Our body is a unique, but incredibly complex system, in which everything is interconnected. It is clear that for the smooth, smooth operation of any multi-component mechanism, an organ is needed that will monitor and direct the actions of each individual component and the individual links of the overall system. In our body, the controlling role is played by the central nervous system, and the functionality of all other organs depends on its health. Disorders of the nervous system is called neuropathy. When we have damage to the structures innervating various organs, the term "ischemic neuropathy" comes to mind due to the disruption of the blood supply to a nearby area of the body. And if we are talking about squeezing the nerve and vessels of muscle, cartilage or bone tissue, it would be more correct to call such a pathology compression-ischemic neuropathy.
, , , , , ,
Neuropathy is in most cases a one-sided process, i.e. nerve damage on the one hand does not entail damage to nerve fibers located symmetrically on the other side of the body. Nevertheless, the statistics show that in about 20-30% of patients the process after 3-5 years can move to the other side. At the same time, older people who suffer from 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) are often affected by the ischemic form of neuropathy.
, , , , , , ,
Causes of Ischemic Neuropathy
As we already understood, ischemic neuropathy is a disruption in the normal functioning of nerve cells due to impaired blood circulation. It turns out that the cause of ischemia of the nerve can be considered those factors that cause impaired circulation. 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 vascular wall, atherosclerotic changes, the formation of blood clots, stenosis of the arteries, which are observed in the case of the following pathologies:
- Arterial hypertension
- Hypercellular, obliterating or nodular arteritis
- Spinal discopathy with vertebrobasilar disorders
- Vascular thrombosis
- Coronary 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, reduced blood clotting (as a result of various diseases). There have been cases of neuropathy and amid anemia.
As for compression-ischemic neuropathy, which is often called tunnel syndrome, inflammatory pathologies of muscles, bones and connective tissue, which lead to their edema (myositis, arthritis, osteomyelitis, etc.), come to the fore. Any inflammation causes tissue swelling. They are increasing in size, they begin to squeeze the nerve and the vessels lying nearby.
Quite often, such neuropathies are attributed to the complications of the above described diseases. They can occur both during the period of illness, and several months after the relief of acute symptoms. Inflammations, especially chronic, do not pass without a trace. Very often they lead to degenerative changes in the tissues (their compaction, formation of scar tissue and pathological growths, restriction of joint mobility due to deformation of cartilage, etc.). All this creates abnormal conditions for nearby structures, including nerves and blood vessels.
, , , , , ,
The risk factors for the development of compression-ischemic neuropathy can be considered overcooling of body tissues, penetration of a bacterial or viral infection into the body, regular overstrain of certain muscle groups, injuries (severe bruises, fractures, ligament rupture, etc.), prolonged stay in an uncomfortable position causing squeezing of nerves and blood vessels in some area of the body. Tunnel syndrome can also be caused by some systemic diseases (endocrine system pathologies, metabolic disorders, rheumatic and other changes in body tissues that change the shape of a tunnel - the cavity between muscles, ligaments, bones, where the nerve lies).
, , , , , , ,
Neuropathy (neuropathy) is a two-part word. The first denotes the nerve, the second - the pathology. Thus, neuropathy requires understanding the pathology of nerves belonging to the central or peripheral nervous system. This pathology is always caused by some kind of cause that affected the work of the nervous system and caused the appearance of painful symptoms.
Depending on the cause of the pathology, there are several types of neuropathies: sensory, diabetic, ischemic, traumatic, compression, etc. Localization of the affected nerve can be distinguished neuropathy of the optic nerve (optic neuropathy), lumbar plexus, ileal-inguinal nerve, neuropathy of the suprascapular and facial nerve, neuropathy of the lower and upper extremities, etc.
In addition, there is a kind 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 the motor functions are impaired. This nerve disease is called polyneuropathy.
Nerves - this is what makes us feel, feel, make any movements, including blinking eyes and swallowing. It is the nerves that control the motor activity of the muscles. Damage to the nerves impairs the conduction of impulses from the brain to them. Muscles either do not receive this signal, or receive it late, or it is very weak and does not ensure the correct functioning of the muscle fibers. As a result, the mobility of the organ suffers, the innervation of which should be carried out by the affected nerve.
Ischemic neuropathy is a nerve damage due to a violation of its nutrition. Yes, nerve cells, like all the others in our body, also cannot function in conditions of hunger. To carry out normal life they must 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 human organs and systems. In this case, the nerve conduction deteriorates due to dystrophic changes in the nerves themselves and the tissues surrounding the nerve.
Nerve 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 type of disease that is more characteristic of the upper and lower limbs due to their mobility, as well as the area of the spine. This kind of pathology can cause degenerative-inflammatory changes in muscles and joints, injuries and just a long stay in an uncomfortable position, when the nerves and vessels near them are compressed for some time, which leads to a decrease in tissue sensitivity. The appearance of discomfort is a signal to the fact that some structures of the body are experiencing excessive stress, impairing their functionality.
