttt'lol
romni: dc ltitcltonsiun{r intracrtlltiat}li , cero iw|1rc ndosea1,xl'(!iv'{ r, \IItrl,r]'
tllncit) 1r'rtl rltr lt.rrtr
r'{lcruihri pi1:iht', r::u'o aIliie m:i t.lci;rtrnc. ll s i11{1ro
i"lr::rirm sc ilcrrla'azii, llelltle tls ltziiute lt, triittlrilot' senzitri|rr sr'rrzrrIiirl{ r
rr rotorii iltr':riier-r"ilxialr.
i'u:lo: ti et,olttgtt-:itti s iiztltoa ,tictor Cor{:i.11de h(ntib,L.ii.
::.) ' 1' t.mor ile: t t r t nor i oll] 'N sil {lt }z\ - o1t alir r ir r sii; i lr , lzr i , 't r it t it r lt t l I
r i inai , j{r ss; lLlr ll{'^t lr , r t lr iI r 'i lir r , '
Lri )Irorici i l l l rI ] ct di] gr lccl|i't lin: iil'llct
vol b:l de tum oli linola, r it r giclr : clt o it l lt lo: t zf i, bll: r ll t r lr lt r it t lt ii. ( lr 'lc t r r : r L
l l tccventc $i i rb t r r lt lof il0 a, t t r ic: ulllt ', lli'lzit lc.r illLlr : r l( rsi r t lt ' lr t t it r lr 'lr r i ( ir t r l' "
t r r ',r t t ir o: rt r r ''
.r,bi cpi l cl i o:rmc alc : j1) af jiloi'bazalo poslt 'r ior t lc it i r llc r iilLt ut t ilt
i i ml l sartl rl l trl o : llo l inolar ingt llli, llit r '( i ir t vllil( r lLzi'ot r lit it t l lt t ilr r liv. t r l'
:ofrrfl l l ne), 1r s cut it 1i t um or ile 1; tit nililt : lllir t t lsclot lllL, zci; i lt lr ' l I I I I iI iI : , t 'Ir r
{ l i l rrosarcoatlc, sllcoim c qi osl, cosllco: t t t xr) ' }I r lir ilr csint Llilt t oliit r lt t t t r t l' '
lni Iitr.\taclri(), ir,lr:}nlalului s:t,l alo glandclol sllivltlt, ({lrtr;1'rriilttrr
;i rrolrrl, ,
1l )l i 5; ,\r' sttr i ; i r lollt 'b. l9?4) , llli"r t Lr r l ; i t t t r r t ot ilt t r r it r I lt slilt 'itI ' r r kr lr r r zr '
rl l l tri l ri , r,i t lt it ui. l r lir lllr : r , alc r lit r ciu ( r it t t xtt no llliil) ) llli' sllt l 1t t tI rt t t I rtit t r' .
i i i tr ti tl l l rrotr,t coil'illo, I , i'( '( r t t lt tli. r lin lr lt o l, Lt t t xlr i lll0llllolllllt t t t t t t lt t t ', : r lr r
rl )i r,Ii l l ,ul ttil 5tr ir id r , i r t igest iv ( , \ l; cni 1i cohlb. , l1) 74; jir - r gcr '1it , olr r lt . , lllt ; lt ;
;{i r,)i n1i [.rrrtt lnir 'r ',ll] 51 ; {llalll ; ii r olr lb. ' 10{iL) .
\1l ;s l rtn t gt i lllt c llt t l, t lt t l, ct 't r t it t t tsir t t lt t lillt t t l t 1o lt t r r t t ilt llzlt : lllt t t t 't 'l
,1' 1,i rl ittl
' r ri rl t' , t r t t 't Lit t git t lt t t t r , ,t ' t I t r I t III 't t ttI ill{r .j ()r I{1l,i II I I j i slir t lt I ot 'lr ipil'lr lr ',
r rrrrrIIoIl l rrr.l r r zr r lr , , i, t t t r t ot i t llot t t it r t , , lr llt slt t r xr ilo: t t t t lr ,t t t ii'I oI I r r r I 't t t t lllilr lr ',
lt or lt ll. ir r {. ir . ( liog( 'l 1i cr r lr t lr ', llllill; \ r r il'! r l I
' Il Ir,r' rrri trr' i ,rit'ir lr , r : r l: t lr r i
, ol ,rl r., l l l i j i
ll) i 1) .
l t)'l 'ttul

1t!l i :1t tl .

l rr:ti ri \!

l tl tr l rl tz rrl t tl ttti ttl tti '

t:t;r

, 11)u'lt
rylrrlittrri t 'rr: :t t t .| , rt r : lt r nt t r lt , t nu l lr . lr i rx r l i ( I I I I I i r| | | I i ( ( I t r i I I ; r r r r u . ,
l l l ,' 1, , r' llll rlI Ii,og r't ;i r . olr r lr . , llt i; ir l; . r r . t t ir t ur ' i t t f . t " r t r ,t t: r 'r t n t \ t t ( , 1 ( 4 i l t t 't , i
, ' . t tlitlt illt t n t (l(is''r'. 1lJ 5: l; . \ t . f ir ' li , r lr r ilb. r 11. ) 7 , 1 ) ,
rlt (lixlitt tro :rlt tinliLjplr , ( , r L lo( . lliz lt ( , baz ali l , \ r s c l r i s j f ( t l l i ) . , l 1 , i , l ;
lj,,,r
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ct
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rr

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ivilo tiirc, zrlir at or "s e, c lilt er ic e i. a. ) , c ar e p o t f i n n e o l 'i ( i o l r r 1 l ) i -

t . rlI l i l l { ' -

ll'. isl,rr roitlrnorLte fornto partic[ia.r'e dr: polila'Jicu]orcn.ite

t.ririiiglo
r l, trl r (lr r ilLr ir r - i3r ule , c n a l :e c ti l ,Ie ab i l a te rn l i i ( ul eor,i predami nal l t rtl i l. l,r':rl :r1 r r r r llir |r 0] ot I J ? l 1 ,tu} e- to o l i i (i e rre i l i e t' ani el i si a ocL1l 0tl l olr' ,ri j oi ,,
, rr ,Ii rl rr.i: r I ir rr r llr ur lir ll -c i to J o g i c :i . ru g e n n e I,l l IG cl e ]{ ' zi ul rc trcr.,,,_.,l n
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\ l rrr.,rl ,1i I lr r lr il' s , 1l|fi 5 ;l l a v t,
1 9 6 ? ; l l o p o ri c i u ti P xsr.i r"i !1,!1). Fi ri l tru
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l! ,{;).
l/ / I rlolr. titulrtrt t( ll( u,nqhi p ctri<,,terthelot Il{}t ilrtt.rni jn uttt!t'.':tttl
, rti r,l t,rli,s i lc z ir r ni ?r l ep c re fl ri l o l II. X , i i
(rareol i ,ri al e hi pogl o; I i l i i i ),
-\I
rr rlr,'r r.lri |rir lt,niori (nlcnir']1^io:)rner
tur] oli c}itlermrli(lc. glio:rrti ._ereI , i,r r . lrlrrrrrrrgioiln)(rarl,{rbol(}tse:tllrrri]r"i:r,lcpilrlii Lltelale ii !entrir,;lnlui
r l 1 r:rt:rlc ir , ir r r r ur r i r ir .r!:i o n l u s j u g L i l tr, tu rn o t,i mettrttrtl ce, tl ent.i noi r.i t;e
iile
i, r:Iu i ,:i s p i n a l u l u i 1 .,\.1 ,& ]..i | * i (j i di .i ?r/i i sl i cr: 1i .,:l c'|,, rrrI:rl ir r I r ' ir r r r r r I rrr' ag
t )t:tn t i tlt lnint ) t i; ( de (i ' i (rC .t:( ,e b rud p ' i .l ta ti l ,rrti (A l aj ol ani l e qi r:' ;i rtl i ,.
r'rl :r : l i ,r , t lr ; ir : olulr . , 1 !i 6 9 :1 rs e l l i ;i r' i i h l l .,1 9 i .i ;Po l rot' i ci Li si P ascr,l $31).
l"l;1.)-

t[{'cttunl

inlranelraxialtr

cu loziu}i

lr}ultiF}c dc nerri

eratrirni.

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\1 ,\i t t , tl , r r nt rlr lu tl b (i .t'
/ ) ' \ it t , I nt t t r t l ] nt tl n !u i i .q 1 L (l i l rri ] o i t, ,U ,i l l entoul .ti S cho{.i),l tu+
'. , tt tI t , , ,rt rt I tnit ).tl;t'tt ul ltti Dljirit.t, :ti,ttl,ro'ttt.t[itrltfuLitrr a[ !ui, ]Le|/toklI', ttllrrl lt,:lr'tittt xrrtr.h utt i;tlr:t1itr,
oltr:t,nir ittferioard) .qlrtt tiduae selri,,logic
t,r rlr , l r rrrjrrrrlzii itrrr I ielliJr lclil.ieaoI)1r'rililteta][ jn1'eriotr.t! (r'esi.x,t.lintl
i. rr, || r i, t ir Lil( ' lr , ill) i (i i o l l tl l i i l l i ta tr!i rl c i L u l l l a re, i .ri scl fi ti ilr]neor.i :i i
'lc o
r 'rr i rrl lr " . iL. , . 1 rI i . r()(,j II 1i { . ri e ti p ta h rffu (p l i n l ezi i rl ea }rel gi i ci i i ri l i ei l )
r ;rr fr l r r I r r liz ir r ir r r ilr rtc l l tl i a , l i tn b i ;,o u :rl i .)fi o si cu fasr:i t,ub.ti r, ai ,,,,ti ,ri ti
l'. ,rrrr i i ,,' ; r lr r r r r iLr I r Li i rt l ri p i i g k )rl rl u i (p ;i ri i c z i n n ca fi l l ,el or r.arl i cui i l .' ,,al o
: r, , tl r, ir r t , r r i|r . lr r l 1 r;r'i l i r,:r-h rr]J ta | i tl i r:g i l tn e a i -i rLl bar
i para rri trI i :rl i i ).
I rL l rrl r rl r lit liy , t : t t , it ui r ri l L l tl tr s i i x l to ttr, ]-.tj ti l tz j l t nerl attrl l ' l rt zonc j rrl r' t,olr r rr,', r'r illlr r lr lc c io 1 i 1 _ l rrrrl i z i el ri b ,ttrl a l :i i i pel cl hi i IItr i pri n l r.l l tzi rr
rrrri rr'l o I r r I l, r ' l| s lr it [ t I ( :l] l i i (r' i o :i l ' c ).
'' I t : ; r t lt t ) t t t ul li ti l ri ' l l .i :: (s i l i (h .o i tl l tI n u ol 0ti l Ll i l i nr]-,i g1111)
i .,!rsl i
r lr ,l r 'r l r ' ; - , ir r r r iz
r r ollr i::i l t r rrc l c trl tri l rn l ri g rrri (I]i, X ). tr,l l duri r sel r;n]r,:tj r,
rti . so
l :i t i r r;1. i )r tl l l l l ()
lr rrtrl rl rr lt r . r r r ipr r lr r liz i l l ' rrri rrg ol a ,ri rrg o -r.r,Io p a
, r o',l ri tri rt r , r lr r z ir r t t r l, ri r rtu i rl l J i s i :i fi t!c i a .u l i i l l ti n[)i r]otrrl l rni (,fl i l l l rl rr
I r'i rtrtIl l' lf lr z lr l, r r lr i | rtl i l trttc z l js i /rl l .rr () h rri i i i ] ri l rrrt,sl r,zj1t.r'
o rrr()
l :i l ,' i l i Ir' i
t rrtL Il rr|rr I r ' r ' r r lr i,
t r , ir lizi rrrl s i rtrl n tz trl l tr.i l )tti ,l ll ' ol .l tl ri tt (l ,otl r si l ,i r' trr.,
ll)ti )). i rr lr r z r t lilt jr r ( ,l ,rtf :r i rs o i .i ;rrl l ri f,' trl L rr l r.trrl rr.l ol t-r,tl l i n l r' l i t,l l { ,,r
, , , r l ,ttl tti r lr lilir r t r r ) , t ' rttl i rtl z .;t
ri r,,i r,,rttrtl i ri ) l i l i rrtt ' i .l l t trui l i ,,t:l t
| 1 l ' \r'r' , I ' lt ilr )
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l ' ,) E i ttl tottr t l lt i St lt nt r ll 1 t ut lt ot t ui t \ t lt ) : 11) int t l) r r t rr lr t ir t t lr lc lczt

tttri i tti tcl rrttl tti 1 '; lgr vslt it t lt l r r l : l lill( lr 'lt llli slr illill ll( ( 't 'sol, slt t l lt lilr t 'r r lt r t
()
l rl l i l rtl rrl c l t,k,ttt t r iot t lt ii v: r , 1or r lr it t ; t L Er r lr t ir t lt git 'st l t r lt t lt llt r t 'izt 'lt z; Iill lllll
Itt:rrri prtr.l rl i zi cV Olill', lir i, illir , lr r , i, r 'zilt , r '\ 'ocale, st {, r llo( il( 'j( l. ln, sloj( liir lr lt llli
'
ri, tlaoezului.
'.i
('{inthomul
s})in{}-]iip{ )sl( i(') irrlr'rl
vag'o4 )-ELnrltontrI lui Jotl;:'rttt'
's ( t it t t r t t r r r
l rett{ l ; paral i zie unilat er alii a r er \ r ilor ct anioni I X, - \ , \ I
irirr
t()lllrillirl(ll
helniparez'i
le cal'c se poatc asocia o
.lirlrLi ) ,si \II,
(
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I
t
t
I
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tLi ni l [ei rr' ' i A l rj our nir r c, ] 935,
196i ).
lui -{r-el1is, Srhurirll iii 'lrr('lis('rr
-{rn aruintit an1,eriol'cir sin(lroan}tlB
l r,i rrt,cel tl l ai ad eset j de or igine l}eliiet icr l "i I l|] coli r i. c 'r t 'iililr t r '( 'ir lr r r li] .
cl l.ezultinil dinir.o-leziune l]| ]}el]-il(' r.enpo.ti\ i h lr;r t.lul g]i||I]'ii |'l||)l(l
(}
DoBteri{}lte san al sr:rliuhli rctluntili&ll llr r'l1L'le (irl'rlli ilr r'lil'(r s'illl I)l
iir:r.,srt
rtu.l,tttt
ir:
l6i,ni
dir
rezultii
elc
iluso printr_o ati'gire br lb:_''ii,
(litr l|zirrlri
l }Jedsebi iu,noruitl, intrlr, SaI etitrabull-litr e, ii nttrtrtti rrll('oli
trlll Irrlrrrrr)
srlli'lililtl
fie
i,usct are,8:lre realizeaz:Llie sLrferintc pnr nulleartl,
(r\l)lit'rr'
oc
zt,)l}c,
tiirr
r''ertl'
folrrr.L{iril,i
pirr nllcl6,rl',1,ci li aie altor
'frel
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tc'iot'(l'ii;rrrt1;lrr':
ltnriltlit-:rr
ll.rr
si
''xlir
rgOi, !os""
;i cohb., 1969: trir-rpor-:iritsi colttr" 1llE0; I'oltrrlilirr 'i
paseri , l gsi ). fn acest e'nlf im e ( r it z1l1in[ se m ui lor t c lolir i t jt 'sit r {lr r ) ir r r r l
(le lrl irutl'(l rrl('
t)rue. ,,cla!icoil ,\volli.q, Scbmidt sau Jtif lisoir' ci rie fallt
'iio,ttu".n,, 1"llsclilalc bulbrre
\1-itllcttlrttr'.
olir-lti
asindlom rctr.,
,'.tio,,l
i.itt 't
Jlrltttt
19El;
si
|trsdl,
(I'opovicirL
r;espectiv sin(lr{lrr interoli'll )
.ol ab., 1f180).
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xrrrr*rtr
(uL l.u,iD, jt,i't' I' sit'ltuttttrl ltr'[ 11-'1[lt'ttbt:r'11
sittt",rc,niu,l,':'et]'o-()1.i1:qr
tetizr::rzi s.riri.l':ri'
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r r l r t ;r r , tr tt l i r r r l to ttt r t'r i i l r tL l r tt l i ) l l l l r r i || I ( 'III||i II
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irrrl rri , rir r , r '. t t 1l' t r t k rttti trrr' tr1rirri ttti ,Irrrl -i i ' Iii ,u l Jcl nl l (fl ol ' (l o.$fl l ori tl l i i l l rl Li
lrr,i r.* i l ii,r r , lr r r ilr r ilr r i (tri g r,rrrri rtrrlIi rl rri rri r (l c o b i cui i udoml l l ] vl l go-i i pi nl l l tl l
r.:rl o Io l lI l, o l) u1; in& 1 ,i n s ; c o r' D ttlt,l i rl o trrL s i n l Lcl ei i vesti bul l ,ri si nt l :o{l ,r1]{\
rrrir.r'r,srr,l,i,
r[c irndc rezdltii rin ;rt:t,tr';.ittdt om vestihulo-cclebelos, ctl m&r(!
l czi utri i l
m i a trn i o !i l &l c ro pul ni c de l artca
r
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r r r i- i, s inorg
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,
l 9 6 i ) ; (e ; l i n droamol e bul bare nucl c:t' tt'
r L i rz!)rI lr ( , i, ll) 07 ;
iz,,llrk' (Avcllis, Schinidt si Jackson), care in mod exceptional lezrlltir'

;i;'"i;f;, :'k'*;;;' *r itl*iire

},iind pe prirn
o"itnlirau ; (r) sin{l,roame

1960);
rl., scncibililal" (SaradiiSvili' i SIr,!- ,\t-cvclidze.
r'l:r,rrI.rrlbrrr':rri
lrr lr,.rrri:r,rr,,.lr.zi(.alLerni
pc fali Ii pc hornicolpul opus;
l'rmo rlgnzi('ir,
r.rr lrlrrriri,ttt'slczic termo-:]lgezlca! contrulaieral:i, ; cu tulburriri dc sensibilgczicS,hilatel'ale pc faJi, iar pe cxti'cmititi doar tle pa'rtctt'
lrirr,lr { r'r'tmr-it
,,trrrrii'lozitrniii 1g1Sinoro:r,me\Tallenberg ii,ri, tull:urili^ dil pa'rtea cor'(I1liJu, 196i, ciir-r,tcle Popoviiiu qi Pascu, 19$0); (h) Cazut'i
,.rkrl r,,rr,rt,lc
, rr Irrll,itlllriilt' s, nsibilitrr,t,bilarerah llc foir'i,pre"uul 'i ''aztiri cu tulbllr':ui sr,trzil,il'cbilate-ra1c,dar lucitlizate tloar perioral, inciusiv pe 1imb5, ctt
:r.:rrlz ir.tSr lr,lt ii cul{r,b.'i9G;,.
'
cu interesa'refi
de sindrom lTattenbtt'gmai' entiinser.
t,,,riit srnttolc,ltice
qi suferintrl
gi
ast
ciazS,.
(l${'l})
care.
1965),
19i?; Scholjt cohb.,
t),rrlirri,
i,rr,l,.ilor''r'r'llnicniVI li VII $i chiar alectarea fasciculuiui piramidal (clt
1r'rrilrr,rozi'1,
controlal,cr:t'lii), sau forme in care coexisti' qi trulburdri vasor,r,rl,oi
ii (ctr orractci' :tltein) fi llgii hcmif:lciale'-&sociate-tneori cu algii
lr,,rrrir,rrr';rrl'it1c
corti,ralatrale(lsch, 19;7). S-t relat-atsinlrcm'tt'lsub-bulbal
,l t t i ();alrlii (crLllpocstezie faciaii, siadrom cerebolosqi ClaudeBernard --palte, hemi:lnestezio clisociati qi eveltuaL hemipa-rezri
ll.r'rr.rl rl. rr,r,r:r:a'i
dar ldri atingerea ncrrilor , I-XI)'
r
r
rr
r
i
r
ir
I
iii
rtlrtrrilaieralS,,
lchol'lt
1 lrr
.i r',rlrr,lr.(l1ili5) qi l?0poriiciu 1i colab. (1980) au -rclatat,. qi sindroamr!
{le paralizia perechilt-rt'
irrslilil;c si de sintL'om Pa,rinatd' 52111
\\ rr'llr.rrlx,rlu
supe'rioar(')
)iittts{r.i, Icl'in l"zi:Lne;iaarl.rci |crcl'ol.Jtl'{c
Ill r .rr,'il\
rizualc de rip uc'"ipita).crt hAm!anopsir',
s,',i ,i,..,,,i.,.-iirlllrrrtrrriasocjr'1e
r .r'ilrlr coli irLlii satLalcxic (Ilcyer si col*b., 1956; tr'irchor-$icolab'' 1961)'
hemibulbttlu'i
li ) flitrl.roirtu,LLui lJabinstii_Jageoltc sau' sindnmll
'rut,t,,,t. \iu,lr,t,,ul clqsi" ,l I'L; B';hinRt:i-\-ageattc sr 'aract el i zeazit,.lli,'f,',,i' ruir, tt"rniftnr.'r:is",ll bcmiplegic nohtralatctali' plin ll('llri
'rrr...l,.zrr'
p,' benricoti:ulronlralale[a1\sipe.llelrulafa ]l)nl'
Icl r,r,r-iulg"zicli
somlrir
(ipsilaterx]c),
lllteropu-lsie
Lhr,rrl,r, IrIi|I tlisrncltir',Il,sjnergie.
-prl'n
ocglurllrt'
de
l'elopalaLuft.
(,r'j
plin Lerrriparllizie
t'lt'il:u'' ti ulr(
.tulbur';rr
iphll*1''Iali,o corzlr vocalc'
.r rl. r,tt Iritc ii Jlriu l':lliLlizil-l,
7 | sittrlrotntr'l lui C estan- Chenatls este asemd'n5'tor cu sindrorlltll
t,', ti,,r,it,*i.i N,ignnrt,', irr labloul clinic asociind totdPauna (pe ,lin'{itr
,'i,,rrr,.rrilkrr,cestui sindrom) qi semne datorite tnei - leziuni * nuc.toullll
r rt|l)i*I , l0rlpoctrY cu o par:]i;ie. ipsilatera15,a I'[]ului palatului \i 8' corzii
ltt'i Dei'tart se caractelizeazil' prin crizo vcrlri'
,\ ) Uirul,totnt+I,lLutJleLtIL[i
nislt'[inrus orizottl*[
r,ii"r"'iri,i
*ii
si",,'i"1..
1,t,'',ir,i"nitlc 1arl,c:rlcziunii),
braiTelor sPro
plin
devielea
i,iii',ii'i',5i ",'iti?,tlt $i/iau rotatjor)' liur:um 5i
lt t l, (' ll

l(fzlllllll.

l e Potttitrc
l\) il in tht ru nt,tt
lizt,ilzri,, solrriologic, o lxurtlizltt
I ) fiitxlrtn ,ttl ht,; "ill.it.t(t)d,-(il.bld.r.r'rr
(10 l )n' l ' czi l l' l {l l l pl !l ' l !l l zl l r
rrl i rr,Ir i, ' I r ir t if lt ilii,ilrs i L u l r' r' rl l i ,i n s o { ' i l ,i i ' ,rk r o l l i cci ,

tttuilrlrirrltridlt,pl rrxl'rrltt,illl rlilrlopir';li sl,tltbistttrolrv('1'g('lrlr,

l)t'c(llllr 11l
rlo o Itorttipltrcziis:lu Ltotttillt,gir,r.ottl,tltllttcrill?l.
l!) lli,nilrotnul, I'or:iLIc irt,lrtior sau sindromul Itr,i llot:i.llrt-llillurrl-'
(irLbl,a:se ca,racterizeazS,
prirr prlldizia rniqcSrilor ooniugatc itltr ttt'ltilot'
illr'o palirealeziunii (,,paralizieconjugatii direct5,"),plin paralizitt,lrcrvikir'
(.I'lLnicrriYI qi YII, iar cind leziunea depLqeqtezo ele dosi:tloalo l,lrllfii'
rrpilrc qi o hemiparezh contralaterali. Se poate asocia ,si o hemialr('Nl('zi(r
rlternii facio-colporald (facial5 ipsilaterali, fi corlorall, disocialil lr'tlirorulgozicl, de partea opusi,).
3 ) Bi,ndlomul lui. Grenet satt ,,paralizia sen.zit'it:ri"tnutt,ci;ltir consfii
rLirtl,l-o a,restezio faci:lll ipsilaterald, (de obicei termo-al61ezicii,tlirl tttrt'oti
:i globali,), ;i ilintr-o anesteziepe h.ernicorpulcontrolateral.,{t[r'st'rt,sl
rusociazlo paralizie ipsilateral5,a rnuschi]or mastioatori ;i ttn hcntisitithottt
r'orebelos ipsilateral.
4) Bi,ndromul lui Raymand,- Cestan (sau' tiptttl str'perior al sitdro'
ttului lui tr'or:illb) t'ealizeazia,semiologic, o paralizio a miqci,rilol corlitl$Ltt"
rr,loochilor spre partca, leziunii, alterarea sensibilitiii,lii supelficittlc r1ilrtrri unale, semne cerebcloase (ataxie, asinergie, dismetrie) $i milcr:,lj (lo 1ilr
.,rtrbric" (atetozice sau balistice) la rnembrelc contralatoralc.
i ) Bi,ntlromul lui Gelli esl,e asem:inXtor cu sindromul lui i\l illr,rrl ( lubier [i cu sindron]ul hLi Raymond -Cestarl, dar reaTizeaziu1ri' 1t'itrt
lrlan o leziune importa,nti' a perechii \rlII, cu snrditate ;i cll r','rt isii,
plcc1111
Ui cn lateropulsii de acceaqiparte cu leziune?)Ia cnrc se iuso('iir,z:i
l)l,r'ftlizia motor-ocrllarrr1ni extern qi paralizie faciali. In cazuli]c cu lt'zitttt,r
irnportanti, a nucleilor cochleo-rrestibulari' se impune diagnosl,iclll. (lili"
lcnlial ct rln proces tle unghi ponto-cerebelos.
6 ) Si,nd,ronul lui Pierre Mari,e-I'oi'n saw ,,hetni'pa'rezacerebchxr:tir"
u lni,' Marie ,s'i Toir (,,sindromul latera|') inminunchcazS,, $cmi('|)git''
lulburii,ri de echiliblu ipsilaterale, cu clismetrie, tlisilergie $i dindill(l(x'o
llrinezle, rsi, exceplional, semno piranridale conl,talateralc.
7 ) Sind,rom,ulntioclonic al trunclzittlwi cerebral &l lui Gu'illain, llol.llrtt'I
,i ilertrand, (1933) Bau sindromul posterior aI calotei (Sohotl
'
ll,6?) se cara,ctcrizeezi,
lrin aparitia unor mioclonii velopalato-fal'ingi0ll(''
rrtlcscalimitate tloar Ia nivclul vilului palatului (',nistftgmus a1 r':"r"hrhli"),
r[lr susceptibile si, se ext'ind[ !i po mufc]rii felei qi/sari ai lncrnlx'nllli
sr perior fschott, 196?; Popoviciu qi colab., 1.973' 1980; Popovitirr 6i
I'rlscu, 1981).
,semiologic lrtlrNl i
$ ) Sindronnr,l,lui Gasperirti, cupriticle nn con1,cx1;
lrrjt riintr-un cleficit al neriilor danielli' V' VI qi \rII rle o 1:altc, rriitx'iit't
r rr hemianestezic contraleter'&l:t tcrmici, si durcroasii ('I'roncorti si l\'lottl,rttr:tli, 1960).
!) O.ltalm,oplagiilei,nlertt'1t'clettre,li lost c).prlsc dc noi llnl,cliot lir
sistemclol oolrlor)lotorji.
1rrr,l;ologia
O) Sirulntu.trn'Lcpetl,nn<ttlure (nte;c tr,eltr,lice,):
pr.',r'rr'nttt],'iatt,
utrtlt'r'1,
I ) iJ'intltou,u,l.ltti lfr:Jxr, si.ndrunnt['Ttr u,nr:u'lctt'
sILpo'iorLrii'
d,( ?itJiat pttl,tr,naufttr (srr,tr, htrniTrlallia (Ll,(t'i1.i1'
rl,totrtr.t,l,
i
n
) At\
'
prrtitlizir,
il)silltl,orillii,
lil
no
it
1[
Il[-lt
cllro
iz('rr,zir,
rr,t'il,ct(ff
lrlitrh'"o
Ir'rtt'ltii
' .tooilr,zi1,ltort
pctt'r'llii
ti;tit,t'ozii,
o
stt,ttltt'tttiltllgirr ('{)lllrtthll,{rt:tlii,..l'a,t:tlizirl,
:r
llI r,stxrl,oillliilir,n plt,r'{irr,lii
1i r,itcsl,rrptorltttiii,
lrtitLllzittttlit,liIrt'r'krltIttIitIrtlonttrl, itr {t'rtilllul lttr pt'itrltir,iot'ttltttt'zt'ttt't'frllir'.
r,lc rrurt,olrxltrlrr,tultti
lir,rr,,
| :t'i

l !(l

, \r'rrl l l r , r ilaI i/ , r ir r r r r l r l l r/rr' l rr.l rrrrr,rl rl rrr' n l i u l t{ r, si utl nntu.l \l thtt' l)t t)t
trnrlitntlttl
itr. lt'11tnrttlu.lI )| tI | | |t t ' t| | t t t . r'tt prttlllizit: 1,o1;itliiit l)cr(r(:hii lIr ,
rl rrl l l rl i i r lr , lic il nr { r i, o li l l rrtc trrIrl r' Io r' IIi ' l ,i rftrtior p l rs?i .

lixisiii si ,,lirlsesintlurattto\\ r'blr'", ltlirr alcvlism localizatle iilturr'

posterioare'p(r al't{ttil
irlr'i,irrl,olrri, in r.eciniit:ltcil lulor'(]i crre,b]ale
'rrlol
.orrrrrrrir.irrrl,i,
pirsterioari,, care complimi in rnod dlect nervul IlIr pli'r rrrrrsi lrir.iotttl poduncular (Ileadorvs, 1951).
:! ) Nirult'oameletrucleu,Itr,iropu (sau, sindroanzeleltedu,ncu'ln'edorsule)
rl,I i rrsI fol sistetnatizate(Loeb si lfeyer, 1965 ; Bodechtel 1965; Popoviciu
1rr
;,rrlolrrl r.. l9S0; Popol.iciuqi Pascu, 1980):
qj ,\ ind rot.ntelei.nferi.oare
ule rLttaleuluiroyw:
ttt Ni'nrlronrull'u,i,Claude-Laye?j ("'(u silldromul lui Xothnagel) se
r ,rr':rr'1
priritr-o paralizie pzrrlialii ft oculomotorului comun cle
rrlizrrrirz,-r
prrr'lr.rrlrrzirrrrii;i lrrin tulbrrr:ir'i extrapiramidale ;i cerebeloasede partea
r' lrlli: 1.

It1 flitulronul hti .Ilenad,il;t,

asemSnltor cu plecedentult se manifest[
1r'ir lrrrlrrlizirrotrulotnotolulti comun de partea leziunii qi prin hemiparezi,
.i rrri,'iili inrl)lrlntare (de tip coreic, parkinsoniene qi intenlionale, aclesea
r'lrirrlrrrirr.lorrii
;i tuioritrnii) de partea opusal.
ale nlr,clewluiroptt:
l',| sinr|rorttt:I.t s1.t?erio{Lre
:t1 Sittdronul lai CltiraE-7'oir-[icolercu se caractedzeazd,prin hipel'
( irrczii rl ir.r,r'st,,rigiditate extrapiramiclal5,, herniataxie, disdiaclocochinezir', prlr.r.rrrn
si priu hemiparezir,toate 1l hemicorpul contralateral leziunii
rrr, li.rlrri r',r1u{la care se poaie asociafi o leziune discrti pir"amitlald,$i
rr;.orrr',,
lullrr ri}i dc sensibilitate, respectirrult sind]om talamic, care sin1,
lrrr.rrlizrrlc
rlc nsernencailc partea opusi,.
It1 triurltrtrn,ul ltti Niaolesctt,este asemiinai,tor cu precedentulr dn',
rlrlorilri lrplrrlui tri leziunea est situati, inapoia nucleului rogu, poate fi
rli'r'lrrlrr i,ri ilrv.rrsrr
! iu'hLiWclnekinli ;i, ca atarc, se produc milciili invoL[n'

l :r tr' l r illrI llt r lr . .

il I in rlr'rr.ttt.do lctltnultQle cu]rrind mai multe grupe de sintlroamtr
(l ,rrcl r ii . \ l11 r ' r ' , ll) ( ii r I l J o p o v i c i n ti c o 1 a b .] 1 9 ?2' 1973, 1976' 1980; P optl t i l i rr i: i l' r r s r lt , 19 8 0 ) :
sllperioare se calacierizctzX, selniot) '\inrl'rrtnrLtlflrlerai cefebela{1se
lrrllrr'. lrlirr rri;rr,ritrcctcbclorlsfl homolatcraH, $i prin hipo- sau anestezio
s,eqsibilitelile )t
rlrrrr.rrrlir, lr.r'rrxr-a,lgezicil (sau un"eori pentlu
toate
|'r'||IlrIlrrI(,r'llit. Sc poate rsocizt lrtl sindrom Claucle Bernard-Ifsrner iDsilrrlrlirl, o pirlrllizie a, percchii a IY-.r, contralaterall, datoritd incmcild,t'ii
lrlrrr,lri lriiclicLLlni qil uneori, chi&r o hi?oacuzie sau surditate (clatotil;r'i
l r.zi rrrrli r r olir r r r lr r lu i n l e ri o r).
lt) N iniromul,tU
norinau'il tr:riluce o leziune 1a nivelul eoliculului
rirr1rllirrt', rtspectil' r regiuuii a.nterioare a tuberculilor quadrigemeni l1i
rrr, nrrrrrilcsi.rj,plil palaliZi:,t milciuilor (le ridicnre qi/sau de coborire Ill(r
rrr'lriLrr',rrrlt,sciits,rtiialt' cu o par:llizit do colYclgenli,t cu o midriaz5, ptllttlriicri ;i orr tl u,bolite rl reflexelor ?tpilare.
oJ Sirulroutul lui l{esxenbau,tl realil'earn un cont\t clinic constil,ui1,
rlirrlr'.rirr siurllorn .|.'aliuilud, Ll crtrc so asociazi['; 1)islitgmug disjunotiv'
rrrirx,hrrriioc rtkr- t ol,r'a,clo
tii, l ttlbnlilli pupililrt ,,sipaleze izolote (lo ntlr.vi
I I I ;i I V. 1,)strrrut sitttlurrri de suft'rinlli il substrr"n{cicenufii porirp()duot,rll(!
Ltrt'ttlor'
rii rr,IrrrrrtIr,Ir,IciIorrgit,urlitlt,loltosl,ct irtilto, ptitr protr'.te oalutir:tt ztlt',:t,t
i
tl
sttl
i
rrl
o
tr'
,ttr,trtl
rtrti
Lr,i
trttrt
,
p
rrrl
i
c
ttl
i
rl
tl
i
p l rrl trlr r i lx x lt ' t ior " r r ' t
l x{ l i orrl l l l tl i
i r,t l rrrrr r r r r iiI r r rr'r,r r r rp l i i r y trtr' * r i u ,l ttl i ru rs l q i , r ' i t l tl i t' tt' , xtr IrII l tsrtt' i l t,Iti 1x' t-

l{)(iliI
rolnnii Ii/sr,u rrrrrlisrro1rl(irrot,ico
(Aqgin,tr
,,siVrriu,,11)l-rl3;
l.)01xrvioiu,
l'rtyrviciu f i -^Dgiil,r, 19ii8; Aflgilur li cola,b., 1975 I l'opovi0itt i1i
coltlt., 1980).
II) Afecliun,ile inJec,lioases'i imunoalergice d,etntnah,i cercbral (polfur\tcirfitlitels de tip inferior sau superior, rombcncefalitele, sclorozr rnull,iyrli"l,qi afecliunile demielinizante inmdito) produc variate tablouri srrniologice, cu configuraiii variabile, complexe, de lcziune a norvilol orlrriolri,
rle cele mai mult ori nesistcmatizate.
III) Bolikt eredoilegeneratinte
.:i d,egenerativeimplioS, do ascnrcll{ll,
k'ziuni ale nen'ilor cra,nieni.
A) S-a conturat incleosebi entitatea clinici denumitS, paral,izie lt .
lr.r,rd,
Ttrogresirti (P. B. P) a adultului, care realweazd,r'tn contexi Bemiologio
crr:ifectarea ilegernerativi, a neuronilor motori din trunchiul cerobl'l|,l, lrl
|Jpecialai ultilnii{)r neryi emnieni (do Ia perechea a Y-a la perechea a XfI-rr,).
.,\celsii, P.B.I' I'eprezintd, doar un $inahom in cadrul unor variato lxrli
r)curologice. In tonrte raro cazuri, P.B.P apare in mod singular, oil oonsfituind cle cele rnai multe ori o modalitate cle debut a acestei sufcrinlo
rroulologice. ln cadrul P.B.P: unii autori inclual qi aspectele serniologioo
din scleroza lateral5. amiotroficd, (Norris gi Kurland, 1969).
Contexl settrioluoie
Cele mai multc ;azuri tlebuteazd, cu tulbuldri de vorbirc (clificu ll')l,t,i
de fohalie, in special cu rinolalie), Apoi se asociazS,dificultd,l,i in doglui,i{ia lichiclelor lsi a solidelor, atrofii faciomasticatorii, faseiculalii po linrbil,
;i pe muqchii rnaseteri qi tulburi,ri ile masticalie. Iieflexul faringin,n rlisp:lr'e la multe cazuri in plimele faze ale bolii (Bonduelle, 1965 ; (iirho
qi Kovarik, 1970). In alte cazuri, imediat clupi elebut, s-au inst;aluh 1,ul
buriri de respiratie, uneori gr&yo (Black gi llyatt, 19?1 ; Castaigrx) {i
colab., 1971). Completa paralizie a mu$culaturii masticaliei duce la dl,rlorr rrr,
rnandibulei, iar afectarea orbiculaluldi buzelor pelmito scurgereasalivei rlirr
gura intredeschisai,'Asocierea aproape constant5, a tulburlrilor dc doglutilie duee la acumularea salivei, alind impresia unei hipersalivalii.
Palatul noale devine imobil qi aton, pemitincl regurgitarea fluirlokrr:
pe nas. TulburXrile de deglutilie sint frecvente, ceeace face necesartrirrl,rorlucerea unei sonde nazogastrice. Bolul alimentar sau lichiilele Du pot fi
l'c!,inute de citre buze, iar gura nu poate fi suficient de bine inchisX,. ltolrravul este, de asemenea,in imposibilitatea de a impinge cu limba alinlontcle in fariDge, motiv pentru care t^z^ reflcxS, a rleglutiliei nu poato {i
rleclanFatd. Bolaavii se ineaci uqor cu alimentele.
I)iza,rtria este frecyenti, $i evolueazi, rapid pinii lzu anar[rie. Ao|ul
soapir,prin nas in timpul fonaliei, iar corziie vocalo sint in pozilie &nol'rnali,. Dificultii,!,ile iniliale in vorbire sint proclusede hipomobilitatoa limbii,
Ll ca,r'ese atiaugii, paralizia pa,latului moalo. Bolnavii n[ pot pro]rur|,lr,
rolect lingualelc, tirnblul vocii captrt5,o tona,litatc nazalX t;i dispa,rornorhth,tiu, vocii. l,ipsrr,clo inchiiloro contpletl zr,glolci, palalizia, mrrsorrlai,rr
rii
t'iit'iLralo tosl)irr11,io
buzclor', cit;i i,ulbLr
cornplotanzii tftbloul serrriuloilio
rr,ltulbrrrtrrilot'tlo vot'lritr:in I.r,l!.11.
Atrofiilo ttluscrrlrrlotirrl' plozrrnto rJi vizibitc. lrirrrb;r,osl,o Iltrsorl,,
rlin prirnolo[rr,zo
irrrobilil,
irrcrl,
lrlo lrolii, $irrtrnrrrrrltr
ryill,rof icit,.llo irrrrrrrrrrrrrr,
tn:t,url,r,,ti,
lrlclil'ot t'r,lirrl'r
rrlrolilt,tttrtryoltilrtt
Ll oxrlrttotrttl
sl,rr,l.io
4i lu *l,rlngo-

l :l tl

l: ! t )
|

11

T
l ,rt rl i tt f ilor ' , r . s il r lc rrrrrl i c o ri r,l l l r . f.l l o l rro rrl ci tl orl l rsl oi rl j l l l rrl ;i l ,r' l rl l rrzrrl
l ;r.rtl l o lilz li, t t t ir iiir z i rr i rr r,rrr' ' rrrlr.trrl l { i c i l ro l ii . [.]rrtroti l ]al l tl i zi i l , qi l l 1,roIi rr,
:tcr,sl , ot ' t t r r r f c lr ilr u p o n rL i l l ro l rl rv i l o l s i ;i l i rli co cl rpul tl tci t cu aj ul ,ol l l l
rrriirrilor'..llrrscit-rulirliilcrrpa,t
prr Iirrrbi, }r tulseteri $i urr0or.iii pe musculatu| rI

llu I l ( 1 1 t .

S l,r rlescris tulburili ale motilitiiiii esofagiene li gastlointostinal(j

{lirrrrlucllc, t965; Boutiin qi colab., 1971), precum qi tulburlri cardiaco
i trlr Iiovrlscrrlare. Tulbut'ilile respiratorii pot fi cauzate de pareze al(l
rrrrrsorrlirluriilt:spiral,orii,de para,lizii ale corzilor vocale [i chiar de crizo
lcslrilrrlolii centrale (Carala$li colab., 1966).
l)(lgcneratea ciiiior corticobulbir,re, relativ rar intilnitii in P.B.P purir,,
;rrlrrugr'i
t'lcrncntesemiologiccde paralizie pseudobulbad. l,.,eziunilecentliLrl vr'11r,tliivi duc frec\.ent la tulburdri circulatorii gi respiratorii foartc
ul it v{' '

iladrc nozologiee
1) Paralizia bu,lbard,progresiril crotui.cdla adolescenli qi la adul{i
;xrirl,orp[rea fie ca,Jorntd sptoratlicdrlie ca Jormd,eredo-familiald. (Colmant,
ll)?it ; Malkland qi DaIy, 1972). Diagnosticul cle P.B.l' puld poate f i
st.rrlrilil;numai pdn examenul anatomopatologic, care va erolude leziunil{,
pilir,rnidale, P.B.P apflrut5, in ailolescenld,a {ost consider.ttii ite Marklanr I
li I ralv (19?2) ca o form5, particuiar5, a bolii Kugelberg-Welander.
:!) Grw)ul sclermelor lateral.e amiotrofiod (S.I'.A.) cuprindo 3 tipuri
lrt itrrripalo,in ca.rcP.B.P apale fie la debut, fie in cursul eyolutioi (Hirano
ri rurlub.,1967; Brotly f i cota;b.,1971).
.r,\ !l'i1tul sporudic al B.L,A. cuprinale cortextul clinic de P.IJ.P in cel
o/odin cazuri (Nishigaki, 1970 L972; }Iiiller-Jensen Be1'nhardt,
1ru{,irrlii
;
Fi
ll)7;t). I,'r(.{,vrr1,a
P.B.P in eadrul acstor forrne sporadice de S.L.A. es1;o
rrrri rrrarrrla biirbatj decit la lemei (Girke qi Kovarik, 1970; Rai qi Jolly,
l1)?1; .Nishigakir1972). S-a raportat o creqterein ultimii ani a, frecvn1ei
irnnoi bulbare fa!d, de forma spinal-d,a S.L.A., indeosebi in jurul qi pestc
vhslolc rlc 50 ile ani (Dazzi gi colal:. 1969; Campbell, 1965; Sahar lllrr t r , 19 69 ).

lr) f ipul ,rd,eGuamt' reprezint;, o asociere intro S.I-,.A,, parkinsorrisrrr1i rlcrncnfi,. Tipul ,,de Guam"'prezinti mai frecvent sernne bulbaro
11iriyrrrsl
irrilirle<lrcit forna sporadicfide S.L.A. Tipul ,,de Guamrt are o evohr(irr rrrri k'n1t1decit celela]teformc (Ilirano qi colab., 196?).
l,'ol'rn(r
dt) S.L.A. asemdn[toarecu cele ,,de.Guam"seintilnesc, se pare,
r1iirr l,)rrropl.Nu s-a putut insi preciza nici un factor ereditar, nici subIr':rIrrl irrfcclios plintr-un virus lent (Gibbs qi Gajctusek,1972), deqi so
prrrrrcii uilt, multe ozuli cu sindromde S.L,.A.realmentevirotice (Popoviciu
:r I'rrrr:u, 1.980).
It,rlalil tliltre complexul parkinsotrism-demenli, si S.fl.A. s-a velilitrrl lrr l5-2io,( din cazuri (Brady ;i eo1ab.,1971), f:r,pl.ronfirmat 5i do
:rllii ((lrrlrl;r;si col a,b.,1966; Bonduellc si mlalr., 196E; llla,it 6i cohb.,
lt?lt).
c,) 'l'iytrl tril,ilar tle iS.7,...|
., r.lesttl rlrr lar', plczirrlii u l rarrsrnisjrrrro
:r,ulosorrllldourinlmtl, ia,r scrnnolebulbalo sint tnai frecvenl,()((1as1;lr,igrrrr
ri colirlr.,l1)70I .llilrr,tro;i r:oltrb.,J067; Ilrrglrtrs[i Jol]r]m{!,11170).
il) I\tuli: itr, hnllttrni,lttolyninti, tlitt, uytr,-tisrkt ,,t |.nt,l.i
i rttu.xr,ttlurt

t) tllntlit rtttrstulurirpittuli in.lutlilii (lnxr.lrr.

ltr.i ll trrl.niqIlo.llurtnt)
, tt tlclt'ttniltistttgcttr,lic (trlri trlrrsrrrrosivirrri,osurrurl)
s(r l)oirl,r'irriurli rlr,
llzirrrri lrtrlllllt'o( l ) t'rr,chtnlLrr
,,siVrrstr,ll:r,
li Illlnli{fr, 1001I M rrrncrrl,hrr,lrrr'
llli0). r\('o!li col)ii, incii rlo Lr rllstrrlc, lr\)zirLl;itl,rrlbrrri'r,r'i
rlc xrrpl 1i rlr,
rllglrrli(ic, alr url filcics irrtrxltlcsiv,rntrxlibulil csto ciizrrlii,lirrrllr lr,llolilrr
,r trrflcxclc lmllta,r'edirnimtll,c. Oclo rnai rnu]bc cazuli rlccrrlcrrziiirr lrrirrrul
:rrrrle v ia!,ii,.ltr forrrLclerua,illcniglc, cu supnrvie!uiro pirrir,irr rrrloicsr,r'rr
i , I rrlbuliirilc bulbalc pol, fi intilnil,e pin5,lzr,douii,tlcitni (li rr olz u li ( Nlu l ln l
'r
r colrr,b.,1969; Ilriul f i ltrnofy, 1{}71).
q ll:tlrrnthr)
ltl Atrotia nyuscu,lu,rd,
tpinulii juaenild ( boala l{,u11r:lltu
l otntctelizeazd,prir) |l,ttofii spiuale proximale pseuilomioprbiccr,iillr. rrrr
,1,,1(.nninism
gonetic autosornalrecesiv (Srrith qi Patel, .l.t)65I l,'rrrlkrrrr
r,ollb., 1969; Namb* fi colah.,1969). ExistL $i cazui slor',r(li(l(,.
lrrlrli
,rrrrir,Ileryilol(franieni(inclusiv bulbari) a putut fi demonsl,r'ltI, lrl :.i1,'i;,
rlrrr crrzrri {,\{eadowsqi colab., 1969; Narnba li co}ab., 190{,r.
a) Atrofia musculard,spinald,lo,rd,iM(boala Yulpian- llcll hrrlr l l,) ;rlr.
zitrlr'i,un dcterrnitism genetic de tip autosomaltlomina[1.,dlt,rsirrl ,sirrrrrllo
, r,zrrrisporadice(Cazzator1969; tr'rieil SiDmery, 1971 l Zellrvcgrrr';i('olrrb.,
llr72). Doar puline cazuri plezinti ,,silczinni bulbare (Dyck iJi I rI|| rI I ) ' r'|,,
'
llrl;,q; Bobowick $i Broaly, 19?3).
,1) P,B.P in alte boli degenerati,t:e.
Dintre atecliunilc degerr.rirlir',,
|lr (riue poate Si apar5,P.B.P, amintim:
tu) Hi.potentitnea orlostalic.d,(sindromul Shy-Drager') s(r 0r|r,olr,r I
z|rtzii in plimul rind plin lipsa transpiraliei, rnanifesti,fi sirrrrPrrk,,pir.r'
,llrr.ll controlului sfiloterelor', sindrom palkinsonian, atrrrir.,ri sr.rrrrr,.
lrrrlllrlt'.
lt) Sirtlrotttrl Riley-Day este plotlus de o ('legcllerarcrr lirlrrrrr(ir,r
t , l iculare a bulbrrlti, cu inl eresaLeaqi a newilor bull:ar'i (Ilrtrurislcr',I l)i l ).
c) P.B.P asociatd,ou surd,itate $i. cu abo.fie opticd. losL rlr.ro is:i rlr.
rrrli mulfi autori, f6rd, a se putoa contur.a un sindrom ^apaltc (il'r'ilk'l 1i
colllr., {?0; Boudin qi co1ab.,1971 ; Serr.atricefi Gastaut, .11)7il).
tf) P.B.P asociaid,corcei cronit:e Ilurttittgtol cste litrli (lrnrli rjr
Vrrin, 19?3).
o) P.B.P asoci,atd,sindromului Bteele-Richardson-Olsaewsk
i u, lirsl, r'r.rrr:rrr,l1iichiar tiin articolul pfinceps al acestol autori (1964)li (l()lrfilnrrlri,
,1,' l.|.hrrn:rnn si colab. (1969);i Constantinidis colab., (Jt)?{}).Astn.l,
$i
1',' lirrgii selrlele cuntrsrute t1e acestui sindlom, au fost des(rrisollr lorrrlr.
r,||rltl' r.uzlr|i .i tulburdri tle tlcgluli{i,..
'iJ P.B.P d,sociatd.nL afectareo,altor sisterne; nucleii nrlzt'rrcr,lrlili
t IiorrrIrrt.IIt.ri
colab., 19?0l, talamusul (Van Bogaert Si oolrrl,.,[Xifi), (1,t(,
r"'lrl (\':rrrJJogaer't;icolab.,J965; tsrbwnellqi cotati.,
tOfO;.
!) I'.tj.P a*ociald bolilor paraneoplaziceale siste.ilu.lu,i
turtttr. l'.1\.1,
rtr tottltlitul umri sintlom tlc sclelozii lateriLlili,
amiol,lrliit,ii rrirlrrr,,oltrrzr,,
rr losl tlrsctiir in cillcinoa,moblonhopulnronarc ;i allr, 1itrl r.i rlt, til,r,'r'r
rrnligtrr, (lllrrirr qi coLlb., 1{}(i5; (iolline qi S'rxrlst,1
, ii)0?; Nor.r.irr
1i
r"olllr.. l lXi9).
ll\ ,\iri qt,hrlltiu .si sr./r'lotaltrlrt(l u,tttiulto,/irrrr
pol rr.lrlizrr,
l(,ziuni
rrrrrllilrlr..r'orrrIIirrrrIr',
rrL' trllt ikrl, r,rrrrrir.rrilrrillrlrri 1i porrl,ili, ICtrlo
rrrlx[lirrrl rl(.r{.1ilt l (tiiur,r',llt,':i) r.r'iirr lrrtzr,rr{lrrrrrrri i.li IrrI r,rrI rr rlo lIrllrli

l t r ' l : r l r i o g l o s r r l :r l i tr g o l r r r .r r r i i r .r ',r ,o r r Ir Ii r I:r l l r r l tr r .i :r l i r r ;1 r l i l i r o r i :r l r . l t r n ,l ,.

t r r r . t r I r . I o I | | | i .r I rI I i I t I ' ( ',t { | l r ( .t.l i i r ' r |r r .l i r I i tl :i r r r r r rr r "rI i r r l tr r r |o z i l i :r l r .zi r r r r i i

l: l{ l
.d

l:tl

a per:eohilol
IX, T, XI qtXtI gi rii1,
Si
ilcrimind,rntnsu;i
]:fllpTlglo
lr:tlrl uorros 4riforico
(rospctiy
lniduva cor-vioaH qi bulbul), ocle tloud, cauzo mdi
I|('ovonro Illnd Bclerozalaterah a,miotrofici (inclusiv sindroamele de SIA)
qi niringobulbia. In. aceste-situalii se nai impune G*; sd; fa,cd,un aUgl

p-iimetor segrnenrccewicale-9i
j:i':lig $il.or9r1ial gi fald de com-prosiunile
{uo.r)ulDurur,cal.eartrg-neaz6adeseatulburxri paretjee Ei atrofiee Elos<iruur)gol|,rlngee(boala I:9tt inalta, .tumori ale giurii oceipitale, iumori
llrl ltmedu laro tnalte, glioze mie)o-bulbare,pachimeningiti hip'ertrofied
cetljcalcinalte E.a.).
, -, t') lnyJqlo1ati.a.lui-fVprnickr,afecliuredesrulde l,ar.i,cauzald"de o
tloliciant[,_
de thiamina,(de obicei ]a alcoolicii eronici), asociazA,
o oftalfii{i.
I
otalS
o
ala.:i
ic
si
progrcsi.r.d
demenfi,
(Vicl,or
qi colab.,
),
.(ldeyai
JI,.lr:qio
071; Iilank
gi colab.,1975).

O.

PNOBLEME
DE DIAGNOSTIC

IwpaRauzu

3,1 EXPLORAREA
SEMIOLOGICA
A DEFICITNLOR
MOTONII

'tJ
i 'l i r,l .

,..1-r' ,,r,

E:plorarea seiniologic5,a tleficitelor motoxii (p&rezogl I&_

nrljzii sc faoe prin :
7,) Examina,re:| a,teutd a m,otititd,lii actiue (s a voluntare) ca,roroprozint:i ansamblul tle'nrlgc[ri pe czre un individ Ie oiecutd,in motl vohtntnr,
incepinalde la nivelul celulelor giganto-piramidal'oale lui Setz dln cor.
l,oxulprerolandic qi pin5, Ia nivelul muschilor striali, care Blnt axocutorll
dilecli qi nemijlocilj iri miqcirii. Se procedeazS,
tottleauna Ia ca:atninurt,
not,ili,td,liiactit;asegmentara,
adicd, invitind pacientul sd,execute tn nurd
sistomatictoate miqeirile fiziologice,alin toato ar"ticulagiile,obsol'vlntlu,ro
{1uatontio amplitudinea, rapiditatea qi precizia executdrii lor.
2) Tottleauna acest examen se comptleteaad,
au: a) aag oraraa,fotlai
nnnculare segmgnlure}.b) probele speciak pentru depietarua pareaalot
(lrobele lui Band, llingazzini; .Gr4sset,Vasilescu, Ba,rr6 -Iiohuror);
u\ enarnenul,
staliunii ortostatice(bipeda,uniperld, pe virfuri qi po c{,lciio);
rl) euam,enul
mersul,ui,al saltulwi,unipeil pi al Jugii; e\ eaptlorarea
molilildlii
ytutiaa(a tonusulbi muscular); t) enplorareamotil,itdlii.dutomatai g) ertid,enliereaet;enlualelor mifcdli, si,ncinetioe; h) eoid,enlderea
a:anhtalelor
ni.ycrlr
I inrclunlarc,
3 ) Semneleasoaiatesint deosebit ale importante pentul. diagn.oatlaul,
lopograliaal paraliziilor: a) atrofia muscularf, importantit $i progrosivd,
ilno{itX de modificfui de excitabilitate electriod,inrlicd ils obicoi o lsziuno
r! Trouronulnimotor periferic i b) nmdificdrile refloxelor ostoo-teud
inoos6,
$uta,nats,a,rticuliro Ei dccelaroaroflexolor patologice phamida,ls il do
,,olihoraro" (sinoinezii,rofloxo ds trip16,retrac{ie otc,) contribuio ln, treD,
rt ,l,oadiagnosticului diferqnliial lntrs o leziuno do neuron motor coutlel
8o,uporiforio,
4 ) lluantenul, elcol,rioolaaia, emmenul, fr,M,Q,, paameai, oto aai.
(lsu protiodsoinrlicnlli d0 dia,tsnortlo
rfl(rrdoEi alte euplordri newotiaiologioe
littp gra{lo: lozlnno po ncruontrl r. otor' fi0ntru,lna,upor,lforlonl lo 0o nlvol,
lsliun6 muBcIlor[,,tttlbrrrnr,ofunollonul{,ol,(,,,).

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ts

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'ii
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T
!) J.'uxt,1tl,r'uitt
lritlittri lroitlrrli plrrtlttsiipt'irrstlltti.tt{rrvIti'rtIttIittt'(ot'Itt
llt'olol
rtL' sislltttttlttivtrtttlrlrl-ltltzilitt),
zir at'iololorplllattttttlillttc
i)tr)(1('s(r
lr' ;. rt.
mativo care comprimL pittirit'ttlporttin, boli tlernit,linizrtn
' 3l Purapleeia paraunl'rald este reznlt.r,l,ullc'ziutiilot' I ti I It'I Irt It Ir' :'ll
lobuftui paiacintrdl (meningioameparasagita'le,tromlrolkrhilri tlt' sittrtr
lonEituclinal, sindroame bilaterale ale suferinlii a altelelot (j('l!fl)I'iIl(| itI| | ('r'i
oar'6etc.). Este important de relinut faptul cd' dcficitul trtolrtt' lrtrt lr' l'i
precetlat sau inso-tit de crize jaksonielle loca izate Ia nrt'rrtlt('l| ittiirtiorltr',
de tulburf,,ri sfincteriene.
'lrecum $i
4l Parapteqto-prin leatuni nt'ultiple.In atelo- $i al'ttli{)s('li'r!tzrrtxrt('brali,,'multiflel"e hlune de clezintegrare ischemicS,pot a,fecta,t'tt ltrtrciirltrtrr
fibrele corticoslinale ale membrelor inferioare la nivelul cmisli'rrrltl cllrr
brale (centrii dvaii, capsuia interrri,) sau in trunchiul. ccrobtrl, Irrlt'lizlttrl
t istt ttr
paraplegii sau tetraplegii (cu predominenll pl raplegiei). Pfi n t ttrrtrrt'r
iimil-arJse realizeazfi p:r,raplegi1leprin ]eziuni multiple din sclororll llr plii('i'
din unele encefalo-mielite, din boala lui Little q. a.

n ttt, n t. l ,rL l tl rti cotobrl l hr I)r' i tl i l ' i \' {r si t,tt

)) I t t oot ' t t 1' , 1' p rt.t1 s ii.ttt
tt.l ,r,u
r rrrl rrsl i r l, ir r r ,I r ot t lt l oll tn e (s trl rrl rrl l r,lr'
, ' l l i rl ttta l , i n traparenchi ml tos), i tl tcoso
|'r.rr.lr Ilr hr, Lrrbct Ouloame, pat itzit ozt: ill1,r'it,cril,niene,
:lJ It n.r:cfulitele, enceJalomielitele, boli ilemi,elinizan a (scleroze muliiplir, lc rrcoencefa,lite $. a.)
1) linceJaloptLtiti inJantile
!;l !l\r , ,lnatistne crani,o-cerebru,le

:1.,3.1.L2.Eemiplegi.a spinald este ipsilaterali,, intereseazi' numai

rrrr.rrrIrlo|o,
iar'leziunea medularS, este situa't5, cleasupra intumescenlei
.'r'r'iolt,lo.l)c cele mai multe ori hemiplegia spinal5, este asociati, cu semne
r,lirrilo r1ohemisecliune medulal5,: sindrorn Bro'n'n'S6quard. Nu se conrrlrrLri rrir:i urr semn de paralizie supra-medulari,, nici paralizie faciald,r nici
:rlirzir, nioi dizartrie. Ilemiplegia se instaleazi, f6rf, ictus $i fd,rd nici o
:rll.r'rrrr a, stirii de constienli,. Se recunosc cu u$urin![ e]ementele senziLivrr lhr sindromului Brown-S6quartl : abolhea sensibilitSrilor profunde
rlc prrltul hemiplegic[' gi hemianestezie termo-algezicS, ale partea opusr,.
Nrr rrrrri pot fi utile in stabilirea cliagnosticului de hemiplegie spinal5, ($i
rrrr plirr lcziune emisfedcd,)tulburirile sfincteriene care de obicei nu lipsesc,
plrrorrrn qi prezenl,a unor mici atrofii radiculare ale muqchilor scapulari qi
:rlrr I nllrozului.
flrrrniplegia spinalf pouta Ji' reut'izatd'de :
:r) 'l'rrurnatisme. b) Mielite (virotice, luetice). c) SclerozS,multipld,. tl)
liilirrgrrnielie. e) Tumori, care de multe ori realizeazi" de fapt o tetraplegie
xpirrrr,lir,,tllr cu pretlominanli pe un hemicorp. f) Discopatie cervicald,
(lirrr'l,o ra,r). g) Sinilromul lui Mills, tle etiologie necunoscuti incS,(probabil
;rlirr rlrgcrrerescen!5,progresivd,, e1ectiv5,,a fasciculului piramiclal) so trarlrrur priutr-o monoplegie inferioari (crurali,), care se extinde lent gi la
rrrrrrnbml superior, reallzind o hemiplegie spinalS, f5,r5,tulburS,ri de sensi
lrilil,ir,1,o.

lin sindnnnr lo
3.3.1.3.Problemed,ediagnostictopogralicSi eliop&Iogenia
paraplegice,
In diagnosticlt'l sind,romuhti parapleg'ic este necesar sL so I),rtrrrrlgr'i
in mod logic $i succesiYurlf,5.toareleetape (Riser' 1952 ; -$ollcirrrr ll){i?;
'
Bodechtel;1965) : a) diagnosticul tlifercn.tialintre o paraplegi(' rii {r.,11rr1,'rl
doparaplegie"; b) diagnosticul de tip al paraplegiei (piramidalil ; tlrr ttltt
ron motoi peiiferic; pedcadon:lla' poliradiculoncvriticd, . polittrrv.t'ili|l ;
rnusculilri) ;-c) tliagnoslicul dc nivel irr crzul paraplegiei pillrttirlrrlrr (rpi
rtald qi topografia acesteia; cerebralal); d) tliagnosticul etiopttl rtgclt it"
Yor fi eliminato in plima et:tpii it tlirrgttoslilrt
1l Pseu,il.oparaplegiile
lui :

:l) Pseutloparaplegiiieprin artrite acute sau clonicc qi tr)lirr rrlllorr\

protLucfalse dAficite rnotorii plin anchilozd,;i prin imobilizrlr'('ir'rrl'rtlAr|ri'
{rtumatismul poliarticular acut, poliartdta cronicil c\-olutili) ul)t)||(|iIiIit
:rrrcllilopoieiici,, artroglipoza congenitalil, rnultipif,, coxNrNlt)z"lt'f. :t );
b) Psetttoparaplegiile pril afec.tiuni carc clolucllzri cu rttitti l.tilrrrlo
silttltttrrtrtt'
rrii, cu ltaxie gi/sau cu tulburiri t1eechilibm (ata;ie 1'rrl-rclit'ii,
r{ uluirnelnice, erodoataxii spilo-cerebe}oase'sindrollntl 1,cs(ilrrll;rrrr,rirr
rllorrme cerebeloase,al,axia frontal[ a lui l]rrrns) ;
plin tulburili psihice : t,pirtrrplr'g..irr
" rsllt'ilrr I
. tr) Pseudoparaplegiile

:1.i1.1.2.Paraplegia poale fi realizati atit de leziuni ale neuronrrlui

rrol,or' rxrrrlrftl, cit qi de afecliuni a1encuronului motor periteric. Oa atare,
rlirr rrrol,ivotlirlactice, in acest capitol vom aborda pe scurt pamplegiilo
lrlirr lrziurri r1o neuronului motor central (cortico-spinal), care pot fi re:llrzirl,orrl numai Ir nivel spinal (indeosebi),dar gi Ia orice nivel al lreYrnrrrlrri, rlrcr"r,sint interesate fibrele piramitlalo (ad.eseacu realizarea de
l,.lr',r,plrrgii).
Nr: vom permite ca in continuare s5,abordi,m separat problorrrr,lr rkr rlitguostic topografic qi etiopatogedc ale paraplegiilor in sensul
lrrr';1rrl rlrrl'itril.iei(atit piramidale, cit qi periferice).
l) I't,ntp[egl,u spinald,. Forma cetu mai caractelistici este realizatii
rlrr iririrllornul de sectiune ttansvers'i,, care intruneqte o para'plegie cu
insolit5, tle anesteziepentru toate modurile ale sensirrlrrrrrr,trilrr,rnirlir,Ie,
lrilii,.rlo,plroLrmSi de tulbuli,ri vegetative qi trolice, cu neti, limitale snbprin apreciereamodilrrziorrrL'r,.
Nivcltl leziunii me:lulare se poate preciz2r,
l'iciiliIrl rrrllorolor qi l nivclttltri trrlbtrdrilor rle sensibilitate ;i, in rnrtrl
olrligirl,orirr,plitt crrrrnonul l./.0.1i. tli prin rndiogr:r,fiiio $implo Ii prin
rlo rurni;trr,sI,.
lrrrl,orlrr
(simiLt,t'o
rlo lrrrrrplogiospiltrr,lii
srxt{iuniitt'rlnsvot'so)
'|'ir,Irlrrrlikr
1tol,lli
tultnltt'rrsitttti
In(nlulrlro,
tnirrlil,c,
lroli
rlt'
crrl6
tnr,i
vrrliitt;rt
lrrrrlizrr,l,rr
llt'oottsc:
r
lcgcttot';t'1ivr,
tt,.
rlrrrlirrlitrizrrttlrr,
lroli
1.

r | | i r Z r) . : tl ) a Z ta .

paraplegice Q(ul,e sutt,Jrnrte rultitl, t'uslilrrill ritl. ti'

2) E'Lt'rdroam,ele
r rrrrrioalcle probleme diagnoslice :
t) Mietitete(transl'c*er in spccial,drtl qi colc tlist'tttiltiticsirttrliltrzr')
rilol,ico sau bactericne,antrcnc:izilil nttitl tltltmalic, btttlrtl, o illirtr' l,irlrr'
lrlogio,ctLscrnnepiramidaic irlso{,itc.sir.ltrt'ulblrrir,r'itlc stllrsilrililrrlrru"iislirrrr
i,'r'i,'t,", t,u sau JarL seinnc prt'tttttnitolii gcntt'iilt, 5i/srtttltttttologicr'.
h),41.ial,o-railitttl1el1tpv'iN1i1t(r'cttpttrlit'rtt.icln-1talirrull,ictrIo.ntt'riltlr.
i l ( , 1 1 1 ,r l r l l d 0 o b i t't'i n t' r 'o ttt'Ii Itti I i tt ( i i t'vr t zi l t', p ttl i tttl l |l r l i zi l l r i r t,l
( 'tt |,r 'o l tt( i 0 r tstIttr l Il ti r l )
i {( 'l l l ttr 'l {'tl t' l |,zl ttttI
P l | g i i s r t t t l ,e t't'l t,p l 0 gii ( :r ,r l t's0 l r

l,rrl

+r'rrziiir(scrrrlrr'lr.
r':rrlir,rr
r.,ilr 1rloIorrr.rrlrrrrrrIrri
i, lr,rtllrrrrluitrtill,otlgrr,lilirr.ic
I r r t t l r , r 'i | , i c r r ) l tti n ttr l tz{

Ir r {fr r l l

l l l t'

tttl r Itt|:ttr ',

t 31l

t: l
A

c) l\l itrrl,irtt.[ntt
t t,tiltlr l' rl tr.rrlrrrrttri(irrllritrrplcgii,lrl)oi ilr r'\{'llll'i(rt
lol,r'r
t lr\rzrlrlir rtrol,otii,ttrllico 1i vt,iJrrl,itlivtt,
r,Ilrrgiir(1ll rrit,r'i LttIIrrrtrr,t
rrrlr,lrnr
rrr cvoltLtica,st:otttlrrnlri
lji r,trrrlr.riir,r'cli1i
iInclvil()r'clltlli('i.iJ{)llLll(t1f
,lrr lrrzirrnotrcylaxiu,Li (irrrltrosolri
pilarnidale) Iipscsc..\Ioclilii iirilo
irr,rrrrLclc
rrr 1,.(l.li. sirrl, cl,r'actcrisi,ico.
tl) l'olk nieli,ta,&cut{i e ltri. II ei.ne-Metlin intli, totdeauna in cliscu{io
lrr rtlr copil s:l,rtIa nn indilid ti[5r, mai ales dacai,s-an conse]l]11:r,t
sclnno,
1rllrrrorri1,olii infec{ioase (febr5, manifest5,ri digesljiye $i/sau respiratot'ii
'rll,clrrrlrr,str:i,r'iigoneralc), algii poriferice, ce{alee,ytlsi,turi, radiculalgii,
.rlgii rrrrcl,h:, fa lialgii, semne meningeale (subiective gi/sau obiective).
| 'rrlrrlrlr{iir, loate ti dintr-odati' masivd,, hipoton:i (,,paraliz izr,de dimileairr') rlcsclisi de West), cu reflexe abolite, sau sepoate instala doar o monolrl,'{ic, cventual paralizii parcelare. De ^obiceifenomenele generale qi meninu( rl(i l)r'ecod partrliziile cu 3-5 zile. In unele situalii, pierdelea blutali,,
rllrrrrrrl,icii,,
a fortei musculareeste impoftanti, qi ertins5,, atingind mu;chii
rr.rlurilor', i:r,itrunchiului, ai membtelot, cu extensie chiar la nivelul mugchilol irrrrlvrll,i de pericarionii bulbopontini. Atlofia rnuscularS, este precoco
si irrrrortantd,.
q N euromielitn optiad, ( oftalmoneuromielita, boala l,u,i Deuic) debaji,rlo obicei brutal, de multe ori paraplegia precedind semnelede nevriti
I rrrr,z
opl,irii,(Dri,ginescu qi colab., 1962, 1963).
l') Ilxistd gi cazuri ile scleroad,in pliici acutrit, care realizenzd paraplegii
(rrrrr hrtrrlplegii) dramatice, flasce sau spasmoalice, cu senrne plramidalo
irnl)r)rl'lntc. Sint frecvente puseele de paraplegie acnti, in cursul evoluliei
rrrrci scloloze in p15ci. Puseele evolutive de mielit5 in cursul unei gclerozo
rrrrrll,iple pot sd, se declanqeze cu o ,,tragici brutalitate" (R5-":.fgP",
g) A.lte encefalornielitepot realiza in contextul clinic malifest5,ri para;rlrgicobrutale, I& care se asociazdqi semne suplaspiuale.
\) Spond,ilita tuberculoasd (boala lui Pott) trebuie suspicionatii totrLrr,rrur,in liulrr unei paraplegii acute la un adolescent (indeosebi) sau Ia un
rrrlull,. l)itgrrosticul este u$urat prin prezenla conira,ctudi dureroase ;i it,
rlru'olii colornci, dar mai ales pdn evidenlierea ghibozitS,lii qi a altor semno
rlrr plri,lrrrryilo
vertebrald,.
i) llr,nrtnu,I primi,tits rah,id,ian al ltti Ewing poate realiza o pa'raplegio
lrrrl,rr,lj1,Lr, copii qi Lr, atlolescenli. Djagnosticul se verificS, prin imaginilo
lrrrl ioglrr,[icr: plulifocale, in geocle, pludver"tebrale qi costale.
tumori primiti,De se,usecurl.darei,ntrarahid'iane,intra- sau extrn.
.iI JLl,l,c
rlrrlrr,lopot plorluce paraplegii acute gau cu ingtalare rapicl5,, precedato
rrrlrnrrirrlo o sourtl periorLdfl tle rahialgie qi ciaudicalie spinal5,.
lil l[t,n.in,go-mteli.tasifiliti,aii a,euttiintfi, astS,ziprea puiit in discufio.
l) Il telom,ataciile (rumolismen'tul, total, transaars li ranxolisrnentul
ttpintl rnl,rtrior) pot realiza fie paraplegii, lie tetraplegii dramatice (Lazot'
Ilrrlr. l l)?2).

ill 8 intlroanzeleparaplegice ou insl,alare lant-progresiud,:

t) f*:lerozn rnultipld, (S.l\[.) realizeazS,cel mai frecvent un ast)tnenolr,
I'ir,lrlou sorrriologic, cu par:lparezd,-paraplegie spastic5, piramitlali evolul,ivil, (url rn:r,irl(losoi)ou puserrri). Iformele ou evolul,io lont progresivir,, liiirrl,
qi.fi,rll rr,ltoscttrno
mici r1iinoorto h mombrolo Buporioa,ro
lrrrrlorrrjcu s{)rrrno
rlo sclorrrzi,rnull,iplii lirlioii, rlosigLrr,lrloblclno tlo rliul4rruslin
nrrlrlrl-npirrirlo
rlilirrrr rrl,irr,l
crt trtiolil,olo
orotrico,ort cotrrplosittttilo
tnrdttli.tt'o
rri ou i!nrllrloi.

rll lrli,cl,it,lc;r,
rlil,i,lrrs1tit rr,lr.,
llrr olrirr,i, ittnii, rrltttttt'ltt
r.l,it.jrrlol
srrlrcr,iotrro
ttcvlrrriltlrrlr,tr.lrirlilttziutttlr'ttr 'itriLllitnc.lr
r,rr
n,,irrrrr,
ri ri rrrri rIIr Irr
1
-l.zirrrrii,
cltt'ltt'lrrrtso,
llr,trlltl,rr
rrtr'rrrltrr,lc,
r,u sr,tnttorrsooiiti'tr
vcslibrtlrtlos.ir,.,r,rr.uri\nr,
S..\I.Itr1otrttrr{'iilrrrrrltrsctlo irrvi,sl,igrr,{,ii1,
crtnlial potrlt tr i.liuglnosticu1
r,l.r,
trrrlir}e1,ice
qi imunoelectrofoletico scljce, I[il| rlr ,i lill|s rljrr 1,.(j.1,].rrrlrr0
rrlqrrrnerltein plus pentru diagnostictl ,l, S.II., ilsr, cltlrr cr{o ru't.rriil:r,
;lstii,zisocotiti, ca o JJoaU,autoimuni rle aut9ag1gsi11l0
(l'clrrlro li ,lolvirr,
ll):14; Ila.bat, 1957 ; Liirventhll li colah , 1960 ilrlrlsrlen 1i c'lu ir., I 15tt;
I )nmii,qi cotab., 190-1,1965 ; Schapira qi Palki 1961 ; Vari Surrrlr,,'I llri? ;
l3r*usqi colab.,19i2, 19?9; Cojocaruli c,",Ja\,19?8;'Pop6viciuryi t,rrr.rr,
l$80; Kright, 197?; Colby qi colab.' 1977).
b) Neuromiellta opticd'( oJtftlmontielila, boala lui, Dpuic) poir,t;o
, y()r f i
o evolulie subacut-cronicii, x11..tlebut ?xlilllrrletic - paraplirgic, rl.5i iir
rn:ljoritatea situaliiior debuteazd,acu'l saLrsr-ibacut(Driig-nncscrr
1i coi:rlr.,
1962. 1963).
p.oru1'1eginspas t,-ttlicd,r:rt:d,oti.lili.
cJ Mielita .cro,icii,.lueticd
-(Er.b),
tui GuiLlain ti Thion {asociotorlc s,.irrrr,,
licd"u, lui XIarJun gi sin(lronr,ul
de encefaliti, cil tabes qi.cu mieiitil Erb), frqiysnls altddatir, sirl .r lr.rrr
r.te rar intil.nite astizi in practic,r,.neurologici,. Nu tr.ebuio i,Ohrqi rri lrr
rLiti.m, iar prezenta sgmlului hii ArgyU-fi6bsrtson, a hipclcil,oz.i, rr
lripefrlbuminozei qi po^zitiviratea-reactiilorB.W. si 5 benzoi r',r1rirlrr.l
rr,,
diagnoslicut.Tn plus. in pataplegia rpasmodici c1orl.-sitilit.i.r,
'.lrrilici
rr.lui Marian apar gi : keratiti,, tulburd,ri psihise importante (ca11,c1;r'r'irr,1r
qi
,1,' tip demenfiall ;i, adeser. convulsii.
J) Compresiunilemedwlarede diver:e naturi (tumoralo sa,u ilrflrr.nr!r.colii, primiiive sau metastatice, subdurale, extracluraLe sau intramoriu lllr.o)
|eailiz.eaad,,
in funclie,.de livelul acestora,_plraplegii sau tetrrrpkrgii. l,)rirr'
1,,rnj'i mulle pobibilitili de reaLizlrea dellsi[11[16e6o,' - O compresiune realizatS, brusc sau tapid se poate manitosl,rr,rrr.irr
{r'-o paraplegie flascfi, ulterior, in decurs dd citevi s[pt5,mini, 0voiirlrrrl
$pro o paraplegie spasticS,senzitivomotorie. Se intelege c5,tle obic.i
I'rrzr1,
' (rrri
ou dureri railiculo-funiculare intr-nn^terit'olil limitat, bine prociz^,1,
stu bilateral) precedd,instalmea aleficitului motor cu citeia sil,,l,i,ririrri,
Irrni, sau chiar ani, fenomen cu male valoar'e diagnostici.
- Alteori paraplegia esto lent-progreSiva, de la incerrut sDrrrticil.
,lrr de mu lte ori precedald,cu mult timp inahte de fenumenetlo clnurlicrrllri
$pinal5, oel mai adesea fir5, clureri.
- Alteori evolutia lent-progresivl nu esls precedati, de fonorncrtrr rlo
rrl:urdicaliespinali, in scbimb pot apxrea 1y15iop11i
sfinctoriene plnooor..
- Dvolulia cea mai tipicS, este unndtoaroa: mai intii faztr, rodlc'.
LrrL ilureroas5,, apoj perioadi, de clauclica,lie,apoi sindrom Brown-sdqnrrlrl
r..i,iLr shriit, paraplegie spa8tici,, inso!itd 5i rle tulburiri tlc scusibiiit.lt.o
(r'rrrctle mulLe ori Pot liPsi).
Compresi,uni,Ierneilulara ceruicala superioare prorluc rnono- s^,ll h.rrrl.
plegie, urma,to r1e tetraplegie spasticS,, cu tulburd,ri de se.sibilit;,6 ,rr
lIlvet.

Compresi:,unila aeraicd'la inletrioare rea5zeazir, o paraplegio fiptrsl,l.ft

- do hrlbul[,r'i pftreto-atroficotlc tip *idlcriin,r' rr.rrr.
insol:itir,
Bubju,cent5,
Irrelo supoliotttrr (Llr- D')'
'i
Oomptroaiunila nvdulara dmtalo ttti,,Lthaa,zi'i,
1r'oooc. 4ollioit. rnol,'rlt
(1ltnlrnlifii,ll'i rrlorofloxolor.
(tlrr,1,0rilil
lngrrstr'rliitIIttt;t,IttIttittt|tlttlrlt),
(jI t ll.
Hi

l{tl

140

,fl

||irlorl |)| | ()| |ri | |i! |(. (rrrr t,irkrrrtrr l' rIol{r'||ltirii, l0trlt'rrsr,rlirrll|zirrtrii).Axl lrrl,tlt'
piklll, itr lrolrlrtoililrttik)
Ll ttivrrlrrll)tr, lrrz, trllcxolo crr1lt,tlt,l,o
lrlxlotrrittttLl
rrrrprrtiolrtc
i ncr:r,
rliu
rni,ilooii
r'ai,lnhl
rlll(l\(ll(i
outanato
lrbd{)rninlllc
1trozonl,o,
rii itrlirliorrro sint abolite. fu stititrtlr, irt compresiunile sub Du, r'cflt-rdo
:r,|rrIlrrrirrIrlrr
so mcnlin pii,strate.In cazul unei compresiuni sub l), r1itlearirrl, r'1,HoglrrorrtuluiDro sepoate evidenlia semnul lui Beevor (itr1, de Arsoni
,,i lolrrlr., l1)?7): la ritlicarea capului $1a trunchiului, ombiJicul se deplarrorrzir,
irr sLuirdatoritd, laptului cd,porliunea superioard,a muqchiului ilrept
rrlrrlorrrinalprimeqte impulsuri motorii, in vreme ce porliunea inferiotr,r':i
r. i rlc lrirllllizitl,i,.

( lrnn?resiu,ni,le med,ulare lombare suptaioare realizea,zn parapareze

r|r' I i;r lrilurnidal, cu Bpasticitate (neobligatorii) qi cu unele indicalii de nivel.
i\ltli.l, iu complesiunile I-.,1-L,2,reflexul cutanat abdominal inledol' esto
prrrlrrl, ia,r'rtflexul rotulian (cu inchiclerela ltr-ln)
este eriagerrlt.In
lorrrplr.sirrttile Ll :rivelul Lu- la, a,tlt reflexul cutanat abdominal infelior
r.rl r1i lr,llcxul ll,nal sint prezente, in schinb reflexul rotulia,n este alrolit.
(iirrrl cornplesiunca lornbali se oxtinde spro coada cle cal, tulliurflile do
rrrolililrrlr,inftr'acii,un caractel flasc, cu fenortene de neuron rnotor pcriI r ' l r(,-

liut prcsi,unile m,ed,llla,re

s&ar ,te realizeaz5, paralizii fd,r',i,sprnne pirarrrirlrrlr,,itr schimb cu nete fenomene raaliculare.Astfel, complesinnile la
rrir r.lul opiconului (L,b-S?) se manifestd aaleseadoar printr'o paralizie
llrscii in tcritoliul sciaticului popliteu interrr, iar compresiunile conului
rrrlr I rrlirr' (S, - Su)se recunosc pdn a,bolireareflexolor anale, prin tulburdrile
rlrr st'rrsibilitate perianale (in qea) qi pril marile tullurd,ri sfincteriene, :rbia
rrrri lirzirL pul,ind si, apali, ma.nifestS'rileparaparetice.
(lonpresiu,nile la nioelul cozii de cal realizeazS"paraplegie iloar in
lrrzrrl sirrrllotttnluitotal al cozii i1e cal (r5,cl5,cini1e
Lr-Su), insolite totdearrrrr,rlrr lulh uri,li de sensibilitate extinse r:e dermatomerele restectiTe si de
rrrrrrli
rrrrli l,rrlbu
l,rrlhullli
llli stincteriene.in schirnb, s]nclroarneletle
t1c compresiune
comliesiune parnarprin l:tl-toUlan
prln
qi
dc Oitt
se CalaCleltzeaz:],
ttlbur'dni m0lolrr
motolii
rotolii Sr
si Senzltrl'l.e
senzitir.e ln
in
cozii (le
cirl SO
caracterizeaz:'i
senzitir.e
{irr,li rrr (x,Zll
llr,lir
Irrrciic rlrr li1ul supe.rior(L.-Ln), mijlociu (Lu-Sr) sau inferior (Sr-Su)
r|r' rrirriIr'orrr
de corilil tle cal,, timul (cel inferior) intrr'unin.l
intlr'unin.l $1telburdri
rr.lctir.trc irnportante.
rLlir
I'rrtrxr'lt erpansiae intramed,ulare, indcosebi cer"r''icale (glioamo
,1rlrrrIiIrrrrrrrrrrr,
i nbclculoame) reakzeafld,tablouri semiologice cu totul
prrr'licrrlrr,rrr,
r,rrrt i.rebuie cu grij5, diferenliate cle S.I-.,.A.sau de alte sil,lrrr:rrrrrr
rlo S.1,.4., precurn 1i de siringomielie.Astfel, aceste:nse manift:stii
1rr irr lr'lllrlrlcgii ploglesive cu semnepiramidale (mai exprimate 1amernblei.o
ou sllrsticitate), cu aljlofii musculale de 1,ip Aran-I)ucherrner,
rrrli'r'iorrrrr
lrr lrrrr, firr rlsociazili,tulburi,ri de sensibilitate suspendate (irritirrl) sau subIr,ziorrrlirrlo l;ip siringomielic, cu clisocialietermoalgezici. Pot s* lpa,rl
rli rlru'r,r'icorrlorrirle,plecum qi dureri de tip radicular la metrblt'le supoli.
,rrrlr, lir rlr,rosc asociaai qi fenomeneyegeiati\.e (va,somotoriigi sudollrlc)
rrrr1rolIrrtrItr.
Irnnginca rnielografic[, descrisl inci, cle Sicard Si l{i],guc1rilu
(lltJt!, cilrr,fido ll,iscr',1952),tlesemnindaspcctul in fus almldrvei dilattt,o,
riu Hculllol'orr
slrbslartlei radio-oplce po pi,rtilc laterale, snb fon:n:l lr rlorrii,
rtrIrirrrc lirriir,rtrlirstrinlrto,vino sii confiune tliagrxrstictl tlr trrruoli, irri,r'it.
rrr.tlr l:rIii.
a) I irirtllom.i tl'i.a,rrslrrttlit,tiv lr;iot'tlc t'ccrrttoscrrt,, ptin ilsocicrrlr,l:r,rrlr
(srur lrrl,ltlrr,trrzil)
pirrr,rrrirlrrJrl,
irrso{,ilrlc lrrlnrlili
Irrlrlorlrlrr l)r,r1rl)l,rt'zii
t42

,.lrrrsttlrlt'ziottitlrl|. li;r sit'iltgrrttlir'lir',

rll' s(llrsilrilillrlr,,rrrrI|r,trrlltl,r,(irri(irrl)
ittltttlr'
irrltsclrtt I tt I,i IIt tI I,r' , pt'r'tlrlttI
i,rrrlirttr,
rrltt,i
lttllrrrriti
il lItot.t)I.(ft,0|(,si
lrl1r,l,t , it,irtr,li.zr.i,il. itrl It'rt
lrr rrivtilirltrriirril.r'qilr1rl.961r,l'r,lr lrtrr1t,r
Nlrxlilicirlik,1,.(l.ll. sittl :tlttlc {iD ,\r'ur),1)ur,l('rrrrr'.
tiilrr si I a1,r0liiLrr,
rliscrtiit
ltipcltrllttttttittozi)'l'rtltt';i'
(cvelttttal
itnp,rrt:rtrit'
r.rrlr.i:ru luiirr
,.rist.r,siririgomi,.liiiu evoiufib rnili r1pirlli, .. 5l.crrj lidrirlirtrr qi t'tt ilttrtgirti
i' tumor.ilc iltra,rcrlulirtr,, siittt{ii
rl,, liniorlolin,,Lerrzi perime4ul*re't cr,r,
-d ev
gnosl
il.
di
[il
fu:rrl
e
ilc
ia
icul
,rrr.:rrtcd
(boaln
luiL'riodteichlitx'tlo tlrr't'itt
i no-cerebektase
I Deqetreresccnteksp
-Marie)
minime olorncult:ltirrtrli.tr
corlrrporl;it,
,, r,L,iloasi a lui 2ie*e
Int$'
'itrt'
rrrirllle. ne Drim Dlan situindu-se sernnelccerebeloasc1i tle col'(loilll(r
i,.r'irart'.- lf nlusi caractelul ereclo-familial tra $eazd,tlia'grrosliortl'
xt Paraiteqia spa'slicd' fatnili&Ld' a lui Btrr'iirnpell-Lorrairi', 1xr litrgri'
glrtrLiologitr
rrila,iiegia li"ait iAaia cu contl'actur5r asociazd,in contextul
.i semnEcefubeloase(uneori discrete),pe ling5,un caracter eredo-tilrttilirt'l'
hl Arahnoiditele sqiinale compresiae (diJuze sau local.e.);i-art'lmo'n itt
titele iealizeazd,4e obidei paraptegii (sau tetraplegii) insolite rle lttrr'tttt,tttr
tardivi f tle semne intinse, etajate ryi atlosca,tlistrttl
{ltrrcroase cu apari.tie
'
atingeri radiculare tlezordontrl'c, itllnrt'lt'"lii
neregulate,
rll,nte (hipoest"ezii
iruronsta,ntieale Ir.C.R,. (in funclie de efectuarea punciiilor etajat., .tl.5ltt
0rr,increqulat $au Dar-t-ial,cu lentoaxe de intoarcere la presiullerl'iltilirrliit
l'l"cljul"fiintl mai iet in pozilie aqezati decit in pozilie culcati' srtl illv{rr$)'
j\lir.loeratia(.ste caracleijslic, (Arseni $i colab. t9?3)'
cute Fi aronice t:ascwlarepot realiza palilpirt(^'r'- rlrr||
i) Mielopatii.le subct
rrrrlallegii le-nt-lrogresive, al cdror iliagnostic este extrem tlo tlifitril 1i'
face plrin"eliminareaaltor cauzerdiagnosticul lor prtNrispttiitttltt
,,,1r.,si,r,.-se
so stnbili cloarlrin arteriografii selective. Se qtie cd ischemiilr t crlrrlrrr!
pot fi realizate prin leziuni Yasculareprimare gi prin compLt'sit.tttivrtrt tt.
]rrrt in cadrul inor afec.tiuni ale m[duvei $i ale rneningdor ((irrrrritt r,ti
1972; Lazorthes, 1972)' Atotrt- ryirur'l'tt
Iirxr(lot, L966, citali cle I-,azor"thes,
r iosclo.ozavaielor lpinale este mult mai rar5, decit arterioscl:tttzit v:trr'1tr'
ct'r'cblule (Jellinger, 196? ; Lazorthes, 1972).
(BLA) este u$ol'lle rtlcttnoscttl' 1tt'itr
i) Selerosatlateramafi,iotro.7icd'
,r.zr]nt'zl atrotiilor musculare tipice, indeosebi dista,le la mern5lrrlc sttlt.t i
i,'rrt (cu sindrom Aran-Duchenne), cu fasciculalii )'li c-usomk) pitrltttirlrtlrr
lrr iorite membrele (mai exprimate totuqi la membrelo infolioa't'c).
tlrr lirrt'tlrr
lateraliiam'iolroficdpol, li lea'iiztt'1t:
de scleroBd'
k) B inal.rcamele
tle tliverse naturi, pa,chirlr('rrirr!{ilt'
rrrrrlt,eirlectiuni: compresiuni cer"vica,le
.r'r'r'vic: c liipertroficd luetice, arahnoidite., encefalomielil,c fortno .irrrlrr',
v.t lt'lrt"
iterjce"). LllrunliLListrlo
spinale (a:a-zisc
colrb., 1973; l)ragilncsctt{i r{'lrrlt.,ll}li:i,
i'r'r'rl'rrrinlni
rr,., I rr|.. I.,. inr.lr()q.r. (Arscni !i ',cen1r'opt'l
r1xi3, t 965).
l\ Stndroatne'p&roplegi( ;i lelrupleglte ltol sii aprlrii' ill Itlllnttlttrlxo
sttIr.rtltil''
ll' urol;lllui In,itut'lrclifcric.{'arovul li rrLrurrllrIr'itt
.rli,,,tirrrri;r lr'
lrrl rrrrrr:rtut.-i clle .c dilt'tou{irrzriltior, ill conlr,rlul tlitLir',rl" 1l;r't':r'Il|giil'
rrrIr.t,r':rrrlcuiileDilunithrle:groliotrti0lil,asnltilcLrl,iisa,usuborl)ni(iil,([i(1r
politttrvl'ii'oltr
i'hrllu,rt-M'rr;i.,,lrniot,rotiil0rlpinilloplr)!{r'oi;ivrr,
rrrrri,,tl.rjli,i-Lri
(!,(lr,fi
Il l ll,(11'iol
.,\lnilll,o[,l
($i 1ll,(!1t('lilgltrrrtrlr,tii),
llulir.ir'rliortlottovlil,trlu.
ltttlttottlirrlr
nttr,ttrttt
la'rc
{rlis1'r'ol'ii
lttr'
, it,,,,rrr.,ti,r'ii., I 1i'rtir,lizrrlr'
\i dt ltd,ilt
tlrr tIiltgrtrtsli11lll,
rtirl rtryot'
rrt .t'ltlr, lri{r'trrol)rrrr
plrrrsivr,,
rrti0zilr,,p0lirrriozilr.),
I t r o o t t ( r , r i t t I i i t'ttti ttl tl |j i l ,'

l.l:i

' l A l l l .l .

i|.il.il. I'llrrlizii plirr lozirrrrirrlo rrrrrlorrrrltrinrolitl' prl ifori(1

;i.;1.:!.1.Oorakt!;ii rttorfo-ttttt,cliortrr,lt
si se'nioloqiceAn lezilln' a lt(uron ul.rti tttolorperileric.
l) fic 5t,ie cil, indiferent de setliul lezi:lrlii, si,nd,romuld,eneui'on molor
yrri.li'rit: irrrplicii o serie de caractere generale : a) deficit motol' proportio'
rrrrlcrr rrni1,i,!,ilc
motorii lezatc i b) hipotonie musculari' I c) retlexe osteol(,rrlirorlsc diminnate Bau abolite; d) contraclie idiomusculari pi,strata
lrrrriila rrr gr:rd al atlofiei musculare; atrofie muscllard precoce li irupor'
l:rrrl,ii,irr crrzurile in care este compromisi, integritatea neurollului motor;
r,) plczorr{,r,fasciculaliilor (indeosebi in leziunile pericarionale) ; l) i'eacliile
rlrr rlrgruorrscon!,ir, electrici,; g) modificlri EMG caracteristice de tip neu-

l Ii gl .i ri l { r

lligeirile

l, l \ l ( r s i l
Iill)lrlIl

I ||flillrrrcu
l r l . { ' rr l l i

Dlepli antcrioli
Sternocleidornosloidieni

cr;.C,
Per. XI. crao+
c , -c t

Pr'nii ner\.i ar.nieni

Splenius
(lomplexul nrare
Drcpti posteriori
Micii oblici

Cr-C"
Ct-C'

l{xrele rlen' {rrcipilxl

Marele n.n' occipital
Primul ner'\'eervica]

S c alcn i
'I'rtlpcz

C,- Co
Pcr. XI -l-

q-c"
cr-c,
cr-c,

n.

spinalI- ramura n
ccrv;cali

C" Co

Coborirea
umi r hri

Itomboi d
IL'tghiular
Pectoral ,nic

,1

Rotalia bratulili inaiDte $i

inrpci

J)orsahrl mitre
Subscapularrl

ca
cn
clcl
ca

Rotatia bratului in ahri

Supraspinos
Subspinos
Rotund rnic

Cr cu
0r Cu

-Cdrtuclia
brafului

Dorsollil mare
l l otund mare
Peotolaiul ma].e
SLrbscapularnl

N eN ul dorsa
all rl
r lru i r r r r ,,
N etv rl l rotLrndul
n d u l r r i r r f.
\Iai Inul l i nc r\',ll t)r,,\,.rl l l
c l i ]r pl c )' rrl i ))rrl ri :rl

Abduclia
bralului

D el l oi d
Sup!aspinos

c, cu
ca-cs
cl-cs
C,-Cu
cs-ce
C" Cu

Fl exi a
4nlebratrului

Biceps
Brahiai anlerior
Ltrng supjnator

ce-cr
ce cr

\Irrs c nl o' ( uti r rr I

l l us c tl o rLrtr rrt l

c6-c?

ExteDsia
antebratului

rygrl

Tl.iceps

Co

Ii adi rl

to

l '1e\i a nri i ri i

Pahrafii
(mare qi rnic)
Cubital arrLerior

C t* C e

tt

Ilxtensia
r:liinii

Prinrul ;i al doilea
radial extcrn
Extensoflrl
degetcl or
C ubi f{ pos tc ri or

Cu-' Ce

i l adi al

co- 0u

n adi:rl

fi

(lolr:l

Marelc rLcrv

t44

Per, XI -F

t:t

Fl 0xi a p oi i c el ui
(pri ma f i a
(loua falangd)

ri t

l l cxi a i n dex tl ui
Itl ter{ )l n,s ipal mx ri
$i a mcdi us ul [i
fi doIS.rli
(D ri ma fal angA )
l rl cxi r { l tl angc l or Fl c x or c omun
(s l |perl , fi pr0f.)

P dmi i 6 n{rri ccrvi rrl i

S pi nal -l - Fl i mi i d,,i i r. f,r'\'i
cali
Mal cl c l rerv occi pi Ltrl
SDinal l- C,

cr"-c"
or--c,

l \l rrcl o nt'r!

cr , (:x
or -- 0N

N trl rdrf rcrv rk ( i l Jl l rl

M{rr!l o tr(.rv (x ( i pi tl l

{.i Ii Lrl

Irrii rri
r r iii (1(' i r, r \ |
S pj nnl
(c I.\ i |rl i
(lilll:Ll
i
N c N ul
{ (l
.rrl l r{
C i rc unrfl (\i

Ileltoid

.!,!. t

1l

S l c rn o clcid o r r : r sto id ia lr slln g

( l r n r Ur lr xu l Dr I| r ( )
sllug
S t ) l flr h r s ( l1 1l) t
Mnr'oh (lr'll.
t x r r l l' ll( n r lr ' r I) t

"--*
C, I3r*
C..

capdui

S p le n iu s
It0lolijr
crtl)1rhri
(sr'fc
drr:rl,trt)

'1'raprz

Il i di carca
rrmi ml ui

Dintat mare

rr olrn{rtlJ.
TABEL NT. I

l l i di carea
bratuhri

f0lfclt.

3) ]tr-'ris&l insii' o serie de particularitii,li ale distribuliei paraliziilort

rrlrrrrlrrrlliilor'qi ale activit5lii electrice musculare, precum $i ale unor simlezionale: a) la ni
ca'reprmit ili.ferenlieri.ale toltograJiei.
;rlrrrrrrrrrsrxria'te,
vllrrl lrcrirrrrrionului motor I b) la uivelul ridS,cinilor anterioare I cr)la nivelrrl pl,rrrlLril tl) la irivelul nervului peliferic.
lf) I'onlrr aprecieraatopografiei ieziuniior nsulonului nlot'or periferic
rrrlc ut,ifii,olrnoaDtreapri.ncipalelor ac!'inni molot'ii segmcnlo,re;i coretpont nla. i erl)etie' rad,iculo-med,ulare,ti, perifc,riaa (a. tabelele nr. I' II, III Si,
Iio. l[i, 19, 20,21t @up}" Iiiser, 1952 qi Chusid, 1970 - cu moalific5,rilo

rrn' ml ,|1' l ol s tl p(.rl onro

t,
I

N r. i l

Scurt il cxor'
Lung

i l (),i a d c gc tc l ol
Ll Lc ros l ,ti p:tl rrrri
'l [i 5
fi dors r' l i
(pri rnr ftl nnl i i )
(rL (l ouu tNl tl
' rl .{ i )
r,|l t,rrl r( i rl
(r' Ir'i rl
l r l r tV ri )

cs
c"
cs
cu
ot

Cn- Ct

C"

N erv ul l 0l l rho
hoi rl r l ri
Nen'lll llDi.jhiLr
ri Lrl N nrl li|
N erv ul pe{ Lorl

Nervrtl rnxr(hri
Ner.JulsuIs.:tll
N erv ul s l rpf)si pi nos ul r I
N erl ul s rl s pi tl (
CircuDrflc\

CircumUex
Ncrlrl sul scl

Mcdian

crbi!1l

,9L9,
o? 1)1
C' D'
cr

l)1

Itac l i al
C ubi Lrl
tr{cdiaIl
ilubit:rl

c?-, T)1

l l c di arr

l -(?
' r)r
i

(tr1)i tj ]l

j,',,,,

N { c (ti x rl

],',,,,

( l rrl rl l :rl

l4ir

(:o|l,llllalo trnbol

CorllnuarccqbcllI
o

tl

I lxl orBl[r
l){ lccrlui
llxlcrrsld
lrlU rrrlo r 4
rl{:grd.c
(primn
hlu rgll)
(r (loro $i a
lrchr ftrlanEtr)

llJ

Extcnsor comun
Plopriu al indexului qi a1 auricularului
Intcrosogi
Lombuicali

o o -o !
Cu-C"
Ct

Dt

liadial

I
/

Radial
Cubital
Cubital

Interosofi
Palmari

c"- Dr
C"-Dt

Cubital
Cubital

dductia
pollcelui

Opozant

ce D.

Median

Adduclorul
policclui

cr-Dr

Cubital

Interosoti dorsali

cr- Dt

Cubital

Abductotul
degetului 5

cr- Dr

Cubital

Scuftul abduclor
al policelui

ce- Dt

Cubital + Median

Abdrctta
(lcgctclor

Alrductia
pollcelui

10

MlgeiTile membroloi lqlodoare

L"- Ln

Fesierul mic ii
mijlociu

Lo-L

fesier superior

Abductori
Fesiexi miilocii

L, - S
Ln- St

fesier superio!
fesier superior

c o[ pid

Obturator
Pdtlatul crural
Croitor

L^_L.
L s- L 4
Lo-L"

Obtumtox
Obturator
Nervul musculo-cutandt extern

l, f lorlll (li)rpsci

Psoas iliac

Lr-Ln

NerYul crural + ramuri

colaterale ale Plexului lamba!

A l, (luc llu
c o l l p Hcl

totofla
IitlrnLru a
(roIptcr
llo[n
(f r th {
(flrll
lr 'In

'jxl

(!n$ln

0xlu
g0r bol

r40

:urator,
musculo-cutanat
interll, Bciatic mare.

Adductorii

Drept iltern
Ilicep$ cluxal
Somlte$dlrros
somllllenrbrtnos
Poplltcu
0rollor

Flexia
pioiorqlui

L4-r"6
Gambier antelio?
(Si rotalia
ineuntlu)
Peronier anterior
Lu- st
($i rotatia ln afardl
Extensor al
Lu- S.
degetelor (tn mod

Extensia
piciorului

Rotatia
piciorului
induntru

Irlexia
halrlcehi
Prima
lalangd
- Celelalte
falange

IJ

Extensia
halrcelui

t5

Fl exia
celorlalte
degete
- Pdma
falange
- A doua
falange

scia!ici

Marele fesier
L^-Lo
Lo- Sn
I-o- sr
I'o- Sr

Lr- sr
Lr- L*

t0
sciatic mare
Sciatic mqre
Sclatlc male
Sclallc poplibou intd
Muiculo-cutaDot cltorn

QnAdJicep$ul
crulal

I _.1 R o t a l i a ,

liJ

iixtcn\iA

piciorului
in alar{

TABEL NT. IIL

(l(llrclln

I
'

A{l(lrr(LinFi
|,Pr)rllla
rhgcl.olor

l tl

2l

Lung fi scurt
oxtensot

'/

llxtensia
celorlnlte
dcgcte

L'n-l't

c fl rrIl
popl i l eu

'fibianul antcrior
Sciatic poplitcu cxtcrD fll
anrenol

Gemeni si solea!
Gambier postedor
(qi rotatia
iniunttu)
Ltng peronier
latelal
(9i rotatta
in alard)

Ln- s,

Sciatic popliteu inlerD

Ln* S"

Tibial posterior

Lu- S'

Sciatic poplitcr exLot.n

Ganbier anterior
Extensor propri[
al detului mare

Lr*Lu.

Iixtensor comun
al degetelor
J-ung peronier
later4
Peronier anlerior

L._ S.

Sciatic poplitcu intern

Ls- Sr

Musculo-cutanat

Ls- Q
La- Sr

Iibial

Lungul flexor
propriu
Lornbricali ti
interoso9i
Lrngul fle)ror
proprm
Scurt llexor
proplrlr
Adductor propriu
I-ombricali qi
interoso$i (pt.
ultihele doid
falange)
Extensor propriu
Pedios

Loinbricalt $i
intr06oqi
Flexor comun
Scurt flexor
plahtar
Flexot comun
Extensor comun
Pedios (ln afala
degetulul 5)
I"omhlcall ti
lnterosoil (pcntr
ul[hnd( doul
fslun{c)

Sciatic poplitcu cxLerD

Ti}ial antealor

anterlor

Tibial posterior
Ln- S.
Ll- Sr

Nervii planlui cx[(,nl

tdrn
Iibisl posterior

vl

Ln- St
L"_ S.
Lu- Sr

n. plantar intern
n.. plantar htorn
Sciatic popllLcLr
exlcrn

plant{r inlorn il
Ln- Sr
Ll- St

Planl inlcln
plantar int(r:t

Lr* fr

plant0r lntcfn

Lo-'- Sr

Dlautmilntqr:1
ll cxl0ID

t4r

-Ttiaeps
corPr
- Exlensor
rodidlis lonqus
B{qrhlcte diaI is
,flexar,'.carpi
ra0talts
,Pqlflchs lcnilus

pallitis.
Apponens
pallicis
Abdua.f.or
brevts
flexat pollicis
Drevls
,Abduclor
Po icis

Exlensorcoai
'tudiolis
brcvis
'fxlensorcffpi ulnoris
Exiensot
digikrun
Abductarpotliais
lon1u5
Abdwlot Pollicis
brcvts

sibiifiis
Flexarccryi
Abdrc.btdigili
.flixor djgilj
quintibretlts

F,t, 20. Muqchiisuperflcialisi membrLrluisuperior(drept)'

SFt

ciis*

Atubusntdits

&

Gluleusnoxinug
.8

Gtoailis
Senilendinosus
Eiceps fenoris
Voslusblerolis
Seninenhronosu,s
Percueus
tonquS
fibiql,is
2a

Exlensor
digilorun
longus

Anloiot

Fastetilr

Irl0. lr, Mur4hltrtrpol'llsldl al mdmltlulrrtInlopl0r (droDt)'

riottrt,l(tttt iitttrltotrtrlt' , , I )()| i(t III i{|I i I I'i1' ItttItrtioItIii t lottit'it),r'iI i1iI'toltrtllrrt'
prrtilirtir,, lrrrrluttt ;i sottttttltltl tjot'tItIit'tttI
l)osl(ni{rllltf. lirllllt lt,ltt ('ill'lllrll'f
Ilr,rrriIilr,I,
itl c0pilli,litl sttll lit, \'il'sl{r.1,itl0l(',
tjr'urlo.
rlr:LrttLc:t'zir
l,ritl rl'i,tolii
rlis[alclocalizi,to1:lrnomblclt inlerioare, cuplinzir([ ittl,ii ttttlst'tllrtltt|rt'
1rr'rrr
la illccpul ou (lolioil lrr()lt)r lrrr
rrior'[, apoi pe cea gambier'; post,erioarr",!,
plc:r,irnporta,rlt, menlinind mu1t5,vreme sta,liunca fi rnol'sul (c,,trr ilttrii rlrr lrr
jlrcep[t poate lua un aspect stepat). Apoir 1en1j
]l iil rrr
-progrosivr ll,Ilriolr'(
Iolllizirr(l
o\tinde in mod simetric qi la treimea inferioarii a co[],J)s()lor'
frl,rofia caracteri,sticd, ,,in picior ale coco,i' (sau ,,in cizmii iltaJl,il,") li
lrozi{ie de mrus-equir a picioarelor, cu consecutiYletulbut'iit i rlo tttoli
lilnte, insolile li do tulblrrd,ri ile sensibilitate ectromelice (strbi()(liivofii
obiectivo). Xlernbrele superioare si]]t afectate mai tirziu, do l'egtllii ilri(,ilrl
{n atlofie tle tip Aran-Duchenne, extinsi, ulterior pini in lr'eimca ttti.ilotrirt
?r antebratelor (atrofie ,,tn rnan$eie"). Existi qi form de tl'ecclo irrlr'(r
boala Chaicot-Marie $i eredo-ataxia cerebeloas;, (boa1a lui Fritxh'tr irrlt),
situatii in caro se asociazd si tulburiri de sensibilitate profundX, cu irl,l \jl'
{prin"leziur ea fibrelor radicuiare lungi din coraloaneleposterioare) li, ov(rlr'
t,ual cifo-scolioz5,,picior scobit cu dgete in ciocan, precum !i mioi fi lirr
dive semne cerebeloaso.
4) Itt siringr.tmiel'iase constat5, lrecvent semne motorii poricariorl:rl(t,
cu sindrom Aran-l)uchenne. Amiotrofia, cel mai adesea simet'ricii, int{no'
{ea,zd,membrolo suporioare cu fasciculalii' excoptional de rar apil,r'irrrl lrr,
lrlembrele inferioare. Prezenta tulburd,rilor de sensibilitato di$o(lirLt(1
:iirigomielic, suspondate, a imporbantolor tulburbri trofice, a sindrolrrlrllri
(li:rglxtH
}iramirlal asociat, procum $i Yolulia foarte lentd, ne sugereazri
liicul.
5\ Iurnori,le intramed'ulare ti traumutismele aortebro-mcdulu,rtt(:tr'
pot genera siDdroame motorii pericarionaler asociirl,c(1ll rt,ll(\
hnnal,omi,eli,e)
$ernne comisurale, indeosebi cu tulbur5,ri de sensibilitato de tilt si|ittgrt
rnielic, de obicei inil,ial suspondaterapoi sublezionale(cu niYol (l{,5(!rr$i
bilitate).
ll\ Leziunila rdd,ic'LLlare
.mteriodre prezintr, o serie de particllllll if i,li.
I)istribulia topografici' segmentarS,a deficitului motor $i a celol'LrlirosorrrrriI
colelate a1esindr'omuhi do neuron motor periteric este identici' ctt |trit' tlitt
Icziunile perica,riorului, dar fasciculaliile musculare sini exceplirtLrtl rlrr
fur intilnite.
Pe de alti, pafte, vocinltatsa ridS,cinilor posterioare facilil,oltzil' rlso
riorea frecventi tL unui silfdron do protoneuron de tip radicnl'l't,'
1) Comprosiunile raaliculare (tumori, arahnoidile, hornii (lisrlrrl{r li
rli,o &fectimi vertebrale compresive, tumori vertebrale primitiYo s2l,tls(xlllrr
rfirrt, boala lui Fott .s.a.)teallzetuz['cele mai Yaliate sindroamotolx)gtrrli(1r
(rorvicale, dorsale, lombare, sacrate) mai mult sau mai pulin o\l,irrsr!.
llrrrliticilrils de reflexe (osteotendi:roasor
cutanater a,rticull,re'pilolrrol(,lii,
rrvsntual m[coase) $i aprecirea tulbu.rAriior de sensibilitate i],so(,iirl,(tl,r\
rlclrnatomerele respectivo tranqea,zl localizarea $i extonsia, loziunil(]I'.
2) RadicxLli,tela(respect'ia ma'rlingo-rdd'i,culi,re1c
) virc1,ieo' ltotitrtt sttlr
rlo llto ctiologii pot fi unilalrorlllo (n&i mult sritt ]nfti l)ulin oKliins(r)$rr'rl
l)ilr,l,(nil,lo.
Jl) I'olirtdia.tl.on,(,,1n
ild( lt\tl t'ollizl irttblortrii;r{,ttltlcgitltr (trtiti tiw tlorrt

.i-,i.1!.)!.
l'roltlrutr dr l.itr1tt,*lrtlrt1t,tt1rulir
pritr
li tliol.oqiritt ltrr.t,r.l,i:iilr
I, irttti rr.lt|tI t|t|)|1.t||tt,i
tttrlrtt1ntilr trl
l\ l., itttil" p rirrtt'iunulr:
l) I'olirnn.irlilr a,nlui.ourd,&u,u,l,(i,
(lM,l,(, l,ut IIein,c-llh:tliri). l)rliciltrl
rroiol sc irrsiirLulziibl'utal in decut'sdc citeva oro sau zilc, rle obicei dupii o
iorrrliilirlrlili, (lo nrulte ori inso{,iti,cle fenornenedigesl,ive,I'espilatolii
1r,,r
i.r rlr. rr,rrrrrrnrorringe&le),
dar uncori Ei in plini, sfnS,tate (,,pam1iziilede
rI rrrrrrrr.rr,{i r' I ). Sc lcalizeazd, tablouri I'ariallile, cu paralizii limitate, parccl:n(1, riur, rIirrLllotlir-Lfoalte oxtinse, tuteoli cu caractexeascendento(sin'lr,rrr l,rrt(ly). 'I'otdeaunareflexele osteo-tendinoasesht abolite in zonele
ll)il,r'rapi{l attlfii musculancDihipotonii remarcabile.
1r:rlrrIiiicrr,
l,ipslsc 1,rrl
brrliililc de sensjbilitatt-,.
')) I'rtl irtm,itl,i.tn,
o,nteri,oud,cronicd se caracterizeazS,plin deficite motorii
lrr rrllolii lnuscrrla,r'c
(rle rnulte ori rii cr fascicldalii), cu instalare fi evolutie
l{'rrl plrrgrrrgivi,,orr loc ,lizare bilaterali, !i simetricd sau cvasisimetric[.
l\l:rjr)r'ii lrljol,lrcos1iol
,r sint degeneraLive(rareori cu caractero erdo-familiale),
c,rk, rrrri rrnrltc iiinrl dc fapt forme atipice de S.L.A. (Ratlu, 1978; Trillet
rli |olrrlr., I070), iar unele cazuri putind reprezenta forne subacut-croDice
rlrr prrlirruriolilevilotiice (Drd,gi,nescuqi colab., 1962) sau sechelelounei
a,nterioat'eacute (Ileine-Modirr), in care atrofiile musculale
1roIiorrrir,IiIu
rrrrlrlir.iirlc rlotolii, dupi mai muui ani de la stinger.eaprocesului acu[,
rtrlcp ;li, so extirrclil {i si se accentucze ptogresiv. Drpi, Radu (1978)
{l \ rirlrlrrlrr,cir,ontil itli distincte a atrofiei nusculare progresiyo Aran-Duchetrrrr., r.rr,rlc lal)ir fi {l pa,raliziej bulbare proglesive Duchenne este indoielr r(ir,, rt'l,i.ii1oilleplezentind mai probabil forme atipice ale altor afecliuni
rr'lr,rrrrrIr'orrrrIrli
lnoitor (S.Ir.A., sindroame r1e S.L,.A. el,c.). Crdem, deci,
r':r lrrlnurLrrlrlc ,,lrolionrieliLiilanter.ioar.i,
cronici],devine incorect in etapa,
:rIlrrr,lii rr,orrrLo;Lin{elo|
noastre, pentt.u cazut'ilec1l otio)ogieneprecizati"
Iritrrl lrlrlirlir,bil si $e nlilizeze telmenii dc ,,sindron tle S.L.A. atipictt
rrr,rrrlrr ,,sirullo])r I )(r'icalion:t
l anterior oronic de etiologie nepleciza;bii,'r.
'l'ilrrrl lrl rilr,i IrccvorLtintilnit este siuchomul amiott.oficAran-Dlchenne,
rrr crr,r'r,
rloiir,ilrrl rroi,or qi atrofia rnuscular5,incepe la triye.lul rniinilor,
rr.:rlizrrrrl,Ir'irr rr,i,r'olil,
oi)ritentolor tenari, |i hipotenarii [i :r, interoso,rl,,r',,,rrririt,sirrrirr,tiii')
;i ,,rrrila in ghear5", dupi cale progresiuneaatrofiei
l:r rrrrclrrl rr,rLi
oll|ir,l,t1or,
tg lrzaa,z\,,m ta t1elredicator.,, $i ,,mina Si antolrrrr,lrrl rrr'Irrrlrrl,icJ'.
-,\tl'{rfia ss poate exti de qi Ia nivelul nusculatur ii bra,I rrlrri |i r'lriitI lrl rIl so[]inturalizomelici a memltrelor Supelioare.
ii:ur (lrF(,r'ir.i
rji cazut'i de ,,poliomlelitrdcronich" in ctre atrolia debu1,.rrz,:lrr nilrrlrrl utl$ct atut'ii proximaie armembrelor superioare,realizind
:r,r1,i.,lc prorrrlolrriopa,tice
(Yulpian). tr'ormole de ,,poliomielitl donicS',
r r rlr.lrrrt,lir rrrcrrrlrleleitlforjoat'e (pe glupele tnuscxlare peroniene) sint
l l l r ll

l t r r'.

'l .l nirlrol'i il.t: s1ti.tt.u.le

progresior (aniotro{ia progresivi, in{a,ntilii,
\\r'rrlrrr;1llollrrulrur, arr)io{irofiaspinalti jnvenilii, pseudomiopaticS,Wohllrrll, li rrgirllrolg-Welanrier)
pot fi recunoscute[i diagnosiricateprin car.:rc| ,'r'rrI lrrl lorr ol ic olc(lo-1atrilial, prin masivitatea sjibilater.alita,taatrofiilor
It IrIrLr|||IrIr'(|, irrirrl(,il,c;i de al1,csernne de afecijare degenera,ti\.:'ia motonurorrilol rpirrrli : rr,r'olltrxil,
modifioXtilc ll.M.G. de tip lteur.oosi.cotondinoasri,
rrrir,Io1rrrIir.,
lipst s trrrrntrlot
11r.rr
trir'lnridalo[i a,lulbnririlor d sensibililaitc,
grllr.rrrrr
'ij (.llNdl, l9?8, t971}).
1i l)t'il o\'olll{il l(n,l}1n1,ictrli
(llttt,t'.n|.
,i) IJrrylu.
(ttjr,it,iro.li()
J/o'iI srxirrzji,irr corrlorllrl f(.Ilrio
l .i
loyJil rorrtll rll ltrzirrtrtlr,rr0rrlrIrri|rIt
rrroIoli ;rr,r,iliIlirriirIjI
llr rrivirlrrl|rt'r'it.lr,
i0

( ]l l i to l l l l l {l
1 r l r , r 'l l p l 0 g i c o) , |) o l 'i ci l ,o l o r r l o l ( t i i i t,JIl ,t'i tt l l tttl ,cr i 'ttl l tl l o l ' l l Il ) 1 1 ) l tl i
(
o
tt
tl
sl
r
o
ttl
,o
tl
tl
i
tl
ti
t,si
i
,
tl tt l ti ;tr t
l t,ttr l l tr xi o
. . l : r , r '1 r l 9 t L {! l tt( ,l r r r i l l o t' ;r r r ti l i r r i t
1 1 i Ir r i r ,lt0 l i i ) t1 i ( l o [t1 ) 1 o l tr \l l tl ttt sttttzi l ,i t' r r tt
l o u i r ! i {i l , l t l r , i,o tr i r r tr tl tsf[|tti i

ll, l

rllrl lilrt(ir! :rl,il,piriLntirllt,lii,

r'il, 11ilrrI,r.orrrrrIirrii,.
X'lai rlifioii po:r,klli rrIroor.i
rlirtrlrosl,ir:rrl
itr silrrrr,!,iilrr
irr r.rrlrrrIr,Ij|iir.|,1rrll')r'iilltr.rlrrt)rinil,
lll r,iuli.cil
trrr,trrIr lrrIoI,
bnrsc
lrtrrrlrrcirtiltrtt llrlrlorr tlilic I)s(ilt(l{)ntio}{,iti(r..l)tbu1,trl
rrrrr Ir,Ir,l,iylnrrs(1,yirsiN, do .r,pl,r'ili{)(l|, or.ioevlrstS,), a,l)olirea]rtlct{ol(r'
,rlrrrrkrrrrlirultso(rlroli cn pistrrr,rear.ellexeloridiomusculare),lipsa atr:oliilrrr rrrrrsrrrrlu,r'o
in si,adiulde debut si mai ales n.otlificXrilelichidienc, cet
rrrr.i rrrlosoil(xr disociatie albumino-citologicX, vin sE,para,fezecliagnosticul
rIrr 1roI i lr rrI icrrlone.vriti. Gtrillain,Baud.
I) ilind,roamele coai,i d,eaal rbaltzeazi, tablouri multiradicuJare par"lilrrlrrrrr, rr,rlcsc:l,
cu paraplegle,4A$cd,,hilg-tp[6r ?ISflexiE[ $L s11at{oJii-rnrsortkllo. 'l'rrlburzirile de sensibiljta.tg pella4aler. in ga.Si tqlb.gr'rilc sfinetelr,ro irnlx)rtitnte ttimiln diagnosticut Oe potiomiitith; tifrsa tulbur{rilor.
,l(. ,.rrlil)ilira.h.
ucllorrrelicdGubiectivc $i obicctive)elirnfiai'dl;gnbiliaril
rlr. llzirrrrr. rnctlula:ii.
Jt)'isl,i\trei til)uri de shdroa,rne cu coadr,de cal :
n,1\8intlrom.utV6ffi.\ol
aoai,i.
ite cal realiwnzd, oteritabild; p,ar-aplegie,pet!
Irrli*i,, 1ltr,scd,,
arafloxigd,r.i1lierosird ioate $rrlelo rnusctlale.alo rnembrelorrr|rriolr'o (cu integritatea psoasului iliac) 5icu masjve tulburdri sfino_

l i i r t l t 1 i l r r r t t t ii r l i stl l l r

tl;tt i1irrtt
r,itrtl irtr boltrr,v rr,rrouzrr,L
lrit0vit sri,lltit,tninisoi ,hr,lgiilu brrsottlii,,
r', itt
illrrliari l,osliaulrIr'o
i]i 1xrrinoi[lo,]rooulrl Ii t-lttittllrttliili slittrlIrt'icrt
tlrolrlenl,ulilt cirr.eau sui'vcnit Ei lorlo ]onololilteliotr ;i l,tLlbttt iili ltt tl0 srrtrli
rlirigrtosticul tlo lotttlttr
lrili[a1,cin ;a, trebuie categoric sii inbi],ndorti'lm
scilticri ban:rH,,,siilii xe gindirn la o compresiuno in cozii (10 (,i '
rrogittrlittt
sau cron.icalan't-progrtsiuo
b) In cattr,L
rtrvi euolulii suba,oute
irr prirrtul rind la o campresiunaa cozii de cal, in spocialprin tutrroli srtlxltt
l e primitive (neurinoame indeosebi; limfosarcoame ;.rr.) sittt ttlol,rr'"
si:ltice (subdurale sau extradutale), alte tumori extrrldttlrrlc,borula,IIotl'
elcirr, alahnoidite chistice pseudotumorale, sau la comptositttti rlrr rrli'r'1,
rrrinrir. inclusiv rertebrale (boala Pott, metastaze !s.tr.)
lll) Lezi'unileplemLrale te^lizeaz\ silldroame de neutott tttrtlttt ;rt'r'i'
li)r'ic cu topoglafie palticulari', uqor de recunoscutr pri]1 ertenBla, (x)lrl'rlr
l,ului semiololic in teritoriul plexului respectiv (cervical, brahia,l, lortrh;rr,
siloritt,).la caie in rnorl obliga-turiu se asociaz; tulburi,ri dc seusibilil;alrr iri
ta'ofice in respectir[l teritoriu tle inervalie plexurali.
sanxiologicd'9'i problem'ele{k dr(llttorlio
Arnintim pe icuri colt.stela,ti0,
r:liologic Ln sindladmela pleaulare :
1.) Sind,rotnuld'eplen cemiu'l impiici : alteratea mi$clrilor tic IL'xirr,
roirrlie qi inclinalie lateral5 a capului qi a gitului' la cate sc pol, asttt:i:r'
i,ulburi,r:i reSpiratorii prin paralizia diafragrnului, prtcum $i trtll.trrtrlri tlr',
n'nsibilitato in teritoriile ratliculare Cs-Cn.
E*te reahzat de multiple afecliutti I tr'aumatice (rlt colonnli tltvi
ra,Lr.inalte), tumorale, inficlior-r,se,malformrtive {r-r'zi Arseli ,si rrolllr.,
ll)iiti.
" "'1;1'
g i nd.ronutdaltlel,iru.bdpoate fi reatizat lie tle leziuni t'rr,rlicrr
l,r', 1i'u-[r,), lic,le'tr"z.iuni-alet-mnehiuri]orltrim1 re (sllln'lioI',trti.jlrxtrt
.;r i,Ui..r:iur),Iie rlr' leziuiri rte trinchillitor sccundult -(suporiorrirrf(rri(rr
q,iptxt|r'ior), fie '.rleptexului insuqi.Ca ataie, se pot rlistitrgepatnt, I)trrittttlt'

I'rrt'jtuul.

lt) N[rulrontr isutrter'ior\ql, cozi,i,Lle ca,l.

prrlriir,l sint abolite ixl cqle achilicne qi medio-plantare sint pishate.

rt xindronuL ffirior'(sauat 1 ol razii dr aul (Io - J",). Inlegrilatea
rrrrr;r'hilrira,ntriori ai coapsei collrastcazi ru imlortaiita -.pariUzie-a
rrr:r.iclor rrrusculare po$teti0-4re, inclusiv a mugchilor fesieli ,;i gambieri.
l'iciolul cstc balant, ou tieticit de flexie-extensie, intilnim nD impo*ant
rlolicil, rlu flcxie a garnLreiqi mari tulburd,ri de se)rsibilitate perianale,
1rrlrrrrrrsi pe fala posterioard gi externS,a coapsei gi a gambei. Reflexul
r')l rlilr fi rnedio-pubian sint p5,sirate, in schimb roflexele achilieno qi
rrrrrrlio.planta,rosint abolite, lt]ulbgrlrile sllgleriene r i,irin pe primul plan.
li,.fllrcL. rrrrrlc (cxlern $i interrl-sint aboliie. Pot .'i apalri si es'care.
I'r'olrr.k, rlo elongalie pentru sciatic pot si, fie pozitivc. Teoretic ai.Ti
1r,' rlril:r r/i/i,r'rnlilttt irtrc leBiunilecorrului Fi ale ep,iconuluimeduldr.fald
,lr tt ittuilr,,'^-iIL]ertrl.Inc[ Lhermitte (1919,citat de Riser, 1952)precizase
rrrr,lr,rrlil,rrlii rlo tliagrnstic diferenlial: in leziunile conului qi epiconului
,l rlllilr s'irrl n)li ])ulin vii gi mai pu-tin persistentein membrele inferioare,
r \ r,nr iiorrnll lrri Babinski, asistd,m la o simetrie a tulbur'[rilor cle scnsibilrlrrirr;i rle rtotilitate, la mari tulburlri sfincteriene si genito-ur.inare,
I'r','rrrrrrfi lrr o paralizie atroficl importantS, si a, muqc]rilor anieriori ai
Sc irrrprrrnc;i tl,iagnosti,cu,l
tliferenlial fa\d, de afec!,iunileprostatice, in
rrllrrlcrr, lrolrravii simlind pasajul urinii prin canalul uretral, precum qi
l:tlti, rlc, ltti.tr,tti ontinpe al,epleuului, lonzbo-sawat (ca de pilcli, in invaziile
Irrrrrolrrlirrrlc micului bazin), care pot simula un sinalromde coatlS,de cal.
lrr frr[a unui sindrom ele coadd, de cal se rialic5,foarte malte probleme
rlt rl.it rttt.o;sl,ic
tl,iologic :
t,) .Ln,cltzttl rlnei, i.nstald,ri rapid,e, aaute sau subaautre,ne gindim in
joa,sii(lombarir,),la o rneningorrdiculil,i,infoclrlirrrrrlrlrrrl ln o borlll I?o1;1;
(iorr,siirr,r'ozii rlo cill, ll, o prr'i,lrtr6iro
vorl,clllllii pliu tunrot'il 1r'irnilir.ii rarr
rrr,r,nrrrlrrtii,
rr,rrolo;ttt0i
vtu't,olrt'ttlo
lotnltit,tr'.
lrt rr litttlirut'lttrrrlotrt;ri,ozi'i
;rcrrli.
t5:l

cl tr tt l r o l ' I o i tl i zl t, ttl t si tttl tr tttt tl r r t o :r l l i tl o r ,l r l ' l ) o p i kl l tt

'' "''".i]{rifl,i,o,rutde.mialiiri-tiitiio pterutr+ibraltialst cirruct.rrz{trLl

i
I
i

lrlirrtr-n paralizie c-o4qd9-t[;-exf6d"-taintreg membml superior rb$lxr(rl,iv,

|rr anestezie gtroba}i iL teril'oriul intregului plex'
b\ sintlr<.nnulsipelioi,rte plea btakial ( By'.9fu94.?q-Hrb
), itr citlrr ltrzitt
rLr.:rintereseazd,rirliicinile Cr-Q, respectiv teritoriul nervilor l-nruo$lrl
,,ltir.lr&lli al riicllcinii erpe.gle! med!4nulyi.se rrracterizcazr'iplirl ilt\lil'rl
llrrruL.i atrofin r tnrrr,.bilorllelt oid,/bicrpsr/blahial lnleliordtutg rtt;rrtrir
lor';i nui pulin a muqchilor dorsal mare, pectora tnarc, diltflrl tttrt'tl iii
rr,1,nir(l
maie. Rellexele bicipital gi stiloretli4l sint rrbolite. Tulbltli-rIil', tlt'
(.,rrcsprtozilL{)atr'((r.-("!).
",.rrsibilitate"inf p|ezcntr'-[r'derma-ioFier?tr'
r'1 sindrcmrt injer.ior,da plex broh;Ltl ( 4t,lrupLv'lM#t;rldJ, itt crrtr'
.,.ziuncrL
inlerclcazr.i'.,'lAciniIeCo-D,, respcctiv lelilrr|iul trctVilot,li:ubilrtl
pliu rlr'lii,il-lloJgliiltlut.fuulrrrrr
parli:r,l
alsncrliauutui,sc cat act-erizeazrl
li
rniinii ti ri gruputui intern el antobrat/ului' tulbutriri rlo srrtrsibili
"Lilol
(Cr-D1), llt, trlltc sc itstxriltzri(itt
lrrlir pt tL:rrniilttrneroli cot'cspurrzir,toa,rc
lczirrrloariuliorr[urii')rttL sintlt'om Ol:urtlc Berna,rrl-IIotnct, iitt tr'lllrrtl
tsl,o rr,lxrl.it.
l:rrlriCo-prrrntlt;ot'
rl\ ,^-intlronrtlttri.jl,riu ir 1'lt.t:htthi'rl .( Hc.mt,tlclitr {':rtr' l{ /ritrtrr'.rrrl
l,.11.s(;rrii
uitlrilitr:t O' tr'.plr'liv t''l il',litll('il(lrrlrlll"\llllli;i rtlfruli:rlrtlrrr.
ir.,'r!r':ri,lrlizt.irz:',
Pliri rlr,licil,tttrttot'1ilt'ltirliutt, lrrtt4rrltilllt/tl'itropx,r'i'xtr,rr

t 0il

r0r'ror
rrrui1r'ir,iDitill
ryi..rrI uu,uriri
''i,1";;;lil;l,;'l ,;r,,litt'r,
ili',,'li,lliiil:,jil

l';rLa,liz,irr
do lrhrx llrlrLiill r.nla.2r.r,r/usri
rlc tliatrtrr:,tlit,!,inni:
,
tl 'laniu,ni l,r& ryjeliq?Irr,rrivr.lil colorrngi/cerricrr,t,, inierioartr
,
li,diorr{ir,l(,Nl lxrljr)rrre, sa,u la nivclufclu,viculei, a/riL,xilei si l-[ zonelor
sujpia_ si
(.tuIi,a
irulrllrrr.ilrrllrr;
,1 frlcturi
tertr
ale
claviculei,
viculei,.luxa.l.ii
ldxaiii scapu
scapulo_humerale.
lu.humcl1l
lc. cl,irrga
clotrEai.ii
rii
1,,,.1,,:]i
l,l,l'..],,; lrir

Sl qlf plerului

ctriar..r.u
snrulsprea
I'iitticinitorl;

l,f.
,(ureori
,|,,rrrl)rr'sl|rlrL,l|f
r , rrlill',fl.llll,,li
)rl sl |l l l|t il,\rla,
il\ lt a. ca
p tl d A ia
p u rl d to ri i de
nl (} rvent,i i chimr,c a d e pil.ld,
l a purthtorii
Ii c. jintewenfii
d e (,i
cirje,
chi nri ,
_de
Icgluurdo mai SUS;traumalismeobstclricaje,cu L.zirrne:r
l:r,.r(,,1)r.:rr'r't,''ts-l
rImpllt
.nrllerii (consecutivexnui bazin sirimt, rrnei
!f::),'],1'.'.,,'::nlrr,rn
l)r'r'?r'hrirlrrrtel{'ctuo-irNc,
unei eompresiuniexercitate tle manevrele obiitetri_
, :rrr.,l)r'lr,\ll ptcxului intre claviculd, prima coast5,
elongafiei sau smul_
Di
llr rii I'julir.irrilor')
elc.
I,'\'.yil,tsa.* r(:Iiculitr ftslp?t;, rudiaut,,pntii)t'intec!i()1sr...."4oxi.c
,b\. r.t:tprr,(.,
,(
purl\ ac.tntln.
l,r':rsr.t1r1
Su.feriu,!e
tlc ditsersenaturi : hpondilite (indeosebi morbul
,r.rr. 1)
-uertebrale
,tumori Yertebr.ale,
r.(rr r.('r'vrcar)
;
i.tr_ara,hidiene ;i extrarahidiene;
lrrrr.lrrli;i rlisiocllii vertelrr'ah.;/herrrii
de tlisc cervicule._
coslt)nertpbrolc deJileu.tu
i sralarir rr6oastricen.icalii,
...,'.rt .l':'rr!!:i
.alc
:.||Inrrr|lr{,
Ni.rtcnlce,rcalizalo ^si
indeosebiprin tribcnrofja nru^chirrlrriscrj
rr.r :r.rrl('llot,crre lxgrslcaz{ ,.defiieul scalenic',(saptiul rliltre cei
doi
Ei pnnra coa-slii)rqicare iD acesl mod r.omprimi,ple.rul br.;r_
if
l,li,
ll'
il,,l
:',,
rrrr sr irr'1(,lltsuDctaviculard,
(Arseni qi Oprescu,196?; Ionescu,*popovicin
rri culalr.. .1.921
; Riser, 19b2).
,.1 rl'lrmori ale, virtulyi p.1r$g-n?T. Sinilromul paneoast_Tobias,
in
i
.
cru,.
Insii p,aralizia plexuliri biafiial, inti]ninr dureri qi un siDaliorn
,lr.

I t i || t{ r.

, { t , l il {} {,t u t.Nl.

I'ut li,ritle_d.1tt(lt sstat realizeand,rin context semiologic in care

. ,ll
I || ' .(.Ir|||I r||it 1'll'uii rilc din parlea,ner"vuluiscialic, la ca-rcsec,sociaziI tro_
tr tr.sr.n.,rlrrrr.r'ipet.inelle si lulburdri sfjncteriene(plin afectare:i
sfinc.
Ir'tllrri ltrutl rrxl;eln).
l.:, i,,: i ,
ur periJeriri pdt. fi izolate (nevrite, neuropatii),
.. l:tl r)Irlt
: ,,
: ,t (mlllUnevi.ite)
lterr
iriroi.rrr.,
rltc
sau extinse, bilatemle gi simetrice-(poli_
rrr,rlilr', lxrlirreulopatii
).
| ) I\ruli:iile i:olnle flte nptrilor pcri.tpt.;(.i
:
l) I'uru,lizia ,ner.uuluicircumJler se traduct
lrintr- n tleficit motor al
rrrr..r'lrilrrirl|llrrirl,."cr,(,r,crccazd
dificultalea,5i11r.,i.i.i p;oicc[ieiirrainle
I rrr':rl r t! t{'s-l,r{.ttv.ir
tnentineriiacestuiala urizonlt ji. Atl,otia mu)r,hiul i
| | r.|||,.||I r,r'r'r'rzi]
rr|l_rrginea
rle ,,umi,r in epoletr) sau de ,,umir tfiiat clesecur.tr,,
!r ||r.| |.| | ||t ||:I o relilxue a articula-tiei scapulo_umerale.
paralizia muqchiuIrrr l.l,r111rl
rrrir,.,impietcazii
ltri;oarea de rolalie ertem5 a bralului. liulbu_
I irrr.:I rtr' $('rrNil)ili1
Ltc sr.distrihuie intr-o ,,zonir,de r:lcheti,)' pe'fala rxternl,
ir llf)rit lrln' (.l,iU,22)u,ni tts ti,ntni.ti.. fractuli ;i rlislor::iri ale cu,pului
,......,1r.::.",,,,r:
,i,:.,'l,rt.t1iri
1r'urunrr1ir,,
(pljn N,rmcnll)o $irn de for_) com])rcsifti lN,
t'tirgr
;
:lll,,,l
rr\'.r,rl;,1,
l'';'rrtr' (l)rr,li,si{nl'1,,,
irt cut,snlsornntrlui,silrr ilr curlrul irrr.slr,_
,||lrt ;.1|.|||
Iir|| 1,.rrr.,rrr ollrlii
1(lrirlr ((l110xirl rlrr rlt|'lrort),r,rrrl0.t0xict,
(tliir
l i r rl

Nervul circumflex
Muschiul

dellaid

,qomufl culanate

Muschtul ratuhd mtc

NervuI musculoaianat

Muschiui biceps

br cnhial

lJIt t}:l ro_ liorn er .

:l) I,'arlrliziile d,eple* lom,bar

.(traumatiee, tumola,le, infecfioasc etc)rr'ri'rr'1r'rizi'|ilzilp.ir deficile motorii
cu atrufii ale coapseigi prin dureii
,.rr iIIiIr'IL||Ir{.}n lct'iloliile nervilol,abdominogenilali,-fernurocut:r,nat,.i

lr' l l |r.

, lrl(t . . t l, sr ' llr t t lt lt , t ' llr it t t lolit r il, t t t olor ,

)) L' dr't . i. r it . t nr t r u, lt t , i.. : ar . l: +( t tnt
rrl tnrrrychilor'lricops, lrrrr[rilrl iull,oriof osicot rtt,olrra,ltiit'I,r'ospccliv (1lr I):lI('zl,
Il ttxi ci l rrLelr r ir lului ( suplinit iL do hr ngul supillr r t or ') ; ; i r r ,r 'ir licli'r 'iit t t t t it t t lt t i,
irso{,itr"rde o hipol,rofic;i hipotonie a rluiiohilor lo.jii ir,ntt',r'iorrrca,
lrt'rrl'tlltri.
1l'rrlburririle do strnsibilitate sint mici (vezi f ig. 22).
h'uctori etiologici mai imporlanJi r pligi pl'hl at'mc albt, srttt tlo lixr I
It ilcl,uli ale hurnerusului I anevrisme ale alteroi Axilttt'e I r:ottrptr'sittlti
(1u'oi'csiorrale san in cursul somnului) ; nor.lile (fotrrtc rtlr).

tIr' { .). ittlr.( tio itst,,

{ - lt .
"r , t l) lr , t , lt Dt |r .

Circumflex
Ramuri cu.onle
ale antebralului

/rr.

.r. \"f\i i

c i i c url rU c \ \i

".' rs , u1oc r,l l l :rl ,

lrli rr cnbitalul :rnterior, lungul supinator qi fasciculele cubitale ale flox rtrtrlt I i
i,ornrrrrplofund). Iilexia falangelor distale a,le{legetolor_?r[-4.{t'orli.ttt.ijkr
r,irr r,sl.oimposibiki. ll\carea de opozilie u,policelrri trLt st.poal,c trlt,oltttt'
Sl lealizclzl l
Iiirrrl inlocdilS, prirrtr'-o rniScalc rG n[duZlli.ai fi,]iclri.
d, policohli po ltnlali llan r:u oolela'lto<lttgcir',t
1r,rzi(it: in a,bduclio
(r,mlna,riitttia4ri"),rtIt olit,t,ttttsolx)11('(fx I illllir
r:rrlr'lt olie rl eririnon
qi prr rnrrs<rrr
il: 'i a) . l, r r lr , xlt t lr lc it t r lt ir lt , t r ': t pt t t t t
llrl;rrt'rrrrt rI r,I rt i r,{ rrI rr i ( , 1i11.
rrrrl ui (rr,ll rt i I 'illor

r i 'l'r , sl, t t l,,,l: i. u. l! il l, ) polir , r . lr .1i r lcgr 'lt t l r r t 'iliil, ot r lt t xr r

| fi[

ll.r'l.rrzii, irn {I(,gd,ulln i jlot,iLrs. i'lrrrlurrzii,doa,r,ptrr,f,inl,rorlizind ohiar rrrr

:rH;rr.r'l,.tlrr.
,,gr.{ii.medianl,l'. J,:r,,,pr:oba,bucleil, (a tui Pitres qi ,I.estut)
(.1i1.. c)r lllangeta irrdexului Du poxte si, se u,propie de cea a'policelui,
.:!:i
rrr;lli.l irrcll;trici nu poal,esL string5.1n obiect inlre ]olice si extremitatei,
cr.lrrr'l:rllo rfrrgcte. l,a proba. ,,{g!!ilgr_-!_nsnrciqate,' (.fig. ZJ (t,), lTd,exal
rir rrrrrlirrsrrlrlmin intinse ,,in sdg---e-at$1'.
Un alt test eonsta in'iinposibili-

rtt
l rrxi co (ti rtl ' , r t i izo|r lc lr nt vt 'lul t t t t r li: r t t t t lr r i; ; r l) l'zi- t t r r r ': r . t t t t 't lj: r t t t t lt t i
r
lit
lir
'lt
lot
lot
r
t
it
r
it
rrl
ir
r
t
ablot
t
l
* i " .i " " -ti f .fn r , ""Jcar Dia8cslccr r lclet ist it ir ,

(n

rrli qi rl,rlr.rrrrrlio
irrbu{it{'
*l*ii iuoe.eio".o in t6i,iioriulncr.ruluilnudj:r,D,
(sulrr::rtlrirrtrl:'l
.i,:l;"it;-;;i", ii .i dc atlolii muscularcin terilotiultlislal
rt('
totali a nervului cubitl,l so(11rt
:
gllfA
cu'biLrId"
de
minh
icuhru
ltrittt'r
,,in
in exlensie,iar |eiilrltr' rlotti IrLlattgcitr
Ialangi a degetelor se
atitudide fiind mai exprimatn h ultimele rlouri, r1.g.lr' ;
iiu"i"l-r""".ie
jnicro$o'so ,.ritrl
frl U"e"iJ mi" se menfine in --qbd,i;ie, iar slaLiile.
qqu"a'
(''a
t,+bachc'ii
xllirt(r
primul
iii
inierosos
spal
inift'ebi
,i""ri,i".
*i.a,t- l"i S-i.rrd).'b" asnninneacrrrirent& hipofcnari cste i4rlrlizitiir I
il. ot.ti'alc, iorso 1leniveluT!or:1iuilii inforioarcrt :r'tl1r'ltrrrtttltri
.i'io f "
';.iinii), 'd'.r,torit5,cru!5,rii fleror'lui c.o1u1 prof.ntl ;i .ttlri
"rir"
;l;;;ii;J;i
la o pozi{ie a nriinij cu ullimele d('ui ilogcl( rrl
,-nt".ioif
^liiltn
'rf.lri
Ji P;i" piralizia intelosoiilor se compromil tnilciitilc rl'' ubrlrrr'lir'
t[\;;
ite degetclor; e) beficilul Ino-torinrcres"r'zi 1i tlcx irr' rtll i
"i-0" ",Oi*i*
aore i"g.ie, ddeosebi a degPtuluimic' precunL.)iudduc!irrp'rli"
t"fot
par[ial aceasti tulburaruptitr miqc:lrt':ttlt' rtlt't
lui (bolnavulc6mpenseazd,
ctthiLrrlrrnl .t i' rr
t) ParaliziamuqchiulLri
medianl;
nemrl
riii". .*ilt.i;.p"iir
;;;i';;;,;;.[ un tlcficit rl adduc!iei!i d llexici rniiLriiigr Testul ltti [rr'rtrr.trl
ailtluctoniiui policelui, in sensul,c5' bolna'vul tttt izlrtt
;;i;;ifi;t
!;irtiria
mina
un ziar siu o hirt'ie intre policele intitrs .6i irttl.r
cu
i;-t";6;i;;
doar prin flectxlea ultimei fala'ng-ea polictrhr i- rti
rla
face
i;l';i;;i;;;;
i; policelui, rcalizeia prin ucrvul median) l-h';,Test'ul tlt: ,,r'ii*
;rl;-;;;;ll
iir',r,"'i, deEetelofi atunci cind r-niinilesint aplicale una pcstc it'lli) l'r'rrr
e:trem6' de par,lli
ti,tele lor pa*Imaro.qicu degetele_
_i.nabduel.ic
P:";:':i
iri{ir'
intre tlegol'tr

o r)istanli rnult, mri micd'

,"ie .". .iia"tiirre ina14"
"fi"
cu fala lrLnara pe rnas[''.rrriti
fiind
a6ez-atd,
trlina
ii
,i" o"tLo *X"Xl.asXI
iar txrl, t lr'
ciegeigluim-j

f f ;cu mina.plasat'icu Ia1* ltrtl.

iutmrrii"t" ri" Oegetului-midiint'ebOIitA
cq d.9gc-tul.l4jq(scrrr'rrl
poat'e
zgiric"masa
u'ul
sd
tru
;;;;;;
'piir"rtrrr.rsd,bo"6a
localiTate
sint
d!
Tulburi,rlle.
r.r
iri
se=qlbj-titaLQ
;
4" ilSY*,f 'l:':'

Fig'
i,

lr,l

!1. ,,LL,r iL :lrrru,i)lj

r -

Pa.alizjr

x'i#A#il
ii ;';t;
Iti"*g*xil],*:'*g*r**gttl'*tm*'"'11"'#

23'i

vul'urlriltl'-t'ut'tt'
i,
i;,.;:;; se
a.'.^"; cu-caiacter
i,,'r'qraat,ercauzalgic;
carrzalpic:m)-Tr-rlb-u
m) Tulburirilo
riU,,eo,i
asociazdXi
Ii dur'cri
"^."^-;"";
;rr,.rrorii
si t rofice se intilncsc atlobeain lelitoriul nerfulul (delonntlll irlr'
o*c,i"ioi."a pielii, cianozd, pielo lucioasS' qi subliatfi, txlt'tttr.'
;;";hiii";;
ovdntual chiar ulceralii a,Iedegetulqi mic).
I'rincipotii faalori elinlogiri: a) Leziuni IrcunaIl( la.nivclnl coi ttlrrr
r,,,,r,o""ttirihuninrusrtni 1-di raI,;'plngi ale ncrvului l& nirelul itlrlcl'ril
rniiuii (adesea o.1io41'so-;iliziunea :lrLeleicubit'al'';1contlrtr'
i,ii,,ti
"i
"
"f
inaIe pc osul pisilolm (par'rliziir ir'liiiiiiii ,1" 1t'nutito. nervo:l,sc-tr'rm
',(trotti
'.{.sto,]:it'tciia1"
g;'dle d'eJileutuisoalenicrco:tstii'
ntii
ljlor"'l: b iU
'?bm
(,:rlli; lri])( 'Jlrofiarnuschjului snllcn an[eriol, cu ingu"l:rt'ea-,,deJilottltt-i
pot ap,lclr irr/lrl(s,/lcltil'/li'lrri'
rir.rr,Ir.rrii . i ) 1 ,'; r)aolile rultilale ittTec!ioase
(livct'se
a.
tnalurie
viroze,
lii('i'lii
9.
neruth,i tatl'ial se carrlcterizcaail'1tt'inlr-rtsct'itrtlo strttttt"
:,:,),1?araLizia
tlt' ('rl,l'os{! lr'l'
i' lirrC1io rltr srrTi*l lt:tiutti,i, itt l\1111,{itr
lrrrlrrgirirrrr,,ni.r,,
:
rlis{irrgo1;t,1tuva't'irtiil,i
tnyttt
hldii u ttt"trttltrixt in[ (purali:irr',,,ltnhirtlir"
l\,))ln ptrrn,l.izi.rr
rrltirt"
ru)';\trir
lr'rt{'ttl
l9l:')
Ilirt'r,
drrxit'i
itru ,r,tiilurd,r'tnhtil.t
,ur.tir,"
"

ilu,rll,il'ir
ii";l;;,ll;fijlir,.il*:tf,',.:}"!!!iliiri'Jll'''::'ill.i5'Jll"L"'r;#:tl'Ll,i'ji1::l*ill;
,,,,, ,.,,.,,.,;"','i,ii.;,Jf;-J'.ii"ll
tin.\, t.\t..!,
r . r",,ri,i.,,,k
1"il :i.::.:',"jJ'"',
;:"J^fr,Ill"f..l;
^

" n r.I..|,.d ,-;g' dtA' r .j.' t) p' tr a:,?.\1r l) j?*t"ir o.r :_,an":Jl

m ei i i anul uj .

lrrllrr llrxici rrltimci falange a rlegetului ariltitor', astfel ineit, atutci cind
r'|rrir ,.rl(! rrrjozirlai.
cu fala pa]marii pe masd,,boLnlr-ulgg pq_?!9_-lg-ZCil!g
rr:rr,rrrjll urrghfu degetului aeitnlotl Unelo mis(.iiri coEi.h,
srtrcrur,ji{.,,
.rlr, polir,r.lrri1i rr,lecelorlalte degete sint imposibile sa,uincoinplete
"
(indeo_
ri'.1)rItriri(jlIiI(r rlo prehensiune qi t1eprindcre ir,obieclelor). Nir trebuie sri
Iil,ir||r |ii rle rnulto ori apal dureri cauzalgice,r]rbotite t1s tulbur,:iri vaso_
rrrrrlolii ;i l rrrliicc,limitate ldhlvehil inAe.iiitui,.i aimerl jusului, in special

rl I l ).r

l| il

rrrirl in-t ( lr. net - v UI lt i m er lial} .

