Ischemic neuropathy

Our body is a unique, but incredibly complex system in which everything is interconnected. It is clear that for the smooth running of any multi-component mechanism, an organ is needed that will monitor and direct the actions of each individual component and individual links of the common system. In our body, the controlling role is given to the central nervous system, and the functionality of all other organs largely depends on its health. Disorders of the nervous system are usually called neuropathies. When we have a defeat of the structures innervating the various organs, the term "ischemic neuropathy" comes to mind as a result of a violation of the blood supply of the nearby part of the body. And if it is a question of squeezing the nerve and vessels with a muscle, cartilaginous or bone tissue, such pathology will be more correctly called compression-ischemic neuropathy.

[1],

Epidemiology

Neuropathy is in most cases a one-way process, i.e. Damage to the nerve on the one hand does not entail the defeat of nerve fibers located symmetrically on the other side of the body. Nevertheless, statistics indicate that in the order of 20-30% of patients the process after 3-5 years can pass to the other side. In this case, most often ischemic form of neuropathy affects older people who have atherosclerotic changes in the vessels (narrowing the lumen of the vessels due to deposited on their walls of cholesterol and the associated formation of thrombi that interfere with the blood flow).

[2], [3], [4], [5], [6], [7], [8]

Causes of the ischemic neuropathy

As we have already understood, ischemic neuropathy is a violation of the normal functioning of nerve cells due to impaired blood circulation. It turns out that the causes of ischemia of the nerve can be considered those factors that cause circulatory disorders. These factors include: vascular disorders and large blood loss. In the first case, we have local disorders associated with systemic diseases, in the second - a violation of general hemodynamics.

What vascular disorders can cause ischemic neuropathy? Inflammation of the vessel wall, atherosclerotic changes, the formation of thrombi, stenosis of the arteries, which are observed in the case of the following pathologies:

• Atherosclerosis
• Arterial hypertension
• Gyptonia
• Giant cell, obliterating or nodular arteritis
• Diabetes
• Diskopatii spine with vertebrobasilar disorders
• Vascular thrombosis
• Phlebeurysm
• Ischemic heart disease and heart failure, etc.

Speaking about the violation of general hemodynamics, here the risk factors are bleeding from the gastrointestinal tract, complications during surgery, severe gynecological bleeding, trauma accompanied by a large loss of blood, low blood coagulability (as a result of various diseases). There have been cases of the development of neuropathies and against the background of anemia.

As for compression-ischemic neuropathy, which is often called a tunnel syndrome, the inflammatory pathologies of muscles, bones and connective tissue that lead to their edema (myositis, arthritis, osteomyelitis, etc.) come to the fore. Any inflammation causes tissue swelling. They also increase in size, begin to squeeze the nerve and the nearby vessels.

Quite often, such neuropathies are considered complications of the diseases described above. They can occur during the period of the disease, and several months after the relief of acute symptoms. Inflammations, especially chronic ones, do not pass without a trace. Very often they lead to degenerative changes in tissues (their compaction, formation of scar tissue and pathological growths, limitation of joint mobility due to cartilage deformation, etc.). All this creates abnormal conditions for nearby structures, including nerves and vessels.

[9], [10], [11], [12]

Risk factors

Risk factors for the development of compression-ischemic neuropathy include supercooling of body tissues, penetration of bacterial or viral infection into the body, regular overstraining of certain muscle groups, trauma (severe bruises, fractures, ligament rupture, etc.), prolonged exposure to an uncomfortable posture the transmission of nerves and blood vessels in some area of the body. Tunnel syndrome can be caused by some systemic diseases (pathology of the endocrine system, metabolic disorders, rheumatic and other changes in the tissues of the body, which change the shape of the tunnel - the cavity between the muscles, ligaments, bones, where the nerve runs).

[13], [14], [15], [16], [17],

Pathogenesis

Neuropathy (neuropathy) is a word consisting of two parts. The first signifies the nerve, the second the pathology. Thus, neuropathy should be understood as the pathology of nerves related to the central or peripheral nervous system. Such pathology is always caused by a certain cause, which affected the work of the nervous system and caused the appearance of painful symptoms.

Depending on the cause of the pathology, several types of neuropathies are distinguished: sensory, diabetic, ischemic, traumatic, compression, etc. By localization of the affected nerve, one can distinguish between optic neuropathy (optic neuropathy), lumbar plexus, ilio-inguinal nerve, neuropathy of the suprapastal and facial nerve, neuropathy of the lower and upper extremities, and the like.

In addition, there is a kind of pathology, in which not one nerve is affected, but several, which are responsible for the innervation of a certain area, as a result of which its sensitivity is lost and motor functions are disrupted. Such a disease of the nerves is called polyneuropathy.

