Ischemic neuropathy

Our body is a unique, but incredibly complex system in which everything is interconnected. It is clear that for the smooth and clear operation of any multi-component mechanism, an organ is needed that will control and direct the actions of each individual component and individual links of the overall 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 damage to the structures that innervate various organs, due to a disruption in the blood supply to a nearby area of the body, the term "ischemic neuropathy" comes to mind. And if we are talking about compression of the nerve and blood vessels by muscle, cartilage or bone tissue, such a pathology would be more correctly called compression-ischemic neuropathy.

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Epidemiology

Neuropathy is in most cases a one-sided process, i.e. damage to a nerve on one side does not entail damage to nerve fibers located symmetrically on the other side of the body. However, statistics show that in about 20-30% of patients the process can move to the other side after 3-5 years. At the same time, the ischemic form of neuropathy most often affects older people who have atherosclerotic changes in the vessels (narrowing of the lumen of the vessels due to cholesterol deposited on their walls and the associated formation of blood clots that impede blood flow).

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Causes ischemic neuropathy

As we have already understood, ischemic neuropathy is a disruption of the normal functioning of nerve cells due to impaired blood circulation. It turns out that the cause of nerve ischemia can be considered those factors that cause circulatory disorders. Such 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 vascular wall, atherosclerotic changes, thrombus formation, arterial stenosis, which are observed in the case of the following pathologies:

• Atherosclerosis
• Arterial hypertension
• Hypotension
• Giant cell, obliterating or nodular arteritis
• Diabetes mellitus
• Discopathy of the spine with vertebrobasilar disorders
• Vascular thrombosis
• Varicose veins
• 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 surgical intervention, severe gynecological bleeding, injuries accompanied by large blood loss, decreased blood clotting (as a result of various diseases). There have been cases of neuropathy developing against the background of anemia.

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

Quite often, such neuropathies are considered complications of the above-described diseases. They can occur both during the illness and several months after the acute symptoms have subsided. 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, limited joint mobility due to cartilage deformation, etc.). All this creates abnormal conditions for nearby structures, including nerves and blood vessels.

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Risk factors

Risk factors for the development of compression-ischemic neuropathy include hypothermia of body tissues, penetration of a bacterial or viral infection into the body, regular overexertion of individual muscle groups, injuries (severe bruises, fractures, ligament ruptures, etc.), prolonged stay in an uncomfortable position that causes compression of nerves and blood vessels in some area of the body. Tunnel syndrome can also be caused by some systemic diseases (pathologies of the endocrine system, metabolic disorders, rheumatic and other changes in body tissues that change the shape of the tunnel - the cavity between muscles, ligaments, bones, where the nerve runs).

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Pathogenesis

Neuropathy (neuropathy) is a word consisting of two parts. The first means nerve, the second - pathology. Thus, neuropathy should be understood as a pathology of the nerves related to the central or peripheral nervous system. Such pathology is always caused by some reason that affected the functioning of the nervous system and caused the appearance of painful symptoms.

Depending on the cause of the pathology, several types of neuropathy are distinguished: sensory, diabetic, ischemic, traumatic, compression, etc. According to the localization of the affected nerve, one can distinguish neuropathies of the optic nerve (optic neuropathy), lumbar plexus, ilioinguinal nerve, neuropathy of the suprascapular and facial nerve, neuropathy of the lower and upper extremities, etc.

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

Nerves are what we can feel, sense, and perform any movements, including blinking and swallowing. It is the nerves that control the motor activity of muscles. Damage to nerves impairs the conductivity of impulses coming from the brain. The 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, the innervation of which should be carried out by the affected nerve, suffers.

Ischemic neuropathy is a nerve lesion due to a disruption of its nutrition. Yes, nerve cells, like all others in our body, also cannot function in conditions of hunger. To carry out normal life activity, they must receive oxygen, vitamins, microelements and other important substances found in the blood. If the blood flow is disrupted, the nervous system suffers, and then other organs and systems of the human body. In this case, nerve conduction worsens due to degenerative changes in the nerves themselves and the tissues surrounding the nerve.

