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

sEtvllol"offi
LA BOALA)
(DE LA SIMPTOM

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 BEMIOLOSI-N NEU ROLOGICA
PRETATA
Probleme d,e cl,iagnosti,c topograJic pi. etiopato-
genie Ln: l,eziunile nerailor cranieni,, paralizii,
Pd,rereanoastrd, baza,tdpa o eaperienld,6nd,elun-
tulburdri d,e tonus muscul,ar,, ataaii,, migadri
ltatd' estacd orice semiologied,i.norice domeni.umedical
inoolunlare, lulburdri de sensibilitate,tindroame
rute bi,nauenitd, iar d,u1td,apari,l,ia sa se {Lftee?tii cu
algiae, tulbnnd,ri troJice, agnoeii, aJazii,, apraoii,
erd,bilaresd, aind, o akd, semiologie cu acela,siproJil.
tulburd,ri de conptiittld, gi gtsihoorganice,
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,uni-
wrrald, 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 librd-
rii.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'ntuluni-
acfd'l/j.r pi !)ostuniaersitrar'Ne-anz gtropus sd aborddm,
ln pogini,l,o o,oestea, o alNd'morl'al,i'tata,mai practicd'.,
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.
Tttomotror, o sinl,aal,ila ternneou lllo diagnottia, oara
td-l orientezainreiliat 4,ntr"o ileci,zi,ediann,orfliad, d,a
urgenld pi,,itnTtldoit,[nlr-o atitud'i'nel,arapuulicd' atlcc'
tatd. XmTinim, grrin munco d'epusd' I'n sistamatizarea
a,castui,material cara refleotd,o dndalungatd' praat'ied'
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' CUPNI,NB
prin acea,std,carte ne aom Jace wtili nobi'lei' sarai,ni'
cnrene std,tn fald,, 4n sistemulnou d'ed'sistenld'med'ical,d, l. lrlr|durnto
0
d,i.npatria noastrd,. l, ln)lrlnmc di dloUnostlc topogrnllc tl etloPAtogonloh lezl[Dlle ncrvll'ol
cioslonl t0
lr.rtologld I . TO
:t,1. Percchli
t6
AAIORII t.t, l,utologl{ Pclechil a II-a g?
l.ll, l:robl0nlo dc diagno6tic ln exottalmii " ' r " " '
Itrottlor ) dc dlagnostic tn patologie sistemelor oculo otorii ' ' ' ' 40
l.l.
78
l.h, Prohlorno de dlagnostlc lr! patologia nelvului trigemen
84
Li lrroblGt o dc diag:nostic ld patologiA nervului laeial
(cochlear) 92
L?. lintltlnnrc de diagnostic in patologia nervului scustic ' ' '
g,l, t robklrno do diagnosttc tn patotogis slctomului vestibular 0tt
11r
t,g, l1$ltonrc dc dlagnostic in patologia nervulul Slorofaringian ' ' ' ' '
116
l.ltl, I'robl no dc diagno8tic ln patologia n€rvulul pneumogastric ' ' ' '
t 18
l,ll. lrobl' rtr de di{gnostic ln patologia nexvului spinal
Lll. t|rot,l(uc dc diagnostic tn patologia nervului hipoglos
[10
paraliziilo! rnultiple ale nervlor
'J,lil, lrro}|lrnrc do diagnostic in patologia
r'flrrlr!rl bulbari 721
183
l, }ltrtlrtlr do dlo0trostlc In parallzti
ll,l, llrDlofltrcu scnlologic{ a delicitelor motolil
13S
11,2,ltllnrh0roo t0lsclor pareze sau Paralizll
194
!l,il, I'rohl{ttlo do dlognostic etiologic ai topograllc ln divo$e pamli'ii ' ' '
19t
168
L Fmlhrnr dn dlo0nostleh tulhurirlle tonusulul mu6euhl
a,l, llholonlllo musaulare .
i08
a,t, lllDfrtorllo mucoulqre .
170

do dlo0trostlc h ottrxll r80

l, litltenl$
ll,l, FrobLrrno do mctodologie seiniologica
180
[81
}1, PmllloDro do dlegnostic etioDatogonlc ti topogratic
ao ilhgnorilo tn semlolo0la ml|oitllof tEvohtlt[lr ' ' ' ' ' ' 101
l, ltrotlmr
191
||l, !llDrrlhrorlllc
1,9, l)lrtonlllo 100
l.S,0onvul.tllo ,08

l, ?nltror dr dle0Do.tlo h tolburlrllc do i'rtlb lrob 210

t,t. nloonundlrl mctodoloSlao do sandologlo t10
?,3. Froblomo d0 dlsgno0tlctopogtqllc $ otlopqtogenlc' ,16
?,!1.Froblono do dlngnoltlcottologlotn dlvo!'so ilndtoamc atglco It6

l trulhur do lth0Do.tl0 tn iuuurtrlllc troll0o do orhhr lirlor|' ' ' ' ' ' 246
t,i, ?ulbt|rdrl trotloo alo plolll, al6 frnelclor $ ilo lo'uturllor $ol ' ' ' ' ,46
l.!. T lburirl tt0tlor orteo0rtrlcuhr! !{t
l tl. Tdb$rirl trollco nrurol|lo$ t02
 9 . l "o l, lonrn dth x,^ti. I n r r 0 r ,o ztl
'tn 270
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 27(t
:r.;J . glloz ii L ! : r u ( i i t i \ c
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 275
276
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 2'.19
d e vo r b ir c
1O.2.l ulbur.;iriale rnrisiunii si arliculirii 2',7S
cuvintelor 275
Io.:1. ' l Ulbrr f i r i r i i r ] t r c p l i c i , co n r p r r jh cDsiu n ii,Io r Dr u tir ii si rfxp}esici siurbolurilor

1.INTRODUCERE
r, . r L.rlc
282
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 295

l i: . Prrbleln( rlr { l i r l l n o r t i ( i n
Penlru a veni in spdjinul rnedicului practician neurolog
l u tb u r ir ile ite co n lti( a ti ( r u n o stilr i) ll, llll llrr)plfssii scriem
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 ;J02 I en?,iologie neurologicdd,eurgenlii, itt <:lra
d e d ia g u o stic e tio lo g i c si topogr:rti c
J02 rl'r rrrr .r rrrr prezenti,m^ceasita
in mod analitic ttiversele semne subiective ;i
I il. l i rl b ur' t iri t )ri h o r , r r f t r i . r , .
315 ,,r'r,, tr\ r.ir,irr numeroaselesemiologii clasice,ci sd,sugeri,m qi si, coltil_
,' (tiro.lr ieziunitc
,tiIlp,,";", *.,1r...;";.; '..
*u.,,,*,,,,i., ,,""0l"i r rrrr rrrrrIIr1,IlIlposibilit5,ti diagnostice sindromatice qi de boa,li,,porninri
lll]..i :1,,,1",
:1.:J . Sirx lro 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
:\,17
l i l .i l . s ; ndr. )u r r x , ( h t c c l r l L : ziu n i 3.19 ,lr lr , rrrr.lrrqirrelementarS, cu alte cuvinte Sd,potnim de ln sint|tltrnt,
co r ticu ic
:i51
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 | ,rlrr'., rr ll, boaliirla diagnosticul neurologic, care si, perrlliijti iur(r(lirLl
l :l .l ). l. iiudroa n r c ( t l t c ( l r l o z i ur i situ ste 352
D .\,.r r ia tc e tr jc 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
|,,,r1r,lr ,,r'IrrrrirIrrL)' rlin cinrliul rlr, ltrplli, trrtl,otlologicrll(xl(r.11,
rlru:nioi
trr lrrrrl. lr (xtlij{t)i')) rlr"r,iillrr nrol'odologillrtlrxl0r'rrii.
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 $ii, ( xi( 't t l. ( r zt .1xr 0lir r it . iir r rlr l gr |lt ir r t , r . sl, i-
',
t,rl rtl r' r | | III:| (,Ii | | i ru.t.l rrrr l tr' l rtrit . r r f r . r r lt I t lr . .
 l ' l l l tr' l i trtri i n.l l n.nrl t t tii ( r t t r lcot r lr i vir t lit 't ', t t t t t i r t lt 't i glilt it lr ') , r : it t l
l " ,l I' rtrl rrr.r' rrrrvti l ,r' ol l rrc livo r t r , t t lr zit t t t i t ir t lt t cr , l: r I ilr '. llillt r t ir t , llt t o
l trl rl ,r , .| | |r| | | | | r(' i I 11i:rl l r, i tr[.r '( ii gct r ollt lo lt r r l, pt 'ot lt t r t 't ll ilr lt t t lt t t r il t t t r vtilr '
r,l l ,r, l rrr 11/rrrr ruorri rrgor,r r r r r 'l: r lilrSr '. '1xr l, ir r lJlt r i t t t lt t it t gr t t 't t r r cf llilr ,( pt t t t t
l rrrl ,. l trl rr,r' rrrl rrrrsr' ,l rrtrl ilr ') , ( . 1( jr , f r r lif t \r , ir t t l'ict ', t t t ct t it t gilr r r r 1t ir I t r I I r icr '.
l l l ' l ' trtttl ttl i sntr: (l ( t!l, r r t . il, ir lii t : t : lu. l, iorr:,,t t r livlr so I r t 'r t lizilr 'i r yi k'
rtrrrr , l rr' l rrr rrr i rrl rrtrrl l rt r r :lrr ,illr t t t ir lci r ir zll( f , ( '( lt 't it ( tl, I lt t t r t r t lit u'illl zt r r r i
rl l ,r. l nr,, l l rrcl rrl i rrkr l l rtrr ci cit r t r t if ir r t , r lt noit lr t lui ( cu lt 'zilt r r t l f ikr t i'lr r l
rl l r,,i rl t\ | | l r. | |(,| | r'()| | i | ()r' l xrlilit |'ici I i, ov( t r l, lliLl,ou sl|plit inr 'f l, t , ii st , ct t t t t lit lc
C' PROBLEME DE DIAGNOSTIC TOPOGRAFICrt rr \ rl r. ,rIl ;rr.Ii vr' ). l Jrrcoli r ur( x) osr niilo po$t - lr : t um a l ioo pl) 1, t '( ! ( it t lloit I lt
r1lrr l .rrrrrrl l rrrrrurrri l ctLl i , I ) lir nt lr llovii, ur i, lr , bulllului t t lllt cl'iv r yi/ sr t , t t
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.
Intlad,ucere, Fatoiogia nervilor cranieni este deosebit A l l ,.,,rt, l rrrrrrurl i srrrcl c, dat li leziunilo vasculluc lot ir nt l'olr r lupl, ur N'
Irogu,l;ri, de rl,rial5,, atit stb proceselor n'||r ,r lrrrrir 1r|rIicrrIrrIrrivnscular provcnilj diu artur:l oerobralil ruti;trl'ittit I l't.
ryi .aspeetul morbide xesponsa
$t[r aslrcct,rrlcontiguratiiloi ;i al contextelor patologice r rr r. r,r, rlr. r';i vrrscrrlrrtizeazii bulbul olfactiv (Dr*loix fi frilrtt'fla, 1l)l-;$,
'.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
(l(,1;{runrnatrr,
,.,r1,'\ pe dc o parte de pozilia strategic[ a nuolei]or de ' | ' rrrrrrrrrrIrrrrrrr'cl| cani o-cer ebr alo pot ploduco r nosm ii, hiposnr ii, t l: r l
rr,u tlo 1;crminarein trunchiul cerebial ;i in iorma.tiunile rl Ir| | | | f trrr, r.rrr:ostrriS i i ha luoina, lii olf aot ive.
rulitoonto &cestora, l,r,l lrrrrl,. lr:rzci craniului artreneazl tlcstul ilrl frecvent hipo- srttr
.l l l l rnl l rl l
porrl;o-ocrebelos,
in stlnca 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
rrtrrrorfiirnrgicalc. Ittul l t,rl rrrl rt, 1rrr rrprti xi m at iv 10o/ o din t r aum at ism ele clllnio- cor ol) UlL'
fl ' l r ' I
l l i ,rl ,)ntl ttt r(l r:ul ur ( cer cbr a, Leant leneazi, r ar 'eor i t ulbr t lir li r ) llir r '
l l tr, \rrrrrrl r.i rrrrl rrrl rti ol cI ochzia pediculului vasculal pr ovollil, ( liI l
2.1,PAT0L0GIA
PERECHII rttl r' rrr r, l l rl rl rr l rrl r,ri ol rl i , calo vascular iz€azi, bulbul olf llel iv ( I ) r xlloir
t tNERVUir
0LFACTIV)
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('
ll.l.l. tn prozonlaunor disosmiila indivizi la caroun eorocr6xam r,rrrfrrrrr,, r ) rir .!lri,.i/(rlostnarceXi,(e se pot flolda cu hipo- s:ru ltltostrtii
rrorrrolol;lolrxt[ intogritatea neuronilor gi n ciilor ollaetivo, esto vorba | | rl l l ,l l "r il
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 :' | 'I' l)ivt:flttiu (unosmia, hiposm,iaFi eaenlualparosmia) cu,'inut -
ryi hiJrosrnlirespiratorii (unilaterale sau bilat€ralo) provoctto ale lntt' ltrti rt prr4tnwit:d. ridicii ulrrlitoarr:lc problomo ct'io-po,togonioo:
rori,at|, e ra. impioclici accesul curentului respirator-la zona olfactivtr lll 'l'trll'tt,trt ,l.f,rt'titt ola-ziw ,,fiaiologice", Sunescenla po&tc 6it ror,-
l,) rtonozoii sinoohiinaza,le;b) hipertrofii ale cornotolornazaloi o) llrr,rr, lrrlr" r'lllr( (i$, i'ot|8('(ntivirprocoselor'fllnolico alo neuronilol olfa,o-
pozo
pozo "
l,llzo (t:ol
(r:ol rn&l
(oot mir,i
mir,i &desea
&desea rdectato);
inJectate) : cl)
infectato); d) deviarii
devialii
de;viatii do
de Bept
rlo scrt: i e)
c't rinite
rinifa'c.iacuto lf vf ;l rrlr lrrrrlriurrilor rru,slom. Unele std'ri,Jiziologicelo femai (graoiili.-
;j i: """"ir
orouitlrl do divorse naturi I f). ozen*.; g) reactii alergice uazalo; h) tum
if 'rii.'# fil,.rdsTH' .#.J,T,ii Itlrt ttun,,ftu::tl / rrrrlleneirzii,uneo porturbtrr'i ln perccplia, milosurilor'.
ll'i;
iii;, .t "i'.]t-i"i#
j) sl;il,r'i.dupl,intorvenfii .
rvellrr o,orruJgrcatopo etajul supeiior iazal qi pe sin
ohirurgicalo po
ii Fh I lrrnrttri, rlr, l)il(li, hi;xrrosntiir din primul tlimostru de gravidittttrl
ll lrlpruurirrrlirr rr,lrloik,ir,1i al l,rcilll trimcstru, cu roverBibilita,totu l,tllbu-
nrrr.i;; l()
fiuli rr) diverso dorogld,ri
dorssH,ri respiratorii.
resDiratorii. l{tlhr| ||ur(,1lr,r ollitrrtivl dtrprinrrqtr.nr,
produse prin aleetarea neuronilor ollaotivi gi a ff) l,nr,ll luli lynualt (r, (liab(ll,ul, ur'('mia,pa,ludiBInul,homopnl,iilo
. 2:1,2, Disosmii lIlr,]llr, lr,l/r'r.rriiq,u,.)1xrl,af,r'ct{t,r)ouxmii c{,ilor olftrcl,ivo,pl'in (liYortt(,
ollnctivo. lrr,r,r||rlxn||', r,rrrr.lltrt i Bllli(.icJlicl:rIil iclrl,(1,
f i) '/'r,,rrrv, llnrralt tatt, lrx,c&r.'ntorlilru, $l[l,ulnifinlul, llr,bngilnrul,
?.1.2.1:.Dieosmia (anosmi a, hiposmia gi eaentualparovnio), *lIrrltlIr, i(x I Ir, lt|r,nl(]lul,r'Itrldn , ritr'l|1ul(1(]n.rginl,,0lonlrfl (lo zlhat,
ituttalowd, brutal y.i astaJi9 un ilaturAld, Jie'ile obicei bilaterald,'ie
nrtgr,r:lrrlt rrill.oir,r'rrlrrlr,tor.!iuni: rtrllurx ilr\ r.rflrrr, llrlirirr(,rr lor'irlil rlc solutii hi;roltonictr (clt.t'usr',1lir. t:11
|lllr,l|lrI r lllr ollirot ir'i).
ltl
ll
 .11 | I t,l t ,' , r' .l ltri r' "
' l l ruttt,tl i ttnt
)rl tttrl trr r r u, t tio- t t n'ebt 'aht( lxt zr t 'lo, I t 'lr lt lllLt l, t t t t t r t t - lt ilxt -
| ,,| l rl ' l ' | ,r rIr(' trc| IItIi t,t' ).
l 1 t j " , 1t,nti t,nrl r' tti .Ia k: ; i r nt t it At t r int im , - r lr ' lt ikli1, r lis1t lut in
,tl r' t,, r1,rttl ,rl t" ,' rrt,' i i i sttnl c: r zil, t lr , 1t r , 1ict in''t lt r t '1 it : i ( r ll hiDo- - sil'llil'lloil
,,, ,,,,,,,,, ,, ,,t , ti z,,ttno ir lt t t t l) qi st : r nr t t lr lt r ir r t a, nf ilisr r lgt t t il; ill ( Alvoolr ',
' ,i ,
lll , I l \l l l l l '.r, l l l {i l )).
lll l trl l ,rrtrrri Trsi l ti t:a nt vnlzt r , llsilt r r zt r ' Anosr ni: l isl'cIioli, t lr r . pilt lii,
,, i i ,,' 1,' ,r,, ,r' l rrrrri bi rt" c 4in4 bolir a'r t r lt r i sil r r t ir oa's. ilr nt t t t iit 't r As1'li'1, '
", ' kr
r|| r,r,l,r, ,l, r 1'r |z ir rl ri Rl lt,rltl nazo-lacrirnnl (pl'in stimultrtn' trigtrtntltlttltti.t
,l tr, ,rrl ,, l i rrl :, i l i ttrrri ri ), lur lecr noa, , st c r nir osul, t lcr yi liicr it t t I r r t 'a' lkl it i
l .rl r' li r r rl { .trl ri (,,\r' soni qi co1ab. , : 11) 77)
' txtrlttrttt'l
l \l lttttt t'lr l)t t)11'!)o cura intereseazd'ratlialiile ^olfud'i'tr(t. .8tt'11'
,,,(
N,Hr(.i .i,u
lbu;x;i,
ti"t-iii^rifit li,ii?':ri:"if ff,.fT1,,T*1ilT%11 rrl l r| , i l trrrrr,rrr, r:rrcl l tl i l e, t r aur nat ism e oi; t l') nu
- sinl.
inso{'it o nir r t ot lr r 'l'r i
:rrkrsoirbollavul se prezinti, Ia medic aor" .to""i- tl tt rrl'' ,' ,,,,,, ,1,, irr crtzurile de kviuni llill,t'cI illo, hlttttttrtrtt-trxplitrlt'ltil
rifilr'i, cofi ce,aqi_tulburirile ocolare *sociat!;;;;ifi "i"dliur sau se il 't
,,,, , ,,, ,, , jiilol intracu eblale (Alscni qi colil'b', l1)?7) Itt .rtstt
rk'.jrr, ifii*roi, , ou rl :rl ,' trtl sr r , lLbilat cr alo, st l llt t llt c t lt ) r ) 's1'l[ i'ir t lr t lt t ' t t t lit t t i-
trilltcratil.S-aardtatastletlerseniqi is?ej;;, degiant i i i r" ,
'
, i ' r,' r' r'
I lt ir l)
in rireningiormer;.1;,rul;i
"biffi, ,,i ,,,r, ,, ' , rrrl r(rr ,,l l l roi i vtr qi, dc ur ul1, cr lr i, lcnom cnc do, t ll! {l}ozio il
;:,i':1:]liii:.1:il
.:"T-1-q'iolippr
z|'r(.rx|||lrlvu,)r'it,cerStii iitactiv,in t\r,, rrr .r l ol rl b., 1 977) '
dcville sesizabili,doar atunCi cind este bilatr "lllt
l)r:.rrrrrllc.ori,cin<Icstc recunoscuti,.1" p;;i;;t]-, Ja'este atritr tl|slttl
localenesemnificrti""'iri"itiil
"iii; l,l l. llll,'r'tl"rrri (or'o$tercil,clplcitir,{ii olll'ctivc) sc i'r.tl'illrclkr
::l::l ll:,:ci'l,rl,1.l,l
rr;rzrl' lli unei
r,lt:.)rrkrcit; 9"qrg iirofla mucc tl t, r.i r,, ,t,i l rrtri l . rri rri niit e la subcr , 1. 2. 1. 2. ' c1- oxc. . p[ ; iit 'it 'f r xr f it t t t il't
leziuni cerebrale
ci, ;i it;.;,,';r;i se*acoroa r ' [ or 'r r r il
l:,rtir, uv!.ritrj. (Ars.ni 5i cohb., .19?J).' i l " rf,r' ,," , , r,,.' , , l ,,rrl rozr') . Hiper osm il por r . ' si. r cllizt 'zr '. r r lr {{'t i
' ;";;;i; d]J"rlrnn,oe
poaleinsoliun sinaroi"F;;;l{";;;d;;';;;ii,fi ;' ,fr' r l , l ,1, ,,t,, tr,,' . r i "t . lodit ) t i", r r r ( ' so illLillr c: l{' lll ll( 'lllir sl. lll( l'
:i:,::l1ll1l,t..lll],'l,t:i:
ir(fr.r'rf
r pl t t,c cu cu atrofia
"ll
I' t i ,,,,,, ,,, , .,r 1,,l N rt| i l ri i ' in'cur sul l1r sS, t ur ilor gr avit lit xl, l'l t r ovt r 4}t '{i
.tumola $i optici,, Deci, anosrnia'prerl llll
nrltir j.rru orolusivii, o parte, qi coincizind cu alie'se;ne tumo ai t,, ,,,' ,, t,' l r\r1r ..rIrItrt| | :|I i. Alt ( 'u1i, ll ipet 'ostr tiit ' si' pr r r t l. llsr ) ci: t cll '
_de
:rlr' (| lt)irit(f vil|ra,r'e diagnostici'in meningioa-"rc (.rr li. n, nlcuu r Jo hipr . r r . r t it r lr ililr t ic l r ig( 'lr r ir r r r Jir lr
ofircli"". i ,' ,,i u,r' ,,1, ,r rr.rr.;rl r.1\i
l l l ?Ii ).
A rrrrv1l;1111111 de arteri, ca?otidd intein-d,, osteomul frontal, l l l Il t l t Il \| tt.,, rrcrr,
giotrtttl sulrrrsr'lirr,ijDmorilc
l.lr{'rr,r||l
sttlltilsclitt. tumorile r'la
de ,r.r'in;.
adpd, mi.; l l l rrl rU r l r. trr,l Ii i rr lihr it r : qi ir r ur r elc cazur i do opil( , , psio,lt t t t lt olo
micd ,lj
cle sfenoiA si unele tumori lullll) l i ( r 'l{'
rlf ) rrrlf l. l.l ln)L (t(,Lerminatulburdrt-unilalerale "i^;:ri;,;:^'^ -. | | || || | | , ,, | | ,,I , ,, , r:r| | ;,, , r,tl .l )t : r lr . ,ir r I ir zr . lt ' dt . t lt br Ll. : ll' llllt , r
ale mirosului, cu deoset in- m ig- ur t o r yi r un. lt r slit 'r i
it
si- corab.,isii,lsd)."-;;rmii
bi.tatel i ,tntu, ,,, l rrl rr,rl r.,i rl i srrr,i rr piu, , lizi. gr r olalll,
::,ll:il,:
s. lgE:,1i-rrtolie.(Arseni
p.l, irrlilrri in meningioamebffactivJ giganiq 1$75; ll'isot''1{)52)'
iiir,ili" ,,\i,,r'rrrri ,,,trrir.,i1)7?;l\lilorycscu,
ql d"
in
l:::: lllll,-itt t umori hilofizare
jArsen.i
"ri6'r" ""ii"a
expansivZ!i in iiO_"oc"rariic" I lf I l, I'r||.orrrriilr. rirrl, rlisosrnii 0i|-0 cuttstittt lu irtl,erplotit,tlrit,ilrrtttlt,l,r'
:::i.T::lll: iillill"Jl,lie:lii qi iota'b,-1'erz).-iiu-u,i'i''au.i,
ur
-""e
y:::ll.:1.,.':'
i":.i::-?lliI anosmieiprecoce in cursulmeningioamelor t l l l r l r l l r , l l l l l l 'l
iltrlorior, in vreme ce aceastae-st" *ai u"ri" iffia1i I l t , t t r I r r r | 'r t r {r 'l l ' t l r r r t p l tl i l i l l r l r l r l 'r l fl r ti i l {) l r ti tr t l i l u l r ' vi tr i :l l r i l tr ' l tr t'i l -
oe cetre
it .neorgmaliunte
-u1t rruruilro"iif l t l r r r l r , t ' r l , l , r ', 'r , , , ' t 'r , t 'i l i l i i 1 i t'r r r r l csl r ' r 'l i r r l :tto g t'tl i l r : ;i to p ttg t'l r l i txr ;
l:liillj,, -jt?.,1"- .":emptu
r:rlus,.t'.r'aniofaringioimele, g[oambte;;"r"r;i-;fi1" "fr' ii nr"
jumoriie "on ,t t I I l'rtttttntiilr lnttrtlt, nt d,otul'tt'flIrur timTtlii tt' nt'itttttrri'l,lt':
gtioamaeEentrale.r" rol"i"t "i"ontJi pragur t
::)-1;li,lil,?"9"_:,-11 l) ', , r r r | / r f t t l t 't l i t \ ': g t'r r vi tl i l :t'l c.
,l"ll,Jg t, ri"lmin:irionnalmultd,vreme,ir" ;;;;'.;;hJta
Inl,iluitri, esturare ll,,lt t t t t t t t t t , l t:ti h i t l l ( r vl o u ( '; l ) si l l o '( \; sl i l r i r l tl l ttr ttttr ttl t'j 1
1,lnliv. .h rr,prorpco treime'din ;-;;l;gr";;;il aripii mici
)ll
"
rli.rroirhtlui, r{o
so pl'o(Illeo
pt'orlucc tnrUrl (, crc}l,oro lllr,,. 1, r r r t l l l t r r ' 1 i I t r l t I t | i i .
in-itria,lo crcgtoro a prag"utul.
pragului. olfactiv,
olfacnv. resnec
res
r i [(r(]{rrl r'l |:I r1r ir,rrlrrsr.lii.llrrr.l.ivrr ll l r t , 't t t t u l u l n i u i t t l ti t'i i r r n o t' tttu l i u tu tt:ttl r : ( I r t r I i 1ri t i t t i i , l l l !1 r r l 'l l l l 'i \
Fi rl{.st:rlrlc I irziu sr,insbal,ltiiirrt
iJrsilnl'rrriuhL r,urrrorii(ltisrrr, lr)fir).'Arsrni tlr' Ir,l r;t rlr rrttll llt").
r'i ,r,riiii. ir.9i]lj-rorl,r,rrl,z{,
lt , '
l"rt..
i , " , ,, , i i r 1 ls
ri
 xl hr,l tv l xrrrl ,o l .i i nkrorri i rl lt r or ulr t r l r r t 'izoi t t t t t : int ll, t r t lr r t t l, t t llt t t r r lr t r
tx r' rl rrl rr..n{ ' " rrryl ,i i nt' tiorrlr r i( r l, it r r it lot l0pt 't r xiu, t lot t , t t xit r l, t t , l, oslt , t t dot t uf or i
11"Lr.' ,Ir| .rrrIrrr,r), ot,r{ r $rr pol, lr r so{i r yi r lo sint lt t ot no r lir t st t r r ll ot r lit r 9i , , r r , li-
ltlFltrrt." (rr,ttl,otrtrt,l,ixtrto (lo ltlt,Bl'itrlltit!, rlo sltliv:r,t'io, sitltltl,tlttttt viutlrtrtt-
q*rtrlllri' r,ri/Hir,tt v iscrrt'o-tnol,orii) ( I'rrssotttt,l Iti, 1.002; l'olxlvioit tii collr,b.,
l ttl rt l ,l rl o i rrrl xrhr,trLxi i rr r {, inr r t tcil, t it t upr t t xilnt d; iv f ioJ[ t lin c1[ r lt t i o{islilt
rr * nn. i ,.r,' rl rr IrrrItrci tur,t,i rtilt aol, ivr rr 1igt t sLlt l; ivc( [ 'r t ssou: r r t t ,11102) ,r llt ilnt r lo
liilrl, rl,, rrrrr,rrrrrrrrrrr,, rl tullgt'ott,ltilo,txrhr tttluitr t;ipuri tlo ttxprcsii otil;ico strn-
rrrrt,rl r ;r.trrrrrlH ri sr. rurtttl l lt i, ozoit t oxpr csill lor ( Pr lpovir r it t qi lllt sr r t t ' 19t 10) -
rtd rrrr rrrl.rrrr,rl(l rslrrI{rn{ll, ri1,,,lillsl" porcopfio ol{llcl,ivir,polr,lo I'i itrso{,illi',
l r ,,,1 ,1,, rrrrrru| rrr:rl ,:i;i rlo: r , lt o t ipt t t ir lo r n: r , n i lit lghr l'r 'ipsilt t t - sllnzot 'iit lt llr r r
l tl r Ir,Irr' rrr:rIor (r i zrr:r1., : lur lit , ivc, Lr , t r ir inl, ico,sonr cst ozico) . I ln0lt r r 't izr r
rrl i ,r,l rr,, p,rl . rr:i ,l i rr i rrso{ rit ot lo , , st t nzr r t ; ii"soxt t llo, r nolgit xI pinll, llr o. lr r i-
!rl r t' ,ri rl i i (r\.j ttti rrgttttut l f i lt la, nc, ll) G l. ) . I 'lt ssouant ( l9t i2) N, PI '{{iizir l,
,,,,,,,!,:,1,,,0;o;,fl{tffi
?lffi&:"\':2i1.-peroeperea.unorcu.rodsubir rl rrrr ,l rl ' ri rrr rrrrrr| osi | l l t oil, r t ir nit osl, r ililol clinim llt r , , clizt li t llf lt cl; ivr r ":

:j;iffii{{Z#:d.
fIii-,:1fi
.i$";"f;*r*" ji:"U/fr
jr":"_d,p';ffinn"T,il'H:ABffi
: l ,rh,r l , r,, 1r(r' ol l rtcl ,i vi , ( hillt t cint 't ir t ' ol! r r r r l, ivii)L, st lr nt r t lo vis" sr l, t tt lr ,
r11,1' r,,,rr,rl rzr,rr..S rr, l rvl tt t snt ipol; t zr t , ct i t t , t t lt olf : r , cl; ivii t lo Ll t lt r lt t t l, t t l
"-;*t':#*::l[it:,"ffJ,",S"JT,,?il,*.f*j | tr.t ' r' ' rrrr' ' rrl l rl ,ol rr l i i d eclilnqllt il t l0, , t illencof alul olf a, cl; ivt ', t lllr t t ( r sl't r
l ,l " ' .,,' l L' 1.rl l rror' l ,rrxrrl propir if onn ( ut r cus) , cl, r o t : st o lt r glt t . lt rI ct lt r lt l; or ii
ll.l.5. Ilalucinaliile tr,rtl ' rt,r ;' rrrr l rrrl l rrrl ol l rr , r . lbiv ( . 1[ r r cl] cr r n li ool&l) . r 1952; ( iloor r lll( il;
;i iluziile olfaetive paroxistiee I q' ,,,,rnri , tl tt;:;. l rr H ch ir nl) , r n*r lif ( ) st i, t 'ilc cor r t lt loxt r psihosor r zor ir|(r i s( \
rlr,,l,rrr, r''r ,rrlrrlri,('ll propa,garotl d tlsciilcir,r'iilil ,,tinontlol'lllttl nttolllttrl,iv"
rr.r',',J;1;''.f iii';,?':gi.uJ,"'1,.y:ioz sintrorme decrize e1r'eprico | | r| ;r,l ,r,rIrr,,rrrt toprozi n t ii un vor it ilbil , , cl'oior t iut r t t cof l ir l", t r ot r slil't t ii;

;rli;irt'ii:;rl#i:i,:ix:fri:ijir:::{b1.r$'",'.r'-;;:T,'3i,:
, ti,,.,
r rtr.'r i:eu(a.ti oe,tr*i"i
"G'tdi "#rezulta[ui
i,i,,r-r'r:"
j, ;i r.otab.,. t9Z6). Reprezinrd.
:i'uiJr-.
.f"ii iiH,f r:;
rl l t trr r r,' rl r rrl rrl ,rrs(cl r pa,rt c r eccpt or ic) [ i ( lir I ct t r lllr ] lui At nt r t on ( cll lllt r i'o
r-l r{ ,1" lr' I
t ,rrrrl rl .rrl ;rl r.rr,sorrti ologicl a t t lizoLt r t t t t t t inlt t t , r osput t , iv it t lt iclt t olr ,
:..::ll:i"',.'
ir'||:rtr.
:rt( . r , ( , t l, . x ului r rn r.i n a t (c ri z e ior"a"",i"i t t | ,I i I I | | ,, | ,| | | I | , | ( r'il,i(x) ?sihosenzorilllc cu forttttnonul de sliillo",
u n c i n a te ),
r.rr rr,rrr, r | ' :| | | r,Irl Ini ()i i ,, , ilt r ocut uluit ', ct t r ca, cliilo t t r no!"{ll(rarny r yi t lt r i, r r I
, iolt t t 'lo
. lriret,c.u,nainate
,.. ...,:,.!:.!!:,! ,,:::!
Wr!ir|. Crizeleepilepucecarede l rl r,rrl l , ;,,rr,' i rrl i cc i rl o ,,oonf lt iiDl, oit teului, st t pot inf clego f olt . t , t r lr ilt r r
'itzil lrntt lx.l.(,(,p{,jin
unor mj

;:;,lili*riiiii:niis
srrrrrdrrr':, ,i J"-"j:"'il'.j?tS^fl*:llfot slrt iare tz- rloTo
rr/ir,,,rr'i{,r([ rlHi.it llrrr'nr r.rrtir, (lo contploxitatell func{iilor dtl intcgt':rrtl alc ,,tirttltttrtrlit

{t'.'rl)$r,: rllTf;,], '}:::

i]ji,
{l{,!,'ff :l$::fl
i:,r;l:
r-i.".-a"p"[,"g;,Jfi.;i:;h#","r",ryHr
rrr{,r,,,'gimioi
Irrl l l rr, , ' | | r, I rr ' ' , rl sprrtrliv t lc r olul jucir , l; r lo I t ipoc: lr r t 1 li I or r nil( it t I t ilt t
'
r r r rr 'rl,i rrr:rrrr r,irrirnrv{tlntii lirnbicc in exprcsia tnto{ion:llii, [i lrl rrttlo(l{}

:i,'i'
li:Ii: (,lll;,i i :ll,'#i;
:J': ::,-f + ;*; ;ilffi 'sT, ;tl
rura
r "tc.1 l rl trrr" rrrr.IrrrrIrrrrr.IoI
nlr|| tli,r v(.glro
rl rr tt t om ot ie, in 1ix: lr ca, t lalt lot r nnt r zir lt r ,in r r r gllt -
rii tlt: somn, procurn Di in lcgl:r,rcJ'viscorall qi soxualil,
Il:i'iil' "ff:T,'*
,11i;il;ti,i.'i;i''I:;.fff;
#.it;;'";il:';;'ffi"f,1,",iii'161i,[ii;)r
t!,{ 'lr,
l l ' or' ,r' rr,,r' t, tl rr;' -ti (l l ' )" r' , l06l; O r r , dillt t or ) i colr b. , 1962; St 'gcr qi colillt . ,
l l tl tt 1 1,,1' ,' rrl i rr ri i crrl rr , ll. ,1{) ?8) .

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
qil
"iT
fl',,i?.flru:
#,# ' I tt ,l t't it! r lltilc\tl,ioa ilttzi,on,ulc oL.Jacti'DaBn clr.N,cl,erizoll'zi' prin
l + ' rr,,,11, r,l l rrr' l rvrr:rl l rrntt t . Ui lt t l st t ger t r it zt l, o t lt lt t t liir calt tnt lulonillf i, N,( l( , t ''
l rl rl rrt ,rl l rr, l rr rpr.r' i fi c nlr t t t lin vt r r inii't at t , puf , lnd t aco par t o dit l <r t izr t ,
l l fl ,l l ' rl ,l (l l rrtrtrrtl l , l (17i3) -
tt |', I tttir'lr tpiloptice o$actitse ,,telflcna" ((lnstllut, 19?ii) sinl, orizrr
xfll|r1ltr r, rIr.r'Irrrrrlr|,rr yttitt rt'ltlitllrotl urrui 8t'irnul rllltctiv, tjrsp(to1,iv1tl'in'
t; frfrr,r. rl r' rrl ,;rl rrrrrcoux cir t ilzllkr . Act r st t t olizo Blnl;r t xt r or n t lo r lo( M ot lis,
l l l l l I | ' ,,Ir' r' i l rrt ri i rxrl rrl r , , ll) 70; Sct vil r yl ur llt lt . , 1002i St 'oiulr l9( ilJ
Fl thl l ,l r, ,\rrrr.rrr11i (xrl l l, l) . , ll) Tu) .
' I ft h Ntrr,lrtn'ul hnl'u,oirtuhr oronio ,y'la n,l,ribttli a't (,,r1o inflttcrrl'ri'"
rqrl ,rl , ' r( (l rrr\" ) (l ti sr' ,r, l{}li9) sr c: tt 'ltr llt tr izt r t lz; I pr it t l'r - o gl, llr ot lolit 'ir t r l'ii
l l .tl t,rl t, ri , ,r. r' rl l r,i l (,nr1r l, iorr1, 'sl0 r 'onsl, ilt ti l, r l r li|l olt r r r t r r nf irlt illt t oit t it l'ot 'ii
rrl l !i r,l l rr, l rr l r,r'r' r'i l i r' , rr,xplr iiv it t r t '[ it , t :rt 'pir ' olt t lt r Lr l lt lllt t t : it lilkr r ii, lt olt t t lvii
l rl t,utl l r' ;t l rrrr,rl rrl rrri l o$| lt ilo, lt t t t t t xl ; t r t t r : ir1i t r t t lt t olit r t t lozilt t , lo,{llll ll( {'l( 't l
Ittl tl l r rrrrr l r,rrrl l ot ,,rxl 'il" t 1i t lr ' , , ; r . t gt , r r t t I it r ".

14
I It
 2,!. l'l1I)lnXllA l,l,)Rlri(]llrr tr-l (NlillvUt, 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, lr lr l i( 'ilr li'll
ot,1,l0)
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 ) .
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. dr po. Tt ilo
rliavrrostie rdinic' lopogruricsi .tiopatogenic n, ttili ttl,t1||,i0/ousti, (r'ttt.lrinu.rtsulnrc'u,li) (llintrr, l115!; l\'llttrolcxrrtt, ll)fil{1
,,,,',,i;;;l'rli;ll$;rlt' 1u,:rlrrfi t.ttrilitt,tuirl?iHilu l)illlrfr'lllt si rrrrilizcltzi't,tta,t"r lrtlbtrrtit"i, lltilr lrzitr
rrrl " i trl l urrtatori j < l e tu,vtill, in1t , r 's1, if ial1'it t xllr hullr lr r 'li, : r t ) Ar r t t ilit lt 'ir
uizuote sepot exprimain urmatoarete r r:rrrrrl sr:ade ii totdoaruta l ap it l, lt llt al, in cil, cva zilt : , ut t ilai. t 'lr t l, slt t l lr illt
l.r;rl (cga,l sau jnegal), pini lr o drarnntici arntntrozil; ll) (lirrrprrl vizrrrrl
'11llll{ffiJi,Jcaititlii
lll .4nbliopio lepl.czjntdtlimjnuarer acuitrilii
vizurle. , rir. rlrr ollicei ingustat concentric, dar uncori tloar sectolial 1sitrtt st ttlnltttt,'
"i'#trXl:::iu^K:T:##,ffi:-ii"$:iilrTi,l":?Xr*,J
ll\ Cecitalea silsiu amauroza reDrezintd, nicrrl,,roo rnnoti .,
,,,'',,iJrv'ffi 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, c*orectEiinli*iX,-piiiiizt;ne' l,,irrr{f pontru culori, cu discromatopsii qi chiar acronliltopsitr I'olrtli);
tlllLLi,'#'ii?'ifdi""lffi
i?:{?::;,;,i:!:,"'i##ii "'f"""11?Y1
D) Ilemerabpia reprezinti iliminualea acuitelii
ce.nt.",u
..io ,lr \rlrrptarea la intuneric este loarte deficitari I e) Adcscn lo1'oltsii '1i tltr
, rr ll rrtilci,rile globilor cculari I f) Pronunlat edern pa,pila'r, prrpilrr,Iiittrl
l.l spl:c Seara.
*, lrrlblre, tumefiat5, cu conturuli foarte qtelse, cu sll'ii (r1| I ' I I Ii t'I t l i | |r{'
"irort" r,,.rr,,,
,,.rrrl,ii-rozate. Manifesti,rile edematoase peripapiltlle se itrt'itttl ltrr zott,
r:I l'lr!{,?i'[]i,'i1iii."1iL,slf
j:311", se
#,l:'tiH"
se
i'_lTi,$"",i,",1
Lci' oiieiene#iea
,r;rri rrLr cimpului oftalmoscopic, r'ealizind aspectul rlc ,,ntrlttorrrtirtilri,".
invizibilc ( llisr r t , l1) l': l;
]jlj,,lltu'l]:l;.,o:11 llry:fant tap ae
.,,.itri1i, {ininelseamaindeos?binc.rmai.oarete-;i.;l,iii, ' ,,rrr1i rrJl cpapi l ei deveni nd , in accst c sit ualii,
"':?n
r.rrulal fundului de ochi gi pi,strarear"tf"iofui p'r!i"ar iiJpiltir",i
la tuminri.
\1.
t,r.rri
n()l
r.
('
rl
s(i
i
u,
htate
1958;
qi
D
si
uke
nuoase
E l d
,
el
ar t
$i
er
Sco1,
ele slnt
t ,19?1)
inecat
; g)
e
Yelele ; i t ,II I t i IIt tr ' It ' st t r l
in et lcm ul lt t r t sir '1 lt ) lt r
, i l,,:rr'('l(i papilare pedpapilale se obscrr''X hemoragii si ctstttlrtlt', r'l'r'tt
... l') !):l!r"*,atoysja_peytyyalb negru fi tentru iulori reprezintri tl ,,l
$i
zone vast e t lc t 't lt r t t t llt 't t t t iI r r I lil t t t
in-considerare,'inirucit aceasiapoaresd,l i rsl l ccte de trombozd velt la, s: i cu
: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
:!./,,.1.1.
i!.2.1.1. Amb_Iiop.iile
Amblioniile ;i, am.turncplo "pti"b
si,amaurozele n.alra
acute si "in "ail'*
<; a,,t,-..,]-
sul.tacute *^
se iatilnesc in
rors(| ir1(:(i1i1tni, de diverse etiotogii qi cu vdriate tocatizXri pe 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
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,
wtic r I rLri,rr'il canalului op1,ic.
:!.:4.l. /. l. l. Perinct:ritele,optice (nearitele
rr.lrlczirriiio irrIllLrnl.r,t,io lrr lrr!r unui tablou dc papilit[ trebuio sii plecizitrrl .lut,lrttii r lio1ul,,
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 ) ;
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
( l') rrrrzii,o (anterioare, sfenoitialc qi ctmoitlale postcrirllurr) I tr) rrlirr'littrrr
illl in nn|lrngrl
ir illlii, rc l i n g i taa-SUpUrJlivi cprr.bro_spinalri i
t, 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
l(|i.|
o u; r Jr1 i l||l|st.
rrl sr r l ((t,ut({r
l) r r k c ll)
lrjl(lcr
ldcr sli s c nol-tt.
fir Scott,
Sc t. 19?1).
l 9 7 l ). Este
E s l c vorba
-di fuzi uni
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
i'.1,):.,.'.',ii,'flll
lil)..1::ll::tsauale,altor p"occs" 'rniiai,ato"ti
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
l.l:1,',','f,':1,1 1 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( :
,il:]:l:rl:lij:_"1,"T: sinuzjie sfenoidar" r.r. i,'alarc,se
::'l: ;:1,r, I ll r'tinicc: perinevrita ; r1 rrrltrr{ii virotice ncurot'ropc (o{tralmonculoln itrlilrii, lrollrt lrti l)rrvirr;
jl;:1,:1: l]l,i::,..1:llr, , 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 '
, , 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
pollrurli -irn"eor, /,,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
. r"rre cx_plic:iambliopia * $i cu la*traiua *
,rcrrllrr,|r,).
r.rrtr':rL.)- a ved l rrri rl rrrl b:rri l , pri n l i ps:l sa r r r I isclef ia, m or lif icii, r ilol t t ] t ir xl, ivc r r llr t lt r t t r st r r t
lrr r,rz,rl
cu,zlrlriirprr
dispari,tiei
ili"i qi a vecleiii centiale se lnsiJeaza o
ti-;-;.d.;ii l ' r( | rrr i tchi mb pri n prczo nl'll ilr alilor l, t t lbut i i vizt t lt Lr lt t t it '{iot I I t hr .
:lllj,,.ll.',11:1, f,ln ;i consecin{d a-eclematui pupitr" ;"riuiloio" q, I !txtrioristici clinil : lt) l)cl)Ii, l)l'ujr(f, itt c,ilcvu, ziL' trrrlizitttitt tlr' ,,
('l' llr'{. I it l)j' J o .
" ,l l r.r,r' r, rl l l rnati c:i a tcrti 1 t if ii vizr t lt lt r , pir r ii' l: l ct 't t ilr t 'lr t(rt t t t t r t t t t lt zii) t r ot t t
"fiff,
,1.,,,ir1.,1i,!.1.,,fl"'l:.it'i,
J"i,*" 1,1l :i , cl ri l rl ctt rl i sprtri {,i ir ,pt r tcoplit r i I t lt nilt lt it . st '; lr ) ilt r it r lr r t 'r 'lrlt r r t t ilir {ir
-l'iTl,:*gx,"ll,';ji,:l*$"1
..r'rr.1;rl. neyritc optice) iealizeaa:i.tabtorii
t1escciiuJ afecrdrii vu,ur"ti"i""-,iitrirJ"f"Si."
;t;;;'fr
r ri rr:rl ,rci i { ,r pt' ouxl tt,l i i si , 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,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\ r ' lr 'r il
li:::f:.lll,f13"ll: """.*. *,:.:i." .rr|r up0rc: pc pl.rmail.i,", I
por . i Ll rl i ,r,rIl .i { (i i l rfitrtrtti
t 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,
.irrrl:llrrrllrarJ, cl.recuprinde ptpila ".r-""l"i 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 r rrrr :rri rr!r' i )' 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( \
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 st 't t , llt l'l"i) ,$( ' ilt lllt lllr zli ( ) illr lillll! ) zll lolll
l \'lt t t r t t lt
rlrrI l ,,l ( vl i l i i | | i rtIri | r,Ii .i i ' '

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
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,, h t l , , t r t " 'l 'r ,
ri,",i,],iiuir,',1*i'iili;ifi'i,,i;;;',;,i;i;lllir",l"'T.llll
I t r l t *'. ,
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 ';.)
.r 1,rr, ..\tfilit,
l t r r .tttr x':r r t:r tt.i r r ,ttr ,ttr t
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 ,
rt,rLt,ir
slrLl.rr o.( .r .r.
. |rl{'(x)lor.itr.
| {' { || | )| I r Dlpih'1.1,,
prr li1,_(lr.
rtr. ,,fricci
lrih t"mporatit,
f'enrpo.a obicei
t,i. it,ii.,,,;;;i'
,;;,,,,,.,,,
rrn riisnraf
rt'i rr,llir,ro
nn rliscrot , l t r r l , ,, r t r rr t , . I r i . r r r .r'r';r
r ;:i i , r i .
,j1lf,;'rt,'t,it,,.
(tt.s.'-ryi.Ashrvorrh,
rsos,'oit*U'd;"ijor.," iir,r"" '. t k r 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
I n71). gi Scott, llBt '
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
l l l r t ', t r ; 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 ,
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
. 'l , vl ,'{\t {x,l 't,i tl t. :l
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 r
;;i^1xrs.to|io.rlc) ; .e) Oftalinoneu"rpj:llte ft;;i;'t"ib;;;;; ty no". r.', lr,.rrr,,r'irAiil,,
lrl lrull
ilini,.llll{lr,r)itsrr
;ri Iilrr,l,rrrixl,irrsrr
pr, irril.g
virotic(.(ruieotd, parolirtild or.ioiil'ur,c"ira"e Sll. ll:, l,:,1,,
lllltl'rl r,lrrr,r,, lrrrir l:r 1x.r'rli,r'ir,,
:]ll,l Ii:l.l-,1
\':tlrorr.it,, zonil zoster, variceld,l--bacteriene
"piau-i.;,
rl. lrlrr'u.rrl v.tr.Lrr,(.rr.lrr,rrrrri t,, irrlri
(diverse), riclettsiene qi l || t' rl rl r' )
(in special mataria, 'irip,a,no^*]r;r- qi;;Aiiiiloza)
Fl i tl , t'
t,rr,l(.,,,{'irr(. '
; s) ltt I tltnlttlttnttlt ti o l t n l l tl t ttr r u l u i o Jr ti r j l \r l , r u r l i zi r , ctl ctr r o ;r
, 1,r1'rt.rr,, rrlri.r.i,,. ,,,.ii(l,.11.ir
ini.tlirrti ,, ,,.,r,it,i1iiuii,,,,i,.
l,ll,,lr r1,,
l , | | |lr' .r1,.
ll|' , l l l t ; O) .

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

tlc t lli .lu,ckri: rcalizate I r.rlrnriloirrdirc<rlt:rk, rrerrulrri op(ic ilr LratruraI isrn
rlt.
r.tu rrio-rrrtbrrtle inehis0

I r' ' rrrrrrr' I r rr rrrrr: r r i rrrr iadilr *ir '( r r . r *r v ( u) r i( . st ' ir t t ir r t t r gait t r , r . '
,1, | ," ,, rl rrr l rrrr r r 'r lisr r r r . lr . r , r . lr r r i'r , r , r i. b'lr L, 1r t .
It{t.l t' ir r . hir-ir- r, i,
. l., ) L. r l, . , , 1ii, , , . ,
l [h.l r,r,tt' ,t,rrrl r' , I I 1I j 1I1I| 1 ;
; | ; ;1|t r si r r r r r i I *. avar r in sr , ingi. ir r i; ir r r . s. r r r .
r" r' L' rr' | i r{ rrrrr' ..l 5- r 0 it li, ir r nlxr r iir l ir r r r inr i. 'l, isr r r . r .
IH rr' ' r r 'r '. 'i*r r . -
,r,t, rri r.rl :r rr r . r Lt *r l, l . pr lir . , r t . r , v, l pollt , .
l S tl r' r' ,r I i <xr trtllr it r 'r 1. ,lr , z; t l,
t,,t:rt
l l fl ' ,' , ,,,1,1," ',rr , .1,:r l ,rr cir . r r [ iiir r oour i, , ilr ol, t , zi ulr r i lczir r r r r l ncr . r , r r lr r r
tl l l l l r .r.rrl urrl i r r r ir lr . ilr zlr , t r r r . l'|, i t r . , t t sglt suoloollt i( r t , vil, l, .
;;'i,r,' n(i r j n{,ir,r
(jilzaro retrobulbar6r cu scotom initial centrL,l, rrrIrl ' l ,,rrrrol oi l ,' u l 0 zir r r r ilor ir r r lir '. olo , . r t r , r , vikr l
"Ireyrltra"
rrlrrrrrIri_rlrro rrl,rnfiooptic:fi progresivi, cu intens?i, . 0pl, i. , i ir r l, r , r r . I r r r r lir
a papileir fllrih r r'rrrt'',, r.rrrrrIr'
rrr.lris.r'li. vitriui,ii,.
J)ur,rirrur'rir1,ur
t$2; "*ouor"u
Eiiazzoni, ,,p,ur.i{i,,i
ni,li
'lii],,i,jl:.1.,,,:11,1.s11""^o-3joas';,^{sf,annon,
;l:,1,:l';
lil,rr{i.rlrr l)1lrq-l!|lcr fi Scott, 19?i). i6[f : filllr,l,,r ,,, rrl;rr.r,lc JxrlIi gnrllr,tcin il crLtttolii:
l; [t,'r'rlrrt,rrr (|pli|t. loll,l r,lrrrrnlr
. -. N tu.r.oltutitr.o1tt.icd,chininicd apare in urma ingerilii cle dozo mari -,
t,j(t imrrtliirlc. lr)kr sirrl, hr,r.v0rrl'|
(ci l.v;r grrrrrrc).rltr
chirrinii(in scopteiap_eltic sauabofiFj qi p"oauceamaul Ir' '"rrlrr rtr rrrrrrr'.r(,;rs(f
vrrIirr{iillt,it crr,gru,vilrrl{'trii,rli (xr rrslx,r.l
|r'r| iiir, :r,rrblir4rii, irrsolite;i de suiclitate,re_marcatd ll,i,i,,,',"
OulA ieqireatiin
.trr,(';trrr'r,l,oirHli,rlo citeva
rrnrrtr.rliti,r'rrrrl,irr,lo.tu,ff
de alte
Examenuloftalmologicarald,ciieva elo.
're, nouropatiitoxicu , asiecf
isclemic aI re-
,rn,,,i'l,li'i",l,i"i,r;,iiil;;liil;llililii;lfi1'lilll;iillL
l,'t,,r,r',r,,,r
r^r,r.l,rrr.o cu paloarea F.O.; TACR^estemult crescut[. l4llirt r,rr:rrrr.rr{it.ziuirir,r'1r,rpil,
r-ri,tirit,
vr;;,,;,i;ii
,,, rl..r :rs1).rr
lllll''l i'',
I'rrlril.hr sirrl, ,Iiliforme,.
inl,0nsmidriatice, iar reflexul fotomotor este atrotit. $l l l ttr rl ,' l rr,,rrrl l rrr.rI rl i r ) lr ti( . ir .r . lr 1) l, llll) : u. i t r , : r r r *vor sli.
Nrur,,,u,tr1.1r,.oTtticedin 1rr rrrrr| , I Ir ,1rrr, rrrri Hl. u lr ill, t or , ; r , lii,scr nir ni<lr . ir r zr<ti r r r lilr r ut lr r r lr
.alte_into,ri,calii.(optgchin, f"iiix mas,'etc.)
barbitu. ^,.,
.,'t:'rrirr r cllr r
'aciri :,r,s,rrrr,,,r,'r,i
:in','"i
lillil,,lill;J,';i:i":i,,lii,;ii,,]::ljij'lij;l'1rNcor,"'|r'ii,,
t ilr.,., irl (lo.
'r ',.r,r.lrln,bromuri, injtoform, ialicilic, snli"itnti sini
Irrr'tr' :r,u,rrri'itolrft! cu cele chininice, dal,oriti *u'""oirro"i'o.
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.
;;;G;;i
,d,,,,1'
,ill:ilill::,i'il 'ij,ll,,,Il,'i,,1"1i,j,ljlili,1 r,r'r,
1,,,,,
ilxlillilii;l,ii;ili:",'
opticd din intoiiealii iautd araenineld rl t rl r.l t' .rt rl r. r.i rrrtr r t zr r : r l t lr .
rmporr:)nle, cu evolufie spre amaurozi in citeva zile, I . ip lr r . ur it , r r , , lr , , i,r r r r iI r r t clir I , , , r . iz, , t r lit l
,i1]li'.,.r.,.,,r:,r..,1,,'l]],'(,1)u l l Fri l | l | | l i | | l i .l trl t, rtrrri t t lr t
llill,i,., !1.,l:::l9ll.l"Irn,!,yii,,cu.srrimtorareaconeertrici a cimpurilorvi] lt'tttpttt'rl,
rttrti .rt' tt;tz^1,
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 . ifrtr,tr.rrrr prrr,r.hrpirlririri,
,,,ll.llillili;,,rtnl."i.rl'
jl) ,,r,i::1,::.i^i por realiza nevrite-optice, inctusiv papilte. | | nt|||||Iorr||.t'I|izoLrlii,lr, r:lnrprrluivizulrl,
1 | r'n.?rscnutt ,,:!!r!!ci
rascutarepot produce . .
lt rrrrrIrIr'IrIrr'trinir, lriltrltrl,uli(lo (,t,ilJitr{!
lunc(i'rrlrlil,rrtrr.ll.x lirkr
retinopal,ii;i retinopipilite ede.
r (.1.1)tr*r, .^r'u r.tllizeazl dramntije l rlo r'rlr.l' rurrr.*rr. drr ;r.rriratr,vizuirri
4i *inip
grij:r rtili'r.r.rr.{i:rl.r.rlc -ambliopii_amauroze, carc tiebuie cu
prpilitc :.r,) Rrtinopatiie fit llltl{rlr, rlr. rrlrlilt,rrrrrrr,lr.ttlui u,tttraL, lr ri,tilrr,i_
'irrrat 'nriirhir.
din atrrusiieria si d,in hipo_
r|'|tittt||tttr t'rttttuln,L sii (loClarlfczo inrpol.tanteexSUdltopl,pilurt,qi pCri. l,/ .r,l*r.t, (lr, lt('''t1ont trr l.rr.rr, oIti. ((,(l(,.t,lt t,,'n)r.irr,{t.
F :llrilirtl'(.(l(.tll'uIs(',.prr.clun1i lcmor.:rIii,cJr,(.tntr,.nclzl: sr,,irtr:ri
ma-uivo HI r,*r,'lrll I tl ) 't,t'trlrri
:frr\ I'r'{rf,flf ; lt) I toDtl)tt3(lt' r( Afterinle gO lrtS0l,r,S0rl0 irr rIll,ul.oz{},
oeSe S(.,1.0 ()l)ti(,rJrortl.ru
unurtilr,,ubu,rr,nlr,
rlnPl ? l(l zilr rtr,
l" ,,:ll,,llii'1,,t.,,'0ri
lll

)
 irl,,r':11 :tt-r,il]i|rrr||( . |{ || ( . \ iNl( , lt lir ir r s llt llllr r t t r r , t l r : r l r l ( |\( r '||['l ItI|1 l I
lrir lr,trrrith.ttl,l 1. 1 , '1 1 ', 1 , r r r I r '. r ,rI t t Ir I t r, t t I : r I I i l t i t t I t'I t'rr t I t i I I t' I t l l l r ' tl r 'l !l l l l l l '
:rp: rliflt I||i(,I II i I I I | , i ( | | ! )(r it r c r is ic r Ll, t r llu llr ir r r r r l {\ \ r r r ( \ l : r r l c r u p a 1 t i , rr l tttr to tl i ' tl tl 'tr t o tr ttl r ttr t j ) r \l l o l r r r .l r l i r r :r '
, , r , r r r r t r r l 'r 't l l i I
l:rt, r rrr rr I i l i rrI i r i tlc r,irnlr r . iz Linl c t c . i ' ,r 'r l i tt l :r 'l r cs, l i tt,r r .l I r i I : t I r' r': r I I r ' tr 'r tl t
l. r'.
. . '
, r , . r r . 1 ,,|||II||IIIII r l tl l l l l l t( 'i 1 l r r
I | | ) Nl;r,rri li.rI,ii,r,iopl.ioo pnsttlrur[:]ticc 1,al'diy0{!r r pirr dupi slptit' l1)i l)'
. r , , I ', | , l , , 1 1. r r l ( r ! l l : l t l rl l r l i l r' l r l r t' i tti tttr r r t i tr ( |) r r l i t' Ir ) Ir Ir 'r 'i "i fi r r .l 'l '
rrrrrriri:rrrlrrui rltr lt Ncoidont: tx) l l ( 1 1 \l l l l i r fl i i l ' ( fl l t) l r l l l l l l
*1 . r . . , , , r 1 't r ', 1 'r i ' ; , t r t t l ll i tttl ,,t;tr '( r l l ' l l tr ) * tl r fl i \''i
.IruurI rnrI o prpillrii primitivi (consecutivd,pseudonevdtei retro" l =r . l , ! r t r , , . l l l l rl r' l ){f l l l t rl r o ;l t) , tttso l ,'i l 'l i r l l r r r p l r 'r 'i ( 'i l r 't.tl to l " l o l o l tsi i "
frrrllr:rr r.)I ' ' s:r l l r l q i r r l i .tr ( l l l r l 'l r o fi ' l l ) 0 j t'
l . r r r r ', , , , . . , 'l , r r r r l r 'r t l 1 1 ) r i l l ' \'; 1 1 l {':l l l ti l l
rlr.cololirnrpapilali li atrolie optic[ secundari unei pseudopapilito; r r , r , 1 , l r , r l . , l ) l r l r r | r i i l r r o l ,l , l !l r l l ' tl l l l 'r ( r r 1 1 'r i |f i r l ( l l r sl :tl r l o r l l lrllrl
rlrtolonLro pr.1lil.ui, apirutd tardiv prin calus dupn traumatisrrj , { r r r . , l l l l t l r ' :l l r tr r t l r l l l :l l :l I l l l \ i l :r l l i l
rll ' "l '
c r rrr: rl oJilic; l 'l 'i ," t r "r l l l i l i Itt'tr vr fl l l :r '
l l l 1 . , t t t t ,t t t u l t t r r r r ttL t r r ) S1 :l ( 1 1 'zr r r tr ttl l i l |l 't
i rrllrrrllili lunclionale tardive. I l l r r r r l l .r 'v,r 'i
, r r , 1 , r r r l r r r r r r l r r r r r t i ( 't'r r r r l i ;i l i r r r l 't r ', l l fi ;t'r r l l i s,.l l l {i l i
:'.:;.| -:!. ..lrnhl,,iopiile
si amaus.azele
cronice , r l : r l t r l . I'r r '.r i ' i r t si l ':r s''tt, l l r s( ) ; l ) r l l i t l tl l r l ct fi St'ttl t''
lll,ir l,r'
('urrtlr risli.r:i(li?i?ce..aproape lotdeauna este yorJla {le nevnte I , r r r r i r r l i l l r ' r l r ;, l "i ttr tl :r :l ( l tl i r ; r ') N ,r 'ttt'r ttti r 'l i l ';t' r r l r l l tl t
l,t,lr Ir l l r r '' l :
p t i tt tttr xl ttl IIttti ItItII tIr 'Ir tt|'
r l , , ', 1 1 , ' l r , r r i 't . r 'r r l i l l r l c I l tl r '' r l I ttr tl l l 'r ' r tti ,
Ir i r Ii I r .r r ' p l i r .r l r 'r 'l tt( .i r r ',sr l | i I I I i { I I I I I I I I I'
, , , , , , , ', , , , , , , , r r l , l , l r r r 'r r I i Ii r IIi l i Ii ' ''i
sl fl ' ( 'l l r z:l l l l l l l '
,., 1,r , l , r L r Lr r r l . r l r I l l l : t tcztttr r i l o t p i i r 'r ', l r 'r l r i ' r '|,ttl i l r zl t,.r ,l r l
Il l l i l ; | ) | I Ii (' - .I 'l I ( ' '.r '
,,fi, 't , ' l l l 'r l r . o l r r l r . , l !) ? i l ; l ) r "i u r r r r l sl r l si .."'l r r l ', .I.
,' , ,,, tr;, lr ( r . r ! x 'l i r | i ,,,,,i ,,]i , l r r i r \p |i l \i Vl l l l so l L l l ( r l r l ) ( r tg ( l 1 l i ( i )
'r ,,i
, , , . , ', , , , , , , , , , f i , , , , , r t,ti tl l r I t t I t t I I rt t t i t ' I i 1If i r 1 r 1i r r i 'r 'tl r r l i p i ) tr vi l r l ) r '( r zi l r l r r '
l l ( r ( 'f'1 'o l ( l l l zl l l l
r r r r ' , r ' l , l r r , r r l r o l r l r r tl cttti tr l i tti zl ttl l r r q i ti i ' r r r l r '.i o ti l l l i t'i l '
l l l i i si \'l i i l tl t'tvi l ttt o l l ti o i l ( '1 ) t( l zl l tl i l '
I952 ', r , , r . l " t ', 1 r , l r , 1 l 1 r l i ( i l Ii o l l l ( 'zi l l l fl l '
', 1 , , t 'L r t r r r l l t r r i r l l i tl i zi l ,l l l {r l r t( ( 'i tl r i r l tr l i I I I 1I I i I I I I t I I (| ; r l ) .l r ) tr cr '
, t r '; t l)lilr. ,
r ') l r i v{ r i i ' l ' l i l tttti tl t l cl l l tt
t . l r r , i , , , ', r l r l r r z r i (l r o r l l l tti Sr l r r l 'l l r l ;
', 1 . r
, . 1 , 1 ', l r l r i '
l r r ttr r o r l i s
tt l l 'l t t t t t t t t t t ) | |||It |t||tt!Ii 1 "t: ttt r l r :l r tttt'i u i sttt tl tt.tttL i t: l t)
( l tr tl tl r t 'l 'r tt' Sr tl r l t'l l i i l r l t'r l g r l r tg l i o zi r l r r zr ') ;
,' lr, r 'r , , l , , , l r r l , , r r r r r ;r ttl o I'i tItI
\ | rrI I i I rrrI i Irr,Ir tlc. .lucl,ori etiopatogenici ai nevritelor optice l r r tl i ttcttttt
, I l ' , , 1 , | , , | , l , r 'r ( : r l t o l t rt o p t'i r r i i ' r r r r 'r l i l r r 'tl i l l l l l i Ir ( l l ) ( !t) 1 i l tl l i r
l !) 'i 'r ') -
t'r1r'r,ri\ r. rr lirsi sisl,rrrrur,tiz:tbi, dc noi (Popoviciu $i Pasou, 1980),pe r r l | , 1 , '1 , , , r , l , l r 'r r r r l l l r , l ltl l {r 'tttl l i tr ( ( l t:o ttr ti 'tto t'l r tt,l l ) 7 fi 1 l 'l l r l tl l i g l i o r r t"
:r Ir||rIr|.r'r|irs(| sirtrlii slrr,listicc, publictilc indeosebide Dukc-lJkler SI Sco . ' ( ||l ( j ( l l l l - i ( l ( l tr l l tl l t l ttt
| | | 1 ', 1 | | , | '| . 1 | I l | | 1 :' |\| i tt i r 't'i l :t l r t t t 1rl l t i I I l i Ei g i t,Itt,r l
(r1rir): l l ', r , r r ', l | , r r r i , r , r l r 'l r r 1 r l , r r r r l l r 'r 'i "l 'l l l ( '.'i i i i 'r 'l r l i r 'l l ,'l r '.r '1 i {) l ) i L l ( l g tr l l l ( f lll(1rl
ll l"ttt rt\i itt.lltuutl.ar.i.Lor:ali ,1i ai B.i[.C. .. a) Uveitc si I'etinite i r 'i l l r l i r l cl r ', l l r t ' i t t 1 l t l ' i l 1 ( i ( ) |1 t | : I I ( | I t ' i
rl 1 ,,., ri ,. , , , , , , 't , 'r '', ,.r u .l i i t',tl r r , "ttl tt '.' .
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 ( l l J7 l ) r !r t l )' l ( ..!zi r l '
,,i., r , , , , , , 1 " " . , 1 , . , , : r ll ( . r '1 .r 1 ,. Ir r r l i r , l r l 1 l .r . si i - r ( ..i |
lr , lri :r);rl l \ r ' r r lr r r oir lii,rr
o p l o c h i i i s rn a ,l ,i c e(c u e x te n .si eantori orl ti , cu rea- r l | r 'l r r r r r { :r ;r :r r l ttl l r r tti i t'i o r i l i l i l l ( f i l l l 0 i r {) t]{r tl i tt l r l tzttt'i '
, L , ', ' , l '
lrr:rr, r,lrr:rl rlr. rlvlil(l .jrrxl,l,liullrtre ,sipapilito) ; e) Sinuzite antedoaJe fit I l | . . 1 | . . | . l r . . t t , r r r l ; r I l 't '; r I r ', r ll 'r ttttl l l '( ) l 'i ( :||l Il l l tIl i l l i ( j l l l l IIl i |,1 |t.{) z( 1 ,|) t'l Il
tr.ri,.r r,, rlr' ; l) 'l'()\oplltsruozir,;g) Tubelculoza, fic prin lropagare, directi/ ( x'tl tl i l l 'i l l tl tt- str str tttttr r tl c
u , t , , 't , , 1 r , '1 r l r r '. r r r , l r ,'tr r i ci i , Il t r ttttsl 't' ( l l l ztl Ii
rlr. Lr ri lrrclrrlilr vooirrc (proceso tbo intra-ocula,re, iridociclite, osteite etc,), ('t.,r,l ' r r ': r r r r t o r : li l ztr ') ',t i ttl ''tt'i tl l r ttl tl l kr l t Il i l i tl ( r i ( l l l l l i l l Jl ' ,l 1 l l j i l ;
d l , l ! ',
lr,. rlr' lrr o rrrcrrirrgil,iitbo bl,ztli,, {tretermlnii,ferromenc de ne.t-r'iti, gi rI0 l 1 ) l t{i \\l r r l l i r l r l i ;r . .''r l :r .l r ', l l r l ;:l ci l r ( i r l r r I) ttl i r r
i,., r rrf,, r r r r l , ; - r l i r t h i l ttt l r 't t
t)(.rrr,vr il;r oplicir,, clrirn dc pl.pilitd, (Sverdlick, 1964, citai de l)uke-Eklof i r t , l ', l , , 'l l , l l r i l ) ; lr ) i i 'r r l i r r' ' 1r: r I i i I r' r I i t r :r l t'r 'o sl l r .r 'r 'zi 1 i
rrr ll ,ri l, l!)7l). li,ll,rl\rli ljoitte dctermina un tuberculom Solitar masiv ' I I r I'r sttr l l t'l t'
, t , 'r , 1 . , 1 , , , 1 i r r r p r ','zi l tl r t i t t t 1 I r I I I I t t t I) i l 'l ) i l i i r i ! l i l xr l i p i l '
pr, p;r.prl;roplicii, crr rolliz:lreil urrui tablou de pseudogliom optic (cn sim- - , , , , , ', ( r l 1 :r l l l r l l l i i l zr . {r 'i r l ( r i l tl :l r i l ( '
''1 . t , , | | , llt.. r 'r l l r l .r l r cr r r "r "r g i i
'1 , , l .l :r l r -
lrlr)nri , r ;riil rrriri s{)v(lro c1t cit i,uberculomrl se extinde ;i spre apexul ', f , ,,. t , i ', . f l , f , . ,tu f,,,i r '.r .r 'ttl .r r :i r r l ,r :l r l r ''r 'ti l ttl t'l "r ':r tl ( i 'r i - "{si
,'r'l)rlru ); lr) Nlvlil:r, ol)1,ici:isifiliticd de obicei provinc de la o meninEitf ' Il l l r l ( r r i r i S( r o l l , l 1 ) '/l ) Al l r r tr r .l :r i l l ( l i vi zi i l l l 'r r '
r',l , r r ' l 't r . ', r r l i l r r l r t ll l l l ( ( '
r r :rrrrrrr.rri rrllr llr r r ' lr r lili lue ti c i i l , i n s ta d i n l s e c u n d r sau terti ar al l uesul uj . | | ( , | | ( I I I t i I i 1 1 i :r l r l t,t i r l l 'l l i l ,r l t't i ( ) s( i l {) t( tl i tl i , l l l tl l tttr l tt i tt
,,,,1, r r , |
| I
Ir l l ItItIto i r Ir I
'\r1,.r.rr rlrislirrrL l:l lriirttrrrcn, cr'ncomitenti, a neryilol' oculomotoli, faciall rl,, rl ,l r r l , r r 'r r 'r r t r l ti l l r ' l r r i 't i tr cr sr ' p o l ' r l t'zvo l l l u l tsl i r r r r l 'r '
r.r r.r,lrlco yr:rlilrrrlrrli. illtrlLnrii r.iltr rl c r*cdere sint yaliabile, ,te h u$oir,l.[ IIL I,|,I|, I I | '| | | . | | I i | | | I I r r/, r 'r r r .r .Ir .r Ii r r 1 'r r 1 r r Ir I,' I'|| |tItII|| I,'II) i II!I1 . r i i III'|||( |
_
:rrrr| I r, rI rir, ;rirr'i lt rrrrrir,unrzi 1ofltli,. flalacl,eristice sin1, strimtorii,r.ile corr il,,., , ; , , , , t . , , , , , , , , r Ir tr , l r t :r l l l l i i '\r '" i ', r r l i r '{i r r tr i 6 i r r i ' r r r r r 'o l r
' , '
l c r Lt lrl l rrl r lir r r lr r r lr r i v izl l l l L p c n ttrr a l b fi l x rn t ru cr ori , precunr si s0o. ' , r "p l i '' r l "l i 'r 'l r ' : r I I i i t t r I i t t I t I r' l t l r '
r r r I t ', '1 , , r r r l r 'l r ', '1 . tl zr tl tl ,: t,,, tIi tt''|'t|'' l " """'
l o rrr'1 , ((.rllir lr , s i/ s iul l )i u i l ro l )l l a l c . l )i i L g n o s l ,i c u l se bN zcazi i ,po dl i l (!l r , r , , 1 . , 'l . r r I r r . r l l ) r l l l r l r r l ttr tl ttl tt'zi i '<'"tl r ;r l r 'l i r ; r l ) l r j r i til i i cl r z rt l i ( r l l r l l l r 'r ' r l l
.
i r I r: | | | rI r| ,Ii i i {rr,, pr r , lc s t r ' lc sc ro i o g i c (' , l x ) ri ro (l i l i c i i .t' i . l ()
r:l i rr 1r" (l .l L. (crr pkrr , , 1 , , , i . 'l l , rlr I1;(,Ilill r IIIIi i 'r 'ti r tt:IIi 'IIl i i fi l l r r \i l r l ( '( 'l l tt' l t'l l l l l ' l l t'r \l l l U l ) l l ( 1
( rl! r zi r I|| 1(I( ) r ||iI r I r r r ilir r r l i x ri l rr| i i ,,c tr p o z i i .i v i i l rl o i i rtl r(j i i i l or l l i .ri ,r' rr l i l | s), (r rr t r rr' 1' I
, , , ', , t , 1 ', r , , , , , i , , ,Ir cIi r r i Ir r '' '\r 't'tr l i ^ tIcIIcttI'ti |II'r 'IIIi I i i l l rr "l 'r l l
(,IIrrri | rri i rrrstrr0l rti rr ', , , , , l r tl r l r '[r 'r r l c ttt i tt'tr
1 rr . r rrrrrIi l i (, ir liI r rlr r t pilt r r r , 1 i 1 x . rro rrl i ' c l l tl rl t,.trr,r' r' i IrIt ir ,,,,tr,,,.,,' l l r l l t r l l l l r ' r r ,tl t,ti r r l r ' r l r vt't;tr l i l ti ttl r "
r r :rlr ; i ) l l o rrr lll r r I iI iI ill rrIr.| | 1r' \rIIIri rrl rl i { j s i rrl l i rrrrl r, rrrri ., l or,:rl i zi trrl rrsrr ( l l l o l l ( l r ' l r l l l l l l l l vr '
i .r I r r r I r r r l r 'r , l r t l l r o t l tttl l tl t ; r ') 'l 'r r 'tttl r o zr 'l r ' :l tl r 'l ( 'l

' 't ! '.t.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) ' llt ( 1.llr t t t r ii t t t t t t t t 'iI I r I i
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 ( , ll
|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 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,
,,1,,' ,' l ' rl ttl r:rgi crt: : r.t t rI I I i Ir , ri t t 'll s( 't ) I
l t lll |clll I ill'
pllrirr rlrr I)Nr'1olol)lrsijriJi o rrmaurozi:i, prin atrol jri opiilr'i, rlr. :r<,r,r;a6i pltr'l ' r,r
rr r I r'ocrrsrr l istdrernir: (catc intcr.eseazii,artera ofi,lt,irrrici,). tt t\tutol )ttl i a opl .i , r 'iit t r t t t ': . r t inii( r slo ( lo ol) i( xr i r lo lip t clr olt t t llr lt r ( r r t r
t lt r plr lr ilil'li''
ll\ Ilol.i. .sistem,icali toaico-metabolice: a) Diabel,ul lealizcazi, neulr 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
lrrl irr,rrlrl,ici, dirbctic5,,. relatatii, destul de frecvent in evolulia diabetuh 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
rr.r,rrtrlir,hiirr.,cu, se_ml al bolii (Skillern qi lackhar"t,' 19i9 ; Duk 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 '
-inilial optic5, diabeticl (retrobulbarl, adeiea IrIl .rr' r.r,Ior' 1i l l r Iri vol tt l I l( ) r 'vilot ' p( f I 'it or it r i ( pr llit r t : t t r r t palii) '
l,llrltr si Scott, 1971)-.Nevrita
ci:rlii ,ri crr ,,pu,pitjti,',) nu este atit toxicii, ci mai alegrabe l l l ttl r:rl r,l i i l rtr.rrfu - i. lr t : "'t 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"
froclusi, t t t r opllt slt t ozit , ( Zilnt noit r r llt l, 1{) li{i; I r llt r lir 'l r yi
rrrcclrrisnro vl,soulare. Apare in diabetul zaharat cri acid6zi,. anro-a It,ti
' | l ,,, ,,, i ri l ri ol rl ' i ctr ir r
.rrri.rrsiv lrl biirbali, este dc obicei bilateratd,, cu evolu{ie cronic6; re;lizil ,,,,t,,, l l tl ,u r:i l rr{,irlt I ) tI Ii I ri I')I rI trI r ii Sco1, [ ,1{) ?1) , ct r t r it r sii' I t r llizt 'r t zr t '
re:'irlcrtir vr:derii (cu scotom central, inilial pentru culori, in Bpecial Ir ,,1t, rr.nrro rt,.ttrri Lt git t o( lo $llf of it lliii, ct r lilt l l'.
rrllr:rsllrr, ultorior gi pentm alb-negm). ModiJicirile 'papilare ( lr) ,\r'r,rrtr,/rroltlitrt tit'r ir:a ;ilsatt i trtu'ttttlol1irn, cu'. srttt ,lrird rrkrlil
rrl,r' o rlccololare cu predominanll temporald,, la ilebut iuilnalu-se in ,u ,' t,' ,,' ,, tntdt.i pl i i l ,!. , 'lI ') . I "or liiir t nult o I it 'vr lilc olt i'icr o.1xr 1'sii' r r pr r t r iI
'.r l, n{)monr, ('rlomatoas{'i b) AnenriiJe, in lpecial a.ne-miapernisir ,rt l rr ,,,trl ,' rl ttl i tl ,,,ti ,t t t ct ^lir lt t lt t it lilt it r lt 'cl'iolr sr rsit ll I X) slill[ ( f ( i( ilr ll${i( l( 'H
llllt li lllr r r ( r lr llllllr l
;rlrxirro ndeseu novrite- (neuropatii, n.n.) retrobulbare (Oliva;ius, 1961 1r,, l tr 1,.rr.rrrrl | (1{ i ors|) ; b) ( ) iuo t lollt pliclt lit r ir r t 'ir zilr lii r l
.ltrru'n, 11,6I
.r(,lH('lr, 11)61- citati de Duke-Elder $i Si Scott, 1971);
19?1); c)cj pol
pofineur'onatiil l i , , rl t" ,' i , t t
, t i , , i , , , , , t t , r lt r l'ult t - : lgt t r sit t t r r r( Wllslr 1i
' trri
,,,1,
1,,:i t t '1, . u", , *, , ', iii ( 1ol1r l'''I 1l?l';
rrrrLlil,iorlrle, oarenlrare-,
rur,r'rl,ronllro, oarentriale-,o'rsmetabolrce
diqmetabolice pot atecta
afecta qi
qi' nervii
nerwii optici
o (: i t,,,,, rl u;r' ; hi r-tl l lir r lsi li( lir t t ' 1l) it 1'Nilioskr 'lr r ilr oll
rrrirrozrrlo(lin pclagr5,, din beri-beri, din deficientele tle vita,rnini, B,; i ,,,,,,ri ,,,,11 ri l ,Lttri i i rrrl i . 1{t ?d; 1l'ot t r lt cllol, t r : , l! ) ?l) , clr 'r r ls'r t 't tlr t r r cizr t 'l
lilro|Irlvinls din su-ferinlele rligestive cu fenomen€ ile malabsorbliil ,,
rrrt,, r,l ,,l rrti i urrttrol i rgico, "d', , i. ,
sit r l; t *izlil, ll N, lI t ( nior ( l( r r t lr i ( lblt r r vicir r $i l't ls( ir l'
r lit t
rrlrrrr4rr,l,iilela etilici). f;,..,,,, ..1 t,, .,,.1ri r' t,,,1 s, . r 'i, . , 1, ., , ( , \ r . il, 1r , l, t i, . ( , ( r r . i r r ull. l. . r lr . . jr r r r r r r l: r l,
t r li'r 'ilr r r r pf icl ir t ililr lo t l) ir 'r 'olr l'izo
lt) Sutcri.nlele endocrine (tireotocicoza), ,,,,,,,,i ,l r,,l rrr' ' rzrii,tr' cllt h'ul ll. I l', s: r t t
f , t t r ir ri'
l it , r sll' s( ' illiJr '1'( iit llll'(
s{il'i' r lit ) l t lt '
l;)_ l,olin.euro?aliile paraneoplaaire pot implica qi neuropa,tii 1,,t, rrr,l , ntonosir np ', 11, , 1
(M c Alf ir r qi g, , lr r t , . , llt ?: t ; Nilt r . 'sl<r 'lr t ilt t r t t qi colr r 'lr ',
r-rrlrtrr)rli opii. u,,| ' ,,, ,.1,,' rrrrtr.
' r' ttrl .trl$.,1-
tl ,
S.rr,l'5o.g-\\7,Llh.itn,
r',i,i , rli;l'; i,,'tri,i-;i'tt1a5.,'J9?+; I Srrr.llx't'
11)'il-i
lI) ln trlt,imii ani se relateazi, aparilia de tabloud clinice de O liilr r r r r r tlll{il};
p:rlii (irrclusiv.l,abloruide ,,neulomielitd,optici,r' asem5nltoa.r,e ' 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
, ; Sclr r r f cli \ j
cu s 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.,
rrrr.lrrf )r'r'io) itr b<tl.ilcde colagen,cc, dc ef emplu in lupusul eritema i{' l\'l''
(A.l)ril $. Vl ils(ltnenbcrg, ,r,, l, , r rrir*'rtttistticttr,ioilitogrlrii",r',ir, S.ll. li lrici-lllr .vrllrt(lN'zi' spnr
qi co1eb., l9?2; Shephcril rfr1t rri,rrIilirriililr of l,rr,lriotofico :titt ttearttr:Le ,p'ice ([(1.,t'tulzii Itrrpttrtrizrtlri
-19?6;-Fulford
cirl:rlr..llrTl ; \-ii:t|. ;i r'ulrb., lg73). rlo
,,,,'1",i ,"i Li,',iilt,'irt il'i',t," ,i i t"1., .*u,strtatc iir clr'zurilcbillo tlolittil'tr
(rB1'{r
ll 'ltor:itt u:oqene fi.end,o.gene(ambliapii gi &md,uroBeto(xice S_al i.tt cvolttlir'r, ('llro ill
. ). nil' ;t,, i,,,1,,,tt,t,rlcci, o otnritili,t inrlelungatd,
rl.r.r'iri rr.lrrrr.rrrfiIarl,oli toxici, care pot, sii prorluci, nevrite (nouiopatii) ni ni'rru"izirzt, ovllnl,ua,lelt, ilitrh6
i:t'lrr,(ii rLt'vlitlr'opticri rii S'M' (lJrr'llrl-
111it,r1r.i
l.rrricr., rljrr
,clro lt)(fnliorilm pe^coi mai importanli (clupi ,\hnoGscui ll r1, ry llirrkrr, lll?it) .
l{rIri 11iI)rrlc l,)klt'r qi Scott, 1971):
r) N icol.irtu,delorrninii, cele mai frecvcnte amblioDii toxicc. o sclio (lo lno(llllil'i'l'ido trll'o
ii.il,i!. Morlitirtfirilotinlpului vizrtll oforrii,
rrrrrl rl rrnrxriirzi'r cu intoxiclli€ etilici. Arnbliopja tnbagicii este'b lor, rr rrru.ll,rrur,.(]i!I.(l nO p0t fUrniZA, Ctll rUli a'tl0SOA,l)I'l{)iSO OOR'SpOnlt(llt['{!
i
cll'-osiovont'ruii Jattt'or
lrr r{'oiorrr
r'rr rl'oiorrr rurnhal
rurnlral (inilial pontru
pontTu rosu
r'o$uqi verdc)
r.erdc) caxe
cale u-iterior se poat€
I ox i'; ,'1,',;;;';':;;;d,,'iliii',,-t.' *iii- t,iietetiatenionattt,
Irrrrlr spro zonrlo_peliferice, indoosabi-t€mporale superioare. Uieoli t l t " r " r l 'u n n i a i t)(. c l r r c .i D l l fe r n l l l cl l tn l n a .
rii, rrpalri
rrii, palri rnili
rnili multo
mullio Bcotoame
-" 'i.,,:i:,:;;i'i,,iprli,,ip,rit"tnodat ittili srm,oloui i.c alterdrea otnptt.tu
Bcotoame centr.alo
centrftle cu rtrargili
mareini difuze
difuze (Duke_Elriei
{Dr:ke-Etd "nt'gttrt'lrzl
lirrrrl,l, Mi l ) . t'l-rt,rlt!r p.t o,,'., lu (tlu![ ]\ri$Ili,rJi
Ttal'oktgiac
'l{)??; 'It,isir, flriZ; 'etnrsiA, 19?0; t)rrke-liklor qi St:rtt'l
",,rrr1,r)ndonlela
r,,t,rlr,' lllli?,
b) Al<nolul ?rilic produce ,,amblyopi& potal,orum;', probabit pdn
I ilxrvil rrntinozil,IJ, cu tablou clinico-oftalmoltgic a.semlnd,1.or
eu nevrito lIirr (lrH. l);
opi,iri), din intoxicalia tabagicd, cu ovolutie oonici, Rple al,rolie oDtic{, tuhtll'driN
, c:lro rctrliztltt'zi',r'I).ed(tca
''' r.t.l) orhi'r'tt,rrtirrru'mJcranlitltii"
t) Al.utolul. metdlk prodrtce mai ales ,rnevlite" (neuropatii, n.t,) 1,11g,,t jL (prqrilitil);
: r4 novi:itil,opfi,IL xtrr,birllrrr,r'il'
r,ir,zi'1, lr) ttrtrrr
novt'it'r'l'
1q1.
opl,irlr u,rruttrcu:lmbliopio soverl, lar care BoaBo{iuii I miihiazl, parezo $l; Ir llr,rr ii l c) iHl'irrio,
rrrrrrrchilor'(,xtrinscci oculari (cu diplopie, div€l'se strabisme qi thztr pol.
prrlrllli),) gi alltr l.ulburiri ncur.o-psihice. tlltoi lt'zitttti tIottI1tIt'I
' :1.:1.!.o orhirc lal,/jldtntilttu.tld, l0 tllt.l,oltr6to (
d) N uropalii opticl ?rin dioerce alt.e mecan.i:tnteloui<urmetabolkn r. rr| | t tl rrrv ol rl i tr (t llr lt lxolr i lr ir 't t lt llt l'klil, l't t t t xt t 'lt lii gt t t t i t t I I I It rt tt 'rI I i r' ) '
tnllolJttttrl-rr,u mai dercris in: auJlrril$lutinnc, tlrnoli (nour.opa,l,ia r.4lt;io6
prlrunouphzitrrl),In trrtnrr,htmoragiilol mtsivo, lrr grtll,i(lil lt,l,rf,In ptrion. 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' | | \ ' ,
r|r,lo drr la,ut,tr,l,irr
olrr,
: l. t
'.1.4
 '' :' :!-4. Iln tT)|,.r'ttt' unl'rdl hrttttirttto,xiahrtlttt'ttrtirtt |ll'rr t tlvtrllllr0t'ptrttl,ttt
clM P VTZUAL | | l ,' rl r| | (\ l oorr,l i zl rLi1xr , 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
r, 0hi rr st t llt olt
| ,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
lllllr{ r'il,rr,[,irlo I ) ttl<c'lt]ltkrt r,{i Scotir, l.(}71.)-
I
I 12
\3 1 ' :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.
'.:'.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;
' r t l i r' { i rrtri sagi l ,l ,k, i l c c ir iasm ci; b) if um oi'i schr e {in( lt r ) s( {ii hilr r r li.
,i,|,'t rorr,rtiir,ttlcrtoca'lcinoame, clrcinoarntl mel :r,sl,tlt'i(Nl) I .tr) 'l'ttrtrrttl
( lr t sir lr ,
1r,rr' ,l rrtrr (tttotti rgi oame par asclf t le, t nm oli alc gllglionulr r i lt li
Irrrr| ' rr rrl rr osrrLui rfonoi d ( ost eoam e, ost cocondr olnm o' slu'( x) NlI l( f ) lllllr ' (ru
l rr, Lrr)rl l t(!, 0l t' toi noa,me,salcolm e r nct ast at ict ' li. a. ) \ si chist lll i : t lc t r t t 't t it t
,,, l,,r l,rrzr ti, lrrtrxxi (orllitale, :nazale sau nazofaringi{'tttr ct: ittvllllttr' rr
l ,,r,, r ,' r' rrri rrl i ri ..si a, zoi i ci p am solar e) ; 11)it 'r ulor i supr '2r solir r '(olt 'I t t io I r t t it l
t.r,,,,rr(, | l ror)i i l gi oamc S up r asellr '1, ,t ut t r or i [ i abcos, ol c lr lt t t lt li it 'r t t t llt l
I,ttr,,rL rirt rre,trlrtiiuiirnoame qi nl1e trLmori nlo ventriouluhli lrl ilcilt'ir' ltitlrrr
,,,1 rl rr, l rntrrtl i opi tl cunoi do, cor doam e i c) Tu I O I 'i pt ost r llt lr ' ( lllll, i llll)
ttt, trrtr.Ii ol l l tt(rl r,l ti i i anl uhLi olf act i\ '; f ) Ant vlisr nt l llt r ilt t clt i t r it lt t lit lt ' it t
trrrr, ; g) Arul'r'isme ':r,1o?r,rtct'eic;municattllc ilttl;criollttr I lt) l)r'gottt'tlr
,i irl(fto. sl,u :rrtoliosclerotice, DIin sclelozti oblit,cm,ltt'ii it tltitrilttt vittt,'
,r|,'|lir'Irrrrritttrri opl,ice;' hcmi i) Anevrisrnui rle arlcr':i corel)rrIli'1, ilttttttirtittri ltolrlt'i;1
anopsio
tl rrl rzl zrr rttttri ri o llit er npor all, sit not r icr ii ( FI illor r . . si llr r 11,
l l rr;l ;)t ,i ) i J-i ru rol ata,t \,i cit cva caznlj. dc ancvlisr ll 'll l\ r lt r t 'r lr : r zr lr r r r
, tl,rir iiirloliol prirl sp;tiul intcrpetiuncular, ott ctttnplitnlr t eit t rI t i It r'ttt tt't
,' l rl ri (1( Lr' r' oud, i off , ci tat , de. Duk; - Elder $i Scot l, 1{) 71) ; , k) At 'r tht t oir lilr ,
,'jrl,r,'liitsrnalice (poitmelingitice virotico' bactcl'ierrc, r'ickti,l'siozitro, Ittl
ti ,r' , l trl xrt' t,ttl tti tsttitraunr alicc) ; t ) lf : r lr esr r l f n, ir t " 1( ': r ljzir I I( rI I I i II I I ()I )Nii
'
l ,rl r" rrl )oti [l o, rcspti ci i v l l i tuzalt i, t lr r r t 1e cclt - nt lt i r t t t lllt ' r r r i it sit t t t r lt icr '. ; 1
r, r' tIul :l l r: i t' 1) l l ttri ngi l .cl ( olr t 'plr t cocicr ', Jr r l( 'ulr t t x( x'it ( llr ( ^llilr , {( x'ri(n{
r'rir irl(,s); rr) lri t vrilelii r-rpio-chia'smatir:r' I rr) St'letrrzrt trrrrlliplii, ' It'rt'lizlrtzi
,,rr,',rri ltiritirinopsii bit'cmpnralc pl1n lcziul)c t,1i:tstnrr,lici'i(l:rt tittit' sittt;tlrtttl
rrrr(i rrl ), i tr o116 sht neci) sar e ir r vcst igr lii l. t llt r u'lit t ir c ( ilr r lt 'ost 'bi t t t 't t t t r
r.' rIrr,l i ,ui cr' ) rIr rt:rl trt' i u clir nililii r liagnost lr . r llr r l r lc lt t t t t ot i lt i; xr I izr r r i
t l ,' , 1,n' fi l \i t' I.rr, l l l ?:,; l rt,bot : zky, . t C5; t j; p) 1lI t t t t t ot ik pt ir r t it ivc r t l'' t lr i: ',
rrr.i rilrlirxr (gliotrrrclo, ganglioneulorrrntlti)J r) '-llrrrn,rri*.1,11111111111 1lo cltirtl
rrr,'i olllitxr (gliaa,mrr iau rirenirrgionmo do ncl'v opt,i(!' oll ittt'tttllt$lt' tLltitlx
r rrrri ).
f{r'ryiitr <ri't, lozitrnikr rno(liiilo l1r rrivtrlul chitsrnt'i opl,i('(" (1ill'o il[(('l'(rrr7
lrlrr'('l(' llttzlr'lt\ (caro so i nct'uciryoazir,), . tr)ro{luc tillitlc rltlilllr ll(rltliil'Itol)$i(r
cAt ontcE lrilcrtr';xrrillo. lia,r' brobuitr ticoirlat,ii riurrrr iltctr{ it . ttt rot' irslorrt'o it'li1litn,
,r' l r' r' :i ,l o tl tr ttttol * ,rocoso f i) r I [ [ r t t 'r 'iir . t 1'j's ( r lr r lt t r r r , t i h ipr t f iz'r lt r '1
,,,[.rr;trl 1,ptrxl rrr:rri i ri {,i rr,ltl t r lixr t r ldt cir r t p vizu l ir'i1lii, r r . v r lt 'ir t r lt , lr .Ht t llt t liot t t
I(,I| | | | ol .i l | (i(rl v(' l l l ,l l u,li ttl ,t' " t t t tnit r gr t I r 'ir r r p vizt t t r l) , t lt t lt i' ot t t t l t lt t r r lt ' lt 0nt lt t l'

ll l;':1lt;i'i,''mliii,{i"',';;,
,,rrtrrl rrtor.l i trl otl o tl t,ttstt;lt 'itp, , r i, pr , , r lr r i, ' it r i[ ir t l r lr , lr r r l vizt lt r lt r t lot t t ' it t
njj*iHiilifiiii,l
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lr ' r I r , r . , r lt r r t ( r 't , , r ,
l l ;l tl nrttl l ' l o i ttl i rti ol l t' t,.l l i rollr r i't r 'i t t t : t i ( , it r lt t t $( 'r ll) l: r( l( ' l\ r l) llll ( ! lI ' l) r ( xx'$( 'h
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pl | r,i c | l i ,,nrftttl rrl t,l r,kr rl rr| r r t r Lr t I t rt ili, , t r it t t lt vlzt llll l\ lr r i lt t lt ll, lll] r '! 'li! lll0l( r
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. u r 1 / , , rl ) ; rt . 1 t l ( , ? i t l \ t | ': r , rI r l r r I r r I i I i i ( i Ir . r Ir 'l l r ,Ir 'Io l i Ir 1 ( 'r l r r l ) \'i zl l :r l .
|l rlr. I | | | | r .r.Ir|i||.| trlr. IIIr t r r I r , |r . I r , I oI o; r lir , r , . ltt , n t t
/ ii| |o ( , l1 r l t , t r l r l r r I r r r l r r l ( . r , r 'r . l r n r l r r( i r t
L ' zrrrrrrlc lcrrrlro r':rlr.) ( f ig. il) . llr l,rlrlr r r l t r r li e i o ;l l i l r '.
t r l i i r ( ( r r l t t t ;ti l tttr , ttl r l r r r l tl ( '-
o.'i. lrr l , r l r i r t l r . : r tIr r .ItIr ttr r l l t IttIttttr r ti t1 .
I r | ) | r I r | | | | | i I r'r.: r ,,r 'r r ttr yl i cr r l i zr i ti i " r l r 'l i 'r 'l ,ttl tti vi zr t:r '1 .
I r \ r l o . r 'n l t lr r sl tttl r , tl t stl l i 'r 'i tt( l 'i t'r 'r 'r 'IIl ItIl i " t'tl tl 'l tl t' i r r r l i t:l r ( i i r l l
l r ' l o 1 x r l q l r r l i r ,.
'l i , , l ', ,,,
r : l l r r l c z i r r r r i l l l ttl r l r r g l tti l ttl l tl r ', ( i l l l ( i l l f i l l i l tl r 'l ttl l l l i ttr tl l i tl t\ r '$ l ( ! l l l l
I r r , , i 'r l r r . l r r i l l r i l . i ii r 'r tti tt'l cti l l i r ', t':ttc ttttt'o ti tttt sl r tt'zttl ttl 'i tl l l l l l :l t l i l ti 'r l
j l 'i tr
l | ', | " , . r r l | r . r z o r r f r l c ( .i ttr p vi ztr r l tl r r ci tc .i tl tttl 1 Ittttr 'Ir '|o I tIr 'l i r l l l i ,',
ii , 1,,,rli r . . , l i t t t l r ';tc i ttl tr .;1 r t t c I i t I i rt t I t t I r 'r 'l l i r ':tl ( ' I ' r'I t r ; t rI ri t , l 1 l '1 ( 1 ,r r i i r r l tl r '
I t r l l r r l l o \ '1 , l l l( ;!) ; \\/r r l sl r 1 i l l o l l , l l Xi l l ) .
l l | | I | | | r rj r l I r | )| i i I r t'sl r ' l ttt't'r 'r l l tl i i i tt ttttttl l ttttsl l tttl tl r ' l ttttti :tl ttr ttt:t
'
l , 't ', , t\\rrlrlr r , r l lo 1 1 , l l ) ( i l l )
I r l 'r ' z r 'r 1 r I {' Ir ( |ItI|I) tIIIIi ( l r ' ,,i l l l l 1 ( 'l l ti c r i zttl l l l j ttl ti l l tl cl l tIi i "' tl t'ttttttttl
1 r , l r r r r ( r c l r z t r r l i i i tt tr i tttItttti Io I t t t t t tt t t t i I t tt ' ' ' ( l 'l l 'tr r l l t ;i l l ttl kr u , l l ) l j ';
i r , , t , l l t , t , r '. t t l , 1 l ) ), t'l r r r r r ,o tr si i r i tt tr Ittti i Io ItII 1 i 'tttttttctt: l 'l r l ttttt'tl ttl r l l l tsi l
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 .
r l . r , r , ; , r i , z r r r l r r J ro l tl r vttl tti si ttttti i l ttt r l o ttti o l ti l i 'l r '- l t'sl l tt tl i sl i r ttl l i r ,g l r l l r
l , ! l r , l ' I 'u h ( 'l u l r l r . Ii r l r ( i r r i tt i ttttl l t'l t' .j r l r r r i l i ( i l tl t' t'i Itt1 ttt|i Io | t i zttr tl t' r tL '
t , ', r r r r r , 'r 't r i , l r r r l t r r,r 'r r l vl r l x'r ( '( 'l ) ( 'tl tl tt o l l i t'r r l ttl - 1 r 'sl i tl .i t t t t tl 't 1i t I t II t ttr r tttt:tl ,r
iit. J t . I I cm jr | o p sie h o m o o illr i ]a tcr a li
r , , r , r ; , r r l r r r r i z r r r r l 1 i r r r r I yi r Jx,tccl xr i tt .j ttttti l l tl t'r t' t r tI ti I I rI I I ( r' t I t I i i Il r {r 'i r l c
i l congruentd,
lr rrr., \ r 'r '1 r l r i r r p i o ttt r ,s1 c cl tu r r ,l t'l i s1 i ( ' l ) ( 'l l l l l l l czi tttl i L ' r 'r r tl i r r :tL ' o i 'l 't
:.',:!:l ll) (!rcdt antanopsiile h.ontan.i.lt.te
(de.Jet:te 11,,1, r r r o l c i l r i l o ltr r l i l l ,l tL '.
,
ttttrttt tle cimp r)izual in am tl l tl i zcr tzi i t'l 'l t' Ittl ti r l tti l tl r ' l i l tttti r l r
) t:irt t)r'o(lusodc lezi,ni ter.irp'rale, *i'""it1tit,r., care in1{,
. l r l a z r r r r r i l r ' lo l r ttl u i l l tttl to l r l
t,' u ;rz;r rrrlitr.1iihoplice. I;;iii;i; lr, r . r r r r r r l r r i r I | { )| | rr | | r i I I t ' : r 'tt tl l i i 'r '1 r ' st'r r l r l t i l tL ' (' (}I I t I i | |i I.t (' I I l I (' Ito tt to It i tr tr
(
1 1 , r r r ; , r r r r l r . r r r l r r 'r'i o i tr t,, tl 0 l i 't'l c r l r ' t'i r ttp r i zr ti tl I t ( I | | t ( )I I i I I t (' 1 l l I1 \':ItII:ItII

, ,,;,;:;;,,'i;,t':ll ('gr,',rr(,nic.snrc .d; i.1a;,ri t entp nTuIr. ne orienteazi, prirr 1 , , r " r r 'r l ) i r r l r o r r r o r r i l n r ,co l l g l l r ( 'l l 1 r , ( t'tr sr ttt Ii ti ' t't'tt( i tr t'l t zttl tt'i tttl tr ,ttl l ttt') .
sl ttt i ttttr tl ti i tt scci r r tttr ', i l s( ) l l i l l ( 'l l l l r \r r
,'i,,,,;i."j plir lczii;i;;rri];,.
,,,i,,,rt.i"i,1.{i-iiffiir[i1]fiJJii,ti':iii:Xll,'i.*,,.?:li.
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r . I r . r r r1 r o t'ItIr rt( ,1 ,( 'l i l l o l tl ( '.
; t o r ' :rlr' ' ' ),
"1,:,;,t,',",::',:,,:!:,-"::."'!:i:i")."i,!..,::i::,s.ety,11!unn" ti zr tr r l r l r
l r t l , r 'z r t r t r i l r . L r l tttl tti l r t.ti cl l tl to r tl i zr r a zi i tl t'l i 'r 'l c tl r r |i tttI
',,, ttotLd
pusibititd'li . 1 , r , , r r r r t rr r I t l r r r I r ' I rr i l tl i 'ti tti r ttr co r r IIItIi Ii t'tItIt', l tsr tt'i l t1 t' fi tr tt l tl l t' r l j r r r
,1',,1J:,i'11,1;1'jlj11"i'j:,'13f...:',.s^",1::i
) lrr rri r cl r.hiasnatic ; b) Ieziuni ealcai.inc- rezkt l r l , , r r r r . | | t i ( , r l i \ r . : r r sl I 'o q r r o zi r ," si tttl t0 ttt ( l i 'l sl ttti tl ttt, l l tto zr tg tl ttz i l t r l t'l i 't
', 'I'r':rrrrrrrr,ir
rI irrsnostir:ii,
riifelr:ir1,ialii
de seOiitesil realizath pr.ir.ireac{;ia, I '1 , , ,
'l (
i r r u p r i z rl r l f.l r . ( \\'r r u i tr g i o tt, 1 l Xi ) J) ,
r.rtrr.r.lrr llllcrrl lolontotor hcmiiuopsic l , t l , r 'z r t t t r i l r . rtt kr l tttl r t<'ci l ti l l tl si i tt tr o tl t:r tl l \ i ztl tl l ( 'o l l l i 'l ':'i l l l tl l l i l r ') l
al ful Wim;cke-(vczr antenor).
trll,,r ; r : r I o I r r 1 1 i l l l i ztr tl l 'o st'ti r , tl t, t'ttl l tt'1 r 't i sl i t'i : r t) Il r l ' n i :tI'r r r .r l ti zr
l,u,ttnninte ,.ot,strt:area. , r r r . r l , . r 'l l r r r r r l l r r r r ( l l i i l l - r r i , l r r ttti tti l , i tr t'o ttl ta sl t'tt cti zt'|r ^ r i zttl tl t'tr o l tl l r l l r r '
.dultle, nt Disiynii
'.... .,',,.,.,: !t ,.,!turin,noyts,i.ile
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tr,tr.r.,rpir.i..
,". ,tnp t t , t ,;.o" , u n ro ri(t o (. o a rl l , | | r ''r . r | | | | i r \ , r l i t r l r ,zi r r tr i L 'l o l tttl tti l l tttl xr t'l tl ; l r ) l ) r 'l i 't'l cL ' tl l
( 1 \l {l l l l l l I sl l l
il:?'#JJfJi;rii?#?il
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,, rr rLr.rr l l z i r r r r i l l o l ci l r i i l tk,, i r u ci ttr l r tl l r t', l i ttl ttl :ti l l l t's i tt r r t'l tr l l l tttl l l r
r r 1 l ,r r r : r r . ( '| 't r r r 1 t t :r i t. l l l l {) , r 'i l r { r l r ' \\'r r l sl r i i l l r ) ) 1 , l 1 ) {;1 ) ) I <') ( 'i tr tl l l zi tttti l ,
l;ll'1,;,:j,'/;l',ll;:lll:l:lilp::..:l:.'.11:'^,.!t
rl' !1;
tr.zirrrri'.'ilrr,t.r,rlinasiv,, "';;i;;;;ilffiilft,\'Jil
nt" s"irriii'cat'c*a,"i.'r;-i;;';;;iei''d_fiU;iii: 1 r r t ! r | i , ] r z l r l r r r r ( i r rtr i k, ;i o sl r 't'i r r r ttt' l r l l . tItr |i It{i i Ir I o l tl i t't', st' I|l tl i z|l tzl i tt
. 1 , , , r , l r l r . l i 'r 'l r , t l r , r ,i tttp vi zu l tl t'r i ttg l ttt'ttl t', i l tt ci tl tl p ttr t't'st'l tr l l i l l o l o g i r '

,!,ll;:;',iii;,?,i|!;,i,ljltiixr?,t
,,,,,,,:';',,:,,,",,',,!, ,l"flT,X"T"J.lili*?"li;#f,,j,li irt,r, (rzrr lrrtltrtrl t,i ztr tl ;i l ,( 'r l i l ttr i l ( ' l tt;tt'ti r tl tl t' l r l t' tr u l i r t{i i l o t o l r l i r 'r
, l r , r l t l r r l t z r r l t t l l st'r t tl r 'l i 't l t' : t I I i I t t t I i I t It It ' , t'tl l tl l t't l t tt'l t ci tl t;ttr t'i l ttt' t i zt tl t I
r r l , r r 'i r r r ' ( \ \ ': r l r , l r si l to l l , l t|l i l l ) ; r l ) i {'o l o r ttttl l t' Iti l i tIt't;tL ' I't'ttl t:tl t

:,:;;i:"'t:i;i; ffi,J.xil(11
i;",?,:iii);
il;,l,ii,:*:|l;li[:r"i:?:lri':,?:iliillf,
, ', , , r r r r l r r r l r i i p r r tr <'l r 'l c r l r . l i r r r ( i t', si ttl Ir t'tr tl ttl c i tr r l i sl tttr ,{i i l c l r 'l c tr r r
, l r . t r r r ' : r l r ' p o l i l r r r r tcci ;ti l r tl i ( l k'r r r l r r r ' q i l "tl l l {r \Y, l l ,'l .r t; \Vl r l i r l r ;i l l o r I
l r " l l , r , ) ( 'r 't t ( r t r \ : l tr Itr 'ttl t'i t'r l tr 0 i ttr l i tr i t{i tr tl tr o l l sl tttt'ti r r v:tst ttl l tl i i ,tr ttl l t
t,,1t,,4.t.trlr
1i d.i,tr tir 'tiuqn')ett'
.irt,t,,,,,,',t,i,l,t;',)"):,,1,i!',,::,,;i,7'il,1.:;i:'r:#c
ll.e , 'r l L r ( ' I ' r ; I rI t I i | | t , l 1l ,l l f, ( 'i l !r l , r l r r Wl l sl t fi I l o Yl , l l l ( i !) ) .
;;l;':'ll;fl;i,,li];l:,lriril;lirijlnlliti,
;l:i:liifir'll:11'.::ij;;1,: ]\l ) ( \ : r 'i l : t l r l t t,o t l i t'r tl i i t'ttl t' r r 'l ti vl tl t'tl l l 'i t'tt l tt'ttti l ttttt|si l t l to tttr ttti l tt
l , r l . r l ', t , r l l r q i 0 r l r . r ,l tr tr ,r 'l cti sl i |i i l t'zi ttl r i l o t l r i l Il r .tl t|r ' l tl I n |i zttti i t'l tl tr l t,ti t
r \ \ 'r l r l r r i l l " \ '1 , l l l ( ;tt) . ( ' rt I rt,r' I t ' I r' I rr l l ci l l i {i i t'o l i i l r t[' ( l l ttt tr t'ttr l tr ttl t'

:lt l
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l:ii;lf:l'll;lill
ll,;ltj,,ili:^,11,'l,l;llli:t1l'ilit,;.1;:l,,lJ;,,lljijlii,,:ii,i,l;:.,:
r"tt'i'rt,r irt'l':rtirr'tttr'tr
l ', \ 'l 'u t t t ) t i l t t r t l t t rtl r ' r yr l r l l r ' Itr r r l st i ttl r xr tti l r l ttt r l l sp tt( i tt ; t i t t ' i r ' | 'I t I r' ,
l '. t r l r r , r r l r r r i o | r 'i l r i l l r L ,: ;l l i r ,l r ttl r ', ttt( ,tti ttg i o r ttttr ', i l l l l l ( ) l i tl l ( 'l i l sl i l l l ( 't\, g t]l l r (
;,i1.:],1,;li,,l '
iii'llll,;;l.,"l,,,ilil:llil':1"';' ^ 'r. e r l l l l i i ' r '. l r r l r r . r r . r r l o l r t rr r ., r ,l r i sl r r Ii D r u r r zi l r u r ', r tl r ccsr , ;.;t.
i,,rr,..',,r,,i
r;,,i;;i,;.,;;;-i;l;.i;,,l"iloi,,ll,il*l;tli',i;,.,;;,;lllil;lli,,,,li"l,];l,JH;lil,1
'tri-
r t l 'r t u r ': : r ' i t t . l l r r ntl o r i i ,.si i ttttttt,t r l r ttl i l r : l t) | ,)t rrrr ' I rt I i I r' I r' , tr l r ,tr i ttg r
rl) irrI.r.i'iIrrI'r,rr,
sr'r'rrri;rrrii n.r'm'ic r"tirei l,l, r r r r l r r r r r I , o c r r r l . I l r Ii i ,r ,l ' l r cu I.r , i tr l i ,c{,i o tr sc ( Itl tcl l 't i l tItr , r 'i to I i r r r ', ti t'l i cl
uil i,,u,l,,,'t",,t.t,r,ruroscopir,
;
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,,:,1:ji,i1,'il,';:,i
1l;;;i,,1;l1i3i"l"rbutii'ri ri, }l r r r l t r l , l , r , l r o r r l r r l r r i S <,l r i ) r l l 'r '; r l ) l ,t( 'sttl n tctti ttl j tr t':ts|ttl :tt si {l l l r l ,) l r .

:Iiril,rr
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:i]..11,,,.,.1',.
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lt) l 't t x t : \ r l t u n r ti .l a ttt : 1 ( ) \{,1 ) i i l $ l tr o zi l f.i t.
I t 'l 'r r r u t t t r r l i s 't t t r '/co cci l r i l i tl c, l r l r , r tu l l 'r tl l tti r i zl tl tl , 1,t rt t t 1t t t t l t I I ' , p l tl i l
r':rurrxlisme,
de-trmori, ao i"toiiiuiii de cnr.. l.l, , 1 , | | r r r r r . o l r i . i : r kr l 0 l r ttl tti l r o tr i r r l ( o r t Ir 'l tr ,ttttsi tl tti ]l o xl t'ti ttl tt'o r l tti tl
,, ,,lil.:l:,
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ane;rfecliuni
(boata"r,lnonoxirl
gazoase'
rui schilder,ecra"m- , i i 1| 111. r .r l l l ,') ,

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hemaloam^e.subdural'', | | l t ttt,ti l o,r' i r.l ( ir r lor iir . r r {iir 'ulr r or r 0xir lt l0r 'it t lr o: r t , ot t or i{lnilI osr j. t t . i.
simptome psit ic" , sie"i-A" l,patie, Iipsd,do
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t)t l )l t' I r' r' rrl uu lc. ' 1r ': r t r t t r lt 1ir u',
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un't 'u1. 0) (' lxr al: r , I ui l?ick, boallr lt t i Alzhoir not )

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li,lii;iii,,l,iil'll'lii1,*ll,i3t'nif vizuarrr
i.l #.#lu;.hls1,l,'J,X;3zosrozra
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isvi"""'i;
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| , r r r.:rpul Irrr,rrlrri so itnlrulro ltt tt.lira,trr:rcii,,ilt sl ltzlt,llitlrilnlli, lt 1x'tioirrl:i
r,,r;r,.r .i r.,r,rLr..
rour,*'ri""'rii""l]*;ri1ui;uffoovicia l rrrrl ' rr rl r' l rrrrp rrrrri l it , 101r , ur li, sc I t r |r t {it t c t t r lt r t t I t I t i, 111'1'11
vizt 11r ; 11'llr t ilr '
r, 'i,,rr.r
t',z
ltlc o'"cipilnlo s :r m dr.scrisun defoci rle cimp vizual l rrllnrul d,e cauzd in..llu.tnotot'it (papilitil), itt tlttt^ r'tlltt't'rt
' :.ll'l, ;,,i i (r't'rix,
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r*q;",1r,?,1*.:,}'i]ilJl"tlg:,j{:1,*lxmn in ltl'ittlt(ttn
| ,l ' | ,| | | Ir| (I| ,ri L)i Is< .tizt r 1ii, ht ct i, t le llt it t t r t '1lt t t ; .
I' i \ r l r.l r(;r rrrrci l ('t t i1r 'i, f ivizlr ir l( ' l( lt llli[ l( ' slur r , r 'it silt t t llt t al( " ( ll) ill' ( ll
;tr,j:illl,11,
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incimpul
supbrior
orept
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rdcons,;enie
,,1r r{rl ' r,prl rl i ' .i i tl rr ollnr r bjliili slt t t t ( lipst r vizr t t ilt r t lt l cit t r vlr slr t lt r t t r ll'
';11'
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,;,il:ii,,T?il*jlllfiT"Tll?,j."" i,eunis. | | rr!rrrl r' , crr l rrr, zr r nt l,r r r li s1: r zo llallilt I e I lor it l', <r r nst ilt t io t i|'t il{11r

,,i.i;1,1;;!;;ii,,lii,,1l,1i'iEilld'1"",fi:illt
,,r Nlljurfl.r,
r,l r , Lr' r(ri rl r,i rl rr xl uz r : i lr ir , pilr t t rnr r : cat t ict . , I t t t ilt llt r t aiot ii, pl'ol) li( f I i lr t r '1r '
Irr"rr, r lr i;rr.rl('trsittrrii in1'Iltcratticrr'. Aouilirtelt rizua,lii, irxttrlrtr sri tlirrtr
i#l;*,1,?ii,?i,?i"r,K?l;
,iit ttlii?, r:illr!i rlc Walsh q-inoyt, iS6-9).--- -'-
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l frf,ff, l l rl rl l l r.rrr.l i i rrr t t lr illr ir , r r r ll iii lr or r lr rt 'r , r t liz: tlt ci . 'lt 'r lll( ': : t ) l\ t lt t t . it t
l frrfrrrl rrrrrr,rtl rrt' (r,rol ir r lt t t iot t lolul) lr ) r , t t t . llulut ir tnt r t lt t r r li: t '\ t nt t hilit t r nul.
f.i l .l . ,l pfr,r.i oInr r linir il $r , lr r r , r , lt t t ': t |ot '1,r , t t I ozi( ir r r {r t lt i'( 'i lir t : i r lt '
l l l rtrr r11r.11111' (' i rrr,
t r' ol r r r r ll t lr r llr : r t |'r r t lr tf lr lr t l|r 'lt oit si. . '\ lr t |r 'i|'t I lt I ot 'r 'r 'lit ,
Iti
in
 , t i t t r(ilr,:r, .,. f.,r.,. . tl r '
lrr.rrr , i , tI I t t I II t , , tI t , I t .t | \ , t l r.| tl , l rl , r,r.r.l ,rrl tri r r r l | r | r l c l r l r 'l r ' 1 r:tI'r Ir r ;'t'r ', t'r i sl |'ttl l t
tl c r 'ttl l ttti 1 t|t|t'1 r ttI|'
r / : rt l ,rtl. . tt(' fr :r1 ,. liitrrl tlr . l rri l l l r r ! ! ', r , i
l; , lt i t 1111, , , . , ,o Lollr . r r r t r r r l ( , t j l n n r ( l i l i , l , r
I I r1 ' I lrt : I lll| r1.t.
ttl l l l r i l j i : 1 \ l tttl tr tl i tr l l ) - I( tl l l l i l r l l l ) i l l
l 'l . r n t t t r t t t r l r r l ti l l l i l
I ' "
r Y t 'l r ) 1 , " tl t l l .g tttttt ttl |l o t 1 "'i i t'tl 'i l "tt'; l r ) .l l r zi {'i l r g l 0 l r l tl ttt
io l ,r, r
"rr lrlllill

t,.;;'1i11,"!"ii' lt
':":'#lilJi'
i:l.iiiliil,fj'iiill$"}"f,-,ff Jiliill;:;"x]1, 1;; ,iir' , 1 1r , l , , , , l l r l r r r r r ' ( l l l l ( r , l , r l l ,"tl l tr s:r r r ttr t, i tr tr ttr 'i l ' l l r '. sttg tr l l l zl i sr 'r l i l tl
; "1 Vrrliabilillir'",1{t:ltl'11111..:.1.t'
, ,,,, rrlrrillrrl'()l(){ir')
r'xo|IItItIti. t'rt
:;l;l;l
rrrr:i',,,lli;iill"i'j:.11r,
r,r.rrr,
r,:r.,,,.rvd':]::il?ly.3.ot"*Jdd-o gi,r,oiiii'u.or"",
r,,,,,*i,, ( i tr r l to tl l tr r l i tr ,r l i l r g tr l r sl i r r r r l Ii sl l tl t'i
I 'r l , r r l l l r t r ( l l l i l l
',, ,rrf..r:.ttri.tiL onrii..
r;{;1.1:;g;if.b"*",i"iji'i#rrl,,,i}::;t,;i'l],li l!l ,r,,1' ,,,"l "i t'l i t' t'- r o l l r r l l tr i l 'i i tt Itttr r '{i r '( l t' |r ) zl l r :l
(rr);; patri gttipedp ero.ftatn;i,ri" I r r , r , , , , . . | \ | | | ( |: I i ( I ; I I I rr r l r i i l ti l i l l l l ( 'l r
ic sis[em:rt.jrl l l r l r ttl tti i tr l r i tl l e ) t t r l l l t <'t ] t'l l ' ( l ( ' (x rl l l l )l t r l r ' i l
'llll:;: ii .or2r.1jo;r1.
out..r-era;"'ii
s..ii'tiiiil
"A1#""riL 5iL,opoui,,r,r t u 1 ', t , ' , ' 1 r , r 'i r r l : r [ l l r l t t t l t
i l i t l r r; r l r{' \Il r ''i t ' t t t t l ""t' si
l .l l t
'i l l |r i r r r r i .l }l 'o \'o {'1 1 1 1 '\
|i l r r ( i r r i l
I lr N(,|liii;i,r
| 1 ,5 0):
(t l ,l,, t|"rrlrrt
r l r ' II|:IIIi l i r i ttt r t|ttl :tt''
] l , , r t , , l l , { i t t r 1Ir rt I I t t I t 1 " l r l t tr r l i l r l l r rxl i ( r l l II(
I t l.'.r,'Jlttl.ni.iproduse pri tt Iezi,r i,,,,, - | | | I I: I I I i II I I I I |
11
i ay6I1o.o"u1o,,". ' '
;, r |,(.ztutl1 itte l t 'r . r l r , l r l l l l l r 'r r "l r ' '
lereti]or orbitari : osteoame, osteogarcoame, ma.lli
r,l r) ,'r,,,
l tl l ttl r tl i r l o l l ttl o : t'II'tttt'ttIt :
,,",,1,,,.t.i
,,;,,1|:tzi,r,1 t ', 1 1 , , , , i , , t t i t l i t u l i tte .i ttl tl tl ttl 'i tzi i l tsttl
,,,,,
i,li n::Lmduisa,ua unuiadin p;";r.ttl;;;;ati (fonr
r,,lr,'ri,,"r,"'"'"",";;il"l,,Y"1'i"'H,fliliiil
:1:."1X,'.i:"li:i;; lt rrrl,,, rlrrlrlll(:r s : r r r ttt'r r ttl l i l l i l i l l l l tl l
t')
t'- r r l l 'l l i l r tti t'i ;
tl t'.1 t'l tsi
I) ,)
ttttc
r l l l l ) l 'l l l ( l ( 'l ( 'r l
i r r ''l r ) l ) l l l l l i
l rr.z iur r i iDt r J or bita re : lttrr, , r l rr LJr ' 1, t , , , , , t i r , , , , ,,,ti '"'i 1 i i t""'t ''l r tl tl t
,ii,rr,r,..,.r,rt.r.lio,,,o",
.:r(,rnr(,.
ale nerYului optic (glioame, lnot
{,'it?,ir.ti^.,,-^ p""li.iioi.-;:'fi.ffi;;il:rl"r1*lTi",xt";lli,
-^-,.^,,1:30ri ; ; r ', . , ' ,l) l:rlrr l r r r l r 'r r l i lr i sr r tt tL tl tr tl sr tl i l i i :t g l ttl ttr l tti o r r ttl i tt'

| , t t t l , t t t r t r l i r r ', t :i tl tl tu 'r tsl i ti o tl ti l r r tr i ;i 1 tIti ttr b i l u t |t'tttti l r

fr""';;;;" "pri.1_"in,ii,i"""oiiioiuo.,I",,r
,
ili,;.,lj;l:11,'.'"i,lll..,ill::1,""^lll{,i
l,.l;r.rrr;111., t t rr 1, , , , , , , , , r, t t t t t r i , , t , , , 1 t , ,,1 sttl l tt ( l tttt'l l 'i stl t sl tl l l i si tr l i ( ''l l ( r l i ( l ( ) ( 1 i l \'( 'l
r',,i,-i:r'r(.ti.'staze),
rrrr){ lli l:ourn,"vin. i;;g,"'ii,i."if1i,r'ilt'Hii#j'rJi;ll
1;urotiL,rofiri";;l;1 ;;; ihtfingh,,,,, llt r,| ,
Ii t' tt l tl ttt'zr 'i l l tl t
p"oces"
io"ito'iitorii
i,;li']l)ii,]lll;'i'.i,*j,iJffi:"?Hff;jiilr"groa'n"' [cet,,ti l t I t t t t"t',r ',t,t,t,t l t t t r t t i ! i I i i !i t u l u l tttl tti tn 'ttl ttl
r l ..
r l r '' r l |r tzi
{'r 'r l l i r l i l r l 'tr " r ''
f ,f, , i ', - t ', , . l i i ' r ttr l l ' t' r 't tr r U l r 'l r tr r l ' ' l)l
ale ochillui : d.iversctumori, facomatoze,glaucom, ;ttr, "'
,,,,,1i*1,,1,,1'ri,,r,i llilr , il' l rl
txl r l l 'l i 4 tl r tt:,- l ) ( tl i tti tt sl Ir r ) l r l c
I I l ': t t u t l t 't t 't r I r' l l rt I t t t ' ' I t t11i '

jilirtr,iy?:1g!f-t$d*e{;"#^{#:#y:!;:*{i
;,l,lii
.rurr. l r,onl ::ttr#"i:i,l
o-orbitare, mctistize,sarcoame.
.1,, t' rttt lrlltlt
t, rr.,,,
l t l 1 r I I ' r r :i ;r l l r r t,
I II , | | I . I : I | | .: | : l r 'r r l l l l r 0 r 'l l l l tl .
'l l ttr l tt'* i s,
r 'l i 'tti
I |: I I I ' ' l l : I I I I I .
ttl
i i
r l :r
tl
r
r
'l l ctl tl i i i i '
'tr r r 'l r ti
t":i t'r ti '
:r
ttct tttzl l
- l 'r l tttl ttt
' t"r t''
trrrr:,)r'r(r(dr.rlo(xic etc.); ny li"ffii""i.#irql, ; ' , '; i , '; ; , i 't , 'r r rtr r ( l i i r sr '|r ''r tr '"tt I't'r tt"tttt
; c) I,eziuni'i"til,m"i"G paraorhi
;;];'
lrouto-orbitare 'i i i r t l . 'l\r r t u l u i r l t l tl o tcscl t'( 1 r r 1 1 r
rrrlt lr'
, 1( . I r . , I I I | .I i t .| . . o.tr.ii r,. I lrc es o) . ' ri trtl;i ''l h i l ttt'r .i za ttzi i ( 'r '( 'r r l r l r tl r l tl ) i s
' ' ' ;;,. , '',
', , ,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 ''
II,l t);ntl.trntii prin, r r sl l tzi i l r l l l t) l l l l i r Il ( '
...,., ., -pt.otluse' factori a1 cranio-e.mefalici: ir,,.' '" r t r l t , r t r r l i 'l c t l i |'r r tr r 'r l r .
:,l,r.rnl roflebitc ate-sinu,s\rlui r r l cr xr r r t i tt:ti n r l t'tttn u l
:l]';l ::]:,',,lr)
:rrrrli.r'; i.i] tioti \.itsc.l'ro , '"iloii;;;r;;fi;;S.,'""Yi;,filli
"""""oor,-r"r1fr
liOit", ' 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?):
ti),rurrrori .tist"iui" a"i"lllixT#Il"i"rrit"i r r o l l r l r '
i',r.,,l*,, intro""n"i"nl, 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
::.',:.il,l:ll::l i
t,rrrrr.r,i
tlc ariri, clesfenoial, , t,,,, I 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 i l l l l 'tl o r '
tumori-_;il;fTril;i"ii;i;;ilii l r r l tr!
'r,.,..'tir*., grionme,siil".,i,tsi;";;;"."-kiJiit. 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
::l',;11:l;1.,1:,1:!:1,:,'1.:1l_qit,i:
r'1 \r rlr,,r'rrr:rlii
,.r..r'ioce'cbrale: ro""ri,n,,i '
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 ,r l l : r l t t t i c i , p t'r 'tl ti l i tr tl l l l l ( \ r l i t]
iii'sto"gu_w"r r,1r'.
Ir.:rt: trrr ti,',,titirt.Lirusen:ir Trr"il"i;;i;;;;;^i;Jrl
urnaiis'nr,.-.,;l,i;;;"#"'lo, hcm:rl.,l 1,, 1r, , i, .1 rlr.o|iuirr| or.liilrrljirl. r,r.rrr.rrrl.orrflrrrirrrri
;iit, ";,, ,, ., ; ,, , , 11
iIlrJ||r:t1,,sr r.rl ntduralt. .,t lt,l,t,,t.irilr rtrt|,i,,|,,r1itr,. rk, lirlrlottlclirrir i,i oIlltlrtrrrlogir',
irr Irrrrrr(ic 'l ttt
l\ t l ,).' , lt r r t t nii pt , r t 6 p D r,i tt 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
J a rl o ri ,i s tc mi c i ; a) A fecgi uni r:rrl , Ftr' 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'
,1",';;i1,,,,,:l,l:: ,,1*tisrir;"r,f 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 ) '
sr ' l ttr tt
i l,j,,ij;:i".) Iroli,s,r,.EJuine
;:rt.riatr .u-.liiiii"iocrinr. 1tril
1r.u".-iiit"rii#);'il';#;!ii"l;,.\l'l{ilil
iif r r " r 'r r p ,
],,':ll:1j1.]:
, r L'r|,r11rirrII{,
y(,s.clall\-o
r.egc[al,ivosltn)a1ice
sillrlalice f) Boii conEenitale (e\oftdlmia, |r,rrl'r
t'
, 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 r l l r r ti l r i l o l
LL,I|'',.,',',I':'l:
rIrri rt,i) .,i ; f)Bol) o,,ir :r l l n l tt
; ) | )isyri,zia,Iiilu,ri',sii,, lui riichte;;re;iitii^'f
"noE"oit^l"'{oJfta,lmir,
i.s,c"rri"iicotat,.,r rrl rlr 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 '' Ii |''r '
.r 't'Ir i IIL ti '
' :|"tt l r 'l 'l r ' 'l Il ,:
x". c:to.f,luluzti : |"r |' l , l ) : r : / , r , 'l : 'l l l . t ll r .:r l r ''l tl l 'l i l i l ''r
ful
,,,",,) 1..,,,,",i:.f:..:t a) Co-nstitufionale ; b) Sindrorrrrrtrrr "":|"il r .l i i o tl r i l r tr " Ii "'iIIIIi
"l l l '' | ||||
li,"r'rrir'rl
It,r'rrrr'r,rr
.rof1r:t'nio
t".,r,i , , , , 1 , , , , t r , r 'i r t r i r 'l l ( i t r r li ttttr l r ' i tr l |i r Ir 'r r !r '' l o ttto tl t
I r | , ; rl ) \l )l lz ii "*i-; porr,r.u,,,,i ! 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
llr , l) { , lr ) tj l o r o r.b i i ,i rri . "iliiJiiitli.,tin" 1,,,, r r l t : r r i i r ',
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'
i.ll.il. I,irrrrrrclrrl conrplex al llnoi t t t rro t.t t I r' 1: l l ' r
crioflalinii solicilir: , 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 '
t,r r,, i . t r I r i ( I | | | 'l l I i I l l r '.
" .il. ii. l. l,l.rtt tn t tt rtI t,linh:
I I ) l t t l r t , r t t l , t l r t l t t rI t r r'
' : . , : i.,' i. 1./. .l nltttttr:tr n t int t liot r : t ii, t iolir r r lt r . s o 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
. r r r or I I r I i I I r I i | r , r [ i . t||s I.i rl rl 't I I l t l t 't t t t t ': l t r r i , r l r :
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 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
'| l
"ll ; :i i !
 ,",,,,111
,iij.i,:jl'i;l{l;ll;l',ll:l,lll;; 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
Iilj;,,)ll?:iliiiiii,X,t,,1ll:il;llll,,,,l;l;,,il,,,li.Jl
trl i r' ,l rt{i l tr fi :rzrrIi l o rl c
1 lt f cllilol.

"""'li''il,l,1;,;l;;,,:,'',:r;i,),';,,:),,,,,,,":;,:,i;f1i;;-.,!\-df;llll'":i 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'
l rr:ttr.l a l i nri i r. ti i ne[ fi z iolr gi|r , : : r ) , {r r l, ( . r . ior
rrltr i irri l,.iilst,r,r',
_ 45. ; [ r r t ( . t
r'rr,rrrii
I , r , r . r l I.i :
, 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,
r.4. pfioBLEME
Dti DIAGNostrrc
INRPATOLOGIA rrri;cirilor in maniera indicatd, mai sus. |n cazr in care ot,liul lxrllrrv
SISTEMHL0R cnI'c_fixator, o-chiul sind,tos ya prezenta o extind.ere a cimpulrri rlrr Iixrr(,io
iu,.tlircclia ,,liperacliunii', miqchiului sinergiccontrllaicrl) ,clrri lirr-
I i \l (Lal ,
Cl T.imitareacfmpului rL. motilitqte oculard,coniuaatr;.11,,1 ilillir'll
pxpjoreazl prin in.pccla.rea-ex"curslilor

;,r"*.rm,m
volun €rd sc gl,biLr|

:ififf*liflri,ilffi
i;$tiFrl fu",x[
"'rrjuga.ld
or, t3rl t0.col]l€Itzllede 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,

**l,-;'pg,f i';ffi
rlivct,sedireclii: orizontal, vertical, oblic qi in plan medio-sagitlal

f
(corrvrrr.

*l*fftl',i"lffi ;3Hl*T.1
jiril"lr',',","ff j$ti:p1r,ir"*:r
r('nt{ ).

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

,riri;r ilft{i,:}}}"{*;1$
rlr'tli procedee: a) Deplcsareain cimpril vizual a unui obihct-1cst lumino*,
,)l'servindu-se ulmdxirea acestuia prin miqcirile globilor oculari (,,tloll's

jiilililtf
ri t:flr.rriffi'ft;ffi
ld'*f T-pfroq:*ffi
jiri'i,r1ir,J'llidnilltl[lFt*l::r;i"ilr3rp;;1:;i*:""*r::
''\,'..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,,
, trvilie, fali
.de
lui

ori a,ll,o
nou_a.poziliea capului, .ror privi s'prcstinga. l_i rotirr.rr.
,'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,
,,,,,'"iljli:ilil,iIii;,n:Ttj"i,{'fiii1"fii.
T\;:ii,,ilx."lljy,,
;l ilil:lixl
r:rr'l[r flexiulea .apului, aceslia ror lua pozilia rcjrtiv' srrlcr ionri. Ll| llr(li

iiiljinrl:ii;rril{}1l*#il}:ryfffi$il,r1if#*#r,lxrY
t[trea capului pe un um5,r sau pe celdJali, sc vor produce^miqc?ilitonjugfl,t,0
tr'llr'-tccu ca^ra_clcr ghaior, in sins orar cind calui csm aplccll spo rtir.i1l.rr.
rl,rituterior.cind eapul aplecat spre stinga.^Seva ruriri,ri qi cirmxrrr,ll,ir1,
rl|llrre Iimrtalea ml$crr -este
or cojrjngxlo r.olullarc 5i rr.fle:r.cu rri.t:rgllrrrst
;,r',rvocai prin cscitarer labfujtriiciprix teslcl,.clnsicc(rolltor.ii,lc|rrricc).

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

r'
i
iii:ii:
;i *flt+ury$ffi*ffiffi
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.

,iiiiit-i|'i,::,*i#iilii$#*:#11lt
i,ukrm lnlilli
trltrLitoar€Ie-tiprr-ri de strabism a) donr:ergmt,prin rnrr6chilor
llaralizil

,,v:"
*;,; ,,i,,:
' 'i:',ii;lilr'u*l,,i
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
;

ll;iil;ill'lx;''
-iii ,ll1#i:i''',1fl'
d1?"iih:,,,"',,,,,'
}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.
, . :;..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

,.ltittl pu,rolizol;tt,ln lncolctttr,a,

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
ta rl. it t,.,nJ,(,ltHlt, Itttrrr{rilt
lrtt4rlrirrltt
l0
4t
 I
tl i r t l l t l , \ 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 -
li i l r, 1 1 1
1111, 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 .
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
, 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
rrslrr.r,l,rrl clirLirr rj.e
lrl) stnului sau
N lil
r lrrIlrrr,{ici utrrlrlrirrlrris1cll,r t.leirlo-mestoi{lian)lRiior, iOlZ ; Aneni

IN IN
!
1i lo lrrh., 11)67
). s
1.1.1.5. lltumenul d,iplop,iei. Diplopia (perceplia a clouL imagini alo
I
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 n€15, imobiii,
Si
rrir.:r.nr.rrrfi pozitia calului, fa!5 de ,,imaginea falsd,t', care este mai puliri
I IN I N
N
llrilrrcii,oarc,mai pulin neti, d.ar mai ales mobiH in raport cu deplasXiile
+a
-01@,,
rl iv irii (Iiisur. 1952).
ln diagnosticul $i tn interf)retarea d,iplopiei,trebuie si se tin?l seama
lrr rrlrrrii,l,oart>loprdncipii. (Riser, 1952 I Sachsenweger, 1966, 1969) :
*a)l Moo
r) Irrirginol care trpar{ine ochiului afectat (imaginea ,,fals5tt) estetotdea;una v l .q K
fullirrcrrlrii il dieclia_ de acliune a mlgchiului paraliza.t,, de piltl5, sprg o b
lrrr:r,1rl,rr,
strbiectului, dacd abd.uctorul drept este in cauzi, I b) Oaracteiul Fi?. 7. lnvestigalia unei diplopii priD paraliziea nelvului aotor ocular (xlfr|l (lr('l)l'
[r rrrobilitlto estc deosebit de important, in sensrt cd, ,,indepd,rta,r'ea" ochilLl sting fiind normal:
pc'e relr'znkli
r,|,rl rkrrrii,Lna,gini este mai mare Ia dirijarea privirii in direcfia de acliuno .- StiLla r6ie s-! Dllsl in fdta o.hi. ui Prrc ?d lnagnra @lorait F tufL i' llnii 'ln
c onti nr ,o.Se i .r s " r v a'c a eLo a " o d i i ' l P n h o mo ri n l mJ 8 i ' e a ro ' i e s " d P p l r. e ? e rr a l l r'', n l D u l r' s
rrrrrrichiuhriparalizat; c) Oinat privirea este astfel diriiati, incit.cele 'oi u
Li r bol nav Ll D r i v es l es D r e D ar t.a s a d Fa p i r, . d i c d d F P J r' 1 e d ! (h i ! h l t " n l i ' a l O P a € l i t i e d d Fl rr! i h t l ' r'
orrl irrrir,rrirri$int indepf,rtate la maximum, imaginea cea mai perifericd) .tr r gar a" o i i ptopi e or i ani al A j ,n" i sre , . u 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
lEvrJ' spre pLn€ drPrfr3:
lrrrltitrc ochiului afectat. ,- 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
d FP l " /
rn l -l r. i h ' L r! :
l I t r Fi s P r' o 5 2 l
$ f i r i . . n F a f rs rt d r" .
" , . rri ' n i -l rI
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$il,ll.c(tlir,crirl uloi luminflri) rDezatd ]a o distante de 4 m. Do
rlilr, i r lr.( r ,rr,hirrlrridrept de ptascrzi o sticld rosie,prin carc Sursa
rrrrirrorrsii, rrltlrc coloratri.Apoi sursa luminoasS,va fi aleplasati,in directie
lizorrl,rr,ll,v(x1,i(n1,1,
t aa t
;i oblici. Bolnavul va relata pozilia qi direclia depia-
irii irrrrr,ginilrr.,
rrr r,rrsir.,
prcc[m qi distanla dintre ele. Una dintr.e imagini (fib6
r'r,s|i'ctiy cca,falsf,) se indepi,rteazi de cea rea15,mai mult sau
rrri pr(,irr, in l:urr(rtiede direcfia privirii. Astfel, rlistalta rtintre imagini
, rrrirrrrql,rr 1xrrnrisurri ce bohavul pli'veqte in ctireclia cle acliuno a mu$-
n$ UH
u8
H
n
tirrltti lt,lirci
rtt.
l)i1rlo1rir, po:.,t,(',li (produsdde afeetareamuschilor ztbductori
ot'irontdl.d
rrrIrIrrrrIoli),rertica,Id,(prorlus[ rle a,fectareamuqchilor rialic[tori sau
rl,rr|il,rrIi) ,".ioblicii (ft!1. i,8,9).
u w H
t{ I
l)rlir inrir,gilloit{alsri i.lparede aceeaqiparte cn ochiul afectat vorbirn ;, eita,J
':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-
ttt rr r l i t ' r rlgott l.
"el r,-" I tf,Vt,,
o s( ) l V//tL l n t,
\_.// \.4,'/
|

|tg.8. Diplopie priD p:uRlizir nrutchiultri Iri 0. ,. 1)i pl 0l )i c geuc tal i r tl c l l l |nrl l z Ir IIrt
l)( liltlii,: I)i,plo7ti,(,
o|izont.aldh,unzon.i,mii poato fi prodllsi, do luloz:r,
d]'ept intern, carc se :lIL'i llllr-ulr u$or slri' dri l l ui drol )t i rrh' r' i or d0 l )l ttl rr rl f,.i r!trt.
rrlrlrirrltrirllrpl, r,siorrrtltr l:r 0,IJ., ilc la, 0.S. s:lu do Ia,a,lnbiiochi. l)rurjl, lrisnr divergent (sprc drcnpta). Stlcln fo$i( 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
lt,girrrlrsc rlo;li,r'lcuzrlir rLrlrIlts:lltl,srrrsci)utrrinolse slrtr (1t{.il,l)trit,
(,sjn s{ rlld plasattr 1lr fnfa oohiului palrllril 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
rlllpltrl rrr l'rr rlrrilr,()..1).lrr sitrrattill
rrrl,rrl, rrol(,rario,tst,cnfocl;;l{r
tlrr,lrfittl 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' l i ni i ) s ,. i |, I)|r|,I,:|2n\l )tf l " i ' f. I r l l l l l IIl ||
r1,lr)mlI iri roflt (tnrr(r1,fi {lLr lilrii ol)ll(f) rl rrl l ( r (1l t)ri \i |rr :rr i l l rl l ri rl n i [,,r\
IrrrrrrL, I:r (),iJ. Nli,r'irrlr([iitll,r(,(,irlirrllc irnrr.girri
lrr lnrlttrlrrxoir;rrli rlrr nr. {ll)llrs(:rrzilslr(j !ttltlIrt, oltlntl rlllrl l),,1_ rl rr' , rl r, rrl rl r ((l rrl rr ,l i t$rrl , l l l l :r).
tl

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 (
r l, ljl rl l l l r'
;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 (.rl r||r Iri ri rl i i ,
ill l :rl .tl
l )i p l u lt it r t't i.illilti I I t I t ) t) tIit) | ;| . r ,tilc
s$'l
r .{ r illizilliL r l,,
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
l r..rrrrrL,..r rj r,l ){r1.)r
o c l ti . .\sl i r i ,,]l ,,,,, ,,,,,,ui l i l e
d wao dttl I
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
. , l: t * i ,a " .fi a,.,1,i ,,,,i l (, i l i {.ti cl € @ E
lt l rrl, , ('i csl
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 ,
I. r rlr rr'l rriri .r ' 1ir . i ir r lt ' ir r rr (J .r). r,ezul ti i ,ci ,
i i ti a g i -*rlrol"tr_
"
..r'r'l rl.plrrsi.li ruLsci lrrrniLroase-A.1 ,u l c i i .del fi rtoazi N
rr l r ilol rl r,r'1 r liit r t or ni.
1n ambele " i uclirec_tii
a " ' s" ateotarea 5 d d rut
w p e D

,li:"lli:",:';,:#:;'#;:;,,:::!,,t:;,,","_3;',?'"J't,Jj'lil;,"i"
iyJffiil EE w
v
Tru
-l::::iiii.qinH't,iiiilt*,:,*.#ii,:;:,?#;,rl*,ru;11;,1*"*1".ru;; # d I

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

, i"iJ"i'i ir,,_oo*u
t,r;lril:1ilriiiii,ll,$l1x-"#:'oin{ff
,;t*m:"*|i",:,*;lTg"%f.?
m,,
m,, ',o1
"r."

,,,ii,,ii,'i,
lnr rlorri irrrrr,gini,
riiicr
prin inclinz
paralizie
:ll,rliliii;;t:i',ii,Jillll.t""ir.:'*-##
.l"r, u t,rrrr.i.rkfiicicnla^;,,#ilX
;I r
ji,i":;:-..#,J,jljf
t'i". aparli:re mqchildr
;?d;L1'JJJfr#ii:flf #friH
conoriioi,i, ia"-iaca distanta
.rlrr lrr,irr.lintu.taspre in sus, este-vorbacle. p"";rt;;di;;#il;
-o1
Jriq. .17.Diplopie generatd de paralizia
rniEchiului drept superior de Partea dreaptA.
Sti;]a coloraLl s-a plasat ln fata ochiului
Fi g. ,?. D i pl opi c genrrJ Ld d. l ' rr rl j r i l
.
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
rrr,rrr{r,lr,s
sc ilnlunc ileterm,,inarea.
ochiuluipi a mu-;ctttului depl :c eaz e gl obul oc ul ar In af' uJ s i l rr
j" '
c vollrl rlr ochiul drcpt, daci, imagineaiann aJectat.Astfat, paralizai. Imaginea colorate se depiaseazl i rl i l i fnl
snrc in sus, cu atit mai mu1t, cu cit privirea S ti c l a c ol orati (l i ni i obl i c e) s ' i
lrosle)est",ma, jos sau spre ln sus 5i spre dreapLa' inaintea oehinlui PamliTrrt '

,, I --T-----l
sc
f"?:,iff;"|;;H"Jil"f,,",1J"J;'"ffi,,f1
rerpecbi_v
oblicirl
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)'
b, I 1 mare sau dreptul irfe'_
_ rror pp de o prr le (coboriforia.i globnlui
.-r, I n. I 2./r.2. Paralizia nervului oeulomotor eomun
* oc.ular) Mu dreptul superiorsi-oblicr
] lq I p:.
.:....., I | --- .rl1'!, qo a.l1,ip.Irtc lridicitori/. Asrlel,
orca_drptolrr Existii,,srisesitualii sen'iologice in cadrul paraliziilor perechii I Ill-tt' I
slrlr rtlir'
I ,".... I /_ | verticalflso lccenlrreazi, .'t oarali2iaertrinseed po$iald (inconpleld ) cu alectarea uJrttrll
r!rs. iit".rl hdh la ridicarea sursei luminoase(sau1aritti_ completd' (cu rfr^r'lrrt'r
I lO
carea_ rl,,itir." . o..tili u:.irinsi"i iil p)arat'iziit'ertrinsecd (cu aflctlr'('r' ilr'rrr
capului), ochi l fiinal in adrluctie, iri*""'*t*ilifi" ;'c\ Ttaraliziai rt\rinsecd-
muqchiul afectat esteobticut mic (/2.q.JOjl ridtra rei : d) paralizia totald'(cu printl"l'rr :rlri
""trinsi'cij
;, il;;"ill*ii ;; pilocor'st
llntry dcpistarcapdrtii paralii1,i",oi_ &iGi".i.ii qi, intrinseci); e, r) irt mllort ctt.frr.trr'i
tarmo,ogrjDbtlizcazd" ; ;;;;;;i;ii
si prob& lui Eott- i;;;;"s;;;;;i*iiri" p6tn"nii a "*lei
rrr-a poate fi : wnilateraLd'sau bil'axatatd
rnannqi Bielcho.n-sky : dacf,indepirlarer,
imaginilor se mx,re$teprin inelinareaca- 2.4.2.1. Paralizia tctald' a nenu'lui oculomotoraomtLmilmpliax'
o-.ptond
pului la d.reapta, inseamnd,ci, oblicul glob ocular imobil in dirocliile- ilo a'o{iuno a
/i Ess oo*rrieta ;i un
pic sting este palalizat, ln sittratia in ""f""fr"aie ati, i"i"t", arupi inferior (mi;ci'rile iu jos fi ind tol'ttqi itttt tr-
,/--\ | ./h. i'rr(.rirr"" -".ii*"i
o'( carediplopianu seaccentueazi, in aceastd, ,:ii*]"p"!u't" "Tir";" rnuqcbiului bbuc-mar'')|i drc'prsulx'ri'r
\ | /////An n--
\
\*.. I I V/////t pozilie cleadduoliea ochiului,estrevorba St:rabi.imulttivirsent csbe foarte'evidenb, irr rliplopia cste orizontllfi ;r
Yal i'"i"-ii*i,. ptpita este midriabicl $i ,,fixa", nercacfiolrirnl lr lttmitrii
I de paraliziadreptului superior (fig. l1).
/ 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 Daci, diplopia se accentueazdla cofori_ Ir! flcomodare gi la converAoo!6.
' h llll ,ri l | ri( r)l)ll(:( s lea sursei luminoase (sau la coborirea
obllc inflrlior)
, 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 2.4.2.2. Itaralizirt' parliatrd, a nerawlui ocuLomotot coT'?lzzr, osl'o ltlllll
capului), ochiul fiintl iu arlclucl;re,rnury- 'corirplel,ri. l)iur trcbuio rolinut fllrl'lll cil' tttltttrrrtxt
r r r rzn{l i , lrrl r)r: u l r t rl n o L r i r ' [t l h su s. ,no,iireoventl ,fecit oca
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 ), i,,itriitil ulcc Irtin nl,rlrlitrlincompleL (prr'rlirLll .lir'
lrl th'btrlt
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-. ",,i"ttt,ltr: .,',,,u I'ii Ar:r'sl:r' p:Lrlrlizii prrrIirrlort
r1r lt, I|l l x lI lil nlt r t r ( : l d ( l b o l u l v u l i,i,,..r.i""ii. ii,:'i"-i',,i*ui 1x'.'t 1r:rr:r'lizici'
, l lr ' l I M t i
I l i t I r ' r \ I g n ( d t r t) {
irzil jn lcou,sti,pozifio, a[unci lllul1(jhiul ;;;;;ili,t blli,i,, s,,h t'rtrtil llzitrtrii 'iinoi sing.r. rl'rtrttti, srt'tt $lrb ll),nN
iiii rr ,,*,,i,,ii vrr,r,itbil.rlo nrlr*rr* tl.rr ttrtttr!i rnttll,,t rrllllltl'i lrol'vr)lr'
/ti r' r. , 11)5.t), rrsl,orlr0llt,rrlitrl'rilior,
Irrrrll,lizDli ^f(nJli[,tr)
il,i,',ilii'li','n,, vrrrirllriLl'tl ltit'tozohttHrlll l'lrrll
irr,bl,rrrlitltl iltl'trtrttltt'ttr
'',',,fizol,zr1,
 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 )
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 rr ,,lrlr, r, ,.,,i/ 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 . 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
; rtr rrrlr| trlo r' l:r Jrlr"rl r lr r . r I I t I , r ' I I r I I ||( , .
| 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'
: ' . ! : ' ,:. !'t!,ljltltr 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 , 1t 1t,tt.,ti;:iilc 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 ( '
t lt t t t t l l t I t)t ttl tU )l (,l t)t t ( ) l,lt .
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 ' 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 ( '
( 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( '|'
:'.1.:!..;.1.I'uruli.,:iilc lronculare itint ijelc tn:li lutnet,oil.se,in specia!
imobil lrin 1lalalizia le.rechilor III' lYSi YI), trxttliticitri 1)lrl)iLrl!' (lirilril:i
|rrrr :rl,,,ii',i (.11t.se (lezvolt;i la nir,elul bazei craniului (J,hnsi,ori qi areactir.-i la luminii Si la acomodare), hipo - silit lnestozi(r itr 1r'r'ilo|irtl
l'r',1I .lollriou, l1)6?i liucker, 1966; Riser, 19i2; popriviciu
li l?ascu, oftalmicdui, reflox cornean abolit' dureri in teritoliul llorl'rrltri rtllrtltttic.
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$oioulc, Daei, sint a;fectade$i fibrele simpatice oculal'e, apare o ltiozti ltrritrIIItctrIrrIIi
leziunik: ,,rad,iculare,1
lil accsl,rrivr:l ltaiizcazL r1e cocainii. AceastS, tr,iozil ne indici, respectatea g^rurglionul i t'ilirtr' ;i, r'rr,
:rl,. i.r'i l'lltill(' si irLcualealo muschilol oculomotorj.il schirnb, l.rrlte
.afare, o lr:zjune exttaorbitlri. Dimpotrivii, aplril,ia midrir.zli rr(' rrltrrll^
It ttt,tlt. lrr ',i.t,drr[,lrttttchiului rertos prod'c o ]tt.alizie lotali'i dc pcrtcho
atenti:i rsllpra unei leziuni intr:rorbitarc, ct lldecta}.eafilrt't'loi' rh' Lr tl:rtr
l l l. r u (,\(1{il,1ifri'ibrelol pentru mUsculatura ocularii intrinse0i. care
.Elionul .1iliaf.
..ri. l,r( o olul'ciite protectie specialirin lozirLnileblza.le.ltrin ;i:rptrrl b\ Sintlromul de apen orbitd,l' al lui Jacob ti Eollcl sollmirri ('rr lrrl'('{r-
r':r r.lr. 'r'rirr(lc
rr, rrlli silrrLl,trintr-o pozi!ie arialir ir.r interionrl nervrrhri. doar
dentul, dar, lrin distrugerea soncomitellti, qi a giul'ii opti('t, s(' rtrltrt::;:io
Itrltrtlr ttsittntrr ittltut't antirttd plotlucintl a.fectaroa pfr,(iorrr lt llce\loI[L leziune progresivii, de nerY optic cu cecital,e Trrogl'esiYri r i^rtsolili'r si rlrr
1l r , l ri ,r' liliigilr r , 1! ) 50 ).
chemo$js. Dxoftalmia estc mai lrronunlatl'i, rlecit irt siiltllottrlll llt(\lrtlltrll
'' l.:.'.;;.1.1. I)u.ru.li''"i([rcnrcttlard izolutd, singu,latri a nrrvu]ui o0.rlo- .qi pulsltili, {prin comprimalea $i a Yonelor olliiillnicc).
, ,1,,r' (l,r''r p,rric lii r.r,aliza1,iido procesc nevritice, meningitice (iriclusiv Iractorii etiolol\ici care irebnie dccelati sint :
lrrr,lrlr'), r'rrlr,ori do alie pluceBe bazale (dupii culrr rom r.etlea), ri:r, de - L-actori traumatici: iriterven-iiile chirurgiotle (peJlLllr sirrr;''ili.'
olrrr li, lrlirr \'(rrit)iilit1c1llcestui terv cu ceilalti nervi oculon$tori fii (,n'tlti .de exernplrri ; fractruile (,ralu'cnL' care intercseazli' ii orl)itn: lt:t|Itr|ilrr
rr, r'r r r.ltrrriIrri, sc rt'lllizeazI sindrolrne tt.otLctrhrc r.-\1r.ilrre\"r,it,\in]eale. .aripii mici a ,ifenoidrlui (cu afec{area ini.tialil a lel'fclililr' Ill ;i l\'. rlrlr
l, rr i ,, ' r lt i; r li r lr . r r , r' \ i (.l ttri ,,r.i . ultelior si a tligemennlui - Rollvet' 195?r citat tle Iloger fi ('trlrrl), ll,(il));
tractura crtstei supraorhitare (in aceasiin sittatie, oetit:ltcll lrlrr{,trtl{'ollrul-
:'.1.:!.:j.l.:.'_,\inrlntu,utt tronc:ttlr.r,t r: entraneuoJ)iale d,c It::i.tttti rnullifie m0piegi:l).
, 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,): - Iunrcrile: neoplasmele orbitare i tnclliltgioanlel(' ,'ii uli,r:rrrtllr'
\t ll itrtttrr, oIt rtl..tn eryului optlo: t, Inorile osoasc (osteoamo' rnot:lsl'Nze osoils(r, llllriot'r rrrl
oltk:aiaii- Se ltie ci, trunchiul lerr.rilui oculoritotor. .ostcocla"cte,chistuli osoa.se)t meningoencefllocel ; clistut i tlt't tttrtirtr'; lrr'li
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 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'
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 o-
I l "1, ll, ' ll'. :l. l..t,rt i I,.l' .. s( . r ,\ir li( ,1 ,t ,,:! rl rtt6ptl l i .t l i n
r3inusuhli sfenoidal, tumori hipofiza.re; tumori n:tzol:ll'ilrgi{fl)c, itttlcosr'ltr
n lir n ti,trntttr
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 , €arcinoarne rpki{.xmoide, limfoe.pitelioame, hemangiot^pili:lirrrt'tito St t tt i
r1'.,r'r.r|. ,lri.r'i irr rr.lriliilio sa,uadolesilcnli, (tiickerst:iff, 19{l+), lr, siiliiircti l'asarl si colab., 19i5), Aceste ultirne tumori rlazillc 1i tritzolrrt'ittr.1t('lr,
, , r',.rrrrrrr l, r , r . r jt ' t r llr pot lenliza ilttii si'ndronu,trcleJosi Ttleriyopalnl i n i al I rri lir ht stttt siutlt,,nul.
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 ,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
, 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 ,{nlrilal superior qi a non'ulrri clnalul[i ]ierjgoi(lilr.lr (li,rxct' 1i .olrtlr.,
||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 1969; S ri ni vts lt q. i
colab. , 191ir ) ; ilm or i m {- : t asfillr ir {}( t r t Llr t t t t r , ir li' l) lr 'r 'ir r ! '
il, , l,rt l ',1 . ( 1 r li t , r r t . r r |irtrl ,u . 'ntitlntr sau Df[,siallc l.
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 , - tr-scli,ii l\usclllari: ltner'risn c]; iingiolnxr (ir spi,ciirl crrr.l ttorr'rr');
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 , - , ti oI icc u:.esr caro t idir .
, , 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 - Ll-ip crrt,'tee, cu ale1brtilat'orlfisulii or'bilnlc sttpt't'iurtt"r'.
, { 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 ttJ Sintlrt'tnttL in.fracltnoidian al lai I)rtwl.tl st' tltl'rlrrlotizcrtzit pt itr
.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 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 ,
, '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:. < 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 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 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 '||
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 ra- 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 '.
rli 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 (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,
'
. 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 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 ,
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,, :,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)
ll) t ; l l t. ,,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, lll, lV r r i \ ) , lt r ' I 't r t r l

4t l 4'I
 It, Si.Ml,fomu|Lui .It'hrhn' | tllrli) H(\ ( irr ollr!l ln('pl(!grr,'
t'rttittrlt't'iztrttz'i1',ltl
';;;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 rrta,,rio'rtri t1*.7t1i'nauroytrtlirt
1,1rr,r,rirlri,tr ftrltrrirt l.irt'.''.ii'
rt,rrdloxirr.l)o l'rr,1rl,,
l'rlrrr), lll(il'')
I t) N iurl.nnn.ul,ilo ,nt likx,,iwirr r;i l(t ll1', lll{il.; \V( irrlt
$i llosor' l!)(ill; {lilrlr,lr',1 l"i
'
:tr,r::i,:,1:;t,;,*,ii#x;!i:x*[ffi ffir:;li#j:P"*:Trl;:3:;
t; Bi)mtrom'u'l'
(Lgiiffili se da;torc'Uo
de ar(xutltL
(x)t'l)r.('Hilrrii
rt,Iosl; tloslrl'istkr Ifisclrot'-llriiAgl
,r' t'littttsu,lrti
.crvttlui
'cltltttttttl,,t'
tl..r'i,ltrr
<,ttttttttt
t[. sltitl'itt (rxlrttr
l' tii,;;ll,l; ;t;t*:ll,*lt,ru i" Ff til;,"l;l;fu".,?ftritlts#Hl;{i
^t"'ito"iuriliiifri".\i.ii
,,i'castailivus'lui, ca urttt:iro , proccsclol hrloc,it'lr.
"eiebral,
,,ste
hematorir subdulat q.a.i. Succcsiunea
miozi tranziiorie unilaterali -de -
ittsl'alaro rt' 1ta'l'rtlizit'i
lrritf iazr'i' ;-i
I ;;..;i'ii ']'l1l'|fili*,1:"'n'*" p""uri,ia
perechilor fixd - 'r'in5,toa.rea:
ptozd palpebrali' - in final, paralizie completi I I [-rt'
a perccltii l' 'rrpili'
Fischer:Briigi€ iiolo; a izolat dou5, forms clinic-e: a) lorma aau't'd', itt t"'ttt'
Eoger
,,,r,i,;j,:iill,JllI:i,,gl?j"t: qicorab.,
1e0eqideArseni
qicorab., naralizia ocirloniotorrllui este urtratd, ime4iat de pierderea o111lofliilrfoi i
i,' Surn,nprogresiad,, in care paralizia perechii a [II-l sc.ast.rci:rziitr tttrNI
tr) t|,in.d,rornulanNerior-e,ste identic
ri lrr,r,r{|lrrii,
(cu coafeCtare&qi
cu sindromul de . fisurX orbitard, lreplar cu somnolenli qi apoi cu piertlerea cunostrntol'
nervu]ui opU"l.'^--* ' H1 Bindromul Iotoia-Eunt' Olialm'oplegiadureroasd"(sitrtltrrtn-ttllir-
-a .
tt) N,intlromul med,,iancoafecte?zd, to.,i icuiomotorii 6i primele rloud, tosa-gi*t) reprezintd, entitatea nosologic-5,.incatc se-asociazii o oft;n'ltno-
j,lilil!lT:f;it*.1i{1'jx'H',",r"1,Hffi
J:l:l:l j?rtl#
1r;ll"t*;;":nf,I;i
pf"ei" o ndrratgie brigeminalSde aceeagiparte' Tolos:r (I9j41 a. tk'rctir+
itriimunfeeia, dur-eroasi la ul caz cu le'iunj peria.rteriulc :rlo ritirrrrrlrri
"u
llunt gi colab. (1961) la qaso cazuri cu inflamalii gri ttrlo-
,,,,,,j;l ll;iilj;fif'l atecteazd,:.
toateramurire "r"otioini.-iutlente ale sinusului ealvernos' Smith qi Taxtlal (1966) alr folo$il'

ri:;,r;ni;,**uili::,,J,ffi
#i'"'#m'Fl:,-k*#?#i
"#:mi:

;iil;litil;'li",ll:,T,1#**,ff
-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
r rrrp | 'r.l i l i rr(| ( , r rI iic t ' im are ),
p ;Hr,i"#fd
i'*1116*:f1ti*_T,%trf 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
:ry,,,rr,,r,1,riirrri,li;l,,1if
?*1i"-?H1fl*T*1":i'fli*i"",S1llf
fml*: tle'sindroin Toiosajllunt trebuie folo8it numai la caz*rile la
('!,t{) llll n(!
seadaugr'd pQ'tro' poate stabili cu certitudine etiologia'
l)ariantii,:
,,,,,,,,',t'1,t,,"'i,l,i"'i;'i,"0!,rll.on') sindromut'
gtaratrise- Mai recent, I[unt (19?6) a stabilit urms,toarele criierii pclrl'm tLingttttx
Ir't <ttori tli.ol,ollici : ticul tle sindrom fotosa-nunt : a) Criteriwl, anat'omic: deficitul tttrtttolttgitt
prin leziuni la nivelul sinusului cavernos anterior qi nl fisru,ii
,,,,,,,,1,1,,,'11i,11:,T,ill,;il,H11i,f,l"Jifig:'.ljx"l?,:i"tfdeosebi ornitiale sun,jri"are. Structurile care pot fi implicate incltd nervii rttrttlo
"*i"-prio",
lol:rlr., l!t(il)); b) ll\rmori rn "'anior,rin- *.io"i, oftalmic, fibrele pupiloiilatatoari parasimlrilf ico tt l trrt'trt' l l i i
tigt!,",",Lq;
i;,llll,,ll)(;ili,'ii,1,,,,,,".,,'*i*l,'iff-:"'i;"if,fl:x;"^'ii*iiL
""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'
,t,,,,ur,tr,u:ale arterai carotid,e(Jeftercol, iiatizatA de un iirodes inflamator granuloma'tos oronicr 1i botrigtt, citto
,r; ,.ri,.t 1958; Arseni qi colab., reaclioneazd, favorabil 1a corticoterapie.
:il ,l,t.u.t.t,Dtul.i,rzr Cafuu,I'notologioolsindrom,nt'lui'Iolow'Huntloa[()1:irtstl'olsist'rrttt;t
c/c, incleosetri cr. realizarea de fistule
.
r,,'iu,.! r.irrt irr.rrriolrgisrtalizrnzdLrapiO : ottalmopt"egli carotjrlo_ca.yer- 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'
r,r LI||||,|||I||I\i,r'illonirrrlc(Iioger ?riftamli puts:"tite
irl colab., lgOiO)." rrlo; it A""ua" a VI-;), cu predominlr,rtl,llll virsLtdonrii6cii;
"nufl o) (l('l)lll'lrl
| ) 'l,nutlnfhltitt:le sin .sului caaernos tti;n1to (lo-?l llllrglrl lllloi
ilaie fi nroelesiv, in citcv:l zile sau in inni tntLlto
,,ri.rrr IrrrIIrr.IrlrrIrju (,xtensic ,tealiz(,azri : exottalmie masivd,, rlc debut ce1 nai <xtnsl,rlrtt' ()sto olro lllllll'1r
ftuni9 qf _p"" ii,ota-itrii; ii) seninul
rrr,;rt
rlr,rrrir.i,p.rrvii, 5i Jcziunilelfrerespective ""gr""#iemporata,
stare
br-usc, de obicci ct clt(rvr zilo ina,ittl,oa' oftalmoplogici, oontx)lllil'(rrll(111
'Lrre're&'
Ae ocrriimoiori trigemen. tItt':i itr:rlrlrtLtu' oIl':rlttt'1llt'gi.i I
!) i.lll( lr.ro.ta,ea $i oaar*iu, *uu, iu rarc cirzurirll l,niirr lilrtlr
infecJi,oase : meningite t rrrtn, o.oiogite sifr_litice. gontrraL', r:tr.Irrlrt'ii'
;i-;;r"i air'ctiunea ([t'buleazi Filr :tli,,ralr'a slirii
ti) ltol.i d,o sxrtarz.. mir{om. multiplu
(boala iui foft.1 rnodeTAtd;f) dUrerea esLellnilAtol:llii, 'crlr.'i;itrrI rl{1t(gttlii 1r!rrlt)rl.lll
t,',) tlintlrr.trnn,l da hemiboad, (sindromul 5.*.
, lu,i Garaii, tintl,rotnul lt6 oital*ic, raroo'i prezonLin{f i*,rliri'. ilr horrrir:rarrju;g) rlrrorilo
tttrttlriu yi Q rrn:itt,sutt, sind,romul pnroxitttioo. qi. u'0o U)il'-
tui
io"tu realiza, in
..Bc.rtolotti-.Gairil,"i' sin't severe, cu caracl,cr contitnru ii urt oxu'c"arbrtrri
""i,o,"li.i
..rir,xl,{rl .lirriu rkr rna,sivll, Bi r:xtcrrsivi,utu"t""" ii" o".Ji;i,'ieni, :r,ti.,"r,nzii,ou na,t ll1rI trrllrrrrilr'i do eurLsibilil;rr'i'. tn t'ori
qi p',ra_ iii^iu ao
'5icri'ivo ttltxiltr qi ortr.''r{illtttl
conmn (curorlizal,oa,
a" r"r,f,l'r""i ori;,nroprosii iirririf n-ffii-i",1lrri, urrtrrri hr i,r,r,iI,r,irrI lrrl,vltlrri
lil:jl,l,,;iililli:11;lrrlui 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,
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 l r ) ( 'r r r t z r 'l r . r 't l r 'tttr r t Ir 'r i 'Ir |, Ir |, r l r ttItr r r r 'l l l l r l /r l r |
rIr. .riirr,,r,r,rr ''IIIr Itttr r 1 r Ir ';1 r |r
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 \ , 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
l,l r]t / I I I I
' ir ol| t ]:rltl.t l:l', {lil ( , ir z ||r i) ,, I|ir.:r|( ).
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 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
lr . / , : l r . . r 1 , . , r . , , , r r ,1 , , r l i , , r r l r r i , , , l 'r r x t 't r r l t r c t ;tl tttsi t, 'r tl r i l l r l '
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 'l 'l tr ttr r l t:l si \ 'r r r - r l l l l i ( l )
nlr u r r illl l r l ] ( , t , , , ', , r , . 1 , r , , , 1 r | t , 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
rl,, ,.lirir 1,ortl,. ll
'l,lr lrlollr r ur I ir . r . lr r .I r |r , l, , t ll, ir , , , , l , l , , , l , , i i s {, l }r ) i r r {f r {, l l }l l i , t l , 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 '''
I ilrrr!r'lt. :r.,,r'r'\ lilllj olt l, ic ( 1,.' {I ) ( [ ilr ,I(,,r;rtlli. ( l !r l
Zt U, i) it , t g r l r r t , . r ] , , r , I t l l i i 0 ,
Ou InrN;i,ii; . , , 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 ";,
1 r. : r . r l,itiiir.i rro ([ili( jir . ilor . I r r nt lr r lr r i dn oc hi ( ( ) l l sti i i l i l , fi o r l r - t i r L r - :ttl i l tr l t' l tl l l l i ttr xr l tl r tsl r t ttr tz't
, ; lr) \,.S.lI. cste rirxlr,r,rrl t , ', , , , r r l . l I i , x p l t t L , s ir - e csto
''r ' 'rli, | ',' riir, r.rzrr'ir. iur' {.\rnroDllr riehirrrrlui,...t,,to,,,,t,i,ri,rii 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
( iII *
' ! . \ r,t,.lrt:r(j tl| li,r,iiozi rliscrcta (ll6 din ,r,,,i,.' 'r r : i : r t r , ttIr Ittr rr
p r i m i ti ve ( n l e tti n g i o l t l ttr " Itt[t
.r.|l cazuriT;lr ilr,ostirri iil,. 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 ,
I ,r'.rr:lirrirr.r'rt:lrrr[ ,r.i.. t(t de_ proce'' in aflra G;rilri""";;;]]:;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 tu m o r i o 0 i d e l r n o j ( l o ( 'l ( 1 ) ' l ,t'{'r l 'tl
,]:l.ll:.ll'].:lril_ll,,.lt,,,t,rrlt'rlfla in unete cazuri ouilpr""et"coriiri,.,iii r t rrrrrolil<' ,,ru,t*,, 1,r'imitive mieloame, silrcoallti) rrh' ) ('\r'rrcrri
, ],,,]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 ,.1:rl r., Il )17; lllhor nas si Yoss' 1970) .
l tui l S r,,i n l fl ,,r .i
r',.lrrr,tlrl'l ; S,rrrllr.irrL.r. si ltrrlpp, 19?3); n) sirr.pto_,ii"
.,rr. .:i;rr:irrrirri p(rl p.ozcnl,,-rbmisiuni -u pritil;;;i,, i\lrrllirlrrraiiilo \::lsctlai'e reprezintir d.upti, 'I'horla's fi \''(tss (l1l';0)
.f,i spontan'e,- neori cu defit.it. ,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
',: '.,,11',19,,,: rr.zrr rirrr.: (,) l:cnomcn.,lo pol .reapFrolr jnterval, dr. lrrrrl 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 ''
' ,.i'.,; ll urn:tglr, slulrlntn:tlologierispunde [rlorabil la ldmhistr:rrr.: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 or){Urilr(hr-seunoo4 o remisiune complerd, ilr
i,llllli::, i'll:'!il}, cil,ovrr, ,,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
,,1 ,l::'.1:l:ljlll.rl \riu'c:,I ezj: :^lapr.estesi Desi.reTi);r) rtinprrrrr.r ,,,r' rl )l (,l i i ri ' pcr' cdr ii a I I I - a si cu dur or t - : localizat L pe r r t 't 'r r lr r i
., ::',,i::.1r,rl'Ntrlg,.lr. .r. disculi
,'. ,,,rl11, - t cr jf 'r t . ir ll
,|| rI rrII Ir,| |IiI |,'.t Iie exislenla Lmui proces i:rfllm:rlol. ,,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
I)fi 1rs.r.l.t,urno,l 1g73 ;' flult, iOfOl, , ,1,. .'itr.vr'istu'le inliiaclinoidjenc (intr:rcaverno:nsc) silli' reslt,trsrtlril'
.(IIallpikc,
Jtr,r'r',,r'irrurrilrrrl| cil Ia clzrDile. Aeicrise Oe-Uathe* -Clanhyti" a ii,,,,i,
{i 0l. , , ,,llrrlrrropleuJi(ltllett)rt$o ctrro se inst:r'leaz5,prop5resi'l'(,,pst'tltLrltItrtIIlItI''1,
ri',rr,r,"rrr:rr,,r,rsi:r criuici, a sindromllui rolosa-rrnirt poate-fiilSf nevralgie trigtlrn-irrat'i tlttc lxrrtlr'
t I t (4 t ut ttt tt't r t ttt tn ) e care:,par prin afeCtarea intilirir,ir ' ' ,, l,rrlulizic oculolnolorjo complt*il' $i o
',, ilr. r':rr,{r aceleagfzOnetopOUrl,li|r, ' t, 1,:rri l ,oi l ori rrl n et vului r - , f t 'llm ic qi s, : , r com paniaz'r id'' t r r lbr r lr 'ir ir t lr i. r r iir '
lrrrl'ri. sri,-ldiferenlie-m,,ieqi gi: isi o dolicom eg: r t ': lrrr1ir li sr r t t . I isl t t lit
. 'rritrlurlrl lrrrrl,r,isfcnoirl:ile( iloctton_Duvigueaud) a" di'iiiii,,f " llar oot 'i st r p'r r r lc
"""orie;t;-0.#Jit
b) Si"O"omut ' " rrsi l l i l i l al c
, | ,rl i rl o {.l l V r.r' nO ilSi.
lrrr ,r"Iri|,:rr, (|IrII'rI,) ; c) Sindroamelesin.sului cavtrnos; ;
cLl Sintlromrrl "1ru*ii,
rt,, l rrl i ' r1i i l c ol rt t it t ologit , r : ( : t r lest r l llr in int cr r n( 'lI iiI I lr ( t r r r l'r 'zr ' ( ll
r:',,lrrrlrr. (Jacoti) ; e) Sindromul pereielui extern al si,,r, - ulLoi
rrirr ,,ir,y(,rtr)s lnrix) ; ii) S."l,lr.uryrt paratrig6minai al lui ! Lr r.:t,\:{,1,t,os) si nl sct nii, . lat c r lir r r r ir r ( , , . ] t ili [ ] t lf , ilrir L I iI |I r t 1t r t I r t t llit r r r l, t l
'.i,rrrslirlr.irlalri
''ti'rrrIr''trrrrrrIrrri.( Raerl,,r,; r' j i l , 11ti i ni ,ti t t t ilr t 'r t zLi: it t lt t liil, , r lr lt t nt r lr r i s; l't lr r lr ' 1: r tit t lr 'lt t r ' ilL r r r r r r l
rr) sinrtromirrtle dff'us aiiui-r,isoner-griilrg,,. i " ,l rl r.l (' j si nttzi l r '1r ',clr t t t ojt lit elc.
l) lrr ;rl;r,nr,sirrrlr.orrrrrltri
'rrrr.rrirxo; ,l.olosir,-Hunt,
a,cirui etiopatogenie a 1it$l
ri r rlrrl: rl:r rrlri srlri, o.ll alnoll( :
|to^te fi produsii,'tit d. crrrzr, ''.1.:1.:i.:1.I'ara,li:iile rutliL.'u,Ll;t'e (i.tLt.ttr'tttttrrt'r:iu'lr, tl(t t tll't) tt'lttttt j
..,.rl,.ril ll., r.rr ri rr. ,,^u"r,,r,rr!|]!o.t"t'eroasd , rrl i i l tot(i i tt l tzit lr t i vlt st lr t lit lo, inllla, r nLit or ii
;i 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 "
'i'ililli1,,":!:::,i!::,,i:,:,,{,i#[":,ii,,iil*fr,1i,\iJ,"?:rlif,fJJ,,,:flj;.'i;iililli
,,t,1,:,1 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 :
' i'i :, i
r r'rrr';r'r,rirli irrr.r'rii. r)rrrariziir.ocuromotoriiqi ale tl
rl\,r rl r, rrlrirr.iilr lr rLrrrrrjrrrn:itirll ir, vietii, trig,r,i,,i, ;,, 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"''
'erv'hii
la iroLnavi caro ar fol.nr, rr,rl l ,rl l r(' tl c l tttt r lclt l't lst t sr r t t r lt r lt t llir t t iit 'i sct t zililI ii r '( 'lt lr r 'lr r r il'
r :,r'r'rIr.rIirrIrcI , sll rrrrrlillrr,i lrrir.n1.f )ff 1i1le1rtegja - 'ir /
, r,,t,t,tr':rzirirr.r:i'lr.yir._ sirrvinebrusssj n,, ,\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'
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,', 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
',,:rrl,:'li"
, ,i Dintr€nerviibciiornoturr, , 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
, ' 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 ,
0t,l rlri 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 lr I ll- lt t lslc lr r llt lr r lr t t t lr r r t
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 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
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 sil sr 'l: l( i r lr jll'lr , , i
r i. lr,.1! ;1 111( \ l; r rl1) r , { ir i) .l i t,s 1 rl ' r,1 .r| r,rr
dri :1. sri i i rrrrr Irri A l ,rl r, 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
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, 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/
, || |',.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, ( "lllt r i) lllilir "l r r
L"'i I rr'rr( r r ' , lr r . r ' r " ir l.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* 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 lr r r 'l'iir 'aiil( . li( . il t r r olr I r l I ||r 't I r I ||{I ( ||t I I
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 1' ,.rl i zi ,,i ol rrl ri r r I r , r . r , r , lr iiI lll|,
',','', Ii l r.r,l rrr. ( li ir lr I
'
i , ',I , i i 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 )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 ,rr.rrr,. t r l r , : r t l r , rr ,r |l r to i t( |, ttr l ( .t|l r . ( r l i l : ) , l l ( . r r r 'l r .l ( 'l r '( ||||||tIIt IIIIII
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 , , r l , r 'l | : r r 'r ' r : t r t r tl , :tti ,'tIi 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
,,,rrrl r , , 't t I o t t t , , Ir !I ( i l r r tl r r l ,r l r r r 'o tttl 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 |)
:,l l
 '.;i
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

;;;,;,;:r
t') b i nl.trl ttrtlt, nucltttl
:rir;m;
l:llririliiixt,,liilii;ilril;iri::iiii:r,li,,l,,ij11liil,'i'rl]rr11 l l l \ '( r 't l l i l l l '.

