Formations of the autonomic nervous system are represented in the cerebral cortex, hypothalamic region, brain stem, spinal cord, PNS. A pathological process in any of these structures, as well as a functional disruption of the connection between them, can lead to the appearance of vegetative disorders.

23.1. Syndrome of vegetative dystonia

Autonomic dystonia syndrome can be constitutionally determined, occur with endocrine changes in the body (puberty, menopause), diseases of internal organs (pancreatitis, peptic ulcer of the stomach and duodenum, etc.), endocrine (diabetes mellitus, thyrotoxicosis), allergic and other diseases. Excessive physical and psycho-emotional stress, frequent lack of sleep, disturbances in circadian rhythms, exposure to stress, intoxication (alcohol, nicotine, etc.) predispose to vegetative dystonia. Autonomic disorders are often observed in patients with neurotic, depressive disorders.

Clinical manifestations. The clinical picture combines autonomic symptoms and emotional disorders. As a rule, an objective examination reveals meager symptoms, although patients present a lot of complaints and are subjectively difficult to tolerate the existing disorders. The syndrome of vegetative dystonia combines sympathetic, parasympathetic and mixed symptom complexes, manifesting permanently or in the form of generalized, systemic paroxysms (crises). With the predominance of the tone of the sympathetic nervous system (sympathicotonia), typical vegetative crises (panic attacks). On examination, tachycardia, blanching of the skin, increased blood pressure, weakening of intestinal motility, mydriasis, chills, feeling of lack of air, shortness of breath are revealed. The presence of anxiety, anxiety, a feeling of fear, which can be of a vital color (the patient fears for his

life, although there is no apparent threat). There may be a fear of going crazy, committing an uncontrolled action, injuring yourself or loved ones.

Hyperventilation crisis also includes a combination of autonomic and affective disorders. The patient has increased, rapid breathing, a feeling of lack of air with a predominant difficulty in inhaling. Perhaps the appearance of a feeling of a coma in the throat, "goosebumps" on the skin, cold hands and feet, unsteady gait. There is a fear of losing consciousness, of dying. Due to transient hypokalemia, hyperventilation tetany may develop with muscle tension in the forearms and hands ("obstetrician's hand"), legs and feet (carpopedal spasms). Hands and feet become wet, cold to the touch. The attack may end in fainting.

Vagotonic crises accompanied by bradycardia, shortness of breath, reddening of the skin of the face, sweating, salivation, lowering blood pressure, gastrointestinal dyskinesia. Possible decrease in blood glucose levels. The attack can also end with a short-term loss of consciousness. In some patients, allergic phenomena are possible in the form of urticaria or Quincke's edema. Such crises can be provoked by staying in a stuffy room, untimely food intake (“hungry fainting”), intense stress, excitement.

mixed crises are manifested by a combination of symptoms typical for the predominance of the tone of the sympathetic or parasympathetic nervous system, or by their alternate appearance.

Diagnosis of vegetative dystonia is predominantly clinical. Laboratory and instrumental methods are required to exclude somatic diseases that have a similar clinical picture.

Differential diagnosis is carried out with diseases of the endocrine organs (hypo- and hyperthyroidism, diabetes mellitus, pheochromocytoma), cardiovascular system (paroxysms of heart rhythm and conduction disturbances, accompanied by fainting), neurological diseases (epilepsy).

Treatment includes the elimination of the main predisposing factor (normalization of lifestyle, elimination of toxic effects). Physical activity should be adequate, showing compliance with the correct regime of work and rest, rational nutrition. In the case of the predominance of the activity of the sympathetic department of the nervous system, sedatives are prescribed (valerian, motherwort, hawthorn), according to

indications - benzodiazepine derivatives (diazepam, alprazolam), alpha- and beta-blockers (propranolol, atenolol). With the predominance of the tone of the parasympathetic system, drugs that increase blood pressure (caffeine, cordiamin), anticholinergics of central and peripheral effects (atropine, bellataminal) are used.

In connection with the frequent combination of autonomic and emotional disorders, antidepressants, anti-anxiety (anxiolytics) and hypnotics are used. Treatment should be carried out with the participation of a psychotherapist or psychiatrist. Non-drug methods of treatment are used: exercise therapy, reflexology, psychotherapeutic techniques.

23.2. hypothalamic syndrome

It is a combination of autonomic, metabolic and trophic disorders caused by damage to the hypothalamus. An indispensable component of the hypothalamic syndrome are neuroendocrine disorders. The causes of the hypothalamic syndrome can be acute and chronic infection with CNS damage, craniocerebral trauma, acute and chronic intoxication, pituitary lesions (primarily tumors).

Clinical manifestations. Most often, damage to the hypothalamus is manifested by vegetative-vascular and neuroendocrine disorders, thermoregulation disorders, sleep and wakefulness disorders. Patients have permanent disorders, against which the development of vegetative crises of various directions (sympathetic, parasympathetic, mixed) is possible.

Thermoregulation disorders often occur when the anterior hypothalamus is affected. Subfebrile body temperature persists for a long time with periodic increases to 38-40 ° C in the form of hyperthermic crises. There are no changes in the blood indicating an inflammatory process. The use of antipyretics in such patients does not lead to a decrease in temperature. Thermoregulatory disorders depend on emotional and physical stress. So, in children, they often appear during school hours and disappear during the holidays. Possible persistent hypothermia, poikilothermia (temperature fluctuations of more than 2 ° C in response to changes in ambient temperature). Patients have emotional disturbances, mainly hypochondriacal and depressive.