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

Compression-ischemic neuropathy is a slightly different type of disease, which is more typical for the upper and lower extremities due to their mobility, as well as the spine area. This type of pathology can be caused by degenerative-inflammatory changes in muscles and joints, injuries and simply prolonged stay in an uncomfortable position, when the nerves and vessels near them are subject to compression for some time, which leads to a decrease in tissue sensitivity. The appearance of discomfort is already a signal that some structures of the body are experiencing excessive stress, worsening their functionality.

It should be said that neuropathy is a fairly common pathology, especially if we are talking about its compression-ischemic variety. The large occipital, accessory, suprascapular, axillary nerves, the long thoracic nerve, the radial, ulnar, median, ilioinguinal and other types of nerves, as well as several types of nerve plexuses, can be subject to compression in the muscular-osseous tunnels and along the spine. And in each case, pain, as a clear sign of nerve damage, will have its own localization.

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Symptoms ischemic neuropathy

Since neuropathy is a general concept, and the disease can be localized in different areas of the body, depending on the affected area, the symptoms of the disease may vary slightly. The first signs of ischemic neuropathy, which appear in most cases of the disease, are considered to be paresthesia (a feeling of numbness, tingling, crawling insects), pain of varying intensity (at the beginning of the disease, most often dull and unexpressed), impaired sensitivity of the affected area, decreased muscle mobility (movement disorders).

Paresthesia can be observed when the nerve is compressed due to an uncomfortable position. If the disease is caused by inflammatory or dystrophic changes, the symptom appears mainly at night against the background of venous blood stagnation. When the nerve of the knee of the lower or elbow of the upper limbs is compressed, this symptom is observed not only at the site of compression of the nerve structures, but also in the lower part of the limb (forearm and hand, shin and foot).

Pain may have different character and intensity, often appearing without any apparent reason. It spreads to the innervation zone of the affected nerve and intensifies with pressure on the place where the nerve passes, bending of the limbs, increased load, active movements.

Sensitivity disorders may manifest themselves as a decrease or increase, which happens much less frequently. In some cases of acute compression-ischemic neuropathy, a decrease in the sensitivity of the limb is first noted, and then its significant increase, so that even a light touch causes an unpleasant sensation (the body trembles).

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

Impaired motor function of organs innervated by the affected nerve is not just one of the symptoms of the disease. It can act as a factor that aggravates tissue ischemia. At first, a person limits the mobility of muscles and joints because of the pain that occurs. But subsequently, hypodynamia, or rather the lack of regular muscle training, which occurs even during everyday activities and habitual movements that we sometimes do not even think about, leads to additional degenerative changes (atrophy of nerves and muscles).

Another common symptom of neuropathy is tissue swelling in the affected area, which also worsens the situation, contributing to even greater compression of the nerve. Thus, ischemic neuropathy can easily turn into compression-ischemic, which is most often observed.

As we have already said, the symptoms of the disease depend on the localization of the affected nerve. For example, ischemic optic neuropathy, in which damage to the optic nerve is observed. It 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 bathhouse or a sauna,
• change in color perception,
• episodes of blurred vision before sudden changes,
• intense headaches,
• a feeling of discomfort and dull pain inside the eye, as if behind it.

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

Optic nerve damage affects peripheral vision the most. The visual field may either narrow concentrically or be lost in individual areas in the inferior, temporal and nasal regions, and sometimes there are individual defects called scotomas.

Muscle pain and throbbing pain in the temples may also occur. Sometimes a person feels pain when combing their hair. In places where the temporal artery passes, the pain is felt especially strongly, especially upon palpation. Such symptoms indicate not only the development of neuropathy, but also its cause - arteritis (inflammation of the vessel walls).