Nerves are something through which we can feel, feel, and exercise any movement, including eye blinking and swallowing. It is the nerves that control the motor activity of the muscles. The defeat of the nerves worsens the conductivity of the impulses coming from the brain. Muscles either do not receive this signal, or receive it late, or it is very weak and does not ensure the correct operation of muscle fibers. As a result, the mobility of the organ suffers, the innervation of which the affected nerve should perform.

Ischemic neuropathy is a nerve damage due to a disturbance in its nutrition. Yes, nerve cells, like all the others in our body, also can not function in conditions of hunger. To perform normal life activities, they should receive oxygen, vitamins, trace elements and other important substances in the blood. If the blood flow is disturbed, the nervous system suffers, and after it other organs and systems of man. In this case, the nerve conduction worsens due to the dystrophic changes in the nerves themselves and the surrounding tissues.

Nervous ischemia refers to pathologies that can affect any nerve in different parts of the body: face, eyes, chest, back, limbs, if a person has problems with blood circulation.

Compression-ischemic neuropathy is a slightly different kind of disease, which is more characteristic of the upper and lower extremities due to their mobility, as well as the spine area. This kind of pathology can cause degenerative and inflammatory changes in muscles and joints, trauma and just a prolonged stay in an uncomfortable position, when the nerves and vessels near them are squeezed for some time, which leads to a decrease in tissue sensitivity. The appearance of discomfort is already a signal to the fact that some structures of the body experience excessive load, worsening their functionality.

It must be said that neuropathy is a fairly common pathology, especially if it is a compression-ischemic variety of it. In the musculo-skeleton tunnels and along the spine, a large occipital, additional, suprapatric, axillary nerves, a long nerve of the thorax, a radial, ulnar, median, ilio-inguer and other kinds of nerves, as well as several kinds of nerve plexuses, can undergo compression. And in each case, pain, as a bright sign of nerve damage, will have its own localization.

[18], [19], [20], [21], [22], [23],

Symptoms of the ischemic neuropathy

Since neuropathy is a common concept, and the disease can be localized in different parts of the body, depending on the area of the disease, the symptoms of the disease may vary slightly. The first signs of ischemic neuropathy, which appear in most cases of the disease, are paresthesia (sensation of numbness, tingling, crawling of insects), pain of varying intensity (at the beginning of the disease most often blunt and not expressed), impaired sensitivity of the affected area, decreased muscle mobility (motor disorders).

Paresthesia can be observed by squeezing the nerve due to an uncomfortable posture. If the disease is caused by inflammatory or dystrophic changes, then the symptom appears mainly at night against the background of stagnation of venous blood. When compressing the nerve of the lower extremity or elbow of the upper extremities, this symptom is observed not only in the place of compression of the nervous structures, but also in the lower limb (forearm and hand, shin and foot).

Pain can have a different nature and intensity, often occur without any apparent cause. They extend to the zone of innervation of the affected nerve and are strengthened when pressure is applied to the site of passage of the nerve, flexion of limbs, increased stress, active movements.

Disturbances of sensitivity can be manifested in the form of its decrease or increase, which happens much less often. In some cases of acute compression-ischemic neuropathy, the sensitivity of the limb first decreases, and then its significant increase, so that even a slight touch causes an unpleasant sensation (a shiver runs through the body).

Sometimes the threshold of tissue sensitivity may increase or decrease. With acute nerve compression, this symptom may appear at the very beginning of the disease. With ischemic neuropathy, a sensitivity disorder is observed already at later stages of the disease.

Violation of the motor ability of organs, for the innervation of which the affected nerve corresponds, is not simply one of the symptoms of the disease. It can act as a factor that aggravates tissue ischemia. At first, the mobility of muscles and joints is limited by the person himself because of the pain that occurs. But later, lack of exercise, or, more accurately, the lack of regular muscle training, which is carried out even during routine tasks and habitual movements, which we sometimes do not think about, leads to additional degenerative changes (atrophy of nerves and muscles).

Another common symptom of neuropathy is edema of tissues in the affected area, which also aggravates the situation, contributing to even more compression (compression) of the nerve. Thus, ischemic neuropathy can easily go into compression-ischemic, which is most often observed.

As we have already said, the symptomatology of the disease has a dependence on the localization of the affected nerve. For example, ischemic optic neuropathy, in which optic nerve damage is observed. Has its own specific symptoms:

• a sharp decrease in vision, which in most cases is observed after waking up, but it can also be provoked by physical activity, a hot bath, a sauna or a sauna,
• change color perception,
• episodes of blurred vision on the eve of drastic changes,
• intense pain in the head,
• a feeling of discomfort and dull pain inside the eye, as if behind him.

