Vasoneural conflict is a condition in which a section of a nerve fiber is directly affected by a vessel passing next to the nerve. That is, in fact, this is a violation of the normal interaction of the vessel and the nerve. In clinical practice, the term "neurovascular conflict" is also widely used. Read more about the symptoms, diagnosis, and treatment of this condition later in the article.
Which nerves can be affected
In everyday life, you can often hear about the vasoneural conflict of the trigeminal or facial. The latter condition is also called hemifacial spasm, which literally means "spasm of half of the face." But this pathology can also spread to other nerves, including:
- auditory, or vestibulocochlear nerve;
- glossopharyngeal nerve;
- oculomotor nerve.
Causes of disease
The exact causes of the development of pathology have not yet been clarified. According toAccording to statistics, women are more prone to developing this disease. Thus, the incidence among women is 6 cases per 100 thousand, among men - 3.5 cases. If we talk about age, then middle-aged and elderly people suffer more. In young people, the disease develops less frequently. And most often there is a lesion of the trigeminal nerve.
Conventionally, all causes of vasoneural conflict can be divided into congenital and acquired. The first group includes anomalies in the structure of blood vessels. This may be the presence of branches, which normally should not be, the formation of loops, the irregular shape of the vessel. As a result, the abnormal vessel compresses the nerve and causes unpleasant symptoms.
The acquired causes include the appearance of volumetric formations that push the vessel closer to the nerve. It can be a tumor (malignant or benign), a cyst, etc.
Main symptoms
Clinical manifestations of vasoneural conflict directly depend on the localization of the pathological process. But you can highlight the symptoms that occur most often:
- pain that comes on paroxysmal;
- pain is asymmetrical, that is, it affects the face on one side only;
- the development of an attack has no connection with any external causes: hypothermia, inflammation, trauma, etc.;
- increased muscle tone on the affected side, muscle spasm in the same place;
- during an attack, the facial expression of a person changes, the patient seems to grimace, this is due to muscle contraction;
- duringpain, the patient freezes and tries not to move, so as not to provoke an even stronger attack.
Trigeminal injury
Most often there is a neurovascular conflict of the trigeminal nerve. This is due to compression of the nerve by the vessel in the area of its exit from the brain stem.
The trigeminal nerve can be compressed by these vessels:
- basilar artery;
- vertebral artery;
- superior and inferior cerebellar arteries.
Most often observed conflict with the inferior cerebellar artery.
Pain attacks in this pathology are very specific, they are also called neuralgia. It is very important to understand the clinical manifestations of the pathology, since the symptoms and treatment of trigeminal neuralgia are directly related. Therapy is aimed primarily at reducing the severity of the pain syndrome.
Pain has the following characteristics:
- pain is felt only in one half of the face;
- the presence of so-called trigger zones on the face at the exit points of the trigeminal nerve from the skull, in these areas the pain is especially pronounced;
- without treatment, the disease has a progressive course, and the frequency of attacks increases with time;
- attacks start abruptly for no apparent reason and just as abruptly pass;
- attack duration - from a few seconds to minutes;
- complaints are completely absent between attacks of pain.
Facial nerve injury
Symptoms of a vasoneural conflict of the facial nerve are fundamentally different from the defeat of the trigeminal. This is due to the fact that the facial nerve performs a motor function, in contrast to the sensitive trigeminal. Therefore, the violations will be primarily motor.
The main clinical manifestation is involuntary movements of facial muscles. It is characteristic that at first involuntary contractions of the circular muscle of the eye begin, which eventually pass to the entire half of the face. The other side remains unaffected. If left untreated, the contractions become so frequent that the patient cannot see from the side of the lesion.
There are also atypical forms of the disease. In such cases, involuntary contractions begin with the muscles of the cheek, and then move up.
In severe cases, seizures appear even in a dream. They become more frequent after overwork, stressful conditions, anxiety.
Neurovascular conflict of the facial nerve can develop due to the following vessels:
- superior and inferior cerebellar arteries;
- vertebral artery;
- main artery;
- multiple exposure to several vessels at once.
