Ganglioneuritis is an inflammatory lesion of a nerve node (ganglion) with the involvement of nerve trunks associated with it in the inflammatory process. The clinical picture consists of a pronounced pain syndrome, sensitivity disorders, vasomotor, neurotrophic and vegeto-visceral disorders. It has its own characteristics depending on the localization. Disease is diagnosed mainly on the basis of characteristic clinical changes. Additional examination methods (radiography, MRI, CT, MSCT, ultrasound) are used for the purpose of differential diagnosis. Ganglioneuritis is treated mainly in conservative ways. With their inefficiency and severe pain syndrome, surgical removal of the affected ganglion (sympathectomy) is indicated.
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Isolated inflammatory lesion of one sympathetic node in neurology is called ganglionitis. If the pathological process affects peripheral nerves adjacent to the sympathetic node, then such a disease is called ganglioneuritis. With a combined lesion of the sympathetic nodes and spinal nerves, the disease is verified as ganglioradiculitis. In addition, polyhanglionitis (truncitis) is an inflammation of several sympathetic ganglia at once. Ganglioneuritis is also spoken about in relation to inflammation of nerve nodes, which include nerve fibers of various types: sympathetic, parasympathetic, sensitive. Of these, ganglioneuritis of the cranial node and ganglionitis of the pterygoid node are the most common.
As a rule, ganglioneuritis develops as a result of an infectious process. The cause of its occurrence may be:
- acute infections (measles, diphtheria, flu, erysipelas, dysentery, sore throat, scarlet fever, sepsis)
- chronic infectious diseases (rheumatism, syphilis, tuberculosis, brucellosis).
- chronic inflammatory diseases: for example, the cause of the cranial node may be complicated dental caries, and the cause of sacral ganglionitis is adnexitis, salpingitis, oophoritis, in men — prostatitis.
- in more rare cases, ganglioneuritis has a toxic nature or is caused by a tumor (ganglioneuroma or secondary metastatic process).
Hypothermia, fatigue, stress, alcohol abuse, surgical interventions in anatomical areas located next to the ganglia, etc. can contribute to the occurrence.
The main clinical sign is a pronounced pain syndrome. A burning pain of a common type is characteristic, which may be accompanied by a feeling of pulsation or bursting. Patients with ganglioneuritis cannot accurately indicate the localization of pain due to its diffuse nature. In some cases, ganglioneuritis is marked by the spread of pain sensations to the entire half of the body or to the opposite side. A distinctive feature of pain in ganglioneuritis is the absence of its amplification during movement. Most patients indicate that they may experience increased pain syndrome due to eating, weather changes, emotional overstrain, etc.
Along with the pain syndrome, ganglioneuritis is manifested by various sensitivity disorders. This may be a decrease in sensitivity (hypesthesia), an increase in sensitivity (hyperesthesia) and paresthesia — uncomfortable sensations in the form of numbness, feelings of crawling goosebumps, tingling, etc. Ganglioneuritis is also accompanied by neurotrophic and vasomotor disorders expressed in the innervation zone of the affected ganglion and nerves. Prolonged ganglioneuritis is often accompanied by increased emotional lability of the patient and sleep disturbance; it is possible to develop asthenia, hypochondriac syndrome, neurasthenia.
Depending on the group of affected sympathetic ganglia, ganglioneuritis is classified into cervical, thoracic, lumbar and sacral. Cervical ganglioneuritis, in turn, is divided into upper-neck, lower-neck and stellate.
Ganglioneuritis of the upper cervical node is characterized by Gorner’s syndrome: ptosis, myosis and enophthalmos. When this ganglion is irritated, the Purfur du Petit syndrome develops (dilation of the eye slit, mydriasis and exophthalmos), a stimulating effect on the thyroid gland occurs, leading to hyperthyroidism. Secretory and vasomotor disorders of the upper cervical ganglioneuritis are manifested by hyperhidrosis and redness of the corresponding half of the face, a decrease in intraocular pressure.
Changes in sensitivity in cervical ganglioneuritis are noted above the 2nd rib. Possible laryngeal paresis, accompanied by hoarseness of the voice. In cases where ganglioneuritis of the upper cervical node is accompanied by a pronounced pain syndrome affecting the area of the teeth, patients are often unsuccessfully treated by a dentist and even go through erroneous tooth extraction.