It is important to note violations of reproductive functions (impotence, decreased libido), disorders of various types of metabolism (carbohydrate, water, energy) that occur when the hypothalamus is damaged. Neuroendocrine disorders appear when both the pituitary and hypothalamus are affected and are most often manifested by Itsenko-Cushing's syndromes (mainly abdominal type of obesity, arterial hypertension, striae, acne), Freulich-Babinsky's adiposogenital dystrophy (obesity, hypogenitalism), Simmons cachexia (severe malnutrition, depression, alopecia), diabetes insipidus (polyuria, polydipsia, low relative density of urine).

There is a certain dependence of the nature and severity of endocrine disorders on the predominant damage to the hypothalamus. So, with the defeat of the anterior sections, insomnia, hyperthermia, diabetes insipidus, cachexia are observed. The defeat of the posterior hypothalamus is accompanied by hypo or poikilothermia, apathy, excessive drowsiness (hypersomnia) or depression of consciousness. The predominant involvement in the pathological process of the middle (medial) parts of the hypothalamus is accompanied by the development of diabetes insipidus, polydipsia, obesity, and memory impairment.

Diagnosis and differential diagnosis. To identify metabolic and endocrine disorders and clarify their nature, it is necessary to determine the content of hormones in the blood of the pituitary gland and other endocrine organs. Since neuroendocrine disorders may be the result of damage to the pituitary gland, it is necessary to conduct a CT scan (MRI) of the brain with an assessment of the size and condition of the Turkish saddle. The diagnostic value of other methods (X-ray of the skull, examination of the fundus, visual fields) is relatively low, especially with early diagnosis. The examination should be carried out with the participation of an endocrinologist to exclude other lesions of the endocrine glands.

Differential diagnosis is carried out with thyroid diseases (hypo or hyperthyroidism), pheochromocytoma, hormonally active pituitary tumors.

Treatment. The tactics of treatment is determined by the main pathological process. A pituitary tumor requires discussion of the issue of surgical treatment, the appointment of hormonal drugs. In patients with metabolic and endocrine disorders, treatment is carried out under the supervision of both a neurologist and an endocrinologist. With the predominance of paroxysmal autonomic disorders, symptomatic therapy is carried out, the main provisions of which are given in the previous section.

23.3. Raynaud's disease

The disease belongs to the group of angiotrophoneurosis (syn.: angiotrophoalgic syndrome, vasomotor-trophic neurosis, vascular-trophic neuropathy). This is the common name for a number of diseases that develop as a result of disorders of the vasomotor and trophic innervation of the limbs. There are Raynaud's disease and a syndrome caused by systemic connective tissue diseases (systemic lupus erythematosus, scleroderma, periarthritis nodosa), peripheral nerve damage (polyneuropathy in diabetes mellitus). It is possible to develop Raynaud's syndrome with prolonged exposure to vibration (vibration disease), with some intoxications (arsenic salts, lead, cytostatics, vasoconstrictors - ergotamine). Of certain importance in the pathogenesis are dysfunctions of the thyroid and parathyroid glands and adrenal glands. Local forms of the syndrome are possible with insufficiency of the segmental apparatus of the autonomic nervous system (for example, with syringomyelia), compression of the autonomic formations of the cervicothoracic region with anterior scalene syndrome, an additional cervical rib.

Clinical manifestations. The disease in women, mostly young and middle-aged, occurs about 5 times more often than in men. The affected areas are more often noted on the skin of the hands and feet, less often the nose, auricles, lips. These manifestations are arranged symmetrically. In classic cases, there are 3 stages of the disease.

At the core I stage there is a spasm of small arteries and arterioles. The affected area becomes pale, cold to the touch, the sensitivity in it decreases. The duration of the attack is from several minutes to an hour or more, after which the vasospasm disappears and the skin becomes normal. Attacks can be repeated after various periods of time, in the future their frequency and duration increase, pain joins.

II stage caused by asphyxia. The spasm is accompanied by a blue-violet coloration of the skin, paresthesia and severe pain, sensitivity disappears in places of asphyxia. An important role in the mechanism of development of this stage is played by dilatation of the veins. These phenomena are also reversible.

III stage develops after prolonged asphyxia. On the edematous limb, which has a purple-blue color, blisters with bloody contents appear. After opening the bladder, tissue necrosis is found in its place, in severe cases - not only the skin, but also

all soft tissues down to the bone. The process ends with scarring of the formed ulcerative surface.

The course of the disease is recurrent. Severe trophic disorders, gangrene are rarely observed in Raynaud's disease and more often in Raynaud's syndrome.

Diagnosis and differential diagnosis. The diagnosis is established on the basis of clinical manifestations. Secondary Raynaud's syndrome should be excluded, which requires additional instrumental and laboratory examination.

Treatment. The most complete elimination of the cause of Raynaud's syndrome (toxic, physical effects), as well as factors provoking exacerbations (for example, hypothermia) is required. In order to prevent vasospastic reactions, vasodilators from the group of calcium channel blockers (nifedipine, nimodipine, verapamil, etc.), peripheral adrenergic blockers (tropafen, indoramin), antiplatelet agents (dipyridamole, pentoxifylline) are prescribed. Physio- and balneotherapy can give a certain effect. If conservative therapy fails, desympathization and preganglionic sympathectomy are performed.