I
sc consl,ati dolr l)c ur.l i,-,ritoriu par{ial
. 'l'u trut i}'i}:. tlp- S-eg51bili.tpl-c
rrl z,rrrr'irlr.itrllvrrlic lr,Iu'rrrrlrri mrtlir.r (.[i,t.:'.j ,^i.
I'rin.ciptlii.lurhti ttidouit,i t a,\ lczilunilrautta.ltceh rrivolrrl br,:r[,ului
,
(Dlrtiirl)r'it)rttrtr,irllrrrslrrrrlrrlirr.,I,,t[l,l!rHilllri,L,ziurriprirr solu{,iiirr,jr,,rIIIrL|
l,jrt;r\r,ni)r lrr rrirr.lrrl lrlilii lolrrlrrr); l') rrr,vlilr,itrl(,r,li,r.rA(,;
r.i r)r,rii1p11,ii
Ih0

1t,?

cutanat a!
cubitql

Gheora
cubitald

FlexoruLprofund
'ol degetelor

Abductcr

po{icelui

(logcltrlor'"(a,lluilr'Iottlolll)
rolol'(fxl'(,rIr.l1)lil()l'(logoi('lr)l
i n)'I(rst,lll,,r'ilslil'iXl'ii
ll cfcctuarrrl tniqoil,riidc cxl,ensicqi indeplrtarc (r'iisl'iraro)a-tltrgtrkrlrr,
rlc nrrter Dirralizati' nu sr: observi tcndoanelo olil,tlnsorilor' (Ji11 25 b);
,,1 destul ,,itringerii miinii (al lui tr'roment) de asemonea alatir, cL (l(r l)rrl
li.a lc ralizi tir,nu se evid"nliazd nici tendoanelecxlonrorilor, niri I)r'(tt'trrl
nent-a radialului extern #ig. 25 c) ; p) Testul prehensiunii uttot ttlritrt'll
mici plasate pe un plan orizontal (a1 lui Pitres). Bolnavul nu pttitl'tr sir'
a,pucdobiecte-,intrucit pe de o parte este imposibilS ridicalon, miinii si rr'
(l(g''it'l(,r' {"
nijmelor falange ale dcgetelor, pe dc altb parlc IIe-\iunoir"
r'i rlrtlolit:,
paraliziei
llcxorilot,
ilce ttificil si cu for(i rcrlusd,nu ilatoriti
rnirtit sr,'
pot
decit
dacii
de
flexie
funclia
exereita
nu-qi
ci,
ace$tia
irpl'ului
:r,fii in cxtensie. In schiir.rb,flcxorii vor funcliona foarte bine tlaczi so t itlit'r'r
rnina de ciltre examinator, sau daci, se plaseazi mina in ii,titutlittcir '.rlc
se rer:narc5,po 1r'r'il'l
lusirciune" (Pitres) ; r) fulburd,rdej.e.-.sen-s,ib,-.ilitate
liu-I cutanat al nervului, dal mai ales la nivelul pr!4ulUi. gpaliu inlrtrrrtsttx
tlorsalsi ruaialcs la nivelul ta bt cherei anal orAiceff;g' 2d d). Este rf irlizrtli
ttild (piin luxalii ale umirului. ftactttl i ittir'llr':rl'
tlr lezi.initJaumgticeti.n.
ef.'.), sau olte prcrcsParilo'e (tutnotil.
brrrrierrrsuiuj

Abductor

Opozant

|^,,,*,*

',': lt )

Interasosidorsali
Interosast palmari
Lambticali iIl, IV
/ i./. 3./, NrNul cubitnl: ramuri nervoqse, distdbulia Dusculali
fi crtanoti.
cubitald.

Crila

ferloriul
cutand

Edial
:
-Fig. 2r. Nelvul
r - r!ri. ,,itr Eit de lebede"; ! - Sequl ,,rasfitnni dertrelot" lF/otuettJ t , - Senntrl ,,std!8erii mlt,il" (l".ott.i,)
.ulirrr
rrrl.a nJrili;tl
ntr se obsenl tenddN'F eteDsonlor it m.i proeminmla tadialtrhi crternj d-T.ilornrl

lr
"

l,\ Iurnlizitr, rad,iata tt,Lilf,cil (aBa-zisd ,.brahialf inferioafti," a, rt'ttlo

rilol rilr.ici - Riser, 1952) e;ie cea niai frecvenlir lormri de paralizirr r:rrli
:r,lir,
.sirezrrllii,din leziuneanervului in partea mijlocie a.brail,ului,lit' ttivr'ltrl
,"'rrn
{,nlui rlc torsiunc a} liuq,ro usului, Apare in cazuli de {rntlturi aJohtttrtcltr
srrlui snu in diverse trnumalisntc humcra'le,la purttl,1,olii<lo oit',ii'lu,lrtrlivl
qi irr rrilcrrlrstlnfc rle coutprcsiurtca' ttetvttltti (cltl$ica',,p nly$io tltlg ttltttttt
rlo rlutnilitfi")' Itt ttt:trrtsiil'fot'ttti
totrxr) dtxcuisi,rlc l)il,tts satt ,,pa,I'alizi:t,
St'
cnlg ottttBtrl'vil,1'
plsibilfi
rt
i,
itrI'tttcil'
1t'itttrlrsttl
t,sl,9
uxIr1lliit,ir I'gIrt'rr,{'ttItt
rrrtrsllll iorric ilrrrrtrr.|t'
t|||,rIt ir,||i| | |' itttllt'irtt'(llt llt,rrrlizirtirrlrr'lI),irrr'lLrril
ill

I li! |

lclt;i,.1rrr1r1r{,iorlrl
rlc trr,vr,ilcioricc lrrrrtitrliro{iorrso)
so t,rrcrtrrolt,qillr
lrlirr:
r') l) inlirrLriLlrirfor'{,cirlo tbttrrr:liu .r,cr.riLltsei
cvirlerr(,ilr,Lii,
rulr,itr,lt,sirr l;iirrIrrl
,.ltl.iltrii 1i :rl trr,.r'.,rrJrri
p'irr i rr,.I i rrIrr',,,r lxzin rrlrririr: p;rr.lr.:r,
r{}'r:i., :rtl.,.i
, ttul bulrruvrrl.1.spfiji'i pe mcmlr.rrlinf.tir.,rtllcctrrl; I'l.rlizlu
[rilrrt.rrr.;rl.r
ro llil(luce priu meriiul legi,nat
,,de ra!:i':.
ttt l'orali;'itt t.ei,,ul'rij,sity inleriu'(prio. fueloL.ieti,rlugili irlr.ltir,i ,.rr
,r'r. r.Xl) lt tir pi,ttitltZl:t
pl,,r.(,!Lcnli)
prin LU,nLiit0ll.t,(.lc
S(,rocUnOtstu
Ji.||ll r
;r.rir.rirte,rlc_paralizj nrufchiului Jesier rnare: i,) Iicttrrc{,i1, j.krxolilol
,
'.)rpsAi:b) Dimil-uurr'l furlei de a\-tr'nsica corpseipc Lttzinjq ILirIir,;rr.,.:r
,lrtr.pozilir'lczindi,
ostedilicilf,; d) ln ortosbarisiruoiorn:rprczirrlir,, lri1rr.r.
LIr,lrrzi,.lo-rnhrrrri
(?entm,r, componsa,$i a egaliza contrailil l,rri,u,goriislir,
I,r1;\ourorcoaps-el); c) ijcolioz.i cu concavitatea spre pat.to|, siirriil,o;r,rii
,1,
;
l) Lu{.r'sul-$i
mti s,lesrucatr . scirilor se face cu dificlultaie; g) Itr rkrcrrbil,
i crrl;r'al, dacl se lixeazL baziul bolnavutui, acesta nu-rsi
r.irlirrrr,
]oatc
q|rnb:l de pe planrt1patului; h) la contraclia fesei,so remircii
o itsirn(!1,ri0

Itltsrrrrolzii Irrrrgrrlrrisrrpirurlor'.ll'irtell (citrr,ttkr liisor, 1952)r lirrruicir,olico

prrlrrliziclirrlillii, ealr: rcspcotl lungul supina,tor'(in al'r.r,ra
unoi leziunijolrso,
,rrlr lri[rrrrrll'1,i
, rrcrvului) se dato]qte unei pnlalizii radiculo-rnodulxre,
rrur,i lxrlirrcvrite satutnirrc sau unei isterii.
i.,) I'oral.izia radiaki antebrctltialdtnaltd, este roalizal,X,ale trautnrtrisme,
rl,. lr( lrlli infccfioqi qi toxici (indeosebide satrmism). Respectd,lungul
rrlririrlor' qi permite r.idicalea pumnului, intmcit lezirmea atinge nervul
rtrlr rrrrr:ichiiepicondilieni.
i',t) ).'arulizia radialti antebraltiald, joasii este intllniti, indeosebi in
rr.rrrrriismc (de pild:fi,in fracturile radiusului) qi in nevrite. Intereseazi,
rll:rt lrrrnrrrilc radiale ale policelui (scurtul qi lungul extensor, lurrgul abducI()r') si (lxirensot'ulptopriu al indexului, cu tulburS,rile motorii Si atrofiile
r',,trsrrtrrtivc.
Tulburiirile rle sensibilitate sint limitate la o mic5, zon[ Ia
r'ivolrrl bir,zeidorsale a policelui ,sia primului spaliu interosos.
li) I?aralizi.tt,nerLr ui obtu,ra.torse recunoaqte prin constatarea unui
rlclicit; rnotor 1)l adducliei coapsei a] rotariei exteme a
cu atro-acesti,a,
lr,r loirlsrri fi plinbr-o ansteziepe -i
fa{a internS a coapsei.In timpul mersulrti lrolrrrvrrl prezintii o deplasare in a,fard,a gambei qi a piciorului. Este
prelnngit, prit:' compresi1rtrrrIusriprirr traurla,tisme qi la fcmei, in tra."-ali,w
Lttrorr,oxclcitatii, tle capul fetal in timpul traversiirii bazinului.
i'jo irnpune si recunoaqtem sindl'omrLl ltti HowshiTt-Rombarg,,
realizat
1r'itr cornpresiunea ner/ului prin hernie obturatorie. ln acesta, pe prim
lrlrrn sc l,flir, o durele care imdiazi, pe marginea intem5, a coapsei, atingincl
r'r rrirnuru de iltensitate la nivelul senunchiului.
i) Puraliziu nerralu,i crural (cu cele patr'u llnuri telminale ale se,le:
,,r'i vrrl musculocutarat exterr, nerl'ul musculocrta,n,.t intern, nerl'nl
, \ r(llioepsului qi ne vul safen intern) se manilesti prin; a) ImposibiliIrlcir fbxioi coapsci pe bazil; b) Deficitul ertensiei gambei pe coapsi I
, r 'i'rrlbuliili rie staliune qi de mers prin irnposibilitatea, ertensiei $erunr lrirtlrri- Aceste tulburi,r'i de staliune qi de mers silt mai mari irt para,lizin,
Irr,rrcrrIIrlii,
inalti,. situa{ie in care bolnavul est oltigat si-$i ,,trag[" ]x?tnlrrrrl irrfeliol in1,r'edoui, cirji. In schimb, in palalizir, troncularir .jo:*1,
lrolrrrvrrlp(,rile merge, dar cu contlilia s[-Di mellini, genunchiul ,,hlor,,it"
Ir ('\t|rrsilr. l)acli se prorluceflexia, gamba se derobeazS,;d) Urcntul sci,r'i1,,r crt,r:irrrlxrsibilsiu {oarte dificil; e) Bolrrayul nu poa-tes{, se rneniin.S,
rrr ,,pozi(irr1x'r'ino':; f) Reflexul rotulian este abolit; g) In lrtostaliune se
llrrllvii o lxrz:i(iecle ,jgenurecurvatum"; h) Atrofia telei antt'rionrea coaprli ; i) 1l\rrrllrnul rotuli:rn este flaso, depresibil; j) Tulburi,ri de sensibilitate
1,r.lrr(t rrrrltto-intelri :r coapsei si pc fala internd, a genlbei.
Ir'ul tt'i,tt'itlogici: a) Atecliuni vertebra,le Di ale cozii rle cirl (traumatice,
Irurrolrrlo1.t.); b) Turnori pelviene; c) Comprsiuni de alte naturi (prin
rl(.r'lrl g|il,vi{l, in cursul unor inter"venlii chhurgicale, cind coapsele sint
rrr rrlxlrrclir rnirximi, sau irr cazul purti,rli unor banclajeherniare compre,,rvr,); rl) Abccsc ale muqchiului psoas iiiac; e) Intervenlii clirurgicale pe
ruilrrl lrilzirrl f) Irractud aJebazilului qi ale porliunii superioale a femurulrii ; g) .s!tnevro de rerlucere a luxaliei coxofemalale I h) Anevlisme a1o
rrrlrloi lemulille I i) 'I'tr,untatisme directe ale nervului (de obicel cu cointerr.sirlcil,corrcouritontl qi a ri,r'tereilcmurale) ; j) nevrito ,si neuopatii (diaIrr.licii, yrrtilinrtric[, toxicl).
it) I'rr,r'llizirr,
rrtrlvrrlrrilir:siolsrrllorior(rc:rlizati (lc frr],ctnrri
irlo l)Mirnllui,
rlc irrrrrolirllrligrroit,lrr
rlrrlrirurrtiitislrcl)rin NI'nIr!
tkr iix, sit,ttlr,urto
llrlzirrrrlrri,
rrllrt.,tlrrcorrrgrtt.r'rittrri
rrrrrrrilirll'rltr i.irllul{olll in crruttl Ilrlir,tii, sltttrlrt llrr'l0tl

1lO COtlUl.aCUe,

s.ctatice
in funclie d.etopograJin
_prezintii,,
ltziurrii, rrrri

. ,]0!PgratjZltlg
rrLllt+j
I'artant(' semioloEice :

r.ia railiculard, to.:l!'trqnoatqlrd'Lnutrli, testa realizrltii plirr

, rrrnce
..,,_!0tl _P"qr-ol.i
r,
rudacinjlor,gr,u a neryuirii s,.iaLici]! bazin, la ie5irol din lrizirr
.,l|r.rn.r.rerrnctlg4rlrq superioaTi a.go]apgqlSe recrtnoagteprirt .
rrr rI r:i I rrr.rr I
t!t::lu9togtr..
carc
.rezulbS
rlin
palatiziei
asociorea
' 'ttt(
sci*ticrrltri prr|ti
rr,r r.Klefir, r_t,scrr,tlculuipoplilieu intern;i a ramurilor
musculare al0-l;r,irrr
, rllttur ncr\-'lut mar.e sciatic la nirelul m.sculaturii posterioar.c
it ooitrl)rior:

tu$1o1 myryh1t91_
garrrb--ei
ai +iciorutrii, realizincl un ;ii,ri,,,.
"qr..
',']:llt]iri"
corrplct rmobil; b ) rUersd,eEte,.Etepatn
f,_
ridicareapc vi|l. tlrir.irr
:,..,,,-,]],,1.
,,:.lrli'1.'bla!.1-yoe?.p:
vjduri
ciiciic
este
imposib[JI r.)tr,rtir:rvl
tipc
.,.,.',']l
,)u
l)r):rr' rgr: ft) r'rrrrizian.rrotici
a
posterioaro
lL uD,llr0j
_ .muqculalurii
rrrr. l.', i*rposibilitateafrexiei gambei
(testsemiologiic
' ' ,rrr1
aetararizi .,rl,,i'iiri) ;
,.r r\ lrofiile muscdare interesor;z;
ri
]r_q-Eq4gt
_"lSlrscriatuxfi"-_postoriol,rd,
i ,.i Inrisclrlalur',gjmbei : tt firlB'ufir-ife
' ',r,t'r.x
de scnBibilirat,.s(, r.\t.rl
tl, rrrl-elnlrntreguluipicior_(cugxceptiapirlii interrrcrt,
l.l,',,,11'll
|lrrrlr'i
| .,, nri,le.'ler fir,lertle),,precum si pe fala laterald, a gamboi
I t) J)c ci,lrr rrrr,r
sciaIicesi,,'tpnnrolc
si-sosilrri-.rzjr
l,llll,: :ll'l-"lE111"
.simpJome
t,,. I,r.irlrl
l , r : r r l l l | l . ] t r t,l ZtU I]l l e IJd ,cu l a f( .

C i t, si i n ce l ,. tt"o n t1 u h r o .

g)

Sr : l r |'l :r .u r ci :
r lrllrtri,ri vasornotoriiFi
_(crleme
g,rnhieroqi atc piiorulii, tript,r,
"rnbritticXii
-Uaf]gs
('r,rLlozir,.
l,
plnntare,
ale pl:lii';i
pi,r,,
l i r r r l s . d , .) .
^f" "iigLiifuii".rlce'.,1ii

iu; fuiltt:ittc
] sint rnuit mai fi,eaveirtc,lrt(,11ri{rrl
,,|oni ttttit.C_7og.re
, r'\ rr ,rcrr-L1jrc
t'ru in trcimer
mijlocie a coapsei fie sub ni]Iehtl tle crrrorgt,lltii
r lrrtirurilor dcstiniite la muschii regiulii
]ostcriouc lr,crrq)sri. 0rr,rr,j,rrri,,
rlr'ri.trtrlrlsrrrnhl-ipo co..psr estein pi,rte cdnservat:i,
i,r,rplriilizil o$tc(liH(l
r"rr')' rir sr riirL rili irL u'.tt:xfrrl cli'ic predomini fie semnelepa.r1lil,i*r
rrr,
iie ccle de sciaiiopopliteuint(.rn.rlrrroiitril:rptrrtrrr
. ]'.,,;.1:llllliJlll,
l*,l,cru.

' ,rrurtn(' nl ri tl lt ir lilr t r nor vs{, i: r t iciilr i: oJr . t r ct . t oi_lst . , icst i||: t lol, r . r : r , lur l', r l]
Irl l l l tl i l nl l ,l l t i ill( r sir |t r loiir ,L0r Lni1rin
, il; r scicl] ledisl; ilr clt .
lt).,\ l)t,r.u,licitt aointiaiWTwfiitc.Ii-iitam)
1s,i ,, ,..t,t.,,1,i tiltirtl, ttost,,ior
Itt trtt' , t,t l t) t t , ) t . r . , llt J t 1, : r lizr llzii, : t r ) I r a, r , lr lizia, '1, 1. \ {) t ilt }r
1i lr ddit ct . t , ll'r
, \ r r l{. |ll, i lI ||lI ir .
| ' r(:| | r| I| | III,(
|| t {( , lt il{) t .I t odl. r , l. iri rjtt r i ga. f r . r r . i ( llr . r ( }r . r
.
u
.tt;rr.tl i ei ;' l i .. r pr 1'lr , r / , i. ; ! . r r r r . r i. , , , r 1, . : r r g,
. . , , r i|, i, . , , 1, , , , , f , r i, , if , Li ir t r r lr r r i, l
rrr| |.rr' | | || r || ,,r |r lt ir . |lirI i" : r r
1,
llUt
,
cr c( r p{, ill [ r , r lir r st t lt t i ( I r t I iI t t r r I O t , ii
l) t r . i0
.r u, \(| l l t rIr.; 1r 'IIi r . llr , r , r r r r , ; r lr r lr r riolij) i lr ) it 'r ( 'r r r r r |r . inI r l, I rrr'I rt rr r,, rrI r r r r
1

l{r I

poil,i,(!
1i plrlsat nici hr addlc,licr-nici"
starp.cvh'firl ?ioiorrlti, (,irtor)ll ?o?t.t(r
rrr lol,rr,{,irr
iltu ni, qi nu poatc sd-fii fle,ctezedegetele: e) },iolta plantard esl;tr
lrtllrrrsilii; d1.1\lcrsrrlcsle dilicil, de alurd tal'$3ld ; ,') Atrofia.i+telesea,za
l''girrrrr.rr.
pl:lnla}i, rnargieiJepiciorului $i moletul gainbier; f1 'Tcndoqgl
'frint abolite
l,.,lrilirln .,s1,odepresibil ; g) Eellexelc achilian fi medioplantar
;
lr) { l1q117xlgigi dureritre de, tip-rne-v.riiicf ' sint destul ile frecvente; i) Une,rli xr, rtrriir.r'ci $i $tergerea lgheibulul retromaleolar ;i picior ,,in gheeri,",
cu tlegote,,in ciocan": j) Tesiul lui Fromunt:
in staliunea intr-un picior, tendonul lui Achile
ri.mine flasc, depresibil, iar gemenii nu se contractfl tle parted paralizatd';- k) Testui ,,piciorului balant') : bolnavtl, plasat in decubit ventral, este solicitat s5, llecteze energic gamba pe
coapsi- Ie partea bolnavS, piciorul rimine balant: l1)l TulburSrile de sensibilitate obiectivS,
sin1, rjecelate pe ta1, plaiitard, * piciomlui
({iq. 26); m} Sopot eviden!idii [ulbur;ri vaso'
ni ricrii qi trofici (edem aI piciorului, ,rlter.alii
ale pielii !i ale unghiilor. ulcere l,rofice nalca-

,i;i='--\',',)\
--'-\:iv
ttervut.
dknhr
' tatirat

rr. iull;,rrr:rl.r|iirlitr rrrir.rrllr:rzirr; c) l,t,:t.utnkl,iHtn(.

'f,r:{irrrri,rrr,lirl.lrrlilirr,.
rlrlr{rl('|:rl' r'tvrlri
l;r rrivr.htlrrr:.r'ii.r'rrlrilrrr.i
s.iirrii.(.,.L [r.s.i, r.rrrr
'r'irrri.
1.l frr{:t 1rosl,'rio:rtr'r,
(lezirrlri prirr rlnrre ir,lllcsrnt jrritr lr,l,lrrrr
rlr,
..ir
-currpsrri
l'r ; lolrg.i ii' dupri i'iectrr,r'e
accidentlalir, in trnuchiul sciiflic ir, rnr.r.
,
srrr)stu,nlcnrrjrtlcamenluase, algog! penicitinii sau alte solnf,ii r:u rrr,{,i_
tttur destrucliyS a nervului)
; {} Nevrite virotice ; tN Noulopatii l,oxii:lr
suu toxicoalerEice.

neenenmaleolato qi/sau digito-pl&ntarc).

'r}a]} Patdlizia neraul'wi c.ialiapoplilea entern'
este reaizatd in. specialprin leziune ln nivelui
.qgDdui leralgd]Li qi interescazi celqgsg m.rl.!-ch]

/,J. ;,;. ti.ritoriulcuL.Luat

cI anterioriai gamboi. tabloul seliriolugicconsfind
ctl
r',;rr,lrris,illicpnpli t(rinlcrr.
din: a) Piciorcizul, halanL, iu va"rus-equtn
primele falange in {lexiune I b)' Impo:ibilitatea
lLrxiei dolsale a piciorulu{i a falangelor ptoximale ale degetelor I diticultal,,rLtbtluctiei piciorului; c) Imposibilitatea de a ,.bate gldsum" cu prcrorul
rrli'ctrt ; rl) tlina botnafirt se spii;inL pe un singui picioi, tentloanele exten'
sorilor deget?lor, ale peronierilor li tibialului an'
terior sint bine proerfinente cle partca s5,]r[toasi
'
il schimb siol $te"rsede partea paralizatS,(prob:'
n,proba-.
sral,iuoii uxipede a lui }'roment) : c) Ia
pingelii inapbi. qecunslald,at'elali fenurnende Iipsri
ile ividentiere a acestor tendoane I f )Mers stepat ;
q1 f mposibifit'ateade sta(iulc .pecdlcii ; b) Er len'i:t
plir'rei fahngel it I)iscrete tulburi ri senzilive,p''
oartea lat'elald,a gambei 5i pe dosul piciorultri
j.Sig.ZZ.),seclelorii, r asomolorii gi trofice; jr 'llr'lieiele ichiliene Ei mediopllnlaresint coneetval''.
-Factoriieliolalici rn leziunile norurlul sr'iulir
pot acliona, ia nivel radicuhr (In-Su) sau Ia livtl
troncular' : a) tr'actorii vertobmli sint cei mai trer:'
venli (hernii diseale; morb Pott; tumori -primitive. sau metastatice ; traumal,isrne ; in ultimclr
situalii, paralizia sciaticS, poate a#5rea in cadrul
unui sinalrom de coadd,tle cal) ; b)' Traurnatismolo
Iuxalii uur(r'
coxo'
a,Ie bazinului:
D&zrutrrur: ruxir,lrr
afecliuni ale
,,
drversoaleclrunr
Si rtiverss
Sl
DislfibUtiesm:,,,vj
-'-"'-'i
:tcnnrrale; o$teo-artriti, s&cro-iliDoli frrottlri a,l(l
lritzinttlnii {:(,rtrl)t'r'Nirrrri
1,4f
.11:.,11;'llllilf
.l'lllll'.".1lrrrzinrrhi; lrrnrori rllo
ll rrr'r'\rrrrrrr
r\r'rrru(
Di'l)rrrlrr
sllrt rlo llir'<,r,ps
,,..,,rcilnlrJrlrt 0rt,l l .l'()i;lr,1
I tlivl)r'sr.
16'J

sciit.icpoptittu i ntern_poatefi lezat prin traumatisntc f,n x:eittrtur,

_. _,..}:r,;,11
l.rltcturi lle oaselor gambei, prin tra rme directe (cu anlc ulirt, srrrr
l1,t)pIdec,
'r,' r(x.r s, tr.oori pria lcvrile (lo:ice sau infcctiof,sc).
. M-rrlril scialtcpopliteu rfrtet'r est.elezat de obicei in tlitrrIn:ll,i$ll(j lir,
'1Y,,']l !"pr-tql peroneului,in rnumiJo condilji prof{,siolritle
(h rr ln(1it,,ri
,;:rrr s l.l.)-u
ml .t qhemuiti.pc !inc Ia pr,r-atrrJ
strdzilor. Ir prrr.bctllIi rj.r_),
rn nerrilc (rusicr.. viroiiro elc.). Trcbuie relinut Irr,plril r,:r
:1,'.j'",,'*n!li
rr rvtl
p_opliteuertcrn por"ie fi lezat qi ilr rrod izolai; chiln. irr rrli,r,
,scra,lic
rrrrr lrlc
lruDcltiului scilriic rlt u aJoplerului srcmr.
reprezinti, constelalii clinice in care serniologir.sr,
..,.,!),-fI:r-l!,1::r,/ite|.
,'-.')l:,
t, par'2tlz 5aL l)ar',zrrrlo nrai mullor. nerr i perifcrici (rrrrr,,rli:.i
,lirnrcnl).rptrute lic simrrlrun.fi,. sitccr.siv,drr
c o rliql}ibuli{' lrrl,.,,.:r
.xp.icioasii, qi nesistematizati, p.ezenfa r,nui trbk u semiologic 'rl.
rrrrrlli
..ys.:l:32i.(in hrnfuicdc n.odutde instalurcpi de cv"olu(ic;rrr.r,r,,
lli.: i]1..i:
etiopolsgpn;.,: J) llult;npwitp rirolice (prin vii.rrsrrriL.
,t.t:t,t
l:1' lrostbtttt,{j.li
rr\s1ckre,tlerpes zoster, rareori prin arborrirusurir, Z) Mlt(tint,
l.::.,.,',,,,
.
tt
'it 'tt.?l:ct, (pusivaccinrlc. po"l seroterapice; rlorgii medicrrr|l,.r,1,,,,
.,
I
otogp
..,:i.r..")l
o:p .Stbott o [otmu a ( polineuromioz
ji e, IUpUSclilr.rrr:rtrr.,
-r'lf'r'o(rr.lrnjo.
i)o.rrartorilinodoa-.ir."ll .l4rtlti pLtrite( n ulI ii europoI i i ) ltx
t;tbttiaetriiabelicr.;,n cvolul.iilLrnorpolfirii; careuqiaic; pr.irrr.r:irrgh,
;y.'
lfl'fl|r,.)..,r -ttttrlt c(,uloli; ptxtnectpluziae
(ta.rc1.
t'),1'rltlrrrittle
oli nearopatL
p
(metabolice,
r.la
torrce, onr.olll,irtr,
.si
...,.i Ii,t l{.' ,za doltctlo tuuscrrh|edc ertclsie letrrplegicl sau rtrIiIr,
totdelula cu localizale p-rerlornlnant .ct"om'effi, insolitc rto 1rIr|Ir.
lrlt'gie,r'i,,
iripo
o tr
1' ,..t ,atrofii .nirr,scuiale,"de are{le:ie osteo-tendinoasii, prccurn si rlrr l,rrl
]lrlll:rrr
rlp s{.n'rbilitalc srLLrier.lii:i
si ,rbioctiv.i.cu ra_facl?r.dl. ir\r.lrr,rr.:r,
rril:,rlr.rl,sirrictlic,;i eclromeli(..,\bscola ori"arui
pilrrri
scim Jn h,zirrrrr,
,lrlr, {btr r-,coldi}ie esentiali in stabilirea diagnosticului.
irLrrs,,l
Maselr
I r'1' .,pl'rlr.rpo
lulLleatrnastnt duLr.rulsell prosiunc, iar elongul.i:lrrr.r.vilrrr.
t,,'lilll]gi c.l,' adc-scl,
h ili . t',,lifpyy;6.1.'.1 polinriu.opttiilr,rrrr
. i I Lsuporta
dc r.-grrld.nici mudiliciri :rlc L.C.H,.,njli t,uibru,ilisfirrr.lclir.rr,..
','rrr1iorLa.,
|,r'',i','el. I;r delrrrl pa|rliziilo jnc(?
ii predominl la cllrenriLiil.i,rlrrr.1r',r.
:;t sr" \l rrdt.

t j( o lDiI li( . i: : sim , - t r icli,>i put si r paljzezr . r . [ ii: ir r ti. , t , r , lt

1, l, gi, ,
' (' l .rl i r.. r,l ;lu lt ir . ipa r . ir ir r elr isir . a m usculat ur ii git ului,
I I lunchiuiui li
rtt t r.' l l i ;r r 'r '. r liuljlgr r r ului. Pulaliziile sini t t t Jear Ln: l in. u1. il, er ll
r r r r r . ii
,.rt,
llrlrotr)lru
rrlu\(.llla,rc si cu irnportante al,rofii rnuscula,re,dilr rii0irxll,l;ti,lr,1rr,
,1. ttrrtsivt. c:r in lcziunile tiir.cte ale pcricar.i.nului
moio. rtin .oiut,,(,|.
'rrrfi'iiriir,r'c( l rrrlirrrrrirI i1i si ulle silnlroa,riie pe.icarionlllc). fieflexr,ltr ,rr,r,.
l i l l rl l l r():rt(.F|lr l ( l{. t r . g lii rI i t rri t rrtIr I r: st r t r : r lt r r lit e, r ilr I l, r , ll, r r , lt , t 1lll. j
lLlr .
, Irl (l ' . r I| l l( . or i ir r l: r lt r : st r r t r l, , l. r rI i rI t i t rt IruI i .. Nli
f r , e, llBt j, t t i l.It r irIj r: I t [ ,rt rr
rrtl l scl rl l l tt,. .Nor lilicililr t lr l cx( , il, 1l) ili1, . t , l1
sh, r r lr . isi. ri,r r llizo1, zi, rt ,lalt {, ii r lr ,
t l t' gr"*rt.ri .r' rr{ii lir . ir r I r r I r ', r 'r r r r ir t 'ilr r {, ir r pr t r r r r r r ir r : r r r r ,r xr r lr t r nr r lir r ir , ,
rrrr
tttvl ' l rl i gl t' fi i L'l') 'M '( I . lr I lr r t r r ,r 'rt t t t 1r k'|'r t .r|,t r rlr npLr lr r , r r r ir
r , iir r zr r lr r lr 1( jr ) pr r 1( ! r 1\
l ttol n)troi ]r sr . r r zlliI il 4i t l iit r r lr r lol'r lr . lr r , lr r lr {,pt
il , or ir r r r r lt ri ir r linlt lhl l) 01 l
ti

lrl;l

zr (lll,o I)trrliolsolxrrrirlllslrr,lrilirrrrr
rlirrgrrosticului
de krziunetroncularil,
lr.rpr.cliv polillotroulari, (polinortrrrpllicii).
Nr lilcbuio sL uiti,m ci, polincvritcle qi polineuropatiile realizaazh
r lulrrrr)Nill:forme semiologice (mixte, motorii, senzitive, pseuilomiopatice,
psrrurlot,ulretioe,acrodinice, hiperalgice, parestezice, predominant trofice,
prtrrlornitralt vasomotorii q.a.), care ne pot sugera posibilitS,tile etiopator1r'rrilo(Iiiscr, 1952; IIareq si Nisipeanu, 1976; Mareq $i Stamatoinr
llttis; l'('rrLlofunda,I976 : fo{letea, 1067;.
l) l. prezcnld unui sindram poline,ari.tric(polineuropalic) cu ilrstalare
rt trli. .ti. str.bacutiine gintlim ln primul rinal la urmetoatele posi,bi.li.td,lieti,ol)trl.t)u(tn(e:
r\ Polinetu'o1tatii, toni.ce {profesionale, med,iaatnentoase,crilninale,
stt i r i il u,yv, eti.lice).
- l?olincuropatia etilicd, est de obicei mixt5,, dar cu predominanla
Lrrllrrrliililor senziti'r'e (sublective si obiective), apare la un ei;ilic inveteratr
rrrrrurli fiind pledorninant parestezic[ qi dureroash. De obicci este leltlrrrrglrisivti. Para iziile mari sint exceplionale, 'Iulburiirile trofice ryi
vosrl rri,ir-esint precoce. Se poate insoli de fenomene de nevritS, opticil $i
rlrr rnrrllrr ori, do tulbuli,ri psihice care realize zh forrn psihotici subacut[
rr,lrri ](ursakov (contuzie mintald,, a,mnezie,confabulalie). Se poate realiza
r1i lorrna pseurlotabeticri) cn algii fulgurante, tulbur5,ri de sensibilitate
rrnd:i [i ataxie.
1rrrrl
* Polineuropatia d,iabetic:d,
cu instalare subacut5, este rarii. De obicei
rc rr:n,lizcir,ziiforma cronici,.
. Polinatroltatio, arsenicalii eeutd,-sub&cutd,
este cle obicei profcsiorrrrli, rlstlizi mult mai rar medicameltoasi'. Apare la murLcitorii care lucroazir
rrr lrriricle arsenifere, in industria pieliriei, in industria unol vopsele, a
ol,r'iivulilol raticide 6i a unor insecticitle, in industria chimicd, (hidrogen
rrlsorrilt, acid arsenios, axseniali). Totdeauna apar iiemne gastmintestirrillu grave, precum qi ali;e simptome neurologice (convulsii, sinthom holelilirlrrr rr,rseuical),tulburi,ri cutanate qi ale fanerelor (stria transversa,ld
r, lrri .Nloesla nivelul unghiilor). TabIouI polineuropatic este mixt, dar cu
lrrrrrlon rinrln!'a tulburi,rilor senzitive ;i trofice.
. PoLineuroytul,iasutrurnind,aautd-subdc'utiieste tle asemenea deoseglrvrii, predomininrl in tabloal clinlc tulbudrile psihice (confuzie
rlr
lril,
rrrirri,r,lit rgii;atd, sau torpoare), tulburiri cardiace) hepatice qi renale,
plrrcrrrr 6i tulburd,ri tligestive (clureri, virs5,turi, constipalie) ,1i hematolrrgirr (crr seinne de podirie). Se poatc realiza,Di un tablou de encefalopatie
psilrolricir,de tip Korsakov. Polineuxopatia poate debnta asimetric (pe
rrolvrl ndial, in dreapta) qi este predominant motorie, cu atrol:ii muscttlrrrrr lilpido.
' .\'oLineuropatiamercuiiald, acutii-sttbacutd'este tle obicei acciclcntalai.
rrrr,rrvolrrrlbar-suicidard,,la cei care lucreazS, in przenta toxicului: distilirlcrr, rnorcnrului, fabricarea lSmpilor de incanalescenli, qi a ampulelor'
lrr,rliokrgicocu trompe cle metcur, industria termometrelorr a barometrelol
ri rr rnilnornotlelot cu metclr, fabricarea sirulilor de metcut, azotat de
rrrurr',ur',olorulX, qi cianurd' de mercurt intlustria farmaceuticd,(calomel,

oiirr[rl'l <[o m.ercur, sublimat). Totdeauna sint prezente tulbur[rilo

(l igosl;ivo(sto ntite me,rcurial5,cu gingivild ulcerativ5 Sihilersalivalie,
lizolrul girgiva,l),somr:ologonet'aleFi renale.

lblirlrrrrrlu,t;ill, os1,o
J)r'orloninr[rt rrotori, Dutin(l (lobullt t)l'in lritltlotr
tl,itttit'1
irr (nrrlirrl, rttttncttlo-trl
rurrriolrgi<l
tlo trntll,ittottroltlf
, lt'iltlil lroplil'trtt
l0{

r'\l(,t'lt)fi rtri){il)(ltt.Nr.rrrlrisl,lr
ri rlo srrrrurctlo ottcrrllt,lr
4lt 1,irt,llrr(xtt.illl
((.rrstllrtl(!rlr.r'rllrrrl0lts0
llri Jrt,irrr
;rlllrr),
lotr:it'o aat,l,r:-su,lta.at,l,c
(11'itt iuriliri, lrli,lol,
.
. Alty.1nl,,inr;u,ro1xr,lii
lrr.trz'rl,srrlIr';i rlc rarJr'n, trioltoclozilfostat, tclanclorel;nn) s,, 'r.,,<,Irr,, ,1,,,
t.r
rlc
ou loxi(,.1. rrrsp.r,l,ivr,)
','/rf('n1,ul aparif_ir,(la rmrlcitori oale lucreaz:'1,
ri plin asoeierea de paralizii do nervj cranieni (oculrrnolor,ii oplir.i,
.fi
rrtolrleo-vestibulari), tulbur.iri psihicc gi sau semne henurl,ologiiur.
/
tulicd.fste rard. P.ealizeazho for.nii rlixl,ri (r,rr 1rr,r,
.- P.olineuropat.i_a
,
,l''rrLirrllni,.r
tulburririlol senzitive)qiseasociazricusimDtonrcr,rr':rol,rrr,isl,ir
:rlopccie,
o\ l,t,rI
.altera{h uxghiiior (cu striile lui Mees),convulsii, Bi}rrl)l,ornc
;ii'rri.irhle (tremuriluri, miscX'i coreice),sirnptome psihicc (rlirrlrrzi'.rrl
l,r Illl0s1;]ce).

lt) P.olineuropatii i,nfecliouse.

Cele mai obifnuite sint :
''-PolttrcDritucltltrricd intereseazi,in special nervii crluielrj (rrrr
1Ir|rr
liz,i;r r-r'rluluipalatului, tulbur5ri tie deglutitie qi de fonai ic, rrnrxrli'r1ir,l
l.qllruri-ri l'.'sp_lratorir,adesea qi cu paralizia rle acomodalic rr
;n,ivilii lrr,
rlisianli,)r iar la nivelul membrolor afecteazi,indeosebi tmnclriul,ilt, rrrr,r,,
ll i,lor inferioare, realizind o formS senzitivo-motorie disocialii (crr rrlr.rlo
rrri rrlnJ;a tulburirilor de sensibilitate profundd,).
* Polinearitu,brucelozicd(rari ia noi) se in,coteqte (le sortrnrl t r, irr
fi
r3'rrleqi de a,lte sinptome (heprrticcs.a.).
-- Polin.e,:ritelesecunderettnor beli infeclioaseqt ltt,.tl.. sild liu,rr ri rr,
r(, ttlrrq. i6 noni, 1Jl l bolii d" \az:r tfelrrrit iloitli,l illi,,.\|lrrlcr r:,1i,,.,lizr,rl
| ,'r irr, laludism).
- Tjolintt*,itetltoi,ulinicrideb.teazi, aproape totclen'ua (1ll (lislirl,,ir.,
Ir,'(i'iiillne& gurii, laralizia \-iluhi lalatului, tarlburiri rle vcrlt,r,rr iri
1i,i
t,,urlizilt acomotlatiei ;i midriazi), ottalmoplegii extrjnsccj hilrllllrr|r,,
l:r lrr'{r s{)1rol,lsocia tleficiie:r,le memll.elol cu p}edol}l'nit1t1ij lizorrrr.lilir.
lrr','r'rrrr1i tulbru{ri gfincteriene (constipalie si retenlie rtrina:,ii).
t.'\ J'o[. 1e1'af]alii Ttostraccbtale
. Sinl I'irfr,(|osi,rrrrrr,i
li :postseroterutpice
trorrl)i0ii, lostselodiitelicd s.a.) qi-de obicei nri sc ilsL:rlttrzi irlrrlrrl, rrr
rr i)r,lllcsa procesului a,lergic r.ilccinal sau postserotcrapic.
:!) JIL fn'eeen!&unui sindront ptlincrritic (polbeuropul,i() (u .irtskt,lrttr
l, nl Uoqr$iui se pun in cliscutic toatc cauzeic posibil,.
lxl (,lt.o (tt,i , tll
tlno|inl succint:
"r
r) ,Pt,/tnett ite.leinfecli.oase
intri pulirr in (liscu(ie (polincvlilrr l,prrrrrurr
. \,.nlllrl. polinelr'ir:r luoticu).
'
1) Potine-uropat.ii.Itto.rice(satur.lliD,;,ulscnic:lli, rlt(ll1lI,iilli, 1;tli(!il
,..
rntdiclrnentoasit)s{r lccLrrroso
irt lorrlor'l,rrlpr.o
,,ttllrr',1r'bon1{fi,.hllic5,
l ' l {rl l l rl ,

C l J nt {, {r . unlcXlnl {o llt clr ) T n( 't illi, L( . . viscCr ll, . . gr . r . r 'r t l, , ,r lr . l: r lr r , r ,

Itl .ttt) 6i sol riologic ucur ologic ( r Lsr , 1'cr '[ r irser r lr r clreir
' llr ci, . r islicr r ilivt lr illo,
1rol i rrorl .ropat iit oxice) ( , \ I ar c5 si t r t lm ir , t oiu, 1968; gof lot ou, lt l( i?; llir lr , ,
tt,| :.1; l Jr> dcclr lol.196i) .
n
iit cr . liabeli. t ir
: e. r dlnic suspiciot r N, t clolr lpr r r pr ir llr r r r r r lir r
. .r' ) P -ol ,i,cw"opal,
l rr' l ,i (. [{1,;11'1,
r lialx, lar l sr ) ( l ( r so( , lxr l, ii,
r lor r r ,ciir r l t lpr il. ${r nut ( , i{1
r l( , polit r r . r r |o
l rtl i cr r,rttr' ( 's1o scnzit ivo- lnolr r lio ( cr r pr r xlor r iir lr r r {r i sr , r t r ilir : i, r r r r r . r r t , r
r' l ti rt' psorrrl. lr r llt . licii) , l|ir r r r r r 'I r r ist r r nilr i t , r r r li, l, it s. r r lr r r ,( lr r , lr , r iopr r lir , )
tl l l rl ' rrrrl rrl olir '. llr r r , r r li r r r t ur lizr 't v, ii o lolr r r i
lr ir r lir r r r llr r ii,slr r r r r r lr t lr i ir r lil,
rl r. l f, gr.r' .fi lJ"Uilor |H( l r , t l, il. ( i r lr r lt isr r r , llt ii: r ) , ( , t r , r r lir r Er rr r r r r r : r lr , r
rrrrrrr' l ri i rrIrr I r r r 'I r r lr. 'r r "r r lr s, i li . 'r li'r t x I ii gr r r r r hr , i,r r r lr r llr r r r , jr lir lr , r r r r r r , r
(l trl r:rl r' F l :r r t lr 'r r lr r l r r r . ir r lr r r '1.llt t r , r r t igt r t r , r lizt , r t zll I ot . lt r ,
lr 8r , luolllr Jll, l, t , ,

100

sini; urttLt'rr-tiri[t"cvctrl'o doci[ so ol'tx[('lt'

i\ I'ot.trt,eurttltuliilttr:ttrtn,!iu,[,tt
Iiirrrl ioulizittt tle tliverse ntcc{,iutLittigcslive, rirrlhbsurbliYo, dc.anacidii,,1,f,.j,,-rr.i"" ;i de alli -factoii (l-nulusival(oolismul .si.rrlteluLice) ':tlc
titttnjrt'ttil carenlc de sil,amine tlh grupul B qi d'' aniil^fr'lit ($oIlclea,
l l|li/ i l\lrrroi 1i Siarnarciu,1968: Popoviciu ;i col:tl-r'.198[,'
fn Iata unor tl1bloultctrorceoe porrdismetabolice.
r't l',,linturonatiile
curontc, trebuie si' ne
prin
ilvesi,ig:r'liile
neolucidate
rr,',rr',,ilL'tii croni&,
clismetabolicu
polfoeuropatii
;i si' praciicim
gnrp
de
fu
acesd
t',',ri'i, li
Llnerl:
lnillvrzlt
la
i rr!r'.lilrrlii si in acest sens.mai a,les
- Ilolineurupatia porflricd sc poate rccunoa$te prin sirnptomatologia
|r|r, rrolvo:r.sli (cLr-tlblo-uri" tle multinevrite,, uneoti l1lononerrito radiale'
(sir}dr.,mulabtlominall,culatrafi'
,.v,rlrrii,rl.nt'e puhncuropatii),vis{'crald,
cu pcle pigmentarecafcuii
la
tumina,
i:ipersen.ibilitare
,,pi,ir,,i
1,rr,.,,,:i
lcziuni
cuLan'1tc
,lr' liIrl l'tnii,lcto'','rc{pcctiv cu
"vaccinifonoe"). gl rle
t,rl,,,r'',ltrr (sinitromul uiinar'; preze$a, respectiv cleqterea uroporfirineiol
qi
' rr coproporfirinelor).
-^ l'rlttirunlropatii,led,isgtobulittemicesint' ra,re' Amintim polileuropatiil, r'irrl so lof iotilni in rericulozeleparaproteincmice (mecroglobuli.nr','r"' tV,,t,i"',*inOt;i l-,oalrlui Kahlcr).in une)elumor!-sarLin tlisclioglobuIirro,ri ,'(lltichorrri cohb., 1959; Faqon ;i Sctrwrrtz.1963; $oflct'ea,1967;
t',,i,.'viciiiii.,,Lrb., 1968). Cootexiul clin!c dc srltelintti lcrvoas5 (polide leziuni multiplo oso-as.e
,,..,i,,,p,il,i,. 1ent-progrcsivi,l, osoasi, (aspectelc
-hematologice,
cr alterarea sti'rii
in iasole late),
,,i,,,'i"l,ii
caracteris(cu.spectr'u1
"""t".Liale'si
ineruicf
Lll
p"*ruot^
hipergamrnaglob
1r,""'irrl,r'll tti

1n schiml,
ili,;i ;,i;;,r'i;rrt"J; aft"osti""i ae 'eticulozaparaproteinemicii'
,,tl,it'r1;a,cepricioasd',6t instalr,rea sau agra,valentrbloului clinic (cu

-mrltirr,r'r'it,'tnigrlutc .1ipolineuroprlie tle oijicei arimeLricd)in pcrioltlcle leci

tliscriola"ritiiica""a ciioglobulinelor ne o.ienteazi' spre
i,t,,
'
','.riii"si
*""'Titli},ii;rr,
nozologic
incadrat
de
ulor
sint
colallenoze
din,
trntiite
,t,,,,,i ,,,srx,.tivlr, iulecenoz,i, (periii"terita norloai5,, lnpusul edtemir'tost derio"ita, sclerodermiarboaltr BehqeLt'a ) se
rrnlurrr.rrirrrniozila,
l."oLiueuroh
ti*i,iu cu simft6matologia tipici. Eristir insii'. crzuri-care pot .delut&
"',,',i
,.i r.r.'lllir r^rrltiir vreine cu simptoine neryoase pc.ite.ice.. Sint totrqi citeYr'
i'r'it,,r'ii olir'ntltive: - Evohitia progresiva qi c:rpricioasi'I - Prezen-ta
lr,rrrrrr,lotgr,rtelalc(asienie, stiri {elril"e,algii rrlticrrlareqi rnusculare etc') I
i,,,l,l,,itii [i" ,,rnultinevrite" capricioase 'fi,-rio polineulopatii asimetrice;
'ide obicei vascuiare) a1e I'.0. : Hipelten$iune :lrterialil'
i\toilil'icrili
;
(irr plr irlrteritn lodoasS,); - Semne de arteriopatie periferici' ;i, de.ce1e
Sderin iu, lrLlscubri, (d tip Eiozitic) pe
rrni' rrrrrlte ori qi cerebrilL;
odiIi'"i ri rk' V'S Fl',. ale
euloiniozile);
trlrrrr trlrrtLiin tlermr,mpoli
-Nl
qi
de dispruteir'emieti
testelor
rlc
p'ecum
*i
waaleriRo"e,
i;.';i,,1,'1:
A3l'o
,,ii', ii"i,r"Gt".torezei
; - Prez6n{,a rnod.ilici.rilor cutanate (in dermatorrri,rzil;o,in sclerodermie qi in lupusul en'itematos).
l,lxtltni itrile E.M.G. qi moditic5rile histopatologice mirscnlare, vasr'Ilr11',iLlcfibrelot uetvuase Si ale ].esutului(lt I nrn-cpidr'r'rni'(in )riupriit'
,t"uin. obligntoril in uc''rtc silr:i'1ii)-pol {i- rrril('
,;;i.i,
' ',i;;;iil,;',;,t
""."
(Dulnn, qi colab., 1960 ar b I Dtma tst (otaD tvttd ;
|r.rrrtt'rrrlia,grLostio
'
l(ft,lrtr6,rr,.L9$l).
::l l,,,lintttt,,l,r.liit{'pard rcpl(tti(:f'c lnl ilrrt'ic trttr'tLi llle ntl l')cl)uio
nt'ttto1tgi.t' l'r(xlrlsr! l)l itl r:tttttltlt'sittltr'
,,,r,|,Trr,1,,.t,.
,r,, ,iit,t .ittiri.r,,lr,trLr''
ttrrtrrti ltritrlilivtr, rttr'l'itr lrr r,iillt Irot'0sttl ttci,ltl:tzlr'(1
rlirtr0l,irt,xi,r.tjilrr,l,ii
l0(i

ttlrrz,r,tr.r'I lIrrrrIr';ri/srrrrr,r'r'r'IrlIiIr,,
I rrir,IrrIrrIrr,, irrli)lllr{ii |r,rIrrtrrrilr,,,
lxrrr,lir
Ilulgkltt ;,rt.), l'olilrrrrrrrrl)itliiltl)iLliut{,('l)llLzictr
so t({l los(1r'r'lrrtiv l$or',
lttitt lthlrrrl lrr trrirl; (rlrrl crr trotti,lrtrlor n irlrrrl,i't,scrtzitir,i),irrll rlr lorr
lr,rl rlo ,,irrrplt'gnalo" ttcttcrtrli treoplazicl, cu cvolu!,io prtrgrr.sivir.
lt) I',litturuyuliilr tlcgru.cruti,rc.
Aoi so inculrt'azir ir5rr,-zisir
,,1r,/ilr,
tt it,i" hip, r(n,.1;,.,itamitiali ,.r c,./piliti?; (buofu ly; D(jlrin, sutt,tx\ .t
rrlulttr(ti (t;ptil, lt;dpsi tourjttrr). SiLr b4li dcgr.rr|r':rtiv|ril
l' rl
',\',trrlir.
1rIrrgtcsi-i'r'i
, in care atrofiile musculare cLrdebut distal itiiing ilr rrlo(l In)A11,.
sir', in tlectls de ciliva ani, toate cele patlu rncrnbre (rlul x,slxrclii r.orr;r
stk', bra,lcle,ct'nl,urile qi fa!a). Se inso(escde mari tulbulriri rlr scrrsilrilr
lrt,lc do tip ectlomelic, cu caracl,ererlisociate (cu nlaforilii hiporrslr.zir',
ltini )r anestezieprofuntl[) si eu mar'e atarie. Cel rnai iiilescrilrr,rli'lrrrl,rrl
lr'rlii, b,rlnrrvii acuz; si clureri fulgurante. Un simptonr pirlrierr0l 0rrir,
({'.rt'.l)crlnitu rli:lgnosticulfftti r}e ,,tabesularniotroJic',)il corrs1,i1,uir,
lrrgr,,r
liitile foarte ugor palpabile, strlr folni, de ,,mitrinii, r]]r, 1r'ul0hilllill
r(.r'\-orse,crlc) itr intregime pot fi hipcrtrofiate. Sint prtztnlr'lrrlr.sr,rr 1i
l.rs.ir'uhlii musculare, c-ares6 qtie cd,"sint,cu tolul excepiionrrlr.ir rr.lr,,i
1rat,iile pe.rifericeD) Poliracliculortr:rri,tele realizeazi sindroa;me senzitir,o-rrro1rir,ii lrilrr
lrtale . Di.sirnetriee, cu diBtributie atit pluriradiculall,, cit si (rl,rr)tl('licir,
rlo obicei foarte extinse, putintl gelera tablouri paraplegice sur rrriri rll
ut abi1 .tetraplegice, cu axeflexie osteo-tendinoasi,,cu nrlrt:lti Iripolorrirr
trrtsctrlari,qi cu atrofii precoce gi lapide. Sindromll ile profouelrrrrr sr,rr
z,iliv (cu tulbur[ri globale de sensibilita;be)
ptezintii aLeasclnclr{,1ilt,tt ,r
rlistt'ibulie poliractricula,ri, clt qi ectr,omclicl. Cel m:ri iulesea sc li:(lclr,lzil
;i trlvii cranjeni (perechiie III, Itrr, VI, Y motor, VII, fX, X, -\t ;i I I I ).
ill,rrlilir.r'i,rile
lichitliene, cel rr..u
i ailesea cu disociatie albumin*r.ilol rgir.ii,
r ir r'i palafeze diagnosticul tle poliratliculoncvr,itir t.irrillain-Ila ll'r.

iUU;ilg;ilt*11l
i;lr)litiri
*l*iiii,--:[-l,li'*

I
+.

PROBLEME
DE DIACNOSTTC
Itr TULSURARILE
TONUSULUI
MUSCULAR

*+*#*t*ms[t*f
r{]niilil
i
*fi#jt!!i?:,T""{$*,il:'lf"{'t*:"tkl'k

j'ml*:*+
i*{i-T*l,l-'*:*"*}T*l$i.*"-t
B'lrH":it'il:l:$
;tE?C";g:yj*ti1d;Jd#1,fi

4.1. HIPOTONIILO
MUSCULARI'

t',",!llr{ff'::"t:t'tilt:?{f ;'!'!t"-'ie

4.1.1. Hipotoniile t/anzitorii, paroxisticcse caracterizeazf,,

ptin bruschcfca cle aparilie qi prin tlurafa scur.t5,(citeva secunde sau
| | llI

l[ e) :

L) Atacli cala,pLectiaconsti intr-o pierdele brusc5, drarnatici,, a

iorrrrsulrri muscnlat qi a motilitd,lii voluntare qi printr-o pritbusire ,,posirrr:rlii') ca,re cortrasteaz5 - de obicei - ct perfecta csnseryare a conqtir.rr{,t,i(.Devic qi colab., 1967; Popoviciu qi colab., 1978.; Rechtschaffen qi
l)crnrrnt, :1.967).De fapt, atacurile catapiectice apar in mocl ercepliona,l
izolrlr', t'lc nsociindu-se, dc reg'Lrli, cu atacrrile narcoleptice (Yoss $i Da1y,
lll{iO; Popovioiu qi colab., 1978). Uneori accesulca;taplecticpoate fi pre.rrr|rl, rlo scmne premonitorii (senzalie dc oboseal5,, de ci1,lduri sau ile
r.r,rrrI,r'ic|ir,ctc.). Inhibi!;ia tonusuhi postunl poa,te plezenta intensiti.{,i
rr|Jirrliillr,ric ll o hhibilie total5,, cu clclere (mar.ileacccsocataplectico),
lrrrrrrlrr o rlirnirrua.rctonicX localizati, la ta telitolin rnuscular (crizek,
r.:rI rLlrl00liIrl pirrlia,le).
t) l[r.uilc urcesecataplectics su,u atacuriie crtaplectice severe (Dal.r"
1i Y oss, 1l)?it; Corfariu gi Popo.'-iciu,19?3, 19?4; Popoviciu ryi colab.,
ll)il{; Irolx)r.i(fiu,1,979)sint tipice ca rnalifestare: in rnod b|rsc, manctilrrrlrrlu)rolti, gura se intretlesohirle,pleoapelese inchid, capul se ilclirri,
pr' lrir'1i1,,urcmbrele superiod,recacl c1e-a,
lungul corpllui, obiectele cacl dilt
rrrrirrii,gcrrLrnchiise indoaie rsi bolnavul sc pri,buqeryte.PrS"buqireaeste,
rllr'i. r'rrpirlii, (La,r'nu instanNanee,brutali, ca in epilepsie, ci progresivi,
Irrpl lritll'inl penl,ru sttubilirea diagnosticulli. Fe de alti parte, bolnayul
:lrisl;i rrrrrlt,ientla at'acul siu de ,,pr5,bus,iret'caiaplectieii,
d:rr r5mine de
.lrilci corrrplct irnobil fi afon, ca intr-o staro tle ,,cLuarizare" si inccarcil'l
rrrlr.rir.rr
o sorztl.,iede neliniqte,de anxitate. Uneori sepoatelcln:rlca : rniozti't
rl lrrlrisrrr riivclgout, mici tresi,rlri mioclonioo li, cxc0!f,i{)na1, rehxir,r'j
rrfirrriclirnr, Sint 1i cazuli, la care inhibilia motiiiti,{'ii Dn etitetotu',li i}bsorr,rulr,lcir,,
Irrl,r'i.prrl,inrlLr-sr:
in culsul clizoi, rllioi rni6ciiri lolutttlt'r:, lititil;rtlrr
posjl'jlilrlti pirrtirrl(r(le ll'tic,ltlrut(r
pr?lrrrn 1i orLrocirlc
1r,
lrr rrrr'loi,r,r'i|,rrlii,
[n lirrrlrttlt'tizci sl irttttslltlii:ltilto'
rrtr,r'r'ttvinlo,rlr, olricrrituritri;cligilrih,.
Irttir
lf ill

* rrttr,r'rrlizrtlri. r t lt olit r r t t

t o1|lr r t ' k t t

r t t loo l l t t r l i l t o i t s r ',

r t l r o l i t t . 'l l

t r 'l 'l t r -

("rarvate"- Devic$i col'rl)'rrxi?;

ii":Hi-""3il*
*:.ql#fr
iil,:i,fi.:*:b::
lli3;*r"'ffi
il
iiill,
:ii*xli**l##ir,r,,",n'lii]*iiiii.!3?i3d':i"il#i3

t','"inrui,s
lif"f*lff "###f*j:":,fiif **,'-ffiiiffi

i:tiffi,"",H#Ti*"T*,H[r..{"3-;1"+$ti
jl,fl],
lf,'(t:ii""-,'::ff;l'l;
i;l*F1;?''1i'hiJt',:3'ff

;Aj"ilf*T,lil,l

,:;ilil
3;
*1
:::fi.li:!i6,:#:;t#f,:!
f::;::
i'*tf
;,;,1/;:,;'"Ti,f
"!i
";fl

i?;j:f##i"+
ltrrffi
d,$gl;ftt*l{r,i.
li;;i;
1[,.*firt1;;[****L:riliiiJ::i:l.i:T,1,,.J
B) Boata Lai, lJnrerrillrt

ll'tl*'#'r;ilt*#illG:!:i'i"":iK:?i'1"1'":TJ:3J

l,""lr;}ir;;
llllni,l.f,i:{'1j.ffi
T1,iii:'{Jpjjt_*i,';#,:lx''

,:,:,.:;,:,iiyi;fiiil!;,f,l:jiii,':,!ij,

liitlrii{iiit'fi',1-:l'itl11ll,;;lx,l,iJ,fi:iL,:":l

iiilfril;li:t
i,r,ir[
iliiillilililifriil;i:
il,llin;f
l*-irui
l(|0

r'rl,ir, rrxir.nrtllri,lrrlrtavul lrlozirrt,ii l,m'rrspiratii ;i poliulie' '1'ottleilutra

oslo tluretoasi|ryiin tirnpul crizei se cYidenliaz'i hipokaliemia'
rrrrrsrrrrlrr,Llrli|
in sr,hirrrlr,itr palalizia perioclicd,familiali hiperkaliemicd (boala lui Garni,,i,,, ,,,r"t.,,o',r dc obicei ilrlc ..,si 10 aui (90% din crzuri;, se dcclanduph inani{ie qi dupd'
iud, os,bi ziua, mai alcs pe nemiD.cate.
r,:'zi' I'r'rr,,r,,
pe mu$chii cranieli'
predominind
paraliziile
,',1,,r'r
rri rritrsculareintense,
r,r:izcise constat[ d cre;ter" lr$oariia ionului de K+ (crr rnetlie.ite
trr I irrrtrrrL
de I 3 g de CLK
poal" fi piovocrfaprin adtrLinist'tarca
', ','l;,,'ir. t iizr,
pruden!d')'
efectuat
cu
trebuie
insi,
rliiglostic.
iare
rtt
r, r
"igrir
pierdere
printr-o
brusci a tonu(lri'.rr
de dt,m atlacl: se mlrrifesti
lt\
este
bruscr f[r6
l)ebutul
pribuqirea,
bolnavului.
,le
. rrlrri rrr';iutir[, tu,ritii
r-Lltrse pro{luco de obicei in timpui rotaliei sau exten,.','1'..'1,r,.,,,.",sr:rle,
r,.i ,,.irrrrlrrir,i rtu se insulrq1ede pierdelea cuno$tintei' Auzul, vederea qi
, r,rlriliir rLttiLl lerltrtlte. i'riza cle drop al,tnck este un simptom al insutilicrrli,j r,irculltl,orii vertebro'bazilare Coriariu, 1971 ; Kubaia qi Millrlirrrr.l1){il; llopoviciu si co1ab.,1968; 19?6, 1980)' Diagnosticul tliterenI ,,rr , r,zr,lt' epileptice akinetice (amiotonic-llkinetice) se imptne tot,l','
,.r,rl',r.ir, nici rlrr crz nu se evitlcntiazi modificdri -tlEG dc tip epileplic.
nt,,,fiti,,iirilelillG ale atacului de dlop uttack nu pot fi suryrinse, din
c\rmeaul
necesart
I,rr, irririrnpli vizibiJici!ii epaliriei crizei,rlai
9lFG esl"
i,,t,rr,rt nu.rl, evidentia oar"cate anom:lii clcctrograIlceca'racierislice
rrrsrrlilit'rLi.tir-ertebro-bilzitare (PopoYiciu si colab', 1968r 1976r 19?8t
| 1)r'i()1,
l'l lr)ristii' ft,rine dc cptlepsie in care dominf pierderile tonusului de
de petit
,,,,tit,rrilin," (cpilepsiile ,,siatice" ale lui ll,amsav -Elunt, crizele
1,,,,t ,,,,,i,rtonici-akinetice, crizeie epileptice temporale amiotonic-akineri,.,, (itstaut 1i colab., 1969; [iastau-bqi Broughton,. 1972;. Gastaut'
de obicei
l :r7;,: I ','r),)viciu ii colab.,i 9707.Cont ert ul s"miologicne orienteaz;'
.,i,, i,r'rri.l,...lnrctizoi, r'tt dttrali scuuti, prin asocier,'afoarle frecvenLd
de obicei cle tipul ulei obnubi]iiri sau absenle'
l,ir,r'iliri conltiinfei,
lr, pllt LLr
-pdstaccesuale, a amneziei accesului si, mai ales,
,, '*iii i'ir,,' colf uzionale
IIEG qi pohgralice din aceste crize'
rrrrorrrrrliilr
Gt I'truLiziile dP sontl (paraliziile hipnagogice,cataplexiile hipoe'
sitrt' in realitate,
,,,''r(r.iirlr ctlt.oleliile cle ,,aclormirc"sir'ude
',l,rezhe")
generatS,
cie structumusculari
prin
inhibilie
.*,.
musculari,
,r,',
rr,t,'rrii
ii,.il
,iil,, .,,,nll,,ni,ofalice ale sistemului somnului REM, apirind de obicei la
irolrrrrviitttlurleptici (Daly qi Yoss, 19?4; Yoss Ei D3'ly' -1-q59;Eis^hikawa
.i ,,,r,,n-. lCoir:- Pompeian6,fOOZ; Nan'no ;i colab.' I970; Cor{ariu 9i
i',,.,,'i,'iir. f974. 19751Popoviciu ti colab., 1978)' Trebuie d iferentiatecle
,,,'i,r,, r,,.'o" tte cpilepsie rnolfelcd, prin inYestigalii EEG qi poligrafice, in
,,,,,,rlizi,l,rtLe sodn iecxisthcl anomalii EEG, in alarX de contextul polir:r"r,lir,,cir,tt:arlti c5,paralizia de sonl, fie in forma sa izolatd" fie la narcoicrrl rci^ implicri aplrilia inhibiliei musculare caractedsticai somnului R'EM'
(Nan'no qi colab., 1970; Cor1ul ti,'gil ,ri, fulcl tle ielativS, stare de veghe
frr,r'irr
6i lbpoviciu' 19?4' 19?5).
1.t.2. IliPotoniilc durabilo :
It) II iytokniil,a lqnarllisate sint raro:
L M.iul,uniu,(rtri]lrtnkt') mn!/ ni.lald'a ltti Oppcnhr,itn $o llll'ilno$l'o

lil',
o x l l ri ttrl i i ,, tl i t' lt t,tf,tl t' i sl ,i tl igrttrrrrrl
lrr,r'rrDii.r r lolr ir r ,t r t il|t ,,ttl :rl l 1I' i i tttl [l tl t,rl ,tr
I ? {l

r.;rlri,1rllrrriIirirIrriisr{i,r,i
llrrriv, rlr',rrr.lrilrlr.;rrrrp)o(sin1;rrrsir,-rrrlrrilii
,,r,oprr
rlc lrrrrcirtci' liiset. 1952).
:!).
l:t.lt'r i nlcl.c aerebeloasenta;ine ( atrofi,i,le cerebelo(s(:
;i. Iltt(.|c tl.is{rofii musculat e progresire.
4..'l's,besitL(forma amiotonicd,).
B,l J{ipotoni.ilenzo,imulNsall mdi gtulitr,locali,zate(tle 1,iplrrtrri;rl,gir,,
lrrla,piegie,l,etraplegicsau doar la citeva se,gmenteale corpulrri) rrlrrrr.irr
,rrrrrilr:,r,'lt.s;lual;; pulologice
:
1. ,ln- najoxii;atea cazurilor, hipotonia se instaleaai, brasc 6i esl,c llrr
liziil,ri tle Le.zittttiale aroalui refler toni.gen, respectiv ile leziutii ntrtlultn.
,.,i pti,Jerice. Aceste tulburili tonice prin atingerea arcului rcfltir lorric
'Ir.rnentar sint totdezruna iinnitate si segmentare, dispuse dup5 o topoglrrtrr.
L rrliculaRi sau tlonculari,. Se constati, qi coexistenla trrlburdrilor srinzilit'r,,
t otice qi paralitice iar leflexele osteo-tendinoase sint abolite (semtr li rirli l
:rrportant). Ilipotonia este cu atit mai importanti,, cu cit lcziun(fl, rr,lojrl
rirri bnrscl. De pildi, sectiunile miiduvei tealizeaz:acea mai masivij lllr
, i(nte rausculalri, ct topografie paraplegici sau tetraplegicd,,
a. [,eaiunile merlulare antrerreazl simultan hipotonie pin[ ll lllon il
tttusoulari qi paralizii (de tip paraplegic, tetraplegic sau mai rar mouoll(lfli().
:l\t'&,rlrnatism?.[e
medt are (cu secliuni complete sau incomplctq t,vcrr
I rriiI prin comolii medulare ) qi lrcnzatamieliarealizeazd,paralizii hipoi,orrir,,,
rrrr atonice imccli:rte, de tip para sau tetraplogic. Adesea debuteiuii ;rr.irr
il o fazii de +oc, insolitil rle un raasiv deficit motor ni atonie crr rr,i'|,.,,,.
' rslco-fendinoase !i critanate abolite, cu incoltinen{.I sfincl,cr,iurrii ri r rr
rrrrrt'i tulbur'dri de sensibilitate. Aceast[ atonie musculari in ]eziurrikr r rir.rI rr
lrr'c masiye persistf pini, cind se instaleazd,ienomencle de aul,orlrr,i,isr
rr
rrrrlulirL, cu respcctivele simptome de elibera,re,cu sincinezii globrrlr.. lrr
, rrlsrrl compresiunilol medulalc br.utale de diverso origini, sa,u irr lrrzrrl
riror'frpctiuni spinalc incornplete,se observS,adeseoriacelagidcfirril,rrrolrrr,,
rlrr trr hipotonie mai pulin marcat[, qi mai pulin clurabili,.
Lc;iunile medulara a.arle nelraxnn(rttce tealtzezzd acelaiii sirrrllorrr
I'rllllitic cu lripotonie. Itste vorba de m,ieliteteaar,tetransoerff $i rlrr 2,,/r,,
ttitlikt acndd,,in care palalizia hipotonici, qi aretlexicriltlotniiri 1:ilrlorrl
' iirric:! 0u topografie tetra- sau paraplegici,.
ln ytoliam,it:lilele
subasutesau tw instalareprr.rgresi,t:ii,
pc prirrrrrl |lrrrr
r r srl,ueazi,paralizia atroficii, hipotonia {iind ins[ nolipsil,il.
!, In compresiuttiientetlulareprogresioe(prin i,umoli tle rlivei'sorr:rirrli,
rltcrxe, pachimeningitii,,arahnoitlitn q.a.) hipolonia^cstc rilrtxl'i irrl,ilnil,ir,
rlrr obicei constatindu-se contrlcturi musculari. ln scliimb irr tir,irrro
trtirrlieqi in tumorile intramedulare, leziunea,pericrliona,lrlpoatr: llrirr,rrr
rrrci, de la inceput hipotonie muscularl.
3. I'eziunile progresil)e spinala posterioarepri,n leziun i ale atnlaqntlrn.
lt,tsllrioare(ale fasciculelorlui (ioll qi Burdach) sa.upr'in leBiuni r(r(li(ut(rt
loxtarioarerealizcazd,de tsorn(lnoa,lripol,onii plin inl,elfln:treilu,tt'ttlrrirrrlh'r
lr)nl{r Olementiu.
a. ilipnl tt,<)ostorrodidllo 'm i(lite poltlffiaor,r.restc rr,prtzlrrl,rr,l rlrr
lrrbrl,nlti nkrsi rr ril,rrt{;iilo cu irnpoltrrrrtrrtull;ulr1l:ir[o stqrsi]ril il,i!1,{r
lrrol lrlriri,.
b, H i.rul;uq,nt
d,t' r t Jihrr lu,rrgi (dt. .nr(loun( Ttuslrtiourt,)?v:u.lththr
,r'r'{r
intnlll('iio lul (x)ut,(fxl,
rr.rrriologirirr t:lrrcpc 1rt'irrrrrl
pllrn sotr,l['i,lrrllrrr
lililo rlrrptol)ti()nr{{rl)(
i{r,rrr ;rrr,llr.lil oslr'ol,rtrrlilo:l,.ll
i,ricrrlriprrlorrir.
rrrrrrr
lrrfrr.rii.Adctr,lr,r.sl,r,vollr:r tlt'ni itou. tt'd( ttrlu t)tii tttuhintlli, ltr lrrrr. irr
(,orir,\lul clirric:r1lrr'4ir, rrrrrr,1rilIrrrrir|Irlrr.
f.{r'girrrlitrr,irr :rr.r.nlr.
rrrlrrlrlir,
t7l

lit' sindroamele tle salerozd,com'bind'td caren\t s irr,rLl'ou,nte

l,e n'au,ronn'ent,i,.xt,
(indeosebi eredo-ataxia sau
;!'a
i nrt-cer,ebeloase
sp
d'egeneresce
lrr,
rrtrolo
liolri,
rlegenerescenlelor
spilo-cerebeloaso,
(majoritatea
irorrJrr,hLi I'rieaheich)
irrrlrrscbi eele de tipul Piene-]farie evoluind, de fapt' cu spasticitato
care teallzeazS"folTa pseudo-.
lrilrrrrrirlnld,).Rareori existS,scleroze in p15,-ci
profri:nld, cu hipotonie $i
de
sensibilitate
i.rIr{'l,it,ri,,
cr marcati tulburare
lrirr,rrr.Il,i.,rie
osteo-tendinoas5,,in cate qi semnele cerebeloaseapar ceva
rrrri litziu.
.1. t,a: tu'nil,e periJeriae ale orat'Iui refLen c\7 hipotonie consecutivi',
Polirad,i'culo-nevdte ; b\ Polirrrrrl,irrl,ilrrite in iumbroase afectiuni |
^)
(ve
capitolul precedent) ;
ttt t,ri:r'.ni ttoltttcur oputii il'e diuerse origini,
metabolice
(tlaumatice'
torice'
, ) V,,,,rift,' si neu,ropatil.
$.a.); d) Leziuni
, ,lt pl,.ttt1 ilt,i

llrt,rL ill,

lot nbar '

o: r c r aL) .

l. Alealiunile rlasculttre, ca c1opi1t15in distro{ii1eilusculare plogte; ir,. (rrLri.rzulilu in c.ne se irxtaleazi atlofii importante, degi :rrcul retlex
r.ilc

rllra,t,t),

0. It;:tutlilc
ftttmaliuttllor cu acliune Jaci'Li.latoareosupta dtaxt'lui'
(
prin
intemediul sistemului rei;iculat facilitator tlescentlent),
t t llt ,t)Lt)tLioen
siirr,r(ii iricLr,rJhipotoniamusculard se datoreqte preva,Ienlei acliunii for:
rrr:rtirrrrilot inhibirorii etescendente
(infec-tioase,traumatice, degenerative, atrofit\ I'eziunile aerebeloo'se
ilr coictreloase cu tliversele lol forrne clinice) se pot insoli de hipotonie
o
rrrrrscrrlat'd(uni1aterald, sau bilaterali, erentual crr predominantd'
'le a
p: lu), care se poaLe evidcnlia, pe linga-ptobele clasice de e:.plorare
i 'r,,ritiiziliipasive, qi prin allc probe senriolcgice:proba pasivitdtii a' lui
A rrrlr'6Tioriias (dd rS,sucirepasivS,a tmnchiuiui bolnavului, remarcindu-se
rrrisciililo rnai ample ale bia-tului de paltea hemisindromului cerebelos) ;
prolrrr, ,,r'ezistenlei" a tui llolrnes-Ste,ivar"t; proba reflexelor pateiare
qi
"'o"ttlll^rl;r*,*or, neostriate (coreile tle diverse tipuri qi etiologii, acute
qi
caracteristicS,
hiperkinezia
asooiazS,
crrrnicol sindroa,rnele atetozice)
variabile.
rle
iltensitS,li
lrip,rl,uttia
c) Llnale sind,roatnaaesti'bulavese pot insoli de o discret5 hipotonie
rrrrr*r,rrlrrlli
insilater ali leziunii'
d\ It l&lunite neuron'ilor tnotori'centrali, hipotonia muscularS, poato
Hriti(' irrl,ihritii,numai in situafiile in care sindromul piramidal s-a insbalat
lrlrrsc.dlr si il accsle cazrrri hipotonia dureazi doar timp de citeva sdptrirrririi.in cale asist[m la o hemiplegio flascS,(sindromul piramidal deficii:r,r:rl iui Barr6), dupd, care se instaleazS,hipertonia piramiilald, c&racteris'
l,irrr'i.Nlonfioni'ni ru:rele parali.ai'i fl'a,ececentrale pseud'opariJwical
-inso"litg
si rlrr u,1,xrliimuscula,re, adesea cu distribulie pseuclora,tliculari (dar fd'ri
(meninfronto'parietale
d.e
tumori
unele
rea,lizate
ii. | ). ,r,,,tlo*usculard),
giorr,rno,glioame) sau de suferinle vasculare.

4.2, HIPERTONIILEMUSOULARE
4,2,1. Iliporl.orriilo plroxistioo sint roprezentata la diversa crize de
Iitr orrt'pul ln int.regilne, Iio auumito scgmonto
(ont,'tu,hffd,cliro inturosor.tzii,
u,
oor.Dori0 ii:ola,toti oi"!l'ol'durlll,iirlrr Iunofio i]o rnocllnigmulcontnlcburii'
t{ll,ll (l(l i)l(1.
rtxl,0 <1()tl00Lttttlr.}-tttittttl,o,
l't !,

4.1!,1.1
. I l ipul,otti,il.upu.rotittl,itl rtutt,r'ttul,izttl,t:
|) lr'onnt:ltLort,i,rd,r:qtik4tsic q(n,arlizal,ii (glarl rn:r,l}r,irntr,r.grrrrrrr,ll'li
zirlritl,u $ootrtr(lirlgonot',liza,1;)
sint rcl ,tiy nryorrlo rxtnrroscrrt,prilr lrrrslr,,n.
rlrrrt* bruscil rr,corr;Liorrl,ei,
prirr carrlr,toruloonvulsioi i,oni(x),l)rilt {lut,t[l,n
sorrrtii (minuto), prin tulburf,lilo respiratorii, vit sor]ro1;ol'iirlo a,rxrrrrprrrri
rrrnonl;,plin ernisia dc urin.i in crizi,, prirr mulscaroalirnbii, prin prrrzrrtl(,rr,
rlo ottioei a miclrirlzei qi prin surprinderoa moclificririlor lrllr)(l (Ar.sorri [i
,
1978; Popoviciu .,qicolab., 1970).
"lrb.,
lr\ Marca crizd piliatici poate sd, realizeze o corLtrrrcitrr,il,
grrrrrrr.rr,li
zt,bii,da,r, spre deosebire de criza tonicd, epilepticS,, ar.eo dulttii tnli lrrrrgrr,
rru se insoleqte de apnee, nici tle emisie de urinI qi do mursclrrlr,lirrrlrri,
rtioi de sernneEEG, apare intr-un context psihic revehtor., illr.sirrr;rl,rr
rlr,l,ologia critic5, este ,,neulomimetic5' t, adicil, are o topogr:r,tir: cN,r.orrrlrr.
sj{)ir{ru colespunde structulilor anatomice reale, ci ,,itleii,, 1o otlr lrolrrr,
vul o are dcspre ,,organizarea" Ba corporald,, creintlu-se zr,sblirlo Irr,lsrr,
.,schem5,corporald,'J (Enitescu gi Popoviciu, 19?8).
c) Tetani (si sind,roamelespasmoJil.ice) pot s5, realizezo (x)trl r.rrrlu ll
spasmoclice ale extremitd,lilor (cu spasm carpo-pedal, minil rlo rrurrrro4
ii cu planti, excavati,, cu inclestarea pumnului), a1o trunchiului (orr rrl,trrr.
ciri ale torsului), ale muqchilor felei (cu,,ris sartlonic,)), spnsrrLtrorrrrkr
rrrotolii, ale limbii, a1elaringelui qi chiar crizc tonice gcnei.r,liia,0orkr lrll r.t,
pscudoepileptici,(Riser, 1952; Figi,rd,qan qi Popoviciu, 19?8). I'rr,zr,rr(,rr
srrrrrnclor
lui Chwostek,Trousseaugi Erb, lipsa pierder.iicunosl,iuf(\i,:lrl,(,
,.rl{lontele,modi{lcd,rileEEG qi EI}IG (1a proba g:lroului), motliliici'lr'ilrr
c:rl
lcrrrici qi/sau als magneziemiei, clarificd, dlagnosticul (f ir,glriiqrr,n;i l.,opo
virirr, 1978).
) CrizeletronicedeJosiiposterioariiau fost ilescrisc inilial rlc .lrrr'lisorr
(ll{?1, oitnt de Arseni qi colab., 1978) sub termenii cle ,,cercbollilr.lilrr",
seizurest'$au ,,crize postedoare,t.Apar mai:llos Lr,r'rrpir
,,l,rlrrrnrs _like
rr rr l:r adulli tineri, in special in tumorile mecliane cle fosri,lrosloliorilrr
(1rrl,po un
pulrti,.r,i
Taterial de 1040 caauri de tumori cle fos[ posteriorr,i.i,
rlr, Arscni gi co1ab.,1974). Aceqti bolnavi prezintii de obicci ;i |i'rrorrrr,rr,"
rlo Iripcrl,ensiune intracraniani,, insolit5, adesea si de o r.cclo:lrol i1(\l'(,ilr
:r lrrhisului, precum qi d.e pozitsia ,,ceremonioasi," a tnpultri.
. ln mod brusc, de reguld,in urma unei migciri bru;tu a ca4trrlli, col
prrl se plaseazd intr-o contractqd, tonic5, in extonsie, in opistotorrris, irr,r.
rllpul este.aruncat_inaloi,eu ochii deplasali in sus, mcmbrclo liinrl Jrlrisrr,tr,
irr lilexieqi pronalie. Uneori se asociaz^$i trismus qi incontinorrl,rlsf irrll
trrrir,nir,.
devin-e foarte neregulatH, qi supcr.ficialtr, stnt (lr! i,ill
^R,espiralia
t llrovne-Stokes,
apare bratlicardie, pulsul este filiform, bolnrr,lI I'jirrrlrlorri.
rrrroori obnubilat . Criza dtreazra do obicei clteva minute, putind I'i nro r,l,rr,lil,.
t)rr!ir, .crizd,cefaleea $i vd,rsS,turilese intensificS,. S-au deicris qi lonnrr pn.r
l|ak) da $tza tonioe, caracterizato doar printr-o contracturfl ;la,rrrxinl,irrrl,
l rxrfci, sau a membrelor qi a oefei, dar nu lipsesc aproa,po nioiodrt,l,it,i'trllrrr
|itrile r'<lspiratorii,
paloarea qi cefaleea.S-nu descrisii crizo tolrim 0rr prrrrlrr
nrirrrrn(;ir,
unilatcrali, cu asloct rlo torsiuno a,xirll5,(Va,n Boglorl;;i Mur'l,irr,
lll'..11"t,
oilrrti d.o Arseni 6i oolrr,b.,19711).
Mrr,ioritatolr,ir,cosliororlzo l,lrrirr.
rirtI rryola,torlropontr,u.trrmorilo rlo frrstlpostoriotli'i,(inrloosolrivollrlt,lr\)
rii ;rorrl,r'u
nngt.jfi,rilol;errrpor.llc,
t5i r.lrtrrlol,sl,lilldo rlrizo in ctr,toso H1ill1,1rlr.i
trrrrr||;iot rl,rt
tr.rt1;r'rrlluio
rIIrrrlrIrrrIr11;o
0u 0r'iz0kr
rrpilopiirrrr
it)llir{r(li,iHr,r',
l0ltll ,
Atlotri qi rlrlrr,lr,,lll?lt1 Al'Horri1i l'opnvilirr, l{)Bt)),tl {!lrrt,{!,rto
II il(,I rIr\I| |\I|,
jf po;rl,olrrliltti o fi{uttoltrfn,
r.o ltrr,tll,ri, I,rrtrit,il,
itrxlrtil,iL
rltr rrillrrozii,
1i rlr'
t i/ ]

rrirl'iilxii. l)lr', irr.lr,llr rlr'lrrrl, rrr i'izrr r.1riIr'1rIr.ir,

s. p|0rliic0 o rrl)lr(,(,,
,lrrpir.r'irrr.tr.,pir':r{iills,.
rllsl rrl rlr.r.r,j{ul;rl,I,r,Olurrd(,i,
-rr,r:r.rll,rtr rrrr,rJ
,{r'r'l()lrrir'slr,
(1lrt(}frd (lii(i'iL(i do criz,, tonici a hri Jaaksun. -tn schirltr,
.rr.r.il. r'r'izr.lunice tlc_Iosii,posterioari, cu rluratii de aBerncneaBcurtii,,nu
.,. rrrr lr..r.ttc.obit.eitle pierdoread,. cuno[tlntr] si ecl rnai tdesex dispar
rrr ;rozilicde decubit dorsal (drs.ri li cohb., 19?8).Arseni (1050) a einis
i.,r'ir v.'Lricu1ari, confomo sireiir aceste crizc se produc printr-rin rueca.rrrsrr rr'1icula,i,ceea,ce erpliri qi_fuptul de cc lrcesiecrize-pot si, apani in
IrrrIr: pr,ocoselepatologice care iriti perelii r'e1}triculari.
t,) 0.izele h,tptertonice
d,in letartostlcbtteazi, prin trismus gi ris salilonic.
,lllrir r.:rr',.
coultactura segencrrlizctrzi,cumpletixdu sc eu rerluarea cefei,
, rr rlivr.rsr.inllexiuriiale trrnchiului (ir:ainte.inapoi Jat,.t,al),
clr reduareJ
;i
rrrrrr..cl_rilor,
tlrepli abdominalj si a muSchilor pectrxali, plecum si clr contrac_
irrli alt rnembrelor. Aceste hipcrtonii ttanice sint pielungitg persistenie,
rtrrrl'roaso, fiind eracerbate prin paroxisme tonice vioientii initise ae c"*ij
l:rI ii scnzoliirlo si psihice (zgomote, lumin5, emotii etc.).
t 1 .7t urb.o
r e apar conrracLuri bnrslo I rringo-tarjngu-d
iafr.aema
I ir"e,
.t
,t(.,,.,.hird,. riolente..insolirpde cri"e de apnec $i ttc blo'cajlrrin;ia;; itiI
l.rrlrr,tivtde
deglutilie a;ntreneazi, desciirrca.ritonico-cloni"ce ale*buzelor.
-de faciali qi ale constrictotilor faringieni.
:rl. rrur;chilor
Ca gi in crizele-cliri
t'.l, rrr)s,acoste conlnacturi tonice rabice sint, in moil caracte'istic, declan_
,rrlrr ii .xacerbate Ia cel mai mic zgomot sau Ia eea mai micii rniscai'e aol,iv6
rrr.rrllilsivii,
,{1it crizele tonice <Iil tetanos, cit qi celc rabice, sp iusolegodc oxago_
ttilet_teloridiom, sctrla,re,ostcotendinoaseSi mai rles i unor rofleie
'rr.r.ir
,lc
llrrnchi cerebral (nazo-palpebnl, mtscter.in, Chwostek).
t) In intonica!,ia cu stricwtnd (sau, tn su.pradotareaterapeuticd) poate
:rlriirtir ti sttire de contracturi d e.,tip tctatic, cu t,rrucorb[-l.i
p""6rliti"e,
.
:',i, .,':r r,llorrrind crr convtrl;ii clunice_
'f .i!.1.2. II ipertoniile paroristice localizate
t) Crizcle epilepslicelocalizate (tonice sau tonico_clonice) tle tio iack_
rr'rirrr ((,u f.i1 fii,rd lierderea de cunoqtir-LlL,cu sau fi,r6 der-iatia'cilj u_
,lrrl.rrrr r.rrpului$i a ochilor')se recunoscprin durala lor scurta,
uneoriipie_
lr.rlirrrlo crizii generalizatl, precum [i pri]r contextul clinico-EEG. '
b) 'I't:tunia ;i, spasm,oJiliase poi manifesta printr-o crizd, de contr"ac_
lrrlii.lirrr.itiiti la un segrnentcorpoml. Oontextul clinic gi EMG o" pr..izr.:rz:irlirrgnosticul.
() (hitete ocwlogireposl,encelalil,icerealtaeazd Im context
semioloEic
rrryolrlo roounoscut: {ixalea brusci,, penrbilA, coercitivd, a globilor oculi,ri
rrr nrrH,itxoliid de,deflexiunea capului. MuIt mai rar se reaU;eazi un spasm
hipr.r,torric latelal (cu sa} flri devialia conjugatd, a capului),
Irr fpilrirn ou coborirea globilor oculari. Une6ri in cursui crize'i ""*p'*iio
oolifogi""
rl, lrollu r.err)in]'&r,
midriazd, sau miozd,, iar alteori bolnavul poate meniile
irr cursrrl crizoi o a,titudine statuiticatd, rigid6, a intregutui c6rp. Niciodati
tr Hrl(xrnst,rtd,:r,ltelarea sttrrii de conqtirn{d, in timpul crizei -(element de
rllrrgrrost,iu
dilorcul,ialfa{,ii,de,unr.lc crize opiloltice cir devi:r,6ia
conjugaid a
;lLrlrilr. oculari itr-ilus,ou [ti1; mlli t ult, cu cit s,l|'rrd escriscrizc o-cu"logi|o
,lo ltnprrtl,tlx ricct-ttl rnic,,rlrtlti"ltrnt'olo Iixrnzii in tlcvia!,io sursllnvor.gcll,:1,
ll,isrrr',l{}Ii2)^(lrizu
ilr., lrr g.rrtiHtl, rlrrrl,l,ilIutrgl (ri. lr, tiit.ovrr
rrrrrrrr1,rr ; ri rri i, llr cittrt'lr'trulogi.i"r,
orr'), llrtlirul Ii rtrtcori rrrplirnir,tr'l
volrrrrtlrr,,tlirr. llrr

ol ti tl t' i tttr6t r lt tt t t li l; t t t t |'t t t t t rio

t gi la,ir lt r t it t isl, r illol r lr r lllt lllr . it , lo r lo : t 1, r o1r ilr ii,
rl l tu N crruol: r ,rr it rji, .
I llrlu,nnptsrtt..nl.si sltttsrnu,l.faaio,t,ltn,i<t lirlicli, irrr.Jrorl,lrrrl(r
,
.rl)
I)|.6I)Ir\|r||,
r.lurlirugrroslic, pul,irul li explorirl urrol rnllnil'estliri spasticrr p'riprr.rrlizi.
Irt,ciu,L'i,,
a unnl rnrr,nifesi,Lriextrapirarnidille, s.m lunc!,iotur,lc, irrdrisiv gril,i
i r h(i {).

a) Crampa scriitorilor se caracterizeazti,plintr-o contr'tt'otuI'ii1[rsa,grrlii,,

.
,,(,ora,1;ivi,,
a murschilormiinii (uneori [i ai antob]'atului), cu otisplu orr,irr liipr,r.'
l'kr.rie a.degetelor,care apare in co!ciilii binc rteteuninate ;i rih,l iv irlorrtlir.r,,
respectiv in mornentelein care boLnavul incepe si, sctic. ()r'runj)1,
rsl,rrrlrrlr,
lol,sri ,5ise extinde adeseaqi la mugchii brafului, ai umintlrri ryirr,igilrrlrrr.
Do aele mai multe ori este vorba de crampe ,,funcfionalo,, irrrrlrisiorrrl,,
(Lr,drctilografe,-la_funclionari,la pianiqti, la violoniqti oto.), irr llrrriti,rr
l iili distonice declanqateqi/sau exacerbate de o fobie a stir,isulrrir-i:rrr:r
prlctici,rli profesiunii lii de o fatigabilitate excesiv5. Unrxllj insii csl,o vollrr,
rlo o diskinezie eltrapiramidali,, sugeratii,incii de Il,iser (19f2) qi vrr,it.icrtl,
clectromiograflc de Aqgian gi Popovi.iu ( 1980). Astfel, se pructirli, cx i r,l rrl trrI
l)lIG simxltan atiL pe rgoniiti. cit,li po i],ntagoniltifprrrt,rr,,irrr.r.v;r(.r,.r
r'e,'iptocc ").In crampr, ncrrolicS,, la accaslA plobl'r :r i rIr.r'v r, ic i lr.r.r
,,
1
o funclionalitate normlh, ln sclsul i:i ll, txrrrl,r.:rr.(irr
lrtoce)t.se tlepisteazS,
rgoni,ltilor se constat[ decontraclia antlgoniptilor. fn schirnb, rlrrrii r.ii,,
vor'lla de o ditq.kinezie
extrapiramiclali,, Ia contracl,ia rgorriFi,iiol sr, r,r,rr
l.r'tct[ .$i rnu$chii antagoni;ti, adici. apare o activitnte EM(i ;i 1xr l,r,rrsr,rrl
rrrrr;ohiuluiantagonist, inregistratd in mod simultan cu cont,r.l,c
1,irr, rlrr rr,.
1r'rr,soul
EMG.al muqchlului agonist..Credemcd, aceastii,prob;i lrlozirri;r,'o
lrrkrilre semiologicS,pen!ry diagnosticul diferenliat intldcrarnpirlo rrrrvlo
I irrr si ccle extrapiramidale ,si pentru olientarea tratamentnhii.
l)..I.n
(boala Lui Steinert i boala lui Tltomsen) ln o\ir,rrr\rl
-m,iotonii,
,rrr;rr'r'licial
ne-ar putea duce in eroa,te,sugerindu-sein mod irr<rorrrcl,
r,ri
r.rilr vorba de o lripertonie. De fapt,.dupii,cums-a precizai,irr uli,irrrir:rrri,
.,irr ciiLdaaparenlelor qi contrar definiliei clasice,miotonir.r,
nu cshr o lrrl
lrrrrrr'ode relaxare, ci o contractie prelungiti, determinatri do irclivil,rrl,r,rr,
I r.ir
x'lcetricS"interactiv[,_suslinut[ a sarcolemei" (Radu, 19?ll). l)i:rgrrorr
Iicrrl este relatiy u$or de stabilit, gratie ulm5,toarelor elomcn{,o:
Caracterul eredo-familial atit al miotouiei congenittlo hipori,r.ol.ico
(lxrrla lui Thomsen), cit qi.aI distrofioi miotonice,(bo;la lui Si;oirror.i);
- Prezenla hipertroiiei maselor musculare irL boa,la lui ll,horrrxoirur
:r rll;rofijLor musculare in troala lui Steinert;
-.Prezenf,a fenomenului miotonic, care se gtio cri nu ptozint:L torrru,rir
iu lotrsitate in toato grupelo musculare.Astfel, sc poate lo-rnl,r,cir
r, lrr.rrrlrr
rrrirrlnll a fenomenului miotonic la musculatura <listllii a lnorrrlrr,il,,r_'1,,
rriol,oni:l,conge_nitald,.
(Thomson).fenomenul mioto ic aprlro gorrot,:[lizlr,l,,
rr vrome cc in distrofia miotonicir, Steinert este mai limitat, alleirlirrrl r|rrr,r"
cilivr,.muqchi sau grupe muscuhre (mugchii policehti, rnuqrchiilirrrlrii,
rrrrrqrhiiflexori ai rlegetolor,'mu;ch
i i orb!culali ui ploo.r,polrr.ryi
odukrrrrol,or.ii).
lrr lrrr|rlmiol;onia congonitalii t, Iui. rlult'nl; rrrg lerrr)luernrlrniol,rtrrioporrl,r,
rrrlclcsil ln rnorl oxclusiv nruqchii faoiali (lilrilu, l-9?8);
-- or)rrBi,rIlil
'ol, Iil 0xir,rrr{)nIllr)l\l(l rr,srr,lvoirrriokrni0rrriir,r.rr,rrI,r, r.i rrI rrrrr
(rrt rlrrt'lulil,
pilrr'i,
lrr,!l) s), corrrl,il,uili,tlirr pot,rrrr{,ilr,lrr
lrlxri,il,ivsqr!r{,r,rl,r{rr
irr rrrlpliirrrlirroqi irr lrrrrrvrrrr{r'i,
;Irr'rllr'l'
rr,irrrrrinrlrr
xrrrDoi irrrr'rr i,r.rr,rfH
(x,n{ l (' l (' l tl , ;
... l ' t' .zr f alir , r .i r rrI r , rrr rrI rri r , r r r lr r r . r 'itit r r lill. r r lir r , r r r i, i, r r i. ir ,
lJi, r r ir r r r l. i.
l Tft

,l.I.ll. lli;lorlorriilc ptrrrrrrrrr^rrlo

(srrbtrrrlc si r,ronica)
oniil,e ruh,itliute (rtthitotaiile) clu,yproase
.scpot intiLni
'l-:!.:1.1.I I .iilt.l't
Ntcctiiuni:
ir rrrrr rotoir,se
t) ilinrlrotnul mentnge&l,realizat de meningite qi de hemola,giilo subiurlrrr)irli('no implici, in tabloul semiologico hipeltonie dureroa,s5,,
ertinsii
irli'${,ir lir i,u{,i muqchii cen'icali postedori qi ra;hidieni dorso-1i:mbari, insode puqci',
Liiri (l(l rlxloarea neiii, a cefei, de pozilia cancterisl,icd,in ,,cocory
1i pozil,ivil,ater bingcunoscutelor manevre Kcrnig f , Kernig trI, Lasdgue,
llrrrrlzitrsliiI, Rrudzinski II ry.a.
al f6ei posterioara trebuic dilerenbiat
lt) tlii,ttdromu,lpseud.o-nz,eningeu,l,
rlc sinilrrrilmelc meninge,alepropiiu-zise. Acest sindrom pseudo-lr cningeal
cslr, rr.rrlJzatde proceselocalizate in fosa postelioari,, dal' qi de altc proiese
r.)il):ll)sivc supratentodale, ca,re produc fenomene de angaja,re a cercbctrrlrri, r',.spor.tivr lobului temporal. Se poate astfel evidenlia, o ledoare
rlrur.r',rrsi rahitli.tuii celvico-dorsalScu Bemnul lui Kernig prezeut, cu o
lrozilio rleflectati| a capului, cu membrele inferioare in flexie, cu atitudine
lr ,,(xxiol de puqci'". l)ar aceastS,hiper-tonie dureroasi, a cefei qi a rahislIrri porrl,eprezenta exacerbiri qi remisiuni, fiind va,riabili in iritensitate, ia,l
rrrrrrrlirr lornbard, (periculoasi in aceste situalii) poate s5, tie urmat5, de o
lr.rrlrrrlrsot:nli a, algiilor occipito-cernicale $i a semnelor meninge:lle. Un
r.rrrrrrr,nlrtont ,i sistenatic al fundului de ochi este susceptibil sd,previn6,
il g('rrrclloln el'oll.

r:) Ilt"pertonia rahi.dialxd,dureroatii,ipolatd,,interesind doi.rrunii musch i

cofiri
rri
;i trapezul, imprimind o atitudine vicioasX (cu torticolis) loato fi
irrlilrrilii in cutsul unor leaiani, endoaranieneqi 'intra-rahidienece|Dicale.
iir.ril rlc;te irita,lici nervilor spinali Si cervicali. In contextul serniologic
litrsirsit, (lzri,:i tle sinclroamele preceilente) contlacl,ura rahiiliand, krmbJrS,
1i'rr nrunblclor inferioare,de ase-meneanu Beevidenliazi, semnnl.lui Kernig
r'r ,', l,Lrl1r.scrrrnelr|ningeale. 1n plus, contractura mt$chilol cefci rnlniDe obicej capul este plasat intr-o atitudine cle anteflexie,
i,,;l:r L1r.turr1eii.
ll;pr.r'1 iv rlc antellexie Si u$oari, rota-fie laterali (in tor"ticolis). In plus,
lr6llrrrvrrlrnen-tinecapul intr-o ,,imobilitate ceremonioasi" (Yan Boo;rcri
-r Il:rrtirr, ltr28, cjlar.i de Rise.r'.1952).AcesI ci.trrclerde lurt icolis .,pcr'.
l r:rrr,rrt. nl;r1i,',firat, pufin schimbiior" 'i dunetos il diierculirzi 'i..iort,i{u)lislllFprsmodic (vezi ln continuale, ca,p' 0: Probleme de dilg'nosl,ic
iul.rlia, lniiqod,riloxinvoluntare). Aceasl,Satitudine vicion,sXa capului
irr rrr,rrr
rr'prlzirt,ii, lrn somn precoc, care apare in tumorile subtentoriale, al.efosei
rrlslr rliolrlc, intl eosebiale ventriculului al fY-Iea qi mult mai ral in st:rtliile
r,rcr|,icr,I,.rrletrrmorilol rle unghi ponto-cerobelosqi ale emisferelor*grobe1,,.rs,..
Acr'lsth pozilie vicioasi, de ,to$icolis ceten:onios" trebuie dif,ercnli:rl,r rl,' Dozitiile licioase ale capulul consccttivo unor leziuni ale colo*uei
irrrit,.,,s,.[iprin morb .Pott cervica,i$i prin traumatisme ccrvirnle). trIxist;,
si riltrttii in oare unele tumori ale {osei posterioarermigrate spre rlr,hi;u}
(,.r vir.rrlt)r'jrr gaura occipii,alS,unele neoformalii extra- sau intre,dnrlle
ilaltc si mai rlr o hernie cliscal5,po1,tlcl,errnina nn tortioolis
1r.t,vigrrlr,l)rnrr,nrnl;, lnsolit, t1e tt ledoa,ro dureroasi a mu;chiltir ceiei, a traputului
iri rr rrrnii,nrlui.'l'r'ebttic,rleci, sti rglinem faptul ci, majorilulea caztrrilrt'
ilrr lor'1icolisnn sinl,tlc origine rounaticii, b&nalii,.lTueori rahiatgia lipstq.te,
jllobilizrtl'ottacostiol'b(]lnilvi tr'{d)ui0
tliftrzi"t,,
Irrrlrrrv rrl arflrzlnd(lor[r o crtttrllee
ilrllll(ii{;
o lttiltrttvt'ii,
frr lrtttllii,It'rttltrrr(it,
lttrr lrIrtt;itlii'lxrlrl;rr
,ii Iir, Ii i,(rr1ii,
iLl l l \l i t, o r , t lt lr . t , blur rl rt' rts l i i l t,i i j tttl tri tttttl u irl t' l ti l l trl l ,t,trsi ttttci trtl i r(j ri l l i l l ri ,
lTl r

o l l i z r r l o r r r l r L , o ;r i r r tu r l l i r ,i , tr u r u r ti , t,l tr tt o ttr l tti r ,

l tr l r i l r r ( l i i r tt, l l l l ,l ';
, \ t r r . t t i r i r , , o l r l r .. l 1 l i ,l ) .
r l r r l r i i cr tr r l l l i
It.l l l l i r (
, \ r , t , l r s l , j i r r ,r l o :tr tr l t ccl i r i so l l o l tl o Iu Ir r r 1 r L r |,Ir ,,
: u r 1 {r i o l , 0 u
o tr l l si t,i ( ,o n tl l o 1 ,n I'i 'i , l t, i tr l ttl l Ji ( x) l o i r l tcr l ) l ( r r tn t si ttt r u zl t,
l o n j c c t l e s c l i so tl c Ja ckso tL q i i l e Ar scn i .si tu r l ttl t. 'l 'tr r l l tti o ;i r tr r {'i ttt'ttt t'i r .

nurlc irnportanlii plactioii prezinli ttlplul cti turbilizrllor, cruprtltricslo tl ttt.

|orrs[ qi ci, se inso-teStefoarte frooYont d.o paloiil'(], q1('1ilr|j.IMI||il|iiIr I
rtri'tiginoase qi rnociifie5ri carclio-vasculale qi iespir:l'1,ot'ii.
t il
Jntt,stulqlu
u'lecol.outtti.1i.
d) Contraeturitt'ni-sau bi,laterale,localizate,
pot fi intilnite in cele mrti tlivr:tsr':tllr'1
t:erticale,tkrrsale;i d,orso-lombare
uni ale coloanei (spondiloze,spondilite, puseuri de rertntalisttt t'titLrr|rtrrI
trrri, c lt rrI rr
hr:rnii dc disc, tumori vertebrale), dar si in alte proccse(aLrccsc
lito do diver"seetiologii, arahnoidite, meningoradiculitc lo<rtlizrrlr,,'r.:r.,
\u trebuie si uitim nici inqeli,torul ,,lumbago primifiv llrrlrrtrrqrh.gir '
rlesclisde Sicard (citat de liiser, L952) c semu dedebut (fazi, t rrt I i rrrrIrrr':' r
rir cvolulia unor tumori extradulale satr subdurale, in snre insii sitttlt0ttrrr]
uranometric qi cito-chimic lichidia,n de blocaj rahidia,n sint rr1iltr 1r.tr{ r r
l:r'an$areadiag:rosticului.
4,2.2,2. Hfutertoni.il,e{ t:onlraclurile
) d,e origi.nece,ntraLri(ernrrr.li:.trl,
tuzt. toc,alizate)
a) trIfuiertonia (contractura) piramidald prezintd, p:llticul;r,riiil {iLr lrirr,
(lnnoEcute:predominanld ectromelic5,; caracter electiv sau (1r'irsir'l(\'lr\
(1troponderenl,ipe flexod $i pronatod la meinbrele supeljoar'(',r.rp(,rl r\
1rcertensori la membrele inferioare) ; atitudinea caxactcristicii a,lnrr r lr rr,l,,r
r,l,',
intcresate (de tip Wcmicke Mann), consecutivi acestoi contl'i|,(,1,rrIi
li1'e; prezenla sincineziilor (globale, de imitalie ;i de conjuga!,io)I crrlrrl
Icrtl de cedate ,,continu5," qi elastici la probele de mobilizrlrt prrrrivl
lopograiia extinsS, hemiplegici,, para,plegici', tetraplogici' sau monopk',;1icrr
plczenla altot semne pirarnid.aie.
Caracterele propdi ale hipertoniei (contracturii) pilanlidillc lrr p('f
rrrit aprecierea topogratiei leziunii qi ca, at'are, un aieosellit itLtu(.s lt)lt)ttt'tl
/ic ]rrezintd,semneleasociate ,,de etaj" (spina1e,de tnnchi cctclrlrrl, rtrr
licrLle,subcorbicale),care trebuie clutate cu grij6.
lt) Eiptertonia (conlracturo) entrapiram'id,alii (paLr:oslriutil din sinrlr,
tttu.l,lt'i,ytntoni.co-hipakinettc
sau porhi,nsotzimd) prezinl,ri,])[ri,i{]uLr'r'il,r(il,
l)ltt(jcunosoute:
De obicei este generalizal,i,,Ia toli muqchii pet'ifot'ici,tllt,r'itrlorr'
rrorraiindeosobimusculatiuraaxo-rizomelici n staticii [i :l echililtlrrlrri (rrrrr;
r,hii cetei, ai g'utierelor vortebmle qi :r,i centulilor scapulnl'it,1i prrlvirrrriil.
!,(' mult'e ori se poabe lealiza un homip*rkinsonisr .
- Este globalir',adic5,intereseazi,in rnisurii, sensibilogillii it,1il, glrrlrrrl,'
llr,xorii, cit Si pe celo cxtonsorii, rlvind toiufi o uDolrl plulorttitlr'rr{rr 1r,'
rr\ (.)ft.

.* trlsl,e ceroa,sX"nla,sticir.
- Ditrimrt'r,rzii iir cnrsrrl .\otnuului"
* Ocderzl in s (.;r,rltrr
loa,lizirrrlscrrrtirrll i Neglo (rr,ltrr(ii rlirr{rr,lr.).
g1;1111,1r11{,111rivir,,
Ii\(ll r()rr)(' rrrrI rrr(,iirlitr{lt,lrr
ovirlor I'ii rrrlrt s0 t)rir,il,rrlfi
ii uur)r'lriulovr'(!tlc trtiriuili nllivr, t'-,trrltt,l,hr
rnrrt jrr <tttltrrlr.iircl,rrit
t:trirllir
rI rr ttrt'rttlrtr,(lr,rrrtrtrlItti Noicl).
Irr'I,rrrrrIrLt
r virlirrt{iltzlrrcrrrtrlrltrllr,
|IIlri't rr ltri l,'r'otttlttL
I'rtrl)1,,,(|(||||rl|
lrrlrr,t
cirrrllrrrlrrlvul
iortiri ln lrrrrDrrltrr,IritrrItlrtii
rr.r,l lrlllrrr, r.rrrlr'Iilrlii rrl,ttttr,i

t't't

r{r rnolllino l)n |lt] }ioior', cin([ $e lirlicii, $uu oilrLltn{.rge,respcctiv atruDci
r rrrl i{i i r.lir)i'r,
irr:-riote.
'."r'Dul
- Jl,ellloxcle <le posturd, sint exagerate.
' Uitracterele contracturii imprimd, bolnavilor o serie de aspecte
prr,r'l;icularecle posturS, qi de migcare : atiiudine statuificatd, qi,,in sein de
irrl,robure", mers rigial $i_cu alur5, tle ,,fug5, dupi centrul rle groutate,,,
- Diminueazl la aclministrarea de scopolamini qi de substanle do
Lip r[tropillic.
-- Llipeltonia parkinsoniani, antreneazX disparilia unor sincinezii
ronlule gi se insoleqte de o serig de sincinezii paradoxale, ca cte pild5,:
lioxiunca precoce, anticipath a lungului supinator la inilierea flexiunii
rrrrt;obla,{ului.
:. l)up5, teLanizarea"faradicii, decontraclia musculari, se prorluce mai
.
lctri; rkrcit ln mugchiul normal, iar cronaxiile tind sii, se egalizeze.
- In cursul ,,kineziilor paradoxale', hipertonia dimlnui| in mod net.
-. I{ipertonia pa,tkinsoniand se insofeqte qi de diminuare& auiomalisnrrrlol rnotorii, plecum gi de bradikinezie.
1r) Sii nn gitnm combinaliile tariabile de h,ipertonie ectrapi,ramiilald,
ti p irn,rn[d,ald.dtn sind,romul pseud,obulbar,combinalii1e d"e conlrq,ctul.d,si
,lr'.:tltusrnedill d,egeneresaenlele
lt epato-Ienfiar,lare(boala, Iui Wilson gi pseurlo;rrllrrrzn lui Westpha;I-Striimpell) qi tlin d,istonia lenticulard,progresi,oii a
I u,i,%inhen-Oppenliedz
(spasmul ale torsiutre qi variani;ele acesttia),' rlistorz,iila
dt, u|ittttline ilin sindroamele extr.lpiramiclale cornplexc, din sindroamele
din disronia musculolum deformausq.a.
'lcrrl'r.r'ubrir"e.
tl) Rigitlitutea ile deaerebrare, prin leziuni ale sistemelor reticulate
rJlsrrcrxlontedin ca]ota mezencefalici este caracteristici,. Este vorba ds o
r,orrlrlacturi, foarte puternic;, a membrelor, a, capului qi a ceiei, care este
rrrir.jola1,ii,
sau diminuati, prin schirnb)i,rilede pozilie ale capului (fenomerrrrl Lui l\Iagnus qi De Klejn). Crizele de rigiditate prin decerebrare realizi,l,zi, t> hiperextensie a capului $i a coloanei, extensia membrelor infeliol,r'e, in vLeme ce pozilia membrelor superioare este variabil5, (in flexie,
rlir,r'rnti ales in extensie). Se insoleqte de reflexe tonice cervicale si labirinlicc. Il,igiditi.tite prin decerebrare pot fi reatizate cle procese rliferile (tumo|rrlrr, irrfocilioase,vasculare, tra;Lrmatice)care iDtereseazd,incleosebi calota
rrrczcrrccfirlicii, sau structudle vecine (epifiza, tuberculii quadrigemeni).
rr) Arseni (1950) :i, d.escris crise untriculare au a,spectde rigidi,tate
dwtLrelnald,in tumori cerebrale cu variate localizS,ri:
-- '{umori rio fosi, posterioa,ri, (50/6,respectiv ulterior 90/6).
- 'I'umori ventriculare (23%, respectiy r;Jtarior 271):
turnori de
glllrlir, pineali, turnori d.o yentricul al Ilf-lea, tumori de ventricul latoral
orr rlivorse localiz[ri.
- Tumori supratentoriale asociate cu angejd,ri do Iob temporal.
ln gloamele frontale profulrde, care prind peretele ventricular,
ln tumori sau hemoragii extinse pe scoarla cerebra15,, situato bilah,,r'rr,l(henatoame cronice subtirrale bilaterale, tumori parieto-occipitale
lrilrri,rrlc).
I)rrpir,Arseni (1950) $i Arseni qi colab. (1978) cxizele ventriculare nu
rrn r!$poottipic de rigiditate decerebratd,,intrucit membrele superioare sint
rlo colo rnl,i rnrrlto oli in hipedlcxie qi nu in hiperextensie. Pe de alt5, pa,rte,
rlcrsl,oclizc vor)l;r'i0u
liu'oitpitl bnlsc, la sohimbnfc:r,
d.epozi!ie, petrtrn ctr,sri
ltrlczrr irrurlirilco lrolrrrr,vttl
se crrlcii.l)in obsctvn{,iilcptczcnl,rr,te
rlo Arsorri
(llllt(l) iii Alsr,rri1i colrIl].(ll]?lt) rr,iirsrr
cii,i,orr1,tr
rrrizolri
rlo hiprrrl,rrrrirr
prrxllss
lTrl

rl r, i ,trrtotrl r. rr rl rrrri r ' l x li{ lr r l( f l" vr '||||iI I ||r t I r it t l ir lr 't r ii|r ', ilr llil, t r 't t I r lt ' vr tt r
r' l ;rl l i r l ol )r,i " r 'it lr r irr r ; r u'r l, ot r t , r 'lr I iit r r l pt r r r lt iscr ll it 'ilr r ( ir r llt 't t '1( 'llt tlclr it L
,rrl rrt, rl i tt crr t r zr rpt t lt t t lr it liiI r t lt it llr xlir lt r r r ir l t lit t lit r t lr t t i st r lt it t t lr iit ii lt ozt
)
l r, i l rtl tttl t.ti . Aocslc r , t izc sit r l, t lr r lir , [ r {'r r lizr r r '1t ilr '; ri(i 'r l . . t] ' I i (I | | I i r I I r ' ( \ r 'il( 'r r t
i l oLrb., l {}7ii) .
l )rrpi i , A rs t ui ; i ur lr r ll. ( t {) Tl: i) r liagr r osiicit l t lt r lt t t t t r t t r 'i\ t ' t t I t i l t t I rrt rI
l rrrrrl rrrl .l l l i l i pc hlzl pr t : zen! oi llt t t xf it r cr jzo ( lo l] ilnr t l, r , lt ic, it t r r li l, , r 'r r li r r r ', ,
Itrtttot'[:rse taoe rlupit cclehlte sitrrptotntt tlrrtlltt'rt;ttlc(l(r iol](tglliIiir l)l!rIr'ill
l r,i I rU rro| rrl, t lr r llr t , ur n ur m ( , r ! zi :
(lrizclc prot'luse t1e tumolile tltr liosi, posLt:r'iolrii ltttplir,rr r1i gtrrr,'
irrllrrrrili caldio-r'espiratorii (brattior,rtlic, puls net'cgultlt ctr vrttirt{ii trrpirl,
,rri l rrr,crrsualeclela60 120/ m in. r espiur , l, ienet eguht r i( let ip( 'lr Yr r ( 'Slr r lilr .
l nl i ,l r' o sau cianozi) , pr ecur n qi it npor t lnt c m at r ilir st lil i ( lf lr il) ( 'r lr 'lliilr lr "
rrl lurrranianfi ;i fenonene cerebeloase.
- f izele plotluse de l'urlolilc fiuntale ca,rc ilfc(icrizii pt'rr'lrrlt' t t'ttltt
, Lrlrr sint deseori asociate cu;rierderi alo cunostilrtci 1i ctt lttllrttliiti prrr
lrilc do l.ip frontal.
Crizele de vtnl,r'ioul al III'Ie:t, se insolcse de li'tttittrcrrt ltiJxrlrt,lrttrtr.r'
rl rlc crize convr sive cu pierderea cunoittintei.
C ri ze le clc yent r icul lal, er al ss inso{csc de ir llspir ': r ( ii, t t t ir lt ir t r : r
i pirrost'ezii in rflcmble.
'i) Contr&ctur'ile psihogene :
;'lindromul, catalitic (al lui, Kaltlbaun, lt K'rappdin ) Htr t'rtlrtt'lt'r'tzt:tzr
lrlirrl,r.o imobilitate prelungiti, cu durate do ore sau tlc zilo rt l rrrl t rrr t t t l t t t .
(':uc pirstreazd, o atitudinc catapleai,icX ,.qitegativistii. l't't irtrlit', :r,r'rrirlrr
r1:rro orltatonici poate fi inlocLritl de sl,ili de agillt{io, trtt it t t I t t rlsi rt t rt ,t
:r;1r'r'sivitete.i,ipsa sennelor neluologice obicctivo, pt(x,tlrtr \'i t rtIrtlIctttI
trrrrr,i.ionalqi pasager elirnilS ul gindron extra,Iit iulli(lll I siur rtllrt irttl,
rrlii olg:rnicd, a, sistemului nervcs.
'
(lontTactx$a (hiperlonia) piliat'icd, se iirrpurie oi} tlll (r])i[r'lr(]frl,tt ttrlt tttL
, r'rrt crt semiologjc crrncieristic cu ccloraturS, nevroticil.
,1.2.2.3. Contt&atur'il.ere.fLere,locale pot sit apari' itr alltilr', rt,tlttrirr'.
,lirllsu adec.tiuli viscerale, precrim ;i in unelo sittt:lrtttrxr t,rt'ttzlt,lgic,'
tji il
(lrttl{.rlttl
,rfir ziBul sindrom extenso-progresiv a,l lui Sic:r,rrl ;i llrurr!.
,'lirri(1 r.ste I eYela,t0r'.

fl

ir.J. l'liolr!,l,li\ll,i
l,l'l'll}l'A'l'l)(il'lNl(i
lrl,l lrlA{iN{)s'l'l(l
sl 'l\)l'{)(illAIl(l
i r l t r lllr r ill
i rr pl rr,,l , ir llrt t t t t t ologicii t llr t gt r oslilr t ll t t t t t r i lt l, it r ii slr lt lt zr r : t zr lr
trr
p"
r
'i
li
t
r
r
r
ot
t
lot
t
lt
t
t
',
rr"r' .rtrrc| ,r' It tlti t o1t r it t lt l lcslr lclivli ir r I I r t t ll'ili t lt r
r, l c rl rr l Irrott t I llt I r ir r t r t t t t 1;
si I t ' r r t t t t t 'r lt t l t r lit lic.

6.

pnosr,Eurg
D0DIAGT,{osrrc
IN ATAXIi

5.1. pR0EtEt{}N DE tttiT0l]Ol0clti

SEMIOL0L}I0I

Ptntru aprecierea serniologicii,;i topograficii, a unei ataxii

, r',1)rrn o serio de con{lili,i,lnetodoLogice
d,eenatnen:
/, lu:iinfe de toate rrebnitl apleciati, sterel r,le conltiot{i,. Sc
;tie eii,
))rr{rl{lr1irl,htntc:lrca proceselol psihice,obnub.ilareaqi dezorientaleRnu
l)r.r'i||il (j Trlni ccorrlonare a rtriscririlor.,ci,cirril astfcl, t|tleser, rlell1tc in
I or.(.i{'tlrit,cxi).ottr a probelor cle ccortlonl-r,rc.
i.l. l_)'ticitelemotorii pril tcziuni a,ie neuLonului motor periferic sau
rir Irrrioiculeloi.piramidalepoi co litiona rt) mcls ezitant, rlificil, 1cnt,
1rrlirr lrrrlonios, precuur qi ,,falsd,"incoorrlona,r,e
a rnisci,rilol pril tlicctiu,ea
rrris|r'l|ilLrrlctive sr:gmentare.
.'i. I'Iisciirilc involuntare pot parr.zita rlano.vrele de
coorilonrre.
.1. Ilrtcizi:r, unei misci,ri poatc Ii, r.Leascr:renca,pertrLrbati,
printr-o
rrrlr,rr'(rrrtri,
tnlbura,rede tonus muscula,r,regltr,reatonic:i a atitudinii si a
rrrisr.ri'iil'iinll unul rliatre factorii edenliali ai coortlollrii. Atil hipoto;iile
rrrrrrr,rrLtrrrr
cit ;i corLtra,ctLrlile(pirarnidale qi extr:.Lpilarnitlale) pot sd perIrr|lrr. r'recutalca perfeeti. a unol migcilt.i,creincl impresia _ clacii,nu sin_
l.r.rrrr l,r'tr{;i cd, este vorba qi rier r: tulburlre cle coordonare
l. inlinte de a trpreci:r,o tulburale do coordonaro tirebuie s:i eliminilm
(
rii | ( vctrtullt:r, astazo-abazie (func{ion:r,lir, sau orgl,nici), plecurn gi un
irrrir ri st'rniologicz1 unui sindrom psenilobdbar.
/i, ,\tr,xi:1, tr.ebuio totdea rma si, fie diferenliati de o apraxie (indeosobi
rrI|IrIrr|itr)rcu (iilt,cse coltuldri adcscl l2t,rn etianten supedicial.
i. itr s1i'sii, i'l:l!:r u'eri lrlrtrii sc i'rptlne
examen sistcrn,t,i.r
'n
1;ipttluirlc itftrsjc (l)r,i)rliultl[t1it,i:r,le
l,(.|llrI r l)r'o(ji(,rorr
ser]siltilitli{iipt,op|io.o1ll,ivr.,Dr,irrlfzitrrri t.,.Lrrrlr.l,rrsr^
srrri ir,sl,i ll..ltr|l), ll topog|lfioi llirr,xioi
11(iirrrr{ili'ii, rlrrrr.r'rrlizlrtrii
lrru l:r Irr r.iirgr|lnrclrrbltt),rl r:llrrlrtlrri.,i :r, irr{r,rrrriilrlri :lrr.,r.i
lJllr

(sl,rrl, r c r , r lir r t r r r ir li ; lr l , r r lr i, r . il: tl l

I r I rI I I i i (rri i,I r ) ,

i i .!.1. A l, r t {i plir r lullr r r r iir i dr , sot r sihilillt r r plopr ir N'r 'plivii ir l\ r 'l ir l
,.ri rrrri1l 1l i l i , r 'icr rsr t t t t xr t t l; t r t lt cr t t r it t t t 't t 'r 't t : t zi,lilikr st r r lsilr ililii{ii 1I t I r I t t t r t I r '
,)rrri l i rfIl l o,[i it ( 1 00t '0llt t r t l it c{'sli( ) ]lt llblllili pr r t plilxllr pf iVr r . r \ t r t 'r t si: ir r i r r ''
i ur,Il i trl l ri i r,l rlor t t egr r idclt : pr t ; liir ilt '; ir r , r lt u|ogllt i'it 'r 'lt t 'ir t lr ilii ( ut 't t llr t lt zr r lr r .
l irlrl;r'rt;rrisl rti t tt t r. r
I r , lr, 1)lli{ri,ilrt rlllrtnilind la mctn}lnrl,: inferioltlc)
'!o
r,' r' rrrl ,l 0fi vililiikr lnot or ii. [ n 0lr t t lilc t lisr , r 'el( ] , pr ohclr lni if r t t t lil't {'r r I r lr r
,,i l rl totl rxtl i ti t: ust 'l; ili. l! st cir npr ) t t lr n1, ( lr t r ol, ; in t r 'i, t nilt r llt t l cslt 't " r 'r 'r "1"
i r r r r ir l' l I
,rl .r i i rci i tl e lir incl'put nl i) cost eiil:dir coljI ge i] r llliiiiir i{l r r ll, 'r '; r lr ir
r 'r' l
,J!l rl rl U l rl ri )ttar vllrti't spct c'r , ir .ou
e, im pr ) 1iil] 11or lcvil{, ii ir r r iit 'ot r t 'lr rsr , r r r r t r r 'r
iI
I
I
I
t
,
)
I
I
I
I I ||
lit
t
t
'lr
't
t
r
t
'r
t
l,
in
sil
lL
:
11f
il]
.
i i l rrl i i :r-rk: ir cll
llr [ t , ] , Lo int r - t ul sot ls
,.rrrilrlirgic{ri,t,.'laplu1 ci ve{1ereii,corcstelrzintlLlbrrllii'ilo tle crxr|riottrttrr Drirr
l]| 1rr',
rp; ior':cepf is fi cir, ocluzia, oohilall' le agr|lvl::t'zii l)itt rtct'rl' ltrolir,
(rriil'rrr
rr',rlrr lrti Hornberg cste pozitivil irl il toalo plrtbole rlo rr.l,rt''rirr
,' r.rrrrrchi ,pl i lnl- ) ar eiicilloiir ilui pc cr ellst l! t iLlici, ?r ol) il, cor cillui, l) t ol, I i! lr lr r
l i ri r,.i r,)oi l uzi. l ochiir , r rr nlir elt e cvjdent ( r t r lt : oli chiat t r ot t sir lt , t r t lr il)I r t llr r r
rl0 c,-{rt,:i0u&tit.
,,!(
i i c rn:l j it sociazi' cle obicei li bilot onic m lr soulr r iu si, r lt r t t t t r ll"'t i,
sitiii (lc i]sotll{)rt(iircttttsrrttittl(.rrl,'
rr iL.lier clsi;eotefr[iiuoe,si,, fenourene ci-!.r'c
pt'oftrntle.
, jri i t irii ciiilot selsibilitirtii
ilsto important tle relinut c[ lipsesc amr)tolilo 1i ttisl'rtgrttttstri. trrl
, o, iliit':r, e$te Iloln][1i.
:j.2.!.j" ;\t.t+tLitr,ilLsolitti d,e drelleaie osteotend'inortld litiioij t I t rt r;r I , ' ,, r, I ,
rrrr lrlcme cli;rgnosfice ;
t. Poli.rir r"iti,le {. 1.talineurol.tatiifu.Si: insolcsc 1i rltr irrirrrsl,r'zii,rll i'rrl
,rrr':ilt titr stn$ibilittte oblcctive cu disl,ril)rti.io p1li{lorllil}ililii t rt I1t rtt rtr' I it ' I t
r lc r llli
rri i i ' ).up(r' l ioiit lc,ci1,li piot ulll1o) , t le iilcf ler ie oslic( )1, ol] ( lilr r ) r r $il,
,,iir. rrrotorii (i[l iicterist'ioe, ova'l]tua] isi de aiil{}1ii. []tttrlrt'i tilltsivilrtl'rrrr I'rtl
l,Iriirilol i'ie scnsibiliti],to profund:i ;i il itLlr,xici Irr:rlizr,rtzri,
,,pscrt{lo I'irl}rlrrrl
pr,lilrlic". .Durerile la presiunea fira$elol ltlllscullu() iii lil lrrcsitlt tolt,1,lltrrrllrI rl
,il,,r' rrervoase sin1, consttllto. .A1bc somnc (li[ ctt)l,()\t'lll s(rrl)iologir' $rlri
e1;ioktgio.
r l i l(' li';rftru. stabiliroa diagnosticultli
!: Po!,i,rtil'icutonet)ri,tale lrrtruncso irr trrl)lolll sotttirtlogitr, 1rl ltttl;:r
trr,rtirrrli r,r'rr
,.Ir.rrr, .I i i;{i I t I gxI.lIse atr]l,oriol,pozitjivital,e& scmne]rl rlti ckrrrgrr,{,io
jt it r dr {) m lr l ( }llillir ir ] - ll: r 'r 'r 'r ')
polL{t
r
t
pl
;
ognot
uonic
r
r
licir
idi,
r
,
rri
nrl
|
otnrr
l
;i
l i l t,rl tl .
il. ;Jin,thonuJ meduLu'rtlt Jibtt luugi (d, d)nl t,tt: po:tlcrio4l'1r)srr trrrt:trr
I I'it (rrl
Itt tr,t::tzi\,rxtrlttsiv pI'ilt l,uIbulilri tic sttrsriLilitrrtc pt'trluttrlii (()lI$1,i1I
it
r
lir
t
'ir
r lr' , t rt')r r
t
r
t
t
t
t
r
br
l'llr
{)
x(
t
ur
jil
ii
lit
,
(
pr
r
r
llr
lt
r
t
inllt
t
l,
l'i,
st lu
rrrrl rott1trl i l , ii, l, 1xic
t r t t t t ir 't t
l, .iI $of , ( , r lr t t r r I il0 llt I ) r c$it lil( f r ,t t t lt t ^ioI ot
.l rr rrtr' l ' l trxiiroslr 00- kr lt t lir ur asii,
l rr| r. ;i :r, L| t t t t oI t it t tiI ot lr ( : lvi) it sr '' lr l'( '( t llllli1i l: t , Lr l0t r gll{iltt 'iir I I 'ir I it r iLt t
i ) ' l \t,lnt r . l,r ) : lliz( lir zii'col t t t : t 'i lt r r lct t l' i, r r lt lt t t rt lr r r ir r lir t ilr ( ii,llr r lr I t r I r r I t t t r '
( j l l tr r .r l l : l l tl t\i r i r ( i l l :t,ttl l l t'r i tt ti i r :tt :r l l r r 'i tl tttl tl r tl t' l tti 'r t tr l t t"tt
116llr1;i9lt,trr,
t' r r r '{t|t
p l |zt'ttl l r
i l r . r r r r r r r l l u i i \l g r r l l ti ,o |r r r |Ii r o tI) r l l l r f( r l l l tl l i l i !r 'l l l 'l l i l l t tt
l
t'ttl
r
i
l
I,'Ittt':Il
t:t
i
l
l
i
l
i
i
r
l
(
r
r
zr
i
l
r
l
o
l
r
i
l
l
i
i
l
l
r r r , r r i r r 1 1 r . r ,lp r '( 'r l r ( r '.
l r tr '1 i tr ';ti l ,

tI

IrI r' r' \ if I r'i'qi lir|rrrclt,trrrl,rr

rlrrllririrr. (Jlizr'ltrviscclllc sirri,rltrrnultu oli ul ilrr
'
rrr |! |\,r' IIi t (,,| |.(' lt0rrLrrrrliagllosl,itr.
h) Ato,r'ti.le
priri l,,ziurri^alc co.rluune]or posterio..rrc(rnklliLe,
_aauta
trrl)t1.siuni
merlula:'e,
cpidurifl,) sint mrc.
'
, ) .4.l.tp.le:;uni
aLeJihrelor lrragi so por iulilni in:
\tndrolnuI ncuroonemic
sc poi]le rFcuouagleprin : arbilie Eastricf.
:rrr.rrrir.lripercromi, scmn{,de c,trrluane posteliolre, *reflexie
o-ri;;;:;_
rlirrorrslelil oare ins5,se adaugd, qi semne de cordoan6 Uterate
lsimpioine
p ilrrrnitl:llc).
. - Nind,romul nauroachilic.. hipocloftirlde qi
achilie, semne de cor(l,i'x.. postcrioare, de obicei cu sellne mai pulin
impurl,ante tle co*loan.
liri,'r'irlr'.
d:rr L[e]nulle oli gi r.u scmncdp potionrroriuii".
Iloala Iui F riedreiah.
intrunc.le rrn minrrnr.bi ,re simptorncpcrti_
(,ulirr,(!; caracter ere.1o-familial,
.fenomene-cordonale posteri6aro (itaxie
Lrlbctifomi,, tulburiri de sensibilitate
profurrdd, hipotoinic, a,reflexie osteo_
Lendimas5,),semne de leziune a f:mciculelor spino:cerebeioaseqi eventual
rr corebelului.(cu ataxie cerebeloasi, tulburiri de echiiibru,
adia,docotrrij lilil:]Jii^lll I:, tremor inlentional, t ul bu r:tti de vorb ire), semne pira,midale.
u||rrnran trotlce (cllo-scoliozd,,picior scobil-cu deg..fe In cioca:r;, uncori
,i jrlrri',llotii dc tip Aran-Ducbcnnesau C.ha
lcotl:\[lrlie.
Itrred,o-ataaia cerebeloasd,a lui pierre Mq,rie asociazd pe prim plnn
sr,rnrro,cereboloaseqi pira,midale, simptomcie cortlonale posterioare {iind
rIU (l tscrete.
.,lantiliald Btrilm?elt L(rr&,in. prezintii, exceplional dc
..
...
,!o:!!trSia
I i||
.ir stn]pto_mecoldonale posterioare, sitir:r,lie in care *taxia este mixtii
(, r,.lx'1,'coftjona15
r pe plari securrdrr'[u1iirle pri,.rplegiapiramid:rLt.
),^.dJ
'
I)lsl,azia.0rcJlettcdaongrnitald Ruusq_Lirg "alrlnoa"zi un sind|our
,
,,lr]llli
r,posrerlor. (cu
,1i rrefle-ri{] ostco-tendinoasii,),
apXmt in
((tr,ollrcel)s ^li,tltxilr
intintc de pube]'tiite.Oaltcte|ul e,redofa,rdlial,
'.,)l,ii;rr're
evo_
lrt{,ii!
benigni, si asocierea uneor.i de niotrofic sitaeazf, ace,,st''atoc^ai
(rntc clr o formd, de trecere int,r,cboeirr lui Fricrlreich si boaia Oharcot,
l\!rrt'ir^.
tt.:!.1.2. Hemiataniile rru, tulbu.r.dri de se sibil itale
Ttn,jundd, d,ar ur,
rqfktn. ost,eo-te,nd,inoo.se
eonseraateridicii urrlilolrele
proilcine ile'rliagnoslil iop''gr'.rIi.si eliup.riog.,nic: '
4taria pariclald esle.produoi prin leziuui vascull,re,tumorale, trau.l.
rtril,lr(,,(r
rlc..:rle eircrtmcolufiei pa::ietalc asr-,endente
slu :r pnriec[iiior pe
:rr'.':rqlii
ri iiirrrrr'.(i'nl( \Lul semiologicinrIrureitclulbrlr;fi d-escn-ibilitale
rrrir l r' (rlur ctr prcrlominanli-Lprofunrlur, h,.mi:,tl x ie, nstereognUzie,
dar de
rrrllr, ofl Fr-altcsjmptornode localizrr'. l,arjctald,{cl.izr.j{rckdoniene
scnzi_
r rvt, rilllr ol il' sr[zrttvomotorii, apt&xie, hemiasom* tognozie, hemianopsie).
l. Ag*ig talamind, (din
talamic al .lui Ddj6rine-Roussy)
-sindrornul
rrlllr. continlatr'al leziunii (de
obicei vasculare sau tumolale) nucleif;,
lrrlunllcl luterah, insotindu-sc de hetnianestcziep}ofrurdd importrnt;
fi
pr.r',ristr,nti, algii de tip hipel'palic (.,overreactiorr" .- EIcrrI-;i Eobnei)
_rle
t|o
ruttcIln
coreo-3.col,ozl0o.
ir
S..l.Alnniile
pedunaulo-pontu-bulbare.
r)ivel'scprocesepatologice(l,umoril
lilrnrrrHri\jnt:c,tlctnot.t.glt)lucitliziLh)iit ctlola truuCbinlUi cercbral pot
trrr,lizll,.dilr(lr()ir.lrlrr
iLlt0r'nrrr
itr cotrt,,rtul {)ilr'orir,
dr intilrr,'sc ryi trrllruril.rid.o
d.nBlrDlrtirt('
prr,ll||r(lilcrr rr"lirrir,.Ar:orrLrr
ilirxlr0rutrciIll{'ln0 pot ,rr itrrp)ice
propri(n1r,lltivo,
rr,lll;rr,1'lrrii
cil qi rlrr lilr crrrrrholos,
l,l (tlrol,ilnt:t,i)hrr
ti)l)r)t82

o*1r,;lrltIicttItr't:rr vl\rlrlr trtt ltt,tttiitltlriitnrrtrziliviioHit!i l l l ' t l l t' i rlil l J[ ,

;.1nr,lio
qtirrtt ltrzi
plttl,trtrtllt'zitltttrit'
rrr.trrlrr'|trtsli,
t'slotlitrrci'ii(tltrttlt'r'rt,'1i
Irorrrirtl,rrrirl
ltr
rrriLr lrrLvilot rrtlrtritrtti),
or oxcrp(il sitrrrriiikrltlo llrzitttti;tt',tltttttrttllttr',
ltti Wtrl'Ittrkitth.
rrirr'lul rrrrclrrtrlttiro1tL,srr,ttrlttltii,iturlttci;rtt'tta,
it' Iozirrnilol nclvtrltti, rrlrrtLr'iilot'
5.it.P. Ataxia voltibulard cslo t'cznl l,rt,ttt
(,rl,r'rt
plitt t,Lrlburrilit.lcrLir{,ittttrr
rt rrlo ttuclcilol vesl,il)ttla,ri
c
t
olizcrlzi-"t
$o
Ii
iii rlo rncls, cu oscil&tii ryiou tlcvit,tt in lcchqi scrrsrillil,inh)'illill)rri fil'll
rtsrxrirr.zri
lrr,lolrrl,irL l'Lrncltic
r[e trivchtl, rlc tilrul ;i tlo rrrtsivitrltea'lezinttij. r'\'io
rr sorllu lionrberg pozitiv (olcmont impoltant (le dilglloslic)t l)tll(lttrrriii
rrislrry4rnus
$i ame.teli. Este ul,il de lctinul, lrytu1 c:i sensibilitiitt(]a,pt'ol]l'irt
crrplivtr, reflcxclo osteo-tendinoase, probelc de r:oordonarc qi volbit'trrr,ttittl'
rrorntlllc.Ata,xia vosiibularii,nu uroclific5,mi$ci,riloizolttc alo tnctttlrtr'lrrtryi,
rir, ;r,1;N,r'or
spre doosebirede bolnavii cerebeloqi,in sindloatnclc vtrsl,iltttlrrt'r,
rrrr sc constati, tulburd,ri scgmentare de coordonalc.
:rpiitittll lit lroltrrtti
5.9.3, Ataxifl cerebeloasise recunoaqteuqor, o1,r,
,rrrrr rLu ptezintl nici tulburi,ri obiecti\-e dr: scnsibilil,rr,to,
ttici sitttltl,ottto
vrsl,ibulare.
5.2.3.1, Sumar de d,ata senziologice
Sindromutr oarebelosla om se cari,cterizeazh prin trei gt'upo ttrtli rlrr
f lt ptomg :
l!., Ata*ia asrabalaasd'se traduce plin urmltoarele sorrrilo:
L Dismetuia consti, intr-o dimensionare grcqitii, n, uriqc:irilot', lxrltrrr,
vrrl neliind capabil s5,ajungi, la linti, in sensul ci firi o depflqolto (ltipttr
rrrotrie), fie se opreqte inaintea lintei (hipometrie). Ilsl,e itnpot tilnl, tlr,, ptl
r,izrr,tcL bolnavul nu eziti, la polnilea niigci,rii, crt tttitxioul pclilirt'ic, rut,rt
ol posed5,,cu toat; tlismetria qi tremurdtura inten.tionalii, tlirect,iu,gcttr^r'rtlrr'
rr, rrriqcii,rii,Dismetria se examineazii, prin umttoarele plobe :
a) Proba i,ndice-nas. I-.,a solicitarea de a-gi duce indexul lrr, vit l'lrl
rlrsului, bolnavul so oprEte inailte de !int6,, sau trece dincolo tlo ott,, iz
birrdu-qi degetele de obraz, de frunte sau de ochi. Direclia genclalit itti!inln,
:r, rniqcirii nu este alteratd,, iar ocluziunea ochilor nu influonleazfi, trrlbrrnrlea,
b) Proba sti,ol,ads D. a, g6,tul/ui'slrlolBd.Cerebolo$ul nu izbutoiito sii,-tti
irrt;r'oduci tlegetul in ori.ficiul unoi sticlor sau uu e in stare sX,apuco glttrl
sl,iolei. el dmerind al6turi,
ci Probd, iniliaa-inilioa. Bolnavul cr oshii inchiqir nu esto ca,pabil Brt,{i
rr,plopioin mod corect Yirfurilo celor doud dcgete inilicatoa,ro.
'
11 frobo Linidlor paral.ele. Se traseaz6 dou6, linii Yorticalor bolrtilvttl
l'iind solicitat st tragi o linio orizonta,lfi, lntro aoo$toa, Oerobolosul nu r4o
lxnllre opri exact la nivelul liniei vortioale tlin droapta' oi o alop6qo[t,o'iilr,rl
inailtoa, oi.
r{r ODrcgto
- 'Proba
prekenaiunii (eatt poharului), IJa solicitaroa do a apuctt }ltltrr,
a)
rrrl, po de o p rte cerebolosul tlop5gogtesau nu ajungo pahar'[l' po (lo olltl,
p:r,r'tominil tui so deschidemai mul[ docit ests nocos&r.
l.) Proba p notului. Solioitlnd bolua,vul s[ faol un purtot rlu ol'oiorlul'
rxurbolosul tl oxecutS,diticit, frloiltlu-I tlin mai multo liniir introt{,i1t1,oslth
forrnil unoi gtolo.
g) Pruba lotisului', Sot'i*ul oolobolosului orl,o tlifttt'trt, tlt'ntttrlttnttl,,
lit,ololo Iiinrl rnlt'i, ttutogulilltt, itrttgtrltr.
lB3

ttttlun,lt,i lrr rlcrrrbjLrlor.srrl,

ririscrr.r,cii
u(f ,r pllll{f,ilijl
,,,,,tt.!..t..":.,,,,,.'::.:
! rrrrr
lrrtl (,[rrrsrr. laCoCUdCpl;ilr:a SltitOLlriirt,ile*iA
lfr' .1(llrllr(il,i,i
t:ii,:t til]tri
r :'lrirr rl,'r'i rii.r'rl rniqcliri de e.resaie, 'boi"""oi p"ot"
olrogegenuntrriur"
,i
tt i'nrtu 7tr'ir,bd'r'i,i
cdrcti.*ru,ipe creastatibiei.-ra eri,rurarca ti. rnis,. {':r |.' lltco <_ru
uu CiLractel,feStonat,
cU oSCilatii.
!. l rliutloc.ohi,neaia ( Disctiadocokinezig) 'con$,j,
in tncapacrtilto.i
,
rl. rr .r.r,rri.ir.t'ifcL.i altel:lratiye-succ.sive.
S6 e:rploreazi,.u aJuiorul urxnat_
iltr 11l9t'llrobc :
t) .l?rohannrioneteloy. Bolna''i
cste solicitati s.i,facii, titi$cxri :iltrer_
rrrr\'(, (1.9pr.onalie-supimlie
irnlebralelor,,prin :rtixgel,e&altel.nal,rvii
_rlc
rr t,or| soi cI pe mele, apoi cu dosrrl rniinrior. De p'artea
rniqcl,ltlr, si,
, rcrrriiu irrtr-un r.itm mai lenf, mali glloi, inteie.dinil bo.frraYd,
o sc o pa,orii,,r,a,,,,
, ,
mjsciiulor succlsive, sau notnavil-gre|e;te rniqclrc:r
'
i]i.,.;:jilr-"
i,n":ilca
"
it i'h)aa JkrtutllL
zr.dla'd.Se constati rrceasi
;i entensiunii clegetelor
,
,rrtrr'zr,rr.
sru gJrc6ir,e
a miqci,rii de partla bollavi,.
r ) 1'r^br. baterii tobei ca"
Bolnavul os1,esolicit&t si loyeascil
.d,e.1tetele.
r)rririr (iu {iegetele aubelor miini,
const:r,tinA"_suac""rr.i-luburr,.e Lo-r*iiii
Itl)l,1.lo procedente,
.rl) })r.abaJleriunii dorsale gi Ttlantare ct,p icioarelot. lJolnaml yl irr_
,r.rzri',
r-ll|l.\J gloci miscar,.xll tnt.tDbrulrlc pitt.u l,,zifririr.
,,. .rrLnerataconstt in imposibilii;atea de a,
coordona artiunea tlifc_
r il /'l{n glupi trusculare in vede-reaexecuti.rii
.
cornplexc. Ast,
|{ 1, rIril(r}ilo ('rnrplerc..se tlesconpun in cornponentele
";"ir;,ii;j;
1or clemeul,iue.
sr)&te(proha asinergigi sratioe a tui Babinski).
,,. ,,'.'..!,_':,.:":::,:o:y:"!:::::!,
|,,
|lr{r(|nr)r.tnal,rasl,urntret pe spale compolti, flexiunea
asociat[,,conco_
rrrrl.rrl,r'1r
a trunchiul.ui;i a mimbi.elor infei,ioare rlin genunohi. Cerebetosrit
(lrlfrxlurl)unemiqcarea qi la accasti,probi
lipseqte tt&iunea ga,mbelord ir:
:'r'rrrrrrclri,incit cerebelosul cade pe spatc.
gi a ao*pseipe bazm, \probli" cnl_
fk.rtunii gaml.,eipe
irr ,.1,)-,['rabo
-ioapsZielebel6sul -rlescompune
tir,:r) sr. erecu15,in decrrbit. rlorsal.
aceasti
rrriqrr,:rro,
irr sensul cd,intr-un prim timp va 1iaceit"r,lo"".ni
tirlicil_
pe
rr.,:{rea,sii
fle,
l,il.ii 1',,1y,.!^,:lt.deplanul fatutrri 6ihou" i" uf a-rir",ii*p"ou1rrni,

( r r l 1 ' l l r j \'l r l r ' l l l r l l tl l l r l '

r r i r 'r r I r o r r : r I r r, ( l r tr l l r l ,u i r '
,r r l r , :r l l l .tl ttt,:t l l r r j i l ttl tti ,
, , , r . 1 1 r r l r r ( r, , r r i l .t|i l i r r l r r l tt tr t|l i r r l o ti l r r l i t' ( l i l r r r r r r l r l t|i 1 i i l t0 u l l l r r ) .
( r !|III\ |I|||III I
l l . f i i t t t . ltl .tttr t.tt:u tl u l u t't'sl ,i l t'nh t'r r . Atr csl ,<'i t,:l l tr tt tl l ti r tti l l l
l , , r r l i " s l , t i n i l t . r l i l l tl
ctr r tr l r r r l 1 i l r l l l tl l tl ,ttL vcsl ,i l l l tl l t,t ! . t l s ! , u ,|'i qo, o tti l i ,i , i ttl 'r 'o i tr si 'a b i l i ta ,i ;tl , cl n 'tl r ttt l r r r l tl ti k'tl r ( 'tl l l tr r 'r 'r 'i t r l l i l
r r , r r i i v e l 'l , i c lftl . [i o l l tl tvtt! ttsci l 0 l tzi i tt l l tl l l r r sl 'ttstttj l tr tr tt l 'tl ttr cl ti tr l , l ttl l r l
,,1,li1";i,li
bitzii, tItt sLtstclll,aliiu. OsciLrt,('iiltrlttl L;oLlpt itttIrr st t'r' I t'
sii,-$i l)rii,r'oru;ol"l
rrrrl:r,i,t'lt,ccf:llici,.

:!. llcrsuL cstc ebriosr ezita,nt qi titubant. lJolltr vji lul Pr)l l)iisl rrr lt'rrii
, rrrrl{ri, in trinlul rnelsului, ci deviazti ii a,ubinza do s ustol lljill,i{r llrirtrlrr'
I r, r' rl r :rnl ,t t lit elo
s'lu r et r opulsia. I r oba r net sulr t i it t slt r a. r it t r it r ir l r
1r ,i rrl l oi ' u1 vt r st ibular , I oat s ?la r elalii p: lt o1, gicc, bolr t r t vt t l t l. t 'iit t r l r r '
r, ri rottstanl de partea leziunii cerebeloase'
ii. lr eftijlrl ,,:i nlStugmusuL L.r,un cerebelOS intliCii lcziLLttcrt,t urt I t . r i I t t r rI 0 I
, r'r*lrrlo-vcstibuliile.
4. Proba tlet:ieri'ibra,telor. Br*lele tlevia,zil dc- partcil ltrzitttrii rrrrlr'lr'
l,)irri', sl,u i1e partca emislerului cerc,belosccl mai lczlt.
4t.. 't'ulbu,itiri care se ea:plicd, ?rin alter&red a,JerenleLoryropt"irtLttplirt :
l .H i potoni*'m 't Lscul&/ ii. Secar act er izeaziipr inllascidii'r t 'l; t 'r t t t t r t s|t t
,lru ii. llicLtm ;i prirr aroplitudincr exirgerat[ a miqci'rilol pllsivr" lio ' '
,l',r{"'2,-i,prin uir,ii, tr,erele plol:c: ',t').I'a mobiLizuTectpasbii u tttttt l't'ttlttt
:.,t
rttllo-.rltlrirrtrri I lrt
1,,'riot',"!e atilge cu uqurinli, umii'rul cu articulaf ia
t,ru ltra.xiurLileprriiTe a10 membr'lui inlerior, se polltc atingc f.srt .tt .itl.r
rl. i,rl flexiLLi*it coapsei pe bazln se facc c* mtlt:-"t'rrqllri1riil'!'1i tlt' rttrr'lr
,lirr* oxagcrl,ii i t ) itintei,sia mtittii Sc lacc,ostc lilnit. lizi,l,r1i.ii (1rt ,l,'
,' i ,, ,l tl Trbo p, . . t "iL: ildt ,uii lui l3ar a, ng. I m plir nar ca ut r ct t t t ilt r illi : r lilr r r ''
r' , l t,ri srrrir t . , 1t L, r r t hjt r lui la un colebillos in sll! iir r it r lt r r 'f it r r t l: t r l'l'r
rrr,ri rl
, tr pi Lr : 1. t itlr ohar ': i excur sii r r ui am ple it lo t r r cr ut lx't t 1uist t lt t li, t r lr r r
ii rrl:r!,ii iiril irr Il o -hrtlnerillia ; e) Probu rcziutuqei' ,tt Iui lloltnts '\lt tr"rtt
ll,;lrri";iil cstr: iolicil'at sil frrci-lflexjunea :mtebrallrrlui pc btrr(. lrt . L r"
l'rLlttttt '
.tit
1,,',1,'r,t.lu itron ienl Ltl in c:r,re dtitn dl'utlul r":utebtLi'1titlLlir
ii I l lr t l'i picpt t Ll or Lm ir lr l ( r lli't I it 'i r r t lt i lt r llit r lr r l"
i ,r(l i ,r' 1,rr
tl { r liir iuir
,, i , ;. tl ri ::1ii: ! i [ r 11]t:ll11or
it ii liliei- int r iir ii 1a t inr p in 1'ut t r '! ior t ' r r r r lr r r lr t r ! r
,
uux clt t 1e t liscr onom cl; r ') c)( '\ t t t lt r 'r 'l'lt ot t t r r ) r '
l r. rLl bLt t : r . r c'er L{- '. I }oiil1iii
\ !' trrl t(t' t' e . f l?, r / 'lrpit
, r t t Tt t Lar r . 1) ccllt t qit iilt t cllt r t t lt t i ir r lt t lir t t t lit t t t t ir olt r : r t
,, :rl i 1turi r ir siL,1r t ;git lt lbole at i. 'i'11, t l*Lt : r r r r iiii r r t t n'llt "- r t , l, t r li: t t t 1r ,t , , lr r
l L.r
i i ' i o si't it , t il lnilciili iuei ln4llo 1i it t r t u'lr t li lit ir lt t t r r t i t t r I t ||i I r I t L'I r r
1 ,r Ll,' 1;:',:'i:ciri.:,,rlttr-iiI !) Praba tisl,n,t't,ricit'onift ( l)]itlltitttsrrtr ri lr"rr
i; i ir il lt r r t 1) t lr r t sl'rlrtt t t r ' r l'
ii f it lio( j r lil ) cl( i bt 'r t 11lr
,' ,,;. j c i rci't lr ir lt r . r , r 't t iL.'si
'
,,,1,1,, ,,r, * li ; r , jr it is ir r lir izi{ir r ) l. iz( ) t lir r li. l) t r plr t i, t : ir lt 'zit t t t ii r r . t r 'I r r '|. 'r r, ,
,rti rl l ' orrrsllt t ir : lii, r f s{r l'it li( jit liaislist lt x'ilt r t 'l t lt t Lt it it L'\ t r r r it llr rllt llr r t t t r t lt I
rl l ri pr,i trr ir l, r 'iasi t lisclr t lt ot r lt l, r 'iir ,pt it t . iI t 1r 'lilt 'I t 1'ar t li"i ill I li r r r r L
,, .r' ,,i ti ;i , ilor , ( , iI iji liiln) t oniiI t ir t isou] illi.

