In an adult, a normal heartbeat frequency is within 65-80 shots per minute. Heartbeat demolition less than 60 shots for a minute call bradycardia. There are many reasons leading to bradycardia, which only a doctor can be determined from a person.
Regulation of heart activity
In physiology, it is distinguished by such a concept as a heart rate. This means that the heart is reduced by the influence of pulses arising directly in it itself, primarily in the sinus node. These are special neuromuscular fibers located in the plot of the hollow vein in the right atrium. The sinus unit produces a bioelectric impulse, which further applies to the atria and reaches an atrioventricular node. This reduces the heart muscle. The influence and conductivity of myocardium affects the neurohumoral factors.
Bradycardia can develop in two cases. First of all, a decrease in the activity of the sinus node leads to a decrease in the heart of the sinus unit when it generates little electrical impulses. This bradycardia is called sine . And there is such a situation where the sinus node works normally, but the electrical impulse can not pass full on the conductive paths and the heartbeat is cut.
Causes of physiological bradycardia
Bradycardia is not always a sign of pathology, it can be physiological . So, athletes often marked the small frequency of heart abbreviations. This is the result of permanent loads on the heart with long workouts. How to understand is bradycardia norm or pathology? A person needs to perform active exercise. In healthy people, physical activity leads to intensive healing of heartbeat. In violation of the excitability and conductivity of the heart, the performance of physical exercises is accompanied by only a minor increase in heart rate.
In addition, the heartbeat is also replenished with the body. This is a compensatory mechanism, which slows down blood circulation and blood is directed from the skin to the internal organs.
The activities of the sinus node affect the nervous system. Parasympathetic nervous system reduces heartbeat, sympathetic - increases. Thus, the stimulation of the parasympathetic nervous system leads to a gentle reduction. This is a well-known medical phenomenon with which, by the way, many people face in life. So, when pressed to the eye, stimulation of the wandering nerve (the main nerve of the parasympathetic nervous system) is carried out. As a result, the heartbeat on eight or ten blows per minute is briefly incremented. The same effect can be achieved by pressing the area of \u200b\u200bcarotid sinus on the neck. Stimulation of carotid sinus may occur when wearing a tight collar, a tie.
Causes of pathological bradycardia
Bradycardia can develop when exposed to a wide variety of factors. The most common causes of pathological bradycardia are:
- Increased tone of the parasympathetic system;
- Heart disease;
- Reception certain medicines (cardiac glycosides, as well as beta adrenoblockers, blockers calcium canals);
- (FOS, lead, nicotine).
Increased tone of the parasympathetic system
Parasympathetic myocardial innervation is carried out at the expense of a wandering nerve. When it is activated, the heartbeat is cut. There are pathological conditions in which irritation of the vagus nerve is observed (its fibers located in the internal organs, or nuclei of the nerves in the brain).
The increase in the tone of the parasympathetic nervous system is observed in case of such diseases:
- (on the background of the cranial injury, hemorrhagic stroke, brain edema);
- Neoplasms in the mediastinum;
- Cardiopsychoneurosis;
- Condition after operation in the head area, as well as neck, mediastinum.
As soon as the factor stimulating the parasympathetic nervous system will be eliminated, the heartbeat is normalized. This type of bradycardia doctors define as neurogenic.
Diseases of the heart
Heart disease (cardiosclerosis, myocarditis) lead to the development of certain changes in myocardium. In this case, the pulse from the sinus node passes much more slowly in the pathologically modified section of the conductive system, which is why the heartbeat is cut.
When a violation of the electrical pulse is localized in an atrioventricular node, they say the development of an atrioventricular blockade (AV blockade).
Symptoms of bradycardia
A moderate reduction in heart rate does not affect the state of a person, he feels well and engaged in familiar business. But with a further decrease in the heart rate, blood circulation is broken. The organs in an insufficient volume of blood supply and suffer from lack of oxygen. Especially sensitive to hypoxia brain. Therefore, when bradycardia, the symptoms from the damage to the nervous system are at the forefront.
Upon attacks of bradycardia, a person is experiencing weakness. Also characteristic pre-corrupt states and. Skin pale. Often, shortness of breath is developing, as a rule, against the background of physical exertion.
At heart rate, less than 40 shots for a minute, blood circulation is significantly disturbed. In slower bloodstream, myocardia does not receive oxygen in due measure. As a result, zealous pain arises. This is a kind of heart signal that he lacks oxygen.
Diagnostics
In order to reveal the cause of bradycardia, it is necessary to undergo a survey. First of all, you should pass. This method is based on the study of the passage of the bioelectric pulse in the heart. So, for sinus bradycardia (When the sinus node rarely generates a pulse), there is a decrease in the heart rate while maintaining a normal sinus rhythm.
The appearance of such signs on an electrocardiogram as an increase in the duration of the P-Q interval, as well as the deformation of the ventricular QRS complex, its loss of the rhythm, greater number of atrial cuts, rather than the number of QRS complexes will indicate the availability of AV blockade in humans.
If bradycardia is observed, and in the form of attacks - shown. This will obtain data on the functioning of the heart for twenty-four hours.
To clarify the diagnosis, the detection of the cause of bradycardia, the doctor may prescribe the patient to pass the following studies:
- Echocardiography;
- Determination of blood content;
- Analysis for toxins.
Bradycardia treatment
Physiological bradycardia does not require any treatment, like bradycardia that does not affect overall well-being. The therapy of pathological bradycardia is proceeded after clarifying the cause. The principle of treatment is to impact on the root cause, against the background of which the heart rate is normalized.
Medical therapy is to appoint medications that increase heart rate. These are such medicines as:
- Izadrin;
- Atropine;
- Isoprenaline;
- Eufilin.
The use of these drugs has its own characteristics, and therefore only a doctor can be assigned.
In the occurrence of hemodynamic disorders (weakness, quick fatigue, dizziness), the doctor can attribute to the patient tonic drugs: tincture of ginseng, caffeine. These drugs accelerate the heart rate and increase blood pressure.
When a person registered pronounced bradycardia and, on this background, heart failure is developing - resort to implantation in the heart of the pacemaker. This device independently generates electrical impulses. Stable given heart rhythm favors the restoration of adequate hemodynamics.
G. Valeria, Medical Observer
Under the influence of the autonomic nervous system, a complex process of regulating all internal processes of the body occurs. Vegetative (autonomous) nervous system ensures the constancy of the body's interior. Vegetative-naughty influences apply to all organs and tissues. The term "vegetative (autonomous) nervous system reflects the control of the involuntary functions of the body. The autonomous nervous system is depending on the highest centers of the nervous system. It is distinguished by the sympathetic and parasympathetic parts of the autonomic nervous system. The main difference is in functional innervation and is determined by the attitude to the means affecting the autonomous nervous system. The sympathetic part is excited by adrenaline, and parasympathetic - acetylcholine. Hergotamine has a slowing effect on the sympathetic part, and at the parasympathetic - atropine.
Sympathetic department Vegetative nervous system
The main formations of the sympathetic part are mainly located in the cerebral cortex, as well as in the spinal cord (in lateral horns). In the spinal cord from lateral horns begin the peripheral formations of the sympathetic department of the vegetative nervous system. The sympathetic trunk is located along the side surface of the spinal column. The sympathetic trunk has 24 pairs of sympathetic nodes.
Parasympathetic part of the vegetative nervous system
The formation of the parasympathetic part begins from the cortex of the brain. The craniobulbar department is isolated in the brain and sacral - in the spinal cord. In the craneobulbar department distinguish:
1) a system of visceral nuclei (III of the nerve), namely, the paired small cell kernels that are related to the innervation of the pupil (smooth muscle), and the unpaired small-cell accommodation core, which ensures the innervation of the smooth muscle - in the bottom of the Silviev of the water pipeline, in front of the foam-hearths;
2) secretory tears-separating cells in the system of facial nerve nuclei (VII nerve) located in the Varolirei Bridge;
3) secretory salivatogenic core in the language of the language nerve (IX nerve) - for easy gland and XIII nerve - for the submandibular and sub-speaking salivary glands - in oblong brain;
4) Visceral nuclei of a wandering nerve in the oblong brain, which innervate the heart, bronchi, gastrointestinal tract, digestive glands, as well as other internal organs.
