Bogorad's syndrome is pathology of which development germination of fibers of the facial or taking-away nerves in plaintive and salivary glands is the cornerstone. The main displays of a disease – the raised dacryagogue during meal which can be combined with a gipersalivation, photophobia, irritation of face skin. Head MRT, Shirmer's test, an electromyography, an elektroneyrografiya, eye biomicroscopy is applied to diagnosis. The program of treatment includes blocking of a parasympathetic innervation, carrying out plasticity of a facial nerve and purpose of vitamins of groups B, P, C.
Bogorad's syndrome (disease of crocodile tears, syndrome of a paroksizmalny lakrimation) was for the first time described in 1928 by the Belarusian neuropathologist F. A. Bogorad. The scientist compared dacryagogue at this disease to allocation of tears of a crocodile at a consuming of the victim. Prevalence of pathology in the general structure of ophthalmologic diseases makes 5:10 000 population. A ratio of occurrence of a congenital form in relation to acquired – 1:5. The disease is observed at 6-30% of patients with front neuralgia. In 30% of cases the etiology of a disease does not manage to be established. Persons men's and female suffer with an identical frequency. The disease is widespread everywhere.
Reasons of a syndrome of Bogorad
The disease etiology is up to the end not studied. Cases when involuntary allocation of tears arose after defeat front are described, is more rare – paresis of the taking-away nerve. Are the main reasons for a syndrome of Bogorad:
- Reception of medicines. The congenital form of pathology develops in case of reception by mother of contraceptive medicines in the first trimester of pregnancy.
- Teratogenny influence. Developing of a disease in the neonatal period is often caused by action of teratogenny factors at pregnancy to which the ultra-violet radiation, the use of alcoholic drinks and drugs belongs.
- Traumatic damage. Paroksizmalny dacryagogue occurs at patients after a trauma with violation of integrity front, the top salivary or taking-away nerve.
- Yatrogenny influence. Intraoperative damage of nervous fibers can act as an etiology. The clinical picture of a syndrome develops in early, is more rare the late postoperative period.
Emergence of symptoms at this pathology is preceded by meal or strong smells. It is proved that the chewing movements without specific irritant or emotional lability do not cause symptomatology. At paralysis of a facial nerve dacryagogue provokes germination of fibers of a drum string on sekretorny nervous ways of plaintive gland. The zone of defeat is localized over cranked knot. According to other pathogenetic theory, development of a syndrome is caused by germination of nervous fibers in a parenchyma of plaintive gland. Scientists believe that regeneration of nervous fibers after paralysis or traumatic damages is the cornerstone of pathogenesis. At congenital option pathological communications in kernels not only front, but also taking away and top salivary nerves are formed. In neurology a syndrome consider a reflex as "heavy rain-lakrimalny".
Symptoms of a syndrome of Bogorad
Regardless of a syndrome form in most cases symptoms arise on the one hand. Patients show complaints to the raised dacryagogue which is often combined with excessive salivation. Development of symptomatology provokes meal. Firm, hot and spicy foodstuff causes more intensive slezoproduktion. More rare clinical manifestations are provoked by a strong smell. At a heavy current of a syndrome patients note development of a photophobia, irritation of integuments of the person. At injury of a facial nerve the violation of functioning of mimic muscles on the party of defeat which is shown omission of an eyebrow, a mouth corner, smoothing of folds on a forehead, incomplete closing of an eye comes to light.
At a congenital form parents find the first symptoms of a disease in the neonatality period. The symptomatology develops in time of feeding of the baby. It results in the increased nervous excitability of the child which is shown by crying, annoyance. Often pathology is combined with other anomalies (, ). If the disease is caused by paresis of the taking-away nerve, besides the raised dacryagogue there is a decrease in hearing, deformation of auricles. At most of patients asymmetry of the person which progresses in process of growth of children is defined. The disease significantly reduces quality of life of patients.
Pathology can be complicated by a secondary eversion of a century (). Because of the raised slezoproduktion the high probability of emergence of a dakriotsistit is observed. Patients are more subject to risk of development of a bacterial bacterial keratit, degenerate and dystrophic changes of a cornea. The heavy course of disease is followed by secondary conjunctivitis. At persons with a congenital form violation of an innervation of an upper eyelid leads to emergence of a lagoftalm. Cases of the giperkeratoz caused by constant irritation of skin are described. Less often pathological process extends to eyelids with the subsequent development of a blefarit.
Diagnostics of a syndrome usually does not cause difficulties. Diagnosis is based on anamnestichesky data, results of visual survey and tool researches. The complex of special methods of inspection includes:
- Head MRT. The magnetic resonance tomography gives the chance to visualize the level and the nature of injury of the taking-away or facial nerve, to reveal pathological sinekhiya. The research is applied to definition of further medical tactics.
- Shirmer's test. Test allows to define intensity of production of plaintive liquid. The normal slezootdeleniye in the absence of irritants and raised in response to meal gives the grounds to suspect a paroksizmalny lakrimation at the patient.
- Electromyography. The method is applied to studying of information on a functional condition of the carrying-out ways by assessment of activity of separate muscle fibers which are innervated by it.
- Elektroneyrografiya. By means of this technique it is possible to study the nature of damage of nervous fibers, degree and localization of a zone of defeat. The research is conducted in dynamics for assessment of efficiency of treatment.
- Eye biomicroscopy. The diagnostic procedure is applied for the purpose of identification of secondary changes from forward department of an organ of vision. At the long course of pathology hyperaemia of an orbital conjunctiva, sites of an ulceration of a cornea is visualized.
Differential diagnostics is carried out with the raised slezoproduktion at a syndrome of a dry eye. At a kseroftalmiya the symptomatology develops kompensatorno because of high dryness of a conjunctiva. Instillations of medicines of an artificial tear allow to eliminate clinical manifestations.
Treatment of a syndrome of Bogorad
Treatment of patients is carried out by the neurologist, however in all cases consultation of the ophthalmologist and neurosurgeon is necessary. Tactics of maintaining patients with Bogorad's syndrome depends on expressiveness of clinical manifestations and a form of a disease. Etiotropny therapy is not developed. The main methods of treatment include:
- Blocking of a parasympathetic innervation. With the medical purpose to patients a small amount of a botulotoksin of type A directly is entered into plaintive gland. The technique allows to eliminate dacryagogue at action of aroma or taste of food.
- Plasticity of a facial nerve. At Bogorad's syndrome removal of pathological branchings of a facial nerve is shown. Autotransplantation of nervous fibers at patients with violation of their integrity on certain sites is in addition performed.
- Vitamin therapy. Is an obligatory part of complex therapy. Reception of vitamins of group C, B and P is shown to patients.
Treatment of the acquired form assumes therapy of the main disease. For the purpose of prevention of development of secondary complications miorelaksant, massage of mimic face muscles apply. In the absence of effect introduction of medicines from group of tranquilizers is shown.
Forecast and prevention
The forecast for life and concerning visual functions favorable. At patients with the acquired pathology form efficiency of treatment is higher, than at people with a congenital syndrome. Specific preventive measures are not developed. Nonspecific prevention of congenital option comes down to an exception of influence of teratogenny factors and reception of contraceptives during the entire period of pregnancy. At adult age with the preventive purpose it is necessary to use individual protection equipment during the work on production (helmets, masks, glasses), to follow safety regulations.