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Wernicke's syndrome (encephalopathy): increasing awareness of this serious, mysterious disease. Treatment by position for central paresis (posture opposite to the Wernicke-Mann position) Symptom: the hand asks, the leg squints

A patient with central hemiparesis (paralysis), which developed as a result of damage to the internal capsule: shoulder to torso, forearm, flexion and hand, thigh, lower leg and plantar flexion of the foot; caused by increased muscle tone in the arm flexors and leg extensors.

1. Small medical encyclopedia. - M.: Medical encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what "Wernicke - Manna pose" is in other dictionaries:

- (K. Wernicke, 1848 1905, German psychiatrist and neurologist; L. Mann, 1866 1936, German neurologist) a peculiar posture of the patient with central hemiparesis (paralysis), which developed as a result of damage to the internal capsule: bringing the shoulder to the body, ... ... Large medical dictionary

WERNICKE – MANNA POSE- (described by German neurologists K. Wernicke, L. Mann, 1848–1905) – the patient’s posture with spastic hemiparesis, caused by increased tone of the arm flexors and leg extensors: the shoulder is brought to the body, the forearm is bent, the hand is pronated and... ...

Carl Wernicke Carl Wernicke Carl Wernicke ... Wikipedia

Wernicke-Mann pose- Central hemiparesis is characterized by predominant spastic tension of the arm flexor and leg extensor muscles. This determines the characteristics of static behavior on the side of hemiparesis (the arm is bent and brought to the body, the leg is extended) and walking... Encyclopedic Dictionary of Psychology and Pedagogy

The system of efferent neurons, the bodies of which are located in the cerebral cortex, terminate in the motor nuclei of the cranial nerves and the gray matter of the spinal cord. As part of the pyramidal tract (tractus pyramidalis), cortical nuclear fibers are distinguished... ... Medical encyclopedia

- (paralyses; Greek paralysis relaxation) disorders of motor function in the form of a lack of voluntary movements due to impaired innervation of the corresponding muscles. In some forms of P., the absence of voluntary movements is combined with... ... Medical encyclopedia

I Contracture (lat. contractura narrowing, contraction, tightening) is a restriction of normal mobility in a joint caused by cicatricial tightening of the skin, tendons, diseases of the muscles, joints, pain reflex, etc. Contracture is often called... ... Medical encyclopedia

Cerebral palsy (lat. paralysis infantilis cerebralis) ICD 10 G ... Wikipedia

HEMIPLEGIA- (from the Greek hemi semi, half and plesso I am striking), literally: defeat of half the body. The term means damage to the function of voluntary mobility on one half of the body, i.e. unilateral muscle paralysis. An incomplete degree of hemiplegia is... ... Great Medical Encyclopedia

Wernicke - Manna pose

Redlich-Flatau disease

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Extensive cerebrovascular accident: causes, symptoms, treatment and consequences

Extensive cerebral stroke most often occurs in people who have already suffered a local stroke or have had recurrent ischemic attacks.

ACVA can be caused by blockage or rupture of a vessel

Causes and contributing factors

Impaired blood supply to the brain causes damage to neurons, and this leads to neurological disorders, sometimes to disorders of vital functions, which can lead to the death of the patient. The prognosis for a major stroke is not good; death occurs in 15–25% of cases in the first hours of the disease; after a major stroke, 65–70% of patients remain disabled.

Contributing factors for the occurrence of a major stroke are:

increased blood pressure;
cardiovascular diseases;
history of microstroke or ischemic attacks;
diabetes mellitus;
atherosclerosis;
bad habits (smoking and alcohol);
obesity;
old age.

Types of major stroke

Damage to brain cells during a stroke occurs due to impaired cerebral circulation. This can happen for various reasons; the table shows the types of major stroke and the pathogenesis of their development:

Symptoms

Symptoms of stroke of various localizations

Depending on which part of the brain is affected, different symptoms may be observed. The table shows the symptoms that occur when different lobes of the brain are affected. The clinical picture may be different for each patient, but there are some signs that correspond to a specific location of circulatory disorders:

When the process affects both lobes (which is very rare), both types of symptoms and complete paralysis of the body on both sides can be observed, often the patient develops a coma.

One of the types of extensive stroke - the stem, hemorrhagic type - almost always leads to the death of the patient unless resuscitation measures are urgently provided, but even in this case the prognosis is unfavorable. Coma usually develops, and breathing problems require artificial ventilation. The consequences of a brainstem stroke affect all functional areas of a person: hearing, vision, speech, and functions of internal organs. Most often, the patient remains immobilized and becomes disabled.