Features of vegetative innervation
All organs of our body are influenced by the autonomic nervous system (both parts). The sympathetic part changes the functional abilities of the organs. Both parts of the vegetative nervous system are interconnected with each other. But there are states when one part of the system prevails over the other. Vagotonia (the predominance of the parasympathetic part) is characterized by narrow pupils, wet, blue skin, bradycardia, reduced blood pressure, mounted (asthmatic) breathing, abundant salivation, increased acidity of gastric juice, inclinations to esophagus, stomach, spastic constipation, replacing diarrhea, reduced exchange substances, a tendency to obesity. The state of Vagotonia is characteristic, for example, for sleeping. Sympathicotonium (the predominance of the sympathetic part) is characterized by shiny, convex, with wide pupils with eyes; pale, dry, with inclinations to skin pilooer; tachycardia, increased blood pressure, free breathing; dry mouth, ahilia, expansion of the stomach, atonic constipation; A lively metabolic exchange, tendency to evil. The condition of sympathetic is characteristic, for example, for affective states (fear, anger, etc.).
How does the autonomic nervous system affect the organism. Possible states in which the activities of individual organs or systems of the body are disturbed as a result of the predominance of the tone of one of the parts of the vegetative nervous system. Vago-tonic crises are, for example, bronchial asthma, urticaria, swelling of Quincke, vasomotor rhinitis, sea disease, sympathicotonic - vessels of vessels in the form of symmetric acroasfycia, migraine, intelligible chromotype, Resei disease, transient form hypertensive disease, cardiovascular crises in hypothalamic syndrome, ganglionary lesions.
Methods for studying the vegetative (autonomous) nervous system
The study of vegetative innervation is based primarily on the assessment of the condition and functions of the respective bodies and systems. There are many clinical and laboratory methods Studies of the vegetative nervous system. The choice of technique is determined in accordance with the task and conditions of the study. However, in all cases it is necessary to take into account the initial state vegetative tonus. The study is best carried out in the morning on an empty stomach or 2h after meals, at the same time, at least 3 times. At the same time, the initial value takes the minimum value of the data obtained.
Great practical value and application have clinical, clinical and physiological and biochemical research methods.
The big group is made Skin vegetative reflexes and Samples.
Local dermographicism - The reaction of skin capillaries in the form of leather reddening, which is caused by a hammer with a pressure handle. Most often, a red strip occurs on the place of irritation, its width depends on the state of the vegetative nervous system. Of particular importance is too long (resistant) dermographism, it can be evaluated as the predominance of the excitability of vessels of the skin.
An even more convincing sign of such an excitability (parasympathetic) is a sublime dermographism, when a roller skin roller is formed after the stroke. The manifestation of increased vasocamatic excitability (sympathetic) is a white dermographism (spasm). The nature of the local dermographist depends on the degree of pressing during barn irritation and from the area of \u200b\u200bthe skin surface. For example, weak irritations usually cause only white dermographism. It is especially expressed on the skin of the lower extremities. The reaction of local dermographs can only be used to determine the tone of the sympathetic or parasympathetic part of the autonomic nervous system.
How does the autonomic nervous system affect the organism. Reflex dermographicism caused by irritation with an acute object (spend on the skin the edges of the pin or needle). The reflex arc of such dermographs is closed in the segmental apparatus of the spinal cord. After some time, after exposure, a strip with festral uneven edges of various widths occurs, which holds for a few seconds. The reflex dermographism disappears with the defeats of the rear roots of the spinal cord, as well as the front roots and the spinal nerves at the lesion level. Above and below the innervation zone, the reflex is usually preserved. The so-called mustard sample can be recommended: finely cut strips of mustard pieces are superimposed with a long narrow strip from top to bottom within the alleged level of the lesion: the changes correspond to the readings of the reflex dermograph (but it is not always accurate).
Pilomotor (Pilotroacent) Reflexes The skin is caused by plumbing or cold (ice, ether) skin irritation, most often in the nape area. "Goose skin" (spinal reflex) should be considered as a reflex sympathetic. Piloarrection, especially in the cold room, arises normally. Pilot reflexes may have a foddiagnostic value. In transverse damage to the spinal cord, sawline reflexes during irritation at the top do not apply below the segment conservation zones (in this way, the upper boundary of the lesion can be determined); When irritating at the bottom (in the area below the lesion), the pailarrection applies up only to the affected segments (i.e., you can define the lower boundary of the lesion). In the area of \u200b\u200bthe affected segments of the spinal cord, the sawotor reflex is missing.
Both dermographism and pailarrection, not always definitely determine the boundaries of the lesion.
Sweat reflexes Skin have a large diagnostic value. Sweet glands have only sympathetic innervation. The sweating mechanism is different. Disruptions of sweat and telly reflex may occur at various localization of the painful process.
Aspirinic test (with a glass of hot tea gives 1.0g acetylsalicylic acid) causes diffuse sweating. In case of cortical lesions, a monoplegic type of lack of or lowering sweating occurs, with damage to the dience-phalochic, hypothalamic region - hemiplegic.
Warming The studied causes spinal sweat reflexes (by cells of the side horns of the spinal cord). With the damage to the segmental centers of the spinal cord, the patient warming, as well as aspiric sample, state the absence or decrease in sweating on the corresponding zones.
Sample with pylocarpin (subcutaneously patient introduced 1 ml of a 1% solution of salt-sized pilocarpine). The absence or reduction of sweating indicates a damage to the peripheral nervous system.
Best way definitions of sweating and sections of his violation is MINORA METHOD. The skin of the patient is covered with iodine solution in a mixture with alcohol and castor oil. After some time, after drying, the skin is evenly sprinkled with starch powder. Then the flow rate is then caused by various ways, as a result of the connection of iodine with starch in places of sweating, intensive blue-violet, sometimes even black staining is formed. In those areas on which the sweating did not occur, staining is not formed. The results are photographed or sketched.
Another method of determining sweating (humidity) of the skin - Electrometric. At the same time, the method is used by a fairly common apparatus N. I. Mesto. With this method, the zones of disturbed sweating are harder.
Interesting, but difficult and difficult to assess the results obtained is Method of electrical resistance. Skin electrical conductivity is determined by a number of factors: humidity, i.e. Skin sweating, vessel state, degree of hydrophilicity of the skin, etc. An increase in electrical resistance should be considered as a manifestation in the test area of \u200b\u200bthe predominance of the tone of sympathetic innervation.
Among skin samples is a large distribution has a study Skin temperature. This test is of particular importance in overall assessment Visceral innervation, tone and its stability. The temperature constant is ensured by the regulatory influence of cerebral visceral centers. In addition to specially adapted for quick and accurate measurements of the skin temperature of any areas of the skin of mercury thermometers, in lately An electrometric method (thermocouple) is increasingly used, which provides the device N. N. Mischik (Combined PC-5 apparatus).
Skin temperature reflects the condition of blood supply to the skin, which is an important indicator of vegetative innervation. Skin asymmetries (type of hemisindrome) exceeding 1 ° C are observed with one-sided lesions of the hypothalamic region. There are territorial changes in temperature during focal lesions of the bark of large hemispheres - cerebral hemipelies.
Definition also refers to skin samples Skin Sensitivity K. ultraviolet rays by determining biodozness, i.e. The establishment of the minimal degree of exposure to the rays at which redness comes.
To ensure the standard, constant irradiation conditions are applied. As a control, the results of irradiation in the same conditions of symmetric, "healthy" territory are usually taken into account. Redness arises by the reflex mechanism: histamine or histamic substances are formed in the skin when irradiated. Early appearance and intensity of redness is regarded as a parasympathetic effect, a delay in the occurrence, a weak intensity of erythema (redness) - as sympathetic. This method is widely used for topical diagnostics: very clear data is obtained by damage to peripheral nerves; Asymmetry occurs under cerebral hemipelies, diancephal and spinal lesions.
For research Hydroid Skin intracudinoously introduces 0.2 ml of physiological solution and take into account the time of the resorption of the resulting papulus. On the different sites Skin resorption speed is different. On average, it is equal to 50-90min. This test is distinguished by significant sensitivity (as well as electrical resistance); Using the results of this test for evaluation general status and lesions of the nervous system requires caution, since the hydrophilicity of tissues varies significantly, for example, with feverish states, edema, cardiovascular disorders, etc.