Hemispasm should be distinguished from other conditions that are similar in their manifestations:
- tic - a spasm of facial muscles of a psychological nature;
- facial myokymia - contractions of individual bundles of muscle fibers;
- paresis of the facial nerve - a violation of its function due to injury, inflammation;
- tardive dyskinesia - a condition that occurs after takingneuroleptics.
Acoustic nerve injury
Vasoneural conflict of the auditory nerve has a very specific symptomatology, different from all other nerves. The auditory nerve is also called the vestibulocochlear nerve. One part of it is responsible for hearing itself, and the second part is responsible for balance. With the development of a neurovascular conflict, both of these parts are damaged.
Most often, patients express such complaints:
- ear noise on one side;
- hearing loss on the same side;
- dizziness.
When the auditory nerve is damaged, diagnostic errors often occur. Although it is almost impossible to confuse such symptoms with damage to the trigeminal or facial nerve, it is easy to confuse a vasoneural conflict with even the most banal attack of arterial hypertension (high blood pressure). And here and there there is dizziness, tinnitus. The only feature is the one-sidedness of the lesion in the conflict of the vessel and the nerve.
Diagnosis of disease
Which doctor should I contact for vasoneural conflict? Much depends on the location of the lesion. In case of a conflict of the trigeminal or facial nerve, they turn to a neurologist. If the auditory nerve is affected, the joint work of a neurologist and an otorhinolaryngologist is necessary. It is these specialists who can diagnose and prescribe the appropriate treatment. But if the doctor with the patient has decided to operate, the patient is referred to a neurosurgeon.
MRI-diagnostics
Magnetic resonance imaging (MRI) of a vasoneural conflict is considered the reference method for making a diagnosis in modern medicine.
The essence of this method is based on the principle of nuclear magnetic resonance. The magnetic field that is created inside the tomograph picks up impulses from hydrogen ions, which are found in all tissues of the body. These impulses are read by the machine, and a high-precision image of the internal organs becomes visible on the computer.
In the case of a neurovascular conflict, MRI can help determine the exact cause of nerve compression. It is also necessary before surgery to adequately assess its effectiveness.
Whatever artery causes nerve compression, early MRI diagnosis makes it possible to prescribe effective treatment in time.
Medicated treatment
As noted above, the symptoms and treatment of trigeminal neuralgia are inextricably linked. And this also applies to other nerve fibers. Therapy, which is aimed at reducing clinical manifestations, is called symptomatic. It is for this purpose that doctors prescribe all kinds of pills.
It is important to remember that medicines only reduce the symptoms, they do not eliminate the cause. An operation is needed to remove the cause of the conflict.
How to treat vasoneural conflict? To reduce the severity of symptoms, the following drugs are prescribed:
- "Carbamazepine".
- "Baclofen".
- "Clonazepam".
- "Levetiracetam".
- "Gabapentin".
A modern effective method of treating a disease that does not involve surgical intervention is botulinum toxin injections. In the people, it is better known under the trade name "Botox". Although many people know about its use in cosmetology, not everyone knows that it is becoming more and more widespread in neurological practice.
The mechanism of action of "Botox" is the blockade of the transmission of a nerve impulse from a nerve to a muscle. This prevents the development of a pain attack and muscle spasm.
Surgical treatment
Although symptomatic treatment plays a big role, only surgery will help to finally get rid of the vasoneural conflict. The operation is performed by a neurosurgeon. It is called microvascular decompression. Its essence is to eliminate the pressure of the vessel on the nerve.
If we are talking about the defeat of the trigeminal nerve, then the operation is performed as follows:
- On the side of the conflict, a short skin incision is made behind the ear.
- A hole 3 cm in diameter is drilled into the skull.
- Using a special technique under the control of a microscope, the neurosurgeon locates the artery that interferes with the trigeminal nerve. Most often, it is compressed by the superior cerebellar artery.
- After finding the vessel, the neurosurgeon separates it from the nerve and places a spacer between the two structures. The padding can be synthetic or made from your own fabrics.patient.
- After the conflict is eliminated, the surgeon performs plastic surgery of the skull bones and sutures the skin.
- The operation ends with a bandage on the head.
A few days after surgery, the patient is in the intensive care unit for observation.
