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Vegetative insufficiency

Vegetative insufficiency — the syndrome connected with diffusion disturbance of an innervation of internals, vessels, secretory glands. In most cases vegetative insufficiency is caused by defeat of peripheral vegetative system (peripheral vegetative insufficiency). Most often at the same time function and sympathetic and parasympathetic parts of a vegetative nervous system suffers, but dysfunction of one of these parts sometimes prevails.

Etiology.

Vegetative insufficiency happens primary and secondary. The hereditary or degenerative diseases involving vegetative neurons of the central nervous system or neurons vegetative gangliyev are the reason of primary vegetative insufficiency (for example, hereditary polyneuropathies, primary vegetative neuropathy or a multisystem atrophy). Secondary vegetative insufficiency arises at the metabolic polyneuropathies (diabetic, amyloid, alcoholic, etc.) diffuzno damaging vegetative fibers, sometimes at defeat of a brainstem or a spinal cord more often (for example, at a stroke, a craniocereberal injury or a tumor).

The clinical picture of vegetative insufficiency consists of symptoms of defeat of various bodies and systems. Dysfunction of cardiovascular system first of all is shown by the orthostatic hypotension which is characterized by disturbance of maintenance of the ABP in vertical position. Orthostatic hypotension is mainly caused by sympathetic denervation of veins of the lower extremities and an abdominal cavity therefore upon transition to vertical position there is no their narrowing and blood is deposited in these vessels. In development of orthostatic hypotension denervation of kidneys makes a contribution also that causes the night polyuria leading to decrease in volume of the circulating blood early morning hours. Orthostatic hypotension can be shown upon transition from horizontal position in vertical or at long standing (especially in motionless situation) by dizziness, emergence of a veil before eyes, a headache or weight in a nape, sudden feeling of weakness. At sharp falling of the ABP the syncope is possible. At heavy orthostatic hypotension patients are confined to the bed. In a prone position of the ABP can sharply raise, on the contrary, that extremely complicates treatment of orthostatic hypotension.
Decrease in the ABP with development of dizziness or weakness can be provoked and meal, causing a rush of blood to abdominal organs, and also overheating, a natuzhivaniye, an exercise stress.
As a result of disturbance of an innervation of heart the cordial rhythm is fixed at one level and does not change depending on a respiratory cycle, an exercise stress, position of a body (the fixed pulse). Most often the fixed pulse is connected with parasympathetic denervation of heart therefore usually it "is fixed" at the level of tachycardia.
Dysfunction of a digestive tract leads to disturbance of motility of a stomach, intestines, gall bladder that is clinically shown by feeling of weight in epigastriums after meal, tendency to a lock or a diarrhea. Dysfunction of urinogenital system is shown by impotence, the speeded-up urination, especially at night, need of a natuzhivaniye at the beginning of an urination, feeling of incomplete bladder emptying. Frustration of an innervation of sweat glands usually leads to decrease in sweating (a hypohydrosis, an anhidrosis) and a xeroderma, but at part of patients the regional hyperhidrosis (for example, in a face or brushes) or night sweats is noted.

Diagnosis.

For detection of orthostatic hypotonia measure the ABP in a prone position (before it the patient has to lie not less than 10 min.), and then after a rising (not earlier than in 2 min.). Existence of orthostatic hypotension is demonstrated by falling in vertical position of systolic pressure not less than on 20 mm of mercury., and diastolic — not less than on 10 mm of mercury. For detection of fixity of pulse estimate its fluctuations at deep breath, a natuzhivaniye, change of position of a body, an exercise stress. Motility of a digestive tract is investigated by means of roentgenoscopy or endoscopic techniques. For specification of nature of disturbance of an urination carry out a tsistometriya and ultrasonic research.

Diagnosis of vegetative insufficiency is facilitated at identification of the accompanying neurologic syndromes indicating defeat of the central or peripheral nervous system. It is important to exclude other states causing similar symptoms, for example overdose of medicines (for example, hypotensive drugs), diseases of blood and cardiovascular system, endocrine frustration (for example, insufficiency of adrenal glands).

Treatment.

Treatment first of all assumes impact on a basic disease. The symptomatic treatment is defined by the leading syndrome. At orthostatic hypotension recommend a complex of non-drug measures.
It is necessary to avoid provocative factors: a natuzhivaniye (at tendency to a lock recommend products with the high content of food fibers, sometimes — laxatives), sharp changes of position of a body, thermal procedures, overheating, alcohol intake, a long bed rest, intensive physical exercises, especially in the isometric mode.

  1. Moderate exercise stresses in the isotonic mode, especially in the water environment are shown.
  2. In need of long standing it is necessary to change often a pose, shifting from one foot to the other and raising one, other leg to cross legs, to sit down on hunkers, in a sitting position to cross or draw in legs, to shower one leg on another, from time to time interchanging the position of them. All these receptions interfere with deposition of blood in legs.

•    central cholinomimetics: rivastigmin (ekselon), donepezil (arisept), amiridin, gliatilin, etc.;

•    non-steroidal anti-inflammatory drugs (for example, ibuprofen);

  1. It is necessary to stop whenever possible reception or to reduce a dose of vasodilators.
  2. In the absence of heart failure recommend to increase salt consumption (to 4 — 10 g/days) and liquids (to 3 l/days), but to limit reception of liquid for the night, to eat food to a bowl, but in the small portions, avoiding vysokouglevodisty products.
  3. It is necessary to sleep with highly raised head (the head has to be raised on 15 — 20 cm); it reduces not only orthostatic hypotension, but also a night polyuria and arterial hypertension in a prone position.
  4. Sometimes wearing elastic stockings which should be pulled in the morning, to a rising in a bed helps.

If the listed measures were insufficiently effective, then resort to the medicamentous means increasing the volume of the circulating blood and a vascular tone. The most effective of them — a fluorinated synthetic corticosteroid fludrokortizon (kortinef). Sometimes it is combined with other drugs raising a tone of sympathetic system (for example, midodriny). All drugs reducing orthostatic hypotension strengthen hypertensia in a prone position therefore during treatment it is necessary to control the ABP not only before administration of drug and in 1 h after his reception, but also in the morning after awakening.
At paresis of a stomach and intestines recommend to eat food more often, but in the small portions; are shown Metoclopramidum (cerucal) or domperidon (motilium). At diarrhea appoint lopetsamid (imodium) or Codeini phosphas.

 
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