It must be said that neuropathy is a fairly common pathology, especially when it comes to its compression-ischemic type. Squeezing in the musculo-bony tunnels and along the spine can be subjected to large occipital, accessory, supra-dorsal, axillary nerves, long chest nerve, radiation, ulnar, median, iliac-inguinal and other types of nerves, as well as several types of nerve plexuses. And in each case, pain, as a bright sign of nerve damage, will have its localization.
, , , , , , ,
Symptoms of ischemic neuropathy
Since neuropathy is a general concept, and the disease can be located in different parts of the body, depending on the affected area, the symptoms of the disease may vary somewhat. The first signs of ischemic neuropathy that appear in most cases of the disease are paresthesias (feeling of numbness, tingling, crawling of insects), pain of varying intensity (at the beginning of the disease most often dull and unexpressed), impaired sensitivity of the affected area, reduced muscle mobility (movement disorders).
Paresthesia can be observed when squeezing the nerve due to uncomfortable posture. If the disease is caused by inflammatory or dystrophic changes, the symptom appears mainly at night against the background of stagnation of venous blood. During compression of the nerve of the knee of the lower 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 part of the extremity (forearm and hand, lower leg and foot).
Pain can have a different nature and intensity, often occur for no apparent reason. They extend to the zone of innervation of the affected nerve and increase with pressure on the site of passage of the nerve, flexion of the limbs, increased load, active movements.
Impairment of sensitivity can manifest itself in the form of its decrease or increase, which happens much less often. In some cases of acute compression-ischemic neuropathy, there is first a decrease in the sensitivity of the limb, and then a significant increase in it, so that even a light touch causes an unpleasant sensation (a shiver passes over the body).
Sometimes it can increase or decrease the threshold of tissue sensitivity. With acute nerve compression, this symptom may appear at the very beginning of the disease. In ischemic neuropathy, an impaired sensitivity is observed already in the later stages of the disease.
Impaired motor ability of organs, for which the affected nerve is responsible for innervation, is not just one of the symptoms of the disease. It can act as a factor aggravating tissue ischemia. At first, the person himself limits the mobility of the muscles and joints due to the pain that arises. But then hypodynamia, or rather the lack of regular muscle training, which occurs even during the performance of everyday tasks and habitual movements, which we sometimes do not think about, leads to additional degenerative changes (atrophy of nerves and muscles).
Another frequent symptom of neuropathy is swelling of the tissues in the affected area, which also aggravates the situation, contributing to even more compression (compression) of the nerve. Thus, ischemic neuropathy can easily turn into compression-ischemic, which is most often observed.
As we have said, the symptoms of the disease depend on the location of the affected nerve. For example, ischemic optic neuropathy, in which there is damage to the optic nerve. 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 exertion, a hot bath, a bath or a sauna,
- color perception change
- episodes of blurred vision on the eve of abrupt changes,
- intense pain in the head,
- 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.
The lesion of the optic nerve hits the peripheral vision the most. The field of vision can either be concentrically narrowed, or separate areas fall out of it in the lower, temporal, and nasal areas, sometimes there are separate defects called scotomas.
There may also be muscle pain, throbbing pain in the temples. Sometimes a person feels pain while combing hair. In those places where the temporal artery passes, the pain is felt especially strongly, especially during 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 manifest itself not only by pain, paresthesia and impaired mobility of the joints. A person's gait changes, he incorrectly puts his foot, staggers when walking, with increased pain and, due to progressive weakness of the muscles, may even lose balance. The foot may have a fever, the toes are bent in the form of claws, difficult-healing ulcers appear on the skin of the legs, nails become brittle, etc.
With ischemia of the nerves of the lumbar and inguinal region, as well as lesions of the lower extremities, there may be a decrease in sexual activity, frequent episodes of urination, forced posture with a forward bend, pain in the penis, scrotum and testicles in men.
Ischemia of the facial nerve is an even more unpleasant sight. Patients have paresis of mimic muscles (a strange grimace appears on the face, eyes can be half-closed, mouth is slightly open on one or both sides, etc.). Depending on what part of the nerve is damaged, tearing, dry eyes, drooling, taste disorders, impaired facial expressions, and the appearance of forced facial movements may appear.
, , , , ,
Complications and consequences
Even superficially examining the symptoms of various types of ischemic neuropathy, it is not difficult to understand that such a pathology will most negatively affect 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 noticeably increases.
Often, neuropathy of the peripheral nerves is complicated by contracture of the limbs. If the mobility of the joints is severely impaired, it becomes difficult for the person to walk. It is clear that this situation may become an obstacle to the performance of professional duties.
