Autonomic disorders in the extremities

Vegetative disorders in the extremities are an obligatory companion of the pathology of the peripheral nervous system and are often encountered in suprasegmental vegetative disorders. They are manifested by vascular-trophic-algic syndrome as one of the forms of vegetative dystonia syndrome.

The symptoms of autonomic disorders are varied, but they all consist of three types of syndromes: pain, vascular and trophic.

Pain sensations in the limbs are characterized by diversity, but among them several types should be distinguished:

1. radiculoalgic type - pain is dagger-sharp, shooting, paroxysmal, spreading throughout the entire dermatome from the proximal to the distal sections;
2. neuralgic type - pain from damage to the nerve trunk is aching, occasionally cutting, relatively long-lasting, decreases at rest, increases with movement, tension or palpation of the nerve;
3. myalgic type - pain is felt deep down, intensifies with pressure or stretching of muscles, gnawing or throbbing, often localized in certain areas, very constant;
4. dysesthetic type - pain in the form of burning, tingling, "skin peeling", localized on the skin more distally, of varying duration, intensifies with active movements.

The intensity of pain may vary: from mild soreness that occurs when palpating certain areas, to intense pain accompanied by pronounced vegetative reactions.

Vascular disorders in the extremities can also be of varying intensity. They are naturally more pronounced in the most distal parts of the extremities. Their characteristic component is a change in the color of the skin: pallor, "marbled" skin pattern, redness, cyanosis. In some forms of pathology, these changes occur in the form of three-phase attacks, reflecting the pathophysiological stages of some pathological conditions (Raynaud's phenomenon). These disorders are manifested by subjective sensations of transient numbness, paresthesia. Often, such phenomena are accompanied by a decrease in skin temperature. Long-term existence of vascular disorders often leads to a violation of venous outflow, which is manifested by edema of various areas.

Trophic disorders are a common phenomenon of peripheral nerve damage. The severity of trophic changes in the skin and subcutaneous tissue may vary: from mild peeling of the skin to the formation of deep, long-term non-healing ulcers. Trophic changes in the skin are usually more noticeable in the hands and feet. Their origin is associated with the traumatic effect of excessive heat or cold, which remain unnoticed by the patient due to pain or associated sensory disturbances. Gradually, the skin surface becomes smooth and dense, subcutaneous tissue atrophy develops, pigmentation areas are detected, ulcers and fibrosis of the subcutaneous tissue are formed. The fingers may acquire the shape of "drumsticks", transverse striations appear on the nails, they thicken, become pointed, become brittle and acquire a claw-like appearance. The hair of the denervated limbs becomes thinner and falls out, but hypertrichosis occasionally develops, especially in the forearms.

The following groups of diseases can be distinguished, which are accompanied by the most striking vegetative disorders in the extremities: neurovascular syndromes as neurological manifestations of spinal osteochondrosis, tunnel compression-ischemic neuropathies, polyneuropathic syndromes of various etiologies.