Ischemic neuropathy

Ischemic neuropathy is a group of diseases of the peripheral nerves, among which the most commonly known ischemic optic neuropathy. The causes of the pathology can be varied, starting with diabetes and ending with inflammatory and allergic disorders. The treatment should be performed as it may result in serious complications such as partial or total blindness.

Ischemic neuropathy (IN) - develops as a result of squeezing of the nerve beams in the region of the spine or muscle-bone compounds. At the same time, not only the innervation, but also the circulation of blood, is disturbed, because of which ischemia occurs. In the course of long-term violations, paresthesias and hypothyroid processes may develop, which in extreme cases reach paralysis and necrosis.

The clinical picture during ischemic neuropathy is quite pronounced, which makes it possible to diagnose and prescribe appropriate treatment without any particular difficulty.

In the process of diagnosis, a complete examination of the patient is carried out, which makes it possible to determine the lesion sites and concomitant diseases that may impair the course of the IN. In particular, computer tomography and electroneuromyography may be used.

Video: Ischemic Neuropathy

Description

Neuropathy is a general term that characterizes pathology or damage to nerves. Nerve fibers can be damaged anywhere in the body as a result of exposure to a traumatic factor or disease. Neuropathy is mainly classified according to the type or location of the affected nerves. Sometimes it is divided depending on the disease causing it. (For example, neuropathy that has developed in the context of diabetes is called diabetic neuropathy.)

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Major Types of Neuropathy:

  • Peripheral neuropathy is when the disease of the nervous system affects the nerve fibers outside the brain and spinal cord. These nerves refer to the peripheral nervous system, therefore, in the peripheral neuropathy, the nerves of the extremities are mainly affected. By definition, "proximal neuropathy" should be understood as damage to the nerves, which in a particular way contributes to the appearance of pain in the shoulders, hips or buttocks.
  • Cranial neuropathy : develops when any nerve from the present twelve pairs (nerves coming out directly from the brain) is struck. Two specific types of cranial neuropathy are visual neuropathy and auditory. Optical neuropathy refers to the damage to the optic nerve, which through the retina transmits visual signals through the nerves to the corresponding sections of the brain. Auditory neuropathy is a nerve damage that is responsible for hearing and transmits signals from the inner ear to the brain.
  • Autonomic neuropathy (autonomic neuropathy) is a pathological condition of the nerves of the autonomic nervous system. These nerves control the activity of the heart and the circulatory system (including arterial pressure), digestive organs, function of the gastrointestinal tract and the bladder, participate in the formation of sexual response and sweating. Nerves in other organs can also be affected.
  • Focal neuropathy is a disease of the nerves, which is limited to one nerve or group of nerves, or one part of the body.

Reasons

First of all, the causes of the development of the general group of neuropathies will be considered. Nerve damage can be caused by a number of different diseases, injuries, infections and even vitamin deficiencies.