When ischemic neuropathy of the optic nerve a person begins to see poorly, is less oriented in space, is forced to leave work, give up driving. In severe cases, the defeat of the optic nerve ends with blindness of the eyes, and in bilateral pathology, which is diagnosed in 30-35% of patients, both eyes can be blinded by succession.
If lameness and blindness cause mainly sympathy and pity in people, distortions in appearance, drooling and other symptoms observed during ischemia of the facial nerve can cause ridicule and hostility from outsiders. It is clear that such a person will not be able to work in production or in the office, difficulties will arise in communicating with people. Moreover, a person will feel defective and deeply worry about this, which will in no way contribute to the recovery or subsiding of the symptoms.
When neuropathy affects the nerves of the groin and lower extremities, conflicts arise in the family due to sex problems, complexes begin, neuroses, and depression develop.
As you can see, whatever the location of the affected nerve, the disease will definitely affect the patient’s life for the worse. And this is an occasion to think about whether to wait until complications begin or hurry to consult a specialist doctor, who, after the necessary studies, prescribe an effective treatment.
, , , , , , , , , , , , ,
Diagnosis of Ischemic Neuropathy
When visiting a doctor, diagnostic activities begin already from the moment when the doctor sees the patient, because some of the symptoms of ischemic neuropathy can be seen with the naked eye. A visual examination plus a study of the patient’s history and complaints allows the physician to assume nerve damage. To confirm his guess, the general practitioner refers the patient to a neuropathologist for consultation.
The neurologist first checks the nerve reflexes and body sensitivity in the area where the patient feels pain, using palpation, hammering, Falen's test (if it concerns ischemia of the median nerve in the carpal canal region). Palpation and visually can be noted reduced muscle tone and skin.
The absence or weakening of the reflexes, impaired sensitivity of the body and motor activity, signs of muscle atrophy already allow us to make a preliminary diagnosis. But the goal of the doctor is also to determine the causes of damage to nerve fibers, because without its treatment, treatment is unlikely to be effective.
To clarify the cause of damage to the nerve structures of the patient's story alone about recent events will be small. It is likely that the problem is far from new, just a person did not pay attention to it, although the mention of past injuries may well give a clue to what is happening.
Special information can give more information about the problem. Common methods of instrumental diagnosis of neuropathy include:
- X-rays of the organs in the area of suspected neuropathy,
- Ultrasound of the affected organs (shows areas of squeezing of the nerve, increased muscle tone, etc.),
- Angiography of cerebral vessels and peripheral vessels with the use of fluorescent components (helps to identify defects of arterial walls and veins, sclerotic changes in them, fibrous changes observed with age, differences in the diameter of blood 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 the nerve tissues, which gives information about the degree of nerve damage: full or partial)
- Ultrasonography (allows visualizing the area of nerve compression and assessing its degree),
- Magnetic resonance tomogram (considered the best method of imaging, because it allows you to get a three-dimensional image and view the situation from all sides).
The term “ischemic neuropathy” is most often understood to mean the pathology of the optic nerve, which is indeed associated with impaired blood circulation in the eye (in all other cases, it is rather a compression-ischemic type of neuropathy). Diagnosis of neuropathy of the optic nerve is not limited to examination by a therapist. Most often, diagnostic measures include a cardiologist, an endocrinologist, a hematologist, a rheumatologist, a neurologist, and other specialists (which is also possible in the case of peripheral neuropathies), and specific studies are also scheduled.
In this case, the therapist will first refer you to an ophthalmologist. An 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 fundus. The ischemia will be indicated by pallor and swelling of the optic nerve, retinal edema, narrow capillaries in the affected area and a strong filling of the peripheral veins, the presence 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.
It is mandatory to study the visual acuity, color perception, testing of visual fields to identify various defects, such as the loss of some areas from the field of view.
It is desirable to conduct special electrophysiological studies, such as assessing the critical frequency of flicker fusion, retinography, and some others, which help determine the actual functional state of the optic nerve.
The patient must be prescribed blood tests: clinical, sugar, biochemical, make a coagulogram. An important point is the assessment of blood clotting, as well as cholesterol and lipoprotein levels. When neuropathies with irradiation of pain in the back and lower back, as well as to determine the functional state of the organs of excretion necessary for the safe prescription of drugs, a blood test is prescribed.
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, by the way, can also cause nerve compression and impaired blood circulation.
Treatment of Ischemic Neuropathy
Ischemic neuropathy is a special kind of pathology of the nervous system when time decides everything. Circulatory disorders very quickly hit the nerve cells, which practically do not recover. Therefore, the longer the nerve fibers will experience a lack of nutrition and respiration and there is no adequate treatment, the harder the consequences will be.
With compression-ischemic neuropathies and facial nerve neuropathy, with appropriate treatment, normalization of the condition can be achieved. 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 disability groups.
