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Diseases of the autonomic nervous system can be caused by damage to its various departments, ranging from peripheral autonomic nerve fibers to the cerebral cortex. For diseases of the autonomic nervous system, it is characteristic that most of them are caused not by loss of function, but by irritation and increased excitability of certain departments.

Migraine. This disease refers to angioneurosis. It is based on a periodically occurring spasm of the cerebral vessels in the basin of the internal carotid artery. As a result, blood from the common carotid artery rushes into the pool of the external carotid artery, causing stretching of its walls and pain in the corresponding half of the head. In other cases, a spasm occurs in the pool of the external carotid artery and the walls of the internal carotid artery are stretched.

Clinically, migraine is manifested by periodically occurring pain in one half of the head. Migraine is more likely to affect women. Seizures begin from a young age, in the menopause the seizures weaken or completely cease. There is an “accumulation" of migraine cases in individual families, more often along the female side. Migraine attacks can be triggered by disturbed sleep patterns, mental stress, alcohol, excitement, various smells, and stay in a stuffy room. Often attacks of pain are accompanied by objective neurological disorders, depending on the nature of which several forms of migraine are distinguished. V Simple migraine. It manifests itself as bouts of headache, which begins in the temple area and gradually spreads to the entire half of the head. The attack lasts several hours and passes gradually. During an attack, patients have an increased sensitivity to light irritations. Nausea, vomiting may occur, and at the end of the attack - polyuria. On palpation during an attack of the temporal artery, its tension and pain are noted.

Associated Migraine In the midst of an attack of a headache or in front of it, patients have transient focal neurological disorders (aphasia, hemiparesis, hemianesthesia, etc.). In some cases, visual or oculomotor disorders appear (ophthalmic and ophthalpoplegic forms of migraine). In the ophthalmic form, the attack begins with the loss of parts of the field of vision (scotomas or hemianopsia), then they pass and the usual migraine headache attack begins. With an ophthalmoplegic form of migraine against the background of a headache, patients have paresis of the oculomotor muscles, which is manifested by double vision, transient strabismus.

Abdominal migraine is characterized by paroxysmal abdominal pain, accompanied by vomiting and polyuria.

Treatment. Outside of an attack, general strengthening treatment (pantocrine, phosphates, iron preparation, etc.), general health procedures (rational work, rest, nutrition, sports, tourism) are recommended; dihydroergotamine, tranquilizers, valerian preparations are prescribed, as well as galvanization of the cervical sympathetic nodes, hydroprocedures, massage, acupuncture.

During the attack, acetylsalicylic acid, caffeine, ergot derivatives, analgin, antihistamines, barbiturates, vasodilators are prescribed (vasoconstrictors are effective at the height of the attack). The attack is alleviated by applying heat (less often - cold) to the head, washing the head with hot water, pulling the head in a handkerchief, hot foot baths, mustard plasters on the back of the head and calf muscles. Treating a migraine attack is more effective if started at the precursor stage.

Raynaud's disease refers to angiotrophoneurosis. The basis of this disease are spastic vasomotor disorders. Raynaud's disease is manifested periodically by the onset of spasms of the vessels of the fingers, less often the legs, auricles, and tip of the nose. Then comes their constant redness, blueness and trophic disorders. Three are distinguished during the course of the disease.


The angioneurotic stage is characterized by spasm of blood vessels, accompanied by pallor of the fingers (a symptom of a “dead finger”) and hands, their cooling, paresthesias, pain, and a decrease in sensitivity. Upon cessation of the spasm, cyanosis occurs, and then hyperemia, the pain passes and the fingers become warm. The same thing happens with the auricle, nose, if the disease begins with these organs. The frequency of attacks and their duration in different patients are different: most often each phase of a typical attack lasts several minutes, as the disease progresses, the duration and frequency of attacks increase.

Stage of local asphyxiation. Patients have venous congestion, accompanied by blueness of the skin of the affected areas. Paresthesia and pain are more pronounced and more persistent, the skin becomes dry, cold.

The stage of necrosis is characterized by necrosis of the distal fingers (skin and deeper tissues).

When treating patients in the first stages of the disease, it is necessary to prescribe adrenolytic and vasodilator drugs, ganglion blockers and tranquilizers, thermal procedures (four-chamber baths, etc.). In some cases, surgery on the sympathetic nervous system is effective (desympatization and preganglionic sympathectomy). In the third stage of the disease, surgical removal of necrotic tissue, prophylactic use of antibiotics is necessary. Patients with Raynaud's disease should not smoke, drink alcohol, be cold, or overwork physically.

Quincke's edema is a disease related to angioneurosis and is manifested by rapidly onset edema of limited areas of the skin, mucous membranes of the respiratory tract or the alimentary canal. Swelling lasts several hours or days, after the disappearance in its place itching is noted. Swelling of the laryngeal mucosa can lead to asphyxiation. Soft tissue edema is caused by increased permeability of the vascular wall. In the family history of patients with Quincke's edema, allergic diseases are noted. In some cases, the dominant-hereditary nature of the disease is established, due to a special biochemical anomaly that affects the permeability of the vascular wall.