\ |l | ||('li g,at]'tbet.

o .:l,l!!'L'-n;cigrutuipe sasva{rJ inf ' rz it i. o t lu s t rri' i). s { '

',

, , . ' , !':'.:!':
' r,| ': r:, r ir i ( . c t c t eos i u ti tp U x e to a l x i t(.ti i .i i , i n Scn.u I C ri i l l p | i rnu l I.i mn face
rrr .rrrr. rr'r { ar ir l|5c r p e l l rz l rl c u n rc ml j ru l i n f| r.i o r
t,xti ni qi i bi e i n rl ci oj l er"
i I i ) r : l( , i r ' \ r unc a g i rm h c i p e c o tT ]J i ' i .
rl1. I\.olxr, ind,ice-nas. Li a_ceasid,miD&r,re so observi,
cri ce'ebelosul

lrr.r' irrl,ii. :r}ducfia braf'lui $i abia,apoi fiexiune:i n"i"t

rrrlr.r

dii;;;;

ului Ill na,s.

"o1lrtni $i
') ,L'r'tha mrrsulu,.i-Iipsind coordonar,*r intro acl,ilnea srrmrttanii, :r
.
tlitn(,lt)utu1 $i .1 membrelor irifcrionre, in timpul mersului,
I i.:,,11.,i11.
r':,.
Nr\rit(.{.c* i'Jzil,(,e sustcntajie lniritd,,_trunchill ll]nlne in
urm' fali
,l( rrr1'rrl)r'c,
incit, bolnavul poate chiar criit"a p" sl,ate.-- ./. I)il1,oli1iituiburii,rilor de ccordonare
.^"o pot irLteresa,si mu;chii
l,'lrirl,rri, t,trbirea asle rltclaii (sacadarI sarr exnlozivij.
'l'ttt
ul.i..Po:rlolIirrea izolt-r,1,
r:rrrrrSUr.r:Ila
CU{liS_
, '.
,utd.latoi tpn!io
. : t t lilii
ri' , | lr' . t,.il flr.t tllc lI: ll dt

::.' 1.' u,l, lr u; r r it i, inu'pr u. t it t cr t lt r t , zil'iilt t t r r ) l'l{) lllilvt llt r t r 't t {ir t t r lr r I t t t lr t 'l'
I iir lj<: it r r r lt r lr r r 'lLr lr / ll
tl r(.r.r/i tt,. i rr 1r t , t r r . , i, 1ir t r r c, , , , 11i- ioI cit
I ll'rot
, 1lr ii t t r t , lt i, si.
lt
r
Nit
't
r
r
lr
t t t l lr it lt t : t v t t t t t , i r t r ,
1,
r
,
.
I
i*lr : r 'li
.,1r,,rs.l i .i l, ii; r r lr 'it 'l't r l sli lj
,,r,i l r poziiir ir t i( ir r lr i, ci r , iir r Lr r rl;, r r r r i r r iyr , l r t t r t ir ir I illr I ; lr 1 ll, r lt t r r t t t l lr t r r '
,,,,,,,1,,,, r 'ir iir r r i,lr r r r t izr r t r llt llt , i{r lir illit r t l ro l t t: t t ' t t l t t i r lr t : 'i I r lt llr r . r l"
'
,
i ,.l ;rl ;ri f,Irr.r r r , Lr t li lt r lillit t t r '. lir '1'lt t lllL l"'lt t r r vlt t t r 't t llr t t t l t t ir lilr r r r r : r r t r
lit r r r ''
( Lt 't t t t llr r )
,i l ' r,,t t t r st , li, 't lt t i) . lt r t t r lit r 't t it t r r r li4r ur ilit

, s i t n; r i lr r r r lr li l J r i l l ( , o i n f C r c B t _ u
ou,lUClCilOr

liirr.titl $, 1 intorrii(,'rlltr, lrr,rii;rrr'lirrl'rrli. lr)iii:rr

cri.irl,xc ul crrrsur .xrculrr rrrrrri rrris.ii .i.ryiJipsoryl
o irr
r*r. s.irbs.r i.ri lrr,iii.tip utr rl ,,n,,i n, ism,irll,
'ii
rlrr'rrrri rrl.'lir, srirlir'rrrrrri;.1)r'ii
'r4irr
r,'a,irt[i.r.rrr
;ri s. r'r'irr.ri(irrzri,
Drrrrr.iirprli11lrri i r, |! r,I r I r r
Il

,1

I l i ;i , ' r I l r' rr'

rIr' l i l '
rr ' ' ,rl LrI:rIl
I'i i rl rtl l tttt,l ti , ttl l r' ,l l rl rt ttl ttr
I I I . | | | I t I I I I I I I i I l l r tl l l rti l l :rl l
tl i t l ,ol l i l tl |.,
I
l
tr
i
(,(.rl
rtrrl
tr
tr;,
l
rtr
|'t'

rr I It lr I l i l l i z o l rrl i i . l i r, rrl t,i l tl i i Irl rl i si D ,,l l .i ;r.,| ,r| ,rrIII| ,i i |

| r| II

r' l r' \{ ' ' Ll l r

i l i l (i ' i '

t.l

lll

l.srrlrri.str .'k'rrrrcrrzli,gi unr,.i rrislllrro ..rnpltr,. Irr scrri'rrr 1r,ctrtutiit

trr,a
.rl|upi'rrrrrirlirlil,nu.stc infhren!,i[t?i;ia'' p.'leia, pilanrida,lti,se accentueazil.
It. tlrilelc auebeloase.Unii bolnlvi-pr eziniducrize tle opistotonus,
crr
lrilx)roxl,ousioa msmblelor. Aceste c'ize- se aseamd,ni,cu i,lgiaitatJi Ae
rlr,r,r'rrrbranrroblinutir, la animale prin secliune mezcnceiatiEA d;;;;pi:;
rrrrclllltii lo6u,
.t-Li1..2. Prlbleme etirpatogenicp,4n sind,romul cerebelos
.1. II r()rtlpcprphel4oscria.trpptezenlafeinapJ'oximaf
iv60o/odiLrcazuri

,.1.r0lo fiild hemargiobla

sioame.cnisrufi,abceseli
il:
.clj:11,1,,;
(A'sr,-ni
r'(,t,agt*ze.
^ll.1lltci colab.._1974).

-\e orieol i.m spre dilguosticrrl cic tu-

rllolil, C(.ln 0r.lOiisa al LlDc t c io( i ln. . ooier LUl

c lini c , p e l t n . q r i s e m n e l C r , e r f l b e _

Iorlno,irprlt f i simptome tle hipertelsiune intrasraif:l,n[,, oi,re este insil r.aria_

D ir..cit- trrjnsrrilre_$r tnoment- de aparilie, in funolie tle rapiditatea tlez-

depeltlr.bd,rilepe care.te.tletermiin.
r,a c6piine gtndim
l.:,1]l:.ii]1119.li
ru
Iixrl ]-l
lt urr mcduloblastom,

crr.e do mulie or.i tle"buteaidnrin

lrrrrrul
' r.l.l'.{'.vhrsalur.i(de ubir.ei!,aJinale. firA greate si fare eforiuriain i,,i.
lcl, bolna,vului), tulburlri de echilibm qi ata;i& indsului (sindromul &reI'r'l)N vclrr an), staz:i papila-r5,precoce, crerytereadimensiunilor cutiei crart|(.nr'. r'll .te.hr$cenl|t suturilor pe
ladiografia erania,n[ simpld,, ,rzgornot
rlr,,
spar1,5t,la cioc5,nirea craliului
;i adesea atitucline ,,cireinonioasf,t
'rrli,
.i rr gitulrrir precum si.,lize lonicc t,,cor.ebcllaL,fits;'j.
rr r':rp.rrhri
n lit rn tumorilc cu localjzareemisferici iglioame: jndeosebi lstro_
.ilrtrrrrr',;,.tuberc.lo_ante; hemangioblastomul ietino_cerebelos sau boala
tru r trlr Hrppel,lmtlau f .a.), cit-$i in celevermiene, Bimptomelcdin
lartea
rr.r viloi cmDieni, precum. si cele din partea marilor cdi senzitivo-r.riotorii
r r (lls(.t|1,..llr lchjtnL,.in lumot jle uug.hirrluiponto_cerebelos
ap:r trrre_
'r)r,c s{,rnnccochleovestibrrlnrc {per. YIIII, precufo si dc afectare a irereihi_
l,rr'\'
VII, serrruele
celcbcloaseapiriu,i inai tirziu.
-.j
ll. ,4.fecti.tmile inf njioate ale -cerebelului:
.in, erotulm enr,eJalitelorde diverse origini, primitive siu secund ,re,
,1)
irc'l() $a,uct'onice, apar adesea.simptome cerebeio-ase.
Dxisti *nele situalii
rr (1llrc,loc:tllzalea- pro_ces3luiinfectios se face cu pre<lileclie i" c"rcb"t,
rr rr.t'si. cazu.i tabloul clinic fiind dominat sau fiiirl constit*it excxus#
g1'rebelos.Pentru aceste cazuri se folosegte adesea l,errncnLtl
rlr rr1111i1;1111'11
rlc urtbeli.ld,.
t'elt'br.litelr.
rle, fapL nemarite arule in.feclioase,
eel rnai udesea
-sint
l)t'|lrrr)rr'({lar,ft seeundare},rounile altidalr, s b lormcnul (1,. ?.atarii
:r..rrr(."irr(, lnl r-_,eyden.(
ljecourt, 1922). Se pot intilni in cele ma,i variatc
irrlor'tii{{r lrrd 1iloirIii .,d ifr t.rie,ru.ico]-d
, sr.&rla
iini. variohi. g;.ipi, pn.r,,,noj",
rlrzr.Ilr.t]r..\ 3t!l-cell.tusc convulsiv5.dir"erqenevrarilp"irolice_cu:urbuviltrsrrli rltr pildil, encefalitXepidemici) ;.a.
:!. AhceselEcarebetdase
sint relativ frocvente, ma,i ales in cazul abceselor
r.rrlillctrlr'(otogenegi rilogene) care rlau in 34% alin caauri abcesecereber',irHr,
rn oeleoJogene{Arseni si colab., I9Z4) mai pulin in cazul abceselo:r
Fi
nl(.rlnliltlcc. l)eDulul subacut, cu sernnegenerale
hfeetioase, cu discret
lirrrlrrrrn d-e hipertensiune intracraniand, lf debut, dar cir aglavareit, pro_
gt'r'sir,ii, lr,tlcsoaryi cu semne mcnilgiene nc sugereazii,djagnosticul.
ii. 'l\tbereulonu,l cu, Iooali:ure enre.lalicd,aDalc mlri ales la conii si lrr
rrrLrh*'r'rr(i.,lo.ir.lizir
lijnrl rrx.mrriiu c,ir,.t,el
1.r.r.rlih'c1ir.
;iin-tfiii,,.i,i,ii
'orr..dr.
.r'r'i!rr.irr(A.s.lii ry.i
.rlrlr., 1074). ll'rrhcrrculoa.m.lo
cerebcl0aFcr'(,aliz(,lllzr'l
rr r.rrr' ('rrzr.ir. sinrrTonrd$ hipr.fl0nFiunointrtucrnnirmii,slndrorn do frr,rr
| (!ri {rrrir, irr l)ilrz,rlirr cuzrrIi rl:rl rrrrnrri irr ri!f^ rli,, r,rrzrrriFirrdrrrrrr
l)oH
180

Ir,rrrl r| [rH ,i tttllf ot t t t ll. t t t lr 't r rI t it I Ir rt Ir' I i rI,i r' ; li t t t t l'oli ; lit t r lt r r t t tt l0 llllglli ll( llllll
r l trrl rt' l os' (,\t'r ir ^t t1i
i r r olr t lt , I 1) ?'1) ( lt 't r r rt r t r t 'xl't rt lllt lht lt l l'( 'lllt ll t liit gr lr t $lr (
r ir, r ! r r , r r lizr r , r rt r, r , t r 'lr t loir siit t t t r lr r lot t t t it t i r lr '
.rl . l ' i rIt,ri l cir , i r r lr cr lulor r , r ir r r k,
,rl ri r:ri i rrtr tl r ! . {r , t r t t lillo,
l, il, ll gt jllt r l( lilziit lr r lt t ' liit t t pklllLt t t list lt r 'l'( )( sl'll|t r st t lt
,' r,rrl ;r, rrsl l trir i . . i sr 'iiilcr t it t gt r 't t llr ir ', r : ellr lt 'r ') .
l ' ..l Jol i teclem 'ial'inizunLa( i, t t t lr t ost t 'st t l, at eu'm nl'LiSt li) t r r lt r t r zit t ir ir r I t r t r
rirrrrihr(,lro lczeazir,ccl rrui tt'o0yorlLcetcbclul. Irrt intlivizii l,ilL(\fj' lll(12('lrt'ir
rrrrri siutltorrt ccrebolos ()u oYolutie lentir, qi ml,i Dls$ ou pu$r)uli i1i totttisi
ri,ti,ii, l;otrle:r,unasuspiciunoa unci leuconovruiitcr lIIiLi rrltts tlrt.rt' rt''
'iiii
si simptomele ,,iiramidale Si vesljibula'rc" I!xistii ittsri,'litltrtt'
'rxx,iu'z,ii,
i,,,,,t,,jiorr'"".1c'scleroz,i inultipH, in cnre sernnolc coriireloa,so l){tL (r,ll$l,i
I u i rrruliril yl'ttno singllrele manifnstd,ri ciinice .
\1. Afeclittttile rasctdare a[e cerebelul,ui
('lr'zlll'
l. llenmagio cerebeloasd'nu este chial asa de r:*r'ir, clllrl slt
irrltir
ptirlrrtr'(!
din totalul hemomgiilor
, ir rt.urizentin{i: de fapt 10-13%
(iorn'villo)
l{l]';ll;
1960;
colab.,
(McKissock,;i
,,.n biale tltpl, uneJe slltistici
|rrrl
tlrl
ccrc'}{''lorlsc
hcmoragii
multe
mai
1942).
Ce]e
\lil,diell 1i,i.ngrist,
olrsorvttte ttc P"opoviciu qi collb. (1980) in zona de vasculaliztl{ irI tt' lrl't't'r't
., r' r.lrl ol se t nLer o- supelt olr ( .
debutul brusc, cu grcluri fi viirsil'tttt'i lrr
Sr Do&t.r recunoaste tlulft
(
azur
i,
l caic se lsocilzS, o t r iadi' cat act cr isf iclr : : t t nr t t '
r,,.sl c 90V din
i ,.' ..t ci oas" ri*"t n, pr "r lir i, pr iYir ii ipsiht er alc ; i p: r r alizic f acilr l{ . 1x't 'if r '

,i,,ii."ifltt .,.1.otrir', rgf+), dup,i car-ese instale?zi.ttilburilri rtxpilnlot'ir'

in speci iri riiplr:r'1iepeti'rtlicri(llc - -tcissrrcltri irolll'l)' tl)(illl
"'rrsl'ind
) . i Rogpl. l$?5) .
r,l ,' ,rl ri cni , oum i lt lpidi if t om ai
$o nut tlistinge 5 tipuri ale instahre , silllptomrl Lologirli itr ItltrIot'IrI'.iIIr'
, , r,'l,r l,iise (rlup.r-Schobl gi colnb., 1965 ; !'isher ,sicolab , l{){ii I Iltlxtv.tt'ttt'
-Pascu,
19801 : a) Tipul ,rtumotal", cara'otcrizrtt lttitt xttttlt
l','rrtrcilntla ;i
t,,rrr. t,c.ebelbrso cu'ticbuf lcrit s.i. piogresir', rtsocilte cu lirttrtttrt'tr. rlr'
izirl' lttitt rtlr'r
iri txrit orlsiulre intracraniand. b) Tiput rrrmingian", - c,.rril,utol
st'ttrttt'
vllt'tsi'!trttti,
:
cr,'f:llec,
sirnptomt
rilirr, rrcuil, ]trul,il1ir, a unnii,tuarelDr
rr,.rrilge:rle. fclornene confuzionale, slnptome ccre'helotlsc sll'Ll olfll'l)r'lrraspoct dc sinelt r t m t lt ' 1t 't t t r r 'lt i
,,,ri t,ri n.si 1. . ( . 1i. sr ugbinolcnt . c) Tipuliu
pr
uf
r
r
ndi'
com
i,
r
'u
, it at .
,,.t:,' ttt* f,' i o-t t i*r
t-,1
l) t ipilt ' r r r ir r lic{" lir t lr it r shr
motoiii mlri (c-rrL,rnrrsch(rllzil,tullrrt'iit'il'
r,ii,r1,<.r'a,1,
hipol,olic $i tuiburili
( r l. sr r 'isil' r l"
.r' trdrol tase'; i r neniligiene) . E\ ist [
li f 't m r t , 'lr t lt t t ir t r t t r li"
\filson,-Itl5i)),-ctt
,i.u'l.r't'it' lrtttirtl't :r
t'lr,,tias ;i liogerr', 1925 ;i'I(innier'
, orusticLrieisi i.u b rnotrle rapidtr,). (l) Tiprrl cu debut mai puf in gr!r\'' t'rl
r' lri . rl nsi {. lt r int il, qlr '2Lii, vir sillll i' ccf ulco violct r t ii, l; t ' r t t t ' ' r t st t l'ir r zl
',
rllr,ii,,t l,Lrliru:r-tIi tt. con;ti,l1')i. er) {ipul ln care dupd' o saurtn 1{tlioll(lrr
rlo rnm[," bolnarrul igi revino, '^cuzind in conlinuatc rltttct'i itt I't'gittttt'rr
vi, r 'sit . r r r 'ilt t t iui ules lir schir nlr ilil" r lr . . lt ozilic r r l{ r ': t lr r l
,.,,gri rLIi , g lr ] t uli
"i
llt r lli$lr r il
r' rrr ' .i rumr'icli'r iul'r
r t c. O bit r '1iv t r i't t tult r gir ', sr 'p( r ir l, ( '. {'\ 'i'l( 't lt iir
,rrr, ,,r,iz.'.i,1 (car,c tlrr,cii,esi,r unil:.toral, inrIi.ri sulirtl Iozillnii) fi tlll lrr'lrrl
,l|rrll itr cor?b0l0s fuOrnOIatOral.I)o lrtrtlto rlti stt pttlttc OVjdtrlItill,i1i rt. Itrt
rrrrrrtrrl i i l 0rlot r , I ( , r Lt coalii, , t lr icI r lI ir nlir r lr lt , t t g[ , i: t t r lt it r lllig( llllolof ( '{r llllr ( 'lollf ir '
rt
:!. I:ltmalnnnrL cerlbAljA ?rrrr0df (,,spo l,ltr itr rkrntttttit'(!il, vo{'ll(', rll
li'i, '
(
losllr
l
r
lo
t 'r t t ( r t lt t t t r it t t r t lit li
,rrr' ,^r' 1rt At r . ict t i1i colr b. , lt ) ?1) cst ( t
ii(
'
r lt r t t r ')
lr lr illi
t lr ' lt ot t t r ll, oilt lt ( 'it t t 'lll'1t r t t 'r 't t t llit t lr t l'0it lrlttlit
' l i r ' ,rrtIt' i l( '
r rt il| {lol) lt llt l br , t t lr r l ( ir r lr lr r t r , lt , it t ; Lt lr . ) r r t t ut r f it lt 't ' ot 'r , iI ilulr l,
rl i grLrrsl ,i rr l)
gr it r t r lt , r ,{hr
.
nlllt of l, it t ( ll, r lr r 'r r ( 'ir l. it lr r 'r lir r l
vi rr;;I,tur,i , vi, r . lij, r 'i[ dcr o lil, r : r 1,

I rl7

(lrrrri
(irLlirrlrr.r.irrtrtrNsil* rrupi,oitevazile (in formeresubacut.e)
. ir*^('ci(l.lr1'
lrr,lrrrzr'i,
r, sindrornneo- sa! paleo-cerebelos,'infi;;1ri; ;;"I"'*ilj
rirr'|ir Ir(rIri rr'| rrrrrI rri (Arseni5i corub.. r g;4r. s'. po, t.'^*-cra
sLazaoaD ar:i-ir,rrllorrrul
do' irilal,ie meningeali,.prr.cumsi ;-";
pir"*;;;i;ili--:;1;
.'
|., | |ir r.( r ,I rrI f r s o. r nD'd. e tn t| rc l ti c e rc b ra l (Ars c ni
1i col uh., i 9Z4). E xj sti

ci

e\irut run.in'erapi.t.indnoseiri-;;iJ
l:ll,'i:l;
.'l,.llr::'n,^"_r',:,:,11
"rf" gaJ? OcCipitali,.
:r|||liirirr(,rul'
cercbeloase
";;'rJ;"',
Alteori

bolnavul igi"revine
] _
,tllr :l ')r' r r.Urn:rloasii
inili:rlr. frri a pfezetrLl,
Scmscpret m,rri
cercbeloase.
(., (l,rpii r.ircvazile .A aparii iemne de nip".i"nJi,rne'in;;;;;^";;.i
'"r,r'r

jt",*]f;
T":rrt,il",f
H:",1,f,i",":;ff
:i*:F:lt-,""""Xi:?li"
rrltlii:iffi
r',r\'(tir'.rru.ui hemal,omcerebelos.ri" ;;l; ;;i;;lti-"Jrr
insl e'olufia
('iri r.rr- p.og'r'si'ii,.aspectul
crinic fiind asemi,ndtorcu cer al unei neo| (,r' lll l I I (,cl'('r'e luJia ( . . lO f
in: t llSCU. lut Um , J r al; ! r r ) .

:1. Eindtoamele iscltemice cerebeloase.Infarctele

cerebeloase izolate.
lrrrl', sint in general destul de rare, intmcr. se qtie cir,
:r .r.rqbelului ests relativ bogati. Astfel, ocluzia'a,r"berei
"i..rfi,tir"."f"i"ilil
cerel:eloaseantero_

inrrucft infarcrele cerebeloa,"se

produse
::l,il.l:ll::,..,"1i"
3,s.imqromalied,r
r,r rr'r'rr,rr'rut
,cestal
ll11erp<int.mi,.isi dispr,rstte(popoviciu, pendefuncl:r,
anrero_supL,_
,i...]'].1..]1.:
,11101:-it :9bl-lr, ocluziaarrereicexcb;rolLse
"r;rr(!

pfufluce, pe- linga, leziuni cerebel0ase la niyelul nucleukri

dint-at.

ponto-meze.ncefa,lice
(popoviciu
J.9l"tt"ooit
il,J:,i,fil]:.Ji,l:y"I"t
r:'nrJ.rfdure sanu_urtamt:,ptur ci, reziuniburbarecu simne si cod,t.j
cei,ebeloase

,rrrri,rr'\r,
(.tl mar Rdeseanumero&Sesinalroameischemice
ale trunchiului
(sildromul
arterei cerebe_loase
postero-inferioare c* r,',iantele s:rlez
'i'r'r1'll.NI
lrlir'e'ran-|-b,'nais,
sind|.orrrul
tui srbin.tri'.r'rg,nrtc, -rndl'onrIt
,.i,',"lll'.':'l']
djudromut trri pi,.rrr, Ilarie.Foir hrr ..h<,miprr.,.z,r
].ii
l:,1).]"':"u
l..s1rn.
. - \'ezi cJp. l), intftr-ir Inlrelgd jligJli.
,, r"-r,,.lo;,{,1
i, ..rcl.;o!ulrii e"t,.
.,\rrrr-,Ulr{r, l,rtm u e cot.cbelo.rs|
l'jscuic Ltio lt"uo(biltJbazil:r,. sc nLri
' rrrr's. r'irn.rismentere cerebel0ase bilaterale trin trombozcre vertebrcr,
l,rrzilirr(.(l)oloyiciu, -pende{untlasi l?ascu., fOSO;
Scotif fO6T a,, b).
ll.,:LtroJii.le cerebeloase
/. \r' sirrdim la o otro.fieaercbploosd
seaundord,s[n$)lomalicd.t] nr(.
/' rrl.r. llrll lurrc.iLnrlrumcclebelos,carc s_ajnsl :tlal la un-bolnar
ti care nLt
rIr' 1risI ii rrr,.rrl1.iiictul. et,iologic, dari la,care eviilenlieia
in antecerlente un
r:r'l|t|-t. tocTlos.roxl c. lraumatic. r,lScular,ctc ., po.ibit gencfttor
cI corr_
c.r.ouotos
si, l:r i.i_Lrc.
prin jnvpstigdliiJor.for.turfo1lncn.
::,)
:il]
I
illll]"1?i-L(.
r.rr'.( { rirl(rgtallc,tomogralie arial{ computexizati,l s_a
eviilenliat ;-trofi:}
l llr' lrll
ul ui.

:!.'ltroJiile

cerebeloose
pritniLile :
ered.ofamitiate ne sint sugerate ite intervenlia,
.. ,,,.,::.).,,1,!.,f
.!il:
-!t!:!il*yt
nnot
l?clori. gtnefici. As el. se surprin.le caraclrrul crerio.
' \ rr{,.rrr,ir
,ir.
ri||r||ri||,(lr,Dt
.ut i]r'cloc j0 cnpildrioSau In-adolescenti.cvolutia bolii erfe
|l'trl Ploglcsir'5,,iar in conteitul semirrlogieo,pal n*irf,rl.t
si alte elernente,

respTtil-e:-. pcta^la
tui. frri,ed.rei,ck
tmphcli'qi l;zi""i
:.:l:.:ll
f:::l-1,1:".,lglli
,jl:,111
tulbur5,ritrofice._ Hredn_ataoi.a
.&pinacirebeloa,aA
$i
1.,]'-1'l
l?)r"froarc
t t l l t.t
.{ C rn n r,
rttr t ' e J A 41L.itds o ei rz i L f i
p i U n ti d a l e Ji , cv{.nLur.l ,i l emeul (. l rnri ,,_
lr,l r((. ( t nl r ) ( r ilf iLlur ( h u | r,r,l . . I)i s i n e rg i a o e rebel oasi mi
i , oel oni ad u, l rti
l.knnwy Hu,nt rk'.ltrttrlzii clt tlizc rlo r:$ik,psio ia,l .sindromul
cerobclor,

rlt,irrrt,,s,, :riirxriirzi,
qi oi rriiocloniit,"liizlt,, la urulrhii
ill:,'::,'1:i,
l":,1r
r.r.r fr .r.,1".
lr{
rrr)rr'k)r'
rr-rr1x'r'irrir'r.,
int.r'rrrrr.ir:rri
Ir','r'rrrrr
1i .u (lr.ir.r'ir,rir.rrr
l|l1,]{r-f.rlvif.

r8 0

.tf.rolta

otrl,od(Vtltt ltnxd,

ltti

eoft]on_tItlittr,$

rlrirttlr.rrz,i

iz|rtziilttitrlt rllr lrllrf''

rlrrrrii,
rl(l il{) tltrlrrri,iIrr. i ,IrI IIrIrr| 0lirrir s0 fltt'rltllttt
vh'trtrt,
tltr l('zilllll ir :rllrrl
rl'1'
scrttlttr
I
ii
ctt ovoltt{iolrlogttsivll,
sirr,lrorntxrttrbclrtx
ttct
voil
N{r.
llttt01'uli
(u detsruLin'ilmaonge'n'ila'l
sittt;.ltryrtrlt' rt\'rrtrtl
lt) Atro! iiLa aerebrioase
ilr l)rillrt l''
rr:rr'nilt'slrrl
oelebelos
,,rr1,,
lriin pr6zen!a,unui funpo*ant sindrom
fiinrl evidenl; lcg,'1i.rlL' ittl'trt
L,,,i hup[tna-steie,suferinti, cere1,eloas:1
't'It{iIr
pzr,lotoeic
su.ueniLin tinrpul vielii inlrartl.r'itrr'{:rrl(ir It rrrrrrri
',ii,ii niin"a
lptctrirt'
se,
clinicc
entitSll
lttr.ltrtzrt
t,.s1ll''c<liscdbriopiazic[. I)iversele
Iot
gi semnelol de indica.!'iclczionrtlii'ltt.p.'
rrrlcnsit:itii
'- su{eri-nteicelebeloase a
i. . (tl'ln
iptazia congenitald,toiald'; - herniaplazia cere-beloaslt'
'
gi,
arhiattlaiia
"i'rii":r
a lui.:Vogt i
li,r,
n,eocerebelitasd'
Ttaleoceretlloasd l)ilrgtr, '
pe rrtliografiikl I'A itt pozift'
lirrtl osto facilitat de pneuinoencefaloglafie,
tlitt itrr.rlr'
.r,zirrrli,evitlenliindu-s6spaliul subtentor'1alrrursiv l;lgit, rtct.rl
rrrt'trr.
tttt
its,tN:i
la;terali
tlin
ventriculii
ce1
irrrr. t'ealizlnr1 irno"eunii cu
l.ristic de X. in fozilia cu capul adirnat, aelul Se ac'rnul.^zr'i ltrrlr.ii\'rl
li'sir posl,el:ioar"l, desemnind gradul tle ap-Iazie."
ti; Atrofi,ile cerobeloasacu- apari'lie tard'iud sint' {:'\plesiir rrrr{'t'l)ri)('t "
,' lriotmfice,' degenetativc, cu irrjtere,sa,rocereboloasil r:leci:ii'i - l)ivtrtsllr'
taraLivese pot incli'idurr.lizlt6cstttl rt. rlilir,il.
de atrStii cerebeioase
r rr,r'i*rrte
gi a extensiei topogralico rt lt'zittttil.'r
debuieazii,
la
care
rr,, liaza virstei
,u'rrrbeloase.
a lui Ddjdrina^Tftomns tiratrr itt itrrrrl
ANrofia o:Li,ao-ponto-earebeloasd,
-ani,
rlrr
ll]Lr,r'osiirdrom cerellelox, t'll trvrtl.tr(ir'
realizinrl
i'stei
50
rie
r
cl"e
de mers, ataria' 1i 1f(nl]tl rii'l I l,lrl
predomin[
tu1bur5,rile
(in
cale
l)rr,gfesirr6
i ,rt;riiiliona,td,;,
la cire pe parcrus se avrciaz5_,1istttttittrttxltitlrilittttitlrtl',
glolrtl"t
qi
1,,r'cuil
iialeze oculbrnotorii.si rrle mi;clrilor cottjrigli,l't'rtlir
, r'l l l i tl

l.

u' Lu'i I'ittr'

ta,rd'i,td cu prellorninanld'
--- Atrofia cerebeloasd,
-@rticnlii
r.
It (,ie-Ioifr:At04nrani,e
apare mai tirzi' decit celelalte iti:t'fii .r.'t't'Irtr1'I
trtttrl'r'rlttl
iar
itt
leniil,
r,lrrrriivirsta d; 60-65 dd ani), are evolu-tiemai
mod net (sau sint crclllsiYli) iit'lrtlr(l(
' r'iiulosic oretiomin[ in
de s1,aliune ;i tlc tttt'ts, lttlltrt'r
irnportante
tulburitri
1',,Ir:oceiebel6ase:
ri
de
vorbire.
tutburd,ri
'
a lui Lejonne'[ifunn'tlid it1l:llo ttt
AtroJia olitso-rubro-aercbelousd'
itt
lentri 9i s. uitlir{jt(.r'iztritzrj,
are
evolulie
50
de
ani,
virsiei"cle
.;rrrrrl
'ritttttl
prin importanll ati,xie a memb.-,'lor',.uu r!:tli tulbr'ir'r'i itrl'rrrr(ir''
'irrrl
vr'1"
,,,,1,,{i o'oziijonale,' la c:lre se asociazil,gi mioolonii (lLtrooti
'it'tttitrir)
globibl
o('lllrtl'i'
ale
diafragmltice
falingolar:ingienc,
ti
lr,rLr,1inei
'
' Atrofia' cerebeToatd
d'ifuzd tr twi llr6utoa :l'prirolnai (l{rvt('rrr('(l('(rl
(intie 40 si f'0 lnj ), are o evolu{iemai rnpid; qi rc*liz.i,z}; lttr trlrtir y
, ,,l,,lrr,ltc
lrr rr'
. rrr,ltotnccrolrcloscompl''l'lirlhi, pslco- 1i lcuc''r' Liel'r'i-lril:rl''lrll'
'
(lurrt
-rlll)llc(')'
(itrcJusir'
r,r' rrsrtciazi,Si semne extlapillmirlalo
troaicasa irrl,iltcsc in iltoricl(,i* trl,ilitlit,(rt,tlttlit
lt. Atunii,te carabeloase
pt'ofesiori:r,1e
crorLicccrt plgrnb '1i ttltlttttr, ptr'trtlttt
ri r,runici,) itr intoxica,liilo
-cronictl
rntli tlo hitlll(oitlt' (ilr sllrvrirrlt'
tloze
eu
i,'
tlatarncnl,elor
,l,tlsul
,i
prirnitlont, 5.,u.
lr,rrobru'bi1,*1,
I ittittrl
trawnatkle sitrl; ttqol llo tccuttosott1,
li. sinilrowtcta acrubeLouga
('r,lll
ltt'tttit
illttt
llr'lrlolttgii
Zii,
rtll,l,ie,
crllrl l)r'rrllt(xr
rir.irrrrit
do fitotlrrrtltr,t,rtr
('nt'r vrrtirltil tltt llr t,ltz lit, tl;tlr',
(ltrrl,oxl,tilsr,rrri.l,rgir'
. lolutc oot.ol,,rtlousr,,
lrrzittttilot'llillulllll'i(x"
ttt Ittltofio tltt lrttrtllizttttrl1i t':il,ottlirt,
rlitl
iod'Jonili'd' ( honkt'ht'i I'r.nti+lltt) (xrrrsl'ii'
ll, Ataoitr, Ialtupinoht'z
: r x u r . i r , r r , n ,t t t r tti si tr r l t'i l tr r tt,t't,|,,'i ,,xl tt

n to l tr l i t'

l tr r r g ttr si ttt, l t tl tttl l 'l t'l ttttg i t'r '

180

alolosuDrerrolor.
ttinjurul_trasusu.rui
si
l"i',i,;lliJ,ijii,.u':tili,oo"_T$'f;,lt
-famiiial(cu tiansmisi
rn(. .rrt(,sorulu
olo"-*;*ti"11?rlter
'cr.csiv*]*t

'"^iffi
t;:"#3"T'fi
li{.i:#-Hffi*
:::tl:l'lt:ffil#xtrall,#ffi

t"*itix'3;Hyt3:l#ff;
:"3lidl3i#5#ft
iijijiHilF::::;,,"i,!"
a lui Dennv'nrowq;
dnexaeae
iii:.ilillii;i; Affi'#-1"Xt'#ignetizare"

i:',"i.}}"x'ffiry**ili|I';
r{iti'qT#{f
;J[Iiugsl$',1ffi1"a,i'fl
ei Botezi
r1);)t
i srsorqi cora).r.,,
r;r;, F.ff"'fi

F
O.

lt'tspl'ttot,,otitlt
DEDIAONOsrlc
PROBLEME
INVoLUNTARE
MIscARILoR

"ul,Ti;lh,t?3t;,.Fradis

6.1. HIPERKINEZIILE
Sint migcx;riinvolunta,re,rrariabils ca aopect sorniologic'
r,rr,topogufie qi- ca eti6patogenie' Majoritatea aoestora sint tle orlgittt'
oxtrapira,rnitlalS,.
xtllt
6,1.1. Hi.nerkineziibruqte ;i clonioo, fir[ dcplasdri sesmenl'ar'('.'
limilatc'
r.u deplasiriiegmonlaredd obieci
(li)r colllli(lllr'
l. Mioctoni'ilasint eontra,cliirrusculareinvolu-ntat'e,
sittcrottr'
alteo'i
rsincrone,
1i nlttr.
uneori
r,.u*ia,J" iil clonie,arirmicc5i
(c.vt'ttl
ttttl
un
rnurochi
la
numai
sru
:nuscula.
lr
un'lascicul
rria"."ii-iiri"
0{)n1trt(tlllr'
cu
mai mulLc grupe muscutare).Sint asemlni'toare
i,fri*t
fntctt*itnlt'tr
"" ptoOrie di e^xcitegiite
electticc galva .no-tarariice'
ino..ri-u
tlo .lrt'
intlivitl
1a
individ
tle
foarte'variatril;
este
iii"ii"" mt"'J""ii
_la
fr,l
'i
iiir'^iai" rr"ri;. u"ele sint discrete, cle micii, amplit.dine, f[r]l 'ir'i,rrrr
r'tt
pntinclu'sc
oottiittttlrt
lespeativcl
corpolale
il,, ,lellasarea segmenielor
:trn1tlt"
tttlgertrtoarc,
sint
dimpotiivi,
Altele;
*ui-cutu"e.
i;,-;i;;i;tiii;
s'egmcniet'corpornlerespectivo $trtr('lrirrl
;i;;"r,;;r.i-;;r;lor"
-eiirix
ritmiec, sfereolipc, conrinut'(ttrirr'll"
rnin6to#
-o,lu.nt)
iiifii:*,ii
i
t'lottit'r'
"J"p.
carepot produco (lorctl'?o!:'j
mai
a,tnple,
mioctoiii
ii'ril"te;;
9i
mai intense.
musculare
"
au remalcat Ga$ttuutfi colab (l97J)'
il;d
cum ne fune dreptrr,te
'reprezentatmultd, vreme o. sut's[
dtt"t'rt:rl'ttzit'
,*,naaoiii d'J,ffiucro"i"" a
ltt st'ttvttl
fie
utilizat
s{
ii ,i"'!ir"tt*iirli.
"*tii.l""ii-"ioei.,i"t*.oot ad ,,*ioelonio" trobuie
involtttt'
musoularf
contraclic
orice
iniptice
s[,
udi"n
nf.
I ot"tilit lictr, Muskens (1928' cit{tt <lo Gastnut 4i
i'iiiii,"r'."i"ti,'"J-;o*
r:olab.,19?4; qi do Popoviciu 5i oolab.' 19?0).
Contraotia'sourtdiivoluntai{, poato afecta,unul sartmni mulli rnu6chit
ri,, no'ptoauclna-nicio mlgcoro(ttoflnsare),otunci olntl ttcli()neftz[!(r lnn'l'
mlioi,lleproducindo rnirlcaro.
i,hi
'
ln luuctio ritt tliatribulia lor splJio-tetnpwald,pot' Il dlsiinro doutl

nlunel
t n)-mipolittiiJragnrenlafe,
u,"roi'orfiiirioiu{a iiiitoiti W"orotir'ote
coqro'
irtttroulntu'li
nlo
vrriat'o'p&r!!
;il{
ll nrjinotrlo
6n.f0
nl0olloutn
rlltlFttl(lo,
rrlnerono
blla,tor|l.1o,
nrnr
il
nncluo
at{oolond{
rnlg i "ft,ift;ti;Jnoron
b)
ill

.l l :::i] , 1 r r ir i r lr . l. l r. I,g i u ,r.r i ,\l i trs { j q i o h i rr ,r.i rrtt.cgrrl

0or!. A ccsto rl (,l ti -i ,
i rl rrl Ir , (l"i, r r r ' ( ' r f ) r l rig ,.rL r' r' :rl i z rrll,()
rc b u i o s i l , fi c rti sti nse i c i ni ocl oni ,i l ,eun.i _
tttttt.It\'lu4 ltutlltlt I ( iLr'\)r'irni]I lOCalizateln o jUrnir,t*te
at cor?UlUi, SaU h
i u r s{ ' llr iI ( r } t t o; po rl l .

impi,r!fte fi in: 3) mioctoniisporadiee,aticit,

.lll::;f,l"ll]:.."-:11f9! fi nesisrematizat5
I b) mioctonii,,pseuttoriknice,,
I, ],,1.
.,ll':.ili_,ll'-r.Tlljj^u*,,
,
n. p|urttrrttu,rnlFtTirll.rnpi muli iaU
pulirr
mai
fixe.
l)i\,pxLnct tle ,ed,erecldnic, ruiocloniile pot f-i ciasificate tn
umi,toarel

,11-{i,
r"or.r
;.popovicru
;i colatr.,Jgz2,
ii r.otub...
.(ll:
_.i.il].1!o,:,.Gr.h,lt,
,:lo'lltcP
,,, ;l^
(ttt.ufne
t
potologiae.

l! .hipnict) bJ
carpoI fi, la rlnrlul
:...,r.,),
,l
t.t.'!,.
i -. ttttn?rotlt'
org.unt?e.ncppilepltcc,
care pol, fi dc divcrsi etiopatogenii:
*_
rl|r.r,rr,rirsrj(encr.Illitc), to)iice, degenerative,metabolice
etc. 1
m-ioc1orrr olganicc epileptice.
L) ,l[ iocloniile orllani@lnepileptricepotfi intilnite in nlmeroase afecliuni
:
di,,t enaeJtlikr epiLlem;ct,(fort,o tt,iortonicdsau, atgo, !. .I!?r,y,ij,e. ultp tt,ptyo
,,,,,'.,,,..,.,,,u,,ru
V[t? eunlrope Srnr l,irpidc. rifmice, Unebri
) lt lttL
'r, irL||.rtormpte (nu-d{'plaserisegrnentare).
Apur rle obicei in coDl.cstul
tchra. radicrrtatgii.pare-liziiouula!.c.bip(,rsomnie(srrr
..' :l.l:,.iir: ll-rl: i!,
menirgeale. sliiiIi-c.ontu:zive.
chiar cu evolugie slre
1.,,.1::l],"',
,,rrrrr'.
. ],i::lor,n.!9
rt.rrLn{ttf t cri alte mc.nilesliririertra piramidal,.
lparkinsonieno
...l|r *lri)snrdo IoliitrLo) ,si cernbeJoasc,
(.lorcaaelectriad,a tu,i Dubiu i cste o formii, pari,ic'iari,
de nevraxitii,
' ri'rl,trrnici.crr rrrlocloniiampJc.brusle si rlpitl"e.

(1lltol)ol,lttrlttiicl,tlivt,tHluslttrclc,tltrltii ittl,ottsilrrlrrrt,
ltctrsltttrt
t1it.tilitttlrrtt':t
((lir,s{;rrrrl,,
I}Irtttgltiott,ll)71JII'rtpovirritt6i ooltlr.,
llllilJ, llll;ll; (lrtrl,a,trl,,,si
nitt
ll)?(i; illt$sir).rti,,sicolrb., J {Xit}): lt) MiockrtriittrLtlivosit,tlgtrltot'rrl.izrtlt',
clrxrt,,[lilafirt'rrk',rlo obicoi silttol,rioo,ltlttxrli itrsii, itsittttrl'rico5i itt lrltsrtttlii
(rrli,errrindd.olao crizri la alttr,,tle o p:irto srtu rtltl lttrrnioot'1xrt'lli1).
Artslcrr,
it rl;clcsoilzii,cu plcczfiderorllusculat ra axo-tizornolicil lii lnu;clrii llrrrioli'
yrlrxlrrcindo bruscii flexie a capuhli qi o proicc{ic irulint,ttit,lr,(,llbt',,l,rtit't1r'
liorr:c, mult mai rar fiind intercsate $i membl'ele itdcrioilrtl (r.rttciitlctr').
lr) llioolonii parcelare, localizate la rnici srrgnrcntooor?orfrlorsitll clt irtr t tttt tr ri
lrr, r.numitc fascicule musculare (fil,ri tleplasi,ri segneDtir,ro).
:lrrrlrr'k'
Aceste rnioclonii insolesc o pierdere de cunoiitinl,il,(ltbsoltl,ii,),
iilri)rnene (rniocloniilc qi a'bsenla) filntl cxtrem de scultc ca rltltrt,lit (ilrr lrr'
ril,cv:l zecirni dc seculdi, pini, la citeva secunde) $i pot sil, sur'\rirrir,firr Blxrll
lrrtt, fie dnp5, unele stimuliri senzcriale insolite (,rrcacljtr s(tllzo"ololtirii"
rr,hri llusirens). Un alt element semiologicimpoll,ant, csto trplcz(rrlLrrl,(l(l
rIcscii,rcarea electroencefa;1ogra{icd,generalizati,, bilil,t{rrN,lir, Hi,)cr()111,
fi
pE f tf

MA L

l \4IA C LON tC

sub,:Utp1r,eSS7qi;n tpucoenaclat.ite.

, i / tl::
t:\tt"^.
nt ps1r,,,,:,*J1!i.tc,te-25!ygzonte
t t t nr , , / .1 L l _ J s /rl e L tp v a n Bo g a e r.t,rni or,l oni i l esi nl mrai tcri __
,r,{.. I j, r r ^nr i. . unoo l rrto i rL u ri b rl i s ti e l
)i m- l l rrrai orl i nre (r" bi r,r hemi g,,n,._

insoiir.r,
rruoori;i de urrciipcriinozii lipisnrt.
I I'll]j .,,',,
,-' r :r ugil!l,,ili.rnl",,
n .t utur .r ale nrembi
elo-r..
spa s me, le ru rs iu u , .b, c ru if rlio n r,
]rl' |r.n
. 1 1.r, r r ( t r r l l|c ) . A p rt L r (.Op i i

..1 '{.r' r r , . i'pl' , gr CS rv i l

s l d ri i

\i l u t{ l o l e \C e ntj , l Ll r_uu | Otrre:l r.l i ni n C rr

.g e U e rl l e . :rrl e s ca oA fcbrj . (,u ,l {.nteol i ch,

c5 -r5

pI,'plir.e.l1y,r1x_1;.
esrcs,ibacurr.rnorl:rti.rlupit.
l,'.,.,:i.:.ll',.',
i,-,,I l,:i::
. I }ljricrrueckpr(1974r
I iirir,.'!rrLr |o{:1,.
ltlrll).
si_['opotir.;Lr ,.,,1Jb.(tgi6]

-,i
i,rri,rrriili.
ttin pESS prr.zrnrao .:,,.initn,.rr,in,,,r"
ttit,,r,.nr,iat^
,,
1t1i1,t-!51,:l
r. I.r {r,. ir11r'.rrr1r,(lonll
ree.pileptice;i epilepl,ice: a) tarea reactivitate ia
r||r,Ur.:i\|lztI.\o-lc-0zoftalr
; b) durilta ln:l'ilung,r)aJ,."el SecirSelC
ntiOclo_
r" r' r r |lt U'rrj,t.
u cont.ra,.l,i(.
lonicJ rez;durLili tl" hjperkin,,ziivrr|jrr_
'tc
lri|, (rczi riilii sus -, inrlecscbi cnreice)1c) lcpetiqil
peiotlic:i a rnioclo_
rrilrl t,u itrt;crr:llt'rLesi,ulcle regul.,lte(intre 1_'1b ,""ioAa;
d) plezenla
1,,,rrt,h'\(,Lor'lttr(+
ale hri R:lrleimecker,c:l'e de cel.emai *.iii" Jrii"so,t"sc
'I ,r'|',trii]r'..
.'.,ir,l .c3 ;i nriocl6niilc o rernrrc:Liti pelioclicir.,r,..

.,. , . \ t , t ! t t t ! t tpt
. L, t l tt)t ,( re p r' o z l o i a ,n l ' o rmJ .ol i go,j i rnpl oni uti ci
de errccfa_
r,l) t l. t ll' l. a s : | t ({ ,, :l rJ . n ttL U i t. i n c tr re ml ,cl oni i l e di rfragl n* i i c{,
' '.I|r.r i. , l: - L; r t lr , , , 1. . s rrg l l ;t c l t d rrr2 l g 4 a z i l . S N u caD i .:tni l i .
L I'ottl)Diu([ottusul tt,ulti,plen (al
aparo la adu11;i si
.lui tlri,etlreiclr,
'(1,12
, crrlrrrl,clizr,lrz,i pril nioclonii sinctxice,
frccvente
pe s), lotali_
r.,l ' l. t r l . , . lt . i Uir p ' -2 , d c l tu i rl , h j 4 o !5
;i c v ldri ceps. S e rcc,,Jl tl i ci l zr l i r
'r ,)l | 1 lLtr llr |: ll( 1., L l .rj j Su l u ]rri , S i rrt d e ,r bi C t.i l Or i nt,r.fi obS ,. (ni ,\ i .rr_
'rr c), I ' l, l( ' r ) r , ir r , ir ii t.i rtril i L p s i l u rp a ti .
W)
clilt1tt,itu ltoi Ii in{,ilrrilc itt ntnna,r.tasl
,.
,)li,trlrtniiIc
Jot tttt: tl,r:L:lrr.,.
, | |,r

1 l I ll l(t'

(l tl

l )l )l l t

)tJt)t :

l.,'llut
tt1,:1 "
( . t . ' 1t . irpt
t iir . r ' r r , il ,f f u r t , i t t r , r , ritrnt ') r * t rr r, , i r, r r :r,,i
r
'
,rti r x : lr t t t it t t r
1, r' ilr; i[(llll l]lIrr'1 rlr,
t r . r lir |r r r , lit r ir . lr r it r S, r t , t t r i| rr I rI I I . rr Ii rrr r r l t l l , i 1 r r r r i 0 1 I t o t t r r : .

!'f0. ,8, ARp(,(ltMl(i dc Pfltt Mlrl rlrioclonlcl copllul ll"NI" 4 nnl. sr

ob$(frvll dcsoilr(r'lrirlo Jxtllvlrlurlulldo bilittorlrlo,6ltlctollcfSi ,llllt0ltirlrl
(drtlI l'.r/nxrl.lr $l coLrb,' 1070).
trrrgfll,ivo tlo l0 o/rrrrtl., izolllto nlltt ttt'ltttt'l,tttltr
ritrrrd,ti0ii,, rlo utxlrr t'rxrt'tr[:r,trl,rr
rrttir,rkluil, utI(lo lcn1,(\ ttlrgtlivrr, clr,t'rr ltt rt I t ltt t,I t t I t I t t I l{)t' tu!lir(\il,zii dotttl tttt

lrirr:hroutn,c'l;trrirl,lco:
Jtollvltfrrrllo4l polivllt-tttrtlrrlo(/ig' l4'l/. lll'rruvltr['rt
tlrr lrr,ltrrlll'll lrr,ltrrlivirl1i rlrr Ll ctlzil
ttntlrrrrll,rrvrr,r'irtJtllrl,
rrlrrsl,ot'ltolivit'I

| 9:l

l(lN

trt cttz r i ( r lr . , i3
rl t, It,,/n r,i ,.,rl rr { i (,,/rj (,( 1.,
srl l rl rr l 0 r.i scc.) (l \rl rovi r,i u
' ir .li,.,
rrr l o l, r lr . , l1)^r
?li)
l l t r r . lr . t r i. ui s r .ru i rrl o g rli tr)j )o rta n t c B te l cptezenl rat 11o(l escei rci r,t,ct
de
,
l )ri rrr r r : r h. ||I I r i\ r . I iIII| ' ;rl rrp l u !o .U l IG, p o te l l i l l l e oare tra(i l .tc si tcus.i e mi ' _
I l,,l',,', rrlr'u(it litr.:rlc lrrrlri I'ecrutan1,1i,I'eslectiy,
fiecale ,,vlrf', t1c pt,
l,ll,l{,1iir
pr,intr.o d.,soaircarentuscnlrii lrioclonic5'iTassilu,i';i
,rlrr)if('stti
t rl rrrr . , I ll( i1|) .
'.. ('ti,:, l" cpileTt.ire tiotlonice qenerrlizate biktter(Il.entttsire (1|mgoclonic
, '
/./i,\
lrl.l,'frnilirrlogilr, rrrrlu'ilor anglo-saxoni) pot sil apa,*.i itt tty.,t[rtc*rele
/,
r ttltlrr!i clin iut tltile.plicr::
) in l,ncl,. t'r'lri rlp ,!.ilepsie.ltetit zral (rclatate antcrio].) in o:,.r,e
,;r
:r', rri'
s r n l 9 ,,,r* r' rrJ i z :rtol l,tp t C a l e j U S ti fi C l i r.l etrrni i l c:.r,
tl e,,mi o_
' , , s( .jtt {' c' t)u) .
r'l rrtri i t' llr
ir) irr :rrullc tlin cazurilc lc tpil.c:psii t:atrLtlsi,tL
11rrLnd,-ntu[.
1tr-iuvtt,
!,l t,'t,r! ; |t . |, 1, , t , i. t . , .,.| o t,.iJ,,
It, r1,.[1;1
1;yfi i z, i , i r,;ri ul ,l
rOt s i .j rl )..| r. i rr s p r,,.' 1,1
r:r/1r t ( , r r , ( . , r r u, r r ' l ,rti tru s i .e , d e .o b i c e i i n fl e,ri r:, A stfel , ti upi
[i l rsdaut,si
l rrl rl r. ( llt 7' 1) o t t ' ei rrrcrl i rr b o h ra ri i r.r1c ti z r. tL,j l i uLrcl uni ce pl tzi nti l
si nri i i _
' l .tri r t r r ' r s ir r . I ' il; , t o r.,l , i tr ,.rrrt,.rl u l , r,i z r.l ' r. r.,!rl \' l \i \r. f,,,,,." ' .],ri ,i ," .
( 1 9 :,7 r.(,i l a ti ,l . C r.ti r.u tS i c ol ul r.. l !]71 j ,tr ,nsi .l :,t r, ,,1]t.l
'1 .,,r/, , i r ll|i. t iil
IIIi | \' | , ) I I I I I . || hll: r l, t . t1 ,. trs t\ts
: rt trl i l i z :rt l o n| l Ii l l d{. ..i trl l ,| tl ,i \.., p;l i t
-c i
r||,rl') l)., 1nl trriocloniili] care apftr
fi. c] uni. fc1lotllrn rpilcptiic (109, din
. rz.rr'il, f io p'ecotiri
din c:rzuri), fie
(3?f/o), I-ie siit (i;lco_
.(50.0/o
rrl {,l t1 o olt 0r iz ele to n i c o -c l o n rc e .
'rmeazi,
,.) Ii.,i;.iii, qi clzuri de cpilepsii manifesl,:lte prin cri:e et:clusi.u
ntio,'/,,rrr,1. ;1;.,,;1,,1"..irr
sleciLl in adolescen_ti
untori si in mica copilir.ie),
_(dar.
l r , ri rrrir,(l,rnii1cm.rsire se produc rle obicei 1a treziic
.si tiot t,i licilit-lte
',
l r. ,l ',lr li. i' lr . t 1' .oc
. r l rj l u i .. Ii c tl n d e p r i v rl o r d . o:rml . t, r rrni i Lr,,1nrvi , mi o.
,lorriiT,. (".jr.r'lis") p,rt fi pr ur.oc:l,tc de stirnularerr, lurninoa,sl intirrmitcnt.),
i l i rr'1 f,
, r r r l, s i c qlf . il,
G,rs ta u t ;i c o ta b ., 1 9?4; A rseni ;i col rrb., 1O?8),
: -1 9 i 2 ;
r'rr Ir rIl,,,i lrtt, lent:r,l
,lC rlzele S-o1arc,de lumina de tCleYizOr, rle
,,Urmriril
r1 ,",\ izI rl.'L(J.'rerr iirg epilelsy,') s1u do stimuli irten,tionaii
lpiiml.r:rrea
r.rprrl i..:r rrriiriii in firf:r, u,.hilur, stimula,rea luminoesti sl,r6boscopiii,i.
Foi,oir, rrrilriliilt,ieir ir,ccsl,Ordesc:i'ciri este bine cuiLoscttri (Gastaui si'colab.,
t:);t.; \ r r . ' . r , i. r . j c uh J r.. 1 0 ;b ; N a q u e t s i W e k l rui n, 19?2). A ceste mi ocl o_
, r.rt
,t'rt,rl.r':rle'i sirlctr.jce, uneorl lilritate cloar ]a rtru.cchii periol,bitui
" prrlpr.lr,;rli,
da. rte'bicei sint difrue, debutintl pe rnrrschii axr,r_r:izome]ici
,rr
r1rrrlrrri crl,inzinrlu se qi pe tnu;chii periterici. lliocloniile masirre pot lveil
l11!,\'('rl4r r'-iililbiio (rle obicci 1-n/s1 si aprr rn ,,elisu.tde mioclonice)'
l rr rl ri r' , r llr( lo 2- I 0
s , d a r u n ,rJ ri s i rn ,,s frti is mi orl bni c,.cu C nl rr,ti t1e
trrirrr1r. .. Ul |hi:rt rl'- o|e, putinit cuirnina.intr-o crizii
Ee]reriiliz?1ti tonic<t_
,1 ,'r,r'.r . lr r r r iz r ' ' , nti u .l On i ,' ^ , U ,l l l :rl i r/r,i I.rLgr. pol .,i i 1l ,ri .r.i
r:,," ,,.i ;i
:r1,, rlrilii.ilc vigilcnfi, insolrite fi rle tulbncr-r,ri r-lgetrtir.v. l)iJgnosticul
i. i 11r'r'{,r'iz. epil.ptice cit mioclDnii masive este con{irmat
,*i p.iri it*,eslirlrrliilr, lrltl(i, cu,ro c\-i{1efri;iazl pclir.irf u;:i-Inde (s:r,u ungo'i r,!rf-ur[le si
trrlrrrli, llcsoilr'liri (1o undo lentr, eelelalizetc, itil,,tr-rrall., si.rrtrrrn. ;i
l ri trrl l til. c .
l l li, t l, Uit r : t c r . s lo t'i rt,j z ,"rI )i i )(II ()I I j (j(| rl i ,i rn l tl i zrt.tl j i tasi \' (r eS 1r,r.l tr.i trl ri l i ,
l rrrl i rrrl s ii, r r llni ir r tn c q fu l .i tr, t,n r' q l l t.l o tc
t,t,., l i rndogutr: si 4n utcr]i l ttl tttli i
ttti rxl tu i. t t r ' t t . t r lt t ! i. .r' .rry ' r,ri(rrri .r.l rrrrx ' D i 1l ri si rr, l l rrgrr' si vi Irrrrri l i rrl i il l ,rr
l r,rrl rr lr r i llr r v r ili< ' l rl I rI I I II I I )r)t 1 l ; rl i s i tri ,rg i rr c . I.Irr,I,IrIIl i trri .r,I' rri .i i :r l tti
l i r trrr.r r l llur r l) .
t!),1

titl

tl

lt

Lr

tl t l ' l ' i l t lr t t t lt ilr l, , t t ir r r lt t 'r \ lr t . t ir r r . lr t nr ilir r l, r ( lxt t lr lr r i lt r ll, n

:rrtt
It ,ul tr l rti l tnt, r r i, lt l l, t t ur llxt r r t )ilr . l, l|ll( '11, ( , I r r r jt sl{, ; lr , ir rr . I r |I r r . ( r 'r 'rllr
r I r r r ili. r l,
l rl r' ! trr .ri l rlit r llir r r ir r clr r sir , ii: r . I ilr 'lr sir '. r r r ir r ljor r ir ,r i r lr . r r r ur lii, cr r r r ir lir r r r l
l rttti tt:rl . l l n: r lr lr lr r r lc ir r lr r r ll)
lll lt r r i ( cliillir r l r lr , vir slii ( r r r I ir r r , r r r I o: r I r .
,l trrr,rr,,"i ,.ri
i ) 1i lr ll o r lr r llt l. irr,lir !
I {l ll. li( iu o r r r cr lir . r lr . ; t r sr . t r r r i( Vr r . t rllr . . i
, (,I ri r' I I I Il r, | | , l1) 7.)1. I lilr t , litr , t 'O l olr zi ir r r r I lt ir r L llo I it zr ' : p|ir r r r I lt zr i ( 'f llr| ( 'r . ] t
,r r.D rr,.rl si i l llt r , llili. pl, icf gor r r 'r 'r t lizr t , irlt. r. lit zr t r r .t lr r r t r tsr
, r lI l: t r r gii, 1i r r r ior 'l, r
rtt| , r' r1l t,si llj ipilllr ioo, lLsir r t cllisc,llsir t gt lt Lq, t 'r upir lc; i vllr . iill) il( j( ir r iir r r p
r ttrl ,trsi i rti r , ) . r \ ccst c r nioclit nii po1,I i1l, t I 'f ilr , lcsir , r rgut r r r , illiz: r lr . Slr liilr . t lr ,
, Ir' r' Ii l rtIrrtr ior , kr r r iill' sint lr pr \ r zont r l, lc r [ c r nr r 5olLiinnr t 'r ilor '1i lr i r r l, nr lr r t
l L,r'Ii Ii Ii ' Ii ()II I{, . l) colr icr ei, r losit ilr 'cii, r 'ilcr lioclot r it t nt t soir r solcst r lr '; t ir , t r l, 't , r r
,ttttorl i rr{r' i si sir r l ilm plilicr r l( r alc nlis( f ir f il( r int en{ior Llr lc. l) ir r inllr
rrl
rl t:p u i r i r{ )r r ) t ) . - htc1r s1l uvglu1, , ioil. r oliisg lr , sist ii,t olr lsl, r lp lt r o r lcr r r r , r r {r
r' r'l )r1\qr' (,siYriti,r . f iiz1Ir kt llr il, f il, Sin
1, cnuill: ll po1.t pii|c: l li s0t t |llirr . r l|r r pit : r
'
rrrtrl rrl l ri rr r Lcor i si t ulbuvir i cer r ebelolr , sc,
r'1 ))i:titrcrytirLtn' telotsri mi.oclonicii (o, LuI lltnr,su.y ,l/rrril) rr. lrrrrr1,,
r, rrt,,rrsl ;c p r ir L cr r ) bext ul ser niologio cit lg l, s0ci: r zir ir
, npr ) t li ll( f l|t ii) r 'lo|lil
i , u i rr(xJl l ,r [ : r n) it t l t , nliot r r Llr r , )cr
, ize o] ) ilt 'piiicLf cor r r . ulsir . ir gcr r . lir lizr lr ,
1 ,i,rfirr lri{)cLoiricc inlsive) ;i ln sinr.lrom atolcbolos crr cr.olrrlio ploglr.rrir;r
l l l i ri r,r' trr!i 1({, 1, t t ) i. 1) . I n r niliot it al, cit c, t zlt r ilor , S. L, . I . ir ir lr r cr , i rrr1rrrr I rr rrI , ,
rI r' .r,rri'r' rrt i rrior:lonice fi descriroirli llil(l
t1o poliv'ilfut i- rll(l{r rlrr il 1"'r'ir
r l r rl r' rri si : r r r t c do 1i li sccnndc ( I i nr lcr . m eclicr ,19?4
,
I lll, sir r r r li ; i lolr r l, ,
l l rr' l ).
ti fn t n t+:.fakryt
(funlr lrtt
cttiu, 'nioclotticii cu, lti.1t
xr,riL'rn.
ic (It.1l.L.ll.)
ll, 'i7 irrlilniirr (le lr,selnener]rnioclonii, ii{losoa rnlt,si\.1-,
("irtl,ssivo rrrr',,,l,r
rrr ji rlis'r). r\ilt,lcl, 11rorzul.ile in caro sp:.ts]Iloleint0r,esolr,zli
l rrr.
]'llLl,oil
{"titr
l rrIr t:i r,!r' i rt t i, so r cllizer zil it spcct ul do lnioclolr ii m r ) sir . . t l,0r r lkr r ir r or r pr r lr t t
1,, 1r pl , i rr. L{'lexit nr er r li'clor snpr r ioit lc; i cu lilc- xinnr cr r iblclol ir r li, r 'i, r : r lr . ,
. , r sr r nlr ht : it it udinoa
r,. 1 r1111' 11 1, rl
ir 5,
r lr
, , 1[ t , u1uiin Lr Not ] ',( xl] ] l] ilr l, ilir
,, ttrIi i rIrrtl rl unr Li bliei: r r , g')( t iasl, r , ut ; i col: lb. , 19ii- l) . lhoi, spil, sr ui. loir l,
r'rr'r,,ii {lr)il,r'rnuscuLltur':l Lr'utchiului ;i a llidircirtii rrrornl)i'clor',fl(' r',,rll
j :rzi 1rprrsnt ill ilr i] - l izom oji{t , c&r 'eil, 1, , sr .s!
. r r I i1t l'f lr 1i: r zr i', r tgr t 'r t r lir lr r r r r . r lr . l, '
, ri zl trLi r;i rlolLicr
r
( r 'r nI 'oclonic jer ks") . ( lol nlli I ir r cr , cr r l1i r r r r i r . r Lr r l
r iusiye
1,rr.l i (, Li } d e spasr n ( pilt cgt t olr ior Licpcn1, r 1rl) oir lil lr r i \ \ r csl ) ( \ si{l f , l) ir , r r ll
I' .' ,i ,' (T1)() /din
o ciizlr i t lupr i , Jcovons si i] or vcr ', ll) ?4, r i t ilr ) / , r lr r pii I 'op r r i
, rrr ,i i url rl ; . r 1li7( j) , iit r r e const ii ir r l. r 'llll sl) ilsr r ) rI riI )(|Ir)rI i (I ( J'lr \ o( lor r ( '
t, rl . / l )r' l i su, soult , f ulgcr ii|n, ', got or i[ lizl[ 1, ,r u I I o: . i r , giir r lr r i, r r . llt r t r r 'lr il
l rtr .i r rttrtrt lr t 't r lolit t let 'io: t t or in yr t r nt , ct r lllit . lt kr sir r 1,lt lt t t r r , lr ir rir r r r l, r r r r r r
rrr l rl l ' , rj i r t t lt [ g r lt r tir . ir ,si t l6t t t t t nit 'r . lrr ,lr r sll r sr r t , , S: t lr r . t t r t "slu , )I I I r||{rr], r',I
trt1,l " , i ttl nrcil lr , nslr nblul pozil, iolr li, ls{r ilr r r illliicu salut r r lor icr r lr r l , , f {r r lr r r r r r ".
\l rrtti i i r r , r , ccsir ot lt t lt r ilosl, lil'i lil sLr gr lr( ir r lr t 'iiir ul ir , r rr lr r r it r lii) , t r . ir r t
i l ul r l )si l i onr olior ic ; r i ir slt cclul I ilt ) ( i cl, r 'iit l, elisi, io ( , , lr ipsir lilnr ir r " r i; r r r
,,rl i rl i l tri r l u r r f i t nl, jot 'i" - ( iilr lls si coiu1. r . ,ll) 54; ( iaslr r r r r l,1i lt r , t r r ot r r l,
l 1l ,)i j ) 1l i l )i rlil, zi,ill r n{) r l ( lili' r liagt t l) sl, i( 1r t l.
l l . tl l i ot iluiilt f opr r r zinlr i,o yr r , t iolr r r l,rolo r ni0olor t ii, ( , lr t llur I r 1r ; r , rr'lr lr l
l rrrl rl t;rrtrri rrlogit r , il sor r sr r ci
l sir r l r 'jllr r ir r r r1,r,rrrrI rrIrr,r'r' , r , it r r t t r t r r ',r lt t t , r , lr r 1, .
,r r I ' ;1rI 11I I i |,11rI i 11,r r , q. r lii, s1,
,
r , r 'r r ol, i; )lr1.
l\ r iv( f lr l: r r r lr , s1, r r r t, r sl
, l r lili. r 'iiii r l, r lr r
'
l | 1r r' :i r, | | l l ,ll I . i lr 'r jl0 r i ll0l) ost r ilr r {ii, / r r r ir rr,l r r ', ir r g, . r r r . r 't r ,r'l,i i t rt i t r , , ', rrr
rl rr I i I r r,, r 'lr r . i lr r r lt lr t , , ; t . t sir r lit t t l r r r , l t r Lr , i: r 'lr ': lr , r li ir r lLt t : t t t l $r ) r' llllll
(l rr| a r,r,i rl.ti |r r l r lr . , llllif l ; Sr r lt l'r 't ir ',l1) {ii ; l'r r 1rr Viir it t 1i r r olr t , lr .11,
, iil) . Ar '( , r l'\
rrri ,rr' lri rl i l i Irr r ilr '( t r r ir r liI r r t ir ) it r l, r r t 'r r t lr zr t lr r olr ir r r r iiil t l) r llr t t r . t t lr r t r . t r , l r l, ir
l115

r'(,rlrlrH(.
rrrrrrychii
rJlului p:rl:rlului(,.nisti)Srr
5i p'efi'r'crr(i:rk,:
rur,.' ,l \iillr_
Irri).,liI;rlingt'lui, h.ring(.lui,aiplan;cului 6ucal, ai timUii 1cumisliri irllctr
rrrrl,r'rlrt pr.ricclic - retractie), ai gl.oiriloroculari (cu
,,nistagmus',ocular
l)r.rrtltrLr, girstor sau retractor)r_ ridicdtorii pleoapelor, rliafragrnul (cu
srrglri0,rrru..r.hii
inrercosbali,
muicbii gitului si;usctiii diilati ri rncmbrclor
j.l|l]r.r'irnrrc
(cu-miiciri ale degelelorqi cu
_migelrialtemante rio lrronalierrrpirrir,{ie). Cele rnai frecvente
miocloniilo (mioritmiile) or'ofa,rin!1o-sint_
lrlingi()nc, precun fi cele oculo-relo-faringo-laringo-cliafragmatice,
care
Firl l)ilaterale,.cu un I'tm de 12,0-180/minut pi care "sint revel"atoarepeltru
a.[u,;!,i,wni
ale_triunghiului oliao-dentorubria(&uillaln si Mollaret, 19Bb; Bon_
(luollo, 1968i Gastau-t,1968;
popoviciu qi
4lajouanine qi colab., 19b6;
colt,b., 1973) prin leziuni yasculare, ercefatitice, tumorale siu tiaumatici.
Ill.
..
.Miokinlile. s.au Jascicu,l.aliile musculare sint contraclii musculare
l,rii(i(:lilirre. dc,mici arnplitudine. eare nu produc deplasiri SegmeotaJe,
rrrur.se-obserni, Bub-pieLe,
_sub forma ulor contraclii-clonice, ieritmicej
lrrlritte, fulgerltoars ale fibrelor musculare izolato li caro so succed la inter.i
vrllo
qi neregulate. Aceste fasciculatii' apar uneori pe teritorii
^lirccvente
rrruffi11s1,
alteori pe grupo musculare intinse, chiai gc nelrallzaie. Sint net
rrurrrntuatede frig, de_ohoseal5,,_cle
percutia muqchiior,-de excita{ia electriei
ryi do arlministrarea de ad.renalin5. Nu sint irifluenlite nici do' somn, niei
rlo srupolaminl.
Vulo-araa semiologicd,a miokimii,Im (fasciculaliilor muscalare) este
.
rluoscllitS,,reprozentintl un sernn precoce, revolator- pentru o sensibilitate
rluorma S,a fibrei musculare la mediatorul chimic (aclienalini,), consecutivi,
rrrxri rlc_rervii,ri (feromenul lui plnngnl prin.leziuni, subacut-cronieegteri oru.ionala (sclerozd, lateral* a,miotroficf ; poliomielite subacuts qi croiice;
r.nr.cllopoliomiclito lirotice subacute 9i cronico - Dr[Elnoscu si Otteanu.
M56 ; gi1ing66i6lie)..So igpune multd atenlie in sindioamelo de pseuclonr.lcrozl lateralS,amiotroficd (Barrd gi Roger, cila!i do Eiser, 1952) prin
Irrsirrni corticale (tumori parieto-fron-tale, a,rahnoidito etc.), ln care so poate
r1)illiza o. monoplegio sau o paraplegio corticald, phamidald,, inso!^iffi qi
.
rlo ltrofii musculare cu fasciculalir, dar. prez-enfa in coltextui semiologi"e
rr,r.r'iz,'lorjacktoniene odenteazi de obicei diagnosticul.
_ Astfcl cls faaciculaiii muscul.are se mai pot intitni qi itj c(ffeea jibtitorf
l, lu,i Moroan, care esljo o newaxiti, acuti Ei caro &soeiazi b 6ntoxtul
norrriologio; f2,g6io1l2,!ii,mioc_l.onii,tuiburiri neurovegetative rlo tipul aerorlirrioi, t,rrlburd,ritrofice qi sudoralo qi eveutual tulburari do somn,
. .fr'usc.iculalii_musculare. izoJate la nivelul mugchilcr felei pot fi observ rr,l;cin sptasmulfacial peri.feri.cpaslp6ral,iti.c.
INncep!,ional,d,a
ra,r.pot ti intilnito Jasciculafiilo musculare ln potira".
rliut.l.on.earitre
qi in unele p olin etri,te inJeclioase fi tasi.cs.
uneori-fasciculalrii izolate_la basedowieni, la i:rdivizii surmena_ti
, J,l..ri,std,
5i rrntxrri dupd, o obosealS,musculard,intensfl la indivizii normali {miokimiile
lrri {'rrrt'ho1).
{i,1.!. ll{igctrri involuntare alternatile, regulate, rilmiec ;i

stereotipo

ozintir,o-m;$careinvoluutar; rapidi, sf orcolipit, rIc irtcn. .'l'rr utor_ul.r'a1lr

silirlc viLlir rili, prc rlo Lininrlla nivclui c-xtremitirlilor.Sc impune ililcrcn_
I i(rr(rir,lrrrnll,toil,rcktt',formo semiologice fi, pa,l,ogenice
:
.1. lltrentlLrdlura ila posturiL. (a,ry1,-zisi1,
lcp&us"
-- lolmon vechi,
,,do
tlrv:0trrx.llrttrzriltrr')
0sl.ot.ltrtltlt,or.iHl
i(ir'1,lxtnt,t.u sirxlrotrrtrl rrxlrlrfrjt,tr,rnirllri

Irt1tlIIotrirrolrilxrJrirrr,l,ic
(;llrrliirrsorrilr,lr)
rlrrrlivcrsrrrrl,ioplrlogrrrii
(poslorrcr,
lrrlilic, rrirI'urrrIIrl',
posl,lntrrrrurlic,
strrrilrrl,c.).Alrir,r'oltr rrrI' rr( i rIr,r'r,Il, llror
rlo Irrrr1rIiLtrtIitrrr
rttorI(,trLl,i'h,
lrrrzi(ii(ittrtlttsivirrlrozi{ilttir:ttrltitus),cslc t il trritrirr
rll Itr'rl.r,rr(ii,
rrrir:ii,
(J l{) oscilr,{ii/sr,c.),
r'oi,r'ornt'lit:i
(irrrilil,
;i llrt,rlrlogr.sl,rrrrli,
rrrrrrrrrilc:rtr(,itttri
; dc lrutniirar,c
n ltarrilot.,
tlo,,flr,r,rrr,,ir,
lrilrr|.lor',rlrr llr,lrrrrr
:r lolrci crr rlogel,clc
ci.c.),dilritrrroluti,slnrclisplrcirrcrrlstrl
.rrriqr,l'i,r.ilrrt.
lrqlivr,,
l irrlrursiliciila cmof,ii qi tlisparc in somrr. l)c rnllli,o ori irrlrrrrrsclzi,rri
, rlrcrrrilir,t;o:r,
ccfalici (rniscIli ,,tlc afinna,r'cr)sau ,,rlo rrcgrr,{irr,)).
:!. 'l'ten.ulr\I,ulaintenlionalii,(d,ea<:!tn,nt) ap:rrc il sirxlrorrlrl rrr,rr,lx,krrr
irr lirrrpnl nisclit.ilor acl,irjer,
:r,oceritnirllu-sc'progrusiv
otlairi rrrrrlczlollrrr,r,l
rrrir.r'iilii(ovcrrtualtlori,rlrr,slh.qitulrniqcirii). Ilstu rnai arnlli'l dtcil, lrr,rltrr.rr
lrlr Jlrr')r
insonitr,n[,rrereg'ulatd,,
rlisparc complet in reparrsqi Irr rrrt,rr{irrorr.ir
rrrrr.i1rostuli. Se insr:festede alto sernnecorebclolse.
:i.. Tr.enlurdlura optoz,l]ion
alii este tot o trcmn.rii,turir ilc rr,o[irrrrc,rupi
lrrrl lu sfirqitul uriqcririlor activc, da.r'esbeconstiluitl r)in osciLl(ii lirrrr.lrr
rrIrl,lr, (iirniste,,biit{i,, dea,rip:i,ca?etind sii indeplidrczorrrflu[)nll lr,nprxrtiv
lrlrr obicci supcrior) dc lintii (de unde tennenul tlc ,,oyrozi
{iortali'i,"nrru rlt
,,irc1iu1roantagonistL"). Este ca,racteristiczipentm sintlroa,lrokrrlcrrt,o
rrrlr.t'itro
dc, diverse etiopatogenii qi pentru degenerescctll
elo hellll,o 0o|rr
lrlrrl' (lioala lui \lrilson qi pseutlosclroza lui Wcstphal-stliimpt,ll), rrsor,i
Irr I u sc a,f)roapel,otdeauna si do miqciri de tip coreic qi de spasrirc v iololr1,r,.
,1..il'r.emurd,ttuile
permanlnte 86 obscrri,;tit in rdpaus,-cil,6i ll (irtrprrt
rrrl rr{i rcrii r:nor postuii qi constau ln oscil{ii neregulatd ale ilegrt'ck.rr( ulrooli
ir.r (tle iltosr,:rl,i11irl,,
',r :rlr. lruzelot) de mici rmplituclinc. Pot fi : .fi:-iolcrg
lt4t), (moli1)e (simultnil boal* lui B:r,sedow),"lt i pcrii r,itliene, \rt tt,ilittrtrtt.
rlrrrric,ln intor'icaliile en mereur, cu nicotin[, cu coteinti. Nu so lrrsol,onc
(lf, $('funo extrapiramidale, eu exeeplia ccTor senile.
;,. Trcntoru,l isltric ,si al sirnulan!,ilor trebuie diferonliat do vtrirurl,okr
Irrt.r\trlnte do 1,remu$,tufti. Acost tremor nu are car.actelo rituri<,o qi rlu.rvr
lilx', eri dimpotriv{,: apare intemitsnt,
apare in prezenla epr:otu,trxllor',
lrrl o 1l1yq1la,
neregrrlat, heterotipie, Iiinit variabil tlela un morncnt; lrr, oll,ul\lrirlc_fio ln, repaus, fie in miqoare, are caracter net circurnstau I,ilr,l, l'iilrl
rlr.pcrrrlentde_sil,ualiile emotionale qi/sau levenrlicativo (Soflo1,(rt,,
J1r0?)
qi de ticrrr;i,tlc spasmt:;i rkr curilorsiulri'llizrr.rr.'.
.r .lr.rrrtltc ori sc.insofesto
p;rlrrrloxulc,clownieno(Riser, 1952).
{i.l.i}. Iliperkinezii bru;te, iliseonl,irmc,rapide, dc ounrolrr rdorrir, tlozor
.
rkrrrrlrr (ncrilmicel
1. . Ii;cd,rila coreice sint rniqciiri involunta,re gencmlizrd,r: (dc ohicr,i).
,,rr prrrrrlominanld,la,fa,t5 ryila rnrrnrblcle supcrioarc, bruql,tr,dworrlr.rlllo,
rIrfir,(,, il,$irne1;r'tioo
do lir, llrr gl'ltp
$i asincr,ono,schirubintlu-se noirrccl;:r,1,
rrrrrslullll ll altul. Sinl; va,r'iabilcdc la un monrcnt lir,altul, so inl,rrrsilicir,
lrrr.rrro( ii, lir,eforl,uri 6i ln cfcclirilrtu,rrnor acNiuni rnrr$cul:llcicllmcl,or,ncrrri
rrl(,nfional) 1rlra,zi1,ind
rniqcir,r.ilo
vohrntalr', ca,rtrdcvin asl,lrrlilra,tlrxrvll,r,.
iir. rrluLrrcl,z
ii, pinr'i,lrr rlispari{,ioirr loptus doplin lr pl,i, ill lrr routn rlilprr,t'.
I rrr.olisirr! linritrr,l,o
Ia,rrn ltt:rnirrorlt(lrcrnitnroi),irlr,do }iklir, ltr r.rirrrliorr,
rrrr'lr.llrllr.rttir.rr
qi .jttxttrllt.l:trrtitr'.
Nfitt,ririfrrr,orlioo ,vr, inlthuso )n:
q) (lol'rrrrtrt.tu,lii( tl'utl.t,thtr,ttt),
tr:[ttrrtpltr lit rtrlrii,rlrr ollirrci in1,rofi lfl
rrtri,l'iitrrlrlrril oli nrrr,llrocvrrtrlll,
ltr,1irl,ilo.lCrcr,pl,iorrrrl
ro lnlllturnl,o11vl r,lr|'t
rrrlrrllil. \lrrrrri ilr rrrrrlrul,rrlrlrrri lloli rlrrrrrtl,ixrr
lr,lo.

'|t0
I0?

':"..":
,,...,,'i1...".'.':
I I | | | | I | |IIItiI

rirll l)trlt ir ll. \ ' t nt . ut . t l11, l11, lr J . . . . r r t . . c c t t t r r l t t f : i

rtLrOiji,lrt.r.r.r.trrrlir.t,-

r(x1r*(,s(r*(lrrso i* .,rrlcxt,I scmiological rospectir-ei onc,t.riiin

,i
rrllor' (l(r irLloctic gencr:ll[.
"i
""m]
c) (lort:eo,itronicii a lu,i Eu,.ntington aplre la vir.sti adultti, fiild
eredi_
lrrli si l'arniliilliJ.cu transmisie.dom;n:lnb,i.Atingc ir
mocl'egal ambele
,,,.i'_.:",11!]i,.
lr'nr-pli|gresild. biperkinrziiio sirt rnri emptc, mri
;1,)i.:
,rzirrr'. rr:tt.r,cvl rnitr tcnto decil in cureea
S.rderrbam,tnr.r..uliiind ntrri
.,rrrrrrricrAt";i mai ,,dansant',. Eruluetzr-r, cii tlnrnrr,iii f"o.t_pi,,,gr_esii;ii.
;i
rp,rre 1lr,indivizi in r'ir.st[, pe tondul suferiniei va.sculare
::!rild
:.
, ,
' ...,,1),..,'r.,-,,r::
r r r' : rlr c l e fo t ( o , a . oolr nd Ll_s e( , U f t , om o r uoojl , | .

.em

n Di l l r n i r i l l O _ r . l t r a _

o l r l l tr 'l '
l tti I't1 1 :t) l r 'l r l l zi l r l i r
( ti r ttl r u n ttl
: '. l l r n t i l nl i sttttl
''r tl ttr l tti
l r r r r ', 'r , l | | r | l . r 'r i , Ir Ii r l :t, t l i sru t t t l i r t t l ri , IIItt II|' tIII||1 | I t t rt 1t I i I t t t I i t t r' , l l l ( l tr i i l l l
, , r , r r r r r r c r r r Ir r r 'Ir 'r Ir ,o ;l ti l r .si tti
r l i r r l o cr tl r ' l r ti tt tl r '1 tl i tsl tti l r l tt,i l r '1 i r r l l l t'l
l tr o l tr t'
t r l r '. r r t ( r t r l l l ttr ,:r zr i si i ,r 1 t,'tttl ttl tttr r l ttttl t,i t l t I I t I t t t ' I r i t I I t I i . St'l to l tl t
, r r t r r r r r . r i ti ( ( ) t!,i r '( ' tl ttr l l l ( '.
l ) i l u l i : t n t ul ,
r i Il r 'Ii tttI,' r 'tcti o l r tr r r i l i r L l i i ( tr r r i i ) r t' t r tt'r ttr l l t i zr ':r z:t l r tttt
r , , , , r r r i I rr, t r ri I rri I i i ' ( ( 'i r l ) l ttl \ i tt j tt ttttxl si ttto tt i r r tl l l ttr tl tr r l r l l l r i t ( 'i l tt tr r i l r r t'
1 , , ' r 1 , . , l r l r , i r tr t r l i l i r i r tl l o cvo l tt{i o l ci ti p to l l ttr si vi ,.
{i . t . i i .

| | iIr 'r 'l i i r r czi i

l r .r tl r ', Ii ti t

t'r r l i l t'l ct

cl o tti t'

l)iril,rllidille;i dc lacunarisin celebrel (inctusiv cLr nerrrrrcile ,rr"ol.igic-psi

Iricii).
(',tttik ?)'on,ices;mptomd,ticepot
ap[re:t in t raurrrJt isrnole clajtio., )
(.or\.t,t'irlc
sr rr unele clcctalopatii toxice (indeosei:i cLr oxid de ca|botr)
.ri t.ltslula,rc.
{',tt,",t rlln ptcrlr'upoliile inlunlil" r,,prr.riUlI rl,ty
ult qindrum
,. ..i )
qcminlogicclr jl|rporl.rntr.;r,rn,rL,
pir...rmidaI,.
r.\l,.,pi|ami:ll.ritrll||l,:9rrfe\l
,lrl{'. l)sr,)rcc(tcl ,ird.tr.cminL-llril,e\pnl ,ri si r.u ciiz,, opilepr
i6...Du obicci
r.sli.rrrrbatle Dc, mi;c5rile coreiceliind asciat; artesea,
cu misciiri
-hcmicule
:|l (.]r,ltcr., toallzinrt
o Coreo_eletOZj
rytre'r hpnipleqiriIur est,' o bomicor{'ocrr. :lplli, rudlu.cbi
in
.
7).
lr'ttllrl(.gllp infrni ilc ..i uneori ir horrtiplegiiiusascrrl.rie.Sr. irr.,rfoslo
dc
olricti qi de rnigci,ri atetozice.
h.) I{ernicarei,le d,in, leaiunile mezencefaliae (sindroanrcLe de ,n,uclezt,
) ttlt r-tllln.i.oarp
snt infertoarc), talatnice ;i ju,nlatalamiu sint tle obicei
\;r\('t.rre lr se .ecunoscin contextul semiologic
de suferinli
xrrrr tiilamicX.
'rclcncet:rlicd,
i)
istpric{irp:r_tr, Ia copii t1e vilsl,ri scoltrr,X,t1r. obicsi il nici
..
.(.lareeu
( ||r1.r.'.rlrrr..rTrtrritLcoliTe,
prin ,,contamin:lle', psihogenit,do Ia un caz cu col,ee
\ r,r'rtirhrlt,Irin,rmitatic- Slilcirrile coreica au calacl,erc to:r,tlalc, apar ir1
|r1'r'rrf:rJspecllr1o.Ijlor,srut mai a.mpleqi rnai d:lnsanle;i so evirlcnliazri qi
;r||(' I'ielnenle Dtihoqen
e.

r t l tJl r 't l i i ttczi c tl i 'r ti ttt'r 'i r ttl ti l ctr l i r l l r ,i l ttti ',i r l i 'i t
1 . . l l t l , t : r l r 'l r l czi ttl i
t t t t t I t t I I t t t I t r, l t|r 'r l ,r tr tt
, , , r , r , : i , r , r r t lr l ,i |t'i zi tttl r r sr r i r ) 'j l l In i fci i fi
i l IV{}l l t]l l r l l l '
l r t tti t'r l ttl i r r i tttn i l i i l Ji l tl r r l l r sl tctr i r tl Ir t tl cg r 'l r 'l l r r r i i
r r . r r r l . r i : r r r c l ll r r si t'r '
Si l tt' r n i l tl i ti
i ,t'l l l 'i ttr ttl r l tr ', \'( 'l 'rl r l r 'l r l i l r l ',
| | l ! , r , ( l ( ' rr t r r 1rI i I rrr I i t rr r tn o tl ct'l ti L
|,r'
l l l l ( 's{'r ]' l r j zr l tt', r 'tt r l t'tti tr 'l r ttl .r r
| l | | l r I i l | r i ( l ( 'g ( ,1 |l o l si r n i i n i i :tl i l tr tl i l l i
u r l cg t'i cl o t', ti tL tl ttttttl i ttl l tr r ,i c' t'i ti r l r tl l l tl i tt t'r l r r ttsi r ', 1 1 1 "1 r 'l r 'l r '
r,' rrrr(lllrj
''r l L r L r l r r i r . i t r tr to tl i r ttl r 'p ctttl e ttl , i ttt'i l ci l c, tl e r ti vtl ttl t' tttr r tl Ii r ( l 'i r l c l r 'l l r l l r l l ,
, r r r r r r r l l . r l t rl l i s( 'r i r i vi r t'i i ) l ) i l 1 r l to ttl r 'tt fi cr ,tl l c tl i n l r tr cL ', tl t' l ti 1 tItIr l .'tr r l i r '
ttti ti si l 'l tr r tl i l tt'' tl r tl tzttr
r r r r l . l l t 'r i r r l i r l {i r l i .
l ,i r Ii ti l r t r n i r l l 'i r l l r r si tr l 'l l tt{i l l
, l r r ; r i . r r r i s c r i li r l e i r r ti cl r r i tl l r tc l tl cg r i t,l o i l i r l c tl i l 'i .i r ti t l r vi l l l l l tti l ti l i o tttl tr t
, r , l r l r r r . i r r i u ttl n r ,
r 'i r r tl sl tl r j tt a 1 r ti i , $ l ttr l ttl r i i fcl r :i ;i r i l i tt ttto tl ( ( ,r r ,l :r r r l ,

i,wnlu,rtalr:iliseuntiluc, inulto, rapide, dlr rnutt mni

.. .l;.t.l..,tfloc;r;
li||rilitlf
.i InHi rtcroolipe({l!.r.r., 19-,.,:

l t ) l l o a l u. l 'u i l l r l l l r l r i l u t
fl tl I: * i b tu l t. l tr i l 'o tl r i r tl r r l i 'r '( i tttr i I'tl r l l
r l , ; . r r r r . t 'r r l i r c i a tn i l i r r l c ( cr r i r tst'ci r t{r t'r tl tt'i l tl r td i i }r i Ir I1 r 'tr tIo I) r l l i ( l r r l r r $ i :r ( 'r ) t
( l i r tttti t Vtr g i ) r r r r t ttr
l , r r l r r i l r r i l , l l l 's) . ,\l ) l r tl n p r i r ttt;i tr t't' i l ttt l It l tr i ti tttl r ttt
r 'o l l l r '\l
,,l,,lr rtlli
i tl l l 'l l t
N ( 'l r l i r ,l n l 't.
( ) r o l r l r r l r r i Jl r tl l t,tvo tr l ctt- Sl ) l l l 7 ) ,
t'o t|o tl r i 0 zr t
q r r tr ctr tl i zn l i i
, r t r . r r ; r o | i l t zi :
t'\1 l tl l ) i l i l l l l i ( l l l l i l ,
l ti l x'ti r ttti 0
l , l . r 1 r , r 'r r l i i , ( i tr r ,l r r r i r 'l i r tn tr r r cl ti i i i '( r ,i ) , l i r l l l tr l i i l i tl t' t'ttl l r i tr '( tl i r l r r g i r '
"l ti r tl i ) '
r r l t( |i i r r o l tf i t'i , l !'l i l ) i 1 i i l ) i u l l l ( 'l l l r l r r r . tl i
i ttti tsl i t,i tl ttl i i ,
l ' | l r , ' o ( 'u L|l l ] r .r
r r r , r r {r r ; r r u g r tr i vl 'i r 1 i t.r i l r r s ( i r r ci l l vr t l tr tti i l l i r tttti r i l tl r r r r l i l i l i r l tti \ o ;1 1
i i l ) l tl z) .
, rrr liiilrr
i rr r i i tt Io tttl t,.i u vctti l i i , r t, l tti l l r tl k'tr o ttl ( 'l I
, 1 , l t t L t ,l i r r p o l i r l r , l u l l ti tn i i
IIt|) ti n 'u i t'i i tr . l tr i tr r tt Iktl r tr tl csl c o r r l to l tl
, 1 , 1 , r r , 't r r l i r , i Il l i r i l i i r l i i
( tr tti i ) , r 'r r tt ttso l i i tzi i : Iti 1 tctIr ttti tr r 'r i tr tl ti t'r tttti tl r tl :r
r , , r r l r 'l r r r l l r r Ittr "tttIr It Il , i ttl i 'ti o r tl '( ' si l ttttr l t!r 'r i ttttl ' tl s( x'l l ( l ( 'l l {i i ) , l l i |( 'l l \ l l r |z r l
, r r r r l r i l l ', ( , r ) l ttIl r '\r , ( ;tl r 'l o tr i , l r i l r r ( r 'r r r l i , s;l ttttttl ' tl 0 i tttsi ttttr ', I t r ' t t t i I r: r I i ,t r t )
l tttt
rl) liult
/ti ( ttr
tl ;l r l r l ,l r l i r tl ( l tr ,l i r tn tt'.l i r l r tl tr tl .i l l ttr ttr ti l ti n ttl tttl ttl tt
r r r r .l
, Ita l;tlrl)(lil'
i tl r tttt' l r t I ,{i I l ''r ), I I | , ' tl r ' vi tn i i r
tl t.l tttl i .l i tt ttti i ttl xr ,ttl i )
l r r , 'r r , , I r r t r r l {Ir '|{ ||tIi Il l r Ii tl r , o t ttl r 'l :tIr 1 r :r Ii l l i tr r Ir i l tt cvo l r tl i r , l ctr l l i ( ( l r t I
, l r r r . l r i l r r l r r l r., |!) r 'i I, r 'i i r r ( i ( |( , l ) tl i i ,l r r tl i i i tl 1 i l 'r r .j r r l , l l ) i l ) tttt'tr r l ti r i l tt l r r r tr l r t
l r r r \ l z l r r . i t r , r . :\r i r r r r r r z;i ttt l r tl r l r r ttl r tl tttr r r !r ;1 i r r : l i tl l r ttl 'i i t'r {l r ' \'r '( l ( ^ r l , ( tr l l

. Tiaurtle
,lrl ,1,.,,-r,,lrlorrr1rN,
,/
.silt ;nisc,rli inyoluni;are intelmitenie (discontinte), c,Lescorrtplere,.brn;tc, repet:.te, rapide ,,litle clr:rcicr clonic,
Ir.r.rr Lpc.-\cestc acio sillt inoportrlne gl absurdc, ailerea :.ealizind
,,ges_
lrti incomplt:tre'r,tloar schifate. Sint loarte cliferite ca morlalil,ate tle"ex_
jucrnntlrr,
Jttitrt rtr. (clipit,
blelerospasm, grirn:rse,tuse, rtisucirea gitului
sr,r,r ,' LPului,rniccili :rlp_membrelor).Acela;i tic po:r,tgsi'r,
fie lepetat timp
,lr..lrrrri_r'lu_
rr,ni,ri,minind absolut sterectip, pinii'cind pozrtc sti tlisp:llii,
.r'rlirrrl locul altuin. Ticurile ccrleaziiin sorirl
!i, la incep'ut,pot fi influonl
1r,l,{irl(l critro voin.fri. Sc exagereaziiIa emobii.
llorr,l,rr.
tk.tttri,ktr(a l,ui Gtlles d,elu Ilourette) so polNe l'esunoi]lbcplill
lt1.z''rrlir{lr. ii(uIi rnLrliiII,',gorreritliza1'0,
la, nivclul 1c{,0i
cn pt'orlornilrrur!ri
.1r,;-lrlrllut,ir,N(,('ii|,t,'.
s i Ulr [,rilbtrli-r,r'i
psilricesi 1,uIbLLlr'i,r'i
{10 vol.l)ir'{)((]ol)r{,lrt'lic.i ciroIrr,IiIr).
l)obrrtr:rr,zii
in copil,;iriil,tlc rrlriccicrr ticLu.iir,r,riirlo,
iritri,sir
r,rlittrl lrlourtsit', po rnir,sur.rt,
lutorrnl,rti,r'ii
psi!to1lri,irr,.
Nrr
;ii rr Lrt)IIttr.riliIor,
tio {,otrIrI,IrIr'i,
trici rrrrll\rntrrlr, srtt0ritri,illrrr.v0l r,si,
olgrl,lli(:ii.
' ll

r r r r r r r r t i , r 't . l r l i zj r r tl r tr n i i r r i t,i i tl i vt:tsr fxp t'( .si vi r o u g ti tti i tst,l t'( x'l ( 'ttl i l i |.i l l ( l i r l r '
i tt r t{i l ttr l tl tr
r i str l r i l i
Irrri
r {. 1 ) r '('vi r z ttr , i l n ' ttttti i th i i Si tu l i r i l e a l i zo l l zi
, , , , 1 , . p l r r i r , . i tr t'r n str l r i r i ;i r i i r i l o r ,
h i p ti l l i i r tl z i l t' r tl r r l o zi t'i i
l ) i l l i r r r l , i r zr l
r r r . L r I i I l r I l 'l r l r c1 i vl j : r ,i ttt tl ct'i tte i r n ti ccvl tl i ,.
\i"lf)zl
l ) {l r i ( ' l i ttn .i l u .l r ttl .i stt;r t l ti l r t.l e r ttIr i , l u 'r tIi ::u .l r i . si \tt tl tl tttttl t t!l tt
r t t t r | r r t i i tr r r t'i l tl i i tr tt i tl ttr ttt:l tti l tr sti Ii
st'tr ti r I l o g i 0 l ', i tttl l ',r st'l r i tl i tt r r |ttr r
, I rrr;rilirrrrirlrilii.
rr) ltdo::rt, dubtii' (st.:,tu.s )u Q,tttto'a,lll* al hti lt o!ll.) t'r'lt'vi rlc rrlrtlli 'r
, 1 , , ( i r n r ' ( 'o ng ( fl i tr l ,i ,, sr tl r e ste co l l str o i n l a , n tl tl l tr r ttr tr fl l l i l tr i tl tr l r tttttt'i r ',r ;r t
I r r r r i u r r l l n o l se ch cl o ( l o e 1 I( i e f:ll o p l l l 'i c i n fl ttr l i l i i ' ( i l r tl r ,l l stl r i l ) l i l l l l r l ) .\r l
l l l r co l i c.q i c i tso ci l r l r 'i l tt o r l i l t!'i 1 i r , I ri I'I t t t t i r I I r |: r tl r '
'r r : r l l i I r r c l r i ti r r e o u tl a l i ) .
t r l r r r l l r o l i i l u i l ,i ti .l c, r 'u l u l l ) r ':ir i l l si l l i ( '( r fi 1 l ( l ( r s{'i t {1 l r 1 'r 'i z( ' ( x,tl \ l l l r i v{'.

l t)

rrriuctouii,
atirriir.,
J,r.()Ar'csivii,
tlizrrlLUo
qi rtr.rrrrrr,
l]l1i::.i:lill;,1'i:,1llu]1,1,1t,',
, ir.totozrccfi 0r'izo
corr\,1r
lsiyo.llvolulia osrerrpidii( | _ 4 rrrri)spr.ir
lll',,]ll,llt','
. t') Ilncr,lalqtotid corsccutiDd,pritrobtastozei.fetate (i.terut ntralear)
dc Joet0/r_Ehintrutre:te de fo:lrtc multe ori in tabloul
tUut. tnt,t.ntp((ttntt,tqk
i(\rrU,)iglc col.co.atel,ozi,bilateraLi,. geoer.alizabJ,,
,sociatd cu spasm de
- ar,axiecnier"ioaJ?

."".]lapiramidalni
Llt::':ll.
(,rvt s r r ol,
{].::lll:lll,:l
r t ( . pt lc o ft d e ti C i b i n i c l p C tu a l .

l,erraparezi,

dltrt{ m.al poate face.parte.qi_tlin cortegiul simpromatic

.,.",,{] 1,t}..1:1.

,:lli:i11
iJ"i/#'f#
;#i'fi,1
ifi ll$T5lll,lil:l*,Ll"",^fi
i;Hf$,.1"",*f
l,li;

(listnnin lcnticulard,, corcea iui-Ilnntington

; .r"ao-oi"iI, cerebeloasb.
11
),Ilamiatetozaesto rezdtatul unor leziuui localizate, care generaza
jiil ].lli?l .ggt"togic cu hemipa,rezi,,silriro.ln t aramic qi'nip"rk'inezie de
r rp
r.riuzr(.
(Bjl.u.coreo-atel ozic). La copii tablouI a parr. dupL tr?umaf igme
.i)l ( , J lo
,,i )srrLlr
gr dupa c U c r.ti l l i re
.(ru j e o l i c d ..s c arl aui noasj ,. L.ul reol i ci . dupJ,
l rrst'.oonvulsivi,,

.diftericd 5.a.), La ,aury;.,',JeJUi""i-u*i"'to"*ucutivd tra;u_

lii;l'':ft]'$' iitti3i,T"Lo"""'

accidenbelor
vasculare
cerebrale
ryiexceplio-

(',!. I)IS?ONIILE(SINDEOAMELE
DISTONICE
SAU DISTONIII,,E
KINETICE
_ RISER.1952)
SPASMODICE
,'lirrt mirycxriinvoluntare cu caiacter tonic c:!re teurizcazia
o atitudine
pllti':Il;tr]i,
cnrc semrn!ine un timp rrariabi] (citeva *""aro,l" *uo mlnutet.
l,r'rrrilrpcl r,irnramal mult sAumai pulin durabild,pe care o induc. SpaSmrii

in frod_srereotip,
f1;arielrlcvent qi -adesea

lll"j:,.::--!]lli
lll,.!ll,
!o Tgp:t1
||(.
o Uri llutit
suOrotrirott
in tol cursril st,lrii de l,ogl(,(llnpol.i in sontn).
.\r'r.,-trr
rl.isronii,kiuciiccpot sj lie.rnaj mult s,u-urri'pr:.i; "i
;r';",:;i;;;i;
i\ir,ll/ix?/,3nt.. lJe obrcerse insolesc,1ide hipe.r.bonii
e.rl,rapiramidilc,precum
rii rfrr-liipolliinezii, Aceste distoaii hirletice tealizeazl o'a"phr*"u'*'"g;""_
{lnruritii unei contrrcLii spasmodit,e
lorens" a $nrp,,lo. .,,iuscul.:']i.ll:,Ii.
rjUl'rlr.(!r'r-fi;11(r,conl.rtctie-crrrccstcprogresivi.re[r,ri1.dur;l).f-.(,aractcrul
r(!l)r.r,rr,lr/
itt mlfcar rnroluntars realizate so datorreryleunor varialii nein_
rotnlr: rlc tonrrs mrsclhr', bmsc_diminuat
_siapoi din nor i:msc exagerftt.
n {x,stc rtcplasi,ti tr)nioe a,normale sint ritmate qi oarecurn stereotipe
Ia
rtrxrlrr,ri
bolnav, putind ant.rena cu yreme& deformalii scoliotice qi aiiicu_
Lrtrr. Nu slnt $on,sibilela preparatrele cle tip atropinic.
(i.2.1. Distoniile kineticc localizatc
L Torticolisul spasmod,icprozinti urmitoarele c&ractelo semiologice :
..
llu Bptsm musoular tonic antrencazii, o lonti, rotalie qi laclina{ie vicioasd,
1r,ol,pului, ou o contraciio a muqchilor stemocleidomastoitiian qi ttapez
(ovonl;ua,l.qi. o_piolosrrlui gitr ui do acooaqi parte, .rareori qi r murichilol
itrvocinrlri ,i glbulrri).uuor:r'i rxruLrac{ia,
tonicrna color doi n.rry.hi ino'rrrr,t,i
{lo (pinull oiri,obilltorluki,, il,r: cu,prl to flccto',zil 1,oni(rspro u.u.fI (rol.rrrcolini.
20{t

\r'rrrrll'ri,
rrorrl,rlclir lotrft,iiltrlrrlzi'l,lll,rrnlrlrtprl o trcrrr'1il,
yrtu'irrirrlll,
(notrrnrlr,),
, rr!ttl litrir,irrrl
xrt rr'virrrlirr lxrzil,irr,
rrorrrlrli\,rltr. irrrcrlirr,l,
lo lrt.orlttr,rr
ttn rrli,
,lrrrltt],(filrr"l lr.prrrir.ct.r,lrzii,
lrr lxrzi(,irr,
vi0iolr,s:i,
*i I11lltrt'llirlrrprrrhr,
rltr rrtrrli,
rlr,r'rrii,
o solirrrlc osci[ir,{ii
Iotrkr,irrcglllc,cilrc ]lol, l'i rnirilc rlrrr,fr1111,1
1u,1tt,,
r rrlrri,cllt, r,on;(ir.rr{,
si!lr lut, s(} ollutlt llr,rltrltLlsalclt,
olrprrltri,ltlilr goHl,rrl
rrrrlrrgorrirl
rlrr cortl\ic, rnili rlcgrtllii,sjrrrJxrlic
rlocil,olic:tco(l.i,iBrr,ll)f!:
llrllrllt, lf)iri),ci1,tr,t.tlt
$oflrrlirt[,1$(i7).J3olr,llilpllrt rlo obir,r'illu lrlll(i li
rrr.r'|Iltoh)r lrrrrgltrsiv.lr:i, trn it(lolosoorrttto Vorn gi di irt f itnLrlrltrrl llr,,r
, rrr','f;rlilrioltidcrrrioi,sitn l[ o seclttrlii,
postcrrccfa,li{,i.ii,rnlt,iilkrs rllroii,gixirrr
I irlllr $culno rlin selirr,exl rrlpirl,rrridllii qi dacr'lplr:zini;ii,gi r:r.izcrrcrrlogirr,
r
r,vrrrtur'r,l- pareza c,onvcrgenfci globilol ocula,ri.
f,)st,rrrlu o dcosebil,ii,irnptntln!ii, practicr-l tlil en!i?r'm
,i :llitului
,ltrrtttttotlit(tlc ori.gi.nce ra,piramlduld,) d.t: aLte
dc
turl,ir;olix,
r.lnpfi
J'orma
, rrrrr lrrrrrti:r,z:i:a,\ l.lorlicoli,sttlcon.geni,t&l
csto perrnnncnt, irrstl{il rrtr0rlr,i
r rlr. rrsimctlii trl.nnio-fa,ciale.
Acest torticolis congcriital loltro I'i i:ol,vrrlrlil
ttn',t nmllatrnatii crutt,icne,ocr:ipitale,ratebrnle sau, nru,trcu,fuxt
(rlrr olriru,i
,,r irfcrr{iabileratliologic); b) I'orticol,isnlsimptomatic cste rnnstxrrrl,ivrrrror,
,'r izr. loc,ir'le: tnimitd, localli (roumaticit, virol,icd, atc.\, red,i(rtLilii uroi.aqll
rultniot'it,s1ton.d,i,l,itd,,
arahnoirli,td,
ceroi.t:aki,
ln acesto situ:t,l.,ii,
tol.t,iooliHul
r,rrlr,irrsolit tlc durcli in muqchii contractati, dlrreri cilre dc ,.rbir.cisinl, r.r,rr
, , r'b, I rrslu dcclanqatc tle tuse, de stri,nut qi de migcilrile oapul ui
ryi:llcgi t,rrlr I i I
rl I'rri!,ii.le aici.oaseale atpztlui tleterminate tle l,umoli ale losci postoliorr,rri
'.r rl'. L.ziuui vetfehrc,lo(dc^pildii, un morb Pott cervic:r,I,o ftaciurii, ru,rvi
, rrl:i,ry]11'111ip
rLscaliietc.). jn acestesitunlii, de obicei tottiicoli$ulcrl.oIirrrlr
tllr.r ic.irnintc, cu inclinarea,.laterali,a capulli), tlacl nu drrfilitiv, ccl prr(irr
lrrrrp rlc. srlpt5.mini,firl exaccrbilri tonico, filr'L manilit'stririlespu,strrixlilo
I rrrlr,rriiil icc ;i rapid intcrmite;nte, o& in cazul vcriljabilullti torticolis slrrrn
rrr,xlir...Si!u, elrerrtual,:ttitudinea vicioasii a capului (.'s1cpar.oxisl,irr'l,'rlrrl
,lrrlr';rzii,citcva, orc, so ilsoleqte rle ce{aleebrrifall;i tlc vir,r,srituri(ciizr,hr
Irrgxjiirr') ; rl) It'alsul torticolis spasmodiaad,reinsole,ltc, 3u11,
axtr(J
s(u .
'li' ,.r
tl.tr l .t i net:ralgii a
nera occiptital al lui, Arnold,, se rccunorulo rr4rrr,,
_m.arelu.i
,lr('ir I,incrtrsea,made ]ocalizareadurerii qi de scmnelodc a<rornpir,rrirr,rr
ri,rrl,
l,lituur 1i ntliologice) de lezirrne rrtliculrr,r'ii('r-('o (rr11r'rrze,
rlirtrt,lcif
irLl,r,i
lrr|rr.lizrr1c,
]riperostoze, deform:r,]ii ale lNrlui olos ctc.) ; ri) ,I,ttt,l,itnliyLtl
,,rrrric(r'echiul torl,icoiis mental al ]ui Rrissaurl qi }krigr', ci1;rL,{,i
dc liirrrr',
llrl,2) $o_
r ccunoaqteuqor, plin car.acterulatipic (pozifionu,l),lllin irrkrrrsi"
lrrlr.,rr,
ltrllluri,rii (majoratii r1eenrclii), pr.in callcl,enrl inttrlrrril,trrrl,
(iru'{ill
anxioasi,) qi prin depista,r'cafaoliot'ilol psilrogtrnictruzu,li.
,r (l(! rjt,luo{1,
!. Spas,nulntonoplagi,c
(Jiiscr, J 952) ('Iorrnt'n incorcct,,ll.ll. ,l\.rnr(\nul
rrrri oorcet ar fi ,,Spasm rle 1;orsiurrclrr,aobil,lt,).Actstn ilt.r",irr 1yrrrr,r,rl,
| , ti r(1lirlosimilir,r"c
cu tor.tiurlisul spasrnorlic,
da,r'otrloonlizilr.olll urr rrrrrrrrltrrr
rrrr1r.r'irIr'.
Dsto vor,ba,do 0 nriqcnrc de lorsiunc ircestui rntirnlrrrritr .irrlrrl
rrrrrlrri sIu, dc pronrl,tic ;i ilo supinl,tio {orltl,:'r,llt,rrrnativitr,r:u,urr Icl rlrr
,,rrluliu(r') illttnrrrr,tivii.Oorrira,o(,irr,
spirsmfiljci[ esle lehljiv lcntil, qi plogrr,.
rrvir, r,!t'(toricOvtr,rnili r:tpidii (d1Ir niciodnl,li,0u r:illilctc|ul d0 brusr;hoh,
lotr,icil), llstfrl incil pozi!,ia lnorrnlllir, estc nlrrrtinul.il oitcvt, sturtrndo
Jrlru'l
lrr.r'itovl, rtrinrrlr,,plinl,r-o ,,hipcr.1,onio
rlo lroiti,ult),,'
(ltiscr, l{}I?), Allrin
rrlrrrlrntl srrllrrr,iolr.r,sprcLivrtvinrr Ll loc, llr.irr trlitrxll t(yr rrrrstrrrlrrl,trril.
'rrll'lr,Ht,i,
rlooorrtlrur{io
liirrrl tlo rrsrrrncrrt,rr,
ltrnl,[ (in !.- Ii nlcrrrrrlrr),
rlru r1tr,6ri,
rrrrrorr
rlltrl,t'[,it t1r'ttcillr rh.ol,intp xrl v irrr,ll rrlrou Hplll{|l],t,l,lr r1\l)iJl,li
r,()l11,fl,(]t,illu.
(1ruIi ltt trttzttll,(]rli(rolimtluittltrr.xtrrrxlh,,
;ttttrt'tltttthr.
,{t,lrril)ul ttrrrrrllortrt,lo.

201

(io(]roili\',iruril rri<,iv0irrlrr,r
ltr(r lttr (] rt'il,r11.r'
ilupir|it,l,iv,
litrviziili ; $l).lrittttrl
ri{,i l,r,st,lltir,
trioi rni4clililrrirrlctL{,iorr*le
s:ru aut,ornatc,trici rnlnovrr:loilo
olrlirr^ll spllsrrrului(irrclusiv r.[on3a1,ii]
ltclivi r.,:inp rsirir'r,
rr,nrcrnbrului re$1rofiliv)rru llot suprirna spastnr:lt,.T)oll sornnul le abol,5te.
. r\ccst slastn brahial ap:r,rein sti,ri postencefalitice (de obicei), in sufelil{o \/tl,sculare,tra[maiice eti],
{i.il.2. 1}istoniile kilotice gencrnlizatc sau cxlinse
.. 1.. lJpasmul de [,rrt;une. (tlisbutia, lord,otit:tia, l.u.i.Ziehen *i Opytt:nhcim;
tl,i:tlotrirt l.entit:ulard,progresird,) prezinl,il douii elt'melte somioloEice: disr,'0i;.ri luriiun(,1 (lla..li.r. 19..3._citrtde Soil,.ler.lC6ir. .\.r fpl. ii,
lrnz;iir.
ri{. ropll,us.iI1 decrLbil,,:rceqti bolnar i lrrr aplorrp., n(,rlDali (cu er-c,,p{ia
corriil,atrilii :\lNor eyentmle semne-t1e encefalopir,tic: herniparezri, nins-ciri
r,rrlcu'ltr,loziceq.a.).,1nmomentul in o:l,re $o lidirii, !lin pet, t-rLrnttriirliniepe
Lii sr,irrilbozo in lordozii, crpul se re-rroflectcazit,,iar eOoi, ollatil cn o:recirlrr\,| primilDl'pa;i, ap*re (sll] se er.rcelbei-Lzi)u I lrurrrro r:le i,onusposirrr'rl, o:u'c intereseaz5,
atit trunchiul, cit si rnemblcti:. llolnavul se riiicd,
lxr villirl pioioarelorprintr-o e\t,,nsit' a mombrrlor iD{criotre,a,poitrunchiul
lslt inr:ulbnt in rnod ploglesiv intr-o ptternicfi lordozil qi rot:1i,. lxtr:nlr,
lirrrlr in ou,r'ecapul sc plaseaz:iir]tr,o pozil,ieda tolticolis.sau dc rctrocolis,
irrl rncLnbrelc janpcrioarc se r'risuctrscirr pr.onalio sau in supilai:ic. Acest6
riprrsrrrccetleazii,tot I'cla1,ir;lent- si apoi din troLl l'caplr, in mod alternativ,
rrrrliziiul o lernarc.rbild, variabilitlte postuf.lliir cu rtltudini bizar.e, contorsiorrrrtorincit :icest ilspeot grotcsc a,l bolnavului :l fort fo:lrlc llastic
rorrl)lrirl (Lccitre liiser (1.959).-u ,jIraocooninlirnt ui li,,,j,turL. (.ritrc\\iurmer
(r'ilrr1rlc_liiser)cu-rn ,,clorvn mrcirbr.u').Dil lrricinr lrcestor sla$mer mis-iar
r,iililc voluntare silt inadccyat: si, apllrent, rrecc{)r{1on!,te,
rnelsul
cslrr r.rtlem do.cliticil. l)e f:lpi, se prodtic i.':tlialii toni{ro(in scns de hipers rrr ilt, hilxrlolie) la un grup muscular fa$ii tle alt Lrl iji dintf-un monrent
irr rr,llll (lie siruultan, lie alterultir.; inert s-l qi sug?r,rt(,.i lt accastjl []oa1{,
lrl rr yrn'ba rlc o ,,dismetric a r',plr turilol f i :i !rju.tifilor tonice,' (Riser,
l1r'l).
r lr, iji in caznl boh:Ivilor pr,rkins;rieni st p:)t rir jtfol, ;i l:r, aoe91,i
lrrrlrrr,r'i,kinezii pr,ra.lox:lle.De obicli rn,rschiifetei si :r,i lirnbii nu sfnt
irrlolr,riii, 11.lrs-::r,u
rlescL.is
cazuri eil ccintefe3,lret aceJNorl,roxlizinLlu-se:
r'rL\lliirrrrlir,. l,tl'lu"ari de vor'l|lr'e.i lio rn yr1i..,11.,
l)in,.puttct.d,e"leilre eti,op{rtog6??,ic,
sepot rlistinge mai nrulte tormedo
(lo t{)rsluno:
irl)itrslrt
r) I)istonia cle l,ortiltne agu-zisd,,,id,ictpr.tlicd",ialentificati do unii cu
it.r,,masr:u,lorum.
,,rl,isl.rtrt
, ,elte in realitate o boali, clegenerativii,,
-tleforrnans))
lllosirrril rne'labolicd,
(Wooten
qi co1ab.,19?3),de obicei cu c,.t
t'a-ctereredol rrrrilirl, c'r,r'c
ap.tre ir copiH,ries.r,uin adolescentil(Eldridge, 19?0; Marsrlen
rri llrr,r'r'ison
1974)si cirro poate fi recunoscutti,pr.in evolutir sa ptogresiyuctttt'.r,lizrt
tit .
il l)isknin de tol"r.iule sitnptomaticri est{l mult n-rai frecvent5 qi aparo
.
rfrrlri, srrrrin crrrsul svoluliei rl.nor {LJc.a!,i,toLi
a.la stru,cf,urilorentrapiramiilalarl.(!(livolslr tntt,uti: Ancc.falitrit:p,irl,enicti
(cel
mai arlesea); - Alte enctfn,
.
lil,rrl - Il nrrrfrr,Io
p tr,l,
ii, toni.oa(crr oxirl d0 cl,rbotr de pikli) i - I)e11c.netrcs)nb lutltolo hnl i.r:t.r,l.rt
rc (hou,lu,Lu,i lYil,son;i boa,ktIu,i, lVet I,p htr,l,Striint,pr .)
In rt,ttr rt,1tl,l'rii
r,li,l )sotnitutrslt.r,llit.r,ttrirIrllc
(iuolrrsiu sl)it$lno{j.l,ri[ol(]l.istitlo
(lo li;l ;l.r,r'liitisrrlir,rr),
lrlo irr(,rri,rr.iili,r'i ur)r'(fo
.Il;01,r)zi()t\,
r{Lrtrilr\
|,rrI I I rrr.il,
r.

.rl l trrl l i r I rrrI rr,rrrrI I rri r , r r I r t rlt t i, Hr , r r r l r ll r r rli, r 'ir {ir

r lt r '|r rI ilii, ir r r . lr r llt r i li r r r u, r
l i l l rrr,l rr,r' rii , r r l; , lr r 'lr r , , t t t l'lu: r t r . r r lr r r t , 'lr r i", lllr r lr . r 'r 'r r lr . r , r r l, r I lr r sr r r ilr lr ,
, r rzl r' 1ri l r. 1rir(, , . r 'lr ', I
l ,)ttrt.l i tlr t lt r t liiit t . lir t r lilt \ lt r it r lt ilr r r ir , t t cor r r r I r r I ii,I r rr rrrrr rr i i r r rrr , rrl rr l r .i r i
,,rl r' . IrIrr1rrI r I ir r r r r si
r r ct r cr , [ I r I iI l r r r r r r iclt t , olt ilit ir . r , lr . ) ;
l l l ! i t' tl i d t qt , t t t t i ir , r ( ir ( , r l11'r lislor r ilrr lI l rri s i rrr|(. i rrl r i, i rr r r r r r 'lr , gir rrl r , r |lr
,rl ,r,,Lr.trIri r , ( ) llr iil( . \ ir l lr , , r 'll0t 'ir; t t r isciit i ( r olt 'r ) . lr l{, lozi( . r ,rrr lt r r ir , . r ir . r r I r r ,
i tl l l r cit . ) .
1,rr:rrrr
2. l l nrl c r t it : t t t lt iI t l, 'lit r r l, is]iu
, r l. it 'r lt ) lt lr t ) alr pol r , r lilizr r lr slr llll r i, ,
rrLrrrl rrl ol , Ii t r r Lt I r it t lI r i ; i lt r r r r - r t t lt icloi',r r or rpliil
t
r r{r r r , r t uillr , t ii, ( , r t r . lr l I , lt ir . . l
.r rrI i ti tl ttt' ir ilr ( '11) illr.rsisii ( t '|, ze ir r t lr t csilr(,ii t r 0 [ 1] iit n il) [ lt 1it I I I ||r | ( |ir i|( ||||I
(l l i otsi l l rr('. , \ sl t lr l, ar r lunt r ilisr nclc 0ir cr r r ncr lsivc ( sir r or r ir lc ;
, , ( , t iz( , 1r(,, lr l
l , l ' l i (,(' r' ol rt r Jliir '1 , . r , rizt 'lt r f l) ikr plico t ilr r uncr r |sivt r ") ( r ot isl, it Ui lr . ( ) r t l
t,' i r' { ' (' l f (' i l c lt lir r i, clr t lc polt t r r ut t r ir t li ct ir npkr ir irr,, l r r Llr ilut t lt t r ocolr t r i pl
,:rl r, l rol rtavr r l lc f lt r c 1n jluir l sii. r r .l) c lscm onot , I 'r isl, li lr bslr r {r , qilr r lr r iir
r r ri zr: l orrlr olir kr il clue gillli: r pol, i, c 1i inlolt r il, i ct r o I ilr cllor r it r r r r ilr r ll
rrrl rr ((l rrsl l r r r l ; i collr lt . , . l1174) ,on] 0 ir lit : i Lir rlr sDer r tt lc sllisr r r r lr , lol r ilt r r . .
Itr:' IrrosLi r: r t lr c 1r 'at r f r lr z: it t ; 0r 'ill f ilvO r t t t , t i t r r r ci clizt . r , lr ilcpt it . t , , 1i r r r r r r
rrrrl r rl i sl i i ngzii t , : r lr t ] t ilar nidalcr pr in a, lt r r a cl, ilic: i, t lulr r i, r r lir ir lll r lur , lr r ,
(i lrr-rl.rtorrlc.
,||II r'i|1{IiLstii,tii dc r:rxirlicrrti si ruiolr}irliile l,11tr

ii.ft CONVULSIiLE
(i.il.l. Aspcetesc.rniologiot'.
S1r'erltrisdbilt'rlcaltc rniir,irlj irnolrrrrlrrlr,,
,,rrrvrrlsiiklso pl\izitrtii s lt formi-t,tlc acatBe.lllo llol 1li y(uutrlt:;rrlt,,tl\t
corliotalii fi insolindu-suct:l rirrrilrrlr.rr.
;.rrrrlir lotalilatc rnust:ul;ll,urn,
r rl.
,' picrrlcre tutali srrr rcl:tf,ivti:r, siiuii de constiitltti, sirrr,rIirrr1roIrirri,
7,,rr'lirll:,silul!ii in caro intercseazilun gmp rn iir:rtln,r.
ttrtri irrtrll itrrI rrrlrr
lr1rlin 0xirilts.
l. (lon,mtts
i ilc tonir:osittl re,prczenl.iltc
tie conlrrrc{,iirrrrrst,lltrr,prt.lrrrr
o stiu\) p[,ro)iisl.ioii])0 t)lln(, 1i'i,,tllrI r'lrIirl lr.ri,r.ri
i,rlr', (r1lr'oatrtron(l:lzat,
l,rlri,rlr: iigirlital,e,crrt0antLent':rz,:i
urr scgrnt'rrl(.,,r'l){rlill,
srrrr,ilirrrlrolriIrr,
rrrlrt,lrgtr,
lnuscul ,ttilii t0tpol:rlli, JJrcrnplulr.r'lrrr:rirl rrorrsl,r'rr,liv
cilr, l;rzri
,l'' r'oltla(1uri, lotricl gonu'aliznliurr,tliilepsiciglllnrl rnrrlturrrvrtlsir,
lrrrir,rr
, lorricr',itr (iu(', luzilulrll st'c11s;olol
(x)rrvlllsirrlprrir,ir
si hipt'r1,rxriLr,
rt't,lizcilzir,
rrr llrrric sl,r] irr cx1t,r'rsiu,
irrso1it:ir1irlc o piclrleltrlolaLi,rr sliit,ii(l(f .rl!l r
i tr(,i .

!. (l utt: ul. siilt clot ir l sinl r ni6r r ir i it r voluni, llu r list , or r r r r r r r r ,$lr
, , l{\ l
l r.l ,r' , i l rrpl ('r r o1t , li1ir . r . , r r lr , l, ltr. 'r
r 11
'izt t(.)l l) lit r ilp, t i( iit lr r *t r . r r r i; . iil, i lr r , r r qlr , ,
.' 1..i {' r,} i rkr . r nilr i g. u p. nr r r s<r r r lr rr','Lr . r lur ill, rscr
i nl. ii ( zt x, i r l. sr r . r r ir r lr r, r r ir r r r i, , l,
{ rl i N l )l l ri ( , iirr,'r r pit ir i1i r , or r r lllclli, ir t lt , soltt r l l) r , ol) illf illo ( chir r l . r r g. r r . r , r r li
z:.| r' ) l i (l c ( , r 'lr rr r I r i r r r r r llo r r I i oI | sr r sllor r r llt r 'r sliiI
'lr ii t lr , t 'igilI r r {, i, , li, r , , r r r r , , r r
[[l !)t l i l l l l lr olilt r t ir lt 't r lif icit f ( , i1,[ i i) t ol( ) gir I t I t , cl! r r ilr t r ilr , sllr t , ct lr r 0lr ic|t
r' 1ri k' pl ,i ci i .
r\r' ci i i r I r r t r r l'r lir r r nr r r ji,( lr r r r ir , irqi
, ( r llli{r ii) I n) 1.$i ir r r lr r , ir r rrrr r , r r r illolr , r r r L,
Irrhl :tu.ri ..tt r : ut it loqilr ';lt ) ( lr . lr . t lor r ii lir lr r r r , r lo t ur r r vr I I iiil sr , l, ( , r r ll( , 1, r . t lnf
r.rrl i zi nrl folr r r ' l'r r i. o . lr r r i. i
. ir , r , lr ilr '1r si. igr , r ( 'r r r lizr ilr , ,llzlr , lor r ilii, ( r r r r r i
| ' ' rr' l i i ) l )r!'( . 'lir r r l |or r Vr r I r r ii|r.r'l0li( 'r '; [ r ) ( 1r r r r t r r l. . iiL,l( ] , , ir ', rr . lr r r i( , r t
lr il f ii1
:10J

,{{rg'(r'.rul , i. lr,t.irr,I'l,r.rlitrl,(ft,vulliln'.,

lrrlrlizitrrl sl,ur.cd,
dtt ril,tt rpi.lrnl,i,
1{)rior}
ohr)i(:;.) (r.rurkr'i, rirrrn.p'r'gr.aii
Jil
cxistti
ir.irtii,
i.*iir[,,r''i,,irii,
t'rri.ir nr,' t'r.r.* .[oni.L,,,t,pit,,,siol i il;i; ;iC;il dou[,fon'o pot

nr),srr pr.rxluciibilatcral-siuroirioo (,epiGpsiato"l"o'_"io"i"i generalizati,),

ri.ur. ruril,tr:ral. (epilepsia tonico_itcinici ir"*igu"Lri;tey,"
sau numii

ut' roc'r,'ioci
ri sa,'Ibcrr,i: r,J
rmi,
;:',fl
i:llii'i i.i l&"'"t#,#?ljlli".",ln,1"b
(i,iJ.2.l,roblcme de diagnostic
etiopatogeniegi topografir:
.I. ln fal;a-rlnei crize conrrrlsive.sepune in primul rind importanta
Jrroblcmla sl,abilirii dacXeste
g" d".ir;
sau, dimpotrivE,
'carepoate
{frc{, este rrorba de o cridd,conaalsiud,
"o+?
"pii.pli";
neepiLelttiid,,
s, survind,

(pgloyier3
rriio.'rsrsr: 11 crizd,
ni ",irnr,.,'
:,1")11."-i]"3::rj,.:j::]l:!1"t"

r,pllr,pHil
lir,tr l'lrntl tttic llclor prtllrgr,tril.
rlr,uztLrotgrr,trir:r
Vottt I'oztttrtil
t:rrl6
rrlr Ilr\lv(!ll, (\rtln otiztrlot'opilopl,icrr
lil ttttgrr,t'i:
I ) lll tnt,nqo.trn,ar'.lulo1xtl,iu,
l,m,ut ,l,ittd,(pt'irr frr,ctori itrlrtIlrrrrl;rr,li
olrnl,o.
Itrlrrli) r'gl,oc:urzlr ooir rnlli 1t'rrrvontitllr rrcolsh'1,
virnt'fi,,I'txlto sl'[fio orlrrr,
rlr, rr *irrr.;rlii,tr,4fi.r,ir( hi,lnnit) n,aonotu,Lil sittt tlo h,nnontgi,i ottrclru,lt utu,
I l t'(,hn.oidick0,Ittovocirtullritr:oircullln"utlooortlottttrt,ttitnotrulliirloculrl
orrrIriIir111|,
lt'l,vr.r,liuprolurrgit, munopot'o lllutalo do tlcga,ju,r'o
foIirL'[, rr,lrli
,,rt,, rlr forctrps, vitlext,t'it,c{,io,
cxpulzii lrtltorioilso (prczotrlt,l,ii virrirrlrHr.,
rltrrlrxrii,iror'{,ioutcrint'r,),opora,{iicrzilricne (prin soltimbtilo ltlrrscil rlo pro
,rtrrr,), ltjliziIr'o tlo ocitocicc, b]oo:llcit,cr'tilol rcsplriltot'ii uJo frlt,ulrri lrlirr
q.a.
rrrpilir(iu tlo lichid arnniotio, rlpl,urii, tlc pla,ccnt':i1,
)! ) .Mani,nllitre,s,iencefa,lita.lcDrile: mtningito acutu ba,ctrrt'iotronrrpl,L.r,,
r.rrllI rr,Ii1,on,cnto bactcricne, viroticc, richettsiono, lucticc ntc.
ii ) I I em,u,toama
subd,urale(fotrtc frccvente lil sugar, pinr),lt 60'/, rlrrlrr'i,
\rir('ui [i colrb.), angioame (28o/sdupl Arseni 6i colab., 1071).
.l ) Putapitoza(cisticercoztl,,
hidatidozd), do ascrncnul l'oir,r'l,o
l'rrrcvcrrl,o
lrr rtrrglr'(Arsoni .1icola,b.,19?4).
t),Llleence,faloptali,iTtri,nJactoriprenatrali(careaunoliouirtitrprrr.iorr,tll
{l|z\ ()fiii.r'iiombrionarc 5i fctale) : a) Anomalii congerlital.a
(iuolrrsivil,lroDtllii
.,rl'rrr()zonLiu,lo),
carc produc disembliophziilc {ct:r,Io:mlrlfOl'lllll{,iir: r':r,rrir,rrrr
(rrr'r,('rfitlic, oxiccfdie, turicefalie, scafocefillie,piatiblrzir., irrrplr,rirrrr,,
lrrnil:rlii). b) Malfortna!,ii cerebrale(microgirie, polenco{alic, tnlllirlrrlr,(ir,.
\r'rrrrlrf( lltirrli). c) Anoma,lii occi,Tttto-ceraicale,
<1) Mu,Ifor,nru]iirtutturtltn'
(i,llAi()rriLliozir,
cerebro-trigeminali,,
boir,la,
lui
Lind.a,u
d,0.). ti) AJit,l,iu.tt
i
_
i ntJiilt,
1i tel&urfumoza(prin factoli gcntrtici): la.*txtd
'ltrnrtlrLhol,.ice.feXale
,{rrIr')tirIfonilpirul'icii, sinrlromul lui ILutnup din por.Itirr,lrclll,liot'l,sol,rrrzir,
l:rrrrilirrlii
diiuzii ctc.) ; lipotlistrofiilcsauslingolipitiozdo (irlio(iir,IrrrniIirrIIr,
,rrrlrrrlrrlic;i
a lui Tu,y-Sacrhs;
boala lui Niernlln-PiokI gir,r,goilirrrrrrrl;
lrrrrrlrr
llrl (liurolrol el,c,). f) Atte, aJeeliuni,metubolicaeraLlil&re: ftrlilrrriotrrrr,irr.,
lr,rrrrrrr.isiilrnliir,,
zlciderniahiperfolicii, piridoxin-tlepcrulcn{,ilnou-rriiscul,rrlrri,
r,l Niutlto&megcnetiaeau tulburd,ri ale formulei, cromozomi,o,Le.'
rirljrrrrrrrrl
lrri lt linoftltcr, silrrlromul lui Patau (trizomiu l) s:tu ttizolni:! li, lb),
rt|||(||{|rIruIlui Erlwards ('l,rizorniaE sa tlizorni:r,f 6-l.fJ), itli0{,irr,rrrorr60f,,l(lir(ilizorni:r,27),h) Infec!,ii materne(lat.srltoli or,rrptivolr,lt.rrrrrrrrri,rrrrilrr,
rlr,, rr,ltirboli infocfiol,so).i) Afec!,i.uni.
paratitara uLl rnunari( rxoplrr,xrrrozrr)
II IIr.lrIrI rj rrrI IIr
,11I,)rtrr,[tlopta,l,iip,rin aplenlitizi,ci asu,pra norzci.' tr,trunrr,t,isrrur
rl{\ lrlluurli gosl,ilntc,iradioli cu rulit{ii Iioontgt:n. k) '1'ttlltu,rdri.
nu:hr,hl,irt
ttlt lunttr(\ oa;'o pot prod[co oncelirllopll,iiirrla,nl,ilo(tlilr,hoi,,lirtrrl,oxir,ozi),
t'lt.). L) It)ttctfu,lopuli.iprin aJenl,iu'ni
ambrionare6i,fttuk ltrit irloorn1rrr,LiIrif rlrri,rrrlrr f,rct,rrr'-Zfli,
n) ALli faaktr,iu,ntennktll(vllirrirr rltrr
ou ic1,<t'rruckrilr.
lrr li lrilrrxrfioo otc.). rr) l'rcrnd,tur,;l,atp..
f/ir lrol.llil,scul;vrr, lrtrhrti sii Icctrtrolrilorn oonruls,i
otr.,trt
ilt
tr tr *in,L rtt i tr..t,b.iI ep i.Lep lioe , drlr orlrolutooli pol, lilsrr,o plorp,
'lr rzi(irrtrliklrl,irri :
l-,\pttt lu,l,ltoltttl,u,Lrti
(,,sp/rsl}r,c
de pl,ti.n,s
tht sLnolol,lt:r,llrri Itrrlrr,tlrii
l,r'rvr';,l'r,rr rHil lio tlt oligino llfircl;iv-orrrofionlli,
oit,o t.oirc(io
rlrrlllrrrril xtrit
rlr, rrrrrri,,.ll|rrsc srrrl(xilrt,n,!tiilzil
s1trsrrrrilrlr, lrlitrs,itr H|r,r,lrrlrr
llt.ri ittlli, rtpol
ttt ltolrol,tr1rI'rrftttuIr,,
ott irgii;l(ic, gtr lril,jri rlirr piliglrrrt rii s1 1vi,ril,rrliilil,
rlrau rlrrlriprl ltrrlt',_lrt rrxpilt(ii rlitt crr itt co rtrrti1tt'olrtngilo,
cI irlo(lxrJ,t,tl
Itrtrrlr',r'rrrtr.itt l'itttr,l,
xli|lr,lrLolt ltI Nl)itsttt
rrl gLllrri,rl0 tttlrlrrrlrrr,ivll,tr
rlr,t'|.
Ittlttlrtrt'lttt|t,irHlisi(,iclt ('lrrlrrzii,l)i(\r'rl(rrrr
rlrr,,lIrrr\rl
llt[r1rylrrorrvrrltii.ltttltr'1,
r,tlr,yrr,
rrrirr lr,, lrrllll rt'irrlr,riln ltr,t tll, litl,rlytrttt,r[
r'tizr,hr|r,rlr. V l,i.rltlh..

;::::l:,ii3-X,:fi'Jifilj".'*lffffHi3,.f,,J.,F,;:,A{:l{;.'\f"n,:J:;Xf:;,,;
tt(iriLc
urenl'ica.
s).c on,)itsiiteah cnceJo.ropiii
h$itlt-plitita.

6) centoutsiile
i i n. k,r en ;o, gra uitli ad. T Cott aul s iile, rti n' i nt
)
or tta! i o ;t tian ; n icd. Z1 Coo ii t
xiilt din tu.tbur,iiIp pnrloarin"
lr,ctrnie. pi*uJbniiop,,,f i.iOi**
;.u.j.
ll\ Unele conrulsi,i febrile.
.. .l)itgnosticul se orienteazi. uneori relativ ulor itt contextul semnelor
.liri.. ;i de h,borator, alteori imlrlicind i"""stigalii
Aeoi.",lit dc aminun(il,o 6i.,atente.Astfet, Gastaut.(19?3)._$i
eop""t"i" "1i
ffSZ6i;" pl"_
lrrrsd illercnllie.eaclintre ,,atac.l ckr.epilbpsie.''lresp"ctiv"rtrU.
A"?""r,ulsie
tonico_
,,'"uri"l,i,ra',lll,ll'lll[)
propriu-zisi,,
ads
i'ouiir"
u",_"o
puor,"o
!i
t,gpilupsia
f|rzr'tlr ctre sc repoti! dc o aiurd, mai mult sau
mai pulh cronici {i care
rr'zrrlti-r,rlin..dcsci,rcarahiporsincrcni, a unci populr,'tii';urotrrle.
O crizi
,,rrPilo|tic:i" ,Iic[', precum l-r crizele convu]sive accidentale ("o a" priJe
rrrrckr conyulsii febrile, crizele de.ecl;rmpsie p"o"pui"lif
tolice,
rrrcl,tbolico $_.a.)nu constituie o veritabili'epil"pri.,.';;p;
"r,i"tu
cum
nu
constijo
1rr o voritabilii epilepsie nici rcpetalea mai-muit
s;u ;;i pugin frecveni.d,
ir lnror crizo conyulsiye in crtrsul.unci afecliuni acute (eniefilopatia
urerrri.i, rlin boola lui tsright, encefalitele acuti). CrirJ"
.irii.pt,"e veritabile
:rrr, tlrxri, un c&racter iterativ, crnnic, ele repetinclu_selat
anumite intervale
(r)rrr,ii!(jllrte sau mai lungi).
I flngem atjenlia indeosebi asupra oo,nawlsi,iloy
kiltoglicemtca din hiperin..
strlin.i:tnt.uL
t u_ncftonalgi clin kiptirinsulinismul orginl, (i"oo
sru ca,r(r|r,)nt irJtcelulelol belrapancreatice),
Caro tle obicei se confuncli cu epileprrirr,.l,)xist[ insii, citeva elemento care ne pot orienta
asupra ulei conmlsii
li;xrqli..rnice: a) precesiunea crizei piin unele simptime
revel&toare:
1rrIn,r'c, tchicardie, tremurd,turl,
hidriazb,,
patiitalii,
anxietateI
l)).ifr ist,(ilL!,a
unor simptome interorilice,_ca : so-noterrali,,"concentrareilificili,,
itrrilrlrr'rru,
ir,1;entiei,a mernoriei qi a inlelegerii unor nogiuni abstracte,
st[ri

qi de dezoricntare,
aprtie,brirtipsihie,irclerenfi, sti,ri de ag!
il:li:,1,.1,,1.:
I i l I , li\ ( ll il { l ( ' S l V r t a t e .
ll. ,\tumar de d,ataetiopl,togenice4n,uieele conaulsirseepileptice

A .. ()r.i.zele
epilepN,ice
conuu,l,s.ira
la sugari.llajorita,tcLlcrizelor convulsiyo
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rrIr'1srLlil'irr]rrr}iu|ir{,rr,rreos.llir,iicu oalo copilul mio pr.zitrLit
0 cr,izit,r.lo
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lrrrrlrx'ilrr'rii'
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2.^.(lr'izale.
c,pitep,liaa
An meningite g^iencefalite,foarte frecvente l$ copii,
'.'. -irrlilrrr.;r..i .h aduUi. eLiologil infccfjors riplasinduse prinrrc orim-elc
rri.i r':ruz(.irupL,rtanloale rnanifcsllirilor:
cpil cplico (Gudrn-urLrlsson.
tC6Cr rt:rt.rlr.,{r'rnni1i cotab.,1C78;.
?n cazul crizeloier,ileDlice
sur\.cnitprLlr-un
lorrlcxt irifeclios acut sau subacut, v:l trebui sA ni ginaim h: a) Meningite
srrpural,ol b) Meningite virotice (vezi anterior) ; c) Encefalite'de divErst:
rrrrl,nri (viloticc plimitivc sau secuudare) at) Meningitd, triberculoasi,l
I
r,) .Abces ccrebral.
lrr oadrul rnanifestii,rilor epileptiec postmeningoencefalitice clomin[,
tlizclc con-vllsive generalizate, :liit iu pelioada acutl u, bo1ii, cit mai ales
irr cr^rr,1,a,r'divf.Trebuie sd,nu uitlrn faptul cL ulele accesepot si, survini,
rlrrpiL,luni sau ani de la sting_ereaprocesului infeclios (Arieni;i
cotab.,
l1)73; I'opoyiciu ryi colab., 1076).
. ij. Orizele epileptice ca simptome de ilehut sau I,n cursul et:oluliei procesr'.lrr,r,t:pamsire intracraniene.
,sinl deosebit .de frecventc, putintt ijungo
a,dult(Arsenisi r.ulrtb..l97S). Arti;|,
lirrl .l:r50o/udin rolalul cour-ulsiilur-lr
,.rizr.lr.r1J)eptir.ed.in pelioarJade tlebut a proceselorerplnsire intrlcraj
rrir,lr (22o/o)reprezinti un prelios gimltornde alarmii,, cu-tleosebiti, valoarc
l,r,rrljzrrto:rre.
de focar,putind udpseaintlicl qi natrrraprocesuluie\ptnsiv.
rr |ursnl rjyolutlcr proceselor oxpansive intracraniene (360/o) reprezinti
(l{r lrrulto ori coirsccinla fenomenelor de hipeitensiune intracraniand,,
pirt'zirulLr-si rraloalea precisS,localizatorie (Arseni qi colab., 19?8). Cei(r mai
r'pilcptogene tumori cerebrale sint cele situatc in vecinitatea zonelor moiolii .si scnzitive ale cor"terului, in specia,l astrocitoamele, oligodeldroglir'irr)r{rl{', rncningioamele si glioblastoamele,
l. lrizele epileptice prorlase d,euJecli,unile aasculure neurochintrqicala
lrrr lrlrxlu{l irl ungioarnelecerebrale suprateutoriale, in aneurisntele:.rterei
|rrtrrl itltt irtternc si alc rarnurilor acesteia, \n boalo Bturge-Weber .si tfuai,rar
I tt.ltt ttttr,[otn,
ul prinr,&r i.ntraparellckintdtos (netmuma,l,ic).
5. (irixtle e.pilepticenn pt"oceselainflatnatorii, tt eurochirurgicale se in.tilrrcscirr : l) Tuberculoamocerebru,le(fcrarte frecvent - 850/odn cazuri dupd
,\r'rcrii rli rrolab., 19?8); lt) AbcesecerebraleI c) Ifai rar in araltnctid,ilawiorhir*utt,l,icd,qi in go'melesifil,itice.
(i. (lri.zele e,pilepticein
Tsarazitozelecerebrale: a) Cisticercozacerebrald,
il
l1l')1, tl, sirnptome de debtit, fie focale, {ie generalizate, dupd, Arseni ryi
;i
lr rfrrIr., t.f)78) 1 ls) H iilatid,ozacerebrald.
ii
7. Ortzele epilaptricet:ascalure ss intilnesc indeosebi la adultii mai ln
vilsli qi la biitrini, fiind realizato de: a) Ramolistnentala
Tsseuotuntorale1
It\ INnlr.fal.upa,ti.a
hiputcnsid ; c) Unele hemoragii cet'ebrale.Debutul ictilirr.r)r si oonlioxtul clinic sint rcvolttoale pentru accste manifestiri
r.1ri
lcpl,icc.
,\. Ori::i.r api.l.e;plito in, bolikt rlrttontnlite $h1t m.ult miri lrur:
tJ I)itinuqit, t:r'rrhttkn,virtt,ior:ltntirii
n,Iu,i
i b) It)pik'psinmior:l,onicd,proTTt*irnl,

,ii
ilil
il:

,il
{l

it0tJ

l tpnrti dtl Lut r t ll'ur q Lt . ll, r t ; c) liur lt lt i l, , r r l, it : t ou ( r 'r r r r . or i) 1 r l) , li, ar l, r

I tri l l tl l r t ntr r ltu, \ 1, ( l: ; ( , ) lior r lr r lr r i ( r r r , r r lzli. lr l. lr r t , or l.
!). (tri r'1. r lt ilt plit r : it t it t l. . t i. u! iilr t t t , t t t . r t ,s. l | ,tt r| |||It ,tI t / \ l'lr l. i. r l
.rtrIl t' j ol rrIi ir r r r r r t lit ir r loxicr r ( ii po1 sii lr llt r ir cr izl r . r r r r rulr ir . r , ,
1xr( , ir r , ur n
.rrrl .r' i trrr l o I 'or r sir lor , iir lt r r 1t 1,r ,rrr.i I rr I ri Irr t , I ilr , ; r sii, r , i r l. lr r , , , r , . r I yr r I r . ii r r r . r . r
rl , rrl rtl o' ): tt,)it t , inlnl; iu! , iih e, t : t r t t t t e( r , lililii, r r r r
1r ) r r r r r f l,r , 11illr ; r , n, ( . u r r , r r i
, rrl rl o cl rl l xl lr ou sulf ulli dr r ouliot r , r , t r lx, lllir loLr j. cr r sl lilr r ir r r , r . r t r ir r lr lr lr ,
,lt liltrtl
ln,ll,scori s.a,.); Ir) in irk*iur!,iilt tniortlttr.,(urr,lrir,. r,rr.r.
-4.n att.[\r.t,
l:rlrrllrlic poltali, cncofirlopa,li(f lrit t(r r'(,;[1
ici ) .

ry

PfiOI]LEN,IE
DE DIAGNOSTIC

{ . tmruLBunARiLE
Dltsnnsuitltt*tCu

?.1 RIICOX{ANDARIMIiTODO],OIiICI]DI' SF]MIOLOGIE

7.1,1,,{ltnliza {nlhirrli.ilor snbieslive do sansibilitate
,r. l,t(,c piiltl,r LLninteroSl,rtoriultonl,, cu,o pLecizt rzii prczenla rli,Lrcrilcr
,;i,'.rrurlr, ir,ltoL senzl],ii :rnolm r,l^, topogr'a{i.i irrestor'.t,J\L)cicretrcu alte
ir{rrzr sirbi('ritirre,oiarul de ap-rriiie, c:u'aotcre,le
drlrcrii etc.
L Sint .sittutlii..1tt. cuye du,rerile ;i,fsau,pareste:iile constitLtie si,nlyut
u,l
'tt t . sUbierlit al bclii, st u,s imptornuLsenzitir:ilol.t,i:tu,tut,
Lllb:rri.rilc obie;tive
fii,,(l ririirirnesilu lirsinil) crr,rLr;pillri rrr cefrl,i, ir ariErr:rrr:,
in unele n:vrite
,i lrLrlirrtrlit: ({orn* stnzitivi ri p,rJirnvlJtcietiliccl, iiLuncle r,lrlilrlone,

vti Ir'.
?. I,lristii sittttlii in ctre ,lntpt,le si sa prr,'t,slt:irle Dneei| alte seny.e
trrrrtrlrtli.ae.si, clcci, au t.:r,ior,.r't,
,[,, si, ptonl s, mnQl : .,t1 rLrtlerilo mu:;culare
rii ru 1icrrlrr'..ir pe|ioada i.le inr.-ir,zieprcp],ratitic:i a poiiol.riclitci ir,iriLrrio:lre
rrrrrir_;
.lr) -llgiile premonitorii cclvicale s.lu dorsrie il hern r,tornielii;
r).l L rluiilr r inr
r olioi. , ti .l d e c l c b u tl u n e i p a rl l i z i i fa ci al o;ri )
el gi a i rr' rugural d,a
rrlri lrrllx's zostcr I e) drlrei.ili. clhiJicle c.r pr.edoninr ntil noctirrnd, in
irililis l rrr'(l1ilu; f) duierile lJ Lirlrl-rre di,r r,,jrnpl|simrilu medulare.
;j. lf rirli,. siltutlii in cwe urrrtlr c;t ea, prii inpari(1jqt:L lor,, tarita_
.
hilt .lltturc rl.in.icenle u,nor afer:liuni I i,1 forrn r, ,le.ici, a crmplesiunilor rneilu_
I rlr. ;, lr ). l"r'n r tlgiui. a
qi polineurop:ttii ; c) forrn,l algo_
.mrof
Il Ir|| {| ( ||||( . : | ; l nr . v r J \tr-l c p t:l_poliner-rito
r.tn tp p ,
L 'L.'ul.bn
rd,tile de sensibilitete subiectiud, pot sd, aibti o ,rnure uLlo&re
.neurologice(Guiblrt
t tltx'.n
lt)4..rtu, nnor
;i Guibert, 1g?4) ; :i) Terino_
-a.fec!,itm,i
rrrrrlqczi:t,srlmnalati
poinihe eyoc:lrea unci ,siringctnielii
de ci',tre
-boin.,w
rrrrrrrr rrLti sindrorn siritgornielic;
b) ll,el.ltarei1 rlc ciitre boln:,lv-* unei
irrcrr;r,rrilil,i rlc lecunolstere a ohiccteltrl cu liuturul pipiitului, rre face sri
rrr. qrrrrlirn 1i 1:r,o agnozie t:}ctil:i, plr)Irie luui sinr1r'ornp rriet:li; c) Rela_
liu(.:r ulr,'r'rltreti (cuntlnut-, dar cu execcrbliii in p.r.rorisrne ittloce hemi
| ')r'|),,IiLIr.,L.\ir{cl.rtu rlc prl}utii, precurn qi cu 0 coior:lturii afectiyl clezil,
grt,'lrilii) srrsctci.uziidonri p0siitiiitrili : - l) rlur.ilr.e tzl:lrnicii oLt c..lractor
Ir.i;xrr'1rr
Iic I - o IcziLLucr, firsciriLlluluisliir't.'hrlic
(ltunci cintl sc colstrr,tii
8i o l,0u1l{)rr,lrrrlit0zi(r.
5 . ( lq. r t t , l. u' d: 'l tl rrtl .r:i i l o t (rl i s t,s l t,z i i i rri )t rtrj rrri r,si i l i o l ri rru
r,i ,o,
j tccsi ( ' [ I iit t r l t t lr r l rr,i r,ri rr l i i l rr l rri l rl i v i s rr!l ri i l i ' ;,i l ;r rrs;)r' rl r: 1l ,t,ci z
,,rni (c,r,l i ,,
Irtl tri r r iiI r r li, s r , r r z t r!i irl o l trl rl s trtr rl c l o ru ' r,1 r.,,\rl r" strrr rJr-rl rr,r,r,< i l r,ri trrti rc

l rol trrti r ;rri r t r lr , lr 'gy'r , it t r piot r r l r lili, t iir , , , \ r l1, l, t r t t r l( r lr , r lt r r r ti t r r l, lr , ; . 1lr r r r r

.rLrtot(r' rrIrr,lr r r t r r lizir rt t t r t r i t r t , 't r t lr t t t ,I lt t 'ir r : r lir 'r 'r r t lr r r t il' i) r ( 'Dzir lr r ' l'. l|1]
l l i ri trr. l l rr I I i.(i' t | |r.t l (' rl ( r 'r , lrt r ir . lr it t r . 1r rt . r , izr r 1ir r ilo'ir l ; r , r t 'l'silzi, . r llor r t , , , , .
.l rl r,sl(' l i Irt ( {r izit t t 'r t lt
, r , r 'silr i ir . t il{r t ir l ot t r , t t lr ': r zr rt lir t gnoslilt t l. l\ t r : t lr t r lt
tprr l trt.l tr! it r t r ilt nlt r ilot lt t 'r i. lt t ir i, it r lr ': . ir t t r ilr t t t r t lt t llr l r i loill'l' iL( l( . r lr , r l
rt tut' tt):.!\ilt r r |r 'slr 'lt t lit t r t lt t r il l0lt ogiir iir i l) r r ll, sl|ziil | liilr t l t rt ' r t ;lI r,rrr,r I r
,ri ri . i tt rrl rt t t i t lc llr lilc t t i, t ul logit , r , ,lt ir t r . slt , ziilr , pul r r pllr r . irt , i t r lt r t lt r t lnt
ttl ' t' i ttttl rr lor i. t lt t r i. llr [ ut ( s1r r ; lt c t r r sct t Lr lr ', it ot ir lr r t r alii: L olr lilr 'r 'r r r r l: r
,l r' .). l )t(\' u nI ; i it t dit 'r 't 'ilt ler r . lt t : iit t ui l( olt t t ot ( lot i) t lt / / r , ( 'ir r l r 'li pu: r r lr
,l crrrrtrri l l rr r lt r . , I lt r t 's1t 'zii" \ 'isc( , t lll{r ( lcr r t ior r it r r ; r r r r lr 'iu. lr . l. ) r : lu {', / r , l
l ,,l ' ttl i i .l \t ll'r , r t l, ocit zLt ii, lxr lr ir t vii ect t zil s( nr zillii {l1r lt r r i'{iut r c ir ; lr ( lr . lr '
rrl i ;u(, l sl rl) ll r iif elil. t 'lot s( 'gin( r ll1( fir lc lr r lr ulr r i r ligt sl ir ', pr lI r lr r lr r ir r r
;,rrzrr{i l t rl o r iplir r r lt . ininr ii r : t c,
(i . ()an r t Lr r t l. r{ixr
: ?'ii r r inl a( lcscirr '( 'v( 'llI ( ) lii lxr r r lt t t slr r lr ilit r ': r r lir r i, , r rir r
l i ' rtl rri rrfi -'rlir r r r ii. I lt u'er eu,( , or r s1: ilui(o) sr : it zit lio lr r , t t ilr ilr i, t r r 'lr lr r r r lr r . lr r
i rr:uul r.:ri L t t ur r , r 'ii, t r clluie 1o1( leauoll sii pt t N, izit t t : r lr . r 'ir r r l r r r r ' lr r , lr r : r r r l
rl rrtl ti k' r l ocaliziuca lol pr ccisli, r iur 'r icnir cir lot ( t r ot t I it r t lt t , 1u, r 'ior lir ', , r r r r
,' ,,rl j uutt cl t er aiccr l) ij,i )f , dut 'et t t , t izt ir t r ' ( luf ( , r i) ir s( 'r l r ': r zr lc r lr r r r 'r i lr r . rr o
,ti l r' , i rtcnsit lt ea, t ir nllr r l dc alr [ 1i1ir ', t 'r r t 'lt , r , lt , t t trl<, r t zr r lii] ot r lr r r cr r r : r , . r ',
,l rrci si rrt s r Lr r in ir ] so1, jt odt i f cr r r llr r t r o iur ilolii sinr lr , gr t ir , lir c si r r r rlr r lr r
rrl l sl ol l , 1ielul de inst nl: r lc zll dulclilor ' ( lr r r 1, slr u ) lt r t sr , r '1r '. ) . llr r lr 't ilr . r , ,
, {ii;
,l :rsi i i cri acir alr nr : nt c in t r ei lr il) uli l] r il, . iol'o( . , \ r sor i si ( ) 1, 11'sr . r r l1r
tl trl ' l ou, 19?2; Wr ilt on, . [ t ] 75): t lut 'clt : : t sul) li) r 'lr r 'i ilc i I r{, clll I Irlr i , r lr r r , r r ', r
rrl r l i )r' rl [ tle iusr t li [ i dr len] a . , J( lur 'ol'o) ' lilopt ir r zisr i ( , , r r llr ir r q 1r : r in"1.
i { ' p{ )1i:l (l i i ugu, : dul( ilcl, pul. qlr i, ilirdur
, cr r r t it r : xr ( it i ( l{f gl{'lllr , r ir r r r . r 'r 'r r r l,
lor ruai (lc clampai ,,qidurcrell lirneinilnli.
7. l n l a polt ou r c( , st i 1lilt ilr lt clli t lc r t t r t i st t s, dt t t , 't il, ' xr 'lt t l r li. ltt t lt , r
t|: nrrralgii, tltteyi rdrlitu.Lar4 dlt|'rf i. ()t'tlt)|a.l(.j dutt't i lqldtitit't :\t ttlll
,lttttri r:entrale ,<,itlu.reri.[iftrt'ult. [.-Il]loo ll]rLr{o ot'.u1ti tr',ltlnrr strrr rlrrttr,,r
l ) tt"r:a algin,est c dlr r er eil cn loc: izill'( 'pt r illilr t t 'it t l t t t t t t i nct r . N. t r r l
r:i r l )oi rrti i nur nele ncr vului in t ot 'it ilr it r l t , t ilt t ir t lt pit t r '; t t r r vut lgi: r it iil, r r r r
rr:rl i , rtevl i t lgiil scir t icii ct c. [ , r ueoI 'i t t cvir t lgir t t , r t t t slil't t it , t t t t ir , t t l sit r t plot r t
rl ( sl 1fori l i ti i,: r l ncr '\ . r ilui r ospocl, i\ r .I lu t 'r iic r lt lt 't t t t it lt li t lc o llzit t t r c r r t r ct r r t
l rri l rrl i fcl i c, cir le unt ) r t i uu llr i. r n'nr ir lr 'i,
r ii lllt ' r it t t plot t r ', O vr r lillr r ic r lc
trcvl i rl gi c o oolst iLuio cit uzalgir i, it t clr lt 'st 't t zlt lir t t lt t t t 't t r it ilt r 'f ii( ' r '$illr ( il: r ,
t 'lt lt t t it t t lt tr ; r ' lr r r r ; r I icr r {ir r t r t I r '
' rtl r Iri nri , ( . lo alsur i! , ct lt r l, ir ur i, ir t sLt pLr r 1: t lr ilii,
r1' rl i ,rroti v pdlt nl calr ar r csli llolr t r t vi i; i it t vr 'lt 'sc t it iit r ill it r t 'it pr , t t r lr . r , r
ri ' ri ) N ,j urrg ir r (sli,
l a, ibr i,, , r it iir r i t ll spiililor t r t sr i"; lr r r r r r t r I iI jlr liI c r r llit llr r r , ,
l tol l rtl l i ri gi l t r r llr r r t 'r it 'iir r r ljct 'lt lr , I lt t l't t lor ', ; i it r llr r lt i'I i t r t sot t t r r lot ii. ( 'r t t t zir l
;1i rrstr rl l r,l o r t , st oI r r zii|ii f illt clr it r . r 'gr '1lr 1.t 'itill( r li( 'lYil( t l ; t |t 'ili't i( i f i ir l) r t lI r l'
,,l ri | r.i 1xr 1 r 't 'ilot iul ] |( ll'\ 'Ullli llr c( liillr r '. lt l : t l lt t 'lt , t t lt t i s|iit lir r lr r r lr lil|r r
rrrLt' t' n.
l t) I)urt t i. lt r r udir t t lqr r ' t t t t t t t it zi llt ilt t t it t l t I t 't t I t I t 1r t t t t t 't cI r r Ilt: ,; t it ir r r l
rl ' ' i t l IIrg l r r |r nlt t r 'Lt t , illr lir niv( 'llr l i t I I | |{' | | i r|| I I i lt t it t t l f it t it r . l|t r r t t t |r 't t
Irrl i i " . S rrl v ir r sr r ll lir ur r i t lc siinr '1i( r t t i sr it t r lr 'lt t lgr r t 'it lt t r ii, lr t oPr gr t lil r lt r r
r,l | rr l rttrl i ttllr l s; lt 'o r lislir l. St t t t it t lt t lt 's|lt it t lr lizt r t lt t t ct t lilsl', t llt t lt ol ll t , t
l ol i i rl o
cl t ( '\ ir qr ll) iir i llt t oxislit 'r ', I lr t r lil t r lllgiiL' lt r t ", lt t 'r 't 'lr t 'lt ziillt lt t lt r ',
rl l r' i rl l srrr r 'lir r 'lt r t 'i I izilr . , lr 'ir lit r r l it r llt r lt t lr t ' t t r '1lr 't 'ii l) 11'r iillt r iilr ( lll t n{t l
l rti r l ri (l i r.i l ii lr . z: r lr . . l) t t t lt ill t : t r lit 't t lr t ll lt t t t ll r t lr it 'r 'i llt lr ir zli it t llI t t r t r r ( r t
r,r,rri l i l rr(i i :1r t r lr , r r , r t st t lr : t lt t lr ' lt . lr ,t r ir I r ir r it r iI oIt rt It iI I i I ' t tr' , ililll t r illlzr\ ( li' \ r 'r I
rrrrl rrl r.: l rttrt r r t i t r r lr I t t I r t I t , rr t rt I t t rrrtrI i I r' , r t t r r llr t t l lt t i llr l l, lt lt t t ri t lr , t lir t r :r 'lr '.