. i t t r l t {r
t J i n r . l n t t u l l l u n i tl ,r
'\ )r t n l t o l o g i r 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 l l i tl i z{.:r zi 'i
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;;::''ili:ii,,l;iilfixr;,,iiiil[*"jlti4!ij1l{i"i1l;rlJl:,|':l'';]-:'"r t'lt'i" (:iintlrontul Gttllrl ll rtnitlit:).

rlrorr sint : a) oftalmrplt,gic [rilrrl,elalti in glatkr (lifoli1,(r; lr) sorrrrro-
Sernuele eiLrtlitrirlc it,lc :rcrrsl,ui riitt-

I :l;r'r,i;i;lillj;
';il;i;ji:[ji],iil,1j;.",:ii{i:[]:l,ffiiJ1,J*1-i,,i'{#;i; lcritri: c) ataxie; it) lis1,:i,grnus;e) delir in faza acul;li rii stalo arrrtrcslilo
r,oufabulatoriein fazele tardile. Pzrraliz:iileocukimol,olilor sinl rrrrclrrirlr,,

f,',i,,1',ir*rili**p,;ti*;.t,;ifiixr*ilfiit1{{;ll* 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').

'r*ii;iliiltifi;riiifii:;#xrrn!:,;"!i,:":i',iiru#*, 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

;r,;;1iil;1;iif#l*li,r*""""**-;ii#!{;i;x$*l,4,fr*#r ischernicii, (ocluzii rle arterelor plandui posterior al pediculului rotr.urnrl-

i;,ij,,
rniler, sari ale ilsusi pediculu.lui retromamilar (Aqgian ryi Vuil, I l)5$ ;

i:iI;rii,IiiI
IIri hr*li*rtl gtt'1,,ru
st.,.ffi
;.}l 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,
I I;,t,:Il';r:'':t,
ii,lj-;.;,t
* de un sistern morfo'fu:rclional periapeductal mezercefalo-diencciir,lic, crrrtr
rrrc conexiuni cu nucleii oculomotorului qi cu centrii oculogiri din tnrntlrirrl
5 $;*g*iiffi ;gi,hT,ii,,i cerebral, prin comisura albii, posterioari qi prin bandcleta krngil,rrrlirrrlli,

,:-i[t'id**,f*iir***"1,*n*i*l**rui:?',","l[
:l,:i;il,,,il-;,ii
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

*i,'illJ:?j**ffi:ii."i?:*""
I 'orrlrr Ii lrr.orhrs5i de tumori
"..,"."",i1{iitfli*s:;
de ,,mioclonie oculoretractorie", ari,tind ci aceasta are ca, substrnt rnollir-
logic leziuni vasculare sau infectioase, reversibile sau irevcr.sibile, ils('til,o
de multe oii de hipersomnii qi de mutisms akinetice (Popoviciu qi collb.,
aie glantlei pineale. 1980).

:uffi.r*?;
*",+,,grf:if
.ir,11;li,'lll{rii3i#i3{,,1fr{$Sl1"fu
C) Sindromrr,l Lgle (o vaiantd a sindromului Kestenbaum) Bo (litrrl(i-
teuzeazd, fie prin palalizie bilaterali, ile new oculomotor connnr (1n
midriazS,,sonuolertri fi uneori paralizia miqcd,rilor riculare cle vcrticir,lil;rrttr,

iillllii;irj:lir,l",1",x'1"{lli*ii:i":"dl?:':il"J'"{"'rT;
;lll,ir;i;.lirl; *t+ffi$-**+*ffi
li*':i*$*?i*ruTlfl
{ie prin spasm de convor'gentd,qi mioz6,. I:eziunile rcsponsabilo dtr }rorl.rrrxr-
lea acestui sindrom sint de naturi, inflamatorie sau.prolifclai,ivi,.
D) Leeiuni,le ttu,cleureala ocxr,lonxoton ,ui comun, tnai illos ookt rlo
jffi,".it';;:;;Xg 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

l;:l:tjlliril;'{i,',ri,iffi otareamuscu. Olaude Bernard-Ilorner este thficilS,.

E) Sindlornwl arterei. nuclatr,lwi, oculornotorull,wicornu.n (ALlllolli 4i
#j:ifiT!:i{{:{il1'.::.,rj'-,:f cola,b., 1952) implic5, afectarea n ucleului oculomotomlui oonrun, nn{,loii

rriiiil:i-iili*i*i!4ffiiq1ll;giEil{iti;*lffi
I,l::l:l::':l?l'1,:"il'l,il,,ii,,il,il,,',il,itli,"l';,ll,,l*ii,iS;jUruifii.,*f
(,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
n:ll Alsorri

iiil*iff
t l r l"; t l )rrl ri l l, i 11ipr r r r r l- r trrr,rro rrr 6i <xlllb., 1.1)67) csio o n rir,tt
ilirglu,r'u
lirilr,totar[, oir,r'llc1;or.iznlii
plin uxisl,rrtrf,u

i*ili
mrniil,-'lr'-*'i-ili
tlrft;t*'iti,liifi
rlo oirltrli, (ru o (lutitii;i'i,
lrrrxlio tlo 90 Noo rr(Lr,lrt r:l,r'oir,ll,ur.tr
cornplol,it,rr ;tolrxrhiirt,ll.l.l, cu ir,r:l,iv
(fottrrtrrrttttl
v:tlrfl,tlo rrcrr:r,sl,il
il;rl,ou,axngorrr,l,rl,
rr:tzr),
lllrillizirr,
lr, rrrrrirorrln,t,ur.ii
,,rriclic" :r,l ooulorrlll,or.u
lrrcr.-
lrti rronrrttr).Anllirl,

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" 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
l l l ttr r t'tr l ti i tt IIl r r tl t'

iiilriri,ll,ir;ii,,ri
;rillrf :liji;li,illrili;l-.ll$r
imi:lii;iiUiU_i, : L c t . o r t l i l t a r l 't l si ttt tl r ' l tttt'l l l t
tuu"i i t i o , r . l t t o efl l l i l i t't':;tttt Ittttto
r r l r ttl
tItIr
i i
''
r r sl
l ) i
r
l
r
r
( [(
ci
'l
[l
ti
l
]l
zi
l
l
l tl '- l l l l ( 1 1 ( tl tti i l r ti tt l tt'txl t'sl
( [( '( l l l sl l ti ( \i l to l 'r 'tl l ti i r t l V:l
t

jitit
iIriIrillli:in,ii;i lii tiiii*l'l;
ltw jn*lttllr,,l t*xxl* ;t:
itr portiunea
;;;"i";;;;td;";.1ii
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
ol)rrsi.' I'^r'rr
i'tirl,' rrrrrrl.hiulriioblic rirrr<' tlo lrit't'lrtrt'
rr leziuno nu(l(l'l'ti1' Hi vrr
binccontr',tr'r lizia bilaterald, izolalit rr ttt't'vrtlttipatt:tic inctici
li",'1,,li,i.]'"ili?l;'i*t'rLitr rs,,-*"'ris*iiiii''re?4;\,oiculescu 1pp13pi {i-ferenrirtd rL' .itrrItDtttttIfhgcodr|--ll"llwrI'
b\ Sindromut de ortcrd, cerebeloasdsuperioarri^(s.itrdronlll(I()IIj'Li1'IIiI' [x'rt'itrlr.ii
iJ,4.it. lhrolizia ncrvului paletie (trohlear) *,,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
d" pil,r'trotl
:!..1.;1./.N n(r de semic,Iogi,e lrtn"Jf- *,i 1""iirin6rom senzitiv tle tip slringomk'Iic,
leziunii. Se loate asocra ot *-d"o- Ciaude Eernerd-Ilornor i It i ItI 1r'I'It I
"l
Leziultile lntereseMi' lxxlttntrttlttl
Nrrr.vrrl lrrrl,ctic (trohlear) iaerveazd, si chiar o hipoacuzie *u. *"*Oitni"'
mu;chiul oblicul ma,re, care "r,,oJ"io",-1"*"iscui fibrelo prrpil r('
t:Lrlrrtlot,t lr,, produc
",,lro:r.tji - i;";;;;, metliat, lemniscul latoral,
fJSfiff*"ur?#j":
ll,;ll;l;,-;li':till,:';itx",{if;i#ii#?;31[.i"_fi ;i coliculii inferiori.
c) Nucleul perechii a pa,tra mai poate fi implicat itt .
sirldromtr'l :ttt'h
('lriilr r prrr':r,rizic ile lcziuni opifiznnr'
., d. gradmed.iua muqchiuruiobricmareeste
suficienti *n ii il*iii tt":riipia"ctati sili,sizd'rimut tectl piotlus
vertislrd
liliill,iil,,'1,,1,1,',',,1,':Ji'i'ill#3fi a imaginilo"
;j; ,!g-P.u"1':' .*'"94di;
inciina'li 2.&.4. Paralizia nervului oculomotor extorn
;;I :;Illj;il;ir,il,#[Ii$:1ff:i!i".'" i;iff 2-4.4.7.Bum'at d'ed'atesemiologiae
1tild-1#l
:;ll;iili'l',1;,,11:;1i.,:l1;*gT{,i;;ff
:i'TT,:'^'f
il
r;;;q1,;1;riiiiiurriLi,rhn1ir,:{lir:lrr{,rf*ir#jirilnti P erecheaaYl- ae$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
;rliiri:l,tl;iir,;iiril:l.;lriu,*r,;'an'l*lxl*:i*#lii*#
li:.;f,:i#,1i:""..""'t'lTirui"?llTHHii#,f*.tiilii
se incieb1iteazi,orizontal itr privirca in jos, colror.lrL. u.gor
ii""tii'i.", r" ttt. Aiest ultim finomensc explicS' I" !(tnlirrlrr
\r s.
priJr
irl)r'i.)'r.

l::t1:':l:r.:lll
riiir'il; i#il"ei"a ;li .""unre""t" lr privir'u in jos ;i tit,div15t1n1;t
"l#Jii'r l'.11.]ll.::
ll ; i' 1,,
11,,:,:i:11'lli l;1,,,:1,11),lillil::;l
rr ,..rr.rrlt':rlrrjiziikrl r.rrrhi- in
;,r\{;1*?J,?*1.1ijli l lilil in Susl Srrabisn?al csle convergr.nl,iar mi$c.'.or d(' iru(tllopclr. l{l.r'rrlrrr
esie lirnitat5."Capul-este-rotal'compcn'satll1:' -l:ll.li1
""i""'r.ip."il" ( t ( l lt lllgil r lr r r : r r ; l
iartr s_auinstalilt ,i s""i" d"'iiipr*_ sau lipo- par ezel, ' dc per cchc VJ do gr ad lr r cr llll ll
"l",,,ll,,i];lii':i,,:l;lilr,ii';Trlli3i*;+i*i":i"i*i""
,i;l;ll"i",,"lllil;ll"llll para,iziei .;;';;;iil";;i"
afecral 5. i n
rlt'opl'trltti
mod gr,,hat ;; echilibrii intre hipor;a'c{'iunr:u'
cxtornctopartoa
-.rtopt..r"i
i"t".i' iiirrp"'ritri"n"" {tt'.lllli'l
-::iitt.l Jll
slirl}rlrl'
:lp"*1'
carurifd pctrlru prirnrl rlatil in :lccast'iililzi! osl'ttllr('u
t t t drt tl'iugnosl,icetiogtntoienic toltograf ""nirliouitut
dacfl teziunile initi;lo au ?ost tlrcpLc satt stingi'
, , ,.,,ii l,',",j,',,,,',',',,:'"lt ,si ic 6tt pa.al.iziile
t,.,. ,',,.:,r,,,i,iilt,t,rl)rcu,l.are. inso!,esc jle-cjieni pa.rali-aiilepercchii pt t'oTtogra[i'a ti'tt1to'rnli;iilrt
,.., , ii 2.4.4.2. Problemade dinllnostice'ti'o'pntogen'itt
' (rcrrers;n)i'i"-'i"a"ui""r
jllil,,,','l,,ii"ii]",liiilil,,,ili,/"lilnll"9""oas
,rj"{X1",'
si
i"i't"i neruultti oculotflotor artern.
,.,,,,,,rr
,r,,r.,,.,1,rrrrir, roilcr;i A)Para|.iziilalron'tn,arc,sitttflelcventittl'ilrti|tl,r1ll1;rrril,i1|'rr;rltrlttirlit
,,,,,.,"o.,lXiulil""lt,ll, 'u'.:n- ou"n"fr6r-,r-iii-o'ai t, t,rrs"rrl o.l m,i lung dirrtr. 1,.fi norvii
ttcrltltitttttl'tttt
rliforif. nr{uri. 1)l rxil,. trut,i vttlttrr'irltil
,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
;i;;;;";"r.i-j !"pii*t rn f,,i.',i,t rt*
tnzonainca,rctrcotpur,,,,-*fitt""t'1'otnporl'ltlltriqiltil'trrrrrtlolttsittttxttl

iii,tii'l cavetnos.
a)Pt'oaesauuS|lll'I'(t.(11t,'sittct'r'ulrtt:ttlttttlttl'ot"'rltttttn,portxlllott'tlVl-
til, i"r'itii lirrttic :tIrrrlrirtli'rttt rtr ( sd lttittt:' Arlf..l' ittlol'tt'
( I ' I I r :l 'r ( !t) ( \'

:n,liil :i:;Kili;E:f:::i#,,Jffi,/,,:i1l
iiili,r'li,,if:i:;i!i':,,,{:i:'i lL?"li
"-,riuiuu,i,
{ra,rul lrn1;r*o.iiilrr,i'r,pl 4i rr,r,hr'ulrt,biritrt,itlilil itttrrttt,irtrt't'I'
lrl6rrlll' tt
t
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 '
"ao.
llitr rItr|.'Itt'||'tI
rrfl{tr.i ('iu'ot'l(l{!
li:n'ti. Itt s!tlltslll 'llv('rlr's s. ir,lli"tl)(r
1l !\tratiziih:
) nttderr,rr:rlp IVa sinl gr'(trt(l(r(li[('r!'rrtiitl; tt lx)l llli(]l'll tlotvttl txtttlttltlttl'rtt'
,trr il(\ r1(lt(\ itl,tirrtc, I li llr i,r'tttl,ttAiLtt'pro(t('x(ul ttl'ttudtrotlt ',llt'l'(rll
lr,rr.rlir,rrr ;,,|i:j;li:Ji:'.rr
^,,,, {! r 1 i ( ! l 'l l , u l l ( ', o l 'i l ti l a ,l 't'r l tl .
t l5
 l,lll'ililiifiilr;iritiJii,iiiii::rlliiilr;lil;l;l"ll';11,i:'il1'll1;t
r'rrrl'r't,''r(
Ni :rtr'r't'rt' l;li;"i;11,,:ilil,
rtrtzir:tttt
l-l
rt''r1i.''"'.'".''''
gi l o,
r.969).
.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 . ,

;l,i;i';'iiih.lill;lill,i,',J;illiij;l',1,;ii;*;l
l,'l';,iliiil,j;l:;iiillill;jl,
,,,,,(,,:,,i{,,,,
, ^
h) Paralizia percclriirr V I ir :r,llilrerle :r,scnrorcrr
sJewidale pi 4n, celLal ,uirl\tlui or:bttar.
Si.irt sinilrttnu,l.,liutlti
rr:,;,,,,,,, .
jn
i).Tu.mori ale fosti 1tl,ru'ir1o-Ttalatine ptotTLa ltilroestezio qi rrcvlrlgirr
teritoriu-l ramu-r.ii 1r,.ll-1, l ncrvului trigcmcn, hiposecrc!,io lrr,r'irnali,
stincii
#:;';:::,:,i",!'i:w*.,t,f3,wi.
l,:,.,!,:.).!:':"r::i,'!::':i;j!:,li:",,#H::^ te,n. si pa.ralizia ner.vului oculomoror e:lern.
j) Paralizia cronici a neryului oculomotor exl,ern poate consl,itrri

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

i-isrr*,t*i*i+g***g'l'am':ln*}i;ffi
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,
jl.ii,l,i;l'lil'i,:ii:,'i?*ffi
lr"*",:i:t":*;*lii;)*T""*,tT.ff 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.
"i,:":#;
;,,:1i:iliimk#;il**i5xrl?*atr,':ur#fff ::
;l;;,ll;;ir-l,,lll#Tif i,:,ilTiiT,?fiii"*k*t"li:x
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

ri;i;itr1*llr*rl*l"l'ai*ffi
"l'":#i::tlfi
*"!*;l{6ryffi.,##i
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,
rli'll-li,:*l',::*;,:,lh$.t"i"rli,*xJi""';ii#.#o"",."*,..,
'"'n"ii"i, cu al.ctarea altor sttuoturi neryoase din \-ecinr:i,iit r.. .\stlr.l. Dlirillizirr
ll;;ii:l;:lll;:ll''ll'i'l;,iliih"3 'runo'"i .i""ii"",fr" nuclenri, de ocu-lomotorexterrt apare aproape tot(lc:runa lsocilrti t'rr 1,rr
,*t":1rgoame ralizie facialiL periferici..
,l.'',,';,il;lll'1,*f
'.,il;1,i{x'ffi
i1t"#:?",'"'":HtJf,[gilii*1',?l;, Nucleul perechii a lrl-a sc :rfLi aproape elc rr:rrtrul porrtin l,onl,frt

li:l:rljrrilnir#rl*i:",ffi
plivir..l ipsilateralir,de la care o cale tlc asociatiecorxlticc,prirr intrrr.nrrrrl irrl

r;:'lr;;r, 1;i:{"g:#qJ#$t?
bantlt'letei lotgitudinale postelioare, la nuclirul pcltlu nrn;clrirrl rlr.rpl,
oxtern de partea opusti,.Ac€st ccntru ponti estc Nd{rserllfccttt (lc lczi-
unee care inteleseazi,nucleul oculomotorului cxtcln, qa incit, po lirrgr"l

:,ii'Illi1,ji
I';I i,
;i,iii[,*31g
paratizia de nuqchi rircpt cxtelrr, :ll):ll.e;i o paralizic rr prilir.ii lir,1,i,r'rr,lo
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,
rlo

"k::rilr*11#x"ii;*t
rl,.;l1ii'1illl::t,,tr:,*!#itr#::*#"*{,ffi
.;x?d,Ti:Tif"::,ff;:H:
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
;ll,I ' ];l ; l";i';;;l'ii";:"r"..1;?; pu"ro'J,ili,io,."u.
r,ezi.nea certl,r,rl foarle :lplr,4c lrtrul do r:itlirlrl1,.t)llnllizirr,rirrtleu,rii irilrrl,rrlrrli
fll,t"-l" ^u"."';i de ootlornotol ertenr nu txtc rlr.ii, rlacr'ii:irrcurslrrrrlr rlo lattl rrl ri, cli rkri
('oncornilr.trl;
trucleise giscsc in apr',11itrr'.
1,'.,,;11:r,iilir;ii.,Uil{-$1$l=qitr#,*i':iI:}{1.+l
l'.:'n**"
$
trigenicu':L
i'tii
s(rlLsoci:lzii

at Sinrlromttl lui (lus?tiui (sittrlln,ntl ilot;;o-[t lu.or:a

llrrlalizilrrrriscir.ilor
rle la-crilltate ;i plr';rlizir rrrrilrrtcllliisirrrlriluict'rrli Irrri:r,liipuiliilicri.
urLulftl lrqnt: .
$"'JiT,'""!
i'i,liii:i I lil;ririlii?*ii,
ffi ,'[l jd'jff'I' i tttlui pontin) s(' lrlllit(i1(nizl'llzi rlt.fioil
1rIirri,t.rrIr lrl (t.llIti(ji V,
tt('l\.il()r

j,tI Lr,,,,il,il
iiliit jlt',lltiliil;l i'dtr{trf*lil,Hi
Ijii1,liiriili
i'ili*i
TI,YII qiYItrIrl, lrurl,r':r
de pi,rfor,ol)r tsii,(1('\'iil1
rnus {ilrc bfi1c tlr 1|rr,lr':r
llzirrrrii,lrrl)rrrlrilir|^ scrrsilriliiirlr'l,r'r.rnoll!:.r'zill,
il illolrilol oirrrlltlisl)l\. 1)itt1r!ll sililolrsli rii lirlrrg-
lr,zitrrrii(l{r,rrlr.rrlriilrl1i \-lrsrrlgil,lllir?: ,l,rrrrr

iipl4*1n,htikirilH
r.Hrr* irrfr
)vlrriru
iil;r
ilnriliix#"*n*
rrrr4ig,,rr,ri,
z.rirz.frr(\rr
irrli,r,{ii
rrxl'rrr,,;:ill,ll'l'lil'lJll,'r
r|()rrisi .Nlonl,rrrtN,l'i,
lt\ Sintl.tonrt,l.
tliU'irrllt'fizu
,zii 1rt.itt
l!r(i0).
Lu.[ ll,utturtntl(*irrltrnu.l urrrrltl tl lt,ilnht't'(nl(i) \rl
llrr,rrlizirr1l(\n,('lriilt \'1.:r rlr' 1Ir1l1,1q lr.zirrrrrisi Drrrr
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
 o,ltnl.n11lt11iil.r 'iul(t't'ttt:l(xt.t't
(ollllrtropklliik' ittlortttttlt'nro)
:1,4.!i.lhrnllziilrr ittlctrrur'k'rtrr'
t'r'zttll,ii, I )i I tII II' II' I t' i lotrgiltttli
rlill I(rza,r'oll
rrrrlr.jroilIcliirrrlr'. ( lltt'lr'1t't'olr,
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,
|||rr1r'iri(.r| tle lRtclr'titatr:, insi, funclioneaz5,norrnal in timpul
r,,rrirllglrr{r'i ; ll) prozerrla nistagmusului tlisociai, singular sau_prepolgc-
l.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
1.,'.:irrn,ilepozlina (indeosebi vasculare) se poi intilni doui forrle
1rrrr i ilrrlrrlrr rIo oltalmoplegii jnternucleare:
| ) (),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
r rrrlr.sr.rrllilrrzittnca,), tliptopieincruciEatb, $i lrjstaguus ulizontal la othiul
r':rr',.pr'irlsic irr lrfrrii. AJoste lenomone se explicr'i?r'iir 1ri'tnl ci, nrtcleul
;rr,rrllrr rrrrryrlriuldropt intern nu primeqte impulsrrl'i pentrt mileatea'
r.orrirri:,rrIi1, lrrl,rtrrJi,rle ln centrul pontin de partca ol)trs:i.Pe de altii pnrte,
rrrrr,lorl rrrrlvrrlrti rlbdncens primeqte impdsuri cerebrale qi vestibuJare
r; rrri IrrI r,r'rrIrr fi r sl,lit funcl,ioneazi normal. Convergenia se produce, intrucit
r:rrrlr. l)r.r1r'u rc('rstir, mifiare nu tr€c ?rin centrul pontin aI mi;clrii la1'erale
,'{,| | i ||ri rrI r' . I)rrrri leziurrea este bi1il,terald, apal'e o paralizie a adducl,iei
l,lolrrrlui rrrrlar irt arnbelc sensu'i (dar cu conservarea convergen{ei)l
| | iIi I i r:fi| |rrIr.rIrr liot'alo din ochii afla{,i in abduc.tie li nistagmus lt} privircir.
rrr rr|11.\iN1irglnusul opi,olri etic qi indus prin excitalrie vestibultril cvi
rlr'rrlr:zir list)rrsrli tliferite la cei rloi ocli (Bender,1969' cita,t de Popo-
r rcrrrsi l'rrsr,tt,l{).B0).
li ) | ).llrtltrtrryilrlti( internucle d, Ttoslerioard'este adesea greu tle _diag_-
r,rtrri. i) 1rrr,r':rlizie supranuclearl a, perechii a Vf-a este foarte dificil
rll rlil!.r'r'rr(,ilr,t, lil{ii, tlo o afingerela nivelul nuclear sau radicula,ra' net'r-ului
\ t (llrllrlri si rtlab.. f9;$). 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
;rirr'lr,rr olrrtsi,lcziurrii l:t ooliittl c:Lre?rjveqte in aflrii
l)ili,f('r1,ii^r'(,rr intlc celr tlouli forrne se facc pf ii'l lruliza' compr,tr'tlrii
( 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,te-
lrlilrrlr. 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
rrr lirrrlrrrl rrrir;r'r'iliirkr l.rLclt.tlit,:tte, r:it i11timpul corn-ergen1,oi. N rnai
rlr'r,l)lrl('\l{,1'rrrLr prtr' 1t,ir "ri
loziunii cstc pat'alizal mi;carea tl'lrtte-
pcrttlr'u.
r':rlilirir'.lfrrlrrlr lrorict'ioilt'ii tltl ltalirlizil,ptr4llitt zisi
Ii tli'lirt'ctt('ia,iir,
1xrrr1,o
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
1r't'trr.ttii
1i tlr ,,o
dc ,,o1lrrInto1tl,6ir'
llt,irllrtoll
ltrgic i tt 1r' t' t t
rllllrtlrllrll'ii tL' :rlxlrlr'('il"'(1i trtt lxrslctiort'ti)
t tr,Ir':t t ri tltl rltltl.utrlitl"(1i lttt ltttllrirlltl'il)'
l)iaqnostic etiologio: 'rr'/rto;-rl'in pliici eslr' (1:l'llzilti(rll'tttrti lt'trtrvtrtll'ri
lt)
il
siltt 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)
1
I
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
2.4.6.1, Sumat d,e iJ'ata semioloylice . L'ezi.ltlile suptanuclt'ilt t rrrtttt
afecteazij, mecanismele miqclrilor conjugate se traaluc sentiologic ltt itt :
a ) Dim,imtarea *atr abolirea mi;cdrilor conju'gate oolunl,arc s(r (lirril'(t'
lr 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
b ) Itttensifi,aareo, Dlec&nismelor refletelor de .fitalic st' pttxltttrrr ;ttitt
pielclereaconti'olului inhibitor. ln mod normal, iirlrtt *,r itllil sLtlrcolr
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\(', $(\
riurnegte pseudo-oftalnnplegie.Paratiziilc m\ciLrilor dc ltttttrlitrtlt', rrtr
pistr:.rer -conrergiltei, indicii o leziune corticdld'sar pe c(idl. tnrl,ittol'tt 11ult,
inainte ca acestea si, a,tingi centrii subcorticali. In untlc cazttti, ilt rrrt'tr'
contloltl voluntar se pi€rde, reflexele de fixalic pot dovdii t tt' i tI It i I tIrI I' ,
prir-irea se,,ancoreazi" de un obiect, lncit o mi;cart ultcriorl'rilIlll lxrirlr'
li fir.urtri decit tiupi, ce se elimili irnpulsrltile lctirticno (itrcltitlt,tlrt rrt,tt
acoperirea ochilor). :Lceste situa'!ii ar1 fost dcnul]Iil;r' ,,a'l!1t,1:it o()ttl'!ri
tttolorie'1(Goldstein li Cogan' 1965).
rlrr Irt. lrrlrititrl'
t ) Intensi.ficutearcll(.relor proprioaeptiu cillo l)or'11{ls('
si de la rnurschiigitului epa'e atunoi cincl leziunt'lrsc:rllr-t' tlcilsul)lilllll(lf ilt)r
pontini ai sistemului l'estibulal. Astfel, tle piklir la lttr clz lilcrtt'trttrilt'ritill
voluntrro itL sus sau spre dreapta sint irrrfosiJ]il{',lLrltriiinsi ('rt,l)lll('sl,r'
br s'r (oborit sau illtori sl)rt! sl,inga, otrlrii str r.ott'it.zri sttlr tttt tttt$lti rr{ttl
in srrsi1islr'(f {lrolrpt,it,ct':t1xli ilt Illo(l aul,ornfl1sii srrt t' i rtI'rI It t'tIii, ltt lrozililr
Irrt'rrt'izotll;fii. Ilsl,t'.lcnonenttl ,,oohilotilt Ttityttt;i'". ttt|tliltlthr<'il,rrr t't'll0xt'ltr
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
(krllrrtrl 1i 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 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')11
 r t t'rtnt4 lttt ( 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
l)t lt t ilt ) t . . x I lt , t lit / ir r r J r li|l. r:
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.
,, ,,,:;,1,,,,1'lll"-i1:';1"','i,"'j1i:.'i,ii,'iiill;lli,il,l,l,i;-;,,l,,i,"
rl.rrrrrrrr'r':rzi llil,li,;i,i,,,1,,:iii,;,,'l,iil; 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
, r.zirrrr.r'rr':rrr'r'li.rrrolr,,iitl"",';,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
r',,iil],,,,,,,",u bilirc:r, diagnosticului topogralic al It-'zitrnilor'.Astlcl, iIrtrclnpcrc:l Iilrl''1,,r'
:i':li'i,';,',;:ill;);;:;i,l',;;l:]'ili.-:1il,i;:;,,r.ziunei,ll,ii,.;.iiir...i,rili"li
",,ri,""" sintpii'r"1.te 'riscririlo' deasupra incruciqirii induce pitlalizia milcilii latcralo slfc ?l11crl' (il)rrfi,.
,,,,1,,,,,,,,i,.
,i,,.;i.,,,;i,;;,;''il;';ili"Ji
;|?1iil11:# T,;:i:i:".
tt ) t,tix:iir.itc da .u,tmd,riresint l,estatesofi"itilJ
,,,.
r rr l' l)| (.1, |lrt0 se tnis c t j, di; laci"ntuhi si1 jireze
rita, la aproxirnativ
r,,r,,,,,.r,ir,,,l.irl,,i;,;.,ilil|":;:ll:i^tu:!"i" 60 t,rl irr
,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
\ i.:, r'rrrlr'('l)1i l.ixuJie: piLcierhul csio sol;i,;tat pri-
rJl-fat. cramirxtoruiui, ilmp in care
,,l,rr'.t;r l,(,rili,r'i', .roA.airu;o,rrL uir",;.
,ii'iul
.imltului vizual (#i;r:arit:a,"ii"ii, _"ii),'i_,s*
tr rr,,rt rrl.trurl, st: dc lLi,l*il)i).
ltroduceo rniscare
r 11r'rr.r!'' rr.r'srr:irnisciiri s.gereazii -a privilii iplr stinlnlui r,e:jljr,!.Li\,.
r( rrr'|r o t,,ri*" t"ri"""ur,i cr-iiLr. ;rrir_
(''!*1r' rrc re'einrui
'|", occipital oi ","u'li i,riir" i rre rir,,:*:.
, t \t,4t,tt( t ttttt'p)
gen,rri.., "i""riit
examinatolul cr'le
, .. . " .,' ('.rr. (e borr[r\'rLrui si_i rlr,rnr-
',, rni..:j5.
lerNir fatraochitorip,:" .,io,i,,;",,ia"iiiiii
ii, I ,'i,;.;'rrr,
) '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.
r'i" .str soricil,atsii tiui,p'ir-irea u't 'riicat
'r{rr
,, rlrri, ii'rt) irr salp ngeslj, pe ceni,.lr er,-r11-
"ruJ'"u"..t,,ir'i
esti miscat-l;^il#;,i;;jtr.u
,.,rrriitr l{)t.lrlll(j apari: nistagmu-"ul -- ' direci,ii.ln
optokinetic.
) ,. , ,, , ,.,, ttirttt0tnusul.ui,_;c11t!Uuia,r
t ..,.!
tttt , t t t . :.rt ',,
rotator srLr\ tlistq(nt| ).tllui
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-
' l1iI rl,tihrrtlr (ncrvulr,,estilul "i"
ur_nuclcut _,.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,
\, .1rl)rlr1 ( sI{l ilrlrft. ln_prezenfaparaUril". .oculoin"t""i- aral
, Ir r,r ,r| | iI I( . r| jl:rrt,rr ulechii protluce iril21i"r"lJali'prs,irii llri,r:rale
' 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]; I:i{/. 1 1 . L t . i u l ri i e c.iilar aculolttc:

r1
l, ;iI;r;,
r , r rrl ,rrl i riI r , or r t ir lir ljr r a; rtb tl c t,

:
i, lli:liilui#]rliixnsft,,;li
.l : N.Eon .artnrl :rdliocnl:rrat.r; -B
: Ne!rc! mezo.cialnr hcDicrrltrrnrr ;
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 i . ri re rn i a . c l l o n '

I i 1;1, [mlri#"1*,uffi
l.rt ll:i .\tdn : I - Pi.rli2ie n!(l.arr .onjlgali | ., - I-rerialic conjrrgai' lrnr leTirx'

l t ' rrrjli' r' r )lilriilo:lsii.lrr i illr ir llr , , lr r r r , : r l. iz , iilr , pr , J lilii

I l l l l i llul lllr,lrr,trl r,itrl r ir . r llr : r lli I t t lt i llrrrrhtst. f[(] lozil,lri in i n 1,i rrr1r
)pNte'di.il 4 _- Dc;irlie tunjlgat: lrin itTnD'

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'
crnisJ'r('

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

r , rrN r(' rr(. r.. l, ziLtlj ci 1rr, rtct,ou5 ilt lr t '1r '.
| ) 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 , 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
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 : '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
, , . , , 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 l l g. I l ).
fi,, . i,r,, i,,,,i,i

ll t )
 :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 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'
ot t
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). lrovillo ttrijlocill' lrt'
t,in) culrirrdtr, in conljexl,ul sorrtirrlirgir', tttt sirLrj'rotn
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 o- gl'5rrli
l ,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 l,;'i;;;;;it ;;;ililii';tti f i hotrliliipo.sl'r'zi'
c,'i,'l,t,il's'ipsilatoral
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 de
-' parlea olusl leziunii.
,i o hemi _ '",'is;,,air,rr1 fstiTll In.fPrioi (ptolltl)rtta!ial itll.'.itttl crlr gr'ttlt;rl
lrlcgir'.rtc l)itll,(fr ollnsir lczinnii. L,eziulile cauzale sint hemoragiile, infalrc- ptitr p;rlirlr/r:'
t r.l r. i .i lr r r r ur r ilr c m i s fc ri e e . O" l"riooi ,i".ailol oculogiri-ub inciucjsarpii st malrilc'\lI
alevjerer- coniugatir a globilur o(:rllirrinl)11'
Nlrrriii'stiir.ilo inverse, ilitative, pleced aleviatii conjrgate alo globilor irii:i.iiirrt" pn,1oaleziunii, cu
. i'r,1"^i'-ii,gi SioO,omufTorlillc
jnfeliol s. loir,. rsocia.$i urr siI(lr','t'l
,.rr
,,, rrlrli (rrrruor,isi alc capului) sprc
lartea oprrsil (confotm legii lui pr6vost fif;iijt.r-"dijnj"tI ilin'"nua siluirii sislemelo' tle asoci{rlio:rlr'.irlr.
tl'
I
'll
tl( ll )llZ\').
ii'iiiiiii"X#"i, oil"iiriir" p"tl"e sint aclesea bilalerale,iirs:i i'og^ltr' irtt
It\ '{inrln,nul Fot,ille m ijlocitt, (protuberanlial superi,or
) cste realizat -irnpulsruili'
rostibulale silt pierilute'
(1, 1,,,:rl,ir iilrlelor ocnlogire dup5, incruciDare astfel globii
$i oculari sint ' *"-.'i"o*firiifn li
risnunsulile pot irnbrlca, lirirrt
i"cdmpt"te ale privirii de latiralitate-
nistrE orizorlh, c"."i i-pn" cintl globii oculrri silrt itttlrtrlrlrrii
ln diieclia"tii,r,ii
paraliziei.
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.'
aoietlo"i p.ino tibrele ocirlomor'o'ii bupran ucloa'r' litt
;;"r;l';t.;;;i
vcrlicalp' L;ltiur!i (ar\':r' si'-'"
iiir:'riiliilTj.'i;l o pu'i-li,i"ryivirii paralizia pr-ivilii i.n-'us, iar r'r'l(' (:tx rr'l
inri-aor"rio' (craniait prorl'uc
mai posterioare (cautlal) realizeazi parallzla prwrr]r rn Jos'
rt'
fn cazul in care pa'ralizia migcirilol, conirgate de vertiur'lilrt'1't'
purlotizia miqcAritor orizontale, teziuiica se gdseqte irr lta'ttthrl.lrt
"*o"irn'*
r"i'"ii'iur"i5- din regiuner 1ep12li 1J.5olli qi Srrlli' llrtil
paializiil,'
Si;"i,bl;;i;i .i""tio"io"ii cle veit icalitate nrr apar in leziunilc 'irt;:ttl:tt'
r-" sup'eriori, ci ntmai in leziunile care a'fecteazi' zotlil l)r{'l"r
B€nderl1)(i1r)
ibt}t;.rttltli. colabl,tooz; Pasikqi colab' 1966;
i.rx"oli*fifo"
oxtrltrlrrrtt
Sindromul Parinaud se mani{e)t; prin imposibilitalcl
dr. coborir(' a globilot' ocuJari' -hlr portlr'lr
rolr"Ariiol de titlicare;i1 sau
,n"iiiA-.ti."' ilrigcare de verticali{ate' lntr-o paralizio itttrtttt-
"";,Jf.ia"i'iiirii- t"ri it:"cl,"nr,afcctarca priririi in sit''' rtpui rr'.|rit i"ii
i,i"ti.
"el to ti.p ce numai in jos apare foartc tat l'ir'trk'trir
i; ilb;];; ;;;! ;i
lrr l1r
ilr_?irir,", il--ll.s L asociizi rdesea cu absenla rcaclici l)ulilxl.(i (lollv('l'g('rr1rr
;i; miclriazS, relativ2i li tu menlinelea ree-c{ici dtr '
;;t-. It''"
privire in jos, rparc ln plus tlisprtt'i{'irl
Daci,'*;';ierd; si iniqcareade
modirii qi a oonvergenlei.
llll(l{'irf rl
ReEiuncr precolic(llal'lnsle fl':.rl'lcaplorpr. do uumJrlo\lll {{' I rr
rn si, ca alal.-' ..indlomul Pat inaur[ 'rt(rt'iirzii
"",lotrrJi-Gi'ctm
;;;;;;-;i;. o;;"}ii a rrilu', in special a llruscbitLlui lidicrilrx' itl l)l(r()tr l l"
a1e rl.'omodal tr Sr (x)ltvtf'gr'rrl.r '
i'ncrioare ii tleficite in )ol,ilitatcp.lupilei, -ebt{i il"
p""".hii a I\''-i excepl i()tlir'Li .In krzitrnilt'
A'r:oli;"ll-a' rr"t*lrl.i
;;;';;ljid- ;i;cdrile t1eurmirile pot ti pristri't^e,in tirtrli.l,t' trtiq|r'i.r'il'
t
i.,i."i;" i"t oinitt''" DiIlopia 1'o'rt''Ii 1r'oz't'tit irr ParrrliziilrL'v.r'1"
satt vestibttlalr'tttu ittrlttr'' tlirlitqttl't
I l!1, . Sl lltoulnele Lui FoDiItre:
tiiri",- ,st,it,',rtareaopl orl 'irLeiic,-r
/.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 lerl,ical.
l l rd rn , l .!.h l )j i,- SLr ||,J"nl 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 ne-
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 ,
Sintctizincl4llpjgtlinlitr.r':l1Ltr.i,Il{'ILdcr'(]{)U|r)iLlillli(jiiil||,iu'll'llxIiI
.,t91,
' ' Ir t
lloi,4elqrl.iculitatosir
,,ris,,,i: lsi'ciit,ttttnlsntiIrrlti tttttllr,rlitttttltti'l'l'trittr'l''
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 t;ii;ii,,;";i,,t;irlorii : a,) tliirrirrrtleit s:rtt ltit'ttlctt'itr'('gt,rrrlrtiltttpilltt'lrt
,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 i;;;;;i;i,;; i'i;; r'otr*trtgr:til,ir; b) sp:tritrrsittt (1r)rr\'('r'gt'rr{'('i ; | ) ('
tlislrtAtttlls
i,'r', ittr,lttsit,'ir't'rtlizia l!rlrllrtl' I I If1I IIII I |)|||1
l ,t rvo l lr , t lr , lr llr ( , 1r , ;rrtl rrl i z l rl ,rr). vitlirrllrlt,ir riqoirilol nisl,rrgrrr
r i: l
0 :l
 I) tl l r tt' ttttt l t'
r||rInrirl.Firrii rrifl. vrlIrlr..( lrii. (1r'iz('l('rt'Il(,{.if.rir,|t{rr . 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 ')
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, I r l l l l l l l l 'i i l n\Z l l .
Ar'fhl"
"r'iz. rirrl 1r'rxlrrsr'(lr'srirrlrlirrrc.sivi 1lr,,v.rri{,irlrrrl.zirrri iriliac(r}l,o
'''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 .
criilrrl r.or.l iro trtrr,ltrartpr'trl lrr rrrJ;r,iirilc
coi r.iugatci u tTo l 'i r l i tw '
l,)) (rlst)ilatliru firls1ri, irr- lr;rrril,ia uror urisrr:ili (x,llrlrc 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,lipidc $i i " r h ' D "z i I i r t
lr;r.li.(., rtislilg,l'irk'sntt nri,rr.l,rri.c,-in specialorizc,.ialt.,tllr. qi v-ortical'e , ,t t t ,t , l i t r, , i rl i r u , t) to r l u ( ' o si ttr l tl tr tr tl 'tl o g i r '' i l i i tr |'r r tr r {
'l(i il 'r
i 'l'ctr l l r t'l ; r l l s|.r r l
srrrr 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 ; a \1 .( a ) l r r l r '1
.rrrlirl,r,ii,ir'etliat inairrlr,rle a fixa un obiect (u'tel de,,tremordo . , i,i,'l'., lrrtri, l.9t.r, 197?) : ctkt untirioare leze:r'zil t'o!'i ltot'vii octtLrtttttl.ri
lrrr'lrxrrrr"'). ,\r,cste.miqciri pot fi acompaniate de tlemor il capului. I lt
()lrr.(,k)lriir rr fos1,descrisrli,.in dir-e'se cncefalite, iiinel prod'si, de i6ziuni ,,,,,1,,,sr,I'ti t,,ttiu.rl superio,uii ll, pcrethii a ltt-a) ,si tlltntttlt't tI i'It I ttt it It
Lok)rl
rrL,olivtri bulbar.e;i a,lenucleilor ditla{i din cei.ebcl(Jicnder, 1969i. trr;','rrrlrrrrItri) ; tde rniitoaiilezeai5,la fet to!'i nervii,oulllulr t l)t1\rllrrl
l,') ,ll i.oclouiileritmice ole globitor oculari pot upiire:l in leziuni ale
'1,,ii',,'ri, it,Jtili rormu:i ale trigerncndui ; uieltisrnt'lc ptttteri'oaroloztt"tr'ir '
rrtl l, l i rIirrr:ttrlirr.cerebel. rrr r,lrirrilr, n('r'\'uloculomotor;rteru (VI) $i rrel'vultrigeruetLirI l()lrrliltll'r.'
rrle ruclctrlui roiu. oli\-ei' lrrrllralesi7sau ale
r'r'r'rrr1r.lr,r'lrrlrunorrrbroolir-ure.Se manifesti, prin contraclii riimice ale ,,,,,;;;;i,;-'_,; _i rrri sindrom claude Bernard llolner ([t'ziurLet,1rrit,$lo;tt"Zl\r
,,,a,,'ii,",'*i,*",t'i,'rrn).Anet:rism,ele aarotid'i'ene s'upt'aclinoitlieutpttl lt'zrt ttt
llnlrilol or,trlali ('u o flecvenld, de 50"-90 pe lfinut, clrora'Ii *" o*o"i*rii, comtltt. Att'eurismele de urterd tiont'lttI it:Qrt'lt1
rrr rr.r.lrrqiri1,rn,tnioclonii ale.palalului mdale, ale f01ei,Iinlbii, faringeluij ,,,,,,i ir,,lal tt,', t'tLl oculomotor
s1' manitesta atlcsea- cloar plin plozii' pllptilt'llii' lrlr'ftirtlii
rl irLl'r'lgn*rluisi chi:rr ale membrelor. Dc 'rrrrilte' miocl6niile
lr,'r.rrr'r('lri, ,',,,,ti,,:;,,,,r:A 11rL jrlr:rlizii txrtttltitrrt'l'r"
rl|,Iri|'r'.rrrrllr'i silr1,$e'de diferenl,iatde nistag'mus,i.si. o 'ri' rrr trrlitlr'i..'lnrtrisnte[,enrtereibazilurt poi protltce
elaJizi, clinici ,t. ,,,,,i,".i,i1u,, rr lll-.r, .,i f I-.r,-ia" d. hrrllt oLi ttlt sinrlrt,tttI'rtritt:trtrl
rrr:rrlrllrrlli rrc alllri, cii nu eristi, fa.z[ lelti_ 't'r"ntt'lt
i;;;;,:,;,';i; ^ A n.ite ie tt.iJeritcetiutuqii' t't
(i ) ' ' ' si tl 'tt',t,u-r'iri,talirr".
r ',Lt
;lqilatiu alobiloroculuri,(,,ocular bobb:ng',) se craracterizeazii p|in tt,l ,rl r r lni ( Llt Pr t t u^. t ) t 'isl e r ( t olido'( t t Dcr t t oust
rrrrlr'rrliirrvolrrrrtrrr.c sincrone ale ochilor 1n ios,-cu reyenirea,imetliati in
lrrrzi{io rrOr.rnrlii.A fost- d.escrisi,in leziuni iiisiructi\-c intinse alc protu_ l!.1.?,5. '1't'{trunttt itnle ctalt it,cttctfulice : t1 -F\'mtrrri clrrtritrlto itlt' ltrtzt't
lr.r:rrr(r.i(Jrishcr,19e4).ln leziuni ce,rebeloase s-au d.e"qclis mi6ciiri ini-oltn- ,,,,,,i ,i i r,i * i l * r,i r le or bit ei. b) Coniuzii cer ebr alt '. I ) c pilt lt 'r ,
in. n) nlllzir r '
lrrrr. si Ir.IrrlrrlIrr,u r.i ni$ciiri oriznntale ale globilor.ocdari, cu apa{iti:r in , , ; ,'l;;:;ii iiffiil;il pi l"* iniit"i paralizii izolat'e^*lt' ltet'rx'hiirt \/ l rt'
r,r(,l|||i,ilr llrriDul lirririi ur[ri obiect. (x'l'1rl)rllltl
,rrt ttltlltlizii multiplc l)a,l'ttil'lc (le oculomotoli' ln coli'ttzilt
inlr '11'\ 11( i. ( gr
ir L r r r k r lili'r il")
,.,, 1." ,,," i ,:rl ,, i'i, 1, : , l', , i; ; i'l ct r ob'll, pot I i
:i.1.7. I'roblcnre de diagnostie etiolo.{tie in palalogia sistemelor .,,' u t , , i, , , , 'r , i' it r
," ,' ,,i 'r',;;;i;;1i,,";,;;';r.ir,t,: I t : r . t t t r il. c*it r it 'n. r 1c et : r 'j r t r ijlo. it t lt t t lr 't t t t . t t
0rtrl0|[{rI0tii i.,; ; ' tl i i iit oi vt, ,l-n'urteo..i trururriirl(' pc.'(1hii u v I rr
, 1 l,lli'rl ttrcll'al posttlrlumal.it. d-) nlecrnirtrru hitlrr,'tlinarnico' erl('ltr 4l
irr lcristl tt ,prinriltalelorrouze ale olal no,plegi,ilorprezinti,
.'l'r't,r.r,rt'rr r' ' .,' ,u,,,ai ;r," .i " pcdl, 't a le. t ') lln( o{ulopi lii l'o"t t l'r ulnal ic{' 1t 'r 'll lt t r t i vr t t i: t lt '
rrrrrL'osr,bilirrlr,r,trs pr,actic,cr rltale procerld.mla u"sintczit,etiopaiogenich ,,,,;,i;;;;'iiiiii" 'int,ilizi; p, r'ite'ic't',duclcrire,srrrltr'-$i ilrt(t'rIu(rl(rrr'r1')
(rlrrpri .,\r'slrrisi r.olali., 19?? ;i Popor.iciu si Fa,scu, lgg0). -
lir'
''.,1.7.6..PrtrcseL( enptttlsite itttracruniene plothrc rtlll'lt'lrnoplr'gii
1i)l'lllllt illlll
..:!..1,.7..1.l)oli. .inJec!base ;i in.feclios-ulet
gtce acute si srlbttcltte: (( )rrru ('rrilllre ttiltx',ti, Iio*ilut itrtlirtci; l)I'ill rlcPlasar.t'a tlrlor'
',rr 'hil; ( '; i', '1, g -
rr) || rrrrI'I irIi I Ir 'r-i.riticepr.imitir.e(t-pidernicrii,
z,,siiriani, ubici, prin arbo_ l ' ,,,," ,-,,,' ," f ilt l, r 'ilcr . l I I illn I i ( - r \ lscr r i 1i ( x) lr ! l)' llXii''
i, t it ,
.1..). b) )lncefalite necundare(rariceld, vari'olii, rrijeoli,, rr/ l , l l i ??) :
'r'rrsrrr.i 'ir'o1ico infectioas:'i,gripi t [ r r t r lt t kr '
|rr.rl irlili rlrirl'rnictr, n)onontl'.leozri elc.). c) Encetalite 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
rli. I''r'srr.linl*(iiilor generalo Ifebr'i, litoidri, scar.lafini, lrise 'conYulsivd,r , ' 1,,' i ,' i tl ' ;i ;' ,,iir i ii lN, r t ct r ii i0 Jl- r , ur r ilir lclir l: i' sr t 't t lr ili ct 'a'll'
iir,;rIirrltrrii,ltrtrrtttrurnii, richetis jr'ze, malar.ie ttc.) al) Nc.11ingiteacpte sau rlt'llil'lt' xitrl'
rrrrlrirrrrrlr.(r'cningococic5,_.}ncumococici, :1 Silrtlrrlrrrrll do tlllltir sjirrLrlitlitlli 1i sint[r'otttul dr' rtlrtrx
t uber'cuJoasii,, s#itis rr]o.niogo- ,, r,l i z:i l r,tl tt tttt l t it tgit iilnlt l r le r lr ilt i sli'r r oidali, t t t '1't t t t r ot t r '\ oils( r ' lll( 'l'ir sl'ilz( 'r
r;rs.rrLr' rri..) tr) J.)oliradic,loneuopa,Lii (polirad.iculoirer.-ritd, Guillar-n- t t : r zr t liit it t golt t i t '1t "
l rrrrrrl i l tl rr si t t t t st t tilr t t ', lt ll'
lli'r.(t1 r,{li,i{'tk)z(:prrnneoplazice etc.). f) Nevrite interstil ir}lc secunda,re lr ll( 'llr I lll
rrrrrrrirrlr'<rl,ii rl0 r'ccini"lato (sirr zitc,_o-tite,ostei1,e,abceseetc.). g) Nevritc 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 '
,,,,,u,i t,i i r r s1li'l 1xr 1 ; t t r t r lt t t 'o palr r lizii r t t r ot 't tlot t t t t i'or i'
rlir..ltrslrl 1i
.u',r' h,li . inlcc{,i.lrso.(tlifteria, botrilismul, tetriniiiul, s.a.) ,t) (' r'"l itrri
i " -',t lfr ',
lt,lilt
usgit t lt r t t 'lr r t lt lr t t la t t t r t 't lr i cn t r lit I t i: t zii I ] II t'Ir I i I |(' :i
lr) Nr*r'il. irnr'ro,k*c,i.. (lt.slvlr.crinale: asa-ziscle lt ol '
,,p,r'aiiziirccurenic,ial6 t r t t 'vlt lt t {it r pt t t gt 't 'r ir ll
r't I ll( J t ctallli It 01 c.) . 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 '
:!.4.'i.il. ltili ,tdaholiut: il) {)li (irirextirlc (}ri' deliicil, (lc i iirrrlinri' 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
: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 , , 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 . '
)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, (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
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 ,,r,rrl rrl t rl rr | t:t t lllt r llr t t sil k'zit t t t t t .

(l ti tt7
 i1 ' |' r r r r r lliI r ' ro l ru rrrr r, ri rr,' ,r ,l
r,ri ,rrrr. rri rrrrrl ri l i i rr rrrrrl i i l i rl grrrrri ror
,r'ttl : t lt , . it r t qr t liilll{ ' l _ tl l l )rl rr:r r rr rr,r.:r l r ' . r . t r r t r t r , ; r ol :r p l i tr ':t l r r r r r r l r .r r r r l r 'l r ti vi ti i t'o tt,i tttIIr Ir I l l tl l t:r l l r l r tt tl t'
rp rrl r rl cl rrl r 1;rrr rrri rI1i rri .,; r1r l rrr.l .rr r , 1 , . l r l l ) u r ': i l i l r tt;r i l :r r ', r 'r r n r i ,r ,:r t:r l t r r ti tl r i r r zl r i l r si l r tl cl r r l r r .

;;;ljx;,;:i;;;;1iiil:;*i;iiliili'tl,,ir,;l$tl,;u[u,;?,:,iii;1,;liilll,i:i;:i
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;i::1,";
;,:llr,,, ll,l:liii;tfu fli5T1tjl.r.,1'1''-1
rif",l#!ill1H":;L,llll"i'$iilJ t , , , , l r r r '( l i t , I ir r 1 l }i tt r ttl ttr i tti sl l r u l ' tL , ( I - I I I | )i l 1rrI l rI t ' i I I i i , r I ttl r i i |r t r | o l l :r l r r t' r
t , l , r ; r : r . r r , (,( 't) 1 .l l r ':l zi i ,( l e sl r tl r l l r r l xr r 'r u r r l i r r l i sc cl l 'r '1 ttt ttzi l r l l r r l r l r l i l
rr.,j)(i,,)
ri,,u,,;.;i,'liinl,li"li.,":,:ill;lllTlifri:;.1,:lt#f$:l;: . r U I i l ( . l t t r ( l ( , l ,r 'sl l ]l ( l t 1 ( 'r tsi l o r r ttt r t Io sl 0 r Ii Ij t'i ti r r t ) .

i;iII]';r;
ll,i .jtl;#l,
;iiii:i,,l,,r'fui:Fi:x$;l'l::;;
?t,,.Tilitlt :l-i.ll. I 'r o h l t,r r r e r l i a r yr r o sl i l t irr prrloloqirr lrnlrilarii

rl"'u[;]:
t,'rl:i:t ritiixi,liih,'r*{li:!}1ii,,li:1lfill*:*:",,",uxj*nii '. 1 . : . 1 . l l t,r l i .l i r i i r i It' sl tr l i tr tl t' p ttl ti l r ,i

,',,,,r ,,riri.,rii, I '. . r t r t t t l r t tI si r r l r c i r l p r r p i l cl r ) f ( ' Jl t( '( f l r t l tl ttti ttl t zi l ,'i sr ttt l r r 1 r l l r r l r r r i l

-ii,,,,iiii"J]i'lli,j',:;Lii:.:,".(::,il1#;:lll;,::,*ll'u',]l
:l;';:l
I jtijj,],:
i: ," 1,,;.il;,li;i:i,;ll,;*.';1,:lllli"*:;ru"i:**lulliiil r , l r i r : t l r t t r t or Ir 't';tIi |, ( 'i l tr 'si i l l i tttttl czl r l i tt r r l r 'l :tsi tttr r - :l ti .i i tr .r ''r '{:r 't l r l r r
| , , '| | r , i l | | r I r | i ( ,r ,|r i . | ) rt r rr t rr i tt I r i l r . rt r t r , i ; r t I ;t i l r ' I t{)f I r | ; r | {' l rI r ) Itttl r tl ti l l r to ( i r 'l :r l r r
.

,;',"1 ,,1;il:,,,i;il;,,,lil,li;ill,;il;iil,,re,',,,,{;ri,,
, r L . r ! . r r | l l r r ' :j |l r ||l ( l ]r 'r i ,r 'l r o l r i r 'r ,1 r ' :r l r to l r i r tl n ') r i i I l r r r l t l l r l 'tr i l L l ,,1 ) l r 'r 'l r '
ill;;li;ilii,;i ,,, 'r,'"'?i"ii,,r". , , 1 , ; r : r I l : r l l 'l I'ttl r r l ,'l I t ro I r rr :r l r. s i t r | :r r l ,.r r r .r r||r '1( l !l r i r l {', ttsr tt r l r 'l r l r t.r tl r ' l ttt'
, , , t r r r i ; r r : r r :r l tr r i r tt r 'l ||r . r L r j o :r . I|i :r r r r , It', Ir . l r r r l r i l :r r r ' l r ,l 1 L t,l r L L 'i r l , l
';l,llliili;lit,,,,tlLi,,lllli,llllllll; 1.r r r t r r i l o r l r ' ( ( l :r i ,, i i .l l r r l r ., l l l l i l i ) .
;1,11',i,l,lili,,l;;:'',i{1i'lr#l'lit,,;l
i i'|"iii';i:,,':l;,lr,,l,ilr,;liiii,l:i,l,lril,),ili,,;ililli'l,i'liJlilii:i
1 r r t;r r Ir r r Il l r Ii l r .
\ l r r r r r r r , , : r l r r r Ii l {'l |l r ' r '.1 r , i l r 'l cr r r r tr r l r r l i r l :r r 'r 'r r l o , r l r r r t tt tr r L tl ttt, r l ,
' 1 , r , , 'r r , t , l ' r 'l r l tr r r l c tl r ' l r r r r r ,l tr l
, , l r r l r l r r r r l r l rt r l rr . r l i t rr rrl r ;i r r r p r :r i r ,r
l ( ) r r 'l r
1 r :r l r r
r rI
i tr r g
r ,r r r o r r r r l tti ;r tr " tt,ttr ', r l r '
r :r l tl r r l r ' l r r l :r ,,r 'r r , 1 :r l :l
. r , , i r , r r r l r r r tr tl r r r tl Il r tr
 i' . / , , r . ; ' . . lit . r t t , l .i t,tttl r.u t.l trrl ttl rl ,,t
l t rl i .l ,.i l. sn.hsl .* )tl .i rrrl ,i l ;r,l rri rr str.rtl
. ( ) 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 r l o tti i l tttl ti l c
,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 r ', , .
l ,i r,si sl ,rrrrrrrl rri vr,A rr, r r r i 1 ) r r ( l i ( i i sl l tl i t'.', I,tl ' i r l r r r :r i o r r sl l i l
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 1 , , , t , 1 i l o r r s i r l l i l r 'l 'i r , t'r r , Ii zr ,,i ,,; '.r
: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. i l , r r r ,l i : r I i i : t I r r s t r l t,tl o t'l tltto l ta l t r i r l r r r r l r r tl t r r tr l tr tr r ( i t'i sl r r t r l i l l tl r i l i i , i tt l r l r ttr i r r I
| ;i r.r,l n ( ) l ttL i zr x:t- r l 'i cs1 l l 1 j ( i i l r o i l i ( r Ii Ii t'r ttl ttr r l t
;| Jr.r 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 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
l )u l )i l c i , i n ti mp u) S l tl )sl j A l | i ,ellt, rl i " p u r e L i a d ', t'tt;t'r ii t[t'l '1 t':l zl 'i r cttl tttl
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 t l , \ , l t : . i t n t ( i t t , t ti l tttt:r r tl ,ti ,.l i r i r i l u l i tti i ,,l i e
; 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 , 1 'l l 1 , r 1 , r, , 0 t r s l , t i 0 1 ti r q i cl i ,i kr N l l l |' l l f{'l ( 'l l tr '( 'p a r a sl n l }:l '1 'l co r l l l L l l l l l l r r l r l fl ( 'r ) r r r
:1.'l r,r i l' j', ll: : l: i ':i l l tl r r i r l r '
r ' . Z llllu r t p Sl m D a l ,tC L tl U i . i , 1 , , . , 1 , , , , , , 1 , ,s i n r p:r 1 ,i ci r ,.I) ( , ts( :l r I( r l ca , a n i zo co r i a p o a l 'c si ' l l l ':l l i
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 '
,\rii,s/arrlr l" cu)e ,,Jecteaad actiritatea pard,simp( ,,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
ix(i si se folosoFtc ( 't 'il.{r r l( '
.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 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
,' ,,,,,. 1,, t,i rr,l r ir l cont r acliei est e consecinla lezir ii par asil) r l) r 'li( 'lr lr r i"
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
rlrrlr'lrr rrrrochi normalo contrac_ti;-madmai; ^) a pupiGlor
% Uo_ :',t.ti.,t. -/,Iidriaza (creFterea dium'etrultti ltttTtilo'r pesle 4'. 5 tttttt.)
;$ f Aolir$iio
.r,'lllil I ",, i)r.oducer.rzrctiule similari,ezerineifins5 Ae 'ittensitate
-mli r',,.rt, lr rrrt,ilniltj,si in conditii nolrnale. Astfel, pupila trstc nlai
(lil'll1 il lrr
lfll''rl Ir:) rtttttcotl_nasollttie 2,5 i, ,,' I:r l ri t l'r r li, I a m opi, ll' : r r lolescenr i'
7o.nuproduce nici o modificare ia o pupil), ' ' ,,'
ror'r||irt:r. tlr (rzII iD care inervr-ti, r.pflrasimpatielosteixtrerultd, m sihii
c,,rslriclr)t'i rlevin mai sonsibili o/o-va'proriuco l l l ' .i trtti ulr ciilur t 'lt lit r
_$! astfcl hetacolinn 2,5
r,,rrr. rli, ri,. lrlpilrr.ri1 rll Ceg maj loloiitd .s/rslonldp,trusintpiticot.iiica
esie ll i(t.t'i.a,f;(t Qrtaur(i,icii se nallilestri prin faptul cti ltupilrt' lrr oclr ittl
rlt uttttt,ltt tt hldrobromi"d5o/o.ln rimp de 40_60 minute de lt inslilrLre:], ,,r l' { Hl(f irrk'sca' Inai mare decil, ]a ochiul s;nil'tos Acela6i fl]rroltlotr Ntr
Ir| )|, |:| | | r,| , II |{' i . cr pupili normalii se dilrlr] la maximum. DacJ inervabia, bilateral[', apart rt tttith'i:rzii
li irr rrhiul ambiiopic. ll :rmautoza
:,rr.t,:rlr|i r'.ir. irrl reruptir rlilalrrrr.resfe tnici salti)b;:eati. '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
l (i r. r''(.r qi/,surr rr, t'rr,rlor'
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'liu nrtzenct.fll
'r'r 'irr sa2u1 'i itr cnre inerratia sifopati;n'este '1rrrr:rsir
|,tt1rrlrr"ri. intrerupte in afarn, , t,,,.r,1,. rLpatico' Dacri lozjulei estc localizati proxi la'l tlc grrrr*litl
.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
-cocainei o activitato
;.r:rr'.rrirrrprri,i.i. ( 11'suuti,ef,cctuldilatator .aI este slab. Se poaiu r r r l cili: r l si r r elvii r t r r ilizr r t t zr rr r
t.t tt't ..t..ltt')rtt.lIl 1,,,,,l 1,,,t,gl i ,,ttlt ,(tgingiior
'o - ''iliali, slt t r li) 1tn'ytlktir'' ttptti,
gangliutt,ltri stelol cU 5 rnl rle procain:t hictl"ooloricil ol.. 1,,',r,,,,ri ,,r,,,.,itr,,tiii-La lnce4ut irsibla \t' tt nelini$"
rtr |'oD{tr(||lrol rtrl(.,l)ltpilrrdevino miOtiCddit cauza aCtiurii parasimp;_ ,,rl ,l r ,' tt Il i tttk' r 't r a f i a l: ibr dlor pent lu r luschii cilii': i' so lr it 't 't lt rsi lt t r t t t t t r r
',[le,nr
,t.,,,.. 1,,1:til,urytlegie internd,)' iir ilrtr''o llttinrri' trzi jjol',sii' alrrtlii' fiorrrt(r
lrr' rrlrrl
(1;:rr\r li('(ri,{rrrzil
,1, ,t,r,',"ilrrr,",rirpii,1r'i,a pereihii :r, III-n. Nu toli,e lcziurtjlt
l.,l lll rlurlo,[.oq.i( tt.tilizd,rii probelctr colirelor este urmltoarea ; a) Dd,od, r,rr\| | l (| ( tl l ol l l t) li( l'Ioonlult
' poi im plicr r I ibr el'1'r r 1li1'r r ''r t r sit i|1't l: t 1. ( l''llt lt t t t r t l'
lt t.tlt t ltr t :tlt'.tttith i.atiLrii,se ta testa in primul lincl cu metacolin i, 2,i t/o. Api_ rrrr,l .rr l rri l ,)rlit iger - Wr : st pir a, l llult . 1cr r z. ro, qlli'i1'r ll"' i''pogt r t lit r ii st '1t lt
lr{r:r pr;rilrr ( r demonstreazL o leziune parasimpatici:" Liisa i ,t.1 lll .:l(lr..l rxrinpltx*lrLi nu.1ut1' , rt lcr'itrttrt tl.ttdcfitii it, l,tt't'
i)rriirr',r n\:rtlltt'lsir.ic1-iei
puprlare ]trage atentia asupra unei Stiri de excltatiO 'cUlott'tol.t'tt plt llt silr llr lt lit 'i l) it t I or t l't lt ' o
rLrrrrIrrrIi.ii, r l rr, rr l l l -rl , i )oir t , o I 'oNpo{}lll'noof il] i colllir i
r,r*. |.rN{r ti confirmatl printr-rin-bkrcai aI ga'gliouului iiefii
rrlrrl,r:,:r.r.,t 1,11,('r{rler | ' rl l trr.l tl | (' tv| | | lI it lr lt t |olr t t t l; t llcont t t t t l. lt . it t t ] t lsil|ilr r 'r 'llllut t 'lt sir t t ; t ; t 1ir , t . , . llt t , ''
api-(ind ia pupilei)'; ni \icA pupUa isii
r/,','./,,,,..sr..\1',sljrrL.primul rind ,co-nsirici r' r , | ,.r| | .i l tl i ' r,llt |t l st llt lt l': t ,llt l t t ir 'r 'lt t l glit t uI ilr t r t llt t ir . ililt t ,'; i ir I t r r 't . yi|. r t 't . ililr t . i
cu homaLropixdioo. ln clzrt in car,l
l)rrl'rl:rrlr.v||r'.1i,:r11" mrdrirtici, rvem dc,r frce cu o slare d.ccrcilllrilitrto
,l' jri:.:: iar rtaci se md:e$te pu1i1, 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
l,;ll:l ll :l:icu1i, le aflaim in fa,1aui;;
ir(,,rrr, r'r ir trlrunulur simpatic. Du1ri-trecereaefectrlui homatropinei,'pulenl ,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 ,
rrr'{ r r.r (lo{liritril,.Darli pupila se dilati in mod oviclentr probibil , , ,, 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-ziuaca
r,rrrrI rrrI irriii,sc ir,i'lir,in caclrul S.N.C., iar dac[, acest fenomen nu se li t t ( llr li lr
Droduco, ' ,r l , t r.l c. l l t lllllll, ( ! <r lt zt t t 't trt t lr lr ilt zlt ' lllr llr lif it lil n: pt 't t zilt lr t llll
l.zrrrrr.rrs. grist.rjl{'irr:r,ftta S.N.C.,I* nivel'l f.ibrelorple- sau posl;ganglio- 1,,1| | i | | | | l { r)| | l ' t. r i|'llI lr |ir t l( , it t t r ilr lr . lt t t t it t lil, r '. Sji'ilisI lI lt l( |lljllg( t vlt sr lt t I lt t 'lxt lt l, t r
trrrlr,( N1r:rlrtirrr, ltltif)). r.,Lrl rzr o rrri rl t'ilt zi. p11, , "11, ilillr lr ivii 0s1't lI ipit r r i' 'l) ot t lt 'r t t t t t r lt ilt t liit 'lr tlr t 'lt lcr
( !
tr!r rl rl ti i l z:r lr olr ir ' I i l'( 'lll: ll'( f l ll, it r si'lr r liilo l( n l ' I I t I I I I tI I t '
:.)..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 ' | l i d| ' i /l .i !( 'Tt ur t l|, i|'it . iilr r r r t l, t 'l'i, i||lilt I i1iiiI lr , r lr lr . |'lllr t lllt |, iilt , ( , lll'|ll|1|j||( t
1i I0rrclirrrr.nzil rrglrll r stirntli. llacil prrlilcJr,irr
11' ,,Irootrrrr' | rt I o1r it ll( |, iIr rlf xr r ilgi( r iiir lllr lr i( r ilt lr I r r r lt lr t ( lr r lt 'l \ \ r 't t r ickr r ) '
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 , it t li't r {illr Hr r
rtrr,r.I;r I iI r r I lirir l) ir r ( ' u r l i rrrIrrl t,r,l l r,rr,l o r.1 rrr1 ri l rrr,r,, l rri ori rrtr{iilr r t r t t t t l, t opit t ii, t 't t t it t plt ci' lr t i't 't t t t t ii lllr ( 'l( ! l) r ) li
i tvotn o /l xi :or,/)f//rr./i ri (,1 l'illt lI t lt llt
rl .,,trl tl | | r, l ,' l rt t t t , s 4. t 1. ) llt ( r llllr f lr llt r r lizii lr t t lr illt t '' r 'r t t t t ir lli: r zlr
'l i'. 7il
 I ' r r r rr ' r , ll. r| | |i |(' | | | ri rI r , rr, r, l rrr r,i )r rr| r,rrr(N . rri (rr.rj rz:r rr' .rl rri r..t, \'i l l r l l l :r l l
' 1r I t ) l l i l n r l 't :;tu tttr t i rt I t rI r' t rr t t t rr t t rr ( I t I | | |r i I I : | , l r i r l l l tl i l l l r 'r r ,
\r'r,r ' t r r r t l, r r r (r , I l l l l i l )) rrrr ,1 ,. , r ,n ,l t r tr tttti l trl .r,ntl i1.i '
i t Itr s(fl rLui l ti (| l tl
' t' , | | r r ( ) 1 .r(l ( . r l r . r r r o r i i l i , i r r i Itt;r i l l ttr '. \r |r ;l' l l r sr tr i l r to r l ttr r t tr r r r i r r l l r r r r
; rl I t . r t t i o l f I t t t l to l t t t l l t i . \ l' it t i . , lr . r ir r t ( ' |, , : r , l : r r , t r z , t r r i l r . ( , i l t t ( , \ . t i J t l l ( . t l i \
t ', r r r l r ' I r . r r I o l i r r Ir ' :r l r . q i l r n r r l tr i Ir i 1 r o l l r r tr 1 r ttItti ( ;\r ';r 'l r i 1 1 i ( \r r r sl :r tr l i tr r "t r r .
1r' l.r'ir .M)lirlir il r l( ' r ' r ll, r r r r r , r l, r r . lr . ; , r r 1r ir r r r I i r r o i r I i r ^ t r r(,rJl l f ( i
l ) L l r l ) t , ( x n r 1 1 ((!l 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
rrrrr ':rlizir' lzrlrrlii r r r ) ( ' lt f ( ' lr ir r r r r r r r r r l' is r r r r 1 . r | rl r l . r 'i r , r 1 , ! r o i l s e til\.orrolrsi\ , 1 , 1 , r ', r . l r i l o l l l l , I\', \'l si IIl .
rr' if .lrriIrrzii, rli'o lr ir : t ' i, t t lt r r r r r li lt r t lt ilut i c o n l t l t k i . o ] n i ( t r i r r , z r i p.tlrrlii,i(iL
ir' ,rrrr1 r)t,i{f l),ll1 r ! i- L lr } la. , ir r r r r r : r . , r r : r
. it l 1 l r t r r i .t. tTti l r l tl i |i r l r , 1 i p g tr ttr tl I I ri I I , I ) I t I i | (' I (I Ii ttl tr ti r ,i r l r r tr ':r r 'l r r
_u1|Ll rrLoplcuiri, srrrr poltto ,\it lt(xtttt. '
p:rrri 1, ., itrli\.ti, . ; ' r , , ' lulr . lr r r r . r r r r , r it l. r lc l , o i l e r i o l l c . 1 ' r r . ': r i i , l i {, i r . i r r si r L r vi tr r r r i r |r 'i l L i r r r . r tr Il zl r l L r l ti r ,l 'i .
'l'r',lllrrali$rni'[{] cl:rlliclre o c:11'rz;rco'nun:.], a !fr,r'illiziirr)r' \ f r r l l i r r z r r i r r r i r i r 'Ii i r l i l r i l i i i r tc[a u tTtti t, M '( ti ( r 4 .ttt) r tttti !. tts.l i r ;t, ttl
'cr)rrzirt; | , , 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 '\
1,rilrili*i'. Slirh'iilza lloate fi con-(ecinla, lczririi dir.cte a tlunchiuhii (1ercln.rl,
rrr rr .rrFirrrii, re-qp{lctiv a cornplimirii neryul r1i ocrlonrotor 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 ,
cor lrr.
r l('zirr,ilc nuclrarer oftalmollegia e..tc'riri porrle Ii completir,,i'sii..irr. 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
,,1ii rr rL' rrftnhnoplegie.intcrnri. r\c.rLstadil rumil rplre r:rreori sillgurii. , , , r i l r : r z r i i t r l l ,zl r r l c i r tsl r i t'r r l i c a tl i ttci i .
Ir ) l[ idriala sl/asticd,e trtt co'socinta uno. lezinni iritatir-e are cr-r,ir'r
rrrrrl,rrlilr.l)upilo-dilrtatoare. Acest fenomen a,pere in contextul sirdro. . '. l . l i . i . l ll i o .tr r ,( tl i r r ti l ttl ttIr t i I i l t - tt t r' 1t t t I r t i 1 ;ttp i l l l t'sttl t i - l ttttr t) l t;tl tr | r ':r
rrrrrlri lrri Portrfour du Pctit,. care cuprinde: midriazi, lf,rgirca farrloi , ', , r r r . r . r 'i n l i 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
I rrr| |rr.IrI irIrr ;i u;olr.ir. cxo1tamie._LTnc.orise asociazli ou vasdcorrstric{,io, 1",tt., l,Iit 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 ( si l ttl i ( t') .
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 ll l r : i t r . r ti o ,l .t ct n l t i l o t' 1 i ci i l o t i n .l e r i .o a r a
'' ryi
rlr. r,orrvr.rgcrrlir, sint prtrz,ente,sal doar uqor diminuate. ln leziuni progr.rl 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 r tl c ( i {r l r tl l l l l l i co ttsl l i o l ,o r r r i
't )
irir r', slrrrlirrll,.clirninrr. dc irita'fie simpaticil trece intr-un stadiu d;deii(iit, , l , r : r r k r r s l r l c o 1 i 'r r r l l i l so l ) l ) r 1 ( ' i ttl i l l l i i r I: h e r n tl t'l g i i sa u l ,l l tM r ti l ) o l l l ,l l l r '.
i irrrptri i. si , l)irrj1iir consecutiviia miozei paretice in conte)itul sintlrotn.ului 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
('lr,tlt l, ) n.trtd-Ilornr:r,crne estc lniti stabil qi mult mai frecvent intilrril,, r r l r : r r r l r i l l r r r r , l cl l tto N , l ti l ) r ) \i ( ' r ,r 'tr r l r l l l '1 scvt't'i l t'1 c. ( ,Jr tttl :ttto v q i l i ttl r l r r ,
Sirrrlrrrrrrrl I'or.r,lu,r,rdu Petit se inLilneqte in adonopatii laterocervir:,|r,, t,r,, , ('lursi(I,I ()70).
lr,r;rlrrlrri llrll lr ctilo:,lneicgtvicale,traumatismo ver"te6romedulnre ocrvi(xr l ' ) i l l i o : u . ? a l tl i l i ti i 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 stl r tl r r r l i r ',,
rl.rrrrlr', irr .ilr(l{r'ul si in tubelculoza Tirfului prrlrnonrr, in ttmori mrxlirw 1 , '1 , r l , , r l i l : r i , l r l rr i r l c l r l r l i zcl zi i r ,r 'l l l r i r ttl tsl l t :si tr L n tn ttl . ( '1 l u 'ttd l l r u tr l
Lirr:rIr',rilirrgorrrirlio,tnttfltlite si trtmnri cerebrl.le. l l , 't t t r t : t | i o r , ^, r 'r r g ttsl i r t{'r t Ii ttr l l 'i 1 ti tI1 tt'Ir l r tIr isi l l l o l l r i i {.tto l l l l tl tr r i r '. A( ,|, r i ,r l
, 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
llll l,i:irrtti (ltt cenlt'ihl' gi crl,ilortu:perioot a r r r L l r l r r l i l l r l i r l i tr ci , r ,o r r .i r r i r t,li r t'i si r t r l tsr 'l o l l i tr r i l tl t', sti i tl o r t'r l r tttzi l o l r ,
.l ,l Ilrrlr.irrzrr1r.rr1,'llio)r!irr*1,ioxpe.imentalprirr inllibitia co]11.,1.i , 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
,lIi(li(,r',.ir |r,zrrll,rr.l,
1rrrIrrI.r..rr lrl stirnuliirii cortoxnlui ft.oltal !i :r,Ihip.1,rr, 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
rrrlrr. ,\lrrl'irrzrr.sii' rrlri mruo tlc p:rrton opusil stirnuliiii ccirtiorrlrr,
lrrrrrrr ,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
rrr r,lrrrrrl,r.rl. rrrrr r.i I rrrrI:i lr0rnol:rl;i,trtl
in stimulirr,oathipot:llarnusul tri. , 'r I l i r l r '| 1 r i .
ti ) ') 'tt tt t ttt.i I t' ltr)d)t, l.r, rruri iiltrs (jcle srlratdrtOriaje, e\etcitii el:rtl,, l t \ 1 i ) t ) u : h i tl :i t'l r \tl r \ti o /,i \ ;r i ttt1 l r tIi cl ] i l l {) i .1 tl {'N tl i i r i i r r s( 'l ( tr }7 ,:r l r r l r l
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 ; 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 '
r rr.rrrl, ;rrtr :rlr. r'cl'ltrrclol totornotorii. S-a flescris midriazi c6ntralat,rrl*iir I' i . l ) r i s l ( 'r 'o i r r l i ,r 'i o i i r r ' ( si tttl l r r r r r ttl \\'r L l l cttl r o q , r i r r l t'o tttttl l j :l l ) tl r i l ,l
rrr trr r r r or , lri , { 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 , i 'l i 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 r i l r ttl l r r r t( . r i ( ' j r l r r r ) l r 'r 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, , 1 , r r o r ': r I r r r I r tIi I,i o i i ,r l c l tr u 'r ':t;i l ,l ) l r ' r r t Ir ( r '\'i i ( '!r l l i i r 'l r i l ( 'zr l l i . ( ) l ( zi l l l r t r r l
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 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
' " , i t r t , r t r t t i ttr l i i i .tt.l tti o u r tr
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 ) : {'l r r r tr l r " l l l t r l r tr l Il o l ttr t'. I}( ' I ri lr ,r l rr' I l {' i r , :'i r '\l ) r i l l ( l tr tr t r l r tr 'r ' tr
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 ', r r , 'r r r
, c pl r.tei r rrprN i t. 1 . r t , t t l , r i t r l i ti tti l r tt n r l ti r l i l ttr 'l to sl t ti r tr tt r tIr ' * r tl tttr ttl tl t]t t( tr i t4 l t i n i ttt,',tt,
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 , , , 't : , , r l r . \ u l ) tti t) i tt ( 1 r :r r 'Ir i tr r ctr i tIr Ii L i l r r ,'l i , r r , l I r l i l o z;i . l r r r l r l r r i r l i r r r I
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 r i l r l r r l r . , l xr r r l r r l l r l l . l t( 'l tti tto :tl l l {') . l } l l l l i ti l r r tti l l r l l r I I i I I I I I 'r ); r | ! LI l.
,..tr.: r r lr r r : r l: lr r ,ir r r u rl rrrlrrL
, i rh ,i l i z irl, e p a rto :t, l czi rrni i , l l pi l i rLc pl rrl el r, rrl rr* 1, l t t r t h i u l , tr tr tr r l r i r .r i ttl t'r l r tttl t':tr Ii r r ttIl r I l r r l r l ,.i l l l i tr l i l i l r Il l r l i ( i r 'r r r
,r,,ultti
(l rIrrr . r r r r r l r |' pI rrs i rrrrrl i rrrrp o ri )s i i n fl z | , l l i [al l -r,o rni d.rj rrzl iI r i I:rI ri r.rr|;t, I r r r l r l , r ') r ; { ' r r r i o {( vl ( l c Jr i o zr rri t r t I rrt i i t ' rr . l ,.i ttti l r l r ,l ,r ( i r r ' r 'i r tr ' l }r ttr r l
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,: 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
trrtrlt i: r z : riI s ilr ilr ' ; rl i I g ) i tt Itr^ tl rl o a tl c l c s r tl trl untl o rtr)tri ct. : rrri ,rai rr!.i r r r l l r r r r r l r i r r r ;r r l i c r ,',t vi t'r r l r i .i r r r t r ttl r l r r l r t ( l tr ttto t i l r l ctr r r I | | I I | | | | )| | i | | ( ,
l: r | , ) i l l : r .
'
l | | l r - r , | l l r ) z r , L tl tr r l }|i r tt|tIi r tr 1 i Ir r Il r ' tl ti l l l r ', l l tt( l tr r l d l o |i t\t | | I l ( ' \ ' I Irl I I I t ^ l l r '
( r I \ lr r r lili. : i' i l . Irrp i l rU r' :r1 l rl rl rrl ri Itrr,rurt,rr,ri stttr' r' r.trtti ,nr' tr orl r r ; x " r 'r r ( i i l o r :t{r i ( ( ) . l tt l r l r l r , tr l t ttr tp tr l i i l r l l l r t,n tt'ti n r l t r r l i tt:l r r l r ': r '
/rl rrl r' r i r it t t l r lit lr , l rt' { ,i o rl tl cri u 'lllril :lsvrrrri
i l i tir,(,i t Iczi urri l ol
rrcl vo:rl r, (,\r,i r.l rl
-l rto l r r l , r . : r r l r , f l r r l r r ) n r ( 'l l r r r i l r 'l tl ttr r tttl IIi r ttr l t IIi tttIr l r r r tl o :ttttr ', l r o ttl :r l l ,r r l l 'l 'l tr )
ri r ()l u r . : r lr , lllil: ) . l l r l rl rtl ti l r ttl ti l l n r\' (, l r, l r ol i trl ,i l rri rl i rl l i l rzr,i l rsi l :r,l r,r.rtl tr
I I r l r.r, l : l l r. i I r t r r t t I I rt t t l i i r rI i I r r I Ji I i rr' I I I I I I Ir r l tr 'r t r l ,r t ,r , r tIr r r ttrr Io t i l r r r :tl t r l r r r tr ':r
l r rrllr lr lr . : r lr r lr r lol l r.l l l rr' Irr, Irrl ri l rrl r. (;rrtl r rl rrrl r, l i l l l rtl rrrrrrrsorrl
I ' i r r t t t , I ( i .tl r ':i l tl tJtl tl tl t ttl t l i tttti ,,r l 'tl ,r l , t|I) |) It,||) t
'r
'i l
 lll l, itoti t tlt ttn lttl,,r ,,tl,t .) tl) t t i t)tu.t.
:t , , , 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
|) tttrrz]t | r r : r lr ' lr p l.,r r lr r L r r lr ,r lr !ll,L lj.lt!: l r r.r,l l i l rfrt ul tl i tl trtl tl . (.,.1r. , 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
rl, rllir i o ! r t l r ) ( l l l ( f l l ( . S i l i ( . Il l | | l t \, r .,.1 :tlr \, r l 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
l ri kl i i (l t i I I i ( I I I r I i I ti ,l l l tS l ||l
rtrl rilr r l. r ' rri i rr.rIrr I i(i :l ;{ ,1 )r' i rr (' rrrrl r | { ()rrrr .i .i ot rl i rr i r 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,;rl :.,r,s. r' r' i rl
:r(', I I r|_(' (IrrI | rlil r) ii -l l i ' rf\l )l i r' i r rrrrz r (l i l Iro l tl l r, l ,l uki trsotr, i !l n' r1,fi ri u\rl )zi r, , 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 '.
.
i, il) ( ' r ll l l l s i rL (j r i rrr r': rr,r'rrrrr:rrrri
|r"r'r' J r r ' : r I rlr
fi l urol (j fnrr,1rri ,i 1i rrrri rrrrrr,rl r,si 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
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. , , . : 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 '
'.'.'l .,\ "/). lI rd,,iJic ti r i,le d,i,nanticii,p tt il.jr c 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 '
tr)
, 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 ,
ll 'l'ttlht.cdrile relleaului ;folomotor apar ca lezultat al leziilii oljcir.ci ''
r , , i , \ 1 'r r 1 i r r l i l rl i l i i , e ste l r o d u si n d c a ti l ) g e l e l fi b r o l o r l tL l p i |r - tl i l r tl 'i tl l ,:r tr ',
1,,rr'(irrrrirlirr comlticata sa cale, fie peTea uJercliii, fic pe ccrr, c/r,ilir.lri, r', r,obolitrtl de la regiunea tuberiand, trece in fatra corrjstu'ii l)osl,r'r'iorrrl'.
lr rrilrlul un etiurLilot mezeuccfalice. Existii" dozd eucnlital,i[iiti: f icr(lor{rir singulari, a reflexului lotomotor (sindrr.,n 'ltrllll litfurlst,tt
.1.)
.l'ural.i.tii 'pztpilure &sacial.ecu trulburdri de uerlere, L.l ulrriu.(, :r, i,/r, l so porutc intilni in: tumori mezencefalictr, cn(rcti[lii,i' lrrl'rttgir,ri,
rrtt)r' l(.zirrri carc afecteaz5, atit fibrele pupilare, cit qi fi].licle opti$f, ,lLrlx,l za,ltultt, poU oencefaliti , sclerozi, mtltiplir,, a,lconli$nr, zrrttrl zrrrrl'r,t,
l)(! -
I|:||(|r.L.rrIlor comun (intre retini,, rii zona d.inaintc:I coryibr g;nicril;t,i r r.llrll,i,islno Oranio-ccrebrale, In acuste cilzuri fr.rlorlr(.ltl,r sirrl trrrilrrll
, \l,r'ri, lrr)do fibrele pupiiat:e se alespart cle cele optice) i .r1,..Iiiril, rniozli, li?i,rica pupJla si, fie cxcentlici, fi ru)rcgltl:r1ri,i:rt r',islrLtrr
:t\ I'u'rulilia pu?ile,rd, amaurotici, rezulti, dintr-o leziune tlistraetivii, rl lr liolnNl,i'opini:i €)ste evident ;i rapicl.
,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,. I l)'lttt [bu,r iir iLe r eJlelx*lui. [,a'intuneric
lrr iir.irzii, r'.110(ilr'corLsensua,lila stinrulare; luminoasti a ochiului'si,ni'rl,r)$. ' fer.l al , liclilextrl pupilo-tlilatator la intuleric este Inult rnrli vttlttcrrrlril itr
I rr llz i.rrrrilo. r.rniLrtorale, rlc obice:i prrpila F"stedilatati (midriaza arn:ruloticii ,,,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.
),
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 . ,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
lr) I'rrroza, pupilarl ambliopic:i apare in cazurile i]t care leziunilr I l,.ziurLilc de trunchi cor,cbr: .
rr.l irrr,i srrrr ,kr'.r'.lui optic slnt irrcompletc. Rc:r,ctia lulilar:i la I'ntirrl lrr oazril in cale ac1,ivit2r1n'.1, pulilar'ri a lrlrui ochi osto ([ i I r] i r I rIi t I l L iiiur
..i. l..l:'i 5i p.rrlurigit.i, a'tit cea dircctri. cit ,1,(,lirii, r'efiexul consensual la intuneric, pro\.onit rlu lit cclilrt'll, ollrr,
6i cea coirsensriald.ln lczirurilrr
unrl;ril rrl(', (x)lll,rincfiia,consensuali oblinuti, prin si;imu1::r,reaochirrlrri
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
rirrrrl,s .irl. rr'r,i nrla.c rlocit r.ir,spunsuldircct la lurninii. pareza pupil .ii, ,, lrrrl slir iitos este stimulat qi cdiilalt este it,oop(x'i1,pttlilrt, rir'tttrtIo:r:i:r
i r| | | | )| i(| | ' ;r' i i rr iirs1,d.solisii iu nc-r'ritelerctrobulbarc, leuropatiile dlabd;ir*, , ,,orLI,r'r,iri,ri nolinal. DacA se ilumineazi, oohiul zrfocl,rt1,;i ccliil:rll, r'rlr,
r r rrrr r lr lir r lr ilrI lr lr r r g i r,l ' r_ i o ( 1illli1lr '1r
,,,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 st lt pt it r zr r
llit.ir l('zil'r.rt .iiikrr a,lirro.tc se g!'tseftc Ia nivelul chiasrnoi uptirr. ,, r, r'. Airr.sl semrl a fost doscris in neuitele t'ctrobu.l,lrur?.
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 llll '1.'t
tlln r,rd,ril.e rel'l,eltnllLi. de a,ptt'opierc (tlc ul:trnndlrc )
rtr ,'r ltttli ii ltttpiltrl h urt..iurt oltsice (rtrxti-,ia hcmialopsicir, :t_ llti 1,Vll .\llolilL';L jzolllt:i l pupilooonstrioliei ll ltlivitt'tt aprtltltrr /sirr/torrr
trrr'l , l | ,r' :,ri rrrri Irr ccrrl llr.lo trlo
,,rtttrtrl, ^clilsrnei 11roduc
o lr,rralirie yr,pil u,rd, in. lnttll IJri*:r'!totL itn:r:rsu.l, ) a fos1, tiesorisii ilI olt(xfllirliirl,(,1)i([('ttri(jai
rti itt
ri ,rtlr hil(tt)?oftr,lc, i.' i,ianp co lezirlrLilelatcrale ilr'chilsrrL.i r' rrrrrlisr )t|r (ilt,]iio]l{r clt intelesat'o1l ol'bitci.
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. NV) lrlrrrliri Tnrpil.uri:lon,icc
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, ;,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 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. ," 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
:t) l',rnli:.itt. i:t;kr.l.,il rellr.t uLui ! | rr'()Il |()(Ii IJ r' .
. .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 ;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
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, 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 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 ,,,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
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 ,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
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 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, il r
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 ,, ' 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
tt, tr.r ir t r s lr r . r . ir r l rrl rc s s 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.
;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
l 'r' r ' ' . llr \ , lr l.l: r lr rrrri rr:rl rrrrrl ,ol i k rrrl 5 i i rrIIo r rr1I| r,I. l )rr r,,l l rrl rl ri rrrrrl l l rrri , ,\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 ,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 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 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 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,
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 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 It 't't
 I l ol r:l l l l ,' l i 1 rl l r' l rl ,rrrrl r rL \l ri rl ri rl (l l )l r' 1r' rr l l l ' r1l l r | )l trrl ' tt
'l'
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 r r It|rrl rtl tl l l tl tr' 1r" I1IrrrIIItotrttI Ittl
i tl ,tt i tt't l l r, li l (1i l t l l i i l rrI l r Irrr '
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 . : l l l l l l l rt r l l r i Ittrl |rrIr' |rt l tt ttt
I r ,r'l : :rl | {r||I|II( .|I|tI| o1o.r ' Ll rrtl r ' ttrr' ttt;tl l t '
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. t t r t tt l t r r i l l l l l l l' 1( t I r )I
, r,rtl :rl rrt i ||I(),|l |I |Ii I l l t trrl r' l rrl :r1" rl rrr.l :l rl Ll /' l l l ri i l ri t '
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 li ; I l( 'li- ' l1l{i? r 'ilr r li r lr ' \ t r |. t t t
r rt,\,,.11,\r, l l tl l ; ( lr r r r lr r 'r ', r r r l, '1r , 1, .lilr
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 {,
,()l ,l ,rr'l l , l 1)?l ) ); l )l ( ' rt t t t 1t t t : ; t t r t t i t ts ' t.tl tttt (rl ttc V ti s l ttr' rl l r' l l r' { r' i ti l rrtz i l rttr' '
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, r:r' tt' l tr' l 0l ts rr s l l l )t t i i )i l r' (' ' l (s tl { ' (' l i \
l l Ll i l I
rl i l ,rl i tl tr', l l l l l ,i l l i l l i i i l l (' l l l l l ' l !' l rtt
,,: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 ( lot t t 'yt 'r 'sir t r tI, ir t t Iri rt / r ' sr ' 'lt .
, r rir' . )i ( i) .
, ,,I. , ,, , ti , ,, , ,, ,, i i i r t r '( r . r 'i, r - v, 'r r , r r r$. . . r ,ltt igllr t it t lt l' r lr '
,rl ri rr r iI ir iji) lc s r ] ! i d e l e z i u n j i rr g i rrrg l i o n i i s p i tal j , fapl i rral c l rI r,xpl i Irr fr '
, ,1, rx) t lll) l'{lsillllil( tf t t t t t ot t llt r 't 'clliizclt ziit t lt t lllr : ii
: rr.l l r . r . i: rI r si. ( r { )ci na l i n o a F J. i ' l ri r,ci , ( lir r l": 't r 't t 'lt t 't l'r
1lir t ( '\ islli sr r , t liiii iir f ar '( ' t lllolo lt lLuoli
iu rtisl.trtfia i)tltsc,ulat'd ntiotolticd, (boala lui Steinolt) lr [os1, (k'N('ri$rl ' 1, ,' .trtttl rtt, ; r cr r Hliu{" r r ! - r r ir r t {i( }lr r t r (l)'), 1'
,' | ,,;;,;;;;;; i i ' ,,i, , , , i , , yiir 'i, "', ""i0,) r L( 'uLir r ur lur . .
urr'(,ri {) l)upili mjotir:li cu contraclie lelt5, Ei slabi,la lumini fi cotrl'('r.g-cr r1ii . ( Ar seni O l) r cst ill'. lll71) ; I ! r xlr 'r 'lr lr "l'
' ' rrIr' rr trcvtl tl g ii ( l{1 lr ip plu}r it ir ' ;i
ar ier iosci. r ozir cer ld; r li. r ir ir r . l 1. . l1) 'il; ,
1,,(;t,)-/t ) /l l ti lit ( lof ! , : a1{r lo- - , si .( rtrr'l'rr
lt) ll,i.?,pltsul 'lLtpiiar ciJnsti'l inttlo serie de tniscriri allcrnllnl;r, r,rrlrirlr, lsrr) ; rr,q$qioilr'ccrel'rirl';'l'ttllttttiiti
,i, i ,r,i'(.r,,'ii{i'ilii""r"ii,
rll' r,rrrl|rrol,ie {i dc dil:r.1atiopupilar.c clonice Si ritmice, amlli, |Ji d{'stnil rl',, t t r r t lr t r ir " t it vt 't r r t '
1,,,1 r r' (tl i rl rt' l , ir k, , , blism 1; llncf u boli inf r : c! 'iolr c ^( glipi '.
si ( ) lr r ( 'r r r : r r '
r{ r'lrlirl0, cNre intol'cseazil irisul atit in lepaus, cit mai alos la ,,lrrovocln clr," , t t t er , 1', 's"l, '. , , r t ir nult iplir ' t 'nt x: f it lilt r ( At soui
rrrirrr,rrliIrrr' l)Lrpilare (de piltli,, cn ocdzia eJplorirjl reflernlui fotornolor.). ' :," ' , f i ' | i ," f," ]r 'r . 'i,
t' r,i i i I| )(Lr' (!lr t n'lrll) {ii) .
\{,('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 (.
:'.ti./.:!. N (:1't'rllgiutrillemittalti secuntf,ard'( sittTtkttnulir:d')
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 ( [ lt l) ii' t r t t r t r sr r ; 1 ir ',
{ ,l t,i ui l ot('l( ,t Lt r r - r 'lilgiciLr isr lniliill( ' s', ct lnclilTL'silli,
prrrlrilrrr'")(liis(!', l9ll2) ; c) miastenil gr.r,\-is; d) rl1]eori f:il.ii valoale scnrir) t ''it lr ( I c lil' lr t r \ l
,r' r,,l r,' i ,ri ,i tl , r ct , lc lilt , nt 'r 'lr igi''i , , 1r ir ni1ile", r lt lt ''r cr t
l .r' i l ri r lc lit r iir i ( 1lis tr,, 1 l )i ? ). f t t lt t Lt t lt I t lt lt o i
,l i l pi rr,\i \l ,i oai, olt llllll ll( ; s coir t inr i', con^st iuf il', 1xr
r oYr ||] gico scur l'c t 'a' it l t t r r vt r r l'1i: r
r' rr(' l rt' gt' r r f it I llt L*" p, , a, , iir t u"
I' ,,,,,,,i - f ie" s im pr tl'it 'l{icc lir lt 'r '
fi " 1" ] l ir r pr r dur it liit r t I it uzc ct t ' in
1i 'llgiilo ([(f
1i r,1' . i tt si atlii t nr t i il, vr lllslll( ' ir $isiin( 11t - so la' f cnt nnclt t t l
"ir t r ( 'r {t it r .
)I],. I'IT0III]IiMI]I)I' DIA(iNOSTIC , | | r| , .r'r ,i rsrai, ) . 'l'o tlltlll,ttrltl so stll l)uin(l serltltc obi{fctivo: .ltiprttrll'r'zlt" :tltrtt
iN PATOLOGIANIIRVULU] TRIGI,]MI]N '
, i ," .i ,, rrr.rr lr u iuir , i, t ,r u, , , lt t t ilt , dc sot lsil) i1it i! 1, i', ln t t ivr r lLr l I it r lir r r t r t l
: r t t : tl t l n i rr , : r r . r I
' vlr lr r i lr r t r r r r r r l
,' , ;1,' ; ,],1'f , , , t t i'1t t t r '' lolxr gr : r l'i: ' ' '.
", t t l! r 'l|, n r 'iit ( r 's{'lllJir lr r\ l r lI I 'r 'r r \
' ;' ,;;'rrtl
i i ,,'| ri l l i sr r elit ili t l'illr lxt t lr t i c
;;,:j . l) l( r l( t ( 1( "
:!.ir.l. Ntvralrtrit lriryerrrinalii " ,:r- 1': r . r r lizir ' 1i r t 'l't 'lr ' r r
f iiuii . t i. , t ut n ; i r '. r r t r lcinr L
. lr r . . ir . . \ , . 'r 'r
r . : , , , . iir zr i tr ut
l, ,ir,'r l'i, . r i. l. 'zir r r r i . i : r l' : , 11, 'l
''.;t l-1. \'rt.trtlrlirr.lri4c,ntinriri,)primitil)ii11sr.r,u, i,marir1)(irnproprirr ,,, ,..| ,i i ,,,,,,., i, 1, , i, ,i,, . t r r
,,pt i. il''' ; 'l|; , ; 'i i'lt '' . . ' t " t t t "lr r ui' r ' {ir "t r t t 1r r r t . z'' / r 'r
il, rrlril:r rrror ,.irIioIIIIIicIi)I) ;: ;,; '
irotrsliluieo cniitate patologicli(sarrmai lrirrr, ' : '
r ,'t til;rlr 1r:rirrlrqilr'), I r,.rr'r' rr
,' :t Lr,;lczi t'
1x, I t ilt nkr t t t 'pt ll
( x) l) t tlr-lir ll''l( t a I ) '
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 l \l rl l (' \l rl l r 'lit Lir r t t t l ( r f ii'r lt cllzi sl) f o l) ar ?: dl(tlJu: ! it t t t i t jt t ii't \ ! t st ) r t t lt l
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 l ' l ' ,,,ttl l ttr' :
' 'l it xt 'r d'iJ{)l) ill1r ( lii r lt r t t lr li t t t t l'r l
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 1' ''l ' ,ttt,,' r il, t lt lo: t ii t t t 'r t lt t r t liiTt r t slr t t lt l iilt r 't 'r I t t t t r I : r I
t r t r vlir lgiilor 1't 'igt 't r t it t : t Lr
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 I , ' ,, ,, i t I, , i i , ,, , , , t I r r I iir t , ir lclr lci
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 , \r rr.tri rri ()1 , 11'"( - r l,ll) ?1) ):
,,'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 ' .tl ' l ' trtttrtilt t t lt ir lt t 't nr t ilt ; 1' l111r 1t lizt 'r trzli Ll r t lr it r ci lt r t t t t qlt it t l I . , t t lo
f t '( lllr ' ( lo: lr
, , 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 ,, rr' l rr.l rrsrr,tt, t t t t l, 'git lt t t 'lt ., it lr llt llt t r t t ir t ) i, llt ot lt t oi; t t l r lr llllii
, , ( 1ll l( ) ( f illizllt '(trlr , r . t llic|i ill ilt ll{ q lt 'l l
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, ,, , , ,r , ,, , ,, i l ( lll'vl, |lci( , 1r 'ig|t nit r r r li,
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 ( '\ iit r r i si ( ) 1r r cst lt , 11) 71) s1lll.
) ill. i( r 'it t r lit r l lr t ir r t t t t t t t t r r t t
cii ol ogi ,.J i i i Lnttrrrrir ,,,,' i ,i f,i tI,' t,,L, , , f ( ) l) 11't 1( 'll'l1i'il) ) '
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, , rLrrIrr| r' (()Ii r |i t r t t t I t , l1) 11|,( lilr r l' t lr r '\ t st "t r i f i
,,rr rl rnlr ' iir r , ( ' \ r ' s c t r i s i (rl x ' c s (fu , l 9 i f)). l 1 t'ttl tr ^ l tzl i tttr vt'l r l l :- i i l t i r l t'l l l i l l l l l t' rll lllI
l t 't \ | t t t i t t t) t||tt( I'( ' r ttttsl i tt
Ir r IIr r r l i i Ii Ir l ti ctr l i vr r <l c I0 t t i I r t I i I I tI ('
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 ,r 'r l : r l , I r )I ( I i ' i I t I I I i I r 'tl Ir r t1 r o ]IIr tr Ir ' ttt
'
rr. rr lrlrlr, rllt r tntlqnisnt,l, putorrcnic ii,cl,iotx'azi ll, tt.i,lt'[,t:ottltttI lt'.1,r'l tr l r ( {) l i .,r t lrt i ttr r i tttl r i 1 l 'l l i o tl '\'l 1 l ( i :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 ', , i ', , , , 1 , i r , I r r r i l ,r ( :ii )'i1Isi l r r l Ir
,1 ,'sr ',r , 'r r l
l i
l i
l ,(
i l
tl i
l l
, r ( l ( l ( r o l ti cr t tttl ti l i tzi tt, tl ttl r l t r l l o tr l t'r l ttl
l l rri rd). , r l . 'l r l r ' , \ r ', r l rr i i i
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 , l r l r r ', r 1 . . | ] i I l ( | I Il ||l |||'l Il |],.||l l |l It|1 ( |r 'r 't'r .l tl 'Ir r tl ( |,||I) t'l '( 1 1 'Itl i l r l It|( l t'l ti l r tl l l r r ttr r .l r r t
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 , , r r 'l r t l o r l I I I i I rr Ii Ir t'r ') l l l r r xr l l :L l l i tl r l '
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(' l l l ' i l r k'l l tr 'l l ( 'i l t l l l r l l
si tl t, l i ' nrrrnr.rrcrl f l rrrl i , r \ , l l t t t t t ttl t,,tr ttr r 'tr ' l r .l 'x'r | | 1I:t | ( t i | |t I t t t l "l tl i zr 'l tzl t'
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 , , , . l l a ,l l l l tr r r r r 'l r |l .,r r 'r ';tl i l r ttl l r t' 1 1 t r l l r ,t ttl l l l l l r l t\ l ,l zl l t l
, r l r r : r I r r I I r I r : r r ,t.\ i l ( ,r .
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 \l
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 (.r l|| lll7 l|t) ||r'\ r . it l. , || I I r, I ,. rr r rI r r |, , r r r r r lr , lIll(,r)rr ]ii,ll, llilrr(1o (Ali r.ltl l , : r t r 'r r I I i r , t I r l r | | l| ( ( 1, l l l |r frl !( ' [ , l l n i l r ) ; r l ) l l tttr r ttt I I t t ' I I t II I : r I i I ' ( ; r ') 1 L ( l l r l l
,1rI ll|lr.ti( |l, l!l/ll). , r r r r r r r r r : t I r , | | r | | | |r ||1'rL l I r , r 'Ittr r r i tIttItti ( ,\r sl tr i r ;i r o l l r l r - , l l ) , 1) ; l ) l t rr t t t r t r i rr; t rt '
'! ) 'l'tttttttilt: t lr (.t ,t | )t t t t I t t | :
. lux t t r . , t , Lt , t l, t r t t l, , r , it r l i ( l r l ) l : t i , r r | , r 'u r I r r r u , r 'r ':rr l r . l i sl r tl r r t,r ttr r l i tl o ( i i L r l l l l o i l fi {' ( l i o :t'r ' sr r '{r l r r l r ., l l l ( ;1 1 )
,l ,. ,\, t,tlilIt,tI t lt ( x t . lt t r . t r t nr , t r t tt lr ) A q , n , q l . i . o t t t r l t tl.rit i . ( i t . , i , . r , : i i , , ; , r t t
, ''I I , r '. t r r I r o i | r '| r i It r r l r si ttttsr l l tti ( i I\( fl 'l l o i r I l t) tr tctr i tr l l i l r ' l r :r z:tl , tr r l ttr r r t"r l '
tt[,. t tttltt, n n, lt,,ttt r ; 1. , t : t ir , , . |, . , . t r \ r l. . 1, , 1, , i r r r r r , . ] r l t , t l i . , r . i , r l i r . r , : l . i r l r l , . J , . t . r l i {i r , c ; i ) I r ol i r l ti si sl ,tr n ( l r o l l l t, l u i l i r r l l l cr ') .
rrilr:r r,rr |r'||lr'\l ( ' l Llr j t k , r i||ir l ( lf lr ilr oc s l. r : z i e l , t , i ( r , l r r i r r a l i j , r r tt r r tr l r r r r l r .i i l
si rl0 ptrrr.ztr i ) ,\iitttlronul a l o l cl sl .l Il L tr ., N fl o ci tr ,zi o l tl i l tl l r to p l cl i l
rr i' i.rrr rrr.rrrrl.rri ntot or ' , . dul( ' lil. liir r L ll[ ir r ce p u t I o , L ] i z l , t . r](, (l slrgrr.rl 1 | r r . r i r r r l i i d e a ce e a q i p a tte .
r'llrullr it 1r'ig-crI1elului,. apoi ill l)r(xl progresiv extinzitulrl sr, p0 iLrl|r,ri 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
t,,ril,r'ir;l.rr.r.v-,lui$i chiar cu ir'.{.l.i".iceri.icalo(}iasm'ss(,1l,lli{;i), (.il,rl 1,,rrr o l ara lizic a per echii : l Yt r - ir '.
rl, \rsrrri ;i Olxc,scLL, -
19i9; .Riser,1?I2), Un scmn preco(c d{, rll(,r.jr(,1 9 ) Si.trilntmul ?aratf i,lleminctl td I'tti .Raer.lrtrsr' (rillrlirl('r'izcrtzit pt ttt
:r r rrr{liorr0llri lui Gasser este kel'atita neuroparaliici, (Iiisrr, .lt};;l).' ,, 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 '
l.t) illair,[lrgio.a,rnele
d.ecal:um,Jf eckeli,cle ob]cei invatleazii i,ngli,,rrrrl
. (l.rss{rr.
lri
r.rri lllnrr $i paraiizii alc fcrechii n YI-ll.
?oster.ioarr.produc inili:rl algii de i,ip nevlrJgir.,
si r:lirl_:icina l0 ) f i.ndrontn,l tle r,:isplnlie ?eLro-sfenoidd,l'ii ul lrt''i''lu''ul t lrtliz' rtz:t
rlr( r ir)r' ([(,vi]trirrdcontinue insotindu-sc de imlortantt' iripocsiciziri t, :ri rrti i nul l ,i plc t 'le ncr r . i cr at r icni: pcl: chilc I l, lI I , lV ; i Y, 1r r 'lr t it r r plr r r r
(irrrl.rrs.lri po tcrit'riul primelor-$i doui, ramuri) si dc riiminuarea
relle-rrrrrri rlr'irrlu-s(. felralgia o{i,ahnicri ii }irratljzia, dc pcnrlrtr l ll.
r'r)l llt illl,
11) ,lnetrism.elc de (|'rterd. bo'zil'arti ;i. ntal,.f o'r'nn! ii It .trtlt t'i.t)rt ttltttrt
t) 'l'tt.tl,orile ntaligne nazo-faringiene (ittd.eoscbi carcinoilme si srrl
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'rr:rrrrr.)irrr':rrlt'uzi\ b:.z^ crnni]4ui
fi afcctcaz;i trjgcmlmtl in Z0;;, (litl 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) )
(,ir,1ru i ( \r',\('ri ;i. (\trcscu, 1979),,fic prin forarnerr oralc, fie prin {oi.,irncrr
lr.r,r',r.'1 f i. crti'zinth-se l!) Lea tn,i,leinflarnatorii lot fi l:tlctr)ri (rl,llzirli (l{r ll(rvrrrlsi; irlil, ttl
prin f-osa ptc'igo;narilari ;i/ sau prin sirrrrs'l
rrli rr,irlrrJ. Lir trov. gia t'igeminalii sc asociazi, semne neu'oloiice, I.csJ,r\l 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) -
Iu rrr,rrrr.r-olltlhnologice,ia ltrtr_cfiede top,rgrxfia invaziei tu]loialc.- 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
(l) ( I ll niolt ringioamek:, adenolmelc hipolizule, 1'.'::it titxtrd, (tio tnrghi 1rottlo -ccrcl:cltts \ti jurtapolrtirr(') ; lt) 1'r'tlutoirliltlr
, cu ext{,nsie sulrt,rl t,,r rrlr ; <t\ Zrtt,u postcr g8tlcria'tt(i po.'Ltedoclan$il,violt'l(ic ll('vl rllgii l t itl<rlrri
rr.l rr': i, lr r r ( D' ilr f lt a ra s e l a re (me n i n g i o a mc ,S.;.), chi al , ql i oamel e rl e nri r.l r.i
,,1r., l rxral i zate indeosr : bi lr t t cr il'oliul llcr vr lui oI 1, aJ) l) i( l) i. t r t t bit r t 'i r r lr : r r l
lr:rz;rli si tr.rrrlrltlo cu diverse loc_rlizijli pot ger)er"nnei-ralgii trigcrnirr;rJr,,
, , ,lt!iil, lt()rpeticil - bittc outLtisctLtir, --po 1.mni;t,,llo l)l(roiLl)tr'Irrr('r)tlr,'t ,
rrr r,or r llr lc c linic c a d e s e a re v c l a to l l o (.\rseni si Opreseu, 1d?g).
t) l.l.rtrr st.ntcleba:ule, in sinrLsul crre.rnor qi rn qaigtioni! hri , 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
. {irrsslr, 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' r lt r r \ : r
r' tliy,t:tz,:.i, rlc olrirrci siurlroamc, ,.om1llexe, cu alinge;e;Di a tltor ncl,\ |
, r':rr,jlt r i, t ' r I ' { r . , l' i i l r" l l l tl t9 to ti l o f. \ ' ,i i l o l )ol l )('r 'sisl: It : ] 'r t no il idclr r t r glr l, i, iur leosir bi llt , blilr 'ilt i. i\ r lI sr . r P, r ; r lr '
ii ) I'nn:t's. tt,n,.r.c.tlc ale felei, nle ca.ritii!,ilor orbi.t,te ;,,.rri sl l r o ,,(l i sir si. czio l) ost hetp( ir jci " ( . Ar scni5i O pr csct t , 1l) ?1);) t l) t it : ; ': r t t lt t
$i (xle sintsrtilor r/r/i i i r,ri , (rrso ciit i, r icll o u( t r ills{ ) - 1'n t lict tI it : i ) ( liisr r ', l1}5: l) <r ' it t l, ilt r . r ll
,ntt.itll)t firrl rrsoI rl,t I0rIrnriicut, prin sennelc locale ii'prjn coafcctlrrr.|
, t:rri l orr| j o }ir . l. - \ nlor r '{1( 'ilii( lo, pr t ) zullt r Lst lt t lt llt lt t i lui A|gI ll llr t lr r 'tl , r t t ,
rrrl r r r lr r i r r ; r lic li/ srrrrl r o c rtl o n to to ri l o r.
r, i ri l r sttrtloqit ur li cilnlol, {'r Ll1dr Llt 'r 'jLt r ( r t 'lgii I It I t t1;i t t t Lr' , lt t t '. i: r l. t t lr ',
|) lit ::itttlttrrtrr.l.ttltt:t trtui i,/i,it,/), {onr:rtut tle tutnori, hematoatno si
L , rr,ri rrrl l l rpit l 1ot t l, t iiut t ilf ilo ii it lr 'r ni'r r r r lt li)1, t lt , t t ; r 'it ziit li; t alt or iilt t l
Irrr,r' , , ir I r r r r r r r r I i.rr,o l i { ,l tl l rL o p l c g i xu, o c i ti ]te x $i e\ol frl mi a vi n sri , se.s,' , l .i ) Lt:;:it t ; t i. lti) t llLt t lt t Li&)t,llt t r t pliclllt ' t llt lt r ict , t t li llr t r it r 'lr ll : t pr ': r t lr L
.r,..r' l:r . rrr.ri.rrlt,,i.I rigor[)int],Ii; cu iocalizare pe teritorirll ottalrniorrltri.
,,,,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, lr t r 'zit r lr lr ', ir t lr
.t ) l, .\i)titt).,t.1t1 tlc,fantti sfr:naid,ald,,a,\\t*ri de drir.elel loc:rlizrlri irr , 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 r rrl ,. r r r r l, , r l- lr r lr r i, ,rrl rris ,c a s o c i * z r o l l r,l m o l tl c gi a exi ;eri r:i si i ni .cr.rLi io.l , ri rrl 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-
I rrrrl r r r r ilr il . i r , r r rri th ,j rrz i .l l l c i J l ,.;r,. (c i t.r t rl o Ii ..r, j 052) rr suJtl i rri rrl , '; irr r r
l ri ' 1N rlIi , l c: t lir , r t t r rr lt ' t it r t t r ilolii l: r r : iot i < {ioLt llir , i ( llis( 'r ', ll) i, : l) : r t )
p rr,r ',, r i. r t , : r . i r ' , , ,,ri ,.i : 1 r,.\i i .rl q ;i c i n tc ri l o ri ul oftl l mi c' l i ri i rr :.i i tri .rrrrrrrl , '. ,,t ,' i It i tr.. Ij rr s, . 1irrr r , r t t 'ltlt< t 'is1it r t 'r r ir rt t lt t t 'zt 't t l, lt l,l|'lr ilr o lr it r ii l: t lt t t l i, zr , '
rrr i l .r , lr i ir r . , ' r ' : l) rl ,' rl ' ri ," s l l ' o i c -l a .l i l ,i n c a r,c 1a tl ebr* t l l 11i , (,sto ,l ,,, :ri i i r.r' t r r ( }: t l. , r 'zi( ii, r t ", r , r r 'r ',ir r i'it r r r it1r , rlor llr i I t {'t t r illt ! I I '( x l t l l l r i i rr l r'rr( i l
| )rl ,l i
r',ri I I
. I ( , , I I I I I I ( I r, l r.0 rrto -p i ui c ta l i , a p o i e x ti n zi i tdl _S e l l 11i l ci ul l r" .l i rrrri i ,, Li :r ru ;r lr 'ler r , . il11ll1111jrlltli'r l'r r sillil, llt llr llt t livr , llt l llii t llt t i r ilt l r t r t r t r
L rrrrr : r s i irr rrl o } l i l o c ' -rl a r. ' l l i rn p d 0 ci tcva si i }ti i rrri r:i r!rvr.i rl ,Li i l l , r,l rr rrrl rr.t l o t r r lt t t ir " r llt it t r ' I r t t llr r rlxr t t lit t lr ; lt ) l, r : it r nilr r r r : it t t lt r r ,
' r ' l, ilr r l.
.r.l rrr: r r : r s ir r r lr i|r i , 1 i i :i , tl i mi rru rrc a l c fl c x rl u i comcai r si 1l ,ir,r' irrl , l rrri i i l ,r , ti i tt, ::i rrrr r 'lr . / r r lr or rltl t olt r l; t t r r r t l. ir r lt1r r l, t 'r ': r lizltt +it t dr ut t , t tltl,t i ll qllt t t hr , l
rl , rr, ,rr rrI ri i i i Ir i i ,, pl r' ;l ri l i rrrl t-s r c l o n c rl rrl i,i c ,L, 1i p '.
,.1,i ,i r1i r;v).. ,rttr ttl rl t t( ( ': t ! t t ir r , it t c: t t t ' r r r ' I 'o'r 1, , 'ilr lilr r i o lt cr t t ilt ilr oI . r l, r lzirl:r r li: r lr r
ri J.f rr n-itrrlrtyt.tt,l,|(rd(]l,i er.:kirn al sinustt[,ui <:,.t,,n,:t (si.ttrt'totnrriltri ,,,., 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
..
/",,i .i . / r lr r . r ' r ' iL, l) l\ r i r) t(' r' i 1 { )ri _ uolfta l rn i c rl rr i si l tl rnrrri r;r' rrl rri srrl r' i ,r., , l , l r tLr i ' IIIr I ) |I ||iii i ( liir r 'r ', l1lj, : i)
rrI I rr I rrrrr; rI r 1I iI I r l' lr r rl r,l z l i p r.i n l (' z i rrn ,,1
1 rry l t,l ri i rr IJ_r,,,xi tl l l rl rrri r,,,sl ,i
rrL :rrl : r r r liir r ( l) r ir . { k i l i .,r.i .,]' (' it,i l tc rL l :rL i ovi c rr0 rso) qi str i rrs.l .ri rr rkr rrl r.rrr ' ' .t' .l .i l . t 't t lt t t r r r r lt r lilt nt , : ; lt r it t r llr , lr nt it t lqi.ti t t t t '! t t u lt t [ ) t t it t t 't , t t . ! t t ) t
1 rrrI1 r lI r lr rsI i r lr : c lr.,rro z i s . N c l trrl c ru g i n tl i I rr,; l r) l rrrcvl i srrrt rrl r, :rrl r,r.r,i t rr ttttttt r [ qir lt ir lt t t t it t r r lr t
' l ,tl ,
,:r| o l i rlI ir r lr . r , ii, r ' i rrls i rrrrs rrl u i(,i r,\,r,rr)o(,l s i ,l l t,r' rorr,.l l )5i i ; A t,srrrriri .ol rrl r-, l ' r.trl l tt r.r 'lc t t r : r i t r t t t lllt lt t t lt 'r ': t r t r lcr t , I iiI I , 't ( |I ) I ; 1|)t t lilizllt zlt ' lct t r r lt t t t l
l l l i l ); lr ) l. r r r r r . r ' ir rl . r' r' g i rrri i Iri ;x rIi z rrrr' ,i rrrl .. s.l i i .r' l ,ri r;frf rrgr.i rrr. (ri r,- l ,,.l fl l rrrl i r.r lliv r ir ' , , 'r 14ii lt r t t ; lr r ulr ) ',( ': r r '; l(l. t r 7, jllt \ lr t it t : r lt t t lt i t t t ; t l r r it t
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, l)rt|l , , 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 lllll l( '; ( [ ) l'ilslt t r t r r r lilr
: 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 , 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
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 . , , rr' , ; r' ) Ihr..t'i t t r : t r sr : t t llt 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
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 {! ,,,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
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 , 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 t r\ r it lrl)S('fllV. 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 r : r 'lr r
| ;rl ' ti i i (:1o , . ir r ocI ziot it l ir r cur 's, l vilI ( l( f ai. ii l) il*r liziilo. I ir . ir , lo
:j-5.:!. llrrnrlizia norvulti. trigemen (paralizia masticatorie) so (iiu,ir(l t.rrrr r,l i ol ogi tr ( it ui, 't or ( 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 rt rrt rr,ii ll jlr dcli:ltil, tnatiilarul.ui inferior sple pantea pn.ftliza,tiii ((rll
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( ll-
,,(:rzrirrl('s(lrirlot'iigtll.ii) in caz de paralizie unilatera,li (nuclealir,silrr 1,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'
],(;ri
lr'r'r,.ir ) l l,r,igcrlorului (prin aclilrrel predominatrtF :_r, rnuschiului ptt:r;iqoi ,rrrrl cl i oj t, rrrIsr , ii] ar , siinilil] ( 11.( f1] ( lit i l) alr lr lizil!supr llllll( , 1( . lr f li) ( Ll|f ( ' r ll'( 'lllir
rlrir) (.\1,(,tn (x)ntil,ltla,tetal sini,tos), prin rtrofia mugchilor na,iticirl,r,fi ,.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 ''
(|r.IrIIlr||irIsi rrLesotcr), plin diminua;reafortei de stringere a, maxil:rr.rrlrrj 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 t tr lt r llr ', t r r '
rrrl,,rior' ;i ptirr rlirnirLualcasau abolilea refterului maseteuo. ,,' r:rr,tt,r' i zr" rr zii, ( [ ( ] 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
Sr.r[:.rlrrrrr;teur\or'proceseinl,rapontine(tumori, tuberculoame, gl)r|tr., , rrllrirrIii, jttorvalfl ttc taciatrlt supofiol avilld o l o Llt(iz(!lltiilrlf trtrlirrltli
,
lrrrlrrx'rrlllllil,r, {.1.) sau :nnor lezi'Llnifdd,iculalteale rd,d[cinii m;tol,ii l, r, rIIrI r,r,IrI ii . Astlel, lxtlnavuL po:11,cillor.01iIruritol 1i ltu l)rozi|l l,it lrtgoll,rtlrrtir,,
I ti Ir' IrIr'r)|I I rI i (ptocrrseneo{olmatiye sau traumatice bazale) sau tron(rtrtu.tj 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,'r'rrrlrri rrlrrrrlibnlar
:r1,. (trauntatice, tumolale etc,), .patalizia u,niltlt ,r,i^ tll;tolitil ilti;cEli1:lil,iitr[ilot' rnol,ot'ii rlllt.{)rnlto, oa'lorrvollllliiiuii Iiilril
r',r/a;r,rrcrlrrltri lricemcn poate.apdrea Si_incontextul unol suter.inlornll 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
lll'l{ rl(' |r'r'\ i (J'Nlri0i. Paralizia biloterald,a trigemenului se poate rcalizir ,1,r,:r,io h.rniplcgie lr.stii'irl1ii,tlir rt't.retrali pirrl,c (xt prr,ralizia,Irr,irirr'li''llrl r11r,
rr r:r(lr,.l rr1'l' srt{rrinte bulbo-pontine (scleroz:i,laterali1 amiotrofi.ii,, ' rrtrr 1'ra..r,liziiila,cirllcc.n1r'alc (plin srtfori.]c 1r:rsoll]zrrec.tt'lrtrrl., i'ttttrori
rrlr,rirr, rk. s.lrYoziillbclalii amiotrcficd,,diverseproccseintraner-ut,_r iu,L,) t, l, irt .u,r'e, prirL ir rt.r't:sittt'lt 1i.,.iiilor citrr4lir,,'ritl:llo, ltsitlrrrl.irt lr'{"r
,irr :rl llrot rrrli,r,irrlc llaz:rlcextinso (tle obicei tumornle). ( ;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
,Ii I,III)III,I.]I\'II,] r\) -f'oroli:rri faria!,a peri,fet'i,ceprirt lPniu.lli ttttt:lcure. [r]si'r' r'rrtlr:r rl''
I)IJ I)IA(iNOSTIC
iN PAIOLO{.I]A
NER\TULUI
IIACIAL l, ,rr,,ri ttttt,l t: ului iLt r vuhii f icit l ii l) or '1iunolli111r 'r t 1i(ir r ii' lt t it t r ': t lr r r 'lo
r ni
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 ,
:l.li.l. Irrrost,i1;atilscrniologici .,1jnervullii faciai ulnrireqte : ,: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',t.idt)ti().ur,t(ntn,elorclinice d,eTtare*i sau d,eytarali.zie.faci il, 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
.r, rrtrr I rir. x|rt::tu ,;,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 .
.faai,all)f in probcle bine ounoscul,eale era,xrc1rl. i r 1i ,(l { j l r(' t1 'j ( jf lt llicnir or i'c collt ur eaz?i t t ivt 'r 'st 'lll . ! jlr ( [ r o: ilr x) illlt f lt l{' r ll'
t,tttt ,,t rlt' t.t rr,rtt,r'n.rt,l,tr,,i
di,ttr.tmit:,
,lsupra cir'ora nu ilsisti,rn irici.
r r rrrrl l ti cl i cl rt 'it 1.
I: ) l,)rllt))ut'(ionutdtJ.ir:iril,or ] lnd,{odrelorreJlem (Ilist\,7 t1}i2; ll,lr
ll) !'ant,li:;i'i, Juuialt: p ari,Jtt'it:e pritu Le2iulli iu.;lranuclcnrt l'r' lrrtzrr'
r r.r'rrr.r.,
lt)lilt; llrpoyii,ir fi l.,asou,I9g0) : a) rcllext na,zo_lluJpdrll,llr) 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 -
;
r, l, rrl .r'Irir,rrIrr'rrIrri rxrhirLhri;o) r'{rflexull,siho-palpd)ral; rl) rrrrllrrrrrl 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'
, 1,, fo Itort ; l, rsllt ' lr ili r / t iiyr osl
r'r lrlr, Prrl;x'lrlrrl rrl lrri llcclilurcl. 1 e) roflexr corr]orr,D;
I) rr:llc.rrrlrrirzrr. \,' . 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 ") ,
lrrrlrr,rrl; !J r.r"ll{rxui ruu;chiuhristaporlius;h) r,cfloxclortc clipil. l r,l i rl l | ri ]l cr0lot ir r t t , '1r 'lr r t r ltiililJ)ri ( i( lius ( 'iir lrr gisir : ir r'lil o 5i r lcI i t or r |t t sl ir ') ,
| ) ltt::lqt't:uttusluljl.i,(lllpi m{ltodelc oxluse r1c rlri irr 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 $r t ; l'ot t t t 'liI r t
,,, .rrlrrirrlrlrr rrri i l rrl i rl i (( lr : lr lr cr ', ll) ii'; 'l'r r ir r t lr 'lt r i r , ollt }. , ll) {i'/ ; I 't t llr r , lll?l; I 'l1t 't
l\r'rrrolorlir.)' (l'{)l)r)vii,ill$i t,Nsru, l1i,$0).
\ 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) ) 'l t.\l(t.t1!.tnli.tvrliri.,
1,rrrr, 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) :
l 'l ) ' 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
, l;r ri c rr l
|. l 't t ) a t :t 1 n r l ,'l r t1 1 tr 'ru l , l ', tti l tr t:r l t:ti r n ttt
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, t t r I t t I i t t t I I t t t tt ' I t r l r '
: r ) 'l 't r t t t pttl , 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 '
lttttl rtl o t r lr , llr lr ' t r { lr tr r' 0 ItrIIrr,r'rtt l t!fl .t,o l l ,.]r,. I r . r | , l tttttl ) t i l r r r r l ti ;r l ,i r l r ,) p l ,l , l r Ic|l ;l
r
f i , . r \ l t . [ ] r l i r ', I t I ' r I t t | ;' r | r Ir ',:II;r l l !l D i l l i l ti l r ',

811
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
lr), lt r rr lrrtrrlr. yn n.r ; t l, i t r | , r tt t , rI , ,, |
|
:ttl, ( r l! illrzrt I;rt,i: r I c I r iI I r I r , r l I r . , r r r ,
| t |t , l( , l) t ! ) ( {. - t {. I | | I I I I r . ;| | r r i . r r f r || : 1 i , I Z ; l
.
; , : 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 | . I 1rr, .llr. ltrll, rr rr \ ll, , 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 '
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 i , r | | | | r | ; r I | r ' l r l i l .r r r r I l , r ,
r r ,r ,r l l ti y|1 , l |o L ,l l ||,L i l ,r (l l l
\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
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 . lllirrll l i r l , l r ,.r 1 ,, 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
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 r:|{;t. | 1)?:l).
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 , 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
rrrrrloz|lI iIlillll|li\(,rli lr r z c s . : r . _\ ( . , , s 1i.lll. o( . ( , r - , ! (, ,; r i u \ ( {, 1 ) l i i r 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 1rolir.11 rli1,1 1l1 11 11, t ' r . i1( lxrlirk,r |ii,,lor. ,,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
s i iornr ( ' lr ir r r il( l( , t . J pot }r o d u c u L d " r , , , , , ,
l:r.r;rl:riz,lrlr'i- I'rrr.rrlizir, l)itr.rrlizit 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
firci,l.i, ,r,i.,n,:rL
l,;"f",,11i l,," ,, ti'pr,,,,,,,,,,,,,,,,,..
r,:| |1 :r 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 rl.i, 1" ' 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,' .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 , r rrl\ r'iic tlo ilir.crsc neiur'l (f irol,isc sau ilrir) altc inf{x1ii' lr)r1.'lrri1:rurt,lr(l
I r.r,rtt.ttr'lt I Iil tl I c lrlril uhcranl i si stinca temporaluJu i, l:l semnole rl) (iornplesi ri d(f alte niiiLrri (de pildri, ?lr'.rlizil, lirxrialll pritr rr;rlr
di: iI '.l, ):
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 ,.,r1.ir (l(, ior'*.ps sar,r chi?f ln'in uaitelc spont:util 1:[ r{) llli$cIt).
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; :!.(i.2..1. Probl eme de d,iagnorli,c etiologi(; i.n pqr'trliziil.e tu.cialt, p, ri..[t
(j) l)i
rri ' I i ()rrI i{' I rI (l('vilr(' irrsi rrrrri dil icil irr lari'lc sitnaifii tte ,pe:ratirii
Juciut(i ltit,l \) 1'araliziile,faci.ale in.feclioure sint rrr t, mti frccvenlo t|'til rrr'
It rrrtt , t,rr' 1xr1:si :tIr,.i itr trnrle
Jornt de distroJie nlus;ularai,,di,prli.ntio:,iti , r|rl|r lLltritlltiL, dor.i:dinrlu -.rt-'in ultimii ani cii, IOlj oxi til! tlrlrn{'rorr{,
::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 rrl c,,1i i rcspo[ sabilc de pr ot iLr cer eirpar alizii] or laciulc ( ( lr alr t r i'( , , lll7l;
rl t l rtt. : t .
ll l, it t 1, , l. .trtl ri .l u ri rrt .x i ttu -tcp n ,.,i mnt i orrl ,' r' , 11)7 4i 'I ': r in( lel $i colab. , 19, i?; Popovit iu qi [ ?t r , st , r r191J0, , l1l8l)
,yl 4,,1i
, .l Jol i dt qol gti o \:rili'1, l)oi; ji)1n'r'1'orri diverse infectii b*ctcrieno acutc sN,n(,ri)lLi(x',\'i rirrIt
' 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 * , ,,rl i orrri trl i tiil, , yir \ r sur i gliilalt ', t r unlef olse elit er ovilusuli ( lr ) ( h0, 1l, r
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 .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
, brrri n
Ii r(' r' Il I r'r
rI rr(''r)' r.1rr'".rrr,
r gil si ilfccla.ca $rstului in ceb doud tleimi alteriollrr. ';rrr'. r'ilttsttl lrt'r'yrt,it,, \'irlrsul herlles zostor $.[. l)rllizii Ill,irlrr lxri lt
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. 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
l,lr rrrl i rrr'il i lo lrr[io]ogigt' alc lir z,,i (,1,J1iuluj alt.porliunji pietroe,sl lr 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
. fi 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
,, 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, 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
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 (, 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
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 , ri l rl l rrttl l ur i ot iit lor ' $j, r 'csllcr , lit ', Lnm l ir lt st oi( Li1o.
' l lol cni te dt h car' ci troarrrI
r r r,l l r ' llr , : r liz ; u i { ,| ' Irt.r,r' rrl r.,l l )(i l )). Il ) l ,tnr lt plllilizii {. t ollcr \ - i {ilillli( t r i inclusiv unr : lc l) t r llizii I r cr r 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 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) .
'',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 r1.. arLi setancl c cri ri rr.
.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 ). ' rl C ,S C rj se
rt1' r.i qr,. 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
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 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
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 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.
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 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 ,
'. ,, 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 , ' :i lLllri.
, 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,
N l l I 'u . t r tl i :i i l t.l i u ti u l .t l vt) t) t\!.l t'r i ttl 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
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 r l r , rr r r 0 i t l r ', l r ti ^ tl i tl g i o r l l tl |, 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:,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, 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 ( ') .
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 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 i t' i ttl i l r tcsc i r t: tl t;tl r r ,l ,,
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 | | | | | ' 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|'
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 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,
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 '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.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..
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 " ( .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 )
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' 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 r l o l tt Tr ti tt r '''.L ,l ttr l tttr t
l ,l o (j c s { r: i l ti l ti i N l (, rrrr,t,l ri i rrr,,rl i i , tl|tlttllt l t o ti l 'i l i l ttl i 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 .
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 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 ,
. , 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 r l tr r l ti
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 , 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 'l ':r i ct tr l t, l 1 l {l l l ; Wo l l i ,tttr r ttt,
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,

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 'l'11l'l,, i I t t rt I t r r t r rr t I l r tr 'ttttttl r tt r l r 'r 'r 'r 'r ',r l tl tl l t'tl ttti t ;tr 'l t' u 'ttl ttttr l r tl r 'tt l :tr r r
,11i, 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
Ittr li.ll r,rl. l(.1)t1r(. ' 1, ; t llr r l, , , r , r i , r ', : r , l r r l r l r T r r ,r r l l r i r r i ttl tl ttl i l l l . l ttl l st^ l r i tt r r l l r r l i i l t l r r tr l r r tl i i l r l r ' |r :r tr tl tzttt
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 lri I l' l|,
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
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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 : l . l i . l . S i r n l r o r tr r tl l r r i l ta r n sa y- l l l tttl ( l l t't';to stl l !l o l l i tr r l r tl sl ttt l tt'l 'l ttsr tl
,,1i,'r , irr,.'rrr 1,r lr . lr r. - . i r r r , 1, .; . , . , l r . , r.r.rr r L. .1 , , , . , , , , , t r l i r '; h o l l ( f t i zo sl o t o l .i {,tts) l tl tl ttr r i tt zl l l l i l z( l s1 {l l g r tti l ,tl l r ti i , t'r ':tl r ztttr l
: 1.; I \ \t:,. . i,r,.i,,1-ir:,)(,rirt) r,r,,,)tr.
' , ir./rir , 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 r r r , t : r l r l o r r r , l i r r i |r Ii si i r r cl ; ]i r ( ,1 ir,l .( )p l r l l i zi l r l r r i l j r 'l l . l ) o r r r i r r r .r r zr r Ii l 0 r l r r l r i ,,r r r r '
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 'r r r . r 'r t 1 r ( 'i r ') l l tl .r tr i c si '1 i r r ( l l ) l l l 'j r l r N l l ) l i t) ( l {'l l x) l r sl r i l l t':t Ii Itttl i Itr t' ( 'I I II'IIII\
,'r'(. l'(!,({L riri citora zile insialarea par.aliziei, , 1 , : r r r l i l o r ; 1 r i l i r l cr tr r l i i l c ( l c 1 i \i l r ( ' tl c t It I t r t 1t I r^t t I t ' t t I l x'l l l l l l vi l l l i l ( l l zr Itl ( i
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 l l i r ( i r I lr '( r ( 'tl i a i i l Jr !r l r l i zi ( 'i l l i t,j :tl t' l r ct'i l tr l i ct' Il t l r o l i r r r vi i Ir r l r ( r 'l r r 'r r
f ,, ilintre boid.r- doal urr
",ufe,rii,
,.1,1,', " r'r'vrrr,sibil rle co'd'ccre ,Jiziologicir,,', "."qii
A".i ,i"i ,rli.""p.tibili tlr . , l r r ' ( '( l r l i ( r i i {r st l r r ( '( i zr l l i i ti 'l ttt,t'r i ti l t' l l r i Il r r l r l ( l l ) ( l ;r l l l 0 l '\, l 1 ) 0 1 1 ,
r rr rlr.r.rir.rr'rirplctii,in citova sijptrrmini.I-iestulde 40f l )lL. llIli, l 1 'i i ? , ( 'i l N 1 , d {' l l 'l t1 ( 1 n t'r ', t{) 0 $ q i tl o '/,l r 'l i si i ' si ( 'o l r r l ,.. l l ) r :t) ,
s,teri 6 d,_.gencr.s-
r'r,rl: r:rL ri,,rlrilrrri irlt slr completi, cu denervaldo "consecutivii- , ri r r r l r r l r i li l i l t'i g r u l tt, d c tk'1 r 'tttti r ti r i ct l l tl i t't' l tl tr l tl tl tt'sr i l tti zr r r tl l r ,
, flr:.rr|l| ti r:rlr'$t.tlor.i.r.u impnsibjlit:rrrdc rcfrr.n|i.comnlr,1i. a tnlrs- , l r r l , r 'r r r l t r u l r i ( 's:r {[r ]) t1 i Il r tI,su ,y l l ttttt st' l i r l i l r t'i L zi , tl .o l tl l l t ttl l i l l l l l ( l l ( ,l l ;i '
lr lt,csl,itr,
r rrrl irrilrrl:r-:'Ir'orlo rolrlcrur,l. g:,rde \c,,iJbilo O".n1,r"ijr.iri . r r r 1 , ( 'l 'r r v c t tr t't, i 1 i {i l ) ) :
,irrrI.rrcIrrr.l'i,, -uneori ii'ii,.
.u dtlo''.a,re:i f(,t_eiqi cu terrome.'ul ,,to"ri_lto. .i,, l l l l r r y t t x :r t:l r t r tu t'i tttIr r ,t'. ,\;r ttl tr i ttr l t'o :r t'b i l :l l r tl u l {,i l i i r t' r 'Iti IIl Il ti
r rrrrrrlilr'. Itolnrvii cu ul simplu
tr.r,rrrrri ibloc,'tle conducere,nervoasi prezintii, , , r p l i n i r tl i :p r r zi ti {'. Ii ,l ) Ii . tl ti ttl i scvctt'i tt ttl tl r ,l i tl si i l r i r r tttl r tl r ''tl l tr r
siirrrl.o rlisbzrlIati1,dt jrrurciul de origine zJ coartla tirn_ ,, p l i r r si t[tttr t' i II ( II) IItIII( IL III i r l l ( l i l r \
p:rrrrrlri .ri lrr,rr1.51i,,prgul cle,sl,irnulare 1 , r 'i r r l l cIto r tttti tttIIIt) ;i l ttu l i t
""l"J"i a trmbii ri,minr
anodic;,gatr,:urici^ , t , r D . r i r r p : 'i r 'r i r ,, i tt d t:r ,u t's ( l ( l : ;J zi l ( i :i l l l tr ' f,i 1 l i r ,t'l c tl 'zi tr ttl r r Itt tItr '|'t|r '
(i(. :lrnllelcpitrli (l.av_elner., 1969). itr schimb, bolnavii care p c 1 r 'r r g l ts, h cl i r ;i l r ,tl l ,i l r l u tts, p c t'o tttl ttt'l r r l
ll,'1.,y;.' .l' ,,.*,'r 1 , , , i , r r 'l i r l r c i o l r r r l ttci :l ti i ,
',r'llr r\,, ir,r (tr.n,.l\l||or,ulnplelJ.d,,Oh;cni plcziotri rrn prziqdc sLimt arr. r r r l l n s i l x r r r ttr r l ) r i l l r i t, l i tl !l ) l tl tu l i l i .
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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 l l \ I I t r l t tx ::o t!i t') 'c1 t l tr ttu l i e Ju ci ttl .i . l l tttttl i zi i t l r to i a l i 't, i r tl i r tl tttr r l t'r ttr t
trr. ] |i.-lnr-ne: t , ccstia ecuzi hiperacuzie prin aboliret
nr r.., | | r ,lr rcflexului 1. r ', r t t : r l r rr r :..i ttr ;r i i v ? i i ) 1 . t[i tl r 'l i ztl ti l i ' ( l l .]l t'l ]) t^ s zttsl t't l ttIti tItt|:tt l i p r |'
ilillri,rtrUi ( J ilv er j, ol, , 1969. / . ,i, I r t r r r i i ' tt'. l ) l tt r tt't'i tsl i i p i tti tl i zi tr Ir tt,i i tl i i , l l o l i I r tl ti i tt'l t' l l r tttti i l tr r l tr :tt t
. r l r r t l r t 'r i z oN l ( 'i ( i i l ( ' r tl i 't'l t'r tzi r t( g i u l l i l {' i i tti l l L ', l tti l l tl t' si f i r r ttt l i tr ;l ttl tl r ',
Siurlromul ,,lacrirnilor.de crocotlil,, (descrisde llogorod, 1C2g,
, rl rrl.I.{;.:1"..
( $ 1 r tl l :r tr r ',
rlr, 'l'lr1'nrct.) l.$til.))finr\tjrrdl. o r,onditir pxtologiui, iieobignuitilj , , , , , ' r , r s i z 1 ) r r ( .l r ' ( l r l l l l l i r l ,( ' r r L ' r 'r 'tti ttl ti i r N 'ci l r i ti r l r ' 1 i cl t'vi tr l r l r '
1 '| l t . \ l ( ( i o ',r ,r 'r r i l i Fi l z]r r r q l i , 1 {.1 5 ) ; \\'[kcl t'J ,.{i }l l r l l ,r r r ( i \', l l ) i i 1 , i rliril
,.,11 ,,, .t:r lrlr.r,rr r,rir.jr llu\ tle Ia,.rirniin iinrpul .i ,irUr
rlim..nLal,ic. , 1 , l : r \ {l f l r ( '1 , 1 1 ) l i l ) ; ;\l r 'l i si r ' 1 i cr l l l b , 1 9 7 i i ) 'l 'o tr l ' i r r r tr i r o ( l l l l l tr ' l o irll(
l p:rrti,,l,,rtrrpi rlel,.rr.,rr..,',nr...tli"ii",,;rii,
r. rr,, r',.:.rr.r.,.
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illo.nervuluiliacial.Apalo rareori """i.] (la lii s t t s l l i l i o l r i l tt l ttl h t'1 1 ) e szo sl t'l ' L i h i l [r ' t'i tr i l vl zi l 'r r l l 'l l r si ttl ,,i ttl tcr '' t
,lir ,tt; I'r)lrir\ i rrrrrLrrrr.r.r,:rrc.rhr.crisi de .larn,x ii t.f,or.r',,f],fS;f, citili tlc
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dr, nro,r. (1069) il trl
. 1rr .r,.r,, rr'ti{.L ii,.r l. heqr . s z os i, er . Sindr om u l I' r l r '; t t c zi ttl r i . r' l rrr t t t rt rl t tl ( 's( ^ l tl i l l l l ) o tl l n l l i r t tl l l i l 'l tr l r r g r tttg l i o ttttl tti ;1 r 'tl r
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t,l ,',rl 'rl J r l' r ' r ' i( .r r r . r ' v r[rril ,[{ ,i r] s i i , r" to p ro ri ' ' u l fati . de l resl ; san.,l l i ri ,,.
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,l rtr 'l l i ,l rl i r ]rr,r,.rl i zi l
r:rl r r . r ' r r , iilllr il i l trl .l r I,l .r,1 ri .ri ,l I)(,r.v ,l l ti i r ri ,rr* ,,l i i 1,,, (,;11.
' . Il l t l ' (xl r , , , \ r ' l i r . l : r li l r ' Il l l zi l r l l ) i \l l l tl i i l i l l ttl i l i l l r ' l l ':',i tttti ttIt r o l tr r ', r l ;tt r r ' l r r r |r '
tr, | ( r . \ r r , r lr r r r lr lir r,.r,r,l i il,ri p l r,r,rl i trri ri l i l rl r.). " i i ,rr Sr ' l tr r ':ttr t\ttr \
. .r)l |
l ri i i l url rr:rl i , ._1r:r_rrrul ' I I , I I rl . r r ' i ,I r ' r I , rrI t , 1I t t r ' r )| I ',I I I I I r' : | 1 \ i l fi ( 'l l l i l l ;i ;l i L l 1r 'l l r |l :l l i i tr 'i )
'l ri l rrl l ||r it t |ll||t l l l l Ii . .\l i rrq | r,r,tr t | l rr;i rlt. i rrl i sr,;rri l ri
l t Irtl , r.rl rl rr,.r Llllr,tl\lr f r r l l l r r 'l r ' l ,r r :u , .l ,r 't,r [' 1 t,tl t n l tl tl i l i r t. r 'l r tl i r r ': :r ' l r "r l L r /i
r, iDrrr'rI r ' I r , . | | I I | ' I I | | I I r , | ) | l rr ,| | | | I( .( i( |u r ) ii l) ( ,lit;r\ i ,t, ,,,,t,s,,1 {,t.tz(,t (.l utri (.t, ( l 'r "r 'l r r tt t l ':t i l l ' l 1 ) l 'i l l '
r' , . irir i . i , | \ i , I | | { | ( . , . I , , | | I , i r r i| l.r . tI r .r r 1 r . 1 1 ,i ,,.l
ri l t ,,rl r, Ir.
' r 'r l l r i | l t l l lr c r I r : r 1rr t I r t rr t r I Ir|t
r , r., .,1
t r' r \ r, r/ 1 . l r r l l o , . 1 ) i ll) ltlllr .tr l r .,r l,o s,,lr r .r : r,l l ol rrl ,,r I I \ r . , . I , I i 1| I r. ) I rl ,. ( , 1 l l 1 t , r :.tt,tr ll ,tr t,r l ,l i tt |r t:;tr l tttt"t : i ttt|||'tttt|t l 'tr l l "' l "'tti tr r ( r ;ti 1 |L tl "tr ',
lirr. rl l r : r r:|| | tll :l| | r . .1.. ,rl |,i l L
lr :r ] r r tl l,,r r l,, lr r r r trl ,
rl'r n, i l , r i r l t l.,rlirl :l lr r \ i r l:,r r :,1 lr ,,;r lr.
1,, ri ti l rl l rl i r r r r r , i t r l r ', r l r t, r r l l .tr r zr r tr tr r l l r p l l r , r l r r r ; LI t t r' ' r rI I rt | | rt I ) l l r l l i r l l l ( r 'l l l r '\l l l l
r rl ,,1.,|,.:,,
1,:r r,r|l
1 |l
 I
I
I Ir . I r l rr | | ( | I / i ( : t l : [ ' ( ' f r i 0 t. illi\ (, lr r lr It | l | lr .ltr ( , (,|,(,I,t:II, (.u (,{) l i gl l |,i l i ,i c (l I i l .7.i !. S crrr ir t kr llia. t r t t t r lt lt 'lt r ir( lr t . r r s{ir r i) r 't r lr r ir r t l{r : . . . . . l rrrl rtc i rrrr( i i l
i: irr lr! )l | | t r f l t l l r ' r ' l | l . lt ilt ct r t r t t zilt ' '
:!./.:a.1. ' \tt) t 1) iolt , r t r ', ', "''^iii't l) t 'r t "r t ill"'l'"
' ' i l i vc qi rl (' llii) lx) lc, ol) i{) ( 11ivc"'
,rrl
sir r r lr l( t r r r lllr rr' L
::.1; . 1i"S ilr lr ' { r r n u l l u i } l t' l l i c rs s o rr-l l o s s rrl l rrl ronsti i rl i rrtl o ptrr.;rl i zr,, i | i ' cul i " i ,, f e ( t innii'us) pt ii r qr ir 'r 'r 'l. r r iil . it t ot t r t t t 'r lr ll
l r.i rl i i ir lliliu( jlc lr li' , a ,d e s c l Iri Il I.r' i rIr' i , c a rc s c r)or)tcrt' l rcl rr rtrornri rti rl l r
,rr i l rr ir r l( ' r ' r - ul(d0
| lu n i s a u a n i (S n l r| r' rD :rn;i l l e nte, 1gtj 6; ti r\-orn(,rJ l J)(i t| 1. lll'lii"illlll
l :;liii*iii1j*tililr:li**t*:illi;',)l,iilii,i;"i;,:lil'1 r zi( i. i r r r t ; t t t lt t t l
IiIrirrrrrrrL'Irr l)ilrll,li1]iccse pot insoti do urt simplu ,,bloc de r:onrlucci,t'., r,u ,,,i ,,,,r i
';;'r:l;;,;;,rt" " ' i ntl- o cluzi lpar cm il, t t ll( 't t i lr r selr iubr t . l- r ': '; " : rr)itr
r rrrrlclrrlo loilrlii, dllr cu ocaztia repetiil.ilor se pot ilrstir]a yali$ile grllrrlr. i "i i*r'iriit" diYflso cliolosii si lrrrrrliziiti
"p)'1t'iii', rr\r'lrtli{ r
{li. rli rr.r'\.r1r J)o lnUsctlatura faCia,li,,Cu pareze reziclUirl. si cu Coltsl,(ruli\(, t, ittnilt |.s.bit'1,tttic€ (tluT)allttrntttttils-" (''Taniocorcl)lill(" ilt t'tllsttl
"t" ilr " ir r L zit r t 'i r r l'
,1 r:rrrr r rlr ' r c ilr lc . A pt r e d e p re fe ri l tl l a fe me i Si ]a. Ti rsl o tl ai 1i ner,t,tl ,r,rl ,rrrl l ol unol ttr r1 e hi per t ensm nr '- it t t r . - '"n"i'"i', ir r . lllr ilir r l
( t r . r 't il. r t . r t r r ir ''r "
;rrrr':rl iz irlrr r i llell. Ro s e l th a l (1 9 3 1 , c i ta i j d e i l l a verner, 1969) a l el atat crrzrrl i i ' , ,.i i ' i :,;r;;" ,;i , , ; c. j : b) i. ie: ii', r t ae n?r t t illt i. t 101t st i(
r || irr,irlonlir l'utniliale. Acest sindrom se insoteste dc cele mrri nLullo rtri si l l oxi ce. r r culiloam e il( llslit 'r ', lur llor i si : r llt ' lr l'r r ( 't r \ r "( ) I ||I I f |sI \I
r| ,.| | r0D l rl i i
,l ,,.,l cr r r r ' n, . r llr , , lu; r s o i l (.i c t' ,i ,.i .rl r.h rrz e l o r' ,c ar.l rof l i bi l ar..r.:I,..r.r, ,tr.tl ,tl ;i'.,;']:;'ijitti.-afx;iiii;,:)(|rtfn,,i,1itesi',l|t-7l'toct*,|||,,,,,'.,,,'',],,,,,,||,,,,i,|
rrrrr|r'rr Ir'1oi, rftial drc:i ptlr:ilizia fuci:r1[ este Inilaterr]ri. tI' tt!ttt t tt t).t
[-rr rl lr.rril0rr .l t, ;u ; ,,1, tt,tt' l r i t,' t,' ,,rs i i t i s i S otr nl ' ' ti i t ' ; '
rru p l o r r r , ( iille es t e i n s ti i n c o n s ta n t, e s 1 ,ere l rezertat ri ,,o i rl j cnl i i i rrl c rr sirinsoi)u ll)i{" (\n(1('llrlil('r sotni' rrilL
, ,]ti;,,;;,,;';,iiilli',iiiil", t.Lt
l i rrrl ri i ( lit r lt t r l) lic at u ). H a l e o ri tu m c fi e re a fe te i poa:te sr' Ll i tei " url i L
l rrrrrl i zr:r t 'i r , ', '. l t r r r t m e t isl l c e i ,e .) "",,tilL*",
i e ) i 'tl cl tr sl l ' a to [tt!ta i
l 'to r . ]tt't) ( 't'sr tt"l ) ttttsttl
l rr, r:rl rrt r r llt r r i s it u l n i 1 1 ez i l e , p e rn ri ti n r.l u n d i agnosl i r. rctl ospccti r l ' l ,l vt'i tl r 'i r r tl r tl tti rrl lll l 'r t'
, t , t t n r , l t n l 'o t 'i t t l t ( tr l l n o r 'l [e m p n ;ttl t, tu n "'r i - :r ]r '
\, r l i r' , 11, ( i1) ) . 'i ( 'l r l r '' l :r ' t' l :r r /J'
l r l c t r u i l ci l r r r l ,:r zr r l i l ( Ar ''n n i (('/?'-/ir'('lr'
'r r " ,'iti
, r 'i r) il. 1c;iir,i1t '|t.t'4.t.tti
lttiili'";t'":
;;1";;;;;r:o *"
l.li.7. Sirrlronul lui Xloobius este o rar5, afectiutrt, {.(rlgenit{ iiii 1l(, ,lLrclsr ei iologii, lltcnl,ron e:interluj;11) ill tirllr parult:ii lttitlt ltrtt
,l rrrl o rlic ir r r , : i r r c ple c i z a ti l , c a re a s o c i t.,z i o ai f inrl'rtrmlrri,t it'
trspt'.1 sf irIir( r' :
i , !a l . l l l ' zi p l tLrxl a i tni - sau l )i l :r /,,:; ;"it';ir;1i;;iilrir iii.r;"rtlnt torsori ')i (t\tt't'tI
(l'ilrltli(
l .r'rrl :r. c r r llr laiiz ii o c u l o :n o to ri i (i n d c o s e b i d e abi l ucens). , i',, crizclorniQrr'nout7;rl) in cursul unor' tt'(
:l.li.l|. Sindromul lui l{eerlord leprezintii, o cor}rllicalie treulokrgir,:r "i,r'rui
, r.olirb., 19?3' 1li?S; (iastaut', l9?3)' .-
"ili r'li'rrtt'ttlrtt{zrlt'
(irlrrclr'r'\
:r rrrtrrirhrzci, irr cnrsrrl cr[eia poate apirea o p:],]alizic faciali peli{r,r,icrr ?lir,:i""i"t ,i,,ii"l :rrxlitiie l'r"zinli.rr,rr
:r rrx i rrlr i r r r y r r r lot irl i tr' is i c u u v c i ti i ,
lll ll,,lliti:t;:;L:"l#i"l;1il;,il;:"i':;'ll i,',,'l',11;,1'i;;r',1'111 Ii:'il';l
rr
a'u
a'utlit'i\.c o vrtlollc i('
lo(llllizN;l{t li{''rlt
r , r,lrrlt.(.ltl?lJ'l9?li) ?tco\ltjtijzrt
irrti(rtrosi ir lrrl
,l,;i;;;;,,'i,,i,,i,,t"],:',i,,rt irr absc i a hiperltrrtsirtrLii illinri(x
tle rll'c str ttrttrtlo strl('r'irrl :l
, i;;;i;;;'1-ii :'i-: qi, ile obicrri,so acompiir i:'t'zii;i
:]..;. I'II0ItLIINIIiJ)I' I)IAGNOSTIC
IN PATOLOGIANERVULUI ';;
,l,
' lolr
' 1,r,tuporal.
")';;;;;;;;ie rltr zgornrtltrtttl't'itctrtttr..tr'
A(IUSTIC(COCHIEAR) i:\ ,,oltiectit'e"sirtl' reprezcntatc
urehro',t srttt tl. /ir/rrir r'rrt't
,,,,.,:;L,i;'ail,"htl,rlllii'ii,rtt-''ito.i <lt i'rLllittatttt:
1|ltt t't['t\tr')toQtic.
1.7-1. lrrrr.sli(lirti:rsrrtnirllo.r;ic:i
11lrer\.ului acrstic lu'miI'cste: r tl c ttl t'r 'ttItti tIo .ItIl Itt'
') . i , 2 . 2 . 8i ttt7 :tl o n tt( t tl t: th tl i t:i l ' l 't'zi ttt.L i l tl txl i ft'r 'i cc
li'ttotttt rt
| ) I'.'.t
rttttittrr
t'ut rrlnrlii rt,rrrastoirltlot, N utecllii txto.nc,:r conrlrrl 1,r,,tlru' tttrd.i:ltt.leTttrrliulri xtttr'ttlotnT i" d'c li1t lllrlcrlrlitr' t'tt sittt Iirit
alc sr''riiliil'iirl. 1trt.r''{i. sirrl' (1(|IIrIIII|||'
l l rl Ir ; l{ lilir " r ' r 1r ' l [i i l . l i l rrl a rl l tl L l i . l;; i;;;',ii;;;: il;,,li,i,'i,'
i l r r l r ' o ( l i r l L i l l l l l l l r t:t
","''i,,l"ci''ir
1 t'l l r tsl r ttsi '- 'il tt't'i ctttl .si o si r r tsr ' ( i r t ;1 x'l r i r tl ) '
t'r 'i tl r .tr {i r r l r i l r r
I) ) 'l'rsltlt rlc ltplttxtc a, (,rttilrj:!ii tludititc, care iiprecia,zi, colrLl)lt.r'l
ii I t rt I I i rt I t t r^1t r ' '\l 1 t'tl tt'tr r t r t r tzttl tl i ttr r Ir ' l tt '
i l r,'r.rrl r r l, . r r r lr or r , r rl ,c l o l.o n rl trc l i l i i , ', ', ', f , : t i , 'i , , ', i i i i tr r z,o l r r tl r r i ;i }r i tr
fi p c l ' c e p l i v.1 (ni :ural i i ) :i l c stnrcl u. l l l \'\'( 'l i t( 'l tr Il r l tr tl t' l tl i ti i r ti tl l 'r r , l ]l '1 '( 'l l l l l fj l p ( 'l l l l l l
l t'r r l
r rl l r' :rr r r lr iv l r' : , l , , r , r i t r r r t r i i i l ) ( r l r l l 'l l
\'( }( l i l l cl r ' i ( r l l Il r
( l ( {l l l l l ( r fi i ) i i l l i 'l 'l l
:rr ' l\ r s lc lc { [ { r ll l l (L i ti o ri r-o r:i i c x rrn ri n l l to l u hl i . r , t | . s i l t i l l t t l l r ', l ) r 'l l l r l l {'( ,l l so r l l l l l l l 'l ( '
' l ( 'zi ttl r i r l l ( r l l t l ! rllr I
I't ' l' r . s ir , lr ' |r r ' ir rr i i rrl r:tz o r,. l l l i o l t r r l r t r l Itti ,r stl l tl i l i l i l ') l i tttD l i t'i ' ttttttttr r o l tsc
, {'r 'l tLl',r .)
lll :
r') I lr ' l< x lr ' lc r lo i n r< l i o rrri rl ,r' i o n a l ri ((tr) (,ol l l )(,((.1.ti irt { rl ,o[)gj .i ti l or.], l t rt rt i c t r' rl rl l l l ' i ' rl ii'l. (s 1 | ! ' I )| I )| I I I I I||I|'
l ttl ,tr i ,,t l i i llll ri l l i t s l : rl t L { '
r rr1 ,. r,, . 1r r ir r r i r ( ilr ilil i (' l t l u rl i l i l i i i rL s c i ri o l o g lrri l rl rj cc rLr rl ,,r,j l rcl i . '
r' i t r' r i '1 .r '') r r i l tl l t' ttt|r I t|'r r
, , , , , ', 'i , i t r , , . |' i r t r: i r rt i , ' i rrI t , \'l l l l t ') l l r i r r tr l r , r i I rt : r r t ri
rl ) ' l\ . ! lr ' lc lr r i S r,l r$ rrl rrrr,l r,l i j I (i s i \V o l )(,1.. i l r ( "1 1 ( r i r l l l l Il l l l l ( r l ( l r \ |t( 'r l 1 {l r l r r '
r r r , r l r " ( r 'l : i r r i lr i i , sr ,l i r i l l r l i r r 'l t ) , 'r i l l ti r l i i
l J ' l' r ' r r it r l lr r j lr rrrrl rrr (rl c ,,rt' rrt' u 1 ,rrr.c rr i rrl r.rr:ri l i ti i sol r()r' r,rJ). i 'r l i i sl r r r 1 r tccr 'l l l tl 'i i ttL r ':'r ':rr l c l l l l l ) 1 l r ':L r l
1 , , , , , r , : r 'l ''. ] , 't , ,,, ,,i 1 ,,'tL ',,i ,,''i L '. '' "'
(') llt l, t it r lt r ry tt,ti l tt u .l t ti i x l ttrtts u ti l rt t' t,.l l (:t(,| r,r.l l l rr,l rrl or.l rl r" o , , i r l r r t l r r t r ' ( 1,,:r tl r . l 1 ) ( ;:l )
Ir'l , ttl rLr , r ' , r rlr l|o lrl rl p rrl rtrl . fO r,l rIx r l rl ri l l rr' , r.r.l l r.trrl l rrrl i l i t, 0r:trtrrgi r,t I t ) l ) t t r t : ttl r ) tt.l 'r !i i l "t'l 'tttttt i i tttl t tt"l i r '' ( ;r ( l l r l r r l i tr r i ' tttl r r l r r ^ 1 r :tr
rtrl.r r {tt
It ) lr t r r ' , liq, r ! iil t rrrtIi r,| ,trJ i l rl r,l rl t,l i II,| !.I ir.| 1,IrrrrorIi i i .rrr.i Ior,,l rrr i l r,l l,,l,l', ir;-i;',;"; ,', ,'ii,r,,. It.r'lr.I 7'trri.t' lrrrrtlrrll','
ir'trrIrl r I r I i " ; r lI r r r . I I ' r i rl Ir. rl r r' i tl r:rl trl u ii l rl ti i \ rrrl (. r] IIIr. III| | ,\| IIIIi i I Ir.i l ,
( r l r l ( r 'i i l l i l r r |l r t i r l t" '
t ( \ r I I .I I ' ' |, rr' , l r l r r r l r ' rr t Ll l t rrrt l i "":.1',11...)1"""'
r t t t l l , l to " l
rrl r, r rr' lr lr lr r r 1, . , rrrr:rl ,.l l l rr.rrri l i rr rrl trrr, 'r r t t
, , , , L | | I r ''i , ' l r r r, l r I l |l I tr r r ' r r l r ' Ir 'i r r l r ' 1 r l 'r r ''r rr r r '' t|||| ||I||i || III'II |'" L r l t r '
"
,t.i
 (rrlr. t 'r t j l , ' : t i t , . ) , , t l j l t , l u l
I lr1. ljI t r i l . \ l l l l | i l l l li,j
r' ) I Irrriton tttl
( r ,r ,tlr tr .t
.

r)r'tr { 1' , lr r (f ( ' r iir r ' ( ' l5r i rr'l rri ,,r' rrr rrr' .r
l rl rr r r:l l l rl , l t(,l usi v l rrl rr,srrl )l xrl rrrl crrl r,

t , t t r lit , lt . r , lr lr r . r lI r , ( l|l( , ( f r r r r l l r , l r l o r t c l i r L i t r l l l l i
rrrr ,rrrr rtL ghi ur i rtrtrtLrr,r' r' cr* ,rrx,
rrr:rrrir lr ' s . irit { , r r r ir )L } i L l l u s\l.o i [(.2 ,\(,l t.r rr' i .r,l
oolrlpl(]x,
I
I
u ) ( ) 't t t t t t i t l i ttttr r ttl i r ' ( l n tu l t l tr i /'r t4 r l ,) . r tl ttttr r i
t , r r , r i l r t r r g u ,r 'r r l r tl r ti , t'r l p l 'r ,l i t
r r r r l r l r r l c t l r ' l r l l ttp !i c,
L ) 'l'ru u rttrrli.snrellettniout
i r r so {j l i r '
l l l {':l l l l l

(u'
tl c zi l
l)tt(ltttii
o l
rlll(lilit
l l ( 'l ( i ttIt
l ttr r l l | l 1 , , ' t r' i i i ' i t 7 ' 1 , , I
i tti It tt, l ) o r l ( ' l ,tr ) r l l l ,,'
I( 'tIIi I|( '
//(':/i lr('l l!'irlr?'rr sr ttr l r i .L ( r
rr r , rr| | ('i I I I r(I I I .si. p.i,1t,_o i.siriilil.. irrsirlioasi,
,,, ,,,t,,.r ,i i ,i
, i ul Lri a* rl i bi v i rri .rrr, ,, i (' , ( llle l) ol ( l( '1'( 'I I j l) ( ! m llll( 't t( t'1c
r 1i I I I t t I 1I I t 'I t '-
" i ,ri al
a sitrdititii, l ri .r' (' (' l )1
, r rr.ii flrir rri'utijrrtrii{lo ctitrc pacl)til, n{xrl)
(Carmichael 'dos(lt,
1916; Als(,ni
, : ; . . 111; i: . . ll; ,,. .\ti c i ,i u .p r ',ri;;i;;.,
, ,, ," vr.sri bu[,rr.,.a p,.rcchri .r
l1 D' r tu T ;, \i ru a b .i ,.J rtJ -,.o
.i nD rp
rnonn.L
(. r.
nt,,i
si ari j i . proi ,,cl j i i arl ,ol ogi ,.,,
,,ii tenrl,or.ir_tuluipot :r,riita,1""; o ;i;l;'L1"su,e rr merirulur , ll,All
I'tiol ,tiMlt t)ti l)lA(iN0silc iN fA,f0L0(,ilAlilsTlil\ltll,lll vl,ll'11'llll
'l;; l:ll r)r,,r.l|.
.,,,,,r,,. .l]: :1 l I (,iu,ln(,mulacusti(r, sernu clinic, care aparo irr
rr , .zrrli. r...r,,rrlrrlri \r..roni;i,otiU..
-plimulio;i".'iiii1 ,ii,,,,,,,,"r,.*nur,,
..r,,,rl
"'] ,: rr':rr{ lr l,11".r11\i\.i rdo uhi,.eir:irrr hrlriclr,
l,rjn dp,,Lrmp,.,rJ;lr(. {r . t tti o l o l ;i c \ o 'l i l r l l l i r l i i
lrrrllr{,llii, pr.in hernorlgie intratumolal[ sau prin's}as}n -ll.l.
.rrrlrrrrr'. Iir 1r'irrririazr'rse constati ta al iutcrci
e-arn",*i'odi"cti.ril surditate rarri l 'ttl i .i r tt' * 1 r :'i tti l r l o tr ;r r i l
,I,i' t)enrrusuner{re rnai ira t€ (Arsenr;r cotab., : 1 . '\ . 1 . 1 . . lIt]t:.ti o e u si 'n tTtl tttttt[o r s h i tt:l i tt' "
,,j::,'r,,...]:li11.li
,.r. lrrr p('t ,.onstata,(Arseni_ . r i t r t l , r t l l t t t t ,. r 'l l tr ttl l t'l 'i z:r 1 , l ) l j l l tl '( J s( l l i zi tl i ( ' tL ' t[i 'l l l r tsi ttr ' l ttzo ti r '' 'l 'r
, ',', si co1ab.,19?3, 19?i): curlrr^ ', l ) r ) l tr 1 r \tl l l l i \r 'l l l
r1 rrJr,tl(,tll,(' -,r,li,t, rlJro:ir:i de le
fi,ecr"en{e1e
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srLldilate]]€coc€ pcntrri tonalil[til; l ) r i ( 1 " o i r ( "tr l l r ( '
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,l I'r,,tqr t,lrtlrrniti, (.roltaiatiit ttii Babinslti,si
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t r.1 I't\,'h n tn
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rrsriretrrs olizontal care bate ae I ir r
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p rr| rr"is ljc r ' , r ' 10 nu a u _l tu i i i rrl i n c i ta rl ,e a
c ri zel l ur di rL bui l l l r,.N [i rrri r)rrr, I)rr 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( :tt l tttl
i Iri r'Ir.' r r ( |irlrJis t lulnlls u l , L rrl l [rri rti ]c tl c c c l i i l i ]rr:u l ani ffsl i ri hr l l r r ) tl '.i i l :r -
ryi vogol :tl ,i vI ittl.srirt t,,,,i i i l i '* 1 i i l i l i i - l i ttIr :ttII', i tr s,Ii i r r tl tr i t'sl l r l r i l i l r r i r r
ri rtl i ) r lll' r r r i r lir c ..r.' ,\s r,rr,' rri ' r,rn u ,rri l b s tr i rii nrr' i r)ri ri rrrrr. ', , i r l t r i 'r 't ( r ( 'l i I1 1 !', l ) l l r ( 'r i l ( 'zl l l r l
s. i rr,i rrr,s. 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 ',
t.tl.,'itrl,, tttrlt:,,,ti rrr.ntit,:r,itr |ttl,4,t\tl.t,tLbl,, i\ lt,ou) ,el,t)
rrdirslir;r,,itr tttroltr r r ( , l r t l r t {. , l t t l n 'l l l tf f! r i l tl l fi tl l ( r ( r r t l xtp l r l :r l r ' ( l 'r r l N r vi tr i r t 1 i r r o l l l l l , l l l ? ti I
.,,i .!,',., , ! I , . l. \ |w' 1l||ll ' | ' | ' ,\| l tl l ,1 ' ' l t' l | ' ' | 1 1 l t.rrl rttttt1i i l tttl tt' l t' dtrt4| ' dri | l | :l !l ' | ,.l ,(| | | | Il ' | .| |
l \ l r l , 'r , g ( 1 ', t 1) i sl ) - l i l i l .r .i ,ti ( ,' ( l l l i l - i ) r ,<,l r r l r ';r z:r r. 'r r , r 1 r ..r 'i l r ,r l r .l r , .:r l .ti .r r
|l i r\\ l tr( , t . 1, , i |lt irt, , l l )ti !); l i ,i rt(fr, l { } ri :.1 ; l \l i l i ,fcsri rt, l l )?S ). ', , u i , t , ', r , 1 1 ,, r 'r
l r i p ctl ,,r r .r l r r l r i l i l r r i r .tr .sl ,i l r r tl :r l r i , r 'r 'to si r r r i l :r Ir 'i IIr tIr IIi Ii ,
1,,,i
.l l - I r r li. jt lt , . t lr u t.u rtti l o j ;d x (ttl tn l th i t,i ttl i h,l t, l oni tt ). N l rrl pl :rl ri r.i rr. 1 . , r , ; ', : r 'i i r i i t , i , ,,t ,,'l t,'r ',' r cr l r l r tr l o r |i 'r 'I:tL i r Ir tl i ( i r l l r f'l ) ( l l , tl i l t tr i tzttti '
r 'l l .r r
I t I r'l r, I rrr t l r, t r . r l: rlot t.,k . l rr, trtro r.trtr.rl i l trrl (\1 l ,r, 1l l (. I,rr,,' .,, :r r .i r l r r l l r r r ,.r . l r i Pcl l o l l l r l l r l l l i l r l r l l i l l tl r '
lt r.1trl l trt)l ' r.l 1 , . , , r , r I L , J I r r , , 'IIr ,'r r r r :rJr , orrlr,

I t).t 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,).
s). N e,fritele_. cronica (trtritr rkrzrxrhililrrele hidro-clcctrolitico ou rc.pc[.
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.).
Yr,r.1;i.jrr1 " senzalii de instabilitate,
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
rrrirrl lllrirr IInilit1,('ral (l?iquet qi Piquet, 1965, citati de Stoica, 19?B).
I'J.. ,4tkt. d.e..
Dertij ,.labirintic:. vertijul de ascensor, vert,ijrrl
. .lo'tna
rlrllrrrrinnl;rlo unornaliilcrle retraclie(astigmatism,hipcrmetropie,miopio
mioflo
ol,c,), vcrl,i.iulonlcl)1,i:rl,
rrl,c,),vcrl,i.iul vertiiul ino
onlcl)t,i:rl,vertijul inotitor.ilor.Ultimele slni, in roalitui
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
rrpiloltsioI
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.
prrrrzrll,orlruviciului ds rcfrlc{,ie q,a.);
c) I'u,lstrkrvortijo dupii hiperventilalie ;
f) tu,lsrrlevorti;ic prin tulburriri de statici, (a,st,ilzo-a,bnzice - 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,
2.8,i,2, Munfeak\riIt oarl,'i rt ila orillina wstibulatlt (d,in tind,roq,
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
lrtrirurrur'l(ltlitt 1u'oot'lio
t[o vtlcittilhrlo: t,ttttt
lrtrrgitl (rl'(i.),ll'(r1
tti, citrltlritrtr
tirr(\il,
Jl('t'vlrlui liorrll,riryitlotittrtrit'ca,
vcx(,ibt.tlar tlo ,,sitttlttllrtrol,rol:tltit'ittlitrt'.
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'
rrrsii,si, aib5 un caracter pa,roxistic,de 1;iprndni<)l ifolmr oll (!\lc('t'Jrilrilrl
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
',r.lrrtil tle par lor lqzali.
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, $i definitivS. Unoori, instr, sinrlronrrrl
vrlstibular estefoalttl discret, cu ame.felimoderate,pc prinl plan sil,utudrr-sc
rllt]o simptomc ale herpcsului zost'er cefalic'
dJ Sdndromul l,ui, V ogt-I{oy unagi, vorosimil dc originr: virol,icri, tsrr-
r,ilr,z6,I ncvritl'i, oochlco-vostibularli, (cu sualitate qi crizc verl,igiJlol,so),
uvoit[ l)ilatoreltr, vitiligo' rrloleoio 5i polioztr.
a\ Sind,romuLl,u,t Il arada, fourtc ril,r, tot tle la,tuni virol;icl, ol[.rr
t,Bomlun[totcu I)t'$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,
tr.rrrltr0TLin Slnthom ooohloo-vrtt'l,il)l llltr, ct'l ttttt'itttlt'uoll,ttxttcirtlou lczhrrri
rlrlltinlo do rrorvi ofttolortl El ou Sotnllotlc polirmlicttlotrcvlil[ 1,tloroa, orr
sinrlrrirrr liolridiuu do lln Oullll,ln'ltu'r'r{.
107
 rlrt ltttlu rlr, oti,:ittrrotrrtilltliistrrtzrt'l ill tIt' Ii'tt ttII t It IIi, prrlr1t'lii'liltsllt;;r'rr'
,r{.
ri,,,r,,,.i,,,2:,,ri,, i,i.* ,;,i,,illill,,,l,,,i;il:il;il,il'l,i;,]]li;ll,,ll,l);.j,,;i1ii,,,,; ilr". rr.isl,ii,rrr lrr tttt rristtlgtnus Ioillto violclrt,.
,,, Drrcii itL sintlromui-vestibular lierift-Tio itrt'ihrirrLrlislilrglrrrrsrtl r'r'i
li ) ,\ t,u t.t\)(liilr r ( : t lil .ctrirltlii' ttisLrg
vestibulirl de ollgilitl
r,rrrrla,i -si/sau lotator, in sindromrd

;.li.r'r
.,,.,,,,:,
rxriirllriri''iiri
l' rir;ii';illi'lrt*i,ll,,i*-r:,
tilf,"li''j. ,n,,,r,.r:,,
'':1,, ,.(r,,
, t', ;,.,,;;;,;,i,,.:',iq,:ilil:],,]:lil.,Ill,^u;;.;1,'
,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
din unhrtoiditrtrttr unohi n.,,,t,(tt,i),t,,\
, ,,,,1,,i,,,"1i,1",,0''r':t',:,'ii,:i: ,t,tl ii{,}rrl)its rlr cste influentlti de schimbirile de pozi!,ie trlo (r:l'luLli
z,:rri,,
rrr, r ?"n aceste sirrrlroiuile centra'lo se pot remarca nodilicr-lti It i IIt'I t' I'i rI i I
r,,rj^:,
i*p"t d"*,1.i.11;::li:"[Jill
iit;l :,;illi:l;,;l,n:l. t:r, ;,i',1iek.instrumentale ltic hipoexcitabiliiate, fio hipere\oitllbilil'rtlt')'
,sice,r,er,er,j'.
:ll:,,;,',:i'l","t"""lli,rti;_r,i1i,".9*tbul;Lr ,r"',1'i"i,itin
,iiiri;,l,\ ' ' ii'r trcmplt in scleroz:r'
in pl5'ti, in ca;reaproape con'strt'ttiso itti'ilrrrrlll
;;; ;irtii;,d;1;*:*i*|j{{,|"",iti:i,Li;ttr1 .,iii,i,,,
iii:,lili*i "'i,gi, ,, 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
;;;rrr,;rl',l,lll',
Jil#3;[*i #"r#hfif:f fii-{rr
i:.#'tl#!'{i11ifu <llolr-r:ielevasoulare bu.lbo-pnntine (Wa1lenberg, Geli, R:rynond 1k'r'jlrrrl
r (:t,-.tan-Chenais ), in scleroza in plxci (uneori)r in lrnolc cllfi)ftllil(r
(lt!
""""i;'i'li;i;;l;i:l';llfj:,ili*",precizate ci,rai.lliiii,f
larse'ri;: illi,ii: tIrirLr,iiicerebral, in sii'ingnbulbiesi in nneLettrmori de fosit'posttrttttlt'trr,
'serniologicapare q:io hiport'cuzitr(p|irr
#":ft
llt;;,;;*;lll;;;,irij#t#l,i#il""ii'l_;il","#1,ffi ;,,'lil',lii 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.
,,,,r,,i,,
l;i,llllllruj'*i;,f;#4;:.,*ri"''#*t'i.ifr.lllJ
pie'os,,.oar
iz,, i, in sindroanele veslibular:ecentrale reactiile nistilgnrki{),,itt rl'rttr'
itt trrtztrl
ii,,,i,jii'";,;,:;;i;.'r;;';i',lfr'H;,ii:,";li.iti::.1ll,1.iJj"::-'iogic:1,,r 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'
,ii.y:.'yy1';,i '!',,fi;iii,lil',11,,'ff:;:{f;iii',,ii*i,i ,,ebtibt,t.,,,,,
u;i!lil,l,!:,0{;,,,"u', , ',',''il-ititirgi"iisul
st' pretlomine intr-o anuniti, t'li}eo!,ie'hi silrrrr{'irrrtr
r'r,i,ste :r{e"ctatln singrr nutdtlll vestibultlr, pui,cm intiltti llli llislirsrrrrrrl
,r.:rrr.,..).
(I tlDt()r'i, llrt)(,(,s.,rL |glr ngj, ai; 1. ,
r,,,,r,.,,,",,,,,Jtf
l'lii]j.,ii'
{;j}ffi,.'i[1;i$?,#1ilili ,,,r Ir)rnlil p'.r;'". Astfef lezitnea lucleLrlui lui ]leit'ers 1tt'ottircu
rru.r o|izontelr ia.l o lcziune bulbo-ponl,inl d€teu]lill:i 11ll
ttrt ttirl'rtt1
IllslirlllrrrrI
.j r lr\r ti,rl{)1 , I orlil > r r lai. i.
\ (.ii ir:11st.x predominant, reriical, Cintl lezirurilc irilotesc'ilzi cotttisttlrt' prt;;I t'
I i(,i r ir-,se p-ot itttilt-ti dii.erso tipuri de nistagmus, t1:rt prcilttrtrirLr"t' lol't|1r
, ,,,,"i,i,'l,i"ii,'i",fii,
lllfiif,ril,li ,,,
ii,:i:,iili:{L:,,!",,i{,'!,,,ii,j,i,i)1,1;1ui,,,
i;;;;"-;;i
rr I rirlrnltul vortical.
;) E:{isten{,a,leziunilor t*,ltibol^t" oerltralc osl,t' lti'st:Llri fi Irlirr
: l:,;,;,1'l:,',,',li,l', iuror
zir,,
,i
3i,.1yt,.1111i,r,,-,Li','*..
ll;,,:i'i;1,,?:';,f risiagmusului p,:ldulai, c:l.lc nn sil itLtiltrttlie tricirlrlltlli iit lczirr

:r i i;r
1'',,tilr,1;1

,i,lriri,r,rr
i;iit1t;hfr *ifr:iitilfl,'iiffi;l "ir r;,
;
r
j'i1,"Jii;l,1ll;
';:l;
,) 11, ji(rlifolicc.

