Peripheral paresis is a specific neurological syndrome, which is characterized by damage to the motor center, as well as loss of voluntary movements and weakness of a certain muscle group. In medicine, this disease is often called neuropathy. This type of disease among the category of similar pathologies is most common.
General information
Unlike the central paresis, peripheral paresis is clearly manifested only on one side. Another name for this disease, common in medicine, is Bell's palsy. The pathology acquired this name in honor of the British neurologist who described it back in 1836.
Risk groups affected by this disease do not have specific features. Anyone can face such an unpleasant phenomenon as peripheral and central paresis of the facial nerve. Men and women are exposed to the disease with approximately the same frequency - 25 cases per 100 thousand people. As a rule, the main progression of the disease occurs over the age of 45 years. However, medicine knows cases of the development of a pathological process in newborns.babies.
Features
When the facial nerve is injured, the innervation of facial expressions is disturbed or completely stopped - this is a feature of not only peripheral, but also central paralysis. Muscles lose their tone and cease to perform their functions. In addition to impaired facial expressions, paresis causes malfunctions associated with the production of saliva and tears, taste perception and sensitivity of the epithelium.
A characteristic feature of the anomaly is the fact that, despite the inability to control the muscles, patients do not suffer from unbearable pain. Unpleasant sensations can be experienced by the patient only if the ear nerve in the posterior ear zone is involved in the pathological process. The sensitivity of the patient also does not change, but the taste sensations undergo significant changes.
Compared to peripheral, central paresis is much less common - only 2 cases per 100 thousand people. The course of this disease is much more difficult.
Causes of occurrence
Among the conditions leading to neuropathy are:
- neoplasms in the intercerebellar angle;
- consequences of otitis media and sinusitis;
- abscess;
- transverse inflammation;
- ischemic attack;
- multiple sclerosis;
- heavy metal poisoning;
- side effects of certain medications;
- amyotrophic sclerosis;
- Guillain-Barré syndrome;
- diabetes mellitus;
- stroke;
- malignant and benignneoplasms;
- corticosteroid treatment;
- facial injury;
- all kinds of infections - eg influenza, diphtheria, leptospirosis, mumps, herpes vulgaris, syphilis, adenovirus, borreliosis;
- injury to the parotid glands;
- decreased immunity against a variety of diseases.
Symptoms of peripheral paresis may not occur immediately after the disease - it usually takes a long time before they appear. Compression of the nerve in the fallopian duct provokes its excessive narrowness, the manifestation of a viral or pathogenic flora. Traumatic injuries lead to pathological changes in nearby tissues, resulting in impaired patency of small vessels.
Quite often, hypothermia provokes paralysis - it is they who sometimes turn out to be the trigger for the mechanism of the clinical picture of paresis and the appearance of its symptoms.
Nerve damage in humans varies in clinical signs. For example, if the integrity of the endings is violated, flaccid paresis is born. In this type of paralysis, the damage is not complete and usually remission occurs very quickly.
Main symptoms
There are quite a lot of signs of a sluggish and acute form of peripheral paresis. These include, first of all, damage and weakness of the muscles of the face, disorders in facial expressions. The severity of the clinical picture is growing rapidly - for 1-3 days.
Especially characteristic of peripheral paresis of the face is a sharppathological change in appearance due to dysfunction of the muscles on the one hand. At the same time, the corner of the mouth drops, the folds of the skin on the injured part become even, it is unrealistic to raise the eyebrow, evenly, as well as to do other similar actions:
- wrinkle forehead;
- whistle;
- grin your teeth;
- puff out cheek.
From the damaged side of the eye becomes wider, it may not close at all, and there is almost no possibility to lower the eyelids. The eyeball involuntarily turns upward. The patient's speech becomes slurred, taste sensations change significantly, and the person may accidentally bite their cheek while eating.
The more severe the degree of tissue damage, the more pronounced the symptoms become. Mimic muscles are injured in peripheral paresis, and this phenomenon in half of the patients manifests itself in the form of involuntary twitches and tics. In the rest of the patients, the paralysis turns out to be complete.
Classification
Several degrees of peripheral paresis of the facial nerves can be distinguished by severity:
- the first stage, which is called mild, is characterized by the loss of emotional manifestations, but if necessary, chew the product or close your eyes, you can do this with some effort;
- at the stage of moderate severity, the patient completely loses voluntary movements, and in order to do something, one has to concentrate and make efforts;
- appears in the third stagemuscle hypotension.
