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Brain stem consists of the medulla oblongata, pons and midbrain. From below, brain stem is limited by Xia
spinal roots, coming from the segment C1, from top is optic tract on their way to the intersection of the
visual lateral geniculate body (Fig. 6).

Medulla oblongata (ʿ̨̨̨̬̣̯̼̜̔̐̏̌ ̨̥̐̚) represents lower (caudal) part of the brain stem and is,
between the spinal cord and the pons. On its ventral part but both sides of the median fissure is
elevated the pyramid, of which there are pyramidal (cortico-spinal-cerebral) tract. On dorsal part of
the medulla oblongata but both sides of the median fissure are visible elevation of Burdach's nucleus
and soft nucleus, which is the second neuron of deep sensory tract and Rhomboid fossa. Most caudal
part of medulla oblongata exit accessory nerve, part of the roots of which originates from the cervical
segments, and then departs hypoglossal, vagus and glossopharyngeal nerves. At the border of the
connection of medulla oblongata and the pons in cerebellopontine angle in the brain stem enter
vestibulocochlear and facial nerves. in the ventral part goes abducens nerve.

Pons (̨̛̬̣̖̏̌̏ ̨̥̭̯4 includes fibers connecting the hemispheres of the cerebellum, which served as its
name. Pons is situated between medulla oblongata and midbrain. Its ventral part is cushion and include
twisted fibers going from pons to cerebellum (2nd part of cortico-cerebellopontine tract), as well as the
cortico-spinal (pyramidal) tract. On lateral side, transverse fibers form the base of the pons middle crus
(pedunculus) cerebri of the cerebellum, above which there is a place where trigeminal nerve exit. The main
part of the dorsal part of the pons is Rhomboid fossa.

Mesencephalon ˁ̛̬̖̦̜̔ ̨̥̐̚4 represents the upper (oral) part of the brain stem. Ventral part of the
midbrain is the brain stem, which includes the cortico-spinal and cortico-pons tract. The roof of the
midbrain is formed by two symmetrical upper and lower colliculus, which contain the nucleus, respectively
perceive visual and auditory impulses. Between the roof of the midbrain and the crus (pedunculus) cerebri
of the brain are the nucleus of the oculomotor and trochlear nerves, nucleus ruber and substansia nigra.
From the interval between the crus (pedunculus) cerebri of the brain, go oculomotor nerves. From the
dorsal surface of the midbrain go troclear nerves.

In the brainstem are nuclei of cranial nerves, other clusters of neurons, and are ascending and descending
pathways. In brain stem is the reticular formation, neurons which have bilateral relations with the cortex
and basal ganglia of the cerebral hemispheres, nuclei of cranial nerves, cerebellum and spinal cord. Part of
the nuclei of the reticular formation, mainly localized in the midbrain and the pons, has an activating effect
on the cortex of cerebral hemispheres and is important in the maintenance of consciousness, the regulation
of the rhythm of sleep and wakefulness. Another group of nuclei of the reticular formation of the pons and
the medulla affect autonomic-visceral functions (respiratory center, vasomotor center) and the motor
activity of the spinal cord.

Defect of the brain stem appears dysfunction of cranial nerves (CNs), or other clusters of neurons (red
nucleus, substantia nigra or other), as well as symptoms pathways (motor and sensory). Extensive damage
to the brain stem causes disorder of consciousness and death due to disrupted vital functions (respiratory
and circulatory). Damage even in small parts of the midbrain reticular formation of nuclei can cause
disorder of consciousness. Any damage to half of the trunk of spinal appears as alternating syndrome:
disturbance of function of CNs on the affected side and the central hemiparesis and hemihypoesthesia on
the opposite side of the trunk to the extremities (due to destruction of motor and sensory pathways).
Description of the major syndromes is given in alternating syndromes of disturbance of CNs.

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# Olfactory irritation is perceived by sensitive cells (olfactory receptors), mucous membrane of
the upper part of the nasal cavity, which form the olfactory fibers passing through openings in the ethmoid
bone and goes along to the olfactory bulb. These fibers per se form olfactory nerves. Axons of olfactory
second neurons, form the olfactory bulb form the olfactory tract, which the excitation reaches the amygdala
of temporal lobe (third neurons) and from them goes to the anterior parahippocampal gyrus (projection and
association areas of the field of smell).