23.4. erythromelalgia

Syndrome, manifested by pathological vasodilation. The syndrome is caused by arsenic polyneuropathy, scleroderma, thrombophlebitis of the deep veins of the lower leg, less often by mononeuropathy of one of the nerves of the lower leg and foot. The attack is caused by an acute disorder of the vascular innervation of the arterioles and is provoked by overheating, muscle strain, lowered position of the limb. In summer, attacks are repeated much more often than in winter. With vasodilation, the permeability of the vascular wall increases, humoral blood factors come out through the vascular wall and cause an attack of pain.

Clinical manifestations. The disease is equally common in men and women, very rarely in children. These are attacks of burning pain in the distal extremities with reddening of the skin, a local increase in skin temperature, swelling and excessive sweating. More often one limb is affected, usually the foot. Pain sensations sharply increase when the limb is warmed, standing, walking and, conversely,

greatly reduced in the cold, in the supine position. The attack lasts from several minutes to several hours. The course is chronic, progressive. The severity of dysfunction is different.

Diagnosis and differential diagnosis. The diagnosis is established on the basis of typical clinical manifestations. Symptomatic erythromelalgia associated with curable diseases (eg, compressive neuropathies, tunnel syndromes) should be ruled out. Erythromelalgia should be differentiated from venous pathology of the lower extremities, diseases of the joints of the foot, and local inflammatory processes.

Treatment aimed at eliminating the main factor that caused erythromelalgia. Apply vasoconstrictor agents (ergotamine, mezaton), reflexology, physiotherapy.

23.5. Peripheral autonomic failure

It is a syndrome of diffuse lesions of the peripheral autonomic nervous system. It is a consequence of endocrine (hypothyroidism, diabetes mellitus, acute adrenal insufficiency), autoimmune (myasthenia gravis, Guillain-Barré syndrome), systemic (scleroderma, systemic lupus erythematosus), oncological (carcinomatosis) diseases, intoxications (in particular, adrenoblockers). It can be combined with other syndromes of damage to the nervous system (parkinsonism, multisystem degeneration). It is less common as an isolated syndrome within the framework of hereditary forms of polyneuropathy.

Clinical manifestations. The main symptoms are manifestations of systemic insufficiency of the peripheral part of the autonomic nervous system: orthostatic hypotension in combination with arterial hypertension in a horizontal position, tachycardia or a fixed pulse during physical exertion, hypoor anhidrosis, intestinal paresis, a tendency to constipation or diarrhea, urinary incontinence, sleep apnea, disorders vision in the dark.

Orthostatic syncope is noted, in severe forms of the disease developing even in a sitting position. At the same time, tachycardia and arterial hypertension are possible at rest, lying down.

Diagnosis and differential diagnosis. The diagnosis is established clinically based on the complaints listed above. Diagnostic search is aimed at excluding primary pathological processes that can lead to the development of peripheral autonomic failure.

Treatment symptomatic. In case of acute adrenal insufficiency, corticosteroids are used. A positive effect can give a sufficient introduction of fluid and salt. In the absence of contraindications, it is possible to prescribe vasoconstrictor drugs (amizinium, ergotamine). Apply bandaging of the lower extremities with an elastic bandage, compression stockings or tights.

Somatoform dysfunction of the autonomic nervous system is a condition where a person feels sick, although there are no obvious pathological signs. The problem first makes itself felt in childhood, the child complains of pain in the region of the heart, there is a frequent heartbeat, shortness of breath, difficulty breathing, cramps in the abdomen, aching joints, problems with urination, etc.

Many of us are familiar with the situation when a perfectly healthy person constantly complains of headaches, cramps in the stomach, talks about the mass of serious diseases that require urgent medical intervention. Most of us understand that the interlocutor is simply feigning, but this is not so. A person really suffers from pathology, but not physiological, but psychological. The disease is called "somatoform dysfunction of the autonomic system", what it is, how the diagnosis is deciphered - it is useful to know for everyone without exception. Since the problem can arise for each of us and lead to disastrous consequences.

Somatoform dysfunction of the autonomic nervous system is a condition when a person feels sick, although there are no obvious pathological signs

In order for us to immediately recognize this syndrome, it is necessary to familiarize ourselves with the main signs and causes of the disease. The word “condition” is not a reservation, since there is no such diagnosis in the international classification of diseases, only in domestic medicine there is still a tendency to classify an ailment as a disease. But the pathological processes that the child complains about can become a trigger, that is, provoke a number of somatic diseases if preventive measures are not taken in time.

Most adults believe that the child is faking, trying to attract attention. This happens often, but still, it is better to prevent the development of a serious pathology than to engage in a long recovery of the body.

Somatoform disorder of the autonomic nervous system: causes

Experts indicate a number of different factors that cause vegetative dysfunction, but they all agree on one thing - the main reason for the development of pathology is the reaction of the psyche to various events, life processes, stressful situations, conflicts, etc. Experienced doctors already know that a patient complaining of an autonomic disorder of the nervous system will never talk about his life until a specialist raises leading questions. It is because of relationships with others that such problems arise. Some have difficulties in the workplace, others in the family. As for children, everything is clear here: the little man begins to perceive reality, he frightens a lot, something surprises, and so the small organism reacts in its own way.

Important: there is an erroneous opinion that physical activity, weather changes can also cause dysfunction, but this is not so. The reason lies precisely in emotional stress, stress.

A disorder of nerve autonomics does not occur in everyone, but only in those who are used to hiding their emotions, driving negativity into themselves. With the next psychological situation, the accumulated stresses can result in somatic pathologies.