In the treatment of patients with Quincke's edema, desensitizing therapy is prescribed, drugs that increase the tone of the sympathetic and decrease the tone of the parasympathetic parts of the autonomic nervous system, diuretics, and in severe cases, corticosteroid drugs.

Meniere's disease is a type of angioneurosis, in which vasomotor disturbances are observed in the inner ear, leading to an increase in endolymph in it, the acute development of a vodka of the endolymphatic sac of the vestibular apparatus and its sharp irritation. An important role in the pathogenesis of the disease is played by autonomic dysfunction, often manifested by an increase in the tone of the parasympathetic part of the autonomic nervous system. Meniere's disease is manifested by attacks of vestibular disorders: dizziness, vomiting, bradycardia, ataxia, noise in the ear, cold sweat, pallor of the face.

Treatment. During the attack, the patient must be given a horizontal position with a raised head, hot foot baths, leeches on the mastoid processes, anticholinergic, sedatives. Between seizures, dehydration therapy, anticholinergics, physiotherapy exercises for training the vestibular apparatus are recommended; in severe cases, complete or partial transection of the VIII nerve. ^ Acroparesthesia - angioneurosis, manifested by attacks of paresthesia, hypesthesia, cyanosis of the hands, lower skin temperature, myalgia as a result of spasm of the vessels of the distal extremities. The disease occurs in the winter months. More often women are sick during menopause or with dystyroidism. The provoking factors of acroparesthesia are muscle tension, prolonged monotonous work, weight lifting. The lower limbs are usually not affected. The disease is caused by a violation of the tone of the upper extremities and can be considered as a sensitive-sympathetic syndrome.

During treatment, vasodilator drugs, ganglion blockers, bromine, acetylcholine, warm baths (general and local), massage, physiotherapy exercises, diathermy (local and segmental) are prescribed.

Erythromelalgia occurs as a result of an acute disorder of the vascular innervation of capillaries, arterioles and veins of the lower extremities. Clinically, this disease is manifested by bouts of burning pain, usually in the feet and less commonly in the legs and hips. In this case, the feet turn red, the skin becomes hot to the touch, the feet swell, the veins expand, the arteries pulsate.
The disease manifests itself in the spring and summer months. Pain often occurs in the evening or at night, it intensifies with warming of the legs, when walking and standing, with mechanical irritations and decreases with cooling. Attacks can last several hours and days. Erythromelalgia is caused by damage to the lateral horns of the spinal cord and is often associated with syringomyelia, myelitis.

During treatment, vasoconstrictive and hormonal drugs, acetylcholine, intravenous novocaine infusion are prescribed. In some cases, they resort to surgical intervention (transection of the posterior roots, resection of the lumbosacral part of the border sympathetic trunk - in order to interrupt the vasodilating fibers that go to the affected limb).

Sympathy is a pain associated with damage to the sympathetic structures: sympathetic nodes, connective branches, plexuses, nerves, sympathetic fibers in mixed nerves (sciatic, median, trigeminal, etc.). Most often, sympatheticgia is localized on the limbs and in the face. With sympathalgia, pain appears along the corresponding nerve and is of a special nature: it is diffuse, and not localized along the nerve, has the nature of causalgia and is accompanied by emotional disturbances in the form of depression. The intensity of pain is influenced by climatic, temperature and atmospheric factors. Often the pain intensifies at rest and decreases with movement. With pressure on the nerve trunks, pain occurs not only in the place of pressure, but spreads diffusely throughout the nerve. Tendon reflexes with sympathalgia are increased. Pain along the vessels is noted, trophic disorders are observed in the form of dry skin, peeling, hypo- or hypertrichosis, brittle nails, changes in skin color and temperature.

Ganglionitis. The defeat of the individual nodes of the sympathetic trunk is manifested by vasomotor, secretory, pilomotor and trophic disorders in the corresponding areas, impaired function of internal organs, decreased pain sensitivity, symptoms of hyperpathy, decreased tendon reflexes, emotional disorders.

Lesion of the upper cervical sympathetic ganglion is manifested by Bernard-Horner syndrome, impaired sweating on the corresponding half of the face, vasodilatation of the skin of the face and conjunctiva, increased skin temperature in this area, decreased intraocular pressure, aphonia and hoarseness due to impaired muscle tone of the larynx, and a change in EEG by side of defeat. Irritation of this node often simulates hyperthyroidism.

The defeat of the stellate node is manifested by pain in the corresponding half of the chest (in the form of a “half jacket”), giving in the arm and simulating an attack of angina pectoris.