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

ll;l;;l
,li:l,i;l;l;:",,,;nllfl1ijf,illiiili;ll,..,iili"'J'l,il'1i?;ll,T; /) I'arotisnt:h
ttrtr;i.rl;ic constl iu
rerl'igittoasa tle ori,gittt: lxn n'ttlit:ti'
-ssrl"ratir.t
dc tlt-rsigutatriit, in trit:;tiirti'ttrll' tri .,r.r'lilr
l'tt'Liir.tl' cr:rtltt.rl

, , ,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 , 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

, , , 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
( ) 1 ;i 'r 'r ( 1 l l ' l l ) 'r ':l l
1i;i;;i;'.;i;;ii;
o(,,1,,,,rr,o,,r,\
ill l;11';ll;;,'r,:'",,1;lt;ilil,ilifl,r,iv,,srir,rri,rr1. 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 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 '
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 j ,,1: ,,..{,\..,iroii,i,
,,,iiil..'l;-iiil;l;i,:':lJi,,i:,il;il;lillll:;,;l;j;llll; r r r r r L c t s , l t s . r i i ti i
r , , , t i r ', t : r 't 'o ti
i r tt .r 'l l i l r '', 1 t'IIII;ti :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 "
i l i fl 'r ) .l l i i
''i
i r r l ) r r r ''l i .i r l l

', , l r t'r l r r /r tti i Vl r 'l i .i tl l

: ! ) l / r : r l i i t tl t]l t"tti i r ;l d tt, d t r tti r l i n t
,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
: 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 .' I' r , r r i r l i .
, , r , ', i , , , t t r r ,
t r i , ltr i i
|) ||tt) ti ||i i ||
ti l i r t tr r .r 'i l l ,'l r l i i r 't1 ' r 'l l ( ) 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
r i ( . i l ri i rt I i (, i i ' I , I ri l .i |r ti i ,l r ,ti t' l r "t l l 'l r t o l r l tl r i l :ttr r i ti I0 t ttti Ir 'tr IIt.
,,,,,r11),,1i,,'ljli;;,'l;l;1';;ll,,lllllt',1'l',;j,ll;iiiljlili;,ilt;,,ii;ll,",Jt,lll;;1,;';ill,,i;;,liij
lrrl l rrl r\lr ( ir l 1r . ir r
l r : r i i j r r l r r u r t l l l tttl 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 ',
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 r l ( r 'i l {l '/:l l l l l ( l \l l l l l l l l l r tl i I I ) | |( I( )| | | | I't ' I I I'
I r r ' ,rIrr.Ir' i rrrrI' rIrrrr.rrI:rIrr
li .f,,,:,.,i i j 1 , , : r i , r , . , , l t r , r l ,l | l i ,l r tr tr l l tti i ,r l l l l ,l l r l l , r l l l r r ) l r 'l i r l l l l l l l f l l r l r l tl l r ';r l 1 i l l tl r r
i rr l i rrrl .,rrr' l
' r,rri rtri i rr , . 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 , t r i r 'r r r 0 l :r r '1 ,'r 'i :r l |r 'l
l0 l t ' '
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,
,L'('li!l('{,, Bljxlcsltl}lilluil:i,rii, tlo cokr rnlli rtttl{;tlttf i, sotrttttrdo lltt'cllttrr
ir,i\ir(,11i(:,
'8tl:i) )t sir'inltltbulbia )llil,l|il!,81,!iIij(r \ or,l,ig,irorsosc plitrsoirrzi! ru rlclvilor octtlomotori, ott rliplolritr.
" trrllrn.!
1rrirri,r' sirrrpl,'rncloinitialc, pulirr<l ,,pii,rtlt,Jic'in crize foail,o vi'l*nlr, iri. c) B'inrlromut Ttseutlontti tti i,ri,.lorn. (aI .lui .!'iytlty ), tlr'ii td'ittlttgitr
rr r,i,lL(,ulrllur ufoalc, aproapc ioldcartrra accentuate la schirlbiirilrr
dt r,r..tz*tii. se c*ractdrizc:lzrr,t,r'irr inanitcit;rri ver"liginoascirrst*lrl'r' rru'irl,
t,dr rr' :[I, (.1]pllrur$r asoclat(.cu julbuliri de ec]ilibrr. il,r,, :m,i nrrtin brul,al decib-in boala Mdn.idre.
I ) I )t lt ttconertarfte tulbu{rile vestibu,lare apar in pesi;e 90}i, rlirr S1 VeitlSul paroai'sti'cepiteptia,. tr'orna cea mxi pctent:r' do vtrrli.i
,rrzrrri, rrrilnilrlstindu-sesub forrua unor crize vertiginoasg psihoselttoritt'l.ii
cu ahuri'rntt-
rrillilirlrrril, i!.speciai in cursul.py.seulilorevojhtive -ale sclerozeiruultiplc, lraroxlsiic epil'epnii este repr6zedtat:a de criaa tampo,ali'
,.1:"r',rrrrr.l,ri .er :aiie lle ineleal,i 3i-rostogolire(Arseni ii colab" 1978; Grsl':uttl'
,.Liar ca sjmplo.nle.inilialo. Crizejcviolenic. br.u1rt,.,sj;,i rrLrr,. ",t, F6Joviciu ri colab., 1976i Stoica' 1978; Popoviciu \siPascu' l(lii{)'
r:r;r r -vd"iijo1
\ | ,rr,,trl l IISII |
'.Stc.
rIi|| |rIrr.r)||si1(,.t1(.,1
DUitlora[,de ojJjcei olizottal;i schimbilrr1'rlo.oUs,
stu |otalor. inso{i1dc l ulburiri dc ocbiljbrrr.Ur:cot,j,
ii,,'r'. .lueptic {,oatoil apgl {ie .sponran(in cazulcxisl'r'tr1r'i
urrrt j octr cll eploEetrtreoseuitde adtivl, fie in mod rellex, sub itrllttctt(rt
rlrrl.r,itr'irruci par.ezecie ooulomotor citern, putern constata un 'o.siibulrtu, care realizeaza cxacerbrrea paroxislicl :r
.i,'nr
rljrior.iit,lt rtoltriculat, 'istagrirni """it*iii
l'ocaru-lui.
,..ltgc. oetu|lelc sp_itao-eerebeloase pierra_Xlarte, L]t, boale lxti,
,, ,f.) ,l
I t u\t! t, rh .:t V erri.iwl'enitepl,r'c(epiteBsi'a ) poate fi cliferen{'iat tlo rrllo
lrestibutogatud'
di.', rstlcJut'nede altoJii cerebeloctsr
,1.n puD apjrca accc,.^Teiti_ 'de 'vertij - cu ' aluri paroxistici, (Sloica 1969' 1978; S:t'gt't'
. |.clorl-tntc. torruc , lilicc .
''r):r,\{'t clt duraLc dc la {.itora minutc
Iini la citcr i.i,zilt., ,i . uirb., f'glO; Gastaut, I973; fopoviciu ii colab" 1976.;.PrinciPrulcl'r
ir,rioqlriLlo olt ttaxie ccrebeloasii,D-icu nistagmus, cao", -,1" obicei, eiito oril
,,trl:-1,l,ib.{r.r',ri de diattiostic diterpn!itl, sint : a) alterarca cunotIin{er i o) 1l'Fr'r'rlrrr'
ii lcnt, pctbisijnd si inrie g,izelc icrtisiuoo-i. p,ot 'i:tite;ir (Iie-independent,fie altermndcu alte siulptomc cliticc (lo ('l'r
rcrLiiului
, 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 i,';"'";;d;rH,-tie ci si buli, in cadrul unei crize epileptice convulsiv.
adtli,ii ., i g'*o.triizat"l : it couslabareaanolraliilor EEG pr'rorist ilr',r'pi
lrr('r i r ir'('sirn],tiomai,ici din familia rerfiectivi (Fh cox'si L"i*tl -igil;i. ''ul*
ti .4l cr:tiurtite aentriculului
lclrtice cu* loealizars ieinporalS,. Traseele EIQ po! prezent'a' dt':Lll'lr'l'
. ) at ly_tca qglio'arne'qi .[i"t*i *ri.l.*ii iol'rue iritative cu sediu temporal qi in perioaclele intercritice'
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 9. Exi.std, insX gi oerlije tenporale ne.eltileptice(in tumori, .altct'tit"
d'izont,o: l.r'rLum*iiJme de lob ternpor6,I), caie apar in crize cu durati mai ltlttgii'
: rt;r,lot \
,' rr.,)rrlr, ',rli(,irl,\'i.tsiiLuli,semneCn!.pbcloase,
,<i,.(r(.||] divcrsei*Lnnc de tlirr_rrLi
rlrr rliteori sint aproape lerminente qi-au ulele-caractere clinioc pit'rl'itrtt'
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 t,r,rle.Astfel, bolnaivii idcedrci, senzalii .le ghalie, alorid.ica,resau dc loltot il'r''
(L(! irrrllr
r'\ i(l('rtiii,hir,u- st:,' i'excitabiritatevestibulird t'" p""t I;rritt rlu rle proiectie in diferitele pianuri ale spaliu1ui' inso.lite sau nu
rrl u rrcoli JriJxtacrtzie. "r.'i".i"""i"ilt,ir", r,,nolCiostaut, 19?3; Popoviciu qi colab., 19?6; Popoviciu $i Pascu' l1)$o;
I'rrr.rrritrlr ax1;ansive vel.Tiene qi rle ventric'l al lv-lea p'ezi'tii | 9E1).
rruri lqflr;r,1,irr contcxtul clinic cel
6i iindrom,ut lui Bruns, arr" ,tin
'1.'1]ll::l::l.i;.1 i. y,l1 dc crifatcc qi""osti
vir.Jtult,
-!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
mt.nti rrrl i ;i
,:r.1,rrl rrrr,,trit 1i I rrrisc{oda{I cri coipul 1in.,,-60""* i"i.,,lt"i_ 2.f)..PROBLtsMI] IN PATOINGIANIIRVULUI
DE DIAGNOSTIC
r r,r,lr, ). ".,lil"ii-..ii"i
7) Nut,rnnitatestibulard(Dr1 Hallpi,le, 1962 Cawthorne colftb., GLOSOFARINGIAN
llrt;1,;l\I i I' |.,r'ri(.I| , ISZg)cuprindeB $formetlinice : ; $i
uas,t[bulurd
p^ro1triu.-.zi.sd
esteo afecl,iunobenignl, cri inoi"
, ..,::!,.\'::::,,,:!ta
, (30-5qde_ani), careinterescaidneuronifvestibular.i,
lji. ".t I Ll iii!l]9 i$ulte
Debureazi,brusc prin crize vertiginoasocri 2.9.1. Invcstigaria semiologiei a nervului glosofaringianilnlrlicri':
::l: :l.ilill'
rr('||s|| 1ll;lll.! $r i.cr-qenr4,.
t"lr,rr. in citcva ore sauzile,ciup' carcdisparc.-Nuluting0
Irrogrcslvir a\ Entrnenwl fwnc!i.ei motorii.: Se celcetcazti'motilitatca ptrrcLt'ltti
rri. irxIrr,I r'i,irl,onsitatea crizelor Mdniire, dar qr6bek
l'l,N( l) .virltrnli*zii, ".*tii;6;; de
sindrom veslribur'arcu-rripoexcitibitiitate
(ir..i;;T; r,,,tt.r1io" al tr,rinfetui, tlcglutilia pentru Folitle' cYcntuala plczettfi a'
rtli rrrllr,l,tl. 'n lar1,*r .r rnuLtluicoltiuci tl lui Ycrncf.
It\ Itrnu'menulfitnalict sanzitiar, &nalizind scn$ibilittte:r' ltorr:ltrltti
_ . l,)- -ryr'i'r"a,r'ila rertigittoasd,satt tsr.rlijulrpidentic(Cirxthurne r.,rlrr,lr.,
llll;1,; N ir.ls,.rr
;i .rrlrLb.,cil.t(i rirr lVil,r;,1scu,'lC?g)
5i
lt,joro t.,,s,., irrl,ir'i,ii t,onl.rriLrtl flrirrg,lrri ;i ir,tlrjiLrr llnrigd:llicnc'
r';rin.rl irrrir'{i's .rr rulrru'irri r','spi.ati,r.ii "',i;,Ji"r:itrto$ti.?! t:,\ lil,t;urnr:rt'rt'L ttr:n:nrialoconstii,irr investig&ii1l'.glsl'ulrti.ltt
iili",i t(, Fi .' .[tr'na!iei,
,r||||rr'rrIr|('
rrrtrr( r'rIr'r'fr|Iili.r'.T'ru't.r'ific o irrfcr'{,ic t,,,i,nu.'ili rsii'.i, ,r,lim5ii (tltt , s,iu(riol'u.i,, lrttltr,sobi1o r:litrinl't)'
vir,tic,ir,lilrill(r s,i:"ir '.r,r'il
ri rlrr lrlrri.i'1'rzrr,li.hirrilnli, rim{ooita'ri,,-aqa ir,,it'in"t-.i.,"i.rr',,at i\ l': \t unul. Iunoliri ultetdirir ('(,trHl,i-t nrtt't'!irril)ltroi'jtlt\
irl ltltrct'it'tr':t
l'rtrIrrrr.rrcr.l:uIiIr.
(l)rrr nl, T\rnoviliu ruilrll., I{rCf llifur'tiir,sr,u ;i rr,i rrr sitliv$rlrr{'K{'ilitlllrgrtBl,l!l,rvr.
qi rr rr.llr.xttlrri
hiIr.rrrr.ri.li''ilulivrtr';1)
,1lriIo ,r:r,rr
.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, t,t,t'[n,llttrlu
{\\ lt){.tuLu turingirvte.
I t0
ll I
 t'ttrtvrttt
r'i.rrrrtlir
lli:rgllrsi'icrrl pr^ r'ris-
sIrthilc,,sl,o srr'ir.r'i..carr':r,il,ll."i,,;,.!;,''i1.,i:ill,";,i;1.],';.'.""'
rl,.s,.hirtr.r,r.,r
!.lf.i!. Novrrrllliuglosolttritrl;irrrrri.
1(,lrf1[
.st
itt ltttr,lir' (l(' {'clc /rrl Jt']'ttt(cLlture:
ullot' l)rlr'l,iotllllritlilir ' '"f"l"."ir',llrJ",i]:i:$ri*:"t:i*l,,iiii;li:;li':
l) Nnrrutgia glosoJu'in11i attii lt t'i.ttl,i,tirii satr, Ttrint.ard (est'rl'ilr'lii ilt
I r,r'rnirr.rlogia riecbi teime,n care f'olluie abandonat) afecteazd ill go]ll'rtr,l
;l:rll#i::*'l#::;l#y#til'itli;*r"*l!tri:,i
lflf, :o*:i jtr
lrrrlrrrvii peste 40 tte ani. putind insi Bli apar5' ;i la tineri.
t)('l)nlnl bolii cste de cele mai mdte ori brutal, iu llini, siililtal'o
rrllrrrrrlir. lntre prima crizd' durcroas5, si -urmi,to-al:ea pot trece cittvll
ulr,irri'r :tiriril;i,
,t ilrrt::;rx;li lil liri: rcsiuncrmtt-'r
i*lxmil'
ral r"nduclrrl:'ldit;i'ctt'r'r' -'i
l''I
'III:Ii
;i;i;;;i;;
r:itrlirrritrisau cifcva 1uni, perioacli,va'riintl mult de la caz la caz. Criztilrr
rnnilorr(f rlevin din ce in ce mai flecvente. *:l :;ir *nl'';:;l::
[:4tkly;l lo::'jl'I|
i:;'
l)llr'rror debuterzd brusc, violent, la baza limbii sau intr-o zonii' ditt
l,,irr rrnristhlia tii. Locnl durerii maximale se afli' in regiu:reafarirgiarl iii -"' s-,,n
,,ili L. ti o' or"nolrt'ingologicc
rles'is caz*i
'
*'t;n#: r:i",.#*r:":il,i:!i:il
lrrigrrrrli
"inelr-ati, rle nervnl glosofaringian' I)nrexea qi zonele
"s:ie
tlo
"tn;oi
liii$ *i:iilli::
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 :ili,:t',tlii*1"'!i?Fi:Li ;iltrui
t"*yil".:ji,."""',f ji,d{ j[i:i]]
1.}i;r lii.,irri
r rrrrrrrr
1e?8
rlrrr,'iii irr lrd. ,o1u?,in funclie de {or:ma clinici: a) in forma tlctsir:d':lir' p"p"'i.".;i e;o]]1"
lrrzrr lirrrbii, in regiunea arnigda,liani, cu iraclieri^spre.timpan' ruri"ljlll l?il"].i*tT;-ti*[:ii".:i!H1':rgil';
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' pro- 'S:ll*:ii);*,""r1,-q,e:Ld,";';?,,:?;.i
"1,irl,cr
motrorii salr gusia Ye'
ll;1i,T;"#!'::ffij'l;,.'""""
lurr(lil, s:ru nr condlictul lutlitiv exte.rn; d) in marile ytatotisme il''trcreu'
rr,,rrl,r' ir';rrlinsj .in zotre m:ri iltinsc, respectiY rlai inferioaro fa'tlii't1e ccltl
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
];lj
;*tlti'{,,j;{,;:i;,^r,.|,0;'il,i,ll;,i,',!l:;i,!:I
rrs :'
dc'l
|rrlil,". .^rtrrsoc devtlic" etc. In rare sit a;lii, durerea estc apreciatii ca o *T*{ft'"'?l#::tii';tll*'.i:ilr:!"i:l{'rinl;i"' l;;; jlr; I ill;l
,, riz,,ii,. ,[,,
'\r'rr,rii ili
'rlist'onfot
()l)r{rsctl,
t (BoJrm qi Strang, 1962 ; -Bues, 196ts,,cit'a;li dtr
l9?9).
-
Durata unei orize csie la debttul bolii de 20*il0 l',, rl;ji::l;l -: :il" :.'ll';:::'; ill ; ; lll
lll'jil:
tr r r r tr r i i r 'r rrl"i r"rr''' '
bolii. lncetarca cltrerli cst'tr ,, r r ,bii .i ur pc r ,i.1,
.. ,,r u',1,." ;i ;i ;,;-
.;' !:'
rlrlr-se nrilol1,t odat5, cu cvolntia ^l l :i l l ,'

;*:*l**i'lr-i*rli
',',,,rrr,i,l, intelpl}loxist-ice fiilcl asitri-

1r
lrrl,rrlrl.ilrr l:t'tLft,iiort si d ebul,ul ci, intel']'aleJe

iiri,i
i1
I't'l ioliktle libcrtl intru crizele du]eloasc r-al'iez5, de la uI boln:w
1rIrrrrrirIitur.
irr rrll,rrl,rhr lrr,cil,oi,rtItrirutte 1tini,1acitevil orc s:l* Lliteva, zilc. Roala!o:Il()
,,i,rlrri itr l,ttscttt'i rlttltroastl qi remisiuni variabile oa dur:ite (ca;t llttl'
:I|l||,1r, t)r,r;r lrr' I -i atLi). Clizclo apaT tlc cele m:ri multe ori ziull. cltt
,1,'t,,'i,,'itirrs:isi tton,Dtc:t
;r, lr.,i,r1r'ul)r iit slh't,,
jn fazole alvinsa,te2llobolii De asentenea,clizt'ltt
care se relct,i la intervale de tjmp valinbil' iil'In*?im
J-$Sr:;l (?"
i*;lii;i,
filrthi.liIrtr ilittrtttotl'i,r:t,t.ltti'
rrrrrLrlir',':r
corect
"d.eneTralgie glosofaringianri presrlpinl0
lrolrLrir.tjltLiin timpul unei crizor anlliza facl,orilorcaxedetermjllil' xlT*i$:1;'":"'"""1';;liti:iliii'li;
:,*iT \s
rrlrrrli{irrrlizci qi locatrizareizonelor declartqatoa,r'e
r,:rri si {}lrlcsctt,19?9;Popoviciu qi Pascu.r 1981)'
(,,trigger zones") (Ar-
lff:{ii?fr'{h-itffTfr
l,lq:";lrihi{",,$ff
Illrriirirol), pacieirtului in timpul crizelor-permite ollscrvarea crisptirii
Ir,tr,i. rr,rrtrr'l:iti i iuloluntarc a miinii ta nivelul zonei inferioare t[ ltilei fi
,rllr. l:r,r'illr.,, sa,u sDre urcche, intrerupexea masticaliei etc' Fenomcrl:lo
r I ,,, ,rr,, ,t , ,ri i i :.i.rrtl'lr r' ."i se pot manift'stnpt in inroSirr':rhomifotr'i fi pritr
iihi#hiili'"H::*;:*$#,*u!'*;
-'nii'fifiTJ,:iij'lyli:'iil,',*':*,:'';,'',1"{fiiJ'i';
ltiLi':iil;tii,:lit"i
'
rrscirciuncrr grrt'ii tlc partca- dulolii. In tirnpul crizci- tlurerorlsc bohrnvji
F,l,irr.(l(! rrbicei, olisltrti, cu fncit:s imobil ,si a'plccfl1iinainl;or pclltl'u ll
rt
jgi ;g iliq*iTl::d
sind'r om,ttl nel"D'u|Il't LarN1

;iiin;i
1r.#:i ii
i,,iri
iilliilil,;,
lrr,ililrr srrrrlg,r'crsnlivei. ln alte (iazrlrirbolnavul iqi montinc callul a'llooatt
"i
", l,
::r',,lnl,l "irf
l'flllil'ii
rrr,rri rrr :r rrrlii.r:r,
it.r',,grrntrl,
nrtts.ttlllttra h 1;r'r'txrcrvicalli,
lurlitllrgtr,illl 1i/slrtt r':rttltlttl
sn,rtili aptrtd,01 mina' urochon
llll(li1:iv r'\1'\rl)'
rcfirozinlir'o (lllpilr
tlll,
illll,.)/'li,{t,ill,i],:fi*il,,
,t:frin
iifr
Atrtlizit,
it rxrt'l,tt,rr(i
l)r,,rrlrrlilirr
frtol,ot'ilot'tln,trr

iorrlil tttt
'',,,
Irr'cipil,i! ttprtt'i{'irr

t"",, tttlottlrltlitt
cliz|lot
trLcnl srrlorrtrrtitttiliitttttli lrrrlnltv(ilt llr'vtillgi{rglonolilt't'it
tl|!rllllnqltttrn' ltt
tlt'iztrlot',
:rl{i
tgiitnt'[.
tl
HJrt'tri:t'l
Irrolot'i
il rk' rk' gl rrl ,i {, il'slr livci 1i lr lt it t t

;i::[tl,llil"' ";;illl;ll'll],':iii
lll:l;',;;1
llil;i:lll,; ",'ri',flllJ
lniil" l :r '- l ttfr l i r r ;i l r l l l F( 1 - r l r 'r r 'l l e l '1
ii,rti i,l,'1,1" Dr',',tr,rl,l,
, trr,,Ir',',ipil,t rtprrtr(irr
r:ttl ttrfii,.;'i,ttrtlrtlrr,rLrglttlifirri,r'risl'ii'rii
1tt"'rri
criz,'l,rl: rriitrrr:ti'ttli,Hl'riitlttl,ttl, lt:rsrtltti,
ltlsrrrt'rrttIlrtl'ttl II ,i,."itt,' , f i t ', , ' ,,, t1 1 1 1 "1 :""r r i ' r r l r r {r l r
r''' I ri '' fl i

tfr,v*r.X rr,,
,16
I I:t / I \,,l t't, r
 ,,ii|ItIJlii,'rl)tll,r,ltoilir!v:tltilll,r,. Hltt(lt.rIrIluI
I,sl,(!(1()ItI t)I(,I,it,l, rLt u l,tri_irr
cltitr- .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
1(':t,Nir' .lr s:u(ii|nl.o vior(f r,r',rsrrr,rirrrirrri,
(lu tl$urintiro novr'tlrgiL\gl(]solr!- 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
1,,.itfll,lli \i, IoNllt'oIiv,tr rrlir:{irrrrr, t:rrigirr,
li. bo s,:rnudc tliagnost,io cst0 l,'t',lrtl5ar'lra;ri dcsfiiquralicl"'plimrLirti f itrrli rtl-tlrrelrrii{ici 1rt'ttlltt rrolirli' llt'
rlr|| ,'r'(.. '
r,..l)r'r.,vor.iitr-r,
in_punclul lllrirrgrrlrrisuperior, adicd,intre ci}nu] car1,i- ,,f',iiiii, a"id,,t.toasi poato'antr'"n1, lllil,iurr(l{ r('rt ruli.trtlttlrlttl' itr Lt'tittc'r"
r:tjr rr' Lrn( 1.[ fr osul l]roi.l. lloba rlccisivd este alcoolizarea r,, ,l*r"t iezi'nilor b-ilaterale at nt'n t,hri glostrlu.i n gi lrr, l,ttllrtrtri''ilrr rl.
n€rvului, cr,r,o
l'l||rl|rr rltllerca,. Uneori se constal,ti asocierea ,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 t lt t r
sindromului laringritri
rrpcliur' ou sindromul cle ganglion sfenopalatin. ,,i o - . liii"r t n* aspeclului l: r 'tinqolui 1r 'r 'i culio t lc t t 'zot t : ut r lr r \ '
' ,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
I I ) Neuralgia glosofuringianii secund,ard(simptomatici) ,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
. ..t ):.1.1..:l*l g]os.ofaringir,ni,s^eoundari,se d.eosebegte ctini,c d,e aea,primari, ' r .' us (sci l i nl ] coI t jU, i l, i ] ui \ / c] 'r clJ) .
t'r' rin :rL(,al'cte elemnnte:&) fond drrreroscontinuu,pe cale se supropull rr, r,r,tounti a {onom clor . 'o" sl] ll , r a'' 5i Ja or t it elea hr in3' lr : i . r I lr lr : l ilr '1'
' Ii.i,r:r,rlr.r.[rrrcroasc- pr,ro\isbice: Lr) tlurolqa, nrr at idqi - intcnsitateb, dctci r aiw*e repeiie p"in
jiliotic:, comlrnsatorio,, ccl'r.l,lli rrrrrsrlri
,||||.r,'\ l:llglll pnm rf lr : c) dulerca so .localizeazii
aproaDctorclpaunaitr f,ri,iirgi.ti. Rett-exuifaiingiain partea paralizatrircslc cljrttilttt:ti'siuttit,lxrlil.
"i,J'-ii"ii de
,:.,, al. g-ibul i. crr iradieri r,uricutare si frr:r,ndibul*r.e;rt.1 prrrr
1'11 lj^,pro.,ly-dc-
,,' ,.',lr\t:Lt,i A) Tulburririle de scttsibilitateli senzorialese cal1i(rleiiz{ilz'i
ltipo- calr tnrstozi:l lojii.amigdalienc- si a rngiunii farlngie'n,.: pe inge
fri,r pc :r litrrlrii, r'tt
r') r'ris1;i 5i semne de afectare lsociatd ii trunchi.tui - t,ipociiezie sau anesl,czie ;i Jre19c3 lonftlir'rt'ti
dotor ar neryuru i lrifr slfl aSuc;io 1'cnrttl atner, in 5l'al'l{ \'l!lul Iirrrlli'l
rllosofrrliirgian; f) se a,sociazaqi semne din partea altor nervi
rr\ ( r,rrrlr; g) sc constati, extindelea ariei durcrolse peste limitele
cranicni Pa,ralizii]cunilater'alcsau bilat(j]'aleizol:lte alc nttvltlui glosolru|itrllilttt
, ,. j,;1l glooof*ringiao ; h ) evoturia cs[e progrfsivi,
anato- ,,irrt'exceptioaale,ele in'riininc]xse rnai {r't'cvcnt inpletttri ('tr lrrrr':lliziirrl('
" ,ll:.1I"]!i cu agrav:]r(,rr, rrclvilor invccinai;i.
. | ' \.rrl,t.r.r''":li r':lpld:i r simplomat ologioi, fdri rcmisiuni.
l |l ,.rrrrtiLunor 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 patoltttit,q NliRVlll',tll
11rrrl)11'r.i 1l;im;r;. i;i" aceste motiv(! 2.10.PR0BL,EI|uDu IIIAGN0STICiN
tz.'t cii orice ,er'ralgic glosofaria-ngidnJ,irebuic consirlerati, rlo
ll rr,,''( PNI'UilOGAS1'RIC
1.'rll .r n,rmzridrrpi efectuCreain\.obIjo:]I.iilorparaclinit,,.
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,' 2.10.1. Invcstigelia serniologici a ltrvului vag (X) i[r}litrii':
..',::.1
.:.."\ .t"".':t:!j':"^:lJ
!7lilt
tll..(.'il,lr'
r)ttrt: (),{,Un..r'rnolrflngc);
b) tr&umdlismelecranienei c\ arahnoid,itelecen:- A) Dsanterutl futtclie.i ntotoriisomalirt:constil in exattritlnttll tttol'tli
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 r ,tii vxJuilraiatufrli 6i i la:'ingelui,prcturn 5i a deglut'ilioi (pcrrlrrr lir'lrirlt')'
pozi(iru
etc. Enanzeit'I sinlia : vilul palatr:Iui se elamineazii' aprcciitldtt i
r,t,,i,"i.'"u.ttu"asi sirnetri*,r'iiulti, prccum ;i evcltu: a 11N1slio 1i clcttl'ttrt'
I II ) N eualgiu glosofaringiand,
,,Junc!,ionald,, (simpatalgia) llo iriqc[r' inrl'oluntare velo-palaiile.
,\r,r':r,stii,llormd, d.e ne\Tc,lgie glosofaringiani, se caracterizeazd, trr'rl'ir
rI rr!.r r cr rritt,totjercle arsur:i, 1.1b:r,zalimbii si in mirr Daamenul d'inantic: r'om {ace aprecit'1i*supla trrolilil'lilii ir:ult',
regiulea trUgq"ii*ei' sir,promrnl;c allurrito lroc:rlr' (tt:r''
r,ir,rlr{.r,{'rll}ro trompa lui Eustachio, spre ur-echeafoedie, ai, r(J.Ltru care se cere bolna,vului '.'I('''')'
( oar Dl spre alto ii."^A"t"t*lU, licrnn, vi'luluir l[etr' ntin]irrildu,-sc l'c lil]ir)' ltr(tliit'rrii'
zrrr.r ir'o depii,qescteritoriul nervuluiglosofaringian. Std,rea
dd dii;;i;;i;
-tilidi; trileziuni unilaterale"i se remarci u asiuret.ie a *i'luTi, ttt .ttlr't irt'll' ri:t'tli
:t,lr.ltrLvilrl r[r.viuomai prosnant:Lin-1ifrp-u]clegtilt,iliei-.. (rxllttrillr'i'r'i
l'lrr:r.rii :urrirrrprcsinunui"corp sir{in.'Din ,1;;;;;;;
in Soi;'. ,fi,"iu"*, i-pr"u"I cu ltctjar <1eplrtta sllrritoasi'. ln.1ill)lul
c,cesl,in:}ci{!nt.i ttlt tla iLsimcltici Lr'zittttilc
s'r.rtlnatt'i l.tct','nl rlclt'r'
IIiI:r'i.'tItIr'
Ir|'r'rrrrrirsl,lLsnlt'trltr-oglenc r,U LUSC. rn ineerCxrilelor de a Climila l.co"nrit "',,titlt;tii,
i,iiiil'li iiirri"*" ,i nirr"tuiln ambelc prr'1i,accsta liind inr'r''alil sil'rrr
rri,r'riirr)'..fi.,za!iado arsur.X se-.asociazi O"-rii"ti" *i
nu po_f ;;;ilriili""1i c()lI [Ta0tre.
l'1.'1,'j:.l,,i.ll,lli._u-tii,,care fi.obiectivateraun er"-ui"" al gusi";;i: 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,{'ll- , ijliji' r r t : lt r lilit i. r '
|,r! | r,irtr! ctzrrlrtc se noteinzl ,li rut conte_xtnewotic, care
"du"t 'r. l l t tIr t t . : r , I iclt it lr 'lr r t r , l/
irtrl)orlrltul;
in intrerincrm clur.erlor. Joac6 un rol ,t,.,ont,." l u i r. zir r ni u r r il*1, , r 'r ul'.
r ir , ( r l'Nl. ir li . r
( lr 'r 'liLlr \ iLt lt ': r '
t lt nt i l {l( 'lt lN( " l1l l{'zl
,i ,rr i ri i r u.11,'. n, rl., t llt 1t : ult r ', ',t ll 'l1l 't r olr iLs
( lin r uI llll
,,i i i t,i Jri l at * r,,nt , rliohidr
, 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,l.9.ll.-Puraliziarrorvului glosoftringian i , , iir r , , , ll, t . , sl il, . t i, , it , r r l r lcgir lit . lr jr l. lr r '. [ ) {r it s. r l( ''( r l, lr l
,i ,,r,i 'Jr rrl)ii{i.
i'iril
I,,l,l'rrtizi|,
nurvului uk,*"1:11_iilti,l.r=
so rl tt' i l ,i"rri f,r*
,l ,,gi ,rt , iiit 'i, t t t '1'r 'r r 'l'rl!' t r r r r lt : r ' ( 'ii. llr 'lilr gt 'lt t t r t t st t lit licii t lr r
itlitrtc[1,o ilo]irlo ; tr:lftlliziru rnr l)rir: disfagioponNru
-m.r,nifesti1 ' lrr r,rr,1xr.i, r.rr 1.ziur,r,' I rr I : r,I r.'r',.r,Ii L ixnr 1nih,l,cl1tlil tL
l
0i,,,,,",;*,,1';;ii,;h,,1:ii',,;iiiiiiliiiilllli';Iill,iil'ilJ'lfffi;,yilliiilll,fl!,lfiii$flllli
t lil rbil,
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) .

;ltt.l I I li'
 tf
I ') .t ( | I I t i I t I I lt i,lr l,r j1 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
,t , . t ' i tt4 tltti l,lr r r r L tl t,i t1l lll 1ol 1r.l ,i i
i j i tfl l t.l r,l ,l l l tl
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 \, 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
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 ,,. 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
,: ']: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
iir
f(rt. i l /r' pol i l r r . l'r ir lilui 0 , , 1|ig. ; i|t ' z0t r ( , ", ii
l i l ,:,1 'z ir , r i' ;i i irol .i tert.i d, l 1ur,r,nuri 1i l .i r,r.r.i iill|sl{, ziit lo|lr ir i sr r lr I r r r rr
'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 , 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,
|,'.,r,||I I, , |. . r t li. llr . . , , , n s fa l | l !rl u _ s e s i trrj l , rr.::r.i l ri r.r.rL.r.r.:r 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
de respi rrrti ,,. l ,;rr:rl i zj i l r. ,l r.
iIrirIIr(|L()|i pr.oduc modifici,t i accir.tlrte 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
Oe tona,tic'lpiirl, ln ldorrir,), r.rr
I rrir| | |r'rl r r(r lrln lralii. Palariziile dt'rbd.ctc'i 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
realizcazi,' r:r.ir{ cont},i1,,dise,,i.t{l
,,1: ,,, ,.,.,,,j,i..I] ,rporrioletlrbrLriir:i i..pi""i"rii /in s1,,".i:rl 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 '
I :,'l1l :]u.i :rt,,
j , , l ] l ]ii,.ll; i u.r 'r r.il,o-eo.._ii-stridor..
Tn parxliziilero t rlo u riil: rlo ra t ,\,.,, r(. , . : l 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
' rr,.r'r,l [[ir, vox1r1a,Iiri. mociificirri.er.idente de rcspiralie;i cu refltrrrl 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
1". i rs(' r)irsi,r'irt.prraiiziite totare b nteraG-p"o&oJ
'ilrlil'rii'i ,: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.
rkr 1bira1lie 'ir"ind,iiri"iLri sevcrc:
pir:i 1a afo'ie, rips:urctteiirtiri iii." qr dispnec.rr ''ttill|'i), dtp.i rnl i,7r{r;/ecloz,iir.ln irr lLn;.rrl urror I'rlft/:tr (gt,ipr'i clir)- lti:r
i l r'r(i ()1
, inili a, les i r i n s p i ra fi c . " 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|'
).ll,,n1,1,,ryt f.trnc!-iei 'se*zitite sornatice ce.ceteazti 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| sensibilitat t,:r,
', :| |.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 l ['I'l '-]I.
,'::.l l ,Tl:!:.1 p(,r.err.:e
,,o:rcriorat c o n , lirc rL rlrrirrit irir
; , , , . , . ',,',,',',:l,l l , sulcljoari a pilierului
rIr'rrrcr c rrc r: rr, f . 10,3. Paralizia nervutrui ilner{mo{Jatstri(i
i'1.,;1,,li' '', r.rill]Juipalatului, frringclt.,
| | 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 '||,
| , . . , , 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.
{.r!zrlir-n si t'{,gola1tir1'.l)unli:irt ttttil.airrqlit, rlr.urcJa, iu^rrtiillt|rrlizil' v|1{'
j ,,,,], . , ' , , , , . . 1, l, , , *' , ' 1l 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
I' rl rrti l ri L (hcrniviil t izut , liil; ot ot r . liir , 1li t l'r r , , {iir r li. pir lt r l, , \ ir r iior r , ir ) . \ , r r . , , r r
,'. , , l. ' . . 1, ' ! , " t - ; ' . 1 !i i to r u .e g e ' ,:' ;, (1,1trasi 4pn;i se). l n Iezi utti 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 , .
, , ,, ' , l . ]. 1l ttn
i ..,, i rc n e o l ,,r..i . * i.ra g n te ,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
' ' z e .,i e r r1;' 6gp
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 1r;l rel i l or alicl'ior i si lt ost r "r 'ir li, t ) t 1, cluJlr i lt jiult ililii ij'. , il r lr lr lr . r
, , , ; : , . 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 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 .
,.; ] , ll, ] ^ 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
,,1,.,,::i
l';",1;'l;ll'',' '',.1,""',lt',lil,..lii:l;l:|,':
"...;;,,,' ;:"i,:1,:,;,,
ill,
rr'rrr lr(.it liislrrr;rsrrrilorcll],diot-rlscrim:qi
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
cercbral (popor.,icingi criiair., - , '; t 1]{'0|; l- iiit ir }: L|: I I }|I I ii] . i|li, it i. ilr lo, , ii I t , r lr r r. r |r l , ,
llrri; ( I(|| IIII,i{I, Il}? lj) . .i l ri l l .l l ri ).ri I'it s.) ir 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
,,l rl .
I.li).:1, l\ rrvralqia vagdi
;l.l{}./.r" l!oain hri iloska:n { hipelroikrclilll nt tir sitrourrolirlir rrlil irr
Nr.rr,:rl.,iirrI'r|;rrlli s0 crt,racti,r,izeirzi prin parosismc 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
, r 1, , r, r , rr r r t . J , .r li, lr il rrrrj ,. algice c:\ir iiplrr
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
rl n L l l L rl :i ,r..,g . i ,r f t,l ,rrn,,,,0 t rrn( nl i l .i l
,, r:,r' ' r , , r :r ' . , . i " f " .i r ci i i Li tl c popovi ci u 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;
l, i.r' rn :t.u /{ -r ^ l : I' o d d . l 0 t, x. ii
exattria nerrrlgiiiorlilgtle esrctlifi<,ili, I\)pr,\,i (l i l : si Pr ur Ll, 11) E1) :
l,,l lll .ili:] .,.llllll::1j',1".,
' "',,r' r,: rr,r (. :rtrilstLDno:clcpe care .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
le lealizeazi, ramulile periferico llri
:r'r,i rri Irr ]'unitrilc altor ner..vrcr..l]ri,:li i (irt(kroucbi cu iervLrl 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
|.r, r| ,IIII 'r('r'v
r I I I 1- . gloso_
r ilt iill^r ; J l l o d i n c c t,r_ i cl -l e(U r_L].) 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
rrrrl,rriir. trr ir(x,st s1.irsintrri ' .in fi c* si si cnLrrl
i i r[:i ..i n i l r
diqoirtie ,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
si a,;i".in LtoritrLr{m1,r.t.ii
t'tt tt'tttrt r rl,r'1r irf{) si un irnrorr:rlt "irritg'i,;i 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
conriingcnt d" fit it iiitr i1r.s'-
irrr'i rr,rrr t r . ",l""'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 .
| ) l)i.:r:tlt.::irt,ttnn,u,ti.i tttr,t,irulureu nenulu.i,ldq 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, . ,
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
, fi i .,rtr_,i ' ,ti , ri ,* ,, l or:rl i zrti i i rr rrtIrrIr,.rttIl ttI, r lr hl i ( I j1I ir , r '{I irilLlr . , 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 -
,,,,1i11j,,,,1,j,,1,f,,,i.,,,,',,'\. jriroii1,r.i'uncuri
r,\ii(,r.n, do r,,iii,ii,.,i"i
"n"i, sertltoliir.i \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.
i 'rl|
,' 'r, 1Ilrlr(\
' ,,.' .' | ' i\|.tt.t'1t|t1 itt,ll|'
r'l||:1, i-i(f r.ii|'|'ltl'rl|' ll|i,
r l0r ' iz|||,
r , ;t r' 'Zii
1l, |lit lr , |l , i{ ; it r r r r r 0 r , 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
(lt ,iflltSt)
(tt rrl; rr1lr'r'lrrl;1rrr,rL rr l, lr ir , : r liz llr . iir . 1t t , i] |
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 .rl 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 llir i r lir t r , , : r r r r r '( r , li,i, r t l
,,,r i,,i|,|li,,l,(,fil,t,r!
t *' r, t 11, iir,/rl.. illrt.r, 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( ,
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 :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 , .
, , ir i, , r , 1' , 1 , , , , , , I i r , . I i , , , , l i r r r l r r , r . r l r ,

l lrl 1t'l
 !,rr, 1,.[0lJt,ilMtt
t)tdl]ll(;N(]s1,t(i
lN t,A,tut,o(ilA
Nt,RVUt.,Ul
sPlNAt, tro(x1$il,il, ll'rrlro(rsl,outittlo urgolrt'it,.ltr etlzttt'ilo an dabltl lonl,-ptogrettt',
(A00liSl)ll;l'l,jlfl,ljllllA A XI-l)
.rlrrrc strirkrr', dispnoe qi tlisfonii pinir, ltl a'fottit'. Iltllllcxttl (lo l;uso osl 0
, iiur irrurit suu chiar abolit.
't,;,,t.1,"j:"^T"lFl1inserniotogicina rrrrr,ttui D ) f'aralizia neraultti sphtal et'tern'so lllrt,llifcsLilprin ssnlno (lrll
.j"_iiglgsr:r, nermruispirrat
I Jl'l;,1"\'::,::l^"*:,
''| I'i|amctlut clnuc
spi,ralimpti,.,i
impr icri: grrrtr*' mr6ohiului sternocleldomastoidian ryi tlrpez do llcocil,lsipil,ll,o.
nentmLrannna internd, i nurvrtrii-il)i,,at
trt cu cel celpracticat
practicat p&tru compolenta est,t, I'ara,lizia unilaterald, a muschiului, sternoaleidomastoidtal,so ruanilirulf[
I ilri(]. ""
l;li:liil
p&tru compolenta motorie
motorie ;;""Jrir,iiilll"Sli
a nervului r)leumo- irr primul rind prin qtergerea retiefului musculat a'tit in repaus, cit.qi lrt
ill
"tirnpul miqcd,rilor de inclinare qi flectare a capului do parten lozitttrii.

;;:lllili#; ii';"':i:l'';'?'i;ll*,i,,5x*TiffiJJ':i
li'iriii:i;l'1 iil:i::ilI 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' nrttqchirt-
:1.11.3.lraralizia nervului spinal lLri"Ilin cauza actriunii sternocteidomastoiclianului de partea.oprrsir,l"ozitrn ii.,
oapul poate si fie'ugor inclinat ci,tre partea sinS,toasf,' Paralizia unilntclrr,lii,
lu,inuiciriului sternbcleidomastoiilian nu impieteazd, prea mltlt miqrrfililn
,,apului din ca.uza intelvenliei celorlalli mugchi ai gitului. In clzttl lt:rrtr'

ir;,i,i*ii,:q-$*ll#":$|liii,:,yli::,*imiti;$::t{^*Ti*: liziei bilaterale, capul se afii, in u$o&r[ extensie, iar bolnavul oxtrcttl,tl,t:t.t
groutate flexia capului.

jni
ir I lrl,or nii). C drcirLoltlul liroidi

,,iil,i*i+*!#_*ii#_',E,5,1,:*ri:;t'*r{jrft,:ffi
Parali.aia muqchiului trupez re,alizeaziaurmS,torul tnblou cliltir: : rr,)
rrrrrlrul rle partoa lezati estecoborit qi proiectat inainte I b) mugincir ir,trh'

tij!:j:i'
ii:, rtrv;w::;v;r:;i
!.i,il;:'Jt
trtr'",::* ;i:r
Iiuaril a portiunii superioarea trapezului este qtearsd,; c) spD0iulsuJrrltohl-
vicrrlar.eite hdincit, iar r:laviculaapare mai bine reliofatd,$i paro proi{joltlliri
"i,###,:fll{f 'ffi
*'f::'u1":*$,,i:il,#:::fi ):;*'J'1T:Ha
;i';li,:',\"Yf
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'

i.iir,rr
rrcrroui\,
nri
"'#,fi
utrvului.""*"nt 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,
-oi'co*ilJi'ir'rfiL),',"o!!,lJ1f?t1,fl.1 r:,lieiului qi hipotonia muqchiuln) trapez; i) a,trofia,tnu;ohittltti l,rrtlcz
illl,l-llHl-""lHlglinn:Ysx$itni"';''i;;i";;;;ilifr:'J#il.i|#i:
1i r.zr,ipsirarc*ri ;;;;i;-;.f.il-ii #, i;:i: ?:#,,Ir#; *:,Ttli llurulizia sittgulatd'a neraului spiual este raril. lJfl, :lllrtto rlo ttlrltrrri
cu paralizia ultimilor nervi bulbui (in spccial ctt port'rltilo tt,
r. 'orur.rrl;pr[tluCe "
i. rrlrrerLnd,
YoCestlirlet
*" 1i"""?,
lll,ll;iylii,-',l,,. iii,*l"ll;i,li:r".i,",1;,,f,1,J#lH":T;iil,f,H,,,:$it I X-a ii a X-a) (vezi in continuare), 'loluli, procesecaresegd'sesc tn i n nli al,t
ttlrof)iere a foram,enu,Ltrimagnuln ;if sau' u, regiuttii, cetuicule $tt,lcriottrr
I'a.ralitia (lr)carcosteomielibice,pahimeningita specific5,qi nespocificft)pttt prtttlttco
bi.IateraLiide nt
Adesorl, oparul'iilo tn
lrrlalizii nnilaterzlle sa'it ltilaterale de nerv spinal,
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 itqiunea cerui,aaldlnaltd (ca, tle pildi', sec{iunea spinalului in tortiut'1i*)
,:lyitd:'-l",Pml: silrt rosponsabiletle proclucereaparaliziilor nervultli sltittttl' Ane,tritmttl
rcrlebraLecalo se dezvolii) il canalul slritltll superior pott,e t:otttlrrimtl
norvtrl spinal qi poate si plovoace o paraliz,ietrrrilatoral.i'(ljor'loohl;ttl'
^rterei 10(|6)'

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

9.12. PROBLI]MD
DF]DIAGNOSTIC NDRVUI/UIHIPOOLOS
IN PATOIOGIA

tr\, n norvrrlrrihipolllos(XtI) lmXrllod:

somiolofliolt
9.1L1. lnvostigutria

I lj8
@ I ) ( )hsurva,t,irr
gitutt.
1,ozi1;ici."i a nn;rootuluilimbii in sboretls rolf&ultrrln

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 . rrrri. :.1;i.l,Itt)IJLEltuD|ll]IAGNUS,II0iN|,4'trtt,rlrit,tl,^li^1,IZll|,()|tMtl|,1.1|'|.|,:
Hi| lr l)ilill0 titlr'. AI.,ENIIRVIL0R 0ltANll'lNI lllll'ltAlil
OIrsllr"lr,{ilr ; r r . t ' z t ' r r l, r , ir lr , lt r < r t llr r lij il i c . \ 'e n i u l l , l r l l {}r . u l t i r . r r , l
.//,/
r l| ! . )I I llI lt(,-
crt itloctirri mllltii]lc tlc ttorvilor
3.i3.1. Atoeliuai extranelraxialo
:1.l:1.:!. llaralizia nervului hipoglos
0r:rnie i bulbari.
.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 ;i1'*:1i4i*?,'rf
ilTi'lli#,{l,",,;ir;#*ht,ilHiTffi :li
r( ttturrir lt[isd]iulrd
l:rl.rl .*'(l'ill] al li rbii -Eenioglos
de p:rr'lea opus:i ]eZiunii. I]c :rse:lt,,i,orr,
fot]Illeazit o curbiL Lu corca\-itateit, spl,e ilrit,1,(.ir
uul'l
::::uiir'lr ;iir1;'
{iif'.'i'l::'r;l
r :irrlloirfi. -\t:castii deriabie esto produsri
,'l()ir *) ;(l ; r(,!(,:1tueaz:i in tiinlpul cfor.tLrrilor ijrin actinneil mrifohinhti r{ii{).
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 .
"-.iili,Hiitimixa
rl:;:";i,"q.;,,;,;r;#:;;l,l;*;*f
{li$ffi iti',illl*,il,,i;,lilll,,
;r. rrrlrr':rlriri ljrnbii. 11 hernijinba rrlettal i: se poi remarc,a,.Jasci::r.lu!,,i.i
tnt\t tt[/t)t: irr coridi{,ii1i:in cr.r'oieziirle:r sc:rllli lr, nivelul ntc]trdii ne}i.liiui
lr1r,r,:los. l)fil irittitia {.rroliirI a ilctonelronik;t,.
#*:',lillfl**;i,l'll-"*4i!tiT"i$i$:ltil,*t^
l;":il:r o1,T,,.",
1t ) N'rrroli::irl itil.atert;ld, a er,nri.ui ]ti,ito1lios praiar:e tuil.lirlrj
lr,rrri l, r'r'Ive al(.. t|r{rllliti,iii jirntrii. Acessta-nu pca.ig fi .r:ri;catr),r-ilnir"o
iirrrr- 'u,.'',,'
"i,,,r
illi:,:j;jtiti:tiJ11lJtfi1":ii'iii1H!!:HTi::,:,,:.,j
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., $Hil$jiti#fi'iffi ,
jli?'#ll;rmiril
\p tr si lrt tr:t'ii,ri, t!e mostica.rtie, deqlt,:ti!,;e

. . llill(1il:r!11.1 rrt(,t
I l',. \ sj -\ l, !l'r cr,r.rnt.o.tismele
afectat, !n gcnelal,
lsi tle pranut$*re ro consou.jtt:lttr.
tL, er:erlelrsi afcc.tiuni sa Sipeieijjlil(,
craniot:erebrc(l.ecit frac1,lrti rie itazli pot-1,:t,Dtlncr, .,.t
',1,*:ril"s:ru;;r!**ii
. i c 'i
iii*#;!,*{,*"i[i$1i
ffi';:l,t?;;);,H..**,ffi " 1 i n 'r c,
r r 'b r "'r r e r ' '
t:tt' t\t t t!.1(\:)tit ()(! 3i't1.gukt]"ri $, nen:ui'ui hiitogios. Attetsriti,nttl qlte;:ai 1),,1{h;(lt,
:,"'w|*,::iil:!,;;i]t'.#ltlil".:,:1:1.i;,ttlla!::,i
r,rtl' r'r':tlizlrrr 1:rr:rlizic nlilat,jr1r.li. a nerr-ulai hipoglos. lez;unile reqit.tn.ii
t.t) t itltlt' ;ttq[te pot aft'cta re.rvi.rl ]ripoglios in poltiunea sa extracnrria Ilj,.
lrr ;rr,.,r.1r, r,orrtliiir' rr: 1,t'itrrlc si sitnpatitul l.reriiclrrrl,id,lrn si llsist:im tra rrtr
irrlrlrtr r,ljlii, soltprll dia pal,lizie ir11jl:tpri.li. p" 11.,tr-uh.Li
rI|rrrr ('lr nl<, JlerI rartl-Tfutrtrl de a,ceeasi paute (Taverneri f.-Oel;.'
ltiljOgios ;i rin_
:*$i'.ii;Hffi
*#{i":*l+ tr*,'*iffi lr*.
: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. :*ifjl!:::#;t"#;il:,i#{iln+u:r
;,iT$";',J'ff
$iJ,:f :,i'i
D r,,rrL r lI i-
',1:' ::1:
;' ;:,'H {,"i|:;:#LTi{1*#'ffi
;l'i;u:tll,:*#j*jy l;,,;
,
,.\tl(tt)1tt lrrtt:.yui.aL anti-ttiro.ficd (q.L4.)
rlr'lrrrlrr ,,rr ,i. ltzitr.'ro dc iipoglos, da,r de obicei se asociazil
st si,nd,roameletle tt-.[,.A. 1xtl,
\si sentno {lo rll :l.nliTl"til,1"lr,'"",1';:',;tll,;,ll;j,_l;; r'
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
'*'',l:";!E;,!,"ii;;,J,"i,,i","i,iiii;i;ril6l;i1li ,,,,,,",,
l;l;ll;
rrr':rzrrrrrl.rirrrir lrcrvului hipoglos (sinclroilul lui oollet). rreziuni trmorrlo
'-"#llii#;,d#l;i,
1ii1i{tl1i,'"*ff
itii:{:' il;,,;l,J;;
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
ffi.fl"*iihti
tii,i"'.lit|),,T,','l,l,i:;":t::::i:,,,i i,,il,l,,
;
r"rr '' 1,,i,,.,l,rl,
i"i,rl,')','r
'r,vr,rri
rrr.r'vrrl r r i I t ilt ogk r s . '',".,,i ,',:,'ij':.:1lij''
t'#;lil,;,,,Li,l,tl,;,,!,|'li,,l,i,i.)lii'ijili,;,,":,"1,,;",
lu l,rrttrliil.e lt .l?b,[e].ototrrli{'(.lt superi,()are fto
rl c n l 'r' v ll il) 0gl( |s .
lot obsor,va, l)llrlilizii
.;fy'f,i:i
,,,,, lirjj'i'i',{riilllii'
nn#i;i:lfii Wiil lniti;i
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 _
lllllllllI ;l;li;li,
ii;;:ll:iilll'l: .,''
'"' p,i/i,i'tr
'l:l,,ljf
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
l':il.;l.lil, 'lliill1:'ii,';:irllli'l:"
rr ,tri l 'r . , 1lir
li
. 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 - llllllllllllll,,lll;,li,llllllllll'
ltlil,,:l'';l:,,;11,,'1, r i r r l r r l tr l r l r ')
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' . I , , , : i I 1 , 1 , , ', t , i t,g ,ttIr tIt.ttIi Ii ''

| :t0
 :l) 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 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,
llljl, illo l,jlr rt,il
r,il 5i r.ll l rrr, (r l rrrrrrtr,) :r lru,yulrriXl (slritltl).l)irr 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
, rll,:liil. 1,,,,1r]",ir),
' , . \ (' u{ t,. .r. ;,r;rrr,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 rtt' rl l i ,,,i rt, 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 :l . l il llr ,{.trrt,rt ,lr,t U( , lr : jr l, , t : ls lr , i( lt : l i r r lp e z . 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
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 , , : ' 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
l, iit u , r ; i , t ; o ) 'a g ; r : i c i r , i . , , , : r ; :
, ,I rir : l||Il r,mUl nlonellc LL. itcrvii simpatici celvicali, o1t sindrom Cltrtdc liol'nrlr(l lkrl'tti't (liory I I,t
I ) f iudrtntttl l.ii,Iackson produs cie obieei cle o icziunc r-rqirrr- rol al t., 1.969).
lrorrrrlrriillcr,ior, (llcrifolrn) al-este
vagului $i a nervului JripogJos(Llotri:r:si 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 ;
,',Lrlr., ll)(il); Pr.rpoviciusi Fascu, iOSfy. in, simptcrniatotSgia
sindrornrJui h) Fat:tori, ttt.tno"ralipi c,tinpresi,ti (turnori ale glaridttor ptLlrrlitlr', 1f i'ilrrtlozr',
I r, r',rl.rrr,rrrrui scr,nitlt'seadaugS
,i p"*iiri"-d-ii-rrfil,-ii'actorii
it;utoiril lrctastaze l,:.,cele,adencpatii, llmfosarcorrno s.a.) ; c) l:'utlori iilllrtutrrl0tr
,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. (par{}ii(lite) :iircese, celirlite q.a.).
t, ) ,\ittrl*nnit.[ l.Lti Collet-R,card cst,. proihu de
ieziuni c't,c alfr]f,itii,ii,t 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 ]
r' r,,.,,|r*i l itr.rlrloltc for:na,liunile car.c tr-cc pril 'Lain
{or.arlcnul jtgular (l:llinr
r rl,lrr lr.r1.r,j'lir':-r,)qi can:rlli carotidiatl r,ocirr, rrroti'pent'* ;i {ioci.n sau sindromul lui Bertololti'G arain ).
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 '1'ablott'l'semiolagic este constitutt tlin po'ral,illi l:rt11i;rlr: tlt' trlt i I
r ,,llr'l t\itrrd-l'enrcd:'. L'ontirtirl T,otteri oqt.tiu! l tri {'ra}iicni, in {olmele lipicc qi completc fiintl aiccl,:rte tttrtttr c|li' Il1 l'r'r'' r'lrt
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- tLc nenri cr:lnleni <le o p:trte, da.t cu clemsili-c s(xnioloiliot) ll.o tLrirrtl, I rr|i:r
,lr|rrj
Ji ri ,"l
: ,) r 'l,lirrtr(',
,,rr. 1;i l e, i n funcl i c cle sediLr tinil; r ial el leziunii. il f olt nt 'lo int 'ot r t lt lt 'lr rr lt 'r t t r
.\ 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 rlrotn t1o iii:nihazri. tttlii ncrvi cr:iiricni 'q1ni,cruli:i1,i (f1'{'ill rrrrlil.rtit'rt l. r
.r l o Sto i i c a ri!, a l i rnbi i , pal ai i zi | . l {]10_ inti ftecyentil), i:lr nltlrior afect*rorl l]ervilol ci'lnicl]i sc {rtrro lil'tlitt rrlr'
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
I o.l)iuiriizio ipsilatcr:r1[ a rrru;chiJcrritr.qlez 1i rintcro-postfl';or, fie riin srns }ostoio-alltotjoi', oll plirxlet'i'rl iirilirll,i lir' '
l t, j fi s i (1,[otleiclomai.ir:,id illr" rrcrviit)l; c1':1ni{,nirlin fosa oerebralai mijlocic, fie I ultilttlol ijlllrl(l lrltl, lrl
jindr.or,,
.lor,ii t:{iolc,rjiciai aceslu complicrt l]oi- fi riilra- ,qali d;rr;.o- (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 '
't ,,,t'-, t1:.dc ol'i{ixc oticii, iri lite situt,irii, ito llot :lio!:ita li unul sa'.1lillri:illilllli n(llvi rtitlli{flIi {i,' i)irllr ir,
' larotirlianii,, a}e bazei craniului, ileia.
r:r. ,',
ri r', irfl,.r,)jrilt u c, r(,lnonrirtoasc, reticuloz0 (J:oala lui Jiodghin),.tuir:rori ;,ontloittterali, (Arsol]i 1i col:r.b." 19?3; Iloiler iri c(trlJ-), 11){i1i)
, rrrglri ;rr;rrlrr,ccrr,.Jtelos cu ortensie bazaii,, tumori epiclermoitc, coriloanrr, liultir ;remc, itr tvolttfiil sildrotttt'lol Gr;lcirt tL'-t srr sl)rrr,rl('rr'
,,r,r rrl lip il lr lc 6. ir , , romni: dc ltitcltonsiun{r intracrtlltiat}li , cero iw|1rc ndosea1,xl'(!iv'{ r, \IItrl,r]'
t,utttnrr.titsalc (plirr fr:]ctu,i ale bazei crarriului, pril pld,gi, r'{lcruihri pi1:iht', r::u'o aIliie m:i t.lci;rtrnc. ll s i11{1ro tllncit) 1r'rtl rltr lt.rrtr
. .,..|.t)
r'l r(..r1|,'i lo( 1 r , t
llt r n a rrrttr a l b e e tc .).
1r,itr i"lr::rirm sc ilcrrla'azii, llelltle tls ltziiute lt, triittlrilot' senzitri|rr sr'rrzrrIiirl{ r
t.j l'tt)(tr( rtst:u.Lan e ::tncvristne i1c arto.ei carotide sit'ate sub bazll rr rotorii iltr':riier-r"ilxialr.
, ri.rirl*i1 .r{r\ Ii''c ale artcrci.r'ertebr.ale ;i bazilarc, Ilebite i'u:lo: ti et,olttgtt-:itti s iiztltoa ,tictor Cor{:i.11de h(ntib,L.ii.
, 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 ;i trombofle_
l i ri qx,ci al j . ::.) ' 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
i i :,h ri n l i l ,,. u i j l c , .;l,uzi i (. j ,ro[rsyatc, r..l 1l i 1r. Lri )Irorici i l l l rI ] ct di] gr lccl|i't lin: iil'llct r i inai , j{r ss; lLlr ll{'^t lr , r t lr iI r 'i lir r , '
,,..,1
,,'.: t.1,
,,1,':tr'',r,l. . 'l_r
, it llr ,tuulnt
,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 . 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
r'rr-','r,l , t * n^n
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_ 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' "
/ ', 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; .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 t r r ',r t t ir o: rt r r ''
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!
| :(| r| l ]lt { , . . I t , , r . r } , .t^ c i .l l l Z i tl o
rr1i ,l ,, 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'
l )o l U l l e l ,i ,,r s i sc e:ti ni l i i ;: sJ i . i l :zfZr. :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
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
r:rrrrrri ( r ilr rlt ol lll C i l l .c i n ), i i e hi ar al e tni ul or ri el vi l or, { 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, ,
t') , \ it r lr lt t . t t t i 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 '
' lt * l rttl i u .r' d ro -T .ta ro l i d i a na L h l , i l l aref se Oat,:l otel l -
. ': : 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 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' .
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 (. 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
| ' ,':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. 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 ;
l,'rrtlor.i.irl'it!loti(i. silrl re|'rlcz,etrtr1i dc afectilrni lclci,rlizatcin ;{i r,)i n1i [.rrrtt lnir 'r ',ll] 51 ; {llalll ; ii r olr lb. ' 10{iL) .
. 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 ; \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
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 |
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
i i l rrtr.rr_
l l ,)st(,l ,j oi l ,ro, ,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 ',
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 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 ',
I ' l r' l r(. r (| , 1( il', r.l(f..). 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
) ,\ 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 , ol ,rl r., l l l i j i ll) i 1) .
, ,, 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 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 '
''i rrr rrI I r I r , 1 1

t2\ t:t;r
 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
, 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 . ,
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 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 ()
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
, ' . t tlitlt illt t n t (l(is''r'. 1lJ 5: l; . \ t . f ir ' li , r lr r ilb. r 11. ) 7 , 1 ) ,
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
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 ; '
ri, tlaoezului.
lj,,,r | {,rl l).. t||ri9 . / . '.i ('{inthomul vag'o- s})in{}-]iip{ )sl( i(') irrlr'rl
4 )-ELnrltontrI lui Jotl;:'rttt' 's ( t it t t r t t r r r
ct Iirrlirtr,lIlelt, rzr:z,i'ilclr:rnLLltiplc tlr, nclvi cr.anieni 1i ltol,tru.ditu.i,ilr lt l rett{ l ; paral i zie unilat er alii a r er \ r ilor ct anioni I X, - \ , \ I
r rirr, rr .lirlrLi ) ,si \II, le cal'c se poatc asocia o helniparez'i t()lllrillirl(ll irirr
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 -
c t ai' de Loeb ] I e"Ye] , ll) {i- }; I t I t( I (' (' I I I'I ' I ,
t . rlI l i l l { ' - tLi ni l [ei rr' ' i A l rj our nir r c, ] 935, $i
ll'. isl,rr roitlrnorLte fornto partic[ia.r'e dr: polila'Jicu]orcn.ite t.ririiiglo 196i ).
lui -{r-el1is, Srhurirll iii 'lrr('lis('rr
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 - -{rn aruintit an1,eriol'cir sin(lroan}tlB
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 ,, 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] .
, 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 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
(}
1r''rrt.l l i [:, s i I r r r r r - olul i e fa r-o | r.b i l :],(Iri s l e r. l 9 i 6 ; K e1,z si l :{ ol derror"111i 6; DoBteri{}lte san al sr:rliuhli rctluntili&ll llr r'l1L'le (irl'rlli ilr r'lil'(r s'illl I)l
iluso printr_o ati'gire br lb:_''ii, elc rezultii dir l6i,ni ir: iir:r.,srt rtu.l,tttt
\ 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 (litr l|zirrlri
, r, ,,i /:l rt fr ir lr f ( ) pllr it i: ilu tn rl rl i r ,,s i n a l l ' { } tn ullu i Iri shtr:,r,{Ii etz ;i f{{ ,1!l !ti er' , l }Jedsebi iu,noruitl, intrlr, SaI etitrabull-litr e, ii nttrtrtti rrll('oli
i,usct are,8:lre realizeaz:Llie sLrferintc pnr nulleartl, fie srlli'lililtl trlll Irrlrrrrr)
l! ,{;). (r\l)lit'rr'
pirr nllcl6,rl',1,ci li aie altor folrrr.L{iril,i tiirr r''ertl' zt,)l}c, oc
l/ / I rlolr. titulrtrt t( ll( u,nqhi p ctri<,,terthelot Il{}t ilrtt.rni jn uttt!t'.':tttl ',rsocie'e:r, tie alie sinptone. rlupil 'frel
si ll.rr ltnriltlit-:rr tc'iot'(l'ii;rrrt1;lrr':
, 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 ), ''xlir
rr rlr,'r r.lri |rir lt,niori (nlcnir']1^io:)rner -\I
tur] oli c}itlermrli(lc. glio:rrti ._ere-
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
I , i,r r . lrlrrrrrrrgioiln)(rarl,{rbol(}tse:tllrrri]r"i:r,lcpilrlii Lltelale ii !entrir,;lnlui (le lrl irutl'(l rrl('
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 t)rue. ,,cla!icoil ,\volli.q, Scbmidt sau Jtif lisoir' ci rie fallt
iile 'iio,ttu".n,, 1"llsclilalc bulbrre asindlom rctr., olir-lti \1-itllcttlrttr'.
'|,, rrrI:rl ir r I r ' ir r r r r r I rrr' ag
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- ,'.tio,,l
(I'opovicirL si |trsdl, 19El; Jlrltttt i.itt 't
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;espectiv sin(lr{lrr interoli'll )
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). .ol ab., 1f180).
:i i 8 iti.titontr1 lrttti'cl' ctl tttttbultri. o'intlrorttrl listrt'ii [tullnrr Iultttrl"
(uL l.u,iD, jt,i't' I' sit'ltuttttrl ltr'[ 11-'1[lt'ttbt:r'11 xrrrr*rtr
l"l;1.)- t[{'cttunl inlranelraxialtr cu loziu}i sittt",rc,niu,l,':'et]'o-()1.i1:qr
lr}ultiF}c dc nerri eratrirni. (:?rebelodse ii' c:rttr tetizr::rzi s.riri.l':ri'
,ii'ornt,tilarlcrd Ttotl,irinlr:rioar''
llil rurlltoaleLe :
| ) ,'iitrtI*ttrttrIt rIts{ti|||!t'atLt:ttu,ttclti ccrebrctl, '"" - .!.)r',tc,,r,,,Fi (sau lttlntiltilrol
Parl', t:J lezitnea : e) IJemianestczie
\1 ,\i t t , tl , r r nt rlr lu tl b (i .t' 1;ezit) fa'tiali^ cel rnaj ldesea disoc,iatr: (terrno-algezic[ ) ;i Jocalizrtlii rrrrl|rr
l i i i " .l tot" ,,l cf t alm ict ihi; bt .r-oclllc 'I ullr r r r ir i r l' f our lio t lc r lr r glt r li{ir '
/ ) ' \ 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+ . 1i
" " fri i t1 Siitdrotrrrtl Ultruil'r li('r'rrrtr'.l
'. , tt tI t , , ,rt rt I tnit ).tl;t'tt ul ltti Dljirit.t, :ti,ttl,ro'ttt.t[itrltfuLitrr a[ !ui, ]Le|/tokl- {i,tr.,t .',i.*,tgtti1)6i ptrraiizia cotzii ;
( li r r ir r r r r
l i i rrt.r" , l ,ai ri t" r iuir ell coloanei sit nl, r lir c r l) Sit t , L'. r r L ve. lilr t r lr r r '.
I', ttllrrl lt,:lr'tittt xrrtr.h utt i;tlr:t1itr, oltr:t,nir ittferioard) .qlrtt tiduae selri,,logic . '- , i. . r r t Lr ii. . r 11rsr ' t r t t t r r tt' t r tli
L,,ri .i i ,i o-l ,:iitl i l n nasc, gr et , , , r . iqii . t r ir t r : r nr t t t ', ; i
t,r rlr , l r rrrjrrrrlzii itrrr I ielliJr lclil.ieaoI)1r'rililteta][ jn1'eriotr.t! (r'esi.x,t.lintl t rs.
l I,I{ r i i II I I I 1 I i I I I I : t llt I r Lt trlt llt t t l it t li't ior "
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 l tul nl ' e: e) l i i mi siniir ijr n 6161s11sLr
'lc o -' f,)t Ttu, r lea oPi, sd: I t il) o^'t czi" r lisr "'i: r 1r '' t lr lr r ! r 't llr . zj( 'i' {
(rl rrr:I
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 ) i', r I r 't 'r I : L1I ''' r r ilir 'it ' t r r r r 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 rrrl t' rca respi t,l ,ir r t l f nll ( nu t ot t lcr Lt t lr r l. 'i li111r r 1
l) 2 r : ', balr . lliU; r .
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.i ii,.l ,l ,.ti j rtat't r ( lr il , it , t lr oDt t t lt r i lt i
: 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 j ,ste l " ri r,o t r nt sii iecnlt o : l, cir r i, r r l, r r , / / t l, , . lr uit , t i,
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,o- ll: ol[cttbt"t'!l(-,.oziPopoviciu Fi ]'r.'irltl' I llSll :
' l " orntu
lr 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 i' 1'lllli il t {) st r lcr r 'r isit t lc f \ ir ll1'r r lr l't l ir r l$ll "
ttl tr ; t ir : r i, 1i1r icrr lllt
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 r,l l l ri rti i ,l rti ti s1 1s.
'' 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 i i tul rotttttlt 1l'uL[ t , nlt t 'r 1't li] 1i"' it ""'l'l't ' ( r l) I ( t r r lil
i .,!rsl i 't t t r . lr r t xlt :
,rr ,,l ,rj r,l t,zi l rrr , 'r I r li( , lc1l1li lr r r r liiJl't r . i ir l. r f i i. t lllil( li i, 1r it r . I it I I t I t t it 'r r l,
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, |ir t ! I t t l( lllt t
1i1r '\ r c}] isl11r 1 \ I r Li, lr t 11r t
'I Lt
''
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 l :i t i r r;1. i )r tl l l l l () rti . so 1,,,,t1,,ti lt', {rl l l i z ill( illll sir nlt om 'i''
, 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 l ,,,i ,i t ,.i a,i t,,,t, , " i. lit , i'r ', nr r . lLii 11. lilr r r lr r r i sj r , ir r lit t . s f , it 11 I r r r ( i l) r r ( r r r
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 r,:,l rl i ,rrri tl i zi l l r lllr r lt st r llLr r t lt r r t sill( llt ) r r lll( 'lr lt l'lilr lt r 'it t I '( ) t t t 1t I I 'I . t I I {I ') f r i||( i|( ||t |||I
l :i l ,' i l i Ir' i
t rrtL Il rr|rr I r ' r ' r r lr i, l ri tl r,sl ,l rrr tl l tct t r r is, t 'r t l1r lr t lt slr ' t lit lt 'o llir t t t ilt lt t r slczit " t t t t t ilr t ll( ) r t l
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., ( l i | r t l {\ i i t 'l l l i l l ( l l l o t ttr r t, ttr i ' i :i ( r l l l t) ( r l ( f l |zi tttto l t ttttt'l l ,ttl tti l tttl l r i l l tttt'
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 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
r r r s r . l t i r r r l r t r r , I I i t|l l ,l r r tr ;i l tr
, , , 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 rl:rrllllrr' . t i r r i,r r ,l t i l i r rr l rr r t t t t l l l ttt l l ;r l r tttr I'i N r r "r 'r 'l l '' ( 'fl i r " l l l ;r ( 'r 'r 'l l
| 1 l ' \r'r' , I ' lt ilr )

I :1 4
 T
rl t' l l z i l l tr(' i l , l l ,l ' l ,(tt' ('l iitst' l ,r' iIl ttt' ttl l l r l r, l l ttl -
tttuilrlrirrltridlt,pl rrxl'rrltt,illl rlilrlopir';li sl,tltbistttrolrv('1'g('lrlr, l)t'c(llllr 11l
{ i l 1 r'r, tr I ( |r I ( r I I r ii,( , it l l ,i i ,v i t,rl rt,l rl .r rlo o Itorttipltrcziis:lu Ltotttillt,gir,r.ottl,tltllttcrill?l.
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
l!) lli,nilrotnul, I'or:iLIc irt,lrtior sau sindromul Itr,i llot:i.llrt-llillurrl-'
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 (irLbl,a:se ca,racterizeazS, prirr prlldizia rniqcSrilor ooniugatc itltr ttt'ltilot'
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]{\
illr'o palirealeziunii (,,paralizieconjugatii direct5,"),plin paralizitt,lrcrvikir'
rrrir.r'r,srr,l,i, r[c irndc rezdltii rin ;rt:t,tr';.ittdt om vestihulo-cclebelos, ctl m&r(! (.I'lLnicrriYI qi YII, iar cind leziunea depLqeqtezo ele dosi:tloalo l,lrllfii'
r r r r r r i- i, s inorg m i a trn i o !i l &l c ro pul ni c de l artca
, chhctPl l czi utri i l
r,.r I.i i . " B oidc e , rrpilrc qi o hemiparezh contralaterali. Se poate asocia ,si o hemialr('Nl('zi(r
r L i rz!)rI lr ( , i, ll) 07 ; l 9 6 i ) ; (e ; l i n droamol e bul bare nucl c:t' tt'
rlternii facio-colporald (facial5 ipsilaterali, fi corlorall, disocialil lr'tliro-
iz,,llrk' (Avcllis, Schinidt si Jackson), care in mod exceptional lezrlltir' rulgozicl, de partea opusi,).
;i;'"i;f;, :'k'*;;;' *r itl*iire },iind pe prirn
o"itnlirau ; (r) sin{l,roame
1960); 3 ) Bi,ndlomul lui. Grenet satt ,,paralizia sen.zit'it:ri"tnutt,ci;ltir consfii
r'l:r,rrI.rrlbrrr':rri rl., scncibililal" (SaradiiSvili' i SIr,!- ,\t-cvclidze.
lrr lr,.rrri:r,rr,,.lr.zi(.alLerni pc fali Ii pc hornicolpul opus; rLirtl,l-o a,restezio faci:lll ipsilaterald, (de obicei termo-al61ezicii,tlirl tttrt'oti
l'rmo rlgnzi('ir,
:i globali,), ;i ilintr-o anesteziepe h.ernicorpulcontrolateral.,{t[r'st'rt,sl
r.rr lrlrrriri,ttt'slczic termo-:]lgezlca! contrulaieral:i, ; cu tulburriri dc sensibi- rusociazlo paralizie ipsilateral5,a rnuschi]or mastioatori ;i ttn hcntisitithottt
lrirr,lr { r'r'tmr-it lgczicS,hilatel'ale pc faJi, iar pe cxti'cmititi doar tle pa'rtctt' r'orebelos ipsilateral.
,,trrrrii'lozitrniii 1g1Sinoro:r,me\Tallenberg ii,ri, tull:urili^ dil pa'rtea cor'-
(I1liJu, 196i, ciir-r,tcle Popoviiiu qi Pascu, 19$0); (h) Cazut'i 4) Bi,ndromul lui Raymand,- Cestan (sau' tiptttl str'perior al sitdro'
,.rkrl r,,rr,rt,lc ttului lui tr'or:illb) t'ealizeazia,semiologic, o paralizio a miqci,rilol corlitl$Ltt"
, rr Irrll,itlllriilt' s, nsibilitrr,t,bilarerah llc foir'i,pre"uul 'i ''aztiri cu tulbll- rr,loochilor spre partca, leziunii, alterarea sensibilitiii,lii supelficittlc r1ilrtrr-
r':ui sr,trzil,il'cbilate-ra1c,dar lucitlizate tloar perioral, inciusiv pe 1imb5, ctt i unale, semne cerebcloase (ataxie, asinergie, dismetrie) $i milcr:,lj (lo 1ilr
:r.:rrlz ir.tSr lr,lt ii cul{r,b.'i9G;,.
' cu interesa'refi .,rtrbric" (atetozice sau balistice) la rnembrelc contralatoralc.
t,,,riit srnttolc,ltice de sindrom lTattenbtt'gmai' entiinser.
(l${'l}) gi
19i?; Scholjt cohb., 1965), care. ast ciazS,.qi suferintrl i ) Bi,ntlromul lui Gelli esl,e asem:inXtor cu sindromul lui i\l illr,rrl -
t),rrlirri, ( lubier [i cu sindron]ul hLi Raymond -Cestarl, dar reaTizeaziu1ri' 1t'itrt
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 vaso- lrlan o leziune importa,nti' a perechii \rlII, cu snrditate ;i cll r','rt isii,
r,r,rl,oi ii (ctr orractci' :tltein) fi llgii hcmif:lciale'-&sociate-tneori cu algii plcc1111 Ui cn lateropulsii de acceaqiparte cu leziune?)Ia cnrc se iuso('iir,z:i
lr,,rrrir,rrr';rrl'it1c corti,ralat€rale(lsch, 19;7). S-t relat-atsinlrcm'tt'lsub-bulbal l)l,r'ftlizia motor-ocrllarrr1ni extern qi paralizie faciali. In cazuli]c cu lt'zitttt,r
,l t t i ();alrlii (crLllpocstezie faciaii, siadrom cerebolosqi ClaudeBernard -- irnportanti, a nucleilor cochleo-rrestibulari' se impune diagnosl,iclll. (lili"
ll.r'rr.rl rl. rr,r,r:r:a'i -palte, hemi:lnestezio clisociati qi eveltuaL hemipa-rezri lcnlial ct rln proces tle unghi ponto-cerebelos.
ri
1 lrr rr rirI rriii rtlrtrrilaieralS,, dar ldri atingerea ncrrilor , I-XI)' lchol'lt 6 ) Si,nd,ronul lui Pierre Mari,e-I'oi'n saw ,,hetni'pa'rezacerebchxr:tir"
.i r',rlrr,lr.(l1ili5) qi l?0poriiciu 1i colab. (1980) au -rclatat,. qi sindroamr! u lni,' Marie ,s'i Toir (,,sindromul latera|') inminunchcazS,, $cmi('|)git''
\\ rr'llr.rrlx,rlu irrslilil;c si de sintL'om Pa,rinatd' 52111 {le paralizia perechilt-rt' lulburii,ri de echiliblu ipsilaterale, cu clismetrie, tlisilergie $i dindill(l(x'o
Ill r .rr,'il\ )iittts{r.i, Icl'in l"zi:Lne;iaarl.rci |crcl'ol.Jtl'{c supe'rioar(') llrinezle, rsi, exceplional, semno piranridale conl,talateralc.
s,',i ,i,..,,,i.,.-iirlllrrrtrrriasocjr'1e rizualc de rip uc'"ipita).crt hAm!anopsir', 7 ) Sind,rom,ulntioclonic al trunclzittlwi cerebral &l lui Gu'illain, llol.llrtt'I
r .r'ilrlr coli irLlii satLalcxic (Ilcyer si col*b., 1956; tr'irchor-$icolab'' 1961)' ,i ilertrand, (1933) Bau sindromul posterior aI calotei (Sohotl
li ) flitrl.roirtu,LLui lJabinstii_Jageoltc sau' sindnmll hemibulbttlu'i '
ll,6?) se cara,ctcrizeezi, lrin aparitia unor mioclonii velopalato-fal'ingi0ll(''
'rut,t,,,t. \iu,lr,t,,ul clqsi" ,l I'L; B';hinRt:i-\-ageattc sr 'aract el i zeazit- rrtlcscalimitate tloar Ia nivclul vilului palatului (',nistftgmus a1 r':"r"hrhli"),
,.lli,'f,',,i' ruir, tt"rniftnr.'r:is",ll bcmiplegic nohtralatctali' plin ll('llri r[lr susceptibile si, se ext'ind[ !i po mufc]rii felei qi/sari ai lncrnlx'nllli
'rrr...l,.zrr' Icl r,r,r-iulg"ziclip,' benricoti:ulronlralale[a1- \sipe.llelrulafa ]l)nl' sr perior fschott, 196?; Popoviciu qi colab., 1.973' 1980; Popovitirr 6i
Lhr,rrl,r, IrIi|I tlisrncltir',Il,sjnergie. lllteropu-lsie(ipsilaterx]c), somlrir I'rlscu, 1981).
l'elopalaLuft. -prl'n
de ocglurllrt'
t'lt'il:u'' ti ulr( (,r'j
plin Lerrriparllizie .tulbur';rr ,semiologic lrtlrNl i
iphll*1''Iali,o corzlr vocalc' $ ) Sindronnr,l,lui Gasperirti, cupriticle nn con1,cx1;
.r rl. r,tt Iritc ii Jlriu l':lliLlizil-l, lrrjt riintr-un cleficit al neriilor danielli' V' VI qi \rII rle o 1:altc, rriitx'iit't
7 | sittrlrotntr'l lui C estan- Chenatls este asemd'n5'tor cu sindrorlltll r rr hemianestezic contraleter'&l:t tcrmici, si durcroasii ('I'roncorti si l\'lottl,rt-
t,', ti,,r,it,*i.i N,ignnrt,', irr labloul clinic asociind totdPauna (pe ,lin'{itr tr:tli, 1960).
,'i,,rrr,.rrilkrr,cestui sindrom) qi semne datorite tnei - leziuni * nuc.toullll !) O.ltalm,oplagiilei,nlertt'1t'clettre,li lost c).prlsc dc noi llnl,cliot lir
r rt|l)i*I , l0rlpoctrY cu o par:]i;ie. ipsilatera15,a I'[]ului palatului \i 8' corzii 1rrr,l;ologia sistemclol oolrlor)lotorji.

,\ ) Uirul,totnt+I,lLutJleLtIL[i ltt'i Dei'tart se caractelizeazil' prin crizo vcrlri' O) Sirulntu.trn'Lcpetl,nn<ttlure (nte;c tr,eltr,lice,):
nislt'[inrus orizottl*[
si",,'i"1.. r,ii"r"'iri,i *ii 1,t,'',ir,i"nitlc 1arl,c:rlcziunii), I ) iJ'intltou,u,l.ltti lfr:Jxr, si.ndrunnt['Ttr u,nr:u'lctt' pr.',r'rr'nttt],'iatt,
utrtlt'r'1,
plin devielea braiTelor sPro i n d,( ?itJiat pttl,tr,naufttr (srr,tr, htrniTrlallia (Ll,(t'i1.i1'
rl,totrtr.t,l, sILpo'iorLrii' ) At\
i,iii',ii'i',5i ",'iti?,tlt $i/iau rotatjor)' liur:um 5i '
lt t l, (' ll l(fzlllllll. iz('rr,zir,
rr,t'il,ct(ff lrlitrh'"o prrtitlizir, it Ir'rtt'ltii 1[ Il[-lt il)silltl,orillii,lil cllro no
' .tooilr,zi1,ltort
:r o stt,ttltt'tttiltllgirr ('{)lllrtthll,{rt:tlii,..l'a,t:tlizirl,
ti;tit,t'ozii, pctt'r'llii
l\) il in tht ru nt,tt l e Potttitrc
1i r,itcsl,rrptorltttiii,
llI r,stxrl,oillliilir,n plt,r'{irr,lii lrtitLllzittttlit,liIrt'r'krltIttIitIrt-
I ) fiitxlrtn ,ttl ht,; "ill.it.t(t)d,-(il.bld.r.r'rr lizt,ilzri,, solrriologic, o lxurtlizltt lonttrl, itr {t'rtilllul lttr pt'itrltir,iot'ttltttt'zt'ttt't'frllir'.
(10 l )n' l ' czi l l' l {l l l pl !l ' l !l l zl l r r,lc rrurt,olrxltrlrr,tultti
lir,rr,,
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 ,

| :t'i
l !(l
A
, \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 c€rre,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.
l',| sinr|rorttt:I.t s1.t?erio{Lre ale nlr,clewluiroptt:
:t1 Sittdronul lai CltiraE-7'oir-[icolercu se caractedzeazd,prin hipel'
( irrczii rl ir.r,r'st,,rigiditate extrapiramiclal5,, herniataxie, disdiaclocochine-
zir', prlr.r.rrrn si priu hemiparezir,toate 1l hemicorpul contralateral leziunii
rrr, li.rlrri r',r1u{la care se poaie asociafi o leziune discr€ti 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
! iu'hLiWclnekinli ;i, ca atarc, se produc milciili invoL[n'
rli'r'lrrlrr i,ri ilrv.rrsrr
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 ) :
t) '\inrl'rrtnrLtlflrlerai cefebela{1se sllperioare se calacierizctzX, selnio-
lrrllrr'. lrlirr rri;rr,ritrcctcbclorlsfl homolatcraH, $i prin hipo- sau anestezio
rlrrrr.rrrlir, lr.r'rrxr-a,lgezicil (sau un"eori pentlu
|'r'||IlrIlrrI(,r'llit. Sc poate rsocizt lrtl sindrom Claucle Bernard-Ifsrner iDsi-
lrrlrlirl, 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, ptlltt-
lriicri ;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(!
rii rr,IrrrrrtIr,Ir,IciIorrgit,urlitlt,loltosl,ct irtilto, ptitr protr'.te oalutir:tt ztlt',:t,t
p l rrl trlr r i lx x lt ' t ior " r r ' t p rrrl i c ttl i rl tl i tr' ,ttr,trtl rtrti Lr,i trttrt
, rrl o i tl sttl i 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 :l tl
rolnnii Ii/sr,u rrrrrlisrro1rl(irrot,ico
(Aqgin,tr l{)(iliI
,,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\t-
cirfitlitels de tip inferior sau superior, rombcncefalitele, sclorozr rnull,i-
yrli"l,qi afecliunile demielinizante inmdito) produc variate tablouri srrnio-
logice, 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 .
Ttrogresirti (P. B. P) a adultului, care realweazd,r'tn contexi Bemiologio
lr.r,rd,
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 $inahom in cadrul unor variato lxrli
r)curologice. In tonrte raro cazuri, P.B.P apare in mod singular, oil oon-
sfituind cle cele rnai multe ori o modalitate cle debut a acestei sufcrinlo
rroulologice. ln cadrul P.B.P: unii autori inclual qi aspectele serniologioo
din scleroza lateral5. amiotroficd, (Norris gi Kurland, 1969).
Contexl settrioluoie
Cele mai multc ;azuri tlebuteazd, cu tulbuldri de vorbirc (clificu ll')l,t,i
de fohalie, in special cu rinolalie), Apoi se asociazS,dificultd,l,i in doglui,i-
{ia lichiclelor lsi a solidelor, atrofii faciomasticatorii, faseiculalii po linrbil,
;i pe muqchii rnaseteri qi tulburi,ri ile masticalie. Iieflexul faringin,n rlis-
p:lr'e la multe cazuri in plimele faze ale bolii (Bonduelle, 1965 ; (iirho
qi Kovarik, 1970). In alte cazuri, imediat clupi elebut, s-au inst;aluh 1,ul
buriri de respiratie, uneori gr&yo (Black gi llyatt, 19?1 ; Castaigrx) {i
colab., 1971). Completa paralizie a mu$culaturii masticaliei duce la dl,rlorr rrr,
rnandibulei, iar afectarea orbiculaluldi buzelor pelmito scurgereasalivei rlirr
gura intredeschisai,'Asocierea aproape constant5, a tulburlrilor dc doglu-
tilie duee la acumularea salivei, alind impresia unei hipersalivalii.
Palatul noale devine imobil qi aton, pemitincl regurgitarea fluirlokrr:
toate s,eqsibilitelile )t pe nas. TulburXrile de deglutilie sint frecvente, ceeace face necesartrirrl,ro-
rlucerea 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,. ltol-
rravul este, de asemenea,in imposibilitatea de a impinge cu limba alinlon-
tcle 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,rornorht-
h,tiu, vocii. l,ipsrr,clo inchiiloro contpletl zr,glolci, palalizia, mrrsorrlai,rr rii
buzclor', cit;i i,ulbLr t'iit'iLralo tosl)irr11,io cornplotanzii tftbloul serrriuloilio
rr,ltulbrrrtrrilot'tlo vot'lritr:in I.r,l!.11.
Ltrt'ttlor' Atrofiilo ttluscrrlrrlotirrl' plozrrnto rJi vizibitc. lrirrrb;r,osl,o Iltrsorl,,
irrrobilil, rlin prirnolo[rr,zo
ryill,rof icit,.llo irrrrrrrrrrrrrr,
irrcrl, lrlo lrolii, $irrtrnrrrrrltr
rrlrolilt,tttrtryoltilrtt
tn:t,url,r,,ti,lrlclil'ot t'r,lirrl'r
Ll oxrlrttotrttl 4i lu *l,rlngo-
sl,rr,l.io
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
t) tllntlit rtttrstulurirpittuli in.lutlilii (lnxr.lrr.
ltr.i ll trrl.niqIlo.llurtnt)
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
, tt tlclt'ttniltistttgcttr,lic (trlri trlrrsrrrrosivirrri,osurrurl) s(r l)oirl,r'irriurli rlr,
llzirrrri lrtrlllllt'o( l ) t'rr,chtnlLrr
li Illlnli{fr, 1001I M rrrncrrl,hrr,lrrr',,siVrrstr,ll:r,
rrriirrilor'..llrrscit-rulirliilcrrpa,t prr Iirrrbi, }r tulseteri $i urr0or.iii pe musculatu-
| rI
llli0). r\('o!li col)ii, incii rlo Lr rllstrrlc, lr\)zirLl;itl,rrlbrrri'r,r'i
rlc xrrpl 1i rlr,
llu I l ( 1 1 t .
rllglrrli(ic, alr url filcics irrtrxltlcsiv,rntrxlibulil csto ciizrrlii,lirrrllr lr,llolilrr
S l,r rlescris tulburili ale motilitiiiii esofagiene li gastlointostinal(j
,r trrflcxclc lmllta,r'edirnimtll,c. Oclo rnai rnu]bc cazuli rlccrrlcrrziiirr lrrirrrul
{lirrrrlucllc, t965; Boutiin qi colab., 1971), precum qi tulburlri cardiaco :rrrrle v ia!,ii,.ltr forrrLclerua,illcniglc, cu supnrvie!uiro pirrir,irr rrrloicsr,r'rr
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 i , I rrlbuliirilc bulbalc pol, fi intilnil,e pin5,lzr,douii,tlcitni (li rr olz u li ( Nlu l ln l
'r
lcslrilrrlolii centrale (Carala$li colab., 1966). r colrr,b.,1969; Ilriul f i ltrnofy, 1{}71).
ltl Atrotia nyuscu,lu,rd, tpinulii juaenild ( boala l{,u11r:lltu q ll:tlrrnthr)
l)(lgcneratea ciiiior corticobulbir,re, relativ rar intilnitii in P.B.P purir,, l otntctelizeazd,prir) |l,ttofii spiuale proximale pseuilomioprbiccr,iillr. rrrr
;rrlrrugr'i
t'lcrncntesemiologiccde paralizie pseudobulbad. l,.,eziunilecentli- ,1,,1(.nninism gonetic autosornalrecesiv (Srrith qi Patel, .l.t)65I l,'rrrlkrrrr
Lrl vr'11r,tliivi duc frec\.ent la tulburdri circulatorii gi respiratorii foartc r,ollb., 1969; Namb* fi colah.,1969). ExistL $i cazui slor',r(li(l(,. lrrlrli
ul it v{' ' ,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.
iladrc nozologiee a) Atrofia musculard,spinald,lo,rd,iM(boala Yulpian- llcll hrrlr l l,) ;rlr.
1) Paralizia bu,lbard,progresiril crotui.cdla adolescenli qi la adul{i zitrlr'i,un dcterrnitism genetic de tip autosomaltlomina[1.,dlt,rsirrl ,sirrrrrllo
;xrirl,orp[rea fie ca,Jorntd sptoratlicdrlie ca Jormd,eredo-familiald. (Colmant, , r,zrrrisporadice(Cazzator1969; tr'rieil SiDmery, 1971 l Zellrvcgrrr';i('olrrb.,
ll)?it ; Malkland qi DaIy, 1972). Diagnosticul cle P.B.l' puld poate f i llr72). Doar puline cazuri plezinti ,,silczinni bulbare (Dyck iJi I rI|| rI I ) ' r'|,,
st.rrlrilil;numai pdn examenul anatomopatologic, care va erolude leziunil{, llrl;,q; Bobowick $i Broaly, 19?3). '
pilir,rnidale, P.B.P apflrut5, in ailolescenld,a {ost consider.ttii ite Marklanr I ,1) P,B.P in alte boli degenerati,t:e. Dintre atecliunilc degerr.rirlir',,
li I ralv (19?2) ca o form5, particuiar5, a bolii Kugelberg-Welander. |lr (riue poate Si apar5,P.B.P, amintim:
:!) Grw)ul sclermelor lateral.e amiotrofiod (S.I'.A.) cuprindo 3 tipuri tu) Hi.potentitnea orlostalic.d,(sindromul Shy-Drager') s(r 0r|r,olr,r I
lrt itrrripalo,in ca.rcP.B.P apale fie la debut, fie in cursul eyolutioi (Hirano z|rtzii in plimul rind plin lipsa transpiraliei, rnanifesti,fi sirrrrPrrk,,pir.r'
ri rurlub.,1967; Brotly f i cota;b.,1971). ,llrr.ll controlului sfiloterelor', sindrom palkinsonian, atrrrir.,ri sr.rrrrr,.
.r,\ !l'i1tul sporudic al B.L,A. cuprinale cortextul clinic de P.IJ.P in cel lrrrlllrlt'.
o/odin cazuri (Nishigaki, 1970 L972; }Iiiller-Jensen Be1'nhardt, lt) Sirtlrotttrl Riley-Day este plotlus de o ('legcllerarcrr lirlrrrrr(ir,r
1ru{,irrlii ; Fi
ll)7;t). I,'r(.{,v€rr1,aP.B.P in eadrul ac€stor forrne sporadice de S.L.A. es1;o t , l iculare a bulbrrlti, cu inl eresaLeaqi a newilor bull:ar'i (Ilrtrurislcr',I l)i l ).
rrrri rrrarrrla biirbatj decit la lemei (Girke qi Kovarik, 1970; Rai qi Jolly, c) P.B.P asociatd,ou surd,itate $i. cu abo.fie opticd. losL rlr.ro is:i rlr.
l1)?1; .Nishigakir1972). S-a raportat o creqterein ultimii ani a, frecv€n1ei rrrli mulfi autori, f6rd, a se putoa contur.a un sindrom ^apaltc (il'r'ilk'l 1i
irnnoi bulbare fa!d, de forma spinal-d,a S.L.A., indeosebi in jurul qi pestc colllr., {?0; Boudin qi co1ab.,1971 ; Serr.atricefi Gastaut, .11)7il).
vhslolc rlc 50 ile ani (Dazzi gi colal:. 1969; Campbell, 1965; Saha- tf) P.B.P asociaid,corcei cronit:e Ilurttittgtol cste litrli (lrnrli rjr
r lllrr t r , 19 69 ). Vrrin, 19?3).
lr) f ipul ,rd,eGuamt' reprezint;, o asociere intro S.I-,.A,, parkinso- o) P.B.P asoci,atd,sindromului Bteele-Richardson-Olsaewsk i u, lirsl, r'r.-
rrisrrr1i rlcrncnfi,. Tipul ,,de Guam"'prezinti mai frecvent sernne bulbaro rrr:rrr,l1iichiar tiin articolul pfinceps al acestol autori (1964)li (l()lrfilnrrlri,
11iriyrrrslirrilirle<lrcit forna sporadicfide S.L.A. Tipul ,,de Guamrt are o evo- ,1,' l.|.hrrn:rnn si colab. (1969);i Constantinidis colab., (Jt)?{}).Astn.l,
$i
hr(irr rrrri k'n1t1decit celela]teformc (Ilirano qi colab., 196?). 1',' lirrgii selrlele cuntrsrute t1e acestui sindlom, au fost des(rrisollr lorrrlr.
r,||rltl' r.uzlr|i .i tulburdri tle tlcgluli{i,..
l,'ol'rn(rdt) 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 sub- 'iJ P.B.P d,sociatd.nL afectareo,altor sisterne; nucleii nrlzt'rrcr,lrlili
Ir':rIrrl irrfcclios plintr-un virus lent (Gibbs qi Gajctusek,1972), deqi so t IiorrrIrrt.IIt.ri colab., 19?0l, talamusul (Van Bogaert Si oolrrl,.,[Xifi), (1,t(,
prrrrrcii uilt, multe ozuli cu sindromde S.L,.A.realmentevirotice (Popoviciu r"'lrl (\':rrrJJogaer't;icolab.,J965; tsrbwnellqi cotati., tOfO;.
:r I'rrrr:u, 1.980). !) I'.tj.P a*ociald bolilor paraneoplaziceale siste.ilu.lu,i turtttr. l'.1\.1,
It,rlalil tliltre complexul parkinsotrism-demenli, si S.fl.A. s-a veli- rtr tottltlitul umri sintlom tlc sclelozii lateriLlili, amiol,lrliit,ii rrirlrrr,,oltrrzr,,
litrrl lrr l5-2io,( din cazuri (Brady ;i eo1ab.,1971), f:r,pl.ronfirmat 5i do rr losl tlrsctiir in cillcinoa,moblonhopulnronarc ;i allr, 1itrl r.i rlt, til,r,'r'r
:rllii ((lrrlrl;r;si col a,b.,1966; Bonduellc si mlalr., 196E; llla,it 6i cohb., rrnligtrr, (lllrrirr qi coLlb., 1{}(i5; (iolline qi S'rxrlst,1 , ii)0?; Nor.r.irr 1i
lt?lt). r"olllr.. l lXi9).
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 ll\ ,\iri qt,hrlltiu .si sr./r'lotaltrlrt(l u,tttiulto,/irrrr pol rr.lrlizrr, l(,ziuni
ri colirlr.,l1)70I .llilrr,tro;i r:oltrb.,J067; Ilrrglrtrs[i Jol]r]m{!,11170). rrrrrllilrlr..r'orrrIIirrrrIr',
rrL' trllt ikrl, r,rrrrrir.rrilrrillrlrri 1i porrl,ili, ICtrlo
il) I\tuli: itr, hnllttrni,lttolyninti, tlitt, uytr,-tisrkt ,,t |.nt,l.i rrrlx[lirrrl rl(.r{.1ilt l (tiiur,r',llt,':i) r.r'iirr lrrtzr,rr{lrrrrrrri i.li IrrI r,rrI rr rlo lIrllrli
i rttu.xr,ttlurt
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
]:fllpTlglo Si a per:eohilol
IX, T, XI qtXtI gi rii1,
ilcrimind,rntnsu;i
lr:tlrl uorros 4€riforico
(rosp€ctiy
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
j:i':lig $il.or9r1ial gi fald de com-prosiunile
p-iimetor segrnenrccewicale-9i
{uo.r)ulDurur,cal.eartrg-neaz6adeseatulburxri paretjee Ei atrofiee Elos<i-
ruur)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 O PNOBLEME

DE DIAGNOSTIC
tloliciant[,_
de thiamina,(de obicei ]a alcoolicii eronici), asociazA,
I otalS), o ala.:i
ic si demenfi, progrcsi.r.d
o oftalfii{i.
(Vicl,or qi colab.,
O. IwpaRauzu
JI,.lr:qio
.(ldeyai
071; Iilank gi colab.,1975).

3,1 EXPLORAREA
SEMIOLOGICA
A DEFICITNLOR
MOTONII

_ 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,roropro-
zint: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,
'tJ not,ili,td,liiactit;asegmentara, adicd, invitind pacientul sd,execute tn nurd
sistomatictoate miqeirile fiziologice,alin toato ar"ticulagiile,obsol'vlntlu,ro
i 'l i r,l . {1uatontio amplitudinea, rapiditatea qi precizia executdrii lor.
,..1-r' ,,r, 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) erti-
d,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.
rfl(rrdoEi alte euplordri newotiaiologioe (lsu protiodsoinrlicnlli d0 dia,tsnortlo
littp gra{lo: lozlnno po ncruontrl r. otor' fi0ntru,lna,upor,lforlonl lo 0o nlvol,
lsliun6 muBcIlor[,,tttlbrrrnr,ofunollonul{,ol,(,,,).
 "=:ii; :
ii::i:i
;liiiirilial*;iiiigli
i!;l
:21;iii;ilisiisiii:lgslllii*
1!iE4;jiiti,:iiliiilliiEliiii
ts i

=iEiiiiilsiiiiliiiii:iiiE,E:
i iii;i:ii?;Eiiii;iiEiiiffl
E=;i3iiiii=i:
s i1!i
t iiEiiirliiaiii?aiiiiEii;i
;;i:,
t:;: ii:+
i'=,i=
- i;::i::1:;:;!+iiiFi:ii!
'ii
=
 ::l1iiifi j'u
giiiiiiiai
iiari;;ii
:
iiiiii' {::

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ti
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Es fi;:iits
34 E !E .;3

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,.r,. i{ iili;?rii€i;
i:;ii:
I =
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 T
)) I t t oot ' t t 1' , 1' p rt.t1 s ii.ttt n ttt, n t. l ,rL l tl rti cotobrl l hr I)r' i tl i l ' i \' {r si t,tt
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 mulii-
plir, 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 con-
rrlrrLri 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 senzi-
Livrr 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 tra-
rlrrur 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.
: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:l-
lrzirl,orrl numai Ir nivel spinal (indeosebi),dar gi Ia orice nivel al lreYrn-
rrrlrri, rlrcr"r,sint interesate fibrele piramitlalo (ad.eseacu realizarea de
l,.lr',r,plrrgii).Nr: vom permite ca in continuare s5,abordi,m separat problo-
rrrr,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
rrlrrrrrr,trilrr,rnirlir,Ie,insolit5, tle anesteziepentru toate modurile ale sensi-
lrilii,.rlo,plroLrmSi de tulbuli,ri vegetative qi trolice, cu neti, limitale snb-
lrrziorrrL'r,. Nivcltl leziunii me:lulare se poate preciz2r, prin apreciereamodi-
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
'|'ir,Irlrrrlikrrlo lrrrrrplogiospiltrr,lii(simiLt,t'osrxt{iuniitt'rlnsvot'so)1tol,lli
rlt'
lrrrrlizrr,l,rr crrl6 tnr,i vrrliitt;rt
llt'oottsc:tultnltt'rrsitttti
In(nlulrlro,
tnirrlil,c,
lroli
rlrrrlirrlitrizrrttlrr, lroli r lcgcttot';t'1ivr,
1. tt,.
t: l
A
lritlittri lroitlrrli plrrtlttsiipt'irrstlltti.tt{rrvIti'rtIttIittt'(ot'Itt
!) J.'uxt,1tl,r'uitt
zir at'iololorplllattttttlillttcrtL' sislltttttlttivtrtttlrlrl-ltltzilitt), llt'olol
i)tr)(1('s(r
mativo care comprimL pittirit'ttlporttin, boli tlernit,linizrtn lr' ;. rt.
' 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
paraplegii sau tetraplegii (cu predominenll pl raplegiei). Pfi n t ttrrtrrt'r t istt ttr
iimil-arJse realizeazfi p:r,raplegi1leprin ]eziuni multiple din sclororll llr plii('i'
din unele encefalo-mielite, din boala lui Little q. a.
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
rrii, cu ltaxie gi/sau cu tulburiri t1eechilibm (ata;ie 1'rrl-rclit'ii,
silttltttrrtrtt'
r{ uluirnelnice, erodoataxii spilo-cerebe}oase'sindrollntl 1,cs(ilrrll;rrrr,rirr
rllorrme cerebeloase,al,axia frontal[ a lui l]rrrns) ;
" rsllt'ilrr I
plin tulburili psihice : t,pirtrrplr'g..irr
. tr) Pseudoparaplegiile
r | | i r Z r) . : tl ) a Z ta .
2) E'Lt'rdroam,ele paraplegice Q(ul,e sutt,Jrnrte rultitl, t'uslilrrill ritl. ti'
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.
l,rrl 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
i, lr,rtllrrrrluitrtill,otlgrr,lilirr.ic +r'rrziiir(scrrrlrr'lr.
r.,ilr 1rloIorrr.rrlrrrrrrIrri r':rrlir,rr
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 t,tiltlr l' rl tr.rrlrrrrttri(irrllritrrplcgii,lrl)oi ilr r'\{'llll'i(rt
c) l\l itrrl,irtt.[ntt
I rll lrli,cl,it,lc;r,
llrr olrirr,i, ittnii, rrltttttt'ltt
rlil,i,lrrs1tit rr,lr., r.l,it.jrrlol
srrlrcr,iotrro
lol,r'r r,Ilrrgiir(1ll rrit,r'i LttIIrrrtrr,t
t lr\rzrlrlir rtrol,otii,ttrllico 1i vt,iJrrl,itlivtt, ttcvlrrriltlrrlr,tr.lrirlilttziutttlr'ttr 'itriLllitnc.lr r,rr n,,irrrrr,
1ri ri rrrri rIIr Irr
-l.zirrrrii,
cltt'ltt'lrrrtso,
rrrlr,lrnr rrr cvoltLtica,st:otttlrrnlrilji r,trrrlr.riir,r'cli1i
iInclvil()r'clltlli('i.iJ{)llLll(t1f llr,trlltl,rr r,u sr,tnttorrsooiiti'tr
rrtr'rrrltrr,lc, vcslibrtlrtlos.ir,.,r,rr.uri\nr,
,lrr lrrzirrnotrcylaxiu,Li (irrrltrosolri pilarnidale) Iipscsc..\Ioclilii iirilo
irr,rrrrLclc crtnlial potrlt tr i.liuglnosticu1 S..\I.Itr1otrttrr{'iilrrrrrltrsctlo irrvi,sl,igrr,{,ii1, r,l.r,
rrr 1,.(l.li. sirrl, cl,r'actcrisi,ico. 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,
tl) l'olk nieli,ta,&cut{i e ltri. II ei.ne-Metlin intli, totdeauna in cliscu{io
;lstii,zisocotiti, ca o JJoaU,autoimuni rle aut9ag1gsi11l0 (l'clrrlro li ,lolvirr,
lrr rtlr copil s:l,rtIa nn indilid ti[5r, mai ales dacai,s-an conse]l]11:r,t sclnno,
ll):14; Ila.bat, 1957 ; Liirventhll li colah , 1960 ilrlrlsrlen 1i c'lu ir., I 15tt;
1rllrrrorri1,olii infec{ioase (febr5, manifest5,ri digesljiye $i/sau respiratot'ii I )nmii,qi cotab., 190-1,1965 ; Schapira qi Palki 1961 ; Vari Surrrlr,,'I llri? ;
'rll,clrrrlrr,str:i,r'iigoneralc), algii poriferice, ce{alee,ytlsi,turi, radiculalgii,
l3r*usqi colab.,19i2, 19?9; Cojocaruli c,",Ja\,19?8;'Pop6viciuryi t,rrr.rr,
.rlgii rrrrcl,h:, fa lialgii, semne meningeale (subiective gi/sau obiective).
l$80; Kright, 197?; Colby qi colab.' 1977).
| 'rrlrrlrlr{iir, loate ti dintr-odati' masivd,, hipoton:i (,,paraliz izr,de dimilea-
b) Neuromiellta opticd'( oJtftlmontielila, boala lui, Dpuic) poir,t;o , y()r f i
irr') rlcsclisi de West), cu reflexe abolite, sau sepoate instala doar o mono- o evolulie subacut-cronicii, x11..tlebut ?xlilllrrletic - paraplirgic, rl.5i iir
lrl,'{ic, cventual paralizii parcelare. De ^obiceifenomenele generale qi menin- rn:ljoritatea situaliiior debuteazd,acu'l saLrsr-ibacut(Driig-nncscrr
u( rl(i l)r'ecod partrliziile cu 3-5 zile. In unele situalii, pierdelea blutali,, 1i coi:rlr.,
1962. 1963).
rllrrrrrrl,icii,, a fortei musculareeste impoftanti, qi ertins5,, atingind mu;chii p.oru1'1eginspas t,-ttlicd,r:rt:d,oti.lili.
rr.rlurilor', i:r,itrunchiului, ai membtelot, cu extensie chiar la nivelul mugchi- cJ Mielita .cro,icii,.lueticd
licd"u, lui XIarJun gi sin(lronr,ul -(Er.b),
tui GuiLlain ti Thion {asociotorlc s,.irrrr,,
lol irrrrlvrll,i de pericarionii bulbopontini. Atlofia rnuscularS, este precoco
de encefaliti, cil tabes qi.cu mieiitil Erb), frqiysnls altddatir, sirl .r lr.rrr
si irrrrortantd,.
r.te rar intil.nite astizi in practic,r,.neurologici,. Nu tr.ebuio i,Ohrqi rri lrr
q N euromielitn optiad, ( oftalmoneuromielita, boala l,u,i Deuic) deba- rLiti.m, iar prezenta sgmlului hii ArgyU-fi6bsrtson, a hipclcil,oz.i, rr
I rrrr,zji,rlo obicei brutal, de multe ori paraplegia precedind semnelede nevriti
lripefrlbuminozei qi po^zitiviratea-reactiilorB.W. si 5 benzoi r',r1rirlrr.l rr,,
opl,irii,(Dri,ginescu qi colab., 1962, 1963). diagnoslicut.Tn plus. in pataplegia rpasmodici c1orl.-sitilit.i.r,
l') Ilxistd gi cazuri ile scleroad,in pliici acutrit, care realizenzd paraplegii '.lrrilici
rr.lui Marian apar gi : keratiti,, tulburd,ri psihise importante (ca11,c1;r'r'irr,1r qi
(rrrrr hrtrrlplegii) dramatice, flasce sau spasmoalice, cu senrne plramidalo ,1,' tip demenfiall ;i, adeser. convulsii.
irnl)r)rl'lntc. Sint frecvente puseele de paraplegie acnti, in cursul evoluliei J) Compresiunilemedwlarede diver:e naturi (tumoralo sa,u ilrflrr.nr!r.-
rrrrci scloloze in p15ci. Puseele evolutive de mielit5 in cursul unei gclerozo colii, primiiive sau metastatice, subdurale, extracluraLe sau intramoriu lllr.o)
rrrrrll,iple pot sd, se declanqeze cu o ,,tragici brutalitate" (R5-":.fgP", |eailiz.eaad,, in funclie,.de livelul acestora,_plraplegii sau tetrrrpkrgii. l,)rirr'
g) A.lte encefalornielitepot realiza in contextul clinic malifest5,ri para- 1,,rnj'i mulle pobibilitili de reaLizlrea dellsi[11[16e6o,' -
;rlrgicobrutale, I& care se asociazdqi semne suplaspiuale. - O compresiune realizatS, brusc sau tapid se poate manitosl,rr,rrr.irr
\) Spond,ilita tuberculoasd (boala lui Pott) trebuie suspicionatii tot- {r'-o paraplegie flascfi, ulterior, in decurs dd citevi s[pt5,mini, 0voiirlrrrl
rLrr,rrur,in liulrr unei paraplegii acute la un adolescent (indeosebi) sau Ia un $pro o paraplegie spasticS,senzitivomotorie. Se intelege c5,tle obic.i I'rrzr1,
rrrlull,. l)itgrrosticul este u$urat prin prezenla conira,ctudi dureroase ;i it, ou dureri railiculo-funiculare intr-nn^terit'olil limitat, bine prociz^,1, ' (rrri
rlru'olii colornci, dar mai ales pdn evidenlierea ghibozitS,lii qi a altor semno stu bilateral) precedd,instalmea aleficitului motor cu citeia sil,,l,i,ririrri,
rlrr plri,lrrrryilo vertebrald,. Irrni, sau chiar ani, fenomen cu male valoar'e diagnostici.
i) llr,nrtnu,I primi,tits rah,id,ian al ltti Ewing poate realiza o pa'raplegio
- Alteori paraplegia esto lent-progreSiva, de la incerrut sDrrrticil.
lrrrl,rr,lj1,Lr, copii qi Lr, atlolescenli. Djagnosticul se verificS, prin imaginilo ,lrr de mu lte ori precedald,cu mult timp inahte de fenumenetlo clnurlicrrllri
lrrrl ioglrr,[icr: plulifocale, in geocle, pludver"tebrale qi costale. $pinal5, oel mai adesea fir5, clureri.
.iI JLl,l,ctumori primiti,De se,usecurl.darei,ntrarahid'iane,intra- sau extrn. - Alteori evolutia lent-progresivl nu esls precedati, de fonorncrtrr rlo
rlrrlrr,lopot plorluce paraplegii acute gau cu ingtalare rapicl5,, precedato rrl:urdicaliespinali, in scbimb pot apxrea 1y15iop11i sfinctoriene plnooor..
rrrlrnrrirrlo o sourtl periorLdfl tle rahialgie qi ciaudicalie spinal5,.
- Dvolulia cea mai tipicS, este unndtoaroa: mai intii faztr, rodlc'.
lil l[t,n.in,go-mteli.tasifiliti,aii a,euttiintfi, astS,ziprea puiit in discufio. LrrL ilureroas5,, apoj perioadi, de clauclica,lie,apoi sindrom Brown-sdqnrrlrl
l) Il telom,ataciile (rumolismen'tul, total, transaars li ranxolisrnentul r..i,iLr shriit, paraplegie spa8tici,, inso!itd 5i rle tulburiri tlc scusibiiit.lt.o
ttpintl rnl,rtrior) pot realiza fie paraplegii, lie tetraplegii dramatice (Lazot' (r'rrrctle mulLe ori Pot liPsi).
Ilrrlr. l l)?2). 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
ill 8 intlroanzeleparaplegice ou insl,alare lant-progresiud,: lIlvet.
t) f*:lerozn rnultipld, (S.l\[.) realizeazS,cel mai frecvent un ast)tnenolr, Compresi:,unila aeraicd'la inletrioare rea5zeazir, o paraplegio fiptrsl,l.ft
I'ir,lrlou sorrriologic, cu par:lparezd,-paraplegie spastic5, piramitlali evolu- Bubju,cent5, - do hrlbul[,r'i pftreto-atroficotlc tip *idlcriin,r' rr.rrr.
insol:itir,
l,ivil, (url rn:r,irl(losoi)ou puserrri). Iformele ou evolul,io lont progresivir,, liiirrl, Irrelo supoliotttrr (Llr- D')'
mici r1iinoorto h mombrolo Buporioa,ro qi.fi,rll rr,ltoscttrno 'i
lrrrrlorrrjcu s{)rrrno Oomptroaiunila nvdulara dmtalo ttti,,Lthaa,zi'i,
nrrlrlrl-npirrirlo rlo sclorrrzi,rnull,iplii lirlioii, rlosigLrr,lrloblclno tlo rliul4rruslin 1r'oooc. 4ollioit. rnol,'rlt
(tlrr,1,0rilil (1ltnlrnlifii,ll'i rrlorofloxolor.
lngrrstr'rliitIIttt;t,IttIttittt|tlttlrlt), (jI t ll.
rlilirrrr rrl,irr,l
crt trtiolil,oloorotrico,ort cotrrplosittttilo tnrdttli.tt'orri ou i!nrllrloi. Hi

140 l{tl
,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
I rll' s(llrsilrilillrlr,,rrrrI|r,trrlltl,r,(irri(irrl) ,.lrrrsttlrlt'ziottitlrl|. li;r sit'iltgrrttlir'lir',
il lItot.t)I.(ft,0|(,si rrltt,i lttllrrrriti i,rrrlirttr, irrltsclrtt I tt I,i IIt tI I,r' , pt'r'tlrlttI
ittltttlr'
rrrrprrtiolrtc r'ai,lnhl i ncr:r,
1trozonl,o, rliu rlll(l\(ll(i outanato lrbd{)rninlllc rni,ilooii lrl1r,l,t , it,irtr,li.zr.i,il. itrl It'rt
lrr rrivtilirltrriirril.r'qilr1rl.961r,l'r,lr lrtrr1t,r
rii itrlirliorrro sint abolite. fu stititrtlr, irt compresiunile sub Du, r'cflt-rdo tlc {iD ,\r'ur),1)ur,l('rrrrr'. Nlrxlilicirlik,1,.(l.ll. sittl :tlt-
tiilrr si I a1,r0liiLrr,
:r,|rrIlrrrirrIrlrr so mcnlin pii,strate.In cazul unei compresiuni sub l), r1itlea- itnp,rrt:rtrit' (cvelttttal rliscrtiit ltipcltrllttttttittozi)'l'rtltt';i'
r.rrlr.i:ru luiirr
rirrl, r'1,HoglrrorrtuluiDro sepoate evidenlia semnul lui Beevor (€itr1, de Arsoni
,.rist.r,siririgomi,.liiiu evoiufib rnili r1pirlli, .. 5l.crrj lidrirlirtrr qi t'tt ilttrtgirti
,,i lolrrlr., l1)?7): la ritlicarea capului $1a trunchiului, ombiJicul se depla- rl,, liniorlolin,,Lerrzi perime4ul*re't cr,r, i' tumor.ilc iltra,rcrlulirtr,, siittt{ii
rrorrzir, irr sLuirdatoritd, laptului cd,porliunea superioard,a muqchiului ilrept gnosl -d ev fu:rrle di [il il.
,rrr.:rrtcd ia icul ilc
rrlrrlorrrinalprimeqte impulsuri motorii, in vreme ce porliunea inferiotr,r':i
I Deqetreresccnteksp i no-cerebektase (boaln luiL'riodteichlitx'tlo tlrr't'itt
r. i rlc lrirllllizitl,i,. -Marie) minime olorncult:ltirrtrli.tr
( lrnn?resiu,ni,le med,ulare lombare suptaioare realizea,zn parapareze ,, r,L,iloasi a lui 2ie*e corlrrporl;it,
rrrirllle. ne Drim Dlan situindu-se sernnelccerebeloasc1i tle col'(loilll(r Int$'
'itrt'
r|r' I i;r lrilurnidal, cu Bpasticitate (neobligatorii) qi cu unele indicalii de nivel.
i,.r'irart'.- lf nlusi caractelul ereclo-familial tra $eazd,tlia'grrosliortl'
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 xt Paraiteqia spa'slicd' fatnili&Ld' a lui Btrr'iirnpell-Lorrairi', 1xr litrgri'
glrtrLiologitr
lorrrplr.sirrttile Ll :rivelul Lu- la, a,tlt reflexul cutanat abdominal infelior rrila,iiegia li"ait iAaia cu contl'actur5r asociazd,in contextul
r.rl r1i lr,llcxul ll,nal sint prezente, in schinb reflexul rotulia,n este alrolit. .i semnEcefubeloase(uneori discrete),pe ling5,un caracter eredo-tilrttilirt'l'
(iirrrl cornplesiunca lornbali se oxtinde spro coada cle cal, tulliurflile do hl Arahnoiditele sqiinale compresiae (diJuze sau local.e.);i-art'lmo'n itt
rrrolililrrlr,inftr'acii,un caractel flasc, cu fenortene de neuron rnotor pcri- titele iealizeazd,4e obidei paraptegii (sau tetraplegii) insolite rle lttrr'tttt,tttr
I r ' l r(,- {ltrrcroase cu apari.tie tardivi f tle semne intinse, etajate ryi atlosca,tlistrttl
'
liut prcsi,unile m,ed,llla,re s&ar ,te realizeaz5, paralizii fd,r',i,sprnne pira- rll,nte (hipoest"ezii neregulate, atingeri radiculare tlezordontrl'c, itllnrt'lt'"lii
rrrirlrrlr,,itr schimb cu nete fenomene raaliculare.Astfel, complesinnile la iruronsta,ntieale Ir.C.R,. (in funclie de efectuarea punciiilor etajat., .tl.5ltt
rrir r.lul opiconului (L,b-S?) se manifestd aaleseadoar printr'o paralizie 0rr,increqulat $au Dar-t-ial,cu lentoaxe de intoarcere la presiullerl'iltilirrliit
llrscii in tcritoliul sciaticului popliteu interrr, iar compresiunile conului l'l"cljul"fiintl mai iet in pozilie aqezati decit in pozilie culcati' srtl illv{rr$)'
rrrlr I rrlirr' (S, - Su)se recunosc pdn a,bolireareflexolor anale, prin tulburdrile j\lir.loeratia(.ste caracleijslic, (Arseni $i colab. t9?3)'
rlrr st'rrsibilitate perianale (in qea) qi pril marile tullurd,ri sfincteriene, :rbia i) Mielopatii.le subct cute Fi aronice t:ascwlarepot realiza palilpirt(^'r'- rlrr||
rrrri lirzirL pul,ind si, apali, ma.nifestS'rileparaparetice. rrrrlallegii le-nt-lrogresive, al cdror iliagnostic este extrem tlo tlifitril 1i'
(lonpresiu,nile la nioelul cozii de cal realizeazS"paraplegie iloar in ,,,1r.,si,r,.-se face plrin"eliminareaaltor cauzerdiagnosticul lor prtNrispttiitttltt
lrrzrrl sirrrllotttnluitotal al cozii i1e cal (r5,cl5,cini1e Lr-Su), insolite totdea- so stnbili cloarlrin arteriografii selective. Se qtie cd ischemiilr t crlrrlrrr!
rrrrr,rlrr lulh uri,li de sensibilitate extinse r:e dermatomerele restectiTe si de pot fi realizate prin leziuni Yasculareprimare gi prin compLt'sit.tttivrtrt tt.
rrrrrrli
rrrrli l,rrlbu
l,rrlhullli
llli stincteriene.in schirnb, s]nclroarneletle comliesiune par-
t1c compresiune nar- ]rrrt in cadrul inor afec.tiuni ale m[duvei $i ale rneningdor ((irrrrritt r,ti
cozii (le
{irr,li rrr (x,Zll
llr,lir dc Oitt se CalaCleltzeaz:],
cirl SO caracterizeaz:'i prin l:tl-toUlan
prln ttlbur'dni m0lolrr
motolii qi
rotolii Sr
si Senzltrl'l.e
senzitir.e ln
senzitir.e in Iirxr(lot, L966, citali cle I-,azor"thes, 1972; Lazorthes, 1972)' Atotrt- ryirur'l'tt
Irrrciic rlrr li1ul supe.rior(L.-Ln), mijlociu (Lu-Sr) sau inferior (Sr-Su) r iosclo.ozavaielor lpinale este mult mai rar5, decit arterioscl:tttzit v:trr'1tr'
r|r' rrirriIr'orrr de corilil tle cal,, timul (cel inferior) intrr'unin.l
intlr'unin.l $1telburdri ct'r'cblule (Jellinger, 196? ; Lazorthes, 1972).
rLlir rr.lctir.trc irnportante. i) Selerosatlateramafi,iotro.7icd' (BLA) este u$ol'lle rtlcttnoscttl' 1tt'itr
I'rrtrxr'lt erpansiae intramed,ulare, indcosebi cer"r''icale (glioamo ,r.zr]nt'zl atrotiilor musculare tipice, indeosebi dista,le la mern5lrrlc sttlt.t i
,1rlrrrIiIrrrrrrrrrrr, i nbclculoame) reakzeafld,tablouri semiologice cu totul i,'rrt (cu sindrom Aran-Duchenne), cu fasciculalii )'li c-usomk) pitrltttirlrtlrr
prrr'licrrlrr,rrr, r,rrrt i.rebuie cu grij5, diferenliate cle S.I-.,.A.sau de alte sil- lrr iorite membrele (mai exprimate totuqi la membrelo infolioa't'c).
,lrrr:rrrrrr rlo S.1,.4., precurn 1i de siringomielie.Astfel, aceste:nse manift:stii k) B inal.rcamele de scleroBd' lateraliiam'iolroficdpol, li lea'iiztt'1t: tlrr lirrt'tlrr
rrrrrlt,eirlectiuni: compresiuni cer"vica,le tle tliverse naturi, pa,chirlr('rrirr!{ilt'
1rr irr lr'lllrlrlcgii ploglesive cu semnepiramidale (mai exprimate 1amernblei.o
rrrli'r'iorrrrr ou sllrsticitate), cu aljlofii musculale de 1,ip Aran-I)ucherrner, .r'r'r'vic: c liipertroficd luetice, arahnoidite., encefalomielil,c fortno .irrrlrr',
lrr lrrrr, firr rlsociazili,tulburi,ri de sensibilitate suspendate (irritirrl) sau sub- spinale (a:a-zisc iterjce"). LllrunliLListrlo v.t lt'lrt"
Ir,ziorrrlirrlo l;ip siringomielic, cu clisocialietermoalgezici. Pot s* lpa,rl rr,., I rr|.. I.,. inr.lr()q.r. (Arscni !i ',cen1r'opt'l
i'r'r'rl'rrrinlni colrb., 1973; l)ragilncsctt{i r{'lrrlt.,ll}li:i,
rli rlru'r,r'icorrlorrirle,plecum qi dureri de tip radicular la metrblt'le supoli. r1xi3, t 965).
,rrrlr, lir rlr,rosc asociaai qi fenomeneyegeiati\.e (va,somotoriigi sudollrlc) l\ Stndroatne'p&roplegi( ;i lelrupleglte ltol sii aprlrii' ill Itlllnttlttrlxo
rrrr1rolIrrtrItr. Irnnginca rnielografic[, descrisl inci, cle Sicard Si l{i],guc1rilu .rli,,,tirrrri;r lr' ll' urol;lllui In,itut'lrclifcric.{'arovul li rrLrurrllrIr'itt sttIr.rtltil''
(lltJt!, cilrr,fido ll,iscr',1952),tlesemnindaspcctul in fus almldrvei dilattt,o, lrrl rrrrrr:rtut.-i clle .c dilt'tou{irrzriltior, ill conlr,rlul tlitLir',rl" 1l;r't':r'Il|giil'
riu Hculllol'orr slrbslartlei radio-oplce po pi,rtilc laterale, snb fon:n:l lr rlorrii, rrrIr.t,r':rrrlcuiileDilunithrle:groliotrti0lil,asnltilcLrl,iisa,usuborl)ni(iil,([i(1r
rtrIrirrrc lirriir,rtrlirstrinlrto,vino sii confiune tliagrxrstictl tlr trrruoli, irri,r'it. rrrrri,,tl.rjli,i-Lri i'hrllu,rt-M'rr;i.,,lrniot,rotiil0rlpinilloplr)!{r'oi;ivrr, politttrvl'ii'oltr
($i 1ll,(!1t('lilgltrrrtrlr,tii), llulir.ir'rliortlottovlil,trlu. .,\lnilll,o[,l Il l ll,(11'iol (!,(lr,fi
rrr.tlr l:rIii. nttr,ttrttt
la'rc ltttlttottlirrlr
, it,,,,rrr.,ti,r'ii., I 1i'rtir,lizrrlr' \i dt ltd,ilt {rlis1'r'ol'ii lttr'
a) I irirtllom.i tl'i.a,rrslrrttlit,tiv lr;iot'tlc t'ccrrttoscrrt,, ptin ilsocicrrlr,l:r,rrlr plrrrsivr,, rrti0zilr,,p0lirrriozilr.), rrt .t'ltlr, lri{r'trrol)rrrr
rtirl rtryot' tlrr tIiltgrtrtsli11lll,
Irrlrlorlrlrr l)r,r1rl)l,rt'zii (srur lrrl,ltlrr,trrzil) pirrr,rrrirlrrJrl,
irrso{,ilrlc lrrlnrlili I t r o o t t ( r , r i t t I i i t'ttti ttl tl |j i l ,'

t42 l.l:i
 i|.il.il. I'llrrlizii plirr lozirrrrirrlo rrrrrlorrrrltrinrolitl' prl ifori(1 ' l A l l l .l . N r. i l

l Ii gl .i ri l { r rrn' ml ,|1' l ol s tl p(.rl onro

;i.;1.:!.1.Oorakt!;ii rttorfo-ttttt,cliortrr,lt
si se'nioloqiceAn lezilln' a lt(uro-
n 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' t, 3
rrrrlcrr rrni1,i,!,ilc motorii lezatc i b) hipotonie musculari' I c) retlexe osteo-
l(,rrlirorlsc diminnate Bau abolite; d) contraclie idiomusculari pi,strata I Il i di carca '1'raprz S pj nnl r r iii (1(' i r, r \ |
Irrii rri
rrmi ml ui "--*
C, I3r*
C.. (c I.\ i |rl i
lrrrriila rrr gr:rd al atlofiei musculare; atrofie muscllard precoce li irupor' Dintat mare N c N ul { (l i
(lilll:Ll
.rrl l r{
l:rrrl,ii,irr crrzurile in care este compromisi, integritatea neurollului motor; l l i di carea Ileltoid C" Co C i rc unrfl (\i
r,) plczorr{,r,fasciculaliilor (indeosebi in leziunile pericarionale) ; l) i'eacliile bratuhri
rlrr rlrgruorrscon!,ir, electrici,; g) modificlri EMG caracteristice de tip neu- 3 Coborirea Itomboi d ca cs N erv ul l 0l l rho
hoi rl r l ri
f0lfclt. umi r hri IL'tghiular cn c" Nen'lll llDi.jhiLr
ri Lrl N nrl li|
Pectoral ,nic cl- cs N erv ul pe{ Lorl
3) ]tr-'ris&l insii' o serie de particularitii,li ale distribuliei paraliziilort ,1 Rotalia bratu- J)orsahrl mitre cl cu Nervrtl rnxr(hri
rrlrrrrlrrrlliilor'qi ale activit5lii electrice musculare, precum $i ale unor sim- lili inaiDte $i Subscapularrl ca ot Ner.JulsuIs.:tll
;rlrrrrrrrrrsrxria'te, lezionale: a) la ni
ca'rep€rmit ili.ferenlieri.ale toltograJiei. inrpci
vllrrl lrcrirrrrrionului motor I b) la uivelul ridS,cinilor anterioare I cr)la nive- Rotatia bratu- Supraspinos Cr cu N erv ul s l rpf)si pi nos ul r I
lrrl pl,rrrlLril tl) la irivelul nervului peliferic. lui in ahri Subspinos 0r Cu N erl ul s rl s pi tl (
Rotund rnic Cn- Ct CircuDrflc\
lf) I'onlrr aprecieraatopografiei ieziuniior nsulonului nlot'or periferic
-Cdrtuclia Dorsollil mare c, cu N eN ul dorsa all rl
r lru i r r r r ,,
rrrlc ut,ifii,olrnoaDt€reapri.ncipalelor ac!'inni molot'ii segmcnlo,re;i coretpon- brafului l l otund mare ca-cs N etv rl l rotLrndul n d u l r r i r r f.
t nla. i erl)etie' rad,iculo-med,ulare,ti, perifc,riaa (a. tabelele nr. I' II, III Si, Peotolaiul ma].e cl-cs \Iai Inul l i nc r\',ll t)r,,\,.rl l l
C,-Cu
Iio. l[i, 19, 20,21t @up}" Iiiser, 1952 qi Chusid, 1970 - cu moalific5,rilo
SLrbscapularnl c l i ]r pl c )' rrl i ))rrl ri :rl

rr olrn{rtlJ. Abduclia D el l oi d cs-ce CircumUex

bralului Sup!aspinos C" Cu Ncrlrl sul scl
TABEL NT. I fi Fl exi a Biceps ce-cr \Irrs c nl o' ( uti r rr I
4nlebratrului Brahiai anlerior ce cr l l us c tl o rLrtr rrt l
lligeirile capdui Ltrng supjnator c6-c? rygrl
ExteDsia Tl.iceps Co C" Ii adi rl
antebratului
to l '1e\i a nri i ri i Pahrafii C t* C e Mcdian
(mare qi rnic)
Cubital arrLerior crbi!1l
Dlepli antcrioli cr;.C, Pr'nii ner\.i ar.nieni tt Ilxtensia Prinrul ;i al doilea Cu-' Ce i l adi al
r:liinii radial extcrn
Sternocleido- Per. XI. crao+
rnosloidieni c , -c t n. spinalI- ramura n (lolr:l Extensoflrl co- 0u n adi:rl
degetcl or
ccrv;cali
C ubi f{ pos tc ri or Itac l i al
,9L9,
l, l \ l ( r s i l Splenius Cr-C" l{xrele rlen' {rrcipilxl t:t Fl 0xi a p oi i c el ui Scurt il cxor' o? 1)1 C ubi Lrl
Iill)lrlIl (lomplexul nrare Ct-C' Marele n.n' occipital (pri ma f i a Lung C' D' tr{cdiaIl
Drcpti posteriori q-c" Primul ner'\'eervica] (loua falangd)
Micii oblici cr-c, Marelc rLcrv
ri t l l cxi a i n dex tl ui Itl ter{ )l n,s ipal mx ri cr l)1 ilubit:rl
I ||flillrrrcu S c alcn i C,- Co P dmi i 6 n{rri ccrvi rrl i $i a mcdi us ul [i fi doIS.rli
'I'rtlpcz (D ri ma fal angA )
l r l . { ' rr l l i Pcr. XI -l- S pi nal -l - Fl i mi i d,,i i r. f,r'\'i
cr-c, cali
l rl cxi r { l tl angc l or Fl c x or c omun c?-, T)1 l l c di arr
(s l |perl , fi pr0f.)
S p le n iu s Mal cl c l rerv occi pi Ltrl .!,!. t - l -(?
' r)r
1l i l (),i a d c gc tc l ol Ll Lc ros l ,ti p:tl rrrri (tr1)i tj ]l
It0lolijr S l c rn o clcid o - Per, XI -F SDinal l- C, 'l [i 5 fi dors r' l i
i
crtl)1rhri
(sr'fc
r r : r sto id ia lr slln g
( l r n r Ur lr xu l Dr I| r ( )
sllug
cr"-c"
or--c, l \l rrcl o nt'r! {.i Ii Lrl
(pri rnr ftl nnl i i )
(rL (l ouu tNl tl
' rl .{ i )
j,',,,, N { c (ti x rl
drr:rl,trt) r,|l t,rrl r( i rl
S t ) l flr h r s ( l1 1l) t cr , (:x N trl rdrf rcrv rk ( i l Jl l rl (r' Ir'i rl ],',,,, ( l rrl rl l :rl
Mnr'oh (lr'll. or -- 0N M{rr!l o tr(.rv (x ( i pi tl l l r l r tV ri )
t x r r l l' ll( n r lr ' r I) t

t44 l4ir
 CorllnuarccqbcllI (:o|l,llllalo trnbol
o I z I
tl
'/ -
iixtcn\iA QnAdJicep$ul L'n-l't c fl rrIl
I lxl orBl[r Lung fi scurt o o -o ! liadial I crulal
l){ lccrlui oxtensot /
Flexia Gambier antelio? L4-r"6 popl i l eu
llxlcrrsld Extcnsor comun pioiorqlui (Si rotalia
lrlU rrrlo r 4 Plopriu al indexu- Cu-C" Radial I ineuntlu)
rl{:grd.c
(primn lui qi a1 auricula- Peronier anterior Lu- st 'fibianul antcrior
hlu rgll) rului ($i rotatia ln afardl
(r (loro $i a Intcrosogi Ct Dt Cubital I Extensor al Lu- S. Sciatic poplitcu cxtcrD fll
lrchr ftrlanEtr) Lombuicali Cubital ' degetelor (tn mod anrenol
A{l(lrr(LinFi Interosofi c"- Dr Cubital
|,Pr)rllla Palmari C"-Dt Cubital 10 Extensia Gemeni si solea! Ln- s, Sciatic popliteu inlerD
rhgcl.olor piciorului Gambier postedor
llJ dductia Opozant ce D. Median (qi rotatia Ln* S" Tibial posterior
pollcelui iniunttu)
Ltng peronier Lu- S' Sciatic poplitcr exLot.n
l tl Adduclorul cr-Dr Cubital latelal
policclui (9i rotatta
Abdrctta Interosoti dorsali cr- Dt Cubital in alard)
(lcgctclor n Rotatia Ganbier anterior Lr*Lu.
Abductotul cr- Dr Cubital piciorului Extensor propri[ Sciatic poplitcu cxLerD
degetului 5 induntru al d€etului mare Ti}ial antealor
2l Alrductia Scuftul abduclor ce- Dt Cubital + Median I _.1 R o t a l i a , Iixtensor comun L._ S. Sciatic poplitcu intern
pollcelui al policelui piciorului al degetelor
in alar{ J-ung peronier Ls- Sr Musculo-cutanat
later4
Peronier anlerior Ls- Q Iibial anterlor
liJ Irlexia Lungul flexor La- Sr
TABEL NT. IIL propriu
halrlcehi Tibial posterior
MlgeiTile membroloi lqlodoare Prima Lornbricali ti Ln- S.
lalangd interoso9i Nervii planlui cx[(,nl
Lrngul fle)ror Ll- Sr
vl
- Celelalte tdrn
falange proprm Iibisl posterior
Scurt llexor Ln- St
proplrlr n. plantar intern
Adductor propriu L"_ S. n.. plantar htorn
IJ Extensia I-ombricali qi Lu- Sr Sciatic popllLcLrexlcrn
(l(llrclln Adductorii L"- Ln :urator, musculo-cutanat
interll, Bciatic mare. halrcelui interoso$i (pt.
ultihele doid
A l, (luc llu Fesierul mic ii Lo-L fesier superior falange)
c o l l p Hcl mijlociu Extensor propriu
Pedios
totofla Abductori L, - S fesier superio!
IitlrnLru a Fesiexi miilocii Ln- St fesier superior t5 Fl exia
(roIptcr celorlalte
degete
llo[n Obturator L^_L. Obtumtox
- Pdma Loinbricalt $i plant{r inlorn il
lr 'In
(f r th {
(flrll Pdtlatul crural L s- L 4 Obturator falange int€r06oqi
c o[ pid Croitor Lo-L" Nervul musculo-cutandt extern Flexor comun Ln- Sr Planl inlcln
l, f lorlll (li)rpsci Psoas iliac Lr-Ln NerYul crural + ramuri - A doua Scurt flexor Ll- St plantar int(r:t
colaterale ale Plexului lamba! falange plahtar
scia!ici
Flexot comun Lr* fr plant0r lntcfn
'jxl
(!n$ln Marele fesier
t0 llxtensia Extensor comun Lo-'- Sr Dlautmilntqr:1
ll cxl0ID
0xlu Drept iltern L^-Lo celorlnlte Pedios (ln afala
g0r bol Ilicep$ cluxal Lo- Sn sciatic mare dcgcte degetulul 5)
Somlte$dlrros I-o- sr Sciatic mqre I"omhlcall ti
somllllenrbrtnos I'o- Sr Sclatlc male lnterosoil (pcntr
Poplltcu Lr- sr Sclallc poplibou intd ul[hnd( doul
0rollor Lr- L* Muiculo-cutaDot cltorn fslun{c)

r40 t4r
 -Ttiaeps

- Exlensor corPr
rodidlis lonqus
Exlensorcoai
'tudiolis
B{qrhlcte diaI is brcvis
,flexar,'.carpi 'fxlensorcffpi ulnoris
ra0talts
,Pqlflchs lcnilus Exiensot digikrun
sibiifiis
pallitis.
Apponens Flexarccryi Abductarpotliais
lon1u5
Abdwlot Pollicis
pallicis Abdrc.btdigili brcvts
Abdua.f.or
brevts .flixor djgilj
flexat pollicis quintibretlts
Drevls
Po icis
,Abduclor

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

Atubusntdits
SFt r &

ciis€* .8
Gluleusnoxinug

Gtoailis

Senilendinosus
Eiceps fenoris
Voslusblerolis
Seninenhronosu,s

Percueus
tonquS
fibiql,is

2a
Exlensor
digilorun
longus

Anloiot Fastetilr

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

 .i-,i.1!.)!. l'roltlrutr dr l.itr1tt,*lrtlrt1t,tt1rulir pritr
li tliol.oqiritt ltrr.t,r.l,i:iilr riottrt,l(tttt iitttrltotrtrlt' , , I )()| i(t III i{|I i I I'i1' ItttItrtioItIii t lottit'it),r'iI i1iI'toltrtllrrt'
I, irttti rr.lt|tI t|t|)|1.t||tt,i tttrlrtt1ntilr trl prrtilirtir,, lrrrrluttt ;i sottttttltltl tjot'tItIit'tttI l)osl(ni{rllltf. lirllllt lt,ltt ('ill'lllrll'f
l\ l., itttil" p rirrtt'iunulr: tjr'urlo. Ilr,rrriIilr,I,
rlr:LrttLc:t'zir itl c0pilli,litl sttll lit, \'il'sl{r.1,itl0l(', l,ritl rl'i,tolii
l) I'olirnn.irlilr a,nlui.ourd,&u,u,l,(i, (lM,l,(, l,ut IIein,c-llh:tliri). l)rliciltrl rlis[alclocalizi,to1:lrnomblclt inlerioare, cuplinzir([ ittl,ii ttttlst'tllrtltt|rt' 1rr'rrr
rroiol sc irrsiirLulziibl'utal in decut'sdc citeva oro sau zilc, rle obicei dupii o rrior'[, apoi pe cea gambier'; post,erioarr",!, la illccpul ou (lolioil lrr()lt)r lrrr
1r,,r iorrrliilirlrlili, (lo nrulte ori inso{,iti,cle fenornenedigesl,ive,I'espilatolii plc:r,irnporta,rlt, menlinind mu1t5,vreme sta,liunca fi rnol'sul (c,,trr ilttrii rlrr lrr
i.r rlr. rr,rrrrrrnrorringe&le), dar uncori Ei in plini, sfnS,tate (,,pam1iziilede jlrcep[t poate lua un aspect stepat). Apoir 1en1j -progrosivr ll,Ilriolr'( ]l iil rrr
rI rrrrrrrr.rr,{i r' I ). Sc lcalizeazd, tablouri I'ariallile, cu paralizii limitate, parcc- o\tinde in mod simetric qi la treimea inferioarii a co[],J)s()lor' Iolllizirr(l
l:n(1, riur, rIirrLllotlir-Lfoalte oxtinse, tuteoli cu caractexeascendento(sin- frl,rofia caracteri,sticd, ,,in picior ale coco,i' (sau ,,in cizmii iltaJl,il,") li
'lr,rrr l,rrt(ly). 'I'otdeaunareflexele osteo-tendinoasesht abolite in zonele lrozi{ie de mrus-equir a picioarelor, cu consecutiY€letulbut'iit i rlo tttoli
1r:rlrrIiiicrr, ll)il,r'rapi{l attlfii musculancDihipotonii remarcabile. lilnte, insolile li do tulblrrd,ri ile sensibilitate ectromelice (strbi()(liivofii
l,ipslsc 1,rrl brrliililc de sensjbilitatt-,. obiectivo). Xlernbrele superioare si]]t afectate mai tirziu, do l'egtllii ilri(,ilrl
')) I'rtl irtm,itl,i.tn, o,nteri,oud,cronicd se caracterizeazS,plin deficite motorii {n atlofie tle tip Aran-Duchenne, extinsi, ulterior pini in lr'eimca ttti.ilotrirt
lrr rrllolii lnuscrrla,r'c (rle rnulte ori rii cr fascicldalii), cu instalare fi evolutie ?r antebratelor (atrofie ,,tn rnan$eie"). Existi qi form€ de tl'ecclo irrlr'(r
l{'rrl plrrgrrrgivi,,orr loc ,lizare bilaterali, !i simetricd sau cvasisimetric[. boala Chaicot-Marie $i eredo-ataxia cerebeloas;, (boa1a lui Fritxh'tr irrlt),
l\l:rjr)r'ii lrljol,lrcos1iol ,r sint degeneraLive(rareori cu caractero er€do-familiale), situatii in caro se asociazd si tulburiri de sensibilitate profundX, cu irl,l \jl'
c,rk, rrrri rrnrltc iiinrl dc fapt forme atipice de S.L.A. (Ratlu, 1978; Trillet {prin"leziur ea fibrelor radicuiare lungi din coraloaneleposterioare) li, ov(rlr'
rli |olrrlr., I070), iar unele cazuri putind reprezenta forne subacut-croDice t,ual cifo-scolioz5,,picior scobit cu d€gete in ciocan, precum !i mioi fi lirr
rlrr prrlirruriolilevilotiice (Drd,gi,nescuqi colab., 1962) sau sechelelounei dive semne cerebeloaso.
1roIiorrrir,IiIu a,nterioat'eacute (Ileine-Modirr), in care atrofiile musculale 4) Itt siringr.tmiel'iase constat5, lrecvent semne motorii poricariorl:rl(t,
rrrrlrlir.iirlc rlotolii, dupi mai muui ani de la stinger.eaprocesului acu[, cu sindrom Aran-l)uchenne. Amiotrofia, cel mai adesea simet'ricii, int{no'
rtrlcp ;li, so extirrclil {i si se accentucze ptogresiv. Drpi, Radu (1978) {ea,zd,membrolo suporioare cu fasciculalii' excoptional de rar apil,r'irrrl lrr,
{l \ rirlrlrrlrr,cir,ontil itli distincte a atrofiei nusculare progresiyo Aran-Duchetr- lrlembrele inferioare. Prezenta tulburd,rilor de sensibilitato di$o(lirLt(1
rrr., r.rr,rlc lal)ir fi {l pa,raliziej bulbare proglesive Duchenne este indoiel- :iirigomielic, suspondate, a imporbantolor tulburbri trofice, a sindrolrrlrllri
(li:rglxtH
r r(ir,, rt'l,i.ii1oilleplezentind mai probabil forme atipice ale altor afecliuni }iramirlal asociat, procum $i €Yolulia foarte lentd, ne sugereazri
rr'lr,rrrrrIr'orrrrIrli lnoitor (S.Ir.A., sindroame r1e S.L,.A. el,c.). Cr€dem, deci, liicul.
r':r lrrlnurLrrlrlc ,,lrolionrieliLiilanter.ioar.i, cronici],devine incorect in etapa, 5\ Iurnori,le intramed'ulare ti traumutismele aortebro-mcdulu,rtt(:tr'
:rIlrrr,lii rr,orrrLo;Lin{elo| noastre, pentt.u cazut'ilec1l otio)ogieneprecizati" hnnal,omi,eli,e) pot genera siDdroame motorii pericarionaler asociirl,c(1ll rt,ll(\
Iritrrl lrlrlirlir,bil si $e nlilizeze telmenii dc ,,sindron tle S.L.A. atipictt $ernne comisurale, indeosebi cu tulbur5,ri de sensibilitato de tilt si|ittgrt
rrr,rrrlrr ,,sirullo])r I )(r'icalion:t l anterior oronic de etiologie nepleciza;bii,'r. rnielic, de obicei inil,ial suspondaterapoi sublezionale(cu niYol (l{,5(!rr$i
'l'ilrrrl lrl rilr,i IrccvorLtintilnit este siuchomul amiott.oficAran-Dlchenne, bilitate).
rrr crr,r'r, rloiir,ilrrl rroi,or qi atrofia rnuscular5,incepe la triye.lul rniinilor, ll\ Leziunila rdd,ic'LLlare .mteriodre prezintr, o serie de particllllll if i,li.
rr.:rlizrrrrl,Ir'irr rr,i,r'olil, oi)ritentolor tenari, |i hipotenarii [i :r, interoso- I)istribulia topografici' segmentarS,a deficitului motor $i a celol'LrlirosorrrrriI
,rl,,r',,,rrririt,sirrrirr,tiii') ;i ,,rrrila in ghear5", dupi cale progresiuneaatrofiei colelate a1esindr'omuhi do neuron motor periteric este identici' ctt |trit' tlitt
l:r rrrrclrrl rr,rLi oll|ir,l,t1or,tg lrzaa,z\,,m ta t1elredicator.,, $i ,,mina Si anto- Icziunile perica,riorului, dar fasciculaliile musculare sini exceplirtLrtl rlrr
lrrrr,lrrl rrr'Irrrlrrl,icJ'. -,\tl'{rfia ss poate exti de qi Ia nivelul nusculatur ii bra,- fur intilnite.
I rrlrri |i r'lriitI lrl rIl so[]inturalizomelici a memltrelor Supelioare. Pe de alti, pafte, vocinltatsa ridS,cinilor posterioare facilil,oltzil' rlso
ii:ur (lrF(,r'ir.i rji cazut'i de ,,poliomlelitrdcronich" in ctre atrolia debu- riorea frecventi tL unui silfdron do protoneuron de tip radicnl'l't,'
1,.rrz,:lrr nilrrlrrl utl$ct atut'ii proximaie armembrelor superioare,realizind 1) Comprosiunile raaliculare (tumori, arahnoidile, hornii (lisrlrrl{r li
:r,r1,i.,lc prorrrlolrriopa,tice (Yulpian). tr'ormole de ,,poliomielitl donicS', rli,o &fectimi vertebrale compresive, tumori vertebrale primitiYo s2l,tls(xlllrr
r r rlr.lrrrt,lir rrrcrrrlrleleitlforjoat'e (pe glupele tnuscxlare peroniene) sint rfirrt, boala lui Fott .s.a.)teallzetuz['cele mai Yaliate sindroamotolx)gtrrli(1r
l l l r ll l t r r'. (rorvicale, dorsale, lombare, sacrate) mai mult sau mai pulin o\l,irrsr!.
'l .l nirlrol'i il.t: s1ti.tt.u.le progresior (aniotro{ia progresivi, in{a,ntilii, llrrrliticilrils de reflexe (osteotendi:roasor cutanater a,rticull,re'pilolrrol(,lii,
\\r'rrlrrr;1llollrrulrur, arr)io{irofiaspinalti jnvenilii, pseudomiopaticS,Wohl- rrvsntual m[coase) $i apreci€rea tulbu.rAriior de sensibilitate i],so(,iirl,(tl,r\
lrrll, li rrgirllrolg-Welanrier) pot fi recunoscute[i diagnosiricateprin car.:rc- rlclrnatomerele respectivo tranqea,zl localizarea $i extonsia, loziunil(]I'.
| ,'r'rrI lrrl lorr ol ic olc(lo-1atrilial, prin masivitatea sjibilater.alita,t€aatrofiilor 2) RadicxLli,tela(respect'ia ma'rlingo-rdd'i,culi,re1c ) virc1,ieo' ltotitrtt sttlr
It IrIrLr|||IrIr'(|, irrirrl(,il,c;i de al1,csernne de afecijare degenera,ti\.:'ia moton€uro- rlo llto ctiologii pot fi unilalrorlllo (n&i mult sritt ]nfti l)ulin oKliins(r)$rr'rl
rrilol rpirrrli : rr,r'olltrxil, osi.cotondinoasri, modifioXtilc ll.M.G. de tip lteur.o- l)ilr,l,(nil,lo.
11r.rr rrrir,Io1rrrIir., lipst s trrrrntrlot trir'lnridalo[i a,lulbnririlor d€ sensibililaitc, Jl) I'olirtdia.tl.on,(,,1nild( lt\tl t'ollizl irttblortrii;r{,ttltlcgitltr (trtiti tiw tlorrt
grllr.rrrrr 1i l)t'il o\'olll{il l(n,l}1n1,ictrli 'ij (.llNdl, l9?8, t971}). ( ]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
,i) IJrrylu. (ttjr,it,iro.li() l .i (llttt,t'.n|.
J/o'iI srxirrzji,irr corrlorllrl f(.Ilrio . . 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 ( o tt l t,ttr l l tr xi o tl sl r o ttl ,o tl tl i tl ti t,si i , tl tt l ti ;tr t
loyJil rorrtll rll ltrzirrtrtlr,rr0rrlrIrri|rIt rrroIoli ;rr,r,iliIlirriirIjI
llr rrivirlrrl|rt'r'it.lr, l o u i r ! i {i l , l t l r , i,o tr i r r tr tl tsf[|tti i 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

i0 ll, l

l
rllrl lilrt(ir! :rl,il,piriLntirllt,lii, X'lai rlifioii po:r,klli rrIroor.i
r'il, 11ilrrI,r.orrrrrIirrii,.
rlirtrlrosl,ir:rrl
itr silrrrr,!,iilrr
irr r.rrlrrrIr,Ij|iir.|,1rrll')r'iilltr.rlrrt)rinil,
lll r,iuli.cil
trrr,trrIr lrrIoI,
lrtrrrlrrcirtiltrtt llrlrlorr tlilic I)s(ilt(l{)ntio}{,iti(r..l)tbu1,trl bnrsc
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:o-
liilrrr 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"li-
lrrlrrrrr, rr,rlcsc:l, cu paraplegle,4A$cd,,hilg-tp[6r ?ISflexiE[ $L s11at{oJii-rnrs-
ortkllo. 'l'rrlburzirile de sensibiljta.tg pella4aler. in ga.Si tqlb.gr'rilc sfinete-
lr,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 $rrlelo rnusctlale.alo rnembrelor-
rr|rriolr'o (cu integritatea psoasului iliac) 5icu masjve tulburdri sfino_
I'rrt'jtuul.
lt) N[rulrontr isutrter'ior\ql, cozi,i,Lle ca,l.
prrlriir,l sint abolite ixl cqle achilicne qi medio-plantare sint pishate.
rt xindronuL ffirior'(sauat 1 ol razii dr aul (Io - J",). Inlegrilatea
rrrrr;r'hilrira,nt€riori ai coapsei collrastcazi ru imlortaiita -.pariUzie-a
rrr:r.iclor rrrusculare po$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 scnsibi-
lrlrrirr;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.
i rniinii ti ri gruputui intern el antobrat/ului' tulbutriri rlo srrtrsibili
lrr frr[a unui sindrom ele coadd, de cal se rialic5,foarte malte probleme
rlt rl.it rttt.o;sl,ic tl,iologic :
I lczirrrloariuliorr[urii')rttL sintlt'om Ol:urtlc Berna,rrl-IIotnct, iitt tr'lllrrtl
t,) .Ln,cltzttl rlnei, i.nstald,ri rapid,e, aaute sau subaautre,ne gindim in
lrlirrrrrlrlrrrl ln o borlll I?o1;1; joa,sii(lombarir,),la o rneningorrdiculil,i,infoc-
i rl\ ,^-intlronrtlttri.jl,riu ir 1'lt.t:htthi'rl .( Hc.mt,tlclitr {':rtr' l{ /ritrtrr'.rrrl
(iorr,siirr,r'ozii rlo cill, ll, o prr'i,lrtr6irovorl,clllllii pliu tunrot'il 1r'irnilir.ii rarr
rrr,r,nrrrlrrtii,rr,rrolo;ttt0i vtu't,olrt'ttlo lrt rr litttlirut'lttrrrlotrt;ri,ozi'i
lotnltit,tr'. ;rcrrli.
j
t5:l
l i i r t l t 1 i l r r r t t t ii r l i stl l l r 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
tl;tt i1irrtt
r,itrtl irtr boltrr,v rr,rrouzrr,Llrit0vit sri,lltit,tninisoi ,hr,lgiilu brrsottlii,,
illrrliari l,osliaulrIr'o i]i 1xrrinoi[lo,]rooulrl Ii t-lttittllrttliili slittrlIrt'icrtr', itt
tlrolrlenl,ulilt cirr.eau sui'vcnit Ei lorlo ]onololilteliotr ;i l,tLlbttt iili ltt tl0 srrtrli
lrili[a1,cin ;a, trebuie categoric sii inbi],ndorti'lm rlirigrtosticul tlo lotttlttr
scilticri ban:rH,,,siilii xe gindirn la o compresiuno in cozii (10 (,i '
b) In cattr,L rtrvi euolulii suba,oute sau cron.icalan't-progrtsiuo rrogittrlittt
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.
Arnintim pe icuri colt.stela,ti0, sanxiologicd'9'i problem'ele{k dr(llttorlio
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 $i trtll.trrtrlri tlr',
n'nsibilitato in teritoriile ratliculare Cs-Cn.
E*te reahzat de multiple afecliutti I tr'aumatice (rlt colonnli tltvi
ra,Lr.inalte), tumorale, inficlior-r,se,malformrtive {r-r'zi Arseli ,si rrolllr.,
ll)iiti.
" "'1;1'
g i nd.ronutdaltlel,iru.bdpoate fi reatizat lie tle leziuni t'rr,rlicrr
l,r', 1i'u-[r,), lic,le'tr"z.iuni-alet-mnehiuri]orltrim1 re (sllln'lioI',trti.jlrxtrt
.;r i,Ui..r:iur),Iie rlr' leziuiri rte trinchillitor sccundult -(suporiorrirrf(rri(rr
q,iptxt|r'ior), fie '.rleptexului insuqi.Ca ataie, se pot rlistitrgepatnt, I)trrittttlt'
'' "''".i]{rifl,i,o,rutde.mialiiri-tiitiio pterutr+ibraltialst cirruct.rrz{trLl
lrlirrtr-n paralizie c-o4qd9-t[;-exf6d"-taintreg membml superior rb$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
li parli:r,l alsncrliauutui,sc cat act-erizeazrl pliu rlr'lii,il-lloJgliiltlut.fuulrrrrr
"Lilol (Cr-D1), llt, trlltc sc itstxriltzri(itt
lrrlir pt tL:rrniilttrneroli cot'cspurrzir,toa,rc
l:rrlriCo-prrrntlt;ot' tsl,o rr,lxrl.it.
l,.11.s(;rrii uitlrilitr:t O' tr'.plr'liv t''l il',litll('il(lrrlrlll"\llllli;i rtlfruli:rlrtlrrr.
Pliri rlr,licil,tttrttot'1ilt'ltirliutt, lrrtt4rrltilllt/tl'itropx,r'i'xtr,rr
ir.,'r!r':ri,lrlizt.irz:',
t 0il
 r0r'ror
''i,1";;;lil;l,;'l ,;r,,litt'r, rrrui1r'ir,iDitill
ryi..rrI uu,uriri )) L' dr't . i. r it . t nr t r u, lt t , i.. : ar . l: +( t tnt
, lrl(t . . t l, sr ' llr t t lt lt , t ' llr it t t lolit r il, t t t olor ,
ili',,'li,lliiil:,jil rrl tnrrrychilor'lricops, lrrrr[rilrl iull,oriof osicot rtt,olrra,ltiit'I,r'ospccliv (1lr I):lI('zl,
l';rLa,liz,irr
do lrhrx llrlrLiill r.nla.2r.r,r/usri
rlc tliatrtrr:,tlit,!,inni: , 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,
tl 'laniu,ni l,r& ryjeliq?Irr,rrivr.lil colorrngi/cerricrr,t,, inierioartr irso{,itr"rde o hipol,rofic;i hipotonie a rluiiohilor lo.jii ir,ntt',r'iorrrca, lrt'rrl'tlltri.
,
r{ir,l(,Nl lxrljr)rrre, sa,u la nivclufclu,viculei, a/riL,xilei si l-[ zonelor li,dior-
sujpia_ si 1l'rrlburririle do strnsibilitate sint mici (vezi f ig. 22).
irulrllrrr.ilrrllrr; (.tuIi,a
,1 frlcturi tertr viculei,.luxa.l.ii
l,l,l'..],,; lrir
1,,,.1,,:]i ale claviculei, ldxaiii scapu lu.humcl1l
scapulo_humerale. lc. cl,irrgarii
clotrEai.ii h'uctori etiologici mai imporlanJi r pligi pl'hl at'mc albt, srttt tlo lixr I
l,f. Sl qlf plerului ctriar..r.u
snrulsprea
I'iitticinitorl; It ilcl,uli ale hurnerusului I anevrisme ale alteroi Axilttt'e I r:ottrptr'sittlti
r , rrlill',fl.llll,,li
,|,,rrrl)rr'sl|rlrL,l|f
)rl sl |l l l|t il,\rla, c a d e pil.ld,
il\ lt a. ca
,(ureori
l a purthtorii
p tl d A ia p u rl d to ri i de
d e (,i Ii c. jintewenfii
cirje, nl (} rvent,i i chimr,- (1u'oi'csiorrale san in cursul somnului) ; nor.lile (fotrrtc rtlr).
_de chi nri ,
l:r,.r(,,1)r.:rr'r't,''ts-l Icgluurdo mai SUS;traumalismeobstclricaje,cu L.zirrne:r
rImpllt
!f::),'],1'.'.,,'::nlrr,rn .nrllerii (consecutivexnui bazin sirimt, rrnei
l)r'r'?r'hrirlrrrtel{'ctuo-irNc, unei eompresiuniexercitate tle manevrele obiitetri_
, :rrr.,l)r'lr,\ll ptcxului intre claviculd, prima coast5,
Di elongafiei sau smul_
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. ,( Nervul circumflex
l,r':rsr.t1r1
Su.feriu,!e tlc ditsersenaturi : hpondilite (indeosebi morbul Muschiul dellaid
,r.rr. 1) -uertebrale
,tumori Yertebr.ale,
r.(rr r.('r'vrcar) ;
lrrrr.lrrli;i rlisiocllii vertelrr'ah.;/herrrii i.tr_ara,hidiene ;i extrarahidiene; ,qomufl culanate
de tlisc cervicule._ Muschtul ratuhd mtc
coslt)nertpbrolc deJileu.tu i sralarir rr6oastricen.icalii,
...,'.rt .l':'rr!!:i
:.||Inrrr|lr{, Ni.rtcnlce,rcalizalo ^si .alc NervuI musculoaianat
indeosebiprin tribcnrofja nru^chirrlrriscrj
rr.r :r.rrl('llot,crre lxgrslcaz{ ,.defiieul scalenic',(saptiul rliltre cei
doi Muschiui biceps
if l,li, ll' il,,l :',, Ei pnnra coa-slii)rqicare iD acesl mod r.omprimi,ple.rul br.;r_
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,
. i in br cnhial
cru,. Insii p,aralizia plexuliri biafiial, inti]ninr dureri qi un siDaliorn
,lr.
I t i || t{ r. lJIt t}:l ro_ liorn er . Circumflex
: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 Ramuri cu.onle
,.rr iIIiIr'IL||Ir{.}n lct'iloliile nervilol,abdominogenilali,-fernurocut:r,nat,.i
ale antebralului
, { 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
iriroi.rrr., : ,, : ,t (mlllUnevi.ite)
rltc lterr
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
rrrr..r'lrilrrirl|llrrirl,."cr,(,r,crccazd lrintr- n tleficit motor al /rr. .r. \"f\i i c i i c url rU c \ \i
".' rs , u1oc r,l l l :rl ,
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_rrginearle ,,umi,r in epoletr) sau de ,,umir tfiiat clesecur.tr,,
!r ||r.| |.| | ||t ||:I o relilxue a articula-tiei scapulo_umerale. paralizia muqchiu-
Irrr 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, lrli rr cnbitalul :rnterior, lungul supinator qi fasciculele cubitale ale flox rtrtrlt I i
ir llf)rit lrln' (.l,iU,22)- 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'
u,ni tts ti,ntni.ti.. fractuli ;i rlislor::iri ale cu,pului Iiirrrl inlocdilS, prirrtr'-o rniScalc rG n[duZlli.ai fi,]iclri. Sl lealizclzl l
,......,1r.::.",,,,r: ,i,:.,'l,rt.t1iri
1r'urunrr1ir,, (pljn N,rmcnll)o $irn de for_) com])rcsifti lN,
:lll,,,l t'tirgr ; 1r,rzi(it: in a,bduclio d, policohli po ltnlali llan r:u oolela'lto<lttgcir',t
rr\'.r,rl;,1, l'';'rrtr' (l)rr,li,si{nl'1,,, irt cut,snlsornntrlui,silrr ilr curlrul irrr.slr,_ (r,mlna,riitttia4ri"),rtIt olit,t,ttttsolx)11('(fx I illllir
r:rrlr'lt olie rl eririnon
,||lrt ;.1|.||| Iir|| 1,.rrr.,rrr ollrlii
1(lrirlr ((l110xirl rlrr rlt|'lrort),r,rrrl0.t0xict,
(tliir qi prr rnrrs<rrr llrl;rrt'rrrrt rI r,I rt i r,{ rrI rr i ( , 1i11.
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
lr' l l |r. tIr' { .). ittlr.( tio itst,, { - lt .
"r , t l) lr , t , lt Dt |r . 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

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

(n
,,gr.{ii.medianl,l'. J,:r,,,pr:oba,bucleil, (a tui Pitres qi ,I.estut)
:rH;rr.r'l,.tlrr.
* i " .i " " -ti f .fn r , ""Jcar Dia8cslccr r lclet ist it ir , ir r t ablot t l r lit lir 'lt lot lot r t it r it rrl
(.1i1.. c)r lllangeta irrdexului Du poxte si, se u,propie de cea a'policelui, rrli qi rl,-
rlr.rrrrrlio
irrbu{it{'
.:!:i
rrr;lli.l irrcll;trici nu poal,esL string5.1n obiect inlre ]olice si extremitatei,
*l*ii iuoe.eio".o in t6i,iioriulncr.ruluilnudj:r,D,
.i,:l;"it;-;;i", ii .i dc atlolii muscularcin terilotiultlislal (sulrr::rtlrirrtrl:'l
cr.lrrr'l:rllo rfrrgcte. l,a proba. ,,{g!!ilgr_-!_nsnrciqate,' (.fig. ZJ (t,), lTd,exal
rir rrrrrlirrsrrlrlmin intinse ,,in sdg---e-at$1'. Un alt test eonsta in'iinposibili- totali a nervului cubitl,l so(11rt rt('
icuhru de minh ,,in gllfA cu'biLrId" : ltrittt'r
Ialangi a degetelor se in exlensie,iar |eiilrltr' rlotti IrLlattgcitr
iiu"i"l-r""".ie atitudide fiind mai exprimatn h ultimele rlouri, r1.g.lr' ;
jnicro$o'so ,.ritrl
frl U"e"iJ mi" se menfine in --qbd,i;ie, iar slaLiile.
,i""ri,i". inift'ebi primul spal iii inierosos (''a qqu"a' t,+bachc'ii xllirt(r
*i.a,t- l"i S-i.rrd).'b" asnninneacrrrirent& hipofcnari cste i4rlrlizitiir I
.i'io f " il. ot.ti'alc, iorso 1leniveluT!or:1iuilii inforioarcrt :r'tl1r'ltrrrtttltri
"rir" ';.iinii), 'd'.r,torit5,cru!5,rii fleror'lui c.o1u1 prof.ntl ;i .ttlri
;l;;;ii;J;i
,-nt".ioif la o pozi{ie a nriinij cu ullimele d('ui ilogcl( rrl
'rf.lri
t[\;; Ji P;i" piralizia intelosoiilor se compromil tnilciitilc rl'' ubrlrrr'lir'
^liiltn
ite degetclor; e) beficilul Ino-torinrcres"r'zi 1i tlcx irr' rtll i
aore i"g.ie, ddeosebi a degPtuluimic' precunL.)iudduc!irrp'rli"
"i-0" ",Oi*i*
t"fot
lui (bolnavulc6mpenseazd, par[ial aceasti tulburaruptitr miqc:lrt':ttlt' rtlt't
riii". .*ilt.i;.p"iir nemrl medianl; t) ParaliziamuqchiulLri ctthiLrrlrrnl .t i' rr
;;;i';;;,;;.[ un tlcficit rl adduc!iei!i d llexici rniiLriiigr Testul ltti [rr'rtrr.trl
;;i;;ifi;t !;irtiria ailtluctoniiui policelui, in sensul,c5' bolna'vul tttt izlrtt
i;-t";6;i;; cu mina un ziar siu o hirt'ie intre policele intitrs .6i irttl.r
i;l';i;;i;;;; rla face doar prin flectxlea ultimei fala'ng-ea polictrhr i- rti
;rl;-;;;;ll i; policelui, rcalizeia prin ucrvul median) l-h';,Test'ul tlt: ,,r'ii*
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
intre tlegol'tr iri{ir'
,"ie .". .iia"tiirre ina14" o r)istanli rnult, mri micd'
,i" o"tLo *X"Xl.asXI ii "fi"
trlina fiind cu fala lrLnara pe rnas[''.rrriti
a6ez-atd,
ciegeigluim-j iar txrl, t lr'
iutmrrii"t" ri" Oegetului-midiint'ebOIitA f f ;cu mina.plasat'icu Ia1* ltrtl.
u'ul tru poat'e sd zgiric"masa cq d.9gc-tul.l4jq(scrrr'rrl
'piir"rtrrr.rsd,bo"6a
;;;;;;

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

Fig' 23'i
iri
i,
;
i;,.;:;; se
riU,,eo,i
r.r
ii ;';t;
x'i#A#il
d!
Iti"*g*xil],*:'*g*r**gttl'*tm*'"'11"'#
Tulburi,rlle.
asociazdXi
"^."^-;"";
se=qlbj-titaLQ sint
a.'.^"; cu-caiacter
Ii dur'cri
4" ilSY*,f 'l:':'
localiTate
carrzalpic:m)-Tr-rlb-u
i,,'r'qraat,ercauzalgic; m) Tulburirilo vul'u-
rlriltl'-t'ut'tt'
si t rofice se intilncsc atlobeain lelitoriul nerfulul (delonntlll irlr'
lr,l r - Pa.alizjr !

ilu,rll,il'ir
^
ii";l;;,ll;fijlir,.il*:tf,',.:}"!!!iliiri'Jll'''::'ill.i5'Jll"L"'r;#:tl'Ll,i'ji1::l*ill;
tin.\, t.\t..!, ,,,,, ,.,,.,,.,;"','i,ii.;,Jf;-J'.ii"ll
r . r",,ri,i.,,,k
;rr,.rrorii
;;";hiii";; o*c,i"ioi."a pielii, cianozd, pielo lucioasS' qi subliatfi, txlt'tttr.'
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 . ovdntual chiar ulceralii a,Iedegetulqi mic).
I'rincipotii faalori elinlogiri: a) Leziuni IrcunaIl( la.nivclnl coi ttlrrr
lrrllrr llrxici rrltimci falange a rlegetului ariltitor', astfel ineit, atutci cind
r'|rrir ,.rl(! rrrjozirlai. r,,,,r,o""ttirihuninrusrtni 1-di raI,;'plngi ale ncrvului l& nirelul itlrlcl'ril
cu fala pa]marii pe masd,,boLnlr-ulgg pq_?!9_-lg-ZCil!g i,ii,,ti rniiuii (adesea o.1io41'so-;iliziunea :lrLeleicubit'al'';1contlrtr'
rr:rr,rrrjll urrghfu degetului aeitnlotl Unelo mis(.iiri coEi.h, srtrcrur,ji{.,, "i "f " inaIe pc osul pisilolm (par'rliziir ir'li-
iiiiiii ,1" 1t'nutito. nervo:l,sc-tr'rm ',(trotti
.rlr, polir,r.lrri1i rr,lecelorlalte degete sint imposibile sa,uincoinplete
" (indeo_ '.{.sto,]:it'tciia1"
g;'dle d'eJileutuisoalenicrco:tstii'
ljlor"'l: b iU ntii
ri'.1)rItriri(jlIiI(r rlo prehensiune qi t1eprindcre ir,obieclelor). Nir trebuie sri '?bm
Iil,ir||r |ii rle rnulto ori apal dureri cauzalgice,r]rbotite t1s tulbur,:iri vaso_ (,:rlli; lri])( 'Jlrofiarnuschjului snllcn an[eriol, cu ingu"l:rt'ea-,,deJilottltt-i
rrrrrlolii ;i l rrrliicc,limitate ldhlvehil inAe.iiitui,.i aimerl jusului, in special rir.rr,Ir.rrii . i ) 1 ,'; r)aolile rultilale ittTec!ioase pot ap,lclr irr/lrl(s,/lcltil'/li'lrri'
rl I l ).r l| il rrrirl in-t ( lr. net - v UI lt i m er lial} . lii('i'lii (livct'se viroze, tnalurie 9. a.
I neruth,i tatl'ial se carrlcterizcaail'1tt'inlr-rtsct'itrtlo strttttt"
. 'l'u trut i}'i}:. tlp- S-eg51bili.tpl-c sc consl,ati dolr l)c ur.l i,-,ritoriu par{ial :,:,),1?araLizia
tlt' ('rl,l'os{! lr'l'
rrl z,rrrr'irlr.itrllvrrlic lr,Iu'rrrrlrri mrtlir.r (.[i,t.:'.j ,^i. lrrrlrrgirirrrr,,ni.r,, i' lirrC1io rltr srrTi*l lt:tiutti,i, itt l\1111,{itr

l
I'rin.ciptlii.lurhti ttidouit,i t a,\ lczilunilrautta.ltceh rrivolrrl br,:r[,ului rlis{irrgo1;t,1tuva't'irtiil,i :
, tnyttt
(Dlrtiirl)r'it)rttrtr,irllrrrslrrrrlrrlirr.,I,,t[l,l!rHilllri,L,ziurriprirr solu{,iiirr,jr,,rIIIrL| l\,))ln ptrrn,l.izi.rr hldii u ttt"trttltrixt in[ (purali:irr',,,ltnhirtlir"
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 ,ur.tir," itru ,r,tiilurd,r'tnhtil.t drrxit'i Ilirt'r, l9l:') ru)';\trirlr'rt{'ttl rrltirt"
"
Ih0 1t,?
 (logcltrlor'"(a,lluilr'Iottlolll)
i n)'I(rst,lll,,r'ilslil'iXl'ii
rolol'(fxl'(,rIr.l1)lil()l'(logoi('lr)l
ll cfcctuarrrl tniqoil,riidc cxl,ensicqi indeplrtarc (r'iisl'iraro)a-tltrgtrkrlrr,
rlc nrrter Dirralizati' nu sr: observi tcndoanelo olil,tlnsorilor' (Ji11 25 b);
cutanat a! ,,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
cubitql 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'
nijmelor falange ale dcgetelor, pe dc altb parlc IIe-\iunoir" (l(g''it'l(,r' {"
Gheora ilce ttificil si cu for(i rcrlusd,nu ilatoriti paraliziei llcxorilot, r'i rlrtlolit:,
cubitald irpl'ului ci, ace$tia nu-qi pot exereita funclia de flexie decit dacii rnirtit sr,'
:r,fii in cxtensie. In schiir.rb,flcxorii vor funcliona foarte bine tlaczi so t itlit'r'r
FlexoruLprofund rnina de ciltre examinator, sau daci, se plaseazi mina in ii,titutlittcir '.rlc
'ol degetelor lusirciune" (Pitres) ; r) fulburd,rdej.e.-.sen-s,ib,-.ilitate se rer:narc5,po 1r'r'il'l
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
tlr lezi.initJaumgticeti.n. ttild (piin luxalii ale umirului. ftactttl i ittir'llr':rl'
brrrrierrrsuiuj ef.'.), sau olte prcrcsParilo'e (tutnotil.