:i II)
llll

( ) rrrrrrr(,i rrrrIr
rrrrrt,ililrlrr'r',ilir lrrlgrn.rlrrkr
tlbotico: ?toestoaap,rt sul)
.nprvriu,lfi
lirrrrrri,rlrr .r.izo rlo silg.lllrrri s:r,rrIrrlgr,r'Lltrr.i
tl. int.usitate foarte-miro.
int,tliitttl Jtf tt'rt,itxll;0kr
stirr,lri0rrlrri,
rLr obicoi lu :,mbele membre inferioa,ic.
uli nlrrsin.f impul uoplii-ryi nrxxrlinrl la tratl,mentele antinevralgiceobiql
rrrriirr. Asrrsto rlureri au lu, bilzr-r,mouingoradiculita postorioarf iudtic'd.
(l)lnlt,esiuneh rldiculari dir, doui tipuri distincte de durori: durere
rlc tip novrulgic qi durere de tip mialgic (Alexaniler qi peritz).
| )urcloa de tip ner.ralgic e o durere vic, ascutit*, pltrunzdtoare. manili.l:tlit |rt o tln,rn|1sx1'seleclric5,$i este asociaLi-cUlarestezii. tunnicd,turi
^la
nrr,rliirrrl
.rapid pe inLrclgl dislribu{ie a rddi,einii (tle umir in jos, in tot
rruuulx'ul superior, pini la tlegete). Ea este maximi la periferie, bine 1ocali
zrrl;ir,rlistal, iar proximal e r1ifuz5,.Durerea do tip ner,T:rlgicctilrintle de la
irrcrlut lotrnembrul sau se poate manifesta nrimai in reglunea-proximalX,
collorirLrlulterior.
[)ttrerel clp tip ncvralgic are doud aspectoprincipale.
-slrpel{iciali de inlepi,tur5, cir acul in zona perifericd,
.r'rrrr so ^o.senzatie
intinde proxim-al. Atlesea ea este precedat* de amorleal5 -qi furni
(,r'il,uli ; ca este produsi, de compresiunea iibrelor rddd,ciirii rloisale crl
rl isi libu{,ie superficiall ;
- o t.lurere situati, profund, constrictiv5 si limitatd,, c&re so accenLrrtu,z:'i,
ln mlqcd,ri. Este asociatX,lrecvent cu o redoare lroiurdi
localizatd,
rlc r ricci 1a,git, umi,r, bra! I rnreori durerea se intincle pe o regiunc mai
rrl,ro i ol estc provocatii, de compresiulea fibrelor rldi,cinii dorsallece inervcrr,zir,lolmaliunile profunCe: muEchi, fascie, pcrigst, capsule articulare.
'l\rritoriul durerii radicutare esto mult mni intins decit distribrrlia
rkrlrrlri,otnului, deoarece clurerea iradiazd, qi in muqchii inervali de r[cl],cinil lr,ftrcta,t:i.
irr extremitatea supcrioari a membrrrlui dispozi{ia fibrelor nervoaso
csi,o mLrlt schimbat5,, ilatolitii aranjamentului comllicat al muqchitor,
rlirL ou,rrr,
c-alzii,nu e.xistd,o suprapu:rere topografici, exicti, intre distiibulia
sltp(nlioia]ti gi profund5 a fibrelor rddS,cinii dorsale.
.ltrxlrindereadurerii in arii ce depi,qescdermatonmele clasice ar fi tlato_
.r'ilri,qi intcresii,rii fibrelor simpatice din rddicind,, yom putea observa astli.l rlurrrli tle tip sterno-cerwico-faeiaL(datorite compresiutii la nivelul C").
fi liipul costo axilo-brahial (datorite, compresiu:rii la nivelul Cr).
(hi(x) compresiute pe o rXili,cini cerwicalii,inferioarA, poate ila dureri
il rcgiunoa_pectoraiS, fl_vom av_easimptome dc pseudo,angind,pectorali,,
il rirz ('i durcrea este Iocalizaldin stLnga.
precordial5, poate fi dat5, de hernia cliscului Cu-C,
.. l)urcrca
I acest
rlisrt cornprim5, ridi,cina care formeazi, nerwul toracic anterior' 'medial
(t l, 1i 'l\) sl],uner-yultoracic antero-l:,teral (Cuqi C") ; Ice$tiJ, inet"vei],2i,
marelo
4i rrricLrlpeetoral gi astfel bolnr,vul poate rvca o clurete localizati Drellrt,lirtr:.

l)lrrore:i de tip mialgie este caracterizat; printr-o senzrlie profundi,,

corri,inuii.,nepl5cuti,, perforr,nt5, puternicii. E.r, este bine looaliziltd, intr_o
zorrlr,rlirr trlirrtea proxirnali,, sc letlecti, in.,regiune:l sclpularir, qi br.r! (C6)
;
,irr urniir', in rogiuto,r,scir,pulo-pcctorrild,,
n,xilarii, br:rl!, antebr.lt,, iat:r, iirdriiii
,(()r) ; itr t;nlpoz, sc,.lpulrii,,
dolLoid, blll;, cot (Us); cri se ;lsuciu,zliuu rcrlo:uo
Itrrrsr:ttlrr,t'1i,.
l) Lu'or'oi,I
rnitlgicil rlotrrirrir,rrrltrslon
Libloul clirric ryi cil trsl,. rlo obiooi
. l)t ilrlr, lril.t.rili.$l::rnr { i r l' r r ) lr $i. .

'r 0i

l)rt'rrrort,
rll l,i1trrritlgio rrsl,orllr,l;rrlil,L
rrrrcisli,t'i rlo lrilrrrloxrril,irlrililrr,lrr
lr,ut'ornllxcttllr,tii,
itr rutt;clri, nlrtr,ro
r.Irllrrirrii
[rlorlrriti,prin cortrprrrsirtrtoir,
vr,trlfrrlo.l)il llr, tnrrlrrlri,irrrprrlsrtrilo
sirri;oorrrlrrsrr
rlrlrlrilxrl;pr.irrni,rlLr.irrrr,
,lrrlrrllir,crtro$llrrnzir,torr,r'o,
I)rrrcftlr,trsl,osl,riot,Ioolr,lizlt,l'l,
irr rrtrrgoltiiirrrrr.vr,(,irlr,
rirlrioilrilo vorrbrtln oxcil,rrl(fqi uir osl,0abolil,ii ciIrl. r.tlrlir,r:irrrr,
tlors:llrI rrorrlr
sllu sgotioniltii,.
; rrrrrziiI.orr,loosl,o aucgl;oziir,l,ii,
liidii,oinile vontr':r,klsinl cornpusndin {llltr groa,sooo l,rausrnil,irrrlrrrl.
,rlilo r[ot]oilrc Lr,muschi i1i din fibro rnl,i subtiri oaro pol pftrrlrlco o nl,rr,r'rr
rrrlrrlir.i in fasoiculelclnuscuLtr(r,I)urr:rilo obscty:tttr rtnoori lrr crrrltrrr^ni
rrrrr,rr
ri,tltrcinii ventrale uu $lnt inso!its do corrtrrrc!ii nrusnrrlirrrr,
,1,'rirr,.,,'
,l(' iirnt, provoc[tc de exr:itareafi]rrolor radiouhro vontrilkr lino.
lrr regiuncr ccrvicalL, o hernie rle disc intru,fora,rninn,lil
Doll,lorrrrrrrri
irrrr,
trr'orlrrooo comprosiune selectivi, a r5d:li,ciniirrontrtllo, tri,siirl lrl,rlr1,
,1,'r':rli mai rnu[t s,lu mri pu{in intaotii. Acclstii, ovontlrl.t,]ilill,(\
Irr{xlu.r\
'' rlrr'{.r'cdo tip nrielgic. ln astfel de cazuri nr'. cxisl;ii sullnrprrrroirrirrl,r'r,
,',rrr (lo distribuire a durerii ;i dermatom. Daci, ]rct'niu,rlo rlisc rrorrl1r
r,irrrII
rrrrlxrlorridi,cini, cxistd,o combinatio ale durcre dc tip millgio iii rrovr.rr,tgic.
llrrtrrnrt intereseaziio arie mai ma,rs decit cea I unui rlorurrrl;ont; rlorrr'lrr,
rlr,;lrrlardistribulia durcrii corespunde dennatomului.
Nllncvrele pentru proclucereadurcrilor snu acccntnrlrcrlkrl sirrl lrrlkr
lrrrzi{iille capului, glttlui qi bralclor, cum ar fi: intoarcorot or,yrrrlrrisprrr
rleafectatdqintoarccroa capnlui spre pr,rten afecta,l,iirii pli0rr,rr.l,
I'r,r'l,r'it,
pr,sirrrrii pe veltex; hiperextensia coloanei ccrvic:r,loI floxirl coloirirrrir.r,r'
r rlrrloI cornpresiuneaexercil;a,t5,
asupra gitului I prx'cuilirr,rr,lro
l'izrrlor. Hpi
rrr'rsosiru percu,tiaparavcrtebralS la nivclul leziunii ilpliur,rrrr,prrrsilrrii
I
,lri,,ilrlr pe trunchiurile plerului brahial (durclo;t s,rLr'prrrrsl,cziikrrirrl
.r
in aril tlerm;tom ui rospect,ivsl,u pc itlilorl,gtt,tr,r'io)
1rr.r'roptrlo
I Ir,I rIi rrrr,r .rI
t,r!'siruriipo mu;chinl scalcn, Atit in leziunilo rrulicrrliLu!roil ;i irr crlr, rr,lrr
l,lr'\ului,-sint ilurcri pe trunc.hiurile plexuhri su,rrprr rnrrriclrirrlscrrlr,rr
,rrrlctior'.In leziunileplexului cif&ctelistic esto llptul oii sirnlrl,orr
rrrlrrllrrl,
rrrlrrrrsilicate
de miqciirileqi poziliile umd,rnluili brtlului. l)rr,r'qiirr llzirrrriL,
rr rli{rLllilremi$cii,tilemembrnlui afectat ryiin speciilltr,l.o
bltl rrlui (rlrr rrrr,rrr1rlrr
,rrrrl so imbracii sau se pia,ptF,n5,)
decia,lqenzi,rlur.olil purrtr.rrl,orsl rrr,ri,iv
ili limiteazii,accstetipuri de ni;ctrri, frr,pbci,rir so rlirl,or'rr;rlirr
I'rr.iotL1,Lt1
rrrrrri
,prsr.rr muqchilor scapulo-umerali,qi nu trrlc{iunii po t,r'rr
rrclrirri.ilrr 1rk,
_al
,.ttltri.Mi;clrilo urnlrului nu au nici o influcufil, ruuplrllrrrzi(,irriliirli,rirrilor.
\r'r,rrsl:r,
cxplici, tle ce unii pncienli pot sri nri;to tl.ourbl,rrlilltxrl,rr,l,,
crr lolrl,rr
,lrr''.r'ilr'rni,ri po curo )e atr. t|pIiclt,rclrtr',.r"uLiurrii
po blrulrrl:rli,cl..rt.,
rr.r.r.rrl.r
trtrrrliu a,bducfioryisupinaJ,io
cu capul intors corrtr:r,lit*r'Dl
(s.nrurrllui i,rlxfgrro
l:r gil,) (icclan;o,tzriclureri itr nemllrul suporiol. rcsprxil;ir.
I rrtensificare:ldurerii so oblino prin tuso qi striinut, tkxrilurco lrr ptrr.
I r{i(|o clostorobrrrsc},a pr,csiuniiintr.*ab{lomina,loqi intriltoltc i.o. .Atr.ir,rl,rr,
'
ru' pont,r:.oxplicaplin f,r,p[ulor),s0 pfoduco o sl,r,zii,
vonoiwtr furvlsolo opi.
rlrlll(! Di, r.tsttol,$0 comprilnij, $itoul tlural qi rir,d.tioirr
ikr ; oorlplruirr rroir,
:r.t,rrr,sl,l!
so polfo rtlor yr:_rillis
I I'il,ejn,lu-sornioluscopio qi so vir, vtdol cttr
rrrlrr.t Iniclo#r,trrt.risO irtlj.rsl,o:r,zri.
l\plioa,roaplr)$ilrnii po prtrrlolo ntilllgioo rlor:la,ni1cazil,
tlllorj Irrrnr|r^
(.1()nll)r'()silllol,
riuli0lrliirii provoitlriXhipor.rr,lgrrz
ia rnrrgultilor',frr,pl,orr,rrrlrto.
ttrirllgltxrttt'ulll)1,zonolr)(l0oLrlIBlr,ltllr,rrr
ll,Lrrlrrrtriij..l'tttr<il,ol|l
, tltlooltttttttttll(,
trrilllgir:o
rIulotrlr,Ho
r,l,olit, rr.iyolrrlrlrilo rlr,rrrrrlilrr
nitrl,loo.r,liz
lrruvoilnorrrrri.
,111,r*
lirt'ir"1
B ,ll ltntlitf(u,zii,
i'rr,l.luir[.
l)tttrrttlur+r1,rrrrrl'loolrt,l,r1,
Hi (fN1i1x:1,'lllt,g
ltt rtrirt H(tgtltoll
l,lr,
t i1,ittl,rrrrrnll,l,;
rlu 1,t'iroo
rlrr1li1,
i rrl'i I i ,r,rr.(,I i lor,rill crt rrov,rrrri"

'fiimrii^,; ,;i,f[

irrr'r,
liirlir(rrilol tlotsrrLr.Vitttltx'lr(,lr(lttlrtlii l)l'itt itrljl
lr rrr plirt src(,iottirrr.lr
r'ii ltttttriolirrlttlrrllrr(iik' lrx,rr,kr
r.u Ir ot,ociritrir
rrr prrtlr.lr'tltttt'trllxtrtltrtlrtlii'
r,iriirli'iill sLttst,lo
Ititttittt,rrlc r.rlilrt{ir,i. tltrii rtuioti(ltllirn) rrrrlrrii.r,1r'i
sur$l dllr'otji,!jii rcdoitt'eilrtll$orspirs rrclorrrrrscLrlulc
lorlrlizlrlt,r'r..1)r'r'zillii
ilttrolrur,, rlorlurr{urc\irJtiiio des(fii1('it
tc t,rtutintuitle poterrl,iilldin princlt'1e,
Ir)rsr' rulriOlLllll'(r,
t.) I)urqile r:rnlatLalesinl (.trrter]nirat'ede leztrta cordortllclor laierale
ilJ l l)os1('1ioa,r'ot],lcm:iduvei spiri,rii, in special ale f:rsciculelot' spino-talarrrilr,. Sin1,duleli surde, neplecise,lepal'tjzate pe un teritioriu r1ale fi sint
rlr.olritci irrso{ite de tulburlri do sensibilit:rtcobiectiv:i cn l'el.}artizal'e
}e
ltir ll|lni(orp srlu cu nive-l la un anumit segment.
rl) f)ut:orca n,eni,n,gi,alii$e rraractclizeazii plin dureri oel:alice difuze
r rr rrrrloiilc tle ceafi, qi oste deti, in turnorile cerehelo:lrie ;i hemor:lgiile'
suiralrllrnoid jt:ne I durerea mr:ningittlL sil,uati, spinal trstedatoritS, tunorilor
rrrrrlulillo 1i hclniilor de disc ;i se calarterizea,zin priti coiltrootar'ea pilrir
asoc:iatl"lcu dureri pe ma,i multe segmente.
vcr{;Lrbrtrlir,
L:) D,urerile Lalamice apar in leziunile cturc adecteazf grupele nucleare
lirlr,r'alcale 1,alamnsului.I)ulerile se localize*zl pe hcrnicorpul opus talarrrrrsrrlrri
lt:zat,,rrai ales pe fat-i, li pe rnernbml superior, au o accentuata
lrrrrtliltto aiecl,ivS,nepH,cutd,qi se insolesc de lulburi'ri tle sensibilitate
oIirrrlivil,, rnti a]esproprioceptivi,. Aceste dtrcri apar indcosebi irr ll:zinnile
anurne in afecliunile din teritoliul alterei
virroulare ale talamusulli;i
lr,rrliculo-optice I leziunile vascularc tlin tcritoriul artet elor talamo-gt*1iculrrir'i,si talamo-pedol'tltii dau aSterela tulbul'5ri de sensibilil;ate obieciiYl'
cu l.opografie caracteristici, da,r nu genereaz:i durerei'l talamicl propriuzisii, slu goneleazi1doar dureri tle mai mici, intensitate.
.l)urelel t:llamici poate fi conl,inuX cu exacerbiri, sau po:r,te surveni
tliscorrl,inuu. Soarte acleseoriap:Lri!ia durerii sau exacerbarca ci est'erleterrrrirl ii, de survenirea unor excitalii liziologice, liminale sau unoori chiar
srrlrliminal.e.Astlel, drircrile pot si aprrl ll rlpliczr,relupei reci pe o1lraz,
irr lirnpul picptinatului, a survenirii ultui culent tle acr reoe I lrlteori
r t)rrritirr dril'erii cste determinrtd' de excitan!,i senzoriali (mirosuri deza'
gitrllrile, zgomote sau lumini putelnice) sau chiar a unol factori t'rrolioirlrli. -,\cca,sti, integlare in durere a excitaliilor senzitiYo senzoriale sau
ovel'reaction (stprarcacfie). ln
i,*il,i,r', ,r I'ost denluurili, tle citre lead
ilgi I ruli cu tlurerile talamice, mli trehuic emitrtite noi-iunile de hiperalgizitr 1i .lriporla,tie. Il/teral.gezin, se traduce printlo sensibilitate dureroasi,
r.r r,rsivi, plintr-o scidere a pragului durerii, astfei, incit uir stimul ile intensir,poduce^tlui'ere. Hiperpatia este tot o hiperalgezie, in
sillt(, rr({l-rrreroa
tlurerea
are o tonalitate afectiYd' nepli.'cutd fi, palalel, e\ist6,
r.rrrrrilsir,
I,rrllrrrliirj. da sensibilitate obiectivi, in sensul unei hipoestezii mai rrult
;.rr,rrrrrni pu(in accentuate. Iliperpatia apare foarte adeseori in cadml sin,lrrrrrrrrluilalcnrio, al;turi tle duret'easpontrni'
11 I)urerile [isceralc. in eazurile de lezare a dilerselor organe intcrne
lrohraruiiecuzi, rloui, categolii de senzalii nepli,cute : pe de o parte dluerile
l:uu,|rr ilc sufclinla nt'rnijlc citi, a forrna{iilor recept'oare de Ia nivelui orgarrrrlni rtsDectjv, iar p.' dc alti, parte, d'ureri,proiect te (re.ferite)la riivelul
As1{e[ bolnavii cn anginI pectomlS,acnzi' dureli in rogiunea
lcgurrrcrrt^r,lor'.
ll r'ocor'diir,lir,qii pe fr,tl intorYrd,tu brllnlu.i sting, srferinzii de ficai; acuzztr
dtlef i ploicctato in
ilrrr','r'iirr rrrrriltiLl rlrcl'l, bolnavii cu ol'jzc tenalc 2louzil,
pon'rt:1
Yrulncl(f ,zonel0
t'oritorii
A&\$1.(}
oljc.
itrghitro"sctirtn,L'l,
rogi {)a,
'lo
Irri I latult'.
1I4

Irr pt' rr r , llnr , t t r . tr t 'olr t glt r il,cl, lit t t t t t ', llt , t lt t t t r r i r 'ir it r ct lt llrsil) li illlilnit l\
t t r lt t t 't r t i vir r lr , t t l'lrit t t 't 't ll
r| l 1rrrrrrrri i l r, f rt\lit r ( l( ul. t i] ( tlr t lt dir t ', t '. t t r t( r t t t t lr l: t t it
ilr
r
r
t
'st
'r lt lt r viit 'sl'llt t 'i lt ot sisl'r 'tlrr ',
it
t
so{
lt
t
l
tti rcrtrl ri gi t, slt icii, it r sf ir lr llr rlr r lt lo 1i
rl rrr' ,.rrl ,ti go t ir ,1t ) r il'lllr t . t lg It I i tt t t rI t I It I i rr. A. t r slt r lt it lt r t lt t t t 'it zii t r il t '\ 'it , r r t t '
.rl r ! rl (' i :r zik: , cpuizir t t l 1t c lt olt t it , v. Nt t t 't r lcilzr 'i,llt , lt 't 'it lt iil olr iqt t t t ilr i' r t
,rrl i Ii rr1r,l o: gr r . slliir '. I t t lt i, , t , , ( 't 'izI l'r l' gilllli( r ' lit lr t li|'r ' i| t t t lt i t 't lt t 'r st '- 'lt
,rl tr ,.tt.:e t: iicar al. e: ( t 'ila . l( t r inlli e; i cso. f ur ingilnt ' ( r lt asnt t ' t llt t t 't t t it sl. lt t
l rrl i tr{ r si csoit lg, ct t icnil la dcglut ili( \ ) ' oil( t l^t iat kur '( st r t t z, t t ( ii- t lr ' lt r r r '
(i rrrrr;rl rLrtrr or $iin t est iculului) , t t r iza r : lit or iilior p ( st : r r zllii it t i{ir ll Vr I I t t ; I I oI r I r r ',
,,:rrl ri r l trn r if onnii, l r ept at in t lur cr i violcnt o) , ar ize ur inut t ( r lt t t lt 'i t t t
r '.zir'.i i1i rLletril), crizc hringiene (foalte pertculottso prilt lrpl,rtl lri prrl
,l rrr' ,' l rL:r,siixit ') .ln t oat c lcest o cr izc, nt ss ale1list azi'llr t ziuni lr lolt t iit r t '; 1r t
rrrrlrri ll trivolLrl c[ruia se resirnte durerca
7,1.2. Analiz:r tulbur{r"ilor obitotivc ale tliversolor slrrrifuililirli. l)rrr
rrri rri r,rcn
acest ot ' cat egor ii t le scnsibilit at o poat o scof t t ( tiu ovit llt t {r i t lillt ill
rrl)('(,fo piltologico Di anurno : in unclo irnpftrjrtriiri sti pl'o{lll(1rr(, r\\lrl.lr'r'lrl'r\
,, norrsilriliti,!,ii, sbilro nurnitii hiperestazial altoori ill)itr(f tr t l i t t t i t rt t rt t , ' : r' ' rrl':r
lil;ii ii rcco1ttivo, care sc nutle$1c hi,podtniet c:ll(l l)orllr(r lllltl'Alf ltllril lrL
rirrt
IrirrlrIr,r'oilCap:r,citi{,ii recoptivc' sta,re numilii. ansra3iP. IIil)r)(f$11',ilr,
t1 ttor't'ttptt)1:ttlt4!tt|
rrrrcslr,zia pot intclesa 7;e itr)tli aroncttlu,re,raditttt,lu.rar,',t
tt)tt)tt(utna nt e m ad, ula, r e.t r jLelot int oi'csit i; o: t t c r nollt t t 'ilo t lr r sr r t t sjlr ilillt lr l'
,,rrrl rrri'birn rle hiTtoesteziesau' anest'eziegl.oha,ld,s',t'ttlrttt ittlt't't'srt' rttttttrtr
rrrrrrrrri toca t eg0Lii ile sensihilit ; , 1ii,celel: r 1t 0f iinr l iir lir o{r r , <, ir r r lI oI lr ir r r r l, .
h i l tor' :rt,.zie
sau allet t e! ie t l'isoaiold'Exist r i t louli f t r lt t t 'i t lc il's{'lr l( 't r {'rtrlr r r l
,rrr(i i :
1.. D i s ociaJia sir it tgomielicd. , in cilt 'c br t lt r lvt t l lt ict r lr r r r r t t silt ililr t it 'r t
i ,,rrrrl ,rLl gozicii,scnsibilit lr t e: rt,act ilii ; i st nsibililr r icr r lr t ol'r r lr t liiI iit r ti it r lr r , r '1r , .
\ 1rrr
tt iri s lrizgo iit.ielir: 1i \rLsintlronm,elc sirtrtJlontirtlirrtr.ri st'tlrtlot|i1lr. ['zti t tt
itl, llt, ttiyt,lttl tttctttli
lrlrlr'loL tormo:r,lgezice :llc fascioulului spitto-l,tlltt,ttt
r:i l i i tl i n co m isiir a ocnt llie : int er io: r iil, sa, u 1a' nivolt t l I r lst r it 't t lt llt t i r lr ilt o
I rrl rrrrri c post er ior .
\lL care bolnavul lriet'rltr strrtsibilititltrit' IttttltttttItt
:!. I;isocit1,lia l,abel,icd,,
ri s.r^ibilitatci, tacl,ild, opicriticli, sensibilitltcrt l,otttto-lrlgrrzi.il, ,1i t'rrrt,lit.
lrll r rtLrl'r,paticit fiin,.1 irLtirctc. Apare in. trabr:ssit'tt it sindrottttt'lt' 1t:st'trlrlt
t,r'lir',;si eite dctermirutri tlc iezirc'.r, colllolln0l()l [)()sit'rioirrl'.

lrNl(j.
T0P0(ittArl0 lil I,l1'11)l,AT(xl
?.2. pltoBlljMl,l DU DIAGNOSTI0
SIINZITtVIIlI0PO(iRAII(JII
SINDIiOAMIJ

(iii,ih seusibilitri{ilol pot lli lczn,1,o

in ttticaro ltrtttcl;rtl lrtlicr'1'ttlttihrr,
(1linicorlilirr.itc,lcga,t0 tiilrvri,rl{J krrrrrlizrr
si rlrrr:rrrro
Irrirrtlrr,st tclrra,lhoro
ir'{1r,tIrl'
pot, sti ooulxr o jtttttrl,l,:rl'o
lr'lr,lr,ziuttii.'llullturiirikr tlo sr.rlrsibilitaLo
rncrnbru,
l)rr
rr,Hr.l|tr,ttr,t
lr,l<r
t0r.itolii
utrui
nurnrui
utrclo
sitrt
Irri. rrrrrnorrrbr'tr
Iatil, rltxli, (fi l't,pttllt'tt
r,lri rrrrt irrlo'osil (lolt' ltnolo lrlo(lul'i (lo $(rllsil)ilil;irto.
notlttl
lor rlo $t'lllrlrl't.,
lir, I.ullturdrilor xr:nzilirc ;i lu,lifulat'lor, t'cslttrtrtiv
(lo
tlttttsitlot'tutttr,
iux)Ft0
soanta
lL,ziltllii.
'l'ittitttl
ltttl' l'l
tr,rl,D|c0izit;1('([ilrl
,r.l ri [:' Irr tt t t t t t lI r r : tt r 'lr g it t r . lrtrit t tt r r 'r ct t zllivr ' :
A . S i rt t lt 'ont nologlr t t zllivl! plu'il{- r it t t .
l. S indrxr,rnttlt, l,t'uuot[u,ut( rttortotttrtt'ilirr) . l,r'zitttrilt' ll(!l'vilol' l)(\t'lll\'
st r 1t t t 1lit r r il. r tlr r ,t t t r t . lt ill, xl, t '1'r l
ri oi rl r,l ol rrr inr 'iLr r I br r li, t 'it lt 'nt r t t r ilr ilillr l, o, . l1, 11,

l,;ii,:t;1l;.
#lllilil
!iii,#{"rr"ffi
i{#irt"3:l
rii#il'
#*"il*g

rrrurirIcttIrr
rlirt lrollllr,lui Ilr,srrirrr'.Ilocli
t1(lrt)l(ltlrl)ic(,,
Srrltllrrrrrit.trrrr
rlitr lr';rlli,
rlirr polfirii 1i rlirr rrrrrrltr
irrhrxiclr,l,ii
cu srtli'trnrirlrrr
oxirl rlc clr,r'lrorr
qi llrr.
Iriltn icl.
lr, t\in;lxtltttl rarl,iottl,arsi7tol,i,tnilitttlrtt'
irrrrtiirtrrrrcltoit,zr't,
tIrrloli cu rl il
l,r'rlrtr(ii
t l,tlicuhlro,pit,fo$tozii
si tuLbrrlrilirl.osursillilil,ir
t,oobirrcl,ir.i,,
l)t.c(rlrrt
rr lrrllrrrliilialorcllexclolin ttr:'il,oliulrtrlir,cirrikx'
irrtori:srto.l,)slo crr,r'ir,rlr,
r ul icli,t Ii sl;r:ib
n1,iilnet tndioulilril, dot'rnltornoricii,lr,1;ulbur.ii,r'ilo
l rlrr su rrilr i
lrlr lr', r.lrc t,sl;otlo obiceigklltlli,. l)cbutrL[rlurcrilor si ll1 srrrrlnrloltr.ior.jrrlr.
rrr,olir,trl,u:lzri
tlingnosCicrrl.
l,isrrr
o, irr r rlr,rrr
^{ccslrr cstc blrrt,ir,liit 1,r:rLurnlr
qi proglcsiv in tumoli. Adcseorilcziuncrtint cttrscitziirrtrr,i rr l ll l
rrll il itriiccl;ii
rrrrlr'icirii,
oinrl voi'bim de polir:ldiculite, sau irrbcroscl,zii,
lr,lil, r'iirliirrirrilr,
rrlrirli{flc, cil, 1i norvii periferici, cind vorLrirrrde pol,irnilit:u,lorrrt,tilt.ln
rrlr.sl,rsitrurl!ii,semnolemotorii sirrt irrrporbd,nto,cu pu'illiz ii llrxro pr,r.r
l'r'r'ir'1
poliratliculonevrite sint dc obioci irrliccfiorlsu vilrrlirr|
. ,l.ccs1,c
.rr prr1,luil un clt'a,ctcl asccndent.Alteori se lealizclzii ruortirrgorrrir,lo
po li
r';rr
I ir.rrlolcyrito.
5. S'i,ndrom,ul,
d,e,,ganglionitii" so caliloterizoluir,plin srrrrurrrrlrr lr,zi
rtrr: rrrclusivii a ganglionului spinal ;i a lii,t1.[oirriiposl,olioir,r'o
(srurzilivo;
plitr ltectarea ,,pri.r'ilegiatd,)'
de c5,trc virusul hcrpcsului zos1,trr,crr rr,l'irri
lirlr l rcuroectoderrnicil,.
In localizarea clasicri, sintlrornul sorrziliy :rrrr rr
l.rll)ogr'r.t'fie
radicular5, manitestintlu-so printr'-o nevralgio rlo t,ip ,,irrl,r,r'
rrr,ii.rrl"unilatelald,, violenti, continuX, da,r cu exircclltiiri pilrrrrisliru', rrrr
lrrt:url,ereale constticlie, de impuns5,tulir,1i rlo arsurii, lil cu,r.o$o ilr1r,(1irzl,
:rlrtoupcobligiltoriu o enLplie critema,to-veziculaL':i
r-rrrirrxrrl;i hrlrrrglrrl'ir..
lrr practicii, asist:in la varilte loca,liziili: culvicir,lo,colvico Irlir,r'lrr
;rlr,,l rrrilcn,le
(,,intercosta1e"),lornbo-inghintlc, krmbollornrLlir,Lr,
ri:1,(,1'{)
ii{r1lri
,rlicr'. .Sr-r,
mr uitLrn tormele craniene,cu lcziurtoilnctvilor. rrlitrIicrri, V, Vll
\ | I lris, YIII, IX, qi X.
li. S intlrom,u.Itle Ju,niur,litd,tt,l,hti Bicartl.1i l,'ot'trsl,in'(,slorxrrrlr{'itrlrr,
lr,zittttii li,tlitcinii in por!iunea sa erittr-Incnilgcu,lii, Lr,livclul l,r'ir,rrtliiit
ll
,lrirnii t1e conjugare (JtU. 29)
rr) )n sinilrom.u,L
de iritulie funiculafi, Lulburiirikrsinl, ;rrrl lr.rrzilivr,
r1iri. 1utrlucprin dureli vii, a,soci:rtcFilrrlu cLto blLlrt{i,rlc lr ilrocsllz io, rIrrrr'
r ilc liitll cxacetbatetle mi;cririle oolounei1i tlri irn,sirrrrr,l,
prrlll cr'li'lrlrrlir.
;'i, irsoci.rz:"r,
ilor' 1lr,r'lrvc
ll r.lrlir lr .
;i trtitutlil i antllgico ou conl ra,clrrt'lt,trrrrirolr
rroio
1t) ln sbtdromttl tla aompruiutta,fvniattlut'ri,s(tunrkf rlr lrl,itrrlr.tt.
lir^sittt pc prirnul plan, iat cclo tlc altrcl;rr,nr
sirtrzilivi so lliulrrc plitr ;rlgii
,;i lrlirr hipoestezii in benzi (uulicLrln,rc).

ffiiili*tr#t;:l1'-.;iilH$H;xr*;:#i
,,r,lp,m"pirlT*ffi
,."#HTi"",H11"*ir[*W,e"":;
ifl
*]*:ff
it,rli[$ip;i*:Tf

f,i,:K::#::;#::ri3,,1!1i,J&-#"1'1i"",t:Y1X'S1T3.ir
,,,,,,,.1;*1*l"liilill
ti'r,i.i.,.t,)'te clr,racterizatprin diminui,re-agi"rr"i;L--iri"i"r
modurilor cle

3*s,,;tl"":#**;r"x*wii
::iilliiitii:q3":,::lJ#J:'rtxif

*.ii;,,I,{
}!tiii"ft,+*r$:*r$irwf#.1j;#fffi
titl#1ff
i;#:"'tri
i:l1"il"i,"fd'
;i,','+3il:
rrrllio 6i sc instaleazi, atrof

iilii'*ls*;#I;
*,::lffi

senai'tit:e
sintin runclie6i d'ectnna
,,*,,!,':,1!,i;!Tlt,,u'.';:ff;:ty*yvdritor

i'"fir'y';"1;$i"l;;#gi33r
iiiii'Jl'Jfi
J#xi{-$;%Tiltf"",iff
,',,""lfi

:;ilrl;i[T#
;ii,
ii!{:Xi:t#h
!:)",;ii"},
l;:t",.,,';t,xjr"d,
{,'
apatii)' sini senzitito-llxot
ori'i, dar cu
l,I*t-fftu'Jii.;#l;,{tli!n"'"'
,,',,,,

j#fr+"*
t*:"
iil:1lplr_[T:nx*lhn#iii1*f"?".#i*ffi

ii':ll,lfr
*fltT****il;,,*#t+*",+t*t,
,.,,,,,1;1.l111;,#,lJlfr',3'y,:Xril:!:iJiffi",tlifrl1"$itgli,iK:tr;r,li*:

plli'i"i'.ii"Gpostseroreraaitt'elic;.
lliil';|U;,,llti.JJ1trl3i.**?1?o".ui
'i;i

;,!;;;:i;.;il#i#,?#;*flJf*l'?J,1f""#TlHf,"#?'i:
i1fi?Ti:l:
tlJ ,\1te lul;.neuropalti realizetzi"
fot.me spn?ittt)epurc

;lnt;1lxl",ni***i"ffi
".i#Js,trHtil
d,"j;Jr'i{#'fti:,:jxd,Tfu

prrrplirx:tpl,ive.

Il. Sindroarnclo srqrzitivo ccnl rulo

.nulu.Inra
1. llin,tlrtnmole sanli,l,i1)e
L Sinilrornt,Ll
( com.plcte)u nddlu,no
sacli,u,n'ii.l,otala
i rhl,cnuinri,rrJlr,r'ifirr,
rrtrciitnrstozii glollnlo subiocl;ivoqi oLricctil.crlorlcsulrtullczirrtrii (l;rrllrrr.
trrto tlrr scttsibilitrr,{;o
ir',
srr,rrkrl,t'rrllk,g
,,otr nivol"), ittsotitri (lo l)ir,r'itl}lcgio
gi l,ttl'ico.N ivrrlrr
ItrllrtLtiLt
l lu lhu t r],tikrt'
i irlrttr.llrrr.r'Lrt,
l,rrlllurrit
i v(Hot,iIt,ivo
rlrrsr,nsiltililrr,l,r,
rl opirrlo rlo rrivoluI lrrzirrrr
ii urtxlu lu,ru,ryi rlokrrrrrirru,r'ou
I r'rri,lrui,
:r trivlltrlrti l,rrllrrrlr\,rilor
rlrr sotrsilrilil,rr.l,r,,
u,r'odr,oxolriirii,
villonrr itr nl,rr,bjll
tr,rr,rli:rgrrorlilrrlrtilollir. rl ft,zirrtrii.
i!. Sindronn,lrlt hlntirrliun.rtu,rrriulrrlr'igrr,rr
rildrlrrrrrl llnnon Nrtquuxl,
lrilrrr,lrrxotnilrilil,rLlii
fiitrtI rlilr,r:1,r'
6i 11,11.
1ql1r
lorrnilrllilrl,l.ll
lr,t'tro.
;rtol'rrruIrr

iff"+'"onc'1a'le
if#','tr'fi
iril'll;l##iry##Jiff
{{id':,,!fr
"f.',Hf
,r,,ri"iiuriouio..r,rtr*r;*lf
h,S,t'#xil*"?iJ#"fffjffi
l
'-Jft

,xill,',6ldiffi
;rt;
ilifi1;$i;;,,1l;ti;f
;i;lji{{ryi"J.i",1ff
i.,r,iiili,".rri,'iiii;;,l,ilivil;l,ll),ffl'i,"fili,iiJ,1:iii;fff?sfifi.l]
llllll*j;
fl0

qtt

1 rl [(zi (, f l' iir ) ( l it r ( r ' u rri [rri c , ]rt,rrri s o c l i L rc rr rrri rl rrvtri vi t gencra - pe i i l gi i
l rrrrrl i zi; r ,r r r c r r r I r lr r I r rij rrl i ,r' i o l s l i u l r,rn t,n rb L e l o lde accea,fipal te cu l czi ui ter,
i rl rrri rrrii rI rr v c i . o rlisuci:l!itr fa,bcticri horloLll,ct,alii leziutii qri o disotinlie
r irirrlorrrir,lior"ltoll,r'tlatelali leziutrii. Astfelr o lcziune in legiuner ri.ir.ali
(irr|rrr.rrlii) [ Irorniuriir]ur'.ei stilrgi r.* g;cnela i (] tnonoplcgie crula]ii Jting?:?
sctrsjbilii.i,l,ii plofulde conDtiente in membrul infcricr sting si
trr('r'rl('rt.ir,
pir.rrlorr.rrslrrsibiiil,rii,ii tenrro-algtzice in partea ch.eapt5, cu nivel pi*i Ia,
Rdddcinll

posferbad

Rdddcin& posl

Rdddc;rd dnt.
ven!raid

it Cdu vd

Radecihd

| 'o s i I r i I i I r r {i r ,l i r r l r g i t'r ': si ti tr ;l r r r ti r 'l i l t, Itctttr t{ttttti tr Ii r t, It'zi tttti l t' tl ttl to
ttr tl ttti , l ti r l tt
r r r r , r l L r l r r r , L l l io tr r r r l r r l r r ., l r r l to l i
i tr Iti r ttr l r Ir r |r r tr . tl r , tl i tct'sc
Il l l (

l r '_

,.1 \i nrl tonr t t I t ( n) ut ll. i loxl. ( , t 'iott r . r t lizr , ir zi o 1( , lnlr r llit lg( 'zit ' t t t lopr r
1i r:rl r,, trtl i r,lt l, r t i, it r sr , gnl, t t ( 'r 'kt cr t llr olit lr t col'r , slt t t t t llilt llt t t ' lI li{f loll: {r f (lr 'l'
,l r i r,r ,' , r' tr piir l ut , r l"r s|ir
t silr ililiiii pt of t nr t lr r ; i l, r r oiilr ' ( r lcf i t lc ii; r r t it it t ; 1'
rrrrr' l i ,j , rl rrl rlc r r cccit yili '1c lll lczir t lt cr t . St r ir t t ilt t 'slr , ir t r lt 'olr 'lt i I ll lnt llll
1,rrrri ,l i ,' .
IL Si arIntunu'lt srn.-iIi'ta o,lt' I,tttrtrrhitt,lrti ((n'bn|1.
t, i rtt ' l r: l ) lb t t 't ii, pr r t ubr nr , n! it le in. , f ar iour tit t t ct t st azii t . r iiilt r r r t t r 'r ) r t lilr r {r r
trrrr r.l ri Ll rri r. r jnr r , r lllt 'olol r f t 12r iir cr ucir lt r t c: r l{) r '. ia, r ciiilc st r r silr iliiii{ii li'{r 'r
rr,:i ,rl , rl r' i tr I r 'r t t , i1lnt r .l) {) il( ic( r LL,
it t . {t slolcZiilni l. ol g{'il( f l'il Nit t t ll't it t lt t st t t
t I t 'it t t 't 'I I r jilr r t tll r t t
tl i t,rtl ti ttr;l ir lllt t llilit lciicnsil) ilillr loglollir , lii, alt lt 'ici
l r,,r,Ll !r' l r )i bcilt ilr r t t st czic r ror t t lt l nt ellr li , ( t t ilo ixlos( '( ) li illl' I r lt ; r i ll l'
, r ,,,,i rl si t i t t glor ni( '1i0.
Aceir st ir ,t ullr r lt t 'e alt t , r 'r l"t ; i r lir ocir r li t lt ' r lt t r ilr ilt
.rl r' yrri c i n r : ir , ost t hiin sint L'om ullui \ Yallr t nlr ct g, lllt t i llr r lr it t r lii Nr r ; : 'r 'r r ll, '
r ri l rri ( l cst r r n- ( lh{llliir ( \ 'czi ci) p, 1) .
: t c 1'Lpcr lt r t t . t ular t t lr t t t lt t llr lt t r lli r lt t
t.,:i rrtti lc'pr r iubct ut t ! it t le su, 1t tioat
.,1r\ (' (,oi lh ii. l.
i c. r '|, lealo f r , {ci, lt r r t r c}r i. t ilt t i ; i r nt 'r nlr f t r loi.
ll lc;ittrtiIt bu, tu,re intrt'oli t:nrr:,riel,ot'rrtiI Lrrtc llrrolrilci ltlitl rrI r I i I r' t I t t r' ;I
,rri , r' r' isl i i nl le lt t t t cl ioiu'erpt lin1; r ilcz: lr : ol.f tlscr ict t I Lr ht i1t it 't t t tiIrI iI I iii : t t t lt t r t
l rrr l r,| ogl os ( r : ille genot 'oaz: i o hom iple! {ic cr ) lt i. it
f lii t our l; - 1,
; , i lr lr t r r lizir r lr t
l r' ' rti r l rout ilinr ir ii ipsillt t t a, lo) sc lczliizit ; i pr lt r glir r r tlr, r i llt r il ir r r ! ir r r lr ; r ,
, r.i i r Ii . t(l n r f ( r t l, zt i 0 lt t r nti[ ncs1r ] 2i0 oolll. lilliLt ( , 1'r Llii
l] l't lllli st 'r t ; r ilr ililr t i|'r r
r lc i: ip lnlr olit : ) r 't L lt 's; r t r i'ir t r t r t 'sr 'l| . il , i I i i : rt i I
l ,r,rl i rrrri ri (t1m i o r lisr . r cir l! 'iir
I t ( r ', .

l' ? .

:r .

Sin d r o a m cle se n zili\c pcl i fol i cc.

rrtqrrrnrlul ln({lulilr. lezl,t. frrteresalea concomitentii a r"i,cld"ciniispilale

tl 1|r'r'lir,. Lr nir |lul si t)e p rrtoa leziunii, prorluce o balld5 de airt*tezie
" 1 ,'l Il .r r l' . ir i l' l. r z u r,t' i d r l rre -te z i r, Iro [rrn d ri st i ng:,,
,i. Sinrlroqne.Ie tle disotialie & sctlstbilitd,lilor :
t) t\irtrlrrtuu.l de cortloonep <;sle,t,io&r'e
(GII,Lgi l]urdach ) sau sindyum,al
rlr .lilttt lungi. oI l.u,iUijdri.ttt. Tttlhuririfu su,biectiLeconstau in: plrcstezii
.,i rrrri rrL's s(,llllc lcccse de tlurt:ri fulgulanter (fulgeritoale), cu scrliu lir
rrrrr r:u'irrlril. I)1\)\'ociireiri.lt1 ex:rCc:,barea:rcCSiolaprirl anl,efieria i:eprLlUi
rr. lirll('r{,lzi o l1,ingtr,(' ccrlicillii, in sperial plin conrl:resinrir .:ln
irlin
r'1,'1.'i'rii
irl 1tl:iri. X'tttbtnci.rIicobiectil)eteilizeazii o disocia,tie ta]:etici. a rcnrri l ri l i i rr ( ii, lr illt er ' r lir s :u l trn i l rtr' l :ri i (d t: :rc e e a ri parto cu l tzi ul trrl .
I't,t,iltilitti!t r:Ii.olrLrtite
I 1-lbt's, sirrrlrolrnc ]tituro-anemice sau altr] ntial,rzl lrrrricir'lurc (clrrrtn1.
ilo1e, {r'goncratlle etc.), scleroze oornbi rtr, })oli
rlr,*r'l|r,r',ilivc (bollu, lui llriOrL.eich), r'r't:ntr:n,l ftirrnt do cor'ilon lcstc|ior
., , 1 ,'r r r z , . iir r pl: ir . i,
lt) ilint{xtntu,l. dr ttntitturr"r,r:r'nusit poslctioatd (sut rcl.roeTtt'niintur)
tl rtl i zl rrz it ,o t lis olir r { ic s i l i rrg o rrri rl i r,i il ,,rrl rn o -i rrr: rl uczi r,ri
(S rl rul tzc ;i i l i rrl rk' r' ),
rtr l ri tsllir t lr r s r r t r r . il ri l i i ri l i i l rr.r.l i l r'1 i rr, r,r,l c i p r rrl trrul r,, ' l ' rrl l rrrri r.i l c rrr.rrzi li y,,rrtt o I oI r ollI t I ir l l i l (l i c l l l l l l rtrr;l rrttrl l rl i ii,tr l rcrri :i pttl i tk' l t i rrttl rti rrrl trr
Ittr.l rrt, l) r r lii it r I it r r I r' r' l rr l rz i rrrri i , (rrIIrrtl l ' i Ii l rrs i rrl Itr]l j l ()l i l i l i rtl ,' (1, r tu(,i
,.i rl ,) r{ l t I r iI r LI r . r r r lr ,.
:rl l l

lll.
S i n i r o tL tl ttl t l u ki n i cr : i tt l tttl o l o g tu , 'tr tr tr ti tti .' si ttl IIIIII|{'Ii ) i Ii .t,l l l i l l l l
, l l l r i t t t i c s t li st l i cl l l t( ]su i i L c i n r i l ti n :e l l d e ccl ti i ,.l tl i l tl i 'o
l tttt i .i l i r tr r l l tttr r
r ,l l ) r 'l r r i o r r \
I r z l i L . r l t t . I '1 tl e i l o i l i l h l n i ci
i
t
co
n
0
!i
u
l
l
i
l
{}r
'l
l
(
r
csto
r
r
l
,I)
l
(
r
Il
l
l
l
l
li
tl r ' l r r tl r r l r r '1 r ,'
', , r r r r , , , t r l l r t cl o l r tl o r 'Io ftr n cti o l l .t ] o , a ct- 'l o t ( '\l ) ( r l i l l l ( 'tr l i r l ( 'si
1 .9 6 7 I L l r tr r r r r i l {1 r , l l ) .) i , l l l Ji l i I |,Ir ctttr i IIr '
r r r r . t r i ( S i t g tr ', 1 9 6 0 ; f,i i zo tl h cs,
A,i u r i .r g r L tr r tl , L 1 ) l i {i ' ci l l <l tr l l ]r g |l ', l l l ( ;0 ; |'r tIto Ii Ii tt,
. r 'l r r '1 k r s , 1 9 l i t;
l 1 l , i t i l ) o l ) ( i t.i !i i r r ,i i 0 r r L l r b ., 1 l i i "i 0 ) . l 'o l l l tl t i tl l e Jl 'g t'r ,t.l r i' tt'tr sl r tl i t tr 'l r tr r r l ttr 0 ttr
, , r , 'l l t r r i i i r lr o l $ tl i ,
( l 'o p o vi r i tt,
l {) 7 {) ) ( 1 ,'i q . i tl ) ) .
g
l
.o
l
,u
l
cl
n si t' l q o n , tl t'scr i s tl r r l ) ( i ,i ( i l 'i tr ( ' si l i ,tt r r t '
I . s i i u l ro n n l
l r .r l tr ,tr ti tt
tr l ) t!r tl
f r f l l s l r ( {t i t l ttl l l l i i .l {ti l t( l l ( ) sj l l l l ) l o l tt( l :
i \) I]( t i a ttfttl ( '!i ( tl r l ) ( l l ttt
r l l so t'i i r l c ( r r u l i tt<l ctr tl l t.tl tl l Ir i 'l l l l l l l r ( 'l l i i l r l
l , i r t t t i i . t , t t o l ti ( \o l u l i r i tl i tfttl ( i
l r l r r t , : r p t o l u tttl i i ) . l ,) r i sl i i , si l r r r r {i i i r L tr i l r t i 'ttl ) t ttl i t'i l ' tl t s( 'ttsi l r i l i l r r l r ' r r l r i Ir
t r r l r 1 , o l i t r t l tl i i cl t i r sl tco l t' tl tr l l cttzi p s( 'l l {l o l i l ( l i ( l l l l l l l '( ! i 'l r l l l i tl i ( 'l l l l i tl l l r l l ( 'l l
( 1 r [i r r l ) ( 'l r i i i r l !{'tl ( 'zi i l r ^ 1 r r r r ( i r r l l r l r '
I r r , i . r r r l i s l ti l r r t{i r r i :r xl i r r |i i sr ttr l tr l r i l r i l i ) ,
] l r r r l . | | r , ( x ) i l i( i i l i i , i tt i tst'ttto ttti t $ i l l l r l l i i , ( l j i l g l l o sl i t'r r l l l i l i 'r ? tr ( i l l i tti tr 'l t|.tr r i
qi
l tctr ti l tttt'sl t'zi :t t'o t1 i t'ttl l i tl tr vi ttr ' l i l ttl r r r l i l i l i l I
, r r r 'r t ( , z i i l
i r r l l tl ti t'r 'i
l l r 'l l l l r l l '
I t 1 t l t t t t i l r r r tr :i i t,r ,yi r l r r l l r ...|i r i i ( si tttl tl ttttl ( 'i l l ( ' l l l i l r { l l l l Ir l l i l l tIl t'
l l tl i tl ttttsttl tr i , r 'i r r tr ';l i tttti r
, r r 1 r r r , r 'i r r zi il r r tttt ( i ttr , l ,l r l r ti l t l a i s ( l l l l zi l l l l fi t
t'tl t ' tt |'i t t ' I r' t I '
rr r r r,, , i t trr i rr r r , t r r ;r ,l l r .i i n l ( 'tl tr ') ; c) l l t'tti r r l ,tr ',r i t u r ttl .ttl tl r ttl ti
l \//tl xr
r r i r l r . ( r 'r , t t . l r r ,l l r r n ( ,,i l i r 'tt,r i i tl r r l Iti ttl tl l l ti ttr 'r r
l r to l ) t'i ( tl t'( 'l 'l r 1 i t'i ) tl l )
( | l \I ' I t i
t I | | I I I ( i | , t || | I Ii ) i
i
(
I
I
I
r
Ittttr
tttr
i
1
ttt'i
i
tl t
r
,/r
tl
;i
r
.
I
t r t t l t r 'l , , r x t
i
'
l ttl r t
r 'l l l r t t , t i {//r ,r '. r i I r 'i |,t'r ||i {'|( ' l p |r 'i r tl r ' ( t |zi l l tl l i ,j o l ) tl t' ;tl ttl t'i t o l tttl tti ;
l l 'l ', t l t t n I n r , : i r ' ( I rl rrrI r. t r I t t I tttt l tr r l r ' l r x'ttl i l r ,l t zr r l ttt c r tr i l l r l i i , ;tr ' l tt'l r ti ctttp ttl

:l l

Irrrlrrirr')1
g) Asr.*otnu:it (1r.ilr rullrrr'ii.ilr.r'lt'sr:rrsibilit.le,
rr,dcoscbirrrrr"
lrrtrrlrr);lr) J.lipr.'rputirIuLunic.i(silu,,slptrTcaclir.lalamicri,',cn"esprirrio.
lrr' l,.rrrr,rLrrlui o ,,ovcr-rcactiou,' ll tufllcrd), carc constd,in fendmenul
.rr'irrs .ii .r'icr. c-,ir:i1rnt, chiar. sublirninat, ,Lph;at de partea bolnavi sarr
(lr\ p.r,r'l(,a
$rruir,ljoasii
nneori, plecum $i alli excitanti (de ordin senzorial,
fractul mahi la -ta lalnic
5c. cer- | frontatd )
sc.cer 11,6) \

t,..

/i\
f..:.

R:".:..
i' . . i' :
...j ;

\t'^ li ; i'/ '/ \

-/,/ii,t.--

i' ,

:'.

.ia'
"-ttll:i

:::

:::iii:i!l
i,i i:iR
-.
\:.:1.;rj
I

I DM I

i= /

: ro i j..ji \
' .,.,..ji

rf

IPVP\

lvcv',

.^ - (

I ' .'

Wn:
\!Y:/

,ii i:vl-l

-.'.'!
:..:'..:
P.Reit
E spino-tdlah;c Y

sc.rrr.13,1,2.s,7
',
)

:\,^:.

rL

lPt

S' F,.o/r. ref/cu/ard

e Reil lat
Sc. cer (11,12)

LECENDA
6r nucleilor

Gr nrcleilor
OM:N.l)f,Rp-

6r hucleilor

t6a nucleilor

VL(Wj:N.Veitr.ld. CL:N. Cehtral

CL:N.Cq'p gedcuto,
laEral
CM;Ncorygenbulol

+N. furdfasci:ul. l-D:N-lateral

3U: N.Sutndib

Jriq. Jr, Nucleii talamrisului $i concxiunile acestora (poporiciu, 1979, sehem$

({'rnbinnLi dupd sislematizareatf,nucleit";"?;.r,n n" Wa tct, Sager, Le
Gx)s

psihlu)sc,,irrt(.grcazi"
ir.rdurcr,..-A,.1ft.t.
rt,,pililii, o c\(.ittli(.
i:ll'.iJli,il
Iir(.lilii,
dllr(.rl)tfiqrrrlcr'rnir.i1instx.cillirigrrl
srruatt'ulri.r:e),'(,lrirr
simDLl.
ItI ittgr.t'rrniclii, l)ill)i{,l.itnl,
ctc.. rl"r,larrs,.rr.zir
il* Xa,r,,,,liiri
lrir:1r1rirrrl1l
.ru
nr.\'l t {) ( |ut ' f lr r
(l o

t r ) lt H (,.v tr,.c
i l r' \l D,i "di
i r: l tl r t,okl ri l trl i t,l j r_
l l .i l c t{ ,t
r,\l r(,l l l ( lr ! ( l( , Z ir f it 1. r)l )l l ..i i 1t l -(.i
l i i .{ l Irr.l t)1 ,i is i rrl . r r.si rrrl i l i trrrr[1.
tl rrri l )U l (.t, i r.
rtr.(.1 t. l nl( r ( l no
.
it l (l l ,| rl rrl g r,z i r.).
I tr. s l rl r. r ,i l . l rtrrri rr:t.
I rrr I r.I I r i rI.i , rrrrr.l t.

3r0

(ttltir't'ttttlIr'
(itullorolri rlozugrr,rrJrikr),
tt'rttttLici
rrrirrrHrrli
cttto!iiL',rrvlriLllr{,ii
rlrrlrr,tt
tlttttli
tIo ;ttttI't'rt,
rrrllrxlii) 11irrsti(,ir,t,iikr
t,
lirit,r'l,tr
vii
viHorrt:r,Lr
Jrol,
tlrr Sr!g('t! .l{l{i(l)r'r'il
lroltrrt,vr'1,.
Ani,fol,ttltul dirr lrolna,viilui Iltrrrrl(<ritrrt'1,
tt'ili
rlr.orrrlrii
rlo aflxrNilt
rlc rnt:zilii,,lttci{,,,tttrlltrtort,sI rt'zislrt It, ittttttui t lrt1,r
t't'l
sll bolnilvii,", iill rtlt lrtoirrnl, rrl ltri Ilrrrt,tlit,l'it'ttttt,
rrr,ttzrllilkrrdo par'1;ort,
gt'oiLzttirlit
vtrrtltt'tlirt lltt't'trtt,
IloIrtltt'i'1'',
r:intl oinl,itcotul, o srrrtzlt{ir:
,,lrl'rttroi
iOtllt oxoosiv ltt 0ticu 0x0itit(io s0ttei
leritlinl,ir,tlo t t'tr:t,c!
'l'r'o|llil,ii],ceastii,
lirl, srinzoritrllsa,upsilricr'iIr'1rl,zin1ii,
fenoructtulrlo supt'rrrcrtc{ir'lrtltr
rrrirr'i,(,,ovct-teaction"-IJe:r,d
) sa,ud o ltiylpatirt" A ccstolonotttttttost' t'r ltlit ii
lrlirr lrlptul (Sager, 1960) cil, in nuclcii latorali convttg c-roil,lll'iirrfi1,tlitt
rrrr.rlirrlitrtern (prin intermediul nuclcului dolso-mtx.lian),rril,iii tlitt tttr'tlittl
r.rl'r,r'rr,a,tit prin nucleii tjalanici de releu pc cit'iledivcrsclol ilf('r'olrlr\H|tl
zil'ivrr,cit 6iprin nucleii talnmici nespecifici,in lela{'iecu fotttta,tiit,t'trlitrtt
lrrlri, rcspectiv chiar stalii pe sisternul reticulat asccntlcnt (v(lzi lig. iil)).
I lqr,rl1i f161p"* (citat'i de Sager,1960), incercind sL explicc tlut'ot't'trhilx't'
talamicX. au ar5tat cd,lezarea fibrelor cortico-tlllatnicu rt,t t'IiItt'trt
rrrrl,it.,li,
,'r'lrtlelosenzitive talamice de snb in{luenla colt'ical5 inltibitolitr 6i rlo tttrrrrrrt'
rr('r,g1,i
nouloni senzitiYi ar prezenta o ,,supraleact,icr'ln olitto r'rcilrt,ttl,
llrirr,r subliminal. Dup5, alli auttli (citali do Sagor, 1960), rlivcrsohr 2rolr"v
(tasoalare, tumorala, i,nflamatorii, cticatricialeelc',) an cxcil,rt,txrlttlt'lt'
Ir'. ion,a,le
rrr,rrzibivc
talamice qiar producedurelea. Incerclrile cloinl,olrotrrrtt rt tllttt'
lilol talamice au dus Ia ilispute incd' incomplet elucidato. S-rltr rr'lt'iltttil
tlrr rt
rui,fol talamugului, in afard de rolul si,u ds re]eur qi unelo prtnibilit'rl,{,i
r'nlrjbui Ia elaborarea senzaliilor tlate tle stimulii nociccpt,ivi tlo l ip pt'tr
'
lolxr,tic (Mori.n, 1955; Ilead, Ilolmes, 1912r cita!,i do Sagor, I9(il))' lrltot'
rt'li't'
rrrill,e (1936) a ard,tat c5,alterarca nucleilor laterali exalttl, lronalil.rr'l,r,rt,
livil, & senzatiilor, intruclt aceastS altelnre ,,Buprimil, un l[n:]ljj. trl,or, lrll
lill,nr selectiv aI sonsibilitd,lii gsnsrale", a cd,rui func!'ie csto tlo tt,ttllri trtttt
||rrrrcnteledureroagogi protopatice ale acestei sensibilit[]'i. l)uror('r\'lihltl
$onzatie, esto fd,r6 indoialS rezultal,ul uneri funclii coltionlo, lnl,ntt'il,
"
rlorlr
la nivelul scoarfei excitatia se transform5, in senza'l,io.
Desigur, dnrorile rlin sindromul talamic ritlioit, plolllornrl rtivtrlttltti
lrrlrnlior al integririi senzaliei dureroase, iar o ,,soluJic irtrprrr;abill' qi rltrttl
rr problemei nu existd qi mdte tlin concepliilo mai vochi 6i mtli trtotlottttr
pe interpretd,ri $i fapte totuqi obiective, difur\' tlo lit lrutol ltl n,ttl,ot"'
lrrr,zrr,to
(Alnoni qi Operscu, 196?). Scoarta cerelrralii, rcprozint;ii lt,pll.rlll,ulsttporiot
rlc porceplie a clurerii, Dar qi talamusului Ii levirrc, dcsigul rttt rrtl lttlltlt'
<:il,qi llrr
itrrportant, atit do releu pe cd,ilesenzitive (inclusiv dunt'o?r,H{i)'
lt
lill,ru seloctiv,precnm gi de a ,,moclttla" qi do n contribui ln,ttlttlxrrlut'trtt
rrivolul scoar'fei a unor senzc,triiparl,icularc * tlupil, cttttt trlllillt(llllll
rrttotior'- prin convcrgonla,ln nucklii latera,li n' unei lnulti[utlitti tltr ttLr'
tttttrloi t'tt
tr,tr!o extcto -,proprio-gi visooroocptivo ;i prin I'oltrl,iik)ittrtrst,rtr
liltnal,ia, rel,icnlarit'qi cu sc.oa,rfa
ccrclbrt i*l(Sllgcr,l.$60 1,\rscrti qti()l)r('H('lt'
(,or(o'at(totit:t',\'1\t't\Itl
f lf(i?; IloDovioiu, 19?9); i) Mrri pot apiirtr:l rnirscrirti
la nivrdu) rniinii (prin ltrzitrnrrllI'ilrrtrlot'
tlr.norlrlsitrf tliscrcl,ttiii lot:a'liz11,e
lrrlit,ttto'8trirto,r'os1:txrtiv
t trucltttlrti trotti,trl-ttttttlilttt l,l Itri Lu,r-s);j) ,,J\llrrrr,
drrgrdcltrsin1,tltrrli volrll,trtltt trtllt o
lir,liunir{r,"rrsLccu't'it
tttol'int,irfi
, ltt sttttsttlt,i't,
rrri6oil,r'iloltotozi<xt(utStt"zisr,lotfit,utlittitlo,,tlt'gcl,trittglttrlrtlot'prinnri4r
ntnlotittkt Hitlt rtl)roz(flltnlrr lltr: lt'trttltittrt'oltttitt
rt,l,ol,rrzitrr)
i k) ll'rt,l,hurllriIrt
cor]1tt
I tti gcttic ttlrt'ltrxlr'rttuttt l)l ill I'r{rtlll)l,rlr
(ll'itt lrrzlttttr,;r
hk'ntlilltont,oni'ntd
rr,lttt'cll,t,i,
prxlrrriqtrrr,
li rrrt|,zirrrtr,lrr Irrilolirtl rrrrt'li<'nl
rrn1;cin,ltl
tt r1t.r,lrt.rtlcI

zrl

, !l { r.) lli t lt t t lt i hil)ttl ttl i r l tt )tt.i to N Iti N d J ti l )o.t} (tt.(| /),!?}?

i c (ft,i l t l .zi rrrrr,l t
r rrtl rrt r ll lr s olilr lit . c rr l i tIl rrr.r' IIr,IttI).
:.'. t\ittr,ltrrrtttt lt.lttnticr ltrttliuIt,. rt) [)a,tc irnilt ut rro-clinice (a1e lui |hor,
rrrrl l r', l1) 1. r , l1) jili,l, ){ \.l ti i rs i l l c Iu i l l i rr,i te s c u
fi N i cul tsc ,1925, ci tal i rl c
)irll('r , I j){io j i'.j(.I ) Li j.1.(|I ,, 19;i{i, ci1,al de S:tg01,,1960 ?opor.iciu si coial}.,
;
l1r'il'. llr$1)) ,lu (loilLurriilrut crist{tnlt ttr\ot s i,trtlT
ao,rla lalamice at luibu,rd,ri
tl, :;t n:;iltil.ilrrl,t, itrsd .lrirri dureri, prin lezrrea, exclusivii :r, nucleilor ventrali

l r ,ttl tr ttl ,t 0 l tl tt ( r 'l r r r ' l l l j i I

r r l tr r l i Itr l u l Ii
r ) i t i n l t , , tttttl
tl t r l l i l |tr r tr
t'r
ttr
r
tr
l
t'ti
z|r
tzi
t
,r
l
:r
l
It'r
r
l
i
)
r
r
r
r
r
r
r
r|1
,'i
i
;tti tt 1 r t'zr 'tt{r t l ) ( ' tr r 'l l r l l ) l r l r i r
1 u 'r 'i r r l
, l r r r , i r i i ( r t t l o r l ( ' (l i r l i r(' l r' l l ' l (' l ti l l l t ;r l r l i l r ') , I r t'r tl i z:t l l t tr r r r i tl tttl l Il r tttl r r tl r tttl
i t'l r r i i ,.r r .;i l r r r r r |tIl r tU l sttl tr .ti o t si l :t l r i .l t,:r r ttr r l
r r r t . 'r . i D r '1( 1 po si l r i l i l i i !i r l I
i r r r i l r , ( }l r i r .r ,l i v| r l I r r ,"tt'r i lirl r
i , , rrrr I i I rr i r , , i , l i ,,.l i I r ,r ,g cl r l i r ,i 'i r l cr |r 'i r i i .'l 'r r l l i
i r i r ' l i 1 r r 1 . 1 q 1sl',ttt si ttl n ti tti ttr r '. St' l r str r ,i r tzi si o l l t'ttti l tl r t'r 'zl i co tl i t'tl ' l l l r r l :t
l r r r r , r : , , i r l r r i i 'r l i l l i i
i j i tl ( '|l ) sl l l ( 'i i l r l ( l 'l i l ' \'{'( r r l r ( ') .

l)o: l| {'t i( | I i .

Ir) S rrLr rlcrrrris Jitrntc heniotgice pltre

sindromului tr"lamic (L,hor.
rrl l (', I l) ilji ; ( lr Lr r :i rr,1 9 l i i , c i ta ,t r1 e S a ,g o r,
^le
1 960; Foerstcr, 1926 I S ager,
l 1 )l i (l )lliir r lt , z ir r ni u L c n u c l e i l o r 1 a tc ftr1 i .
,1. fiill(lr'{)iulolo [ulln[r:p ruscrthu, sint tot I ind,rotunepu,yli&le, Tez,li,
,i,rll l)iirl plotlsc vilscniale loca,lizate hr teritor.iul ut:ruia di-tr cei cinci pedir rl i rrr lc li: r li t lc r . c r .i qi in c ..ii n 1 9 2 5 d c l l o i r, Il i l i e mand si N i cul esut: :i ,rtcrcl c
Lrlilrl){} i('ri(,rriil|1, si tallirno pe}folate (r'amlrli alc :llterei cerebralc posi( r'rorr('), |1,1()1.,r
l{_'lrt
irulo- opticx (r'l]}rtrii a, rrterei siir.ienc), arteri:I,iuberoIrrlirrrricri,(r'lunuli a itrtcrci romunicante posterioare) .,si artcra coroidi
, rrr rrrrlllionlii (r:rnnu,ii a artt:rei silr-ienc)" Cele mai iinportaute qi mai frec\,'lrlr. !ilrlrl)itrre till:llnice \.il,scu1:lt,c
sinl cdle trei rarietd,li {lescrise de lherrrrrl l r.r. i r ir r r i ul{ r sdc Si tg e r s i c o l a b . (v e z i Sa g e r' ,1960) :
t) ;il(l)\Dtu,l Lle.obliterare e, patlic,tLlu,llLil(.1& xo-qeniclllat (carc irigi,
|)otlirrtroii llltcrl|lii si l]oiitelio:ir;1, indeoselti nurle1rl yentral postcr'o-lal,erirl). fi1' rlrnr{,t{riizr,rrzl plin tulbur.iiri t'lc sensibiliiato obicctivi, la mernbre
lttt:ti i'rplirrlLl,c Ir rncmbrul in{orior), fiirii afeciar:ea sensibititi,lii felei.
I )tttr.tcr'. rJ,rr.i1e-ristii, se tlli pc 1rltn secnndar $i este pulin explimatd,. Se
trrr,r loi,ilrzi
o herlialropsic homonimd,.
l)irrsttosrlir,rlli]rr imllicii tiiiiicultiili atunci cind apar $i alte simptome,
ttt :rlrrlrr cr,loi scnzitirt : ririrtii tl.rlamici, miqor,ri coroo-atretozice,tulburi,
.r,|r.I)('I().I)j('si irrrrnilrtolts!e hurnitnim,i laleralti (cal.e insj, eslc de origine
ro tl i r':r l; 1, r lr ' 1r r ' r r r lo l l i id c l c z i ttrc a c o l ti c a l i :r,i n . tel i l ,ori ul al tcrei col .cbral o
tro rl r.ri oiui, r lil ( ' r r (' p rrl r i re ri i 1 l e ri i c u h l ta l a mo-geni ci rl at).
Iiit innr'\. rltur'lttt t't'rolo11ic,
silldxomnl talarnic gIobu,l (cn de altfel qi
rrrrrJtrr:rrrrIIrrlIi.trniirtr p,li.ii'tlo) cstc re:r1iza,tLl.e!x)c6p, t:usctilare (ramolist trf l r ri ItItrr'rr.l11ii),It' ottt!1i(:e,l itla)'e,le(indeosebi glioir,me), tlegeneratiue
t tu Il u t t t t r t t, ii ( o1 ,(t' .fi l l i te ).
l\\ \litltitt)ltltl rl.e oitliterorc o, pddic'ul'uLai tu,l ma-perJor&t (c'r,re iligd,,
lrrr,tri
r,ltr. l()riri.n{,irLriexti:ttalanlicr], nucleul se.nilunar :r,llui lt'Iechsig).
lr,.
c
trrclclizlriilii
'-lr.
llin iullrur':ili de sersibilitate obiectiY:i ]a nivelul felei,
rr i<i lrr rrrr,rrrlilrrlslrl)ct'ior'rji :ibsente 14,merrrbrul inferior, L:l fe1 durerea,
rl:rlr r.ris1ii, r<csilur::Lzli1u,rrir-e1u1fc;lei i1i er-entlal al mcmblului superior
r |i,l , l)rrl in r\pfinrir,ti;. Se pot asor:iii un homisin{lrom cerebelos, mifcd,r'i
lirrr,rrrrlr,lozire 5i ,,min5, i:llarriicit,". Prcciziim c:i din date lurnizate dc
I'r,r! || ', r ( , r r( 11) { i6,19? 6 ) 6 i rb I? o p o v i c i n D i c o l a b., (1980) si nrl rol nul de obl i lr,r'rrll rLl lrrrrliculului 1r:llarlo-per'1oi'a1poato fi rnnll rn:ii gl':tl, tnai boga,l,
trr .rrrr lir r r r l, it iir t r c it, i rr l rl )ro p j t.rc i Ll i n i c i rn e tl i anc, fi ecal e di ntl e artcl cItt
lrljitr,r Ir('r'li)llL{r ro iLnp,n't.trirL rlouii r':rmnli, cil}r sc dirijeazil bilatcrrl
,i i ri g r r s l lr Lr , lr r lik r ll l tn u o -s rrl rL l rl rD .]j c cs j rn e l l ico- Tn l tcest fel , l rl ,etol e pc
rl i l rrl rrlr r i lllr r r r r o pi. t' l i o l l rti l i q i l ri rn l .trl i :tr.g i u tL i i l i rncefl l l i ce, l udi fcrerrt tl i tt
r':rtt l ) r r ' j( f plr r v r r r . I ' o rrrl rc to n ( l !){ i (i , 1 1 )? 0 );i l >opovi ci n 1i col rtl l . (1!} l i 0), tt,l t
l!l <.ri l r r llr , l c r J ili|r r { i rr { i (| (rr' | ' l Irr| ()Ii } i Ii r(| tt1 tItr
g o ttrti t,l ,c drt o)l stt' ttttl i i t tttttri rt
rl ttrl tl ' r |r ' llr . jlJ lr ' 11,r' r.i rl i z r,i rz i il l rri l )r' { fil l i l ;tl ttt l i l , rl rr ,,fl tLl trtrr" , (rtt tt i ' i i l tr
l
tl i,. Ic z i rtttr,tl i t' ttr,t' l rrl i l i t l ri l l r l rrt' lr l i i (i tr< ' l ttsi vtrtt rrttttti).
1 ri o trtr r I oI o; 1ir , ; 1t r r rr1

ill

I'ti t .i tr i | | r i t t :t i l l tt i ') tttttti ttt

\ '. r ! i t t r l tn ttttt1 r i i sl ti tr l i |i ,,h i l t,,l ,tl 'r tti tr "
'tt
'
:r
l
':r
r l r l r r r l r i 'r i i r r i r '.'r r r l "'r '' l ''
1
1
}sl
l
)
rlltll,
si t'r r l r r i '.r
r 'i l : r {i 1 1 t, l 'r l r .i i ti tt
r , i r r i 'l t 't 't ' t l i tt g r ttp ttl tl l i ( l l ( 'l {) r ' ttr si i i i l tr ti o |i l 'i t'i i l r ' ;t1 r r tl i tl l r l i l 'r 'r Io r 'r l l r r '
r ttl r l r tl ttttt, r r
i , r r r r r ' ( r 'l t r r r t r l i a l o i ,o l tr }n r L ,i 1 ,') J.,l i l l 1 1 ) r i i i i ,:,i tl l i i t,r l .tt
: l , t r l t i ( ) t t t c k ' si ttl cr ttr l l l l tl xc ;1 i ( 1 '1 r l i l 'r l : l r , tr r i l r i l - l i . I I ' I | | | : I I : I i (' t : I I Ii " l l i r r r l :r r l
, r , 'l 1 '( 'l ( l ) ( r l l ) s t,rtn 1 ,r 'tlal 'tct l l ] , h tttl i i ttr ti l l si tr ttti l o tr i ttl ;' I'o ttIIIr I:r Il .t r |:t l tt'ttt
, r r , r i c z i c c o t L l ti l l ti tcl i l l i i p l o i l o r n i n :- i r ) l U o i l l l l {l i ,
1 i i tsl t'r l o q tt'r ztt"
tr ' l r ttti l
l ) t 'i r t 1 i l r , ['o Jxtt'i ci u ;i
co 1 e 1 r . ( 1 $ ( i 9 ) tr r l l tl l ci t:r t1 r 'i i i ttl tttr i l
, r r l , , r ' l ) i : l ] , i n i tl .r l e , t'\ 1 r i l p i n l l l i {l r l 1 .,
{x'l \'l ) {'l o 'r L ( ', ;r 'r tzi l i vt' 'i vi Tr r r r l ' r t | '
' r , . 1 r ' i i i I l ' g i u tl e :t h i p o tl l L a l r i " r , ,'r r l r ., i r ;r i l :,l i r i ' r .l ' 'Ir III r r l l i r l L r r r r r r L l
r r . r l c t t t t t l i l t 'lt, co r 'fl l ti l l i l ttl cl l L r i si l tr l t,'ttl , sl , r i r ' .,.l tttl tr ttl l ( l ( r 'i r r Ir i l l l l
rl , l r l . t n t i t , i i " .

r, . '\iniJrontu.l,san[li,L, rcrti.(:sl lltrielo['

p a r i e ti l l c p o t tl e tctl n i n r t 1 1 1 ) i l l i l i l i l l l i o l l ttl l ttttti t i tl t ' tt

/) l,cziunilo
r l t i l i i t t l t r t n n p l e r r i , cu l u si n l , tr r l l l u l 'i tr i kr r l c r r l l r i 'ttti 1 t ' r rt 1I rrt : t I I t . :t 'l ' " 't
l r tt t
, , r r , ', r i . r , l l t r - ; l oe n o zi l , tl o t'ttr 0 l ] cx i :i ( i m l l i l si ]l i l i l r l l |l r
tl r ' l t ttt tttr o r r l ''
( l ( 's"l l .l . l t:tstl .
rl"
I
sl
l
tl
l
i
tci
i
l
l
c
r
t
i
.
i
,
r
i
:
t
'
vi
i
u
i
l
l
S
ci
fr
.l
cr
1,
'
r '1"r
r ' tttr
l trttr lrltlt '
t , , l l u r l l t ) t , l l t do l :u r l i tl r ttl tt i , cr t r l j l l i {) l 'tl l l tr tl ti I'r t'j l i tr tl i r r 'l i l )
( 'i l cr i l n \n ) l n i i l l r !{'i t
i,ril(
l r r t;i t l r r l :r i r r l ' r 'l 1 r l r tl l
l l i \ l i e t ,l e cl l 'tt i tL tc: o scttt;i r
t 1 '. \ . ) j i 1 'r o ir u ca a n i ,ct'i o l u 'r i r ' ci t c',ttl r - o l u ( i l t tti l ct l ) ,- l '1 , r l l r i r r {' ( ' l l l l l r r r r "r r '
. , , , r r s i i r i l i l , l i ( i i p c j n l l ti tti tca
o l u si l l l co r l n l l l l i , Ittr i i It t ' I ' r' t t I t I I r I i t r '' It.tr r I It'
I n r , i i l l {'s po i n ci n h i u l su p cfi o r . l l l L l JJm r i ir t'l t 1 tr tr r l r " i i u l o l r r r l r i , i r r l "r 'r r r r r 'l
i , , L L ! {r 1 r ( l L r i i l c r l e se n si b i l i tl l te , s'i tl 1 .to i tl t, l l ttr l r r ttti tr r t r l .i r l l r l i r r ( 'r r i l i l 'i l r i r r l
rr
1 r r l t t t t r l i r . A n i 'sttt;l i i l t' g l <tb a kr ;i n r :l si vtr r ti c ttttl i i ttl l l ti i .]tttttl l l r r l t
"'t l r r r
l r r r r . i t r i i t t t i 'oti l 'o i ttl l o sttsl l tcto l l l r 1 ;i ti :tl i str t- ,\!r '1 ) l t'l l i ':r l tttt'sl tzr i r l l r l r tl '
p r r r i r .l :r l :r i tr ttttttti t,:t r tr ttt
I | | l r r s i \ {, i ) i }l l l p i l ( ,tr o l ) i ( x1 {i \- r l Ol tIi r r i .:l ztl tr l i .:zi r r r |(
, r , r 'r r t r r r r i i i t t ttttl - tt1 1 l :.tti e ti tl si n co r tsl ,l t tl ttl tt' i tl 1 l r ',i r tr r r l l t i tr tl tl i r tl |||t||i IIIII||'
l, i;irrrrii.
t i t t c o t 'i lttl l r ttl 'a t'tt,t l l tr str t si I r i l i 1i r1rI l tl l 'l L c stl l l ti r t tl tl t r ri I I{ | | I | | I I I I I I i .'r l
r tr tl 't
t
r l r t l r r t i i t 'r t l tl t'sl ti s tl t' V,'l g l r r i i l ) r i .i {r 'i r r l ', r I r' t ' r' I i t t t I t t i i r 'l r i l tr l r t'
p fo l 'l l l r ( i ( 'r 'r r l l r l I( 'r r l ( ', r 'r r I' i l I r r r 'l
l r l . r t i i I r . l l i l c ( 'p i ( 'l 'i 1 i r '{} si r r si i l l si }r i l i l i ti j
t'i l r r r tl 'r t' tl r r l t
r r r l r r l r t i l r t r r l i l III'tti o ;ttIi t'' r t t'cl tti i r r t ttl o - r tl i j ,zi ( r fi r l tl l tti
r r r r l r i i 'r i t t vq 'r 'i ti r b i |i I tl i so l i r r l i ,r ' ti l i ,i 1 l l r r l r l l i c
si ( l tti l tcr {, l l l i l ) :l i r l r i sl :r l Il sr l p I r r l r r r r r l r r I.
| | l , 't r r l t r t ' ( r r i i tI Il r '( i tr i l r l t'l
sl ttzi l i t' t) i i i ( fl l l r r ) ;tl .i tr x''r 'r 'r r r '1 r 'r 'r l
t t t r t t , t t i l ) t r l ttti l i l i
'r l <'si tttl tl tttr l l r ti
sr 'r fr r r l .r r l :r r I
i ' rr,r i I r i I i I r ' iI i I , rr' ; t t i rI t t t I t i r ' , i ttr l i l ,r |l r i i r si l l r {ttl i r i r tl i ( l t'l i tr i l l 't
.
I I'l 'l ! ( .l r l i ,.! l l r IIII( 'II|| ( :r l r r ,l
r r r S i r r r l r r l r r i \i l t|i l l o t
( p i r l r .l i |zi tr r r l I) |l i i ,tl l ( ,
l , i . l 'r i a r , i ) , r t ;tt't'r 't'1 r Ii l .i ,r Itttl 'ItIti i . r r r r t {l { r 'i r l i ti r tj ( 'Ir 'I'r 'II'Ir Ir ' ( r l r i l r 'i 'ttr ' tr t
1 r 'tr r 1 ''t r 1 Itti . l r l r Ir r 'i l l l l ') ; I ) l r l l '
lrrIiIIrIi|ol
ItIo Ir 'r 'ttIi tr ' ( r ..tr ',t1 ,r i ,
t
t tlr
l ,r r !i ,r 'r i i ,l i r r r r l i l , r ' ( r r l t,1 r ,';l tto zi r r t ,i r r r I i II I i I I I | 1| I | | | | ;
r i t t r ( t t l tti
( | ) r| | I i | .I I , ' r i r I r' t r I r I i l ' I r r t t t I t t t I tl Il |tr l ,tl 'ttl I't l l r l r "L tr tIi tti r ( tIt tI''r ''It ztl r ) '
r l L l , l .r Il :r r tt
i .r '
lrl\
r 't|."IL I||L Ii i
l l :r 'i I1 III|' ||i 'l l ( .
'| 'I t I i , r r t I rti I,.i l f

:l l :t

tr

IrrLrLrrlrrIii,
rlrr olriooi ir cvltlrrrttl, ilrli',r'irrr')
; lt) A'ir{hr)rrrtllui 'ltrl,ttt t1i
rrrir
rrl
ir,,
ll,rl,inxl,:i
(ltrrtr
rirrsotttrtlogttozirttrtzollttttzir',
I i) A'irrrlt
5i itttozrrtlilLlirt'irr)
tli\ lr,
tltr ll, I(tcllllorl!Jl'rr'
lrt lit t'til,uL
\n,' ltgtl(rziotligil,ltlil'(itrcttltrtoilrt'k'it,
tltt llltclrrIl,ttl
rl,,rrrrrrri
qi tltr lt,tlilittttr{,il ctrlocittci tlsgtritr,ttttr'ltritt tllltrrt'1,
lltr tilrttl ,,r,ltrsi1tg
Irr:rllr (lc orit.ttl,rllotlroaltt'lr-sl,ilga
I ltcalcttliel rtgtiu{itr
rrr'rr, lrri Illlyor'-(iross(irr spocirr'l
lltltrtltt cxtxlttliit,lltitti tltt$tlttttrtll:t lllrr\i
llzittttilor"
,,,rr.llrrefii);-j) Altc sernncl,oqtogxlJ
icc corticnle, ptilt osl,ttrl*irt,
l,r Ior'rniri,iurlilevocine.
t, I t tin
:)) lir cailrnl sinih'ornului pu,riotal sa pot itlanti'.li.caur nt,iil,tut
rlr',rrrtttr topograJica
:
r1 iliidront'ul senzitiaparietal global, clasic, lvl lrti, ).)(i6rint xi. l/lyt
tr'lrt
r,. r'r,o[noaqteprin tulburxrilc de sonsibilitatesuhiocl,ilL rii obitrol,ivr'i'
trlo ttterior, Exceplion
asoci;r,zi\: antiotrofic, hctnitlllollsio qi rtlrtzirt
lrrr Ir,ziunilestingi).
ll Sintlromul, de girus puietal su'peric'r (a'riile \tu, 5b) t'tl.r'lizo'tnti,rt
.rll.r'.rrcrnai pulin marcatS,a tuturor sensibiliti,iilort 1o ltt:trticorltttlrrott
lrrrlrloral, cu test&urarearapirli, a sensibititii,filorttlcl,ilo,toltlticii;i tlttt'r'.
li Lii'l,i
krr 1It'rIIttIItII'
r,r.rri, tllr cu rnenlinerea indelungatd'a abolirii solrsil,ri
c) Bindromu,llui Anton' 1i Bn'binski (vezi :ltrtcriot) cslo Ittrt,lizt,l,ltritt
lr',riritrimri ertinse, cate implicii,: puietala, anteriolt'ii, ltt'itttrt uri ri, rlottrr,
r rr, rrrnvoluliepr,rietali,, girusul suprarnillgirralqi u p.r,tlc r[itr pliort,trttrltrlirtl(\r('i{(firzii,
tl) Sind.romul,
lui, Gerstmannestc produs priu luzirtni (1il,l'lr
i cit'ctttrtvoltt
lrrrr.!i'tle trecere.lintre circumvolulia parietalii inlloliollir, ,,s
\', ," \'il,it'lla mijlocie clin pirtea sfingi.
t) Sindromul parietol p08terior al lui. An'drd Th,ottt'tt'tt${) l1!olllrt)rl,'1l'(\
irr
1rr ; henianestezie predominanti, pentru tact 1i portt,r'ttilrttsiltil il,rrlrrrr'
1rrrrl rLrrili'i,
I br':rdihinezieqi disrnatrie, apraxie idoltolicI orxril,rt'lttvrrtltrtlii.
l) Eittdromul'
Ttarietalp ro.fwfl' al' lui tr'oir (prin lozitrncslirrgii)itttlttttt,rrrzrtr
rrrrrrit,otul conteit semiotogic: tulburS,ri souzitit'o billl,rll'rrlo, illirttlntirrrl
trtrri lles simlul pozifiilor, apraxio ideomotorie bililtotrtlit Illtilzitt tttrrrlrrritl,il
(,1,,tip mixt); hemiplegie rl ro-r,ptri.

iii,,iiiii,i;;1,,ril;Li'll,iiili-#l**[qt*[,#;#i'fl"'ii]
;.i;r;;"';i:Iii;itijlil'i'li#,:lii",
rrc.seusib'itateselocalizeaza
pomini,sau
'"1.
jr:
t ul]:uririte
Aus""silriiitat",i-oiaor,ht"

d" tot111;*,lll..
lbi:u_r
(,i,,,, ,',ru,rrr,
,,,'',,..,
ri.lL(lrr(r Icz.lroa conccrnitenti, a fi,ontalei
assendeate in

rr,rlir,ccrrto
;i rrcl,l,rofiioror"oraro-*"*itn.iJiJ.i^o"."rlre
de-Sii"
il;iiiiliili.

gg,lii$11;!li',1$lll;itt,*
;x"Jilill?1,"#"*'jtl:,'"'i",ij""'*'.*t'11:

aproa.
ltii:i?:1TrJ.........,fi";:ilr1,'1,';*i*",'S"iliflili,":"i;*rroduto
lillilli'Ji;J

;IItn,li'l":;;,;lt*lui
il,1,lj:
,t,1*riil"*,y*::[;9l;:ll_itffi:ff
f

iiiiriliffi
!jri,"*lf
#i*:i?rdffi
,rrurmnay,*,i:i:s"*1
)r,rT',trnr rile subiectiw de
din sinalromulparietal con,r,^,,.,,,
'ensiiitita4

a,morferi,
carcpotprera
ra
.,,,,,,il,,0'Ji'''Jifil',i*.."13"'*1ff**n'J".ll;;H:

j?Htli,"i*Hi'"r,"jT;;c?},^pi"si'ci
r,,,,il,i{!i.':,i'if#tll#?ll;,'i

care
,,,,,^,,?,.,1liii,iil#':f::ifj'iij?,1,fi.*1,"*
llj*,llgf;y,i:robiccte,

jfl
l3'fiit"il:;I?f
,*li;l[tx,T"llJH3.:*;l:
:r;r:,rl,i
i:::ii,;T'fiiLi;,tf
'(;il',l:"jlili',J",;;Bli:

i.:,fi'J;i;"1.#ll"T?;"jji"il,lJ,:*.i*:

l:ititlii:;
'ii:ii";11"-iliilililli'hllli"'Tl?#ii.,i?i,,fffil_X"-1m;;sticui,rircrin.lJ [)c

o tenld, t:aloare d,i,

s,,ttitttt,,
h,,,,:.ttiz'r..o
deobicei'JLi'jJ:,:]#:;i;iji,i{x.f,jj";,"ir,,tr",,lf;,::f.
r,'ztt{s'trz':rlii
rreartLor(crl'ti'
ri,,illlf,i'l:,,];"il|ll,l;l,U:lliifi,,i:T,*
i:lll:,;!!ii'Iiiil","iil,ii,r"eori
cLirr imp'r,oir
rr.,.:displriri.,,.
a,meor_
illi;:,
,,'irfl rr'sUn()rly.
Bu-perlor
.

sau itfefior,

a miinii,

slu doar rr, unor dcrelet^

DIIIOI,,()(iI0
?.3. PROBLEMII]
D!] DIAGNOSTIC
IN DIVF]RSESINDROAMII
AI,GIOiI
7.3.1. Cefalalgiilc (Colnlcilr)

ijt:ililil.tiili::;
i,T,:l:;r.,1;';#i;;j;."H"ilffif'J."JilJ,.HX?"",1""'Js,;i;
,,r!
{} r1r'rzl't,
nlororlc dc 1jp R rav&is-Jackson.
\\ Cefalalgiilc acule trc srrgcrcazri,,evitlcnt, o co,ttzdnrt,lli,,
.

!)

I,la o ce d, raloara d,iagnodicd silt

;i ,remzeleserniologiceasociate

lxr or,r'o rl
Inrrrrrin considolarc qi o invostigilrrrin Iunc{,ic de lootlizl,r'ol cofllt'oi 6i rlo
r orrllri,r.LIclinic in c;u'o apu,to(Arsturi qi Oproscrr,1007; llrrrris ryi Wrrlll',
I lrl'1, (rit,trfidc Arsoni 6i Oprosorr; I]otrovi0iu rii .l.,rrscu,
.19?0):
I ) hr t:t'fo,lalgi,it(t la t,l,ir(,l(: it) 7n regiu,nao.fronto-l,arttpora,[ii
.' sirruz i h]
lrrrrLirlir,
sil,uotrnoidrr,lrl,
lcrrii,l gllrrrurrrrlilill'i su,uilirlociclil,ii;lrrrr';x'slli
(Irrrk,o8rrItI
itir,sir,rr
rlo rlivrrrsotrl,1;rrIi
irr'lclioprriio(t,crrr1xn't1I)
1J,,rrirrir,l
I rr,r'tot
l,r orr,rrrltrii
irr yitirli)1 irrxrrlicirrtrlri,
rirttrllr1,rrtirr
crrrol,irlirrtril,
Lt'rr,uttrrr,linttt
I
r l.frlirlli lrl In rtllitttttrttu'ui1t
il,t.tl./r,,'
trrvlllgirr ocoipil,l,lii,
-AlttoltlI ltrzitttti
li't\ icir,lostr;xrt'iol,lt( | r'rrrrt rrir,I i rrrr, trrltrrir,l,icr,,r
lrot'rriorlircrrlir,,trtrrur.tlilctt,t'"
Ilrrzir)1llrrfrrrrrltr lriprrtlr,rrNirrrrrr
(rtr vn {itrrr
rr,r'l,rrrillil
l,u[lr'i,rrrt,rrirrgit,il,
; (!\'(!n
oruri1riIrrIi1
tr,,rrttir11itlr, rrotrli,tlttl rrlirrirr)
r,iolInll rltr rl r,l rttl , tt,t ttttt i
; |ll,,Xirr

ffi'i'l,',v!,##l?f
ff,i,{ti#t"l1.HT,Lr,i:*;n"x*{4*-xi
lli!li,!i:d;f;
l:l:l't.:Yf::,i:.3- Temb,rurBurorior,indeosebila muDchiimici ai miinii, raleolr r(,illzuld un srndrum um6r_mind,),insoliti do tulbur{,ri vasornotorii

Il,fflil;JilfrlT,::li,;,"i:;i,i;'):z!"n,ii:;,yii,.l*:ll',li*rlli*,yl
ii
n(.nzrlry
propriocoptiv);
d) Tu ru.rdtioest
ibutire.1r.arr,,
suir
flll::.iti.l',,:'.rl

fi'i'l-ir'iil,iil
r,lli)|;,!)tiiillffi'iflffiK'ff,(#d:fiiHil,iilli'f
i,,ll;l,i;i;il;

xl,ittgi(vrrzi glp. l0) ; g) ,t,tLl.bniari

lizri,rlr,(lrr.mirr,rrirlrsi,,
lr,rrnotrirnrl,
t,,,rr224

tth
l !-rLl l

lr'rtr'rllgii,-slrl)rr irl:rt.irlit,lrc
(llr, bolrrlvii hip.r'tcnsivi, rrt,teliosckllrri
ici qi
l:r, irrrlivizii ln t,il,Nl,ii,\l/ lrr u.lekrl.yiil(1gtnuali::a.le : a) Protc.sc i.nlt,ucranieneacute (ltenn "
,
I rr rr(! ; ll{rmo}'ugii iltr,:rcerebtrlc - in c*re cefaleea,se instaleaai, deosebit
rlr, lrlrrl;tlr plcccrlind coma - srru extracer.el:rale turnori cerebrale cu evo.
I
lrr{ir, rr,rirrrpi,omilticiBau cu alte sin4rtome pini in moment}l declalqJ,ril
rrrl:rkrr:i, plin creqtere bruscit a tensiunii iniracraniene; procese infla'ma.
l.'lrii, ll)ccsc celcblllc. nreningite, rneningoencefalite
; irdrnboze ale sinu, rllrl lrr'r'on(,rse.-i rle \'onclor cerebralc) l->)In.fertii qenpralesud t.,crtll
;
(sc vrr,ctiutil contextul clilic infecfi_os.1c) Altc inJbatii; ineningite, arterito,
i
'craniene
'n6n
f lrrlritq, 1,..r'rarUebitecerebraleI
Ai
1 71
.d.1
.Traunotismc
lt i.lr(t lt.ttsiunp afieri^ali.I f)
(cu
oaica!,ii,
monoxid de ci,rbon, ititri{i,
.Int
rrilr':r{iq.r.): g) S'rf/.iirlf riscrraleacutcsou aculizate(caretrt,brrje,;rrtrio
l,rlrlliilrnr r.ind nr1 ge poatc clucida utr met,anisrncerebral).
ll)
.C^efalalgiileperioilice (Amcli qi Opreecu, t|)6?; Botez qi gerbi,.
rtcsr:rr,,.1965
I Br"uetman,19{4 ; Kudrow, 19?4; popoviciu Di pascil, 19?9);
,l.l,l!ig11l.o(in.situal.iilcinmr.ealgiilepre2iuliuncaractcrhernicrrnic,
lrrrlsrrtil,inso{it $i de alte simptome, indeosebioculare). Vom reveni rnai
li|z irr iulr-un subcrpitol seDarat.
.l[
cerbrolc (angioamc. anevlisme,; se pot
, a(ormo! iit.e
-ir"oli,2)dc
-r-asculore
crize cefalalgice
pscudomigroroase(dar aproape totdeauna'rlo
:rcr.r'rrsrpat'te) sau nemigrenoase, putindu-se insoli in ulele accese algioo
i.r rle rrllc simptome (crize epileptiee, hemipa,reze, tulburXri vizlale, fdno.
rrrr.rrc:rt:tzice, eventual de paralizii periotticc de nervi oculomotori_ca do
llrl'lir, in rlnevl ismcle de aateri, comunicanti, posterioard si in cele de a.rteri[
Ir'r'|'hrrLi posteIioari).
.. .3) le,Jal.algia p.arocisticd, peliod,icd, tn tam,wile cerebrale este rar{,,
tipul ct'l mai obi;ntit fiind de ceialee progresivii, cu orar. matinal, sa.udo
',.l:ll(.e c()ntinuii cu exacerbi.ri paroxistice (Arseni qi Opreseu, 196?). ABth'1, cefrllccfl,prroxisticl pcriodicri este car&eteristic5,pcntru fazele rie detrirt
;rk, lurrrolilor dc vcntrictli laterali qi de ventricul al treilea, tiind declanr;r.rliirlc _rnoditici,rile de pozilie ale capului, de trecerea in ortostatism, do
,'fotl ;idc slrinul (ArsenisiOprescu,l967) si oste in,lol.iti$i do al[c ,onrrro
r,.tttol,'gict.(obnubil_5,ri
paSagere:rle vedcrii, tulburiri din pa,rle:LLtn r
rrr.r'v
l cl'i|,nt(.nlsI endoerrno),
! ) Aefalceu Ttaronisticd,d,in, hipertensiunea urteri.ald,poate fi tlifuzll,
*rrr locirlizrtL (fronto-tcmpora,15 sau in rertex de obicei), api,rincl brusc,
rl{, rjr'loruil,i multc ori sple rliminea,ti. Se poate realiza qi o formi psettlorrrigrrirou,sf. Examenul funduiui de ochi arati modificd,ri nete vnsc:rlaro
lrprrslrrc ilrteriale, edem sau clia,r hemoragii).
5) ( ofaleaaparonisticd, d,i.n hipatensiunile arteriale tecuntlu,re oltor
u.ltrlir.tti.(fcocrornocitom, aterosclerozS,sistemici, qi cerebrali,, ecla:npsit,
irloricu,lii profcsionale , suferinle renale) trebuie corect gi la timp identifi:
cul,ir,irr contextul clinic qi prin investigalii corespunzitoare.
6) Cefaleea parorisli.cii, di,n encefaloputi& hi?a.tensh)d, se inso[r:qto
,si rlc all,c rnanitcstd,ri cerebralc consecutive etlemului cerobral acu1, rlirr
ircoa,sl;i'i,
oncefa,lopatio.
7) Uttul.eaa parotisl,icri din hi,ytoNensiuneu
o,rteriald, (t:sen{il.1ir,snu
rrrcrrrrrlirlil,
tlivorgilor frlotori) rto csto sugclalll prin survenilca accstt.iir,Iio
lrt ltururlolr,
irr dinosllt,t;innt(,,cclilr,klr
rlo potnil" - I )iirtrrcsctr,1)rxIotllIu,
l1];8),
Iir', rlitrtpoh'it,rl,lrt, l,trr11'11',1
itt ot l6ntll,istrr (ltilxrlt'ltsitrtrrtrr,
6t'i1s1:rlir,:i),
it"\(l

qi t lr r lr ur lr t it t t t r , ,vi. jiil, t r I . iit t t t t |r r lLl,

trr rl rl | rr Irtrrl r r r , [ r r lr r , ,Hr
lt rlr cr r t r t lt r t t t ilr zil,
i rrr,,l ,l r, ;rrrl lr ilr r l, ii; i rrt rrI ri li'nI i l i lr t r , sit t co; t : r ltHlt t t silt collt lt , ,
r: 1i ltlirlirrt rrr,
' ) t'rlrlu't, 1t rt,t tt.t :i :tI i r:i r. d,in. r.nrh su.lrt'i.ttI.rr
!rrt.ltttottrr.t
.l .,,r' r1rrrrrrrzr ri lc cr ir lt r t 'llr t t : ll, t r lilioii, r r , f t t t lr t t t ct t r : lol lr t t lii 1t t t I t t t ot t it , t txt
r ttt
l ,r,l 1 r, r.' l r. l r t r z. li.
1t1 t', l,rlurr, prt,t'o,tisl.itiirl,in,rLirvt'sd,rsttloitx!0 tli.gtsl,i.ruirltirllr itl r'orl
l , ,l rl , rrrrpl, or r lllic ir l lt . r r , sI r t st t lir linlc,
| 1 t't lirlr'ilr pu,rori ,it:t:urrr su,r'pinpa ut. Iond dc ot.fu,lotttn.l,i.nutt,tirlt<' L,
i, r lo t r t lr i iI lr p0t l, lt , t t t e,( ] |, 1'(ir! t lpur l t llilslr li r lr ! lllgr , llt l! ,
rl | | | ,,'r,,rri l (.sr r spioir r r rcr
I l tr, I

l nl t:tl l )i u1)l c :

i ) 'l'rrrun'ilt: cercbrule (tlo obioci sc irtsof,eso 6i rlo rr,ll,o sitttltlotttr').

' ) l n t rolt t . lit r ,hiper t ensiu, ni. i inlr acr uniene t lit t it t t gioilt t r t r Hit ll r r lr r r
r tl

Ir'

| ,t , r' ( \ | ) | I I I ( | .

'| ) ln ralu'liu, tratt matis malor cranio-cerebrale,,clrttl po ftttttlttl ctrl'rt,lrrrri

pr' l l r urri r(i co so llor luco o ccf alalgic Dar oxisl, icr i't lvir lonl, ; i, r r xisl, l' it r r li
r 1rtt, I,rrrrIrrr. r r lii
lnr ui helnat or n int r a, palenchint at os t ( il11,( Ar sot r i f i( ) llr ol( 'lr t
l rrr,, r, ri rr l r r r r r r r ilt lt c com plicat r ii coleblalo.
I ) l)11N111ev7,.,
angajii,rilor (a nnurilor ila, 1n't:t;'i,'unr:
) itt l,ttrttoli trtrlrr
l ,r rl ' ., Irrrrr
t r t izo vi, t
rrr|, oilr
r r r r , abccse, chist ur i par azit Dr o f , a. ( l( x'liill, , oit zt '1
l r,l l , rl r, r' r,l rrlcr r(,1r r r esint inso{, it o qi do f onom cnc dc st r f t r r it t ( , itit',|'t t t t t t r I t it t I t t i
r, 1,' .rl , rl o ir cglilit at e pupilar i, or r ent iual qi do I 'o. t loxo( lo ill) t t ( r , r(r\ ( ! {r r r f i
''
pl l r' l l .' \):rl otn i; cilr ipendular ealeglobilor oculr r i) dol, lt ll) llt t it 'i
t 'oxlt it r t '
l r' r,r | ,1,.rrrrlt l or i( lo com i nr oAr esivr i.
,) tt,.ftlti Ttlsonistice ?e Jondul unor caJulu,llliitrrnl.itr.tr'rt
pol rtltr'rtrrrt'
1l
Itt lt' t:t'rlot,ttt.t:
su,Itduralecronice, \n lTfela procese tlc JoYti,potslt't'io(tri (ilt r'1iilltt,
calt ult t i) ' it t t r it kr r t t ( ht t oit lilr
l l l l , l l l , Lr('(l of l|, locaBeexacer beazd, lam iosct r r ilo
,',r,1,,,'/r (1rosll,r'nrma1,ico, postmeningocncefalitico)r ltt .rldri/r' ltrt:rl trilit't'
t'1,t1'tttttt t irr .lenonenelc d,e kiperterniune aenousd, (\tt lrlir(ll,illlri trrtttlitt,t'rr
rll, | , |, | | |r' | |iii | (,I r sau in compresiuni pe venelo jugularo) $.t1,.
t' ) ltltt'il,& tentporald' (Boala lui Tlorton) ponta ow)lllll, t'tt trollr,lrrl
in ciiagnostic tlupri tabloul clittitl 1rIt t ' |,i t I tt Itt t'
||,r', r,rlirlrf. No oricntim
ir,r,l rl,,r' trrrlsrrl,ilil uisau bilateralir, Iocaliza,tli,Irrtrd,t)-1'ollI I x rl'i[], (\tir('rrt
l rrrl , ,l l ol i rr '1, r r li,de apleci, r iie capului $i clo olinosl, : l[ 'ist r rr yi ilr xr t lilo. t lt t
i rrrl ' , , r' tr{ri p ulsnl, ili a, a; r t r elor t em polale St t lt t r l'f icit t lr1i
r r lr r t t t t t lloot i 5i
(
Wolll,
llxi;
l) .
rl r,
l
i
.rrrrr
r
r
r
nc
colona,
r
'iono)
ccr
cbr
alo
clt
iar
;i
' rl trr (ttlal('uL
tltt ltlticrri itr
, )
d,in atero- ti arterioscleroza tertbrt'Li lt,1tit,t'tl
,,1,r' l l l l .,rl i rl rt ilt o ale acest or af ect iuni, dar do m ult o or i f ilnsl, r t t liilo; t t r r lolr r ,
rl r, rl ' ,l rrrl rro r r r : I st cnic ale at er osclor ozoi ccr obr a'lo ( l'opovir r it t 1i r r r t lr t lr . ,
frfr,r' l ' rrl rrrvir . ir rqi Pascu, 1977, 1979) .
lt I t't'lttl(.t(i.ile continue progresit c ne srgotoivil urttrill,ort,rtdrrltl'rrr'litltti :
| ) 'ltt ot i aertbraLein primul r\T\(1,2\ Ilatnabattac (ittl,rrlctrlrrltt'rtllrrtt
,trl rrl ri rrrl ), rl o obicol sociindu- t io 1i r r , , o sim pt unt u r lu sr t ll*'inl'ii,t r ot t t lr t ; llt l,
.
t l r, l r,r\ :rl r\ sl, i, r 'ii<lc vigilonll gi sct uno olr ir r t ivo llt 't t t l) l( r gio( ) )il)
- . f t r r r r r |nd
rn||,,ttt,rIttii rtnhn t (rr,Lccsti,tiqrnbtrllebitc ct:rolrt:r,lt', 1;tuttrlxtIlolril,rr tlo
alrrr ,'ir1(,nros, l,rrrutlxrfklbil;rj,tlo sintts IIttortl, bt'otttlxrlllollitr'i,rlo rltttttt
,r' r1,rl rrlrrrr.rrir
,
r gil, ro,
noningoot r ct t llr lit ; o)f ir
, l t nili it , t lo$otirl,t t lr t t t l; t lxbsot t t iolr t git r
$(\ l)t)llit\
I r|,I rt , || 'ii i (i 1i irrfrrol,iosrnvolill;or'. ,ll II i ltri,ant itt,nrut i n,lruontnitr'ttr\'
'
. l r,1,,lI rl (r rrr,l'r r , lroor
i t t t , it t t t ol}11) glo'{ivlr
r o r l, ir r t t illlr r r glcxivr 't li)
l) lll, t ! t ll
. {) r r f r r , lrt,xt
fl fl rftrr l r l t i n. f u, ! ii,17n, ur , li, [ t 'hr ilt ( hr lr t r r r , t 't t ; t l, ivr rf ,r r lr lr l lif oir |r \ ' I 'iI on olt t t t '
l r' rr rl l fr tl l rlI r 'i( , , , t t r r t t ot t t t lllt r t zil,it t l'r xt {, iot t t t i]gt
, 'ilii) , ill t r r lr t r $t r I t , f t t lt r ir lit t l,
rrl rrtl r Li rl rrrli, qf i6H l! , , lr 1il, lir r r lllr lr r l r r l, r r ir r {r , r r lr( 1! il, r r tl)t lI f lit , cr llt lt xr l lt l

x27

ir+r., rtl,tirtrnt'
rltfctrtt{it,l)r,tlilicili alc slilii rle cLttts{:iin1,ri
6i pr'rbcltt
1i/srrtt
rlr. I:rlrotlrlot t'c\'clatoi-tr(,.
l')) (lt'[ulutqii co'ntinue curstante sau cM sicotrst{r?rr,(eYentual cu \{r.r'r'lriiri px,r'irxlice)apar in foarte numetoaseafeclliurriI L) Leti/ulli oso(ise
,,trr. tttrtirttlt'tn aie cotoonei.ceraicale su?erioare (fn acestia cefaleea cstc
,rr'r'ilriio-rrrrcrrli,
so cxacerbcaz;lla schimbirile de pozitie ale capulti $i se
irrro(cslo i,,iilc :lrnedeli.)Ilste vorba de: unco-iliscartroze cen'icale, rrrt-rlforrrrir{ii rrlo .iorrc{iuniioccipito-cervjcale,rniozite etc. 2) Insuficienle circuIr lari i rart:ltrale (earotidione qi/sau vertebro-bazilare), 3) Arah'noidit e corc'
/rla1r:(lxrsi,frilumatice, postmeningoencefalitice). 4\ Ce.Jalalflii de tensittnet'
(lrsilrogrrrc). Aci se irrcirrlreazi, gi unele cefalei prin coirtnctura Dlrsculalru ii r:ryLLlui;i a gitului (,,mtscle tension headache"). 5) Diverse o.f(]i1ttli
sislrntirtt (ancmii, le,ucemii, afecliuni a1e sistemului rticuloendotelial).
ri) (lt.lirlcur,bolnarilor cardiaci fi di'n alte stiiri' hiponice (insu{icicnlc catdio'
lr,spirrtolii cronice). 7) Cefaleea posttrarmatici, (postcontuzionali post'
'
a
t , |||' ,( i()i rrrIi ). 8t Ctfqlpeo,boltat'ilor hiperlensir. 9) CaJaleenaroniri
'
,ti,thriiril,tr. '10; ln'direrse suferinlo hipatice., dttohenibiliare fi t'ettale,
Il) i4prstuf i,l,iiladed.iaerseorigitti, (endocrine, neurogenc, in diverse sufet'inlc
rli;1r'slivr:,s.a,.)pot prezenta in contextul clinic cefalei persistente, zdesea,
|rr rrrirr:cl'bii,riparoxistice, asocia;te cu parestezii peliorale qi iir membret
(rr sDirHr[ cmpo-pedal [i uneori cu manifest5,ri conrulsive. ].2) II i;pogli'
(r'rii(r se manifestd, prin cefalei cronice) de obicei cu exacerbS,ririnsolite qi
rl(f sr)rnrrolcntii,, sti,ri de obnubilare, transpiratii $i uneori cdze conY lsiv.
lii)
nu uititrm cefalalgiile din aJealiunile octtlarc (ghucom' tulburiri.ito
'\i,
lcllirc{'io, iridociclite, cheratitc Di alte boli inflamatodi ocularc), din gfec.-.
lirrtti. na:ale, rnastoidtene si. sinttaqle (tralrmal,ice, tumnu e prin infeclii
rlrr frrcrr,r'kroale 5s.a.)qi dit:rir'fecliunilemauilo-dentare(infeclii de focar, perios'
i ittr, l,umori q.t.). f +) Cefti,lalgii.lehot'monale(1* femei cu disfurclii oYat i"
r,rrc, cu mcl,ritc eronice, in proclimaxr in climax etc').
lt) Ceful,algii,lec\nl,inue regr$i1i), (Arsni $i Oprescu' 1967)-sint t'epro"
zr,rri'rrio ile: lj Cefaleile din encefalopatiaposttrm.malicd'' 2) Cefale;iie ltl
h iprrltn.si.ttii tralali . 3) CeJaleeaStsihogenti(hr lemisie). 4) Alte a.;feeliuni{venl
rr:ri sus) in curs de vindecare.
7.11.3.nl igrcnele
Nligrtrrt l,r'ebuie diferen{iati, de restul cefalalgiilor 7}ritL utrs.at$el'.e
xrlt: xrtirtiologtcopaz"ticu.lare,in sensul unei cefalalgii periodicer predonti"
rr:nrl; srrrr o)iclusiv unilaterall, pulsatilXr insolit5, tle obicei de tcttomcrttt
,rrrrlu rr (l'otopsii, hemianopsii, oltalmoplegii), de tulburiri velietiltivo
(itrr'(rfi, vr'irsil,tui'i). De multe ori migrena are o incidenfi, familirtiri. Litt
rrll i.k.rr'rlrrlilyoai)o decisiy de tliagnostic cste reprezcntal,{le r!.ll'i1irl
,rlriirrrrili irr lilolestenli (pind,la virsta dc 1A-25 tlc ani), astfcl incil ull
riirrrlrrirrrrrriglenosapd,rut tlup5, tirsta t1e 2,5-30 de ani sugcreazirllltLi
rlr.glrrbiu o lcziunc organic:i intracllniani,, cri de pikli, un tune\-r'ism' rtll
:rrrgiorrr,o turuolil ctc. (Arselli qi Oplcscu, 1967; I)iamond, 1974; Iilboln
r;i I)r. Iiirrc Olivrrrius,t07l).
trirr
I'tohk.rrtc tk' r.tioprtlolle
l,

lllilltutrt' dttitlt

uilrtnu

ttnnmrii ',ti rttigttttrr',,tin rIi rIt'r'/ti tt r' ' (,,itt

)
,,(l| izrr i t t I i i t r{ t t i I rr' , , , f lt t Hlt ' t . lt t r it , t lt t , t r lt r r ' ) ) ir it r l, t r 'l i t i i v

,.'',,,,||

r t ; r , t ( l ( r l ( \ r l l r) r , 1 r1 l l l ,

l , r r r r ; r t r ; r l t r ( : r , r 'r 'l o t l .tr ,i sl ,:tr l i i ( p l l r 'r .[r l r r l g i r ', r , r' I rr I rr I i i i rr r l i p o r i l cr 'l r r Ir l ;i t,')
, r r r r r r r l r | r r ir r g r .r tr 'r ';r l r r l l c l r to l r l |tr r r r r ,Ii o |tl r Io t|,tr i |r . r l o l r .zi tr tr r '
'r ti j r r r i ,,r
,,r,lrt,rl.r.
l l r i i r l ; r , i t r *i Il r .i i i l r r r ti r l r
tr r i g tr .l t;i , tr ttt i tttl ttr tt, r l ttp r 'i tttr i i r r tr l r r ti ( At.tl tr i
| | ) l 't l 'r , , | | , l tl {i i ;
l l l i 'I ;
l ) i Il |l ''||{1 , l 1 }? .1; l ,]l i l ) o r r !i l ) " l i 'i n r , ( ) l i vr r |i tr s,
I l l r r , ', r r , l l , i) f;) , l r u l ( ( l 1 Itl l r r ttl .i i i tt si ,r tl r i l i l cl r , r l i r r g tto si i r ttl r r i , r r r ,r r o H i i i r u l ,
'
,
r l , r r r ', i r r v csl ,i g r r {i i i l l '.r r l '' ( i r ( ,l r r si v l u l r ,ti o g r r l i cr ',
| )t I r"t rI r | ( )(' r | ( | I i | |, ,| 1r'rI
'
I r 'l r , ( , i l r x'r ( fcl l r l r i g l l r l 'i l r ') , i tr l tl l i l
ll,,
i tt sp r tl r .l l l r tl r l o u l r r i tr r i g l r .r r o i i tr r . l r ,r r l r r
'

, l l r ,,l f

f,

l '\t

'ulu

ti4tt

lttt

t , r, l t t t i , , i

' ,11
i qrr'nr r ( t . st 'nu i) t t t t u'r t lor lit r tdt iu: [ iu ( t t Jr t lr r t t l( l. il) t t t i|t t t|t 't || r t l
1,,,tl ' 1,4t(, tl lr : it , lt r nit nolt t it t *i t r lt sit t t lt lt lt t obI r t : l, it rt r lt nt loqir r ') t ir lr r '; r
rrrr IIui rrr.l (' r'vcllt t t liiili
:
tl l l i rttt, uii t uilabild, it r silr r r r liilir it t r . : ur r sit r r I l, or r r 'lr r r r r . r r r r lr r gir , l
rl rl rl l :rl r, 1r.r! , r r il, r xlillt 'r ,cr r cr izli, lr lgicir ,sl, r r ir r r or liI r Ir,|r r pl'iclizii, r r r r r r ir . r l, ul
rl rr, .rl )i u( r,r t t r cclr t iiicon( ir ir t t ( lo iicr ir l'( )t lr t il'1,ir r t ilvr , sl igr r f iilc cot r r plr . lr r
rr,, l r r! rrrrgio; llr lir r r r r , t r bur li) t r r r ovit ler t ! ir r zr 'it r it t t ir r ot gr r r ir . ,
It1 l ' :i rttrlant i. r lr t ntt liu r tn. giot t , nt , eLc
t : er eLr u, ltir, ) r 'lr t \ r st 'lr lt r 'lr r u{lr t 'r ) l! r iliir .
rl , ,rr,rrrrIrrrrr iir r r r r 't1x'r
r t , sislr i, ; i r lupii r t ispar i( i r r cllr la, luici,sr 1l) lr 1,ir $( r 'r . r : Ji
rr , r' 1rrIr.1rI ilrir',r t lr r ,it r vcsligr t l, iilc I it t liologit 'c si t t t t giogt r lir r r scr l''pixlt "r r zi,
'
rrr rl i , ,r r r.r i ti t, r , I t Sot t lll
t 'ii.
| | l':r ttl.otJtiqt'()tq,tlitt, rt,tt,ttrti.sttttlr<:crtbrall: totrpot lr'i o iu,t'irrrl,' r.lr.
rr rl , r.rni (,lr ) gir ut t lif ct elr ( illc 1l! it t lt : I uigt t 't r l pt r r pt ir r 'zisI ( \ t 'r r r 't r i i1t
l t,r, ,( n, l l ){i 7i / \ r 's( ini ; i colr . lh. , 1974) : - Vilslr r , r r lr i i rrI ri rr|,Ir I ji, it r r . : zr r r l
,,nr \ | .| | rl ,l or' psr ru.
r lorIrigr t : r rot rsc ( 30- . 10 r lu r r r r i) .
l) Ur ': r lr r pr , r r islr , r r {r 'r
0ir t c nU r ot t r lot xleir zii,iDLr r lilll;r lt r lt ; i I r 'izlr ,r u'lt r lr r l, ii|'i,
' r r' | | r.1,' f rrr.r r t r r kr gicc,
, I rrr rrrrrrll (.r l f i/ sllr ilicot r ) plot .
I no(
, lilioiit iI r l slllii r lr r lor r lli
Pt 'r ^zt 'ti,r; r 'r
i ,rrl .r , rr l rrl rlit t
icl, t l iu ilr r evlislnr r ll) r t r pl, o.
l) r r 'zct r {, ir r, r r or I ilir '. r li|ot '
| | rI|| ' II r.rl i | (. (r lcili noYizullizit r el r ] nni 11r r ev|ist r1xr
t ungir r gr ': r liir , nlr rpr t lr ilr l

Lt

t;"j, rlirr trzrui, rlupil,Arseui ryiOprcscn, l!)07).- l,)virlcrrlir,r'i.rr

rrrrrrr
i i urguir olcnl, in ca. zLr I anevlisnr elor f igur llt c slLr r r I plr . f ir r r lilr r zr

,.'rl, I irr i irr sp|!iilc subarrlhnoidiont'.

i l l i qn' n r , of l, uI noplcylt t t i ir sociazii,o r x: [ llir lgir r r r r igr r r r r or r r il,
;i o
rl
( ) f t [ lt noplcgil lr pf i, t '0r lo t llr ir r r r iir r sl, r r r lir r lr u. l: r'llr
111,r;rl ' ;' r,,
rl rsilr r , l, ot 'alil.
I r r |; . 1ir ',
(
l{r
I r lr lll
lu, it t st llilt en t lLlt cr ii qi I at r n}r 'i lr ! |
lll ziL'. l'lt 'r r liziil, , , ', , r r
' rt1'
1,,' r,' 1,' rrrl rrrl,I i pr t , r '{ilt lc( per cclt ca,t JI [ - lt , ) slr t r lol; t Lr ( pr r t r 'r , lr il, lll, l\ / li
\ l l , ., L.,irrl (' c t t
i, t t ot vt r lr r i lt igot r r r t r , So f i'r ur r r I r lr r l, ir , r r
f t cl, ilt 'ell pr u't , ilt , l,lr
i ,rrrr, rrrl rl r, r ligr t r r ii, of l, ll r r uplcgicii, sil r 'iillr ili' t r r zr r r vlr1 r lor r r ' lr r lr r zr r r r l, ,
| | r, rr, | l r ri rr Dr t l, t t l, cvidr r r t {ilr
0lczir Dr o ot 'glt , t t icli,it r lr r r f il, r . r illli |||I |||| r r |, I r t ir
, r.rrrr rl r. ni ,1 t no o, ll. t t . o
l.pl
t nt , 11irlr
n r odt t t t r lo ut t . t t : r i: ; ut ( r lr r r r r lllii, r ': r t ulir lr i
r,, i nr rrrll i r\'{'r 'r ) oNr
r lc lr lr r li, t ur t r r r r r r iolt t r lil) oslcliollnj, jr lr r lr t l, r , r 'rlor
i t l'r ': r lil
t.' l I' rrrl rl l l l :r t r t lc r r t lr 't i, r , r 't lr , lr l1t lii) sr i r lo ( / / f l t . , lir ! ir t t t i. r t hilr r t t t r ot
I r)l l ,rl i t r t plr qiilt il, lt t 't 'r xt : t tlit r l, , r lc I r t lt i , lr scr t r lot r r iglr r t r rltr t r r l t r l
rrrrrl rl ,,.rr,,r' i lr lr ir l) : ll it t . l'it lt lr r , t t r r r l. idr t ct r r rt t t on, r r i( t r r r cvt iir r r r r rtllr . I r lr , t ii
r rr,rl l rl ,r rr . ir , i{t r r r t r ll ( , lt o lr it \ 'c|s{lr Zi, sit r t r sr r l ( l\ '( ' l{'N) , Hr , jt r illr r l|t r zr r
l ' rr , r, rl l .rlr r ( , ll|gio ir |r , r {illr I I r ' I u, llt |r 'r r i|}t ilt I i( 'f lllli, l: t , r . l|r r r ir : r r r . r lr zt r
, ,rl l rl rrrrr' (1r r r r i,I l r r r or 'lr il, ilr r r ) ,lr ipr r csllzio it r lr lilot ir r l Ltigr , r r r r . r r r r lrlrr rr r
rtr,r,, l )r | r. r' ir r r t r t : r oll:
, r I t r r ir r l'i)qi t t t r r it r llt r sit r ct r r t t t , l I r r l r r r l lr r llllr ll
I lll
r,l rrr
l rl l | lln, , r |lr il, r r oor r lr t i. . r \ t l|r 'ir 4gt 'lt lilr r iz rrrrI iz|t rz li |. islt r llr .
l i rt,l rr i tr r i, ; i t r . llr 'r t . l'lt r lnt plt t lii 1t r 'r ir r licr ir t : r lilt ' t ( r , , . lllulgr t 1', r r ',
,, /r,, rtr i r I rr,\ ' I tri rrrr.Irr r lr r lt t llt 'lr l o t rrtt t rtr' : t t rI It lr rr t lr . tir r ir t r r ,I r 'r 'r 'lr r ijt , / / , r /

( t utr t:Llf reourehlid,I, ihrr tttmi1runoatri ln ptuc0s0

r. ttltltlii, tl,tLt'rn)(LNc
irrlIrrrrilixrIiiillo sirursului cilvcr.nosstiu alo olbitoi. '
O 0 rrrlr[o}krgio rlrrroroasii cu..caract()] recu}elli,i:r,l (in care algia, nu
rrri , rr'il'(l{}r' I Lr:mic.alic,. ci prezi,-Itii,o localizare ret.oorbitari sau i"n tori, .
l{ i I rrfl {rrt,rltr'r(i) rLpa,e $i in ldfiaft,erita cdroti.tl,i&nd,
i.ntramternoasd,(descriSii
rl'. I llu, ii ,'rrlrr,Jr.,.
1-00t.cit:t,lid0Arsctriqi Oprescu.1962).tn tatrloulsemi_
r'r,,,4t(.srj
l)L,[us,Jciu[
st scmnede lcziune a oerfului optic.
Sindroamcle pseudomigrenoase (sindroarne migrenoase simpto.
.,1.1.3.
nrrlr(xl):
1. IIem,aragiil,esubarahnoidiene din_ mafforna!iita ,t)aso,u,larc
(aneuris"
tttr:, rr,ttliname) pot genera cefalci pseudomigrenoi,se cu caracter recuren_
(iirl..rrsur
rlr' rlilgnoslicetprin debuful brutal-al cefalcei,pritr semnelesemi_
(lr,):jrr',.rtc
uoompal ament oare persisti, mai multi rreme, prin constatareiu
rrnrri L.C.ll,. sanguinolent $i prjo evidentierel malformitliei.
:!. lllutnortle de uentriatli laterali se poi manifesta prin 'crize cefalalgico
lrllir.rrlioc, deolanqate de schimbArile de pozilie ale 6apului, cu d;bu; Si
rlrr'.it lrrpi,l..ldrA frze precisepre- 9i posteefrr,lalgice
cain migrenr clasicd,
r:'| t|r
.(jv'rturt:I, ultenoari], apar semne de hipertensiune intracranian[
(;\ r solri qi Oprescu, 1967).
ii. Tt.r,m,orilede aentri,clr,l
.III -pot g.exeraIa clebut crize pseudomigre.
rr.rr,s.irr,sofite do fenomene vizuale
similare cu c(-le diD faza frotlromal"L a
rrrigrtuei. l)al aceste crize sint declanqlte si, r.especliv suprinrite
la schim.
lriiri l',
prrzi;ier,le capulli, iar evoluf ia t ra nseaiii d iagno\ticul , pu
-rl.t.
in"r:.lilii.siodr.omului
rle hiperuensiuncintrlcranianii ip:rr qi semne-isu.*
neurol,rgi,', obioclirre erolul,ivo (sindrom parinautl, sindrod Arllylt_Robertson,
l)rllz{) ooulale, semne tliencefalice etc).
ll'ttmorile occipita-le
pot.genera la debui crize pseudomigrcnoase
cu
,
,1..
Itx'rrlizrtt,'.fr.onto-orbitari,, asociate cu manifestd,ri vizfale tranzitorii (foto"
l,fir. nrnlrilrtopsl tru,pziforii),. dar p parcurs apare sintlromul rle hiporten.
sr"" rIrLl,,ct'i).lant, iar hemiatopsia Be contureazd, din ce in ce mai stabil
fr r. ct|,titcteL progrcsiy.
5. .Pseutktmigrenabazilard,reprezinti o formil de ischemie tranzitorio
in lr'r'il,orilrl vertebro-bazilar (inclusiv in teritoriul uneia sau a ambelor
rrllr.rr,rrrlrrbrale p_osterioare),oaractgrizatd, prin tulburiri vizuaie (cu sco.
l,'rrrr. s.i.rrl,illnte hemianopsiee,ilceloqarea vederii
li/sau halucinalii'etemsn.
l.:rlr..;.crfrrlrrr.pulsatilii. (cu localizare iudeoscbi postcrioard. in regiunor,
olcilrirrrlii), rrr;r,ni
festi,ri vcrLig-inoase.
felomene ccrebe]oase,
zgomotd aurillrl.lr', rliziLrlrie, parestezii bilaterale atit la membrele suireiioare, cit rtrl
-chiar
lr rrr,rrrlrrr.lcinferioare si la fa!d, (peribucale$i linEuale) si
alte*,rca
,rlr'rrii.
rlr. r'igilentd(obnubila,re,.bipersomie).
Sc p6t asocia: nistagmus ,ii
lr.rr.rliziirrculomotorjitrenzitorii, Acest contcxl, scmiologictrebuieiu grij'd
r.l.i.lrlttliut a mi,grenabazilard (Binkerstaff, 1961 popovi*ciu qi colab., 1".9gd
;
;
llrJrr.-r.rr
.i furn, 1977).pe care de altfel unii o coniistl, si sJ ne oricntozri
rrr 1'rirrrrrlr.intl spre o afealiune organica in teril,oriut'uertebro-bazilar:
lnsuJicien!,ir, c.irculatorie aertebro-bazilard,alercscleroticd, (forrnolo
,. .t)
.
clirrir.i)
1r'irnzitoriiqi inicrmitcnlo).
, ..lt) Mu1,Jormnliiuasuilare (anenrisme, angiodtna) ln teritoriul veltcbl.o"
l)irz I ilt f .

rl I't'oluse l,nlocui,l,oure
il,c spnli.u r.tl,cfowi ?ostarioare,
S'- it'l)u', rk..i, irrvr,rl.ig,r.{,ii
ltt..rrt,o4i tJ(,tnl}l.xi!(ol:rrrrorrr,
,lLrrhrr'l'-

,{l r" : lr lllr l { 10 r X ' llt , :r,ri l l rL I.ov i z | l :L l i l ,,c i rrrl t v i zt| l rl I | ' rl trrri trIr,i Irrrl i l ()gi crr
2:t{l

r
tr, rrrci rl r,trlrs1x'i,
ilr lr r llr r r , r r r r or r r r r r 'lr r logllr lirfrllr r : ( ior r lr ili, r 'r , sPlcliv llr r lli
, rrI,r;i trtIi r' ,rr l, ilizit r t l r lr , l ri{(,t r| (,| |(|l r , it t cit I r r t t ( r , I r t iur liologir r r spr
r r r : ir r l. pr , t r lt 't t
l rr, r ; rosl ,oti o lt ,ii,
t l lt t 'lct iogt t r f ir r vr ', r lr r ) llr li'i, ;sr : it r l, igt r r lirl , lonr ogt r r lir , : r r ir r l1L
, r,rrr;rrrh' r' i z11li, r , |t 'cl, t t x,r tcr . litlr glir f ic q. 1, . ) .
tlJ ll t,l,lutntt!ii. uIt .losti t:urln'u.lr ltttsltt ittrtrt yi tlt ;ionlirntii. rrrtnio
,,/i rr!rr' (i nr I r ( . $ir t t r o br r zilir t i, plr r libuziir , sir r r l|or r r I ilippl'l lt \ , il q. r r . ) .
| | | | | | ' ' | | i .n( : l; c|'l'u. lt t . t 't t , ut t t i'u. |il. ! ilt 'n'i't t t '11t t t t it l: t lt lt : u|. t t l't ', t t t 't l. |. t lt lll|ill
' ' ,rtr ttttl .l brtnat i, t or ii r lr lci sr r t t spr r ct , [ clil, cliilc sr r gr r lt r lo r lr r llir Lclr r lr r , ll
l l l rl ;l ), i n(l c osel) i aplr r if , iir st r lr vilsllt r lc ll5 r lo ir r r i r ; i nr vt r lsilr ilil, : r , lr , lolr
r r r ll,
,r rLrrrrl ri onr {r lrobject
L
ivc llr scr r r l. i, vr t 'r r : t rr lr r pii,1l( ices,s{! lx) lt lr r $l, r r lr ilir lll
1,rr" l i cl l rl t . r ligr ', r r i b: r zil; r lr i.
lrr slir'qilr, rtiri tleJruic avut irr vtrlclr ftrplu). cii \i u,n.rltaritr ltipruli
,,tttttr 1xt1sit
, nulr r o m igleni, llazilit t ii ( slu ot icu r r lii, f ot r ni r r lir r ir . ii r lr ,
trrrl l r' rri i ).O ar t at t r , s- asipr opus ( l'opcscu qikr ln, . t 9?7) ploht , r lir r gr r r r lir l
,rf l rrr;xrtrti cii,cu solulio t lg glucozii 20- 30% ( 20 - 00 nr l) , r r r nr ir r xilr r ir ( iiL'
rrr ,,:rrrr ptorhce disprlrilia manifcstridlor nenlopsihiur, rrl pul(fl, oli.r'i rrrr
i,rLl (li' ('onfiunLrc a originii hipogliccrLicc l urror clizl rrrigrlrro:r rr'.
7.11.4.llgiilc
Alyiilo
| |rl l l l tl r)gol i l (j

orcipito-ccrvicalc

.oeoipilo-eervieale

riclici, urmi,toarolo ploltk,rrro r lrr rl irrgrrorl to

n ) 'I\ruumo,lismeaertebraletau ,rterlel)ro-marlrr,lrrrr.
'l'rr,llrrio rrrrtl itr
(Arscni qi Oprescu, 196?; Alslnli qi oolrrb., l1)?:t) r'iL rlrr
r rrl,.r'r.Irr,llt,rrl
ll,r',.r Iltuuratismele vettebro-rnglullnu eotvicukr irrcutrrlri,
o rlrvrsr,lrrlir,
lrr,rrrl:rlc 1i cii trebrie ciiuiate cu glijri, irnirlia[ rlrrpil llrrlrrlrlirrrr, rr,rrr
ri,'ll rlc k'zirnreu,tit ver"tebmld,,
cit si mtiduleril,.Silrl sil,rrrrt,ii
irr oilro grr[r,r'rrr(rr,
rrrlrIrrIrrliiesto oligosimptomaticit snu inexisl;ontri,in schirrrlrrrrrxlil'ilnlrlrr
r ltlr.lrt;rlohaumatlce sint importlntr:, sniclinl,alirlicrrllrr1l,trulrrrlrrrltt
Ntr
,'lttrrr,lrtiu tlurcri crlrvicalesau celvico-brahiirlc,lntlc,,st'lrirliskxlrliilr,rr,t'
lr,lrr:rlr,si ilrcturile-disloca{ii rletenninii simlroiuno lr li(jltlrur', il r.rr'r\
l,,lrrrrlrrllrcnzi),llgii puternice in ceafii,,cu ilirdioli sltrtr rtgirrttolrrr,cipi,
lrrl.r ri sprr um5,r, insolite de contr'..rctlu
a rnlscrrlrr,t,rrrii
rrrrrrrr!'
4i rlrr lirrrilr'r'.r uifjr-riiIilorcoloarreiver"tebralecor.vioalc.lr)sto irrlxrr'1,rrl, xl, srr ptr,r,i.
rllzr.rlrrrii,sirrt sau nrL;i sittptone asocial.o(lo lrrfr,rirr(ii,
rrrrlltrlrrll'1.
'|;trttrltte
(lili,rr\rt
lt ) Ilisaryatiile Lefi&)ral.ecerait.:ala
(jirt1tr11(,ro
rlut0r'i ou
{l,rl' rr lrn(jiio de sttdirl alteririi discalc.-Asl,ftJ,irr livrr, I (iIrlI;rir,rrI.rl,
.Do Sdze)dltlrlrril,r'slrrrlolrl Ir'rrli,
'lr' .,rlirtlirionlii,tliscnlii dur:eroasii,t'*
lltrttlrrlirlir rrn scgrncntvcttr'.bril,l,
oa,lijrxl da1;oli1,i,
ir,il,rr{ici
I |,r.I || i IIIr1i i ||||
rr,r\rrri(l rlirr rliscul altclat, I)rrr.elca,
sc tltzvolt?irluobicci Iltl, prrrgr,,.rirr
lirtrrr) r'lrrz"'i
l pltlcrrtiiovi{lcr1;i1,.
l)oar uncoli lr,lgirr,
rlohulclrzr'i,
lllrsr:, lrprrrr,rrl,
rIr'r' IrrrrrIrI r'irlo rrn 1]llr,ututl,igrn
tnirtitn,rlc () tni;ollr0llt ttsoi,glrrt(lt\ (rxtr)Itt(,ftl
l,t lrtl1ri rrrrrozcillil.J)uttrr,rloslclruriviolcrrl,lirlirrritrclrllr,r:u(,cltziit,oxr\lll,
tii
looulljirr,ct,lrl;rrt,irzrl
itlgiir,.ltrrrr'
lrtrrr'lrt rriqrili lrkt coftrinrci,ial pr,rr:rr{,ia
tllr, rlur:r(.{litsl,l'i
ltrzil,cvoltrrrazii,
rlo ollicci itr lrttsclri qi rru srr itrHo{r,lcrlr,
rrr,tttttr,
r,litrico(itt rrl:rlr'i,
rlo sltrsilrililrrl,r'ir,
JoctrLi)tii niui rlc srrltrrrllrIi,rIrgilr,
lr llir l rlo o 0v0trl,rrirlIr'lgitlii:r1,0
lt colxr,rr0i0ritvic,ltlo,
Itr Iirzir,lr, rlourr,(rltr ,,blrlll.j tl sr,grrrorrl,
ltri I'rr 'rlisllrlrrrl,itrJ',
Altr tri 4l
Ill|l1.Ir,[, lll{17)(llnrtr, rlovitrrrrrrrtivi0lorrl,rI,,
lrrrti 0rilirrsr],
itr rr,Aittrrr,ir
|r,t.
l lr,irlrirJi xrr ittltrrlcql.rr
r,i rlrr
li tll lotrl,trrr.lrrl|r1l|,rii lrlltrlUir.ii,lrr.t'1lr1r
r, rrr. tllilirrL,git.o
rliNItrrltrrzlr'r,
4i/r.rrtrlttl'o rlilr'trtlt0zir'r,.
ilil I

, , 1 r l r , r , r r r o i ,,r 1 r r l ,r ccl r r r .;r 1 ,., r ,r r r c Ir 'r 'zi r r l l 'r cr r r l l IIr i r r i r Ir '1 x,r r r Ir .r r Ir '( ||
l i r i ,,!|
, r l {" , r r L l r (l ;r r r r r l r vr zr r r r r r r r o r i i l i r r l r .l r l r .l r i vi ) , |tr t'l r l r r i i i r l o r .l o r l tl i l r .r r l r r r ,.
, r , 1 , I r , . , r r r r r r ,zr ':r l :i .l ) r r l r .r r ,r r ,i l tr r l i tr zti i i i s|r 'r r zo l r .l r r o r r ci l r i i tr l r ,,H I) t!
l n l ., l l l
t , '1 '. , i l l l l l r zr
r .l Ir Ir r r i r , r Il I,r 'Ir Ii .
r l <r l r l l l i '1 ,:r p ;r r l r r i r r r l r r i zr ,.r r ,,
'\r 'r 'r i l r .tr
t r l ,.r ttl r , l o t l rt o L, rri o t rI r k . r r i tr l , r r l r l i ;1 tr( i l :r tr r l n ( i r r ch .; r i r rr I r,I rr rr, , :r I rr
'r r " , , r l " l ttt r r i r ',i r l r rr r l r ' l l tl ttl tti l :i tr l c r :r p u l tr i ( i ,r r ttr Ir tr .i r Io ti r l r r I r rr I o v . I r rr, rr l l
, l r r ;1 ;r , ,l :r r .{i ['g l r r l i ', r l r ,sl l r r l o l i ,
rl,
l r tr r i ccl i r r r {i ;.r r .) , r 1 i l :r l r r ( ,\r !1
I
.
,
r
r
t
l
i
l
t(
1
r
l
r
l
;1
1
(
',
tr
'l
tr
r
tr
r
tr
l
l
r
l
r
t,o
l r tl tr 'tts:tl 0 l i o ( .0 1 !.i r l , Il zi tl i , r t'
I,,,
l 1 . , ', 1 'i r , r r l r .
o i tti t( ,1( ( ,l ttl t r l r r r t'r r l r si , l r l r i r ,l i i ctr ;r r r l r r r , r r r r
l tr r r l r l l r cr i l r r l l
,
,
, r r lr , ,l , r l r ti l l l
l o r r sl l i r ,l i vi i ,
r l tr l r i r tr r p i i r i l r r scr r l r r r ':r 1rl l I r r rrI i i I :'r r r r
r , , , . I ' r , , l , r IIr 'r tttr IIr .r r ti r l ttttti l l sl tti ,.i ctl ttr l o l l i tr
r ,l r tr r cl l t r r l kr l r l l r r 1 'r l .
| , I ' I r rr ,l r ,.r r l r i l r l o r r l tl , r ,tr ctr l tl l i l t I'r l cttsi r ', l ) t!'cl l n l l t ttr r r r ,l r r tl ,. r l ,,
'
, , ,', l l tn i r r l i I l l rr I t t r I t t i , l c tr l ttt r ,l tzl i . l ,l r l tttr i t ti tt'i l rr l ,) i \l ( I :r l l r r r r ,.1
, , l r . r :.r r r r ,ti :r i i r i i r l cl t r .r l r r u i tr i i ti l 0 l
I t,
|i t( l i ( l l o $ i {r ( ' <,o r r I|i Ir r r i r r l r r l r r r
, , , L , 1 r . , ,,rr .l i r r r l r r i .

illi,,l,:l;..;"ijiii,ll,,llii
l:lllirll::lii'tl'1i,,,,i;i1,l,lliil:,1,,1,1.1,,,l_il,li,,1llilili)l:l
il ll,,ti
ilt,:,I
li;i,;ll:::;ll,;
it'';;i;l:i,;11.,;i,HJ
tt,*li;*"li'iii.lt:i'iJill
tt,lr ,l)ir,r('zii
l('tlrr;rl'girr),-r.lo
,,,,,tt"ori .,,i ii,rt,rtrirc
Urusc,i1orlrr,t,rtr
l;1.,,..,1,,,j

ca)seiu:oqrsr'
,1,'atg;i
.r evorurie
l'rrt,
'iJ.1io",,,,,,j,,1,,,1,,'il,i,"i.i.l.!,,
,,ll.1l

lii,,l:jiill;lil*ih+'.1"gll;".,"J*1'l':,l'",,1'1l1ll"H"'#,"Til'$;lll';ll
j;,i"I:#!,fln:ii#j"J*,$*i:il?il
,,,,-{,,ijl,,f
!,lll:':,,[i,o"t,::1,;i,#,r,?,.
extra'rnedula.c
ai"d^tdr oevi,ie
r,:ar:iii

liili,iil-iiiil;llilll$l:::
::ffi:?t'

ri,.,r| ( rr.tipitrtul
osr,e
**, i:Tlli'#ilri.e

rlc blrcalmhir.tian,
itr minr"'

,j.jl:l
l:;lllir:ir-:l;i{:r:f
t:!i:!,'!::"iir,xl,+l#iil?*;lJ*.,i?Fftxfr
ffi
inir,,
l l,j
illll';:^i,lj[#ftil]ii#ifli:';*m;'{l*:.-**jerieasiune

'

'l'i,,',','i')i,,ii;;,"',',i::;?

n.'nicali'p,.rrfi rlcictrlinrte dc /r,'r('ri

fi

,l

, . i l r " ( i r r i r 'o l r n tl r i a l q i i l r : sl sl i l i l ,
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itur,irLplliol,rlll rlc sl,ilrt, ,t,t.,,,,i1,,
si,ri llroz(lrt,.n
r r- $l)rf , lli
llitzIl i.