Ganglioneuritis of the lower cervical node is accompanied by the spread of sensitivity disorders up to the 6th rib. These violations also capture the hand, leaving only its inner surface intact. In the hand, there is a decrease in muscle tone, cyanotic skin coloration (diffuse or only fingertips). Corneal, conjunctival, maxillary, pharyngeal and carpo-radial reflexes are reduced. With inferior cervical ganglioneuritis, it is possible to omit the auricle on the side of the affected node.
Ganglioneuritis of the stellate node is manifested by pain in half of the chest on the side of the lesion. The zone of pain and sensitivity disorders has the form of a “half-jacket”. Often, the pain radiates to the upper limb, while the pain syndrome resembles an attack of angina pectoris and requires differential diagnosis with coronary heart disease. There is a violation of the motor skills of the V finger on the hand.
Thoracic, lumbar and sacral ganglioneuritis
Gangleoneuritis of the upper thoracic sympathetic nodes is manifested not only by sensitivity disorders and pain syndrome, but also by vegetative-visceral disorders. There may be pain in the heart, difficulty breathing, tachycardia.
Ganglioneuritis of the lower thoracic and lumbar sympathetic nodes is characterized by pain, sensory disorders, vascular and trophic disorders of the lower trunk and lower extremities. When the sciatic nerve is involved in the inflammatory process, the pain radiates to the corresponding hip with a characteristic clinic of sciatic nerve neuropathy. Vegetative-visceral disorders are manifested by the abdominal organs. Sacral ganglioneuritis may be accompanied by itching of the external genitalia and dysuric disorders. Women may have menstrual irregularities, acyclic uterine bleeding.
Ganglioneuritis of the pterygoid node is accompanied by a clinic of trigeminal neuralgia in the orbit, nose and upper jaw (innervation zone of the II branch), hyperemia of half of the face, lacrimation from the eye on the affected side and copious discharge from the nose on the same side. Ganglioneuritis of the cranial node is characterized by paroxysmal pain in the ear, which often radiates to the back of the head, face and neck. On the side of the lesion, the development of neuritis of the facial nerve with paresis of facial muscles is possible.
Ganglioneuritis is diagnosed mainly on the basis of the clinical picture, signs of vasomotor and neurotrophic disorders detected during the examination of the patient, detected during the study of the neurological status of sensitivity disorders. Often, with thoracic and sacral ganglioneuritis, patients undergo long-term treatment for somatic diseases, for example, a cardiologist for cardialgia, a gastroenterologist for a violation of the secretory and motor functions of the stomach or intestines, a gynecologist for persistent pelvic pain. In such cases, the features of the pain syndrome, its chronic and persistent nature should be the reason for the patient’s consultation with a neurologist.
Differential diagnosis is carried out with funicular myelosis, spinal cord tumors, syringomyelia, neuroses, cerebrospinal circulation disorders. In order to exclude these diseases, radiography of the spine, CT and MRI of the spine, and electromyography can be performed in the diagnosis. To identify inflammatory changes associated with ganglioneuritis from the somatic organs, MSCT or ultrasound of the abdominal cavity, gynecological ultrasound, prostate ultrasound, etc. examinations are prescribed.
In order to relieve pain in ganglioneuritis, analgesics are prescribed. With severe pain, patients with ganglioneuritis are given intravenous injections of novocaine or paravertebral blockades with novocaine at the lesion level. Depending on the etiology, therapy is prescribed against the infectious process. With the viral nature, antiviral drugs and gamma globulin are used, with bacterial antibiotics.
If ganglioneuritis is accompanied by an increase in the activity of the sympathetic nervous system, then ganglioblockers, cholinolytics, antispasmodics and neuroleptics are included in its treatment according to indications. It is possible to prescribe antihistamines, since they also have a cholinolytic effect. If ganglioneuritis occurs with a decrease in the activity of the sympathetic system, then its treatment is supplemented with cholinomimetic drugs, gluconate and calcium chloride.
In the complex therapy, physiotherapeutic procedures are actively used: erythemic doses of UFOs, electrophoresis of ganglefen, amidopyrine, novocaine, potassium iodide on the area of inflamed ganglia, diadin therapy (DDT), general radon baths, mud applications.
Ganglioneuritis with persistent pain syndrome, which is not stopped by complex conservative treatment, is an indication for sympathectomy — surgical removal of the affected sympathetic ganglion. Depending on the type of ganglioneuritis, cervical and thoracic sympathectomy, lumbar sympathectomy are performed. With thoracic ganglioneuritis, thoracoscopic sympathectomy is possible, with lumbar ganglioneuritis — laparoscopic. The use of such endoscopic methods of sympathectomy is the least invasive method of surgical treatment of ganglioneuritis.