Peripheral paresis is a specific neurological syndrome that 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 is most often found among the category of similar pathologies.
General information
In contrast to the central, peripheral paresis is clearly manifested only on one side. Another name for this disease, common in medicine, is "Bell's palsy." This pathology found its name in honor of the British neurologist, who described it back in 1836.
Risk groups susceptible to 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 is over the age of 45 years. However, medicine knows cases of the development of the pathological process in newborn infants.
Features
When injuring the facial nerve, the innervation of facial expressions is disrupted or completely ceases - this is a feature of not only peripheral, but also central paralysis. Muscles lose their tone and cease to fulfill their functions. In addition to violation of facial expressions, with paresis, malfunctions associated with the production of saliva and tears, taste perception and sensitivity of the epithelium appear.
A characteristic feature of the anomaly is the fact that, despite the inability to control muscles, patients do not suffer from unbearable pain. Unpleasant sensations can be experienced by the patient only if the ear nerve is involved in the pathological process in the posterior zone. The sensitivity of the patient also does not change, but the taste sensations undergo significant changes.
Compared with peripheral, central paresis is much less common - only 2 cases per 100 thousand people. The course of this disease is much harder.
Causes of occurrence
Among the conditions leading to neuropathy can be identified:
- neoplasms in the inter cerebellar angle;
- consequences of otitis media and sinusitis;
- abscess;
- transverse inflammation;
- ischemic attack;
- multiple sclerosis;
- heavy metal poisoning;
- side effects from taking certain medications;
- amyotrophic sclerosis;
- Guillain-Barré syndrome;
- diabetes;
- stroke;
- malignant and benign neoplasms;
- corticosteroid treatment;
- facial damage;
- all kinds of infections - for example, flu, diphtheria, leptospirosis, mumps, herpes simplex, syphilis, adenovirus, borreliosis;
- injury to the parotid glands;
- decreased immunity against a background of a variety of diseases.
Symptoms of peripheral paresis can occur far not 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, as a result of which patency of small vessels is impaired.
Quite often, paralysis provokes hypothermia - it is they who sometimes turn out to be the triggering mechanism of the clinical picture of paresis and the appearance of its symptoms.
Damage to nerves in humans varies by clinical signs. For example, in violation of the integrity of the endings, a flaccid paresis arises . With this type of paralysis, the damage is not complete and, as a rule, remission occurs very quickly.
Main symptoms
There are quite a lot of signs of a lethargic and acute form of peripheral paresis. These include, first of all, damage and weakness of the muscles of the face, disorders in the facial expressions. The severity of the clinical picture is growing rapidly - over 1-3 days.
A sharp pathological change in appearance due to impaired muscle functioning on the one hand is especially characteristic of peripheral paresis of the face. At the same time, the corner of the mouth falls, the folds of skin on the injured part become smooth, raising an eyebrow is unrealistic, exactly like doing other similar actions:
- wrinkle your forehead;
- to whistle;
- bite your teeth;
- puff out your cheek.
The eyes become wider on the damaged side, it may not close at all, while there is almost no possibility to lower the eyelids. The eyeball involuntarily turns up. The patient's speech becomes slurred, taste sensations change significantly, and a person can accidentally bite his cheek while eating.
The heavier the degree of tissue damage, the more pronounced the signs become. The facial muscles are injured with peripheral paresis, and this phenomenon in half of the patients manifests itself in the form of involuntary twitches and tics. In other patients, paralysis is complete.
Classification
In severity, several degrees of peripheral paresis of the facial nerves can be distinguished:
- the first stage, which is called easy, is characterized by the loss of emotional manifestations, but if necessary, chew the product or close your eyes, this can be done 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;
- in the third stage, muscle hypotension appears.
In almost all patients diagnosed with peripheral muscle paresis, involuntary discharge of tears from the eye located on the injured side is observed. Due to the fact that circular tissues are weakened, blinking rarely occurs, the tear fluid ceases to be evenly distributed throughout the eyeball, and gradually accumulates in the conjunctival sac.
In addition, there are two more categories of paresis: functional and organic. The latter species is provoked by disorders in the relationship between muscles and the brain. Functional paresis is due to trauma to the cortex of the main organ. In the first case, therapy consists in the search and elimination of pathogenesis, and in the second, it is necessary to use a whole range of medical procedures.
Diagnostics
When determining the diagnosis, a 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 resolve the first point, it is necessary to take into account 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 is also confused with this type of pathology.
Often patients, frightened by sudden changes, at the first time after the onset of symptoms experience severe weakness, cannot open their mouths, close their eyes. In particular, paralysis of the face of the representative of the weaker sex is difficult. After all, the symptoms of paresis are not only a physical, but also a moral problem for them, provoking the appearance of stress, which only worsens the course of the disease.
Additional tools for detecting anomalies
Hardware and laboratory tests include:
- general blood analysis;
- biochemical examination;
- serological test for syphilis;
- radiography of the chest cavity and temporal bone.
If the work of damaged muscles during intensive treatment does not return to normal after a few months, the patient is sent for CT and MRI.
If the injury covers several nerves at once and the clinical picture is manifested, a serological examination should be performed to exclude neuroborreliosis. In all other situations, this analysis is not urgently needed.
The causes of the disease in children should be identified without fail, but adult patients can be sent immediately after diagnosis for treatment according to the general scheme. For this, it is only necessary to exclude infectious pathogenesis, sometimes in this case lumbar puncture is needed.
Treatment of paresis of peripheral nerves
Paralysis is not a serious pathology and does not represent a life threat, however, the curvature of the face leads to the appearance of social discomfort - especially to women.
Therapy for peripheral paresis is aimed primarily at eliminating puffiness and stabilizing microcirculation in the nerve trunk.
Modern medicine provides for two stages of treatment for paresis:
- the use of corticosteroids, which can not be used in the treatment of mild disease;
- hormonal drugs that may be required in the early days.
Effective technique
An effective therapeutic regimen for facial paralysis was developed by the German physician Stennert. The treatment proposed by him involves the use of anti-inflammatory infusion rheological therapy three times a day:
- 10 days of 300 ml of Trental;
- the first 3 days of 500 ml of Reopoliglyukin;
- at the end of 3 days "Prednisolone" in an individual dosage.
But this treatment technique has certain contraindications:
- peptic ulcer in the patient himself or in his family history;
- renal failure;
- bacterial infection;
- disorders in the process of hematopoiesis.
Treatment features
When choosing an appropriate therapeutic regimen, the causes of the pathology should be taken into account.
For example, with herpes in the course of treatment should include "Acyclovir" and "Prednisolone". And in the case of bacterial pathogenesis, powerful antibiotics may be needed.
Due to the fact that the eye does not completely close, the dryness of its cornea can lead to ulceration. That is why patients are advised to wear darkened glasses and use special drops from excessive dryness. In this case, you should always consult an optometrist.
By the end of the first week of therapy, physiotherapy must be connected - for example, acupressure, paraffin baths, reflexology.
Treatment of newborn babies should begin in the hospital. In this case, it is not recommended to use medicines, in particular, corticosteroids, since the likelihood of developing 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 during the 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 about two months, with pathological degeneration of nerve endings - within three months.
The general condition of the patient can significantly increase due to age-related changes, as well as with arterial hypertension and diabetes. If the dryness of the cornea is irreversible, the patient has severe neuropathy and facial asymmetry.