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== Einführung ==
== Introduction ==
Bevor wir zum Kern der Diskussion über die Pathologie unserer Patientin Mary Poppins kommen, die aus den vorangegangenen Kapiteln einen neuromotorischen Typ zu haben scheint, insbesondere einen „hemimasticatorischen Spasmus“, müssen wir uns auf einige grundlegende Punkte konzentrieren, die uns helfen werden, die zu verstehen Wichtigkeit des Exkurses der Kapitel und gleichzeitig das Wesen des Prozesses der Entschlüsselung des bereits mehrfach erwähnten neurologischen Signals besser verstehen.  
Before getting to the heart of the discussion regarding the pathology of our patient Mary Poppins, which from the previous chapters seems to be of a neuromotor type, in particular a 'Hemimasticatory Spasm', we should focus on some fundamental points that will help us to understand the importance of the ''excursus'' of the chapters and at the same time to better understand the essence of the decryption process of the neurological signal, already mentioned several times.  


Comencemos diciendo que no es tan complejo hacer un diagnóstico de 'Espasmo Hemimasticatorio', es hacer un diagnóstico diferencial entre Espasmo Hemimasticatorio y Hemifacial porque nodepende solo de las nerviosas involucradas, sino que más aún lo es de comprender la naturaleza de la enfermedad Abs abordar, posteriormente, una terapia adecuada.
Let's start by saying that it is not so complex to make a diagnosis of 'Hemimasticatory Spasm', it is to make a differential diagnosis between Hemimasticatory and Hemifacial Spasm because it does not depend only on the nervous districts involved, but even more it is to understand the nature of the disease to address, subsequently, adequate therapy.


Zunächst müssen wir Bewegungsstörungen betrachten, die als unwillkürliche oder abnormale Bewegungen definiert werden können, die durch ein Trauma der kranialen oder peripheren Nerven oder Wurzeln ausgelöst werden.<ref>{{cita libro  
We should, first of all, consider movement disorders which can be defined as involuntary or abnormal movements triggered by trauma to the nerves or cranial or peripheral roots.<ref>{{cita libro  
  | autore = Jankovic J
  | autore = Jankovic J
  | titolo = Peripherally induced movement disorders
  | titolo = Peripherally induced movement disorders
Line 20: Line 20:
  | LCCN =  
  | LCCN =  
  | OCLC =  
  | OCLC =  
  }}</ref> Daher ist es kontextabhängig, unwillkürliche Bewegungen, einschließlich Spasmen, auch Pathologien des zentralen Nervensystems sowie des peripheren Nervensystems zu berücksichtigen. In einer Studie von Seung Hwan Lee et al. Zwei vestibuläre Schwannome, fünf Meningeome und zwei Epidermoidtumoren wurden eingeschlossen. Hemifazialer Spasmus trat bei acht Patienten auf der gleichen Seite der Läsion auf, während er bei einem Patienten auf der gegenüberliegenden Seite der Läsion auftrat. Bezüglich der Pathogenese der Hemifacial Spasmen wurde bei sechs Patienten eine Beteiligung der Gefäße festgestellt, bei einem Patienten betraf der Tumor die Auskleidung des Gesichtsnervs, bei einem Patienten und einem Patienten eine hypervaskuläre Tumorkompression des Gesichtsnervs ohne Schädigung der Gefäße. Enormer Tumor, der den Hirnstamm komprimiert und somit bei einem anderen Patienten den kontralateralen Gesichtsnerv mit einbezieht. Der Hemifazialkrampf verschwand bei sieben Patienten, während er sich bei zwei Patienten mit vestibulärem Schwannom und Epidermoidtumor vorübergehend besserte und dann nach einem Monat wieder auftrat.   
  }}</ref> From this it is contextual to consider involuntary movements including spasms also pathologies of the Central Nervous System as well as the peripheral one. In a study by Seung Hwan Lee et al.<ref>{{cita libro
| autore = Lee SH
| autore2 = Rhee BA
| autore3 = Choi SK
| autore4 = Koh JS
| autore5 = Lim YJ
| titolo = Cerebellopontine angle tumors causing hemifacial spasm: types, incidence, and mechanism in nine reported cases and literature review
| url = https://pubmed.ncbi.nlm.nih.gov/20845049/
| volume =
| opera = Acta Neurochir (Wien)
| anno = 2010
| editore =
| città =
| ISBN =
| DOI = 10.1007/s00701-010-0796-1
| PMID = 20845049
| PMCID =
| oaf = <!-- qualsiasi valore -->
| LCCN =
| OCLC =
}}</ref> two vestibular schwannomas, five meningiomas and two epidermoid tumors were included. Hemifacial spasm occurred on the same side of the lesion in eight patients while it occurred on the opposite side of the lesion in one patient. Regarding the pathogenesis of hemifacial spasms, in six patients the vessels were found to be involved, in one patient the tumor involved the facial nerve lining, compression of the facial nerve hypervascular tumor without damage to the vessels in one patient and a huge tumor which compressed the brainstem thus involving the contralateral facial nerve in another patient. Hemifacial spasm resolved in seven patients, while in two patients with vestibular schwannoma and epidermoid tumor they improved transiently and then recurred at one month.   


<blockquote>Daher sollten mitwirkende Ursachen des zentralen intrakraniellen Typs berücksichtigt werden, die eine mitwirkende Ursache für Gesichts- und/oder Kaukrämpfe sein könnten, beispielsweise Fälle von vestibulärem Schwannom und Epidermoidtumoren.   
<blockquote>Therefore, the contributing causes of the central intracranial type should be kept in mind, which could be a contributory cause of facial and / or masticatory spasm, for example, cases of vestibular schwannoma and epidermoid tumors.   


</blockquote>
</blockquote>

Latest revision as of 11:38, 1 May 2023

Introduction

Before getting to the heart of the discussion regarding the pathology of our patient Mary Poppins, which from the previous chapters seems to be of a neuromotor type, in particular a 'Hemimasticatory Spasm', we should focus on some fundamental points that will help us to understand the importance of the excursus of the chapters and at the same time to better understand the essence of the decryption process of the neurological signal, already mentioned several times.

Let's start by saying that it is not so complex to make a diagnosis of 'Hemimasticatory Spasm', it is to make a differential diagnosis between Hemimasticatory and Hemifacial Spasm because it does not depend only on the nervous districts involved, but even more it is to understand the nature of the disease to address, subsequently, adequate therapy.

We should, first of all, consider movement disorders which can be defined as involuntary or abnormal movements triggered by trauma to the nerves or cranial or peripheral roots.[1] From this it is contextual to consider involuntary movements including spasms also pathologies of the Central Nervous System as well as the peripheral one. In a study by Seung Hwan Lee et al.[2] two vestibular schwannomas, five meningiomas and two epidermoid tumors were included. Hemifacial spasm occurred on the same side of the lesion in eight patients while it occurred on the opposite side of the lesion in one patient. Regarding the pathogenesis of hemifacial spasms, in six patients the vessels were found to be involved, in one patient the tumor involved the facial nerve lining, compression of the facial nerve hypervascular tumor without damage to the vessels in one patient and a huge tumor which compressed the brainstem thus involving the contralateral facial nerve in another patient. Hemifacial spasm resolved in seven patients, while in two patients with vestibular schwannoma and epidermoid tumor they improved transiently and then recurred at one month.

Therefore, the contributing causes of the central intracranial type should be kept in mind, which could be a contributory cause of facial and / or masticatory spasm, for example, cases of vestibular schwannoma and epidermoid tumors.