Vegetative and vascular dysfunction (dystonia)

Vegetative-vascular dystonia , more correctly: vegetative-vascular dysfunction (VDD) - the notion of various in origin and manifestations, but functional in its basis, vegetative disorders, caused by violation of neurohumoral regulation of autonomic functions, is common in medical-diagnostic practice. These disorders are most often observed with neuroses, hypodynamia, with endocrine disharmony in the pubertal and menopausal periods, as well as in neurosis-like conditions associated with neuropsychiatric or physical overwork, infections, intoxications, withdrawal from toxicants and another nature. In the pathogenesis of the VSD, disorders of regulation of vegetative activity at all levels-from the cerebral cortex to the peripheral parts of the autonomic nervous system (including adreno- and cholinergic receptors of the executive organs), as well as the endocrine links of regulation, are usually involved. However, depending on the etiology and manifestations of the VSD, it is often possible to identify the predominant pathogenetic significance of the disorders at any level-the cortical, hypothalamic, with the predominance of parasympathetic or sympathetic activity of the autonomic nervous system, and so on.

Symptoms and course. The majority of patients have any manifestations of asthenia - fatigue, irritability, sleep disorders, low threshold of pain sensitivity with various senestropathies (feeling of dissatisfaction with inhalation, cardialgia, burning in different areas of the tep, etc.). Of the signs of autonomic dysfunction, there may be palpitations with a tendency to sinus bradycardia or tachycardia; Supraventricular (rarely ventricular) extrasystole, paroxysmal tachycardia; Pathological vasomotor reactions-sensation of hot or cold flushes, increase or decrease of blood pressure, pallor or hyperemia of the skin, chilliness of the hands, stop; General or predominantly local (axillary, palmar) sweating; Signs of secretory and motor dysfunction of the gastrointestinal tract; Disorders of sexual functions, etc. Depending on the nature and level of the disorders of regulation, the manifestations of the AVR can be represented as a few of the above disorders mainly within a single system (eg, cardiovascular, digestive) or even one organ, A combination of signs of a violation of the activities of many organs. In the presence of neuro-vegetative imbalance, the predominance of parasympathetic nerves activity is expressed by the propensity to bradycardia, skin flushing, increased peristalsis of the stomach and intestine, a symptom of persistent red dermographism, a decrease in pulse rate by more than 10 beats per minute (usually in combination with a decrease in blood pressure by more than 10 mm Hg) in clinostatics (the reflex to Danielopoulou), with the head deflecting backwards (the Ortner reflex), with pressure on the eyeballs (Ashner's reflex). Absence of a decrease in pulse rate when these reflexes are caused, its increase by more than 12 per 1 min with a simultaneous rise in blood pressure by more than 15 mm Hg. Art. When moving to a vertical position, as well as a symptom of persistent white dermographism, are regarded as signs of the predominance of the activity of the sympathetic department of the nervous system.

The course depends on the nature of the IRR. Often it happens to be permanent with wave-like strengthening and weakening of manifestations of the VSD depending on the dynamics of the condition, with which its development is connected, and on the changing conditions of the patient's life. In a number of cases, VSD manifests itself paroxysmally, including in the form of a "vegetative storm," or crises, with a pattern of predominant excitation of cholinergic receptors (cholinergic crisis) or adrenoreceptors (adrenergic, sympathoadrenal crisis). Symptoms of the chopinergic crisis: a sense of fear, anguish, nausea, hypersalivation, "rumbling" in the abdomen, diarrhea; Pollakiuria; Profuse sweating of the head and trunk; Miosis, bradycardia; In rare cases also hypertension of skeletal muscles, fasciculation, lifting of blood pressure. Symptoms of adrenergic crisis: a sense of anxiety, excitement; Spotty hyperemia of the skin of the face, neck, chest (sometimes sharp pallor), tremor of fingers of fingers, trembling in the body (more often without sensation of cold); Dilated pupils; Tachycardia, increased blood pressure; Polyuria; Sometimes imperative defecation; In the blood often leukocytosis, hyperglycemia.

The diagnosis of vegetative-vascular dysfunction is essentially syndromic, and not nosological. In medical records, it should be indicated after the designation of the main disease with respect to the VSD (eg: "Neurasthenia, vegetative-vascular dysfunction with paroxysms of supraventricular tachycardia" or "Pathological menopause, vegetative-vascular dysfunction with sympathoadrenal crises," etc.). However, this is not always easy to implement, since the nosological forms presented in the current classification of diseases do not cover all possible causes of IRS, among which there are, for example, "donorological" conditions, such as hypodynamia or mismatch in the development of executive and control systems Teenagers and boys. For the equivalent nosological designation of this type of VSD with a predominance of circulatory disorders (mainly in young people), the term "neurocirculatory dystonia" is often used (see).

Differential diagnosis is carried out, first, between VSD and diseases with an organic basis of violations of any function (eg, with extrasystole - with myocarditis, ischemic heart disease, cardiosclerosis, cardiomyopathy, etc.); Second, on the etiology of VSD, with the establishment of the underlying disease. This requires careful exclusion of the organic pathology of the nervous and endocrine systems. Thus, paroxysmal manifestations of VSD in the form of a "vegetative storm" always indicate the pathogenetic involvement of hypothalamic disorders, which can be a manifestation of both neurosis and organic damage. N. from. With the formation of diencephalic syndrome; With adrenergic crises, the exclusion of pheochromocytoma is necessary.

Treatment is directed primarily to the underlying disease (neurosis, pathological menopause, etc.), includes also pathogenetic therapy (sedatives, if necessary, anticholinergics, adrenoreceptor blockers) and the use of symptomatic drugs - antihypertensive, antiarrhythmic, etc. In all cases, normalization Mode of work and rest, providing full sleep, physical education, hardening. Emergency therapy of vegetative crises begins with parenteral administration of 10 mg of Seduxen. Adrenergic crisis shows beta-blockers (eg, indenter parenterally or inward), and with a marked increase in diastolic blood pressure, alfa-adrenobacter pituitary (tropafene). Atropinergic crisis subcutaneously injected atropine, platifillin, and with the concomitant pronounced rise in blood pressure, the excitation of respiration - gangleron.