Ischemic nerve damage is always associated with impaired blood circulation, leading to a violation of metabolic processes in body tissues. So, the prevention of ischemic lesions is the timely treatment of a variety of vascular pathologies. Prevention of compression-ischemic neuropathies is considered to be the prevention and timely treatment of inflammatory diseases of the 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, stop smoking and alcohol abuse,
- avoid excessive physical exertion and prolonged stay in an uncomfortable position,
- to practice a balanced diet, limiting the consumption of foods with a high level of harmful cholesterol, which subsequently accumulates on the walls of blood vessels,
- engage in amateur sports, daily exercises, temper,
- make daily walks in the fresh air (movement stimulates intense metabolism and blood circulation).
Ischemic neuropathy in most cases is an unpleasant consequence of our inappropriate attitude towards life and our health. Therefore, the treatment of this disease implies a further change in one’s lifestyle and the formation of a responsible attitude towards one’s body.
, , , , , , , ,
Short-term compression of peripheral nerves
The reasons can be "sleepy paralysis", an unfavorable body position in case of poisoning with hypnotics, pressure during anesthesia, etc. These lesions generally have a favorable prognosis.
Conservative treatment is indicated. With a slower regression of symptoms, it is recommended to wake the patient regularly during a night's sleep in order to avoid secondary nerve damage.
Chronic peripheral nerve compression and tunnel syndromes
The causes of tunnel syndromes are compression of the nerve fibers due to uncomfortable posture or unsuccessful organization of limb movements (for example, “habitual” crossing of the legs, work with an emphasis on the elbows, etc.), volume formations (tumors, lymph nodes, chronic hematomas) in close proximity from nerve, somatic and endocrine diseases (for example, hypo- and hyperthyroidism, acromegaly). The main tunnel syndromes include carpal tunnel syndrome, ulnar canal syndrome, posterior tarsal syndrome.
The main task of neurophysiological diagnostic methods is the objectification and topical diagnosis of the lesion, as well as the identification of subclinical changes. An important role is played by the study of the speed of conducting on the sensory fibers, since this method is more sensitive than the estimation of conducting by motor fibers. Prolonged compression of the nerve leads to axonal damage, which is expressed in slowing down of motor impulses, a decrease in the amplitude of action potentials, the appearance of spontaneous pathological activity and other signs of denervation and reinnervation on EMG.
The most important issue of therapy is the choice between conservative and surgical treatment.
- Conservative treatment is prescribed when only pain and paresthesia are observed, while there are no clinically expressed motor or sensory impairments. Immobilization of the affected limb area is recommended, the use of special aids (for example, a back tire on the forearm during a night's sleep with carpal tunnel syndrome, a roller for the elbow joint with elbow canal syndrome), avoidance of positions and movements of the limb, which can exacerbate the symptoms, if necessary weight loss, treatment of endocrine and other diseases that caused nerve compression (for example, replacement therapy for hypothyroidism). Perhaps the use of nonsteroidal anti-inflammatory drugs, for example, diclofenac, local effects using diclofenac-gel. Conduct both passive and active exercises.
- With the development of carpal tunnel syndrome during or after pregnancy, surgical treatment is not indicated, since in most cases spontaneous regression is observed. Perhaps the appointment of diuretics.
- Surgical treatment is prescribed for the ineffectiveness of conservative measures, as well as for severe motor and sensory disorders. In carpal tunnel syndrome, a surgical dissection of the transverse palmar ligament is used; in the ulnar canal syndrome, decompression of the ulnar nerve is used.
Symptoms and signs
Anterior tibial syndrome is most commonly observed. Syndromes of the muscular beds of other localization are less common, mainly after operations. They also include the turnstile syndrome that develops during the operation due to the imposition of the cuff of the blood pressure monitor, which prevents blood from reaching the distal parts of the arm.
As a first aid measure, one should be cautioned against giving the affected limb an elevated position (which limits the flow of arterial blood), it is necessary to ensure the stabilization of blood circulation, remove the tightening (circular) bandages, and correct the disorders of coagulability.
In the syndrome of muscle beds, an emergency operation is shown, aimed at decompression of the limb area. In the presence of tires and plaster casts direct mechanical damage to the nerves is possible. The forecast depends on the duration and strength of the damaging effects.
How to eliminate the disease?
Typically, the doctor prescribes NSAIDs drugs - ibuprofen, naproxen, diuretics, dressing with the necessary funds in the canal area. Also, first of all, immobilization is required in the position of easy extension for a period of about 2-4 weeks.
In the period of therapeutic interventions recommended to reduce the load on the brush. Patients are prescribed corticosteroids to relieve pain. If conservative treatment does not give the desired effect and the symptoms of the disease persist, then the next stage of treatment is surgery.
Expert Editor: Pavel Alexandrovich Mochalov | D.M.N. general practitioner
Education: Moscow Medical Institute. I. M. Sechenov, specialty - “Medicine” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.