DISEASES OF THE NERVOUS SYSTEM : VEGETATIVE NEUROSIS (VEGETATIVE DYSTONIA). - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Under this name understand the disease, in which there are functional disorders of the autonomic nervous system and the internal organs. Organic changes if this is not observed.
Etiology and pathogenesis. One of the main causes of the disease is the lability and irritability of the autonomic nervous system, and there are violations of biochemical (cholesterol metabolism, the ratio of potassium and calcium, sugar metabolism). Serious value in causing the disease have psychogenic and emotional factors which influence is enhanced irritability of the various divisions of the autonomic nervous system and neuro-vascular apparatus of the patient. This effect is explained by the relationship that exists between the functional state of the cortex, subcortical and stem parts of the brain with blood vessels, endocrine glands and internal organs. This relationship is physiologically based and the conditioned reflex influences (Acad. I. P. Pavlov).
Thus, vegetative disorders cannot be considered in isolation from the state of the higher functions of the Central nervous system. In organs innervated by the autonomic nervous system, you may experience functional disorders, referred to as neurosis, because no organic changes in the nervous system, nor the authorities have not yet identified. It should be borne in mind that long-term functional changes can lead subsequently to organic disorders.
Strengthening autonomic disorders can be observed in preclimacteric and menopausal period, under the influence of infections and intoxications and depending on climatic and other external factors.
Symptoms. Patients complain of paresthesias in the form of itching, coldness or sensation of heat, especially in the hands and feet, on pain of different localization (hands and feet, heart area, stomach). Pain and paresthesias usually unstable and amplified under the influence of excitement and exhaustion. There is increased sweating. Many of the patients have shortness of breath, a tendency to increased and frequent palpitations, nausea and heartburn, often constipation or diarrhea. It should be noted that depending on innervated by the autonomic nervous system of organs involved in suffering, and are the main complaints of patients. This complex subjective complaints accompanied by numerous objective symptoms largely depend on the preferential damage to the parasympathetic and the sympathetic part of the autonomic nervous system.
Changing the shape of Sreckoin may manifest in their narrowing when the parasympathetic and expansion in sympathetic influences. When the General instability of the autonomic nervous system can be observed variability in the magnitude of inhibition, which then narrowed, then expand (game of the pupils). There are often changes of the pulse in the form of bradycardia with high vagal tone and tachycardia when the sympathetic influences. The predominance of the last blood pressure may be slightly increased, while the parasympathetic is often lowered. Disorders of the autonomic nervous system cause increased salivation or prone to dryness in the mouth.
Often the increased sweating. Pronounced cutaneous vascular response. Especially often observed dermographism, which can often reach a sharp degrees and manifest in the form of urticaria. Notes the appearance of red spots on the body, which sometimes reach degrees of erythema. Typical amplification pilomotor reactions.
Patients can be detected at the same time many of the symptoms characteristic of sympathetic and parasympathetic influences.
In the clinical picture of vegetative dystonia may include various non-persistent anomalies of pigmentation. Violation of thermoregulation as a stand-alone syndrome is a disease of the Central apparatus, regulating temperature and located in the field of grey Eminence (tuber cinereum). Thus, there is a persistent low-grade status. It should, however, be borne in mind and the possibility of less stable disturbances of thermoregulation. In such cases, we have to take into account the inherent patient prone to significant fluctuations in autonomic regulation, including temperature.
The symptoms of "vegetative neurosis" should include some of the peculiarities of the psyche. Among them the most important are prone to hypochondria States to revaluation of subjective pain and their exaggeration, fixing attention on of SOMATO-visceral sensations and celebrate many patients with emotional anxiety. In addition to all the above symptoms may also be observed changes in the animal nervous system. Under the influence of irritation of the sympathetic nerve can change the physiological state of the muscles of the abdominal organs and skeletal striated muscle, as well as state sensitive devices (sense organs, peripheral nerves). In this regard, often have high reflexes, hyperesthesia, changes in the sphere of the senses, for example, increased excitability of the vestibular functions or intolerance elevated irritating factors (tactile, visual).
For chronic disease always with a tendency to remission and exacerbation, depending on a number of specified factors.
First of all it is necessary to exclude organic disease. The above-described polymorphic symptomatology, most lability and instability of emerging symptoms, the impact of the psychogenic factors are hallmarks of the disease. Meanwhile, it is possible to determine precisely the body that are particularly heavily involved in the suffering, bearing in mind that the neurosis of a specific organ, for example, cardiac neurosis, always in some degree connected with the General condition of the nervous system. From vegetative neurosis should distinguish those diseases, which belong to the group of Eviscerate (gastropathy, cholecystopathy). Psychogenic neurotic reactions can be combined with vegetative symptoms of neurosis. The existence and nature of the vegetative neurosis is confirmed by the study of some cutaneous autonomic and somatic reflexes. Thus the symmetry of their identification is often violated (autonomic asymmetry). The excitability of the sympathetic nervous system is determined by the study of dermographism. Pilomotor reflex, which is based on the reduction of hair muscles due to irritation of the skin, caused by application of pain or heat and cold stimuli. In positive cases, there is a sharp local or General pilomotor reaction, known as the "goose skin". The solar plexus reflex is caused by pressure in the epigastrium, which periodluminosity the sympathetic nervous system is painful. Potomy reflex points on the overall excitability of the autonomic nervous system and focal damage. To obtain potootdelenie.so reflex used iodo-starch method studies minor. With a brush in the investigated area of the body to put a solution consisting of 15.0 iodine, 100,0 castor oil and 900,0 wine alcohol. After evaporation of the liquid skin pripudrivayut starch, giving the patient an aspirin, or designate the dry-air bath and cause sweating. Under the influence of the iodine-starch reaction of the investigated area of the body is black. In pathological cases, the sweating may be missing. Reflex Asner is invoked by pressing the eyeballs. In case of an increase of vagal tone to the heart rate slows down to 12 to 15 beats per minute.
The same deceleration can be obtained when the pressure in the common carotid artery at the level of the upper third of her or at the level of the angle of the mandible.
Good action has firming patient mode:
Favorably affect water treatment - wiping water in the morning. Recommended morning physical exercises. Walk before bedtime. Essential psychotherapies: calming the patient, removing emotional arousal. In this regard, efforts should be made to resolve traumatic household and utility factors. Tonic means are arsenic, strychnine, drugs phosphorus. With significant periodluminosity appoint bromide preparations. As shown by Acad. Pavlov and Petrov, better apply small doses (1%, 2%).
Total favorable influenced by the use of galvanic calcium collar on Shcherbakov, calcium supplements; more energetic action has calcium chloride (when administered intravenously): 12 - 15 injections through day 10% solution in 10 ml Recommended itching, urticaria, Quincke's edema. In the latter cases effective and ephedrine (by mouth or injection). When the excitement of the vagus nerve prescribe atropine (by mouth or injection), when diarrhea vegetative origin - adrenaline enema (20 - 30 drops of 1% solution of epinephrine 200 - 300 ml of water).