Course of the disease

Coma is a fairly common complication of a major stroke.

A major stroke is often accompanied by a coma, and coma can occur immediately or gradually. Coma during a stroke also affects the prognosis of the disease. The longer the coma lasts, the worse the prognosis and the more often the consequences develop.

Coma is a disorder of consciousness when a person stops responding to external stimuli, as if he is falling asleep; this condition can last from several hours to several months. Coma is accompanied by involuntary urination or defecation, respiratory and cardiac problems.

Before the onset of a coma, the patient may experience incoherent speech and confused consciousness.

Coma is characterized by a lack of reaction to bright light, sound, and changes in body position, and some of the patient’s reflexes, such as the reaction to light, swallowing and corneal, may be preserved.

Coma during a stroke has 4 degrees of severity. Coma of 1-2 degrees gives a significant chance of exiting it and recovery. With grades 3–4, the probability of removing the patient from this condition is low; respiratory and cardiac problems lead to undesirable consequences or death.

Treatment

Drugs used to treat stroke

The principles of treatment for extensive stroke are the same as for local:

It is necessary to limit the lesion. Therefore, neuroprotectors are prescribed. In case of ischemia, thrombolytic drugs can help in the first hours; in case of hemorrhage, it is necessary to reduce blood pressure to optimal values, and antihypertensive drugs are prescribed.
Measures are being taken to combat cerebral edema. For this purpose, diuretics and plasma-substituting solutions with good rheological properties are used; osmotic solutions to reduce cerebral edema.

Oxygen therapy is mandatory.
If vital functions of the body are impaired, cardiopulmonary resuscitation is indicated.
Patients in a coma may be prescribed parenteral nutrition and vitamin therapy.

Consequences

If a patient has a major stroke, the prognosis is most often unfavorable; only 40% of patients can recover, but they also remain with certain neurological disorders. In other patients, the consequences of a stroke may be as follows:

Memory impairments, they depend on the localization of the process. There may be a loss of certain fragments from life, as well as a disruption in the perception of new information. The patient does not remember details.
Speech disorders. The patient has difficulty pronouncing long sentences, and speech may not be clear enough due to muscle damage.
Paralysis, paresis, sensory disorders (paresthesia, numbness) of the limbs. Their distribution also depends on the localization of the acute process, but a stroke patient can easily be spotted on the street by the Wernicke-Mann symptom (“the hand asks, the leg squints”). This is due to residual effects after paralysis. The patient has increased flexor tone, so the arm on the affected side is in a semi-bent state, and the leg, as it were, describes a semicircle while walking. Central damage to the facial nerves leads to facial distortion. The patient cannot show his teeth or smile, the nasolabial fold on one side is smoothed.

Wernicke-Mann pose and facial distortion

Impaired cognitive functions. It is difficult for the patient to concentrate and concentrate.
Partial loss of vision, loss of visual fields.
Impaired coordination of movements. More often it is expressed in the form of impaired finger motor skills. It is difficult for the patient to grasp small objects, but sometimes the impairment is so severe that the patient cannot even hold a spoon in his hand.
Urinary incontinence, involuntary defecation.
Epilepsy.
Development of dementia.
Lethal outcome.

Long-term rehabilitation and training in simple self-care skills are of great importance for such patients.

Rehabilitation after stroke

Physiotherapeutic treatment, therapeutic exercises, and massage can be useful. This helps reduce the consequences resulting from neuronal damage.

Patients in whom an extensive cerebral stroke has caused complete immobility require constant supervision and care. Such patients, in the absence of normal care, quickly die from associated complications (bedsores, congestive pneumonia). The addition of infection and its generalization lead to sepsis and death.

An extensive stroke is much more severe than a local one, and patients who have had a local stroke subsequently develop a large one in 30% of cases. Therefore, you need to follow preventive measures: monitor your blood pressure, get rid of bad habits, and lead a healthy lifestyle.

Wernicke Mann pose for stroke

I remember my promises from the videos. But for now, it really sucks, I would like to lower my temperature for at least a couple of days. But for now: “work-home, work-grave.” In the meantime, catch this.

Another chapter. Stroke.

Today we will talk about rehabilitation after a stroke.

The article is addressed not to specialists (they are specialists because they themselves know everything), but to those whose relatives and friends, or themselves, have suffered from a stroke. (I will not consider speech therapy and cognitive problems in this article - this is not my profile at all.)

Stroke is an acute disorder of cerebral circulation. It can be hemorrhagic and ischemic, that is, with or without hemorrhage into the brain tissue. More detailed information is easy to find on the Internet.

