Treatment of the vagus nerve. What is the vagus nerve: symptoms and treatment of its damage Vagus nerve compression

1. Facial nerve (VII pair, 7th pair of cranial nerves), n. facialis (n. intermediofacialis).
2. Branches of the facial nerve (n. facialis) in the facial canal. Greater stony nerve, n. petrosus major. Drum string, chorda tympani.
3. The remaining branches of the facial nerve after exiting the stylomastoid foramen (foramen stylomastoideum). Intermediate nerve, n. intermediate.
4. Vestibulocochlear nerve (VIII pair, 8 pair of cranial nerves), n. vestibulocochlearis. Parts of the prevernocochlear nerve.
5. Glossopharyngeal nerve (IX pair, 9 pair of cranial nerves), n. glossopharyngeus. Nuclei of the glossopharyngeal nerve.
6. Branches of the vagus nerve in the head and neck n. vagus.
7. Branches of the vagus nerve in the thoracic and abdominal parts n. vagus. Recurrent laryngeal nerve, n. laryngeus recurrents.
8. Accessory nerve (XI pair, 11 pair of cranial nerves), n. accessorius.
9. Oculomotor nerve (III pair, 3rd pair, third pair of cranial nerves), n. oculomotorius.
10. Block nerve (IV pair, 4 pair, fourth pair of cranial nerves), n. trochlearis.
11. Abducens nerve (VI pair, 6 pair, sixth pair of cranial nerves), n. abducens.
12. Olfactory nerves (I pair, 1 pair, first pair of cranial nerves), nn. olfactorii.
13. Optic nerve (II pair, 2 pair, second pair of cranial nerves), n. opticus.

N. vagus, vagus nerve, which developed from the 4th and subsequent gill arches, is so called due to the vastness of its distribution. It is the longest of the cranial nerves. With its branches, the vagus nerve supplies the respiratory organs, a significant part of the digestive tract (before colon sigmoideum), and also gives branches to the heart, which receives fibers from it that slow the heartbeat. N.vagus contains three kinds of fibers:

1. Afferent (sensory) fibers, coming from the receptors of the named viscera and vessels, as well as from some part of the hard shell of the brain and the external auditory canal with the auricle to sensitive nucleus (nucleus solitarius).

2. Efferent (motor) fibers for voluntary muscles of the pharynx, soft palate and larynx and efferent (proprioceptive) fibers emanating from the receptors of these muscles. These muscles receive fibers from motor nucleus (nucleus ambiguus).

3. Efferent (parasympathetic) fibers coming from vegetative nucleus (nucleus dorsalis n. vagi). They go to the myocardium of the heart (slow down the heartbeat) and the muscular membrane of the vessels (dilute the vessels). In addition, the composition of the cardiac branches of the vagus nerve includes the so-called n. depressor, which serves as a sensitive nerve for the heart itself and the initial part of the aorta and is in charge of the reflex regulation of blood pressure. Parasympathetic fibers also innervate the trachea and lungs (narrow the bronchi), esophagus, stomach and intestines. to colon sigmoideum(increase peristalsis), incorporated in the named organs of the gland and gland of the abdominal cavity - the liver, pancreas (secretory fibers), kidneys.

Parasympathetic part of the vagus nerve is very large, as a result of which it is predominantly an autonomic nerve, important for the vital functions of the body. Nervus vagus represents a complex system, consisting not only of nerve conductors of heterogeneous origin, but also containing intra-stem nerve knots.

Fibers of all kinds associated with three main nuclei of the vagus nerve, exit the medulla oblongata in its sulcus lateralis posterior, below the lingual tract nerve, with 10-15 roots, which form a thick nerve trunk that leaves the cranial cavity together with the lingual tract and accessory nerves through the foramen jugulare. In the jugular foramen, the sensitive part of the nerve forms a small knot - ganglion superius, and at the exit from the hole - another ganglionic thickening of a fusiform shape - ganglion inferius. Both nodes contain pseudo-unipolar cells, the peripheral processes of which are part of the sensitive branches that go to the named nodes or receptors of the viscera and vessels ( ganglion inferius) and external auditory meatus ( ganglion superius), and the central ones are grouped into a single bundle, which ends in sensitive nucleus, nucleus solitarius.