  • Diabetes : most often associated with neuropathy. Specific symptoms of peripheral neuropathy, often seen in people with diabetes, are sometimes referred to as diabetic neuropathy. The risk of developing diabetic neuropathy increases with age and duration of the course of the disease. Neuropathy is most commonly encountered in people who for decades suffer from diabetes and are generally more likely to be diagnosed with those who have difficulty controlling their diabetes, overweight or with high blood lipids and high blood pressure.
  • Lack of vitamins : deficiency of B12 and folic acid, as well as other vitamins of group B, can cause damage to nerves.
  • Autoimmune neuropathy : diseases such as rheumatoid arthritis, systemic lupus erythematosus and Guyenne-Barré syndrome, often contribute to the development of neuropathy.
  • Infectious diseases : some infectious diseases, including Lyme disease, HIV / AIDS, leprosy and syphilis, can damage nerve fibers and cause neuropathy.
  • Post-herpetic neuralgia : A viral infection of the smallpox can lead to this form of neuropathy.
  • Alcoholic Neuropathy : Chronic Alcoholism is often associated with peripheral neuropathy. Although the credible causes of nerve damage are unclear, this probably arises from the combination of nerve damage by alcohol itself, as well as poor nutrition and the associated vitamin deficiency, which is often observed in alcoholics.
  • Genetic or hereditary disorders : They can affect nerves and cause the development of some neuropathies.Examples include Friedreach's ataxia and Sharko-Marie-Zub's disease.
  • Amyloidosis is a condition characterized by the presence of abnormal protein particles in the blood that precipitate in tissues and organs. Accumulation of these proteins can lead to damage to organs of varying degrees and may cause neuropathy.
  • Uremia : develops due to renal failure and represents the presence of high concentrations in blood exchange products, which can lead to neuropathy.
  • Toxins and poisons often damage nerve fibers. Examples of this are the compounds of gold, lead, arsenic, mercury, some industrial solvents, nitrogen oxides and organophosphate pesticides.
  • Drugs or drugs : some drugs and medications can cause nerve damage. Bright examples of this are medicines used to treat cancer such as vincristine (onokovin, vincasar) and antibiotics such as metronidazole (flagyl) and isoniazid (hydrazide, lantozide).
  • Trauma or mechanical damage to the nerves , including prolonged compression of the nerve fiber or a group of nerves, is a common cause of all neuropathies. A decrease in blood flow (ischemia) in the affected nerve area can also lead to long-term damage.
  • Tumors : benign or malignant tumors of the nervous system or adjacent structures are capable of breaking the integrity of the nerves, penetrating them, or causing neuropathy due to pressure on the nerve fibers.
  • Idiopathic neuropathy is a disease for which no specific cause has been identified. The term "idiopathic" is used in medicine to denote the fact that a reliable cause is not known.

Ischemic neuropathy often develops due to the traumatic factor of influence, when the circulation of blood is disturbed against the background of injury or misuse of immobilizing bandages and tires, and, with this, the normal functioning of the nerve fibers. Similarly, this occurs when the tumor grows near the passage of vessels and nerves.

Video: Neuropathy. Reasons for occurrence. What do you need to know about neuropathy?

Clinic

Regardless of the cause, neuropathy is accompanied by the appearance of characteristic symptoms. The severity of these or other signs varies depending on the specific form of neuropathy.

Sensory nerve damage is common in peripheral neuropathy. Symptoms often begin in the legs with gradual loss of sensitivity, numbness, tingling or pain. Then, the progression of symptoms to the center of the body is often observed.Hands or feet can lose their functionality. It may also be an inability to determine the position of the joints, which can lead to clumsiness or falling.

Extreme sensitivity to the touch is often another sign of peripheral neuropathy. The feeling of numbness and tingling in some parts of the body from a medical point of view is known as paresthesia.

Loss of sensory perception in the area of the foot means that the bubbles and ulcers on the legs can develop rapidly and imperceptibly. Due to a reduction in the sensation of pain, these ulcers are often infected, further infections can spread to deeper tissues, including bone. In severe cases, amputation may be required.

In the event of damage to the motor nerves (those that control the movement), symptoms are expressed in weakness, loss of reflexes and muscle mass, spasms and / or loss of agility.

Autonomic neuropathy or damage to autonomic nerves that control the function of the organs and glands of the internal secretion may manifest itself in a wide range of symptoms. In particular, it is often diagnosed:

  • Nausea, vomiting or bloating after eating
  • Symptoms of the urinary system, such as urinary incontinence, difficulty in urinating, or the feeling that the bladder was not completely empty
  • Impotence (erectile dysfunction) in men
  • Dizziness or fainting
  • Constipation or diarrhea
  • Blurred vision
  • Heat intolerance or decreased sweating ability
  • Hypoglycemia: Low blood sugar, which is associated with tremor, sweating and palpitations. People with vegetative neuropathy may have these characteristic symptoms, which makes it difficult to recognize dangerous levels of blood sugar.

When to seek medical help with neuropathy?

If any unusual or disturbing symptoms suggesting neuropathy or its progression are identified, it is advisable to seek medical attention so that timely diagnosis and treatment can be performed.

Diagnostics

The purpose of the research depends on the clinical manifestations of the disease in a patient with a suspicion of ischemic neuropathy. The diagnosis of neuropathy and the determination of its cause are based on a thorough study of the history of the disease and physical examination of the patient. An important component of the initial diagnosis is the neurological examination, the evaluation of reflexes and the function of sensory and motor nerves.