Skin samples include the study of local reactions to Sympathicotropic and Vagotropic Substances. Sympathicotropic is attributed to adrenaline (administered in a solution of 1: 1000 in an amount of 0.1 ml intracudino). At the injection site for 5-10min, there is a spot of pale and sawing ("goose skin"), which is surrounded by a red border of various sizes and intensity. With great severity and the duration of the reaction, it is concluded about the sympathetic effect.
Acetylcholine is used as a vagotropic (parasympaticotropic) substance (intradermal 0.1 ml of solution 1: 10,000) is used. At the injection site, a pale papule with a reddish border appears; After some time, the redness area increases to a maximum and after 15-25min completely disappears. The large intensity of the reaction is regarded as a parasympathetic effect.
Pretty widespread in clinical practice Received research Cardiovascular reflexes.
Hydraulic Reflex - The studied lies on the back in a free position, after some time he considers the pulse. After that, pressure is performed, it is better for both eyeballs at the same time large and index fingers hands. Pressure is recommended not to produce not on the front chamber, but on the side departments of the eyeball, and it should be quite intense, but not painful. After 20-30 ° C, not stopping pressure, the pulse is considered for 20-30 s. Pulse frequency is compared before and after pressure. Normally occurs a slight deceleration of the pulse (up to 10 beats). A large slowdown is regarded as a vagotonic effect, lack of deceleration or paradoxical acceleration - as sympathetic.
Cervical reflex caused by pressure big finger On the area of \u200b\u200bthe Kepenti from the breast-curable-nose muscles, at the level of its upper third, below the angle of the lower jaw - to the sensation of ripples sleepy artery. Normally, the pulse is slowed down by 6-12 beats in 1min. High degree slowdowns, as well as a change in breathing, intestinal peristaltics And other signs are regarded as a manifestation of an increased tone of a wandering nerve system.
Epigastric (sunshine) reflex caused by the position of the studied on his back with the maximum relaxed muscles of the abdominal press; Blood pressure and pulse are measured. With the help of fingers, pressing the area between the sword-shaped process and the navel, gradually reinforcing the pressure to the sensation of the clear ripple of the abdominal aorta. As a result, the pulse slows down and the decrease in blood pressure; The sharp degree of these reflex phenomena is regarded as an indicator of increased excitability of the parasympathetic department. Sometimes simultaneously there are sympathetic order reflexes - the expansion of pupils, etc. This is explained by the presence in sunny plexus both sympathetic and parasympathetic innervations.
How does the autonomic nervous system affect the organism
In the study of the vegetative nervous system, various hormonal studies are carried out due to the possibility of developing neuroendocrine disorders. A number of studies are also conducted on the definition of the emotional and personal characteristics of a person to determine its mental state.
A detailed study of changes in vegetative innervation in diseases of internal organs can help exact diagnosis and determine the area for the use of reflex therapy.
Violations of the functions of the vegetative nervous system are usually available in the clinic of each disease of the nervous system. But there are diseases in which vegetative disorders are leading. They are due to the defeat of the vegetative formations of the nervous system. Eliminate forms of diseases depending on the level of damage to the autonomic nervous system.
Based on the anatomical functional data, the nervous system is made to divide the somatic responsible for the relationship of the body with an external environment, and vegetative, or plant, regulating the physiological processes of the inner environment of the body, ensuring its constancy and adequate reactions to the impact external environment. VNS is visible for animals and vegetable organisms by energy, trophic, adaptation and protective functions. In the aspect of evolutionary vegetacy, it is a complex biosystem providing conditions for maintaining the existence and development of the body as an independent individual and to adapt it to the environment.
VNS innervates not only internal organs, but also organs of feelings and muscular system. Research L. A. Orbel and his schools, the doctrine on the adaptive-trophic role of the sympathetic nervous system showed that the vegetative and somatic nervous system are in constant interaction. In the body, they are so closely intertwined among themselves, that it is sometimes impossible to divide them. This can be seen on the example of a pupil reaction to light. The perception and transmission of light irritation are carried out by a somatic (visual) nerve, and the narrowing of the pupil - due to vegetative, parasympathetic fibers of the glasses. When using an optical-vegetative system, the light has its own direct effect on the vegetative centers of the hypothalamus and pituitary, and the pituitary centers (i.e., you can speak not only about the visual, but also photographetative function of the eye).
Anatomical difference of the structure of the vegetative nervous system is that the nerve fibers do not go from the spinal cord or the corresponding nucleus cranial nerve Directly to the working body, as somatic, and interrupted in the nodes of the sympathetic barrel and other NATOSS, the diffuseness of the reaction is created during irritation of one or more pre-glyonary fibers.
The reflex arcs of the sympathetic department of the VNS can be closed both in the spinal cord and in nodes.
An important distinction of VNS from somatic is the structure of fibers. Vegetative nerve fibers Thinnomy somatic coated with a thin myelin shell or do not have it (silent or cinema fibers). The pulse on such fibers occurs significantly more slowly than in somatic: on average 0.4-0.5 m / s in sympathetic and 10.0-20.0 m / s - on parasympathetic. Several fibers can be surrounded by one Schwan shell, so the excitation can be transmitted by cable type, i.e., the excitation wave running over one fiber can be transmitted to the fibers at the moment alone. As a result of this, a diffuse excitation of a nervous impulse comes to the end point of the destination of the nervous pulse in many nervous fibers. The direct transmission of the pulse via the immediate contact of nonimeelinized fibers is allowed.
The main biological function of VNS - trophoinnergetic is divided into histotropic, trophic - to maintain a certain structure of organs and tissues and ergotropic - to deploy their optimal activities.
If the trophhotropic function is aimed at maintaining the dynamic constancy of the inner environment of the organism, then the ergotropic-on vegetative-metabolic support various shapes Adaptive targeted behavior (mental and physical activity, the sale of biological motivation - food, sexual, motivation of fear and aggression, adaptation to changing conditions of the external environment).
VNS implements its functions mainly by the following paths: 1) regional change in vascular tone; 2) adaption-trophic effect; 3) control of the functions of internal organs.
The VNS is divided into sympathetic primarily mobilizing in the implementation of the ergotropic function, and parasympathetic, more directed to maintain homeostatic equilibrium - trophhotropic function.
These two VNS departments, functioning mostly antagonistically, provide, as a rule, dual innervation of the body.
The parasympathetic department of VNS is more ancient. It regulates the activities of the organs responsible for the standard properties of the inner medium. The sympathetic department develops later. It changes the standard conditions of the internal environment and organs in relation to the functions performed. The sympathetic nervous system inhibits the anabolic processes and activates the catabolic, and parasympathetic, on the contrary, stimulates anabolic and brakes the catabolic processes.
The sympathetic department of VNS is widely represented in all organs. Therefore, the processes in various organs and systems of the body are reflected in the sympathetic nervous system. Its function depends on the CNS, the endocrine system, the processes occurring on the periphery and in the visceral sphere, and therefore its tone is unstable, requires constant adaptive-compensatory reactions.
The parasympathetic department is more autonomous and is not in such a close dependence on central nervous and endocrine systems, as sympathetic. It should be mentioned about the associated with a whole-biodical exogenous rhythm functional predominance at a certain time of a particular department of VNS, during the day, for example, - sympathetic, at night - parasympathetic. In general, the operation of the VNS is characterized by frequency, which is associated, in particular, with seasonal changes in nutrition, the number of vitamins entering the body, as well as light irritation. Changing the functions of the organs innervirored VNS, can be obtained, irritating the nerve fibers of this system, as well as under the action of certain chemical substances. Some of them (choline, acetylcholine, physostigmine) reproduce parasympathetic effects, others (Noradrenalin, Meston, Adrenaline, Ephedrine) - sympathetic. The substances of the first group are called parasympathetiants, and the substances of the second group - sympathomimetics. In this regard, the parasympathetic VNS is called another cholinergic, and the sympathetic - adrenergic. Different substances influence various VNS departments.
In exercise specific functions The VNS is of great importance to its synapses.