A typical stroke patient looks like this:

This is the Wernicke-Mann pose (I found this classic sketch with great difficulty). “The hand asks, the foot mows.”

What do we see in this picture? The leg does not bend at the knee due to hypertonicity of the quadriceps muscle; on the arm there is hypertonicity of the biceps and finger flexors. It is clear that in this situation a person cannot effectively interact with the world around him.

Rehabilitation consists of three equally significant components. This is support for muscle tissue (solved by massage and other methods of physiotherapy), restoration of motor functions (massage and exercise therapy) and ergonomic support (usually, these issues are dealt with by exercise therapy specialists).

What are the common problems?

First, the patient at the initial stage has a sharply reduced muscle tone, then hypertonicity begins to increase in certain muscle groups.

Second, the patient experiences a sharp decrease in volitional impulse. Typically, this occurs against the background of a sharp decrease in blood pressure, which in itself is uncomfortable and causes weakness.

So, we begin to work with the patient.

Rehabilitation should, ideally, begin immediately after transfer from intensive care.

And, yes, I perfectly understand the distance between a conventional 40-50 year old man who was “hit” at work and a 90 year old woman who has a history of Alzheimer’s and stage III obesity.

It is clear that in the first case there is a very good chance of complete rehabilitation, but in the second there is no hope. However, even with a “conditional grandma” you can work quite effectively. I had patients 70+ who were completely rehabilitated at least to the level of self-care.

The first stage, the development of initial coordination. The problem is that, against the background of extremely low muscle tone, there is a global impairment of motor functions. The patient is literally unable to maintain balance even while sitting.

The first task of massage at this stage (and at all subsequent ones) is to restore the conductivity of the nerve impulse. This is achieved through acupressure. We work on the exit points of the nerve. Intense stimulation. No “energetics”, just getting on your nerves. You need to understand that this is not osteochondrosis or plexitis - we are completely fixing the nerve - we need to establish a neural response in the brain. Well, we also remember that in 2-3 minutes the neurotransmitters at the point will “burn out.” It follows from this...

The second task is to restore tissue nutrition. Roughly speaking, “pump up” the muscles. There is nothing complicated here, the main thing is to catch the moment of increasing hypertonicity, and, accordingly, do a relaxing massage on the toned muscles. However, there is a tricky trick: you can squeeze the tendon in the upper third, activating the Golgi organ. It works bypassing the central nervous system so that the muscle can be temporarily relaxed.

The objectives of exercise therapy for this period are to restore muscle functions as much as possible. Here both therapeutic calculations and supporting positions come into play. The minimum task is to teach how to roll over independently, and the maximum is to sit up.

The main problem is that I am now describing a certain “vanilla” option.

Very often, the patient enters rehabilitation very late, after 3-6 months. Relatives and friends believed that “it would somehow resolve itself,” and when this did not happen, we practically get a “vegetable” who doesn’t want anything and secretly hates everyone.

The first stage of treatment here is always working with relatives. There are no miracles; any recovery is the result of work. Often, teamwork. In the event of a stroke, the involvement of relatives is extremely important. The patient is in dire need of support, but due to the nature of the course of the disease, he is unable to correctly describe his condition.

Then we follow the path of consolidating the result. To be honest, I read this about ergonomics on Wikipedia. Previously, this was naturally included in exercise therapy. That is, every movement mastered was interpreted as useful. In fact, that’s exactly what it is. If you can straighten your arm, you can dress yourself.

Although, of course, some ergonomic assessment of the living space is useful. Especially if we have a case with partial restoration of functions. This also happens, unfortunately.

Let me summarize.

A stroke is not a death sentence. You can restore everything to normal (my father had three strokes - after each he fully recovered).

There are extremely difficult cases. But recovery and partial social rehabilitation are also possible there.

Sometimes they die from this. Two people died from strokes literally before my eyes. And there was simply nothing that could be done. Repeated hemorrhagic strokes, there is a 100% mortality rate, although resuscitation... Or rather, than a bullet to the head.

Well, the general result.

Stroke is a complex, combined pathology. There is no “uniform” course, and, in fact, no treatment. A number of points remain at the discretion of the attending physician, who monitors the development of the disease daily.

Perhaps this article is absolutely useless, perhaps it will help someone.

I will state my position once again. The most effective thing is early rehabilitation. But there may be categorical restrictions from the attending physician.

Late rehabilitation is a pain! Payment for reinsurance.