!$ % are carried out with aromatic substances (tincture of valerian, camphor
oil, etc.) separately in each of the nose entrance.

&%& '()* '* occurs in 1% of the population aged until


60 years and more than 50% of people aged over 60 years. Patients are often unaware of the loss of smell,
and complained of breach of taste, in which the perception of odors plays large role. In 2/3 cases of
hyposphresia or anosmia are caused rhinogenous diseases, sinusitis, head trauma, degenerative-dystrophic
changes in olfactory neurons in older people. Less likely, bilateral anosmia caused by degenerative diseases
of the nervous system (Alzheimer's, Parkinson's), epilepsy, somatic (hypothyroidism, kidney disease,
diabetes) and mental illness. Unilateral hypo- and anosmia could be the first and only symptom of tumors
and other pathological processes on the basis of the frontal lobe (shown in detecting computer or MRI of
the head). Transiet distortion of smell is possible during pregnancy, poisoning by chemicals and
schizophrenia. Olfactory hallucinations (feeling of absence of odor) may occur in pathological processes
(most tumors) in of the temporal lobe, they may be a manifestation of an epileptic seizure.

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&!% 

 &# The visual impulses are perceived by retina as an ordered cluster of specialized cells.
Retina has three layers of neurons: the first - rods and cones, the second - the bipolar cells, the third -
ganglionic cells. Diagram of the visual system is shown in Fig. 7. 7. In rods and cones, light information
through photochemical reactions is converted into pulses that propagate successively to other sections of
the neurons. Axons of ganglion cells form optic nerve, which penetrates into the cavity of the skull. At the
level of the optic chiasma or chiasmata opticus= fibers from the inner (nasal) part of the retina pass to the
opposite side, the fibers from the outer (temporal) half of the retina remain on their side. As a consequence,
in the optic tract  
4= forms after the intersection, in which is located fibers from the temporal
part of the retina of his eye and nasal part of retina of the other eye. - Therefore, right optic tract conduct
impulses from the left visual fields, in the left visual tract - from the right visual fields. Optic tract terminates
in the lateral geniculate body, where the excitation is transferred to the next (fourth) neurons. Axons of
these neurons pass through the posterior part of hind femur internal capsule and in the temporal and
occipital lobes form radiatio optica, which ends in sulcus calcarinus of occipital lobe (first projection of visual
field). In other divisions (mid-sections and the outer surface) of the occipital lobe is the analysis and
recognition of visual images (second visual field).

!$!+# Visual acuity was tested with the help of special tables, which have alphabets or
simple shapes.
The fields of view can be precisely measured using a special device (perimeter). To estimate the field of view,
you can use a simpler technique. The patient is asked to close one eye and hand to fix their view on one
point, for example on the investigator that is sitting oppositely. The researcher moves the hammer of the
perimeter because of the patient's head to the center of his moles from different points of view (right, left,
top and bottom) and asks the patient to indicate when he saw the hammer. After examination of one eye,
another eye is examined. The normal boundaries of fields of view (in white) are: external - 90 °, internal -
60 °, lower - 70 °, upper - 60 °. It is important to study the fundus of eye, in which we can see the optic disk
and signs of defect (blanching, edema and other changes).


!+ develops as eye and
neurological diseases. In case of defect, usually we
refer to an ophthalmologist and in those cases where
we detect eye diseases, explain by the visual
disturbance, are likely due to defect of optic nerves,
conducing tract or the cortex of the occipital lobe.

Reduced vision (amblyopia) or its total loss


(amaurosis) in one eye in the absence of its
pathology shows the defect of the optic nerve. In
these cases, in fundus of the eye, there are changes
of optic disk in the form of its blanching (atrophy) or
edema (often with increased intracranial pressure
caused by, for example, brain tumor). With the
defect of part of the fibers of optic nerve may causes
partial loss of sight (scotoma), in which the patient
perceives as a "dark spot" in the eye.