Ischemic neuropathy of the lower extremities may manifest itself not only in pain, paresthesia and impaired joint mobility. A person's gait changes, he places his foot incorrectly, staggers when walking, and with increasing pain and due to progressive muscle weakness, he may even lose his balance. The foot may also have an elevated temperature, the toes may bend like claws, hard-to-heal ulcers may appear on the skin of the feet, the nails may become brittle, etc.

With ischemia of the nerves of the lumbar and inguinal region, as well as with damage to the lower extremities, a decrease in sexual activity, frequent episodes of urination, a forced posture with a forward bend, pain in the area of the penis, scrotum and testicles in men can be observed.

Facial nerve ischemia is an even more unpleasant sight. Patients experience paresis of the facial muscles (a strange grimace appears on the face, the eyes may be half-closed, the mouth may be slightly open on one or both sides, etc.). Depending on which part of the nerve is damaged, lacrimation, dry eyes, salivation, taste disturbances, facial expression disturbances, and forced facial movements may occur.

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Complications and consequences

Even after a superficial study of the symptoms of various types of ischemic neuropathy, it is easy to understand that such a pathology will have the most negative impact on the patient's quality of life. Pain syndrome does not allow a person to move normally, because with any movement or exposure to heat it significantly increases.

Often, neuropania of the peripheral nerves is complicated by contracture of the limbs. 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 optic neuropathy, a person begins to see poorly, has poor spatial orientation, is forced to leave work, and refuse to drive a car. In severe cases, damage to the optic nerve ends in blindness of the eye, and with bilateral pathology, which is diagnosed in 30-35% of patients, both eyes can go blind in succession.

If lameness and blindness cause sympathy and pity in people, then distortions in appearance, salivation and other symptoms observed in facial nerve ischemia can cause ridicule and hostility of strangers. It is clear that such a person will not be able to work in production or in an office, difficulties will also arise in communication with people. Moreover, the person will feel inferior and worry greatly about this, which will not contribute to recovery or relief of symptoms.

When neuropathy affects the nerves of the groin area and lower extremities, conflicts in the family arise due to problems in sexual life, complexes begin, neuroses and depression develop.

As we can see, no matter what the localization of the affected nerve is, the disease will definitely affect the patient's life for the worse. And this is already a reason to think about whether it is worth waiting until complications begin or to hurry to consult a specialist doctor who, after the necessary examinations, will prescribe effective treatment.

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Diagnostics ischemic neuropathy

When visiting a doctor, diagnostic measures begin from the moment the doctor sees the patient, because some symptoms of ischemic neuropathy can be seen with the naked eye. Visual examination plus studying the patient's history and complaints allow the doctor to assume nerve damage. To confirm his guess, the general practitioner refers the patient to a neurologist for consultation.

The neurologist first checks the nerve reflexes and body sensitivity in the area where the patient feels pain, using palpation, hammer tapping, Phalen's test (if we are talking about ischemia of the median nerve in the carpal tunnel area). Reduced muscle and skin tone can be noted by palpation and visually.

The absence or weakening of reflexes, impaired body sensitivity and motor activity, signs of muscle atrophy already allow a preliminary diagnosis to be made. But 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 determine the cause of damage to nerve structures, the patient's story about recent events alone will not be enough. It is quite possible that the problem is far from new, the person simply did not pay attention to it, although mentioning past injuries may well provide a clue to what is happening.

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

• X-ray of organs in the area of suspected neuropathy,
• Ultrasound of the organs affected by the disease (shows areas of nerve compression, increased muscle tone, etc.),
• Angiography of the cerebral vessels and peripheral vessels using fluorescent components (helps to identify defects in the walls of arteries and veins, sclerotic changes in them, fibrous changes observed with age, differences in the diameter of vessels, stenosis, etc.),
• Dopplerography of large arteries (makes it possible to note any changes in blood flow),
• Electroneuromyography (allows you to evaluate the passage of electrical impulses through nerve tissue, which provides information about the degree of nerve damage: complete or partial),
• Ultrasonography (allows visualization of the area of nerve compression and assessment of its degree),
• Magnetic resonance imaging (considered the best visualization method, as it allows you to obtain a three-dimensional image and examine the situation from all sides).