Upon exiting the cranial cavity trunk of the vagus nerve goes down to the neck behind the vessels in the groove, first between v. jugularis interna and a. carotis interna, and below - between the same vein and a. carotis communis, and it lies in the same vagina with the named vessels. Further, the vagus nerve penetrates through the upper aperture of the chest into the chest cavity, where its right trunk is located in front of a. subclavia, and the left one is on the anterior side of the aortic arch. Going down, both vagus nerves bypass the root of the lung behind on both sides and accompany the esophagus, forming plexuses on its walls, with the left nerve running along the front side, and the right one along the back. Together with the esophagus, both vagus nerves penetrate through the hiatus esophageus of the diaphragm into the abdominal cavity, where they form plexuses on the walls of the stomach. Trunks of the vagus nerves in the uterine period, they are located symmetrically on the sides of the esophagus. After turning the stomach from left to right, the left vagus moves forward, and the right back, as a result of which it branches on the anterior surface left vagus, and on the back - right.

The vagus nerve (n.vagus) is the tenth pair of cranial nerves and is classified as mixed. It is divided into 4 sections according to its topography. The vagus nerve is very long and runs from the skull to the middle of the gastrointestinal tract, which is why it has such an interesting name.

Topography

The vagus nerve has a rather complex topographic anatomy. This is due to its length and the fact that the location of the right and left nerves are somewhat different from each other.

Both of these nerves begin in the same way. They are formed from a dozen fibers and exit from both sides to the base of the skull from the medulla oblongata. Then they go down through the hole in the skull. The first large node, the ganglion superius, is also located here. The second is below and is called the ganglion inferius.

After both nerve trunks have reached upper aperture chest, they begin to "behave" differently. The left vagus nerve is located in front of the aortic arch, and the right one is located near the subclavian artery.

Then they go around both bronchi from behind and approach the esophagus.

It passes down through the diaphragm to the upper floor of the abdominal cavity. In the epigastric region, they are divided into many smaller branches that transmit impulses to the diaphragm, solar plexus and organs of the upper floor of the abdominal cavity.

The vagus nerve consists of the following fibers:

• sensitive fibres. Carry impulses from the organ to the brain. Fibers from the vessels of the respiratory organs, the esophagus and stomach, the heart muscle, and the external auditory canal are suitable for the sensitive nucleus of n.vagus;
• motor fibres. They transmit impulses in the opposite direction. From the motor nucleus, the fibers reach the muscles of the pharynx, soft palate, and larynx;
• Parasympathetic nerve fibers. They affect the autonomic function of the heart, control the muscular membrane of the vessels. They can also narrow the lumen of the bronchi, increase intestinal motility and affect all organs that are innervated by the vagus nerve.

Functions

The vagus nerve is divided into four sections according to its location. They are different in length and in each of them smaller branches depart from the large nerve trunk, which innervate nearby organs and tissues.

The shortest head section. From this area depart fibers that innervate part of the hard shell of the brain (one of the causes of migraine), the inner ear, as well as two connecting branches that lead to the eleventh and twelfth pairs of cranial nerves.

The branches of the cervical region are responsible for the work of the muscles of the pharynx and larynx. If the vagus nerve is damaged in this section, the patient loses his voice, dysphagia appears. Also from this area depart small nerves, which are part of the cardiac and esophageal plexus.

The thoracic region ends at the level of the diaphragm. Two separate plexuses depart from it, which are responsible for the work of the esophagus and lungs. As well as two types of branches - cardiac and bronchial.

The vagus nerve ends in the abdominal region. Here it is divided into the anterior and posterior trunk, which innervate the stomach, pancreas, liver, and solar plexus.

The activity of n.vagus is increased mainly at night. This is due to the fact that he is responsible for the work of the parasympathetic division of the autonomic nervous system.

The vagus nerve slows down the heartbeat, reduces the contraction of the nasty muscles of the bronchi. At the same time, the secretion of the stomach and pancreas increases. The greatest activity of this part of the nervous system is manifested at night.

Also, the vagus nerve is responsible for the occurrence of coughing and vomiting, which are protective reflexes. We also owe the appearance of hiccups to pathological impulses that pass along the branches of the vagus nerve to the diaphragm.