Abductcr po{icelui Abductor

Opozant

|^,,,*,*
Interasosidorsali ',': lt )
Interosast palmari
Lambticali iIl, IV

/ i./. 3./, NrNul cubitnl: ramuri nervoqse, distdbulia Dusculali

fi crtanoti. Crila
cubitald.

ferloriul
cutand

-Fig. 2r. Nelvul Edial :

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

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
.sirezrrllii,din leziuneanervului in partea mijlocie a.brail,ului,lit' ttivr'ltrl
:r,lir,
{,nlui rlc torsiunc a} liuq,ro usului, Apare in cazuli de {rntlturi aJohtttrtcltr
,"'rrn
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
totrxr) dtxcuisi,rlc l)il,tts satt ,,pa,I'alizi:t, rlo rlutnilitfi")' Itt ttt:trrtsiil'fot'ttti
t,sl,9 plsibilfi rt
uxIr1lliit,ir I'gIrt'rr,{'ttItt i, itrI'tttcil' cnlg ottttBtrl'vil,1'
1t'itttrlrsttl St'
rrrtrsllll iorric ilrrrrtrr.|t' t|||,rIt ir,||i| | |' itttllt'irtt'(llt llt,rrrlizirtirrlrr'lI),irrr'lLrril

ill I li! |
Itltsrrrrolzii Irrrrgrrlrrisrrpirurlor'.ll'irtell (citrr,ttkr liisor, 1952)r lirrruicir,olico lclt;i,.1rrr1r1r{,iorlrl rlc trr,vr,ilcioricc lrrrrtitrliro{iorrso) so t,rrcrtrrolt,qillr
r') l) inlirrLriLlrirfor'{,cirlo tbttrrr:liu .r,cr.riLltsei lrlirr:
prrlrrliziclirrlillii, ealr: rcspcotl lungul supina,tor'(in al'r.r,ra unoi leziunijolrso, cvirlerr(,ilr,Lii,
rulr,itr,lt,sirr l;iirrIrrl
,rrlr lri[rrrrrll'1,i , rrcrvului) se dato]€qte unei pnlalizii radiculo-rnodulxre, p'irr i rr,.I i rrIrr',,,r lxzin rrlrririr: p;rr.lr.:r,
,.ltl.iltrii 1i :rl trr,.r'.,rrJrri r{}'r:i., :rtl.,.i
rrur,i lxrlirrcvrite satutnirrc sau unei isterii. , ttul bulrruvrrl.1.spfiji'i pe mcmlr.rrlinf.tir.,rtllcctrrl; I'l.rlizlu
[rilrrt.rrr.;rl.r
i.,) I'oral.izia radiaki antebrctltialdtnaltd, este roalizal,X,ale trautnrtrisme, ro llil(luce priu meriiul legi,nat
,,de ra!:i':.
rl,. lr( lrlli infccfioqi qi toxici (indeosebide satrmism). Respectd,lungul ttt l'orali;'itt t.ei,,ul'rij,sity inleriu'(prio. fueloL.ieti,rlugili irlr.ltir,i ,.rr
rrlririrlor' qi permite r.idicalea pumnului, intmcit lezirmea atinge nervul ,r'r. r.Xl) lt tir pi,ttitltZl:tpl,,r.(,!Lcnli) S(,rocUnOtstu prin LU,nLiit0ll.t,(.lc Ji.||ll r
rtrlr rrrrr:ichiiepicondilieni. ;r.rir.rirte,rlc_paralizj nrufchiului Jesier rnare: i,) Iicttrrc{,i1, j.krxolilol
,
i',t) ).'arulizia radialti antebraltiald, joasii este intllniti, indeosebi in '.)rpsAi:b) Dimil-uurr'l furlei de a\-tr'nsica corpseipc Lttzinjq ILirIir,;rr.,.:r
rr.rrrrriismc (de pild:fi,in fracturile radiusului) qi in nevrite. Intereseazi, ,lrtr.pozilir'lczindi, ostedilicilf,; d) ln ortosbarisiruoiorn:rprczirrlir,, lri1rr.r.
rll:rt lrrrnrrrilc radiale ale policelui (scurtul qi lungul extensor, lurrgul abduc- LIr,lrrzi,.lo-rnhrrrri (?entm,r, componsa,$i a egaliza contrailil l,rri,u,goriislir,
I()r') si (lxirensot'ulptopriu al indexului, cu tulburS,rile motorii Si atrofiile I,r1;\ourorcoaps-el); c) ijcolioz.i cu concavitatea spre pat.to|, siirriil,o;r,rii
,1,
l) Lu{.r'sul-$i ;
r',,trsrrtrrtivc. Tulburiirile rle sensibilitate sint limitate la o mic5, zon[ Ia mti s,lesrucatr . scirilor se face cu dificlultaie; g) Itr rkrcrrbil,
r'ivolrrl bir,zeidorsale a policelui ,sia primului spaliu interosos. i crrl;r'al, dacl se lixeazL baziul bolnavutui, acesta nu-rsi r.irlirrrr,
q|rnb:l de pe planrt1patului; h) la contraclia fesei,so remircii ]oatc
li) I?aralizi.tt,nerLr ui obtu,ra.torse recunoaqte prin constatarea unui o itsirn(!1,ri0
rlclicit; rnotor 1)l adducliei coapsei a] rotariei exteme a 1lO COtlUl.aCUe,
cu atro-
lr,r loirlsrri fi plinbr-o an€steziepe -i -acest€i,a, s.ctatice in funclie d.etopograJin
fa{a internS a coapsei.In timpul mersu- . ,]0!PgratjZltlg
rrLllt+j
_prezintii,, ltziurrii, rrrri
lrti lrolrrrvrrl prezintii o deplasare in a,fard,a gambei qi a piciorului. Este I'artant(' semioloEice :
1rtrrrIusriprirr traurla,tisme qi la fcmei, in tra."-ali,w prelnngit, prit:' compresi- r.ia railiculard, to.:l!'trqnoatqlrd'Lnutrli, testa realizrltii plirr
Lttrorr,oxclcitatii, tle capul fetal in timpul traversiirii bazinului. , rrrnce
r, ..,,_!0tl _P"qr-ol.i
rudacinjlor,gr,u a neryuirii s,.iaLici]! bazin, la ie5irol din lrizirr
i'jo irnpune si recunoaqtem sindl'omrLl ltti HowshiTt-Rombarg,, realizat .,l|r.rn.r.rerrnctlg4rlrq superioaTi a.go]apgqlSe recrtnoagteprirt .
rrr rI r:i I rrr.rr I
1r'itr cornpresiunea ner/ului prin hernie obturatorie. ln acesta, pe prim ' 'ttt( t!t::lu9togtr.. carc .rezulbS rlin asociorea palatiziei sci*ticrrltri prr|ti
lrlrrn sc l,flir, o durele care imdiazi, pe marginea intem5, a coapsei, atingincl rr,r r.Klefir, r_t,scrr,tlculuipoplilieu intern;i a ramurilor
musculare al0-l;r,irrr
r'r rrirnuru de iltensitate la nivelul senunchiului. , rllttur ncr\-'lut mar.e sciatic la nirelul m.sculaturii posterioar.c
i) Puraliziu nerralu,i crural (cu cele patr'u llnuri telminale ale se,le: it ooitrl)rior:
tu$1o1 myryh1t91_ garrrb--ei ai +iciorutrii, realizincl un ;ii,ri,,,.
"qr..
,,r'i vrrl musculocutarat exterr, nerl'ul musculocrta,n,.t intern, nerl'nl ',']:llt]iri"
f,_ corrplct rmobil; b ) rUersd,eEte,.Etepatn
, \ r(llioepsului qi ne vul safen intern) se manilesti prin; a) Imposibili- :,..,,,-,]],,1. ridicareapc vi|l. tlrir.irr
,,:.lrli'1.'bla!.1-yoe?.p: vjduri tipc ciiciic este imposib[JI r.)tr,rtir:rvl
Irlcir fbxioi coapsci pe bazil; b) Deficitul ertensiei gambei pe coapsi I .,.,.',']l
,)u l)r):rr' rgr: ft) r'rrrrizian.rrotici a
_ .muqculalurii posterioaro lL uD,llr0j
, r 'i'rrlbuliili rie staliune qi de mers prin irnposibilitatea, ertensiei $erun-
r lrirtlrri- Aceste tulburi,r'i de staliune qi de mers silt mai mari irt para,lizin,
' ' ,rrr1
rrrr. l.', i*rposibilitateafrexiei gambei (testsemiologiic aetararizi .,rl,,i'iiri) ;
,.r r\ lrofiile muscdare interesor;z;
Irr,rrcrrIIrlii, inalti,. situa{ie in care bolnavul est€ oltigat si-$i ,,trag[" ]x?tn- ]r_q-Eq4gt
i ,.i Inrisclrlalur',gjmbei : tt firlB'ufir-ife_"lSlrscriatuxfi"-_postoriol,rd, ri
' ',r,t'r.x de scnBibilirat,.s(, r.\t.rl
lrrrrl irrfeliol in1,r'edoui, cirji. In schimb, in palalizir, troncularir .jo:*1, tl, rrrl-elnlrntreguluipicior_(cugxceptiapirlii interrrcrt,
lrolrrrvrrlp(,rile merge, dar cu contlilia s[-Di mellini, genunchiul ,,hlor,,it" l.l,',,,11'll
| .,, nri,le.'ler fir,lertle),,precum si pe fala laterald, a gamboi |lrrrlr'i
Ir ('\t|rrsilr. l)acli se prorluceflexia, gamba se derobeazS,;d) Urcntul sci,r'i- I t) J)c ci,lrr rrrr,r
sciaIicesi,,'tpnnrolc si-sosilrri-.rzjr
1,,r crt,r:irrrlxrsibilsiu {oarte dificil; e) Bolrrayul nu poa-tes{, se rneniin.S, l,llll,: :ll'l-"lE111" .simpJome
l , r : r r l l l | l . ] t r t,l ZtU I]l l e IJd ,cu l a f( .
t,,. I,r.irlrl
C i t, si i n ce l ,. tt"o n t1 u h r o .
Sr : l r |'l :r .u r ci : g)
rrr ,,pozi(irr1x'r'ino':; f) Reflexul rotulian este abolit; g) In lrtostaliune se r lrllrtri,ri vasornotoriiFi _(crlemeg,rnhieroqi atc piiorulii, tript,r,
llrrllvii o lxrz:i(iecle ,jgenurecurvatum"; h) Atrofia telei antt'rionrea coap- l, ('r,rLlozir,. "rnbritticXii
plnntare, -Uaf]gs
ale pl:lii';i pi,r,,
rli ; i) 1l\rrrllrnul rotuli:rn este flaso, depresibil; j) Tulburi,ri de sensibilitate l i r r r l s . d , .) . ^f" "iigLiifuii".rlce'.,1ii
1,r.lrr(t rrrrltto-intelri :r coapsei si pc fala internd, a genlbei. iu; fuiltt:ittc ] sint rnuit mai fi,eaveirtc,lrt(,11ri{rrl
, r'\ rr ,rcrr-L1jrc ,,|oni ttttit.C_7og.re
t'ru in trcimer
Ir'ul tt'i,tt'itlogici: a) Atecliuni vertebra,le Di ale cozii rle cirl (traumatice, mijlocie a coapsei fie sub ni]Iehtl tle crrrorgt,lltii
Irurrolrrlo1.t.); b) Turnori pelviene; c) Compr€siuni de alte naturi (prin 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,
rl(.r'lrl g|il,vi{l, in cursul unor inter"venlii chhurgicale, cind coapsele sint i,r,rplriilizil o$tc(liH(l
rrr rrlxlrrclir rnirximi, sau irr cazul purti,rli unor banclajeherniare compre- r"rr')' rir sr riirL rili irL u'.tt:xfrrl cli'ic predomini fie semnelepa.r1lil,i*r
rrr,
,,rvr,); rl) Abccsc ale muqchiului psoas iiiac; e) Intervenlii clirurgicale pe iie ccle de sciaiiopopliteuint(.rn.rlrrroiitril:rptrrtrrr
. ]'.,,;.1:llllliJlll,
l*,l,cru.
ruilrrl lrilzirrl f) Irractud aJebazilului qi ale porliunii superioale a femuru- ' ,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]
lrii ; g) .s!tnevro de rerlucere a luxaliei coxofemalale I h) Anevlisme a1o 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 .
rrrlrloi lemulille I i) 'I'tr,untatisme directe ale nervului (de obicel cu cointe- lt).,\ l)t,r.u,licitt aointiaiWTwfiitc.Ii-iitam)
1s,i ,, ,..t,t.,,1,i tiltirtl, ttost,,ior
rr.sirlcil,corrcouritontl qi a ri,r'tereilcmurale) ; j) nevrito ,si neuopatii (dia- 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
Irr.licii, yrrtilinrtric[, toxicl). 1i lr ddit ct . t , ll'r
| ' r(:| | r| I| | III,( , \ r r l{. |ll, i lI ||lI ir . || 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,
it) I'rr,r'llizirr,rrtrlvrrlrrilir:siolsrrllorior(rc:rlizati (lc frr],ctnrriirlo l)Mirnllui, . . , , r i|, i, . , , 1, , , , , f , r i, , if , Li ir t r r lr r r i, l
rlc irrrrrolirllrligrroit,lrr rlrrlrirurrtiitislrcl)rin NI'nIr!
llrlzirrrrlrri, tkr iix, sit,ttlr,urto rrr| |.rr' | | || r || ,,r |r lt ir . |lirI i" : r r llUt , 1, 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
rrllrt.,tlrrcorrrgrtt.r'rittrri rrrrrrrilirll'rltr i.irllul{olll in crruttl Ilrlir,tii, sltttrlrt llrr'- .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
l0tl
l{r I
I
poil,i,(! starp.cvh'firl ?ioiorrlti, (,irtor)ll ?o?t.t(r 1i plrlsat nici hr addlc,licr-nici"
iltu ni, qi nu poatc sd-fii fle,ctezedegetele: e) },iolta plantard esl;tr
rrr lol,rr,{,irr
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) { l1q117xlgi- gi 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 con-
tractfl tle parted paralizatd';- k) Testui ,,picio-
rului balant') : bolnavtl, plasat in decubit ven-
tral, este solicitat s5, llecteze energic gamba pe
coapsi- Ie partea bolnavS, piciorul rimine ba-
lant: l1)l TulburSrile de sensibilitate obiectivS,
sin1, rjecelate pe ta1, plaiitard, * piciomlui
({iq. 26); m} Sopot eviden!idii [ulbur;ri vaso-
' reprezinti, constelalii clinice in care serniologir.sr,
ni ricrii qi trofici (edem aI piciorului, ,rlter.alii
ale pielii !i ale unghiilor. ulcere l,rofice nalca-
,i;i='--\',',)\ neenenmaleolato qi/sau digito-pl&ntarc).
'r}a]} Patdlizia neraul'wi c.ialiapoplilea entern'
--'-\:iv
ttervut. este reaizatd in. specialprin leziune ln nivelui
dknhr
' tatirat
.qgDdui leralgd]Li qi interescazi celqgsg m.rl.!-ch]
/,J. ;,;. ti.ritoriulcuL.Luat cI anterioriai gamboi. tabloul seliriolugicconsfind
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 diticulta-
l,,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 $te"rsede partea paralizatS,(prob:'
sral,iuoii uxipede a lui }'roment) : c) Ia proba-. n,-
pingelii inapbi. qecunslald,at'elali fenurnende Iipsri
ile ividentiere a acestor tendoane I f )Mers stepat ;
q1 f mposibifit'ateade sta(iulc .pecdlcii ; b) Er len'i:t
plir'rei fahngel it I)iscrete tulburi ri senzilive,p''
oartea lat'elald,a gambei 5i pe dosul piciorultri
j.Sig.ZZ.),seclelorii, r asomolorii gi trofice; jr 'llr'-
lieiele ichiliene Ei mediopllnlaresint coneetval''.
-Factoriieliolalici rn leziunile norurlul sr'iulir
pot acliona, ia nivel radicuhr (In-Su) sau Ia livtl
troncular' : a) tr'actorii vertobmli sint cei mai trer:'
venli (hernii diseale; morb Pott; tumori -primi-
tive. sau metastatice ; traumal,isrne ; in ultimclr
situalii, paralizia sciaticS, poate a#5rea in cadrul
unui sinalrom de coadd,tle cal) ; b)' Traurnatismolo
D&zrutrrur: ruxir,lrr
Iuxalii uur(r'
coxo'
,, Si rtiverss afecliuni ale
drversoaleclrunr a,Ie bazinului:
DislfibUtiesm:,,,vj
-'-"'-'i
Sl
:tcnnrrale; o$teo-artriti, s&cro-iliDoli frrottlri a,l(l
lritzinttlnii {:(,rtrl)t'r'Nirrrri
1,4f .l'lllll'.".1lrrrzinrrhi; lrrnrori rllo
.11:.,11;'llllilf
ll rrr'r'\rrrrrrr
r\r'rrru(
Di'l)rrrlrr
,,..,,rcilnlrJrlrt 0rt,l l .l'()i;lr,1 I tlivl)r'sr.
sllrt rlo llir'<,r,ps
16'J
'f,r:{irrrri,rrr,lirl.lrrlilirr,.
rr. iull;,rrr:rl.r|iirlitr rrrir.rrllr:rzirr; c) l,t,:t.utnkl,iHtn(.
rlrlr{rl('|:rl' r'tvrlri s.iirrii.(.,.L [r.s.i, r.rrrr
l;r rrivr.htlrrr:.r'ii.r'rrlrilrrr.i
1.l frr{:t 1rosl,'rio:rtr'r,'r'irrri. (lezirrlri prirr rlnrre ir,lllcsrnt jrritr lr,l,lrrrr
..ir rlr,
-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.
sciit.icpoptittu i ntern_poatefi lezat prin traumatisntc f,n x:eittrtur,
_. _,..}:r,;,11l.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,
rrrrr lrlc ,scra,lic
lruDcltiului scilriic rlt u aJoplerului srcmr.
..,.,!),-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:
l:1' lrostbtttt,{j.li
,t.t:t,t
etiopolsgpn;.,: J) llult;npwitp rirolice (prin vii.rrsrrriL.
l.::.,.,',,,,
rr\s1ckre,tlerpes zoster, rareori prin arborrirusurir, Z) Mlt(tint,
.
tt
'it 'tt.?l:ct, (pusivaccinrlc. po"l seroterapice; rlorgii medicrrr|l,.r,1,,,, .,
ctl ..,:i.r..")l I otogp 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 p oli nearopatL r.la (metabolice, torrce, onr.olll,irtr,
.si
...,.i Ii,t l{.' ,za doltctlo tuuscrrh|edc ertclsie letrrplegicl sau rtrIiIr,
lrlt'gie,r'i,, totdelula cu localizale p-rerlornlnant .ct"om'effi, insolitc rto 1rIr|Ir. 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
scim Jn h,zirrrrr, pilrrri
,lrlr, {btr r-,coldi}ie esentiali in stabilirea diagnosticului.
I r'1' .,pl'rlr.rpo Maselr irLrrs,,l
lulLleatrnastnt duLr.rulsell prosiunc, iar elongul.i:lrrr.r.vilrrr.
t,,'lilll]gi c.l,' adc-scl, . i I Lsuporta h ili . t',,lifpyy;6.1.'.1 polinriu.opttiilr,rrrr
','rrr1iorLa., dc r.-grrld.nici mudiliciri :rlc L.C.H,.,njli t,uibru,ilisfirrr.lclir.rr,..
|,r'',i','el. I;r delrrrl pa|rliziilo jnc(?
:;t sr" \l rrdt. ii predominl la cllrenriLiil.i,rlrrr.1r',r.
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
,.rt, r r r r r . ii
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
I
zr (lll,o I)trrliolsolxrrrirlllslrr,lrilirrrrrrlirrgrrosticuluide 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 etiopato-
r1r'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,o-
l)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 lelt-
lrrrrglrisivti. 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
1rrrrl rrnd:i [i ataxie.
* 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 profcsio-
rrrrli, 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 gastmintesti-
rrillu grave, precum qi ali;e simptome neurologice (convulsii, sinthom hole-
lilirlrrr 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 deose-
lril, rlr glrvrii, predomininrl in tabloal clinlc tulbudrile psihice (confuzie
rrrirri,r,lit rgii;atd, sau torpoare), tulburiri cardiace) hepatice qi renale,
plrrcrrrr 6i tulburd,ri tligestive (clureri, virs5,turi, constipalie) ,1i hemato-
lrrgirr (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 musctt-
lrrrrr lilpido.
' .\'oLineuropatiamercuiiald, acutii-sttbacutd'este tle obicei acciclcntalai.
rrrr,rrvolrrrlbar-suicidard,,la cei care lucreazS, in pr€zenta toxicului: disti-
lirlcrr, 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.
J)r'orloninr[rt rrotori€, Dutin(l (lobullt t)l'in lritltlotr
lblirlrrrrrlu,t;ill, os1,o
rurrriolrgi<l irr (nrrlirrl, rttttncttlo-trl
tlo trntll,ittottroltlf tl,itttit'1
, lt'iltlil lroplil'trtt
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),
. . Alty.1nl,,inr;u,ro1xr,liilotr:it'o aat,l,r:-su,lta.at,l,c
(11'itt iuriliri, lrli,lol,
lrr.trz'rl,srrlIr';i rlc rarJr'n, trioltoclozilfostat, tclanclorel;nn) s,, 'r.,,<,Irr,, ,1,,,
t.r rlc
','/rf('n1,ul aparif_ir,(la rmrlcitori oale lucreaz:'1, ou loxi(,.1. rrrsp.r,l,ivr,)
ri plin asoeierea de paralizii do nervj cranieni (oculrrnolor,ii oplir.i,
.fi
rrtolrleo-vestibulari), tulbur.iri psihicc gi sau semne henurl,ologiiur.
/
, .- P.olineuropat.i_a tulicd.fste rard. P.ealizeazho for.nii rlixl,ri (r,rr 1rr,r,
,l''rrLirrllni,.r
tulburririlol senzitive)qiseasociazricusimDtonrcr,rr':rol,rrr,isl,ir
:rlopccie,
.altera{h uxghiiior (cu striile lui Mees),convulsii, Bi}rrl)l,ornc o\ l,t,rI
;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.oaseintri 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
,..
,,ttllrr',1r'bon1{fi,.hllic5, rntdiclrnentoasit)s{r lccLrrroso irt lorrlor'l,rrlpr.o
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) .
. .r' ) P -ol ,i,cw"opal,
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
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 , ,

l0{ 100
 sini; urttLt'rr-tiri[t"cvctrl'o doci[ so ol'tx[('lt'
i\ I'ot.trt,eurttltuliilttr:ttrtn,!iu,[,tt I rrir,IrrIrrIrr,, irrli)lllr{ii |r,rIrrtrrrilr,,,
ttlrrz,r,tr.r'I lIrrrrIr';ri/srrrrr,r'r'r'IrlIiIr,, lxrrr,lir
Iiirrrl ioulizittt tle tliverse ntcc{,iutLittigcslive, rirrlhbsurbliYo, dc.anacidi- Ilulgkltt ;,rt.), l'olilrrrrrrrrl)itliiltl)iLliut{,('l)llLzictr so t({l los(1r'r'lrrtiv l$or',
i,,1,f,.j,,-rr.i"" ;i de alli -factoii (l-nulusival(oolismul .si.rrlteluLice) ':tlc lttitt lthlrrrl lrr trrirl; (rlrrl crr trotti,lrtrlor n irlrrrl,i't,scrtzitir,i),irrll rlr lorr
titttnjrt'ttil carenlc de sil,amine tlh grupul B qi d'' aniil^fr'lit ($oIlclea, lr,rl rlo ,,irrrplt'gnalo" ttcttcrtrli treoplazicl, cu cvolu!,io prtrgrr.sivir.
l l|li/ i l\lrrroi 1i Siarnarciu,1968: Popoviciu ;i col:tl-r'.198[,' lt) I',litturuyuliilr tlcgru.cruti,rc. Aoi so inculrt'azir ir5rr,-zisir ,,1r,/ilr,
r't l',,linturonatiile dismetabolice. fn Iata unor tl1bloultctrorceoe porr- tt it,i" hip, r(n,.1;,.,itamitiali ,.r c,./piliti?; (buofu ly; D(jlrin, sutt,tx\ .t
rr,',rr',,ilL'tii croni&, neolucidate prin ilvesi,ig:r'liile curontc, trebuie si' ne rrlulttr(ti (t;ptil, lt;dpsi tourjttrr). SiLr b4li dcgr.rr|r':rtiv|ril l' rl
t',',ri'i, li fu acesd gnrp de polfoeuropatii clismetabolicu ;i si' praciicim 1rIrrgtcsi-i'r'i
',\',trrlir.
, in care atrofiile musculare cLrdebut distal itiiing ilr rrlo(l In)A11,.
i rr!r'.lilrrlii si in acest sens.mai a,les la lnillvrzlt Llnerl: sir', in tlectls de ciliva ani, toate cele patlu rncrnbre (rlul x,slxrclii r.orr;r
- Ilolineurupatia porflricd sc poate rccunoa$te prin sirnptomatologia stk', bra,lcle,ct'nl,urile qi fa!a). Se inso(escde mari tulbulriri rlr scrrsilrilr
|r|r, rrolvo:r.sli (cLr-tlblo-uri" tle multinevrite,, uneoti l1lononerrito radiale' lrt,lc do tip ectlomelic, cu caracl,ererlisociate (cu nlaforilii hiporrslr.zir',
,.v,rlrrii,rl.nt'e puhncuropatii),vis{'crald, (sir}dr.,mulabtlominall,culatrafi' ltini )r anestezieprofuntl[) si eu mar'e atarie. Cel rnai iiilescrilrr,rli'lrrrl,rrl
1,rr,.,,,:i ,,pi,ir,,i i:ipersen.ibilitare la tumina, cu pcle pigmentarecafcuii lr'rlii, b,rlnrrvii acuz; si clureri fulgurante. Un simptonr pirlrierr0l 0rrir,
,lr' liIrl l'tnii,lcto'','rc{pcctiv cu lcziuni cuLan'1tc "vaccinifonoe"). gl rle ({'.rt'.l)crlnitu rli:lgnosticulfftti r}e ,,tabesularniotroJic',)il corrs1,i1,uir, lrrgr,,r
t,rl,,,r'',ltrr (sinitromul uiinar'; preze$a, respectiv cleqterea uroporfirineiol liitile foarte ugor palpabile, strlr folni, de ,,mitrinii, r]]r, 1r'ul0hilllill
qi r(.r'\-orse,crlc) itr intregime pot fi hipcrtrofiate. Sint prtztnlr'lrrlr.sr,rr 1i
' rr coproporfirinelor). l.rs.ir'uhlii musculare, c-ares6 qtie cd,"sint,cu tolul excepiionrrlr.ir rr.lr,,i
-^ l'rlttirunlropatii,led,isgtobulittemicesint' ra,re' Amintim polileuropa-
tiil, r'irrl so lof iotilni in rericulozeleparaproteincmice (mecroglobuli.nr'- 1rat,iile pe.riferice-
,'r"' tV,,t,i"',*inOt;i l-,oalrlui Kahlcr).in une)elumor!-sarLin tlisclioglobu- D) Poliracliculortr:rri,tele realizeazi sindroa;me senzitir,o-rrro1rir,ii lrilrr
Iirro,ri ,'(lltichorrri cohb., 1959; Faqon ;i Sctrwrrtz.1963; $oflct'ea,1967; lrtale . Di.sirnetriee, cu diBtributie atit pluriradiculall,, cit si (rl,rr)tl('licir,
t',,i,.'viciiiii.,,Lrb., 1968). Cootexiul clin!c dc srltelintti lcrvoas5 (poli- rlo obicei foarte extinse, putintl gelera tablouri paraplegice sur rrriri rll
,,..,i,,,p,il,i,. 1ent-progrcsivi,l, osoasi, (aspectelc de leziuni multiplo oso-as.e ut abi1 .tetraplegice, cu axeflexie osteo-tendinoasi,,cu nrlrt:lti Iripolorrirr
-hematologice, trrtsctrlari,qi cu atrofii precoce gi lapide. Sindromll ile profouelrrrrr sr,rr
,,i,,,'i"l,ii in iasole late), cr alterarea sti'rii
"""t".Liale'si
p"*ruot^ hipergamrnaglob ineruicf
Lll (cu.spectr'u1 caracteris- z,iliv (cu tulbur[ri globale de sensibilita;be) ptezintii aLeasclnclr{,1ilt,tt ,r
1r,""'irrl,r'll tti
ili,;i ;,i;;,r'i;rrt"J; aft"osti""i ae 'eticulozaparaproteinemicii' 1n schiml, rlistt'ibulie poliractricula,ri, clt qi ectr,omclicl. Cel m:ri iulesea sc li:(lclr,lzil
,,tl,it'r1;a,cepricioasd',6t instalr,rea sau agra,valentrbloului clinic (cu -mrlti-
;i trlvii cranjeni (perechiie III, Itrr, VI, Y motor, VII, fX, X, -\t ;i I I I ).
rr,r'r'it,'tnigrlutc .1ipolineuroprlie tle oijicei arimeLricd)in pcrioltlcle leci ill,rrlilir.r'i,rile
lichitliene, cel rr..u i ailesea cu disociatie albumin*r.ilol rgir.ii,
i,t,, la"ritiiica""a ciioglobulinelor ne o.ienteazi' spre tliscrio- r ir r'i palafeze diagnosticul tle poliratliculoncvr,itir t.irrillain-Ila ll'r.
','.riii"si '
*""'Titli},ii;rr,
trntiite din, colallenoze sint ulor de incadrat nozologic
,t,,,,,i ,,,srx,.tivlr, iulecenoz,i, (periii"terita norloai5,, lnpusul edtemir'tost der-
rrnlurrr.rrirrrniozila, l."oLiueuroh io"ita, sclerodermiarboaltr BehqeLt'a ) se
ti*i,iu cu simft6matologia tipici. Eristir insii'. crzuri-care pot .delut&
,.i r.r.'lllir r^rrltiir vreine cu simptoine neryoase pc.ite.ice.. Sint totrqi citeYr'
"',,',i
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
rrni' rrrrrlte ori qi cerebrilL; Sderin iu, lrLlscubri, (d€ tip Eiozitic) pe
trlrrrr trlrrtLiin tlermr,mpoli euloiniozile); odiIi'"i ri rk' V'S Fl',. ale
-Nl
i;.';i,,1,'1: A3l'o *i waaleriRo"e, p'ecum qi rlc testelor de dispruteir'emieti
,,ii', ii"i,r"Gt".torezei ; - Prez6n{,a rnod.ilici.rilor cutanate (in dermato-
rrri,rzil;o,in sclerodermie qi in lupusul en'itematos).
l,lxtltni itrile E.M.G. qi moditic5rile histopatologice mirscnlare, vas-
r'Ilr11',iLlcfibrelot uetvuase Si ale ].esutului(lt I nrn-cpidr'r'rni'(in )riupriit'
,;;i.i, ,t"uin. obligntoril in uc''rtc silr:i'1ii)-pol {i- rrril('
' ',i;;;iil,;',;,t
|r.rrrtt'rrrlia,grLostio (Dulnn, qi colab., 1960 ar b I Dtma tst (otaD tvttd ;
""."
'
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
,,,r,|,Trr,1,,.t,. nt'ttto1tgi.t' l'r(xlrlsr! l)l itl r:tttttltlt'sittltr'
,r,, ,iit,t .ittiri.r,,lr,trLr''
rlirtr0l,irt,xi,r.tjilrr,l,ii ttrrtrrti ltritrlilivtr, rttr'l'it-
r lrr r,iillt Irot'0sttl ttci,ltl:tzlr'(1

l0(i
 iUU;ilg;ilt*11l
*l*iiii,--:[-l,li'*
i;lr)litiri
I PROBLEME DE DIACNOSTTC
*+*#*t*ms[t*f r{]niilil
i
*fi#jt!!i?:,T""{$*,il:'lf"{'t*:"tkl'k
+. Itr TULSURARILETONUSULUI
MUSCULAR
j'ml*:*+
i*{i-T*l,l-'*:*"*}T*l$i.*"-t
4.1. HIPOTONIILO
MUSCULARI'
B'lrH":it'il:l:$
;tE?C";g:yj*ti1d;Jd#1,fi
("rarvate"- Devic$i col'rl)'rrxi?;
t',",!llr{ff'::"t:t'tilt:?{f ;'!'!t"-'ie
4.1.1. Hipotoniile t/anzitorii, paroxisticcse caracterizeazf,,
ptin bruschcfca cle aparilie qi prin tlurafa scur.t5,(citeva secunde sau
ii":Hi-""3il*
iil,:i,fi.:*:b::
lli3;*r"'ffi *:.ql#fr
il iiill,
| | llI l[ e) :
:ii*xli**l##ir,r,,",n'lii]*iiiii.!3?i3d':i"il#i3
L) Atacli cala,pLectiaconsti intr-o pierdele brusc5, drarnatici,, a t','"inrui,s
lif"f*lff "###f*j:":,fiif **,'-ffiiiffi
iorrrrsulrri muscnlat qi a motilitd,lii voluntare qi printr-o pritbusire ,,pos-
irrr:rlii') ca,re cortrasteaz5 - de obicei - ct perfecta csnseryare a conqti- i:tiffi,"",H#Ti*"T*,H[r..{"3-;1"+$ti
lf,'(t:ii""-,'::ff;l'l; jl,fl],
r.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 i;l*F1;?''1i'hiJt',:3'ff ;Aj"ilf*T,lil,l
izolrlr', t'lc nsociindu-se, dc reg'Lrli, cu atacrrile narcoleptice (Yoss $i Da1y,
lll{iO; Popovioiu qi colab., 1978). Uneori accesulca;taplecticpoate fi pre-
:::fi.li:!i6,:#:;t#f,:!
f::;:: 3;
i'*tf
;,;,1/;:,;'"Ti,f *1 ,:;ilil
.rrr|rl, rlo scmne premonitorii (senzalie dc oboseal5,, de ci1,lduri sau ile "!i ";fl
i?;j:f##i"+
r.r,rrrI,r'ic|ir,ctc.). Inhibi!;ia tonusuhi postunl poa,te plezenta intensiti.{,i
rr|Jirrliillr,ric ll o hhibilie total5,, cu clclere (mar.ileacccsocataplectico),
lrrrrrrlrr o rlirnirrua.rctonicX localizati, la ta telitolin rnuscular (crizek,
r.:rI rLlrl00liIrl pirrlia,le).
t) l[r.uilc urcesecataplectics su,u atacuriie crtaplectice severe (Dal.r"
ltrrffi d,$gl;ftt*l{r,i. li;;i;
1[,.*firt1;;[****L:riliiiJ::i:l.i:T,1,,.J
1i Y oss, 1l)?it; Corfariu gi Popo.'-iciu,19?3, 19?4; Popoviciu ryi colab., B) Boata Lai, lJnrerrillrt
ll)il{; Irolx)r.i(fiu,1,979)sint tipice ca rnalifestare: in rnod b|rsc, mancti-
lrrrlrrlu)rolti, gura se intretlesohirle,pleoapelese inchid, capul se ilclirri,
pr' lrir'1i1,,urcmbrele superiod,recacl c1e-a, lungul corpllui, obiectele cacl dilt
ll'tl*'#'r;ilt*#illG:!:i'i"":iK:?i'1"1'":TJ:3J
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
llllni,l.f,i:{'1j.ffi l,""lr;}ir;;
T1,iii:'{Jpjjt_*i,';#,:lx''
: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
o sorztl.,iede neliniqte,de anxi€tate. Uneori sepoatelcln:rlca : rniozti't
rrrlr.rir.rr
,:,:,.:;,:,iiyi;fiiil!;,f,l:jiii,':,!ij,
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}bso-
liitlrii{iiit'fi',1-:l'itl11ll,;;lx,l,iJ,fi:iL,:":l
iiilfril;li:t
i,r,ir[
Irrl,r'i.prrl,inrlLr-sr: in culsul clizoi, rllioi rni6ciiri lolutttlt'r:, lititil;rtlrr

iliiillilililifriil;i:
rr,rulr,lcir,,
pr?lrrrn 1i orLrocirlc
lrr rrrr'loi,r,r'i|,rrlii, posjl'jlilrlti pirrtirrl(r(le ll'tic,ltlrut(r
[n lirrrlrttlt'tizci sl irttttslltlii:ltilto'
rrtr,r'r'ttvinlo,rlr, olricrrituritri;cligilrih,.
Irttir * rrttr,r'rrlizrtlri. r t lt olit r r t t t o1|lr r t ' k t t
1r,

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 - il,llin;f

l*-irui
lf ill l(|0
r'rl,ir, rrxir.nrtllri,lrrlrtavul lrlozirrt,ii l,m'rrspiratii ;i poliulie' '1'ottleilutra r.;rlri,1rllrrriIirirIrriisr{i,r,i llrrriv, rlr',rrr.lrilrlr.;rrrrp)o(sin1;rrrsir,-rrrlrrilii
,,r,oprr
rrrrrsrrrrlrr,Llrli| oslo tluretoasi|ryiin tirnpul crizei se cYidenliaz'i hipokaliemia' rlc lrrrrcirtci' liiset. 1952).
in sr,hirrrlr,itr palalizia perioclicd,familiali hiperkaliemicd (boala lui Garn- :!-
l:t.lt'r i nlcl.c aerebeloasenta;ine ( atrofi,i,le cerebelo(s(: ).
i,,i,,, ,,,r"t.,,o',r dc obicei ilrlc ..,si 10 aui (90% din crzuri;, se dcclan- ;i. Iltt(.|c tl.is{rofii musculat e progresire.
r,:'zi' I'r'rr,,r,, iud, os,bi ziua, mai alcs pe nemiD.cate. duph inani{ie qi dupd' 4..'l's,besitL(forma amiotonicd,).
,',1,,r'rrri rritrsculareintense, paraliziile predominind pe mu$chii cranieli' B,l J{ipotoni.ilenzo,imulNsall mdi gtulitr,locali,zate(tle 1,iplrrtrri;rl,gir,,
trr I irrrtrrrL r,r:izcise constat[ d cre;ter" lr$oariia ionului de K+ (crr rnetlie.ite lrrla,piegie,l,etraplegicsau doar la citeva se,gmenteale corpulrri) rrlrrrr.irr
poal" fi piovocrfaprin adtrLinist'tarca de I 3 g de CLK
', ','l;,,'ir. t iizr, pruden!d')'
,rrrrrilr:,r,'lt.s;lual;; pulologice :
r, r rtt rliiglostic. iare insi, trebuie efectuat cu 1. ,ln- najoxii;atea cazurilor, hipotonia se instaleaai, brasc 6i esl,c llrr
"igrir printr-o pierdere brusci a tonu- liziil,ri tle Le.zittttiale aroalui refler toni.gen, respectiv ile leziutii ntrtlultn.
lt\ (lri'.rr de dt,m atlacl: se mlrrifesti
,le pribuqirea, bolnavului. l)ebutul este bruscr f[r6 ,.,i pti,Jerice. Aceste tulburili tonice prin atingerea arcului rcfltir lorric
. rrlrri rrr';iutir[, tu,ritii
,.','1'..'1,r,.,,,.",sr:rle, r-Lltrse pro{luco de obicei in timpui rotaliei sau exten- 'Ir.rnentar sint totdezruna iinnitate si segmentare, dispuse dup5 o topoglrrtrr.
r,.i ,,.irrrrlrrir,i rtu se insulrq1ede pierdelea cuno$tintei' Auzul, vederea qi L rrliculaRi sau tlonculari,. Se constati, qi coexistenla trrlburdrilor srinzilit'r,,
, r,rlriliir rLttiLl lerltrtlte. i'riza cle drop al,tnck este un simptom al insu- t otice qi paralitice iar leflexele osteo-tendinoase sint abolite (semtr li rirli l
tilicrrli,j r,irculltl,orii vertebro'bazilare Coriariu, 1971 ; Kubaia qi Mil- :rrportant). Ilipotonia este cu atit mai importanti,, cu cit lcziun(fl, rr,lojrl
lrlirrrr.l1){il; llopoviciu si co1ab.,1968; 19?6, 1980)' Diagnosticul tliteren- rirri bnrscl. De pildi, sectiunile miiduvei tealizeaz:acea mai masivij lllr
I ,,rr , r,zr,lt' epileptice akinetice (amiotonic-llkinetice) se imptne tot- , i(nte rausculalri, ct topografie paraplegici sau tetraplegicd,,
,l','
,.r,rl',r.ir, nici rlrr crz nu se evitlcntiazi modificdri -tlEG dc tip epileplic. a. [,eaiunile merlulare antrerreazl simultan hipotonie pin[ ll lllon il
nt,,,fiti,,iirilelillG ale atacului de dlop uttack nu pot fi suryrinse, din tttusoulari qi paralizii (de tip paraplegic, tetraplegic sau mai rar mouoll(lfli().
c\rmeaul necesart
I,rr, irririrnpli vizibiJici!ii epaliriei crizei,rlai 9lFG esl" :l\t'&,rlrnatism?.[e medt are (cu secliuni complete sau incomplctq t,vcrr
i,,t,rr,rt nu.rl, evidentia oar"cate anom:lii clcctrograIlceca'racierislice I rriiI prin comolii medulare ) qi lrcnzatamieliarealizeazd,paralizii hipoi,orrir,,,
rrrsrrlilit'rLi.tir-ertebro-bilzitare (PopoYiciu si colab', 1968r 1976r 19?8t rrrr atonice imccli:rte, de tip para sau tetraplogic. Adesea debuteiuii ;rr.irr
| 1)r'i()1, il o fazii de +oc, insolitil rle un raasiv deficit motor ni atonie crr rr,i'|,.,,,.
l'l lr)ristii' ft,rine dc cptlepsie in care dominf pierderile tonusului de ' rslco-fendinoase !i critanate abolite, cu incoltinen{.I sfincl,cr,iurrii ri r rr
de petit rrrrrt'i tulbur'dri de sensibilitate. Aceast[ atonie musculari in ]eziurrikr r rir.rI rr
,,,,tit,rrilin," (cpilepsiile ,,siatice" ale lui ll,amsav -Elunt, crizele lrr'c masiye persistf pini, cind se instaleazd,ienomencle de aul,orlrr,i,isr
1,,,,t ,,,,,i,rtonici-akinetice, crizeie epileptice temporale amiotonic-akine- rr
rrrrlulirL, cu respcctivele simptome de elibera,re,cu sincinezii globrrlr.. lrr
ri,.,, (itstaut 1i colab., 1969; [iastau-bqi Broughton,. 1972;. Gastaut'
de obicei , rrlsrrl compresiunilol medulalc br.utale de diverso origini, sa,u irr lrrzrrl
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 riror'frpctiuni spinalc incornplete,se observS,adeseoriacelagidcfirril,rrrolrrr,,
de obicei cle tipul ulei obnubi]iiri sau absenle' rlrr trr hipotonie mai pulin marcat[, qi mai pulin clurabili,.
lr, pllt LLr l,ir,r'iliri conltiinfei,
-pdstaccesuale, a amneziei accesului si, mai ales,
,, '*iii i'ir,,' colf uzionale Lc;iunile medulara a.arle nelraxnn(rttce tealtzezzd acelaiii sirrrllorrr
rrrrorrrrrliilr IIEG qi pohgralice din aceste crize' I'rllllitic cu lripotonie. Itste vorba de m,ieliteteaar,tetransoerff $i rlrr 2,,/r,,
ttitlikt acndd,,in care palalizia hipotonici, qi aretlexicriltlotniiri 1:ilrlorrl
Gt I'truLiziile dP sontl (paraliziile hipnagogice,cataplexiile hipoe'
,,,''r(r.iirlr ctlt.oleliile cle ,,aclormirc"sir'ude sitrt' in realitate, ' iirric:! 0u topografie tetra- sau paraplegici,.
.*,. musculari, prin inhibilie ',l,rezhe")
musculari generatS, cie structu- ln ytoliam,it:lilele subasutesau tw instalareprr.rgresi,t:ii, pc prirrrrrl |lrrrr
ii,.il ,r,', rr,t,'rrii r r srl,ueazi,paralizia atroficii, hipotonia {iind ins[ nolipsil,il.
,iil,, .,,,nll,,ni,ofalice ale sistemului somnului REM, apirind de obicei la
!, In compresiuttiientetlulareprogresioe(prin i,umoli tle rlivei'sorr:rirrli,
irolrrrrviitttlurleptici (Daly qi Yoss, 19?4; Yoss Ei D3'ly' -1-q59;Eis^hikawa rltcrxe, pachimeningitii,,arahnoitlitn q.a.) hipolonia^cstc rilrtxl'i irrl,ilnil,ir,
.i ,,,r,,n-. lCoir:- Pompeian6,fOOZ; Nan'no ;i colab.' I970; Cor{ariu 9i
rlrr obicei constatindu-se contrlcturi musculari. ln scliimb irr tir,irrro
i',,.,,'i,'iir. f974. 19751Popoviciu ti colab., 1978)' Trebuie d iferentiatecle
,,,'i,r,, r,,.'o" tte cpilepsie rnolfelcd, prin inYestigalii EEG qi poligrafice, in trtirrlieqi in tumorile intramedulare, leziunea,pericrliona,lrlpoatr: llrirr,rrr
rrrci, de la inceput hipotonie muscularl.
,,,,,,rlizi,l,rtLe sodn iecxisthcl anomalii EEG, in alarX de contextul poli-
r:r"r,lir,,cir,tt:arlti c5,paralizia de sonl, fie in forma sa izolatd" fie la narco- 3. I'eziunile progresil)e spinala posterioarepri,n leziun i ale atnlaqntlrn.
icrrl rci^ implicri aplrilia inhibiliei musculare caractedsticai somnului R'EM' lt,tsllrioare(ale fasciculelorlui (ioll qi Burdach) sa.upr'in leBiuni r(r(li(ut(rt
(Nan'no qi colab., 1970; Cor- loxtarioarerealizcazd,de tsorn(lnoa,lripol,onii plin inl,elfln:treilu,tt'ttlrrirrrlh'r
1ul ti,'gil ,ri, fulcl tle ielativS, stare de veghe lr)nl{r Olementiu.
frr,r'irr 6i lbpoviciu' 19?4' 19?5). 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,.
1.t.2. IliPotoniilc durabilo : 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
It) II iytokniil,a lqnarllisate sint raro: lililo rlrrptol)ti()nr{{rl)( i{r,rrr ;rrr,llr.lil oslr'ol,rtrrlilo:l,.ll
i,ricrrlriprrlorrir. rrrrrrr
L M.iul,uniu,(rtri]lrtnkt') mn!/ ni.lald'a ltti Oppcnhr,itn $o llll'ilno$l'o lrrfrr.rii.Adctr,lr,r.sl,r,vollr:r tlt'ni itou. tt'd( ttrlu t)tii tttuhintlli, ltr lrrrr. irr
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 l', li- (,orir,\lul clirric:r1lrr'4ir, rrrrrr,1rilIrrrrir|Irlrr. f.{r'girrrlitrr,irr :rr.r.nlr.
rrrlrrlrlir,

I ? {l t7l
 lit' sindroamele tle salerozd,com'bind'td caren- 4.1!,1.1 . I l ipul,otti,il.upu.rotittl,itl rtutt,r'ttul,izttl,t:
\t s irr,rLl'ou,nte l,e n'au,ronn'ent,i,.xt,
lrr, rrtrolo d'egeneresce ;!'asp i nrt-cer,ebeloase (indeosebi eredo-ataxia sau |) lr'onnt:ltLort,i,rd,r:qtik4tsic q(n,arlizal,ii (glarl rn:r,l}r,irntr,r.grrrrrrr,ll'li
liolri,
irorrJrr,hLi I'rieaheich) (majoritatea rlegenerescenlelor spilo-cerebeloaso, zirlritl,u $ootrtr(lirlgonot',liza,1;) sint rcl ,tiy nryorrlo rxtnrroscrrt,prilr lrrrslr,,n.
irrrlrrscbi eele de tipul Piene-]farie evoluind, de fapt' cu spasticitato rlrrrt* bruscil rr,corr;Liorrl,ei, prirr carrlr,toruloonvulsioi i,oni(x),l)rilt {lut,t[l,n
care teallzeazS"folTa pseudo-. sorrrtii (minuto), prin tulburf,lilo respiratorii, vit sor]ro1;ol'iirlo a,rxrrrrprrrri
lrilrrrrrirlnld,).Rareori existS,scleroze in p15,-ci rrrnonl;,plin ernisia dc urin.i in crizi,, prirr mulscaroalirnbii, prin prrrzrrtl(,rr,
cr marcati tulburare
i.rIr{'l,it,ri,, de sensibilitate profri:nld, cu hipotonie $i
lrirr,rrr.Il,i.,rie osteo-tendinoas5,,in cate qi semnele cerebeloaseapar ceva rlo ottioei a miclrirlzei qi prin surprinderoa moclificririlor lrllr)(l (Ar.sorri [i
rrrri litziu. , 1978; Popoviciu .,qicolab., 1970).
"lrb.,lr\ Marca crizd piliatici poate sd, realizeze o corLtrrrcitrr,il,
.1. t,a: tu'nil,e periJeriae ale orat'Iui refLen c\7 hipotonie consecutivi', grrrrrrr.rr,li
rrrrrl,irrl,ilrrite in iumbroase afectiuni | Polirad,i'culo-nevdte ; b\ Poli- zt,bii,da,r, spre deosebire de criza tonicd, epilepticS,, ar.eo dulttii tnli lrrrrgrr,
ttt t,ri:r'.ni ttoltttcur oputii il'e diuerse origini, ^) (ve capitolul precedent) ; rru se insoleqte de apnee, nici tle emisie de urinI qi do mursclrrlr,lirrrlrri,
, ) V,,,,rift,' si neu,ropatil. (tlaumatice' torice' metabolice $.a.); d) Leziuni rtioi de sernneEEG, apare intr-un context psihic revehtor., illr.sirrr;rl,rr
, ,lt pl,.ttt1 ilt,i llrt,rL ill, lot nbar ' o: r c r aL) . rlr,l,ologia critic5, este ,,neulomimetic5' t, adicil, are o topogr:r,tir: cN,r.orrrlrr.
l. Alealiunile rlasculttre, ca c1opi1t15in distro{ii1eilusculare plogte- sj{)ir{ru colespunde structulilor anatomice reale, ci ,,itleii,, 1o otlr lrolrrr,
; ir,. (rrLri.rzulilu in c.ne se irxtaleazi atlofii importante, degi :rrcul retlex vul o are dcspre ,,organizarea" Ba corporald,, creintlu-se zr,sblirlo Irr,lsrr,
r.ilc rllra,t,t), .,schem5,corporald,'J (Enitescu gi Popoviciu, 19?8).
0. It;:tutlilc ftttmaliuttllor cu acliune Jaci'Li.latoareosupta dtaxt'lui' c) Tetani (si sind,roamelespasmoJil.ice) pot s5, realizezo (x)trl r.rrrlu ll
t t llt ,t)Lt)tLioen( prin intemediul sistemului rei;iculat facilitator tlescentlent), spasmoclice ale extremitd,lilor (cu spasm carpo-pedal, minil rlo rrurrrro4
siirr,r(ii iricLr,rJhipotoniamusculard se datoreqte preva,Ienlei acliunii for- ii cu planti, excavati,, cu inclestarea pumnului), a1o trunchiului (orr rrl,trrr.
rrr:rtirrrrilot inhibirorii etescendente : ciri ale torsului), ale muqchilor felei (cu,,ris sartlonic,)), spnsrrLtrorrrrkr
t\ I'eziunile aerebeloo'se (infec-tioase,traumatice, degenerative, atrofi- rrrotolii, ale limbii, a1elaringelui qi chiar crizc tonice gcnei.r,liia,0orkr lrll r.t,
ilr coictreloase cu tliversele lol forrne clinice) se pot insoli de hipotonie pscudoepileptici,(Riser, 1952; Figi,rd,qan qi Popoviciu, 19?8). I'rr,zr,rr(,rr
rrrrrscrrlat'd(uni1aterald, sau bilaterali, erentual crr predominantd' o srrrrrnclor lui Chwostek,Trousseaugi Erb, lipsa pierder.iicunosl,iuf(\i,:lrl,(,
p: lu), care se poaLe evidcnlia, pe linga-ptobele clasice de e:.plorare 'le a ,.rl{lontele,modi{lcd,rileEEG qi EI}IG (1a proba g:lroului), motliliici'lr'ilrr c:rl
i 'r,,ritiiziliipasive, qi prin allc probe senriolcgice:proba pasivitdtii a' lui lcrrrici qi/sau als magneziemiei, clarificd, dlagnosticul (f ir,glriiqrr,n;i l.,opo
A rrrlr'6Tioriias (dd rS,sucirepasivS,a tmnchiuiui bolnavului, remarcindu-se virirr, 1978).
rrrisciililo rnai ample ale bia-tului de paltea hemisindromului cerebelos) ; ) CrizeletronicedeJosiiposterioariiau fost ilescrisc inilial rlc .lrrr'lisorr
prolrrr, ,,r'ezistenlei" a tui llolrnes-Ste,ivar"t; proba reflexelor pateiare (ll{?1, oitnt de Arseni qi colab., 1978) sub termenii cle ,,cercbollilr.lilrr",
,,l,rlrrrnrs _like seizurest'$au ,,crize postedoare,t.Apar mai:llos Lr,r'rrpir
qi rr rr l:r adulli tineri, in special in tumorile mecliane cle fosri,lrosloliorilrr
"'o"ttlll^rl;r*,*or, neostriate (coreile tle diverse tipuri qi etiologii, acute (1rrl,po un
crrrnicol sindroa,rnele atetozice) asooiazS, hiperkinezia caracteristicS, qi Taterial de 1040 caauri de tumori cle fos[ posteriorr,i.i, pulrti,.r,i
lrip,rl,uttia rle iltensitS,li variabile. 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
c) Llnale sind,roatnaaesti'bulavese pot insoli de o discret5 hipotonie :r lrrhisului, precum qi d.e pozitsia ,,ceremonioasi," a tnpultri.
rrrrr*r,rrlrrlli insilater ali leziunii'
d\ It l&lunite neuron'ilor tnotori'centrali, hipotonia muscularS, poato . ln mod brusc, de reguld,in urma unei migciri bru;tu a ca4trrlli, col
Hriti(' irrl,ihritii,numai in situafiile in care sindromul piramidal s-a insbalat prrl se plaseazd intr-o contractqd, tonic5, in extonsie, in opistotorrris, irr,r.
lrlrrsc.dlr si il accsle cazrrri hipotonia dureazi doar timp de citeva sdp- rllpul este.aruncat_inaloi,eu ochii deplasali in sus, mcmbrclo liinrl Jrlrisrr,tr,
trirrririi.in cale asist[m la o hemiplegio flascS,(sindromul piramidal defici- irr lilexieqi pronalie. Uneori se asociaz^$i trismus qi incontinorrl,rlsf irrll
i:r,r:rl iui Barr6), dupd, care se instaleazS,hipertonia piramiilald, c&racteris' trrrir,nir,. devin-e foarte neregulatH, qi supcr.ficialtr, stnt (lr! i,ill
^R,espiralia
t llrovne-Stokes, apare bratlicardie, pulsul este filiform, bolnrr,-
l,irrr'i.Nlonfioni'ni ru:rele parali.ai'i fl'a,ececentrale pseud'opariJwical lI I'jirrrlrlorri.
-inso"litg rrrroori obnubilat . Criza dtreazra do obicei clteva minute, putind I'i nro r,l,rr,lil,.
si rlrr u,1,xrliimuscula,re, adesea cu distribulie pseuclora,tliculari (dar fd'ri
ii. | ). ,r,,,tlo*usculard), rea,lizate d.e unele tumori fronto'parietale (menin- t)rr!ir, .crizd,cefaleea $i vd,rsS,turilese intensificS,. S-au deicris qi lonnrr pn.r
giorr,rno,glioame) sau de suferinle vasculare. 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,
4.2, HIPERTONIILEMUSOULARE 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\)
4,2,1. Iliporl.orriilo plroxistioo sint roprezentata la diversa crize de rii ;rorrl,r'unngt.jfi,rilol;errrpor.llc, t5i r.lrtrrlol,sl,lilldo rlrizo in ctr,toso H1ill1,1rlr.i
Iitr orrt'pul ln int.regilne, Iio auumito scgmonto
(ont,'tu,hffd,cliro inturosor.tzii, trrrrr||;iot rl,rt
tr.rt1;r'rrlluio
rIIrrrlrIrrrIr11;o
0u 0r'iz0kr rrpilopiirrrrit)llir{r(li,iHr,r', l0ltll ,
oor.Dori0 ii:ola,toti oi"!l'ol'durlll,iirlrr Iunofio i]o rnocllnigmulcontnlcburii'
u, Atlotri qi rlrlrr,lr,,lll?lt1 Al'Horri1i l'opnvilirr, l{)Bt)),tl {!lrrt,{!,rto II il(,I rIr\I| |\I|,
t{ll,ll (l(l i)l(1. jf po;rl,olrrliltti o fi{uttoltrfn, r.o ltrr,tll,ri, I,rrtrit,il,
itrxlrtil,iL
rltr rrillrrozii, 1i rlr'
rtxl,0 <1()tl00Lttttlr.}-tttittttl,o,

l't !, 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,.
-rr,r:r.rll,rtr rrrr,rJ
rllsl rrl rlr.r.r,j{ul;rl,I,r,Olurrd(,i,
(1lrt(}frd (lii(i'iL(i do criz,, tonici a hri Jaaksun. -tn schirltr,
,{r'r'l()lrrir'slr,
.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 t€tanice 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
.t I ir"e,
,t(.,,.,.hird,. riolente..insolirpde cri"e de apnec $i ttc blo'cajlrrin;ia;; itiI
l.rrlrr,tivtde deglutilie a;ntreneazi, desciirrca.ritonico-cloni"ce ale*buzelor.
-de faciali qi ale constrictotilor faringieni.
:rl. rrur;chilor Ca gi in crizele-cliri
t'.l, rrr)s,acoste conlnacturi tonice rabice sint, in moil caracte'istic, declan_
,rrlrr ii .xacerbate Ia cel mai mic zgomot sau Ia eea mai micii rniscai'e aol,iv6
rrr.rrllilsivii,
,{1it crizele tonice <Iil tetanos, cit qi celc rabice, sp iusolegodc oxago_
ttilet_teloridiom, sctrla,re,ostcotendinoaseSi mai rles i unor rofleie
'rr.r.ir
,lc llrrnchi cerebral (nazo-palpebnl, mtscter.in, Chwostek).
t) In intonica!,ia cu stricwtnd (sau, tn su.pradotareaterapeuticd) poate
:rlriirtir ti sttire de contracturi d e.,tip tctatic, cu t,rrucorb[-l.i p""6rliti"e,
. ,rrr;rr'r'licial ne-ar putea duce in eroa,te,sugerindu-sein mod irr<rorrrcl,
:',i, .,':r r,llorrrind crr convtrl;ii clunice_
'f .i!.1.2. II ipertoniile paroristice localizate
t) Crizcle epilepslicelocalizate (tonice sau tonico_clonice) tle tio iack_
rr'rirrr ((,u f.i1 fii,rd lierderea de cunoqtir-LlL,cu sau fi,r6 der-iatia'cilj u_
,lrrl.rrrr r.rrpului$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..i-
zr.: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
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,
ol ti tl t' i tttr6t r lt tt t t li l; t t t t |'t t t t t rio
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
lrtoce)t.se tlepisteazS, o funclionalitate normlh, ln sclsul i:i ll, txrrrl,r.:rr.(irr
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,
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.ryiodukrrrrol,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'rllr'l'irr rrrlpliirrrlirroqi irr lrrrrrvrrrr{r'i,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) 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 ) .
'l-:!.:1.1.I I .iilt.l't
oniil,e ruh,itliute (rtthitotaiile) clu,yproase , \ 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 ,, r l r r l r i i cr tr r l l l i It.l l l l i r (
.scpot intiLni
ir rrrrr rotoir,se Ntcctiiuni: : 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,
t) ilinrlrotnul mentnge&l,realizat de meningite qi de hemola,giilo sub- 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 .
iurlrrr)irli('no implici, in tabloul semiologico hipeltonie dureroa,s5,, ertinsii nurlc irnportanlii plactioii prezinli ttlplul cti turbilizrllor, cruprtltricslo tl ttt.
irli'${,ir lir i,u{,i muqchii cen'icali postedori qi ra;hidieni dorso-1i:mbari, inso- |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.
Liiri (l(l rlxloarea neiii, a cefei, de pozilia cancterisl,icd,in ,,cocory de puqci',
Jntt,stulqlu t il
d) Contraeturitt'ni-sau bi,laterale,localizate,u'lecol.outtti.1i.
1i pozil,ivil,ater bingcunoscutelor manevre Kcrnig f , Kernig trI, Lasdgue, t:erticale,tkrrsale;i d,orso-lombare pot fi intilnite in cele mrti tlivr:tsr':tllr'1
llrrrrlzitrsliiI, Rrudzinski II ry.a.
lt) tlii,ttdromu,lpseud.o-nz,eningeu,l, al f6ei posterioara trebuic dilerenbiat uni ale coloanei (spondiloze,spondilite, puseuri de rertntalisttt t'titLrr|rtrrI
rlc sinilrrrilmelc meninge,alepropiiu-zise. Acest sindrom pseudo-lr cningeal hr:rnii dc disc, tumori vertebrale), dar si in alte proccse(aLrccsc trrri, c lt rrI rr
cslr, rr.rrlJzatde proceselocalizate in fosa postelioari,, dal' qi de altc proiese lito do diver"seetiologii, arahnoidite, meningoradiculitc lo<rtlizrrlr,,'r.:r.,
r.)il):ll)sivc supratentodale, ca,re produc fenomene de angaja,re a cercbc- \u trebuie si uitim nici inqeli,torul ,,lumbago primifiv llrrlrrtrrqrh.gir '
trrlrri, r',.spor.tivr lobului temporal. Se poate astfel evidenlia, o ledoare rlesclisde Sicard (citat de liiser, L952) c semu dedebut (fazi, t rrt I i rrrrIrrr':' r
rlrur.r',rrsi rahitli.tuii celvico-dorsalScu Bemnul lui Kernig prezeut, cu o 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
lrozilio rleflectati| a capului, cu membrele inferioare in flexie, cu atitudine l:r'an$areadiag:rosticului.
lr ,,(xxiol de puqci'". l)ar aceastS,hiper-tonie dureroasi, a cefei qi a rahisl-
Irri porrl,eprezenta exacerbiri qi remisiuni, fiind va,riabili in iritensitate, ia,l
rrrrrrrlirr lornbard, (periculoasi in aceste situalii) poate s5, tie urmat5, de o ) d,e origi.nece,ntraLri(ernrrr.li:.trl,
4,2.2,2. Hfutertoni.il,e{ t:onlraclurile
lr.rrlrrrlrsot:nli a, algiilor occipito-cernicale $i a semnelor meninge:lle. Un tuzt. toc,alizate)
r.rrrrrrr,nlrtont ,i sistenatic al fundului de ochi este susceptibil sd,previn6, a) trIfuiertonia (contractura) piramidald prezintd, p:llticul;r,riiil {iLr lrirr,
(lnnoEcute:predominanld ectromelic5,; caracter electiv sau (1r'irsir'l(\'lr\
il g('rrrclloln el'oll.
(1troponderenl,ipe flexod $i pronatod la meinbrele supeljoar'(',r.rp(,rl r\
r:) Ilt"pertonia rahi.dialxd,dureroatii,ipolatd,,interesind doi.rrunii musch i
rri cofiri ;i trapezul, imprimind o atitudine vicioasX (cu torticolis) loato fi 1rcertensori la membrele inferioare) ; atitudinea caxactcristicii a,lnrr r lr rr,l,,r
irrlilrrilii in cutsul unor leaiani, endoaranieneqi 'intra-rahidienece|Dicale. intcresate (de tip Wcmicke Mann), consecutivi acestoi contl'i|,(,1,rrIi r,l,',
li1'e; prezenla sincineziilor (globale, de imitalie ;i de conjuga!,io)I crrlrrl
iir.ril rlc;te irita,lici nervilor spinali Si cervicali. In contextul serniologic
Icrtl de cedate ,,continu5," qi elastici la probele de mobilizrlrt prrrrivl
litrsirsit, (lzri,:i tle sinclroamele preceilente) contlacl,ura rahiiliand, krmbJrS,
lopograiia extinsS, hemiplegici,, para,plegici', tetraplogici' sau monopk',;1icrr
1i'rr nrunblclor inferioare,de ase-meneanu Beevidenliazi, semnnl.lui Kernig
plczenla altot semne pirarnid.aie.
r'r ,', l,Lrl1r.scrrrnelr|ningeale. 1n plus, contractura mt$chilol cefci rnlni-
i,,;l:r L1r.turr1eii. De obicej capul este plasat intr-o atitudine cle anteflexie, 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
ll;pr.r'1 iv rlc antellexie Si u$oari, rota-fie laterali (in tor"ticolis). In plus, /ic ]rrezintd,semneleasociate ,,de etaj" (spina1e,de tnnchi cctclrlrrl, rtrr
lr6llrrrvrrlrnen-tinecapul intr-o ,,imobilitate ceremonioasi" (Yan Boo;rcri
-r Il:rrtirr, ltr28, cjlar.i de Rise.r'.1952).AcesI ci.trrclerde lurt icolis .,pcr'. licrLle,subcorbicale),care trebuie clutate cu grij6.
lt) Eiptertonia (conlracturo) entrapiram'id,alii (paLr:oslriutil din sinrlr,
l r:rrr,rrt. nl;r1i,',firat, pufin schimbiior" 'i dunetos il diierculirzi 'i..ior-
tttu.l,lt'i,ytntoni.co-hipakinettcsau porhi,nsotzimd) prezinl,ri,])[ri,i{]uLr'r'il,r(il,
t,i{u)lislllFprsmodic (vezi ln continuale, ca,p' 0: Probleme de dilg'nosl,ic
iul.rlia, lniiqod,riloxinvoluntare). Aceasl,Satitudine vicion,sXa capului l)ltt(jcunosoute:
irr rrr,rrr
De obicei este generalizal,i,,Ia toli muqchii pet'ifot'ici,tllt,r'itrlorr'
rr'prlzirt,ii, lrn somn precoc€, care apare in tumorile subtentoriale, al.efosei
rrorraiindeosobimusculatiuraaxo-rizomelici n staticii [i :l echililtlrrlrri (rrrrr;
rrlslr rliolrlc, intl eosebiale ventriculului al fY-Iea qi mult mai ral in st:rtliile r,hii cetei, ai g'utierelor vortebmle qi :r,i centulilor scapulnl'it,1i prrlvirrrriil.
r,rcr|,icr,I,.rrletrrmorilol rle unghi ponto-cerobelosqi ale emisferelor*grobe- !,(' mult'e ori se poabe lealiza un homip*rkinsonisr .
1,,.rs,.. Acr'lsth pozilie vicioasi, de ,to$icolis ceten:onios" trebuie dif,ercn-
- Este globalir',adic5,intereseazi,in rnisurii, sensibilogillii it,1il, glrrlrrrl,'
li:rl,r rl,' Dozitiile licioase ale capulul consccttivo unor leziuni ale colo*uei llr,xorii, cit Si pe celo cxtonsorii, rlvind toiufi o uDolrl plulorttitlr'rr{rr 1r,'
irrrit,.,,s,.[iprin morb .Pott cervica,i$i prin traumatisme ccrvirnle). trIxist;, rr\ (.)ft.
si riltrttii in oare unele tumori ale {osei posterioarermigrate spre rlr,hi;u} .* trlsl,e ceroa,sX"nla,sticir.
(,.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 - Ditrimrt'r,rzii iir cnrsrrl .\otnuului"
1r.t,vigrrlr,- * Ocderzl in s (.;r,rltrr loa,lizirrrlscrrrtirrll i Neglo (rr,ltrr(ii rlirr{rr,lr.).
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' g1;1111,1r11{,111rivir,,
Ii\(ll r()rr)(' rrrrI rrr(,iirlitr{lt,lrr ovirlor I'ii rrrlrt s0 t)rir,il,rrlfi
ilrr lor'1icolisnn sinl,tlc origine rounaticii, b&nalii,.lTueori rahiatgia lipstq.te, rnrrt jrr <tttltrrlr.iircl,rrit ii uur)r'lriulovr'(!tlc trtiriuili nllivr, t'-,trrltt,l,hr t:trirllir
jllobilizrtl'ottacostiol'b(]lnilvi tr'{d)ui0 rI rr ttrt'rttlrtr,(lr,rrrtrtrlItti Noicl).
Irrrlrrrv rrl arflrzlnd(lor[r o crtttrllee tliftrzi"t,, Irr'I,rrrrrIrLt
,ii Iir, Ii i,(rr1ii, ilrllll(ii{;
frr lrtttllii,It'rttltrrr(it, o lttiltrttvt'ii,
lttrr lrIrtt;itlii'lxrlrl;rr I'rtrl)1,,,(|(||||rl| |IIlri't rr ltri l,'r'otttlttL
r virlirrt{iltzlrrcrrrtrlrltrllr, lrrlrr,t
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 , iortiri ln lrrrrDrrltrr,IritrrItlrtii rr.r,l lrlllrrr, r.rrrlr'Iilrlii rrl,ttttr,i cirrrllrrrlrrlvul

lTl r 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& auioma-
lisnrrrlol 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
'lcrrl'r.r'ubrir"e. din disronia musculolum deformausq.a.
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 (fenome-
rrrrl Lui l\Iagnus qi De Klejn). Crizele de rigiditate prin decerebrare rea-
lizi,l,zi, t> hiperextensie a capului $i a coloanei, extensia membrelor infe-
liol,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 labirin-
licc. 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 bila-
h,,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
,rfir ziBul sindrom extenso-progresiv a,l lui Sic:r,rrl ;i llrurr!. (lrttl{.rlttl
,'lirri(1 r.ste I eYela,t0r'.
 fl ir.J. l'liolr!,l,li\ll,i sl 'l\)l'{)(illAIl(l
l,l'l'll}l'A'l'l)(il'lNl(i
lrl,l lrlA{iN{)s'l'l(l

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 i r l t r lllr r ill

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 t r r r ot t lot t lt t t r
', 'i li p" trr
si I t ' r r t t t t t 'r lt t l t r lit lic.
r, l c rl rr l Irrott t I llt I r ir r t r t t t t 1;

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 ''
6. pnosr,Eurg
D0DIAGT,{osrrc
IN ATAXIi 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 .
I r , lr, 1)lli{ri,ilrt rlllrtnilind la mctn}lnrl,: inferioltlc) l irlrl;r'rt;rrisl rti t tt t r. r
'!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"
,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 i r r r r ir l' l I
,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 r 'r' l
5.1. pR0EtEt{}N DE tttiT0l]Ol0clti SEMIOL0L}I0I i i l rrl i i :r-rk: ir cllllr [ t , ] , Lo int r - t ul sot ls sil lL in : 11f il] . lit t t 'lr 't t r t 'r t iI
l, I I I t , ) I I I I I ||
,.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,
Ptntru aprecierea serniologicii,;i topograficii, a unei ataxii rr',rlrr lrti Hornberg cste pozitivil irl il toalo plrtbole rlo rr.l,rt''rirr (rriil'rrr
, r',1)rrn o serio de con{lili,i,lnetodoLogice d,eenatnen: ,' 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
/, lu:iinfe de toate rrebnitl apleciati, sterel r,le conltiot{i,. Sc 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
;tie eii, ,,!( rl0 c,-{rt,:i0u&tit.
))rr{rl{lr1irl,htntc:lrca proceselol psihice,obnub.ilareaqi dezorientaleRnu
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,
l)r.r'i||il (j Trlni ccorrlonare a rtriscririlor.,ci,cirril astfcl, t|tleser, rlell1tc in rr iL.lier clsi;eotefr[iiuoe,si,, fenourene ci-!.r'c sitiii (lc i]sotll{)rt(iircttttsrrttittl(.rrl,'
I or.(.i{'tlrit,cxi).ottr a probelor cle ccortlonl-r,rc. , jri i t irii ciiilot selsibilitirtii pt'oftrntle.
i.l. l_)€'ticitelemotorii pril tcziuni a,ie neuLonului motor periferic sau ilsto important tle relinut c[ lipsesc amr)tolilo 1i ttisl'rtgrttttstri. trrl
rir Irrrioiculeloi.piramidalepoi co litiona rt) mcls ezitant, rlificil, 1cnt, , o, iliit':r, e$te Iloln][1i.
1rrlirr lrrrlonios, precuur qi ,,falsd,"incoorrlona,r,e a rnisci,rilol pril tlicctiu,ea :j.2.!.j" ;\t.t+tLitr,ilLsolitti d,e drelleaie osteotend'inortld litiioij t I t rt r;r I , ' ,, r, I ,
rrris|r'l|ilLrrlctive sr:gmentare. rrrr lrlcme cli;rgnosfice ;
.'i. I'Iisciirilc involuntare pot parr.zita rlano.vrele de
coorilonrre. t. Poli.rir r"iti,le {. 1.talineurol.tatiifu.Si: insolcsc 1i rltr irrirrrsl,r'zii,rll i'rrl
.1. Ilrtcizi:r, unei misci,ri poatc Ii, r.Leascr:renca,pertrLrbati, ,rrr':ilt titr stn$ibilittte oblcctive cu disl,ril)rti.io p1li{lorllil}ililii t rt I1t rtt rtr' I it ' I t
printr-o rri i i ' ).up(r' l ioiit lc,ci1,li piot ulll1o) , t le iilcf ler ie oslic( )1, ol] ( lilr r ) r r $il, r lc r llli
rrrlr,rr'(rrrtri, tnlbura,rede tonus muscula,r,regltr,reatonic:i a atitudinii si a ,,iir. rrrotorii (i[l iicterist'ioe, ova'l]tua] isi de aiil{}1ii. []tttrlrt'i tilltsivilrtl'rrrr I'rtl
rrrisr.ri'iil'iinll unul rliatre factorii edenliali ai coortlollrii. Atil hipoto;iile l,Iriirilol i'ie scnsibiliti],to profund:i ;i il itLlr,xici Irr:rlizr,rtzri, ,,pscrt{lo I'irl}rlrrrl
rrrrrrr,rrLtrrrr cit ;i corLtra,ctLrlile(pirarnidale qi extr:.Lpilarnitlale) pot sd per- pr,lilrlic". .Durerile la presiunea fira$elol ltlllscullu() iii lil lrrcsitlt tolt,1,lltrrrllrI rl
Irr|lrr. r'recutalca perfeeti. a unol migcilt.i,creincl impresia _ clacii,nu sin_ ,il,,r' rrervoase sin1, consttllto. .A1bc somnc (li[ ctt)l,()\t'lll s(rrl)iologir' $rlri
l.r.rrrr l,r'tr{;i cd, este vorba qi rier r: tulburlre cle coordonare r l i l(' li';rftru. stabiliroa diagnosticultli e1;ioktgio.
!: Po!,i,rtil'icutonet)ri,tale lrrtruncso irr trrl)lolll sotttirtlogitr, 1rl ltttl;:r
l. inlinte de a trpreci:r,o tulburale do coordonaro tirebuie s:i eliminilm ,.Ir.rrr, .I i i;{i I t I gxI.lIse atr]l,oriol,pozitjivital,e& scmne]rl rlti ckrrrgrr,{,io trr,rtirrrli r,r'rr
(
rii | ( vctrtullt:r, astazo-abazie (func{ion:r,lir, sau orgl,nici), plecurn gi un rri nrl | otnrr l licir idi, r ,r r pl ; ognot uonic polL{t r t jt it r dr {) m lr l ( }llillir ir ] - ll: r 'r 'r 'r ')
;i
irrrir ri st'rniologicz1 unui sindrom psenilobdbar. l i l t,rl tl .
/i, ,\tr,xi:1, tr.ebuio totdea rma si, fie diferenliati de o apraxie (indeosobi il. ;Jin,thonuJ meduLu'rtlt Jibtt luugi (d, d)nl t,tt: po:tlcrio4l'1r)srr trrrt:trr
Itt tr,t::tzi\,rxtrlttsiv pI'ilt l,uIbulilri tic sttrsriLilitrrtc pt'trluttrlii (()lI$1,i1I I I'it (rrl
rrI|IrIrr|itr)rcu (iilt,cse coltuldri adcscl l2t,rn etianten supedicial. rrrrl rott1trl i l , ii, l, 1xic ( pr r r llr lt r t inllt t l, l'i,
st lu {) x( t ur jil ii lit , t r t t t t r br l'llr it r lir t 'ir r lr' , t rt')r r
i. itr s1i'sii, i'l:l!:r u'eri lrlrtrii sc i'rptlne .l rr rrtr' l ' l trxiiroslr 00- kr lt t lir ur asii, 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 t r t t t t ir 't t
examen sistcrn,t,i.r
l,(.|llrI r l)r'o(ji(,rorr 'n
1;ipttluirlc itftrsjc (l)r,i)rliultl[t1it,i:r,le 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
ser]siltilitli{iipt,op|io-
.o1ll,ivr.,Dr,irrlfzitrrri t.,.Lrrrlr.l,rrsr^ 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 '
srrri ir,sl,i ll..ltr|l), ll topog|lfioi llirr,xioi ( 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,
11(iirrrr{ili'ii, rlrrrr.r'rrlizlrtrii
lrru l:r Irr r.iirgr|lnrclrrbltt),rl r:llrrlrtlrri.,i :r, irr{r,rr- p l |zt'ttl l r t' r r r '{t|t
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
rriilrlri :lrr.,r.i (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 ) , r r r , r r i r r 1 1 r . r ,lp r '( 'r l r ( r '. l r l o l r i l l i i l l i l l i l i i r l ( r r zr i r i l I,'Ittt':Il t:t l t'ttl l r tr '1 i tr ';ti l ,

lJllr tI
 '
IrI r' r' \ if I r'i'qi lir|rrrclt,trrrl,rr
rlrrllririrr. (Jlizr'ltrviscclllc sirri,rltrrnultu oli ul ilrr o*1r,;lrltIicttItr't:rr vl\rlrlr trtt ltt,tttiitltlriitnrrtrziliviioHit!i l l l ' t l l t' i rlil l J[ ,
;.1nr,lio
rrr |! |\,r' IIi t (,,| |.(' lt0rrLrrrrliagllosl,itr. t'slotlitrrci'ii(tltrttlt'r'rt,'1i
rrr.trrlrr'|trtsli,
Irorrrirtl,rrrirl qtirrtt ltrzi
plttl,trtrtllt'zitltttrit'
h) Ato,r'ti.le priri l,,ziurri^alc co.rluune]or posterio..rrc(rnklliLe, or oxcrp(il sitrrrriiikrltlo llrzitttti;tt',tltttttrttllttr',
rrriLr lrrLvilot rrtlrtritrtti), ltr
_aauta
trrl)t1.siuni merlula:'e, cpidurifl,) sint mrc. rrirr'lul rrrrclrrtrlttiro1tL,srr,ttrlttltii,iturlttci;rtt'tta,ltti Wtrl'Ittrkitth.
' , ) .4.l.tp.le:;uni aLeJihrelor lrragi so por iulilni in:
\tndrolnuI ncuroonemic sc poi]le rFcuouagleprin : arbilie Eastricf. 5.it.P. Ataxia voltibulard cslo t'cznl l,rt,ttt it' Iozirrnilol nclvtrltti, rrlrrtLr'iilot'
:rrr.rrrir.lripercromi, scmn{,de c,trrluane posteliolre, *reflexie rt rrlo ttuclcilol vesl,il)ttla,ri Ii $o (,rl,r'rt
c t plitt t,Lrlburrilit.lcrLir{,ittttrr
olizcrlzi-"t
o-ri;;;:;_
rlirrorrslelil oare ins5,se adaugd, qi semne de cordoan6 Uterate iii rlo rncls, cu oscil&tii ryiou tlcvit,tt in lcchqi scrrsrillil,inh)'illill)rri fil'll
p ilrrrnitl:llc). lsimpioine
r[e trivchtl, rlc tilrul ;i tlo rrrtsivitrltea'lezinttij. r'\'io
lrr,lolrrl,irL l'Lrncltic rtsrxrirr.zri
. - Nind,romul nauroachilic.. hipocloftirlde qi rr sorllu lionrberg pozitiv (olcmont impoltant (le dilglloslic)t l)tll(lttrrriii
achilie, semne de cor-
(l,i'x.. postcrioare, de obicei cu sellne mai pulin rrislrry4rnus $i ame.teli. Este ul,il de lctinul, lrytu1 c:i sensibilitiitt(]a,pt'ol]l'irt
impurl,ante tle co*loan.
liri,'r'irlr'. d:rr L[e]nulle oli gi r.u scmncdp potionrroriuii". crrplivtr, reflcxclo osteo-tendinoase, probelc de r:oordonarc qi volbit'trrr,ttittl'
Iloala Iui F riedreiah. intrunc.le rrn minrrnr.bi ,re simptorncpcrti_ rrorntlllc.Ata,xia vosiibularii,nu uroclific5,mi$ci,riloizolttc alo tnctttlrtr'lrrtryi,
(,ulirr,(!; caracter ere.1o-familial, rir, ;r,1;N,r'or
spre doosebirede bolnavii cerebeloqi,in sindloatnclc vtrsl,iltttlrrt'r,
Lrlbctifomi,, tulburiri de sensibilitate .fenomene-cordonale posteri6aro (itaxie rrrr sc constati, tulburd,ri scgmentare de coordonalc.
profurrdd, hipotoinic, a,reflexie osteo_
Lendimas5,),semne de leziune a f:mciculelor spino:cerebeioaseqi eventual
rr corebelului.(cu ataxie cerebeloasi, tulburiri de echiiibru, 5.9.3, Ataxifl cerebeloasise recunoaqteuqor, o1,r, :rpiitittll lit lroltrrtti
adia,docotrri-
j lilil:]Jii^lll I:, tremor inlentional, t ul bu r:tti de vorb ire), semne pira,midale. ,rrrrr rLu ptezintl nici tulburi,ri obiecti\-e dr: scnsibilil,rr,to,
ttici sitttltl,ottto
u||rrnran trotlce (cllo-scoliozd,,picior scobil-cu deg..fe In cioca:r;, uncori vrsl,ibulare.
,i jrlrri',llotii dc tip Aran-Ducbcnnesau C.ha lcotl:\[lrlie.
Itrred,o-ataaia cerebeloasd,- a lui pierre Mq,rie asociazd pe prim plnn 5.2.3.1, Sumar de d,ata senziologice
sr,rnrro,cereboloaseqi pira,midale, simptomcie cortlonale posterioare {iind Sindromutr oarebelosla om se cari,cterizeazh prin trei gt'upo ttrtli rlrr
rIU (l tscrete. f lt ptomg :
.,- l!., Ata*ia asrabalaasd'se traduce plin urmltoarele sorrrilo:
.. ... ,!o:!!trSia lantiliald Btrilm?elt L(rr&,in. prezintii, exceplional dc
I i|| .ir stn]pto_mecoldonale posterioare, sitir:r,lie in care *taxia este mixtii L Dismetuia consti, intr-o dimensionare grcqitii, n, uriqc:irilot', lxrltrrr,
(, r,.lx'1,'coftjona15 r pe plari securrdrr'[u1iirle pri,.rplegiapiramid:rLt.
),^.dJ vrrl neliind capabil s5,ajungi, la linti, in sensul ci firi o depflqolto (ltipttr
'
I)lsl,azia.0rcJlettcdaongrnitald Ruusq_Lirg "alrlnoa"zi un sind|our rrrotrie), fie se opreqte inaintea lintei (hipometrie). Ilsl,e itnpot tilnl, tlr,, ptl
,
,,lr]llli r,izrr,tcL bolnavul nu eziti, la polnilea niigci,rii, crt tttitxioul pclilirt'ic, rut,rt
r,posrerlor. (cu ,1i rrefle-ri{] ostco-tendinoasii,), apXmt in
'.,)l,ii;rr're ((tr,ollrcel)s ^li,tltxilr
intintc de pube]'tiite.Oaltcte|ul e,redofa,rdlial, evo_
ol posed5,,cu toat; tlismetria qi tremurdtura inten.tionalii, tlirect,iu,gcttr^r'rtlrr'
lrt{,ii! benigni, si asocierea uneor.i de niotrofic sitaeazf, ace,,st''atoc- rr, rrriqcii,rii,Dismetria se examineazii, prin umttoarele plobe :
^ai
(rntc clr o formd, de trecere int,r,cboeirr lui Fricrlreich si boaia Oharcot, a) Proba i,ndice-nas. I-.,a solicitarea de a-gi duce indexul lrr, vit l'lrl
l\!rrt'ir^. 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,
tt.:!.1.2. Hemiataniile rru, tulbu.r.dri de se sibil itale :r, rniqcirii nu este alteratd,, iar ocluziunea ochilor nu influonleazfi, trrlbrr-
Ttn,jundd, d,ar ur, nrlea,
rqfktn. ost,eo-te,nd,inoo.se eonseraateridicii urrlilolrele proilcine ile'rliagnos-
lil iop''gr'.rIi.si eliup.riog.,nic: ' b) Proba sti,ol,ads D. a, g6,tul/ui'slrlolBd.Cerebolo$ul nu izbutoiito sii,-tti
4taria pariclald esle.produoi prin leziuui vascull,re,tumorale, trau- irrt;r'oduci tlegetul in ori.ficiul unoi sticlor sau uu e in stare sX,apuco glttrl
.l.
rtril,lr(,,(r sl,iolei. el dmerind al6turi,
rlc..:rle eircrtmcolufiei pa::ietalc asr-,endente slu :r pnriec[iiior pe
:rr'.':rqlii ri iiirrrrr'.(i'nl( \Lul semiologicinrIrureitclulbrlr;fi d-escn-ibilitale ci Probd, iniliaa-inilioa. Bolnavul cr oshii inchiqir nu esto ca,pabil Brt,{i
rrrir l r' (rlur ctr prcrlominanli-Lprofunrlur, h,.mi:,tl x ie, nstereognUzie, dar de rr,plopioin mod corect Yirfurilo celor doud dcgete inilicatoa,ro.
'
rrrllr, ofl Fr-altcsjmptornode localizrr'. l,arjctald,{cl.izr.j{rckdoniene scnzi_ 11 frobo Linidlor paral.ele. Se traseaz6 dou6, linii Yorticalor bolrtilvttl
r rvt, rilllr ol il' sr[zrttvomotorii, apt&xie, hemiasom* tognozie, hemianopsie). l'iind solicitat st tragi o linio orizonta,lfi, lntro aoo$toa, Oerobolosul nu r4o
l. Ag*ig talamind, (din talamic al .lui Ddj6rine-Roussy) lxnllre opri exact la nivelul liniei vortioale tlin droapta' oi o alop6qo[t,o'iilr,rl
rrlllr. continlat€r'al leziunii (de -sindrornul
obicei vasculare sau tumolale) nucleif;, r{r ODrcgto
- 'Proba inailtoa, oi.
lrrlunllcl luterah, insotindu-sc de hetnianestcziep}ofrurdd importrnt; a) prekenaiunii (eatt poharului), IJa solicitaroa do a apuctt }ltltrr,
pr.r',ristr,nti, algii de tip hipel'palic (.,overreactiorr" .- EIcrrI-;i Eobnei) fi rrrl, po de o p rte cerebolosul tlop5gogtesau nu ajungo pahar'[l' po (lo olltl,
t|o _rle p:r,r'tominil tui so deschidemai mul[ docit ests nocos&r.
ir ruttcIln coreo-3.col,ozl0o.
S..l.Alnniile pedunaulo-pontu-bulbare. r)ivel'scprocesepatologice(l,umoril l.) Proba p notului. Solioitlnd bolua,vul s[ faol un purtot rlu ol'oiorlul'
lilrnrrrHri\jnt:c,tlctnot.t.glt)lucitliziLh)iit ctlola truuCbinlUi cercbral pot rxurbolosul tl oxecutS,diticit, frloiltlu-I tlin mai multo liniir introt{,i1t1,oslth
trrr,lizll,.dilr(lr()ir.lrlrr
iLlt0r'nrrr
itr cotrt,,rtul {)ilr'orir, forrnil unoi gtolo.
dr intilrr,'sc ryi trrllruril.rid.o
d.nBlrDlrtirt(' prr,ll||r(lilcrr rr"lirrir,.Ar:orrLrr
ilirxlr0rutrciIll{'ln0 pot ,rr itrrp)ice g) Pruba lotisului', Sot'i*ul oolobolosului orl,o tlifttt'trt, tlt'ntttrlttnttl,,
rr,lll;rr,1'lrrii propri(n1r,lltivo, cil qi rlrr lilr crrrrrholos, l,l (tlrol,ilnt:t,i)hrr ti)l)r)- lit,ololo Iiinrl rnlt'i, ttutogulilltt, itrttgtrltr.

t82 lB3
 ttttlun,lt,i lrr rlcrrrbjLrlor.srrl, ririscrr.r,cii
u(f ,r pllll{f,ilijl ( r r l 1 ' l l r j \'l r l r ' l l l r l l tl l l r l '
,,,,,tt.!..t..":.,,,,,.'::.:
! rrrrr lfr' .1(llrllr(il,i,i
lrrtl (,[rrrsrr. laCoCUdCpl;ilr:a SltitOLlriirt,ile*iA 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 :'lrirr rl,'r'i rii.r'rl rniqcliri de e.resaie, 'boi"""oi p"ot" t:ii,:t til]tri , , , 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 ) .
,i olrogegenuntrriur" 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 ( r !|III\ |I|||III 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 , , 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 -
!. l rliutloc.ohi,neaia ( Disctiadocokinezig) 'con$,j, ! . t l s ! , u ,|'i qo, o tti l i ,i , i ttl 'r 'o i tr si 'a b i l i ta ,i ;tl , cl n 'tl r ttt l r r r l tl ti k'tl r ( 'tl l l tr r 'r 'r 'i t r l l i l
,
rl. rr .r.r,rri.ir.t'ifcL.i altel:lratiye-succ.sive. in tncapacrtilto.i r r , r r i i v e l 'l , i c lftl . [i o l l tl tvtt! ttsci l 0 l tzi i tt l l tl l l r r sl 'ttstttj l tr tr tt l 'tl ttr cl ti tr l , l ttl l r l
S6 e:rploreazi,.u aJuiorul urxnat_
iltr 11l9t'llrobc : ,,1,li1";i,li sii,-$i l)rii,r'oru;ol"l bitzii, tItt sLtstclll,aliiu. OsciLrt,('iiltrlttl L;oLlpt itttIrr st t'r' I t'
t) .l?rohannrioneteloy. Bolna''i cste solicitati s.i,facii, titi$cxri :iltrer_ rrrrl:r,i,t'lt,ccf:llici,.
rrrr\'(, (1.9pr.onalie-supimlie irnlebralelor,,prin :rtixgel,e&altel.nal,rvii :!. llcrsuL cstc ebriosr ezita,nt qi titubant. lJolltr vji lul Pr)l l)iisl rrr lt'rrii
_rlc
rr t,or| soi cI pe mele, apoi cu dosrrl rniinrior. De p'artea , rrrrl{ri, in trinlul rnelsului, ci deviazti ii a,ubinza do s ustol lljill,i{r llrirtrlrr'
, rcrrriiu irrtr-un r.itm mai lenf, mali glloi, inteie.dinil bo.frraYd, rniqcl,ltlr, si, 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
o sc o pa,orii,,r,a,,,, 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 '
, , mjsciiulor succlsive, sau notnavil-gre|e;te rniqclrc:r
' i]i.,.;:jilr-" i,n":ilca "
it i'h)aa JkrtutllL r, ri rottstanl de partea leziunii cerebeloase'
, ;i entensiunii clegetelor zr.dla'd.Se constati rrceasi
ii. lr eftijlrl ,,:i nlStugmusuL L.r,un cerebelOS intliCii lcziLLttcrt,t urt I t . r i I t t r rI 0 I
,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 , r'r*lrrlo-vcstibuliile.
r)rririr (iu {iegetele aubelor miini, .d,e.1tetele. 4. Proba tlet:ieri'ibra,telor. Br*lele tlevia,zil dc- partcil ltrzitttrii rrrrlr'lr'
const:r,tinA"_suac""rr.i-luburr,.e Lo-r*iiii
Itl)l,1.lo procedente, 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 :
.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. 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
,,. .rrLnerataconstt in imposibilii;atea de a,
coordona artiunea tlifc_ ,lru ii. llicLtm ;i prirr aroplitudincr exirgerat[ a miqci'rilol pllsivr" lio ' '
r il /'l{n glupi trusculare in vede-reaexecuti.rii
. ,l',r{"'2,-i,prin uir,ii, tr,erele plol:c: ',t').I'a mobiLizuTectpasbii u tttttt l't'ttlttt
cornplexc. Ast, :.,t rttllo-.rltlrirrtrri I lrt
|{ 1, rIril(r}ilo ('rnrplerc..se tlesconpun in cornponentele ";"ir;,ii;j; 1or clemeul,iue. 1,,'riot',"!e atilge cu uqurinli, umii'rul cu articulaf ia
sr)&te(proha asinergigi sratioe a tui Babinski). t,ru ltra.xiurLileprriiTe a10 membr'lui inlerior, se polltc atingc f.srt .tt .itl.r
,,. ,,'.'..!,_':,.:":::,:o:y:"!:::::!,
|,, |lr{r(|nr)r.tnal,rasl,urntret pe spale compolti, flexiunea rl. i,rl flexiLLi*it coapsei pe bazln se facc c* mtlt:-"t'rrqllri1riil'!'1i tlt' rttrr'lr
asociat[,,conco_
rrrrl.rrl,r'1r a trunchiul.ui;i a mimbi.elor infei,ioare rlin genunohi. Cerebetosrit ,lirr* oxagcrl,ii i t ) itintei,sia mtittii Sc lacc,ostc lilnit. lizi,l,r1i.ii (1rt ,l,'
(lrlfrxlurl)unemiqcarea qi la accasti,probi ,' 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 ''
lipseqte tt&iunea ga,mbelord ir:
:'r'rrrrrrclri,incit cerebelosul cade pe spatc. 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
fk.rtunii gaml.,eipe gi a ao*pseipe bazm, \probli" cnl_ 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
irr ,.1,)-,['rabo
tir,:r) sr. erecu15,in decrrbit. rlorsal. -ioapsZielebel6sul -rlescompune ii rrl:r!,ii iiril irr Il o -hrtlnerillia ; e) Probu rcziutuqei' ,tt Iui lloltnts '\lt tr"rtt
aceasti
rrriqrr,:rro, irr sensul cd,intr-un prim timp va 1iaceit"r,lo"".ni ll,;lrri";iil cstr: iolicil'at sil frrci-lflexjunea :mtebrallrrlui pc btrr(. lrt . L r"
tirlicil_ l'rLlttttt '
pe 1,,',1,'r,t.lu itron ienl Ltl in c:r,re dtitn dl'utlul r":utebtLi'1titlLlir
l,il.ii 1',,1y,.!^,:lt.deplanul fatutrri 6ihou" i" uf a-rir",ii*p"ou1rrni,
\ |l | ||('li g,at]'tbet.
rr.,:{rea,siifle, i ,r(l i ,r' 1,rr tl { r liir iuir
.tit
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"
', o .:l,l!!'L'-n;cigrutuipe sasva{rJ inf ' rz it i. o t lu s t rri' i). s { ' ,, 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 '
' 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 l r. rLl bLt t : r . r c'er L{- '. I }oiil1iii
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" , 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
\ !' trrl t(t' t' e . f l?, r / 'lrpit
i I i ) r : l( , i r ' \ r unc a g i rm h c i p e c o tT ]J i ' i . ,, :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
rl1. I\.olxr, ind,ice-nas. Li a_ceasid,miD&r,re so observi, 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
cri ce'ebelosul
lrr.r' irrl,ii. :r}ducfia braf'lui $i abia,apoi fiexiune:i n"i"t 1 ,r Ll,' 1;:',:'i:ciri.:,,rlttr-iiI !) Praba tisl,n,t't,ricit'onift ( l)]itlltitttsrrtr ri lr"rr
dii;;;;
rrrlr.r ului Ill na,s. "o1lrtni $i '
,' ,,;. j c i rci't lr ir lt r . r , r 't t iL.'si 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
') ,L'r'tha mrrsulu,.i-Iipsind coordonar,*r intro acl,ilnea srrmrttanii, :r ,,,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
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 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
urm' fali
,l( rrr1'rrl)r'c, incit, bolnavul poate chiar criit"a p" sl,ate.-- - ,, .r' ,,i ti ;i , ilor , ( , iI iji liiln) t oniiI t ir t isou] illi.
./. I)il1,oli1iituiburii,rilor de ccordonare ::.' 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'
.^"o pot irLteresa,si mu;chii I iir lj<: it r r r lt r lr r r 'lLr lr / ll
l,'lrirl,rri, t,trbirea asle rltclaii (sacadarI sarr exnlozivij. I ll'rot
tl r(.r.r/i tt,. i rr 1r t , t r r . , i, 1ir t r r c, , , , 11i- ioI cit , 1lr ii t t r t , lt i, si.
'l'ttt .,1r,,rs.l i .i l, ii; r r lr 'it 'l't r l sli lj I i*lr : r 'li lt r 1, 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 ,
, '. ,utd.latoi tpn!io ul.i..Po:rlolIirrea izolt-r,1,
. : t t lilii
ri' , | lr' . t,.il flr.t tllc lI: ll dt
r:rrrrrSUr.r:Ila
CU{liS_ ,,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 '
, 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 ,,,,,,,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"
'lirrl'rrli. lr)iii:rr
liirr.titl $, 1 intorrii(,'rlltr, lrr,rii;rrr-
cri.irl,xc ul crrrsur .xrcu- ' ,
lrr rrrrrri rrris.ii .i.ryiJipsoryl o irr 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
'ii r*r. s.irbs.r i.ri lrr,iii.tip utr rl ,,n,,i n, ism,irll, lit r r r ''
rlrr'rrrri rrl.'lir, srirlir'rrrrrri;.1)r'ii
'r4irr ,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 ( Lt 't t t t llr r )
;ri s. r'r'irr.ri(irrzri,
r,'a,irt[i.r.rrr Drrrrr.iirprli11l- I l i ;i , ' r I l r' rr' r' l r' \{ ' ' Ll l r
rri i r, |! r,I r I r r
Il ,1 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 | I I'i i rl rtl l tttt,l ti , ttl l r' ,l l rl rt ttl ttr
rr ' ' ,rl LrI:rIl rIr' l i l '
| r| II tl i t l ,ol l i l tl |., 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 i l i l (i ' i '
|'t' l rtr rtrrl tr tr;, I l tr i (,(.rl
t.l
lll I
j
 l.srrlrri.str .'k'rrrrcrrzli,gi unr,.i rrislllrro ..rnpltr,. Irr scrri'rrr 1r,ctrtutiit 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
trr,a 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 $lr (
.rl|upi'rrrrrirlirlil,nu.stc infhren!,i[t?i;ia'' p.'leia, pilanrida,lti,se accentueazil. r l trrl rt' l os' (,\t'r ir ^t t1i
It. tlrilelc auebeloase.Unii bolnlvi-pr eziniducrize tle opistotonus, .rl . l ' i rIt,ri l cir , i r r lr cr lulor r , r ir r r k, r ir, r ! r r , r r lizr r , r rt r, r , t r 'lr t loir siit t t t r lr r lot t t t it t i r lr '
crr l, il, ll gt jllt r l( lilziit lr r lt t ' liit t t pklllLt t t list lt r 'l'( )( sl'll|t r st t lt
,rl ri r:ri i rrtr tl r ! . {r , t r t t lillo,
lrilx)roxl,ousioa msmblelor. Aceste c'ize- se aseamd,ni,cu i,lgiaitatJi Ae
rlr,r,r'rrrbranrroblinutir, la animale prin secliune mezcnceiatiEA d;;;;pi:; ,' r,rrl ;r, rrsl l trir i . . i sr 'iiilcr t it t gt r 't t llr ir ', r : ellr lt 'r ') .
rrrrclllltii lo6u, l ' ..l Jol i teclem 'ial'inizunLa( i, t t t lr t ost t 'st t l, at eu'm nl'LiSt li) t r r lt r t r zit t ir ir r I t r t r
.t-Li1..2. Prlbleme etirpatogenicp,4n sind,romul cerebelos rirrrrihr(,lro lczeazir,ccl rrui tt'o0yorlLcetcbclul. Irrt intlivizii l,ilL(\fj' lll(12('lrt'ir
.1. II r()rtlpcprphel4oscria.trpptezenlafeinapJ'oximaf iv60o/odiLrcazuri rrrrri siutltorrt ccrebolos ()u oYolutie lentir, qi ml,i Dls$ ou pu$r)uli i1i totttisi
,.1.r0lo fiild hemargiobla
sioame.cnisrufi,abceseli ri,ti,ii, l;otrle:r,unasuspiciunoa unci leuconovruiitcr lIIiLi rrltts tlrt.rt' rt''
il: .clj:11,1,,;
^ll.1lltci colab.._1974).
(A'sr,-ni
r'(,t,agt*ze. 'iiii si simptomele ,,iiramidale Si vesljibula'rc" I!xistii ittsri,'litltrtt'
-\e orieol i.m spre dilguosticrrl cic tu- i,,,,,t,,jiorr'"".1c'scleroz,i inultipH, in cnre sernnolc coriireloa,so l){tL (r,ll$l,i
'rxx,iu'z,ii,
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_ I u i rrruliril yl'ttno singllrele manifnstd,ri ciinice .
D ir..cit- trrjnsrrilre_$r tnoment- de aparilie, in funolie tle rapiditatea tlez- \1. Afeclittttile rasctdare a[e cerebelul,ui
l.:,1]l:.ii]1119.li depeltlr.bd,rilepe care.te.tletermiin.
r,a c6piine gtndim l. llenmagio cerebeloasd'nu este chial asa de r:*r'ir, clllrl slt
('lr'zlll'
ru Iixrl ]-l
lrrrrrul lt urr mcduloblastom, crr.e do mulie or.i tle"buteaidnrin , ir rt.urizentin{i: de fapt 10-13% din totalul hemomgiilor ptirlrrtr'(! irrltir
' r.l.l'.{'.vhrsalur.i(de ubir.ei!,aJinale. firA greate si fare eforiuriain i,,i. ,,.n biale tltpl, uneJe slltistici (McKissock,;i colab., 1960; (iorn'villo) l{l]';ll;
lcl, bolna,vului), tulburlri de echilibm qi ata;i& indsului (sindromul &re- 1942). Ce]e mai multe hcmoragii ccrc'}{''lorlsc tlrl |rrrl
\lil,diell 1i,i.ngrist,
I'r'l)N vclrr an), staz:i papila-r5,precoce, crerytereadimensiunilor cutiei cra-
olrsorvttte ttc P"opoviciu qi collb. (1980) in zona de vasculaliztl{ irI tt' lrl't't'r't
rt|(.nr'. r'll .te.hr$cenl|t suturilor pe
rlr,, spar1,5t,la cioc5,nirea craliului ladiografia erania,n[ simpld,, ,rzgornot ., r' r.lrl ol se t nLer o- supelt olr ( .
'rrli, ;i adesea atitucline ,,cireinonioasf,t Sr Do&t.r recunoaste tlulft debutul brusc, cu grcluri fi viirsil'tttt'i lrr
rr r':rp.rrhri .i rr gitulrrir precum si.,lize lonicc t,,cor.ebcllaL,fits;'j.
n lit rn tumorilc cu localjzareemisferici iglioame: jndeosebi lstro_ r,,.sl c 90V din ( azur i, l€ caic se lsocilzS, o t r iadi' cat act cr isf iclr : : t t nr t t '
.ilrtrrrrr',;,.tuberc.lo_ante; hemangioblastomul ietino_cerebelos sau boala 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 '
tru r trlr Hrppel,lmtlau f .a.), cit-$i in celevermiene, Bimptomelcdin ,i,,ii."ifltt .,.1.otrir', rgf+), dup,i car-ese instale?zi.ttilburilri rtxpilnlot'ir'
rr.r viloi cmDieni, precum. si cele din partea marilor cdi senzitivo-r.riotorii lartea in speci iri riiplr:r'1iepeti'rtlicri(llc - -tcissrrcltri irolll'l)' tl)(illl
"'rrsl'ind
r,l ,' ,rl ri cni , oum i lt lpidi if t om ai ) . i Rogpl. l$?5) .
r r (lls(.t|1,..llr lchjtnL,.in lumot jle uug.hirrluiponto_cerebelos ap:r trrre_
$o nut tlistinge 5 tipuri ale instahre , silllptomrl Lologirli itr ItltrIot'IrI'.iIIr'
'r)r,c s{,rnnccochleovestibrrlnrc {per. YIIII, precufo si dc afectare a irereihi_ , , r,'l,r l,iise (rlup.r-Schobl gi colnb., 1965 ; !'isher ,sicolab , l{){ii I Iltlxtv.tt'ttt'
l,rr'\' VII, serrruele celcbcloaseapiriu,i inai tirziu. -Pascu,
-.j 19801 : a) Tipul ,rtumotal", cara'otcrizrtt lttitt xttttlt
ll. ,4.fecti.tmile inf njioate ale -cerebelului: l','rrtrcilntla ;i
.in, erotulm enr,eJalitelorde diverse origini, primitive siu secund ,re, t,,rrr. t,c.ebelbrso cu'ticbuf lcrit s.i. piogresir', rtsocilte cu lirttrtttrt'tr. rlr'
,1) iri txrit orlsiulre intracraniand. b) Tiput rrrmingian", - c,.rril,utol izirl' lttitt rtlr'r
irc'l() $a,uct'onice, apar adesea.simptome cerebeio-ase. Dxisti *nele situalii : cr,'f:llec, vllt'tsi'!trttti, st'ttrttt'
rilirr, rrcuil, ]trul,il1ir, a unnii,tuarelDr sirnptomt
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# rr,.rrilge:rle. fclornene confuzionale, slnptome ccre'helotlsc sll'Ll olfll'l)r'lrr-
,,,ri t,ri n.si 1. . ( . 1i. sr ugbinolcnt . c) Tipuliu aspoct dc sinelt r t m t lt ' 1t 't t t r r 'lt i
rlr rr1111i1;1111'11 g1'rebelos.Pentru aceste cazuri se folosegte adesea l,errncnLtl
rlc urtbeli.ld,. ,,.t:,' ttt* f,' i o-t t i*r t-,1, it at . r 'u com i, pr uf r r ndi' l) t ipilt ' r r r ir r lic{" lir t lr it r shr
r,ii,r1,<.r'a,1, hipol,olic $i tuiburili motoiii mlri (c-rrL,rnrrsch(rllzil,tullrrt'iit'il'
t'elt'br.litelr. rle, fapL nemarite arule in.feclioase, eel rnai udesea ( r l. sr r 'isil' r l"
-sint .r' trdrol tase'; i r neniligiene) . E\ ist [ li f 't m r t , 'lr t lt t t ir t r t t r li"
l)t'|lrrr)rr'({lar,ft seeundare},rounile altidalr, s b lormcnul (1,. ?.atarii t'lr,,tias ;i liogerr', 1925 ;i'I(innier' \filson,-Itl5i)),-ctt ,i.u'l.r't'it' lrtttirtl't :r
:r..rrr(."irr(, lnl r-_,eyden.( ljecourt, 1922). Se pot intilni in cele ma,i variatc
irrlor'tii{{r lrrd 1iloirIii .,d ifr t.rie,ru.ico]-d , orusticLrieisi i.u b rnotrle rapidtr,). (l) Tiprrl cu debut mai puf in gr!r\'' t'rl
, sr.&rlaiini. variohi. g;.ipi, pn.r,,,noj", r' lri . rl nsi {. lt r int il, qlr '2Lii, vir sillll i' ccf ulco violct r t ii, l; t ' r t t t ' ' r t st t l'ir r zl
rlrzr.Ilr.t]r..\ 3t!l-cell.tusc convulsiv5.dir"erqenevrarilp"irolice_cu:urbu- ',
viltrsrrli rltr pildil, encefalitXepidemici) ;.a. rllr,ii,,t l,Lrliru:r-tIi tt. con;ti,l1')i. er) {ipul ln care dupd' o saurtn 1{tlioll(lrr
rlo rnm[," bolnarrul igi revino, '^cuzind in conlinuatc rltttct'i itt I't'gittttt'rr
:!. AhceselEcarebetdase sint relativ frocvente, ma,i ales in cazul abceselor ,.,,gri rLIi , g lr ] t uli vi, r 'sit . r r r 'ilt t t iui ules lir schir nlr ilil" r lr . . lt ozilic r r l{ r ': t lr r l
r.rrlillctrlr'(otogenegi rilogene) care rlau in 34% alin caauri abcesecerebe- r' rrr ' .i rumr'icli'r iul'r "i llt r lli$lr r il
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
r',irHr, rn oeleoJogene{Arseni si colab., I9Z4) mai pulin in cazul abceselo:r ,rrr, ,,r,iz.'.i,1 (car,c tlrr,cii,esi,r unil:.toral, inrIi.ri sulirtl Iozillnii) fi tlll lrr'lrrl
nl(.rlnliltlcc. l)eDulul subacut, cu sernnegenerale Fi
hfeetioase, cu discret ,l|rrll itr cor?b0l0s fuOrnOIatOral.I)o lrtrtlto rlti stt pttlttc OVjdtrlItill,i1i rt. Itrt
lirrrlrrrrn d-e hipertensiune intracraniand, lf debut, dar cir aglavareit, pro_
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 '
gt'r'sir,ii, lr,tlcsoaryi cu semne mcnilgiene nc sugereazii,djagnosticul. rt
:!. I:ltmalnnnrL cerlbAljA ?rrrr0df (,,spo l,ltr itr rkrntttttit'(!il, vo{'ll(', rll
ii. 'l\tbereulonu,l cu, Iooali:ure enre.lalicd,aDalc mlri ales la conii si lrr ( losllr l r lo t 'r t t ( r t lt t t t r it t t r t lit li li'i, '
rrrLrh*'r'rr(i.,lo.ir.lizir ,rrr' ,^r' 1rt At r . ict t i1i colr b. , lt ) ?1) cst ( t
lijnrl rrx.mrriiu c,ir,.t,el
1.r.r.rlih'c1ir. ;iin-tfiii,,.i,i,ii 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 lrlttlitr lt r t t r ') ii( ' lr lr illi
.r'r'i!rr.irr(A.s.lii ry.i 'orr..dr.
.rlrlr., 1074). ll'rrhcrrculoa.m.lo ' l i r ' ,rrtIt' i l( '
cerebcl0aFcr'(,aliz(,lllzr'l rl i grLrrsl ,i rr 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,
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 vi rr;;I,tur,i , vi, r . lij, r 'i[ dcr o lil, r : r 1, 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
l)oH

180 I rl7
 (lrrrri (irLlirrlrr.r.irrtrtrNsil* rrupi,oitevazile (in formeresubacut.e) rlrrrrii, vh'trtrt, rl(l il{) tltrlrrri,iIrr. i ,IrI IIrIrr| 0lirrir s0 fltt'rltllttt
iz|rtziilttitrlt rllr lrllrf''
. ir*^('ci(l.lr1'
lrr,lrrrzr'i, r, sindrornneo- sa! paleo-cerebelos,'infi;;1ri; ;;"I"'*ilj ctt ovoltt{iolrlogttsivll, I iirl'1'
scrttlttrtltr l('zilllll ir :rllrrl
rirr'|ir Ir(rIri rr'| rrrrrI rri (Arseni5i corub.. r g;4r. s'. po, t.'^*-cra sirr,lrorntxrttrbclrtx
sLazaoaD ar:i- ttct voil N{r.
do' irilal,ie meningeali,.prr.cumsi ;-";
llttt01'uli
-ir,rrllorrrul pir"*;;;i;ili--:;1; (u detsruLin'ilmaonge'n'ila'l sittt;.ltryrtrlt' rt\'rrtrtl
.'
|., | |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 lt) Atro! iiLa aerebrioase
oelebelos rr:rr'nilt'slrrl ilr l)rillrt l''
1i col uh., i 9Z4). E xj sti ci ,,rr1,, lriin pr6zen!a,unui funpo*ant sindrom
l:ll,'i:l; e\irut run.in'erapi.t.indnoseiri-;;iJ
.'l,.llr::'n,^"_r',:,:,11 L,,,i hup[tna-steie,suferinti, cere1,eloas:1 fiinrl evidenl; lcg,'1i.rlL' ittl'trt
:r|||liirirr(,rul' "rf" gaJ? OcCipitali,. 't'It{iIr
cercbeloase
] _ Alteori ";;'rJ;"',
bolnavul igi"revine pzr,lotoeic su.ueniLin tinrpul vielii inlrartl.r'itrr'{:rrl(ir It rrrrrrri
,tllr :l ')r' r r.Urn:rloasiiinili:rlr. frri a pfezetrLl,
Scmscpret m,rri ',ii,ii niin"a entitSll clinicc se, lptctrirt' lttr.ltrtzrt
cercbeloase. t,.s1ll''c<liscdbriopiazic[. I)iversele Iot
(., (l,rpii r.ircvazile .A aparii iemne de nip".i"nJi,rne'in;;;;;^";;.i gi semnelol de indica.!'iclczionrtlii'ltt.p.'
rrrlcnsit:itii'- su{eri-nteicelebeloase a
'"r,r'r
rrltlii:iffi T":rrt,il",f
H:",1,f,i",":;ff
r',r\'(tir'.rru.ui hemal,omcerebelos.ri" ;;l; ;;i;;lti-"Jrr
jt",*]f;
:i*:F:lt-,""""Xi:?li" "i'rii":r
li,r, '
iptazia congenitald,toiald'; - herniaplazia cere-beloaslt'
n,eocerebelitasd' a lui.:Vogt i - attlaiia arhi- gi,
i. . (tl'ln
Ttaleoceretlloasd l)ilrgtr, '
insl e'olufia lirrtl osto facilitat de pneuinoencefaloglafie, pe rrtliografiikl I'A itt pozift'
('iri r.rr- p.og'r'si'ii,.aspectul crinic fiind asemi,ndtorcu cer al unei neo- tlitt itrr.rlr'
| (,r' lll l I I (,cl'('r'e luJia ( . . lO f .r,zirrrli,evitlenliindu-s6spaliul subtentor'1alrrursiv l;lgit, rtct.rl
i in: t llSCU. lut Um , J r al; ! r r ) . irrrr. t'ealizlnr1 irno"eunii cu ce1 tlin ventriculii la;terali tttt its,tN:i rrrt'trr.
:1. Eindtoamele iscltemice cerebeloase.Infarctele l.ristic de X. in fozilia cu capul adirnat, aelul Se ac'rnul.^zr'i ltrrlr.ii\'rl
cerebeloase izolate.
lrrrl', sint in general destul de rare, intmcr. se qtie cir, li'sir posl,el:ioar"l, desemnind gradul tle ap-Iazie."
:r .r.rqbelului ests relativ bogati. Astfel, ocluzia'a,r"berei
"i..rfi,tir"."f"i"ilil ti; Atrofi,ile cerobeloasacu- apari'lie tard'iud sint' {:'\plesiir rrrr{'t'l)ri)('t "
cerel:eloaseantero_
::l,il.l:ll::,..,"1i" inrrucft infarcrele cerebeloa,"se
3,s.imqromalied,r produse ,' lriotmfice,' degenetativc, cu irrjtere,sa,rocereboloasil r:leci:ii'i - l)ivtrtsllr'
r,r rr'r'rr,rr'rut
,cestal ll11erp<int.mi,.isi dispr,rstte(popoviciu, pendefuncl:r, r rr,r'i*rrtede atrStii cerebeioase taraLivese pot incli'idurr.lizlt6cstttl rt. rlilir,il.
gi a extensiei topogralico rt lt'zittttil.'r
,11101:-it :9bl-lr, ocluziaarrereicexcb;rolLse
,i...]'].1..]1.: anrero_supL,_
pfufluce, pe- linga, leziuni cerebel0ase la niyelul nucleukri
rr,, liaza virstei
,u'rrrbeloase.
la care debuieazii,
"r;rr(! dint-at.
ponto-meze.ncefa,lice
J.9l"tt"ooit (popoviciu ANrofia o:Li,ao-ponto-earebeloasd, a lui Ddjdrina^Tftomns tiratrr itt itrrrrl
r:'nrJ.rfdure sanu_urtamt:,ptur ci, reziuniburbarecu simne si cod,t.j
il,J:,i,fil]:.Ji,l:y"I"t
r i'stei cl"e 50 rie -ani, realizinrl rlrr ll]Lr,r'osiirdrom cerellelox, t'll trvrtl.tr(ir'
,rrrri,rr'\r, (.tl mar Rdeseanumero&Sesinalroameischemicecei,ebeloase
ale trunchiului l)rr,gfesirr6 (in cale predomin[ tu1bur5,rile de mers, ataria' 1i 1f(nl]tl rii'l I l,lrl
'i'r'r1'll.NI (sildromul arterei cerebe_loase postero-inferioare c* r,',iantele s:rlez i ,rt;riiiliona,td,;, la cire pe parcrus se avrciaz5_,1istttttittrttxltitlrilittttitlrtl',
glolrtl"t
,.i,',"lll'.':'l']
lrlir'e'ran-|-b,'nais, sind|.orrrul tui srbin.tri'.r'rg,nrtc, -rndl'onrIt 1,,r'cuil qi iialeze oculbrnotorii.si rrle mi;clrilor cottjrigli,l't'rtlir
djudromut trri pi,.rrr, Ilarie.Foir hrr ..h<,miprr.,.z,r , r'l l l i tl l.
].ii l:,1).]"':"u
,, r"-r,,.lo;,{,1 l..s1rn.
. - \'ezi cJp. l), intftr-ir Inlrelgd jligJli. u' Lu'i I'ittr'
i, ..rcl.;o!ulrii e"t,. --- Atrofia cerebeloasd, ta,rd'i,td cu prellorninanld'
.,\rrrr-,Ulr{r, l,rtm u e cot.cbelo.rs| -@rticnlii r.
l'jscuic Ltio lt"uo(biltJbazil:r,. sc nLri It (,ie-Ioifr:At04nrani,e apare mai tirzi' decit celelalte iti:t'fii .r.'t't'Irtr1'I
' rrrr's. r'irn.rismentere cerebel0ase bilaterale trin trombozcre vertebrcr, r,lrrrriivirsta d; 60-65 dd ani), are evolu-tiemai leniil, iar itt trtttrl'r'rlttl
l,rrzilirr(.(l)oloyiciu, -pende{untlasi l?ascu., fOSO; mod net (sau sint crclllsiYli) iit'lrtlr(l(
Scotif fO6T a,, b). ' r'iiulosic oretiomin[ in
ll.,:LtroJii.le cerebeloase 1',,Ir:oceiebel6ase: tulburitri irnportante de s1,aliune ;i tlc tttt'ts, lttlltrt'r
/. \r' sirrdim la o otro.fieaercbploosd 'ri tutburd,ri de vorbire.
seaundord,s[n$)lomalicd.t] nr(. a lui Lejonne'[ifunn'tlid it1l:llo ttt
/' rrl.r. llrll lurrc.iLnrlrumcclebelos,carc s_ajnsl :tlal la un-bolnar AtroJia olitso-rubro-aercbelousd'
ti care nLt virsiei"cle 50 de ani, are evolulie lentri 9i s. uitlir{jt(.r'iztritzrj, itt
rIr' 1risI ii rrr,.rrl1.iiictul. et,iologic, dari la,care eviilenlieia .;rrrrrl
in antecerlente un prin importanll ati,xie a memb.-,'lor',.uu r!:tli tulbr'ir'r'i itrl'rrrr(ir'' 'ritttttl
r:r'l|t|-t. tocTlos.roxl c. lraumatic. r,lScular,ctc ., po.ibit gencfttor
cI corr_ 'irrrl
,,,,1,,{i o'oziijonale,' la c:lre se asociazil,gi mioolonii (lLtrooti vr'1"
::,) :il] I illll]"1?i-L(.
c.r.ouotos prin jnvpstigdliiJor.for.turfo1lncn.
si, l:r i.i_Lrc.
ale globibl 'it'tttitrir)
o('lllrtl'i'
r.rr'.( { rirl(rgtallc,tomogralie arial{ computexizati,l s_a lr,rLr,1inei falingolar:ingienc, diafragmltice ti
eviilenliat ;-trofi:} ' ' Atrofia' cerebeToatd d'ifuzd tr twi llr6utoa :l'prirolnai (l{rvt('rrr('(l('(rl
l llr' lrll ul ui.
:!.'ltroJiile , ,,l,,lrr,ltc (intie 40 si f'0 lnj ), are o evolu{iemai rnpid; qi rc*liz.i,z}; lttr trlrtir y
cerebeloose pritniLile : lrr rr'
. rrr,ltotnccrolrcloscompl''l'lirlhi, pslco- 1i lcuc''r' Liel'r'i-lril:rl''lrll' '
ered.ofamitiate ne sint sugerate ite intervenlia, r,r' rrsrtciazi,Si semne extlapillmirlalo (itrcJusir' (lurrt -rlll)llc(')'
.. ,,,.,::.).,,1,!.,f
.!il:
' \ rr{,.rrr,ir,ir.
nnot -!t!:!il*yt
l?clori. gtnefici. As el. se surprin.le caraclrrul crerio.
troaicasa irrl,iltcsc in iltoricl(,i* trl,ilitlit,(rt,tlttlit
ri||r||ri||,(lr,Dt .ut i]r'cloc j0 cnpildrioSau In-adolescenti.cvolutia bolii erfe lt. Atunii,te carabeloase
|l'trl Ploglcsir'5,,iar in conteitul semirrlogieo,pal n*irf,rl.t ri r,runici,) itr intoxica,liilo pt'ofesiori:r,1e crorLicccrt plgrnb '1i ttltlttttr, ptr'trtlttt
si alte elernente, -cronictl rntli tlo hitlll(oitlt' (ilr sllrvrirrlt'
respTtil-e:-. pcta^la ,i i,' ,l,tlsul tlatarncnl,elor eu tloze
:.:l:.:ll f:::l-1,1:".,lglli tui. frri,ed.rei,ck
tmphcli'qi l;zi""i prirnitlont, 5.,u.
,jl:,111 $i tulbur5,ritrofice._ Hredn_ataoi.a .&pinacirebeloa,aA lr,rrobru'bi1,*1,
1.,]'-1'l
t t l l t.t l?)r"froarc .{ C rn n r,
rttr t ' e J A 41L.itds o ei rz i L f i p i U n ti d a l e Ji , cv{.nLur.l ,i l emeul (. l rnri ,,_ li. sinilrowtcta acrubeLouga trawnatkle sitrl; ttqol llo tccuttosott1, I ittittrl
lr,l r((. ( t nl r ) ( r ilf iLlur ( h u | r,r,l . . I)i s i n e rg i a o e rebel oasi mi rir.irrrrit rtll,l,ie,
do fitotlrrrtltr,t,rtr crllrl l)r'rrllt(xr ('r,lll Zii, llr'lrlolttgii illttt ltt'tttit
i , oel oni ad u, l rti ('nt'r vrrtirltil tltt llr t,ltz lit, tl;tlr',
l.knnwy Hu,nt rk'.ltrttrlzii clt tlizc rlo r:$ik,psio ia,l .sindromul . lolutc oot.ol,,rtlousr,, (ltrrl,oxl,tilsr,rrri.l,rgir'
cerobclor, lrrzittttilot'llillulllll'i(x"
rlt,irrrt,,s,, :riirxriirzi,
qi oi rriiocloniit,"liizlt,, la urulrhii ttt Ittltofio tltt lrttrtllizttttrl1i t':il,ottlirt,
ill:,'::,'1:i,
r.r.r fr .r.,1".l":,1r
lr{ rrr)rr'k)r' rr-rr1x'r'irrir'r., iod'Jonili'd' ( honkt'ht'i I'r.nti+lltt) (xrrrsl'ii' rlitl
1i .u (lr.ir.r'ir,rir.rrr
Ir','r'rrrrr int.r'rrrrr.ir:rri ll, Ataoitr, Ialtupinoht'z
l|l1,]{r-f.rlvif. .tf.rolta otrl,od(Vtltt ltnxd, u ltti eoft]on_tItlittr,$ rlrirttlr.rrz,i : 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 '

r8 0 180
 alolosuDrerrolor.
l"i',i,;lliJ,ijii,.u':tili,oo"_T$'f;,lt ttinjurul_trasusu.rui
si
rn(. .rrt(,sorulu -famiiial(cu tiansmisi
olo"-*;*ti"11?rlter
'cr.csiv*]*t
'"^iffi t;:"#3"T'fi
li{.i:#-Hffi*
:::tl:l'lt:ffil#xtrall,#ffi
t"*itix'3;Hyt3:l#ff;
iijijiHilF::::;,,"i,!" :"3lidl3i#5#ft
a lui Dennv'nrowq;
iii:.ilillii;i; Affi'#-1"Xt'#ignetizare" dnexaeae
;J[Iiugsl$',1ffi1"a,i'fl i:',"i.}}"x'ffiry**ili|I';
r{iti'qT#{f ei Botezi
F
O.
PROBLEME lt'tspl'ttot,,otitlt
DEDIAONOsrlc
INVoLUNTARE
MIscARILoR
r1);)t
i srsorqi cora).r.,,
r;r;, F.ff"'fi
"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'('.'
r.u deplasiriiegmonlaredd obieci limilatc'

l. Mioctoni'ilasint eontra,cliirrusculareinvolu-ntat'e, (li)r colllli(lllr'

r,.u*ia,J" iil clonie,arirmicc5i uneori rsincrone, alteo'i sittcrottr' 1i nlttr.
rria"."ii-iiri" lr un'lascicul :nuscula. sru numai la un rnurochi (c.vt'ttlttttl
i,fri*t mai mulLc grupe muscutare).Sint asemlni'toare cu 0{)n1trt(tlllr'
ino..ri-u "" ptoOrie di e^xcitegiite electticc galva .no-tarariice' fntctt*itnlt'tr
iii"ii"" mt"'J""ii este foarte'variatril; tle 1a individ _la intlivitl tlo .lrt'
iiir'^iai" rr"ri;. u"ele sint discrete, cle micii, amplit.dine, f[r]l 'ir'i,rrrr 'i fr,l
il,, ,lellasarea segmenielor corpolale lespeativcl pntinclu'sc oottiittttlrt r'tt
i;,-;i;;i;tiii; *ui-cutu"e. Altele; dimpotiivi, sint tttlgertrtoarc, :trn1tlt"
;i;;"r,;;r.i-;;r;lor"-eiirix s'egmcniet'corpornlerespectivo $trtr('lrirrl
iiifii:*,ii rnin6to#
-o,lu.nt)
i ritmiec, sfereolipc, conrinut'(ttrirr'll"
ii'ril"te;; "J"p. 9i mioctoiii mai a,tnple, carepot produco (lorctl'?o!:'j t'lottit'r'
musculare
" mai intense.
il;d cum ne fune dreptrr,te au remalcat Ga$ttuutfi colab (l97J)'
'reprezentatmultd, vreme o. sut's[ dtt"t'rt:rl'ttzit'
,*,naaoiii d'J,ffiucro"i"" a
s{ fie utilizat ltt st'ttvttl
"*tii.l""ii-"ioei.,i"t*.oot ad ,,*ioelonio" trobuie
ii ,i"'!ir"tt*iirli.
contraclic musoularf involtttt'
nf. udi"n s[, iniptice orice
i'iiiii,"r'."i"ti,'"J-;o* I ot"tilit lictr, Muskens (1928' cit{tt <lo Gastnut 4i
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'
i,hi mlioi,lleproducindo rnirlcaro.
'
ln luuctio ritt tliatribulia lor splJio-tetnpwald,pot' Il dlsiinro doutl
u,"roi'orfiiirioiu{a iiiitoiti W"orotir'ote t n)-mipolittiiJragnrenlafe, nlunel
;il{ ll nrjinotrlo vrriat'o'p&r!! nlo irtttroulntu'licoqro'
rnlg i "ft,ift;ti;Jnoron
b) at{oolond{nncluo nrnr rrlnerono
blla,tor|l.1o, il rlltlFttl(lo, 6n.f0nl0olloutn

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 _
(1lltol)ol,lttrlttiicl,tlivt,tHluslttrclc,tltrltii ittl,ottsilrrlrrrt, ltctrsltttrt
t1it.tilitttlrrtt':t
tttttt.It\'lu4 ltutlltlt I ( iLr'\)r'irni]I lOCalizateln o jUrnir,t*te llllilJ, llll;ll; (lrtrl,a,trl,,,si
((lir,s{;rrrrl,, I}Irtttgltiott,ll)71JII'rtpovirritt6i ooltlr.,
at cor?UlUi, SaU h ll)?(i; illt$sir).rti,,sicolrb., J {Xit}): lt) MiockrtriittrLtlivosit,tlgtrltot'rrl.izrtlt',
nitt
i u r s{ ' llr iI ( r } t t o; po rl l .
clrxrt,,[lilafirt'rrk',rlo obicoi silttol,rioo,ltlttxrli itrsii, itsittttrl'rico5i itt lrltsrtttlii
.lll::;f,l"ll]:.."-:11f9! fi nesisrematizat5
impi,r!fte fi in: 3) mioctoniisporadiee,aticit,
(rrli,errrindd.olao crizri la alttr,,tle o p:irto srtu rtltl lttrrnioot'1xrt'lli1). Artslcrr,
I, ],,1.
.,ll':.ili_,ll'-r.Tlljj^u*,,
n. p|urttrrttu,rnlFtTirll.rnpi muli iaU
I b) mioctonii,,pseuttoriknice,,
, it rl;clcsoilzii,cu plcczfiderorllusculat ra axo-tizornolicil lii lnu;clrii llrrrioli'
maipulirr fixe.
l)i\,pxLnct tle ,ed,erecldnic, ruiocloniile pot f-i ciasificate tn yrlrxlrrcindo bruscii flexie a capuhli qi o proicc{ic irulint,ttit,lr,(,llbt',,l,rtit't1r'
umi,toarel€ liorr:c, mult mai rar fiind intercsate $i membl'ele itdcrioilrtl (r.rttciitlctr').
,11-{i, ii r.otub...
r"or.r ;i colatr.,Jgz2,
;.popovicru
.(ll:
,,, ;l^_.i.il].1!o,:,.Gr.h,lt,
,:lo'lltcP (ttt.ufne t potologiae. lr) llioolonii parcelare, localizate la rnici srrgnrcntooor?orfrlorsitll clt irtr t tttt tr ri
:...,r.,), ,l l! .hipnict) bJ car€poI fi, la rlnrlul
t.t.'!,.
i -. ttttn?rotlt' org.unt?e.ncppilepltcc, care pol, fi dc divcrsi etiopatogenii: lrr, r.numitc fascicule musculare (fil,ri tleplasi,ri segneDtir,ro).
rl|r.r,rr,rirsrj(encr.Illitc), to)iice, degenerative,metabolice *_ Aceste rnioclonii insolesc o pierdere de cunoiitinl,il,(ltbsoltl,ii,), :lrrrlrr'k'
etc. 1 m-ioc1o- iilri)rnene (rniocloniilc qi a'bsenla) filntl cxtrem de scultc ca rltltrt,lit (ilrr lrr'
rrr olganicc epileptice.
L) ,l[ iocloniile orllani@lnepileptricepotfi intilnite in nlmeroase afecliuni 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"
di,,t enaeJtlikr epiLlem;ct,(fort,o tt,iortonicdsau, atgo- rr,hri llusirens). Un alt element semiologicimpoll,ant, csto trplcz(rrlLrrl,(l(l
, !. .I!?r,y,ij,e. ultp tt,ptyo
,,,,,'.,,,..,.,,,u,,ru
) lt lttL V[t? eunlrope Srnr l,irpidc. rifmice, Unebri rIcscii,rcarea electroencefa;1ogra{icd,generalizati,, bilil,t{rrN,lir, Hi,)cr()111, fi
'r, irL||.rtormpte (nu-d{'plaserisegrnentare). Apur rle obicei in coDl.cstul
tchra. radicrrtatgii.pare-liziiouula!.c.bip(,rsomnie(srrr pE f tf MA L l \4IA C LON tC
..' :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,.
...l|r *lri)snrdo IoliitrLo) ,si cernbeJoasc, lparkinsonieno
(.lorcaaelectriad,a tu,i Dubiu i cste o formii, pari,ic'iari,
de nevraxitii,
' ri'rl,trrnici.crr rrrlocloniiampJc.brusle si rlpitl"e.
, i / tl:: sub,:Utp1r,eSS7qi;n tpucoenaclat.ite.
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,._
I I'll]j .,,',, ,-' r :r ugil!l,,ili.rnl",, insoiir.r,
rruoori;i de urrciipcriinozii lipisnrt.
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
\i l u t{ l o l e \C e ntj , l Ll r_uu | Otrre:l r.l i ni n C rr c5 -r5
..1 '{.r' r r , . i'pl' , gr CS rv i l s l d ri i
.g e U e rl l e . :rrl e s ca oA fcbrj . (,u ,l {.nteol i ch,
pI,'plir.e.l1y,r1x_1;.
esrcs,ibacurr.rnorl:rti.rlupit.
l,'.,.,:i.:.ll',.',
i,-,,I l,:i::
I iirir,.'!rrLr |o{:1,. . I }ljricrrueckpr(1974r
ltlrll). si_['opotir.;Lr ,.,,1Jb.(tgi6]
i,rri,rrriili. -,i
ttin pESS prr.zrnrao .:,,.initn,.rr,in,,,r"
,, 1t1i1,t-!51,:l ttit,,r,.nr,iat^
r. I.r {r,. ir11r'.rrr1r,(lonllree.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
, | |,r 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
, crrlrrrl,clizr,lrz,i pril nioclonii sinctxice, .lui tlri,etlreiclr, aparo la adu11;i si
'(1,12
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 !'f0. ,8, ARp(,(ltMl(i dc Pfltt Mlrl rlrioclonlcl copllul ll"NI" 4 nnl. sr
'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_ ob$(frvll dcsoilr(r'lrirlo Jxtllvlrlurlulldo bilittorlrlo,6ltlctollcfSi ,llllt0ltirlrl
'rr c), I ' l, l( ' r ) r , ir r , ir ii t.i rtril i L p s i l u rp a ti . (drtlI l'.r/nxrl.lr $l coLrb,' 1070).
W) clilt1tt,itu ltoi Ii in{,ilrrilc itt ntnna,r.tasl
,. ,)li,trlrtniiIc
(l tl Jot tttt: tl,r:L:lrr.,.
1 l I ll l(t' l )l )l l t )tJt)t : trrrgfll,ivo tlo l0 o/rrrrtl., izolllto nlltt ttt'ltttt'l,tttltr
ritrrrd,ti0ii,, rlo utxlrr t'rxrt'tr[:r,trl,rr
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 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
,rti r x : lr t t t it t t r ' 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 : . Jtollvltfrrrllo4l polivllt-tttrtlrrlo(/ig' l4'l/. lll'rruvltr['rt
lrirr:hroutn,c'l;trrirl,lco:
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., 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
srl l rl rr l 0 r.i scc.) (l \rl rovi r,i u 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
rrr l o l, r lr . , l1)^r ?li)' ir .li,., r I r r r ili. r l,
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 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
, de 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 )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, ,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
fiecale ,,vlrf', t1c pt, , (,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
l,ll,l{,1iir pr,intr.o d.,soaircarentuscnlrii lrioclonic5'iTassilu,i';i
,rlrr)if('stti
t rl rrrr . , I ll( i1|) . ,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
'.. ('ti,:, l" cpileTt.ire tiotlonice qenerrlizate biktter(Il.entttsire (1|mgoclonic

titl
, ' 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 ,
/, /./i,\ lrl.l,'frnilirrlogilr, rrrrlu'ilor anglo-saxoni) pot sil apa,*.i itt tty.,t[rtc*rele , 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
r ttltlrr!i clin iut tltile.plicr::
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
) in l,ncl,. t'r'lri rlp ,!.ilepsie.ltetit zral (rclatate antcrio].) in o:,.r,e ,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
,;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_ tl 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'l rrtri i t' llr
' , , s( .jtt {' c' t)u) .
ir) irr :rrullc tlin cazurilc lc tpil.c:psii t:atrLtlsi,tL
!,l t,'t,r! ; |t . |, 1, , t , i. t . , .,.| o t,.iJ,, 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
It, r1,.[1;1
11rrLnd,-ntu[. 1tr-iuvtt,
1;yfi i z, i , i r,;ri ul ,l
lt '
r' r'l )r1\qr' (,siYriti,r . f iiz1Ir kt llr il, f il, Sin
rrrtrl rrl l ri rr r Lcor i si t ulbuvir i cer r ebelolr , sc,
1, cnuill: ll po1.t pii|c: l li s0t t |llirr . r l|r r pit : r

r'1 ))i:titrcrytirLtn' telotsri mi.oclonicii (o, LuI lltnr,su.y ,l/rrril) rr. lrrrrr1,,
[i l rsdaut,si 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
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 _ 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 ,
' 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 ,i,rfirr lri{)cLoiricc inlsive) ;i ln sinr.lrom atolcbolos crr cr.olrrlio ploglr.rrir;r
'1 .,,r/, , i r ll|i. t iil ( 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 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 , ,
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 rI r' .r,rri'r' rrt i rrior:lonice fi descriroirli llil(l
-c i t1o poliv'ilfut i- rll(l{r rlrr il 1"'r'ir
r||,rl') l)., 1nl trriocloniili] care apftr fi. c] uni. fc1lotllrn rpilcptiic (109, din r l r rl r' rri si : r r r t c do 1i li sccnndc ( I i nr lcr . m eclicr ,19?4
. rz.rr'il, f io p'ecotiri
, I lll, sir r r r li ; i lolr r l, ,
.(50.0/o din c:rzuri), fie (3?f/o), I-ie siit (i;lco_ l l rr' l ).
rrl {,l t1 o olt 0r iz ele to n i c o -c l o n rc e . 'rmeazi,
ti fn t n t+:.fakryt cttiu, 'nioclotticii cu, lti.1t xr,riL'rn. ic (It.1l.L.ll.) (funlr lrtt
,.) Ii.,i;.iii, qi clzuri de cpilepsii manifesl,:lte prin cri:e et:clusi.u ll, 'i7 irrlilniirr (le lr,selnener]rnioclonii, ii{losoa rnlt,si\.1-,
ntio- ("irtl,ssivo rrrr',,,l,r
,'/,,rrr,1. ;1;.,,;1,,1"..irr sleciLl in adolescen_ti untori si in mica copilir.ie), rrr ji rlis'r). r\ilt,lcl, 11rorzul.ile in caro sp:.ts]Iloleint0r,esolr,zli
_(dar. ]'llLl,oil {"titr l rrr.
l r , ri rrrir,(l,rnii1cm.rsire se produc rle obicei 1a treziic 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
', .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. 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 . ,
,lorriiT,. (".jr.r'lis") p,rt fi pr ur.oc:l,tc de stirnularerr, lurninoa,sl intirrmitcnt.), r,. 1 r1111' 11 1- ir 5,
r lr. , r sr r nlr ht : it it udinoa
, , 1[ t , u1uiin Lr Not ] ',( xl] ] l] ilr l, ilir , rl
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), ,, 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 Ir rIl,,,i lrtt, lent:r,l : -1 9 i 2 ;
,lC rlzele S-o1arc,de lumina de tCleYizOr, rle r'rr'r,,ii {lr)il,r'rnuscuLltur':l Lr'utchiului ;i a llidircirtii rrrornl)i'clor',fl(' r',,rll
,,Urmriril
r1 ,",\ izI rl.'L(J.'rerr iirg epilelsy,') s1u do stimuli irten,tionaii j :rzi 1rprrsnt ill ilr i] - l izom oji{t , c&r 'eil, 1, , sr .s!
lpiiml.r:rrea . 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, '
r.rprrl i..:r rrriiriii in firf:r, u,.hilur, stimula,rea luminoesti sl,r6boscopiii,i. , ri zl trLi r;i rlolLicr
Foi,o- r
r iusiye ( 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
ir, rrrilriliilt,ieir ir,ccsl,Ordesc:i'ciri este bine cuiLoscttri (Gastaui si'colab., 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
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_ 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
, r.rt
" prrlpr.lr,;rli, ,t'rt,rl.r':rle'i sirlctr.jce, uneorl lilritate cloar ]a rtru.cchii periol,bitui , 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 ( '
,rr da. rte'bicei sint difrue, debutintl pe rnrrschii axr,r_r:izome]ici 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
r1rrrlrrri crl,inzinrlu se qi pe tnu;chii periterici. lliocloniile masirre pot lveil 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
l11!,\'('rl4r r'-iililbiio (rle obicci 1-n/s1 si aprr rn ,,elisu.tde mioclonice)' 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
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 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 ".
trrirrr1r. .. Ul |hi:rt rl'- o|e, putinit cuirnina.intr-o crizii
Ee]reriiliz?1ti tonic<t_ \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
,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 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
: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 ,,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,
,*i p.iri it*,esli- Lr 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.
rlrrliilr, 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 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 ri trrl l til. c . 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, .
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 , ,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 lili. r 'iiii r l, r lr r
l\ r iv( f lr l: r r r lr , s1, r r r t, r sl
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 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
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 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 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 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'\
l i r trrr.r r l llur 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

t!),1 l115
 r'(,rlrlrH(. 5i p'efi'r'crr(i:rk,:
rrrrrrychiirJlului p:rl:rlului(,.nisti)Srr
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
rrrpirrir,{ie). Cele rnai frecvente _migelrialtemante rio lrronalie-
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
. ,1..il'r.emurd,ttuile
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 pseuclo-
nr.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 aero-
rlirrioi, t,rrlburd,ritrofice qi sudoralo qi eveutual tulburari do somn,
. .fr'usc.iculalii_musculare. izoJate la nivelul mugchilcr felei pot fi obser-
v 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.
, J,l..ri,std,uneori-fasciculalrii izolate_la basedowieni, la i:rdivizii surmena_ti
5i rrntxrri dupd, o obosealS,musculard,intensfl la indivizii normali {miokimiile
lrri {'rrrt'ho1).
{i,1.!. ll{igctrri involuntare alternatile, regulate, rilmiec ;i stereotipo
. .'l'rr utor_ul.r'a1lr ozintir,o-m;$careinvoluutar; rapidi, sf orcolipit, rIc irtcn-
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 : Nfitt,ririfrrr,orlioo ,vr, inlthuso )n:
.1. lltrentlLrdlura ila posturiL. (a,ry1,-zisi1,
,,do lcp&us" -- lolmon vechi,
tlrv:0trrx.llrttrzriltrr') 0sl.ot.ltrtltlt,or.iHl
i(ir'1,lxtnt,t.u sirxlrotrrtrl rrxlrlrfrjt,tr,rnirllri
'|t0
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
lrrrzi(ii(ittrtlttsivirrlrozi{ilttir:ttrltitus),cslc t il trritrirr
rlo Irrrr1rIiLtrtIitrrr
rttorI(,trLl,i'h,
rll Itr'rl.r,rr(ii,rrrir:ii,
(J l{) oscilr,{ii/sr,c.), r'oi,r'ornt'lit:i ;i llrt,rlrlogr.sl,rrrrli, (irrrilil,
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,.
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
',r :rlr. lruzelot) de mici rmplituclinc. Pot fi : .fi:-iolcrg ir.r (tle iltosr,:rl,i11irl,,
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?)
.r .lr.rrrtltc ori sc.insofesto qi de ticrrr;i,tlc spasmt:;i rkr curilorsiulri'llizrr.rr.'.
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 $i asincr,ono,schirubintlu-se noirrccl;:r,1, do lir, llrr gl'ltp
rrrrrslullll ll altul. Sinl; va,r'iabilcdc la un monrcnt lir,altul, so inl,rrrsilicir,
lrrr.rrro( ii, lir,eforl,uri 6i ln cfcclirilrtu,rrnor acNiuni rnrr$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'.
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.
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,-
: '. l l r n t i l nl i sttttl ( ti r ttl r u n ttl
''r tl ttr l tti
l tti I't1 1 :t) l r 'l r l l zi l r l i r o l r l l tr 'l '
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(x1r*(,s(r*(lrrso i* .,rrlcxt,I scmiological rospectir-ei onc,t.riiin , , 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
,i
rrllor' (l(r irLloctic gencr:ll[. "i ""m] 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 l tr o l tr t'
c) (lort:eo,itronicii a lu,i Eu,.ntington aplre la vir.sti adultti, fiild , r r t r r r r r . r i ti ( ( ) t!,i r '( ' tl ttr l l l ( '.
lrrli si l'arniliilliJ.cu transmisie.dom;n:lnb,i.Atingc ir eredi_
mocl'egal ambele 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
,,,.i'_.:",11!]i,.
lr'nr-pli|gresild. biperkinrziiio sirt rnri emptc, mri 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,)i.:
,rzirrr'. rr:tt.r,cvl rnitr tcnto decil in cureea
S.rderrbam,tnr.r..uliiind ntrri 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 ,.
.,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 {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'
' ...,,1),..,'r.,-,,r::
:. ::!rild
, ,
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 _
l)iril,rllidille;i dc lacunarisin celebrel (inctusiv cLr nerrrrrcile ,rr"ol.igic-psi 1 . . l l t l , t : r l r 'l r l czi ttl i 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
Iricii). , , , 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 ' t t t t t I t t I I t t t I t r, l t|r 'r l ,r tr tt
(',tttik ?)'on,ices;mptomd,ticepot
., )
(.or\.t,t'irlc
ap[re:t in t raurrrJt isrnole clajtio- r r . r r r l . r i : r r r c l ll r r si t'r ' 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
sr rr unele clcctalopatii toxice (indeosei:i cLr oxid de ca|botr) | | l ! , r , ( l ( ' rr t r r 1rI i I rrr I i t rr r tn o tl ct'l ti L 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 ',
.ri t.ltslula,rc. |,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 l l l l ( 's{'r ]' l r j zr l tt', r 'tt r l t'tti tr 'l r ttl .r r
{',tt,",t rlln ptcrlr'upoliile inlunlil" r,,prr.riUlI rl,ty 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 '
,. ..i ) qcminlogicclr jl|rporl.rntr.;r,rn,rL, ult qindrum r,' rrrr(lllrj
pir...rmidaI,. r.\l,.,pi|ami- ''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 ,
:ll.ritrll||l,:9rrfe\l
,lrl{'. l)sr,)rcc(tcl ,ird.tr.cminL-llril,e\pnl ,ri si r.u ciiz,, opilepr , 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 '
i6...Du obicci
r.sli.rrrrbatle D- c, mi;c5rile coreiceliind asciat; artesea, 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 ttti ti si l 'l tr r tl i l tt'' tl r tl tzttr
-hcmicule cu misciiri
:|l (.]r,ltcr., toallzinrt o Coreo_eletOZj , 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
. 7).
rytre'r hpnipleqiriIur est,' o bomicor{'ocrr. :lplli, rudlu.cbi
in , 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 ,
lr'ttllrl(.gllp infrni ilc ..i uneori ir horrtiplegiiiusascrrl.rie.Sr. irr.,rfoslo 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 '
dc
olricti qi de rnigci,ri atetozice. 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 r i str l r i l i i tt r t{i l ttr l tl tr
h.) I{ernicarei,le d,in, leaiunile mezencefaliae (sindroanrcLe de ,n,uclezt, , , , , 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
) ttlt r-tllln.i.oarp snt infertoarc), talatnice ;i ju,nlatalamiu sint tle obicei 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 ,.
\;r\('t.rre lr se .ecunoscin contextul semiologic de suferinli \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
xrrrr tiilamicX. 'rclcncet:rlicd, 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) istpric{irp:r_tr, Ia copii t1e vilsl,ri scoltrr,X,t1r. obicsi il nici , I rrr;rilirrrrirlrilii.
.(.lareeu
( ||r1.r.'.rlrrr..rTrtrritLcoliTe, rr) ltdo::rt, dubtii' (st.:,tu.s )u Q,tttto'a,lll* al hti lt o!ll.) t'r'lt'vi rlc rrlrtlli 'r
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 , 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
|r1'r'rrf:rJspecllr1o.Ijlor,srut mai a.mpleqi rnai d:lnsanle;i so evirlcnliazri qi 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
;r||(' I'ielnenle Dtihoqen e. 'r r : r l l i I r r c l r i ti r r e o u tl a l i ) . 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 '
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.l..,tfloc;r; i,wnlu,rtalr:iliseuntiluc, inulto, rapide, dlr rnutt mni 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
li||rilitlf .i InHi rtcroolipe({l!.r.r., 19-,.,: 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
. Tiaurtle
.silt ;nisc,rli inyoluni;are intelmitenie (discontinte), c,Les-
,,l,,lr rtlli ( ) 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 ) , i tl l l 'l l t r 'o l l l r '\l N ( 'l r l i r ,l n l 't.
,lrl ,1,.,,-r,,lrlorrr1rN,
,/
corrtplere,.brn;tc, repet:.te, rapide ,,litle clr:rcicr clonic, , r t r . r r ; r o | i l t zi : l ti l x'ti r ttti 0 q r r tr ctr tl i zn l i i t'\1 l tl l ) i l i l l l l i ( l l l l i l , t'o t|o tl r i 0 zr t
Ir.r.rr Lpc.-\cestc acio sillt inoportrlne gl absurdc, ailerea :.ealizind 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 ) '
lrti incomplt:tre'r,tloar schifate. Sint loarte cliferite ca morlalil,ate tle"ex_ ,,ges_
l ' | l r , ' o ( 'u L|l l ] r .r i ttti tsl i t,i tl ttl i 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
Jttitrt rtr. (clipit, jucrnntlrr, blelerospasm, grirn:rse,tuse, rtisucirea gitului 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
sr,r,r ,' LPului,rniccili :rlp_membrelor).Acela;i tic po:r,tgsi'r, fie lepetat timp , 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 i i l ) l tl z) .
,lr..lrrrri_r'lu_ rr,ni,ri,minind absolut sterectip, pinii'cind pozrtc sti tlisp:llii, , 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
.r'rlirrrl locul altuin. Ticurile ccrleaziiin sorirl
!i, la incep'ut,pot fi influonl , 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
1r,l,{irl(l critro voin.fri. Sc exagereaziiIa emobii. 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
llorr,l,rr.
tk.tttri,ktr(a l,ui Gtlles d,elu Ilourette) so polNe l'esunoi]lbcplill , 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 )
lt1.z''rrlir{lr. ii(uIi rnLrliiII,',gorreritliza1'0, cn pt'orlornilrrur!ri la, nivclul 1c{,0i 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 l tttt
.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{,- , Ita l;tlrl)(lil' tl t.l tttl i .l i tt ttti i ttl xr ,ttl i ) i tl r tttt' l r t I ,{i I l ''r ), I I | , ' tl r ' vi tn i i r r r r r .l
lrt'lic.i ciroIrr,IiIr).l)obrrtr:rr,ziiin copil,;iriil,tlc rrlriccicrr ticLu.iir,r,riirlo,
iritri,sir 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
r,rlittrl lrlourtsit', po rnir,sur.rt, lutorrnl,rti,r'ii psi!to1lri,irr,.
;ii rr Lrt)IIttr.riliIor, Nrr , 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
tio {,otrIrI,IrIr'i,
trici rrrrll\rntrrlr, srtt0ritri,illrrr.v0l r,si,
olgrl,lli(:ii. 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

l t)
' ll
 rrriuctouii,
atirriir., \r'rrrrll'ri, rrorrl,rlclir lotrft,iiltrlrrlzi'l,lll,rrnlrlrtprl o trcrrr'1il, yrtu'irrirrlll,
(notrrnrlr,),
J,r.()Ar'csivii,
l]l1i::.i:lill;,1'i:,1llu]1,1,1t,', tlizrrlLUo qi rtr.rrrrrr, , rr!ttl litrir,irrrl
, ir.totozrccfi 0r'izo
corr\,1r
lsiyo.llvolulia osrerrpidii( | _ 4 rrrri)spr.ir xrt rr'virrrlirr lxrzil,irr,rrorrrlrli\,rltr. irrrcrlirr,l, lo lrt.orlttr,rrttn rrli,
lll',,]ll,llt',' ,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,,
. t') Ilncr,lalqtotid corsccutiDd,pritrobtastozei.fetate (i.terut ntralear) r rrlrri,cllt, r,on;(ir.rr{, si!lr lut, s(} ollutlt llr,rltrltLlsalclt,
tUut. tnt,t.ntp((ttntt,tqk
dc Joet0/r_Ehintrutre:te de fo:lrtc multe ori in tabloul olrprrltri,ltlilr goHl,rrl
i(\rrU,)iglc col.co.atel,ozi,bilateraLi,. geoer.alizabJ,, rrrrlrrgorrirl rlrr cortl\ic, rnili rlcgrtllii,sjrrrJxrlic rlocil,olic:tco(l.i,iBrr,ll)f!:
,sociatd cu spasm de llrllrllt, lf)iri),ci1,tr,t.tlt
- ar,axiecnier"ioaJ? $oflrrlirt[,1$(i7).J3olr,llilpllrt rlo obir,r'illu lrlll(i li
{].::lll:lll,:l
Llt::':ll.
(,rvt s r r ol, ."".]lapiramidalni l,erraparezi, rrr.r'|Iltoh)r lrrrrgltrsiv.lr:i, trn it(lolosoorrttto Vorn gi di irt f itnLrlrltrrl llr,,r
r t ( . pt lc o ft d e ti C i b i n i c l p C tu a l .
, rrr','f;rlilrioltidcrrrioi,sitn l[ o seclttrlii, postcrrccfa,li{,i.ii,rnlt,iilkrs rllroii,gixirrr
dltrt{ m.al poate face.parte.qi_tlin cortegiul simpromatic I irlllr $culno rlin selirr,exl rrlpirl,rrridllii qi dacr'lplr:zini;ii,gi r:r.izcrrcrrlogirr,
.,.",,{] 1,t}..1:1.
,:lli:i11
iJ"i/#'f#
;#i'fi,1
ifi ll$T5lll,lil:l*,Ll"",^fi
i;Hf$,.1"",*f
(listnnin lcnticulard,, corcea iui-Ilnntington l,li; r r,vrrrtur'r,l- pareza c,onvcrgenfci globilol ocula,ri.
f,)st,rrrlu o dcosebil,ii,irnptntln!ii, practicr-l tlil en!i?r'm ,i :llitului
; .r"ao-oi"iI, cerebeloasb. ,ltrrtttttotlit(tlc ori.gi.nce ra,piramlduld,) d.t: aLte dc turl,ir;olix, r.lnpfi
11),Ilamiatetozaesto rezdtatul unor leziuui localizate, care gener€aza J'orma
, rrrrr lrrrrrti:r,z:i:a,\ l.lorlicoli,sttlcon.geni,t&l csto perrnnncnt, irrstl{il rrtr0rlr,i
jiil ].lli?l .ggt"togic cu hemipa,rezi,,silriro.ln t aramic qi'nip"rk'inezie de r rlr. rrsimctlii trl.nnio-fa,ciale. Acest torticolis congcriital loltro I'i i:ol,vrrlrlil
r rp r.riuzr(. (Bjl.u.coreo-atel ozic). La copii tablouI a parr. dupL tr?umaf igme
.i)l ( , J lo ttn',t nmllatrnatii crutt,icne,ocr:ipitale,ratebrnle sau, nru,trcu,fuxt (rlrr olriru,i
,,i )srrLlr gr dupa c U c r.ti l l i re
.(ru j e o l i c d ..s c arl aui noasj ,. L.ul reol i ci . dupJ, ,,r irfcrr{iabileratliologic); b) I'orticol,isnlsimptomatic cste rnnstxrrrl,ivrrrror,
l rrst'.oonvulsivi,,
.diftericd 5.a.), La ,aury;.,',JeJUi""i-u*i"'to"*ucutivd tra;u_ ,'r izr. loc,ir'le: tnimitd, localli (roumaticit, virol,icd, atc.\, red,i(rtLilii uroi.aqll
accidenbelor
vasculare
cerebrale
ryiexceplio- rultniot'it,s1ton.d,i,l,itd,, arahnoirli,td, ceroi.t:aki, ln acesto situ:t,l.,ii, tol.t,iooliHul
lii;l'':ft]'$' iitti3i,T"Lo"""' 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
(',!. I)IS?ONIILE(SINDEOAMELE
DISTONICE , rrl:i,ry]11'111ip rLscaliietc.). jn acestesitunlii, de obicei tottiicoli$ulcrl.oIirrrlr
SAU DISTONIII,,E
KINETICE tllr.r ic.irnintc, cu inclinarea,.laterali,a capulli), tlacl nu drrfilitiv, ccl prr(irr
_ RISER.1952)
SPASMODICE 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
,'lirrt mirycxriinvoluntare cu caiacter tonic c:!re teurizcazia
pllti':Il;tr]i, o atitudine ,lrrlr';rzii,citcva, orc, so ilsoleqte rle ce{aleebrrifall;i tlc vir,r,srituri(ciizr,hr
cnrc semrn!ine un timp rrariabi] (citeva *""aro,l" *uo mlnutet. Irrgxjiir€r') ; rl) It'alsul torticolis spasmodiaad,reinsole,ltc, 3u11, s(u .
l,r'rrrilrpcl r,irnramal mult sAumai pulin durabild,pe care o induc. SpaSmrii 'li' ,.r axtr(J
tl.tr l .t i net:ralgii a nera occiptital al lui, Arnold,, se rccunorulo rr4rrr,,
_m.arelu.i
lll"j:,.::--!]lli
||(. lll,.!ll, !o Tgp:t1 f1;arielrlcvent qi -adesea
in frod_srereotip, ,lr('ir I,incrtrsea,made ]ocalizareadurerii qi de scmnelodc a<rornpir,rrirr,rr ri,rrl,
o Uri llutit suOrotrirott in tol cursril st,lrii de l,ogl(,(llnpol.i in sontn). l,lituur 1i ntliologice) de lezirrne rrtliculrr,r'ii('r-('o (rr11r'rrze, rlirtrt,lcifirLl,r,i
.\r'r.,-trrrl.isronii,kiuciiccpot sj lie.rnaj mult s,u-urri'pr:.i; "i lrr|rr.lizrr1c, -
]riperostoze, deform:r,]ii ale lNrlui olos ctc.) ; ri) ,I,ttt,l,itnliyLtl
i\ir,ll/ix?/,3nt.. lJe obrcerse insolesc,1ide hipe.r.bonii ;r';",:;i;;;i;
e.rl,rapiramidilc,precum ,,rrrric(r'echiul torl,icoiis mental al ]ui Rrissaurl qi }krigr', ci1;rL,{,i dc liirrrr',
rii rfrr-liipolliinezii, Aceste distoaii hirletice tealizeazl o'a"phr*"u'*'"g;""_ llrl,2) $o_ r ccunoaqteuqor, plin car.acterulatipic (pozifionu,l),lllin irrkrrrsi"
{lnruritii unei contrrcLii spasmodit,e lorens" a $nrp,,lo. .,,iuscu- lrrlr.,rr, ltrllluri,rii (majoratii r1eenrclii), pr.in callcl,enrl inttrlrrril,trrrl, (iru'{ill
l.:']i.ll:,Ii.
rjUl'rlr.(!r'r-fi;11(r,conl.rtctie-crrrccstcprogresivi.re[r,ri1.dur;l).f-.(,aractcrul
,r (l(! rjt,luo{1, anxioasi,) qi prin depista,r'cafaoliot'ilol psilrogtrnictruzu,li.
r(!l)r.r,rr,lr/
itt mlfcar rnroluntars realizate so datorreryleunor varialii nein_ !. Spas,nulntonoplagi,c (Jiiscr, J 952) ('Iorrnt'n incorcct,,ll.ll. ,l\.rnr(\nul
rotnlr: rlc tonrrs mrsclhr', bmsc_diminuat
_siapoi din nor i:msc exagerftt. rrrri oorcet ar fi ,,Spasm rle 1;orsiurrclrr,aobil,lt,).Actstn ilt.r",irr 1yrrrr,r,rl,
n {x,stc rtcplasi,ti tr)nioe a,normale sint ritmate qi oarecurn stereotipe | , ti r(1lirlosimilir,r"c
Ia cu tor.tiurlisul spasrnorlic, da,r'otrloonlizilr.olll urr rrrrrrrrltrrr
rtrxrlrr,ri
bolnav, putind ant.rena cu yreme& deformalii scoliotice qi aiiicu_ rrrr1r.r'irIr'. Dsto vor,ba,do 0 nriqcnrc de lorsiunc ircestui rntirnlrrrritr .irrlrrl
Lrtrr. Nu slnt $on,sibilela preparatrele cle tip atropinic.
rrrrrlrri sIu, dc pronrl,tic ;i ilo supinl,tio {orltl,:'r,llt,rrrnativitr,r:u,urr Icl rlrr
(i.2.1. Distoniile kineticc localizatc ,,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,
L Torticolisul spasmod,icprozinti urmitoarele c&ractelo semiologice : lotr,icil), llstfrl incil pozi!,ia lnorrnlllir, estc nlrrrtinul.il oitcvt, sturtrndo
.. Jrlru'l
llu Bptsm musoular tonic antrencazii, o lonti, rotalie qi laclina{ie vicioasd, lrr.r'itovl, rtrinrrlr,,plinl,r-o ,,hipcr.1,onio rlo lroiti,ult),,'(ltiscr, l{}I?), Allrin
1r,ol,pului, ou o contraciio a muqchilor stemocleidomastoitiian qi ttapez rrlrrrlrntl srrllrrr,iolr.r,sprcLivrtvinrr Ll loc, llr.irr trlitrxll t(yr rrrrstrrrlrrl,trril.
(ovonl;ua,l.qi. o_piolosrrlui gitr ui do acooaqi parte, .rareori qi r murichilol 'rrll'lr,Ht,i, rlooorrtlrur{io liirrrl tlo rrsrrrncrrt,rr,
ltrnl,[ (in !.- Ii nlcrrrrrlrr), rlru r1tr,6ri,
itrvocinrlri ,i glbulrri).uuor:r'i rxruLrac{ia, tonicrna color doi n.rry.hi ino'rrrr,t,i 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.
{lo (pinull oiri,obilltorluki,, il,r: cu,prl to flccto',zil 1,oni(rspro u.u.fI (rol.rrrcolini. ;ttttrt'tltttthr. (1ruIi ltt trttzttll,(]rli(rolimtluittltrr.xtrrrxlh,, ,{t,lrril)ul ttrrrrrllortrt,lo.