Damage to the central part of the visual


contralaterally involving intersecting fibers (typical
for pituitary tumor) causes a loss of temporal lobe of
view, or bitemporal hemianopsia (due to damage of
fibers going from the inner part of the retina of both
eyes). Less often, damage to the external parts of the
visual intersection leads to loss of internal fields of
$#,#,- Visual Analyzer and visual disturbances:
A - field of view; B-retina; B - optic nerve; G-optic decussation;
view, or binasal hemianopsia (due to damage of
D - optic tract; E - lateral geniculate body;F - occipital lobe of fibers coming from the temporal retina cha STI both
the cerebral hemispheres; eyes).
1 - amaurosis, 2 - bitemporal hemianopsia, 3 -- binasal
hemianopsia, 4-homolateral hemianopsia, 5 ʹ upper quadrate In case of damage other parts of the visual tract
hemianopsia, 6 - homolateral hemianopsia (with preservation (optic tract, medial geniculate body, optical radiant
of central vision) and calcarine sulcus of occipital lobe), there complete
or partial loss of the either right or left half of the visual field of both eyes, or homonymous hemianopsia
(due to damage of fibers going from the inner part of the retina of one eye and the outer part of the retina
of another). The loss of sight is marked on the opposite side to the defect, such as damage to the right
occipital lobe revealed as left-sided hemianopsia. Loss of view field depends on the amount and localization
of damage to the optic path. If the damage is radiatio optica in temporal lobe sometimes causes view loss
only in the lower part of the fibers of radiatio optica, and therefore develops a partial hemianopsia, which is
limited only the upper quadrants of the visual field (upper-quadrant hemianopsia).

Any damage to the outer cortex of occipital lobe, which is responsible for analysis and recognition of visual
graphic, causes psychanopsia (loss of technique to recognize familiar objects). During stimulation of the
cortex of occipital lobe, occur possible visual sensations in the form of light flashes (Photopsia) or more
complex visual images (visual hallucinations), an increase in items (macropsia) or decrease (micropsia) or
distortion of objects (metamorphoopsia).

%% $ # Short-term (from minutes to several hours) loss of vision in
one eye  
  4 usually causes transient ischemic attack in the basin of the orbital artery -
branches of the internal carotid artery. In such cases, the patient needs urgent examination and treatment
to prevent stroke. Long-term (days, weeks) decrease in visual acuity in one or both eyes may be the result of
retrobulbarno optic neuritis, which in most cases is the manifestation of multiple sclerosis. In this case
except reduction of view, sometimes is noted pain in the eyeball, which increases when eye moves. Bilateral
reduced vision may also result from a toxic optic neuropathy caused by poisoning of alcohol substitute
(methanol, ethylene glycol), carbon monoxide, lead, arsenic, thallium, or taking certain medicines
(levomixetin, isoniazid, penicillamine, etc.). Progressing reduction of vision in combination with papilledema
develop in intracranial hypertension caused by tumor, brain injury or other diseases. In such cases, urgent
examination (CT or MRI of the head) and treat it.

The loss of both fields of view (left-handed or right-sided hemianopsia) with acute development is more
often caused by stroke or traumatic brain injury, if gradually - a brain tumor. Transient hemianopsia occurs
when transient ischemic attack and it͛s like aura before migraine attack.. Acute arising of blindness in both
eyes is possible in clogging of the main artery, leading to bilateral infarction of occipital lobes. The loss of
the outer field of view (bitemporal hemoanopsia) is observed in pituitary tumor, craniopharyngioma,
meningioma of turcica sellae, lesion the internal fields of view (binasal hemianopsia) ʹ in aneurysm of the
internal carotid artery, a brain tumor.

.c&% $ 
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&   / 
Amblyopia, or amaurosis in one eye (in the absence of eyes Optic nerve
pathology)
Bitemporal hemianopsia (loss of temporal field of view) Internal divisions of the visual intersection
Binasal hemianopsia (loss of internal fields of view) The outer sections of the visual intersection
Homonymous (right-or left-sided) hemianopsia From the contralateral side of the optic tract,
medial geniculate body, radiatio optica or
calcarine sulcus of the occipital lobe