Angioneurosis is a group of peripheral vascular diseases caused by a local violation of the regulation of vascular tone. The main clinical symptoms are pain, discoloration, temperature, sensitivity and trophic skin of the affected area. In the process of diagnosis, they rely on clinical data, the results of hemodynamic and microcirculatory studies (angiography, ultrasound, capillaroscopy, rheovasography). Conservative therapy is carried out using a combination of vascular and vitamin pharmaceuticals, supplemented with physiotherapy and sanatorium treatment. According to the indications, the sympathetic nodes involved in the pathological process are removed.
Angioneurosis is a generalizing concept that combines a variety of pathology that occurs due to a disorder of adequate innervation of the motility of peripheral arteries and veins, mainly of small caliber. This group of diseases includes Raynaud’s syndrome, rosacea, Reille’s disease, erythromelalgia, acrocyanosis, etc. In the modern literature on practical neurology, the name “vegetative-vascular neuroses” is also found, with a combination of vasomotor and trophic disorders, the term “angiotrophoneuroses” is used. Angioneurosis refers to functional vascular disorders. Unlike organic vascular diseases (obliterating endarteritis, diabetic angiopathy) they are not accompanied by morphological changes in the vascular wall.
The disorder may occur primarily as an independent nosology or secondarily as a separate syndrome of the underlying disease. Adverse external influences, metabolic and endocrine disorders lead to a disorder of vasomotor regulation. The main etiofactors are:
- Hypothermia. The etiological role is played by severe hypothermia of the extremities, persons with signs of frostbite. The effect of low temperatures on peripheral nerves and nerve endings provokes their damage and subsequent dysfunction.
- Injuries. Damage to the tissues of the extremities is accompanied by compression of the neurovascular bundles, injury to nerve fibers with a violation of their regulatory function. In some cases, angioneurosis is a consequence of incomplete recovery of nerve trunks after nerve injury.
- Intoxication. The provoking factor may be the toxic effect of lead salts, mercury vapors, pesticides, nicotine, alcohol. Vasomotor dysregulation is possible due to carbon monoxide poisoning.
- Vibration. Angioneurosis is one of the classic components of vibration disease. Vascular disorders are caused by regulatory dysfunction of the nervous system that occurs during prolonged repeated exposure to vibration.
- Hormonal disorders. Individual angioneurosis is associated with a disorder of adrenal function (hypercorticism), thyroid gland (hypothyroidism). Since women get sick significantly more often than men, a certain role is assigned to female sex hormones.
In some patients, vegetative-vascular neurosis develops as an occupational disease. Workers who are exposed to several adverse factors at once are most at risk of pathology. For example, repairmen, road stackers work in conditions of vibration, cold, increased mechanical load on the upper limbs with possible microtraumatization of the fingers.
Nervous regulation of vascular tone is carried out by a multilevel system, including nerve endings, peripheral nerves, sympathetic ganglia, autonomic centers of the brain. The level and mechanism of occurrence of functional disorders that cause angioneurosis is unclear and has its own specifics in each case. Mainly small arteries of the distal parts are affected: fingers, auricles, nose, cheeks.
Dysregulation of tone leads to excessive dilation or vasospasm. In the first case, the blood flow slows down, the diameter of the vessels increases, they fill with blood, which causes local hyperemia (redness), hyperthermia (fever) the skin. Due to the increased permeability of the vascular wall, tissue edema occurs. In the second case, the lumen of the vessels and blood filling decrease, which is accompanied by pallor and coldness of the skin at the site of dyscirculation. With a prolonged course, trophic changes occurring in the tissues due to microcirculation disorders are observed.
According to the etiological feature, angioneurosis is divided into cold, post-traumatic, toxic, neurogenic, vibration, etc. In clinical practice, the definition of the main pathogenetic component of vasomotor disorders is of great importance. In accordance with this criterion , angioneurosis is classified into:
- Spastic. Excessive increase in arterial tone prevails, leading to narrowing of their lumen. The most common diseases of this group are Raynaud’s syndrome, acroparesthesia, Reille’s disease, acrocyanosis.
