Herpetic and postherpetic ganglionic

Among the neuropathies affecting various structures of the nervous system, ganglioneuritis or inflammation of the sympathetic and parasympathetic ganglia is distinguished - grouped in the form of nodes of nerve cells that provide the connection between the peripheral nervous system and the central one.

At the same time, the ICD-10 code does not have ganglionovirus: codes G50-G59 show diseases associated with the defeat of individual nerves, nerve roots and plexuses.

The pathological process with ganglioneuritis affects not only the nerve nodes, but also the adjacent interlacing of sympathetic or afferent vegetative-visceral nerve fibers. When the nerve node becomes inflamed, ganglionitis is diagnosed.

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Epidemiology

The clinical statistics of ganglionvrit and ganglionitis are not known, but the most common localization of these diseases is the vascular knot and the elbow nodule.

There are some melons about the annual frequency of pterygoid gangloneuritis: in young patients with shingles or as a complication of chickenpox, it is diagnosed in 0.2-0.3% of cases, and in the general population postherpetic ganglionovritis or  postherpetic neuralgia of  different localization is observed, on average, in 12.5% of patients.

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Causes of the ganglionery

Inflammation of the peripheral ganglia of the peripheral nervous system, called by domestic neuropathologists ganglionovrit, develops as a result of locally acting infection: bacterial (most often streptococcal or staphylococcal) or viral (adenovirus, herpevirus, etc.) that spreads from structures and tissues that are close to the nerve nodes.

Experts associate the key causes of ganglioneuritis with inflammation in tonsillitis and monocytic angina; carious tooth decay; influenza and diphtheria; otitis and eustachyte; tuberculosis and syphilis; with some vector-borne and zoonotic infections (tick-borne borreliosis, malaria, brucellosis, etc.).

For example, the inflammation of the spinal cord and trigeminal nerve rootlet ganglion pterygopalatinum (ganglion pterygopalatinum) - pterygoal ganglionvrit or Slader's syndrome - can be the result of both advanced caries and a consequence of chronic and acute inflammatory processes located in the maxillary sinuses with sinusitis, etmoiditis, frontitis, or sphenoiditis since the wing-joint node is associated with the ear and ciliary).

Especially often inflammation of the ganglion of the VNS occurs with  shingles, and as a complication of chicken pox caused by a single pathogen - the neurotropic virus Herpes zoster (or Varicella Zoster virus). In such cases, the diagnosis can be defined as postherpetic ganglioneuritis.

Pelvic ganglionic ganglionitis / ganglionitis of pelvic plexuses in women may be a consequence of inflammation of the appendages (adnexitis or salpingo-oophoritis) or ovaries (oophoritis), and in men there is a sacral ganglionovritis in a chronic inflammatory process in the prostate gland (prostatitis).

Risk factors

Neurologists perceive risk factors for ganglionovritis in the presence of foci of chronic infection against the background of a weakening of the defenses of the body and a decrease in the resistance to oxidative action of free radicals, in hypothermia of the body (especially in people who are forced to stay in the cold for a long time and are often overcooled).

By the way, there is a risk of contracting shingles, that is, the Herpes zoster virus, although herpetic ganglionovrit is not contagious in the absence of dermatological manifestations of herpes zoster. But the lumbar ganglionvrit may be contagious at the stage of vesicular rashes in the lumbar region. And the special danger of Herpes zoster is that this virus, when it enters the bloodstream, captures nerve cells and settles in the ganglia of the peripheral nervous system, but may not show its presence in the human body for a long time.

The risk of inflammation of vegetative ganglia is not ruled out due to the negative effect of exogenous toxins (primarily ethanol) on them, as well as damage to the nerve nodes with nearby nerve trunks and axon plexuses in metastasizing malignant tumors.

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Pathogenesis

Considering the pathogenesis of ganglionovrit, one should keep in mind the fact that the structures of the  autonomic nervous system  - in particular sympathetic, parasympathetic and sensitive ganglia - react to infection not only by their release by immunocompetent cells of pro-inflammatory cytokinins, but also by certain changes in trophism and neuro-metabolism - and gliocytes, as well as tissues of fibrous membranes and stroma of nodes.

This leads to functional disorders in obtaining ganglions of nerve signals coming through the preganglionic fibers, the subsequent differentiation of these pulses and the subsequent transfer along peripheral nerve fibers, as well as postganglionic trunks to the corresponding centers of the CNS analyzers (in the brain).

Because of such disorders, there is an increase in outgoing impulses, which are associated with the symptoms of vegetative, motor or sensory character that arise during ganglionvreath.