Often the cause is a family environment in which more attention is paid to one of the children suffering from certain diseases. Looking at such a situation, another kid understands on a subconscious level that love and care is possible if something hurts. In the future, under stress, somatic ailments may manifest as a built-in reaction in the mind.

Nerve autonomic disorder occurs in those who are used to hiding their emotions, driving negativity into themselves

Somatoform dysfunction of the autonomic nervous system: symptoms

Almost all patients with this pathology complain of the same number of symptoms:

• pain in the region of the heart;
• fast or slow pulse;
• dizziness;
• headache;
• stomach ache;
• pain in the stomach.

When examining and examining the patient's body, no pathological processes are usually detected. But to convince the patient that the problem is hidden in his psyche and there are no serious diseases is a waste of time. Persons suffering from this kind of ailment are frequent visitors to clinics, like to demonstrate their “bad” condition, seek re-examinations and demand that they have been given a serious diagnosis. If the doctor refuses to follow the imaginary patient, then the patient considers him incompetent and goes to another. This can go on not for months, but for years, the number of doctors serving the patient increases exponentially.

The symptoms listed above indicate the complaints of patients, but in fact a person with this pathology has clear signs indicating the "frivolity" of his disease:

1. Complaints are not confirmed.
2. Constant visits to clinics.
3. Complaints of poor health immediately in conflict, uncomfortable situations.
4. Constant complaints of headaches, weakness.
5. A huge medical record stuffed with a bunch of papers with analyzes, epicrises, etc.
6. Constant talk about illness.

The above points are a clear example of the behavior of a person with dysfunction of the autonomic nerves. At the same time, the symptoms of the patient can, as “by order”, manifest themselves in practice, including poor urination, impaired defecation, numbness of the hands, feet, tremor of the limbs, pallor or redness of the skin, itching, swelling. A person in this state quickly enters a state of panic, swallows a lot of pills, calls an ambulance, fearing for his own life.

Additional symptoms

Violation of the autonomic nervous system can cause a number of side effects:

• temporary loss of hearing or vision;
• violation of olfactory, tactile functions;
• partial loss of sensation in different parts of the body;
• violation of coordination of movement;
• loss of motor skills, up to paralysis, paresis.

The condition can lead to the fact that with complaints of pain in the abdomen, stomach, there is an upset, nausea, vomiting, bloating. Women often experience profuse vaginal discharge, itching in the genital area, etc.

With violations of the autonomic system, there may even be temporary hearing loss.

Other types of disorders

In addition to vegetative disorders, there are other types of somatoform dysfunctions that need to be remembered for general development.

Pain disorder

In this situation, patients constantly complain of pain in a certain area of ​​the body, the examination of which does not reveal any pathologies. Usually - this is the only complaint about the condition, while there are no complaints about other symptoms. When communicating with a patient, a doctor sees that a person is really tormented by severe pain, pain, and it can make itself felt for months, years.

hypochondriacal disorder

Among patients with dysfunction, there are often those who do not suffer, but fear a disease that can take their life. Often, patients try to “timely” detect a malignant tumor, AIDS and other severe, intractable or incurable diseases. The condition contributes to the development of various kinds of phobias associated with the nature of complaints. If the patient complains of pain in the abdomen, then a “tumor” develops in the stomach, intestines. With pain in the region of the heart - "mandatory" ischemia, heart attack, defect. Hypochondriacal dysfunction, supplemented by unfounded fears, leads to depression.

A frequent companion of the disease is the syndrome of "irritable bladder". A person who has cramps, pains in the lower abdomen, is sure that there are problems in the genitourinary system and is afraid to leave the house because he cannot find a toilet.

Somatoform dysfunction - undifferentiated

In this case, the patient has numerous complaints, some of which really bother the person. The mass of diagnoses does not fit into the clinical picture of an undifferentiated disorder, after a detailed examination, the doctor prescribes the necessary treatment.

Somatoform dysfunction of the autonomic nervous system: treatment

Doctors who have experience working with people with this pathology know very well that not a single drug, whether it be painkillers, colds, anti-inflammatory drugs, will help. The main thing is to deal with the mental aspect of the issue, because of which the somatoform disorder arises. All treatment is reduced to the correction of the patient's behavior, the elimination of fears.

When a patient is treated with this diagnosis, the doctor in any case must conduct an examination of the body in order to exclude the development of serious diseases. Next comes the psychiatrist, the psychotherapist.

The task of the psychiatrist is to help the patient rethink his existence, take a different look at the environment, his own body, and study the disease. It is important to convince the patient that it will be much easier to live without fears and fears, "imaginary" diseases.. Thus, a person will be able to adapt with society, take his condition for granted and fight phobias.

It is important to convince the patient that it will be much easier to live without fears and fears, "imaginary" diseases.

Somatoform disorder of the autonomic nervous system: treatment with medications

As sedatives that affect the psyche of the patient, appoint:

Antidepressants that eliminate depressed mood, lethargy in emotions, contributing to a rise in the level of working capacity: amitriptyline, citalopram.

• Tranquilizers with a sedative, anti-anxiety property, helping to eliminate negative thoughts, obsessive fears, excessive suspiciousness: Elenium, gidazepam, phenazepam.
• Antipsychotic drugs with more powerful anti-anxiety properties than tranquilizers: Truxal, Sonapax.
• Mood stabilizers, contributing to the restructuring of negative thoughts in a positive direction, reducing the level of phobias, fears, obsessive thoughts: carbamazepine.
• Beta-blockers aimed at eliminating excessive sweating, rapid heart rate, tremors, numbness of the extremities, dizziness: propranolol, atenolol.

