Angionevroza — group of diseases of the peripheral vessels caused by local violation of regulation of a vascular tone. The main clinical symptoms are pain, change of color, temperature, sensitivity and traffic of integuments of the struck area. In the course of diagnostics results of haemo dynamic and microcirculator researches are based on clinical yielded (an angiography, UZDG, a kapillyaroskopiya, a reovazografiya). Conservative therapy is performed with use of a combination of vascular and vitamin pharmaceuticals, supplemented with physical therapy and sanatorium treatment. According to indications removal of the sympathetic knots involved in pathological process is carried out.
Angionevroza — the generalizing concept uniting the various pathology arising owing to frustration of an adequate innervation of motility of peripheral arteries and veins of mainly small caliber. Carry Reynaud's syndrome, a rozatse, Reyl's disease, an eritromelalgiya to this group of diseases, and so forth. In modern literature on neurology also the name "vegeto-vascular neurosises" meets, at a combination of vasomotorial and trophic frustration the term "angiotrofonevroza" is applied. Angionevroza treat functional vascular frustration. Unlike organic vascular diseases (the obliterating endarteriit, a diabetic angiopatiya) they are not followed by morphological changes of a vascular wall.
Reasons of angionevroz
Frustration can initially arise as an independent nosology or again, as a separate syndrome of the main disease. Lead adverse external effects, exchange and endocrine violations to disorder of vasomotorial regulation. Act as the main etiofaktor:
- Overcooling. An Etiologichesky role is played by strong overcooling of extremities, persons with symptoms of a frostbite. Impact of low temperatures on peripheral nerves and the nervous terminations provokes to their damage and the subsequent dysfunction.
- Injuries. Damages of tissues of extremities is followed by a compression of neurovascular bunches, traumatizing nervous fibers with violation of their regulating function. In certain cases angionevroza are a consequence of incomplete recovering of nervous trunks from a nerve injury.
- Intoxications. Toxic influence of salts of lead, vapors of mercury, toxic chemicals, nicotine, alcohol can act as a provocative factor. The vasomotorial disregulyation is possible owing to poisoning with carbon monoxide.
- Vibration. Angionevroz is one of classical components of a vibration disease. Vascular disorders are caused by the regulatory dysfunction of the nervous device arising at long repeated impacts of vibration.
- Hormonal violations. Separate angionevroza connect with disorder of function of adrenal glands (giperkortitsizm), a thyroid gland (hypothyroidism). As women get sick significantly more often than men, assign a certain part to female sex hormones.
At some patients vegeto-vascular neurosis develops as occupational disease. The workers who are affected at once by several adverse factors are most subject to risk of developing of pathology. For example, repairmen, stackers of roads work in the conditions of vibration, cold, the raised mechanical load of the top extremities with a possible mikrotravmatization of fingers.
Nervous regulation of a vascular tone is carried out by the multilevel system including the nervous terminations, peripheral nerves, sympathetic gangliya, the vegetative centers of a brain. Level and the mechanism of emergence of the functional violations causing angionevroza is not clear and has the specifics in each case. Mainly small arteries of disteel departments are surprised: fingers, auricles, nose, cheeks.
Disregulyation of a tone leads to excess dilatation or an angiospasm. In the first case current of blood is slowed down, diameter of vessels increases, they are filled with blood that causes local hyperaemia (reddening), a hyperthermia (temperature increase) of integuments. Because of increase in permeability of a vascular wall arises swelled fabrics. In the second case the gleam of vessels and a krovenapolneniye decrease that is followed by pallor and a cold snap of skin in the place of a distsirkulyation. At a long current the trophic changes happening in fabrics owing to microcirculation violation are observed.
On an etiologichesky sign of an angionevroza are subdivided on holodovy, post-traumatic, toxic, neurogenetic, vibration, etc. In clinical practice definition of the main pathogenetic component of vasomotorial frustration is of great importance. According to the specified criterion of an angionevroza classify on:
- Spastic. The excessive increase in a tone of arteries leading to narrowing of their gleam prevails. The most widespread diseases of this group are Reynaud's syndrome, akroparesteziya, Reyl's disease, .
