Facial neurosis: objective and far-fetched reasons

Pain is one of the main alarm signals in the body, which haunts a person. People with a healthy psyche certainly react to pain. Nerve endings are responsible for this sensation; pain can occur when they are irritated or inflamed. It is for this reason that we feel pain in the area of ​​the abscess or bruise. Nerve endings should not be confused with nerve roots and trunks. Their compression, on the contrary, leads to numbness and paralysis. Inflammation of the nerve endings can occur with various specific and nonspecific infections when neuritis develops, for example, with herpes zoster or, as it is also called, herpes zoster. But most often you have to deal with the fact that the initiator of the process is muscle spasm, and, as a result, compression of the blood vessels in this area occurs. Impaired blood supply leads to damage to nerve endings.

Symptoms

With neuritis, the nerve fiber is damaged, and therefore the functions suffer, the main ones being sensitive, motor and trophic, therefore the following symptoms are clinically noted:

1. In the phase of irritation of the nerve fiber: pain, burning, feeling of “crawling goosebumps”, feeling “as if many needles are being pricked”.
2. In the phase of loss of functions: decreased muscle strength, muscle atrophy, decreased reflexes, decreased sensitivity, tissue atrophy including skin, subcutaneous fat, muscles, bone tissue.

Diagnostics

Tibial nerve neuropathy belongs to the group of mononeuropathy of the extremities. The clinical picture of the pathology is characteristic of dysfunctions of the musculoskeletal system and is of a traumatic nature, and therefore is subject to joint observation and control by specialists in the field of neurology and traumatology.

The first step in making a diagnosis is to question the patient about injuries to the lower extremities, working conditions, as well as the characteristics of the clinical picture and the presence of other diseases that may affect the normal functioning of the nervous system. After this, the patient is examined to identify atrophic and neurotrophic changes in the lower leg and foot.

Based on the data obtained, an initial diagnosis is made, which is confirmed by instrumental studies using one of the following methods:

• ultrasound diagnostics of the lower extremities;
• electromyography is a research method that allows you to determine the performance of the muscular system of the lower leg and foot;
• X-ray diagnostics if indicated, for example, for fractures;
• trigger point blockade is a therapeutic and prophylactic method that involves administering a medication to the affected areas of the lower extremities, which makes it possible to determine the degree of nerve damage;
• CT and MRI are used as additional diagnostic methods when using other methods there is insufficient data to make a diagnosis.

Causes

The main causes of neuritis:

• infectious (viruses, bacteria, their toxins);
• exposure to toxic factors
• metabolic disorders (diabetes mellitus, deficiency of vitamins B1 and B6);
• allergic reactions;
• injuries;
• oncological diseases;
• hereditary diseases;
• diseases of the spine leading to mechanical compression of the nerve trunk (intervertebral hernia, tunnel syndromes, etc.).

The mechanism of nerve damage when exposed to various unfavorable factors is associated with the launch of a cascade of inflammatory reactions. Swelling of the nerve trunk occurs, damage to the myelin sheath and subsequently to the axial cylinder, which in turn leads to the death of the nerve cell.

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Clinical picture of some individual nerves

• Trigeminal nerve – pain is sharp, piercing, in series, along one or several branches of the nerve.
• Facial nerve – muscle weakness on one side of the face. It is difficult to close the eye, the corner of the mouth on the affected side is drooping. When liquid food or drink is taken, everything comes out of the mouth.
• Diaphragmatic – feeling of lack of air, shortness of breath, hiccups.
• Median – impaired flexion of the hand, fingers I, II and III and decreased sensitivity on the palmar surface.
• Ulnar – weakness of the flexors of the IV, V and partly III fingers, decreased sensitivity on the palmar surface of the above fingers.
• Radial – impaired extension of the hand and fingers, decreased sensitivity in half of the back of the hand (I and II fingers). It is difficult to move the thumb away.
• External cutaneous nerve of the thigh (Roth-Bernhardt disease) – pain, numbness and burning along the outer surface of the thigh.
• Femoral – impairment of leg extension at the knee joint and hip flexion. Pain and sensory disturbances on the lower 2/3 of the anterior surface of the thigh, the anterior inner surface of the lower leg.
• Sciatic – pain along the back of the thigh and lower leg, weakness of the flexors and extensors of the foot.
• Olfactory – anosmia on one side (lack of sense of smell). When a nerve is irritated, foreign odors may appear.
• Visual – decreased acuity and loss of visual fields. The phenomena of nerve irritation manifest themselves in the form of photopsia (sensation of light, flames, sparks, etc.).
• Oculomotor – drooping of the upper eyelid (ptosis), limited mobility of the eyeball, dilated pupil, diplopia (double vision).
• Block - restriction of the mobility of the eyeball downwards and outwards.
• Auditory – hearing loss, often accompanied by a feeling of noise or ringing in the ear.
• Glossopharyngeal - twitching pain in the tonsils, root of the tongue, pharynx and taste disturbances in the back third of the tongue, impaired salivation and swallowing.
• Wandering – manifested by disturbances in swallowing and speech. On the affected side, the soft palate is lowered, the uvula is deviated to the healthy side. There are also disturbances in the functioning of internal organs - bradycardia, shortness of breath, motility disorders of the esophagus, stomach and intestines (spasms), etc.
• Additional – difficulty turning the head in the healthy direction, the head is tilted towards the affected nerve, the shoulder is lowered.
• Tibial – the foot is extended, but the patient cannot bend it. Cannot stand on toes. Sensitivity is reduced along the back of the lower leg and on the sole.
• Peroneal – the impossibility of standing on the heels and straightening the foot, it hangs down. Sensitivity is reduced on the outer surface of the lower leg and the back of the foot.
• Intercostal nerves – pain in the intercostal space, often radiating into the chest, simulating pain in the heart, chest, lungs, and stomach. Often, pain in the paravertebral muscles is detected at the level of the thoracic spine.

