Correlações Anatomoclínicas da Ponte
Autor: Felipe Monte | Publicado: 2011-08-31T18:58:00-03:00

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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Diversas síndromes podem acometer a ponte:
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndromes Pontinas Basilares Inferiores&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndrome de Millard-Gubler, caracterizada por paralisia facial ipsilateral e hemiplegia contralateral do tipo motoneurônio superior. A lesão freqüentemente atinge as radículas do VI nervo;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndrome de Gellé, com surdez ipsilateral, vertigem, paralisia facial variável e hemiparesia contralateral. A lesão envolve o nervo vestibulococlear, trato corticoespinal e nervo facial;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndrome Brissand-Sicard, caracterizada por hemispasmo facial ipsilateral e hemiparesia contralateral.
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndromes Pontinas Basilares Superiores&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Hemiparesia Motora Pura e Atáxica: comprometimento do trato corticoespinal e fibras pontocerebelares;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndrome de Disartria – Mão Desajeitada – caracterizada por fraqueza facial central, disartria e disfagia graves, paresia e desjeito da mão;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndrome de Encarceiramento, conseqüente a um infarto na metade anterior da ponte, caracterizada por paralisia de toda a atividade motora, afonia, com o olhar vertical e piscar de olhos preservados servindo como única forma de comunicação;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Choro e Riso: pequenas lesões na parte basilar da ponte podem levar ao choro patológico, e, mais raramente, ao riso;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndromes Pontinas Tegmentais&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Síndrome Tegmental Medial, em que são afetadas as radículas e o núcleo do nervo abducente, o nervo facial e o lemnisco medial. Portanto, as manifestações clínicas são: paralisia ipsilateral do VI nervo e paralisia do olhar lateral, paralisia ipsilateral facial do tipo periférica e perda contralateral do tato discriminativo e cinestesia;Síndrome Um e Meio, caracterizada por uma paralisia ipsilateral do olhar lateral e oftalmoplegia internuclear (paralisia da adução ipsilateral e nistagmo do contralateral na adução);Síndrome Pontina Tegmental Póstero-Lateral, causada por lesões vasculares combinadas com lesões no bulbo em lados opostos (artérias cerebelares inferiores anterior e posterior), leva a perda sensitiva dissociada com perda de dor e temperatura e preservação de vibração e sentido de posição em todo o corpo, acompanhada por ataxia dos membros;Síndrome de Raymond-Foville, caracterizada por paralisia facial periférica, hemiparesia contralateral e paralisia do olhar horizontal ipsilateral;Alucinose Musical, em que a lesão pode envolver estrias cocleares, núcleo olivar e/ou lemnisco lateral. Provoca alucinações devido à evocações da memória acústica;Síndrome Pontina Tegmental Média, caracterizada por termoanalgesia em toda a face e metade contralateral do tronco, comprometimento motor ipsilateral do nervo trigêmeo, ataxia, tremor e hemiparesia contralateral;Síndrome Pontina Tegmantal Superior, cuja lesão envolve o lemnisco medial, fascículo longitudinal medial, trato espinotalâmico e fibras cerebelares, levando a oftalmoplegia internuclear, ataxia ipsilateral e perda hemissensitiva;Hiperventilação Neurogênica Central: lesões pontinas tegmantais mediais podem afetar a formação reticular pontina paramediana (FRPP) bilateralmente estão associadas a esta síndrome. Caracteriza-se por taquipnéia incessante apesar de pO2 e pH arterial elevados e da pCO2 arterial baixa.
Além de todas estas síndromes, a ponte também é necessária e suficiente para gerar o sono REM (Rapid Eye Movement). Lesões na ponte podem impedir este sono.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A ponte está relacionada à respiração, de forma que lesões em sua parte basilar acarretam na perda da respiração voluntária.