Consequences of a stroke

Hello, dear readers and guests of the site dedicated to neurorehabilitation. Let's talk today and take a closer look consequences of a stroke- ischemic and hemorrhagic, as well as everything connected with it.

Consequences of a stroke.

Disturbances in any functions after a stroke are directly dependent on its severity, and the severity, in turn, on the size of the lesion and its location in the brain.

Of course, it is fair to note that the size of the lesion and its localization are not all the factors that determine the persistence and depth of neurological disorders that resulted from a stroke, the consequences of which (the nature and their severity) can vary significantly, depending on the specific case. What does this depend on?

The degree of dysfunction after a stroke is not always permanent. With a minor stroke, the consequences may be minimal or even absent, but this does not happen so often. We will discuss cases when these consequences exist and they are persistent. Let’s take a closer look at what exactly the consequences of a stroke are and how they are expressed. Listed below are the most significant dysfunctions of the body that occur after a stroke.

Right-sided and left-sided hemiparesis after stroke.

One of the most common permanent consequences of a stroke is a decrease in strength in half of the body - hemiparesis. As a rule, after a stroke, there is a decrease in muscle strength in one of the sides of the body, which is opposite to the damaged hemisphere of the brain: if the persistent consequence is hemiparesis of the left side of the body, the stroke occurs in the right hemisphere. The same principle applies to hemiparesis on the right side of the body, in which a stroke is observed in the left hemisphere. That is, the focus of the infarction in the brain is located in the hemisphere opposite to the affected half of the body.

It also happens that a stroke leads to a complete lack of muscle strength in half of the body, which is called hemiplegia. With hemiparesis, a person experiences difficulty moving; with hemiplegia, the difficulties are even more significant. Simply put, hemiplegia is paralysis in half of the body (complete lack of movement).

Normal movements in the body are disrupted, and many people have to learn to perform normal daily activities again in order to be able to take care of themselves, be able to eat, change clothes and walk. In general, do everything that before the illness was considered extremely simple and ordinary to do. It is the decrease in muscle strength in half of the body that is the main cause of disability in a person after suffering a cerebrovascular accident. It is because of this that patients lose the ability to move independently - either they lose this ability completely or it is significantly impaired.

As you have already described, gait after a stroke can often be disrupted, and the person begins to move with great difficulty. In some cases, you may need auxiliary devices - a special walker, a support cane or a crutch. The characteristic Wernicke-Mann posture develops when walking. Individual parts of the body may be affected without affecting the entire half of the body. Depending on the affected half of the body, left-sided and right-sided hemiparesis are distinguished.

Central prosoparesis.

The next, one of the most common consequences is the so-called central prosoparesis, in which the facial muscles suffer, resulting in facial asymmetry, as in Figure 1. In this case, a decrease in strength is observed not in the entire half of the face, but only in its lower part, involving the mouth, cheek, and lips.

With this paralysis of the facial muscles, the eyelids and eyes remain unaffected, despite this the distortion is quite noticeable and causes discomfort not only when eating or drinking. Central prosoparesis regresses with recovery from stroke.

With central prosoparesis, eating and drinking fluids is difficult. A person experiences obvious discomfort when performing some actions with facial muscles. It is more difficult to express habitual emotions; due to a decrease in strength in the facial muscles, sound production is disrupted and speech begins to suffer.

The defect itself brings noticeable inconvenience, purely from a cosmetic point of view. Facial distortion causes great emotional discomfort, especially when communicating with other people. This can cause withdrawal and withdrawal from communication with others and cause deep depression.

Speech impairment after stroke.

Speech disturbances after a stroke are also quite common, and at the same time they are one of the very first signs of an impending cerebrovascular accident. Speech impairment is the result of damage to the speech centers of the brain, which is a partial or complete loss of the ability to speak and perceive other people's speech, called aphasia.

According to statistics, such disorders are observed in a quarter of all people who have suffered a stroke, and their consequences can be quite persistent. Sometimes, it is difficult for a person to speak due to a violation of the speech apparatus, and the speech of such people is unclear, as if “porridge in the mouth,” and this disorder is called dysarthria . Dysarthria more often occurs with a brainstem stroke or localization of this focus in the cerebral cortex. The next speech disorder is aphasia.

Aphasia- this is a complete absence of speech. Aphasia can be of several types, let's name some of them: when the speech center responsible for pronunciation of speech is damaged, motor aphasia develops. When the focus of the stroke is located in the speech center responsible for its perception, so-called sensory aphasia develops. With sensory aphasia, a person does not understand what is said to him and does not understand what he needs to answer. If both centers are affected, mixed or sensorimotor aphasia occurs. The “pure” form of aphasia is extremely rare, and with a stroke, it is the mixed form that most often occurs.