Folk treatments for disorders

Some patients in whom dysfunction has not acquired pronounced, acute signs are recommended to take light, sedative decoctions and carry out procedures at home.

Important: before starting treatment with available means, it is necessary to consult with your doctor.

• Linden. Steam 2 tablespoons of flowers in a glass of boiling water. Drink a third of a glass 3 times a day.
• Raspberries. Leaves, fruits (fresh or dried), shrub branches (2 tablespoons) are steamed in half a liter of steep pitch, insist and drink 3 sips 5-6 times a day.
• Mint. Dry or fresh grass leaves (1 tablespoon) are steamed in 0.5 liter of boiling water, insist, add 2 tablespoons to tea, drink three to four times a day.

The course of treatment of disorders should be long, in any case, not less than 1.5 months. Correction of the psyche requires a detailed, individual approach. In many cases, a course of psychotherapy using the cognitive-behavioral method has a great effect. The doctor conducts conversations with the patient, trying to identify what his fears are based on. Usually 1-2 courses are enough, as a person stops obsessing over illnesses and becomes interested in more interesting, pleasant things. Lessons can be group or individual. If a child suffers from a pathology, his parents should also participate in the sessions. As a last resort, they should be familiar with the diagnosis and follow the doctor's recommendations for the next attack of the disorder.

Important: the appointment of the above medicines for minors is contraindicated if the condition does not cause particular concern.

Somatoform disorder of the nervous system: prevention

As we already know, this pathology is rooted in human childhood. Parents should remember that attention and care for the child should be in moderation. Negative consequences can be both due to excessive severity, alienation, coldness of adults in relation to the child, and excessive guardianship and care.

Caring for the health of the child should be in moderation

It is necessary to pay attention in time to the moments when the baby is trying to manipulate his parents, call attention to himself, beg for another toy, treat, complaining about his poor condition. Of course, no one has canceled visits to the doctor, and if a specialist points out a somatoform autonomic disorder, a course of treatment with a specialized doctor is necessary. At the same time, the child needs to be “switched” to more useful things: playing sports, interesting hobbies, visiting circles, etc.

Autonomic neurosis or autonomic dystonia is characterized by a disease of various organs and tissues, which does not occur due to organic changes in the tissue of the autonomic nervous system, but as a result of a violation of its functions.

Normally, the autonomic nervous system, being part of the general nervous system, is a complex of cells that regulate the innervation of all internal organs and systems, blood and lymphatic vessels, as well as endocrine and external secretion glands. The work and functions of the autonomic nervous system are not subject to a person and are not controlled by him. The centers for regulating the work of the entire autonomic nervous system are located in different parts of the hypothalamus located in the brain.

The functions of the autonomic nervous system are as follows:

Increased metabolism.

Increasing the level of tissue excitability.

Mobilization of the internal forces of the body for active work.

Regulation of the work of all systems during sleep.

Recovery of spent energy reserves.

Participation in human behavioral responses.

Influence on physical and mental activity.

Based on this, one can understand what happens to a person in stressful situations or changes in the autonomic nervous system under the influence of any factors. In fact, a disorder of the functions of the autonomic nervous system can cause any pathological conditions in humans.

Symptoms of autonomic neurosis

Autonomic disorders belong to the group of neuroses or neurasthenia and are manifested by the following clinical syndromes:

Vasomotor syndrome - headaches, dizziness, migraine, jumps in blood pressure up and down the scale, vasomotor form of Meniere's syndrome (sudden dizziness and nausea). It is also possible the appearance of pain in the joints and muscles, pain in the limbs, in the stomach.

Vegetative-skin syndrome - hypersensitivity of the skin, marbled or bluish color of the skin, itching, dry skin or excessive moisture.

Vegetative-trophic syndrome - a violation of the trophism of muscles, nails, hair, muscle atrophy, trophic ulcers, erosion.

Vegetative-visceral syndrome - a feeling of lack of air, skin hyperesthesia, pseudoangina pectoris, violation of the act of swallowing, outflow of bile, disorder of the stool, bladder function, violation of all types of metabolism.

Vegetative-allergic syndrome - angioedema, food allergies, urticaria, allergic rhinitis.

The course of autonomic neurosis may also differ, and is subdivided as follows:

Autonomic disorders can develop after manifestations of general neurosis. First, patients have signs of neurasthenia, and then all other characteristic signs join.

Vegetative dysfunctions occur in the subcortical vegetative parts of the brain, causing disruption of the work of all organs and systems.

Vegetative disturbances occur against the background or after brain injuries, and then the clinical picture is limited to a violation of the work of those organs whose vegetative centers were located at the site of injury.

Causes of autonomic neuroses

The causes of autonomic neurosis include the following factors:

Brain injury.

Individual characteristics

Transferred acute and chronic infections.

Prolonged emotional and mental stress.

General depletion of the body due to malnutrition.

GBOU VPO North-Western State Medical University named after Mechnikov

Department of Neurology. Academician I.S.Davidenkov

ESSAY

"Diseases of the autonomic nervous system. Autonomic dysfunction syndrome. Panic attacks."

Completed by: 4th year student

419 groups

Shabunova M.V.

Lecturer: Zuev A.A.

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 belongs to angioedema. 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, spasm occurs in the basin of the external carotid artery and the walls of the internal carotid artery are stretched.