The last 3 symptoms are not observed in all cases. Pain may not appear at all or be very weak.

The defeat of the optic nerve most affects the peripheral vision. The field of vision can either be narrowed concentrically, or individual regions in the lower, temporal and nasal regions fall out, sometimes there are individual defects called scotomas.

There may also be pain in the muscles, throbbing pain in the temples. Sometimes a person feels pain while combing his hair. In those places where the temporal artery passes the pain is felt especially strongly, especially when palpation. Such symptoms indicate not only the development of neuropathy, but also its cause - arteritis (inflammation of the walls of blood vessels).

Ischemic neuropathy of the lower extremities can be manifested not only by pain, paresthesia and impaired mobility of the joints. A person changes his gait, he incorrectly puts a foot, staggers when walking, with pain intensification and, in connection with progressive weakness of muscles, can even lose balance. The foot can also have a fever, the toes bend in the form of claws, on the skin of the legs appear hard-healing ulcers, the nails become brittle, etc.

With ischemia of the nerves of the lumbar and inguinal area, as well as with lesions of the lower limbs, there may be a decrease in sexual activity, frequent episodes of urination, forced posture with a forward incline, soreness in the penis, scrotum, and testicles in men.

Ischemia of the facial nerve is an even more unpleasant sight. Patients have a paresis of facial muscles (a strange grimace appears on the face, eyes can be half-closed, the mouth is slightly open on one or both sides, etc.). Depending on what part of the nerve is damaged, lacrimation, dry eyes, salivation, taste disturbances, mimicry, the appearance of forced facial movements may appear.

[24], [25], [26]

Complications and consequences

Even having superficially studied the symptoms of various types of ischemic neuropathy, it is not difficult to understand that such a pathology will have a most negative impact on the quality of life of the patient. Pain syndrome does not allow a person to move normally, because with any movement or exposure to heat, it is markedly enhanced.

Often the neuropathy of the peripheral nerves is complicated by contracture of the extremities. If the mobility of the joints is severely impaired, it becomes difficult for a person to walk. It is clear that such a situation can become an obstacle to the performance of professional duties.

With ischemic neuropathy of the optic nerve, a person begins to see badly, is less oriented in space, is forced to leave work, to give up driving. In severe cases, the damage to the optic nerve ends with blindness of the eye, and in bilateral pathology, which is diagnosed in 30-35% of patients, both eyes can blindly go blind.

If lameness and blindness cause in people mostly sympathy and pity, distortions in appearance, salivation and other symptoms observed in ischemia of the facial nerve can cause ridicule and dislike of outsiders. It is clear that such a person can not work in production or in the office, difficulties will arise in communication with people. Moreover, a person will feel defective and strongly worry about this, that in no way will help the recovery or subsidence of the symptoms.

When neuropathy affects the nerves of the inguinal region and lower limbs, conflicts arise in the family due to problems in sexual life, complexes begin, neuroses develop, depression develops.

As you can see, whatever the location of the affected nerve, the disease must necessarily affect the patient's life for the worse. And this is an occasion to ponder whether it is worth waiting for complications to begin or hurry to consult a specialist doctor who, after necessary studies, will prescribe an effective treatment.

[27], [28], [29], [30], [31], [32], [33], [34],

Diagnostics of the ischemic neuropathy

When you visit a doctor, diagnostic activities start from the moment when the doctor sees the patient, because some symptoms in ischemic neuropathy can be seen with the naked eye. Visual examination plus examination of the patient's history and complaints allow the doctor to presume a defeat of the nerves. To confirm his guess, the general practitioner directs the patient to consult a neurologist.

The neurologist first checks the nerve reflexes and sensitivity of the body in the area where the patient feels pain, with the help of palpation, rapping with a hammer, a Falen test (if it is a question of ischaemia of the median nerve in the carpal canal region). Palpatory and visually one can note a decreased tone of muscles and skin.

Absence or weakening of reflexes, disturbance of body sensitivity and motor activity, signs of muscle atrophy already allow us to make a preliminary diagnosis. But after all, the doctor's goal is also to determine the causes of damage to nerve fibers, because without its elimination, treatment is unlikely to be effective.

To find out the reason for the damage to the nerve structures, just telling the patient about recent events will be few. It is likely that the problem is far from new, it's just that a person did not pay attention to it, although the mention of old injuries may well give a clue to what is happening.