20{t 201
 ltr(r lttr (] rt'il,r11.r'
litrviziili ; $l).lrittttrl (io(]roili\',iruril rri<,iv0irrlrr,r
ilupir|it,l,iv, .rl l trrl l i r I rrrI rr,rrrrI I rri r , r r I r t rlt t i, Hr , r r r l r ll r r rli, r 'ir {ir r lt r '|r rI ilii, ir r r . lr r llt r i li r r r u, r
ri{,i l,r,st,lltir,
trioi rni4clililrrirrlctL{,iorr*le s:ru aut,ornatc,trici rnlnovrr:loilo l i l l rrr,l rr,r' rii , r r l; , lr r 'lr r , , t t t l'lu: r t r . r r lr r r t , 'lr r i", lllr r lr . r 'r 'r r lr . r , r r l, r I lr r sr r r ilr lr ,
olrlirr^ll spllsrrrului(irrclusiv r.[on3a1,ii] ltclivi r.,:inp rsirir'r,
rr,nrcrnbrului re$- , r rzl r' 1ri l r. 1rir(, , . r 'lr ', I
1rofiliv)rru llot suprirna spastnr:lt,.T)oll sornnul le abol,5te. 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 . ) ;
. r\ccst slastn brahial ap:r,rein sti,ri postencefalitice (de obicei), in sufe- 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
lil{o \/tl,sculare,tra[maiice eti],
,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.il.2. 1}istoniile kilotice gencrnlizatc sau cxlinse 1,rr:rrrr i tl l l r cit . ) .
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, ,
.. 1.. lJpasmul de [,rrt;une. (tlisbutia, lord,otit:tia, l.u.i.Ziehen *i Opytt:nhcim;
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
tl,i:tlotrirt l.entit:ulard,progresird,) prezinl,il douii elt'melte somioloEice: dis- .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
r,'0i;.ri luriiun(,1 (lla..li.r. 19..3._citrtde Soil,.ler.lC6ir. .\.r fpl. ii, (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
lrnz;iir.
ri{. ropll,us.iI1 decrLbil,,:rceqti bolnar i lrrr aplorrp., n(,rlDali (cu er-c,,p{ia 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
corriil,atrilii :\lNor eyentmle semne-t1e encefalopir,tic: herniparezri, nins-ciri 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
r,rrlcu'ltr,loziceq.a.).,1nmomentul in o:l,re $o lidirii, !lin pet, t-rLrnttriirliniepe ,:rl r, l rol rtavr r l lc f lt r c 1n jluir l sii. r r .l) c lscm onot , I 'r isl, li lr bslr r {r , qilr r lr r iir
Lii sr,irrilbozo in lordozii, crpul se re-rroflectcazit,,iar eOoi, ollatil cn o:recir- r r ri zr: l orrlr olir kr il clue gillli: r pol, i, c 1i inlolt r il, i ct r o I ilr cllor r it r r r r ilr r ll
lrr\,| primilDl'pa;i, ap*re (sll] se er.rcelbei-Lzi)u I lrurrrro r:le i,onuspos- rrrl rr ((l rrsl l r r r l ; i collr lt . , . l1174) ,on] 0 ir lit : i Lir rlr sDer r tt lc sllisr r r r lr , lol r ilt r r . .
irrr'rl, o:u'c intereseaz5, atit trunchiul, cit si rnemblcti:. llolnavul se riiicd, Itr:' IrrosLi r: r t lr c 1r 'at r f r lr z: it t ; 0r 'ill f ilvO r t t t , t i t r r r ci clizt . r , lr ilcpt it . t , , 1i r r r r r r
lxr villirl pioioarelorprintr-o e\t,,nsit' a mombrrlor iD{criotre,a,poitrunchiul rrrrl r rl i sl i i ngzii t , : r lr t ] t ilar nidalcr pr in a, lt r r a cl, ilic: i, t lulr r i, r r lir ir lll r lur , lr r ,
lslt inr:ulbnt in rnod ploglesiv intr-o ptternicfi lordozil qi rot:1i,. lxt€r:nlr, ,||II r'i|1{IiLstii,tii dc r:rxirlicrrti si ruiolr}irliile l,11tr (i lrr-rl.rtorrlc.
lirrrlr in ou,r'ecapul sc plaseaz:iir]tr,o pozil,ieda tolticolis.sau dc rctrocolis,
irrl rncLnbrelc janpcrioarc se r'risuctrscirr pr.onalio sau in supilai:ic. Acest6
riprrsrrrccetleazii,tot I'cla1,ir;lent- si apoi din troLl l'caplr, in mod alternativ,
rrrrliziiul o lernarc.rbild, variabilitlte postuf.lliir cu rtltudini bizar.e, contor-
siorrrrtorincit :icest ilspeot grotcsc a,l bolnavului :l fort fo:lrlc llastic ii.ft CONVULSIiLE
rorrl)lrirl (Lccitre liiser (1.959).-u ,jIraocooninlirnt ui li,,,j,turL. (.ritrc\\iurmer
(r'ilrr1rlc_liiser)cu-rn ,,clorvn mrcirbr.u').Dil lrricinr lrcestor sla$mer mis-
r,iililc voluntare silt inadccyat: si, apllrent, rrecc{)r{1on!,te, -iar (i.il.l. Aspcetesc.rniologiot'.
rnelsul S1r'erltrisdbilt'rlcaltc rniir,irlj irnolrrrrlrrlr,,
cslrr r.rtlem do.cliticil. l)e f:lpi, se prodtic i.':tlialii toni{ro(in scns de hiper- ,,rrrvrrlsiiklso pl\izitrtii s lt formi-t,tlc acatBe.lllo llol 1li y(uutrlt:;rrlt,,tl\t
s rrr ilt, hilxrlolie) la un grup muscular fa$ii tle alt Lrl iji dintf-un monrent ;.rrrrlir lotalilatc rnust:ul;ll,urn, corliotalii fi insolindu-suct:l rirrrilrrlr.rr. r rl.
irr rr,llll (lie siruultan, lie alterultir.; inert s-l qi sug?r,rt(,.i lt accastjl []oa1{, ,' picrrlcre tutali srrr rcl:tf,ivti:r, siiuii de constiitltti, sirrr,rIirrr1roIrirri,
lrl rr yrn'ba rlc o ,,dismetric a r',plr turilol f i :i !rju.tifilor tonice,' (Riser, 7,,rr'lirll:,silul!ii in caro intercseazilun gmp rn iir:rtln,r. ttrtri irrtrll itrrI rrrlrr
l1r'l). lr1rlin 0xirilts.
r lr, iji in caznl boh:Ivilor pr,rkins;rieni st p:)t r€ir jtfol, ;i l:r, aoe91,i l. (lon,mtts i ilc tonir:osittl re,prczenl.iltc tie conlrrrc{,iirrrrrst,lltrr,prt.lrrrr
lrrrlrrr,r'i,kinezii pr,ra.lox:lle.De obicli rn,rschiifetei si :r,i lirnbii nu sfnt i,rlr', (r1lr'oatrtron(l:lzat,o stiu\) p[,ro)iisl.ioii])0 t)lln(, 1i'i,,tllrI r'lrIirl lr.ri,r.ri
irrlolr,riii, 11.lrs-::r,u rlescL.is cazuri eil ccintefe3,lret aceJNorl,roxlizinLlu-se: l,rlri,rlr: iigirlital,e,crrt0antLent':rz,:i urr scgrnt'rrl(.,,r'l){rlill,
srrrr,ilirrrlrolriIrr,
r'rL\lliirrrrlir,. l,tl'lu"ari de vor'l|lr'e.i lio rn yr1i..,11., rrrlrt,lrgtr,
lnuscul ,ttilii t0tpol:rlli, JJrcrnplulr.r'lrrr:rirl rrorrsl,r'rr,liv cilr, l;rzri
l)in,.puttct.d,e"leilre eti,op{rtog6??,ic, sepot rlistinge mai nrulte tormedo ,l'' r'oltla(1uri, lotricl gonu'aliznliurr,tliilepsiciglllnrl rnrrlturrrvrtlsir, lrrrir,rr
irl)itrslrt (lo t{)rsluno: , lorricr',itr (iu(', luzilulrll st'c11s;olol si hipt'r1,rxriLr, (x)rrvlllsirrlprrir,ir
rt't,lizcilzir,
r) I)istonia cle l,ortiltne agu-zisd,,,id,ictpr.tlicd",ialentificati do unii cu rrr llrrric sl,r] irr cx1t,r'rsiu,
irrso1it:ir1irlc o piclrleltrlolaLi,rr sliit,ii(l(f .rl!l r
,,rl,isl.rtrt it.r,,masr:u,lorum. , ,elte in realitate o boali, clegenerativii,, i tr(,i .
lllosirrril rne'labolicd, -tleforrnans))
(Wooten qi co1ab.,19?3),de obicei cu c,.t t'a-ctereredo- !. (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 ,$lr , , l{\ l
l rrrrilirl, c'r,r'c ap.tre ir copiH,ries.r,uin adolescentil(Eldridge, 19?0; Marsrlen l r.l ,r' , i l rrpl ('r r o1t , li1ir . r . , r r lr , l, ltr. 'r 'izt t(.)l l) lit r ilp, t i( iit lr r *t r . r r r i; . iil, i lr r , r r qlr , ,
r 11
rri llrr,r'r'ison 1974)si cirro poate fi recunoscutti,pr.in evolutir sa ptogresiy- .' 1..i {' r,} i rkr . r nilr i g. u p. nr r r s<r r r lr rr','Lr . r lur ill, rscr i nl. ii ( zt x, i r l. sr r . r r ir r lr r, r r ir r r r i, , l,
uctttt'.r,lizrt tit . { rl i N l )l l ri ( , iirr,'r r pit ir i1i r , or r r lllclli, ir t lt , soltt r l l) r , ol) illf illo ( chir r l . r r g. r r . r , r r li
il l)isknin de tol"r.iule sitnptomaticri est{l mult n-rai frecvent5 qi aparo z:.| r' ) l i (l c ( , r 'lr rr r I r i r r r r r llo r r I i oI | sr r sllor r r llt r 'r sliiI 'lr ii t lr , t 'igilI r r {, i, , li, r , , r r r r , , r r
. [[l !)t l i l l l l lr olilt r t ir lt 't r lif icit f ( , i1,[ i i) t ol( ) gir I t I t , cl! r r ilr t r ilr , sllr t , ct lr r 0lr ic|t
rfrrlri, srrrrin crrrsul svoluliei rl.nor {LJc.a!,i,toLi a.la stru,cf,urilorentrapiramiilala-
rl.(!(livolslr tntt,uti: Ancc.falitrit:p,irl,enicti (cel mai arlesea); - Alte enctfn, r' 1ri k' pl ,i ci i .
.
lil,rrl - Il nrrrfrr,Io p tr,l,
ii, toni.oa(crr oxirl d0 cl,rbotr de pikli) i - I)e11c.netrcs- , ( r llli{r ii) I n) 1.$i ir r r lr r , ir r rrrr r , r r r illolr , r r r L,
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
)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 .) 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
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 . ir , r , lr ilr '1r si. igr , r ( 'r r r lizr ilr , ,llzlr , lor r ilii, ( r r r r r i
lrlo irr(,rri,rr.iili,r'i ur)r'(fo .Il;01,r)zi()t\,
r{Lrtrilr\ |,rrI I I rrr.il,
(lo li;l ;l.r,r'liitisrrlir,rr), r. | ' ' 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, r,pllr,pHil lir,tr l'lrntl tttic llclor prtllrgr,tril. Vottt I'oztttrtilrlr,uztLrotgrr,trir:r t:rrl6
t'rri.ir nr,' t'r.r.* .[oni.L,,,t,pit,,,siol i il;i; ;iC;il dou[,fon'o pot rrlr Ilr\lv(!ll, (\rtln otiztrlot'opilopl,icrr lil ttttgrr,t'i:
nr),srr pr.rxluciibilatcral-siuroirioo (,epiGpsiato"l"o'_"io"i"i generalizati,), I ) lll tnt,nqo.trn,ar'.lulo1xtl,iu,l,m,ut ,l,ittd,(pt'irr frr,ctori itrlrtIlrrrrl;rr,li olrnl,o.
ri.ur. ruril,tr:ral. (epilepsia tonico_itcinici ir"*igu"Lri;tey," Itrlrrli) r'gl,oc:urzlr ooir rnlli 1t'rrrvontitllr rrcolsh'1, virnt'fi,,I'txlto sl'[fio orlrrr,
sau numii
;:',fl ut' roc'r,'ioci
i:llii'i i.i l&"'"t#,#?ljlli".",ln,1"b ri sa,'Ibcrr,i: r,J
rmi, 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
(i,iJ.2.l,roblcme de diagnostic ,,rt,, rlr forctrps, vitlext,t'it,c{,io, cxpulzii lrtltorioilso (prczotrlt,l,ii virrirrlrHr.,
etiopatogeniegi topografir:
rltrrlrxrii,iror'{,ioutcrint'r,),opora,{iicrzilricne (prin soltimbtilo ltlrrscil rlo pro
.I. ln fal;a-rlnei crize conrrrlsive.sepune in primul rind importanta ,rtrrr,), ltjliziIr'o tlo ocitocicc, b]oo:llcit,cr'tilol rcsplriltot'ii uJo frlt,ulrri lrlirr
Jrroblcmla sl,abilirii dacXeste g" d".ir; sau, dimpotrivE, rrrpilir(iu tlo lichid arnniotio, rlpl,urii, tlc pla,ccnt':i1, q.a.
{frc{, este rrorba de o cridd,conaalsiud,
"o+? 'carepoate
"pii.pli";
neepiLelttiid,, )! ) .Mani,nllitre,s,iencefa,lita.lcDrile: mtningito acutu ba,ctrrt'iotronrrpl,L.r,,
s, survind,
(pgloyier3
:,1")11."-i]"3::rj,.:j::]l:!1"t" rriio.'rsrsr: 11 crizd,
ni ",irnr,.,' 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,
;::::l:,ii3-X,:fi'Jifilj".'*lffffHi3,.f,,J.,F,;:,A{:l{;.'\f"n,:J:;Xf:;,,;
tt(iriLc
\rir('ui [i colrb.), angioame (28o/sdupl Arseni 6i colab., 1071).
urenl'ica.
s).c on,)itsiiteah cnceJo.ropiii
h$itlt-plitita. 6) centoutsiile .l ) Putapitoza(cisticercoztl,, hidatidozd), do ascrncnul l'oir,r'l,o l'rrrcvcrrl,o
i i n. k,r en ;o, gra uitli ad. T Cott aul s iile, rti n' i nt lrr rtrrglr'(Arsoni .1icola,b.,19?4).
) or tta! i o ;t tian ; n icd. Z1 Coo ii t
xiilt din tu.tbur,iiIp pnrloarin"
lr,ctrnie. pi*uJbniiop,,,f i.iOi** ;.u.j. t),Llleence,faloptali,iTtri,nJactoriprenatrali(careaunoliouirtitrprrr.iorr,tll
ll\ Unele conrulsi,i febrile. {l|z\ ()fiii.r'iiombrionarc 5i fctale) : a) Anomalii congerlital.a (iuolrrsivil,lroDtllii
.. .l)itgnosticul se orienteazi. uneori relativ ulor itt contextul semnelor .,rl'rrr()zonLiu,lo), carc produc disembliophziilc {ct:r,Io:mlrlfOl'lllll{,iir: r':r,rrir,rrrr
.liri.. ;i de h,borator, alteori imlrlicind i"""stigalii (rrr'r,('rfitlic, oxiccfdie, turicefalie, scafocefillie,piatiblrzir., irrrplr,rirrrr,,
Aeoi.",lit dc aminun-
(il,o 6i.,atente.Astfet, Gastaut.(19?3)._$i eop""t"i" "1i lrrnil:rlii). b) Malfortna!,ii cerebrale(microgirie, polenco{alic, tnlllirlrrlr,(ir,.
ffSZ6i;" pl"_
lrrrsd illercnllie.eaclintre ,,atac.l ckr.epilbpsie.''lresp"ctiv"rtrU. A"?""r,ulsie tonico_ \r'rrrrlrf( lltirrli). c) Anoma,lii occi,Tttto-ceraicale, <1) Mu,Ifor,nru]iirtutturtltn'
,lll,ll'lll[) propriu-zisi,, ,,'"uri"l,i,ra'- ads i'ouiir" u",_"o puor,"o (i,llAi()rriLliozir, cerebro-trigeminali,, boir,la, lui Lind.a,u d,0.). ti) AJit,l,iu.tt i
!i t,gpilupsia
f|rzr'tlr ctre sc repoti! dc o aiurd, mai mult sau _
mai pulh cronici {i care 'ltrnrtlrLhol,.ice.feXale 1i tel&urfumoza(prin factoli gcntrtici): la.*txtd i ntJiilt,
rr'zrrlti-r,rlin..dcsci,rcar€ahiporsincrcni, a unci populr,'tii';urotrrle. ,{rrIr')tirIfonilpirul'icii, sinrlromul lui ILutnup din por.Itirr,lrclll,liot'l,sol,rrrzir,
O crizi
,,rrPilo|tic:i" ,Iic[', precum l-r crizele convu]sive accidentale ("o a" priJe l:rrrrilirrlii diiuzii ctc.) ; lipotlistrofiilcsauslingolipitiozdo (irlio(iir,IrrrniIirrIIr,
rrrrckr conyulsii febrile, crizele de.ecl;rmpsie p"o"pui"lif ,rrrlrrrlrrlic;i a lui Tu,y-Sacrhs; boala lui Niernlln-PiokI gir,r,goilirrrrrrrl; lrrrrrlrr
rrrcl,tbolico $_.a.)nu constituie o veritabili'epil"pri.,.';;p; tolice,
"r,i"tu
cum nu consti- llrl (liurolrol el,c,). f) Atte, aJeeliuni,metubolicaeraLlil&re: ftrlilrrriotrrrr,irr.,
jo
1rr o voritabilii epilepsie nici rcpetalea mai-muit lr,rrrrrrr.isiilrnliir,, zlciderniahiperfolicii, piridoxin-tlepcrulcn{,ilnou-rriiscul,rrlrri,
s;u ;;i pugin frecveni.d,
ir lnror crizo conyulsiye in crtrsul.unci afecliuni acute (eniefilopatia r,l Niutlto&megcnetiaeau tulburd,ri ale formulei, cromozomi,o,Le.' rirljrrrrrrrrl
rrri.i, rlin boola lui tsright, encefalitele acuti). CrirJ" ure-
.irii.pt,"e veritabile lrri lt linoftltcr, silrrlromul lui Patau (trizomiu l) s:tu ttizolni:! li, lb),
:rrr, tlrxri, un c&racter iterativ, crnnic, ele repetinclu_selat rt|||(||{|rIruIlui Erlwards ('l,rizorniaE sa tlizorni:r,f 6-l.fJ), itli0{,irr,rrrorr60-
anumite intervale
(r)rrr,ii!(jllrte sau mai lungi). f,,l(lir(ilizorni:r,27),h) Infec!,ii materne(lat.srltoli or,rrptivolr,lt.rrrrrrrrri,rrrrilrr,
I flngem atjenlia indeosebi asupra oo,nawlsi,iloy rlr,, rr,ltirboli infocfiol,so).i) Afec!,i.uni. paratitara uLl rnunari( rxoplrr,xrrrozrr)
.. kiltoglicemtca din hiperin-
strlin.i:tnt.uL t u_ncftonalgi clin kiptirinsulinismul orginl, (i"oo ,11I,)rtrr,[tlopta,l,iip,rin aplenlitizi,ci asu,pra norzci.' tr,trunrr,t,isrrur II IIr.lrIrI rj rrrI IIr
(r|r,)nt irJtcelulelol belrapancreatice), sru ca,r- rl{\ lrlluurli gosl,ilntc,iradioli cu rulit{ii Iioontgt:n. k) '1'ttlltu,rdri. nu:hr,hl,irt
Caro tle obicei se confuncli cu epilep- ttlt lunttr(\ oa;'o pot prod[co oncelirllopll,iiirrla,nl,ilo(tlilr,hoi,,lirtrrl,oxir,ozi),
rrirr,.l,)xist[ insii, citeva elemento care ne pot orienta
asupra ulei conmlsii t'lt.). L) It)ttctfu,lopuli.iprin aJenl,iu'ni ambrionare6i,fttuk ltrit irloorn1rrr,LiIri-
li;xrqli..rnice: a) precesiunea crizei piin unele simptime f rlrri,rrrlrr f,rct,rrr'-Zfli,
ou ic1,<t'rruckrilr. n) ALli faaktr,iu,ntennktll(vllirrirr rltrr
revel&toare:
1rrIn,r'c, tchicardie, tremurd,turl, hidriazb,, patiitalii, anxietateI lrr li lrilrrxrfioo otc.). rr) l'rcrnd,tur,;l,atp..
l)).ifr ist,(ilL!,aunor simptome interorilice,_ca : so-noterrali,,"concentrareilificili,, f/ir lrol.llil,scul;vrr, lrtrhrti sii Icctrtrolrilorn oonruls,i ilt otr.,trt
itrrilrlrr'rru,ir,1;entiei,a mernoriei qi a inlelegerii unor nogiuni abstracte, tr tr *in,L rtt i tr..t,b.iI ep i.Lep lioe , drlr orlrolutooli pol, lilsrr,o plo-
st[ri
qi de dezoricntare,
aprtie,brirtipsihie,irclerenfi, sti,ri de ag! rp,
il:li:,1,.1,,1.: 'lr rzi(irrtrliklrl,irri :
I i l I , li\ ( ll il { l ( ' S l V r t a t e . l-,\pttt lu,l,ltoltttl,u,Lrti de pl,ti.n,s(,,sp/rsl}r,c 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
ll. ,\tumar de d,ataetiopl,togenice4n,uieele conaulsirseepileptice rlr, rrrrrri,,.ll|rrsc srrrl(xilrt,n,!tiilzils1trsrrrrilrlr, 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,
A .. ()r.i.zeleepilepN,ice conuu,l,s.ira
la sugari.llajorita,tcLlcrizelor convulsiyo rlrau rlrrlriprl ltrrlt',_lrt rrxpilt(ii rlitt crr itt co rtrrti1tt'olrtngilo, cI irlo(lxrJ,t,tl
...
itrlrrrrlilrr
'sirrl;i.r'(itrr r.r.pi*r'r1e.ort' cunoqtinfir,itr,u cro obnubir.,rc.Nu tre. Itrtrrlr',r'rrrtr.itt l'itttr,l,
xli|lr,lrLolt ltI Nl)itstttrrl gLllrri,rl0 tttlrlrrrlrrr,ivll,tr rlr,t'|.
rrIr'1srLlil'irr]rrr}iu|ir{,rr,rreos.llir,iicu oalo copilul mio pr.zitrLit Ittlttlrtrt'lttt|t,irHlisi(,iclt ('lrrlrrzii,l)i(\r'rl(rrrrrlrr,,lIrrr\rl
llt[r1rylrrorrvrrltii.ltttltr'1,
0 cr,izit,r.lo
r,tlr,yrr, rrrirr lr,, lrrllll rt'irrlr,riln ltr,t tll, litl,rlytrttt,r[
r'tizr,hr|r,rlr. V l,i.rltlh..
204
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, r rrrrr .rrrri r i I rr lr ll, l( l rrrr s c 1 rl ;r,g c rrrro rrl rl i j rrir.i t,l ri rrr i rrLrrtl i l i rl ri l ri r
; . ( t r : t r t t r . ls iil, h i l n .tt.rttti t r, (1 c l r' i l r:, l ri p rrl ri i .t:1i c.) r.i r.[i ci i ,
rl i zi i . I r r i t I r I l : r i r r r |r '
r 'i r r i t l r ': r t l t ti o
I tr l |tt I r l 'l tu t'ti r tttl tt,r l ,; l r l l l r l .l ,) t l
t,.tto :tr ,.( \tr u tti ;r i r r o l r l r ., l l ) t'.) t: r 'l l l t n ttl ,ttttttt i ttl ttr 'r r ,
ttl tt r tt i , ttl tttl

,
,I l rr,: r lr r lr . r lir r ar r , s i i r' (l ,t,rrrrri r,l i u c h 1 h a l , t9 i . j ,; pc4ruI' i ri u qi l ' .obl ,rrr. I t 'r l t y t i t t t t r t r ( tr tttl l tr r ti r r L l r . l i r r o l ) i i r l l r l l r r tr l r tl {i \ttctr i r ,r r r ','l r r l '
col ai r., l f)?ti ;
.
| ' , l I )r)\ i ( i II si l'iisr,rrr 1(tT9), {hrpit .llnr vo'r r.eilea iir coirtirL.*are: tj Unele l1l, {l ) l l i ,l tu :r 'l i l i i r l * l r ttl i ttl xi i :l tr t r t,r tl tl i n '.
. ') ; ( i t i ) " l t'
irrl i I rrri'rI t rr .'tr''lsi.i ). r' rt | | t.It | )| i t.I t i n tn n ,l t',ttl tt.l ttn r tt xttIr r i tl t tttr l ttr tl r ' r 'r t r r r 'l r t l tr
'r', ,,:ir,cidenl_ale', gcnerate 11e'liL:b'ii1 t ', n i t t i ( c . u i i r i i l r l r i l r r r l r l i r ,i l c r ttr r l o l i i , o tt Ir r ttr i l l sl i i ,r 'i {r \l 'r 'i r l r i r 'tr r r i r l ,r I r r r 'r l
l rt \l lr . lo s il1, r lc l tp t ,,s i n'olLzi'rrlh ru l ;e c o 1 r.u l s i 1 .c ' ' l l su-r,rqrl e s21 cl rcl i oi ahj l '
]ri l ri rii s r . r )rtl i rr.tu l i e l i rr.i ; ,,1 \l h .h , } ,t rzi ti un .Jpotcl l l i rtl f' e\,()l u_ r , i r | r i r r r t r r r r i tL l.tl i ) t( f o i i ( fr r h !i l zi i , r |t\t 1 J tttL .l ,t,l t) l t,t,l i I r 't,,tti ,"r i t.l ,tttl tl 'r
i i r r'p ik' r, 'pt lltir: r,.; r l)
, \l tc l e s i n t e l ,i l e l ,)i i rL l i L i i l i i r. rni rt,fenl :i t0 si i ;r l rI:rr,,,res_ 1 , r r r r l r t r l o i 'i i r r s.l l tt'i i l r tr tcti r r r ' ( r 'czi cl i z,r l t, <r p i l cl r l i l r r tr tl tvl tl si vr ' l r , ttt'i L ttl
1r.r,iiIr'Jr (,1)ilrt)1t(i0 hillctl.ct'llicc, rll'l carc silt e\ it{ter}lil,i,e s:l ,,pl,ccipiiate" l.llri:tlt stn tu [,si r r ' 4 ttu 'n tl i :.:r tl r ti ( r l o tn l i a tl t str ) tttti l , i tr l t tn t , 'tt
,i, rlii.il. Iir)r.ilt' intruLlc'te; tr) Alte colmlsii {ebrilc pot sir,intr't, irr c.n- t
'l . ; , t t t i r t [ o 4 i l sti b a r ,tr l ( r :t,tc r tsr tt'i i tzr i ,t'r 'i zl r r ]ti l ( r l l f i t'tr , t t t. t r t i l l rI ; r l i l r r Ir 'r 'l .r
l, rlirl r,lirri. .l u.,r' rlcningitc, oncefarite sau mcuingi). c:cliLliteinf:rrrtilc, r , l i i 'r ', ( l ( 'g Jr r l l i r tc 1 r '0 g ttsi t,i i r , l 'l l n {1 1 :i i l l ) r i i t1 ,L 'l tr l i ;tl tl r ') l l ( f o !i 1 'l l , r r I r l r l r '
l )()rl lir r ili' ir ' oit lt t ' l L :1 , c l i n i l i i . s i l l l i { 1 , p tL , {.urr sj p\-rti i 1.i i t,pci t pl eci zi ,r, , ' t t ) 1 . 1 t ! l i l t i ::tth tr t:t.ttti( p ,r tu ,r L t'r ,l i r l l i l ,i s!) l ct1 r ,,,u r 1 i su l r ,r ctti i . s t,r t l l r t, ,,, tr ,,
,.:., I i' r , , : r r ' , r l' : r:.,,1 , 1 ,.\,J n r i ,rcrrl r,r. I r l L i . r r i r l t r 'o zl ti r tr 1 sr r i t.tl tl L ) . r \:i l ) 1 ) r l tl l l cl co t,r 'tX'ti 0 i r l 'i tl o q i r tIi <:ctl l r tr 'p Ittr r l Ir 'r
i). 3 pu,t;ttt.ofi[iu lin sugal ' .rt' .g { !ti i , , , r r r 1 r l l r c k r L l tti l i l tl tr r r r o l l l t
se rnarrift st:i rmr'lt urai t,rcvc}rN tlecit ]r;, a,Jult o stc tcl - o l tl o t .
lrrirr r,riz. t,.rr'alsi'e crL pie'dc'c 11ornnoqtirifii. Di:rqnostic*l cste dr:osr- . , . ( l t i : r 'l r u r ttt:tr .L si t:r h , r .l u ti z, so L i l r r ,r r :t'i tl i g i tr tIl i ,i l r l r r I) I( |L |, Itr I' r l ( ( l r ,
l ri l rl . r iilit , il, c u r t i l m:ri l u 1 1 ..,1 i n r' .rrj r uj i rLl cl i i l tl ' .l i i l or ci .!o rorba ''r r , , . i i r : l) l i i 'i r h i r l c i n l r i i ,l l n l i yo l tl i , r i u 'tti ttL o - cttr u 'l r l i i r 'l o l r r r ,l r r l r r r r , r ;
'il
rL . rl rrr s nr oiilii (P o p o rl c i t q i c o l tb . , 1C 76, Igi g; Ii i gi l ,[$rn si l , r 'l i r L r r n i i l i sl ) i i r r i :l n i r ^ n i ,;r ) .\ti th n o i tl i i c ct,r 't'Ir t'r tItrI r l ) {l i l r l ti r ' r 'r 'r ',l r "l
l \rl ro 'i{ . iu, t 97E - t r c ulro geno
i l ri i c u l i Po l e n r.u , 1 :ri 3 ) ij i rl r\i s,,r.rrui }rri l l i r* ' stei i t 1 , , , r t , 'l r f , . 'l r t) i i ,i , i x) s[,l i r i fl l i l tl l i l i i i . s( ]u tl l l i l i tr o tttti tL l tttl ttttl tfi sr tl . {'i r r r i
',
r 'r ,
,.rlr' lrozilir', r rr:rni{rsl ii.r'ilc EE(l .rnt :rrrrlriguc i.i rlpl,rrtrnl,(,. 1 ', l i . i i r n i r ll fi 'i r sr L r rr tn i ti tzi tt o l t") ; o ) ,,\ttg i i r l l n o I i ) Ir ) Itr r l Ir r Io 1 r ,r ,Ii ii r r l ,r r r
r l , , l r t l i l tttsl r tr r r l r tti .
ll. lri:tle tpi[r:p!lce rt)ttt t.rlt il:t L(L rro?il. / i . f r r r co l ) i i l i L r tf,r i ) l r i r ^ si i tl i l ,i i l l t t\i {tr ( tr i ;( l ,c co n r tt,l si tt tl ttr t,r i t ,tl r
1 t 't i . '1 1 ; 1i 1 1 6 1 "( r l r r p i 'ir ''a cci n i ti i l cr r r ti i p o l i o ttr i cl i ti tt:, r t t i ,i i i i i r ',' 1 i ;r r r l i 'l r l i ,,r r ,,1
. (ri::t[t epi\eptiu i.nso!ite de Jcbrd si de samne tlo lti,perLet:sirtneintrc_
.l
t ttttti,ttii r:tt,itt;;tu,lctre aurtii |a,tLsltboclit(i.ne orienteazi ini]eOsciri spre rrnni- 4 , . ( i ; [ : tIt e 1 .r i [e p 'l ,i ocot n r ttl * i .r .t L ct"r u L tt,l ,l .1 ) tl tu l r ti r tttr ,i r 'p i l r '1 r 'r i i l r r r ,l r l l
Irrrrtr, lI af t ' < : f iuni : i n i r i 'l l t'r i 1 i u :l fi i r [c1 r .l l i r tl ,t ( ,\tso i L i i i i cl l r r l r ., l 1 ) 7 $ ) . {1 r 'l c ttt tr Il ,r 'r 'tr l r '
1 ',
tt) il[::rtingite qoLte_])xu,1t[ent,. il |onturtrL] clitric crir,li si un sindrom r r i i , , , r '! i l ( , tl ct+r 'i n i ;r i i tr ti z,c ci r i L ci i ti o c l r l r ttL ttl t si tL l i l ,r l l r l r r Ii |l ||| Ic r ',, r r r ,,
rr,,rir{'r,ill asocid,, iar l:r, r:rhicerrtezir,se o}r{ilt urr J,CH trilbure sall puru- , , , l r r '. r l r ', }n ;ci ,sci o l r l r .r i i si vc i n L 'r 'i i ,,r i i l tti o tr c si i tr l i r r ,l i i l r ..
lr.ri1, irr cirlo st tlicien'!,iazi gc,mcnii rluz:Lli,.prin cliirrlr,.'url Sacterioiogic.
l i rrrrrl lr . r . r r . r . r . ' 1, , ,1 ipnrr' l ,rrg i l a .e i n s L rl ,.v .s i rl ,.rrl l o r.oml rl i l r,l i i r,oul rl l u_
.'r, r' r l' ul llt r ir ' ttr.t.\' t .r.:| trr/,' tr. ..n l !U p n r c pi | rrnri ,l .rl r,, r
L tlriylt c1 ti .!r p l i r ,: l t) t ,t't.{)tlt.o t i ce so tt'l !'ti , l :r cti zr 'l r , c r ', l ,,r r l
l L l ;,:r.i d!. , , r r , r r r o l l r : nt i l n p i '1 ,L l l l tt'i t,tttL r r l l i sr tt ( i fr l i l i i ) - ( i c]l 'l ) l l l l i ti r l i l i r |r 'i r i r l , "r r r r
v r, ll{ t 1 r i 1 1 ( ' .) .
i , 1 , . r l l t s i ,i r i r L , t[u ]) fl 1 1 fu ,,( i r n o l {) g ,Il 1 ) r ,'r l l r ci r 'l r i l r '1 r si i 1 r ,r 'rllr ',r i r r 'r ,i r , ,
lt) .illeninltite rirot[ cectt lir'.hi,] ,.1a r' (rnt,lingila Lu.liruriL,nrcningita poli- t r , l r r i r r i i u l c p l i n i k' tn l i r '. r L ti l l c co l vl i {i i ( r l L r p i i \r si l r i r i ( ,) l r 1 ,., l 1 r ,i i )
, rrrri.I i i it,ii, tncDillgitelo cr rilrrs C.rs:rclie si EL,II(); corioirteniriuita, r ) l i , r l r \ r y 1 1 l si i , n u l i i r r .L r t,cl i zo o p i l {r p l ,i cl r l n l l r 1 'fi {}i r ,r 'ol t,r ,u r r r r l i r r r r u l r r i ; lr) llr
lrrrrlrx'ilrr'rii' rrr rrirus Armstrong I mctingitcle dia bolile eu linillotriopl 'r r r c i i s i c o l r ,l 1 ,i il o zi r i o o ( j r '( t) t'r tl fi cl l i l o l tl ,r r g r !ti i | )| rI t rr rr I rri r,i i r l i i , ttr l l . r r r 'l r r
IrrrrI'r.il.z. inf.c!;ioas,e,rnononucrieotra '.ilus Oin bofilti
infeclioasi; r.uringit.ele r r | | l ] t 1 ) i l r 't {tr l ) l tl fi i v i n l l l ,( tl r tl r i r l l t l L tr ttr ttl l L r ts0 ttl ', ttt,ti t,l r 's r r r i r r r r ,r i ! r '.r r t|l
,.r'rrplilr'; nroningit:r herpeticri) se manifcsti, prin. sirllrori meningr:al l r l l o l ( l {r l ) )i ) ( i ( 's i ;i p l r ,fi r vr r ,l i tl i t,1t rrt i rt t { i r ,I i I,rr I rrrt, i tttcr l i r r l r i r r l tr i , i ,t r r r r r r r i r r r r r ;
rrrrcoli r.rr olize cont'ulsivc asociltlte. osi
, ) : i r l r t r r r i st,r o l i ,l i 'l {,i l r u r cl l i L r yr l ,o g r tti i r l t o l r l i tr r - g r r r r .r '.r ,1 s i l, I r' r rr rr, ( rr r L , r r, ,
tt illt:ttin.gitetrtberculctase. r\ntecetlenteletuberculo:rse famili:rle sau , , l r . r ', r z r i , i t .zD i ;ctr ti o , l r i l tl g l i o t'r tti rr ) ; ( l ) 'Ir ',r ,l l i !r l l ,i sr tr ttl sr i , l i l ,|r l r r i r r 'r ,l r r l ,
1r.r'srrrrrl.(indco,sebip.imointoclia reocntii), deb[tn1 insir'Liosprecedat cle , l , l r : r l r t t t i t : l ) {'l ) l u t cl , cl r 'o i ttI l tr zi r tu r i l r ,o t'o l r r ',tIsr i Ii r r r '1 ti l r ,Il o ;1 r r .
lr.rNlrrr:r'rr'(rnodificareastirii gcneralc, scidc'e:r, in grcut&t11,episoadcle I r r I l r l r , ,l l r r I r [i l i r c i r r tl r r r r l r r l 1 t,r r r tr r r r i i o ;i cti zl r l r r r l r i l r .l l l i c r .r r i ,. l ,r :r r l r .
lrrr,rrrlog|iyrnlf_.1i.
(rrrrrr'z.ripr'.liziidele.vi _modiliciuilc. r.6rr}ort neuta)r,;, i.mnel{j nc-u1'(,.logicr,, r : r I t r l r i l , r l o l tr fi l r r yi l r u i r ttti o l ti ttr i l r , r r i {i t,.t r i l ti . I) l tl ) r i \r 'l r ,r r r ;t r ',,l .r l r
crarrienilrlc rmLltc uri c.izLrcpileptico), ev.lirlin, i l r r '. i 1 , r l i z l l ( , r i r r r ,p i l cl r si r r p o sl l ,ti r ,tttr r r l i ci i p o l l i :r r ) l tttr r l i r tl t ( r 'r r r .1 . r r r r '
r,rrlrr.rrlri,r.rosug.rcazii,etiologin l) ecisii--ptritru riiagtrosiic
,, Ii rr r t | r i { \ : r ln, . t( l r.D tn l l n r :rl-tnb(.r'crrloxsi,. r , L r t t t , l l t r r i l ( '\'l l sr 'f l l i r sr r t ttti r r ttl o tl ttl l i i ,r tl l r r ,l ;, r l o o l r i c|i r r r .r .r i r ':r l r r r r ,l
L .( .1 1 . l , r r '. r l r '; l r ) l t'tt n l t ( x,l 'r t, l ) tu t) t:t') J :r l ttr r l c r , sl l l ) si ,r 'i r i , l l r fL l ( 'r r i l l i l ,r .r l , r l
tl) liut:tl^alite (rctttc si, suba,culoprinr,il,i.tse(rto obicci ;.,irot,icr!.
t r | | r r i r i | 1 1 rr o o r r i ,r tzi o stL t tr tr i ,r l tti 1 r ( l r ,i tr l ) ( !'si L Ih l r tr o t |,i o :r ,Ir r l,i i r r ,.r r r 'l r r l ,,
r'1 lNnce.lu,l itc acutc sr:cu,nl'lare in cursul urror boli cruptive (rujcoli,, , , r 'p i r l r r i r r sr ,r r l l l L r i i 's ( f\l ) r ,i r i i \ .L r r tl ( |tr ',r r :r I,u tr ti tr Itr r 1 r ;r tr .r r r r Ir i r r r ,r Io L l,r r .r r r r
iurr (x)nvlllsir.i) rlup:i varxrinarr: anti,r:rliolicir),
l , r r r r i i r l r l r r , r l tr tr ,.Ii l r u r l ;. \r i ,r l r . r ti zr . r .1 r i |r '1 r Ii i u , si tr l , r r r r r r.r,1r , r r I rr | , . ,
t1 llnx , l, , - t , lt nl r In ,l ,i i r (1 ,' l rU r{ 2 ,.b l u t: ,1. pr.i n cIi z| r,Iri I,.trrj | t, .i
lrrrl ; r , ) l tl .i t. i ,tl t,:r l r t,l cr i r r l l r l r '.r l l l r r 1 r |i l r r Ii i Ir . r 'r 1 r .r tr r i y, l r r ,L l l r .l r
Iri rr :rllr . r i. llr t r | |. |I rrl ' rg i rr.rl r. Irn ,i rl i Z :1 tlrl ..:rI i rr D i rl r., t rI :rj , I r i t , r t , , :, r.trzri _ r r r r l r r '. :
Ii l 0 r'u r t l|t lr ' l. r r z ii o ,,rl l l rn trrc z i rrl . s rrl r.l rl J o ' ,i :l | trr,l rl trLrl i r r 'r r r r i ,r r r r r l sr tl r l r r r 'r l r r r ,r i ,r l r 1 r L r l r t,'|r i ttr r r 1 r r r , r l r r r "l i r r l tr r l r r l r .r r .
.i i tti c srl r,otrrpl rr l r l r l , r 'I r r 'r i r r l r I,. l .1 r l l r . Ir t',.r 1 1 ', r l ) r l r Ir l tr r r ;r ,r Ir tr 'IttIr tL l r tr l {,l r r r r r
l r';rzrrr r r pir l lr r r , r ' l:r)t,r,, o IrrrtIIri IrL rtr lrrrrr
Irl g tc s i l i i .si ttl l rr sr,trrrrtr rl r, Iri Irl l i ci rl .ri , l rr . , 1 , r , I r t r rz r i , , . r rt 1rt , ' r t rt I L r tl rl r r '.r l .r ( r r r r r r '.r r ') r' Ir' I I r' rr' r' r. : I I i r I r , |tr IL i r , r
rrrrr, i r r I r ' r r lr ' : r r r i: r r r(iritrc l rtri t, l l :rz i i Pl rp i l l l l i )_

'l {l '/
:10{i
 irrI't'rr'.olclrrirlii
I i) I')pilr'1r:ttlt,:r t rttrttt,.r,i.tti.
tu.rtllitii(<:trrrprr,r'i(irLr,(i lrrrri, 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
| :, Nni rlrrlii' irrrrrrrrr,lisnr) r,rrrr.r'r'rrlizrr,li"r,
rkr cica,1,r.iccu, irgrinuo-sr,rllrra{ii, 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.
rltr ll.Lrrrrzlr,rlilrrzrl, li rriu r':r. il,r rrr.lo conLplicl{ii taltlivc (rbr.str
, r r',.1,r':rh..r.lrislUli.l.l, |ir ,\l.r,.rrrsi {,,,1irt,. !). (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
([t17,{),m jorii.atela,.cslor(,rizu -
r.rrrlrlr. I.i1rllitlr'l t irl (.1!t,,/.,|itr i.rzl i/, dupi l.ure ur.meazd .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
crizclul,ocaJe,
i,u (1v('tr1,uli,l?i generalizarc (lfio/o rlin botnavi) qi alte tipuri de crize. .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
2.^.(lr'izale.
c,pitep,liaaAn meningite g^iencefalite,foarte frecvente l$ copii, 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
'.'. -irrlilrrr.;r..i .h aduUi. eLiologil infccfjors riplasinduse prinrrc orim-elc , 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 ,
rri.i r':ruz(.irupL,rtanloale rnanifcsllirilor: cpil cplico (Gudrn-urLrlsson. tC6C- ,lt liltrtl
r rt:rt.rlr.,{r'rnni1i cotab.,1C78;. ?n cazul crizeloier,ileDlice sur\.cnitprLlr-un -4.n att.[\r.t, ln,ll,scori s.a,.); Ir) in irk*iur!,iilt tniortlttr.,(urr,lrir,. r,rr.r.
lorrlcxt irifeclios acut sau subacut, v:l trebui sA ni ginaim h: a) Meningite l:rlrrllrlic poltali, cncofirlopa,li(f lrit t(r r'(,;[1 ici ) .
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 proce-
sr'.lrr,r,t:pamsire intracraniene.
,sinl deosebit .de frecventc, putintt ijungo
lirrl .l:r50o/udin rolalul cour-ulsiilur-lr a,dult(Arsenisi r.ulrtb..l97S). Arti;|,
,.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 mo-
iolii .si scnzitive ale cor"terului, in specia,l astrocitoamele, oligodeldrogli-
r'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
ul prinr,&r i.ntraparellckintdtos (netmuma,l,ic).
I tt.ltt ttttr,[otn,
5. (irixtle e.pilepticenn pt"oceselainflatnatorii, tt eurochirurgicale se in.til-
rrcscirr : l) Tuberculoamocerebru,le(fcrarte frecvent - 850/odn cazuri dupd
,\r'rcrii rli rrolab., 19?8); lt) AbcesecerebraleI c) Ifai rar in araltnctid,ilawio-
rhir*utt,l,icd,qi in go'melesifil,itice.
(i. (lri.zele e,pilepticein
Tsarazitozelecerebrale: a) Cisticercozacerebrald,
l1l')1, tl, sirnptome de debtit, fie focale, {ie generalizate, dupd, Arseni ryi il
lr rfrrIr., t.f)78) 1 ls) H iilatid,ozacerebrald. ;i
ii
7. Ortzele epilaptricet:ascalure ss intilnesc indeosebi la adultii mai ln
vilsli qi la biitrini, fiind realizato de: a) Ramolistnentala
It\ INnlr.fal.upa,ti.a hiputcnsid ; c) Unele hemoragii cet'ebrale.Debutul icti-
Tsseuotuntorale1 ,ii
lirr.r)r si oonlioxtul clinic sint rcvolttoale pentru accste manifestiri
r.1ri lcpl,icc.
ilil
il:
,\. Ori::i.r api.l.e;plito in, bolikt rlrttontnlite $h1t m.ult miri lrur:
tJ I)itinuqit, t:r'rrhttkn,virtt,ior:ltntirii i b) It)pik'psinmior:l,onicd,proTTt*irnl, n,Iu,i ,il
{l
it0tJ

I
 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
ry PfiOI]LEN,IE
DE DIAGNOSTIC ,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
{ . tmruLBunARiLE
Dltsnnsuitltt*tCu 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
?.1 RIICOX{ANDARIMIiTODO],OIiICI]DI' SF]MIOLOGIE
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
7.1,1,,{ltnliza {nlhirrli.ilor snbieslive do sansibilitate ,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 ',
,r. l,t(,c piiltl,r LLninteroSl,rtoriultonl,, cu,o pLecizt rzii prczenla rli,Lrcrilcr ,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
,;i,'.rrurlr, ir,ltoL senzl],ii :rnolm r,l^, topogr'a{i.i irrestor'.t,J\L)cicretrcu alte 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 , ,
ir{rrzr sirbi('ritirre,oiarul de ap-rriiie, c:u'aotcre,le drlrcrii etc. ,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 , {ii;
L Sint .sittutlii..1tt. cuye du,rerile ;i,fsau,pareste:iile constitLtie si,nlyut u,l 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
'tt t . sUbierlit al bclii, st u,s imptornuLsenzitir:ilol.t,i:tu,tut,Lllb:rri.rilc obie;tive 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.
fii,,(l ririirirnesilu lirsinil) crr,rLr;pillri rrr cefrl,i, ir ariErr:rrr:,
in unele n:vrite 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,
,i lrLrlirrtrlit: ({orn* stnzitivi ri p,rJirnvlJtcietiliccl, iiLuncle r,lrlilrlone, lor ruai (lc clampai ,,qidurcrell lirneinilnli.
vti Ir'.
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
?. I,lristii sittttlii in ctre ,lntpt,le si sa prr,'t,slt:irle Dneei| alte seny.e
t|: nrrralgii, tltteyi rdrlitu.Lar4 dlt|'rf i. ()t'tlt)|a.l(.j dutt't i lqldtitit't :\t ttlll
trrrrtrlrtli.ae.si, clcci, au t.:r,ior,.r't, ,[,, si, ptonl s, mnQl : .,t1 rLrtlerilo mu:;culare
,lttttri r:entrale ,<,itlu.reri.[iftrt'ult. [.-Il]loo ll]rLr{o ot'.u1ti tr',ltlnrr strrr rlrrttr,,r
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; 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).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 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
irililis l rrr'(l1ilu; f) duierile lJ Lirlrl-rre di,r r,,jrnpl|simrilu medulare. 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
;j. lf rirli,. siltutlii in cwe urrrtlr c;t ea, prii inpari(1jqt:L lor,, tarita_ 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
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_ 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 ,
.mrof
Il Ir|| {| ( ||||( . : | ; l nr . v r J \tr-l c p t:l_poliner-rito
r.tn tp p , ' rtl r Iri nri , ( . lo alsur i! , ct lt r l, ir ur i, ir t sLt pLr r 1: t lr ilii, 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 '
L 'L.'ul.bn rd,tile de sensibilitete subiectiud, pot sd, aibti o ,rnure uLlo&re 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
t tltx'.n lt)4..rtu, nnor .neurologice(Guiblrt 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 , ,
;i Guibert, 1g?4) ; :i) Terino_
rrrrrlqczi:t,srlmnalati -a.fec!,itm,i
de ci',tre poinihe eyoc:lrea unci ,siringctnielii 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
rrrrrrrr rrLti sindrorn siritgornielic; -boin.,w ;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'
b) ll,el.ltarei1 rlc ciitre boln:,lv-* unei
irrcrr;r,rrilil,i rlc lecunolstere a ohiccteltrl cu liuturul pipiitului, rre face sri ,,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
rrr. qrrrrlirn 1i 1:r,o agnozie t:}ctil:i, plr)Irie luui sinr1r'ornp rriet:li; c) Rela_ rrrLt' t' n.
liu(.:r ulr,'r'rltreti (cuntlnut-, dar cu execcrbliii in p.r.rorisrne ittloce hemi 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
| ')r'|),,IiLIr.,L.\ir{cl.rtu rlc prl}utii, precurn qi cu 0 coior:lturii afectiyl clezil, 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
grt,'lrilii) srrsctci.uziidonri p0siitiiitrili : - l) rlur.ilr.e tzl:lrnicii oLt c..lractor 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
Ir.i;xrr'1rr Iic I - o IcziLLucr, firsciriLlluluisliir't.'hrlic (ltunci cintl sc colstrr,tii 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
8i o l,0u1l{)rr,lrrrlit0zi(r. 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 ',
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 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
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 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
,,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 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) l)rt'rrrort,rll l,i1trrritlgio rrsl,orllr,l;rrlil,L rrrrcisli,t'i rlo lrilrrrloxrril,irlrililrr,lrr
.nprvriu,lfi
lirrrrrri,rlrr .r.izo rlo silg.lllrrri s:r,rrIrrlgr,r'Lltrr.i tl. int.usitate foarte-miro. lr,ut'ornllxcttllr,tii, itr rutt;clri, nlrtr,ro [rlorlrriti,prin cortrprrrsirtrtoir, r.Irllrrirrii
int,tliitttl Jtf tt'rt,itxll;0krstirr,lri0rrlrri,rLr obicoi lu :,mbele membre inferioa,ic. vr,trlfrrlo.l)il llr, tnrrlrrlri,irrrprrlsrtrilo sirri;oorrrlrrsrr rlrlrlrilxrl;pr.irrni,rlLr.irrrr,
uli nlrrsin.f impul uoplii-ryi nrxxrlinrl la tratl,mentele antinevralgiceobiql ,lrrlrrllir,crtro$llrrnzir,torr,r'o, I)rrrcftlr,trsl,osl,riot,Ioolr,lizlt,l'l, irr rrtrrgoltiiirrrrr.vr,(,irlr,
rrrriirr. Asrrsto rlureri au lu, bilzr-r,mouingoradiculita postorioarf iudtic'd. rirlrioilrilo vorrbrtln oxcil,rrl(fqi uir osl,0abolil,ii ciIrl. r.tlrlir,r:irrrr, tlors:llrI rrorrlr
(l)lnlt,esiuneh rldiculari dir, doui tipuri distincte de durori: durere ; rrrrrziiI.orr,loosl,o aucgl;oziir,l,ii, sllu sgotioniltii,.
rlc tip novrulgic qi durere de tip mialgic (Alexaniler qi peritz). liidii,oinile vontr':r,klsinl cornpusndin {llltr groa,sooo l,rausrnil,irrrlrrrl.
| )urcloa de tip ner.ralgic e o durere vic, ascutit*, pltrunzdtoare. mani- ,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
li.l:tlit |rt o tln,rn|1sx1'seleclric5,$i este asociaLi-cUlarestezii. tunnicd,turi
nrr,rliirrrl ^la rrrrr,rr ri,tltrcinii ventrale uu $lnt inso!its do corrtrrrc!ii nrusnrrlirrrr, ,1,'rirr,.,,'
.rapid pe inLrclgl dislribu{ie a rddi,einii (tle umir in jos, in tot ,l(' iirnt, provoc[tc de exr:itareafi]rrolor radiouhro vontrilkr lino.
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 lrr regiuncr ccrvicalL, o hernie rle disc intru,fora,rninn,lil Doll,lorrrrrrrri
irrcrlut lotrnembrul sau se poate manifesta nrimai in reglunea-proximalX, trr'orlrrooo comprosiune selectivi, a r5d:li,ciniirrontrtllo, tri,siirl lrl,rlr1, irrrr,
,1,'r':rli mai rnu[t s,lu mri pu{in intaotii. Acclstii, ovontlrl.t,]ilill,(\ Irr{xlu.r\
collorirLrlulterior.
[)ttrerel clp tip ncvralgic are doud aspectoprincipale. '' 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
-- slrpel{iciali de inlepi,tur5, cir acul in zona perifericd,
.r'rrrr so ^o.senzatie rrrrlxrlorridi,cini, cxistd,o combinatio ale durcre dc tip millgio iii rrovr.rr,tgic.
intinde proxim-al. Atlesea ea este precedat* de amorleal5 -qi furni
(,r'il,uli ; ca este produsi, de compresiunea iibrelor rddd,ciirii rloisale crl llrrtrrnrt intereseaziio arie mai ma,rs decit cea I unui rlorurrrl;ont; rlorrr'lrr,
rl isi libu{,ie superficiall ; rlr,;lrrlardistribulia durcrii corespunde dennatomului.
- o t.lurere situati, profund, constrictiv5 si limitatd,, c&re so accen- Nllncvrele pentru proclucereadurcrilor snu acccntnrlrcrlkrl sirrl lrrlkr
Lrrtu,z:'i,ln mlqcd,ri. Este asociatX,lrecvent cu o redoare lroiurdi lrrrzi{iille capului, glttlui qi bralclor, cum ar fi: intoarcorot or,yrrrlrrisprrr
localizatd, rleafectatdqintoarccroa capnlui spre pr,rten afecta,l,iirii pli0rr,rr.l,
I'r,r'l,r'it,
rlc r ricci 1a,git, umi,r, bra! I rnreori durerea se intincle pe o regiunc mai
pr,sirrrrii pe veltex; hiperextensia coloanei ccrvic:r,loI floxirl coloirirrrir.r,r'
rrl,ro i ol estc provocatii, de compresiulea fibrelor rldi,cinii dorsallece iner-
r rlrrloI cornpresiuneaexercil;a,t5, asupra gitului I prx'cuilirr,rr,lro l'izrrlor. Hpi
vcrr,zir,lolmaliunile profunCe: muEchi, fascie, pcrigst, capsule articulare.
rrr'rsosiru percu,tiaparavcrtebralS la nivclul leziunii ilpliur,rrrr,prrrsilrrii
'l\rritoriul durerii radicutare esto mult mni intins decit distribrrlia I
,lri,,ilrlr pe trunchiurile plerului brahial (durclo;t s,rLr'prrrrsl,cziikrrirrl
rkrlrrlri,otnului, deoarece clurerea iradiazd, qi in muqchii inervali de r[cl],- .r
cinil lr,ftrcta,t:i. 1rr.r'roptrlo in aril tlerm;tom ui rospect,ivsl,u pc itlilorl,gtt,tr,r'io) I Ir,I rIi rrrr,r .rI
irr extremitatea supcrioari a membrrrlui dispozi{ia fibrelor nervoaso t,r!'siruriipo mu;chinl scalcn, Atit in leziunilo rrulicrrliLu!roil ;i irr crlr, rr,lrr
csi,o mLrlt schimbat5,, ilatolitii aranjamentului comllicat al muqchitor, l,lr'\ului,-sint ilurcri pe trunc.hiurile plexuhri su,rrprr rnrrriclrirrlscrrlr,rr
rlirL ou,rrr, ,rrrlctior'.In leziunileplexului cif&ctelistic esto llptul oii sirnlrl,orr rrrlrrllrrl,
c-alzii,nu e.xistd,o suprapu:rere topografici, exicti, intre distiibulia rrrlrrrrsilicate
sltp(nlioia]ti gi profund5 a fibrelor rddS,cinii dorsale. 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
.ltrxlrindereadurerii in arii ce depi,qescdermatonmele clasice ar fi tlato_ ,rrrrl so imbracii sau se pia,ptF,n5,) decia,lqenzi,rlur.olil purrtr.rrl,orsl rrr,ri,iv
.r'ilri,qi intcresii,rii fibrelor simpatice din rddicind,, yom putea observa ast- ili limiteazii,accstetipuri de ni;ctrri, frr,pbci,rir so rlirl,or'rr;rlirr
I'rr.iotL1,Lt1 rrrrrri
li.l rlurrrli tle tip sterno-cerwico-faeiaL(datorite compresiutii la nivelul C"). ,prsr.rr muqchilor scapulo-umerali,qi nu trrlc{iunii po t,r'rr
_al rrclrirri.ilrr 1rk,
fi liipul costo axilo-brahial (datorite, compresiu:rii la nivelul Cr). ,.ttltri.Mi;clrilo urnlrului nu au nici o influcufil, ruuplrllrrrzi(,irriliirli,rirrilor.
(hi(x) compresiute pe o rXili,cini cerwicalii,inferioarA, poate ila dureri \r'r,rrsl:r,cxplici, tle ce unii pncienli pot sri nri;to tl.ourbl,rrlilltxrl,rr,l,, crr lolrl,rr
il rcgiunoa_pectoraiS, fl_vom av_ea- simptome dc pseudo,angind,pectorali,, ,lrr''.r'ilr'rni,ri po curo )e atr. t|pIiclt,rclrtr',.r"uLiurrii po blrulrrl:rli,cl..rt., rr.r.r.rrl.r
il rirz ('i durcrea este Iocalizaldin stLnga. trtrrrliu a,bducfioryisupinaJ,io cu capul intors corrtr:r,lit*r'Dl (s.nrurrllui i,rlxfgrro
precordial5, poate fi dat5, de hernia cliscului Cu-C, l:r gil,) (icclan;o,tzriclureri itr nemllrul suporiol. rcsprxil;ir.
.. l)urcrca I acest
rlisrt cornprim5, ridi,cina care formeazi, nerwul toracic anterior' 'medial I rrtensificare:ldurerii so oblino prin tuso qi striinut, tkxrilurco lrr ptrr.
(t l, 1i 'l\) sl],uner-yultoracic antero-l:,teral (Cuqi C") ; Ice$tiJ, inet"vei],2i, marelo I r{i(|o clostorobrrrsc},a pr,csiuniiintr.*ab{lomina,loqi intriltoltc i.o. .Atr.ir,rl,rr,
'
4i rrricLrlpeetoral gi astfel bolnr,vul poate rvca o clurete localizati Dre- ru' pont,r:.oxplica- plin f,r,p[ulor),s0 pfoduco o sl,r,zii, vonoiwtr furvlsolo opi.
llrt,lirtr:. rlrlll(! Di, r.tsttol,$0 comprilnij, $itoul tlural qi rir,d.tioirr ikr ; oorlplruirr rroir,
l)lrrore:i de tip mialgie este caracterizat; printr-o senzrlie profundi,, :r.t,rrr,sl,l! so polfo rtlor yr:_rillis I I'il,ejn,lu-sornioluscopio qi so vir, vtdol cttr
corri,inuii.,nepl5cuti,, perforr,nt5, puternicii. E.r, este bine looaliziltd, intr_o rrrlrr.t Iniclo#r,trrt.risO irtlj.rsl,o:r,zri.
zorrlr,rlirr trlirrtea proxirnali,, sc letlecti, in.,regiune:l sclpularir, qi br.r! (C6) l\plioa,roaplr)$ilrnii po prtrrlolo ntilllgioo rlor:la,ni1cazil, tlllorj Irrrnr|r^
,irr urniir', in rogiuto,r,scir,pulo-pcctorrild,, ; (.1()nll)r'()silllol,
n,xilarii, br:rl!, antebr.lt,, iat:r, iirdriiii riuli0lrliirii provoitlriXhipor.rr,lgrrz ia rnrrgultilor',frr,pl,orr,rrrlrto.
,(()r) ; itr t;nlpoz, sc,.lpulrii,,
dolLoid, blll;, cot (Us); cri se ;lsuciu,zliuu rcrlo:uo
, tltlooltttttttttll(, ttrirllgltxrttt'ulll)1,zonolr)(l0oLrlIBlr,ltllr,rrr ll,Lrrlrrrtriij..l'tttr<il,ol|l
Itrrrsr:ttlrr,t'1i,. trrilllgir:o rIulotrlr,Ho nitrl,loo.r,liz r,l,olit, rr.iyolrrlrlrilo rlr,rrrrrlilrr lrruvoilnorrrrri.
l) Lu'or'oi,Irnitlgicil rlotrrirrir,rrrltrslon
Libloul clirric ryi cil trsl,. rlo obiooi lirt'ir"1 ,111,r* B ,ll ltntlitf(u,zii, i'rr,l.luir[.
l)tttrrttlur+r1,rrrrrl'loolrt,l,r1, Hi (fN1i1x:1,'lllt,g
. l)t ilrlr, lril.t.rili.$l::rnr { i r l' r r ) lr $i. . 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"

'r 0i 'fiimrii^,; ,;i,f[

irrr'r, lr rrr plirt src(,iottirrr.lr liirlir(rrilol tlotsrrLr.Vitttltx'lr(,lr(lttlrtlii l)l'itt itrljl
llrr(iik' lrx,rr,kr r.u Ir ot,ociritrir r'ii ltttttriolirrlttlrr-
rrr prrtlr.lr'tltttt'trllxtrtltrtlrtlii'
r,iriirli'iill sLttst,lo Ititttittt,rrlc r.rlilrt{ir,i. tltrii rtuioti(ltllirn) rrrrlrrii.r,1r'i
spirs rrclorrrrrscLrlulc sur$l dllr'otji,!jii rcdoitt'eilrtll$or-
lorlrlizlrlt,r'r..1)r'r'zillii
lrur,, rlorlurr{urc\irJtiiio des(fii1('it tc t,rtutintuitle poterrl,iilldin princlt'1e, ilttro-
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-tala-
rrrilr,. 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
vcr{;Lrbrtrlir, asoc:iatl"lcu dureri pe ma,i multe segmente.
L:) D,urerile Lalamice apar in leziunile cturc adecteazf grupele nucleare
lirlr,r'alcale 1,alamnsului.I)ulerile se localize*zl pe hcrnicorpul opus tala-
rrrrrsrrlrri 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
virroulare ale talamusulli;i anurne in afecliunile din teritoliul alterei
lr,rrliculo-optice I leziunile vascularc tlin tcritoriul artet elor talamo-gt*1icu-
lrrir'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 propriu-
zisii, 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'erleter-
rrrirl 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'rrolio-
irlrli. -,\cca,sti, integlare in durere a excitaliilor senzitiYo senzoriale sau
i,*il,i,r', ,r I'ost denluurili, tle citre lead ovel'reaction (stprarcacfie). ln
ilgi I ruli cu tlurerile talamice, mli trehuic emitrtite noi-iunile de hiperal-
gizitr 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 inten-
sillt(, rr({l-rrreroa sir,poduce^tlui'ere. Hiperpatia este tot o hiperalgezie, in
r.rrrrrilsir, tlurerea are o tonalitate afectiYd' nepli.'cutd fi, palalel, e\ist6,
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 orga-
rrrrlni rtsDectjv, iar p.' dc alti, parte, d'ureri,proiect te (re.ferite)la riivelul
lcgurrrcrrt^r,lor'. As1{e[ bolnavii cn anginI pectomlS,acnzi' dureli in rogiunea
ll r'ocor'diir,lir,qii pe fr,tl intorYrd,tu brllnlu.i sting, srferinzii de ficai; acuzztr
ilrrr','r'iirr rrrrriltiLl rlrcl'l, bolnavii cu ol'jzc tenalc 2louzil, dtlef i ploicctato in
rogi {)a, itrghitro"sctirtn,L'l, oljc. A&\$1.(} t'oritorii pon'rt:1 Yrulncl(f ,zonel0
'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\
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
t t r lt t t 't r t i vir r lr , t t l'lrit t t 't 't ll
tti rcrtrl ri gi t, slt icii, it r sf ir lr llr rlr r lt lo 1i it t so{ ilr r rlt t l t 'st 'r lt lt r viit 'sl'llt t 'i lt ot sisl'r 'tlrr ',
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. an€sra3iP. IIil)r)(f$11',ilr,
rrrrcslr,zia pot intclesa 7;e itr)tli aroncttlu,re,raditttt,lu.rar,',t t1 ttor't'ttptt)1:ttlt4!tt|
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
lrlrlr'loL tormo:r,lgezice :llc fascioulului spitto-l,tlltt,ttt itl, llt, ttiyt,lttl tttctttli
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 .
:!. I;isocit1,lia l,abel,icd,, \lL care bolnavul lriet'rltr strrtsibilititltrit' IttttltttttItt
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'.
?.2. pltoBlljMl,l DU DIAGNOSTI0 lrNl(j.
T0P0(ittArl0 lil I,l1'11)l,AT(xl
SINDIiOAMIJSIINZITtVIIlI0PO(iRAII(JII
(iii,ih seusibilitri{ilol pot lli lczn,1,o in ttticaro ltrtttcl;rtl lrtlicr'1'ttlttihrr,
Irrirrtlrr,st tclrra,lhoro si rlrrr:rrrro(1linicorlilirr.itc,lcga,t0 tiilrvri,rl{J krrrrrlizrr
lr'lr,lr,ziuttii.'llullturiirikr tlo sr.rlrsibilitaLo pot, sti ooulxr o jtttttrl,l,:rl'oir'{1r,tIrl'
Irri. rrrrrnorrrbr'tr sitrtnurnrui utrclo t0r.itolii lr,l<r
utrui rncrnbru, l)rr rr,Hr.l|tr,ttr,t
Iatil, rltxli, (fi l't,pttllt'tt
r,lri rrrrt irrlo'osil (lolt' ltnolo lrlo(lul'i (lo $(rllsil)ilil;irto.
lir, I.ullturdrilor xr:nzilirc ;i lu,lifulat'lor, t'cslttrtrtiv notlttl lor rlo $t'lllrlrl't.,
(lo
tr,rl,D|c0izit;1('([ilrl lL,ziltllii.
'l'ittitttl soanta iux)Ft0 tlttttsitlot'tutttr,ltttl' l'l
,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\'
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, st r 1t t t 1lit r r il. r tlr r ,t t t r t . lt ill, xl, t '1'r l
 #lllilil
!iii,#{"rr"ffi
i{#irt"3:l
rii#il' l,;ii,:t;1l;.
#*"il*g rrrurirIcttIrr rlirt lrollllr,lui Ilr,srrirrr'.Ilocli
t1(lrt)l(ltlrl)ic(,,
rlirr polfirii 1i rlirr rrrrrrltr irrhrxiclr,l,iicu srtli'trnrirlrrr
Srrltllrrrrrit.trrrr
rlitr lr';rlli,
oxirl rlc clr,r'lrorr qi llrr.

ffiiili*tr#t;:l1'-.;iilH$H;xr*;:#i
,,r,lp,m"pirlT*ffi,."#HTi"",H11"*ir[*W,e"":;
Iriltn icl.
lr, t\in;lxtltttl rarl,iottl,arsi7tol,i,tnilitttlrtt'irrrrtiirtrrrrcltoit,zr't,
tIrrloli cu rl il

ifl
*]*:ff
it,rli[$ip;i*:Tf
l,r'rlrtr(ii t l,tlicuhlro,pit,fo$tozii si tuLbrrlrilirl.osursillilil,ir
rr lrrllrrrliilialorcllexclolin ttr:'il,oliulrtrlir,cirrikx'
r ul icli,t Ii sl;r:ib
t,oobirrcl,ir.i,, l)t.c(rlrrt
irrtori:srto.l,)slo crr,r'ir,rlr,
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.
,,,,,,,.1;*1*l"liilill f,i,:K::#::;#::ri3,,1!1i,J&-#"1'1i"",t:Y1X'S1T3.ir
ti'r,i.i.,.t,)'te clr,racterizatprin diminui,re-agi"rr"i;L--iri"i"r
rrr,olir,trl,u:lzri
rrll il itriiccl;ii
tlingnosCicrrl. ^{ccslrr cstc blrrt,ir,liit 1,r:rLurnlr l,isrrro, irr r rlr,rrr
qi proglcsiv in tumoli. Adcseorilcziuncrtint cttrscitziirrtrr,i rr l ll l
modurilor cle
3*s,,;tl"":#**;r"x*wii
::iilliiitii:q3":,::lJ#J:'rtxif
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

*.ii;,,I,{
}!tiii"ft,+*r$:*r$irwf#.1j;#fffi
rrrllio 6i sc instaleazi, atrof
rrlr.sl,rsitrurl!ii,semnolemotorii sirrt irrrporbd,nto,cu pu'illiz ii llrxro pr,r.r
l'r'r'ir'1. ,l.ccs1,c poliratliculonevrite sint dc obioci irrliccfiorlsu vilrrlirr|
.rr prr1,luil un clt'a,ctcl asccndent.Alteori se lealizclzii ruortirrgorrrir,lo po li

titl#1ff
iilii'*ls*;#I; i;#:"'tri
*,::lffi i:l1"il"i,"fd'
;i,','+3il:
r';rrI 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;
senai'tit:e
sintin runclie6i d'ectnna plitr ltectarea ,,pri.r'ilegiatd,)' de c5,trc virusul hcrpcsului zos1,trr,crr rr,l'irri
,,*,,!,':,1!,i;!Tlt,,u'.';:ff;:ty*yvdritor lirlr l rcuroectoderrnicil,. In localizarea clasicri, sintlrornul sorrziliy :rrrr rr
iiiii'Jl'Jfi i'"fir'y';"1;$i"l;;#gi33r
J#xi{-$;%Tiltf"",iff
,',,""lfi 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

:;ilrl;i[T# {,';ii,
ii!{:Xi:t#h !:)",;ii"},
lrrt:url,ereale constticlie, de impuns5,tulir,1i rlo arsurii, lil cu,r.o$o ilr1r,(1irzl,

l;:t",.,,';t,xjr"d,
: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,
apatii)' sini senzitito-llxot
ori'i, dar cu ri:1,(,1'{)
ii{r1lri
l,I*t-fftu'Jii.;#l;,{tli!n"'"'
,,',,,, ,rlicr'. .Sr-r, mr uitLrn tormele craniene,cu lcziurtoilnctvilor. rrlitrIicrri, V, Vll

j#fr+"*
t*:"
iil:1lplr_[T:nx*lhn#iii1*f"?".#i*ffi
\ | 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

ii':ll,lfr
*fltT****il;,,*#t+*",+t*t,
,.,,,,,1;1.l111;,#,lJlfr',3'y,:Xril:!:iJiffi",tlifrl1"$itgli,iK:tr;r,li*:
,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,
;'i, irsoci.rz:"r, ;i trtitutlil i antllgico ou conl ra,clrrt'lt,trrrrirolr
prrlll cr'li'lrlrrlir.
ilor' 1lr,r'lrvc ll r.lrlir lr .
plli'i"i'.ii"Gpostserorera-
aitt'elic;. 1t) ln sbtdromttl tla aompruiutta,fvniattlut'ri,s(tunrkf rlr lrl,itrrlr.tt. rroio
lliil';|U;,,llti.JJ1trl3i.**?1?o".ui
'i;i lir^sittt pc prirnul plan, iat cclo tlc altrcl;rr,nr sirtrzilivi so lliulrrc plitr ;rlgii
;,!;;;:i;.;il#i#,?#;*flJf*l'?J,1f""#TlHf,"#?'i:
i1fi?Ti:l: ,;i lrlirr hipoestezii in benzi (uulicLrln,rc).

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

1. llin,tlrtnmole sanli,l,i1)e .nulu.Inra

L Sinilrornt,Ll sacli,u,n'ii.l,otala ( com.plcte)u nddlu,no i rhl,cnuinri,rrJlr,r'ifirr,

iril'll;l##iry##Jiff if#','tr'fi
{{id':,,!fr iff"+'"onc'1a'le
"f.',Hf rrtrciitnrstozii glollnlo subiocl;ivoqi oLricctil.crlorlcsulrtullczirrtrii (l;rrllrrr.
,,otr nivol"), ittsotitri (lo l)ir,r'itl}lcgio
,r,,ri"iiuriouio..r,rtr*r;*lf
h,S,t'#xil*"?iJ#"fffjffi l
'-Jft
trrto tlrr scttsibilitrr,{;o
ItrllrtLtiLti irlrttr.llrrr.r'Lrt,
rlrrsr,nsiltililrr,l,r,
l,rrlllurrit
i v(Hot,iIt,ivo
rl opirrlo rlo rrivoluI lrrzirrrr
srr,rrkrl,t'rrllk,g
gi l,ttl'ico.N ivrrlrr
ir',
l lu lhu t r],tikrt'
ii urtxlu lu,ru,ryi rlokrrrrrirru,r'ouI r'rri,lrui,

ilifi1;$i;;,,1l;ti;f ,xill,',6ldiffi
;i;lji{{ryi"J.i",1ff ;rt;
i.,r,iiili,".rri,'iiii;;,l,ilivil;l,ll),ffl'i,"fili,iiJ,1:iii;fff?sfifi.l]
:r trivlltrlrti l,rrllrrrlr\,rilorrlrr sotrsilrilil,rr.l,r,,
tr,rr,rli:rgrrorlilrrlrtilollir. rl ft,zirrtrii.
u,r'odr,oxolriirii, villonrr itr nl,rr,bjll

llllll*j; i!. Sindronn,lrlt hlntirrliun.rtu,rrriulrrlr'igrr,rr

lrilrrr,lrrxotnilrilil,rLlii ;rtol'rrruIrrfiitrtI rlilr,r:1,r'
rildrlrrrrrl llnnon Nrtquuxl,
6i 11,11.1ql1r lorrnilrllilrl,l.ll
lr,t'tro.
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 | '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
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, 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 ttr tl ttti , l ti r l tt
i rl rrri rrrii rI rr v c i . o rlisuci:l!itr fa,bcticri horloLll,ct,alii leziutii qri o disotinlie Il l l ( l r '_
r irirrlorrrir,lior"ltoll,r'tlatelali leziutrii. Astfelr o lcziune in legiuner ri.ir.ali ,.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
(irr|rrr.rrlii) [ Irorniuriir]ur'.ei stilrgi r.* g;cnela i (] tnonoplcgie crula]ii Jting?:? 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'
trr('r'rl('rt.ir, sctrsjbilii.i,l,ii plofulde conDtiente in membrul infcricr sting si 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'
,l r i r,r ,' , r' tr piir l ut , r l"r s|ir
pir.rrlorr.rrslrrsibiiil,rii,ii tenrro-algtzice in partea ch.eapt5, cu nivel pi*i Ia, 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 ,' .
Rdddcinll posferbad
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
it t . {t slolcZiilni l. ol g{'il( f l'il Nit t t ll't it t lt t st t t
rr,:i ,rl , rl r' i tr I r 'r t t , i1lnt r .l) {) il( ic( r LL,
tl i t,rtl ti ttr;l ir lllt t llilit lciicnsil) ilillr loglollir , lii, alt lt 'ici t I t 'it t t 't 'I I r jilr r t tll r t t
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
Rdddcin& posl .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) .
Rdddc;rd dnt. t.,:i rrtti lc'pr r iubct ut t ! it t le su, 1t tioat : 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
it Cdu vd
ven!raid .,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
Radecihd 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. 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
rrtqrrrnrlul ln({lulilr. lezl,t. frrteresalea concomitentii a r"i,cld"ciniispilale 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 li 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 r ,l l ) r 'l r r i o r r \
tl 1|r'r'lir,. Lr nir |lul si t)e p rrtoa leziunii, prorluce o balld5 de airt*tezie ', , 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 tl r ' l r r tl r r l r r '1 r ,'
r r r r . t r i ( S i t g tr ', 1 9 6 0 ; f,i i zo tl h cs, 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 '
" 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:,,
. r 'l r r '1 k r s , 1 9 l i t; 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,
,i. Sinrlroqne.Ie tle disotialie & sctlstbilitd,lilor :
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
t) t\irtrlrrtuu.l de cortloonep <;sle,t,io&r'e (GII,Lgi l]urdach ) sau sindyum,al , , 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 ) ) .
rlr .lilttt lungi. oI l.u,iUijdri.ttt. Tttlhuririfu su,biectiLeconstau in: plrcstezii
I . s i i u l ro n n l g
l r .r l tr ,tr ti tt 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 rrrri rrL's s(,llllc lcccse de tlurt:ri fulgulanter (fulgeritoale), cu scrliu lir 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 tr l ) t!r tl
rrrrr r:u'irrlril. I)1\)\'ociireiri.lt1 ex:rCc:,barea:rcCSiolaprirl anl,efieria i:eprLlUi
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 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
rr. lirll('r{,lzi o l1,ingtr,(' ccrlicillii, in sperial plin conrl:resinrir .:ln
irlin 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
r'1,'1.'i'rii irl 1tl:iri. X'tttbtnci.rIicobiectil)eteilizeazii o disocia,tie ta]:etici. a rcn-
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
rri 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 . ( 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 ) ,
I't,t,iltilitti!t r:Ii.olrLrtite I 1-lbt's, sirrrlrolrnc ]tituro-anemice sau altr] ntia- ] 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
l,rzl lrrrricir'lurc (clrrrtn1. ilo1e, {r'goncratlle etc.), scleroze oornbi rtr, })oli , r r r 'r t ( , z i i l i r r l l tl ti t'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
rlr,*r'l|r,r',ilivc (bollu, lui llriOrL.eich), r'r't:ntr:n,l ftirrnt do cor'ilon lcstc|ior 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 r 'l l l l r l l '
., , 1 ,'r r r z , . iir r pl: ir . i,
, 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 l l tl i tl ttttsttl tr i , r 'i r r tr ';l i tttti r
lt) ilint{xtntu,l. dr ttntitturr"r,r:r'nusit poslctioatd (sut rcl.roeTtt'niintur) 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 t'tl t ' tt |'i t t ' I r' t I '
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' ), 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 )
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 -
t r t t l t r 'l , , r x t tl t r ,/r tl ;i r . ( i I II I r ' ( | l \I ' I t i Ittttr tttr i 1 ttt'i i i t I | | I I I ( i | , t || | I Ii ) i
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 l ttl r t
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 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 ;
,.i rl ,) r{ l t I r iI r LI r . r r r lr ,. 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

:rl l l :l l
 Irrrlrrirr')1g) Asr.*otnu:it (1r.ilr rullrrr'ii.ilr.r'lt'sr:rrsibilit.le, rrrirrrHrrli (itullorolri rlozugrr,rrJrikr), cttto!iiL',rrvlriLllr{,ii tt'rttttLici(ttltir't'ttttlIr'
rr,dcoscbirrrrr"
lrrtrrlrr);lr) J.lipr.'rputirIuLunic.i(silu,,slptrTcaclir.lalamicri,',cn"esprirrio. rrrllrxlii) 11irrsti(,ir,t,iikr viHorrt:r,Lr Jrol, rlrrlrr,tt t, tlttttli lirit,r'l,tr
vii tIo ;ttttI't'rt,
lrr' l,.rrrr,rLrrlui o ,,ovcr-rcactiou,' ll tufllcrd), carc constd,in fendmenul lroltrrt,vr'1,.Ani,fol,ttltul dirr lrolna,viilui Iltrrrrl(<ritrrt'1, tlrr Sr!g('t! .l{l{i(l)r'r'il
.rr'irrs .ii .r'icr. c-,ir:i1rnt, chiar. sublirninat, ,Lph;at de partea bolnavi sarr rlr.orrrlrii rlo aflxrNiltrlc rnt:zilii,,lttci{,,,tttrlltrtort,sI rt'zislrt It, ittttttui t lrt1,r tt'ili
(lr\ p.r,r'l(,a
$rruir,ljoasiinneori, plecum $i alli excitanti (de ordin senzorial, rrr,ttzrllilkrrdo par'1;ort, sll bolnilvii,", iill rtlt lrtoirrnl, rrl ltri Ilrrrt,tlit,l'it'ttttt, t't'l
,,lrl'rttroi r:intl oinl,itcotul, o srrrtzlt{ir: gt'oiLzttirlit vtrrtltt'tlirt lltt't'trtt,
IloIrtltt'i'1'',
fractul mahi la -ta lalnic 'l'r'o|llil,ii],ceastii,leritlinl,ir,tlo t t'tr:t,c! iOtllt oxoosiv ltt 0ticu 0x0itit(io s0ttei
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
5c. cer- | frontatd ) 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
sc.cer 11,6) \ \t'^ li ; i'/ '/ \
t-
,..
/i\ r.rl'r,r'rr,a,tit prin nucleii tjalanici de releu pc cit'iledivcrsclol ilf('r'olrlr\H|tl
f..:.
R:".:..
i' . . i' :
i' ,
:'. -/,/ii,t.-- 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)).
...j ; :::

.ia' I lqr,rl1i f161p"* (citat'i de Sager,1960), incercind sL explicc tlut'ot't'trhilx't'

:::iii:i!l talamicX. au ar5tat cd,lezarea fibrelor cortico-tlllatnicu rt,t t'IiItt'trt
rrrrl,it.,li,
i,i i:iR "-ttll:i
I DM I IPVP\
,'r'lrtlelosenzitive talamice de snb in{luenla colt'ical5 inltibitolitr 6i rlo tttrrrrrrt'
-.
\:.:1.;rj I i= / lvcv', rr('r,g1,i nouloni senzitiYi ar prezenta o ,,supraleact,icr'ln olitto r'rcilrt,ttl,
: ro i j..ji \ rf .^ - ( llrirr,r subliminal. Dup5, alli auttli (citali do Sagor, 1960), rlivcrsohr 2rolr"v
I ' .'
' .,.,..ji
Ir'. ion,a,le (tasoalare, tumorala, i,nflamatorii, cticatricialeelc',) an cxcil,rt,txrlttlt'lt'

P.Reit
E spino-tdlah;c Y
-.'.'!
:..:'..:

sc.rrr.13,1,2.s,7
) ',
Wn:
\!Y:/ :\,^:.
rL lPt
,ii i:vl-l
I
S' F,.o/r. ref/cu/ard
rrr,rrzibivc

'
talamice qiar producedurelea. Incerclrile cloinl,olrotrrrtt rt tllttt'
lilol talamice au dus Ia ilispute incd' incomplet elucidato. S-rltr rr'lt'iltttil
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'
tlrr rt

e Reil lat rrrill,e (1936) a ard,tat c5,alterarca nucleilor laterali exalttl, lronalil.rr'l,r,rt, rt'li't'
Sc. cer (11,12) 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,
LECENDA "
rlorlr la nivelul scoarfei excitatia se transform5, in senza'l,io.
6r nucleilor Gr nrcleilor 6r hucleilor t6a nucleilor Desigur, dnrorile rlin sindromul talamic ritlioit, plolllornrl rtivtrlttltti
lrrlrnlior al integririi senzaliei dureroase, iar o ,,soluJic irtrprrr;abill' qi rltrttl
OM:N.l)f,Rp- rr problemei nu existd qi mdte tlin concepliilo mai vochi 6i mtli trtotlottttr
VL(Wj:N.Veitr.ld. CL:N. Cehtral pe interpretd,ri $i fapte totuqi obiective, difur\' tlo lit lrutol ltl n,ttl,ot"'
lrrr,zrr,to
CL:N.Cq'p gedcuto, (Alnoni qi Operscu, 196?). Scoarta cerelrralii, rcprozint;ii lt,pll.rlll,ulsttporiot
laEral
CM;Ncorygenbulol rlc porceplie a clurerii, Dar qi talamusului Ii levirrc, dcsigul rttt rrtl lttlltlt'
itrrportant, atit do releu pe cd,ilesenzitive (inclusiv dunt'o?r,H{i)' <:il,qi llrr
lill,ru seloctiv,precnm gi de a ,,moclttla" qi do n contribui ln,ttlttlxrrlut'trtt lt
+N. furdfasci:ul. l-D:N-lateral
3U: N.Sutndib 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'
tr,tr!o extcto -,proprio-gi visooroocptivo ;i prin I'oltrl,iik)ittrtrst,rtr tttttrloi t'tt
Jriq. Jr, Nucleii talamrisului $i concxiunile acestora (poporiciu, 1979, sehem$ liltnal,ia, rel,icnlarit'qi cu sc.oa,rfa ccrclbrt i*l(Sllgcr,l.$60 1,\rscrti qti()l)r('H('lt'
({'rnbinnLi dupd sislematizareatf,nucleit";"?;.r,n n" Wa tct, Sager, Le f lf(i?; IloDovioiu, 19?9); i) Mrri pot apiirtr:l rnirscrirti (,or(o'at(totit:t',\'1\t't\Itl
Gx)s
tlr.norlrlsitrf tliscrcl,ttiii lot:a'liz11,e la nivrdu) rniinii (prin ltrzitrnrrllI'ilrrtrlot'
lrrlit,ttto'8trirto,r'os1:txrtiv t trucltttlrti trotti,trl-ttttttlilttt l,l Itri Lu,r-s);j) ,,J\llrrrr,
psihlu)sc,,irrt(.grcazi" ir.rdurcr,..-A,.1ft.t.rt,,pililii, o c\(.ittli(. drrgrdcltrsin1,tltrrli volrll,trtltt trtllt o
i:ll'.iJli,il
Iir(.lilii, dllr(.rl)tfiqrrrlcr'rnir.i1instx.cillirigrrl
lir,liunir{r,"rrsLccu't'it , ltt sttttsttlt,i't,
tttol'int,irfi
srruatt'ulri.r:e),'(,lrirr
simDLl. rrri6oil,r'iloltotozi<xt(utStt"zisr,lotfit,utlittitlo,,tlt'gcl,trittglttrlrtlot'prinnri4r
ItI ittgr.t'rrniclii, l)ill)i{,l.itnl,
lrir:1r1rirrrl1lctc.. rl"r,larrs,.rr.zir
il* Xa,r,,,,liiri
.ru
nr.\'l t {) ( |ut ' f lr r (l o i k) ll'rt,l,hurllriIrt
rt,l,ol,rrzitrr) ntnlotittkt Hitlt rtl)roz(flltnlrr lltr: lt'trttltittrt'oltttitt
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_
r,\l r(,l l l ( lr ! ( l( , Z ir f it 1. r)l )l l ..i i 1t l -(.i l l .i l c t{ ,t hk'ntlilltont,oni'ntd cor]1tt
(ll'itt lrrzlttttr,;r I tti gcttic ttlrt'ltrxlr'rttuttt l)l ill I'r{rtlll)l,rlr
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. . rrn1;cin,ltl prxlrrriqtrrr,
tt r1t.r,lrt.rtlcI li rrrt|,zirrrtr,lrr Irrilolirtl rrrrt'li<'nl rr,lttt'cll,t,i,
I rrr I r.I I r i rI.i , rrrrr.l t.

3r0 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). r ) i t i n l t , , tttttl tl t r l l i l |tr r tr r r l tr r l i Itr l u l Ii l r ,ttl tr ttl ,t 0 l tl tt ( r 'l r r r ' l l l j i I
:.'. t\ittr,ltrrrtttt lt.lttnticr ltrttliuIt,. rt) [)a,tc irnilt ut rro-clinice (a1e lui |hor, ,r 1 u 'r 'i r r l r r r r|1 ,'i i l :r l It'r r l i ) r r r r t'r ttr r tr l t'ti z|r tzi t ;tti tt 1 r t'zr 'tt{r t l ) ( ' tr r 'l l r l l ) l r l r i r
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 , 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
fi N i cul tsc ,1925, ci tal i rl c 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
)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}., 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 , , 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 r r i l r , ( }l r i r .r ,l i v| r l I r r ,"tt'r i lirl r
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 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)o: l| {'t i( | I i .
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 ( ') .
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 \ '. 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 " I'ti t .i tr i | | r i t t :t i l l tt i ') tttttti ttt
1 960; Foerstcr, 1926 I S ager, 'tt '
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 . rlltll, r 'i l : r {i 1 1 t, l 'r l r .i i ti tt si t'r r l r r i '.r 1 1 }sl l ) :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. fiill(lr'{)iulolo [ulln[r:p ruscrthu, sint tot I ind,rotunepu,yli&le, Tez,li, 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 '
,i,rll l)iirl plotlsc vilscniale loca,lizate hr teritor.iul ut:ruia di-tr cei cinci pedi- 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 r ttl r l r tl ttttt, r r
r 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 : 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
Lrlilrl){} i('ri(,rriil|1, si tallirno pe}folate (r'amlrli alc :llterei cerebralc pos- , 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"

ill
i( r'rorr('), |1,1()1.,r l{_'lrt irulo- opticx (r'l]}rtrii a, rrterei siir.ienc), arteri:I,iubero-
Irrlirrrricri,(r'lunuli a itrtcrci romunicante posterioare) .,si artcra coroidi 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 tr ' l r ttti l
, rrr rrrrlllionlii (r:rnnu,ii a artt:rei silr-ienc)" Cele mai iinportaute qi mai frec- , 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 | '
\,'lrlr. !ilrlrl)itrre till:llnice \.il,scu1:lt,c sinl cdle trei rarietd,li {lescrise de lher- ' 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
rrrrl 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) : 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
t) ;il(l)\Dtu,l Lle.obliterare e, patlic,tLlu,llLil(.1& xo-qeniclllat (carc irigi, rl , l r l . t n t i t , i i " .
|)otlirrtroii llltcrl|lii si l]oiitelio:ir;1, indeoselti nurle1rl yentral postcr'o-lal,e-
rirl). fi1' rlrnr{,t{riizr,rrzl plin tulbur.iiri t'lc sensibiliiato obicctivi, la mernbre r, . '\iniJrontu.l,san[li,L, rcrti.(:sl lltrielo['
lttt:ti i'rplirrlLl,c Ir rncmbrul in{orior), fiirii afeciar:ea sensibititi,lii felei. /) l,cziunilo 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
I )tttr.tcr'. rJ,rr.i1e-ristii, se tlli pc 1rltn secnndar $i este pulin explimatd,. Se 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
trrr,r loi,ilrzi o herlialropsic homonimd,. , , 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 r tt t
l)irrsttosrlir,rlli]rr imllicii tiiiiicultiili atunci cind apar $i alte simptome, r t i . i , r i : t ' vi i u i l l S I ci fr .l cr l i tci i l l c sl l tl ( l ( 's"l l .l . l t:tstl . rl"
1, '
ttt :rlrrlrr cr,loi scnzitirt : ririrtii tl.rlamici, miqor,ri coroo-atretozice,tulburi, r '1"rr ' tttrl 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 )
.r,|r.I)('I().I)j('si irrrrnilrtolts!e hurnitnim,i laleralti (cal.e insj, eslc de origine i,ril( l l i \ l i e t ,l e cl l 'tt i tL tc: o scttt;i r
( 'i l cr i l n \n ) l n i i l l r !{'i t l r r t;i t l r r l :r i r r l ' r 'l 1 r l r tl l
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 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 '
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). . , , , 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'
Iiit innr'\. rltur'lttt t't'rolo11ic, silldxomnl talarnic gIobu,l (cn de altfel qi 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
rrrrrJtrr:rrrrIIrrlIi.trniirtr p,li.ii'tlo) cstc re:r1iza,tLl.e!x)c6p, t:usctilare (ramolis- 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
t trf l r ri ItItrr'rr.l11ii),It' ottt!1i(:e,l itla)'e,le(indeosebi glioir,me), tlegeneratiue 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
rr
"'t l r r r
t tu Il u t t t t r t t, ii ( o1 ,(t' .fi l l i te ). 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 '
l\\ \litltitt)ltltl rl.e oitliterorc o, pddic'ul'uLai tu,l ma-perJor&t (c'r,re iligd,, 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 |( p r r r i r .l :r l :r i tr ttttttti t,:t r tr ttt

lr,. lrrr,tri r,ltr. l()riri.n{,irLriexti:ttalanlicr], nucleul se.nilunar :r,llui lt'Iechsig). , 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||'
c trrclclizlriilii l, i;irrrrii.
'-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, 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
rl:rlr r.ris1ii, r<csilur::Lzli1u,rrir-e1u1fc;lei i1i er-entlal al mcmblului superior 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' t r tr tl 't
r |i,l , l)rrl in r\pfinrir,ti;. Se pot asor:iii un homisin{lrom cerebelos, mifcd,r'i 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 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
lirrr,rrrrlr,lozire 5i ,,min5, i:llarriicit,". Prcciziim c:i din date lurnizate dc 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 t'i l r r r tl 'r t' tl r r l t
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 - 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
lr,r'rrll rLl lrrrrliculului 1r:llarlo-per'1oi'a1poato fi rnnll rn:ii gl':tl, tnai boga,l, | | l , 't r r l t r t ' ( r r i i tI Il r '( i tr i l r l t'l 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.
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 t t t r t t , t t i l ) t r l ttti l i l i 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
'r l <'si tttl tl tttr l l r ti
lrljitr,r Ir('r'li)llL{r ro iLnp,n't.trirL rlouii r':rmnli, cil}r sc dirijeazil bilatcrrl . 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 sr 'r fr r r l .r r l :r r I
,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 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 ( , I I'l 'l ! ( .l r l i ,.! l l r IIII( 'II|| ( :r l r r ,l
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 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
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 t lrrIiIIrIi|ol ItIo Ir 'r 'ttIi tr ' ( r ..tr ',t1 ,r i , 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 '
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
t tlr r i t t r ( t t l tti 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 | | | | ;
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
( | ) 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 ) '
1 ri o trtr r I oI o; 1ir , ; 1t r r rr1 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).
l
'| 'I t I i , r r t I rti I,.i l f r 't|."IL I||L Ii i i .r ' lrl\ r l L l , l .r Il :r r tt l l :r 'i I1 III|' ||i 'l l ( .
:l l :t

tr
 IrrLrLrrlrrIii, ; lt) A'ir{hr)rrrtllui 'ltrl,ttt t1i
rlrr olriooi ir cvltlrrrttl, ilrli',r'irrr')

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
ll,rl,inxl,:i (ltrrtr
lrt lit t'til,uL
rl,,rrrrrrri
ir,,
rirrsotttrtlogttozirttrtzollttttzir', 5i itttozrrtlilLlirt'irr)
\n,' ltgtl(rziotligil,ltlil'(itrcttltrtoilrt'k'it,
qi tltr lt,tlilittttr{,il ctrlocittci tlsgtritr,ttttr'ltritt tllltrrt'1,
Irr:rllr (lc orit.ttl,rllotlroaltt'lr-sl,ilga I ltcalcttliel rtgtiu{itr
I i) A'irrrlt
tltr ll, I(tcllllorl!Jl'rr'
rrrir

tltt llltclrrIl,ttl
lltr tilrttl ,,r,ltrsi1tg
rrl
tli\ lr,

'"1. jr: t ul]:uririte Aus""silriiitat",i-oiaor,ht" rrr'rr, lrri Illlyor'-(iross(irr spocirr'l lltltrtltt cxtxlttliit,lltitti tltt$tlttttrtll:t lllrr\i
,,,'',,.., 111;*,lll..
(,i,,,, ,',ru,rrr, lbi:u_r
ri.lL(lrr(r Icz.lroa conccrnitenti, a fi,ontalei
d" tot- ,,,rr.llrrefii);-j) Altc sernncl,oqtogxlJ icc corticnle, ptilt osl,ttrl*irt, llzittttilor"
assendeate in
rr,rlir,ccrrto
;i rrcl,l,rofiioror"oraro-*"*itn.iJiJ.i^o"."rlre
de-Sii" l,r Ior'rniri,iurlilevocine.
il;iiiiliili. :)) lir cailrnl sinih'ornului pu,riotal sa pot itlanti'.li.caur nt,iil,tut t, I t tin
rlr',rrrtttr topograJica :
gg,lii$11;!li',1$lll;itt,*
;x"Jilill?1,"#"*'jtl:,'"'i",ij""'*'.*t'11: r1 iliidront'ul senzitiaparietal global, clasic, lvl lrti, ).)(i6rint xi. l/lyt

lillilli'Ji;J aproa.
ltii:i?:1TrJ.........,fi";:ilr1,'1,';*i*",'S"iliflili,":"i;*rroduto r,. r'r,o[noaqteprin tulburxrilc de sonsibilitatesuhiocl,ilL rii obitrol,ivr'i'
trlo ttterior, Exceplion asoci;r,zi\: antiotrofic, hctnitlllollsio qi rtlrtzirt
tr'lrt

;IItn,li'l":;;,;lt*lui
il,1,lj:
,t,1*riil"*,y*::[;9l;:ll_itffi:ff
f
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
iiiiriliffi
!jri,"*lf
#i*:i?rdffi
,rrurmnay,*,i:i:s"*1
)r,rT',trnr rile subiectiw de din sinalromulparietal con-
lrrrlrloral, cu test&urarearapirli, a sensibititii,filorttlcl,ilo,toltlticii;i tlttt'r'.
r,r.rri, tllr cu rnenlinerea indelungatd'a abolirii solrsil,ri li Lii'l,i
c) Bindromu,llui Anton' 1i Bn'binski (vezi :ltrtcriot) cslo Ittrt,lizt,l,ltritt
krr 1It'rIIttIItII'

,r,^,,.,,, 'ensiiitita4 lr',riritrimri ertinse, cate implicii,: puietala, anteriolt'ii, ltt'itttrt uri ri, rlottrr,
a,morferi, r rr, rrrnvoluliepr,rietali,, girusul suprarnillgirralqi u p.r,tlc r[itr pliort,trttrltrl-
carcpotprera
.,,,,,,il,,0'Ji'''Jifil',i*.."13"'*1ff**n'J".ll;;H: ra tl) Sind.romul, lui, Gerstmannestc produs priu luzirtni (1il,l'lr irtl(\r('i{(firzii,
j?Htli,"i*Hi'"r,"jT;;c?},^pi"si'ci
r,,,,il,i{!i.':,i'if#tll#?ll;,'i
lrrrr.!i'tle trecere.lintre circumvolulia parietalii inlloliollir, ,,s
\', ," \'il,it'lla mijlocie clin pirtea sfingi.
i cit'ctttrtvoltt

llj*,llgf;y,i:robiccte,
care t) Sindromul parietol p08terior al lui. An'drd Th,ottt'tt'tt${) l1!olllrt)rl,'1l'(\
,,,,,^,,?,.,1liii,iil#':f::ifj'iij?,1,fi.*1,"* 1rr ; henianestezie predominanti, pentru tact 1i portt,r'ttilrttsiltil il,rrlrrrr'
irr
jfl l3'fiit"il:;I?f
,*li;l[tx,T"llJH3.:*;l:
I br':rdihinezieqi disrnatrie, apraxie idoltolicI orxril,rt'lttvrrtltrtlii.
1rrrrl rLrrili'i,
:r;r:,rl,i
i:::ii,;T'fiiLi;,tf
'(;il',l:"jlili',J",;;Bli:
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
l:ititlii:; i.:,fi'J;i;"1.#ll"T?;"jji"il,lJ,:*.i*: trtrri lles simlul pozifiilor, apraxio ideomotorie bililtotrtlit Illtilzitt tttrrrlrrritl,il
'ii:ii";11"-iliilililli'hllli"'Tl?#ii.,i?i,,fffil_X"-1m;;sticui,rircrin- (,1,,tip mixt); hemiplegie rl ro-r,ptri.

.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':rliirreartLor(crl'ti'
ri,,illlf,i'l:,,];"il|ll,l;l,U:lliifi,,i:T,* ?.3. PROBLEMII] DIIIOI,,()(iI0
D!] DIAGNOSTIC
IN DIVF]RSESINDROAMII
AI,GIOiI
illi;:, i:lll:,;!!ii'Iiiil","iil,ii,r"eori
cLirr imp'r,oirrr.,.:displriri.,,.
a,meor_
,,'irfl rr'sUn()rly. Bu-perlor sau itfefior,
. a miinii, slu doar rr, unor dcrelet^
7.3.1. Cefalalgiilc (Colnlcilr)
ijt:ililil.tiili::;
,,r! {} r1r'rzl't, i,T,:l:;r.,1;';#i;;j;."H"ilffif'J."JilJ,.HX?"",1""'Js,;i;
nlororlc dc 1jp R rav&is-Jackson.
\\ Cefalalgiilc acule trc srrgcrcazri,,evitlcnt, o co,ttzdnrt,lli,, lxr or,r'o rl
I,la o ce d, raloara d,iagnodicd silt Inrrrrrin considolarc qi o invostigilrrrin Iunc{,ic de lootlizl,r'ol cofllt'oi 6i rlo
. !) ;i ,remzeleserniologiceasociate

lli!li,!i:d;f; ffi'i'l,',v!,##l?f
ff,i,{ti#t"l1.HT,Lr,i:*;n"x*{4*-xi 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):
l:l:l't.:Yf::,i:.3- Temb,rurBurorior,indeosebila muDchiimici ai miinii, rale-
olr r(,illzuld un srndrum um6r_mind,),insoliti do tulbur{,ri vasornotorii
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
Il,fflil;JilfrlT,::li,;,"i:;i,i;'):z!"n,ii:;,yii,.l*:ll',li*rlli*,yl
n(.nzrlry
ii 1J,,rrirrir,lI rr,r'tot
l,r orr,rrrltrii
irr'lclioprriio(t,crrr1xn't1I)
itir,sir,rr
irr yitirli)1 irrxrrlicirrtrlri,
rlo rlivrrrsotrl,1;rrIi
rirttrllr1,rrtirrcrrrol,irlirrtril,
I
(Irrrk,o8rrItI
Lt'rr,uttrrr,linttt
flll::.iti.l',,:'.rl propriocoptiv);
d) Tu ru.rdtioest
ibutire.1r.arr,,
suir r l.frlirlli lrl In rtllitttttrttu'ui1t il,t.tl./r,,'
trrvlllgirr ocoipil,l,lii, -AlttoltlI ltrzitttti
fi'i'l-ir'iil,iil
r,lli)|;,!)tiiillffi'iflffiK'ff,(#d:fiiHil,iilli'f
xl,ittgi(vrrzi glp. l0) ; g) ,t,tLl.bniari
i,,ll;l,i;i;il;
li't\ icir,lostr;xrt'iol,lt( | r'rrrrt rrir,I i rrrr, trrltrrir,l,icr,,r
Ilrrzir)1llrrfrrrrrltr lriprrtlr,rrNirrrrrr
lrot'rriorlircrrlir,,trtrrur.tlilctt,t'"
; (!\'(!n
rr,r'l,rrrillil (rtr vn {itrrr
l,u[lr'i,rrrt,rrirrgit,il,
lizri,rlr,(lrr.mirr,rrirlrsi,,
lr,rrnotrirnrl,
t,,,rr- tr,,rrttir11itlr, rrotrli,tlttl rrlirrirr) ; |ll,,Xirroruri1riIrrIi1 r,iolInll rltr rl r,l rttl , tt,t ttttt i

224 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
.d.1.Traunotismc 1 71
lt i.lr(t lt.ttsiunp afieri^ali.I f) oaica!,ii, (cu 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 $i de alte simptome, indeosebioculare). Vom reveni rnai
li|z irr iulr-un subcrpitol seDarat.
.l[
-ir"oli,2)dc , a(ormo! iit.e -r-asculore
cerbrolc (angioamc. anevlisme,; se pot
crize cefalalgice pscudomigroroase(dar aproape totdeauna'rlo
:rcr.r'rrsrpat'te) sau nemigrenoase, putindu-se insoli in ulele accese algioo
i.r rle rrllc simptome (crize epileptiee, hemipa,reze, tulburXri vizlale, fdno.
rrrr.rrc:rt:tzice, eventual de paralizii periotticc de nervi oculomotori_ca do
llrl'lir, in rlnevl ismcle de aateri, comunicanti, posterioard si in cele de a.rteri[
Ir'r'|'hrrLi posteIioari).
.. .3) le,Jal.algia p.arocisticd, peliod,icd, tn tam,wile cerebrale este rar{,,
tipul ct'l mai obi;ntit fiind de ceialee progresivii, cu orar. matinal, sa.udo
',.l:ll(.e c()ntinuii cu exacerbi.ri paroxistice (Arseni qi Opreseu, 196?). ABt-
h'1, cefrllccfl,prroxisticl pcriodicri este car&eteristic5,pcntru fazele rie detrirt
;rk, lurrrolilor dc vcntrictli laterali qi de ventricul al treilea, tiind declan-
r;r.rliirlc _rnoditici,rile de pozilie ale capului, de trecerea in ortostatism, do
,'fotl ;idc slrinul (ArsenisiOprescu,l967) si oste in,lol.iti$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 psettlo-
rrrigrrirou,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, rlo potnil" - I )iirtrrcsctr,1)rxIotllIu,
irr dinosllt,t;innt(,,cclilr,klr
Iir', rlitrtpoh'it,rl,lrt, l,trr11'11',1 itt ot l6ntll,istrr (ltilxrlt'ltsitrtrrtrr,
6t'i1s1:rlir,:i),
it"\(l
trr rl rl | rr Irtrrl r r r , [ r r lr r , ,Hr 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,
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 , ,
' ) 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 r: 1i ltlirlirrt rrr,
.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,
rl | | | ,,'r,,rri l (.sr r spioir r r rcr 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! ,
I l tr, I
l nl t:tl l )i u1)l c :
Ai 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 rrr|, oilr r r r r , abccse, chist ur i par azit Dr o f , a. ( l( x'liill, , oit zt '1 t r t izo vi, t
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,
l l l l , l l l , Lr('(l of l|, locaBeexacer beazd, lam iosct r r ilo calt ult t i) ' it t t r it kr r t t ( ht t oit lilr
,',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 ui- sau 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
rl r, l i .rrrrr r r r nc ccr cbr alo clt iar colona, r 'iono) ( Wolll, llxi; l) .
' rl trr (ttlal('uL ;i
, ) d,in atero- ti arterioscleroza tertbrt'Li lt,1tit,t'tl tltt ltlticrri itr
,,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
I r|,I rt , || 'ii i (i 1i irrfrrol,iosrnvolill;or'. ,ll II i ltri,ant itt,nrut i n,lruontnitr'ttr\' $(\ l)t)llit\
'
. l r,1,,lI rl (r rrr,l'r r , lroor . {) r r f r r , lrt,xt
r o r l, ir r t t illlr r r glcxivr 't li) i t t t , it t t t ol}11) glo'{ivlr l) lll, t ! t ll
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 '
l1];8), , 'ilii) , ill t r r lr t r $t r I t , f t t lt r ir lit t l,
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
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' 6i pr'rbcltt
rltfctrtt{it,l)r,tlilicili alc slilii rle cLttts{:iin1,ri
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-rlfor-
rrrir{ii rrlo .iorrc{iuniioccipito-cervjcale,rniozite etc. 2) Insuficienle circu-
Ir 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 Dlrscula-
lru ii r:ryLLlui;i a gitului (,,mtscle tension headache"). 5) Diverse o.f€(]i1ttli
sislrntirtt (ancmii, le,ucemii, afecliuni a1e sistemului r€ticuloendotelial).
ri) (lt.lirlcur,bolnarilor cardiaci fi di'n alte stiiri' hiponice (insu{icicnlc catdio'
lr,spirrtolii cronice). 7) Cefaleea posttrarmatici, (postcontuzionali post'
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), (Ars€ni $i Oprescu' 1967)-sint t'epro"
zr,rri'rrio ile: lj Cefaleile din encefalopatiaposttrm.malicd'' 2) Cefale;iie ltl
h iprrltn.si.ttii tralali . 3) CeJaleeaStsihogenti(hr lemisie). 4) Alte a.;feeliuni{venl
rr:ri sus) in curs de vindecare.
7.11.3.nl igrcnele
Nligrtrrt l,r'ebuie diferen{iati, de restul cefalalgiilor 7}ritL utrs.at$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).
I'tohk.rrtc tk' r.tioprtlolle
trirr
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
,.'',,,,||
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 ) 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, l l l i 'I ;
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
'
ll,, 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 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
' a
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
' r r' | | r.1,' f rrr.r r t r r kr gicc, 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,
, I rrr rrrrrrll (.r l f i/ sllr ilicot r ) plot . Pt 'r ^zt 'ti,r; r 'r , lilioiit iI r l slllii r lr r lor r lli
I no(
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
t t;"j, rlirr trzrui, rlupil,Arseui ryiOprcscn, l!)07).- l,)virlcrrlir,r'i.rr
rrrrrrr
Lt 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
111,r;rl ' ;' r,,rl rsilr r , l, ot 'alil.( ) 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 rl
I r r |; . 1ir ',
I r lr lll ( l{r 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 f t cl, ilt 'ell pr u't , ilt , l,lr
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
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 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
t nt , 11irlr
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 t ; r , t ( l ( r l ( \ r l l r) r , 1 r1 l l l , ,, /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 /
 r. ttltltlii, tl,tLt'rn)(LNc ( t utr t:Llf reourehlid,I, ihrr tttmi1runoatri ln ptuc0s0
tr, rrrci rl r,trlrs1x'i, r 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
irrlIrrrrilixrIiiillo sirursului cilvcr.nosstiu alo olbitoi. '
, 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
O 0 rrrlr[o}krgio rlrrroroasii cu..caract()] recu}elli,i:r,l (in care algia, nu
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
rrri , rr'il'(l{}r' I Lr:mic.alic,. ci prezi,-Itii,o localizare ret.oorbitari sau i"n tori-
, . , r,rrr;rrrh' r' i z11li, r , |t 'cl, t t x,r tcr . litlr glir f ic q. 1, . ) .
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_ tlJ ll t,l,lutntt!ii. uIt .losti t:urln'u.lr ltttsltt ittrtrt yi tlt ;ionlirntii. rrrtnio
r'r,,,4t(.srj ,,/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 . ) .
l)L,[us,Jciu[ st scmnede lcziune a oerfului optic.
| | | | | | ' ' | | 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
Sindroamcle pseudomigrenoase (sindroarne migrenoase simpto. ' ' ,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
.,1.1.3.
nrrlr(xl): 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,
1. IIem,aragiil,esubarahnoidiene din_ mafforna!iita ,t)aso,u,larc (aneuris" ,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
tttr:, rr,ttliname) pot genera cefalci pseudomigrenoi,se cu caracter recuren_ 1,rr" l i cl l rl t . r ligr ', r r i b: r zil; r lr i.
(iirl..rrsur rlr' rlilgnoslicetprin debuful brutal-al cefalcei,pritr semnelesemi_ lrr slir'qilr, rtiri tleJruic avut irr vtrlclr ftrplu). cii \i u,n.rltaritr ltipruli
(lr,):jrr',.rtc uoompal ament oare persisti, mai multi rreme, prin constatareiu ,,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 ,
rrnrri L.C.ll,. sanguinolent $i prjo evidentierel malformitliei. 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
:!. lllutnortle de uentriatli laterali se poi manifesta prin 'crize cefalalgico ,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'
lrllir.rrlioc, deolanqate de schimbArile de pozilie ale 6apului, cu d;bu; Si rrr ,,:rrrr ptorhce disprlrilia manifcstridlor nenlopsihiur, rrl pul(fl, oli.r'i rrrr
rlrr'.it lrrpi,l..ldrA frze precisepre- 9i posteefrr,lalgice cain migrenr clasicd, i,rLl (li' ('onfiunLrc a originii hipogliccrLicc l urror clizl rrrigrlrro:r rr'.
r:'| t|r
.(jv'rturt:I, ultenoari], apar semne de hipertensiune intracranian[
(;\ r solri qi Oprescu, 1967). 7.11.4.llgiilc orcipito-ccrvicalc
ii. Tt.r,m,orilede aentri,clr,l
rr.rr,s.irr,sofite do fenomene vizuale .III -pot g.exeraIa clebut crize pseudomigre.
similare cu c(-le diD faza frotlromal"L a Alyiilo riclici, urmi,toarolo ploltk,rrro r lrr rl irrgrrorl to
rrrigrtuei. l)al aceste crize sint declanqlte si, r.especliv suprinrite .oeoipilo-eervieale
la schim. | |rl l l l tl r)gol i l (j i
lriiri l', prrzi;ier,le capulli, iar evoluf ia t ra nseaiii d iagno\ticul , pu n ) 'I\ruumo,lismeaertebraletau ,rterlel)ro-marlrr,lrrrr. 'l'rr,llrrio rrrrtl itr
-rl.t.
in"r:.lilii.siodr.omului rle hiperuensiuncintrlcranianii ip:rr qi semne-isu.* r rrl,.r'r.Irr,llt,rrl (Arscni qi Oprescu, 196?; Alslnli qi oolrrb., l1)?:t) r'iL rlrr
neuro-
l,rgi,', obioclirre erolul,ivo (sindrom parinautl, sindrod Arllylt_Robertson, ll,r',.r Iltuuratismele vettebro-rnglullnu eotvicukr irrcutrrlri, o rlrvrsr,lrrlir,
l)rllz{) ooulale, semne tliencefalice etc). lrr,rrrl:rlc 1i cii trebrie ciiuiate cu glijri, irnirlia[ rlrrpil llrrlrrlrlirrrr, rr,rrr
, ,1..
ll'ttmorile occipita-le pot.genera la debui crize pseudomigrcnoase cu ri,'ll rlc k'zirnreu,tit ver"tebmld,, cit si mtiduleril,.Silrl sil,rrrrt,ii irr oilro grr[r,r'rrr(rr,
Itx'rrlizrtt,'.fr.onto-orbitari,, asociate cu manifestd,ri vizfale tranzitorii (foto" rrrlrIrrIrrliiesto oligosimptomaticit snu inexisl;ontri,in schirrrlrrrrrxlil'ilnlrlrr
l,fir. nrnlrilrtopsl tru,pziforii),. dar p€ parcurs apare sintlromul rle hiporten. r ltlr.lrt;rlohaumatlce sint importlntr:, sniclinl,alirlicrrllrr1l,trulrrrlrrrltt Ntr
sr"" rIrLl,,ct'i).lant, iar hemiatopsia Be contureazd, din ce in ce mai stabil ,'lttrrr,lrtiu tlurcri crlrvicalesau celvico-brahiirlc,lntlc,,st'lrirliskxlrliilr,rr,t'
fr r. ct|,titcteL progrcsiy. lr,lrr:rlr,si ilrcturile-disloca{ii rletenninii simlroiuno lr li(jltlrur', il r.rr'r\
5. .Pseutktmigrenabazilard,reprezinti o formil de ischemie tranzitorio l,,lrrrrlrrllrcnzi),llgii puternice in ceafii,,cu ilirdioli sltrtr rtgirrttolrrr,cipi,
in lr'r'il,orilrl vertebro-bazilar (inclusiv in teritoriul uneia sau a ambelor lrrl.r ri sprr um5,r, insolite de contr'..rctlu a rnlscrrlrr,t,rrrii rrrrrrrr!' 4i rlrr lirrri-
rrllr.rr,rrrlrrbrale p_osterioare),oaractgrizatd, prin tulburiri vizuaie (cu sco. lr'r'.r uifjr-riiIilorcoloarreiver"tebralecor.vioalc.lr)sto irrlxrr'1,rrl, xl, srr ptr,r,i.
l,'rrrr. s.i.rrl,illnte hemianopsiee,ilceloqarea vederii rllzr.rlrrrii,sirrt sau nrL;i sittptone asocial.o(lo lrrfr,rirr(ii, rrrrlltrlrrll'1.
li/sau halucinalii'etemsn. '|;trttrltte
l.:rlr..;.crfrrlrrr.pulsatilii. (cu localizare iudeoscbi postcrioard. in regiunor, lt ) Ilisaryatiile Lefi&)ral.ecerait.:ala rlut0r'i ou (jirt1tr11(,ro (lili,rr\rt
olcilrirrrlii), rrr;r,ni festi,ri vcrLig-inoase. felomene ccrebe]oase, zgomotd auri- {l,rl' rr lrn(jiio de sttdirl alteririi discalc.-Asl,ftJ,irr livrr, I (iIrlI;rir,rrI.rl,
llrl.lr', rliziLrlrie, parestezii bilaterale atit la membrele suireiioare, cit rtrl
-chiar 'lr' .,rlirtlirionlii,tliscnlii dur:eroasii,t'* .Do Sdze)dltlrlrril,r'slrrrlolrl Ir'rrli,
lr rrr,rrrlrrr.lcinferioare si la fa!d, (peribucale$i linEuale) si alte*,rca lltrttlrrlirlir rrn scgrncntvcttr'.bril,l, oa,lijrxl da1;oli1,i, ir,il,rr{iciI |,r.I || i IIIr1i i ||||
,rlr'rrii. rlr. r'igilentd(obnubila,re,.bipersomie). Sc p6t asocia: nistagmus ,ii rr,r\rrri(l rlirr rliscul altclat, I)rrr.elca, sc tltzvolt?irluobicci Iltl, prrrgr,,.rirr
lr.rr.rliziirrculomotorjitrenzitorii, Acest contcxl, scmiologictrebuieiu grij'd lirtrrr) r'lrrz"'i l pltlcrrtiiovi{lcr1;i1,.
l)oar uncoli lr,lgirr, rlohulclrzr'i, lllrsr:, lrprrrr,rrl,
r.l.i.lrlttliut a mi,grenabazilard (Binkerstaff, 1961 popovi*ciu qi colab., 1".9gd rIr'r' IrrrrrIrI r'irlo rrn 1]llr,ututl,igrn
tnirtitn,rlc () tni;ollr0llt ttsoi,glrrt(lt\ (rxtr)Itt(,ftl
; ;
llrJrr.-r.rr .i furn, 1977).pe care de altfel unii o coniistl, si sJ ne oricntozri l,t lrtl1ri rrrrrozcillil.J)uttrr,rloslclruriviolcrrl,lirlirrritrclrllr,r:u(,cltziit,oxr\lll, tii
rrr 1'rirrrrrlr.intl spre o afealiune organica in teril,oriut'uertebro-bazilar: lrtrrr'lrt rriqrili lrkt coftrinrci,ial pr,rr:rr{,ia looulljirr,ct,lrl;rrt,irzrl itlgiir,.ltrrrr'
lnsuJicien!,ir, c.irculatorie aertebro-bazilard,alercscleroticd, (forrnolo tllr, rlur:r(.{litsl,l'i ltrzil,cvoltrrrazii,rlo ollicci itr lrttsclri qi rru srr itrHo{r,lcrlr,
,. .t)
clirrir.i) . rrr,tttttr,
1r'irnzitoriiqi inicrmitcnlo). r,litrico(itt rrl:rlr'i,
rlo sltrsilrililrrl,r'ir,
JoctrLi)tii niui rlc srrltrrrllrIi,rIrgilr,
, ..lt) Mu1,Jormnliiuasuilare (anenrisme, angiodtna) ln teritoriul veltcbl.o" lr llir l rlo o 0v0trl,rrirlIr'lgitlii:r1,0 lt colxr,rr0i0ritvic,ltlo,
l)irz I ilt f .
Itr Iirzir,lr, rlourr,(rltr ,,blrlll.j tl sr,grrrorrl, ltri I'rr 'rlisllrlrrrl,itrJ', Altr tri 4l
rl I't'oluse l,nlocui,l,oure
il,c spnli.u r.tl,cfowi ?ostarioare, Ill|l1.Ir,[, lll{17)(llnrtr, rlovitrrrrrrrtivi0lorrl,rI,, lrrrti 0rilirrsr], itr rr,Aittrrr,ir |r,t.
S'- it'l)u', rk..i, irrvr,rl.ig,r.{,ii
ltt..rrt,o4i tJ(,tnl}l.xi!(ol:rrrrorrr,
,lLrrhrr'l'- l lr,irlrirJi xrr ittltrrlcql.rr li tll lotrl,trrr.lrrl|r1l|,rii lrlltrlUir.ii,lrr.t'1lr1r r,i rlrr
,{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 r, rrr. tllilirrL,git.o rliNItrrltrrzlr'r,
4i/r.rrtrlttl'o rlilr'trtlt0zir'r,.
2:t{l
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 ,,!|

tt,lr ,l)ir,r('zii
l('tlrr;rl'girr),-r.lo 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
,,,,,tt"ori .,,i ii,rt,rtrirc
, 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

li;i,;ll:::;ll,;
l;1.,,..,1,,,j Urusc,i1orlrr,t,rtr
il ll,,ti
ilt,:,I it'';;i;l:i,;11.,;i,HJ
tt,*li;*"li'iii.lt:i'iJill
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 'r 'r i l r .tr
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 ,,
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
ca)seiu:oqrsr' '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
'iJ.1io"-
,,,,,,j,,1,,,1,,'il,i,"i.i.l.!,,
,,ll.1l ,1,'atg;i
.r evorurie
l'rrt, rl, , 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 , l r tr r i ccl i r r r {i ;.r r .) , r 1 i l :r l r r ( ,\r !1

lii,,l:jiill;lil*ih+'.1"gll;".,"J*1'l':,l'",,1'1l1ll"H"'#,"Til'$;lll';ll I,,, I . ,
l 1 . , ', 1 'i r , r r l r .
r r t l i l t( 1 r l r l ;1 1 ( ',
l tr r r l r l l r cr i l r r l l
l l r l r tr 'l tr r tr r tr t,o l r tl tr 'tts:tl 0 l i o ( .0 1 !.i r l , Il zi tl i , r t'
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

,,,,-{,,ijl,,f j;,i"I:#!,fln:ii#j"J*,$*i:il?il
!,lll:':,,[i,o"t,::1,;i,#,r,?,.
, , , r r lr , ,l , r l r ti l l l l o r r sl l i r ,l i vi i ,
r , , , . I ' r , , l , r IIr 'r tttr IIr .r r ti r l ttttti l l sl tti ,.i ctl ttr l o l l i tr
r l tr l r i r tr r p i i r i l r r scr r l r r r ':r 1rl l I r r rrI i i I :'r r r r
r ,l r tr r cl l t r r l kr l r l l r r 1 'r l .
extra'rnedula.c
liili,iil-iiiil;llilll$l::: ai"d^tdr oevi,ie
r,:ar:iii | , 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 ,,
'
::ffi:?t' rlc blrcalmhir.tian,
itr minr"'
, , ,', 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
ri,.,r| ( rr.tipitrtul
osr,e
**, i:Tlli'#ilri.e I t, , , 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( 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:;lllir:ir-:l;i{:r:f ,j.jl:l
t:!i:!,'!::"iir,xl,+l#iil?*;lJ*.,i?Fftxfr
ffi
, , , L , 1 r . , ,,rr .l i r r r l r r i .

l l,j inir,,
illll';:^i,lj[#ftil]ii#ifli:';*m;'{l*:.-**jerieasiune ,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 ,
, , , , 1 , r l i o ;l r {r q r ,tr i r ,:
r r Itr r i i i o Ir ItIr ' 1 II'i Ir l i ;r :L Ir ' p r l l ,l r .r r r , r l ,.

n.'nicali'p,.rrfi rlcictrlinrte dc /r,'r('ri

' 'l'i,,',','i')i,,ii;;,"',',i::;? fi I r ', r i ,,,l .i ,r h i r r l ti i i l a l t 1 0 n ( L i r tt Ic( i l l r o sl 1 t | | r ,('r| | | i s | | | r' r i r r r i l .r r r r r ,r ',r

j:r:""i:i':Tj#Jilrr#i1'."..,ril:iiil:4.,xiit
:':ii:i:':::i,[:i;!!1:i
t t t , tt.ttUt, t,, rt,lnz lc ( at t r oZt
| , , 1 , , , , I I'Ii i I r .r r i i l IIIr I Il IIi r tttIIIi r .i ', i ttsi i l tl i r t l t'zi tttr i si l r r tr l l r r r i r r ,;r tr ,l .r l
1, l , '. , r r . r. tr l r l l l i v l r l tti r ck'i c ( l l
' t , t t i ,,,l ,n h i q l l l i i l t
l)r.

p r i tr , ,str .l o i tt!t tl i su tl r , ( i tt,Ittti r - l ttr n r i r l i ,ttr l r )

;l:r,::i:1,:'; iil",'l'"'iJ'i?,};]r,ll,'lX';;
:ijl,.";lll[i:t;hfli{ijfi}l:l r , I , , r r l : r r r r ||r r ( ( Ii Ir ( i I |r r r ttp l c,si r ttti l 0 t l a tl i r , l tu tr si l r ti r r l r tcr Ir r ( :r l r 'r ' ( 1 1 .,",,

jll
jlr:l*t*:*"g*1t,J*fuffi
;,t;1,,;,,; t,:11,"J,.Ti?:'ffi
tr."*tl
"fr
'r , , L i r , , i r r r l l l r :r l r i r r l * i i Ii i tr r l co l sr cr r l i l i r r l i st,o l r i i i i l r ,tl r '( r ,l r l r r l r ,
, I l ', ' i u , l l l ( i l ) r r r r r r b l i g i , si i Io a to tr r i tr p ti r ttr r l l i r r r l i r vr r l r .r 'r . l tr r r ', r ,r r .
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l ri l )( fl I.r,l t(ri l i rl r,)l tzr.i,,,,,,,, f 1 , , , l l , , r : rI , ) , r l i I i i l l l Ir r l r l r ' ( t t t I I ' t
r,r r, r r r " r , l. i r lr . r r \rl l r \1 ,r' l c l r!.c(!,r,\,i o rl r,,orl , l [r l r r l r 'r ;i ' r l r r ,I'Ir Ir 'r 'r tr Ir . ( r 'r t]r l |i l ) l l l tl l 'l 'r l l i r 1
i rrrrrl ,,(j { )ti ,r.i brrii i , f,fi ,* ' i i , , , , , r l r l r r i l i r l tl l tttr l l ,i
' , 1r',rl:rlr.,
' ] 1 .',,,1 i ;]i,,1'lt'ltrri,rrrrtcrric(,\r.strris iOtIlc
:11
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rrrrs , is c nl,,(U)r)r. i{ 1 irl 'l ,rlt lrrrl r :t ttl r t " .r r 'r 'l r "tr r r tl l l l i I'i r l l r '"r I l "l 'l :r :l '
lti'/l).
Nu t11,l)uic '
.r iuvi si rritlri, f,,pii,i ,,,i lrr',jiut int,clscat"r,i,, tttr t
,.';:..,,, ir,q,r t.,t :i r-;rri:,.r.r,. rnu..l.ll.ii. c.,r,g.,n;1jIf \ " ; : t n t l ) t ,r tttl ttti l ,t tr ttti r t l :;i n r l tr tn tu l l tti l "r r ::'tttr r 1 "l 'tttttr t) :;''
.,,1. (' tr.,j I . lrirr i,r,nn1116 qi ,,,.1,, ( ttr r ttr tr r t l ,i r r t r r r l tr i i ;' l ttl l r ttt;ttI
. , l| , \.r|.rtrt, j: \ ' I , . ||I : I I . r . . i t r ^ot i1r |it , r . , r l S , , r i I l D . i f t J C l r i {t l i r f i r ' l r i l i n ) { i t tl r r , tl r r r l tttl tr ,,Ir i Ir l t:Ih ''
.
,'r l rtr', rrsliirl irroit:olitx: coltrlclic muscul:lr.ri , , , , l , , , , ,r 'l .r ,,i i r i r l r t r r i r r ,l r r l rr rr. r , r | , r rrI rr i i .r r 1 r Ir 'i ,r r '( r .r l r .r r r ,', l ,r r l l r r r |r i Ii Ir r r ,,
olercite o iriiaiie de plex, rlrr,r l , rr r rrr i : I 1 ( r r r r 'r r r 'l
r* rit.'.' p. lr.lr'i, pr.rrlucind r.cacliir.:rso,sp:rstice. , , , '' , , , , . , , ', i , i,f,,'l i l i i l l l i ( 'r r l i l r \', i r l tr r l i i ;i l r sl 'r r o l tr i tr r zi ) l tr l rt' I t'
Trebuid lu:r,tiin clrrrri l tt' l l i tl r l i r r r Ir t ttttr l l r
. .r, I r r l l r r i r ) l i fg i t, IIr , si IttIIr Itti ,,r r r i r l i i tr r r i i r '" 1 t'r 'l l tti r r sl i '
dora,r'e lt stabilirea diagnosi r , r r l tr r tttl i l r ttl tr tzr '.r 't.t {ttr :tt
cului qi nnii factoli profesiorrrrrr, ', , , f i , , f,,'l i ,i : l l i i l i l ) r ) i 'j l 'l l r ;r l l ) l r l l i l l ', ,i .|i
{) ;Ill r{ I1 r :r Ittl 1 l {;r
l l l !r ll'
1 r " u r r r l il r r r , si tr r l to i r l Sr tt[tl . p fi '
c.n de pildii : 1a h:"n:Lalipiil c,, 'sl l r "r r L tn r l i t:- ( '\t'r 'l l r
Sccl cn i r i r r r i l ',r r r t,tt. l 1 ) ? 1 ) ; \\'l l i tt':;i Si l r l t, 1 l ) i fr ) ' Fi i r r 'l l o r r r r r l r tl ;1 " r 'r r r r r t'r "
borireu nincrilor prin greuti (, ; ",.,rr,
, l r , r i ,fi ,,,,,l r 'l 'o tl r L r :r l o i l cv,l ;'i 1 'l i tttr tti i r r tt l ttr ti , r l r 'r r l r i r ci ( r l l l l r r l l r r L r l
lr z.ugrrli :i h tlli nrcsr.tirii, 't,i 'j ,,p tl r ,l ,i ,,.i r i cl 'i r r i s}l o j r L i r r r i ' l ) r tt' r tl r 'o l i i l .' r tttt r r 'r tl r r t' '
; i ; , '; , ';;,
.,,r,. llclpilzi crr braJr.lein hi r n ti e u l u o p o 1 ' l l tr r si sl l r .r 'r 'r 'r tr r r r r r r l .l r r r r
, , 1 , i ,,,'r ,,,,r i ,i ,i r i i ;i r cr l o l i l l
l rp | r,l ,,l ti ,1i i ' ;i cu gi trrl i n hi l ,.r t , r l . t t ttr l t' r l l l i l 'r i q i i cn tr t't'l tl Tl :'l i l t) "l t d c t,l l g o l l i sl tr r fi l
r "l l r r r r i " tttt
r r1crr" i t,i I r urri i sporl i vi t' tt i rr
l , I r : r z i r l r r r r tr i i tr i i r tl ci cn i p ttttl tr a o csl ' sl r l ( l l ( 'l l l '
I o I si S o]i ci 1l | r. I ml htuhtu l
tt l o r '1 r 1 .
slalcnice qi a gitului. Ne c.:r.jlrr i , . I : t n h i n l .r tii .l tt tr tn m t'u ti r ,e( i n sp tci 'r l P"i l t l l l r l l i r l l l i 'i :r l r l ttr r l
tiim sprc di:ignosticul de sinrh'urrr 1 ,rit.l l l l |i c"In l r i r 'i c s.'r r zi l i r " r r r {'l r r Ii i ' vr "'l .'l "r 1 r \ '
, , 1 , , , i ', f , 'i i ,r !.L i zl ,:tzi i ,
r l i zr i Ii ( '1 l o l r r l "
sc:rlenic in siluafiile in carc lrrrl , | , 1 r r '- t) r tt'cti L r l ',stp r r o sto ti i l c l o f i l Yti l r - i l 'i i l t'to $ i si ,r r r r
codsld nr\-ii acuzir durori ce..rvico-br'rr , | , l . r i 0 i r r !l l i i o n cd xl c) .
' r l . 5 c l r 1 . l l d c l i l (\llu i 1ri .'1.(irL urn:jr",p. frr!:r 1r951r.11
;.:t.7. ltiv(:rse sindl:oamc algiet alc t1r0n)lulr!i srlprrir'/'
/ r, scd cn ic. Se o ]]se r \.i
l'li i. , rI i r r i i ( l a r I i r ) i l o l l l t | r \' o a sc ltr r a p o r t cu tcn d o a - oar; a braluhi qi pe borrltrl
| , l' , i, . i r r \ r ' r l i f l l c s c n l f ilo r ( a n L e r jo r SiI) o sL e o r _
, rl, : , 1'I l ) f , i l n r t ) $ i cu a .tcr a su b clivi€ L lla r l
cubital al anlebr:llrrlui), carr sl
l. ll.rrii!.tt diwrsr: ttriirtiii (tttt.li'ttt'r'rtt'tltrl
t,ronau,lare'i'n
lLttt'i,ittt:le, ) '
'1
: pr'r'l rt"
11, . t t \ t \ , , . r , r r r s r r d j a r i cxacer*leaz:i diurn, mr:i ales I rr , ,,,, ti.,,i i;t;;;;;g.rti, rlurtL'ii,5i lritr rrli{.' i'rrlr'r'ilrilr'
"
{ } ,r z_ r t,u "r .i fr ila r a ijto cir .
/ / r' tr.u.tri t)rin$ irterior. ocaziil prrrtilii de greuti,li si r,rr ( l J C l ' )l l l l l r)l rtl l r' i '
i
' l' . . It tl c 0l ' i f
' rt
rr.; rr {rr(,i,,r),i,ii,i r:rtfiriirrr' rll rlt tr tL'
orrostatis,u. 11. /rrr /ixr iitosebit til, ottlpd sind'faDllrl' tl'o <tr'ntl
( is+r , O pr oscu, I l) {iT) l') t r lt rr r 'lr r lr \ r r '"1
rrr,rr.r'rrirri. ".,".,,,f:T3r'r:tj;Hfill'#j,lilil,lill
li' irf,r'irrziirpri,lrpo tottleaunao set.iede'ttrlburijr.iy:l,scullrr,r,: , ,,- i ,1 , , t , 't , .
ic
di
cir r . r '! , i Ar seni
ii pr : 'il'ziilc
ii
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II I I I I : ' I I | I I I | I i|'''i||I r r ' r \ r 'l I
|r, rrrrrt |1..trtrrl ,ltl it |[rtrrJ,rlrli-supcrior,care pfezittti o piele rnai rtt,,, ' l ' . ' ,;' .', , , - l, l; n , lu , . ' r
. '
lt . r it r 1" r r r r r r r r 'l'
i"i'i i' . ; iii init 'i: r r iut r . llc, i: r t t t lir 't i''t .
'r rrr r.lui':i':)rsi,(li iinrrirr?,ramllituirinii lursLrhri tcnsiuo* s,iterixrii [rri " , ,
( '\ : r r '( : r 'l) ( r rrt zI r r r t t lr rt
'; . r evclat or u'o: 1l) ljt
ltfcciat {i __-.nror.i __ t'l Lruril,r.i
r,' r .r. l.:r II,Ii'I||LI,rILs'p,.r'i,,r, trofice p.irr
, ,;: ,' l ; ; ; . , i; iioi] 't r "i. . sint
l'r 'r '
rr, ri, llrr,. !i\l,r rir(.rt:.v:rttrnncureretelatortrc.:2,) .' ., i'i"i"i'i"'l p"i ir ''r 't i" piui in ir lr lt l) r 'r r f ir r r '"1, 'i I I r r 'r r 'r r r
B etnnu!ltti Ochnergi(|Q1r,: ilt I t |'t r t t l/ r J ( \ r t r t I r t . I iit t r r "
t,r,. rL||ri'.r.r'rrrl,qi'1rrJ tlcrr51p1r1 cl: -iculei,in zona colespunzXtoari \,r.rri r . i l'. uiozl' 19t ??) iii sc ir nclior cezii
tcnit,, r t r 7r 'r , r 'l
i""f ui t iLnr lului ( "r t l'iir lr ( lr I 'lir r rr ': r zir r . llr r 'r 'r 'i
'|'rrr 'i rrrrr.'r,:rrL1r'rrrerzii
:r' o durere cu 1.]c:r,1iz:l,le t; i ( |||l
:r a,min1,itd,
mai s|ls. irl ' , l ' , i;I,i1illt ii '|. t lllr t lt 'it 'i1. .lt ll'I l't 't I lt |( '''|}
,r'lrrrrlr, rrrrlsllzir zonci do inscr,!;iea rnusphiulni
scalen anterior supt,irl r, | ,' , l i l , l L r. rl isr r t ; i ll m ^{li: ln|llui; r ') ''l|
t r lr t r
l'r r r i lt t zit t lir t ( : r t r t t t r r '
,,,, l i ,, t , , t , iiir "i"'* pt it "- oir . r '"'i t t cgt 't 'u , t i
'ilrlr!l(il l)) lt r itritruc* utnii,ruruitruteraariimiflu5, iar ra iniinderea scir,rrr, '',
lrri |rrILlu]|li si 1)l::,sa,rea rrrci greutiti i" mina p:Icieillul i, ,Irr'' i rrrrui tt l: t i : llEs l, r , nit 'i: lt 1 pDlicclui'
.(r,'1r,,'r'11",1 ot ti; lt 't t lt 'i'tlnlls{)
lt t llilllr ( r r r 'r r : r r "
I rl lll.l.rll ttt.fiul,,rruf l)[tr.uiic a,langit) se agravelzd,.c) gemnx;t
lui Als,nt 'ii, ii, ii, ,iiii, '-t 'lt
l l ' i rsooiilzil ni, iti[, ft i' t t 'olicc
t i,lbuf {'soils( l llip, r 't l. zi: r . r l. t t ' l
't | 'tt,x t;,, r.rvllt.ll :rl itr ._czufcu rrrrirrile , , r' ' i it 'Li r 'lloli) ', '{ i
lrlrsrie lejor pc gr.n trr,l.l
,.r.1),ut lrii,rilr'a-t t, ,rr rl ri p , : t t lit r it it t l t iLLt : ut r r r lI t ' t r r t r ilir r t t ult t i'
'r .rn
oxl,ensic$i r.plectL;dc p:,rtel ilurerorii, cste soliciLrt,
r ,r lrlrrr.lr.zc ir rr'.r,oc1cin inspiralie for!,atii.Aceastil mr,ncvr,i decl,"tscrrz.r, i l . ( |rr rr":ti | ll i.rt , : t u, r t siniJ,
, t r t t nu. t r , illI t ir - ll ilclt t 'll ( li't r r t 1't t \ ( 'r r llr ' t r r '( '( r r !
l.l.
r lilt t z r '
I , iri,..r,lrr'i. irr rrr,tLbr.uls'psrior dureros si o dimin'r'e a ar.pl;tu,1ii,;i1,,rt
,, ,' ,r,,' ,,,, ', iii, : ir t , r , lgi, , ,st )l cr t l'r "i'r lizt r r lzii' pli. r r it '( l lllll'( llr ) - r ii) lr 'r r {r t '
',tltrt.tl) ll,rtrrrrt lvi I lalsteo,tl, r lisl': l
r t t t 'ir tit rl l r lf lr r r lir r 'r 1rI
: 'Irlc,liunclr,iu jos in axtl membrulrri srrp,, ] ,, ,' r,u f i, ,l , .)rl i l i i l ii,l l (r r rlsllt 'ii, lr it r rlor rr ir iit rr l 1i lr
( r lr r r r r r r lr
)ri)r',r'u ;irlrrl rrr ori0nsic ' , ' ,, I 't "', ir r r l''"'r 'lr i t t t I t r r . r t t , l r r {'I lr r
fi cu c,t,pullotttt cloirt;t,alrltci,ltl, jii l
exuccl,bt,ilzii. , ,,,, l ,:,,i , ', 1.S, ' , ' iiiii, ii*it i, 'ii' l" ': ''i
r l ,' Irrr. r c . r itL il l. ( r t c i t. f , ,tit ii, , , 'iil t llt li lji t t t r t l. r l'l' t r t t t t 'r lt . 'r 'l: t r ll't r r(rllr ilr ' r l{\ r 'r trrlr r r r t r '' r r r r 'l
' trf lr r r i illiii l) : i llzit t t r i t l" r " 'r t t
Itr l. r r . r l liir r ' r ' ( L 0 i J ;l ) u , $ frr,rri ,l i tt,.i i , | , ,, 1' rl r r , r 'ilir tilr r ll llt r r r r lr ( r 'f i''l'"i
} r.h i r , l rri A i l rrorr-O.fl .v I,rrl r. l r '', ", li', ; ; "1"iti.'r r r r i: t 'l( r ir r tviI r r ', ''t t lt ilr Ll t : r lr r lr '
,i ' , ,' i ' i; ,l ;;; 'r
Itrztl tt: r , lr : li' lo r lir rl ,rrls rb i rru { ,i i tro i .i n tl i , u i i ,r Ii l ci l c cj i i rrri rrl crl rr i r .,1.1,.,,,,, 'l'r l' "'l''"'l i l ..:l l l 'L l r l r l 'l lrrLr rrl
,r r ', r t l r 't lt i l l zl l l l , (ril
1 1 1 1 1 1 "1 tr t' r 'tl r tttl IL l i l l !r l i Y
r | |.IrI r|1) i I i rj I I I r lLrs ir r . l l o rI l c l l i ,,rj c v u I r,rl l ri tis i i I:r r 'l I r 'r r t tttt't
t ,l i rrri rri i rrri rr,tr l i rl ri rrl l ul i l o,
, r r l r 'r ' Ii |r 'Ir i r I|,'i '
( l .i ,1 1 ,"1 "'. l 1 1 1 ;i ) '\l l l i r l ' r r ' i i I1 I r ;Ii Ii ' It
r'l l rl r. , , lr , r r r i: r r r jr " r' i rrl r.tr.r r.r,l r,l rr,rr,l(ir,rrc l rrri v r "r 'i l r r r !i l r r ','tttl t' l'
ri i ;.rl ri p,l i i l r., ;r1r, ,I r, I i I i I , ,I r. , 1 r , , , 'r 'i , l r r r l i r ttl tl t r r l l L l r \ 'r r l r l ,r r r r r l ' l 1
1 l 1 vr "rti
,
:l :i ri
 I tr r 'tr r l r l r ' tl tttl
itIt,r(r'lrrrlrr ittlr'ltil ifli.llolttorr lt,gr,1:rlivrr
(|ri1r|r,r,rrrirr
l1111rrlii,
crr Dirlc rrr1i11 t L l r / r / r/r r r tttl t tt tr :.l tt!tt'r r 'l r tczr ttl r i tl tl i r i tr tl r l o tr t r 'l ttr r r ' ;1 i
i ttl l ttr r 'r l r r l '. r r tr l r l ' l ;r Il ' tr ttl t
,rrli,'r'lrirrlr', oVr.nlllirlcll (1iln(,2i,(jrt(r{lclnlli,,i(j;t\il,
ntiinii si sllt1l,1 i1lr1,glll1l ,,., t , , , , , i i tl l l r r l i l r r l ,', ,,,',l i t t" .i ,l )l ./ l l / l . ||l l r ||( 'l I
'' '1 , , l t't'i'tl l r
l rl ;1
l r i i
l ir . n t'r tl Iq i i i ] l / / /
rr.rrrlrlrr. rirr'1xrIior) si {'rrrlico ort,itlsc (1,('glrurctrtrurtr, , '. t , , r , t ''i,l 'l 1 i l Il ,l tt, ttr r r '1 .. l l i tr l ' '
trrrtsotrlar(irri rlr\ i r tl l r r r o l r l ':tl i o cttl i l i l tl r tr 'l i l r ttr 'l r ':r r t
l:rttrrlr'lot). t , , r 'r r t l ii l ti l r ttl i r r i r cr t i i 'r t
. , , , r r r r '{r r r r r 1i'ItIr ' ( 1 l l ' r i i I i i t I i i (i i I I i I t I ti tIti IIi cttII l l r l i tr l l r l tr ( o tr 'l p L l l l z;l l ( r r r11' ( ll
ir lr(,r tnlriiLscrn(ruolll,ablou olinic trebuie si, ne Eindim cri silr,lllrrrrrl ( l i 1 r l l l ( \r ;r l
rl
l rrrz;rl;ii"lrollrf li gerr(rlit.rlc lirrrrle ntll.i ctiopa,logetli (;\rsoli 1i r,., i l l i l r r 'l t'r l i l i ,,i ] si , f.t'l l r r o r cl r tl tstr i ' o ti ttl i cttl r tl g i tr l o l r l ( 1 i (
( )t)',.r(,, l1t{i7 ,lohns(m._iiSp.r,lding,t9?4;Jnctctri -tg6-?) r, , , r | , . r I . o I I I r Ii i . '1 ,( |1 l l fl , l l l t r .i r r r r r r .tt :tl t'l tl , l l o l r l ( \ Sl 'l r l r i .l i r l i r r ;';tt( |r lr Ittl .r l ''
i. $o el,ea, : a) I,r,zirrrii I i I t I 1t I ' rI r t t ' l r t t r Ir r r
Ir'rrrrrrrrrii< rr (rrLri rrlcs),il{1a,rn:rtoriisau toxice alc nenlilur periferir,l si rr|., I I : f i , ' i ; ; i I l , I i t , rrI ; i r 'i' ' ; , l ) r 'i tt ( l {1 x1 i :r 'l ( 'i t'i 'o cr i sl tr r l r :i
tl tl l l 'zi tttl r r l t' tl l r l i tl ttl ;tl 'l i ( l ctr ttr l l r tl ti L t
lrlr'...rrlui1 Ir)..l)r.oct'so r:on4rlesiv-e rcgjonalesau locale cu readlii conjulciir o , , , r . , 1 , , , ', ', ,i l i tL tti l r l l ' tl tl i ttl i r l r r sl tl o
i.i.rl'ir:. iilrr..s. crr,r..inglobeazi,nervd Si vasele; c) Iractnri c'rl. i r '. . , r " l rl il t tl r ( ) so l l s{l ( 'l {1 .)
', l :r tt r l r ' l r I
.Irr ir.llrrlc;. {l). l(lcfi)?:r1ii (boaln,I[odgkin, tuberculozii) e) L l | r 't l l 'i r , ,,,t'cl l |l l 0 i cl tl L l .i tttr g l r i , tl t'. r r ti tttr t' 'l l . r ''r r r r i l r r 'Ii "
I -4feullrrrri , , ; 1 1 1 ,' l r l i si l i l l r l i t i r r b i i r u tl L , n i l l t l r I ( r 't1 1r l l l r , r l r '- r t l r t,tr l ttl ttr r ci l .r r ''l r "
:rl{ rlr)r}IllIi l)l(,ttl'i[l. 'I ( l l l l l r ( ) 1 l r r i r \r l r r
( l c1 r r r |i l ttl r 'stl l t s{l ( x) n sti r l 'i i ' tl l l l ) l l l l ( 1 1
l)rrpi.A.r'serrirli Otr)r.rscu(1962) cauzalgi,r, pfczitti, trei grade : gri,,{l,tlI 'r r l r i l t r l |tl tl i ,. tl ttttt':t
rrrr r.r zirlsirr Lrcrrli; g|ldul tl_Il-le:t, uru ca;rzalgiaregion'ab (ciirl {tri,, 1 , , , , , 'l , l , r : , , 1 1 i a l l tr l p l u stcL m l l ,.l t,tl i tttr tl ;l t'si L 1 1 1 i r l xtr r l t'tl cl l ;tttr i r r
rrrrrrr.l...p.irul i,1r,cg rncmbrul .respcctiv); gradul al Ilf_lea sa.ucsatz,rl , 1 , z r r r r r | r r r l sl 0 si l L r i tl i i i n tl r l :r 'i L l i i tl i i r n s^ r ,i tL g "':"tttl 'r co ttj ttg r r |r "r l ttt't"'
', r
,iirr,rlil rrzii(.i,rl l.',r'cnele sl: extindpeo jurni,tatc , , , 1 . , . , . 1 ,ri r r r r i n u l l tco r i ,r l o i p o l i r l cl r l i r \i ti l i i l r l ( r l l si l r r l tr :ttttttl Ir ) fl ( 'r r r tr ( |'r l
rle corp qipot chiar.srr ( r r r r 'l ' l r r { r r i ' r Ii l i |r 'tr Ii ItI' r r 'l tttt ttt
lrl r('. ri rl. 1,'hil opusi,, cu tendinfii de gencralizar't). cr6tleri cii aci.srrr , l , l 'r r r l ) si a l i ,u l a l r te 'l i o r i p ,tr ,l sr tL l t"l l
i n tcl co su tl , tl l l r '.'tr "r I 'r t t : I I ' t I I ' I r t I t I I t l i l tr tt"r r l t'
r.lrrrili.rrrr'_rliu.ti pr.cfioaseindicl{ii de diagnosl,icin cazu.ile cu srirpror..,l ', . I
; i i l ; i i "r i i r "i j " '
t.Lrr',ir,p.li'L'rfir,, ,,ba,slard[,), cu topogiafie nesislienatizati t , , , , r r r , t t t , it. r tti u tr m "* -fa t"il :l u l o l i b i l tr tt'r 'l l l i tl r 'l l r l l ' ( l l l tl 'l i i ' Ir l - ( 'r 'l l l r l r 'l i r ( ( r 'r r
;i lierrrrir,, '. f ,i ,' l ;t l ttso ' i r i l l t!l r l r '1 " r r {i r ' ( l ( l l t'l :r r l I i 'l r i r 'r 'i " l 'z'r r r r r l
rrr |{ I,iIr'IiIr'(|Ilrrrror tclrrrerripcrima],ic:r,,,siurlr'ornf izioprtic" (al lui ]Je,-hir,rlri
, , - si
l r,,r'|,rrl] (.\t(.r)sop|ogr,rriv', , , , 1 , , r l r | r i . l lxi sti l q i a i c i n d i cl r ,l i i tl L zi ttttr r r :l i i i t'r l l i r l ;r : ( l l l 1 1 'tr ':r Ir r l r t\ r 'r
-.i ..-irrrlr','rrr (rrl lui t,r116;.
, , , , '. , tl i cl a n l a ti r l t l tr t'si r n r cr r ' tr ';;i r ttr i i |r ';i " \ {' I I (' I } | I I I | ' ; l ) ' l
', , , ',i ri,,'i i , l :i l cl r 'to i tn p t i l r l i r l r ' t 1 1 ' 1 1 11 't r l " I r tt "' '
7.i|.{}. rll11iiloloraco-:rbdomilale ' ' , r i u '1 'i m i tci l i l o '
" ; ,
, , . i ', 1 , ', ', 'r ,i - r ,,l u r e r e i , ]:t Ir i ve l L r l r ') i d i r 'ci r r i i i r r 1 cr ( 'sr tl '( " tl l t'ttl r i i tr i ttl :ttt.tt
, i i , , , r,tr l l c o r i d u r e r i l e , l n o t'i ]' p t'l l l l l l ( l i l r '( \ l l tr i i l to l r r r t\'i tr r Ir 'l t"
|. h'rn\t,l0i.o.fNnicu}ui (f renalgia) esterealizati, r1oleziuni ilitatir.t r 1,, r ', .
r r r r i l r tl ' tr r l ' tl tt
rr,r'vrrlrri irr lrrngul sii'traicct din regiurea cervicalii ((rr-Lu) pirrir i t t i tl o l i n sa u i n o r '1 o o l :tti sr n l 'l tl tr 'tr 'r t tl ' l r t,r l ' 'r ,z'r
,l'r'rri. '. t , l , r p l r " .'s' l ' t:r 'l r l r tl r tr r ( r ttr ti r r l ' r ' r l '
I:r,rrir.lrrl rlirrh,griLului.In prezenla unei frenalgii trebuie si, girir,lilrrt,, , r I , , , 1 , ' st,tiOt';vi u c r a p i tt b i l l r t''r 'l tl l ' ;
', , l l r l t'tl l i 'ci n i sr l t'r 'r 'i r \ t ; ' | ' I | | I | | | I I r l r l r "l
I I I | | I I 1
rrrrr,r'r'isrrrr rrlo lrlolelor invecinatc (ale arterei subclavicularri 'c , , " , , r . r l r ') p l i r xl {o a r te i a l i se l 2
sal rrL, ( r 'tt,' r
, i , t , , , , , . '<l .r n ftl e tca zi i co tl te xtu l So n r i {) l o g i ' .l t fii I I I I )I r )t t I i r l . r l .l t.tl
1rlrIirrrrI.LIIrrJ. }Lrlrnonur'),h tumori sau.infl?malij rlediasl,inale,l*, pkurilrr ttsti t'i ''tr '" r l r ',st ttr tr r ' t i t 'I t t rt tr | ' r I r t tt
rrrrrrIi rrr.I i rrrr,Irr s[rr rliilli'rrgmatico,lil pcricartlite sau ]t un abces'subliirl|rg , ,,' t"r i i ttti tt,,,t1 l l l i l r c, cu 1 ' '
. ', ', , f , , , 1 , 1 ti :'l tt :i r Itr r r ttr ;"
t' 1 n l u .l r l l sr r r .i l ) i l i l r r l ( ' tr l '' l :r tr j .r "l r tl l i r ttr 1 r t'
t | ll I t ( 1. ' t r i r : , i ,1 ti l ,
| )'.lr'(\it si1 locirliz.azri,l:r, Jtezrl gitul*i, il}a,poiil mJrgiDii sternrrlrri, , i t t t t r tttt * i ci te va d e ta l i i l u p o g r a Ji ca ( $ o {l r 'l ':r '.1 1 1 ( ;i ) : i r ) l r |zr r r tr r "'
1r'r'rrrrrI qi Lr brr'z,.' tol.Icc]rri (cu.proieclie lnteliou,ri), fiinr[ i"nsolit:i arltsr',r, ,', p"oau"" aigii iri blrt{,.cu it:rrli.t-irlr:rr lrtrri'ttlttr'rl
t,,) ,,i,,::,i-lii"".os'lnl
,1,.rrryllri{si rlo i onii,rospiratorre. | ,,,, ,,,r,ii,'i,,,i' L,)LcziiLrre:r' t'r'liri.rll'i.l"ilrt rttlt) tttltt't'rltll
( ir)rri(.\hrl slmit ogic se complcteazi, "rlt.fr"ttrit.,i. it r llt 't t ir : r l, r rr ( r r lr r i' r r t l lr lt t t
cu prezoniia umtiiioarf lor t' , ,l r,i ' rt tt ovli- Llgiccim t onlt i, , pt 'r t ut t gilt r lr '
', (r ( t III | || I |.| i , ; r ir r : i r llt r ' I ol( 'r r 't lr' r ( r
I ) tt)t ( I | || tt | (t't)(| 8(t |e1)d&toenpentl? adeastri neVralgie : 1,, ,,,r,rrt t llir r l- st cr nal si 1r r . sf- t ir r lr , I I I ' I ( ' I r . 'r lr r llir ( ' t r r r r l0
:r) |'r'r'rirrrrr.;r puu.lului Jrenic,-situa,tiintre cele doui. inserlii iufcli.rrrr, r , ,,, ,,' ., r:r 'lt t i dc- ll t r eiLcu t it t r u it tl'at 'r : oslnlt t : t t 'liv't t t zt i'
,
rr rrL:r'Ir irIIrr i st'.tuoch.i(IollastoidiJn. rs/rr/ lr''tlrt.r
'1,. ; ; ;i) i,;;i',ii;t irt,l"i ao'ur put)' l(tL '\i ril '.'in"ilt'.' ttrtrr i rtr.r'r'i
f)) I)r{)Hiun{tr, irt primele spalii intercostala,imediat in afara rnargirrii .t,,,,,, r,r zo t-t i't r t ''- ii ( 'lt t . r t l t lsit t lr r t s1r ir t : . r . t :ltr it t : r lr lr lr ' \ 'r lllr l
't
Dort i, it: im alm
- t gr , llon: li )
r l,,r'rr:rlcrts1tc01,ivc. .' ,,,. ,l ,' f,,i. pu, nt , ' slt r t t t lit t r t t izir r r t igi- t t t r r t n: ril- l/ r ''r r r r l( 'ir t {\ lr t l
, ) ,,\lriislrlol,.in punctul- d.iaJragma,tic, situat la incl'uciqat,catlirrlri, ,l ' i l" i ,,r:ttl r: r r , t u: r r t i, t , l, t : iit r t 'sl'i, lt t , iit u: ur , i'r r lt t r . t t - l'r r : r lizr t 'i': i'l: rI 'lr t 1I: lt t rtI ict 'I t t t
t z:
1rr,lrr;1ilr.rr, litrici parastelnalecu coasf,aia X-a. r r t t Lr t lll: t lt t lt t i lt t sl'it t g: t ' l) r t lll( ' i: llr lr llir ' il
rl ,,!rl , (rl l i i ril'i{1c,p'ilr 1; ii st r b vt lf t r l
si / / t r r r t lt
r11..\;r:isrr,r'rr:r pa regtuneatle inscr!ie trJracicia diLtJtagnului (1xtnr:t1,, ,,' , ,,,,J1ir r or t si, li . J, cziun, tQ lr t t o't ) ilo; i nlur : r t t t kr 'li''/ 1- x '. ! ' I ll
trtt r,u rt, t t , r t t, 1, l[ us 4 " pl( ) ir '( l'r
liil f sl) lr r l') r lzil' 1r r t I t I : t I I t t i.
1i r l; t t . r 'pt ''r t r r lt t t
) p l o ,tu c o , rl ,. a S p l n { ,n e J,rl rrrc| i . " ' ' ' l r' i r' t"r 'i
it t r lilnt t t t li',
r r t iz: i . , 1'r I I
,,' ,.," ,,;;;.,, t{) r r ) iliqlll'1, .llil, t oli, ir r r llor r lr l'r r ,lt or t lr r , sit t t t lLt '
!" It'routt.artlin,-descrisil.d_eclilrir'icrrii m:ti vlchi, sr: traducc prirrir o t t olr s[ lt t t t t lr r t t t r t i r r \ : r ll lr l. lr r ! r r r '
. tr, , llla, , r , r , t '1r , , ', , , ; "'{r t lr t : t lli
rlr';ir'1,.:tlizir,l;ii, h, nivclnl virhrlni cturlirc, suir {'r'rnri tiie irr!ep:ituri, irrs,rlilrr, ' I' oi rI| , ||r ) t , l o. r lt t t ' t ''
t l, t l) l', nit t t t t r t, 'r lt r i t ! '' r l l: l lr t t t t r i inlt t ': "sln lt t r xlt t lr r
, rrl rrrrrl ' r'frr
r l r,.rrrrr i. t r r 1, . , ilpilin{ l D r) rrtr fo n d n c v rtrti . c .l l osl ;r,pl tti cJi rrspcci l l l rl i rl rrr, r i it t zr r t t : r r t r l''lt r r r r r lr r
,,' ,,,r' ,.,r:,,i ' ,i, ', li', r ; ii, ir ir , *li, r l r lt ': r lt t lr llt r l . . t ( 'jl( 'i ilir r ( lr !
Ir'i rrzrri . ' pi. lls ( 1, c ll ro i u ' d r,,i l rrn i l tl r,tl i l trrrrs i . g.rst,ri i :i i ,, l [l rr rgri si ,r.i 0si ,/si rr
r rl trx'o l ir ' ( S ollr r ior t ,l{ X i ? ). A l g i i l c l rr.n rx rrrrl i l c rr rr r,ripot ri pi rr,rr,si l rr l roi ri ;r,r,i r I' rol rl ot t t t , dl r lir r l r r t slit r 'liof t r r 1il:
. rr l r.l r: r l. ilr r r s lt l0rrtl l [t,rfrrl i r'I', 1 !] l l t l j i i rr .rr| trrl srri t,i rri i . N rt l r,,,l rIi r, ,,1 i tt,, r t zt t l t t t t r i ir , t 't , r llii it r l'n'i"sl'r l' lt t 'lt t it t : it lt , t lt ' llir t t lit r t lr t t t t t t t
tl ti l l tl c l tl ttrl i trl l tl tt; tttl tttIrr
r'rrrrIrrrr r I I r Icrrl r r lr t t t r t i l rl i l tj i | l ()i | l i t .rrc rr rti rt' r:rl i j i rr,
i | | l r.r' t!rl i l l l i l . t,.,r,tr':l tl rr'l ttti |ori l l rl r' l r' ' i tt' l |' i t' ttt \((l l l i "

:t:t1 l ut')
 ri1:11,,r,, I t'ridioulurr,,
c,,,,{,,,,,,,,
ilillii);i,,lilll;'H,,,lllli'1i,1,,1;lllr,il"i3lllli,,l,li1l;liil' oit,Io nu so asocilt'zitrctr tlLtr
tlltrttlt'ttltt itctttiol0girro l'('v('lrtloitr{'

p'u'aaii"' (ecrrinococozil) lrcntm altii, rfcctiune netrologrca'

lll;'i,iiii;$iii.t"'i I ;;;i;;:i;,1,i''";:fi:i,l:i"illil,Nl
se ridiciaumitoarere snspiciurii:
,,,.,.',:1,,";,,;';):;:\!',*,!'!"r{{!^Yt'tat'e -
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ii" si,iiiL,,,
r,1r,i
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;;; ;;fi ;"-ffHi:l, *T,i?Htr;r,?1tl_"ilt,l
f H:t}Tjij**."-#}rli',],,'irc"
ur pr'r,t.s 'i'rr',,r,iiri,ri'r,,
i;"il;t;*'iliil;
'T;T"T"?,:,;ll*l*f;d"Xf \t')' "^"\AE;;',;;
lif",ft;ti#llT",,'itt.1;il; fiprinrr
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^;lill,li{:i,"f jiilm*ri,::*:fl#ilfndi;*ltJ":jffi )i**fu1ilti:ilix*:!i3'i; .l;f:',);1,;';:xltt):"
:'""ihr"'.'""'",T.",
f ffrlrHrlifdru:i
?^;;"f'::r{:,:" d ,".",,;.il'{;'ffi
::^l:XW::;AXi;:j:iilX,1,,ff lfi,lliil:i
;$:iq{:#:r#jtj'";?x1ltru;n
;i[iii\.
itlt.,- -tr;"il; L:'1i"
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/t. 1)'Lst:oltatia
uytebrald, :i'*i:{*":rl*lil;,illii"r:"
l;ililr;i"';:l.'tll*fi
!::.i_!lti. !tyuc,a.!d/,.destul dc rarr! in accsl;o
;tt:iiil;,1:;l'sJik+'!,il"ir!.H"i:,il:tli:":.,1f
tii*;
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.;'ep"iiti ri,."t.i*.irsi0)"li; -u,,3,,,Ti'#',{;'*iT,',*iJ'J,:'xifliild*S:iji
il,ill'i[Tr1?;,t,1iff'ri;t?fl"1"::l,.gl9t1
,r*''ryrm m:r*#$t*trl';:r +mtgf*ru;ll riliri
liliiiil r
lit['ti[i:q1.nt*iltfli*h';,'t*:ffi
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u";n;"J;;;;"1,11"r11',ilu",'S';i:Ln"':tT:"ffiii:tl1i:ln
ll1'ft1l1ii-1{}ffi+[:T;f
iri,lh-i#i"'Tf i$?i1*lfll]i;-l,l:;:,:l;
r:naDselor,insolinch-sc ;i dc
lcnbo'sacrate.