Clinically, migraine is manifested by recurrent pain in one half of the head. Migraines are more common in women. Attacks begin from a young age, in the menopause, attacks weaken or even stop. There is an "accumulation" of cases of migraine in individual families, more often in the female line. Migraine attacks can be triggered by sleep disturbance, mental stress, alcohol, excitement, various smells, and being in a stuffy room. Often, attacks of pain are accompanied by objective neurological disorders, depending on the nature of which there are several forms of migraine. V Simple migraine. It is manifested by 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 increased sensitivity to light stimuli. There may be nausea, vomiting, and at the end of the attack - polyuria. On palpation during an attack of the temporal artery, its tension and soreness are noted.

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

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

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

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

Raynaud's disease refers to angiotrophoneurosis. At the heart of this disease are spastic vasomotor disorders. Raynaud's disease is manifested by periodically advancing spasms of the vessels of the fingers, less often the legs, auricles, and the tip of the nose. Then comes their constant reddening, turning blue and trophic disorders. During the course of the disease, there are three

Angioedema stage characterized by vasospasm, accompanied by pallor of the fingers (symptom of the “dead finger”) and hands, their cooling, paresthesia, pain, decreased sensitivity. When the spasm stops, cyanosis occurs, and then hyperemia, the pain disappears and the fingers become warm. The same 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 asphyxia. In patients, venous congestion is observed, accompanied by cyanosis of the skin of the affected areas. Paresthesia and pain are more pronounced and more persistent, the skin becomes dry, cold.

Stage of necrosis characterized by necrosis of the distal parts of the fingers (skin and deeper tissues).

In the treatment of patients in the first stages of the disease, it is necessary to prescribe adrenolytic and vasodilators, ganglionic blockers and tranquilizers, thermal procedures (four-chamber baths, etc.). In some cases, an operation on the sympathetic nervous system (desympathization and pre-ganglionic sympathectomy) is effective. In the third stage of the disease, surgical removal of necrotic tissues, prophylactic use of antibiotics is necessary. Patients suffering from Raynaud's disease should not smoke, drink alcohol, overcool and overwork physically.

Edema Quincke is a disease related to angioedema and is manifested by rapidly advancing edema of limited areas of the skin, mucous membranes of the respiratory tract or alimentary canal. The edema lasts for several hours or days, after disappearance, itching is noted in its place. Swelling of the mucous membrane of the larynx can lead to asphyxia. Soft tissue edema is due to 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 angioedema, desensitizing therapy is prescribed, agents that increase the tone of the sympathetic and reduce the tone of the parasympathetic parts of the autonomic nervous system, diuretics, and in severe cases, corticosteroid drugs.

Meniere's disease- a type of angioedema, in which vasomotor disorders are observed in the inner ear, leading to an increase in endolymph in it, an acute development of water in 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 bouts of vestibular disorders: dizziness, vomiting, bradycardia, ataxia, tinnitus, cold sweat, pallor of the face.

Treatment. During an attack, the patient must be given a horizontal position with a raised head, hot foot baths, leeches on the mastoid processes, anticholinergics, sedatives. Between attacks, 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, a decrease in skin temperature, myalgia as a result of vasospasm of the distal extremities. The disease occurs during the winter months. Women are more likely to get sick during menopause or with dysthyroidism. The provoking factors of acroparesthesia are muscle tension, long-term monotonous work, weight lifting. The lower extremities are usually not affected. The disease is caused by a violation of the tone of the upper limbs and can be considered as a sensitive-sympathetic syndrome.

In the treatment, vasodilators, 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 the capillaries, arterioles and veins of the lower extremities. Clinically, this disease is manifested by bouts of burning pain, usually in the feet and less often in the legs and thighs. At the same time, 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 increases with warming the legs, walking and standing, with mechanical irritations and decreases with cooling. Seizures can last for several hours or days. Erythromelalgia is caused by damage to the lateral horns of the spinal cord and often accompanies syringomyelia, myelitis.

In the treatment, vasoconstrictor and hormonal drugs, acetylcholine, intravenous infusions of novocaine are prescribed. In some cases, they resort to surgical intervention (transection of the posterior roots, resection of the lumbosacral region of the borderline sympathetic trunk - in order to interrupt the vasodilating fibers leading to the affected limb).

Sympathy- this is pain associated with damage to sympathetic structures: sympathetic nodes, connecting branches, plexuses, nerves, sympathetic fibers in mixed nerves (sciatic, median, trigeminal, etc.). Most often, sympathalgia is localized on the limbs and in the face. With sympathetic pain, pain appears along the course of the corresponding nerve and is of a special nature: it is diffuse, and not localized along the course of the nerve, has the character 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. The pain often gets worse with rest and lessens with movement. With pressure on the nerve trunks, pain occurs not only at the site of pressure, but spreads diffusely throughout the nerve. Tendon reflexes are increased in sympathetic pain. Soreness is noted along the course of the vessels, trophic disorders are observed in the form of dry skin, peeling, hypo- or hypertrichosis, brittle nails, changes in skin color and temperature.

Ganglionite. The defeat of individual nodes of the sympathetic trunk is manifested by vasomotor, secretory, pilomotor and trophic disorders in the corresponding zones, dysfunction of internal organs, decreased pain sensitivity, hyperpathic phenomena, decreased tendon reflexes, and emotional disorders.

Damage to the superior cervical sympathetic ganglion 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 a violation of the tone of the muscles of the larynx, a change in the EEG on the side of the lesion. Irritation of this node often simulates hyperthyroidism.

Star node lesion manifested by pain in the corresponding half of the chest (in the form of a "half-jacket"), extending into the arm and simulating an attack of angina pectoris.