Vegetative system S. endocrine glares On the one hand, it innervates glands internal secretion And regulates their activities, on the other, the hormones released by the glands of internal secretion have an regulating effect on the TONUS NAS. Therefore, it is more correct to talk about one neurohumoral regulation organism. Hormone brainstuffs of adrenal glands (adrenaline) and hormone thyroid gland (thyroidine) stimulate sympathetic VNS. Pancreas hormone (insulin), adrenal cortical hormones, as well as hormone milk gland (During the growth period of the body) stimulate the parasympathetic department. The hormones of pituitary gland and sex glands have a stimulating effect on both VNS departments. The activity of VNS also depends on the concentration of blood and tissue fluids of enzymes and vitamins.
The hypothalamus is closely related to the pituitary, neurosecretory cells of which are sent to neurosexreter in the rear lobe of the pituitary gland. In the overall integration of physiological processes carried out by VNS, the constant and reciprocal relationships between the sympathetic and parasympathetic system, the functions of interoreceptors, humoral vegetative reflexes and the interaction of the VNS with the endocrine system and somatic, especially with its highest department, are the bark of the large brain hemispheres.
Tone of the vegetative nervous system
Many of the vegans of the vegetative nervous system are constantly in a state of activity, as a result of which the organs inexeded by them receive from them exciting or braking impulses continuously. So, for example, cutting on the neck of both dogs wandering nerves It entails the increase in heart abbreviations, since at the same time the inhibitory effect falls out, constantly rendered on the heart of the nuclei of the vagauric nerves, which are in a state of tonic activity. The one-sided cut on the neck of the rabbit of the sympathetic nerve causes the extension of the ear vessels on the side of the cut nerve, as the vessels are deprived of a tonic effect. When irritating the peripheral segment of the cut nerve in the rhythm of 1-2 imp / s is restored by the rhythm of heart abbreviations, which took place before the break of the wandering nerves, or the degree of narrowing of the eared vessels, which was with the intake of the sympathetic nerve.
The tone of vegetative centers is ensured and maintained by afferent nerve signals that come from receptors of internal organs and partly from extero receptors, as well as as a result of the impact on the centers of various blood factors and the spinal fluid.
Vegetative, or autonomous, the nervous system is usually opposed an abnormal, or cerebrospinal, nervous system. The latter innerves mainly the senses and organs of the movement, i.e., the entire transverse muscles; Its innervation is strictly segmental, and the nerve fibers go from nerve centers (nervous cells) to the worker without breaks. The vegetative nervous system innervates the advantage of a smooth muscles, glands and internal organs of the body (blood circulation organs, breathing, gastrointestinal tract, liver, kidney, etc.), innervation is non-mental and compulsory interruptions. Thus, the main function of the cerebrospinal nervous system is to regulate the relationship between the organism and the environment, the main function of the autonomic nervous system is in regulating relations and processes inside the body. But it goes without saying that the cerebrospinal and vegetative nervous systems are only parts of a single integer - the uniform nervous system of the body. They are connected with each other and morphologically and functionally. Therefore, all organs of our bodies have double - vegetative and cerebrospinal innervation. By this way, with the indispensable participation of internal secretion, closely related in turn with the vegetative nervous system, the unity and integrity of the whole organism is achieved.
Vegetative nervous system, like cerebrospinal, is divided into central and peripheral. The central vegetative nervous system consists of clusters of ganglion cells and fibers - vegetative centers and nuclei, laid down in various departments of the central cerebrospinal system, in the brain, mainly in the striped body (Corpus Striatum), in the interstitial, oblong and spinal cord.
The highest vegetative centers governing all the main common functions of the organism's vegetative life, such as: body temperature, metabolism, respiration, blood circulation, etc., are located in the head of the brain located under each other - in subcortical nodes, intermediate and oblong brain.
The peripheral vegetative nervous system is divided into two departments: the sympathetic department and the parasympathetic nervous system department.
The sympathetic nervous system originates in part in the oblong, but mainly in the spinal cord - from CVIII to Liii-IV (the thorachambal subwinding nervous nervous system), and its fibers after a break in the prevertabral nodes (border post) extend to all areas of the body, so What sympathetic innervation has, one can say universal meaning.
Parasympathetic nervous system originates on average and oblong brain - Cranial subwind (NN. Oculomotorius, Vagus and Glossopharyngeus) and in the sacral part of the spinal cord - sacred subwinding (n. Pelvicus) - a break of parasympathetic fibers occurs in plexus on the surface of the organs, or in ganglia inside the organs.
Adrenaline gives the same effect as irritation of the sympathetic nervous system, and the choline and its derivatives (acetylcholine) cause an action similar to the action of the parasympathetic nervous system. Thus, we can talk about the adrenalinotropy of the sympathetic and cholinotropy of the parasympathetic nervous system. The effect of these two departments of the vegetative nervous system in many cases is opposite, so they previously talked about their antagonism.
However, this antagonism is not a law. There is no complete antagonism between the sympathetic and parasympathetic departments of the vegetative nervous system (in the sympathetic nervous system there are cholinotropic fibers, and in parasympathetic - adrenalinotropic), neither between the vegetative nervous system as a whole and the animal nervous system. It is much more correct to speak not about antagonism, but about their synergies. Vegetative, actually a sympathetic nervous system, having universal distribution and innervating all organs and tissues of the body, including the senses and the central nervous system, is the regulator of their work, changes the conditions of this work, the power facilities, etc. and thus plays an adaptation (adaptive ) and a trophic role.
The transfer of nervous influence or irritation on organs and fabrics, as well as the fibers on the other (with preggglyonary per postganglyonary) occurs, with particular chemicals, chemical intermediaries or mediators (for the sympathetic nervous system - syptine, for parasympathetic choline or acetylcholine). This fact, as if throws the bridge between the nervous and endocrine systems and binds them into one. Especially close relationship between the vegetative nervous system and adrenal glands, the brain layer of which develops from the primaries of sympathetic ganglia. In view of such a close functional connection between endocrine and vegetative nervous systems, they are often and not without base are combined into a single endocrine-vegetative system.
Violations of vegetative innervation occur depending on the various types of endo or exogenous moments in the direction of increasing or lowering the tone of the vegetative and nervous system, the entire ass or its separate parts. Accordingly, paintings of hyper-or hypoamphotonia, hyper- or hypospatics, gallery or hypovagotonia are developing. Pestrot clinical manifestations Vegetative innervation disorders and the difficulty of their correct assessment are aggravated by the fact that the same nervous excitement is also observed under the action of hormones, causes a different effect depending on the state of the reactivity of the working body and on the physicochemical conditions of its environment.
Tone of the vegetative nervous system
In natural conditions, the sympathetic and parasympathetic centers of the vegetative nervous system are in a state of continuous excitation, called the "Tonus". The resulting tone of the autonomic nervous system is manifested primarily in the fact that the flow of pulses with a certain frequency of the following continues to the organs. It is known that the state of the tone of the parasympathetic system is best reflecting the activity of the heart, especially the heart rate, and the state of the tone of the sympathetic system - vascular system, in particular, the size of the blood pressure (alone or when performing functional samples). Many sides of the nature of tonic activity remain little-known. It is believed that the tone of nuclear formations is formed mainly due to the influx of sensory information from reflexogenic zones, individual groups of inter-precipulator, as well as somatic receptors. At the same time, the existence of its own rhythm drivers - paiskeners localized mainly, in the oblong brain. The nature of the tonic activity of the sympathetic, parasympathetic and metasimpatic departments of the vegetative nervous system may also be associated with the level of endogenous modulators (direct and indirect), adrenoreactivity, cholinoreactivity and other types of chemoreactivity. The tone of the autonomous nervous system should be considered as one of the manifestations of the homeostatic state and at the same time one of the mechanisms of its stabilization.
Constitutional classification of TONUS VNS in humans
The predominance of the tonic effects of the parasympathetic and sympathetic parts of the autonomous nervous system served as the basis for creating a constitutional classification. Back in 1910, Epinger and Gess created the doctrine of sympathetic and Vagotonia. They divided all people into two categories - sympathicotonics and vagotonic. Signs of Vagotoni, they considered a rare pulse, deep slow motion, reduced blood pressure, narrowing the eye gap and pupils, inclination to hypersion and meteorism. Now there are already more than 50 signs of Vagotonia and sympathetic (only 16% of healthy people can be defined sympathicotonia or wagotonium). Recently, A.M. Greenberg proposes to distinguish seven types of vegetative reactivity: general sympathicotonium; partial sympathicotonium; General Wagotonia; partial vagotonium; mixed reaction; general intensive reaction; Total weak reaction.