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,*lffi #i"itr$i,lfii:ffi"1*i-1"'.*lftt;ll::"'*''T.*'Tillr 'x;)lil'i'f,;'''lli:il"l:1"
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ri,
5iaoar
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jgijil"Hl;"t1T,ff
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ii:ii i
r
il*ijr .l?f f*1?#t$Tlt'".m$jf:l'.,"4p*il:
rrpo{izci spinolso rcspcctive.
i*i;;;*i;;il-;i*IulPliciiointe.resie1jllrl''ll,'+l:;)Jil,",,,,
*,,*,,,,,,,,,,,,,
,ll,ii3:??,i*1*'J'$":?"?'-1,i;ir;;.m'"iiqei]i,,
il;,ll:l;ll';r
!tl1:l!'J$tiiiJ'il9$:i',f ,1i1"'-:i,'.Hl'6"'*'H;Tff
lui tindbcrg:.dacd-.n
t,r,)l)rr o""iT.' a" lo_i;L l'fl1h1X1,,**;T1i
d99gl9y4 lTJ;"ff:"jf;
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r'i' '.'
il,'i"'lil"'i".'*
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i";itG-;J";.l sigmoicllr"n etc.).
llill;:Jr',I'lTi t#i3'Hi*,ff ii?.f-:JfTl;f. :g:,*:t*J:'l,il lliil ittioriot'
Lttr rrotir,lir,). 7.3.9. Sinitroanele algiee alc mcrnltrului
i, Allliile rarTicularedin l:e:p:! zoster,(aonaa,oster Zona
|lrrlizol,ztr csl mai frecvcnt - ).
.pc segmenteldt""g1i;:;;a;.
l'rlr:"ii'
zostcr A0

Iiri'll:iiif$
t'i#ei:,,:'*T,*ilitfttidr*#T3stT;fili*'"#:i,,li jiiii
jr,,:ii
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( il, rl r(lroil, r'c(liculad, este

rli.:,r;u*Fi*o**q*iFjt'ir#3iTh".:,,"riffi
zrI,, 1r,rrir,.,
Lr citevrr,
1 rr,i
lr

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so siliuottzriqi dUrorilc
ii, r J)nrcriie,
rrr slrr,rlirrlposternptiv.
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; ir;-rr*;ril,i
ii, ;,1'[t*ili il|
'l xf
irm]rliiuri
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l'u''i;]lil"'l:i:'il''l'lil;"
iililiritijilii,li;i;iill.
Itifi.rrltri{,i t'Nrsobit. .o rlirgrrosl,iui.rr.l
ir'lrirrinr l'
i:ililX'il,lli'',:lJii:l,i:i:ll,'*
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rlrrlrrrrrlrotHirlon{;ir,
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 1 ,, 1, , ir r *r lr i. r lr i t,rl i r,l r.l r rl .' r.,,r.i i l :ri rr rrIIII rrr.Irr:rr.:r :
1 i r. 1 I rf:r' Il ){ri Ji , l rl i rr.l i i r r :t t'r tl tl tt r 'ttztttt
rr l | t z i( , ||itr ' t r ir , lt t k,l.l i rrr. i rrrl i r,i i ,0 i t,z i Itl (r l i l l ti v(.l U l /, ) ;I i tl r l r r r tr r l l l tt:,ti Io Ir Ir ,r tttttl t, ;j i :ttr ,ttt ttt tr vl l tt'
l ,], S t- l' , 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 '
l, , , , , ' , t , t , :\ttt 1 ,t..,t,..t.4 t.,.,, ,l tr, ti l ,,t ;,,.i r, ,.,,,i ,1,,.,..i ,r,r. srl [r\r.
.r, ,.1 '
r,.' t\ r . r ' r , ,r 'r;r ' :,rl r ; r1,
, .rr' .r,.tl ,.l rr.:rl :i-i j i | l l p ,. ,rj i ,{.l rtl rr,.r.r.U l rri .,.i :r i c tpurr,,
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 . ( 'ttIII||t|i ]||IIII l :r l l l |l l
l ,-1 , t ) , , lrl ,r.ru r,r,i p l i n i l i v e r:i e l e mancfrl ,o rte el ol gal i c: i i ra,n,, lr ;,rrrr lrtrrroli ( tr r r ttti r r o Ittr tr r , co l csl cr tl o l r tr tr ' r 1 .r t.) sr ttt p ti tt : t I rt I rt t r , tr I rI r' ,
.r r ,l r i, \L:rsr',tir,.
Iil| . r llr . i (r,rr|r. lrrl|1r. li pozitiyir unililtelirl, contrrr,la,teiai_ Sernrrrrl , , , ', l , r r l l r r i l l r l l , ( l tl co l i tu l r ( 1 ( 'i l sl i i , l ttci tl i zr ttr r ) , l tl tttl ttl tl i sttttr vl r Il Ir Ir r |r ',
, |l l ;,\ ' lr l, ' 11. , \ n , 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 tl r r tl i vctn c ttr tl r ttt l l r '
', , ,
,rrr| ||{' \ ' r'r|, I i I i .l'i6r'i,' L lr}itltevrarb i l rrl r,r' l l ))rrl | ]n -e ].-? l nBonnei
i , ml ncvrt l ti C harn1()l .,
I t , , r l r i l oi , i r tsi , sr i r tl 'i cl r , tr tr Ii ctt|l t'tr 'i ;tto r l ttsi l tt i r r i r si 'l r l ( l to r r r r ttl zt cr tl tr
. lui Nlf{ziger, mane.!,li,i lui \i!'asselman'lr,
lli lirir{ixil (lrltnr. cletalii, yeziAiseni si Oll,escn) 1g0?; Arscrri 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,
r . r , , r r , , ll. l{ 10 8 : [' ,rp o r.i c i rr , 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 .
:i r" o l a b ., l lTU /.
. ) , \ 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\rctt;!rt, ttitu,tli.niLor atdalg ir.,e(inclusiv a ci{ozoi loml::u,c
rntii,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 ',
i i l r,, r ' r ' s pir l. il a , ,s p ri te l u i d re p t" ). , , , , 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 .) . I) o r tr ttl l c o t'i r tl L i i l r ', r 'i o l ctr l r ', r r r r r l l r r l r
, , , 1 , r r I r I o 1 .i r r r Irscsj
. rl ) I)rt:r.n.lu,tulbtniirilor rle tonut mtscttlnr.; hipoionic fcsiorl, a co.lp
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
,, i r,i l gr,rrr)rei,fleoum
li :r, trri,lonnhi ahiliu; in sc,trimtr, coritractuiii,
;':Ll rrv t llr llla lli . , 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)t t .-.tttl rt t rett.zi ilu ,_.czro pot irnplioa, rtlele scrnnilica!ii localizrr, 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
. ' I,),\ 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 l (-.p,
r l) r c q ,.l l . 1 9 6 ;). l SU e l ,
I)a rc s t,,zi i l (.,.r| o i t,:rri i azi i u hal u,,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
,,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. , , \ 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 ,'
,,. r.r'irr... Llterlli,-a ph'tei, pc tiosul picioiulni" qi/suu ' rr,,.stezi
po i l t. dcgcl,t, 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
., rrrrr ili,i o lr lr nir . l i ! o i y p l l l rl i i c i tl rri t._ -S r. 'ltimele ,, , ci t 1 i su l l Ii r tttu l tl ttr 'i l ttttr l l i l tt tl ttt.t,r r : ,'
', . r l r r l i l ot l l ti b su l ) cu tl l m l c,
.l ) L'ft:){:nld Lulbtn iirilor obiec.liued.esensibilitatc ne polte, de ilsemenolr, ' I ' i r r r l l r r r p l i fr 'L t s:tr t Ia n i ve l u l ci l ,p u h r i p ( tl o tx) l r l tr i ( l j o l l t'1 r 'r r , l l l ti ,1 .
,.ll.t].1,'
irrlice{ii ropugrafice:
'1"'j,,l,
)' ).rr1'
rrr,.,.L.rl .:rstfel,irr hernirj rliscalir,l,n_ I-.,usri
U nlpoe\tczre.lela!r, aotorolitterd,Li ''. \ t t ' tl q i ft c]'t{r a l d :
a gnnbei,pe alosutpici{)
rrtrr .. tr trrz:i ltrlr rcelrri,lu hcrui:rdiserrl,i.l.s_S,.6ipucstczi.r , , I \ r 't t a l g i tt cr u r u l d tl tt o r 'i g i ttt t'.'r f.( tb ) ttl i , tl i ::u l ,r '. ,\r r l 'l l l ' r tr ,:r i r r r l
st. eflh,crl,
.," 1:rry l;11py.,1,igrmbPi. p+ irrnr:ilaieaLt'ter,r.[i
,r pttllrei fi r dosu , 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,|| ||,,.,,IIIIIIrrl,r.ecln ji po ultirneL,rieg,.lc. ', ,
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 s- I- 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
1) Pn:r ntt )nalif icir ol' d,e re.flene.Reflcxul ahili*n este diminurrl r r . : u i i i r co :l l se i , d e - n l u n g u l n o t'vttl ti i s t,i i r tt i ttl 'ct'tt, p tl ctttr t ,i i r r ;r r r r l
r.rr ,rtrrrtrtirr Jrfrilil rle aliscli*Sr_. Uleori refloxul cutanat, pla,ntar po?],h\ ' ",1,
Ir rr.lrrlil, sirrr..ilp:ircchiar semnul 1ui ]3abinski, ca manifeiljaie ' ' , , 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
supn;iozio. , , 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.
r rl:i (rlrr,lolilii tulbirrririkrr vesouhre l,scji te comprcsiunii raii^icul&r,.).
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
h ). I'r(;:(n,t{t tu,lb*riirilot de btet itata po:tie avs:i certe yalori looa,lizit,. ' l l , r r l r r i t o l u l i :l tr , n n cl e d e fi ci to tl u tto l i i ( I i t t t i I 'rt t t rrt cr l l ttr r i l i i l i r r r r l r ' r l r ,,
',,r rr. \:ii;[ol, <le.pild[, p:rrezx ilerorilor :tp-r,reiri ]relni:l discului Lr._S,, , '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
mu:"hilor ld_0Jd\DLltrslrr -&_,u,
',.'t:.'.' .,rr Ir.r.r,rli
l ,r,irr'r,r,r'
1i, tl h,r,lue.:lui.
n.r*n=o.
il scll o{tcn{oI Jt ,t,,j.Lelornc p ).[to rugur,rlrer,ni,lrIis;ulrrr
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 ,,
L, |,,,. 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
frr lr,.r'rriilu ,li.:-r,lop.iu coinprciiunr piurir.rdiculir'i,se pcato rec,lizr, , , , ', '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 .) .
, i' .r.Ir , r l) r.t..rllnLl , cu p-r,fJ llzie.dL.nerv scit[ic popliteu ericrn, dc nor.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
,i, r.,lr,i l)r)plitouintern s:)u cl:i,' oinrL.'m (henidifah;m) cte
coadii,do orr,l, 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 ,
i) I'tt'.:(,njdtulbu,rd.rilorsl i,ttcteriene ne poalc intlica hernii media,rr. 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 |,
,1rr tr rr':r,ur(NIi:rirre, c&rc comprimi $i I'ii,laiciniles:lcrute infet,ioare. 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 ,
I' n I t l,t,me tlc d,itr,gnostic etiopd0 genia 6n. Iotnbosciatalgi,i : 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
,r) li,olruirrtim cir, mrre:l rn ljoritatc rt rombalgiilor, a lornboscirllrrr,l .
,] l,rr)1,.)cr'trr'rrl.,iiiL,,r.tlr.,t,,.s0it,lirr crz,rl.i)"srrrt i,l, ori,qinc rert" ''1 , \ t t t il q i ( ttr r |u l u 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
;li
t4\ tl;'l :r
t , , tttstlttt(\.t('i[) \r Lr y pL. t r ri I ls or l, r ' oz r "tSi hof n i i r l i s c l l e ( r \ r s o n i . ; i f a , r u r l r , i r l ' l r ' l : r {:r , i l l l l t) i :t 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 ' | ,,
,L)j,r'i si.()pr*{ju, l1)iiTlAlstni si.Nirniott:su 'r
rr, 1.9(irt ir\tscni ryicollh.,
llif:ll 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 Il zttttti r l i r r l r l , ( 1 , 1 ,,
1J'/ l ; ( )l)l' rii Ii's', lt,{;ll; I'.p'vi.irr si r,rrt,lr.rlt.ii!; l\,i)r)vi(,i*
I r)ii;). li ilir,,f,, 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\ , , 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 II i t Ir I t I rt rt t t I t t t l tl l l r
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 , 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 tt'l l ttttti i t't'Ito tttItI|Ir I r tr ', tr "Ir 't 1 tr ,
,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 , , , 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 .
'
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.
.,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 i , t rt;tl E i t)Il l tr(fsl ozi (i i so l xrl rl r, 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
,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
l i tl o pfovi l l o di rl l [oectl l i Ii i rl :l 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
, 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 | | \ 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 '
,.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 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
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 . '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
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,; , 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 '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 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 . l ) o zvo l tl l t'cr ] l l ( l vl r ) l i l l l l l l i t'$ l I l :r tr r tr zr r l ;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! 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
,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 , . , 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 , ttr :r i r r l r ':r l r r '
,.r' r \ trl . 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 , o sl o o co n d r i tc 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 '
:"- Nindrorn,rLL;ohJ-piciorreplczintii' corespontlartul slnclromului utttri't ' 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.
: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(, 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 l .i boD rt l 9 6f / est clelat iYuDor t lo 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
rIil,)r' \'(l,folir1,iv()trl)(lomino-peh'iene (afec{iuni alc por!:iunilor telmittrrlr,
, ,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 . '
.'i.. lrrlirrlrri rligcslrir', rtocl;iuni uter'o-anexitle qi .t,-ezicale,procese inflilltrrr
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
i,rrii ,i rrrli'r'trrl,ilrlollcrito|elle Di rctropcritolrealc, psoi'lo .,q.4.),precul)l til
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
rir. lczirrrri lrr,riiculrut (sponililutloze, spinclilite ry.a.). Se poate recunorrtlr'
,,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
l,r irlr o rlrrrolc lsooiirti, cu. rn:rni{est;d l.egetatiYe de tip simpatllgic t1t 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 '
(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' ri 1); sD fl stca qi cohl: . , i90L) .
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 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
lrr.r't" rrrr(rrhlr';irL,nii,). llobiliztre:i actiYil, Si pasiYri a membrului inforiol ,,, ,rri l rti sci :r t ic, cu oar act cl'cle ilr nilt il o iinl( 'liol .
,. , '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 . 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
,\lrlorr,pr' l,oi,rhrrnurts9 cr.itlerrliazir,m{liologic motlificiri osljeoco]lrlf. I I t I' I l I I )I (' I I' it t lct io: t t ; r rl|r r ' 'r
rii r.irl(, (.(,loirriri vilrli{rbrale {orso-lonlblre, mcciitici,ri ale arl,iculalici t'r'r,, ' r rrrl f), cu il] t ej. ] 'ale liber e I 'ar iahile i l) ) I r ll "
rrl i rrr;i '
pcr, tiniec|: 1c scir it icut ui; c) At r t ] r t , t I t I t Ir I' r 'i I I I I I r t I r t t |,
t . i: I r Il ttt | 1.t t'1
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?). '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 '
li. Sitrl,rr,nrul ctnaltr,hri tursiutt, iKeck, 1969, citrr,t ds Dofletea' 11)li?) ',
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,
. rlr., olrrrrrrrr, r)tnologul sinalromului cnrpian tle la membrul supu'jot '
i ,, r.; l ) S e ]i ol asocia $i Cu ll, I t c cr iz{) it lgll( ] Llt lt t r lit 't r( r' i ;iI 't' I I ' I rr, r t r I I t r I : r r 'I r r
l,l rlr'.rl'rrolrrl, rlrr iritrtria nervului tibial posterior in canalul lLri ll,iclrrrl'
, rl r Iti ').
rr:rrr rlrrl I,ibio ir$ir-ilgirl.o-cirlcelrcan).Se $tie cii, in acest canal osteo-fil)rrl
Ir;,,'r,,.',,,,' r|(r|r.Lrltibial posterior qi r-aselc cilitoresc intr-o teaci fibrorrHrl,
rrr r.r,irrr irrl,crr,i;ocii sinovirle a tendon',rlui m[lchidui Ileror proprirt rtl
lr rlrrr.r.lrri.irr l,iicsl, cilnrl, ncrrul tibial poiterior sc bifurci, inceidoi rxrt'r'r
1,1,rrl.rlr, r'rr rlr,stinillio notorie In lnulchii pia,trtari qi senzitiYl la plttti'ii
iirrrrIlorrrrrI rr,l;1iocsLe fiivorizat de traum:}trisme locale (lractnri lnitlrr,r
lir rl, rrrl r.i'r1) (l )rrlrr:,jii, ontorsc, di',-ofse intcn'erilii chirurgicale) ;sido picio
rrrl 1rlrl, rii rir, c,rr'.iol,ctizc:trzii prin furtlicrituri, infcpS'trLli, a'mof$eli 1i dttltrr i
, ,.,r' r r , li, , ( l{ i 1
r r ! s u l i ' r, 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 c r r ilr , lilli
:r1 l rt,!l i trl ,o L ' tril ti , g l ,u rl ){ r i .
; i 1 ro
\1 , r ; iilr 1ir 1r r , t ' r l l ' u i i Il s 1 rN r0 1 ,i rl t{ itz l l li)-t i tr trl l ori ' ri ,l i stn;i i tt l i tnl tttl l ttrrl
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
 10. Ihhnl rh dirr:rtttt lipu,ri 1i h)pollt'Jii lol' Ii itri'ilrrilrritt 1olirtr,v ril,r,,
1,r'lrlrr,rliouLrrrrvt ilc, polinotttrtpttlii,colagotroztr, ilt tlttccllt'lrt-tttiolttl'rtl liotl
l,'rr.r,r'ite(irusir,-zirstrl ,,sindlorn neurrt-cdelrtal,us tl}irlotlritl" ltl lrti l)r'pt6
\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.tr,rt'irrin jlilul gurii $i al na$ului (dar gi in alte zono 1;ogrlrtl('lllrrr{r) r{illl,
peni]u sclcroza tuberoasi' a lui BournoYillo,

B. PROBLEME DE DIAGNOSTIC
iN TULI}URANIUI
TftOFICEDE ORIGINENBRVOASA
',r',,fi[toare
l2- N tutfiibrctnato!(r lui Becltlinghausen,se po&to t'trcttltttrtrslrr
1,r,.zr.rrlu, de tLunori multiplu pedicula,tecle tip ,,rnollLtsr.lultttlt
lrrrrrrrrepediculate),de consistenli moale, pigmcntate (brttttc srt,ttgrt'llrltto),
ltt'itt
; trrrtrI tt I tt tt t ' '
, 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.
8.1. TULBURARITROFICEALE PIELII, ALN FANERELOR 13. Ang ialnul cutrd,urtpktn hernifacial, adesca voltttnittos, sil'rrrti,ilr
$I ALE TESU?UBII-/OR
MOI ,l,r|rrrLiultrigernenului, este revelator qi nc obligir,sli oil,uliinr :lltgirttttrt'ltrzrt,
,,rri.r.l1rlo-trige.rninali, a iui Sturge-Weber-Krabbo.
14. Preaen,ta de ytetepi'gmenta,te (tle culoareacafolci olt Lr4rl,o) itrrlivrrllo
l. Pielpausruld,sol2oaso, . 1L;rps11ls, ilsolite tle novi pigmentari $i pilofii po zonolttttt'rtctt rrlttlrt
slriardprin fisuri, r.calizinduneori aspcctul 'rrrr
r,rrrr:rl), Ll un copil sau la un adolescent,ne cvocii o rncli[tl(tziillotlr(t olll!r-
:tr' .,(tecrap" sau 1{e gopirld" poate fi intihite in sirixgomieliogl
l)rr.t',
ln slI|(|l'oilmete rrrrlri, rnir,iales tlaci ln contextul clinic existl ;i crize olilopl,ico6i/srt,tl ttrrttrttrr
strtnqomteltce.
'?. Pielea_rece, ,lu l)n)cesexparsir intracranian,
nAkdd,.sub!.ia-ld, uneori pitald,, lividd, cle aspect I,amo-
lil, rr. prrrrlcobservl i n,poliomielite, mielite;i altc atecfiuni medulare, daL tti. f um{'facliilecutanqte noLlularela nivolttl trtornlrtrtlor,tll l,ttr:rrtrltli
rI|rr.or't sr rn ncl]lrpl0grljevasculrre {Arseni,i .8o1ez.19Zl). ,r ,rl :rlrdonelulii, insolite de crcqtereain volutn ir, $irlilot' siltt tttrrtrrrltr
''1.I'rr.zcnla tle Jlirtens, de eruplii butoase1i d,6 aspcite sclerodermioo r rl ir.o pentlu adipoza durero&sd,din sind,ronzu,lLu,i I)trouttt,
'
In,rLl,cI t -r'cvelatoare pentru siringomielie $i alte atectiuni medulare. 16. Pana,riliu,l ana,lgezi,a, earactorizat pt'ittr-o l,trllrttlrt,tttI'lrrl'irrtl'tu
.l\'lot'maled,^,:I Irfl!]ilit.otpd.unghiilor,precum ;i eJilarca degetelorss r r|lu|ilol unuia sau mai multor degete (merginrl pinii lrl N,lIll)lll'll'r{n[ llll'i
. ,4.
rrlrlrr'.jc rrrr,il:rhngo)r in absenla durerilor spontane sau pl'ovo(ill,ortlrt't'tltt rltrtroltt '
lrccvcnf iu rlivr.rsclcalec{,iuniale nervilor'pei.itelici,piecurn gl
Irr ${ilu'ozrrin pltici. r"rr rlo tulburii,ri de sensibilitate tle tip siringotniolio, ovcttlrtttt'ltr tttttli
5.^,lIipcrtroJia. i,inilor,. mergind pini, la aspectul d.e ckeirotnegati,o ,rrilr'{)mamiotlofie de tip Aran-I)uchenne qi:r,uuol sctttltopinltltitlttlrr, ltrr
rl\ ^
.n
l,ll l lll{.:rllo ln SlTrngOmtelte- I rrrr,' si'rne orientezespre diagnosticul de siringorniclio stl,t I tlo nitttltttttt Hilitt-
l;. ltcq me lple reci, cianozalese intihese in compresiuniie med ularo. l.,rrrriclictle alti naturl,
rl:rr' ,.i irr hcrrriplcgiile vasculare, in'polinevritr,, pol ir:adiculonevritc gi iri l7- Panari,!iul anulgt:zic, insolit de faoics.ltxtttin,tltt lulbtrt'flli pigttrr,tt
ull,rr nouropatii. I rrrrr,rlc leproame cutanate, ile hiper"trofilr,nLtlnilifornri,tl trotv ilttt',t lo tt,ltttn
7. Arpootul do membru rogu, dureros, se intllne$ts in sindromul eri- l,rrri,,1.oo"ot, " (eu protlominanli, tormoillalgczicii, ittifirtl, n4roigkrbrt,hl'),
pituitare, no orionl,oil,zilnpro (l it,l{ttu$l,i(!uI
Ilorrroliulgio,i:r,rd ogetul alb, ischemic este u$ol de recunoscut in faza aga- '1" ,rr{}ficxie, do loziunea mucoasei
zilri ,,Hiltooplltrlocal[t, din sindromul Raynaud. ,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,
'\'. 'l'rofalemul crozio (sinouime: boala lui Meige i distrotia edcmaloa- 18, Ulcarwl perforant (mal perforant) ylunl'ur attt tlttbrri, innirlior ryi
u:'lI rrrirrrltrrurrl.localVat; edemul ,,reumatismal,- cionic al lui Desrnos rrrrlo!rr'.Inilial aparo o zon6 tle hiporkeratozl, apoi so dozvrtli,il,tHtl(nos[v'
.rlrnr'l H.gr'cntar aI lui Debove; pseudo-elefantiaza neuro_artritici, a luiI l lirl,cni {i apoi o ulceratriorotunjitti sau oYalrrtr cu tondilr{,i1, tlo Ildittclrot
l\,lrrl,hirrrr I lr{)rrlu,luiMilroy) repre,.lintg,o v&rietate de e.demcrorlie aib, Aur, ',,rr
rrrrr,r'giniploeminentg, cu fundul acopolit tlo 'o sorozitrto giiJltttitttltltt
rr{lr)l(,r',-ou lclxurtilio segmentari, avind _cel mai adesea_ sediul la ineml rrrr,rrrrrrirroloni;ri.Ulooralia gi togrrmoltelo din jur sint indoloro, Siu[ $l[ul!'
l, i {,to rl lct ior,l o, uni- sau bilateral. Nu are * se pare _ nici o specificitato,
[,ri irr crllo ulcoraii&, clozvolCindu-soin profunzimo, atingo orliiottlnl,llltl
Ilrrr,t,ulli congcnital, ererlitar gi 16afl.jal1 dar ddmulto ori inso^,teqtebolilo r1irrrrrl. Ilvolufia, osbotorpidtr, cu oioD1;tizfltiotomoro. Ulor:r'Lrlpulfrtt'rltrl,
r\rorlo-{logonot&tivo,unelo boli do colagen, apd,rind chiar in rcuinatismnl rr.rrr',rrl$ obicoi ln Labos,so locolizoDzfl, fio t.litlonnoan, fio [a,nivoluI rlrtlott'
clorrio crr poliartrit5. lrr(,rrrrrrrrrtirl;ilr$o-tir,ltngionot lllltrooltri, fio lrlnisolul tlrtpttltti <xtlttltlrt tll
0; lldcmul qisolloitlo itsoci:!titt (livor$o:!Tl;l'ol)tlliil,tlhttl,lcrr,
, ,r'HI|.rr. .rozat^aI ,fclcir..ulobrajilor, al gitrrlrri. al spnt(.lui ,"i al iolol r.rrroilc,r rnol'lr,ht,r'sitn ltt'tr'
il, |lInl(rr.lillii{rLiL lrnoori fi rlo pigrn.rrl.rr{.ii tri tlc l()lr git,ctlzii) ,rrrrr 11iort lozirrtri rt,lt'DIi0u1i rtrtbrrrttil,ioo r![o [r!lrtn{(!lol',MlIi pol[l,o tt,pgl'otr,
ho Irl.ilr(,!1.(, irr pDikiLx k,r'rnlll DrnirrziLll(lrirlrlt lui I'olrgorr-,1:r
rrolri.1,- Irr rrrrirrgorrriolio, irt uitult'untru.lo tlo crt,l,rlrrltt'[rrulicol,otttiilo
rlrt rtort,tlrl, 1rt'lttttr.

24t t4'l
 |'rt.t:rrI r i. ir r i r r r . r ' r r l r' , i rr rl i l rl x rl , i rr I.;r' i ' i , l) it t lr t t r r r r lr lt r '. r l't "
D tr.r' rrrr l i i l r rrtl ,i )I)i ILi i I(|rl r{.r' . l ,,r' ,.;i i i rl ,trrt I r it zr ri l0 olr iot r i it t t lxt lI t llo lir r r ilr r lr '1 lr 1
Itrl l rl i r llr f r lil s itl l rl trrttl Il l ,ri ti l i l tl 1 l l 1 i ' l ,l tgv.otri trrl sl l t I I (,I i I rI I i I i II I I I r l' t t t lr lr ilt i I 'ir {iirr 'r 'r : r r r l
, , t,rrt,,i ,l ,, t iu silll r ': r lilcl( liz; ll{ plit l i I | | I I I : I |1 '
( rl ro r' : r ( li( ,lr
) l lr r i llru t' rr,rr-l l l rr.L i t)ro ({ i rri l x rr.{ ,;i (i rri )xrl i ;, .l !} ?4), '' : 'lt l t i't r
I!t . liJ ( ! ' t . . t .pr
! 1,t.l o n rn t,.u ,lc ,l 1 l ti , trl rti i ,ttl rt xi tl nru.t,i l a,i ul tti,ti t,l t,,r,
. i ,;,1.;r;.J;;' ; ; or . t io l- r iPt r lr r r lic. , 'il 'i ir r t r 'lir '' t . slr . r 'lii ( lr '
"iii, . t " : t t lt ''r 'r r i'l{. t t lt r r " lllr l. ilr ll lr r I r r 'l
/,i )r' r. r l, . D' li r,i l r' .,{ p l [l rt' .l ri c r,i rrr 1 r rl ,r,s,r] rr si i ' S i ri ng' tl ti .Il l r r-\' | J.C i t f i CSt nt Ct i\ '( 'rCcl'm li
' llt ll, , , ", ,.i ' u' l n pr o"i, f """ain. t ) , t lugcnic,su p. r l, '( 'ir r 'r 11. .'lir r r l) ''r 'i
r t r l . 1, ", t
Irttl l rtr . 'simi.' rrr1 |IrrI tIi' i t t I I't t r r.t I tI'
,ir',.,1,ir"1""""drif"r'"ng"t"tit i tici ,tliri ztrr..''.
:'(). ll inft sttctt.lttLii u ltti J[a ncsat, so irrtiltrcst]e in siringorri ir,lirr
rr rr' ( irr]l(11{'r'iz(lirzli' p|itt1r| urL tltlrrn irl rttiirrii ;i ll rlcgeiclor, 0ir10 apinl r]rr I r1; r.rlc si leziunile tiolice osteo-articulare'
irl rrrrl r :rl' r I
l l . l r:, I r i. l. r r I iir r r Lr k r,l ri c .i u r)l u t' r c l rn rh tc i .l i l i . U ' ci ri i nsi , pi el ea' p.rt. tr)e multe od afiropatia loatc constitui semnr.l -itrii'irrl
li Sr r l) : r r '' r l : r 'l" ' I
rr rr:rl : r . r u$) ilf r ii i s (,l l i u rro i l s i . U n g h i i l u ti u t rrtrufi cu qi ri ^eform:l fu, i ,rl ; .,rrri oE ia". lndeose- bial t abr - ului 5i r l siling, r r nir 'li"i.
_f i ,, i ;tl t" u ?tiilnar i"i poat n r \ cr t o t l( oqcbit i vll( r r r r 'r 't lir ': r r "r '1r ': r ' r r r "r '
rl .r'.l .l rr 1r r il,I i r l. li,' rrrrL 1 ,o s i p ri i L o s tc o :u tl o l Jrti i l c coc\' j 5tcnte al e i ' Irrr" lr r\ \,
. ,f ,]"-i-oi.trorr"iic locilizat,1 Ia nivclul membrului slrl.r't)t'l),itl(:
r';,.Lrr',1r'ir.st,.,liz.kr si pfiu resot bliilc schelctice, prin frectlrrilc sl,,)' t t r lr 't r lt t t r r r l' r r "'
l :rrrr.,1r . ir r r iI . , . r ' : LI i r| ,,:rl (,rrc i i p ri n p a n i ri l i i l e l ,n g;z]ce i rsoci rLtc.,l Irrirrrr. , ; ;;* ;i ;' u ili"g"- i"ii"' in vr ct nr : cc 1r Lr upat iil'r . r r t '
' r lr t ' t t ncot i si p' t r 1r 't tt r t r r r '"1''r r ''
', ttri t llr ' , 1, ' , . lr ir ' i IL tl s { l c ttl (.r,1 " - ,' , , :i inoit set i pcut r u lt bos,
" ' ;i ;;l
,l i r l r:1i c[,. ;;"
:; t. llitur, irt,ttttk:it l, l,tti Lhetltitte (tlin sinrlromul tl,lamic al lui l_rii,jri
Iirro lirrrrsrt.) so cilt itci:cr.izclztrr intt.un aspect ciiinotic al trriinii, cLr lr r ''lr
.pf irirr_ ," . l ti osnoslict , l v[ , 1, ia: {t ) I n ?"r i'ad'' l( dr t r lsit r l r llr t i . r '
I.:r .rrIrIirr,Iii,;ri lcce, cn unghiile recur.bate, fisulatc si sfil,rinicio:lsc] lrr ( lr "{cr '|r 'f ir .{ r x: r / r , r rr,rrr,r
r t t r opr t iJ Sc r r
, rrtrr r. rrriocirtzir, lti [ulinosCUte]e pozilii denir.elate aIe rlcgettlor, car,! ii l, .. ' .I i i e tu; idioS, Silut ( ie in car e I 'r r r r : 'r '
llt '{: t llr r r r r : lt ll r ': r '
:rrrrrrrr lc r lo r lis c iir i ttt:L o z i c e rl o l l e x i e , e x te n si c gi abrl uci i c. l .r .. -l l ont aneslu a llnoi dislociiiilr liculllc'
sau-oiil'eun .foll :r t l i('rrli t.r" ttr vtrl'-t" 't,'
r'1. l,)sorttcle si lrtutili:eazti i:r, livelul legiunilor in care ccmprcsirr 'l' . J'i*"i"ti;;;;i;"; .tt)
f{ r, {r'1Ul,rrliLr}l'(siirllpLicit, ischcrlril; cs1,eurrli pronunt].r,tir,,arlicii Li niv0 ' r' ,, cousllt i: lspccllll pscuilo- I I "gt n. , noslI llllr lr llir \ r {'l' ir lr lr 'r rI r r r 'r r rr 'r '.
(lilirlrr(t! rlt llrt' rrrr
lrl r,rr.r'rrlui,,.1 zri'cltr.clrloinct.Lrc ,,,1,,,,n, r'osie.
' ft:l i cril. tatlese'4,
il cchiilotici') qi-prczenita dtr vettti
fialfefclor itrtcr..e lle c,.r.Lpselor. ln lrrzir
est e caldil si desf insi dc o colcclit ] s( '|r t ) lrt (r r r r lr r 'r r 'r t : r l
,l..rl.lrrrl, r.sr:rLr'ir, r'nccfrcia nivelul piclii, care intl-o zonri lirnitatir, capitir, , , .
' ,, ' m bdcr at ii' r ') it r 1"t i"t '1" r 't r r li"r ' : "r r t t ' l" t t -
, rlr,r|r. r'rrsi,.,rlrrlri r,t|r: li1lnlo nesroza tisularii, sub forma unci lLlcet. ' ,::;' ;;- 'l- '"im nor , 'r r t i
rr,.rIrI, r ' I i' r , i||r Illr ) $e s i I p i c l c r" , l c s u tu l c e ]u l at sul ]cutanat D i mu$cl ti i ,
: ,, i i a. . f . "Lr er r ?i t 'ini l: r dispar iI i' ' cr lct r t t t l =r ' t i s( 'ir r lr r " i'r 'r r r r r r 'r r r ( r '
r r r ir r ': lr r '
;rrrlirrrl rr.jrrrrqrpitrii irl, os. I)c rnulte oli se supi,a,infecteazl. Aceste eior,rr, ,L,t,,t' ;r" l i A " li upo. " o ir ipcr t lof ie : r 'pir 'lilt r l r r r r 'i' : r : r r 'li' t t l: t {i|t
cr lcm 'nlr '( 'r l ll) r 'r l' l' r ll l" ir l" lllr r r r ' r '
r| ,.rIcr,r I I r iL r c iul. ilt rc s c i n : a )_ p a r.a p l e g i i d e cl i -r' erscnaturi si ol .i gi rri ' ,r r ' .r,l oso: So. S'pr ll- 'cr zii "
; r ilm in ir lf i'L r l|sl t t l r l. ' ir t t t lr I r 'i t r r r l"l"t '
l ,r rl rr, r : , f t z ir r r , i r r r..rl rrl .r.c ;c r L " n ri p l c g i i d ) pol i ncv.i tc, pol i r.uri i cul ,i rr,. ,i , :.' 1:. rj , , t iiLit t eiii'inilc; ir it o
;
\r'rr'.;., ) ( t t \ , . r ' s t , l, , ,l l ,rn It,,Irl i i ; l ) l ,r, b o l n l v i i comrto{i ; g) Id, bul rr\ i l : ir r l. lr r |"
',1 , r'.r1 i., . r . r1iir , ; . . ,' .. i rrrri ,rl r,rp c ,l i c .n .ru rr.u ntr.rti zrri ,' supi i } i uoci :urrl j i tr| ,..f' ttct t Li: c, . t ea, ciit e Yar i: r hilir ilr {u'r ''li' r l' lr r r 'r lr r 'r r t zr r lr i
: r llr 'l r lt r t lr r r : r lor r 'r 'lr ''r r ll
I rI r'r| ! | | |/ , .I r i , , r r ' . r . , , 1 rrrrro Ii,,.,rr.l rL .tl c , h C m iC Or!U l C oul L,A l a[crrl(Jrr,,rri ,,ri i .l ezi ruii sist er nulni nen'os i) N obict i sr ir l
l )0 t r m iit r Llni ( l'r t r r |t r t lr t t . t l t I I I I I t II II ) ; :t l i
:t l l o l l z . ' l1) i I *f t iiiui, git uhr i, nuilii ; i '
' i ,.,;;,' " i " ( l r t 'r l r r r l'.t r l ir r li r r . t )
, ,, . i ri nf"i' f lZior ut r il ; i r le colpsci
"1" sit it qoulplir " llir r g iI 'I cr ' I I i. 'r r 'r r r lr r r r l : r r l'r 'r r "r '
' . -l rt: ou, r t lit t 'lit ' i, ; "i, . r 'l. i: ir r li( . 1t , r r i. ; , lr t lr t i r r t r ir r r t .r r 'i ', r I . l r i . l
. .,:i ;;.. i, '""1: ; il'; ; . d, .
I:T.,.TULBURARI
TR(T.IOE
OST}'OABTICULABE ' r r riL1lui,
:r t t t lr r t t
:." i ,,l i , ovut iiled, Lt t t alt csilt cr cscr zilot ll) lt 'r lil( '( |ilI r llir r r lr r liilr 'r t t t
lr r lx {t r " lt 1'tt
I ,i ;;i 1") , r r t i' t r lat h gem r t r chiulr ii ( , , r t t r i|r 'lt '. q|t t t t t t t . l, r i
1, 1.,'nr,cl,ut.il,c r . r r lr ir . " r r . I
l r r r {'I r I r r . r 'r , .
1 r l r ir i ) ,
. spontaneindolora srttyit fie insidios si fd,rri o ctuzii irlr.r- ; ,..1 . ]rt-;ii; lil, r ! ia picior : ului ( , , pii: it , r r Ll
r',rrlri, Iirr rlrrpr'i,.urr o'" l ll r ; rr l l i . ' l l l r r : r ( ( ir 'il't r l - i ( : I I I I '' ||' I 'I I I I '
tr':urrnrliismrninim. Indolcnla aoestorfriacturi gcncrlr,, rr, ,r,;ri l c in c. t r r lezlunct 1'
. r utr'|' nnlsuinla ; a,)iliind igncratc de bolnav qi rlo medic, cintl anilr,,- , . i ful , ii" t r lcr liu- lur iir t r r ': r ir '111i1 111; rr1i . . ir .t ': r 'r 'l' ' r r lr "r 'lr r 'r '
] i: r r ir ( r r . , L , : , r r ;
r, rzrr,rr I,rrllrull,rofunolriolta,Li moderatd,,riscd,sii nu fie ti'atate. b) Anl;r,o , L, j ,],;;l ' i; ; il*neo- cuboir lir , r r i ; i) r ur lir . |I Lr li, iir 'i. . , l: r r
n, rzr, l'rrr!o (,ltl)ul.iri osoiirtc,cu deforrnS,rischeletice,dezxyi.ri, incrlr.h'i,r,r ,, r,ri l l ;r-r: r i, ilrt ,also- r net it Llr r r il I n li' ( r , 'if c f i''r l1! r "llizr ' 2 r I ll lllil\ llr r r r lr r ( lr '
,,jr',ri", IIirrL)riiiIi,i'ounlro (lc pgcudo:utroze do cr,lLlsuli viciol.tsr, ( r }l {' r ' r r l r \ l l l r rl l( ( r l r' r rr',
$i Irr{!_ r' ,,,.,.,.rl i i I a, nir . elul halucclr r i; i s, 'r t r . olnsi, {l{ l . ,
, rrrrrr,r rurrrrlrrr'sitrrri ti.qulirrcsi ncrvoaso (inclnsiv mc(lulare !i/sr1ulri.lllrftr, 1l | rl l rl i rl l l iar ) ; h) ar ir opilt ilr ' ( r ) \ r , ji'lr lilt ir li ( 'sl( lill ] ( r 'r 'l l) lr r lilr li r r 'r lr r l r r ''
I ir, t r1 :tzll lr':r0 lut . ili[ Vor t ebr illc ) . t,1, I'ililltrofirl cl r,ololllto, ci rltr t'ip lr'i'trrliitr)'
, ,.\,
r . r . lr rf li, r ' t r r i s l x ,rrtn u i n rl o l o ro tre L ru i esl :inc , sugcreze: a) l fi l l rcsrrl l j .:t ttl rr nlll t Ll slllloliol, it lli'lt t Pr i i l (r i 'rt l t rrl ' i t rtl sillt ' l( r lr li{ lir l i" llr l'i ir 'LI
l') l l rrrr r ' " ' r r r ir ' lir . f r r ,c r;rs 1 ,rirrl t,i rn i l Il fe c f,i rrrri ,,ffi l Ll tru,i l o vurl ;cbl rl l tr sl rri ,
r' , l , rrl c ( lcg( r t ( 11) r .
:.,l | rr.'r rr r r r r ir r lr
r r r lo r l r.l o Irn i l ,r' i l oc o l o ru ;rc i(i rrrl ro sLrbirl 0 oi i i rscol i r' rzl t, lr l r l r r r ! lllr '
1r| i r.ri s. r l t i ,,it il, l, t t it lt r it t t lr , t lI 't r 1 : lll) t r illll l) r ) lli'lrl) l! ) t lll 'r ' il( l( 'r 1{'r l
I ('rrl l J r lir r r t l lt t t l'i't ' t
:rrLt, trl r{i i it r r r , r r , l, r 1il, , , lt r t r ' t 0r t lizit t t l l'r lr |r lt t l lt t t lir t 't lt r r lt
\1. j r' , ' l ri rr r ' ( "r l: r r , i r l, {ir r r l' r l - i t ir r ilr "r t ' llt ll) '
ll. ir liiL, rtro 0 r' i rl l rl $ n rM )i l i i i l l r)t)rl )rrrli , rI s0t i o rl l f t4)ttrl ttr lt "J
' \ r lt ' o i . l l i r : ilr l. t |it t t I r t |ii lr r r r r lr r lir lr r ll ; r r it illr lir r '1 r r l lt r ll't lir il"t "'
l,rttttu l t r , r . ' ir ) llr r l )u l rL l l i,l r! r' r' rl rrrrc l i rri rr, l i rrl , l rl ri rrIrr l ol rl r.,rurrr rrrrl o tlr' "t i trtti ttr 11s 1tl rt4t' t
iit 'tl l r
:I,III illl,
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i:l;
i,f ,,,i,,l riililrlit,l"-;irrrr
:illl[,*;:r ii,Ilill*lih
iiint
lric", compiu:ubil cu col nl.tlbosului'
t,rr'iiruir,$i ccu 11,gcn[ncl]lulul'

,,,,i]r*;'l*.l:#";;;ffii.Ll,HlT.,l3ili?il"h
ryit:nli
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in tarres
qi1nsirin-
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,, $fffsg"'#:';"ili:;.{iJii?ill
llilirili*ut{;ffifu ;H$*d;*:fn'rffii3Jift}lj:}1fi ^ii"t*r,:;mg:lilllli,f,?
,"i,"{i{rqJi:uii"iul**lisf
i'l'iJi,,Xli"jtl),1;,:llli",1i',ftii
i: itilj n_"$l!;f1l*ifliiil;fg?i[*si?; J'l*-""':tH;*tililiil-
r"#x"i*r#hf*r;'[,,"fl"$$l:lJ
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fi:lllilJ3,lltlJff
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i11';;',1:'ii;llf, i",.l""tt' t:li:'lTl;&f,T#;ii''l'd;"""n"'"'iTftT.,t
j,l,:lilT;lli,ill'li#:,{$H"::jfi?1"^?"1,?f'#"11.;1"p""*il#;l
IrIi r|lrr|r.lr, r'r'rtliCitrilor'-1,rmbu,
,i;i;11;:l iit$^i,*r,r,.,,
li;i;iil:ii"f#ltll+fi,1itrT1"#""i1{5giT3#fr
*TltcL,,r)nr,, rriv rrticulare I tl) In ulelo tt
'it'iffi'$:lifii,,'j",'i$"e!ffi{i,$,iiH:"3:1""f
l,i;:,}*.:Hl}j;if;
i
, r'i--t:ilburiri osteo-artlcuare'

tradturi
lililil;1,"1if'"',*li;if,*i:uro-, parcetarZ,-""
1"1,,"!oA;;;;6; i"ll|,"'11),'liilii*
,,,,,,,1,1|;nf,'11.i:"'i:il1'Jtisl--.Tl'lii:x?'#
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rll,",!'r',:,'i::"iil,#':*,":i?'r"ji:"$;iji-!ti",,.i.11'?li_gfi.li',lll:
|| l i rr.i L ll ui lr L' r . r ' c rtr.b | a l o s o S b e te | u g e n .
iliitilil,,,lllll,l:li
(l!r,f{\:r,|lI tt)ltcit zii O inflexiUne
li;:"1t"*H"'Ll,T:i";l'?,liJ!;t!*;,'-,"';.l;'iii
i n egal (mai i U r

i',"u'
ii1ili11rm*'[#**q:T:lr1x*i{t ,li1,,,1';';;,'',r
l;l'\,1,,.ti"*;""llli:ii''";[*.:1"*?ftli'T];ll'';i
toxice q' a')'
aeo'surii-
iilil',;'liliilfl1il,:ir;l'ilii'il:li"il*t"ff"lil',*-l:iiffil1,t" ,tl,rlri,'o{1,"a..-"tice,
lV. Aeropatiile ulcero-mutilante
'i:.,I:;il;:i:.
t,t.t
:,;t::!:r!:i:n;:;;ir
i;ftli:t
Ittt tAi
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bpi u, t , t [ c olp ir nf r c n0az ;
p|in tlrttri'ituttrrlt
se eatact'e;rizoilzir'
1' Din lttmct d'a uetlua a'{'ini'a
itttlt

al, lr o p a I i j l e ]a I Irl tl l g :
liorrrr,, lrr.irr ut.rrri,toriifactor.

ili:ti,il'i;illitli,,lllrlr"ii,ft 1,,,..:1"*r*'g'uffiL"xiu5i;#if'x'T:i*Jl,i'i
:;;; p"t'=':*ru;l*,tfT#iill'ii
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r' rirr'r '*$:".1if&lii;ffi1r#:'d,1iTli#"":;r"t
); r,) ficrer'2,r,,,,",,?liJ'iili$i"l#:;#i* l'fiii/i:|{illiiliilli ;Jil'ilil,li,illl: l l i Inuti l S n t e. se pot t socia m odlLlcilr l
at e uugr r Lt r ( 'r+' Lt
:llllli,lt,Sil#-;1$'i'
l;l *'1"4*;;i; ^'i:"#jiii?ill3:
cLio"iifptii
r'iirl.yei ^"ii^rr'$::;",,
r,.r'1r'r'sirtru,,r
. .l,niunilt n,ritl;utrcilotnbo,s,cclraie
rffjlJ.::i*l'oi
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,"tr"no"ra u,:i"ii"ii :illlfiil';'h-ll
il.Hy,;lfi
il,il1{:$"{#-:-#"i?t*tli'',""'ffi ate nerlbr.o-

i:lI,j;':i,,i
iirx,f,i,r.i i
i1,;i''i}:ltt'iij::t1iiffl:!131',"1i"i,,3;iif,i,*iffffi
r,xt,lrnsiviafalangelorrametatarsienilor'apoi'si'LtN'r$ttllli'oll(lt'(ritl'
t,, tiu , a unor importante detormaJ'ii'
1,\,li(1(!;
;1i,,il;;";l
c1sirirqomreiif::lil#l
';,1,1'i''i'
ltffiitllJSilrr",#?:g,*:i;i'l,rir
ilffiilir":i"'li"':"'i"i
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,lly"#"ru;:rme;{!;;:lffi ';l:ill'i l,:tillt''l,,lll,"T,"l',t,,'',Ti,';::
a"#:;lf
2. latziun,ih sistamului.nerun pat,[!tri.t
lxrt *ntrenrl rrltrtprr,tii rlis_ i;ji$ rtrur!
.st.
r,,,iiurln,'io1,,t'o
l r r ll I
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,,,,,,,i1
,nilillll,ll'lll,l1;i'lli'lil:
,lli;.li?li,,i,llii
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l i z:1,1(J 0c l ,l \ l l l r | ! l l (l i t"

260 !nl
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,1 n\ lt \ t ) r lioy t t r . l. or T, t r ir( , lt lc y i , r . l ) i r , (':i l l l i l l (' i l :r IIrIt' i |rrIIr(i i |' r| ttttIIt IIIItt' ' '
r l r r t r , l i . , r t i r r r r ir l g s l r r l r l o 5, l ' i i rrl t' trl Ii |ol i l ti l r'
',i,liil:i;l"l;;t,i;:i';,:,l,ili;'i;
Lji;;,'ij Xi,f;lilll,iill;,;,,1,1*l:llllll
;ji:iil'ilillll;, (i .\'l ,t'i l 'i l l l t l r' l t' r.l rrttl l l rtl l i t' i i t' r' |' l l ' rr' Irrt' i rl i rrttl Il s tl ttIl l t' ..:l tl rtl l rl rl l l l .t.t' tt.' '
(l )l l l ' ), r' rl rqrrtl tl rr i tt rl i rl l rrl i i l rr rrrrtri tt
:rl,r r:rrlrrcirrilol
r,rrlrirlicrrrr
qi llir rrrr,vikrr. " "' " ,rr rl i sl tol i i l rr ttttts rrttl rttt' l ttrtgtts i v r'
1i.r.Uii;,ii."" pt t 'zlr t r ( r ' r 'r r r l ( li) : ! r
i ' ,." t,ti ,,i ,i ,ti, *', r llr t t lzlt lt ii. iir sit ulr lilt r t "lr l t lt ilt st t lt t ir r t "
't ) rt tt)r),ti. ur.txt ntur'i/rttttri
.fan ttialii a rui, ,l!dren.r{L (sa. rir,ul.- , Lrrrr i rrrri l lrt i tt it t ir ioI t r I I iiI t I I lot lt t ) ! i( '1) {) '
r r t t r i. 'lt "lr r l'
rr'':lr:rrrrli.rrr:r.i t'rr'rriir.i, rui I).ir.v-rJrr*'ni
,i"r,"iili,,,,ii,,r,iirog,.,*;,i Z. V .ri l i t r lt r cr r , r . l1'xc1r r . . slr iit lct t llit t . lisr ': ll. lllllllt r it r
it r I t r t t ioiI oI iiI c t || I I 11I j'i||I
riitl*som'i'ri1,
l,,l']';ll;ll:;,];liil"ili':iJ:ll"Tl,ililliii,nc
llt t t ll; r I i I i t i r Lt t I t 1t I
",,,p,iiii*i*trel;--;l{r
,r, ti cttttrl ttgicc, r llolilt l sllt t
1,r,s1l tl c ni ttllii. r '1'or r r cir l l) lll'.
ir r t r t r ' l" r lr
l l ' (l ntrrr lul t lit - or sr : lt t lsr : r r silr ililili, cr t r c lliil 1i r t lilt r r f
sporattit:ri,
neereduard,
o ltti Bt;tr:au, l r(' l i i l l curogcn( : ( r adicr t llr c, 1xr lir t lr . t 'iliot ', poliir t t lit 't t Lr t t |t t t lr ( '{ ' lr r 'r r r r r

;l-l,:;l;l';lli,,n
rl*t#;uJ[$*i:*it,l
,,,,,!:/,,,t,:,:,i,:i:!,:,,:i!,:,','"ril"il,l:u',i1,),1^,it
l rrrc ctc,),

ml:xrkit;1;i#
llrlir', c\ l)ulrcl.ilitlt lrig.
$. C kutrr t l, cxist cnlei posibilo
rrrrclc amiotlo{ii n"t,.og"itc
r,, nenroloEice,
-.1i,
t t ' t lr t r cr ilot , t ': t t t r pol li lt lcz. 't t lr r l' r Lr
lrrli tlts, in tnirtzil'o;i
'itt t t t i t l r :rrrr rrrl rr rl Ll
'

rrrrrr"
t,) ..lcropoliu,ulctro-muti.lan
tii din ttiahet :tlrre riircori, d;tpi. i0 t}r 10. n8tar ca t livcr selor at it lt t lilt i pa t t ict r lit t 't ', t t r t clit l'or t t l l) ( 't ll! r l
llctll'og'(rl(r (il s(' \ t'(l('il rlr r'')rr
lI , lr,fiil(: lilicgcner sat pcntru unt'le :rtttiotlofii
i rrrrl
' ' ' " .itte).
i .,
tlit,erscbtii
eredod,tgetu-
,,,,,',",,i1,"','i!,)'l',;',ilii,,:',i';,:,.";':";:'"ri,#,,i,7*illilii" yerit icalell or . igir iii llr icgele slr U t r ilr lr gr . lr r . , r r si: r r ii . 't olr r lr r r ' . r
( l') \ l( lr
,' 1 i pr in ilect lot li'jgnost ic t 'i plin . lr '' it r r r r r r r t glr t lir r
' ' t,,gttost'l"ut u t rrrctrlt rri rt .r:'
1I. Ufcctuarea, in unele cttzul i, ll birlpsitli rmrsctlllrl,tr
, I;,;lllf,"Jli,
#ii iii:.1?,.ilfii
#11i,:li:*:33it
ffti*lii:r;i,.:it':*i#
zrr*r rlr r'iDrrlsiruhor'nr.i urnri.niinir,.;i
, rr.rrnlui histopiltologic.
13. ]l fe clr uar ca, unt lc est c cazul, : r unei anclr eit '
gt 'r illi. r ' ; i r lit lt r lr
o" aoo,ialir.vegeirr,trvc),
"aoao", a"-p*i"t.'n-sc,-p,,riii r'.r orrliotipului }rllnavului.
i;,;;;l;
,'x'1i:ilil.,)lil,,J#ilh*'t"T$:l;i,
ilil"" t4. Efectuaretl t1e tletelntini'r'i biochinrir* lllo rrtrritlitlrri si
.tr":rlttrttt' r
IIrcIi..rIi Irt
ifj;h"*i*"*:H"#ff.1#xn$'#:tl;lrjlrili
lliiiri,ii:rlltxlf
i,ri,, strig;,Sl llririi)' 1 cxzilnclol
,r' ,' j j " ;;l
rnusclrlilto
:. t . ) , , r ll, luhzelor , a t r ansanit t r r zt r lot ,
(fosloct't'rtlittllirrlzrr'
lt r lif t 't t iI r r ir lr r zt i r 'lr ''

i;lii.li,lJ': i.:""'- 8.3,2. I'robleme do diagloslic stmiologie |i lopollr'rrlit'

,,i;,rr,'1,,,,{,l,ri?lil?,'g**;il'f,t!-fir"qiii'&l,Ti*tii+'}'i.;i$ff111?"-'l;i);
( rr i u tl l ' r r ilr ( , r t ,unoI . le fl e x c s i n l
"Tll,l;1"1,1,-13,::i?:i,";il::l;1,,,'1,.i1;.;,;;"ffi",:,iair, .r,.J.2. t. . 4 t t ; olr L, f iiI r uc- nr ur af , git t '
I. .4i rc liih nr in". def r cl" dr ut ili: 'nt e ( ult "Jiilr r lt t uulili nt ") : r 1': 't
rtr tttttt '

rrr;:iir,rrr;,irill;
"ii{*li[i*,i:ii?ig,t'"#'l.,{i1]ffi:Tii
iti,'ri:#tf ' ' ,,' ,trl i i i n' l i i'
r,,i i'ii;"iii""t
lna"I ur gat e ( indeosebi in apar , 1'1cgi}sr r lo) ,

"r",
,rrrrri secl i u ni t le t cnt loane, 'plin
i,,ti"rit"1iito" url:irlhri,
unelc t t r r
a1c
t t t t t
i:orrpsci
lt iist r t r ' r r
ilt
fi
r r
rtl
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' ,' i' ,,,,i
l zi urte,' ;l ( iilr / 'r l I lr ' 1l or
,1, lt neur or r uluf m ot or . per iiel'i( r ' ill t ' t lilt gt losli|r r l
't iiour
: '- l'i r t r r pi 11"p111111i; '111r '. it t r ; t t r t llt t t lr '( t trt "t t i
,t, st,rbi tl t, in cazul al, r of iilor
s.J. I'ULBUttAlil TR0IiICL. MUSCULARII. r lr 'li'r 'lr r l ' t l'
,r" ,,oI a , *: i"ui qi coloana') , sli nr r u' h's'- r t r rt r t r *''l'r ( r . r l"
oi sit , cx1ilo}ir I n 1i evollur l. l lt 'ziLt t t t lt it r I r I t t I I r t I I r r i : r lr lr '\ r r lr r r 'l lr r
' rti i i zrrre,
l ri rrl .
Il.il. I. l,r.irr.i,ii .c corrrlililiiscr'iol'lricir i' *uri*troiii. :/. .4m it t lr of iil. e , , nu- t r ilir : nale' yi llI st t t ilult t 'lict tpol li r r r lr lr r r l.
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 - r 't t t'lt t lr '' t ' r '. t
so iir1,or,
-irrni"ez,i "" o sir,i{,{lrl rrl i n cur sir l sr r l r lnpit pcr ioadc do lipsi dr r I t I iI t t ct t I , I I I ir ",
lrr r r.rpii rlrr rrorlluiirr'isriinioir_.gicii, ,t,rf,rl ,,,rrl i ' l l l i ment lr o r 'r : slt ic^t it . i sir r r dczr : i, lt ililr t 'r t lt r , t 'vl't t lt llt l t lt ilt t r '1t t r . r t t l'
l' fll irrlirl rrr.rrL.l r.rrrrrrui rr, iirrl'.ir.rrc.;i
"r"r r,' ,rrl ,rl canor it xico( plir r r t 'st licliit , glohr r lisr t t t cll'r l1il'r ir lc r r l) ( r r l it lr r r r ( 'r r lLr r '
,,r-',ii:,,i
,r1i,,, il rirr|.
Al,',',,j,.rr',r 1.01t0,1;'rrfiri.t.r,rrr:1...:
r) unil.,t0r.ril,i;bj bri:|terai,,,rr.,r r r llit t t igit r t l'r lt lt : t r r r lt t l r lr '1r 'r lr r'
,i.], l r) l hrtli' llj: t t 'ci ct r t t t it , c, ir r 1or ", 'O t r t ii 1t 'r
lil,l'I s,rr
lrrrrxir,rir'iitr)r'cnriz
'ri'srrr .,rr l ' i l rolnllii r t t r Lclicit o t lc r t lr sr t t lr lir r I
'iillil;1"'l,:illl,;li,l'iliill;,,;l,li:'''.'n
i l . , \ llr r liz t r c t r r ' : l(ti i rr' | l o It,rrrr i I ri t I rI i rI i i tr c r, () i l t t r t t t st t l t t r t ot lt Ji'illit t t r i t 't r t t t i|il t llliil't t lizlllil{': llll}( l( lll r / 'I iir 'r \ 'r '
t ''
rIr';rl l ri I r iI I i, r . lr r r lilii, rl rrl i i r,l r..). 1 l ri t.r,1l 0c()nsi i t0l rl .l (tl t.i | i i ,r,l ,r' i i i fto t t i<u', lt t lt t r t t i I t llt lilSt t r '( i rIrI r'' I I r' I I i visllut lLlr ') ,r 'olr t gct t 'r zr "I lt t '
l ri rl i rl c sisllt t t ;
'1 , iilr t r lir r l, r ' r r , t r Il rrt(i l i s i rrl rIr' ru rrrIr.rrrrIin)l li' {
( ,i rri l l i t,tl r (i l r t.,,r1,,r,,,r,r i rl ) l ,rr lr , r lLr . riir lt t , lir ct r l'r llt i{: r r r r it r oz. , ( ir r r r pllir l r lir t lit r r plll
rl, i l tl |l ,|.|t r ' \ . i, I lt r r lr , lrrt l r.rI, rrrr, .rII, rrri .rIII r,t rj , ,i .
I r , tl l tri ,,1,,,, ,,,,,,, .r.). ,r t,t).
').tt"l
',ll t i
 T
r r lr . r r t ,.s i l rr,r,{ i i ,rrrl i rrIrrrl .i rr,(rrl ri l r i rrrrzi s (j i rfr,\i l ) rsl ,rr rl i l .uzi , t't'ttl tl ti l c' tl r r r t tttl tl tl t t t
,, p
'.i ....'.
.l r.r: L,
r r 'i]r ::r|'
' , lt
I ., . lr r . |ll r.tf
i l l ,.s rtl rrl rti l r,rl i p rts .I)0 r rrrtl ht ()t.i ,sol rs0(]i i tzi ,0tt t| l t I i l o l ', c r r p t r r l r rttr i l tl u l ti l , I) l o xi l l l l r l i 'i , l r l i tr g i tttl tttl l i r tl cs
, : . . : li" J ll Su rrrrrrit,irrrirr.,i.ri, :r.r.:r'ri 1,,rrliz,rt.r'-l. t:rl:tlrrl:r
ii, ,.,i,,i,,ii;,,i,,,,,,,it,i.
rlrrr''rr' r'\r5l:r
i ]l l )1 ,,i . ] ,'r
,t,irrlrr . . r r r.rl ,,l
,, l'.rrr.tl.t x .r' ' 1{ i i r .rrrIi l )rrt,0 r' rr i { 1i
I r 1;1151'1'1'Sir,l,
rr,
, tl rl l ri r u,.i chi pl uvnu,ci r, f-r.nr.p.iip llirch"nnn ;i clt" tuttrr' rrl. c''trlrrtil'rt,
Clt0 pcrsislii citovlr, st{I,'i l.,. iieflcxclo
-rnusculrre ',,','ui:r
I'i rj:i.rY. a'i-i^r.'iro,nirl ui fuLrurr
rr,;rrrrrler'. lui curr.r'i, rrr'rrr:r lri l'li.lr,'
rr llr)ilrrlirolsri sirri, ctirrsclvai:cr nr]_ r':rrr1Itr'l {'ri"l
la,scicrihlif spou, 6,""s'rrdr forntr Iui L\ltlloni) ;i cel'.o.rrl:r!i'
l i rl r. i r ilu pr r ) v ( ' 0iL( ,0i ,rt,r't:x i l tn c l tu l -rxistil i",,lorin,'l (lrril)('r'lI |1l'i|)'
IG e s te n ofrna,l .'
';i
t,'ii""-"^ttl""ite,t'i' ii2gnosticc (Ratlt, 19?E; Guibert ;i
rj c f)L ,rt,, l .e c u n o i r:te pIi n rr.l ul i r si cu cpi sor._ t tt tt Itilrrrtltoli|
l.,.,.,.').
{ r':1 1r. 't(.'"r:,,s: .r,vrrr.,(l:lr, .rr. t. rr\r,,j
t.ti ti rir1
t,,t
tc ,.li l i c i . p t.i n p rc d o rni nanpa,h r,i daci n.r, oi De nlulte oli' a'miotrofia plorimr J contrlstr':rz:i
m.i nbrc - gxrtt['it|i {trr:ri irlst' lri"l'
trrlr.,rgrosi rc cvidenti dupi, intreruperea toxicului, pr\)- ,,1" ;rn;';*;;;i;Lirrn':ii"tie) rr alt6r mu-'chi: r
rrrrrrlrlrr':'i
l,,j 'l,j.il]::':.;
,]]rrr' consisrenla lnuqcrrhrr-r tttt r''t.
f r l)r'irrIn.g:utrv rt irl.ri!_c\umenuluiclinic neurologicqi clecele mai milt0 i;;' h';i; i"ri"i,l:'d)
.
, 'f ,r IIl,)f l,.uti (cu exceptia polineuropatiilor etilice deja cou_ ,i;;il'l;-;;;i'il.j;, a"rjrotg,rii de zonc fibroa,se;i i], urr'r' ,srurl.lri'r'r'l t r'\( 'rrlrr
t'pt rr'
'','*' 'S pr:ccorir". lrr ii
i,i,;ii,,'.,1" ,'r nefie,'ul idiomuscular este totdealro'l abolit '
tlin tm.ele i i P;il;;ilid;io.-uJii ost"o-a'rr'iculare prog|osivo,irtvrtJirlrttrlt'(itt r;r|r'r'rI
.. .ll.'1..4nioln[ii[c r.icalii endogette.De piirll, amiotrofit i
rtt.rrrr,ri ,.i.nto
sltrvilL. irL oursitl insuficicrLlrci renr,lecronice, ar6 o pieclominantir, ii,-f";; nocnlm" de Boulugne); g) iJleltrorti,rg , rsiir. l .rlr. rrl .r,rrl;rl|
pt,rr i.rrLrrlii,
rrlr,r'ir.rlrr,
so l,sooiazii:ldcseacu.crainpe musculare, iar invesilgitffi"
*''uLi. Dilicull,lli cliagnos--ticeintirnpiirnin Ooar -in'silualiiio "li#il ;i;l i.,liiTJ;1" :',-,l",\lil"Jl'
-U ,li'C i:il",llilijljl; r,''::illil r l
illi"lilllii,"'li':j;
. g tr r l : r t " r r
;
rr rr|:rIjir.iilrolirrouropa,tiei ulcmlce. i' i g t , i' ii. " " i o t r t e u n t l a s . ' u t i p i c t n i o u . r r ; l t . l . t t ( t "
b:,r.ata
lui llac Ard"Ie-scttmirl-peorsol, i,i," ?"-iirli"t" ir"torie, a c5ror<lurataqi lnrplitrrrlirr.sirrl, 1r rrrr
rr.ilrrso
.,,.l.,t poate crea
'll r',. .1,!,,i,!':,'Jiu,.rlin
l)r!,',1|llr'.rtllguosticec.uamiotrofiiicmiogene.Do frpi, eilc o amio- rtti asDccl, polifazic cu componenie scultt I rldlorrlt'lrt'{lt'{trrfot'lltttltllr'lot'
:,.
I'1'r, ( ,,|l.r\' ttvrt urrui t[oficit cougenital iraseu DMG dcirscbit tlc-bogirl;itr lirttlrttl tr.tt
al fosfori]rzcifruscul,rr,.,car,, ;,;it#-iLtdl;liratu"t"it; rlcsittl
rrr l,' r'r.ril.{rLrilnsfo|ntjrrcJ glicogenrilui in acid lactic.
Ii,eprezinta o boali, r.a"1iei care gencreazi'virfuri neidentilicabiltr; i) '\spcrrl
ln biopsia : lrrliirlr"
rrll'r'r'rr'{ii tlrri
(cx transmisieautosomalL_recesivA),
tegateSi ale -iirlmite, in geniral,
rle tiaracteristic, .muscularii' t'
,l.llllll l.]l,l,,l,l.l,rr,rlrir,
"J|'irlrXlllrlt.:rtr...SSpolfe r(,cunoir:Lcprin crr.r,ctentleretliiar, prin apari- 1,ersate,segmentare,'ct inegaliti'ti ile
tibrc'lor muscttlittt' (tIrtt
tttItIr'' lti;x
ftrscictrl, r'' Ijlrtrr t.ir'rtIr|.Irr'r'
,:, II|,r,,II)I|:||L. rrr arlolcsccnti.prin amiotrolia
rizomclicd,inso1,iU, ii d,r i.oiice lalr-nt.ntice), c' coelistenlii in acel:rqi irrrp,r'lrrrr
r-|||r.U,Irl:rlr.\r{t(..cn|npo.p|in aprrilia de
sidri episorliccde conbracturi _i ii" i ri"'r"r"i", cii intittralio grisorsl rnli mull $iru rlr.ri1l(il
'i.i'i-"r'i.t:i"iii
dc clorturi pi urrnrtc de.miogtobinrrric p,'."o"L h'lperllazie a tesutulrri irrt'clrl'i{irrl,rlrt.t lrttrt
ffanziroric(revo- i,r. si rrrrr'itrlrr'
ll,'i::.,:.1:,'j]:..,j:."1
rllrguo\t rn), prin cs?mcnul ncurologic ncg-r,tiv (in afara sirngttitt:i.;t.t'rtzittrr'h't
jt-Doz:'rr't,r
: |lrl,ll.olt(.i ';,"ii";,i';ldinllaliarot'i"; impoitan a valuril,,r' rrkl,,trrz,.isr,r'ir,r"rr r,rr'rrlrrr
t,rr'.',.||l(.r discrelcrizouelicetl-tJ0% dincrzuri,)jiprinoramenul ,,lr,ie.-al-irrrrd, rlili'rr,r
, p'obcide ischemic "Gierea
iiiii-lliqt";'i;iiioti"iia"og"i."rui, in schinrho sci,ttt'rr. ir v,rl.,r'i|.,r'
I :rotr.yrlrtlii-bioelect|ice,
l ' :llr:.,11 r', ii"',ii;;;;;e-p'ind la sitcnliu
'.;l].1:,I
irrl ttrr',.ir paralel cu instalare:l coftracturii cluic_ ii;;i;l"r"i (in unele forme,-clt de'pilt}-r' Jorma llrtch.rtttt') I li) IIt.IrIitIItrI:r
,"Lr{L(riir , ,/s' tiorvlanrl ;:;;;;;";di""G&otx pt'.ir.' l)Nll" lrrrl,rrr,l
(a"" nu eJtc prtogn,_,rLronici'i
$i gglg!., 1965, citali de Radu, 197g; Sr,ior ii ; 1 l ), 1'ilrs|Krrl trt ..ttL'
qi.neurogcnt
rnioge?Le
,1rSli.lrrri,1.0?5,r:il,Lli de Raa1d,19?g).' i i;""";;16- qid aite-amiotrof
.i. .l!tit'tt,,li;tr de origine eu.rlouind pot \tt a" r'r'lr rll
il'ft n,rlparc;m) lipsesc irampt'le trrllsclllrrll';tt) 'l
se inriini io: ictrttt..ttt ttti'
tltittlt'ttfia,hipertiroid,ianiiare-o pred.lominanld, proximali, (ce1m:r,i -"""tr"c spoirtan" stu pnrvocul''; l'i1,s's" rtllc
.t .rt .l
.rir'.,,r l)r\r\.r ,1l t,.rtir,rn:rlrar sc.rpulohumcrali;, sc asoci.r,zii ':,i.1i""rorii-riar't"t,'to"itelot foarte dvoluatc, utLtl* srt rrlt'li rtrllrrrr'''
adcscltcu fas. iU;;'i;;^
, r,'ur.'l||1,.t,.rr,.t Sr .m iologjc nl ). dar cxrmenul clinic neurologio
";;;pilsi apar retraclii musculotctxlinortstr)
,rieotentliloirsd ; ',1' lf rr$l(\rrr'rtrrl
o) l'(l
i lr r' ri.{r,r I v, lrr. ox&msnul llMG parlicrrl:rrt IriIr.r|,'r,I,rz.r
r.irr.:rrtr.r'ist.i..r.:
-der.uh
evidentiazi, semne minore d.e tip neurog6n. ;iJi"al ;;; Eilta ii'ronr" alil,udini
i,,rinLl' oIfr,f o*onului'ri tali:r '.rlr' r ir'-pr"' (itr i.ttrt:t llrtr'lr'
t,prIn hip,ercortic-lsrru.
(indeosebiilin sinch.omutti,i Cusn'i"gt ,:'i oiili'i1f
,.. ,..,.,), l,:.::.,,,r::!
r, ,r't l|rirr lrtcs,.irrn3SCJlii, dC obCZitate. ""
,;,i ,1;;i;"i;iopai:ic cu mindci' lijrrt:i, ctt rl.schirlct'':r rrrrrilirlailrr lir rrlr'
luir t'f ii pdltnr i,,,:itifo"f,r."ia,.:u'buza,le .,tlpir'''. ciL rrslrIr'1l:ttrsv('r's" itt "lrttrtl rlc H 'ttr:r'
;t ir tlr \r.vItr..\prr| op&uz;cili,_
,r.,ltrr\,, sc itsetmilrd cu miop-rtia 11rogresivii
rin t..ltnin l:tciuscal'rtl'rlrrLrLt't:tlirt lrtr lr'rtrrl'rrrr\
L, femciintroi0si G0dc ani, pieclominnIa rhdii- ,,;','';;";;;i;rlIl:;
r rr:r rr,.rllrllot. (irxloosebila rne-mbreleilferioare) gi l)6j6r'ine) ,,q.4.
id asociazi,cu hipo"
l,rrrrr. rrrrr.rrLrr.i-r,. I)i.lr nu existi frlscicula,lii,r,eilexele osteo_tenilinoi,so
rrrl .r)rr,r'virl(!, rru sc evidenliazii,alte serin6 neurologice, iar ('niotttttiile )' S-tr'11'iocir' :rlil lrrirll'rrrrrrr
examenul E.3.2.2.2 -i,';I)istrtfiite ntiolott'ice
ll\l (i rrr rtllvi, rrrrxlifiq"lr.iirirportanl,e. ,,,, u;;;;;l; .'itrluL sc pL's'',zi ;i.iiprrl .l'. r..'ftntliY lrrr'rl'tltrt
"irci,t
;ili,,;',,*"ii^"f,i*i"lj,''iiistrotir, (srrrrb,'iLr,,lui.Sl.itr.r'l), tlirtlt'lt:r
,\.:t.:!.':.il nioh.oli.ile miouerl,e 'ijo!r'icL rx)rrA('rrilr[
cit fi 1'rtl'rr'rtriulrrlriir'. (J)r'irlil
,,,i,i,ini,lii intaniilr'i,(congolitalrr,), tt
t'lttttt
t'r.'t.zittl:i rrrrlil:i{i
liii V'rr liul.*lrr:r'g),prtxtiirtr1i rr,,irrr'rrri,il,,iriile,
l)istr:4iit, trnrsculorepyognsiac r r r l tttzi ttti t' tl l r i tt tttt l l i l tl p l o ttt 1 i tttl r r
, , '1.,..i,t'
1, (llNt.l,1rlt, obicci nu ct'e0il,zii {{'I t o i ; i o ( r ( l i sl ,i n ( 1 1 ( 'i l l t ( l i l l {) tn i o l 'r r tti l t
llUr" .r r r t
{ l r .. l )l .i l l Il | 1 rri rto i ,{ .l u c ; ,:tCl ,(,t.(j
t , r l- {r } , rlc : l r rr r rl i r ' ( l i l r r lr l , l l ) ? fi )
:r) l ' . r lir . l( ' r ' A , ! r . l ,i t r.rr{ l o ,ti trrri l i l l (rrl ro o ri l i i nrl spotarl i ce) I t r i l r r p l ;, i ,o l tl tl l ttr l 'sl tr :r l i r r r ( i tr tti si ttl t r l tti t'o l 'tr l i zr
I I'tt i tt l tti l ttr i ;tr tl l ttttt
,lirl ; lt) Do- j
l ,r,!. oi r ' , lr , v ir s l ,r.l o rn i r:i ;i rrv o l tri i o l rtn i , L, rl trl i l r.oxol l l bj i progto- r n o t t t c t t t t l r tti ,,l ,,n i t, tr l tl tr tt'p ttzi tti i i ' r t l ttl l r ttl r ttt' I r t r rr ' I i r rI rI r I i I I ' I I t ' I' i t | | | i | | | | r l
rrrl r; r,) . , \ l, r ' oii. rs, i t lr rl i c i l rrl rrr,rl ,o l s i rri ;, i rr rrrti rul rnl .j ol i l tr,i ,rr (rirzu' ( l l I |1' I I I t II l iI | t
l[ r r l i r r i r ';r t i tr l t tr r l tttr tl r t :l r r o l l r r :r l
/ l i l , t r 'i I r r t t s.r r l t,r 'r ', i ,l r i .r 'l i t'l r l i r ' '
lllr4 ' .l l ' l l

.Jl
:r (I|('r'IrI|'ir(I{i.irrrl(ilriUlri sl.irri, r.rrlizirrrl rrrr.lilr rrri'|,,rri'ii,.Asl,Itl, rri,, *)'i.'ri,1ll1,lll],il,["i,ll.il;]11,,:i;,;;;lil''i;i,,i
(r!.*kr,r,
rlrt,)rl Iri'{iir rurf( rlirii (,sl,clollii, si. prrlrrrrgili, rlrrl irrrlolor,ii,
| ,. r'lr,r'i\'ol nlilt rlr.rrtrlril.lcoltsiii,lnrorrrllioll tlccottltir,cIiei
lll. ,rt)rl.Al/r),talr,r, (lltl)ri o c()l]1]t,t[o1,i0.
rrcggsiLirrri
pott,t,e
sut,vgtti
v ohrrrtrLrii,sir[ (lo o trtitniitir,Ttronncatd,
|iil#{;j;4i#:"1{H"i"*:1,;irtv:{rli*i li",illii*i,
:rrlilrr rl.rr.piir) (i{)lllir(i1ioiru.lusii,_:
rrr,l'r' ' l,i ;r.r'rrri rrr.rI I ,.i t(.rr)r'r..
lic_.prinl;r.oac!iruro rncornicii'(percuf,iri itr*,#,F,"?H',:g::'*".Te;:"x"*;;t"lr'***:.i1
Ir ,, ;'i111111 111.r.l,r.lrir..r.
tirrl r.rr ocrrzilrrli;0itilot tlo plehonsiune.
ir lirnbij. srrr ll lurrgulrri$upilrrtor),iic pt,ill-
li{.rr(,rn(,rrul nriutonicpuilc fi torr.ic l]et cvidcu_
I. lirtrr.llt,Lui, Sleiu.t'rl (,niottnia atroficd, sau. clislrrf ia rni,otonicd,
iilll*#*$nllt*s+:t$u""ttll{y#'i{i*ilr
trapartal t*nr",]Tl'j.".1{'_!1['"ti,.f;"'.ltlii,il,l,,
r,',r'mer1ul ;,
,rirrr,.rri,.r
) st
||a ||r|,,:|-i(r'r'lrrIiIrr.,,rr,l)o l_,rz,lUrmiIurului conluxt Sp-miOlugif : in deglutilie,
illlili"rixffnJ:"T,:?;,u,n",ii,ila rtrrirrgr'.t:r{:r.
co'sLr,r'
rlupii,
t 1 I'rt.cttlrt ,ttnl,tr,t.litlar, sub acest aspect boal& lui Sfeinert fiind
lif. lill,l \rlrl,tr'.rIII,.'.tirrrrr.
"#
i'i'' ";;;;l*i" *4,d.rr l{:}lil llillJliii,
,lirr r|est grup CtrC re|tlizoazi,rlrolii muSCul$TC.
,\r.rsllrr,.<,.1
rr,i
t rqrogr.ir fitr, sinti faciaL 5i diitele la, membre, atilginel trmdto-
.rrrrr;chi.:rrrrri;drii1cfei, rcalizind un facies inexpresiv, atoir, de aspect
"Hf-#lXit$Jil'*ililE# ll$lL:
irli,'lil"ii",i,ll$i* "n".'1L*1?.',1;?11"1?iii"TlT,li
#'tgdllt*"t' I
..llirrrulrirrlilr.'),cu lipsa cutclor fruntii, cu deficit;I ol6icdarilor ociilor
.i irl lIlz,r'lr)r':r'iriir':ttoIiipleorpclor_:uperioare(cu plozir pJtpebr.nli,); lllj#ii #*""qf #t;; j*j*;,iitill,
T+?,l3""i'ii,gT:?Tg# l,illlitiirl;
.rl', aroplitudinii potenf ialelor
r.-(, t)lrllli t 3{Ir(.Jlont (cu cvldcnta alrolic)i slernoclcidornastuidi_
,r|'r {tl{ :r{,.) ,.rr,..r i'i;o;"'ni"t""-ql iinioii"tt" 1972, cilati dc Ilrdrr, 1178)
cu {.\'i(l{.nt:i.rll.o[ie) ; musc]ii ,ntcb|rtulrri .ttltt irrrl
rrrrr.,lrii rli.iirli I,i r tLelbr{l,rT inioliolrc {mult mai taldiv}. 5i
ei rniinii; s-au itleniiticat qi conl''rat i' .lf i.rii ir'tri1i
4. N eurorniatoniilla
l,) .1't't: ( tl Iu, ! ttt rttnenultti m,iotonio relatat anterior. i,rei entiti,li cliliee :
t ) o)illi: cu Q(|t?lic(i, c\ anurnite caractere particulare:
I trrrlsririsioc[r'e urrnclzli o moda]itate clomidanti,, srrb aces, aspec[ ;f i;*;:'"*J,'" "'T"'lll;l';:"1'
:#3Y'Hi:#i11:'i:'1y?i1t,i"'f;ll; ii'i
liirrrl o llrrr{irurc rlotr:nninat:ide o gen5,ploiotropr,autosomalf clominait[,
r'|| |)I.rI(,I|II||tiirurrnplcti,s&u_i]pruitpecompleti,
ifarii sri sr,rtipeste genelaliii
lll#,*ihttn*:xl*x;'*,:xx"l"*:lig;#T'r*il'Il;
..r' ,r r .,r',.\:rriir bililrlt' dc crp|r,siviilte (Crughe-yli Mwienr[onoulos.
l:rr;r,i 1..'r,.,s. I:1.,7 citali rle nrrdu, tgTd); apxre Oin ce in cc 6ai dc- llr"i.mi$*;i":,:ru1"**L*"'l*lm:i1,i[i:t;
r 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,,
Tt':$tH
;ri:ii#:tT&f;***tUx,,*gt, ;'l,'l,l'
tll'iiiliiilil''llil'
lir.r,, lru,l; ( 'rrugli(J' ,si lWyri:rnthopoulos, -de-n,adu, .rrloalte etiopatogenn.
,.,1icr .1966,' cit;!i"
r:rrs); rt(.|' 1r'irz:-r
l\t':tnlo iJc
rle olricei in arlolescen![si inainte de 30 rle ani.
tttlburd,.ri tndocrine; - alopecie precoce, ptogresivt
iili'',1'i;l"i:llll:"1
.'"li-X"'gnl,#x,?".'ii,:,"1"i".:i:3-S"'#;;'f
r rr rl, .rl1
Lrrr Irrrrrlrtl: (,I)ircifier.i cr.isiulinicne generaloire do catnra6ld <it, *LiJo*..l8l?r)'1,?
(inilamatorie
i,j.nai"cta.e ,',i:ilii;:,1;1,
f.,lfli;,illllJ,illiltlll
l,ii:ll..1;:lt-r?ffi:J136;3#;ru;;ilil;;i;;;i,r,i,rr.ii ' :r
l rp \ , r;ll s:l r rt,. 1i1rJrJeisubut * atrofie l,esticulari,, cu sci,derea activifi,_
l
r.rlr r, )r,,,tr(r'r iru :rz,rosllcrntie,sicu scdllereaeliminlrii de 1?_cetosteroizi I
.rlr.';'ir'';i('ir'
l:, 1(ir, i, It'r'cvcn!:rl,a enol'cei, a aTorturilor iterr,ltiYe saU ft StedlitS,iii;
r rr rlrrlr,n.:r r:Llolilor oestrogonilor' si a pregnantlioluiui. iil*:.*u:l*',";t**l*i3;r"l*:;*:r':lrifl'l"liili:lililti
<'\ )lorl,i.Jittiri ItrtrI{}: Prezen\a tlescSlcdrilor bioelectrice musculrut.o
r',rr';LIll,r'i.rl iirrr oill.oloalizeazd,,,rafa,lele,,,,,avorselot, sau,,sayele" mioto_
-,fi
iil-]j*fl%Tr"*fi
,tlt!t"';;"ff jli,llrlrt/.uri
inl"+i*,r':#l$
rr'( (lr'rrllrr rlcttlii, vozi liadu, 19?8). { Ii{)hmer qi colab., 19?1).!'er
". 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 urrnii- ;x,l**mii,lmnl'"t;"*'*"*:"t'8"J;1".h?'li:
,,riitffi""" atlf"hlor
$i
lrittlrtritrltttrtlt'
ti'ipletelor tli' tetanic llx^ir'rn(rrrrrl
l,' r, L'.I i,rirrr,.r',.:.:rrApJrili3rnulI mri mrJ I b) Exirtcnla rue-i bipnrtlo-
Irr l r1I1I.1,,1 ;1,,,, r'rirl'icirrilor membrelor supcrioare qi in{crioale, a geflsnik)f ,:'i,i""ii,rr" ^-w"in ob,n,'i"-"*".o""l'ol"ifiljl ii,;liil;ll:;
i-iri,i,,]lll:ilil;
'
rr :r rrolr.rrlrllrli; ll'? l), tir plrrje de lihre alro
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
tirl;''Lll;;n,*+:""i*iii"lili
;;"'"liliiil+iffiii'hii;:l'i'lli
! ('grnl:t'ir,re(Pctttlolutltll, I t)?5' I $79)
r rrtrr ri crrprrcil.;11c tkr rmrncl putin alicctatc, sirnpiomltologie de obicci
r') ulr'uZdc ,,rul,i,t:ita,l'tt )nt13('l([rii t:rttt'Litt'ui't.1 (Isruurstl{xil' ll)li,i)
rrlrr{iorrrui (lll,rlrr, .11)78 I Caughcv qi nlyri.:r,nthopoulos, 1906, citnli tto
li rrrIrr, ll)?fi). ^girr.tlt
, 'l l t r l i t i t 't l , t : i l , il ( fl l l i l l l l ,l ,o l 'r l tt tl o |' tl r r tti i r 'l i 'r 'l i r r r r i l 'tl {l r n l r n l i ( r ' Str ttti ttl o g i l r
:tl ttr t
l l l l l $ r l l l l ,r ti i r l i i tr r l 'i , i ttsl :r l r tl r 'i 'l l l l '"l |i l r l ti r '' :r 'Ir:t ' tr I t t i t tr I t t :u '
,i. I' t'lltiolilil t.on,trn.il,ald i,,i,' f , r ', , t " i f ,,,,t'!
(hoal,a, Lrr,il.'qtt lNtl,tnbu.rl), nrultii yt,crrur
l rrrrI rrrrrI rrI ir rrr lrorrlirlrri 'l'lrorrscr rr 1ro:r,1cfi tol,tr6irlilirrr,rr(irr,ll'i,
rlo lrolr,lilltti
'| 'IIr|| rrrrr^tI lrtirr rrrrolorlr,r'llolcrlttltr lrrrlii,sirrlri irlt'slrlrrlirriorrIrrrrrrIrri nriol,o-
Ti.'lii:il,lll;1,'l::;,0i,;lirlilll:"lll;1,'if"illi'
l'l:,,ii,',"1
:lli'/
llir(i
 ('tzri' , ir r r I i' iI r r , | ,rrru rrrl i rrrri rr l i l r' r' l .l rr' ,rs .rIrr,r.,rr .i ' i rr,i r.rrrrzrr
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,(,.
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, 11q11111i11r 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 )
, \ . , 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
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
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 ' ' 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 ,
trttt. r ' t l: ' r i. ir l. lr lr ; l l r.' l :i
l rti rrri l i r,.. r.rr,r s r.rrri ,,l ,rgi r, ,1,, (,1,i ,.,.iputi ,n,,rfl i ,,:i i 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
lopog":riitr ot'l rrriLi trtlcsol, r'izorrrclicti, pscutlorirJopal,icti,
tlc ruturri infla,, 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
rlr.s,.rrcr':rl
iv:i ;i/s:tu
lll.]1:ll.il;1
l|'':rr.rrir'irU r'11lrr(':r .autoirnurili,nesupuihl,c,ctL er.olugie:rcutr'i,
{r tl. rnull.'
l , r,rl rur ( | ' r)| )(| \ . i r, i rr , 5i r r ollr lr . , l97it , ll) ?ii) .
t,licu ilrlcrl.sirr.c:r
--iir t(,-r,rur.ilor
ti]'larir[(! 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 iilt ot liuilr , , t . t r t ,
,.r ||ln rrl.:'|rjrl,..
rr |i rl:rr.irri l,rt si ir, lrrrochirrril,rt,
nprruaso.i clrii,r.: iLltol 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 ) ( lr r r llr r r r lr V. S. ll. , r r r lr , por r lr , lr
\Irr'{11(I}||I|rirri c hb., I,Jti3,1965' PopeSouqi R:i,tlu,19ig; Iropor-iciuqi 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 ,
lolrrlr., l1)Ti]. .1.1)?5)-
' t,,tttttl t' s.l , t l, it r r : : r , i( llipcscrsi r llir lr r , : 11) 78)c) ; [ I r xlif ici, r i ir lr , lr , slclor ', \ iil, t I
I,'!iyi,',:.it'l_1,lJtiut;_tite 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
L,(.,..1.._ _(g:rnpul.I illpti \,lralton-Ac1ams,grupul
| I Ir||rI t,' ,rI('I ;I {i Ir Nlontli{lii tle Neulologie ,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
. ' ($rFN) (\-ezi popescrl ,"i "naiu,
Il,7,s) Nirli trxohrsi' viLotice, ar<a.-curir s_a crezut (priir virus Coxsn,l ' 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 ',
'*rrl.i I3), de obicei fiind r,-orlba
r'liir, rlirr glrrpnl. , , 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
rle rnecanismeiirtoimune puse in '
(l{r di\'{,tscinfeclii Yirale-(Ohouqi colab., 19?0, citali 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
.1rrr,.rrn|o|i tlc liopesoLl 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,
ri l.i.rrlu,.19?8;J)un12 colab., 1963, 1965) rlar ile mfite
;i t i.i rtc piceso | tr, ' r
lrcii rrtrr,llr,r'if ictrttr. ;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 |
rL) l)olin.iozilele acuf,es.i subrrctLtcse pot reclnoaqtc prin debutul l rr , 11,r' ol rr r lroiI il c\ pl'csio: r ,unci polineur opr it ii - , , d. yilg- l) l( . 1(") t polr , r r
l rrl , l ri rl rIi r, zir rcom r 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
lolllti\ brucr').,.u
]:,1.1.
ll| r' f n l - i:llll
vrrt'jirllttt\. t ttsr ttt.u ' p
.sc np y rpit? rnti,Wzti,". i"Urr.,."iai,.,,, | . tr\ i i i i l i t r r pet it ive ( pot cn! iale cu f r ( xjvol1, ii, r , Pi( lii l0 : \ 0/ |j,
tt t.u tL tlr u lp . , ,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
lI iu,l.oi.i.k: sinlj acuzate la nivclul brale1or qi gambelor, inso!,ite do ' ,,, 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 ,
i,tntt (rattlpr
Lr.t.iltr'llil ,1i ,mt6(ulc,ra, apoi.5i de parize'interesirrifs"g;e"t"ii, ' , 1,, rrr r' " ( , r Il ilot ef izcnzi polim iozit ele.
l)r1,\||r,rirri.,:llr._t[rnrl)reJor, ial uneoli qi rnusculat0ra faringelui sia rrd,hr-
r|| l),rrrUtrul, uuscnllrtur't cste.sensiltilii,la presiune ''1 ,ll uli,licii,rile histopatologtce din biopsir.t, ltttsrul.rr,rir,rr(lu( ,,r'r.rlr
lr l)rll) ur. I,ioilexeleosteo,tendinoasesint insd, de obicei ;i fermi, (indura,tl) 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,
no"mri", e*J l ' rr' , l ' r,l r{r s( , u1i ll, adu, 1978; Popovichr si colir lt . , ll, 1iJ, lt ) 7ii) :
r, 1r{ir li'r'r r.lLr. rl'' pulir':rrlic uloneuroiliozite, ill care se constat[ si'moiiifi- "o 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,
' |l'r {,. L.Lt1.\{,,p]e(,nrr}.sitrLlbnriri de sensibilitate dc tip pclincvritic , i . r r r : r ; L,r r
;r:r.r.r | !' , rir'rlctit'r'csconte :r,le tibrelor mlrsoulitre, cu lrol,iviltiti r|gi.trr'r'irl!\ r, ;
.l)('1||rrlr{.ltoll',rtiLir'(l)rur],, ryicolab.,1963,196b; popoviciu qi colab., | ,'{,rlr)zit festtului
l.riiif. llr;.;,).,\itrt1,l,,tt,.rlulsqitr ,,tt04,tti t.steprezenli lu i1r|orirnalir 40o1, nocrozat; - fibrozii inlclsti {,irrlii.
rrrr rirz |r (t,'. r.{(' .i ( |tie. 1974.cif rli dp pup{-sr.u Ri,lu, t9;g,,
;i iiiriri ' l ' ol iut io: : it cle ( t ler m ut opolin iozit ele
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_ ) , dt r : sr r ollr i') ( r lir r ilr ult . r I t
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 ,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
utnr.ri , p,,tur,:l 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
, '. ,t l'. t : , r I : | ( I | | I |( . m e lr llr l.F lUt,) .
sl l,r'l sittrplonteuiscepulede cardiopatie(tahica,rdie,subticui_ 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
,
\,.l.rri.r ,:t.','tt.'i:t_ rrr , rl ,r' i r; lr ) I r upusul er . it em at os r liscnr inir , L
rr.rli.i.1f, blu,,rtlior-entricrlar.),. adenopatii,splenontegaiie,
ulcera_ I c) I I t liI r , r 'I r 'I , iI r rr r r r r lor r ; r r ;
ut tt,t*{)" t tt.-tItdt. ..a .. p t( ,cu n l
,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 o !lti( t lt,t ;;l of[;.
ltl I)ol.ii i.azitelerzozice contllrerzlr in motl prl,grcsi\. 1,al.ilouripseud0- lll , li 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
r,rr',1,.rrr,,.'.r,.trl,. t.2,('.ri:Ir.ri,'troiiilriorimaln. pfer.x111 .1 cU sinrprLmntlr. 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
r rlr ||rIiIs| .r| | i | ,.rIr| (,totrnr, -:i colal:..l9it; J,oporinirr.cinohb.. ! gtJ, lgT;),
,' 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
",. irf(lr-lirzai cpisorlic trtialgii, precum-si_Jenomene cutanate ia ;i iii l rrrl r.rr r.ilii, olLr l la: I ?opcscu , li }iadu, 1{) 78, I {6hnit n, l1) ${) . )
rll'ttrtr',4r,rlirrri,rzi1.Jr. aCrrle.io0,,ntencrl^ tip HarnrLrtl,rrr.,ni[e"1;ir1 .,1.1,,1
Itlr' (ttllr,rrsrrlriltr, livelul artir.uletiilor.scapul",-uiner.ale a1emiinilor.)
tlrr{ r'ri{\ ||l rrI i li l[ t ilri visceralo. (rniocrirtlite, 1i
' ;i \ '1.::.;i. I ILi,tt'oJiila n,eu,rogene
lncunonii tra,nzitorii q.i.j.
(l( re{ ilxt laptul cil a.miotrofiilerizornelicesirnetiit,i'r,
,1,}-lr,.irrr1r,r'laxt
rr \',1ttr' ,,' rlr. r-r'rr1r.tr,1n.i \.;i.:!,,:1.1, ( l rr,ft.t(Ltr( s( ttt,ioLot1 ir:( glenuutt' :
.-i rl( r'ctrn,clii,creeazri(lc cclemai multe ori t.rr.,
, ol'|r ,lr. lrIul rlirlroliilrl lJruscltltltel)rogro$ive liacio_scrapulo_hrrrnorir /) 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
ltr
.i rr ,rrr,r'r
i rii.l.,1.L'i-1,)rrlr.11(' (ltothstoill si (trri.lson, 1f)?1,c,itrriirle I>npcs.' 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 ) .
.,r,li ,il|1U...lllTs.i rru.:r r.olrLlr..I9ti:'i,l!)rii: Nrrrirr, lt16l: l,,r|',rri,,irr r;i 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 .
,r,l:rlr-.l1,7il,It,7J)r. _lJ 'i
I'..1'tir. s;i litrr, rlrr,i.rl,.rrs,.lril
rlr.r,l,.rrli.pr:rrit.rr
lr Irr .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
rlrrlrili rrrrrli:rgrr orlirr gr'1';il,rlc l) I,. 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 fi crolli(xf.lllrsciorrllr,tiilo
sirrl;rlrrostfiittlo strgrrsl,ivtr
ll,rrlltt rtt ;tlocls rlo tlctrot'\'l,ttrr (ll ' ltl)srlt(,tn
lot. ntt cxclurlocllrlotLrfulnou-
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 $i sudo-
lrrlo rlcstrrl rlo frccventc I f) Existii, in unele cazuri semne neurologiceaso.
riiri(', rjil,r'cpulmit diagnosticul topografic: tulburi,ri de reflexe qi/sau do
si'rsilrilil,lto, cventual alte semne spinale.
4. INl.tatrodiagnotticulclerutind, incumb5, o sedede aspectereyelatoaro :
t) I)t:n.cn:urcacompletd,.' irexcitabilitate galvanici, qi faradici a ner-
vrrlrri I incxcitabilital,o a mu$chiului la curen_tii ile excitalie scurt;,; len-
lrrr,r'ca,,si miiriren pragului contmcliilor la curentul galvanic i scidercil
plrrgrrlrri rcobazic a1 muqchiului; galvanotonus muscular pa.tologicI creq-
l0l'(rlr cron:l'xlllor,
b) Deneruareo,incompletd,.' conservarea excitabilit;lii galvanice qi
lrrlrrrlicc u,nelvilor, contracliile avind ins5, o amplitudine scflzut5 ; la nivo-
Irrl 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
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,
I t r r , l r r r r i : r r lr . r r r ! r ,
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
r,ttr,,U l i r/rr Lr r r r r Trlrr llhilr , lr , l 11) ; \ r niol, l, of iit , sc llsociizij, ; ir r ; 1r , f l1, , , 1, ,
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 .,
l\Ll, I l' 11'r 'r r . lizir r. ,. r lr , rI i rrri rrr.:I 1i r r r lr r r
- 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 ,Noi. c) Nu Be const at i f asciculalii, t ulLr ur r i, r , sr i r nzilivc olr ir . r . t irr , ,
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 , i r ilr ilr r 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, , ,
trIr.r' Itl rI.l , i. n LCR ^r t hit lXii, . r
{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( | ( ) -

rrolrrrll'l. Iieapari.tia acestor poterlia,le reprezintS,indicalii precoce, adesor '.). A nt,ioNroJin miel.opaticdd,in hentatomielic..l) So rttnl,il,rrirr r,lrpirl,
(.lrirr' l)r'(!cliliice,de reinervare. t,r,r r'()rril,riorealeziunilor cIeate prin hemolagiil,iriI.ir,rrrrrrIrIIIrr.ii
l,;'.rl:i. rlr.,,un.{lctor ; lr,) li)*tri
;r) I )11t1cy1)o,ys(r cotngtleld,se caractedzeazE prin: - Existenla unci .etioiogic generator dc }ior.nir,.l,orrrirrlio
(1nurirrrriIilrr;
rrotivil,i,{,ispontane perrnanente a fibrei musculare, cu prezenla de potenfi- I r l,rr,rrrl"(, c1roFi,,T"t, sau la_chesonieriI a,rxrnrirlio vlrscrrlu.iir,lr,.)i
l,lr tlo fiblila!;ie tle scurt5, durati, de slabd, ampliturline qi de frecven!tr I J t.i*ir.iL tiipcctul ate "q;
liip Alan-Duchenno Unililtot..l ga,. Iri Ii r|,rIr.tr,I lrltrrr
.jorr,si-r,,rlir,t'rrrlal,iv sl,abilii,; - Absenla oricS,ruipotenlial de unitate moto- lr' ! rr ( irzal leziunilor cervi-calecu cea mai bogal,r.i, vir,srrrrlrr,r,izrrl,ir,,
r'r,
ric crr rxllziir, conl;ra,c{,ieivoluntare. l,'rrl'osl,(, r'iltii, in cazul leziunilor segmeDtclor1,":S,; (l) $o:r,so|iriziirrrr:
)t\ I)cnart)eree,par,tiald, se caracteizeaz\ prin : - Prezenta in repaus 1,rr,rrr,lir.i..f lit,sc5,,
cu abolirea_mpid5, a i.eflexclorosico-ti,irrlii r,rr,x.,{1rrl,*1r.r(.rl
rlr. plit,rr{i:rle tle fib4lalie sau cle fasciculalie qi atlesea de potenliale ilo rrll)r.iiri.s()nzitivecle tip tlisociat siringornicli.,crr rlislr,zil,irr irrrrrrirrr.rir.ri,
l ilirlr. Ir'rtoti!', - In timpul contmcllei voluntare, se inregistreazl o rri,Ir,rrrliLl,t-r,I .o) ln cazul unci hematoini.lii rrrrilrrl,.r.ir, h,, $. lr,s,rriilzii,rl.
riiliicilrr :r,poton!,iatrelorde unitate ;rrotorie, care pot prezenta uneori chiar lr:rrlcrrlozirrnii,un sindromRrorvn-SCclunrrl ; f) lrr rrrrr.hr
l.irrrrlrrlo lrr,rrrrr,l,o.
rrrrr1rIi I rrrI i rri cvasinormale. In cazuri extreme, un efort deosebit poate de- rrrr,rlirr Nc insta,lcaz[sublezionalun sindrtirr ;lr,r,lr1llrgic, lrrrrrriplogiir Hrr,rr
r,lirrrllr, l,r'irsr:ulsimplu rl,rrrph'si( , h inceput.fJasc,a,poispl,stic g) $r srrlprirrrlrrroriiI'ii,iir,i rr,l,,
(i. .l)i.opsinmusc't d,rd,ofer5, de obicei imagini histopatologice net difr:- I
| | ri :,,s;ulgltlloletrtr ta tnccput, a!oi xantoolr)rnic,ctt pttl,orrrir,l lri;x,rtrllru
lr,rrlirrl,o l'rt,tii dc amiotrofia miogend,: a) Existenla de Ieziuni in insultr, r.rrrrr.,:r, ,.ji rnoderc,ti:i,crcrsterea clcrlcntclor c.lnlirt: (u,1,illirrrlir.ii,zii, r,il."
srrtr itr pliioi, care corespund atingerii fibrelor unei aceleiaqi unit5li moto- r rrolirrrrcltxrzil,).
lii, i vr'ornoce fibrele unii,5,lilor motorii nelezate prezinti aspectenonnrlc I l',.
..lu.iutt,tlii.le-littormctajoasr olo ncuru.;ittitpidruit nIr lln,tt tttr,,
lr) ltilrrrrloiozate sint atrofiate qi inlocuite de lesut fibros sau adipos. 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,iirrrlrr,r
,\.:l.!.:1.:a.AmiotroJiile mielopatice l,r rrrrrlrl'irril;rnrrLOtflascrrccl rrrli lrrlr.stlr, ru 1r)|l.,i_trrLIi;r Irgir,ii, Hi,
Irr,i,rr,;l
l. (:u,ntdere sam,iologicegen,erale: 1) Amiotrofia este de obicei bilal,o- rrl.'rrrt1.rsr1 ;i ptiu contrrxhrlitrli'r.],irrs, r.r:llrllr,irr,rkrsirr,
Iulr|il, prcfrrrrr1l Ir. r
lrrlri, rlrrl rrl cste toldeauna simetrici,. 2) Amiotrofia debuteazi, cel rnai rrr'rIil'i.iili|rrrkr 1ip inllilrrrir,l,or rlirr 1,.(1.11,.
or'l rrlri rfilr.s.rrrixislii,ni rrr,irrrr,r
rrrllscl rlisl,tr,l,tll,t cxamonul electric nc irrdicii totus,i o leziunc mai tlifuzil, rlr. |r.zirrr ro I'rrctlillir.ir,.
Jl) l,)volrr(irr,os1;otlc obicoi progresiv ascondcntl. 4) Irasciculaliile sint do
rlgrrlii lrlt,zrrrttr, dar ele cel ntai adcscll tlcpiiricrsczoncle musculart ilt,ro- I I I " rl tttiolroliilt ntitlolurlIttr t:u.r rrol.tr!i1 [r:rtUl,
li:rt,c.4) li,ofloxoloos1,co-1;ondino:lso sinl; abolitc (eventull rlirrrinut1o) lrr l'\trtrt.tll:.
,,1tttt'tl'd. ttttiolro,lii.rtt,irloptlir,ru uolttlirrlr,lrlit({ iIilrr,l.tr
lt,trl;ctionro . .,\,.
;roIiorrrirrIiI,oIc 6i ln sinr'lrolrmclo tlar.,silt dc rirgttlil
,,r'ccirrtr)t, .r l irrilrr'tl, ll)i'l):
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, ,1. ,.lnt illt"li,r_rl.in lntliluidilt tulttilurll, r.r.r1i1rl.
, ,ltrlrlt,rrJrrIrll
rl,
ilrr lrlplr\ r(f(.11q1H16
ll (irr|,rrr
rt,tr,rrrit,
tlr,l:rlrlrrl|ii,tirttt,r.rrIirtrr,r,lirrr,ttrrl
Irrrtriliir,l.
ll(,0
 { il,i{ulvilo l)t.ofol'( (irr1,r,,g5 ,li ,lI rlrt n,ni),o arrtio_
i l (,ilI lu,arlul{,ii rrlr,scrrlirri
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 drg€tclor. tmina de prcdioalol.); esDensorii
rlrrgr.lr.lor' (r.a,rotlansformi, mina de predicator in r-niniiale ,,marionetX,D)
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 cere-
Irllr,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).
. . .). ,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 $i Olted,nu, 1915) ci,-estl} rorba
rlo o vorita,bilX poliomielitS, (ence{b,lopolioririelitX)pur5, viralil.
:1.
.Am,iotnJin sltinald, iu,fantild, (boala lui Werdnig, EofJ nztnn ) te-
prrzirrlii,,in realitate, una din cele mai fJecr'onteboli genetice'atecopilului
(ittt'irltrn{,ir, dc 1]a 20 000 de na;teri, dup5,Kriiger fi-Franke, 19?4, citali
rh Itrr,rlu,1978).
r,l 'l'ipuL ,racuf' malign (Radu, 19?8)prezint5 urmittoarele caractere:
- I,l'rNlitl,1,u rricesivii nclegati de sox; - At.ingcrea ambelor sexe i -
l)ol)lri;li)rrr,[oprcrnoe (uneoii fetal, dar iri generallntre 3-6 iuni - md,xi
trtrrrr I a,rr)1-.Alioctarea musculaturii oste generalizatii, qi deosebit tlc
r,rrvcrii,I *-llt oarirotcr imlorl,ant al amiotrofiilor din boala lui llierdnig-
Ilolltrrir,rrtrt:stc cointcresaiea,,:i a musculatur.ii par,avertebrale,care cair-
./.ril./.;i{.ilrl,.r'r.:1,
in fa!i, a copilului in pozi{ie qeziridS,,intr-o atitudilc
,,IriuItir, iIrrr:-t''
(ll,rr,du, 1978); - Evoiulia esterapidd (3*4 ani maximum);
r\ l,i|lgrrrrril trLrrsculaturii rospiratOrii determin,i, clispnee permanenti ;i
t cu;ril{,{;iorliafra,gmaticS,,p}eoum Si infeclii intercru'ente i - Aretlexia astc
l,olrtli ;i gonoralizat;, ; - Eipotonia este masiv*, generalizatX, sirnetricit,
(r'tt rurltloplcgie, hipcrlaxitate muscuto-ligameniar[, realizind- ,,p5,purya,
rlrr rit'1ri, dozarticulatS,')- Guibert qi Guibert, L974); - Iievelatoaro
lx)lrl nr rla,$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 ,ritnugchii distali ai membrolor I * Se adaugS,cifoscoliozd,, picinl
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,
ltlirr (lirr,rlrr, 1.1)7t11 (iarrrstxrlp, Ili07) : -- I )rodornin&rrlitr lrr, trrolnl)l'olo
!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 i
l .rrl ,rr,11o slr ; i i lolt b. , l{) ?0 - , - r il, lii iic I il, dr r , ll}ilt ) I l, ) r 'r r lr r ( ir rlr r lr r
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
' 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 |) ( . I r t I I |ir , . , 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.
a .'. 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 ) $o ] ) oillr r , ( , 1
ror rl o l rl i t r t O pogr af ia am iolr uliilur , r 'ar . o sir 1, t , ur r 1, , llr rr ir r r . r , li t r iLr
, rrl ,rrl rrrrr(r 'r spoct iv t acio- sc: r , pular e)qi ir r m usr ullll, r r t it
I r r r I . or I iolli,Sr r plr r r r
, r r oz.olo.,.lic it,pr,r,r'|inc bolii lui \\'ohllarl-Kugclbcl,g-Wrllrirrlrrr., r.rr,o r.:rlir'rrrlil
.r rrrl rl ri u, ( 1ladu, 1978) . Sii, nu se conlundo ir r st l cu hlr r r l, scr pllo lr r , r , r r r r i
, t,r rr | ).l \1 [. ) .
l l . l ,' ot ut cle , , usacial, etde l am iot r oJii m , iclopelic( r u er olu! it / r ir l 1( ir t r
l ' , ri ,i (l rri lr r r r '1,19?4)
r clpr inr lo selie desindr 'ot , t r r ( lir r r r iol, lr licr r r r r ioI r llr lir , r r
. rrlir lr r.rr itltc sirrelroame sau conste)a,!,ii sinrll o rrlr,l,ir,tr :
l . ,\i nd xt r t m el, ed, a B. L. A. I iadu ( 19?8, l{) ?l) ) , ii pr llr z: r sr r gor liihr r .
rl l ol rrui oli, t 't , com ant lil ut ilizar ea t er r ncm ui r lt r , , sir r r lr , or rrrlo H, 1, . , \ . , , '
l ,rn ci rro i ( l dcf inef t c , , cor nplexql sim pt om at io cor r sl, il, r r il,( lil lt , lt iolt . lr lil
rl r,i :rl r' , Ii r,sci cr Lla! , ii$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 :
.:r,) [,' o r nu, Jlencr aLizr . t ld,alasidi, , a S. - iI , . , 4.I ) i19r r oslicr r l r r r r r lr , Lil, , r lo
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
;
llr r r it nr scxr r l t r r ilsculir r . lr ) ! r lr lr l\ r 'r \ ll
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 r ir ( r c 4( }; i {i0 ( lo ll, i' |i( , t
.' 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,
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
lir lr ir r r nlt l, t , r r , t . 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, r r r r t lr lr i! r l cr r llir r uli,
1i r r l) ( r cl, ( , f nli,t llt l
rl rrl ur,l i ,r' or r r lr r ) iziI lloir r , r r r r r , lit
i ziu t il\ lt lllr , l, ( \ it , zil | | I | | (
it ,I | |i | 1,rI |,II lr t r llr r t t , r l, l
{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,. sfinc-
fr.l'irrtrllitrl litu., iir.l'(li\'(1 :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
;i rlisr.r',:i,'
t 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 .
.u,,r)It'orn.ut,Duilorri, rnalignill, Ii .a.pig evolntiyii, &fcctcazil inil,iaI $i r,, rrrrrl rrl, cr r rr , lililr j, c$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
rrlrsiv rrrrrscula,l,uril irrorvati5,cle nucleii motori bulbopontini. Tiebui'o
rni{i:rl..rlili.r't'l!i:r1,1de 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
polioencefalitii infcrioar:i $i, dineirlrelcs, cle o
| |lt r)r'ii(to 1r.ltrleltlc(jlcDlut,l. ? ,, LrI rrri II iI r r I r r ; r r , ir rr r llxr vit r r sr r li ( l h. iigillt csou [ i ( ) ll, ( ] [ lI r , I t ll- , ; i) 11lgll
,r' , r' r r.Li(, ( ) l, r l'. , ll) ( i9r ll) {; : }1. 1) r ur r t ; i colab. , . l9( i0, l9( ; ; t , l{t ( ir '') ; r ) llt r r . r r
. .t.;) I,'orntu TtstudultolI ncuri,tri,cii tle SLA (form6 lui patrihios ) pr(,do_
| ,r| ,,rrrrl Ii I r 'I r r lir r r r r r clcI i, lr r e t r lr r lil, iveI d) L'o) ior nicli[ a lr r t r r r ioir lii, xr r lr r r r . r r lir
r||Iir trr,t''x t l'ctntnin. I' sn caractorjzerzS, priu al-ingereade obiceia gr.rrpc-
i,rl rrrrI i r.[| |Ir,I (. jur.rvrlc dc sciaticu] p-opliteunyLorn,cle scil I icrrl po.-ptiicu r,r' orrir .Iii c) , 4nor r r ir Jiikrjot r cf ir r nii occilit o- c( x'vioiilo 6i lr lo I r r lr ir r r lr r r
' rr
rrlrtr'tr, sir,u:I amhelor, , r | \ r{ ;rl ( l, ( 1,I, l) {l'r r r lor ilo col'! 'icillt ir r a, lt c; g) ) ) ilchir nor r it r gil, rrr.,r , r 'rilllr l
rrr),'sfr {le all')lirea reflexului ,insotindu-se.de crampe _muscularein repa-uJqi h l rrp, rl l rrl i r . ii ( lr r r lilir , ; r i r lo aJlo ct iologii) ; h) Alahnoidit clo <ur r . r 'ir . I r rI r1ir r lr r
achilian, eventual si a celui rotullan.
j l ,' | | | osi cl'ioit ] i, 1i) , \ m iollo: l'il r ] in sclor oz- ain pLici ( linr r r ir ,ir , r r r ioI r . oI iI I r ,
.lt) ll'ipul uaenil de BLA .ear semlalat) apaie snb 30 de ani fi reali- rl , i l \1.:r,lr r i l, r , . i. r r r r r ,( iit , al,do ( iu iber '1,$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,
r,,orrzii,. cu 1trcc,;rde,re amiotro{ii proxirnale pseuclomiopaticc scapulo'_hume-
r.r1'lr.;i/,sau pclvi-lombarq sau-formc scapulo-peronieie 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 ,
iNclsoni5i prensky, l ,r,,rrrrr 11ilr lr : zcn( lr ,u, l1. olset nr t il ( cer cbeloase, t , est jbulit o, r lr vlilii oplillr ,
ll|7:. (.il (i tle.Rutlu, 1978; Cioran. ICZ9). r.arc por diticultiDi diai:
r'|:ir ,r,r',1l&nsflrtetnsa prin prezen{a [asi.iculatiilot,) ",:ca 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
a lrlse,atol E-\IG,; ,.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
rro(l t (,llttol Dlopstc^sr a ovoluIlot.
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
Q. llormu Jarnil,iald,d,eBLA lpare inlr-o proportie tle 1?o/odin totalul ,,r, rr rrr:ulrrlogic ltoatc stuprinde cycltualclo scrnne :lsooiill,rr rrrvrrllllotrrrr
,r'ir,zurikndc SLA (Haberlanalt,1964), atectinclde fapt, tn paii,Iel, celulele
t'r'r.rrrIrri, antcrior, tracturile posterioare, spino-ccrebeloasi 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
,si piiamidale, \. .'r l t l l l 1'l |l l ' ).
{tr''.r li unelc semne ce;rebeloase,de corclon posterior qipiramidald
( lil,rlu, -rrrptrcin(.1
19?8 ; Kurlancl ;i Mulder, 195b; iTaberlandt; 1964 Cibr'an,19riij.
; ,\.,1.:!..1.
il.'Lm iotrofi tla r ad,iculonerritice
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
.1. (lqvn11[py4 semiologice genetale:1) Survin ln or.icrr lil's1,i1,. !) A rr, rrr
{r,rr lrrti),stjii,formd, are etiologie virotici, (virus leni) li in cazul unor sin-
rl'r.r:rrrrrr rlr.-Sl,A.rntilni[e5i .la noi in larii iu ialrloul senriologici]LIcfrror.a r',,rr,,r':rl, urr rlcbut tlistal, mai ales la sxtlcmilil1,rlt, rrl,lrrlrrrrlorilli'r'irrirr.r,
it l',rl,l i lri la,tt*:r,lcsi simetrice(in poliradiculonollil,u;i ;roIilIrrIirrtr|rrrrrrrIrr
J)ot sir :rpilrit fr altc simptorneoarecum asemxnd,toare cu cele din ,,comple-
r.rl, ( lrrir,rn') (fenomene ext_rapiramidnle)tulburd,r.i psihice qi altel6') qi 6aro t,.rlr) r;Lrrrt,sirrrel,t'ice, tlar qi unila,teralc,chia,t'lrcirlizlrlc.,l) l,r.r'zirrlito
, lrrrr lopogllr,ficlit dicular'5,sau troncnl&t,i,,ctt txccp(ilr,polirrirrrrrrplrlirLrr
,i.rrIllr.l in'.xdrrbilc nozologic.dar care,probabil-rcprozintiforme .,sim_
,) li(l irNo(cscrkl tulburlri senz,itivcsubiective$i/ slr,rr olrir,clilrr (,lt lli.r'rr]l
, ' | (' rrrrIi i,:r.' ' (yilot,ir,c Nnu_degeneratit.e) (popoviciu ,Xil?ascn, 19?9i. S_a |,'Irrri1r'||irrradicularii, troncularX, l]rultinovriticir, $i]u l)0liltovrili(,ii. ) it,I
{ r'r|$Ii11ir,1; crr,plcvrr,lon{:r, SLA este de 100 de ori mai marc in insulele Guam rrr ,r1i'lirrlc (Lilninualeasau ab0liroa reflexr:lorosltrr-t,crrrlirrotulrr. i) Nlrrr
rri l rlu,,rlrlci[ in oricc altir,regiune a lumii (Iieed qi colab.,1966),o frecvenl,i,
, lrr,rr,,ii, o croluiio favorrr,bili,,regresivS,cu cxccpljr ]x)ljl{rvt.ilr'lur'(['rlr
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 rr,rrtoIrirLiiIor') geleticc tamilialc cronico..9) So a,socil,zfl o li,l), rlrr lr,;irrlir,
, l.rrrr. ;i lipir.ir.!.|)Ilareori s0 insolescde fascicuLt(,ii. l0) Aplorr,;rrr I rrI,rIrrrrrrrrrr,
\ rIir|r..||rirIlll(.r'u Fr lt,lco cyolufie mai leriti, semnelepiramiilale precedintl
, |' ,1rr;rI r'i rrr scrrsibilit*tca la, prcsiunoa rnil,solor' trnrscrrlarrr;i lr, Ir.rlrrrIrirtlrIuI,
lrrr cr'lo lrrrlllilrr. rL,r'ror,s(,,11) illulbur:irilcsfinctclicnc rlc ol.liceilipsosc(crr (!)irx!ptii[]1irl
, ,..\\..lIlt\li& ]nusculard,progresitd,Aran-.Duchenne,prccum fi Tsoralizin rIl,rrrrrrrrLrl radicnlarelombo-sact,a1n, inclusiv ir,lcoozii (lo tflll). l:J) ,l,rrllrrr
4trllurrl.TtrytqresiM, DucltctLne se p_arecd,nu reprezintii 6ntit;!i aiisiincte, ci r,rrrlr,vlr sorrrol,rlrii, $ocrotrlI.iiqi tloficc sinl; ft(!(rvcni,r) iii iltlx)t.l,tutl(f.
r,ii,, rrrrr,,jolil,a-tctr, acestora, in realitate roprezintd, forme al,ipice dc S.L.A.
( llurlrr, 1971J). li. .l t'ioNfoJ ii.lc ru,tl,icttla,rc so pot rcounon$to prirr rrrrrril,lo:r,r.rrLr r11s1q,'
l) l, r',,sctriologico: J.):\rniotrof:il,csl,o1lrc(locoqi rrkrc1,ivii,, ll,ingir)(lrlr,.lr.lril
't
hbrm.aLa
t,utr atipice u,e
,uLault.plue d,eDr_1t
B-t-4 (_(Irinuu,
(Raclu, 1978 ; Cioran, 19/U)
-ryi6;Utofan, 19?9) OSte
este tmpor.tani
important
Hll,,lio locrrrLoscutcin plactica rreurblogici: - foima mo:roparetici, (cu I'rrtirlrzir,{i. !) Iripsos(jc{)[t]:aoliil(]la,scicullrrcq,i librilrr,rrr.lt) AiriHlirrrlrr,
rlrrlrrrl,
rlrrlrrrl,.lr runrl rurtrl.dindin membre,
membre, de cleobicei
obicei dlstat;'membru lnr'rl,/rrilr lll,tirliziifl:tsccllltr gntpolor.llusa lal() (inclr,:llrrrlir trrxlxrcl ir rrll
('l ; - forma
forma ptraplegice
pariplegici, (tot
(iot r',rrIrrcirri), cllro irnllrnril, o loDoJ{r'lli()spociu,lii,,r,rldicLrLllri,", rIrr,I,or.iIii, lirlr-
cu| (l 0 lr { , (rlisl;nl,cvcntual intii
rlolrrr{, la un singur infirior); a foima lrrlrri lii, lirlrrrrr lftlii.oitrir,(lit, r'ilnnlli lir rnili rrrul{,irrrtrqrrlri ;,i crl, Iirr'rr,r,rr
; rlcrr l rrrriopa,l,ioil(rolatati, $i a,nterior)I - forma cu debut brusc; _ forma rrrrtrllricsl,rrinrrrt'a,l; rlo rnl,i lnlrlt{r rrjrlii,oitrj. 4) I rlkrxolrr(,$lnlo.in}ItlilttltHr
|I| l Nrlt(.Il:r1,ii mu$culare la rlebut; - forma miaSteniformi, dC debUt,
(ctr
i t l rr,llirri(,iiu
,r r,rrl;rrltir (| i l rri t Irri l 1,() sllu i )olito pcrrrrii;tliagrrosl,it,rrl tlo Lrcrrlizrr,r.l rr,
ull;orioari de fasciculatii Ei dc amiotrofii; - founa cu tulburtiri
ptilrir,o l{, dobut (confuzionalc, dr:melr!,i incipicltii)1 irlrrrlillii nrrlirrtlirrrr,fr) firr srrr'Ir'irrrlrr o ltilrocxr,illrbililillogillvrrrrilil r1r
incipielti) ; - forrna
forma cu sonlno
somno Irr,trrrIicr'l,. li) Il lrr,zrrlrr,lrcl,r'irii
ux l,rllliliuuit.lulo. i r[ r'ilr]iir,irri|o|'poslrrlioirrrr,
,,r l,ullrrrrjl,rilrr rlr
rtr,trtti Iri Ii 1rr,I rr t'iNlitrtrlr,tii,olirll, Jrosilrilili{i irr pltu rlr lor.tr,liztrro: lt) 'l'ltllnt.
2.. It'tn.oortyti,ida amiol,ro.fii,neuro{lcn.a(<n i,ablout'i t r S.T:.A.) pot sir,
t'rttilrrsrt rzil,ivoslll)i{rrli\{rr'('l,lizcllzii {,tizcl(!rl(! ritrlirtrli gii, r,rr,r'rt,olr,r'llrr
Jrl)il,r'ir,
ln sonilil,:r,l,o,irr ncoplir,ziirnrligrru ryiirr rnickrp:r,tiiloisrdrcrrrigoilil,tlrr,
lTrJ). Il itt t,irt lrrtr(rt, it|r'hlot'it,r Irt'jrt i.rir('r,llIrt'r'rr
Iot' tltr o,illr\ Iot {r rr,r,lr,l$ r'tr,ttr
r r t r l f r , t r l l l z fi 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
l(i'l
a0$

,rirrl,r'il, lrzir,l,(1,
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(fxit-
crtlrrrrzr'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,olcvirale, 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 acest€ia 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 vaso-
rrroiolii 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, $i durere la presiunea maselol
rrrrI sr,rl Iirrrr11il, trunchiurilor nenroase.
rl) ltollcxolc locale sint abolite.
o) ll,ogr'oiiiunea,qi vindecarea sint posibile, cu restaurare muscularii.
l. lllor)tL(l,ascntiol.oclicedi.feren!'iatetn J unclie d,e natllro leziunii:
it,) lli.tulnn,t.r,l.tfu secliune aompletd: - Amiotrofia este precoce, pro-
glr.sivii,i1ilirir,t'h:cxplimati, pe tnuqchii paraliz^\i ) - Asist[m la o paralizio
rurrrr;r|rrLr'i, crr hipo- sir,tratonio; -lieflexele osteo-tendinoasesint abolite;
li,rrl'lrrrrrlirlio-rnusculareste. de asemenea,abolit I - Nu sint tulbur5,ri
rir,rrz ilir ll lrrrlrioctivo,nici alureri Ia presiunea maselor musculare , i a trun-
r'lrirrli|rl rroLv()rs{i
slrb niyelul seclidnii; - Se constati, a,nesiiezie superf!
r,irrlir gbbr li, I - 'I'ulbur'5,ri1e vasomotorii sint putin exprimate ; - So
lrr rul,rr,l,i,I ). Ii. l)iasivl.
It) Sinrlrom,ul,tle iritalia: - Amiotrofia este de asemenea precoce,
.r'rrprirlri I Asistim do:lr la o parezi,, cu conservareatonusului muscular;
lirrllrrxrrloostco-tendinoase$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 impor-
lrurlr: tkr pirrlii, ostcoarticllare qi ale Janerelor.
11 r\inlxntuL da compresittne:* Amiotrofitu estc tardivri $i mai
prr{irrirrlrrrrsi,;- |)rr,r'illizil, poal,oii c(,rlrplol,il, tl*r tolusul rnuscularosto
tr,litl,iv ('r)llr.rolv|,t,1 '-.ll,ofkrxclo ostft)-1,(irxlirIor,so qi cttltttLill.osint clirrLi-
rrr,lo rir,u l,lxrlitoI - Liol'lc.r-rrI irlio-tttttscttlarc$li(J(1t)tIs(tt virL; - 'l]rtllrrr-
tiililo solrzil,ivo strlriccl,ivo Asislir,ttr
silrl,r'rt,t'itr,bikr
I lrt tt yrr,r'itbiLi,
ltipttttrsl'ozitr
(rrilirr rlrr,lri rrrrrrsl,rrzirr) Iilrii,i'rrlJrrrliiljtlo sottsilrilil,lr,l.l
li l)rtir irlilrf,,ir,, lrlrr-
l0$
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
I r , ir r : Allr lil, ilt r lo r lir r ot , i Hjr or r l, lr r r rirr. r r , ili
t r lr t t r lr r i, . i t k. r ir r lr . r 'i
:,,l ll. r r vir r . r t li.lr lir r 1rrr ,r ii rr rrt .rr .Hirr t l, r . r . {.lrr tl
| | | | | |l(,f;rI|1,.:l ] ll. ,l,I]ll|r r t
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.
| |r| | , || . | | | r| | | ir l lUl 'l lcll; - lxr lili. r ir r 1r _r , r r r t ir r l
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
i lr r r t r r lr lr
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 ,
1rrr rrrrrr,l I i kI t . t r k: r lt it , i.
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 .
| ,r, 1, i1il
' '|, Ir,r 'ii r t ilil': r _t i) sr '1. , i, . i)
bt; \ r r r iut r , , f iilr i"jl1l, I ri |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
, t i i . rr,;o ciilzii t : u t ulbuliili senzit ivo
lr r r . ii, r r r liij
l rrl l rIfri ti v r l; or r r ot olii, scc] . ct o] . iisi t r uf ict ;
r luf icot iyo f i ol) i{yr 1, i\ , ot lir l: r hr , 'r , r i
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 ri rr{' ..lr llllllr , loglcoe1'1. ) ,in f unclic ;i r lLo b, r l r r , . 1|'r r ||r r r |I iI i , t r , , , , ,
l|r
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 ,
I lt t r ir , r r lr t l r r r lr ir r soliI r r . , r r l
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
, r ,r,' tr' tc n I ( locan Pr . i, l. r r r , . lr r l
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 :
' l rrr, r' r (:l rl csr , t ri'ulgulanlr
, ) , hi1r 9- sl, r r r ur ciit t izict up( r r , liciir ljlglr lr r lir , r r r 1r or . .
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
,,,, 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( !
; , t r llr r . r , , , ,
l i it r r lr r r ir lr , ,
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 $t iBir r r r i h, i, lir r r r ( l uir , , r ii l
:( t'/
(l(\ I'il) rrr(riliiv,{lIl)ii (iulI riofirlrr ,' rill(llrziifi iirflr{r sIrorl li0(!; l)) ,,\rri{,lnr)lii! ' ' .l l ro t iilr : r t t r t : t t : ulut tr lit t lt '. , it r nilt I t t 'Nlt tt tt lr ( l( ' ( plt t 'it r llr lr r )illl HllHlr ilr t l'
Ilrrrzirrli'i, o rrllii 1,o1xrgr.llio rlislirli, irr ilcrrtrlirlsirrrctlicii,;r,) I)cbrL.[orzir, la, ,,,,,rr,' ,i ,,* ' t i( ii, r r lr , l lr i r , lr r lr ol' I i t t t r r "'ti t t r r l'r r tl: t t t 1. r r . 1ipr r l' sii' lt t t lr t lt t r t t
rrrrrrrrI rrrrltr irrlirrioltril,lczirrtl irritlelr,urrlrtllr,t.ior.si trrctrrlrrelc ( llil'clr kr vr l1) ] il'
sulcr.ioilr.o; , ,,,, i , r,' 1,rr ',ti r | , , r'IrI t i r,I rIIt t I r ( I \ 'ir I illI ir i ll{r h( l lHolr ' lll lil ;
', r lr i
rl) l)rrlililrrl rriol,ol uvoluclr,zit, ' lt l?l) ir r . sr r it r s'r l'lr s'. 'i ( it r r r r r lr l lt lt t lt t lor : t 'l)
in ltat':r,lclfi propol,liorlal cu aniol,rofiu; ,rl ,rl r rl i r Allct r i 6i lir l, r '2, 1i ( ] r ilr r r r
.) l,lr isl,ii,o slrc.o$iullo oronologicii, de dispozifictopograficil a mriotrolioi, 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
rlrrlrii r,'rrr u notzii: l,:l nrelnbrcle inferioarc: pcronierii, cxtensorii degc- trrrrr, l 1l {i l l cil, r r I i t lo Als( ] lr i r ii l] ol, r '2, lll?l) Nlr r i t t t r t ll, Alil( r r r i f i lkt ln'z
t r t r ll,t t t r r i llt r cvclr t t ' t t t : r i r r t r r t i sr r t t lt r ; r 'tt il lt t
lirlor',glrr,rnbiurul a,ntclior, muqchii moletului, apoi, mai tliscret qi tardiv, i ,,,,i t ,,l t l rlii'l'r r l,r ili,lllt 'olliilo ;i
: t 't r r r 't r r lr t 'l
cvrr,rllitrpsul (mai ales vastul in1,er.n),ceea cr: realizeazi, amiotrofia .,irr 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)
, , | | , ,,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 I t tlll'( l
.irrliirrli,)'a lLri Clarcot, cu ,,picior de coco;', sau in ,,labe dc barzX". l.,a ir t lr lt . r r liilo l{r zilllr i l'lllr lor lr lr \ r ir t '
rrrcrrrlrlclosupcrioare (dupX aploximativ 2-b ani rle evolutie) amiotrofia 1.,f r| r, l rrrlilir tioo t t t lii ir r t lxr t 'llt t r l, |: lllill
( 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
rr,1,i1rs1) suri{lcsiy:muqchii mici ai miinii (intcrosogii,apoi muqchii tenarieni 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 r r I t '. iriII I i1ii r r lr r r
li lrilx',1,orrl,rieni), rcaliziml amioirofia aietip Aran,Duchcnne, iar m&i tir_ i ,,r," l ,i i i ' trt 'r r r ilit t 'giit cir nsr t t r hr . ', i'slo it t t lc's. lr i r [ ( o lilr Hii'r l( \ r t l'r
zirr, rnrrschiia,nljcbtalrui (extcnsorii, apoi flexorii). pronatorii si scurtul l , rr' ,,:r, rrr r ur lr t 'r r lt r ipualil, ic $i at lof iilt ''r.'r l'ii'
rrr1rirrlIoI'sint pu1,inafectali (sau de]oc); f) Amiotrofia respccti, urmitorii
rrrrrs<lri : atlrluctorii coapselot', mugchii centurii peiviene, lungul supina-
lor,.rrrrrschii brafului, muqchii centur.ii scapulare, muqchii trunchiului,
rri giirrlui qi ai fel,ei; g) Amiotlofia se insotefte cle fascicula,tii(lu totrlea-
rrrrrr) 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
lr) 1l'rrJburir;r'ile yasomotorii sint importante (eritrocitozi,, rd.cirea extremi-
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, mani-
lr'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) Amiotro-
Iiilr 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 \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
,,Irl IrrrrIr," frr ! jI r '1, i{r r t t ( jll ollvil, illoi! l) ll( lilli[ .

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) '

A III
9. 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 sensi-
l)ilil,il,tiolducrtale sint intacte. / i,/. .rr. 'touograria
lcziunilorcare taclil0 ((lrrl,hltisfr' lrrl'11.
".;Jroii,:lriYt"rttt"
r\ccstcl, apar in leziu,nileyasculare
l(,rnrc),lntrrorale,- traumaticc.etc., _(homoragii,ramolismente,hema_ 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 r" rt r' r"
lobului larietal qi ate g'lrusuiui ',,,,
,,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'
.4rlr rczirno r,rdkr; .rrr '- rn/r""'
rrrr;l.rrrnu,r'gin:r1 -ale_
(ariatactognozicia,lui ;' L."i,'lLrr.!,oN',;/i"e,
' i l i l ; L r1
Brncrin,r Jjno/icp(ri -
lhermittd: cimlurie Z qi iO firoa_ f:'&:il':"1#.,i','jl.'
rrrtlrr).
l,) .,lsl(rmgnazia bilateralti poal,c fi roN,lizltlii ltt ittl,t tt lt'zittttrr :t .trrttr
.. .!l.l,l. I)iagnosticnl tle agnozic taetiti !i al iliverselor sale formo t, r, r l cnrl rr ': t lc st ingi.
r.lirricoso
fl.].llilg!!" printr-o irpJorare-semioiugiciiriguroasd,: a) Se stu_
rli:rzi sursihilil,il1;ile. ck)mcntare (superficiale
r',',:rt.l
hilu4.,t,,:i,r, irrlir.ri..idflrlilicarcr _;i.-profuiile) ; b) Si;"pi;_ ti) ll ulostercoagn ozia (Ilalpern, 1945, citat tto I(tlritr(ll{n', lll?7)(l(rtrrllri
mfllpriei din r.areeslo folrnrl obieibul 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 , '
{ l||., ||r iU(', rtr.lrt(,srtrrt stU rcziSfoni. leled S:ru rugos ctl.,.; JCmn,fier, ,1,,r' rI i tr rc nlit at e.
Irrr'lir.,rirrlii. sti|l'i or..) .\i mor.togozitt {fol.m,L diminsjunilo oUi.cLif
$i rii I
.) r\r. r'r1rfor.cu,zi tttpognoz.ia(se o excit;tie cutanati, Si iridit-idili
I.rrlrrrir' *i i irrrlico sediul cu ind€xul);-face- d) Se'exploreaze
disc ,mlniiii
luclili.: a) i''rr;.111i1.i1; bolnar.ulsX,facfl detmnirea etictd a obieatuizt; prtieitl VIZUAI,I,]
9.2. AGNOZIILU
jrr t|rorl (,() tl)iu.|,l;iv,cu ambele miini.
(l rrshl u in pier der ca posibilit il, t ii t lc r t t ct t r t r t it lit r lt t il ( ) l) illt iln\ lot r 'll
!1.1,!. l,r.olrlcrro de diagnostie clinic: i r;rrl rrl rrlvct lcr ii, t le; i llolr r avr r l nt t it r t t t t it li o r nuliI icr t t 't r r r vit lt r t r l'jit lr '! lzilivr t -
rr'rzolirli,, irlr liacull,Ifito sa,lomirl,a,lo sittl; contlcrv:lt,tr' I\rt, fi rlr, tttrti tttttllrt
t!u!.j,l,e
prin^o:e a,)Agnozia,d.eintensitatel,(ah,i,Iognozia: l rl rr| i :
..... r't(,rncntaresinl iintaclc fi tolu$i sutriectul
!1,,,,1t/,'!,i,iil!
't.rI r|||||r:I(r|(' )
iiicalabil
r,r'rrr,r''rr.rrrr,:IIr'in 1ra)puronrrfcrir din cat,C eslo for"ma "r1e l. A1;rrozia vizunl"r U)ntru obittcttt txrt'esputl(lo (xr(iil,i,t'iil)$ilritrri rr lrri
t Obie;td: 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
ttt t ttnt'.t",,'tt t, lc nsittte',(a norlogno:ia : dcsi 1111
6,"1a,;
l rdbwiri
1 obiecj )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 : it ,t t llt t i olr it r t r l lr t t t t r r l,
livrr rl. s.rrsilrilil:rlo, subiectul este incapabil sL rccunoasc?iform:l qi iii_ ', |
Irrrrtl l rr,rl i s lilt t l, it ',illl Nnlln'( ! lt ( lilzt 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\
t lolt
rrrr,rrrirrrrifrr
olriocl,nl ui (!,ig. 32). 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
I i lt lt r st 'lr cor t, Irr'
:J) .Agnoti.itt:t.uctilesectmdare
rIrli .(asinbotia tactili )- In aces[e c&zull, i rrl , r,r.r' l r, 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,
to il, t t l, t r l, r ollzii, lllllli ol) i( , t 'l
qi )rilog'ozia sin[ inl,aclc, bo]nav.l nu.ccu.oaqto obiec- 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, ct t lt llr r lt r r yi t , ll'r r
'rin'log.ozi*
Irrl. l,)'l,rr
. Irrlllrllrrr do rtrcrrnoa6tcrc a semnitioalricisirnlxrlic. a, obirrrt,uhri 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 '.
(vt't,i .1i11.:ll! ).
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,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 r , lir r lr i,t t r t t lil'ir r t 1, t l
2?t)
'.','ll
 rhr li1q11y vizutrl ;i rlc rrrrrll,o iIii,Ii|or,i rrI r,Irrr:t rrIrIr,
Iliclt r) rlii(l(llt) ll, rIIr1rIrrl , '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, :tl r ' t t t r I r' r rt i t t : r r r
', r r
1li Ir.irrr
llcr, ll)'/7). 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
lfrl)\!t) (11)71)i[ (]cs(1lis utno::i.n,
tiztr.uliiuptrt:t'1tli.r:ii.,
irr r.trt: r.ltprrli 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
lrrl.rr rl. rlisclirrrirlrlca, obit:rl'rrlrrir:s1opistiliil,ii,dai' ccl, tlc rcr:ulolriiclo 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
r.rl. lrrllru|rr,1i.irr lrlto citzrrl'i,s0 tnarrifes'tr:io,falid,t.r:t:ttttoalf,r:rc
a abiic'rtlu', 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'rr..r |r'la,|rrrr,zi.
lrulnlrvul ilvinrl o olrecarc irLrudiredc liolmii cu obiffhti 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 q ii|,lril (1tlt'lrg^noziir,optir::i a lui r.on n'Iayendorf). S&u, ctaci obiectrd a 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 ,
l.rl rr'(ittr1r)scrrl,, rirunelos[u este ulteriol' aplicat ;i la a,ll,eobiccte, fo:r.t,to , 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
rlili'r'ilt (,,iirloxicai;io pt,in obiect),). Ei po1 si, nu rnai rocunoasci r.rjci 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 r tr r tr r l l , r
, rl.rilr.. (,t4t,,,:it ). Stu diferoxl,,le dr. r.ulor.i.irrl 1ic,,ceI,rrlr,, 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
.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 ) . , ) 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,l\ i$l,r"r,
\\i o, ccail,(dacorti.cctldpenl,nt culori, calacterizat5 prin frptul .l,r p ; r i c r r , Itr r Itti L t ttItIi , tl csi ti r :L r tttl l l j l tr 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
lri l,rlrl o crrlor,ilo sint virzute cenu$iu. Existil ,li o hem,iagttrnie yteittru 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 ,
,'rrlr,rri((llonning ;i colaLr.,1966, cit:tli de l{reindlcr, l9??J. , , 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
. 9. lguozia pcnlru. imagirri poa1,es5, existe in mod izolat. ,lstfel, , , 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 ,.
Irolrr:r,r
rrl recnnoafte obicctele co:rcrcte,dar nu recnnoaqteaceleaqiobiectri 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
|)
lrllzlrrllri,c_in irnagini. Aceasti formi, de agtlozie se poal,e in\rcstiga pr{) , 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
zr,rrlirrl. ]rolnarru-lyi imgsini- harsruate cu linii sau im;gini la tabfrtofoolr 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
r,i rrrliciiintlu-1 sii, ls identriflce. ''' ', - i r l r , l tt"tti n l 'r ,t4 tI,;i t .

il. ,trgnozia vizuali asocialivi sc ca,racte.rizezi, plin imposibilit&telt, i , " , \ r pr o zi i l e l i zu a l {) alo s!tn b o l u l i l ttr r l r a Ii ctr :
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 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 ''
:r I irlcrri;ifior,prin alte ,,canalo". Diferen(a dintro agnoziavizuali, apercep- ,
', r r r r , r : r r l o ttttt:l e r tl n 'czo n 1 i l 'i 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 '
li\ ir, iri t(':t u,sociaivrj, consl,i in faptul ci, in aceastiadin ur.inii, p e,rcep_t"ia
' , 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 '
lrr|rrrr.i.si 1l co-nformn:ticisint nomlale (Rro.$'n, 19?2; Nreindlei, tO-t?).. 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
.\r';rrrizirr, r.izu:rli, asoci:rtiv5,ar fi ut.t fel de ,,asimbolie,,r.jzualii. 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 ,
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 . l l ) ) . l l r r l r r :r r ttl ' i '
.1. ,tlynozia viru:rli spaliali cuprinde o bog;.tie c1e manifestiri: 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 r r r r :r 'l '
rr) .l r1ttrt;i4,t:izu.akirlelocnlizarelcnoitater,pcntru spl.lqiu)const[ in incapaci- '
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 ( '"
lrrir.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 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 ) r r ':r l r .,:r .' r r r r r
r'lr"ri olrir.r,ltlolalil de obserr-ator. Dlcd, tle excnptu, su soticit; bohavul , , '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
'.r ,,r:'rr'lr'zl rlijlo' ul rrnei linii drgptc. cl rr grn.i.
'r t 't r l , , l i ii 'i r r r l l o l r 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 ,,)
l' ) .ltlttrrirt,tlitu,uldsteteoscopdcd, foalte lari, constEin inposibilitate* 1, r r l r z k r 1 ) i l i l r i |i L 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 :r {r 'l r l r r
rlc:r Iirit urosimea ulti ol:icct tridimensi onat. ,,,,t(..
r ) ..111n.o::iile ttzuale topogra,;f,icc,strlius legatc de tull:urilile prece_ 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 i ".tr tl , :ti l ttl l ttta 'r r r ttl l tl l tt t | | ttttl l
rl, rrlr., r,orrslrr,n in inca,pacitateacle a se orienta in spatiul erterior, de 1I , , ' 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
, 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 'l l
rll rlrjc si (l{) l,-Ei leprezenta tlrurnul pc care trebuie s[-l uruezc. Acc$ti
''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
lrrrlrrrrri ir,i rl<rr'l.c<lrum*l ghidindu-sc, r1epildi, clup[ afiqr:iede pe ziduli, , 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 tl l ctl l r i l l i l r ' .t ttr
rlLrlr:ir illirrr elc. Ei se lltlicesc adeseain oraf, sau in propria 1or locuin!:io , . i r 'l i 1rc l r r ,r 'r , l r , r 'i l r '1 1 r '. l ) i ' i i tt'l l tl r l ( 'i l ' tl tr l i i Ii r l l tr ,l r r ttr o l r i l l i , ' l
r tr r
irrl irr rlrilirl grclesc salonul $i nu Di gi,sescpatnt. r l)( | r 'r '|l ) r tti l i tr tt r tl l ' r tl r i l r I tl i tt i tttl tl i l tl l t l r t r r '. i i r t i l rl l l l l :r l c r l r r i :r l ':r r l
', r
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
rl,i O lrrrrnir, ," aqno:ie,i spa:lialc cstt: r'eprezentatir, d.e agto:[a ai;tLo-
r r r r r r r r Ir r tr tI l i 'tr r l ttl cl r : l t,r l tr tt'ttl tttt .i l r r t:tl r r tl Il tl l tr l l t' i tr tttr r l l t'r l tl r r l .r t
:,1trrlinlii,trruc I cltt'czintr'i,ti l;ulbruaro [ ,,concetptla,liziirii),r'cla_tiilorirr 1,r,rr
t,rr\rr,:t, 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 l r l Itr {i r 'i l r ctr l Itt Ir r l r r " 'r r r
rlrrr{irrllxlnr,cor'1)ol'll, ()lrcl,cLizali,in diiicrrlta,ireil (lc a, asambl0,o sei.i(} lrllrilllrlir
,lrlrlttl r r r t:l 1 i tr i Ir ) | r 'i r r {' l r tr l l ) tr l l l l l l tr ' ,.\t'tl l tt l t l l tr ItIt|:r , '
rlr rrr ril,rilirrrrirlirrrtrrrsion:rlc, lrsllil irrcit s.i,lonnozo ,,1iguri,'sl_r,u ,,r]lo{lltlo), , ', 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
lrirlitrtlrtrirrtrtlo ((Iilclrlrl', 11)5;1, r'il,1l;ilg .li1i'ilrllqr', lt]?7). (invitul,rrlr, , , 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 l r r 'l tl ' l r ;l i l r 'l l l l l l
:r,irrozirri r izrrosplr,l irrlo I'slr, rlili lili. i\sl,lrrlrirr rrrrr,lct,lrzrrr.i,
Irrrlrr:rvlisrr r, 1r ,,l r r l rr' (' ? , r| l l r | ri l l l t l rl l I ltll,l lll | ' . I | | | ) I | | | r ) | I,, | ' rl l t ilIlll ,ll Ill o l l l l r,

lrlrtt;1 rlo :r.t tlt'Irtlrlttl 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 ;'r r r r i rrrrl r, rt j r' , . ri r' ,:r il:r | rr r( rr , ' l ' r, I lLll
' : rl ,
r , r' I t I r' r' . L rrl rr. l )r' r' : l l r' lll 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 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
rl i tt trort l l , rrrl tl tl l r "ii,r t gr t oziill ollico 11r 'ot r r r , I r 'irir. ir
,,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 , r rr i gr , r r r r ir lc r lr r lczir r r r i llillr lr , r 'lr ll
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 ). 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 ,plrl llr ^: r ,pollr , r r
, 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 ,,.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
. 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 , 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.r'o ri r 'rr .rllr. 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
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
.. rir I irlr-rrlrrl r.c(\tcin, ci la rnijlocul ei, sau manevreazn eulitu.l in l i gara
failurle
{rr.t)llr't{irtc l')(.Ll[ in c{u'e trebui si taie o bucatx cle caine (Kr€indler,
t|)? ? ) .

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 t t,t i r. (hrrs pr)ndc l c topogratl ec al e
ri I 1ri1r.iic,sit audil oyentual zgomotul pe car-e-l prodllce un obiect,
sau x gn{ )z i i l or \i z ui l e :
.:i I rr.rir'rlsr..J)ifr.rcrrtadintre cecitatea
lsihici, qi-cea corticalX rezidn l; ,, 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
l:rl)llll rl rr Irnmir,^:el,il.rdo drra.rreprczentarea(imagioca) I izualii , .' i .r . l : , . . l" ^ li\,', . i r. ' -
,, a , , ( rri a l 8 s 1 n . . i i' . , l l . i c d l o rn d )j lfl
r,|)r'a||.Ir,|. I'r' clLd rn crcilrtea COrlicall, se pierde comple1211p61,s ,,, I 'r
. 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
61j6,6 ' ' ' ,r :i de ii t.grm. lormrlor ii a .d..il.r!,
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;; ,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 \
rrrci lizir.rnonriirlo lirjrb:lt sau de lerleie, dc om tind,r sai l,i,tritl etc. Uneoil r..r
, r' rrozii sllllialc unilateralc,, in vleme cc l eziutrikr cr rrjsli,rti sl rrrjl r
rrr,;i lir.r {,rr.r j/,l
.r'ir.rrrrl,r1lu.ici 1r.opria sa fa_tiiin oglindi,. Unii bolnavi prezinif , ,r pli'r,ii,tkrrtl a,gnozie pentlu culoli.
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?). e.3.A(iNOZIILE
lut)tTtvt,)
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 ( lrrprirrd urrnii,toarele formc clilicc ;
r,r,izrrr.ii si alc. regiunii_paracalcarine stingi (cuprinzina intreg
.r,irlr.arino
( rrr(l.rrrl) pr,rluc :r,grrozii 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
bilatcrale. Adeseaeste volba rle l6ziuni simetricl
:rl. rrrrrlril.r l'1ri occipitali (fig. t,31. T,hermitte a subdivizat aceast5zo;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
irr rlorrri rrgirrni : una clestinatilformelor qi culorilor (aria 19) Si alta. mai 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
rr,rrI,'r'i,rrrlii, rlcst,jnilhiicleserului,litelalor, cifrelor. Tulburi,rile'dg 61i.r6rr,. ,1,:fl' rri r,(i r
)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 .
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, 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 .
18), e{ingind si mlirile fascjcule dc 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 .
:rrrocirriirr. 'l'lll)uliu'ile memolioi ton,rgllficc depin,l insi, de obicei, do i ,rrr)l ri nl i ( 'u sur dil, r Lt cit t ( r . l) lt , lr i.
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- ::. 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
/i,r'rrlrlrr'l,1.Nl'i r,ru.'rlr,It,r. (11)04,citai; dc triirrin.llcr,l!,)i?) a arittat.iJ .
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 , ;
ir,li|,i )]/iiilrf,riz,flirl(r.sirrl;^l)rrrlrrso rlo rlrrconectarca,iilor sonzolirlieroo{rl)1oirr(! 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
rlrrrrliilo I i rrrIrrr,j rrI rr i . In lrirclr'sl,i,
v izirrno, l,{rroziiJrr riplico so a,drni6 rlil si1l, -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
lttrrrlrro lrlirr lczirrrriIri III I rrr';rI rr. lr,lrrpilt,ilor, lr:lzl,lririlc lo btrlrri riccillil,a,l, ;
,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 , ,
l,/r'zitrrtil('silltirl{\ trririitl)rt)il'l,rtrlrr lolrll lrriliclrrlilt'Ilrrrlrtcc sirrrlrlorrriptr,. 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 .
tItrtrtitrotri, olrlir,rrsllr{,irr,lrr, irr ir.r,rrrrrcrr lirzirrtrilculr,i Ir1rr,o1rirr,ii,
,lrr lrilrll

:n4 it'10
 il. Srrnlil.rrl.olvrtthrrlirsirrr rllrr)lil r,orl)llit Illt.ri, .L'rlr,(x)
ltt,rl,o rlirr , 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 ttttt-
rtlirzirt,\{rrrtttioko(ttttrlt vlt li rlirs<,r'isli- y(izi Olp. 10). l 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,rlzirntilog(llr(flitl,oar'(i
rlc irgrrozii u,LLrlil,ivc
sint colticr,lc, cu loc:r,lizlu(r lrrp;i l ftcr l l ti r 'l i l j ( 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
irr 1ror'{irrrrrrrl, a plirnoi cilcurnvolutii tcmporale qi a cclci de
lxrst,rrlioa,r'il , 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 rlorrr, r,ir\rlltrr\'olu1,ii
lorr)poralc a cmisferei doninu,nto (Nielsen, 1962), ,
'r '
, 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 '
rlcri rrrrii slrsl,incai loziunilo gcncratoare de agnozii auditive sint bilateralo 1, 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 , t'r tl r t i ttt
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.
| , i t i lr t l( 1( 't 'olou: n, ir : i st t it 'l'li,ilr ct t t isit r t it 't lt t lr lt lr r
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 ,
-Fi9, 31. Topografia lcziunilor care antreneaztr 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
c g n o T i 3a u d i i v ; :
,.lI: pljcile de tr€c.r€ tcmporo-nrsulare ald circunvoluliel 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,
,). iemporale tnnsvcls. a luj Heschl (zoDa slJdtllii corricale 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
aldio-senzoriale);,,itI:zona urn.zi.i;,4?7I-zona suditeJli
vcrbale (drpi ltsa/, 1052). ,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 ' ' )
t,r, l rrrtr0;i oxist cl! a ulr or spcoiiilizir r i din or r t isf t lr irill'( , r lll) lii,ill 'it t lt , gt lt lt r t
,r,,,r' I rlrl(tso vizuospzr,fiale.

$.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 exis-
Irrrr{,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 bol-
rrr,vii crr lrt:rrriplogiesting5,,manifestindu-se la nivelul acest'uihemicorp
Ii rrr lrrlrrcl,clizoilz[ prin citeva si,nrytomecard,aterfut;iae : a) Nerecunoaqterea
1rorlo o parte a tulburXrii morbido, a paraliziei (anozognoai'e
rrirr|r'rrrrrLir.ii,
rrrrgirrrllii, r,r'i,epirralizat I b) nerecunoaftereahemicorpului stilg sau a
llrlli H(lg)rl(!nl, rl hemicorpului (asomatognozie propriu-zisd,) r' c) uneoli
irslo vorlrl tlo o cornpletii indifcren!5 fa!5, de acest' hemico4r, pe care il
c[ liirrrl o ,,p:n'tc inuti]ir, a corpului)' (u"nozoLliaJorie
igrrrrlr'i,, ); d) alteori
lrolrrrr,vii rrotttlltelo, dal lo polcoll dota\satedc cotp, sau defot-
i6i r'(xilllro$(,
lrrrl,r r(:llurrgil,o sl,u rna,iscrrr'1c) I o) itt unolo crtzttrioi perccJlrloLtti, htttnicor-
lrrrri sl,irrgi (ilrrzirr,
ttrrtti ir,l l,tttilurt,
tttirtttlrtusulxrtir)t), sittt lttrttop tttirytilri
n;xrrrl,rrrrr itr rrrrrtrrIltrr|oI'oltrryiitttollilrr (iltr:tii l;irtrs tzirrlJ; l) rrriri t itt'itr
:,' , 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
r'lr o[{)rn{)ntc: ?,) O afqzie-dgtrozi€ toa]'t(l sltiltria lii', t I I ' t t t t t t t i i i t, ,,ltttjir.t
' 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,
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
l ,r' ::i tt, t t , ea
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 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:
r' ,rrr:r,fi i Ixr, I 'l, ict Lllr ,do t r lr ',
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
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, 1ir l) r ilt lt t l
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
, 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
l l r,,l l ot' l l !1' t lr r J\ r lt t , t t 1t it , t lr tVr t 't I iI r i|, I t , I r t
rrl ttr;1i .

!'t t; )'t'l
 li MelrrhrlJr,hurrontll:.t.\ ,llrurltul
. . . ik'(.iIl.ll.I'L|||I|\.|||IIrrr1rtrirr,I .lurthnld ul tultutolil,r rr.pr.,.zirrr.r.l
lr'.rt.t.ptl:t 1x.,rlr,,irrr I rrrlriI .rr.rll,
lr,rrrrtrrllr.rtltri
-\li'r.l,ntl r.slr. I,(:Ir'|,|)IIi,
r,ir,li,ri0rrrr,rr
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:
. .lrk:yuIilot, alo }idiciuilor nervoase,gangt,eur. ct(.., r:urL,r .
l)r'r||lirI (,ttouiLlt r lrlrtltbru, not an^ll,cnr,in rnod jn-icrntiterrl.p.,rr.otirr
rrrrrri.rrrr.rrrlrlulirntonli suprtiul sau fLrzionatmembrailui
rr*. I:r.1r)r'i lr,L (xislil ;i la buloarii cu secliune Daralizat..DIcm_
compleli iau llti Inziurro
:r nrirtuvr.l sl)I|tirnl,TlrccumFi in lcziuni talamice pal,ictale(ir.,,pi,,.
t
7. 'l'ulbrrrririft.paroristice ale somatognozieireprezilLi fonne parli- I n DE DTAGNOSTIC
r)lt()trLEME
, , , , |,. rrLrir'rrr.i
Irrrl.,r('sl{.
.i I l. -l : , fl,-r
,.pilep1icr.,in cursul cdiora boLr:-rrvrrl
rriicglc ,,iuilar.a,
t4)scDtoun henieorp, d, qi-a pierdulr rn membru siiu ull
lU. $tlNAt'AZtl
DDvotuutuJ
iu rtrr,uuR,4nu,D
Alteod inceaici, jluzia ieplasirii corlnlni, tlctapi,rii
::'fl:t,..trt._,,.t.-1",'Tbru.
urrui fautomi.i.u ,,u,i ,'rcrrrbnr
,.mernbru sirfla-
l:illlli
rrl l rlrlll::',,b1y..ll,L1zjr
: r . r ' , . au tliie\te
llir i ,.{ l e o
o haiucina,lie
h a -l u c i n a ti e heautosco;iricir,,
h o a u l oi copi ci . in
i n tn1,
fa(a .,rro"
' ii']].'.,.1:,"_l .Fau *irro
rrnor ai al o
sil r,l:l]:1i.ll.:
ra,{,iirro gildim
srndrm lir o epiiepsiefosali, pariettld, (tumoraiii,, va,s l)li volllll ltli
r0.1.cLASIIrICAltl.lA'l'ULttURARIL0lt
lli l/a,$crlarti,,
crlilrli,,
I r'li,rrrrur,tieii
ctc.).

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
' , 1,.rt, rl i r r lulbulit ilc lor Lilii.