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

Pterygopalatine neuralgia(Slyuder's 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. Seizures often occur at night and are causal in nature. After an attack, hyperpathy is noted in the areas of localization of pain. Pain can radiate to the tongue and palate, temporal region, neck, ear and area behind the mastoid process, to the arm, half of the chest. Often it is accompanied by convulsions of the muscles that raise the soft palate, which is accompanied by certain sounds. Attacks can be complicated by shortness of breath, nausea, photophobia. Slyuder's syndrome is more often observed in the elderly and, as a rule, occurs as a result of inflammatory or neoplastic processes in the main or ethmoid sinuses.

Neuralgia of the crankshaft. The pain begins in the ear area, is paroxysmal in nature and spreads to the face, back of the head, 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 these nodes and the nodes of the sympathetic trunk, the pain in Slyuder's syndrome and neuralgia of the geniculate node can spread to more distant parts of the body or half of the body.

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

Damage to the nodes of the thoracic region sympathetic trunk leads to dysfunction of the lungs and unstriated muscles of the intestines. Diagnosis of the disease of this part of the sympathetic trunk is very difficult and represents the border area between neurology, therapy and surgery.

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

Damage to the celiac (solar) plexus(solar plexitis, or solaritis) is manifested by boring, periodically recurring pain in the epigastric region (“solar nail”). There is pain with pressure in the midline of the abdomen between the navel and the xiphoid process. The functions of the alimentary canal are often disturbed.

Treatment of solaritis should be carried out taking into account etiological factors (infectious, toxic solaritis, symptomatic plexitis due to diseases of the abdominal organs). To eliminate pain attacks, antispasmodic drugs, ganglionic blockers, neuroleptics, salicylates, amidopyrine, intravenous administration of novocaine are prescribed. Physiotherapeutic treatment is widely used: electrophoresis with novocaine or amidopyrine on 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- these are symptom complexes of vegetative-endocrine-trophic disorders resulting from damage to the hypothalamic-pituitary region. The peculiarity of the vascularization of the hypothalamus in comparison with other areas of the brain is the intensity of capillary blood supply and the high permeability of its vessels for macromolecular compounds (infectious agents, toxins, hormones and other humoral substances). This explains the high sensitivity of the hypothalamus to various physiological and pathological influences and its high vulnerability.

The following hypothalamic syndromes are most common.

Syndrome of paroxysmal disturbances of wakefulness manifests itself in the form of paroxysmal or permanent hypersomnia, narcolepsy and 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 most often manifested by Itsenko-Cushing's syndrome, adiposogenital dystrophy, gonadal dysfunction, diabetes insipidus. Neuroendocrine syndrome is associated with dysfunction of many endocrine glands as a result of damage to the anterior and intermediate groups of hypothalamic nuclei.

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

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

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

SVD includes the manifestation of all forms of violation of autonomic regulation. Vegetative dystonia is called a syndrome because, as a rule, autonomic disorders are secondary manifestations of various forms of pathology. Three forms of SVD can be distinguished:

psychovegetative syndrome;

syndrome of peripheral vegetative insufficiency;

angiotrophoalgic syndrome.

Psychovegetative syndrome. Manifested by permanent paroxysmal autonomic disorders (panic attacks, some forms of fainting), caused by dysfunction of the suprasegmental division of the autonomic nervous system. In the etiology of this syndrome, the main role is assigned to psychogenic factors. Syndrome of peripheral vegetative insufficiency. It is caused by an organic lesion of segmental autonomic apparatuses, i.e., specific sympathetic and parasympathetic nuclei, nodes, peripheral preganglionic and postganglionic autonomic fibers. Typical clinical manifestations are orthostatic hypotension, tachycardia at rest and a rigid pulse, hypohidrosis, bladder atony and urinary incontinence, constipation, diarrhea, and impotence.

The syndrome occurs mainly in diseases affecting the PNS (diabetes mellitus, alcoholism, amyloidosis, etc.), but also in diseases of the central nervous system (multisystem atrophy). Angiotrophoalgic syndrome. The clinical picture of the syndrome consists of characteristic combinations of vasomotor, trophic and pain manifestations (acroerythrosis, erythromelalgia, Raynaud's syndrome, complex regional pain syndrome). The syndrome is based on the defeat of mixed nerves, plexuses and roots that innervate the arms and legs. But it can also be part of the psychovegetative syndrome (Raynaud's disease). Analyzing SVD, it is necessary to take into account a number of factors: 1) the nature of vegetative disorders; 2) permanent and paroxysmal; 3) poly or monosystem nature of disorders; 4) generalized systemic and local disorders.