- Dilatatsionnye. Vasomotorial violations consist mainly in decrease in a vascular tone, expansion of a gleam of arteries. Angionevroza of this group include Mitchell's disease, Melkerssona-Rosenthal's syndrome, a rozatse.
- Combined. Alternation of vazospastichesky and dilatatsionny states is observed. The syndrome of marble skin belongs to the combined defeats ().
Symptoms of angionevroz
The clinical picture of the majority of vegeto-vascular neurosises consists of painful paroxysms of a vazokonstriktion and/or dilatation. Duration of an attack varies of 2-3 minutes till several o'clock. Changes have local character, cover one or several fingers, an auricle, a nose, sometimes – all foot, a brush, the person. Each disease differs in certain features of paroxysms, the course of pathological process. Secondary angionevroza are followed by the symptomatology characteristic of the main disease.
Reynaud's syndrome makes 70-80% of all paroksizmalny violations of blood circulation of extremities. It is shown by the angiospastichesky episodes provoked by a psychoemotional overstrain, cold, smoking. In a typical case of change cover IV and II fingers of brushes and feet, is more rare — a nose, an external ear, a chin. The specified parts of a body grow cold, get white coloring. Patients complain of a sleep, and then — of burning, pain. During the mezhpristupny period the cold snap, , a tsianotichnost of fingers of feet, brushes is noted.
Reyl's disease (syndrome of a "dead" finger) proceeds with angiospastichesky paroxysms in vessels of fingers of brushes, sometimes — stop. Most often the attack begins after holodovy influence, strong emotional experience. The affected finger suddenly becomes cold, in a deathlike way pale, loses sensitivity. After a paroxysm natural skin color, temperature and touch feelings are restored.
Akrotsianoz is shown by the tsianotichny shade of integuments which is symmetrically arising in disteel departments of extremities at their lowering, stay in cold. Humidity of skin, pastosity of fabrics is defined. Rise and warming of an extremity lead to restoration of its healthy state.
Eritromelalgiya (Mitchell's disease) is characterized by angiodilatatsionny paroxysms with a burning pain syndrome, hyperaemia, puffiness. In most cases changes arise in a foot thumb, is more rare — in both feet at the same time. Defeat of brushes, a nose, ears, a female breast is possible. The Eritromelalgichesky attack is provoked by a sdavleniye (footwear, clothes, a blanket), an overheat, an extremity svisaniye. Between attacks residual vascular changes remain, trophic violations are observed.
Melkerssona-Rosenthal's disease differs in constancy of clinical manifestations, localization of pathological changes in borders of the front area. Vascular dilatation has permanent character, is followed by blood outflow violation. Resistant is result swelled lips, cyanosis, a swelling and a skladchatost of language. Other parts of the face (eyelids, cheeks) are surprised much less often. Angionevroz is combined with neuritis of a facial nerve.
The Rozatsea is expressed in constant hyperaemia of a nose, cheeks, a chin, forehead. In a zone of reddening vascular asterisks, eritematozny rashes are found. Permanent expansion of vascular network leads to a swelling, a roughness, consolidation of skin over time. Defeat of a paraorbital zone and a century is possible.
Livedo arises owing to a spastiko-atonichesky condition of capillary network. It is shown by the alternation of pale and cyanotic sites of skin reminding the marble drawing. Typical localization — skin of shins, hips. Pathology is characteristic of young women.
Permanent and paroksizmalny violations of blood supply of fabrics of the struck area lead to formation of trophic frustration over time. There is a dryness, the increased vulnerability of skin, fragility of nails. In the started cases are formed it is long not healing recurrent trophic ulcers. Emergence of permanent touch frustration is possible: gipesteziya (decrease in sensitivity of skin), giperpatiya (pathological perception of external irritants). The Rozatsea of periorbitalny localization is complicated by damage of eyes, development of a rozatsea-keratit by dangerously progressing decrease in sight.