- Dilated. Vasomotor disorders consist mainly in a decrease in vascular tone, an expansion of the lumen of the arteries. Angioneurosis of this group includes Mitchell’s disease, Melkersson-Rosenthal syndrome, rosacea.
- Combined. There is an alternation of vasospastic and dilated states. The combined lesions include marble skin syndrome (livedo).
The clinical picture of most vegetative-vascular neuroses consists of painful paroxysms of vasoconstriction and/or dilation. The duration of the attack varies from 2-3 minutes to several hours. The changes are local in nature, covering one or more fingers, the auricle, nose, sometimes the entire foot, hand, face. Each disease is distinguished by certain features of paroxysms, the course of the pathological process. Secondary angioneurosis is accompanied by symptoms characteristic of the underlying disease.
Raynaud’s syndrome accounts for 70-80% of all paroxysmal disorders of the circulation of the extremities. It manifests itself by angiospastic episodes provoked by psychoemotional overstrain, cold, smoking. In a typical case, the changes cover the IV and II fingers of the hands and feet, less often — the nose, outer ear, chin. These parts of the body become cold, acquire a white color. Patients complain of numbness, and then — burning, pain. In the inter-approach period, there is a cooling, hyperhidrosis, cyanotic fingers of the feet, hands.
Reil’s disease (“dead” finger syndrome) occurs with angiospastic paroxysms in the vessels of the fingers of the hands, sometimes the feet. Most often, the attack begins after cold exposure, a strong emotional experience. The affected finger suddenly becomes cold, deathly pale, loses sensitivity. After a paroxysm, the natural skin color, temperature and sensory sensations are restored.
Acrocyanosis is manifested by a cyanotic tinge of the skin, symmetrically occurring in the distal parts of the limbs when they are lowered, staying in the cold. The moisture content of the skin, the pasty of the tissues is determined. Lifting and warming the limb leads to the restoration of its healthy state.
Erythromelalgia (Mitchell’s disease) is characterized by angiodilatation paroxysms with burning pain syndrome, hyperemia, swelling. In most cases, changes occur in the big toe, less often — in both feet at the same time. It is possible to damage the hands, nose, ears, female breasts. Erythromelalgic attack is provoked by compression (shoes, clothes, blanket), overheating, hanging limbs. Residual vascular changes persist between attacks, trophic disorders are observed.
Melkersson-Rosenthal disease is characterized by the constancy of clinical manifestations, localization of pathological changes within the facial region. Vascular dilation is permanent, accompanied by a violation of blood outflow. The result is persistent swelling of the lips, cyanosis, swelling and folding of the tongue. Other parts of the face (eyelids, cheeks) are affected much less often. Angioneurosis is combined with neuritis of the facial nerve.
Rosacea is expressed in constant hyperemia of the nose, cheeks, chin, forehead. Vascular asterisks, erythematous rashes are found in the redness zone. Persistent expansion of the vascular network over time leads to swelling, roughness, compaction of the skin. Possible damage to the paraorbital zone and eyelids.
Livedo occurs due to the spastic-atonic state of the capillary network. It is manifested by alternating pale and bluish areas of the skin, resembling a marble pattern. A typical localization of livedo is the skin of the shins, thighs. Pathology is typical for young women.
Permanent and paroxysmal disorders of blood supply to the tissues of the affected area eventually lead to the formation of trophic disorders. There is dryness, increased vulnerability of the skin, brittle nails. In advanced cases, long-term non-healing recurrent trophic ulcers are formed. Persistent sensory disorders may occur: hypesthesia (decreased skin sensitivity), hyperpathy (pathological perception of external stimuli). Rosacea of periorbital localization is complicated by eye damage, the development of rosacea-keratitis is dangerous by progressive vision loss.
