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NEURITIS

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NEURITIS - damage to the trunk of the peripheral nerve. The etiological factors are diverse: bacterial and viral infections (diphtheria, brucellosis, malaria , typhoid, herpes, measles , influenza), intoxication (exogenous - alcohol, arsenic, mercury, lead; endogenous - diabetes , thyrotoxicosis), hypothermia, hypovitaminosis, vascular other violations. A certain role in the development of neuritis belongs to trauma or compression of the nerves. For example, radial nerve neuritis can develop with compression of the nerve in a dream, during surgery, axillary nerve - "with prolonged use of a crutch, peroneal nerve - as a result of working in an uncomfortable position (squatting), etc. One of the causes of neuritis is narrowness of bone and fibrous canals with compression of the nerves passing through them (the so-called tunnel syndromes), as well as compression of the nerve roots by an osteophyte or a herniated disc.

The clinical picture of a lesion of one or another nerve depends on the functions that this nerve performs. Most nerves have motor, sensory and autonomic fibers in their composition, so with neuritis paresis and muscle atrophy, impaired sensitivity, as well as vascular and trophic disorders develop. Neuritis begins most often with pain and numbness. Motor disorders are manifested by paresis or paralysis of individual muscles or muscle groups, atrophy of these muscles, decreased or loss of reflexes. Vegetative disorders are characterized by cyanosis, local swelling, sweating, hair loss, depigmentation, etc. The clinical picture also depends on the etiology and pathogenesis of the disease. So, methyl alcohol poisoning primarily causes damage to the optic nerves, lead and arsenic poisoning of the radial and peroneal nerves: with botulism, the oculomotor, abducent, glossopharyngeal and vagus cranial nerves are more likely to suffer, with diabetes mellitus - mainly the oculomotor, abducent, facial, and radial and peroneal nerves.

Neuritis of individual nerves is characterized by specific symptoms determined by the area of ​​nerve innervation. So, with the defeat of the olfactory nerve, a unilateral decrease in the sense of smell is observed; visual - decreased visual acuity; oculomotor - drooping eyelids, limiting the movement of the eyeball inward, up and partially down, double vision; abduction - limitation of abduction of the eyeball outside; facial - paresis or paralysis of the facial muscles of half of the face; glossopharyngeal and vagus - violation of swallowing and speech, lack of swallowing reflex, upset sensitivity and taste in the back third of the tongue, earache; sublingual - atrophy and fibrillar twitching in half of the tongue and its deviation towards the affected nerve; phrenic nerve - shortness of breath , hiccups , pain in the hypochondrium with radiation to the neck and shoulder; middle - violation of flexion of the hand and I, II, III fingers, as well as sensitivity on the radial side of the palm and three and a half fingers; ulnar - weakness of the flexors of the IV, V and partly III fingers, difficulty in bringing them, atrophy of the interosseous muscles (“clawed paw”), impaired sensitivity on the ulnar half of the palm and on its rear; radiation - violation of the extension of the hand and fingers (hanging brush), sensitivity on the radial half of the rear of the hand; femoral - violation of the extension of the lower leg in the knee joint and flexion of the thigh; sciatic - weakness of the flexors and extensors of the foot, flabbiness of the gluteal muscles, pain on the back of the thigh and posterolateral surface of the lower leg, impaired sensitivity on the lower leg and foot.

Treatment . With neuritis of bacterial etiology, antibiotics, sulfonamides are used; with neuritis of a viral nature - interferon , gamma globulin; with ischemic neuritis - vasodilators (compliment, aminophylline, papaverine), etc. In the acute period of traumatic neuritis, limb immobilization is recommended; anti-inflammatory, analgesic and dehydration drugs (brufen, indomethacin , amidopyrine , butadione , diacarb , furosemide), B vitamins are widely used, after 2 weeks they begin treatment with anticholinesterase drugs (proserin, nivalin) or biogenic stimulants (lidase, aloe). .

In the complex treatment of neuritis, physical factors are widely used. So, to anesthetize and accelerate nerve regeneration, pulse currents, an UHF electric field, ultrasound with hydrocortisone, electrophoresis of analgin, novocaine, iodine, lidase are prescribed. In slow recovery of nerve function, mud or paraffin baths, induphophoresis and electrophoresis of nivalin, proserin, chamber hydro-galvanic baths, underwater shower massage and electrical stimulation of muscles with pulse currents are used. Physical therapy in combination with massage helps to restore nerve conduction, improve regional blood circulation, metabolism in surrounding tissues and contributes to the process of nerve regeneration.

In the period of remission, sulfide and radon baths, mud therapy, and UHF therapy are used. In the absence of the effect of conservative treatment prescribed alcoholization of nerve trunks, as well as percutaneous electroanalgesia. For the treatment of trigeminal and glossopharyngeal nerve neuritis, the use of anticonvulsants (tegretol, finlepsin, diphenin) and antidepressants is effective. With a persistent course, alcoholization of individual branches, blockade or ligation of the sensitive root of the trigeminal nerve is performed.

Well respond to the treatment of neuritis of traumatic and infectious genesis in young people. Significantly worse prognosis in elderly people.