Trigeminal neuralgia

This is another lesion of the nerve fiber structure, which is often chronic and accompanied by periods of exacerbation and remission.
It has several causes, which are divided into idiopathic - when a nerve is pinched, and symptomatic.

The main symptom of neuralgia is paroxysmal sensations in the form of pain on the face and in the mouth.

Pain sensations have characteristic differences. They are “shooting” and resemble an electric shock; they arise in those parts that are innervated by the n.trigeminus. Having appeared once in one place, they do not change localization, but spread to other areas, each time following a clear, monotonous trajectory.

The nature of the pain is paroxysmal, lasting up to 2 minutes. At its height, a muscle tic is observed, that is, small twitching of the facial muscles. At this moment, the patient has a peculiar appearance: he seems to freeze, but does not cry, does not scream, and his face is not distorted from pain. He tries to make a minimum of movements, since any of them increases the pain. After the attack there is a period of calm.

Such a person performs the act of chewing only with the healthy side, at any time. Because of this, compaction or muscle atrophy develops in the affected area.

The symptoms of the disease are quite specific, and its diagnosis is not difficult.

Therapy for neuralgia begins with taking anticonvulsants, which form its basis. Their dose is subject to strict regulation and is prescribed according to a specific scheme. Representatives of this pharmacological group can reduce agitation and the degree of sensitivity to painful stimuli. And, therefore, reduce pain. Thanks to this, patients have the opportunity to freely eat and talk.

Physiotherapy is also used. If this treatment does not give the desired result, proceed to surgery.

Diagnosis of neuritis

The symptoms of neuritis are in many ways similar to the clinical manifestations of various diseases, including non-neurological ones. Therefore, the doctor should conduct a thorough differential diagnosis to make an accurate diagnosis.

Primary diagnosis consists of a thorough collection of patient complaints, identification of possible preceding factors, and direct examination of the patient. Most symptoms of neuritis are specific, so depending on their severity, the doctor can make a preliminary diagnosis.

Stimulation and needle electroneuromyography are used to diagnose peripheral nerve damage. This study makes it possible to answer the questions - which nerve is damaged, in what place it is damaged, what percentage of nerve damage, as well as give a prognosis for its recovery and monitor its recovery.

Diagnostic methods

Electroneurography is used to measure the speed of passage of nerve impulses through the fibers of peripheral nerves from their exit point to the nerve endings in ligaments and muscles. The technique allows you to determine the damaged nerve, determine the location and extent of damage, and identify the severity of the process.

Electromyography – used to study the bioelectrical activity of muscles. This method allows us to answer the question: what is the problem - damage to the nerve or damage to the muscle itself? EMG allows for differential diagnosis of neuropathy with muscle pathology (myasthenia, myotonia, myoplegia, polymyositis).

Ultrasound is a method for diagnosing damage to peripheral nerves. Evaluates changes in nerve diameter, continuity, and deterioration of sound conduction. Ultrasound clearly shows swelling of the nerve trunk and surrounding tissues

MRI – visualizes nerves and soft tissue structure, detects malignancies and provides information about muscle atrophy and nerve damage. With the help of MRI diagnostics, it has become possible to detect nerve damage in areas that are difficult to examine using electrodiagnostics or ultrasound.