Treatment of diseases is aimed at eliminating the symptoms that appear when there is a violation of the transmission of impulses along individual branches of the n.vagus.

Diseases

The vagus nerve, like any part of the nervous system, is subject to various damages. Clinical picture disease largely depends on the location of the lesion.

If the lesion is located inside the cranium, then most often it is compression by tumor neoplasms, the consequences of a traumatic brain injury, multiple sclerosis, ALS, or infections that are tropic to the nervous tissue.

The most common diseases that affect peripheral part vagus nerve include neurasthenia, Raynaud's or Meniere's disease, nerve paralysis or paresis.

Vascular diseases are associated with the pathological work of the vagus nerve.

Symptoms of a malfunction of the vagus nerve depend on the depth, extent and location of the lesion. First of all, the work of the vocal cords is disrupted. This is due to damage in the cervical region. The voice becomes quiet, hoarse, may disappear completely. If both nerves are affected, suffocation is possible.

Swallowing problems are also a common symptom. Water or liquid food can enter the nasopharynx.

The work of the heart is disrupted. The heartbeat slows down or accelerates, its rhythm becomes uneven (arrhythmia). These symptoms prevail at night.

In case of serious damage to the n.vagus, its paralysis may occur, which leads to death.

Research methods

With symptoms that indicate damage to the 10th pair of cranial nerves, you should contact a neurologist.

The doctor first of all determines the sonority of the voice. This is a simple research method that does not require cost and effort. It is necessary to pay attention to the sound of the voice, its timbre and clarity of speech. A certain nasality may occur due to paresis of the soft palate. The timbre of the voice becomes lower due to the fact that the vocal cords cannot close tightly enough. For the same reason, the patient is not able to cough on purpose.

On examination oral cavity the doctor draws attention to the fact that the soft palate is relaxed and sags slightly downward. If you ask the patient to pronounce vowel sounds,
then the tongue will deviate to the side of the lesion.

As with any pathology of the nervous system, there will be a weakening of some reflexes. With this lesion, the pharyngeal and palatine reflexes will not be fully determined.

For differential diagnosis, instrumental research methods are used: computed and magnetic resonance imaging, radiography of the skull and chest organs.

Therapy Methods

Treatment of pathology of the vagus nerve should take place exclusively in a neurological hospital. This is due to the fact that it innervates vital organs (heart, lungs).

The most important stage of treatment is the elimination of the cause that caused the disease. Therefore, attention must be paid differential diagnosis. If the disease has an infectious etiology, then the main drug of therapy is antiviral or bactericidal drugs.

The main medicines that are used to treat many diseases are steroid drugs. These include prednisolone, dexamethasone. The course of therapy is long and requires constant correction.

Also appointed symptomatic treatment. For example, with a decrease in gastric secretion and intestinal motility, prozerin is used.

Our nervous system has a complex structure, because it is responsible for the passage of all processes in our body. Problems in its activity are immediately reflected in the functioning of organs and systems, and require an attentive attitude and correct, as well as timely correction. So one of the rather important parts of the nervous system is the vagus nerve, it is a representative of the twelve nerves in our cranium (the tenth pair of cranial nerves). Damage to this part of our body can affect the activity of the heart, broncho-pulmonary system, intestines, etc. Correction of this pathological condition requires proper therapy under the supervision of a doctor.

The vagus nerve has a rather complex structure, because it contains motor, as well as secretory and sensory fibers. Such a fiber is responsible for conducting impulses that enter the cerebral cortex and awaken all sorts of functions. Of course, damage to the vagus nerve negatively affects the activity of the whole organism and can provoke a variety of ailments.

Why is the vagus nerve damaged? Causes

There are many factors that can cause damage to the vagus nerve. Let's try to consider the most common of them. So most often this pathological condition is most often caused by diabetes mellitus.

Damage to the blood vessels caused by high blood sugar can cause inflammatory lesions as well as damage to the vagus nerve. In addition, such an ailment can develop as a result of a number of chronic ailments, including HIV or Parkinson's disease. Such diseases have a rather negative effect on the activity of such an important fiber.

Serious problems with the vagus nerve can occur due to injuries and severe accidents. In addition, in certain cases, surgical interventions can, under a combination of unforeseen circumstances, provoke a sharp increase in pressure on this area, which is also fraught with damage.