Taking into account the division of the autonomic nervous system into sympathetic and parasympathetic parts at the beginning of the 20th century. among vegetative disorders, vagotonia and sympathicotonia were identified. The doctrine of sympathicotonia and vagotonia has often been criticized, based on the idea of ​​the rarity in real practice of such pure syndromes. Indeed, more often one has to deal with mixed sympathetic or parasympathetic manifestations, however, it is often possible to single out the predominant orientation of disorders or a different orientation in individual functional systems (for example, sympathetic activity in the cardiovascular and parasympathetic - in the gastrointestinal systems). With all reservations and additions, it should be recognized that the principle of identifying autonomic disorders according to sympathicotonic and vagotonic manifestations has remained fruitful today. The second factor is associated with the permanence and paroxysmal nature of vegetative disorders. If the latter are delineated in time and intense "vegetative storms" (panic attacks), then the designation of the remaining violations as "permanent" is to a certain extent conditional. All autonomic symptoms are dynamic. Thus, permanent disorders are not absolutely stable indicators, but their frequent fluctuations that are not clinically detectable and do not reach the level of vegetative crises. The allocation of generalized, systemic and local disorders is to some extent conditional. It would seem that the question of local syndromes is most clear. It is known that local autonomic disorders can occur when the PNS is damaged. However, as they develop and deepen, they begin to acquire generalized psychovegetative disorders that occur as a reaction to chronic pain (if any) or to maladjustment caused by local disorders. Nevertheless, this situation seems to be sufficiently outlined from the point of view of the dominance of local forms of SVD. It is more difficult to separate generalized and systemic forms, since they can be the result of both disruption of the functioning of suprasegmental vegetative formations (psycho-vegetative syndrome) and damage to peripheral vegetative structures (progressive autonomic failure syndrome). These disorders are always polysystemic. Clinically detectable monosystem nature of pathological manifestations is most often the result of either non-detection or subclinical course of disorders in other systems. SVD, as a rule, is not a nosological unit. In the classification of autonomic disorders, primary and secondary central, peripheral and combined autonomic disorders are distinguished. The vast majority of autonomic disorders are secondary, and in these situations, the analysis of the nosological nature of the pathology that led to SVD is essential for correct diagnosis and especially for treatment. With a certain degree of schematicity, a number of factors that cause vegetative disorders can be identified.

constitutional features. SVD of a constitutional nature usually manifests itself from early childhood and is characterized by instability of vegetative parameters: a rapid change in skin color, sweating, fluctuations in heart rate and blood pressure, pain and dyskinesia in the gastrointestinal tract, a tendency to low-grade fever, nausea, poor tolerance of physical and mental stress , meteotropic. Often these disorders are hereditary. With age, these individuals, with proper tempering education, achieve a certain compensation, although they remain vegetatively stigmatized all their lives. There are also very severe constitutional vegetative disorders. We are talking about familial dysautonomy, the Rye-lee-Day syndrome, in which gross violations occur in the internal environment of the body, incompatible with life, and the peripheral autonomic system is significantly involved in the pathological process.

Psychophysiological state. SVD psychophysiological nature. It occurs in healthy people against the background of acute or chronic stress. Emotional-vegetative-endocrine reactions to acute stress are a normal physiological response of the body and cannot be considered pathological. However, excessive inadequate severity of reactions, their duration and frequency, violation of the adaptive capabilities of a person are already pathological, the basis of the clinical manifestations of which is psychovegetative syndrome. A mass manifestation of SVD of a psychophysiological nature is observed in stressful extreme situations.

Hormonal changes in the body. Occurs during puberty and menopause. At puberty, there are two prerequisites for the appearance of vegetative syndromes: the emergence of new endocrine-vegetative interactions that require the formation of other integrative patterns, and a fast, often accelerated increase in growth; this creates a gap between the new physical parameters and the possibilities of vascular support. Typical manifestations are vegetative disturbances against the background of mild or severe endocrine disorders, fluctuations in blood pressure, orthostatic syndromes with presyncope and syncope, emotional instability, violation of thermoregulation.

Vegetative disorders are also aggravated during menopause, which is associated with the physiological endocrine and emotional accompaniments of this condition. Vegetative disorders are both permanent and paroxysmal in nature, and among the latter, in addition to the characteristic hot flashes, feelings of heat, profuse sweating, vegetative-vascular crises may occur. It should be emphasized that both menopause and puberty are characterized by significant psychological restructuring. Given this fact, we can assume that these autonomic disorders are based on both endocrine and psychological factors.

Organic somatic diseases. In many psychosomatic diseases (hypertension, ischemic, peptic ulcer, bronchial asthma), as well as visceral diseases with a pronounced algic component (cholelithiasis, urolithiasis, chronic pancreatitis), psychovegetative syndromes are often formed. In psychosomatic diseases, these disorders are an essential factor in pathogenesis, occur before the final development of the described diseases, and are of a psychophysiological nature in the early stages. Chronic pain syndromes, which are essentially chronic pain stress, are also accompanied by psychovegetative disorders. The latter are clearly represented in allergic disorders. A large group of somatic suffering, including endocrine (diabetes mellitus, hypothyroidism, etc.), systemic and autoimmune (amyloidosis, scleroderma, etc.), metabolic (porphyria, cryoglobulinemia, etc.) diseases, is accompanied by a syndrome of progressive autonomic failure . Of particular importance should be given to diabetes mellitus (given its high prevalence), in which peripheral autonomic disorders occur in 50-60% of cases.

Organic diseases of the nervous system. Their damage often causes clinically significant psychovegetative disorders. In addition to the significance of the limbic-reticular complex, the role of interhemispheric asymmetry is also revealed. A closer connection of the right hemisphere of the large brain with psychovegetative regulation is shown. The above considerations are based on the topical principle, which is quite reasonable, since the nature of the disease is of less importance. At the same time, one should not forget the type of disturbances (destruction and irritation, extensive destruction of the brain). The syndrome of vegetative-vascular-trophic disorders often occurs with peripheral syndromes (radiculopathy, plexopathy, neuropathy). The main clinical manifestations are found on the arms and legs, often they are unilateral. Peripheral (segmental) vegetative syndromes until recently were reduced to the diagnosis of "ganglionitis", "truncites" and damage to the celiac plexus ("solarite"). With all certainty, it should be emphasized that such a diagnosis is not justified.