Symptoms of the ganglionery

The way ganglioneuritis manifests itself depends on the localization of the inflamed ganglion, but the first signs of pathology are  neuralgic pain ;  in most cases it is a bursting, throbbing, burning pain (pronounced causalgia), perceived by patients as diffuse - with a subjectively difficultly defined focus.

Pterygoid ganglionitis / ganglionitis of the vascular nodule is indicated by such symptoms as sudden attacks of severe  pain in the face, which captures the eye area (with its reddening), nose (in the nose region), jaws, temple, ears, giving back to the neck, neck, shoulder blades and even the upper limb. The pain appears against the background of unilateral hyperemia and edema of the skin of the facial part of the skull, increased sweating, photophobia, sneezing and increased secretion of tear fluid, nasal secretions and saliva. Often there is nausea and dizziness.

Symptoms of ganglionitis of the ear node (ganglion oticum), too, manifest with paroxysmal pains (aching or burning), which patients feel in all structures of the ear, as well as in the jaw, chin and neck. In the ear there may be unpleasant sensations of stuffiness or bursting; the skin near the ear and on the temple blushes; increases the formation of saliva (hypersalivation).

The localization of pain with ganglion sublingual ganglion sublinguale (ganglion sublinguale) is the language and the area under it, and with inflammation of the submaxillary node (ganglion submandibularis) patients complain of pain (including articulation and eating) in the lower jaw, in the neck ), in the temporal and occipital regions; characterized by increased salivation.

Inflammation of the ciliary ganglion (ganglion ciliare) or Oppenheim syndrome located in the orbit is characterized by intense paroxysmal pains in the eyeball, photophobia, hyperemia of the mucous membranes of the eye; possibly lowering blood pressure.

The ganglioneuritis of the trigeminal nerve, more precisely the ganglionitis of the trigeminal, trigeminal or Gasserian node (ganglion trigeminale) located on the upper part of the pyramid causes causalgia (the most intensive at night), fever, swelling of the soft facial tissues, and violation of skin sensitivity along the trigeminal nerve.

Hunt's syndrome, ganglion ganglion node of the facial nerve (ganglion geniculate in the facial canal of the temporal bone) or ganglionovrit of the knee of the facial nerve is caused by the defeat of Varicella Zoster virus. His symptoms and pain localization are the same as in inflammation of the pterygoid and ciliary ganglia, but more often malfunctions are observed.

When cervical ganglionvreatm develops, the lower cervical, upper cervical and cervicothoracic (stellate) ganglionovrites should be distinguished. In the first case, in addition to pain, there is cyanosis of the skin on the arm from the side of the affected caudal node (ganglion cervicale inferius); decrease in the sensitivity of the skin on the arm and in the region of the upper ribs and decrease in muscle tone; the eye gap disappears when the cornea is irritated, and some other reflexes are disturbed.

In the second case - in case of inflammation ganglion cervicale superius - cervical ganglionvreath manifests itself with pain radiating to the lower jaw, and also leads to a shift in the eyeball (with a decrease in intraocular pressure), an increase in the ocular gap and dilatation of the pupil; reduce skin sensitivity below the clavicles; increased sweating. The paresis of the muscles of the larynx and vocal cords (with the appearance of a sypot) can develop.

With ganglion sickness of the stellate or cervico-thoracic node (ganglion cervicothoracicum), the pain is felt in the sternum (from the side concerned), and often a person thinks that his heart is hurting. In addition, the motion of the little finger on the corresponding hand is difficult.

Pelvic, or ganglioneuritis of the pelvic plexuses in women gives a paroxysmal burning pain in the lower abdomen and in the pelvis (giving back to the waist, perineum, on the inner thighs), hypo- or hyperesthesia of the skin of the indicated localization. Intimate closeness can be accompanied by unpleasant sensations.

Lumbar ganglionovritis is manifested by diffuse debilitating pains in the back and abdomen, deterioration of trophic tissue of internal organs, negative changes in the vascular system of the lower extremities and abdominal cavity organs with violation of their functions. In general, experts note a wide range of vasomotor (vasomotor) disorders and segmented innervation disorders.

With a sacral ganglioneuritis, pain is given to the lower back, peritoneum, small pelvis, rectum; there is itching in the genital area and urination disorder; women may have a menstrual cycle.

Complications and consequences

There are such consequences and complications of ganglionvrita:

• with ganglioneuritis of the knee of the facial nerve, a large part of the nerve can be affected with the development of  paralysis of the facial nerve;
• inflammation of the ear ganglion is complicated by the damage to the tympanic membrane and internal ear structures;
• with inflammation of the knee of the facial nerve, there may be a reduction in the release of tear fluid, which leads to irritation and dryness of the cornea;
• cervical ganglionvreath can lead to increased hormone-producing activity of the thyroid gland and, as a consequence, to hyperthyroidism.