Almost all patients with a diagnosis of "peripheral muscle paresis" have an involuntary release of tears from the eye located on the damaged side. Due to the fact that the circular tissues are weakened, blinking is rare, the lacrimal fluid ceases to be evenly distributed over the eyeball, and gradually accumulates in the conjunctival sac.
In addition, there are two more categories of paresis: functional and organic. The latter type is provoked by disorders in the relationship between the muscles and the brain. Functional paresis is explained by trauma to the cortex of the main organ. In the first case, therapy consists in finding and eliminating pathogenesis, and in the second, it is necessary to use a whole range of therapeutic manipulations.
Diagnosis
When determining the diagnosis, the specialist should solve several problems at once:
- differentiate peripheral paresis and paralysis of the central system;
- exclude secondary manifestations of the disease or find a pathology, the consequences of which provoked injury to the facial nerve;
- develop a treatment regimen and further prognosis.
To solve the first point, it is necessary to take into account the typical signs of damage - in the case of central paralysis, weakness occurs in the lower part of the face, and the muscles of the eyes and forehead, due to bilateral innervation, do not lose mobility. But not everything is so simple - in some patients, the ciliary reflex goes astray even with this typepathology.
Often, patients, frightened by abrupt changes, for the first time after the onset of symptoms, experience severe weakness, cannot open their mouths, close their eyes. In particular, the paralysis of the face of the fairer sex is difficult to tolerate. After all, the symptoms of paresis are not only a physical problem for them, but also a moral problem, provoking the appearance of stress, which only worsens the course of the disease.
Additional tools for anomaly detection
Hardware and laboratory research means:
- complete blood count;
- biochemical examination;
- serological test for syphilis;
- thoracic cavity and temporal bone x-ray.
If the work of damaged muscles with intensive treatment does not return to normal after a few months, the patient is referred for CT and MRI.
If the injury involves several nerves at once and the clinical picture is severe, a serological examination should be performed to rule out neuroborreliosis. In all other situations, this analysis is not urgently needed.
The causes of illness in children should be identified without fail, but adult patients can be referred immediately after diagnosis for treatment according to the general scheme. To do this, it is only necessary to exclude infectious pathogenesis, sometimes in this case a lumbar puncture is needed.
Treatment of paresis of peripheral nerves
Paralysis is not a severe pathology and does not pose a dangerlife, but the contortion of the face leads to social discomfort - especially for women.
Therapy for peripheral paresis is primarily aimed at eliminating swelling and stabilizing microcirculation in the nerve trunk.
Modern medicine provides for two stages of paresis treatment:
- use of corticosteroids, which should not be used in mild disease;
- hormonal medications that may be needed in the early days.
Effective method
An effective therapeutic regimen for facial paralysis was developed by the German doctor Stennert. The treatment proposed by him involves the use of anti-inflammatory infusion rheological therapy three times throughout the day:
- 10 days for 300 ml of "Trental";
- first 3 days, 500 ml of Reopoliglyukin;
- at the end of 3 days of "Prednisolone" in an individual dosage.
But this treatment method has certain contraindications:
- peptic ulcer in the patient himself or in his family history;
- kidney failure;
- bacterial infection;
- disturbances in the process of hematopoiesis.
Features of treatment
When choosing an appropriate therapeutic regimen, the causes of the pathology should be taken into account.
For example, for herpes, the course of treatment should include "Acyclovir" and "Prednisolone". And in casebacterial pathogenesis may require powerful antibiotics.
Due to the fact that the eye does not close completely, dryness of its cornea can lead to ulceration. That is why patients are advised to wear tinted glasses and use special drops from excessive dryness. In this case, you should definitely consult with an ophthalmologist.
By the end of the first week of therapy, it is necessary to connect physiotherapy - for example, acupressure, paraffin applications, reflexology.
Treatment of newborn babies should start in the hospital. The use of medications is not recommended, especially corticosteroids, since the likelihood of side effects is high. After undergoing therapy in the maternity ward, treatment should be continued at home, but it is very important to systematically examine the baby and laboratory tests.
Forecasts
If the patient's body does not recover within a year, reconstructive surgery is performed.
With peripheral paresis of the facial nerve, complete normalization is observed in 70% of all cases. With partial paralysis, recovery occurs within approximately two months, with pathological degeneration of nerve endings - within three months.
The general condition of the patient can become significantly worse due to age-related changes, as well as arterial hypertension and diabetes. If dryness of the cornea is irreversiblecharacter, the patient has severe neuropathy and facial asymmetry.