There are other types of speech disorders after a stroke, which we will discuss in detail in the following articles on speech disorders. Now let’s move on... In addition to the listed violations, the following also occur: consequences of a stroke.

Impaired coordination of movements after a stroke.

Poor circulation in the parts of the central nervous system responsible for coordinating movements and as a result of a stroke can lead to coordination of movements, which is called ataxia. Impaired coordination of movements more often occurs with a brainstem stroke and this is due to the fact that the centers of coordination of movements in our body are located in the stem part of the brain.

It comes in varying degrees of severity. In the most favorable case, these vestibular disorders disappear within the first day from the moment of acute cerebrovascular accident. In other more severe cases, unsteadiness when walking and dizziness persist for a longer period and can last for months.

Visual impairment after stroke.

There may be visual impairments of a wide variety of nature. Visual impairment depends on the location of the stroke and the size of the lesion. Most often, visual impairment manifests itself in the form of loss of visual fields (hemianopia). In this case, as you may have guessed, half or a quarter of the visual picture is missing. If a quarter of the picture falls out, it is called quadrant hemianopsia.

Other consequences of stroke.

Impaired hearing (hypoacusia), sense of smell (hypo-, anosmia), loss of movement skills with preserved strength (apraxia) and other disorders that can and should be treated; rehabilitation in this case is very important and should be carried out in a timely manner.
Sensory impairment after stroke. Sensory impairment after a stroke can be of a different nature, but most often it is a loss of the ability to feel pain, recognize heat, cold, and a part of the body as such. It is also possible for a pain syndrome to appear, which has a wide variety of character and localization. Most often, there is a decrease in sensitivity in some parts of the body, this phenomenon is called hypoesthesia.

Depression after stroke.

Depression- another consequence of a stroke that can negate any efforts of the doctor and loved ones to restore lost functions. According to some reports, up to 80% of stroke survivors suffer from depression to varying degrees. This is a rather serious consequence that can and should be treated.

In addition to the mood for recovery, an additional no less important “bonus” of eliminating depression will be the analgesic effect. It has long been proven that depression can increase pain in a person, and with a stroke, pain is not a rare occurrence. Prescribing antidepressants can help solve this problem.

It is extremely important to prescribe the “correct” antidepressant, since some of them can cause an “inhibitory effect”, which in some cases can also reduce a person’s desire to follow the doctor’s recommendations and become more active for better rehabilitation.

Stroke, the consequences of which remain after a course of treatment in the hospital, is a common occurrence. Such people need a course of full rehabilitation, which often begins in the hospital. The rehabilitation course itself is prescribed individually, depending on the severity and persistence of the consequences, as well as on the time that has passed since the stroke and the general condition of the patient.

Read about an example of such a rehabilitation center in the article rehabilitation center after a stroke.

Wernicke - Manna pose

Wernicke - Manna pose(K. Wernicke, 1848-1905, German psychiatrist and neurologist; L. Mann, 1866-1936, German neurologist) - a peculiar position of the patient with central hemiparesis (paralysis), which developed as a result of damage to the internal capsule: adduction of the shoulder to the body, flexion forearms, flexion and pronation of the hand, extension of the hip, lower leg and plantar flexion of the foot; caused by increased muscle tone in the arm flexors and leg extensors.

Articles on the topic Wernicke - Manna pose

Hand The hand (manus) is the distal part of the upper limb, which has complex sensory and motor functions. The border between the forearm and the knee is the line of the wrist joint.
Pick's disease Pick's disease (A. Pick, 1851-1924, Czech psychiatrist and neuropathologist; synonym: limited presenile brain atrophy, Pick's atrophy, Pick's syndrome) is a disease of the nervous system, characterized by total presenile dementia with speech decay.
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Discussion of Wernicke - Manna pose

Two months ago I received burns to my hands and forearms (with an electric arc). Now n. Two months ago I received burns to my hands and forearms (with an electric arc). Now contractures have formed on the arms, especially on the bend of the hand. Can they be removed non-surgically? Even on my left hand, my little finger cannot fully straighten, the doctor said it will work out, but for three weeks now there is practically no SD
We picked up a cat with a torn hand, and from the forearm (if that is possible). We picked up a cat with a torn hand, and from the forearm (so to speak) the skin is torn off and the paw is bleeding. We sprinkle it with streptocyte and bandage it, but the paw does not heal . tell me what to do.
I have a congenital absence of a hand, a slightly underdeveloped forearm, maybe l.

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