Ischemic neuropathy is most often understood as a pathology of the optic nerve, which is actually associated with a circulatory disorder in the eye (in all other cases, we are talking more about the compression-ischemic type of neuropathy). Diagnosis of optic neuropathy is not limited to a general practitioner's examination. Most often, diagnostic measures include a cardiologist, endocrinologist, hematologist, rheumatologist, neurologist and other specialists (which is also possible in the case of peripheral neuropathies), and specific studies are also prescribed.

In this case, the therapist will first refer the patient to an ophthalmologist. The ophthalmologist will first listen to the patient, assess the situation with the naked eye, and then conduct an ophthalmoscopy, which can be used to assess the condition of the optic nerve and fundus. Ischemia will be indicated by pallor and swelling of the optic nerve, swelling of the retina, narrow capillaries in the affected area and strong filling of the peripheral veins, the presence of foci of small hemorrhages. Unfortunately, at the acute stage of posterior optic neuropathy, such changes are not yet visible, which complicates the timely diagnosis of this dangerous disease.

A mandatory test is carried out to examine visual acuity, colour perception, and visual field testing to identify various defects, such as loss of certain areas from the visual field.

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

The patient is required to undergo blood tests: clinical, sugar, biochemical, and a coagulogram. An important point is the assessment of blood clotting indicators, as well as the level of cholesterol and lipoproteins. In case of neuropathies with irradiation of pain to the back and lower back, as well as to determine the functional state of the excretory organs, which is necessary for the safe administration of medications, a blood test is prescribed.

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Differential diagnosis

Differential diagnostics of ischemic neuropathy can be difficult due to the spread of pain along the nerve, which makes it impossible to quickly determine the localization of the lesion. In addition, the symptoms of neuropathy often coincide with inflammatory myopathies, neuritis, congestive conditions, tumor processes, which, by the way, can also cause compression of the nerve and circulatory disorders.

Treatment ischemic neuropathy

Ischemic neuropathy is a special type of pathology of the nervous system, when time is everything. Circulatory disorders very quickly affect nerve cells, which are practically not restored. Therefore, the longer the nerve fibers experience a deficiency of nutrition and breathing and there is no adequate treatment, the more severe the consequences will be.

Prevention

In compression-ischemic neuropathies and facial nerve neuropathy, with appropriate treatment, it is possible to achieve normalization of the condition. The main thing is to start treating the disease when its first symptoms appear. It is clear that in severe cases of peripheral neuropathy, improvement does not always occur, and a person may face not only long-term hospital treatment, but also receiving a disability group.

Ischemic nerve damage is always associated with circulatory disorders, which entails metabolic disorders in the body tissues. This means that prevention of ischemic lesions consists of timely treatment of various vascular pathologies. Prevention of compression-ischemic neuropathies is considered to be prevention and timely treatment of inflammatory diseases of muscles, bones and joints, as well as any systemic infectious pathologies.

A win-win option in any case would be to follow these rules:

• maintain a healthy lifestyle, quit smoking and alcohol abuse,
• avoid excessive physical exertion and prolonged stay in an uncomfortable position,
• practice a balanced diet, limiting the consumption of foods with high levels of harmful cholesterol, which subsequently settles on the walls of blood vessels,
• engage in amateur sports, do daily exercises, toughen up,
• take active walks in the fresh air every day (movement stimulates intensive metabolism and blood 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 further changes in your lifestyle and the formation of a responsible attitude to your body.

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Forecast

The prognosis of ischemic and compression-ischemic neuropathy depends on the localization of the affected nerve. In case of optic nerve ischemia, the prognosis is usually unfavorable. In most patients, even after an effective course of treatment, vision remains weakened. Many complain of loss of visual fields. This refers to empty dark spots in front of the eyes (scotomas).

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