10.:.TULltuttARIALII EMISIUNII$I ARlrOULAltll(itlVI N't'l{l,r)lt

tAl,lt MI,ICANISMULUI
IT0NATOB PR0PRIU-ZIS'5[ I)l'] All'l'l(llll,Alll'lA
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 t t t ()t l || || ||' | | | t ( 't t l) l r r r l
rrr rrrrr1rr rrrrkr gnr po r lo l) lt , r lilif sf iiI 'i ( r illi( x) :

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
;rrrrrrrrrr(rr , r 'c, 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, ( )
l rrl rrr:r l rrrrr vr r t r liir r ,r r , r . r r slrrrliHl; i 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 rl r Il rnl l {, ilt '{\ il r lr lr r r l't r r r ir , lt
sir ,,t it t t t r r lr lloln, z, t l, . j. At x) r l,Niijlr lI liHr t lr oillt t
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 i { ||I|I|II|I II
'l 'r , ( ttti tt 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
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 , r II':ttIIr o tttr "' l :ttl t 1 'l tt':tl t,,tr ' 1 tt"ttttr ' tl ttt
I : t l r ll r ',l 1 l l l i r 'l l l l . \r r ':tl l l l t
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. ,'1 ,,, r 'o o tr l r t t r ' l r .r l r ' r i 'I:r It':r t'. r l ' l l r ItI ItIItr i ' r :r tl r '
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 r , l l ' r r L r {: l , ,1 ,,r l ,,,1 ' ' .r
\r l ',l r r It l ' l r r r r l r 'r l ttl
rrl r'l i r r z r ' lor ' ( c l. l rrtz i t,(l o i o l )tu c ). , , '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 '
t l l r l r i r ", ttl '.ttr l ', 1 'r l .t.l r r rr
, l' , , i 1 . i tr t t t I t t ' I:1i t t t r' ,,',, "'ti ' 'r 'l r r t
t ) l)islrrliilrt 1tt:ntrtt,stttt,tlttl ),r), poitrtii rrrlnelo dn lt)lacisu. "t 'l r r r '( 'r 'l r r l r r l l r r l
l ; ; i ', i '1 ,'u r l i ,,,',,,,' l ) l i zi r .r 'l r i r l ) 1 r tr r :r r r .'!i r 'r tr r \i r l ' r :r l l r l
,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. , . '. , r i : r |i ';i l r r r l i ;l l r zi i ,
'
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 ) t 'l t'tfi ttr ttti l 'r l r : Itt \i tttl tt'ttttttl t l ttttl 't) l
r.ag i siniLron'rt, ) ! ) i t ! r 'r tti i l r ' ( l i sl r r "i i l t
;rr.rflrrlrrrllrl;ro). l,it copii, IroLi])ii nexlli \r l)egetaliile 'crvut ad,enltile llot 1ttorlur(1 , , , , r i , i',i ,l ,'r i ,, l l l r u l i t,i i ,l i ,,,, r l r r , IIIl ,I||,II) IIi |- '.r 'tt Itr tztr I i r rr I rI LI rr':r I r' '
| tt
t i rro lr r lir ' . 'I , r L l l i i t r l l i tr l t!tttl r l l tl tr l i l tttzL r ' l l l l "' l {r sl l r l r l t l 'r l l r l I l r r |r i ttttl r tr i r '-
( r i l .ttl l 'o l ttttl l ttr I r i i r )
,l r , r ) 1 r ) r r r r r l cscr t i r r i 'i l tr i l , r 'sl r r si 1 '1 r 'l r i /( '//r i r tr t/i r ti r i ( r'
li. I)i:;ltttt,irr,(:ti.ofctn.icr, l tr r r i l r t:r
) cstc o tulltullre a cmisirtnii fonc.rlelo: si, irr Lrti l t:tzr t t,;1 r , r l r 'l l j i r l i i , Ii ti tr tr r i i tl ,tr , .l l l l r l l o l o l l ,,( l i l l l ) {r
r
'
l r t:tt
(,ir,1rti Lr,rrlil, tr cuvil-rtelor iri a,nsil:nblu, in tlisfonii,.i,ulburur,rea loi.bir.ii , tttl i ttl l r l l ' ( l o yi l l .,1 ) 1 1 'si l L ( r "ttttl r l tl l r l 'sl t' l tl l tr l r " tl r r tl ttttr r l
' 'i , r , ', i ^
rf (lil,l,or(irfc [tt,.ri.1tarlce.satt, .ptnli.zii $, ttnor elenzente r si i r i l ,,. ,\!r 'a sl i , l i |i t i 1 'r l r l tr ' :r l t:r u "t 'r ' :r |r ''
l |r t'i r zr r r r r r |r ) r 'r 'r r l '
.loraalorii (b1121,1,i11 r , i , , l , , ir
rr,l prLLriuLrri, liLnbi,, l*ringe ln spcclal). in toate accsie cazuri, limljL.r,ju I r, | , , r r c i r tr l i i l tl l i l r r ,,p tl l si l l l r i rt tl r :tl r "" Itts:i , 1 tt'- tr l l r r l J l :r r xfl l ( r :r 1 r 'r 't1
rrrllliol csLc crlnsorvat, or.icare a,r fi intenritr"tea paraliziei. Chilr dicii tr - r 1 tr ','sL i l
r ;t1 t :t si {,tttj tti r 'l r : l i tr l r l 'i l r r l o l ttt:tt
r , , r l r i r '| rt i ;i l ti l l r r l tl -tttr
t l l r r r tl tt.l r
IroIr.rrr,r,rrI trLr,mlli poa1,c cmiLe akrcit, citc\.a suneijc fi'agmcltir,tc, c1 estc L , '1"t"l p l " tl tt i L l o r r i tt" U tr r l l l ' 'i tr r 1 'tr r l 'r . ttr l tl t.r i l
ttl " l r l tl t
'r , , 'i i l r "i l i l 'r l r l i r l r l r l r i i r ( ( :l r l r i r I
lrlr'lirct lir,p,r,bilsil inlreleagil, sii citear,sc:is&ll si, scric. ln:r,cesl,e cazur.i cs1,r. L l, i , s i l tr r l i l o L i u ,r 'i tttl t'ttttsti i tr l l o r l l l l i l i '
rorlrr rlr o lirr,r.iLlizienotr.o-rnusctlarii (a rtu$.iltilor labil,li, lingu.}li. relo . Ir l r ' r r r IIIr '- :. .. i r \r tl ( l l l r '( r 'r ( 1 "
, 'i l , j r,',u fo l l tl l .r l l l i p i i l l ) l l r l l r l r l i i l l "'\i
qlol,ici sau ir,lutola rlintrc el). Trezilitler, poaLe li l 'l l l ( r l r l i tr l i l r r i r ;r l l t"'
1r:r1ril,irr.i, ierifericd, (trou . . f .r r ^ tti u i o tl r r tr r , r r i t'i o t l l t'fi L , tr i t'i i xl l i tr i "r ) IL l
.trltrri), bu,[boprot ubetnr,Iiald, (nuclenrd,] san r:eiebruld,(ii,fecilr,rr:aneuro r,1' ( l t'p r r l i l i r r ' ( l l \l l tl l l l l l r l 'r 'i r l r rIl r \
;,1 l r l :r l i r ' :tf,,tr :r l r l tti L ,i 'v1 '
Irt' rrrr"r'l r
rrrrlrri rrr0i,ol cerlll'il,l). In c*zuli u$oale, unelt) totrerno si t Delfect cOnsill,. ,, t, i,':ri.,iil"irii.'-iti ,,tu'lt' siirrlti'l'-i'r"trx{trtpitrttrritlrtL" r tr i ' l "r
|rrlo si lultolrt.rnult ii,ll,crate,citiir,r'SLrltju,1t,,. lD r.ltzuile arinsal,e clc pa|t ttl r i ti t r r tt
,tr, , , ' , 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
lr,,i. rrilr'(ir!,ti,slr,u totllli l, ru.uschilol fonatr.ri, i-lsisttirn lit o bLrp|t.iiLixc ir, l ""l ' Ir r
I t ; , t ,tt;i 1 , "l tt,tt l r tf i ' :l ) :r |i r r r r l r r r : l r l r r i \\i l "r r ' r r r
lrrl rrrri rLurrrrloilsc Ionerne, pinri la irnposibilitatca totalil, ll, rrorbilii, rczu- l r r i \r '1 t r :r t' "r I
r ', i ', ' i ,'',f'.ff.'i ,i ' f""l r "zr r l ttl r l 'r ':r
rrrrrlrr,ll til,cr':l sun{)ti} elei:neittnrc, sau l:l o afonic comploiil, ln it;ldiul i ttvtl l L ttl l l r ttr , ttti i r t'l o tti i : t I r ' t r r t r I r ' I r t I r t l "tt
t t i l r l i i ( l o l o tIL ts, sl l l t,sl i ttr . '
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 ahco- ( fl '!l ( i i i i l t'i L r l i r l , tl l l r 'o l r ( 'l r l r ''1 ' \l ' l
j r1 , 1 . 1 1 ,, ti tn p u l c rl i j l ti ni . , , , '. t , r r r l r l l I,^ r l .i l l i i r r i \{}l i ) i l i i
| .,r' , : r r r : J , , , ' l. r :rrr. tl i ' Ittti r r tr r r ': ttr r l 'r l r r r l r ' l 'r "r '
, , i t , i ,,r i t'i i t,,'r a :ti ,'tl l i l l ( r ( :'III) Ii IIIi i I'j
| | is.lon I il rt so i nlil n.tst: fn .. a,) Atitigcr.i ale nervilor recuronli $i ( '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)neurn(l ' , 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' 1 ;o tl i tttr i '
r i t I l r r r r 'r r l r 'l r
,1rrliili. Iir rLivclirl gituiLri , 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
;i rrrr:diastinului, care anNleneazii lalilguplegii
r rr .rirrlrrrrirr<r. r'tlcLrrcrrl,illlo_ (r'uce t.ligtrsitJ, [.,itunlriii, cu tinrbr:n ir,siulii,, i It:'o r Ii l tr i '
I r , , i l j ttt tr ti l i l ) l o l l u l l l i i l i ( r ti l 'r 'i l 1 l t 1 r Ir If
, 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 ) ,' r l r ', l r 'l l 'r r r - L ttl 'r r ' {l i l t) r r r r l
; ! ) i : : i ttr ti i ( tt ( tti s.l t i i l t ) r '''; 'i t 'l r 1 'r ,r 'r "r ' I
l,) 1,,..'irrrrirrlc lrrzci crrtninlui, cu siudroalle Coltet-Sicard, verntl b, Scbrnirli,
, . , i , , r ' i'o l l i i l r ', i 'l i i i , i Ii t,'I' ''''/I1 L l r r l l '"l r r t i 'r r r :r l ',r ti ',. " ( :r l :r r l .r
(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 r 1 ;l r r tl ttr r L :r tl " r'
l ro S rcri rri ! vol o pl l al o-l :t;' i ngec I t,i, r l , r r r ' r l l l l l {l \t) i 1 ) r ,l \'r l tti tl o tr ti r i tttti l r 'r 't'r r r tr l r ' 1 1 1 1
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 :r " r r r l l tl r r l ':r r l I
, , , , , , 1 r ,r ,l i l i i r tt'l ) l l ,l l zc. i '( 'l i o l l r i {l i i \r Jl l l i l '( r l tr ttttl r tl l t
1r:rr':rlii,irrVirLr-lluinqeo sau labio-gloso-r'e1o-laringeeI d) LcziLtni cxtiurl(\ , , 1 , , t : it,l ttl t, tl r r l r l l 't'ti l l t: I0 l l l l t'l i '-
,lrirlr lrrrllro prol,ubr:lan{ialc, c:r,de excmplu siringon:Lielobll}:izl, ,sclerozr,
fi ( l 'r r tr r r r l I'
l:rir;rrlri rr,ririo i,lrrticLi; er) |ezinni vl,sculitre, tuitorale) infeclio:,se
"rlrr t 1 I ) i ::Itttti i Ir : ( d i s,l t:i i l t ) tr ) t'l tr l r tr r sr , tl r r 'l o l i l r r i r r i l r l l r i r r ''
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 ( | I ( ) I l 0 r Ir l o r i , r ,f ( l l r 'l r 'l , r 'r , i r r '']r l r r r r
, l , , , , , , ! , i r;r ,.,.i ( ,i r 1 i IIi i r o Ir r r r i r .i I I I I I i . I i i
;rrrrr l,.,.irlr,r ctt'ri lrtlr,lil a loli;iunii inferioare a celor doli, cilcunr-olui,ji i ) fi r l l l ( 'i l 'r t tr l r L r zi i :i Iti I t t I rr I : I t ri I r I r r 'l '
,, ,,, , , , .l :,,,l rl,,i , stttt st'l ttttl l i l i i , , '
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 - \ tr l l ) i l l l ' ( l r 'i r l r 'r r r r 'r l |r l
, , , ', 1 , , r' It ' It t I t rI I I t I r' ' ' l i i l l l 1 I) IIII) I i IIII|1 ( I l l .l {'l l i r l l l l ,
r rl i rl ,l ( i||( |r ' r ) iLln rr p s e ttl o b l L b a re ), ', , ', , , . r r l r r l r ttr tl o t- l r 'l ) r l r ' l l l
,,, , f i ' ; ,', ftr 'si l l r r r r r i ci l l r r r i i r l i ti 1 t;r t'l r zi l r r "( 'i
r "l l t( ' l r r r l Ii l i l r :i ' ( 'l r 'l l |'tsl ttl t' ( r l ;r l ( l r ' l l l l r l " r t
, , . , , r I l l \i l r l ( l ( i l i r l 1 r ,i l l l l ) i t
:.1.tlisiaziilo (rlisicmiile lui {kr-rsx, 19i8, sau alistorriile vorbirii) sint,
. I r : r l , i . r 1 , l 1 l 'i l ) .
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,,
] | , t t | | lttl ttti ItItl l ,Ij l '!) l l ||ttl ,ttr ttIi ti t.i i tl .ttt'r d tttttl tt) 1 l l |||||\|'|.
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l;'llili:'iiT""l';?:':y;*
llx,'*1i.,rfl
,1i"*JJi"1"1,1#
l i l ,ri l i i i ( , 1 r . t iir c o o ,,c o p i e s e i v i l i ," .
, , , , i , l , . r r {il r zi |i i l l i 0 si r tr U l ( t r l 0 l t,g ttttzi r '( l t
| 1 " r 1 . l r t t c tttr t |i l t'l 1 r l so ttl ttt' tl
r l r , r r r r r i r l l t s i tr I I t t t I t t I I t i t t I l - l tl tl r tl ti i
tr l cr 'i l ttttr
r tl tr ,)
l l tr l i
l
l
,r
r i
tr
{l
r
l
tt'l
i
( ,r
1
'(
1
t'r
1
tt.l
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ti
1
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i ;;l
t i
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r ',,
.t
.r
r i 'r tr r r r :l l l l .

ttttt'l t' t'l tzttti ' l tti tt l r "r r i tr tr . r tl tl l t'ttt

i:"."itffi*
t"::#l?|::,;)
,,,,,,.,i111i,1"11111,;ll-i'f"r,11,;i,"1i,;'ff;,:i*ftf
/,/r/1 ,r(' l) r . llt r i 5i l, h c l rn i tte , .[9 6 8 ) :
r ) . l l , L :i l r tl l tto :i r r i si a ,l u :i ti .l tt
r , ' , , 1 , , t " , s l l ti ,r tti l i , r 'i l fi o t'l l i l r i l r r l i i , sc l 'r 'r r l i zcr r z'i ir ttttl x'l r ' l i 'r 'tr tl r r ( 'l r r r r l i r l 'r r (
l i , , i ; 't '" ' ( i r i si ,t',,i i 'l p ,,:i ,, 1 ,,,,,','''' i tttttr r tItIr ', r l r r r '5 i l t.i tr l 'r .r '( ''i ( '
\r t I'ttl r tr ''
"i r l i cr l i r
, . , . r r l r f t , ; ,s{,l r ;i i l tl i l r .i l :r i l ,tl l t'l t tl 'tt'l ttl tl :t l to l l l l t tr r l ttl r )
,,,,,,it;r,.i;,,i1lll,!j;#::'1il:;:i1:ii.i5:*:*"l.Tlii'till,l;1:;i.:"",l1illlll . '1 . i t t r tl r ttl t, l ttl l i r tt
- r i l l i r r tti ,
l ttl l r tttl i ti l t t t t r I i t t t I c t t I I t I r I ( si tttl to ttttl l l t tr l r i r tl tt

;;i,i:i
ili{lili,(:li,i,f,1liil",:i;;1,J",';:'l.r;l''1"1i?ii.tl,i*i*'};l_l*ll*l; r , , 1 , , , i , '" i si tttl to l ttttl l l l i i l 'i ( r i
t t r l l , t r t r r t i l t o ti i tt 2 si ,l ti r ', l tr l ttl r t l r ci r tr tt l t
l l l l r l r l ") ,
r t i
i tt l tl :r l r i :t \\r r r tti i l 'l i l
ttr r i sl :r 'i i r r r i i f i r r t tt' i \l r
I
tti
r i tr
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l
:
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l r l
t tl l r
ttr tt tt
t''"r"-noii"il"*c
.,,, i,lll,ilfi;''Jl'll1l,,;llill'l11::lllgy:,lt .
tr';tczin1'r'r' , , , , , , , , , , , i i t , , ,,,i i ,,.i r i I r , , t r i z. i 1 i i I rI l .r . r l . r ''l l r r .r i . r r r r r r 'r i l l i tr tl r tl r 'l tr t Ir 'tr t, ttIItt,'

',,'li. i:;.:,i"l;I;T:-glt'Tl
It;tiliil:iiliiiil,Iiliji;iiirir:f ;:r#t:iTiililt;tilt,lx,i
| | r i | , I i ! i I | | {i||'
r l , 'r i L l r t t i r ', g co ;.1 t':r l i l r 'l r '.,r i r l i r r l r to l i 'l i r t' l r tt r i l l l t I I I I I i I I I | | | I t I i l t i I '
l r tt i tr l r 'l |t l ttr tl i '
I ( |'I| |I I II lr

:It /
:1l ;
 .ll. l,ltr:irr,lr orolir corrsr:jir irrlrrsirriJitlrtclrlu t,-rplirnar,c
vor.bil,rii,, tttrt. lintlttjttlrtt. t\lrtttliIirt.. I|\|| | I)|| r'I| |rIrI lo:r rrr:r,iit rlror'
r'.) fltt,prt:iitt
,4,r'rrllsllll st,r.isii.l.iolrr:tviiillr4eg cr.el_celi se spune, jar
nu ptit, cvoca iirltl'L lr, un(,f lr,lit,zirri rroruljr irrll o lrrrlrlr{,iclr, rtrlrrrxirriolrr,lc.lrlrlrlrlrilr,
,:,'l:l crpriinlre,cu al1,c cuvinti ci s'"oru,in ii"posiiriii_
l::illl,lll ll'ill,'rL1r'rr
ru rnl.r, i,ii fon;rturi. r cllrillli 1xtn,lclii-- rlrrpii,clln jt,ln llrrrirrl,il,- 1,ulir,l suplitrrir,l,i, slr,rrlr,rlrrti
].,'1. 1t:.1]..: ),:,-,rll. rni..narilecorenpLUzrjloald fcnilu iil ( itcva lottc,rno: stolcol,illiilo r.'ctltillc. So inlrelcgcptin stttrol,iltirtn'rlnlt
:r.s(,,.\l'tUnir trr \'utbrl'' O.rlii. .inrrr.rrrrru;,.Liimiinii, pentrU a ScCipriml
rrr vorlriro scrisi. Afazia, rnotolie cuprinde 2 forme- principale: o t eductie a limbajului I'olbit, lir, o e-rpresies1,oreo1,ipir crr slrr ir'1,r'ii i
sr,,rrrrr
i,fazia lirltic lingl'istici, ca un fel dc .Loit-motir.,pe caro Jacksor)il colIrIrIr,r'Ir, r'rr
rrrol,olurprlrpriu-zis?i,(alemia) qi agrafia.
tttLteflen de org5. Aceasti, expresie stereotipX poato fi corrsl,il,rril,ii, rlirr
.1..Ll.,fcntkt {.a;faziamotorie propriu,_zisii, (mu,tria lui ptene Marie ) lrrrorne,tlin cuvinte sat dintr,un fragment de frazir. Io }itr(llrrsul r.orlrl
lrrrrsl,ii,.il imposibiiitatea dc exlximare oralii. Este produsi,
ae feriri"i af," lrilirii, afazicul i$i poate recuper& unele formule &utomalrizitt,(), pol,
r,rr,r.rr
..r)11111'_i. ,,irnaginilor.t)yorbir.if:lrtioul:lte, localizat' in piciorul trontatei
,
r t t , i;r. rI i rr .tilr{l r.nnl ru I lui Bluca;. r,u roI in eLaborared- rlot'eni,in mod pasager, noi sterootipil. Se intilnerytclroovenl; irr lrrrrrlr,
. m iscililor mus_ lornncle intra.er.ebrale (temporale; Arseni, 1980).
{ r, ,'r' .l,)rrirl,rftrn llrnpul !orbirii :r.rticulrln.Spr" dcosebire
i rrll ul irro(lurnrlecolo lutr inasi\.e,boltayiiflot pronunla de muLism, d\ Agramutismul se manifestl prin imposibilitatea rlo I rrlilizrr lrrr'
ci.te,uncuvint, rrttrile (modurile de a$ezaTea cuyinbclo{ in Im,zi,), cuyinl,cl0rlri logiil,rrlli,
o,\i1.,l)ii(ta-ta,_ti-ti,rnil-ma, da,._nuetc.). 6i fa; efo"iui, urrror_,e p"'tru
'rr
r rrrrlr.i.:rrrL.dr'zola{i;i i'a.cihili rlio-r.anza nerou.itci rrrotilurile qi formele grama,tic e ale verbelor. In cltlrnl lt,gnt,rnir(i,rnllu!
Lenttlivci -lur de irlliilnim sirnltomnl denumit ,,stihr,[neorilor", carc conslir il rrlilizrr,rr,rr
.r ri,)lr'r.lolu-rocltdoiol gl.slU.l ila|gi. ln lULmelemai Ufuaro,boitraViipo0
r' \ lrl llrl;b
lirtlrnlui la ilfinitiv, procurn qi simptom[l ,rstilul teLqr&Jid), r,it,rc r.orrslri
.'U\ r Ulp
''llo r:l "aU I I AZe Sr - Ut 1o. \ d c s e t Ci SpUt: . , s l i U , d a f 'n U irr omisiunea ile cuvinte (in special de legi,turii) rlin frazir,.
ll:il.^.,ll:l.9iflii1 rlroruntii,substa,ntivele. Alreori t"t"'avii uiiiizui"x p""i c) ParaJo;iilr, j arouna;fa,zi,ik:,tlisinteniile. Oa ;i in a{a,zirr, sorrzolill:i,
l], i:']il::-I. tjl loc d_e,,qutri" sptn :.,,[staestecn caresetaie',).Deieori
r",llrir\.ut r{r rcrzi nrilrri,.a.crpros.i\.ir, rll iitilziir nrotorie scpol,intihrj celcmai lariate tipuri tlepm.tlittii ,,ti;jtnlrttt
nasl indicind prin moiliiic,ri ale fclei
uLr.rplin gesluri, ooea ce estc incapabil si, cxprim6 prin grai. Exprimarca rr/,r:i;. lsupra, r.irola nu mai insistiim. La acesteaso Ldlrrgii rrrrrlilrrrlo
r u loirrrlrri (lurniratul, rint.;xit, (d,isinlari.ile), care constau in aceea c5, irnbiutr,r't.: r, :rr':r,rr.|rrr,
rr
denllrir.ea zilelor tlii si,pfdmin? sau a lunilor
rrrrrrlui,cintatul, recitarea ulei poezii etc.) este inai line l l lzelDr comportir, confuzii. Disintaniile, numito qi lrt il,-l{lil rrll,isr rr lr rl
conseryata. .,rlslarnatismeimpresive') se diferenliazi, de aglam;ltisrno l)r'ir l,(,(\.r,r'r,
.irr rf:rzi:r }Julorn intilni urmiiorrele grupc dc tulbur.iri
( ., ^rnotor.ie
\rir.t,';l|rIlrn.(Jmtlredaoe li J)urrnd, j939; llolal- li Lhct,rnj e. .1963).
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'
;t) il'tr,lburdri artrice. Dez,integrarea fntensitatea tulburiirilor rr r-i:tloriielenentelor gramaticii si ale sintaxei, cr,l'orlrrlr, lrr,rrlilizrrlr,;r,l,,r'
{t(l (,\l)i ll1il,rc..(:inartlia,duprii,unii autori)foneticd,.
este variabili,, de ta sr"Lpresiunea rrfoorentii, la conluzii in orrlonan_ta cuvintelor'.
p0sibiLif
ititor de,crprirnare,
pinilla tulilurii,ri
:l,l.,,flli:.].1:1ll.l,i
r.\ l4r, l|ol1iJ (in(,la osle nocc_'l,t,irttilizlrcr dc lcste spenialn. l) $i in afazia motorie se intilnesc p erseue t'ii.ril.( fi inlt).1 ituliilt' ltttt
r.lr v1'11911-
-tA;;;1;;
Din'prtnof t'u 11)
|1,,
lorLcticr estc net tletorrnnti. r-i"earizareava-torilo' g) Unii descriu in afazia motorie o anosognoziau. ult:.ir.trlrri, r'tlt
:1.]'l::' cirrc\e, 'orbi.ea
rompLrre limba,jul necesiti,o a rtinst*,in aceeacd,,clemulte ori, ca,racterulpatologic al l)r'rr(l(,tiiIrr r r,r'lIr,lr'
, lllrrUl llll
',1 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. lrtl este perceput de bolnavi, car€ so comporti, ca qi cLrrrr:r| vorlri rro|rrrrl.
s,presi- Accgti afazici anosognozicisint intr-o staro do oxcilrr,!iop),ilrorrrolorrr,,
rir (,, si/ riiL. deteriorareafoncmeloi crpr.inrl: elizi.ni, asimiliiri (ex.';;ii
,ll l,'r ii. Fnniiiruri-. pri,{rclrnluc,lc,.eslcl ctc.). orrbrririiili iin cruberanlX, qi logoree.
l],11"'j 11,ci. Pentru enamenula.faziei,m<tlorii se ulilizc:lzir,o lrr,r'giigrr,rrrii,l, t,iiLi:
mel:1rozo(bel.rilouiu iuc dc [ribelour.npc||inzo
iilll'l
( |)||,r,rrll: r.iri ll"'l'11'i'9t,t,
rI I "l' rLlu( de tliblioteci,). Se mai prodrlc unelo modific5,rif6netice, 1r)Teste care apreciaziibilanlu1 posibilitiifilor lrlir,rrlilkrlii: irrliirrrr,rr, rlrr
r rr : rrlrzir,lizl,r.cilunor vocale dcschise,_diiiongarea unor r,-ocale, a se exprim& liber asupra diverselor subieoi,o;soli|iirr,r'orr,,;,r.1,;'r,Ir,lrr,
asurzired li)l}eme, cuvinte qi fraze din lis1,eintocrnite de nr-riirr lfl, li'I, in( rl, lr,
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 luprindd, cele mai diversevariet[,!i qi ansarnbluli<lclirnrrrrrrr, ilrr r,rvirrlo
lirrii lrr rlislorsiuni fonetice complexe. A):i,joualirre qi .,;trlr. iig3g, -i?.6ti fi de fraze. b) Teste care apreciazS, ,,va,1orile"solrir,rrlir.rr;i glirrrrirlrlrrlr'.
rrrr r.rrrril, i.i[lic aceste tulburi,ri an:rtrice qi foneiice *.,b in";;;;i ,\stfa'l,se vor studia sistematic: -l)osibilili,tilcalcov{x'itlr)rrlrrfrrrirrlrrlor';
..;rrrrlrr'rrrrl,',rlozinlcgrlre font.lici.'. d; :ltomaliiLeYalorilor fonenri,e eiprirnrl,r (rlcfo}rrrriIi:rlo I|lvirrlr,lor',
_!nsi"lirid 1i arupra apra.:iei buco_ itiltrcuiri dc cuvinte) ; - natura lingvisli.lil il cnviulolrrr crrIrIrrllIIIrr ir,l
r:rr'ri|lr., i tr lrrt ,rr r ntlJZtrcflar.oSt0t,Itdllut,-ri aie eSpreSieioi.ale.
lrr .urlrul turb,rEr or de articrrare are afazicirormotori se situeazi
1rl)sl'nte (substantive, a,rller'be, olvinl,c rlc lcgii,1,rrlri,) ; r r|,Irri r,r'r.rr, rlrr
..lr) irlitmalie :l limb:ljLrluioxplinrirtl - slllJfosil.lrrilo sarrllolilo irr rllrr.l,rrlrr,
itt ii.\ltt(.':(4l.iitc(Alajouanine ;i colab., 1939, 1964; Iloriad_Krohn,
tS+Z : .*rrrrrfiicnlii, rL I razolol,.
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 lnc:ir,.llrill:rlg0r'1i,lirrlis()rr(cilrr{,irlo'l'issot, l1)i;(i)rrrr 1r|olrrrri r.ir lirrr-
1r' | ll| r.]rii itt{.r ttt. li, l( lDt o l, r t lAlr - t . : j do r it m , llt,jttl sri Iic si tttlilr,lirr Itttrc(,ilrlrrcorrlrrr{,rrl silrrirrIrrlor,(,rrlrI
ryilr,lirr,lil,rrlllr,l
cai,o cOnfOrij t.Orbirii tliVCrSe
oslo grosolanaltoratir,irL afaziilcmotorii, incit litr|i1^itr trrrrlftrt,r,rrlrrr rl0 llrrrlirr rr,lill:r:rir.iso rrliliz;r'ltzii
irr slurlirrlricrrrirrl,'
].1.,.,:1ll!,..../.1'f',,*t1, I)r1,2(,rlrc rlic: - litrrlrrr,jrtlrilll\1lttl rrrrlorrlr{iztrl (,,girl:r Iitrrri") ; lirlrrrtr|rr|rr tll
i l l .rs''r. ' , ' . 1r ,((r , lr l ,u l
l, (i l s (,,..u l l x l l trtv rtl rri , fo i n ,t. atl esoi t,vorl l i rti ;l fi i nrl ' tyni si ,
('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 . lrttlii,'{r,,rlo lrrtcttlir',rlrrlrtr,, :rcr.r'1riIrrr', r,rrlltzI lilrrlr;r.irrl
rrrlir,lil lporrlrr.rr
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,
 ' 1,, l,t,itrlllt ;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 lloli l l :''r t
l rrr:r lr , r lr r r r ulr
i i o l rl tt(' l i l rc t l .l tl r. i l l rl r,L r,tr ,rr l u\ i l l l cl rl t i i r l l l ol gi l l rr,rrl (' i r
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 : 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 ' :
' r 'r r l i 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
' f \ lr l r . r r r r r ; l, o rr,
* 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
,, 1 t,,ilr.{ r r u ,i l r .{ ;.:r .
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 l , onl i !; I)s ul i l j | i ,ri 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 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 o . i - j o ( 'l ( r ( fl l zl l :l r i l l r 'l
lrolrr:r,ri lr, rn{ri $(iori) lLriLlc siuLlligut inl,o })o u}r tabl{)lr I .- l?or-estiltit, rlr,
,,
'
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' )
.rrlll lrrr:icrrl,N rrl{ji isiolioar'o (are i-a iost e-\}rrsi i - C'onstrutca tlt i.r'rtzrr
, 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 "
r. (lolii, l|oi sjt,rrrll:ri lmrlte c[\.inte inpuse ; - Solicitirli tlc lcperrll e ri,,
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 rr(.1( f J ( ilr \ ir r 1, c; i 1 r' a z c .
t, , , 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
'!. ilgru.l irr (x)rstil,lrio o a,11;.forDri. t1e afazie r-notorie, caic eor;siir il ,,,, ,r' r. ,rplilii l r , o l ti u ttttl tti 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
Irlrrrrlrrlr.r,lrosibilitir.t,ilol unui indiyid dtl :l se cxprima c[ rjutoml sti'isu]ri. , 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 )
I,lrr,rc rlrrlurc\tc ur)ol loziuni la nivehil centrului ,,imaginiior" graiirt ll{' ,, , l , L l i , ,r t'l 'r tzi trr u tttti ti t'l i t", sl tl l ( .l l t'r t,tl ) l l t l r r l r 'r r r :r l r ':l
r orlrilii, lolrrlizat, iir piciorul circumvoluliei fuontale, a doutl din cnisfcr':r, , r r r , i tl tl i ttn i ',str
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
rl | l]i t . , 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
',
,\glllir csle trra,igreu de :lprcci:lt la bolnalii afazici, dcoareceii{aziilrr , , , , . 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
lrr rllclrt,lci sc irrso{:esc 1i de htlmillegii dlcpte. In acestecazuri, se l'ecul'sil 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 "
ili llr prrlrc speailllcde exarni ale a,scrisului,prin folosireade litele con{trr . 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
i irrrrr I c si plin solicitarea bolna.r.ului dc a, sclie cu rlina stingii. Se poill o . , 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
,orrsi:rirr cli, bolnar.ii tru pot sct'ic nici spont:r,r:l, nici dicta1,,nici copilll. 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
jzlrrrtesototuqi sir scrie, se consiali, ?oralJrafie,jMgonajrlzie li. '
l,r (,('i r.lnr'(! 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
l)t r!:rt\.t'&re (fonrirircno ascm[niitoare cu cclo descrise anterior). ,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 '{;)
I'toltel.ctttiliztttein so'tsttl sponlan, tltctat pi aopiat sint foarte variairr 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 .
rii .onsl,ltr irr : - Scrici'ea de lilcre, cuvinte fi propozilii (eventriir,l,irr ,, '1 , 'l i ri o tr l r i 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 '
lrr.zrrlilc lllrrver in consNruireade cuvinte tlin litere con{ectionatq s,rl , , 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 tp l ttr r tt{i sl r tr i l r \Il r r l l r r ]'
rulisrr po (iilr'loarrrc), - Denumirea prin seris a unor obieci,ecare s€ pr'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 :'
lrrrlii lrolrrrir.rrlui.- Solioitarea de a rd,spundein scris Ia intrebi,ri puso, , 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''
rlrrr rlcsnio in sclis anumite scene,de a povosti (in seris) scurte istol'iat:ir(', . 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 {1 ,o r g o toi t 1 1 III1 1 I|1Ir 1 r1r tr r riI|o |l ||r , r r ,, i r l i ,
rl0 lr rurrrrlllct:r, ou anumite cuyilte o serie de ftaze scrise,in care lipJos{: ' 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
rrrrrlrriic crrvinto. Se apreciaz[ astfel defectelede evocare scrisi ale c .i11 , 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
ir,lor' (\ri ur:r,rlrrlerlcslJora))deformarea,cuvintelorr tulburirile ortogfifi( o . ' | | ) 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
:tl ,r ':r r l :r :tl r t;t'
rIlrrrrrlrIir,lrIrrsi dr sintrl,-.i:i,
etc., despre care anr amintit. 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
,,' 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 i ,r r l 'r :r 'l t
l',. tl.lt:iu ntirtd, (totalii satl tle tip Broca,) constd in a,socielea r:elit , | , 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
ill|r:r lir|r)r' r,lirrit'cdcscrisc:Scrizorial[[i motolie. In contextu] clinir: lxrl 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
;rlr,rIorrrirr:r, rirrrlrlonrclecelei senzbriale,s:m ale celei motolii. , , , 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
' \ , , 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 ,
'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
, . , 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
t 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
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 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
, . 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
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 tr r l r :r ;tr l r l l t i r l tl ttt.'r ':r l t,
| , t t . t.t't,'t r , I | | | I ), rr I rI I r | : r I r . r r l , r ,r r l i .r ,, r r r r , r l r l r "r d l r i r r r 'r r r
'

:,l l r) '',||
 urtnrnit't,
rrirrlrrr
,.rrl.,rrrririt,jnr
post,ur,1i
l,;.i,l ,,ru,rrj,,,',irti
l,tl,:1.lll:1.,, i i ;ilffi;ili,,,i,i
.ti;,1,:,,l,,ii,:r".",il''il':'l.il'i,li.:il,j.l,.itt I
ll;,,lii;:;l;
Jiiliiii,l,i,illli;lli 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, '
liil,,i;:li,|i
,l,ir,r't,rrl. ;.";,ti ;i,,';,,,
'I,.,111,:lti:,'jl.t.:r':,pjlit:.:*";
rsl,or.,r.ba li'.'i"liloi*r,
ccpi,i1,io ,,rl Ll r1r,, , rr,tI t r t lr Lir . r ',
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 cirr lr lr r r , . ,1.
acia,,ar,scila-"i.""ri'iiiiiiildi;;;;1,;:.lililil 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
seconside"d,
,,,,ii,iii';',ti"rt'i-i.oiii")irTiJi$#i"'l#1"$;$"iJ.:""J:l*,t,lfft,,i
1,,,'";:11,,1:,,:1l,)iilo,pticii a ri-"n gr;,i'*ii'.il tio rreaqnozio
apartc de *n",]".
tecital e r ilbrll,,
\\ ' 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
rr car'{iirJo.yiir,
\-erbalil predomini, asupra aloriei literalt:.
I ll| l.r L \jl Ci\L,
;xT:,l
tH:il1iJHl,.;lif:1i; i::;fl;t,:lt::
iii.r:",i Confrrziiln ,,r^_^i
",,r^ li+nr,,t,'ri
lllI:
ur, I r, , rrtrrt t i t t tii, cot t llolalr 't r t lii, lt lt llxit r it it r o- t r ut olio; i lt t llr t t liili r I r , r r 'lr lt r r r
, , , r ; ,, , r,rr Iii ) . lt , r r r r r olisr r t cr r lr rllr
l r 'lilll lr lr . ict oyr licir ,r r r ir , bli s( l (,l r |r 1| (' I r,r.i r ' r , 7|
,' , r,,,,rl ,r;1i ollir r i, r r lbr r lir . r ir r lo lir nbiliulr r i sclis ( : lg^r 'r r l'ic
lit,.n'i rcsp|criIr..Cornpr,.trcniiu;;Y; ; i lloxir r ) . \ lr r lr . lr r
r,r,,,rl r i rrrrrr r sill ( , it r t r sulli, r 'iir . ill 1t t 'r it lr r r ur t r f ilziir ,t ir ixli"l 1, ip llloclr , ilr , r r' r r r r , r ', , 1, '
rr,r lr ilr . , . , i: t r qc liq u l o l l c n o rm2 l . C 6 p i ,.i ,e j
| ,r | | |, I I I rrr|(! rl i; silVit r , t iplolt uLd si, ing r lcLclt nit r ir ln f ol lrt ziiI nt ir i lli, r t r r r 'lr r r r l
"ilrili. I'rrl1c o,cc,,lenrrlctcrc a.*ii
,,,,rii,
1,,,,r"liii,-j;;;;#;i;j; c,i rlifi
i',,;i,;,X.
t'X;yllrf?"*i,,1.":1,X.:,
:l',l,ll:
plns esteqi eridcu.
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
*"i'",iuo u,.iil;f;
l,li,ll;:i;,,*",::l; i;ffir|,:'!"T;""|i;'""i:'); l rr,,i l rr.' i ' rrl zio t t t 01r ot ie. t u, r r Lolisir r ot t t LLl
crrlolilor ( v c z i
f i rtn tp ri o r). ""1,'* It., l , r| oi l ,| {
l l , rrr:rl rrrrrrrin'la'apt
j r sr
l
i it Lsof c; 1, o t le u, f |l. zi0 \ \ it l'nioko cr t 1lt 'r , r I or r r ir r r r lr !:Irrl,, r i, r i.
r cnchir nat os r Li t uibur iir i dc volllir '( , , , I r r ur \ 'r 'r r l r ll, r 'r 'o
l tl ,r, , r rl l l l ilcl{l'llnt sc r , l}t c ar : Lcscapune , , i: r l, r cbit i" r lir t , i lr olr ur r r r l r r r r

1",1,i'f il:Tg:,J:ffi
ft{i-,*if :i{:##:{,*,i:i'^$i::tJSlli*:;tji"Ji,tl r t, 1rtrl ri t,
''. (la,tnc i.nlcLr!ioascFi torice (mcningii,il cotcbro-sliirrrl.;i, rrrrr,r. I rr I i I r.
,

"r:rifl ,ilt;*n;t*xxrtilltrJ:*lll"xnl
i:iiir".,*,iJi1g,ff r' i l rl rL,rrl xrri Jccot 'obnr , lc,int oxicalii cLt opiu, ou bolllt , t ot , ir l r lr r lr r r lxr r r
l r r r ir ,or

;itnlf l'l;,*?r{{,1$l
ffirrTi#:il$l?tl*i'"4lTbtiilrifi
.) '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,

:l'i;Lir:;:.:rrin;tti*ix;#::;;i;#:f*#riirif"'f};,ktrJpl
;;6b,;
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),
il;;ll'1")i';'ii"lo!Iit"l1.T;"iff3jl'*
"on*1"" iii"io"i"illii
^"in'ro']""
,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,

Iilllti*ixl;h,k'Hrf,{t*il. #,i%..Tl
!,"Jn#",,!'Tff$ ;)"Ji"i*'lTlji 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
rrrrl,ri
rr^,ncauii
riir,;iiir".:i"iii'ibl?i"$it,?",lffr,"ljl_!t
,,F;ll",i*ui.,H,,{1
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 '

rrt jih"*;il*:
:;h"#i"l$,.'.19:,lai,a";e"l*;
jrllllli,*Hf,rfllrr'.ifr 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

Ii'ilil.l;l:ii'
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varoare
delocarizare
laniverur
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
,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
( r r gr r , zir r

,i'rill-;\1i",*J_'1i#f 4i'tpionpn 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
r,,,.,i
n,i,r,,.gr,,iii,,
i;ffiii;#li,f*"]tf,rS{il1;"?"1',,";,f";'i"il*li:.fi[1,ii 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
rr) llot t t iplcgia ( cu sat r f t ir ii t ulbur ilr i r lt : scnsilr ilil, a, lr r r) , lr r f r il
' 1,1,11,1
r',,lli"lil,l,1ll"lI,l*,**I"T."1,".ii,1*:gL*;g*#J*,",,"",:*i"j1ilt | ' rrrrl (i l l ,l {0r 'io*r 'e, inso}int [ lf r t ziih lr olol'ii, r ] ar r lr r lr t ull, o oli 1i : r , lr r , zt t lr r
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
' rrl , t; l ) | ' (rt '1, r r llt ir , r ih lt llxioc, dc cr ) ct r l r ii sor t i|, 1, ogl r ozir , r rrI rrrrrrrrr, .I r', .rr,zrr,
I | | | I , , | ( i LIr1i t, ur git t nii Din ict o- t ct t I puli c it L cllbr l: r , t r r il llr lir iliililot 'r 'r , lr r t '
,,,,,,,,111;';";,,li,J;illiiii'il''ii lil},,lii'ii,tix'#ili;"il:il,ff1:_imporra,,i,o
i l $ lllr lill r r r r 1, I . o Iri csi tl rc rl
'
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,

in-i1,tfl"u4i'''"1'il
Fllif;;i,fii
;:il:il:;t,,1,;,,1,j\,,llt:),-i1,1,,,11+1,,,lt31if
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 ,
iii'frr,j,r,l'ti,r,,"iil,i,,J;r,i,fdljl'lliJ,:"J:i;,,;:i.]l,tt'l;
,"i!,i,Ji!,,i,,i,,,,ii
trr/l )_

),llllUlllr',;li,';,ll'l,lJ","i'i';]TlUl***lilt:tj's;'"'r,t,il;ffi;;;;'iii,i
iilijllirlili ,j,jilr*rlir,
in:r{rjlrilr irriilr;:,,
;t:,i,:i;,,,:,:
Lt):l
:ltlll
 ll. r. l':\ Al\ll'lNlll' Al'liA\lll'lrli

\ , ' , l i r ' s ( r l l tt'r " I tl l tj tl l tttttl ttr l tti i l r r l t'tcl o l p tr tl r t' :

r l r r r r ) ti r r r r l r r ) : r r ')
| {l l i : L c i il i i r tl r l tr tzi l i r r ' ( l 'r r f( r l l tl i r ttl l l i r r i t' tr IIt'tti 1 r ttIi Il i
ti ' r i tl tt
r,r,,",tt r t t l t r r tt',i l i t't. ( l t) n I( :l tl t.L t( t: i 1 n 'Ii l l l r l i r l ;i tL r r scl l i tl tr tr r l t'o o l ti l r tt'
r r r l 'tl ttsi l l tl i [o ti i cl ttt i i tr g ttto tl l . l tl t'
r l r r ' r 'r t t i i , $ r r ttl l l 'r l ttr l t,l i r r l l r i i , l l tl xi i L ;i i g i
tl r l .tti i n cl - tl tt l tr r l i r l tl I r r i t r l Ii .r 'l o
t r , ' r ,r | , r . l 't , s I t i ttttj t i 'l l 1 trt t t t r t t t l i l i , t',t"'t'l 't't'l t
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 (I I (\
g r r sl ttl tl I l l ,l II( r 1 Ii n 1 1 r r o ,i n tl t tL r i 'l l tr r a '. cl 'tr '' I i l \ I ' I I l 'ir
1 , , , ', ' , , r , ) : stl l i h L l l r
i n l r tn ti l 'i ttr : r l r sttti l tl i ,,t :
, 1 , , 1 ', , , , , 1 , ', r l 'tl r i tl sr l i t l l r i tl i r r r i l 'l r '( ;i o I r N r r r i l r ;r i r ti
11. pBoBl,EME
D0DrAcNosrrc
iN ApRAXrr p , , 1 , , 't , t , , : r s r : l r i tl r i o r i , tl tr l t, b :r to tttr ctL i , tl l r t'
p ti tttl c o l i r l l 'so 'l ' r l ( j r l ' ]i l l l l i l '
tl o l t',.l tr i tL tl a ' tl tr i r l r tt i '
l l , l , '1 r , l r '1 , ( lr l l , sl l l ) i l l N ' so n cl i t\) t.kl t' si t sr l i l r p i n a ,
r .tt
, f , , ', ', , , , , t ', , i , , rr r i i r r r i r ti g i r ,ctc.;d ) i n i ;t'i i r i 'i n l r a "zi l i ':ct"t'ttl ttr ttr 'Tte l l tsi r ttl r 'l
2 l t\p l i l l l ( l i ) ' i ) \( r ( 1 1 l i l l 'l '( 'i |;l r 'fl l l l l rll
*n , , t t l t , , t t r t l i i: sl i ,l tL l ti l tl i i l i ta r , g o stu l d ( r
cu n l i n &, !s i n '
l r r r ', r r r r r r l r r l t t i , i I' g o stu h l i d e l l r l i o
1.11.DUFINITII r l ( r /l ) f:i '
I l l i s c r i l i l r i ttr zi l i l e ( 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 ) :
l a cr a vr 'ti ', stl 'i n g {) ] ( r N l i ttl 'ttl tti ' l r p ttl t
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
Pnntlu cxecutareaunor acte mai cornplexe,nu estesuliciun0 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 "
cr ,'ri r,ri,r'il,r olcrn:nLatosi {il nor'nale tloar c} for!:a$i cooidonare. ci sc iut- 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
;rrrrr , ,r r,oir s:r,so desfir,loare qi inlir-o &numiti, forinS,si succegiuno.ExecLrfit
lil't t t t I 'r 't r
,r,rr,,rrrLii, l, iniSc-"urilor, a geslrurilor, ittr-o formi qi succesiunoadecval,itr ,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
ir, rr r, , , { r)rrs{r'lrtll,irlnnoi tiguli din ohibrituri o1'(r'
xrrrrllrlrri,crrrrstil,uieaLLpra.ritT, iat aprania este o tulburare a gesiualiljfl,ilt
gr r slt t : t lilt t l" r 't t
r,rrr,oorrstir, in irnposibilibl,taa,pcntru un subiect caro nu estenici paralizlr,trt l l ,l r\ (l r' of ic] ) it d0 lr npolLaut ca t oat e acest c pr olxr t lo
t m nzit 'iv( i) sr 'i I ir r ir r slllr r it r r r r or l
rriri rr,l,rr,ctio, nici coroic, nici doment, t1e:1, efoctuft corect gesturile. Cu 4,11,(t ,rl l rr.r
' l ri l tl ' *t t it iv int r anzit ive $i
( r cs}ect
pent t u nr in: l dr cn'pt d, cit qi pcr r ir r r t r t 'r tt't i'it t ll: i l') r r lr r
\.|\ i\1,\',,nproixitt,csl,o incapl,cit:ttea de a orecuta mitrc5,riailecvate unrtl l r, l ,l rl ri r i r,;r r r ; r r t ,
, rrr l rl ' i r ir lt por '1. t lntsi, ne : I sjgul; m cL bolr r llvt t l t t o ilt {r r lr '4o' it t lr 'r r r . il'
rl ,
uoo1r,rlr;i lrolnavul nu prezintl parozi, tulburii,ri de sensibilitate, ataxio, l) o &s( 'lt l( r t lr . lt t r r t t it r lt illt t t it l
il',
rrrr, ' l ,Lr\i (' i r in- t ir t a, r claqit inlpi; i af : lzici
rrri,r,rrli i rrvoIttnta,l'ouou tnlburilri psihice. pt t lzeli{, t li t t t lot t lr r . t icillr t t r r t lolii r t i'it r r t t l'
Srr sl,irroii roalizrlrcl unei acliuni voluntare in vederea indopliniril 1,,' ,t,1,,1,l rc t r lt lt : t ,nu gr '( lgi,a, sr llt ll,
i , ,, ,,,,, ,, t' ,* i i, lI ult r ] r 'i. ulbr u llj t l t : cor i'lr n l lt r nt t r t l, t lt r a'( r t r { ir r 1i t lr r it r ilir rlr r r r '
rrrrrrist,rp lrlrr,vrt su rlestiiqonriiin mcd grailai;, la trei nivelo succcgivo r t l. ( ' a'r r ( 1t l i'oilll lr llr r sr r t t r t r ilr 'r r 'l'r t
1,r,,1rr :rl l ot lr , lir o! 'iuuin( rut 'o- Dsihi( l( l'1i
(f(r,,irrrflrr', l1)77; Zl,urvill, 1960) : Primul esre nitselulclnceptwul,\L atrL\ 1,' ,,,1,,;,r' r ;i I ollogt r , f ico.
irrrliri,lrrl i1i pr:opunrii-li stttbilelto un aoumit scop al acliunii motorll
r,,lrrrrlrrrc,i1i rrlrrlrolcn,zri o schilii,,o schem;ianiicipatoare a actului. Al
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 l l " ; t .t , I ) l l M l t l , l ,(]t , l N I ( r l ,A
l l , l ' lA l ' l l l x l l ' l l
Irr',r,,',1,'r,zri
irrr. Lll,c, rr,rr,cokrT lirnnLrlocntir sint colo ma,l aalccyaterealiz'irii ac{,iunii,
tttl tt tttl tt
rr, rl,rirrlrri 1r,,r1rrt,r. A1 i;rr;iloacsto ni,uelali,neruw!,i,ei n otori,i,ccntrillu 6l l ', f l l l l l 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
tl o l i l r r i tttl l r r ', l 1 }7 7 ) t cr t'ttt tr ttttttttt
lItl if|r'ir!r (f |l inllrLr'{Ji,
in joc * sistolnclor rnotorii piramitl',llc, extra,pir'&mi" - , 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'
rlrlr, rrr'r'clrrllr,so si spitlrlo), ilalo conourii lll rolllizlurol ac!iunii vrtluntllt'o, , , 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
i r l t,l r l o r r 'l r r "r tl l r | sr t ( r l l l l r o I t i r 'l l l '
l rrcsl,rrlilrt,I'r'rlrirl roztrlt;i't, v it ir,filor: oolor l,t'rrl
lr,cl,i
doci, rIit irnllirr,llrlit, ,1, 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 , , l 'r 'l l ttttttti t'tt,,r r r ttl tttl tti i tItr tIttto Iu t''
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
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 'u ' I I'r 'l r l l l l l
,rlr,rl 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
r,rirl 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 " | ||1
l r i ', , r r r r r l o t 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
tr.lril rll irtrprrt lrr t t lii.
:'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,ri1 o c i rrl r.orrl
ii ri l c(,i rLrr,rrrrtgrrtrtrr1tl1q(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) $o l ,nl ,nsunt, s(,l l t,tl i !l , , , 1 , r , r l l r , rr ,l r l ttl r r u l r r r :r l r tr ,;r ti ttr l ,r Ittttr i tr l ttI l |) l ) tl l r i r t r t'ttl tr :t,l t ttl i l r , r l l
rrrrrl" ' r ' ii, . r ' ' I : r r r r Iir1.r...:r' r' r' ;.rJ i i (r (l { r.l ,l l rt(' l .1rrrsi i(| , r,i rr..r1l rrl rl r,l ,rs;,l ;rt , l r r l , r , l r r r r l ) , ,1 r . l r r tr r i tr i ttr r t;t r ,o ttttl r r t'r 'l r t tr tr ti t ttl i o l tn r r fi i t tI t,t I rrt rr : t I rr r tr l r r .
| '.l l ||r I rI i :r' | {| i Lr'(:: ! rrL rs l ' l i Ii i . |.l)ol l l t fi , r t r , t , r . r t l r . r 'r i i l i ( ,r l l r l r ,l l l r r ,r ,Ir r r l r ,i l r l l r r r tr l o l r r ,( i r r tr i , r l r : l ti l r l i i , i tr l ttr r l r r l l r r ':r ,
l l ,o r)o l lIrz
, i rtni l t 0ttri srb| (} i rna,j 0r' tr (sl i i rl .gt;
\1or rt(jru)rir,rr,plrt,rio bi lli,l,olrtlir,, llr. i,ulrl lczjrrrrjlu corlrrlrLi ctlos srr,u rr,lri , 1 , , I ' r | , r r ': r , l r r ,u i ttl r 'r 'r 'r ttl i t, q l r r 1 1;i r r , , 1r i t r1r I l t t I I |,) I r r tt tttt l tt i l t'l tg , l l l t,tt r l r r ;t,
.rrri rl.r'.i ririrrr.o (rlropto) relLizurr,zir, rp.*lie_ urriJll,cr.al.i stirrgri. ijupt ,,;i,r; , ', r r , , r r r l r r i r ,r 'r r g sr r ,r rctr o !ttttti i , si i sttg i t r l i tt ttti ttl ttr l tttto i r ':r tti , t:r tr ti :r ,
11,y1,,11 1l1rrr,1lrliio0rr o lozirrn(] a, rrnuii.r,slln :t alhtia alin acclti cdntli, ;si$irt'l 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 -
la llifcritc l,ipuri dc apraxic: ideatorie (lozirr tr,l \ | '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 i tIcr IIttr tIo t, r 'r r r tttl l t
nea centrului ideator parietal), apraxiLl rrrrr 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 ,
lori,'sau melokiueti,d, llcziu'nca conI.r,rr I I 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 .
ld{'L,nlolol ) $i irl,.omulorie (lcziunoc ciilirt'
.tro uu{.scr.ei dei c,.nlri) [fig.36i. uxi*trr, ' \ ; 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
'
binointplr':. .i u,Ltn forme - clc apr.rr,ri,,, 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
seiniologiit crirora o \rom exp lre in (xll . 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
l,lnuale, ' ",l.il'
. ; 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
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
I. Apraxia idcatorie. ln aceasti lrrrrrfl 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
este perturbat insuqi planul general, lrpl'rr.
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, r. . r / i . S c h r i n a d t sici a lu i
zertilrea generalir, a, executiei actului, r,tl 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
f"i(,pma[n: incapacitatea de a utiliza, corect obiorlr,lrr 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
.l i! , 1 i , | ! r i ) r r i e h l t s i hg A; B:Ce n -
r,
rL, .,' ) !lil slingi; C-- Ccltrji moldi
uzuale. Clasicii inl,erpreta,u acest feno||r{,tl 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
rlir dreatta, cil,o ,,uil,are" a formulei kinelice, ca o ,,uitllrrllr 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
a identificirii simbolice utilil,are a obirrr,. w, ,i 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
irrlrri. ,\r. fi vor'l:a de o n,gnozie_cle utilizare a obiecteior. Apltxln l , l r r ':r \i o ( l o l L 1 ,r ) ,\i l f;l r ( l o l o l e ( '.
rilr':rl,rli'rr.ni,ci,llroa,p,jtol"dorr,irna bilateralzi ;i se caracterizeazH, prii rr,ll,rr \ll, , 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 .
r'1,r,.1plorrr.hrr cato implicd, utilizaTa de obiecte (migcX,riletr-anzitivrr), 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.
It,,l r.trrl l, .l,L;,.uIecul I acte rirnplo,dlr nu poato ln6nplini x,ctccomll(,\r,. ', 1 , , 1 , , l , r , r ! l l r . r',
rrrrr , 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
,\si,li,l, :litt,clcparrialc, elementare (hrnte iiotat) pot fi execuraro col,or,tl |, | , 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
rl:ll .,sr.oy1.11f;1 Ior lo]]ici'r,, a,rmonioac;)'estc tullruraLi (Zaurwill. I tttloi 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
Iil, irrrlL,r',ll,7/). Urrlll.i lrtrlnavulscoprc<tulr primuI acbeleinenlarctlri 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 , i tIr 'ttttr o Io t i c i r \ r 'i r || .'
i:r,":l):Lll,. rlirr c'r'p,rzifiir,{(.ltul i o'ilou}t. Altei'i. el nu r.ospect:i,0r,rlitrr,rl '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 ,'
rrtt'rrrrt.r,:r,gi.sl,rrutor.I)ezordinoa,este cu atit mai exprinatt cu cit {[(1l,lll ', , 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
(;1rr:rl,rrl) s'licitlr,i,ostc mai complex. pacientul nrr cste-capabiLnici sL irrrll,it 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
r, rriricrrl!, l)o (rirrLro dclatureazi- prin bulversa,reasecienl€ior gesLrrlrri, ,r l r ' l r ttttt.
'.
I,'r'rr :r,r',..-ir' 1r:r.l iculr,r.itir,!i,apl.,,&ia idcatoare (ideatorie) de difei.cnI,irr,r ri , 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
,1i , ,, r i,l(.,,rir.r.Llrir,, in clrt. qi gcstuite simplo sint tulbural,e, datirlil,lt i,rl' 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 .
r r,'i Jrir,nsnrisii(lefcctuoilse a Comenzilor li centrii motori. , , , ', , 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
'
I ) . ) t i , s r r L i ) [ t ) i t llpr.lricul idoator pottc sL irnite mi$cili 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
nu Droa (x, li
I l, , , i t t v t ' r ) l n i r , ';r,l)r.i,\;r.ltl j,l'o norur nu po,r,r.,r'ca,lizl rrcerqlri pr.r.lirt , , ! 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

Irr :r,1rlrr,r
ii! idol,l,oricbolnavul lccirno&$le)irr gcnet.&l,obiectolc D0 (,lr1r
ll, rttrr ilri, Io titin
i, I() ririnrriascii, darr runeoli
r r il, s oi, . da, r nc nr . i ractiilnile
nf , ir ' "i ] " si,le
o i . t ^ creoaz5iirnprisia,
'- ^ . i " ; , , ,rr1
.n | \ u r : r 'ri r r ttttl ttl ti l ttl i r ,;i si r r i tl r tr xi l i tto t'r i tl tl ti t r r l r r i l i l l i st. l tr ,
, \r. , ; r r t |l i. r : t 11 ,(i ,rtl ' g ra lrl e _ :rg l ]Oti C .D n ""^,,."; , 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
pl [, l A
' ,\ct l rrOU fti pri rrrl r.t.l t 1 , , , 'r r l r 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 ti l ttt tl t, r i tttl i r tr l l r ,
'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 , 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 ,'
r, u a u , rrtri'' r irrllrr,rrlr,ltilir,
1,l"ri'll,rr,
': 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 lrr,
{,ii, S l,r Uu
l tr:trl cLrticiI sr.rrrinc,.,r,r.ri,
r,lr n([i r] 1,rgi
r r r i r J r r r ,0 r r lr i! ir
sir, tr lOl; St.ll
l,igira tiu cl
l]O^ l!l' Cu
_tI,aO11 clrilrlii,rrl rrinrlii,
tj l )t,i l ,ul l , r l , l I , r r 1 r o r r ,l ,ol l i cr r r r l i r r
rrrrrr,1rIirr|,
srt,l.,irr finlll, lnl stin{r. <.hiIrIi|,rrI.
llri lr,tt,l,csi,"rocot na,tulrt,l rln l,i L | , , r I r | | r l r 'r l j r .sl n l si i r r ,;r |sr Jr o u r t l r ttl o tt. N Ii ;r 'l i t'i l c r l l l o l r l i r l i , l ]l l r l lir
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 r ' | , 1 , r l , , l : r ,l r ., r 'l r , i r i r r r 'l c r o l tr tr l r r ,ttr . ( 'i tttr :t, r tt'r 'sl ci l r r ttttr r tl r ' :1 1 't:r ,\r i . 1 1 |l
(lr),{l.ilt1,i,
0 l,),rll,r rrrt1ilr,r,l:rtil,
o gtrrrrii,,
rrrrlllci,l,crr o clulirr;o lrrlrril:lr.rr , , l , r r r r r . r l . r ,l r u i r t, r 'r l l r r r ttl r r i tr r r r l o t l r l i l tr r l ttl r r tl r l .
lul,, rlrrolrilrr.il,rrri.. 1i ri
Alloi.srrsolicil,iilrolrrir,vrrl
sii, irt irr nrirrr'i,
lrtr r.irrrltlrisl,rr \ 1 , r . r . r r ; r, ttr r ,Io |'i ttr .|,i r r i 1 r tr .r i ttIi i , o l r r 1 to g l tl l l i I l o :ttl r ' Ir t|r t,Ii :zr tIi t, ttr l , t,
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 | | , , 'l , 1 , , L r l | t||r i 'r o r r |:r ,r i r tr r r 'r r l rr r rt rrr' t I I I r r' , ;r r 'rr l i l Ir i r r r :t I|Ji i r 'tl r l tttL tl l r r ,:t
l l '. r l r , , r l r r ,l r , r,, r r rI r' rr I rr I r. r' ; r | ; r r r r r r 'i l r .r r tttr i r l ttr ./r ) r i r , Ir r 'r tl r 'i ,,r 'r ,
 t rr t L l |) , lr r r poI r ilr ilillr 'l'lr r r ll t t '
l ri ,i ,rl rrr :rrrr r r r lir ,liili. i, t t ili o I ' 1' :I I rt t :r' . 1t t I
{ | ,I l t' l r|, ,,I | |I ; (i ) . r \ l i ,r' t.i rz tr Ii trrrl .l r ,,.i ' r,rrl rri rrrr,l ,rri rr.,' :rl rrrrrfr.l ri krr.trl r,r,.r:rrr.tt[i r 'l r l. : l'l lll t r ': r li'/ lr 'r r lr r lllllii"
r,l rr,,rl rr,r' rrr r t lr r i( f t t lt l 1, t 't t - ; t , "'i'r li,
i i (' Nl, ' r ' i. |r. . 1. r r ri l ,i i l i l i rl rrrr(,i rr,1(,\.j r.. tr' i .rq l ,,r.t.:rsi l l ,1.l ,i )l L, l {l (i t). (.l osl ,u;:l l ;
rlrv Jrr Ii1rsi1,0rlo t t t r t r r r ( r ' r El. lr s r r lir , r iU,r r , it r r l, r l r r i l j , 1 , l i r , r . , l c n i t r c 1 1r l i z i t t o " , I ,rr rrl: r , f r ilr l t t t t t lr r r r li. / r 'tt rlt lt t lr t t r lt t ''r ''i. r r''ont . lt , u, t lit lil'llt : I t t r 'lr t t \
,,r I , ' , : it t 'ir . 1t : ttiit t d't r . t t it t 'r t t . lil ( r lr r r '11lr 1 t t r r r 'i lr r r r r r t t r lii)
|,:r,r'Ir'IrLrIIr,;Lo cu,.;li0r11, (,ii, .,l] 1,. lrirt1,r. ,,1,.r,1,1r,r, srr,U,li, u |'r,cul o u:oit,t,o. ,t " ,,,,,' t,, i ,, i1ii, t , , , , ', : , lr
,' ,f,,,,,,' :,' r;I il v", , jl', , t , , lll{i2; I 'i( 'r ( v si r ''r lr r 'lr 'r11l{; l) ; l) r r ( r lsilr g f i r , . lr r lr ''
r r r t lr t 'lt ll) {i{}1
i ;,' , - ,,,,u: '11,t , ; t , , t iV: t t 'ii, gllll', lll{ilr ; - A. ilr r i: r t lt r . r r ': L'- isi
r 'iir r '{i r . lo lit . 'it r r lI r ', . l! ) i7) : r r ) / l]' ) t t t 'I t t
l ,' ,,,,' l ;' ,l rril r 1i , ", 1r , li. , t 1l( i!
lr t llr t r t r r t i
1.,, t,,,, t,,,, , 1, t : nr is. loiilolt it r , t t t l. ir ( siir r gi, ) Hr -r 'alr , '1r 'r iztu, zi,1lt it r
r, r r r |, I : r 't t i't I t t ;
i lt t t t t lr t t t ilt r lr ii' lir ot lt r l, t t t t lr r lr ir ! r " t t t
trr ,l r -,, . 1i ''t "'t 11t lt r ] ilt
,,,u, ,, 1,,, , , , , , , 1, 1, , 'sl iiir , ii, 1r r t lr r sr it r r llst 'lt t 't lla'i'ic . ollit r t 'lclor lit t r ; r lr r '
rri , ! , ,, l r ( li ii{ l lt r r r l) 0r 'r , . llr r l, ir ii ( 10 r ': ur r I silt r lr lilit ii) ' l) f ilt l'r 'r 'ir t r lr r
l't t lr it lt llr r t t t t t l lt r r
'1. rlpra,ria colstrrrclilii a iui l(leist consl; in imposibilitatea do I 1,,,,,, ,,,' r,,' , l, , , , , it , , r i', , : 'ilr "'f i lt ill iisot 'it t ll'l' adosr or i
fr, I l r l l tl r r l/ t ll, ll ( 1ll it t lt zt lt , lr , it t t t t lsl'it it " ill ult r u't ir t t t t u: t lt t t t lit 'ii 1'tt t t
(.)r'rl{',,,sprr,ri*[actolo'rotol.ii rcce,s:]Jru crci!,tieiutei ,,foime,,, Ita se lrrlrri. r . 'ir r 'zi' lr it r r r li1'r r r r 'r
;,' ; ,i , ;,i, ii'r 1: , r :,:,ii. it , , iiiL"uir i, i ( t lr c: r '1r li) , 1'. cit 'ir 1r . r l
l{ r$1ri rnlti al(jrjin ir,otulde a dosenlt,,}il tomanclri, o Iornrai,
Itrmiii getrrrretricii,
geotDetr'icii,(p,Ltt,ltt,, ( '; l{' t t li'lr : " r lir r t 'r r r t r r r r ll''
{pLtt,lll,, ,,' , t , i. 'i, i'r , : i, , 'r i l, 't ' l, r r r r lr t r r il'( 1 ?, r r r 1i'
l,r'irrrrgLri,
..r'c .1,c.).f.i.ii;lt si desc..zco fafl o'reneaJoX,,
up.^"i",ii'iriiii ", ' r sl' I r r '. lr 'l t 'r r 'lizr r r r ': r li"t ' t t l"r
(,1,r :, r,, , r r r l ir , 1', r ',1x, r 'lir ir ' t 't t lr osibil'
ril,r'll(,1,r
iil,r'u \- alu[(]ii pc lriltic
alu[(]ii pc lri|tic la
la hazard
hazardlrngmeltelc
lrngmeltelcfclei,
fclei, fir5 a line seamil,
tlS r llr r r t t t r r ': '1i. I
1:llr ' I I ' I I I i r | I I i : I I i | ll' r 't r t t lt t t r 't
i .. .' , lr ' , l, sl r ' '' ''t it t : lr r -
jlir afir.rir,ror,,rL. La fel, crnd-i se ieri) si, deseneze
t',:,.]l].-1.]J,l.1l,t o cu,xttr, i ,r". lr 'r 't : 'lizi r r zr t i( 'r r ll( ll( i( r lur r '' I r t t li ' l
l t l l r l rl t ' l{ t t 'r r 'l lr lr 'l r \ ''
{, (,irJrr.iir/r,T,u.tr t.od analug-, Lronsl,luc{,iado figuri geometricc Sau de lil,old : r l ll
| r { ' r r l( . din br ' 1 r.l ,t.rL i L ,r:i t ,,,,, ,r, r , rl :r r lr ,*1i lr r lnlvilol ( i1 l( . zir t ni ilLr it nisf ot t t i ll{f ( l{illlillllt llr '
A}rl}\lil' constructivil poirl'rl g( 'r lt l'alo I i7'uopt ''t '( '( 'l) lt
it llo ( lt t it t I t t llr t t t r r lt
Ii',:r
1i , ir
,.,..,ri.,,.1
.r,rr lizr.L,l,il, rtit .,r..r^-i.,-i ^-,.1:,:,"- it:il9:1')rld' qiire?tc.
-+i{. rle Lcziuniemisfericc.stlngi, cii, AsttA, in teriuiiiiii
,,' ,, ,,
' ,' ,i, , , 't , , i, i
t l, , i lllt r liit iI t '
l) r 'ilr 'r r . lr \
.rrislcr.i stingi,
|rnislcrci I !,,, t.l r,rIr slt t t Pt it t ct lTt t pot t it Lt er le agr r ozi| lizlr oslr r l1, 'ilt lit ')
stingi, apra,xia
apra,xiacorrstructirii
corrstructiriise. se.manrfesti,
manlf n'in im,osihilit,,r,r'rr, t,,,r, ,' ,t,,, , , r r lr . zir ir r i ill( i ( , t r iislil. i ledut uir n nl{ sit t i r r t r r i llir gr r r r 'lr lir lr ' lr
rl, :, r'r.;uli:rir, r.hj:'r'cr l. mri simplu ,rbir(.le $i tjgut.i tpAlr,at,,dreDlunslll, a r claljik) r sl) l! 1, ilt 'lr ) ) '
r' ,,, ,1 l ,, rilr , i( r ( r lovr , t lillt l }it lr dolc {l
ttrrrrrslri.r1.,i..,.r'lr..c clc.r. ln leziuLril.t.rnist;.r,,.i.lrnpi". tr l6r;,;;;;-;J;r;;: llr l lr r r t l
r i(rr, irrl,rlrcscazlrlrai alcs dcsunelc compluxe, cvidi.ntiindu_se tulbulil,r.l t;,,l rrrtii r . t l lr r zit t r ii t lc t . liiisl( r lil donlillanlr l lnr r r liol( r r 7t i llr r ) r l(
( lcziuni d( ) ( r t liFli'lii I |I I | | ) | | | I | | i I t | | iI rrrr I
rlrr rrliutLtr,r'r_r spatriali,a-,,cle-mentelor'-constructivc,,, rlisproporlii qi r:l1xrr," ' ..t,1, , t,r lir r r l llr , boht alii lr r
nr ot l' l si r l'r ''t r t t l Lt t r olilil: t t '
1rr i gr,rjsiln) :r,k:diversolor €lenf.ute dc cunstructie,'irnposiEititato de i.r,l, ,' ' l r r l', i, it : ilt t r r colt it t t r t ' t ilt pir ' r 1'lr "
r 'it l' t r lilr 'zi ilr t lr r r ; r 'lr i r r . l lr lllt r lllt r l lr
lirrrrr. rr,lrorspeclivei spalirle si, dc multc ori, neglil#ea pd,rlii stirqaiiu i ' r,," ,1, , rr r ir t li't it iilor r r illr r t l sr "
r 'it t 11 iI t r clr ' : ull llt r i l't r 'i | | | | I| |I | | | | |' t' | | | i I
Iirrrii lcsortctive- r, Ll L l t,lr r ir r i t 'olt slt Lt ct ivt , lt '
l'r,olrtilc tlo dingriostic seilioJugic sint reprezunt:lte do probcle rln ,,," ,' ,, , , , , ', 1, , , 1, u1, lt r,ili: Ll'- I lllllir lllilit r "t t olt r t 'lit 1r . t 'r I lr r lr lr ll''' "t '
" ' r1 I t r I lr '{lllr I l( r l/
.
r|l's.rr ;i d* .o'sl,rur{ic rlin cuburi,.diu belc dd chibrituri g.a.-Se solicilrl, \ ,,rr r,' ||, r 't il. . l{lt 4) lll lt z, it lnilil om i$f cr ( li n( 'dolll illil t l lt ')
'
il;il,lirlrL)sc|larcila dir.erse obicclu, iroagini figuri. tr-,apiobele rle . , , . r.'r l. r r , t ,r t . , 1ll1l11'] 0}i Jir t ic elt lir t ir l, t lalr n'iili t t t r t 'i , , t I r lr t r t l, . t t t t
;i urtr. " lot t t r lt t t r 'lr t r r l'
,irrrr'1,i.s. snlicitii pr,cio,tur si' culstruiasci, din;hibrrturi'un triunghi, riit , , , ri ' ,, t i, ii Np; ! il, lo" ( Zlngv'i11,. l lJG ())' lr r : t lt t lt r , ir r
r ' r r ''r '
pl I r';r1,,rrrrrltt4rl,ulghi eto., sii,construiascd,din cuburi un scaun, ui girrl, ,," r., i l r'l, t , r i't , r : r lr 'r isi ill') 'nclilit i ir lc lr r ', l) ( r r lr r l'r r ' lr t lr "'|lr |t
'i, ', , , , , , , r lr 'f i. it r r in , , s'r 'ilt l""'i r lit . r 1'r 'r t {i r r lt lr "r r t r r
, ,'rriir, ur) l rLurJsi lc_cofirpun;iun orlr d.]n pnrlile lui componeirte
tIial,,i ',",,,.,,' ' i ' ,,: 'i 'l"r
r: r ''t t t r I t i'iUtt I r |'' r i"
,irrr .r11.rr, sr-r,,kragi1 din1,r-'n 11'I Xr dc be.te-p6celc cu dhiensiuni cg.lrr, i ,' , ,lt i'*r t , ii't ; , ', , . 1, , t r t t r isilil r lr opt Fit t l' rIrt I tt It Ii II 1 t ; i.
', r ', ilt t l't 'llt r : I 'r r lllr llt r iilr r { ollh1I lt r 'lr \ r '
r;rr,rrrrrl.lrrzrrrlirL plastilini. construcl,,i,r, tridirnensionald,se testeazri'irli, ,t,' ,,,1,.,,,,r ii, : i1,lt, t lt r t r pl; ivt l spl, i, il
,i , ,, i ,.,. , iii, , ll ir , lr lalsr , : lzii in cur r l, , . , r l lt t r llr r r |ir il, r r t . ' I ir r r lr r r .riii r lo ; r rr . , .r . . ,
,,r] $rr.r'(.pr.odu{,,X din buci,li rle lemn de diverse foruur lll{; ii; lir '( r r r r ll|r '
:.lli.ll:1.,t','1,1,
rr:lrru. rrl,,tr.t(1. 'll rlrlcrjte, sau sJ, transpul_rd, o iruaginc bid nelsiorlr,lil
4{ r,1,,1,,r. r r i/ slr r r ir l, t ut r ol r . 'r it r ( 'Air t liir 'gu0t Tll osi ll'issol'
rr t,r!, (r,tiilirll.lie tridimension:r,Iir(Kreindler, 19?Z). Testul lui Abcls,tt t , i l
r , t )t lt t l) t l : ; t ] t t l't 'l
(rl.lr;r l(r'(1i')([lr)i,1.97?)co'st;, i' solicitarea bolnavuiui de a marca pilr.l,uu l , rl , lllir r lir r i, t l, t qlt [ dii\ t . in. diuSr t oslir t r l.st nit , louir
( r niisl( ii( r i I
I tI tI t tt t t i t tI t t t I I r ir l|r lr lr ') : L|r ' l: t
,orrrrr :r, l,rci tig.trli goorrrotrice suprapuse. ' , ,' ,, , , i, , l, 'i lr i t ' , , it 'r t it t ' it LI r t ir r : t t r '' t t t t t r ; ill1: 't 'r ''
{1ll ill) l'll\ ill' t lt l
llrrl.rrrr,vii.crr rt,praxieconstructivi, comit urmX,toarelctilturi tle arttstr,ll ' ,,, , ' ( ot r llllt l( 'ilvlt , st r it sr r l'ilt zi' ( t li( r t r r lr r l
, | ,,, , i, i , , r i, r r r l, f li r . u lullr r r r iili illiir r r r , r r r r lici 1o|oqlr licr
(rlrrlr;r
,lir..irrrllrr',t977):-a) Conturul.clcsenuluiap&re nerel'lat qi'irrt,rrr, ; ; lr ) ir r l' zir r r r il"111i I r I . 'i r l r rt r t i t r t t
' ' ' t t ir l't : r '\ i; r ' 'r 'r '
I lr) I'rir'(ili rlt:sc'urui sint- grcgit asamblatc,-putirrtl Ii izolalc lrrt,r.rr ' ': 1, iili, i; r t I r t zi" t 'r t t r . t ir t lr t ' r lo: r 1r t t 't "
'rrIr,t,,'
r'1. 1;1l,r7i;1, rl,:\,.1r'l'i.".J ,,,,' r,, i, , , , it n',, i', i, , , 'i, ut '" r t t r ; '1ot r r r '. t I I r
; C) I)"soUUl(.it,. 11.irl ir:r,t- mir,isirrrplifiulf,sr:t'," ', ,
,,1, i ,,' ' , , r ir l'r , ot t r oI ot ir : , t 't t llit 't lt ''t l' ( l (' t 1 : l l ri l l l l r l' i lt t it ; lt lt lir '( r llli lt t lr r l
rrr:rl.r/:r.t, rrr, rrl.r_rrrl rI rr,r'ii;.i r.rtliuii irtrr rslul.c,riirr r,,t;riirnrti'rnicislrtt rr tl
l , , ,' r rl , lr r r r lr r r . j) .
dJ t)ctirulr rI.rrricrrtrili.rlin,r.1iuirrr,lu,ut,,,f".ui,,,i,ri
flr'l
:| ' I i' iI(i|:1,,lll .rrro'.1,'IrrII
|.III||tIi ,') Ift ln) lr I . lt r t I r l. , r ClO Silt g- iUt t , t l . S r r t 'i S t l . l \ , l . l r V r U . _ r,i
i t' 1' l l l i l t' l Il r"r' i r/l l l rIl l
OfoSS (lllilli, \r, r. ti :r IrttI rI-l :rr,i Ir|:r (5i |ItII It-[rrt"i o' Ii IrIIrIi I|:i ]
.il;r,1il. l(r'r:irrrllr',r, ll)7'l) c,rrsl,ii, irr i,rrrulin!,rr, rl'Ir,,,irrI,r,ir,'t r 'lt t t r l: r t r r rL
irr rrrJrtol'ryi rlri , ,il; : ; ; ', ; ; i, , ; . ' t : "lir 'i t t l t r t t ur it lr ' 'ili ' lt t r t t ''i'j'"t i
ir, ri r! , ,rJLI I ) r'I I | ) | I I rrr' ' iuc os l, t r it t lt r r : n ls r r I r ' rr ir , liz :r . j i tttt l rt)l l ' l rr rl l r rl r L
|r,r,iirlru lr,L
-J,, r [ r l i r r or l . t l ; r , ti tl l , i v o
I rl , rLr i r l ttttl rrl l l t IIoIi I i IIutl Ir'
rrrl ttrti tt:l l ot
' \i l l
ttl tti ' l r' l '
llirrr'rrr.rrrlr,rirrrril,
si ,,l.i.ri,rl. s|:r,(.i,;1,r1',);.) ,.,,.,,,.,;ir.rrv,,,
prr,.i.rrl
ttl ru 11\u1rl ol i i rrr:rl orl i rrl i i ,rrr t' t,ttl "
rrtt f r lf rr:r,p lr,lrilrilr ,r , |pr r ) llt t t , li, t t ir , i lir |r r I t , r . r .: t r r t l r , i , l i r r r I l : r , r . , , , t , r 1 1 i r 1 1 1 :,,, ;';,, ,t,,,r,,,r,i j ,rrrrr, Irr r.Ir1ri l rl r.,
111,,11

:Lli
 it,;;;ir|;:";;i'l,lliill,'r
l i ri l u l
'i' lli"l;;l,ili
| rI i {|r'rr |,,rI I rr i , l l 1 rIc s rrri ,i L rrIrri
,,, , , ,,1,',. nir/ nrx,ir , , it i, I, r ll, 'i,,,llli 'J','1";',;,,.,il"
rl i rr l i rrrbi i . N rr
,,ll:i'l;
ill,,,llii;,,,lll
I lSl, lr lt t |I l) , [ . N l l p O i t , L O t t i C i S i r , i t t o l L i t l i l i t r 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
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 ,.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
{ Ic nri r,sl ,i (,i rl i r! tt. ,rir,sl,i(,irtir!
, l] ', , , , , ' , , r r , . r r 'i rrrl r.,rrr
rtrrrri;ii /su ,u ,,,r i rur clcu;",r't itil;;;;i' ;ciiri _l' i,' Li,il,. , ', , , , 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 ')
,,. ., ... rrrl' r grrst[| 1,u lil,ului,,a.[ str;-r,nu1,ului,
r r i, r ; r r r u r l l , lal l 'l respir.ll!;ioi
r . t \ l ) I . i l , l l r . t prol|.r
p r u l t ru
i i ' . ' l r u r r ( l r i l ( l [l ) l r tr t, I1 ) l i :]) .
1
,i ]'.,,,.1
1,...1,1.,, ;-
',.1;, | | lrr
lr,
,, , , . r1 ,ri r.irr b ,u L rri.tud iu n;Ls.I' r r cor ri iu
'I i
i .\ (i,! ',r1l,,:]ril{
,,lrl)ls. ll,.lll. ;slilu
,l.
,:tn
I1:L:;uI.r
i ,i. iul ril:rtulrriintr,o lurnintrc. ,t,
1r ,,:r r ,r 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
Uuiuairii,,r llrrittl';rrlttr
1"'l r.r::lLi1,i
[:].uL'rrr,'rliL,
drl,lizbutrse si"r,
inghitii,lnrnoJrenex. ".,..f,i ' r,, .i ti. il,lltlt,xirl t.trlooltirLtri.;ic,i, lollllizltl,i 1xr ttttt;.ltii
l]ac:i, bol'*vil 'rr:r 'ii,
, 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
. . , )r\:
l||,|| ,:\'i']i
.1;'l ) - :':'
.i: t rn i:9lt'nu . I)c IO: ,te rnUlLeori apr*sir bUCuf*r,i;Lll
mod itutolrru,l
rrr
l{fruLOGIC
11.4.I)IA(iNOSTI0
,',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 lrr lrlruclir,ii,,:tplilxiile api:l,tde celc mil,i llullto tlti itr lt:'iurtr t'.tt(ttlttt'
:l LUe.nt1,lc,1960: K'oind.lcr.,tgll; Ar.seni;i IJ.l,rz, , ,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'
ltt0{)). P..tru rr,sr: prod*cc accaiti, apraxie, trebJie
,ll)l)!,, si, exiite rlrrrrl, ,,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
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, , t't,1,), it\ I {d,Itrnat'i's ne ar&nio-urebw,Ia l'1.,.
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
.\ p.rltr irL krziuni dc rlivcrse ulturi (_intlcosebitunori) ryi Ae asincigi".
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
l]1,l),ij,,,ll1l.r:l11/ q
|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,
r'||)!,;r,,/r,.]. nasul Oe toc tlri
*t,rr rl,,.prrnrl grcrr picioarelctlc pe sol, iar lrunchiul iimin,r.irr
rr'rr,:..,.\i t,r\:r.il1ruil,l)rir\iu mursul.,i u,pat,e ln Ieziuni liniloosebitumorllrr)
111,rrkI,prtlon1;rt,'u car,' irnp-lic;
:111 ',,',]1,,,1 $i.pllrtca arrlerioari.a corprrlrri
,.rrr, .,ii. ,'(:r1...r'rrllin ttenlie disc€rnii,mintin iclentific,areaacestei fbr'rrr
r'.||" ,r" :rIr'ir\ , lr{:n1 -$i
rLt.l'urr li cou[undald,cu lipsade iniliativl
p,.trlrrl, .rr rr,1;lr,xiN 1i dn,torrrr,r
trunchiului a lui'Brun.qsau-cufenornind d";,;;g,ni;i;-
l;].,1 al.mcmbrelor interioar"
fali Aeiol, cliiru,.
r,.r ,r,'.
r,,:l,.lll.rl.'tj'ir.,ra,or:r,iion)
rr ,,r's tr: rrfe p.rctroOtalc
(Kleinrl_lfl,,
1977; popovir.iu qi'Aggirlrr,
tr)ri; \t,,y{.r.pi ttrrrrunl 1900, citaii a" XrcinUier,'
fOi?;".
ll. \pr.rrxia rlr imbrieare (descrisi, de Ildeaen) se caracterizeazil
rrrrprrrrlrilil,rr,lrt, pr.irr
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
llli,,
r'r,,,r"'t ''r'iL('.'r.'rlrr r:t1
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
,\ jrtlirr,urrrrlr':r,
ll)51), 4i

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 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 '
L' , ,', ,l ,t l ,ttttrr' l l i pt ttt l rrrr' trr' l i :rrrIroI:r' Ii i
',' i fi "
{ ' trv rtl ttl ' ' i rr rtrl rri l rl trl ri ' ' rl rr' l "rl i i
l rr I t,.: rt, i tLi l ,i l r,l ri , trrttttrt, l t' r:r' 1 I r!\ or!
,' ,.l ,,i ,''ili, ,i', iili, r r 'bii, r 'il, , r 't lrir it Lr lr t so .l ) trl ti i't li tt t l : t 't : t r rLl
t 'r r
It ' ' ,, : t 'lot t t r t l'r icil'r r i't rt o1'r r 'l'iir r ir 'qlilvr r 'r r l'r i' r 'r r
il)
, ,,r,,,i , , it i,rt 'r o: t Lrrlir slr r I io r '" 'r isivii' pllr l; ill r t li
1li " ' " ' ,' ,,,,,,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
r lr r ( r lr rr l r r l
' ; ' 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
( 1 0 co ]u i i p r o p l i u - zi 'l - L ' tL 'r l r L "'tr o tr ti i ' I r .;1 tl r r ."
r, , r l | , ) l o {i( 1 , In ) l ,i n to l t ;i
tr-';cI :r'i;i1'r'rtrtt'Lri rrrir'rlrrrrrrl
, , i ,;i;i--;,1 u,,-.clt'in't
,ii,,i:irL,, .rtr'ri."lll]]1.*"'"
1 6) I'RO|JLEIVIE
DEDI{G],I0STJC
ilVtuliluRnnrr.t: |;
LLt. DE coN$TTENTA(ctrNo$Til\TA) : ,i,ii'illllll,u'l"i';";ll.1,,Xin"."s'',iil
,,i:1.';llll
';i:"T;;
i llll"
l;,J"l:li'J;:l''",'
r"rr.rrrrrl'
i1i,,r',:t..'1" tr"
I ,;]: ,,
;Ji ,;.';"; rrri ,,ri't,i,. l)e rr'suti
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
It "" "i'*iriJ"or,, 'rzirrrr.
1I. I. PRINCIPIILE M]ITODOIOGICESEIIIOLOGICI, i.n cuvirrl r';tr
ttl..gttr' '
l',,,r,r,,ont c1ecom5,irsiarc ori$irel "litttttrr"''"rt ,
iirl'i'rr
1)B DIAL.INOSTIC IITIOTOGICSI TOPOGRAI,'IC ,;ti';,;il-;-t""0.'1"p'r'r'ot'isi"ttlli'::.::l-.l',lll:1.rt'rIrltl'rt'r'(rrr
illt r o. iolt r lI ' t r r t Trtr|r lr I '
Es: Leo clct r se, bir t i
' t, .rl r rl i | o il st ilr ii de conlt , eili' lr r r'. '
L r' , I rl i r o{) nLr , cllcu m adiul t . ii't i- O o" t " lunct 'ii vir sol; r llir t t t r r t lt t t r [r. '
r lir r llr r r r i lr r '
12.I.1, Prceiziri de {tr.meqi Qi alc Droblerxati*i. in:r,r.t,rrl co- 1, unAe exlst ii' o leziunc r r ' Slt 'A'\
' , , ' ,,,"i"f , r r iici li prr <'irttl s,rrrrrrrl .irlr'
.rr,lril,rrl-
vorir abtirtla succilt problcrnctc de diienosfic doan itt std,ri.tet:attrr , i;i,i;6f ;;1;.'co** 6siu-ostareprtologicr-r'' "
lr.,a*r qi.in.alte su,sp€nd.d.I'i de con$tienli, de scurtj, tlurati, ca dt, }illii r r. lizioLogici,.
irr rrlurrifcstilrile silcepale.
I) irrruno51iu15salr cunriienti Se1nlolegcposibilifatca clea fi i.rl-r.rr.rt , NL1.2, Problcms rte diagnostic in s{irrile tolnlloilt(l
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,. ; '-1.2.1.As7e?teY niotogiac
.rrr,rsl,ir4,ir,inseamnii it,nu Dti de sine (Dicfionarul lirnbii romf ne tnc,il"r,,,,,
r i'
r1,l'7). ' ' ,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
il'rrlburdlile care survin in sfera cunoqtintei constau nu in rnoriijir,rlrr 11 , lt r . t ! t l . r ' l: r ' l. r r r r '
, ,,1 "", nilni* a con, . ricuici cu 4ispar i, . ir i, . . nit r r
rl,r rliloril,c gr':r,rL.,
cum.se.s1une, liinrl vorba-numai dcspre pr,czen{rrrrir,l la slilnulii lt r t r t ": t ' {\ lr lr r r 'r r ''
l t,,i ,,,' ,t' .. ir or , t l"cval', : r r eacliilor 'lit t r(rr
:r,I| {| | lllL {1r n ilrU L, ons llt ut e c Um a. i , i l ,; : i"t i"i"". "lcd; i. cu supr im nr cr ' ( sir 'r .rlit r r ilr r r ll: t ) t r r 'r lt lr i
it t t t c{t i vt r qr 'llr lr vr " r t lr '
Oorna csto un sindrom care, prin definilie, Se traduce prin abolirrr[ ,,,l Lr rl rrl ) . ou m o{lt r calr u, i"iut 'it o i'lo t livot sclt "
lrrlrr,Li, rr,conrytion{ci* element constant;i dorninani * asociatii,frecl,t,rrt, ,,,',, r,,,,i',in" hidro-etectlolitico qi umor:llo'
r:' :r,lhr'ii,r.ialc luncliilor tulburi,ri biochimice ryi, evcntuill .rr
^ve,getativo, sitttltl'rrtrttrl l t t t rrI I t't tt ' ' t r
irrrrrrrrrr r.urr)lr)gico de diferite grade, dup6 intinrlerea laterali, a bziurril | :.1.2.1.1. 'l'ttlba'area ite t:ons'tienlii'cottstil'ttio
rrr Llrrrrr:IrirtIurrebral. ,,, ,,, itit"* diagnosticului dc cotrrii'
du fiziopatolugic,ncuropaiuJogie 'lt^t Ii rulrlilrtir'trrlr'l:r l'rrr '
,l)rrlulu qi clinicXau dus la cot,.lr,,irl , I i )'.tL'rt.lsl altlele d"e inst(llare n std'rii d'e aotnii 1xt|' l'r r r r '
i:, :.r),'rrro u slant de cunolllnlti, csle expresiaunei L.ziuni sau lcrtu|lri||,1
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
rr.rr l lrr ri,rn'a f-orma,liulii roJiculare ascondcnte de pe linia median-d,din tr.rlrr" li l ri , it il iic cbnqr ; i. *t 1";la t n int livit l in r t 'plt . t t lr i
'r 'r
,lrrrrl lcr.rrbral.Porturbi,rile legetati-ve, care insolesc fi.ecr.cnt $tal,orl(ll ,, ';,.;.,ri
, lir , r 'r r t r I r 'r '( , \ ) r ( \ \ l, r r , r r r !
. ; ; 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
''r,rrir, f{) {lirl,oroBcimplic5rii stlucl,urilor vegetative din trunchiul ccnrlrrrrl irr rrrrl,r,r,r,rlrrrrt,.L)
*n.tcrnnio-oirlobnrl
,.,,,.,,;ri,ii;,;:"ii;; i.:.ir,r-,,nu
:r,lr,r.irrlc.rIraccoali leziunc, prin intindcro:l ei laterali,, caro dtlpitfr,ltl.(, 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
:r'r'iil. :r'rirrlr ryi_pcriariialo *le formaf,iurii roticularc. Nuriai o.xporirr,irri:r,r ( ) ttl i t* i 0 r l l l i '" Ittt l l r tl t'l 'tl 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
r r l , r l t r | r l l) . l ttti l tn n o zl t, ,,p t I
, r',rrri p,rut,o[i dctcrmilati, printr-o l.ziurLopurii fu SIiAA rtin 1,r,rrrrr.lri, lil,.,,',rr(r
Irr r lirrifir,lrzirrui puro .il trunclri sc irrtilncsc r;ir,r';ccl rna,i iL,4os11,
, , , . , ' , , , 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
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ir r r r , 'l'r '1"1i'r 'li'r sr r 'i'r t t 'r r ir r ii) '
r, l. rliluzii, crrflinzind,,si<ltrriclrrrl. 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 '
l)oci irr corri, o.xisliidc Irrlrt o Lrzirrrrr, ,' .,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 r rr'
,, lr rrrr.lrillsooia,l cu ;5 lrzirrri ir lrx rl <rr.irrrrrlrri, slrLl,lr,rrl,ori r.:li. lnr {l.ir(.r'ri 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 l l t'tt l o r i l 'o tr l r 'tti " 1 "'l
r,trrl. itr lozittttisttlD'itl,r!rlorilrLl, r j l l l ) l i l r l .'i r r ( l ' r l r ""
ftt itrl,r.ti|i 1,lrl,o:l Ilrrtrr,IrirrIrri .rrr'r'IrllrI.lrr , , , , , , , 'l , t tr ttttti i IItti t Ir IIt'tIi ' r l ttt i tl 'tL r o l 'o tttl i l r ti r r
;r'rirrr'rrfrIr, zrt|i Ir|rrl)ir'lril rii rr';r,rri rrllrrrr]i,i,i i tt,ItIt'tr ':t' tr r Io l r r i r r r r r r l r "r "r '
rl0 rrorrrr'l,iirr(r'i, (olrrrtrlril;r,r,, i ttl r tr ttl i i ,r cl t'r 'r .r l r r tttr ttr tl r t tr r Ii 'l tl r .r
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5i rrtrIr:r'ii;ilrilii{,r)rrii; IirI rr, rIi I r,:| ,,,.,,,,.ur,,,
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, r 'r , , l r r l l t,l , tr l tl r , i l ,l l tl ) tl t l r l l r r l Ir l t'tt't'r ';1 i i rrr
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r r , I I lt
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r' r' r)llrr f ({lt o rirl rlc c lt , t lt r ir r , plr t r r t ll, r lr r r , iv lll; i r l o l t , t , s c r t c l ; o . ) .
t' 1, , I ur l trr r r r olllgir r ,r r r t r r I llllt ii,it t r , ot t lt ,c( ilir r ii ; i t t r t t r oli it t r lr t t t r t ,lr r t ) r t it t
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rr" (x)J r(! rt0 0r'i0 rrr , 0r r , z li, \ r . i t , . ) i ) r . l r r {r '*i i , t , r) i l , r r t
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rlrrrrrrriirrsir'. sr)r(), ilf..(irr*r v'sclilirr:1,
irit',it.rjtui i,..ilt.br.,rbazil,r,r,. ,,,,' r,, (ci rrsir ) lt 'pir lii t t c 1t ot t 1,ot t r ior r l' sl) l'( )o t r t t nij, l, r r jr i'r ,or it ': t t lr ot r r r l: r '
l'r.rlrr'rrfr.lrl .clir..,ritt:poi 1i rorr:latoalc p(rlltr. r Li l ,, ,,:r, i rl ct ilr r , li, t cgr r r r r ur t cln'( c\ 'olr i, ur t l Ei pr ozct t lr t ,t lc , , ; ( clulc" r : r r
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|||(|l|||(|I)1rrrrIrIr|)rrii,slrt)l,iocrnii).(.t.lu,lllgiilnvit,,:nt.ii;rsufirct1e,hip,.1,*rrrri,,, ll.r.
,,t' ,r, rrrl rr. [ 'r 'r 'zcr Lir l,r ut ui hcr pcs pot ll, c f i LLLilr i,it L t lit lqt t or lilt t l t t t r , r
1,.11r.r'r,r,rlrl .rr .i1<'ri rnt su,ri.zilcinstitarlca cum"iir. ..ii"r*rit",, ,, ' ,' r' rl .' r' r'r t lr r r r spir r t lo slt t r al t t noi pnout r t or t ii. I 't l1, t r ; iih ll{i ( ) |iI r t I I i i| |
r,r'lrrrr'$r.r'r'('I)r'ir|(^, or"riu.,lir,,,
l.rrrLlro{r.Lritc cc*rbrare.o ar*ri i,."""a".1,ii, dc cor,r,rrirr rl rtrr r r suli, r 'int li hep: li, it : i, , sllo o scpliuNt r ie sit , t Lspt r r o lr r r r r l: rr l.
j ':,,;,,11:::l ,,,,,,.1i1r tkrauna ,sprt o arecliunei"tntiacramanri ,' r l l t.,r,t ir iLlr t cit iLt , guur clt clor ' ; i it , t im cillt sclol r sl, r t [ cst , t t l t lr : r 'r r r , r lll
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situ lcmatorrr in plirrrnl rind _, clritrrlilrr, ' ,. ' l rr' rrl t 'r Lt ollt , r liu, bct 'ict i $i pont r u cot t r li, t lo i II r 'ii )III I i (|, it t r , r 'lr r r r r lr
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strr'al1,d, tulbrlra,r.,: "rri";',
ruetaboiicd,. f,a,o temeieg}a,i,irlri, l , ,,r ,,)rrr! r liir int or icai, iilo cu iDSe{1{, iaii(tl(t t},t l, it t t t lit t t r sit r t r t , zirr :rir rlr lt r llr t
ji "r\l j j
I:IIi)l :II:IrIll{I . u, .li:.lll:.I:..tt"t,l r,. oricnr,eazi, spr" o .o,ria,'.*t"irp1ici. Deulri.,r,r ' ,,l ,,rrrrr i lillilo,
I I I I : . l. |,,.1 { . l ,l, I' l r. i tJ p l .c r n l J t,e t .rl OA l ,o l ' , i rl rr , ccit inr ozclor , a, cseor ialiilol I i il, 1r n{) r pliui I 'r t pir i, r r L,r ''
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.,, ,1 ,. r lt ' ' l 1, r , . , ' 11:r,,.In rr' ;ri rl i rl r.s c l n r(.
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rl .,l i p lir *r l lr r : l' r i. s i i r1 o (' r' i c l ri ' ,2 { r tp .,, " i i z" i n . ,,,:r,.:r i l ) r i) r ) couii"Lt r r cr nicr i, ccllm pt icii,
(lr'r)r'ii, (ii ' r'{rl ) r'ir 1ri,. abc.s cc'e),r'r,1,truuirottit1 ".o.,.r" -
,i .,i " -t i r.,c.i i ,ri ,rrr,, f i ult {r ( }r 'islt t ir t t t t r r l, 't r r , ', t , '
rte, eu""}uiital. " ^r" \,iir.sri1rrr,ir. rl
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r rrr1rr.r.i, 'r'...r1,, crrorirl rlc c:r,ibon (slal1t,tori,:e;,corn"le """r"i"a, ' ' lt tit.pt|u,llti"aurpor*\d,. Ilipotorflriil, poi}to sii t,rritttrirl:i'r'11tl ,,) ,r.l
rli:r,lr,tic poril,oiltra in rliscuiiLr Gidi.;. t;;;il;ii ,'
r,ii1,o curni i.ip"ig1i"or"ia lrlr p1,ir1rlt r,t,r,l), ' rL ' r,, r, r)\ if i! r Jt {}nat ii, hipot ir oit li*t r il sm lt ilr r pii, uilr t lr i.
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':ri) i "rrir/ J'r'|l11r'n lccrctcnt vascular cercbral (arteriopatia atolonrairrirrrr , l rr r t rrc t t it t go- encef illit li, abces cel'cbr it Ls: r . t tl, t t t t r t lr o llr 'lr ilr r r , r ', 1'r ': r lrt r
rr rli:rlrrrti*'i) sir,rrchi*r' o corrrir,hiperosmot";i".i."-i;;;ili;
lrr lrr1rlrrl .i, . r,,.ri, la rrrrbolnr,r. dpileptic .sii tiii.r :rl,.r,ri ,i I ,1r rrrl r, l tilxr lt er t r dla *pr ir ut ir , pe par ct t lsul t t t t r r i r ', t t t t l r r t l lr r r '/ ir r i r l'r , I
l, ;rl,i,:r,,,'r'r' s.", r'i 1;1p,,;r,tc{i rlaforif,i;";l"., "*t" ioiO"*"l*-" ."ir,; ,1,i' ' ,, ,ri (l r!l s, ilr t r uclir int cr vinc in conlicr t ul t iLt t llol t r r t t t c: r t l) nlr l, , | , . ,
h.,;il;;:i;i*anio_ctr.r,tr.rr,t , ,rr .rl i ri i ,, i rL st at [ s cpilcpt ic, t um or i ccl: br r r lc lu lt t r gr r '. ir ili,it t lor r , r ( r ,
Irr,,\r)(i:, llt r.rt|lrut Il lt ll{.{,(]sconr,_ulsir,, unei suferinte ccrcbrale Jrrr,,,,.
,li I' ,I' l r| i (i i i i lr , t r opir r ici ct c. ) .
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v : t "c r t l l r i , s&u chiAr u A1, , Ii,ut,
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r, ,, t,r' r)l un ilc - - in cor nelc do gr aalclo li iji'l , r lr r r r iilr ( r l'7llli ( , r r lr '; r t r t t t
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lcil, ir t bt t llr . llr iir lii, r lr r lr , l1r t liro, lr ilr , 'r
lirr;i; Arl,llli..ti 1Voft"fe s",i qi ii,,i,,r, 1,,' ,1,, pl ilt ou", pr oglt si\ '. i\ sllcl, t r lt t Lt t t t t iitr lo zilr r cr ir r l. r '
tg?3;- popoyiciu lt .fhi,.,"-ibzg; Arstli ,,,i ,.rr cu. car act or
I'r)lro\ 11,il llll"j0). /\.colNb., rrtcccdontr;lr'hepatice, ,1,,1,,r1(.rrrj o r not lcr at ii, ( il jul do i] 8') ; i t r r I I r f it r r r ii,r t '1t t tit i r I t lt t r iil, r : r t , 1, ,
pohlo^rc, a<lclisorrilrrl , | l r{ l i rl l vjr r c 0 noui clclt ct c ( 0u o( 'lr l") soi 'ur ; l! t lr t t t r l,zi l, r ; lr ,] : r ,: r t , l: r ; . r
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l :r un b6lnl,r hipor.tr.i,.,rr' lr t t ; t l,
1r' r:r,lrr l i g.rrr'rr,t,ii rl. bou,r, .o b*zii,-icnccfatop*l,ia frip""i"osrvii,),dir,' r.l ' 1,, ..l l r pl i li( ) u) '( Alsoni 1072) 5i r Lql,si sc r olt t ll, t t Pit t ii l: u r r lr t r lt t t l
1'r'rrrr'li ;r..irl.rrr, vr,s.rrla. c,rub'*l' 1r,"irr,rr.'gi. -*ii ,l i u\i r(1 r i lt illcli, clt nio r io 11" siLt t lllli t i1ul1"
iltac ischerrri,,1,
l|r i l l | || r , irl|f f r r i|i, J rl ! ttrt i t,l c rru l i c1, ,f,,b u i es ..,l l i ern i rr rtrri cl ,c rtrai
rrrrl l ,r : l l ta.rt lt t l, t 6- lt it f t lor ; i cr ut lio'nat t r : t t lt t t :t ) ll, t lt t r r t I t oI I t r I r t r I t I i 1r , r ; r l"
1rrrr, rI rrI rI rr { r : . r.'rrrir, *lrr,,li.ii pr,lxiu_zisii, , ,rrurit, tr,,"iii, 11,rcil (rrrril
,,,),o coriiri.prin , o t ,r r rl rr,gr r oslit t t l, t 'r ^t t <lsc ct t t t sllllil t , i, r r r lllii ( t li lt t ili, s t lo : t llr t ol lr lr r r . ,
il: l:.1;:.,1 ,ll::,:: :.:::,.t1,:li]i intoxiorlic ic,ii,nltr,r,a, o ,,,,r,,,r tl ,' r). rl c rr r lr lot t ii, sllt r t lt t t t r . t 'r '( r f ( t ( ic ( r t r t r t : t ,I I i: r , I r r , I icii) ,lr , lr r l lr r '1': r lr ,
' r t' r' i | | ,,i r|l,,r.,rir,|| I l. t r , . t , r r r r r r r i r . 1r il. Dt i, . i. r . r r . r r l r . : r l
( t : r . i I , l t , t , ), , ( . , r r , r i l , ' ,r l rr' l rrrl, ir i) $ u lr t t t r t t t ir t t lt 'l( t 'r r r t r lrt,t lr , t r r i, r ; i) 1lt ) linr iilt t t t |r r 11'1, o; r lr '
l ' r rr, l(r 'l:rl,,lj:rli(,,.1 ili, , r r 1r i1r , y , . l. \ \ , I , r iir L, . l.
,' Lr,l r,r rr r' ,rr t t r 'LrI t r t r lt llt r r lit it t oI ilr , t 'r 'r rir i ill llll{r lr r t 't t t t t t l I t I t , t I t t I t t tr ', , , )
l :.1.;!.1.:i, l u,l,outcrr,dtld.or tr,rrrt ttnttltr.i, qtttrru.l. t ;' r,rti rr. l trolt nt t l'i,r lt t ilt h iixst t t r t , t iir t l t t t t t t I t t t 'it ,r t t lr r r icltit t r 'or r r : rr lr , r l) li , I
li p( (l)(t.(rla , , ' Ii , r' orrr r r : r r r ir |, I ; , . irr 'r r lr ii r r r lr lr ic r 'r r t t t r , lrJllr t v{r ,( 'Ltt t llllr 'r r r {; rlr t r ll'. r t . ,
lr ',
I . l'tUu t()tld r: f i, t t t t t r ' , t r ut r , l. r 'Nr , r r r r l olt t r r r t r , I rIr ri I r rr, r r I rrIr r | | : l nti l i tt pr r it r li, ii. t lr lt lt ( 'hr t lt t r t , \ r / / , r r r lr lr lll'r illr r I r ; l r r ir r t l, t t r r l L lr t r l
l. ltrprr lrrr,
I r { , liln r rr{\o Irirrrr|,ir:I lt r 6ilr ilil; q, lr , 1r r, r r nr iI , r , : r r r r r r : r l i ; i r r r . , , r : r r, , i l , ,rr. l i , , \ r ) 1 ,l l r l L j i
i ,,Ii ,rl l l )t , ). ' l l () t l trl ilt : , t ' t t r t t rIt |, , r' i I Ir I r'rr <r r t r r r r |, r) t" t t t t t r t , ir lr 'r r l r r , t r l; r . r
i \ \ I,| | | | IIIl||(r ]l( t 'r'r.fi rlr r r iit t ! o lir l, ( t li r i ';.,l ,l r l rrrtr,,t:i r ' r ' t , I r r'r r | ; I j , rrttr: ttr' , ttttr' :t l tr' tl l r i ' l l ri l l r' \ l r' l l t l l r ) l l r l r l r ' 1. ;
; 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 tttrrl t,r rl t |i 1t l )tt,l . ri , t,l r!:rr' r rr rrr l trrl rtrl i .l l l rrl l l l l :rl rrrrrl l ol r' ' ,r' ,,;

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:i l |,
i I I n,utnarat,lipu,Luiraspirator'(ijoiaoic lrr,blrba'li qi abdominal la femei) 'l Al Jr '],1 Jl . N l l . r v
rtrlicii, rr ulrvilirto rrraxirnil a comeii g) Bradiaard,iaeste caracteristici, Ilodlfic{}llo lulrr'llllot r''lt(lrth$ lrt flrt)orl (:r tlroilrl lozlunlk}r cer(llrirrkrr ltollrrosllo
rrrrlirlirr{,rltrbulba,roin ca,drulsindlori,melorde hipertensiunoiDtracranian[ tl llr{lic lll opclatorii
plirr lrorrror:rgiecelcbralX, hematoame intracranieno, tumoni si abcese
cf |ob|r,lrr ntrningite , ineningo-encefalite. IIai apare ln comsle din nixe-
rlr,rrr qi in rxrle pril hipopituitarisrn ; h\ Ta,hieard,iaapare in multe come, I n d i f u l i L t , l , l , L r, , rr
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 cere-
irlrr,lir,; j) ,lritnii.le card,inceFi,alte mod,ificd,ri card,iaceie pot sugera meca- 'IrrnpeIatU Ia
rrisnrc oxtraccrebra,lo ale unci come (embolie, infarct, iusuficientd circula-
telot lull L,
lrrlic lrermodinarnicS, etc.) ; k) Eipertensi,unea d,rterid,ld,cu intXrirea zgomo-
lrrtui a1 doilea la nivelul orificiului aortic $i cu hiportlofia ventriculului
sl inq ne poate orienta sprc o hemolagie cerebralS,,encefalopatie hiperten- l 'l l l sul ahicardie S c i i dc rc a pr0l .trrrl 1i ,
r'ir.ii sau urcrnie; l) Eitrtotensiuneaatteri&ld, Ia debut poate sugcra o insu- bradi- bmdi-
ricrrLil saptatenali,, o comX cliabeticS,,o com5, prin tleshiilratarc, o com5, c 0l otl rl l l ,'

l.oxiu"r,,sau rnctabolicii, (prin oxitl de carbon, barbiturice, alcool, suferinle

lLop*ticc, boala lui Addison), o com5,hemoiiina:nicii prin hemoragie masiyS, Impollant?i atunci clnd ccielalte curbe orarti c oul l l rl
r;rlrr prin infatct mioca,rdic etc. arteriald agravare

It0$pi l l 11i a Adinci, rapidi, pe Ltrz c

4. iligesti.ts, Vd,rsd,turile sint n€caracteri$tice, putintl st spuml
-A.paratul
:rprlrii, in nuureroase come de origine neuroiogicr, toxici sa,umetabolic5,.
Ilepatosplenonegaiia ne poate sugera o comd, hepatici,, leucemic5, mala- (iullos,tii4a
rir:L, in boli de colagen sau a,1teatecl;iuni d.e sistem.
l1olenld
Dagluti,li.aeste perturbati, in leziuni caudale ale trunchiului cerebral
tirrrlinl nucleilor :rervilor IX*XI) qi este un elemcnt de prim ordin in l )fgl rLLi ti a Tulbuleri greve in
rrprrrcicrea grtulului de profunzime a comoi. Deglutilia are aloi timpi. deglutitie
'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 Inrportant IIemillegie A ((f rrl l rrrfr,rrI' r r' i l r.
- iltunci vom spune c5, timpul I (labial) este prezent sau abolit. Timpul cnl nr Iipilepsie s i rrl n rIrIr' l ,rf r,
)rrbi:rl are o reprezentale cort,ical5,qi una la limita superioard a trunchiului Simptome de hernje rtr.ol (,grfL!
lur:olrral. Timpul II (degiutifia propriu-zisd,) zicem c5, este bun atunci lemporali
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 tlo-
tlrri'i{,ioi csto intirziat atunci cind o introd.uccm in guri,, paoientul lino rrroningitS,tuberculoas[', parazitozd, cerebrald,, mai ra1' cncolil,lil't'I,ltsrrtttl,r
rr,pl,irr gurii, rn timp gi apoi o inghite, Leziunea eslo Ia nivelul nervilor 'hrrnorald,):
crrr,nioniIX I inl,roducem a,pii,in gura holnavului, pacientul trine a,pa, cars a) ln comele superficiale, deficitele motorii silt uryor do I'0orllrorrrrl'r
lrolboloseqte, dar nu o inghlte, are un refler c1otuse, o parte tlin ap[ rr,1,itprin probele motilitS,lii active gi pasive, cit $i prin inogtll if ir,l,r,rr' rl,r
irrllri in ci,ile rospiratorii $i se ineacS. Spunem c5, timpul II al d.oglutijiei roactie a membrelor la Dracticarea stimul5,rilor dur'otoitsa.
'b)
osl,r a,bsent, cu sau f[IH, reflex de tuse. Ireziunea este la niyelu] nueleilor ln comeie profu,udo Be ror practica o serie de pr'obo : . lrlf ul;(tnlt[
rror'r,ilot cranieni X-XI. rrrcmbrelorparalizate, care cad mai rapid pe planul Jxll,tthtilrr ttttt,tttrvrl|r
I udoral,io este semnificativi, numai in cazurile f5,r5,hipertensiune. (lc ddicare qi d€ Hsare brusc5,; -,,semnul piciorului totilr In nlh,rfi)'nl
lioziurrol, csto in ium;,tatea in{erioard, a bulbului. lrri Bogolepov (citat de Yoiculeseu qi Stoica, 1907): - trrl:tt;irt,prt,tlirii,
rrrir,ximI, ln afar5, a membrelor evidenliazl' lipsa do lovolliro itr lozi{irl
'lluto tulburirile vegotative (afari ile deglntilie) au valoare daod irridial5,a mernbrului paralizat, plin hipotonia rotatorilol intrrtrti I . lrtl
nirrl, lrrl,1;oin ansamblu (tabeiul IV); izolat, elo nu au y&loare. 1rit.ift1cst}lt ttrritzjltt,xltt"
z.rr{,aparezei faciale dc tip centlal (eviden{,i:r,bilir,
lrr,{iilur',prin ,,semnulpilr'i" sau ztl ,,pinztrido cutitbiottI lll plrtlrrrlr, rlr,
I 2. 1.2.1.3, Y al,oaread,atelorefro,
menului neurol,og
ic rrrl,r'ortrarrtl ii lltt trlltlttl
rrpir,t
illo pe globii oculati, lxJ rtlillgirroi! illttla't srltt 1rr
l:rlirrlrrhri,rn lipsl grittr:rsti tlo 1r*rl,tlit, prr,ralizlll rl')I - ltntzrtttl:t,tt tIi IrrI r' I'tr,Itl
1.. Il;ri.ttcn;la harniplegioi,l,robrLie vcrilical,i, din capul locului. Consta-
rr llt,rrrrrrhriltri ltiulritrtlii;- tlitttittttirtt'lt' tilt,ttlllxrlinlil ttlrill'1,r',rilli'1,
It' tr^lh,
r nci ho,niplogii irrstalir,tobLusc sugottnzii -a,ploilpc totrlcauna un
l,ir,r'oir, rclltrxrrlot'r)$t,(r(t
t;ii Iriritrtrl;t'iit, hrll(luroirrltt.
ylrii0rtljr,r rllot' ctt1,ir,ttir,1,r.r
it,lxlrtrrirriikr
rlr.rcirlr:rtl; mrobral $ll,I lln(x)ri {] r,11.q?}jilro.
Itr sohirnb, su]prirriloron)
rrrrrrilrorniplogiiir ri;r'-o in trrorIlotrl t1uporr,1;o
cotrtrtitr.l;rr,lll,ri $ugoni]Fi u,l1;c' it" I'rn( l,t.tuttilu.l'ttt'tl<L,, 1111v,i trNr).u(rt't'{lltuHpilU{
1'rrl'lrt't'd( roJlox) rtrrtt
(1;utttrrr,r'o
rrii,rloqirlrr itrr,lr
r!b00$ oot'ullt'1tr1,
hrttttrt,li0rn
Nlrlxl|rnrl, rlrrlrlrrrcrrfr. (,lr,,l'iljl tr'l|r,;i):r,lrriittii, rr'l;rit Ilt ttIrti,ltl gtlt'ii,lrttzllor
lr)rll!1ii,
Jrosilrilil,r"r,l,i
iill'i
;10
0
 ri :t'l litttlrir' ptt,ztrtt(it,ttttiIiutrrlrlIit
ir liislllnslllrri Iorric lll uirrior,rrIrri
ill ]rri
-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,-
h rrll (l.lrlsl.irr ll rrrrlrolrr;r,r, rblrrrbilill srr,LrcorrLill,os
iroatoiugcra o loznllx)
lrsottrloirrlror.lrlii,
iolrirl'ilrII i I)r' r'I r.rr ri r Ii , r.Irlr.IrrIo1rrr,I
r.cclllrrr!tioi, lrotrollt,gicsrrllrr,lllrrrrrr
IrtrrIr.rrl,rr,lii,trrrri,r,rrl[1.r.r.r,I/u.
LIrr gr(]spiugrotlox bil;1,el'tt,l.]ru il,t,cIaloa,t,o
lrrr.rlizrr,lolio,lLrcsLusrrgctiltl o su:tilinli, dc lrunclri cet,ebr,il. Itrr,t rii.
:';. .4ho[.it.'ctlre!l.et;ektr o1teoleniliuoase sc poal,e constata in diabr:tr 13. Alrof iu opLioiiutlilolet&l,ri,la, un bolnav couli)los porrl,csr'i rro irr
,
rr lrcrrLor.ilgiiic
. Ilrrrrrsgp16 o hcmor.agit subarahnoidianirprin anelrisnL lupl, (rlilcii rirrl,
subiuahnoidiole, irr unelc mcningil,c blcilare, in situali:i, ri scrrLlemcniageale), sple o tronbozii, de alterri carotirl"L(rllrci, r,sl,rri rr
1r,{l\isL{)lrl,ci urror polincvrite (polineuropa,tij)inteitiorsr', etihde,cliabeticc, lr(:rriplegic contralaterali) s&u spre un sindrorn l.ostel .Kcrrrrcrlr' lilirr
r:o.lirgritrozicc, lxccurn fi in hts. hr stntlii ar arisr,tl alc'coneloi, abolirea rrrrrnli bazrlii {lo claj rnterio).
lolIrxr,lul ost(]o-tondinoasonu prezinti somnificalie patologici, (ce1mult
prrrgrrrrsl,icii). 14. Motli.;ficitrile reJlernlui cornean, pot,si, ofcre inrlict,lii rlo prrrlrrrrzirrrrr
r,rortteiriat uneori prezinli, ,sit-aloarelocalizatorie. Asl,fcl, tbolilclr, rrrrilrr,
. L L'rczerrla sem,.nelctr de rigitlitate prin decerebrarepi a cel,rtrde ri,oiditate
it'raiinne sugcle:lzilo leziunc pontind,, iar o abolirc llilftLcl.itlil(rrrrrrrlrliorlrr,
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, irtiu gradul de profunzime al comei) ne sugelea,zlo lcziunrrrrxlirrsii rrr
I l)0{)) |ii scnrrifica,Iiilc prognostice. tlttl chiLrl cerebrul. Prezenla rutlexului corrrcu-pteligoir_liu,n (ur, ,si :r rr,llor,
5. [trezo]]t& temnelor meningeale intr-o comX, instalatir, ictiform no r',.llcxearhaice) lre poato intliel o suferinl,i f trun]chiului ircrtir,rrt, ,lrr,r.
irrrlicir,in prirnul rinrl o hemorlgie subtrahnoialiax,i,, dar si o hemoragio lr'rflLilte oli nu are valoa,re ]ocalizatorie (reflexo clc clibor.lr.c).
,r'(,rcl)r'o-rnellingocs:l,u o inundalie ventriculard,. jDtr-o coni, fcbrild,, sem- 1i. Abolirea reJlerelorJaringi,an ,si 1)elo-p&latin, rr:prczilti'i, irrrIir:rr,Ior,i
rrr:lcnctir4leale sint lerela,toare puntm o meningil,i (urruilles) sau pentru 1,. l)rol[nziur(' i.i,comei, dlr uncori qi semnc cle srLfclilfii brrll)lr,r'iIrr:r||
rnr lbces ccrcbral. Recloareacefei (cl atte s,,rnn6merringeale'absen?esau i,rtcuilobulbin'ir,.
rLrr,r'schi!,:r,te)se poate intilni in proceselc expansile intralcraniene (tumori,
tlrctrscrLernatoame) cu fenomene de angajare. 12.1.2,2. Clinica sintl,ro
mu,lui comatos
6. _Prezerrla unr_ rnipcdri au,tomatico-rejlerech co;r&ctarstereolip, o":d-
tLu.1,,if,cle_miFcltri caqfologice(readocerea cuverturii ori cle citc ori desc-ofeiim Olinic, siridromul comatos,ue uriniitoarele co[1pouc]11,o :
Irolrull'ul1 miscd,ri do apucare qi de frecare a organelor geriitale, a na;ului, 1. Abolirea, total[, a stS,riidu cuno;tinld (cou;iienfn;. fir corrrii,rrrr rrrr
lnr r'r,ltcrni,sciri ges1,ua1e storcotipe) se intilnesc irrrloosebi in comele mai ' otte vorbi de eristen_taaltor tipuri do porturbiiri ale $1rii,rii
d.ocrrrrollnrlrr,.
,,ul,,r'ti,.illo din irrtcclii, in[o:ic-r,1ii,ii unclc mo n iugo-cnccfllire. alr)ua $9 poa,te agrava, ducind. la exitus, san so poate a,tnclioll, Irr,rrirrrrI rrI
'/. 1't nurdturi ole e.ttrenitd!ilot tu I
a*p.(t ttc ,,biitdi de oripi', (,,Jtap- rrr'ozertinalin a,ccst caz simptome de trezire.
pinl lrrmoi" 1 apr in cornr.lehepatice. !. Tulbur:lri vujjetativc.
8. Mod,iJicd,rilepuptil.are. .J. -LtL.DUraIl OCUm,IC.
, rr o;rinrr.c.in.conLauro-nrice;i .Pnpileie se prozinti miotice in intoxicalia 4. Tulbur5ri neurologice,
in unclc l,.ziuniprotu bcra,ntialrl (benloragio
1,,,rrl.ini., l rornbozii.bazilar'ri,t unrorj puni inc). pupilele midrirLticesugerca*zi,
,r rrrr,'rrc:trtre al,roplmcAstu o comd,gravd,vascularS,O midriazx unilate- 12,L2.;i, Gradarea Si clasiJicurea comeilor
rrrlrt (ipsilai;er-ali, sc intilncqte iu heruatoame epiclurale, Nubd.uralo
r,;ru irrtr;lcercbr ale, -lezirnii)
in tumori cerebrale cu anga,jare a tonutui temporal llator-itir,clracterului evolutiy al leziunilor, c:r, fi Ltltilil,ii,(ii lx\fi,ll
ryiirr anovlisrnele de arterd, cerebralil mijlocie sau postrrioard (asociaid cu i)r'lrilory&sornotorii existi o variabilitate a aspeoteloi r,linioo rii rlc i1t",,,,r,
lrt,oziipllpebralil), ,, sl,riutl cl$siiici]rcrru cste posibili practic. nst:e ins[ }osil)ilL (; grrrlrrrrrl
9. Pre:renld.anai oftalmoplegit (ptozh, strabism gi rnidriazd,) asociatd, t'.r'',turzimiicomci $i aceastaesteindispensabilsi fie reaLizl,tir, d irr rlooo*i I,ri,
Ii
('r.ri.crrnc rnenrngrale ne sugereazl o meningitd, s&u o hemoragie subarah_ clinice qi practice, adicfl ds rS,spunsla tratamcnt (lc apr'c(Jiol,o pr.r,;jr'r,t
ruritlia,nd prorlusi^ prin rupturi de anevrfum. O oftalmopl6gie masivd, I rc,l,. 'i
ilrl,r'-rnr corrtext infcclios ne poate indr.uma sprc o tromboflibi[i, de sinus ,G,raclul rls profunzime a comei nu poate fi cert stabilil, rlrrril, 1;11f i1,
, iivr.r'r',r. socieroa, oftnlmoplcgicicu bcmnc piramiclalc.caro realizeazd rrivelnl gi intindsrea leziunii majore din trunchiul oerobrtl, (lol,orrtitxrt
,r lr'.rripL'gio:rlLernfi,, nc sugfroazii, u leziunerle tnlnr:hi ocrcbral (tunrori, rlrrpri criterii clinice Si paraclinico.
i,rrr.r'Irr,Ii1,o,tt ombozll dc afieri, bazilar[ s.a.). Dup5, acest criteriu al lcziunii clominante, noi am propu$ siiitorlrl i
tU. n,flr.ru| Iolo.n?,otar zrr,r'eain 5 grado de comi,, cu urm5,tora,le caractorc (tabcltrl V) :
ti abolir, in conrele protundc, in unelo
|'' ro irr ciLr.(fsrj &Nociazi afcctarea-poi\I" motorocularnlui Grailul I. Bolnavul este inconltient, functiiis vogota,tivosinl; ln linritrr
coinun qi/ Sau nervul
ol)1ic, pr'ocunl qi in comele vascularo prin a, jeriti lueticA. 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,'
, ,I1.. .l)euialiaconjugatda globiior oculari constituio un semn important lrlo prozcnt, boln*yul so apillri la, cxcitaliilo oxtorocoplivo (srr:r,l)iI,r"d, rlrr o
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- rrLrLsoii,). .Il,oflorclorr,ul,urnlll;o
sirrl;plrrzonto,bolrllvul so apilrii,h oxoil,rr,l,irll
*spre'partoa 1rt'opriorotxrlrt,ivr,(rlrrcrr rnirll lll,oit.U(Li.!rjiir
il rlollro,so:lcopor,i'l crr o lriil,rrlrr,
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 rlrr,oiiii oirl,ollig). l,rt;rilolohilti norrnlln $ll rtfr)t.ruirli.ilttirui, r,rr lrrllux
(ri rrrl l rnr ltovil lo [t11,rrlrrrr,lr,rrl,irII Irlllltr(rl,i)rrlitrtitrttrr,l
s:t,unlrulil,.Irrr,lrtolr.lrlIrr.icli, voil,ilrttllr.ji,
so rrotr.tlillii,
i nlor:ior),

:i{)tl :()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 "
F, , t . i r r s c u t t r rr r tl tr l Ii r tl l l r l l Il l ,r l l tl l l l l l l l l l i ( i cl o b r i l l '

J ( 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 '

r! r-:stc
iii'y,t'i i it.tri,,tll,l rltrglrrfilici abulit, rlttrttrltttttir'
,', ,,"'':rl,'i,i,, '1'fJ:'),1'1"
vt:slilittlit'til' t'rtIrti.lt'
r,olti tlo ,r,irir,r;,r,itiT I.rir'Ilobii
I i, ,,, ,",iLst','r'vrrti., 'boiitt''
,. ,l i i o dovi|lc ler it cor l. iugr ll, ira, globilor ocula'r 'i spr '( j ] ) r r lliil
llr gr r r ir '
+ 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'
',,1, ,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':r tt"
,,.''1,,j,
,i.i,;;i;;;iffii"irtrit,'. i* pr'ba rt' jurrlrr'ri
''rtl'tt
i srt'ttlt'ttstttrl'u
r, r'rr,iri'i,u (Ii'l1'rolea glrbilor oculari, frecvent .discorrjttgit'1 '
,l, r illii ocliilor'. Hipertcrmle qi i"tt"iooo oscilarLl'i',ou 1(\lr(lilrlri'
lr .r,ltut'r'. Lezitrncl cbl,c in parlca' in[r'tioati "t"riali' c p nlll'
ii.ltt t tt4tt"
{i rud,u.II{. Bolnar-ui este inconqticnt, 1'otll areactit', liuno!
,rlr,, iiiiii"te gr:aypertltrbate' kr, limiirr, cu
curnl"atil''ilitrr'.tii stll)Ill'vr{rlllrrtrir"
's.au
',r, .r,,tlr.'ia-aliiiii,, 'reilexul ae iuse p"c,ent,*intirziat abolil;' Nli'ltirr'zo
i .'',';,,il"il;;,l"'r;i;;;;;t-$i;iii-o;pi"r'l i,bolit"' rit'tl"t"ltr ttottlotrtrrrt'lt
, r,.. r)r{llo-l.tr,iibulare sint *froiii".'ff*t"iAita,te muscula'ii, .r t'trttrirr
i, i,"''ii,',l" l.i;;;.-i";il; ;s!" io pattea quperioar[ a' bulbultri'
'i
', t irrttlLrl | (eoma tlepir,qitd,)' Bcrlnav total inconglicnt, crr circullr'{'irr' t1i
zit t t r f r r '. r "'lt t
r, r,,r' :LI ;rr rl l ilic; al sust r nule- 'piin m et or lc de r csus, cit ut '" l"
ct ] l{ \ l) llllt lr \ ( 'r 'r r r rr r r
rr,r.rt.r trr sc! r nenl0le bulbar c inier ioar e. Sindr ot nt r l
:5 .r,rr,:r l l c i i cr eielului".
(lo$otr$ trr'
lllr,;iic. tailloul tle comd' depnqiti' - a,,& cuin t' li)sl
<5 ( 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
'a ,r) ,\br:lirca totalii a tuncl,iilor vielii do relal'ic'
l,) ,\bo1irea, marilor f unc!,ii vegcttltive '
6,1 (,) llEG cu traseu izoelectric persistent'
t'rt'tt'
ttton'r1'ttu'
lliD(rl,oniacor]leeicu lipsa cletransparenld'a ei tlonot?1'
i."i*'."t""e denoti, cd,Ieziunet , cttlt'itts l'rrrilrrtirtl
t, ,';:il;"".i.i;iii.
t r t,l,rrit,nuhti tli:f zona bulbo-medularS''
E
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.
Itittt'
i,i;ii',f;iiit#';i";'iiJA;ffi"'ili*-ffin;v;ryft, aop'i""u ttrrittrit'zr'l'
z
.,;lll,'il;li**lr;h";:;*;,tl*t';*'*rr*qLll;t'"
'lili;i.i"p#ffi;;il. ari
asistrtir
,lill;lll:
rrrrrrlir"
rfi't't'.
:l il b;A;"r,-'" , lost tlt
,L L nr r o o sorioasa .si o catarmxlzi', caro rto lii'ttrut'ttq[tr'.l)ltt
z "o^tnr.ro'r,i ."u,ltntor'intru(iii)lr Hlirfil'rrl
, ,,l,,ii','i''it,ir^i^;,ffi;;;;";;i;t-l",uiu-'ii .rl'itt't
aroactiv la- sfirnnlt'i'rila
;,,,;'';'i,,,ri;; i;;lu"uuf iiii"itt,t incirnrytiont,
,rrrr',,, sbcrtorolsir,,
r'rtttrsltit'rt,llia, S,tpoi in cLrlllulit'll:i l::::ilit'11:l]
rtrtnnrca'
l r 'l i 'l '
n l ) l l l t) r r l l si t, l l tl r r sr ':t l sl l t,tl {l l l l l ( r l ( !l l l i r t
, , , ', . , . r r ', . 1 r l i r r r l r i i , r ( 'r 'r r '{i :r J l i Il i \
'I'r i "t
, , , , r ', 1 l . i r , tr ,r l tr ,l i i o tl ,r r i tt',r ,r r * 1 ,i r "r ['i 'ip 'o l r r z:'t',.r 'v'ttr l 'ttr u l tr l tt l ( r zi l l l r i .l l l l r l l l l l l l '
4 r r r l r r r r r r t r l , 'ti 'zci .t,'l r ttt,,l ,',t,','i 'l'l,i,ii;t':
t'i '1 "'ttti i tt:u l i ,r i tl l t'xt'l t'r 'tl l l ttt:Il r tIIIIr Ir ttr r i ttttIt'
,,,;i;,,;,;;;i iri i'rln'r'"'i'", i'ttttttrttl ttrrrt'ttttrlit't .pr'rrl'tttrrl
'li,,li,,il,',,,rr,:',,i lr ilii'il'* r r r ol'olii
,i ,' 1,' r' ,i ti ,r, , , , v, , t r l, t t r t l, , l,r ', r i'ziilr t r r 'l'r ( plt lillizir r ' lt t i 'l'lt lt l; '
lir ' lr t t r t it t ii',t |llr r r r r lr t t t lt l't t t t
! f , \ il, r f lr \ oit r t t tllilt t r I . r l: t 'r 'l'ivo
lll ril,
1,,r' 1,rI,' I,r, 1I ir I |ir r , ii(
t l{) : l|l
 . lrtitttii,it'tttrI'IIt,ttttritLit',
l r.trrl ir r r r : r , s o: llr s c trll,.,
l \.rrrl i rr(l r,l i r, r.r.l rri .i rrrrr. sl rorrl .:rtrri r,Lr I rr ,rI rI rrrrtIt, 0x ilkltr (tri ltrrr lrr,rrrirl,orrI itrI.r't
r,r.r'r't,lrtirl
(xrllll)., lll? l) $tlll ll'
i t, sl :. r,' ., ,,.it ..Ltr,,tti,It,tr''Llt I tr, tt ittt'ttltrrl' ,\r'ltlrtti tii
rlli,iilll#iit,ilr',";ii'l}
ii'ii,iiii;.iil,l,:"{ijl r*li*ulr,rliiliili|l ,,,,,; ,,,',ii,,iirrrrrrlrr':Ltrr.
rL:r r rrztli,) sitnll{,0tltlti,olrtgilt,
Hrrrll.irrr.ii,llr rrrrrrlrr,',zrr.i(trrrrrI t i rtt ' It,ijiI tlrr trt,t.t ttttt
i( ltii,tirr:i,(itrsttttLitr'l tlivt'ts| tlrr[itriltrttrrttttrlrr
l;iliilj;ii:l':i"1;".11'.lhl1!"flijll siriqrro'r,,
ili.h$,J:;s,:i,;,.;:'.1.*,,','i.' r1',',,r.i coirrir,)lioato fi
'"'t"'irrrnoralir'!i rti:i (,
(1.(,
liz.lr,l,i' (!
t,Ltru(,i!l .trt .5r'lllt' (1tt'ittlttrttt'rrt';1it
ctloln,prirLl'rrgl j i'ri lle unor tutnori ltt .r'ttltl{'irrl.tlrrttlii'
r.,,,,.,..ii
Itrrrrol'i irrsii, ooirla doviuo
picriv I
;;i;;;ii;"li'i',:li;'i1i*it lj}*lim
i[in1til:,Hit*: ,,rr,r li'!rlr r oirient tlai;, prin mlt, staze cereLrrnlocu r-rvolLtfio
. ttmr
IlrPitli'r'1i rrtt
i,',' l,o1ontitl edemaio=s;i bcmolagic intt lt 'r'll;'
&trrcse-itnpunn' p'iir investigatii
riri?i r"ijdentintna unei hemiplegii la un boln:rv colnftloJ (srr'llorl r'\t'lrrtir'
ii'li,;;:il,;lj:illi;;,:ll,;iilifl'"1cir' r.rr,.,i ;nro tom5) reprezinti-in-generalun bot;,rilor atgutttr.ttl. itr frrt,,:ttr';r'
;l;lj;i;:ii',lilji;i,iiiii,[i]""i:
,,,,
1,.,
i1ui
'li'"il'l.ili'i;.T,J?f,$'Tl":l:iilill"lli
hipertcn;
i*i,i,
,, ] ,.,,'iident o aicuia" cercbrali TotuSi, in unelc sixufl'tii'irr ('rl'r'(r
vascular s-a constituit la ttistan!5,fa!5, de cd'jlonrultlii l)inrltI i(lrr|1'
l(rr':r'trll
11,,",'cu,iilr,
fi i ffi ililrt":?H_?t,
*"""iL:,t$1ii;i,* I r i,rrr,r,l
r,,."'ifttcgiapoato lipsi, dar putem constaiaalliesemneneurologi.. l't(\21\lr(r!
llig':f *MJll]'l',:#i:::i"xb""'"r*ir"
il+ill#'i:'"('1,.11ff,,:,"'; l,rl,rit,tr,l-La unor- semno neurologice (indeosebi pirlq'1i{alg)'
jttsl'rrlitirr
.,' .,, :iLitent sau in tloi t,impi, suger-eazd, mai multe posibiliti (i : ' ' tt trrt :t ;ii rr
I t
lli."*o*i6t)tiebuio
Iln'iltliii;i#,;,xxfti#fltii,"-1il,!:"xi.':',*':l"lfl , u ri tt(latie vcutriculard',-
,, r, :,r.Ll. h'".atom emisJeiic
procis
cercbral
ocluziv bazilar, hcmatolrr (lr' 1r'tllrr'lrl
(ctt marc cdcm lii sau irl)grr"iitIt\ tl()
lilti,I1uiilj,l,j;t
'l-n:*:,#.1*:-.*lxkill#";*i**ir'llili''""1'f"'u*#;
rf#'?i l',1,,, ,,r|oral, cu c,rlrenareain suferinl1 ;i a enristmului optts)' l'r'r'z'tr{rr'

l;;;;
iJ;ll, i]",*if
;;;;;';';ruu;;"1;;?ffili"L'i""{1i:iii3'Tli:fir; ,rr',r lr,,mipl"giiinr"omplotela un paciont cate cvolu-cnzd.
, ,, Licirineaunui Drbces expansiv : hcmatom subdural,
splo ('{rlrriil l{lrt:r
htrlttrt'lotrt ittlt't'

j1T*,'?#*1.,.fi
t,r,',il;1,5';
;x*5:i-i;"*+i"rJ::i$il.iffi*m;J"l't{l;
,,'
',r,,),,1.
||r(;; ).
tumoale cirebraiS.(Lrseni qi colab., 1974 ; Yoicultstltt ryiNloit'rt''

i'r':lcticaneurologicS,ne mai invali' ci, tol'deauna, i'aitrtt: tlrr rt'rt'littttrt'

2. Oonxeled,in accid,entelaaasaalnre cerebra\e rlr,r.l|,rsticljllde accid"entvascul:lr cerebral (hemor:agit,Fr,ltill,rt,t:isrrlttrttrir'),
. r, ',l,lit:l1o|irlrd,climini,m, prin cxatniniti tlr'nlo i'lirri(''r;i ||itlrr''lirri"':

;rllr:iitiHif# jiti:ffi1"*']?:*:",*Iii*ilffi '!1:':i,""#*ili

1,,,' trrrr, ilcle l raumaticecxlraduml $i subdulat (iL('uL
,, ", t ,.,lo, r'rcningitclefi mcn illgoce{aUl
iti slll)ll'('lll)'
r'l{ rl1uilrslitlitlcrrr;lirli li tttr'ltr{t"
l Irr ,,'rnil, encr'[alopalir,hipertcnsivi si crrllLru( l)]l{'l'lr|ir'
l lrlrrrrlrr('

l::ltiti,l:.*!t:::,,_,.n"i
hemiplef#lJi/
J;''J:,?li":iflli"i:.,,1ff?;*lf,;j,tr
1i.:.,1'#1"i3;i,*",""'sf,f lti|r,grrt,s|iculde mcefaloptt,tie hi.pcftensiniiosi,e]'ol:L1,iV tttltlt.tlrr ir|,lllliIt|,

,,i l
!]lir:.,i:lt{*jijrlJ
irr v..rl.r.. cii,,,pari1,iD
fifi iji tl ffi1""i"f;Tli i r, , ,r i. nl toarelor eleircnie ; a) n6 afl6,r
i,,,,,,1,,r,si..e{fie cu hipertensiune a'terialii, a.sa-zisir'
in falil urui crt'z' rrtt It'tt1'tttItrt II ' tt|'rr
cstrnl'irrlii',lirr tir" tttt
unei corneh un.tind,r po^t" porinifit"ioii ,t,ir.r:lrcfr.Se;Amaial6s,irrcadr"ulunuifeocromocitotrsil,llrr,rrlrlli lrrlr'lr,rrl
iti;;il,iitiitfil*Ji"v,lliih*11,1?"ilfiliiti*t"Ji
"" "".1"0"
i""i:tt*il.i*,*"i#il ,,,',' ,,,unla-rnoal,
, ,.lrrri,tsii'sau
in cadrul unei coarctalii rll i-1 lrLltorli(,
al unui Satu'risrn),cu masir-r't r]1't! lr.ttsi.trlllir;i trtt ittt'rrl'
rrl ttlr' i tttt'trttr,

:li,riiiil:ii,
:iiiiiil', r,:liliiuis:t
:{rl,"i
iu ":3fr"w,,n*i,li,?*:d:;*Htix,"ti;i tr rli
'lirodific[ri ale Il.O. (pini la maro edcrnprr,liLtt) 1. b) Ootttittttt t'rtl"
lrr.ofunr15,, cste de obicelitranzitorio I c) O'trta,trs1,t: tltr tttttllrr rtl'i ;rlttttt
iii"".lil;
iT'lili;i,T.i,J,'i1f,.',",r1',Hi"d"
ifT,.fj,li1.:"iTi,T'1,#
'r,,rr iiui
lr,,r,l
,i,i r,,,,,.,"
I il) Cefaleeaesteintensii; e) Se 1lr-tt' asotriit'1i :rll'tt rtrtttttrr
(uriu importantul etlem cerobra,l); f) J)c .bicci I rtttItrl rt,IrIIrIt I tIt'
"oo""i*ii
'lrccetlatS,
l;llii,il,i"i,?#i*:l1l*,?gH'Hhffi1"j_".i"11"i;*ii.lr's;r"il;;;
lilcrrlrlltllii cotoJ.rralo
t, ,,,,l,,,ir"iaid,este
rrr'r,'r
rle fenor*ene protlrottti.t
rrnii, episoacle-deconfuzic qi obnubilare)'
ltt (trtrlrlltrtrittlrrttttil,

lrin me de obic.i nu crccuzi, rI i I i r,rr| |,ii,t i rlirr,ifrr,

iiii,iil'i"lX"iiil,lili,t:l?Y*#.&?#,1#;"it#-"r*:#!;'#..ru
H,ri'. r,,,,,rrrr,(Li-
r t;
ilamoriaia subayahnoid,iand,
, i, ,,. ,,,inilr"iiot *amiologicliind cel mai adcseare't'lil1,ot': s.rttttrrttt.ttitt*rrtrlrr
tu vii,rsl,t'ltri,rrrotliticili :r'Lr'lr''O (itrrlxrrlirttl'
'r

'i1,'
rlrrlrrrr,.
f Jiff stt.l?3f
ir'l.it',r.r'r.rr ,.,i",.1':.u,]ll,l
#til9,',ffi"*|t,1i#5,i#:filj'lii 'rrrrr,tiri,ntc"
,,1, 1
cefalee inf,erLsit,
i f ,d^o.*gii ret irri, n,'), rnici tulbrrrlri d{! oonltiinli, (t || I II I| / |' ,,, I
unui hcrnalom posttraumitic etc..1. ( '( '1, ,lt r ir r lr r r lllr '
Sd||lr r ulr 'l) ( : i,t : lr , . or i cr t t ni) , r 'lut r rt lo
,,,,,r,lii,,itll,*;llili;,li,l'fil,)iLl"i'xlii imporLalrr
,'i
J";iffi""""_T,l,xl'3""T
.r.,rt,,t;;. l )^. ih, r nr O 1O Tic,
,,i :i .t,i u,rj t ipS"*". plgzon! ; , n
'lcziuuilor
de nor vi cr ani{t ni r t lli't t t 't r t 'r r t t i t t r t lr r
''i trrltlli)lrtrrrl'i.i \rr'r{
r*,i,,,,,, 6.o lioalizaro p.1; srrn.r.i:r, topogtalilt, qi latttrt
,' rrl rrt,,ti ,slt t t t Lzi, t t t it'o t 't tilt r I lt t t tt ot 'll, git r 'pI 'ilt I 'll1lt ulii''

"i,h3ilii3xlihi3*11?J#j''il;3,{i$
--iir*l*|lx'ffi
{ .1 r'''n r i. ' t lit r , ( 1v . llt l r:L l(l o l [r.c tr
rrll'rr'irr"r.lrr.r,zi[ ..rrrir,, _ Eo .' to l 0 n !i 1 ,, c ' t tfuzi c sl ttt obnrtl > i l i ' .u,
in rr..u.s tru,itova u,,, uoir'ar"
.itavlt,
* l rrr
zirrr, rrrt,
l ri ti rrrr t lit i t li: t gt t r r ; ,ilr 1 : pt r llt r l t t I I i t t I 1r i t tIl, it t 'iiir t : r '{ir r ir

," ,,u,f,,i i , ui'if i f ir r lil r ur r r *I iLr r ir . orr 'r

r .
( '
Pl't 'i( ili t t t r r 't
| r| | rr{ | | | It)ii l, i[ , : r ll t r l't 'llt t t zilr r t lt l: r 'r I r' I rt t I t t | :r t' (' i | I I I I llllll l ll : lr 't : lr r Hlllllllll
r ,'i lt r t t t t ll, r t t t tr r r t t 'olt r irrlt t i lt l o t 't r t 'it li't t ,
r tl', lr l it t nl'lt llt 't t r ltt t t t t t l
r , , r t r lr t 0. t t t t , , t t it t gr{it
-irr{ it t ut lr , liuc it { 0lt olr r io
r l' (' t' lll(l_ r'll,/.llll,l,rt lttti ," Ll ,,,,,r,r , t i, , i, lir r lir , o lr lt lr . , |il$io
t : t t it r , l r t l t , l l l l o p t . o g t t r s i v l 'i , , i l r D r l r r r

iJ t 2 ;i,l 8r3
ffroti '
J r,ttlr r'. ll
 I rI r| | , I.||r,III
IrIIiiII {r(tl jl, r lt l) lt , ( , iillt i , ) \ is lc lllr . i r r i r ; 1 l l l i , r r r u l l l i t 1 . ,l l : Iiirllr r :r.trtr{ ' r i trr|l ri l l :r l rl '
I t t t : t ttIL ittti'tt iI1)i ( t ( f olllilr lr ir ( r r r | lr r r ir i ir r J r .r r r i r t r t l i i , r l i r r l tt\ ,l ttrtti l i rt It)ttt\' lt l ttl tttl ttD l tt) i ' rl rl l rl ' 'i
.r si lt,zirttil. isr,lr. ltr 'l' lrL rlr':r'':rrrr'|l.i':' l''
rrri c. r ' r ' r . I r lr r , |o)
( i \r' s o ri 5 i ..,l ,rl .rt).-,l t,? 1 ; V ,,i c,rri ,,,s,,i i S l ,rl ci r,,
f-fi ti Z; 1" r,, t' l,r'rrr()r:r'''r.lt'''
l1';ii"li"):,1'i,i,,,i,,
l ':rr.r, r . 5i r r r Lr lr - , J ,l .t7 tir,i 1i r , , r i r r r l t t l t t r trt r l g i r '.
, lrr,l i jd g J j 6 1 r6 r..i 1 i rr 6l ab., Jl i fi ri 1. I
t'ttt.qitttxttt'utttt.ltt.tntiq[ ,ln,trc.henro.a,i.d,eerthrulii ;i ' ltr:tttrtttruiiltn'r'tlirtit:nt 1i ir rdottttlrti 'lttlil'rtt' lltrlt 't
;, i;; i;i,;;t il 'ttrlt,tt,
. ;i in.ivctul urehro.t l tttttttti .r 't'
lrrlrr,r'rrl isr'lr.rrri.)
r'sl. rr. c.rornili nrurl,.i*i or1;rr:rn ] , ; , '. 'l ;;,;;;; t,i ,i ,,t,r si i i i r 'l t'r r !i r ', i ttsi l ', l r r i r xr 'l l ttl cI\r r r ' tttt.i
rrIrrrrr.iI.r'iii.'rrrrria. trc'rririrrii, '
i,tcr'r'ite,ia,aio"ipr,r,i;',,;i.]];i;;
t,ra,rLz*rl'ii.qif,si:r,u ilISugrilcesl,
l' , i r u tu r tti IIctr r It'I'r ti I) '
crrlrrcirrl irii J)iu'ir,fc:tzi'i diaqnosi,icul. 't ilirliri:i"?iac.lipo,lt"constituitunsenlnI)I(io{)(iotl.Jtilr.tl.ttrttttt''
l,lris1,ji,, (). , (hemoragie,llernaton, tumollel',- . .
, .. 101rr5i scrie rlo clerncltc rlifercllialc (nraiotltatea stal:ilitc ','r '. r'rr,rri:tilii, umitafurAtiia TAill (<ltrlrrt,tl'rrrt.'t'rrr lr.rrrr
rrlrir,rt(i rnirl,o'ii.l:rsici) i't:.e :r,t:Iculaloploctic'heinJ'a.gic;i ,,, Srti,ilercairftnorlantrd,
,, qi-S'oiru. irroil
ce. isoheruirr
i, ,,"tiJi"i"iri'oo""' p""t"" o trombozii' cle artolii c:llrl'irlii' rrrrrr:rl' i
\-rricrrlosnrr r,. ,,,, .-i {oJcb., ,,
ll];l
r: ' rD. ' ;llil i::lli.r.li
rf,,, ,rrlr1,:i-
r'tiiltt r l, , , , r , pr ) \ I c iu c c l"lr . , Ig s O ) : lr $i/ sr'u rtltfirr' IritIItrrrrI:tI
', iu"st"ir-usi un sinilrom asfigmo-pin'rnitl,3'l
(lr'ril
,,1.,.il
)i poitu-e-vc'1'ual-:ugut'L, Jrt'ttt.trtrirl'
,,.... " apr,'r.irzi ,i.,, .omti )'olid(ir iLclr,l:rrii,,d.c, rirlcc),
rX,':ln,rtll ',', i;';;;;;;'ititriulie*;el Stoica' I0{i7)'
jii, ; l i . , , .,i. , ' l ll]j , . ' j :l r.l i l 1 '.p ro ti u n dfii i.sm,vi_rr n:oi,irsi i r i, ir np,.,r ;r n1,. "' , ;'ix-.*-*cmn inlelXtor frroiculcscu $i in-pest"^?tt'l''llll
diagnostic.l
' rr, f : r r r Y r , ir liult \ ' p ) i .s l c rc !.(.l i 1 J fo 3 l ,u i n d e osobi peutru bnmoragi r, nerc_ ,i'lii,,oiirri-i?nii""q#a ':l'lli l'
rrrcnr.innt.a.srrir.ii r' | ' i'lcntieroa (macruscopicA sau microscopjci) r'r'sing' tttt i::r'rl: ' rr
]l:. 1 : ll ,::.l,lll.i,. .teconrrieni,r,'irr-"-.on," \upcliciatit, -io hernoragii' Da. lipslr'..atxrsl'o'ir rrrr I'l:r l"
ji,r'illill;ri
lil'i;li;;;lj';,:,31j"3i,.i1,;liin,8i,"",.l
.,',, f,,,- *""o"t i"d io f,,Cn
focar l:emoragic(Voiculcs"rr $l'i.ru' llrr;' ;
l':r 'rr
rrr,lrorrric.?rczenta nnei irnr:ortante obnubit.iri, l';l'.J;?;l:)iu';J,'1"':,".1;
,. . tl"iff;;uu-i (lr' I ir r'|
rrbiccntczr'( u irrr'
lrl(rlt:\
*;;iu;t"",, o hemiplcgic
' , ',' ,.. 11," '"cfecl
i .- J,tarc,
lC?7).iCft
' ;r l;:;1i i i " i i .'unei
r ,ti iuarca 'i
i r oti c nr c c i {l 'uL\:r 's .r tl r.r'rr ''1'r 'r r '
i.r,rrr.rrplctir,ne sugereazi, riai tlegral-li, u"
h;;;;;; intracerobral, rrrlr"r'r:rrrl
t) Ih.utatitatea, t)rusctletteainstat,iirii iiifi"iiiiti,* . , rrti:t rielrloPtii a carriiLor cu S"lnnc dc hiptlr'l''trl;irttr' t' r"1"'r''l
';,;.";;i;.",
r,rootitii nraltii, t"'"bnlot"" qi/ siu I L'lrtrlrr'
\.r'r'rrr.{.irr,.ictcl.isticii homoragic,s_aiio\_edita Ii rlneoli ulr eleir:eni: . I rril
_p.ntrr
||rl'r:rtr,r,,trul,J:l lel de bTusc,de lirutal, putinilu_sc rr-'r'illtoaro: midriazil Lrnilat€rali''opi$1'o1('rrrrr
,' ', ,,,t" iiifiouse "'"ic;.i"l"i '
instala qi ntr etac is-
hr,moragie-se , ,,., i''li"'a"i.tii..r"r, udem pttpilar) qi a stazci l)lrDilit11" ,.
ir:rrir
1:.:'Iljr)llt,iltr
]i.l,l.|i:"iidllltnea,,o loiateirsra,ra,
uncolr icrirorm,da,r '
.llrtdi.ficdrite EllG ut pot fi hot':'iritoi],re p-(llr1'lll{lrrri:rr'r'rr( (\ I'rr rl
n c olr s lt i. ulJ , s r t t , . hit l, in r u t l ] c n l . t. r't
t l { t' rli,ltt;,c0 p. r uqt ps ; t ) i. in r lpc I I S ,. i l;ri,iin. id67 ; l'opoviiio Ii co]3,L., 19R0 I 'tr'1rir'r''ll)(i'iI lirrlttrtr(l.r
.rrrrrr do c l t , . \ . a t r i l r , , a t r l , , i i ( . i j c l o r r n o _
,l . iil,z'i"illtcmi:la'li colrr'b',t9i9; Fir"\'rjr'r irrl'rl' r l1r{;l ; \ rrrr
{i:rll :}:lllo l dclt , , i1c r or t r ol, , r ic r , ) Si C t Li l b r r r i r i l u l t l e t . o r r . l i c L , , ; - t c s t l ,
|{ . (
' \ ' l:rI Ir r,| ) ind,o-obi perrtnL ata-euli*tt u*i". nu" ir=ilui" ,,, ,rr",r, tot_ ,, '
i ii'ilr;t ilol dbPupr"irirL;i r'"r'r'rr.,,.
-'"i0""1i 1'"l')' r ' lli'
ll r 'r lll:iill.
rrrrrrr(
cr ,.1cnl alii4rcftun,.ihcmor. : lgr.iiurt i, b rr1 r" c: r l, "p: llXl nt l t t C pt 't t nil' 'i l" ' \ l) t lr ' : r l"Lr ' '
: , ,:r. l ll |!r
j ll:( ],:.) i, r.it , i, ,p, re c u n r ' , " ., . ), 1 ; 1 1 1 11 ' t 'r 'r l'
';r ' r , r ln,.,u,.ir
L|lt tt c . ttc m o ti t{ j c i rrl ra l u n L U l a l i ) , r.r(j It, l l I ttr,ui bemutum. i , , , r , , ; . "l, . r t n*ii' pl'''duc nr uclir i': | - I I 1 I r rr : r
' ' '' ' '
ttttl
Q ) I ' t t , t , t t s t t t , ! a I o r i .l u < u r' o n l p ti o a f, , ri a, ', ". -t Uiot Jit air a, it , ce f ouillr lt o isr lt t r t t t ir r r (r t t t r r i lr li I I
, j' r , l) r' 1 tr.a l l .tro r rl a r,l rri r 1 rn l uui l u i l l ,u:rtri i prf,cpdeJrti ). .,,r,,,*it i: ut ") genor eazi. r-lor ootlifn" icii'r i lt ll( ; r r lr 'i lit t iilit 'l'r r ' ( lr r . r I ) r ' rr
i n l oros:trcl l ac,,hri r.sj fe| i rOri i i ,
l\' rsr'rri'
1 .,..i ' , " . 1lrrr
. : ) l' r "., I ,i cn car:l'cLel i'egrcsrY.
ringrLf:trzi-L trrr i.laLct cerebral. Atacuriie iSchemico-tranzitorii ( 1jt i{l r nl I 'r ) it l" r ll" lr r 'r '
( \ | | ) nr.:r,11/r.r'rtpnie pledcazii t()t pentru
un atac ischenucr, , ti o. : ioivq{la cst ; cont r aindicaf it ' in <'lr lii t r lt t t
t\) | it r.t.ttt .,, i': r : r r 'lu'lr i1' llr it r t r t t t I t or . ' r r r 'lt t "'ir '' 1t '
to lturLrni(d srur.eniti concomitent cu instalalcr ictusurilor, ' ,l t' ii el, : ineir t e t liagnosf
iir'r |)11{Irr(IiII(I<,u citeva }nomente o'apoplexic
lr,r pute* constilui un argl J i'- : r "r lir " 1I r t r r o1't I t I t t
,tt Jr,'rrrrrra gJir'-t) .0{a1€e cai-e procerli, t { it il, izarea, ( r lt ot 1, }tD, slillt t ! ii I ) |t t t : ||ir t it t ir ''ir r l
']:.:]], ll,;i ci rnnlt t:imp un actittenl; r r lir r l lcli t t . lr r i l) olr pl' t : r : r t
:rl!'lL'r'r l(. l,(,ltte I i f|\ clat, rilt,e I r, r conpit clizat i, , ecot nct i'lilllr ''lir ''. s1 '
l)ettrn un artevrjsm care s_:l riupt, pentl,u L it r lr l' r r 't r {i: r l'
lrrlrlrrlol.tr,tic liportcnsii,'d, s2!Lrpenltn clcm cliLe lr of ioas{r t LLrt liagr r ust . itlr t ; z'i1 'i
un plocos ocluzlr, vasculai,. l ," r' i
l) | | r!1norir$ii.r,sc insl,a,Icazii -rr.ai frecveit Ari ' ,t t n et t er ea dir et ililor l't ''lut i t lt t 'i'r t '3" t r it r t t t t t t t l 'r : r t t r llr r lr lr r r t i ll
, ci:rii-rlle;, in vrr.rnc err
:tl :,, rrl i , lr , , r I i, , ic n ru rl u r" c m:l i l rl r.S,.i t ' l . . . r i, Llir l ||I I : . I ir '; r : ||I r r l l! r , r 'l
i tt ti n p tl trot,,l i i . ,t, i i ri ' ir ", iir *i. ilr , . i. , lr i, , iit , , i', ft i, , r jur ilir l llr ,
r r i' ) r ' i : r r r r r i r::, rrn c ' h ru d i c o ttri i rr d c L rurur ui ri i 'ir r t lr r nf iill'o1l {liiI g^}r ( }slit 'lr lr li"
rccr,rr.nr, \i .r.rrri r. ,,, t' ,,' i ,; ir r xt t ir i ljr r t r L,
i ' r' ,"' ,f
r'r' : r r l, , , it t r . lt r p \.u l i tto i n l ) p e U tIU h e m o ra g i e (dN ,r
nuD ai Jrl tk:bri t !).
It) llirlr"itr'..:rr, .iTtsilaterald116.:.rului '.i. (|ork(l,o tlilt lruLLn(|tis))t|l' {:r()I io t!:td)'r([!
, cstt ri,veiit.ar. l'clecsebi lltrir.ir
lrt ltt''I ilI l( -
r1 i\ , , . r r 1; Ln-ttttre l o r m tn i n g l e a l ep l | r1 c l z l ' .ii,rr farri l R .a
tnt(i l tcntora,gi i " l. (luittt:tt insluLulrr itt uottt'trttlttl ltttttttt'ttlienrtltt'i :
r'(''.it ttlci(:on.trut.:tur,i ill( il {: r r '( r i' r r r l'l
utustutQrt:
pt.iloa,zii
irtj.osi,tri , i t: , nt t t , 1in t t u r : bt 'ai'ii ir r r lr lir r iio lr it 't r lt r t o r lt r lt lr t r ) f l
,,,,,;il, iil;l;:j;,1i,:r,,Pc, l ,:r ., i trtlt liit l, lllo llt t t lt lir ' t li'r t t ili ( r cct r lr t l. r ', , t r r it r t t t r ') llll
, llr r lt r 'l( ) lr l( r lr
tl r lr
l ,) I I ilu. l, tttI ' i. lr t,l :tq
* e ttz rttrl t.r.i
I.u. i ]J a h i rrs l ri i< ,rr oxr,crrli i r r.ri rrrl ri l l .orr,r.l r, '', r r l r r i o r l t {\ \'t.i l ( l l l r l l \( , ttl l tr r l tr l l i r o t rrl c t l i i l ri l i l l t'l t r t'o tIr ItIt'Ii t' l i l t "l l r
i l r r l tr l l {j tl {r l l tr Il .l 1 t.* r r l r t.r 'l tt r'
;tt.Irrrrr I r r ). x r . r r r r r i l .rrr,r.rrrl i i rr rr.rrr.r' l r,r,;i rr,l ,,),ii ,,t ,,l i r,l ,i i rri{.I r(,I l ri 1, . , i . , r , ' , , , :,',,i i ,r :i ,t" I'r 'l r r 'r r ttt tr tt l tr '<r zi ttl i t
l ) I ' nit t t ! t t t |t rtttrl 0 t rl r: i ttttn i u .l i t, t.rtrl riIttl r ''' ' ' r :r tttt tti i i i tr r l l r ;r l tl l tl t r r r r l o :r l 'r : r 'o l r l r r
ti i (r.l r.) rrr, trri ul l ti t, ) t 1 ( lo n l tt:.:i tr ' t't'fr l n 'tl i 'l 'tl l r tttl
I'
lrt l'it r' , itl)t| r , I I ( I | | I I , I ,I I .1| i I : r ,,,t.r ,lr r i r ll r . r r l r '1 r . r r r |r tIr Ir . ttr t ttr l o l r r r l l Ii :r r i r Ir tttItIr t:ti I' Ittr t l r r 'l tr l tt I l r l r "r r r l 'r
l ;r l ) r r l t'r 'r r 'r r r l 'r 1 :r Ir r IIIIt||'II||I|( :l 'Io tr l tr 'ttl "r '
f,irtlI l r i( 'r r l r r l ! ,1 ,',,,,,,j i r ,r r i :r '
 r' ,.ir, lrr 1rr I I rrr I j r r' i rlc lor r qt i ic r rl; i, ill l l . l l r t t t t r l , i tt',l tl ,r l t,l t1 n t r n t r ttl 'tt'tl l tl ',t l tt tl l ti l r r '.r si l tl r r tttttti l '
t r . , t \ ilr . i, 1 r t u . t i t l r r l l i f i r l r t ( . l l t ] . ; f l 4 )v i n . i i l , l ri l , , l r 'l r tttttl tl i sl l l ^ l r o l l l ) l \l l l i L ( 'l ti 'i t 'r
('ir'r" , .
/rl{" r'rr1r1:i rrri rri ) r'.\'(lr''iir'ir,'s:r'rr
ir','rr.rsirrir,,1erLi,rlirr'1rof,,tlllii). ri,r I I r t t rr,r I r, tt t t t I !ttl ) tl tt) ttl t) I'tttt lrrllrr
( t
, l r t r , l l t t . o g t ,r r si r i t, l l r , r ':r l r , i i i r i l !r r 'L i t,,:t, r l ttl i i , r 'tl l r t l t sl r 1r I i i r r r i r r i . L l ,l l !r r l i f
r.rrrr.rr,r'.rrsli.rrl.i sir l'1t.. ptrgrcsir., pr:irttt-' afit"r,i" r .r r ,r 'r r i r r l tl tr i sl i r t'tl tl i i tt t'o tttr i - i 'r 'l tr ttl l 'r
"rariai,e , , r t r i l i r . r r r . rr r l .zr i r .i .r r l ;yr .,
' rr rrlilrr{i. lrsilr'rrrrrt,r'i..r).-obitci o,i cnu,tat;
l r tr r q t'csi v
'.ccirtl '""iii l;ar "^,,',r,,),,,
s.'rl. rr. t lr r l ttt'l l l sr , r 'ttttl tttr ':i zi i l l tl l l scttxr r l t:l l ' Pl ( ) g r ( r si v: l ttl l r tl tr tl i
rl'
r,r.:r,trl.rr.,, (r,.r.r,r'silrilr,,i rr:r.r,r,sibikt ',_, ,,
pat,lrial t,,;, p;,,;.,,,; 'r r , r l , r g i c c
, , , 1 'l r l r i , I t r,ttti l i i l .tczi i , {i tl l \( j ) l l l l o l l i l l r n i tl i - l 1 tt. co l l l r l ) l i [1 ( ) tl l 'l l ', i :r r ;r
rr,|rl) r)|
rr||r.ir) \'0a(r 1rli\.0 -s,ntr*qri"at,rrii1
(irrcru,si\- "..r."isibi -l ittr itrll'tt tr t'
,r'rrrIrrr'ii'i
t'tri \ r rl itil)li(,s) 1rii1.sra cu'esi)i.*{i. , , , r l ' t , . , i 1 i l tttrrtl tl ,o r 'u 1 l i czl r . se l l o t'i n czl zi l '( c* l u a r e t'i tl ttl tt'tr l ttt r t zr
sj chirr,tlrinr,fi;r,r:rtic (seurnif ,, **.itrrtiJ rrrir.ede.pinrlrlr
ririrlt rl (x,lllltzici si loi, t , Uz a' r . qu c t .
,' ,." r,,,,i i t,,,ir iLir iiai. r r ct 'r 'i1oroculom ot or i. Sc ir nput r r r r r l. r il. it r lr t ' r t 'r r 'tilr : '
( j I
rhr' cciliil. t br lt lioa, r 't lit li 6i r l r nu{lif iciI ilor 1'r'ir 1' i r x'i ' I i t it t t 1r lt - lr t t r'
' ,,1,r' ri hilln''ir , lr pif ( - \ r 'st r ii |r r lr r lt l1l?l)
t',',,,,t, itt,r r l, r t , , lt r pt i ,' ,,,,,.rl ,r ri u glr , ia, r 'e
t t uncnsului ;i '
! ,. t t t t it t t r t r , r l lilt r r
,.,,!,, ttrt irtut:etr Libets{iL$t {aiter* ort:, pit:ii ttt rrrrrt
,,, ,,t,t,:;,,',,1
ttt ),,,,,t,\ r/i .i,.,.:,,,,,t:::.:..,!::1,!
,,/i.l .r,l.d.purtl co'st.itLri.ii horrrato:,.rncilor 1. 0ontt:le Dt it t 'pr r . r celeeaponsir e ir r t r r t cnt 'nienc ( t 't lt t t oti lt t ir r r ilir .
lcute, . t c. ) se inst aleazit lont - pr . gt , 'si\ '' r ': r r r '( rLr
, ,, l ,rrl rrl i ct, a[ ccSc' ccr ebr ald
,tr,t,,',' ',,t'::,:,,:,;i.t,
,',!,'.i"1,1,",,'.".:"' ,, ;,. ;ii; ,;1,1";l;iifirirx lprin heurirlrrgiiinl r.aturno}rr,t..gi r{l0r ), rlrrlriio
lrr ilrr,lrrlrlisrrrrrl
t:"r,,,",,i,'.ti;;:,',1,1'.,11,,,?lJ,t"l',1;_,"-ri::l,:iiil,,i;l
, ,,rrr[i r,
rel at 'it 'lu}gi culim ploule r le i) c: l'r ii cr t r , lt 'lnct t liot lo st t t t lt t t t t t
I -- un inten lll libcr rle cilcrir, .,re, pilii, la, rlaxiluurn !,1 ' in (,lllii' l)ttirllr ( \ I
,".,1 il lalc - intlacli.r,rrianil. Dxarnelul nolrlologio
, , lrrl,,t 1.en,,iune
l::i
iiir,Ll:f ,il:l ,ttcfapt boJn;r,r
ut puat_t,
srj ru iic'perfeot hcitl, r.r
lrrlz)rrt{) o rjtit t rlo obnubilarr ; -_ tirnpll al trciJea, in drue sc rn't&l.azrj ,i ,,], 'iar,r"" pir r,tr.tit.t:r,toatlesoa bila't'crale (pt'in torsiurLrrli L!'IIIII'IIiIII|||
rr t o 'r:i , lr r r : , , ir r r , r ir ;,.rl ,.i .J .tl rl c rL orl n tOc l _ t,r.. ,, r,'.,,t *i rr, iu'her'rri,r,anicdillelor rltlr.,belo:lsegi/ srru lr' tttitlttsttltti lrr;r"
f-",,,11,.* J" pr.," .,.,f.t,f,i ', 'crir"
l ,'r,ri rr' \ r \ il! ( t r . a, r x { ,l i rl t-l r_ rl c0 Sta tC c C rn fU z i r:i , LT[0oi ,i l i pS eS C
tl e C efl tl ,.,,
r, ,), ,1c lLi|o-ttolric, anizocolic ctr midriazi ) etlottL }ltltilrt't '
.,
r:r , r,r||:[\ llr 1,]czf,nilnd rncri dg Ia. aC eS tO1,l r.i
itrceprrt, dupii traunr tisrn, o stll|r, t
rlil (l(lzr)r'ioil{in(', t:11corrlnzio qi agrta]ie, i. (lorne[e prin uJoqitllLi cerebr&le de origi'ne inJ ecJi.ou 'i
caie s,, :lfravcarri ]rogrisi]-.lri,,i., Ne a1'rnge ntor{'ill rt'sttltr':t'I'tttttt
lr, rr)rri. Srnrncjo focalc sint repiertirtite ,i ) C,,rrn tfin troibillebitele cerebrale'
A" u lin ipiuea_xemrpregu (,1 r r llir r ir 'l: r '
r.rrrrrr lrrlurrridalt, clize conr.ulsiye 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
de tip 1:r,cksoniari,ac,r._ia1ia rrrrl
,1..:;:::l.lt,,_l t'pusi,focaiul"t'ii,
cb:rj-uga1,i ' ' ,," ,' ,,' ,,,,i ,. it " 'i ', i, n" do iuc, r 'iiznt 'olr lc pild'r r 'f t : r lt r r r r lr lr ": ii l: r 'l' l{r
i1,i:1l:1, I lv si \ I r r r ir 'r r t . r r r r , t 'ir . r rr.ir r r r . r r lr r r
,':,r.rr :t,r),,'t('iuIr.flr\ul.i iul,Ornot'l), Cu mal.o'"lo,Ginli"luiterarxlei,,,, ,r' .,.,tl . l ;;i o i"r lr , , "" f , , . n. ct r ilor f l1,
-.,1,":ir a.r',,'o,nto-"iui.
lomliz-A,t(rrie, i'rli
' , , ,,,,,;;
j rnr , r ir r al', 'zc alt "r 't r ant c qt ingl dl: oupLJ'it l I t ot r r lr oll' lr il: r ' t it r t t : : t t lr t t
l,l,ii,,,jl,1'1::ll::ll,,1,3':lll1:111,1
.,,[||i,. ||Ili|.III|||I||r.
i;-;;;;;i;;*."
'aloa,re por,!piir.oi, , , .,i .,ol ,i t if , cot t t ulsit - c ir t - t lot r r bt 'f lcbit u' r ''r r 'Ii''ir |: i) ' \ r 'r '- l "', t '
]'|t;ulclu.l{,
lprill, ang:rj; 1.ir Urr,.u.ulrrilripucar,,1li,. "r ir . "
(rlrrl,rr.sril t'rrrrriti.hri cerebltl) ;i , ,i ' O-tri"oirc ap:'L,retlupiL' "ti1(j srr!rrr':lrti"'..irriirc{'ii l:rl'irrl"
rlt.r111li11 ;i ir'portarLle sir*ploure r eg6ta,tirre.-
1l;r,i ,,', r,, t,iii trfi,ii go-arnigtlalie'n,' c\-eiturr'1 t.rpi! itrtc'r''rr{ii
",,',ii'"i"n:i" itt tttit ttl lr:t"rtr
11,pei irrr a,ccclrrl,r.or.r,
plog."*^i, ,"rpi, *qi"-],lriiio(la, rari,, st€r1/r_
,,'., .i., ,.]l {.r,)ll{i{. {l)11.ri;r r lrr,lrrr..Stoli,..l.7. l r l otttl i . '
t rr(rt rrr rri l l ' '
ttl ll I t.!l't t,tl s uhdr t t , ' c ul lt r at inr i, ltl (lotntt mettittttiticii apllc itr motl progresiv in cursttl lll)iri
o . in t p l o u u l , , J , r ! i o rirnilrrlri st u sau duP: r t r . t . t t ir t 'il: r lt t l"t . t t
r : , . , , : l : : l l : lrl';r,r1 r.r,,.n ,{,,r,trrr. ".urr ,i" , , f r i, i{r ulo r ublr ut n'
,lll] , , ' . j, , . ' . " 1j, , , ' i" r .,rtr..c ,i a ' j rre rr:r,lut'
r ii"i:' ,."i"' ,,,.,i
put:n,.\.i ' ' ,;, ;,: "i,
'
,,l i .:]].:. ,u rs ti c r} l i i .fi i n d
d e fa p t pr.ezonte i n cl rrsi l i D bl ri ei i ' ,,,,,," " t" l " ti"t iei'ipt ihnini. : luluni'I ) iagnuslit : ult Lr r . ir r r lr lili'r I ilr lr r I I t: trr{r rrr' I i l.i r':r t t
t",',:'1 ,, , , r i' t | l r' | i rl i o n r (Ar." n i .i ro h l r., l gi l ). ,' rrrrl itr vcdeit prcre-n1a selllnelor rncningealo ltcrr-risi;trnltr,..lt ,
' t , r l' l r,' ' i rj . .i . . set ir n, 'le, l'in[ ct t ior . t : c gct Lct r t 'io ;i t lir r I r li' I I iI r . r r I iir 1i r ' t l'
r,ul' : r . ' r l' . \ : r , r , r ' r,,I,i .o Ii . p i t.d l l t rr,l ,ri rrr
r rr ." .J,J zi )e, Irul rrurl .l .trl r.:r I 'r , r r ,
\ : , r , , i, . r 1: , l ,rr.;rti z i ri o Ii r.I rrri rl ri i ,z | i i p ,.i Jal r.trrL: ,r , ,.i i ,:. . 1, ut "r , , ir , r it , , pin: t lr r , r . upii qi. 1l lr a{r 'ir r i. .r r : ilr ir liil"
]:j ::1 ,,..11:
1] i .ste i rrrporr,,rrr.r , rntti l rt sc ir ''t : i, lol, i l, l'u: c ( t l ( r r ll\ 'lllill sl
r,lr'rr.rt nrr{,ri sc instalcr.rzl
o niidriazi,bihter:ili)i Ll trl rr. ''ollllr '
ll'.:,,,1 ':,, r'otL II
IIi I| | | | ,iII1 ./r'I II r ii. r . I r , I r , . I ) o m UI t e 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
r lr r olr il r
or i
$ernnc de rigiditititlr , p i r , r
rlI r l' sit r r lt . r r t t t " t t t t lt r
rl,r',( r('l,trrrr'o,;i r,cgcLatir.,e ,r,r , i ,i r,ti i i rliaenosl, icc.- \ st - f el, cir r r elc sit r l' lr r er ''r lalr r
,:lirrt,trr.rrc it,prlrtiirtit. EIcc:tu:r,i*i g:i,.r.ii rl. r';rIirrlrr {'otr'l.lrri r
Ir, l )i r r ' \ lr t r ) l. ill0r ' ii c s 1 ,00 b l i g a to ri c . ii,,,';i;iiJil;;'iiui.i.;lt,nt'ii,.iir"-r{itu tlt' currvulsii 1i .rl'.' t lr r iip it t ll; t t r t r lt
tl IL rtttrIrttrttrIittlrqtorr:Lni,l dcitt er-olucitzii
lil fcl in 1,rei statlii, rrrt rrrr ,' ,' rl,l ,rgi ooir t i, r - un. ct t r t 1't lxt t lc r t r gr t lt l'f t 'lt r il, r 't l r nor lilil lilj "t
rrrl , r\rI lilr lr , lir , lr ' irri l n l l trrl l i ri rrr LI l l l .
r1 c t:u n ;ti c n 1 i . t;e f,rtul i , Ll c obi r.ri ,i .,,rr ,,
r r r ' r l"r r r 'r r ,'tir r ( .r.':rrr
rr, ,'r'rj,Lir'r'r'.s'.r',i,,. t , . ,r, i.,'siru
, , iri), i,",i, , , , 1 ., , ; 1 , ir,.
-h.,rrrtal.i,
'l'- r,,)t'(,trrli., s:r. pleiliJt:cti, (turirpolnl:i, r.,,,,,",r, li. ( lo rtr:ltt rli.sn d ubo[ice
l] l' ,1:
.i. l]l]]l il,,
rrirtt'rrrllrisl:i,rrrj,llir L, z it ips ill, f r . r alii: t ielr alc r - llll t l l c l o t a j ; r r i l o l j r , , 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
li, t,,,tjttlt n t\l,tl, t t t t ll|t i. ut L r l r ' I|:r tr r r '. "l l r l "' l t r tsp i t:r l tt I't"l tt ' t'
inlr l t ) a. |.I . ibt r n t i j t o c i r L ( " 1 I . t " . i i . , ) : 'l r , , r 'l r l r s , l|'r "t i , i i i r t,, r 'i ,,r r 'r '' ,r 'i r t r tr tt
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 , , , , , . . , 1 , , f . . i,'.i ,u ..,,',fi ,.', i ,'r tu /i , r r r r r r l r ,l :r . ..'r tr tttl l , r i l r ,, l !1 'r tl r t'
( l l l l ) i r r ''l l '
' ' ..: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 , , 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 ') ,
]..]
. l\ lrl, l i (.r'l | \ itlr):.t1 . : L I r ,, ,; r,I i , . , 1, , , .; , . . " r l r o l r l c ti |||I!||I( |i r '
.,1,,,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
lt) llt u tttlt)nn tl it t lt r r t ot t lt t t t l " t i r i t l o t
, i r , 1 r i I , , 1 r ; r i r r1ttl l l
,isi r ,'r
cr r ,i
r r r r t I;r i Ir '1 ,Ir l Ir ' 1 r o r l cl i l i ti r '
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 '1 ,
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 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
r : l , i, i , j , , , , i i " i , , 1 , , j , , r ,.,,r.,,,,,,t, ) t ', , t tr ,r i tl i ttl tr l i ,"i r l r r r r l r l cl r
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 r 'rr { r ' t r' t l l l r l r' : r t " i ( . l l r l l I l l : L
, t i r rr 1ri r , r rrr, I , , : rl r, I r r r . I . 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
'
iit{ i '.tI I
 , ' r! \ r, rl i t (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 l l r ,l l l l tt r tl 1 'r ' ' r r r l r lrr l r I Ir ' r tl l r l ' tttl r l t' tr r ' l ' tr l r ' l r tr r l t:'
tl i tl i tl I r r r 'q r r : r 1 ,1 i 'r ' r 'r ) r 1 r l l :r l :l r r r l
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). , 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 r 1 r r Io Ir tl I'IIItr ';
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 , l "r r r L r r 'r l r l r ' r 'tl l r l { l tr tr r tr r r r l : l r ' l r i l r r l Il l 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 '
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 l t l t l ,i i l t l r l i rl l 1 , t' i l l l l " lrrlrlr' lrrlllrrl i r r tl ) ( r 7 .l l l o l l i r l '
.l ) r ) r l l l l l i l l
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,, i , r r l r i l i ( l {'l i p tl o r ',',, r r l r 'l 'r r r ', r l r 'l ;r i r l r i l l i l r sl r i i r l ) '.r r \( l l l l l r r l i l l :\l ( '
l){)| t |l ). t ', , r r r l l l ri i p l tl i ,'i i r r c t t r I I : ' : ' r t r r i I r 1 r t'r g r l r i t '.i tl ci tr l i r l i r r l i i i Sl r tr 'l o r 'l '
Ii l r r l i r l r ' |'ti 1 ) r tvi t'i tt' l l l i fi ) ' r r r |r 'Ittr r l
lirr rrIrt,i,oIr,r'rIsirrl,tlili;clo r.r-lbrtrrlrlluigonctrll, p(. irrpli,t.l.Itc,
]lcurol(\lil 'r , l ; ( i I l o i l , , illii?; l i ( ,r 'l ( r r r , l !'( ;r i
;,i rl. IrIIr'r,ii,lo} r ' llsltcct tltshi,l|ltlut it t,t,tnrri-tLtui, , 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" 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
cu tegurn(x]i.lr\ i 'i n tl r 'l L r ''vti . i j l .r 'l r ''l
.ii*r I.. I'(l(liIi ciurLotict:.1 - gl.bii ocul.L,ri r ttstti .i i t,r i i ( r i ( r l r l ) i i tl n n l r r r u l
h.iytrtori la p:ll1:lrc - itratiilrrrr,,
(llJ Irl,irrriri),crr iuspiralie pr.'ihngiti, apoi pauz{ tt-upi,Ibare cxpii;l(,itr, ', , , , , ''l i , i " i *i',,
, , i b , i , , r i ,i i i e i ce fu l .o p u ti ,t l tr 1 t':tl "'l ttttl u l t l xttu l t- t't.t',n l :i t) tr ';r ttzi ttl "
j r t r ttr r r r l o ttr ,,r r 'l '
{,ilr) irrlurli) rilrrtlr,ii,rlr.o:r,ltir p:r,trzr'r rn:],ilunE:t,(r,espirllic ascnri,niit, o i 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
r'rr (r.rrr{l{r i,ip li.iissnnrrl); ; i,; ,.,,i; ,iiltiilui,oili"i.r,19?d),c,ll,elnrnltrLur-,herzio_sirrrlrrorrrrlolrf'r,
,-- in haloni, se pcrCepclniroslrl de acetoni,;
lrilrolr'lrsiururl,t{ct il,lij,, l)uls slab si r.rWidl - hipotrrrnic,i _ nalcati; lri , ,''1,,ii,,,i taLrioulhtpalic qi neuiopsihict'\pll s in cadllrl t(il)r(riltr'prtltr'
lrrrl.rri* rrL'srrrrlrr,r,i,; hipo- sau arefletiu
'ostco-ien(Linoas[,
I * nidriazii : | ,rro so aclarlgil'J in sladiul precornntos;i subr'otnalos'tlll lr(rlrr('lt'\lr'l
(Slr.r'l,r'l'
,
'r.rr,'rlr:r',,1 inu|rtir. d jrl'otir.irnu n)ici hemortqii h l'.O.; _ pt.nz,.lrl:i i'.1;r:,;' ;,i;; ,apffii'at"pr., a rrriirrilor',elcnLuiib,'ll.lllils ti'' root))
,
,,lLrrrrzr.i : tle
cii,it,1i T'rrpuvjcirL, 19il{1 Iropxrr-ii'irt, l!)?!i; iiir
si rr,r.oll)il{rr(etnnici in urin5,1 - gliccrnia rnult cresenti,irezcr.r;rr, ijilieJ, 19iiT
:r,lr rrr,lirrii sciizutli. iiii;ri.'i"EIII'diagriosticul"'':"r'rLileqtcliplinlrrulrtrlctIt'IItIt.tItIIIt
t ) Ct)ntq tlre ricd Nste relativ usor de rccunoscut : _ antececlcnl,rr ' |,LI";.
)r.r'rluronient ie).
rr|lloprrlicel - arproalc totd{ aun:t r.str. Irr.:cet1rr,1,ii 7. Ootnelelo,riee.Spa!,iulnu ne permitc decit clumtTlttrr'f slli( trrlir :r
tlc Drotltoarne ca,r0 to)'icc mai tlt:s jrrljltrilr":
rrrrrlurrrrrrlrcezii : oboseal5,cefalee, anorciie, glealri, v:.irs[turi, diarr:o, ,,,,,r'rr,criterii tlc diagnoitic in citeva come
rr''trl
(liril)rcr',n).iodozopsii (,,,rnuqtez}uritoara,,), eclipsevi2uate (pini, la amlrr ,r ) Cotn,r,alrooliccioste precodat'; de citeYa serrne dc rtltrottlisttt l
r',,r...1,r'rrrrz,ltririi), rnioclonii,,sitresiriri fnscicll:lre mlscuhre, ufteorl ortl , r ,',i,i'r:,.L,1rtzic, rliznrilie, ulr\i' ' \ilri'lllii' rlupJ {-rr11' s(' Irr'"tlrr{
i rrlsiiI - l'rillonii,lu.c rriros a.mouitcll; respirrr,{i:r,
r:s1,e
de in[lte ori rlr,
',f iii,
, ,'i.', ilolot' tnidrirzS. laLicardi( 5i lr''Iit:r'{it 'l' t.
t.1ni ,.i i ' on.itrrrcr
lrlr (rirr1'11s Stokes; - bolnar-ul Ostc palirl, hilotelmic, cu pleoapol(l ,,',,,,;il.Apoi aoar lenomenede colups:palut'rertransltjrltiiit ;ttll:rt:r;rrrl
( {'rrr'r
r,rlrrrrr,l iir,lc fi lrozinlii, sughit; - pulsul este f,,irtc binc bi,ttti Ourl ,i,,t, tr:iiiri, iipotensiune, cianozir, r'lcirea cxtr emitr'ililor ''$io
CI(r).r(i filr)li('r(, , Ll
l.rr.irrrrrrr,rr,r,tclia,lil este cr.cscut5, - cordul estc rnirii,, cu zgomote dlllr ,,,,,i,,,*fii-"ii-Oiula'ri1iatlltutil rellcxelol, cLl respira.lie (rrcDr
.i lr lrlrriii.uli pcuicardiacci * la examenul nelrologic'sc cons1,atrX, ,,,,,r rrlsii f,.rr"o"i) si'clria" cu tenourene de rigitlitalc de tlt(crthlrrrr'
semlr{,
rrr.rrrrgitrlri,rniozir,.hiperr.eflexicosteo-ten(1inoasii,, ilneori seinne pitatrri ,t, l,roundstic gtli- ). Coma dureazi pini' la 20 de orc'
,lrL, ii c x I rrlpi r:lrnidillc (inclusiv flapping tremorj ; - la exaucail F.(). It ) Ooma mc'titicd,se instaleazi| brusc (chiar 1& ('ii;tlYr'r' tltirrrrl'. rlrrlril
,r, r.irirslrrl;iL:ncur.orci,irritilalbnminurici, cu nLorlificiri evidente vas(ilr ,,,, ,.,,ri,r,,i,,uufiiliti metilio)' realizfutl ulmXtoalc'le silllptt)rnc: Irtri. r I rrl
i;rr',',r.rrirr.srrrllll,rr ,r..!Ilb t.rr|irrrrrIir,.lrr' ,
,,il stca,,',.cu cdern sau s,lazXpapilar[ cl hemoragii I , , |',,,r""r* ccf"i, ,.onIul.ii. areUcrie pulilt
tltt
,. r,orrrirlii oliguri(i, :r,lbruninurio,azotemie ma,siv6,acicLozJ, 1,,rri f1r1ripnec,aloi paralizie respfuatol ie) ;i txitrrs lrt' Jttrslt lrlr""
tl ) ('ort.tt,.ttotrnir:ti sc irst&lcazit tr€pta,ij I,r,un bolnav carc a prezentu,t, , ,r
' 7l' l t' i l t.i r loll' r r t r r iir r ilr r r r r l
, rr;r:rlrrii*rlrirl,ltc (pri1ra{ociiuni gas.iiro-intcsitinale salr vi.r,situricentra,l.) C ,r, no bar bilur icd, . in c: r 'zu'i r D'lllc sr ' I caliz. ir l; r
r,i , :i,r',,rnr t)it,r:i[1,11 rles]ridratat. Se,rllne1e proclrornrlloSint asemxni,toitr\\ , ,' ,,' ,r' t,' u d izalt l'je, at axie, conlvie lninlt r 'li' 5j cr r l"t i' ) ' 'lf r t tt t r r 'lr ' gt : t r '
lr
.rr r.r'1.riirr (,o riL ltr01)t.icil, ca fi,tar.ediaglosticul difcrenlial va Ltrre scanlr, , ,,sl ri tal l zi,r,alid, c. , Som n lr ogr esit - J p, of und, t , r r pulc'r r lr ',r r r iozii, r lit
lr, ( rl,:\ir r,lcirrcnl.ct.cr.olatoare:, bolnav tleshidratat; * TA scizLrtrl; .r, * 1,' i l ilot lt "ulail, blldi''lr ''lic' hiliut el: ir r nc' I I t I t r I iI r t r lt lt il"'l' t r r ''
r,rrrlrirr,zii t li: r 't r ii: r iir t r "zr r | \ ilr '' l: r t l. z' lt t l'
i l)l.ozon1:n :lzotemiei, a alcalozel qi a cloiopeniei. ' L , Li ' ; tl i i, , 't r cnnin) . ar cll( - xi{'' ' 'i
, ) il,ttttrr,tr:itr,ny|ioi este u,sol.de recunosou.t:- ilsoleqtc o toxicozi r t{ t u_
IrIrr,
'r'rrrrlrr':irlirr:r,rlorutimniil_rte:i,sa,rciniisan in crrsul nastariii _ prczirll,i, ,l i c,rtnt at t lpinicil dcbuLor zil cll 0 st , li, r or {0 er t ilr r lir ' I r I r iI r r r r r r \
,l i r' cr it om t xpr inlllt ' lll | ( ' 1I I | |I I | | I t'
| | r, ;rlii Ii 1r|,lli orlr!,lcI ovelatoare(r:elaiee, v5rsi,tori, cdlme , ilbuilimrr ir,, ,,r , .1i halucin'r f ii. Se I t r m alcil; , l( 11( 'r '
'r:r
lrlrr.ri,.rr.irrrrr', I ri Lr(' or:.or ls{llr lc,t ulbur i, r j t io deglulilit r qi dt r lt l] lalir r , lt r l}r r r r iiI i
r lll r I r li'r '"
oligillitr pin:"lla arulie) I -- coma debtteazf,'cu mioclonii, ( l( r ( t I I |\ I I I I ( '||\ iI
I 't t t r lt not ot
lrrrr rr i rrIri rrI r.rriIII .,ir.,,.lsii l,onico,clonice(:rdescasubiriIante) qi chirrr; i , r nrl si yi t t r r it lr iizir ) , disl}lll'ilia 1'0f i( 'r t 'lor
( 'olI I
li
cj' ijt f r ) l'l( '( lr \ ( : r r "il
r,rl rl.r rrr, Ior.:r lo crrlclrrir,lo (parcze,mftniiestiiri alazice etc.)" r, r' rri ti l l ttl i, r o|or r t it l't t t it r lit i {) r ilr , ii I r r it r sl: r lilr ( '11'
r '( l( 'r t rI r llr r r r r
( itttrttt.lu ut ridicir f" , ,,fi ,' , pr , l, sf ilif , , lr t r , ll ipoi ct t silt r t t r ,lt llt r lr liir it t r sllit lt l'olii'
|) ltrrLirii lroblemc cliagnosticedir,ci,_tiflomSca,rI| , i lt io; r 'i: t t r r it t ii I iit r t l r lr '( l llt I I
rl. rr.rrrrri.rrr.Irr .l.rrrcrri(::-- antooetlctrte ,,| | r,' l | 1 fi inollllr , ( r l, r zli lt 'ir r lii r lo: l{t r r lr it t r i
]ropatil-rothcp:i,titegr:il\'e1i{)xio{r t r t or 'lit r il) t li'lr t t lt lt r r r lr t r t t lt "
rrl rrr|r'r'irorlrc,r irtzc, nctiltlitsrrLliep:tlic), eltrnluil etilism cloniol r ) (| or t t r r lJt it t t t lt it t t Nt '( ir r r lllr sllr i r lt t |ii'
' ,1,, t t r r r iit it t r ot it ii lt t t t ir ii t lt i. zr t ll'r t I r l''
rrrrrilr.sliililrr,r rrltuttlt,ltrorta,r,r.r.rrlnlrcltinslcsjrll;r,tllrlrr,,N,l)atiorx,Ni(\ni(r l ,,r' , l rt r r ii'llr ir ', I lr t 't t ll, , i lr r r llt
lr t lr t lil'; llt li. , ' ) r r I t r I i; r t r |r ' ( t t t lr : lt t z'r t r r r r t r it lr lor ii t lt t t il' t t t
rrr:r.rrrlrt,suiilri(,yirsil,lri,nl{'i,'i,r,is r.,,iirr;1i1,rr{i,.,s.rrrrr,,l,,rr(,r.i,progrosiViI,, 1' rrrrr' l i l i rt t t t t r ")
'r r, r r r r
r'lrirrr:r'1. r'orrlrrz'iorrirlo, sl,iili rlrr rrqir'rrriir.
Illscicttlrrliisi sprr,srnc ,,: rr,,rrl rrrrglilli lr , ', t r 1ir ', , 'r r r r ir I r 'l r lr , , I I I |, i|||'I i( ' 1r t t ir r I I ir ': i'') 'l""t t
rrllrsrirrrtrlr, r llr t lr r r lr r
rrrr,,olrr',rrrvrlsiirl r lilr o;rilrr!lir,; ,\rpr.cl ,rrlI rrIIrrrrt,rrI rri r:liirrlrrlrr|rrl,ol,: rr' l l { rl r' !j tr l t t t lt r 't l( f ,I 'I I |' |||: I it 'I t t I ' , i r : r llir ', ir lr r r i r lr 't ' t r it t r l t 'r 'i
I l r r r l: r lllr ": r llr lit lr llil I liI olr r r r r : r ' llr llilt 'r lllll
| 1r1, I 11111rI I I r' ri i. or r . irrrt.,lr'
i \l 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 t.,1,,, ri l ,,trll 11i lt t r t r , 'lr , , .