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"
)
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l l l l r r l l l r :r l r l r r
,,
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r r r r r r r i i 1 i :t, l tttt0 l r |l r {tl l tl i .'l 'o tr l tr
i , r r r r i l r i r .tl tl .
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t;r r tr :'r ttt|t''ttl tI
d r '.l i l ttttr ti sr tr l ttti r , t:i ttd tt,tn r r l * r tl 'tL i r
.
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r l "i tr r tr
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j: \ ' I , . ||I : I I . r . . i
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,'r l rtr', rrsliirl irroit:olitx: coltrlclic muscul:lr.ri
olercite o iriiaiie de plex, rlrr,r
r* rit.'.' p. lr.lr'i, pr.rrlucind r.cacliir.:rso,sp:rstice.
Trebuid lu:r,tiin clrrrri
dora,r'e lt stabilirea diagnosi r
cului qi nnii factoli profesiorrrrrr,
c.n de pildii : 1a h:"n:Lalipiil c,,
Sccl cn i
borireu nincrilor prin greuti (, ;
lr z.ugrrli :i h tlli nrcsr.tirii,
.,,r,. llclpilzi crr braJr.lein hi
l rp | r,l ,,l ti ,1i i ' ;i cu gi trrl i n hi l ,.r
r r1crr" i t,i I r urri i sporl i vi t' tt i rr
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slalcnice qi a gitului. Ne c.:r.jlrr

tiim sprc di:ignosticul de sinrh'urrr
sc:rlenic in siluafiile in carc lrrrl
nr\-ii acuzir durori ce..rvico-br'rr
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oar; a braluhi qi pe borrltrl
cubital al anlebr:llrrlui), carr sl
cxacer*leaz:i diurn, mr:i ales I rr
ocaziil prrrtilii de greuti,li si r,rr

rr.; rr {rr(,i,,r),i,ii,i
orrostatis,u.
rrr,rr.r'rrirri.
li' irf,r'irrziirpri,lrpo tottleauna
".,".,,,f:T3r'r:tj;Hfill'#j,lilil,lill
o set.iede'ttrlburijr.iy:l,scullrr,r,:
|r, rrrrrt |1..trtrrl ,ltl

it |[rtrrJ,rlrli-supcrior,care pfezittti o piele rnai rtt,,,

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r,' r .r. l.:r II,Ii'I||LI,rILs'p,.r'i,,r,
ltfcciat {i __-.nror.i __ t'l Lruril,r.i
trofice p.irr
rr, ri, llrr,. !i\l,r rir(.rt:.v:rttrnncureretelatortrc.:2,)
B etnnu!ltti Ochnergi(|Q1r,:
r'rrrl,qi'1rrJ
t,r,. rL||ri'.r.
tlcrr51p1r1
cl: -iculei,in zona colespunzXtoari
tcnit,,
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:r a,min1,itd,
'|'rrr 'i rrrrr.'r,:rrL1r'rrrerzii
mai s|ls. irl
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lrri
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rrrci greutiti i" mina p:Icieillul i,
.(r,'1r,,'r'11",1
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lui Als,nt
't | 'tt,x t;,, r.rvllt.ll :rl itr ._czufcu rrrrirrile
lejor pc gr.n trr,l.l
lrlrsrie
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.rn
r ,r lrlrrr.lr.zc
ir rr'.r,oc1c
in inspiralie for!,atii.Aceastil mr,ncvr,i decl,"tscrrz.r,
I , iri,..r,l
rr'i. irr rrr,tLbr.uls'psrior dureros si o dimin'r'e a ar.pl;tu,1ii,;i1,,rt
',tltrt.tl) ll,rtrrrrt lvi I lalsteo,tl,
: 'Irlc,liunclr,iu jos in axtl membrulrri srrp,,
)ri)r',r'u ;irlrrl rrr ori0nsic
jii l
fi cu c,t,pullotttt cloirt;t,alrltci,ltl,
exuccl,bt,ilzii.

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7.3.9. Sinitroanele algiee alc mcrnltrului

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zostcr A0
).
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rntii,l
i i l r,, r ' r ' s pir l. il a , ,s p ri te l u i d re p t" ).
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,, i r,i l gr,rrr)rei,fleoum
in sc,trimtr, coritractuiii,
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,,l r".r , , lt , r ' ir i( i r iis a a l J L r u i v c l u l d i s r.u l u i L o _L.;
c.r i radi rrr.
,,. r.r'irr... Llterlli,-a ph'tei, pc tiosul picioiulni" qi/suu
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dcgcl,t,
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irrlice{ii ropugrafice:
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)' ).rr1'
a gnnbei,pe alosutpici{)
rrtrr .. tr trrz:i ltrlr rcelrri,
lu hcrui:rdiserrl,i.l.s_S,.6ipucstczi.r
st. eflh,crl,
1:rry
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p+ irrnr:ilaieaLt'ter,r.[i
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r,|| ||,,.,,IIIIIIrrl,r.ecln ji po ultirneL,rieg,.lc.

1) Pn:r ntt )nalif icir ol' d,e re.flene.Reflcxul ahili*n este diminurrl
r.rr ,rtrrrtrtirr Jrfrilil rle aliscli*Sr_. Uleori refloxul cutanat, pla,ntar po?],h\
Ir rr.lrrlil, sirrr..ilp:ircchiar semnul 1ui ]3abinski, ca manifeiljaie
supn;iozio.
r rl:i (rlrr,lolilii tulbirrririkrr vesouhre l,scji te comprcsiunii raii^icul&r,.).
h ). I'r(;:(n,t{t tu,lb*riirilot de btet itata po:tie avs:i certe yalori looa,lizit,.
',,r rr. \:ii;[ol, <le.pild[, p:rrezx ilerorilor :tp-r,reiri ]relni:l discului Lr._S,,
-&_,u,
mu:"hilor ld_0Jd\DLltrslrr
1i,
tl h,r,lue.:lui.
n.r*n=o.
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il scll o{tcn{oI Jt ,t,,j.Lelornc p ).[to rugur,rlrer,ni,lrIis;ulrrr
L, |,,,.
frr lr,.r'rriilu
,li.:-r,lop.iu coinprciiunr piurir.rdiculir'i,se pcato rec,lizr,
, i' .r.Ir , r l) r.t..rllnLl , cu p-r,fJ
llzie.dL.nerv scit[ic popliteu ericrn, dc nor.r
,i, r.,lr,i l)r)plitouintern s:)u cl:i,' oinrL.'m (henidifah;m) cte
coadii,do orr,l,
i) I'tt'.:(,njdtulbu,rd.rilorsl i,ttcteriene ne poalc intlica hernii media,rr.
,1rr tr rr':r,ur(NIi:rirre,
c&rc comprimi $i I'ii,laiciniles:lcrute infet,ioare.
I' n I t l,t,me tlc d,itr,g
nostic etiopd0 genia 6n. Iotnbosciatalgi,i :
,r) li,olruirrtim cir, mrre:l rn ljoritatc rt rombalgiilor, a lornboscirllrrr,l
.
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,L)j,r'i si.()pr*{ju, l1)iiTlAlstni si.Nirniott:su
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llif:ll
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li ilir,,f,,
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, r , r r a . r l c rl i r t r I tt rrr rrrr. l r l g i r r o ( sr x:i r r l ,r rr l c r r |l f tr t:tt tttttl l r r r r tr l t r r tt :r l l i '
( 'ttIII||t|i ]||IIII l :r l l l |l l
i l l l l , r l r ( 'r , r l r .\l r r l Il i tIi f) 1 t0 l ' si i i r i l r l i , ,;:ia l l t tl i o l r ttl i i .
p ti tt : t I rt I rt t r , tr I rI r' ,
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,
tl r r tl i vctn c ttr tl r ttt l l r '
l r , r i t l r tl i cttl r ttr ', sl i r l r tr l i L r l i si czi s, n l l i tttl i l r r
', , ,
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l , l l , r . r l r r i r l tr l r u l l o r i l i l l czi r r i i i
6 i tu t si tttl tr tr tt tl c tu r tr l i i r l r r r ':rI r r r ''i r r r ,tr |:r I,
,
rrrlr.rlrrtrlt
l ,r r l l l r ti r ti
stttzi l ,i vr t- r r l r i o ti i .
. ) , \ r i t r l il r t, 1 tIr tttl tr i i csl 't't'r 'r tl i zttl r 'i ( l t ( l i v( r 'so J]t( xx's( ' sl l tl :r l ( r L r r r r r , r l l
| , I L (Lnr\i(c,
l u tr to t'i i r l c sl i ctttl tti , r tl tl t'sr r l l tt'sr ttl tl tt'( 'j I'l r l r r ) ti l ,r r ,,l .r l r r ',
, , , , l . r r r r r c r r l l l i r r c si r n txi i r l r ;.r .) .
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, , , 1 , r r I r I o 1 .i r r r Irscsj
r
i l c si n r l l o :r u to i r l g i co r n l i cr l i ttst, i tt l r .r i l o l i r r l 1 r l ,,r r l ttr
l'

, l ) , \ t i t ! !i t1 L l r o ttL ti tr d ,
cl t';i t'r L t'i , 1 t'tb tti r r l o i r tl i r tvr r l r i i r r vcr l l r r '. l l r
, l r t t l v ti l .i o i i , ( i tr tl o scl l .i vi ttr l i ci ) ,
stl ,t.ll x) l l i ( f Ii l to r l tr r i r r l c r r l tr tr r r r 'r
' r i r r l r i s cj tl i o ( ti o r tl i n o n t) , tl c ti {:ttttr r ti tl tt vct,i r r j i l l r l r r ( o r r l co tr r . o r l l ,r
, , 'r r r 1 , r l t tn i cl tl u s o so s vi ci o s^ o l tl o (I()I I I I ) t i I I Ii i l tcl Y r l l ) ( 1 !( 'l r {r r r l ( l r ' \:r r l
, , \ i | | ( . l r ) r ' r r c|r 'r tl r r i sci r i ti c. Ir l r "co l tst,i ,r tl l .i ttr i si l ,tr t{i r r ( r :tti i ) , r l r r r l 'tr l ,'
t ' 1 , r r r r c l i ri o sl ,:tl i sr r l l i l cr p :r ,r i II o r '&) sl i r 1i str t, ci tttl st't'ttttr l r tl :t r ;i 1 r r ',r r , r r {:r
,, ,
tl ttt.t,r r : ,'
ci t 1 i su l l Ii r tttu l tl ttr 'i l ttttr l l i l tt
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,
l r , r r i i r l i scr tl o Ii i , L 1 - L 2 , sc p t( xl ttt1 , ( l o o l r i tci tl tl r :r , tttr r 'l o tl , r l r r t, r r
', ,
r l , , r r l r : r , r r r r i t'a tl i e l i i n l cg i u n cr r :l l tl ,cl i o l tl i i r si sttl l tt'i ,r r r tr r r t r u l tl r :r l r . l r r , r r r tl
, , r l r , r 'r r i i i r ( l i scu l u i l sI- r u , r l u l e r i l tt i ti l tl i l i l ,r r i tt 1 1 '9 - i l l ttt'i r:l r tl l r \) r r r ttr r r 'l
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' ' , , rrr ' I r i rr I rr i . Sr : co n str ,ti i , ;i o h i p o r r :sto zi c i l t l ,cr i r ti ttl ttt ttl r L l ttl r tr . l i ,'l r r 'r
, , 1 r i r , . r r l i r ) {1l l tl o se l l o o a p si t d l l r cl o i r si 'r , fl txr tr tl ,i r 1 l r l r r ,zi tt.
lr
r r ) n t ( f\tu 1 scm i o l o g i c se n l a i l o i r tsr xr i :t : t I i t t I i t t t t : t I (' i I l i r r l l i r l l r ) l L r r ',r
l
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'
, 'r 1 , . r 1 i l r Il cxi e i co r r p sci p e N ,b ( l {) l l l r {l ) , l tl tr l ttttt ;i IIi Ir ( |Itl 'l i It tr r r r i .l {'l r r r l
t , , ', r . r l r i r r l t s , S i r td r o r n u l tl e cr u r i l l r tl g i i r l ) {) l tl ( 'l i
l l r r 'o l i l r i l r tl ctr tl , i r r l r r :r {l l
, , ' , r 1 1 1 r g i lr d i r n l i o l * o r n tsi vi l h o r tti r l tl i scl u l i i tr ttr r l i r ttr i i , l i r ' l r t o r r l l .r r tl ,,
r rrr, r.thrhlllLi
( sp o n tl i l i ti ,
tttm tl ti i , vctl r r l tr .l l ,i ) sr r r t i r ti r r r r :r l ti r l i r r tr :r ( tr , tt
, , , ', 'r r r , r 'r r l l s tcttl ;o m , r r i r h n o i d i ti i
{i ( r .) .
l, ] ;\ t:ontl.Qitt tittl.t(Ild prin al,to t;rt,tt':t: (tu,ntori., ultrttsr: ttt 4llr l,t ', t t:t
n t t t l . l t tti n )
tsl ,c tl o o l l i l o i t I t t i I l t i r: r'rr I ri', q i tl o tttttl l .r r o ti l r r Jr :r l ;,:r t, r ,
l , I r i l r | l i r l i i l ttr r i tttttl i t, str ]tt) i tt0 l ) o tl xl l ) l ) ( ) tt'q i tttttt tttr l l l l l l ( r l l r :ti {r r i i l l ttr r |,
t
r N i . r , r : r l q i r r s{) l l ) o l tl i z0 l r ,zi 't,p r l f,l l .r , tr ,r r l ,0 r 'r r - i tr l ,Otttrtti , c{) l l t:r r .i r r tr ? ,,l r |l
. r r r , I r i r r l t t i , i tr u l i i tu l si ttc fr r l .,l rl t,ttl l r tr t- i ttl r r l tr i :r ' i i l r i r r i . Al ttu r tl tc Io Ir |, Ir ItIr :r ,
r l ) :i l tl r l i .
, r ', , r r , z , i l r i p r r i 'l l L r r i l t.r l r l i r r r 'i , 1 i l r i p r l t r l i t, cvIl l i r
t,

''1 , \ t t t il q i (
r l tl tttr r l o l s( ' Il ( tl tr ( r l l l l ( ' tt;' t ;r r i tl tl ttt'r 't i l , , 'tr
ttr r |u l u i
i
r l ' l r ' l : r {:r , i l l l l t) i
r r r tl r l r l i r i i l t 1: r' t t t t t t r I r i t I I t t i , l l r r ,l r l r r r ' ;r 'r r ' | ,,
:t
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1 ,,
Il zttttti r l i r r l r l , ( 1 ,
I r , . . r : r , t t t r t1 r r Ir i Io I :tItr Ir tr r Io l t. l l ) r tl o t( 'r r l i zr Il r i i r r 'Iti l t
L l ,
1 , . , ) , li r l r l i l r l r tt l ,r ti l r tr r tl r r i l tt:ttt i tr ttr r l ttl l r :r zi tr ( tl zr , tttr r t tt , l tt
r , r r : r l l . r . r r ' l r tr ';rl tr ) ,,1 L

i . \ ' r t r , r llt ir r I t' u trrto ttrl rrtrrl tr (ttrr' r,tl tti rt l ttttt tl t i i t I l ui l i rl h ) u\
r', rrrr,r : r r i, r r lot pt itt l o t,rl i z rtttrt i l tttl t i i p tr l :t,l :t :tttl ctoctl trl r)l t, rt (' (ri tprl l l ,
,r o l rrru, irrrri Irr I r' t rrIli , i trs o !i l l i , l r1 tIrl rtP rr
IrtItIl rtttItIt,l l t: rt Iti 1tl r' 1rrtIi ol t(r1rl i i rl tl rl
r rrl r l r r r r r : r r r r r li s lttz rtl i i rtl g rl )i tl i ' :i l i (' z i (x )tl c tl rrl ti ,i trl l itl r t' xci l ,l l ttl i l trl t' ttl tr.
i , t rt;tl E i t)Il l tr(fsl ozi (i i so l xrl rl r,
.,rrrri rr r li) . S r i r r r r r ri l i i tl t' i , rttti u rti l tr,t:rL s l itn
l i tl o pfovi l l o di rl l [oectl l i Ii i rl :l
,r,r,,rrr : iI r r n r r qlqir r,tt t) t)t.t.li ul l i :i t i L o (r'
' IL l ' & (o
, rrr:r I:, r i r uc r r r r {trri o o l , Io l t.i l t' i rp ro p i l l L c tt fotnr ro oul turi l tul i tt tl ri l ttl
,.rzrrr; r i r r r r r l. r ( , lr iu l l )s r)i [s ),s i fu i [fi (] i n c l rc s o :rsoci r.tzi lo, dul ' cre po 1r1rl
rrrl cl i rr r r ir : 1,c ot |s r ,i , i ttrttl i rl , s u l l l tfc l l tl t l c ntut i l l i i .
t,' r t t l' , r i t liol, t ! lic i : l ) $ p o n (l i L )z c l o u rb i i tt-' , cl i scop* ti i ; b) S potttl i l i l r,;
.) 'l 'rrrr r r ir ir , ' r ' lr , bt . lt l f s i l rLi rl l t i i rri h i tl i c n o (o a rc trrebui e ci i utate tottl ci tttrri r
rrr l Lz rlo 1xr',risii'rrlii,li ilgt'lyiuli i tlulerilor) ; t1) ArLhnoidite sphtrl(!; i,)
I i rrrI i r. rrI i I rr, fr lr rrri)nono|li['i', r'i|oticil I f) Procese inlhntntorii siiu tunl{)] irlr!
,l rrr rrr ir r r l lr r r z ir r: i1 ) I' ;o i i i ' .; h ) C o mp re s i L rn ea,Irel rLrh.Lide cX ,tre rtl ' rrl rrl
,.r' r \ trl .
:"- Nindrorn,rLL;ohJ-piciorreplczintii' corespontlartul slnclromului utttri't
:rrirLrrrlr lrr, trrirnLrrttl supolior', fiind gencrat (foflctea, 1967) tlc faol')r'i
! rr! ir{ t.ior(,iririr,r,snpri\ liutulni ganglionar prevei'tebral s:lu asullra pl(,
rIil,)r' \'(l,folir1,iv()trl)(lomino-peh'iene (afec{iuni alc por!:iunilor telmittrrlr,
.'i.. lrrlirrlrri rligcslrir', rtocl;iuni uter'o-anexitle qi .t,-ezicale,procese inflilltrrr
i,rrii ,i rrrli'r'trrl,ilrlollcrito|elle Di rctropcritolrealc, psoi'lo .,q.4.),precul)l til
rir. lczirrrri lrr,riiculrut (sponililutloze, spinclilite ry.a.). Se poate recunorrtlr'
l,r irlr o rlrrrolc lsooiirti, cu. rn:rni{est;d l.egetatiYe de tip simpatllgic t1t
(rrl l rrrl iili v . r s r r ' r t r r to l i i .D u re re a s c l o c a l i z c a z i , i n arfi cul nl i a qol dul ui , r' rrr
r, r'lrrrrlr sr, lir rui;cir,rile mai ampl ale acestei articnit[liir iar episodic ilrr
,lrrr,l rrltc zortcli: i.nt'ecinate (r'egiuDet inghinald,, lontbilrd,, fesierii,, Irr'lrr
rrrl.r'o irrlolni ir, coirpsoi), Irecrlm li dista] (in regiunile tibio-ta,rsialtii, r1t
actiYil, Si pasiYri a membrului inforiol
lrr.r't" rrrr(rrhlr';irL,nii,).
llobiliztre:i
,. , 'r i! r lr (.irzii {ir! r(.r'{)ir')
illl rcplusu1 o am0lioreazit) de;i de rnul0e ori se irsinlri.
| ! r'.i rr r { r r l) r ili lr t r t r i i l .i l cn o c tu rn e .
,\lrlorr,pr' l,oi,rhrrnurts9 cr.itlerrliazir,m{liologic motlificiri osljeoco]lrlf.
rii r.irl(, (.(,loirriri vilrli{rbrale {orso-lonlblre, mcciitici,ri ale arl,iculalici t'r'r,,
tl rrrrrl r r lr 1ii r r r r t ut i ()s i c o l o ro z e tl l s o -rn e ta ta rsi ene ($ofl etetr l -96?).
li. Sitrl,rr,nrul ctnaltr,hri tursiutt, iKeck, 1969, citrr,t ds Dofletea' 11)li?)
. rlr., olrrrrrrrr, r)tnologul sinalromului cnrpian tle la membrul supu'jot '
l,l rlr'.rl'rrolrrl, rlrr iritrtria nervului tibial posterior in canalul lLri ll,iclrrrl'
rr:rrr rlrrl I,ibio ir$ir-ilgirl.o-cirlcelrcan).Se $tie cii, in acest canal osteo-fil)rrl
Ir;,,'r,,.',,,,' r|(r|r.Lrltibial posterior qi r-aselc cilitoresc intr-o teaci fibrorrHrl,
Ileror proprirt rtl
rrr r.r,irrr irrl,crr,i;ocii sinovirle a tendon',rlui m[lchidui
lr rlrrr.r.lrri.irr l,iicsl, cilnrl, ncrrul tibial poiterior sc bifurci, inceidoi rxrt'r'r
1,1,rrl.rlr, r'rr rlr,stinillio notorie In lnulchii pia,trtari qi senzitiYl la plttti'ii
iirrrrIlorrrrrI rr,l;1iocsLe fiivorizat de traum:}trisme locale (lractnri lnitlrr,r
lir rl, rrrl r.i'r1) (l )rrlrr:,jii, ontorsc, di',-ofse intcn'erilii chirurgicale) ;sido picio
prin furtlicrituri, infcpS'trLli, a'mof$eli 1i dttltrr i
rrrl 1rlrl, rii rir, c,rr'.iol,ctizc:trzii
(
l{
i
1
rr,
n
i
v
c
l u L o .Itt.tl L L l i rit:ttsi i tl , i n }l l )nl i i i l i i n dcgol r,,
,
,.,r' r r , li, ,
r r ! s u l i ' r,
'r ,,,:'r c r r ilr , lilli
l
rt,!l
i
trl ,o L ' tril ti , g l ,u rl ){ r i .
:r1
; i 1 ro
l l li)-t i tr trl l ori ' ri ,l i stn;i i tt l i tnl tttl l ttrrl
\1 , r ; iilr 1i
r 1r r , t ' r l l ' u i i Il s 1 rN r0 1 ,i rl t{ itz
q rrl rri r i, r lr , r r t t t llc r t ti , ttrttl ri l i . Ii ttl ri i l i L l l tIIr rl i ItII:il,ri l torrrl l rrl rili)l rl ' l l l i l ' t(rl i l
rl r ' r', .I ,. r| , . I i rri | .\ r r | )r' i i i ttl ,' r' ,rri i t l l l ' r t l i i s i rtl rLl ttci ' t i i r l r" 1r1r' l or' . l )i r11
rn rj t, ll r , t lr r l, r ; llii rl ' i l ' t 1 r' i i r I i ( r tl tl ' i { tt rrl l rtt i i r rl l 1!' r,r| 1' rrr 11frrl
:'tl

II i t Ir I t I rt rt t t I t t t l tl l l r
, , L l r r r 1 1 {, l r r l : r l r l 1 r 'l l r ,r ,, l t l rr (I t r( I I i I I I i L| | i I l l i l l l ( \r l {,l l ) i l l i :l
t't'Ito
tttItI|Ir
I r tr ', tr "Ir 't 1 tr ,
tt'l
l
ttttti
i
1 , r r , l r " ; l i ( 1 l r r |, r cL tl i l r '',.i ,i l lrrt l l r l r ,l ti tl i l tttl t
, , , i r , l l i l c r i,r r l o l sr r l r r [o r 'l :r l r i , r r 1r i <ri r t t t t I t t i .
'
7 . i l 'L t t t a !4 i tt Tl ttn ta ti ( h o ( ,l l u i 'l l o r l r tu ) si ^ cl l t:tr r i l 'ti zcr tv,r l l ) l r l r r l l l r 'r 'tl
1".lizrrli,
l t i L i vcl u l tr r l i cL i l r l i ;i i l o f l tti r ti tl r r ttso l i tl i tl ttfi r ,l to ( tl r r r l r cti :r l l l ' l l l
| | \ i i i i i t t s i )i t1 i i l o d i !{i l .tr l o i ttl ctr tr ttr tl r L l si tl ttt', tr tt i l i tr l i tr l i r p tr ' r ttl ttl r l r ';1 '
I l , 'r s i ( r i i l f s.p ]'c ci \,l o i i l i Fl ) l {r l 'r l 1 '1 r1 ) {) stcl i o i i l l 'i l l u r l r r r l r ( 'r , { tl i r l r r r r r l r :r r r l
'r i , , l , . r fi s t n s i i r r ti n p r r l r ttt- r tsttl tti , l t'ttl o l i o l 'i t,ttr i tt to l l l t;tts r r i l r r .,i r l r r :r l ct'r r
, r r r i r l i l o t i ' ( $ ';Il e t:e l , 1 9 {i 7 ; L i d vl o ;i Il u ca , l !]i i O, 0 i l r r ti t l o [r r l h l tr r , l l tl i r l
l , r l : r i | ) I o s f o u n * i n e r r o r t si tu fl t p o r n u l d i tt r l ci i l o i l I( :l Yi
l ) l i r l l l ':r Ii . l ,r r 'r r r ( l
, , r '1 . r , i t c l v i l 1 r | ti i g i ta l i p l .r n tl |i .
t'$ l I l :r tr r tr zr r l ;r
l ) o zvo l tl l t'cr ] l l ( l vl r ) l i l l l l l l i
1 , r r . r r i r i . i ii n l l al r r r to r i i
l o cl tl e ( o so i r so l i n e t.l ( ,i l ti ti ) , ( l i r ( ' I t I I I I )I (' r 'ii I I I I i r l r tr l r :i l
ttr :r i r r l r ':r l r r '
r , . , j r r c i 'r , l f i 'r , m i :L tl i ,r 1 e o ste o fi te , d c r o i l cfi i }{) fi o sl 'i l l l 'tl i vr r l sr r ,
t , r r r ' i . 'l \ : e l . r L ti e 1 1 i {cr cn !i a ti i d e l l te a l e o i ,i r r r L i ttr l o l tr l l i o r ' : tr ttr l :tl r r tr r r l l 1 r r r l ,'
, l r r , r 's o o r 'i g i l i ,
4 .1 ( lo D p o tcl o l l l l l r l i ,i l l i j i ( 'l r ( f, ttI( |:||III i i ||Ii L r '
o sl o o co n d r i tc

' rl ,,rr,i -r,

(cri ct ent uala t lepist ar e t lc t olli Eu1'osilr lr t r lr r t il.
11. S i ttd''ant al , picioar elor nelini. : lit e" ( , , lit sl'[ t sx lt 11t sr lt t r lr ot t t " l"'ult
t *", t 1n1511111'lt t it ir t lt r t t i( ir r , t lclr : r t r 'r llr 't lr l
,t l .i boD rt l 9 6f / est clelat iYuDor t lo
, ,l rrl ' ft' i i t rt t elr br clo inf elioluc ( in giunJ) o iii colt lr ilr ', lr ilr t lr 't r t lr 11tI t r r t . '
r,r,,.1, i rI xcp t nil, in: t . i ales noilpt ea, in ciLlt . lt t r iillr t lt llt li, r 'r l 1r t lt I r r I r 't l I r r
t, rrl , i . r\cestc p: r t 'or ism e a. lgo- p; lr cst ozioc( 101, ( r l'lllilli
l) ( ' l) ollr r r r r ': r r '\ r '( 'r t li
,,rr,,' :i | i :l l s l lt , r r r biclor , t 1e t , r t t e t lolivii t r lt lt t ot t t t l. I Jt t I ll. t r t I r t l t r r r lr r 'r 'l: r r r l
I ,ri ri i l l osi ,ic cst e negr t ir il: it ca c- {llr lor lt llr li olt it 't r liv t t t 't t I oI r r ; 1ir('l'll'lr "t r r '
r' ri 1); sD fl stca qi cohl: . , i90L) .
It, (1uu: aleii }ot f i illt , ilnit e qi lil t t t tIt rt I I t r' 1II it t I lt ir I : r t r ', t t t l. t t l"r r t t l
,,, ,rri l rti sci :r t ic, cu oar act cl'cle ilr nilt il o iinl( 'liol .
11.\,i ),{te t ile t l'bet ice$ r ocur t osc I clill, iv llf or , lt Lilt t I t t t t I r |. I t t . I ' '; r t r '
i r, r i r) A l :rr . in saive ile dLr r cr i llf [ lt er lt t lt Lt ll sllllt i't r ( r r t t r lt t r ', t ll t li r r 1r 'r'r
I I t I' I l I I )I (' I I' it t lct io: t t ; r rl|r r ' 'r
' r rrrl f), cu il] t ej. ] 'ale liber e I 'ar iahile i l) ) I r ll
"
t I t Ir I' r 'i I I I I I r t I r t t |,
t
]
r
t
,
t
I
t . i: I r Il ttt | 1.t t'1
At
r
rrl
i
rrr;i
'
r,
c)
pc
scir
it
icut
ui;
tiniec|:
1c
'r
r,, r,l rrtl Gci t cleclan, sat ode sl, im uli pf ol) lio( jol, l'ivi ( t lir l t , r it lo r r r lt it r t lt r r t t l.
, l , ,rrol ogi e c, ccuRce r t neoli pollic i[ dll( xr lt t t r t r r r r t r '); r l) A; r : t t r r l ll t r r lr r l'r '
',
r r t t : r llc l. r 't t t t t r 'lr r l"'
,rl , r,rl ttl i v, cit gi iu t : r . bcst f , , f ixr L1r "I t l) St l lr socir r 'zii,
i ,, r.; l ) S e ]i ol asocia $i Cu ll, I t c cr iz{) it lgll( ] Llt lt t r lit 't r( r' i ;iI 't' I I ' I rr, r t r I I t r I : r r 'I r r
, rl r Iti ').

B.

PROBLEME
DE DIAGNOSTIC
iN TULI}URANIUI
TftOFICEDE ORIGINENBRVOASA

8.1. TULBURARITROFICEALE PIELII, ALN FANERELOR

MOI
$I ALE TESU?UBII-/OR
l. Pielpausruld,sol2oaso,
slriardprin fisuri, r.calizinduneori aspcctul
.,(tecrap" sau 1{e gopirld" poate fi intihite in sirixgomieliogl
l)rr.t',
:tr'
ln slI|(|l'oilmete

strtnqomteltce.
'?. Pielea_rece,
nAkdd,.sub!.ia-ld,
uneori pitald,, lividd, cle aspect I,amolil, rr. prrrrlcobservl i n,poliomielite, mielite;i altc atecfiuni medulare, daL
rI|rr.or't
sr rn ncl]lrpl0grljevasculrre {Arseni,i .8o1ez.19Zl).
''1.I'rr.zcnla tle Jlirtens, de eruplii butoase1i d,6 aspcite sclerodermioo
In,rLl,cI t -r'cvelatoare pentru siringomielie $i alte atectiuni medulare.
.l\'lot'maled,^,:I
Irfl!]ilit.otpd.unghiilor,precum ;i eJilarca degetelorss
. ,4.
rrlrlrr'.jc
lrccvcnf iu rlivr.rsclcalec{,iuniale nervilor'pei.itelici,piecurn gl
Irr ${ilu'ozrrin pltici.
5.^,lIipcrtroJia. i,inilor,. mergind pini, la aspectul d.e ckeirotnegati,o
.n
rl\ ^
l,ll l lll{.:rllo ln SlTrngOmteltel;. ltcq me lple reci, cianozalese intihese in compresiuniie med ularo.
rl:rr' ,.i irr hcrrriplcgiile vasculare, in'polinevritr,, pol ir:adiculonevritc gi iri
ull,rr nouropatii.
7. Arpootul do membru rogu, dureros, se intllne$ts in sindromul eriIlorrroliulgio,i:r,rd ogetul alb, ischemic este u$ol de recunoscut in faza agazilri ,,Hiltooplltrlocal[t, din sindromul Raynaud.
'\'. 'l'rofalemul crozio (sinouime: boala lui Meige i distrotia edcmaloau:'lI rrrirrrltrrurrl.localVat; edemul ,,reumatismal,- cionic al lui Desrnos
.rlrnr'l H.gr'cntar aI lui Debove; pseudo-elefantiaza neuro_artritici, a luiI
l\,lrrl,hirrrr
I lr{)rrlu,luiMilroy) repre,.lintg,o v&rietate de e.demcrorlie aib, Aur,
rr{lr)l(,r',-ou
lclxurtilio segmentari, avind _cel mai adesea_ sediul la ineml
l, i {,to rl lct ior,l o, uni- sau bilateral. Nu are * se pare _ nici o specificitato,
Ilrrr,t,ulli congcnital, ererlitar gi 16afl.jal1 dar ddmulto ori inso^,teqtebolilo
r\rorlo-{logonot&tivo,unelo boli do colagen, apd,rind chiar in rcuinatismnl
clorrio crr poliartrit5.
0; lldcmul
.rozat^aI ,fclcir..ulobrajilor, al gitrrlrri. al spnt(.lui ,"i al iolol
, ,r'HI|.rr.
il, |lInl(rr.lillii{rLiL
lrnoori fi rlo pigrn.rrl.rr{.ii
tri tlc l()lr git,ctlzii)
ho Irl.ilr(,!1.(,
irr pDikiLx k,r'rnlll
DrnirrziLll(lrirlrlt lui I'olrgorr-,1:r
rrolri.1,24t

10. Ihhnl rh dirr:rtttt

lipu,ri 1i h)pollt'Jii lol' Ii itri'ilrrilrritt 1olirtr,v ril,r,,
tttiolttl'rtl
liotl
ilt tlttccllt'lrtilc, polinotttrtpttlii,colagotroztr,
1,r'lrlrr,rliouLrrrrvt
ltl
lrti
l)r'pt6
tl}irlotlritl"
neurrt-cdelrtal,us
l,'rr.r,r'ite(irusir,-zirstrl
,,sindlorn
\l,rrrrr),in unolo cornpresiunimielo-radicukr're
, in silingontiolitr, itr Itritttilrlc
I' rrI,, rIrrrliverseorigini (Arseni si Botcz, 1971), in sintllrttrtttI l trtt it'l,ir'l(,,1ritrrr'
,! |r'oriLl,or,siitt
din sindromnl parieta,l) $.a.
IL Ar:lenaarnek cuta'no,tetmai rnult slu rnai pitl,itr pigtttctrlllrr, rlrr
(de la un bob de linte pinii la o circlg:i), rril,ttitlo itt tttorl
'rrrrliririclifeli.itl
r{illl,
r.tr,rt'irrin jlilul gurii $i al na$ului (dar gi in alte zono 1;ogrlrtl('lllrrr{r)
peni]u sclcroza tuberoasi' a lui BournoYillo,
',r',,fi[toare
l2- N tutfiibrctnato!(r lui Becltlinghausen,se po&to t'trcttltttrtrslrr
ltt'itt
de tLunori multiplu pedicula,tecle tip ,,rnollLtsr.lultttlt
; trrrtrI tt I tt tt t ' '
1,r,.zr.rrlu,
lrrrrrrrrepediculate),de consistenli moale, pigmcntate (brttttc srt,ttgrt'llrltto),
, r!, {rolmai arlesei)coexist5,cu pete ligmentare br'[nc- oirlolI ii 1i ott I'tttttori
rr lollni de qiraguri de mi,td,nii rotuujite sau fuziformtr, tlispusrtlrtr I'trt,irrrr
1,,1,.lroryilor leriferici.
13. Ang ialnul cutrd,urtpktn hernifacial, adesca voltttnittos, sil'rrrti,ilr
,l,r|rrrLiultrigernenului, este revelator qi nc obligir,sli oil,uliinr :lltgirttttrt'ltrzrt,
,,rri.r.l1rlo-trige.rninali, a iui Sturge-Weber-Krabbo.
(tle culoareacafolci olt Lr4rl,o)
itrrlivrrllo
14. Preaen,ta
de ytetepi'gmenta,te
.
1L;rps11ls,
ilsolite tle novi pigmentari $i pilofii po zonolttttt'rtctt rrlttlrt
'rrrr
r,rrrr:rl),
Ll un copil sau la un adolescent,ne cvocii o rncli[tl(tziillotlr(t olll!rttrrttrttrr
rrrrlri, rnir,iales tlaci ln contextul clinic existl ;i crize olilopl,ico6i/srt,tl
,lu l)n)cesexparsir intracranian,
tti. f um{'facliilecutanqte noLlularela nivolttl trtornlrtrtlor,tll l,ttr:rrtrltli
,r ,rl :rlrdonelulii, insolite de crcqtereain volutn ir, $irlilot' siltt tttrrtrrrltr
r rl ir.o pentlu adipoza durero&sd,din sind,ronzu,lLu,i I)trouttt,
'
16. Pana,riliu,l ana,lgezi,a,
earactorizat pt'ittr-o l,trllrttlrt,tttI'lrrl'irrtl'tu
llll'i
r r|lu|ilol unuia sau mai multor degete (merginrl pinii lrl N,lIll)lll'll'r{n[
'
rrrr,il:rhngo)r in absenla durerilor spontane sau pl'ovo(ill,ortlrt't'tltt rltrtroltt
r"rr rlo tulburii,ri de sensibilitate tle tip siringotniolio, ovcttlrtttt'ltr tttttli
,rrilr'{)mamiotlofie de tip Aran-I)uchenne qi:r,uuol sctttltopinltltitlttlrr, ltrr
I rrrr,' si'rne orientezespre diagnosticul de siringorniclio stl,t
I tlo nitttltttttt Hilittl.,rrrriclictle alti naturl,
l7- Panari,!iul anulgt:zic, insolit de faoics.ltxtttin,tltt lulbtrt'flli pigttrr,tt
I rrrrr,rlc leproame cutanate, ile hiper"trofilr,nLtlnilifornri,tl trotv ilttt',t lo tt,ltttn
l,rrri,,1.oo"ot, " (eu protlominanli, tormoillalgczicii, ittifirtl, n4roigkrbrt,hl'),
pituitare, no orionl,oil,zilnpro (l it,l{ttu$l,i(!uI
'1" ,rr{}ficxie, do loziunea mucoasei
,l,r hpril, obliginalu-ne sA,ci,ut5,m bacilul lui l{ansou ln tttttounul trt,ztt,lryi
r,Lr pnlcbic5,m reaolia lui Midsutla,
18, Ulcarwl perforant (mal perforant) ylunl'ur attt tlttbrri, innirlior ryi
rrrrlo!rr'.Inilial aparo o zon6 tle hiporkeratozl, apoi so dozvrtli,il,tHtl(nos[v'
tlo Ildittclrot
l lirl,cni {i apoi o ulceratriorotunjitti sau oYalrrtr cu tondilr{,i1,
',,rr
rrrrr,r'gini
ploeminentg, cu fundul acopolit tlo 'o sorozitrto giiJltttitttltltt
rrrr,rrrrrr
irroloni;ri.Ulooralia gi togrrmoltelo din jur sint indoloro, Siu[ $l[ul!'
irr
crllo ulcoraii&, clozvolCindu-soin profunzimo, atingo orliiottlnl,llltl
[,ri
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fio [a,nivoluI rlrtlott'
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r'1. l,)sorttcle si lrtutili:eazti i:r, livelul legiunilor
in care ccmprcsirr
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;
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2. latziun,ih sistamului.nerun pat,[!tri.t

lxrt *ntrenrl rrltrtprr,tii rlis_
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r'.r orrliotipului }rllnavului.
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8.3,2. I'robleme do diagloslic

stmiologie |i lopollr'rrlit'

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s.J. I'ULBUttAlil TR0IiICL. MUSCULARII.
Il.il. I. l,r.irr.i,ii .c corrrlililiiscr'iol'lricir i' *uri*troiii.
i r rrr r.i irrr':rrIiri'iirr.z,losic. ,recise a .in,,i at"i oi.niii, i. r_c.er.e.iti, iris
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m.i nbrc -

T
t't'ttl tl ti l c'
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trrlr.,rgrosi rc cvidenti dupi, intreruperea toxicului, pr\)l,,j 'l,j.il]::':.;

,]]rrr'
rt irl.ri!_c\umenuluiclinic neurologicqi clecele mai milt0
f r l)r'irrIn.g:utrv
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rrlr,r'ir.rlrr,
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lui llac Ard"Ie-scttmirl-peorsol,
poate crea
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r',. .1,!,,i,!':,'Jiu,.rlin
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'll
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al fosfori]rzcifruscul,rr,.,car,,
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Ii,eprezinta o boali,

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iraseu DMG dcirscbit tlc-bogirl;itr lirttlrttl

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care gencreazi'virfuri neidentilicabiltr; i) '\spcrrl
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1,ersate,segmentare,'ct inegaliti'ti ile
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i ri"'r"r"i", cii intittralio grisorsl rnli mull $iru rlr.ri1l(il
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(cx transmisieautosomalL_recesivA),

tegateSi ale
l.]l,l,,l,l.l,rr,rlrir,
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polfe r(,cunoir:Lc
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prin crr.r,ctentleretliiar, prin apari,:, II|,r,,II)I|:||L. rrr arlolcsccnti.prin amiotrolia
rizomclicd,inso1,iU,
ii d,r
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sidri episorliccde conbracturi
dc clorturi pi urrnrtc de.miogtobinrrric
ffanziroric(revoll,'i::.,:.1:,'j]:..,j:."1
rllrguo\t rn), prin cs?mcnul ncurologic ncg-r,tiv (in afara
: |lrl,ll.olt(.i
t,rr'.',.||l(.r
discrelcrizouelicetl-tJ0% dincrzuri,)jiprinoramenul
,

p'obcide ischemic
r', ii"',ii;;;;;e-p'ind

la sitcnliu
I :rotr.yrlrtlii-bioelect|ice,
l ' :llr:.,11
irrl
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ttrr',.ir
paralel cu instalare:l coftracturii cluic_
,"Lr{L(riir , ,/s' tiorvlanrl
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,1rSli.lrrri,1.0?5,r:il,Lli de Raa1d,19?g).'
.i. .l!tit'tt,,li;tr de origine eu.rlouind pot
se
inriini io:
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,1l t,.rtir,rn:rlrar sc.rpulohumcrali;, sc asoci.r,zii
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, r,'ur.'l||1,.t,.rr,.t Sr .m
iologjc
nl ). dar cxrmenul clinic neurologio
i lr r' ri.{r,r I v, lrr. ox&msnul llMG
-der.uh
evidentiazi, semne minore d.e tip neurog6n.
t,prIn hip,ercortic-lsrru.
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l,:.::.,,,r::!
,.. ,..,.,),
r, ,r't l|rirr
lrtcs,.irrn3SCJlii,
dC obCZitate.
luir t'f ii pdltnr
sc itsetmilrd cu miop-rtia 11rogresivii
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;t ir tlr \r.vItr..\prr| op&uz;cili,_
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id asociazi,cu hipo"
l,rrrrr. rrrrr.rrLrr.i-r,.
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rrrl .r)rr,r'virl(!, rru sc evidenliazii,alte serin6 neurologice, iar
examenul
ll\l (i rrr rtllvi, rrrrxlifiq"lr.iirirportanl,e.

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o)
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; ',1' lf rr$l(\rrr'rtrrl
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r.irr.:rrtr.r'ist.i..r.:
parlicrrl:rrt
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r
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,,,i,i,ini,lii intaniilr'i,(congolitalrr,),
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t
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prog|osivo,irtvrtJirlrttrlt'(itt r;r|r'r'rI
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i i P;il;;ilid;io.-uJii
i
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rlrt,)rl Iri'{iir rurf( rlirii (,sl,clollii, si. prrlrrrrgili, rlrrl irrrlolor,ii,
rrcggsiLirrri
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pott,t,e
sut,vgtti
(lltl)ri o c()l]1]t,t[o1,i0.
lll. ,rt)rl.Al/r),talr,r,
v ohrrrtrLrii,sir[ (lo o trtitniitir,Ttronncatd,
:rrlilrr rl.rr.piir) (i{)lllir(i1ioiru.lusii,_:
lic_.prinl;r.oac!iruro rncornicii'(percuf,iri
rrr,l'r' ' l,i ;r.r'rrri rrr.rI I ,.i t(.rr)r'r..
ir lirnbij. srrr ll lurrgulrri$upilrrtor),iic pt,illIr ,, ;'i111111
111.r.l,r.lrir..r.
li{.rr(,rn(,rrul
nriutonicpuilc fi torr.ic l]et cvidcu_
tirrl r.rr ocrrzilrrli;0itilot tlo plehonsiune.
I. lirtrr.llt,Lui, Sleiu.t'rl (,niottnia atroficd, sau. clislrrf ia rni,otonicd,
) st
||a ||r|,,:|-i(r'r'lrrIiIrr.,,rr,l)o l_,rz,lUrmiIurului conluxt Sp-miOlugif
:
t 1 I'rt.cttlrt ,ttnl,tr,t.litlar, sub acest aspect boal& lui Sfeinert fiind
lif. lill,l \rlrl,tr'.rIII,.'.tirrrrr.
,lirr r|est grup CtrC re|tlizoazi,rlrolii muSCul$TC.
,\r.rsllrr,.<,.1
t rqrogr.ir
fitr, sinti faciaL 5i diitele la, membre, atilginel trmdtorr,i
.rrrrr;chi.:rrrrri;drii1cfei, rcalizind un facies inexpresiv, atoir, de aspect
..llirrrulrirrlilr.'),cu lipsa cutclor fruntii, cu deficit;I ol6icdarilor ociilor
.i irl lIlz,r'lr)r':r'iriir':ttoIiipleorpclor_:uperioare(cu plozir pJtpebr.nli,);
r.-(,
t)lrllli t 3{Ir(.Jlont (cu cvldcnta alrolic)i slernoclcidornastuidi_
,r|'r {tl{ :r{,.) ,.rr,..r
cu {.\'i(l{.nt:i.rll.o[ie)
ei rniinii;
; musc]ii ,ntcb|rtulrri
rrrrr.,lrii rli.iirli I,i r tLelbr{l,rT inioliolrc {mult mai taldiv}. 5i
l,) .1't't: ( tl Iu, ! ttt rttnenultti m,iotonio relatat anterior.
t ) o)illi: cu Q(|t?lic(i, c\ anurnite caractere particulare:
I trrrlsririsioc[r'e urrnclzli o moda]itate clomidanti,, srrb aces, aspec[
liirrrl o llrrr{irurc rlotr:nninat:ide o gen5,ploiotropr,autosomalf clominait[,
r'|| |)I.rI(,I|II||tiirurrnplcti,s&u_i]pruitpecompleti,
ifarii sri sr,rtipeste genelaliii
..r' ,r r .,r',.\:rriir bililrlt' dc crp|r,siviilte (Crughe-yli Mwienr[onoulos.
l:rr;r,i 1..'r,.,s.
I:1.,7 citali rle nrrdu, tgTd); apxre Oin ce in cc 6ai dcr t.,rrr,.ii irrrl'r'rcrr,
rrs.l('rtrclinice dince in ce mai graye dc-a lungul genera_
1|l1,,'r(l( ,rll](.Jr'(l(.nLrrilc ,):rntepozitiertSAU,,anti0ipAigio,qi ,"rprOlreSie,,
-de-n,adu,
lir.r,, lru,l; ( 'rrugli(J' ,si lWyri:rnthopoulos,
cit;!i"
,.,1icr
.1966,'
r:rrs);
rt(.|' 1r'irz:-r
rle olricei in arlolescen![si inainte de 30 rle ani.
l\t':tnlo
iJc
tttlburd,.ri
tndocrine; - alopecie precoce, ptogresivt
.rl1
r rr rl,
Lrrr Irrrrrlrtl: (,I)ircifier.i
generaloire do catnra6ld <it,
cr.isiulinicne
l rp \ , r;ll s:l r rt,. 1i1rJrJeisubut * atrofie l,esticulari,, cu sci,derea activifi,_
l
r.rlr r, )r,,,tr(r'r iru :rz,rosllcrntie,sicu scdllereaeliminlrii de 1?_cetosteroizi
I
l:, 1(ir, i, It'r'cvcn!:rl,a enol'cei, a aTorturilor iterr,ltiYe saU ft StedlitS,iii;
r rr rlrrlr,n.:r r:Llolilor oestrogonilor' si a pregnantlioluiui.
<'\ )lorl,i.Jittiri ItrtrI{}: Prezen\a tlescSlcdrilor bioelectrice musculrut.o
r',rr';LIll,r'i.rl
iirrr oill.oloalizeazd,,,rafa,lele,,,,,avorselot,
sau,,sayele" mioto_
rr'( (lr'rrllrr rlcttlii, vozi liadu, 19?8).
". Iirnlt, l.tt,i I'hontsen clasicd replezintd, ula diltrs formele clinico
rrl, rrri,lrrri.i .rilgc'iti e qi so diferenliaz5,de boala lui steinerbprin urrniil,' r, L'.I i,rirrr,.r',.:.:rrApJrili3rnulI mri mrJ I b) Exirtcnla rue-i bipnrtloIrr l r1I1I.1,,1 ;1,,,, r'rirl'icirrilor membrelor supcrioare qi in{crioale, a geflsnik)f
'
rr :r rrolr.rrlrllrli;
o) Iieacfie miotonic[ mai marcr],tit,Ia nivclul membrelor,,
rlrr.r'rrrrloli prrtiml intcresa intreg ansamblul muscu]aturii, cl) Absculli
IrrIIrrrr;r.r'iIol
lnrlrxl'ine I e) lrognostic .mai bun, felti1i1,ate,.
speranli rio
r rrtrr ri crrprrcil.;11c
tkr rmrncl putin alicctatc, sirnpiomltologie de obicci
rrlrr{iorrrui (lll,rlrr, .11)78
1906, citnli tto
I Caughcv qi nlyri.:r,nthopoulos,
li rrrIrr, ll)?fi).
,i. I' t'lltiolilil t.on,trn.il,ald
(hoal,a,
Lrr,il.'qtt lNtl,tnbu.rl
), nrultii yt,crrur
l rrrrI rrrrrI rrI ir rrr lrorrlirlrri 'l'lrorrscr
rr 1ro:r,1c
fi tol,tr6irlilirrr,rr(irr,ll'i,
rlo lrolr,lilltti
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nriol,ollir(i

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4. N eurorniatoniilla
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i i l r r.i .,A r,rl rr,
r Ii o iUI llUt h\ l r l rl i i Ii i rrrrrrr,o trru s (i trl l l r,(,.
, \ . , 1. t 1. ?. . i.I ' r l i n i tri l r,l r, r.j rl i c i l rl t, c rrl trrrl ri l rrrl l o ol i rl i l i ci kr prol tl currr
tl c tlir r gt r os ic
l , ! ir r i rl l s rra n l r rl c l l r,I)l ttl(j i c l ( 1gl .l tl )cl ,zi lr,
, g. nl -L(l o rt,tcci i urri
trttt. r ' t l: ' r i. ir l. lr lr ; l l r.' l :i
,1,, (,1,i ,.,.iputi ,n,,rfl i ,,:i i
l rti rrri l i r,.. r.rr,r s r.rrri ,,l ,rgi r,
lopog":riitr ot'l rrriLi trtlcsol, r'izorrrclicti, pscutlorirJopal,icti,
tlc ruturri infla,,

rlr.s,.rrcr':rl
iv:i ;i/s:tu
lll.]1:ll.il;1
.autoirnurili,nesupuihl,c,ctL er.olugie:rcutr'i,
l|'':rr.rrir'irU r'11lrr(':r
{r tl. rnull.'
t,licu ilrlcrl.sirr.c:r
ti]'larir[(!
--iir t(,-r,rur.ilor
rr |i rl:rr.irri l,rt si ir, lrrrochirrril,rt,
,.r ||ln rrl.:'|rjrl,..
nprruaso.i clrii,r.: iLltol
\Irr'{11(I}||I|rirri c hb., I,Jti3,1965' PopeSouqi R:i,tlu,19ig; Iropor-iciuqi
lolrrlr., l1)Ti]. .1.1)?5)-

I,'!iyi,',:.it'l_1,lJtiut;_tite
_(g:rnpul.I illpti \,lralton-Ac1ams,grupul
| I Ir||rI t,' ,rI('I ;I {i Ir Nlontli{lii tle Neulologie
L,(.,..1.._
($rFN) (\-ezi popescrl ,"i "naiu,
. '
Il,7,s) Nirli
trxohrsi' viLotice, ar<a.-curir
s_a crezut (priir virus Coxsn,l
'*rrl.i I3), de obicei fiind r,-orlba
r'liir, rlirr glrrpnl.
rle rnecanismeiirtoimune puse in
(l{r di\'{,tscinfeclii Yirale-(Ohouqi colab., 19?0, citali
.1rrr,.rrn|o|i
tlc liopesoLl
ri l.i.rrlu,.19?8;J)un12 colab., 1963, 1965) rlar ile mfite
;i
t i.i rtc piceso
lrcii rrtrr,llr,r'if
ictrttr.
rL) l)olin.iozilele acuf,es.i subrrctLtcse pot reclnoaqtc prin debutul
lolllti\ brucr').,.u
rnti,Wzti,". i"Urr.,."iai,.,,,
.sc np y rpit?
]:,1.1.
ll| r' f n l - i:llll
vrrt'jirllttt\.
t ttsr ttt.u ' p
tt t.u tL tlr u lp .
lI iu,l.oi.i.k:
sinlj acuzate la nivclul brale1or qi gambelor, inso!,ite do
.
i,tntt (rattlpr
Lr.t.iltr'llil ,1i
,mt6(ulc,ra, apoi.5i de parize'interesirrifs"g;e"t"ii,
l)r1,\||r,rirri.,:llr._t[rnrl)reJor,
ial uneoli qi rnusculat0ra faringelui sia rrd,hrr|| l),rrrUtrul, uuscnllrtur't cste.sensiltilii,la presiune
;i fermi, (indura,tl)
lr l)rll) ur. I,ioilexeleosteo,tendinoasesint insd, de obicei
no"mri",
e*J
r, 1r{ir li'r'r r.lLr. rl'' pulir':rrlic
"o
uloneuroiliozite, ill care se constat[ si'moiiifi' |l'r {,. L.Lt1.\{,,p]e(,nrr}.sitrLlbnriri de sensibilitate dc tip pclincvritic
;r:r.r.r
ryicolab.,1963,196b; popoviciu qi colab.,
.l)('1||rrlr{.ltoll',rtiLir'(l)rur],,
l.riiif. llr;.;,).,\itrt1,l,,tt,.rlulsqitr
,,tt04,tti t.steprezenli lu i1r|orirnalir 40o1,
rrrr rirz |r (t,'. r.{(' .i ( |tie. 1974.cif rli dp pup{-sr.u Ri,lu, t9;g,,
iiiriri
;i
L l 'l r ' 1, . lr llr l. r { l! . : { .i tl t{ r' . r.i o l j i c \(.l n l l o a "e. po.ki j udIl rni i ,, otl cmt
.ul r_
l ttl :r t r : , 1r .ll' , ( . : r lir .rt,.rrr:ri :rl ,,sp 4 , h r1 i . p c ri o l b i trri p,,gi l , pe
utnr.ri , p,,tur,:l
, '.

,t

t : , r I : | ( I | | I |( .

l'.

m e lr llr l.F lUt,) .

sl l,r'l
sittrplonteuiscepule
de cardiopatie(tahica,rdie,subticui_
,
,:t.','tt.'i:t_
\,.l.rri.r
rr.rli.i.1f,
blu,,rtlior-entricrlar.),. adenopatii,splenontegaiie,
ulcera_

ut

tt,t*{)"

tt.-tItdt.

..a ..

p t( ,cu n l

\L o !lti( t

lt,t

;;l of[;.

ltl I)ol.ii i.azitelerzozice contllrerzlr in motl prl,grcsi\. 1,al.ilouripseud0r,rr',1,.rrr,,.'.

r,.trl,. t.2,('.ri:Ir.ri,'troiiilriorimaln. pfer.x111
.1 cU sinrprLmntlr.
r rlr ||rIiIs| .r| | i | ,.rIr| (,totrnr,
-:i colal:..l9it; J,oporinirr.cinohb.. ! gtJ, lgT;),
'
,,' ,, ,,.
cpisorlic trtialgii, precum-si_Jenomene
cutanate ia ;i iii
",. irf(lr-lirzai
rll'ttrtr',4r,rlirrri,rzi1.Jr.
aCrrle.io0,,ntencrl^ tip HarnrLrtl,rrr.,ni[e"1;ir1
.,1.1,,1
Itlr' (ttllr,rrsrrlriltr, livelul artir.uletiilor.scapul",-uiner.ale a1emiinilor.)
1i
;i
'
tlrr{ r'ri{\ ||l rrI i li l[ t ilri visceralo. (rniocrirtlite,
lncunonii tra,nzitorii q.i.j.
(l( re{ ilxt laptul cil a.miotrofiilerizornelicesirnetiit,i'r,
,1,}-lr,.irrr1r,r'laxt
rr \',1ttr'
,,' rlr. r-r'rr1r.tr,1n.i
.-i rl( r'ctrn,clii,creeazri(lc cclemai multe ori t.rr.,
, ol'|r ,lr. lrIul rlirlroliilrl
lJruscltltltel)rogro$ive liacio_scrapulo_hrrrnorir
ltr
i rii.l.,1.L'i-1,)rrlr.11('
.i rr ,rrr,r'r
(ltothstoill si (trri.lson,
1f)?1,c,itrriirle I>npcs.'
.,r,li ,il|1U...
lllTs.i rru.:r r.olrLlr..I9ti:'i,l!)rii: Nrrrirr, lt16l: l,,r|',rri,,irr r;i
_lJ
'i
,r,l:rlr-.l1,7il,It,7J)r.
I'..1'tir. s;i litrr, rlrr,i.rl,.rrs,.lril
rlr.r,l,.rrli.pr:rrit.rr
lr Irr
rlrrlrili rrrrrli:rgrr orlirr
gr'1';il,rlc l) I,.

l l tl tcttl lli{i t I r r r t nr . I t iIttlr

r r t llt l. {noll ic t r r , cTlr . r r zii,1111
1111,1,
11q
11111i11r
r r r lit, r Hr , ,
,,r, l .rl tar,r r zir lr t lr lot nir lr . r , lcr , lr r lot r r ir , kr lxr lit illior r lor cr r lor r r iozilli,( : lt lr lr t )
lll
t r t oI ot ii ir t t 1r ot I , ir r r I(rr' r r rplr , r lor r r ir r r r I r (lizor
. ii r r r , lir . r i){lt
, lullr uf iur
' ' Ir' | | r' II(
rl , , rrrrl ' rl ilr r lr r r lr , lip [ olilir r lir uLr t r r . r 'r 'il, ir , r, , r r ir r r I r or 'I . r r r r Irrr, r r xliliciili r lr ,
r,l l , .,, (rl r.u Jr ir r r .riI i t rri t rrrIri rr sr r r rI r , lr olilr . )r,llr r '; i cr r t x isk'r r {, rr l( 'sct r r {'pir ; l
trrr,lrl r , rl r, l r r llr r liir i lr r r llr r r lr '1i, cr . |, r r r r , i: r r lt 'sr r ir5i
r r lr r I r r I I I r I lr i, rr'ilr r l, ilr r r r ir r r i
l , r,rl rur ( | ' r)| )(| \ . i r, i rr , 5i r r ollr lr . , l97it , ll) ?ii) .
iilt ot liuilr , , t . t r t ,
Irt l ttqto: r lit t r l poliut io; il. t lr n lr {\ il, , iul, . ,l,i. t t . t t t sli. y1u!put
(
lr
r
r
llr
r
r
r
lr
trtl
rti
rr
r
lr
r
r
r
t
r
r
lilolr
t
t
r
lr
r
r
r
r
xlilir
i,
r
'i
:
lr
)
V.
S.
ll.
, r r r lr , por r lr , lr
1r,,1
l rr ' ,l rl r rl r, lct r cor r ilozirr,t r llr ull) lilic;
ll) O lr qlt r r r l r r it , r 'lr , lol lllr r : r ' r r . lr ,
; [ I r xlif ici, r i ir lr , lr , slclor ', \ iil, t I
' t,,tttttl t' s.l , t l, it r r : : r , i( llipcscrsi
r llir lr r , : 11) 78)c)
r \\, rl r,r' l ir r sr '( it r r , or r shir r i, rIr )r l) i\ t r xlif ict ili l\ : lut lt it t r ur l r / / rr r r / r / , , r 'u
,r, l rr' i r rrllr r 3; i r r giut lul, - glolr ulir r r ilr r , ( Wllllr r r r qi Ar lir , r r r s,lllir i{; l! r lr r r
' r, rrr r l rrl rr lr . , f 1) ?: , i,t 9?5) I c) I ur poll; r L: t r i.tonor . li, l. irr:i.i it nunu, lt r lt o. lor , lir ',
, , l , l ( r' r,irl( i( l si I ( i[ I ( . t 'opoviliu qi r xr ll] r . , 197; i, l{) ?5) ; ll , lluli. lir , ut lt
'
I l l 1, l rtl Ii r r . r 'r lill, olt r r r ,pulin<l sLr r plinilc r r lr r r i, lollr , lt , r . lr . t r r r , llr ' ( r lr r lr i
rl rrr l r.i tr ; i Nillzbuch, 1969; ll, ar lu, . 1. 078;L, olr ovit r iu 1i colr r lr . , ll) 'r 'ii,
| tr, ' r
;r r r I r r t t {ilr I ud0 f ibr ila! ic, sur yenir r il i <xr r r r PL, li,r 't r llt , r r r lfr r r r I r |
l rr , 11,r' ol rr r lroiI
polr , r r
il c\ pl'csio: r ,unci polineur opr it ii - , , d. yilg- l) l( . 1(") t
l rrl , l ri rl rIi r, zir rcom
1lloxc sullvnlt a, t o, O r l,ol il] l] lil conI |ir t , {ill, t , oI r r r r I . I I |IIr
r
| . tr\ i i i i l i t r r pet it ive ( pot cn! iale cu f r ( xjvol1, ii, r , Pi( lii
: \ 0/ |j,
l0
,
,l
,
rl
r:
s{,
it
nLr
lr
t
r
el
m
ecat
r
icij,
r
nuqchiului
lnr
)
l)
ilizir
t
r
r
r
r
.
lr
. clr r r
a
sil,
u
dr
i
' ,,,
,l rl rr l )rl )i i I 'opcscu qi I iadu ( 19?8) t ocm li acest c f ir r sr r r ^l, ) N'l( l , , lr r ; r r 'lr ,
' , 1,, rrr r' " ( , r Il ilot ef izcnzi polim iozit ele.
''1 ,ll uli,licii,rile histopatologtce din biopsir.t, ltttsrul.rr,rir,rr(lu( ,,r'r.rlr
rr, r rrl ' ri l c isiv t le polim iozit l, punif t l ln evit ion( ii ( llr r r r lr si r , {, l, r lr . ,l1}( ; ; 1,
l ' rr' , l ' r,l r{r s( , u1i ll, adu, 1978; Popovichr si colir lt . , ll, 1iJ, lt ) 7ii) :
ir r lr l
l , rl , rrl l rl l i L lot ii lim f o- plasr nocit ale ; i m onocit ale r r r r r scr r llr r ', . rp,
, i . r r r : r ; L,r r
| !' ,
rir'rlctit'r'csconte :r,le tibrelor mlrsoulitre, cu lrol,iviltiti r|gi.trr'r'irl!\ r, ;
| ,'{,rlr)zit festtului
nocrozat; - fibrozii inlclsti {,irrlii.
' l ' ol iut io: : it cle ( t ler m ut opolin iozit ele
) , dt r : sr r ollr i') ( r lir r ilr ult . r I t
,l rl rr \\ l ,' N
r . czi ?opescr si I iadu, 19?li) sir r l; nnllr , r . oir f ir i,
f r i pnl ; . r , 111'1. 1q
rt' rIr,,rIrrri . rrrlif icult ir , f i di*gnosl, ice. Cu, : it r r , r 0,ir r I , O r r icI , llr lor r lilr r r lr r I r r r r l, r r
l rr,l rrrr,rzi i icr , cr onioet r ebuio sil, se slu'pr in( lii hr u, lq,r lr , hr : ii . . r r ) Nlr lr ur ir loz: r
rrr , rl ,r' i r; lr ) I r upusul er . it em at os r liscnr inir , L
I c) I I t liI r , r 'I r 'I , iI r rr r r r r lor r ; r r ;
,l r l ' ,rl .rr' lri iii loum at ici) , ; e) Sint lnlr r r . r l Sjdglcr r I l) I lr lir r r iozil, r r lr
, r lr r r r , u,
l )i ir gn( ) st icul se st nbilc; t c t loill t lupii, plir ( iiiulllr
innt t ir lt t l. r r l, , r
lll , li
1" r1,r'l trttrr' : a) hnunoeloct r olor eza ; b) . l) ivclso it lt o ilt v( , sl, igr ( ii ir r r r r r r r r lr r
,' rr , , rl l rl Lt t t inii, r ileDM ( 1 ; t l) 13iopsiiloinusot llt r o; t r ) ( 1l. r 'r r r r iI iliIrrIr , lr ir r lo
, rr. rl r,,l ,rr1ir I 1i)
- I nvest igaf ii ladiologioc, oncologicc r i. il. ( l, or r l, r 'r rr lr , lr r ll
l rrrl r.rr
r.ilii, olLr l la: I ?opcscu , li }iadu, 1{) 78, I {6hnit n, l1) ${) . )
\ '1.::.;i. I ILi,tt'oJiila n,eu,rogene
\.;i.:!,,:1.1, ( l rr,ft.t
(Ltr( s( ttt,ioLot1
ir:( glenuutt' :
/) l )i sl, t ilnt ( io il g{r lt ct ir l <r t t pt 'r ulort it lr , r ( ii, t lis1, r r lirlt, ,r r ioiloI iiI r r I 'r r nr l
l rl rrrrtl :ri r, t lr ll,1i loclr lizir kr , I ir r I I i I IrI I ' r'rrIrr ( sir r r r r llico llr , r r lr gir r r t llir r r r ) .
i ' ,| l l tr,lr : r r r r io|, t r r f iin{llr ( }glllo r r r r ir , r r r lir r {, Lr lr r t r x, r , r r nir r r r r r .
.i ,/ S o ir solcsr r r lr : ir ) I I i1r oLor r ir r r r r r r cr r llr lt r'i,r lr , i r r r lll, r : lu llt i pllit l
rrrrpotl ;utl ,il,ilr r t cir f t r r lr r lt r t r llr . oli r r t t r . t , llllr r zli, ir t ; lr t ; r lr , l ( r u ljlll( lll llr ir l
Itol rl i ; l r) llr lr lict t llr t ii r r r dr , llir t r ', <ur t r ,t ir r l r : : r lr clr . r 'illilir ir r r llr ur , lr i lx'r r lr r t

llitl
?illl

fr,nr('loHl)illlloHul)t(1lllo
sirrl;rlrrostfiittlo strgrrsl,ivtr
fi crolli(xf.lllrsciorrllr,tiilo
(ll ' ltl)srlt(,tn
lot. ntt cxclurlocllrlotLrfulnoull,rrlltt rtt ;tlocls rlo tlctrot'\'l,ttrr
lr41r'rrrrriclollllic :rl nrniotrotici, nta,il,lcs cil (lo pot {i rnascatodc fcsul,urilo
rrIr|)| :rI rrIii(r) irrrlcostdli cind ili rlu origin{t& In fasciculclo lnusculare profuntlo
(lirrrlrr, lll?lt). 'I'rchuic sii mai;tim ci fasciculaliilc,de rcguld,,ploced amio.
lloliir. c) Iltrlkrx idio-rmrsculalconservat; rI) lieflexe osteo-tendinoasecol
nrri irrloiJcl,dinjnuato sa,u abolite; e) Tulburili vasomotodi $i sudolrrlo rlcstrrl rlo frccventc I f) Existii, in unele cazuri semne neurologiceaso.
riiri(', rjil,r'cpulmit diagnosticul topografic: tulburi,ri de reflexe qi/sau do
si'rsilrilil,lto, cventual alte semne spinale.
4. INl.tatrodiagnotticulclerutind, incumb5, o sedede aspectereyelatoaro :
t) I)t:n.cn:urcacompletd,.' irexcitabilitate galvanici, qi faradici a nervrrlrri I incxcitabilital,o a mu$chiului la curen_tii ile excitalie scurt;,; lenlrrr,r'ca,,si miiriren pragului contmcliilor la curentul galvanic i scidercil
plrrgrrlrri rcobazic a1 muqchiului; galvanotonus muscular pa.tologicI creql0l'(rlr cron:l'xlllor,

b) Deneruareo,incompletd,.' conservarea excitabilit;lii

galvanice qi
lrrlrrrlicc u,nelvilor, contracliile avind ins5, o amplitudine scflzut5 ; la nivoIrrl rrnrqchilor se remalcd o oarecare excitabilitate a unor fibre musculato
lrr crrtcntul faradic, dar cu r5,spulsuri heterogene la curentul galvalic, in
sctrsrrlcir,uriele fibre au o contractie 1ent5,la prag mai sclzut, iar allete au
o corrl,nrc!,icdestul de vie la ul pmg mai ridicat.
5. ,Eleatromiograia araLd o sd,rS.ciresau o absen!5, a potenliale1or do
rlrillrlo motorie, in general aceste potenliale conservindu-Si morfologin
rrolrrrll'l. Iieapari.tia acestor poterlia,le reprezintS,indicalii precoce, adesor
(.lrirr' l)r'(!cliliice,de reinervare.
;r) I )11t1cy1)o,ys(r
cotngtleld,se caractedzeazE prin: - Existenla unci
rrotivil,i,{,ispontane perrnanente a fibrei musculare, cu prezenla de potenfil,lr tlo fiblila!;ie tle scurt5, durati, de slabd, ampliturline qi de frecven!tr
rlir,t'rrrlal,iv sl,abilii,; - Absenla oricS,ruipotenlial de unitate moto.jorr,si-r,,
ric crr rxllziir, conl;ra,c{,ieivoluntare.
)t\ I)cnart)eree,par,tiald, se caracteizeaz\ prin : - Prezenta in repaus
rlr. plit,rr{i:rle tle fib4lalie sau cle fasciculalie qi atlesea de potenliale ilo
l ilirlr. Ir'rtoti!', - In timpul contmcllei voluntare, se inregistreazl o
riiliicilrr :r,poton!,iatrelorde unitate ;rrotorie, care pot prezenta uneori chiar
rrrrr1rIi I rrrI i rri cvasinormale. In cazuri extreme, un efort deosebit poate der,lirrrllr, l,r'irsr:ulsimplu
(i. .l)i.opsinmusc't d,rd,ofer5, de obicei imagini histopatologice net difr:lr,rrlirrl,o l'rt,tii dc amiotrofia miogend,: a) Existenla de Ieziuni in insultr,
srrtr itr pliioi, care corespund atingerii fibrelor unei aceleiaqi unit5li motolii, i vr'ornoce fibrele unii,5,lilor motorii nelezate prezinti aspectenonnrlc I
lr) ltilrrrrloiozate sint atrofiate qi inlocuite de lesut fibros sau adipos.
,\.:l.!.:1.:a.AmiotroJiile mielopatice
l. (:u,ntdere sam,iologicegen,erale: 1) Amiotrofia este de obicei bilal,olrrlri, rlrrl rrl cste toldeauna simetrici,. 2) Amiotrofia debuteazi, cel rnai
rrrllscl rlisl,tr,l,tll,t cxamonul electric nc irrdicii totus,i o leziunc mai tlifuzil,
Jl) l,)volrr(irr,
os1;otlc obicoi progresiv ascondcntl. 4) Irasciculaliile sint do
rlgrrlii lrlt,zrrrttr, dar ele cel ntai adcscll tlcpiiricrsczoncle musculart ilt,roli:rt,c.4) li,ofloxoloos1,co-1;ondino:lso
sinl; abolitc (eventull rlirrrinut1o) lrr
lt,trl;ctionro
tlar.,silt dc rirgttlil
;roIiorrrirrIiI,oIc
6i ln sinr'lrolrmclo
,,r'ccirrtr)t,
r,xrrgrrlllc'in fll,A (plin rirxlrrrnrulpirrr,lnirla,l
aso0il1,),ti) Trr gr,rrllrl trrr
oxixl i trrllrrrtlri sulrirrcl;iyc
ulrtr olrir,cl,iyorlc sonlrilrililtrlr,,
rllrr"r,rislrrtrt,lr,
ll(,0

trr" i rl i ' i ,x i lr {ii l, . r '''r {r : t it lg, . r j|r f r lr . lil sir , ir r g0t r r ir , li(
r ,1sllr r1,\ (.Ii I I i )i | |I , l, . . , . lt , r l
I' trrrA ol rllr 'lr r 'r
. I I lt t r r t I r r t I t ir 'I itNr
l t t tt t t t sit r r lt r r r r rlor r isr r llr l r lr , r r lll'i r 'lir ilr r r lir , :
i ,r,r,r' r r' l r, - {; ) lr gr 'r r ( . t . jll,r r sir r l, iI r r 1r o|I , I r r r I ri.r llr r r liili
slir r |lcr , i|r r r , .
I l. .,1ttiol.xtliilt tttit,lapulict rl, t,r,ol,r.tlir:
rnlidi,
1.. ,,1ttt.
id rolti.tr,tli.tt, bau[u, Lui, .lI t:irrt+f,It:rlirt, (paliotttitlilrt. rnttt.it)tu,tl
' , rl ,t! )..n. r , : 'r t . lr . r iz. lr zi p. ir r : it , ) Jr Lsl, , hr r : r alr it li, j b) _Al, ir r g. r r ,rr it iir \ ir ir
r, rr' | r' rror' r r r I s', r lillr r alir r , 1 l, 0 1r ) . 1. : 0ca, lizlrriLr lt igr r llr , lo,
t r r , l r r r r i : r r lr . r r r ! r ,
I
r 'rtrtolIir0, irr grriru':ll lrt'ixln'.rir ritnt0 lil rn.|rbrtlir
irrlirriorr,rrr ( i rrrI r,rrrlr, I rr
1,, !' r' ttl xrl ( ] r Tr u, alc, ; i, pclonict 'c) , ilr l la r not t r lir u'kr sI l) ct , i{r i , ( l
; ir r ; 1r , f l1, , , 1, ,
r,ttr,,U l i r/rr Lr r r r r Trlrr llhilr , lr , l 11) ; \ r niol, l, of iit , sc llsociizij,
t,rr;
pr r r |lr li, , ir
.,
,: ,., i , sljr , lj'c lir r r r 'lc r r r pir Li. Lr , t r r lit
11'r 'r r . lizir r. ,. r lr , rI i rrri rrr.:I 1i r r r lr r r
l\L
l, I l'
- llll) r '1r ) llr . loit . r l( . illpor . l: t niJ ;
lr lxr lir , , , lr , t , ( . ll{. \ r . lr t , r , t , lr . r ,
i , rr.rl rrr.l l ,No
i r nzilivc olr ir . r . t irr , ,
i. c) Nu Be const at i f asciculalii, t ulLr ur r i, r , sr
IrrIl .,rrr' Ii liil lir n, icli( r r c ( t l: ar 1n, , ot t , 1; r ecI inir c)
r r ici 1, r r lbr n, ii, rpr
, i r ilr ilr r i
;
i
r rr, (r' tr.l ll: t Ull, . , , r i. Si 1 pr czcnlc; i : _] t ipr . r t r . r r r r ir . . r , , . l. : r h: r : , sr . t
r I . ir r l, r . r .
' rr.r ,. rj ,.| |. r 'ir lr '.
ixlgji. r caci.ie I n( : njlr gr . r "li l: r , r ir . lr 111,, 1, 1111, , ,
^r t hit lXii, . r
trIr.r' Itl rI.l , i. n LCR
{pli. i, ) cit ozi. apoi_ r si hipr r , *llr ur r r ir r ozi r r r oilr . r r r t l; ;
1'r lir.rr,.{,irr,
dc <legcnerescenfzipc mlschii cor;spunziil,ol,i l.zirrrrii .,r,rrrrliri
.r,1,ri or' .r: iir slr il'. r zi lr pid. ; h; pot , i 1px1, . -si
|, r lt , . lr r llr r r |ir . i llr , t i{, r . r , . i
' ,l :r.l i rr:: i) I iind vor ba r lc u r f cr . qjunelir olici, , r . lr c t ) n, ilt r rr . ( 1, .r r r lt ; ,
,'rr l,,j/.il*i rnai extinsc (poliocncefalomielitri) po{
sil ,,ira.i, 5i si,rIl.rrr.
, | | r '(
| I| | I( | ( ) -

'.). A nt,ioNroJin
miel.opaticdd,in hentatomielic..l) So rttnl,il,rrirr r,lrpirl,
t,r,r r'()rril,riorealeziunilor cIeate prin hemolagiil,iriI.ir,rrrrrrIrIIIrr.ii
; lr,) li)*tri
l,;'.rl:i. rlr.,,un.{lctor
generator
dc
}ior.nir,.l,orrrirrlio
(1nurirrrriIilrr;
.etioiogic
I r l,rr,rrrl"(,
c1roFi,,T"t,
sau la_chesonieriI a,rxrnrirlio
vlrscrrlu.iir,lr,.)i
"q;
I J t.i*ir.iL tiipcctul ate
liip Alan-Duchenno Unililtot..l ga,. Iri Ii r|,rIr.tr,I lrltrrr
lr' ! rr ( irzal leziunilor cervi-calecu cea mai bogal,r.i,
vir,srrrrlrr,r,izrrl,ir,,
r'r,
l,'rrl'osl,(, r'iltii,
in cazul leziunilor segmeDtclor1,":S,; (l) $o:r,so|iriziirrrr:
r,lir.i..f lit,sc5,,
cu abolirea_mpid5,
1,rr,rr
a i.eflexclorosico-ti,irrlii r,rr,x.,{1rrl,*1r.r(.rl
rrll)r.iiri.s()nzitivecle tip tlisociat siringornicli.,crr rlislr,zil,irr
irrrrrrirrr.rir.ri,
rri,Ir,rrrliLl,t-r,
I .o) ln cazul unci hematoini.lii rrrrilrrl,.r.ir,
h,, $. lr,s,rriilzii,rl.
lr:rrlcrrlozirrnii,un sindromRrorvn-SCclunrrl
l.irrrrlrrlo lrr,rrrrr,l,o.
; f) lrr rrrrr.hr
rrrr,rlirr
Nc insta,lcaz[sublezionalun sindrtirr ;lr,r,lr1llrgic,
lrrrrrriplogiir
Hrr,rr
rl,rrrph'si( , h inceput.fJasc,a,poispl,stic g) $r srrlprirrrlrrroriiI'ii,iir,i
rr,l,,
I
| | ri :,,s;ulgltlloletrtr
ta tnccput, a!oi xantoolr)rnic,ctt pttl,orrrir,l
lri;x,rtrllru
r.rrrrr.,:r,
,.ji rnoderc,ti:i,crcrsterea clcrlcntclor c.lnlirt: (u,1,illirrrlir.ii,zii, r,il."
r rrolirrrrcltxrzil,).
l',.
..lu.iutt,tlii.le-littormctajoasr olo ncuru.;ittitpidruit nIr lln,tt tttr,,
t, ,t'trlt,r.,
rlitt rny'rlnl','nti,lilirVtin ullr uirusLttirinL, ilrr olrilr.i,r.rrIo,.:rIi.,
rrr,,,
rr ,rrrrr.lili.(rrr:rir'.rrilr.
liP,\r'lr,n-l)uclLrrrrrr.).rrtirrs{luilrt.rrlrrIirli.,irslr,iirrrlr
r,r
l,r rrrrrlrl'irril;rnrrLOtflascrrccl rrrli lrrlr.stlr,
ru 1r)|l.,i_trrLIi;r
Irgir,ii, Hi,
Irr,i,rr,;l
rrl.'rrrt1.rsr1
r.r:llrllr,irr,rkrsirr,
;i ptiu contrrxhrlitrli'r.],irrs,
Iulr|il, prcfrrrrr1l Ir. r
rrr'rIil'i.iili|rrrkr 1ip inllilrrrir,l,or
rlirr 1,.(1.11,.
or'l rrlri rfilr.s.rrrixislii,ni rrr,irrrr,r
rlr. |r.zirrr
ro I'rrctlillir.ir,.
I I I " rl tttiolroliilt ntitlolurlIttr t:u.r rrol.tr!i1
[r:rtUl,
l'\trtrt.tll:.
,,1tttt'tl'd. ttttiolro,lii.rtt,irloptlir,ru uolttlirrlr,lrlit({ iIilrr,l.tr
. .,\,.
.r l irrilrr'tl, ll)i'l):
ilrr lrlplr\ r(f(.11q1H16
, ,ltrlrlt,rrJrrIrll
,1. ,.lnt illt"li,r_rl.in lntliluidilt tulttilurll, r.r.r1i1rl.
rl,
ll (irr|,rrr
rt,tr,rrrit,
tlr,l:rlrlrrl|ii,tirttt,r.rrIirtrr,r,lirrr,ttrrl
Irrrtriliir,l.

{ il,i{ulvilo l)t.ofol'(
i l (,ilI lu,arlul{,ii rrlr,scrrlirri
(irr1,r,,g5 ,li ,lI rlrt n,ni),o arrtio_
1t'rtfitt, (r:tt tlofirriI n1t;1,e1)
Ar.o lir, rlgbrr.l,1 t opog4tio' [ista lir,la inclnbrglg
lrrlx.r'irr:rrrr
(:r,nriolrulictip Atan-Duohonuo) qi iiii,ovotuoazii,
lent,_progresiv,
|lr ll,lrnr\I)rally Ur.tntl,uitrciLsucccsiune ]ezionalii,: rnu;chii erninen(oi
Irrrrr,rrriii. hipotrrnir,rc.(nina sirniani) mu;chii interusoli qi iombricali
;
{r||ill:r.$(.lt(:li.lir' i);flcxorii drgtclor. tmina de prcdioalol.); esDensorii
rlrrgr.lr.lor'
(r.a,rotlansformi, mina de predicator in r-niniiale ,,marionetX,D)
I
rrrrrsllrii brt{,ului (,,brrr,f,ulineft
$i btlnnt',); muqchii limbii (mai tirziri).
l\lir,ilrr'fi rrrult rnai tarrliv arniotrofia atinge qi mu;chii rnembnilui inferior,,
tnurs-cbiisrlqrulari, murychii abdominali. Aini6troti'a se inso!e;te totdeauua
rlo luscieula,i;iiovidcnter incd, din perioada de Cebut.
. _ lroziu.ni aualoago pot cointeresa .si nucleii motot'i ai trunchiului cereIrllr,l, r'o:rlizind. polioenceialita superibarii cronicd, (ct oitalmoplcgie nu, l"l,ri_
.1lrogrcsir-i.), rcspectiy polioencefalita inferioari, eronicX^(plralizia
Itttllrrr,t
ii plogrusjr .i).
a
. . .). ,IniotroJia.din ,,atruJia m,usculardprogresiud,spinald, su,bacatd.
1,.r1ll:lr,Zu"rt
7i Alajounninc', /, descrisX,;i Ce Stl,te Driglincscu $i Olteanu
( ll)l-t,";),so instaleazd,destul de rapid la e,rtremitilile tiisiale ale rnembrclor
tittprlioaro, sal eventual ale membrelor inferloar:c, evoluinrl relativ rapiil
r'ii l!1)gr'()siv,ducind la un sfirqit letal prin grav sindrorn bulbar terminal,
il rlttlrrs_dc citeva luni pind,la u.n an. S-ar pi,rea (Drigincscu qi Olteanu,
l_lrlir'j
; fJuhova, 1951, citatr, de DrlgLnescu $i Olted,nu, 1915) ci,-estl} rorba
rlo o vorita,bilX poliomielitS, (ence{b,lopolioririelitX)pur5, viralil.
:1.
.Am,iotnJin sltinald, iu,fantild, (boala lui Werdnig, EofJ nztnn ) teprrzirrlii,,in realitate, una din cele mai fJecr'onteboli genetice'atecopilului
(ittt'irltrn{,ir,
dc 1]a 20 000 de na;teri, dup5,Kriiger fi-Franke, 19?4, citali
rh Itrr,rlu,1978).
r,l 'l'ipuL ,racuf' malign (Radu, 19?8)prezint5 urmittoarele caractere:
- I,l'rNlitl,1,u rricesivii nclegati de sox; - At.ingcrea ambelor sexe i l)ol)lri;li)rrr,[oprcrnoe (uneoii fetal, dar iri generallntre 3-6 iuni - md,xi
trtrrrr I a,rr)1-.Alioctarea musculaturii oste generalizatii, qi deosebit tlc
r,rrvcrii,I *-llt oarirotcr imlorl,ant al amiotrofiilor din boala lui llierdnigIlolltrrir,rrtrt:stc cointcresaiea,,:i a musculatur.ii par,avertebrale,care cair./.ril./.;i{.ilrl,.r'r.:1,
in fa!i, a copilului in pozi{ie qeziridS,,intr-o atitudilc
iIrrr:-t''
(ll,rr,du,
1978); - Evoiulia esterapidd (3*4 ani maximum);
,,IriuItir,
r\ l,i|lgrrrrril trLrrsculaturii rospiratOrii determin,i, clispnee permanenti ;i
t cu;ril{,{;iorliafra,gmaticS,,p}eoum Si infeclii intercru'ente i - Aretlexia astc
l,olrtli ;i gonoralizat;, ; - Eipotonia este masiv*, generalizatX, sirnetricit,
(r'tt rurltloplcgie, hipcrlaxitate muscuto-ligameniar[, realizind- ,,p5,purya,
rlrr rit'1ri, dozarticulatS,')- Guibert qi Guibert, L974); - Iievelatoaro
lx)lrl nr rla,$i! a, hipotonie sinti Si abdomenui bombat Si faciesul inexpresiv,
ll lr gflr'it, tlrst:hisd, (Rariu, 1978); - Paralizia flasci, este generalizatx,,
tlilttz.ii,,rilrLotriotr,rlar mai exprimatS,Ia nivelul mu$chilor gitului, ai trun"
trltiultti ryiai ri'tdiicinilor; - Iiareori se constat5,fasciculalii; - Progresiv
nrt ilfuc1,oa,zi:r,
$i mu$chii limbii, masticatorii, muschii felei, ai faringelu i,
irt,t'1,ir,nliv
picinl
,ritnugchii distali ai membrolor I * Se adaugS,cifoscoliozd,,
ir vr,t'.o([uiD5i urroorl palaplogio in flexic; - Rcaclia de degcncresccnfii,
rtrlo nrrxivit; DII(i ontc alo tip naurogon (pericarional clc reguli,) ; * Nrr
oxixtll, ttrlflrriiri do sursibilitato, sornno pira,midalc, trrlburh,ri psihico
(t'itt'rxrt'ioligolirrrrio) (llronkol, 19?il, cit&t do lia,alu, 10?t/.
lt) ll'ipu,l.,,ltlttiy'nf irrclrrrlrrclrrno l;nrirno(lin oil,zuriqi so rrilra,ll,orizoir,zil,
(iarrrstxrlp, Ili07) : -- I )rodornin&rrlitr lrr, trrolnl)l'olo
ltlirr (lirr,rlrr, 1.1)7t11
!0t

rrrIl rroIr| ' rr ;

I , ) r 'oI r r ( , irr r , l: r lil r r r lr , ilr r r r r il,r nlr i lr r r r gi ( ; r lr r , f i,
lir lr r lolr slr , r r t r l) ,
,l ,rr rl i r' ryi ir r l . s1, . lr , . . llr f i I
l) r . lr r r l r lr r Di, r , ir , r r i, lr
t l., I lt r r ;
Nlr r s. r r lr r lir r r r ,
I rr.i rrl ri l rl c nll, i l) lt ( ilt lr f r r r , lir l, i, .
l . .l ttt iolr o. lit , spir r t I d. ynr yr 'slLt i . jnwuiI d lt xr r r lot t t i, t lt t r licll ( lxt r r lt lui
l l ' ,l tl l 11yll ', '11r t 7lb1't 4- ll'r lt ulr/t-' 'l) ( . 1) lllil/ . ir ir r lr r lr ilir . ii. slr r r ir r lr r lolr , l
,, rrl rr, (i 0' ) {, r lir r cir z, t r r it r , r 'ir r rur
l t c1r '1, slgrilir r r ilit r l ( r 'r r 1r 'lr , r r sr r r isir
r . r . r , r . r r ir ii
Iri IrrIIr)| | | |r I ii,I )r ,r slr r lI iit ul s0r loijl. 0 clr zr t r . isllot 'il, r li( r(rNt ) l) lt f ii ( , t ) lill] . , lt ] i 0
i
l .rrl ,rr,11o slr
l{) ?0 - , - r il, lii iic I il, dr r , ll}ilt ) I
l, ) r 'r r lr r ( ir rlr r lr r
; i i lolt b. ,
l , rrl l rl ' grrr r iir , li, r r r r 0r 'i r r r 1r t r r gi lr oliolldo r lo iil, lllr ilizir , r . r r r \ r r r i, ll, r r l'ir r ,
I
|) ( . I r t I I |ir , . , i|,
' l , .r(' l .l ). r '0\ ir r r r r , lii,, r lr r I ir r ir or i r r r u, st r al, iir t o t r rI ilt ozil, lli c I
,l , ol ri r,r,i lt r lcr nlt lclc jl{( n. ioar o, : llt ur , it r r l olt . ost l, {, ir r r ulr , r r r r , r . i, r ur ;
;r
l i r l l r rrl c {) : \ lr ! ( , 1{r t ) ( lir r r ) itlindcosc}r
so
i r ot ulier xr lr : ) sili ir , llolilc l}t . ( llr ) ( , r ;
l rr , i r.rrl rr{iilr r$i 1, inc{}t r sl, a] lt ei - - l) ia, gnosl, icul r lilcr r r r ( i|l I r r {r i,r lr r o I r . M .
I' ur Ii rrrr p c ba, zilc- r t m er lr lui I lllG , car c it t boala,hr i Wolr lllr , r 'l- lir r gr , llr lr '1. 1.
\\,,11q11111'1'
lrli,l iL srrrirrc tlo tip rrcurogen pclic:lriclrLl,l.
.'. tllrolirt rnusau.Lard,
sltitrulii sau.pulo-petnnitd (boult ltri. I)t r',itlrttl;ttr,
, r ecentsub r t u, t nel,ie br t e[ a
' tt)ti t;tttl ti t nui
lui Nt ut l, , ht r xt r ) $o ] ) oillr r , ( , 1
ror rl o l rl i t r t O pogr af ia am iolr uliilur , r 'ar . o sir 1, t , ur r 1, , llr rr ir r r . r , li t r iLr
, rrl ,rrl rrrrr(r 'r spoct iv t acio- sc: r , pular e)qi ir r m usr ullll, r r t it
I r r r I . or I iolli,Sr r plr r r r
, r r oz.olo.,.lic
it,pr,r,r'|inc
bolii lui \\'ohllarl-Kugclbcl,g-Wrllrirrlrrr., r.rr,o r.:rlir'rrrlil
.r rrrl rl ri u, ( 1ladu, 1978) . Sii, nu se conlundo ir r st l cu hlr r r l, scr pllo lr r , r , r r r r i
, t,r rr | ).l \1 [. ) .
l l . l ,' ot ut cle , , usacial, etde
l am iot r oJii m , iclopelic( r u er olu! it / r ir l 1( ir t r
r
l ' , ri ,i (l rri lr r r r '1,19?4)
clpr inr lo selie desindr 'ot , t r r ( lir r r r iol, lr licr r r r r ioI r llr lir , r r
. rrlir lr r.rr itltc sirrelroame sau conste)a,!,ii sinrll o rrlr,l,ir,tr
:
l . ,\i nd xt r t m el, ed, a B. L. A. I iadu ( 19?8, l{) ?l) ) , ii pr llr z: r sr r gor liihr r .
rl l ol rrui oli, t 't , com ant lil ut ilizar ea t er r ncm ui r lt r , , sir r r lr , or rrrlo H, 1, . , \ . , , '
l ,rn ci rro i ( l dcf inef t c , , cor nplexql sim pt om at io cor r sl, il, r r il,( lil lt , lt iolt . lr lil
rl r,i :rl r' , Ii r,sci
cr Lla! , ii$i sem ne pir am idalc, t lin cauzir ,vilr it r lt L( ii cilr . r r r r r r lr r r r
1, 1,,r'i n (' rrr {)ace: r st ii sir t pt om at ologie se int ilno; t o, ir r I r o ] ir |r t r ii r r llr j r r r r r ll
,,rr trrrri pr r ( , in t ipic[ ; aceast S,vi] det at o t le cir ct r r r r slr r r r {olit , r r r r r , lt lizllt , u
tr
l l .r ol i P rrl fil, A r n r eclur oa, r ; t ein nici un ( : it z un r nr r r r ilor ' ( , ol|||l|l ( lilt
lr ll! , 1,
rl I r r,rl (| r' or di( ) iogic) '.
Irr rrrlour t t r ddt ilc noaist r c da plact icit , I r ct r t r r kr gici, I or r r r t lilizr r , r 'I r , li
l r, rrl r,rr rl rtr r iologicil a r . ar iant clor pr t zor r 1, al, or lc lllr . lr r ( ll) ?H, ll) ?|) , r , ll
rrr,r,l i l i r,i i l ikr 5i com plct [ r ile ] r oast r o :
,
a S. - iI , . , 4.I ) i19r r oslicr r l r r r r r lr , Lil, , r lo
.:r,) [,' o r nu, Jlencr aLizr . t ld,alasidi,
l ,, l i rl i r l l r' r r ii( o1r , r 'r lor . clr act r lt tsut r iologiLi( ) : - llr iir lt i,lit lij, r , r nt r llt , r , r , r , r , r lr r
l ,rrrrl i rrl (rl oci f l'i,5r uu dct clr nir r isr r r gt ^1c1, ic) . - . Alit r gr r loir , lr r r r r r r , h. ili
;
rtrrl rr' k';1' 11, ,r lar ct r pr ct l ot nir r an{ii
lr ) ! r lr lr l\ r 'r \ ll
llr r r it nr scxr r l t r r ilsculir r .
l r" trr,l i r i rl l i r r l. t r lc 20 t lc illi, I n, r . i1,
ir ia, illc t lc l! 0 ( lo t r , lj f i r lr r ll'i,?{) r lr , r r r ii"
Irr.rrl r| o : ir r r ir ( iv 30) {, r lin t . ir , zr r rsulvinr
i
|i( , t
r ir ( r c 4( }; i {i0 ( lo ll, i'
.' l .\ (l i ' r(,r r r '0 r r r ol, 0l t , on( I r r , lsi. r r 1,
r l0 obir . r , i lt r r pr ilr r lr lir r r I , llt , r r li, , , r , r r zii
,rrrrrrrIr,ol ii( l{l 1, il) , \ r , ilt r - l) ll( , llir r t r crr , r r ( f r l( ! lt $io I ) r ogt r t iivt i,
lir lr ir r r nlt l, t , r r , t . r r
r,1ror IrrIr' i rr r l ; i l}r ( lr r r llr clo jt r li'r i0ir lo, M ili r ilt ' r lollt t l, r r r iar i,Ll t r lr t r y, lr r r
l rrrl , rrrl ri rr ir lor ', lr ir , c! s, lx, llr ir r l lr r r I , oliolr
lt ot 'iscr r , pr t lilr i, li I \ ) i|.(I | | rr| | |' i lr i
r.rrI r.I rr'; r,( rr I Lr i ( lx, ) ( , ir r 'o ir r sl ii lilir r r lr r ir r r r r lsr r l cvolr r {ici)
Alixl, r lr r rlr l r r
I
l ' ,/rrrrl rrl ,i r lisllclii, ; i r r r lr i lr r lr lilii,
cr
r
llir
r
uli,
r
r
r
r
t
lr
lr
i!
r
l
r
r
1i
l) ( r cl, ( , f nli,t llt l
rl rrl ur,l i ,r' or r r lr r ) iziI
,I | |i | 1,rI |,II lr t r llr r t t , r l, l
(
lloir r , r r r r r , lit
i ziu t il\ lt lllr , l, ( \ it , zil
|
|
I
|
|
it
{i
l i r rrl (i l r , r , r lr r lr 'lr r 1,I 'r , r r r lr ir r r r i,r . ir , I ir l pr . . g|r , nivii, ,ir r r , r i. r t ulr ilr r r oli lr l lt r

20ll

! li lulij - I,'rwr;iotr
la,(,iikr
prrrzrrlir.1rrl,dqlu1lI -. ,l.rrlbrLrii,L,ilo
sirr1,.
sfincfr.l'irrtrllitrl litu., iir.l'(li\'(1
;i rlisr.r',:i,'
t
.u,,r)It'orn.ut,Duilorri, rnalignill, Ii .a.pig evolntiyii, &fcctcazil inil,iaI $i
rrlrsiv rrrrrscula,l,uril
irrorvati5,cle nucleii motori bulbopontini. Tiebui'o
rni{i:rl..rlili.r't'l!i:r1,1de
polioencefalitii infcrioar:i $i, dineirlrelcs, cle o
?
| |lt r)r'ii(to 1r.ltrleltlc(jlcDlut,l.
tle SLA (form6 lui patrihios ) pr(,do_
. .t.;) I,'orntu TtstudultolI ncuri,tri,cii
r||Iir trr,t''x t l'ctntnin.
sn caractorjzerzS,
priu al-ingerea
de obiceia gr.rrpcI'
i,rl rrrrI i r.[| |Ir,I (. jur.rvrlc dc sciaticu] p-opliteunyLorn,cle scil I icrrl po.-ptiicu
rrlrtr'tr, sir,u:I amhelor,
,insotindu-se.de crampe _muscularein repa-uJqi h
rrr),'sfr {le all')lirea reflexului
achilian, eventual si a celui rotullan.
j
.lt) ll'ipul uaenil de BLA .ear semlalat) apaie snb 30 de ani fi realir,,orrzii,.
cu 1trcc,;rde,re
amiotro{ii proxirnale pseuclomiopaticc scapulo'_humer.r1'lr.;i/,sau
pclvi-lombarq sau-formc scapulo-peronieie
iNclsoni5i prensky,
ll|7:. (.il (i tle.Rutlu, 1978; Cioran. ICZ9). r.arc por
diticultiDi diai:
",:ca
r'|:ir ,r,r',1l&nsflrtetnsa prin prezen{a [asi.iculatiilot,)
a lrlse,atol E-\IG,;
rro(l t (,llttol Dlopstc^sr a ovoluIlot.
Q. llormu Jarnil,iald,d,eBLA lpare inlr-o proportie tle 1?o/odin totalul
,r'ir,zurikndc SLA (Haberlanalt,1964), atectinclde fapt, tn paii,Iel, celulele
t'r'r.rrrIrri, antcrior, tracturile posterioare, spino-ccrebeloasi
,si piiamidale,
{tr''.r
unelc semne ce;rebeloase,de corclon posterior qipiramidald
li
-rrrptrcin(.1
( lil,rlu,
19?8 ; Kurlancl ;i Mulder, 195b; iTaberlandt; 1964 Cibr'an,19riij.
;
d\ n'orma d,e SLA d,in cotnplerul Gtmm, ( SLA - parkinsonism *
dtvtt:ttlti ) rru ridici, probleme riiagnostice la noi in 1ari, cleiit in misura it
{r,rr lrrti),stjii,formd, are etiologie virotici, (virus leni) li in cazul unor sinrl'r.r:rrrrrr
rlr.-Sl,A.rntilni[e5i .la noi in larii iu ialrloul senriologici]LIcfrror.a
J)ot sir :rpilrit fr altc simptorneoarecum asemxnd,toare
cu cele din ,,compler.rl, ( lrrir,rn') (fenomene ext_rapiramidnle)tulburd,r.i psihice qi altel6') qi 6aro
,i.rrIllr.l in'.xdrrbilc nozologic.dar care,probabil-rcprozintiforme .,sim_
(popoviciu ,Xil?ascn, 19?9i. S_a
, ' | (' rrrrIi i,:r.' ' (yilot,ir,c Nnu_degeneratit.e)
{ r'r|$Ii11ir,1;
crr,plcvrr,lon{:r,
SLA este de 100 de ori mai marc in insulele Guam
rri l rlu,,rlrlci[ in oricc altir,regiune a lumii (Iieed qi colab.,1966),o frecvenl,i,
rrrr.lri5rrrritrlc t'arc intilnindu-se si in F,itipine si in Nour, Griinee.Ilirario
:ri.r' Lrlr. (ll,tj7) alr rrjLtl ci, rle frl'1, ..,"ornpli,xulCrm,rn'.tlcbrrloazi ll
\ rIir|r..||rirIlll(.r'u Fr lt,lco cyolufie mai leriti, semnelepiramiilale precedintl
lrrr cr'lo lrrrlllilrr.
, ,..\\..lIlt\li& ]nusculard,progresitd,Aran-.Duchenne,prccum fi Tsoralizin
4trllurrl.TtrytqresiM,
DucltctLne
se p_arecd,nu reprezintii 6ntit;!i aiisiincte, ci
r,ii,, rrrrr,,jolil,a-tctr,
acestora, in realitate roprezintd, forme al,ipice dc S.L.A.
( llurlrr, 1971J).
l)
,uLault.plue
hbrm.aLa
t,utr
atipice u,e
d,eDr_1t
B-t-4 (_(Irinuu,
(Raclu, 1978
19?9) OSte
este tmpor.tani
important
; Cioran, 19/U)
't
-ryi6;Utofan,
Hll,,lio locrrrLoscutcin plactica rreurblogici: - foima mo:roparetici, (cu
rlrrlrrrl,
rlrrlrrrl,.lr runrl
rurtrl.din
din membre,
membre, de
cleobicei
obicei dlstat;'membru
pariplegici, (tot
forma ptraplegice
(iot
; - forma
('l
0 lr { , (rlisl;nl,cvcntual intii
cu| (l
rlolrrr{,

la un singur
infirior); a foima
; rlcrr l rrrriopa,l,ioil(rolatati, $i a,nterior)I - forma cu debut brusc; _ forma

|I| l Nrlt(.Il:r1,ii
mu$culare la rlebut; - forma miaSteniformi, dC debUt,
(ctr
i t l rr,llirri(,iiu
ull;orioari de fasciculatii Ei dc amiotrofii; - founa cu tulburtiri
ptilrir,o l{, dobut (confuzionalc, dr:melr!,i incipicltii)1
incipielti) ; - forrna
forma cu sonlno
somno
ux l,rllliliuuit.lulo.

2.. It'tn.oortyti,ida amiol,ro.fii,neuro{lcn.a(<n i,ablout'i t r S.T:.A.) pot sir,

Jrl)il,r'ir,
ln sonilil,:r,l,o,
irr ncoplir,ziirnrligrru ryiirr rnickrp:r,tiiloisrdrcrrrigoilil,tlrr,
lTrJ).

:1. N i t lt e( nt , r Nit nllt ) t lli( r '

r lr t \ . 1, . . 4. i. r r r r ylio r r ii, r r lr r r r lt lulr r r r llr r
rl r' , (rrrrri r r r lt r lologi|0 ; r 01,t oillizt , lr , s|r r r r l, rsir
r r t llot r t lt 1, ir r r0lo i. {lr A, ll t , r I r . or .
r,, rrrrrl rrl, cr r rr , lililr j, c$l, r r r kr osr r jl, r lr r i r tr 1xlr ,lt1, rl, i, llot r i, r r t r lin, gr r ot l, ic 11i
t I i , I rr| | |r.rrL ; lr ) Nr r vr l, r il, ir ,ollir lor r r icr Llb) Sindr oilr r r clo r lo l{l, A r lir r ; r lr r r r r r r
,, LrI rrri II iI r r I r r ; r r , ir rr r llxr vit r r sr r li ( l h. iigillt csou [ i ( ) ll, ( ] [ lI r , I t ll- , ; i) 11lgll
,r' , r' r r.Li(, ( ) l, r l'. , ll) ( i9r ll) {; : }1. 1) r ur r t ; i colab. , . l9( i0, l9( ; ; t , l{t ( ir '') ; r ) llt r r . r r
| ,r| ,,rrrrl Ii I r 'I r r lir r r r r r clcI i, lr r e t r lr r lil, iveI d) L'o) ior nicli[ a lr r t r r r ioir lii, xr r lr r r r . r r lir
r,r' orrir .Iii c) , 4nor r r ir Jiikrjot r cf ir r nii occilit o- c( x'vioiilo 6i lr lo I r r lr ir r r lr r r
' rr
, r | \ r{ ;rl ( l, ( 1,I, l) {l'r r r lor ilo col'! 'icillt ir r a, lt c; g) ) ) ilchir nor r it r gil, rrr.,r , r 'rilllr l
l rrp, rl l rrl i r . ii ( lr r r lilir , ; r i r lo aJlo ct iologii) ; h) Alahnoidit clo <ur r . r 'ir . I r rI r1ir r lr r
l ,' | | | osi cl'ioit ] i, 1i) , \ m iollo: l'il r ] in sclor oz- ain pLici ( linr r r ir ,ir , r r r ioI r . oI iI I r ,
rl , i l \1.:r,lr r i l, r , . i. r r r r r ,( iit , al,do ( iu iber '1,$i G uibcr t , l9?4) . O lr r r r r iir r r r r r lr r r r r , zr i,
l rr,rrrrrr ;i t nr c- \ N, ln( int r cul, olof lio at cnt st t r pr . ilil cy{lll1, i1r ,ir r pr r r r 'r r lr ,
l ,r,,rrrrr 11ilr lr : zcn( lr ,u, l1. olset nr t il ( cer cbeloase, t , est jbulit o, r lr vlilii oplillr ,
r,l l .l rrrl l l r,r 'i, r r vr r nt ull r loar cu paloale papilalii, t t , r nlxnillit ; r lir or , ir r , {r r r
,.rrrrrl l l i sl ilr 'i,I il loa, c! ir cu bonzol coloidal ct c. ) 1 i) Sir . itr uorr rir r lir r ,11ilir r
rl torrrrrcl rrsilir r gor liclicc pot r caliza t ablour . i dc S. lr , "A, , r llr , t 'r nr : r lr , lr l r r r t
,,r, rr rrr:ulrrlogic ltoatc stuprinde cycltualclo scrnne :lsooiill,rr rrrvrrllllotrrrr
1,Irrrrrl i rr( iI rscnzilir
,.
ii sir ingom iclici I t ulbulir , r 'i lasonr ol, ol. ii ; i t r r r licr r
\. .'r l t l l l 1'l |l l ' ).

,\.,1.:!..1.
il.'Lm iotrofi tla r ad,iculonerritice

.1. (lqvn11[py4
genetale:1) Survin ln or.icrr
semiologice
lil's1,i1,.
!) A rr, rrr
urr rlcbut tlistal, mai ales la sxtlcmilil1,rlt,
r',,rr,,r':rl,
rrl,lrrlrrrrlorilli'r'irrirr.r,
it l',rl,l i lri la,tt*:r,lcsi simetrice(in poliradiculonollil,u;i ;roIilIrrIirrtr|rrrrrrrIrr
tlar qi unila,teralc,chia,t'lrcirlizlrlc.,l) l,r.r'zirrlito
t,.rlr) r;Lrrrt,sirrrel,t'ice,
, lrrrr lopogllr,ficlit dicular'5,sau troncnl&t,i,,ctt txccp(ilr,polirrirrrrrrplrlirLrr
,) li(l irNo(cscrkl tulburlri senz,itivcsubiective$i/ slr,rr
olrir,clilrr (,lt lli.r'rr]l
|,'Irrri1r'||irrradicularii, troncularX, l]rultinovriticir, $i]u l)0liltovrili(,ii. ) it,I
rrr ,r1i'lirrlc (Lilninualeasau ab0liroa reflexr:lorosltrr-t,crrrlirrotulrr.
i) Nlrrr
, lrr,rr,,ii,
o croluiio favorrr,bili,,regresivS,cu cxccpljr ]x)ljl{rvt.ilr'lur'(['rlr
rr,rrtoIrirLiiIor')
geleticc tamilialc cronico..9) So a,socil,zfl
o li,l), rlrr lr,;irrlir,
, l.rrrr.
l0) Aplorr,;rrr
I rrI,rIrrrrrrrrrr,
;i lipir.ir.!.|)Ilareori s0 insolescde fascicuLt(,ii.
, |' ,1rr;rI r'i rrr scrrsibilit*tca la, prcsiunoa rnil,solor'
trnrscrrlarrr;i lr, Ir.rlrrrIrirtlrIuI,
rL,r'ror,s(,,11) illulbur:irilcsfinctclicnc rlc ol.liceilipsosc(crr (!)irx!ptii[]1irl
rIl,rrrrrrrrLrl
radicnlarelombo-sact,a1n,
inclusiv ir,lcoozii (lo tflll). l:J) ,l,rrllrrr
r,rrrlr,vlr sorrrol,rlrii,
$ocrotrlI.iiqi tloficc sinl; ft(!(rvcni,r)
iii iltlx)t.l,tutl(f.
li. .l t'ioNfoJ
ii.lc ru,tl,icttla,rc
so pot rcounon$to prirr rrrrrril,lo:r,r.rrLr
r11s1q,'
l, r',,sctriologico: J.):\rniotrof:il,csl,o1lrc(locoqi rrkrc1,ivii,,
ll,ingir)(lrlr,.lr.lril
!) Iripsos(jc{)[t]:aoliil(]la,scicullrrcq,i librilrr,rrr.lt) AiriHlirrrlrr,
I'rrtirlrzir,{i.
ir rrll
lnr'rl,/rrilr lll,tirliziifl:tsccllltr gntpolor.llusa lal() (inclr,:llrrrlir trrxlxrcl
r',rrIrrcirri),
cllro irnllrnril, o loDoJ{r'lli()spociu,lii,,r,rldicLrLllri,",
rIrr,I,or.iIii,
lirlrlrrlrri lii, lirlrrrrr lftlii.oitrir,(lit, r'ilnnlli lir rnili rrrul{,irrrtrqrrlri
;,i crl, Iirr'rr,r,rr
rrrrtrllricsl,rrinrrrt'a,l;
4) I rlkrxolrr(,$lnlo.in}ItlilttltHr
rlo rnl,i lnlrlt{r rrjrlii,oitrj.
,r r,rrl;rrltir (| i l rri t Irri l 1,() sllu i )olito pcrrrrii;tliagrrosl,it,rrl
tlo Lrcrrlizrr,r.l
rr,
irlrrrlillii nrrlirrtlirrrr,fr) firr srrr'Ir'irrrlrr
o ltilrocxr,illrbililillogillvrrrrilil r1r
Irr,trrrIicr'l,.
li) Il lrr,zrrlrr,lrcl,r'irii
i r[ r'ilr]iir,irri|o|'poslrrlioirrrr,
l,ullrrrrjl,rilrr
rlr
,,r
rtr,trtti Iri Ii 1rr,I rr t'iNlitrtrlr,tii,
olirll, Jrosilrilili{i irr pltu rlr lor.tr,liztrro:
lt) 'l'ltllnt.
t'rttilrrsrt rzil,ivoslll)i{rrli\{rr'('l,lizcllzii
{,tizcl(!rl(! ritrlirtrli gii, r,rr,r'rt,olr,r'llrr
Iot' tltr o,illr\ Iot {r rr,r,lr,l$
it|r'hlot'it,r
r'tr,ttr
Il itt t,irt lrrtr(rt,
Irt'jrt i.rir('r,llIrt'r'rr
r r t r l f r , t r l l l z fi

l(i'l

o l tl r l tr t'r ,

l l r r l tp r ,ti i

i t, l ttr tti tttr i i

l ,{'l t

r l i l l ttr ,,

tr ,|r l t.ttl l tttl U

lrr

a0$

lrzir,l,(1,
,rirrl,r'il,
r'i1,(lii,i1iIilor
rlrrrll r;rr,lr,zii,
rlrrrrrriltrfrr ptoior'{irrirr loIil,0r'iul
lrrlrrtrrl lrl rrrt'sl,otriirlicirri. l,lsl,trIrrcvorri.il,
rlc lntrirxrtlrr\r
lrilillola,lil,rtlca,
rr rIrrlllikrr', I\'lirncvttlrrrlo oklrrga,{,it:
llc lli,rLicirrikrrrkrcliltr;ca,ziiJitru(fxitcrtlrrrrzr'irr,lgiilo; b) 'Urtlbtttir,t'ilo
do scnsibilil*tc obicctivir,s(, 0&l'aotolizoilzr"t,
plirr lrilrrxrsl,ozii,l,lLcslczii,unoori 1)rin hipercstczii, cu ilspect global fi
prrrlrotfiotrill,(lo ilsorncncaou topografie speciali in bcnzi ra,diculilr'c.
'i ) ,\ pr'orr,lxrt{)tdoaunr, gi.sim trtoclificilri ale ICIi : fic de tip in{eclios lu me
rrirrgo-r'u,rliorrlil,olc
virale, luetice sau prin alte infeclii, fic tle tipul disocia( iihrl lllrtuniuo-r,itologico in compresiunlle radicularc.
(1. AtniotroJiila d,in ntonon,eurite(9i mononeuropatii de ilba'se c.,rigini)
(rltrpil (.1u,ibert
Si,Quibut, 1974):
l, |u,racl,(/rcgenerale:
r,) A riotrotia reprezintai un semn constant, alar precocitatefl, $i
irrrlxrr'la,ntra
acestia variaz5, tn func,tie dr natura leziunii I este precoco
r;i inrportuntii in sindroamele tle secliune $i de fuitalie; tardivii $i discretl
rrr sirrrllotrrulde compresiune.
lr) Arrtiotrotia se insole$te de: parez6,sau paralizie flascS,cu topo.
IlrrIi,r Iloncularil ncti; diminuarea $au abolirea reflexelor osteo-tendi.
rrorrsciri toil,oriul jneryat de nervul respecti-r; tulbur5ri de sensibilitato
iiulrirri,ivo 5i obicctivc cu topografie periferici,, do asemeneade intensitato
vrrlirr,lrilii,irr luncfie de natura leziunii I tulburi,ri trofice cutanate qi vasorrroiolii irnportante in sindromul de iritalie; L,CII,este normal.
r) I)rucrilc pot fi foarte vii, spontane ira,u proyocate d.e citlo
rrrirlr.irli,rrrrroli ou hiperesteziecutanati, $i durere la presiunea maselol
rrrrI sr,rl Iirrrr11il, trunchiurilor nenroase.
rl) ltollcxolc locale sint abolite.
o) ll,ogr'oiiiunea,qi vindecarea sint posibile, cu restaurare muscularii.
l. lllor)tL(l,ascntiol.oclicedi.feren!'iatetn J unclie d,e natllro leziunii:
it,) lli.tulnn,t.r,l.tfu secliune aompletd: - Amiotrofia este precoce, proglr.sivii,i1ilirir,t'h:cxplimati, pe tnuqchii paraliz^\i ) - Asist[m la o paralizio
rurrrr;r|rrLr'i,
crr hipo- sir,tratonio; -lieflexele osteo-tendinoasesint abolite;
li,rrl'lrrrrrl
irlio-rnusculareste. de asemenea,abolit I - Nu sint tulbur5,ri
ilir ll lrrrlrioctivo,nici alureri Ia presiunea maselor musculare , i a trunrir,rrz
r'lrirrli|rl rroLv()rs{i
slrb niyelul seclidnii; - Se constati, a,nesiiezie
superf!
r,irrlir gbbr li, I - 'I'ulbur'5,ri1e vasomotorii sint putin exprimate ; - So
lrr rul,rr,l,i,I ). Ii. l)iasivl.
It) Sinrlrom,ul,tle iritalia: - Amiotrofia este de asemenea precoce,
.r'rrprirlri
Asistim do:lr la o parezi,, cu conservareatonusului muscular;
I
lirrllrrxrrloostco-tendinoase$i cutanate sint diminuate, rareori abolito;
llr,l[rr rrl irlio-mnscular poate fi exageratI - Se constatii impon;ante
lrrllrrrllili rrrrzil,ivc subicctive: dureri vii, Bpontane,exacerbatede frig,
rlrr pllrirlrrlr rrLasclormuscularo ;i cle migchrile de elongalie; - Adesea
rrrtlrlirrrlrrrrlriporcstoziecutanat'),I * Se remarci, tulburiri trofice imporlrurlr: tkr pirrlii, ostcoarticllare qi ale Janerelor.
11 r\inlxntuL da compresittne:* Amiotrofitu estc tardivri $i mai
prr{irrirrlrrrrsi,;- |)rr,r'illizil,
poal,oii c(,rlrplol,il,
tl*r tolusul rnuscularosto
qi cttltttLill.osint clirrLitr,litl,iv ('r)llr.rolv|,t,
1 '-.ll,ofkrxclo ostft)-1,(irxlirIor,so
rrr,lo rir,u l,lxrlitoI - Liol'lc.r-rrI
irlio-tttttscttlarc$li(J(1t)tIs(tt
virL; - 'l]rtllrrryrr,r'itbiLi,
lrt
tiililo solrzil,ivo
Asislir,ttr
tt
ltipttttrsl'ozitr
strlriccl,ivo
silrl,r'rt,t'itr,bikr
I
Iilrii,i'rrlJrrrliiljtlo sottsilrilil,lr,l.l
(rrilirr rlrr,lri
rrrrrrsl,rrzirr)
li l)rtir irlilrf,,ir,,
lrlrrl0$

l rttrl i i ; -- I \ lt t 6r 'lr ii r yi n. r \ ii t , ijnr r r r r r xilr ili lll pr t Hir r r ur I Nt t

so r . r r r r xlr r lr l,
l rrl l rrrl i rl i l r olit , o t r vir lt r r r l, r , rl l N .l n dt t nt , uLt lt ! , , t . t , lt lt r ut . ( . r tHulvilo
, 1t
I io $l) olt l, il, n,l. ior lr r ; r i1,ir r lr r r vr . r r ( io
tr r i r 1rrr1r|,i r,1l,, r . lrllr r . lt lizir r r lr r .sr r
Allr lil, ilt r lo r lir r ot , i Hjr or r l, lr r r rirr. r r , ili
I r , ir r :
t r lr t t r lr r i, . i t k. r ir r lr . r 'i
ll. r r vir r . r t li.lr lir r 1rrr ,r ii rr rrt .rr .Hirr t l, r . r . {.lr
r tl
:,,l
] ll. ,l,I]ll|r r t
| | | | | |l(,f;rI|1,.:l
Irr' ||(
\ r , : r sr I r lr . it sulr l, i(lt . zir t t r ii, if t r r liir r r l t pf l.
lxr
lili.
r
ir
r
1r
_r
,
r
r r t ir r l
| |r| | , || . | | | r| | | ir l lUl 'l lcll; 7, r t ir , t l{' llr r r . lLczir ,li, . r . t . U. ir j- l{r
, r i r lr . , [ : t , r . r . ,
lr pr
r,r
s. r r silr ilil, iilii sa 1, , r : r ir t u'r niit oa, r 'ulr or
, r iir r . , i. , , r r , , 1, , ; 1i,i. it
' r' r' ri n' r'ir
. r '( ir
' | | r| | r | | | rrrr | i[ [ |r '(rr rI I |(I i r , l l) rr i ( j( , i[ I , r r , 0t ilii; i ] ll dt r r ut r t r yi, ir r I ir r r r l, r , r , l lr , r
r' rr,:r ;
| (|lt llSlt l lt lt r h( . I t u. r . ( t ill) in. ( i _ Rt liof Ur il0 t t ut sct t li t r
lr r r t r r lr lr
i
rrr r" 1rIi rr ( 'r '( 'sr r lf (,1ir r 1, "( ) lur raf
r r nasir i r nuscur r t r : 1 - - . lt i, 1cilr . ilr vor r r r r r r r r l,
,l , \ | tr, i l r rnor l 1) t . ( ) gr r r xiv, r lilr coinccm a, it unllo; - - 'Snpt lilr r , , , , ,
11l( , llllr , r , jr f ( , ir ,
I i kI t . t r k: r lt it , i.
1rrr rrrrrr,l
l ). .l u t . iulr , 'J. iil,, lit pr , lI r t t Dt . ; lt ( f t *peliD
lt t ) lint t r , ) Ut t ii ) :
:u .\rrr ir '( r '''liik snr t t r ili r llllt . it r , ri,
r r ai
: rr.r.r. rrI rr:r I r, lr r r lr r t r r , ( r .
1,
i1il
|
,r,
Ir,r
'ii
r
t
ilil':
r
_t
i)
sr
'1.
,
i,
.
i)
;
\
r
r
r
iut
r
,
,
f
iilr
i"jl1l,
bt
I
r
' '|,
i |11| r.r : r Ir., sir r r r . r lilr . 1ilr .
" r' r,1 rJ.,{ ' u - ( lr Fli ll'lr t r e r list lli, . sin1;
f iill ._t opogr , a, f io
r ixlicult Ll, ii,sir , r r|. r . ( ||r r I I I iI r ;. i|
t I l i rl l L' xol. r islt ur- t . r ilir oa, s.
aboiit ii ; d) N. s. . r 'st ir t ii
lr r r . ii, r r r liij
, t i i . rr,;o ciilzii t : u t ulbuliili senzit ivo
r luf icot iyo f i ol) i{yr 1, i\ , ot lir l: r hr , 'r , r i
l rrl l rIfri ti v r l; or r r ot olii, scc] . ct o] . iisi t r uf ict ;
I ) . lt . I ) . ( slo lr t 'r r zr r r r i,lolr
i lr , lr
rrr,.,.I U l ,r|oslir I i, . disr r li; g) S, . it sot 'iir r I
r
lLo
r
r
,
.
b,
r
l
l|r
;i
1|'r r ||r r r |I iI i , t r , , , , ,
| ' r ri rr{' ..lr llllllr , loglcoe1'1. ) ,in f unclic
de nat r t r a, polir r t r r r |o; I r I ir r i ( l( 'r r . r r ,
Itrl .r' {i oi t;r1 , pr r r losional[ , car elLt iali, ,
t lisr net abolici, ir , r r ioir r r r I r r ii,r , r llr r ; 1, _
Il. .l tr.iol.roJii.le di,n
Ttolineuropatiile uonict .litntilitlr
1.. .l ttt. I dr o. f ia r ] it t polt neur it u ( t cr nen. i. nr : ur t r : |. pn, lr t r r lt il :
I
lr r lilyl 111, ,
l ,' tl t,t ) i Il tn \ li! t elii h. [ per t r oJ. icd,
alui Dijir ine_got , Lt : t ut , zir t , t i, lr r r r lor r r r , I r
,.rri r( l (' 11rsct niologice i a) I ) ebut e; I zii
in copilir , t , ic Hir , r rir r l|, r lolr r r , r , r r t irI r
r,' r, l ul trrt r r lr lr ) lor inf er ioa, r e b) pr eilom ir iir ,
lt t r ir , r r lr t l r r r lr ir r soliI r r . , r r l
I
t" trrtri .r' i klr '1i- : t l r r r uqchilo. plant ar i, anl, r . t iint l lnor . $ Hl{il) it , l
Pr . i, l. r r r , . lr r l
, r ,r,' tr' tc n I ( locan
f l cu gr if a degot clor I c) . l, ozon, ziir r [ r i lr r r ( ir r r r r r r lr , lr r i
I,,,,I, Ii | | r' i rr , igilm bei ( iu f Lzcle inil, iak) )
I r l) ( lr r plilr r ll lr r r r lr r
li: t , i ( 1) 1t l) soi
rrrrrrr' l ri j rr r 0r r r lr r : llclot supcr io: ll: , t , oalizind ( )
luir ir il, r r r li0 r lo lip , , \ r , r r r r
l rr, l rl nr{r i r ) I I xlxr pl; ional so oxl, illdc
f i llt lluf ( 1hii li, {r r i ; l) lir . ir lr r , r , lr i
rrrrt,r' ' l rit'i i 'i, r l: ir r it r ilor
r lcr r r llt 'cl0r 1i lr , it m nchit t lni
I g) . ll. lkr x. r r r , r lr r ' lr , r r r lr
r' r' r . rri rrl,ulr , li1, . t h) ( lr r it cxlr r l s. r . i, r ugi. ir r plit . ir qi r r r llr r r r , r r 'i
! r , r r r r r r Lr r :
,
) , hi1r 9- sl, r r r ur ciit t izict up( r r , liciir ljlglr lr r lir , r r r 1r or . .
' l rrr, r' r (:l rl csr , t ri'ulgulanlr
t,rrl ,, l trl l r r r t 'it li ( [ o $( llt sil) ilillt t ( ,
lnol) r i( ] ccl) li\ , c, llclir ) r illoilr i! r lr , r r 1; r r r r , ;
rl l i trt.l .r' i s li( xr sir r l,lip. r lr ', iiil. r r . r , r , ilt it , r . lllr 1r , i, f i. x1r l. r lr ( ip. ir r
; , t r llr r . r , , , ,
,,,, 1,,'Iri IroI ir oI ii llr r t ilr r l I i )(l t.(.(, )t t l-(, sr r lr lur uut , lt nol, ( x) 1, ( loi1l( !
it r r lr r r ir lr , ,
l
i
t,; rrl rrl rl ,j) lt . l) . r 'I r r t , I lir , i'i,
r , slo ir r r lt or ir r llii, , so\ . clii, ; li) I lvolr r ( ir r , r , r r lr r
l ' .rl i r, I ,(|r' I I I i t ,i I r( | o hnr gli, ir r r lllilvit r l, r r ilt r .
' .' ,. ,l ntit lt r ll it . lin lnt lq lui ( t ht . x. ol l, I ut ir , l, oolh. . il) lr i, l) llr , lzi,
ll
r rrl rtIu' i c f, il|l iu i |{I I )|rIii ('(|I | ( ii r , r r l r r [ li lr , r lr r s|lrir,r l r r r lt ) - g0 ilr r i ( r ||r r , or , i
r , lr iI I
,
trri rr rl l vl r,tr r o, I lr . l I llr r i) , lr r it , i lln. lr lt r r lll
ii0 r lr r lr t r i, lt lit r plinr l r r r r r ll, |r
l ,r,\r, (l l tl l i I t ot , t r , t r l, xcr r r l t r r I r t ilt r I ir r ) , t lr t lr ii o rt rrrrI Ir I i1I r I rr r lr r 1tI t .I tnI rr rr rirr
l ,r,r,' l !' ar rL, lilr r I or r r ir r I r , r r Ilr. jr ir r lir t I |r ii r i ll, it t r $t iBir r r r i h, i, lir r r r ( l uir , , r ii l

:( t'/

(l(\ I'il) rrr(riliiv,{lIl)ii (iulI riofirlrr

,' rill(llrziifi iirflr{r sIrorl li0(!; l)) ,,\rri{,lnr)lii!
o rrllii 1,o1xrgr.llio
rlislirli, irr ilcrrtrlirlsirrrctlicii,;r,) I)cbrL.[orzir,
Ilrrrzirrli'i,
la,
rrrrrrrrI rrrrltr irrlirrioltril,lczirrtl irritlelr,urrlrtllr,t.ior.si trrctrrlrrelc
sulcr.ioilr.o;
rl) l)rrlililrrl rriol,ol uvoluclr,zit,
in ltat':r,lclfi propol,liorlal cu aniol,rofiu;
.) l,lr isl,ii,o slrc.o$iullo oronologicii,
de dispozifictopograficil a mriotrolioi,
rlrrlrii r,'rrr u notzii: l,:l nrelnbrcle inferioarc: pcronierii, cxtensorii degclirlor',glrr,rnbiurul
a,ntclior, muqchii moletului, apoi, mai tliscret qi tardiv,
cvrr,rllitrpsul (mai ales vastul in1,er.n),ceea cr: realizeazi, amiotrofia .,irr
.irrliirrli,)'a lLri Clarcot, cu ,,picior de coco;', sau in ,,labe dc barzX". l.,a
rrrcrrrlrlclosupcrioare (dupX aploximativ 2-b ani rle evolutie) amiotrofia
rr,1,i1rs1)
suri{lcsiy:muqchii mici ai miinii (intcrosogii,apoi muqchii tenarieni
lrilx',1,orrl,rieni),
rcaliziml amioirofia aietip Aran,Duchcnne, iar m&i tir_
li
zirr, rnrrschiia,nljcbtalrui (extcnsorii, apoi flexorii). pronatorii si scurtul
rrr1rirrlIoI'sint pu1,inafectali (sau de]oc); f) Amiotrofia respccti, urmitorii
rrrrrs<lri : atlrluctorii coapselot', mugchii centurii peiviene, lungul supinalor,.rrrrrschii brafului, muqchii centur.ii scapulare, muqchii trunchiului,
rri giirrlui qi ai fel,ei; g) Amiotlofia se insotefte cle fascicula,tii(lu totrlearrrrrr) si rkt crampe musculare in perioada c,ledebut, tle tulbru.ilri senzitive,
rri,il srrbicct.ivc (parcstezii: uneori dureri), cit qi obiective (tulblrdri tle
sirrrsibjlilu,l,otactilf fi proprioceptivX cu localiza.re distali, ectromelicd)
I
yasomotorii sint importante (eritrocitozi,, rd.cirea extremilr) 1l'rrJburir;r'ile
1,ri(iLrl etc.) ; i) Reflexele osteo tend.inoitse,indcosebi cel achilian, sint
(lirr)irllill,e sau abolite; i) ,Iotdeauna se constatl Ii.D. de jntensitato
r rrr,irrlrili,rilar progresivS,si trasee EMG iie tip neurogen troncular;
f ) l,lvollrlja cste lcnt:i.
I,'. ,Lmict|rotiilc multiner:ritice: 1) Apar in teritoriile mai multor nervi
(jorrli'cla,{,i,rxtea co confer:i o configuralic asimetricl;i
asincronii, care 1o
(lililrtrr{,iNziinol, de polinevrite qi rie polineuropatii. 2) ln general, esto
l,li'r:1rrl,irrl,ii ln nerv, apoi, la intervale de ziie -sd,ptimini sint cointeresali
||l(i r,rvi. il) Tulbud,rile de sensibilitate sublectivr, apar mai intii, manilr'rrlirr(1.s. prin algoparestezii,iar mai tirziu apar
$i tulbu'd,ri obiective,
r u lrr l)lsc po tu'itoriile de ilervali6 multinewiticd afectate. 4) AmiotroIiilr sr ov ir[or!i:r,zi,, in general, mai tirziu fatii, de d.eticite]e motorii.
li) Vrl{)llrot, scmiologicil a semnelol de leziune multinewiticd, constd, il
oucllilt.o,t,sprc urmS,toaleleafecliuni: a) Colagenozd,:periatrita nodoas[
(borrLrlrri t(iissmaul-Meier),lupusul critematos diseminit q.a.) b) Diabet
;
z,rrlr:rlll;. rr) frrkrxicatii (cu sulfamide, barbiturice, oxid de carbon)
;
rl ) li rli rLr s isttrm (boala lui Rue,rger,boala lui Besnier-Boeck-Schaumann,
lr,rrl,r lrri \V;rlrk.rrsllijrn);r,) Lcpri.
,\.:J.:!.J. L. A ntialrof iile d.a origi,ne centrulri
|. Alroliilc la hemipleui.imai l)ech,iau fost relatate incii, do Marinescu
( ll'ilt,ri)5i rk: rl{i lr,rrkrr.i
cllLsiui(cil,a{i de Arscni qi Jlotez, lg7j), So intolcgo
{rii l)t(,2{rllll Irrrrnil,1.gioi,0u (xnltrtLcturii,qi ilnobil izr',ro,trrt lro
1I,.rntil,o
Itii, ir,r'r,riirrr
rlirrgrroxli<rrrl.
liirnirru rknr. sii-i ptoiztirn ul iologilr.
:l{itt

' ' .l l ro t iilr : r t t r t : t t : ulut tr lit t lt '. , it r nilt I t t 'Nlt tt tt lr ( l( ' ( plt t 'it r llr lr r )illl HllHlr ilr t l'
r r lr , l lr i r , lr r lr ol' I i t t t r r "'ti t t r r l'r r tl: t t t 1. r r . 1ipr r l' sii' lt t t lr t lt t r t t
,,,,,rr,' ,i ,,* ' t i( ii,
( llil'clr kr vr l1) ] il'
',
r
lr
i
, ,,,, i , r,' 1,rr ',ti r | , , r'IrI t i r,I rIIt t I r ( I \ 'ir I illI ir i ll{r h( l lHolr ' lll lil ;
'
(
it
r
r
r r r lr l lt lt t lt t lor : t 'l)
it
r
s'r
l'lr
s'.
'i
ir
r
.
sr
r
lt
l?l)
,rl ,rl r rl i r Allct r i 6i lir l, r '2,
1i
( ] r ilr r r r
rl , rr| rrrrrr'l , ) NI ( l ( [ |l ( kl|l{'r vil, l{)Ei r t ', I t t "r lili( 'it 'i r lt ilt |. lr 'lir - r ' ( lir lr r z t Ji
Alil(
r
r
r
i
t
t
t
r
t
ll,
Nlr
r
i
lll?l)
f i lkt ln'z
cil, r r I i t lo Als( ] lr i r ii l] ol, r '2,
trrrrr, l 1l {i l l
sr
r
t
t
lt
r ; r 'tt il lt t
r
r
t
r
r
t
i
t
t
t
:
r
i
llt
r
cvclr
t
t
'
t
t
t
r
r
i
t
r
t
r
ll,
;i
i ,,,,i t ,,l t l rlii'l'r r l,r ili,lllt 'olliilo
: t 't r r r 't r r lr t 'l
i ,l ,' ,' ,' r,' r,, 'iii, it t lo r t kr r r t t t ir lt t t t lr t i t lt 'op1, 'Ar soLi; i I nit r r z ( lll?l)
I t tlll'( l
, , | | , ,,l tr' ,liil, ' t lt r t t r igit t r r t lt r r Llt lt lli ir Llr ': Lir r r lisr 'lll'ir '. ( t r ) ll: i. llt {r ( ] lllliilt llt
l'lllr
lor
lr
lr \ r ir t '
l{r
zilllr
i
ir
t
lr
lt
.
r
r
liilo
lllill
1.,f r| r, l rrrlilir tioo t t t lii ir r t lxr t 'llt t r l, |:
( lr ,, , r r r r t r lr t t
tr ,,,,,.1,ri
rrr lr i llss ( [ o ] i1) sil,( x) lr t lr lulr t i l, t r r lio t lo or igilr o t r t t t ( t 'lt li
r r r I t '. iriII I i1ii r r lr r r
l rrr I r'r, I irr)) r Li rr git 't lsuI post cor r t llr I 1,in lr cr nc ct r , iu <'r lz't ll,
r
[
(
o lilr Hii'r l( \ r t l'r
it
t
t
lc's.
lr
i
i'slo
i ,,r," l ,i i i ' trt 'r r r ilit t 'giit cir nsr t t r hr . ',
''r.'r l'ii'
l , rr' ,,:r, rrr r ur lr t 'r r lt r ipualil, ic $i at lof iilt

l \1 l sl tr u4nor il, lt . hio hr r nr lii ( r lt 'Hcllr ii t lo ( lr ilclt lr r y, l{}5i1, r r il, t t '|,r lt r

o , t t lr it 't t l't r lt t t
Il r rrrrl l r.r' ,lll??) r r r r r xlr i it r it t r 1r ot t iI t iI i1I t I r 'It tIt r t t r ot tt t t t it , , st lr t it
(
jll
frr
ollvil,
illoi!
l)
ll(
lilli[
.
i{r
r
t
t
,,Irl IrrrrIr,"
! jI r '1,
l) .ltrt,:ii(, t.u,tl.il,ii,
srt illEo((iH1'otttlcot'i ctt u,1tnt':riantiitrii irtfrtrlrl plitl
l r,rrrrrrr.i rrur tllt lui r lt los ( ( lt r sr lr r vin( t 8i Kr pllur , l0( i2) '

9.

A III

PROBLEME
DEDIAGNOSTIC
IN AGNoZII

0.1. AGNOZIILETACTILE(astereognoziile)
Constau intr-un deficit de recunoaqterea obiectelor cu
a,irr1,,r'rrl
.pipiii,ului de c.),treun subiect (cu ochii lnchili) ate cd,rui sensil)ilil,il,tiolducrtale sint intacte.
r\ccstcl, apar in leziu,nileyasculare
_(homoragii,ramolismente,hema_
l(,rnrc),lntrrorale,traumaticc.etc.,
lobului larietal qi ate g'lrusuiui
-ale_
rrrr;l.rrrnu,r'gin:r1
(ariatactognozicia,lui
lhermittd: cimlurie Z qi iO firoa_
rrrtlrr).

.. .!l.l,l. I)iagnosticnl tle agnozic taetiti !i al iliverselor sale formo

r.lirricoso
fl.].llilg!!" printr-o irpJorare-semioiugiciiriguroasd,: a) Se stu_
rli:rzi sursihilil,il1;ile.
ck)mcntare (superficiale
_;i.-profuiile) ; b) Si;"pi;_
r',',:rt.l
hilu4.,t,,:i,r,
irrlir.ri..idflrlilicarcr
mfllpriei din r.areeslo folrnrl obieibul
{ l||., ||r iU(', rtr.lrt(,srtrrt
stU rcziSfoni. leled S:ru rugos ctl.,.; JCmn,fier,
Irrr'lir.,rirrlii. sti|l'i or..) .\i mor.togozitt {fol.m,L diminsjunilo oUi.cLif
rii I
$i
.) r\r. r'r1rfor.cu,zi tttpognoz.ia(se
o excit;tie cutanati, Si iridit-idili
-face- d) Se'exploreaze
I.rrlrrrir' *i i irrrlico sediul cu indxul);
disc ,mlniiii
luclili.: a) i''rr;.111i1.i1;
bolnar.ulsX,facfl detmnirea etictd a obieatuizt;
prtieitl
jrr t|rorl (,() tl)iu.|,l;iv,cu ambele miini.
!1.1,!. l,r.olrlcrro de diagnostie clinic:
t!u!.j,l,e
prin^o:e a,)Agnozia,d.eintensitatel,(ah,i,Iognozia:
.....
!1,,,,1t/,'!,i,iil!
)
't.rI r|||||r:I(r|('
r't(,rncntaresinl iintaclc fi tolu$i sutriectul
iiicalabil
r,r'rrr,r''rr.rrrr,:IIr'in 1ra)puronrrfcrir din cat,C eslo for"ma
"r1e
t Obie;td:
ttt t ttnt'.t",,'tt t, lc nsittte',(a norlogno:ia : dcsi 1111
6,"1a,;
rdbwiri
l
1
obiecj
livrr rl. s.rrsilrilil:rlo, subiectul este incapabil sL rccunoasc?iform:l qi iii_
rrrr,rrrirrrrifrr
olriocl,nl
ui (!,ig. 32).
:J) .Agnoti.itt:t.uctilesectmdare
.(asinbotia tactili )- In aces[e c&zull,
rIrli
qi )rilog'ozia sin[ inl,aclc, bo]nav.l nu.ccu.oaqto obiec'rin'log.ozi*
Irrl. l,)'l,rr
. Irrlllrllrrr do rtrcrrnoa6tcrc
a semnitioalricisirnlxrlic. a, obirrrt,uhri
(vt't,i .1i11.:ll! ).
2?t)

taclil0 ((lrrl,hltisfr' lrrl'11.

/ i,/. .rr. 'touograria
lcziunilorcare
".;Jroii,:lriYt"rttt"
f,.r r\ $ rp r. d l ra i ri i s ; P . : t l i c d c l rb 2 t ; P a : P f i c t rl a a s . o . d c o l l t j , ' U ' l r' / i rn x ' i ' 1 r' 1
\ rn i l l , i l . . l L d mJ t J l e s l i z s i g c rd i n d o ! , l n o ri e . o rl i (rl J ri l ' rr! l n rl l ; -1 l l ' l rl r'
' i l i l ; L r1
r,rdkr;
.4rlr rczirno
L."i,'lLrr.!,oN',;/i"e,
Jjno/icp(ri

',,,,
,,1 '

;'

Brncrin,r

f:'&:il':"1#.,i','jl.'

r" rt r' r"

.rrr '- rn/r""'

l,) .,lsl(rmgnazia bilateralti poal,c fi roN,lizltlii ltt ittl,t tt lt'zittttrr :t .trrttr

t, r, r l cnrl rr ': t lc st ingi.
ti) ll ulostercoagn ozia (Ilalpern, 1945, citat tto I(tlritr(ll{n', lll?7)(l(rtrrllri
i ' r l i rl rl l l cir bolnavul sim t e obiect ul, pe car e- I llr ir t r lt l ill t t t it t it , t r t t t i r r r r r t , '
,1,,r'
rI i tr rc nlit at e.

VIZUAI,I,]
9.2. AGNOZIILU
(l rrshl u in pier der ca posibilit il, t ii t lc r t t ct t r t r t it lit r lt t il ( ) l) illt iln\ lot r 'll
i r;rrl rrl rrlvct lcr ii, t le; i llolr r avr r l nt t it r t t t t it li o r nuliI icr t t 't r r r vit lt r t r l'jit lr '! lzilivr t rr'rzolirli,, irlr liacull,Ifito sa,lomirl,a,lo sittl; contlcrv:lt,tr' I\rt, fi rlr, tttrti tttttllrt
l rl rr| i :
l. A1;rrozia vizunl"r U)ntru obittcttt txrt'esputl(lo (xr(iil,i,t'iil)$ilritrri rr lrri
l \l rrrrr' l i .l i r . t olr nt lc gr avlr , r t colli bolt t r t , vi r r lt loct t ll{) f i( ,t t ioi t t t t olr it r r r l, t t ici
t : it ,t t llt t i olr it r t r l lr t t t t r r l,
)r' r' l 1rl | | |ii ,, lili t ir ilt t ' pr opt it lr ll I igt t r i, , I 't 't r zot t i, at
', |
t lolt
i, t tt nit 't lll,olt ir r ll; t t lt li, lllo t r iir t t i( 1il, t 'll( f li'11\
Irrrrtl l rr,rl i s lilt t l, it ',illl Nnlln'( ! lt ( lilzt
pr i l l rl rr pot t , ol, r r 1isil {io t lost r ist r , St t lr it xr lt t l f ixollzit ol) i( x1i'lllrI ) t ( 'zilllt t ' r l
rrrrrrri r' :isrr r '; r r ir r Fli
, c r t , t t lotizlt {iit ,t lo lt I ili, it t gt r ,t lt r I l, 1t t t , llt tolr
t, Irr'
I i lt lt r st 'lr cor
lllllli ol) i( , t 'l
t lr r t r t lt t t it t ll slt ,t ', xlt cl'li. llo( llllt r ) : l, ijl( t f oil,
i rrl , r,r.r' l r,
to il, t t l, t r l, r ollzii,
ct t lt llr r lt r r yi t , ll'r r
l rrl r. rrrrrl i ,ir r glr r t t ir r l, ii t lit , r 'iiit , r 't , slitt 'xlt r lt ilt t zlli"it t t lt r ot t t r l'i,
l rr i rl i l , rrrr , i r liLilil, cr t lil , , r it t t lr r t l" r lo t t lt ir r r r l'ttrr sl't tt t t lt , i t t li[ t 't '.
r\l l rror ir t 1r t 't t l't 't olr
t it r r lr r ii ir r r r r ; lir r iligr t t r r 'livt ',Ht r t t st t t 'ilt zli,r lt r t t lllt , r t i
r
, lir r lr i,t t r t t lil'ir r t 1, t l
r,rr rl urr,ri r, r or r sl, rt t ol ivit , r lir lr , r ir , llr : r lit r lii, ' r lir t 't r , lt , t t lit xlur

'.','ll

rhr li1q11y
vizutrl ;i rlc rrrrrll,o
Iliclt r) rlii(l(llt) ll, rIIr1rIrrl
iIii,Ii|or,i rrI r,Irrr:t rrIrIr,
Ir.ir
rr
llcr,
ll)'/7).
1li
lfrl)\!t) (11)71)i[ (]cs(1lis
utno::i.n,
tiztr.uliiuptrt:t'1tli.r:ii.,
irr r.trt: r.ltprrli
lrrl.rr rl. rlisclirrrirlrlca, obit:rl'rrlrrir:s1opistiliil,ii,dai' ccl, tlc rcr:ulolriiclo
r.rl. lrrllru|rr,1i.irr lrlto citzrrl'i,s0 tnarrifes'tr:i
o,falid,t.r:t:tt
ttoalf,r:rc
a abiic'rtlu',
.r'r'rr..r |r'la,|rrrr,zi.
lrulnlrvul ilvinrl o olrecarc irLrudiredc liolmii cu obiffhti
r q ii|,lril (1tlt'lrg^noziir,
optir::i a lui r.on n'Iayendorf). S&u, ctaci obiectrd a
l.rl rr'(ittr1r)scrrl,,
rirunelos[u este ulteriol' aplicat ;i la a,ll,eobiccte, fo:r.t,to
rlili'r'ilt (,,iirloxicai;io pt,in obiect),). Ei po1 si, nu rnai rocunoasci r.rjci
, rl.rilr.. (,t4t,,,:it
). Stu diferoxl,,le dr. r.ulor.i.irrl 1ic,,ceI,rrlr,,
.t.tt,t,tltlirn
l: , t : i

:r lr. l,|Il'.ir, ir l( . nlilic X

( o, s in, bolip t r onu l i L . 4 ) .

\\i o, ccail,(dacorti.cctldpenl,nt culori, calacterizat5 prin frptul

. l,l\ i$l,r"r,
lri l,rlrl o crrlor,ilo sint virzute cenu$iu. Existil ,li o hem,iagttrnie yteittru
,'rrlr,rri((llonning ;i colaLr.,1966, cit:tli de l{reindlcr, l9??J.
9. lguozia pcnlru. imagirri poa1,es5, existe in mod izolat. ,lstfel,
.
Irolrr:r,r
rrl recnnoafte obicctele co:rcrcte,dar nu recnnoaqteaceleaqiobiectri
lrllzlrrllri,c_in irnagini. Aceasti formi, de agtlozie se poal,e in\rcstiga pr{)
zr,rrlirrl. ]rolnarru-lyi imgsini- harsruate cu linii sau im;gini la tabfrtofoolr
r,i rrrliciiintlu-1 sii, ls identriflce.
il. ,trgnozia vizuali asocialivi sc ca,racte.rizezi, plin imposibilit&telt,
rlo il
.lf[]ri, tlo :l descrie li/ sau a indica utilizarea nnui obiect perceput,
r izurL,l,in schimb cu conserla.rearposibitit;,-tii de a clesenaobieciul qiritl
:r I irlcrri;ifior,prin alte ,,canalo". Diferen(a dintro agnoziavizuali, apercepli\ ir, iri t(':t u,sociaivrj, consl,i in faptul ci, in aceastiadin ur.inii, p e,rcep_t"ia
lrr|rrrr.i.si 1l co-nformn:ticisint nomlale (Rro.$'n, 19?2; Nreindlei, tO-t?)..
.\r';rrrizirr,
r.izu:rli, asoci:rtiv5,ar fi ut.t fel de ,,asimbolie,,r.jzualii.