The question of the tone of the vegetative (autonomous) nervous system requires additional research, especially given of the greatest interest that manifests him in medicine, physiology, psychology and pedagogy. It is believed that the tone of the vegetative nervous system reflects the process of biological and social adaptation of a person to various environmental conditions and a lifestyle. The assessment of the tone of the vegetative nervous system is one of the complex problems of physiology and medicine. There are special methods for studying the vegetative tone. For example, exploring skin vegetative reflexes, in particular, a sawmother reflex, or a reflex "goose skin" (it is caused by pain or cold irritation of the skin in the trapezoidal muscle area), with a nomotonic type of reaction in healthy people, the formation of "goose skin". With the defeat of the side horns, the front roots of the spinal cord and the border sympathetic trunk, this reflex is missing. In the study of sweating reflex, or aspirin sample (reception inside 1 g of aspirin dissolved in a glass of hot tea), a healthy person appears a diffuse sweating (positive aspirin test). With the damage to the hypothalamus or paths connecting the hypothalamus with the sympathetic neurons of the spinal cord, there is no diffuse sweating (negative aspirin sample).
When evaluating vascular reflexes, local dermographism is often explored, i.e. The answer of the vessels on the barn irritation of the leather of the forearm or other parts of the body with a neurological hammer handle. In case of easy skin irritation, after a few seconds, Nimotonikov appears a white strip, which is explained by the spasm of surface skin vessels. If irritation is stronger and slower, then Nimotonikov appears a red band, surrounded by a narrow white border - this is a local red dermographism, which occurs in response to a decrease in sympathetic vasoconstrictor influences on the skin vessels. With an increased tone of the sympathetic department, both types of irritation cause only a white strip (local white dermographism), and with increasing the tone of the parasympathetic system, i.e. With Vagotonia, a person has both types of irritation (and weak, and strong) cause red dermographism.
The orthostatic reflex of the prevession is the active translation of the test from the horizontal position to the vertical, with the calculation of the pulse before the start of the sample and after 10 - 25 s after its execution. With the normalone type of reaction, the pulse is increased by 6 shots per minute. Higher pulse increases indicates a sympathetic-tonic type of reaction, while a small increase in the pulse (no more than 6 beats per minute) or the unchanged pulse indicates an increased tone of the parasyptic department.
In the study of pain dermographer, i.e. With a stroke irritation of the skin with a sharp pin, the red strip 1 - 2 cm wide appears on the skin, surrounded by narrow white lines. This reflex is due to a decrease in the tonic sympathetic effects on the skin vessels. However, it does not occur during the damage to the vessels of the fibers going to the vessel in the composition of the peripheral nerve, or with the defeat of the depressor department of the bulbar vessel.
Symptoms of the diseases of the vegetative nervous system
Signs of impaired vegetative innervation are violations of the function of the working bodies. Naturally, they are very numerous and very diverse in the degree of their severity.
The following symptoms on the part of various organs, if there are no special reasons for their occurrence, indicate more or less disturbed vegetative innervation in its respective departments. The narrowing of pupils and tearing, reinforced salivation and sweating (saliva and pot liquid), cooling and scattering of hands and legs (vascular paresis), esophagus spasm, dyspeptic phenomena (belching, heartburn, nausea, vomiting), spasms (pain) of the stomach, hypersecretion, constipation or diarrhea, gallbladder spasms, bradycardia, extrasystolia, arterial hypotension, reduced tone of the heart muscle, the impossibility of deep breath and complete exhalation, type attacks bronchial asthma, Dysuric phenomena, increased endurance to carbohydrates, eosinophilia - all this symptoms of increased excitability or reinforced tone of the parasympathetic nervous system, symptoms of Vagotonia. Expansion of pupils and glitter eyes, reduction of tear and sweating, tachycardia and often hypertension, easy passability of the esophagus, stomach atony, the noise of the splash in it, the reduced acidity of the gastric content, the athony of the thick bowel, the meteorism, reduced endurance to carbohydrates - these are the main symptoms of the increased tone Sympathetic nervous system, symptoms of sympathetic.
Patients in the clinic very rarely these two rows of symptoms are observed isolated; Usually, we see a motley picture of symptoms due to the simultaneous strengthening or weakening of the excitability of both parts of the vegetative nervous system.
P. S. Medovik indicates the relationship between the development of pneumonia and the impaired tone of the vegetative nervous system. In his opinion, vasodent disorders, due to violations in the vegetative and endocrine system, are the main cause of the development of pneumonia. The opinions about the fact that the disorders in blood circulation and swelling are the cause of pneumonia and A. A. Speransky, D. S. Sarkisov, etc. They believe that different influences on the nervous system cause disorders in the blood circulation of the lungs or swelling in them that In the future, leads to the development of the pneumonic process.
In experiments on dogs A. V. Thin, achieved changes in the lungs, similarity pneumonia, and microscopic examination Detected bronchopneumonical foci of a deskvamative - hemorrhagic nature. Based on its own experimental studies, it assumes that when irritating the upper cervical sympathetic nodes, more significant amounts of wagopressin are highlighted, which increases blood pressure in big Circle and pulmonary veins, and reduces pressure in pulmonary arteries; The latter, for its part, leads to a stagnant edema - amendments characteristic of the early phase of the development of pneumonia. B. I. Lavrentiev installed in children who died from pneumonia, changes in the upper cervical sympathetic nodes.
In view of the smaller morphological maturity of the nervous system in children of early age compared to the nervous system of older children, its regulatory influence on the body's life processes is not enough, in connection with which the functions of individual systems, including the lungs in which conditions can be created are much easier For the introduction of infection and the development of pneumonia. In this regard, the insufficient tone of the vegetative nervous system and the internal secretion glands plays a major role. This explains the more frequent incidence of pneumonia in early childhood, as well as a more peculiar and more severe course of these pneumonia.
Vegetative-vascular dystonia (vegetative dystonia syndrome)
Vegetative-vascular dystonia (vegetative dystonia) is a disease of the autonomic nervous system due to dysfunction of the inventive regulation of vegetative regulation, which leads to an imbalance between the sympathetic and parasympathetic departments of the autonomic nervous system and inadequate reactivity of effector organs. Important peculiarities of vegetative dystonia are:
- functional nature of the disease;
- as a rule, congenital inferiority of the oversegmental vegetative centers;
- actualization of the disease against the background of the impact on the body of adverse factors (stress, cranial and brain injury, infection);
- the absence of any organic defect in effector organs (heart, vessels, gastrointestinal tract, etc.).
Pathogenesis. The main role in the pathogenesis of vegetative dystonia plays a violation of vegetative regulation and the development of vegetative imbalance. The relationship between the sympathetic and parasympathetic vegetative nervous systems corresponds to the principle of "swing equilibrium": an increase in the tone of one system entails an increase in the tone of the other. Such a form of vegetative support allows you to maintain homeostasis and create conditions for high lability physiological functions. Clinical and experimental studies have discovered this lability in almost all systems - variations of the rhythm of the heart, blood pressure, body temperature and other indicators. The output of these oscillations beyond the homoeostatic range increases the vulnerability of the vegetative regulation system for damaging factors. In such conditions, exogenous or endogenous incentives can lead to the limit voltage of regulatory systems, and then to their "breakage" with clinical manifestation in the form of vegetative dystonia.
Clinical picture. Clinical manifestations of the disease are diverse and often do not differ in constancy. For this disease, a quick change of skin coloring, increased sweating, pulse oscillations, blood pressure, pain and disorders of the gastrointestinal tract (constipation, diarrhea), frequent bouts of nausea, tendency to subfebelitet, weather-sensitivity, poor tolerability increased temperatures, physical and mental tension. Patients suffering from vegetative dystonia syndrome, poorly carry physical and intellectual load. In extremely severity, the disease can manifest itself in vegetative crises, neuroreflex synicopal states permanent vegetative impairment.