Some clinical tests are not specific to neuropathy, although they are often used to check for diseases and conditions (such as diabetes or vitamin deficiency) that can contribute to nerve damage.

Research on images taken with X-ray, CT and MRI scans are often used to search for sources of pressure or nerve damage.

Specific tests of neurological function include:

  • Electromyography (EMG) is a test that allows you to determine the degree of functioning of nerve fibers. To carry it out, a very thin needle is inserted through the skin into the muscle. The needle contains an electrode that measures the electrical activity of the muscle.
  • eats on the conductivity of the nerve impulse : measures the velocity of the passing signals along the nerves.This test is often conducted using EMG. When holding it, stickers containing surface electrodes are attached to the skin in different parts of the body. Each electrode gives a very soft electrical impulse that stimulates the nerve. The electric activity of the nerves is measured and the speed of electrical pulses between the electrodes (reflecting the speed of the nerve signals) is calculated.

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  • In some cases, a nerve biopsy is performed . A biopsy is the surgical removal of a small piece of tissue for further examination under a microscope. A pathologist, a doctor specially trained in tissue diagnostics, examines a sample and can help determine the cause of neuropathy. The procedure is carried out using a local anesthetic. The most commonly used biopsy is a nerve located near the ankle, or a surface radial nerve of the wrist.

Treatment

It has been noted that some prescription-only medicines give relief to patients with neuropathy. In severe cases, a combination of drugs may be required. Oral medications that have been successfully used to treat pain during neuropathy include:

  • Antidepressants such as:
    • amitriptyline (elavil, endept);
    • imipramine (tofranil, Tofranil-PM);
    • desipramine (norpramine, perthofran);
    • duloxetine (symbalt);
    • venlafaxine (effector, effector XR);
    • bupropion (wellbutrin);
    • paroxetine (paxil);
    • citalopram (selexa).
  • Anticonvulsants, such as
    • pregabalin (lyrics);
    • gabapentin (gabaron, neurontin);
    • carbamazepine (sarbatrol, ekvetro, tetrethal, tetrethal XR);
    • Lamotrigine (lamestal).
  • Opioids and opioid drugs, such as:
    • Controlled release oxycodone and tramadol (ultram).

Other drugs that can be relieved for severe pain include creps of capsaicin and lidocaine patches (lidoderm, lidopan).

Means for home treatment of ischemic neuropathy

Special and careful attention to the legs is especially necessary for patients with inflammatory diseases, since this reduces the probability of developing ulcers and infections. Most often, the nerves of the feet are struck, so you should do the right foot care, which includes:

  • Wash your feet with warm water every day and then thoroughly wipe them (especially between your fingers)
  • Do not go barefoot or wear inappropriate, damaged or over-tight shoes
  • You need to inspect your legs daily, which allows you to determine cuts, bubbles or other problems in time
  • It is important to treat nail illness in a timely manner
  • Thick seamless socks can help prevent leg irritation
  • If you have problems with your feet, you should contact a doctor (a family doctor, a neurologist or a dermatologist)
  • Foot massage can improve blood circulation.

It is also important to stop smoking because it further disturbs blood circulation (nicotine damages the blood vessels, blood may thicken in the extremities, which often worsens the patient's health).

Prevention

Neuropathy can be prevented only if it is possible to influence the main cause of the disease or to adjust the risk factor.In the case of diabetes, it is necessary to practice long-term control of blood glucose levels, which is crucial for preventing the development of neuropathy and other complications of diabetes mellitus.

Neuropathy due to malnutrition or alcohol abuse can be preventable, especially if the causes are completely eliminated.Genetic or hereditary causes of neuropathy can not be corrected, therefore in such cases prevention is not possible.

Forecast

It is possible to assume the further course of ischemic neuropathy only in the case when the exact cause of the illness is established. If the clinical picture or the cause of the IN can be effectively cured and / or corrected, with no serious damage, the prediction may be excellent or very good.

Nerve fibers that have been damaged during the development of neuropathy may require a long recovery, even if the underlying cause is properly addressed. In other variants of IN development, such as genetic predisposition, the disease can not be effectively cured. Severe nerve damage for any reason is usually an irreversible process.

Video: Diabetic neuropathy. Prevention and treatment of neuropathy with diabetes

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