:tl r ' t t t r I r' r rt i t t : r r r

, 'r r r 1 r o l , r 'l r .r i r r :r tr i r .r r 'r 'l r 'r r r :r r r r r r r r ;r l r 'l .r r i . r l l tr Pl r r tr tt,
', r r
I 'r l r . r l r 1 l ( r 'r 'i r r r l l "r ', l !l i 'i ) , ,\r ,r 'r l i r t, tr tt tr l r i l r o i r ^ r r 1 r i :t,l i l i ttti 1 'r 'r i tr r r l r r i r
rrl,l1 , lr
n r :r i tr ) 1 , r l l r ( ,l l i r r l i r r tr tr ,ttto ti r 'r l r r l ttr r ti l r r r {, tr 'l tl l tttt l r l "ttl r r i r tr
l '. 1 , . l r t rr r r i 1 r o i , :r si tr r r l r l l t r r o l '1 tttl tl tttti tr ttt l l i tr Jr i r 'l r 'l tr t rr t I t t I tt t t t r' t t I r' , l ttt
lrr
g r , r l l o ttr r Ittti ,,i ti r Ii tr tr r ttr r i r l tt:tIJ) tr i ttr I l i ;tr t't,tr , si i , tl csr r tr cztr . {l tr i i l r o l r r :r 'i r
r ' r . r r r t r r t I tr r c r l r 'r tttttl i tr tl tttr r u r l {, r tl l ,r l l l i l r i i , i l t't tr ttl ti tt, ttt i |'ttl ttr l r "l ( r r r ,r '
r r r , r r l . r 'i l ttto tl l l ttl . ,\l {i l r u l r r r r .r i ci i r cl ,ttcr u i i i tr vctsr i l i ,,i tt o r l l r tr r l r r ' ;r l ,
, 1 , , r r r r l r r i . l :r r r l r r r l ,o r r r l i r r l r r ,( l ( 'i [ {l ( 'si r r :r , o l l l i o ]i tti i l r ' \'r 't l i l i tl ( '. ( 'r r r l l . r 'L r
( l r tr r tr r l l , r
r r l r ', r ( i .r l , si r r r l l o r r r i r r r p l i r .i i , ;r r i tl i l r
r u r ttt1 r tr |tt'ItIi r l t,l tl tr i l r
l ', , 1
r r , l l( ) zi l o l ) i ,i r l i i , i i I I (' r' \ rrt t i t t I I i tt l t l tu tti l r t'o tt s l tttt'l i t i i ( t l z'i ( i r l r tl l
, ) l r l n r t.i r r 'r l t: si ttt,ttl l u n r i l ttl .r : ( r r ' ( .tt,i l l 'o l l tttl ) t,o l tsl i i i tr i ttt1 r r rIr Ir r Ir IIr |, r
.l,r
t'i l ttr l t,
i I t I t I I I | | I | | I (' r i i r r l r i l
p ; r i c r r , Itr r Itti L t ttItIi ,
tl csi
ti r :L r tttl l l j l tr
I I 'r ', ( r l i r .r 1 r g n r l i r l 'i ttu ti co r ttp l cr r 'r ,, tl tt i t, Il tt'tl u tl l l ) i l l ( \l t t'Il tttcttIr '|.t
tz,l .r l ,
, , r l r L r r r l o l sl r i l ti l i cl t,l ,i r .. ,\st- tl l , cl l 1 ) '!'l l l l ( Ji l fl i o ( l ( 's( fl l ( 'l tr l l tl { l
, ttr r ;,l r '
,
llrrrll rlr' , I
'r , , , r 1 i r r l r r r r r i tr g ,tu o b i tto t,, tl r tt tl r l l ( l l l s{'sl ( i sl i , l r tr ':i si ttl tr zl t
, , r , r r r i u l ', r r L :L i co L ttp l i c,i :i 1 r ,{- tu t i r r i i tl i i l ( }r tzi i , o :tcl i ttttr ,.
l qtto :;i r r , t,i ::u o sp u ! i ( r !d sc i l ISo l ( l ft( r , i tt si ttr l tr ttttttl l tr tti l l o o cr l r tl :r l
|)
, l ' , r r r r . l i r r':i cr 'r 'o l r l r r l i , d r ta p l ,i i ( r r ;a , zi si 'i l l ( r {l o l tl i l r r l ttl i t) tl t' t,4 l i i ,r t,,r
l t, ttr r
t' ttttlui
sl i n tl l d \', ( J,( ::0 1 'i ( tl to r c:t1 ttr !i tr .l i r l t'tu l tl u tl i n 4 r r , tl t tl tr tt ti , r l ' r ttt
- i r l r , l tt"tti n l 'r ,t4 tI,;i t .
''' ',
i , " , \ r pr o zi i l e

alo

s!tn b o l u l i l ttr

r l r a Ii ctr :

t ) , l r1 n o :':i u , 1 1 t:o tttt:tti ci i se

o :l t'l lI t cl i ztl i t zi l tl i r r i tr tl r o r i l r i l i l :r l cr r r l ''
,
q co l i l ( l 1 l r i ( t( r ( ttl t t'r 'tr ', tttt l tr r i t:ti , ttr r r l , r 'r '
', r r r r , r : r r l o ttttt:l e r tl n 'czo n 1 i l 'i
' , r , r , 'l r r r rzi tL ti u n o l .) j e {i 1 ,); b ) :l 1 1 n o t t, ( l l 1 r .r 'i r 'l{i ' ( ' I (' i I I | | | | ! r I rI |r 'r 'i i r r i r r t |t l r 'r l '
1 '1 " r i j ) l ) l {r 'c, i n ci :r ,l ol i n r l l a j ttl i n t'i l tl i o t' r r sl tr i ttl r t'r 'l ' l l o l ttr r r r l l Ir 'r l .. I r r l r r l
L , l , r l r r : r , r 'cr r ,p o n i q l ,c d o so r o , l i i l r 'r ,i l , [) L tt{'l l ( I t ' i ] I }I ' i t rr I r' r l i r r tl , r r l r ',:r r ,,r ,
l l ) ) . l l r r l r r :r r ttl ' i '
1 , , 'r r , l ,r r ( r i ,; r r ) Oe ci ta tm m ttzi t:u ,L i i ( i l l :x:r i xi i , i tt tl p .
1 'r r r r r :r 'l '
r r , | ': r l r i l si i ( kr sti i fl 'czo tl r l tl ) ti 1 , l i r tL zi cl i l . l ) r r l r r i r tr r i i , r ',r l r r
'
1 , , , r i , . , r l r i p i i r l !:i i
o {o n }r i r , ( l o a Ja ;r i ( '"

.1. ,tlynozia viru:rli spaliali cuprinde o bog;.tie c1e manifestiri:

rr) .l r1ttrt;i4,
t:izu.akirlelocnlizarelcnoitater,pcntru spl.lqiu)const[ in incapacilrrir.rr.rlc l, sosiz:l rclatiilc sp.lfiale intre obiettc, de a le localiza -'mai
:rllir irr Irofr.rlzirne -, de a aptceia distantele calc seDarx.obiectcle intlr
r'lr"ri olrir.r,ltlolalil de obserr-ator.
Dlcd, tle excnptu, su soticit; bohavul
'.r ,,r:'rr'lr'zl rlijlo' ul rrnei linii drgptc. cl rr grn.i.
l' ) .ltlttrrirt,tlitu,uldsteteoscopdcd,
foalte lari, constEin inposibilitate*
rlc:r Iirit urosimea ulti ol:icct tridimensi onat.
r ) ..111n.o::iile
ttzuale topogra,;f,icc,strlius legatc de tull:urilile prece_
rl, rrlr., r,orrslrr,n
in inca,pacitateacle a se orienta in spatiul erterior, de 1I
rll rlrjc si (l{) l,-Ei leprezenta tlrurnul pc care trebuie s[-l uruezc. Acc$ti
lrrrlrrrrri ir,i rl<rr'l.c<lrum*l ghidindu-sc, r1epildi, clup[ afiqr:iede pe ziduli,
rlLrlr:ir illirrr elc. Ei se lltlicesc adeseain oraf, sau in propria 1or locuin!:io
irrl irr rlrilirl grclesc salonul $i nu Di gi,sescpatnt.
rl,i O lrrrrnir, ," aqno:ie,i spa:lialc cstt: r'eprezentatir, d.e agto:[a ai;tLo:,1trrlinlii,trruc I cltt'czintr'i,ti l;ulbruaro [ ,,concetptla,liziirii),r'cla_tiilorirr
()lrcl,cLizali,in diiicrrlta,ireil
rlrrr{irrllxlnr,cor'1)ol'll,
(lc a, asambl0,o sei.i(}
rlr rrr ril,rilirrrrirlirrrtrrrsion:rlc,
lrsllil irrcit s.i,lonnozo ,,1iguri,'sl_r,u
,,r]lo{lltlo),
lrirlitrtlrtrirrtrtlo ((Iilclrlrl', 11)5;1,
r'il,1l;ilg .li1i'ilrllqr', lt]?7). (invitul,rrlr,
:r,irrozirri
r izrrosplr,l
irrlo I'slr, rlili lili. i\sl,lrrlrirr rrrrr,lct,lrzrrr.i,
Irrrlrr:rvlisrr

r,

lrlrtt;1 rlo :r.t tlt'Irtlrlttl

;'r r r r

t li r r r t lr r r l r t liliz lr . r r r r ll{ r , . l r r r r l t l r , l r z r r r . l ,i r 1 . i i , l r l l r r l r y j i

l i zu a l {)

r r ':r l r .,:r .' r r r r r

l i . S i u( l l o n l tl
l u i Ik i u l ( p r r r a l i zi r r p si l r i ci r r r p r i r i r i i )
, , '1 , \ i r r ( 'ttl i ( ) i () g i o ( x) tl sti i l tl i l r l i tr l tl i 'l i r r r 1 r Io r tIl l r tt'r l i tr r r l ,' ( l i i r l r r r l . l l t( l l l
t{}? 7 ;IIti t'l tcL r si .\.j ttt i r tl 'l ttl t tr t, I l l l , l ; I \ | I | | I I | | I I l l l ,,)
'r t 't r l , , l i ii 'i r r r l l o l r
:r {r 'l r l r r
r
r
l
r
z
k
r
i
t
Ii r i i i ,r 'i i Vi zr r l r l ,', l l i l r r i 0 o p l i l ,i r .r l i l l l l 'l tl r l r |i r
1,
1 ) i l i l r i |i L
,,,,t(..
ttl l tl l tt t | | ttttl l
r i ".tr tl , :ti l ttl l ttta 'r r r
t 'o t t t l i...i q l txi h i o i i r r , Ii ti i r i i
, , ' r r r r l , r l i r l r si l i r l : Jxr l i l tr ttl tttt r t'r l c tl cl i l ' ttl t t;i IIL ItIt r IIIi l I I r r r l t r l r r r tr ,r r r r t r l
r 'l l
, 1 , 1 . r r r t l l |i r i tl l r |l i i st: l tl tl r q r r r tl cl ti i r t i tr tttr r r l i tl r i ,l i l ,tr l . r 'l l ( r r .r 'I'
''r , r r r r r r u ti t'l t,r l l i l i r tl l r r o l r i r r cl c l r tl zt'tl l l
i tt l i ttt;r tl I r r .tt:'l \l r r l r r | ' r r r l
tl l ctl l r i l l i l r ' .t ttr
, r l , 1 r . , l r rr l r l r i tr l tr tt tr l ti l ttl c
r tl tso l ttl tr i ttti r r :tl i l ctl t
r tr r
r ttr o l r i l l i ,
, . i r 'l i
tl
tr
l
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l , r . r I r i l r i r ':i l r ;r t i ti l i i
si 1 III|) tIIr IIfi I l r l r 'l L l !r 'i \ l zl l l l l l i l ( f l tl i r l l l r r r l r r l r r l r
i
tr
tttr
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tt'ttl
l r r t:tl r r
1,r,rr
l r l Itr {i r 'i l r ctr l Itt Ir r l r r " 'r r r
rr tr r tti l |l l i ttr l l r i l r t|) o r i l ttl :i ;l |l r r l tl r ':r
t,rr\rr,:t,
lrllrilllrlir
l
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r r r t:l 1 i tr i Ir ) | r 'i r r {' l r tr
,.\t'tl l tt l t l l tr ItIt|:r ,
'
, ', r l r r l r i r .r zi ttl l i r r tl 'r l i r r l o l r r |r 'l ttl r l i tt Ir r i :r l .l t, r l r t, r r r r r l t l r ' r r r l l l :r l r l l l r 0
l l r r 'l tl '
, , r r ; r l o r r l i r . r 'r 'r tl l r r .l :t r r ,r tr t;r r l l ttt r r :ttl l tr ttl r l .
l l r tr l r r 'l i
l r ;l i l r 'l l l l l l
1r ,,l r r
i rrrrl

l rr' (' ? , r| l l r

| ri l l l t l rl l I

r, rt j r' , . ri r'

,:r il:r

ltll,l
| rr

r( rr , ' l ' r,

t ilIlll
| ' . I | | | ) I | | | r ) | I,, | ' rl l
,ll Ill
r'
:
l
l r'
r , r' I t I r' r' . L rrl rr.
lll
I lLll
l )r'
' : rl ,

lll

o l l l l r,
l rr , rL l ,

l l Ii \ r ' lt z ii. ( it ' : t t rti ti t tt ' i t t tt t ' t t t t tl t,I l i rl rrl l l rl l r,r' r,l r, ol l i rr,l ,ttl tri ptrrrl trrro
rl i tt trort
,,Iri . r ' r I r ' r ' r . Isrr r ) ' r l i ' .i rrrp rrI v i z rrtrl (r| ,1 i .s l .a I.,t,r,l . i rrqr.i ,i i l rrt, (I. I,c{,i l rul ,
l rr J r , r lr lr v r r l llt l ,r(!z i rrl i l rrrrrri i u rro p s i c ).
, llt . t ir r . olt li( t i s t' , rrrl r,rri l i .s l i r..p l i rr1 r,-rr
i rul ror,i bi l i i l t(r (l o i I pr.i n(Io (
.
rrrir'r
.lrirrrl,
so Ir{.?,i,tii J,.l.ir,vrrl.i (dilL }rir:inD lrrrpol,tantelor
.rllr.
r.r'o ri r 'rr
r r . , - : r r r .lr . ir rc r.rl :rl ,l r,{ .i { .t1 .;l
d i s rl r1 1 1 ql sa1,
l stl el i ncrt acei La exccul i i
rrr.r, . r lr { t ( ' : r } r r r ( .l u (,b i l ,r,_ s rrr h i ;rr.rdi m r.n r i unaI o (fi i l .,.ra ti
un atacti c
Ir'r'r 1, . H, ,iir I l, ( ' { ' r 1 .1 ' c l o s )..Ui i b o l n a v i c u s i n drom B al i nt i l i apri trd
l i gara
.. rir I irlr-rrlrrl r.c(\tcin, ci la rnijlocul ei, sau manevreazn eulitu.l in
failurle
{rr.t)llr't{irtc l')(.Ll[ in c{u'e
trebui si taie o bucatx cle caine (Krindler,
t|)? ? ) .

l rtrr;roti rl l. t lj( ! nt f nt t ir r r lllot r r r , pr r , r lot r r it r it , r roplir

l, r o of r ir , r 'lit lt r( llt . s1, t 1|l". ll
l l , rrrl tl tl l r "ii,r t gr t oziill ollico 11r 'ot r r r , I r 'irir. ir
r rr i gr , r r r r ir lc r lr r lczir r r r i llillr lr , r 'lr ll
rl , l ,rl ri l or' llr lici: r li ( ir r r , luzir r r l1i gilr nr r l r r r lr r . lr r r ur , r 'gir r; :i r ,plr
l llr ^: r ,pollr , r r
,,.rr.r:r,l ol rt t lt r i Plr lir lt r l sr t lt t 't ior ') lr r r r ct t t r tqi lr lr r ct r lci t lo lr r lot lr , 5i lr lr t ir r
, rr, rrrrrroIr r ( ii olr , ilt il, aJr r; i akr . jor r c{ir r niicr r a, t loul {'ir r lllnr v{, llt t , ir ,1( . r r ln,
r.rl .r l l i ' .cl, r . lt 5i Ar r golclgucs ( l00lt ) llu 1ur r r . izr ll r , ii lcziur r i r r lr , r r r r r ir illllr

7. - li. r ' it r r t c a p " i l i c i re p l e z i n ri o rl l i i formX (mai gral A ) de agnozi e

\ r/, : r l: , . \ s i. t . b o l n a \.u l Il tt p o a tc re c u noal te obi ectul excl usi v
nri n

r crk,r'r',r,i csk) necesar si recurgi, $i la atte mijloacc senzltivo_ienzoriiiel

ri I 1ri1r.iic,sit audil oyentual zgomotul pe car-e-l prodllce un obiect,
sau
.:i I rr.rir'rlsr..J)ifr.rcrrtadintre cecitatea
lsihici, qi-cea corticalX rezidn l;
l:rl)llll rl rr Irnmir,^:el,il.rdo drra.rreprczentarea(imagioca) I izualii
a
,,
r,|)r'a||.Ir,|.
I'r' clLd rn crcilrtea COrlicall, se pierde comple1211p61,s
61j6,6
irlrzirlic si
vizualai. Cecitatea ?.sihic.i se insole,ste,de obicei,
_p(,I'ceptje
rr rlc ir.ltc rrlcmentcagnozice .r-izulle (aleiie, acromatognbzie), ae Ue_ll
:rrrr'1r.i..
..i rl. lprarir. (LrDntrucli\i.
ii.. X)roroPnllrrozia
lagnozia pontru fizionornii) se crrrclelizeazi prit)
rlll',' rL)rlrl:rlcit
Uolna\trlut dc a r'.Cunuasle
pcrcoatj.lcdin jurul oiu, cLiar
pr, r'r'lr,rrnri:tllropiatrc.Recunoa;terel.persol.nei rr.spectir-ese poate r.ealiza
rlorrI rl pii :r"llc olorneutc carncter.istice(imbrriciniinte, talicl voce etc.).
ll,rlr r.rrrrinl Ir\'ulrrtsle ni,.i figuru unr.ipersotncintr-ungnrpdefnlografii.
.' l ,r,:rt ,. rIr,. r'I ir'.rrrirIri,.ltpor:oan(.lordin fot ogrl fin. nu poirt e facc d if&e;i;;
rrrci lizir.rnonriirlo lirjrb:lt sau de lerleie, dc om tind,r sai l,i,tritl etc. Uneoil
rrr,;i
.r'ir.rrrrl,r1lu.ici 1r.opria sa fa_tiiin oglindi,. Unii bolnavi prezinif
rlilicrrllili {lrr 1'(:1111,u,,,0r"""
a r}numitot segmente faciale, ca de n^ildb iu_
rriilrr(r'ir,srrlr,ri'ari silu iirferioari a felei, iumitatea dreapti, sait stinid.
lr,11irrrrtr,
oolrilor', regiulea truntii etc. (Glonning gi colab., 196?, citli
rll l( r'r.irrrllcr',
lg7?).
Stttttt.i.l
itrt!i.rr,
t9.lo-lyof!a(n ogae:i_ilorr.i":unle.Agnoziile yizuale au ca
,
.
r;rrlrrl.rrl lr,zirrrLiu,le klbrrlrri rccipitll sting
la drepiaci, c[ci leziuni alo
r,r,izrrr.ii
si alc. regiunii_paracalcarine stingi (cuprinzina intreg
.r,irlr.arino
( rrr(l.rrrl) pr,rluc :r,grrozii
bilatcrale. Adeseaeste volba rle l6ziuni simetricl
:rl. rrrrrlril.r l'1ri occipitali (fig. t,31. T,hermitte a subdivizat aceast5zo;L
irr rlorrri rrgirrni : una clestinatilformelor qi culorilor (aria 19) Si alta. mai
rr,rrI,'r'i,rrrlii,
rlcst,jnilhiicleserului,litelalor, cifrelor. Tulburi,rile'dg 61i.r6rr,.
1:r;'rr,ziilr.slr;rlia,l.)sint rlatorite unor lezi'ni profunde :rle pir_iii superioaro
,r irrir'r'rrrll,lr, u,r'ioipar':l{jalcarjrrc1:r,r'i.r,
18), e{ingind si mlirile fascjcule dc
:rrrocirriirr.
'l'lll)uliu'ile memolioi ton,rgllficc depin,l insi, de obicei, do
lr zrrrrrilril:rlrr':rlr.rrlr.rr,spintini {r'rrrlruro-o,.r.ipifrle.
,Agnozilr,
r.izu,.snrtirrli
, lr' Ir',rrlrr'.iir.lr',rs,lri rl. l.zirrrri:,lo'i.pinri' iprrir'looccipirrlc diri
"inir/i,r'rrlrlrr'l,1.Nl'i r,ru.'rlr,It,r. (11)04,citai; dc triirrin.llcr,l!,)i?) a arittat.iJ
ir,li|,i )]/iiilrf,riz,flirl(r.sirrl;^l)rrrlrrso
rlo rlrrconectarca,iilor sonzolirlieroo{rl)1oirr(!
rlrrrrliilo I i rrrIrrr,j rrI rr i . In lrirclr'sl,i,
v izirrno, l,{rroziiJrr
riplico so a,drni6 rlil si1l,
lttrrrlrro lrlirr lczirrrriIri III I rrr';rI rr. lr,lrrpilt,ilor, lr:lzl,lririlc lo btrlrri riccillil,a,l,
l,/r'zitrrtil('silltirl{\
trririitl)rt)il'l,rt
rlrr lolrll lrriliclrrlilt'Ilrrrlrtcc sirrrlrlorrriptr,.
tItrtrtitrotri,
olrlir,rrsllr{,irr,lrr,
irr ir.r,rrrrr
crr lirzirrtrilculr,i Ir1rr,o1rirr,ii,
,lrr lrilrll
:n4

t t,t

i r.

(hrrs pr)ndc l c topogratl ec

x gn{ )z i i l or \i z ui l e :

al e

,, r ,,,,r L) . a ri a r(: ! , ! $ L l J i l i ' d , L a i l i h r. a a l e ri e i

.'
i .r . l : ,
. . l"
li\,',
. i r. ' ^
,
( rri a l 8 s 1 n . . i i' . , l l . i c d l o rn d )j
,
lfl
. r fr.Lr i r 1 9 , ! (s t )o rl rL , i l i L1 ! n 1 ! c mi s l ri rl e l f r
,,, I 'r
' ' ' ,r :i de ii t.grm. lormrlor ii a .d..il.r!,

,l rr 1ri r' .pr ot luo indeoscbi agnozii pent r u ir nagini I igr r lr r I r r 1pr r , iLr , l) r t liI r 17r \
r..r
, r' rrozii sllllialc unilateralc,, in vleme cc l eziutrikr cr rrjsli,rti sl rrrjl r
lir.r {,rr.r j/,l
, ,r pli'r,ii,tkrrtl a,gnozie pentlu
culoli.

e.3.A(iNOZIILE
lut)tTtvt,)
( lrrprirrd urrnii,toarele formc clilicc ;
l . l l ur dit t cu, psihicii l, luLt t sau r r . r lt u*ir rt r ur lili. i. r , r t ut 1t I r . lrlt
r .r lr r r r r r r l
;' , r' rr' 1rrrzgoit t ot t io, poit , t c.r O r r r lr it t irir t l, t , nsililil, , lt r t sl. , r , lr ,r . i lr , pr r lr lr . l, r I t r lr zr r
1r;r(i rrl rrllt t 'cst c. incapllbil sil r lllir l r r , , r , it r lr ,rl r llr , I r l. r r I lr r ir . |r ( r r ,ir r . r r r r r r rrrrrlr r r
l ,' r (l r l rl 1 , o( il. r vinlc si'1,
lc id'r r lili. r '. lr r . ll, 'r r r l lr , r . ir r 'lir ''rrrrI l i r.rrr.: rt r '; r r r .r , l
' rri r,(i r
,1,:fl
)ll sor\ . ii, t rlt. r skl ir r r lr or '1, : t r(rlol,
t {ir ir r l llr I ir r l I ii lr olr ir r r , r r(l . u : r ! . , r . , , r r r .
I' r.rl l t sl l lt r t , o lr ct 'cc1lo t lc r r r t t llo oli r r lr i lr illr r or , lr il. r , r rt lr . r , r l r iur t r , lr . lr .
I l yorrrol r', lot r ur i f . it . ) si lii lt gt r ozit t , l) ( , nlt . u ljllllcio r r c\ r , r . llr , lr r r r r t lr , lr .
i ,rrr)l ri nl i ( 'u sur dil, r Lt cit t ( r . l) lt , lr i.
::. S u . lit r ililo lsilr ir , r . . sp*r . ializnt o. ': r i) Nt xlilt r lt t r / . r r alr i. . ir r r , r r lr r r , . r
.
l rri .rr rl * i r, r lili't r r r r liir ,r klr *'i ir r r r lr ir r r r l'r r : r lr . r 'r r r lisr : r r r {ir r r r i. li r r r r 'r , r . lr , ;
l tt,\,1di l (l ra snt , r r gno; iu t t t t lr xli, , ,r i rrr,:r I r. rr. i I :r I r..r r l. ir ir lr . r r lt lt ( . r r. l' t r . t r r l
-r, rrfrr,(.rri t r r : r . ir r r r r ) ( i . r ', r r sir l. r 'li r ': r r r lir r r r r ii r lr , lr l: r zir , ) r ) lir t lir ulr t r xau
;
,uttrrt i rr t' ilt t t it ii: i t trr:t 1ri rr,. i I Ir I r.II r lr , lr r l, . r iizirliir r r r t l t r r r r . illlr ir . lr r r , i r rrlz r li r lr , ,
r l rl trl r ( ( \ 1rr,t r.r,1r( r:r , lor r : r , lli r . r r lr . it r llr r 'lir .

it'10

il. Srrnlil.rrl.olvrtthrrlirsirrr rllrr)lil r,orl)llit Illt.ri, .L'rlr,(x)

ltt,rl,o rlirr
rtlirzirt,\{rrrtttioko(ttttrlt vlt li rlirs<,r'isli
- y(izi Olp. 10).
rlc irgrrozii u,LLrlil,ivc
l,rlzirntilog(llr(flitl,oar'(i
sint colticr,lc, cu loc:r,lizlu(r
irr 1ror'{irrrrrrrl,
a plirnoi cilcurnvolutii tcmporale qi a cclci de
lxrst,rrlioa,r'il
:r rlorrr, r,ir\rlltrr\'olu1,ii
lorr)poralc a cmisferei doninu,nto (Nielsen, 1962),
rlcri rrrrii slrsl,incai loziunilo gcncratoare de agnozii auditive sint bilateralo

, l ' , r l l r r : t l t - i r t.'l o t.l tl i zi r ,tt':t r l r , r 'i r ,l tr r l r r r l tr :tt i tt l tl ttl t'i t si i tti tl o ;tr l l i , l t l l i tttttl i r l 'r r o r z i l,i \'o r r ;r l i ( 'r r ,l r , |l r ', ;[t,t l |r r l r l 'l tr r vr i ,
( l l ) l i l ) ) , l tg tto zi r t l tcr tl tl t l r r r tr ti p l cg i r r tl o ttt1 Ir tl Ii i tl r r ttr 'i
lrrp;i
l ftcr l l ti r 'l i l j
, r 1 " , i l r l i l i 'r 'i l ,o : l r ) l l tr o zo g tto zi l t vo tl r r t'l i i ( ttcg r tttr l t, vcl l r tr l i i , r r ' ItcIIti 1 r II'I1 i l t) ,
,
, r l r r , l o l c;l ,o l ) r 'cz( l r l ti tl c I t l t I t t I ri t t I t i i i l i i l ttr sl tr zi t'tr ( r l r r r r r i ;r r r 'i l i ) i l t 1 r r ttl t- :r '
'r '
t'r tl r t i ttt
r
r
.
|
, , r r l l i '1 l t) :tttttzo g u r tzi l t l r l i tr l tt[) r ttr i ,r i ( l ( ! ( ( ) l r tl ]o l l l u l l ( 't) 1 ,
1,
r r r r r r l l r l r i , p l i r r l r '- o l ,ttl l r u l ttr r l tl ,r 'tr !i ci 1 r r ,( 'i ri l tl j tttr ti l ,a ,i .( i l l , ( r o tl ) r ) ti tl i r l tr r ti l
lilr.

-Fi9, 31. Topografia lcziunilor care antreneaztr

c g n o T i 3a u d i i v ; :
,).

,.lI: pljcile de trc.r tcmporo-nrsulare ald circunvoluliel

iemporale tnnsvcls. a luj Heschl (zoDa slJdtllii
corricale
aldio-senzoriale);,,itI:zona
urn.zi.i;,4?7I-zona
suditeJli
vcrbale (drpi ltsa/, 1052).

$.1. AGNOZIIL]I IMAGINILOR CORPORALE.TULBURARILE

INMGINII (SCHEMEDCORPORALE

Irrlr,sincil, sau schema corporal[ este o noliune foarte complexi,, caro

lrrzrrlii, rlin iltegrarea multlplelor mesaje senzitiYo-senzoriale $i care
rurrrsl,iiin pel'ct:perca fi reprezentarea exacti', in fiecarc moment, a exisIrrrr{,ci,,eului') rrosl,m corporal in ansamblu qi pe segmente.Integrarea
lul,rrlo:: cxciLu,liilor senzitive supedicialet profunde $i Yisceraler a1e celor
r izrrrlc, lrlbirinlico etc., permite in permanen!5 r,conqtiinla') eului nostru
r,or'pollrl in ftnsamblu, precum ,si volumulr pozi-tia exacti, in spaliu $i
(lr,r| | | rorrorr[a diyerse]or segmente corporale.
f,)\ isl,ir,urm5,toarele ti,puri de agnozii.ale im gi,nii (schemei,
) corporale:
l. Asornatognozia constr, intr-o nerecunoa$tere sau o ignoranli, din
subitxrtului (in lipsa altor hllburdri psihice) a imaginii propriului
1r:r,r'l,r'ir,
Hli,lt (x)tl) :

I I rntinsomutognozrla(sintlromul lui Alton qi Babinski) apare 1a bolrrr,vii crr lrt:rrriplogiesting5,,manifestindu-se la nivelul acest'uihemicorp
: a) Nerecunoaqterea
Ii rrr lrrlrrcl,clizoilz[ prin citeva si,nrytomecard,aterfut;iae
rrirr|r'rrrrrLir.ii,
)t
1rorlo o parte a tulburXrii morbido, a paraliziei (anozognoai'e
rrrrgirrrllii, r,r'i,epirralizat I b) nerecunoaftereahemicorpului stilg sau a
propriu-zisd,) r' c) uneoli
llrlli H(lg)rl(!nl,
rl hemicorpului (asomatognozie
irslo vorlrl tlo o cornpletii indifcren!5 fa!5, de acest' hemico4r, pe care il
igrrrrlr'i,,
c[ liirrrl o ,,p:n'tc inuti]ir, a corpului)' (u"nozoLliaJorie
); d) alteori
i6i r'(xilllro$(,
rrotttlltelo, dal lo polcoll dota\satedc cotp, sau defotlrolrrrr,vii
htttnicorlrrrl,r r(:llurrgil,o
sl,u rna,iscrrr'1c)
I o) itt unolo crtzttrioi perccJlrloLtti,
sulxrtir)t),
sittt
(ilrrzirr,
l,tttilurt,
tttirtttlrtu
ttrrtti
ir,l
sl,irrgi
lttrttop tttirytilri
lrrrri
I'oltrryiitttollilrr (iltr:tii l;irtrs tzirrlJ; l) rrriri t itt'itr
itr rrrrrtrrIltrr|o
n;xrrrl,rrrrr
!'t t;

ir : i st t it 'l'li,ilr ct t t isit r t it 't lt t lr lt lr r

| , i t i lr t l( 1( 't 'olou: n,
u. l, tltt t r t t iusont n. kt t t t t o:
r ,r, rl i rrl ,o tlll, r 'ir l; t l, gilt t st t l I ) ilr i( lr t l it liol'iol', gilt t st ll iilll) lll, lr r illiiir t ir l) .
l l ,r,, r rorttrr;l, r ) gllozirilplt
t
t ir t lo ol. r icci ir L st ldit ll iloul lt l t t t t t r i I t t It t t i I I Ir' I1t t ,
rr' 1,rr" r' l c zilu r lr r ; lii ic1, ns; i st i. t r so! , i: 1t$i
e ( lc r llt olt ll) ( illl'( rgr i[ ( l ( lr r ( '( ] llir i, 'ir l
r,l , rl i uol i cr Lllr , t c.Lllcor i llccst ,silt ( honl ar c t t t r volt r ! , int t t lli lt t t lgii. i\ t r r r z,
r'r1" rrr lr(llll l ll lrtrtuiplcgic sc iri,ilntrll'c .trrrovtrtrlll lloll rrt'vii tltt t rtl t t i l t t l l rt t l rt t t
,1, , rr ri l ri l i l't t o ( sulr or licialii i1i pr of undi, ) , t leci t lt l it r lt t r t lt r t , t t t kit t t 'slr r zir ': t '
, ,r, l ,rrti r nr r ir l int polt llnl, 'iii , , or glnizt r ol"
slr il( it t lr r i t lt I I ; t t t t it |. l) t t lt r t ,
r rrrri ol i ( I lr ulcna, n, 1925, cil, : lI de Klcinr llcr ', [ 1) ??1 Nir : lst r t t , lllli'- l) , t t r
' rrr
r,,,1, ( i r,zru ilo dc : lgt lozic : r , r juca uD r ol im lor '1iil, I L1;
; i lt llr zit t t t r rir t lit r r t t r ': t ,
, ,,, rrlri. l,oo*Iizaro:r, ltlziunil in crrrisfcrl rh ca1llii, (ll;rr,-zisii , I I ri t Irrt Ir ' ' )
, r lll) lii,ill 'it t lt , gt lt lt r t
t,r, l rrrtr0;i oxist cl! a ulr or spcoiiilizir r i din or r t isf t lr irill'(
,r,,,r' I rlrl(tso vizuospzr,fiale.
:,' , S i rrdr onr ul lui G cr s{m ar t n ; i SeLilt lcr se oir t it cl, t r l'izt r r t zii
; r t it t t lt t t t it , 'r t
t
t
t t i i i t, ,,ltttjir.t
lii',
t
I
I
t
t
t
toa]'t(l
sltiltria
r'lr
o[{)rn{)ntc:
afqzie-dgtrozi
'
?,)
O
' l,r
, r,' i , ' 1 : b olr r avul nu poat c disl, lnlie, al'it iilt 'r ii ( l( lt r r r r r r it I iI r 't iI r 'I r ' r lli'r '1"
,l , r,rri rri l ot'sr i, lcf icolo: r , lcr liit r iiobscr Yr ut ollt llli ( t t t t t t t t t t t r t it r t toclt it t t r llt t , r t ,
,l rr rl ti rtt fi ot 1 ochii deschisi) t lt ) . l) c: or i. t nr ln
t '( . ut t Y) t t t lii t lt r t t l) lt t xlt t t t lt l
rrrrr l rrr:r,l csr i t list ingir par t ca dr cipt il a colPlllt li t lt r r l': r slit r gr i, t ii \ r t lt r \r r r r i:)r. ;
,t l r, rl l ttl i .c( lipsir de est im ar c a vil, ] or ii cil t olor ', it t rpor ilr ilil r rlr r r t r, lr r rr ,r r l: r l, r lr
rrrr l rl rnr t[t: oalcu] f i t lc a, r ezolva o pr oblollt li'r lr Lt xr t t t r r 1i , , I t cI I I ct t I r l I L; 'I t
i r.rl rr" , i rr ser Nul c[ boln*r 'ul ignor S, ser r r niliot{i,ilt lot r t t lr t i ot , t t lt lt l r lo lt lt "
r,r rllx'r'rrfiilo matomal;icc) ; d)- AgraJia, itar fiirir, 1,t tI I I t t t'it't'rr rr I i rI rI rIr.i tt I t tr
rrrt, r' ror' .A ceast l agr aiie se pr czint d, m 2] i r nu11,t : lr o lllr t lt , xit r ( 'ot r r r lllll'lr vil
1' ,rrl rrr i i tere Si cuvint e,
l ,r' ::i tt, t t , ea
int cr cseazil,p5r l, ilo an1; olio: l, l'of i l) ilzlI l{r lt 'lt t git t t st t lt t i t . t t ; t t r l
rrr,r,r' :' i rI1l
i l l om is{er ci st ingi, pr collln , ) i T, ollilllo l, t t r t r r t r t lt lit r ii I t lr 'lr ir l lr
,,, r' i l ri l rr,l (cir npur ile 39, 40 lsi l- 9 llr odt t t it t t t t ) .
:1. [l l totopoaqnozia so ca, r aot or izo{r , zil,
] ) lilI t lt r zt t lit r r t f it 't t 'ltI 't t I I I ior 'I t t I t t t
rrr trr.p0tl ;ou Cor pir l sit u f i pr in ir r t posibilit lt l, r lt tt,lt t t t r t , l'ii'lrtrI it 'r 't I I {. I r rt t r r lr r
r{ .,rrrj ul n) [i ost o g( ] t nr t al; ir(,io l( iziuni pal'icliir lo ( t lr l olr ir r r r i I ri I; t I r,t I r Ir' )
l . | ) i sir sor r r tro 1;noziilt t t 'clt t t zinl, ir , i, t t llr t lr iili ct t t t t lt lt , xt , r ii vlr t ilr 'lr ilr t ,
t r lr ',
r' ,rrr:r,fi i Ixr, I 'l, ict Lllr ,do
r r i sohir r r lir , t ( iiL ( x) t 'plt llli it r lt r r g , silt , sr r gt t t r r t t lt , lr tll:
rr r,. l )l ' i vo sl, o lor t t r a, , lt t t r gilt xlr t , ,gI 'ot tl, ltl; cit , volt t t t t t t l, llslxr ci, t ll.
l-r, | | el ttltlsoopiit ( I t i t I rrrri rt : rI i rt s;ttt vizittttt'rt spctrttlttrl't, || | I | | | 'iI '| | | | i . I
1ir l) r ilt lt t l
rLrrr' :ui r,rl ,ofizol, zii,
,
Pt 'it r f ct r or r r ot t r t lt r t 'r r r iilot ': Ut r ilt t lr ir t 'i, ,ir t ( f it , ?,\ 'ollr
l rtrrr i r [l t , r r , lt t i o it t r lgit t r r l lr t i it t st r li, l) t t r l) l'ilt l $ii't t , , r lt t lr lt t ". lr ) \ if lt r lt l\
l rl r.r' rr,r'lrr
l rr l, r 1oi. ll, lr
li\i nor r ol gli, lir r t it r , , Nt t il, t lr r l) t 'r t r iit t llt lr r ) 't lo l\ lt t t t lt i, l,ut
l l r,,l l ot' l l !1' t lr r J\ r lt t , t t 1t it , t lr tVr
, t ttl,l,.r t 't t t ltlr, t lt ugllulir : i : lr r zit t t t i lt : t t 'it r l'rot
t 't I iI r i|, I t , I r t
rrl ttr;1i .

)'t'l

li MelrrhrlJr,hurrontll:.t.\ ,llrurltul
.lurthnld ul tultutolil,r rr.pr.,.zirrr.r.l
. .
. ik'(.iIl.ll.I'L|||I|\.|||IIrrr1rtrirr,I
lr'.rt.t.ptl:t
lr,rrrrtrrllr.rtltri
1x.,rlr,,irrr I rrrlriI .rr.rll,
r,ir,li,ri0rrrr,rr
-\li'r.l,ntl r.slr. I,(:Ir'|,|)IIi,
r,.lrl, <.u rrr,,i,folOgia
.ii rlirrr.rrsirrrrilr,
irlu,rr',ir.r lxr:rtc tr l)cl.(:rT.rltt
ctr i.uIirrtlmi;r,iu,isuprrsevoinlei ;i lrt.lr.se:l
r.strr
l('flr,ll rff.f{flnlr'rts;.lt) ll[rnLreb,foh-lomA
lu urirrtputu!i sintirxct,priurlr|,.
rnl,/.l|u it,ti:
r .
ct(.., r:urL,
.
.lrk:yuIilot, alo }idiciuilor nervoase,gangt,eur.
l)r'r||lirI (,ttouiLlt r lrlrtltbru, not an^ll,cnr,in rnod jn-icrntiterrl.p.,rr.otirr
rrrrrri.rrrr.rrrlrlulirntonli suprtiul sau fLrzionatmembrailui
Daralizat..DIcm_
rr*. I:r.1r)r'i lr,L (xislil ;i la buloarii cu secliune
compleli iau llti Inziurro
:r nrirtuvr.l sl)I|tirnl,TlrccumFi in lcziuni talamice pal,ictale(ir.,,pi,,.
t

DE DTAGNOSTIC
r)lt()trLEME

7. 'l'ulbrrrririft.paroristice ale somatognozieireprezilLi fonne parli, , , , |,. rrLrir'rrr.i

,.pilep1icr.,in cursul cdiora boLr:-rrvrrl
rriicglc ,,iuilar.a,
Irrrl.,r('sl{.
.i I l. -l : , fl,-r
t4)scDtoun henieorp, d, qi-a pierdulr rn membru siiu ull
Alteod inceaici, jluzia ieplasirii corlnlni, tlctapi,rii
::'fl:t,..trt._,,.t.-1",'Tbru.
urrui
fautomi.i.u ,,u,i ,'rcrrrbnr

I n

sil r,l:l]:1i.ll.:
ra,{,iirro gildim
srndrm lir o epiiepsiefosali, pariettld, (tumoraiii,, va,s
l/a,$crlarti,,
crlilrli,,
lli

l)li volllll ltli

r0.1.cLASIIrICAltl.lA'l'ULttURARIL0lt

,.mernbru

DDvotuutuJ
iu rtrr,uuR,4nu,D
$tlNAt'AZtl

sirfla-

l:illlli
rrl l rlrlll::',,b1y..ll,L1zjr
: r . r ' , . au tliie\te
llir i ,.{ l e o
o haiucina,lie
h a -l u c i n a ti e heautosco;iricir,,
h o a u l oi copi ci . in
i n tn1,
fa(a .,rro"
rrnor ai
*irro
al o
.Fau
' ii']].'.,.1:,"_l

I r'li,rrrrur,tieii
ctc.).

lU.

Dxist il dour Ygr t t pil iLnpor t a, ut t r t lo 1t t I I t t t t 'I it i t lt ' t r t t lr t lr ':

l . ' l ' rrlbt t r ii, r i alo cr t isiunii qi : r , r t icr Lli, t iicuvir t lt , lt t t ' ( lt lr ) I I I ( ! ( I l I ||I I t I |||||I
l ,rrr.rl rrr';i (lo at t ioular e a ct r yint olor ) .
l l .' l ' ul i ) ur it r i
ilL) r coepliei, cor npt ohcllsit lr I ii, li) nlr ll lij'r 'ii lt i r , r I r 'r 'r ir 't
,r" rl ,,,l rrl i l i r vcr : bale. Aces|t a cor ut it uie af llziit , , t r lt t r t lt r r , i t t t t lt lr t lt t 't : t t lr , r 't l
lor Lilii.
' , 1,.rt, rl i r r lulbulit ilc

)lt
10.:.TULltuttARIALII EMISIUNII$I ARlrOULAltll(itlVI N't'l{l,r
A
All'l'l(llll,Alll'l
I)l']
PR0PRIU-ZIS
MI,ICANISMULUI
IT0NATOB
tAl,lt
'5[
CUVINTDI,OR)
l i i ri , rrI innif osl, iili pnl, ologioe {r il, t 'opol' r t lit t gr r I io sl, lll'llt r l' t 't t viI t I r 'I ot ,
;,rrrr l rrl l l ut 'iu'i f ona, t or ii ] ) r o?I 'iu- ziso ( t lu r r ut isit t t r o ; i t lr t plr r t t t t t t lr t t r , r t ,
l orrr:rrrcl ol5 i n silabelor ) , f io alt t r or t ia, , lil, r r t t t l, r lollil't t l f i r ', t {lr ) r t f ltt' or 'lt t lit .
f' r' rrl l r 1r)ilt ioaccst oa s0 t ozt r l'vil,t t t t t t ur t lul gr r t t cnll t V' t li*r t t lr ii, lt t lt ult 't t l
r rrol rr, i rrl ,t '1"i,
loit t 't o r t t ult c t nlbr r r iir i:
l . ' l ' rrI bt t r ir r ilc t lo t t nisiunt t si ( l( t l) r onut t lit r t
rrr rrrrr1rr rrrrkr gnr po r lo l) lt , r lilif sf iiI 'i ( r illi( x) :

t t t ()t l || || ||' | | | t ( 't t l) l r r r l

l . l )i xlul. it , r r r r r sl, liir r ir r r posilr ilill, lclr ,r lo lr lr t t r t r r r t llt ir , t r t t t r t ilr ;, t t r r , ln

r,rrr ,' or,LIr it r r r , l,riilo iit r t lr 1, t r( t lot t iillc, lit , bit t 'lc,gt t lt t t llt r i1. lt . ) . t \ t r t it t lir r t t lor r t
l rl rrr l r l ortt lr r lt t r lisllt , lir;r
,t ) I)i .- l t i( , , p( 'nh't , su, nt 'lt 'lr r lr t r lt lr , . r 'ot r sl, li ir t it t t Posilt ililr r llr l r ll
t t ir , I pt ot t t nr ( it , r r , lr r, lllir t 'l, t t oit lil, r u i. it t t t r lr , lot r l, 1, ,H, z, r i, , i, ( )
;rrrrrrrrrr(rr , r 'c,
llii r , slr rt illnr r . lisnt , n.rl: t Lt r ir iir ulr t , t t t ir t t t lr r t t lr t lt t ,
l rrl rrr:r l rrrrr vr r t r liir r ,r r , r . r r slrrrliHl;
i
lt
,,t it t t t r r lr lloln, z, t l, . j. At x) r l,Niijlr lI liHr t lr oillt t
r
lr
lr
r
r
l't
r
r
r
ir
,
sir
l rl r Il rnl l {, ilt '{\ il
l l Irrrrl ur rl r ' r , ir , t zr r, li\ r l, r , lo ( lt t lr r t t r lii ir t it r t I r lit , t r I lt , r ',r'rlitr ,r ( ilot , t ir , t t t t t lir t t r r t t ,
11lr I rrr; rrrr,i ( i l r , t t r ir r ilir t t , lr r t i l, t ! , jt lll! , lir ll, lr lo; ir t r io) r yi r lr r clt 't t zt rlt r r r lt 't t l, t t I r

'.'.'t,,l

i ri ri t rrI r I i r. rrr it ( l( , llr L l ), t,tr rl l r,rl rrrl tl tt (l o i l s czl l l .rl t,rl ci i rct rrol r,sli'hi l i l l l )i i l n
I rr,', r ' r ir|r : r , r 'iri . r rll' t r,i i fo rtr:rtrt:L tltl o rtL l l l i t.
I t ) l) is I uliilt : k ti q h : s t' rl a l ,o rts c rl c o bi cci rl ui r. rl t,l i rcl c Il ,rIi i {{)I rI i (,(L
rrl r'l i r r z r ' lor ' ( c l. l rrtz i t,(l o i o l )tu c ).
t ) l)islrrliilrt 1tt:ntrtt,stttt,tlttl ),r), poitrtii rrrlnelo dn lt)lacisu.
,l ) Ilinttlulit ( utrbirL:u,na;onutd,) csto o \.iuietitc de tlislalitr ntzalii,.
l,li ric (lrflor()si,(\ ttttot' a.nomulii ale rtiLttlui pt[l(,ti|r, si\t ll&i :],rles{}i.l
u})(}r.
l)t!t.(:t stuLl|tt (,[iri.i ml0 ?(r[dtine (plr'|rlizii ale rago-spinalului pt,iir 1rLLrrrr.s,.
IrLrllrr.., r'llrli.'lllro strlr trotfc*laro intercsind
r.ag i siniLron'rt,
'crvut
;rr.rflrrlrrrllrl;ro). l,it copii, IroLi])ii nexlli \r l)egetaliile
ad,enltile llot 1ttorlur(1
t i rro lr r lir ' .
li. I)i:;ltttt,irr,(:ti.ofctn.icr,
) cstc o tulltullre a cmisirtnii fonc.rlelo: si, irr
(,ir,1rti Lr,rrlil, tr cuvil-rtelor iri a,nsil:nblu, in tlisfonii,.i,ulburur,rea loi.bir.ii
rf (lil,l,or(irfc [tt,.ri.1tarlce.satt, .ptnli.zii $, ttnor elenzente
.loraalorii (b1121,1,i11
rr,l prLLriuLrri, liLnbi,, l*ringe ln spcclal). in toate accsie cazuri, limljL.r,ju
I
rrrllliol csLc crlnsorvat, or.icare a,r fi intenritr"tea paraliziei. Chilr dicii
IroIr.rrr,r,rrI
trLr,mlli poa1,c cmiLe akrcit, citc\.a suneijc fi'agmcltir,tc, c1 estc
lrlr'lirct lir,p,r,bilsil inlreleagil, sii citear,sc:is&ll si, scric. ln:r,cesl,e cazur.i cs1,r.
rorlrr rlr o lirr,r.iLlizienotr.o-rnusctlarii (a rtu$.iltilor labil,li, lingu.}li. relo
qlol,ici sau ir,lutola rlintrc el). Trezilitler, poaLe li
1r:r1ril,irr.i,
ierifericd, (trou
.trltrri), bu,[boprot ubetnr,Iiald, (nuclenrd,] san r:eiebruld,(ii,fecilr,rr:aneuro
rrrrlrri rrr0i,ol cerlll'il,l). In c*zuli u$oale, unelt) totrerno si t Delfect cOnsill,.
|rrlo si lultolrt.rnult ii,ll,crate,citiir,r'SLrltju,1t,,. lD r.ltzuile arinsal,e clc pa|t
lr,,i. rrilr'(ir!,ti,slr,u totllli l, ru.uschilol fonatr.ri, i-lsisttirn lit o bLrp|t.iiLixc ir,
lrrl rrrri rLurrrrloilsc Ionerne, pinri la irnposibilitatca totalil, ll, rrorbilii, rczurrrrrlrr,ll til,cr':l sun{)ti} elei:neittnrc, sau l:l o afonic comploiil, ln it;ldiul
l rrrrrl r r , lp4t ir iir iilt ir l o ,b i o -g L o s o -l .rt)i
l (, s p l rl cel l e dl ,l { r zqornotul tl ahcoj r1 , 1 . 1 1 ,, ti tn p u l c rl i j l ti ni .
| .,r' , : r r r : J , , , ' l. r :rrr.
| | is.lon I il rt so i nlil n.tst: fn .. a,) Atitigcr.i ale nervilor recuronli $i
1)neurn(l
,1rrliili. Iir rLivclirl gituiLri
;i rrrr:diastinului, care anNleneazii lalilguplegii
.rirrlrrrrirr<r.
r rr
r'tlcLrrcrrl,illlo_
(r'uce t.ligtrsitJ, [.,itunlriii, cu tinrbr:n ir,siulii,,
, ri rrrr loir |, ir r lc z jL rn i l o u n i l a tc ra l -;, ru tL : rrtbni i , j rr' l nzi rrl i bi hLcrati )
;
l,) 1,,..'irrrrirrlc lrrzci crrtninlui, cu siudroalle Coltet-Sicard, verntl b, Scbrnirli,
(l rrl l rr . r . r , l, r r : s o i n s o l e s c d e .p a td l i z i e
l ro S rcri rri ! vol o pl l al o-l :t;' i ngec I
r Il i rrl ilulor r r v r ilt ; i
p o l i n c v ri te , c i ,rrcp o t c u p_ri rrrl n,
i n corLl :crtul cti ni c, ri
1r:rr':rlii,irrVirLr-lluinqeo sau labio-gloso-r'e1o-laringeeI d) LcziLtni cxtiurl(\
,lrirlr lrrrllro prol,ubr:lan{ialc, c:r,de excmplu siringon:Lielobll}:izl, ,sclerozr,
fi
l:rir;rrlri rr,ririo i,lrrticLi; er) |ezinni
vl,sculitre, tuitorale) infeclio:,se
"rlrr
l l rl !rr:r 1iix ) lr r r lllr r ;o s i b u l b o -p c n ti u e ; f) P a lal i zi i al c rmrl cl i i l or fol rl tot
i
;rrrrr l,.,.irlr,r ctt'ri lrtlr,lil a loli;iunii inferioare a celor doli, cilcunr-olui,ji
Iro rrl r Ll, .. r r |r r r r lonl;c (o p e rc u l i i ro l :l n d i c i ) ; g ) Lezi uni al e fasci . ekr| g,,ri i r rl i rl ,l ( i||( |r ' r ) iLln rr
p s e ttl o b l L b a re ),
:.1.tlisiaziilo (rlisicmiile lui {kr-rsx, 19i8, sau alistorriile vorbirii) sint,
.
lrrllrrrliili rrlc rr,r'rrrouici,a,kt urorhrllilii, ale litrnrlui si a,le caclcnlei \.tlirltirii.
Itr rt0 r ; ir r r , ir , u, t t lisr i l i l l l rr s i rrrrIi n te s i n L I e l ttiti rtrl S l l S ul tl i rntte, 1l l OCi ,r,,
i i rl r r! , r iil( r s r r , < , lu l rr,1
0 r' i s | rL t(1 tr,1l ,,
l 1 tc 0 ti , rl i tr c0ri h' l l , trxpl ozi r. (i truhcsui l ,rl
rrrrrrl r1ir
, r r . r ir r ; r . I I r rki i.),
i i r,l i rtl I i t(l c s r,i l(,l
, t o Ic | i l l r l rj l i , l l i l l ri i l r,l i . I)oci r:l ' r' :l zl ti rr
tttl ttl ,t t t t t r t s lc t t r t l l t,rc i rt,o l ttrl c tr(i tro rri i ,i rrroIrrl i rl ti .I)l t,r' .,
rl l tr,i ,sc sol i ci l i r,
o Io tlr it r llr r iii, r i l l l l rl l l r| I' ,1 I{ | i | ,Ii I,l i i l ti rrl r, i Ir,rIi ,orrIIrIi l i i ,l ri rrrl ,i 1rrrl ,crrr
r.,rrr:ll: r l; |t
r r I l|r r r . t r rr.l i l r' { . l r:tfr' l tt I rt I rr, i t rri r I r" i : rrt l i r: l f:rl i Ir' i rl r,, rj rrl rrrri l kr

i i { ||I|I|II|I II
i r 'l ( r l ,l l :l r I r I rI r I ' t I r i Ir I rI r o tr 'l r l r t r l t|I |||I |II|II
l
:ttl
t
1
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' tl ttt
r
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o
tttr
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1 'l tt':tl t,,tr '
I : t l r ll r ',l 1 l l l i r 'l l l l . \r r ':tl l l l t
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, 'l l r t t r t Ii zi ttr ti l ,' r ,, Io Ir ttIr r ;r ''i ,i t r l l ; r 1rr t : r r r ri r l : r I '
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l ; ; i ',
'l 'r , ( ttti tt

, . '. , r i : r |i ';i l r r r l i ;l l r zi i ,

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Itt \i tttl tt'ttttttl t

:
l ttttl 't) l
) t 'l t'tfi ttr ttti l 'r l r
) ! ) i t ! r 'r tti i l r ' ( l i sl r r "i i l t
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t, i,':ri.,iil"irii.'-iti ,,tu'lt' siirrlti'l'-i'r"trx{trtpitrttrritlrtL" r tr i ' l "r

ttl r i ti t r r tt
, , ' , l r, r l i r l i i l ; "\o }u ttl ,c :l stttl i l t ;i o IttIJIItIi Iti I l t' l ttl i r
l ""l '
Ir r
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( 'i l r ( f l r r ,r r r r l l r l r r l r 'l tr r r 'r r '
1 ;o tl i tttr i '
' , r l l " r -r ,,i ttl t^ si tti .,,i l l l l l ttr i r tL l l tl tr ) 'i l t'
r i t I l r r r r 'r r l r 'l r
, r , , l , r r 'l l l l r '. i tl l t ttl l sl 'l l tl i tL l l ttl i l L r l l r tsr l i , i IItt IL tIIr ti Il
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ll'ill,'rL1r'rr
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i,fazia
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rlroruntii,substa,ntivele.
ll:il.^.,ll:l.9iflii1
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indicind prin moiliiic,ri ale fclei

nasl
uLr.rplin gesluri, ooea ce estc incapabil si, cxprim6 prin grai. Exprimarca
r u loirrrlrri (lurniratul,
denllrir.ea zilelor tlii si,pfdmin? sau a lunilor
rrrrrrlui,cintatul, recitarea ulei poezii etc.) este inai line
conseryata.
rf:rzi:r
intilni
urmiiorrele
grupc
}Julorn
dc tulbur.iri
.irr
^rnotor.ie
( .,
\rir.t,';l|rIlrn.(Jmtlredaoe
li J)urrnd, j939; llolal- li Lhct,rnj e. .1963).
;t) il'tr,lburdri artrice. Dez,integrarea
fntensitatea tulburiirilor
{t(l (,\l)i ll1il,rc..(:inartlia,duprii,unii autori)foneticd,.
este variabili,, de ta sr"Lpresiunea

p0sibiLif
ititor de,crprirnare,
pinilla tulilurii,ri

:l,l.,,flli:.].1:1ll.l,i
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-tA;;;1;;
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r.lr v1'11911lorLcticr
estc net tletorrnnti. r-i"earizareava-torilo'
cirrc\e, 'orbi.ea
rompLrre limba,jul necesiti,o
:1.]'l::'
a
',1
, lllrrUl llll
lr.Llre[[, a tensirmii corzilor vocale, gi a "oor,loo^l" Ierfectii,
,,forrnuleloi, rnotorii
lrrrr'. r'r'l r-lilringiene' caro sint proprii, adec.iiatletietliirlii-ton"m.
s,presirir (,, si/ riiL. deteriorareafoncmeloi crpr.inrl: elizi.ni, asimiliiri (ex.';;ii
,ll l,'r ii. Fnniiiruri-. pri,{rclrnluc,lc,.eslcl ctc.). orrbrririiili
l],11"'j
11,ci.
mel:1rozo(bel.rilouiu iuc dc [ribelour.npc||inzo
iilll'l
( |)||,r,rrll:
rI I "l'
r.iri ll"'l'11'i'9t,t,
rLlu( de tliblioteci,). Se mai prodrlc unelo modific5,rif6netice,
r rr : rrlrzir,lizl,r.cilunor vocale dcschise,_diiiongarea unor r,-ocale,
asurzired
r'r'|)r'{'r)rso:rlre
sonorc' o red,clie g10bal[ a varia.fiilor mel0diceaie vorbirii,
rr r,,Lt:r,lizir,r..
a, accL'ntului tonic asupra fieci'ei silabe enuntate etc., merEitld
lirrii lrr rlislorsiuni fonetice complexe. A):i,joualirre qi .,;trlr. iig3g, -i?.6ti
rrrr r.rrrril, i.i[lic aceste tulburi,ri an:rtrice qi foneiice *.,b in";;;;i
d;
..;rrrrlrr'rrrrl,',rlozinlcgrlre font.lici.'.
arupra apra.:iei buco_
1i
_!nsi"lirid
r:rr'ri|lr.,
i tr lrrt ,rr r ntlJZtrcflar.oSt0t,
Itdllut,-ri aie eSpreSiei
oi.ale.
lrr
.urlrul turb,rEr or de articrrare are afazicirormotori se situeazi
..lr)
itt ii.\ltt(.':(4l.iitc(Alajouanine ;i colab., 1939, 1964; Iloriad_Krohn,
tS+Z :
I i, )rr,z, | :r(iz). Ao(,rtrt,l touic,. ritmul, tonalitatea,,timbrul si intensitated,
r,r':rliz,.rrzrr.rrr|'lorli:r,.siru.l,rozo(lin
rorbirii. I).jn pro.oai, oe ;t,teteEvariatiiLc

1r' | ll| r.]rii itt{.r ttt.

li, l( lDt o l, r t lAlr - t . : j do r it m ,

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('t Il t i I ri (.| {,]r,I I I I I lL( ' (' 01| (l
, (' l i rrrb rLs l l L i rri i .

r'.) fltt,prt:iitt
tttrt. lintlttjttlrtt. t\lrtttliIirt.. I|\|| | I)|| r'I| |rIrI lo:r rrr:r,iit rlror'
iirltl'L lr, un(,f lr,lit,zirri
rroruljr irrll o lrrrlrlr{,iclr, rtrlrrrxirriolrr,lc.lrlrlrlrlrilr,
r cllrillli 1xtn,lclii-- rlrrpii,clln jt,ln llrrrirrl,il,- 1,ulir,l
suplitrrir,l,i,
slr,rrlr,rlrrti
iil ( itcva lottc,rno: stolcol,illiilo r.'ctltillc. So inlrelcgcptin stttrol,iltirtn'rlnlt
o t eductie a limbajului I'olbit, lir, o e-rpresies1,oreo1,ipir
i
crr slrr ir'1,r'ii
sr,,rrrrr
lirltic lingl'istici, ca un fel dc .Loit-motir.,pe caro Jacksor)il colIrIrIr,r'Ir,
r'rr
tttLteflen de org5. Aceasti, expresie stereotipX poato fi corrsl,il,rril,ii,
rlirr
lrrrorne,tlin cuvinte sat dintr,un fragment de frazir. Io }itr(llrrsul r.orlrl
lrilirii, afazicul i$i poate recuper& unele formule &utomalrizitt,(),
pol,
r,rr,r.rr
rlot'eni,in mod pasager, noi sterootipil. Se intilnerytclroovenl; irr lrrrrrlr,
lornncle intra.er.ebrale (temporale; Arseni, 1980).
d\ Agramutismul se manifestl prin imposibilitatea rlo I rrlilizrr lrrr'
rrttrile (modurile de a$ezaTea cuyinbclo{ in Im,zi,), cuyinl,cl0rlri logiil,rrlli,
rrrotilurile qi formele grama,tic e ale verbelor. In cltlrnl lt,gnt,rnir(i,rnllu!
irlliilnim sirnltomnl denumit ,,stihr,[neorilor", carc conslir il rrlilizrr,rr,rr
lirtlrnlui la ilfinitiv, procurn qi simptom[l ,rstilul teLqr&Jid), r,it,rc r.orrslri
irr omisiunea ile cuvinte (in special de legi,turii) rlin frazir,.
c) ParaJo;iilr, j arouna;fa,zi,ik:,tlisinteniile. Oa ;i in a{a,zirr,
sorrzolill:i,
rll iitilziir nrotorie scpol,intihrj celcmai lariate tipuri tlepm.tlittii ,,ti;jtnlrttt
rr/,r:i;. lsupra, r.irola nu mai insistiim. La acesteaso Ldlrrgii rrrrrlilrrrlo
rint.;xit, (d,isinlari.ile), care constau in aceea c5, irnbiutr,r't.:
r, :rr':r,rr.|rrr,
rr
l l lzelDr comportir, confuzii. Disintaniile, numito qi lrt il,-l{lil rrll,isr rr lr rl
.,rlslarnatismeimpresive') se diferenliazi, de aglam;ltisrno l)r'ir l,(,(\.r,r'r,
rlrrc tleosebirede agramatismul adevdrat sau exprcsil', irr r,lrrrrcslr, r'rrllrr
rl(rritil.izareaunui limbaj simplificat, in disintaxii cslo volllr rlrr o ;rir,r'rlr,r'r'
rr r-i:tloriielenentelor gramaticii si ale sintaxei, cr,l'orlrrlr, lrr,rrlilizrrlr,;r,l,,r'
rrfoorentii, la conluzii in orrlonan_ta cuvintelor'.
l) $i in afazia motorie se intilnesc p erseue
t'ii.ril.( fi inlt).1
ituliilt' ltttt
t'u 11)
|1,,

g) Unii descriu in afazia motorie o anosognoziau. ult:.ir.trlrri, r'tlt

rtinst*,in aceeacd,,clemulte ori, ca,racterulpatologic al l)r'rr(l(,tiiIrr r r,r'lIr,lr'
lrtl este perceput de bolnavi, car so comporti, ca qi cLrrrr:r| vorlri rro|rrrrl.
Accgti afazici anosognozicisint intr-o staro do oxcilrr,!iop),ilrorrrolorrr,,
iin cruberanlX, qi logoree.
Pentru enamenula.faziei,m<tlorii se ulilizc:lzir,o lrr,r'giigrr,rrrii,l, t,iiLi:
1r)Teste care apreciaziibilanlu1 posibilitiifilor lrlir,rrlilkrlii: irrliirrrr,rr,
rlrr
a se exprim& liber asupra diverselor subieoi,o;soli|iirr,r'orr,,;,r.1,;'r,Ir,lrr,
li)l}eme, cuvinte qi fraze din lis1,eintocrnite de nr-riirr lfl, li'I, in( rl, lr,
luprindd, cele mai diversevariet[,!i qi ansarnbluli<lclirnrrrrrrr,
ilrr r,rvirrlo
glirrrrirlrlrrlr'.
fi de fraze. b) Teste care apreciazS,
,,va,1orile"solrir,rrlir.rr;i
,\stfa'l,se vor studia sistematic: -l)osibilili,tilcalcov{x'itlr)rrlrrfrrrirrlrrlor';
:ltomaliiLeYalorilor fonenri,e eiprirnrl,r (rlcfo}rrrriIi:rlo I|lvirrlr,lor',
itiltrcuiri dc cuvinte) ; - natura lingvisli.lil il cnviulolrrr crrIrIrrllIIIrr ir,l
1rl)sl'nte (substantive, a,rller'be, olvinl,c rlc lcgii,1,rrlri,)
r r|,Irri r,r'r.rr, rlrr
;
irlitmalie :l limb:ljLrluioxplinrirtl - slllJfosil.lrrilo
sarrllolilo irr rllrr.l,rrlrr,
.*rrrrrfiicnlii, rL I razolol,.
lnc:ir,.llrill:rlg0r'1i,lirrlis()rr(cilrr{,irlo'l'issot, l1)i;(i)rrrr 1r|olrrrri
r.ir lirrrllt,jttl sri Iic si tttlilr,lirr Itttrc(,ilrlrrcorrlrrr{,rrl
silrrirrIrrlor,(,rrlrI
ryilr,lirr,lil,rrlllr,l
litr|i1^itr trrrrlftrt,r,rrlrrr
rl0 llrrrlirr rr,lill:r:rir.iso rrliliz;r'ltzii
irr slurlirrlricrrrirrl,'
rlic: - litrrlrrr,jrtlrilll\1lttl rrrrlorrlr{iztrl (,,girl:r Iitrrri") ; lirlrrrtr|rr|rr
tll
r,rrlltz
lilrrlr;r.irrl
rrrlir,l
il lporrlrr.rr
lrttlii,'{r,,rlo lrrtcttlir',rlrrlrtr,, :rcr.r'1riIrrr',
I
il

l 'l r l ) i r l '1 .r 'tt i l ttl r i cl i r ,

l xr r 'l o l u tl r \ ( l r r r r r i l i r ., l r r r r l i 'l i u r r r '. r .i r l i r l i r l r , r '1 r .,) , r 'r r ,r ,,

:.| t
:ll il,

l rrr:r lr , r lr r r r ulr
l u\ i l l l cl rl t i i r l l l ol gi l l rr,rrl (' i r
i i o l rl tt(' l i l rc t l .l tl r. i l l rl r,L r,tr ,rr
1 r':rz liI
lir r r lr lr , j rrll rri rr p l rrl x r ,,< o l rIIIrIr.' ' (r! i l l i ti l (' l r[c{ ,l i \ r' .
* r l o J t .rrtu ti n rt l t) i tt :
\ ' orbi l c:t H p()nti nl i i si rl -i ri ,i l r,l 'rr
' f \ lr l r . r r r r r ; l, o rr,
l , onl i !;
r o rrl o |r r r i|s lc l0t (l o rn i ti s l l s , (l i l l c o l l \ (r ' sl l ,,l .i l (rrl
I)s ul i l j | i ,ri
o l ri l rlr ' lol s l, r L r r ,in tl g i u i k rt' l l l e z c u l i tto l l rw ri u rrLttl ui ; Ll oscri cl e;-utl o tl i l tl
lrolrr:r,ri lr, rn{ri $(iori) lLriLlc siuLlligut inl,o })o u}r tabl{)lr I .- l?or-estiltit, rlr,
.rrlll lrrr:icrrl,N rrl{ji isiolioar'o (are i-a iost e-\}rrsi i - C'onstrutca tlt i.r'rtzrr
r. (lolii, l|oi sjt,rrrll:ri lmrlte c[\.inte inpuse ; - Solicitirli tlc lcperrll e ri,,
r rr(.1( f J ( ilr \ ir r 1, c; i 1 r' a z c .
'!. ilgru.l irr (x)rstil,lrio o a,11;.forDri. t1e afazie r-notorie, caic eor;siir il
Irlrrrrlrrlr.r,lrosibilitir.t,ilol unui indiyid dtl :l se cxprima c[ rjutoml sti'isu]ri.
I,lrr,rc rlrrlurc\tc ur)ol loziuni la nivehil centrului ,,imaginiior" graiirt ll{'
r orlrilii, lolrrlizat, iir piciorul circumvoluliei fuontale, a doutl din cnisfcr':r,
rl

| l]i t .

,\glllir csle trra,igreu de :lprcci:lt la bolnalii afazici, dcoareceii{aziilrr

lrr rllclrt,lci sc irrso{:esc
1i de htlmillegii dlcpte. In acestecazuri, se l'ecul'sil
ili llr prrlrc speailllcde exarni ale a,scrisului,prin folosireade litele con{trr
i irrrrr I c si plin solicitarea bolna.r.ului dc a, sclie cu rlina stingii. Se poill o
,orrsi:rirr cli, bolnar.ii tru pot sct'ic nici spont:r,r:l,
nici dicta1,,nici copilll.
jzlrrrtesototuqi sir scrie, se consiali, ?oralJrafie,jMgonajrlzie li.
l,r (,('i r.lnr'(!
l)t r!:rt\.t'&re (fonrirircno ascm[niitoare cu cclo descrise anterior).
I'toltel.ctttiliztttein so'tsttl sponlan, tltctat pi aopiat sint foarte variairr
rii .onsl,ltr irr : - Scrici'ea de lilcre, cuvinte fi propozilii (eventriir,l,irr
lrr.zrrlilc lllrrver in consNruireade cuvinte tlin litere con{ectionatq s,rl
rulisrr po (iilr'loarrrc),
- Denumirea prin seris a unor obieci,ecare s pr'c
lrrrlii lrolrrrir.rrlui.- Solioitarea de a rd,spundein scris Ia intrebi,ri puso,
rlrrr rlcsnio in sclis anumite scene,de a povosti (in seris) scurte istol'iat:ir(',
rl0 lr rurrrrlllct:r,
ou anumite cuyilte o serie de ftaze scrise,in care lipJos{:
rrrrrlrriic crrvinto. Se apreciaz[ astfel defectelede evocare scrisi ale c .i11
ir,lor' (\ri ur:r,rlrrlerlcslJora))deformarea,cuvintelorr tulburirile ortogfifi( o
si dr sintrl,-.i:i,
rIlrrrrrlrIir,lrIrr
etc., despre care anr amintit.
l',. tl.lt:iu ntirtd, (totalii satl tle tip Broca,) constd in a,socielea r:elit
ill|r:r lir|r)r' r,lirrit'cdcscrisc:Scrizorial[[i motolie. In contextu] clinir: lxrl
rirrrlrlonrclecelei senzbriale,s:m ale celei motolii.
;rlr,rIorrrirr:r,

l l :''r t
lloli
;r l ,'r ':r tl r r , l :l i o ) :
i l i r ,l o l l l i i , Il Itttr IIIItt, l l tl r ':t
' 1,, l,t,itrlllt
r ', , l : i r , r l r |r r i tr r l l r .t r r r l ,'r ':tr l i t, l 1 ) r {) ) i l i ti l r r i l l l ' g r r r tt {'{}tt( tIt,ti i Ir I Ii r ItttIt,ttIt|r ' :
l tt r t|l ti tr tl r , L i i l r r l l r r l tt:ti l tr r r t |r r ttItItti i ItI l l l l tl i :l l l .i |r 'l l \ : l r l L l
' r 'r r l i
,, 1 t,,ilr.{
r r u ,i l r .{ ;.:r .
t ' J , , 1 f i i i r l r r r ,r 'li Ittl l tti i tl t' l tl l tzi tr l r r r ttti 'sl i r r i i ' ( l sl {r l l ( 'tf( fi r i tt t'i ttr r tttt l "l r 1 'l o l
o . i - j o ( 'l ( r ( fl l zl l :l r i l l r 'l
,,
r r l , o r r l I v,r t l r i i tt l i r ttl r l t, sl r i i tti
l ) o ( '? l l o l t' i l l \i i ,l l l
'
, i !
. r t t t r l i r tl r tttl r zi i ( tl r l tl tttl i l vi r tl l ;i tl o r tttr tti r 'tl i t r t,tr cs]tr il i tttttr ' r l r r :tl r tzt' )
, L ', i i r l |r i l t,t'l r l tsi i i l u l L ttttl t,ttr 1 .,i l ttrtl o i r l i o t'i l ,tr r l r l {'l r l ,{i i l ( r l r l i r r l |r r r r '1 "
L , r r l I l r r r r i r , r i 0 r r tl l t,l i z:l r r r ,si i r r sl l tl ( i l l l tl tl Ii l r l l l l tl l t l ti l l l sl l l l l n r tr ! l l l r l r l r r L l
, , r r 1 r ti t ti r tl i tr l tl r l tl i l ctr si sl tr tr L tl tl stl tttl t:t,l i zl u r r r l 'i i ,t'i i tt tttr r r l tr r 'ttr t:r l
t,
,,,, ,r' r. ,rplilii
tttt ttvo r ti i i tr i a g i ti c:t' l tti si tttl r o l i ci i , r cr l r :r l :r
l r , o l ti u ttttl tti
,
r r r r ' r i l r i i ,1 r 'o i u ti i , cl i l tctl l tsi i ' :L l i tzi o l u l l l l o ;i l i ( 'i ) ( 1 l l l l ( ti r 'l l l l l i r r i r r l l )
( .l l t'r t,tl ) l l t l r r l r 'r r r :r l r ':l
,,
, l , L l i , ,r t'l 'r tzi trr u tttti ti t'l i t",
sl tl l
',str
, r r r , i tl tl i ttn i
o ccir :l
l )liil1'i:i
!ltr
( l i i )d' i tt i 'i tti sl ctl t ( I ( | | | I | | | | I | | | I I
l ta l i cto - te m p o l o
, r r t l l l l {i . ( 'i l i l l ( l o l ) cl J,y ,.si Jr l ttr r tn i tte , l l ) ( i ;i ) r r r l ( r r r l l r tl r l ' :r |r 'i r 1 l:l
',
, , , , . 1 : i t r q l l tr l {0 l i r ttn l l ]:i ti o r r :i ]e A,1 ) ,( 1 l 1 IO1 l ,I( 1 ( i 1 .i tr rIr, tl tr ,ti l r , , I t I t t t t i I t ; t i t r r r
l , r r f r r trr ,i 1 ,r o il ttzi u n e tl i i a ccl sti vo tb i l e si tt'r ttr i i ',i ItItr |l tt;IIIi , l r l tr r :r r l "
. rlrjrl{, r,rt1'oiniliriz:r,ter lilrii conlimll,
cL1 i'(til,ir'i, I r I t t I t t t I rI t t ! I t rr lr:r'rr'rrlil
. , r i r , . l fr tttcl ,i r t, u u D i n :r ,ti Yr i ( ,'r e p r e zo r r tr ,i ,i vi r ) ) ) r t t'o t b i ti i , ( l ( r l r r r r r r :r l r r
r , , i LL r Ii r r , ( 1 1 1 1 i 6 ,( i i 1 ,a t,d o []]r o l m i 1 ,t,o $ i l ]i i r ( ) l l r l sl r {i , l l J/{;) , ( .r r l l r l
'
ti ]'i l l i , i l ) ti l - l l l ,t u In i t, o b i t) ( i I ;i l t0 t tl ttl r t r Jl ( fl tl t'z|.t!|l l Ir 'i r ',
i , r l i i r 'i r I i ( ) ti i "l ,r 'Lcu
,r
1 , L 'r ' i r , j l l L r u '"'i n te l e e o l csl l l m zi r ,to r c. L l to tr tti i ,l r r fi l ) ( !r '') r r ' r r r r i l l l l '{;)
r : 1 t ii t'L r l L i n r [r 'i l c r l e l j m ]a i
d i n :r 'j i t'zi l t' l r 'tr tttr r zi r r i 'r r l l n tl r { r '.r 't l i r l .
,,
i
n
L
cl
cl
ttu
a
l
i
i
,
n
i
si
ci
t o t,L tl b ttr l i ,tr l ,) g r l l ) ( 'l 1 r l r i ":r r r r r 'r r r 'r r r r '
'1 , 'l i ri o tr l r i
]'
\Il r r l l r r
( ,,i tp l ttr r tt{i sl r tr i l r
, , i t tl b l ti i l r c
a , r 1 1 1 1 .[1 i [r i l o r vi zn a i c"
, i , r l r ri l l cu u n d o l i o i l i a ,Lm 0 l r L tl f i o i \'o l i ) tl o . /\l l l ti i l r :ttttttl ztct tttr l 'l t :'
,
, l L l r r t' sttti su l tti u n i ti i i /i l o r l i u * l i sl i tr tl , ( 1 i i r '{!r 'r 'zr l l l i i r l r tr l r ''r ..tr '1 i t''
.
1 r1r tr r riI|o |l ||r , r r ,, i r l i ,
i {1 ,o r g o toi t 1 1 III1 1 I|1Ir
r , l o | j l 0 r 's.r l n a l r ti o o g i ( l i n tt',o
i , r '" ( l ,l r {r n i i ,tr : q i l ) 6 r o u e sn i '
L 9 i tl ) . I) r l l ti i :r ( 'r 'i r i r l r r r l r tt r ' l ( 'r r r r r r l r
'
, l r 'r r rl ) t) l a l c st'i l l g i l r n tl cn e a zi i o tl i si r r tr cl i r r tr r ttl i l r r l r i , r :r r ''\ r r l r r r "r
:tl ,r ':r r l :r :tl r t;t'
.
' | | ) r r r l j r tctL l i a ,l u }l n tl c D xl e zi ce l l o ci r vi l l i ( :l r ) r '. i ) :r t
lr, r cillr
r l u p i r , |,1 !i :l u i ,o r i - - a l i ) l l l $ l i l l ( i i l ' s( r 'l r ( 'l i r r ':i ;r r l r r |'r r r l 'r ' r r
i ,r r l 'r :r 'l t
,,'
l , 1 r o t.r tkr t.l o r cg r e si tu r c ( l l i cr r c - i \L l r i o I l l r i r I l i tl i ttr l l l r
,
| , r L i l tt l l l l ;i i , :u r ;p l e ze tl L i \ tt l i l t'l n i , tl tr l tl r tzi tr tttr r i o t i r r . r r r ttt r l r ' :r l r tr "tl
i, l. 1,
Itr zi tttttr i tt l r o r l tr tr r l r t I'r r r '1 r 'r r o ;r .l
'r l r r r r l r i , r l l t Or i g j n t, i ,ctn l tOl l u l i ,, l tr i tt
, , , r : rl r .i l r , l t e l r .

ll. tlllt.lo) ta iliniae de aJuzie. S-zru]rlai desclis o sei:iede :fulrrrt rlr,

:rlrr,T
irr,rrrri rrrrrllstLrr
luaj prliin binc in r.lir-it'lu
alizaie ,,\iacccpiNteca elrtiilili
rl rrl i rr lir :
l" l lt:itr t,nncsticii (t1tlsr:r:is:i
iniljnl de Pitres qi de Wilsol): ronf tii
rrr rrr r I r or r r I r iI iI lI t r rttl c a p rrrri u n !r,, (l c a e l o ca anumi tc onl i nte, mi l i i l l { ' l
rrrrIrr Lr r r I r r r ' I r ' ,lr ol rrry rL l i r.t i tu r$ u l I o rb i ri i d i srursi l c l rti l i zi ni l ' nul t,' , i l
{ | |r|| i) |r t iI r I r i s i 1 rc i:frl z e (c u i n rl i c a l c a u til i ti i l ri i obi ectel or) fi E r' ,ri ur' l
r' '. 1rI i, :r I rr r' . l lfrlo rin f(d r'lc i,nllltllro cltl.tili, a alenllnril'ii) cu rncrrfirrcrr.rr,
rrl rrII llr r I ii, r r lr . pc li ,r' i i 1 i rr,i n 1 ;c l c g c l i i \' o l l )i l i i . [Il l 11i (l i r]tro :r,cel i bcl rr\ i
,l rrrr ir r r I r llr r ir r r, lc o rrtu trtri ri i s i ,r' i r1 ri
s l u r l ri l l l (r i . l J(i ovi tl crrl i rtzI l a, I:ol rr' 1,'
rrr,rcllr o v ot llr lr t r tl c tl c rrtttrri trra , o l ti rrtrl o t . l l vo< ,l utl t, r' tn,i ni ttl ni ri r,t i rrr,
rrrrrr rlr, olilr ilii, r lr u' i , i r,rl rrrrrtrl c l l c l r,j trl l r,lrl, r c\ri l i ri l l ,or' . l )r' r)l rrr)l i l rl Ll i xl
l rl i rrrr r illt lr ii, r t rrrrv i rI i rrI rt i , rl rL r rl rtr' i i i r.rtrIrl orr_rrrrIioL srri l l i rl tr l i i i i rri r' ,
p ttrrlt r r r . : t t r t r r . r ' ,1 1 ;rr' ;lrioi r' ttr,i tri ttl trrs l rr.rr l i i . Itt tttrr.l r' l ottttt tl rr r' r,ztr'
,rr,rtr llii, : r ( r r t r rr , r i r tc tl rrrl i i rl tt1 tri rttri i rttl o l i ) l rol r:tt rl ru l r,rrl r' ,t.r Ll
rrrrrrrir r l , r r ' l, ljr ' , i rr.rl r.l i rrl l l c o ,' l tr,ri , rl ,' ,rl r i l r' 1r' l rl :rr,rfrrrl ). rrr rl , ,i l rl rt
:,l l r)

'

,
,

( ]$
\ , , 1 / 1 :1 1 1 [1
1 ,to o [( ]l ttl i tl o l t,l 'r tzi rirl t l l tte l l o l ttl t,r tl l !r fi l l l r r r r r l ( 'l l t'l r "
, l r r l r i r r l i r ,l tr ,l ;, i l i l t'tl s1 ,c i l i r ,:tl tr tl r i l si i , r r l i o l tzr '( 'r l r r ( 1 r l :r l tI r l l tl \l ' r r l r ,
t
'l t o t ttl tl l tti ( l tr t'sl ,tn l l t t t t ( t i tr l r r zi r l ttr r l tl tttcl r t l 't'tr tl t'r t. o ( l l ) L l r r l L
, . , t r , r r sr ti r i l t,zi ,r l r l tl t:ttl i t, l t,u l r tl i t', ttq l tttzi tr r l i r l i i l r l :i ;r l ttl l ' r r 'r r r r l i
r ', , r 'p o tr l i i ( t I i I i rrI r I t,ri ( i tl r r i ti tr ttl ,i l i l r ttc tl i r ':t1 r 1 r r ,i l Ir ttl r r l

r l r , r tl r tzl r '. r 'l l l l t,( l r 'l i 'i l l i r l r l r r r

l / / / r / i .t i 'i r l c o fr tt tr ti i , l ) i r l l i ( 'l l l l l l i i
, . r r , , ol r t,l l r l r , l i l tti l r tr l i tr i l ,r r ' l r l r l zi ( fr r l r r . l l c l :r l r l . r r l r l r ) :r ,l r r ' l {r ( l i r l r r i 'r r r r
t r , r r r t r l .tr tttt;r i ttttq tr ttl l l l :l 'i r l l l l l l l l t r t rt l r i 1rt t 1i. t t rrr l rI i rr r:r l r l r' : t t r t t t r I
i I L r ,'( 'l r ( L i t l i tttr r 'i |l r 't ttr ,t.;r 'l tl ( ' l l r , r tl l :t i tr l i l i l l l l l i I1 1 ||III\I||IIi I|'
r l r r r l rl r tj i i r r ,ri r r l i S) , i :r r ', l r r l l r r l l ttti i tto l r 'l o t'ttr ttzi r ';tl r ':r r 'l l l o r .r 1 t.'l
I r ' , ' I I | | r)| I .(I i tl tttti l t) tl t1 1 r /r tr tr ', r r t'r tt
', , I r l ,:r p l r l i i ' tl r l r r '. \tr tl l ti :r
l , r t t t,r :,, tt |t i tr l ,r .l :r tr r r r l tr l t:ttt i tl tl t) tttt /;) /r r r ,. i I|IIt||I:||i I| r r r 1 r ,I
'
, r | , , rr |,r |r i r r 1 r ':t r l | i r r r' (' I I I l ( || | .II r ( ' i l r 'l | tl r l l l ? .I(l r l :r l tttr ,r l l r ) r r r r l ,l ' . L r
l r tr r l r :r ;tr l r l l t i r l tl ttt.'r ':r l t,
1 l r r r l l l r ,l l r l r l r l r r .l r l r <1 , :l l r ', l r l r o :l ,l r '
l r i r r r 'r r r
r l r l r "r d
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I | | | I ), rr I rI I r | : r I r . r r l , r ,r r l i .r ,, r r r r ,
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a ri-"n gr;,i'*ii'.il tio rreaqnozio
1,,,'";:11,,1:,,:1l,)iilo,pticii

l r,,l r rrri rrl r' (|lir t pt or , , r r oor 'lt t zit o ir lr lr . t , r ii lr t 'l, r .irt r lt lr t ozii, , it r lr t ilt ilr , l, '
,,rl Ll r1r,,
I ilir r c, r r lr '. , r r lr u pt it r r , t r r lr r lii it r r ulir r . l, ir r t r ilr
cir
r lr lr r r , . ,1.
, rr,tI t r t lr Lir . r ',
t l l , l , r' rr,r r r olisr r r t r t r lr
t l , r r sr r pr . tliciill poslr lior ' plr r r lt t m lt llr , zir .r lr , lr lr
sillilt
\\ ' rrri l ,(' . llir , t t t olist t ( , t r lI l pr r t i, , ir r llr , t t r lr r t o- lr lit r i r , r r t ll'i r I r r i, r t, rt r ir r I r :, r lr r zr r ,
\\, rrrr.l ,c r,tr I r I ct I ut r t it r r t r t I rsr
t , t t r lit il, ii t cr blllc ( 1lut 'ir ,ot sr rlr r lr r r r grlt'i ot r t i; r r , r lr
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r,r,,,rl r i rrrrrr r sill
t r f ilziir ,t ir ixli"l 1, ip llloclr , ilr , r r' r r r r , r ', , 1, '
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rr l r, rrri l rl rrgir .ll, iulr olislr l( ] lrut l ir r t clit oliul r : lt r Lr r lilr l ilr r l, cr iollo r r , lcsr li r r , r r , 'i
in l, or it ot 'it t l ir t i, ( 'r oi ( 'if r '( , lr r r l( r
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r t, 1rtrl ri t,
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,
r' i l rl rL,rrl xrri Jccot 'obnr , lc,int oxicalii cLt opiu, ou bolllt , t ot
l r r r ir ,or
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iii.r:",i Confrrziiln
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crrlolilor ( v c z i
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.) 'l' u ntot i cerebraleale lobului.ternporal. ;i alc regiu rLii lxr,r'icLo-lr.rrrp.r'rr

rrr, rtrlrrlrr stingi. Caractrfrul afaziei oste c:i, ca cvoluo:lzir, lont lrtogrr'.rrr,
r!| l ' ,,rIr (l i rl ' lr t ear ziibr usc, cind in t ut nnr ii, sc llaco ut r I his1; sir , t rlr or r , r 'r r , gr i, .
|. 'l'nun&lbma cr ankt -cerebrale.
., it atroJiite corticale din dcmclfcle prcsonilo (bou,lr lrri i\lzlrr.irrrt),
,rl rr.r l l rrl i zcl, z- i,t le obicei L- rinceput
,
o af azic anr m r sI icil, .Ar r r sl: r , sr , r r r o, r
rr,r rrl i l ti or cu a, lt e t [ lbur il, r i cle t ip af lzic, cu alt . t i sit t t lr lr r t t t r r lr r r r lr . t it r lr i,
r'r,,lrr;r,lri ;i cl l,ulburiili de tip derncnlial.
f){,sigrlr, I,n d,iagnosticul,topograJic pi eNiol,oJlia
lc irirrii, ,ti lulhtltlttlt
tr,ru"lt4it:1: asr.tciate: a) Ilemianopsia lateral[ hotrrorrirrri,, rllu,r'r,lr,/rrl(.1,
Irl r,' r' rrl xr t' r r , r lialiilcopt ics in subst anla aibii par iet o- t or t r polillir ,I lr ) lt r r r , t '
ri li, rrtl)1orll(i parietalc, tcrnporale ,si/ sau occipil,alo l)l'r'z.ilrl,i],rrrr irrl,,r'(1r
rlr rr L,lrrl, irr sta,bililea exa,cti, a t,opografiei; (t Acrrlo ljn,, a,grroziir,rli'z t.rr,rr
l rrrr' .r rl rrri l l r 1; a- st ingtqi t ulbur ilr ile bilat er ale r lo sor t t ir , l, ogt t ozio
( r r gr r , zir r
,l r1.ri ;rl rr,trttut opoagr xr zie $. a. ) cocr ist t i at unoi oilt ( l lczilr r c: r , lt it r gr r lr lr liu
I rr l ri r rj i l l i tr t cf t post cr 'o- it f cr ior u'il a lobr . r luipar iolal; r l) Apl't xir r , ( xr r r $lr 'ur l
l \ r, rrl col n ot olic f i nneoli ideat or ie sc ilsocia, z: "r
in, lczir nr ilo piu'ii, lr lr , r ur l
,
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' 1,1,11,1
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trr' . l ,' ri l l ti a r ', ii colc sollzoli, r , lo( 1r ljn cxl, cnsia lozir r niLlr r or 'l, ir , osr r lr r r r tl. r
r ozir , r rrI rrrrrrrrr, .I r', .rr,zrr,
lt llxioc, dc cr ) ct r l r ii sor t i|, 1, ogl
' rrl , t; l ) | ' (rt '1, r r llt ir , r ih
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'
rrl r rl i l i rt' ctr{ir u1, c.
, \ r liir r gr r , l, o{, r r llr r t lij, r ilolir J'u, zir c,r ilu f lir r cir , zi ; i r r r ir i r nr r ll,
r r1'r.,r1:i l ,i l r rgot lr t '; t lo t Lr ct t ir r lr r lt Li qi r ir licli, llr t r blcr r lr , I 'I t p( |r '|, I I r iI r Ir|'l'ir / ili
, | | ,r.' rl ,zi i r, si r r r r , pr ilxilt ,( , \ l*. iour t , r ino si r nlilb, , I l) ( i'1I | | i t rI rt r' I rt t r, I r rrr, t ,
trr/l )_

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varoare
delocarizare
laniverur
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ti ' r i tl tt
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l t\ r tt'i 1 r :i i r t i r ! r tl tt':i l i t'tt l tr t ttt tt't'
r f , ' , r r , r . r t , , ' t , ,ti ,,,'r 't,l ti vi l l 'r r l p i i r i o r r r l tr i "ti 'c' i
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p ti tttl c o l i r l l 'so 'l ' r l ( j r l ' ]i l l l l i l '
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r .tt
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|

D0DrAcNosrrc
iN ApRAXrr
11. pBoBl,EME

1.11.DUFINITII

Pnntlu cxecutareaunor acte mai cornplexe,nu estesuliciun0

,'ri
cr
r,ri,r'il,r
olcrn:nLatosi {il nor'nale tloar c} for!:a$i cooidonare. ci sc iutqi inlir-o &numiti, forinS,si succegiuno.ExecLrfit
,r
,
oir
s:r,
r,
so desfir,loare
;rrrrr
,r,rr,,rrrLii,
a geslrurilor, ittr-o formi qi succesiunoadecval,itr
l, iniSc-"urilor,
iat aprania este o tulburare a gesiualiljfl,ilt
xrrrrllrlrri,crrrrstil,uieaLLpra.ritT,
r,rrr,oorrstir,
in irnposibilibl,taa,pcntru un subiect caro nu estenici paralizlr,trt
efoctuft corect gesturile. Cu 4,11,(t
nici coroic, nici doment, t1e:1,
rriri rr,l,rr,ctio,
\.|\ i\1,\',,nproixitt,csl,o incapl,cit:ttea de a orecuta mitrc5,riailecvate unrtl
uoo1r,rlr;i lrolnavul nu prezintl parozi, tulburii,ri de sensibilitate, ataxio,
rrri,r,rrli i rrvoIttnta,l'ouou tnlburilri psihice.
Srr sl,irroii roalizrlrcl unei acliuni voluntare in vederea indopliniril
rrrrrrist,rp lrlrr,vrt su rlestiiqonriiin mcd grailai;, la trei nivelo succcgivo
(f(r,,irrrflrr', l1)77; Zl,urvill, 1960) : Primul esre nitselulclnceptwul,\L atrL\
irrrliri,lrrl i1i pr:opunrii-li stttbilelto un aoumit scop al acliunii motorll
o schilii,,o schem;ianiicipatoare a actului. Al
r,,lrrrrlrrrc,i1i rrlrrlrolcn,zri
rlrrr1,.r l il,rrn i atl.ul,,[ornzul,iiriilrinaticea actului) a gestului, in caro indivit] ul
lr rlcrloerr,r'ou,,
din cadrul stosul[i innozical foimule]or kinotiotr
Irr',r,,',1,'r,zri
irrr. Lll,c, rr,rr,cokrT
lirnnLrlocntir sint colo ma,l aalccyaterealiz'irii ac{,iunii,
A1 i;rr;iloacsto ni,uelali,neruw!,i,ei
n otori,i,ccntrillu 6l
rr, rl,rirrlrri 1r,,r1rrt,r.
joc
(f
if|r'ir!r
|l
inllrLr'{Ji,
in
piramitl',llc,
extra,pir'&mi"
*
sistolnclor
rnotorii
lItl
si spitlrlo), ilalo conourii lll rolllizlurol ac!iunii vrtluntllt'o,
rlrlr, rrr'r'clrrllr,so
lr,cl,i
v it ir,filor: oolor l,t'rrl
doci, rIit irnllirr,llrlit,
l rrcsl,rrlilrt,I'r'rlrirl roztrlt;i't,
Irrr,'l,r l rrtrrt,iorrrt,I r rl) t "lr t iz r ll, lr ) t I ir ' i N|lJ , I , r lr s I r t r r r I r f , r r L l l i $ t r u , t l t t p t l t l g t . l l t r t i ! t t t
rlrslo crr,r'r, in lr iLt r f , , lln r z ir t , ; ] os l, ulli, J ' t ', r 1 l t 'r r z i l l , i , o t o t t t ; t r i t l r t l t l i u t l r t t t "

r,rirl

tr.lril rll

irtrprrt lrr t t lii.

r l ( r /l ) f:i '
( ctn o i tr i l l l i cl ' l n a n i p []a r ( xt' r l r r o l r i tr tl tr ) :
I l l i s c r i l i l r i ttr zi l i l e
(
r
N
l r p ttl t
stl
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n
g
{)
]
l
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cr
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r , , r r , , , l | r l r 1 1 i fi t'to a , l i n ccL {i i l r L ,r tl u l r r i

tt;ii, I t i rr; r|'I i t rI r'|' tt | ,

,1,.,, , ,,,,,,i r,ltillrit, tpr.indcrcr, til]ci ligir,ri, incuirr,l,nl
ocllclr lt iLr t pt r t r ir {' {lr r t l
1r,1,'rr,:r i cl clir t t t t lr Li, ar t t ncilr t t l ningii, punt lr cll
lt t i r r l'r "
r l ri ,t, r,:r rtri i cLl ohciar pllner cil unei hir t ii in plic ; i li; r it r r r t
lil't t t t I 'r 't r
,t. l ' r' i rri r r ( 'ot lsl. I t r oli\ il : descuul din nlcnt ot ic, l'olt ilt ' t t t t t r i
o1'(r'
ohibrituri
din
ir, rr r, , , { r)rrs{r'lrtll,irlnnoi tiguli
gr r slt t : t lilt t l" r 't t
l l ,l r\ (l r' of ic] ) it d0 lr npolLaut ca t oat e acest c pr olxr t lo
ir r slllr r it r r r r or l
I
ir
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t
m
nzit
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*t t it iv int r anzit ive $i
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t
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qi
pcr
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r
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cit
pent t u nr in: l dr cn'pt d,
l r, l ,l rl ri r i r,;r r r ; r r t ,
ilt
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t
t
o
bolr
r
llvt
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, rrr l rl ' i r ir lt por '1. t lntsi, ne : I sjgul; m cL
rl ,
lt t r r t t it r lt illt t t it l
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r
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il',
rrrr, ' l ,Lr\i (' i r in- t ir t a, r claqit inlpi; i af : lzici
t t r r t lolii r t i'it r r t t l'
t
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t
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lot
pt t lzeli{, t li
1,,' ,t,1,,1,l rc t r lt lt : t ,nu gr '( lgi,a, sr llt ll,
t
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i'oilll
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1,r,,1rr :rl l ot lr , lir o! 'iuuin( rut 'o- Dsihi( l( l'1i
1,' ,,,1,,;,r' r ;i I ollogt r , f ico.

l l , l ' lA l ' l l l x l l ' l l

l l " ; t .t , I ) l l M l t l , l ,(]t , l N I ( r l ,A
tttl tt tttl tt
r l l l ( fl ( r g ( r l 't'tt,.l o t ttt,tl o r r tl "i n i u t u 'l tt d 'l l 'tt' t i i l o r I'tr tl i i ttt
l ', f l l l l l
tl o l i l r r i tttl l r r ', l 1 }7 7 ) t cr t'ttt tr ttttttttt
- , l , , t t 'r , l , , s i t ' i r , t l tr i l ,i .r p n tu r u ( l !|0 1 i , {'i 1 l l l
r .r '' r IIr '|'i t'
, , r l 'r l r r l r r , , r l r ,r tl l r :,r il.) ttPi t l ,i r ';tttr l t r r tt,0 l i cl r I'r i r yttl t't0r 'o l tr .ll.t: t t i i tr tl l tr Ir t
(
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i r l t,l r l o r r 'l r r "r tl l r | sr t
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l , l t , r r 1.i r .r t|IIr IIItr Ii i i 1 tIt,Io t, tl r r o ,,n r r l r i fi ,
'r , ,
i tItr tIttto Iu t''
l 'r 'l l ttttttti t'tt,,r r r ttl tttl tti
t r r 1 , , l , i r l l r r r,r i r 'l r r l sl i r r g ( r r ,ti l r '1 0 ) i ti
'u '
I'r 'l r l l l l l
I
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r r I o lr ttl l to ttl l t,l l l r r l i l ( r r l i r r ' {i ) , i l l t' rri 'll l l l rr l r' I I I | !t | | | )1| )| ' i t l l l
||1
|
l l l ,l l l l i r i l l tr l r f t rrl rt ' r' z ' ' t t l i i t' i l r r l r r r tl o t i i t rI r' t t I I ' t rI i |' | , 1 ,{'||II|:It||I
l r i ', , r r r r r l o t
:'l tl l

i,lt I

| .i ttrr LiI I t r ' I . . . r ' : t t rr:t,tl

l rl l i tt rl i ti .i r1 ,trrlrr,ri
1 o c i rrl r.orrl
ii
ri l c(,i rLrr,rrrrtgrrtrtrr1tl
1q(xfS l htal
Il o (lll( x \ r ii r r r ilc i i ,ti l o r.. A (.t\ri 1 (\),rl g ti r,l r)o Ii i | || |i ,i {r(\1) $o l ,nl ,nsunt, s(,l l t,tl i !l
rrrrrl" ' r ' ii, . r ' ' I : r r r r Iir1
.r...:r' r' r' ;.rJ i i (r (l { r.l ,l l rt(' l .1rrrsi i(|
, r,i rr..r1l rrl rl r,l ,rs;,l ;rt
l l l t fi
| '.l l ||r I rI i :r' | {| i Lr'(:: ! rrL rs l ' l i Ii i . |.l)o
l l ,o r)o l lIrz
, i rtni l t 0ttri srb| (} i rna,j 0r' tr (sl i i rl .gt;
\1or rt(jru)rir,rr,plrt,rio bi lli,l,olrtlir,, llr. i,ulrl lczjrrrrjlu corlrrlrLi ctlos srr,u rr,lri
.rrri rl.r'.i ririrrr.o (rlropto) relLizurr,zir,
rp.*lie_ urriJll,cr.al.i stirrgri. ijupt ,,;i,r;
11,y1,,11
1l1rrr,1lrliio0rr o lozirrn(] a, rrnuii.r,slln :t alhtia alin acclti cdntli, ;si$irt'l

la llifcritc l,ipuri dc apraxic: ideatorie (lozirr

nea centrului ideator parietal), apraxiLl rrrrr
lori,'sau melokiueti,d, llcziu'nca conI.r,rr
I I
ld{'L,nlolol
) $i irl,.omulorie (lcziunoc ciilirt'
.tro uu{.scr.ei dei c,.nlri) [fig.36i. uxi*trr,
'
binointplr':. .i u,Ltn forme - clc apr.rr,ri,,,
seiniologiit crirora o \rom exp lre in (xll
l,lnuale,

)'r

I. Apraxia idcatorie. ln aceasti lrrrrrfl

este perturbat insuqi planul general, lrpl'rr.
zertilrea
generalir, a, executiei actului, r,tl
/ i, r. . r / i . S c h r i n a d t sici
a lu i
f"i(,pma[n:
incapacitatea de a utiliza, corect obiorlr,lrr
i! , 1 i , | ! r i ) r r i e h l t s i hg A; B:Ce n .l
uzuale. Clasicii inl,erpreta,u acest feno||r{,tl
rL, .,'
) !lil slingi;
C-- Ccltrji
moldi
rlir dreatta,
cil,o ,,uil,are" a formulei kinelice, ca o ,,uitllrrllr
a identificirii simbolice utilil,are a obirrr,.
irrlrri. ,\r. fi vor'l:a de o n,gnozie_cle utilizare a obiecteior. Apltxln
rilr':rl,rli'rr.ni,ci,llroa,p,jtol"dorr,irna
bilateralzi ;i se caracterizeazH,
prii rr,ll,rr
r'1,r,.1plorrr.hrr cato implicd, utilizaTa de obiecte (migcX,riletr-anzitivrr),
It,,l r.trrl l, .l,L;,.uIecul
I acte rirnplo,dlr nu poato ln6nplini x,ctccomll(,\r,.
,\si,li,l, :litt,clcparrialc, elementare (hrnte iiotat) pot fi execuraro col,or,tl
rl:ll .,sr.oy1.11f;1
Ior lo]]ici'r,,
a,rmonioac;)'estc tullruraLi (Zaurwill. I tttloi
Iil, irrrlL,r',ll,7/). Urrlll.i lrtrlnavulscoprc<tulr primuI acbeleinenlarctlri
i:r,":l):Lll,. rlirr c'r'p,rzifiir,{(.ltul i o'ilou}t. Altei'i. el nu r.ospect:i,0r,rlitrr,rl
rrtt'rrrrt.r,:r,gi.sl,rrutor.I)ezordinoa,este cu atit mai exprinatt cu cit {[(1l,lll
(;1rr:rl,rrl)
s'licitlr,i,ostc mai complex. pacientul nrr cste-capabiLnici sL irrrll,it
r, rriricrrl!, l)o (rirrLro dclatureazi- prin bulversa,reasecienlior gesLrrlrri,
I,'r'rr :r,r',..-ir'
1r:r.l iculr,r.itir,!i,apl.,,&ia idcatoare (ideatorie) de difei.cnI,irr,r
ri
,1i , ,, r i,l(.,,rir.r.Llrir,,
in clrt. qi gcstuite simplo sint tulbural,e, datirlil,lt
r r,'i Jrir,nsnrisii(lefcctuoilse a Comenzilor li centrii motori.
I ) . ) t i , s r r L i ) [ t ) i t llpr.lricul idoator pottc sL irnite mi$cili
nu Droa (x, li
j,l'o norur nu po,r,r.,r'ca,lizl
, i t t v t ' r ) l n i r , ';r,l)r.i,\;r.ltl
I l, ,
rrcerqlri pr.r.lirt
Irr :r,1rlrr,r
ii! idol,l,oricbolnavul lccirno&$le)irr gcnet.&l,obiectolc D0 (,lr1r

rttrr ilri,
Io titin
i, I()
ririnrriascii,
r r il, s oi, . da,
r nc nr . i ractiilnile
nf , ir ' "i ] "
o
i . t ^ creoaz5iirnprisia,
'- ^ . i " ; , ,
,rr1
.n
darr runeoli
si,le
""^,,.";
, \r. , ; r r t |l i. r : t 11 ,(i ,rtl ' g ra lrl e _ :rg l ]Oti C .D n
pl [, l A
ll,

l rrOU fti pri rrrl r.t.l t

' ,\ct
'rr", { i, 1. ' r ' i. l: r r . ' ,rt.j t r.rr r.h i rrl i trrr.i fri ri s ii , sr.,r rr ,,l ri bi i tul , sau rl rr.r,iI ,
irrr.,rlr.,
sl,i. ,. sir,fac.i cu ol I sau fi'clr,cir,grosit chibrilnll, clc pari,ctr,l.il,rlt
':
r, u
1,l"ri'll,rr,
a u , rrtri'' r irrllrr,rrlr,ltilir,
r r r i r J r r r ,0 r r lr i! ir
l,r Uu
cLrticiI
tr lOl; St.ll
sr.rrrinc,.,r,r.ri,
l]O^ l!l' Cu
rrinrlii,

{,ii,
r,lr n([i r] 1,rgi
sir,
S
l tr:trl
tiu cl
clrilrlii,rrl
tj l )t,i l ,ul
_tI,aO11
l,igira
rrrrrr,1rIirr|,
srt,l.,irr finlll, lnl stin{r. <.hiIrIi|,rrI.
llri lr,tt,l,csi,"rocot
na,tulrt,l rln

l rl l i rr r lllr ' ( - l: ) ji) rrs l l rrl rn i i l o l rrl : s o l s l tr,z i i,i rr f,i r,!l l rol rrl ,vrrl rriurr t,i or,rr,l rr

(lr),{l.ilt1,i,
0 l,),rll,r
rrrt1ilr,r,l:rtil,
o gtrrrrii,,
rrrrlllci,l,crr o clulirr;o lrrlrril:lr.rr
1i ri
lul,, rlrrolrilrr.il,rrri..
Alloi.srrsolicil,iilrolrrir,vrrl
sii, irt irr nrirrr'i,
lrtr r.irrrltlrisl,rr

orrri, r r

rjt lI,

r l|ltflt t l, 0 lir g|Sl, t t r i Sli,r lr r Dr or r s l , r '| z l \ ( 1 r t t r r L r t r i i l i z r l t , z i i , , j {r t , l l |

, , , 1 , r , r l l r , rr ,l r l ttl r r u l r r r :r l r tr ,;r ti ttr l ,r Ittttr i tr l ttI l |) l ) tl l r i r t r t'ttl tr :t,l t ttl i l r , r l l

, l r r l , r , l r r r r l ) , ,1 r . l r r tr r i tr i ttr r t;t r ,o ttttl r r t'r 'l r t tr tr ti t ttl i o l tn r r fi i t tI t,t I rrt rr : t I rr r tr l r r .
, r t r , t , r . r t l r . r 'r i i l i ( ,r l l r l r ,l l l r r ,r ,Ir r r l r ,i l r l l r r r tr l o l r r ,( i r r tr i , r l r : l ti l r l i i , i tr l ttr r l r r l l r r ':r ,
, 1 , , I ' r | , r r ': r , l r r ,u i ttl r 'r 'r 'r ttl i t, q l r r 1 1;i r r , , 1r i t r1r I l t t I I |,) I r r tt tttt l tt i l t'l tg , l l l t,tt r l r r ;t,
, ', r r , , r r r l r r i r ,r 'r r g sr r ,r rctr o !ttttti i , si i sttg i t r l i tt ttti ttl ttr l
tttto i r ':r tti , t:r tr ti :r ,
r r r , r , r , , , 1 , r r r r l I:r ti tttttti |r r tr l r '. l l t g ctr r r l tl , l i o l ttl tr tr l r l i i i tttPtl si r r tl r r o tr t r l i l i tIcr IIttr tIo t, r 'r r r tttl l t
\ | 'r r r " . r r r r l i r l fr r ,l o r ', sl r tr r r l r r r t;r l l ti ttr tl o r tp ti !r i t,ttl
tr,l
l , r L 'r r . I 1 , , ir r r r l r r l ) r i l i u r i i l l l r i , r l l l i l , l l l o tr l i tt. l ,'i i tr l vo t'l l l l tl r ,o k zi tr tr r , l l r ,
1 1 , ' l r l r l r t r i r r r l r l i r ,n l r tg l i tr r ,l c r i i ttg i l r t,ti r t 'l ( ) ) , tr t'r ';i i l to l tr r r ,vi si ttl l ,i :t,l i tzr r .
'
\ ; r r ; r r i r r i r Io r tr r r o Io r i r , :r , l tti L i r l r ttl l r r t
l r o l t,l c Ii ttl i l l ti t'r 'r r l i r l r r r r r l r r l ;r
r , r , ' i r | l r r : r l r ,l i ) , I rr I I r t r t l r r t ' rt, i t;r ti tr i t'i r , l ) l j \ i l r l l l l l i i i l tr l l r l tr t r Ittt Ir Ii |i r Ir '. r tl
. I l , ' , 1 , . r 'r ; rr si r r r l r l r ', r l l l t tr r r ttr i r ,i 1 l c tr r l c r tr ct'L tl l t,1 o l l u tr ttl i tt, tr tt ti i ;r r ' ,,,l r r
. ; r o r r i l n i .r r r ,ri rn tl o ttr i l l ,. Al ( l i '1 , b o l l l l r L tl
l to l r i t, ( l i :r i \( r n Il r , r r ,r i l
' ",l.il'
1,, 1,,,
I r r r : rr ,Ir l r cl i r r r I o l :t,r ,ci t,r tlo r tl l r l ,l l l u tttt tt'tr st'sl r l l t tttr l i tt. l r r r r r ',r r 'l r r
t,,r,
rl,r:r
n r s|r ,'i :r l tr r i ;ci i l i !r
i r tl t'l u tz,i l i r r '. .l ) l tt'i t'r 'tcttt l r r l tr r ,r r r l tl
, r1.
:r l r r l r r l r r r i l i l :r r ', s:'l ,tLsi , l l ) l l ( {r
l l tr l ) N .l l i r ,l, t:l tr tr r l l l ,r l r 'i r l l ( r J
r , , r , , , . , , r r : 'i l i n r l r r ;1 i r r r i r r :t, i r r i l {i l , i Jl ,l r , tl c l r i l r l i l , tl i t<'i i ' so l i t'i l i i r r r l to l tr r r r tr l
I i , ( U r i r i l i i r r r l l i l tr i tstr l , o l t[t tr 'tt;r 'sl 0 si t't( ( |l i o ]l t r r ttl i tr :r ,, r I
i
,
l
r r r l l r l r r i r l r , l \'l tl i ztl n l i i ( l l i o t i tttl r ccr l l ti l , f( ) t( '( 'i \l i f.;to ttl r t,tr , r r tr r l
r,
r r ;r l
r , ', r . r ' r '.
Sp r c r l co scL i j r t d c i ,tl t r l xi e u l i tl t'r t,1 t- tt',t'i l tr r s( \l l r l l r r r
r , , r r l i , r r r r r r , r r r r r l i sl 1 .1 u t,l t,Pti txi IttI i tl o o ttt0 '1 ttt'sti l i s|l r Itl ti l l i i tr l t,i tl cr l r r ) r r r r r t
r i l : r,r i r u u r r ( 'o l r j ( i si '1 r 'cl ;u i c n i ttl l i r i tl ctr ( i o l r t'tti l tt l r , r l i i l t, r r tr ;l
w, ,i
l ,
l r r ':r \i o ( l o l L 1 ,r ) ,\i l f;l r ( l o l o l e ( '.
, 1 1,1 1 1 1 1r1l o1 l cstc se ttti o l u g i tu r p o tl tr l l l l r ,i c i ttl tl tttr r i r t, i r Ir 'r r tr L r r i .r r r .
M ? ? ) : l r ,ct,sl i b o l n l tr i n tt tl l i l ,i l ) o l L '\r 'l r l r t i t r rl t t rt rrr ' rr l r.
', 1 , , 1 , , l , r , r ! l l r . r',
,
r l , r r r r so 1 xtl , s( tIi d o N ti l o l r l x|]) i l l I i ) , s( 'l i l r ( l tL i l l |l '\ ti tttl tt I tt r r l | .r
rrrrr
|,
| , I L r l r ol ttl r l i zi t {l ,c1 l ( l o l l ttl cL c ,,1 r i t'i o t l r t'l 1 c p i l i o r '", tr tt 1 ,,r 1 l ,'r r
r , r r r t ' ' , r r l l i ( .i o r l , tr r t Io i i tL ci l fa , co to ct, tttt l .) l [l i o l r |l I l ) o l ( l ' , r .r ' r l
i tIr 'ttttr o Io t i c i r \ r 'i r || .'
r,rr, |
l 'r r l r i r ,i t) tr r l l i i u u Ii g co r n e l ,r i c{i g .i t,. r \l r l l xi i l ,
'r r
r,i,,
. ' t ( l ul r i , Kr 'o i r xl l r r r ', 1 9 7 7 ) i l r tl tr o so l ti 1 ) l 'i 1 1( 'o l r Il l zi r t, i ttl tr , tttt,r ,r tr l ,'
', , r 'r 1 , , , r r rr r l r r l l l r r r tr tci i r ,c{i n i , l l r i n r ,( l ( i l i l ,i ( fr o i ttr l t,t'r 'sl r i t tn i i r 'l r .t i i ,;r r , r r l tl
t.,it,,lr
| | r rrri r t t I : r,r' rt l tcN ,tl ccl 'l l ) sl ]i l p l i tt , ) sl l l ) l '{r si tl t r{'i tl ' r r tr r l ( ( ,tl ||,r ,r |, r IIr r
\ll,

,r l r '

'.

l r ttttt.

, t , ( l l . ( ll l r r l l vl r , i t'ci vl u 'i cl i i ],i tl o 1 tt,tstr t:tt'ti t'i ,r 'l r tc tl r r t,l l l i 'l l r o l Ii r tr l r l

r r r r : r , l rl r r ,xi l r i r kl l l ,o r i o : tt) 1 tt:r se t:cr u ,rta , /r ) r i i ( '/i ( g ( ,sl ' ,,1 i g n ") ; l r ) 1 r ,r r r .
i,rl'
, , , ', , t , l , t n i r :i l .( t'0 i l ,r i r i u ( ,i i ru,l r l i l l ,o {tl r i i l i {i g r r sl ,) ; c) I) ( tsttl l ti tttt'(
i u l tn !i i r ttl .l
'
r , r r i r . l , r l , r i r r kr xi r r r ,{,i t l ) r i n i r ,( i l i ) , cl ,l {i ( 'o l sl i l , i tr l u ,}ttr I ti r IIo Ittr t,t'ttI, r tl tt,.r tr tl
, , ! 1 , I r r , r l 0 r 'si
i n vi l l r ,l , Ii i r r r l Si l cx{|ctr l ,( ) tr l l , i l r ,l r r 1 l l t,r 'yr r 'l i j r r r fr ,,r r r r |i r r l

i tto t'r i tl tl ti t
r r l r r i l i l l i st.
l tr ,
| \ u r : r 'ri r r ttttl ttl ti l ttl i r ,;i
si r r i tl r tr xi l
, 1 , , , r r r r r r l r r l ll l l l i i ,:r ,cl i l s1 ,i i , l t,p l i r r i r sr 1 to :t,1 ol i ttti l r t. ti ti i u l :l ttl t I t ' ; trt t I rt t t t , tr I
1 , , , 'r r l r r
ti l ttt tl t, r i tttl i r tr l l r ,
l l r ,r '\r 'n r l ) l r t,n tr l r i o cl u l tr tr
r :t l r ttl ci t si - ;i l l l l l l zl
, l , r , 1 , , n r l ll r ,i i ,
sr r <r ,o ti i r r r r cr r ,r 'o tr Itr r r r ( ,i i |o t r ';1 o ti r tt o l g r r tti r tl i t, i i ttt, r l ,'
lrr,
p r r tr r i r l i i , ttr i Sr 'i i ti r l r i l tr i l r tttr :l l r tr i r tl ttl r r
l , r l , l I , r r 1 r o r r ,l ,ol l i cr r r r l i r r
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rrr,rl r.,.,rlrll,.iLr.riu _, . lr i, . s r "r , - ; i ur nllt . Lr r . , r , . ii i ,
s i r ,i . r , c i t
tt. ,rir,sl,i(,irtir!
, l] ', , , , , ' , , r r , . r r 'i rrrl r.,rrr
;ciiri
rtrrrri;ii /su ,u ,,,r
i rur clcu;",r't itil;;;;i'
_l' i,' Li,il,.
,,.
., ... rrrl'
r grrst[| 1,u lil,ului,,a.[
r r i,
r ; r r r u r l l , lal
str;-r,nu1,ului,
l 'l respir.ll!;ioi
r . t \ l ) I . i l , l l r . t prol|.r
p r u l t ru
| | lrr
lr,
;1
]'.,,,.1
1,...1,1.,,
',.1;,
,i

,, , , . r1 ,ri r.irr b ,u L rri.tud iu n;Ls.I' r r cor ri iu

1r ,,:r r ,r

'I i
,,lrl)ls. ll,.lll. ;slilu
,l.
,:tn
I1:L:;uI.r
i .\ (i,! ',r1l,,:]ril{
i ,i. iul
ril:rtulrriintr,o lurnintrc. ,t,

Uuiuairii,,r
[:].uL'rrr,'rliL,
1"'l r.r::lLi1,i
drl,lizbutrse si"r,
inghitii,lnrnoJrenex. ".,..f,i
l]ac:i, bol'*vil
, r rr1 ,:l
lI

r]::-t|llrl:, lt oL , . \ r jpUl u ir - , , . iLC O r , aliU . .

pot fi cxe'utulr' la -u rt linp, o 1I i irrrlc p liu it rr

) - :':'
rrr
. . , )r\:
.1;'l
l||,||
,:\'i']i
.i: t rn i:9lt'nu
mod itutolrru,l
. I)c IO: ,te rnUlLeori apr*sir bUCuf*r,i;Lll
,',rr . . rri,r,.rr,,r,',,,\l*irnl,[urnJ,tiC,I,SOCi
in:],1
a[rrzi:lmO1'o.eSi a lrri lrr(){.ir,.
r'rrr, r{"/.ra'rrr r','r:'rrr"lrinr',fior,riia e'ir.i pr+ceutrare(Dcrlv-si Lber,rrir.r.,,.
r:'r'.,; \r:1..1,)'iutltn{r
:l LUe.nt1,lc,1960: K'oind.lcr.,tgll; Ar.seni;i IJ.l,rz,
ltt0{)). P..tru rr,sr: prod*cc accaiti, apraxie, trebJie
si, exiite rlrrrrl,
,ll)l)!,,
r'lrrli
rul,! rr r,cgnrnenilterio]tii a, ariei preccntrale gi a iloua lezirrtrrr
|Ir)rrrt,lr lr) iurrlu.r)tcmrst,lrj sau in ernisfetaopusi, (Arscni,
1959. lg7g).
l;, ,\l)raKi' l.ru'chiul'i se.caracterizeazir,
prin dificulti,lile bolnavulrri
,
,.,.llc:t, rn pr1. do a q" r,irlicactin piur,tlc,, aj-loio*."n
'l{..r
si de a urirl
rl)) r,r,'\iu r:r,p'rr.
lic J5o(.iiul,i
unnori ii c,t iemnc dc lpraric a' rncmbr,lt,,r,.
lrlsl,,1rrsir,toarte g_rerde rlitelenliat dc nra\ia t""ncnii f"i
ryi Ae asincigi".
.\ p.rltr irL krziuni dc rlivcrse ulturi (_intlcosebitunori)
lr,iebrrpof"i-rii* j
lr u I l,,llt;ilk),prccum gi il bo.r,l:tlui pick (la nge 1930,
cita,t A"' X"oiriai,,ii
,
I l); ;
i.

(d{,n.risa
dc cersrrnannqi Schitdcr,t926, cit.,r,l.r
.. ,.: ltlJ|:tllrrr{|llui
/ )"s,e.
c,r
ctcrizcazir,
prin piuderr.* ini[,iariici ;i I ilrtl
q
l]1,l),ij,,,ll1l.r:
l11/
|l. t|l.r.ittt
t. A$1lel. in timpul

tncrsului pirioarele se inciur.iSolzl,

'r||rir.r
,r,,||,.,\
lll,.Tgc|| l,Jil rnici. pr. virfurilo piciOarelor,bat,
nasul Oe toc tlri
r'||)!,;r,,/r,.].
*t,rr rl,,.prrnrl grcrr picioarelctlc pe sol, iar lrunchiul iimin,r.irr
rr'rr,:..,
.\i t,r\:r.il1ru
il,l)rir\iu mursul.,i u,pat,e
ln Ieziuni liniloosebitumorllrr)
'u car,' irnp-lic;
111,rrkI,prtlon1;rt,
arrlerioari.a corprrlrri
$i.pllrtca
',,',]1,,,1
:111
,.rrr, .,ii. ,'(:r1...r'rrllin
ttenlie
discrnii,mintin iclentific,areaacestei fbr'rrr
-$i
r'.||" ,r" :rIr'ir\ , lr{:n1
rLt.l'urr li cou[undald,cu lipsade iniliativl
1i dn,torrrr,r
p,.trlrrl, .rr rr,1;lr,xiN
trunchiului a lui'Brun.qsau-cufenornind d";,;;g,ni;i;-

al.mcmbrelor
interioar"
fali Aeiol, cliiru,.
l;].,1
r,.r ,r,'.
r,,:l,.lll.rl.'tj'ir.,ra,or:r,iion)
rr ,,r's tr: rrfe p.rctroOtalc
popovir.iu
(Kleinrl_lfl,,
1977;
tr)ri; \t,,y{.r.pi ttrrrrunl 1900, citaii a" XrcinUier,'
fOi?;".

qi'Aggirlrr,

ll. \pr.rrxia rlr imbrieare (descrisi, de Ildeaen) se caracterizeazil

pr.irr
rrrrprrrrlrilil,rr,lrt,
lxrl nar.uluidc,a.seimbr5oa,.de-a se A"rn"i.o, Oe a qiirgii
I r.r,\.rl:rsi ;i|rr1.rrril,.rle
la panloli, dc a maDipula,ilr mod adecvat div|r,lolrr
,',
(il,Lr1,
spontan, cit qi la coma,nrli).Se asocirr,zr-L
r:t1
llli,,
r'r,,,r"'t ''r'iL('.'r.'rlrr
LJ'||1IIIi||rI
itrcapta.sl,ingJ,J
cu tulburir.i vizrtorurrslruclivo ti/
,l',.
.,r,,rlu rll)ut.:u.r:r.t,:s,.tl0mcicorporalo alto trtlburiiri grruzir,c
5i
(lc-li,j:rrirrl
lrrrrrris'rr(irlrri
sri.g.t,c.), evont-ualqi un rrurnirlniipir,"rr,rrxr'irnistirrgitr
lrlrrr. loziruri prrr.i ctllo,lospcotir ptrioto_ocoipil;tlorllopto (llCclon
4i
,\ jrtlirr,urrrrlr':r,
ll)51),
l). ,1;rrrrxi:r
,.sirnpll,ol.ir:ii
" (,,sirrrp:r,l,icil,r)
-lclluol lo(r,rc(j1,,
rr.rr,)rnl,rr
Itt tlllilrtic rrtrsitrllorrrtrtlt,icorrrIlcl, r,tr,l,rt,srroiit,zli
o tr,Illr,lirr
lr,rrIorrrI rfrrlrrt.
;t0{)

l r r 'r ,
I I r, t r I i | | i t r' (r,,ri , r l tr r r l Il l r i ,,l ;tl :r /l r r r l r ' l i p l i t o |l t. i \tr ':tl l 'i i ' Io ttl tr i ' l r l r tl r
,.rlir
r l ', r tl r tl r r i | r ';l o to r tl i zl tl l t r l r r l o zi tttti l l l r r t'tl tl ttl l tti t'l l l r tr ( i l tr l |r r l r 'l r t
, ', , , , l r t z t i l c l t,t'l 'o to i tr r r ttr l tttl l r r I I I t I t rt i t t I t,t rI ;i i tt Ittttto t i l 'r It'ttttl 'r r tr l tIr l r l r ')
i i ' . ' l r u r r ( l r i l ( l [l ) l r tr t, I1 ) l i :]) .
l l l - l l r rtr i :l
:tttttl zi t:i ( a tl ttttzi a vo e tl i i sl ttt:tvo l a l i a l tti l l r r ttse h r r r r ) r ';tl 'r
llrrittl';rrlttr
r,,
.i
'
ti. il,lltlt,xirl t.trlooltirLtri.;ic,i, lollllizltl,i
1xr ttttt;.ltii
'rr:r
'ii,

l{fruLOGIC
11.4.I)IA(iNOSTI0
lrr lrlruclir,ii,,:tplilxiile api:l,tde celc mil,i llullto tlti itr lt:'iurtr t'.tt(ttlttt'
, ,t ,, Lrl i i scit t , t uict t i r llm olisnelr t u, het nor r r , gii, Lct r ulor t r t Lr ') \ i it t . l. t r nt "tt l'
,,i ,r,r/r.srr r r r aiir t lilr t escinal't o. liit e( Uebr alclt r t sct t ilL ( lt t nl4lt r i ll hr int t t
, t't,1,), it\ I {d,Itrnat'i's
ne ar&nio-urebw,Ia l'1.,.

{ l rtl l
i l r' rt' l rl i t' l | | I I t | i III t i I ' Ii | | | | | | I I t I I I i I i l r'
, r r. r, t rr' i r ,: i rr ) l l l l ,fl l l l r' l l rrl l
'
' ttr ' rl ' r"r' l
(l
i
l
(i
l
l
l
ti
l
'
pt ttt l rrrr' trr' l i :rrrIroI:r' Ii i
,l ,t l ,ttttrr' l l i
L' , ,',
i fi "
','
{ ' trv rtl ttl ' ' i rr rtrl rri l rl trl ri ' ' rl rr' l "rl i i
trrttttrt,
l t' r:r' 1 I r!\ or!
l rr I t,.: rt, i tLi l ,i l r,l ri ,
,

It

1li

t 'r r
it Lr lr t so .l ) trl ti i't li tt t l : t 't : t r rLl
,' ,.l ,,i ,''ili, ,i', iili, r r 'bii, r 'il, , r 't lrir
: t 'lot t t r t l'r icil'r r i't rt o1'r r 'l'iir
il)
r ir 'qlilvr r 'r r l'r i' r 'r r
, ,,r,,,i , , it i,rt 'r o: t Lrrlir slr r I io r '" 'r isivii' pllr l; ill r t li
r lr r ( r lr rr l r r l
" ' " ' ,' ,,,,,,r., , t '
r r 'ocsLoit lolit Lif ii sil Lr f , ulut Lt lilr plt 'L*t r t 'llii- r 'ot r lr r i

' ' ,,

' ; ' i; , li- ; ; , , i ' ; ' ; ; n l " ) i * - , l i i i ' ' r t " t : t n " n u l ' 1 ' ' , p ' r r n r r v i g i l i ' ' ' t s l ' o t r t t l r r t t r r r

r,

:
I

It
12.I.1, Prceiziri de {tr.meqi Qi alc Droblerxati*i. in:r,r.t,rrl
.rr,lril,rrlvorir abtirtla succilt problcrnctc de diienosfic doan itt std,ri.tet:attrr
lr.,a*r qi.in.alte su,spnd.d.I'i
de con$tienli, de scurtj, tlurati, ca dt, }illii
irr rrlurrifcstilrile silcepale.
I) irrruno51iu15salr cunriienti Se1nlolegcposibilifatca clea fi i.rl-r.rr.rt ,
rtrl :r,:r,v(.iri
siru a ltu crrrro;lirrliide cer&, de a sii in ruor] iust de obi(.,.i,,1,.
'-i lr.rr,r|lrr.nole
inconjurltoal.e 1dc rcalitatea inconjuldtbarcl. J pir.rrl,.
.rrr,rsl,ir4,ir,inseamnii it,nu Dti de sine (Dicfionarul lirnbii romf ne tnc,il"r,,,,,
r1,l'7).
il'rrlburdlile care survin in sfera cunoqtintei constau nu in rnoriijir,rlrr
rl,r rliloril,c gr':r,rL.,
cum.se.s1une, liinrl vorba-numai dcspre pr,czen{rrrrir,l

:r,I| {| | lllL {1r n ilrU L, ons llt ut e c Um a.

Oorna csto un sindrom care, prin definilie, Se traduce prin abolirrr[

lrrlrr,Li,
rr,conrytion{ci* element constant;i dorninani * asociatii,frecl,t,rrt,
r:' :r,lhr'ii,r.ialc luncliilor
tulburi,ri biochimice ryi, evcntuill .rr
^ve,getativo,
irrrrrrrrrr
r.urr)lr)gico de diferite
grade, dup6 intinrlerea laterali, a bziurril
rrr Llrrrrr:IrirtIurrebral.
du fiziopatolugic,ncuropaiuJogie
qi clinicXau dus la cot,.lr,,irl
,l)rrlulu
i:, :.r),'rrro
u slant de cunolllnlti, csle expresiaunei L.ziuni sau lcrtu|lri||,1
rr.rr l lrr ri,rn'a f-orma,liulii roJiculare ascondcnte de pe linia median-d,din tr.rlrr"
,lrrrrl lcr.rrbral.Porturbi,rile legetati-ve, care insolesc fi.ecr.cnt $tal,orl(ll
''r,rrir, f{) {lirl,oroBcimplic5rii stlucl,urilor vegetative din trunchiul ccnrlrrrrl
:r,lr,r.irrlc.rIraccoali leziunc, prin intindcro:l ei laterali,, caro dtlpitfr,ltl.(,
:r'r'iil. :r'rirrlr ryi_pcriariialo
*le formaf,iurii roticularc. Nuriai o.xporirr,irri:r,r
, r',rrri p,rut,o[i dctcrmilati, printr-o l.ziurLopurii fu SIiAA rtin 1,r,rrrrr.lri,
Irr r lirrifir,lrzirrui puro .il trunclri sc irrtilncsc r;ir,r';ccl rna,i iL,4os11,
1rz,irrr1'rr,
r, l. rliluzii, crrflinzind,,si<ltrriclrrrl.
l)oci irr corri, o.xisliidc Irrlrt o Lrzirrrrr,
,, lr rrrr.lrillsooia,l cu
;5 lrzirrri ir lrx rl <rr.irrrrrlrri,
slrLl,lr,rrl,ori
r.:li. lnr {l.ir(.r'ri
r,trrl. itr lozittttisttlD'itl,r!rlorilrLl,
ftt itrl,r.ti|i 1,lrl,o:l
Ilrrtrr,IrirrIrri
.rrr'r'IrllrI.lrr
;r'rirrr'rrfrIr, zrt|i Ir|rrl)ir'lril
rii rr';r,rri rrllrrrr]i,i,i
rl0 rrorrrr'l,iirr(r'i,
(olrrrtrlril;
r,r,,
r'otrlttzir',rrorrrrrlrl'trt,i'i,)
rrrlr,rrr;lrl:r,
5i rrtrIr:r'ii;ilrilii{,r)rrii; IirI rr, rIi I r,:| ,,,.,,,,.ur,,,
Ir;.i rrr r ilr :lllut lc r r ioli ;l l r
:t(| 1

l r,rrrI rrI r,r.rrri rrI ri , r.r,l Lrr, l rrl l i rrri r.r.il t!l t t i r)l l Ll r. ((l l

( 1 0 co ]u i i

p r o p l i u - zi 'l - L '

;i

tL 'r l r L "'tr o tr ti i '

I r .;1 tl r r ."

rrrir'rlrrrrrrl
tr-';cI :r'i;i1'r'rtrtt'Lri
u,,-.clt'in't
,ii,,i:irL,,
.rtr'ri."lll]]1.*"'"
, i ,;i;i--;,1

DEDI{G],I0STJC
ilVtuliluRnnrr.t:
1 6) I'RO|JLEIVIE
LLt. DE coN$TTENTA
(ctrNo$Til\TA)

1I. I. PRINCIPIILE M]ITODOIOGICESEIIIOLOGICI,

1)B DIAL.INOSTIC
IITIOTOGICSI TOPOGRAI,'IC

, r l | , ) l o {i( 1 , In ) l ,i n to l t

|;

,;]:

l;,J"l:li'J;:l''",'
i llll"
,i,ii'illllll,u'l"i';";ll.1,,Xin"."s'',iil
,,i:1.';llll
';i:"T;;
tr"
r"rr.rrrrrl'
i1i,,r',:t..'1"
i
rr'sut
l)e
rrri ,,ri't,i,.
,,

;Ji ,;.';";
rr.ttLttrr' ' r
;,,
.i,,1 rie t'uilur:r,riv";ciativc, niti rlr ln'rrlili.i'ti rlrr .rtrr l,\r',1
',:,",t",r";,rrrl,
iicurologlc tlir,i r'r.
. ,l ',,i,iii
'rzirrrr.
"" "i'*iriJ"or,,
r';tr
ttl..gttr'
cuvirrl
i.n
'
c1ecom5,irsiarc ori$irel
l',,,r,r,,ont
"litttttrr"''"rt ,

iirl'i'rr
,;ti';,;il-;-t""0.'1"p'r'r'ot'isi"ttlli'::.::l-.l',lll:1.rt'rIrltl'rt'r'(rrr
illt r o. iolt r lI ' t r r t Trtr|r lr I '

Es: Leo clct r se, bir t i

' t, .rl r rl i | o il st ilr ii de conlt , eili'
lr r r'. '
O o" t " lunct 'ii vir sol; r llir t t t r r t lt t t r [r. '
L r' , I rl i r o{) nLr , cllcu m adiul t . ii't ir
lir
r
llr
r
r
r
i lr r '
co- 1, unAe exlst ii' o leziunc r r ' Slt 'A'\
.irlr'
' , , ' ,,,"i"f , r r iici li
s,rrrrrrrl
prr
<'irttl
"
, i;i,i;6f ;;1;.'co** 6siu-ostareprtologicr-r''

r r. lizioLogici,.
NL1.2, Problcms rte diagnostic in s{irrile tolnlloilt(l
; '-1.2.1.As7e?teY niotogiac
i'
r
' ' ,rrtn icl) loz; nli, o slt r ': p'l't oloqicii, r n *r ' r : r t : r ' lr 'r 'iz' 'r "! r r r r lt
l:
r
'
l.
r
r
r
r
'
,
lt
r
.
t
!
t
l
.
r
'
11
a con, . ricuici cu 4ispar i, . ir i, . . nit r r
, ,,1 "", nilni*
{\
lr
lr
r
r
'r
r
''
lt
r
t
r
t
":
t
'
slilnulii
la
l t,,i ,,,' ,t' ..
ir or , t l"cval', : r r eacliilor
'lit t
r(rr
cu supr im nr cr ' ( sir 'r .rlit r r ilr r r ll: t ) t r r 'r lt lr i
i , i l ,; : i"t i"i"". "lcd; i.
r t lr '
r
vr
"
vt
r
qr
'llr
l
it
t
t
t
c{t
i
,,,l Lr rl rrl ) . ou m o{lt r calr u, i"iut 'it o i'lo t livot sclt "
qi
umor:llo'
,,,',, r,,,,i',in" hidro-etectlolitico

sitttltl'rrtrttrl l t t t rrI I t't tt ' ' t r

| :.1.2.1.1. 'l'ttlba'area ite t:ons'tienlii'cottstil'ttio
itit"* diagnosticului dc cotrrii'
,,, ,,,
'lt^t
Ii rulrlilrtir'trrlr'l:r l'rrr '
, I i )'.tL'rt.lsl
altlele d"e inst(llare n std'rii d'e aotnii 1xt|'
l'r r r r '
r,,nr' Itl l i lgnosil", ^t r o""'o'^iiit xI t locolt lt na'it r t it llor r t iI I I ) I 'i|||IrIr|:r |'I
I Ir r r r l'r r r r lr . r r ' r r l
'r
'r
l ri , it il iic cbnqr ; i. *t 1";la t n int livit l in r t 'plt . t t lr i
li
,
lir , r 'r r t r I r 'r '( , \ ) r ( \ \ l, r r , r r r !
,, ';,.;.,ri
. ; ; i- t ; o; i{icni'vasc, ul1, r :r r cr g6r 1l ; i r r r ult r ^r lr i
:,t,r',,t,r:,1

irr rrrrl,r,r,r,rlrrrrt,.L)
*n.tcrnnio-oirlobnrl
,.,,,.,,;ri,ii;,;:"ii;; i.:.ir,r-,,nu
r r i r l t l l 'l fi l ' l r 'r 'l r

( r r xi 'r l r 'tl ttt:tl

1 q , 1 r o : t 'lo ti l tq {) ti n o l to r n o tl l 'g i tl sl t'tt ttl t l ttl ttti l l o tr l
i tttl i r r r l l r r r vr r tr l 'tr :tl r t' r ''r r r r r r
Ittt
ttl
i
t*
i
0
r
l
l
l
i
'"
(
)
l
l
r
tl
t'l
'tl
l
ttti
l
tn
n
o
zl
t,
r r l , r l t r | r l l) .
,,p t
I

lil,.,,',rr(r
, , , . , ' , , , r i i l i : i , r ' , r , r i a , , r , , - , r i , l r i i J , , , r . L r l t r r '(iliit
i , riit
h 'or
r . rtr' ,trt t' tl ,i r' r r :,r_'tlrrr'lrol:irrrrl"r r rt'l"i i , r
ir r r r , 'l'r '1"
1i'r 'li'r sr r 'i'r t t 'r r ir r ii) '
' ; ' .;' ' ' i ;, ; i, ; , i, i I
l t t t l t t i lr ( r r ': r 'r r r {lr {r r r r I r 'r r r r '
,' .,i ,,, | J"', , , 'i, , i, i t , , i; t , t 'it tn'i" it l r t Dt 'olt ir r t r r Jr rtt't l tl ' t
r rr'
r

1 "'l
l l l t'tt l o r i l 'o tr l r 'tti "
l , r , r r t , t t l r' r l i t l : l 't t t l tl t l ' l )l l 'i 'i1l' ' A ttl r r l r r l l r l ttl l ' l tr l i l ti tr tl
( l ' r l r ""
r j l l l ) l i l r l .'i r r
l
'o
tttl
i
o
r
l
ttt
i
tl
'tL
r
l
r
ti
r
r
Ir
IIt'tIi
'
IItti
t
tr ttttti i
, , , , , , , 'l , t
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i \ \ I,| | | | IIIl||(r ]l( t 'r'r.fi rlr r r iit t ! o lir l, ( t li

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; r t , ir r r r : |1, r r r i r r . I r i ; r : r r r r i I r : r . , _ r , \ . r , r . r , t .

i ';.,l ,l r
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l rrrtr,,t:i r ' r ' t , I r r'r r | ; I j
r' ' ,r' ,,;
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i I I n,utnarat,lipu,Luiraspirator'(ijoiaoic lrr,blrba'li qi abdominal la femei)

rtrlicii, rr ulrvilirto rrraxirnil a comeii g) Bradiaard,iaeste caracteristici,
rrrrlirlirr{,rltrbulba,roin ca,drulsindlori,melorde hipertensiunoiDtracranian[
plirr lrorrror:rgiecelcbralX, hematoame intracranieno, tumoni si abcese
cf |ob|r,lrr ntrningite , ineningo-encefalite. IIai apare ln comsle din nixerlr,rrr qi in rxrle pril hipopituitarisrn ; h\ Ta,hieard,iaapare in multe come,
irrrlrroscbiil cele infeclioase, in comele in care apar complicatii pulmonare i
i1 NotntLc|ad,al.e:iune aaloul,ard,ca,rd,iacd,
ne olienteaz;, spre o embolie cereirlrr,lir,; j) ,lritnii.le card,inceFi,alte mod,ificd,ri card,iaceie pot sugera mecarrisnrc oxtraccrebra,lo ale unci come (embolie, infarct, iusuficientd circulalrrlic lrermodinarnicS,
etc.) ; k) Eipertensi,unea d,rterid,ld,cu intXrirea zgomolrrtui a1 doilea la nivelul orificiului aortic $i cu hiportlofia ventriculului
sl inq ne poate orienta sprc o hemolagie cerebralS,,encefalopatie hipertenr'ir.ii sau urcrnie; l) Eitrtotensiuneaatteri&ld, Ia debut poate sugcra o insuricrrLil saptatenali,, o comX cliabeticS,,o com5, prin tleshiilratarc, o com5,
l.oxiu"r,,sau rnctabolicii, (prin oxitl de carbon, barbiturice, alcool, suferinle
lLop*ticc, boala lui Addison), o com5,hemoiiina:nicii prin hemoragie masiyS,
r;rlrr prin infatct mioca,rdic etc.
4.
iligesti.ts, Vd,rsd,turile sint ncaracteri$tice, putintl st
-A.paratul
:rprlrii, in nuureroase come de origine neuroiogicr, toxici sa,umetabolic5,.
Ilepatosplenonegaiia ne poate sugera o comd, hepatici,, leucemic5, malarir:L, in boli de colagen sau a,1teatecl;iuni d.e sistem.
Dagluti,li.aeste perturbati, in leziuni caudale ale trunchiului cerebral
qi este un elemcnt de prim ordin in
tirrrlinl nucleilor :rervilor IX*XI)
rrprrrcicrea grtulului de profunzime a comoi. Deglutilia are aloi timpi.
'l'iurpul I (lzr,bial): bolnavuiui inconrstiont i se apropie o liugurili, cu apd
rlo )ruzorel intinde buzele, o suge gi o inghiie normal sau nu intintle buze]o
- iltunci vom spune c5, timpul I (labial) este prezent sau abolit. Timpul
)rrbi:rl are o reprezentale cort,ical5,qi una la limita superioard a trunchiului
lur:olrral. Timpul II (degiutifia propriu-zisd,) zicem c5, este bun atunci
rrirrrl tirnpul labial este absent (pacientul nu intinele buzele sH,sug5,aprd,),
rlrr,r'cind, introducinal apa intro dinli, eI o inghite bine. Timpul II al tlotlrri'i{,ioi csto intirziat atunci cind o introd.uccm in guri,, paoientul lino
rr,pl,irr gurii, rn timp gi apoi o inghite, Leziunea eslo Ia nivelul nervilor
crrr,nioniIX I inl,roducem a,pii,in gura holnavului, pacientul trine a,pa, cars
lrolboloseqte, dar nu o inghlte, are un refler c1otuse, o parte tlin ap[
irrllri in ci,ile rospiratorii $i se ineacS. Spunem c5, timpul II al d.oglutijiei
osl,r a,bsent, cu sau f[IH, reflex de tuse. Ireziunea este la niyelu] nueleilor
rror'r,ilot cranieni X-XI.
I udoral,io este semnificativi, numai in cazurile f5,r5,hipertensiune.
lioziurrol, csto in ium;,tatea in{erioard, a bulbului.
'lluto tulburirile vegotative (afari ile deglntilie) au valoare daod
nirrl, lrrl,1;oin ansamblu (tabeiul IV); izolat, elo nu au y&loare.
menului neurol,og
I 2. 1.2.1.3, Y al,oaread,atelorefro,
ic
1.. Il;ri.ttcn;la harniplegioi,l,robrLie vcrilical,i, din capul locului. Constal,ir,r'oir,
r nci ho,niplogii irrstalir,tobLusc sugottnzii -a,ploilpc totrlcauna un
ylrii0rtljr,r
Itr sohirnb, su]prirriloron)
mrobral $ll,I lln(x)ri {] r,11.q?}jilro.
rlr.rcirlr:rtl;
cotrtrtitr.l;rr,lll,ri
in trrorIlotrl t1uporr,1;o
rrrrrrilrorniplogiiir ri;r'-o
$ugoni]Fi u,l1;c'
(1;utttrrr,r'o
oot'ullt'1tr1,
rrii,rloqirlrr
itrr,lr
r!b00$
hrttttrt,li0rn
Nlrlxl|rnrl,
Jrosilrilil,r"r,l,i
;10
0

'l Al Jr '],1 Jl . N l l . r v
Ilodlfic{}llo lulrr'llllot r''lt(lrth$ lrt flrt)orl (:r tlroilrl lozlunlk}r cer(llrirrkrr ltollrrosllo
tl llr{lic lll opclatorii

I n d i f u l i L t , l , l , L r, , rr

'IrrnpeIatU Ia
telot lull L,

ahicardie
bradi-

l 'l l l sul

S c i i dc rc a pr0l .trrrl 1i ,

bmdic 0l otl rl l l ,'

Impollant?i

atunci

arteriald

clnd ccielalte curbe orarti

agravare

c oul l

l rl

Adinci, rapidi, pe Ltrz c

spuml

It0$pi l l 11i a

(iullos,tii4a
l1olenld

Tulbuleri greve in
deglutitie

l )fgl rLLi ti a

Inrportant
cnl nr

IIemillegie
Iipilepsie
Simptome de hernje
lemporali

A ((f rrl l rrrfr,rrI' r r' i l r.

s i rrl n rIrIr' l ,rf r,
rtr.ol (,grfL!

rrroningitS,tuberculoas[', parazitozd, cerebrald,, mai ra1' cncolil,lil't'I,ltsrrtttl,r

'hrrnorald,):
a) ln comele superficiale, deficitele motorii silt uryor do I'0orllrorrrrl'r
rl,r
rr,1,itprin probele motilitS,lii active gi pasive, cit $i prin inogtll if ir,l,r,rr'
roactie a membrelor la Dracticarea stimul5,rilor dur'otoitsa.
'b)
ln comeie profu,udo Be ror practica o serie de pr'obo : . lrlf ul;(tnlt[
rrrcmbrelorparalizate, care cad mai rapid pe planul Jxll,tthtilrr ttttt,tttrvrl|r
(lc ddicare qi d Hsare brusc5,; -,,semnul piciorului totilr In nlh,rfi)'nl
lrri Bogolepov (citat de Yoiculeseu qi Stoica, 1907): - trrl:tt;irt,prt,tlirii,
rrrir,ximI, ln afar5, a membrelor evidenliazl' lipsa do lovolliro itr lozi{irl
irridial5,a mernbrului paralizat, plin hipotonia rotatorilol intrrtrti I . lrtl
1rit.ift1cst}lt ttrritzjltt,xltt"
z.rr{,aparezei faciale dc tip centlal (eviden{,i:r,bilir,
rlr,
prin ,,semnulpilr'i" sau ztl ,,pinztrido cutitbiottI lll plrtlrrrlr,
lrr,{iilur',
rrrl,r'ortrarrtl
ii
lltt
trlltlttl
globii
rtlillgirroi!
illttla't
srltt
pe
rrpir,t
oculati,
illo
lxJ
1rr
prr,ra
lizlll rl')I - ltntzrtttl:t,tt tIi IrrI r' I'tr,Itl
l:rlirrlrrhri,rn lipsl grittr:rsti tlo 1r*rl,tlit,
tilt,ttlllxrlinlil ttlrill'1,r',rilli'1,
It' tr^lh,
rr llt,rrrrrrhriltri ltiulritrtlii;- tlitttittttirtt'lt'
rclltrxrrlot'r)$t,(r(t
hrll(luroirrltt.
t;ii Iriritrtrl;t'iit,
rllot' ctt1,ir,ttir,1,r.r
it,lxlrtrrirriikr
trNr).u(rt't'{lltuHpilU{
1111v,i
1'rrl'lrt't'd(
roJlox) rtrrtt
it" I'rn( l,t.tuttilu.l'ttt'tl<L,,
(,lr,,l'iljl tr'l|r,;i):r,lrriittii, rr'l;rit Ilt ttIrti,ltl gtlt'ii,lrttzllor
rlrrlrlrrrcrrfr.
lr)rll!1ii,
iill'i

ri :t'l litttlrir' ptt,ztrtt(it,

ttttiIiutrrlrlIit
ir liislllnslllrri Iorric lll uirrior,rrIrri
ill ]rri
h rrll (l.lrlsl.irr ll rrrrlrolrr;r,r,
rblrrrbilill srr,Lr
corrLill,os
iroatoiugcra o loznllx)
trrrri,r,rrl[1.r.r.r,I/u.
LIrr gr(]spiugrotlox bil;1,el'tt,l.]ru il,t,cIaloa,t,o
IrtrrIr.rrl,rr,lii,
lrrr.rlizrr,lolio,lLrcsLusrrgctiltl o su:tilinli, dc lrunclri cet,ebr,il.
:';. .4ho[.it.'ctlre!l.et;ektr o1teoleniliuoase sc poal,e constata in diabr:tr
,
.
rr lrcrrLor.ilgiiic
subiuahnoidiole, irr unelc mcningil,c blcilare, in situali:i,
1r,{l\isL{)lrl,ci
urror polincvrite (polineuropa,tij)inteitiorsr', etihde,cliabeticc,
r:o.lirgritrozicc,
lxccurn fi in hts. hr stntlii ar arisr,tl alc'coneloi, abolirea
lolIrxr,lul ost(]o-tondinoasonu prezinti somnificalie patologici, (ce1mult
prrrgrrrrsl,icii).
de rigitlitate prin decerebrarepi a cel,rtrde ri,oiditate
. L L'rczerrla sem,.nelctr
prin lcc,o.rlir:are
(y. a.)poato fi constata,tiiirr rnulte corne(vasculare,'toxice,
rrlri rr,l,rolicc,tunoralc, cncefa,litice) qi pot indica sediul leziunii (Jouvet,
I l)0{)) |ii scnrrifica,Iiilc prognostice.
5. [trezo]]t& temnelor meningeale intr-o comX, instalatir, ictiform no
irrrlicir,in prirnul rinrl o hemorlgie subtrahnoialiax,i,, dar si o hemoragio
,r'(,rcl)r'o-rnellingocs:l,u o inundalie ventriculard,. jDtr-o coni, fcbrild,, semrrr:lcnctir4leale sint lerela,toare puntm o meningil,i (urruilles) sau pentru
rnr lbces ccrcbral. Recloareacefei (cl atte s,,rnn6merringeale'absen?esau
rLrr,r'schi!,:r,te)se poate intilni in proceselc expansile intralcraniene (tumori,
tlrctrscrLernatoame) cu fenomene de angajare.
6. _Prezerrla unr_ rnipcdri au,tomatico-rejlerech co;r&ctarstereolip, o":dtLu.1,,if,cle_miFcltri
caqfologice(readocerea cuverturii ori cle citc ori desc-ofeiim
Irolrull'ul1 miscd,ri do apucare qi de frecare a organelor geriitale, a na;ului,
lnr r'r,ltcrni,sciri ges1,ua1e
storcotipe) se intilnesc irrrloosebi in comele mai
,,ul,,r'ti,.illo din irrtcclii, in[o:ic-r,1ii,ii unclc mo n iugo-cnccfllire.
'/. 1't nurdturi ole e.ttrenitd!ilot tu
a*p.(t ttc ,,biitdi de oripi', (,,Jtappinl lrrmoi" 1 apr
in cornr.lehepatice.
8. Mod,iJicd,rilepuptil.are.
.Pnpileie se prozinti miotice in intoxicalia
, rr o;rinrr.c.in.conLauro-nrice;i
in unclc l,.ziuniprotu bcra,ntialrl
(benloragio
l rornbozii.bazilar'ri,t unrorj puni inc). pupilele midrirLticesugerca*zi,
1,,,rrl.ini.,
,r rrrr,'rrc:trtre
al,roplmcAstu o comd,gravd,vascularS,O midriazx unilaterrrlrt (ipsilai;er-ali,
sc intilncqte iu heruatoame epiclurale, Nubd.uralo
-lezirnii)
r,;ru irrtr;lcercbr ale,
in tumori cerebrale cu anga,jare a tonutui temporal
ryiirr anovlisrnele de arterd, cerebralil mijlocie sau postrrioard (asociaid cu
lrt,oziipllpebralil),
9. Pre:renld.anai oftalmoplegit (ptozh, strabism gi rnidriazd,) asociatd,
('r.ri.crrnc rnenrngrale ne sugereazl o meningitd, s&u o hemoragie subarah_
ruritlia,nd prorlusi^ prin rupturi de anevrfum. O oftalmopl6gie masivd,
ilrl,r'-rnr corrtext infcclios ne poate indr.uma sprc o tromboflibi[i, de sinus
, iivr.r'r',r. socieroa,
oftnlmoplcgicicu bcmnc piramiclalc.caro realizeazd
,r lr'.rripL'gio:rlLernfi,,
nc sugfroazii,
u leziunerle tnlnr:hi ocrcbral (tunrori,
i,rrr.r'Irr,Ii1,o,
tt ombozll dc afieri, bazilar[ s.a.).
tU. n,flr.ru| Iolo.n?,otar
ti abolir, in conrele protundc, in unelo
-poi\I" motorocularnlui
|'' ro irr ciLr.(fsrj &Nociazi afcctarea
coinun qi/ Sau nervul
ol)1ic, pr'ocunl qi in comele vascularo prin a, jeriti lueticA.
, ,I1.. .l)euialiaconjugatda globiior oculari constituio un semn important
rll lt.zirrnn.el,ir
focar._I)eria_!ia,.
eonjugati, a globilor oculari spre-partoa
oprrsi, Ircmiplegioi indicil o lezirLnc eniisfcricil 1l_,olnavul,,iqi privegf,e lezi*spre'partoa
rtrirr,", conf{rrrn.Icgii Jui IlrCv,'sh f i L:r,nilouz.y).Ilcvii,lil,
h.rrriplugitii, inilicir, ilo obicr,i . l(,zitnlc nlr,i ji,risr'i,in lrLrnchiiLl <drcbt.li,l
(ri rrrl l rnr ltovil lo [t11,rrlrrrr,lr,rrl,irII
i nlor:ior),
:i{)tl

-1

l:!, Nln:rrl)t!ltl ttl pl:rll rrrr,:r.

rrrrrllrplcllrrrrrilir,lrtii: l)11,(x'.r
r,\l,lt,liltv
r| | t rr(1I ir,Irii r,It , lr!rlrl)ollrlllir r r,r'r'IrI;IIII,
r,rrcr'lltlii,rj
r'rrlr,ltr,lrsottrloirrlror.lrlii,
iolrirl'ilrII i I)r' r'I r.rr ri r Ii , r.Irlr.IrrIo1rrr,I
r.cclllrrr!tioi, lrotrollt,gicsrrllrr,lllrrrrrr
Itrr,t
rii.
13. Alrof iu opLioiiutlilolet&l,ri,la, un bolnav couli)los porrl,csr'i rro irr
Ilrrrrrsgp16 o hcmor.agit subarahnoidianirprin anelrisnL lupl, (rlilcii rirrl,
ri scrrLlemcniageale), sple o tronbozii, de alterri carotirl"L(rllrci, r,sl,rri rr
lr(:rriplegic contralaterali) s&u spre un sindrorn l.ostel .Kcrrrrcrlr' lilirr
rrrrrnli bazrlii {lo claj rnterio).
14. Motli.;ficitrile reJlernlui cornean,
pot,si, ofcre inrlict,lii rlo prrrlrrrrzirrrrr
r,rortteiriat uneori prezinli, ,sit-aloarelocalizatorie. Asl,fcl, tbolilclr, rrrrilrr,
it'raiinne sugcle:lzilo leziunc pontind,, iar o abolirc llilftLcl.itlil(rrrrrrrlrliorlrr,
irtiu gradul de profunzime al comei) ne sugelea,zlo lcziunrrrrxlirrsii rrr
tlttl chiLrl cerebrul. Prezenla rutlexului corrrcu-pteligoir_liu,n
(ur, ,si :r rr,llor,
r',.llcxearhaice) lre poato intliel o suferinl,i f trun]chiului ircrtir,rrt, ,lrr,r.
lr'rflLilte oli nu are valoa,re ]ocalizatorie (reflexo clc clibor.lr.c).
1i. Abolirea reJlerelorJaringi,an ,si 1)elo-p&latin,
rr:prczilti'i, irrrIir:rr,Ior,i
1,. l)rol[nziur(' i.i,comei, dlr uncori qi semnc cle srLfclilfii brrll)lr,r'iIrr:r||
i,rtcuilobulbin'ir,.
12.1.2,2. Clinica sintl,ro
mu,lui comatos
Olinic, siridromul comatos,ue uriniitoarele co[1pouc]11,o
:
1. Abolirea, total[, a stS,riidu cuno;tinld (cou;iienfn;. fir corrrii,rrrr rrrr
' otte vorbi de eristen_taaltor tipuri do porturbiiri ale $1rii,rii
d.ocrrrrollnrlrr,.
alr)ua $9 poa,te agrava, ducind. la exitus, san so poate a,tnclioll, Irr,rrirrrrI rrI
I
rrr'ozertinalin a,ccst caz simptome de trezire.
!. Tulbur:lri vujjetativc.
.J. -LtL.DUraIl

OCUm,IC.