Vegetative crises can be sympathetic, parasympathetic and mixed. Sympathetic crises arise due to a sudden increase in the activity of the sympathetic nervous system, which leads to excessive release of norepinephrine and adrenaline with efferent sympathetic fibers and adrenal glands. This is manifested by the appropriate effects: a sudden increase in blood pressure, tachycardia, death fear, subfebrile (up to 37.5 ° C), chill, shiver, hyperhydrosis, skin pallion, expansion of pupils, excretion at the end of the attack of abundant bright urine. At the time of the attack, an increase in the content of catecholamines in the urine is noted. Increased arterial pressure, heart rate and body temperature in such patients at the time of the attack can be verified by daily monitoring of these indicators. In parasympathetic paroxysms, there is a sudden increase in the activity of the parasympathetic system, which is manifested by the bout of bradycardia, hypotension, dizziness, nausea, vomiting, sensation of lack of air (less often suffocation), increasing the depth and frequency of breathing, diarrhea, redness of the skin, the feeling of the heat to face, decrease the temperature Body, abundant sweating, headache. After an attack in the overwhelming majority of cases, there is a feeling of lethargy, breakdown, drowsiness, there is often abundant urination. With a long history of the disease, the type of vegetative crime may vary (as a rule, sympathetic crises are replaced by parasympathetic or mixed, and parasympathetic is moving into mixed). The clinical picture of neuroreflex syncopal states is described in the appropriate section.
Treatment. Based on the pathogenesis, the clinical picture and data of neurofunctional diagnostics, the basic principles of treatment of vegetative dystonia include:
- correction of the psycho-emotional state of the patient;
- elimination of foci of pathological afferent impulsation;
- elimination of foci of stagnation and circulation of pulses in additional vegetative vegetative centers;
- restoration of impaired vegetative balance;
– differentiated approach in the appointment of medicines, depending on the type and severity of vegetative crises;
- elimination of excessive tension in the functioning of internal organs;
- the creation of favorable metabolic conditions for the brain in the process of therapy;
- The complexity of therapy.
For the correction of the psycho-emotional state of the patient, preparations of different groups are used - benzodiazepine tranquilizers, antidepressants, some neuroleptics and anti-kvulsants. They also have a beneficial effect on foci of increased excitability and "stagnant" circulation of nerve impulses.
Benzodiazepine tranquilizers potentize the action of the GABA, reduce the excitability of the limbic system, thalamus, hypothalamus, limit the irradiation of pulses from the focus of "congestive" excitation and reduce their "stagnant" circulation. Among them are especially effective for phenazepams, with sympathetic crises - Alprazolam.
Antidepressants to varying degrees block the reverse seizure of norepinephrine and serotonin and have an anxiolytic, thimonaleptic and sedative effect. Amitriptyline, Escitalopram, Trazodon, Maprotilin, Mianserin, Fluvoxamine are widely used for the treatment of vegetative paroxysms.
In the event of the ineffectiveness of the drugs of other groups, for the treatment of vegetative crises with them severe course Some neuroleptics can be used to which thiuridazine, periciazine, azaleptin.
The drugs of carbamazepine and a pregabalin, which have a normotimic and vegetative effects, found from the Anti-Wurals Group.
In light cases, it is possible to use preparations of plant origin that have antidepressive, anxiolytic and sedative effect. This group includes the preparations of hormour grass extract. To correct a psycho-emotional state, it is also necessary to use psychotherapy, including aimed at changing the patient's attitude to psychotrauming factors.
The effective means of preventing vegetative crises are stress-protectors. For this purpose, fleeting tornction tranquilizers and aminophenylmaceic acid can be widely used. Tophizopam has tranquilizing activity, without causing drowsiness. It reduces psycho-emotional tension, anxiety, has a growing stabilizing effect. Aminophenylmaceantic acid has a nootropic and anti-leaving (anxiolytic) action.
Restoration of impaired vegetative balance. For this purpose, preparations are used prophetsane (reduces the general sympathetic tone) and etones (increases the activity of the hypothalamic-pituitary and adrenal system). Good effect showed a hydroxyzine preparation with moderate anxiolytic activity.
Eliminating functional visceral voltage. The latter is particularly often detected in the cardiovascular system and is manifested by the Tachycardia syndromes of peace and postural tachycardia. For the correction of these disorders, β-adrenoblays are prescribed - anaprilin, bisoprolol, pindolol. The purpose of these drugs is a symptomatic measure, and they should be used as a supplement to major therapeutic agents.
Metabolic correction. Patients with organic diseases of the nervous system, in the structure of which there are vegetative paroxysms (consequences of closed injuries of the brain, chronic insufficiency brain circulation) It is necessary to assign funds that create favorable metabolic conditions for the brain. These include various vitamin complexes - Decamivit, Airport, Glovyevit, Unicap, Spectrum; amino acids - glutamic acid; Nootropics with a slight sedative component - pyriditol, deanol.
After the regression of the main symptoms (after 2-4 weeks), adaptogens are prescribed to reduce asthenization and apathy phenomena.
To relieve any vegetative crises, the use of diazepam, clozapine, hydroxyzine is possible. During the predominance of sympathetic manifestations, the peerroxyan is used, with the predominance of parasympathetic - atropine.
Migraine
Migraine is a common form of primary headaches. The big prevalence of migraine and its associated significant socio-economic losses contributed to the fact that the World Health Organization has made a migraine into the list of diseases to the greatest extent to the social adaptation of patients.
Etiology and pathogenesis. One of the mains etiological factors Migraine is hereditary predisposition. It is manifested in the form of vascular dysfunction. This dysfunction can be caused by changes from the segmental sympathetic apparatus, disorders of the exchange of neurotransmitters (serotonin, norepinephrine, histamine, glutamate, and a number of others). The disease is inherited by autosomal dominant type. The overworking, insomnia, hunger, emotional and stressful situations, germ excesses, menstruation (decrease in blood estrogen), infection, infection, head injuries can be overwhelmed for the development of headaches. Often, headache may occur without a visible cause. During the attack, generalized violations of vasomotor regulation arise, mainly in the head vessels, while the headache is due to the expansion of the solid vessels brain shell. The phase flow of violations of the vascular tone was revealed. First there is a spasm of vessels (the first phase), and then their expansion (second phase), followed by the enemy of the vascular wall (third phase). The first phase is most pronounced in the intracranial vessels, the second is in extracranial and meningeal.
Migraine classification (international classification of headaches, 2nd edition (MKGB-2, 2004))
1.1. Migraine without aura.
1.2. Migraine with aura.
1.2.1. Typical aura with migraine headache.
1.2.2. Typical aura with nefhenous headache.
1.2.3. Typical aura without headaches.
1.2.4. Family hemiplegic migraine.
1.2.5. Sporadic hemiplegic migraine.
1.2.6. Basilar type migraine.
1.3. Periodic childhood syndromes, usually preceding migraines.
1.3.1. Cyclic vomiting.
1.3.2. Abdominal migraine.
1.3.3. Benign paroxysmal dizziness of children's age.
1.4. Retinal migraine.
1.5. Complications of migraine.
1.5.1. Chronic migraine.
1.5.2. Migraneous status.
1.5.3. Persistent aura without a heart attack.
1.5.4. Migraine infarction.
1.5.5. Failure caused by migraine.
1.6. Possible migraine.
1.6.1. Possible migraine without aura.
1.6.2. Possible migraine with aura.
1.6.3. Possible chronic migraine.
Clinical picture. Migraine is a disease that manifests itself in the form of periodically repeated bouts of headaches, as a rule, in one half of the head, and is due to the hereditary deterministic dysfunction of vasomotor regulation.
Starting by usually during puberty, the migraine is mainly found in people aged 35-45, although it may suffer from persons in a much more young age, including children. According to WHO studies conducted in Europe and America, 6-8% of men and 15-18% of women suffer from migraine every year. The same prevalence of this disease is observed in the central and South America. Higher incidence rates among women, regardless of accommodation, are due to hormonal factors. In 60-70% of cases, the disease is hereditary.
Migraine is manifested by attacks that each patient proceeds more or less uniformly. The attacks are usually preceded by prudent phenomena in the form of poor well-being, drowsiness, reducing performance, irritability. Migraines with aura precede various sensitive or motor disorders. Heap pain in the overwhelming majority of cases has one-sided character (hemikrania), the entire head hurts less frequently or an alternation of the parties is observed. The intensity of pain - from moderate to considerable. Pains are felt in the field of temple, eyes, have a pulsating character, are intensified under the influence of ordinary mental and physical activity, accompanied by nausea and (or) vomiting, redness or pacelas. During the attack, overall hyperesthesia occurs (light-free, intolerance of loud sounds, light, etc.).