For years, the lasting ganglionvrit of the trigeminal node becomes the cause of chronic insomnia and psychoemotional disorders (turning a person into a neurasthenic); often patients with this disease lose their ability to work.

Diagnostics of the ganglionery

The basis for the diagnosis of ganglionvrites is the clinical picture of the disease, the history of patients and their complaints.

In addition to a general blood test, tests for HIV, tuberculosis, syphilis are needed; the analysis on herpes, that is the IF-analysis of a blood on antibodies to virus Herpes zoster is done or made  .

Instrumental diagnostics is used to determine the exact localization of the inflammatory process, to evaluate its distribution to vegetative nerve fibers and to differentiate pathology: X-ray of the spine, ECG, ultrasound, CT or MRI (thoracic and abdominal cavity, pelvis, skull), electromyography and other

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Differential diagnosis

Differential diagnosis is necessary, which should distinguish, for example, lumbar ganglionovritis from osteoarthritis of the spine or herniation of the intervertebral disc; cervical ganylovirus - from manifestations of radiculopathy (radicular pain), osteochondrosis, spondylosis and reflex myofascial syndromes; ganglioneuritis of the cervical-thoracic node - from angina and other cardiological problems; ganglioneuritis of pelvic plexuses in women - from gynecological diseases.

Treatment of the ganglionery

Etiological treatment of ganglionovritis involves the use of medications aimed at the cause of inflammation - an infection. If the infection is microbial, antibacterial drugs (prescribed by the otolaryngologist, gynecologists and other narrow specialists) are used. For antiviral therapy, other drugs are needed, read more -  Treatment of shingles

To get rid of the pain, neurologists recommend analgesics of various pharmacological groups. So, the combined anesthetic agent Spazmalgon (other trade names - Spazgan, Revalgin, Baralgetas) can be used for a short time (for three days) inside - 1-2 tablets no more than three times a day; in the form of IM injections - 2-5 ml twice a day. Among the side effects of this drug are nausea, vomiting, abdominal pain, increased blood pressure, increased heart rate, headache, skin allergic reaction, etc. Spasmagglong is contraindicated in cases of blood disorders, expressed hepatic or renal insufficiency, glaucoma, prostate adenoma, bronchial asthma , pregnancy and lactation.

The drug from the group of ganglion blockers - Hexamethonium benzenesulfonate (Benzohexonium) - is taken orally (in a dosage of 0.1-0.2 g for one dose, three doses per day) or 2.5% solution is injected (0.5 ml) . This medicine can cause general weakness and dizziness, tachycardia, a drop in blood pressure; it can not be prescribed for hypotension, thrombophlebitis, severe liver and kidney disease.

Drugs are applied to the group of peripheral cholinolytics: Gangleron, Metacil. Platifillina hydrotartrate (Platyphylline) or Difacil (Spazmolitin, Adifenin, Trazantin).

A single dose of Gangleron in tablets is 40 m, it is supposed to take three times a day for one tablet.

Metacil tablets (2 mg each) can be taken one to two at the same frequency, and 0.1% solution of the drug is injected into the muscle (0.5-2 ml each). Platifillin is used either inside (0.25-0.5 mg not more than three times a day), and parenterally (1-2 ml 0.2% solution p / k). A Difacil is administered orally 0.05-0.1 g 2-3-4 times a day (after eating). All anticholinergic drugs can cause headache, temporary visual impairment, dry mouth and upset stomach, and an increase in heart rate; these medicines are not allowed in patients with glaucoma.

Do not exclude the use of ganglionvritah NSAIDs, for more details see -  Tablets from neuralgia

In cases of pelvic or sacral ganglioneuritis, rectal anesthetic suppositories can have a positive effect  .

With unbearable pain, novocaine blockades are carried out  .

It is also recommended to take vitamins of group B, and on prescription of the attending physician - immunostimulating means.

In complex therapy ganglionevrita is actively used physiotherapy treatment, details in the material -  Physiotherapy with neuritis and neuralgia of peripheral nerves

Helps reduce the intensity of pain and improve trophic tissue treatment of ganglionvrit by massage.

If the drugs do not relieve the pain, surgical treatment is performed, which consists in removing the affected nerve node by laparoscopic sympathectomy or by radiofrequency destruction.

Prevention

The main prevention of inflammation of sympathetic and parasympathetic ganglia is the timely and adequate treatment of infections leading to the development of ganglionvrita.

Measures to strengthen immunity also contribute to the body's resistance to pathogens and viruses.

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Forecast

With the overall favorable outcome of ganglionvreath treatment, it should be borne in mind that the therapy of this disease takes time, and very often the process becomes chronic. There are also possible irreversible complications of this disease. And even radical intervention does not guarantee relapse.