4. Tulbur5ri neurologice,
12,L2.;i, Gradarea Si clasiJicurea comeilor

llator-itir,clracterului evolutiy al leziunilor, c:r, fi Ltltilil,ii,(ii lx\fi,ll

i)r'lrilory&sornotorii existi o variabilitate a aspeoteloi r,linioo rii rlc i1t",,,,r,
,, sl,riutl cl$siiici]rcrru cste posibili practic. nst:e ins[ }osil)ilL (; grrrlrrrrrl
t'.r'',turzimiicomci $i aceastaesteindispensabilsi fie reaLizl,tir,
d irr rlooo*i I,ri,
Ii
clinice qi practice, adicfl ds rS,spunsla tratamcnt
(lc apr'c(Jiol,o
pr.r,;jr'r,t
I rc,l,.
'i
profunzime
rls
poate
a
comei
nu
fi
i1,
cert
stabilil, rlrrril, 1;11f
,G,raclul
rrivelnl gi intindsrea leziunii majore din trunchiul oerobrtl, (lol,orrtitxrt
rlrrpri criterii clinice Si paraclinico.
Dup5, acest criteriu al lcziunii clominante, noi am propu$ siiitorlrl i
zrr,r'eain 5 grado de comi,, cu urm5,tora,le caractorc (tabcltrl V) :
Grailul I. Bolnavul este inconltient, functiiis vogota,tivosinl; ln linritrr
rrorinalc sau_,uqormodifricatc, toli timpii ds aleglutitio slnl; plczorrli, rlo
rri{rrrruc&Iel'lexolc rlo apirr,r.o $i autom&to plozonto. _tictloxrrlrkr rr,[11,r'rr,r,'
lrlo prozcnt, boln*yul so apillri la, cxcitaliilo oxtorocoplivo (srr:r,l)iI,r"d,
rlrr o
rrLrLsoii,).
.Il,oflorclo
rr,ul,urnlll;o
sirrl;plrrzonto,bolrllvul so apilrii,h oxoil,rr,l,irll
(Li.!rjiir
rnirll lll,oit.U
il rlollro,so:lcopor,i'l
1rt'opriorotxrlrt,ivr,(rlrrcrr
crr o lriil,rrlrr,
rlrr,oiiii oirl,ollig). l,rt;rilolohilti norrnlln $ll rtfr)t.ruirli.ilttirui,
r,rr lrrllux
Irlllltr(rl,i)rrlitrtitrttrr,l
s:t,unlrulil,.Irrr,lrtolr.lrlIrr.icli, voil,ilrttllr.ji,
so rrotr.tlillii,
:()tl

l ,l r zi ttttttl t'
r , ( 1 1 'v i r , t r ll r r t r ir ,r i |o tr ,j r r IIIII;r tr ;,.I rl r r l rrr ' , , r' r rl t r I i i i ItL , l ) l L r l ( l l l , i l 'i q l l l i i "
(
i
cl
o
b
r
i
l
l
'
l
Il
l
,r
l
l
tl
l
l
l
l
l
l
l
l
l
i
Ii
r
tl
l
l
r
l
, t . i r r s c u t t r rr r tl tr l
( l r l , r l t t l L l ,l i tr l ti i l vttl
o i l r r i tttr o tti l fi ctr t, fttu o ]'i i l t: vo g ( !l l t't'i vo l l l r xl ( 1 l IIl '

F,
J

rlttrttrltttttir'
r-:stc
abulit,
iii'y,t'i i it.tri,,tll,l rltrglrrfilici
,', ,,"'':rl,'i,i,,
'1'fJ:'),1'1"
vt:slilittlit'til' t'rtIrti.lt'

r!

I.rir'Ilobii
r,olti tlo ,r,irir,r;,r,itiT
i, ,,, ,",iLst','r'vrrti.,
'boiitt''
llr gr r r ir '
,. ,l i i o dovi|lc ler it cor l. iugr ll, ira, globilor ocula'r 'i spr '( j ] ) r r lliil
1,,,.,l| lci} este lnedin-pontini.
l)il'l'i .i!l(!
rttqd,ul LII. Bolnalul este inconqtient, exist':i- gravo lnn'trll
I l it r lit zir r 'l'
, ,l f,o u" u"iur j'e, i ilr t ul f nf J"gr r iit i, . i, lor cabolil. t ir r r lr r t l

I
+

',,1
,,.''1,,j,
,i.i,;;i;;;iffii"irtrit,'.

i':r tt"
i* pr'ba rt' jurrlrr'ri
''rtl'tt
lt'ttstttrl'u
i srt'tt

r, r'rr,iri'i,u (Ii'l1'rolea glrbilor oculari, frecvent .discorrjttgit'1 '

oscilarLl'i',ou 1(\lr(lilrlri'
,l, r illii ocliilor'. Hipertcrmle qi i"tt"iooo
"t"riali'
p nlll'
c
lr .r,ltut'r'. Lezitrncl cbl,c in parlca' in[r'tioati
ii.ltt t tt4tt"
{i rud,u.II{. Bolnar-ui este inconqticnt, 1'otll areactit', liuno!
stll)Ill'vr{rlllrrtrir"
cu
curnl"atil''ilitrr'.tii
limiirr,
,rlr,, iiiiii"te gr:aypertltrbate' kr,
's.au
abolil;' Nli'ltirr'zo
',r, .r,,tlr.'ia-aliiiii,, 'reilexul ae iuse p"c,ent,*intirziat
i,bolit"' rit'tl"t"ltr ttottlotrtrrrt'lt
i .'',';,,il"il;;,l"'r;i;;;;;t-$i;iii-o;pi"r'l
.r t'trttrirr
, r,.. r)r{llo-l.tr,iibulare sint *froiii".'ff*t"iAita,te muscula'ii,
quperioar[
bulbultri'
a'
pattea
io
'i
;s!"
i, i,"''ii,',l" l.i;;;.-i";il;

',

:5
<5
'a
6,1

crr circullr'{'irr' t1i

t irrttlLrl | (eoma tlepir,qitd,)' Bcrlnav total inconglicnt,
zit t t r f r r '. r "'lt t
r, r,,r' :LI
;rr rl l ilic; al sust r nule- 'piin m et or lc de r csus, cit ut '" l"
\
l)
llllt
lr \ ( 'r 'r r r rr r r
ct
]
l{
rr,r.rt.r trr sc! r nenl0le bulbar c inier ioar e. Sindr ot nt r l
l l c i i cr eielului".
.r,rr,:r
(lo$otr$ trr'
lllr,;iic. tailloul tle comd' depnqiti' - a,,& cuin t' li)sl
(
l(
r
sit r r l'lt ) r r r r r :
r' . ti r,,i l u,tl eili it . G odon, in 1959- - bupr inct e t r ci oit 'logor ii

,r) ,\br:lirca totalii a tuncl,iilor vielii do relal'ic'

l,) ,\bo1irea, marilor f unc!,ii vegcttltive '
(,) llEG cu traseu izoelectric persistent'
t'rt'tt'
ttton'r1'ttu'
lliD(rl,oniacor]leeicu lipsa cletransparenld'a ei tlonot?1'
l'rrrilrrtirtl
,
cttlt'itts
Ieziunet
cd,
denoti,
i."i*'."t""e
t, ,';:il;"".i.i;iii.
t r t,l,rrit,nuhti tli:f zona bulbo-medularS''
I :l . I .2.4. Probtame d'e d'id,gn\stic etiololia
N. Oont epibpticd. Ctiz:r,cpilepticri,grant-lmal $'r ill\olr1iln)l:i:l,],1:,,1:l
,t, t,.r,,.t{, .r prolunhi, tulburar,. a, ('on$titulci, cftr"oitnrrrrt,i'
tn rnoclbrusc, sau r lu 1ti'r'i' rir,sll,I);l(ll,',,;;,ll;i:i:
, rr l" o t iro idtt'a- si poetaccosuate.

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l,rl,rit,tr,l-La unor- semno neurologice (indeosebi pirlq'1i{alg)'
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mai multe posibiliti (i : ' ' tt trrt :t ;ii rr
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splo ('{rlrriil l{lrt:r
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subdural,
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tumoale cirebraiS.(Lrseni qi colab., 1974 ; Yoicultstltt ryiNloit'rt''
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li, t,,,tjttlt n t\l,tl, t t t t ll|t i. ut L
inlr l t ) a. |.I . ibt r n t i j t o c i r L ( " 1 I . t " . i i . , ) :
t
ttt ttt'tltttt ul :r t t lt t lt t r t t l r ul\ . r l t . \ , , lr t r . lr . z ; r
rI rlr.r rirr,j,i, .,,rrttr, ,
ri.U
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' ..:ll l"r':rl'zrrt'r { t r ' ir lt i: uz : r ii lr , r r it , ; , r ' r , r ' I i r l , 'r 'u r , , r r " , , 1 r r r 'i l , . r l r 1 ,
]..]
. l\ lrl, l i (.r'l | \ itlr):.t1 . : L I r ,, ,; r,I i , . , 1, , , .; , . .
lt) llt u tttlt)nn tl it t lt r r t ot t lt t t t l
s r r f r r lll
r r r lr r r i l i , i r i t i , r l r r r r , : 1 r r l r i , , . . , i r i r r r
r lrrir. rr. r rr llr.i lirrrlri, r , r r ir r I llr r r I I r I r_r , r , r I r ,
r
: l , i, i , j , , , , i i " i , , 1 , , j , , r
,.,,r.,,,,,,t,
l lllrr' :r |r| | | |rr I r )| l I I r I rI r i, r ' r r r r r t r il, l: t j, l. i|| : r lr ; ll. ; ii] L
, t i r rr 1ri r , r rrr, I , , : rl r, I r r r . I . L , .
iit{ i

'
in (,lllii' l)ttirllr ( \ I
, , lrrl,,t 1.en,,iune
- intlacli.r,rrianil. Dxarnelul nolrlologio
atlesoa bila't'crale (pt'in torsiurLrrli L!'IIIII'IIiIII|||
,i ,,], 'iar,r"" pir r,tr.tit.t:r,to
,, r,'.,,t *i rr, iu'her'rri,r,anicdillelor rltlr.,belo:lsegi/ srru lr' tttitlttsttltti lrr;r"
'crir"
',
,1c lLi|o-ttolric, anizocolic ctr midriazi ) etlottL }ltltilrt't '
r, ,),
t
i. (lorne[e prin uJoqitllLi cerebr&le de origi'ne inJ ecJi.ou
'i
rt'sttltr':t'I'tttttt
ntor{'ill
Ne
a1'rnge
,i ) C,,rrn tfin troibillebitele cerebrale'
r r llir r ir 'l: r '
t,,,l l , l ri t.cl or r Ln cor t egiu sir npt or r it t ic cu f t ! 1n, bt u'lc {r 'r r r n'r r 'lii
rrrrl
l{r
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, , .,i .,ol ,i t if ,
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, ,i
itt tttit ttl lr:t"rtr
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rrr' I i l.i r':r t t
,' rrrrl itr vcdeit prcre-n1a selllnelor rncningealo ltcrr-risi;trnltr,..lt
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sl
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''ollllr '
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rn ele,ilit t nt eninloen, : I, at it a , t i et t ccJ't lr l' lr r r lr r li( 'ii'
t: ) (.l r.t
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r
{'otr'l.lrri
r';rIirrlrr
currvulsii
tlt'
1i
ii,,,';i;iiJil;;'iiui.i.;lt,nt'ii,.iir"-r{itu
.rl'.' t lr r iip it t ll; t t r t r lt
t lc r t r gr t lt l'f t 'lt r il, r 't l r nor lilil lilj
"t
,' ,' rl,l ,rgi ooir t i, r - un. ct t r t 1't lxt
rrr LI l l l .
li. ( lo rtr:ltt rli.sn d ubo[ice
j ttsi i l l tr l l zi r l r r r tl ti t'ci tl ttl ti ' tr r t l l ) l r o r l l r r r l
, t . ) ( 1 , tttt,t,l t'L tr tr l l i r ttn t,i tti str
t'
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'r tl r t'
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( l l l l ) i r r ''l l '
, I I , . r' rrrr rr I , |r r l . r r r i r l 'i i r zr i r r r i .zr r , .t'.tr l ttr t,l l l tl tti tttr ' .l r .l l D i ( 'l .l l i l l r ') ,
" r l r o l r l c ti |||I!||I( |i r '
o .r 'r r tr r r i r Ir i i ttIt tr IIi I:tI'r ' 1 ;1 1 i 1 1 'fr i l l iSr
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'1 ,
r r l l l r . r '1 11 r r l '/i l I I rI rrI rt I | : r ( r' :r 'ir tr r r t I r tr r l
) t ', , t tr ,r i tl i ttl tr l i ,"i r l r r r r l r l cl r
r 'rr { r ' t r' t l l l r l r' : r t " i ( . l l r l l I l l : L
. , 1, ,, , , , i ,, , , , , r l i :r l r l i i l r r ', l r t, r 'tttl r l i 'l l l ' r l l r 'l r '' l l l r r l r
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(lrf r'{tliltt

i | | ir | | | | IIIiL I ,Il,lr ;II| ( I( | IIir ,II,:I

fiittr t\(,:i rl r,t(,i l 0r(.(l i (r:t,l i rfi l

tl i tl i tl

l rrl r(,, r ' loll ur i pr,r,l rl rg i h l , rrrc rri ru rl l |,I ,r|,r,i (,i i l , u l i .i i rrl .c(,l i j i rri r.r.(,r
l r{ .rrl ,r).
i i c i r r llr r llr r z ir ,ir r r rrrrrll tl r)t.l l s i \, (s o rrrru rL l rrl l irl, l sl rrl rl q l l i rti , rrl xri 1l rrri i j ,
p rctr r lr r . l, ir lr r . lr r r r l l o l rru c (o l l o s tl l l i l , rl ttl o t' i l t l trl ol rri tl l l o, ;ttror.uri i c,gl o{ ur,r,
r:r,r'I r r r I ri,r I ( ! r lit , l( : { f,i l ,l n ..l ,c l i ,z g ()l u o t(i N ,i l l i i i u l i l r' o,:r}ati 0, s0Irztr,i ,irti
ti r i .l r,,
l){)|

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lirr rrIrt,i,oIr,r'rI
sirrl,tlili;clo r.r-lbrtrrlrlluigonctrll, p(. irrpli,t.l.Itc,
]lcurol(\lil
;,i rl. IrIIr'r,ii,lo}
r ' llsltcct tltshi,l|ltlut it t,t,tnrri-tLtui,
cu tegurn(x]i.lr\
.ii*r I.. I'(l(liIi ciurLotict:.1
- gl.bii ocul.L,ri
h.iytrtori la p:ll1:lrc - itratiilrrrr,,
(llJ Irl,irrriri),crr iuspiralie pr.'ihngiti, apoi pauz{ tt-upi,Ibare cxpii;l(,itr,
{,ilr) irrlurli) rilrrtlr,ii,rlr.o:r,ltir p:r,trzr'r
rn:],ilunE:t,(r,espirllic ascnri,niit,
o i l,
r'rr (r.rrr{l{r i,ip li.iissnnrrl);
,-- in haloni, se pcrCepclniroslrl de acetoni,;
lrilrolr'lrsiururl,t{ct il,lij,, l)uls slab si r.rWidl - hipotrrrnic,i _ nalcati; lri
'ostco-ien(Linoas[,
hipo- sau arefletiu
lrrrl.rri* rrL'srrrrlrr,r,i,;
I * nidriazii :
,
inu|rtir. d jrl'otir.irnu n)ici hemortqii h l'.O.; _ pt.nz,.lrl:i
'r.rr,'rlr:r',,1
,
,,lLrrrrzr.i
si rr,r.oll)il{rr(etnnici in urin5,1 - gliccrnia rnult cresenti,irezcr.r;rr,
rrr,lirrii
:r,lr
sciizutli.
t ) Ct)ntq tlre ricd Nste relativ usor de rccunoscut : _ antececlcnl,rr
rr|lloprrlicel - arproalc totd{ aun:t r.str. Irr.:cet1rr,1,ii
tlc Drotltoarne ca,r0
rrrrrlurrrrrrlrcezii
: oboseal5,cefalee, anorciie, glealri, v:.irs[turi, diarr:o,
(liril)rcr',n).iodozopsii
(,,,rnuqtez}uritoara,,), eclipsevi2uate (pini, la amlrr
r',,r...1,r'rrrrz,ltririi),
rnioclonii,,sitresiriri fnscicll:lre mlscuhre, ufteorl ortl
i rrlsiiI - l'rillonii,lu.c rriros a.mouitcll;
respirrr,{i:r,
r:s1,e
de in[lte ori rlr,
lrlr (rirr1'11s
Stokes; - bolnar-ul Ostc palirl, hilotelmic, cu pleoapol(l
r,rlrrrrr,l
iir,lc fi lrozinlii, sughit; - pulsul este f,,irtc binc bi,ttti Ourl
l.rr.irrrrrrr,rr,r,tclia,lil
este cr.cscut5, - cordul estc rnirii,, cu zgomote dlllr
.i lr lrlrriii.uli pcuicardiacci * la examenul nelrologic'sc cons1,atrX,
semlr{,
rrr.rrrrgitrlri,rniozir,.hiperr.eflexicosteo-ten(1inoasii,,
ilneori seinne pitatrri
,lrL, ii c x I rrlpi r:lrnidillc (inclusiv flapping tremorj ; - la exaucail F.().
,r, r.irirslrrl;iL:ncur.orci,irritilalbnminurici, cu nLorlificiri evidente vas(ilr
i;rr',',r.rrirr.srrrllll,rr
,,il stca,,',.cu cdern sau s,lazXpapilar[ cl hemoragii I
,. r,orrrirlii oliguri(i, :r,lbruninurio,azotemie ma,siv6,acicLozJ,
tl ) ('ort.tt,.ttotrnir:ti sc irst&lcazit trpta,ij I,r,un bolnav carc a prezentu,t,
, rr;r:rlrrii*rlrirl,ltc (pri1ra{ociiuni gas.iiro-intcsitinale
salr vi.r,situricentra,l.)
r,i , :i,r',,rnr t)it,r:i[1,11
rles]ridratat. Se,rllne1e
proclrornrlloSint asemxni,toitr\\
.rr r.r'1.riirr (,o riL ltr01)t.icil,
ca fi,tar.ediaglosticul difcrenlial va Ltrre scanlr,
lr, ( rl,:\ir r,lcirrcnl.ct.cr.olatoare:, bolnav tleshidratat; * TA scizLrtrl;
r,rrrlrirr,zii
i
:lzotemiei, a alcalozel qi a cloiopeniei.
l)l.ozon1:n
, ) il,ttttrr,tr:itr,ny|ioi este u,sol.de recunosou.t:- ilsoleqtc o toxicozi
'r'rrrrlrr':irlirr:r,rlorutimniil_rte:i,sa,rciniisan in crrsul nastariii _ prczirll,i,
| | r, ;rlii Ii 1r|,lli orlr!,lcI ovelatoare(r:elaiee,
v5rsi,tori, cdlme , ilbuilimrr ir,,
'r:r
lrlrr.ri,.rr.irrrrr',
oligillitr pin:"lla arulie) I -- coma debtteazf,'cu mioclonii,
lrrrr rr i rrIri rrI r.rriIII .,ir.,,.lsii l,onico,clonice(:rdescasubiriIante) qi chirrr;
r,rl rl.r rrr, Ior.:r
lo crrlclrrir,lo
(parcze,mftniiestiiri alazice etc.)"
(
itttrttt.
lu
ut
ridicir
|)
,
ltrrLirii
lroblemc cliagnosticedir,ci,_tiflomSca,rI|
rl. rr.rrrrri.rrr.Irr
.l.rrrcrri(::-- antooetlctrte
]ropatil-ro
thcp:i,titegr:il\'e1i{)xio{r
rrl rrr|r'r'irorlrc,r irtzc, nctiltlitsrrLliep:tlic), eltrnluil etilism cloniol
rrrrrilr.sliililrr,r rrltuttlt,ltrorta,r,r.r.rrlnlrcltinslcsjrll;r,tllrlrr,,N,l)atiorx,Ni(\ni(r
rrr:r.rrrlrt,suiilri(,yirsil,lri,nl{'i,'i,r,is
r.,,iirr;1i1,rr{i,.,s.rrrrr,,l,,rr(,r.i,progrosiViI,,
r'lrirrr:r'1.
r'orrlrrz'iorrirlo,
sl,iili rlrr rrqir'rrriir.
Illscicttlrrliisi sprr,srnc
rrllrsrirrrtrlr,
rrrr,,olrr',rrrvrlsiirl r lilr o;rilrr!lir,; ,\rpr.cl ,rrlI rrIIrrrrt,rrI rri r:liirrlrrlrr|rrl,ol,:
| 1r1, I 11111rI I I r' ri i. or r . irrrt.,lr'
i \l
:t It

l ,i .l ( t.t{ ,r,.
r.rr Ir' | :rr, l rr rl ri 1,.,i ,fl i i ri rl o l rr,rrrol .l rgi i

tr r ' l ' tr l r ' l r tr r l t:'

Ir ' r tl l r l ' tttl r l t'
r lrr l r I
l l r ,l l l l tt r tl 1 'r ' ' r r r l
I r r r 'q r r : r 1 ,1
r 'r ) r 1 r l l :r l :l r r r l
i
'r
'
l r r 1 r r Io Ir tl I'IIItr ';
, l , r t r ': r l : r , 1 ,* ,1 1 1 1 l r l r 1 r l tl l r ', r tl r "r l r r '
l r ' l r i l r r l Il l r l '
r
'tl
l
r
l
{
r
l
r
'
l
"r
r
r
L
r
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'r
l
l
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tr
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r
l
:
r r r , l t o r t t t t r, t t t t I I t II i I t I , 1 ,,tIr r Ir ,,r I '
i r r tl ) ( r 7 .l l l o l l i r l '
lrrlrlr' lrrlllrrl
, , , 'r r , , ' r l t l t l ,i i l t l r l i rl l 1 , t' i l l l l "
.l ) r ) r l l l l l i l l
i l l :\l ( '
r i l l i l r sl r i i r l ) '.r r \( l l l l l r r l
r l r 'l ;r i r l
tl o r ',',, r r l r 'l 'r r r ',
i , r r l r i l i ( l {'l i p
ci
tr
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r tr 'l o r 'l '
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1 r t'r g r l r i t '.i tl
r r r |r 'Ittr r l
l
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)
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'r , l ;
t l l tti tL 'l l r i tr 'i Jl r l l r r r l l l ) tr ) l l l l .l l l l l Ir l
, r r l r t l t 's c g r i tl l tl r i ,, l ti l tr :tso tr r r r t"
i 'i n tl r 'l L r ''vti . i j l .r 'l r ''l
i i tl n n l r r r u l
(
r
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r ttstti .i i t,r i i
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l
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l
xttu
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ti
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, , i b , i , , r i ,i i i
1 t':tl "'l ttttl u l t
j r t r ttr r r r l o ttr ,,r r 'l '
, , , , ': i 'i , , i , r a i j ti ,,,tr .i ,u cl ti ,,to r r r i i l r tp r L 'i i '''r " 1 1 'r i r r l r cIu L r r 'l r r r r i

; i,; ,.,,i; ,iiltiilui,oili"i.r,19?d),c,ll,elnrnltrLur-,herzio_sirrrlrrorrrrlolrf'r,

, ,''1,,ii,,,i taLrioulhtpalic qi neuiopsihict'\pll s in cadllrl t(il)r(riltr'prtltr'
in sladiul precornntos;i subr'otnalos'tlll lr(rlrr('lt'\lr'l
| ,rro so aclarlgil'J
(Slr.r'l,r'l'
,;' ;,i;; ,apffii'at"pr., a rrriirrilor',elcnLuiib,'ll.lllils ti'' root))
i'.1;r:
l!)?!i; iiir
Iropxrr-ii'irt,
:
19il{1
T'rrpuvjcirL,
tle
cii,it,1i
ijilieJ, 19iiT
iiii;ri.'i"EIII'diagriosticul"'':"r'rLileqtcliplinlrrulrtrlctIt'IItIt.tItIIIt
' |,LI";.
ie).
)r.r'rluronient
slli( trrlir :r
7. Ootnelelo,riee.Spa!,iulnu ne permitc decit clumtTlttrr'f
jrrljltrilr":
tlt:s
mai
to)'icc
come
citeva
in
,,,,,r'rr,criterii tlc diagnoitic
rr''trl
,r ) Cotn,r,alrooliccioste precodat'; de citeYa serrne dc rtltrottlisttt l
s('
{-rr11'
rlupJ
\ilri'lllii'
Irr'"tlrr{
ulr\i'
rliznrilie,
, r ,',i,i'r:,.L,1rtzic,
'
',f iii,
ilolot' tnidrirzS. laLicardi( 5i lr''Iit:r'{it 'l' t.
, ,'i.',
t.1ni ,.i i ' on.itrrrcr
,,',,,,;il.Apoi aoar lenomenede colups:palut'rertransltjrltiiit ;ttll:rt:r;rrrl
( {'rrr'r
,i,,t, tr:iiiri, iipotensiune, cianozir, r'lcirea cxtr emitr'ililor ''$io
, Ll
filr)li('r(,
CI(r).r(i
,,,,,i,,,*fii-"ii-Oiula'ri1iatlltutil rellcxelol, cLl respira.lie
(rrcDr
tlt(crthlrrrr'
de
rigitlitalc
de
,,,,,r rrlsii f,.rr"o"i) si'clria" cu tenourene
,t, l,roundstic gtli- ). Coma dureazi pini' la 20 de orc'
tltirrrrl'. rlrrlril
It ) Ooma mc'titicd,se instaleazi| brusc (chiar 1& ('ii;tlYr'r'
silllptt)rnc: Irtri. r I rrl
,,,, ,.,,ri,r,,i,,uufiiliti metilio)' realizfutl ulmXtoalc'le
,r..!Ilb t.rr|irrrrrIir,.lrr' ,
, , |',,,r""r* ccf"i, ,.onIul.ii. areUcrie pulilt
tltt
ie)
respfuatol
;i txitrrs lrt' Jttrslt lrlr""
1,,rri f1r1ripnec,aloi paralizie
, ,r
' 7l' l t' i l t.i

r loll' r r t r r iir r ilr r r r r l

C ,r, no bar bilur icd, . in c: r 'zu'i r D'lllc sr ' I caliz. ir l; r
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5j
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( t t t lr : lt t z'r t r r r r t r it lr lor
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,,: rr,,rrl rrrrglilli
r llr t lr r r lr r
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tr, I I i I I I I | { | | rI i I lt :rlr ' lilr lt . llr f \ t . lt f lr f llr ollit ( , lr i l ; r r l o z t r r l t . {) , l 0

tl (lr(,t.of)
, r ll. llJ ri' (nr()llrn ir ir r . ilt lt r , lr illr ) ir c
I I rI )I Lr,i (.i r ,.
ll! liu( . ( f
lt s ( , lul) iinli i r r l i r r i i r r l r , r . i ( . l l r o l r i r ,
.l ) tlt)tttt l)nt) t lt ut ulioll( 4i( ?' s c
llin
11) (1rn tt uxrtitt , it , r i. . s l( ) llr ". r ) ( liLli, r l. ' s ir r r . i n

|.r,ioii(lii

(r, ir.xicllr,r(\

r :r'rrl.li.. r^ilr.rrr,1r'i. si.rL rra,rrroirrarii.

obicat,ili ir ,,.0irsi,ipar.r''ilrrrr,
'i
rr
.irrrrrlrlrr,(
i. .rl...s.l*llopo1,Iir.vrllu|r:r'r.((l:l'liir.r,hi i,i,lrrl).,.ll)66): rrri'l_
lrr,lrrrir',...trrirl.irr,zii,
i,*lri.a,rrli.,. (,r'iic'r .,1 fc!oi, h,anipirrr,!ii,h\re.icnsirr ir,,
:rrl.r.r'irrIii,
lriIrr.t.r.riri..I)oslul ila .r,pir1se insialclzi, cu'.a, aio0iatin.' :
I,:r1,,.'r-,.
I'rrli l,'|ll.. li]ilor' l. lpslrirllit.ncrcglrlul:i.tr.lt"spirurii r.eci,slrr,r.,.
| | r' I t:ll).r. 1,,'zjt t, t t il r t r . r , s r . 111g; r . . ln l_2
g I 'o r o t , , l *: u . 2 u
u r j t {} A
rrr rrrI r rr in islL lr,t,o l)i[r c n1, oi' a] i, .
). (,','t' tlit.itr , l". t . i, ' , t lia hidt a. : i. , lic g c lebu l c r z J r . u i a g i r l t i o p i i L o r r r , r
"
.r"ri , 1,.
i. t)',r, t . t lll I t , r , n1 , , 1a' ' 1oni. o_r . l u n i n o , : r l c o s n j , , r . o n ,
u l " s i 'r ,
.'tL'lt
.ij trn r . ir r inr . lnr > UbinL|ant .
rll:
l, | | r rrl tr
O(ltt:-r CU anrOlJndtt.oa
SlliIii

( orrrloils{r. l,l, r.lozemai nra,ri dc.hidr:lzide, coma,

sd instalcazd rapirt,
rrrrrrlilii rkr hipol,onsiule, tulburir.i respilatorii (cu impoltanl,i,
bipdlsr,
, r('tro J)rt)ltfioii) f i de hipertcrmie. pupilele slni m:irlrjatice.
t (t,.il,:: it, s,,t.iaitg!i,o,ta
m:Ii rarj. putinJ ii ancirleulrli \r.u lrutirlll
!:t r{ltnirisltit
' .. .rt':ua.rir ur'rnr
i! tleaspirinj in dozernrr.ill ,.ul_,ii
tlcshidrrr,rrr(l
.t ',li..rrtir.,.situ:t'ii,nlro permit.r^umuil|ot .tli,.ilctiluf. Jnrurina,i:r ,.1'..
, r ii, li r rririj.Lllin (Vui,.ulcscu_
ql Stoica, 196? GaL tier
colab.;196(;):
I r,rrr)||r(,r|(, rlc e-rcitafie nellroasii, ct tremur[turi, i anxietate;$i
agitali6 psjlrir
rrr.lolirr, sliri l\alu cinator,delir-a,nte.
qi (uneori) conrulsii. Apioape titrt,,rr
-colici
rrlt ,.,' irfx)(,iir,zai
;i t,ulburi,ri digcsti'e (grof,uri,r iir B:rturi,
abdorrri
r,:rl() r{i t|ir,rispirn{ii abunrlenic.
sin1, ll,mlle qi irnbracii rrrr
.
,ficspirttijlc
:r rlrlli rlo lip l{iissnriurl. Faza rlc excrtilic lrccc it'torpoare
si colrii,
,lr':rl,t., irri!iu,ir-r
fiitrrl inloc*itl de acidozd,.l]e cele rnai'ilutte bri- ajr,,,:
(n'tugipirre
I'i||{||rri'r)()
lr(x11
la nivelul tegumcntelor ;i ar rmrcoaselor(carilr,
I r.r'rsl
rr,rrtr1rs1li itLl;oricA!ii).
i 1 .'r,,,' t:.t;.',,,'.:,:., aryonoJus:Io
t;.i , d iizopr,,pilfluoroIost:)t _ l)1,1,;
. ..
!.,,'.).i.
r,
t r i ,, l r,t
t l tt1)t, , - l i rl
l'1.)l'l);. h|ril.,.1iltclrafosh { _ U"ef t'; ociumctilpjrl,'
'
. . ..
l::,],,i ]l:1,.,()ut-.\;.t1ir.ti_rpararitrofcnilfos
fat_paraoion;c1ietitlia,r,rr,
,rrr1'rr'
rtr.rrtost,Jt
I'lr1.rr,thion.
EhatoxI
metiltrimebilpropanituorofoslilr,l
i ",r,rI r ; rlrrr.lrtruLrriri.eluxirianfosfe,t.
_ Tabun). Ne pnat6 atrage aterr{,irr
|, ,:r:r, 1r'r'r,rl
l,[. l.)tolesir)na]
(aparilia, la rnuncitori a.lricoli care milui0l|
ii\r'rrr'rtr'lirfrr r.ctrrlramenl,de proteNtie),fie inciden{a lor accidrrrr
.
r:', t:r
tl i i,it11.itll colrnunal lructe sau logun]e stlopito cu {tccsi,tt
't.t\;ii'l .rtL{}.u utilizai
rlr l:rrl.,
ace$ti pi'odu$ipent'ru dcparazitarealoollirr
1r,l,r. ll,ii('. rr.rrl:tt..rc simplomal,ololia geneiat5 tlc iiaciivarea
coli.os
r,,:,/i | ,i (t,.r,i'lsc(rlwlt, tlclllrlulare excesivir,de acetitcolini,
cu fenomrirlrr
itr. lrl, r,rrN1.',r'i'ic:triozii; hiper,itll\.ftlie; rlal'ioreeI
hipersutlo*l(,i.;
j
' r{,i" ; lll,, i-,.r.r,.linlr'orr.ic:r; L,ronllucnnSlri.l.,.;rrisprr,.r,r,tntllit,ur.ririr
:,r' .r.r l, r,rlll,. rtr.edem l)ulmonar acut; brarlicar.rlio;hiDotcngiuyl6l
111,.
Lr.rt:.: \ :r . ,, I r|:, I IrI ir, r.nlini :rlr,lornirnlo.dirrrer,
I
: rrri,,rirririjrrrlr,,r.ir|rsr..
I .,ttr,otr
rlorrl
tr,nxiohl,c,:rgilrr,t
ir,
,,t,i.,
lt,cmlir.tituii,1:r,sr,i
1rsil191lt,,j
,lrptrr':
_
turn'l,c t10r,r,rrrILsii,.11I1ri
|nr', s,.jrrsllllr,zil coln:l,,(,ir,r!\
'iIr:rr|| ,l||r]j{1lr|)rIrr
lrrilrl, i rr ltliurclrrl0 !{) rtl oirr tlcIir,illoricillitr prin prr,r,it,li
|,o:rIr.r'irrIrrIr,
r'r. r,' lri,'rri'rirr"Iir,rrrrr.rr.lrlrilrr,
I.lrr. rr{ii liL (l(,zorri.,irl. ai,r,rlii'ii r,rrsl i
Irrr,Lrrrr'll'rrrl'Jrl
t'rr lrlrrsrlc rlilrUrrrrsi
ir..
l , ) ( lr t t t r r lt r in o t i rl tl l u trl n tu c ti r I4 IIIr.:r,rrrrIrpt,l yxl l l !j l i , rl rr 11l .rtl 16
trl r.r i i r. \ r r r r , . lr r . i r . i rrg i l trl i r,. (t.trri r l . i rrr,l r.rl . rl . I r i rr,r I rrr rrr i , , rl ..
,
;

L 'I r I r i | | | l
t r ) ? :i |:I r l l .l i l r .,j 1 ,
r 1 ,, l r tr
i r i r I r, r ,r, I r , t rr; Li r r r tr l l r o r i
1 ,,.n l l u
r,li |ori
r l r i i , l cr I,r r r r ,:r . r { l , I l L l ,r r r .r r r r ,
Ir r r i o r 'r i r r r r l i , r .r l ,,l r Ir r r Itr r r r r r l l l
L l r l l r t t i L 'i
tl i '1 'l ( r i ,r r '
I'r ,',r
||r r ,L 'r ,
l l r ( i 'r ') r 'r r l .
1 r r l r r l . r l r ' fj ,l l .l .r r ,
' t : r . l r , r 'i r r l i . r i :r r Ii i r r l r r r r r r l r r .,r . r l r , I r l ,.l r :r ,t 1 r r 'l l i i r r r l r r r r l :r ,r ,r r l .r .:r ,l r .
r " r r '. r i L \ r i 'r r r I r 'r 'Ir i .i r i L r r :r r l . r r r ,', r l , l :r r r r i r r r l i l j r l si i ,r r i [r r r ]i i o ( r l ,:r r .r "
[ ) ( l t t t r r , L l i tt i ttl o tt,i .tr r l i r t r tr ,ttr l ,r i ,.i r l cb i L l .o i r ,zi i 1 n ]t,( l {j l r u i t1 rl ,,r r i r r l ,r .r r r l
t r l l r r r . i . i r l i g .r ;l i ve ( co l i r i r r Ir r I.r r r i r r r Ir ', vi i .si 1 .r .i , t1 i l n ,a c, c) ti l l . i t,l .r .r ,r r l r i r l ;.
\ 1 r r r 1 1 , 1 1 i 1 ,1
r :r':'i t,cr r r cu i i l ,i tl .
r ,i r l 'i r r zl i ,
i ,l l h i * L r i l i r :. si tt"o ( l r ) ._ r .i l r r ti i , r .i r
,1, lrr'. r.uur-rrl"riir sttre d0 r,oLll)s, (]orrir ail odcri.r pulmonar.,

l;j.l.ii. Problenre rie diagnostic i.,r tuanilestjirile silrcopalrrsi rrllc

lrrllrririrri de constiuri.rtde scrlrli Jut,niir
ll.l.:).1. DeJini.li.i,.P rtti::t\ri tle tet'yaeni
iiirr"!i,i, io lr:',lrrLcJrriul,,r pier.derr:br rr;:r.i:-i dt, st.ulrri {lr,r.:rlit:r
' ','.rill.,.i. iu:otiti slu ul r:t tnrnilt,stiri tonru:ri1(,, lrrr.r.r.rl.rl.:i
:lrrr rrl
ilt' rlrilttolnLr preaccesuale,in determinisnll ci,reia intclyirru U tr,rror,
ir.
,, r!'l)urJL gensralizati[, ?roil-.rsii,l:r lildrLl r.i tic o oplilc r:onrplr,{ii,rrru
: ,r,rrpe cornplel,i, a ci}culatici sii'salL :r respir,afici (Oollurirr, |);1i;
.r,1rrr.l si

\ i g r r u l o U \.

l U ;1 . 1 \l :r .i i n v,

Ig L i l ) .

i'l{r ltic c:i piertlerite d,euLno\\tin\d ile saurtti durafti sitri, rnlr,i r,l,,ri i/,
,.,rrt..::ri
tteurololliati,in _centrul acestot manifestlri situindu-se lr,.a.li.l,rr,1,r
l, 1rlirr.,rlil. pot./i intilnite
foarte fr.or:ent $i in diyersa]'<r
tu,lbu.rii,itl. t,ri4t tt,
, ,t:it urd, cu crxplesioneurriloglticii,ca de pikli)
sincoTteled.edivlr,str rrrrI r r i r.r
.ll
i,lisilri, carc iusE trsbnie tol,dcarua difererLliu,iirde
:
.fu,lselc tittr.t,1t,:
lrl'rlit.ii srL' sirnplc ,,leqinuri,,(Faii.re, J.9?2).-llrcbuic aco*irr,iii
,r
rr rlrrrl,art!:ir,
'r:rr.,,
,ti sincopelortagale cane,,nc conduc la o ncurologio 1rlr.itllir,.r
ct sau f[.r5, reflexe rascrltio r-aso-vagfl,Je
l,rrllicrrlari".l,
snu vagir vrr,11:u1,,,
, i rrlii.lurminologia arrglo-saxoni.,c*rc fac tlil ilcest secior hibir.rl, rrrr,ii.rr'i
,1, rr ii1,rcin1rr.cardiologic.lincurologicr'(Faivre, 19?2).Asl,icl,rlrrr.iilrl,r
, rl,i" (1,.I'il,r.si nce fibr'ulor.telntirrrlu llo rugulrri (iu lr:u|trrl rlig,.;,trr
. i rl ()r'ii-til,r.inge
Jcsplc rcJi.ru aayt,uagu,l.c
, rle pildi) sc r.olbpDbe
( llatlli.ts ) ,
r 'l:rr-i ri llr _rrrldr.cl&nfrlul dr, sinropc pl,.r"i tlin \isu, c:r {l,i
IiLl:i rlirr
' li',lll4 iru d||r tltc ad'.ro, cSfe to|lr:r tlv rrJllls DaSo.tdqnlr.
lrr 1,,:rr,,
.r' i'ii1. (razul'icstc I-orba de intcrIcn!,ia ulot tcflexc ri:[l{o_{].1,r{r1.1{,:t,t.r,i'/
rrr rl. clcctc cardio-inhibitorii. ln accstc c{r,zul,i,
corclxl rilsprrrrrl. lrr,lrilrr,r'
r rr.rri.Iio lio prin tulblriili silro z],[ricu]iare,fic jolcriotialtr (1r.irr
{,r.rrrrl,rrl
J"r( (ior)ul atlio-vcutliculrr). Iiielderile dc crrnogtinf,ir,
vagal(J),1(! irrlr',r,lrr,,
,rrlto pt1ohrgie dc grani(ii nouro-ca,rd
io,vnscu1."lr5)'(.Ir,ilivrr),It)i:jl.
I r slir'5ii. sc insistii in Lrltitrriifttri asupll i4o-rruntit(\lor
,,sincopirrrrir I,r,,,
r | )rrlr,l li grial:., 1954),ttro poi I't colscr,ittlrlr,
rrnr,iitrull or rr,fco{iLtrri
sjrl rrll,;r,
rrr
r,.rl l (,

\'ILIi ('ILl i t, l ().

l :!.1.:1.' ! , \ t ut 'l( lu pit nlr r i

t lt ' t . ut j( , it t i.t it dr r uu: , i

nr ur ologir : il,

| ' i | |I (| rII'{' I t,rI rr cu r r nl, irr (lr lol: r l: i li r uI r r r 1I lr i: 'iir trp t i<, 11,
r lisol t t ( , il lr lr r Lr r , lr \ : r ,
rtr(ti 1tsi l ri .. ( lii: ilr , r r {r r ,ir r r , r r r , . , r r ') ,: r , r ir , ( ii r lr r r . r , lr r , ( , ir
( lrr r r t r , ( ii sr r r r z't . ir r
trtrrl .ti i ) 1i 11,f ir , ( r i r r r ; ir , l: r iir r . ir ': r r r ii,
,
lr
r
r
r
.
i; r l) .lr r r r . ||r r l, I i r ii
1r r r I r r r . r r : I I . r . ir r
l rrl rl l rl r.ol r r lr , r r r : r i nlr ll r , r r r r r r r pr r {r r r r . or r r lr lrlr . : r |, r , r , r 1r lir r r ( r r i,r . r r r lr ,

;It0
:t:f I

lrilrliLltr ct'i;ck psihoulol,orti,

ryihr alrd s/dri lnsotito do tlivrrr.sorrr:rn il't:st,r1,r'l
to1,ot'iiqi vrgrtativo.
turtrzot'io-rt
tfrlrrlrrricBfi a,\'(xlrin vcdere aci doud,gru,pede pierd,eri ile cunoftinlt\
rlt sou,rl.tl,
dura&[ (;\ruold, 197?; Popr,iviciu gi Pascu, 19?9).
1t.1.3.2.1. Crisele d,e epilopie, care comport5 o disolulie scurt[, tt
t.orriii,iolferi,dar cu hiperacl,ivitato sau activitate normal5 sau cvasi.
trrototic $i vegctativii, pot fi: a) Crize generalitate, respectiv
rrrrlrrrrr,Iii,
ll rrl,r'orLnrl'llicc(Crantl Mnl, Pctit Mal) ib) Crize parliulo, fie cu ,,somiologiu
rrlrrrrurnia,r'ir,!'(rnotorii, senzitive, senzoriale), dar fd,r5 alterarea cnnqtienfol,
lirr rru ,,stirrriologi.o
elaborati)', ca de pildi, c]'izeletemporale, crizele insularo,
rlizclrr psihomotorii cu moalific5,riale congtienlei ctc. Diagnosticul pozitiv
ll cljzckrr cpiloptice se bazeazi, pe o bun; anamnezd,gi observalie 61inic ,
;ru rlirl,ulo ltltG (standard qi mai ales prin actil'5,ri) qi pe datele complo.
rrrrrrr1,rr,r'c
(a,rtcriografice,pneumoenccfalografice, gama-cncefalografice eti.) t
r,) (irfuctc de peXit m,ql ahinetic (saa amiotonic-akinetiee) nu trebuie confuntlrlc t:t.r,ututut'ile co,ts,plecticeilin
ncolepsie, in care disolulia tonudulul
rrrurculil,r' la lrembrele inferioare, eventual generalizati,, se proaiuco do
olrilci rlupii o cmol,ie, firi, nici o tulburare anigilenlci qi ffrf motlificnrl
l,)lt(i ((bltariu, 1971; Corfariu gi Popoviciu, 1971; PasBouant,Popovioiu
1968; Popoviciu gi colab., 1-97A,1972, 19?8). Derutante slnt
ryi r.rrlrr,h.,
clizclo cltaplccl,ico inso{ito $i de oareca}e tulburd,ri de vigllenlX (Corfariu
qi I'opoviciu, 1971 ;Popoviciu si colab., 19?2, 19?8). ln sfirgit, crizolo rlu
1xr1,ibrnirl akinctic nu pot fi confundate cu acceselede kiryersomnie ulo
u an:o[t:TrLicilor,ale cSror manifestid
clinico-EEG qi poligrafice slnt
Ilrr,rrryirrLi,o
(Popoviciu qi colab., L972, 7978). ln sfirgit, la oamenii mai h
l ilrl,ir, (inrleosebi dupl 50 do ani), care de altfol rareori pot prezenta crizo
rltr pctit rrLalalcinotic (Arnoulcl, 1972; Popoviciu si co1ab.,19?6, L9?8i
lblxrviciu ryiPascu, 19?9), o c5,derebrutal5, in genunchi (prin alerobamo
t(!rrrl)rolo1 infcrioare), fd,ri, pierdere de cuno$tinld,, fXr5, sau cu veltij, tto
rrvrru"i,rr cr'f,pdde ,,rlt"o7t-attacktl,caLe cel mai adesea este declanqatd cle tor'.
gil;rrlrri qi rotalia capului, care antreneazS,o obliterare tranzitorio
rrirrnrrrr,
r, l,t lor'(ji vcltr',brale qi, in consecil!5," o ischemie acutl a sistemelor rei;iou.
Lrlo rlirLlrutrchiul ccrr:bral (Arnould, 19?2; Aqgian, 1968; A$gian qi Po.
lrovicirr, l ${i91A;gian qi colab.,1969 ; Popoviciu qi colab., 1967, J-969,19?Er
tll?t)). Atn'N,gcr atentria asupra faptului cd, fenomene de insuficien!5 vol"
i,rrln'obrr,zilillii, cu crize do ,,drop-attack" qi cu obnubild,ri pasagero d0
rrorr5l,ion{,ir,
}retabile la confuzii cu crizo de tipul absenlelor epileptico potr
nrnvrrrri 1i l& indivizi tinori, purtdtori de unco'discartrozi, cervicald,I
rll (h'imla psi,hornotoriiprin leziuni tomporale, limbioe (Alnould, 19?3 I
Itrlroviciufi colab.,1976,19?8;Sagerqicolab.,1970),sau alo triunghiulul
lxilrorrurl,or(Dimitriu, 1972) sint lesne tle rccunoscut din punct tle vocloto
ofilio ,,rillliG. Acestoa nu trebuie conJund,ale
cu ,,ictusul,omneziol,, sar}
Irll)rozintr, o staro confuzional5, do mai multo ore, cu alezorienta,rotompolo.
Hptlitlll, dal in cato $taroa do vigilerth, qi funcliilo sonzot'io-motorii Blnt
pul,irr altorato (Arnould, 1072; Iiisor, it962; Popoviciu qi },asou, 10?0),
Acusl, islru'r aurnozio, duptr,cnro br:Lravul mauifcstb o arrutozio o fonornsno.
$o (ll,l,oloflto umri irrsulioiorilo cir,oulalrorii, cu o consooutiv[
klr a'ooorJr.ru,lo,
ttt I brtli r,ro Ittttol,iortttltL totttJxrrtr,l[.

I)ia(ln,o,iott'/"d,lfot0,ttl,Jdl
ln lrrrlrrl 1rrNi1,
tr olirrrirro ttllt rnrr.
ni.ltttl,ll.t'i
n t u,ro-psi.h
i.u,l.riat,,
flirt n r. nl nt tlt' ttturrl, r pilrlttitil, li uti 0 u, tnt,porlll
0 1,(tikr,l)il.drlittol.u,l,i(
tr ntuylir'nlr'i:
l. Oritcl( ),mearopal,iorrt)
..n) (lriut ntnLnld.Soplodu outrr cir.(illlrrfl1,rr
l l(\
rprrcitlo,si ou trn,,sor)l) rr1,ililtr,r")(Alrrorrld,
1972; J?opoviciurli colrllr.,
ll)713),obsol'vindu-soirr rnrrtlicirlr,,,rIIr,r.rIrl'III)i,'t,
qcolarr'!,
sau socia,l)t(oxl)ol.
l,izr'i).Sirnularca,esto grosolruril,rlrl rrra,iadeseavizibil ,,volunta,ri,tt,lir,l'i,
lrtlltnt'ii,rivasomotorii (in slxtcia,lla fa!ir,), firi rnitlriazi, Id,rI tulbrrr'fiti
Ilill()toliene, fLrX somns piramitl:r,loeta. b) Cripelepitiatice pot rca,lizl,fi(!
lrsorrdo-comeletargice, dar cu absenla tulburXrilor nourovogetnl,ivu, r'rr
, cosdo tezistenfi ia tentativele de ,,trezire, t $i cu ,,impresiott dc vigilol rl il ,
'r
lir! crize pseutlo-convulsiyo,dar care nu comportd, nici citlole br,rrlllfi,
rrici apnee, nici clonii, nici stortor, nici hebetudine postoiticl.
So nlr,i
lo,
lrrrte nota ur tremor palpebral qi circumstante emolionale docla,nqa,rr
r\ Criza afeatiad,banald,,.omare a unui $oc emotiv, poate comporlrL llltol{r
pot preto la erori tliagnostice : stupoare, hebetuclino, il,gi1rlio
'.lolnente care
psihomotorie dezordonatS, rlar totul clerulindu-se pe un registru do torr,rnil,
rji {1o anxietate.
2. Criaele m,atebol,ice:a) Criaele kigtogl,icenicese manifost?t do obicrl
rlupi un efort, la un inttlrval mai lung clupX,alimentalie $i sint pr.o(1(xllrl,(l
rhr tlanspiralii $i ale o sonzatie de foame bruscd qi violentd,, Dsrulilroil lrl
porlte fi similard cu cea a crizelor epileptice, chiar cu prezenla do furrr|lrrr
1riltrrridale. Efectuarea unoi glicemii trangeazd diagnosticul. b) Oritt'lrt
xpnsmofilice, Experienia ciinicS a diverqilor autori (Arnoulal, J.0?2) rii l
ruiu,strS,
din ultimii ani (tr'Xg5ri,gangi colab., 1971 ; Popoviciu qi r:olirlr.,
ltJ70, 1.972, 19?8) aratd, cH,acests erize spasmofilice $int alostul (lo I'l,r
vrt il,rbile crize ,,tetanice" prin tulburare primiiivi, a rnctabolisrrrrrlrri
.rrlcic. De multe ori este vorba cle crize de agitaiie anxioasd, cu pal;ril,rr,l,ii,
rrr irnpresia de ,,moarte iminentE tt, cu tendinie lipotimico llsol,il,rr rlo
rrr,nzalii de rd,cile gi clo furnicituri, dured $i amorleli in oxtrornit,i,fi rii
l;r rrivelul buzelor, precum $i de contracturt in membre. Amintirlr oil, nrrrrlrr
{ r'izo spasrnolilice pot imbri,ca aspecte ale crize pitiatico, iar alt,olo pol,
lrrru:r,specteclinico aproape tipice de ,,absenfett,sau chiar do qnvrrlsii
lonico sau tonico-clonice epileptice. I)oar prezenla spasmului clt.rlll
1,,rrlu,linainte, in timpul criZei iau postcritid precrirr, ryi aspocl,{rlo.ltiri( I
(rk'scd,rci,rilc d.e unde lento asculite hipersincrone gi/ sau clo undo lorrl,rr
rrirrrrsoidale
induse cle hiperpnee; absenla modificd,rilor do tilr opilolrl,io
lrr, st;imularea foto-carclidzolicS, qi la activS,rile cu Mdgimido) 'puf t,r,it,,irr'
rlirgnosticul in fa,r'oarea spasmofilioi, oventual diagnosticul do slxr,rrrurfilirr
:rvrcilr,t5.c-u epilepsie (I'A,gArE
$an $i colab., 1971 ; Popoviciu fi c(,lub.,
l r)?0,1972, 1978),
.12.1.3.2.2.Iotusurile de saurtd, duratd, Al[,turi do ictusul apolloot,io,
,r,lr r{,r'ui rnanifcstd,ri pot 1iiile lungi tluratf,,, so pot obsorva la unii vtscu,
lrriJ i{}lilr$uri$curto, atkrsoartpotatc, caro survin do multo ofi cu oqlzill
rrrroiilohinrbii,rirlo pozi{io in spaliu, dor unoori chiar Iu ropaus (Arrroull,
lll72 i.llopovicirr ryi.I.)ascrr,
1{)71}).
So paro citrln &ooctocinzuriogl,ovot'lu do
o l,nlbuto,to d0 iriga,llg oorobmlfi,, produ*Itr prin hiloto:nsiurri t,ol tivo, rot{"
rrlr.obrtloty[nzito]'ii Ii/ snrrint;olrniln)r]1r(l
;xrrl,ivpt'in it tufioianl,ouilrIrrIrr,|rolii
(rIr,1,1
rlo l,rorrrlxrzolx!rlir o l)r! slnl,orrrrr'l
oaroti(li0,n).lfupil, n<ttrtllio
t.l,rr,rrrrri
irrltonlln(l(ort (lltrr!1, (lo ollr!\,1,noctrtrdo1rlrr11,
ln oil,ovn rrrlrrll,rr)rll,lnltr

irrttji,tlr' olrirltrittrtclr.rrtir,ilit.rturrttIrtIt.rrIrrI"icr,:
lll1riu.r,,
1r1q:1r51,1,7i1,
J,iu.(,/.(,
rlr:rrrrrrlrr
l,rtllrtrr:ifiltfllzi(Nl{)1,o
, 1 1 r r i r l r l l L r l , , I r i | ,r , r r , r r I r|
,
r t t i l r t l o I I r I i rL Ir ( r cr r l r tr r r i .

I!.1.3.i2.;i.XIui.f stiirilc si &pqt(,

l::,.;.3.1!.:J.1.
l) tIini.!.i?-,{rnirL.Lt:ir,rrr
ti), $i)tcoP(,r.tlrrlzirrlii o l)i(jrilr,rlr
.
Ir..rir-ii,1(rrlior':nii, a crrrxrqtintci,do dlu'atli scuilit, pl'(l.o(lrii srrLirrrr rl,,
(,i.l,tIz:.ttii
r.r|lrliln|lrtol)t'(iir]c(10stL|.1r,
(lo (} tl,nori0 crtrtb|alii .qi itillrsocrili,lri
rlr,
olricr,i ilo rrrorlilir:ir,riorgllnioc ccrcbralc (Oorfar.iu,t g?g Wrlvnc, l tlti l ),
;
Sirr.r1rr,l.sn u;1, intrluh.a,
iu.r';rnprrlaccosclolrliitlnc riccpiioplicc ((irr,lrr,r,irr,
llrilr lll?il). tia$taut [i (iastatt (1956) au a,{irilat loati;c sugcst,ir.r,i sirr
lulr,lr', r'rr,rollu ayut totrlcllunl soarta ,,p:irinli.lor silraci)i in cor,l,cilirrl
,rirrrIr'.Ir,r
rrrrIrIr.
pa,r'it.risl,icc,
r.e1xczintilin re:llit:tte-cauza cea ma,i fl,covrilrlr!
;r lrioltlr'rilrrl rlo c u n0,5l;in!:_"r,
lure, s:tu :tsocille cu convrLlsiitonicc;i t,ii
r*rr';ilar
rrrrr'rriftrsfii|i
tlcbuirr in rirod cltegodc difclcnliate in p]'irurl r.i},11
rlr,
rrizrlc clrilcl;ticc,
l:'./..1.i1.,i.2.Ula:tiJictititr BilLupelor sint Ioarl,e clifcritc rle 1a rlor,
I:r:r.rr.l'r'.
llrit,l (1U.50)
r-i li gel ;i i.otab.rlg.-,.1
I relr.ter,ziciuci etuzo rr.r..1,,r.,.
,:rprrl'ilr.s)r,lrr,otluci sirLcope:iulbtrrriri rle cir.culalie perifericri, aliec{irrrri
r,:rIrIr:rr'|',
r.r'|tLZLr
Iorlu.i!t{'rii, rfertiuni ccrobra,]eqi boli psihice $i, ca,[11r,,
;lrr llrol)us rurniitoruca cla.sificare: l) 'Iulb".trdri ale cirau,laliei
ltcri.fn.il :
;t sir{:i,l)N,'r'l.r,so_-tlepreso:lre
(raso-\.agalii)i b) sincopa din }Lipoterrsi
Lrrrorr,
rrr'lrrsl,rrlicii. Af(,cliuni cardiace: a) tultluriiri de ri[m cartlia,c
lin spcr.ill
,2)
rrrrrlrrrrrrrrl,,\tllm Stolics); b) sincopa,din biperreflectivitatel ,sino,ll,r.r,
lirlirrrrii; rr) sincopa prin aitc tulbuliri ; rellex6 vaso-vagale,r,efltxe g.lrrrrr
lrrlirrrlovrulir,lc,rcflexe oculo-ra,ga,le.l) Sincope prin iawze respiritorii:
:r1 ..,i rr,-rr1r:r, rlt' 1Lipr.r'reriliJri,lic; b) Silrop:r, la trse. 4) Sincopa tlin tlif rit.r,
.
ttlhurtiri ffrrl.trqle (sinc,,1ri psih.icl). fi)- Alte lrpari; sinc,opa do tiri(,li
rn I r

I ll,( ] .

Wlyrro .(11)61)lr,.propls cea mai complet5,clasilicare a sincol)(ll(l!.,

,
rlr..,ir'r'iiilrr,]rilir,
plin liirsr rlc procizitrneryi11eexactitatc a unor itoiirrrrir
,\ " NirrooTrr_.
pri n isch,amieaet"ebrald,
gener&Lie&Nd
:
l. l'rin scdil,r.narezistenleiperi,ferice:
Atiire: - sinropa r':rs,r
r;r;1rlii,
sircopl, simtsrlui cmotk'li*i,n, -- ^)
sincopa de liper-.lenl illt ir,,
sirrlo;lr, plirr rci'lexe ccrcbralo (sincopr 1a tuse), - sincopa,prin lollr,rr,
rrrllrr r:rlrlilrr) (siritnpn din stalrozn qi insuficienla aorticit), , sin()l)ir
(ilfl:t'r.ct;i anginir,pectora,lir,),
- sincopa pliu rolll(,\rt
lrt irt tollrrro (,nlorrlLt'c
prrlrrrorlr,rrr
(sincop:r,11 1,use,sirrr:opadin onlLioliapulmonari,. sincopa rJirr
Irrlrr,r'lcrrsiurron
plihnonafit, sincop:l prin pulerei! in joc a nnor iefltrxo
rrrll,ir-r'),lr) I)usiae: - liipotcn$iune o.r'tostaticil(in convalesccllii,j lrr.irr
lr.:r,r'{iil:r rrritdorlrogLrliI postsitnpalie{itortrie),
- hipoterrsiurLcortosjllicrl
ll'rricii (irliopr'r,tirrii,
slu secnndarii unot: lloli nel.voasc).
.r.rni,r
l. I'rirr, scrirlt:rtntlebitrt,l,tr,i
cardi.dc: 1) stoyt card,itc (srruurprr,
r:rgrr,lii (r,lrrlioinlrihii;oric), sinoolr, s;imrsulrri rrmotirliinr, silcopt rlirr
rrlrtctrl Atfrt,trr-Slol<<rs1
1;1prin descrafl.rrfi tnlu.tn-hci\d,ii
rrardilrrt (sitrrrozjl
rroll,ici, irrltloL tniocitrdic, a,nginir,
pecl,rtllllir,lrlil,lnic caldia,ci,)jrrsrtiirriorr(ji
rrrrr'I
it,:'i;i sl,orozr'r,
mih:r,ll).
il" I'rin. tnu,.tu(t,l,rftcot\Iilti(:
ilrsirntu lrLr)rnonltr.ii
ir,)lripr.r.l
I lr) sitrlr'1rrr,
l:r. ll$(,r; r.) ll.irr rrra,rrovllr,
Vlr,lsrrlt,rr.
ll. NIttcrtltt 1trin.iwhrrnr.itu.tthnt,hi,Iurtli:tlii :
l.
:t:f.l

llo li

tur.srulq . t t rt r t r lu' llt :

lr , ) lr , l, , r ' o r ii : r l i l l i o s c l c r r r z t i

; lr) irontltor,;i.

I'!l

, r r l r r l :r t( . r 'l l r l l ,r 't i r :r tt i l o r r r l r ,r
i r r l i r r l t rl l i : r i l 1rrr 1i : r Iti 1 r ,,ri r .tr l i t:r ;
tL l i r o t i tr r tl l r {l r ; l l ,i l ,.r ,l l r l i r r r r

1' ,.t\i ttutlt t ' 1t r in, nr r , |: it ', 1 i it t lt t t l, o: iliq, iit t lr lt t i:

l ) .l \t' i n hipor , it : r ) r r r r ) , r ( ii1ii r . lc : Llii1iidiur , I lr ) ir r ir oli r '( 'r q( nii: r l( l
, l l rfi i r(r{ ' .2) l) t 'ir t ,h. i, 1t ot r r .ir1't(rr i; Liolr c lt ir L liii; t , r 'i cr {, illt 1u: 1.ll) I 'r it t lt ilt 'r
,,ri rtri r (i rr r:or r t lif ii t lc lslir ir , , ir r z) : or r t i r t 1- r : ljillc) .11) 1'r 'ir i It i 1t r,r1I i , r' tt t i , .
:' ) I' ri n tu.Ibur d, r 'ide nulr iiir .
U . S i nco pc pr in t lisju. nt f ii r c) t tt 'cir : 1) I i' r1,i t ' 7, ir '. 'l) S it t ntlt r r. : ir
t ti
i t t r : : r lt
''
r,'
l
i
rl
.i
q,n
ist
t
ir
'.
{,
t
(.far
na
I
n
I
)
lt
t
t
:
:
,
',
,
1i
ln
cent
r
ald,
)
.
3'1
lt
t
t
t
t
t
i
'ut
.
.
:
,
)
"
,, tt l l i tl ,a.
l'1{roiz[m cii rrra.ioritl,tea crcr.ttftli iirtilt}r de la irrrrrrt:lc ll si lt rrrr
rrrl rcri tl bi l c sincope, ci. le f alt r epr czint ii t Lt lLr t Lr iilillc i. or r slicr r ( r , ir i, ,
,l r, rr:r' :t,i .i pr i r I r l^ |li. Jt , i.
l, .
|:!.l.3.2.3,:). I i.tt1ttont
nt.ologie clixiari
tnainte de a aborda, clj.rcrselg entitiili clinice, al,r'tgolr ir,r,(lrrlt rrrpr:r,
, rtttltt.ont,clol'
r'
{lenarole, camune \\i, a 4inpreju.rdrilor in cllLo so {I('(,IiIIIrilir?.rI
I r(' opa,
r\ntliza iirlprejurililor carc ilu dLrsla inltalarea picltlt'r'ii ilr lrrrrorji irrl;r
, ir rlc o deossllit[ inipoltaril,ii, in s1,a,l;iiirca dingno-qliorilrii ((]or'lirrr,
I l) , I , 19?8). Tlebuie si, so liiiil so:lina de sohimbi.i'ilc dc pozil lc rrlc l. r tru
l ri , rl c e.,.en t uala deciau$ar e la t use, t iicliunc, f elt r l. r , oLr r lr lr : sir r rlr
r ir llr o
i , r'\ iclrle, la einoitii, sl,irii de "lrisii si rie lerrsitrre elc. .r\lictr:rIrrL1rl,, lrr'r'r,,
rrrl o r e bol nar . uhi sint t ic inar e \ - aloar o: t t ecliiur ile cilr r lililr , I ) llnr lr ir ( . .
, rl orl i l er un ele sr lf er in! e ne. ', r xologicc( sir ingom ielie, lt it t s i, lr '. ) . , \ r 1, . , . r ,
l,i( r'(lcrca cunoqtin!ci esto prccedati gi,/slu urm:r1,ir,(lo lrr{,r,r r.irrI r | )| | ,rI r.
, t)r | i nsi ncopale'' ( G asLaut , i9j0) . O or lar iil ( 111'i. t.J19?8,\ r i ( . lo|llt iir t i l', r t , ,
r ilitL (19?1) a,Lr insista'. Rsup]'* il tlou i, gt'rps do sirnpl.omo; u,) sirrr;rlorrrr,lr,
l, r lir{rcesualc,care rnoori se poi lnallitegto filrir, sii, {ie xr'mt1{) (lr) 1rir,IrIr.r,,r
, rrrrosti l ei , put ind deli 0oDst it ui un , , echivalcnt ) ' al sincol) ol0r '; lr ) r r I r . r 'r ir r l
t'r'r,ln:iu-zis; c) siinptomrrlc !ostaccesltlo.
pr,lneig cu aproxinutir'
S imptomele f)rcacces1Ld,le
5. jl{) rlrr rrrlrrrrrlr,
rrrrl rrl al ca pi cr dcr ii de cuno{iini: 5, r nan iloslinr iu'se pinlr - o s1, r r , rr'rlrr. r l*
,orrl i rL' t, translilalii
ieoi, inccf oqar r : 1,Teder i; , am clcli, gr i'lr r li, pr r lor r r , , ,
r, rrzrt,ti ede p r ir bniit 'e. - ilccst e siinpt or nc pr eacoosuilo , , r lr , lr r ct lizr r r r '" |t l'l
/rl ' ;i i , { i :r,de p il<iit ir i sincopa 1a nir r l; it : nc. Ln schim b in cuzr r l r ir r lr , 1, ,i r lr r r
rrrlrlt'c1.ulit-Liocartlic sau dirr angirra pcotolaJl, pr: lingii ir,r'rliio sirrrplrrrrr.
p l crr,r.r:cs
ttal o obi$nuit e, pot zpar e: dur cr i plccoLr iiillc ir r lor s, ', I lilii r lr ,
r r,rrrt,c q.ll., pc lilgil semnelc stilrii rlc qoc.
,4ccasulpropriu,-zis tle pia,rtlereda at,nofttnl{:tcstc sourl (i
{i{) si r.rrrrlr'),
Lr (' utsu1 oi " tr uia so lcr nllcii ilii ir r , l o f lllscit lit lll, t , r lt iscr r lr r r ii 1i lr r r lr r r lr . ,
,l r! (l i t(,i 1,a,ccr r : srsc
r l J) r 'ulnngar llc,sc l) olt . lc insl, r t , lt o r , or t llt r oir r t , i lr r r r ilr r ,
,rr' trrtl i i , tti tco t 'i ( lc ( , ii( jvil <'ot r r t r lsii ( , 1{) lt i{. r ('., r t r lr r t . it lr 'i,
l1e 1, 1 l( l r r r r . r r r r r lr , .
Ir {' l tstl l l l l zr, i 1, r li<t , llr r lcr r r lr sir , ir rllt ,o lt ; t r r t , ir ,ilr r lr ii lr Lr r r ,llr slir 'qilt r l : r r t . . i
l , rr, i tr l ttl str l Jr zr : i llor r ill r li lr r r r lr r lr , csr lr lirr r ^llr ilt r ii: r r lr . r ilr r
r ll r r lr i,r . i
l r,tl otrr:tsi i ,$i ( lt 'nr nl
Irt rr1rI i I t rr I i t rr' . Alr , llr . rrr ir I r ilir sI iiI i I or ricor 'I or r ilr ' |r , , 1
r. r i ttti {o rr l l izii r lr , r '1r ilr , ; rr , 1qt : r t r r lr r r r l.
fi i rttl tl rut r r lr 'lt t t t lr r t , r ', 't r r r r ltllr'.r I r i r 'lr r r izt r , r r :rr. r 'it , i, r lr , ; r ir '1r I lr , , , : rr r r l, r . .
Irttl rri , l rrl tl t,t ' t l 1r lr . , . it r|,
| , r r r lir lr r r il r , r lr i r l' r ', r r r lr r , r ir '.r lr r lr r i: r r , r 'ir i
l ovi trr. r' otrtl lr 'l , t l; r l lr lr , r r r l r , , r , r , lr r r r r l, I r r I r r r : I r I r r , , l: r , lr rtrr lr lr r . , r lr t r lr r l
.l i r

(u ri t rl t r r r lr oir ir : r , ir r ll rr,| r).,\r.r,| i o rti rrrl rl ,,rr(' t:r, rl rroi .i cl | }i frrl r.fi ,rl rrti rrrIl o
rrrri o l rr r lr r ,lr ollr . r ilir ' 1 ir' 1 ri Ir,IrIi l Ii ,l )l i l (i l ti .i l l l l l o l l r.rrr.l i i ,r,l r,;i
Jrl i rr(,t)l l (,\l l l
l t rr 1r1rrrrr:r1rr. rl i t r r til i i IrrrttI]o Ittr,.
l . |ir t t l) t lt : , , , , ' U ..,u ,t,'
l .i.. , 1 r' rr.irz
r i i , ((i i l i l r.rLl i .rrrrl z,l l ti ti ) i .i , l rrr.1,.1q1,;
;L rr.rr1 r r r I rr,l.r ' . r ' ir J irri i rl u l l i rIi
o s l o a k i rl )1 { ))i i rnr}li v I l l o si rrrrrpo, rl ..rr
rrIi . * Irr I is I i. i r l, llii (i i l ,l r l )r' o (]{ rJ rti
(l o l 0 % d o a,l :or(,i l ,' rir.' u' rl i o-vi ,scrrl rr,rrr
I rL l r' l i lt r . r ' iqir r . r r s i ttl u rp .l 0 r' , l l o c i r, i ri i u U l s i ]tcopol ol , (i i u,di i l fi l osl ,(, l .l ,
rl .rrrrrr ' r r i' r ' lr r ii, I iir rrl r,r' b l r, { l o o fi rl l )n } l ,r' o h em-' di nami oi i cl e grrvi l rr,r.
l i o -' p ,rrz i r c n l rl i L c ri r,r
.i rl r.rrlii r r r . ilrliili rr,)_
,^ ' i n rl cl 1i crnscci nt i .' i rn.r Ii :rIrr,
,r ,Ir'i .r' . r , i' r ' r r I I r , I r I.|i: i r;b ) l i c o ttrl b rr| ru o d e ri trn , uttri l rtcl rl rl l a, trn gl l rl rl r,
i rr, Ii .rr' iI r r I r r . lr r lili' il, I r) fi e ri s i mp l i l l r' i b r' .;ir:c :l cl cbi trdni , c:r,ro
D { ),rl t,
r1( rn r)r r t r ' r r r r r i r nr rl l o l ro c :1 rri s r' n cr'
. ro g rn s N i cr l l rccstol si ncopc { r:l ,ri l i rr.r,
l rl r, Io I r I r , r r , r r r r glt
r I r r' , o x i s ti n tl l i s c ti l rrL rtr' !;isrLl
i
ti te.
r," linrttlrtIa. rl.in t:u.rsuI r:tt tliopltiilor
rr) lrr .r./aro:c {{0rli&i sinoop:t :u.q ciu'itotoro prtognoixoDice: sullirrrr
L II(| ( i || iI r ir ir r or r i. s [ l i tf0 r' 1 ,u ri l o r,e s 1 ;cto l a l l i i , i l u r etl td 1:Z mi n te si l i l sr,rtr.
,,'..r'rrl
,.1,ilt1rlifrrr.rnr',rle\i prczerrl:r, a,oestiola,nu elimini iiilglroi t,irrrrl
(t;rl ',r'rr.iil,
t , r ' ir1r 1 lllil) .
(i rl t1 :l\.a i ' d i n , p t' e c rrtn
]Jammarst0n l C i tal i rt,,
(lrll',{'rl{r'''lz, l9?ti) N,ur.r'llta,l, e:isloD{a rlrror Di
tulJ:urH,ri premoniiorii, r.rr,r.,,
l',.r'rrrii.lrr.rlrlr,r'rrlui sit-fi , rprcgiitea$o['r {10 multe ori iXclerea: clisltrrr,rr
Ir orilr,sir ii, plo,siruro i,olr-ucicil,senzir,fie hitllJir, tle ,,glmbe de vat5,,, ovr.rr
lrrrrl o. r r.r'il,l,lrilr"r.
itizii, r1e
lngor'. St. r(lttitr,.il ,, pibuqire {r, T.A., ptils f ili
l,,r'rr. (,11.'s('il,irn pci,r.tptibil). a,sur.zi'eil zgomotelor cardiace, arleiea s.llrr
.1,_,1i,rI i rrri rrrrr,t r'r, s Ln {ii\lriu ilia ttil{hri sistolic. Dupi, Trendgre (cilrrl,
,r, {:i r,,' ,
,1
r r l. r ' r r r t r . lir;? t. s i rr..u l ):ltl " o fo i , -rrl r i rru i o :b% di n" sl enozr,t,.
: ,r.i ir r', r'rr r.is. dc t.o:lr|c subil.i si r.r, p.oEnostic ulter.iur reZervat (mour,l,r
rrr rrrr,r lil ir r r lr r r r r ls d o :' -4
a n i d u p i t p l i m a si ncop;).
lt) Itt, ttti.tot"tttr.l le,u trotnboz& u,u,riculo,rd,(afec{iune rari,), tuiburilr ill
r. 1r'rrlrr. r,cl rrl,i rilr'sou,r,u ocazii:l schitnlllililor de pozi!:ie : crti, digpnoi(,il,
, rri r)zi l , ( lr llt llli s i c t.c rr{ ,u a ls i n t:o p i r,.
, ) lrr h i1t.r'tlerLs
iunea 7tulm,onari1,,pierderiie de cuno;tinli
sinl 1rulil
I cl rr.rlr ( ( lilgc r r lit r .rrl ,z ,1 .9 7 2 ), Ii i n d l l l o re rl a te- de cl i spl cc qi consti i ,,i i ,,
l,,r:,r, r (1,irrii,lrr,, ll*ntrri, d u.e'e llrrginrrir,sril.ln cadr-ul hip'ertensiurr ilrrr.
l rrrl rrl rrr:rr . , rrrr.lot. spcci:ll-i) o',rr1u, hipcltcrrsiunea puhnondrX primil,ivir,
rrr .rr|r' I ir r r ur I r r r I us in t m a i tl c rv e l tc . l i r s rh i n rl r , hi pcrtensi uni l e -securrtl ,u,,,
rr.r'r,| || ! I ir ) I ) iI I ii dr lri u d i te s rn l c o n g c n i trl l . &r d t si ncol c tl oar i n 2/o rl i rr
, i l l r i r fiir l, ir S r , . 1) l ' .. , i u l rl c G i l l n .n l u a n l z , l C 72).rl\. ltt i tt*rtlioientu. coronq,ri(Lr1.d,
t)ot Bit so producii si,ii,ri sincopalc, rlrr,r.
1 rr i ' l a rc fl rl trti o c a rd i c ,p o a,tc sul reni , i n faza a,rtrrl ,i 1,
l rrrrr rrllr r r r r r i, ; t , t r is r n ..
lr ltrrtrt rlr Ilrrr.,vgrrl;ro sinCgpli, :ltlCSea,mOltit]ri" lllt,I, Aoeeaisil,radu1r,,r,ri
,l rrrr':i r ; ir r . olr r l: ' i,1x [ 1 l ,tll i i 1 r| o rl u s i i ,d e c l l rtz e d i l 0]' i i i e: 1,ul btrr.nL,e
dc l i l ,rrr,
r',.l l r,r r : r t ir r lr s r r r r r . rl u 1 rs . l i 0 c u n o i l q to , tb p i l d ri , gt,i tvi t,at,ci t,1,ul l tut.i i ,r,i l ,ri
(1 ,' Ii l n r ( lir ) ir r I t t r r l, i rL s l c l i l l
i n b l o c ru i l o ll t,r' i o-venl ;I,i (tr
l :Lfo. I)unrr.t]l t,
:| | r|| I I t I j i, i I I t t rt tI t t trt I 1t t I d cttlttrr',rit,t,ii
l{jftr)Z(ri I)olt1,ol)fovotjlI o sincol)it,ro1lcXil,.
Irr i rrri rrI i r. i rrrrI l r, r , oir l rl n .i l n ri ' t,r' r' o rti i ri l i c c rtrr,l rr i i r
,,l l ngoru I si trr,,ol ti tl r).l )l
||IiI I| | I r\| |t III ! lr it t l, r t t t t r ts t,trl o l tt,r' i tl trtrl r' l o ;rrrl ri l ,r' rl i rtIIr| rIi o1rItIi i IrIi st' l l {rrrri | r,.
ll" |;i tt,ln'lt tlil turlt"ttl l,tt,lhuriitilrt rle ri.l,n utnlit,r:
r\ r r r c ilr r r r rr rrrri rrl l i rI r' rrI, rrrrn rrJ rl l i r.r' rrl rr l r l oi :rl l i rr r l rrIl i rrrrI:r,r,
l rrrrr,l ri
L tttttIr'It ' t I Ir r r r t r lt r t t tArl
t l l tttrtl { l o l i trs . I' t i tr r.rl i trrl r' rr' ,rrr'Iroi IIr' rrrrrrIti rIo
l rrr' { ,l rIi
,l l ri

l l tttti ttol rtgi c;,r t r , it t r l , 'r iir , r lr l, r , 1, ii l, i rLl l , rr) rr l i r l l : t ilr t t lr r r lilr r r ( ( lilt 1r 't r
J,r' ;rI l z, l l tt:l ).
lit t sit t r lr ot r rt l \ r lr r r r r ; 1i, r l\ 'r r I ( r l) l( r zir r lii ; l, l'11, ( lilr l( ) lr r lr r l
I' i i tttrtt1rt'It1|
( lr r t I r r r ir
, rrzttti l ot sl rtrl ilLlo r lo \ \ r t r r r '( ll( ; ll
, r i t ) r : , ili, {lill st r t lir {, iiit , lt t i
(
l(
j
ilr
'
lr
r
'it
jr it li I t L
lt
li's
llt t i, t llili
(l 1l ;l J). ,r\l )rtr tlc ol) i( 'i'i r lr llr r r \ r r 'r l: r r lr l l0
:rrrl ccctl cri to c{. ! Tdit t f t )f i : lI I I r,rt rrLI ( ,|| | (i . illli, llt or r lcliuic r lt ljr t , zli it t I t t t t r '{t r '
l iliilile r t 'pcr cr lt r ir t r Lii: r st t l't : t
rl rf 1,i pu1tl e asislolie, 1r r I rt t t t t r ii r lr r p r tr '1, iciraa
, ir r,Lrl:r,!iciocrobralo. lJll{rii s1.ol)ul cludiac tluieazi ci{ cr;ll stttttLtltrr ltprtttr
,lorrr o st&te dc slil,biciuno, itLso!it,il,do pftlo:lrc) alneloli, ;ri tLlllrrrlili, tlr'
rrrrlcre. :\sislolia r1e pesle .10 secnnde produce piet tlcr'cll c1n1(rltiltl('i,.(1ll
, irr,rtozir,turgescenla i'enelor jugulale, Ii"rirea qi suler{icjllizir r' rt, r'l'slrirrl
l i(fi (pin:l li. npneir) 1i convulsil tonico-olonice (tr1-a1'ne,11)0i I ( 'olIrt't itt ,
rl ri l i ).
dc lii,m, ''je descritl:
ln cadrul 1tll-rlriu'ilol
1) I'ulbtu i'rile (le co duc(re, ca'ie sini celc rrrtli Jritrc cunoscttttr trtttzr'
rI0 sincopelor :
(rLlar. De obicei, pic,rdelea ile cuirorllilt{ii t'rlt'
Blocltl etri.o-t)etLtri
^)
qi imprevizibilir,. '\Itrll, rlrai r:ll oa estc dccl:rn;atir, in-tirtLltttl tttrrrr
'rlNrtrtllnir,
'
\'
Sc-;tie cir, daci' blr.tcttl '\
,,iirrt, ca, Oe pilrti, mictiune:t slrn defccalia.
t ir lir : r
,,,rrrfl et se i tiagnost ichcazf r r . ur ' ( ii3. j; ; ) , l, loculile
- pr t r r isI ir r t r
(le L L1lrof
\
't'in1ii'diu blt.rctrriltr'\
l,rrbleme di{icile t1e diagnostic. PiFrllt'rcir,

/t

D i 4' \i rrt,,l ,:l

i 'i t. 3?. l nrc gi s trare po)i gr.rl i c i h bol nav ul S .I.,61 dc
^[jtus c l )i l opti trrs '
Ios L i nternal i n 19i 0 c n dg. S tx
(si ndrorn A dams -S tok er).
'
l
pcnhLr l rec \c nl c .ri z c dc I i c rdc rc a c l 1nol l i nl l i , l ns ol i te dc mttl Lc ori d(i
Tg. Ii uret ex anc r[rl U l i (;
con\arl s i i i unj c ! ri oni c c . I I c i i ni c a
^v c nrol ogi c i r
i rtcrcri ti c a l os t D eg.l ti 1' .E -\anrc n]rl pc ,l i grai i c a eY i denfi aL un ])]oc nl l i rl '
vcnLri cu l ar pe E C G, c u uD l i l nl v rri aLi l (i nl ro 22 $i 18 bi rl i l i pc rrri ' r),
s . P e fi gur;t s e v ede aprti l i a pc l i l l (;
cu D unc roas c x s i s tol i i , i utrc 1i -3i
de undc l ente bi l atel al c , s i rc ronc ti s i rnetl i c e (Irc domi rx nte dc dc ri trrl i i l r'
arrl eri oa rc ), dupi c arc , odat:r c u i l s Lx l arc a & s i s tol i ei fi pi trdc rc x c rrrr(' )
primei conLreclii c:1rdittco fuco rii-t
tilllei, trascul se aptatizcazir, Aprdlia
rtrpar'5 l l nc l c l e di n barrdx de1ta. C uuofLi l rl l l rc nparc Lrc ptet, odLIl .i (rrr
r{ri uarca ac ti .i i ti tri i c ardi rc e $i rc \.c ni rc a l .i no nal N rc Li v i l i i l i i fl r(:l ri r' ('
corcbrale. l ntreaga P c ri oadd dc 1a i ns tnl :trea as i s tol i (i P i ni Ir ror(rrri rc rr
cunofti nl fi l )ol nx v ul ui a dtrat 3B s i :c Lr[dt. S l i j r:rl .a i rl di c r"r r({ tri r(i :r l c l i '
c x tati { c 0 (drrptr C orl drtl r, 1!' 17, C otl i ui tt } i l )opori |i rr, 1071 fi
vi l i rl i i
l ,.,l at,i ri rr ti c ak l )., 1tti 3).

z, ?! ) : lio o lI t 'llzii,vot t l, r 'ir 'lll1L|r i

| rrrl rrr0l r,5l ,0
l ,tr li r r {. {'r r , r iir r r '( ( lih1r 'r r lr t 'lr , t r i,l{f
(' i l ;r/, (l i r) r,rr, zr r I i) ,I ir . o lilr |ilr r lio lr r r I I t it r t t I it t ii ( 9{t r ) i, ) ' lir t o I r t I r t I i|I t I r I io
, ' r.l ,nrttri .
l t\ l l l oru.l. xit t r tqlt i, r l, t r r Lt ll t r r r . i t t t t t lt , t 'll lt t r ', r 'r lct t lt t l, lr r t t t lt 't t t lr '; t lli'
,l i tri r:1r' i tr rr,,r 'lr '; r ,trrrit r r l'l, , r , r r ' r : r t <l rrr" i ro rl i r 't rl l lir ' lr r r l r 'I r 'r 'I r 'olI r 't r I i, r I 1r ir , lr i.

( ) lloo' 1. &t iit *, ' tti . s (' r' ' .,r' l r.ri ' i /,' rz i r,
rr.i , rLI I r.|' | |rr,r) (l r, r:r l rr,.l rt,5il l ' l trn,v,
rt, l trr , i : r lilr r r ii r'r rrr I rIr' I r. 1 ' r' i rr rrl rl i l rrl i ,,i ,tu .i l l l i rl i l
'
.
;,i ,, rrrr,.i l ri :r,,l i cl rrrl l i
i rr, l i t tttr t,i l ttt l tt,
"\tl r'tt t { \ P t l t lt ! t t i i l )N ltl ttl i \' . ,{ r.r,s i 0 1 r!t,r .t,i l rr.trl ,:t,lrl
rrl l rr,l 1r ' l lr ' r r.l r r . ll- rri rr.r[a ' i rr. t' rrr.rl L i rr{ i r,,c i t'.
l ri rri r,i rr apr:l i r, rrr,rrr* tri r,tl rr
,.i |,IrI , I ( ' I I I I I I ) I r I r cL'lt)rc trrrs i s l ,o l j c(p l i rr p 1 r,r,1 1 r)i rr,),sl i i r.rsr.:ri
p1i
t 1 tl i i i rruft,ni l
l r'ri r;r c rlr ir r ' lt r lr . . r .:r i rt s l rrr0 t rl l r I i 1, ,.
!, !l\tr,l,lnu
ii,rilp de ?raitabili,t lt'.. I,rjrrilc ltcslclr, trit,rrl,ioniun fiiblill,!ln
trtrl l i rr r lllli, r lr c iu e i c o rrs c c l i u !ri i trrc rl i l tl estu ol ri l el t,' c i t,cul tl ;ori o.
i )o

, I,, ,l,,lrrr'r|lr,\'1'
i',,1,il,
iceI)ol..rii
pot.silsu
seinsot,ensci,
rrl,,o{o0,s.i
rt9t,i,,"ac"i
dr'1rir.r'dr.ri
,t,,c.*;,rliir,iii,
rh:
urro;rirr[.11,
:1.',i]1.
' l' rro
l]
'l :]:]
l1]l.il
i]:l :,iil,,lru.it,^
,i I r'iu'r'
.\rrr)l)('r(!
i\rr!)r)cirt
sl
srrti
.i,l'r' irrr ltitl
c r'rl lr. SUp"A
rrhicrrr'<iiilo
supra-ventriculili'e
I onlr,ir.u]rr|e
(J3oriver"b,
. FittLlirt,,
Firruiu,,
lllotrvCrcl
h ibr il r{i.,a,r:ri.ulll.ri lllr,xistitiL I irr ulltirna va.ictu,1e,'sincopapbato
surl

lr, ,slir;itLrl,rtrustrlui,,pr.iripa,Llzir,
auriculari, post_tifirifdliej.SiiiL,
'r'ri
rrr/ , r'rLr lr(.llcUl()rNc,
i;r stlLirnb,tahicardiile
ile vontriculalc,
prin riscurllo
vontricula'c,prin
l o l rl r los olt il, o,

'l' uI [ou.[,sincultul poale irnbri,ca urrniitoarcle configurafii :

rri, -l
ru)
lr pr:r'turbiililc
_10 setunde,tulllu.
hcrnodinarrrice
l)u liulDtl rlo llclnodin&nice
cu druati,
cu
tlurati, de
Ae bl-iO
llrlil r, .i'.rr
cirrrrrl.1,t',iit
lll,tx,iit trn
tr. osle
osle de
de obicei
obicci losinll;jtii
.tsinriitii de
tle bolnav,
hotnav, perioaciafiirrd

ptlrr st,ttrtit.
( f ala. rr;ag5,
d;
sl rrrl,ir,.(iol
tul i- holt
holnsrar-nl
, r . ' r r l resim
r es inr tbe
o o
n stare
.r1e
t^
UeJtnrr-ult,
,,rb,u,,-sau
- x . 1 r - ^ - , . o efemot{r
s"rr,zrr,(it^
rle
i.tv'ior", cr_i,re-i
pemrit evitare"acXa6i.iiin cazul in cftr,(l
",,vitl
,lr)l,|1rrcrL
Lcnlodiritnli(.i lI liude Si se prciungeaSCH.
-seeunde,
b)
pcllutbirile
Lr.
hernodinamice ae 1O-ZO
manitestlrilo
. ,
;,r|lI
O pal oAr,. b.ruiati a fetei, VOrtil.
,lrrirt ltrlr.lrsr.,l,ulnurut [|r'Czerrlind
t.r'i.opr rfc .r \ oJlJirii $i I acr iv iln lji mo tori i, d u pir cari: inai viOtji
I'r r\ r11.ir,irsr.rr
rijr ttrlli ilol,rv ttatc:t.

c) lli 1't.tlrtrl,rir'iJosnls dcpiqcs,.20 de secunde.piol'dct,earle cuxoqtiritN,

r.rilr.r.'si\ ri, (.u rboli.r'il rcllexr.rluicorneln dupd, iO O" ,-"*A".-fl-,i.,r,iii
Irr' i :r.il^li
l dr' iilr,.uljuse sirucazi jnlre t ,ci3 frinute.
r.l)
Itr
,,ineuptle cu dur'lltI de pestc B*4 minute, leziunile cerobralo
.
sirrl irrrr.
clsihiloIlin(liu|olcs, in contcxtul clinic al tuturor a,cesnol slnoope so
}ot
i rri cl l , c liz e c onv r ds i i .e ,
,\rl,1il tlc accrirltirite in repctilie

corstituic

,rstarende rdu

.{iar',r7,1/,,oJ tla. Einaopa uaso-uagald,

re.f\efi, po:tte Ii tlofi-uittt
. .ll.
I)rllt ' l,l'l'(rorouc cutroltlu{a scu_rte,cu sau f5ri convulsii, sccundar,
rlrfr Iriurz,!(1il,ldl&ue
s&t unei prd,buqiri tensionale reflexe (W;ber, 1g?2).
I trr.l;rDl,,*crstr: sirx.ope,cele mai frecvcnte qi mai benigner'sint pluriotirir(,lirr'r'!(|ilI r o:l.Loalr ull ctcmcnl cumun : tercnul pe t ar.esurrin aceite
nranl"
o .labilita,teimporraniI a sisl,crnuiuincrwos wegctativ. Aprw
]1..1.1:ll:.lr:f
i:t
r', r,'tr1tr lrrnlr,l& 40. dc a,ni $i sint mult mai fr ccve.ntela femei decitlO
rr:l,u,ir.lr_
l)rn t,)tctut.srn('ololorstudiatc de CnIflriu si popovicin (Ig78),
l.(r'rlr' tr)r'ln{,
llll tl.ilttzAtun ptocc {nj de 93,l o/o,In antocedcnl,ele
:r,costrji
r)r)Ilir \r Iu ,.rusc||ltrl'lutziide obicci bo.liorgallir.e,ci, rJt.r,eguli,
Simptotno
vcgo.tarivcJ
tutburtrripsihicotle ortlirLdiccti" ta'peiuo.
:llll,i,jll,"l,trrlburiiri
..'rrrir{.r or.otive' instahire 9i labiio vegetatir,'. uneoli in antecedefrtoso
Hr''rrr lr'irzi,fillcIt( sirrnc artcrialil,. ca fncl;ori declanSatoriso somnalo&rll
(( lr)r'l:'i, f i
,l,opovicill, lg?J; Co'f ,r'in,1.0?g): frioa, sii,rilo de crnotir,iiai"o
sl r'cssrtrilo,sul,;IliIll|1nitliil, ilrsolll|liilo, aorul tlolttUt,
fi l dl:rl.,titl.il,lo,.
r\\ril, (t(':l,tcrxrt,
(l(,in,it'cliii.t. ,ll)1i lrccqi;ifacloli iloclanJ
n(ttlrinirtll,a.ron,
t:trrrr'zr\,
rrttrlt mai uf(n'rl.,osrrl sirr.rrprr,l
riur,,i,bulna,vrriso ntlll in ol,r]ostrol,iHm.
'
llttpil, rrbiryrtuilrrlrr
rrlr,lili'nlr"r,r,i
ntrnollzij, sr,url,rup ior,rlririr ciO
Jllr':rircrrsrrrr,l0,
rrrtrroEl,irrt,i'I,,
:|tfi

.*t,rr r,[1. r,rr,rri',rr

l,t.r'sl.i litrt,,Itr, 1r''1,. fi .rrrt,lizrriit
, .\tr,xitr,r,*trrbru,lt'1,,
lllrr ltliUitttttll,orttorut,trlxtrItr
t1,).lilr,i,'t
Il rrlr,rr{iaJ
0s1rir.olxrrzotritr,l,,
lrr !l!'f,
(lil .ir')tn'i' rlrrp)i(lir,xl,rrrrl'
r,ri.rrlrlr. (rri(;), {lo o onrdio-irrlrilriIio. (]clul:r,lii,
.rr,ztt,r'i.ritrl,in
r''' ,r l r i l x rl r.rrr i rr o tt'ilrrzit,oriollt,itr v|,xorli[a,1,1t,{,i
.trr,1ror'1,
ru*Lirl,(nirr.'pi,
r,rrrrrrlrrplr.sil.il,)
;x.r'il.ricir,
.saucu o illiibitio rospir,:.r,1,'i,it
(illslrr,rrL
l,lpnecNru clli:l,r:r1rrrr.r'),
qi cola.b.(1956)au a,r.ijlili;
ixi$1,trlrl,u,
1].,':rl'
rtnrrrI,)rme \.aso-rtol,
t'('$i r 1' 1trr.. il sincopei,al5turi de fot:na cauli,_ilhiliilottc puli ;i dc fonnr,lo rrri_r.1o.-l)o
faptl aqa cum arn r.emarcal,$i rr{)j(( lrr
l:rriu si?opoviciu t9-/l ; (:urfi'i., .t928),aceili ftctot.i bc pot ai't:ilt,
lrr.rl,
l)c bunA.drepfate.Webcr (1972):ttirmd,cL, pare iluzorirr6J,sc tlifrrr,,.rr1i,.z,.
,[iversc iipuri de sil_cope (r''.utfalc, vaso-depr?sire,vago-vagr,lcslu vin,]r,r.,,
vagrre. rcsluiitorLi. vaSo-vagale cu bradica,rdie primitivi). Do l|,r.r,r,:r
\\-obe1 i1972; susline cd,.estepr:oferabil ca.toate acesie $incope sit $o rrri{lr
pez:
llp nxm e1ede. ,,s;ncopetaso-aagale,,,cu atit mai mu1t, cu <:il,rist,,
pt'obabil c5, se asociazX sau succed o cardioinhibil,ie yagali
6i o r,ir,so
tlepresie simpa_tic5,qi cL do
aceste diferite m'ecanisine pol, ir,von,rr
-fapt
origine comund, depinzind..de
un reflcs care pune in joc Ir. Tl,. ponto
bulbrtS. care.conline centrii respirarori qi circulatori qi in special c:urli,r.
rnoderatori Bi vaso-deDresori.
Starea sincopali propriu-zisd(in mod impropriu denumit{ dtr Wr.jx.r
(L572)..rtazd,ictald,") esre dc obicei precetlati, dd o fazd,prutlromtlrl (irl
propr'iu dcnumitd dc Weber ,,{azd pre.ictald.',;.
. Faza prodromald,( pre-accesuald,;
pre-ictald,dupd Weber), cu rltl.Lt.rr.
, ^1
dc.zU-J0
Becunde,se manitcstd,prin impresic de ,,rd,ugcneral", t,rrurrsIi
lafii, am6{,911,
zgomote.auriculare, alteraJii ale peiceptici vizLraio,lri1,i,r.
s_ialoree,
senzafii iie ,rvid ce.falic", parestezii in extremitl1i, palou,i,,,.nrtrr,
(tunpotrivi, roleata, t-egumentelor,uneori dureri opigastric6iitrrr
rl,,l,irrit,.,
grelud $i exceplional vi,rsS,turi lOorfariu, 19?1
;'Weber, 1g?2).
2. Atacal sincoptal (,,Jaea ictald,ii d,upd,Weber ) corespllodo piorrlrrr,ir
cat.eesl,ccompletS,$i urmattr dc cd.clrrolI'rrlnrrl
Iropliu-zjse a-_cunogtiafej.
,'st'e.inscsizabil,zgomotelo ca.rdiacestnt siabe'sau ab$ente,dar nr,rpiru,Lirr
dc obicei este conseryat5,.Reluarea congtien{eiesto rapidi, drrrrur,,r,'t.,riiiiii
a sincopei fiinrl sub 10 secuncle, iar treiirea iiinii totain, fd,rt, oburrLrlhl'.
plelungit5,. secundari, amnezia fiincl limitati, doar la durata pierdorii urrr
pjielpi. Sinco.lete-cole mai grave, aproximativ o.trsime din-cazud, so 1xrt,
Insolr de manfesttri conyulgiye : spasmetonico ln opistol,onuB,oxcotrt,hr.

r: 9*p-"9!!oto^nq,r1rm?Fsauprccectate
uneorido ctonii girrr"ruririii",
lpl
(CorIariu,
| 97.1.;
gi

Cortariu Popoviciu,19?1i Weber,19ZZ).A"cobto

nnuti
rosra{rconvursrvose,lnsolesctotdeaunado o rnarcat[ midri&zd,,u[.(,r'i
de trtstaf,'mus..
hrpJrsatlvatie,emisiode urind gi mugcarcalimbii, rin ltrxrr,rr
smr expucabrredlrrcuitaFiledo diagnosticcrLepilopsia(fig. Bg). tn htorllr.i
anto_rioaro(Corfariu qi Popowiciu, 19?1; Corlariu, fOZ"A;Ijopovioiir
fi
colab., 1976, 19?8) am oxpus pe larg criteri.i,ted,ediagnostic,po o.iro rlrlrr,r.
le Tom lezuma :

a) Examenul clinio este negativ, iar traseeleXEG (standarrl plirr

ryi
'.lli{tfi
nctivS,ri) din fazolo intorcritico sint normalo (Cir,lcii,ianu
$i Stoio,,,
_
;
Oorfariu, 1971; Corfn,r,iu,si P,opoviciu,19?1; Gastaut, tO6f; flnsirr,rrtiqi
.olab., 1956; It&illofl,1000; Slioica0i Bro$toanu,lgit9). DoartV.rcolhrl,1,ir
(1960)a gfl'siila 30'1, rlirr lr'lnrlvii cu sincop., anolnaliilr.r!(1 r',rro.rr,1,.
rrlrr.l,r'i.u
rro ilslxrcrtcornifin,l,inrl.osobil,l sLrbi.'l,ii.rr
si Itul-0% {,n"{,rnrIlii
$irl(Dpevll,Bo-vlulllo,
3:)tl

.i
.llt tclritrrlr,irr LitrrIrrllirrcolroisirrrlrlosrrr,rtlrrgrrrrdolont(!, I) iIiI I i II |,I(I
(l(!iIlul.i'i,
tiiiBiIl(,r"r,IIir,
xrrlr|lr,r
(1lt
ol1,lr,l,rr,
.l
sirrrtsoirllr,lli,,o Irr!ov(!l)1,i1,
il0 it.
r,/rr
((|rrfrU'i]t].ll)71.; (l(irlal'irlryi l,,1r,vic'irr,u)?tl Wt,brrr, lt)?J). lrr sirrrr,lrl
(lr)rn(lo lcrrto sirr1,
.rrrIrrlsiIr'i,lrrrlirut.ilo
rnai Jrirrgi6i siirl irrtrurrrpiorlo irn
Ilrr.l'r'irL
rrilrrrr{'irr
lIplo '1loo0rnplr.t,(,:rrl1.
c(u{.NI,uur[o
sl]lr,s]lllrllri
loiric. ,,t<rcsl,
lil.l {ir rlrrrclrz'ii'
rrilcla,sccundoqi cstc urrrr:r,tdc lcirlllr,r'i{irlrr}(|j'loli{'l11o,
.rr|. o Il,rrr rIlzii, lrr0grosir', pinii h rcculrc}a}t,llurrr-rir.iirri rronrrrrl,l\rsti
r1r'iii(rllt cx isl;i,ilrxrrna,liillDG.
(.lrr,sl,rr,rr1;
. (I950) . a . doscris sirtolpi], nrrcturnir,a hiperl.agotorjicilor Si
rr.r,r,r,iLirI.it,
ili lir|crr'(;ioriia,ocstciade- opile+sia rnodei;i,. Aiestr: sincolNr
\r,,o \ ir,gir,l(,
sirrl l:lyoriz:11,c
in oursul nopl.ii, de ridicarea in tirto,.talijin
I.rirlc rrrrvoiir,
rlo ir,.rLriru,la vagotorricii constitnlionali irL faza ch hipor,rr'ot,ulnr"l.Asocierca acestor diterili factori (staliunc l,ertic:Lli,
'rr,g.i.rrirr
rrr
lrili'l lr, ln srrbicci,prcalabil culcat $i cu tonus vascuiar r:eclus,afer,r,nlo
r irrrrrr':rJrr
ctrrl;r'ipcl,crJ)rovalen1,[nocturlX a reactiviti,lii vagald) oxpljcll
.'r'rr,vil:rlorr
il,cosl,olsirrcopeqi asociereafreclenti a nra,iifeBtSrilorcoiyul_
riVrr Iirlifi1, u.ol)lonM, tliagnosticului diferenlial cn epilepsia rnorfoici-r,,
'l'oIrr1i, lrr.ozon{,:r,
tloar a tnei contmclii tonic6 in opistAtoius (pl.cccdlr1,rj,
rrrr uIrIrt'i rkrlr r10 1*2 sccuso muscnlare gcnel;lizate, ilar'-Iiciorl:r,1ri,
irrrrolilii,rlo o 1'rr,z[c]onicii ritmicii propriu-zisi), precesiuneacidorii ;i rr,
dc c5,tle o stare de riiu gencral cu gre!.uri, paltiilr.o
;riclrlolii .orlLory1,inloi
,,i tr':r,rrslrir':r1irr
r!lrund,nli!, a-llscotIr
ncmoolorEEG de epilppsi;. 1,r.ecur,r
si
rxrinpro$iunc .a globilor oc[lftTi pozitivi,, etimind, Olignosticril
1rroIrII..rlo
rlrr rrpilrrpsiolnorleicd, qi obiectiveazi, hipeivagotodia (Gastaut,'i9I0).
l)orli.s-1,orczu-t tri sincop-ayaso-vagald, reprezint[ u ri,spnns teusio_
.
r.lrrIr'rriror
}r {).lt,l{r()sirne
psihici,,cercctiri ale rioastre(Corfariu $i l,opor.icirr,
l!r?.ll; ( iorInlitr, I97-8)au arltat c5,existir,o irnportanti participarti cardiol
rrrlriliil,oirnl
.(1i11.38), carc oste capabila prin ea ilsh,-;i sb, declanriezco
rrrr,rrio cottll'i,|,il"t.
l'onl,ru rlocllnqarea unei sincope, respeoi;iv pentru leprodueerea irt
.
lrIr()r'ltl,rt:..1,
nroocsllhlisinco_pal,se.utilizeazi, conprcsiunea oculari, compr\)_
rrirrrrur, rJilrusulr.ricr,roljidian qi rnanevra Valsalva f Corfariir. l9?t.
I lr78; ( lrrl'ariu Si Popoviciu:,19?1.;Gastaut, 1950; Gasta,ritqi cola,ti.,f ObOi
( lirrrlrr.ri,
1_956;
YercclJctto,
1960 j \ycber, 19 Z2)..Oompresiun{t;
6i ^(h,$1,lr,ut,
olrrlir,riitrr fu,rxr
tirnp de 10-15 secunrle,etecbuindu-seconcomitent o inrollirrl,nrlr ;xrligrtfici, (EEG, ECG, pneunfograrnd,,eventual $i pletismogra.
nrii,). l\,llrnovla, o$to pozitiyi dac}, aceasta antreneazl, nauli cardi;,rr?.i
rlrr 5.,I l:lu rnai nultI
_ririrea,. ftec\.enlei cardiace cu c6t pulilr 50o/o;
rrrrrrilcll;flri1r'o.siucopale (prc-ictale), sventual chiar o siircopn
1vb)i
lirzlrltoto poziti.l'e cI valoare
,
_diagnosticr,au ob{,iDut Gastaut (1950)
i1 (.il, 1,rnr'1,4i
colab. (19-lir6),
Vcrcellctto (19ti0), Corfariu (1971, 19?S) fi
l Irr'l'rrlil ;ri l'oqovicin (1971).r,s, uncle djn cazurilc noastre, pe lingi nlrrd(rrlrrobiqrlril,odo opriro cardiac5(la 4? 0/odin cazuri) am obsbr-vatgibloruri
rrrrrrrrr,lrirrkr ,,ltr lanltt, lil intervale iie 2-3 secunde.La cazurile obsorvtlo
lrri. ((lorj:)l'iu,-19?1, 1978; (,trrJariu qi Popoviciu, 19i.t) nu arn putul;
'l('
1'rrrrrrirr.rrvidonftr prin acuastL.probii riispunsuri ,,corrrphtetr itrU(i, <nr
lrl l.trri rlo.rrnilokl-nto scpu,r0.bi
rlr:1x.r'itr.r,tlLr
tk' tl, ]rrrlsjr.t,luutr.ici-r,,
il,Dil,
iflntt
I r'.rri[t(,i!lVorcollt:1,10
t)1,)(i ,,irrtiorri1rl0.lr,)t
.11{}60),ei rloir} r.its1rrrrrsrrri
(frrtlottt'i
rlo uttrlo.lontti,.lrillll,olllle,
sirrcrtrrr',siriruirJru.,ri,rllru'|,sirLrrsoirlrr,lii).
(l atl,iul't6iorlitb. (ll]5(i) ltu lu'i,tir,l.ii, r'rlrrtsiit ulxrl,r'rx,rrc.lrr,l.g'ri1r...Irp1r,
lirrt'I,onlo rltri,rrntritlr,lli,
rlc rlrrlrr,l,ll
:mliri1,ol,i
: rur llloc rrlrrrlillotirro.lliriirl
J30

pl tri l l :r,(i scrr r r r ( lr lu r r r or lr llril l. r 'r r r r r r rlllr

r l ) ( 1, r r lr , xislar lirr rlr t xr sl, r 6r Hr . r . r r r llr r
l
tttl
!
r
r
t
t
'i
r
lo
r
,
r
r
r
lr
'll:
r , gclr ct : lliz- ir i, c,ia, t ' r t t t slolr clr , : 'r lir t , t r
t
t
t
t
r
lo
lr
lr
r
,
l trotl ttcc
ctr o rl rrt' 1r,l;ril,
lo 1r c$lo lil r ilr r r r l{' [ lr , ir .sii, r r , llllli ( loscl- [ r ( r ir i( lo ull{l1r h, ul, o
bi l l r,l ,rrnl l rIi il|l( 11r 'i( , rr) r r I r , lr . r lr r lr lr lI lizilr r ': l t I 'ilsor t lr r i ( ( 1{)
n( x) lnil ol ll, t lll
ollrtultiliura, clinir:ri, 6i cl o (.ol nrrrl,io irr opistotonuS, proccdill,i, {lif I :l
cJortii gcntilllizate). Nirriorlrr,tii,nu ti4)l,l'e insi o fazl convulsi\'li, clr)r)i(,r'[
l)l olrli[-zisai,. CastlfirL;ri c01 lr. (.1050) au mai demonstrat cir, Ja, trioi rrrr
p teE
LI4 o

ca L.tpREs tJ t,tE 0.ur,1,ii-'--'']-;;:"--*

1-\.n'{>-f --' \,.a

ECG - f 81r'mtn.

1tY,:^\*.\

44-',4-/,-4"Nr"-.^-,v4,,'"--,\A^/,+"^

VA . C

t-

-+,,rt\
"q^rnvl-t"

rA^
\^!1414^,{12\4/*!1/4/"^4^%

PD .D
Yry.^"*{i&a'

"

}.@q..!,,\V/

aaa^^'\&{/'{a,,a

*'\'arv

.lrig. .r3. Proba comprcsi(i octl]arn ln cursul unei lnregistreri poljgralico Ir

bol nav ul P .D ., 23 de ani . D g. s i nc opi v as ov agal i . R ohav ul s -a i i k ' r)rul
pieldcri dc ctnoqlinl:i
de scurti durat:i, declanFate in special d(l
lcntru
crnol i i ti de eD erv i rj , l ns ol i tc uneori fi de c onv ul s i i Loni c o-c l oni c ., Ii i ' r(l
suspcct!t cle epil clJsie. 'foate iDreejstrir.jle EEO intercdLice eu iost nci{aLi\'( .
Proba comprcsiei oculare evidenliazd, dupi 6 secunde de la inceperea nlArl(
yr ei, o nrodilicare a ri[mnlui cardiac(de ]a 84 bltli pc ninu t 1ai0 b:itnii tnin L),
nul ncroas e bj oc rrri s i noatri al e c u dural e de 2-3 s ec unde i n ,,s |i tc ", Iri t.i
nod if icarua 'f .l\. si a activitilii
EEG. TesLele de cornpresie siDo'carolidi r)ii
gi maDcua Valsalva a fosi negati.ic (dupi Corfcriu, 1W7, Cotlilriu tii
P opoD i c i rl , 1977 ;1 P opoD i c i & s i c nl ab., 7978),

iii

ca,z de sincopl vaso-vagal5,,actiyarea c&rdiazolic5,lru pro(luco li(,ilrl

lit de reactivitatc epilepticS,,dar c5 aceast[ ac1]ivarede multc ori l)t o\,r)it,('ii
sitrcopa, in cantit;,li rnici ale substant5 injectati,.
Masajul regiunii sino-carotialienepoate antrena o pr5,bulir'(iloltii(l
lra15,
in cazul unor sincopeyaso-depresoare(Corfariu, 19?1.,1978; Cio}lrrlirr
Popoviciu,
1971 ; Weber, 1972).
1i
In sfirgit, in sincopele prin inhibilie respiratorie poate fi rrl,ilii ptrrrl,r'rr
rliagnostic proba lui Yalsalva (dup5, o inEpiralie profuldii, so plrlciicir,
rrrrefort expirator cu glota inchis5,,ceeace produ ce un blocaj tl Irrlo:r,rr.,'r'ii
vonoase,prin hiperpresiuntoracici). AceastS,prob[, practiclltlt qi rlr loi
(Corfariu, 19?1, 1978 I Corfariu qi Popoviciu, 1971) a ploduH Lr rrrrr.l,r
sincope vaso-vagale o reaclie cu totul particularS. Antfr:1, h slir;il,rrl
probei, s-a produs intii o reacrie bratlicardicS,de lungi, durntr:r.irll lrr,jl li
socunde de Ia terminarea manelrei s-au produs blocuri sirxr"rl1,r'ilhr
,,rrr
|l,rr],".Accstu roaclii au fost interpretatc de noi drept consccirr!otrl(! luror
mI'lcxe exagcl':ltri dc tip va,go-r,
agal (13ozol<1-J
aris ch) cu tcJ)()t'(lltsil
li
(Oorfarir, 1971, 1978).
rr,srrpranorhrlulrri sirxr-a,l,r'irl
Ilu,clori,,itl.irfut11it,i,
tti :titttoptil.or'tttso-ota,guLr
sir11,rrrrrrrrl'o;i ((I()r'lrIIiI|,
1071, .l07llI (rotlttirr tii I'o1rolicitr, l()?.1I Wrlx r, l1l?l-r)
:
l. llittoltrt, tnulit'rt,: ltitri,, sliiri tkr irttto|,ititiII r,, ctl't'tiilir sllll+rrrli
(l l vt't's(1,

:l .i l

1 l l ,rrIrrrrrl ' t' .ttl ,il ri , sttt:rt' ri i 1i l rr,rrr4ri i i rr l ,i rrrl rrrl

. hipttl r rl u ' tr' 1 tri
I I..rt I.ir.'
Ir| | ,| r' ',I"I1]
I | l]
|!ii"
r LI iI r . , r ru r.l nrl i rri ,rc l ,r.c i tL rr
tii rtt,o l tcl ' i i url r,oi rl tttrrl tr,i otr
,o r,ol rti tl1.
H||t|l I I I | )r,| | r\ I I I rI ( r.. S|) rrlt,i so ]uN,loil,zi,sitrrxiJi0lil itrr livjzi r:ltt,tr
sl,:Il,io oil,zi,[
rl | rrc r r r r . lllr r r r g; r ' 1.r
i, rri u l i -r,1 rc liirrc h i s c , s rrp l rr,- i trci l Jzi to,
grt l t,st' i rrrpul i ri l i rr,
.i. ,\ Ltt'ol),ttt,tt tluH)t.c u1l:lrt in caznl tnrol dur.rli viscer.tkt
(t:olfui lro. ,
I':rl ri .r' s : t ||r . I ||. I I (' . , c t i z r. a trg i u u u ,s r.)s i L rt n u t i rt i (,r,.
1.. S;; roplh tl,i.n cu,rsul efitr)lordrilor inslru.rcntu[,e al)i]r ildoosol,i iu
.lr.|rrl rrrrr)r stirrrnlir,ri in teritoliul
r.ilgului (risofagn.iu1,u, ganrrus,,,,lri i ckr.) ''- S it c up, lr , t r los tttl i r a p l r.i n tu rs u l u rru r l U rrgi sl rLl i onari i rr pi r,i 6111q1,
r:r.'rl :r r ir lii. lr r r ' : rr lir r 1 rrr,t.
i l (.D n v i rl e s c c n l ad u p :i rrui l c rnrr,t,l tl i i .U rrj i i rr.l uri
:rr r sr s [ l( , ) pc t o lI lr . t ,l (,trtte ({ o rl & ri . 1 9 7 1 . ttTE W eb(.r, 1972).
tl ._i i rr
;
:r.,r.sl .r . :irr r t r r lv inc li rl i S L .n ,.{ i t.\' c Z i c a l a . Si r_ r, :trpol ortostaLi
,,
cc ;i cot,. l ;r,
r|| r'l || |l ) o v r ) r ' t r lr llr , tr. rl c n o i S c p a rtt 1 r| z i i n | onl i nua:,t).
ll.. 8 i,runl(.Lc i.atrogene: dupil ingerarea, unor rnedicamente sr.rlr lll
r rrrl srrlt nr ot iujec { ii.
i. il irr,copele tlupii r:onsu,,m,d,e alrtxtl
s. ,\itttttltcle d,upo. ttuu in cursul tt t,t,r r Iurturi Iizice.
lt,. Sitropclc pri.n
.
.h;11ttse s;biLitutt^ t sinusultii rortiidiatt au I,t,,l.
rrl,rirt
itf cad].ul sincopelor vaso-'agale? crezi'du_se c;, intervirro
'r{rirrse
rr lrilr.r'r.:terl,u,h,iJilate
r...r,g,,1i..Da_r_tle_lapt eld constituie o entitate apariir,

( lot fi r l (f s(fttttt 0rlt r t slt t , r 'r u'r t t t t t{l)

lt ', , lr r 'r 'r rir r lir r lr , llll) 5 I ( lr t t lir lit t , l1) ?lt ) .
l rr,r' i rr(l l )Ttr) 6 i( ior lir lir r f jr I 'olr r vr r r t ( llli l) , r t t t t 't it lon( iill, l: r ar r t '; li lr olt t ilvi
3! )) .
it , r ir r lt Hulni lr t t oI it I iit t t ( . 1: i11.
o l ri porscrLsilr ilil, ir l, o
it rt , l1) 78; Llor : I : lr iu qil\ r llt lvit r it t , l9?l)
l )i n obsc lva, liilr r lr r r r illr ( ( I r r r 'lr L,
(vtrzi 5i 1Jg. 139), rticsrr cri, irr sitrlolrt, lrl tuse pilrtricipii hr miuc rn[sttrli
i ' i 1,,' rserrsi i i lit aiea sir r r sr lr r i lr r lr r t , ir I ir r , r r( , t 1 im pbr t alt r ilspuns t 'lr dioit r lt i
5]NUSULUI CAROTIDIANDRPT
PNEL.IMACAI\IPRESIUNEA,
-,/--'\-/----\,1

ECG
r-e@.-i!/t^"\*f

4@,t4-,\-1.4J

T.r'' 150/80

Jv+4

-^.-4r'4,.\"44.l'

urrr"^rrtr.l.r-^.Ap*.^^r.r^^.^i"
irig. 39. Inregistrare poligrafic! tn titnpul compresieisiDusuluicarotidiaD
dr:ept.le bolnavul L-'\., 47 de ani De mai multi ani prezinte rare c ze
(2-3 pe an) de picrdelc a cuDoqtiniei, declansate de tuse (de obicel),
dar ti de rls. Esie mare fumdtor $i are o brcnqilti cronicd. Proba (k:
compresiea globilor oculari a fost negativd. Se poate lemarca laptul ctr
la compresia siriusului carotidian drept apare o pronunlatd bradicnrdie (cu 16 bitii/min lali de valoarea initiall). Concohitent s a produs
o scidere a T.A. de ]a 150/80 la 85/40 mmHg, cu revenire la valorilc
initiale dupi 22 secuntle, L:r manevra Valsalva, scddrea tensional{
{usese si mai mare (ta 10 seculde dupi lnceperea acesieia), iar dupf
itrsu1314sn4nqvrei, s-a evidentiat o rcaclie hipertonic{, cu cre$tefl alc
'1.A. pini le 170/B0. Ileicsc o hiperscnsibilitatc a sinusului carotidian
dc Lip crrdioinhibi Lor$i t ensiodepresorfi o reactie hipertensiv{ exagcralI
(lup[ tcminarea manevrei Valsalvs (dupi Corfdair.l, i971' Corturiu
Fi I'opauiciLl,19'176i Popooiciu$i doldr., 1978).

I t'lr,ttrrull,icl'i,-

l).. f:ii,runpele1tr_inalte d,i,oersecause: subalimentalie, dupX insomnii

ur,rr sLir,r.irlrr obosealil ctc.

: l:l:l

'r''lr-/i-

1i-\^^^,}r&&@^/qq^-1*w

| ,ttriu l .ir | 1)povici . 197.1

) : :t,) ripul vagal sau c:rrdio_inhibilor;l)) I iprri
l,r,rrsio-tloplcsor'
I c) tiptrl cer:ebral.(':r, :Ll,il,r'ur-or' 1i expuse pe larg intr_un
subcapitol separat.
l1l. It'luxtrl,lar[ngiott.esLe.o formi de sincap[-gal"s r,pare la indivizi
((!vi!. rr&i r.i'slilici (50 de ani), pnrti,tori ai uior afecgiuni
respiratorii
' r'{)ri,r', Irr .rr.. r'iLcurnstanfelede aparilie sint chintele de fuse. b fornril,
n|l |J, ir. t''lus0l|ll t]rrngtan cSte ,,LuSeaobnubilantai,,..
| | ". Si.ncopel,e
post-traumati,ce.Se confuncli, arlesea cu epilspsia posF
,

. lY."Nitr,rropaIa truseesta ugor.de diagnoslicat,.Aparo tle obicei tlupitr

r l rrlr rlr.:li -4{i ilc lni. la btrrbalii carr:lquferJ.rje dii,crscafecliuni Irrrir.
lr,rpulnl r.)n:trr..,
t1'rricr.(bron;ito cr.onice,crnfizcm
lrulmonar, a,$tn)$.i..),do
rrrl(,r'tst
Ac{,eJUlsIIlcopftlsc pl,o(lltcuirt litttpul tttsci, lI
''l.t.t
'ltn:Ltorr,
f,,.1:(,:irrrlil,rn'rrt-rlopr)ziIirl,.
col.Plrlli, iir sirrrprorr.rclc
l)t,esrl,,rll):r,lo
l:il':l
rrr'tz:t.rrt.';llrli rlrtrr,:r.zii,.lnt.rr.
tr|,.x.,r('.
ll0,\o.l'r(lo 1- :l_;l rrrirrrr[orii'rrrt
(r inHo(r''il,(r
rlo co,'vrrlsiil,oniu]-([r)lli(:o,rrolrrrr,rrtr
rr,vturirrtrrr-;i
lrr,pitrr'f;,r,ri
rr'rl.rrrr.i'rr.irrl,l
rro rurrrhrzio
l'lt do ilrrrrrazir',
rillsi
r
rio rirgrrrI
'Irrrl'irrrtrIii,

-/^\_-'^\/--\,--l_-\,^/\_

T.A E5/ 1A

' . Cor r ar iu,

ji l; ll. l,] 1 , , ! , , 1 ( w ",:s.f,{:5I9
::,i J3}l.;i rrvi e i ttrru5i;
t9,i, i ezs;

tle
aentriLalia
este mai rareori intilniti,. Aparo indoo, .l1l...Nin!\1,?
..'.\r,r
tr! t,'rI|t,rInLrc ^lt,ipu
z0 -40 rle ani,.cu-tulburhri Iuncl,ionalegaitl,o_intcsl,i.: .r,/ ir,lr .i mlb-.r,.:,sculare. tractorii d6clanganfi sint'totcleadna de naturr"r,
:r.rrllr.rintl_osimptomalologiepreacceiualLmai lunga (3*l rni_
;,,,i,lri.ri,
|lrr,(.),,r'irr':tl'I.(:t'rza,l,i
prin^palfi1,a1ii,sl,arcde rd,u, transpiratii ieci, senzatii
rI|,,,,1)rrrIrr,
lclci, usctciuneagurii, incetogarca,
, cong0sl,l&
vederii, furni. ir.r.'r'rl| *'rr)rtotr in exlrmititi, prccum
!i respira(ii frecvcnte. Aecosrrl
rlo.lrirrrkl.o rucuno$tintei este de scurtd,duiath
iZO secl, in ti-prl U"oiii
lr,rl.rr;r'rrl
r..rrriirt'riscito cd,-vedc,
dar cd,nu poatc rlsprilrde.Acestemanir'.. :r.fr ..Illr, l,l.orlusoprrrr htpervenlilltia pulmonard (wayne, l96t).

-\*-\---_\-7---\

IT A $A/80 Plussla/min.

se pare c; acosto zone b&r)rls('llsjl)ilt'

lrit.ol qi tensioclepresor.Da11,1e.1,
:rr pul,ea sd, fie influentate qi de hipertensiunea artorialfi protltlsil, tlttpir
rr,ocesulde tuse (ca tlealtfel qi dup[ incetarea manevrei ValsaJva,itt oltst't
vrll,iile noastre) ,.sial conduce implicit la instalarea unui bloc sitlortlt itt'l
srnLla o pd,bu$ilc a tcnsiunii arteriale, cu ro1 in cleclanqarcrr,sitrloltti.
\t. Sincopu ortosttLticiieste socotiiX' de cei mai rul!'i (Dod.irlol;' I lli'll ;
( iilgenklantz, 19?2 i Hrs, 1972 ; Weber, 1972) tlrept o sinoollt, vlg;Il?l,.
l,h reprezinti 5,5 o/" din totalul sincopclor studiate de Wayno (l 91jl) {i
1,3% din sincopele studi:r,tcde Coliariu (19?8) Si Clortaliu ryi.l'opovitritt
( l$?1). Apare cleobicoi la' inclivizi treculi de 40 de ani. Forma ,rprlitilg('r'I'"
iNtIt
rr, u,ccstei sinoopo sc tlulnrt;oirzX, dupir, o pcrl'ioadl lungi, tlo ot'l,o'!1,1!f
qi oola,l).,1f).17,r'il:r,\;ido Corfr,rirtqi Popovilirr, J97l)' lt'rrlrrrrr'
(1,)irrhno
posl]ulrLlir
i6i vl'lirlcrrzil,
rrrrrricil,([!rrgol, l1)fi0);ri folrrrrr'rlitr hipotottsittnofl
irr tt t tt tttttt t1,ttI I ttrtrtu'ii
ctttt5tiott{,tli,
sirrrptrtruu!rlogi:r,,
Jl il lrirrrlrt!rillrrttlrtllj,lt,
tttrrit i dtlJ)iLo scllrl l"r'prll'io:t'rlll'
rlirr clirrosilt,l;isrrr
ltr ot'Lolti'rrIirrtrt,
l)l'('lt{'(r(rNlI
.i ilmo{trli.I'itrrlotrriltltt trtttto{1
itt1fi,ln
rrlr'icrr lrt,lrirn,rrlitr,
rrlrzl(rrr rlri 1''i11
lorrir.rrr.lotrilo,lfotrrlt llottir'fiit,ltitrtt
lrr,lroltttt,vii
Itrso{r,1lrr
tlrrrori rIt lorrt rrlrrrr
rli:rlr|l i|i,

r r ,r ItIi n o tti t,tr t, tti tItt1 i r r tr r i r 'Itr 'i H l t,l l l ttl ,r !l i ( 'i .

l '1 tt,tt r l r .g t'ti N L i tt|o l ttt

:t:t:t

(' l rl { ' H c l ,l u if l: 'i . ior r lli,r r r r lol t r r r 1r olir r , r rirI r r lr r r llt r r r slr r r rlriu
, r . r r sl,Hir
r . i r lopr r ,plir r
i tcl ,i tLtrir,rllrlio ir rlrilr ilol ir .

oflosl,iIl,iriolrr sirrrlrornrtlShy-l)nlgtrr',bol,[il rlogurroltr,l,ivir,

ln r:rt'opo lingil,
lripol,orrsirrrrou,
or'krstalicii, sc cunslal,ii, urrhidrozil, impotcn!,i srxuali,,
1roI;Ihittliurrxrl,urnii,,abolirea roflexclol pupilare, simptomo cxtrftpirtuni'
rlir,lrr ryi rr,bs0!l crc$torii orijostatice a catecolaminolor.
lrtrrvis (1904) a descris un sindrom de hipotonsiuno ortrc,staticil,{||,rIIiliirlii, i,ir,r'r,loplozinti, o boali degenerativd, cu transmisie er'odilarIJ.

l i l l , Nt ncopokt lt 'it t , t t u. t : . r r r i, r f u( l) or linot , 1972) sint lr lor lr r sr r pr , ir r

rni[i rnu]to alooljiulri (,il,r1lilrirr,rrcrrlologicc sau vag:lIc, prtiirrrlrt-so ;rlrrtizlr
ou lnaro dilicultato
rlr,rtzlr, crurtii
a, acestora,
PNEUMA COMPRFSIUI,IEA
SINUSULUI AROIIDIAN DREPT

PNEUMO COMPRESIUNE.4
SINUSULUI CARA|IqAN DREPf
.^\.-/2\

ECG

TA, 120/75

-l+\

FM. -4.4. Plus 66lmin.

JlqtuW

Pius51/min.

u a. - 4.
F D. - C. D.

l 5 A rV

^e,\^4^^ryu4,^^\/r/q.^^'/lJ,1lA/(\4r'^l-ar-t^^1^A/!^d^"a.-y1^

P D,- T,D.

^^.^4

Vu^,ve-

PS. - tS.

itir, d?. Inrcgistrare poligraficd 1abolnavuM.L., 53 de arli. l)g. sillcof,

la nliclirne, La compresia sinuslllri carotidian clrepl s produce lrrr
bloc sinoalr'ial de 5 sec., insolit de o senzalie de letin iDinenl. Lr clir(
ttarea unei manevre Valsr1vaa prezentat - spte sfi$itul acesleix - 0
intonsi reactic tensionald, insoliti de extrasistole ti bradicardic (dul)ir
{:arfariu, 19'11,Corfaria;i Papariciu,1971,i PapaDictv$i co1or.,197t1).

Ii0. lr, Inrcgistiare I)oli$afici tn timpul compresiei sinusului carolidiu drept lli bolnavul A. I., 3? de ani, alg. crizc sincopale orto_
statice. Boln4Yul prezinli erizc sincopdc tnatinale la trccerca din
ciino- ln ortostatism. TA. ln clinostatism era de 120/?0 nmHg'
irr in orl,ostatism de 90/60 nmHg. Comprcsia globilor oculari a
{ost negalivi. ln schiarb, (jomprtsi.rsinusuluicaroLidiandrept se
voalc ci produce o scidere a tmului caldiac cll 12 ]ritdtlmiDut, crr
o cliscretl scitlere a T.A. (de l^ 1201'15la 11/75)' Manevla Yalselva
a proalus o masivi scidero tctlsionali dc la 120/75 la 75145mmHg
1s71 ei -PopoDictu$i
((rupi alorlariu, tn t,
""Il:i"i:.qisP|apa'icilt'

ItrrlriL,Oorfariu (19?8) qi Corfariu qi Popoviciu (1971)' multe sincopr'

r,r'{,rslrrlicosiut, rle fapt, consecinla unor hiperreflectivitS,fi sino-carotltli'
rr' 1.1i4.lr) ).
\1, SirLcopade micliune este destul tle raril, (3,30/6in statistica ltti
\\ r yrrr, .1lil0Li].13oloinstatistica lui Corfariu, 1978). Se intilneqte indeos0lri
lrr,lriillrl,{,i, dupii, yirsta de 40 de anir alo obicei ilupd, coasum de alottttl
irr s,,rrlrr,plcmfrgiitoare a'ccesIni. Dup'i un timp variabil de somn, bolrrrr,r
rrl rr.spr,<.l,iv
se scoali, Qi imediat dupi, micliuno se produce o sculir'1,
ilo curio$tinlE,de 1-2 minute. l)oar uncori se pot semnala simlt'
;rir,r'rlr,r'o
li,nrr' | r()il,c0esuale(amelelir gleluri, amo{eli in mernbre), dc obicsi actrsltttt,
' (Oor'l'ariu,1978). Criza sincopal[ dlrea,zi, 1-2 tninute, ra'tottti
lipxirrrl
|rirro(.irrrlrr
so (lo conyulsii tonice sau tonico-clonice, iar postaccesutl hol
rrir,vrrl:ltuzr"r,
ailtonie, amclrelircefaloo ,5i o stare do te&lni'r.Waync (l9tll)
rr,lrrcrr,rlllr,t
at:casth,tolm',i in cadrul acceselotsinoopalo llrin hipotonsiullo
oll,osl,irl,ioL,
irl ()asta,ut (1950) :r, pla$ft1jsin(iopa tlo micliulo irt otdrttl
sirrcolrolorvrs()-virErllorliirrd fnvorizrltt'i,do orto,gtatisfirrInl,r-o ftzit, tlrt
lir, indivizi vtl,gotr)lli{'i.In doclanqarcil ittrosl,oi
Irilrrrlvir,guLorrio
rrocl,ut'nir,
irtlri,tcllox[, prodttsLplil] golirou,
:tt'1,ttt
nirrolro irrl,olrirro 11iltipol,onsirtttsit
(lrr'Irr,r'irr
qi
(lf]?lt)
i1il'olxrvicitt(11)71)utovirltttr(irll,
Oor[rtt'irt
vrrei,,iirrlirlrro.
(Jig. a| ),
qi
Ir,
r'
lri;rolrotrsilrililtr,lo
sitrttsttlttitrtt,trtlirlilt'tt
l rr,rr,r'rrril'i
lrolrrir,r'i
:r:t4

lr
'i

ilI
L:.

, 1. Cauzanzi,rtecardiace(ctepilcld,stenozi aortici, qi bloc a,tr.io-vr,rrlli

curar palotiis0rc).
2.Oau'ze miute tago-cartlidc.Este vorba de piltlir, do irri,rrlvr,rr{iru
nnui factor vagal in docklnqareade sincope la bolnavi purtr'ltoli rlo lrlor.
al rio-ventricular comolet.
3. Cnztzemiute niuro-card,iace: a) Epilepsie pi s,indlctm,A.tltuns Sl,tl,t:r.
Se ''stio ci sincopa Adams-Stokes, fiind f-oarte aclesca txrrrltrlsivrr,rrlii,
poate fi confundati cu o criz5, de epilepsie, iar Dorlinot (19?2) l tlr,rr,r,irr
un caz de comilialitate interpretat ca un sindrom Adams-Slokcs,rlir,l,olilir,
unor tblburS.ri de ritm car:diacapirlte dupl episoadele talricirrrlito rlirr
cach'ul manifestirilor sale epilepticc si la care o ttrra,lic anl,it,orli (irrli :r
dus la suprimarea acestor mo{lificif i.-Tot Doclinot (19?2) t,clrrlt':rzir|r,uu
cazrrricare prezentau concomitent celedoui afecfiuni
.pe (epikrpsirr6i sirrrll0rrr
Acb,r'rs-Stokes).Totugi, Doclinot se intreabi,
buirri rir.tr1rLir|,rr,
r,rr 11i
nai, dac5,aceasti,manifestare eliloptic5, nu reprezintii in rclrlilllo rtrr,lrr'lrr,
anorial a unui sindrom Adams-Stokes. lt) Sincoped,e rrilin
trt.l'':ulru.tt,
5i, si nilrotn A.dams-Slokes,Tot Dodinot (19?2) relateazj,i cir,zrrr,ilir, r.irrr,
ltlocurile paroxistice Adams-Stohs pot agraya urele tullnlttili viriilrrlrrrr,
<rcrcl;r'ale
la bolnavi cu insu{icienfe fie vcrtebro-bazilaro, 1io oIro|,irlir,rrr,,
lrodncindu-so sincolo t1o etioJogiernixt:i, do aceoa,l)tolnuto rngtrrrizirr,r,ir,
ttnot cortsnllra,{ii
rrorr
lo-tr lrliologico la bolnavii calc plczintri lrirrtrlrrr,i
rlo
( l l r i f ) ) t l l i t t ( i t'i i r t o l ttIi tl i tl ,r r ,

O sor.iorlrrirrrlor,i(llrrrr, l|t7ll; {ir)l(lllr)'(!t,i1i icor', l{}?0; ,\lorrrrrrl11l

colir,lt.,lllTl; liolrrrr11ir,ll:rlr,, ll)?l yi lrl{ii) ;rl l)t,(}lrllll
osorio rlrr rrllor rfrr
tt,tltrort tt,.l\rtrr'!ir
i ttrrlultlui titttwultrit.irr trli.rtili!ii l)iarltt'( ptin ntrlrtlt
I

tl t

,,t! ttl ')'t'nl ,t! ! ul ' r r,l rl tutti tl ,,l i t'

,rttti l uItt.

V{l r f ( r i l l {I
i t t t t 'g i t l t t r r l t , s i t t o r r l tto l i tl i l t,ttl t : :tI|' tr ''I'Ir Ir r ' 1 r r 'r i r r r JItL i l r "..{.1 1 ) l l i l xl zi i ( l r r l
lrllill
l
{}i
"i
i
(
i
\l
i
r
l
l
i
l
i
l
l
r
',
r
':i
r
"l
i
r
l
r
"tl
r
'
t r t l i , i r t r t t o t i t , r ,tvi Il t,l r , r tl ttr ,tttt'

Vffl . Nir r lr , 2r ir ' lt r i tl . h i y tn l l t(l i t.i l rrl l ti tto u nl ,i tl i t.rl i .

l l i rrvilillr . ( ll) 5 1, l { )J )7 )rr i ri s l ,r' ttl rl i z rrls i rrrpl ol rrl rr i )i t)(,tr,(,l l ccti vi tri { i i
r rrr,' ('rtr'olit lir r t t t ir t I I I I t )i i | ()l r!'1|I (r g t ttl rt, rk r i rrl )} l r| i r i (crr (ol tl l )l l ' 1i i t,i l (lr]i ,i trrr,{' r
! i) r l i rIi s i llr pr iY ii. ir r , l 1 )7 2 )I
/. 'l\tll\t,r'ritilt, l(,t.l\)us(j:
tl l'lttrttttLttttlt prod,rotnak sirrlr int,otrslitrrl c (lirxl rrrcslclr, r.rjrl:'iy
r 'rrr rr,l rlt , z r , r r lt r lcr li' o s 1 :i ,r' t'd (' t.u rx i rj l :1 1 cc, u ( .o s1ti 0l i (, 1r,tr' acj r.i:r.l
r. gi i
,
l I r r'( i | | (| jII (.1|, (li$lll{,(i sj sonzlltio de sufoc:}t.e.
l)) ,4t u'tltl xi?r(,r1lrrl
,,pNt'edo obic{}i dup:'l,\-irs1,i}dc 30 :lni, rle l)l l,li\.
lillr
llt, sr'\rrl lllrscrrlin, dlpli cum I'ezulti li rlin obsetr.atiikr rorrslr,c
(( tr lllil,
ll)71 i []ot'lll iu $i llopoviciu, 1972). Acegti bohra,vi sint tlr rrtrirci
:rllloririr,lo;i fi hipi{'tLlrsiyi. Arlf,'1, NlthtrLsnu (citr,t d'r Wa)rrc, tliilJ ir,
:rr:rlrrl (i'i 1t,l)r'o)(itntitiv0lreimo djn bolnavii cu afcctjuni oor(,ni.r,l
i(:r!1..\Lrri
: rr j :i rri i l x ( ' t ' , lir li : r r r r i Ii p c | re n .i l ,i l i ,Il ' te s i ]ro ,c tr,]fi rl j anrj . l rrrr.,r i ., t,,,t,
lrrrrrc iri ovidtrnfti, dirrel.sc ft)rmaliulri ganglionare latolo-ce.rvisale si pliiir,
rllrrrlo localo. Sinoolii propriu-zisi, se declanqeazii do obicei lrr rr.,r. i.ilri
o irirrr1i orrur,lologio plesifrcopali, apilind in colditii in oare clc).1c ii,lrr I rrrrlt, (l c l:r,n ivolul gil,uhri (comptesiuni in di\rorse circumstantc, iltl I)i!_r'(11,(,ir
r,r r iisl rt| lrt.(,a oa,plrlrli la b5.r]:.it'.r,,miqoi,ri bruste ale ca,pului (rto.). _\1rcp-\trl
riir( ol)l,l (,iilo rlc sourti, duati (10 -60 secunde) ,i poatc ti irrs<ifi1 rlc lorir ulrii
.lolricrr'cloni0(', cale pot imita pcr.tect o criz;, epileptioi. ilt, la,pt,
rrrrr,ioliirrIr,Irltolnavilol no$tri au iost fuldrull}.ati cu dia,Enosticul ,lr. criz0
, l'rl ' t,l i , (1 ( ( ur J : U. ir r ; i l o p o t j c i u , 1 9 i 2 ).
t
$til.ro clr'o.pus.
. ) .i:lin?lonrclc ?ostacceslt( e se c&ractcl.izeazii printr,o
r'rIlrt ii {l(t (,ii ot'a nitrrl e, printr-o Senzaliede anxietato $i de mal.i_,ftl.iiista,}tic/
r,u rlulirlr'i {lc cit cva ole, pini la, citeva zile (tr{invieille, 1$,1?),tulbluiiri
rlI r'rr,rir,01,cl',nc}r,ozi1a,tc, somnolenti, prelungiti,,
st;ri de depr.esie, i(l(ri
rlr rl i ti ttri o t r lc ,
( lllrrhr ir,(|r:t,sopo1,
Irozcnla manifestdri tle tip nal,colefl ic (_\Iayollr ;i
('hr,N.iogr'('s,cila{,i d0 Minvieillc, 1957). Turne.r:
fi I/ealu}onth (19,1S) u,u
rllir(.r'ir.i lsi :r,lr'r,ctui ou criderta elpului, ca in accesole al{r petit Ijral rle lill
prlrrrl,lrl ic. S-au rnai descris 6i echivalerrle verliginoasr, ilccese cn tnlllulifl i ltl lliri o {lo r.c(]cr'o ulri- Br]u bi1ate.1.a1e.
Weiss iii Bzr,lier. (1983) gi \.f.r,risr+
ijr lolrrlr. (11|110,ojtali de Cor{a,riu qi Bopoviciu, 19?:,) au individuriiizll
lirrufl(J o('r'oblir,lo rr,L(.jhiperleflectiYithlii
sino-caroXidiele,
Dnnifesta,l,o
lrlirr clizo rlrr ollrubilalc, tulburiri de volbire, atacuri irntste de sl.ibiriuuo
, , . r l l ri ,l )|l ] , jlj : r lr . lr r t r r r " rrl u i mu s c l u r' , r' p l l l o d n s o I ' r.i t! ,i ntl ,l & cunrpri ...i r r('
rr ; i rrrn l l r r i c ilJ( ) ' l, idi: ll 1 .
:!. .ll.t( lrltrniltstdrri : Il.anifestiirilc
ca,r'dhce ci)nstau in tulbur.irIi ilr.r
r iirrr r.:rr r li: r r .. . i lr r iur i[i ' i i i l i l n g i rro ;ts r' .
''1. (trilrtiil,r ila d,iagnos'tia t c hiperreflet:tir:itd!ii, s i.tlocq.roti(l,ie,irasr. lrol,
|r rrl |i r l ls l, f ( f l:
t) I ! intt,tuslrr,rt,lt.l,(
da tl,eil.unSQ,re:
O rni;tltr,t lfusoir, ll cit,pului (il11ttrsflri
rrrlIitrrrlrrlrillr.poi sluttlN,1,eraJ{i,)
itt rttettcil,zli,
o ci,rlolc ort picldeltlt, rjoniiliierIloi.
,\liIoIi lrrlliu|ti,r'i]o su(lced ulxri c(]l] r])r0Ftiutri (.('t\,ioa,le (gult.r'1rrr,rr,silirrs,
i||,iIr.iir|r,ir,
r'rr r[irri.l irL tllr])ul bi,tlbj(r'ituhr.i, rlu,Lr[iil,ul ]irlor:r'l](j olot.lrit l)tot,
r lr rl i r cl o .) $r lr ( lu} L r r l rri rrl i tl c trrs o (Ii o i rr d c rtL bi i , (l or.si ul Ii
, o i rr 1r,rzi (i l
ot lrrslrr,licii) ; lt) Utt tLt:tu,tt,l.
i.lt.l)ot'lttn.:|.
tskt t:i.t:slrt(Jt olrl<roiIcsl,o l'.'0tlr, tr,rri)
t , i l ttczl tt(ir lr lt r t r t s t ic t t r z rriri i /s l t,tt tr, I r iI )(rr I | ' Irtii I I | | i i l l rl cl j l rl o; c) (.l i rrrl,rsl ,rr
r rrtl Ir tl rr int lir " ir t it t t ui I .i n tt" i .,
i ::tt l i , F i l i rl ,rol l rl z(,l tl i l ,ti (l rJ i r\.i l i r
,l n l o ri i ,l tt1 ' t)t
lr ili l r'i {i r,r r r r r lit r r , lr r ,lr r lri l i l i i l i \r,i T e l l l i \' (.i i r
rrI\i { ,1i i l ,i rrovl rrl i r' rr\| i rrIr,.i | | rr,
llll'i ; (trt lr r r il, l! l?l) ; rl ) N l rri l l r,r.N (\l ,r' tl ru l ,l i rr lvj rl rrrr{ i i , (' i nrz,' r)r!1,Lrri ,,rr

$i'rf.l)tl.lootr .rrrzirt ittlt't

i'ii"i,li,i,l,,r. t$t:t; ,.) Sirr{ r'itrrtr,;rr,r'irIrrtrI.Ir:
rl,.r,.rrrl
rl:rr'
r,.,.-ri t.,i {"r i ;1.11
r,rrrrlri.
,,,,iiii;;,,',iilltl-l:*i*,r,.i'rr r.,.1rrrrr,.:,

: lllr lr '
'
rrti tl t' cj trrl so it |lclit l' I t lt \ r 'lr lit t ' l' r ': r ilr iz: r 't l'itsllllt
idic'tt'r' I'lrcilrrr.rt
si'tr'
tl' s ernn'ele obier:ltt;t'trlt lti1"rn llrLlirila!ii
' "urot
cal(11ido lrL
r
digitrli
pr
iir
crrirrplo'irnca
prttct
icii
se
,,i,n-"*rliiOiaoi
',,if"riil'
"unei
oN,r'(liruu'"
sr._utinic poljgr:lliu('1r,1.ri.

r,ii.li.iliei,
..i
itl i rl ri g1r1r.rt'lI
'rmi'iril.
respiniorii
r,irrsirirale.
Si cerebl'ale.Itroitaxea sino-ca'ro1
'""liiiii"
,, ,itl.o'ri
iolicita,rea ixdiyidrhi de a-1i llsiurna cllpul i]rlrl).i.
lrrir'r'('
lrl
dfirl)t
are
car
,', ,J.
-arilorsi comlr'csiuncacarotidci llimitiYe'
j ,,, "tt"ii*
;'
ldier i'rnrti nrlltl salr mai pulin colnplclj rI'li'tr'1tt''
fr-ria
('rr(losr
Lipott'tsiuno:l,
rc:i'c!ii
antlt'nellzi
r l|l'zt's-Rueft, 1953), care
.prin
ir'
rrrtz-iLli
* 1]rorlxci. Prohl itrvot.:] rlc hipcrtlnsiLureendosin-uzdi-t' lrrrtlr'
luiY:tl'ir'lt;'
p
pr'rba
irr
I9L7)sau
,,Iri: o-'-- ".."ui 0,'t'rsr.' (Ntinvi.jllc.