In 10-15% of cases, a migraine aura is preceded by a complex of neurological symptoms arising immediately before the migraine headache or at its beginning. Aura is evolving for 5-20 minutes, no more than 60 minutes remain and with the beginning of the pain phase completely disappears. The most commonly visiting (the so-called "classical") aura, manifested by various visual phenomena: photopsy, "melting of flies", one-sided loss of fields of vision, zigzag-like luminous lines flickering cattle. Less often, one-sided weakness and paresthesia are noted in the limbs, transient speech disorders, distortion of perception of dimensions and shape of objects.
The clinical forms of migraine with aura depend on that the pathological process is deployed in the zone of which vascular pool. Ophthalmic (Classical) Migraine is manifested by homonimous visual phenomena (photopsy, falling out or decreased by fields, watering before eyes).
A parser migraine is characterized by aura in the form of sensations of numbness, tingling in hand (starting from the fingers of the brush), face, language. Sensitive disorders in the frequency of occurrence are in second place after ophthalmic migraine. With hemiplegic migraine, a part of the aura is hemiparesis. Speech (motor, sensory amphias, dysarthria), vestibular (dizziness) and cerebellar disorders are also found. If Aura lasts more than 1 hour, then they talk about migraine with a prolonged aura. Sometimes an aura can be observed without headaches.
Basilar migraine is relatively rare. It usually occurs in girls aged 10-15 years. Manifested by vision disorders (the feeling of bright light in the eyes, bilateral blindness for several minutes), dizziness, attacksia, dysarthria, noise in the ears, followed by a sharp pulsating headache. Sometimes there is a loss of consciousness (in 30%).
Ophthalmoplegic migraine is diagnosed when at the height of the headache or simultaneously with it there are various eye violations (one-sided ptosis, diplopia, etc.). Ophthalmoplegic migraine may be symptomatic and associated with organic brain damage (serous meningitis, brain tumor, the aneurysm of the brain base vessels).
Retinal migraine is manifested by a central or paraccentral cattle and transient blindness for one or both eyes. In this case, the ophthalmic diseases and the embolism of the retinal artery should be excluded.
Vegetative (panic) Migraine is characterized by the presence of vegetative symptoms: tachycardia, edema of the face, chills, hyperventive manifestations (lack of air, suffocation of suffocation), tearing, hyperhydrosis, and the development of pre-imaging state. In 3-5% of patients, vegetative manifestations achieve the extreme degree of severity and look like a panic attack, accompanied by expressed alarm and fear.
Most patients (60%) attacks arise mainly during wakefulness, in 25% of pain occur both during sleep, and during wakefulness, in 15% - mainly during sleep or immediately after waking up.
In 15-20% of patients with a typical picture of the disease in the subsequent pain become less strong, but they become permanent. If these attacks occur more often than 15 days per month for 3 months. And more such a migraine is called chronic.
A group of children's periodic syndromes preceding migraines or accompanying it, clinically least defined. Some authors are questionable in its existence. It includes various disorders: the transient hemiplegia of limbs, abdominal pain, attacks of vomiting, dizziness, which arise under the age of one and a half years.
In some patients, the migraine is combined with epilepsy - after an attack of severe headaches sometimes there are convulsive seizures, while the electroencephalogram is noted paroxysmal activity. The emergence of epilepsy is due to the fact that under the influence of repeated migraine attacks, ischemic foci with epileptogenic properties are formed.
Diagnostics is based on clinical picture data and additional methods Research. In favor of the diagnosis of migraine, there is no symptoms of organic brain lesion, the beginning of the disease in youth or childhood, the localization of pain in one half of the head, hereditary history, significant relief (or disappearance) of pain after sleep or vomiting, the absence outside the attack of signs of organic damage to the nervous system. During the attack, palpare can be determined intense and pulsating temporal artery.
Of the additional research methods, ultrasound dopplerographs today is the main method of verifying the disease. With the help of this method, hyperreactivity is revealed during the interconcephate period brain vessels On carbon dioxide, more pronounced on the side of the headaches. In the period of pain paroxysis, they register: in typical cases of migraine during the period of the aura - diffuse angiospasm, a more pronounced in the relevant clinic of the basin, and during the period of expanded pain paroxysm - vasodilatation and a significant decrease in the range of vascular reactions in the sample on hypercup. Sometimes you can register the simultaneous narrowing of the intracranial vessels and the expansion of extracranial; In some cases, there is a reverse picture. Patients are widely distributed signs of vegetative dysfunction: palm hyperhydrosis, Riino syndrome, symptom of tape and others. The diseases of the internal organs of migraine often accompany chronic cholecystitis, gastritis, ulcerative disease, colitis.
Differential diagnosis is carried out with bulk brain formations (tumor, abscess), vascular anomalies (the aneurysms of brain base vessels), temporal arteultite (Horton's disease), Toloque syndrome - Khanta (based on a limited granulomatous arteite of the inner carotid artery in sinus caverning), glaucoma , diseases of the apparent sinuses of the nose, the micaeer syndrome and the neuralgia of a trigeminal nerve. In the diagnostic plan it is necessary to differentiate the migraine from the episodic headache of the stress.
Treatment. To relieve an already developed attack, no more than 1 day use simple or combined analgesics: it is acetylsalicylic acid, including soluble forms, acetaminophen (paracetamol), ibuprofen, naproxen, as well as their combinations with other drugs, especially with caffeine and phenobarbital (Askofen , sealgine, pentalgin, spasmodaralgin), codeine (codeine + paracetamol + proppopenazone + + caffeine) and others.
In more heavy cases Preparations with a specific mechanism of action are used: selective agonists of 5-NT1 receptors, or triptans: Sumatapan, Zamitriptan, Naratriptan, Eletript, etc. Preparations of this group, affecting 5-NT1 receptors located in the central and peripheral nervous system, block the selection pain neuropeptides and selectively narrow the extended vessels during the attack. In addition to tableted, other dosage forms of tryptans are applied - nasal spray, solution for subcutaneous injections, candles.
Non-selective 5-HT1 receptor agonists with a pronounced vasoconstrictor effect: ergotamine. Despite the fact that the use of ergotamine preparations are quite effective, especially in combination with caffeine (coofer), phenobarbital (coffegort) or analgesics, care should be taken, since it is a strong vasoconstrictor and with improper use can cause angokard attack, peripheral neuropathy and limb ischemia ( Signs of ergotamine intoxication - ergotism). In order to avoid this, more than 4 mg of ergotamine should not be taken at one attack or more than 12 mg per week, why drugs of this group are appointed more and less.
Due to the attack of migraine, many patients develop a stomach and intestine atony in many patients, which not only disrupts the absorption of drugs, but also provokes the development of nausea and vomiting, anti-ansulistic means are widely used: Metoklopramid, Domperidon, Atropine, Bellid. Preparations are accepted 30 minutes before accepting analgesics. There are data on the use of drugs that suppress the formation of prostaglandins (fluufenamic and tolfenamine (cloots) acid).
The prophylactic treatment of migraine is aimed at reducing the frequency, duration and severity of migraine attacks.
It is advisable to the following set of events:
1) exclude products - migraine triggers, of which the most significant dairy products (including whole cow's milk, goat milk, cheese, yogurt, etc.); chocolate; eggs; citrus; meat (including beef, pork, chicken, turkey, fish, etc.); Wheat (bread, pasta, etc.); Nuts and peanuts; tomatoes; onion; corn; apples; bananas;
2) to achieve the right regime of labor and recreation, sleep;
3) conduct preventive treatment courses of sufficient duration (from 2 to 12 months, depending on the severity of the disease).
The most widely used the following drugs: beta blockers - metoprolol, propranolol; Calcium channel blockers - nifedipine, verapamil; Antidepressants - amitriptyline, cytalopram, fluoxetine; Metoklopramid and other drugs.
In case of insufficient effectiveness of this therapy, it is possible to use drugs from the group of anti-kvulsants (carbamazepine, topiramat). Topiramat (Topamaks) showed its effectiveness in the prevention of classical migraine with aura.
