- Ganglioneuritis reasons
- Ganglioneuritis symptoms
- Treatment of a ganglioneuritis
The isolated inflammatory defeat of one sympathetic node in neurology carries the name a ganglioneuritis (ganglionitis). If pathological process affects the peripheral nerves adjoining to a sympathetic node, then such disease is called a ganglioneuritis. At the combined defeat of sympathetic nodes and spinal nerves the disease is verified as a radiculogangliitis. Besides, allocate a polyganglionitis (truncitis) — an inflammation of several sympathetic ганглиев at once. Speak about a ganglioneuritis as well concerning an inflammation of nerve knots which part nerve fibrils of various type are: sympathetic, parasympathetic, sensitive. From them the ganglioneuritis of a cranked node and a ganglionitis of a pterygopalatine node most often meet.
As a rule, the ganglioneuritis develops as a result of infectious process. Acute infections (measles, diphtheria, flu, an ugly face, dysentery, quinsy, scarlet fever, sepsis) and chronic infectious diseases (rheumatism, syphilis, tuberculosis, a brucellosis) can be the cause of its emergence. Often the ganglioneuritis develops against the background of a chronic inflammatory disease. For example, the complicated caries of teeth, and the reason of a sacral ganglionitis — an adnexitis, a salpingitis, an oophoritis can be the cause of a ganglioneuritis of a pterygopalatine node, men have a prostatitis. In more exceptional cases the ganglioneuritis has the toxic nature or is caused by a tumor (a ganglioneuroma or secondary metastatic process). Can promote emergence of a ganglioneuritis: overcooling, overfatigue, a stress, an alcohol abuse, surgical interventions in anatomic areas, close to gangliya, and so forth.
The main clinical sign of a ganglioneuritis is the expressed pain syndrome. The thermalgia of widespread type which can be followed by feeling of a pulsation or raspiraniye is characteristic. Patients with a ganglioneuritis cannot precisely specify localization of pain because of its diffusion character. In certain cases at a ganglioneuritis distribution of pain on all half of a body or on the opposite side is noted. Distinctive feature of pain at a ganglioneuritis is lack of its strengthening at the movement. Most of patients indicate that strengthening of a pain syndrome can arise at them in connection with meal, at changes of weather, an emotional overstrain, etc.
Along with a pain syndrome the ganglioneuritis is shown by various disturbances of sensitivity. It can be decrease in sensitivity (hypesthesia), increase in sensitivity (hyperesthesia) and paresthesias — discomfortable feelings in the form of numbness, feelings of crawling of goosebumps, prickings and so forth. The ganglioneuritis is also followed by the neurotrophic and vasculomotor frustration expressed in a zone of an innervation of the struck ganglion and nerves. It is long the proceeding ganglioneuritis often is followed by the increased emotional lability of the patient and a sleep disorder; development of an adynamy, hypochiondrial syndrome, neurasthenia is possible.
Let's consider separate types of a ganglioneuritis.
Depending on group struck sympathetic ганглиев a ganglioneuritis classify on cervical, chest, lumbar and sacral. The cervical ganglioneuritis is in turn divided on verkhnesheyny, nizhnesheyny and star-shaped.
The ganglioneuritis of an upper cervical node is characterized by Bernard's syndrome — Horner: ptosis, miosis and enophthalmos. At irritation of this ganglion the syndrome Pourfur du Pti (expansion of a palpebral fissure, a mydriasis and an exophthalmos) develops, there is a stimulating impact on a thyroid gland leading to emergence of a hyperthyroidism. Secretory and vasculomotor disturbances of a verkhnesheyny ganglioneuritis are shown by a hyperhidrosis and reddening of the corresponding half of the face, decrease in intraocular pressure. Changes of sensitivity at a cervical ganglioneuritis are noted above the 2nd edge. The throat paresis which is followed by a voice osiplost is possible. In cases when the ganglioneuritis of an upper cervical node is followed by sharply expressed pain syndrome affecting the area of teeth, patients are quite often unsuccessfully treated at the stomatologist and even pass through a wrong exodontia.
The ganglioneuritis of the lower cervical node is followed by distribution of disorders of sensitivity to the 6th edge. These disturbances take also a hand, leaving intact only its internal surface. In a hand decrease in a muscle tone, cyanochroic coloring of skin is noted (diffusion or only finger-tips). Corneal, conjunctival, maxillary, pharyngeal and karpo-radial reflexes are lowered. At a nizhnesheyny ganglioneuritis omission of an auricle on the party of the struck node is possible.