:t It
 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 ,. L 'I r I r i | | | l
ll! liu( . ( f t r ) ? :i |:I r l l .l i l r .,j 1 , r 1 ,, l r tr 1 ,,.n l l u i r i r I r, r ,r, I r , t rr; Li r r r tr l l r o r i
.l ) tlt)tttt l)nt) t lt ut ulioll( 4i( ?' s c 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 , 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
llin
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 , 1 r r l r r l . r l r ' fj ,l l .l .r r , l l r ( i 'r ') r 'r r l .
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(\ ' 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'rrl.li.. r^ilr.rrr,1r'i. si.rL rra,rrroirrarii. obicat,ili ir ,,.0irsi,ipar.r''ilrrrr, 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 "
'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,, [ ) ( 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
:rrl.r.r'irrIii,lriIrr.t.r.riri..I)oslul ila .r,pir1se insialclzi, cu'.a, aio0iatin.' : 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 ;.
I,:r1,,.'r-,. I'rrli l,'|ll.. li]ilor' l. lpslrirllit.ncrcglrlul:i.tr.lt"spirurii r.eci,slrr,r.,. \ 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
| | 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 ,1, lrr'. r.uur-rrl"riir sttre d0 r,oLll)s, (]orrir ail odcri.r pulmonar.,
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 l;j.l.ii. Problenre rie diagnostic i.,r tuanilestjirile silrcopalrrsi rrllc
.r"ri , 1,. "
.'tL'lt
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 ,
lrrllrririrri de constiuri.rtde scrlrli Jut,niir
l, | | r rrl tr rll: .ij trn r . ir r inr . lnr > UbinL|ant .
O(ltt:-r CU anrOlJndtt.oa SlliIii
( orrrloils{r. l,l, r.lozemai nra,ri dc.hidr:lzide, coma, ll.l.:).1. DeJini.li.i,.P rtti::t\ri tle tet'yaeni
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. iiirr"!i,i, io lr:',lrrLcJrriul,,r pier.derr:br rr;:r.i:-i dt, st.ulrri {lr,r.:rlit:r
t (t,.il,:: it, s,,t.iaitg!i,o,ta m:Ii rarj. putinJ ii ancirleulrli \r.u lrutirlll ' ','.rill.,.i. iu:otiti slu ul r:t tnrnilt,stiri tonru:ri1(,, lrrr.r.r.rl.rl.:i :lrrr rrl
' .. .rt':ua.rir ur'rnr !:t r{ltnirisltit ilt' rlrilttolnLr preaccesuale,in determinisnll ci,reia intclyirru U tr,rror,
i! tleaspirinj in dozernrr.ill ,.ul_,ii tlcshidrrr,rrr(l ir.
.t ',li..rrtir.,.situ:t'ii,nlro permit.r^umuil|ot .tli,.ilctiluf. Jnrurina,i:r ,.1'.. ,, r!'l)urJL gensralizati[, ?roil-.rsii,- l:r lildrLl r.i tic o oplilc r:onrplr,{ii,rrru
, r ii, li r rririj.Lllin (Vui,.ulcscu_ ql Stoica, 196? GaL tier : ,r,rrpe cornplel,i, a ci}culatici sii'salL :r respir,afici (Oollurirr, |);1i;
colab.;196(;):
I r,rrr)||r(,r|(, rlc e-rcitafie nellroasii, ct tremur[turi, i anxietate;$i .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 ) .
agitali6 psjlrir
rrr.lolirr, sliri l\alu cinator,delir-a,nte. qi (uneori) conrulsii. Apioape titrt,,rr i'l{r ltic c:i piertlerite d,euLno\\tin\d ile saurtti durafti sitri, rnlr,i r,l,,ri i/,
rrlt ,.,' irfx)(,iir,zai -colici ,.,rrt..::ri
;i t,ulburi,ri digcsti'e (grof,uri,r iir B:rturi, abdorrri tteurololliati,in _centrul acestot manifestlri situindu-se lr,.a.li.l,rr,1,r
r,:rl() r{i t|ir,rispirn{ii abunrlenic. sin1, ll,mlle qi irnbracii rrrr l, 1rlirr.,rlil. pot./i intilnite foarte fr.or:ent $i in diyersa]'<r tu,lbu.rii,itl. t,ri4t tt,
. ,ficspirttijlc
:r rlrlli rlo lip l{iissnriurl. Faza rlc excrtilic lrccc it'torpoare
si colrii, , ,t:it urd, cu crxplesioneurriloglticii,ca de pikli) sincoTteled.edivlr,str rrrrI r r i r.r
,lr':rl,t., irri!iu,ir-r .ll
fiitrrl inloc*itl de acidozd,.l]e cele rnai'ilutte bri- ajr,,,: i,lisilri, carc iusE trsbnie tol,dcarua difererLliu,iirde
lrl'rlit.ii srL' sirnplc ,,leqinuri,,(Faii.re, J.9?2).-llrcbuic aco*irr,iii .fu,lselc tittr.t,1t,:
:
I'i||{||rri'r)() lr(x11 (n'tugipirre la nivelul tegumcntelor ;i ar rmrcoaselor(carilr, ,r
I r.r'rsl rr,rrtr1rs1li itLl;oricA!ii). rr rlrrrl,art!:ir, ,ti sincopelortagale cane,,nc conduc la o ncurologio 1rlr.itllir,.r 'r:rr.,,
i 1 .'r,,,' t:.t;.',,,'.:,:., aryonoJus:Io t;.i , d iizopr,,pilfluoroIost:)t _ l)1,1,; l,rrllicrrlari".l, ct sau f[.r5, reflexe rascrltio r-aso-vagfl,Je snu vagir vrr,11:u1,,,
. ..
r, t r i ,, l r,t
t l tt1)t, , - l i rl !.,,'.).i. , i rrlii.lurminologia arrglo-saxoni.,c*rc fac tlil ilcest secior hibir.rl, rrrr,ii.rr'i
' l'1.)l'l);. h|ril.,.1iltclrafosh { _ U"ef t'; ociumctilpjrl,'
. . .. ,1, rr ii1,rcin1rr.cardiologic.lincurologicr'(Faivre, 19?2).Asl,icl,rlrrr.iilrl,r
l::,],,i ]l:1,.,()ut-.\;.t1ir.ti_rpararitrofcnilfos
,rrr1'rr' rtr.rrtost,Jt I'lr1.rr,thion. fat_paraoion;c1ietitlia,r,rr, , rl,i" (1,.I'il,r.si nce fibr'ulor.telntirrrlu llo rugulrri (iu lr:u|trrl rlig,.;,trr
EhatoxI metiltrimebilpropanituorofoslilr,l
i ",r,rI r ; rlrrr.lrtruLrriri.eluxirianfosfe,t. _ Tabun). Ne pnat6 atrage aterr{,irr . i rl ()r'ii-til,r.inge, rle pildi) sc r.olbpDbeJcsplc rcJi.ru aayt,uagu,l.c ( llatlli.ts ) ,
|, ,:r:r, 1r'r'r,rl l,[. l.)tolesir)na] (aparilia, la rnuncitori a.lricoli care milui0l| r 'l:rr-i ri llr _rrrldr.cl&nfrlul dr, sinropc pl,.r"i tlin \isu, c:r {l,i
IiLl:i rlirr
ii\r'rrr'rtr'lirfrr r.ctrrlramenl,de proteNtie),fie inciden{a lor accidrrrr . ' li',lll4 iru d||r tltc ad'.ro, cSfe to|lr:r tlv rrJllls DaSo.tdqnlr. lrr 1,,:rr,,
r:', t:r tl i i,it11.itll colrnunal lructe sau logun]e stlopito cu {tccsi,tt .r' i'ii1. (razul'icstc I-orba de intcrIcn!,ia ulot tcflexc ri:[l{o_{].1,r{r1.1{,:t,t.r,i'/
rlr l:rrl., 't.t\;ii'l .rtL{}.u utilizai rrr rl. clcctc cardio-inhibitorii. ln accstc c{r,zul,i,
ace$ti pi'odu$ipent'ru dcparazitarealoollirr corclxl rilsprrrrrl. lrr,lrilrr,r'
1r,l,r. ll,ii('. rr.rrl:tt..rc simplomal,ololia geneiat5 tlc iiaciivarea r rr.rri.Iio lio prin tulblriili silro z],[ricu]iare,fic jolcriotialtr (1r.irr
coli.os
r,,:,/i | ,i (t,.r,i'lsc(rlwlt, tlclllrlulare excesivir,de acetitcolini, {,r.rrrrl,rrl
itr. lrl, r,rrN1.',r'i'ic:triozii; hiper,itll\.ftlie; rlal'ioreeI
cu fenomrirlrr J"r( (ior)ul atlio-vcutliculrr). Iiielderile dc crrnogtinf,ir, vagal(J),1(! irrlr',r,lrr,,
hipersutlo*l(,i.; ,rrlto pt1ohrgie dc grani(ii nouro-ca,rd io,vnscu1."lr5)'(.Ir,ilivrr),It)i:jl.
' r{,i" ; lll,, i-,.r.r,.linlr'orr.ic:r; L,ronllucnnSlri.l.,.;rrisprr,.r,r,tntllit,ur.ririr j I r slir'5ii. sc insistii in Lrltitrriifttri asupll i4o-rruntit(\lor
:,r' .r.r l, r,rlll,. rtr.edem l)ulmonar acut; brarlicar.rlio;hiDotcngiuyl6l ,,sincopirrrrir I,r,,,
111,. r | )rrlr,l li grial:., 1954),ttro poi I't colscr,ittlrlr,
Lr.rt:.: \ :r . ,, I r|:, I IrI ir, r.nlini :rlr,lornirnlo.dirrrer,
I : rrri,,rirririjrrrlr,,r.ir|rsr.. sjrl rrll,;r,
rrnr,iitrull or rr,fco{iLtrri rrr
I .,ttr,otr rlorrl tr,nxiohl,c,:rgilrr,t ir, ,,t,i., r,.rl l (, \'ILIi ('ILl i t, l ().
,lrptrr': _1rsil191lt,,j lt,cmlir.tituii,1:r,sr,i
'iIr:rr|| ,l||r]j{1lr|)rIrr turn'l,c t10r,r,rrrILsii,.11I1ri |nr', s,.jrrsllllr,zil coln:l,,(,ir,r!\
|,o:rIr.r'irrIrrIr, lrrilrl, i rr ltliurclrrl0 !{) rtl oirr tlcIir,illoricillitr prin prr,r,it,li 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,
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.. | ' 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 ,
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 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
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 .. 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.
rrrrlrrrrr,Iii,trrototic $i vegctativii, pot fi: a) Crize generalitate, respectiv
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.
(a,rtcriografice,pneumoenccfalografice, gama-cncefalografice eti.) t
rrrrrrr1,rr,r'c
r,) (irfuctc de peXit m,ql ahinetic (saa amiotonic-akinetiee) nu trebuie confun-
tlrlc 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'.
rrirrnrrrr, gil;rrlrri qi rotalia capului, care antreneazS,o obliterare tranzitorio
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.
klr a'ooorJr.ru,lo, $o (ll,l,oloflto umri irrsulioiorilo cir,oulalrorii, cu o consooutiv[
ttt I brtli r,ro Ittttol,iortttltL totttJxrrtr,l[.
I)ia(ln,o,iott'/"d,lfot0,ttl,Jdlln 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
lrrrte nota ur tremor palpebral qi circumstante emolionale docla,nqa,rr lo,
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{"
;xrrl,ivpt'in it tufioianl,ouilrIrrIrr,|rolii
rrlr.obrtloty[nzito]'ii Ii/ snrrint;olrniln)r]1r(l
(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,:
1r1q:1r51,1,7i1, lll1riu.r,, , 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
J,iu.(,/.(,
rlr:rrrrrrlrrl,rtllrtrr:ifiltfllzi(Nl{)1,o 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 ;
, 1 1 r r i r l r l l L r l , , I r i | ,r , r r , r r I r| , I'!l 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
I!.1.3.i2.;i.XIui.f stiirilc si &pqt(, 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 .
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::,.;.3.1!.:J.1.l) tIini.!.i?-,{rnirL.Lt:ir,rrr
ti), $i)tcoP(,r.tlrrlzirrlii o l)i(jrilr,rlr l ) .l \t' i n hipor , it : r ) r r r r ) , r ( ii1ii r . lc : Llii1iidiur , I lr ) ir r ir oli r '( 'r q( nii: r l( l
.
Ir..rir-ii,1(rrlior':nii, a crrrxrqtintci,do dlu'atli scuilit, pl'(l.o(lrii srrLirrrr rl,, , l l rfi i r(r{ ' .2) l) t 'ir t ,h. i, 1t ot r r .ir1't(rr i; Liolr c lt ir L liii; t , r 'i cr {, illt 1u: 1.ll) I 'r it t lt ilt 'r
(,i.l,tIz:.ttii
r.r|lrliln|lrtol)t'(iir]c(10stL|.1r, (lo (} tl,nori0 crtrtb|alii .qi itillrsocrili,lri
rlr, ,,ri rtri r (i rr r:or r t lif ii t lc lslir ir , , ir r z) : or r t i r t 1- r : ljillc) .11) 1'r 'ir i It i 1t r,r1I i , r' tt t i , .
olricr,i ilo rrrorlilir:ir,riorgllnioc ccrcbralc (Oorfar.iu,t g?g Wrlvnc, l tlti l ), :' ) I' ri n tu.Ibur d, r 'ide nulr iiir .
;
Sirr.r1rr,l.sn u;1, intrluh.a, iu.r';rnprrlaccosclolrliitlnc riccpiioplicc ((irr,lrr,r,irr, U . S i nco pc pr in t lisju. nt f ii r c) t tt 'cir : 1) I i' r1,i t ' 7, ir '. 'l) S it t ntlt r r. : ir
'' i t t r : : r lt
t ti
llrilr lll?il). tia$taut [i (iastatt (1956) au a,{irilat loati;c sugcst,ir.r,i sirr r,' l i rl .i q,n(.far na cent r ald, ) . 3'1 I n ist t ir '. I ) {, t lt t t : : , ', , 1i ln lt t t t t t i
" 'ut . . : , )
lulr,lr', r'rr,rollu ayut totrlcllunl soarta ,,p:irinli.lor silraci)i in cor,l,cilirrl ,, tt l l i tl ,a.
,rirrrIr'.Ir,r
rrrrIrIr.
pa,r'it.risl,icc,
r.e1xczintilin re:llit:tte-cauza cea ma,i fl,covrilrlr! l'1{roiz[m cii rrra.ioritl,tea crcr.ttftli iirtilt}r de la irrrrrrt:lc ll si lt rrrr
;r lrioltlr'rilrrl rlo c u n0,5l;in!:_"r,
lure, s:tu :tsocille cu convrLlsiitonicc;i t,ii 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, ,
r*rr';ilar rrrrr'rriftrsfii|i
tlcbuirr in rirod cltegodc difclcnliate in p]'irurl r.i},11 rlr, ,l r, rr:r' :t,i .i pr i r I r l^ |li. Jt , i. l, .
rrizrlc clrilcl;ticc,
|:!.l.3.2.3,:). I i.tt1ttont
nt.ologie clixiari
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.-,.1I relr.ter,ziciuci etuzo rr.r..1,,r.,. tnainte de a aborda, clj.rcrselg entitiili clinice, al,r'tgolr ir,r,(lrrlt rrrpr:r,
,:rprrl'ilr.s)r,lrr,otluci sirLcope:iulbtrrriri rle cir.culalie perifericri, aliec{irrrri , rtttltt.ont,clol' r'
{lenarole, camune \\i, a 4inpreju.rdrilor in cllLo so {I('(,IiIIIrilir?.rI
r,:rIrIr:rr'|', r.r'|tLZLrIorlu.i!t{'rii, rfertiuni ccrobra,]eqi boli psihice $i, ca,[11r,, I r(' opa,
;lrr llrol)us rurniitoruca cla.sificare: l) 'Iulb".trdri ale cirau,laliei r\ntliza iirlprejurililor carc ilu dLrsla inltalarea picltlt'r'ii ilr lrrrrorji irrl;r
ltcri.fn.il :
;t sir{:i,l)N,'r'l.r,so_-tlepreso:lre (raso-\.agalii)i b) sincopa din }Lipoterrsi Lrrrorr, , ir rlc o deossllit[ inipoltaril,ii, in s1,a,l;iiirca dingno-qliorilrii ((]or'lirrr,
rrr'lrrsl,rrlicii. Af(,cliuni cardiace: a) tultluriiri de ri[m cartlia,c I l) , I , 19?8). Tlebuie si, so liiiil so:lina de sohimbi.i'ilc dc pozil lc rrlc l. r tru
,2) lin spcr.ill
rrrrrlrrrrrrrrl,,\tllm Stolics); b) sincopa,din biperreflectivitatel ,sino,ll,r.r, l ri , rl c e.,.en t uala deciau$ar e la t use, t iicliunc, f elt r l. r , oLr r lr lr : sir r rlr r ir llr o
lirlirrrrii; rr) sincopa prin aitc tulbuliri ; rellex6 vaso-vagale,r,efltxe g.lrrrrr i , r'\ iclrle, la einoitii, sl,irii de "lrisii si rie lerrsitrre elc. .r\lictr:rIrrL1rl,, lrr'r'r,,
lrrlirrrlovrulir,lc,rcflexe oculo-ra,ga,le.l) Sincope prin iawze respiritorii: 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 ( . .
:r1 ..,i rr,-rr1r:r, rlt' 1Lipr.r'reriliJri,lic; b) Silrop:r, la trse. 4) Sincopa tlin tlif rit.r, , 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 ,
.
ttlhurtiri ffrrl.trqle (sinc,,1ri psih.icl). fi)- Alte lrpari; sinc,opa do tiri(,li l,i( r'(lcrca cunoqtin!ci esto prccedati gi,/slu urm:r1,ir,(lo lrr{,r,r r.irrI r | )| | ,rI r.
rn I r I ll,( ] . , 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 , ,
, Wlyrro .(11)61)lr,.propls cea mai complet5,clasilicare a sincol)(ll(l!., r ilitL (19?1) a,Lr insista'. Rsup]'* il tlou i, gt'rps do sirnpl.omo; u,) sirrr;rlorrrr,lr,
rlr..,ir'r'iiilrr,]rilir,
plin liirsr rlc procizitrneryi11eexactitatc a unor itoiirrrrir l, r lir{rcesualc,care rnoori se poi lnallitegto filrir, sii, {ie xr'mt1{) (lr) 1rir,IrIr.r,,r
,\ " NirrooTrr_.
pri n isch,amieaet"ebrald, gener&Lie&Nd : , rrrrosti l ei , put ind deli 0oDst it ui un , , echivalcnt ) ' al sincol) ol0r '; lr ) r r I r . r 'r ir r l
l. l'rin scdil,r.narezistenleiperi,ferice: Atiire: - sinropa r':rs,r t'r'r,ln:iu-zis; c) siinptomrrlc !ostaccesltlo.
r;r;1rlii, sircopl, simtsrlui cmotk'li*i,n, -- ^) S imptomele f)rcacces1Ld,le pr€,lneig cu aproxinutir' 5. jl{) rlrr rrrlrrrrrlr,
sincopa de liper-.lenl illt ir,, 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*
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 ,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
lrt irt tollrrro (,nlorrlLt'c(ilfl:t'r.ct;i anginir,pectora,lir,), - sincopa pliu rolll(,\rt /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
prrlrrrorlr,rrr (sincop:r,11 1,use,sirrr:opadin onlLioliapulmonari,. sincopa rJirr
Irrlrr,r'lcrrsiurron rrrlrlt'c1.ulit-Liocartlic sau dirr angirra pcotolaJl, pr: lingii ir,r'rliio sirrrplrrrrr.
plihnonafit, sincop:l prin pulerei! in joc a nnor iefltrxo
rrrll,ir-r'),lr) I)usiae: - liipotcn$iune o.r'tostaticil(in convalesccllii,j lrr.irr p l crr,r.r:cs ttal o obi$nuit e, pot zpar e: dur cr i plccoLr iiillc ir r lor s, ', I lilii r lr ,
lr.:r,r'{iil:r rrritdorlrogLrliI postsitnpalie{itortrie), r r,rrrt,c q.ll., pc lilgil semnelc stilrii rlc qoc.
- hipoterrsiurLcortosjllicrl
ll'rricii (irliopr'r,tirrii, ,4ccasulpropriu,-zis tle pia,rtlereda at,nofttnl{:tcstc sourl (i {i{) si r.rrrrlr'),
slu secnndarii unot: lloli nel.voasc). 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. I'rirr, scrirlt:rtntlebitrt,l,tr,i
cardi.dc: 1) stoyt card,itc (srruurprr, .r.rni,r
,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 ,
r:rgrr,lii (r,lrrlioinlrihii;oric), sinoolr, s;imrsulrri rrmotirliinr, silcopt rlirr
,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 , .
rrlrtctrl Atfrt,trr-Slol<<rs1 1;1prin descrafl.rrfi tnlu.tn-hci\d,ii rrardilrrt (sitrrrozjl 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
rroll,ici, irrltloL tniocitrdic, a,nginir, pecl,rtllllir,lrlil,lnic caldia,ci,)jrrsrtiirriorr(ji
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
rrrrr'Iit,:'i;i sl,orozr'r,
mih:r,ll).
il" I'rin. tnu,.tu(t,l,rftcot\Iilti(: l r,tl otrr:tsi i ,$i ( lt 'nr nl Irt rr1rI i I t rr I i t rr' . Alr , llr . rrr ir I r ilir sI iiI i I or ricor 'I or r ilr ' |r , , 1
ir,)lripr.r.l
ilrsirntu lrLr)rnonltr.ii
I lr) sitrlr'1rrr, r. r i ttti {o rr l l izii r lr , r '1r ilr , ; rr , 1qt : r t r r lr r r r l.
l:r. ll$(,r; r.) ll.irr rrra,rrovllr, Vlr,lsrrlt,rr.
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 . .
ll. NIttcrtltt 1trin.iwhrrnr.itu.tthnt,hi,Iurtli:tlii : 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. 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. 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

:t:f.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
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
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 J,r' ;rI l z, l l tt:l ).
l t rr 1r1rrrrr:r1rr. rl i t r r til i i IrrrttI]o Ittr,.
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
l . |ir t t l) t lt : , , , , ' U ..,u ,t,'
, 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 .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 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 ( l( j llt t i, t llili lt li's ilr ' lr r 'it jr it li I t L
;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 :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 '
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
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 l iliilile r t 'pcr cr lt r ir t r Lii: r st t l't : t
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 , , ir r,Lrl:r,!iciocrobralo. lJll{rii s1.ol)ul cludiac tluieazi ci{ cr;ll stttttLtltrr ltprtttr
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.
,lorrr o st&te dc slil,biciuno, itLso!it,il,do pftlo:lrc) alneloli, ;ri tLlllrrrlili, tlr'
.i rl r.rrlii r r r . ilrliili rr,)_ l i o -' p ,rrz i r c n l rl i L c ri r,r
,^ ' i n rl cl 1i crnscci nt i .' i rn.r Ii :rIrr, rrrrlcre. :\sislolia r1e pesle .10 secnnde produce piet tlcr'cll c1n1(rltiltl('i,.(1ll
,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,
, irr,rtozir,turgescenla i'enelor jugulale, Ii"rirea qi suler{icjllizir r' rt, r'l'slrirrl
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, l i(fi (pin:l li. npneir) 1i convulsil tonico-olonice (tr1-a1'ne,11)0i I ( 'olIrt't itt ,
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 rl ri l i ).
r I r r' , o x i s ti n tl l i s c ti l rrL rtr' !;isrLl i ti te. ln cadrul 1tll-rlriu'ilol dc lii,m, ''je descritl:
r," linrttlrtIa. rl.in t:u.rsuI r:tt tliopltiilor 1) I'ulbtu i'rile (le co duc(re, ca'ie sini celc rrrtli Jritrc cunoscttttr trtttzr'
rr) lrr .r./aro:c {{0rli&i sinoop:t :u.q ciu'itotoro prtognoixoDice: sullirrrr rI0 sincopelor :
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. Blocltl etri.o-t)etLtri (rLlar. De obicei, pic,rdelea ile cuirorllilt{ii t'rlt'
,,'..r'rrl ,.1,ilt1rlifrrr.rnr',rle\i prczerrl:r, a,oestiola,nu elimini iiilglroi t,irrrrl ^) qi imprevizibilir,. '\Itrll, rlrai r:ll oa estc dccl:rn;atir, in-tirtLltttl tttrrrr
'rlNrtrtllnir, '
(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,,
,,iirrt, ca, Oe pilrti, mictiune:t slrn defccalia. Sc-;tie cir, daci' blr.tcttl '\ \'
(lrll',{'rl{r'''lz, l9?ti) N,ur.r'llta,l, e:isloD{a rlrror Di ,,,rrrfl et se i tiagnost ichcazf r r . ur ' ( ii3. j; ; ) , l, loculile t ir lir : r
tulJ:urH,ri premoniiorii, r.rr,r.,, (le L L1lrof - pr t r r isI ir r t r \
l,rrbleme di{icile t1e diagnostic. PiFrllt'rcir, 't'in1ii'diu blt.rctrriltr'\
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,
,1,r, {:i r,,' ,
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 /t
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 ,, 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
l,,r:,r, r (1,irrii,lrr,, ll*ntrri, d u.e'e llrrginrrir,sril.ln cadr-ul hip'ertensiurr ilrrr. (si ndrorn A dams -S tok er). Ios L i nternal i n 19i 0 c n dg. S tx ^[jtus c l )i l opti trrs '
' l
l rrrl rrl rrr:rr . , rrrr.lot. spcci:ll-i) o',rr1u, hipcltcrrsiunea puhnondrX primil,ivir, 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
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,,, 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
Tg. Ii uret ex anc r[rl U l i (;
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 '
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
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),
, 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).- cu D unc roas c x s i s tol i i , i utrc 1i -3i s . P e fi gur;t s e v ede aprti l i a pc l i l l (;
rl\. ltt i tt*rtlioientu. coronq,ri(Lr1.d, 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'
t)ot Bit so producii si,ii,ri sincopalc, rlrr,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(' )
l rrrrr rrllr r r r r r i, ; t , t r is r n .. 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, tilllei, trascul se aptatizcazir, Aprdlia primei conLreclii c:1rdittco fuco rii-t
lr ltrrtrt rlr Ilrrr.,vgrrl;ro sinCgpli, :ltlCSea,mOltit]ri" lllt,I, Aoeeaisil,radu1r,,r,ri 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
,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{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' ('
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 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
(1 ,' Ii l n r ( lir ) ir r I t t r r l, i rL s l c l i l l 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 '
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, vi l i rl i 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
:| | 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,. l ,.,l at,i ri rr ti c ak l )., 1tti 3).
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,. | 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
z, ?! ) : lio o lI t 'llzii,vot t l, r 'ir 'lll1L|r i
(' 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
ll" |;i tt,ln'lt tlil turlt"ttl l,tt,lhuriitilrt rle ri.l,n utnlit,r: , ' r.l ,nrttri .
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 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 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 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.

,l l ri
 ( ) lloo' 1. &t iit *, ' tti . s (' r' ' .,r' l r.ri ' i /,' rz i r, , .\tr,xitr,r,*trrbru,lt'1,, .*t,rr r,[1. r,rr,rri',rr l,t.r'sl.i litrt,,Itr, 1r''1,. fi .rrrt,lizrriit
rr.i , rLI I r.|' | |rr,r) (l r, r:r l rr,.l rt,5il l ' l trn,v, lllrr ltliUitttttll,orttorut,trlxtrItr t1,).lilr,i,'t Il rrlr,rr{iaJ 0s1rir.olxrrzotritr,l,,lrr !l!'f,
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 (lil .ir')tn'i' rlrrp)i(lir,xl,rrrrl'
. ' ;,i ,, rrrr,.i l ri :r,,l i cl rrrl l i r,ri.rrlrlr. (rri(;), {lo o onrdio-irrlrilriIio. (]clul:r,lii,
"\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 i rr, l i t tttr t,i l ttt l tt, .rr,ztt,r'i.ritrl,in
.trr,1ror'1,r''' ,r l r i l x rl r.rrr i rr o tt'ilrrzit,oriollt,itr v|,xorli[a,1,1t,{,i
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'. ru*Lirl,(nirr.'pi,
l ri rri r,i rr apr:l i r, rrr,rrr* tri r,tl rr ;x.r'il.ricir, r,rrrrrrlrrplr.sil.il,) .saucu o illiibitio rospir,:.r,1,'i,it
,.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,lpnecNru clli:l,r:r1rrrr.r'), (illslrr,rrL qi cola.b.(1956)au a,r.ijlili;
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, ,. 1].,':rl' ixi$1,trlrl,u,
rtnrrrI,)rme \.aso-rtol, t'('$i r 1' 1trr.. il sincopei,al5turi de fot:na cauli,_ilhilii-
!, !l\tr,l,lnu ii,rilp de ?raitabili,t lt'.. I,rjrrilc ltcslclr, trit,rrl,ioniun fiiblill,!ln lottc puli ;i dc fonnr,lo rrri_r.1o.-l)o faptl aqa cum arn r.emarcal,$i rr{)j(( lrr
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. l:rriu si?opoviciu t9-/l ; (:urfi'i., .t928),aceili ftctot.i bc pot ai't:ilt, lrr.rl,
i )o
, I,, ,l,,lrrr'r|lr,\'1'
i',,1,il, iceI)ol..rii
' l' rro pot.silsu
seinsot,ensci,rt9t,i,,"ac"i
rrl,,o{o0,s.i ,t,,c.*;,rliir,iii,
dr'1rir.r'dr.ri
rh: urro;rirr[.11, l)c bunA.drepfate.Webcr (1972):ttirmd,cL, pare iluzorirr6J,sc tlifrrr,,.rr1i,.z,.
l]l1]l.il
'l :]:]
:1.',i]1. i]:l :,iil,,lru.it,^
.\rrr)l)('r(!
i\rr!)r)cirt ,i I r'iu'r'
sl
srrti .i,l'r' irrr ltitl c r'rl lr. SUp"A ,[iversc iipuri de sil_cope (r''.utfalc, vaso-depr?sire,vago-vagr,lcslu vin,]r,r.,,
rrhicrrr'<iiilo I onlr,ir.u]rr|e
supra-ventriculili'e (J3oriver"b,
lllotrvCrcl . FittLlirt,,
Firruiu,,
h ibr il r{i.,a,r:ri.ulll.ri lllr,xistitiL I irr ulltirna va.ictu,1e,'sincopapbato vagrre. rcsluiitorLi. vaSo-vagale cu bradica,rdie primitivi). Do l|,r.r,r,:r
surl
lr, ,slir;itLrl,rtrustrlui,,pr.iripa,Llzir,
auriculari, post_tifirifdliej.SiiiL, \\-obe1 i1972; susline cd,.estepr:oferabil ca.toate acesie $incope sit $o rrri{lr
'r'ri
rrr/ , r'rLr lr(.llcUl()rNc,i;r stlLirnb,tahicardiile pez:
ile vontriculalc, prin riscurllo
vontricula'c,prin llp nxm e1ede. ,,s;ncopetaso-aagale,,,cu atit mai mu1t, cu <:il,rist,,
l o l rl r los olt il, o, pt'obabil c5, se asociazX sau succed o cardioinhibil,ie yagali
6i o r,ir,so
'l' uI [ou.[,sincultul poale irnbri,ca urrniitoarcle configurafii : tlepresie simpa_tic5,qi cL do aceste diferite m'ecanisine pol, ir,von,rr
ru) lr pr:r'turbiililc
rri, -l origine comund, depinzind..de -fapt un reflcs care pune in joc Ir. Tl,. ponto
hcrnodinarrrice
l)u liulDtl rlo llclnodin&nice cu druati,
cu tlurati, de _10 setunde,tulllu.
Ae bl-iO
llrlil r, .i'.rr
cirrrrrl.1,t',iit tr. osle
lll,tx,iit trn osle de
de obicei
obicci losinll;jtii
.tsinriitii de
tle bolnav, bulbrtS. care.conline centrii respirarori qi circulatori qi in special c:urli,r.
hotnav, perioaciafiirrd rnoderatori Bi vaso-deDresori.
ptlrr st,ttrtit.
sl rrrl,ir,.(iol
UeJtnrr-ult,
tul i- holt
holnsrar-nl
, r . ' r r l resim
r es inr tbe
o o ( f ala. rr;ag5,
n stare d; .r1e
t^
- x . 1 r - ^ - , . o efemot{r
,,rb,u,,-sau
s"rr,zrr,(it^rle i.tv'ior", cr_i,re-i pemrit evitare"acXa6i.iiin cazul in cftr,(l Starea sincopali propriu-zisd(in mod impropriu denumit{ dtr Wr.jx.r
,lr)l,|1rrcrL ",,vitl
Lcnlodiritnli(.i lI liude Si se prciungeaSCH. (L572)..rtazd,ictald,") esre dc obicei precetlati, dd o fazd,prutlromtlrl (irl
b) pcllutbirile -seeunde, propr'iu dcnumitd dc Weber ,,{azd pre.ictald.',;.
. , Lr. hernodinamice ae 1O-ZO manitestlrilo
;,r|lI
,lrrirt ltrlr.lrsr.,l,ulnurut [|r'Czerrlind O pal oAr,. b.ruiati a fetei, VOrtil. , ^1
. Faza prodromald,( pre-accesuald,; pre-ictald,dupd Weber), cu rltl.Lt.rr.
I'r r\ r11.ir,irsr.rrt.r'i.opr rfc .r \ oJlJirii $i I acr iv iln lji mo tori i, d u pir cari: inai viOtji dc.zU-J0 Becunde,se manitcstd,prin impresic de ,,rd,ugcneral", t,rrurrsIi
rijr ttrlli ilol,rv ttatc:t. lafii, am6{,911, zgomote.auriculare, alteraJii ale peiceptici vizLraio,lri1,i,r.
c) lli 1't.tlrtrl,rir'iJosnls dcpiqcs,.20 de secunde.piol'dct,earle cuxoqtiritN, s_ialoree, senzafii iie ,rvid ce.falic", parestezii in extremitl1i, palou,i,,,.nrtrr,
r.rilr.r.'si\ ri, (.u rboli.r'il rcllexr.rluicorneln dupd, iO O" ,-"*A".-fl-,i.,r,iii (tunpotrivi, roleata, t-egumentelor,uneori dureri opigastric6iitrrr
rl,,l,irrit,.,
Irr' i :r.il^lil dr' iilr,.uljuse sirucazi jnlre t ,ci3 frinute. grelud $i exceplional vi,rsS,turi lOorfariu, 19?1
r.l) ;'Weber, 1g?2).
. Itr ,,ineuptle cu dur'lltI de pestc B*4 minute, leziunile cerobralo 2. Atacal sincoptal (,,Jaea ictald,ii d,upd,Weber ) corespllodo piorrlrrr,ir
sirrl irrrr.clsihilo- Iropliu-zjse a-_cunogtiafej. cat.eesl,ccompletS,$i urmattr dc cd.clrrolI'rrlnrrl
Ilin(liu|olcs, in contcxtul clinic al tuturor a,cesnol slnoope so ,'st'e.inscsizabil,zgomotelo ca.rdiacestnt siabe'sau ab$ente,dar nr,rpiru,Lirr
i rri cl l , c liz e c onv r ds i i .e , }ot
dc obicei este conseryat5,.Reluarea congtien{eiesto rapidi, drrrrur,,r,'t.,riiiiii
,\rl,1il tlc accrirltirite in repctilie corstituic a sincopei fiinrl sub 10 secuncle, iar treiirea iiinii totain, fd,rt, oburrLrlhl'.
,rstarende rdu
plelungit5,. secundari, amnezia fiincl limitati, doar la durata pierdorii urrr
.{iar',r7,1/,,oJ tla. Einaopa uaso-uagald, re.f\efi, po:tte Ii tlofi-uittt pjielpi. Sinco.lete-cole mai grave, aproximativ o.trsime din-cazud, so 1xrt,
. .ll.
I)rllt ' l,l'l'(rorouc cutroltlu{a scu_rte,cu sau f5ri convulsii, sccundar, Insolr de manfesttri conyulgiye : spasmetonico ln opistol,onuB,oxcotrt,hr.
rlrfr Iriurz,!(1il,ldl&ue s&t unei prd,buqiri tensionale reflexe (W;ber, 1g?2). r: 9*p-"9!!oto^nq,r1rm?Fsauprccectate
uneorido ctonii girrr"ruririii",
I trr.l;rDl,,*crstr: sirx.ope,cele mai frecvcnte qi mai benigner'sint pluriotiri- lpl
(CorIariu,| 97.1.; gi
Cortariu Popoviciu,19?1i Weber,19ZZ).A"cobto nnuti
r(,lirr'r'!(|ilI r o:l.Loalr ull ctcmcnl cumun : tercnul pe t ar.esurrin aceite rosra{rconvursrvose,lnsolesctotdeaunado o rnarcat[ midri&zd,,u[.(,r'i
nranl"
o .labilita,teimporraniI a sisl,crnuiuincrwos wegctativ. Aprw de trtstaf,'mus..
hrpJrsatlvatie,emisiode urind gi mugcarcalimbii, rin ltrxrr,rr
]1..1.1:ll:.lr:fi:t
r', r,'tr1tr lrrnlr,l& 40. dc a,ni $i sint mult mai fr ccve.ntela femei decit-
lO smr expucabrredlrrcuitaFiledo diagnosticcrLepilopsia(fig. Bg). tn htorllr.i
rr:l,u,ir.lr_ l)rn t,)tctut.srn('ololorstudiatc de CnIflriu si popovicin (Ig78), anto_rioaro(Corfariu qi Popowiciu, 19?1; Corlariu, fOZ"A;Ijopovioiir
l.(r'rlr' tr)r'ln{, llll tl.ilttzAtun ptocc {nj de 93,l o/o,In antocedcnl,ele fi
:r,costrji colab., 1976, 19?8) am oxpus pe larg criteri.i,ted,ediagnostic,po o.iro rlrlrr,r.
r)r)Ilir \r Iu ,.rusc||ltrl'lutziide obicci bo.liorgallir.e,ci, rJt.r,eguli, le Tom lezuma :
Simptotno
vcgo.tarivcJ tutburtrripsihicotle ortlirLdiccti" ta'peiuo. a) Examenul clinio este negativ, iar traseeleXEG (standarrl plirr
:llll,i,jll,"l,trrlburiiri
..'rrrir{.r or.otive' instahire 9i labiio vegetatir,'. uneoli in antecedefrtoso ryi
nctivS,ri) din fazolo intorcritico sint normalo (Cir,lcii,ianu '.lli{tfi
Hr''rrr lr'irzi,fillcIt( sirrnc artcrialil,. ca fncl;ori declanSatoriso somnalo&rll _ $i Stoio,,, ;
(( lr)r'l:'i, f i Oorfariu, 1971; Corfn,r,iu,si P,opoviciu,19?1; Gastaut, tO6f; flnsirr,rrtiqi
,l,opovicill, lg?J; Co'f ,r'in,1.0?g): frioa, sii,rilo de crnotir,iiai"o .olab., 1956; It&illofl,1000; Slioica0i Bro$toanu,lgit9). DoartV.rcolhrl,1,ir
fi l dl:rl.,titl.il,lo,. sl r'cssrtrilo,sul,;IliIll|1nitliil, ilrsolll|liilo, aorul tlolttUt,
r\\ril, (t(':l,tcrxrt, n(ttlrinirtll,a.ron,(l(,in,it'cliii.t. ,ll)1i lrccqi;ifacloli iloclanJ (1960)a gfl'siila 30'1, rlirr lr'lnrlvii cu sincop., anolnaliilr.r!(1 r',rro.rr,1,.
t:trrrr'zr\,
rrttrlt mai uf(n'rl.,osrrl sirr.rrprr,l riur,,i,bulna,vrriso ntlll in ol,r]ostrol,iHm.
' si Itul-0% {,n"{,rnrIlii
rrlrr.l,r'i.u
rro ilslxrcrtcornifin,l,inrl.osobil,l sLrbi.'l,ii.rr
llttpil, rrbiryrtuilrrlrr rrlr,lili'nlr"r,r,i ntrnollzij, sr,url,rup ior,rlririr ciO
Jllr':rircrrsrrrr,l0, $irl(Dpevll,Bo-vlulllo,
rrrtrroEl,irrt,i'I,,

:|tfi 3:)tl
 .i
.llt tclritrrlr,irr LitrrIrrllirrcolroisirrrlrlosrrr,rtlrrgrrrrdolont(!, I) iIiI I i II |,I(I 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
tiiiBiIl(,r"r,IIir, xrrlr|lr,r (l(!iIlul.i'i,
ol1,lr,l,rr, (1lt
sirrrtsoirllr,lli,,o Irr!ov(!l)1,i1,
il0 it. .l r,/rr l tttl ! r r t t 'i r lo t t t t r lo lr lr r , r , r rr lr 'll: r , gclr ct : lliz- ir i, c,ia, t ' r t t t slolr clr , : 'r lir t , t r
l trotl ttcc
((|rrfrU'i]t].ll)71.; (l(irlal'irlryi l,,1r,vic'irr,u)?tl Wt,brrr, lt)?J). lrr sirrrr,lrl 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
.rrrIrrlsiIr'i,lrrrlirut.ilo (lr)rn(lo lcrrto sirr1,rnai Jrirrgi6i siirl irrtrurrrpiorlo irn 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
rrilrrrr{'irr Ilrr.l'r'irL lIplo '1loo0rnplr.t,(,:rrl1. c(u{.NI,uur[o sl]lr,s]lllrllri
loiric. ,,t<rcsl, ollrtultiliura, clinir:ri, 6i cl o (.ol nrrrl,io irr opistotonuS, proccdill,i, {lif I :l
lil.l {ir rlrrrclrz'ii' rrilcla,sccundoqi cstc urrrr:r,tdc lcirlllr,r'i{irlrr}(|j'loli{'l11o, cJortii gcntilllizate). Nirriorlrr,tii,nu ti4)l,l'e insi o fazl convulsi\'li, clr)r)i(,r'[
.rr|. o Il,rrr rIlzii, lrr0grosir', pinii h rcculrc}a}t,llurrr-rir.iirri rronrrrrl,l\rsti
l)l olrli[-zisai,. CastlfirL;ri c01 lr. (.1050) au mai demonstrat cir, Ja, trioi rrrr
r1r'iii(rllt cx isl;i,ilrxrrna,liillDG.
(.lrr,sl,rr,rr1;
. (I950) . a . doscris sirtolpi], nrrcturnir,a hiperl.agotorjicilor Si p teE
LI4 o ca L.tpREs tJ t,tE 0.ur,1,ii-'--'']-;;:"--*
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 1-\.n'{>-f --' \,.a
ECG - f 81r'mtn.
I.rirlc rrrrvoiir, rlo ir,.rLriru,la vagotorricii constitnlionali irL faza ch hipor,- 1tY,:^\*.\ 44-',4-/,-4"Nr"-.^-,v4,,'"--,\A^/,+"^ t-
-+,,rt\
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 VA . C "q^rnvl-t"
r irrrrrr':rJrr ctrrl;r'ipcl,crJ)rovalen1,[nocturlX a reactiviti,lii vagald) oxpljcll rA^
.'r'rr,vil:rlorr il,cosl,olsirrcopeqi asociereafreclenti a nra,iifeBtSrilorcoiyul_ \^!1414^,{12\4/*!1/4/"^4^%

riVrr Iirlifi1, u.ol)lonM, tliagnosticului diferenlial cn epilepsia rnorfoici-r,, PD .D

aaa^^'\&{/'{a,,a
'l'oIrr1i, lrr.ozon{,:r, tloar a tnei contmclii tonic6 in opistAtoius (pl.cccdlr1,rj, Yry.^"*{i&a'
rrrr uIrIrt'i rkrlr r10 1*2 sccuso muscnlare gcnel;lizate, ilar'-Iiciorl:r,1ri, " *'\'arv
irrrrolilii,rlo o 1'rr,z[c]onicii ritmicii propriu-zisi), precesiuneacidorii ;i rr, }.@q..!,,\V/
;riclrlolii .orlLory1,inloi dc c5,tle o stare de riiu gencral cu gre!.uri, paltiilr.o
,,i tr':r,rrslrir':r1irr r!lrund,nli!, a-llscotIr ncmoolorEEG de epilppsi;. 1,r.ecur,r si .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
1rroIrII..rlo rxrinpro$iunc .a globilor oc[lftTi pozitivi,, etimind, Olignosticril pieldcri dc ctnoqlinl:i de scurti durat:i, declanFate in special d(l
rlrr rrpilrrpsiolnorleicd, qi obiectiveazi, hipeivagotodia (Gastaut,'i9I0). 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
l)orli.s-1,orczu-t tri sincop-ayaso-vagald, reprezint[ u ri,spnns teusio_ 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(
r.lrrIr'rriror }r {).lt,l{r()sirne psihici,,cercctiri ale rioastre(Corfariu $i l,opor.icirr, yr ei, o nrodilicare a ri[mnlui cardiac(de ]a 84 bltli pc ninu t 1ai0 b:itnii tnin L),
l!r?.ll; ( iorInlitr, I97-8)au arltat c5,existir,o irnportanti participarti cardiol 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
rrrlriliil,oirnl
.(1i11.38), carc oste capabila prin ea ilsh,-;i sb, declanriezco nod if icarua 'f .l\. si a activitilii EEG. TesLele de cornpresie siDo'carolidi r)ii
rrrr,rrio cottll'i,|,il"t. 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),
. l'onl,ru rlocllnqarea unei sincope, respeoi;iv pentru leprodueerea irt
lrIr()r'ltl,rt:..1, nroocsllhlisinco_pal,se.utilizeazi, conprcsiunea oculari, compr\)_
ca,z de sincopl vaso-vagal5,,actiyarea c&rdiazolic5,lru pro(luco li(,ilrl
rrirrrrur, rJilrusulr.ricr,roljidian qi rnanevra Valsalva f Corfariir. l9?t.
I lr78; ( lrrl'ariu Si Popoviciu:,- lit de reactivitatc epilepticS,,dar c5 aceast[ ac1]ivarede multc ori l)t o\,r)it,('ii
19?1.;Gastaut, 1950; Gasta,ritqi cola,ti.,f ObOi
( lirrrlrr.ri, sitrcopa, in cantit;,li rnici ale substant5 injectati,.
6i ^(h,$1,lr,ut, 1_956; YercclJctto, 1960 j \ycber, 19 Z2)..Oompresiun{t;
olrrlir,riitrr fu,rxr tirnp de 10-15 secunrle,etecbuindu-seconcomitent o inro- Masajul regiunii sino-carotialienepoate antrena o pr5,bulir'(iloltii(l
lra15, in cazul unor sincopeyaso-depresoare(Corfariu, 19?1.,1978; Cio}lrrlirr
llirrl,nrlr ;xrligrtfici, (EEG, ECG, pneunfograrnd,,eventual $i pletismogra.
nrii,). l\,llrnovla, o$to pozitiyi dac}, aceasta antreneazl, nauli cardi;,rr?.i 1i Popoviciu, 1971 ; Weber, 1972).
rlrr 5.,I l:lu rnai nultI In sfirgit, in sincopele prin inhibilie respiratorie poate fi rrl,ilii ptrrrl,r'rr
_ririrea,. ftec\.enlei cardiace cu c6t pulilr 50o/o; rliagnostic proba lui Yalsalva (dup5, o inEpiralie profuldii, so plrlciicir,
rrrrrrilcll;flri1r'o.siucopale (prc-ictale), sventual chiar o siircopn
1vb)i rrrrefort expirator cu glota inchis5,,ceeace produ ce un blocaj tl Irrlo:r,rr.,'r'ii
lirzlrltoto poziti.l'e cI valoare vonoase,prin hiperpresiun€toracici). AceastS,prob[, practiclltlt qi rlr loi
, _diagnosticr,au ob{,iDut Gastaut (1950)
i1 (.il, 1,rnr'1,4i colab. (19-lir6), Vcrcellctto (19ti0), Corfariu (1971, 19?S) fi iii
(Corfariu, 19?1, 1978 I Corfariu qi Popoviciu, 1971) a ploduH Lr rrrrr.l,r
l Irr'l'rrlil ;ri l'oqovicin (1971).r,s, uncle djn cazurilc noastre, pe lingi nlrrd- sincope vaso-vagale o reaclie cu totul particularS. Antfr:1, h slir;il,rrl
(rrlrrobiqrlril,odo opriro cardiac5(la 4? 0/odin cazuri) am obsbr-vatgibloruri probei, s-a produs intii o reacrie bratlicardicS,de lungi, durntr:r.irll lrr,jl li
rrrrrrrrr,lrirrkr ,,ltr lanltt, lil intervale iie 2-3 secunde.La cazurile obsorvtlo socunde de Ia terminarea manelrei s-au produs blocuri sirxr"rl1,r'ilhr ,,rrr
lrri. ((lorj:)l'iu,-19?1, 1978; (,trrJariu qi Popoviciu, 19i.t) nu arn putul; |l,rr],".Accstu roaclii au fost interpretatc de noi drept consccirr!otrl(! luror
'l(' mI'lcxe exagcl':ltri dc tip va,go-r,
1'rrrrrrirr.rrvidonftr prin acuastL.probii riispunsuri ,,corrrphtetr itrU(i, <nr agal (13ozol<1-J aris ch) cu tcJ)()t'(lltsil li
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 rr,srrpranorhrlulrri sirxr-a,l,r'irl (Oorfarir, 1971, 1978).
I r'.rri[t(,i!lVorcollt:1,10 .11{}60),ei rloir} r.its1rrrrrsrrri t)1,)(i ,,irrtiorri1rl0.lr,)t Ilu,clori,,itl.irfut11it,i,
tti :titttoptil.or'tttso-ota,guLr sir11,rrrrrrrrl'o;i ((I()r'lrIIiI|,
(frrtlottt'i rlo uttrlo.lontti,.lrillll,olllle,
sirrcrtrrr',siriruirJru.,ri,rllru'|,sirLrrsoirlrr,lii). 1071, .l07llI (rotlttirr tii I'o1rolicitr, l()?.1I Wrlx r, l1l?l-r) :
1r...Irp1r, (l atl,iul't6iorlitb. (ll]5(i) ltu lu'i,tir,l.ii, r'rlrrtsiit ulxrl,r'rx,rrc.lrr,l.g'ri-
l. llittoltrt, tnulit'rt,: ltitri,, sliiri tkr irttto|,ititiII r,, ctl't'tiilir sllll+rrrli
lirrt'I,onlo rltri,rrntritlr,lli, rlc rlrrlrr,l,ll
:mliri1,ol,i : rur llloc rrlrrrlillotirro.lliriirl (l l vt't's(1,

J30 :l .i l
 I I..rt I.ir.' . hipttl r rl u ' tr' 1 tri 1 l l ,rrIrrrrrl ' t' .ttl ,il ri , sttt:rt' ri i 1i l rr,rrr4ri i i rr l ,i rrrl rrrl
Ir| | ,| r' ',I"I1]
I | l]
|!ii"
r LI iI r . , r ru r.l nrl i rri ,rc l ,r.c i tL rrtii 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 ( lot -
sl,:Il,io oil,zi,[ lt ', , lr r 'r 'r rir r lir r lr , llll) 5 I ( lr t t lir lit t , l1) ?lt ) .
fi r l (f s(fttttt 0rlt r t slt t , r 'r u'r t t t t t{l)
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, 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
.i. ,\ Ltt'ol),ttt,tt tluH)t.c u1l:lrt in caznl tnrol dur.rli viscer.tkt o l ri porscrLsilr ilil, ir l, o it , r ir r lt Hulni lr t t oI it I iit t t ( . 1: i11. 3! )) .
. , (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,. l )i n obsc lva, liilr r lr r r r illr ( ( I r r r 'lr L, it rt , l1) 78; Llor : I : lr iu qil\ r llt lvit r it t , l9?l)
1.. S;; roplh tl,i.n cu,rsul efitr)lordrilor inslru.rcntu[,e al)i]r ildoosol,i iu (vtrzi 5i 1Jg. 139), rticsrr cri, irr sitrlolrt, lrl tuse pilrtricipii hr miuc rn[sttrli
.lr.|rrl rrrrr)r stirrrnlir,ri in teritoliul r.ilgului (risofagn.iu1,u, ganrrus,,,,- 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
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 5]NUSULUI CAROTIDIANDR€PT
PNEL.IMACAI\IPRESIUNEA,
-\*-\---_\-7---\
: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). -,/--'\-/----\,1 -/^\_-'^\/--\,--l_-\,^/\_
; tl ._i i rr ECG IT A $A/80 Plussla/min. T.r'' 150/80
: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-e@.-i!/t^"\*f 4@,t4-,\-1.4J Jv+4
'r''lr-/i- -^.-4r'4,.\"44.l'
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). T.A E5/ 1A
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
.
rrl,rirt .h;11ttse s;biLitutt^ t sinusultii rortiidiatt au I,t,,l.
itf cad].ul sincopelor vaso-'agale? crezi'du_se c;, intervirro 1i-\^^^,}r&&@^/qq^-1*w
'r{rirrse
rr lrilr.r'r.:terl,u,h,iJilate r...r,g,,1i..Da_r_tle_lapt eld constituie o entitate apariir, urrr"^rrtr.l.r-^.Ap*.^^r.r^^.^i"
ji l; ll. l,] 1 , , ! , , 1 ( w ",:s.f,{:5I9
::,i J3}l.;i rrvi e i ttrru5i;
' . Cor r ar iu,
t9,i, i ezs;
| ,ttriu l .ir | 1)povici . 197.1 ) : :t,) ripul vagal sau c:rrdio_inhibilor;l)) I iprri irig. 39. Inregistrare poligrafic! tn titnpul compresieisiDusuluicarotidiaD
l,r,rrsio-tloplcsor' I c) tiptrl cer:ebral.- dr:ept.le bolnavul L-'\., 47 de ani De mai multi ani prezinte rare c ze
(':r, :Ll,il,r'ur-or' 1i expuse pe larg intr_un (2-3 pe an) de picrdelc a cuDoqtiniei, declansate de tuse (de obicel),
subcapitol separat.
l1l. It'luxtrl,lar[ngiott.esLe.o formi de sincap[-gal"s r,pare la indivizi dar ti de rls. Esie mare fumdtor $i are o brcnqilti cronicd. Proba (k:
((!vi!. rr&i r.i'slilici (50 de ani), pnrti,tori ai uior afecgiuni compresiea globilor oculari a fost negativd. Se poate lemarca laptul ctr
respiratorii la compresia siriusului carotidian drept apare o pronunlatd bradicnr-
' r'{)ri,r', Irr .rr.. r'iLcurnstanfelede aparilie sint chintele de fuse. b fornril, die (cu 16 bitii/min lali de valoarea initiall). Concohitent s a produs
n|l |J, ir. t''lus0l|ll t]rrngtan cSte ,,LuSeaobnubilantai,,.. o scidere a T.A. de ]a 150/80 la 85/40 mmHg, cu revenire la valorilc
| | ". Si.ncopel,e post-traumati,ce.Se confuncli, arlesea cu epilspsia posF initiale dupi 22 secuntle, L:r manevra Valsalva, scdd€rea tensional{
, {usese si mai mare (ta 10 seculde dupi lnceperea acesieia), iar dupf
I t'lr,ttrrull,icl'i,- itrsu1314sn4nqvrei, s-a evidentiat o rcaclie hipertonic{, cu cre$tefl alc
l).. f:ii,runpele1tr_inalte d,i,oersecause: subalimentalie, dupX insomnii '1.A. pini le 170/B0. Ileicsc o hiperscnsibilitatc a sinusului carotidian
ur,rr sLir,r.irlrr obosealil ctc. 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).
tle aentriLaliaeste mai rareori intilniti,. Aparo indoo-
, .l1l...Nin!\1,?
..'.\r,rtr! 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, lrit.ol qi tensioclepresor.D€a11,1e.1,se pare c; acosto zone b&r)rls('llsjl)ilt'
:r.rrllr.rintl_osimptomalologiepreacceiualLmai lunga (3*l rni_ :rr pul,ea sd, fie influentate qi de hipertensiunea artorialfi protltlsil, tlttpir
;,,,i,lri.ri,
|lrr,(.),,r'irr':tl'I.(:t'rza,l,i
prin^palfi1,a1ii,sl,arcde rd,u, transpiratii ieci, senzatii rr,ocesulde tuse (ca tlealtfel qi dup[ incetarea manevrei ValsaJva,itt oltst't
rI|,,,,1)rrrIrr, vrll,iile noastre) ,.sial conduce implicit la instalarea unui bloc sitlortlt itt'l
, cong0sl,l& lclci, usctciuneagurii, incetogarca, vederii, furni- srnLla o pd,bu$ilc a tcnsiunii arteriale, cu ro1 in cleclanqarcrr,sitrloltti.
. ir.r.'r'rl| *'rr)rtotr in exlr€mititi, prccum
!i respira(ii frecvcnte. Aecosrrl
rlo.lrirrrkl.o rucuno$tintei este de scurtd,duiath
lr,rl.rr;r'rrl iZO secl, in ti-prl U"oiii \t. Sincopu ortosttLticiieste socotiiX' de cei mai rul!'i (Dod.irlol;' I lli'll ;
r..rrriirt'riscito cd,-vedc, dar cd,nu poatc rlsprilrde.Acestemani- ( iilgenklantz, 19?2 i Hrs, 1972 ; Weber, 1972) tlrept o sinoollt, vlg;Il?l,.
r'.. :r.fr ..Illr, l,l.orlusoprrrr htpervenlilltia pulmonard (wayne, l96t).
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
. lY."Nitr,rropaIa truseesta ugor.de diagnoslicat,.Aparo tle obicei tlupitr ( l$?1). Apare cleobicoi la' inclivizi treculi de 40 de ani. Forma ,rprlitilg('r'I'"
r l rrlr rlr.:li -4{i ilc lni. la btrrbalii carr:lquferJ.rje dii,crscafecliuni Irrrir.
rr, u,ccstei sinoopo sc tlulnrt;oirzX, dupir, o pcrl'ioadl lungi, tlo ot'l,o'!1,1!f iNtIt
lr,rpulnl r.)n:trr..,t1'rricr.(bron;ito cr.onice,crnfizcm
rrrl(,r'tst lrulmonar, a,$tn)$.i..),do (1,)irrhno qi oola,l).,1f).17,r'il:r,\;ido Corfr,rirtqi Popovilirr, J97l)' lt'rrlrrrrr'
Ac{,eJUlsIIlcopftlsc pl,o(lltcuirt litttpul tttsci, lI
''l.t.t 'ltn:Ltorr,
f,,.1:(,:irrrlil,rn'rrt-rlopr)ziIirl,. rrrrrricil,([!rrgol, l1)fi0);ri folrrrrr'rlitr hipotottsittnofl posl]ulrLlir i6i vl'lirlcrrzil,
col.Plrlli, iir sirrrprorr.rclc l)t,esrl,,rll):r,lo sirrrptrtruu!rlogi:r,, irr tt t tt tttttt t1,ttI I ttrtrtu'ii
ctttt5tiott{,tli,
l:il':l rrr'tz:t.rrt.';llrli rlrtrr,:r.zii,.lnt.rr.
tr|,.x.,r('. ll0,\o.l'r(lo 1- :l_;l rrrirrrr[orii'rrrt Jl il lrirrrlrt!rillrrttlrtllj,lt,
(r inHo(r''il,(r rlirr clirrosilt,l;isrrr tttrrit i dtlJ)iLo scllrl l"r'prll'io:t'rlll'
ltr ot'Lolti'rrIirrtrt, l)l'('lt{'(r(rNlI
rlo co,'vrrlsiil,oniu]-([r)lli(:o,rrolrrrr,rrtr
rr,vturirrtrrr-;i
lrr,pitrr'f;,r,ri .i ilmo{trli.I'itrrlotrriltltt trtttto{1
rrlrzl(rrr rlri 1''i11
rrlr'icrr lrt,lrirn,rrlitr, itt1fi,ln
rr'rl.rrrr.i'rr.irrl,l rro rurrrhrziol'lt do ilrrrrrazir',
rillsi r rio rirgrrrI
'Irrrl'irrrtrIii, Itrso{r,1lrr lorrir.rrr.lotrilo,lfotrrlt llottir'fiit,ltitrtt
tlrrrori rIt lorrt rrlrrrr lrr,lroltttt,vii
rli:rlr|l i|i, r r ,r ItIi n o tti t,tr t, tti tItt1 i r r tr r i r 'Itr 'i H l t,l l l ttl ,r !l i ( 'i . l '1 tt,tt r l r .g t'ti N L i tt|o l ttt
: l:l:l
:t:t:t
oflosl,iIl,iriolrr sirrrlrornrtlShy-l)nlgtrr',bol,[il rlogurroltr,l,ivir,
ln r:rt'opo lingil, (' l rl { ' H c l ,l u if l: 'i . ior r lli,r r r r lol t r r r 1r olir r , r rirI r r lr r r llt r r r slr r r rlriu
, r . r r sl,Hir
r . i r lopr r ,plir r
lripol,orrsirrrrou, or'krstalicii, sc cunslal,ii, urrhidrozil, impotcn!,i srxuali,, i tcl ,i tLtrir,rllrlio ir rlrilr ilol ir .
1roI;Ihittliurrxrl,urnii,,abolirea roflexclol pupilare, simptomo cxtrftpirtuni'
rlir,lrr ryi rr,bs0!l crc$torii orijostatice a catecolaminolor. 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
lrtrrvis (1904) a descris un sindrom de hipotonsiuno ortrc,staticil,{||,rIIi- rni[i rnu]to alooljiulri (,il,r1lilrirr,rrcrrlologicc sau vag:lIc, prtiirrrlrt-so ;rlrrtizlr
liirlii, i,ir,r'r,loplozinti, o boali degenerativd, cu transmisie er'odilarIJ. ou lnaro dilicultato rlr,rtzlr, crurtii a, acestora,

PNEUMA COMPRFSIUI,IEA
SINUSULUI €AROIIDIAN DREPT
PNEUMO COMPRESIUNE.4
SINUSULUI CARA|IqAN DREPf
.^\.-/2\
-l+\ I
ECG TA, 120/75 Y
FM. -4.4. Plus 66lmin. Pius51/min. JlqtuW
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^ Vu^,ve-
P D,- T,D. ^^.^4

PS. - tS.
Ii0. lr, Inrcgistiare I)oli$afici tn timpul compresiei sinusului caro-
lidiu drept lli bolnavul A. I., 3? de ani, alg. crizc sincopale orto_
statice. Boln4Yul prezinli erizc sincopdc tnatinale la trccerca din
ciino- ln ortostatism. TA. ln clinostatism era de 120/?0 nmHg'
irr in orl,ostatism de 90/60 nmHg. Comprcsia globilor oculari a
{ost negalivi. ln schiarb, (jomprtsi.rsinusuluicaroLidiandrept se
voalc ci produce o scidere a tmului caldiac cll 12 ]ritdtlmiDut, crr
o cliscretl scitlere a T.A. (de l^ 1201'15la 11/75)' Manevla Yalselva
a proalus o masivi scidero tctlsionali dc la 120/75 la 75145mmHg
((rupi alorlariu, tn t, 1s71 ei -PopoDictu$i
""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, bol-
rrrr,rrrl rr.spr,<.l,iv se scoali, Qi imediat dupi, micliuno se produce o sculir'1,
ilo curio$tinlE,de 1-2 minute. l)oar uncori se pot semnala simlt'
;rir,r'rlr,r'o
li,nrr' | r()il,c0esuale(amelelir gleluri, amo{eli in mernbre), dc obicsi actrsltttt,
' (Oor'l'ariu,1978). Criza sincopal[ dlrea,zi, 1-2 tninute, ra'tottti
lipxirrrl
|rirro(.irrrlrrso (lo conyulsii tonice sau tonico-clonice, iar postaccesutl hol
rrir,vrrl:ltuzr"r, ailtonie, amclrelircefaloo ,5i o stare do te&lni'r.Waync (l9tll)
rr,lrrcrr,rlllr,tat:casth,tolm',i in cadrul acceselotsinoopalo llrin hipotonsiullo
oll,osl,irl,ioL, irl ()asta,ut (1950) :r, pla$ft1jsin(iopa tlo micliulo irt otdrttl
sirrcolrolorvrs()-virErllorliirrd fnvorizrltt'i,do orto,gtatisfirrInl,r-o ftzit, tlrt
Irilrrrlvir,guLorrio rrocl,ut'nir,lir, indivizi vtl,gotr)lli{'i.In doclanqarcil ittrosl,oi
nirrolro irrl,olrirro 11iltipol,onsirtttsit irtlri,tcllox[, prodttsLplil] golirou,
:tt'1,ttt
vrrei,,iirrlirlrro. (lrr'Irr,r'irr
(lf]?lt) qi i1il'olxrvicitt(11)71)utovirltttr(irll,
Oor[rtt'irt
l rr,rr,r'rrril'i qi
lrolrrir,r'i r' Ir,
lri;rolrotrsilrililtr,lo (Jig. a| ),
sitrttsttlttitrtt,trtlirlilt'tt
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 Vals€r1vaa 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).
, 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
lr .pe (epikrpsirr6i sirrrll0rrr
Acb,r'rs-Stokes).Totugi, Doclinot se intreabi, buirri rir.tr1rLir|,rr,
r,rr 11i
'i nai, dac5,aceasti,manifestare eliloptic5, nu reprezintii in rclrlilllo rtrr,lrr'lrr,
anorial a unui sindrom Adams-Stokes. lt) Sincoped,e rrilin
ilI trt.l'':ulru.tt,
5i, si nilrotn A.dams-Slokes,Tot Dodinot (19?2) relateazj,i cir,zrrr,ilir, r.irrr,
ltlocurile paroxistice Adams-Stoh€s pot agraya urele tullnlttili viriilrrlrrrr,
<rcrcl;r'ale la bolnavi cu insu{icienfe fie vcrtebro-bazilaro, 1io oIro|,irlir,rrr,,
L:.
lrodncindu-so sincolo t1o etioJogiernixt:i, do aceoa,l)tolnuto rngtrrrizirr,r,ir,
ttnot cortsnllra,{iirrorr
lo-tr lrliologico la bolnavii calc plczintri lrirrtrlrrr,irlo
( 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.

:r:t4
 V-
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 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
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 ':i r "l i r l r "tl r ' ( i \l i r l l i l i l l r ', l {}i "i i lrllill
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'
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'ii"i,li,i,l,,r. t$t:t; ,.) Sirr{ r'itrrtr,;rr,r'irIrrtrI.Ir:$i'rf.l)tl.lootr .rrrzirt ittlt't
! i) r l i rIi s i llr pr iY ii. ir r , l 1 )7 2 )I r,rrrrlri.
,,,,iiii;;,,',iilltl-l:*i*,r,.i'rr r.,.1rrrrr,.:, rl:rr' rl,.r,.rrrl
r,.,.-ri t.,i {"r i ;1.11
/. 'l\tll\t,r'ritilt, l(,t.l\)us(j: 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
' : lllr lr '
tl' s ernn'ele obier:ltt;t'trlt lti1"rn llrLlirila!ii si'tr' idic'tt'r' I'lrcilrrr.rt
tl l'lttrttttLttttlt prod,rotnak sirrlr int,otrslitrrl c (lirxl rrrcslclr, r.rjrl:'iy ' "urot
,,i,n-"*rliiOiaoi se prttct icii pr iir crrirrplo'irnca digitrli r cal(11ido lrL
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 ',,if"riil-
,
l I r r'( i | | (| jII (.1|, (li$lll{,(i sj sonzlltio de sufoc:}t.e. r,ii.li.iliei, ' sr._utinic poljgr:lliu('1r,1.ri.
..i
"unei oN,r'(liruu'"
r,irrsirirale. respiniorii 'rmi'iril.
Si cerebl'ale.Itroitaxea sino-ca'ro1 itl i rl ri g1r1r.rt'lI
l)) ,4t u'tltl xi?r(,r1lrrl ,,pNt'edo obic{}i dup:'l,\-irs1,i}dc 30 :lni, rle l)l l,li\. '""lii- iii"
lillr llt, sr'\rrl lllrscrrlin, dlpli cum I'ezulti li rlin obsetr.atiikr rorrslr,c ,, ,itl.o'ri iolicita,rea ixdiyidrhi de a-1i llsiurna cllpul i]rlrl).i.
car€ are dfirl)t lrl lrrir'r'('
(( tr lllil, ll)71 i []ot'lll iu $i llopoviciu, 1972). Acegti bohra,vi sint tlr rrtrirci ,', ,J.
j ,,, "tt"ii*-arilorsi comlr'csiuncacarotidci llimitiYe'
:rllloririr,lo;i fi hipi{'tLlrsiyi. Arlf,'1, NlthtrLsnu (citr,t d'r Wa)rrc, tliilJ ir, fr-ria ldier i'rnrti nrlltl salr mai pulin colnplclj rI'li'tr'1tt'' ('rr(losr
;'
r l|l'zt's-Rueft, 1953), care antlt'nellzi rc:i'c!ii Lipott'tsiuno:l,
:rr:rlrrl (i'i 1t,l)r'o)(itntitiv0lreimo djn bolnavii cu afcctjuni oor(,ni.r,l i(:r!1..\Lrri - .prin ir'
: 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, * 1]rorlxci. Prohl itrvot.:] rlc hipcrtlnsiLureendosin-uzdi-t' lrrrtlr'
rrrtz-iLli
,,Iri: o-'-- ".."ui 0,'t'rsr.' (Ntinvi.jllc. I9L7)sau p irr pr'rba luiY:tl'ir'lt;'
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,lr- $'Jfii:1"Jt
,,,,f;i*#i",'0,,),2ufii$Jl:t"$ fi J:,{:Ti:{,1:"','[,i
i"%"*{ri;
r I rrrrlt, (l c l:r,n ivolul gil,uhri (comptesiuni in di\rorse circumstantc, iltl I)i!_r'(11,(,ir t'olfariu. 19?8):
r,r r iisl rt| lrt.(,a oa,plrlrli la b5.r]:.it'.r,,miqoi,ri bruste ale ca,pului (rto.). _\1rcp-\trl 1\'] I i.pul aag*L tatt c{ 'dto'1'nllibilor' fnci' ]a <lel:utul excitilrii' rlsifliirtr
riir( ol)l,l (,iilo rlc sourti, duati (10 -60 secunde) ,i poatc ti irrs<ifi1 rlc lori- l.Lo;tu;e';'e;;'i"iui, upoi chiar la o oprile cardiaci timp de 10 stttttttk''
r ulrii
.lolricrr'cloni0(', cale pot imita pcr.tect o criz;, epileptioi. ilt, la,pt, ;ll,i,i;;; i" ,"^r,ia la frecrcnla i'o'mali' lllectrocardiogra'Ir. it'r'it'llt
r
rrrrr,ioliirrIr,Irltolnavilol no$tri au iost fuldrull}.ati cu dia,Enosticul ,lr. criz0 ,.iL'bradicaltlia s€ datdrefte urui b16caj sino-atrial sru. atrio-vtll1.r'i(iull
""t:i""
, 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 ). r\ tlopinizarca pr€alabilX sau ld inistraJca de adrtrrlini' prevu]f rr{r'nl('
t
. ) .i:lin?lonrclc ?ostacceslt( e se c&ractcl.izeazii printr,o $til.ro clr'o.pus. rulbrirnri. Ar iitra in ioc u:r rnocanism bulbar (nfinvieille, 195?)'
r'rIlrt ii {l(t (,ii ot'a nitrrl e, printr-o Senzaliede anxietato $i de mal.i_,ftl.iiista,}tic/ b\ fitrut lttnsio-d,epresor consl,S,intr-o hipotensiune altoriitlil irKl(l
r,u rlulirlr'i {lc cit cva ole, pini la, citeva zile (tr{invieille, 1$,1?),tulbluiiri r,rm"irtri 'Oe t t:l,rc s-ar d*tot'a unei va'sodilatafii g(trcrirl('-
rlI r'rr,rir,01,cl',nc}r,ozi1a,tc, somnolenti, prelungiti,, st;ri de depr.esie, i(l(ri i"-"it. "ud.i"utjdi",
i c€d€azii, ta adrenalidi li o. sht inflrenlate d(*r1r'.1)itrrl
rlr rl i ti ttri o t r lc , ifriin i";lfc, t95?l Corfari[ [i ?opovicili, 19?2). Ar inira in joo iirl rrrl
-o"itn*tl',
( lllrrhr ir,(|r:t,sopo1,
Irozcnla manifestdri tle tip nal,colefl ic (_\Iayollr ;i uiecanism bnlbal (Minf ieille' 1957).
('hr,N.iogr'('s,cila{,i d0 Minvieillc, 1957). Turne.r:
fi I/ealu}onth (19,1S) u,u c\ Iivut c€??rr&l cor($Iulde tablourilor de hipelTefleci'ivil it'il sitttt
rllir(.r'ir.i lsi :r,lr'r,ctui ou criderta elpului, ca in accesole al{r petit Ijral rle lill ,:'rut idian'I (are nu |.c ilso!r'sf de rprct'inl-ri)c modif ic5-r'j cattlirttr':i srttr
prlrrrl,lrl ic. S-au rnai descris 6i echivalerrle verliginoasr, ilccese cn tnlllu- rrt
,, rt.ioooi. ..i carc nu .ilt in{luenlafddo atropilri sa,tt adrr'tur'litr'r'
dr- 'l
lifl i ltl lliri o {lo r.c(]cr'o ulri- Br]u bi1ate.1.a1e. Weiss iii Bzr,lier. (1983) gi \.f.r,risr+ (Minvieillc, 19571. I.t trti.
,l,i,rcrvarcaiino-crr.titljanil Iijnr.le{icrce -A.r'rtili
ijr lolrrlr. (11|110,ojtali de Cor{a,riu qi Bopoviciu, 19?:,) au individuriiizll
r,rfebrali, n fosi individu€rlizati' inci de lTeiss $i Raker (1933), rlltrti tltr
lirrufl(J o('r'oblir,lo rr,L(.jhiperleflectiYithlii sino-caroXidiele, Dnnifesta,l,o t1'flris. UaDrs si Weiss (193T,cita1i de Corfariu $i Popoviciu' l1)?!), trrttro
lrlirr clizo rlrr ollrubilalc, tulburiri de volbire, atacuri irntste de sl.ibiriuuo ,,, iof'Jti rLou)itreiini .1in caiu,r.ile4e hiperreflectivitatc situr.r,rrtrrl i
, , . 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(' ".i realizeazi' aceaJttd, forlllri, tleqi llilvicille (19i7) Fi Corl lirl {11)il)
rlir,ni,
rr ; i rrrn l l r r i c ilJ( ) ' l, idi: ll 1 .
llr ai.[tat cE,,de fapt, este Tot.bacle ccle mai multc uri r.lc folrru, rrrirlrr-
:!. .ll.t( lrltrniltstdrri : Il.anifestiirilc ca,r'dhce ci)nstau in tulbur.irIi ilr.r ,\ liji autori ilaSeurl, in cadrul formel'r cerebrale Sindroanl(trf tl.r' lt ilrt't
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' . j,4ifrtrrtttl ('rt'('ir' li
r,,liectivitatei, a cirot simptomatologieesto nervoasi,
''1. (trilrtiil,r ila d,iagnos'tia t c hiperreflet:tir:itd!ii, s i.tlocq.roti(l,ie,irasr. lrol, rrrutriicst.it ilo obi(cl i\ e de Laz*.
|r rrl |i r l ls l, f ( f l:
t) I ! intt,tuslrr,rt,lt.l,( Mjnvieille (195?) a individralizat mai multc Jomt' ;
da tl,eil.unSQ,re: O rni;tltr,t lfusoir, ll cit,pului (il11ttrsflri tlc rlittti
rrrlIitrrrlrrlrillr.poi sluttlN,1,eraJ{i,) itt rttettcil,zli, o ci,rlolc ort picldeltlt, rjoniiliierIloi. a,) U'anneLe cetebraLePxrr(i(rara) ^secaracterizoazilpr,in rr'trrtrsc
t|rtalc a s15rii tlc cort:lticnl,ii,piolderoa, totLusriitti lLlsoulinl', llJtlrl((li lL
,\liIoIi lrrlliu|ti,r'i]o su(lced ulxri c(]l] r])r0Ftiutri (.('t\,ioa,le (gult.r'1rrr,rr,silirrs,
zl_L,rrot.au'icu lar'(',.hiu' r,tirrvulsiid0 ti, ()pjl(rllLio,$0.l',iriiialrfsli,ltitrittttrr,
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 ti]ibrLlir,ri do yt'drrtir,il(l('s{'it, lt(j(1(rs(' , tliurr1ro1'Ii tr'1rt'
rk' lllitts ttctrlot'ivlr'1
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) ,tiisc *i f1,lr, l)1.(,si'r'r,, rirrrrsrrtrri(,iir1)i
i(litur,I)lill .lliIXrt''tt{r\$i }rrirr rltr.l.
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 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
r rrtl Ir tl rr int lir " ir t it t t ui I .i n tt" i ., ,l n l o ri i ,l tt1 ' t)t 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 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' '
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, 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
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 l roi rti rr| ' vi rN (l ol lt 'l llr l{'lt t ',

: t : t {i :t:l 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
I J):.rlllir ltt,tl,
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 *rsi11i.rtih,**;lx|rl:I'jiili
i;li, ;]ri;iriliiiffii
:r';'trll*[rtf;
| | l1, .,r | .lr zi|r' :rlr. . it r ir r lr r i , . : r r , r t ir lilr t r
\ lir i i"rlr,, (l|,:,t)' r ir L' iiur L' - s u1t r os iv ii lr , iupll
"
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
s i i r . 0 {) 1 ) ( ! 1 0 1 s l r n ) . {j l r r 1 ) 1i r l i ( 'r ( \ ,
;)'ffii;-i,p"l#ii;t$tru**l,:";lf t"';iy:;t,ltiil'li'f,Lllr;.liiit
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 (l01 .o 't'i
vilitii sino-carol,idiene ii"'*u t lu tl' pt"'io iult ri trl ' r'irr'lir)'
rt'grrlrrlir..rrrrl.lrl. rlir irrflrrx'r'ikruo.iirepl,i\ao'(i rti.'l l^ ,r'igiru,ri
sirrr,,r 'pio*
ii'bi lr;t" *"prinde o'rJ.r'ircp"o-i*iox a activ.jtaiii clcclrir"r lr.trtrtlir'1"
I|(i1' | . , I)(,i rILi I i I |(I irr rr,rrtrlirfi
rrrllr lllrr.
limp sir r.zlste l:l ilchcmirr,t\dati;ir,

,.1..)l,trli.li,<irilr Illiri it hiperrefLecth|tuteasi.,o_carctlidiartii.

{i itrl(,r.
l,i}lrf :'.i'lJ't't;lii;lill'ii
\T:f".li::'tJ-ru"""t*ti?;','""*"#iJff
Jt)l.t,l,,
'i r* *rir,rrg"'.1('l, r 1r'ltti*lir,r in pelioadelo interditice sint cel mai [rlrrrur,
rrlrrrrir,L,lrllilrv,ifiilc,, tUtT l Cor1a,riu,19?1 Corfariu qi Fopoviciu, 1{t?:,}). ,;il"r"''
,$11i;,**-;;*it*[:41"*6]t":1l3"Tlill'"',
l]l ll,
,,,ll,,ll ut l,ir lrrl ,siicupel0r,,
;
sau la excltarea sinisuluf(prin corrr[r,ii t'ffli11uf#k*t44"-#.:*ili'lt"'*g_si::!"i .
,'llill:' l.1,cil-!,1,.,1'xl,ulii,,
r,l'.l,ilrrlR., tr)ugrliu([iDr,li1,
pr.irrrnasaj,.sauprin stirndarcm6canicl,il.trr
asupra axului carotidian, rcaliza,lEprin rii,sl,Lrirur, i;t*m' "*llx",*ril;ll ;lT$H"{:ii#"T ce
.ti*a'liksopio,,r,
rr':L,:rjlltt't
;rrrrr.or:rl,',:Lti0 'lr-rput),
r,..spdctivp.in variatiilc dc presiunc cntlrrsi.rrzrLlrr
irr lripor','rrsiu{ru lcomprcJiu;e subsin-uzali,),
t(.r.rirrr,'(iiu,luiiijde luse, prubl lui yalsalva), se pot obfin6 o seiie
cil, si irr lripr.r.
tlc iirrli
*l"*fl1*"#*
*;*flX.*:\s{.l*$*f*1yi*tl*:"*d
(.rl,llrl,r1{r(,:r,i0,cit}.er,u tost sistemat,__zate de n[invieille (19bT)in J tilturi:
rr') I'r'irrrLrli ip ; uu ,r)ri,r'Jnici o modifioare EEG. Doai. sistemul crir.rri. ;*?;,:"tntmm*t*iif "il?xtl;'de-hipcrr
u-.*::,igm*1;)f
\,:r.,.'ii' ; b) AJ tloilea tip: arnp.lil,udinea
'.il(.
'nlcrcsii,.l
ol| | ll| llr r.:lzjL l i.i!
riflnurilor Iilr
tit { t c 0ut ||[ r t x CiLal ini gi Sc nO r m a l j z C a z L l a s t . i r q i t u l p I t | i x . l , it*,T:".ii#,","'*##i*i-*l?H#4il1:
L'rrrrrrr,'rrlJiirrrlbihte-ral sincrond,]tiina ae fapt idlentic'cu rirr,.{iil,i
,qi, -",,*gm'ttif
,,I';iffi;l;r*t""on5ria"""i'iii"$""\1]#i:lllrsriJii:3i!,?lH"
rr" .lr'rr'(1\ rzr:urcsftudc irlta
1,1,r!. |
natulir,.Irodiiic.irile cardiacesau tcnsi0rr[|.
, r.i, iri' ir,c{-.ltip de r.iispunsEEG ; c} Al treilna tip: rrrodifici.r,iIr
'ri, tr'
r'.r',t,s'rt m&i plu'utrfr,tc, l,raducindu_scprin rdriii ale trils.rrLrr.
'ii,1::r:?T,ff
:,ff*1ii:ifii.g1*,.t11i""t*','f;:gf
il*iil,l;ll;l
rrirlrt,,rlii rol:rtr.,.1.952;
lr:r.;,'.rlrr|l :'r:rrrrrdil
.tIinvieillc,1957).Astfel, limp de citeva scclulllr
jci. r,poi scadr.ampliturlinea,iar -drLpi
5_10 gccrrlrrlrr i#tltril;,
T:rj:i:rdf#"r"*rT{#:ni#"*;#"J
:r'r' r' riJr.rlr'ii.ur,ll'\'ollrrle(to t0 ci'ri/scc si undc rtate, mai cvitlerrt,orrrr
lr;lirtrril', I'ttrtrirLl .
.lrifu.lr.rulr.. d:lr cu o ur.olru,prcdominanln de prr,r,f.i,ru ;'ru;:l ll llil;;i
Ji,ri;:iirilllti,i*lt#"lii,''i:
:li:'I;:;llt"i:l'.i;l m
ililikn""l'Jl*"j,l*,.ff;?"*:pl*"-tf;:li,ll:""l,nl*'i,'il
., 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 al ciirnii;ii etc').
lrrr,r'rl.r',,11ir..1f,,,putind _l)l,eze'tas,i _citevaconvulsii. Unrielc 1e.1,. lrit,
r'|r'r'$rrlir l(,_ -l() s'' {'nd'', tlar' uneoxi chiar 1-2 minute. ccl mai arrrrrsarr
;d:::*il'i"i*lii:ilkij?{,*r jl:,k#::L,$ffi *:fi,lliil;fii
,r.r:{;r,,' r'r.Lr,{io ct.'r'lugitiu intre ri,rirea ttaseelor EEG qi br:ldioar.rllrr,

h- t ji :;
:iit I;;ll;;ill;'
'r'rr1r.r'Lrr 1lrr,rrzu, tl:r,rdiacii nu depiqe;te 6 secuntle,lr,rr,oeulEEG nu srrlirrii
lir,rir,tri, rlL]. du,cii a,julgc ia 10-1b secuntle,apar modificii,ri EE(i, crxru
lr**llunHitr
i{1, J;*ft
.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
':l"""th
irii"i""1 .ir""rr"A ;;"tt;p'ii"i;;il.
icurtii,starecrcluscrit'I,.$:.ii1$"".:i;''ff1',i:1,%:t-ilL[llili,,
Iii
|o rrH
Si*ptoro'atotrgiapost:}ccosua,lii

,,r'rr';r.r lJnr.rlr(,ilnrlll -E-DGin :llrar,rr1rr,

;:r,ll hilrotcnsiuni ar.teriale.Aceste constati,r,i altrnf,$
''tr-o
dulatii pind, la 24 de ore)' e
onitt' delir (Passouant gi Minvieille, 1954)'
' \r.ltr,llt,ir, lot. lbLlrrourlollralti. purc, aliluri d0 formo intricate, irr rr lrr cruneori*i:Si;i"tt?l,t'J:ff?r-li#iH:Il
faptui
serelateazs,
""
.r,;r,l|,rrtlu, irrllrrr'r{:"r, r',,r't,bta,li,
diro.ctd,la, 1i.r,r,tOriicardi:r,rrsau 1jonsiorrrr,l. :il]'lliillil:
'I r'olrtl"irrll,irrvudrrt:lr,ptulcir,p_o.Ill)Gnuscpuuileviclenij,
,,1,,.1,r'ir','
manilcxl,i,fl
clilr.Ii,it.. irr lirtrlrrrl p.ob.ktr dc .xcii:r,1li.sirLo-oar6tidiarrii(.Nllrr, ,ii:rHitff
f'"iL:f i'.:titgp"ryt41*itrf kilil[il,lift*l
rr'.rllr'.,l^l)fi.7 i |!')|.Ii,iir|,lU7l, l.9Zlii Liorlariu ryi l:bpoviciu, 19?2). illllor lillll' ;iiiiiilli,*lii':ffi
Iti;iii,li:ln,lrl i;iifl}liiii
i,1:
,ilil;;,;ill,lit; ilii]
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.rrl. rri rrr..Il,i,r'rl .ii,.rir I'ir'|i-rrrrrI. (Cor.fa,rirr
l,rr1r,zir,
rlrlgil,itrrrln
ryi ltrl,ovicirr, I1)?2),l)rrrrl ll,,,llilil:;;,l,,li,ij,,lli
l*!:,,lii;,jllilr,i;,i'ill"llilll,,
,;l;ii;,1;lt,,i,i,li;1.;l,l:ill1
tt,tr,tt,ll,lr,
lr,lxrrrr(li, rr IcrrIr,o-rrIiIrirrii,
r'sirr 1,ollt,lrlilirr.ilrii,
rlrr it,lrstrrrlit,
rlirr |rrl,ilt ,
;;;ii,,i.i:
i, ,
trlrl 1i rlr,,,lillltr.lr" irlrrir,rrlrr 1;rrrrrIrolrIIr,. i:lfl
;lilllili:i,l;ll
:J;Il :r30
,"I
 l l tl r l tr l 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
t '| . 1 . : ; - : J , l . t "
\ 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 I iItt,l, uc(Je:t!o1 5I IIr:tt1trr Ir
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 . 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 ' tr zttl l 'l cl L l l l l ( r q i sl l 'i l i l ( r l r ) 1 1 ) ( l fi
rr,lli.rrrrs lI i so pou,to l,ratluco lio pritrtr,-un r0lIrr <lo tip c1t,r'(lil|- i l l ( [i $ P( 'xl 'i u l ) l l ( p o l 1 1 'l tl ( l l i l ]g l l t) s
.r,rr,r0t,irlilr,rr I X ) l i g f a f i o o t l ) l l i i 1 ,i 1 , i o |\i l ,ttl i l r i r ,r 'i 1 r :r r :r r .Ittti t{1
rrrlrilril,or' (lig. ,12), fic pr,irrl,r.-rrnrcl:lcx tdnsi o(lcpl'osol'. itr unrikr crr,zrrr.i i i . -r i l '1 i tIi I.tr :tr 1 i :r I :r l si tr .,1 ' I.r ''
t,utiiir
rrllslt rlorrir, lirlnrrt rlc r rlt,nil'os1,a,ro nutindll-se inti'ica, . \ '. - i , , r " q i i t , A i i k t:t.t, stttd ti r t ;;l tttti t:t\ 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
(ort'r'r'irt, 19?1, 1978; (.lollir'r'rll '
(Gast*ut, 1t)"56i Oilcfia,ulL qi 51oic.t,, lutj;;
COMPRES/UNEA SINUSULIJI CAROTIDIAN SII NG l C 7 :.j i . l ) o r t Vo t"t l l ctto ( 1 9 6 0 / 3 g a si l l r ' 3 u o /o tl j l r cr tztt.tt
.iFrno"iaiu,
Fffi--- ,i"o"rloiii nroilcr,rte'Silu 10o/odin 10O de bolna'i cu sincolo, itld',str1i tl.
\/1 n n f\A nnA A r ..,.^ A \ tip 1-aso-ragal), anomalii EllG de tip epiieptic'
a i{X!4^,4^,\^.&-^^.^.4ae@
^ vv
F.u Gvv !4 v v v v \/v w -'\/v v v^ l/ v tri, I'nregistrd'tile
'iar potigrdfice pot furniza- clate pre!io:l's() lu rltlrrr'L(ltr
-Inecanismele carc concurS' h instit'irlt rrrr'
FM-V/\ ,tia,g";sti;, ryi ref'erit6ar; la
@Va{Url^t*r^r,r. "."".,, sll]oopol,
{*:S***@ i. In.reaistrarea accesttlui,oste posibili, foatte rat, dar clnd se lx'irl'(l
"Y-:-'":,;:*' Ir-r,ce.ie tlifdrentiazX, in motl net aCc€sul slncopal de accesul cpilolf i(r'
" l
PD.-TO
2. lt .faBeleintercri'xi,cetp1'rl,cticarle&clirerselor nrcto'lo de testalr rr
?t1*\t'$^^&4!t'{ry&+@ roncdr rofiexogelre (test€le d; compresie a glollilur oculari, de corltpt(!$i(l
,r" ti"iu.if"i caiotitiih,n, netoda Vtlsa'l"rr') pot surplinde po poligli)'rtiir'
liincrrettcxiritatea zonelot reflcxogencr evetrtuill chiar s5' l€ptodtr('ii' irt
./.it. :{.9. I cflistmrc lolisralici (compresiunea sinusului earoLiCian dupi iaborator acoesul sincoPal.
|ilx'ryDce) Ii bolnr\,ut C.ll., 48 dc ani. Dg, cr.izc sincopate p n hipclreflec-
a,\ Testta'eT refletului aculo-card,iao se fir,ceprin crjmpresil gkrbilrrr'
li\'il.ntc sinocar.otjdian:I. Pentlu cr.izcle de pierdorc a euno$tintrei, deti IirA
collvuisii lo i(!)-clonicc ti lir;r njci o simptonratologie preacces[a]d, a lost 1,culi.lii,ur rnirin{lu:se p0 poligrami, actiYitatoa ECG' re,spira!ia' 'I'r\- 9i.l't:t''
r.lidrctr)t:1 drelt epileptjci. lll clinica noastri loate invesligaljilc clinice i,lpC. L.tf"t,Verceilefto 1iOO0),testind roflexul oculo^-cardiac,i],ol)l'irrrrI '
\ i t , r r , l i l l i c e t i n r l .iv UEG .i I' F :b ) cr r fo .t n cg rti vc. C ompi restun,a gtt,-
lo'iz ,iin 33 cte cazuri cu si[cope' stopuri ca,rdia,cede 2 -9 s' cu "lil'r]rtlrr$
""ot
li'n O lncomptet" (unde lente dihterale, sincrone $i $imotrice), iar lt!.rrlli
l r j l o r o c u l r l i a i o st lr e g a tivi. In sch in jtJ p t llg u r a ie r edc cum_conl prcsrunca
sir rsului curolidiAn sting (dupi hiperpnee) produce rrn bloc siu;atrial cu
( l r r r N l i r d c I s r c nn d e , In so lit d c u n b u fcu d e u n d e lente
bi l ateral e, si ncrol l e l- t oi"r"i toi" li3 studiali;, stopuri cardiace cu ,,ri'spuns EEG cotttltLrl')l
""i
u*de Ieutc cripate tle pcriuldc de eloct't"gr':r'lir':r)
ii ni )rilrict, llodiliciri
rirolidiln
similflre s-au produs 9i prin comptesiunea sinusrlui
d r c p l . lla n cr r a Va lsh h :a a lo st. Dcg a tiYi (dupd L'ortori u, 1971, 'rrui"uii cic iretoda. cornplesici -dePrr:sie
globilor ocrrlmi Lr 'l() rl.'
( h r l a r i u$ i ? o p o Diciu , tg ? l si p o lo r i.iu
ilr;ui t Lf iOr utilizind
$i col ab.,Tgj B ), 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
.-. l\. r9inccrpzle- din net:ralgia ltlosofuringianti. Ri1cy i1g42, citat rlo
()oltu[olla
llnei U 18 cazuri, pauzi pe ECG uai m*ri de 6 s (cu.ulde lcnto ltila'l'r'
"'i""i
\Vr!,yn0,.11)01) ;i (1OiT, citai de Coriariu, 19i8) au d'escrislsO- !io"r"o" Si sim-otricclre EEG) la 4 cazuri, sljoluri caraliaco ntli tttrt,ti
r.ilri rlrr.rr':rr.&lSiiglusotaringir.lc (.u sincopc pr.in b ipersousibjl jr.i,t.,,rr, ,l,r iii s (cu undo foerte lente bilaterale, sillclone $i simetricct ul'lna'l.! -(l(r
"nt".
H|llrs||tut {:t.1..r1.1(lli! . Ac' sl.c loTmc ,plrf iculare dc sincope intrtttr,,u,, instalalea piorderii de conqticnttr') la' lllli li
rrr,r'r'rr,lgi..gl',solnringianL in accescduicr'oasesfir;itc prin aciese sincoprr,Lr,
; "uolu,tirrr,i"otraseului $i de
i16lna,r-i.
- -i.,a
Irilrr,r'rr.rrsilrililrr,t,c sino-r:aro lidil,iti, 6i prezen!a unui h.ig-qer zone, a i,iir.,,r bolnavii obserYa,tieleloi (Corfariu, 1971' 1978; Corlariu usilhlto-
ir r':r,(ir.irrrlrrr.rr .r,izlr,sincoplli. Dur.rilc alri in rcnnseuiolentecu dr,,rr,ll, i,
ticlu.'igfZ. l9?3) s-a obtinul' prin testul dc cotnpresioa globihrr rrcrtliLt
{l(. :j(t..ltl,-s, IiirLrl r.rr,ntorrir,trr la.baza linibii, i n amigdali, qi in unghitrl la 47 o/o di[fie bolnavi, cu alur.ir tlrr lrlrr.rrri
, reacr-iedi oprirc cafdiaci
rrrrrrrlilrrrlot', irrr.intro crize dc obiceribolnavul nu:lcuZ[ nici'un simpl:ot', 2-3 s. I.ta unelo cqzuri ann evidotrtil'li bl)lrrtrt
lriris|,ii I r)L rii lxrl nlrl i car,.acuzil dureri pcrrnanente,peste care sesnpt.it ^ri.ro-otiiat" cu d.ura,totle
l)lrrl ;;;i;i; iant", la intervale do 2-3 s. ln cazuistica noastl i'i' Iru rlrrr
pr o.,-,ilruc lr,lgiilrYiolt:trtc,I'io_spontano, fie tlec]an;a,lede deglntilid;i/'srr,rr "i;; -iu 'accstei probe, clenivcliri tcnsiolalo 9i nici IJrlttttrsttt'i
,,f,*"."oi, it""*,'sul
rl^ i'il,rr'.rr,z,rr.l'r' ilrcLyatn rlc glosofaringian,rle.rnulte orioontimirii. si pierddea c6nqticnfei, ca in relat5'rilc lui Vt't crrlhrltrr
rlilrilrr Ir'irr rrplr,r'il,ia, -.,ro,noi'i"; uuG cu
sincolci qi insoi;i1,e sfl,unu de convulsiii,rnico_.loli,,,, ii.s-ooi- iteatttoi. Gasfaut (1956), Corfaiiu (19?1' 1978) gi Cortariu 6i l'r.r-
i-li rr| si 1,rrlr,I i i il r,rrrosineop:l su declanqoazirrruml,i la i,.rt:i.i" irszz, isza) au c,picciatci' ,.t:xpresia)'EEG csto doloI'milrrL{iL rlt'
- ,,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 1i,,,*i* Asitut uri bl,rcsirr,-:-ulrial cu tlltIaLAstlb 6 $, trrrlrlixlili{ ii
rlrr.Lrrrsrrl,. 1i l.in corIqutsiurL.:l sinutlrrluicir,r.otirlilrr
(|.'l,illrr,s,
Jg00), irrrprf ia'r.r,scul EEG. in schitnb o rlsisl,olioruai rnato do 6 sr prodlrco lr{1 l'r'ir'r'iorrl
^iir,otti.
rlirt11r11,'q,1,,,, rrrl'rlit.t,trrrrntoitsii,
ll, sirttrsu]rriso pot itrl,r'crtuxt iiiJC lr,rt"u.i rlo *rtrlo 1,IrIILII.rLrIItir, gotroralizal;0,cilro oLos. i1 ilrttltlitt-ttlit't
nocosolcsjrrrrr tlludiltl tltr, durill;ir'tltl 12--1'l tt lrrrrr
iiril,,err.s rl.o,ii,trvrl lJtt
tirrrrtItttItr, n1','
lrrlrr,rlir,r'rrrrryiclizclo ncvllrJgicc.lrr rrrullositrra,(ii,trrrtirol,olniil, lllrl,a.l.lt,- rrrrrkr $irr(jlrtlro
krtrl,olti[:r,l,ortlo, irro,
l;iisitttirl,t
rrilul'i,ir, rrolvulrrii{losrlinilrgil,lt1rolrloirr.l,r.t',tuprr uo lt)lC(.1
,ii,r,irlrr,r:itr rloscrilrr:ilrrlrr
rr,(il,rrt,izcl.lilgicr,,r,il, yi 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
rt,llrttili rt, lt,sinl,rrlci r.lr,trlirr,r,rr
5i l, sirrrrolrcilil cotl;tr,r,siltrcrtsirllsutrl ,.rrrrrt r. ', 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:.
rrjrljrir'rllIr, rr(.N|rrrrrlr'lrr ;rr.tlirr.t.rrl 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
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. 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
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. :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,
lctrl'0s-rr,I,'orlus dr|r"r'_?-l0 $(1(,utulc, iru pi,";.t,,",roiiiirrulsiill,,i s-1,irrs1,rr,t1r; ,,lt ruTcllc lurmd rto iil]l.,)J)r't (l.oitr il,lr'o)iirMtiv 5o/o au {ost indlrrrrrat,i
rlrrpii,. .sistoli. va'i*bilii fintre 12 qi fS s;, i'frurc{,ic crr
t1i ptirt,ic,I*il ii,1ii. 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
oilollrrtorti alo fiecilrrri bolnav. ,l j \' r' rrcl e.sorri cji polir . ) iline, dr cpt cpilr . pl jcj, ceet ic culjnor ( li
b) Oonlpr*il,jrea sirtttst.Llui cttrotitlion,dnpii cutrLun pl,eorzil,ti ; i , . r r r r r i, , l, .
:tnto,iot,,, ,'l,surla!l a1e lui.Gastaut qi Broughton (19?Z) si ale lui \-v-ayne (11)(il).
r lrrirrllln tcstmrr:l re ,ctiviirilii lcr,sl,,i irnpoitante zonc ieflexog"ui., {,) r,n:unnrzi, prrp.,tl,
.iislrLrrrrn.ile rt,Jupra,activititl,ii ti,rdiacc, a;f-.1.
lirtli
a't.ai.irlrii .sau o relatare inexactX a sirnptonr:ll,irlogiiri
.irn pallet Dolnavului $i/Sau A apar{indtorilor, poate
'lrlilrrt.e
r',rirr. trr lti.t{.(,ilzllr'i Ui lrr,liL h u {,rrriLI0
5{. poL olrLin(.lnrogisLrijTj polig|afic,.ulo urrUr.,.r,izo ,lr!gn,,s]rcX, srnco]Jctepot fj Conlundalcindeosebicu accoselr.
sirr,-r,1r;r.lr'.lnr:ri\\',.isr:i lJlk,,r rlb3l/ &u !rr.(.izati.ir,ll'..luoor.llr,r,..ju,jir izji ,.1jlr,1rti|'1
rrkinetice sau a,niotonicu, dar (in cazul coexistentci convulsiilor- toirioo-
r{') rrirtt! I r) t[,le;.i lt{,1]sinusul i carofidiAn tru prodUcenici Utl ,l,lnice) qi cu clizole upileptice grand mal. Existi-totusi ulele
lJsl $ elclncrri,rr
rr,rrrrtrnal, iu,r'ltr,rostul inclivizilor, rcrj[str, cornpres'iune i,'tluce o braclici|rlitr i,rtr(rpot fi utilc in oricntS.riledi:r,g-nosticuhri
rrr','rl(.rrtii dc sincopit.(Gastaut, 195(ii
1sub.0bdthi/;rrirrI11ilid! r.alorr.-rinilirla) 5i o scnrJero u ,1,..\, t'orfariur. 10?1, 1978 I Corfarit ;i -Popor-iciu,
19?2 ; Fopoviciu ;i'cohtr. j
: r, ll, |l rr I l:i- lalii l irloJrea jnilirli.
'l{, lll?ti) : chiar lu sincopa con.i-ulsivi,, faza tonicii Si jaza ?Ionicii Jint, rrnrlt,
Irr schimb, la bolnavii cu hippr.r,,flt.ctir-jtat c siro-corobicliani, mns*iul rrLli scurte si irrai t stonp:lte, iar dup5,epuizarealor nu se ingtalcazi, currlr,
y]]l!]^"!l"l:"1 r,r-.,steiregiuni anl,reneazi o serie de noditic5ri, rliqrt[ l, 'jlcr'rtrcJ.cale este (rlra(t:crioliciacce\rrluiiic cpil,.p.ic.l,rcsigur., irr|r.qi;.
):,:ii. lUxr(:tzlr,
irI|rr j('ille. 1957; Corfariu. 1971. 19?g; t
1_\tr.o\ urfrriu ;i'J-,,prr- 'ririlc EE(i. sf:lntla.r.tl. drI rna,iales pri,r actir jti, plec m qi iil,r.girir,,r.r:i1,,
rr' rr, 1972,.t913i.
1) fi,. nurnrli rrru,lirjcili ECri, firii mudificlri ,t-.Ei;: ll, lr{ralr.o (ln',luSr\, u lc.iarcc toDelo.rreliexogcne)ulucidr.azidiir.;rr,,sl i_
1,.) .1..r-'ortrlrult'rttl(jc, ins{Jlite dc apatilia de unde iente din bancla thet,. lrLl in marca maioritaiie a cazurilor.
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. . 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,
lrjirl(i t"l LLe1ir(.n1-2 minute. Rezulli5 ci, Ia bolnavii c. hiperreflcctivi- 1umplet5,, cu ataclri cataplectice, cu hajucinatii'hipn*gog,ir,rr ryi
lrr,i,t'r,i rru-e:.ro1idiitnJ,,comp.esiunea sinusului carotidian deteiminX, itilco- , rr lrrclizii.re,specl,iv
de sonrnp|ei na.rrjla,croii alodiagnostic. Lrar,,rc"isul ,lt, ..,,r,,i,
i.i(l)r rr,'id.liciti ca.dioiuhibitorii \i nrai pulin cu scirlor(.ib rrirrcoltlljc lI{' o dul'trti rnr,ilu_ngd,clrcurrr,,tanlo du apari1i,. crr ,,t,,r,,.
1.,-rrsirrrrii iiriorirl(..,1rr oxperionrl 'blu{.ul
'csodep.rcsorii
sin6-airial O"ntan.ai',i .lilice qi poligraficc. (inclusiv_ de-orgalizare a iomnuliri;, calcDil,rarrqoir,ri,
ir,v|l1,rtLrr';tt,' .nua,strA,
]-i.trubile (itrtre 2^qi 15 s) Di a fost faTorizat de hipcrpueoir, rli:rgriosticul(Pop-oviciu-li colab., 16?2, 19?E). Mai Oifiiil Oo rlif0lr.rr{irr,t,
Modificirite pEG sirit crependentenu nrmai de duratii, r ,iiu uneori accesulcalaTtlectir,,
|r'tr.,labilii'. *isisto- al,unci cind sun ine izolat. Acest ilccls r,lrl:r
litri, rlilr';i de uncle reactivitiili indir,'iduale,in sensul ci, la unii bohavi l,lcr'1rc5c.ctl'acIetizc;tzdpri-nll o p.rirbu\ile a boj:rartlui. c[Lo I r , I ri, .,.i Ij I j ,
irrr apii,rut unde lente biiaterale, sinerone Ei'simetrice (mai exprimatc tx) r.prerdcl'rDrulttealonuSutuimuscultr.inclusiv
rh.r'i.r'ir.liiL.&nterioar(') ,,r'i l)osluraj. logttri rlrrrrrrrli
dupa o asi"ioliedo 8 s, in schimb Ia al!,ii;io ti;Ii I atc(l[v-eJnotio_nali. lnsd, spre dcosdbirc t]e aecisul sirrrr,;rrrl,
rfll(.r,r:r..t.lU rlc l2-14 s (fobdcaunadupd hiperpnee). .de.factori
|lr runpul &taculul catap]ccLiuCOnqlieUla CStepr\TlC,1d,C.(,acu (,(,lrIt.t,ii.
(.j'|rl,riu (1971,.1978)ft.demorstrat ce dcncrvarex, ,,,rr\alid semnde dilgnosfic difercnlial. Dcalrfol, iffegislrirljlc puligr.:rIi,.,.
iprio infilrrrr{irr,
ir.rr(.i1.{.,,'ci) a siuusului r.a.oridian a coudus la suspendarei.muditicirri'r. "locttratedc::unrc-rogiccrcetatori (Elishikarva;i cotabi, 190g; Co|firli ,si.
p.ligltlic. ltr, compresiunea sinusului carotidian, in-clusiv cu o desincrlni. l'opov_i.ciu, I973; Popoviciu 9i colab., tC72, lti;g $i allii) au dcrr,,lrtrr;1,
zrrro olocl,roencefalograficd ipsilaterald,, ('ir praougrea totuSu.lurmuSculu,r.S,.Ju{cc in decurs de cilIvir, s|r.rrrrrlr.,
,;:) Maneura Yalsaloo paate induce modificd,ri ale dinamieii circul*ttirji tiind :rdeseainso{ilri de urjF.ar'ioculare ,.a in sonrllulRE,\I, Iiri rrrurljti,,rrli
ruporianl,eale alior pararnorripoligrafir.i,sprc doosebjretlr. r.J.iz:r,
l)r l cr'o$tolea_presiunii intratoracice, cu aparilia de uncle lente r,hctrt. sirrr,,r
r|rlt,rr,yxr pHG ;! ghiar cu decianqarea ile accesesincopale (Clkfi, |rLtal rn carc p_e^ inregrstrtr.ea p9]lg1afi9d apar modificdri IIOG, ,kr lll.A.,
i:rrrrrsi -traseelo
Sr6i11r,1963; Sbcrpey-Sbater,t953). ( orfariu 1lgi.l, ji?xt *j Jrlccum qi modific5ri ale activitilii EDG (untle lente ditr ut jr, ,", ,,,,,,i
t.rl;rljrr fi Popoyiciu(1C72,lgZJ),pracricinrl manerraValsaira la Uohiavi .rrrrplc),concomitcritcu pierdercacuno;l ;n1{,ilColfaIiu, JC?i, l t}7rt r'rrr..
i.'r'ju li Po"poviciu,1972, t973). 1
, 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, Cit rlespreparali ziil.ede wmn, &c(]steaau caractcre r:linice qi poliglli l.irro
rt{. Hrultr-rr thrrati, (B "rtO
-4 s), .lar {H,r[,modifici,ri EEG concomitente. .l,rr, ,'u,l'lcteristice,care lranqcl,zii diagnosticul (Oorfuiu, 19?t, .iO?Z .l,opo_
r,lrrl{r(,irizuli, colcrtilLrl nostru a r€nrarcat ue$terea T.A. cu 60_g0 n}m}lg r iciu qi colab,, 1072, 19?8). ;
Irrl'ir, drr r.rlloaloli,-injtiali. Sciiclerile T.A. in cursul manevlei valsalvrii 3. Crizek:iic cirtlcratlin ou.rsu.lq.ltutu,l,u.i,
]ll htii:n, itrs.{,ii,. r.'r.'r,i si tl.
lr\xlrru fi roac!;iikrhipertensive ap5,ruts dupX sfirqitul acestei manov:rr, 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
nr\'ir,lrrJrro('r"rl irkxxl cii aooasl,ilnrrl,ncvriiar putea infhrcnla zonele rrfhiro. 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 . .
gr,rrrlrrrrrrsrrnsilrik:, c&r'o,irr cir,zdc l igllscnsi lrilitalc,pot lcaclktna,irukxr- (i ,ri ;tl t r . |. r c1t . lr t 1, , I |iI 1I |iI ||o|I |( |r I i1,p(
t r t (j 'r r l, r , r r
i I rr . I
rr sr r ir rrI ,Il cir . r I I llu
ri(lr l,r'rrrl,r'-r crrrrlioinhibil,olio (Corlar'iu,J.f)2J., 19?,$; Oor1llIiu . .4. !r
'rriliviirlto rol rc \r' r' l l l ri ' l rl/ jlr , t ir r , r r : r lr r r r I r 'r 'j; , r , r r ,plir
zr jrr ilolr r l, lr t , r r lir , l,I iir . ii,t r it r r 1r I or r r r r
Ir llfl)(f! ioi , L!72, l!'l:J). l rt' i i i r,(t(f{r$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
it,l:l
343
,illll
 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 ttttl o l rl rtl .tl :i t t '
(N l l t' i l ' i t' l l 1' Lt' ; I ] I :I I : I t
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 ' Itl l (rl ' l l l rl l l l l l
],rr,. , , ' i, , i. u, ' i, r . r it . $ i v o rl ri l c u , ri i i ,ru i rL i rritrcrrl
t l ,ol l ,l ,o(S l rxrl rrr,rr;i trl rt' l t.t
j .9 U 5 ; I' o p o v i c i rt (i trt
r1 rr; r i, i, lu, t r Ni iU" ,u
(' v r_o r,1
r' , . 1i col rt' l r' , l 1)(i 1lI W i l l i rr' trts 1i
l ' l l ' l (i ttttrroti tLrsl ;ttl tl o
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 r
vortcllrobazilrrtir il'1it'r rrlui rlhrs Ll ru1'rrIitt
,",ll'.,-ii*'u..i"l,tt-ir,s,iiiclcri1,1,
.,'i " i' ii' iii" , ' li" t io. ' i n o ,i u 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 , r , if i' " i" , t f . f " - l. rl ,e l rro -l ra z i l rr' , a p a ,' p i ttrrr:gi sltrrti l o l ' l l ' l (; :ttl i vi i j i (l
-tl(,
;;:";;:;'i.'lt; '- iegirinilorr,Lcrioitr'(', llp Ftlil).\ ili lIllA, !t,"llllll]];il1
l' (1inc Ldlul ill:r(lllllll
-iiocirr: c{'put, cunllllrdil,cll urrdt.Lr llli
.r ((,Lrl)..ltitU)'
.;" ,;;;;il ,I,tr a.l actslur g.ir'lo{l"rIr.ute .stc rlilt'til'
i."t,, t ilo :r,pari1i,:
ac es f e anoD] ; r lii l: l. l( l lpJ l l n t t 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 (TULIIUIIARI
PSIHOOROANICE
TULBURARI
,r, t ,.rzu l'sin uu pci
cnrdirr,r,,respo;tiv ilupri prir,trugireaT' d., IE'. OIIGANI(;)
CUSUBSTRAT
DE CONSTIINTA

I. Con;tiin!g este forma cea mai inalti, de teflectare subicc

tir.i, a lumii obiectiye (Dic{ionar enciclopeilicvo1. 1' 1962). Ea cuprirrrLr
cunoa;terea propriului 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
iau p&fte toate structurile cerebrale, unele fiind de bazi, cuttt tiitrl : cut
texu1, nucleii bazali qi trunchiul cerobral, Conqtiinla reprezint5, ult pr'o( (\H
complex anatomic, fiziologic $i psihic.
1r. Tulbur5,rile psihoorganice sint de diferite gracle, in lnnol,irr rlrr
sediul leziunii.
5. Orice leziune circumsclisi sau difuzii, a creierului poatc dol,ot'trtirur,
tulburiri psihoorganice. Tulburii,rile de conqtiin!5, datoritri hrziurriLu'
cerebrale pot fi grupate in tulburd'ri rle conqtiin!5,specifice localizir,t'ii, liiirrrl
rlate de leziuni circumscdse, incit in clinicX aceste tulburlri siul, iirkrsil,rr
ca simptome pentru iliagnosticul tle localizaro (moria, ,,antriebsnulttgr'1",
sindromul Gertsmann, agnozia spalialE etc.) qi tulburii,ri psihicc gk-rbllo,
oind leziunea este intinsi,, tabloul clinic fiind totu;i specific in rrpor'l, orr
loziu nile etajelor encofalnlui intcrcsato.
I)csif{ur aftsto luzirrrri difuzo, pe lingit, cri, dau tulburlr,r'ipsihico rrrr
<,:llaotclclinio llirrr,rlrrfinit,, poi, itrclurkrli.SIi-4.4, alc ciinri tulbulr1ri vol rlrr,
irr plrrrrplirr trrrrlificttrrillulbuli,r'ii do cunrllioufil,l)itr u,r,rrsio
o corrrporurr rl,r'1,
rrr0t,iv0,:l,Pnrrr,Prr trr urrcrri
1o(,irr,rtlot'ii i1 rlroIi, trtllltrt'ir,torl0 c0n,;1,i0nlir,trr'irr0
trjrrrlnrl tlr'$lrr(ltrir,ci1,olt,rt lol,it,lii rirxl lozirttr,:r,r,rt
trrllrrrrirtrrtrrrvt'rt,xinli[

34t'
 T

itt l,rrrtrcltittl otrtrrbtill(trotrrii),sirrii rrNlrtpttt'tilllli',tllltri,Itzitlttttlt,

trt'rtsilttlt,fii t). l rrrzi tttl i r lilt t r 0
(''rlrlll/i', il,ili tt. N i ttrl toa, r r r rr lt l, o r lo I ozit r r r r J l. liigirlil,rr,l,rrrr,
rlrrrrr,rr r[rlu,l,ir,
rlrrlrsrrpll, tnozottco{illulttilit,sl[olittcif ittglttlllt'sottttrttltrll(ii,' lf. Ililxrlkirltzic ol Irgotrrrr
Irr,{irr1rr l,rrIbulrit'ilolrrlr{ialr dc cot16tiicrL{,ii. itt t'llriill,o cl,lr,.io.
Arlrsl; pundr do votlcro nu trste coloctr dtxlattrctl1,ullrur'ilt ilo slts-l)l(tl-
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,, lIJ.l. SINDIIOAMII
I)A1'I{I)I' I,,IIZII]NII.,TI
DIN PARTIJA
rn:r,jolir,fiintl insi, tulburarca de conry1;iinlrri, SUPIIRIOAITT
Irrrr'|,ici1rir,r'ul, A TIIUNCIIIULUCEREBRAL
Arrrsto sintlroarnc sint foarte elocvente in lcziunilc traurnatioe cr'ruii(l
(|r('olirliccgrirvc or,rc sc Iemit. Cind bolnavul iesc din comL, leziuuilc siltl,

f#fjdjs?i','"',g;l#,i,|Uq*'ih"""?,1,,:'^1';"""J
irr cnrislirrele cerebrale pinii in regiunea mezotlienccfalici''
loziunea din intreg creierul este pini, ileasupra capi,tului rostral
I )u,<fr,
rrl Llrrnchiului corobral per;iapetluctal duce la instalarea unui muti$ur
lkirrrrtic sau h, sindromul de d.ezaterentarc.
I)l,cii leziunca r5,nline cantonati, in emisferele cerebrs,Iepini l:r zona
it$li;
;llil"';#l?'"1""J"?Iit:#;,t*$it*f":ih
rrrczorIienccfalioS, apare,,staroa yegetativ5,".
+j+1:;-*e*aH##tH*.;q",XT r,',',flt
Jl,iiij
I)rcL lcziunile de intensitate variati, sinii cantonate in emisferolo
r,r'r'ollale, inclusiv nucleii bazali dau sindromul cliencefalic.
G, I)acii, Icziunea este in totalitatea, cortexului' in general provoacil
g:*#ri"*i}!"'','ffi:ffi;iq'*w
ill"{*l"
o rl'ru'e tle agitalie, cu iusomnie, confuzie agitat5, sau anxioasS,rpdn fa,ptuI
lri, iul,rca,gaactivitate rdmine sub controlul nucleilor bazali Dial trunchiultti It'"t'T"'*vniyll:l1lt*tirtlxktti+
,lolollral,
;\dcseori, in diferite afecliuni, procese infeclioase' procese itrlocuitoaro yil,}*:_Tf*}:rd:F:diiFirml
llH*l"{ifl
:ffi:*i"",Tffi
rlo spu,fiu, traumatisme cranio-cerebrale etc., leziunile inte,reseazd,toal,tJ
cclr t,roi ctaje ale encefalului - cortex, nuclei bazali, tr"unchi cerebral -
1ap{;rarrr du"cela realizarea unor sindro'ame combina,tA lsiniiromui apalic),
iffst$i iJ"tii*#l'?*1",1?J**T]]H',1n
l)rrcori, intr-un sindrom pot fi implicate tliferite etaje separat (hiperkinezio Ilutismul akinetic se cr
r,rr Iogorcc, rigiditate decerebrati,).
I),r1,orii,i,legii biologice, structurile anatomice cit qi funcliile cerebralo
ffH:lli;;ffi*#'1#x"""t"ff
ri?"J ;';ii1;,;'
l'"*"-ii:{{J:t:*i13ft';';;1
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 i;"!l"q.'":t.rH*idih*r,"r'*l f;-
irrcii,rrrr 1,imp dupf revenirea integralS a celorlalte funclii (surdomutitattl'
rirrllornul vogelativ prefrontal tiescris tie Ttinnis).
ItiNliitrrr][r,i ios aceste sindroatne
i',fi*{i;"##"";;r;;:f#1,"jt#*fitl*i:,":j:t
Sindrotmclc generate de lcziuni Ia iliverso niveluri ale creierului t3l;llJ#d"f#rr:f
:d{i{Fii}-lilih'tii-i"""""
/1. l,czi[ni situats in partea supc- t1. lfutismul akinetic
'12. Sindromul de dczafectare
lttliH"txt'.'ji.T#iiil",iljtril?i:'.*,?
'iJill;iif!it?,1!![i:l'i"
firi'{ft
ri{)r,r'ir,a trunchiului cerebral

in nuclcii bazali
ll. l/{!z.iunisiLtla'hc
[3. Starea yegetativi persistent?t

Ii
dup5, leziuni cerebrale
Sindromul dienccfalic rr"ffi+e$*t}"m;at{[1
f*{ilfr;;grig+;:;;f4';:{'fl
f *;1
t;: Sindrornul Korsakorv
Sindromul Kliiver-J3ucy };;if
iiji'}:b'dr'"arii
{1. Loziurri sil,uir1,o
in coltex
t; R,igiditatm clc decorticalc
Surdo rutita,tca
Siridrorrrulvcgctativprcfnrrrltl H,:t{il:#if,iir**irH"Jid,r
lf:
(Tatnnis)
A1;ita!ir
Arrrttozin l)o$1,1,t'lulrrtl,i(rir
-t1ff ir1
lrLr{11*r[t'iil1i1,fl1
,liri"l*ioiii*
Sintlrorrttrl rt,prr,lio ili'.liillll,ll,lll:l'llliii:tl,,"ii,,ll,f,:l,i;llllli,ll
i;liik,w:ilii:li;$*li*llT
:t4(l
.)1,
 F
rji rrlllliHllrlllltol,(lrrfil'
illll)t'(lsilr sil'llil(r(l(1llr(rlr('i',
(l(rill(x)llijli{rl11il' rkr;tilxrlrrrt'vii (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
iirrl, pctlrtl''crtttill,iottfi. I'irrrltrit ll',
rrort,sl irrtttilil';i rkr a'llii (Ort,itrrs qi trol. 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
ll).1l; lll{i!; Skrr1l,01,y, 1f}(is; $dn)i'i, iii (r)1. .ll)(i5 Ifrlyattrl - lltttrrt,T,tl I Itrttl t: sttpl i nr r lllr , lr slr , r rr , lr ilr r r r r r lilr r r : r lllr , rrrrrrrI Ir I i I i I .i I I ri Irr ir r sr i,lir sl ir r r r r lii
liissirl l..irrol., l1)(i{))(,slo cit oxislit,vit,rir[1,ii l,ir,(clriirr
do lit, thitxrzirt ir(lovit,r'ir t i zrl r,l i , a,rrr lilivi silr r nooicclll, r vr ,
1r:rlrrlizicitr sottsulor(lirlr,r al otrvinliului) ;i rmrtisn (sart tloilt l,Ionitr)IItri . ' l opogr' : r , t ia1i inlinr kt r it r r Lt
, zir r nilol nu llr r pr r lr r l,licr r r r r r l i{r r r lir r csir r lr ilill
ir Lrrlbrrlanrolalil tle corr;liinlii, (sau doar u$oa'r'ii, hipolsolnnio situ obnLbi- 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
lrrrr,) pi rri, la,o sirnpli'l apatie generalizati, cu reactivitat'c bun:i h exoita,lrli. I.zittIri neocolticale. So cilea,zii cazuri crr lozirrrii t,rt..nsit'ir srrlr..r.i i.irlr,,
{ l(ilrx;lirilc rroa,slrfa iln mai ari-rtat c5,,de ceic mai multo ori, dupai,o 1u ir, rllrr cu crulat'oa structurilor. trunchiului cetr:ltlll si inr,crs rrr lr,:rinrri
lrrlrr,lrrl'qi I{cmpcr qi liomanul (196?), XIA (in folma clasici rlesclisil,rltr rlc lrunchi sau cu r:xtinse zone isr.hcrrtice tut iii,Lile s;r,u srrlxurr,l,it.rr,lr,.
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"
i,orr1iiin1,L(prin" leziunea ialoi,ei pontine qi/ sau .mezencefb,lice, atinginrl
s RAA ) . 13.2.SINDROAME
DATEDE LEZIUNIIN NUCLEIIBAZALI

Sindrornul de dezelerenlare (sindromul'oloked'in") Sindromul diencefalic

Af octarea ci,ilor cortico-spinale qi cortico-bulbare printr-un mmolis-
rrtorl; localizat in piciorul piotuberanlei (I{emper qi Romanul, 1967), Se earacterizeazX prin tulburS,r'i rle constiintf cle intensit:r,l,o r.:rlirrl,ji,
rlncind la tetraplegfu qi afonie, determind, o stlrtdo imobilitate com-pletf ci.n'econsl,au intr-o sta,re de apai,ie, lolpoare, obnubilaro, soIIll(t (,1{i'i,
rr,lrolrulvului Eiin;apicitatea iui de a se exprima I'erbnl sau gestual. Ta- 'il Ipoirre-Rcspirr(ia e\te de !ip Cheyne-stbkescau t'espirrlir,.rr Iit r rr.*,,ri
hlrrrl ciinic p6ate sugera o stare de mutism akinetic. Spre tleosebire dtr I r1'ttrgulat,", rnllerullt uncorr de pauze scurte, pupile mici, rtrilr,tivrrlll, lU
rrll,irlul sindi'om, car-acterizat pritr tulburi,ri mari in sfera- p€rceptq?lr,r r nrr;.lellexul cilio-spjntl este conservat, miqci,rile reflexe rlo gl0lriloI
irr sirllrornul de dezelerentare perceplia nu este altera,ta, bolnavii fiintl {r'uralr ln plan orlzontal slnt con$ervate,insi, uneori rnotilitate r,r:lltrrii
rrtiorL{,a,1,i tsmporo-spatial, putind face calculor a$a cum a ar5,tat-o (]onouni' rxrular5 rrerticall este.IimitatS sau abo]it;, (comprimarea rcgiulii
l)t.ol,(r,
,.,,1,,,1,j11 irin iiteim;diul cotlirii miqclrilor ]or oeulare. fale) ; existS, reflex oculocefalogir (in lezidnile'de ironticrtii rIitrrr|r,IrrIo
"i rrrczencefalici), deriere ronjugatd, a capului qi ochilor, ten0rnt,lrrrIrlrr
Sttrea vcgclalivd persistentl dupi leziuni eercbmle. Jannett (1972) ,.r.nr dc prpu$i,'. rinooli der it,re Ienti ti porsistenti a glolrilrrl rx,ul:rlr.
rlcsrrlit: sindroinul tle ftaro vegetativX, persistent5 in motlul urm5,tor : So noteazi, semne de suferinta, pir*midal5 ditatcrali, (I3::r,blnsltihilrr,l('r.rr,l
).
I)upii o perioadS, tle comi profuldS' de" reguli, cu-ItaJiate grade do Ibt fi evidenliate o rci,istenjii, ^muscularii, tle l,ip paiitor,fu rrrr r,,ll,Ji
,1,.ftpucarefortatA.;iD abscnla unui deticit rnoloi ri.eqtclnorliii{,riIip,rt Ii .\i
Ii,spunsirri eftensoare (rigitlitate prin decerebrare sau prin decortlcare)r.cu
o rlrrratii do o snptimini, sau mai mult' supravieluitorii i!-cep.s5,deschidit l,ihter:!le. Pot erista diskinezii. Tulburi,rile vegetative sint abscrrtr,.
-numai ca o reaclie la stirnuli rlureroqi. Ulterior bolnavu I .par(,iall
ochii la, inceptt ._Sttpoar_ea.**" *oilnoi&1" reprezinti, u p,ig_rdere a t,ir$l,l rl
rrrorrl,ine periodic ochii deschisi, chiar in absenla oricirui stimul qi pa,re a sit'ilor la solicil,5rile mediului inconjurilor, iii starea-tle colt$liitrlii r)Hlrt
rrlrrr:'ili ci privirea, dar firX:r, fi atent, apoi recade intr-un somn apalen-1'. rrtectati, r.ra,i rnult sau mai pulin. precurn d,ratii,denumjlile iu;_rirr,rrt,io
\rr poir,lc ii insrl r:orbr de un real ril,m lcghe - somn. fn perioadcle drr rirte. pacientul prezinti o stare de somnolenli, mai mat,e sa,urnti rrrir.ir,
:L||i|tIIrIi'Lstlte rle tcghe nu exisli ldspuns de apdtare ptin ocluziepalpc- elrr lr
'.)ic aln sau ..hlat,.uncori. cpontan (dupn gl,a(lulslrrlrrlji) rr. l|r.
lrirrLil:L:rnrcuitrtalc.in unele cazuri i:.i;,1dmilcdl'i sponlanealc globilol' z' rl' . l urbe:lo, (lA riispulrsuriader.rat. compl"ie,lncornpl,.tridinl tiurli\ r.,
olrrlrr,ri,tlind impre$a ce bolnivul urrnire$ro cu privjrea un obiecl c:rttt (,,,r'ece a}e ne\-orc, mill]rnci, singur sau rlacd,i se di, sL rniirrirr<:o
l|r'rroil.loule tlr'sr.lridc I rlr.rrrrr
sr, ,1,'pllscrt'zr-r' in-cirnpul si,u vizual, dar nu se poate afirma cA este vorb{[ ochii, str (eara Si.$i fa(,i ncccsili{ile, rrrrr.rrIi rrri;r.:r,
,1,.r' iirrrrr:ltlu aleulie. In alle cirzuria1larchiar lnj[cEri cert r. rrll(. Sponlrn. cbtrr potte urubla; [ulcqiile vi[lt,lcrjlt Lrlrrrr,. Sr.r,lrtlr,.t,.
-cooralonah!t
.r rlr.csr,rrrtrlu de scilpibtle sau de adueetua miinii spre locul de oxcibattt rizprtzi, printr-o. mai iltensi, cr.g;t-glqa plairurilor s€lzoriale, cilrt arrr rlrr,pl
rr,,r'i,rr.1rlivii. Cx toate ci, cxcitarea nociceptivS,poate d€termina fie Yi$cAri r|rrrrt: o recepl,ieintilziai,i, qi inadecYatd,o lentoal,esi o tllfi<:trl1,|ltrr rlr,s
fic trismus sau grimase, bolnavul nu emite nici un ele}u-orl,
rlr,,n rrr,il,i<lr,{,ic ii.-ttririi 1rror..esalot tsociatire, Bolnrr ul c.tr. lpllir, r,iitrrrtrrlr.r,rr irrlirzrclr.
vclbrll irrt,cligibil, ci cel rnult'- sunetb artic-ulate' Starca de constiinf il' l:r itrlrr,biri. pr'in rri.punsuri vagi. apluxirnriir,,, irroirrpl,.tr.
1i, rlr, ,,,,1r.
liirrrirxr rloci frofuncl alteri],1jI,bolnalul ri,mine inapt de. orice comunicall)t r,rrairnulte ori, lipsite de sens.
-lltpori (,s1e,\ornn;leut, tlr'zurirrnill,;i corr
rrrr illr nioi ri leaclie aalaptivil, la mediu, nu este leceptiv la nici un lltxl Itz,. Evocaro:, ar'nczi(ii so efc(.tucazir,rliii,.il, rr't,rrri liirrrl irtrlrrisilrilri.
irrirnnill,iv. J)in punct dd vedere legetat'iv, funcliite sint conserYate,du'r llr'lrrrr,vnl cst c..lI;r11i1tsihiu ;i.lnitdikinetic, sc or.iirrrl,cl,zL ilifioil si irrr,'rrr1rIr,|,
slirrrrrlii nocicepLivi puternioi pot inducc rcacl,ii vogotative auortnalo-,ltt tr {l}t(ill .i .li'ri irrlir'rrrrrIii si irtr.s:r.lcrlr.sIr.r,lr',lr'itr *r P,.r,.,,r:rrri.
rpocirrl t'cspilafrrrii. Strlrca vogetzllivf potrl,cpol'sisi2r,lim1lloarlje inclclutt" l,rt int,ila,{,ii rrritilc;x,lrrlir!i lllti'rrli
irlr,lrfir.,lrolrlrvrrlir,r,rli.trri.zcrrla, riurirrrllllr
g1,1,6i, ovr',irtuu,l, sopo&l,o1lcurr2utdrtizaa,lil,l,irnp tlit; bolnavrtl stlpl'2l\'iolrt' l,r'(\rizi. rii t'iirliI:r'|r'.
Il.lh'rrtl rlr.r.lilrit l:r rrrrLr.rriir{*r,.si r',rlloxrtl.o|rr.irrr
r{rft,r), ;rittl lttcz,r'tttr,.lirlrrrrvrrj lrr lrrrir,lrr IrIi rrIrrrr|,Ir,, illl r,litr,l,i,r,ll Irrrrr:(iorrr,ir,zii,
'l't'rt,soclo I,)li(i a,rrttl i[l,iL1', t'tl lxlittsr' 1i gt:t,vtrltrzittltiIttttl
itl t'ltr-ttriltt rlr,..rtbirrrri ttottrtrr,l,l.llu;Jgati);t r\sls rrllriytr,lslrli, (11 (,oglir,Vigilr\, llr,rrrr.rr
totl'ictlo, ttll 1,l'ilsoll1-rll11, slr,ti lirtrp tltr tttlti trtttlltr sirlriiitrritti
iz.r,lr,cl,tir', rrliliz:ll,tl. ilrtirrr.iiI'r,rrrrr.r,zi.
l)rr,r,tr,plr.it,trlrrl \,rl,lr, lr\ 4i trrr ltr,
'lt 'illDrtrrrlr,
(t4lr
it4rl
,{il
 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 ,
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 . ' 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 |,
, . 1r. rt r l.t (l ..1:r1 1'r"' llillz i\ . ' . s i t lt l ( l' s i ll|r t r ll l . . ' , '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
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
rlr'{l:r ' lr r l l, * t , it ' ' r t llr t t r z i" ': r t t : t r I . t I r t 't I r ' s . r r r r r 'l " r r l : i '
Jriiti,,,l,',' ' i' l
, slc tlatir,t1c troitrtcrosltrclplrr'lirrJii
r,i,, 1,,'ip,,,'tr'.,
,,1,rr,,f,ii,i':,., rr'trlf(11('il1rr
,t ll\'l't,t Irti l,liztUNt ( j()tt'i,l(
l,rr,z,rtli: r)iscotrlil rtti,Prr'(i"lt1rl(lN(loilI (r:i'(lilr
i'"1,ctnotLcr':r'til,
sotrtttttlllrrl,rt
l:t.;i.sitfril)tioAi\' tAl,t,l
,,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 lligiditallt prin docorlicarc
i i ,,i ,i . , . , , , . i, , r i" 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
" , r
ii',iiiiirl*liri,"lt,.i" sc,[t6.c:l ilifilr,tirli, ir'liltlcttiiri ;i ruptiof. Stalcr tltr Eindrornll r'1c rlecorl,icare ale u}tuitoalele ea,r.l:ld,t'r'is1ir.i :
i,f,i,ili" ,r"*in intro craqierri :t, prrlgul ilur srnzorjirle oLr r) dirrinuaic ir'
groutabe 'li.ctr -- r'igi{litate in elterrsie :,r c:}pillui li trnnclliului, ile jtil,rrrrsilrrlrr
rrro-
rr,rsilrilit,ir,lilol rlc leccDtrie (care s6 rdalizeazi ilu oarecare ( l r't'l l i l
i,,i,,"i'ri.'I,rrAiiitotiiii tn*rti"tin"' preculn ;i cu dirnintarcr stplelei ;i r.r'
;
postrrX, a, membrelor tuperioare cu contraetulii in fle_rirrrrr:r irr
.'""''.1'i;1;ll.ilj;'hi l rrlor sr€inentelol cu pt'cdominanlii a celor dista,le;
bolnav'l
,''ai a":'certrltit'i,'
!i'trLl lr osteo somnolerrti' ('cLl Lin(1}ri - Iostuli a,rnembrelor infe.lioayecu conlracturi, in cxlorrsir,,r'ol:r,li,,,
,r ,', ,,ilin,,lr, itu1.=i,r"t"5tn lrstiLnuli' r'orbr'.i+ttuci)rirr{'cl'u'
jn nuolclt Uazllt' irrl elnii gi l1cxie planta,t:i.
ir. rrrrrrr,.voic; l,'zitttrilpsini lrilaleralc
.st'iiru,itnn.t" gi:;uO,,t ITI (obnubilalct cslc r) nonrnnl{'nli.ploturtdi' . fi,rotnencle.de rigitlitlte sint rrrai p[!in sau tleloc inl]uorrt;rll! rl0
,
:rrrrrr:i,rrr.'t:onlin'li I pacieotrtl Jbia risfundc l2 11nila1ii fi rnlleburl' l:lleorl l[||rlJt noch,-pljri qau rle a]t 1i,1.
.,i ,il"i..t. ri ";;;;i-,r; lt'z!ttncr e'lie in nttclcii brzrli 1i irt bipotalrmut - rellexul llagnus-rle l{leijn poate fi pns in e.r'irlerr{r'rI
tt'
;,',;,i;i'l';c.l;r;; r'c"tlrlui crcicr"ului; t|irn' birrl ctr"lrrrl csie ittdtt - semne de piramidalitate bilatemli,.
intilneqte in' im,umatismelc crl'trio -oelcblale glave'-.iin
Strtloarea sc - alterarea accentuat5 a stfrii de conqtiinti, dar nu r:onli |rrrrr rLr,
r', t"ii,r '"ot"'J" ,ne.ri.*r& fi"tix irr comil) sau in foruele {rarc se al11elio- rrrlilnesle in rigiclitatea prin dccttebt *re, ;i :r,socialii,
"
; :,;; i, i",l in.. ,iio in cn 'e[:rlit' .'i pro'es":\P:rnsi''rt'in'tr' t:'nir:ne cu pcrt,ulbiili vr.ril
"o,n;1.
: in cole cc cumrvirni inrlirc('t dioncefrlrtl' ll|ive ma.i pulin ample sau in unele cazuri chiar absenle.
, r"",,,,t.iJ io.tlir*t" )ii
prog-
I'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- Snrdomulilatea
'',',tr'i,,iti-,r*i"'t
I i(,r
' ll {.ltc er'3\.
''(i;;fJ*".,=1c
o .'frrc psihicir, clati dc o leziune a cmisfclc'lor corcbralc nfai. pulin
_{reclent ini,ilniti, dup[ tlaumal,isme grtlve, rtir,r,lr)jrlr\
ri'i;a'lc sint -
rrpirrrca,-chiar
',, ,,;iil;;;;;t;; parrtial[, ii insularit, n diencefalului; {rLnctiile ('r
qi dup:i.cele u$oarre:bolna,Tulqi-a rcvenit iornlilt,i, rlrr,i,r,r,,,
I'rur('.t)ttrionlrrlt,uar" i"si ir''lrt-ilc 'oelPrrl 'e tico.clri 1r,r'risli"o itlutitnte timp de 1-2 slpti,mini, fXfX,alte sirrrpLonrr,rrrrulo
,,, ,f:u'- .i',fi "h'lt"ii,rLit"
innLlc'v:l.l'; uueqli ostt r'hirl prrliu ticlini'{il' I'gicp_p:rntai61.c. A{-c|LSlii rnanifestarceste clator.iti procesrihtirlrr irrlrilrili.
: 1. , {il, l,1 t .
'i"pito.uri stLpralimintrrii a zorLelorcelor r:rai noi apifltte pe scari, onl,o- gi filogr.rrrrlirirr.,
Itolvcin inclutle torpozrrea' stlllJ{rlrr''t-]i oblu]rihre:r i[tr-ur] singnr t ouforln legilor biotrogicecare au demonstrat ci, structurito :r,rrriorrrir,i,,r
r^r',",,u', ,,io""!olaie a cinrytiinlef"'(,,1'loucliirg of r'olscciousuess" )' Ittnc{iilelor revin cu aiit mai tardil', cu cit sint de :rchizi1i,, ;rrri rr,,.,.rrlrr

Sindrornul Korsakol" -rinrlromul vegetativ profrontal (Tiinnis)

|';\||.1|onIi|''Ier.iinir'."-laloIogi..ibincrIofinit:r.l'cz''].''r'ldin:rq,.!{'iotc}
,1,, ,ririiiL..tffiii neurologice'dc tii polinerritic cu manitostilri psihicc'
in . ln partca supclioari, a ariei premotorii existri, o zolir \,(,11.( 1tiI I r\ :r r u
trtl de a, legla teasiunea ar1,t,r.iull-u ;i pulsul. Sindlonrrl irr)llt,irur trr,z:rrtrl
clr'r tltttrtitlit, &mnezia antcrogradJ, confabulalin' dt'zorientarca' rr,.t.r.lriljlo:r
"'i bclrt,rrrlui ,lupR difcr'iicpnc,.iulilo ,i rrui :,li.s lt.injtr:l,t r.rrl
lJrrrliul lcziunilor dominantc este mezencefalo-dicncetaUc' , r'rllr,)roleltlulc: ptcir.trl,ulOste to]nplct rtrstabjlit norrulklgi0 prrilrrr,
1i
iu: marea {llr })ersisti.ui}c1t:tnllturS.ricardio-vasculalo.l-,a,cicntulI:rr,cri lri;rrrl.i*irrrr,,
lrr cliolottic, factoml dominant esto toxioo-metabolict
Alt.
,,,,ul,,llir,,t"','r'-7"r.Lrrjlor' t'onrlit,iiotinlogico sttrvitr,intt o rrtiutrlilltt: r'1rrria,lti,si o taliica,rdieaturrci ti'i[ isi sr.]irrrLi,lozifiir rlirr ilrr,,rrlriirrr
()11{)s1.:rlisln.
ii,, l,iil,,ri ri rt"i-tl,r riaturi, turno'al;i (tt*roL i tle uutJei brz2r1i,rnetastazc' ,l(iesto tulb lli.li sirrl r.Liilr'lrrirlr.rlr irirrtr rlc l)t.olirr,rlr. rrr
t.r l,,,r,rrikra,rno),infectrioasil,, l'asculatit' slu t'r'atn af ic;" ri rrbilircl (iollllt,lcs(.('lt
l (]i.

sitttlrtrtttttl Klii lc r - lNt t t ' r lUil lirr

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 \ 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 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
l t i 1 'r x 'r r t r r l 't t l t l l ( l l i l ' {'o i l r l l l
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 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 .
il\ r ( { lt ( } rt
1 ' l l t t t l rl t l r ' : r'
lrti A rtrtrtritr, rrtirtlilc r t t l lr ' t r r igt llllillr t ) ;

;i l ' I
:lti0
 A rnnoziikr posttrnutnll,irttl
I vcgrrilrIivii.Ntt lrixlri nr'r rl lrlr rlrr lltt,r'(irrlrr rrrcrlirrliurrlriiutl,,lrr rrrorl
(jotrsfil;ttic urtttl tlinl,rc oelo rnai cornunofcnornone alc ctcoltlor ttitu-
rrlrlictr rurrr'lrrille- iltit lt:cento cit si tardive --- indifotcnt de inl,onsitltcit
I r';r,rt
rnlll,isrnttItri.
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 rotros-
lxxrtiv,
' rlupii ce bolnavul gi-a redobintlit un suficient nivel de_conftien!5.
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 compo-
norrto ((lcrBtonbrilndt, 190?) :
rr') r\ltiora,roa sttrnii de ritttrqtiini';i,estc intt'-o oaroo:lle milstlril asemi-
ctt crla tlin mtrtisrnul zr,kiletic. JJohllvLtl rnott{,itreoohii deschitsi,
rrii,l,olr,irr
rllr lru rrnntr,rc6toott ptivirel, rtu ,r,torcfl(rxlll do clipirc ltr u,m(rlinhrot
rrrr rut roJlo-rpll,lpoht'r,i.Ntt ntr ttbsorvii'ttitti o lrra,c{;io cnlo{ionlllil tliforrtrt-
('irr,l11,
oi rrrtrrtu,itttrt'lo Ptlutt{lttotttoiion {lo lltll'llril,
n,lorrrilto sint, ttttslxrcifirrtr,
JI'I'
Itcct'r'ttl,r'rislii o ;rltlttrllrlr, rr,r'rlrrrrrlrtr tr-vogitr,,r,rr f,r,urltrpr,rioilrlr,
r.iorrr
tlttt cgltc (ll .l otr') lrllllrrrrrrlr tr lrrrrgilrlt iolrrlc(l(!sornr, rlil llrrrl lroltritvrrl
lxla r li l,t rrzil plin rlilrrrtli rror.irur1rI,ir,i.
b) Ilonomottolol)oHlurill(!, r.irrrrcorrsl.aLl irr Ucxiolr rrrrrrrrIr.r,
irr 1tozi1il,
so poakf lrr.r,orrlrrrllr, sclritnbtlet, pl,sir.l.'i,
Ior'. :\colt,sl,lt, 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,
Simptouratologia., corcbr':r,lir, plozcnl,l1,L, ca,ro ostc ll,it tle d ivtrrxr\,,rrrr
poa,tofi ()xpli(llr,l;ir, dtxrit plin irrl ticrlruil loziontlfl ooutxrrnil,unl,r'l {i in pltr-
j)orl,ii v:l,Ll,hil)ir, q.lol rl0rrL Nisl,r!rno (lo l{! :r,r11:rg()trlHl,rr
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,,
$-ill'l)ltl,rtb(,xl)li(,r!l)rifl rrrIrrriIrrlr,rr,
trrrrrilrrzittrtiil xlxlurrrrrlUi trrlicttltrrinhi
r'il r,rilrlil (1|rrnlrlr' Ir'r,Firrrro
llil,(llrrllll(ll'llhti r,rrrllrrllprilllrlrrnr,l, Ir,rrr1ror.:r|,
JUJ
 ?
rllurf(xllrl)r'inlirl,t'tttrcltiul grtspittg-
otrrrlrtillrIrr,1tdolttrlit lii plin lroz(rlll,il,
rr.l'lrrr rrlui tltt Drrrttr:tinsiltlttr:tlii.
irr cunclu)ic, tablloul urrui bolnav cu logorec ryi hipcrl<inezi.ociittr
rrlrrriitorul : pacicntul prezinti, o dolinfi sau un irnpuls irezistibil ;i aproalxr
rorrl,irrnrr spi'e acfiune, miqcare ,sivorbire cu : a) logoreer.cre$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) coe- I}IB LIOGR A FIE
rr,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, $i tie fenomenul
rlr, hipcrtensiune intracrania,nl, in cazul proceselor e{pansil'e; hipermle- ,{arli J. A.- AcLa Neurol. Scand.} 19ti9, 45, 484-492,
zi,, (cu r.xagcraroa cvocS,r'i1or,care deYin tnmultuoascr intempestive qi A b e r f c l d D . C ,, N a m b a 'I. - Ar ch . N e u o l ., 1 9 6 C , 2 0 ,2 5 3 - 2 5 tr .
r'.r,lriil,.),cxagelareil atcnliei, u reflexului de orienl;are, logoreea, mobilitate i!juriaguerra J., B1ar!c C.- Le rhinenciphaledansI'organisalion cirlltrule.I'hysink4llt
siini, critic ascu-tit,somn foarte pulin (2--3 nre din 24)r jud.ecatd
,.rrrr,.r',r,tri, et palhologie du inencaplrcle,Xtasson ct Cic, Parjs, 1961, :97-3iJ2.
;ri lr iunamcnt- nortn:tle sau deteriorate dupX gratlul ;i localizarea leziuni.i A j u r i a g u o r l n J,, Ti sso t R . - En cycl o p 6 d i cm 6 d ,- ch i r ,, 1 9 6 3 , 1 ? 0 3 G 1 r r ,tt, I 1 l
{ir)ttrl)raLc, -\ j o r l a g u e r r e J., :I' i s s ot R. - EnciclopidiemCdi@-chirurticale,1004, sllj)I'|. .t,
1 ? 0 3 6 .d r o , 1 - o
lliridital€a nrin dt'ccrebrarc ,\laiouanine Th ,, Om b l e d a n e A., D u r a n d M .- L c sg n d r cm ed c kt d l sl n l l u tl
SintLomtl de rigirlitate prin dccerebrare, sub dileritele sale Yarianto lian phont!iquc tlans I ophosi{, tlasson {L Cie, Prlis, 1930.
r,i irr rliiirritclc ettpe posttraurnatic,€r survino cu o incidentl relativ mare, Alajouanine Th ., L e b e a u J., Il o u d a r t R .- R e v. N .- e u r o l1.,$ 4 B,3 a l ,:]:a l :t:t/
r':r'r'iirrrlintt'e t1lroximalir J00'o d;n cazuri in sPria,noasrr; ;i a proapr-r 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,
.t0,1,(tin oazuriin atte serii (Bricolo qi coi'' 19?7), Deoareceun sindrom 4,i, 158-330; 29F330.
rlo'r irriditate prin decerebrare poate surloni imediat post-impact sau in 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 tr .. l t,\'.
,,llsrr[ unui sindrom de agravare, incidenla cstc in furrclir; nu numai de Neurol,, 1956, 9t, 357*373.
Lrcrlliz.areasi,gravitatea leziunilor, oi. qi de promptitudinea qi eficienla Alajouanine 'f h ., Sa l r o u r a u d O.* En ctp h a l e ,1 9 6 q 3 , 5 5 - - 1 0 1 .
rrliruclrL misuii tera,peutice' -A.cest€asint, in ordinea priorit5,lii, antihipo- Alajouanine t h ., L h e r m i tte Ir ., l - e d o u x R cn a u d D ., Vi g n o l r l L . A.
ri,.r,, rr,rrtieclenraioase qi chilurgicale in cazurile in care se reveleazd, un Bev. Neu!oI., 19134,110, 5-20.
rrro(i(lscxDansiY intracrania,n. .\lbe-Fes!iard D ., Il e sse O.* J. Ph ysi o l ,, 1 9 5 3 ,4 i , 1 6 - 2 9 .
' Sinrli'omul clinic. Sindroruul de rigiditate prin decerebrare poate s;J l\leksic S , N ., Bu d zi l o vi ch G. i {,, L i e b e }n }a l r A. N .* J. N o u l o l . Scl ., l l t;:t,
Iio sub forrna $a completXr tipic;, rsprezenl,ind prototipul sinchomu-
:r,rrr,r'rr, 2A, 1,tr9-159.
lui" Iio slrb lorma dittritclor varianto clinice. Frecventr sindlolnul de dece- Appenzcller O.-The a\lonomicnefltoussgslem,North I:IollandPubl, Co., Anrslenllrrr,
l,lililnr cste asociat cu alterXri ale stS,rii de con;tienli, ,sicu semno ncurolo- 1976,
tioo, irr lunctio dc intindorea leziunilor clil tlunchiul corellralr precum $i 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 .
il,' lrziutrilc lerebrale coexistonLe. ' 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.
!)xistil si o l/ariantii, f{iii, abolire total5, a stS,rii de conqtiin}L, care so Sei., 1974, 22, 419-_-428.
olrsrrrvi't,erceptional de rar qi in literaturi, exist5, citate url numir restrins Arnould G.- An n . !{e d . N }n cy,7 9 1 2 , 1 1 , S7 g - 9 i 6 .
rlr. r'ir,z.rrri{uairn., tgi2; .Ralsevqi Downie, 1966 ; Arseni s.iOprescu' 1966). ,4.rseoi C., Iacob T. *.)-ciolica Derlebftld,Ed. Welther, Sibiu, 19.18.
SrrrrrioLrgic. in ace.te cazuri r:igiditatea,decereb.ratiiapare l]umai industr Arseni C.-Bul. $tiint., Edit. Acad. R.P.R,, 1950, ,, 4.
<lo si irrrrili nociceptivi, niciodatS, sponta,I}; tabloul clinic este mai atenuat A r s e n i O. - Neurol., Psihiat., Ncurochir., 1957, 2, 297-294.
riirl urrLIi rccunoscutc toatc €lementele. Ca nivel de conqtiinli, acesta so Arseni C . , L a sco F.- Ac[a N e u r o l . Bcl g ,, 1 9 6 0 , r r , 9 0 1 * 0 0 4 .
lr.zrrirriiI.r,nusibilitate& do a mcn!,!rLeochii deschigirde a negn sau de a .Arscni C . , L a sco 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 ,,
corrtirnu c6va prin rniqcXri ale c:Lpului, do a reacliona lont $i.mai mult Arseni C , , Bo te z M . I.- Actr 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 ,
r:r,rrrruri nul;in corrrplet la un ordin Yerbalt in unele ca,zuri de a incerca sI Arseni 0 . , D a vi d M ., C h i l i m a n tr {,, Gl i va n I. I., l l a r ct6 l r l l ,''fr i .r -
rrrr,rrrrlbticuva inill,eh'{ibil sau de a incerca sii, rd,spundl grafic' de aso- gnostr. r&Ltooflalilolotic, Ed. trledicaltr, Illcure$tl, 1967,
irurrr,,rr,inill,elilibil. Triseelo E:ltrG efectuate ln unele dintre &cesto cazuri Arscnl C , , Op r cscr t l - * I) u r cr t:d .Fi .i o p d l o l o g i ecl i n tcdsi l r tl d m e r r l ,Ii d . Acu ( 1 .l l .S,l l .l
ru,rruorrIjlnrlt ilitgrrosticul. llucrrrcltl, ll)(i7.
Arscof ( ; , Si D r l o n cN o l l \1 ,.- I>a l o b l i a D ( tl n o - n l kl l r tl n r [0 .Ii a l r yi ( r l d , l i r l , I\1 r ,.,
(lk:nlil, Iltlcu.otlI, I{lli8,
Arrfnl ( : . , O!r I c'' 1 ., [!n r r l BI$ ,\1 -, - /) /l r l r |r l i ]l r i .i , l tl l l Sfl ,,l ', l 1 2 .

305
it5,l
 \ 1, . , . 11r i i . . (,Ir.r,r'll 1 ., \l :' r ' lr ir , \1 . t) ltttthdnui rt, t1|ri i t,. /,,:j .-|l l _
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 ,,,
r\ | l. e, i ( : . , 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. Ii l ' i '1 .
AI I r. rrI O - . 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,
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
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l)tf)rrs \', S., Iicrr A. - ( , o qh ! r . / n. opr(, lhNr l0s'l l r o n l l r sl l r b l i s h c r . S p r . i i g l i f l ( l( l l l - ) , N t,rrr'' r(l ri r., l l rl l (r. ,. l ,l ;
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Ilishik:rwn \'., l f r " r 'yl | ti .,Wr h xn r a tsu l L , \'o n r n r o ( o .].. - th ,I. I,t,Jsk,
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(ii1)l)or(t Ir. D., liclly n, I t . - nr ain, 19G 4,67 ' f ) 5 7 - 6 6 4 '
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(ll l' l, x li. T,., li l (f nl lr r I Nl. N' t ' ,( i i b l) s l"' A' - - ' l\r d l r t r l c s ' 1 $ 5 4 ' 06-73'
'J ' Ilu u (;, Ar r ', N I|| r , l 1 l ,:1 , ,l t" l 'l j :' .l tXi '.1 ,
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N l$hll{ nk; S.-- J\rz l. l.l. or s ( h. , 1l?2, ) ! 0, 102- 407, V r r o 'r l t n,' ( ) tr r i r .r n 'r ( j ,. {i tr 't) :r n 0 Nrrrl. , ( ]i l r
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Nlrltrrrrllo 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 , 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
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 f'.,f,,,\'l fl r' 1,., \![l ,rr l l . l ' ,1r,,, \,l ]t' rl Irt (,., l ' |r, rr t. ti trl r' l
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! 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
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 . ./ s 1/,/,. (i us l r' \ Ii s |h,,r \,,/t!l l ,
/r,q,r'r. fl r | .!. l ,' \ ,,,,i \ r, rl nt. IIr tl ttl tt
f' r I ii l{l \\r., .l r s t r r I I I . 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 S tul tqr rl . l l rl l l . t,t,. l l l l , l .l l
Liltl(, ltfo\!n un d ( i) m p. , lJ os t oD,l0l, 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
ll, rlicld w., ltol)rr Ls 1, . - - ^Spr c cat i ldbt ain Dt r c h a i s n l s {) , r {i ( n ( t r l l i v . I \ . c s s ,l , o r ) {l o n , 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 .
I1 |tlt. 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
I',.f (lrf lo|l (i. - -lilndc(nalo1liqu?tl\ thakj'll$ dc l'honu/r .tdullt tI de sa udsculrr'is(Ilioir rol ., Irri l ri r|-. N , |l ro(l ri r., 1L)7t, 1t, 1]i --1tl t).
tri .-N c
(i"/rjrir'11?, l'h'(c, P:rri!, 1960. P oD ovi ci rL I-, I' x s (:l | 1., (i of l rt' i u O,, ;i pot (1., S z .rL] 6 L.-, t)|tl rttttutl utn
I' cirlro rolr (;.-ltrv . Nc ur ol. , 19?6, 132, t 0\ l- : 12 4 . 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
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, 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,
../(, J09-316. l l rscrrc l r C odgl c s s , i j di nbnfgh, 30.J une-4 J ul y , 1975, p. 159.
l' lroqu rs .J., Oriz os - Rr eI l ( l h. - ' I ' oulous e r n d d . , 1 9 5 3 , f , 5 6 $ - 5 8 1 .
l ropa\_i ci u L., D ul i u ]J ., IJ c c u$ ' f., C oi oc :1ru 1,. - U rtl c U oIh I tr i tl
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 . .: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!_
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 .
Tg. l {u res , 12 i |l !;e 1975.
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 . 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.
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lld. Mcdic{rli, Brcrir'$Li, 1978, p}. 3tt7-113. .otund.ii ,,.f-onros{ialica lteftcbraki lil pri.ti.a uedicald", Tg. Muref, 20 rl]ni l1);'(;.
lropo!jciLr 1,.- CLrceltuiosuptu Dalo|ii utlat dalc Liothimi.e ti eleclroencelalogrufi.e tn P opovi ci u L., P as c u I., ,)i po$ C ,, C orJ ari rL O., LA z trr L,, A S i ti :r r l t..
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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 , 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 ,
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S oral fl, 1077, 1-21,
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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 - B ucurr$1i , 19?8.
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 . 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 ,
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L., $i pof Maf t.r--(i rrl rrl ,r/r,
1.908, 1r, 39-'16. l ( sl ud i ul .l i nfu s i el ec ranl i ogral i c ul putu\l i ol atni i [ot, C onr. S rs i unc r N rri rl :r r ti t.
llopoYiciu ^-eurul.r
L., Afg ian I } . , Sz alr . l I . , Rado l I . - S l u d . C c r c c t .N e u r o l , , 1 9 6 8 , Tg. l l ure$ a S oc . S L. l l c di c al e, 2:] apri i i c 1978.
1.7, 15.J-77/1. P oFo 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
l' opovi0 iu L ., Atg ian t s . * Rev . ed. ( Tg. M u r e f ) , 7 9 6 8 , 2 , 1 2 2 - 1 2 5 . rcsti , 1 970.
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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.- (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).
Slird. Cdcct. Ne rol., 1$69, 11, 111-426. P opovi ci u 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
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 ', bu:i l ar. 1o. L.P opo\.i c i u, Gtt. P c ndofunda S i I. P as c l l (s ul ) (rl .), /,,,/,/
1i]1..,135. 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 .
l' r)pov ioir L., .{Fgian 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 , 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.
lrr)po\.iciu L., BecuS ' f . , Liz Lr L. , Sz abd L . *R e v . M c d . ( T g . I l u r e *, 1 9 6 $ , P opo\ i ci r 1,., B c c ut T., W ai ts rk P ., D ul i { u D .-l trt. Me(l . (' l d. \l |r,,,r.
/r,3 90 .-39 4. 19t9,:5,32.* .3s .
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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
I' r)J)o!iciu J-., P::l s c u I . , Af gt an 8, , S i p o F C ,- R e v . N e ! r o l . , 1 9 6 9 ,1 2 1 , 3 8 O -
eetlcbro-buziltlr, Ild. Junimca, IaSi, 1S30.
31):t.
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
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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 - r.rl Li , 1081.
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l' olrrlv l(,iI| L ,, I)xs( : u I . , , , Sipot ( 1, , I . : ' r z ir 1 , , , A $ {i t | | | I],. Nlol(l ovc0ru
l 0) .l ;t i ,
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:t( l
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J
 N l Il r" rr (1" l l r rrrrL'
l lfrl 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 ( n, i;. \\r" l ri rl l $ ('l l l ' i i rrr l l l ' l rr l 7 l "' l l \ rl ' I l ' l ' "i ' l :!rrl '
" ' nr( l j l l tr(l '
i l l i l l l )(i '
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:\2t 372- n d b e l g-\' o I t h c i D r [1' A l l tx N trrf"l ' :' :rrrrl ' 11)/l i '
S a s i ]r' l rdl rri l l fttl ni n s ttl ttl l l ' '
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