Patients senior age group It is possible to use vasoactive, antioxidant, nootropic drugs (Vinpocetin, dihydroeergocriptine + caffeine (vasographed), piracetam, ethylmethylhydroxypyridine succinate). Non-drugs with reflexive effects are also widely used: mustard pieces on the back surface of the neck, the lubrication of the temples mentholny pencil, hot foot baths. IN complex therapy Psychotherapy, biological feedback, acupuncture and other techniques are used.
Migraneous status. When a migraine attack carries a heavy and protracted character, not amenable to ordinary therapy and is repeated a few hours after some improvement, they talk about the migraine status. In such cases, the patient must be hospitalized in the hospital. To relieve migraine status, intravenous drip administration of dihydroergotamine ( long reception Ergotamine in history is contraindicated). Also use intravenous slow administration of diazepam, the reception of the Melipraline, the introduction of the laziz, the injection of pepolfen, suprastin, diphedrol. Sometimes neuroleptics are used (hanoperidol). In the event of the ineffectiveness of these events, the patient is immersed in a medical sleep for several hours or days.
Eritrolealgia
Clinical picture. The main clinical symptom is the bouts of the burning pains that are provoked by overheating, muscle overvoltage, strong emotions, staying in a warm bed. Pains are localized in the distal limbs (most often in the thumb, heel, then go to the sole, the rear of the foot, sometimes on the shin). During the attacks, the skin redness is noted, the local temperature increase, swelling, hyperhydrosis, expressed emotional disorders. The painful pain can bring the patient to despair. Pain sensations are reduced by applying a cold wet rag when moving the limb to a horizontal position.
Etiology and pathogenesis. In the pathogenesis, various levels of the autonomic nervous system are involved. This is confirmed by the observations of erythrolealgic phenomenon in patients with different spinal cord lesions (side and rear horns), Diesefal region. Erythrolealgia may occur as syndrome with multiple sclerosis, Siringomyelia, the consequences of nerve injuries (mainly median and tolnis), the neuromy of one of the nerves of the legs, thrombophlebitis, endarteritis, diabetes, etc. (see Fig. 123 on the CV. On).
Treatment. A number of general measures are applied (wearing light shoes, avoiding overheating, stressful situations) and pharmacological therapy. Breakfasting agents, vitamin B12, novocaine blockade of TH2-TH4 sympathetic nodes are used with the defeat of the hands and L2-L4 - with damage to the legs, histamineotherapy, benzodiazepines, antidepressants, comprehensively changing serotonin and norepinerenaline exchange (iexin). Physiotherapy (contrasting baths, ultraviolet irradiation The fields of chest sympathetic nodes, a galvanic collar on shcherbak, mud applications for segmental zones). In severe disease, the disease resorted to surgical treatment (pregganionic sympathectomy).
Reino disease
The disease was described in 1862 M. Reino, who considered it the neurosis due to the increased excitability of the spinal vascular centers. The disease is based on a dynamic vasomotor regulation disorder. Syptom complex Reyny can manifest itself as an independent disease or as a syndrome with a number of diseases (with finger arterys, added cervical ribs, scalen syndrome, systemic diseases, siringomyelia, sclerosis, sclerodermia, thyrotoxicosis, etc.). The disease, as a rule, begins after 25 years, although there are cases of 10-14 years old and people over 50 years old.
The disease occurs in the form of seizures consisting of three phases:
1) Lading and cooling your fingers and legs accompanied by pain;
2) the connection of the blueness and enhancement of pain;
3) Redness of the limbs and sacrament of pain. Attacks are provoked by cold, emotional stress.
Treatment. Compliance with the regime (avoidance of supercooling, impact of vibration, stress), the purpose of calcium channels (nifedipine) blockers (nifedipine), means that improve microcirculation (pentoxyphyllen), tranquilizers (oxazepam, tassels, phenazepams), antidepressants (amitriptyline).
Panic attacks
Panic attacks - seizures of severe alarm (panic) that do not have a direct connection with a certain situation or circumstances and therefore unpredictable. Panic attacks relate to neurotic disorders and are due to psychotramp. The dominant symptoms varies from different patients, but the generals are unexpected heartbeats, chest pain, sensations of suffocation, dizziness and sense of unreality (depersonalization or dealerialization). The secondary fear of death, loss of self-control or mental disorder is also almost inevitable. Usually attacks continue only minutes, although at times and longer; Their frequency and the course are quite variable. In a state of panic attack, the patient often feels sharply growing fear and vegetative symptomswhich lead to the fact that the patient hurriedly leaves the place where it is located. If this arises in a specific situation, for example, in a bus or crowd, the patient may be subsequently avoided this situation. Panic attack often leads to constant fear before possible in the future attacks. Panic disorder It can be the main diagnosis only in the absence of any of the phobias, as well as depression, schizophrenia, organic lesions brain. The diagnosis must comply with the following characteristics:
1) these are discrete episodes of intensive fear or discomfort;
2) the episode begins suddenly;
3) the episode reaches a maximum for a few minutes and lasts at least a few minutes;
4) there must be a minimum of four symptoms from those listed below, and one of them is from the Vegetative group.
Vegetative symptoms:
- reinforced or rapid heartbeat;
- sweating;
- trembling (tremor);
- dryness in the mouth, not caused by the reception of drugs or dehydration.
Symptoms related to chest and stomach:
- breathing difficulties;
- a feeling of suffocation;
- pain or discomfort in the chest;
- Nausea or abdominal distress (for example, burning in the stomach).
Symptoms related to mental condition:
- feeling of dizziness, instability, displacement;
- the sensations that the objects are unreal (deoryalization) or their own "I" moved out or "is not here" (depersonalization);
- Fear of loss of control, madness or upcoming death.
General symptoms:
- tides or a feeling of chill;
- numbness or feeling of tingling.
Treatment. The main medical event is psychotherapy. Of medical therapy The drug selection is alprazolam, which has a pronounced anti-suspension, vegetable stabilizing and antidepressant effect. Less efficient to phyphizopes. Carbamazepine, and phenazepam can also be applied. Positive action is provided by balneseeration, reflexotherapy.
Shaya Syndrome - Drajder (multiple system atrophy)
In this case, the syndrome expressed vegetative insufficiency is combined with cerebelchkova, extrapyramine and pyramidal symptoms. The disease is manifested ortostatic hypotension, Parkinsonism, impotence, violation of pupil reactions, urinary incontinence. The nature of clinical manifestations depends on the degree of involvement of these systems into the pathological process. The vegetative sphere remains almost intact, but the nature of the defeat of the central nervous system is such that causes violation of the regulatory functions of the autonomic nervous system. The disease begins with the development of Parkinsonism, while there is a weak and short effect of drugs of the Levodopa group; Then join peripheral vegetative failure, pyramid Syndrome And ataxia. The content of norepinephrine in the blood and the urine is practically no diffant on the norm, but its level does not increase when switching from the position is to stand standing. For more information about the disease, see ch. 27.6.
Progressive hemiatrophy face
Slowly progressive weight loss of half of the person, due to the mostly dystrophic skin changes and subcutaneous tissue, to a lesser extent - muscles and facial skeleton.
Etiology and pathogenesis of the disease are unknown. It is assumed that the disease is evolving due to the failure of segmental or additional (hypothalamic) vegetative centers. With additional pathogenic effects (injury, infection, intoxication, etc.), the influence of these centers on sympathetic vegetative nodes is disturbed, as a result of which the vegal-troopic (sympathetic) regulation of metabolic processes in the innervation zone of the affected node changes. In some cases, hemiatrophy of the face is preceded by a trigeminal nerve disease, teeth removal, face injury, general infections. The disease occurs in 10-20 years, more often found in women. Atrophy begins on a limited area, as a rule, in the middle part of the face and more often in its left half. Atrophy leather, then subcutaneous fat layer, muscles and bones. The skin on the affected area is depigmed. Developed by Gorner Syndrome. Hair is also depugmented and falling out. In severe cases, the coarse asymmetry of the face is developing, the skin is thinned and wrinkled, the jaw decreases in size, teeth fall out of it. Sometimes the atrophic process applies to the neck, the shoulder belt, arm, less often for the entire half of the body (total hemiatrophy). There are cases of bilateral and cross hemiatrophy. As syndrome occurs with sclerodermia, siringomyelia, trigeminal nerve tumors. Treatment only symptomatic.
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