More information about the problem can be given by special studies. Common methods of instrumental diagnostics of neuropathies include:

• X-ray of organs in the area of suspected neuropathy,
• Ultrasound of diseased organs (shows areas of nerve compression, increased muscle tone, etc.)
• Angiography of cerebral vessels and peripheral vessels using fluorescent components (helps to identify defects in the walls of arteries and veins, sclerotic changes in them, fibrotic changes observed with age, differences in the diameter of the vessels, stenosis, etc.)
• Dopplerography of large arteries (makes it possible to note any changes in blood flow),
• Electroneuromyography (allows to evaluate the passage of electrical impulses along nerve tissues, which gives information on the degree of nerve damage: complete or partial),
• Ultrasonography (allows to visualize the area of nerve compression and evaluate its degree),
• Magnetic resonance tomogram (considered the best method of visualization, since it allows you to get a three-dimensional picture and consider the situation from all sides).

Under ischemic neuropathy is most often understood the pathology of the optic nerve, which is really associated with a violation of blood circulation in the eye (in all other cases it is more about a compression-ischemic variety of neuropathies). Diagnosis of the optic nerve neuropathy is not limited to examining the therapist. Most often diagnostic activities include a cardiologist, endocrinologist, hematologist, rheumatologist, neurologist and other specialists (which is not excluded in the case of peripheral neuropathies), and specific studies are also assigned.

The therapist in this case first of all will direct to the ophthalmologist. The oculist will first listen to the patient, assess the situation with the naked eye, and then conduct an ophthalmoscopy, with which you can assess the condition of the optic nerve and the fundus. On ischemia will indicate pallor and swelling of the optic nerve, retinal edema, narrowness of the capillaries in the affected area and a strong filling of peripheral veins, the presence of foci of small hemorrhages. Alas, at the acute stage of the posterior neuropathy of the optic nerve, such changes are not yet visible, which makes it difficult to timely diagnose this dangerous disease.

The study of visual acuity, color perception, testing of visual fields for detection of various defects, such as loss of some areas from the visual field, is mandatory.

It is advisable to conduct special electrophysiological studies, such as estimation of the critical frequency of flicker fusion, retinography and some others, which help determine the actual functional state of the optic nerve.

The patient is obliged to prescribe blood tests: clinical, for sugar, biochemical, make a coagulogram. An important point is the evaluation of blood coagulability, as well as the level of cholesterol and lipoproteins. In neuropathies with irradiation of pain in the back and lower back, and also to determine the functional state of the excretory organs necessary for the safe administration of medications, a blood test is administered.

[35], [36]

Differential diagnosis

Differential diagnosis of ischemic neuropathy is difficult due to the spread of pain along the nerve, which makes it impossible to quickly determine the location of the lesion. In addition, the symptoms of neuropathy often converge with inflammatory myopathies, neuritis, stagnant conditions, tumor processes, which, incidentally, can also cause nerve compression and circulatory disorders.

Treatment of the ischemic neuropathy

Ischemic neuropathy is a special kind of pathology of the nervous system, when everything decides time. Violation of the blood circulation very quickly hits the nerve cells, which are practically not restored. Therefore, the longer nerve fibers will experience shortage of nutrition and respiration and there is no adequate treatment, the more severe the consequences will be.

Prevention

With compression-ischemic neuropathies and facial nerve neuropathy with appropriate treatment, one can achieve normalization of the condition. The main thing is to start treating the disease when the first symptoms appear. It is clear that in severe cases of peripheral neuropathy, improvement does not always occur, and a person can be threatened not only by prolonged treatment in the hospital, but also by receiving a group of disabilities.

Ischemic damage to the nerve is always associated with impaired blood circulation, leading to a violation of metabolic processes in the tissues of the body. Therefore, the prevention of ischemic lesions is the timely treatment of a variety of vascular pathologies. Preventive maintenance of compression-ischemic neuropathies is considered the prevention and timely treatment of inflammatory diseases of muscles, bones and joints, as well as any systemic infectious pathologies.

In any case, the following rules will be a win-win option:

• adhere to a healthy lifestyle, give up smoking and alcohol abuse,
• Avoid excessive physical exertion and a long time in an uncomfortable position,
• to practice a balanced diet, limiting the use of foods with a high level of harmful cholesterol, which subsequently settles on the walls of the vessels,
• to engage in amateur sports, daily do exercises, temper,
• daily to make active walks in the fresh air (movement stimulates intensive metabolism and circulation).

Ischemic neuropathy in most cases is an unpleasant consequence of our wrong attitude to life and our health. Therefore, the treatment of this disease implies in the future a change in one's lifestyle and the formation of a responsible attitude towards one's body.

[37], [38], [39], [40], [41],

Forecast

The prognosis of ischemic and compression-ischemic neuropathy depends on the localization of the affected nerve. With ischemia of the optic nerve, the prognosis is usually unfavorable. In most patients, even after an effective course of treatment, vision remains weak. Many complain about falling out of the fields of vision. It's about empty dark spots before your eyes (scotoma).

[42]