The ganglioneuritis of a star-shaped node is shown by pains in half of thorax on the party of defeat. The zone of pain and disturbances of sensitivity has an appearance of "semi-jacket". Often pain irradiates in an upper extremity, at the same time the pain syndrome reminds an attack of stenocardia and demands differential diagnosis with coronary heart disease. Disturbance of motility of the V finger on a hand is observed.
The ganglioneuritis of upper chest sympathetic nodes is shown not only disturbances of sensitivity and a pain syndrome, and and vegeto-visceral frustration. Pains in heart, breath difficulty, tachycardia are possible.
The ganglioneuritis of the lower chest and lumbar sympathetic nodes is characterized by pain, sensitive disorders, vascular and trophic disorders of the lower part of a trunk and the lower extremities. When involving in inflammatory process of a sciatic nerve of pain irradiate in the corresponding hip with characteristic clinic of neuropathy of a sciatic nerve. Vegeto-vistseralnye disturbances are shown from abdominal organs.
The Krestsovy ganglioneuritis can be followed by an itch of external genitals and dysuric disturbances. At women disturbances of a menstrual cycle, acyclic uterine bleedings are possible.
The ganglioneuritis of a pterygopalatine node is followed by clinic of an epileptiform neuralgia in the field of an orbit, a nose and an upper jaw (a zone of an innervation of the II branch), a hyperemia of a half of the face, dacryagogue from an eye on the struck party and plentiful separated from a nose on the same party.
The ganglioneuritis of a cranked node is characterized by pristupoobrazny ear pain which often irradiates in a nape, a face and a neck. On the party of defeat development of neuritis of a facial nerve with paresis of mimic muscles is possible.
The ganglioneuritis preferential on the basis of a clinical picture, signs of the vasculomotor and neurotrophic disturbances found at a research of the neurologic status of disorders of sensitivity revealed at survey of the patient is diagnosed. Often at a chest and sacral ganglioneuritis patients undergo prolonged treatment concerning somatopathies. For example, at the cardiologist concerning a cardialgia, at the gastroenterologist in connection with disturbance of secretory and motor function of a stomach or intestines, at the gynecologist concerning persistent pelvic pains. In such cases of feature of a pain syndrome, its chronic and persistent character have to be a reason for consultation of the patient at the neurologist.
Differential diagnosis of a ganglioneuritis is carried out with a funicular myelosis, tumors of a spinal cord, a myelosyringosis, neurosises, disturbance of spinal blood circulation. For the purpose of an exception of these diseases at diagnosis of a ganglioneuritis can the X-ray analysis of a backbone, backbone KT and MPT, an electromyography is carried out. For identification of the inflammatory changes accompanying a ganglioneuritis from somatic bodies MSKT or ultrasonography of abdominal organs, gynecologic ultrasonography, ultrasonography of a prostate and so forth inspections is appointed.
Treatment of a ganglioneuritis:
For the purpose of stopping of a pain syndrome at a ganglioneuritis appoint analgetics. At the expressed pains to patients with a ganglioneuritis carry out intravenous administrations of novocaine or juxtaspinal blockade with novocaine at the level of defeat. Depending on an etiology of a ganglioneuritis appoint the therapy directed against infectious process. At virus character of a ganglioneuritis use antiviral drugs and gamma-globulin, at bacterial — antibiotics.
If the ganglioneuritis is followed by increase in activity of a sympathetic nervous system, then according to indications include ganglioblokator, cholinolytics, spasmolysants and neuroleptics in its treatment. Purpose of antihistaminic drugs as they also have cholinolytic effect is possible. If the ganglioneuritis proceeds with decrease of the activity of sympathetic system, then its treatment is supplemented with cholinomimetic drugs, a gluconate and calcium chloride.
In complex therapy of a ganglioneuritis physiotherapeutic procedures are actively applied: erythema doses of Ural federal district, an electrophoresis of Gangleronum, pyramidon, novocaine, potassium iodide on area inflamed ганглиев, diadynamotherapy (DDT), the general radonic bathtubs, mud applications.
The ganglioneuritis with a resistant pain syndrome, not stopped complex conservative treatment, is the indication for carrying out a sympathectomy — surgical removal of the struck sympathetic ganglion. Depending on a type of a ganglioneuritis the cervical and chest sympathectomy, a lumbar sympathectomy is carried out. At a chest ganglioneuritis perhaps carrying out a torakoskopichesky sympathectomy, at a lumbar ganglioneuritis — laparoscopic. Use of such endoscopic methods of a sympathectomy is the least invasive way of surgical treatment of a ganglioneuritis.