Angionevroza are diagnosed on the basis of clinical data, survey of the neurologist, vascular surgeon. The research of the haemo dynamic violations which are their cornerstone is conducted in the mezhpristupny period and during performance of provocative tests. For the purpose of identification or an exception of secondary nature of vascular neurosis consultation of the rheumatologist, toxicologist, geneticist, endocrinologist, phlebologist can be required. Diagnostics of the angionevroz caused by professional activity is made by the pathologist. The main components of diagnostic search are:
- Poll and survey. During the poll find out the frequency, duration, character of paroxysms, provocative factors, existence of addictions, adverse working conditions.
- Laboratory researches. Determination of level of catecholamines of blood, a rheumatoid factor has the diagnostic importance. According to indications the research of concentration of hormones of a thyroid gland (a tiroksin, a triyodtironin), cortisol is carried out.
- Haemo dynamics assessment. Allows to estimate a condition of large and average vessels, to exclude their organic pathology. Duplex scanning, UZDG of vessels of extremities, an angiography is applied. Lack of pathological changes confirms the diagnosis of an angionevroz.
- Microcirculation research. Reveals characteristic changes (a spasm, dilatation) of the microcirculator course. It is made by methods of a kapillyaroskopiya, laser doppler sonography, a reovazografiya, a termografiya. At the initial stages of a disease in the mezhparoksizmalny period pathological changes can be absent.
- Provocative tests. Holodovy and thermal tests are usually used. The microcirculation research in the conditions of action of a provocative factor is shown in the absence of objective changes in the period between attacks.
Angionevroza differentiate with polyneuropathies, an erysipelatous inflammation, pannikulity, angiokeratomam at Fabri's disease. In case of the expressed hypostasis the exception of a limfostaz is required. Difdiagnostika with organic vascular diseases (endocrine angiopatiya, the obliterating atherosclerosis, endarteriity, amiloidozy, vaskulity) is carried out according to haemo dynamic researches.
Treatment of angionevroz
As pathogenetic mechanisms are definitely not defined, therapy has mainly symptomatic character. Conservative treatment is performed in a complex with application of medicamentous, physical, physiotherapeutic methods. At its small efficiency surgical interventions are possible. The main directions of complex therapy are:
- Knocking over of a paroxysm. At a vazokonstriktion make warming of extremities, introduction of vasodilating medicines: spazmolitik, sympatholytics. At a vazodilatation for improvement of outflow of blood of an extremity give sublime situation, carry out careful introduction of vasoconstrictive means (adrenaline).
- Mezhparoksizmalny pharmacotherapy. Spazmolitik, ganglioblokator, calcium agonists, dezagregant apply to the prevention of repeated attacks at spastic forms. Dilatatsionny angionevroza are the indication to purpose of vasoconstrictive pharmaceuticals, caffeine. In complex treatment use vitamins of group B, routines, ascorbic acid.
- Physical therapy. It is recommended during the period between paroxysms. Galvanization, a darsonvalization, reflexotherapy, mud cure is applied. Sanatorium treatment with hydrosulphuric, radon waters is shown.
- Simpatektomiya. It is carried out at insufficient efficiency of conservative techniques. Removal sympathetic , innervating the struck zone, allows to reduce number and expressiveness of vasomotorial attacks.
At insignificant expressiveness of clinical manifestations of an akrotsianoz, therapy is not required. In case of a rozatse effectively laser treatment, cryotherapy, photocoagulation of dilatirovanny vessels. At Melkerssona-Rosenthal's disease in addition appoint glucocorticosteroids, according to indications carry out a surgical decompression of a facial nerve.
Forecast and prevention
Angionevroza do not pose hazard to life of the patient, but have a long chronic current. Treatment facilitates a condition of patients, allows to keep working capacity, improves quality of life. The forecast of secondary vascular neurosises depends on success of therapy of a basic disease. Akrotsianoz in many cases is independently allowed at achievement of puberty. Primary preventive measures come down to an exception of injuries, intoxications, adverse physical factors, professional vrednost, maintenance of a normal hormonal background. Secondary prevention includes change of working conditions, refusal of smoking, avoiding of the compelled position of an extremity, overcooling, overheating, stressful situations.