Another fairly common cause of problems of this kind is considered to be alcoholism, which provokes alcoholic neuropathy.

What indicates that the vagus nerve is damaged? Symptoms

The manifestations of lesions of the vagus nerve can be very different. In this case, the severity of symptoms directly depends on the severity of the pathology. In most cases, inflammatory processes and other lesions of this area cause problems with the voice, for example, cause hoarseness, various kinds of difficulties in pronunciation, as well as a significant change in voice. The next stage in the development of pathological processes is considered to be violations of swallowing saliva or food.

A similar symptom is explained by the fact that the vagus nerve is responsible for the reflexes of the movements of the tongue, respectively, its lesions lead to movement dysfunctions. A failure in the same reflex function can cause the development of unreasonable gag reflexes, which can cause suffocation. As the pathological processes develop, the patient experiences problems in the digestive process, which can be expressed in indigestion, constipation, etc. In addition, lesions of the vagus nerve can cause disturbances in the functioning of the heart and blood vessels, which manifests itself in arrhythmia, pain in chest, respiratory failure, and dizziness. Manifestations of such a pathological condition can be expressed in urinary incontinence, and in the development of deafness.

How is a damaged vagus nerve corrected? Treatment

Therapy for problems with the vagus nerve should be carried out exclusively under the supervision of a doctor. Significance proper treatment is extremely high, since malfunctions in the activity of such a part of our body can cause extremely serious complications, and in severe cases, even provoke a fatal outcome.

Treatment of lesions of the vagus nerve is carried out only after confirmation of such a diagnosis by a qualified specialist. The doctor takes measures to eliminate the causes that provoked the pathology. The most common drugs used to correct such an ailment are considered to be hormonal compounds (Prednisolone), multivitamin drugs (the use of B vitamins plays a particularly important role), as well as antihistamine and anticholinesterase drugs. In certain cases, plasmapheresis can be performed.

If we talk about the use of physiotherapeutic treatment methods, then doctors often recommend the use of diadynamic currents aimed at the site of pain localization. In certain cases, surgery is the only possible treatment.

It is worth considering that the treatment of damage to the vagus nerve should be carried out exclusively in the clinic.

Vagus fibers conduct impulses to organs in the head region (they innervate the larynx, palate and middle ear region), as well as the chest and abdominal cavities.

The main functions of the vagus nerve are associated with the work of the parasympathetic nervous system. What does it mean? - IN nervous system Man has a pair of opposites - the sympathetic and parasympathetic nervous system.

sympathetic- associated with the activation of the body, vigorous activity, aimed at increasing the speed of reactions, intensive production of hormones, preparing for running, for fighting.

Parasympathetic nervous system - prepares the body for relaxation, recuperation, digestion of food, sleep, sex and other activities associated with pleasure. Thus, the vagus nerve partly regulates the mood and sleep of a person.

With chronic overexcitation of the nervous system, muscle hypertonicity and similar conditions, dysfunction of the vagus nerve can be assumed.

Where is the vagus nerve located? - You can feel it yourself directly in the hole under the earlobe.

Coming out of the jugular foramen of the brain, the vagus descends along the side of the neck as part of the neurovascular bundle along with carotid artery and the internal jugular vein. Passes near the trachea and pharynx, innervating them. Further, the vagus passes into the chest cavity, its right branch goes next to the right subclavian artery, and the left one - in front of the aortic arch. Both branches approach the lower part of the esophagus, passing from it in front and behind, and regulate its functions. Further, through the opening of the diaphragm, both nerve fibers enter the abdominal cavity. They innervate the stomach. Then part of the fibers goes to the liver, part - to the celiac (or solar) plexus. From the celiac plexus, the fibers approach all organs of the abdominal cavity, except for the lower sections of the large intestine and the organs of the small pelvis.

The vagus nerve in its composition has fibers responsible for motor skills and sensory (mixed type), but all its activity is still associated with the autonomic nervous system - from the word "vegetable" - "vegetable" (that which cannot be controlled by consciousness) - as opposed to somatic nervous system - from the word "soma" - "body" (we can consciously control the movement of muscles).