Along with the defeat of the nodes of the sympathetic trunk, there is a lesion of nodes, which include cells and fibers of the sympathetic, parasympathetic and somatic fibers, most often these are pterygopalatine and cranked nodes.

Pterygopalatine neuralgia (Slyder syndrome) is manifested by bouts of pain, accompanied by autonomic disorders. The pain is localized in the eye, nose, upper jaw and teeth. Vegetative disorders are manifested by conjunctival hyperemia, hypersalivation, lacrimation, swelling of the nasal mucosa, rhinorrhea. Attacks often occur at night and are causal in nature. After the attack, hyperpathy is noted in the areas of pain localization. Pain can radiate to the tongue and palate, temporal region, neck, ear and region behind the mastoid process, into the arm, half of the chest. Often it is accompanied by convulsions of muscles that raise the soft palate, which is accompanied by certain sounds. Attacks can be complicated by shortness of breath, nausea, photophobia. Slyder's syndrome is more often observed in elderly people and, as a rule, arises as a result of inflammatory or neoplastic processes in the main or ethmoid sinuses.

Cranial neuralgia. The pain begins with the ear, is paroxysmal in nature and spreads to the face, nape, neck. Often, patients have herpetic eruptions in the area of ​​the external auditory canal. Often the facial nerve is also involved in the process, which is manifested by paresis or paralysis of the muscles of the corresponding half of the face.

Since there is an anatomical connection between the indicated nodes and the nodes of the sympathetic trunk, the pain in the Slyder syndrome and cranial node neuralgia can spread to more distant parts of the body or half of the body.

Gangliotruncite. The defeat of the individual nodes of the sympathetic chain is rare. More often, several nodes of one or the other side or the whole chain are involved in the process.

Damage to the nodes of the thoracic sympathetic trunk leads to impaired lung function and unstretched intestinal muscles. Diagnosis of the disease of this section of the sympathetic trunk is very difficult and represents the borderline area between neurology, therapy and surgery.

With damage to the lumbar nodes, a violation of the sympathetic innervation of the lower extremities occurs, manifested by vascular and trophic disorders.

The defeat of the celiac (solar) plexus (solar plexitis, or tanning bed) is manifested by boring, periodically repeated pain in the epigastric region (“solar nail”). Pain is noted with pressure along the midline of the abdomen between the navel and the xiphoid process. Often the functions of the alimentary canal are disturbed.

Treatment of solaritis must be carried out taking into account etiological factors (infectious, toxic solaritis, symptomatic plexitis due to diseases of the abdominal organs). To eliminate pain attacks, spasmolytic drugs, ganglion blockers, antipsychotics, salicylates, amidopyrine, intravenous administration of novocaine are prescribed. Physiotherapeutic treatment is widely used: electrophoresis with novocaine or amidopyrine to the epigastric region, transverse diathermy, mud applications, ultraviolet irradiation, with persistent pain - x-ray therapy. General effects on the nervous system are also needed - sedatives, climatotherapy, sea bathing, hydrotherapy.

Hypothalamic syndromes are symptom complexes of vegetative-endocrine-trophic disorders resulting from damage to the hypothalamic-pituitary region. The peculiarity of the vascularization of the hypothalamus compared with other areas of the brain is the intensity of capillary blood supply and the high permeability of its vessels for large molecular compounds (infectious agents, toxins, hormones and other humoral substances). This explains the high sensitivity of the hypothalamus to various physiological and pathological effects and its high vulnerability.

The most common are the following hypothalamic syndromes.

The syndrome of paroxysmal wakefulness disorders manifests itself in the form of paroxysmal or permanent hypersomnia, narcolepsy and in other forms of pathological drowsiness, hypnophrenia (split sleep). This syndrome occurs as a result of damage to the reticular formation of the hypothalamus.

Neuroendocrine syndrome is most often manifested by Itsenko-Cushing's syndrome, adiposogenital dystrophy, genital gland dysfunction, and diabetes insipidus. Neuroendocrine syndrome is associated with dysfunction of many endocrine glands as a result of damage to the anterior and intermediate groups of the hypothalamic nuclei.

Vegetative-vascular syndrome, manifested by autonomic sympathicotonic or vagotonic crises, or a combination thereof, is most common.

Neurotrophic syndrome is manifested by trophic disorders of the skin (itching, dryness, neurodermatitis, scleroderma, bedsores), muscles (neuromyositis, dermatomyositis), damage to internal organs (ulcers and bleeding along the food canal), bones (osteomalacia, sclerosis). This syndrome is most often associated with damage to the intermediate hypothalamic region.

Neuromuscular syndrome is manifested by periodic myasthenic or myotonic disorders, as well as paroxysmal paresis. Often there is a combination of different types of muscle disorders.

Neurotic syndrome occurs as a result of a disorder in the normal interaction between the cortex and the subcortex and is manifested by irritability, irritability, weakness, sleep disturbance, anxiety, and autonomic disorders.
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