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Treatment of intercostal neuralgia

Treatment for intercostal neuralgia depends on what causes it. Statistics say that the vast majority of pain in this area is caused by mechanical causes - pathology of the spine and muscles - osteochondrosis, disc herniation, protrusion, myalgia and myofascial syndrome. Therefore, the answer to the question of how to treat intercostal neuralgia is obvious. Since most of the reasons are mechanical, then they should be eliminated mechanically. This means that the best way to treat thoracic intercostal neuralgia is manual therapy. Moreover, not ordinary, but soft manual therapy, which is not only softer, but also much more effective than simple realignment of the vertebrae. Gentle manual therapy works extremely gently and delicately. Its main advantage is the safe elimination of muscle tension that “pinches” the nerve and stiffens the spine. This is why a chiropractor is the primary physician for intercostal neuralgia. In cases where the problem is advanced, manual therapy can be supplemented with medications and physical therapy.

Treatment of intercostal neuralgia with herpetic lesions requires parallel treatment by a dermatologist. Rare and severe forms caused by fractures and tumors require high-tech and expensive medical care, which is carried out under government programs in specialized clinics.

How to relieve pain from intercostal neuralgia if a person finds himself far from full-fledged medicine and only a pharmacy nearby? Pain in acute intercostal neuralgia is best relieved with the combined use of non-steroidal and steroidal anti-inflammatory drugs. But, we draw your attention - see a specialist as soon as possible. This must be done even if the pain stops completely. It is in your best interests to be sure that nothing more serious lies behind the pain and intercostal neuralgia.

Treatment of neuritis

Treatment must be comprehensive. It is necessary to fight both the damaging factor and restore the damaged nerve trunk.

In treatment I use the following groups of drugs:

• Vascular;
• Anti-inflammatory;
• B vitamins;
• Improving the conduction of impulses along the nerve, etc.

Non-drug treatment methods are also used:

• Acupuncture - exposure to biologically active points of the skin leads to signal transmission along the nerve trunk to the spinal cord and brain, resulting in a complex cascade of reactions, which includes improved blood circulation, release of biologically active substances, and hormonal response, which in turn accelerates restoration of nerve fiber.
• Physiotherapy is designed to locally influence reflex zones. The main effects achieved after physiotherapy are: analgesic, anti-inflammatory, antispasmodic, fibrinolytic.
• Massage (improves microcirculation, reduces swelling).
• Therapeutic exercise (by working out muscle groups using a feedback system, the recovery period is accelerated).

To relieve pain and accelerate the recovery of nerve fibers, local injection techniques are used - therapeutic and diagnostic blockades, pharmacopuncture - with various mixtures of drug solutions, if necessary, together with ultrasound navigation. Due to the local administration of drugs (vitamins, anti-inflammatory drugs, anesthetics), it is possible to quickly relieve pain, reduce swelling and the inflammatory reaction, and restore the nerve trunk.

Therapy

The initial stage in treatment is therapy of the pathology that is the root cause of nerve fiber dysfunction. For example, for endocrine disorders of the system, hormonal drugs are prescribed, for diabetes mellitus, medications are prescribed to normalize blood sugar levels. If there is a deficiency of B vitamins, intravenous administration of drugs with vitamins B1, B6 and B12 is indicated, which will improve the nutritional capacity of the tissues of the nervous system.

To reduce the severity of pain and resume motor activity, the patient is prescribed special orthopedic shoes or insoles. The choice is made in accordance with the localization of the damage to the nerve fibers.

In case of severe pain, severe swelling as a result of pinched nerve endings, blockades are carried out with the introduction of analgesics (Analgin, Novocaine) and anti-inflammatory non-steroidal drugs (Ibuprofen, Dicroberyl). Less commonly used are steroids (hydrocortisone) or antidepressants (amitriptyline).

For trophic disorders of surface tissues, reperants (Solcoseryl, Actovegin) are recommended, the action of which is aimed at renewing cellular structures.

Anticholinesterase medications (Ipidacrine) are used to suppress nervous excitability.

To restore performance and strengthen the muscular system of the ankle, normalize blood flow, physiotherapeutic methods of therapy (electrophoresis, magnetic therapy, shock wave therapy), exercise therapy and massage sessions are indicated.

Surgical intervention is necessary in the absence of effectiveness of conservative therapy, nerve damage, the formation of adhesions, impaired sensitivity of the lower extremities and severe pain. The operation is performed by a neurosurgeon.