$'Jfii:1"Jt
fi J:,{:Ti:{,1:"','[,i
i"%"*{ri;
,,,,f;i*#i",'0,,),2ufii$Jl:t"$

t'olfariu. 19?8):
1\'] I i.pul aag*L tatt c{ 'dto'1'nllibilor' fnci' ]a <lel:utul excitilrii' rlsifliirtr
upoi chiar la o oprile cardiaci timp de 10 stttttttk''
l.Lo;tu;e';'e;;'i"iui,
,"^r,ia la frecrcnla i'o'mali' lllectrocardiogra'Ir. it'r'it'llt
;ll,i,i;;;
i"
r
""t:i""
,.iL'bradicaltlia s datdrefte urui b16caj sino-atrial sru. atrio-vtll1.r'i(iull
prevu]f
rr{r'nl('
r\ tlopinizarca pralabilX sau ld inistraJca de adrtrrlini'
rulbrirnri. Ar iitra in ioc u:r rnocanism bulbar (nfinvieille, 195?)'
consl,S,intr-o hipotensiune altoriitlil irKl(l
b\ fitrut lttnsio-d,epresor
'Oe
t:l,rc s-ar d*tot'a unei va'sodilatafii g(trcrirl('t
r,rm"irtri
"ud.i"utjdi",
ta
adrenalidi li o. sht inflrenlate d(*r1r'.1)itrrl
i
cdazii,
i"-"it.
t95?l Corfari[ [i ?opovicili, 19?2). Ar inira in joo iirl rrrl
-o"itn*tl',
ifriin i";lfc,
uiecanism bnlbal (Minf ieille' 1957).
c\ Iivut c??rr&l cor($Iulde tablourilor de hipelTefleci'ivil it'il sitttt
j cattlirttr':i srttr
modif ic5-r'
,:'rut idian'I (are nu |.c ilso!r'sf de rprct'inl-ri)c
rrt
dr,, rt.ioooi. ..i carc nu .ilt in{luenlafddo atropilri sa,tt adrr'tur'litr'r'
'l
trti.
I.t
(Minvieillc,
19571.
,l,i,rcrvarcaiino-crr.titljanil Iijnr.le{icrce
-A.r'rtili
r,rfebrali, n fosi individurlizati' inci de lTeiss $i Raker (1933), rlltrti tltr
t1'flris. UaDrs si Weiss (193T,cita1i de Corfariu $i Popoviciu' l1)?!), trrttro
i
,,,
iof'Jti rLou)itreiini .1in caiu,r.ile4e hiperreflectivitatc situr.r,rrtrrl
".i realizeazi' aceaJttd,
forlllri, tleqi llilvicille (19i7) Fi Corl lirl {11)il)
rlir,ni,
llr ai.[tat cE,,de fapt, este Tot.bacle ccle mai multc uri r.lc folrru, rrrirlrr,\ liji autori ilaSeurl, in cadrul formel'r cerebrale Sindroanl(trf tl.r' lt ilrt't
j,4ifrtrrtttl ('rt'('ir' li
r,,liectivitatei, a cirot simptomatologieesto nervoasi,
rrrutriicst.it
ilo obi(cl i\ e de Laz*.
Mjnvieille (195?) a individralizat mai multc Jomt' ;
tlc rlittti
cetebraLePxrr(i(rara) ^secaracterizoazilpr,in rr'trrtrsc
a,) U'anneLe
li lL
llJtlrl((
lLlsoulinl',
t|rtalc a s15rii tlc cort:lticnl,ii,piolderoa, totLusriitti
()pjl(rllLio,
sli,ltitrittttrr,
alrf
$0.l',iriii
ti,
d0
r,tirrvulsii
zl_L,rrot.au'icu lar'(',.hiu'
rk' lllitts ttctrlot'ivlr'1
lt(j(1(rs('
, tliurr1ro1'Ii tr'1rt'
do yt'drrtir,il(l('s{'it,
ti]ibrLlir,ri
(,iir1)i
.lliIXrt''tt{r\
i(litur,I)lill
rirrrrsrrtrri
$i }rrirr rltr.l.
,tiisc *i f1,lr, l)1.(,si'r'r,,
prrrrl l s'Il i rtrrl t,t , llr t git r r ,t ,ll, t lr r I 'r lt l: i l) t ilr r llllt t it r ihLlilt l r lr '. ll'( lili lli( t 'l llli( 1
I i t ' \ ' i I | |tI I i ||'| (I r l t lr '( llr r
i l \l i rrvi rri l | ,, l l )b'l) , I lr lit t t |lr l lt |t slr 't r r r r xsr \ |r 'l'
'
i ( Nir r r i|illr , , llllr 'i) , ir r I lr u t r ot t lt r r l olir t lt t t Dlr t gir ',t r t or lt
i ' l l ,)(i rl rr ti I rrl rilr , |)io
l roi rti rr| ' vi rN (l ol lt 'l llr l{'lt t ',
:t:l i

: t : t {i
../Itu

r-d-rr

Iltlri,rrrrtr
l ilt r , r l, t , t , n. lt x r l ; i, r r ,lilt t r . l, u i ( t t . t , d i r t . s , , l . t t s i r t r t r l ,
, ltt
ltt,tl,
I J):.rlllir
Ir. l'r.Z;r r llr t , . l' r l. r lit r r r . , . : , , . , r , , iir r r l l l i i , t , {l , t i . r , r l r r r., r rr - I i , . I I t . | ( , . 1
:,t I i,r'ir rlirr\'l.iir.,,1, r ir , . : r
r . r , r r lr r lr r i . i f r r lt r r i r . : i r i l . r., . ; r i r : . r , , r, i i . l r r l . i l l i , r
"
| | l1, .,r | .lr zi|r' :rlr. . it r ir r lr r i , . : r r , r t ir lilr t r
1dr . r L , . r t : r r , , . l ;r , r r . , t , . 2 i , . : i ) . r t , r . . r l l r l r i r
\ lir i i"rlr,, (l|,:,t)' r ir L' iiur L' - s u1t r os iv ii lr , iupll
s i i r . 0 {) 1 ) ( ! 1 0 1
s l r n ) . {j l r r 1 ) 1i r l i ( 'r ( \ ,
I )lrlr r ''.'\l.t1 it, Ir':r g . il' , t r l. CO t liiiiir t t lir , Si p t , i i t . l i l X , r , l ] , t r , : I f 'r , t r i l r , f i r r r r i l , r l

ri;iriliiiffii
;]
I'jiili
:r';'trll*[rtf;
i;li,
*rsi11i.rtih,**;lx|rl:
;)'ffii;-i,p"l#ii;t$tru**l,:";lf

t"';iy:;t,ltiil'li'f,Lllr;.liiit

ii"'*u t lu tl' pt"'io iult ri trl ' r'irr'lir)'

(l01 .o 't'i
vilitii sino-carol,idiene
'pio*
a activ.jtaiii clcclrir"r lr.trtrtlir'1"
ii'bi lr;t" *"prinde o'rJ.r'ircp"o-i*iox

rt'grrlrrlir..rrrrl.lrl. rlir irrflrrx'r'ikruo.iirepl,i\ao'(i rti.'l l^ ,r'igiru,ri

sirrr,,r
limp sir r.zlste l:l ilchcmirr,t\dati;ir,
I|(i1' | . , I)(,i rILi I i I |(I irr rr,rrtrlirfi
{i itrl(,r.
rrrllr lllrr.

,.1..)l,trli.li,<irilr Illiri it hiperrefLecth|tuteasi.,o_carctlidiartii.

Jt)l.t,l,,
r*
*rir,rrg"'.1('l,
r 1r'ltti*lir,r in pelioadelo interditice sint cel mai [rlrrrur,
'i
rrlrrrrir,L,lrllilrv,ifiilc,, tUtT l Cor1a,riu,19?1 Corfariu qi Fopoviciu, 1{t?:,}).
;
,,,ll,,ll ut l,ir lrrl ,siicupel0r,,
sau la excltarea sinisuluf(prin corrr[r,ii
l]l ll,
pr.irrrnasaj,.sauprin stirndarcm6canicl,il.trr
,'llill:'
l.1,cil-!,1,.,1'xl,ulii,,
r,l'.l,ilrrlR.,
tr)ugrliu([iDr,li1,
asupra axului carotidian, rcaliza,lEprin rii,sl,Lrirur,
rr':L,:rjlltt't
r,..spdctivp.in variatiilc dc presiunc cntlrrsi.rrzrLlrr
'lr-rput),
irr lripor','rrsiu{ru
;rrrrr.or:rl,',:Lti0
cil, si irr lripr.r.
lcomprcJiu;e subsin-uzali,),
t(.r.rirrr,'(iiu,luiiijde luse, prubl lui yalsalva), se pot obfin6 o seiie
tlc iirrli
(.rl,llrl,r1{r(,:r,i0,cit}.er,u tost sistemat,__zate
de n[invieille (19bT)in J tilturi:
rr') I'r'irrrLrli ip ; uu ,r)ri,r'Jnici o modifioare EEG. Doai. sistemul crir.rri.
\,:r.,.'ii'
; b) AJ tloilea tip: arnp.lil,udinea
riflnurilor Iilr
'.il(.
ol| | ll| llr r.:lzjL l i.i!
'nlcrcsii,.l
tit { t c 0ut ||[ r t x CiLal ini gi Sc nO r m a l j z C a z L l a s t . i r q i t u l p I t | i x . l ,

L'rrrrrrr,'rrlJiirrrlbihte-ral sincrond,]tiina ae fapt idlentic'cu rirr,.{iil,i

,qi,
rr" .lr'rr'(1\ rzr:urcsftudc irlta
natulir,.Irodiiic.irile cardiacesau tcnsi0rr[|.

|
, r.i, iri' ir,c{-.ltip de r.iispunsEEG ; c} Al treilna tip: rrrodifici.r,iIr
1,1,r!.
'ri, tr'
r'.r',t,s'rt
m&i plu'utrfr,tc, l,raducindu_scprin rdriii ale trils.rrLrr.
rrirlrt,,rlii rol:rtr.,.1.952;
.tIinvieillc,1957).Astfel, limp de citeva scclulllr
jci. r,poi scadr.ampliturlinea,iar -drLpi
lr:r.;,'.rlrr|l :'r:rrrrrdil
5_10 gccrrlrrlrr
:r'r' r' riJr.rlr'ii.ur,ll'\'ollrrle(to t0 ci'ri/scc si undc rtate, mai cvitlerrt,orrrr
lr;lirtrril', I'ttrtrirLl
.
d:lr cu o ur.olru,prcdominanln de prr,r,f.i,ru
.lrifu.lr.rulr..
., rlt.. t'r r'\(,r1.;[1
, /\,...il,, rrrlu]ente Sint la inCcpUtdin bAnda l,cl,a1rr.||rrl
ir1r.r'itt.sofi rr)rl,itn[1], odat5 cu crcDtereaamplitudinii. realizinil'rrrirl.
rlrrlirrrlrr I,r'rrri, sirrrrs,idal5,.Oda,tricu-e,pa.ilil u-ndclorlente, bolnavut i4l
lrrr,r'rl.r',,11ir..1f,,,putind _l)l,eze'tas,i _citevaconvulsii. Unrielc 1e.1,. lrit,
l(,_ -l() s'' {'nd'', tlar' uneoxi chiar 1-2 minute. ccl mai arrrrrsarr
r'|r'r'$rrlir
,r.r:{;r,,' r'r.Lr,{io
ct.'r'lugitiu intre ri,rirea ttaseelor EEG qi br:ldioar.rllrr,
tl:r,r
diacii nu depiqe;te 6 secuntle,lr,rr,oeulEEG nu srrlirrii
1lrr,rrzu,
'r'rr1r.r'Lrr
lir,rir,tri, rlL]. du,cii a,julgc ia 10-1b secuntle,apar modificii,ri EE(i, crxru
.rr .r'r'ii' rulrrl u'rroxi.i ccrcbralo *,uzate dc abseuJasistolei ventricirluftr,
rl, li :rr,lrirr.r.rr csr, singuta t,auzri,
lMinrl.illo, j9j7), jntrucit cor.r.r,trlli
:rl, ltti.l,ltrg,,l.ii r,r'lrrb.(19j4) a'r rqtrrrrtti, rnoclifjciri
-E-DGin :llrar,rr1rr,
,,r'rr';r.r lJnr.rlr(,ilnrlll
;:r,ll hilrotcnsiuni ar.teriale.Aceste constati,r,i altrnf,$
' \r.ltr,llt,ir, lot. lbLlrrourlollralti. purc, aliluri d0 formo intricate, irr rr lrr
.r,;r,l|,rrtlu, irrllrrr'r{:"r,
r',,r't,bta,li,
diro.ctd,la, 1i.r,r,tOrii
cardi:r,rrsau 1jonsiorrrr,l.
'I r'olrtl"irrll,irrvudrrt:lr,ptulcir,p_o.Ill)Gnuscpuuileviclenij,
manilcxl,i,fl
,,1,,.1,r'ir','
clilr.Ii,it.. irr lirtrlrrrl p.ob.ktr dc .xcii:r,1li.sirLo-oar6tidiarrii(.Nllrr,
rr'.rllr'.,l^l)fi.7
i |!')|.Ii,iir|,lU7l, l.9Zlii Liorlariu ryi l:bpoviciu, 19?2). illllor
ir|,,|r(r('||rt l,r'r,trir'
iiri Ir:r'Irirliir
prirllr!0 pi0r'rLrr.0
rLl eotrril,icrrl,ii,
crt rnirycr'l,r'l
rlrrI'iIll lrrl,o|.lr,l,isrrurLrr'qi
orr cil,trvllclolrii,rrtr sc i rrrrrgis
l,rr1r,zir,
rlrlgil,itrrrln
l.rrl. rri rrr..Il,i,r'rl .ii,.rir I'ir'|i-rrrrrI.
(Cor.fa,rirr
ryi ltrl,ovicirr, I1)?2),l)rrrrl
tt,tr,tt,ll,lr,
lr,lxrrrr(li,
rr IcrrIr,o-rrIiIrirrii,
r'sirr 1,ollt,lrlilirr.ilrii,
rlrr it,lrstrrrlit,
rlirr |rrl,ilt
trlrl 1i rlr,,,lillltr.lr" irlrrir,rrlrr
1;rrrrrIrolrIIr,.
:J;Il

,"I

:'.i'lJ't't;lii;lill'ii
\T:f".li::'tJ-ru"""t*ti?;','""*"#iJff
l,i}lrf
,;il"r"''
,$11i;,**-;;*it*[:41"*6]t":1l3"Tlill'"',
t'ffli11uf#k*t44"-#.:*ili'lt"'*g_si::!"i
.
ce
i;t*m' "*llx",*ril;ll ;lT$H"{:ii#"T
.ti*a'liksopio,,r,

*l"*fl1*"#*
*;*flX.*:\s{.l*$*f*1yi*tl*:"*d
"il?xtl;'de-hipcrr
u-.*::,igm*1;)f
;*?;,:"tntmm*t*iif

it*,T:".ii#,","'*##i*i-*l?H#4il1:

,,I';iffi;l;r*t""on5ria"""i'iii"$""\1]#i:lllrsriJii:3i!,?lH"
-",,*gm'ttif

'ii,1::r:?T,ff
:,ff*1ii:ifii.g1*,.t11i""t*','f;:gf
il*iil,l;ll;l

i#tltril;,
T:rj:i:rdf#"r"*rT{#:ni#"*;#"J
ll llil;;i
Ji,ri;:iirilllti,i*lt#"lii,''i:

m
:li:'I;:;llt"i:l'.i;l
;'ru;:l
ililikn""l'Jl*"j,l*,.ff;?"*:pl*"-tf;:li,ll:""l,nl*'i,'il
al ciirnii;ii etc').

jl:,k#::L,$ffi
;d:::*il'i"i*lii:ilkij?{,*r
*:fi,lliil;fii
;;ll;;ill;'
ji
:;
I
:iit
t
hlr**llunHitr
J;*ft
i{1,
':l"""th
icurtii,starecrcluscrit'I,.$:.ii1$"".:i;''ff1',i:1,%:t-ilL[llili,,
irii"i""1 .ir""rr"A ;;"tt;p'ii"i;;il.

|o rrH
Iii
Si*ptoro'atotrgiapost:}ccosua,lii

''tr-o
dulatii
onitt'

pind, la 24 de ore)' e
delir (Passouant gi Minvieille, 1954)'
""

cruneori*i:Si;i"tt?l,t'J:ff?r-li#iH:Il
faptui
serelateazs,
:il]'lliillil:

,ii:rHitff
f'"iL:f
i'.:titgp"ryt41*itrf
t*l
kilil[il,lif
lillll' ;iiiiiilli,*lii':ffi
Iti;iii,li:ln,lrl
i;iifl}liiii
i,1:
ilii]
,ilil;;,;ill,lit;

ll,,,llilil:;;,l,,li,ij,,lli
l*!:,,lii;,jllilr,i;,i'ill"llilll,,
,;l;ii;,1;lt,,i,i,li;1.;l,l:ill1
,
,
;;;ii,,i.i:
i,
;lilllili:i,l;ll
i:lfl

:r30

\ rrIL i I|i r I r . , I I ii(A! .t llir l r l o s i rrrg rl o rrrctr,rt;tl i rr1 fi

, Ir,1tttrrl 1s9I)l i 1 { ,1!trl )1.(.ti ;111,!l
r,i ttu strlr r ir ' : r r r r l, ir lilt ,rr
(\l ri s s ,1 i l l tl l i (l r, I l l i l j l ).
l )i l l. l) llr ( 11, r [ { r ! { x ]0 ro l i z i ri l i l ,l ;0 1 tl g i rr,s i n (l rol rttrl (l o l l i l )(i rt]\(l i l l rl )i l i 1r!i ,rr
rr,lli.rrrrs lI i
so pou,to l,ratluco lio pritrtr,-un r0lIrr <lo tip c1t,r'(lil|.r,rr,r0t,irlilr,rr
rrrlrilril,or' (lig. ,12), fic pr,irrl,r.-rrnrcl:lcx tdnsi o(lcpl'osol'. itr unrikr crr,zrrr.i
rrllslt rlorrir, lirlnrrt rlc r rlt,nil'os1,a,ro
nutindll-se inti'ica,
COMPRES/UNEA SINUSULIJI CAROTIDIAN SII NG

a i{X!4^,4^,\^.&-^^.^.4ae@

FM-V/\

"."".,,

{*:S***@
"Y-:-'":,;:*'
PD.-TO

r l ttl t,,l t,tl 'tl "4 tttl 1 ti 1 i

tl

p r tl i r tr tl i ti

i n r l i ttp r ":t

l r ) 1 1 ) ( l fi
cl L l l l l ( r q i sl l 'i l i l ( r
tr zttl l 'l
. D U l l i i , c t t t t r i l l tl i l l i L l :r l :r l .r 'l l l 'l l r r l '
( l l i l ]g l l t) s
p
o
l
1
1
'l
tl
l
l
(
i
l
l
(
[i
$
P(
'xl
'i
u
l
)
|\i
l
,ttl
i
l
r
i
r
,r
'i
i
o
I X ) l i g f a f i o o t l ) l l i i 1 ,i 1 ,
1 r :r r :r r .Ittti t{1
i i . -r i l
'1 i tIi I.tr :tr 1 i :r I :r l si tr .,1 ' I.r ''
t,utiiir
n u r l l r 'l i r l r '"1 'i * t i i I I t' ! t I ; r' I i i
;;l tttti t:t\
t:t.t, stttd ti r t
. \ '. - i , , r " q i i t , A i i k
'
(ort'r'r'irt, 19?1, 1978; (.lollir'r'rll
(Gast*ut, 1t)"56i Oilcfia,ulL qi 51oic.t,, lutj;;
cr
tztt.tt
tl
j
l
r
l
r
'
3
u
o
/o
g
a
si
l
Vo t"t l l ctto ( 1 9 6 0 / 3
l C 7 :.j i . l ) o r t
.iFrno"iaiu,

,i"o"rloiii nroilcr,rte'Silu 10o/odin 10O de bolna'i cu sincolo, itld',str1i tl.

tip 1-aso-ragal), anomalii EllG de tip epiieptic'
rltlrrr'L(ltr
potigrdfice pot furniza- clate pre!io:l's() lu
tri, I'nregistrd'tile
'iar
-Inecanismele carc concurS' h instit'irlt rrrr'
,tia,g";sti;,
ryi ref'erit6ar; la
sll]oopol,
i. In.reaistrarea accesttlui,oste posibili, foatte rat, dar clnd se lx'irl'(l
Ir-r,ce.ie tlifdrentiazX, in motl net aCcsul slncopal de accesul cpilolf i(r'
2. lt .faBeleintercri'xi,cetp1'rl,cticarle&clirerselor nrcto'lo de testalr rr
roncdr rofiexogelre (testle d; compresie a glollilur oculari, de corltpt(!$i(l
caiotitiih,n, netoda Vtlsa'l"rr') pot surplinde po poligli)'rtiir'
,r" ti"iu.if"i
liincrrettcxiritatea zonelot reflcxogencr evetrtuill chiar s5' lptodtr('ii' irt
iaborator acoesul sincoPal.
se fir,ceprin crjmpresil gkrbilrrr'
a,\ Testta'eT refletului aculo-card,iao
1,culi.lii,ur rnirin{lu:se p0 poligrami, actiYitatoa ECG' re,spira!ia' 'I'r\- 9i.l't:t''
i,lpC. L.tf"t,Verceilefto 1iOO0),testind roflexul oculo^-cardiac,i],ol)l'irrrrI '
""ot
lo'iz ,iin 33 cte cazuri cu si[cope' stopuri ca,rdia,cede 2 -9 s' cu "lil'r]rtlrr$
li'n O lncomptet" (unde lente dihterale, sincrone $i $imotrice), iar lt!.rrlli
li3 studiali;, stopuri cardiace cu ,,ri'spuns EEG cotttltLrl')l
l- t oi"r"i toi"
eloct't"gr':r'lir':r)
""i
Ieutc cripate tle pcriuldc de
u*de
'rrui"uii cic
-dePrr:sie
globilor
ocrrlmi Lr 'l() rl.'
cornplesici
iretoda.
utilizind
ilr;ui
Lf
iOr
t
irof"ot:i. J, obtinut sc l:rea ritmului ctr'rrliacctL mai lrr[lL de l0 lrillii P''
ii, io*t" cazurilc, pauze pc ECC cu dun'ta dc 2-3 -s (Ii'ri rrisprrtr'r
"'i""i
llnei U 18 cazuri, pauzi pe ECG uai m*ri de 6 s (cu.ulde lcnto ltila'l'r'
!io"r"o" Si sim-otricclre EEG) la 4 cazuri, sljoluri caraliaco ntli tttrt,ti
"nt".
,l,r iii s (cu undo foerte lente bilaterale, sillclone $i simetricct ul'lna'l.! -(l(r
instalalea piorderii de conqticnttr') la' lllli li
"uolu,tirrr,i"otraseului $i de
i16lna,r-i.
- -i.,a
bolnavii obserYa,tieleloi (Corfariu, 1971' 1978; Corlariu usilhltoi,
ticlu.'igfZ. l9?3) s-a obtinul' prin testul dc cotnpresioa globihrr rrcrtliLt
o/o
lrlrr.rrri
tlrr
alur.ir
bolnavi,
cu
di[fie
la
47
, reacr-iedi oprirc cafdiaci
2-3 s. I.ta unelo cqzuri ann evidotrtil'li bl)lrrtrt
^ri.ro-otiiat" cu d.ura,totle
iant", la intervale do 2-3 s. ln cazuistica noastl i'i' Iru rlrrr
;;;i;i;
'accstei probe, clenivcliri tcnsiolalo 9i nici IJrlttttrsttt'i
-iu
"i;;
,,f,*"."oi, it""*,'sul
pierddea c6nqticnfei, ca in relat5'rilc lui Vt't crrlhrltrr
-.,ro,noi'i"; uuG cu
ii.s-ooi- iteatttoi. Gasfaut (1956), Corfaiiu (19?1' 1978) gi Cortariu 6i l'r.rrlt'
i,.rt:i.i" irszz, isza) au c,picciatci' ,.t:xpresia)'EEG csto doloI'milrrL{iL
cu tlltIaLAstlb 6 $, trrrlrlixlili{ ii
Asitut uri bl,rcsirr,-:-ulrial
1i,,,*i*
^iir,otti.
ia'r.r,scul
EEG. in schitnb o rlsisl,olioruai rnato do 6 sr prodlrco lr{1 l'r'ir'r'iorrl
gotroralizal;0,cilro oLos. i1 ilrttltlitt-ttlit't
iiiJC lr,rt"u.i rlo *rtrlo 1,IrIILII.rLrIItir,
tlludiltl tltr, durill;ir'tltl 12--1'l tt lrrrrr
lJtt
n1','
tirrrrtItttItr,
rl.o,ii,trvrl
iiril,,err.s
irro,
l;iisitttirl,t
$irr(jlrtlro
rrrrrkr
krtrl,olti[:r,l,ortlo,
rlrr
rloscrilrr:ilr
,ii,r,irlrr,r:itr
uo lt)lC(.1

Fffi--..,.^ A \
\/1 n n f\A nnA A r
^ vv
v v^ l/ v
F.u Gvv !4 v v v v \/v w -'\/v
@Va{Url^t*r^r,r.

l l tl r l tr l
t '| . 1 . : ; - : J , l . t "
Ir
I iItt,l, uc(Je:t!o1 5I IIr:tt1trr

" l

?t1*\t'$^^&4!t'{ry&+@
./.it. :{.9. I cflistmrc lolisralici
(compresiunea sinusului earoLiCian dupi
|ilx'ryDce) Ii bolnr\,ut C.ll., 48 dc ani. Dg, cr.izc sincopate p n hipclreflecli\'il.ntc sinocar.otjdian:I. Pentlu cr.izcle de pierdorc a euno$tintrei, deti IirA
collvuisii lo i(!)-clonicc ti lir;r njci o simptonratologie preacces[a]d, a lost
r.lidrctr)t:1 drelt epileptjci. lll clinica noastri loate invesligaljilc
clinice
\ i t , r r , l i l l i c e t i n r l .iv UEG .i I' F :b ) cr r fo .t n cg rti vc. C ompi restun,a gtt,l r j l o r o c u l r l i a i o st lr e g a tivi. In sch in jtJ p t llg u r a ie r edc cum_conl prcsrunca
sir rsului curolidiAn sting (dupi hiperpnee) produce rrn bloc siu;atrial cu
( l r r r N l i r d c I s r c nn d e , In so lit d c u n b u fcu d e u n d e lente
bi l ateral e, si ncrol l e
similflre s-au produs 9i prin comptesiunea sinusrlui
ii ni )rilrict, llodiliciri
rirolidiln
d r c p l . lla n cr r a Va lsh h :a a lo st. Dcg a tiYi (dupd L'ortori u, 1971,
( h r l a r i u$ i ? o p o Diciu , tg ? l si p o lo r i.iu
$i col ab.,Tgj B ),

din net:ralgia ltlosofuringianti. Ri1cy i1g42, citat rlo

.-. l\. r9inccrpzle()oltu[olla
\Vr!,yn0,.11)01)
(1OiT, citai de Coriariu, 19i8) au d'escrislsO;i
r.ilri rlrr.rr':rr.&lSiiglusotaringir.lc (.u sincopc pr.in b ipersousibjl
jr.i,t.,,rr,
H|llrs||tut {:t.1..r1.1(lli!
. Ac' sl.c loTmc ,plrf iculare dc sincope intrtttr,,u,,
;
rrr,r'r'rr,lgi..gl',solnringianL
in accescduicr'oasesfir;itc prin aciese sincoprr,Lr,
Irilrr,r'rr.rrsilrililrr,t,c
sino-r:aro
lidil,iti, 6i prezen!a unui h.ig-qer zone, a i,iir.,,r
ir r':r,(ir.irrrlrrr.rr
.r,izlr,sincoplli. Dur.rilc alri in rcnnseuiolentecu dr,,rr,ll,
{l(. :j(t..ltl,-s, IiirLrl r.rr,ntorrir,trr
la.baza linibii, i n amigdali, qi in unghitrl
rrrrrrrlilrrrlot',
irrr.intro crize dc obiceribolnavul nu:lcuZ[ nici'un simpl:ot',
lriris|,ii I r)L rii lxrl nlrl i car,.acuzil dureri pcrrnanente,peste care sesnpt.it
l)lrrl
pr o.,-,ilruc
lr,lgiilrYiolt:trtc,I'io_spontano,
fie tlec]an;a,lede deglntilid;i/'srr,rr
rl^ i'il,rr'.rr,z,rr.l'r' ilrcLyatn rlc glosofaringian,rle.rnulte orioontimirii. si
rlilrilrr Ir'irr rrplr,r'il,ia,
sincolci qi insoi;i1,e
sfl,unu de convulsiii,rnico_.loli,,,,
i-li rr| si 1,rrlr,I i i il r,rrrosineop:l su declanqoazirrruml,i la
,,nevralgia rl: inulri.
!,irrr"(i'ir i.' si rr,lub., lt)5? I I?:iillu,s,
1lltio),d l d. muli;c o.i sincopclr pr1;fi
rlrr.Lrrrsrrl,.
sinutlrrluicir,r.otirlilrr
(|.'l,illrr,s,
1i l.in corIqutsiurL.:l
Jg00), irrrprf
rlirt11r11,'q,1,,,,
rrrl'rlit.t,trrrrntoitsii,
ll, sirttrsu]rriso pot itrl,r'crtuxt
nocosolcsjrrrrr
lrrlrr,rlir,r'rrrrryiclizclo ncvllrJgicc.lrr rrrullositrra,(ii,trrrtirol,olniil,
lllrl,a.l.lt,rrilul'i,ir, rrolvulrrii{losrlinilrgil,lt1rolrloirr.l,r.t',tuprr
rr,(il,rrt,izcl.lilgicr,,r,il, yi
rt,llrttili rt,
lt,sinl,rrlci
r.lr,trlirr,r,rr
sirllsutrl ,.rrrrrt
5i l, sirrrrolrcilil cotl;tr,r,siltrcrt
r.

I't'i l ,;Io ttItIt,I I t r I t I i I i I Ii t t 'tI ( !i !l ( r i l to tl t'tr l tl tl r l r tl l l tt r ttl I tt r t I

', r 'r r r ', l 1 , rt tl i r l r , l t l lr l ,i tl t,tl !i t
, , f i r r i , , i , r *1 , , , , 1 *t,t,,,
l r to l '{l r 'tl , r l r r r r tl tr l ;l .i ttl r 'i ,. l l tt l l r l :l l l t t'l \l tl i l l ( l l u i i r 'l l l ttl l r i i tr

r l t : l| l.
: l ll)

./141

,l:llli,i',.rfl,.,l,r''r.rlrLtirir,
r'r.rr1lrr,
biilirilrrcrrr,rlrrlui,
rllpri,t,ir,rrr
ljl'j;j',,1:.
;rr.tlirr.t.rrl
rrjrljrir'rllIr, rr(.N|rrrrrlr'lrr
lr.rtlr'.
tl.r,rrllrr,lizlr,ir,,
r,ru.citylt,lrsi, ssrr,rlii,'.irr
lrrrpli.

Itl rl i t t , , l: l r : r lr jr lll rrrrIj rr,r' i , ,I r,r | , . r1 ,. rrr:rri rrrr rrr.:i 0 rl r. r.' .I

I
l rtl ,l t | tut' c sc r.r,i I.
si lr,lolr,zii,
1,r''.,r0rrl
Ir)l!(i rlri brr,ziilr)r'lrxLI. lri.,,.,nrL,.il.,r,t,,rsir,.,,l,pa,r,r{,iir,
rrrrrl.lrl.

lctrl'0s-rr,I,'orlus dr|r"r'_?-l0 $(1(,utulc,

iru pi,";.t,,",roiiiirrulsiill,,i s-1,irrs1,rr,t1r;
rlrrpii,. .sistoli. va'i*bilii fintre 12 qi fS s;, i'frurc{,ic
t1i ptirt,ic,I*il ii,1ii.
oilollrrtorti alo fiecilrrri bolnav.
b) Oonlpr*il,jrea sirtttst.Llui
cttrotitlion,dnpii cutrLun pl,eorzil,ti
:tnto,iot,,,
r lrrirrllln tcstmrr:l re ,ctiviirilii lcr,sl,,i irnpoitante zonc ieflexog"ui.,
lirtli
.iislrLrrrrn.ile
rt,Jupra,activititl,ii ti,rdiacc, a;f-.1.
a't.ai.irlrii
Ui
'lrlilrrt.e
r',rirr. trr lti.t{.(,ilzllr'i
5{. poL olrLin(.lnrogisLrijTj
polig|afic,.ulo urrUr.,.r,izo
sirr,-r,1r;r.lr'.
lnr:ri\\',.isr:i lJlk,,r rlb3l/ &u !rr.(.izati.ir,ll'..luoor.llr,r,..ju,jir izji
r{') rrirtt! I r) t[,le;.i lt{,1]sinusul i carofidiAn tru prodUcenici Utl
lJsl $
rr,rrrrtrnal,
iu,r'ltr,rostul inclivizilor, rcrj[str, cornpres'iune
i,'tluce o braclici|rlitr
rrr','rl(.rrtii
1sub.0bdthi/;rrirrI11ilid! r.alorr.-rinilirla) 5i o scnrJero
u ,1,..\,
: r, ll, |l rr I l:i- lalii
l irloJrea jnilirli.
'l{,
Irr schimb, la bolnavii cu hippr.r,,flt.ctir-jtat
c siro-corobicliani, mns*iul
r,r-.,steiregiuni anl,reneazi o serie de noditic5ri, rliqrt[
y]]l!]^"!l"l:"1
):,:ii. lUxr(:tzlr,
irI|rr
j('ille. 1957; Corfariu. 1971. 19?g; t
1_\tr.o\
urfrriu ;i'J-,,prrrr' rr, 1972,.t913i.
1) fi,. nurnrli rrru,lirjcili ECri, firii mudificlri ,t-.Ei;:
1,.)
.1..r-'ortrlrult'rttl(jc, ins{Jlite dc apatilia de unde iente din bancla thet,.
r:hiur delt:r,,po toate deriyatiite, carc c'oincid cliu punet d;;;ii;;i;i,l
r rr iordu] or, cu Di,l blnlei tinrp c1e10 -30 s, clar cu pirsistenla modificiriior.
.[,
lrjirl(i
t"l
LLe1ir(.n1-2 minute. Rezulli5 ci, Ia bolnavii c. hiperreflcctivilrr,i,t'r,i rru-e:.ro1idiitnJ,,comp.esiunea sinusului carotidian deteiminX, itilcoi.i(l)r rr,'id.liciti ca.dioiuhibitorii \i nrai pulin
cu scirlor(.ib
'blu{.ul
1.,-rrsirrrrii
'csodep.rcsorii
iiriorirl(..,1rr oxperionrl
sin6-airial O"ntan.ai',i
.nua,strA,
ir,v|l1,rtLrr';tt,'
]-i.trubile (itrtre 2^qi 15 s) Di a fost faTorizat de hipcrpueoir,
pEG sirit crependentenu nrmai de duratii,
Modificirite
|r'tr.,labilii'.
*isistolitri, rlilr';i de uncle reactivitiili indir,'iduale,in sensul ci, la unii bohavi
irrr apii,rut unde lente biiaterale, sinerone Ei'simetrice (mai exprimatc tx)
rh.r'i.r'ir.liiL.&nterioar(')
dupa o asi"ioliedo 8 s, in schimb Ia al!,ii;io ti;Ii I
rfll(.r,r:r..t.lU rlc l2-14 s (fobdcaunadupd hiperpnee).
(.j'|rl,riu (1971,.1978)ft.demorstrat ce dcncrvarex,
iprio infilrrrr{irr,
ir.rr(.i1.{.,,'ci)
a siuusului r.a.oridian a coudus la suspendarei.muditicirri'r.
p.ligltlic. ltr, compresiunea sinusului carotidian, in-clusiv cu o desincrlni.
zrrro olocl,roencefalograficd ipsilaterald,,
,;:) Maneura Yalsaloo paate induce modificd,ri ale dinamieii circul*ttirji
l)r l cr'o$tolea_presiunii intratoracice, cu aparilia de uncle lente r,hctrt.
r|rlt,rr,yxr
pHG ;! ghiar cu decianqarea ile accesesincopale (Clkfi,
i:rrrrrsi -traseelo
Sr6i11r,1963; Sbcrpey-Sbater,t953). ( orfariu 1lgi.l, ji?xt *j
t.rl;rljrr fi Popoyiciu(1C72,lgZJ),pracricinrl manerraValsaira la Uohiavi
, I snl ,rl,n ul.fosfalice.]a-mieliunc Si la 1,llse,au ob[,.inutpe poliliralnr.[
trrrrrlili.ili drr Lip
n'oOibilo[, cu instalr,reaunor b]ocuii sino-atrilrlr,
rt{. Hrultr-rr
"rtO
thrrati, (B
-4 s), .lar {H,r[,modifici,ri EEG concomitente. .l,rr,
r,lrrl{r(,irizuli, colcrtilLrl nostru a rnrarcat ue$terea T.A. cu 60_g0 n}m}lg
Irrl'ir, drr r.rlloaloli,-injtiali. Sciiclerile T.A. in cursul manevlei valsalvrii
lr\xlrru fi roac!;iikrhipertensive ap5,ruts dupX sfirqitul acestei manov:rr,
nr\'ir,lrrJrro('r"rl
irkxxl cii aooasl,ilnrrl,ncvriiar putea infhrcnla zonele rrfhiro.
gr,rrrlrrrrrrsrrnsilrik:,
c&r'o,irr cir,zdc l igllscnsi lrilitalc,pot lcaclktna,irukxrri(lr l,r'rrrl,r'-r
crrrrlioinhibil,olio
(Corlar'iu,J.f)2J.,
19?,$; Oor1llIiu
'rriliviirlto
Ir llfl)(f! ioi , L!72, l!'l:J).
it,l:l

1 :1.I .;i,:!.,".in . I 'xlt llt t r 'dt

r lr t r 4t l*t t l li. lt , t t t t ! . ial. , it t si, t r ult l

l . )N pi .l ,t1 t : : .r iu.
't p'. zir r lii, r r , I r ,((t r I I r ( ) : |,
r , r r , , : r , r '.silcopoLl s. lxr t . , , f r r r r r lll
.
:rrl l sea. l :)str' ctr r io; 1r r , llr r l lr r r lir r ir r . slo: J00 ( t ( r bolnai. i invcii, iga! ; i r lr r r r oi,
,,lt ruTcllc lurmd rto iil]l.,)J)r't (l.oitr il,lr'o)iirMtiv 5o/o au {ost indlrrrrrat,i
crr
rl rr,g)l ostl cuI cor ent . t lc. sjur . upi, r est - ul all f ust djl}, Sno. 1ica,i:1l, r f lbr r la1or .lr?l
,l j \' r' rrcl e.sorri cji polir . ) iline, dr cpt cpilr . pl jcj, ceet ic culjnor ( li
; i , . r r r r r i, , l, .
,'l,surla!l a1e lui.Gastaut qi Broughton (19?Z) si ale lui \-v-ayne
(11)(il).

{,) r,n:unnrzi, prrp.,tl,

.sau o relatare inexactX a sirnptonr:ll,irlogiiri

.irn pallet Dolnavului $i/Sau A apar{indtorilor, poate

lrr,liL h u {,rrriLI0
,lr!gn,,s]rcX, srnco]Jctepot fj Conlundalcindeosebicu accoselr.
,.1jlr,1rti|'1
rrkinetice sau a,niotonicu, dar (in cazul coexistentci convulsiilor- toirioo,l,lnice) qi cu clizole upileptice grand mal. Existi-totusi ulele
elclncrri,rr
i,rtr(rpot fi utilc in oricntS.riledi:r,g-nosticuhri
dc sincopit.(Gastaut, 195(ii
-Popor-iciu,
t'orfariur. 10?1, 1978 I Corfarit ;i
19?2 ; Fopoviciu ;i'cohtr. j
lll?ti) : chiar lu sincopa con.i-ulsivi,, faza tonicii Si jaza ?Ionicii Jint,
rrnrlt,
rrLli scurte si irrai t stonp:lte, iar dup5,epuizarealor nu se ingtalcazi, currlr,
l, 'jlcr'rtrcJ.cale este (rlra(t:crioliciacce\rrluiiic cpil,.p.ic.l,rcsigur.,
irr|r.qi;.
'ririlc EE(i. sf:lntla.r.tl.
drI rna,iales pri,r actir jti, plec m qi iil,r.girir,,r.r:i1,,
ll, lr{ralr.o (ln',luSr\, u lc.iarcc toDelo.rreliexogcne)ulucidr.azidiir.;rr,,sl
i_
lrLl in marca maioritaiie a cazurilor.
. 2. Acceselede hipersotnnie cu apari{ie brutali, qi de s,rurti, tlulll,ii, sr,,
lot confunda uneori cu crizel{r bincopale. lnrleoscbi narcolupsia cu 1,.1it,,*lii,
1umplet5,,
cu ataclri cataplectice, cu hajucinatii'hipn*gog,ir,rr ryi
, rr lrrclizii.re,specl,iv
de sonrnp|ei na.rrjla,croii alodiagnostic. Lrar,,rc"isul ,lt, ..,,r,,i,
rrirrcoltlljc lI{' o dul'trti rnr,ilu_ngd,clrcurrr,,tanlo
du apari1i,. crr ,,t,,r,,.
.lilice qi poligraficc. (inclusiv_ de-orgalizare a iomnuliri;, calcDil,rarrqoir,ri,
rli:rgriosticul(Pop-oviciu-li colab., 16?2, 19?E). Mai Oifiiil Oo rlif0lr.rr{irr,t,
r ,iiu uneori accesulcalaTtlectir,,
al,unci cind sun ine izolat. Acest ilccls r,lrl:r
l,lcr'1rc5c.ctl'acIetizc;tzdpri-nll o p.rirbu\ile a boj:rartlui. c[Lo I r , I ri, .,.i Ij I j ,
r.prerdcl'rDrulttealonuSutuimuscultr.inclusiv
l)osluraj. logttri rlrrrrrrrli
,,r'i
atc(l[v-eJnotio_nali.
lnsd,
spre
dcosdbirc
t]e aecisul sirrrr,;rrrl,
.de.factori
|lr runpul
&taculul catap]ccLiuCOnqlieUla
CStepr\TlC,1d,C.(,acu (,(,lrIt.t,ii.
,,,rr\alid semnde dilgnosfic difercnlial. Dcalrfol, iffegislrirljlc puligr.:rIi,.,.
"locttratedc::unrc-rogiccrcetatori (Elishikarva;i cotabi, 190g; Co|firli ,si.
l'opov_i.ciu,
I973; Popoviciu 9i colab., tC72, lti;g $i allii) au dcrr,,lrtrr;1,
('ir praougrea totuSu.lurmuSculu,r.S,.Ju{cc
in decurs de cilIvir, s|r.rrrrrlr.,
tiind :rdeseainso{ilri de urjF.ar'ioculare ,.a in sonrllulRE,\I, Iiri rrrurljti,,rrli
ruporianl,eale alior pararnorripoligrafir.i,sprc doosebjretlr. r.J.iz:r,
sirrr,,r
inregrstrtr.ea p9]lg1afi9d apar modificdri IIOG, ,kr lll.A.,
|rLtal rn carc p_e^
Jrlccum qi modific5ri ale activitilii EDG (untle lente ditr ut jr, ,", ,,,,,,i
.rrrrplc),concomitcritcu pierdercacuno;l ;n1{,ilColfaIiu, JC?i, l t}7rt r'rrr..
1
i.'r'ju li Po"poviciu,1972, t973).
Cit rlespreparali ziil.ede wmn, &c(]steaau caractcre r:linice qi poliglli l.irro
,'u,l'lcteristice,care lranqcl,zii diagnosticul (Oorfuiu, 19?t, .iO?Z .l,opo_
;
r iciu qi colab,, 1072, 19?8).
3. Crizek:iic cirtlcratlin ou.rsu.lq.ltutu,l,u.i,
]ll htii:n, itrs.{,ii,. r.'r.'r,i si tl.
1,r,.tr!: i rln l lUxr[1i li.r,sr' Ir,l rlilr,urrosl,it,rr,
,,rr rr\irtritifi,irr r'rorrlrirl,rrl
I,rrllrrr
rrl rl " l

\(r' l rIl tto: r . : r ', . r ; r r lr lr lir r . qi lr l ; r lr I l. it , r r llr I it r r lilr r r ': r . r , , , . , 1oI

r . r . izr . .
(i ,ri ;tl t
r . |. r c1t
. lr t 1, , I |iI 1I |iI ||o|I |( |r I i1,p(
t
r
t
'r
r
l,
r
,
r
r
i
I
r
r
.
I
rr sr r ir rrI ,Il cir . r I I llu
(j
. .4.
!r
rol rc \r' r' l l l ri ' l rl/ jlr , t ir r , r r : r lr r r r I r 'r 'j; , r , r r ,plir
zr jrr ilolr r l, lr t , r r lir , l,I iir . ii,t r it r r 1r I or r r r r
l rt' i i i r,(t(f{r$t[[l(r|
i ] \'( |t ||, I I 'LIr lo: r r , Pr r r r l|I t , '|ll{. Nli , i t l'r , I , i; ii111r ; 111I
r lr r. t; ), lr i|r , i l

343

,illll

ttttl o l rl rtl .tl :i t t '

I l rtcz.rrtri
l tti , l rrtl tl l t,v tt
I | |I |(| i I i i ]Ii,I iI I i I r : lx l z i l ,i o l l l rr rl l t,l ttt
Lt' ; I ] I :I I : I t
(N
l l t' i l ' i t' l l 1'
Itl l (rl ' l l l rl l l l l l
l l i tr nit t lt lot r ' r t ,l, rl trtts ttl tril l ru s (l l l l i l rr Ii i tl tI p t' r' l i rl l l '
l ,ol l ,l ,o(S l rxrl rrr,rr;i trl rt' l t.t
t
],rr,. , , ' i, , i. u, ' i, r . r it .
$ i v o rl ri l c u , ri i i ,ru i rL i rritrcrrl
(i trt
j .9
U 5 ; I' o p o v i c i rt
"
,u
r_
r,1
.
col
rt'
l
r'
, l 1)(i 1lI W i l l i rr' trts 1i
iU
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v
o
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r1 rr; r i, i, lu, t r Ni
1i
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ttttrroti
l
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l
(i
r
r,, tl , , L . iir r ; : : : ' O or )' r,ri ri , l t,? i , t9 ? u ). l l -o d i i k :ri l i Itr
ru1'rrIitt
Ll
rrlui
rlhrs
il'1it'r
vortcllrobazilrrtir
,",ll'.,-ii*'u..i"l,tt-ir,s,iiiclcri1,1,
i ri ri tr.i rrn i n i (P rr,r rti r:i Lt;i c,' )rr' l r' ,l l l G0T l l rr.' r' l
.,'i " i' ii' iii" , ' li" t io. ' i n o ,i u
a p a ,' p i ttrrr:gi sltrrti l o l ' l l ' l (; :ttl i vi i j i (l
,,,'i i , r , if i' " i" , t f . f " - l. rl ,e l rro -l ra z i l rr' ,

-tl(,
;;:";;:;'i.'lt; '- iegirinilorr,Lcrioitr'(', llp Ftlil).\ ili lIllA, !t,"llllll]];il1
(1inc Ldlul ill:r(lllllll
l'

.r ((,Lrl)..ltitU)'
-iiocirr: c{'put, cunllllrdil,cll urrdt.Lr llli
a.l actslur g.ir'lo{l"rIr.ute .stc rlilt'til'
.;" ,;;;;il ,I,tr
i."t,, t ilo :r,pari1i,:
,r, t ,.rzu l'sin uu pci

ac es f e anoD] ; r lii l: l. l( l

lpJ l l n t t

cnrdirr,r,,respo;tiv ilupri prir,trugireaT' d.,

i l r l l r i u r r t g l i i l . l r '( '& : l i ) l r l r r r l l

I A
IE'.

(TULIIUIIARI
PSIHOOROANICE
TULBURARI
OIIGANI(;)
CUSUBSTRAT
DE CONSTIINTA

I. Con;tiin!g este forma cea mai inalti, de teflectare subicc

lumii
tir.i, a
obiectiye (Dic{ionar enciclopeilicvo1. 1' 1962). Ea cuprirrrLr
propriului
cunoa;terea
eu qi a mecliului ambiant. Este facultatea rlc rr,
gintli;i a determina raporturile cu re:r,litatca inconjuritoare pe baza rtflt'rr
td,rii realiti,tii obiective in gindire (Diclionaml limbii rom6,ne, trl.ii,ttr:r,
Acadcrniei R.P.R, 1958 qi Diclionarul explical,iv al limbii romiino trtli{,iru
J9?5). Starea de congtiinll este sttlrea ,,cle a-qi da seama clo tntirlitt 1i
r1e sine ilsu;i" (Cobb, 1958).
2. Tdburdrile de conqtiinld, sint de "d-o;1i ca.tggorii: tulburirli tlrr
conqtiin!5, firi, srhstrai eyldent de leziune anatomo-patologicil' (;xrrr,to
avea tulbur5ri enzimatice, biochimice) cum se intilnesc in patologirt psi
hiatrici, care nu aparlin probiemelor noastre de neutochitulgio, irrr':ttt
tuiburiri psihice date de Ieziuni evitlente anatomoptttologice. Aoortsirt,rt,
losr nunritii lulburere poihuorganicJ,care ue preocupi.
3. ln ce priveqte substratul ana,tomic a1 conqtiinlei, 1a tcaliztllcrt r,i
p&fte
toate structurile cerebrale, unele fiind de bazi, cuttt tiitrl : cut
iau
texu1, nucleii bazali qi trunchiul cerobral, Conqtiinla reprezint5, ult pr'o( (\H
complex anatomic, fiziologic $i psihic.
1r. Tulbur5,rile psihoorganice sint de diferite gracle, in lnnol,irr rlrr
sediul leziunii.
5. Orice leziune circumsclisi sau difuzii, a creierului poatc dol,ot'trtirur,
psihoorganice. Tulburii,rile de conqtiin!5, datoritri hrziurriLu'
tulburiri
cerebrale pot fi grupate in tulburd'ri rle conqtiin!5,specifice localizir,t'ii, liiirrrl
rlate de leziuni circumscdse, incit in clinicX aceste tulburlri siul, iirkrsil,rr
ca simptome pentru iliagnosticul tle localizaro (moria, ,,antriebsnulttgr'1",
sindromul Gertsmann, agnozia spalialE etc.) qi tulburii,ri psihicc gk-rbllo,
oind leziunea este intinsi,, tabloul clinic fiind totu;i specific in rrpor'l, orr
loziu nile etajelor encofalnlui intcrcsato.
I)csif{ur aftsto luzirrrri difuzo, pe lingit, cri, dau tulburlr,r'ipsihico rrrr
<,:llaotclclinio llirrr,rlrrfinit,, poi, itrclurkrli.SIi-4.4, alc ciinri tulbulr1ri vol rlrr,
o corrrporurr rl,r'1,
irr plrrrrplirr trrrrlificttrrillulbuli,r'ii do cunrllioufil,l)itr u,r,rrsio
i1 rlroIi, trtllltrt'ir,to
rrr0t,iv0,:l,Pnrrr,Prr
1o(,irr,rtlot'ii
rl0 c0n,;1,i0nlir,trr'irr0
trr urrcrri
trjrrrlnrl tlr'$lrr(ltrir,ci1,olt,rt lol,it,lii rirxl lozirttr,:r,r,rt
trrllrrrrirtrrtrrrvt'rt,xinli[
34t'

T
trt'rtsilttlt,fii
itt l,rrrtrcltittl
otrtrrbtill(trotrrii),sirrii rrNlrtpttt'tilllli',tllltri,Itzitlttttlt,
(''rlrlll/i', il,ili
rlrrlrsrrpll,
tnozottco{illulttilit,sl[olittcif ittglttlllt'sottttrttltrll(ii,'
Irr,{irr1rr l,rrIbulrit'ilolrrlr{ialr dc cot16tiicrL{,ii.
ilo slts-l)l(tlArlrsl; pundr do votlcro nu trste coloctr dtxlattrctl1,ullrur'ilt
liorrrlo sirrt lulllulrili t1o conql,iin!:iI osi,o a'dovai'ratcit itt utrttltr <litztlt'i
(riolnrr()lonirir)
cxistir,6i o cornpontlnti' rninirnii do tulburl,trl tltl cott;i'iclt{,ii,,
fiintl insi, tulburarca de conry1;iinlrri,
rn:r,jolir,
Irrrr'|,ici1rir,r'ul,
Arrrsto sintlroarnc sint foarte elocvente in lcziunilc traurnatioe cr'ruii(l
(|r('olirliccgrirvc or,rc sc Iemit. Cind bolnavul iesc din comL, leziuuilc siltl,
irr cnrislirrele cerebrale pinii in regiunea mezotlienccfalici''
I )u,<fr,
loziunea din intreg creierul este pini, ileasupra capi,tului rostral
rrl Llrrnchiului corobral per;iapetluctal duce la instalarea unui muti$ur
lkirrrrtic sau h, sindromul de d.ezaterentarc.
I)l,cii leziunca r5,nline cantonati, in emisferele cerebrs,Iepini l:r zona
rrrczorIienccfalioS,
apare,,staroa yegetativ5,".
I)rcL lcziunile de intensitate variati, sinii cantonate in emisferolo
r,r'r'ollale, inclusiv nucleii bazali dau sindromul cliencefalic.
G, I)acii, Icziunea este in totalitatea, cortexului' in general provoacil
o rl'ru'e tle agitalie, cu iusomnie, confuzie agitat5, sau anxioasS,rpdn fa,ptuI
lri, iul,rca,gaactivitate rdmine sub controlul nucleilor bazali Dial trunchiultti
,lolollral,
;\dcseori, in diferite afecliuni, procese infeclioase' procese itrlocuitoaro
rlo spu,fiu, traumatisme cranio-cerebrale etc., leziunile inte,reseazd,toal,tJ
cclr t,roi ctaje ale encefalului - cortex, nuclei bazali, tr"unchi cerebral 1ap{;rarrr du"cela realizarea unor sindro'ame combina,tA lsiniiromui apalic),
l)rrcori, intr-un sindrom pot fi implicate tliferite etaje separat (hiperkinezio
r,rr Iogorcc, rigiditate decerebrati,).
I),r1,orii,i,legii biologice, structurile anatomice cit qi funcliile cerebralo
loh rrrir,inoi sii-t lezato p{i}Aqle Si cel mai uqor (cortoxul qi vorbirea); lrr
,,rrzrkr t'cYcnire (tlc la trunchi spre cortex) ele iqi revin ultimele, persistin(l
irrcii,rrrr 1,imp dupf revenirea integralS a celorlalte funclii (surdomutitattl'
rirrllornul vogelativ prefrontal tiescris tie Ttinnis).
ItiNliitrrr][r,i ios aceste sindroatne
Sindrotmclc generate de lcziuni Ia iliverso niveluri ale creierului
/1. l,czi[ni situats in partea supcri{)r,r'ir,a trunchiului cerebral
ll. l/{!z.iunisiLtla'hc
in nuclcii bazali

t1. lfutismul akinetic

'12. Sindromul de dczafectare
[3. Starea yegetativi persistent?t
dup5, leziuni cerebrale
Sindromul dienccfalic
Sindrornul Korsakorv
Sindromul Kliiver-J3ucy
R,igiditatm clc decorticalc
Surdo rutita,tca
Siridrorrrulvcgctativprcfnrrrltl
(Tatnnis)
A1;ita!ir
Arrrttozin l)o$1,1,t'lulrrtl,i(rir
Sintlrorrttrl rt,prr,lio

Ii

t;:

{1. Loziurri sil,uir1,o

in coltex

t;

lf:

t). l rrrzi tttl i r lilt t r 0

tt. N i ttrl toa, r r r rr lt l, o r lo I ozit r r r r
itt t'llriill,o cl,lr,.io.

rlrrrrr,rr r[rlu,l,ir,
J l. liigirlil,rr,l,rrrr,
lf. Ililxrlkirltzic ol Irgotrrrr

lIJ.l. SINDIIOAMII
I)A1'I{I)I' I,,IIZII]NII.,TI
DIN PARTIJA
SUPIIRIOAITT
A TIIUNCIIIULUCEREBRAL

f#fjdjs?i','"',g;l#,i,|Uq*'ih"""?,1,,:'^1';"""J

it$li;
;llil"';#l?'"1""J"?Iit:#;,t*$it*f":ih

r,',',flt
+j+1:;-*e*aH##tH*.;q",XT
Jl,iiij
g:*#ri"*i}!"'','ffi:ffi;iq'*w
ill"{*l"
It'"t'T"'*vniyll:l1lt*tirtlxktti+
yil,}*:_Tf*}:rd:F:diiFirml
llH*l"{ifl
:ffi:*i"",Tffi

iffst$i

iJ"tii*#l'?*1",1?J**T]]H',1n

Ilutismul akinetic se cr

;';ii1;,;'
ffH:lli;;ffi*#'1#x"""t"ff
ri?"J
l'"*"-ii:{{J:t:*i13ft';';;1

f;i;"!l"q.'":t.rH*idih*r,"r'*l
i',fi*{i;"##"";;r;;:f#1,"jt#*fitl*i:,":j:t

t3l;llJ#d"f#rr:f
:d{i{Fii}-lilih'tii-i"""""

lttliH"txt'.'ji.T#iiil",iljtril?i:'.*,?
'iJill;iif!it?,1!![i:l'i"

firi'{ft
*;1
f
rr"ffi+e$*t}"m;at{[1
f*{ilfr;;grig+;:;;f4';:{'fl
};;if
iiji'}:b'dr'"arii

H,:t{il:#if,iir**irH"Jid,r
-t1ff
ir1
lrLr{11*r[t'iil1i1,fl1
,liri"l*ioiii*

ili'.liillll,ll,lll:l'llliii:tl,,"ii,,ll,f,:l,i;llllli,ll
i;liik,w:ilii:li;$*li*llT

:t4(l
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F
(l(rill(x)llijli{rl11il'
rkr;tilxrlrrrt'vii
sil'llil(r(l(1llr(rlr('i',
illll)t'(lsilr
rji rrlllliHllrlllltol,(lrrfil'
qi trol.
(Ort,itrrs
rkr
a'llii
ll',
rrort,sl
irrtttilil';i
I'irrrltrit
pctlrtl''crtttill,iottfi.
iirrl,
1f}(is; $dn)i'i, iii (r)1. .ll)(i5 Ifrlyattrl - lltttrrt,T,tl
I
ll).1l; lll{i!; Skrr1l,01,y,
l,ir,(clriirr
do lit, thitxrzirt ir(lovit,r'ir
liissirl l..irrol., l1)(i{))(,slo cit oxislit,vit,rir[1,ii
1r:rlrrlizicitr sottsulor(lirlr,r al otrvinliului) ;i rmrtisn (sart tloilt l,Ionitr)IItri
hipolsolnnio situ obnLbiir Lrrlbrrlanrolalil tle corr;liinlii, (sau doar u$oa'r'ii,
lrrrr,) pi rri, la,o sirnpli'l apatie generalizati, cu reactivitat'c bun:i h exoita,lrli.
{ l(ilrx;lirilc rroa,slrfa
iln mai ari-rtat c5,,de ceic mai multo ori, dupai,o 1u ir,
lrrlrr,lrrl'qi I{cmpcr qi liomanul (196?), XIA (in folma clasici rlesclisil,rltr
t lr,ilrrs si trol. t.i+t) rcprezintil un sindrom tle ocluzic a al'terei bazilare in
por(irtttir sa rnijlocil.sl,u joasi. la care unoori se pot asociz'tulburili rt"
atinginrl
i,orr1iiin1,L(prin" leziunea ialoi,ei pontine qi/ sau .mezencefb,lice,

(l t' i rr' Lr1.1r . , 1. . llt i l) . lr r I ir , z. ilr 'r lilr r , r l. . i ( l'I ii, r lt i r r r r r ll. siPliir r r r r r i
ri tttt.l tttri Ii r,l rr r lr I r vii c sr r ; ) I r t vio( , r r ir .,o, r 'r , gr ,I ,r , li r l'it t l, r 'it sor , Lr r r , r , iiilrr t r r r l0
lr r r l
Itrttl t: sttpl i nr r lllr , lr slr , r rr , lr ilr r r r r r lilr r r : r lllr , rrrrrrrI Ir I i I i I .i I I ri Irr ir r sr i,lir sl ir r r r r lii
t i zrl r,l i , a,rrr lilivi silr r nooicclll, r vr ,
' l opogr' : r , t ia1i inlinr kt r it r r Lt
, zir r nilol nu llr r pr r lr r l,licr r r r r r l i{r r r lir r csir r lr ilill
.
rl t rol :l ti vel o put ino la, zur i st ldial, c. Au hisi, r lt , st r lisc clt ar r r i cu r r r lir r r o
I.zittIri neocolticale. So cilea,zii cazuri crr lozirrrii t,rt..nsit'ir srrlr..r.i i.irlr,,
rllrr cu crulat'oa structurilor. trunchiului cetr:ltlll si
inr,crs
rrr lr,:rinrri
rlc lrunchi sau cu r:xtinse zone isr.hcrrtice tut iii,Lile s;r,u srrlxurr,l,it.rr,lr,.

13.2.SINDROAME
DATEDE LEZIUNIIN NUCLEIIBAZALI

s RAA ) .

Sindrornul de dezelerenlare (sindromul'oloked'in")

Af octarea ci,ilor cortico-spinale qi cortico-bulbare printr-un mmolisrrtorl; localizat in piciorul piotuberanlei (I{emper qi Romanul, 1967),
rlncind la tetraplegfu qi afonie, determind, o stlrtdo imobilitate com-pletf
rr,lrolrulvului Eiin;apicitatea iui de a se exprima I'erbnl sau gestual. Tahlrrrl ciinic p6ate sugera o stare de mutism akinetic. Spre tleosebire dtr
rrll,irlul sindi'om, car-acterizat pritr tulburi,ri mari in sfera- prceptq?lr,r
irr sirllrornul de dezelerentare perceplia nu este altera,ta, bolnavii fiintl
rrtiorL{,a,1,i
tsmporo-spatial, putind face calculor a$a cum a ar5,tat-o (]onouni'
,.,,1,,,1,j11 irin iiteim;diul
cotlirii miqclrilor ]or oeulare.
"i
Sttrea vcgclalivd persistentl dupi leziuni eercbmle. Jannett (1972)
rlcsrrlit: sindroinul tle ftaro vegetativX, persistent5 in motlul urm5,tor :
I)upii o perioadS, tle comi profuldS' de" reguli, cu-ItaJiate grade do
Ii,spunsirri eftensoare (rigitlitate prin decerebrare sau prin decortlcare)r.cu
o rlrrratii do o snptimini, sau mai mult' supravieluitorii i!-cep.s5,deschidit
-numai ca o reaclie la stirnuli rlureroqi. Ulterior bolnavu I
ochii la, inceptt
periodic
ochii deschisi, chiar in absenla oricirui stimul qi pa,re a
rrrorrl,ine
rrlrrr:'ili ci privirea, dar firX:r, fi atent, apoi recade intr-un somn apalen-1'.
\rr poir,lc ii insrl r:orbr de un real ril,m lcghe - somn. fn perioadcle drr
:L||i|tIIrIi'Lstlte rle tcghe nu exisli ldspuns de apdtare ptin ocluziepalpclrirrLil:L:rnrcuitrtalc.in unele cazuri i:.i;,1dmilcdl'i sponlanealc globilol'
olrrlrr,ri,tlind impre$a ce bolnivul urrnire$ro cu privjrea un obiecl c:rttt
in-cirnpul si,u vizual, dar nu se poate afirma cA este vorb{[
sr, ,1,'pllscrt'zr-r'
,1,.r' iirrrrr:ltlu aleulie. In alle cirzuria1larchiar lnj[cEri cert
-cooralonah!t
.r rlr.csr,rrrtrlu
de scilpibtle sau de adueetua miinii spre locul de oxcibattt
rr,,r'i,rr.1rl
ivii. Cx toate ci, cxcitarea nociceptivS,poate dtermina fie Yi$cAri
fic trismus sau grimase, bolnavul nu emite nici un ele}u-orl,
rlr,,n rrr,il,i<lr,{,ic
vclbrll irrt,cligibil, ci cel rnult'- sunetb artic-ulate' Starca de constiinf il'
liirrrirxr rloci frofuncl alteri],1jI,bolnalul ri,mine inapt de. orice comunicall)t
rrrr illr nioi ri leaclie aalaptivil, la mediu, nu este leceptiv la nici un lltxl
irrirnnill,iv. J)in punct dd vedere legetat'iv, funcliite sint conserYate,du'r
slirrrrrlii nocicepLivi puternioi pot inducc rcacl,ii vogotative auortnalo-,ltt
rpocirrl t'cspilafrrrii. Strlrca vogetzllivf potrl,cpol'sisi2r,lim1lloarlje inclclutt"
g1,1,6i, ovr',irtuu,l,
sopo&l,o1lcurr2utdrtizaa,lil,l,irnp tlit; bolnavrtl stlpl'2l\'iolrt'
r{rft,r),
t'tl lxlittsr' 1i gt:t,vtrltrzittltiIttttl
itl t'ltr-ttriltt
I,)li(i a,rrttl i[l,iL1',
'l't'rt,soclo
iz.r,lr,cl,tir',
lirtrp tltr tttlti trtttlltr sirlriiitrritti
slr,ti
totl'ictlo, ttll 1,l'ilsoll1-rll11,

Sindromul diencefalic
Se earacterizeazX prin tulburS,r'i rle constiintf cle intensit:r,l,o r.:rlirrl,ji,
ci.n'econsl,au intr-o sta,re de apai,ie, lolpoare, obnubilaro, soIIll(t (,1{i'i,
'il Ipoirre-Rcspirr(ia e\te de !ip Cheyne-stbkescau t'espirrlir,.rr Iit r rr.*,,ri
I r1'ttrgulat,",
rnllerullt uncorr de pauze scurte, pupile mici, rtrilr,tivrrlll, lU
r nrr;.lellexul cilio-spjntl este conservat, miqci,rile reflexe rlo gl0lriloI
{r'uralr ln plan orlzontal slnt con$ervate,insi, uneori rnotilitate r,r:lltrrii
rxrular5 rrerticall este.IimitatS sau abo]it;, (comprimarea rcgiulii
l)t.ol,(r,
fale) ; existS, reflex oculocefalogir (in lezidnile'de ironticrtii rIitrrr|r,IrrIo
rrrczencefalici), deriere ronjugatd, a capului qi ochilor, ten0rnt,lrrrIrlrr
,.r.nr dc prpu$i,'. rinooli der it,re Ienti ti porsistenti a glolrilrrl rx,ul:rlr.
So noteazi, semne de suferinta, pir*midal5 ditatcrali, (I3::r,blnsltihilrr,l('r.rr,l
).
Ibt fi evidenliate o rci,istenjii, ^muscularii, tle l,ip paiitor,fu
rrrr r,,ll,Ji
.\i
,1,.ftpucarefortatA.;iD abscnla unui deticit rnoloi ri.eqtclnorliii{,riIip,rt Ii
l,ihter:!le. Pot erista diskinezii. Tulburi,rile vegetative sint abscrrtr,.
.par(,iall
a t,ir$l,l rl
._Sttpoar_ea.**" *oilnoi&1" reprezinti, u p,ig_rdere
sit'ilor la solicil,5rile mediului inconjurilor, iii starea-tle colt$liitrlii r)Hlrt
rrtectati, r.ra,i rnult sau mai pulin. precurn d,ratii,denumjlile iu;_rirr,rrt,io
rirte. pacientul prezinti o stare de somnolenli, mai mat,e sa,urnti rrrir.ir,
elrr lr
'.)ic aln sau ..hlat,.uncori. cpontan (dupn gl,a(lulslrrlrrlji) rr. l|r.
z' rl' . l urbe:lo, (lA riispulrsuriader.rat. compl"ie,lncornpl,.tridinl tiurli\ r.,
(,,,r'ece a}e ne\-orc, mill]rnci, singur sau rlacd,i se di, sL rniirrirr<:o
I rlr.rrrrr
l|r'rroil.loule tlr'sr.lridc
ochii, str (eara Si.$i fa(,i ncccsili{ile, rrrrr.rrIi
rrri;r.:r,
r. rrll(. Sponlrn. cbtrr potte urubla; [ulcqiile vi[lt,lcrjlt Lrlrrrr,.
Sr.r,lrtlr,.t,.
rizprtzi, printr-o. mai iltensi, cr.g;t-glqa plairurilor slzoriale, cilrt arrr rlrr,pl
r|rrrrt: o recepl,ieintilziai,i, qi inadecYatd,o lentoal,esi o tllfi<:trl1,|ltrr rlr,s
ii.-ttririi 1rror..esalot
tsociatire, Bolnrr ul c.tr. lpllir, r,iitrrrtrrlr.r,rr
irrlirzrclr.
l:r itrlrr,biri. pr'in rri.punsuri vagi. apluxirnriir,,, irroirrpl,.tr.
rlr, ,,,,1r.
1i,
r,rrairnulte ori, lipsite de sens.
-lltpori (,s1e,\ornn;leut, tlr'zurirrnill,;i corr
Itz,. Evocaro:, ar'nczi(ii so efc(.tucazir,rliii,.il, rr't,rrri liirrrl irtrlrrisilrilri.
llr'lrrrr,vnl
cst c..lI;r11i1tsih
iu ;i.lnitdikinetic, sc or.iirrrl,cl,zL
ilifioil si irrr,'rrr1rIr,|,
tr {l}t(ill .i .li'ri irrlir'rrrrrIii
si irtr.s:r.lcrlr.sIr.r,lr',lr'itr *r P,.r,.,,r:rrri.
l,rt int,ila,{,ii
rrritilc;x,lrrlir!i lllti'rrli
irlr,lrfir.,lrolrlrvrrlir,r,rli.trri.zcrrla,
riurirrrllllr
rii
t'iirliI:r'|r'.
Il.lh'rrtl rlr.r.lilrit l:r rrrrLr.rriir{*r,.si
l,r'(\rizi.
r',rlloxrtl.o|rr.irrr
;rittl lttcz,r'tttr,.lirlrrrrvrrj lrr lrrrir,lrr
IrIi rrIrrrr|,Ir,, illl r,litr,l,i,r,ll Irrrrr:(iorrr,ir,zii,
rlr,..rtbirrrri
ttottrtrr,l,l.llu;Jgati);t
r\sls rrllriytr,lslrli,
(11 (,oglir,Vigilr\, llr,rrrr.rr
rrliliz:ll,tl. ilrtirrr.iiI'r,rrrrr.r,zi.
plr.it,trlrrl \,rl,lr, lr\ 4i trrr
l)rr,r,tr,
ltr,
'lt
'illDrtrrrlr,

(t4lr

,{il

it4rl

l,\lliI ' ilI iil(lll,l.l:.j,iIl(x)lltlit lt lqt . llt I t t ll, ilt l' r I lt r . iit ' iilllr t t t t ll t t t . i I r . l i t t I i t t r . r r r . l 'r , t r | 1 . '
s i t lt l ( l' s i ll|r t r ll l . . '
, . 1r. rt r l.t (l ..1:r1 1'r"' llillz i\ . ' .
grll(lir:
llttttii {rlltlttl tltl s r t nt t t r llet t ll- l ; lt t lr r r lr ' lllr ' r ' r l r ' l r l 'r l l l l l l l l l i
s . r r r r r 'l " r r l : i '
:
t
r
I
.
t
I
r
t
't
I
r
'
llr
t
t
r
z
i"
*
t
,
it
'
'
r
t
l,
':
r
t
t
rlr'{l:r ' lr r l
Jriiti,,,l,','
' i' l

s l i i t r l i r , r 't r ( \r r ,i t\r '

l l r r l r r r i .,. o r .r l ,, l r r r r l r r r l tr . r r r .zr r ;lr l r r l l r , r l l tr , Ir Ii r r i ,,r .o r i tr ,
o l r i l r 'l r l i r r l l r r l ) r tl
\ r zr r r l , ,,i ,r r l ,,r , r r .r r :r l .r ;r r 'r 'lr l l r r tr
r l r . r 'o Ir r 1 r o I.IIr r r Ir 'Ir |,
, 't r r o ( i r t t t i t I | r l i tl r , r ',,r r r 1 r o rl i l r r 'l l
r r '\u :tl

rr'trlf(11('il1rr
, slc tlatir,t1c troitrtcrosltrclplrr'lirrJii
,,1,rr,,f,ii,i':,.,
r,i,, 1,,'ip,,,'tr'.,
r)iscotrlil rtti,Prr'(i"lt1rl(lN(loilI (r:i'(lilr
i'"1,ctnotLcr':r'til,
sotrtttttlllrrl,rt
l,rr,z,rtli:
,,ii',,i ii, ,,irr,l qi {ra'ticlpir, pulin la oxciiat,iilu tlitr tt.rcrlittlitto.ttjulitlut.
St:rr.r.: r l|t t , , r . ; r O ni,.i ,. F o l l l (. d C fi n i r' :' ,i ttl o l r i dtZol i | Ji l i i ro Icntl tt' ror1t:t
t ,' :r,,ti l i i ,' ,' 2 i ,.s i r' .r s r i rl .rr' rr' l .nusttl l l i uf.r' l i ' r,,l i i .i ut.rr' l
i i ,,i ,i . , . , , , . i, , r i"
"
,
r
ir'liltlcttiiri
;i ruptiof. Stalcr tltr
ii',iiiiirl*liri,"lt,.i" sc,[t6.c:l ilifilr,tirli,
oLr r) dirrinuaic ir'
srnzorjirle
ilur
prrlgul
:t,
craqierri
intro
i,f,i,ili" ,r"*in
groutabe 'li.ctr
ilu
oarecare
rr,rsilrilit,ir,lilol rlc leccDtrie (care s6 rdalizeazi

i,,i,,"i'ri.'I,rrAiiitotiiii tn*rti"tin"' preculn ;i cu dirnintarcr stplelei ;i r.r'

.'""''.1'i;1;ll.ilj;'hi
bolnav'l
,''ai a":'certrltit'i,'
!i'trLl lr osteo somnolerrti'
('cLl Lin(1}ri

,r ,', ,,ilin,,lr, itu1.=i,r"t"5tn lrstiLnuli' r'orbr'.i+ttuci)rirr{'cl'u'

jn nuolclt Uazllt'
ir. rrrrrrr,.voic; l,'zitttrilpsini lrilaleralc
ITI (obnubilalct cslc r) nonrnnl{'nli.ploturtdi'
.st'iiru,itnn.t" gi:;uO,,t
pacieotrtl
Jbia risfundc l2 11nila1ii fi rnlleburl' l:lleorl
:rrrrrr:i,rrr.'t:onlin'li
I
lt'z!ttncr e'lie in nttclcii brzrli 1i irt bipotalrmut
.,i ,il"i..t. ri ";;;;i-,r;
tt'
;,',;,i;i'l';c.l;r;; r'c"tlrlui crcicr"ului; t|irn' birrl ctr"lrrrl csie ittdtt
glave'-.iin
cblale
-oel
crl'trio
im,umatismelc
in'
intilneqte
Strtloarea sc
r', t"ii,r '"ot"'J" ,ne.ri.*r& fi"tix irr comil) sau in foruele {rarc se al11elio"
; :,;;
in cn 'e[:rlit' .'i pro'es":\P:rnsi''rt'in'tr' t:'nir:ne
i, i",l in.. ,iio
"o,n;1.
cole cc cumrvirni inrlirc('t dioncefrlrtl'
:
in
)ii
, r"",,,,t.iJ io.tlir*t"
progI'rosnosticul este ill fimctic tlc e|olu{ic : daci sc amoiiorc:lzi,'
.i" I dacii sttpoirel se tgral-cll'z[ ;i trcte in comil' prognos'',',tr'i,,iti-,r*i"'t
I i(,r
{.ltc er'3\.
' ll
''(i;;fJ*".,=1c
o .'frrc psihicir, clati dc o leziune a cmisfclc'lor corcbralc
ri'i;a'lc sint
parrtial[,
',, ,,;iil;;;;;t;;
ii insularit, n diencefalului; {rLnctiile
('r
ir''lrt-ilc
i"si
'e tico.clri
I'rur('.t)ttrionlrrlt,uar"
'oelPrrl
r'hirl
prrliu
ticlini'{il'
"h'lt"ii,rLit"
ostt
uueqli
innLlc'v:l.l'
,,, ,f:u'- .i',fi
;
'i"pito.uri
: 1. , {il, l,1 t .
Itolvcin inclutle torpozrrea' stlllJ{rlrr''t-]i oblu]rihre:r i[tr-ur] singnr
)'
r^r',",,u', ,,io""!olaie a cinrytiinlef"'(,,1'loucliirg of r'olscciousuess"
Sindrornul Korsakol"

|';\||.1|onIi|''Ier.iinir'."-laloIogi..ibincrIofinit:r.l'cz''].''r'ldin:rq,.!{'iotc}
in
,1,, ,ririiiL..tffiii neurologice'dc tii polinerritic cu manitostilri psihicc'
dt'zorientarca'
confabulalin'
clr'r tltttrtitlit, &mnezia antcrogradJ,
"'i
lJrrrliul lcziunilor dominantc este mezencefalo-dicncetaUc'
iu: marea
lrr cliolottic, factoml dominant esto toxioo-metabolict
o
rrtiutrlilltt:
otinlogico
sttrvitr,intt
t'onrlit,ii
Alt.
,,,,ul,,llir,,t"','r'-7"r.Lrrjlor'
ii,, l,iil,,ri ri rt"i-tl,r riaturi, turno'al;i (tt*roL i tle uutJei brz2r1i,rnetastazc'
t.r l,,,r,rrikra,rno),infectrioasil,, l'asculatit' slu t'r'atn af ic;"
sitttlrtrtttttl

Klii lc r - lNt t t ' r

t l i r i {n t t t 'i r t r
Sirrrll0 rrrrrl lili i\ / ( ' f ilu( ' ) . lt 1} r t , , t t r t l, i : r l r l : r l i i s . u r l l t ''z i L l t t i
l l i l ' {'o i l r l l l
l
t
l
l
(
l t i 1 'r x 'r r t r r l 't t
I ri I l t,1' r' t rt I t rr lt'tttltltI'lllt l , 1i lit r c r r ' ' t illr I ir r ' ( gilr t s r t l
' :tliilii tlr' cott(
}
r
r
r
:
t
l
r
t
t
t
t
l
l
l
l
'
il\
r
(
{
lt
'
1 '
lrti A rtrtrtritr, rrtirtlilc r t t l lr ' t r r igt llllillr t ) ;

:lti0

,t ll\'l't,t Irti l,liztUNt ( j()tt'i,l(

l:t.;i.sitfril)tioAi\'
tAl,t,l
lligiditallt

prin docorlicarc

Eindrornll r'1c rlecorl,icare ale u}tuitoalele ea,r.l:ld,t'r'is1ir.i

:
-- r'igi{litate in elterrsie :,r c:}pillui li trnnclliului, ile jtil,rrrrsilrrlrr
rrro-

( l r't'l l i l

postrrX, a, membrelor tuperioare cu contraetulii in fle_rirrrrr:r irr

l rrlor srinentelol cu pt'cdominanlii a celor dista,le;
- Iostuli a,rnembrelor infe.lioayecu conlracturi, in cxlorrsir,,r'ol:r,li,,,
irrl elnii gi l1cxie planta,t:i.
. fi,rotnencle.de rigitlitlte sint rrrai p[!in sau tleloc inl]uorrt;rll! rl0
,
l[||rlJt noch,-pljri qau rle a]t 1i,1.
- rellexul llagnus-rle l{leijn poate fi pns in e.r'irlerr{r'rI
- semne de piramidalitate bilatemli,.
- alterarea accentuat5 a stfrii de conqtiinti, dar nu r:onli |rrrrr rLr,
rrrlilnesle in rigiclitatea prin dccttebt *re, ;i :r,socialii,
cu pcrt,ulbiili vr.ril
ll|ive ma.i pulin ample sau in unele cazuri chiar absenle.
Snrdomulilatea
nfai. pulin
_{reclent ini,ilniti, dup[ tlaumal,isme grtlve, rtir,r,lr)jrlr\
rrpirrrca,-chiar
qi dup:i.cele u$oarre:bolna,Tulqi-a rcvenit iornlilt,i, rlrr,i,r,r,,,
1r,r'risli"o itlutitnte timp de 1-2 slpti,mini, fXfX,alte sirrrpLonrr,rrrrulo
I'gicp_p:rntai61.c. A{-c|LSlii
rnanifestarceste clator.iti procesrihtirlrr irrlrilrili.
stLpralimintrrii a zorLelorcelor r:rai noi apifltte pe scari, onl,o- gi filogr.rrrrlirirr.,
t ouforln legilor biotrogicecare au demonstrat ci, structurito :r,rrriorrrir,i,,r
Ittnc{iilelor revin cu aiit mai tardil', cu cit sint de :rchizi1i,,
;rrri rr,,.,.rrlrr
-rinrlromul vegetativ profrontal (Tiinnis)
1tiI I r\ :r r u
. ln partca supclioari, a ariei premotorii existri, o zolir \,(,11.(
trtl de a, legla teasiunea ar1,t,r.iull-u
;i pulsul. Sindlonrrl irr)llt,irur trr,z:rrtrl
rr,.t.r.lriljlo:r
bclrt,rrrlui ,lupR difcr'iicpnc,.iulilo ,i rrui :,li.s lt.injtr:l,t
r.rrl
, r'rllr,)roleltlulc: ptcir.trl,ulOste to]nplct rtrstabjlit norrulklgi0 prrilrrr,
1i
{llr })ersisti.ui}c1t:tnllturS.ricardio-vasculalo.l-,a,cicntulI:rr,cri lri;rrrl.i*irrrr,,
r'1rrria,lti,
si o taliica,rdieaturrci ti'i[ isi sr.]irrrLi,lozifiir rlirr ilrr,,rrlriirrr
()11{)s1.:rlisln.
,l(iesto tulb lli.li sirrl r.Liilr'lrrirlr.rlr irirrtr rlc l)t.olirr,rlr. rrr
ri rrbilircl (iollllt,lcs(.('lt
l (]i.
lUil lirr
\ g i 1 l r , ( , i l l r r i r r r ;r l r r r l
i r i o r .l :l i i i , r ,r r r r r :r r r i l i .sl l i l i
r l r r r r l r z i t t t r r l r l r l r tr .l .r , ,r rI' I r, r r rI rt r r r ,tr .l r r ':i ,l .

l r j l t.r ,ti l .r , r ,r i l r r H o tr r ,r ,l r l i r

;i l ' I

A rnnoziikr posttrnutnll,irttl
(jotrsfil;ttic urtttl tlinl,rc oelo rnai cornunofcnornone alc ctcoltlor ttiturrlrlictr rurrr'lrrille- iltit lt:cento cit si tardive --- indifotcnt de inl,onsitltcit
I r';r,rt
rnlll,isrntt
Itri.
Amuttzia posxlraurnaticii propriu.zisd
\rnrurzia posttlaumatic; propriu-zlsi (APT) este tlefinit5, ca perioada
rio r,rnnezic dun5, revcnirea bolnavului la un anumit nir-el tle conDtiin-ti',
clrirlr inoil, perturbati, sau la un nivel normal, in care persisti, nurnai
rkrlli0ilul amnezic.
I)ulatja amn0zici }osttraumatice este in diroct raport cu graYitatca
Irrziunilor traumatice cerebrale .:i exist[' o relatie directii intre durata
ru,rrurcziciposl,iraumatice',ql virsta bolnalrului traumatizat.
,\prrocierea amnoziilor posttraumatice nu se 1loate. face {leriit rotrosrlupii ce bolnavul gi-a redobintlit un suficient nivel de_conftien!5.
lxxrtiv,
'
Exisbii, pertulbarea memoriei recente' chiat in condilii de completii,
rorr,bilitare aparentd, a nivelului de congtien!5,, Si nu a1 legfturi, nici c_u
glrr,vils,tea, I6ziunilor core.br&lernici cu virsta ori cu leziunile celebrale
ploorcisbente.Nt ar exista dificultS,li in reamintirea vechilor engrame
inrrcsticc. Bolnavul este in md,sur5,si,-qi rezolve problemele vielii cle fiecare
iri, (lal este invalitlat in achizilia unor cunostinle noi.
S[Jrs1;ratul moriologic, lezionaI, al amneziilor posttraumatice paro
si, f ic in arilie hipoca,mpice ale lobilor temporali'
Amnezia retfogradi (AR) este detiniti, ca imposibilitatea de a reme'
rrrola, ta,pti] sau idei din perioatla imediat precedenti tmumatismuiu'i'
( k)rldiliia-cste c:] in momentul traumatismnlui oreieful sii, fi fost &lelt qi
irr conrlitii functionale norma.le.
I)o regul5, AIl, cste tle foa,rte scrrrti' ahratil (tle ciieva -secunale,citeva
rrLirrrLi,c,
mai lar dc citeva ore). l)urata AR este in prirnul rinil in laport
r:rr u,ruploatea ii ou grayitatea leziunilor serebraltl traumatice.
llxistii, cazuri ile AR <le foarte lungi durati, - citeva' luni sau chiar
ci{,ilu,ir,rri.In aoestecazuri sint implicate pert[rblri gral-e qi ieziuni intinse
ir sl,r'uctulilo rinencefalice (Russell' 1976).

13.4. SINDROAIIF]DATE DE I,8ZIUNI.:.DIFUZ!]

Sirrrlromul apalic
Hinrlrornul clinic poate cxista in forma complet5, sau ir, forme parli*le,
ircornpkrtc, ctrnosoute sub denmiroa de sintlroams,rdispalice".
Sindromul complet, in perioada de stare, ere urmltoarele componorrto ((lcrBtonbrilndt, 190?) :
rr') r\ltiora,roa sttrnii de ritttrqtiini';i,estc intt'-o oaroo:lle milstlril asemirrii,l,olr,irr
ctt crla tlin mtrtisrnul zr,kiletic. JJohllvLtl rnott{,itreoohii deschitsi,
rllr lru rrnntr,rc6toott ptivirel, rtu ,r,torcfl(rxlll do clipirc ltr u,m(rlinhrot
cnlo{ionlllil tliforrtrtrrrr rut roJlo-rpll,lpoht'r,i.Ntt ntr ttbsorvii'ttitti o lrra,c{;io
{lo lltll'llril,
n,lorrrilto sint, ttttslxrcifirrtr,
('irr,l11,
oi rrrtrrtu,itttrt'lo Ptlutt{lttotttoiion
JI'I'

vcgrrilrIivii.Ntt lrixlri nr'r rl lrlr rlrr lltt,r'(irrlrr rrrcrlirrliurrlriiutl,,lrr rrrorl

Itcct'r'ttl,r'rislii o ;rltlttrllrlr, rr,r'rlrrrrrlrtr
r.iorrr
tr-vogitr,,r,rr f,r,urltrpr,rioilrlr,
tlttt cgltc (ll .l otr') lrllllrrrrrrlr tr lrrrrgilrlt iolrrlc(l(!sornr, rlil llrrrl lroltritvrrl
i.
lxla r li l,t rrzil plin rlilrrrtli rror.irur1rI,ir,
b) Ilonomottolol)oHlurill(!,
r.irrrrcorrsl.aLl
irr Ucxiolr rrrrrrrrIr.r,
irr 1tozi1il,
Ior'. :\colt,sl,lt,
so poakf lrr.r,orrlrrrllr, sclritnbtlet, pl,sir.l.'i,
rle lozil,io a t,rr.pllrrr
rii cste mai marcatii J,r rn(llnblrdo superi{)are.l'r'ttlchirrl csl{} in uf olll,ir,
extensie. In timp apal a,rrkilozc,ret,rac!,iitendinoase ;i t:hirrl osiliclri.
c) Fenomenele motolii prilnitivo stei ool,ipe-lurormakr.
!'onomene veEetative
Ilenomene oculo-motorii existi constant.
Simptome pira'rnitlale. O tetraparezi, spastici),,in rnorl rrorrsllrrl,.
Simptomele extrapiramiriale de tip parkinsonian sinl; frtrcvrrl t,i,.
Tulburd,ri sfinctodene (incontinenld, total5 sau de vezicri rtrtlorri).

13,5. SINI]trIOAMEDATE DI' LEZIUNI SITUATR IN VARIATE }.]1'A.III

Existl sindroameneurologicecare pot fi date de leziuni irr to:r,l,ocl,u,irrlrr
encefalului, uncori intr-unul (codical, subcortical, trunchi) sll,t.t rlot|ii
etaje. Astfel, existi, :
Sintlromril dc logoreo eu hiperkindzie (Arseni-Diniilii,)
Urmiirind comportamentul bolnavilor cu dif erite afec{iuli uorrr,orlri
rurgicale, am <lbservat c5, in afala sindromului de mritism akinetic, siir.r.r.l
bolnaviior se poato marrifesta si in sens opus, imbricind. a,spcct,rrl
rlrr lrr
goroo cu hipelkinezie Eau o gamd de aspecte variate, interrnorliarrrirrlrrr
aceste extreme (logo1eefhrd, hiperkineziE, hiperkinezie f,rtr logortrr,, hiprrl
kinezie cu mutism). In tabelul Y sint indicate leziunile Si sind.r.orrnrlr,or,,,H.
punzd,tor in cazul ceior 13 bolnari studiali.
ln genclal, Ieziunile au fost de tip compresiv-clistructiv, ,1irrrr rlt, l,ip
iritativ.
Considerfm cd, sindromul de logor'eesu hipcrkinezio esto un sin(lr(rrl
antagonist accluia de mutism akinetic. Ambele sindroalro il4)ilr (.r, r)
consecintrria unor leziuni distructive (contuzie, hcrnoragie, r'nnnolii{rll{!l
|1,,
comptesiune cerebrall) Di numai exceplional poate fi vorba do o ovclll ln h,
excitafie. Muti$rlul a,kinetic are la bazi, o leziune netlr, si1,uri1,r'1,
lil irigolrrl
formaliunii reticularo activatoare aseendente (SIiAA). $indrorrrrrl rl{,
logoree qi hiperkinezie se produce, in contrast cu precetlantrrl, lrr clz rlrr
leza.re a sistemului roticular inhibitor ascenitent (SIIIA).
Leziunile gdsite in cazurile noalitl'e (punte, partca lostralil l lnlnr,hitr
lui ccrebral, hipotalamus, partea a,nterioa,rilqi intcrnii, a lolnlrri t rrnrgror.rrl
$i cortexul cerebral) marchr:azL cl,lea SRIA, a ciirei lcza,roat plotht(ur u,ru.r1,
sindrom,
plozcnl,l1,L, ca,ro ostc ll,it tle d ivtrrxr\,,rrrr
Simptouratologia., corcbr':r,lir,
poa,tofi ()xpli(llr,l;ir,
dtxrit plin irrl ticrlruil loziontlfl ooutxrrnil,unl,r'l
{i in pltr(lo l{! :r,r11:rg()trlHl,rr
j)orl,ii v:l,Ll,hil)ir, q.lol rl0rrL Nisl,r!rno
r(i,i(jlllllir(!il,r{(,{r
inhibitor t1i u,(11,iv
1,r,r',
ln <:,t,lt,,,t, Privrr6l,rltotrtilti1x,t'l<
itrozirr,rlo ir,lrrr,ilriiul,r'1r orr leziutrt*r,,
$-ill'l)ltl,rtb(,xl)li(,r!l)rifl rrrIrrriIrrlr,rr,
trrrrrilrrzittrtiil xlxlurrrrrlUi
trrlicttltrrinhi
r'il r,rilrlil (1|rrnlrlr' Ir'r,Firrrro
llil,(llrrllll(ll'llhti r,rrrllrrllprilllrlrrnr,l,
Ir,rrr1ror.:r|,
JUJ

?
grtspittgotrrrlrtillrIrr,1tdolttrlit lii plin lroz(rlll,il,
rllurf(xllrl)r'inlirl,t'tttrcltiul
rr.l'lrrr
rrlui tltt Drrrttr:tinsiltlttr:tlii.
irr cunclu)ic, tablloul urrui bolnav cu logorec ryi hipcrl<inezi.ociittr
rrlrrriitorul : pacicntul prezinti, o dolinfi sau un irnpuls irezistibil ;i aproalxr
rorrl,irrnrr spi'e acfiune, miqcare ,sivorbire cu : a) logoreer.cre$terca fluxuhLi
irtcrr,liv(tahipsihic) $i a si$temi ui itleativ (tahifemie)' cind leziunile corl,i, rrlrr rru sint prea mati ; b) latenli, hiperroactiYfi (hiperprosexic) Di reflex
rl,, oli,'ntlre prornpt; c) latcn!5, foarte micd in ri,spuusuri I d) incircare
:r,frxrt,ivi,atiocvatS,aitualiilor e) hipermnezie, cu exagerare, el'oci,rilor7 caro
rlrv irLtrrrnultuoase,intempestivo qi rapido ; f) sim! cxitic ascul,it; g) coerr,nl,r iii ].rttrfunzimea gindirii pot fi pistrate' dar de cele mai multe ori
r-1r1,rk,tri iorate, fapt Cate depinde de leziunea cerebraH, $i tie fenomenul
rlr, hipcrtensiune intracrania,nl, in cazul proceselor e{pansil'e; hipermlezi,, (cu r.xagcraroa cvocS,r'i1or,care deYin tnmultuoascr intempestive qi
r'.r,lriil,.),cxagelareil atcnliei, u reflexului de orienl;are, logoreea, mobilitate
siini, critic ascu-tit,somn foarte pulin (2--3 nre din 24)r jud.ecatd
,.rrrr,.r',r,tri,
;ri lr iunamcnt- nortn:tle sau deteriorate dupX gratlul ;i localizarea leziuni.i
{ir)ttrl)raLc,

lliriditala nrin dt'ccrebrarc

SintLomtl de rigirlitate prin dccerebrare, sub dileritele sale Yarianto
r,i irr rliiirritclc ettpe posttraurnatic,r survino cu o incidentl relativ mare,
intt'e t1lroximalir J00'o d;n cazuri in sPria,noasrr; ;i a proapr-r
r':r'r'iirrrl
.t0,1,(tin oazuriin atte serii (Bricolo qi coi'' 19?7), Deoareceun sindrom
rlo'r irriditate prin decerebrare poate surloni imediat post-impact sau in
,,llsrr[ unui sindrom de agravare, incidenla cstc in furrclir; nu numai de
Lrcrlliz.areasi,gravitatea leziunilor, oi. qi de promptitudinea qi eficienla
rrliruclrL misuii tera,peutice' -A.cestasint, in ordinea priorit5,lii, antihipori,.r,, rr,rrtieclenraioase qi chilurgicale in cazurile in care se reveleazd, un
rrro(i(lscxDansiY intracrania,n.
'
Sinrli'omul clinic. Sindroruul de rigiditate prin decerebrare poate s;J
:r,rrr,r'rr,
Iio sub forrna $a completXr tipic;, rsprezenl,ind prototipul sinchomului" Iio slrb lorma dittritclor varianto clinice. Frecventr sindlolnul de decel,lililnr cste asociat cu alterXri ale stS,rii de con;tienli, ,sicu semno ncurolotioo, irr lunctio dc intindorea leziunilor clil tlunchiul corellralr precum $i
il,' lrziutrilc lerebrale coexistonLe. '
!)xistil si o l/ariantii, f{iii, abolire total5, a stS,rii de conqtiin}L, care so
olrsrrrvi't,erceptional de rar qi in literaturi, exist5, citate url numir restrins
rlr. r'ir,z.rrri
{uairn., tgi2; .Ralsevqi Downie, 1966 ; Arseni s.iOprescu' 1966).
SrrrrrioLrgic.
in ace.te cazuri r:igiditatea,decereb.ratiiapare l]umai industr
niciodatS, sponta,I}; tabloul clinic este mai atenuat
nociceptivi,
<lo si irrrrili
riirl urrLIi rccunoscutc toatc lementele. Ca nivel de conqtiinli, acesta so
lr.zrrirriiI.r,nusibilitate& do a mcn!,!rLeochii deschigirde a negn sau de a
corrtirnu c6va prin rniqcXri ale c:Lpului, do a reacliona lont $i.mai mult
r:r,rrrruri nul;in corrrplet la un ordin Yerbalt in unele ca,zuri de a incerca sI
rrrr,rrrrlbticuva inill,eh'{ibil sau de a incerca sii, rd,spundl grafic' de asoirurrr,,rr,inill,elilibil. Triseelo E:ltrG efectuate ln unele dintre &cesto cazuri
ru,rruorrIjlnrlt ilitgrrosticul.

it5,l

I}IB LIOGR A FIE

,{arli
AcLa Neurol. Scand.} 19ti9, 45, 484-492,
J. A.'I. - Ar ch . N e u o l ., 1 9 6 C , 2 0 ,2 5 3 - 2 5 tr .
A b e r f c l d D . C ,, N a m b a
i!juriaguerra
J., B1ar!c C.- Le rhinenciphaledansI'organisalion
cirlltrule.I'hysink4llt
et palhologie du
inencaplrcle,Xtasson ct Cic, Parjs, 1961, :97-3iJ2.
A j u r i a g u o r l n J,,
R . - En cycl o p 6 d i cm 6 d ,- ch i r ,, 1 9 6 3 , 1 ? 0 3 G 1 r r ,tt, I 1 l
Ti sso t
j
g
o
u
r
i
r
l
a
e
r
e
J.,
s
s
ot
R. - EnciclopidiemCdi@-chirurticale,1004, sllj)I'|. .t,
:I'
-\
1 ? 0 3 6 .d r o , 1 - o
,\laiouanine
Th ,, Om b l e d a n e
A., D u r a n d
M .- L c
sg n d r cm ed c kt d l sl n l l u tl
lian phont!iquc tlans I ophosi{, tlasson {L Cie, Prlis, 1930.
Alajouanine
Th ., L e b e a u
J., Il o u d a r t
R .- R e v. N .- e u r o l1.,$ 4 B,3 a l ,:]:a l :t:t/
Alajouanine
Th ., Sa b o u r a u d
O., R i b o
co u r t
B. ( d e ) - J. Ii 'JJch o l ,,l l tJ,:f,
4,i, 158-330; 29F330.
Alaiounrirc
l 'h ., Gr r n e r
J., Go u l o n
l {., \* e Il l i l
.J., L i o t
l t,\'.
l tr ..
Neurol,, 1956, 9t, 357*373.
'f h ., Sa l r o u r a u d
Alajouanine
O.* En ctp h a l e ,1 9 6 q 3 , 5 5 - - 1 0 1 .
Alajouanine
Ir ., l - e d o u x
R cn a u d
t h ., L h e r m i tte
D ., Vi g n o l r l
L . A.
Bev. Neu!oI., 19134,110, 5-20.
.\lbe-Fes!iard
O.* J.
Ph ysi o l ,, 1 9 5 3 ,4 i , 1 6 - 2 9 .
D ., Il e sse
l\leksic
S , N ., Bu d zi l o vi ch
A. N .* J.
G. i {,, L i e b e }n }a l r
N o u l o l . Scl ., l l t;:t,
2A, 1,tr9-159.
Appenzcller
O.-The a\lonomicnefltoussgslem,North I:IollandPubl, Co., Anrslenllrrr,
1976,
April
R . S , , Va n so n r l e n b e r g
C . * N e u o l o g y, 1 9 7 6 , r r , 1 0 6 &- 1 0 7 0 .
A!nasoD
B.G.W., Fu l l cr
T,G., L e h r i ch
.I.R ., Wr a y
S. l I.- - J,
N u r r ',t.
Sei., 1974, 22, 419-_-428.
Arnould
!{e d . N }n cy,7 9 1 2 , 1 1 , S7 g - 9 i 6 .
G.- An n .
,4.rseoi C., Iacob
T. *.)-ciolica Derlebftld,Ed. Welther, Sibiu, 19.18.
Arseni
C.-Bul.
$tiint., Edit. Acad. R.P.R,, 1950, ,, 4.
A r s e n i O. - Neurol., Psihiat., Ncurochir., 1957, 2, 297-294.
Arseni
F.- Ac[a
N e u r o l . Bcl g ,, 1 9 6 0 , r r , 9 0 1 * 0 0 4 .
C . , L a sco
.Arscni
F,, N i co l csco
M .- R e v. Oto - N cu r oOp h tq l n r .,1 0 0 0 ,J.l ],l . l l ,,
C . , L a sco
p
sych
i a t. n e r r r o l ,sca n d .,1 0 0 1 , Jd , 2 7 $ - - 2 1 J4 ,
Arseni
M . I.- Actr
C , , Bo te z
Arseni
M ., C h i l i m a n
tr {,, Gl i va n
I. I., l l a r ct6 l r
0 . , D a vi d
gnostr. r&Ltooflalilolotic, Ed. trledicaltr, Illcure$tl, 1967,

l l ,''fr i .r -

Arscnl
C , , Op r cscr t
l - * I) u r cr t:d .Fi .i o p d l o l o g i ecl i n tcdsi l r tl d m e r r l ,Ii d . Acu ( 1 .l l .S,l l .l
llucrrrcltl, ll)(i7.
( ; , Si D r l o n cN o l l
\1 ,.- I>a l o b l i a D ( tl n o - n l kl l r tl n r [0 .Ii a l r yi ( r l d , l i r l , I\1 r ,.,
Arscof
(lk:nlil, Iltlcu.otlI, I{lli8,
( : . , O!r I
c'' 1 ., [!n r r l BI$
Arrfnl
,\1 -, - /) /l r l r |r l i ]l r i .i , l tl l l Sfl ,,l ', l 1 2 .

305

(,Ir.r,r'll

.-|l l _
1 ., \l :' r ' lr ir ,
\1 .
t) ltttthdnui rt, t1|ri i t,. /,,:j
l ) t ) | , s ( r , t., t\t :r | ,.t s lx ]t.
t) llu lttr,tnl i t, tl l r;l t t,. /,, .^l ti 1t u1)t.
l\ll'(tsisIt.
Nfu f( ' 1 ., I,sitr i;r t., N| [r .,x.hi r., l t)?t), /.j , t|!t .:j :i 9,
l,0lr,z
t\I. 1 ..
h tth u ttir i ) r isccr or tq | lu tit)t::.,:i tr,l i tt
ttt tr:i tuti t.
|\Ltl ti tr,
l, l ( 1 .A c a ( 1 . l l . S . l t . , Ilr ( .u r ( sli, t9 ? 1 "
( : . . ( j o D s t a ntin cs( :u
A f rc lri
]\l . I._ Ncr ir o l.,
j t;,
P si hi l rt., N eurochi r., l gi 1,
ll) j j - l t { ) .
( 1 . , ( ; o n s L u n t i n e scll
, \ rs rn;
A,l,- ^ Hip e
e n siu ea ttacrani arLd, E d..A .ced. II.S ,R _,
I lr ( u r . { t t i , 1 9 7 2 .
Ars c ui
O., Oprcscu
\*
I' ? a u m a lo lo g ie cr a n io - c ercbrel d, Itd. fkdi cal d, E ucurcl ti ,
M2,
(1., ,tlarotsis
/ \ rs rni
lI.- Ro v.
r .o [m . Ne u r o ]., 19?8, tr, 359_362.
, \ rs f
i ( 1 . , C o n s t a n l i n cscr 1
A. l.J lla r e tsislI.,
S tauci u]I.,
V oi rescu
7.., Itrocescle cxpLotsiDc ifitrdcrutliencr \'ol. L, Ecl. Acacl. tt.S.R., Bucurcsti, 1$?3.
.It
C . , C o n s L a n t i r o \. i c i Al., p a n o za
G l .\._
tl unati smel e ue ebrc-med.u_
' \ rs rui
tut?. si ltl. tLcrDilor, Iad, IIcdicali,
Bucnrc$ti, 10?3.
, \ rs t lri
C . , C o n s t a n l i n e so u
A.t,, Co n sta n tin o vi ci
A ., (]hi f
esc!
M.,
Nl 1 r r e t s i s
lI.I) o cr sc e xp a n sir le itr lr e t! a n icn e , vol . II, Ij d. A cxd. R .S ,R ., B ucufcsti. 1974.
.\ f s c I li(1 . ,
Ioncsou
S., Ir ie tr a r u
N., Ilie scu
D . _ N cul ol ., psi hi at., N enroctri r.,
10 7 4 , t r , 3 8 5 - 3 8 8.
j U ., Din d itii
, \ rs oni
O., Golu
psj hi at., N eurochi r.,
T - ., Alcxia n u
D ._N curoi .,
1$ 1 t , , 2 1 , 2 4 1 - 2 5 : t .
.\ rs c ni
C . , C o n s L a n t i n e scu
Al. I., M a r e isis
l I._
S mi ol ogi errcurcchi rLrrgi col d,
\ 1, . , . 11r i i . .
r\ | l. e, i ( : . ,
AI I r. rrI O - .
\fsi
ni ( 1 . ,

Art(lu||
I l . , t) r , l r o r 't., l ,,r t,,'vt'
tl l L
i ,.r r |'t., Ih r tr r t., N .r r r o i .h tr ..,l 1 t/1 ,, / r ,,,
Ii l ' i '1 .
Atglrn
ff.
l str l i ti u l t r i t.ttl 'ttt'tt ttttl th ,th ,t
r r r i tn r tn :t.
l r r : L . I'o p 0
'ti tl t 1 [i n
( f h . I'r ' r l cl t|l ,l l |
viIirl,
r r t t. t'r ' ! ( , Il o l i l t n t$ t1 fu trff: ,l ,r u k n i tt si r l ,, tl
DcrtI:lrIo
ltu.i[t$, lltliL. .Jrnrlrrfi, l{}1. llrtl{,, t,t', llil) -l8lj.
Avirdo
1 ) . tr I., Avi r {l o
l ) .M . ,l r , .;\r r r r .r '..t. l ,t) ysi o t,,1 $ It, Jr j r , !0 t .U 0 $ .
..t. N ,.u r o t) tr vsi o t.,
llailoy
1 , . , BIcm e r
L
1 $ :t8 , l , .to 5 - - .tr 1 2 .
llancaud
J., Ta l a i r a ( h
.I. - l l ( fv. N d r r o p sych . In L , 1 0 6 5 , J.? ,4 l t3 - 1 0 0 _
Iiannister
R .- L a n ccl , 1 0 7 1 , u , 1 ? 5 - - 1 7 0 .
IJarbeau
sgndtuneof lreteditarulaleonselptosiscn.}dtJsphagia
in l;rnch (: rtttltt.
In: It.^.*The
K u h n, Prc|ressine maskelilgstrophle,mgolonie, mllasthcnic, Springrr V,,r.tllt,
Berlin, 1966, pp. 102-109,
Ilecker
P.E,* Iratamiotoniacongenila(Eulenbery),Fortschr. allg. klin. IluDllur,1,,Ilrl ,
Badd III, Georg Thieme, Stuttgart, 1970, pp, 1-1A1.
i J c c u S T . , Ln l t4 cs
E., Fr i n cr r
I. - N e u r o l .,p si h i a t,,N e u l o ch i r ,,1 9 1 2 , 1 7 , l t:,! Ii t.'.
Ilehrmann
G., C r r o l l
.1 .D ., .l a r Io ta
J, B.j ]Ia tth c\ys
W.B.- D r .l l h r , l $ 0 1 t,
99,663-678.
Ilein
E. S.-Languege and Speech, 1958, l, 23:]-2b,1,
Bein
E. S. .'-..Comunicar.rla,,Simpozionql astrprd afazici", Bucure$ti, 1960.
Ilenard
H . , [Ie r kl e n
F.P.- C .R .
So c, Bi o l ., 1 9 4 0 , 1 8 4 , 1 7 3 ,4 7 5 .
Dender
M . B., Fu r l o w
L .T.- Ar ch .
N e u r o t. Psych i a L ,,1 9 .tr bd, J, 1 0 b - L ? 0 .
p ,J. a n d tsr u yl l
Bcncler
I l . l l . - r i so r d e r s o f e g em o D e m e n l s.
( i . \\.,
In l Vi n ke n
Ilandbook of clitrical nearcIogg,
1, Nodh-tlouand publ. Co., Anstu,(|!Ilr, tl|il,
'tol.
pp.571-630.
Ecrgman
P. S.*Arch.
Nourol. Psychiat., 1957, ZS, 568-b8.t.
Bcrner
S . Jr .- AcL a m e d . sca [d .r 1 9 5 2 , ]4 .3 , 3 3 6 - 3 4 2 .
tsest T.-Aroh.
PsychiAt. Nervenkr., 1952, 188,571-521.
Bickerstalf
E. R ,- L a n ce t, 1 9 5 1 , 1 , 1 5 - 1 7 .
llickerstaf
I E.R .- R e v.
N e u r o l ., 1 9 6 4 , .r 7 r , 5 8 2 - 5 8 8 .
llickJord
R. c. - Elcchocnceph.clin. Neurophysiol,,1952, 1,27b*282.
R i c k f o r d R.c., Wh e a l a n
J,L ., Kta ss
D , W., C o r b i n
K.B,I.r n s. Ar r ,,r .
Neurol. Ass., 1956, 8r, 100-102.
Elack
L . F , Eya tt
R .E.- Am e r .
R e v. R e sp . D i s., 1 9 7 1 , Ir j , 6 4 1 - 6 5 0 .
Dlank
K . N . , Vi ck
A,N ., Sch u l m a n
S.- Acta
N e u r o p a th , 1 9 ? 5 , JJ, l :) T .l l ,( ,,
Blumenthal
FI., M i l l e r
C . - Ar ch , N e u r o l ., 1 9 6 9 , 2 0 ,3 6 2 * 3 6 1 .
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f) r i g i D c s c u N., 0 aj al N. - Enceldlile fi enccfalopattinirale co cuofulielnla, Ed, Acad.
Il.S,Il., Iluclrrefti, 107.1.
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D ., P api l i an
\:. V ., ;erban
II., P opov i c i u
(i r1r.l . N ,.r|],t.
I-.* S tu(t.
1965, I r,4S 9-515.
D u l re-E l d er N . S .._ Iri s rral eal i n.Ii orr. R el al i D eheni otz ops i ft. In : Ter.l book ofo]l ttl rttntl ",rt.
\.ol. I\', C. V. \losblr Company, St. Louisr 19tr0, pp. 3651--3652,
D i i rstel er
N eul ol ., 11]75, 210,25:j -269.
\t. R .,-.1.
D yck
P .J.,
Letnbc rt
E .I:I.-A rc h.
N eurot., 1968, l t, 603-618;
611] (i :l t,
E asl y
R .M.,
S .-A & er.
Gol ds tei n
ll L b o nr Ii. - Ncurology, t$00, rr, 64-68.

J . \Ied., 1071, ;A ,76t,--777,

Ilkbom
I i ., D c Fi n e
Ol i va r i r s
B. - H e a d a ch e ,1 9 7 ,1 ,ll, $7-10t.
Eldridge
R .- - N e u r o l o g y,1 9 7 0 ,2 0 , 1 * 1 8 ,
Ellenberg
M .- h :
El l e
berg
l \i ., R i l h i r
J. ( Ed s.) , .Diob.Iusn(llil ls llt,rttt
and practice, I\lccraN Hill Co., Ne\r York, 1970, 822-B47.
Endtescu
L .- C ti ze l ece r e b r a ldee o r i g i tt p si h i ..i ( n l ,,r i l i t'l i t i l "h t
\r ., Po p o vi ci u
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lellice, ljditu.^ l{rdicali, Bucurefti, 1S?8, 273-297.
E n g c I G. L. - F'aiting, Charles Thomas publisher, Spi.ingfleld (lll.), 1150.
Engel
J., IIcI- i n
T. R .* Ar ch . i n te r n . IIe d ., 1 0 1 - ) 4?, .t, l ( x) |l r
G , L .: R o m a n o
Esiri
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Z. Nervclheilk., 1951, fi6, 11.]-7'i2.
lraton
E , r Stcr i a d e
tr {., We r th e i }n
l I.- R e \'. N e u r o l .,1 9 5 8 ,9 5 , 1 1 7 .t']l r Fagon
E . , Sch w a r tz
B, * N e u r o l ., Psi h i a t., N e u o ch i r ., 1 9 6 3 , 8 , 2 0 3 1 0 1 t,
Fagon
I}., Gh e o r g h i u
l I., i \Iu g ctca D u
E . , Sch \ya r tz
P.- l l f\',
r !'u ||r .
Ne!rol., 1966, 3, 22:J-234,
I . a 9 o n E . , Il o r n ct
Th ., Io n e !j cu
I., D r i g h i ci
L .- R v.N r u m l .,
1 1 1 {i 7.l,r l r .
672-E73.
Faivrc
mcd. Nancy! 19?2, l/, 967-971.
G.*An!!.
Fsvarel-.Benazet
cl insuffisancecirullioire du slplrk : r(rl.Irr
A. U.Thtomboses
,dsilaire, Those Med., Toulouse, 1964.
Figdr5f
B,! Po p o vi l i u
a n M ., D u l d u
8 ., AFg i a n
L . - }l e v. M cd . ( T,{. M u ',r ,}) ,
19?1, Ji, 165-168.
Fdgdrbf
L . - M a n i l e sti i r i sp a sm o l i l i tc.In : L . I,o p o r tr r r l
a n M ., p o p o \;i ci l r
(sub red.), Manifestdri pal oxislice cerebralenccpileptice,Ld. Iledicaltr, llu(urrftl. lltTlt.
pp. 335-388.
I.crIaro
Fischer
Fische

A., .Icr vi s

G. A.* Ar cI.

N cu r o l . Psi ch i i t.,7 9 4 4 , t2 ,4 4 tl - - .1 U i t,

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lI. - . 49noii. 1s . I n: P. J ' Vink c n,
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ol clinical ncutolog!1,\'ot. 4, North-llolland Publ' Comp', Amsierdam' 1969'
G enet - 1971 , 2 ' 2 0 3 *2 0 9 '
A. E. I I . - Clin.
lrf i(:,1 Ii., Dme ry
ciculata|lJ
l'Ii(](l]Jcrg
|ailufe' s]loc}:'sgncopean.l suddendea|h in dse.lses
c. It.- Acale
al'ltE hea , \Y, B. SaundeN Co. Publ', Philadelphia, 1956'
du toeur, Massonet Cie, Paris, 1950'
trIatadie$
l,ricalborg
C. K.I ' I '- B r a i n , 1 9 1 2 ' 9 5 , 3 7 3 - 3 7 7 '
R. D. , D elhant y
f. lr lIor d K. W. M., C at t er all
Y '- J '
Neurol'
F I ', T o y o k a r a
H. , Sugit a
l llrul(awa
T.. 'Isuk agos c hi
\ci., ll09, r, 3bl- i9?.
O t o- lx r y ng. ( Pads ) , 1967, 34 , 4 3 : ) - 4 5 0 '
lilrbcrsch
V.-Ann .
Neur ol. , 1968i 118' 481- 47l'
{ irrl)crs clt
V.-Rev,
(irrcin
G . * I nt . J . Neur ol' , 197 0 , 8 , 7 0 - 8 1 '
R., lla nig an d
ge A. R. - Tr ans ' Am e r ' N e u r o l A s s ', 1 9 6 2 , 37 , 2 0 4 - 2 0 6 '
(;rrrrctson
l-I. D,, E lr id
Neur ol. ' 1952 , 8 d , 5 9 6 - 6 0 9 '
A. - Rev ,
lirrsLart
H., Remo nal
C. - Ann. } I ed P s y c h o l ',1 9 5 5 ,I l '3 , t ? 6 - 2 0 6 '
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Ne r ol, , 1956, 9 5 ' 5 4 1 *5 '1 9 '
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E-Rev'
{ ilst rrLt
I_ 1.. }- i s c h e r _r - i I I i a m s X{ . , Lt r gar es i
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G '- R e v ' N e u r o l '' 1 9 5 6 '
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M . Sal a m o n
P. , Pit ot
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{ irstrut
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N '- L 'e n c t p l n t o p a t l t tm
e to'
(;l$ta rlt H., Itog e r J . , Soulay r ol
R' , Pins a r d
1964'
Paris,
Masson
et
Ct',
clonique infanlile aDec|ll|psatlJthmie'
llxstxut
I'I.- Re v . Ner r ol' , 1968, 11t ' 7* 3O '
r;rsLxut
t{.- Psy c hot ogiem 6d. , 19?2, 1' 5L- 62'
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I{., Broughton
{Iiaonosisandlreateal,CharlesThomas,Publ'comp,Sprinstield(II')'L912'172-139;
22D-2,t0,
(Ixsl.nut
tI. fen collabolation1lvecun gloupe internaliorlal d'cxperts)- Dictionafuede
l'EpiLepsie. Partie ! | Difinitiotrs, Organisalion llondiale de la Sant6' Genove' 19?3'
C ' A '- G e n e r a l i z ecdo n '
R. , Rog, er J ' , Tas s i n a r i
t;nst . rut
lI., Bro ug ht on
(Eds')' EdndBruyn
W'
G'
J'
Vinken,
In:
P'
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oLrlsilescixures
13O-744'
107-729;
7974'
Amsterdam,
Elsevier,
1ol.
15,
neuftIogrJ,
clil:]cal
bool:of
J '- U n i l a l e r a le p i l e p l i c
(irst aut
C. A ', R o g e !
P. . , Ts s s inar i
IL, Brou ght oI I
seizure sln :P.J.V ink en, G . VBr uy n( Eds ' ) , Eond' o o l c o f c l i n i c a l f t e u t u I o g g '
vol. ?i, Illsevier, Amsterdam, f974' 236-245'
B i o l ' c l i L , 1 9 6 6 ' 2 4 ' 327-A52,
F' - An n '
Et . , M elt end
lirullicr
M., Fo rrr nie!
5
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5
38'
1951,
52'
M
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G . - Ann.
li(f lln
c., Sau lnie r
J ' Physlol.,
H '- A m e r '
M ' , Ha i l m a n
(iollhorr
L. ' Ke s s lc l
E., Ye si nic k
t$,1 2,1 J7 ,39 6-4 03.
(l.rling
(i. M., Wo ols e y R. M . - M is s our iM ed ', 1 9 6 7 , 6 1 , 5 0 3 - 5 0 6 '
(l rch wina l
E. - Neur ology ( M inn e a p ') ,1 9 6 2 , l '' 6 7 5 - 6 8 5 '
N., K aplan
(ir,frrmIncanrr
\t-- Pdtologieindusd enaIal,Ed' Medicali' Bucurctti' 1978'
(i lr s i (f G. .1.- cufrent ilidlnost$dndlre. mzrTl,Medical Publicalions, Palo Alto, califor[iat
10fi0.
19G 4,67 ' f ) 5 7 - 6 6 4 '
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Ir. D., liclly
06-73'
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G o n y e a il. F. . -l\r.rh. N(,uj.ot.,1!74, J/, 168-1?j.
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p .* Acta N e l l l o l .Be l g ,,1 9 6 l ,6 /,4 1 1 7 .,t.t.
O.,D u sti n
G r e e D \ \ '. R ., l l a e ke tt
D . R ., Sctr l e zi n g cr
N , S.* Ar cL . Op h th r t., t{l l . i ,,
15,1*167.
Greer
l{.- ceriatrics, 1975, Jr, 133-136.
Guibcrt
A., Gu i b cr t
C .* D u
sg m p ti n e A kl m a l a ( l i c cn n e u r o l o g i eXtr
, tr ) i r ( i \. ,\"
Edit." Paris, 1974.
p ., Be r tr a u d
Guillain
G., i 'Io l l a r e t
I.- Ite \:. N cu r o t., 1 0 3 j ,3 , U fi ( ; ti ;t,.
p ,- p l e sse I{6 d ., 1 9 3 5 , 4 J, 5 7 - ,6 0 .
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C ., M o l l a r e t
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C ., \ti l so Il
R . A., 1 ) e In e n t \\r . C .- Ar cL . N e n r .o l(. ( ]tr i c.) ,l !r ,t.
21, 255-_261.
Guyton
A. C.*.Strucf&re dnd tdnctiorrof lhe neNoussysfem,\V. B. SaundcrsCo., I'l,it ,t, t
pbia, 1g?2.
Ilaberlandt
W. T. * :{rtio,ropii schenLate rlsclerose,
Gustav Fischcr \rorlnd, StI ilr't,
196,1.
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A. (Cds.), fraitC dc mtdeciie, vol. J6. ilcsson et Cie. paris, 1C4S,pp, 02?- -{i{it.
Itallpike
J. 1.'.- J. Neurol, Neurosurg. psychiat., 19?3, ,r, ,180-.190.
Ilarrin1an
D . c. F., ca r l a n d
H .- Br a i n , 1 9 6 g , 9 1 , 4 0 1 - - 4 1 8 .
Ilarrington
R , B,, Fl o l l e n h o r st
R , \\i ., Sa yr e
c. p .- Ar ch .
N r u r o l ., l txi r ,.
15,29--34.
IIauss
\ V . IJ., Ar n a t
T., D e r l a r n
G,, Ke r r r p e r
F.- Zsch r . I{r ci ssl l [r tfr "j nl '.,
1954, {,?, 831_840.
lleck
A, !'.- J. Ncurol. Sei., 1964, 1, 22t -285.
lleymans
C ., Bo u ka e r t
J. J.* Pr e ssen 6 d ., 1 9 3 3 , s6 , i 2 g - 7 i J},
II e y m a n s C., B o u k a e r t J. J,, R e g o i e r s P.
- Le sinus catutidiot et Ltstortt I hor\l
Iogueeca lto-ao iqus, Gaston Dotn ei Cte, palis, 1938
Ilecaen
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J.* Br a i n , 1 9 5 4 , i 7 , 5 ? 3 * 4 0 0 .
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s R .- L a ca ci ti p sl l ch i q u eIl,a sso n e t C l c, p o r l s, tti ;t.
II6caen
I l . , An g e l e r g u e s
Il .- Pd tl to l o g i cd u l a n g a g c.l .,.|p h a si e ,L n r o u n sr .l h r t\,
1965.
Hilton
G . F., H o yt
W. F.- J.A.M ,A., 1 g ta 6 ,2 0 2 , 1 0 tB* 1 0 2 0 .
Ilinterbuchner
P. L .- Bu l l .
N e w Yo r k l ca d . \Icd ,, 1 9 7 4 , ,r , b 8 9 - - $ 0 r ,
Ilirano
A . , Ar a m u g a sm y
N ., Zi m m e r m a n
I'I. M .* Ar ch .
N o o r o l . ( ( :h t,..) ,
L967, 16,357*3$5.
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n, , Ris bc r g
J,, I.I o e d t,n a s m u s s e n
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I .rr n {rs lJ. -.r. Neurol. Nruroslug. Psych., 1961, ?4, 319-325,
lsrircs
ll.---.I. Ncu r ol. Neur os t r g. Ps y c h. , 1967, 3r , 1 2 6 - 1 3 0 ,
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H. , O ls r l( i
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L. , Papay
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Chirurgia
E,(Brc.), 19?1, :r, 8111-824,
.l r:lrvon s Ir. [I., 1]o we] B, D. lnlat r t it es pas r nsTn
, :P. J. \.inken,
G , W. B r u y n
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.l ( f l c I s on G,- Bril. .1, Surg., 1938, 26, 2tt7*302.
.l r)lIoI s orl
]I.- Bnio, 1952, 7i, 55- 67.
.l rllinck
I]. Ii.Br ain, 1969, 12, 35- 58.
.f rllingcr
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:ic fol. \cl 'osurg. Psychiat., 1967, 3A, 195_-206.
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t: t t t i t t t t s i + I i r l i l r r r {l c S l {1 , I }l l ( u !
rr!li. ll L
'
:t{i I

.,|,,,1
l ,r,' i
l )l |!r. r/. l :l l l
l i i l ).
rr \
\,.,,|' . ri ,j l l .:i .l l ., l l r' trfr' l l i , l 1r/(1,
l /,{ /,i . l ,l
f\rri rl
A.
\j rfu rr .t "1t,"rt.
l ,l . \,,,,1,.ri r.i l t.S .l t.. Inr,rrr.s l i , l 1t?7.
fi l l l l :rl r| N - l i .. \1 l l l rl ,' r
r, l l
i \r,.1,. N rrrrr)1. ((]' ri c .), j t{ i l . t!, l t)l
1l :,.
f\rrrl row
1.. .l ' ,rrl l tr,rl .
\1,,1. l 1r,l , :tt;, l l l ,r 111.
Ii rf
l!
rl 1, . 1., \l r' l .l (.r l ). \\.
N fIrol { ,gy (Mi [D orp.), 101,5, ;;,211] 26fi .
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A l .s c rri
I., N i c ul es c u
II. - N eul oc hi fl trA i ( .
l \rr.rurl
i r,l
l \rf

l, r

l r|
(l l , r

\.

4..

,l r,l

Ir,,,1

l l rl )tl ,
1, t2tI
12\).
(i ol l c w ac rt
l .,atLerre
!i .0.,
A ., Il erenIars
.1. ts ., S l al l o
Z.N c rrr-oh11y ,
1970, rr, $82-990,
l ,azorfl rcs
G.-Le
s gs l i me n$oeur c c nl ral , l l as s on et C i c , P rri s , 1967.
(i .*
l ,azortl l cs
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L- Frogr.
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(E (l s .), l l rrrl l ,,,r,l t

l I. A , -- In : f. J . V i rk c n,
G. W . B rry n
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Li tl vcnthal
L,' .
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A ., V an
S ande
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[,rmsden

L.E.,

K abat

E . A ,, $roi f

A .,

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llic

L c {r n P. D ., Il o .w i l z
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F.* Yr l c

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N{a Ir Il- X.-_./.ro&6es anttuelles
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r p . 8 3 - 1 0 0.
i \ '1 : r n o l e s c u L ) .,- A'.fl ,u /o p l i c. In : l l a n o l cscu
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N 'l a r c t
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A . , S tr n r Il o i !|
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A . , N l ,r l r ) o r r r r r r 1 ,. .l r r :l
{y/i r S? si u t't( n n tl i t Sr 4 i ti l i tl ( , ti i \I( ; |
l i t i o h n n tl i l ti h t, I'l Il 'I N ,l '|1 , Il l 7 l ,. ? .2 t1 .

[itli||,
lInrk1urrl

!r.r,

l l ,,
|i .,, i r i .l l , r '
( ) . r .1 ,. l ,!|I
l l . 1 ,.

A.

!tt'tr .)

,1 , l ,l r ysl ,,,. :'n l l r o l ., l 1 ) :tl , r ]r /, '/j ,.

N , fl ,l ( 'l l v, l l r ? :1 ,r 'l . l :'i r

/!N ,

: l5

(1. I)., l!lflv

\ l .' rs(l (
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, , 1 ,l 2 l - - 1 3 3 ,

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l'., tr'lr lr r $

A. . . - N{ ' r ! } 1. , I r s lhLr t . ,No | l t i ] r 'h i r ',1, 9 7 5 , t 0 , 1 J 5 . - - l l ] l t ,

Norrir

f , . l l .. l i ,r 'l xr ,t
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! ( l t t . r tr r j i l tttn tt,t tl t. tl t,., ti ,,,,,, !,!t l ,l r i r tt0 , N r ,\1 \'( ,r l i , 1 l ]fi l .
N o r t 'i s
l f . fl .,
i n l ,.r r ,.r r r \ \\ tt, tr :,r |l l r ( t
tt. O,- ",1 l |tu .l i ,h o r .]t
tu |ttt\r n i t,
dtrrirt)1ntn|$^ 1rttutrIrrttittttu tt'tltrrtttt rt!tt oth.r
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l \,l a r i cu $ i C o zr r r :\ Vr r .r ,r Ir ,n ,
Ncuro)., Psitri{t., Ncuro(:lrir.,tg1i, 1,3,2ilj_-241,
( ;h . , i r : A XV l - :j r si n n c:r n |n tl . Scr :l i {,iti ti G,
Pendof un(l
ti t\{{; f, N fr j r .0 ti r i 0 l l ,ti ,,
cliniril, I,ill|.lr Nt, |l[, ll]7{;, t,t). )-, .,1,1,
( i l t,, l i tr t''.f
i l ( ) n ( l r f r r ''l
tr . tr o ti .i ',
I r , ( . 1 :1t'
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li t c r * t
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',
V r r o 'r l t n,'
Nrrrl.
( a''l
lrt
U l r .|,r' U i ..
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sl r!lil
u l n n t r ti i r t t tt .t|\|tn ttt.tl l i t,tuttr u ,t|tti o to l ti lAt
. \ l ,. r t r t||,r to ||r t,,Ito r
fr ,l ofl l r

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ti trl r' l
(l r! tthrl ttrl urttt,tt' htt
,,t I , ' I It It t , , I , I | | ,t I t , r tl l t rttl l . rd Ir tl tl i )t:t l t s :;utrtt o trl tnttt,l r
,,,,i \
r, rl nt.
./ s 1/,/,. (i us l r' \ Ii s |h,,r \,,/t!l l ,
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IIr tl ttl tt
S tul tqr rl . l l rl l l . t,t,. l l l l ,
l .l l
l '('po\,i r:i U
1,., /\i ,Ii i r
l | l t., l )
Lru
l .:., I' l s f
u I., l ,al l rl
c O. .ti rrrrl ,trr
i \l (l i fr
l i rl . (l i rA r. l r,rl ,\, l l ri :1, l l l (i , t). l ;i j .
j r r L., \V ri l \fl
P opo\i c
l t l ' ., ( ; i i J i t) ri r' g 1., l (i k ol i
1,., Os l s z i rr
,{ ., tt:rrl ,' rl
rol ., Irri l ri r|-. N , |l ro(l ri r., 1L)7t, 1t, 1]i --1tl t).
tri .-N c
(1., S z .rL] 6 L.-, t)|tl rttttutl utn
P oD ovi ci rL
I-, I' x s (:l |
1., (i of l rt' i u
O,, ;i pot
tl re t?Io ti ans bc l l !,tc nu:tl (i n l es i ons al U tc broi ns l c t dl Ld Ihe rrl odi l i c ati ar\ ac (u1!i ttt Lu tttl
orl l dni .fl l i on ol s l etp an.{ l he poLl l gtuphi c (i nannl i es af s l c .p, S fc orrt Iutc urati orx l s t,.,,t,
l l rscrrc l r C odgl c s s , i j di nbnfgh, 30.J une-4
J ul y , 1975, p. 159.
' f., C oi oc :1ru
l ropa\_i ci u
L., D ul i u
]J ., IJ c c u$
1,. - U rtl c U oIh I
tr i tl
.:ti opdl onuri a
at .rl .c l i uni tl c urc nus c ul are c u (]c l etl ni ti s m arrl oi l ndn, (b r. ti S t!_
Tg. l {u res , 12 i |l !;e 1975.
Iropo\i ci u
L. (r.d.) -.fi i l c ps i i !?,
E d. D ac i a, C l uj -N apoc l , 1070.

I' i r I ir'l(l
\\'.
,\'( l' . ) , J r lr l' t . l' ! \ ( lr ir l. , 11J : 111,
ir ' , l l i ) i l : l / l .
l' r' rr lic l(l
\\r., Sr|llbr
li. , ( : it r r ir r i
r\.
. ,. N c r r r o l ) l r l s i r ) 1l.l ,l i ] 1 ] ,: : , : i " ) . ) . t \ '1 .
I ii l{l \\r., .l r s t r r I I I .
f' r
I it ) il. t s lt anl lht l t u : ! i o n u lt t l t r t ) t no l t l I h I t 'I t h a i ,
'l
Liltl(, ltfo\!n un d ( i) m p. , lJ os t oD,l0l, l.
ll, rlicld
1, . - - ^Spr c cat
, r {i ( n ( t r l l i v . I \ . c s s ,l , o r ) {l o n ,
w., ltol)rr Ls
i ldbt ain Dt r c h a i s n l s {)
I1 |tlt.
I',.f (lrf lo|l (i. - -lilndc(nalo1liqu?tl\ thakj'll$ dc l'honu/r .tdullt tI de sa udsculrr'is(Ilioir
(i"/rjrir'11?,
l'h'(c, P:rri!, 1960.
(;.-ltrv .
I' cirlro rolr
Nc ur ol. , 19?6, 132, t 0\ l- : 12 4 .
l' lrilco\
I). V., S(! 11: r r s S. I - . , Panr plelt
I t ., B c i g h t o n
P.-Brain,
X97j1,
../(, J09-316.
( l h. - ' I ' oulous e r n d d . , 1 9 5 3 , f , 5 6 $ - 5 8 1 .
l' lroqu rs
.J., Oriz os - Rr eI l
l' lll (hin o
lr., Orivolli
G . , Vog- hi ] I . - { . - Ac ta
N e u r o c h i r . ,1 g 'i 5 , 3 L 2 A 1 2 2 1 .
llrl lt)F( irrno 0 ,-Ilcs .
illr bl. As s . 1c nt . ner v . Dis . , 1 9 6 7 , / 1 5 , 3 5 1 - 1 2 3 .
I' ol)cscu
Il. i\., Io an \ r . - . llif r z r d,
lld, Uc dic : il i r ,B u c l r c l t i , 1 9 ? 7 .
l' oprsou
tL , R!{lr
( E d . ) , P a l r ? . , g tu
lf . - - I ' olinlio. ilc le.ln: I i. R. d u
an i t d l i i m a l o t i i ,
lld. Mcdic{rli, Brcrir'$Li, 1978, p}. 3tt7-113.
lropo!jciLr
1,.- CLrceltuiosuptu Dalo|ii utlat dalc Liothimi.e ti eleclroencelalogrufi.e
tn
tlecliunile DascnLarc
ccrebrale,Tczi de doctorat, IMF. Breur9ti, 19{i5.
l' op(, ! iciu
L ., Alg j) lar !
D. , Sc r ' llan
J t . - - S t t r d . C e r c e t .N e u r o l , , 1 9 6 6 , l r ,
'211t-237.
| ' op(, ! i(l
iu L ,, -.\rginLar r
I ) , - - Rev . M od. ( ' I ' 9 .I t u r e $ ) j l ! L 'l , 1 3 , 7 0 - 1 1 .
I' opol
ir ju L., 1 \S! ijan
B. - Re1- . - \ - r ur ol. , 1$6 7 , 1 1 1 , 1 a l 2 - 7 3 '7 l' opo.,'icir
I-., Gre c u
I r . - St ud. O elc et .Neur ol . , 1 9 6 " 11, 2 , 4 2 9 4 1 1 .
lf ot )oviciu
1 ,., Af gian 8' L^z . Ar I - . , P: 1l: r d e C . , S z a b 6 L . - S l u d . C e r c c t .
1.908, 1r, 39-'16.
^-eurul.r
llopoYiciu
L., Afg ian
C c r c c t .N e u r o l , , 1 9 6 8 ,
I } . , Sz alr . l I . , Rado l I . - S l u d .
1.7, 15.J-77/1.
l' opovi0 iu
L ., Atg ian
ed. ( Tg. M u r e f ) , 7 9 6 8 , 2 , 1 2 2 - 1 2 5 .
t s . * Rev .
l' r)po\ 'ic ju I-., A;gian
l] . - - ] ] ev . l{ ed. ( ' f g. M u r e s ) , 1 9 6 8 , l r , 2 0 - . 2 4 .
l' ot)o\ ' iciu L., Pa s c r
I . , AFgian
8, , Lr z dr
L., Becu$
a l '. , D u l i u
E.Slird. Cdcct. Ne rol., 1$69, 11, 111-426.
l' ol)ovicir
L ., Aig iar
n. , Duliu
E. - \ eu. ol ,
P s i h i a t . , N o n l o c h i r . ) 1 9 6 9 , l y ',
1i]1..,135.
l' r)pov ioir

L., .{Fgian

lrr)po\.iciu
L., BecuS
/r,3 90 .-39 4.
i' r, t )oviein

L ., .{tg ian

I' r)J)o!iciu
31):t.

J-., P::l s c u

l' ol)oviciu
I-,, Atg ian
| | .1, 2t)G-2tj'1 ,

tsopo\:i ci r

L,, l l i rc k
L.C ol l c l uz i i fi IntbLrmi bi nl el o{ l ol oti c c .ID :C ous fi i l Lri ftI ti rLn!,,
.otund.ii ,,.f-onros{ialica lteftcbraki lil pri.ti.a
uedicald", Tg. Muref, 20 rl]ni l1);'(;.
P opovi ci u
L., P as c u
I., ,)i po$
C ,, C orJ ari rL
O., LA z trr
L,, A S i ti :r
r l t..
B e c u t ' I. - W s hi ng rnd S l c epi D g, 1970, l , 89-101.
P opoIi ci
l l L., P as c o
I. - h ; S i mpoz i onul ,,l c htl l ;"Ldl i l rr pal ol al l i d oas (ul urd rrhtl ttt ,
S oral fl, 1077, 1-21,
IropoY i ci r
L. (s ub red.)-

i U dti fes l ti ri paroti s l i c e utebrtl e tl tepi [rt][i tc , t,i l - [l ,rti (,' t]r,
B ucurr$1i , 19?8.
P opo\,i ci u
1,. (s ub rc d.)-- t' i s al , ed. D ac i a, 0l uj -N apoc n, l 97i j ,
(1. fi S rt.c k
P opo\i ci u
L., l J ec x t
T., D rl i u
L., $i pof
Maf t.r--(i rrl rrl ,r/r,
l ( sl ud i ul .l i nfu s i el ec ranl i ogral i c ul putu\l i ol atni i [ot, C onr. S rs i unc r N rri rl :r r ti t.
Tg. l l ure$ a S oc . S L. l l c di c al e, 2:] apri i i c 1978.
vi ci u
T,.- J n: { i . A rs eni
(l i d.), al ' rattl Lde neurc l ogi c , v ol , I, l i rt. } ti (l i (rl rl ,
I,rl
rcsti , 1 970.
P opoti ci n
L., I):rs r|1
l .I' ri ux i pi i general e de l Lrapi e naw ol oti c ti , l rrrO.,\rr,
rr r
(l d.), ' !ral dL.l e x euob7i e, \' oi . \' ' ., Ii d, l i l rdi c al i , I]rour.c s ti , 1079,pp.25:t
l ,ti r).
P oFo

tr,., P as c u
l .-' Iul burbi l e
de c an;ti i nl d c l i tt l c z i utti te s i s l t:ttrl ui t,ttl tl ,l r
bu:i l ar. 1o. L.P opo\.i c i u,
Gtt. P c ndofunda
(s ul ) (rl .), /,,,/,/
S i I. P as c l l
l a7i tr uos c ul ari i d !i s l c rntdui D ertc bto-bu.i l ar, Lr.l . .l uui nrc a, Ia;i , 1!?9 l )p. 2:ti t :l tti .
Fopoyi ci u
f,. (s ub red.)- S dnl i ol ogi a neutul ogi c ti , Li togul i l r Il l l .. l g. N l or(t, l l r/1r.
i ci r
P opo\
1,., B c c ut
T., W ai ts rk
P ., D ul
Me(l . (' l d. \l |r,,,r.
i { u D .-l trt.
P opovi ci u

11, , Pir os , I J - - I lc v .
l u c d . ( T g . I ! u l e i ) , 1 9 6 9 ,J i , , 1 1 - , 1 8 ,
' f . , Liz Lr
L. , Sz abd L . *R e v . M c d .
( T g . I l u r e *, 1 9 6 $ ,
8. , Sz ab6
I . , Af gt an

L. , Rado

l l . *R c v .

8, , S i p o F C ,-

8. , F: lgiir t r f

19t9,:5,32.* .3s .
popo\.i ci rt
L., P i s c u
'trdtal de neurobgie,

1.- I,e{ obti (L nerD i l ar trani c ni " l n: (1. A rs c rr

i (!rl ,
' ,,t.),
!ol, IiI, [4.]. iUedicali, Bucuresti, 1980.
l ropo'i ci
rr L,, P ende{ unda
Gh., P as c u
l .B ol i l c aas c [arc c ?t(hl l (tl i uN i rl ,|ul
eetlcbro-buziltlr, Ild. Junimca, IaSi, 1S30.
P opovi ci u
L., W ai ts rl k
P ., A s gi an
R ., I)ul i u
Il ., C l i s pr' rr
S t., Il l |l t
I
'l
Zs.P ol i i eLtopati i h c atenl i al e (s Ludi u c l i ni c fi l i rl G), 1980 (l uc tN l c |l (.pl l l rl l (!rtrr).
P opovi ci uL.,
Itnul i c l
l ,*
P ul ol o7i a s i s tu\ul ui netD oi D eotl al i Lt,l rJ . Mr' (l i (x 11, l l rr.(l
r.rl Li , 1081.
P o L t c r .I M. -- .1. Lar' l gol . Otol ., 106.1, ??t, { i 5.1--{ l -r7.

N o u o l . , 1 9 6 9 ,1 e 1 , 3 2 6 *

R e v . N e ! r o l . , 1 9 6 9 ,1 2 1 , 3 8 O -

an ] I . , D u l i u

E,-Rev.

Ncurol., 1070

f' { , pr)viciu
I.., S tam : r t oiu
1. * Ropor l ld a X, I - a S e s i a r aE E G , E X I G t t N e a r o t i t i o Io!)ie clinicll, Tg. trlur'e$,9-10 oct. 1970, pp. 43-5B.
l)opoviciu
I-,, Prs c u
1. , At gir n
trr. Al{d . l}a lh., 1971, , , 603* 606.

8, , $ipo$

C,, Moldovcanu

I'o L1rr

,L
.t. l ,rrry |l $)|. Otol ., 11)7:1,l l (i , ul J l tl 1l 2.
. /' ri ri /r/ri ,, l ,:{ 1. ;\rc (l i (.l l i , l } |l i ror(.i l i , l 97l j .
l | \' ,
I,ro(l csr
\i r \' .
l 'fi tc'l
fl ., f' r' I,
Il l rrl tou\\' l i l t,l rtl i (
I)t i l ri c d, l i l .
1111,;t .

M . *A r c h ,

lropovici
1 ,", lgit D
I . , Sz ib6
I-I t , , Pas c u
Sonnul nornwl $i pak)lo|ia,
Iid. Ilrdicr)lt, llu(Lll(sti. 1972.
l' olrrlv l(,iI|
L ,, I)xs( : u I . , , , Sipot ( 1, , I . : ' r z ir
1 , , , A $ {i t | | |
I],. Nlol(l ovc0ru
,11,. Nerfl,l,, |rilrirLl., Nrur'ochlr., 107!, /7, 3:ll-!-.31{i.
:I

l 'r'ol r

|'I
l 0)

4.. l !|||r,.,r,
.l ;t i ,

.1. L

/\11l r. S ui \v

\r,urri .

N (r' r,r' l ri r.

i \l f,l j rl l i .

l l l |(. r,)l l .

I' s )r' l r|l r1., 11,' ;' l ' ,///;,

:t( l

n, i;. \\r"
lir:r ,J.-- llt ) il! ls u iu llt t lt ! t u! : t uliD. . iix r a {r r .15r.' : 1 '. . 1 . \ '| I l i (
" ' nr(
1l I rl y Il (lnls.), Ildndbool,ol tli lk:ul nalrclog!1,\rll. J5, lils{:\ior',r\rnslfrdrni. 11174,
:\2t 372l iirrl rlvi( :i
Fl. * I ' r ' c s s c m dd. , 1913, J 8,5 7 3 .
/\., I-ascu
ll r {l u lI.- . l,doloUie utlihlii motorii, Ed. X{edica)i,Bucuregtj, 1977,
llr(f u 11. - IJalolotliaunitdlii lnolotii, Ed. Medicxu, Bucure$Li,1978.
(s b red.), I-tutal cle ncarolaoir,
Ltrrlu ll..- -lJatolot
i4 rleutumusculurd.In: C..r\rseni
\'1,1.\r, Itd. Xlediqali, Bucureiti, 19?9, pp. 17S-208.
l lli
8., Jolly
S. S.- J .
I Ddian if ed. As s . , 1971, 57 , 3 1 5 - 3 1 3 .
l l:rvrr lI.-Acta
Nru rol. s c and. ,1967, 4. 1,Supp] . 30, 1 - 6 . 1 .
I t.ch ts ch alfe n
A., D c m en t 1\ : .- - Rc s .Publ. As s . m e r r '. m e n t , D i s . , 1 9 5 r - ,l ; , 1 3 E - .
.108.
l lr' (f 1l D., Pla to
L. T . - - - A m e r . J , E p i d e n . , 1 9 6 6 , 8 , 9 ,
C., ! liz an
T. , I ( r r land
5 t-?3.
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dist4:ic) with parliaular referc1celo lherapeulicotul pdthogcneticaspcts.Tr : D, B. T o w e r
(Iid.),'lhe D c r \ro r s sy sl e rn, vol.:, Ralcn Press,New York, 19?5,pp,22$-234"
llis(:r
lt.Pr,dliquen.u|ologiq e, vol. I, 1I, trlassonet Cie, lreris, 1952.
I tr)l)( rts A. H., Ba '1f or t h
J . - Nc nr ology ,1968 , 1 8 , 6 4 5 - 6 5 2 .
l l,){ rr
R. A. - M & I l i p a e $ a n i a l n e r D ep d l s i r s . I n i
,1 ., BiIlc
J. alld Vigour oux
(Dds.),Ilanlbook of cLinicalneuolagu,'tol. 2,
I,. J. Vi)rken
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pp.8 6-1 06 .
l i(' lLrrlcr f'., lsch Ij,, I s eh- Tr eus s ar d
C. , Nor t h
J . - R e 1 '. N e u r o l . ,1 9 7 1 ,l ? J ,
2:t0-2.1G.
l l (' son
K,, Lo eb 1 1,, Sino
I . , Ram int oola
1I., Cunnar
R. - Circulationr
1$51, l.?, 836--8.1{.
l i 0scnberg
D. , Lov elac e
R. , R o $ l a n d
L.-Areh. Ncruol,"
R,, Scho t land
1068 , r9 ,36 2-3 ?6 .
Ii,) s l( r r .t.- Prcsso lled., 1930, ,:li, 5lO-591.
l l oss ,^.., I-ipsch vitz
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D. , Aus t in. I . ,
Sm it h. I .
Jr.-NewEngl.J.
230,313-376.
ll rr (' li . r C. \V. mer. .J. Ophthal., 1960, t/, 1293-129B.
i i rl)e ID r rrl fI. D., fen t a
L, T. - Alc l! , O t olar y ng.( C h i c . ) ,1 9 6 6 , 3 1 , l $ 2 - 2 9 6 .
irr'lfs(:n\regcI
R. * ,\ulloi,lusk.lliiftmuntci, Vl:B Gcorg.'flrirme, Leipzig, 1860.
: r (: ir s o11$o gcr R.- {:linical locoliselional otulomolor(listurbunces,
In : P. J. \'inken
lln(l G.\{. Bruyrl
(Eds.),Handbaakol clitricalncuNloglJ,\.o1,?, North-Ilolland Pub1.
(b., Amsterdam, 11)09,pp. 286-357.
lr,r I l( s ,1. G., fi r I o i O.- .I.A.II.A., 19i5, 2J1, 69-'12,
S l gol O., Oltea 11 r
L, Cez ar
I . - St ud. Cer c ot .N e u r o l . , 1 9 5 0 ,7 , 2 2 3 2 4 2 .
lil|((,f
O.- ricr.ct(?!t, Itd. r\cad. n,S.n., Bucurciti, 1960.
l r rl ltrr O., llore s
A., Net Lianu
Y. - ior r nalnr t e l i c u l a l d ,E ( 1 ,A c a d . R . S , R , , B u e l r t csli, 1965.
l lfrl

i i irrlr' r' O., Cin ci

I., I r lor c a- Cioc oiu
\ t . , \ { er ei
A . - I - o b t l l{e m p o r a lE
, d. Aca{ lcrriri li.S.It., Bu (x ur s t i, 1r 70,
l , :l lr' r(l . va ll l\1 . (1 .-.1. A$. I r ir y r . I ndia, 1C61] 11,
, 255-2$0.
s :r lirlrrs
Il., I I o r h i s i) n . i. \ V. , \ iinc s
r1l?t. ,.i, 18{; 1{x).
srl1lr i 4 ., lr:rutlit|s

l\ ) . , Vllillionpii: i

I r . S. , Dc li c r

D, P.-irdr,

R.

lt'/(|

J' S' - N cr u o l o g J'1 !6 0 '.1 '' 9 6 &- cl i l i

1 ''' I], M o ycr
S ', Ra u e r
Shceh$n
N e u - r o ] 1 9 t4 ' i '' /l :l :i l l l "
P' Y'- Ar tL
f:e
"t
\'l
':'
'
D . I., D o \1 n i c
'q "
Shophord
9' 511-1"27'
1900'
Nculol' (Chic')'
G' A'-Arch'
(i. II., tr)rager
Shy
]I'tr I" Go d f ) ( ) ' l i l l
S N " l l i sh l i i n
D '1 r '' Ap p e l
S h I G . t r I . , S l l h cr g cr
Amer. J. Mcd, 1!6?, 4i1' 163-168'
N e u r o l ' Ps]ci l i a t'' 1 9 5 6 ' fl i ' 1 - 1 3 '
R . G.- Ar ch '
Sickcrt
N o u o l ' ( C h i c) ' 1 !6 !':l ' 2 :i l "' l l l l
f" n 'A., Si l tzb cch
'n '* u '
silrerstein
Nerrol ' 1968' 19' 1-14'
I r ' M .- Ar ch '
I"ty
r'
it,,f
i' lrrIl
andliant nilo(:holrdl
*un 9lg"og"^
I('iti
E., I'loscr
-ll19o
slugr
I'
'lo'oa"
N
l
fr
l
r
r
E\r r xp tr r
( Er i t ) ' i vu s'l e <l i sca "e s'
G'- - ;"t;i ';t;
N {l r n a l '
Nalton,
11&-120'
-{ristcralrm, 1970, PP'
A'
- N e tu o l o g v' 1 0 6 5 ' l J' 4 6 9 * 4 ? 3 ',^ - e . J . , Pa tcl
s , l , i f }r
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