Dysfunction symptoms

Since the vagus nerve innervates the larynx, its damage leads to problems with speech and uncomfortable swallowing, to the loss of the gag reflex. Disruption of the gastrointestinal tract is also one of the manifestations of vagus dysfunction, manifested in loss of appetite, there may be a feeling of satiety after eating a small amount of food.

Reasons for the defeat

One of the causes of damage to the vagus nerve is diabetes. The mechanism that destroys nerve fibers is not fully understood. The causes of damage and irritation of the vagus nerve can also be body injuries received, for example, during a car accident and others when a pinched nerve has occurred. Surgery can also affect how the nerve works.

Vagus Nerve Exercises

Training:

• Sit upright in a chair with your hands folded in your lap
• Place both feet on the floor and take a deep breath

Neck area

• Stretch your head as far as possible with the top of your head up and turn it to the left and right. Repeat this movement several times.

Lower jaw area

• Move your lower jaw, slowly opening and closing your mouth, moving it from side to side, back and forth. Feel the jaw muscles, the tension of which can cause pain. Do this exercise until you feel slight fatigue in your jaw.

Eyes

• Open and close your eyes. Look in different directions without moving your head - left and right, up and down. Alternately open your eyes wide and squint.

Facial muscles

• Remember your childhood, and for a few minutes, "make faces", trying to use as many facial muscles as possible.

Middle ear

• Listen. Hear ambient sounds in the background, such as the creaking of chairs, the sound of tires passing through the street, the chirping of birds, the sound of an elevator, the sound of a computer running, or the sound of an air conditioner or fan.

Throat

• First make a few coughing movements (as if something is in the trachea), and then swallow the saliva.

Larynx

• Start developing your voice, for example, you can hiss like a snake, or roar like a lion. The main thing is that these sounds lead to tension in the muscles of the larynx.
• Feel the vibration in the larynx, the vibration sound should reach the diaphragm and disperse throughout the abdomen.

Listen to how you feel, especially the feeling in your chest. Pay attention to every, no matter how small, positive change. With the daily implementation of this complex, you will increase the tone of the vagus nerve and the whole body, revive the internal energy!

From the anamnesis, chest surgery (40%), neck trauma (35%), past infections (30%) are important.

When the nerve is damaged, the tone of the voice changes, there are difficulties in swallowing, choking for several weeks, months, sometimes years. As the disease progresses, difficulty in swallowing and speaking increases. Paralysis of the muscles of the pharynx, esophagus, palatine muscles leads to a violation of swallowing (dysphagia), the ingress of fluid into the nose during the act of swallowing.

On examination, soft palate drooping (80%), dysphonia are revealed. The tongue deviates to the healthy side, there are no pharyngeal and palatine reflexes - 65-80%. With voice paralysis, a change in voice appears: it becomes hoarse (50%). With damage to the vagus nerve, aphonia develops on both sides, a violation of breathing and heart function.

Diagnostics

Diagnosis includes computed/magnetic resonance imaging of the brain.

Treatment of vagus nerve injury

Treatment is prescribed only after confirmation of the diagnosis by a specialist doctor. It is necessary to eliminate the cause of the disease; shows "Prednisolone", vitamins, antihistamines, anticholinesterase drugs; plasmapheresis.

Differential Diagnosis:

• Tumors and disorders cerebral circulation in the medulla oblongata.
• Herpes zoster.
• Tumors of the lungs thyroid gland, esophagus.
• Hypertrophy of the left atrium.

Essential drugs

There are contraindications. Specialist consultation is required.

• (systemic GCS). Dosage regimen: the average oral dose for adults is 5-60 mg / day. in 3-4 doses. Maximum daily dose- 200 mg.
• (vitamin B complex). Dosage regimen: therapy begins with 2 ml intramuscularly 1 r / d for 5-10 days. Maintenance therapy - 2 ml / m two or three times a week.
• Prozerin (an inhibitor of acetylcholinesterase and pseudocholinesterase). Dosage regimen: inside adults 10-15 mg 2-3 times a day; subcutaneously - 1-2 mg 1-2 times a day.
• (antihistamine, sedative, hypnotic). Dosage regimen: intramuscularly, 1-5 ml of a 1% solution; inside 0.025-0.05 g 1-3 times a day. The course of treatment is 10-15 days.