Angioneurosis is diagnosed on the basis of clinical data, examination by a neurologist, vascular surgeon. The study of the underlying hemodynamic disorders is carried out in the inter-approach period and during the execution of provocative tests. In order to identify or exclude the secondary nature of vascular neurosis, it may be necessary to consult a rheumatologist, toxicologist, geneticist, endocrinologist, phlebologist. Diagnosis of angioneurosis caused by professional activity is performed by a professional pathologist. The main components of the diagnostic search are:
- Survey and inspection. During the survey, they find out the frequency, duration, nature of paroxysms, provoking factors, the presence of bad habits, unfavorable working conditions.
- Laboratory test. Diagnostic significance is the determination of the level of blood catecholamines, rheumatoid factor. According to the indications, the concentration of thyroid hormones (thyroxine, triiodothyronine), cortisol is being studied.
- Assessment of hemodynamics. Allows you to assess the condition of large and medium-sized vessels, exclude their organic pathology. Duplex scanning, ultrasound of the vessels of the extremities, angiography are used. The absence of pathological changes confirms the diagnosis of angioneurosis.
- Study of microcirculation. Reveals characteristic changes (spasm, dilation) of the microcirculatory bed. It is produced by methods of capillaroscopy, laser dopplerography, rheovasography, thermography. At the initial stages of the disease in the interparoxysmal period, pathological changes may be absent.
- Provocative tests. Cold and heat samples are usually used. The study of microcirculation under the conditions of the provoking factor is shown in the absence of objective changes in the period between seizures.
Angioneurosis is differentiated with polyneuropathies, erysipelas, panniculitis, angioceratomas in Fabry’s disease. In the case of severe edema, the exclusion of lymphostasis is required. Differential diagnosis with organic vascular diseases (endocrine angiopathies, obliterating atherosclerosis, endarteritis, amyloidosis, vasculitis) is carried out according to hemodynamic studies.
Since the pathogenetic mechanisms are not precisely defined, the therapy is mainly symptomatic. Conservative treatment is carried out in a complex with the use of medicinal, physical, physiotherapeutic methods. With its low efficiency, surgical interventions are possible. The main directions of complex therapy are:
- Relief of paroxysm. With vasoconstriction, limbs are warmed, vasodilating drugs are administered: antispasmodics, sympatholytics. During vasodilation, to improve the outflow of blood, the limbs are given an elevated position, careful administration of vasoconstrictors (adrenaline) is carried out.
- Interparoxysmal pharmacotherapy. To prevent repeated seizures in spastic forms, antispasmodics, ganglioblockers, calcium agonists, and disaggregants are used. Dilated angioneurosis is an indication for the appointment of vasoconstrictive pharmaceuticals, caffeine. B vitamins, rutin, ascorbic acid are used in complex treatment.
- Physical therapy. It is recommended in the period between paroxysms. Galvanization, darsonvalization, reflexotherapy, mud treatment are used. Sanatorium-resort treatment with hydrogen sulfide, radon waters is shown.
- Removal of sympathetic ganglia. With insufficient effectiveness of conservative methods, thoracic or lumbar sympathectomy is performed. The operation reduces the number and severity of vasomotor seizures.
With minor severity of clinical manifestations of acrocyanosis, livedo therapy is not required. In the case of rosacea, laser treatment, cryotherapy, photocoagulation of dilated vessels are effective. In Melkersson-Rosenthal’s disease, glucocorticosteroids are additionally prescribed, and surgical decompression of the facial nerve is performed according to indications.
Prognosis and prevention
Angioneurosis does not pose a danger to the patient’s life, but has a long-term chronic course. Treatment facilitates the condition of patients, allows them to remain able to work, improves the quality of life. The prognosis of secondary vascular neuroses depends on the success of therapy of the underlying disease. Acrocyanosis in many cases resolves independently upon reaching puberty. Primary preventive measures are reduced to the exclusion of injuries, intoxication, adverse physical factors, occupational hazards, maintaining a normal hormonal background. Secondary prevention includes changing working conditions, quitting smoking, avoiding forced limb position, hypothermia, overheating, stressful situations.